June 19, 2006

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Report on Daniel Hanley Center for Healthcare Leadership Forum
On Friday, June 16, the Daniel Hanley Center for Health Leadership held its annual forum and focused on the question, "Who will pay for quality care?" Noted health economist Stuart Altman, PhD. of Brandeis University facilitated the discussion among about 60 invited guests, including nearly 20 physicians. The Center is named after Daniel Hanley, M.D.(1916-2001) who served as Executive Director of the Maine Medical Association from 1955 to 1979.
The Forum convenes about 60 healthcare leaders from across the state each June to develop strategies to address a major healthcare issue. In 2004, the issue was obesity and in 2005 electronic clinical information sharing.

Following a keynote talk by Dr. Altman, five breakout sessions were held on the following topics:

  • Statewide Quality Agenda
  • Pay for Performance
  • Public Reporting - Transparency
  • HealthInfoNet
  • Reimbursement Demonstration Project

In introducing Dr. Altman, Sheila Hanley called him both a pragmatist and a visionary.  He currently serves as Dean of the Heller School for Social Policy & Management and Sol C. Chaikin Professor of National Health Policy at Brandeis University.  He has held a variety of appointments in government and academia since serving as Deputy Assistant Secretary for Planning and Evaluation /Health at HEW from 1971 to 1976.  For twelve years he served as Chairman of the congressionally legislated Prospective Payment Assessment Commission. In 1977, President  Clinton appointed him to the National Bipartisan Commission on the Futureof Medicare.

Among Dr. Altman's observations:

  • The topic of, "Who will pay for quality care?" intrigued him as normally the quality people don't talk to the payment people.
  • Maine can be, and has been, a laboratory for health care innovation and reform.
  • Dr. Hanley, through his work with Jack Wennberg, M.D.,  provided an important contribution to healthcare policy in this country.
  • Efforts to control healthcare costs nationally have been a colossal failure, with costs increasing from 7.5% of GNP in the early 1970's to 16% of GNP today.
  • The healthcare system has seen a level of unparalleled growth in the past five years, since the demise of managed care.
  • The current rate of growth is not sustainable.
  • Paying for services regardless of their quality does not provide the appropriate incentives.  In what other segment of society do we pay for correcting errors, in theory creating a situation where the more the system does wrong, the more we pay them.
  • Pay for Performance is now generally accepted, with the real debate focusing on how and what to measure.
  • Most good PP programs have some elements which measure process, structure and outcomes.
  • Focusing on the sickest patients, such as chronic disease management, is very important, but it must be lead by physicians.

Following Dr. Alt man's talk, two panels reacted to the presentation with most observers noting that attempts to measure quality are here to stay and that you can't improve what you don't measure.  Nonetheless, there is widespread disagreement about what is "quality?"

There was much discussion regarding whether Pay for Performance necessarily would result in winners and losers or whether a win/win strategy ("a rising tide raises all boats") was possible. 

Perhaps for physicians, the most important items to come out of the day's discussion was the need to standardize the measurements, rather than trying to respond to different  and multiple requests and the need to adjust patient populations for severity of their conditions and illnesses.

A final observation:  There was much discussion about the current reimbursement system not providing appropriate incentives to improve quality and that fee-for-service medicine may have seen its best days in the past.  Quotes heard:

  • "Hooray if fee for service dies.  Fee for service drives the incentives to do more procedures rather than emphasizing preventive care."
  • "Is is systems that provide the best care, not individuals."
  • "No one is trying to provide poor care"
  • "The current legal standard leads us to playing to our safest card.  This will always be more expensive."


Governor to Slow Down Effort to "Manage" Behavioral Health
Acknowledging the importance of including patients and families in the planning, Governor Baldacci agreed on Friday to move back the July 1 implementation of an aggressive managed care program which the legislature had already included in the budget at a savings of  $10.4 million.  With the federal medicaid match, the total savings would be about $30 million.

The Governor's announcement followed a meeting with mental heatlh advocates, including former state legislator Michael Fitzpatrick, who now serves as Executive Director of the well-respected National Alliance on Mental Illness.

The state had intended to issue a request for proposals by July 1 for companies in the business of managing mental health benefits.  The actually contract was expected to begin by January 1, 2007. [return to top]

MMA 15th Annual Practice Education Seminar in Bangor on Wednesday
Spectacular Event Center on Griffin Rd. in Bangor will be the site this coming Wednesday, June 21, of the Association's 15th Annual Practice Education Seminar.  Formerly called the Physician Survival Seminar, this year we have  chosen a less negative title and will present six and one-half hours of CME with a plenary session in the morning and a dozen breakout sessions in the afternoon.   Registration materials were included in your issue of Maine Medicine which should have been received by you last week.  Should you need a copy, just call MMA at 622-3374 and press 0, or register online at www.mainemed.com

The program begins at 8:30am with a keynote presentation by CMS Medical Director Eric Handler, M.D.  Dr. Handler will discuss the CMS quality initiatives.  At 11:00am, MaineCare officials Laureen Biczak, D.O. and Deputy Commissioner and Acting MaineCare Director John Michael Hall will discuss the current situation at MaineCare. The breakout sessions conclude at 4:00pm, although it is expected that the session on technology may go beyond that time. [return to top]

Watch for Annual Session (Sept. 8-10) Materials in the Mail
The Association mailed to all members last week registration materials for the 153rd Annual Session to be held Sept. 8-10 at Saint-Andrews-by-the-Sea in New Brunswick, Canada.  The CME program is entitled, "Medicine in Extreme Environments", and is the most ambitious program MMA has ever presented at an Annual Session.

If your mailing does not arrive, or if you need more registration brochures, just call MMA ast 622-3374, or visit us online at www.mainemed.com [return to top]

States Required to Document Citizenship of Medicaid Beneficiaries on 7/1/06
The federal Deficit Reduction Act of 2005 (DRA) will require states to meet new requirements for documentation of citizenship of Medicaid beneficiaries beginning on July 1, 2006.  CMS recently issued guidelines for states indicating that an affidavit may be used to prove citizenship when other types of documentation are unavailable.  Opponents of the measure claim that it will impose new administrative burdens on Medicaid programs, but proponents point out that the measure could save as much as $735 million over 10 years.

You can find more information about the new requirement, including a CMS fact sheet and letter to the states on the web at:  http://www.cms.hhs.gov/MedicaidEligibility/05_ProofofCitizenship.asp.

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AMA House of Delegates Endorses Health Care Reform Resolution
At the American Medical Association annual meeting in Chicago recently, the House of Delegates approved Resolution 613, a proposal that would put comprehensive health care reform at the top of the AMA's lobbying agenda.  Resolution 613 states that health care reform should include reasonable health insurance for all and should address the "broken" medical liability system, "flaws" in Medicare and Medicaid, and "improving" the physician practice environment.  The House passed this Resolution on June 13, 2006.

On June 14, 2006, the House received a report (Board of Trustees Report 9) urging a moratorium on advertising newly-approved drugs and suggesting guidelines for manufacturers on DTC advertising.  The guidelines include:

  • That advertisements should be indication-specific and enhance consumer education about the drug or implantable device and the disease, disorder, or condition for which the drug or device is used;
  • That advertisements should convey a clear, accurate, and responsible health education message by providing objective information about the benefits and risks of the drug or device for a given indication;
  • That advertisements should indicate clearly that the product is a prescription drug to distinguish such advertising from other advertising for nonprescription products, but should not encourage self-diagnosis and self-treatment, instead referring patients to their physicians for more information;
  • That advertisements should exhibit fair balance between benefit and risk information when discussing the use of the drug or device and should present information about warnings, precautions, and potential adverse reactions associated with the drug or device in a manner such that it will be understood by a majority of consumers, without distraction of content;
  • That advertisements should not make comparative claims for the product versus other products, but should include information about the availability of alternative management options such as diet and lifestyle changes, where appropriate; and
  • That advertisements should be placed so as to avoid audiences for which the ads are not age appropriate.
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IOM Says Emergency Care System Is "Overburdened, Underfunded and Highly Fragmented."
New reports from the Institute of Medicine (IOM) say that insufficient funding and uncompensated care are among several threats to the U.S. emergency medical system. The reports call on Congress to establish a pool of at least $50 million to reimburse hospitals for uncompensated emergency and trauma care. Noting that one ambulance is turned away from an emergency room every minute, the report also recommends that Federal programs revise reimbursement policies to reward hospitals that appropriately manage patient flow and penalize those that fail to do so. It calls on the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) to reinstate strong guidelines to reduce crowding, boarding, and diversion, and the Centers for Medicare and Medicaid Services to convene a working group to develop standards to address these problems. For more information and links to the reports:
http://national-academies.org/morenews/20060614b.html [return to top]

JCAHO Issues 2007 National Patient Safety Goals
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has just issued the 2007 National Patient Safety Goals and related requirements for its accreditation programs and disease-specific care certification program. The goals and requirements apply to the nearly 15,000 JCAHO-accredited and certified health care organizations. Major changes include extending the requirement to define and communicate the means for patients and families to report their concerns about safety. New language in another requirement stipulates that office-based surgery programs provide a complete list of current medications to a patient when he or she is discharged from care. For the full text of JCAHO's 2007 National Safety Patient Goals for each of the Commission's accreditation and certification programs:
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Advisory Panel Urges Universal Health Coverage by 2012
The government should guarantee basic health benefits for all Americans by 2012 even if it means raising taxes, according to a recommendation by the Citizens' Health Care Working Group. The 15-member, nonpartisan advisory group was created by Congress to address health care coverage. The Chicago Tribune says the panel's recommendation is consistent with public opinion polls that support guaranteed health insurance as long as it does not require more than a modest tax increase. If taxes or premiums are substantial, support disappears. Public demonstrations across the country, such as one held by Healthcare-NOW in Pittsburgh this week, call for extending the kind of coverage offered under Medicare to all U.S. residents. The advisory panel recommends protection for catastrophic illness as a near-term goal, and by 2012, a healthcare package that includes preventive care, doctor visits, hospitalization, and prescription drugs. For more information: 
Also see:
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Medicare Drug Benefit Covers 37.5 Million Beneficiaries
Approximately 11.5 million elderly and disabled individuals met the May 15 Medicare drug enrollment deadline, bringing the total number of beneficiaries covered under Medicare Part D  to 38.7 million, reports the Chicago Tribune.  That still means, however that 4 million to 5 million eligible beneficiaries have not signed up for the coverage. Most enrollees chose plans that charged the lowest premiums, an average of $23. For more information: http://www.chicagotribune.com/features/lifestyle/health/chi-0606090121jun09,1,2807708.story?coll=chi-health-hed
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The Coding Center's Coding Tip of the Week
Can a newborn seen for a first office visit be coded as  a new patient E/M code even if a member of our group already saw the newborn in the hospital?
CPT defines a new patient as "one who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group practice, within the past three years."
If the member of your group who saw the newborn in the hospital is of the same specialty as the physician seeing the newborn in the office, then the office visit is for an established patient. If the physicians are of different specialties, such as a pediatrician in the hospital and a family physician in the office, then the visit could be  considered new.

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

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