June 30, 2008

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Senate Fails to Pass Medicare Fee Fix: Cloture Vote Falls One Vote Short

On June 26th, the United States Senate fell one vote short of being able to move H.R. 6331 to a vote, achieving a vote of 59 when 60 votes were required.  Congress then adjourned for the July 4th recess, assuring that the 10.6% reduction in physician fees will occur on July 1.  Congress returns to Washington July 7th and attempts will be made to correct the fee schedule retroactively.  Maine Senators Susan Collins and Olympia Snowe both voted for cloture, and were prepared to support the provisions of the bill fixing the problem.  For more details on what to do with your Medicare claims in the meantime, proceed to the full text of the article below.

By all accounts, there was broad, bipartisan consensus on providing an 18-month reprieve from the scheduled payment cuts.  Agreements has also been reached on virtually all the other issues pertaining to physicians.  The legislation considered on the Senate floor on June 26 had just passed the House with overwhelming bipartisan support (355 to 59).   Both of Maine's House members, Rep. Tom Allen and Mike Michaud supported the bill.

Unfortunately the Senate vote got caught up in partisan issues dividing the Republican leadership, the White House and the Democratic majority.  At the Direction of the White House, a group of Republican Senators refused to support a vote on the bill, objecting to some of the funding that would be taken from the Medicare Advantage Plans.  The AMA put it this way:

         "The physicians of America are outraged that a group of Republican senators followed the direction of the Bush Administration and voted to protect health insurance companies at the expense of America's seniors, disabled and military families.  These senators leave for their 4th of July picnics knowing that the most vulnerable Americans are at risk because of the Senate's inability to act to stop drastic payment cuts for health care services that are needed by our Medicare and TRICARE patients.  The AMA appreciates the courage of the 59 Senators, including 9 Republicans, who voted to put patients ahead of partisan politics and voted for H.R. 6331."

In Maine, as in other rural states, the cut is deeper than 10.6% since the "floor" on geographic adjustments made to a portion of Medicare physician payments is also expiring on July 1.  In Cumberland and York counties the cut is between 11 and 12%.  In the remainder of the state, the cut is over 12%.  Over the 18 month period, the cuts represent over $50 million dollars in Maine alone.

While all four of Maine's representatives have strongly supported Maine physicians in trying to restore the cut, calls to their offices thanking them for their support and urging their continued diligence in urging their colleagues to do the same would be appropriate.  You may access the offices through the AMA Advocacy Hotline at 800-833-6354.

MaineCare Misses Weekly Cycle Payment

As noted in the Weekly Update last week, the Department of Health and Human Services (DHHS) announced the previous week that it would miss paying its last Medicaid cycle of this state fiscal year (the state's fiscal year runs from July 1 through June 30).

No claims were paid the week of June 23, and the department will make double payments either this week or will catch up the following week.

Department staff states that unusually high payments earlier in June created the deficit which caused the state to push the last week's claims into the new fiscal year. [return to top]

Register for MMA Annual Session Sept. 4-7 by July 9th and Receive "Early Bird" Discount

MMA holds its 155th Annual Session Sept. 4-7, 2008 at the Samoset Resort in Rockport, Maine.  This year's theme is "Taking the Initiative:  Steps Toward Quality and Collaboration" and the program opens on Thursday, Sept. 7 with a Symposium on Quality Improvement jointly presented with the Maine Hospital Association.  The Thursday Symposium is being supported financially by the Maine Quality Forum, Quality Counts and the Aligning Forces for Quality grant.

You may register online at www.mainemed.com or call the MMA office at 622-3374 ext. 219 for registration materials to be faxed, e-mailed or mailed to you.

A discounted registration fee is available to persons who register on or before July 9.

The Samoset will take reservations for the MMA room block only by phone.  For reservations call 800-341-1650.

We hope to see you in September! [return to top]

MMA Office Closed on Friday for 4th of July Holiday

MMA offices in Manchester will be closed this coming Friday in recognition of the 4th of July state and federal holiday.  The office will re-open on Monday morning, July 7 at 7:00am.  The office is normally open from 7:00am to 5:00pm Monday through Friday.

We have been experiencing some difficulty with the current voice mail system and a repair is scheduled for July.  We appreciate your patience.  The portion of the system which is malfunctioning is the option that would normally get the caller to a live person by pressing "0".  Unfortunately, if you press 0, you are directed only to the general delivery mailbox and directed to leave a message.  If you do have the extension number of the person you are wishing to call, you may punch in the extension and receive the person's extension.  That function of the system is still working fine. [return to top]

Board of Pharmacy and DPFR Work Group Meet on Midwifery Law

An ad hoc Advisory Committee requested by the Governor and established by the Department of Professional and Financial Regulation met on June 24th to review draft proposed rules that would allow access by direct-entry midwives to a limited category of medication to have available at home births.  Medical interests were represented on the Committee by Jay Naliboff, M.D., District Chair for Maine for the American College of Obstetrics and Gynecology.  Dr. Naliboff practices in Farmington.  MMA representatives also attended the meeting. 

Other members of the Advisory Committee include:

  • Dr. Dora Anne Mills, Director of the Maine CDC
  • Jill Breen deBethune, Certified Professional Midwife
  • Dana Hunter, Pharmacist, Member, Board of Pharmacy

The Committee is Chaired by Anne Head, acting Commissioner of the Department and is staffed by Geraldine Betts, Administrator, Board of Pharmacy and Jeff Frankel, staff attorney.

Following introductions, the members reviewed a draft set of rules that would implement Chapter 669, effective July 18th which allows access to the medications, which the Legislature granted while at the same time defeating the midwives attempt to be licensed by the state.

The draft rules, which still must go to public hearing and ultimately be approved by the Board of Pharmacy, include details on what credentials the midwife must show to the pharmacist to obtain the medication, and also requires the midwife to report use of the drugs to the Maine CDC.

Anne Head reminded Committee members of the letter she had received from the Governor, which requested comprehensive oversight of the use of the medication in order to protect the safety of mothers and their infants.

In a letter dated April 22, 2008, the day he signed the controversial legislation, the Governor wrote to Acting Commissioner Head, and made the following requests:

    I direct you, as the Acting Commissioner of the Department of Professional and Financial Regulation, to take whatever steps are deemed necessary, in conjunction with the Board of Pharmacy's rulemaking process, to incorporate, among other provisions, recordkeeping and reporting requirements regarding:  the verification of midwife credentials by licensed pharmacists, access to specified medications by certified midwives, and the administration of any of the specified medications by midwives to their patients.

  Further, I direct ...a report to my office by Nov. 15, 2009 including information on the activity of certified midwives, their access and use of any of the specified medications, and any recommendations that would enhance the safety of Maine citizens who may receive services from certified midwives.

   During the meeting, the committee members made a number of suggestions regarding the proposed rule.  An amended draft will be distributed to the members prior to the Board of Pharmacy proceeding to consider the proposal and sent it to public hearing.  Until the rule is considered and adopted, it is unlikely that any pharmacy would be comfortable in dispensing the medications, although the law is effective July 18, 2008. [return to top]

MMA Participates in HealthInfoNet Stakeholder Pocess

The HealthInfoNet Stakeholder Process, being conducted as the result of a Resolve enacted by the Legislature in the past legislative session, continued this past week with a June 24th meeting at the Dirigo Health Agency in Augusta.

After welcoming participants, which included MMA EVP Gordon Smith, Esq., co-convenors Josh Cutler, M.D. and Dev Culver went through a number of house-keeping and scheduling matters.  After considering the minutes of the May 30 meeting, the results of a June 20 conference call regarding valuation and return on investment models was presented. 

Next on the agenda was a presentation on approaches in other states made by Shaun T. Alfreds, MBA, CPHIT of the Center for Health Policy and Research at the University of Massachusetts Medical School.  Mr. Alfreds presented a number of slides on the sustainability and approaches of similar projects in other states.

The primary purpose of the Stakeholder Group is to help identify potential revenue sources to support the on-going HealthInfoNet project.  Based upon discussion thus far, and considering what other states have done, potential sources include one or more of the following:

  • State general fund appropriation
  • Revenue Bonds, issued by the state
  • Assessment on each prescription filled
  • Assessment on health insurance premiums
  • Tax on providers (MMA would vigorously oppose this option)
  • User fees

The HIN Board is currently working to develop a sustainable business model, but some amount of public financing is likely to be required.

Currently the HealthInfoNet project is preparing its demonstration project involving several of the larger health systems in the state.  To date, the project has received substantial funding from the Maine Health Access Foundation, the Maine Quality Forum and the Maine CDC.  Several hospital systems have also generously contributed. The state has also provided some general fund appropriations.

Based upon the Legislative Resolve, the stakeholder process must include at least the following:

  1. Identification of broad-based, stable, ongoing revenue sources;
  2. Development of a technology investment account to help ensure the establishment of the HIN and provide financial assistance in the future to health care providers with limited resources with the costs of electronic medical records and e-prescribing;
  3. Estimating return on investment from shared electronic clinical information;
  4. Establishing eligibility criteria for funding assistance.
  5. Developing a methodology for measuring the quality and cost impact of HIN and shared electronic clinical information.
[return to top]

Medical Care Development Seeking CEO

Medical Care Development, Inc. (MCD), a well-established and highly-regarded health care organization headquartered in Augusta, Maine with a vibrant international division located in Silver Spring, MD, seeks a President and Chief Executive Officer.  The President will play a key leadership role, together with the board and staff, in strategically sustaining the organization’s mission by diversifying sources of revenue to support existing and new programs, enhancing the operational infrastructure, and serving as an effective advocate to nurture existing and create new relationships with a network of complimentary public, not for profit, and private affiliates. 

This individual will be responsible for an overall budget of over $40M and a staff of approximately 600 employees.  In an increasingly complex funding environment, s/he must join with the board and the MCD community to strengthen current MCD domestic and international programs that will continue to reflect the organization’s commitment to providing excellent domestic and international public health programs and services that are critical to the most vulnerable populations domestically and internationally.

The role requires an innovative, creative, strategic thinker with a keen understanding of the rapidly changing healthcare/behavioral health environment, a demonstrated track record of at least 10 years management experience in leading preferably multi-sited, organizations that are dependent on grants and contacts funding, and an advanced degree in business administration, public health, or a related field.

Please direct all applications, nominations, and inquiries to: Denise O’Grady Gaffney, Vice President and Director, or Liz Vago, Managing Associate, Isaacson, Miller, 334 Boylston Street, Boston, MA; fax: 617-262-6500; e-mail: 3646@imsearch.com. Electronic submission of credentials strongly encouraged.


Medical Care Development is an Equal Opportunity/Affirmative Action Employer. [return to top]

MMA Nominations Time; Volunteers Sought

MMA's Nominations process is in full swing with the Nominations Committee chaired by President-elect Stephanie Lash, M.D.  Nominations and volunteers are sought for all of the Association's offices and committees.  If you are interested in becoming more involved in your professional association, please contact Gordon Smith at 622-3374 ext. 212 or via e-mial to gsmith@mainemed.com.  A wide variety of experiences may be awaiting you! [return to top]

The Coding Center Offers a New Professional Medical Coding Course, July 23

The Coding Center will offer another edition of its popular AAPC-certified Professional Medical Coding Course (PMCC), Wednesdays, 7/23/08 - 11/19/08, 1pm - 5pm, at the Anchorage Inn in Portsmouth, NH.

This 20-week course, developed by the American Academy of Professional Coders (AAPC), and taught by Jana Purrell, CPC-I, will take students through the 2008 Current Procedural Terminology (CPT), International Classification of Disease (ICD-9), and HCPCS books to address proper coding in physician practices.  This class is intended to educate students on proper techniques and rules of coding and will also prepare them to sit for the AAPC Certified Professional Coder (CPC) exam.

The Program includes the following:

  • One year membership in the  AAPC;
  • Student workbooks;
  • CPC exam; and
  • Group discussion and networking opportunities.

Click here for more information or to register. [return to top]

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