January 22, 2007

 
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Health Care Reform Back on State and Federal Agendas

The pressures for wide-spread reforms of the health care financing and delivery systems are the strongest they have been since the failed attempts of the Clinton administration in the early 1990's.  As a front page story in the Wall Street Journal stated on Friday, Jan. 19, "Suddenly, the long-festering issue of providing health coverage to the one in six Americans who lack it seems to have leapt to the top of the national to-do list."  While most of the action is in the states, with Massachusetts and now California leading the way, the 2008 Presidential election is also setting the stage for another prolonged and passionate debate about the issues of cost, quality and access to care.  Watch the pages of Maine Medicine and Maine Medicine Weekly Update for updates on what is happening and the likely impact on Maine and your practice.

On last Tuesday and Thursday, broad-based coalitions, including the AMA, announced plans to support increased health insurance coverage for the currently uninsured and President Bush is expected to include some health reform proposals in his State of the Union address on Tuesday night (Jan. 23).  The President's proposal to allow individuals to deduct from federal income tax the full cost of a health insurance policy up to $7500 but to pay for it by taxing the value of any employer paid plan costing more than $15,000 will likely be the most controversial part of the President's initiative.

15.9% of Americans, or about 46.6 million people currently lack health insurance.  About 70% of the uninsured are employed, but the percentage of employers offering health insurance to their employees is steadily decreasing.

Within the past two weeks, California Governor Arnold Schwarzenegger and Pennsylvania Govenor Ed Rendell both proposed bold initiatives to cover the 6.5 million and 1.0 million uninsured in their respective states.  Governor Schwarzenegger outlined a plan that would make uninsured residents purchase insurance, and require businesses with 10 or more employees to either offer insurance or pay 4% of their payroll into a fund for the uninsured.  The plan would levy new taxes on physicians and hospitals to help pay for the cost.

The Pennsylvania plan does not include an employer mandate but would require that individuals earning over 300% of the federal poverty level purchase insurance, similar to the Massachusetts model enacted in 2006.  The Massachusetts law requires residents to purchase health insurance and creates a state-operated "health connector" to help them with their choice.  Massachusetts also included an employer mandate, but with only a nominal "play or pay" charge.

Maine's Dirigo Health law generally is discussed in the national media, although there is usually acknowledgment that enrollment has been less than anticipated and financing is not secure.

MMA has endorsed an individual mandate since 2003 and currently is reviewing its White Paper on Health System Reform prepared in that year.

While most of the focus is again on covering the uninsured, many experts and observers are noting that the cost of care, which continues to rise at twice the rate of general inflation, and the quality of care, are equally important issues.  Minnesota Governor Tim Pawlenty noted recently that simply focusing on getting everyone insurance ignores deeper problems, such as cost and quality. "Expanding access to a broken system is no solution...in the long run, that will be a failure," Pawlenty stated.

Stay tuned.

MECMS Provider Advisory Committee Meeting Contentious over Issue of Future Plans

The Governor's MECMS Provider Advisory Committee met on Thursday, Jan. 18.  After discussion of the usual reports and weekly metrics, attention turned to Commission Brenda Harvey's remarks before the Legislature's Committee on Appropriations and Financial Affairs on the preceding Tuesday.  At that time, the Commissioner acknowledged that she would be preparing a set of recommendations for the federal government and expected them to be sent by the end of the month.  As the recommendations will set forth what the Office of MaineCare Services intends to do to bring the current system into federal certification, providers have a huge stake in the report.  However, to date, OMS officials are not sharing the options under consideration and do not intend to ask for provider input into the recommendations until it hears back from the federal government (the feds may accept or reject the recommendations.)

While it is widely known that one of the recommendations may be to scrap much of the new computer system (MECMS) and contract out the processing of claims to an outside vendor (called apparently a fiscal agent in OMS language), what is not known is how long that process may take and how disruptive it may be to providers.  After living with the MECMS problem for two years, it is patently unfair for the 7000 MaineCare providers to be kept in the dark as to the department's plans.

"Perhaps if the providers had been asked their opinion on such matters between 2000 and 2005, much of the problem could have been avoided," noted MMA EVP Gordon Smith, who advocated for the department's recommendations to be made public even before they are shared with the federal government.  "While we acknowledge the need to be sensitive to issues such as employee morale, the physicians, other health professionals and institutions caring for the more than 260,000 MaineCare patients should have a timely opportunity to provide input into this critical decision," Smith noted.

The Committee will meet again on Feb. 1.

The weekly metrics showed that paid and denied fresh claims were processing at 93.2% and suspended claims are now below 70,000 for the first time since Jan. of 2005.  Total interim payment balance is at $516.2 million with $315.6 million recovered and another $61.3 million being agreed to relative to repayment.  Over $202 million remains to be returned and letters will be going out to all the providers who have not been previously communicated with who received interim payments. 

The Department continues the development work necessary to implement an offset of pre-2006 claims.  This solution will alleviate duplicate payment of 2005 claims already covered by interim payments.

Because of the danger of the program running out of funds by the end of the fiscal year in June, 2007, a cap will be placed on the amount of funds being out each week as was done last year.  The weekly cap will be set initially at $34 million which should ensure that no claim approved would be delayed by more than one week. [return to top]

Save Dates for MMA Golf (June 18); Physician Education Program (June 20) and Corporate Affiliate Breakfast (April 25)

The MMA's Annual Breakfast for Corporate Affiliates will be held at 7:30am, Wednesday, April 25 at the Portland Country Club in Falmouth.  The Guest speaker is New York Times best selling author and physician Tess Gerritsen, M.D. of Camden.  There is no charge to MMA Corporate Affiliates for this event.

On Monday, June 18, the Association will sponsor its Annual Golf Tournament at the Augusta Country Club.  Lunch will begin at 11:00am with a shot-gun start at noon.  This year we will revert back to a traditional scramble format.  The net proceeds of the event will this year go to the Association's Long Term Development Account.

On Wednesday, June 20, the MMA will hold its annual physician education program at the Hilton Garden Inn in Auburn.  Watch for preliminary registration materials in your next issue of Maine Medicine.  Topics will include the new Medicare Pay for Performance initiative, beginning July 1, 2007, health system reform, current regulatory and legal issues and a Medicaid  and Dirigo Health update.  Public reporting of physician identifiable data will be featured, as well.  Call Gail Begin at 622-3374 ext. 210 for more information or to reserve a seat at this popular yearly program. [return to top]

U.S. House Passes Bill to Permit Price Negotiation in Medicare Part D Program

One of the more controversial aspects of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, the legislation that created the Medicare Part D prescription drug benefit, was a provision prohibiting the Department of Health & Human Services from negotiating lower drug prices for Medicare beneficiaries.  During the fall campaign season, Congressional Democrats declared this provision one of the issues they would address in the new Congress. 

On January 12, 2007, the House passed such legislation (H.R. 4) by a vote of 255 to 170, but this margin is insufficient to overcome a veto promised by President Bush.  The Senate has not yet considered similar legislation, though Senate Finance Committee Chairman Max Baucus (D-MT) has said that he favors removing the prohibition on negotiations, but not necessarily mandating it either.  The debate on the issue has been very partisan with Democrats and Republicans arguing about the proper role of government in the health care system.
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SAVE THE DATE: Legislative Committee Forum on MaineCare on February 27th

The MMA Legislative Committee has planned two issue-oriented meetings of the Legislative Committee for this session.  The first is scheduled for late February.  Committee Chair Katherine Pope, M.D. and Vice Chair Sam Solish, M.D. invite any member to participate in this informative session.  The details follow:  

Date:  Tuesday, February 27, 2007  

Subject:  MaineCare, including the MMA’s effort to increase reimbursement rates an tthe claims management system issues

Time:  5:30 p.m. to 7:30 p.m. with program beginning at 6 p.m.

Location:  Frank O. Stred Building, Manchester, Maine Medical Association  

Other:  Hors D'oeuvres and beverages available; we expect to invite guests from the legislative and executive branches of Maine government for a panel discussion.

Please RSVP to Andrew MacLean, Deputy EVP, at amaclean@mainemed.com or 622-3374, ext. 214. [return to top]

January 31 CME Program on Preventing Prescription Drug Diversion in Machias

In sponsorship with the Maine Office of Substance Abuse (OSA) and the Maine DEA, MMA will be presenting a two hour CME program on preventing prescription drug diversion at the Downeast Community Hospital in Machias on Wednesday, Jan. 31 from 6:00pm to 8:00pm.  Refreshments will be served and there is no cost to attend, due to the generosity of a grant from OSA.  The program will be held in the MacBride conference room at the hospital.

MMA presented seven such programs across the state last year and expects to do nine such programs in 2007.  If the program has not been scheduled in your area and you would like to host it, contact Gordon Smith, Esq., MMA EVP at gsmith@mainemed.com.

The Maine Primary Care Association has also been an active participant in the offerings and the Jan 31 program is being hosted by four federally qualified health centers.

The state's Prescription Monitoring Program (PMP) will be discussed, as well as the legalities associated with reporting violations and the requirements of the state medical licensing boards.  A regional DEA official is also expected to attend to discuss what is happening locally.

Along with the DEA agent, faculty includes attorney Gordon Smith and Deputy Director of OSA Guy Cousins.

Persons interested in attending who have not already registered through the hospital or one of the area health centers may do so by calling Gail Begin at 622-3374 ext. 210 or via e-mail to gbegin@mainemed.com. [return to top]

American Heart Association 57th Annual Maine Scientific Session, Feb 10-11, 2007

There's still time to register for the American Heart Association's 57th Annual  Maine Scientific Session at the Samoset on February 10 & 11.  The program, The Metabolic Syndrome & Coronary Risk, features Robert H. Eckel, MD as the keynote address and the annual Drake Award recipient. Dr. Eckel is President of the American Heart Association and Professor of Medicine, Physiology and Biophysics at the University of Colorado Health Sciences Center.  Click here for the full program.  You can register by sending the registration form and check as indicated on the website, or by e-mailing Melissa.Goodrich@heart.org or calling Melissa at 207.523.3002. [return to top]

Older Americans Not Discussing Complementary and Alternative Medicine Use with Doctors

A survey of people aged 50 and older conducted by the American Association of Retired Persons and the National Center for Complementary and Alternative Medicine at the National Institutes of Health reveals that 69 percent of that group do not discuss their use of complementary and alternative medicine (CAM) therapies with their physicians. Reasons for not discussing CAM use included: physicians never asked (42 percent); did not know that they should (30 percent); not enough time during visit (19 percent). For more information: http://www.nih.gov/news/pr/jan2007/nccam-18.htm

A PDF file of the complete report can be downloaded at: http://assets.aarp.org/rgcenter/health/cam_2007.pdf

 

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Maine Urological Association Annual Winter Meeting, Feb 2-4, 2007 at Sugarloaf/USA

The Annual Winter Meeting of the Maine Urological Association (MUA) will be held February 2 – 4, 2007 at the Grand Summit Hotel at Sugarloaf/USA. Dr. Mark Moyad, University of Michigan, will be the guest speaker. Evaluations of his previous presentation rated him good to excellent with notes asking for him to present again There will be a presentation on Healthcare Crisis in Surgery, Man to Man and more.

For registration information please contact Warene Eldridge at the Maine Medical Association, 207 622 3374 ext 227 or weldridge@mainemed.comIt is not too late to register to attend this meeting! Contact Warene today for more information or to register. [return to top]

MedPAC Urges 2008 Physician Pay Increase

The Medicare Payment Advisory Commission (MedPAC), which advises Congress, voted on Wednesday to recommend a 1.7% increase in the physician payment update in 2008, a stark contrast to the anticipated 10% cut physicians currently face.

The 1.7% figure is the difference between expected practice cost inflation (3%) and greater physician productivity (1.3%).

In the December 2006 lame duck session, Congress only found part of the funding necessary to prevent the 2007 payment cut. It pushed the rest of the costs forward to 2008, resulting in an expected 10% cut. [return to top]

Next "First Friday" CME Program Feb. 2 Features Accounts Receivable Management and NPI

The first of the 2007 "First Friday" CME Programs will be held on Friday, Feb. 2nd from 9:00am to noon at the offices of the MMA in the Frank O. Stred Building in Manchester.  Breakfast will be available to attendees beginning at 8:30am.

Presenting at the Program are Vaughn Clark, President of the Thomas Agency, an accounts receivable management organization with offices in Portland and Brewer, Andrew J. Finnegan, a Health Insurance Specialist with the Center for Medicare and Medicaid Services (CMS) and Gordon Smith, Esq., MMA Executive Vice President.

While Mr. Clark will focus on effective collection techniques, Mr. Finnegan will discuss the process of obtaining an NPI number (National Provider Identifier), which every physician must do by May 23rd.

Mr. Smith will discuss the requirements of state and federal law in performing collection activities.

There is a $60 charge which includes all course materials and breakfast.  Registration is available through the MMA website at www.mainemed.com or through calling the office at 622-3374 (Press O and ask for Jessica or Gail). [return to top]

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