October 17, 2005

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Blue Ribbon Commission on the Future of MaineCare Holds First Meeting
The Blue Ribbon Commission on the Future of MaineCare held its first meeting last Tuesday at the State House. Commission members reviewed the legislative charge to the Commission (see below), the recently granted federal waiver to the State of Vermont, the Sept. 1, 2005 report of the federal Medicaid Commission and held a panel discussion on the current status of MaineCare led by Deputy Commissioner Mike Hall and Trish Riley from the Governor's Office of Health Policy and Finance.
Future meetings of the Commission will be held on Nov. 1, Nov. 15 and Dec. 6, all from 9:30am to 3:00pm at the Cross State Office Building (Room 209) in Augusta. The Legislative Resolve establishing the Commission calls for it to submit its report, with findings and accompanying recommendations for legislation, by Dec. 7, 2005. It is an ambitious timetable, but then again, the Commission was to have been appointed and begun its work by August 1, so it is already more than two months behind schedule.

The Commission is Co-chaired by Senate Majority Leader Michael Brennan and Rep. William Walcott. Other members from the legislature include Sen. Richard Nass (R-Acton) and Rep. Darlene Curley (R-Scarborough).
Non legislators on the Commission are Nancy Kelleher, representing the MaineCare Advisory Committee, Ronald Welch, of the Maine Association for Mental Health Services, Jean Cotner representing privately funded healthcare, Christine Hastedt, of the Maine Equal Justice Program, Lynn Davey, representing health data collection and interpretation and Paul Saucier of the USM Muskie School of Public Service.

MMA staff will attend each of the Commission meetings and report to members via this electronic newsletter.

The Commission is charged with studying the MaineCare program and making recommendations on how to improve the quality, adequacy, effectiveness and delivery of services under the program in the most cost-effective manner possible, in an effort to ensure its sustainability over time, including various options for providing coverage for persons in need of health care services.

In conducting the study, the commission shall:

1. Review and make recommendations about the extent to which MaineCare is meeting its current and future responsibilities and include a review of the effectiveness of various models in financing and providing health care coverage to low-income and vulnerable populations, including, but not limited to, low-income families and children, the physically disabled, the elderly, the chronically ill and the uninsured;
2. Study and report eligibility levels, service benefits, expenditures and other factors affecting future costs under the MaineCare program;
3. Estimate future program costs, taking into account relevant factors, including, but not limited to, demographics; health care cost drivers; cost-savings and cost-control initiatives in place at the time of the study; other economic variables, including changes in individual and family income rates, changes in uninsured rates and changes in employer-based coverage rates; cost drivers and cost shifting related to coverage provided under the program; and other related economic factors;
4. Review and summarize the economic effect of MaineCare and its role in maintaining Maine's health care provider network, including primary, specialty and acute care;
5. Provide an analysis of changes in federal funding and health care policy, including changes in the federal match rate formula, and how such changes will affect MaineCare; and
6. Review and make recommendations related to actions taken by the federal Bipartisan Commission on Medicaid and the Medically Underserved. Recommendations based on the federal commission's study must be included in the commission's interim and final reports.

MaineCare MECMS Update
The Provider Advisory Committee on MECMS met last Thursday and received an update on the progress of the claims management system from DHHS Commissioner Jack Nicholas and Deputy Commissioner and Acting OMS Director Mike Hall. The Key Weekly Metrics showed that progress is steady but slow. For the week ending Oct. 9, 2005, the system processed just over 80% of the new claims, but only 25% of the recycled claims. Total claims remaining in suspension increased slightly to 369,930.

A Special Projects Team on Crossovers has been established, with the objective of processing and delivering crossover claims by the end of the year. If accomplished, this would be an improvement over the previously announced February timeframe. The Team includes JoAnn Samon, Jane Bryson, Mike St. John, two members from CNSI (the vendor) and an additional consultant with over 30 year's experience in Medicare and Medicaid. The Team has been sequestered off-site at the CNSI offices, in order to fully focus on the Project.

It is estimated that about 15,000 Part B crossover claims are filed each week, so a total of over 600,000 are likely to be in the pipeline.

Staff is testing the processing of paper claims for the crossovers, and watch for an announcement this coming week as to whether paper claims can be filed with the likelihood that they would be paid before the end of the year.

Plans for the repayments of the interim payments through reconciliation are on-going, with focused meetings with representatives of each of the provider groups scheduled. Although each of these sessions is likely to focus on the claims of just one group, others in the provider segment will be invited to attend and provide input.

Committee members also received the draft CMS Project Review Report on MECMS, dated August 2005. Several recommendations were made in the report and MMA EVP Gordon Smith asked at the meeting for a report next meeting on those recommendations which the Department is prepared to implement. The Committee meets again on October 27. [return to top]

Maine Health Data Organization Proposes Rule Changes on Physician-Specific Claims Data
The Maine Health Data Organization (MHDO) held a public hearing last Thursday on proposed amendments to its Rule Chapter 120 entitled, "Release of Data to the Public." Since the creation of the MHDO in the early 1990's by the Legislature, the agency's rules have prohibited the release of both patient specific and practitioner specific data to the public. The proposed changes to Chapter 120 would continue to protect patients' identification but would open up the practitioner specific data to the public. The rule impacts not just physicians, but any licensed healthcare practitioner in the state who may have a claim in the all payor claims data base.

The MHDO has been urged by the Maine Quality Forum and employer interests to open up the data base to the public, while professional organizations, including both MMA and the Maine Osteopathic Association, have urged the MHDO to go slow until it is certain that the data is accurate and useful to the public. MMA and MOA also testified Thursday in opposition to the rule arguing that certain safeguards needed to accompany any such release.

In addressing the MHDO board members at the hearing, MMA EVP Gordon Smith asked that physicians be personally notified of the release of their data, that they have the opportunity to examine the data for accuracy and the opportunity, as well, to object to the release of the data. Smith also asked for a panel of specialists to review any such data before its release. "Professional reputation is hard earned and easily lost if data shows up in the newspaper in a comparative way," noted Smith. "It is essential that any such data be reviewed first by the physician affected by the release to assure accuracy and to prevent any unintentional adverse consequences."

Interested parties may file comments on the proposed rule by 5:00pm on Monday, Oct. 24. Only MMA and MOA opposed the rule. No one testified in favor of it. Representatives of the Maine Quality Forum expressed support for the release of data to the MQF, but also expressed general support for the amendments to the rule requested by MMA.

MMA will file written comments on the proposed rule this week and will provide a link to them in next week's Maine Medicine Weekly Update.

As some version of this rule is likely to eventually be enacted, physician practices should begin preparing for this type of data to be at least in the hands of the Maine Quality Forum, and likely in the hands of the public as well, at some point and subject to certain conditions. In order to assist, MMA will hold an educational program regarding the release of physician-specific data on Friday morning, Feb.3, 2006 as part of the First Fridays Educational Series. You can reserve your spot now for this program by calling or e-mailing Chandra Leister at 622-3374 at cleister@mainemed.com. [return to top]

Payor Liaison Committee Meets Wednesday (10/19) to Discuss Specialty Networks
Following up on a meeting last month that featured presentations by Aetna and Cigna regarding their announced specialty networks effective Jan. 1 '06, MMA's Payor Liaison Committee will meet again this coming Wednesday night at the MMA offices in Manchester (dinner at 6:15pm, meeting at 6:30)to discuss last month's presentations. A representative of the Bureau of Insurance has also been invited to attend.

Representatives of all affected specialties should be present to participate in this discussion. Just give us a call at 622-3374 if you are able to join us. [return to top]

MMA Executive Committee to Meet on Wednesday, Oct. 19
MMA's 26-member Executive Committee will hold its first post Annual Session meeting this coming Wednesday in Manchester. In addition to reviewing the results of the Annual Session, members will discuss the continuing issues surrounding MECMS and the proposed decrease in Medicare reimbursement. All MMA committee members are open to any MMA member, whether they are on the committee or not.

The meeting begins at 2:00pm on Wednesday and is scheduled to conclude by 5:00pm. The new Chair of the Committee is William Strassberg, M.D., an orthopedic surgeon from Belfast who practices on Mount Desert Island. Five new members will be welcomed on Wednesday, including Jennifer Charity, M.D. of Newport, Ibessat Daudi,M.D. of Presque Isle, John Van Pelt, M.D. of Ellsworth, David Halbert, M.D. of Belfast and Sumit Kohli, M.D. of Lewiston. [return to top]

MQF Advisory Council Elects New Chair & Vice Chair
At its meeting on Friday, October 14, 2005, MQF Director Dennis Shubert, M.D. and members of the Maine Quality Forum Advisory Council thanked the outgoing Chair of the Council, Robert McArtor, M.D., M.P.H., for his service as the group's first leader.  The Council is the stakeholder group established in the Dirigo Health legislation to advise the MQF.  The group went on to elect Rebecca Colwell, R.N. of MaineGeneral/HealthReach as Chair and Robert Keller, M.D. as Vice Chair.  Ms. Colwell had been the Vice Chair of the Council. 

Council Member Dan Roet provided an update on the Dirigo "Savings Offset Payment" working group established by L.D. 1577.  Council Member Paul Tisher, M.D. presented his views on quality measurement in behavioral health and his presentation included an overview of a QA program at Acadia Hospital.  Dr. Shubert updated members on the MQF's progress in responding to a directive by the Governor's Office of Health Policy & Finance to recommend changes to the state's sentinel event/medical error reporting system by the end of the year.  Also, Dr. Shubert briefed members on web-based, publicly accessible quality data for the Norton Health System in Kentucky as an example of a health system that has taken the lead in making quality data available to the public.  Finally, the Council members discussed their role in the certificate-of-need review process.  It seems likely that the group's role will be to advise the DHHS Commissioner, the decision maker in the CON process, on the quality aspects of projects undergoing CON review by suggesting quality-oriented questions that may be asked of applicants.

The MQF Advisory Council has not planned a November meeting. [return to top]

Talking Points on the Recent Cigarette Tax Increase
The following talking points on the recent cigarette tax increase may be helpful if you are asked to respond to the $1 per pack cigarette tax increase effective 9/16/05 as a result of P.L. 2005, Chapter 457.

When cigarette prices go up, Maine kids and the Maine economy are the winners.

  • Tobacco is Maine’s #1 killer – nearly six Maine people die EVERY DAY from smoking-related diseases. Smoking kills 2100 Maine people every year and 3800 new smokers replace them.
  • Raising the cigarette tax by $1.00 per pack is a tremendous victory for Maine kids. Every year 3,300 Maine kids become regular smokers and, as a result, one out of three will die early.
  • The $1.00 tax increase will keep over 13,000 kids from smoking. The $1.00 increase in Maine’s cigarette tax will avoid 6,600 smoking-related deaths and save $292 million in lifetime health costs.
  • The cost of tobacco use in financial terms is staggering. It would be necessary to tax cigarettes at $5.82 per pack in order to pay for the $554 million in direct health care costs Maine is experiencing each year as a result of past and current smoking.
  • Kids are particularly price sensitive and, for many young people, higher prices could make the difference between addiction and a life free of tobacco-related disease. Tobacco pricing policies are an integral component of any comprehensive tobacco control program because raising the price of cigarettes is a proven method of reducing smoking, especially among young people.
  • We know that 70% of smokers WANT to quit – we need to do everything we can to help them. For many, especially young people, a substantial increase in price will be the final straw that pushes them to seek treatment for this deadly addiction.
  • The tobacco industry continues to work overtime to get and keep new smokers. Latest research estimates that the industry spends $74 million every year, in Maine alone, promoting their products – that’s $200,000 per day. Raising the price of cigarettes is one way to counteract this onslaught of deadly messages.
  • Mainers overwhelmingly support increasing the cigarette tax. In a survey conducted in January 2005, 67% of respondents agreed that given the lives and health costs saved, Maine’s tobacco tax should be increased by $1.50 per pack..
  • Maine’s cigarette tax rate of $2.00 per pack places shows national leadership but is regionally tame. Maine is in the top five nationally while, at the same time, nineteen states and Puerto Rico currently tax cigarettes at $1.00 or higher; the New England average is $1.58; and Maine’s bordering Canadian province average is $3.33 (in US dollars).
  • We applaud the Governor and the Maine Legislature for taking strong leadership on addressing tobacco use. They can be very proud of this life-saving new law.

Prepared by the Maine Coalition on Smoking or Health
September 2005
[return to top]

Sen. Santorum Says Liability Reform Debate May Have to Wait until 2007
At a briefing sponsored by Doctors for Medical Liability Reform on October 6, 2005, Senator Rick Santorum (R-PA), the 3rd ranking Republican in the U.S. Senate, said that the Senate will not take up medical liability reform before the end of the year and that the Senate probably will not have the votes to pass medical liability reform in 2006.  The most prominent medical malpractice bill in the Senate is S. 354 sponsored by Sen. Judd Gregg (R-NH) and Sen. John Ensign (R-NV), a bill that includes a $250,000 cap on non-economic damages.  The House last passed a medical liability reform bill (H.R. 5) by a vote of 230-194 in July.

Santorum said that the Senate may tackle medical liability reform in 2006 with a bill other than S. 354 in an effort to bring more Senate Democrats on board.  You can find more information about Doctors for Medical Liability Reform on the web at www.protectpatientsnow.org. [return to top]

Congress Faces Budget Reconciliation
As required by the FY 2006 budget resolution, Congressional Committees are considering ways to achieve $10 billion or more in Medicaid savings.  The House Energy & Commerce Committee may suggest changing the Medicaid reimbursement formula for prescription drugs (to base it on average manufacturers price [AMP]), tightening the rules regarding asset transfers to qualify for Medicaid long-term care services, and changing Medicaid cost-sharing rules.  Cost-sharing changes may include implementing tiered cost sharing for prescription drugs and making all copayments enforceable.

As soon as today, Senate Finance Chairman Charles Grassley (R-IA) may release a Chairman's mark of a proposal to save at least $12 billion over 5 years.  The additional money would be used for Hurricane Katrina relief efforts.  The Grassley proposal likely will eliminate the planned 4.4% Medicare reimbursement cut for physicians required by the SGR in 2006, an element that would cost about $7 billion over 5 years.  Also, it would make physicians eligible for a 1% bonus for reporting quality data.  The Chairman's proposal also could cut payments to Medicare managed care plans, home health agencies, skilled nursing facilities, and hospitals. 

The Grassley proposal faces significant difficulty in the Finance Committee and on the floor of the Senate.  The ranking Finance Committee Democrat, Max Baucus (D-MT), is not participating in the development of the plan and several Republican members of the Committee (Sen. Snowe and Sen. Gordon Smith of Oregon) remain opposed to Medicaid cuts likely to be included in the final product.  Sen. Collins, Sen. Lincoln Chafee (R-RI), and Sen. John McCain (R-AZ) also have concerns about the Medicaid cuts. [return to top]

Next "First Friday" Program on Medicare, Part D
 The next program in MMA's "First Friday" CME series is on Medicare Part D and is intended to prepare the physician practice to assist patients who are seniors and need information on the Part D drug benefit. The primary presenter is Anne Smith of Legal Services for the Elderly. Other speakers will be announced shortly. The program will be on Friday morning, Nov. 4, 2005 from 9:00am to noon at the offices of MMA in Manchester, Maine.

In addition to Medicare, Part D, other provisions affecting physicians that were included in the Medicare Modernization Act will be discussed. Registration materials are included in the Sept./Oct issue of Maine Medicine but you may call Chandra Leister at 622-3374 or via e-mail to cleister@mainemed.com to reserve your seat. The cost is $60 which includes breakfast and extensive written materials. [return to top]

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