December 10, 2007

 
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Timeline for Medicare Physician Payment Fix Grows Tight

An omnibus health care spending bill to be considered in the House this week appears to be the best chance for a 1 or 2-year Medicare SGR fix, other Medicare policy changes, and a long-term funding extension for the SCHIP before the end of the year.  Last Thursday, December 6, 2007, MMA Past President, current AMA delegate, and Bangor plastic surgeon John R. McGill, M.D. participated in a Medicare advocacy forum sponsored by AARP and attended by more than 150 senior citizens in Bangor.  Dr. McGill addressed the likely impact on access to physician services by Medicare beneficiaries if the proposed cut is carried out.



Congressional action to avert the scheduled 10.1% reduction in physician reimbursement by Medicare did not take place this past week and the action this coming week moves to a negotiation between the Senate Finance Committee leadership and House leadership in the hope that the necessary language can be included in an omnibus appropriations package expected to pass before the holiday recess.

Hopes that the Senate Finance Committee would mark up a bill appropriating funds to restore the cuts faded mid-week when the Bush administration, through DHHS Secretary Michael Leavitt, informed congressional leaders that President Bush would veto a bill which paid for the fee fix by cutting reimbursement to Medicare Advantage plans.  By the end of the week, Senate Finance Committee leadership announced that it would not try to mark up a Senate bill, but would instead work directly with the House in hopes that a fix could be included in an omnibus appropriations package.

Action must take place almost immediately, as the House expects to adjourn by Dec. 15 and the Senate by Dec. 22.  A house vote is tentatively scheduled for this coming Tuesday on an omnibus appropriations bill with a possible price tag of $520 billion.  If an omnibus bill is not agreed to this coming week, a continuing resolution would be needed to carry the cost of operating the government from Dec. 14 through Dec. 21 and then a larger continuing resolution to cover the costs until the Congress convenes in January.

In the past years, physician payment reductions have been paid for through increased cuts in future years.  Given the administration's opposition to using the Medicare Advantage plans to pay for the legislation, the likelihood now is that the Congress will restore the cut but pay for it again with future cuts.  The AMA, several national specialty societies and most of the state medical societies (including MMA) signed onto a letter this past week opposing any legislation that would correct the fee reduction by paying for it with future cuts.  The letter, addressed to the Senate Finance Committee, eventually became moot when the committee mark up of the bill was canceled in favor of the alternate approach of directly negotiating with the House.

At this point, it is still very possible that the January 1, 2008 cut will be avoided, but any such correction is likely to be paid for by future cuts.  If this course is taken by the Congress, physicians would have to begin their advocacy almost immediately to avoid an anticipated 15% cut on Jan. 1, 2009. 

Health Information Technology Provisions Likely to be Included in Medicare Bill

While DHHS Secretary Leavitt expressed opposition to the Senate approach of offsetting the cost of the fix with cuts to the Medicare Advantage Plans, he did express support for and encouraged inclusion of health information technology provisions in the legislation in order to promote cost savings.  The HIT language that Secretary Leavitt proposed would require all physicians to meet DHHS HIT standards in order to be eligible for higher Medicare payments.

This past week, Massachusetts Senator John Kerry, introduced an electronic prescribing bill as a stand-alone bill.  Its provisions have also been included in the Medicare bill discussed above.  The legislation would require that all physicians implement e-prescribing by 2011.  Those physicians who have trouble attaining the necessary equipment in the time allotted would receive a one to two year waiver.

Maine Medical Center Board Approves Medical Education Partnership with Tufts

Maine Medical Center President Vince Conti announced to the MMC medical staff this week that the Board of the Medical Center had approved the plans to work with Tufts Medical School to establish a MMC-based undergraduate medical program.  This unique program, developed conceptually by a work group of physicians, was described previously in an earlier issue of Maine Medicine Weekly Update.  It is hoped that as many as twenty slots annually in the new program would be available to students from Maine. [return to top]

Judiciary Committee Maintains Status Quo in Medical Liability Reform Debate

On Thursday, December 6, 2007, the 123rd Maine Legislature's Judiciary Committee held a public hearing on 6 medical liability bills carried over from the First Regular Session earlier in 2007.  The Committee considered the following bills:

  • L.D. 367, An Act to Protect Emergency Room Personnel from Civil Liability (for denying drugs to potential drug seekers)
  • L.D. 469, An Act to Disseminate "Lessons Learned" from Medical Injury Claims (based upon liability claims data analyzed by the Board of Licensure in Medicine)
  • L.D. 608, An Act to Extend the Statute of Limitations  for Certain Medical Malpractice Cases (proposed a "discovery rule" for the statute of limitations)
  • L.D. 684, An Act to Permit Medical Providers an Opportunity to Express Regret for a Medical Error (duplicative of legislation enacted in the 122nd Maine Legislature)
  • L.D. 857, Resolve, to Create a Medical Malpractice Study Group (Bureau of Insurance conducted a study of the Maine market in 2005 as required by the Dirigo Health legislation)
  • L.D. 1271, An Act to Establish Health Care Practitioner Immunity for Consulting Physicians in Critical Specialties or Subspecialties (proposed "Good Samaritan" protection for "curbside consults"

As reported last week, the Judiciary Committee leadership had advised interested parties that it did not intend to move forward with legislation in favor of either side in the tort reform debate, but to maintain the status quo.  Accordingly, the MMA, the Maine Hospital Association, Medical Mutual Insurance Company of Maine, and the Maine Trial Lawyers Association agreed to recommend that the Committee kill all 6 of the bills.  At the same time, each organization gave Committee members its perspective on the issues as well as the history of the tort reform debate in Maine. 

Two members of the public spoke in favor of L.D. 608, the most damaging of the bills for the tort reform coalition, and they were the only members of the public to speak on any of them.  Richard Flowerdew, M.D. spoke on several bills on behalf of Spectrum Medical Group. 

While the MMA was disappointed not to move forward with L.D. 1271, submitted on behalf of the MMA, the relatively stable liability insurance market, the political environment, and the downside risk of action on L.D. 608 and several other of the 6 bills caused the MMA, along with other members of the coalition, to pursue this course of action.

You can find members of the Judiciary Committee on the web at:  http://janus.state.me.us/house/jt_com/jud.htm. [return to top]

Primary Care Study Commission Considers Recommendations to Legislature

The Commission to Study Primary Care Medical Practice, created by a joint order in the First Regular Session of the 123rd Legislature, held its 4th and final meeting on Friday, December 3, 2007.  The physician members of the Commission are MMA Immediate Past President Kevin S. Flanigan, M.D., Jeffrey Aalberg, M.D., and John Irwin, D.O.  During the 6-hour meeting, members reviewed summary documents and draft recommendations prepared by Elizabeth Cooper, Legislative Analyst.  The Commission report's "Findings and Recommendations" section likely will be broken down into the following categories:

  • Administrative & Business Climate;
  • Education & Training;
  • Patient Centered Medical Home;
  • Payment for Primary Care; and
  • MaineCare Reimbursement.

The Commission's recommendations certainly will include recommendations to increase MaineCare reimbursement (eventually to match Medicare rates), to reduce the administrative burdens in the MaineCare program (such as prior authorization), to promote the patient centered medical home, and to try to address the undervaluing of evaluation and management codes in the RBRVS system.

The Commission's report and recommendations should be released in early January 2008.
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Study Shows Doctors are Reluctant to Report Incompetence by Peers

A study based upon a survey of more than 1600 physicians published in the December 4, 2007 issue of the Annals of Internal Medicine concludes that 45% of physicians with knowledge of impaired or incompetent colleagues or of serious medical errors do not always report them.  The survey of physicians in anesthesiology, cardiology, family practice, internal medicine, pediatrics, and surgery focused on 3 principal areas of professional standards:  competence, moral attributes, and self regulation.

Maine law, 24 M.R.S.A. section 2505, requires a Maine physician to report to the appropriate licensing board, " reasonable knowledge of acts . . . . amounting to gross or repeated medical malpractice, habitual drunkenness, addiction to the use of drugs, professional incompetence or sexual misconduct identified by board rule."

MMA President William M. Strassberg, M.D. is focusing his Presidential year on efforts to improve "professionalism" in medicine in Maine.

The study, Professionalism Among Physicians:  Results of a National Survey, is available on the web at:  http://www.imapny.org/. [return to top]

Evaluation of Dirigo Health Program Access Provisions Published by Commonwealth Fund

A study entitled, Leading the Way?  Maine's Initial Experience in Expanding Coverage Through Dirigo Health Reforms performed by Mathematica Policy Research, Inc. and funded by the Robert Wood Johnson Foundation and the Commonwealth Fund, was published on December 5, 2007.

The study pointed out that the legislation's goal was to cover Maine's 136,000 uninsured by 2009 when it was enacted in 2003.  As of August 2007, the DirigoChoice product covered about 15,100.  According to the report, DirigoChoice covers less than 10% of the uninsured population.  Most of the uninsured covered through the Dirigo Health Program have been covered by a Medicaid eligibility expansion associated with the Dirigo Program and a separate unrelated Medicaid expansion. 

The study is available on the web at:  http://www.mathematica-mpr.com/publications/PDFs/Dirigofinalrpt.pdf.
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CMS National Provider Conference Call on PQRI, December 19, 3-5pm

The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host the second in a series of national provider conference calls on the 2008 Physician Quality Reporting Initiative (PQRI).

This toll-free call will take place from 3:00 p.m. – 5:00 p.m., EST, on Wednesday, December 19, 2007. The call will cover the 119 PQRI measures available for reporting by eligible professionals in 2008. Information on the 2007 and 2008 PQRI programs are posted to the PQRI web page located at, http://www.cms.hhs.gov/PQRI, on the CMS website. The website is continually being updated, so check it often for the most current information available.

There are many educational resources available on the webpage, so feel free to download the available resources prior to the call. In addition to a formal presentation, this toll-free question and answer teleconference will provide eligible professionals the opportunity to ask questions of CMS subject matter experts. Materials for the call will be posted at least one day prior to the teleconference on the PQRI webpage at, http://www.cms.hhs.gov/PQRI, on the CMS website in the Educational Resources section so that you can follow along with the presenters.

Conference call details:
Date: December 19, 2007
Conference Title: 2008 Physician Quality Reporting Initiative National Provider
Call Time: 3:00-5:00 p.m. EST

In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation.

If you cannot attend the call, replay information is available below. Registration will close at 3:00 p.m. EST on December 18, 2007, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.

  1. To register for the call participants need to go to: http://www2.eventsvc.com/palmettogba/121907
  2. Fill in all required data.
  3. Verify your time zone is displayed correctly the drop down box.
  4. Click "Register".
  5. You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Note: Please print and save this page in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as messages may have been directed there. .

For anyone unable to attend, a replay option will be available shortly following the call. This replay will be accessible from 5:30 p.m. EST 12/19/2007 until 11:59 p.m. EST 12/26/2007. The call-in data for the replay is (800) 642-1687 and the passcode is 24219737. [return to top]

Addictions: Moving from Problems to Solutions, Offered at Dana Center, January 25, 2008

"Addictions: Moving From Problems to Solutions", January 25, 2008, at the Charles A. Dana Health Education Center, Portland, Maine

Health care professionals are faced with the challenge of providing care and treatment for patients who experience the disease of addiction which is pervasive in today’s society. This program is designed for clinicians who practice in any setting and is intended to: increase professional awareness and sensitivity; provide an understanding of the underlying pathophysiology of addiction; and offer approaches and resources available for the care and management of addicted patients and their families.

Objectives

  • Investigate the present status of the substance abuse problem in the State of Maine.
  • Examine the neurologic mechanisms of addiction as a disease and causes of associated behaviors.
  • Discuss prevalence of alcohol addiction disorders and implications for healthcare professionals.
  • Distinguish distinctive conditions and needs associated with women and addictions.
  • Describe approaches to and options for treatment within the context of:
    • Women’s additions
    • Opiate addictions
    • Tobacco addictions
  • Weigh the use of motivational interviewing as a patient-centered approach to promote changes in patient behavior.
  • Discuss the prevalence, risk factors, recognition, and treatment options for addictions in healthcare professionals.
  • Examine the concepts and process of “recovery” and variables that impact the same.
  • Address the challenges of providing successful pain management for addicted and recovering patients.
  • Analyze best use, interpretation, and limitations of drug screening.
  • Relate the role and impact of families in the setting of patient addictions.
  • Through panel presentation, address situational challenges and questions posed by program participants.

For more information, call:  207/ 662-2290 or email Anne Bowdoin, bowdoa@mmc.org [return to top]

Monthly MMA Educational Programs Begin Jan. 4 with "Marketing Your Practice"

MMA begins its third year of the popular "First Fridays" educational programs with an innovative program offered January 4, 2008 at the MMA offices in Manchester entitled, How to Market Your Medical Practice & Collateral:  Production & Printing.  The program will be presented by Healthcare Marketing, a Portland marketing and public relations firm.  Since 1989, Healthcare Marketing has helped clients throughout New England promote their products and services with outstanding creative design, planning, production, and media placement expertise.

The market for health care services is rapidly expanding and your practice can benefit significantly from the knowledge of experienced marketing professionals.

Begin your new year by learning to execute a superior marketing campaign.  Health care today is not immune from the forces of the marketplace.  Whether you need a new patient brochure, a new website, or a promotional video, this three hour program will be your best investment.

A $60 fee covers all materials and breakfast.  The program runs from 9:00 am to noon and you may register on-line at www.mainemed.com or by calling 622-3374 (press 0 for assistance). [return to top]

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