February 4, 2008

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Political Pulse: Legislative Highlights of the Week
Perhaps the most critical issue of the Second Regular Session of the 123rd Maine Legislature is up for a public hearing before the Appropriations Committee this week - a proposed $20 million cut in reimbursement for hospital-based physicians in Governor Baldacci's FY 2008-2009 Supplemental Budget, L.D. 2173.  The Appropriations Committee has been hearing the DHHS portion of the budget, along with the HHS Committee, since late last week.  On Friday, February 8, 2008 at 9 a.m., the two committees will begin hearings on the section of the budget including this cut.  The MMA is working closely with the Maine Hospital Association in preparation for the hearing.  Both organizations need your help in opposing these cuts!

1.  Governor's FY 2008-2009 Supplemental Budget, L.D. 2173

The MMA consistently has argued that the MaineCare fee schedule for individual practitioners is woefully inadequate (now approximately 53% of Medicare), but that increasing the fee schedule cannot come at the expense of hospital-based physicians.  Any cuts in physician reimbursement rates will exacerbate Maine's recruitment and retention problems and will result in patients having inadequate access to a range of physician services.

The MHA has provided more talking points on the budget issues on its web site:  http://www.themha.org/advocacy/physcuts.htm. 

We need your help by contacting members of the two key legislative committees to urge them to reject these cuts.

You can find members of the Appropriations & Financial Services Committee and their contact information on the web at:  http://janus.state.me.us/house/jt_com/afa.htm.

You can find members of the Health & Human Services Committee and their contact information on the web at: http://janus.state.me.us/house/jt_com/hum.htm.

You also may  leave messages for members at the State House as follows:

Senators:  Call toll free, 1-800-423-6900

Representatives:  Call toll free, 1-800-423-2900

If you have questions or comments about this matter, please contact Andrew MacLean, Deputy EVP at amaclean@mainemed.com or 622-3374, ext. 214.

2.  House Approves Funding to Update Single Payor Study 

On January 29, 2008, the Maine House voted 90 to 52 with 9 absences in favor of L.D. 1072, An Act to Establish a Single-Payor Health Care System, a divided report from the Insurance & Financial Services Committee carried over from the first session.  The vote divided along party lines both in the committee and on the floor with Democrats supporting the measure and Republicans opposing it.  The bill would appropriate $5750 from the General Fund for professional services for grant writing and other technical assistance and would authorize the expenditure of up to $60,000 in outside grant funding to update the December 2002 document entitled, Feasibility Study of a Single-payer Health Plan Model for the State of Maine by Mathematica Policy Research, Inc.

The Senate likely will take up the bill this week.  You can see the legislative history of the bill, including the roll call vote in the House on the web at:  http://janus.state.me.us/legis/LawMakerWeb/summary.asp?ID=280023753.

3.  Public Health Highlights 

Last week, the HHS Committee unanimously recommended passage of an amended version of L.D. 1939, Resolve, to Establish a Method for Reporting the Statistics of Diseases.  The amended Resolve instructs the Maine Quality Forum and the Maine CDC to make reportable information available to Maine citizens through a variety of means including, but not limited to, the MQF web site and the distribution of written reports or other publications.

The HHS Committee could not come to final resolution on L.D. 1956, Resolve, to Expand the Case Definition of Lyme Disease for Purposes of Compiling the Annual Lyme Disease Surveillance Report and so the bill was tabled pending further discussion among the Maine CDC and interested parties.  A proposed amendment offered by the bill's sponsor, Senator Bruce Bryant (D-Oxford), would have required the Maine CDC to report cases of physician-diagnosed Lyme disease in the absence of erythema migrans or laboratory confirmation of infection.  House Chair Perry moved "ought not to pass" on the proposal which was then tabled.  The Maine CDC goal is to ensure that Maine uses uniform national reporting and surveillance definitions.

The HHS Committee voted by a 12 - 1 margin in favor of L.D. 2012, An Act to Protect Children from Second-Hand Smoke.  The final version would be a primary offense when children 16 or younger are in the vehicle.

Finally, the HHS Committee voted "ought not to pass" on L.D. 1975, Resolve, to Require the Department of Health & Human Services to Promote Awareness of Parkinson's Disease

4.  Mental Health Review Board Legislation 

On Tuesday, January 29, 2008, the HHS Committee held a public hearing on L.D. 1951, An Act to Create the Mental Health Homicide Review Board and L.D. 2107, An Act to Establish a Forensic Case Review Panel to Advise the Department of Health & Human Services, both similar bills.  The sponsor of L.D. 2107 recommended that the Committee kill her bill in favor of working on the other.  The Department, the Disability Rights Center, NAMI-Maine, and the Maine Association of Psychiatric Physicians (MAPP) and MMA all expressed general support of the concepts in the bills, though MAPP expressed a preference for the approach of L.D. 2107.  The bills had no opposition.  The Committee held a brief work session after the public hearing and then asked the interested parties to reach agreement on final language.  The MMA & MAPP are involved in that process.

5.  Reminder:  Legislative Committee conference call schedule 

The Legislative Committee will hold its weekly conference call on Tuesday, February 5, 2008 at 7 p.m. using the regular MMA conference call line, 1-800-989-2842 and passcode 6223374#.

6.  No bills for review this week 

The MMA identified no new bills printed last week that are of interest for review this week.



Governor Baldacci Nominates Mila Kofman as Next Insurance Superintendent
On January 25, 2008, Governor Baldacci announced his nomination of Mila Kofman, a lawyer with extensive experience in academia, government, and non-profit organizations, to fill the unexpired term of Alessandro Iuppa that ends in April 2009.  Ms. Kofman will meet with members of the MMA staff on Thursday, February 7, 2008 to get acquainted.  The Insurance & Financial Services Committee has scheduled a public hearing on the nomination for Tuesday, February 12, 2008 at 1 p.m.

You can read the Governor's press release on the nomination on the web at:  http://www.maine.gov/tools/whatsnew/index.php?topic=Portal+News&id=49365&v=Article-2006. [return to top]

A New Look for the Maine Medicine Newsletter
Be on the look-out for your January/February issue of Maine Medicine to arrive in your mailbox later this week.  For 2008, we have enlarged the publication.  Although the newsletter remains 8-pages in length, the size is now 11" x 17" versus the old 10 3/4" x 12". 

The size of the publication was changed in order to provide our members with more helpful information in each issue.  The newsletter continues to include advertising by our Corporate Affiliates; however, the ads are now on the back cover and throughout the publication.  

Please let us know what you think of the new format and give us your input for future improvements.  Also, please feel free to submit information that might be valuable to members for inclusion in future issues of Maine Medicine.

We want your input.......contact Shirley Goggin at sgoggin@mainemed.com or 207-445-2260 or Gordon Smith, Esq. at gsmith@mainemed.com or 207-622-3374, ext. 212. 




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Place Your Vote Today on www.mainemed.com
The first day of each month we place a new question on the home page of the MMA website, www.mainemed.com, to solicit member opinions on issues.  The question posted for the month of February is:  Do you support the pending state legislation prohibiting smoking in a motor vehicle if a child sixteen years or younger is in the car?

Please take a moment to go to www.mainemed.com and place your vote.  The questions are for members-only, so you will need to enter your username and password and then it is as easy as toggling on a button indicating your choice and pressing submit.  If you haven't registered as a member, you can do so easily by clicking on "Register online" in the upper right hand corner of the home page under MMA Member Access.  Once registered (and approved), you will be able to access members-only areas on the website at any time.

Your opinion matters....please take the time to vote today! 

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DHHS Proposes Rule Change on Reimbursement for Physician-Administered Drugs
On January 22, 2008, the DHHS, Office of MaineCare Services proposed changes to the MaineCare Benefits Manual, Chapter II, Section 90, Physician Services.  The proposed change to Section 90.04-7 regarding Drugs Administered By Other Than Oral Method in the Office Setting are as follows:

 MaineCare will not reimburse for physician administered drugs that are not rebateable under Centers for Medicare and Medicaid Services (CMS) regulation unless the physician obtains Prior Authorization (PA).  PA will not be granted for non-rebateable, physician administered drugs for which there are therapeutically equivalent alternatives that are rebateable.

The Department has scheduled a public hearing on the proposed change for Tuesday, February 19, 2008 at 1 p.m. in Conference Room 1A at the DHHS Office, 442 Civic Center Drive, Augusta, Maine.  The written comment deadline is February 29, 2008.  You may direct written comments to Nicole Rooney, Comprehensive Health Planner, DHHS Office of MaineCare Services, State House Station 11, Augusta, Maine 04333-0011.

If you have comments you would like included in oral or written submissions by the MMA, please contact Andrew MacLean, Deputy EVP at amaclean@mainemed.com or 622-3374, ext. 214.

You can find the proposed rule changes and provide comments on the web at:  http://www.maine.gov/bms/rules/provider_proposed_mcare.shtml.  Scroll down until you see Chapter II, Section 90, Physician Services. [return to top]

MMA Holds First Meeting of Senior Section
The "Senior Section" of MMA held its first ever meeting on January 23, 2008 at the offices of the Association in Manchester.  Twenty interested physicians attended and heard a presentation by Brunswick physician Peter McGuire, M.D. on his successful establishment of a free medical clinic in Brunswick.  In addition to the Oasis clinic in Brunswick, there are now free clinics operating in Biddeford, West Buxton, Rockland, and Ellsworth.  Following Dr. McGuire's presentation, MMA Deputy EVP Andrew MacLean spoke to attendees on the licensing and insurance requirements for furnishing medical services as retirees.

The purpose of the Section is to furnish MMA's retired members with opportunities to volunteer in four areas:

  1. Medical clinics serving uninsured patients in the state;

  2. Medical missions around the world;
  3. Mentoring Maine youth, medical students, and residents; and
  4. Advocacy activities before the state legislature and in the regulatory agencies

Buell Miller, M.D., a retired Ob-Gyn who practiced many years in the Portland area, has agreed to chair the section and has provided much of the energy and vision for the Section.

Members or non-members interested in the activities of the Section should contact Dr. Miller at 622-3374, ext. 228 or via e-mail to bmiller@mainemed.com. [return to top]

Payor Liaison Committee meets on MaineCare and Physician Tiering
MMA's Payor Liaison Committee met last week and discussed two primary topics:  the MainceCare fee increase scheduled to become effective on July 1, 2008 and the continuing efforts by health plans to tier physicians using efficiency ratings organized around episodic treatment groups.

MaineCare Director Tony Marple and Medical Director Rod Prior, M.D. met with committee members and described the State's plans for the fee increase.   Although the plans are still tentative and rule-making would be necessary for some aspects of the plan, the State is interested in using about half of the $9 million increase for an across-the-board fee increase with the remaining funds being used to benefit primary care.  There is also going to be an attempt to direct funds to pediatric specialties so that some of the MaineCare patients being sent to Boston would have an opportunity to receive their care in Maine.

Additional meetings will be held to discuss this topic.

Committee members also heard an update from Gordon Smith on the continuing efforts by Aetna, Cigna, and Anthem to tier physicians by measuring their efficiency using software looking at the total cost of care during episodes of treatment.  Various problems with the measurements were discussed included small sample size, inadequate risk adjustment, and inaccurate data.  The recent activity of the New York State Attorney General Andrew Cuomo was noted.  A.G. Cuomo recently established a set of ground rules to be followed by any plan that is tiering physicians using this type of approach.  Most of the major plans have agreed to abide by these principles.

Watch for further information on this important topic in this publication, in Maine Medicine and through various educational offerings offered at MMA. [return to top]

Maine Collaborative Achieves Chartered Value Exchange Status with HHS.
In December 2007, a collaborative effort involving the Maine Quality Forum, the Maine Health Management Coalition, Quality Counts and HealthInfoNet filed an application with the federal Department of Health and Human Services to become a "Chartered Value Exchange." Last week, the organizations were notified that the application was successful and that the Maine collaborative would become one of only fourteen such Exchanges in the nation.

The effort embodies four aspects of value-based purchasing including:

  1. interoperable information systems
  2. performance measurement and reporting
  3. price measurement and reporting
  4. quality incentives

The HHS press release on this announcement is available here. [return to top]

Maine Gastroenterology Society Winter Meeting, February 29 - March 2, 2008
The Maine Gastroenterology Society Winter meeting will be held at the Bethel Inn in Bethel, Maine on February 29 - March 2, 2008.  This year's theme is Cancer Surveillance in Gastroenterology and the agenda for the meeting is as follows: 

Friday, February 29, 2008 - 6:30 p.m. Reception

Saturday, March 1, 2008 - 7:30 - 10:00 A.M. topics including Hepatocellular Carcinoma, Interventional Radiology, and Liver Transplantation.  Break for afternoon.  Saturday, March 1, 2008 - 4:30 - 6:00 p.m. Barrett's Esophagus, Endoscopic Treatment of Barrett's, and Esophageal Cancer.

Sunday, March 2, 2008 - 8:00 - 9:30 A.M. topics will include Colorectal Cancer, Colon Cancer Surveillance, and Quality Care Initiatives.

If you would like to attend this conference and would like registration materials or if you would like to exhibit at this event please contact Gail Begin at the Maine Medical Association at 622-3374, ext. 210 or email at gbegin@mainemed.com

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Gastroenterology for Primary Care Conference Planned for May 3, 2008
The Maine Gastroenterology Society will put on its annual conference, Gastroenterology for Primary Care on May 3, 2008 at the Harraseeket Inn in Freeport, Maine.

Preliminary Agenda

8:00 -8:30 AM Registration  - Continental Breakfast

8:30-8:40 Opening Remarks Drs. Schneider and Bosco

Session I Liver Disorders

8:40-9:10 AM – Acute Liver Failure

9:10-9:40 AM – Update on Viral Hepatitis

9:40-10:10 AM – Hemochromatosis

10:10-10:30 AM – Panel discussion Q and A

10:30-10:45 Break

Session II Clinical Symposium - Gastroesophageal Reflux

10:45-11:15 AM – GERD How do we get it? How do we get rid of it?

11:15- 11:45 AM – Motility studies – When it can help

1:45 – 12:15 PM –GERD- Should we operate?

12:15-12:30 PM – Panel discussion Q and A

12:30 – 1:30 Lunch Break

Session III - State of the Art Lecture

1:30-1:45 Inflammatory Bowel Disease- We have come a long way!

1:45-2:00 Question and Answer

Session IV Case Presentation

1:45-2:05 Case #1

2:05-2:25 Case #2

2:25-2:45 Case#3

If you would like more information on this meeting including registration materials or exhibitor information please contact Gail Begin at the Maine Medical Association at 622-3374, ext. 210 or email at  gbegin@mainemed.com [return to top]

The Hospital Acquired Infection (HAI) Work Group Update
The Hospital Acquired Infection (HAI) Workgroup met January 30, 2008 at the Maine Hospital Association and addressed the Utilization of Administrative Data for HAI Reporting, as requested by the Maine Health Data Organization (MHDO).  Attending were Infectious Disease Physicians and practitioners from Maine hospitals that are a part of this collaborative discussion.  Ms. Susan Schow from the MHDO and Dr. Josh Cutler from the MQF facilitated the meeting.  The presentation included a review of how CMS defines HAI’s, the accuracy of POA coding, other approaches to identifying HAIs occurring in other states, and issues surrounding HAI public reporting approaches throughout the country. 

For guidance on accurately collecting and reporting HAI, the Maine hospital community turns to the Healthcare Infection Control Practices Advisory Committee (HICPAC).  This federal advisory committee provides guidance to the CDC regarding the practice of infection control, strategies for surveillance, prevention and control of health care associated infections.  In 2005, HICPAC released its Guidance on Public Reporting of Healthcare-Associated Infections:  Recommendations of the Health Care Infection Control Practices Advisory Committee.    The consensus recommendations in this report have also been endorsed by the Association for Professionals in Infection Control and Epidemiology, the Council of State and Territorial Epidemiologists, and the Society for Healthcare Epidemiology of America.  The report includes the following highlights:

  • HICPAC found no published information of the effectiveness of public reporting systems in reducing HAIs.

  • A reporting system should collect and report data that are useful not only to the public, but also to the hospital for its quality improvement efforts.

  • Process measures are desirable for inclusion in public reporting system because the target adherence rate of 100% to these practices is unambiguous, and the metrics do not require risk adjustment.

  • Outcome measures should be chosen for reporting based on the frequency, severity, and preventability of the outcomes and the likelihood that they can be detected reported accurately – this is one of the biggest challenges in the identification of infection rates for public reporting purposes.

  • Do not use hospital discharge diagnostic codes or ICD-9 codes as the sole data source for HAI public reporting systems.

The Maine Hospital Association is committed to public release of quality data that is valid, useful, and actionable and has published annual reports of hospital-specific performance for clinical indicators and patient satisfaction years before the Maine Quality Forum existed and before the Joint Commission or the Centers for Medicare and Medicaid Services began publishing hospital report cards.  Currently, all MHA member hospitals submit quality data for the Centers for Medicare and Medicaid Services for posting on the Hospital Compare web site – including critical access hospitals that are not subject to the market basket penalty for nonsubmission. [return to top]

Maine Urological Association Winter Meeting a Success!
The Maine Urological Association (MUA) Members met this past weekend at Sugarloaf/USA under the direction of President Dr. Michael Parker and had an excellent cadre of CME lectures.  Mark Moyad, MD from the University of Michigan Medical Center, Dept. of Urology, Complementary & Alternative Medicine, provided a thought provoking discussion on Diet and Dietary Supplements:  What Works and What is Worthless for your male patients., as well as a presentation on New and Old Side Effects on Androgen Deprivation from A-Z:  What do I tell my Patients?  Dr. John McGill spoke on the Healthcare Crisis in Surgery, with Dr. Brian Jumper providing a discussion on Deflux with medically educational video of procedures to create a lively discussion.  The American Cancer Society provided an overview of the Man to Man Educational program on Prostate Cancer and Jana Purell, CPC assisted members in a Urology Coding Update.

The MUA Winter Meeting was successfully attended and the group is working on developing another successful winter meeting at Sugarloaf in 2009.  For more information on  next year's meeting and/or to become a member of  the MUA, contact Kellie P. Miller, M.S. at the Maine Medical Association at 207-622-3374, ext. 229 or kmiller@mainemed.com.

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Penobscot County Medical Society Outing, February 17, 2008
The Penobscot County Medical Society will hold a winter outing to go snowtubing at Hermon Mountain, February 17, 2008, 3:30-6:30pm.  The event is free for all Penobscot County physicians and their families.  RSVP by phone to James VanKirk, 990-3294 [return to top]

State of the Union Recap: President Bush Advocates Health IT and Tax Changes, Likely to Propose Medicare and Medicaid Cuts
In last week's State of the Union Address, President Bush reiterated some familiar themes on health reform. Similar to last year’s plan, Bush proposed changing the tax code to eliminate the deductibility of employer-provided health insurance. He would instead give a standard deduction to everyone purchasing insurance.
The President also urged Congress to provide consumers with better information, increase use of health IT, expand health savings accounts, allow businesses to purchase insurance across state lines and pass medical liability reform.
Medicare physician payments will be cut by 10.6% on July 1, and many state Medicaid programs may cut fees, too, during this economic slowdown. ACOG is working with Congress and the physician community to address these issues.
The President’s budget, to be released this week, will likely contain additional deep cuts to Medicare and Medicaid.. [return to top]

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