April 28, 2008

 
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All Members Invited to 1st District Congressional Forum, May 13, 2008

Six of the eight First District Congressional candidates have responded positively to an invitation by MMA to participate in a Forum at MMA on Tuesday evening, May 13.  All MMA members are invited to attend and participate in a discussion about health care reform with candidates vying to succeed Tom Allen as Maine's First District Member of Congress.

MMA's Legislative Committee will host a candidate's night for 1st Congressional District candidates at the MMA offices in Manchester on Tuesday evening, May 13.  Refreshments will be available at 5:30 pm with the event beginning at 6:00 pm.  Six of the eight candidates have responded that they will attend, including front runners Chellie Pingree, Ethan Strimling, and Adam Cote, along with Steven Meister, M.D., Michael Brennan, and Dean Scontras.

After presenting five minute opening statements, each candidate has been asked to "discuss 3 steps you would take to improve the health care system of the United States. "  Following that, candidates will answer questions from physicians in the audience.

Representatives of the Maine Physicians Action Fund, a state-registered political action committee, and of the American Medical Association Political Action Committee (AMPAC) also will be in attendance, and following the forum will discuss potential endorsements and contributions.

All MMA members are invited to attend.  Please RSVP to the receptionist at the MMA at 622-3374.

Governor Signs Midwifery Minority Report, Subject to Conditions

On this past Wednesday, Governor John Baldacci signed into law the minority report of the midwifery bill (LD. 2253) which authorizes pharmacists to dispense certain essential medications to certified midwives for administration to mothers and newborns during home births.

The medications covered by the law are limited to oxytocin, for the sole purpose of postpartum control of maternal hemorrhage (not to be used to induce labor), numbing agents for laceration repair, vitamin K, prophylactic eye drops for the newborn, and oxygen.

The Governor's concern over the bill, brought to his attention largely through the efforts of Dora Mills, M.D., M.P.H., Director of the Maine CDC, led him to direct a letter to Ann Head, Acting Commissioner of the state Department of Professional and Financial Regulation, asking that the Department or the Board of Pharmacy develop new rules to ensure "significant and meaningful safeguards" are developed before pharmacists can dispense under the new law.  The measures are to include a process for verifying midwives' credentials, a system of recording and reporting what drugs are sold to midwives, and a process for midwives to report when the drugs are administered.

The Governor also asked that the Acting Commissioner establish an advisory group to help develop the new rules and to seek guidance from the Maine Center for Disease Control and Prevention.  A report is to be developed including any recommendations for improving the new law, by Nov. 15, 2009. 

MMA expects that one or more physicians, presumably an Ob-Gyn, will be asked to serve on the advisory board.

While the midwifes in the state (approximately 25 representing about 1% of births) already claim to have access to these medications through physicians or brought in illegally from New Hampshire, a majority of legislators believed that the presence of these few medications should be made legal in the case of out of hospital births. [return to top]

2008 Physician's Guide to Maine Law is Subject of May 2nd "First Friday" CME

MMA's popular "First Fridays" CME programming continues this coming Friday, May 2nd, with a special three hour program featuring the new Physician's Guide to Maine Law 2008.  A pre-publication version of the Guide is available and will be distributed to attendees in both paper copy and in a CD.  The CD version when linked to the internet has many new links which can take readers to sites which provide statutory and regulatory language. 

The pre-publication edition is current through 2006 and will be updated to include the relevant actions of the 123rd Legislature this summer.  Following that, the books will be available in three-ring binders for a charge but will primarily be distributed as CD's.

The CME program on Friday morning will include MMA attorneys Gordon Smith and Andrew MacLean pointing out significant sections of the Guide and discussing new laws and regulations of significance to physician practices.

The $60 registration fee includes the copy of the Guide and the CD and breakfast.  You may register by calling MMA at 622-3374 or by registering on-line at www.mainemed.com.  All First Friday presentations are at the MMA offices in the Frank O. Stred Building in Manchester. [return to top]

ACOG McCain Fellow, Hector Tarraza, M.D. Briefs U.S. Senate on Fetal Alcohol Spectrum Disorder

ACOG's 2008 McCain Fellow and Immediate Past President of the Maine Section of ACOG Chair, Hector Tarraza, M.D. delivered opening remarks at a Senate briefing this month on fetal alcohol syndrome (FAS), hosted by Senator Tim Johnson (D) of South Dakota and Senator Lisa Murkowski (R) of Alaska.

The National Organization on Fetal Alcohol Syndrome sponsored the briefing to educate Senate staff on the range of physical and mental birth defects that can occur when a pregnant woman drinks alcohol.

Dr. Tarraza, of Cape Elizabeth and Chief of OB-GYN at the Maine Medical Center in Portland, spoke about his experiences caring for mothers with FAS in the Women's Health Center at MMC.  He focused his comments on the importance of an ob-gyn educator on FAS and on the need for effective public awareness campaigns on FAS.  Dr. Tarraza noted the difficulties in convincing pregnant women to give up alcohol. [return to top]

CMS Posts EMTALA Report

CMS has posted the final report of the EMTALA Technical Advisory Group (TAG) on its website.  The Medicare Modernization Act (MMA) created the EMTALA Technical Advisory Group (TAG).  The TAG has met several times over the past several years and sunsetted last fall.  The AMA has actively engaged the TAG during the time of its existence.  This report consolidates the TAG findings and recommendations.  The AMA will review the report and look for additional opportunities to advocate to ease the burden of EMTALA.  The report can be found at:

http://www.magpub.com/EMTALA%20%Final%20Report.FINAL.PDF [return to top]

New Stark Law Regulations Featured at May 28th Physician Education Seminar

MMA holds its 17th Annual Physician Practice Education Seminar on Wednesday, May 28th at the Augusta Civic Center.  Formerly called the Physician Survival Seminar, this day-long program offering seven hours of CME will feature several topics, including highlights of the New Stark Law Regulations.  Boston Attorney Dean Nicastro, who for many years served as general counsel to the Massachusetts Medical Society, will present a special two hour breakout session at 1:00pm on the complex subject of the "Phase III" of the final regulations under the federal prohibition against physician self-referral known as the "Stark Law."  The Phase III regulations had an effective date of Dec. 4, 2007.

The Stark Law prohibits a physician from referring Medicare beneficiaries to entities with which the physician (or an immediate family member of such physician) has a financial relationship for certain itemized services referred to as "designated health services" or "DHS," unless an exception applies.  In addition, the Stark Law prohibits an entity from making a claim for payment for the provision of a DHS furnished pursuant to a prohibited referral.

Some of the other topics presented at the program include preventing drug diversion (the U.S. Attorney for the District of Maine will be the keynote speaker), the pending physician shortage, and quality improvement initiatives in the state.  Four separate tracks of breakout sessions will be presented following the plenary session in the morning, representing technology, compliance, practice management and "hot topics."  The "hot topics" segment includes updates on HealthInfoNet, efforts in improving health literacy and the status of the state's Prescription Monitoring Program.

You may register for the conference on line at www.mainemed.com or by calling MMA at 622-3374.  [return to top]

Report on Maine AAP Spring Conference, "Bright Futures and Foster Care"

Maine's pediatricians and other supporters of Maine's children journeyed to Sunday River this past weekend to hear lectures and discuss issues related to "Bright Futures and Foster Care."  Topics ranged from "Preventing Child Maltreatment" and "Shaken Baby Syndrome" to "Domestic Violence Response Initiative" and "Preventing Alcohol Use in Young Children."

Among the presenters were Maine's First Lady Karen Baldacci, Patricia Powell, PhD., Chief, Science Policy Branch, Office of Science Policy and Communications, National Institute on Alcohol Abuse and Alcoholism, NIH; Richard Heyman, M.D., FAAP, Adjunct Professor of Clinical Pediatrics, University of Cincinnati College of Medicine, and Lawrence Ricci, M.D., Director, Spurwink Clinic Child Abuse Program.

At Saturday night's banquet, the Maine Chapter of the AAP recognized Jonathan Schenken, DDS., of Bangor, for his efforts in successfully promoting the recently enacted Maine law prohibiting persons from smoking in motor vehicles when children under the age of 16 are in the vehicle.  The law takes effect on Sept. 1, 2008.

At the Sunday morning business meeting, MMA EVP Gordon Smith presented highlights of the 123rd legislature in so far as the action related to children.  Discussion focused on the several bills passed which favorably effected children, as well as the midwifery legislation. [return to top]

Advisory Council on Health Systems Development Discusses CIF and Medicare Equity Project as part of the 2008/09 State Health Plan

The Advisory Council on Health Systems Development  (ACHSD) met this past Friday and announced the release of the 2008-09 State Health Plan, with most of the discussion at the meeting centering on the development of a Capitol Investment Fund Work Group (CIF).  In reviewing the CIF and receiving public comments each year, the ACHSD heard  testimony from hospitals that the process in the current regulation (1) makes it difficult for hospitals to do strategic planning, because the available CIF amount can vary significantly from one year to the next, and (2) results in a number that is too low (based in part on its adjusting for affordability using a cost measure that is based on the Medicare wage index, which the MHA says makes Maine hospitals appear less efficient than other hospitals. Consumer groups, on the other hand, have testified in support of the rule in its current form.  Based on this input, the ACHSD will – prior to the setting of the 2009 CIF amount – examine the possibility of revising the regulation to deal with these issues, including the possibility of a multi-year CIF.  One of the constraints the law puts on Certificate of Need is an annual limit – called the Capital Investment Fund (CIF) – on the third year operating costs (i.e., the annual cost to the health care system once a project is fully implemented).  Its purpose is to ensure that the infusion of new capital into Maine’s health care system remains balanced with Mainers’ ability to financially support the added costs of those new investments.  The CIF value is determined annually by the Governor’s Office with review and comment by the ACHSD and after public comment following a process set out in regulation and approved by the Legislature.   Depending on the costs of proposed projects the CIF may or may not be large enough to accommodate approval all of pending applications, reinforcing its purpose as a cost containment tool.

Thus the ACHSD will:

1. Convene an ad hoc group to develop options to revise rule for ACHSD consideration.  This ad hoc group is comprised of ACHSD members, with stakeholder involvement,

2. Present options to revise the rule for ACHSD consideration, and

3. If decision is made to revise the rule, GOHPF will propose a revised Rule in sufficient time for review by the Legislature in 2009.

Medicare Equity Project
The ACHSD committee members also spoke to the Medicare Equity Project, outlined in the State Health Plan. The Goal is: To increase Medicare hospital and physician reimbursement rate. 

Thus, the GOHPF will 1)  convene an Ad Hoc Medicare Equity Work Group representing the Governor’s Office, the Legislature, the Maine Hospital Association, the insurers,consumers, employers, and representatives of our Congressional delegation, 2)  Develop a white paper documenting the cause of the Medicare under-funding, the amount, the impact on private payers and identify strategies to resolve the issues, 3) Present the white paper to the appropriate legislative committee, the media and public to generate support, (all to be completed by December 2008) 4) Meet with the Congressional delegation to brief and develop strategy, 5) Meet with MedPAC and CMS, 6) Assess progress in reaching resolution with CMS, and 7) Seek Congressional action should CMS discussions fail to yield a solution.  (all to be completed by June, 2009)

Other workgroups to convene as directed by the 2008-09 State Health Plan are:

- Rural Health
- Emergency Department Over-Utilization
- Hospice
- Technology Investment (HealthInfoNet)
- Analysis of Maine's Healthcare cost Drivers
- Use of Maine's Existing Research and Analytic Capacity to Greatest Effect

All of the above are listed in a 7 page timeline table in the State Health Plan, beginning on page 83.  The State Health Plan can be accessed through the following link:  http://www.maine.gov/governor/baldacci/cabinet/health_policy.htm [return to top]

2008-09 State Health Plan Released by the Governor on April 25th

On April 25, 2008, the 2008-09 State Health Plan was officially released by the Governor.  The Plan is organized in three major categories representing the components that need to occur in Maine:

I.   Improving Health - building a system that supports every person getting and staying healthy;

II. Assuring Best Practices/Less Variation in care delivery, making sure that every health care consumer receives the right care at the right time; and

III. Efficiency and Effectiveness - eliminating redundant or ineffective systems and treatments so that every consumer gets the quality and services needed at the lowest possible cost.

As one of the MMA's Public Health Committee's Priority Initiatives - "The need to ensure that Maine has an increased Childhood and Adult Immunization Rate", has been specifically written into the plan (page 37), and sets a goal to achieve a 90% immunization rate.  As Maine's consolidated statewide public health infrastructure emerges, the plan indicates that it is important that it doesn't operate in a silo, and that our public health systems should work hand in hand with our health care delivery system.  The plan indicates that the need to increase immunizations, which has emerged recently as an important public health topic, given the on-going reductions in federal funding for vaccines relative to their cost as well as increasing numbers of effective vaccines for both children and adults.  The Public Health District Coordinating Councils (DDC's), will conduct (as outlined in the plan) an assessment of adult and childhood immunization needs in each district, using data from Maine CDC/DHHS, in hopes to achieve the goal of 90% by the end of 2009.

The Plan also accentuates an investment in Prevention (page 10), and also points out the need to ensure the health of the environment, reduce dependency on chemicals containing toxins and references the MMA's Public Health Committee's priority initiative in this arena (however, referred to as the Public Affairs Committee), as well as providing healthy neighborhoods and communities.

The MMA's Public Health Committee will be working to move these prevention efforts forward and will work in concert with the development of the District Coordinating Councils throughout the state.  To access a copy of the 2008-09 State Health Plan, go to:  http://www.maine.gov/governor/baldacci/cabinet/health_policy.htm [return to top]

Genetic Information Nondiscrimination Act (H.R. 493) Passed by Congress

After years of inaction, the U.S. House and Senate both have passed legislation to prohibit discrimination in both employment policies and issuance of health insurance coverage.  On March 5, 2008, the House voted 268-148 in favor of the bill language attached to the mental health parity bill, H.R. 1424.  The Senate voted 95-0 in favor of the bill on April 24, 2008.  The bill would prevent employers from discharging, refusing to hire, or discriminating in other ways against employees on the basis of genetic information.  It also would prohibit enrollment restriction and premium adjustment on the basis of genetic information and would prohibit carriers from requiring insurance applicants to undergo genetic testing.  Maine's senior Senator Olympia J. Snowe (R) was a sponsor of the original bill on this issue.  The insurance group, America's Health Insurance Plans, also supported the bill.  President Bush is expected to sign the measure. [return to top]

Hurley Travel Experts Presents Luxury Explorers Showcase

Hurley Travel Experts cordially invites you to its inaugural
Luxury Explorers Showcase
Saturday, May 17, from Noon to 8pm,
at The Woodlands Club in Falmouth, Maine

Enjoy refreshments on the terrace, listen to a private concert by the Portland String Quartet and learn about the hottest trends in experiential travel.

The day promises to be filled with exciting travel exhibits, informative speakers and exclusive travel incentives for all who attend. Our international travel suppliers will showcase their cultural, educational, culinary, spa, wellness, adventure, family and conservation vacations.

Please RSVP by Monday, May 12, by calling Hurley Travel Experts at 800.874.1743 or rsvp@travelexperts.com.

Visit hurleytravelexperts.com for complete details and updates.
[return to top]

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