February 13, 2006

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Governor Baldacci to Speak at AMA Advocacy Conference in March
Governor John Baldacci has been asked to speak at the American Medical Association annual Advocacy Conference in March in Wahington, D.C. The Governor will be featured in a segment on the topic of covering the uninsured. He is the only Governor invited to address the anticipated group of about 300 physicians from around the country but he is expected to be joined by other speakers from the United States Senate and the House of Representatives.
The Governor is expected to discuss his Dirigo Health initiative, a program he has vigorously defended despite increasing criticism from the business community and health insurers.  The program consists of several components, the most controversial of which is the health insurance product offered by Anthem through a contract with the state.  Enrollment in the product is currently closing in on 10,000 persons.

MMA President Jacob Gerritsen, M.D., President-elect Kevin Flanigan, M.D. and Executive Vice-President Gordon Smith will all attend the Advocacy Conference and will meet with members of Maine's Congressional delegation before leaving Washington D.C.  High on the agenda will be the need to advocate for changes in the sustainable growth rate formula which controls physician payments under Medicare.  Without a change in the formula, physician payments will be reduced again in 2007.  Despite the restoration of the proposed 4.4% reduction which took effect on Jan. 1, 2006, the Congressional action was for one year only.  The significant dollar amount associated with any change in the sustainable growth rate formula is a significant barrier to a long-term, multi-year fix.

Dirigo-related Bills Currently Before the Legislature
The Joint Standing Committee on Insurance and Financial Services voted unanimously on Thursday to postpone consideration of L.D. 1845, An Act to Increase Access to Health Insurance Products after the sponsors of the bill asked for more time to work with Baldacci administrative to work out details of the proposal.  The bill would allow the Dirigo Health Agency to establish its own insurance company, without the need for further legislative action or oversight.  The Governor made note of the need to study such a possibility in his State of the State address in January.

At the hearing on the bill earlier this past week, Dirigo Board Chair Robert McAfee, M.D., presented the Agency's testimony in favor of the legislation.  The bill was strongly opposed by business interests, health insurers and the Maine Hospital Association.  MMA testified in the "neither for nor against" category noting that the Association's ad hoc Committee on Health System Reform is continuing to look at comprehensive reform and the Association is reluctant to take a strong position on the proposal until the work of the Committee is completed and approved by the membership.  The bill was supported by consumer interests.

On this coming Tuesday, Feb. 14, L.D. 1935, An Act to Protect Health Insurance Consumers, sponsored by Sen. John Martin, would prohibit insurance carriers from passing along the cost of the Savings Offset Payment (SOP) onto premium payors.  The MMA will again testify  "neither for, nor against" the bill but will offer comments on it.  Concern will be expressed that if the offset payments are not passed on to premium payers, the health insurance carriers will be under pressure to recoup them from providers.  With less than 10,000 enrollees in DirigoChoice, any savings to physicians as a result of the reduction in bad debt and charity care have been modest at best.  Therefor, it would be inappropriate for the carriers to try to recoup any of the payment from physicians.

Virtually any issue involving the Governor's Dirigo health initiative quickly becomes mired in partisan politics and constant bickering between business interests, the health insurance lobby, consumer organizations and others.  It is unlikely that progress can be made until the election process is completed later this year. [return to top]

Maine Quality Forum Advisory Committee Met on Friday, Feb. 10
The Maine Quality Forum Advisory Committee met in Augusta on Friday and heard a presentation on the current status of the Certificate of Need process from staff to the Licensing and Certification division.   The Forum has a role in the CON process under the Dirigo legislation, consisting of reviewing applications and commenting to the Commissioner on any quality issues.

The Committee also heard updates on the DirigoChoice product and reports on various Forum activities from Executive Directive Dennis Shubert, M.D.

Dr. Shubert reported briefly on the anticipated collaboration among the Forum, MMA and the Maine Osteopathic Association on a medical practice self-assessment project.  MMA's Committee on Peer Review and Quality Improvement will meet on Feb. 28th at 4:00pm to review a proposal and budget expected to be submitted to the state by early March. It is hoped that perhaps as many as 100 primary care practices would complete the self-assessment tool during the period of the contract.  The results of such assessment will be confidential by law, although de-identified aggregate data may be submitted to the state for information purposes. [return to top]

MMA Payor Liaison Committee to Meet this Thursday (Feb. 16)
MMA's Payor Liaison Committee will meet this Thursday at 6:30pm (dinner at 6:15) to continue its discussion of the tiered specialty networks announced and implemented by both Cigna and Aetna.  Cigna Regional General Manager Richard "Skip" White will attend the meeting.  An update will also be provided on MaineCare.  The meeting will be held at the Association offices in Manchester.

The purpose of the Payor Liaison Committee is to meet regularly with representatives of health plans, Medicare and MaineCare in order to keep open the lines of communication between Maine physicians and the payor community.  The Committee is chaired by Thomas Hayward, M.D. who practices family medicine in East Corinth and is President of Sunbury Primary Care. [return to top]

Bush Budget Seeks Savings from Medicare
President Bush released his 2007 budget last Monday and it contains nearly $40 billion in Medicare savings over the next five years.  Most of the proposed savings comes from slowing the growth of payments to hospitals and home health agencies.  While there are no cuts proposed in physician payments, the budget does not include the positive physician payment update recommended recently by the Medicare Payment Advisory Commission (MEDPac), a bipartisan panel of experts that makes Medicare policy recommendations to Congress.

Elsewhere, the $2.7 trillion budget asks virtually every domestic agency except Homeland Security to operate at or below current budget levels.

MEDPac recommended reducing payments to hospitals for both inpatient and outpatient care by about one-half of one percent below scheduled inflation adjustments.  The Commission also recommended freezing payments to nursing homes and long-term care facilities. [return to top]

Orthopedic Surgeons and Anesthesiologists Hold Successful Meetings this Past Weekend
Both the Maine Society of Orthopedic Surgeons and the Maine Society of Anesthesiologists met this past week in separate meetings at the Grand Summit Hotel at Sugarloaf.

On Thursday at 5:00pm, following CME presentations as part of the Contemporary Issues in Orthopedic Surgery conference, the MSOS held its twice-yearly business meeting and heard reports from officers, the ASOS delegate and MMA EVP Gordon Smith.  The approximately 20 members present were interested in the issues of tiered networks by payors, workers compensation, Dirigo Health and professional liability.  Thomas Murray, M.D. of  Orthopedic Associates in Portland is the current President of the Society and chaired the meeting.

On Saturday, the Maine Society of Anesthesiologists met and heard a presentation from Lisa Percy, M.D. from the Washington D.C. office of  the American Society of Anesthesiologists. Cynthia Jensen, M.D. of Waterville is the current President of the MSA and chaired the meeting.  Maroulla Gleaton, M.D., an Augusta Ophthalmologist who chairs the Maine Health Access Foundation gave an after-dinner talk on the current activities of the Foundation.  Richard Flowerdew, M.B.B.S., ASA delegate was recognized for his 15 years of MSA and ASA leadership.  Dr. Flowerdew and the Society are passing that role on to Christopher Cary, M.D., also of Portland.

In March, meetings will be held at Sugarloaf of radiologists, ob-gyns, and ear, nose and throat specialists.  Information on any of these meetings may be obtained by calling MMA at 622-3374. [return to top]

Dr. Mills Leads Briefing on State Pandemic Flu Preparations
On Wednesday, February 8, 2006, representatives of the Maine CDC, the Maine Department of Agriculture, and the Maine Emergency Management Agency held a briefing at the Senator Inn in Augusta for approximately 80 stakeholders on the State's plan for responding to a potential influenza pandemic.  Maine CDC Director Dora Mills, M.D., M.P.H. opened the meeting and presented a history of flu pandemics and the history of pan flu planning in Maine.  Maine CDC Deputy Director Paul Kuehnert, M.S., R.N. provided a summary of a Summit on Sub-State Influenza Preparedness held on December 14, 2005.  Don Hoenig, DVM, gave an overview of avian influenza on behalf of the Department of Agriculture.  Department of Defense & Veterans' Affairs Commissioner General Libby made it clear that the Governor would be responsible, with advice from Dr.  Mills, for supervising the State's response to an influenza pandemic. 

The speakers described the roles of the key state agencies as follows:

  • Maine CDC:  The Maine CDC is responsible for protecting the public's health, including detecting and controlling the introduction and spread of contagious diseases among Maine people, and with developing public health emergency response plans.
  • Maine Department of Agriculture:  The Maine Department of Agriculture is responsible for controlling the introduction and spread of contagious diseases among livestock and poultry, and with developing emergency animal disease response plans.
  • Maine Emergency Management Agency:  The MEMA is responsible for coordinating the state's overall response to any emergency or disaster, including development of the state's all-hazard emergency plan, and for coordinating emergency preparedness, response recovery and mitigation efforts with business and volunteer groups as well as emergency managers and responders at state, federal, county, and local levels, in other states, and Canadian provinces.

The State has called this group the Maine Statewide Pandemic Influenza Advisory Committee (SPIAC) and plans to bring the group together again after a national pandemic flu exercise in which Maine participates scheduled for May 4th and 5th, 2006.  The MMA's Public Health Committee will participate in this group. 

Maine expects to receive approximately $800,000 in federal funding for pan flu preparations.

You can find more information about the State's preparations for a potential flu pandemic on the Maine CDC web site:  http://www.maine.gov/dhhs/boh/pandemic_flu_info.htm

If you would like to participate in the stakeholder group, please contact Charyl Smith, Legislative Assistant, at csmith@mainemed.com and she will ensure that you are added to the list. [return to top]

MMA Annual Physician/Practice Management Seminar to be Held Wednesday, June 21 in Bangor
Spectacular Event Center in Bangor will, once again, be the site of the MMA Annual Physician/Practice Management Seminar.  The program will be held on Wednesday, June 21, 2006 from 8:30am to 4:00pm, with registration and breakfast being available at 8:00am.  This year's program will be presented only once, unlike past years, and Bangor was chosen because of its central location to most of the practices in the state.  In the past years, more practices attended the Bangor program than other locations in the state.  This program gives MMA staff and outside presenters a unique opportunity to present to physicians and practice managers the practical information one needs to know to manage a medical practice in Maine today and in the future.

The Maine Health Alliance will co-sponsor  the program this year and will assist in marketing the program  to its member physicians in Northern and Eastern Maine.

A brochure with a detailed agenda will be included with the March-April issue of Maine Medicine and the registration materials will also be mailed to all past attendees.

Topics this year will include pay for performance, compliance, quality improvement, practice assessment, MaineCare, Medicare, prescription drug monitoring and a legal/legislative update.  More presenters and topics will be announced by the end of February.

If you wish to reserve a space now, e-mail Gail Begin at gbegin@mainemed.com or call MMA at 622-3374. [return to top]

Maine Association of Psychiatric Physicians to Hold Psychiatrists' Day at the Legislature on Thursday
The Maine Association of Psychiatric Physicians will hold its Psychiatrists' Day at the Legislature this coming Thursday, Feb. 16. Psychiatrists from around the state are expected to attend and interact with legislators on a host of issues of issues involving behavioral health.

As part of the day's activities. the Association is holding a "Unused Pharmaceutical Return" event, encouraging legislators and state house staff to bring in their unused medications for proper disposal.  Pharmacists and law enforcement will be present to assist.  The State of Maine, urged by MMA's Public Health Committee, the Psychiatric Association and other public health interests, has been a leader nationally in urging the establishment of sanctioned medication return programs.  Such programs help preserve the environment by preventing the entry of the medications into the waste stream.

For more information on the event, call Warene Chase-Eldridge at MMA at 622-3374 or via e-mail to weldridge@mainemed.com. [return to top]

The Coding Center's Coding Tip of the Week
Use of Modifier 78: Return to the Operating Room for a Related Procedure During the Postoperative Period--Modifier 78 is used for a return trip to the operating room for a related surgical procedure during the postoperative period of a previous major surgery. Reimbursement may be reduced, since pre and postoperative care is included in the allowance for the prior surgical procedure.

Note:An “operating room” is defined as a place of service specifically equipped and staffed for the sole purpose of performing surgical procedures. The term includes a cardiac catherization suite, a laser suite, and an endoscopy suite. It does not include a patient’s room, a minor treatment room, a recovery room, or an intensive care unit unless the patient’s condition was so critical that the patient could not be moved to the operating room.

Questions? Call the Coding Center: 1-888-889-6597 [return to top]

HIPAA Training for Your Staff (new or experienced) on Friday, April 14, 2006
Federal law requires each medical practice to update its staff on HIPAA regulations annually and to train new staff.  MMA will present a training session for office staff as one of its "First Fridays" CME programming.  The program will be held from 9:00am to noon on Friday, April 14, 2006 at the MMA offices in Manchester.  Discounts are available for multiple attendees from the same office. Note that this particular program is being held on the second Friday of the month, rather than the usual first Friday (because of speaker availability).

This program, presented by experienced HIPAA attorneys, is a good opportunity for a practice to meet its annual HIPAA obligations.

You may register for the program on the MMA website at www.mainemed.com (print out the registration form and fax it to us or mail it) or call for a registration form (622-3374). [return to top]

Insurance Committee Hears Bill to Permit Dirigo Board to Consider DirigoChoice Alternatives
The Dirigo Health Program and health care reform top the legislature's health care agenda last week and this week as a series of bills are up for public hearing or work session - L.D.s 1845, 1935, and 1945.

On Tuesday, February 7, 2006, the Insurance & Financial Services Committee held a public hearing on L.D. 1845, An Act to Increase Access to Health Insurance Products, a bill that would allow the Dirigo Board to consider alternatives to providing DirigoChoice coverage through Anthem Blue Cross Blue Shield of Maine, such as through a new state-sponsored health insurer or through an existing state program. 

For more on this topic and others of interest to MMA members, read the Political Pulse, published electronically every week during the legislative session. [return to top]

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