June 18, 2007

 
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123rd Maine Legislature Approaches Wednesday Adjournment Date for First Regular Session

Before leaving Augusta for the summer and fall, Maine's 186 legislators must address the contentious tax reform and Dirigo Health proposals, as well as moving hundreds of routine bills through the legislative process.  The MMA urges you to contact your legislators to tell them not to include the cosmetic procedure sales tax in the tax reform bill (L.D. 1925) and not to tax Maine hospitals to fund the Dirigo Health Program (L.D. 1890).

The legislature's tax reform plan (L.D. 1925) & amendments to the Dirigo Health Program (L.D. 1890) are the two most significant issues facing the MMA as the legislative session winds down towards its scheduled adjournment some time on Wednesday, June 20, 2007. 

The MMA encourages you to contact your local legislators & Governor Baldacci on these issues during the next three days.  You can find your legislators & their contact information on the web at:  http://janus.state.me.us/house/townlist.htm.

 During the week when the legislature is in session, you can leave a message for legislators by using one of the following toll-free numbers:

For Senators:  1-800-423-6900
For House members:  1-800-423-2900

Dirigo Health Program

 

Last Tuesday, the Legislature's Insurance & Financial Services Committee held its last work session on L.D. 1890, An Act to Make Health Care Affordable, Accessible & Effective for All, the Governor's Dirigo 2.0 reform proposal.  

The Committee issued 3 separate reports.  Senate Chair Nancy Sullivan (D-York) supports some more aggressive insurance market reforms, including modifications to Maine's community rating & guaranteed issue laws, & establishment of a reinsurance high-risk pool, along with some modifications to the Dirigo Health Program.  Sen. Sullivan proposes to repeal the savings offset payment (SOP) & fund the program through a hospital tax not to exceed 1% of net patient service revenue & a health insurance premium tax not to exceed 1%.  She also proposes a modest voluntary assessment on Dirigo participants.  Sen. Peter Bowman (D-York) joined this report.

House Chair John Brautigam (D-Falmouth) proposed more modest insurance market reforms, modifications to the Dirigo Health Program, & repeal of the SOP.  He proposes to fund the program through increased tobacco taxes & a hospital surcharge.  The House Democrats all have joined this report.

The Republican report makes the same insurance market reforms as Sen. Sullivan's report, but retains the savings offset payment (SOP) as the funding mechanism.

Also, last week the legislature passed L.D. 431, An Act to Enable the Dirigo Health Program to be Self-Administered (supported by MMA) by votes of 83-55 in the House & 18-17 in the Senate.

Tax Reform 

By late Friday afternoon, the tax reform package appeared to be in danger.  The House failed to pass L.D. 1819, RESOLUTION, Proposing an Amendment to the Constitution of Maine to Restrict Tax Increases, a proposal requiring a 2/3 vote of both chambers for any increase or decrease in a tax rate, something that many Republicans claimed was a pre-requisite to their support for the statutory changes contained in L.D. 1925. 
 
L.D. 1925, including the cosmetic surgery tax, passed the House on an 87-49 vote on Wednesday, but remained tabled in the Senate for the rest of the week.  On Thursday, June 14, 2007, Bangor plastic surgeon John R. McGill, M.D. participated in a State House news conference expressing concerns with the tax reform package & spent several hours lobbying members on the cosmetic procedure tax.
 
The following are the MMA's latest talking points on L.D. 1925:
 
Among the services to which the sales tax would be extended in L.D. 1925 is an “elective cosmetic medical procedure.”  See Sec. E-6 on page 21 of the bill.  This section tries to exempt “reconstructive surgery or dentistry,” but experience in New Jersey, the only state to enact such a tax, suggests that application of this tax will be complicated & administratively burdensome for physician & dental practices, will be costly for middle income Maine families, & will not raise revenue sufficient to justify its weaknesses.  Recruiting physicians to Maine is difficult & this tax will further hamper recruitment of plastic surgeons, dermatologists, & otolaryngologists (ENT specialists).  
    NEW JERSEY SPONSOR CHANGES HIS MIND.  Assemblyman Joseph Cryan of Union, NJ sponsored a similar tax enacted in July 2004 with limited input from health care practitioners & patients.  Collections under this law have been 69% less than projected ($7.6 M v. $24 M estimated).  Application of the tax has been difficult – there is a fine line between “reconstructive” & “cosmetic” - & often the decisions are ones of medical judgment.  Some procedures are partially cosmetic & partially functional.  Physicians lost business to Philadelphia & New York.  Because of such problems, Assemblyman Cryan sponsored legislation to repeal the tax enacted at the end of 2006, but vetoed by Governor Corzine.  Assemblyman Cryan has lobbied colleagues in several other states to reject similar measures. 

    THIS IS A DISCRIMINATORY TAX ON WOMEN.  91% of patients receiving cosmetic procedures are women.  86% of these women are working.  60% of patients planning to have elective cosmetic surgery in the next 2 years have incomes between $30,000 & $90,000 per year, while 40% of those have incomes between $30,000 & $60,000.  These data contradict the notion that this is a luxury tax on a privileged few.  It is a selective tax on working women with average incomes.

    PHYSICIANS & DENTISTS DON’T NEED MORE ADMINISTRATIVE HASSLES.  The administration of this tax will be extremely difficult.  Practitioners today must argue with insurers & regulators about many issues of coverage & standard of care in a complex & rapidly changing health care system.  Please don’t add to this list debates about the line between “reconstructive” & “cosmetic” procedures.  Maine enacted legislation mandating insurance coverage for breast reconstruction after cancer treatment because insurers called the treatment cosmetic.  Practices do not now have office systems in place geared to the collection of sales tax – they will incur additional costs to comply.  Practices will face health information privacy questions each time they have a dispute with Maine Revenue Services.

Leavitt Aims to Put Top HIT Advisory Group In Private Sector Before Next Administration

Secretary of Health and Human Services Michael O. Leavitt announced his intention June 12 to convert the government's top advisory committee on health information technology into an independent, private-sector HIT leadership organization by January 2009.

The announcement--made at the 14th meeting of the panel known as America's Health Information Community--officially launches the transition plan. Leavitt created the advisory board in 2006 and selected its membership of federal, state, and private-sector executives. AHIC's charter called for it to explore creation of a successor group in the private sector.

"Over the past 20 months, AHIC has proven its ability to effectively and efficiently address the breadth of complex issues surrounding the advancement of better health care through health information exchange," Leavitt said. "Now we must preserve in the private sector the significant momentum the AHIC has created to engage key stakeholders across the health care spectrum to ensure long-term sustainability as a guiding force for health IT development."

After an AHIC member suggested that the successor organization be affiliated with the federal government, Leavitt said he did not want the next secretary of health and human services to be able to derail the Bush administration's market-based HIT initiative. President Bush in 2004 called for electronic health records to become a nationwide norm by 2014.

The secretary said health care payers, including government payers, will have a role in the successor organization, but he said that the organization eventually should be free of government funding. Leavitt told AHIC to help establish a broad-based organization representing many stakeholders.

Leavitt reminded AHIC that he can accept and implement, modify, or reject its recommendations. However, he also said he values the board's perspectives and asked it to carefully consider recommendations for the successor organization. He offered a detailed timeline for the transition before three consulting groups presented AHIC with ideas for the structure, financing, and operations of the successor organization.

HHS's Office of the National Coordinator is scheduled to release a draft proposal for the successor organization July 2, allowing three weeks of public comment. AHIC is to receive a revised ONC prototype proposal at its July 31 meeting and to recommend a final model to Leavitt at its Sept. 18 meeting.

Robert Kolodner, HHS national coordinator for health information technology and director of ONC, presented AHIC with draft principles and criteria for evaluating the proposed successor organization plan. Among the many evaluation criteria is one that calls for scrutinizing the governing documents, structure, and operations of the proposed entity to "ensure the privacy of consumer and provider data."  Asked what kind of provider data would be kept private, Kolodner explained that he hopes to bar pharmaceutical firms from scrutinizing doctors' prescription patterns. After the meeting, he said provider privacy would not apply to data regarding the quality or cost of provider services. [return to top]

Two Reports Compare Health System Performance Across States

A pair of reports released this week compare health care conditions among the states. "State Snapshots" was assembled by the U.S. Agency for Healthcare Research and Quality (AHRQ) from data collected for the agency’s 2006 National Healthcare Quality Report. The report examines what AHRQ calls “promising gains” that are being made in healthcare quality, and statistically combines 129 quality measures to rank states according to a five-color “performance meter.” Additionally, the report highlights some specific areas of concern, among them: barely half (approximately 54) percent of Medicare managed care patients responded that their health providers always listened carefully, explained things clearly, showed respect for what they had to say, and spent enough time with them; and only about 59 percent of adult surgery patients insured by Medicare receive appropriate timing of antibiotics. More information, along with links to the complete report and supporting materials can be found at:

http://www.ahrq.gov/news/press/pr2007/snapshotspr.htm

The second report, "Aiming Higher: Results from a State Scorecard on Health System Performance", was issued by the not-for-profit Commonwealth Fund, and compares states based on 32 indicators grouped into categories including: access; quality; avoidable hospital use and costs; and equity and healthy lives. Researchers found that—although no single state performed well in all categories—there was a strong disparity between the highest- and lowest-ranked states. Other findings of the report include: nearly 90,000 fewer deaths before age 75 would occur annually from conditions amenable to health care if all states achieved the level of the lowest rate state; and if all states reached the lowest levels of potentially preventable admissions and readmissions, these hospitalizations could be reduced by 30 percent to 47 percent and save Medicare as much as $5 billion each year. More information, along with links to the complete report and supporting materials can be found at:

http://www.commonwealthfund.org/newsroom/newsroom_show.htm?doc_id=502554

Across all measures, according to USA Today's coverage, "the top-performing five states are Hawaii, Iowa, New Hampshire, Vermont and Maine. The lowest-performing states were Kentucky, Louisiana, Nevada, Arkansas, Texas, with Mississippi and Oklahoma tying for last place. The report, "Aiming Higher: Results from a State Scorecard on Health System Performance," used "data mainly gleaned from government agencies, such as Medicare, the Census Bureau and the CDC." 

WebMD (6/14, Hitti) adds that "for every additional condition patients had, the quality of their medical care rose by about 2 percent." The reasons for that pattern "aren't clear, but the researchers suggest several possibilities," including that "patients with several conditions see doctors more often and thus have more chances to be offered recommended services" and patients with multiple conditions "who see specialists may also 'advocate more effectively' for the care they need."

Higher costs may not mean better quality health care.   The New York Times (6/14, Abelson) notes that a report by the Pennsylvania Health Care Cost Containment Council, a state agency, "provides a rare public glimpse of detailed information about hospital payments and patient outcomes. And the seemingly random nature of the payments is striking." For example, "although federal Medicare payments are largely fixed, they varied somewhat among the Pennsylvania hospitals surveyed. The far greater disparity involved commercial insurers, which must negotiate their rates hospital by hospital." Moreover, the "survey found that good care can go unrewarded." For example, "one Philadelphia-area hospital...which performs a large number of bypass surgeries and has a high success rate, according to the survey, was paid an average of $33,549 by private insurers. That was less than half the nearly $80,000 in average payments received by the other hospitals, with poorer track records." [return to top]

Over One Hundred Persons to Attend Wednesday Practice Management Seminar in Auburn

Over one hundred practice managers and physicians are expected to attend MMA's Sixteenth Annual Physician Practice Management Seminar on Wednesday at the Hilton Garden Inn in Auburn.  The program begins at 8:30am with a keynote presentation by Erik Steele, D.O. of Bangor.  Presentations following the keynote cover the topics of quality improvement,  the characteristics of a successful medical practice, workforce shortages and MaineCare.  In the afternoon, a dozen breakout sessions are offered on a variety of topics ranging from a Board of Licensure in Medicine Update to the Medicare Quality reporting initiative.

Among the presenters are MaineCare Director Tony Marple and new Region One CMS Medical Director Larry Kassler, M.D.

A limited number of vendors have also been invited to exhibit, including OfficeMax, the Thomas Agency, Northern Data, HRH Northern New England,  Network Systems, the Coding Center and Medical Mutual Insurance Company of Maine.

A limited number of walk-ins can be accomodated, but call the office at 622-3374 (Press 0) to let us know so that we can plan for adequate food and materials.  Over seven hours of category one CME are available. [return to top]

Voters in Bar Harbor Reject Proposed Ban on Smoking in Cars with Kids

Voters in Bar Harbor last Tuesday rejected a proposed ban on smoking in vehicles when minors are present.  The vote was 439 to 369, which was much closer than many proponents felt was likely.  Only Bangor currently has such a municipal ordinance.

Bar Harbor Councilor Jeff Dobbs lead the petition drive which placed the proposed smoking ban on the ballot.  He noted after the election that he is considering mounting another petition effort next year on the same subject. 

The Maine Medical Association will consider a resolution on the issue at its Annual Meeting in Bar Harbor in September (Sept. 8).  The resolution is being prepared by the Association's Public Health Committee. [return to top]

CMS Offers Two National Provider Calls, June 20 and June 27

CMS will offer two National Provider calls, June 20 from 3:30 pm to 5:30 pm EDT, and June 27, 3:00 pm to 5:00 pm EDT. Both calls are toll-free and will have a question-and-answer session. Materials to download before the call will be posted on CMS's PQRI website, www.cms.hhs.gov/PQRI , in the Eduational Resources section. To register, go to the "sponsored calls" section at www.cms.hhs.gov/PQRI and scroll down to downloads for instructions. A replay of a June 13 call will be accessible from 7:00 pm EDT June 13 to June 20. The call in number for the replay is (800) 642-1687; the passcode is 3685662. [return to top]

Public Citizen Issues Annual Report on State Medical Boards

On June 6, 2007, Public Citizen issued its annual report on disciplinary actions by state medical boards, concluding that Mississippi ranked last & Alaska first in the rate of serious disciplinary action taken against physicians from 2004 through 2006.  Public Citizen found that medical boards took 2916 serious disciplinary actions against physicians in 2006, down 10.4% from the 3255 actions taken in 2005.  The report found a national average disciplinary rate of 3.18 per 1000 physicians in 2006 compared with 3.62 per 1000 in 2005.  Maine ranked neither in the top 10 or the bottom 10 states in the report.

You can find the report on the web at:  http://www.citizen.org/publications/release.cfm?ID=7525.
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Hanley Forum Addresses Need for Collaboration

Approximately fifty invitees to the Hanley Forum met on Friday (June 15) at Bowdoin College to discuss how the various organizations and individuals in Maine working to improve the quality of medicine in Maine can collaborate in order to be more effective.

The Hanley Forum's topic this year was "Let's Accomplish More!...Improving Health Quality and Outcomes through Collaborative Leadership". An interesting series of observations from David Flanagan, Esq. (former CEO of Central Maine Power and the General Counsel to the US Senate's Homeland Security Committee's special investigation into Hurricane Katrina) about what went right and what went wrong in the first few day's of Katrina's aftermath began the session. Mr. Flanagan was able to cite examples of leadership styles and how they combined with information sharing (or lack thereof) to define the success or failure of different leaders and agencies involved in Katrina response and relief. Parallels were drawn between this complex national disaster and the responses of different agencies to it and the complexity of health care quality and the involvement of different organizations in it. There were twenty-nine organizations with a stake in the healthcare quality movement in Maine who were invited and sent representatives to the Forum. Most of the work in the Forum focused on how to work with other agencies: how to share agendas and concerns, how to share resources, and how to stay focused on the big picture. The MMA was represented by Executive Vice President Gordon Smith and Dr. David McDermott. Dr. McDermott is a family physician in Dover-Foxcroft and chairs the MMA's committee on Peer Review and Quality Improvement.

Other presenters included Joseph McCannon, Vice President of IHI (Institute for Healthcare Improvement) and manager of its "Five Million Lives" campaign, and Ed Cass of Senn-Delaney Leadership. [return to top]

MMA Committee on Peer Review and Quality Improvement Meets June 21

The Committee on Peer Review and Quality Improvement meets again on Thursday afternoon of this week, June 21st, from 4 until 6 PM at MMA Headquarters. MMA members with an interest in the quality work being done by the MMA are welcome to attend. Please email Dr. McDermott if you have questions about the work of the committee or this meeting at dmcdermott@mayohospital.com.

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