October 24, 2005

 
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Summary of MMA Executive Committee Meeting Oct. 19, 2005
The 26-member MMA Executive Committee met last week and considered a number of matters related to Medicare, MaineCare, specialty physician networks and internal MMA matters. Members discussed feedback regarding the Annual Meeting, held last month in Bar Harbor, and voted to move the '07 meeting from the Balsams to the Harborside in Bar Harbor. Generally, members felt it was important to meet in Maine more frequently, particularly if acceptable sites are available. The 2006 meeting will still be held at the Fairmont Algonquin in St. Andrews, New Brunswick. The dates are Sept. 8-10.
The Executive Committee is chaired this year by William Strassberg, M.D., an orthopedic surgeon with offices in Bar Harbor. Eight members of the committee are new within the past year.

In addition to hearing committee and staff updates, committee members took the following actions:

1. Voted to support medical relief efforts in Pakistan with a $2,000 contribution from the Maine Medical Education Trust. At least one MMA member will be assisting directly with relief efforts in Pakistan and he will asked to use the funds for direct patient care in the area affected by the earthquake.

2. Voted to support the concept of public release of practitioner-specific claims data, as proposed in a pending rule change at the Maine Health Data Organization, but only subject to very stringent conditions, including the physician reviewing the data for accuracy and a group of specialists vetting the data for public value.

3. Voted to have the Committee on Membership and Member Benefits determine any benefit changes in the MMA Health Plan which is pending a renewal Feb. 1, 2006. Members were pleased to hear that the renewal would involve an increase of only 2.2% and that benefit changes could decrease that increase further (individual physician premium increases could be as much as 6 or 7% if they are subject to an increase in an age band).

4. Heard an update on personnel changes at the MMA office, including the loss of two employees this month.

5. Heard a presentation on the finances through Oct. 15. Over 200 current members are still delinquent in their 2005 dues which is creating a deficit in the budget. It does not appear that the projected deficit can be made up from other areas of revenue.

6. Considered a proposal to amend the Association's White Paper on Health System Reform to include a mandate that large employers extend health insurance benefits to their employees. The proposal was brought forth in response to reports that many of the so-called "big box" retailers do not provide health insurance to the majority of their workers. The proposal was tabled in order to receive more information on the extent of the problem. The issue will be taken up again at the next meeting on Nov. 16.

The Committee meets again on Nov. 16. The meeting will be followed by a two-hour orientation session for new members of the committee.

Preview of Bills For Second Session of 122nd Maine Legislature

This week, the Legislature released the list of bill title requests from members for the Second Regular Session of the 122nd Maine Legislature.  Legislators may introduce bills in the second session only with the majority approval of the 10-member Legislative Council, the partisan leadership of the legislature.  The MMA staff has pulled from the larger list those bills likely to be of interest to the physician community.  Not all of these bills will be accepted by the Legislative Council.  The list will be finalized in the next month.  This list will, however, give you a sense of the new bills facing the MMA in 2006.  In addition to these, the Legislature also will address a number of bills carried over from the first session when it convenes again in January 2006.

 

If you have questions about any of these bills or if you would like to be involved in the MMA's legislative advocacy activities, please contact Andrew MacLean, Vice President & General Counsel at amaclean@mainemed.com.

 

ABORTION ISSUES

 

None

 

BLOOD & HIV ISSUES

 

None

 

BUDGET ISSUES

 

LR 2470, An Act to Allow for the Reimbursement of the Private Nonmedical Institution Service Provider Tax (Rep. Craven)

 

LR 2494, Resolve, to Study the Designation of a Portion of Tobacco Settlement Funds for Hospital-base Smoking Cessation Programs (Rep. Marley)

 

LR 2938, An Act to Require the State to Honor Its Obligations to Health Care Providers under the Tax and Match Program (Sen. Plowman)

 

LR 2696, An Act to Eliminate Inequities in the Service Provider Tax (Sen. Rotundo)

 

CHILDREN’S ISSUES

 

LR 2785, An Act to Prevent the Use of Nutritional Supplements by Maine Student Athletes (Sen. Brennan)

 

LR 2993, An Act to Expand Childhood Readiness to Learn Through Dental Screening (Rep. Dudley)

 

LR 2792, An Act to Ban Vaccines Containing Thimerasol (Sen. Edmonds)

 

LR 2519, An Act to Provide Parents with Information about Biohazards Affecting Children (Rep. Faircloth)

 

LR 2902, An Act to Increase Child Safety and Health through Biomonitoring of Infants and Toddlers (Rep. Faircloth)

 

LR 2832, An Act to Protect Children from the Onset of Autism (Rep. Lerman)

 

LR 3020, An Act to Require Audiological Reporting for Screenings of Young Children (Rep. Pingree)

 

LR 2670, An Act to Include Dental Screening with Other Preschool Testing for Maine's Children (Sen. Sullivan)

 

FIREARMS & DOMESTIC VIOLENCE ISSUES

 

LR 2571, An Act to Provide Notification to a Person Who Holds a Protection from Abuse Order When the Person Against Whom the Order is Held Attempts to Purchase a Firearm (Sen. Strimling)

 

HEALTH CARE REFORM ISSUES

 

LR 2734, An Act to Ensure Eligibility for Citizens 65 Years of Age and Older to Purchase Dirigo Choice Insurance (Rep. Barstow)

 

LR 2454, An Act to Provide Access to Health Care for Workers (Rep. Canavan)

 

LR 2817, An Act to Establish Requirements and Standards for Health Savings Accounts for Small Businesses (Rep. Cummings)

 

LR 2669, An Act to Increase Accessibility to Health Insurance (Rep. Glynn)

 

LR 2826, An Act to Provide Health Care Security (Rep. Lerman)

 

LR 2483, An Act to Enhance Free Market Health Insurance Reform (Rep. McKane)

 

LR 2717, Resolve, to Improve Quality and Access to Care through the Development of a Joint Strategic Plan (Sen. Rosen)

 

LR 2814, An Act to Access Federal Money for Health Insurance Reform (Rep. Tardy)

 

HEALTH CARE INFORMATION & CONFIDENTIALITY ISSUES

 

LR 2450, An Act to Provide Access to Birth Records by Adopted Persons (Rep. Davis)

 

LR 2764, An Act to Preserve Patient Records (Rep. Smith, Van Buren)

 

INSURANCE MANDATES

 

None

 

INSURANCE PRACTICES

 

LR 2466, An Act to Require Health Insurers to Provide Notice of Reinstatement (Sen. Cowger)

 

LR 2809, An Act to Protect Health Insurance Consumers (Sen. Martin)

 

LR 2693, An Act to Amend the Maine Insurance Guaranty Association Act (Sen. Sullivan)

 

LONG-TERM CARE ISSUES

 

LR 2991, An Act to Improve Retention, Quality and Benefits for Direct Care Health Workers (Sen. Edmonds)

 

LR 2787, An Act to Reexamine and Reformulate Nursing Home Licensing and Inspection (Sen. Sullivan)

 

MANAGED CARE ISSUES

 

None

 

MEDICAID (MAINECARE) ISSUES

 

LR 2896, An Act to Ensure Coordination and Effectiveness in the Provision of Outpatient and Medication Management Services Under Maine's Noncategorical Waiver (Rep. Brannigan)

 

LR 2875, An Act to Establish a Residency Requirement for MaineCare Recipients (Rep. Browne)

 

LR 2613, Resolve, to Study the Efficient Delivery of Contracted Services by Social Workers to MaineCare Recipients (Rep. Burns)

 

LR 2710, Resolve, to Study the Efficient Billing and Delivery of Social Services by 3rd Parties (Rep. Burns)

 

LR 2698, An Act to Protect the Health and Welfare of Children and Spouses in Need of Enhanced Child Support Enforcement Services (Sen. Cowger)

 

LR 2539, An Act to Streamline MaineCare Billing (Rep. Fischer)

 

LR 2541, An Act to Direct the Office of Program Evaluation and Governmental Accountability to Investigate the MaineCare Billing Crisis and to Hold Individuals Accountable (Rep. Fischer)

 

LR 2737, An Act to Protect Services for MaineCare Clients Designated as Noncategorical (Rep. Glynn)

 

LR 2468, An Act to Improve the MaineCare Program (Sen. Mayo)

 

LR 2789, Resolve, to Ensure Proper Accounting for Funds at the Department of Health & Human Services (Sen. Mayo)

 

LR 2786, An Act to Appropriate Funds to Eliminate Cost Sharing under Certain MaineCare Programs (Sen. Sullivan)

 

LR 2609, An Act to Increase Wheelchair Reimbursement Rates (Rep. Tuttle)

 

LR 2705, An Act to Streamline the Reporting Requirements of the DHHS (Rep. Walcott)

 

MEDICAL ETHICS/MEDICAL RIGHTS ISSUES

 

LR 2464, An Act to Ensure the Authority of "Do-Not-Resuscitate" Orders in Health Care Directives (Sen. Bryant)

 

LR 2448, An Act to Amend the Laws Governing Living Wills of Terminally Ill Persons (Rep. Grose)

 

MEDICAL LIABILITY ISSUES

 

LR 2780, An Act to Reform the Maine Tort Claims Act (Sen. Martin)

 

LR 2788, An Act to Ensure Patient Safety (Sen. Martin)

 

LR 2603, An Act to Enhance Health Care Safety (Speaker Richardson)

 

 

MENTAL HEALTH, MENTAL RETARDATION, & SUBSTANCE ABUSE ISSUES

 

LR 2503, An Act to Require Mandatory Training for Law Enforcement Officers and Prosecutors Regarding Interaction with Citizens with Developmental Disabilities (Sen. Bartlett)

 

LR 2936, An Act to Define "Disability" in the Maine Human Rights Act (Sen. Clukey)

 

LR 2994, An Act to Reduce the Long-term Costs of Substance Abuse (Rep. Dudley)

 

LR 2996, An Act to Protect Children's Access to Mental Health Services (Rep. Dudley)

 

LR 2833, An Act to Ensure Adequate Capacity at Riverview Psychiatric Center (Rep. Lerman)

 

LR 2742, An Act to Improve Substance Abuse Rehabilitation Services (Rep. Millett)

 

LR 2910, An Act to Establish a Child Advocate Position in the Disability Rights Center (Sen. Mitchell)

 

LR 2745, An Act to Address the Problems Created by Substance Abuse in Maine (Rep. Perry)

 

LR 2842, An Act to Ensure Appropriate Services for Certain Adults with Disabilities in Transition Due to Actions of the State (Rep. Webster)

 

PRESCRIPTION DRUG ISSUES

 

LR 2629, An Act to Guarantee Access to Medically Necessary Medications during the Implementation of the Medicare Part D Prescription Drug Program (Sen. Brennan)

 

LR 2639, An Act to Provide Additional Opportunities to Purchase Affordable Prescription Drugs (Sen. Mayo)

 

LR 2864, An Act to Protect Community Pharmacies (Rep. Mills)

 

LR 3029, An Act to Maintain Prescription Drug Benefits for Seniors and People with Disabilities (Rep. Pingree)

 

LR 2630, An Act Permitting the Recycling of Unused Prescription Drugs (Sen. Sullivan)

 

LR 2475, An Act to Clarify Prescription Drug Labels (Rep. Thompson)

 

 

PUBLIC HEALTH & SAFETY ISSUES

 

LR 2711, An Act Concerning Seat Belts (Rep. Burns)

 

LR 2563, An Act to Establish November as "Cancer Awareness Month" (Rep. Curley)

 

LR 2995, An Act to Assess Maine Residents' Vulnerabilities to Natural and Man-made Disasters (Rep. Dudley)

 

LR 2831, An Act to Protect Pregnant Women from Mercury Overexposure (Rep. Lerman)

 

LR 2502, An Act to Provide an Exemption from Wearing a Seat Belt for Medical Reasons (Rep. Saviello)

 

LR 2614, An Act to Prevent the Introduction of Chronic Wasting Disease (Rep. Watson)

 

REGULATION OF HEALTH CARE FACILITIES

 

LR 2880, An Act to Amend the Law Concerning Sentinel Event Reporting (Rep. Canavan)

 

LR 2825, An Act to Adjust the Eligibility for Nonprofit Exemption (Rep. Lerman)

 

LR 2772, An Act to Strengthen and Improve Review Procedures in the Certificate of Need Program (Rep. Miller)

 

LR 2677/2811, An Act to Conform the Certificate of Need Law to Industry Standards (Sen. Rosen)

 

LR 2658, An Act to Allow an Ambulance Company to Function as a Medical Care Car (Rep. Tuttle)

 

SCOPE OF PRACTICE, LICENSING, & DISCIPLINARY ISSUES FOR INDIVIDUAL PRACTITIONERS

 

LR 2970, An Act to Modify the Requirements for Provisional Social Worker Licenses (Rep. Grose)

 

LR 2829, An Act to License Behavioral Analysts (Rep. Lerman)

 

LR 2852, An Act to Clarify the Accountability of Advanced Practice Registered Nurses (Rep. Perry)

 

LR 2714, An Act to Improve the Procedures of the Board of Licensure in Medicine (Sen. Rotundo)

 

LR 2969, An Act to Exempt Dentists from Jury Duty (Rep. Schatz)

 

TOBACCO ISSUES

 

LR 2509, An Act to Prohibit the Advertisement of Tobacco and Alcohol within 500 Feet of a School (Sen. Bartlett)

 

LR 2597, An Act to Amend the Law Governing Smoking in Private Clubs (Rep. Clark)

 

LR 2586, An Act to Amend the Law Regarding Smoking in Private Clubs (Rep. Grose)

 

LR 2654, An Act to Clarify the Voting Procedures for Private Clubs to Determine Smoking Policies (Rep. Jennings)

 

LR 2694, An Act to Clarify the Workplace Smoking Act of 1985 (Rep. Miller)

 

LR 2482, An Act to Repeal the Requirement that Employees Who Are Minors be Overseen by a Superior in Order to Sell Tobacco Products (Rep. Moore)

 

LR 2647, An Act to Clarify the Workplace Smoking Laws (Sen. Turner)

 

WORKERS’ COMPENSATION ISSUES

 

LR 2839, An Act to Protect Workers and Medical Examinations (Rep. Smith, Van Buren)

 

LR 2608, Resolve, to Expedite a Workers' Compensation Case (Rep. Tuttle)

 

LR 2895, An Act to Allow Employers to Make Payments for Undisputed Portions of Workers' Compensation Claims (Sen. Weston) [return to top]

MQF Sentinel Event Ad Hoc Committee Considers Changes to Required Reports
On Wednesday, October 19, 2005, the MQF Sentinel Event Ad Hoc Committee held a meeting to discuss the MQF response to a request from the Governor's Office of Health Policy & Finance for recommendations to improve the state's mandatory sentinel event reporting system in light of changes in federal law and in the national patient safety movement.  The 121st Maine Legislature established a mandatory sentinel event reporting process following lengthy negotiations among the MMA, the Maine Hospital Association, and consumer/patient advocates.  MQF Director Dennis Shubert, M.D. advised the group that he did not intend to change the confidentiality provisions applying to the sentinel event reporting process, but that he did want to adopt the National Quality Foundation (NQF) taxonomy and list of reportable events so that the data collected in the Maine system is comparable with the data collected around the country.  The sponsor of the original sentinel event reporting statute, Rep. David Trahan (R-Waldoboro), attended the meeting and expressed concern about the potential pitfalls of any effort to change the legislation.  The Committee, chaired by MQF Advisory Council member Jonathan Beal, a Portland lawyer representing labor on the Council, will make its recommendations to the Governor's Office of Health Policy & Finance by December, 2005. [return to top]

Leadership Changes at Medical Mutual Insurance Company of Maine
Medical Mutual Insurance Company of Maine has announced the selection of Terrance Sheehan, M.D. of Kennebunkport as its new President, effective Nov. 28, 2005. Dr. Sheehan will be resigning from his current position as VPMA at Southern Maine Medical Center in Biddeford. Prior to going to SMMC, Dr. Sheehan had practiced pediatrics in Augusta for many years.

MMA expresses its congratulations to Dr. Sheehan upon his appointment and we look forward to continuing our close relationship with the company. Medical Mutual is the endorsed carrier of medical liability insurance for MMA members and is an active Corporate Affiliate of MMA. [return to top]

Senate Finance Committee Schedules Mark-Up on Temporary Medicare Payment Fix
The Senate Finance Committee is scheduled to mark-up a legislative proposal that would eliminate the proposed reduction in physician Medicare payments scheduled to take effect Jan. 1, 2006. The proposed reduction of 4.4% would be replaced with a 1% increase.  While the 1% increase is not sufficient to meet increasing expenses of operating a practice, the total swing of 5.4% is likely to be the best physicians can do in the current environment.

MMA staff communicated with the office of Senator Olympia Snowe on Friday. Senator Snowe is on the Senate Finance Committee. Her staff indicated that the Senator is prepared to support the proposal which calls for a one-year fix. Unfortunately, the proposal does not change the underlying formula which is causing the proposed reductions, the so-called sustainable growth rate, which holds physicians accountable for increases in Medicare spending regardless of the underlying causes of the additional spending on physician services. [return to top]

Next "First Fridays" Program to Feature Medicare Part D
The next MMA CME program scheduled as part of the "First Fridays" series will be held on Friday, Nov. 4 and will focus on the new Medicare Part D prescription drug program for seniors. The program will be held from 9:00am to noon at the MMA offices in Manchester. The MMA conference room can accommodate about 40 persons, classroom style, for this program so register now if you would like to attend. The cost of the program is $60 which includes breakfast and all materials.

Speakers will include Ann Smith from Legal Services for the Elderly, Mary McPherson from Maine Equal Justice and presenters from CMS, the AARP and the pharmaceutical industry.

To register, call 622-3374 or e-mail cleister@mainemed.com. Information on the Medicare Part D benefit is available from Medicare at 1-800-MEDICARE; www.medicare.gov. The nearest Area Agency on Aging also has experts trained in the program. You can phone 877-353-3771 for the agency nearest you.

The January 6 First Friday program will focus on the need for all practices to have a regulatory compliance plan. Sample plans will be distributed and discussed by a combination of private attorneys and enforcement personnel. [return to top]

Maine Heritage Policy Center Presents "Life After Dirigo" Nov. 4, 2005 in Portland
The Maine Heritage Policy Center will present a forum on Friday, Nov. 4, 2005 entitled, "Life After Dirigo Health - Real Solutions for Effective Health Reform in Maine." Cost is $20 per person and you may register by calling 207-321-2550 or by going online at www.mainepolicy.org. The program is from 10am to 3:00pm at the Holiday Inn by the Bay in Portland.

The conference will bring together a group of state and national experts to explore successful health care and health insurance reforms that might serve as effective models for lowering the cost of health care and health insurance in Maine. [return to top]

Report on 1st Annual Muskie Health Care Forum
The Muskie School of Public Service at the University of Southern Maine held its first Annual Forum for Health Care Leaders on Oct. 17 and 18 in Freeport. MMA leaders attended the one and one-half day conference and joined 50 other leaders from around the state in discussing the current state of quality improvement in Maine and how to move to the next level. Presenters included Douglas Libby, R.Ph., Executive Director of the Maine Health Management Coalition, Maureen Kenney, MSSW, Manager of Health Care Strategies for Bath Iron Works, Stephen F. Loebs, PhD., Professor Emeritus, Division of Health Services Management and Policy, School of Public Heath, Ohio State University, and Andrew Aberdale, MBA, President of Aberdale and Associates, LLC.

On Tuesday morning, successful case studies were presented by Jacquelyn Cawley,D.O. (Martin's Point), Larry Anderson, M.D. (Maine Health), John Yindra, M.D. (CMHC and Central and Western Maine PHO) and Lois Skillings, RN, MSN (Mid Coast Hospital) The panel provided insights on and examples of how they were applying performance and quality improvement techniques to their specific health care settings.

One consistent theme of the conference was the need to have physician and provider buy-in to quality improvement activities. [return to top]

Payor Liaison Committee Meets on Specialty Tiered Networks
The Association's Payor Liaison Committee met last Wednesday night to discuss further the tiered networks announced recently by Aetna and Cigna. A representative of the Bureau of Insurance attended the first part of the meeting to provide a perspective from the Bureau and to listen to physician concerns. As the networks are currently only offered as an option for self-insured, ERISA exempt, employers, the Bureau has no jurisdiction over them. But if the tiered networks were to be made available to commercially insured patients, the Bureau would have to approve the networks under the provisions of Rule Chapter 850.

As most practices had not yet received the letters from Cigna announcing their designation, the committee will meet again on Dec. 1 to further consider the issues inherent in these types of networks. [return to top]

Symptoms of Physician Shortage Are Increasing

Signs of a growing shortage of physicians, particularly specialists, are increasing, according to an article in the Baltimore Sun. The Council on Graduate Medical Education predicts there could be a shortage of as many as 96,000 physicians in the United States by 2020. Rural and inner-city areas currently are experiencing physician shortages, and some experts expect these shortages to spread into other areas. Long waits for specialists, such as orthopaedic surgeons, are symptomatic of the trend, which will be exacerbated as "baby boomer" physicians retire and the elderly population increases. Younger physicians increasingly want to work fewer hours in order to balance their personal life and work and are choosing specialties that tend to have more flexible schedules. Read the article from the Baltimore Sun. [return to top]

Higher Medicare Costs Will Cut Into Social Security Increase

About a quarter of next year's Social Security increase will be offset by an increase in the Medicare Part B premium, which covers physician and outpatient services, The New York Times reported. Social Security payments will increase 4.1 percent for 2006, with the average retired worker receiving an additional $39 per month, but Medicare Part B premiums will increase by $10.33. Although the Social Security cost-of-living adjustment is the largest increase since a 5.4 percent adjustment in 1991, recipients will most likely not notice the increase due to rising gasoline, heating and medical costs. Read the article from the New York Times here. (site registration required)

  [return to top]

Prescription Drug Plan Finder Now Available at www.medicare.gov

The Prescription Drug Plan Finder, available at http://www.medicare.gov/  , is just one of the new resources CMS is now using to help train local partners, such as the State Health Insurance Assistance Programs, senior centers, faith-based organizations and others who will be assisting beneficiaries in learning more about and enrolling in drug plans later this year. The tool will ask questions based on the coverage beneficiaries have now to provide them with tailored plan comparison information based on what is most important to them, including cost, coverage and convenience. Beneficiaries can also get personalized information on particular plans that they think may be a good fit for them. Medicare beneficiaries who don't use the Internet will be able to get the same information by calling 1-800-MEDICARE (800-633-4227).

[return to top]

MMA Supports Relief Efforts in Pakistan; Donations Welcome
Rifat Zaidi, MD, an orthopedic surgeon in Lincoln County, will lead a group of health professionals in a relief mission to Pakistan next week. Many of the injuries suffered as a result of the massive earthquake are orthopedic in nature. Dr. Zaidi, a native of Pakistan, will spend approximately three weeks on this humanitarian mission.

MMA members wishing to make a tax-deductible contribution to the mission may do so by sending a check payable to: Miles Health Care, 35 Miles St., Damariscotta, ME 04543, attention: Anne Smith. Please write Pakistan Earthquake on the memo portion of the check. MMA itself will send $2,000 in support of the effort. [return to top]

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