April 21, 2008

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123rd Maine Legislature Adjourns Sine Die Late Friday Night

The 123rd Maine Legislature came to a close on Friday, concluding a session that included definitive action on Dirigo Health, successful efforts to close a gap in the two-year budget and action on several public health issues of interest to physicians.  All in all, MMA believes the session was a successful one from the perpective of physicians, with more money for MaineCare coming July 1 and with the defeat of midwifery licensure being among the highlights.

Following a final flourish of activity on the Dirigo Health Program, school and jail consolidation, bridge repair and maintenance, and driver's license security, the 123rd Maine Legislature adjourned sine die late in the evening of Friday, April 18, 2008.  Practically, sine die means this legislature has adjourned for the final time.  Members of this legislature now are either enjoying their retirement or planning their re-election campaigns.  Technically, sine die means adjournment without a definite date and time to return.

As you have probably seen in the press, the legislature enacted and the Governor signed an amended version of L.D. 2247, An Act to Continue Maine's Leadership in Covering the Uninsured, the bill intended to provide a sustainable and stable source of funding for the Dirigo Health Program and to make some modest changes to the regulation of health insurance in Maine.  The new funding for Dirigo replaces the controversial "savings offset payment" (SOP) with a 1.8% "health access surcharge," a combination of alcohol and soft drink taxes, and some money from the Fund for a Healthy Maine.  The $0.50 per pack increase in the cigarette excise tax proposed in the original version of L.D. 2247 simply could not achieve sufficient support in the Senate to assure passage.  The MMA continues to believe that the Dirigo Health Program has been a positive contribution to our health care system.  For physicians, remember that the DirigoChoice health insurance product pays market rates for medical services.  From a quality improvement and public health perspective, the Maine Quality Forum, under the direction of Josh Cutler, M.D. advised by a panel of providers and other health care experts, is at the forefront of the patient safety and quality improvement movement in Maine.  The MMA will defend the Program through a "people's veto" initiative for L.D. 2247, if necessary.  

SAVE THE DATE: 1st Congressional District Candidate Forum Scheduled for May 13, 2008

The MMA Legislative Committee and the Trustees of the Maine Physicians Action Fund (MPAF) have scheduled the second forum of the year for Tuesday, May 13, 2008 from 5:30 to 8:00 p.m. at the MMA office in Manchester.  This event will be a candidate forum with the Republican and Democratic candidates for Maine's First Congressional District.  While we have not yet heard from all the candidates, we do expect Steve Meister, M.D., Adam Cote, Senator Ethan Strimling, former state Senator Mike Brennan, and Dean Scontras. 

Legislative Committee Chair Katherine Pope, M.D., Vice Chair Sam Solish, M.D., and PAC Chair John Makin, Jr., M.D. invite any interested member to join us for this event.  Please RSVP to Lisa Dennison at ldennison@mainemed.com or 622-3374. [return to top]

May 2nd First Friday Presentation Features "2008 Physician's Guide to Maine Law"

MMA's Physician's Guide to Maine Law was last published in 2002.  Many members and practice staff have patiently waited for its update.  We are pleased to state that the pre-publication volume of the 271 page book will be available in connection with the "First Friday" presentation on Friday, May 2nd at the MMA offices in the Frank O. Stred Building in Manchester.

All attendees will receive a copy of the volume and a CD that when utilized with the internet will automatically link to a variety of additional resources.  The entire publication will be placed on the Association's website in the coming weeks.

The final edition will be available this summer following an update for the actions of the 123rd legislature.  The pre-publication edition is current through Dec. 31, 2006.

You may register for the May 2nd program, which runs from 9:00am to noon and costs $60.00 by calling MMA at 622-3374 ext. 219 or be registering on-line at www.mainemed.com [return to top]

CMS Publishes Rule Expanding List of "Never Events"

On April 14, 2008, CMS posted the Hospital 2009 IPPS Notice of Proposed Rulemaking (NPRM) which includes expansion of the list of its Hospital Acquired Conditions (HAC) for non-payment, the so-called "never events."  While the rule affects hospital DRG payments only, there are significant implications for physician documentation on admission and patient care.

Nine new conditions have been proposed for nonpayment to hospitals in 2009:

  • Surgical site infections following certain elective procedures;
  • Legionnaires' disease (a type of pneumonia caused by a specific bacterium);
  • Extreme blood sugar derangement;
  • latrogenic pneumothorax (collapse of the lung);
  • Delirium;
  • Ventilator-associated pneumonia;
  • Deep vein thrombosis/Pulmonary Embolism (formation/movement of a blood clot);
  • Staphylococcus aureus septicemia (bloodstream infection);
  • Clostridium difficile associated disease (a bacterium that causes severe diarrhea and more serious intestinal conditions such as colitis).

The AMA will be drafting comments on the proposed rule.  If you have comments that you'd like the MMA to pass on to the AMA staff analyzing the rule, please contact Gordon Smith, EVP at gsmith@mainemed.com (622-3374, ext. 212) or Andrew MacLean, Deputy EVP at amaclean@mainemed.com (622-3374, ext. 214).

Also, CMS is proposing an expansion of the hospital quality measure reporting program, which reduces the amount a hospital is paid if it does not participate in the reporting of standardized measures.  Hospitals currently are required to report on 30 quality measures.  These measures are publicly reported on the CMS Hospital Compare website.  CMS is proposing adding 43 new measures to the list for hospitals in order for them to get the full inflation update for 2010.  The proposed new measures are on the following topics:

  • Surgical Care Improvement Project (1 new measure);
  • Hospital readmissions (3);
  • Nursing care (4);
  • Patient Safety Indicators developed by AHRQ (5);
  • Inpatient Quality Indicators developed by AHRQ (4);
  • Venous Thromboembolism (6);
  • Stroke (5); and
  • Cardiac surgery (15).
[return to top]

Protecting Children’s Health and the Environment From Toxic Chemicals Passes by an Overwhelming Majority!

As one of the MMA Public Health Committee’s three Public Health Policy Initiatives, many of the committee members were actively involved in supporting LD 2048, An Act to Protect Children’s Health and the Environment from Toxic Chemicals in Toys and Children’s Products. 

The Chemical Industry’s lobbying force, didn’t survive the combined efforts of the Medical Community and the Environmental Organizations persistent message that evidence is growing daily that these chemicals are linked to reproductive problems, learning disabilities, and cancer.  This bill focused on the already known worst chemicals and requires their use in children’s products sold in Maine to be disclosed.

The Senate approved and amended LD 2048 by a 35-0 roll call vote.  None of the chemical industry amendments were offered.   

Four new minor amendments were approved unanimously by the Senate.  They are:

* Senator Raye Amendment - makes more explicit a stakeholders process and Maine CDC's concurrence prior to designating priority chemicals.  This integrates Public Health to Environmental concerns, which is what the medical community advocated for! 

*  Senator Hobbins Amendment - makes designation of priority chemicals subject to a routine technical rulemaking

*  Senator Martin amendment - cell phone service providers are not responsible for reporting on priority chemicals unless they are the manufacturer, and if manufacturer does not have a presence in U.S., then importer or first distributor is responsible for reporting priority chemical use -exempting local distributors

The House then receded and concurred with the Senate's engrossment of the bill.  

By bringing together the environmental proponents and the medical community/public health proponents on the bill, Maine is now poised to sign into law, perhaps the most comprehensive chemical policy framework ever enacted, which reflects a new paradigm that rejects risk assessment and embraces the availability of safer alternatives as the basis for restricting the use of inherently hazardous chemicals.

This is a phenomenal victory for Maine kids, environmental public health and chemical policy reform.  The overwhelming margin of victory speaks testaments to the effectiveness of the organizing, advocacy and physician involvement.   

[return to top]

Study Says Physicians Base Decisions on Medicaid/Charity Care on Income, Practice Ownership, & Practice Size

In late March, the Center for Studying Health System Change (HSC) released a study report, "Effects of Changes in Incomes and Practice Circumstances on Physicians' Decisions to Treat Charity and Medicaid Patients."  The study found that decreasing income would lead physicians to stop taking new Medicaid patients, but would have no impact on the decision to provide charity care.  Physicians who moved from ownership to employment or from small to larger practices were more likely to stop taking Medicaid patients but to start taking charity care.  The study's conclusions suggest that physicians view charity and Medicaid patients as alternatives rather than the same type of patients.  The study was published in the March issue of the Milbank Quarterly[return to top]

Academic Detailing Planning Initiative Moves Forward as the "Regional Prescriber Education Program"

Prescription Policy Choices convened a second Academic Detailing Planning Initiative meeting recently, with representatives from Maine Medical Association, Vermont Medical Society, New Hampshire Medical Society, and Medicaid Medical Directors, along with other organizations to continue the development of a collaborative Academic Detailing (AD) program to provide doctors with independent information about prescription drugs.  Medication information for other states and countries that have implemented AD programs is obtained through the Drug Effectiveness Review Project (DERP) (www.ohsu.edu/drugeffectiveness/description), a collaboration of organizations that have joined together to obtain the best available evidence on effectiveness and safety comparisons between drugs in the same class.  DERP is housed at the Oregon Evidence-based Practice Center and has a long history of conducting systematic reviews for the Agency for Health Care Research and Quality (AHRQ) and specific experience conducting reviews of drug classes.  The Classes of drugs reviewed consist of:

  • Drug classes that account for a significant amount of pharmaceutical budget and may not have an economic interest in the subjects under review;
  • Drug classes with multiple drugs;
  • Drugs that are being used for purposes not described in the label;
  • Drug classes with recent additions of similar drugs (including extended release formulations);
  • Addition of a significantly expensive drug to a class; and
  • Consideration only of drugs approved for use in the jurisdictions of Participating Organizations.

Chuck Bell of Consumers Union/Consumer Reports Best Buy Drugs gave a short presentation on the Best Buy Drugs program, which compares drugs using DERP, to assist consumers in finding best medicines for less.  For more information, go to: www.CRBestBuyDrugs.org.

Working groups have been established and will report back to the full group at the next meeting on what it now being called, the “Regional Prescriber Education Program”.  The four working groups consist of:

  • Potential funding sources
  • Materials and Training
  • Delivery of the education
[return to top]

Maine Radiological Society holds Annual Meeting – Elects Officers

The Maine Radiological Society (MRS) held a very successful Annual Meeting this past week at the MMA.  The meeting was well attended and members elected their Society officers and ACR Councilors.  MRS is pleased to announce its elected Slate of Officers:

President - Martin Kernberg, MD
Vice President – Jeffrey Young, MD
Sec/Treasurer – Barbara Biber, MD


Jeffrey Kugel, MD
Charles Grimes, MD
Paul Gagliardi, MD
Jeffrey Young, MD

MRS Initiatives for 2008 include:

  • Attend and represent the membership at the American College of Radiology’s Annual Meeting in May;
  • Assess possible legislation strategies for the upcoming 124th Maine Legislative Session;
  • Organize a 2009 Winter CME meeting; as well as,
  • Conduct a Membership Recruitment/Outreach Campaign

The next meeting of the MRS will occur in the Fall of 2008 to continue work on their initiatives as outlined above.  For more information on the 2009 meeting and/or have interest in becoming involved as a presenter, and/or if you wish to become involved in the MRS activities, contact Kellie P. Miller, M.S. at the Maine Medical Association at 207-622-3374, etc. 229 or kmiller@mainemed.com [return to top]

Coding Center Offers E/M Chart Auditing Courses in Manchester (Me) and Portsmouth

The Coding Center, operated by the Maine Medical Association and directed by Jana Purrell, CPC,  will be offering two E/M Chart Auditing Courses beginning in May, with one course being in Manchester at the offices of MMA and a second being offered in Portsmouth, N.H.  The classes are offered once a week, from 3:00pm to 7:00pm for five weeks.  The classes at MMA are offered on Wednesdays beginning on May 7th and the Portsmouth classes are offered on four Tuesdays beginning on May 6 with a final class on Monday, June 2nd. 

The courses offer 20 Continuing Education Units for certified coders, through the American Academy of Professional Coders.  The cost for the class is $600 and previous certification is not required. 

For more information or to register for the course, contact MMA at 207-622-3374 (ext 219, Lisa Dennison) or go to The Coding Center webite at www.thecodingcenter.org. [return to top]

Senate Finance Committee Chairman Discusses SGR and Medicare Fees

In an effort to build support among medical groups, Sen. Max Baucus (D-Mont.), last week outlined a Medicare bill he hopes to have ready in May.  Sen. Baucus intends to pursue an 18-month sustainable growth rate (SGR) fix with a 1.1 percent upgrade for physicians in 2009.  Agreement on funding offsets remains the deciding factor in formation and scope of a final bill.  Even a temporary fix that postpones the July 1 and Jan. 1, 2009 SGR cuts for 18 months and leaves physicians with more than a 20 percent cut in 2010 would cost more than $8 billion.  No agreement has been reached so far between the White House, Senate Democrats and Senate Republicans on how to pay for it.

Senator Baucus also commented that he wants to do something for primary care along the lines of MedPAC's new recommendation for a primary care differential.  While no specific language was available, the concept has surgical and specialty organizations concerned, as this is an issue that could split medicine.

The Medicare bill could be a vehicle for a number of other Baucus priorities, including extending current Medicare bonuses for participation in the Physician Quality Reporting Initiative, rural physicians and government practice cost index (GPCI).  He also indicated that incentives for physicians to e-prescribe are likely. 

The AMA is supporting S. 2785, the Save Medicare Act of 2008 sponsored by Debbie Stabenow (D-Mich.) which would keep the current 0.5% increase in place for the remainder of this year and up payment by 1.8% in 2009.  Sen. Susan Collins has agreed to co-sponsor the Stabenow bill.

Without Congressional action, Medicare reimbursement for physicians is slated to drop 10.6% on July 1, 2008.  Over the next decade, fees would be reduced 40%.  During that same period, medical practice costs are expected to jump 20%.

  [return to top]

Cover the Uninsured Week, April 27-May 3, 2008

The Sixth Annual Cover the Uninsured Week will be recognized April 27 through May 3, 2008. The national event, a Robert Wood Johnson project, is designed to raise awareness of the number of Americans living without health insurance and to build broad-based support for change.

Thousands of activities will take place across the country including rallies, health fairs, and conferences. 

For more information, see www.covertheuninsured.org [return to top]

National Group Develops Principles for Measuring Physician Performance

In early April, a national coalition called the Consumer-Purchaser Disclosure Project drafted the Patient Charter for Physician Performance Measurement, Reporting and Tiering Programs that is based on 4 principles that health plans will be required to follow when measuring and reporting physician performance:

  • measures should be meaningful to consumers and reflect a diverse array of physician clinical activities;
  • those being measured should be actively involved;
  • measures and methodology should be transparent and valid; and
  • measures should be based on national standards to the greatest extent possible.

America's Health Insurance Plans (AHIP) and the 3 largest carriers doing business in Maine, Aetna, CIGNA, and Wellpoint (Anthem), have endorsed the charter.  AMA President-elect Nancy Nielsen, M.D. issued a statement in support of the charter and the American Association of Family Physicians, the American College of Physicians, the American College of Surgeons, and the American College of Cardiology also support the charter.  The National Business Coalition on Health, the AFL-CIO, the AARP, the Leapfrog Group, tand he Pacific Business Group on Health also support this effort. [return to top]

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