MMA Hosts Medicare Part D Training as Part of "First Fridays" Seminar Series
Next "First Fridays" programs are the Best of the 2005 Physician Survival Seminars on December 2, 2005 and Medical Practice Compliance on January 6, 2006.
The greatest expansion of the Medicare program since its inception in 1965, the full implementation of the Medicare Part D drug benefit, will begin on January 1, 2006. Maine physicians and office staff gathered at the MMA office on Friday, November 4, 2005 to hear several students of this complex law speak about what physicians need to know about the new program.
MMA Vice President & General Counsel Andrew MacLean welcomed participants and gave a short introduction to the Medicare Prescription Drug, Improvement & Modernization Act of 2003. Next, Anne Smith, a Medicare Rights Advocate with Legal Services for the Elderly, Inc., a leading state expert on the new drug benefit, presented the basics of the Part D benefit. Andrew Finnegan, a provider relations representative from the CMS Region I office in Boston, demonstrated CMS' web-based Prescription Drug Plan Finder tool. Nancy Kelleher, State Advocacy Director for Maine for AARP, discussed AARP's perspective on the new benefit and resources for seniors and their physicians. Mary McPherson, Outreach Coordinator with Maine Equal Justice, addressed considerations for the low income and disabled populations including the relationships among the new benefit, the MaineCare program, and the Low-Cost Drugs for the Elderly & Disabled program (DEL). Finally, Stevan Gressitt, M.D., a member of the Maine Association of Psychiatric Physicians, spoke to participants about behavioral health considerations in Medicare Part D.
You can find more information about the Part D benefit on the CMS web site at: www.cms.hhs.gov. CMS has designed a beneficiary-friendly web site for information on Part D, including the Prescription Drug Plan Finder tool, at: www.medicare.gov.
Finally, each of the 5 area agencies on aging in Maine has a Medicare Prescription Drug Coverage Specialist on staff to help people with the Part D benefit. The Specialists can be reached at 1-877-353-3771 (1-877-ELDERS1) or at the local information below:
Aroostook: Tammy DeLong, Aroostook Agency on Aging, 764-3396, 1-800-439-1789, email@example.com.
Knox, Lincoln, Waldo, Somerset, Sagadahoc, & Kennebec: Nicole Biron, Senior Spectrum, 622-9212, 1-800-639-1553, firstname.lastname@example.org.
York & Cumberland: Katlyn Blackstone, Southern Maine Agency on Aging, 396-6500, 1-800-427-7411, email@example.com.
Hancock, Washington, Piscataquis, & Penobscot: Stacie Sparkman, Eastern Agency on Aging, 941-2854, 1-800-432-7812, firstname.lastname@example.org.
Oxford, Androscoggin, & Franklin: Amy MacMillan, SeniorsPlus, 795-4010, 1-800-427-1241, email@example.com.
Enrollment in the new Part D benefit begins January 1, 2006.
Senate Passes Budget Reconciliation Bill Including 1% Medicare Payment Update
On Thursday, November 3, 2005, the U.S. Senate narrowly passed a budget reconciliation bill including a 1% Medicare physician payment update that will cost $10.8 billion over 5 years. The bill also includes a pay-for-performance program opposed by the AMA and a ban on physician-owned specialty hospitals. The vote was 52 to 47 with 5 Republicans voting against it and 2 Democrats voting for it. Maine's Senators Olympia Snowe and Susan Collins were among the 5 Republican members voting in opposition, apparently because of a provision allowing drilling for oil and natural gas in wilderness Alaska.
At the beginning of the process, Senate staff proposed a one-year Medicare physician payment freeze, but Senate Finance Committee Chairman Charles Grassley (R-IA) and Senator Jon Kyl (R-AZ) negotiated the 1% update as a substitute for the freeze.
Unfortunately, the House reconciliation bill now does not include any Medicare provisions. The AMA has been seeking inclusion of a Medicare payment fix in the House bill, but the Bush Administration and the House Republican leadership have been avoiding politically difficult votes to revisit the Medicare Modernization Act. Work in the House will continue this week.
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Public Hearings Scheduled on Draft State Health Plan
The Governor's Office of Health Policy & Finance (GOHPF) and its Advisory Council on Health Systems Development will hold public hearings to receive public comment on the draft State Health Plan on November 21 and 22, 2005. The schedule for the public hearings is:
Lewiston, November 21, 11 a.m. to 2 p.m., at the Lewiston/Auburn Campus of the University of Southern Maine, 51 Westminster Street.
Brewer, November 21, 4 p.m. to 7 p.m., at Jeff's Catering, East/West Industrial Park, 5 Coffin Avenue.
Portland, November 22, 11 a.m. to 2 p.m., at the University of Southern Maine's Portland Campus, Hannaford Hall in the Abromson Community Education Center.
The draft State Health Plan should be available on the web this week: http://www.maine.gov/governor/baldacci/healthpolicy/index.html. [return to top]
MMA Welcomes New Corporate Affiliate, Rx Security, Inc.
The Maine Medical Association is pleased to announce our corporate partnership with Rx Security, Inc., a provider of State-approved tamper resistant prescription forms.
In Nova Scotia, Canada, Rx Security has been providing tamper-resistant forms for more than ten years having developed the technology in 1989. The secure prescription forms are their only product and exclusive focus. Currently a supplier to tens of thousands of prescribers throughout North America, Rx Security also is a partner of the California Medical Association and an approved printer for Florida Medicaid.
The secure forms provided by Rx Security are available to Maine physicians for as low as $1.82 per 100-sheet pad. This is substantially lower than other printers - in some cases savings of more than 65% can be realized.
We encourage Maine Medical Association prescribers to take advantage of the online ordering available to Rx Security customers at www.rxsecurity.com or to contact them at 1-800-667-9723 for an easy-to-complete order form. [return to top]
Update on Maine Health Information Technology Project
This week the Maine Health Information Network Technology (MHINT) project moves into the second half of the 12-month Phase II Planning and Development process that began last May.
Thanks to the active and growing support and involvement of many individuals and organizations across Maine, tremendous progress has been made toward our goal of establishing an integrated, statewide electronic clinical information-sharing system. In fact, we believe Maine is positioned to become one of the first states in the nation to develop such a system. The MHINT project is based on the principle that electronic clinical information-sharing holds great promise for improving quality and patient safety---and moderating the growth of health care costs over time.
Here is the timeline for our project:
- Phase I Feasibility---August December 2004 (completed);
- Phase II Planning and Development----May 2005 April 2006 (now at mid-way point);
- Phase III First Stage Implementation---Early 2007 (initial planning now under way)
- Phase IV Statewide Implementation---2007-2010
With this email, I’d like to briefly update you on the progress we’ve made in recent months and outline the work we have on the horizon.
Oversight & Project Direction
The MHINT Project currently is overseen by a Steering Committee that meets monthly. The Committee is made up of the project’s original funders: the Maine Health Access Foundation, the Maine Bureau of Health, the Maine Quality Forum, and the Maine Health Information Center (MHIC). The MHIC serves as project director. Our current project team includes: Project Director Suanne Singer, members of the MHIC technical and administrative staff and project consultants Jerry Edson, Alice Chapin and Jim Harnar.
Funding support for Phase II Planning and Development has grown considerably over the past two months. In addition to ongoing support from our original funders, we recently have received important contributions from: the Davis Family Foundation, the Betterment Fund, Anthem Blue Cross Blue Shield of Maine, the Bingham Program, the Robert Wood Johnson Foundation, and the Osteopathic Heritage Fund. We currently are finalizing details surrounding contributions from Maine’s four largest hospital systems, which have expressed strong support for the project. Once this is complete, we expect to have needed funding in place to complete Phase II work plan and lay additional groundwork for Phase III first stage implementation. Recent funding also is allowing the MHINT Team to do more to address the needs of small physician practices without access to electronic medical records (EMRs) and to perform technical planning necessary to interface with Maine’s public health community at the state and local levels. Work is now beginning on a plan to identify and secure Phase III funding and ongoing sustainable funding for long term system operations.
Key Phase II Work
The focus of the Phase II Planning and Development Process has been in three key areas:
- MHINT system governance;
- Consumer engagement (including privacy and security);
Under the guidance of a highly-involved Technology Committee of CIOs and physician leaders that has met several times a month since May, a great deal has been accomplished:
- An extensive request for information (RFI) was developed and provided to the national health care IT vendor community;
- Sixteen national vendors responded to the RFI;
- Following an extensive review process, five vendors have been selected to come to Maine later this month for presentations and in-depth interviews with the MHINT Technology Committee;
- One or more vendors will then be asked to make a full proposal to serve as the MHINT project’s primary partner in building a system for Maine;
- A draft functional design document has been completed outlining the system architecture that meets the criteria established by the Technology Committee;
- Site visits have taken place at a number of health delivery systems;
- A preliminary meeting has taken place to coordinate MHINT work with that the state’s Integrated Public Health Information System (IPHIS);
- The MHINT project team has closely monitored health IT infrastructure developments at the national level as well as in New England states so that the emerging MHINT system will be consistent with other systems;
- Work is underway to design a statewide "Master Patient Index" or MPI system for Maine
- Initial planning will begin soon on the technical requirements for Phase III First Stage Implementation, which is expected to involve electronic clinical information-sharing among a small number of un-allied providers;
- Communications is now being opened with various data sources such as labs and pharmacies.
- Plans call for transitioning the MHINT from its current project oversight process to a permanent governance structure in 2006;
- The Governance Planning Group is currently comprised of representatives from providers, government agencies, payers, consumers, public health and others;
- Over the course of four meetings, the MHINT project’s Governance Stakeholder Group has reviewed national plans for a system of Regional Health Information Organizations (RHIOs) and examined how other states are approaching governance;
- At its last meeting, the Group completed a thorough review of governance alternatives and reached consensus on the following recommendations, which will be refined and presented to the MHINT Steering Committee later this year:
- MHINT governance should be performed by a non-government entity;
- The governance entity should be a statewide non-profit organization rather than a for-profit entity;
- The non-profit should be a new organization rather than an existing entity;
- The new organization should be developed in a way that would allow for the formation of a limited liability corporation (LLC), if needed;
- Recommendations relating to funding the planned Phase III first stage implementation and long term sustainability should be deferred to the new governance body.
The Governance Group is expected to devote its next two meeting to reviewing various governance models regarding board make-up, roles and responsibilities.
Consumer Focus & Privacy and Security
- Consumer involvement is a critical element of the MHINT project, for several key reasons:
- consumer concern over privacy and security concerns as Maine moves from a paper-based medical information system to one that is more reliant on electronic clinical information;
- an overall goal of the MHINT system is to allow patients more access to their own medical information;
- The MHINT Consumer Stakeholder Group includes representatives of about a dozen consumer advocacy groups reflecting a wide range individuals, including low income people, the elderly, children, individuals with mental illness, HIV and others;
- With the help of legal counsel and the Maine Health Information Management Association, the Group has reviewed current Maine and federal health care privacy and security laws and regulations;
- Over the course of four meetings, the Group also has begun the development a of a Consumer Vision for the MHINT system as well as a set of principles and recommendations that are expected to be presented later this year to the MHINT Steering Committee;
- The Group will advocate for strong and meaningful consumer participation in the permanent MHINT governance structure.
For more information
A MHINT website currently is under development and will be available for viewing by November 15. You are welcome to visit www.mhint.org to find background information about the project, beginning with the Phase I Feasibility Report, committee presentations, meeting minutes and a schedule of upcoming meetings.
We hope this overview is helpful in understanding the MHINT project’s current status. We will plan to update you again as we move forward with the MHINT Planning and Development process.
In the mean time, please feel free to contact the MHINT project team at any time for additional information:
Thank you very much!
Suanne Singer [return to top]
Maine Health Information Center
Telephone: 207 430-0656
Or 207 623-2555 x656
Fax: 207 622-7086
Vermont Medical Society Issues Health Care Reform Plan
At a public health care summit in mid-October, the Vermont Medical Society released its "Vermont Medical Society Health Care Reform Plan" that would require all residents to carry at least a minimum level of health care coverage. VMS Immediate Past President Harvey Reich, M.D., a critical care physician in Rutland, stated that "Requiring health insurance coverage is the greatest single thing we can do to improve the health status of Vermonters." The plan would be funded in part by health-related taxes such as the cigarette tax. It also suggests standardizing payment codes, prescription drug formularies, insurance plan designs, claims submission requirements, credentialing procedures, and regulatory practices. The VMS recommends caps on non-economic damages and pre-trial screening panels as means to mitigate medical malpractice costs.
Such an individual health insurance mandate is an element of the MMA's health care reform white paper issued during the Dirigo health care reform debate in 2003. Also, MMA Vice President & General Counsel Andrew MacLean included an individual health insurance mandate as one of three health care reform recommendations during a panel discussion hosted by the Maine Heritage Policy Center at the Holiday Inn by the Bay in Portland on Friday, November 4, 2005. Also participating in the panel discussion were Mary Mayhew from the Maine Hospital Association and Dan Bernier from the National Association of Insurance & Financial Advisors - Maine Chapter.
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Cornell/Thomson Medstat Study Examines Disease Management
An article in the October 31, 2005 edition of Healthleaders examines the current state of disease management programs and whether they are truly effective. Cornell University and Thomson Medstat reviewed more than 44 separate studies about the economic impact and the return on investment of disease management programs. The study concluded that there are not enough scientific studies on the return on investment of these programs to make a strong business case for employers, insurers, and governmental entities to invest in disease management programs solely with the goal of reducing health care costs. The article goes on to argue, however, that "there is simply too much 'random' variation built into disease management programs in practice to make traditional testing work." It points out that there are many indirect benefits of disease management programs that simply cannot be measured from a traditional scientific approach. The overall positive effects of disease management programs should not be discounted because the return on investment cannot be quantified in a way that proves their effectiveness. [return to top]
Sub-State Planning For Pandemic Influenza Preparedness, December 14, 2005
Sub-State Planning For Pandemic Influenza Preparedness
Wednesday, December 14, 2005, Augusta Civic Center
Maine Health and Human Services’ Public Health [formerly Bureau of Health]
Maine Emergency Management Agency
Maine Emergency Medical Services
Our purpose is to facilitate state Pandemic Influenza preparedness planning.Identified leaders are invited as likely conveners of sub-state planning processes. Participants will work to help define the parameters of the issues and next steps needed to enhance sub-state Pandemic Influenza readiness and response.
WHO IS INVITED
- County EMA Directors
- Regional EMS Directors
- Clinical leaders from Hospitals and Health Centers
- Healthy Maine Partnership and other Coalition Directors
- Statewide or regional representation from other stakeholder groups (medicine, education, law enforcement, etc.)
- To increase community awareness of the need for readiness and ownership of local Pandemic Influenza response
- To identify the range of challenges posed to Maine communities and regions by the threat of Pandemic Influenza
- To provide a brief review of the State Public Health Management Structure for Pandemic Influenza Response
- To build awareness of regional/local resources that can supportsub-state preparedness for Pandemic Influenza
- To identify action steps to be taken by the sub-state public and private sectors to enhance preparedness
Morning sessions are primarily dedicated to creating dialogue among leaders and organizations in Maine.The afternoon plenary will be used to identify key themes to determine next steps to move forward in strengthening planning for Pandemic Influenza Readiness and Response at the sub-state level.
- 8:00 –8:30 Registration
- 8:30 – 10:15 Plenary Scenario and Discussion
- 10:15 – 10:30 Break
- 10:30 – 12:30
Breakout by Sub-State Region
Breakout for State Level Agencies and Associations
- 12:30 – 1:30 Lunch
- 1:30 – 3:00 Town Meeting Plenary
Please register early - seating is limited! If the State is closed due to weather conditions, the meeting will be rescheduled and brochures will be resent.If weather conditions are uncertain, please call 287-3266 by 3:00 pm on Tuesday, December 13th, or check our website at www.mainepublichealth.gov to confirm that the meeting is on. [return to top]
MMA Endorses "Yes" Vote on Question 4 for Biomedical Research
On November 8, you can vote to improve Maine’s future. The Jobs Bond, Question 4, will create thousands of new jobs in Maine. Good jobs in growing industries like biomedical research. New jobs in construction. Support for small Maine companies with real potential for growth. Jobs in oceanographic research, that in turn will help sustain Maine’s 25,000 fishing jobs...Vote Yes on Question 4 to strengthen Maine’s economy, and create
Jobs for today... Jobs that will stay.
For more information see: www.jobsforahealthymaine.org. [return to top]
WellPoint Posts Higher Profit
On October 26, 2005, Reuters reported that WellPoint, Inc.'s earnings more than doubled for the third-quarter, reflecting the completion of the merger between Anthem, Inc., and WellPoint Health Networks, Inc. Net income rose to $640.7 million, up from $242.1 million for the same quarter last year. Looking at results as if the combined company were in place at the beginning of last year's third quarter, revenue rose 5.6 %. Health plan enrollment rose by 1.5 million members, or 5.6%, compared with the combined enrollment of Anthem and WellPoint Health Networks last year. As of September 2005, WellPoint reported a total of 29 million members. [return to top]