July 31, 2006

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Advisory Council on Health Systems Development Promoting State Health Plan

The Advisory Council on Health Systems Development, created in the Dirigo Health legislation, met on Friday (July 28) and discussed plans to expand public awareness of the State Health Plan that was developed by the Governor's Office of Health Policy and Finance earlier this year.  The Council reviewed a power-point presentation developed by staff which is intended to educate Maine's citizens about what the State Health Plan is, why it exists, how it was created and who is responsible for implementing it.  The presentation will be used by Council members in meetings around the state with stakeholders and the general public.

The Plan is part of the broader Dirigo Health Reform effort to address cost, quality and access problems.  The presentation offers an explanation of cost drivers and data to elaborate on those problems.  It also explains that the Plan contains steps to be taken by multiple players - including providers, public health groups, payors, employers, and consumers - not just state government.  The presentation contains one slide for each chapter of the Plan, explaining specific actions to be taken by different parties over the course of the two years covered by the Plan.  The plan concludes with specific benchmarks that will be used to assess progress towards the Plan's goal - becoming the health state in the nation.

The benchmarks set out actions to:

  • Do more to prevent illness and disability to improve health
  • Help people with chronic disease improve the care they get
  • Make sure we have the health care workforce and services we need - but not more than we need
  • Make sure rural Maine can access the services of urban Maine through improved telemedicine and a strong system of rural health
  • Improve quality and safety by reducing variation in the delivery of health care services.

To read the State Health Plan, visit www.dirigohealth.maine.gov or contact the Governor's Office of Health Policy and Finance at 207-624-7442 or gohpf@maine.gov.

Annual Session Reservations to Hotel Should be Faxed or Telephoned

Because of delays associated with mail getting into Canada, MMA recommends that members and guests making reservations for the Annual Session either fax their reservation to the Algonquin at 1-506-529-7162 or telephone the hotel at 1-800-441-1414.  The room block expires in early August so make your reservation soon.

The meeting will be held Sept. 8-10 and offers six hours of Category 1 CME.  The topic of the conference is "Medicine in Extreme Environments" and features former NASA astronaut and surgeon Story Musgrave and New Orleans surgeon  and former MMA President  Donald Palmisano, M.D.  [return to top]

Medicare Providers Should Plan Ahead for No-Pay Period in September

The Centers for Medicare & Medicaid Services have announced that a brief hold will be placed on Medicare payments for all claims during the last nine (9) days of the federal fiscal year, Sept. 22-30. All claims held during this time will be paid Oct. 2.  No interest or late penalties will be paid during this one-time hold period mandated by the Deficit Reuction Act of 2005.

The policy applies only to claims subject to payment, not to full denials, no-pay claims, and other non-claim payments such as periodic interim payments, home health requests for anticipated payments and cost report settlements. 

For further details see www.cms.hhs.gov/MLNMattersArticle/downloads/MM5047.pdf. [return to top]

Physician Payment Overhaul - Tom Allen Statement

Tackling the Impossible? Lawmakers Address Physician Payment Overhaul

By John Reichard, CQ HealthBeat Editor

July 25, 2006

To get out of a swamp you've got to start walking, and if nothing else, House lawmakers mired in the issue of overhauling Medicare physician payment spent a few hours pickin' 'em up and puttin' 'em down Tuesday.

Getting out of the muck may seem impossible - the Medicare payment formula has cuts of about five percent per year lined up for nine years. But replacing them with a modest yearly payment increase that reflects the rising expense of delivering physician care would cost the federal government $218 billion over 10 years, according to the Congressional Budget Office (CBO).

Nevertheless, Texas Republican Joe Barton, the chairman of the committee, which shares jurisdiction over the issue with the Ways and Means Committee, emphasized at a hearing Tuesday that he does not want to delay dealing with the matter.

"I want to reiterate: I think it is possible to fix the system, and I think it's possible to fix it in this Congress, which means, in the next two months," Barton said at a hearing by the House Energy and Commerce Health Subcommittee.

But Barton and other lawmakers remain perplexed about which direction to go. There's bipartisan agreement that the Sustainable Growth Rate (SGR) formula must be scrapped, but no agreement on how to pay for doing so.

Yet Tuesday's hearing may have marked progress of sorts, not only because lawmakers were at least talking about the seemingly intractable issue, but that they actually offered some ideas for a down payment on a long-term fix.

Offering a road map on the issue - and looking to start making his mark on health policy - was Rep. Michael C. Burgess, R-Texas, an obstetrician-gynecologist elected to Congress from the Forth Worth area in 2002. Burgess introduced legislation (HR 5866) on Monday that would erase the scheduled payment cuts while arming Medicare beneficiaries with more information on the quality of physician care.

The conservative Republican is no booster of government health care, but his proposal is solidly in line with the recommendations of Washington's health policy establishment. The bill would replace the SGR with an increased payment each year based on the change in the Medicare Economic Index (MEI) calculated by the Centers for Medicare and Medicaid Services to track changes in the cost of delivering physician care.

The Burgess bill would lower the MEI by one percentage point, which in 2007 would mean a payment increase of 2.7 percent. The Medicare Payment Advisory Commission (MedPAC) has called for an update based on the MEI, forecast to be 3.7 percent in 2007, minus an adjustment of 0.9 percent to reflect improved productivity in delivering care, for a total increase of 2.8 percent.

The Burgess bill also would enact recommendations by the Institute of Medicine to improve Quality Improvement Organizations (QIOs), which contract with Medicare to improve quality of care under the program. The bill would make the quality improvement activities of QIOs available to all providers, guarantee a minimum of funding for QIOs; and require a review of their resources when the organizations' duties are expanded, among other measures.

The bill also would establish a system of quality measures in which doctors would voluntarily report data on the quality of their care.

"Patients could assess the level of quality their prospective doctors are achieving and decide which doctor they would prefer," Burgess said.

Burgess said in an interview Tuesday that he is awaiting scoring from the CBO on the cost of his bill and declined to offer his own estimate. The savings on the cost of the bill that could be obtained by subtracting one percentage point from the MEI each year would be "speculation," Burgess said

Burgess would pay for the measure in part by ending the stabilization fund established by the Medicare overhaul law (PL 108-173) to ensure the availability of regional managed care plans in Medicare. He also would end a system of "double payment" for certain medical education expenses by taking them out of payments to managed care plans.

But those two steps would fall well short of paying for the bill.

Rep. Tom Allen, D-Maine, also said he supports trimming payments to managed care plans as a way of paying for revising physician payment. He said that according to a CBO estimate, reducing "overpayments" to managed care plans would save $63 billion over 10 years.

Energy and Commerce Health Subcommittee Chairman Nathan Deal, R-Ga., said in an interview after the hearing that discussion of "pay fors" is a positive step. "These are all things we need to look at," he said.

Deal stopped short of endorsing the Burgess bill, however. "I certainly support moving forward" on the physician payment issue, and the proposal "starts the discussion," he said.

The American Medical Association (AMA) called the bill " a major step toward ensuring health care access for seniors." The American Health Quality Association, which represents QIOs, likewise urged enactment of the bill.

"At the heart of the problem is the government's severely flawed Medicare physician payment formula that defies logic and ignores economic reality," said AMA Board Chairman Cecil B. Wilson.

Goading Congress to act sooner rather than later is that its recent pattern of enacting one-year "fixes" to prevent cuts that otherwise could occur under the SGR becomes more costly each year.

To control the volume of physician care, the SGR sets a target each year for Medicare spending on doctors' services. If actual spending exceeds the target, "excess spending continues to accumulate until it is recouped by reduced updates," MedPAC noted in its testimony. "To work off this excess, according to Medicare trustees, the SGR will call for cuts of five percent every year for nine years," MedPAC said. But even as the cost of payment fixes rise, it's highly unlikely Congress will muster the will to act sooner than later on a complete overhaul. Most, if not all, analysts are predicting another short-term fix this year. Asked about the possibility of a markup this year of a payment overhaul, Deal smiled and while not ruling out the possibility this year, also suggested that it might have to wait until early next year.

Statement from Rep. Tom Allen:

Energy and Commerce Committee Subcommittee on Health
 “Medicare Physician Payment: How to Build a More Efficient Payment System”
July 24, 2006

Thank you, Mr. Chairman for convening this hearing to examine the Medicare physician payment system and the impact that future reductions to the Medicare payment rate will have on patients’ access to care.  

The Budget Reconciliation law contained a provision to freeze Medicare physician payments at the 2005 rates, averting a scheduled 4.4 percent reduction in payments.  While this action halted the fall in payment rates for this year, unless Congress fixes the current reimbursement formula, physicians can expect a 26 percent decline in payments over the next 6 years.  By 2013, Medicare payment rates will be less than half of what they were in 1991 after adjusting for practice cost inflation. 

We need to replace the current formula with one that more fully accounts for physicians’ practice costs, new technology, and the age and health status of the patient population being served. 

Physicians are the only "providers" subject to the Sustainable Growth Rate (SGR) formula.  Every other provider in Medicare gets increased payments based on their increased costs. 

Insufficient payment hurts rural states like Maine particularly hard, because they have a disproportionate share of elderly citizens and patients have limited access to physicians, particularly specialists. 

We have two challenges facing us today:
1) can we agree on how to fix the problem of negative payment updates and 2) how to pay for it? 

The burden of fixing this payment formula should not fall on the shoulders of Medicare beneficiaries whose Part B premium has increased almost $12.00 this year to $78.20 a month.  Next year it goes up a full $20.00 to $98.20 a month.  This increase comes at a time when many beneficiaries will be facing an increased financial burden if they fall into the “donut hole” gap in drug coverage. 

Moreover, savings must not be squeezed from providers thru hastily designed and enforced “pay for performance” targets.

I hope that our panelists can help us to understand the flaws of the current payment system and how to ensure that Medicare patients across the U.S. have access to their doctors. 
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Compounding Pharmacies Offer Physicians Options

Pharmacist.  When most people hear that word they instinctively think of mortars and pestles.  However, when you go to your local Rite Aid or Hannaford’s you will be hard pressed to see these being used to compound medication.  In fact, only 1% of all prescriptions in the United States need to be compounded.  Therefore, many pharmacies don’t even offer compounding as a service.  Many of my former classmates have asked me why I bother to compound at all.  My response is rather simple, “I compound because it provides a service to patients that would otherwise be overlooked.”

At my pharmacy we still use mortars and pestles.  We also use electronic balances, ointment mills, an unguator, and a USP <797> certified clean room with an ISO 5 laminar flow hood.  As specialists, we employ a variety of techniques and equipment to ensure quality in every compound we prepare.   We work directly with physicians to formulate each prescription for the individual needs of the patient.

I have traveled extensively throughout New England speaking to physicians about my work and how we can work together to optimize therapy.  Invariably, I’m asked for examples of compounded products and their uses.  Pediatric dosing is a frequent request we receive from physicians.  We regularly compound captopril and atenolol solutions for infants being discharged from the hospital.  These patients require doses that are not manufactured commercially, yet they need these medications to survive.  Through extensive research we’ve formulated preparations that are stable enough to be dispensed and stored at home for up to 60 days. 

Recently we were contacted by a physician who was having trouble with the medication for an epileptic child.  She told us that the boy, who also suffers from Autism, would not take his medications.  Being just four years old he couldn’t swallow tablets or capsules and she requested that we compound his pyridoxal-5-phosphate into an alternative dosage form.  We were able to formulate the medication into a fruit-flavored suspension.  I followed up with the boy’s mother and she said that after 5 days of treatment she noticed a remarkable improvement in her child’s seizure activity.

Medical literature is the source of many of our requests.  There are preparations that are frequently discussed in the literature and have shown to be effective treatments but there is no commercially available source for them.  Some of the more popular preparations include Nifedipine 0.2% Ointment for anal fissures, Progesterone Suppositories and Injections, and Lidocaine Nasal Spray for migraine headaches.  We also receive requests from physicians for bio-identical hormone replacement therapy and ways to achieve the best outcomes for their patients.

Drug manufacturers have done a wonderful job over the past forty years providing research and pharmaceutical products to the vast majority of Americans seeking care.  Unfortunately there are patients that need alternatives and other options.  Utilizing a compounding pharmacy can help physicians with those options to ensure their patients don’t fall through the cracks.  My door is always open and I’m always eager to brainstorm with physicians.

David Rochefort, Compounding Pharmacist
Northern New England Compounding Pharmacy
262 Cottage Street; Suite 116
Littleton, NH  03561
P  603-444-0094
F  603-444-0095 [return to top]

Maine CDC Avian & Pandemic Flu Newsline New Issue Available

Visit Maine CDC's new website featuring specialized sections for businesses, individuals, families and health care workers: www.MaineFlu.gov


September 20, 2006 The Maine State Government (five agency) Avian and Pandemic Influenza Preparedness Steering Committee is planning an Avian and Pandemic Influenza Summit at the Augusta Civic Center on Wednesday, September 20th.  Please mark your calendars!    For more information contact Sue Dowdy at the Maine CDC at sue.dowdy@maine.gov. [return to top]

Revenue Surges 27% at WellPoint (Anthem)

Revenue  at  WellPoint Inc. surged 27% to $14.2 billion in the second-quarter, creating net income for the period of $751.2 million or $1.17 per share.  Net income for the same quarter a year ago was $559.4 million or 90 cents per share.  Executives of  the company credited the increased revenue to more premium and administrative fees.  The company has also benefited from its December 2005 acquisition of WellChoice, Inc.

WellPoint is the corporate parent of Anthem Blue Cross Blue Shield of Maine which is the state's largest insurer.

In Maine, Anthem increased the conversion factor by only 1% July 1, after previous increases of 3% in 2004 and 2005.  In response to MMA inquiries about the very modest increase, Anthem officials in Maine indicated that provider reimbursement rates in Maine and in the Northeast generally were in excess of what WellPoint is paying in other states. [return to top]

Are You Working To Prevent Prescription Drug Abuse?
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IOM Issues Report on Preventing Medication Errors

According to a new report from the Institute of Medicine (IOM), medication errors are among the most common medical errors, with an average of one medication error per hospital patient per day--at least 1.5 million each year.  At least 400,000 preventable drug-related injuries occur each year in hospitals, resulting in at least $3.5 billion in extra medical costs. Costs related to errors do not take into account lost wages, productivity and other costs. To reduce the number of errors, the IOM recommends: more effective communication and interaction between healthcare professionals and patients; guidelines for patients to increase their knowledge of medication usage; consumer-friendly drug information from pharmaceutical companies to address labeling and packaging issues and confusion caused by similar drug names (accounting for 25 percent of all errors); studies to evaluate the impact of free drug samples on medication safety; and implementation of electronic prescribing by 2010. For a summary of the report:
[return to top]

Senators Support Increased Medicare Payments to Physicians

To prevent Medicare physician reimbursements from being reduced by almost 5 percent on January 1, 2007, 80 U.S. senators recently sent a letter to Senate Majority Leader Bill Frist (R-Tenn.) and Senate Minority Leader Harry Reid (D-Nev.) seeking congressional approval of an increase in Medicare physician reimbursement before adjournment in October. The letter notes an American Medical Association survey indicating that 45 percent of physicians would accept fewer Medicare beneficiaries and 43 percent would accept fewer Tricare beneficiaries as patients if reimbursements were decreased.  For more information:
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MMA PAC Trustees Interview 1st Congressional District Candidate Curley

On Tuesday, July 25, 2006, the trustees of the Maine Physicians Action Fund (MPAF), the MMA's political action committee, interviewed Maine House member Darlene Curley (R) of Scarborough who is challenging Congressman Tom Allen (D) for Maine's 1st District seat in the U.S. House of Representatives.  Ms. Curley is a nurse and business woman who is serving her second term in the Maine House where she has sat on the Health & Human Services Committee & the Appropriations & Financial Affairs Committee.  You can find more information about Ms. Curley & her campaign on the web at www.curleyforcongress.com

The MPAF trustees will interview Tom Allen on Thursday, August 24, 2006 at 6 p.m. at the MMA offices in Manchester.  Any interested member is welcome to attend.  Please contact Charyl Smith, Legislative Assistant, at csmith@mainemed.com to RSVP. 

In Maine's 2nd Congressional District, Congressman Mike Michaud (D) faces Scott d'Amboise (R) of Lisbon.

Following the interview with Congressman Allen, the trustees will make an endorsement recommendation in the 1st & 2nd District races to the AMA's political action committee, AMPAC. 

At the meeting on July 25th, the trustees also reviewed the candidates for the 186 seats in the Maine legislature & considered eligible candidates for contributions. [return to top]

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