January 14, 2008

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Maine Again Rates High in American Lung Association Grading
Maine scores 3 As and a B in this year's rankings.

In its State of Tobacco Control:  2007 report recently released, Maine has once again been recognized by the American Lung Association for its efforts in tobacco control by gaining 3 As and 1 B.  The MMA thanks the American Lung Association of Maine and its staff and volunteers for their leadership in the tobacco control movement.  We also recognize of all the other partners in the effort who comprise Health Policy Partners (formerly the Maine Coalition on Smoking OR Health). 

You can find more information on Maine's report card on the web at:  http://www.stateoftobaccocontrol.org/states/report-card.html?state=me.

MedPAC Recommends 1.1% Medicare Fee Increase for Physicians in 2009
On January 10, 2008, the Medicare Payment Advisory Commission (MedPAC) voted to recommend a 1.1% increase in reimbursement rates in 2009 over 2008 rates, indicating that the group does not believe that physician fees should be cut or frozen.  MedPAC made this recommendation on the basis that Medicare beneficiary access to physicians generally is equal to, or better than, access by a privately insured comparison group.  Regardless of the MedPAC recommendation, Medicare physician fees still are controlled by the sustainable growth rate (SGR) formula.  In keeping with its past approach, the MedPAC recommendation is based upon a projected change in input prices (2.6%), less expected productivity growth (1.5%), leading to the 1.1% increase.  Under the SGR, physician rates are expected to be cut by 5% in 2009. [return to top]

Medicare Update Replacing Cut Results in $14 Million to Maine Physicians
A recently completed analysis by the AMA shows the financial impact state-by-state of the passage in December of S. 2499 by the U.S. Congress.  The analysis was developed using actual Medicare claims data for each state. 

Maine physicians will receive  $14 million dollars more than would have been received if the 10.1% reduction had taken effect.  The average amount per physician is $3,300.  The law replaced the reduction with a 0.5% positive update for the first six months of 2008.

Note that the impacts for S. 2499 are through June of 2008 only and do not include other provisions of the bill, such as payments for quality reporting or rural extenders.

  [return to top]

Medicare Physician Fee Schedule Clarification
In two previous messages distributed to providers, the Centers for Medicare & Medicaid Services (CMS) indicated that the Medicare, Medicaid and SCHIP Extension Act of 2007 replaced the scheduled 10.1 percent reduction in the Medicare Physician Fee Schedule (MPFS) conversion factor with a 0.5 percent increase for dates of service beginning January 1 through June 30, 2008.  CMS has received a number of inquiries asking whether physicians need to take any special action to get paid at the rates required by the statute.  Physicians do not need to take any additional action in order for their MPFS claims to be paid at the new  rate that reflects the 0.5 percent increase in the conversion factor.  Medicare contractors are able to process claims for services paid under the MPFS that contain dates of service January 1 and after with the new 2008 rates.  No adjustments should be necessary.  Your Medicare contractors have been instructed to process, beginning January 7, all claims with dates of service January 1, 2008, and after, that contain MPFS services.

We are also taking this opportunity to reiterate two points made in earlier messages:

1.      The new fees are expected to be posted on your local contractor’s website no later than January 11, 2008.  The “Medicare Physician Fee Schedule Look-Up” link on the CMS Website, which allows you to customize your search, will be updated with the new 2008 fees during the week of January 21, 2008.  However, the carrier specific public use files are available now on the CMS Website for the new 2008 MPFS rates at the following link:  http://www.cms.hhs.gov/PhysicianFeeSched/PFSCSF/list.asp#TopOfPage.

2.      CMS extended the participation decision period an additional 45 days.  The participation decision period now runs through February 15, 2008, instead of ending on December 31, 2007.  All participating status changes will be effective January 1, 2008.  Contractors will accept and process any participation elections or withdrawals, made during the extended enrollment period that are received or post-marked on or before February 15, 2008. 

To become a participating physician, complete the CMS-460 form which can be found on the CD that was mailed to physicians in November.  You can also request the form from your local contractor.  The form must be completed, signed, and mailed to your local contractor and post-marked by February 15, 2008.  If you are changing your participation status to non-participating, please send your request in a letter to your local contractor, post-marked by February 15, 2008.

Contractors will not automatically make adjustments for providers who change their participation status after January 1, 2008 (you should begin billing claims according to the participation decision that you have made).  However, they will adjust claims based on participation status changes that you bring to their attention.

 An official CMS change request and an MLNMatters article will be forthcoming. [return to top]

CMS Reports U.S. HealthCare Spending Growth Accelerated Only Slightly in 2006
The Office of the Actuary of CMS (Centers for Medicare and Medicaid Services) this past week released several findings on health care expenditures in the U.S. in 2006.  The findings also appear in the Jan. 11 issue of the health policy journal Health Affairs.

Health care spending growth in the U.S. accelerated slightly in 2006, increasing 6.7% compared to 6.5% in 2005, which was the slowest rate of growth since 1999.  Health care spending, however, continues to outpace overall economic growth and general inflation, which grew 6.1% and 3.2% respectively, in 2006.

In 2006, health care spending reached a total of $2.1 trillion, or $7,026 per person, up from $6,649 per person in 2005, according to the report.  The health spending share of the nation's Gross Domestic Product (GDP) remained relatively stable in 2006 at 16.0%, up by only 0.1% from 2005.

"The cost of health care continues to be a real and pressing concern.  Making sure we are paying for higher quality health care services, not just the number of services provided, is just one of the most critical issues facing the American public and the federal government now and in the future," said CMS Acting Administrator Kerry Weems.  "This review of health care spending reminds us that we need to accelerate our efforts to improve our health care delivery system to make sure that Medicare and Medicaid are sustainable for future generations of beneficiaries and taxpayers."

Out-of-pocket spending grew 3.8% in 2006, a deceleration from 5.2% growth in 2005.  This slowdown, is attributable to the negative growth in out-of-pocket expenditures for prescription drugs, mainly due to the introduction of the Medicare Pard D benefit.  Out-of-pocket spending accounted for 12% of national health spending in 2006; this share having steadily declined since 1998, when it accounted for 15% of health spending.  Out-of-pocket spending relative to overall household spending, however, has remained fairly flat since 2003.

CMS found that overall private spending growth slowed in 2006.  Private health insurance premiums grew 5.5% in 2006, which was the slowest rate of growth since 1997.  Benefit payment growth also slowed, from 6.9% growth in 2005 to 6.0% in 2006.  The slower growth reflects, in part, a decline in private health insurance spending on prescription drugs.

Medicare's share of federal spending increased from 29% in 2005 to 34% in 2006,while Medicaid's share declined from 45% to 40%.

Total Medicaid spending declined for the first time since the program's inception, falling 0.9% in 2006.  The introduction of Medicare Part B, which shifted drug coverage for dual eligibles from Medicaid into Medicare, contributed to the decline in Medicaid spending growth.  Other reasons for the decline include continued cost containment efforts by states and slower enrollment growth due to more restrictive eligibility criteria and a stronger economy.

Hospital spending, which accounts for 31% of total health care spending, grew 7.0% in 2006, a decrease of 0.3% points from 2005 and a continued deceleration from 2002 when the growth rate was 8.2%.  The 2006 growth was partially driven by lower utilization of hospital services,especially within Medicare as fee-for-service inpatient hospital admissions declined.

Spending for physician and clinical services also slowed, increasing 5.9% in 2006, which is 1.5 percentage points lower than 2005 and the slowest rate of growth since 1999.  The slowdown was driven by a deceleration in price growth, fueled by a near freeze on Medicare payments to physicians (whose fee schedule update in 2006 was 0.2%) that influenced private payors as well.

In addition, spending growth for both nursing homes and home health services slowed.

Prescription drug spending growth accelerated for the first time in six years - from a low of 5.8% in 2005 to 8.5% in 2006.  Roughly one-half of this growth was due to increased use of prescription drugs, partly a result of coverage now available under Medicare Part D.

These and other findings can be found on the CMS website at: http://www.cms.hhs.gov/NationalHealthExpendData/ [return to top]

2007 Public Health Work Group Report now Available Online
A copy of the 2007 Public Health Work Group report to the Maine Legislature, entitled, "Goal of the Maine State Health Plan:  Making Maine the Healthiest State" can be accessed at www.mainepublichealth.gov. [return to top]

Massachusetts Approves Final Rules on Retail Clinics
On January 9, 2008, the Massachusetts Public Health Council voted 8-0 in favor of rules permitting limited service health clinics to operate in retail businesses.  Five members of the Council abstained from the vote.  The rules impose new conditions specific to retail clinics on existing rules governing the licensure of health clinics.  MinuteClinic, a subsidiary of CVS Caremark Corp., anticipates opening between 25 and 30 clinics in Massachusetts this year and expects to have between 100 and 150 in the state by 2010.  Apparently, Planned Parenthood and a large physician group practice in western Massachusetts also have expressed an interest in opening limited service clinics in the state.

The final rules include the following provisions:

  • enhanced credentialing requirements to ensure that staffing is adequate to address the needs of both children and adults;
  • handicapped access;
  • hand sanitizers;
  • interpreter services;
  • infection control procedures;
  • toilet access;
  • referrals to physicians; and
  • signs warning about the dangers of tobacco use. 
[return to top]

UNE Announces 2008 National Health Literacy Institutes
Announcing: 2008 National Health Literacy Institutes - the premier opportunity to learn plain language skills to plan, write, and design effective, accessible information for print and web. This Institute has been sponsored by the University of New England in Maine for the past 16 years.

See: www.HealthLiteracyInstitute.net

The 2008 Summer Institute will be held June 8-11. The 2008 Fall Institute (repeat) will be held October 26-29. Both Institutes are hosted in Freeport, Maine, home of LL Bean, and just 20 minutes from Portland. The area offers many venues to explore, both indoors and outdoors.

All details and registration information are at this website: www.HealthLiteracyInstitute.net

Each Institute is limited to 30 participants, so register early to hold your place. [return to top]

Maine CDC Seeking Medical Director
OPENING DATE:  December 26, 2007            CONTACT:  Virginia Roussel
CLOSING DATE:  January 25, 2008              TELEPHONE:  (207) 287-1873

Agency Information:  The Department of Health and Human Services (DHHS) is driven by its vision of Maine people living safe, healthy and productive lives.  Its goal is to assist the people of Maine in meeting their own needs, as well as the developmental, health and safety needs of their children.  It serves the public in an environment that reflects a caring, responsive and well-managed organization.  The Maine Center for Disease Control and Prevention in Augusta, Maine is seeking an individual to provide expertise to projects focused on statewide preparedness and response to incidents of bioterrorism and other catastrophic public health emergency events.

Job Duties:  Duties are specifically related to emergency preparedness planning for Maine hospitals and healthcare systems in the event of a public health emergency, providing medical, epidemiologic and public health expertise in establishing regional systems for emergency response. Responsibilities include collaborating with the Director of Division of Public Health Systems and the OPHEP Director.  The OPHEP Medical Director will:

  • Develop and exercise healthcare systems surge capacity plans
  • Manage the operation of the healthcare systems during a public health emergency event
  • Develop policies regarding the appropriate use of medical assets
  • Write plans, guidelines and advisories related to the medical aspects of public health preparedness
  • Serve as medical consultant to the Division of Public Health Systems
  • Provide medical and public health guidance to state agencies, health care providers, emergency management agencies, and the public during a public health emergency response in collaboration with the Maine CDC Director

REQUIREMENTS:  Graduation from an accredited school of Medicine or Osteopathy.  A twelve (12) year combination of post-graduate training and experience in public health, health administration, emergency preparedness, and/or emergency medicine, to include a minimum of four years of related administrative or managerial experience, OR a Masters Degree in Public Health, Health Care Administration, or a related field and six years experience in the field of public health or emergency preparedness, to include a minimum of four years of related administrative or managerial experience.

SPECIAL REQUIREMENT:  Current license to practice medicine in the State of Maine and a Masters Degree in Public Health, Health Care Administration, or related field.

To apply, please send a completed direct hire application, and resume to:
     Department of Health and Human Services
     221 State St.  Attn: V. Roussel, Human Resources Div.
     #11 State House Station
     Augusta, ME  04333-0011

The Department of Health and Human Services is an Equal Opportunity/Affirmative Action employer.  We provide reasonable accommodations to qualified individuals with disabilities upon request. [return to top]

Political Pulse: Legislative Highlights of the Week
1.  State of the State 

Governor Baldacci delivered his State of the State Address to a joint session of the Maine Legislature on Wednesday, January 9, 2008.  You can find his remarks, including a few on health care, on the web at:  http://www.maine.gov/tools/whatsnew/index.php?topic=Gov+News&id=48517&v=Article-2006.Go


2.  Governor's Supplemental Budget


Governor Baldacci's supplemental budget statement, dated January 10, 2008, can be found on the web at:  http://www.maine.gov/tools/whatsnew/index.php?topic=Gov+News&id=48553&v=Article-2006.  In this budget, the Governor has had to address a $95 million budget gap in the current fiscal year ending 6/30/08.  The budget includes numerous cuts in mental health, mental retardation, and social services.   It also includes almost $20 million in cuts in funding for hospital-based physicians.  See page 87 of Part A of the supplemental budget for this cut.


3.  Commission to Study Primary Care Medical Practice Issues Final Report


The Commission to Study Primary Care Medical Practice has issued its final report with 15 recommendations for immediate legislative action:

1.  Develop a Patient-Centered Medical Home pilot project.

2.  Increase MaineCare reimbursement for primary care.

3.  Identify MaineCare benefit limitations.

4.  Streamline ManeCare paperwork for cost effective prescribers.

5.  Provide flexibility in dispensing prescribed medications.

6.  Expand "Opportunity Maine."

7.  Align MaineCare's Primary Care Case Management (PCCM) fees with the medical home concept.

8.  Evaluate MaineCare's clinical management contract.

9.  Supporting medical school partnerships and in-state clinical opportunities and residencies.

10.  increase outreach.

11.  Invest in and sustain Finance Authority of Maine (FAME) medical education programs.

12.  Maintain a stable medical practice environment.

13.  Support initiatives that increase or preserve access to health care.

14.  Support quality initiatives.

15.  Support investment in medical information technology.

The Commission included 3 physicians:  MMA Immediate Past President Kevin Flanigan, M.D., John Irwin, D.O., and Jeffrey Aalberg, M.D.

The Commission will present its report to the HHS Committee on the afternoon of Thursday, January 17, 2008.

You can find the final report of the Commission along with other work on the web at:  http://www.maine.gov/legis/opla/primarycare.htm.

  [return to top]

New Bills for Your Review and Comment
The MMA has identified the following new bills of interest to the physician community since the 123rd Maine Legislature began its Second Regular Session on Wednesday, January 2, 2008.  By clicking on the "LD xxxx," you can go to the text of the proposal on the legislature's web site.  For each bill, MMA Deputy EVP Andrew MacLean has suggested a proposed position and any specialty society or MMA Committee that may be specifically interested in the bill.

If you have comments about the bill or the proposed MMA position, or if you or your specialty society would like to participate in the public hearing on a bill, please contact Andrew MacLean, Deputy EVP, at amaclean@mainemed.com or 622-3374, ext. 214.

 LD 1939, Resolve, To Establish a Method for Reporting the Statistics of Diseases (support; coordinate with MHA; Public Health Committee; Committee on Physician Quality)

LD 1945, An Act To Update the Regional Greenhouse Gas Initiative (monitor or support; seek input from Public Health Committee & Physicians for Social Responsibility)

LD 1951, An Act To Create the Mental Health Homicide Review Board (monitor or support; seek input from psychiatrists)

LD 1956, Resolve, To Expand the Case Definition of Lyme Disease for Purposes of Compiling the Annual Lyme Disease Surveillance Report (monitor; seek input from Maine CDC, infectious disease specialists, lyme disease practitioners, and Public Health Committee)

LD 1961, An Act To Repeal the Ban on the Sale and Furnishing of Hard Snuff (oppose; Public Health Committee)

LD 1963, An Act Regarding the Training of Applicants for a Limited Radiographer License by Licensed Practitioners (this is a MMA bill that will be withdrawn at the public hearing on Tuesday, 1/15/08; MMA may seek other means of addressing issues with physician delegation statute; seek input from radiologists & Spectrum Medical Group)

LD 1967, An Act To Establish a Consumer Council System of Maine Consistent with the AMHI Consent Decree and the State's Comprehensive Mental Health Plan (monitor as a concept draft until more information is available; seek input from psychiatrists)

LD 1975, Resolve, To Require the Department of Health and Human Services To Promote Awareness of Parkinson's Disease (monitor)

LD 1977, Resolve, To Establish a Statewide Protocol for the Early Detection and Treatment of Autism (monitor; seek input from Maine CDC & pediatricians)

LD 1986, An Act To Expand the Pool of Qualified Mental Health Examiners for Purposes of Involuntary Treatment (the MMA and the Maine Association of Psychiatric Physicians (MAPP) opposed this bill at a public hearing last week; the HHS Committee unanimously recommended approval of the bill over our objections)

LD 1991, An Act To Ensure Continued Operation of the Poison Hotline (support; emergency physicians; pediatricians; Public Health Committee)

LD 1999, An Act To Amend Criminal Laws against Domestic Violence To Ensure Appropriate Recognition of Prior Convictions (monitor; Public Health Committee)

LD 2000, An Act To Authorize the Department of Health and Human Services To Investigate Suspicious Deaths of Children  (monitor; seek input from Maine CDC & pediatricians; not sure that we should be increasing physician reporting burden; doesn't the medical examiner have jurisdiction over such cases?)

LD 2004, An Act To Establish the Department of Substance Abuse Services  (monitor; seek input from psychiatrists & OSA)

LD 2009, Resolve, Regarding Legislative Review of Portions of Chapter 150: Control of Emissions from Outdoor Wood Boilers, a Major Substantive Rule of the Department of Environmental Protection, Bureau of Air Quality Control (monitor; seek input from American Lung Association of Maine & Health Policy Partners; Public Health Committee)

LD 2012, An Act To Protect Children in Vehicles from Secondhand Smoke (monitor; Public Health Committee; see bill submitted by Rep. Blanchette on behalf of Health Policy Partners)

LD 2014, Resolve, To Extend the Deadline To Adopt a Rule by the Department of Health and Human Services Regarding Smoking in the Workplace (monitor; Public Health Committee)

LD 2024, An Act To Clarify the Licensure of Advanced Practice Registered Nurses (monitor)

LD 2027, An Act To Provide Parents of Children with Disabilities Access to Ombudsman Services (monitor; pediatricians)

LD 2032, An Act To Implement a Consent Judgment Regarding OxyContin Abuse (monitor or support; Public Health Committee; psychiatrists)

LD 2034, An Act To Prohibit the Sale of Energy Drinks to Minors (monitor or support; seek input from pediatricians; Public Health Committee)

LD 2035, An Act To Clarify the Laws Governing the Inspection of Medical Facilities (monitor)

LD 2042, An Act To Facilitate the Diversion of Persons with Mental Illness and Substance Abuse away from Incarceration through the Co-occurring Disorders Court (monitor; psychiatrists)

LD 2043, An Act To Protect Student Athletes (monitor or support; seek input from pediatricians; Public Health Committee)

LD 2044, An Act To Prohibit Hospitals from Charging for Treatment To Correct Medical Mistakes (monitor until we coordinate position with MHA; Committee on Physician Quality)

LD 2048, An Act To Protect Children's Health and the Environment from Toxic Chemicals in Toys and Children's Products (monitor or support; seek input from pediatricians, Maine CDC, & Public Health Committee)

LD 2051, An Act Regarding the Sale of Firearms to Minors (monitor; pediatricians; Public Health Committee)

LD 2052, Resolve, To Create the Blue Ribbon Commission To Study the Future of Home-based and Community-based Care (monitor)

LD 2053, An Act To Ensure That Children's Toys and Products Are Free of Lead (monitor or oppose; seek input from pediatricians & Maine CDC; I suspect there are insufficient funds in the lead program now & that we probably should not be diverting them to another initiative)

LD 2054, An Act To Encourage Access to Respite Care Services for Maine Families with Behavioral Health Needs (monitor; psychiatrists)

LD 2059, An Act To Establish a Wellness Tax Credit (support; Public Health Committee)

LD 2066, An Act To Clarify the Laws Governing the Extension of Health Care Coverage to Dependents (monitor; pediatricians)

LD 2081, An Act To Prohibit the Retail Sale and Distribution of Novelty Lighters (monitor or support; Public Health Committee)

LD 2084, An Act To Protect Vulnerable Children by Allowing the Use of Emergency Medication (monitor or support; seek input from pediatricians; Public Health Committee)

LD 2085, An Act To Protect Children from Secondhand Smoke (support; pediatricians; Public Health Committee)

LD 2098, An Act To Prevent and Treat Cancer in Maine by Providing a Source of Funding for a Comprehensive Cancer Prevention Program (monitor or support; Public Health Committee)

LD 2106, An Act To Enhance the Newborn Hearing Program (support; pediatricians; Public Health Committee)

LD 2107, An Act To Establish a Forensic Case Review Panel To Advise the Department of Health and Human Services (monitor or support; psychiatrists)

LD 2108, Resolve, To Adopt Respectful Language in Programs Affecting Developmental Services (monitor or support; psychiatrists)

LD 2109, An Act Relating to Insurance Coverage for Colorectal Cancer Early Detection (monitor or support; gastroenterologists; can we point to problems with coverage now?)

LD 2132, An Act To Amend the Family Medical Leave Laws To Include Siblings (monitor)

LD 2138, An Act To Amend the Requirements for Approval of the Use of Physical Restraints (monitor or support; seek input from pediatricians & psychiatrists) [return to top]

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