January 29, 2007

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President Bush Addresses Medical Liability and Health Insurance in State of the Union

President Bush called for standard deductions for health insurance and again called for medical liability reform in his State of the Union address this past Monday.  The President acknowledged the growing popular sentiment for more affordable health care and called for a "standard deduction for health insurance" to operate like a standard deduction for dependents.  Addressing the need for medical liability reform, the President said we must protect good doctors against junk lawsuits.  "In all we do, we must remember that the best health care decisions are made not by government and insurance companies but by patients and their doctors."

The President claimed his proposal would result in lower taxes for about 80% of individuals with insurance through their employers.  Democrats were quick to criticize the proposal, arguing that the deduction is not helpful for low-income Americans and is not likely to encourage more employers to offer health insurance.

As he has done in previous State of the Union addresses, President Bush called for medical liability reform.  However, given the Democratic control of Congress, any hope for traditional types of medical liability reforms on a federal level is slim or non-existent.

President Bush also called for federal support of states that are coming up with innovative ways to cover the uninsured.  States that make basic private health insurance available to all their citizens should receive federal funds to help them provide this coverage to the poor and sick, the President noted.



Mike Hall, Director of MaineCare, Announces Resignation

J. Michael Hall, Director of the Office of MaineCare Services (OMS) for the past year, has resigned to accept a position in the Commonwealth of Pennsylvania.  His resignation is effective Feb. 16.  Hall will become Deputy Secretary of Public Welfare and Deputy Secretary of Aging in Pennsylvania. 

Prior to becoming the Director of OMS, Hall had served as Deputy Commission of DHHS, having come from Vermont in the latter part of 2004.  Both as Deputy Commissioner and as OMS Director, Hall directed the efforts to complete and improve the flawed claims management system (MECMS) and directed the "transformation project" which was designed to create a culture of customer service at OMS.

"Mike has provided strong leadership and his work has been integral to the improvements made at the Office of MaineCare Services," said Maine Department of Health and Human Services Commissioner Brenda Harvey. "Mike certainly will be missed and we wish him well in his new endeavors."

The search for a new Director has begun.  Commissioner Harvey said she is looking for a strong leader with Medicaid program experience and expects candidates from around the country.  A decision on an Acting Director will be announced soon, Harvey said.

Gordon Smith, MMA EVP, noted that Hall faced a virtually impossible situation at OMS when he arrived in 2005.  "Mike certainly did not create the MECMS problem and he diligently tried to fix it," Smith said.  "Unfortunately, it now appears that the problems are insurmountable and that a new approach will have to be tried." [return to top]

Survey: Reimbursement "Collapsed" in 2006

Calling it "the worst looking data" ever seen, Physician's Practice has released the results of its 2006 Fee Schedule Survey, which indicates that physician reimbursement has been falling in the United States for the last several years. Payment levels overall are 17 percent lower than in 2002, and 36 percent below those of 2004. Researchers blame the decreases on insurance industry consolidation, which gives payers much more bargaining power even as their profits rise. For more information:

http://www.physicianspractice.com/index/fuseaction/articles.details/articleID/933.htm [return to top]

MMA Committee on Peer Review and Quality Improvement; Report on Jan. 25 Meeting

The MMA Committee on Peer Review and Quality Improvement met this past Thursday (Jan. 25) and reviewed a number of quality improvement initiatives in the State, including some that MMA†has established. †The following projects were discussed:

  • Voluntary Practice Assessment Initiative (VPAI).† This initiative, funded by the Maine Quality Forum, offers a confidential practice self-assessment for primary care practices in the state.† Currently, the project looks at the care of diabetic patients and CVD in adults and immunizations and asthma care in children.
  • Proposed Contract with Board of Licensure in Medicine re Chronic Pain.† This proposed project, funded by the BOLM, would offer an in-office consultation from an experienced health care professional on the subject of the appropriate use of opioids in the treatment of chronic pain.
  • Pathways to Excellence:† Jan Wnek, M.D., the Medical Director of the PTE project, sponsored by the Maine Health Management Coalition, provided an update on the experience of the project during its first five years.† The focus has been on primary care with the potential measurement of specialty practices is just now under discussion.
  • MMA Peer Review Program.† This program offers confidential, external peer review to small hospitals, health centers and group practices.† The program provided more reviews in 2006 than ever before and business has been brisk so far in 2007.
  • Maine Quality Forum:†† Gordon Smith briefed committee members on current activities of the MQF, including prospects for activities now that Dr. Dennis Shubert has resigned as Director of the Forum.
  • MMA Office-based Quality Improvement Program.† Mr. Smith noted the four practices currently participating in the program and noted the need for some marketing of it.† Committee members noted that the Program should become more popular now that most of the medical specialties are requiring adoption of a QI plan in the office as part of the Mainetenance of Certification process.
  • Quality Counts.† Jean Eichenbaum updated members on the current activities of Quality Counts, including the establishment of a learning network to assist practices across the state who want additional services in the area of chronic disease management, disease registries, etc.

The Committee meets again on March 15 at 4:00pm.† The Committee is chaired by David McDermott, M.D., a family physician practicing in Dover-Foxcroft.†



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Legislative Policy Forum on Health Care

Legislators both experienced and new attended last Friday a "Legislative Policy Forum on Health Care" provided under the auspices of the Maine Development Foundation.  The day long program at the Augusta Civic Center was designed to inform legislators, in a non-partisan, non-advocacy setting, of the major health care issues facing the state.

Three major presentations were provided by Wendy Wolf, M.D., President and CEO of the Maine Health Access Foundation, Dr. Karen Davis,  President of The Commonwealth Fund and Erik Steele, D.O., Vice President & Chief Medical Officer of Eastern Maine Healthcare Systems.  In between the plenary sessions, legislators participated in small group breakout sessions addressed  the following topics:

  • Innovations in State Health Reform;  What are other states in the US doing?
  • The Changing Face of Medicaid;  What's happening at the Federal and State level?
  • Prescription Drug Access, Quality and Affordability in Maine
  • Can Health Information Technology Be the Answer
  • Dirigo Health Reform; Introductory Overview and Current Status
  • Public Health
  • Health and Aging:  A Road Map for Maine's Older Adults and Their Families
  • Jobs & More Jobs:  Will Maine have enough health care workers for the future?
  • The Realities of Maine's Health Insurance Markets
  • The Challenges of Rural Health Care in Maine
  • The Mind Matters;  Mental Health and Substance Abuse in Maine

MMA was invited to be a guest at the conference.  Copies of the presentations were not provided to guests but MMA is attempting to get a copy of the presentations which would then be placed on the MMA website at www.mainemed.com.

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Initial 2007 First Friday CME Program a Near Sell-out

The initial 2007 First Friday CME program, being presented this coming Friday, Feb. 2, 2007 at the Frank O. Stred building in Manchester from 9:00am to noon, is nearly sold out but a handful of seats are available.  Anyone interested in this program on accounts receivable management and the new National Provider Identification Number should register on-line at www.mainemed.com or call 622-3374, press 0 and ask for Jessica Violette or Gail Begin.

The faculty for Friday's program includes Vaughn Clark, President of the Thomas Agency, the MMA's endorsed provider of collection services, Andrew Finnegan, Health Insurance Specialist with the Center for Medicare and Medicaid Services Regional Office in Boston and Gordon Smith, Esq, EVP at MMA.  [return to top]

MMA/OSA CME Program on Preventing Prescription Drug Diversion in Machias and Bethel this Week

The Maine Medical Association CME program on preventing prescription drug diversion, sponsored and funded by the Office of Substance Abuse, will be presented at two locations this week.  On Wednesday evening, Jan. 31, this 2-hour program will be presented at Downeast Community Hospital (MacBride conference room) in Machias from 6:00pm to 8:00pm.  This program is being offered in cooperation with the four regional health centers but is open to any health professional or staff.  There is no charge for the program.   Persons wishing to attend should call  Gail Begin at MMA at 622-3374 ext. 210. 

On Thursday, Feb. 1, the program will be presented at the Annual Clinical Conference of the Downeast Association of Physicians Assistants, meeting in Bethel.  The program runs from 10:00am to noon at the Bethel Inn. [return to top]

Report on Jan. 19 Program: Transforming Health Care Delivery in Maine

Over 100 representatives of Maine's business community attended a Jan.19 business forum in Augusta organized by the Maine Chamber of Commerce on the topic of  "Transforming Health Care Delivery in Maine:  Harnessing Information to Make Maine Businesses More Competitive." 

The featured speaker was Francois de Brantes, National Coordinator for Bridges to Excellence.  Additional presenters included Paul Tisher, M.D., Chief Medical Officer, Acadia Hospital and a member of the Maine Quality Forum Advisory Committee;  Devore Culver, Executive Director of HealthInfoNet;  David Howes, M.D., CEO and Medical Director, Martin's Point Health Care and Vice Chair of the HealthInfoNet Board;  John Everett, Vice President Corporate Banking, KeyBank; and Wendy Wolf, M.D., M.P.H., President, Maine Health Access Foundation.

In addition to focusing on the value of information technology in healthcare, the general theme involved making a business case for improving the quality of health care. 

Mr. de Brantes' presentation described the current landscape in the following terms:

  • Numerous reports confirm substantial gap between best possible and actual care.
  • Research has demonstrated that public reporting of performance leads to improvements.
  • There are increasing demands from purchasers that providers demonstrate better performance, and initiatives that link payment with performance have proliferated in the private sector, and HHS is getting into the act.
  • Consumer-directed approaches require valid information on quality and cost of care.  President Bush has issued an Executive Order to that effect, and efforts to aggregate data across payers are blossoming.
  • Health Information Exchanges are emerging as an important nexus to improve "productive efficiencies" and add value as a health information intermediary. 
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Commonwealth Fund President Karen Davis, Ph.D. Speaks on Health Care Reform

Karen Davis, Ph.D., an economist who has been President of The Commonwealth Fund since January 1, 1995, visited Maine last week to give the Charlene B. Rydell Lecture at the Maine Legislative Policy Leaders Academy and also visited informally with the Dirigo Advisory Council on Health System Development.  The Commonwealth Fund is a national philanthropy engaged in independent research on health and social policy issues.  The Commonwealth Fund is the 4th oldest private foundation in the country founded in 1918 by Anna M. Harkness with the broad charge to enhance the common good.

Prior to joining The Commonwealth Fund, Dr. Davis served as the Chairman of the Department of Health Policy & Management at The Johns Hopkins Bloomberg School of Public Health, as Deputy Assistant Secretary for Health Policy in the US DHHS from 1977-1980, and as a Senior Fellow at the Brookings Institution.

Dr. Davis' Rydell Lecture was entitled, Why Not the Best?  How States Can Lead Us Toward a High Performance Health System.

Her Rydell lecture and her comments to the Advisory Council on Health System Development, Dr. Davis described the Commission on a High Performance Health System, an activity of The Commonwealth Fund.

The Commission seeks to move the U.S. toward a health care system that achieves better access, improved quality, and greater efficiency, particularly for those who are most vulnerable because of income, race or ethnicity, health, or age.  The 19-member Commission will identify public and private policies and practices that change the delivery and financing of health care and improve system performance.  The Commission is charged with:

  • Defining the characteristics of a high-performance health system;
  • Identifying policies needed to achieve such a system;
  • Setting realistic targets;
  • Recommending concrete steps to achieve 5, 10, and 15 year goals;
  • Issuing an annual "scorecard" documenting progress;
  • Issuing an annual set of issue briefs on key policy topics related to achieving a high performance health system.

You can find more information about the Commission on the web site of The Commonwealth Fund, www.cmwf.org.

Dr. Davis reported that the Commission issued a framework for its work in August and that it is now working on national goals, priorities, and strategies.  The framework includes the following elements:

  • "universal participation," meaning insurance coverage and a medical home;
  • quality care, meaning safe care, the right care, and coordinated care across sites and over time;
  • efficient care, meaning care that brings value;
  • equitable care.

Maine does fairly well on state scorecards established by the Commission, with the exception of 2 points:

  • Disability.  Maine has a high percentage of children that miss more than 11 days of school because of illness and a high percentage of disability in adults that keeps them from working;
  • High Costs.  Maine's health care costs are 10-15% above the national average and better states.

Dr. Davis said that the Commission's assumption is that the U.S. will continue with a "pluralistic" or "mixed model" health care system and that health care reform in our country will require more "system-ness" in order to be successful.  She identified 7 keys to reforming our health care system:

  • Extending health insurance to all;
  • Pursuing excellence in providing care everywhere - learning from best practices;
  • Organizing the care system to ensure coordinated care for all - a medical home for all;
  • Increasing transparency and increasing incentives for providers for achieving high quality and efficiency;
  • Expanding the use of information technology;
  • Creating a health care workforce that emphasizes patient-centered primary care;
  • Government taking a leadership role in setting standards.

MMA members Lani Graham, M.D., M.P.H., Maroulla Gleaton, M.D., and Josh Cutler, M.D. participated in the discussion with other members of the Advisory Council and stakeholders. [return to top]

Increases in Operating Costs Challenge Some Specialty Medical Group Practices

Managed Care Information Center, January 23, 2007
The Medical Group Management Associationís (MGMA) report Cost Survey: 2006 Reports Based on 2005 Data indicates that the financial health of group practices in 2005 varied by medical specialty.  Family practice medical groups reported a decline in margins of 3.5% overall in 2005 due to the groups being unable to absorb a 6.3% increase in operating costs and declines in reimbursement.  However, even with increases in operating costs, multi-specialty groups boosted margins by 7.3%.  The MGMA Cost Survey Reports analyzes cost and revenue indicators for 967 single-specialty and 335 multi-specialty groups.  [return to top]

WellPoint 4Q Profit Rises 23 Percent

Yahoo Business, January 24, 2007
The nationís largest insurer, WellPoint, Inc., reported a 23% increase in fourth-quarter profits.† Earnings rose $1.28 per share from $652 million to $801.1 million.† The company credits the increase in profits to strong enrollment gains in 2006.
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