July 14, 2008

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Update on Medicare Physician Payment Issue

The MMA is pleased to report that on Wednesday, July 9, 2008, the United States Senate passed H.R. 6331, the Medicare Improvements for Patients & Providers Act of 2008 by a veto-proof majority of 69-30.  The legislation replaces the 10.6% payment cut that went into effect on July 1 with a 0.5% update extension through December 31, 2008.  For calender year 2009, the update will be 1.1%.  The President still is expected to veto the bill, but a veto override is both hoped for and expected. 

Maine Senators Olympia Snowe and Susan Collins both voted for the bill and joined 16 other Republican Senators and all the Senate Democrats to make the vote bipartisan.  The bill also extends the GPCI floor on the physician work value which assists Maine and other rural states.  Over the next 18 months, enactment of the legislation will restore cuts of more than $50 million to Maine physicians.

"Enactment of the bill represents a significant victory for Maine physicians and indeed for physicians across the country.  The American Medical Association, the national medical specialties, and the state medical societies have all been engaged in a truly grassroots effort to pass the bill," noted Gordon H. Smith, Executive Vice President of MMA.

On July 10, 2008, White House spokesman Tony Fratto said that the President still intends to veto the bill because of the negative impact on the funding of Medicare Advantage plans.  "The President does intend to veto it for that reason.  We're concerned about the impact of that should this bill become law.  We expect that one of the impacts of this bill is it will remove about 2 million seniors from a wildly popular Medicare Advantage private plan.  We don't want to see choices being removed from the 9.6 million seniors who are in this program, and our estimates lead us to expect that as many as 2 million seniorswill have to drop off the Medicare Advantage program, and that's the wrong way to do it," Fratto said. 

Although the President may still veto the bill, the significant margins in the House and Senate suggest that the cut will ultimately be restored.  Votes on any veto could occur as early as Monday night or Tuesday of this week.  It is important to resolve the issue as soon as possible as CMS is currently still holding claims for services provided to Medicare patients on or after July 1. 

Other provisions in the bill include beneficiary improvements, such as increasing asset levels to help more  beneficiaries become eligible for low-income assistance under the Medicare prescription drug benefit, incentives for e-prescribing, and provisions to delay Medicaid cuts to pharmacy reimbursements and to ensure prompt payment of Medicare pharmacy claims.   


Meeting with U.S. Attorney Focuses on Prescription Drug Abuse

U.S. Attorney Paula Silsby convened a meeting of interested parties this past week to discuss the continuing problem in the state of prescription drug abuse.  The meeting was the third is a series of sessions focusing on the topic.  Organizations represented included MMA, the Maine Osteopathic Association, the Maine Pharmacy Association, the Office of Substance Abuse, and MaineCare. 

Attendees discussed the efforts to register more prescribers to use the State's Prescription Monitoring Program (PMP) which the state established in 2004 to provide physicians and other prescribers with an important tool in the effort to reduce the number of prescriptions diverted from medical to illegal use.

While more than 1500 prescribers and pharmacists are registered to use the PMP, many regular prescribers of narcotics are not registered.  To register, go to www.maine.gov/dhhs/osa/data/pmp.

"A recent medical liability case settled in New Hampshire, resulting in a payout of hundreds of thousands of dollars in a case involving a death as a result of prescription drug abuse show the dangers of not using a tool such as the PMP.  In today's world, a physician who prescribes a narcotic to a patient for long-term therapy who is not checking the database for other prescriptions is in danger of being found not to have met the current standard of care," noted Gordon Smith, Esq., EVP of MMA.

A recent study of accidental deaths in Maine by drug overdose in 2007 demonstrated that methadone and cocaine were the substances most frequently implicated in the deaths.

Practices wishing to take advantage of the MMA program offering in-office consultations on this topic should contact MMA EVP Gordon Smith.  The program is being funded through a contract with the Board of Licensure in Medicine.  Mr. Smith is available at 622-3374, ext. 212 or via e-mail to gsmith@mainemed.com.

MMA also is continuing a series of CME programs on this topic through a grant from the Office of Substance Abuse.  Twenty programs have been presented in locations across the state with another six programs scheduled through the remainder of this year.

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Dirigo Health Agency Board of Directors Meeting

The Dirigo Health Agency Board of Directors met on Monday, July 7th, at the Agency offices in Augusta.  The Directors heard an update from Trish Riley of the Governor's Office of Health Policy and Finance on the follow-up regarding health care cost drivers required by the State Health Plan.  The work group on the CON capital investment fund is hard at work with the interested parties being consulted and a report being prepared.  A new work group on emergency room utilization has been established but has not yet had its first meeting.    Physician interests will be represented on the work group by Scott Kammerer, M.D.  Dr. Kammerer is an emergency physician associated with MaineGeneral.

The Board went into Executive Session to discuss its negotiations with Harvard Pilgrim Health Care regarding the DirigoChoice product being offered in 2009.  The current contract with the plan expires at the end of the calender year.  The health plan is offering the product this year for the first time after negotiations with the previous carrier Anthem failed to produce an acceptable contract.

Hearings will be held later in the month on the establishment of the Savings Offset Payment (SOP) for the next year, needed only in the event that the tax package enacted by the legislature is repealed in an effort to impose a "People's Veto."  The veto would require the presentation of more than 55,000 signatures to the Secretary of State's Office and then a successful vote in November.

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Annual Session Leads Off with MHA/MMA Quality Symposium, Sept. 4, 2008

On Thursday, September 4, 2008, the Maine Medical Association and the Maine Hospital Association jointly present a Quality Symposium at the Samoset Resort in Rockport, co-sponsored by the Maine Quality Forum, Quality Counts, and the Aligning Forces for Quality project.  The Symposium begins at 8:15 am with a welcome and introductions by David McDermott, M.D., MPH , Chair of the MMA Committee on Physician Quality.  Dr. McDermott also serves on the the MHA Quality Council.  The featured speaker at the Symposium is Elliott Fisher, M.D., MPH, Director of the Center for Health Policy Research at Dartmouth Medical School.  The program continues through the day with a wrap-up at 3:45 pm.

The Symposium is being held on Thursday prior to the MMA Annual Session that convenes at noon on Friday, September 5th at the Samoset.

Physicians, nurses, quality improvement directors, and other interested persons may register for the Symposium at the MMA website at www.mainemed.com.  Full registration information can also be obtained by calling the Association offices at 622-3374, ext. 219.

Members and guests registering for the Annual Session are reminded that the room block at the hotel expires on July 25.  Room reservations can be obtained by calling the Samoset at 1-800-341-1650. [return to top]

Clement Hiebert, M.D., 1926-2008

The Association was sorry to hear last week of the death of long-term member Clement Hiebert, M.D., former Chief of Surgery of the Maine Medical Center.  Dr. Hiebert died July 3, following a long struggle with Parkinson's disease.

Dr. Hiebert grew up in Lewiston, where his father, Joelle C. Hiebert, was superintendent of the Central Maine General Hospital.  He graduated from Bowdoin College and Harvard Medical School and completed his internship and residency at Massachusetts General Hospital.

In l960, Dr. Hiebert returned to his home state and the Maine Medical Center, where he would spend the next forty years as a cardiovascular and thoracic surgeon.  He served as Chairman Emeritus of the Department of Surgery until his death.

In his long career, Dr. Hiebert held many positions in the hospital and also was a highly regarded speaker and writer.  He also was a true humanitarian and many institutions, organizations, and individuals were the beneficiaries of his efforts.  He was particularly proud of his work with the handicapped skiing program at Sunday River.

Dr. Hiebert was a true Renaissance man - an extremely accomplished surgeon, but also a teacher, writer, skier, gardener, photographer, and musician.

The entire MMA family extends its condolences to Dr. Hiebert's wife, May Cameron Hiebert of Yarmouth, and his several siblings, children, and many friends. [return to top]

Board of Licensure in Medicine Holds Monthly Meeting

The Maine Board of Licensure in Medicine held its monthly meeting on Tuesday, July 8th at its offices in Augusta.  During the public portion of the meeting, representatives of the Federation of State Medical Boards (FSMB) updated board members on activities of the Federation which represents the interests of all the medical licensing boards in the country.  Most of the discussion focused on the trends in licensing and relicensure.

Following the report of the FSMB, the Board received an update on the MMA Chronic Pain initiative from MMA EVP Gordon Smith and Project Director Noel Genova, PA-C.  The project is funded by the Board and is scheduled to be completed by December 31, 2009.  The project has three components, as follows:

  1. Appropriate resources on pain management and tools to prevent prescription drug diversion placed on the MMA website at www.mainemed.com.

  2. Creation of a home study course eligible for CME credits.

  3. In-office consultations, also structured to offer two hours of CME.  The consultation, conducted by Ms. Genova, will consist of auditing of charts and educational components.

The first component has been completed and items two and three are in progress.  Practices interested in a consultation on this issue should contact Gordon Smith, MMA EVP at 622-3374, ext. 212 or via e-mail to gsmith@mainemed.com.

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Commonwealth Fund Report Rates Maine's Child Health System

The report, initially released in May, was revised and reissued with more recent data this month.  It shows that Maine's child health system is second only to those of Iowa and Vermont in overall performance and ranks among the top 14 states in every measure, except for its cost, which is among the highest in the nation.

The report noted that Maine's infant mortality rate is the lowest of all the states.

The study measures five broad areas including access, quality, cost, equity, and the potential to live healthy lives. 

Regarding access, Maine rated 14th among all the states.  Only 7 percent of Maine children lacked public or private health insurance, compared to the national average of 11.3%. 

In quality of care, Maine rated fifth best.  Massachusetts ranked best in this category. 

At $6,540 per person, Maine spent more on health care costs per capita than every state except Massachusetts and the District of Columbia, based on 2004 data. The report may be read in its entirety on the Web site of the Commonwealth Fund at www.commonwealthfund.org .  [return to top]

August 1 First Friday CME Session Features "Rediscovering the Care in Health Care"

MMA presents a new program as part of its popular "First Fridays" CME series on Friday, August 1, 2008 from 9:00 am to noon at the offices of the Association in the Frank O. Stred Building in Manchester.  Directions are available on the MMA website at www.mainemed.com.

The title of this innovative session is called, "Rediscovering the Care in Health Care" and it features Kenneth Hamilton, M.D., FACS, a retired surgeon who now presents workshops across the country associated with the HOPE (Healing of Persons Exceptional) program. 

The three-hour program will examine the ways in which medicine can restore a sense of care to both parties in the physician-patient relationship. 

Interested persons may register on-line at www.mainemed.com or may call MMA at 622-3374, ext. 219.  A $60 fee covers breakfast and the course materials.

There will be no "First Fridays" program in September as it would conflict with the Association's Annual Meeting at the Samoset. [return to top]

The Coding Center Looking for a New Director

As has been previously announced in the Weekly Update, Coding Center Director Jana Purrell, CPC has accepted a position in practice administration at MidCoast Hospital in Brunswick.  She will be working one day a week (Wednesdays) for the Center until the end of the year and is teaching a certification course offered in Portsmouth, N.H. as part of her remaining responsibilities at the Center.  But, MMA is searching for a new Director of the Center which has become such a valuable service for MMA members and institutions.

If you know of a certified coder who may be interested in taking on this responsibility, please have them send a current CV to MMA's EVP Gordon Smith (e-mail any inquiries or CV's to gsmith@mainemed.com).  Or call Mr. Smith to discuss the position (after July 20).


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PhRMA Updates Code of Ethics on Drug Company Interaction with Physicians

On July 10, 2008, the Pharmaceutical Research & Manufacturers of America (PhRMA) issued an update to its 2002 ethics standards governing its member companies' interactions with the physician community.  The voluntary code becomes effective in January 2009 and includes the following components:

  • prohibits company representatives taking physicians out for restaurant meals, but permits the continued practice of modest lunches (usually sandwiches or pizza) in the physician office associated with an informational presentation;
  • prohibits the distribution of "reminder" items with a drug or company logo, such as pens, cups, or other nick-nacks;
  • more detailed standards on the independence of CME;
  • principles on the use of prescriber data;
  • more guidance on practitioner speaking and consulting relationships; and
  • requirements that company representatives receive training in the code and related laws and principles of ethics.

Pharmaceutical company marketing efforts have been the subject of scrutiny in Washington, D.C. and in state capitals around the country for years.  Senator Herb Kohl (D-WI) and Senator Dick Durbin (D-IL) have said that they will introduce a bill to establish a federal academic detailing program.  Maine has been working on such an initiative with New Hampshire and Vermont as a result of legislation enacted by the 123rd Maine Legislature.

PhRMA President & CEO Billy Tauzin described the new ethics standards as an effort to improve member companies' long-standing work to address public concern about the industry's relationships with physicians.  

You can find more information about the new ethical guidance on the PhRMA web site at:  http://www.phrma.org/   [return to top]

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