February 5, 2007

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Governor Receives Blue Ribbon Commission on Dirigo Health Reform

The Blue Ribbon Commission on Dirigo Health issued its final report last week which included several recommendations including new funding sources to replace all or a portion of the so-called Savings Offset Payment.  The Governor received the report and indicated that he would have legislation prepared implementing it in a few weeks.The final report is available online at http://www.dirigohealth.maine.gov

Governor John Baldacci met last Monday (Jan. 29) with members of the Blue Ribbon Commission on Health Reform and accepted their final report.  The Commission included recommendations addressing how to strengthen and improve Dirigo Choice; identified new funding sources to continue to support the program; laid out market reforms to make coverage more affordable for all Mainers; and encouraged shared responsibility for health care costs among employers and individuals.

Key recommendations included:

  • Allowing the DirigoChoice program to self-insure;
  • Identified new sources of revenue for the General Fund, including taxes on specific behaviors and products that have negative influence on health; and
  • Continued to support the recapturing of bad debt and charity care savings to fund a portion of the Dirigo Health program

The Commission called for further study to implement market reforms to make coverage more affordable, particularly in the individual market, and endorsed the concept of an employer mandate along with a mandate for individuals  earning over 400% federal poverty level to secure health coverage and recommended that the Governor explore how such mandates might work.  The group further recommended an independent study of the cost drivers of health care and made a series of recommendations to increase access to health coverage and reduce its costs.

The Governor stated his hope to provide more specifics after more complete review of the report and to have a plan to implement it, including specific legislative proposals, ready in a few weeks.  The Blue Ribbon Commission represents business, consumers, insurers, labor, health professionals, government and academia.  Their final report is available on line at http://www.dirigohealth.maine.gov

The Commission, which held nine meetings over the course during the last half of 2006, was chaired by Sandra Featherman, former President of the University of New England.  Among the nineteen members were Robert McAfee, M.D., former MMA and AMA President, Gordon Smith, Esq., MMA EVP and S. Peter Toussaint, M.D., retired surgeon from Fort Kent.

Save the Date: June 20, 2007 Sixteenth Annual MMA Physician Education Seminar

MMA's sixteenth annual Physician Education Seminar will be held on Wednesday, July 20 at the Hilton Garden Inn at Great Falls Plaza in Auburn.  The program will run from 8:30am to 4:00pm and will feature presentations on pay for performance, quality improvement, using technology to improve quality, coding and reimbursement, handling the disruptive patient and working with difficult individuals.  Updates from MaineCare and Medicare will also be provided.  Erik Steele, D.O., Vice President and Chief Medical Officer of Eastern Maine Healthcare Systems  and weekly columnist will provide the keynote address. Watch for registration information in Maine Medicine or register today on the MMA website at www.mainemed.com.

Exhibitors to date include HRH, The Coding Center, Medical Mutual Insurance Company of Maine, The Thomas Agency and OfficeMax. [return to top]

Tony Marple Named New MaineCare Director and MECMS Update

DHHS Commissioner Brenda Harvey announced last week that former Maine General CFO Tony Marple will become Acting Director of MaineCare, effective Monday, Feb. 5.  Marple will replace J. Michael Hall who is leaving to take a cabinet level position in Pennsylvania.

Marple takes over at a critical time when the state is preparing a plan to either fix the flawed claims management system or move to an outside vendor.  The plan is due to be given to the federal government today (Feb. 5) and the feds are expected to take a few weeks to respond.  It is not clear at this point if the report to the federal government will be made available to the public.

The Governor's MaineCare Provider Advisory Group met on Feb. 1, 2007 and reviewed a number of issues.  The weekly metrics showed that 136,423 fresh claims were processed during the week ending Jan. 19, 2007 and that 96.7% of the fresh claims were either paid or denied.  The suspended claims inventory has been reduced to an all-time (since the problem began) low of 61,091. 

The cap on weekly provider payments discussed in the Weekly Update last week was implemented and is expected to be in effect until the new State fiscal year on July 1, 2007.  The cap is $36  million.  Claims not paid in the first week will be paid first on the following week.

Relative to interim Payments, a total of $319.9 has been recovered representing 62% of the $516.6 million paid out.  Many practices have been receiving letters requesting that the interim payments be returned.  If you still have outstanding claims and do not feel your claims are processing correctly, you can request a delay in the repayment of the interim payment.  In fact, physicians are still owed more in suspended claims than they owe in interim payments received ($15,843,878 vs. $11,932,428). [return to top]

David Simmons, M.D. Assumes Full-time Position with Physician Health Program

David Simmons, M.D., Clinical Director of the Physician Health Program on a two day per week basis since 2003 will assume a full-time position with the Program beginning today (Feb. 5, 2007).  Dr. Simmons ceased his clinical practice of internal medicine in Calais this past week.  In addition to serving the Program in Maine which works with recovering physicians, dentists, PA's and dental hygienists, he also is the Director of the PHP in Vermont.

"The Maine Medical Association is thrilled to have a physician of David's background in our employ to direct our Physician Health Program," said Gordon Smith, MMA EVP.  "Having a full-time clinical director gives us an opportunity to take the program to a new level, as well as to perhaps expand to assist some other health professionals such as pharmacists, podiatrists, veterinarians etc.", Smith added.

Funding for the program comes from a combination of state contracts, association donations and medical staff support.  The PHP has existed for nearly twenty years.  The Program is overseen by the Committee on Physician Health, currently chaired by Guy Raymond, M.D. of Fort Kent. [return to top]

Aroostook County Medical Society Meeting Tuesday, Feb. 6 in Caribou

MMA President Kevin Flanigan, M.D. will be the featured speaker at a meeting of the Aroostook County Medical Society meeting to be held Tuesday night, Feb. 6 at the Caribou Inn and Conference Center.  The evening begins with a reception at 6:00pm and dinner at 7:00pm.  Members or guest interested in attending should contact Carol St. Pierre Engels, M.D. [return to top]

Quality Counts Receives $600,000 for a Maine-Based Initiative Aimed at Improving Health Care Quality for Chronic Illnesses

Quality Counts Will Lead Robert Wood Johnson Foundation’s Three-Year National Program in Maine Which Uses Local Market Forces to Help the Chronically Ill Receive High-Quality Health Care

February 2, 2007 (Portland, Maine) – Quality Counts received a $600,000 grant from Aligning Forces for Quality, The Regional Market Project, a national program of the Robert Wood Johnson Foundation (RWJF), designed to help Maine improve the quality of health care provided to people with chronic illnesses.  The grant proposal was developed in partnership between the Dirigo Health Agency’s Maine Quality Forum, the Maine Health Management Coalition, and Quality Counts. The Maine Quality Forum will serve as the fiscal agent for the grant. 

“We are excited to join a program that seeks to align the efforts of Maine leaders, consumers, doctors, nurses, employers and insurers in a collaborative effort to improve the care we provide for chronically-ill patients,” said Quality Counts representative Lisa Letourneau MD. “No one person, group or profession can improve care for chronic illness without the support of others.  This program will help engage the people of Maine to create a coordinated system of care that best meets their needs”, noted Chris McCarthy of the Maine Quality Forum.  Doug Libby of the Maine Health Management Coalition stated, “Maine has already made great strides in collecting and reporting quality data, and in efforts to engage consumers in using quality data in decision making.  We’re looking forward to working with all organizations involved in improving quality to align these efforts”.

Quality Counts joins 13 other grantees in the three-year, $14-million Aligning Forces for Quality program. The selection process entailed guidance of national experts and intensive site visits that confirmed Maine has taken significant initial steps toward the program’s goals and has the capacity for further improvement. Quality Counts will receive $600,000 to use over three years for planning, convening, coordination and infrastructure development. In addition to the grant award, Quality Counts can also receive technical assistance.

Through Aligning Forces for Quality, Quality Counts will participate in the Foundation’s work to ensure that all Americans, especially those with chronic conditions such as asthma, diabetes, depression and heart disease, receive high-quality health care. Americans get only half of the care recommended for their chronic conditions, according to studies the Foundation has commissioned.

“We want to help doctors, nurses and other health care providers work together to deliver better care, and educate patients and consumers to make better, more informed
choices,” said Patricia Powers, M.P.P.A., the president and chief executive officer of the Center for Health Improvement based in Sacramento, Calif., who directs Aligning Forces
for Quality. “Market-based, regional collaboratives can help us achieve this; they represent a logical next step in the national drive to improve quality.”

Aligning Forces for Quality is designed to help communities do three things to advance the quality of chronic care provided in doctors’ offices, clinics and other outpatient settings: (1) help health care providers improve their own ability to deliver quality care; (2) help providers measure and publicly report their performance; and (3) help patients and consumers understand their role in demanding high-quality care.

RWJF conceived of Aligning Forces for Quality as an effort to help communities use multiple market forces to drive and sustain quality. The goal is to help regions such as Maine retool their health care markets so that they can function as markets should. For Quality Counts to improve the quality of care in Maine, there needs to be participation on many fronts: 1) civic, business and health care leadership that is committed to quality care; 2) doctors, nurses and other providers who are committed to improving and who have the resources and capability to improve; 3) purchasers who are willing to reward high quality care; and 4) patients and consumers who receive accurate understandable information about the performance of providers and are motivated to act on that information when making health care decisions.

The other grant recipients are:

  • Alliance for Health – Grand Rapids, Mich.
  • Maine Health Alliance of Humboldt-Del Norte – Eureka, Calif.
  • Greater Detroit Area Health Council – Detroit, Mich.
  • Health Improvement Collaborative of Greater Cincinnati – Cincinnati, Ohio
  • Healthy Memphis Common Table – Memphis, Tenn.
  • Healthy York County Coalition – York, Pa.
  • Kansas City Quality Improvement Consortium – Kansas City, Mo.
  • MetroHealth System – Cleveland, Ohio
  • Minnesota Maine Measurement – Minneapolis/St. Paul, Minn.
  • Oregon Health Care Quality Corporation – Portland, Ore.
  • P2 Collaborative of Western New York – Buffalo, N.Y.
  • Puget Sound Health Alliance – Seattle, Wash.
  • Wisconsin Collaborative for Healthcare Quality – Madison, Wis.

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 30 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. For more information, visit www.rwjf.org.
The Center for Health Improvement is a national, independent, nonprofit health policy center dedicated to improving population health and encouraging healthy behaviors. CHI uses evidence-based research as the basis for policy innovation and implementation. Since 1995, CHI has partnered with all levels of government, advocacy and Maine organizations, philanthropic foundations, and educators. For more information, visit www.forces4quality.org. [return to top]

Dora Ann Mills to Receive AMA Nathan Davis Award

On Tuesday, Feb. 13 in Washington D.C., Maine CDC Director Dora Ann Mills, M.D., M.P.H. will receive the prestigious American Medical Association Nathan Davis Award for Career Government Official.  The award will be presented at the AMA Advocacy Conference.

Dr. Mills was nominated for the award by Brenda Harvey, Commissioner of the Maine Department of Health and Human Services.  MMA supported the nomination.  Dr. Mills was the recipient of the MMA President's Award at the MMA Annual Session in September, 2006.

Dr. Mills will be accompanied at the event by her husband Michael Fiori, MMA President Kevin Flanigan, M.D., Maine AMA Delegate David Simmons, M.D. and MMA EVP Gordon Smith. [return to top]

MMA to Become an MPBN Sponsor

Beginning tomorrow (Tuesday, Feb. 6), the Maine Medical Association will become a sponsor of two popular radio shows on Maine Public Radio including "All Things Considered" and "Morning Edition".  Using a tag line of: 

The Maine Medical Association, physicians working to ensure quality healthcare for all Maine citizens since 1853; on the web at mainemed.com

MMA will be a sponsor on Tuesdays for 26 weeks with the Tuesday evening sponsorship beginning Feb. 6 and the "Morning Edition" sponsorship beginning in April.

The sponsorship is part of a communications strategy that seeks to provide more MMA visibility in the media to our members, non-members and the public.  Other activities will include more op-ed pieces and the enhanced MMA website.  The Association's efforts to improve quality and provide coverage to all Mainers will be highlighted.

The public radio sponsorship has been made possible through a generous contribution from one of MMA's senior members. [return to top]

Maine Society of Anesthesiologists Meeting this Weekend at Sugarloaf

The Maine Society of Anesthesiologists will hold its Winter Meeting this weekend, Feb. 10-11 at the Grand Summit Hotel at Sugarloaf/USA.   The annual business meeting will be held at 3:00pm on Saturday, Feb. 10 and will include a report from the American Society of Anesthesiologists from Ron Szabat, the ASA Director of Government Affairs.  A legislative and regulatory update on the state side will be presented by Gordon Smith, MMA EVP.

A dinner will be held Saturday evening with the key note speaker, Timothy Quill, M.D., from Dartmouth Medical School presenting, "What's New in Pulse Oximetry - You'll be Surprised."  Dr. Quill has been with the MSA group on previous occasions and is an entertaining speaker. 

The weekend meeting will finish with an educational program at breakfast on Sunday morning.

MSA members interested in attending who have not yet registered for the meeting should contact Anna Bragdon at 441-5989 or via e-mail to abragdon@adelphia.net [return to top]

Newsweek Magazine Offers Tobacco-Ad Free Version to Subscribers

According to an ad in the January 29th New York Times funded by the Tobacco Action Coalition of Long Island and the NYC Coalition for a Smokefree City, Newsweek subscribers can order a tobacco-ad free version of the magazine by calling 1-800-526-2595.  This is a great option if you have Newsweek in your waiting room! [return to top]

FDA Announces Initiatives on Drug Safety

On January 30, 2007, Food & Drug Administration Commissioner Andrew C. von Eschenbach announced his agency's systems approach to improving public confidence in the safety of prescription drugs on our country.  The FDA initiative focuses on 3 important drug safety areas:

  • the science behind drug safety;
  • improving drug safety communication; and
  • improving the operations and management of the drug safety system.

The agency will pursue the following specific steps in carrying out this initiative:

  • a pilot program that will review the safety profiles of certain newly approved drugs on a regularly scheduled basis;
  • the establishment of an advisory committee on risk communication;
  • a new post-market drug safety data-sharing agreement with the Department of Veterans' Affairs Veterans Health Administration; and
  • a comprehensive formal review of scientific needs across the agency and a newsletter on post-marketing drug safety findings.

The FDA's report, The Future of Drug Safety, is available on the web at:  http://www.fda.gov. [return to top]

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