July 5, 2005

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Update on MaineCare Physician Fee Increase
The $8.5 million physician fee increase survived the recent cuts in the state budget and will be available for services provided on or after July 1. Edits have been made to the MECMS system for all services except for anesthesia and radiology. Those services are expected to have the increase available by the end of this week.
Bureau of Medical Services officials have assured MMA that the proper edits have been made and that the increases will be paid now for any services provided after the beginning of the state's fiscal year, which began July 1.  No fees have been reduced and all fees have been increased to at least 53% of the Medicare allowable rate.

During the recent Appropriations Committee deliberations, a proposal was considered to cut $4.5 annually from the reimbursement to hospital-owned "provider-based" practices to help pay for the fee increase, but that proposal was eventually rejected.  The proposal was opposed by both MHA and MMA, partially on the grounds that the state lacked the data available to make an informed decision as to what the impact of such a reduction would be.

Two years ago, Governor Baldacci made a similar attempt in his first budget proposal, but the proposal was rejected based upon an agreement for the state and MHA to collect data on the extent of these conversions and their impact on the MaineCare program.  The provider-based practices were also required to accept MaineCare patients unless the practice was closed to all new patients.  It is MMA's understanding that the meetings on this topic (to which MMA was asked to be included) never took place.  Therefore, it was premature, in MMA's view, to reduce reimbursement to such practices now.

Under federal law, hospital-owned practices may organize themselves as a department of the hospital, thus becoming more like a clinic and receive MaineCare and Medicare reimbursement based on their allowable costs, including both a professional component and a facility fee.  Patients who are commercially insured  will sometimes pay more in terms of co-payments and deductibles and there are other implications for the medical staff.  Therefor, not all the hospitals in Maine have converted their practices to "provider-based" reimbursement and are still paid off the fee schedule.  These practices will participate n the fee increase.

This 15% fee increase will hopefully be the first of several aimed at increasing MaineCare fees to the level of Medicare fees.

MGMA (ME Chapter) and MMA Team up for Technology Conference Sept. 28 in Augusta
The Augusta Civic Center will be the site of a technology conference and exhibit on Wednesday, Sept. 28, 2005 co-sponsored by MMA and the Maine Chapter of the Medical Group Management Association.  With medical practices under pressure to use technology more effectively, whether through palm pilots, EMR or other applications, both organizations are interested in offering members the best information available on applications, vendors, etc.

Plenary sessions will include a talk on what to look for in choosing a vendor and there will be one or two panels featuring physicians, vendors and practice managers who have successfully implemented a technology project. There will be ample opportunity to attend live demonstrations of products by vendors in an exhibit area.  This conference is intended to be a "must attend" for any practice that is expecting to shop for electronic prescribing options or an EMR system in the coming weeks.

Save the date mailings will be going out shortly and a full registration packet for vendors and attendees will be mailed by the end of July.  Persons interested in knowing more about the conference may contact Chandra Leister or Lauren Mier at MMA via telephone at 622-3374 or via e-mail to lmier@mainemed.com or cleister@mainemed.com. [return to top]

Despite Awareness of Best Health Care Practices, Quality Gap Exists

Despite an increased focus on evidence-based practice guidelines, the gap between the best possible health care and the health care that is actually delivered to patients remains quite large, according to a report in the most recent issue of the Archives of Internal Medicine. Researchers at Stanford University School of Medicine found that the percentage of visits during which patients received appropriate care improved significantly from 1992 to 2002 for only six of 23 quality indicators. These six indicators included: treatment of depression (83.4 percent from 46.7 percent); statin use for hyperlipidemia (36 .9 percent from 9.6 percent); inhaled corticosteroid use for adults with asthma (42.2 percent from 25.4 percent); inhaled corticosteroid use for children with asthma (35.8 percent from 10.9 percent); avoiding routine urinalysis (72.8 percent from 63.4 percent); and avoiding inappropriate medications in the elderly (94.6 percent from 91.8 percent.) Increases were actually shown in 11 other categories, but the researchers classified these gains as modest or not statistically significant. Researchers said the study's findings seem to lend evidence to a theory that it takes 17 years for medical practices to go from research to widespread practice. To read an abstract of the report:

http://archinte.ama-assn.org/cgi/content/abstract/165/12/1354 [return to top]

Pathways to Excellence Update on Office Systems Survey for Primary Care Practices
June 30, 2005 was the deadline for submission of the office system survey that all primary care practices were invited to complete.  As of the deadline, 247 practices or about 57% of the eligible practices had completed the survey.  This was an increase from the 215 practices that completed the survey last year.

A submission validation process is now underway and there may be some additional practices who had tried to send the data but were unsuccessful.  Bill Perry at the Maine Health Information Center will be sending out letters this week to practices that did not submit data, just confirming that nothing had been sent.  Letters will also be sent to practices with partial submissions and practices that submitted but had missing data in some fields.

Persons interested in the Pathways to Excellence project may contact Ted Rooney at trooney@healthandwork.com. The project is sponsored by the Maine Health Management Coalition. [return to top]

Maine’s Unused Pharmaceutical Return Program Gaining Momentum as National Model
In the United States, there has not been a safe way for patients to dispose of unused prescription medication; and the accumulation of unused prescription medication has been dangerous. Some people have died from accidental poisoning, while others have died by purposeful ingestion. Drug abusers have diverted unused controlled substances for illicit purposes. Americans have flushed unused pharmaceuticals down the toilet and polluted our environment.

In response to this public health and safety problem, the Maine Association of Psychiatric Physicians in collaboration with the Maine Medical Association and other interested parties supported a bill that was passed in 2003 by the 121stMaine Legislature entitled: “An Act to Encourage the Proper Disposal of Unused Pharmaceuticals.” This bill allows Mainers to safely dispose of their unused prescription medication by mailing unused pharmaceuticals in a prepaid envelope to the Maine Drug Enforcement Agency for destruction. The Maine Drug Return Implementation Group, which was charged with the task of making recommendations to the Legislature for the implementation of the Unused Pharmaceutical Return Program, gave its report to the Legislature in January 2005.

As options for funding the prescription drug return program in Maine are currently being explored, several groups across the country have expressed an interest in Maine’s innovative program. List-serves regarding this serious public health problem have been set up and Maine’s Unused Pharmaceutical Return Program appears to be gaining momentum as a national model. At its convention in March of 2005, the United States Pharmacopeia passed a resolution to work with appropriate constituencies to develop programs to promote safe medication use and disposal. In May of 2005, the Assembly of the American Psychiatric Association endorsed an action paper that encourages state legislatures and the federal government to adopt programs for the proper disposal of unused pharmaceuticals.

At a time when Maine is trying to find a way to save $56 million in pharmaceutical costs for the coming biennium, Maine’s Unused Pharmaceutical Return Program represents a potential savings to Maine’s Medicaid program. Here is how it works. Since every returned prescription medication represents a wasted health care expenditure, a careful analysis of which medications are not taken by patients may provide important clues about ways to eliminate wasted health care dollars. It is this potential in Medicaid savings for cash strapped legislatures across the country that makes Maine’s Unused Pharmaceutical Return Program such an attractive model for improving public health and safety. [return to top]

Mandatory Public Reporting of Healthcare-Associated Infections Session to be Held in Augusta, July 18
This program to discuss the possibility of mandatory reporting of health care-associated infections, which will be held July 18, 2005 at the Senator Inn in Augusta, is intended to provide Maine's key stakeholders the opportunity to attend a neutral educational session and receive important information provided by national speakers with experience in mandatory reporting and public policy.

Stakeholders will have the opportunity to learn about the possible legal ramifications of mandatory reporting, benefit from the experiences of other states that have already adopted mandatory reporting legislation, and hear from experts who are working toward national standards for reporting.

The event is being organized by Maine Medical Center's Department of Epidemiology.

For more information, contact Gwen Rogers, 207-662-2550 or email rogerg@mmc.org. [return to top]

Bangor Cardiovascular Surgeons Leave Anthem Network Over Fee Stalemate
As noted in last week's newsletter, there continues to be a fair amount of publicity generated by the decision by Cardiovascular Surgery, P.A. of Bangor to drop out of the Anthem provider network as of Sept. 1, 2005.  The owners of the 18-year old practice had sought an increase in reimbursement rates under its existing three-year contract with Anthem.

Many Maine newspapers have inaccurately stated that Anthem patients will pay more out-of-pocket as the result of the group's decision, but Maine Bureau of Insurance Rule Chapter 850 protects patients under these circumstances.  Anthem officials and owners of the practice have scheduled a meeting for later this month to discuss the ramifications to patients of the decision. [return to top]

Study: Healthcare Spending Holding Steady for Privately Insured
According to a study published in Health Affairs, spending for U.S. residents with private insurance increased by 8.2% in 2004, which is nearly the same as the growth rate in 2003.  The study found that outpatient services rose to 11.3% compared with 11.1% in 2003, growth for inpatient spending  rose by 6.2%, compared with 6.1% in 2003, and spending growth for prescription drugs decreased for the fifth consecutive year from 8.9% in 2003 to 7.2% in 2004.  Researchers said that the use of generic drugs contributed to the decreased in pharmaceutical costs.  While it is good news that the growth rate in 2004 did not increase from 2003, analysts still say the the general growth is alarming and cause for concern.  A growth rate of 8.2% is still almost four times the growth in wages.  If this trend continues, analysts predict that it could lead to a substantial decline in the percentage of people with health insurance. [return to top]

Most Physicians Believe in Annual Checkups

A survey conducted by researchers at the University of Colorado Health Sciences Center found that 65 percent of primary care physicians think annual physicals are necessary and nearly nine out of 10 said they perform annual exams, according to an article in the Archives of Internal Medicine. Annual physicals have been the subject of debate since about nine years ago when the U.S. Preventive Services Task Force said there is insufficient evidence of any benefit from many of the tests often given with yearly checkups. The task force doesn't recommend for or against annual physicals, and neither does the American Medical Association. Among the 783 physicians surveyed for the study, many said routine exams should include tests that the task force says haven't been proven to prevent diseases in healthy adults, such as urine tests, blood-sugar tests for diabetes and thyroid tests. The most frequently recommended tests included complete blood counts (CBCs), which check for conditions including anemia. Nearly 40 percent of doctors said those tests should be part of routine physicals, despite studies showing that routine CBC testing does not have much benefit. To read an abstract of the study:

http://archinte.ama-assn.org/cgi/content/short/165/12/1347 [return to top]

Growth in Health Spending Due More to Increased Rates of Treating Disease than Cost of Treatment

Increases in private health insurance spending are due more to the increase in treated disease prevalence than to increased spending per treated case, according to a study published today on the Health Affairs Web site. The study examined the 20 medical conditions that accounted for the largest portion of the rise in private health care spending from 1987 through 2002. For 16 of those conditions, the rise in treated disease prevalence, rather than the increase in cost per treated case, accounted for more than half of the growth in health care spending, particularly in conditions clinically associated with obesity. Costs per treated cases of back problems actually dropped, while the number of treated cases nearly doubled. The role of rising obesity also had an effect on costs. In 1987, obese adults with private health insurance spent $272 more per person per year on health care than did normal-weight adults. By 2002, that difference had increased to $1,244 per person per year. Spending on medical care related to obesity accounted for 11.6 percent of all private health care spending in 2002, compared with just 2 percent in 1987. To read the study:

http://content.healthaffairs.org/cgi/content/full/hlthaff.w5.317/DC1 [return to top]

Congressional Action Needed to Avoid Medicare Fee Reduction
On May 12, Reps. Clay Shaw (R-FL) and Ben Cardin (D-MD) introduced H.R. 2356, legislation to reform the method used to determine Medicare payments to physicians.  H.R. 2356 would repeal the current sustainable growth rate (SGR) methodology, which will reduce physician payments by an estimated 4 to 5% annually for the next seven years (4.3% in Jan. 2006).   Instead of the SGR, H.R. 2356 would determine physician payments using the Medicare economic index, which is based upon annual changes in physicians' costs to care for patients.  Passage of the bill this year is expected to be difficult because of its $150 billion cost.

In the Senate, Sens Jon Kyl (R-AZ) and Debbie Stabenow (D-MI) introduced S. 1081, which would provide temporary relief to the Medicare payment crisis.  Instead of replacing the current methodology, the Senate bill would legislate across-the-board payment updates based on inflation in 2006 and 2007.

MMA will communicate with Maine's congressional delegation regarding co-sponsorship of these bills and you are encouraged to communicate with Congressmen Allen and Michaud and Senators Snowe and Collins, as well. [return to top]

For more information or to contact us directly, please visit www.mainemed.com l ©2003, Maine Medical Association