October 29, 2007

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Primary Care Study Commission Holds Second Meeting

This legislative study group, inspired by physician-legislator Lisa T. Marrache, M.D., is considering some of the most difficult issues facing medicine in Maine today.  The Commission includes 3 physicians (MMA Immediate Past President Kevin Flanigan, M.D., Jeffrey Aalberg, M.D., & John Irwin, D.O.) & will make its recommendations to the legislature for consideration during the 2008 session.

The Commission to Study Primary Care Medical Practice, established by a joint order (S.P. 732) during the First Regular Session of the 123rd Legislature, held its second meeting on Friday, October 26, 2007.  The focus of the meeting was continuing to gather information on primary care practice in Maine. 

At this meeting, the group heard a presentation on the Patient Centered Medical Home by Commission member Jeffrey Aalberg, M.D. & the following 3 panel presentations: 

1.  Panel discussion on the Business Climate, Malpractice, Insurance & Rate Negotiations

  • Martha Ridge, Anthem BCBS
  • Douglas J. Jorgensen, D.O., C.P.C., Jorgensen Consulting, LLC
  • Terrence J. Sheehan, M.D., President & CEO, Medical Mutual Insurance Company of Maine
  • Mark Souders, Director of Payer & Employer Contracting, Kennebec Regional Health Alliance & MaineGeneral Health
2.  Panel Discussion on Challenges for Primary Care Physicians in Maine
  • Kevin S. Flanigan, M.D. (MMA's Immediate Past President)
  • John H. Irwin, D.O.
  • Jeffrey M. Lovitz, M.D.
  • Timothy Pieh, M.D., 3rd Year Resident, Maine-Dartmouth Family Practice Residency Program
  • Amy Madden, M.D., 2nd Year Resident, Family Medicine Institute (MMA Executive Committee member)
  • Kelley J. Harmon, D.O., 1st Year Resident, Maine-Dartmouth Family Practice Residency Program
3.  Panel Discussion on the Future of Primary Care & Regional Issues
  • Jacquelyn Cawley, D.O., Interim Dean/V.P. for Health Services, University of New England College of Osteopathic Medicine
  • Hugh F. Harwood, M.D.
  • Judd Knox, President & CEO, York Hospital
  • Jeffrey Landfair, M.D.
  • Virginia Ann La Noce, F.N.P.
  • Full Circle Health Care - Cathy Bradley, F.N.P. & E. Victoria Grover, PA-C
Dr. Flanigan presented testimony in which he outlined 3 primary challenges for primary care practitioners in private practice:
  • inadequate reimbursement for physician services, particularly by the government programs;
  • administrative burdens in the practice of medicine; &
  • issues with medical management & quality improvement initiatives.
Dr. Flanigan's testimony soon will be posted on the MMA website.

The Commission has 2 more meetings planned - on November 9, 2007 & December 7, 2007.  The Commission must make its recommendations, including any proposed legislation, to the Second Regular Session of the 123rd Legislature.

House Passes Revised SCHIP Bill, but Not by Veto-Proof Margin

On October 25, 2007, the House again passed an SCHIP reauthorization bill (H.R. 3963) by a vote of 265-142.  43 Republicans voted for the bill - about the same number of Republicans who voted to override the President's veto of H.R. 976 & who voted with the Democrats in favor of the original bill in September.  The White House said that this bill did not address the President's objections to the original SCHIP reauthorization bill "in a meaningful way."  The Senate may take up the bill this week.

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Legislative Council Accepts Bills for Consideration During Second Regular Session

On Thursday, October 25, 2007, the 10 members of the Maine Legislature's leadership, known as the Legislative Council, met to consider legislators' bill requests for the Second Regular Session that will begin just after the New Year & will run until mid-April.  In order to be considered during the second session, bills are supposed to be "emergency measures" & must have a majority vote of the Legislative Council to be admitted.  Legislative requests denied may be appealed by the sponsor in November.  The list of bills admitted during the first review by the Legislative Council may be found on the web at:  http://janus.state.me.us/legis/lio/accepted_by_sub_123R2_2007/accbysub.pdf.

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MECMS PAG/TAG Receive Update on Fiscal Agent Procurement Schedule

At a combined meeting of the Governor's Provider Advisory Group (PAG) & Technical Advisory Group (TAG) on Thursday, October 25, 2007, DHHS representatives outlined the following fiscal agent procurement schedule that has been approved by CMS:

  • Phase I vendor site visits are completed;
  • RFP-type document distributed to vendors on October 5, 2007 - responses are due by November 29, 2007;
  • Phase II will be a more detailed evaluation of vendor finalists; site visits & presentations will take place from November 5 - 16, 2007;
  • Phase III will include selection of a vendor, negotiations of a final agreement, & approval by CMS - expected to be completed by December 21, 2007;
  • Phase IV is implementation - anticipated to be complete by January 2010.
DHHS staff also provided members of both groups with updates on the MECMS metrics, the status of interim payment recovery, & MECMS repair initiatives, patches, & implications.

The PAG will meet next on Thursday, November 8, 2007 & the PAG/TAG will have a combined meeting on December 6, 2007. 
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AMA Calls for Nominees for Dr. Nathan Davis Awards for Outstanding Government Service

The AMA invites you to submit nominations for the 2008 Dr. Nathan Davis Awards for Outstanding Government Service.  The awards, currently in their 20th year of presentation, are recognized nationally as one of the most prestigious honors extended to elected officials & career government employees for outstanding endeavors that advance public health.  The AMA presents these awards in 7 categories of public service, including local, state, & federal government.

The Davis awards are presented at a Gala Banquet at the Grand Hyatt Washington Hotel in Washington, D.C. on Tuesday, April 1, 2008 in conjunction with the AMA National Advocacy Conference.  Maine CDC Director Dora Ann Mills, M.D., M.P.H. was a Davis award recipient earlier this year. 

The deadline for submissions is 5 p.m. on Friday, November 9, 2007.  For more information, you may contact the AMA Awards Secretariat at 202-783-9156 or see the following portion of the AMA web site:  http://www.ama-assn.org/ama/pub/category/8234.html.
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Report on Dirigo Board Meeting; Contract Signed with Harvard Pilgrim

The Board of Trustees of the Dirigo Health Agency met on Tuesday, Oct. 23, and interrupted their meeting long enough to officially sign a contract with Harvard Pilgrim Health Care to administer the DirigoChoice insurance product, thus ensuring continued coverage for the approximately 14,750 persons currently enrolled.  The transition from the existing carrier, Anthem, will take place on Jan. 1, 2008.  The contract is a one-year, renewable contract which will immediately increase Harvard Pilgrim's book of business in Maine by approximately 20%. 

Harvard Pilgrim Health Care, a non-profit insurer based in Massachusetts, has more than 1 million members in the sates of Maine, Massachusetts, and New Hampshire.  Its Chief Operating Officer, Bruce Bullen, attending Tuesday's Board meeting along with Robert Downs, the plan's manager in Maine. 

"We wanted to do something to increase our visibility in Maine.  We saw this as a good opportunity to partner with the state and we really think we can make Dirigo a viable program," Bullen said.

Charles Baker, the CEO of Harvard Pilgrim, gave the keynote presentation at the MMA Annual Meeting in September, the day following the announcement that the company would be the new carrier for the DirigoChoice product.

Physicians seeing DirigoChoice patients will receive the same reimbursement as they currently receive for seeing any other Harvard Pilgrim patient.

Harvard Pilgrim has agreed to limit DirigoChoice premium increases in 2008 to 2% for small groups and 17% for individuals and sole proprietors.  The increases will not take place on Jan. 1, but will kick in during the month that each group or individual renews.  The carrier has targetted a medical loss ratio of 90%. (Anthem had targetted 80%, thus retaining 20% for administration, broker's commissions and profit.)

Much of the remainder of the Board meeting focused on the financial difficulties facing the agency because of the decision of the Acting Insurance Superintendent to limit the amount of the Savings Offset Payment (SOP) to about one-half of what the Agency had recommended and the failure of the Legislature to pass legislation authorizing an alternative funding source.  Without an alternative to the SOP, the agency will run out of funds in February, 2009.  Because of the financial issues, enrollment in the product for the population which is subsidized has been suspended.

In her legislative report, Trish Riley, Director of the Governor's Office of Health Care Finance and Policy, stated that the administration is working with legislative leaders on a proposal to address reform of the individual market.  Solutions to the problems with the individual market alluded  legislators during the last session, where proposals to enact a reform statute based upon a re-insurance model for high cost individuals were not successful.

The Board will meet next on December 10, 2007.  [return to top]

MMA Contract Review Service

One of the many benefits of MMA is its contract review service.  Lawyers at the Association will review employment contracts and managed care contracts for members, for a flat fee of $250 payable to MMA.  A legal analysis of each contract is prepared and consultation provided to the member.

During Mr. Smith's three month sabbatical, MMA has been fortunate to obtain the services of three experienced health lawyers (all of whom are corporate affiliates of MMA) who have agreed to provide the reviews for the same fee.  The service can be accessed by sending your contract to the MMA's Acting Executive Vice President Andrew MacLean (amaclean@mainemed.com). 

Many thanks to attorneys Ken Lehman, Mike Duddy, and John Gleason for offering their assistance. [return to top]

More Than 200 Attend Health, Culture, & Literacy Conference in Freeport

On Friday, October 26, 2007, more than 200 individuals attended a one-day conference  for health providers and patients exploring the issues of Health, Culture and Literacy: Solutions for Clear Health Communication.  The program was put together by MaineHealth and the University of New England with MMA and many other organizations participating in an advisory committee assisting with the important event.  The conference was subscribed to capacity and nearly one hundred persons were denied registration because of space limitations.

The conference began with an inspirational address by Anne Fadiman, author of the best selling book, The Spirit Catches You and You Fall Down.  Following Ms. Fadiman's talk, Terry Davis, PhD, Professor of Medicine and Pediatrics at Louisiana State University, Health Sciences Center, discussed the prevalence of low health literacy and practical solutions to it. 

Workshops made up the rest of the day, including offerings on Understanding Culture and Clinical Interactions;  How Patient Friendly is Your Practice -an audit tool for assessing your practice;  New Cultures, New Connections, Informed Consent & Health Literacy;  and Tools and Techniques:  What's Good/What's Great. 

Research has revealed for many years that both a lack of literacy and cutural issues are substantial barriers to meaningful communications between patients and physicians.  A substantial effort is now underway in Maine to remove these barriers and this important conference was an excellent beginning.  There is much more to be done.  MMA will inform members through the Weekly Update and Maine Medicine of additional opportunities for education and resources in this subject. [return to top]

Hot Topics in Hospice! And Annual Blaine House Tea, November 8, 2007

This program will offer an opportunity for participants to dialogue with representatives from National Hospice and Palliative Care Organization (NHPCO), National Government Services (NGS), Centers for Medicare Services (CMS), Maine Department of Licensing and Certification, and Office of MaineCare Services.

Guest presenters include:

    • Jennifer Kennedy from NHPCO
    • Susan Albrecht, Centers for Medicare Services Boston
    • Alyssa Morrison, Office of MaineCare Services
    • Carol Cherry, National Government Services
    • Alelia Hilt-Lash, Department of Licensing and Certification

Each panel member will offer a brief presentation and then take questions from the floor. The day will end with a general question and answer session.

$65 Registration fee *
OR CALL 1-800-438-5963

8:00 a.m.       Registration and Continental Breakfast
8:30 a.m.       Presentations from guest speakers
12:15 p.m.     Beef and Vegetarian Lasagna Lunch Buffet
1:15 p.m.       Closing remarks

Council members receive a $6 discount ($59). Registration received after November 5 will be charged a $6 late fee ($71).

Annual Blaine House Tea

Welcoming remarks by Governor John Baldacci and presentation by Attorney General Steve Rowe.
Please join us to honor the many dedicated volunteers and professionals providing care and support to individuals and families throughout the State of Maine in celebration of National Hospice Month and National Home Care Month

“Perspectives on End-of-Life Care: What the Community Has to Say”
For seven weeks, Attorney General Rowe has been listening to community members around the state answer some basic questions about end-of-life care:  How are we doing? What is working well? What is missing? What conversations do we need to have? Who needs to be involved? Is pain being managed? Are wishes being respected?  Attorney General Rowe will share what he has learned from our friends and neighbors in these “town-hall” meetings.

<> http://www.mainehospicecouncil.org/registration_blaine_house_tea.htm)
There is no charge for this event, but registration is required.
OR CALL 1-800-438-5963 [return to top]

Three Cases of Mumps Diagnosed in Maine

Officials from the Maine Center for Disease Control and Prevention announced last week that three cases of mumps had been diagnosed in Maine, the first such cases in a dozen years.  There was apparently no known connection among the three adults infected with the virus.  A health alert was sent out to all physicians in the state.

The three cases were in Cumberland and York counties and public health officials were awaiting the possible diagnosis of two additional cases in Kennebec county.

Adults born after 1957 and unvaccinated children are at the greatest risk of contracting mumps and suffering its complications, which may include reproductive complications including sterility, meningitis, pancreatitis, and permanent hearing loss.

Dr. Dora Anne Mills, Director of the Maine CDC, stated that she expects more cases to surface in Maine in the coming weeks.  Two of the stricken adults were hospitalized briefly, but all are expected to recover fully.  State officials are still trying to trace the source of the infection.

Dr. Mills noted that recent outbreaks in Maine and across the country are very likely the result of a decline in vaccination rates among children. [return to top]

Aetna Profit Rises, Beats Wall Street View

Hartford, Connecticut-based Aetna, Inc. reported a 4% increase in earnings in the third quarter on cost cuts and rising medical membership, prompting the company to boost profit forecasts. Net income rose to $496.7 million or 95 cents per share. Last year at this time, net income was $476.4 million or 85 cents per share. Total revenue increased 11% to $6.96 billion. [return to top]

WellPoint Profit is Up by 7%

WellPoint, Inc. credited higher membership and improved control of operating costs to their 7% increase in third-quarter profit.  Net income increased to $868 million or $1.45 per share, from $810.8 million, or $1.29 per share a year earlier. [return to top]

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