February 11, 2008

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Political Pulse: Supplental Budget & Other Legislative Highlights of the Week

The MMA thanks 5 physicians for taking the time last Friday to come to the State House to testify before the Appropriations and HHS Committees in opposition to a proposed reduction in MaineCare funding for hospital-based physicians of $20 million.  Thanks to Doctors Jim Raczek, Ned Claxton, Frank Bragg, Kevin Flanigan, and David Dixon for your efforts!

1.  Governor's FY 2008-2009 Supplemental Budget/Public Hearing on $20 million cut to hospital-based physicians 

Representatives of the Maine Hospital Association and the MMA spoke out against the Baldacci Administration's proposal to help balance the state budget by reducing funding to hospital-based physicians by $20 million in state and federal dollars during a public hearing before the Appropriations and HHS Committees on Friday, February 8, 2008.  The following individuals spoke during Friday's public hearing:

  • Mary Mayhew, MHA
  • Jim Raczek, M.D., EMMC
  • Ned Claxton, M.D., CMMC
  • Frank Bragg, M.D., EMMC
  • Kevin Flanigan, M.D., MMA
  • David Dixon, M.D., Franklin Memorial Hospital
  • Darlene Stromstad, CEO, Goodall Hospital

All witnesses emphasized the important role that "provider-based" entities have played in maintaining access to physician services, particularly primary care services, in Maine.

 Dr. Flanigan's testimony included a news article on Midcoast Medicine's withdrawal from the MaineCare program from the October 18, 2007 issue of the Rockland-based Village Soup newspaper and an opinion piece by MMA President William Strassberg, M.D. from the February 7, 2008 issue of the Bangor Daily News.  Dr. Flanigan's testimony soon will be posted on the MMA website for your reference.  The MHA's talking points on the budget issues may be found on the web at:  http://www.themha.org/advocacy/physcuts.htm.

The Health & Human Services Committee has scheduled work sessions on the budget all week this week and then will report its recommendations to the Appropriations Committee on February 21 and 22, 2008.  The MMA and MHA need your grassroots assistance as we work to persuade both committees to reject the proposed cuts.

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

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

You also can leave messages for any Senator at the State House by calling toll free, 1-800-423-6900.

You can leave messages for any Representative at the State House by calling toll free, 1-800-423-2900

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

2.   BRED Committee to Receive Sunrise Report on "Lay Midwives" this Week

The Legislature's Business, Research, and Economic Development Committee (BRED) will meet on Thursday afternoon, February 14, 2008 to review a report of the Department of Professional and Financial Regulation (DPFR) on a proposal to license direct-entry midwives, who are currently self-regulated.  These direct entry midwives, sometimes called lay midwives, should not be confused with certified nurse midwives, who are currently licensed by the Maine Board of Nursing and have substantial education and licensure requirements.

The Maine Medical Association, the Maine Chapter of the American College of Obstetrics and Gynecology, the Maine Academy of Family Physicians, and the Maine Chapter of the American Academy of Pediatrics all oppose the legislative proposal to license such individuals in Maine.  Such licensure would confuse the public and could lead to more patients being encouraged to give birth at home.

The Department was asked to prepare a report on the legislation under Maine's "Sunrise Review" statute.  The report has not yet been released so we will not know until later in the week, but certainly by Thursday, whether the DPFR has recommended against a licensing approach.

3.  Single Payer Study Bill Stalled in Senate 

L.D. 1072, An Act to Establish a Single-payor Health Care System remains "unfinished business" on the Senate calendar following a favorable vote in the House.  The bill simply would authorize the expenditure of slightly more than $60,000 to update a 2002 study on the feasibility of a single-payer health care system in Maine.  The partisan difference of opinion on this subject is evident in the following roll call vote on a procedural motion, failing on a 17 - 17 vote with one absence:   http://janus.state.me.us/legis/LawMakerWeb/rollcall.asp?ID=280023753&chamber=Senate&serialnumber=259

4.  Joint Order on Parental Consent to Dispense Contraception

In response to the controversy surrounding the school-based health center at King Middle School in Portland, conservative legislators and advocates have sought various ways to get a bill before the legislature on parental consent over the objections of a majority of the legislative leadership.  The Senate passed a Joint Order (S.P. 842) Directing the Joint Standing Committee on Health and Human Services to report out, to the Senate, a bill regarding parental consent to dispense prescription drugs to children.  On February 5, 2008, the Senate voted 29 - 5 in favor of the Joint Order.  On February 7, 2008, the House voted 75 - 67 to "indefinitely postpone" the Joint Order.  Given the close vote in the House, there may be a move for reconsideration.  The MMA will continue to work against the Joint Order.

5.  Fund for a Healthy Maine 

Kellie Miller, MMA staff and the Friends of the Fund for a Healthy Maine (FOFHM) representatives, Betsy Sweet, Becky Smith, and Megan Hannan met last Wednesday with Speaker of the House, Glenn Cummings, President of the Senate, Beth Edmonds, Majority Leader, Senator Elizabeth Mitchell, Assistant Majority Leader Senator John Martin and  House Majority Leader, Representative Hannah Pingree to discuss the preservation of FHM for prevention and public health initiatives.   L.D. 1977, An Act to Fully  Fund School Breakfast from Kindergarten to Grade 12, sponsored by Senator Elizabeth Mitchell and passed out of the Education Committee, suggests funding through the Fund for a Healthy Maine.  This bill and the difficult budget situation have prompted discussions with leadership to preserve the integrity of the fund.

Prepare to be "Profiled" by Health Plans/ Employers

Many health plans across the country and in Maine now are creating profiles of physicians for the purpose of publishing "physician-ratings" aimed at patients and establishing tiered and narrow health plan networks.  While these efforts are not, in and of themselves, objectionable, physicians must insist that the ratings be based upon data which is accurate, transparent, and appropriately risk adjusted.

Both MMA and the AMA have been active on many fronts to help assure that these profiling programs are based upon accurate data, appropriately risk adjusted, transparent, and include enough encounters to be credible.  Distinctions need to be made between profiling aimed at identifying physicians practicing at the highest quality level and those practicing "efficiently."  While all physicians will wish to strive for the highest quality, many will not choose to be the cheapest.  Any health plan or employer holding out one group of physicians as superior in quality to another must be prepared to prove that based upon accurate and meaningful data.  When challenged legally in cases across the country, the data and software currently used has been found "not ready for prime time."  The laws of libel and slander remain powerful tools for physicians damaged in their reputation by labels and distinctions based upon data not yet proven to be reliable indicators of quality or efficiency.  Most of the current data is drawn from administrative or claims data, while most experts agree that data directly from the patient's chart or based upon actual outcomes are better measurements for establishing benchmarks of quality.

Most of the profiling in Maine and across the country is currently based upon software using "episodic treatment groups" (ETG's) which include costs associated with episodes of care, including both physician and hospital costs.

In New York state, Attorney General Andrew Cuomo recently ordered health plans profiling physicians to agree to a list of requirements that were negotiated among consumer, provider, and regulatory interests.  Most major health plans have agreed to abide by the agreement which will go some ways toward preventing the abuses that have been seen and litigated in Texas and Washington state.  Eventually, the data and software will be better.

In Maine, Cigna, Aetna, Anthem, and the State Employee Health Plan all are profiling physicians at some level.  Physicians should become familiar with these initiatives.

This topic will be the subject of a breakout session at the MMA's 18th Annual Practice Management Program being offered in Augusta on Wednesday, May 28th.  Registration is now available on the MMA website at www.mainemed.com.

In the meantime, the AMA offers an array of resources to help members understand, prepare for, and, when necessary, challenge the way they are profiled.  Among the most recent additions to these resources are Physician profiling:  How to prepare your practice and How to challenge your profile or narrow network.  They are available on the AMA website www.ama-assn.org at no cost.

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President Bush Unveils $3.1 Trillion Budget With Cuts to Medicare & Medicaid

On Monday, February 4, 2008, President Bush unveiled a record federal budget, the first ever to exceed $3 trillion. 

The proposed budget would cut approximately $560 billion from Medicare over the next decade and $17.4 billion from Medicaid over the next five years.  Despite these cuts, the budget would leave intact program subsidies to health plans worth an estimated $150 billion over ten years.  "Outrage would be the appropriate reaction," noted MMA EVP Gordon Smith when asked for reaction to the proposal.

According to administration sources, the cuts would slow the program's projected annual growth rate from seven percent to five percent.  The cuts would save the program, in net present value terms, roughly $10 trillion over the next 75 years which would reduce nearly one-third of the program's unfunded obligations.

Because the budget has been presented to a Congress controlled by the Democrats, it is likely to be dubbed "Dead on Arrival."  It would be possible procedurally for the majority party to pass continuing resolutions keeping the government running through the 2008 election period, thus waiting for a new President before adopting a budget.

On the physician side, the President's budget does not restore the significant cuts to Medicare reimbursement, effective July 1, 2008, Jan. 1, 2009, and beyond as a result of the flawed payment methodology based upon the sustainable growth rate (SGR).  Fixing the formula and providing positive annual updates are the highest legislative priority for medicine this year.  MMA staff and physician leadership will be in Washington the first week of March to join with other physicians from around the country to advocate for a Medicare payment fix.  A large "White Coat" rally will occur at the Capitol on Wednesday, April 2, 2008.

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Massachusetts Health Care Reform Plan Costs Will Exceed Expectations

According to Governor Deval Patrick's (D) FY 2009 budget, Massachusetts will spend $869 million on Commonwealth Care, the subsidized insurance product for those earning less than 300% of the federal poverty level (FPL).  This amount is almost double the initial appropriation for the program in FY 2008 of $471 million.  The FY 2008 figure was later revised up to $618 million.  The projected spending is a result of higher than expected enrollment.  In calendar 2007, the program enrolled 126,000 people with incomes under 150% of the FPL who receive free coverage and 42,000 who pay part of the cost of coverage.  The state has, however, seen a 24% decrease in free care, a drop from $592.2 million two years ago to an anticipated $453 million.  The health care reform plan has enrolled approximately 300,000 previously uninsured individuals since it was initiated last year.

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Membership Growth Lifts Aetna 4Q Profit, Cigna 4Q Profit Up 13 Percent

Aetna Inc.’s profit increased 3%, according to the insurer’s quarterly report. Net income increased to $448.4M, up from $434.1M during the same period the previous year. Aetna attributed the increase to a rise in membership, which grew by 168,000 to 16.85M members. The company reported almost a 10% increase in revenue, nearly $27.6B, as well.

Cigna Corp.’s attributes it 13% profit increase to overseas business, and gains in its group disability and life. Cigna’s net income rose to $263M, up from $232M during the same time last year. Revenue also rose to $4.46B from $4.21B, which the insurer attributed to higher premiums and fees from specialty insurance and Medicare Part D.

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Maine Medical Center and Tufts Announce Joint Training Program

On February 5, 2008, Maine Medical Center and Tufts University last week announced the creation of a joint medical school training program that has the potential to increase both the opportunity of medical school for Maine students and the likelihood that more physicians will practice in the state.  The selection of Tufts as the partner for the program had previously been annnounced but at a press conference in Portland on Tuesday officials from both MMC and Tufts explained the details of the program.  The Maine Medical Association has been supportive of the program and passed a Resolution at the Annual Meeting endorsing such efforts.

The program will start accepting applications this fall for the 2009-2010 school year.  Students will spend their first two years taking classes at Tufts and spend most of the final two years at Maine Medical Center in Portland or at other area hospitals.  The program expects to graduate 36 students a year with 20 of these slots reserved for students from Maine.

"The medical center sees it as having a special responsibility . . .  to invest in the future of education of physicians, many of whom could stay in the state," said Vince Conti, MMC President and Chief Executive Officer.

It is also hoped that traditional tuition costs could be reduced by using a combination of public and private dollars.  Governor Baldacci last week noted that he supports the program and is interested in exploring opportunities for funding.

Dr. Michael Rosenblatt, Dean of the Tufts Medical School, stated that Tufts is interested in graduating primary care physicians needed in rural Maine.  Maine Medical Center will have an important role in not only choosing the students in the program but also in developing the curriculum which, in part, will be aimed at preparing students for careers in rural medicine.  Graduates will receive a combined degree from Maine Medical Center and Tufts. 

MMA President William Strassberg noted in a media interview that the new program will give students the exposure to Maine that will help them see it as a good place to live and practice.  He said the program will help Maine physicians who have trouble attracting and keeping partners because of the high costs of maintaining a Maine practice in Maine, partially because of the low reimbursement from MaineCare and Medicare.

The new program is not expected to affect MMC's relationship with the University of New England.  However, the current affiliation with the University of Vermont will end in 2011 in order to make room for the Tufts students.  UVM had been the primary medical school relationship for MMC for many years, with Vermont most recently sending 28 students a year to MMC. 

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Need Staff Training in HIPAA? Let MMA Take Care of It on March 7th in Manchester

The federal HIPAA law and regulations require yearly training in HIPAA, including the privacy and security rules.  If you have staff that need an update or have a new employee who need this education, consider the Friday, March 7 program at the offices of the Maine Medical Association in Manchester.

At this "First Friday" presentation, well-known health lawyers Ken Lehman, Kate Healy, Andrew MacLean, and Gordon Smith will review the nuts and bolts of the HIPAA privacy and security provisions and re-aquaint attendees with Maine's landmark medical confidentiality law that pre-dated HIPAA.

The program will run from 9:00 am to noon.  A fee of $60 per person includes breakfast and the cost of all materials.

You may register by calling MMA at 622-3374 (press O for assistance) or by registering on-line at www.mainemed.com.

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Public Health Committee to Meet Wednesday, February 13 at 4 pm

Under the direction of Dr. Charles Danielson, the Public Health Committee’s (PHC) first meeting of 2008 has been scheduled on Wednesday, February 13, 2008 from 4 pm – 6 pm at the Maine Medical Association Conference Room.  Video Conferencing will be available in the Portland area at the MaineHealth Board Room at 465 Congress Street (in the Maine Bank & Trust Building) and to participate by conference call the Dial-In Number is:  1-800-989-2842, access code: 6223374#.

The PHC agenda will include a discussion on potential PHC initiatives for the year ahead, including:  Childhood Vaccine Supply & Immunizations, with Dr. Jiancheng Huang presenting on the current status; Childhood/Obesity Management; Miscommunication of Risk; Effective Public Reporting on the Statistics of Disease; and Public Health Functions and the Physician's Office.   A brief update will also be provided on the statutes regarding Public Health Emergencies (authority, investigation, reporting, etc..) as well as an overview of the 2008 Legislative Agenda on Public Health Issues.

If you are interested in strengthening and broadening our public health policy initiatives in the year ahead and would like to serve on the PHC, please contact Kellie Miller, Director of Public Health Policy, MMA staff for the PHC at 622-3374, ext. 229, cell at 207-462-5713 or at kmiller@mainemed.com.  

The next meeting of the PHC is scheduled for March 26, 2008, 4-6 pm at the Maine Medical Association. 




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Child Psychiatry for Primary Care, June 5-6, South Portland

The University of Vermont College of Medicine presents "Child Psychiatry for the Primary Care Clinician," June 5-6, 2008 at Wyndham Portland Airport Hotel, in South Portland.

The objective of this course is to equip primary care physicians with practical and updated strategies for the diagnosis and treatment of many of the most common childhood psychiatric conditions. Specific disorders and behaviors covered in this conference include ADHD, autism, and mood disorders.

For more information, and to register, visit http://cme.uvm.edu

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Consumers for Affordable Healthcare Selected for Grant Supporting Health Reform in Maine

Consumers for Affordable Care Foundation (CAHC) announced today that they have been selected by the Robert Wood Johnson Foundation (RWJF) and Community Catalyst to participate in a new grant project providing technical and financial resources to support health reform efforts in Maine. The organization will participate in the Consumer Voices for Coverage grant initiative, which supports state advocacy efforts by fostering strong and robust advocacy infrastructures. A Leadership Team made up of the American Cancer Society/Maine, the Maine AFL-CIO, Maine Children’s Alliance, Maine Council of Churches, the Maine Center for Economic Policy, Maine Equal Justice, and the Maine People’s Resource Center will work with CAHC to help guide the efforts of this project over the next three years.

“There is tremendous momentum in the states for implementing effective health care reform. We know from experience that the voices of consumers – the men and women who work hard each day to support their families – are often the most effective in driving necessary change,” said Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of the Robert Wood Johnson Foundation. “As states launch ambitious health care reform efforts to ensure that more Americans have health insurance, advocates for consumers will be able to make their voices heard.”

Consumer Voices for Coverage will enhance the critical role that advocates play in shaping and promoting comprehensive health reform. The $15 million initiative will strengthen existing advocacy networks in 12 states. Community Catalyst, a national non-profit consumer health advocacy organization headquartered in Boston, will coordinate the effort nationwide.

“Consumers for Affordable Health Care Foundation is a non-partisan, non-profit organization that works everyday to make health care more affordable for Maine families and businesses. Being chosen to receive this grant signifies that health care experts nationwide recognize the tireless work of our organization and our partner organizations for the public interest over the past 20 years. It also recognizes Maine’s continued role as a leader for the nation in increasing the number of residents who have good health insurance coverage,” said Joseph Ditré, executive director of Consumers for Affordable Health Care Foundation.

“The voices of hard working people who face real struggles because they lose health coverage after losing or changing jobs, or who don’t have coverage because their employer can’t or doesn’t offer it need to be heard by state policymakers. We see this grant as a real opportunity to bring the needs of the people that ultimately pay all the bills for their health coverage and care together with businesses, health providers, government agencies, and civic and religious leaders in our communities. We look forward to working toward a common goal to ensure that all Mainers can get medical care when they need it without worry of going into debt,” said Ditré.

Other state organizations chosen to lead Consumer Voices for Coverage networks in select states include:

  • California -- Health Access Foundation
  • Colorado -- Colorado Consumer Health Initiative
  • Illinois -- Campaign for Better Health Care
  • Maryland -- Maryland Citizens’ Health Initiative Education Fund, Inc.
  • Minnesota -- TakeAction Minnesota Education Fund
  • New Jersey -- New Jersey Citizen Action Education Fund
  • New York -- The Community Service Society
  • Ohio -- Universal Health Care Action Network of Ohio, Inc.
  • Oregon -- Oregon Health Action Campaign
  • Pennsylvania -- Philadelphia Unemployment Project/Unemployment Information Center
  • Washington -- Washington Community Action Network Education and Research Fund

Consumers for Affordable Health Care Foundation was founded in May 1988. Through this project, it will continue its long history of working with broad-based coalitions to expand access to affordable health care coverage. Over the next three years, it will work with the organizations that are members of this project’s Leadership Team, listed above, to achieve the objective of working with community and business leaders to identify ways to ensure that all Maine people have affordable, quality health care and coverage. In short, the goal is guaranteed, affordable coverage that provides choice and stability in our health system.

“For almost 20 years, Consumers for Affordable Health Care has been a leader in efforts to reform health care in Maine. We are excited to work with such a strong organization to increase momentum towards action in this state,” said Susan T. Sherry, deputy director of Community Catalyst, who directs Consumer Voices for Coverage. “Supporting networks that bring the views of real people to policymakers and key thought leaders in the states about the need for coverage expansion can be a powerful inducement for reform.”
Additional information on Consumer Voices for Coverage can be found at www.voicesforcoverage.org and www.mainecahc.org/ [return to top]

New Bills for Your Review & Comment/Reminder of Legislative Committee Activities

The MMA has identified the following new bills of interest to the physician community.  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.

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

The Legislative Committee has scheduled a policy forum on MaineCare financing issues for 5:30 - 8:00 p.m. on Monday, February 25, 2008.  The MMA will invite several members of the legislature's Appropriations and HHS Committees to participate in the forum.  The forum, following the same format as the two events last year, is open to any MMA member. 

L.D. 2172, An Act To Protect Children from Lead Poisoning (monitor or oppose; pediatricians, Public Health Committee)

L.D. 2192, An Act To Increase Access to Dental Care (monitor; Public Health Committee)

L.D. 2193, An Act Regarding Clinical Review of Certain Requests for Involuntary Mental Health Treatment (monitor; seek input from psychiatrists)

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