December 31, 2007

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123rd Maine Legislature Convenes Wednesday for Second Session

The 123rd Maine Legislature returns to Augusta this week to begin its Second Regular Session.  The session is expected to last about four months and to focus on the state budget deficit, school consolidation, and other administrative and fiscal issues.  Without new leadership emerging to work on health care reform, it is unlikely that meaningful reform can take place when efforts such as the Blue Ribbon Commission recommendations for Dirigo failed last year, with this same group of legislators.
Maine Medical Association staff Andrew MacLean, Gordon Smith, and Kellie Miller will direct the Association's advocacy efforts this year, and with staff from the Maine Osteopathic Association, will provide assistance to the "Doctor of the Day" program.  Physicians interested in serving as the "Doctor of the Day" should communicate with Andrew MacLean at

Among the health care issues to be resolved are the following:

  • Efforts by the "direct entry" midwives to be licensed (opposed by MMA, the Maine Chapter of ACOG, the Maine Chapter of the American Academy of Pediatrics, and the Maine Academy of Family Physicians).

  • Seven health insurance bills carried over from the previous session, all pending before the Joint Standing Committee on Insurance and Financial Affairs.  The proposals cover a wide variety of issues, including market reform, rate regulation, single payor, mandated benefits, and Dirigo Health.

  • A proposal to mandate that employers with more than 25 employees provide up to five sick days per year to their full and part-time employees.

MMA's Legislative Committee, under the leadership of Katherine Pope, M.D., Chair and Samuel Solish, M.D., Vice Chair, will meet on a regular basis to review pending proposals and to determine the MMA position on each.

Happy New Year From the MMA!
MMA President William Strassberg, M.D. and MMA EVP Gordon Smith, on behalf of the physician leadership and staff of the organization, wish all Maine physicians, their staffs, and their families a happy and prosperous 2008.  The MMA enjoyed some successes in its advocacy, member services, continuing medical education, and member recruitment and retention roles in 2007 and the leadership and staff look forward to the new year.  The Executive Committee will hold its annual retreat at the Wentworth-by-the-Sea near Portsmouth, NH during the weekend of January 18 - 20, 2008 where the focus will be the President's theme of "professionalism" and a continuation of the MMA's ongoing strategic planning process. [return to top]

Ready for Consumer-Driven Healthcare? Start with January 4 First Friday Program
Given the drive toward more patient-directed models of care, marketing of a medical practice is increasingly important.  Simply providing excellent care is not always good enough when there is a variety of providers for consumers to choose from.

MMA's popular "First Fridays" education series begins 2008 with a program focused on marketing your practice, presented by HealthCare Marketing of Portland.  Attendees will learn how to attract and keep the patients they have, and will be given hands-on assistance in preparing appropriate marketing materials.

The program will be held from 9:00 am to noon on Friday, January 4, 2008 at the MMA offices in the Frank O. Stred Building in Manchester.  There is a $60 fee which covers all materials and breakfast.  You may register on-line at the MMA website at or by calling 622-3374 (Press O and ask for Lisa Dennison or Gail Begin.) [return to top]

DHHS Announces MaineCare Claims Management Fiscal Agent Award
In a letter dated December 28, 2007, DHHS Commissioner Brenda Harvey notified Unisys Corporation that it has been conditionally awarded the contract for the MaineCare Management Information System and Fiscal Agent Solution, the MeCMS replacement.  The company and the Department must now negotiate the details of the relationship. 

Unisys was one of three vendors that responded to the Request for Proposals.  ACS State Healthcare, LLC of Atlanta, Georgia and First Health Services Corporation of Glen Allen, Virginia also submitted proposals.  

The Department expects contract negotiations to continue through January and the final contract is subject to review by the federal government and must be approved by the State Purchases Review Committee.  Those who submitted proposals have 15 days to appeal the award.

Unisys currently provides similar fiscal agent services in West Virginia, Louisiana, and New Jersey, and recently earned the award to develop a Medicaid Management Information System in Idaho. 

  [return to top]

Anthem Contract with Dirigo Health Agency Expires Today; Harvard Pilgrim is the New Carrier
Anthem Blue Cross Blue Shield of Maine ceases at midnight to be the carrier of the Dirigo Choice product and Harvard Pilgrim Health Care takes over as the health insurer for the approximately 14,000 Dirigo enrollees.  Because of funding constraints caused by the failure of the legislature to provide any alternative funding to the Savings Offset Payments (SOP), the Dirigo Health Agency capped individual enrollment in DirigoChoice on August 1, 2007 and small group enrollment on September 1, 2007.

Physicians treating DirigoChoice patients will be paid based on the Harvard Pilgrim fee schedule in their provider agreement. 

As of October, costs of coverage year-to-date have been just over $60 million, with employer/enrollee contributions making up approximately $27 million and Dirigo subsidies making up the remainder.

In a recent interview with the Kennebec Journal, Governor Baldacci opined that he hoped that the move to Harvard Pilgrim would help inject more competition in the health insurance market in Maine.  He expressed the same opinion in a brief meeting with MMA staff over the holidays. [return to top]

DHHS Publishes Revised MaineCare General Administrative Policies & Procedures
DHHS recently has published final revisions to MaineCare Benefits Manual, Chapter I, Section 1, General Administrative Policies & Procedures.  In this rulemaking process, the Department adopts definitions of Authorized Agent, Emergency Medical Conditions, Emergency Medical Conditions for Undocumented Non-Citizens, and Medical Necessity.  Also, the rule adopts language under subsections for Provider Participation and Member Participation to ensure compliance with federal law.  

Further, the rule clarifies language for telehealth services and adopts a new code for language interpreters.  It permanently removes obsolete language concerning the Physician Directed Drug Initiative.  It adopts language describing the 30-day timeframe fro reporting overpayments to the Department as well as the 7-day timeframe to request an informal hearing in instances of emergency termination.  Finally, the rule clarifies language under the General Principles section of Provider Appeals and allows for provider requests for arbitration be made within a 60-day timeframe as opposed to 30 days.  The rule also adopts minor technical and grammatical changes.

The Department held a public hearing on July 30, 2007 and established a deadline for written comments on August 9, 2007.  Along with a number of other interested parties, the MMA participated in the public hearing and submitted written comments.  Many commenters, including the MMA, expressed opposition or concern about the definition of "medical necessity," but the Department made no changes as a result of these comments.  The MMA and other commenters expressed a concern about eliminating reimbursement for off label use of drugs and the Department has dropped that proposal as a result of such comments.

You can find the final version of the rule along with public comments and the Department's responses to those comments on the web at: [return to top]

CMS Addresses SCHIP Funding Shortfalls in 12 States, Including Maine
In a notice published in the December 19, 2007 Federal Register, CMS announced that it will immediately provide $606.9 million in supplemental federal funding to 12 states facing FY 2007 funding shortfalls in their State Children's Health Insurance Programs.  Maine will receive an additional $1,989,198 for its program.  The other 11 states are Alaska, Georgia, Illinois, Iowa, Maryland, Massachusetts, Minnesota, Mississippi, New Jersey, Rhode Island, and Wisconsin.  The money was approved as part of the U.S. Readiness, Veteran's Care, Katrina Recovery, and Iraq Accountability Act of 2007 (H.R. 2206; Pub. L. No. 110-28) enacted on May 29, 2007. [return to top]

Commonwealth Fund Study Examines 15 Proposed Federal Policy Options to Moderate Health Care Spending Growth
The Commonwealth Fund Commission on a High Performance Health System recently has published a study entitled, Bending the Curve:  Options for Achieving Savings and Improving Value in U.S. Health Spending that addresses 15 potential federal policies falling into 4 separate categories:

  1. Producing and using better information;
  2. Promoting health and disease prevention;
  3. Aligning incentives with quality and efficiency; and
  4. Correcting price signals in the health care market.

The Lewin Group estimated that implementation of all 15 policies along with the achievement of "universal coverage" through a combination of public and private health plans could save $1.5 trillion over the 10 years from 2008 through 2017.

Among the 15 proposed policies and the estimated cost savings are:

  • $368 billion from improved cost-effective treatment options and in providing both providers and patients with incentives to use those alternative options;
  • $9 billion from requiring providers to use educational tools to inform Medicare beneficiaries about treatment alternatives;
  • $88 billion from promoting health information technology to permit providers to share patient information (after the initial investment in the technology which could be funded through a 1% tax on private insurance premiums);
  • $283 billion from reducing obesity and $191 billion from reducing tobacco use in the population (both examples of programs that promote health and prevent disease);
  • $19 billion from encouraging workers to join workplace wellness programs (based upon a $2 billion federal investment in employer incentives);
  • $194 billion from paying providers for coordinating patient care (promoting the "medical home" concept);
  • $34 billion from a hospital P4P program to reduce the number of hospital readmissions;
  • $229 billion from changing the current Medicare fee-for-service payment system to a fixed prospective payment system for hospital and ambulatory care;
  • $122 billion from requiring all payers to use Medicare rates for hospitals and physicians; and
  • $43 billion from permitting the U.S. DHHS to negotiate prices for prescription drug plans.

According to lead author Cathy Schoen, the study does not endorse any of the options identified at this time and the authors recognize that it will be easier to implement policies where there is general consensus.

The study is available on the web at:   [return to top]

FCC Dedicates $417 Million to Expand Rural Telehealth Systems, Including Maine
Efforts to enlarge telehealth services in rural communities got a boost in November with $417 million from the Federal Communications Commission (FCC).  The three-year allocation, under the Rural Health Care Pilot Program, will fund construction of 69 statewide or regional broadband telehealth networks in 42 states, including Maine.

The Rural Western and Central Maine Broadband will receive $3.6 million to link 80 healthcare facilities with fiber-optic cable.  The increased capacity will support uninterrupted, secure connections between the facilities for distance learning and transmitting electronic medical records.  Franklin Community Health Network Chief Information Officer Ralph Johnson will implement the project.  The funds will also enable on-call physicians to access high-speed Internet in their homes, which is currently unavailable.

The Rural Health Care Pilot Program will defray up to 85% of participants' costs for establishing their dedicated broadband networks and up to 85% of the costs of connecting the networks to the Internet.  Funding comes from the Universal Service Fund, a surcharge on telecommunications companies, and is earmarked for programs making communication services more affordable for rural areas. [return to top]

CBO Report Identifies Comparative Effectiveness as Means to Improve Quality and Control Costs
On December 18, 2007, the Congressional Budget Office (CBO), issued a report entitled, Research on the Comparative Effectiveness of Medical Treatments:  Issues and Options for an Expanded Federal Role in response to requests from Senate Budget Committee Chairman Kent Conrad (D-ND) and Senate Finance Committee Chairman Max Baucus (D-MT), both of whom would like to pursue legislation on the subject in 2008.

The report describes comparative effectiveness research as evaluating the clinical benefits, effectiveness, and risks of medical technologies, medical devices, procedures, and pharmaceuticals.  

The report says that comparative effectiveness research has the potential to improve quality and control costs, but that it would mostly affect private health care spending.  "Any impact that the resulting research would have on federal spending for health care would have to come primarily from changes such research induced in doctors' patterns of practice or patients' choices of treatment," according to the report.

The focus of an expanded federal role in such research could be in the Agency for Healthcare Research & Quality (AHRQ), the Institute of Medicine (IOM), a new agency, or a public/private partnership according to the CBO.

The report is available on the web at: [return to top]

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