February 20, 2007

 
Subscribe to Maine Medicine eNewsletters
Manage Your Subscriptions
Email our Editor...
Maine Medical Association Home Page
. Search back issues
. Plain Text Version
Printer Friendly

Dora Anne Mills, MD, MPH Receives Nathan Davis Award for Outstanding Career Public Service

On Tuesday, Feb. 13, Maine CDC Director Dora Anne Mills, MD, MPH received the prestigious Nathan Davis Award for "Outstanding Career Public Servant at the State Level" from the American Medical Association.  Now in its 19th year, the Dr. Nathan Davis Awards honor elected officials and career public servants at the local, state and federal levels for significant achievements in the advancement of public health.

Dr. Mills graciously received the award at a dinner in Washington D.C. attended by hundreds of AMA members and guests including several representatives of the Maine Medical Association.  The Master of Ceremonies was ABC News Washington correspondent George Stephanopoulos.

Dr. Mills was nominated for the award by DHHS Commissioner Brenda Harvey.  In remarks made upon receiving the award, Dr. Mills encouraged the physicians in the audience to return to their hometowns later in the week and to talk with young physicians and to invite their participation in the work of organized medicine.  Dr. Mills noted that when she returned to her hometown (Farmington) to practice pediatrics, it was MMA Executive Committee member and urologist Michael Parker who invited her to participate in the public health activities of MMA.  She also credited Robert McAfee, M.D., former MMA and AMA President and MMA EVP Gordon Smith for their roles in her rise to prominence in public health.

In an accompanying press release from the AMA, the organization noted Dr. Mill's work in reducing the incidence of youth smoking and in preparation for the pandemic flu in distinguishing her from the nearly forty nominations received for the award.

Dr. Mills also received the MMA's Presidential Award for Distinguished Service at the 2006 Annual Meeting.

Dr. Mills is a native of Farmington and a graduate of Bowdoin College and the University of Vermont Medical School.  She was appointed the Director of the Bureau of Health by former Governor Angus King during his first term as Governor.  She is a board certified pediatrician and is a former Democratic National Committeewoman from Maine.

Dirigo Group on Future Funding Through Bad Debt/Charity Care Recapture Convenes

In accordance with the report of the Blue Ribbon Commission on Dirigo Health issued in January 2007,  the Dirigo Health Agency Executive Director convened a group of interested parties on Thursday, February 15, 2007.  The Blue Ribbon Commission recommendations on future funding options for Dirigo included the following initiative:

capturing and redirecting bad debt and charity care funding.  The Commission further recommends that a group consisting of interested parties, including, but not limited to providers, consumers, employers, and insurers be convened to meet with the Dirigo Board and staff as soon as possible to determine the methodology and mechanisms through which bad debt and charity care savings will be captured and redirected.

Attending the opening meeting were representatives of the MMA, the Maine Hospital Association, Anthem, the Maine Association of Health Plans, the Maine State Chamber of Commerce, Consumers for Affordable Health Care, Maine Equal Justice Partners, the Dirigo Board and staff, and the Maine Health Data Organization. 

At the first meeting, the group scheduled 5 additional meetings through late March and discussed potential data sources and resource documents. 

As the original Savings Offset Payment (SOP) included an amount presumed to be "recaptured" from physician offices as the result of the modest medicaid fee increase in 2005, MMA is concerned that any new formula based upon recapturing savings in bad debt and charity care may target physicians.  Please watch these articles in Maine Medicine Weekly Update  for information on the work of this interested parties group.  MMA will not support any proposal which attempts to recapture any imaginary savings from reductions in bad debt and charity care in physician offices as a result of the various Dirigo Health initiatives.  Any positive impact from the modest MaineCare fee increase has been more than offset by the MECMS problem, increasing overhead and reductions in Medicare reimbursement. [return to top]

State Supreme Judicial Court Hears Argument on Dirigo Savings Offset Payment

On last Tuesday, Feb. 13, the Maine Supreme Judicial Court heard oral arguments on whether first-year savings generated by the state's Dirigo Health program were established legally.  Last August, Superior Court Justice Roland Cole rejected an appeal of a 2005 decision by Insurance Superintendent Al Iuppa that the Dirigo Health Agency programs produced savings to the health care system of $44 million in the first year.

The parties appealing the decision include the Maine Automobile Dealers Association, the Maine Association of Health Plans and the Maine State Chamber of Commerce. 

The Superior Court decision noted that the parties contesting the decision of the Superintendent focused on the methodology used by the Dirigo Agency Board of Directors during the course of the regulatory proceedings.  Justice Coles stated that the court would not second-guess the agency on issues within its expertise and found that the Superintendent's decision was based upon substantial evidence in the case record.

Because of the tradition difficulty in overcoming a regulator's decision in this type of appeal, most legal observers do not expect the appeal to be successful. [return to top]

INVITATION: Legislative Committee Forum on Current MaineCare Issues

To the MMA Executive Committee & Members:

The MMA Legislative Committee is hosting an Open Forum Legislative Meeting on Tuesday, February 27, 2007 from 5:30 to 7:30 p.m. at the Frank O. Stred Building in Manchester.  We would like to extend a special invitation to all MMA Executive Committee members and members-at-large and encourage you to attend.

We expect several legislators and DHHS representatives will participate in an open discussion about MaineCare, including the MMA's efforts to increase reimbursement rates, the claims management systems issues, and any other MaineCare issues that may be of concern.  We will have a reception with light refreshments preceding the program to allow time for informal conversations as well.

At this time, we expect the following legislators to attend:

Senator Lisa T. Marrache, M.D. (D-Kennebec), a family physician and a member of the Health & Human Services Committee

Senator Karl Turner (R-Cumberland), a member of the Appropriations Committee

Representative Robert Walker, M.D. (R-Lincolnville), a radiologist and lead Republican House member on the Health & Human Services Committee

Representative Janet Mills (D-Farmington), a member of the Appropriations Committee

This is an opportunity to learn about the issues, to personally meet and talk with key legislators, and express the views and concerns of Maine physicians.  Please make every effort to attend and to encourage your physician colleagues to come as well.

Thank you and see you there!

Katherine S. Pope, M.D., Chair
Samuel Solish, M.D., Vice Chair
MMA Legislative Committee

[return to top]

MMA Advocates in Washington for Medicare Payment Reform/ Maine Impact Significant

MMA President Kevin Flanigan, M.D., AMA Delegate David Simmons, pediatrician Ann Simmons and MMA EVP Gordon Smith traveled to Washington D.C. this past week to join other state medical societies and the AMA in advocating for permanent change in the sustainable growth rate (SGR) methodology used to establish Medicare payment rates for physician services.  Because of the flawed SGR formula, Maine physicians stand to lose $28 million in Medicare payments due to the projected 10% negative update in 2008 and the state will lose $820 million by 2015 due to 8 years of anticipated SGR cuts.

Compared to the rest of the country, Maine, at 17%, has an above-average proportion of Medicare patients and, at 17 practicing physicians per 1,000 beneficiaries, a below-average ratio of physicians to Medicare beneficiaries.  In addition, 46% of Maine's practicing physicians are over age 50, an age at which surveys have shown that many physicians consider reducing their patient care activities.

In addition to the potential of an overall cut of 10%, the "Southern Maine" locality will be cut an additional 1.06% and the "Rest of Maine" locality an additional 2.3% due to expiration of the temporary GPCI increase included in the 2003 Medicare law.

Meetings were held with Senator Collins and Representatives Mike Michaud and Tom Allen.  Senator Snowe was tied up in committee hearings, but her aid William Puwen, PhD met with MMA representatives.  All four members of Maine's Congressional delegation pledged their support for a change in the SGR formula.

"Maine physicians can not sustain another decrease of this magnitude in Medicare reimbursement," noted Gordon Smith, MMA EVP.  "The higher than average number of Medicare recipients, along with the highest percentage of Medicaid patients, per capita, in the country, has led to an unprecendented decrease in the number of Maine physicians able to practice privately and has also taxed the resources of Maine's hospitals.  This annual insanity over the SCR formula must stop and we are pleased that the Maine delegation supports necessary change in the formula.".

In addition to advocating for changes in Medicare reimbursement, MMA and the AMA lobbied last week for system wide reform that would result in more persons, especially children, being covered with health insurance. 

Visit www.ama-assn.org/go/insurance-reform for more information about the AMA proposal, "Expanding health insurance: coverage and choice. [return to top]

Let MMA Do Your Annual HIPAA Training - March 2nd in Manchester

The federal HIPAA regulations require annual training of medical office staff in privacy and security regulations.  MMA will offer training intended to meet the annual requirements on Friday, March 2nd as part of the Association's "First Fridays" CME presentations.  The program runs from 9:00am to noon at the offices of MMA in Manchester.

There is a charge for the program which includes all training materials and breakfast.  You may register at the MMA website at www.mainemed.com or call the MMA office at 622-3374 (Press 0) for more information and a registration form.  Specific questions about the seminar may be directed to Gail Begin at extension 210.

The faculty includes MMA attorneys Gordon Smith and Andrew MacLean, both of whom have extensive experience in state and federal medical privacy laws. [return to top]

Report Questions Usefulness of Price Transparency to Health Care Consumers

In the February 6th edition of Health Affairs online, Center for Studying Health System Change President Paul B. Ginsburg has published an article entitled, "Shopping for Price in Medical Care."  The report suggests that "consumer-driven health care" requires different pricing information to be provided to different patients depending on a variety of factors, such as insurance coverage, in order to be useful.  The report concludes that price shopping in health care has the most potential in these situations:

  • the services are not complex;
  • the need tor the service is not urgent;
  • a diagnosis has already been made;
  • bundled prices are the norm for the service; and
  • the insurance benefit structure provides incentives to choose lower-price providers.

Also, the report warns that increased price transparency could lead to higher prices because lack of transparency permits providers to offer discounts to some customers while keeping the discounts from other customers.

You can find more information about this report on the web at:  http://content.healthaffairs.org/cgi/content/abstract/hlthaff.26.2.w208. [return to top]

Senate HELP Committee Passes Mental Health Parity Legislation

On February 14, 2007, the Senate Health, Education, Labor, & Pensions Committee passed the Mental Health Parity Act of 2007 (S. 558) by a vote of 18 to 3.  Applying to businesses with 50 or more employees, the bill would not require covered businesses to offer mental health coverage, but if they do, they must offer mental health coverage on par with medical coverage in areas of patient deductibles, co-payments, annual and lifetime coverage limits, and covered inpatient and outpatient visits.  The bill includes a "cost exemption" for covered businesses if they anticipate increased health care costs greater than 2% of total plan costs in the first year or exceeding 1% of total plan costs in each subsequent year.  State mental health parity laws would have to match this coverage.  This bill is very similar to federal legislation enacted in 1996 that has been criticized by advocacy groups, including the American Psychiatric Association (APA), for having loopholes such as lack of limits on cost sharing provisions. [return to top]

Aligning Forces for Quality Grant Seeks Project Director

The new Aligning Forces for Quality grant seeks a full-time Project Director. This position will be instrumental in helping to lead and coordinate the activities of the grant.

JOB DESCRIPTION DATE: February 9, 2007

SUMMARY of Position Description
Serves as Quality Counts Project Director to successfully accomplish the goals of the Robert Wood Johnson Foundation “Aligning Forces for Quality” (AF4Q) initiative.  Primarily responsible for all operational aspects of AF4Q initiative, including project planning, workplan implementation and maintenance, convening stakeholders, budget management, and reporting.  Duties include project management, and relationship management with QC Members and key interested parties throughout the state.  Oversees project administrative staff and consultants. Reports to the Quality Counts Board.

MINIMUM KNOWLEDGE, SKILLS AND ABILITIES REQUIRED

  1. Bachelors in healthcare, business, or related field required, Masters preferred.
  2. Knowledge of project management, administrative practices, and healthcare systems normally acquired during 3 to 5 years of related work experience.
  3. Excellent project management skills.
  4. Excellent communication and relationship management skills.
  5. Excellent organizational skills.
  6. Excellent oral presentation skills.
  7. Ability to work both independently and to collaborate with teams of individuals in diverse settings, with solution oriented approach; ability to build alliances and coalitions with wide range of organizations.
  8. In-depth understanding, or ability to develop an in-depth understanding of concepts of clinical quality improvement (e.g. Planned Care Model, the Institute of Medicine’s “Crossing the Quality Chasm” report, complex adaptive systems as applied to health care) and the role of the multiple stakeholders as they relate to this model. 
  9. In-depth understanding or ability to develop an in-depth understanding of concepts of social marketing and consumer advocacy.
  10. Data management skills.
  11. Experience with budgeting and grant management preferred.
  12. Knowledge of Maine healthcare environment preferred.
  13. Knowledge of computer software, including Microsoft Office suite.

ESSENTIAL FUNCTIONS AND PERFORMANCE EXPECTATIONS

  1. Manages all aspects of AF4Q initiative
    • Collects relevant data and background information needed to ensure successful development of project workplan, including Internet and library searches, telephone and personal interviews, review of related materials, policy analysis, surveys and focus groups when appropriate.
    • Develops annual project workplan and timeline, and monitors timeline to assure timely completion of program tasks.
    • Convenes and provides staff support to project Leadership Team, workgroups, task forces, and other meetings as necessary, including preparation of meeting agendas and materials, facilitating meetings, preparation of meeting minutes, and ensuring appropriate follow up of action items.
    • Oversees development of project surveys, or contracts for needed services as appropriate.
    • Develops project materials as needed.
    • Manages project budget and assists with planning for program budget annually.
    • Collects and manages project data.
    • Works with project Program Office to develop plan for project evaluation.
    • Produces annual project report summarizing key goals, accomplishments, and outcomes.
    • Oversees and manages project administrative staff, and contracted staff, as applicable.
    • Identifies and manages staffing for additional project needs.
     
  2. Facilitates integration of AF4Q initiative with other related initiatives
    • Identifies and facilitates opportunities to integrate project with other QC initiatives (e.g. Learning Network, annual conference).
    • Works with other relevant statewide groups, as applicable, to coordinate efforts (e.g. Maine Center for Disease Control & Prevention, MaineCare, etc.).
    • Develops relationships and works with other consumer organizations to find and cultivate interest in health care quality.
  3. Ensures appropriate communication with key stakeholders
    • Makes presentations about AF4Q initiative to individuals and groups
    • Writes articles and summaries of program results, and promotes awareness of the project with diverse groups.

WORKING CONDITIONS

  • Ability to travel throughout the state of Maine.
  • Normal office conditions with little exposure to excessive noise, dust, temperature, etc.

REPORTING RELATIONSHIPS

  • Reports to the Quality Counts Board.

Salary Range: $55,000 - $70,000

Interested individuals should send resume via email to Jean Eichenbaum, Quality Counts Program Director at jeaneichenbaum@aol.com by March 1, 2007. [return to top]

Maine Medical Volunteers in Haiti Panel, March 5 at Lithgow Public Library, Augusta

As part of "A Capital Read 2007", a panel discussion, "Maine Medical Volunteers in Haiti" will be presented on March 5th, 6:30 p.m. at Lithgow Library Reading Room

This panel, moderated by Dr. Laurel Coleman, features Elizabeth Foley, Dr. Cynthia DeSoi, Dr. Larry Mutty. Their discussion will explore the realities of medical issues and health care in Haiti. While poverty and AIDS are overwhelming problems in Haiti, these medical professionals are using their skills to make a difference. Find out how they got involved, what skills and preparations they needed, and how you might help in Haiti or other places that need medical volunteers. [return to top]

Governor's Office of Health Policy and Finance Issues Final Capital Investment Fund Amounts

On November 21, 2006, the Governor’s Office of Health Policy and Finance published a Notice of Proposed Value of the Capital Investment Fund, in accordance with Chapter 101, Capital Investment Fund. The Notice, which was published in the Kennebec Journal – as well as a detailed discussion of the process used to determine the proposed value sent to persons on the relevant Interested Parties list – solicited public comment on the proposed value of the Capital Investment Fund (CIF) either at a public hearing scheduled for December 8, 2006, or in writing, with written comments to be submitted no later than 5:00 PM, December 18, 2006. Five parties provided comments for consideration.

After considering the comments with the Advisory Council on Health Systems Development, GOHPF issues the following final CIF amounts:

 

 

Small Projects

Large Projects

Total

Non-Hospital

$124,795

$1,123,158

$1,247,953

Hospital

$873,567

$7,862,104

$8,735,671

Total

$9,983,624

[return to top]

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