September 4, 2006

 
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MMA Members to Consider Ten Resolutions at this Week's Annual Session

Ten Resolutions have been submitted for consideration at this week's 153rd Annual Session being held in St. Andrews, New Brunswick.  The ten resolutions, which address a variety of public health and practice issues, may be reviewed in their entirety at the Association's website at www.mainemed.com (look under the Spotlight section).  Speakers at the meeting (six hours of CME) include former NASA astronaut Story Musgrave, M.D., former AMA President Donald Palmisano, M.D., J.D., Dora Mills, M.D., MPH and DHHS Deputy Commissioner J. Michael Hall.  Guests will be attending from California, Louisiana, Ohio, New Hampshire, Virginia, Illinios, Washington D.C and New Brunswick, Canada.  A few rooms at the Fairmont Algonquin Hotel are still availble for those members wishing to attend.  Reigstration is also available at the Association's website.  Hotel reservations are available by calling 1-800-441-1414.

 

Jacob Gerritsen, M.D., of Camden, current President of the Association will preside over the 153rd Annual Session, the first such meeting having been held back in 1853!  In-coming President Kevin Flanigan, M.D., of Pittsfield wil receive the gavel from Dr. Gerritsen on Saturday evening as part of the festivities.  Saturday night will also feature the fourth presentation of the annual Mary Floyd Cushman, M.D. Humanitarian Awards to physicians who have performed exemplary volunteer service.

At the Saturday morning general membership meeting, Moderator Thomas Hayward, M.D. and Vice-Moderator William Strassberg will preside over consideration of the ten resolutions as well as the handling of bylaw amendments, a proposed budget for 2007 and a nominating committee report.  Dr. Mills and Deputy Commissioner Hall will address the members on Saturday morning, as will Terrance Sheehan, M.D., President of Medical Mutual Insurance Company of Maine.  Dr. Sheehan will present an update on medical liability in Maine and on the status of the company.

The Annual Meeting provides an opportunity to not only share time with professional colleagues but to also participate in the governance of your professional association.  It is not too late to make plans to attend.  We would love to see you.

MaineCare to Pilot Management of High Cost Enrollees in Care Coordination Pilot Program

The Office of MaineCare Services has contracted with a Phoenix, Arizona firm to help manage the medical care provided to 300 of the highest cost MaineCare enrollees.  The project will be voluntary and neither enrollees or providers will be required to participate.

The healthcare management and consulting firm of Schaller Anderson, Inc. is the contractor and representatives of the firm provided an informational presentation to provider representatives last Wednesday (8/30) in Augusta.  Schaller Anderson is a privately owned company which manages care for over 1.1 million persons in seven states.  The firm has already hired a group of nurses to work in the project and plans to hire a part-time medical director within the next few months. 

The project involves "managing" the care of the high cost enrollees by providing case managers to work with the assigned primary care physician.  These care coordinators will provide assistance utilizing a case tracker system.

The enrollees will generally be individuals with chronic conditions who are currently costing between $20,000 and $100,000 per year for whom such coordination would provide the greatest potential benefit.  Potential participants in the pilot phase will receive a letter from OMS and then a phone call from representatives of the contractor.  If the patient is interested in participating, they will be assigned a care manager and acheduled for an initial in-home assessment.  Based upon this assessment, the contractor will select a provider and care level (see next paragraph).    Either the patient or the provider may challenge the assignment.  Providers may receive additional compensation for taking on said patients in the Project, although a final decision on that issue has not yet been made.   Providers must agree to participate in the program before a care level is assigned to them.

There are three levels of Care Assignments in the project.  Level 1 requires that the medical provider maintain an electronic medical record or a registry used to track key quality of care outcomes for the targeted conditions and to regularly monitor quality of care delivered.  The provider will provide all tasks as specified, use evidence-based guidelines and use the contractor for all care management/coordination activities for the member.  Level 2 requires all the level one items and must provide some care management such as ensuring members are seen for appointments to care for their chronic disease rather than simply for episodic symptom based care.  The provider will explain to the member evidence based care guidelines for the member's condition, and distribute and explain written materials approved by the Office of MaineCare Services and as required for member's condition.  Level 3 involves all of the above and in addition, the provider will use the registry to identify sub-populations of patients who would benefit from proactive care, and will provide all care managment and/or coordination activities (meaning the selected contractor will collect data and monitor the activities of the provider only)  that result in better health and functional outcomes for the members as well as behavioral change.

The Muskie School of Public Policy at USM has been retained to evaluate the project at six month intervals.  If the pilot is successful,  the program may be expanded to additional patients.

Because of the small number of initial participants (300),  any single physician would be unlikely to have more than 3 or 4 patients in his or her practice who would be in the project.  Contact with MaineCare enrollees will begin the week of Oct. 2.

For MMA members or office staff interested in more information on this Project, there is a 36 page power point presentation that can be e-mailed to you or is available in hard copy.  If you are interested in this document, contact Gordon Smith at gsmith@mainemed.com.

 

 

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Andrew MacLean Running for Mayor of Gardiner in November

MMA Deputy Executive Vice President and General Counsel Andrew MacLean recently announced his candidacy for the office of Mayor of Gardiner, Maine.  Andrew has lived in Gardiner for several years and has served as Chair of the Downtown Development Committee.  Brian Rines, PhD., has served as Mayor for the past 14 years but is giving up the post to seek a seat in the State Senate.

The position is not a full time position and Andy will continue his current position at MMA if elected.  Any members interested can contribute to Andy's race, which is non-partisan, with checks being written to the Committee to Elect MacLean Mayor and mailed to his home at  72 Kingsbury St., Gardiner, Maine 04345. [return to top]

A Brief Reminder of MMA Services, Products and Programs

As MMA continues to try to improve communications with members and non-members alike, we continue to discover that even our most involved members are often not aware of some of the products and services the Association offers.  We will begin soon to highlight a program or benefit in each issue of  Maine Medicine and Maine Medicine Weekly Update, but what follows is a brief listing of some of the benefits and programs members and staffs may not be familiar with.

Review of employment contracts or provider agreements (modest charge of $250 for members)

Medical staff bylaws reviews.

Instantaneous access to information relevant to your practice through access to the MMA website at www.mainemed.com.

Work with physicians impaired by substance absue, mental illness or infirmity, through the Physician Health Program.

External Peer Review, offered through the Committee on Quality Improvement and Peer Review.

Accreditation of 28 sponsors of CME through the Committee on Accreditation and CME.

Low interest loans to Maine residents in Medical School, through the Maine Medical Education Foundation, offered through the Committee on Loan and Trust Administration.

Services of 85 vendors and firms offered through the Corporate Affiliate Program

Weekly e-mail newsletter sent electronically to all members and practice managers for whom MMA has an e-mail address.

Weekly e-mail of relevant newsclips through the Maine Medical Association  "News Scan".

Six issues yearly of  Maine Medicine

Coding and Reimbursement Advice offered through The Coding Center

Bi-monthly meetings of the Physician Practice Management Forum, a group of practice managers of hospital-owned practices.

Monthly offerings of CME and Practice Education seminars through "First Fridays" offered at MMA in Manchester the first Friday morning of each month.

Yearly Physician Practice Management Seminar

Publication of Physician's Guide to Maine Law (new edition expected on MMA website this Fall!)

MMA does a lot.  We encourage you to take advantage of these services and programs.

 

 

 

 

 

Accreditation of CME Offe

 

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Update on Pathways to Excellence, 2006

What follows is an update on the Pathways to Excellence Project, a Project of the Maine Health Management Coalition.                                                                                                                                                      Extension of PTE Process Metric Deadline:  We've heard from a number of practices that need more time to adequately submit their cardiovascular, pediatric asthma, and/or optional metrics.  I talked with Jan Wnek and Jen Gunderman-King and we are extending the submission deadline two weeks, until end of day Friday, Sept 15, as long as practices made contact with us by the Aug 31 deadline.  We hope this allows more practices to adequately complete their submission.
 
PTE Subgroup:
  We have a PTE Physician Steering Committee meeting on Thursday, Sept 14, from 830-1130 am at the Augusta Civic Center.  Following that meeting there is a subgroup meeting from 1130 am to 1 pm.  During the PTE Physician Steering Committee meeting we will be providing an initial framework to look at potential physician/hospital/system metrics for 2007, and the role of the PCP in choosing/utilizing those metrics.  The subgroup will be to have some time to have a more in-depth discussion of the framework, with potentially some recommendations to bring back to the October 19 PTE meeting. 
 
CMS Activity:  There is a lot going on at the Federal Level.  We will have some updates at the PTE meeting.  Meanwhile, I thought you would be interested in a brochure put out by Secretary Leavitt of the Department of Health and Human Services.  It provides some excellent background on the recent Presidential Executive Order, the integration of the AQA and Hospital Quality Alliances, the expansion of the AQA pilots, and the direction in which the Federal Government and CMS is heading.

Ted Rooney
Health and Work Outcomes
47 Rossmore Road
Brunswick, ME   04011
Phone:  207-729-4929
Fax:  207-729-3223
trooney@healthandwork.com
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WellPoint (Anthem) to Split into Two Divisions

The New York Times reported last week (8/31) that Wellpoint, the parent company of Anthem Blue Cross Blue Shield of Maine, was making plans for a new organizational structure.  The health insurer will split into two strategic business divisions.  The changes will take effect Nov. 1, with one division comprising its commercial and consumer business and the second focusing on its specialty, elderly and state-sponsored operations.

Wellpoint is the largest health insurer in the world. [return to top]

Number of Uninsured Hits Record High

The number of people living in the United States without medical insurance rose from 45.3 million in 2004 to 46.6 million in 2005 – a record high. According to the U.S. Census Bureau, the percentage of people without health insurance coverage increased from 15.6 percent in 2004 to 15.9 percent in 2005. The percentage of children (under 18) without health insurance increased by 0.4 percent, and the percentage of people covered by employment-based health insurance decreased by 0.3 percent. To review the full report: 
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Blue Ribbon Commission On Dirigo Health to Meet on Thursday

The Blue Ribbon Commission on Dirigo Health will hold its second meeting this coming Thursday, Sept. 7 at 10:00am at the State House Office building.  The Commission was established by Governor John Baldacci and is charged with reviewing alternative sources of funding for the DirigoChoice program, other than the controversial Savings Offset Payment. 

Gordon Smith, MMA EVP represents MMA on the Commission which also includes Robert McAfee, M.D., Chairman of the Dirigo Health Agency Board of Directors and Peter Toussaint, M.D., retired surgeon from Fort Kent. [return to top]

Nicotine Increasing in Cigarettes

According to a new study published last week, the amount of nicotine in most cigarettes rose an average of almost 10% from 1998 to 2004, with brands most popular with young people and minorities registering the biggest increases and highest nicotine content.

As measured using a method that mimics actual smoking, the nicotine delivered per cigarette, the so-called "yield", rose 9.9% from 1998-2004, from 1.72 milligrams to 1.89.

The trend was discovered by the Massachusetts Department of Public Health, which requires that tobacco companies measure and report the nicotine content of cigarettes each year. 

MMA will consider a resolution at the upcoming Annual Session calling upon the Congress to grant the authority to the FDA to regulate the content of cigarettes.  "Cigarettes are essentially a drug delivery system", noted MMA EVP Gordon Smith, a former chair of the Maine Coalition on Smoking OR Health.  "The FDA should have the same authority to regulate this powerful drug as it has over other medication.", he went on to say.

The Resolution will be considered along with nine others at the general membership meeting on Saturday morning, September 8, at the Fairmont Algonquin Hotel in St. Andrews, New Brunswick.  There is no charge to members who wish to only attend the business meeting at the Annual Session.

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