January 28, 2008

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MMA Payor Liaison Committee to Meet on MaineCare, Thursday, Jan. 31, 2008
The Association's Payor Liaison Committee will meet with MaineCare officials on Thursday evening, January 31, 2008 at the MMA offices in Manchester.  The discussion will focus on implementation of the MaineCare fee increase effective July 1, 2008.   Any MMA member or practice manager is welcome to attend and provide input into the process.  The meeting begins at 7:00 pm with dinner being available at 6:30 pm.
The MMA Payor Liaison Committee will meet this coming Thursday, January 31, 2008 at the offices of the Association in the Frank O. Stred Building in Manchester, Maine.  Dinner will be available at 6:30 pm and the meeting will begin at 7:00 pm.

MaineCare Director Tony Marple will attend the meeting to receive input from physicians about the implementaion of the MaineCare fee increase scheduled to become effective July 1, 2008.  Including the federal dollars, the increase is more than $8 million and the meeting will focus on how the increase should be distributed.

All MMA members are invited to attend, whether they are members of the committee or not.  For meal planning purposes, please give the office a call if you are planning to attend (622-33374 ext. 216)

The Payor Liaison Committee is chaired by Nancy Cummings, M.D., an orthopedic surgeon practicing in Farmington.

Report on Dirigo Health Agency Board Meeting, Jan. 22, 2008
The Board of Directors of the Dirigo Health Agency met in Augusta this past week.  A quorum could not be achieved as the Speaker of the House and the President of the Senate and other legislative leaders have not yet named their appointees to the enlarged board established as the result of legislation enacted in 2007.  Items were presented for informational purposes only and no formal action could be taken.

In a legislative report, Trish Riley of the Governor's Office of Health Policy & Finance noted that efforts were in progress to find a compromise in the legislature that would allow the Dirigo Board to have an alternative funding source to the controversial Savings Offset Payment (SOP).  She also provided a list of bills that the GOHPF was monitoring this session.

Jim Leonard was introduced as the new staff to the Maine Quality Forum.  Jim was most recently with the Maine Centers for Disease Control and Prevention where he worked in the Diabetes Program.  Jim will assist Josh Cutler, M.D. in organizing and overseeing the activities of the Maine Quality Forum, including MMA's Voluntary Practice Assessment Initiative (VPAI). 

Ms. Riley also reported on the activities of the Advisory Council on Health Systems Development which is completing its work on the State Health Plan.  She specifically noted the charge to the Council to examine the drivers of health care costs in the state.  Maine has the second highest health care costs per capita in the country, after Massachusetts. 

Savings Offset Payment

A lot of discussion took place regarding the possibility of the legislature enacting an alternative to the Savings Offset Payment which produces currently the bulk of the Agency's funding.  If the legislature does not enact an alternative soon, the Board will have to begin its complex and expensive process to determine the level of savings last year in order to determine the assessment for next year.


Figues provided by staff showed that slightly more than 15,000 persons were enrolled in the plan.  In September 2007, the Agency suspended new enrollment of individuals.





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Effort to name Lewiston-Auburn Bridge after Distinquished Physician (Bernard Lown, M.D.)
This past week,  the Legislature's Transportation Committee endorsed the naming of a bridge between Lewiston and Auburn in honor of Dr. Bernard Lown, a noted cardiologist  and  lifelong activist against nuclear proliferation.  His opposition to the use of nuclear weapons earned him the Nobel Peace Prize.

Dr. Lown still practices in Boston.  He is a graduate of Lewiston High School and attended the University of Maine.

The bill was sponsored by Rep. Richard Wagner, (D - Lewiston).  The recommendation now moves to the full legislature where MMA will encourage its passage. [return to top]

U.S. House Fails to Override Presidential Veto of SCHIP Expansion
During this past week, members of the U.S. House of Representatives failed, on a vote of 260 to 152, to reach the two-thirds majority needed to override President Bush's veto of a proposal to renew the State Children's Health Insurance Program (SCHIP) through 2012 at a cost of $60 billion, up $35 billion over current levels.  SCHIP is designed mainly for children from families that are not poor enough to receive Medicaid but cannot afford private coverage. 

Both Rep. Tom Allen and Rep. Mike Michaud voted yes, to override the veto.

In a speech at a Families USA conference on January 24, 2008, House Speaker Nancy Pelosi (D-CA) identified SCHIP, mental health parity, and biomedical research (particularly in support of personalized health care services) to be her top health care priorities for 2008.  [return to top]

Senate Finance Committee Leaders Push PQRI Expansion
Finance Committee Chairman Max Baucus (D-MT) and ranking member Chuck Grassley (R-IA) recently wrote to CMS advising the agency that they intend to pursue legislation to extend the Medicare physician bonus program beyond the reporting of quality data to a closer alignment of payment with the quality of care provided.  Established in 2006, the PQRI is a voluntary quality reporting program that enables physicians to receive an incentive bonus payment of 1.5% of total allowed charges for covered services.  The Medicare, Medicaid, & SCHIP Extension Act , signed by President Bush late in 2007, provided funding for the program, extended it to 2009, and removed a cap on calculation of incentive payments for reporting in 2008 and 2009.  The Senators urged CMS to collaborate with the AMA's Physician Consortium for Performance Improvement, specialty societies, and other organizations involved in the development of performance measures. [return to top]

Technology: DHHS Plans AHIC Transition
On January 22, 2008, US DHHS Secretary Michael O. Leavitt announced that LMI, a government consulting firm in McLean, VA, and the Brookings Institution would take the lead on an effort to transition the American Health Information Community (AHIC) from a federal advisory group to a public-private joint venture.  The two organizations are tasked with developing "AHIC 2.0" with a budget of about $5 million and an expected completion date of December 2008.  

You can find more information about AHIC on the web at:  http://www.hhs.gov/healthit/community/meetings/. [return to top]

Governors' Association Pushes for Supplemental Medicaid Funding in Stimulus Package
On January 23, 2008, the National Governors Association (NGA) asked the Congressional leadership to include $12 billion in supplemental state aid in the federal stimulus package.  The Governors have urged that half be used for a temporary increase in the federal Medicaid payment percentage, the federal medical assistance percentage (FMAP) and that the other half be used for a flexible block grant.  In 2003, Congress appropriated $20 billion for supplemental state aid, based upon a similar NGA recommendation.  The 2003 package increased every state's FMAP by 2.95% for 5 quarters, enabling states to avoid or minimize program cuts.

You can find more information about the NGA proposal on the web at:  http://www.nga.org/portal/site/nga. [return to top]

Dirigo ACHSD Discusses Capital Investment Fund, Cost Containment Recommendations, & State Health Plan Timetable
The Advisory Council on Health Systems Development (ACHSD), an advisory group of the Dirigo Health Program, met on Friday, January 25, 2008 to review comments on the Capital Investment Fund (CIF) and staff recommendations, to consider its work to date on its new cost containment role as a result of LD 1849 (P.L. 2007, Chapter 441), and to develop a schedule for presenting an updated State Health Plan to the legislature.  The group agreed that its cost containment recommendations in the State Health Plan should focus on initiatives at the system, rather than the individual provider or practitioner, level.  Members mentioned as examples, addressing inadequate funding for immunizations, continuing to promote transparency and to educate consumers about costs, and supporting primary care through, among other things, promotion of the medical home concept.  

The Advisory Council is scheduled to meet next on February 29, 2008.  The Governor's Office of Health Policy & Finance staff expect to send a draft State Health Plan with the cost containment provisions to the group by February 15, 2008 and to present a draft to the legislature in early March.  The Advisory Council plans one public hearing on the draft State Health Plan to be held in Augusta on a date to be determined.

The Advisory Council is chaired by Brian Rines, Ph.D., a forensic psychologist and hospital trustee from South Gardiner, and includes two physicians, MMA Past President and Augusta ophthalmologist Maroulla Gleaton, M.D. and former State Health Director Lani Graham, M.D., M.P.H.  [return to top]

Political Pulse: Legislative Highlights of the Week
1.  Governor's Supplemental Budget Proposal

As previously reported, the Governor's FY 2008-2009 supplemental budget proposal includes a cut of almost $20 million (General Fund + federal match) for hospital-based physicians.  The MMA will join the MHA in opposing this proposal at the public hearing scheduled before the Appropriations and HHS Committees at 9 am on Friday, February 8, 2008.  If you would like to participate in the hearing or if you have comments to be incorporated into the MMA testimony, please contact Andrew MacLean, Deputy EVP, at amaclean@mainemed.com or 622-3374, ext. 214.

You can find information about the supplemental budget proposal, LR 3445, on the web at:  http://www.maine.gov/legis/ofpr/

2.  Mandated Insurance Coverage for Colorectal Cancer Screening 

On Tuesday, January 22, 2008, the Insurance & Financial Services Committee conducted a public hearing on LD 2109, An Act Relating to Insurance Coverage for Colorectal Cancer Early Detection.  Proponents included Jay Bosco, M.D., a Brunswick gastroenterologist and frequent speaker for the American Cancer Society, who represented the Maine Gastroenterological Society, the American Cancer Society, and Consumers for Affordable Health Care.  The Maine State Chamber of Commerce and representatives of the Maine Association of Health Plans opposed the bill, although the state's 3 primary carriers, Anthem, Aetna, & CIGNA, acknowledged that they provided coverage according to the protocol set out in the bill.  The Committee has scheduled a work session on the bill for Tuesday, January 29, 2008 when it is likely that a majority will vote to send the bill to the Bureau of Insurance for the required actuarial analysis before a health insurance mandate may be finally adopted.

3.  Public Health Legislation

Summary of Public Hearings that occurred this week:

LD 1939, Resolve, To Establish a Method for Reporting the Statistics of Diseases -  The Sponsor and a consumer supported the resolve, whose sister and newborn passed away from a hospital infection.  Those in the opposing column were:  MHA, and MMA.  Neither For/Nor Against (NFNA) were: Dora Mills, MeCDC and Dr. Josh Cutler, Maine Quality Forum (MQF).  As stated by Dr. Cutler to the committee, "Emphasis on prevention processes is of critical importance.  The issue of requiring diagnosis reporting for all nosocomial diseases invites inaccuracy in diagnosis, potential misdirection of resources, and misleading comparisons among providers."  MMA opposed the resolve in verbal testimony, based upon the points made by Dr. Cutler and urged the committee to allow the MQF to drive this quality initiative.  The committee requested the interested parties to reach agreement on a redraft of the resolve.  The Work Session on this resolve is scheduled for:  Thursday, January 31 at 12:45 pm in HHS.

LD 1956, Resolve, to Expand the Case Definition of Lyme Disease for Purposes of Compiling the Annual Lyme Disease Surveillance Report - The hearing was filled with consumers unfortunately stricken with Lyme Disease, who passionately brought this issue to the attention of the HHS committee.  Main points were to ensure that the MeCDC considers Lyme Disease a major issue and increased surveillance is necessary, along with physician education on the disease.  Reports of Lyme Disease have steadily risen in Maine from 71 cases in 2000 to an estimated 500 in 2007.  Dr. Dora Mills, MeCDC opposed the resolve expanding the case definition of Lyme disease based on:
·    The CDC surveillance case definition for Lyme disease was just expanded in 2007.  The revised Lyme Case Definition is intended to better reflect the true epidemiology of Lyme disease in the United States.  It was expanded in order to include “probable cases” (any illness considered to be a manifestation of Lyme disease, if Lyme disease tests are positive) and “suspect cases” (cases where a laboratory test is positive, but clinical information is missing).  The revised case definition has been endorsed and supported by one of the most important Lyme disease patient advocacy groups in the United States.  (http://www.lyme.org/cste.pdf)

LD 1961, An Act to Repeal the Ban on the Sale and Furnishing of Hard Snuff -  Supporters of bill were  the sponsor, Senator Brannigan; the CEO of Starr Scientic, Paul Garrietto who testified at length, Dr. Brad Rodu, Chair, Tobacco Harm Reduction Research, University of Louisville.  Their entire premise was “harm reduction” and that the current ban on the least 2 toxic tobacco products should be reversed.  The Health Policy Partners (HPP) of Maine (formerly known as the Smoking or Health Coaltion) opposed the bill on behalf of the entire coalition of members.  Work Session is scheduled for:  Tuesday, Jan. 29th at 3pm

LD 1975, Resolve , To Require the Department of Health and Human Services to Promote Awareness of Parkinson's Disease - Parkinson’s Disease funding for educational purposes.  The Executive Director of the Parkinson Disease Society spoke passionately to the committee to require the DHHS, MeCDC to undertake an education initiative regarding Parkinson’s Disease involving a wide variety of health care, public service and law enforcement personnel. (MMA monitored)

LD 1997, An Act to Fully Fund School Breakfast From Kindergarten to Grade 12 - Becky Smith, Executive Director, HPP of Maine testified in support on behalf of the coalition members, as well as for the Friends of a Fund for a Healthy Maine that everyone who qualifies for free or reduced price school meals should be provided a healthy breakfast, in support of reducing childhood obesity.  Although, there is not a clear link between the availability of free or reduced priced breakfast and obesity.  Ms. Smith also cautioned the committee about adding the School Breakfast Program to the language that governs the Fund for a Healthy Maine.  Due to the fact that when the Fund was created by the 119th Legislature, the specified funded programs were chosen because they were deemed to be the most important and under-funded public health prevention measures in Maine.  It was also written that FHM money should be spent to “supplement, not supplant existing resources.”  Marge Kilkelly (past Legislator), Ellie Goldberg, (Maine Children’s Alliance), Ana Hick, (Maine Equal Justice Project) also testified in support of the bill.

LD 2012 & 2085, An Act to Protect Children in Vehicles from Secondhand Smoke (bills were combined) -  Speaking in support of the bill: Dr. Jonathon Shenkin, a Pediatric Dentist in Bangor, Dr. Don Burgess, Chair of AAP, Gordon Smith, MMA,  a multitude of community members, Ellie Goldberg, (Maine Children’s Alliance), Becky Smith (Health Policy Partners of Maine, Michelle Caliandro (Maine Lung Association), Shawn Yardley (Bangor Public Health Department), Dr. Dora Mills, MeCDC, Peter Arno (Law enforcement in Bangor) and an Economic Environmentalist regarding the costs associated with secondhand smoke.
Work Session on LDs 2012 & 2085:  Tuesday, January 29th at 3pm in HHS.

LD 2014, Resolve, To Extend the Deadline To Adopt a Rule by the Department of Health and Human Services Regarding Smoking the Workplace. The only reason that this came to the HHS is that the department missed the deadline in filing the original bill that the governor signed last session and needed to go through the process again.  It was not submitted to discuss the original law.

LD 2081, An Act to Prohibit the Retail Sale and Distribution of Novelty Lighters - Testimony in support of the bill was read on behalf of Dr. Donald Burgess, MD, President of the Maine Chapter of AAP, along with MMA supporting the bill.  Others supporting the bill:  Commissioner Anne Jorden, (Maine Dept. of Public Safety), Representative from the Fire Marshall’s office, family of child burned from a novelty lighter, Dead River company Representative, Captain Audette from Augusta Fire Dept., Bill Vickerson with the Maine State Firefighters Lobby.  There was no opposition to the bill.  Dr. Burgess in collaboration with the Dept. of Public Safety composed a letter that will be part of an educational packet sent to all pediatricians educating them on the dangers of novelty lighters.  Anne Jordan requested MMA to consider assisting in the recruitment of a FP and PA to compose a letter as well, and to allow the Dept. to mail educational packets to their respective memberships. (Work session in Criminal Justice & Public Safety has not been announced)

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New Bills for Your Review & Comment/Reminder of Legislative Committee Conference Calls on Tuesday Evenings
The MMA has identified the following new bills of interest to the physician community since the Maine Medicine Weekly Update of January 14, 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 Mr. MacLean at amaclean@mainemed.com or 622-3374, ext. 214.

Also, please remember that the Legislative Committee has scheduled weekly conference calls every Tuesday at 7 pm for an advocacy update and to discuss any of these bills.  Please call 1-800-989-2842 and enter the passcode 6223374# to participate. 

LD 2148, An Act To Improve the Health of Maine Communities and Reduce Emergency Care Burdens (monitor; Public Health Committee)

LD 2153, An Act To Improve the Organizational Structure of the Department of Health and Human Services (monitor)

LD 2162, Resolve, Regarding Legislative Review of Portions of Chapter 850: Health Plan Accountability, a Major Substantive Rule of the Department of Professional and Financial Regulation (monitor)

LD 2163, Resolve, Regarding Legislative Review of Portions of Chapter 270: Uniform Reporting System for Health Care Quality Data Sets, a Major Substantive Rule of the Maine Health Data Organization  (monitor; Committee on Physician Quality)

LD 2164, Resolve, Regarding Legislative Review of Portions of Chapter 157: CO2 Budget Trading Program Waiver and Suspension, a Major Substantive Rule of the Department of Environmental Protection (monitor; Public Health Committee)

LD 2166, Resolve, Regarding Legislative Review of Portions of Chapter 294: Rules Governing the Qualifications for Local Health Officers, a Major Substantive Rule of the Department of Health and Human Services, Maine Center for Disease Control and Prevention (monitor; Public Health Committee)

LD 2167, Resolve, Regarding Legislative Review of Portions of Chapter 120: Release of Data to the Public, a Major Substantive Rule of the Maine Health Data Organization (monitor; Committee on Physician Quality)

LD 2170, Resolve, Regarding Legislative Review of Portions of Chapter 10: Rules for Exemptions to the Ban on Flavored Cigarettes and Cigars, a Major Substantive Rule of the Department of the Attorney General (monitor; Public Health Committee)

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