September 22, 2008

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Dirigo Health Agency Board Meeting 9/15 Report

The Board of Directors of the Dirigo Health Agency met last week to review its finances and to approve changes in the coverage for DirigoChoice enrollees provided by Harvard Pilgrim.  For the calender year 2009, premiums will increase 10.8% for individuals and 6% for small groups.  Staff for the Agency also informed Board members that it can and will pay back the funds borrowed from the state's general fund because of cash flow issues caused by the timing of the assessment based upon the Savings Offset Payment (SOP).

The Board of Directors of the Dirigo Health Agency met last Monday, September 15, 2008 and heard regular updates from the staff.  Much of the discussion focused on the finances of the Agency given recent press reports of its budget deficit, created almost wholly by cash flow issues.  Income lags behind expenses because of the current "Savings Offset Payment" being paid several months after it is assessed to the health plans and third party administrators.  The Agency charges an assessment which is established annually, but takes up to two years to collect as it is paid retroactively as opposed to prospectively.  The alternative funding mechanism enacted by the legislature but now being challenged by the "corporate veto" was intended to improve the cash flow problem.

The agency has been in arrears to the state since late 2007 which led to news reports recently that the Agency was "borrowing" $14 million from the State.  In fact, the line of credit is temporary and there are sufficient assessments to pay all bills, but the cash flow problem noted above requires an infusion of funds from the state.

Should the so-called "People's Veto" be successful in repealing the new taxes intended as an alternative to the Savings Offset Payment (SOP), the Agency is likely to introduce legislation in 2009 to make collection of the SOP more timely.  If the veto fails, the State can start collecting the new taxes on a monthly basis. 

The Board also agreed to changes in the current contract with Harvard Pilgrim that will increase co-payments for enrollees.   An increase in premium for 2009 of 10.8 % for individuals and 6 % for small groups was also approved.


Health Workforce Forum Meets

The Health Workforce Forum held its third meeting this past week to review and discuss the latest data on Maine's health workforce.  The work of the Forum, established in state law, involves not just physician workforce but nursing, dentistry, behavioral health, and other health care providers. 

Forum members heard a presentation on the 2006 Health Care Occupations Report prepared by the Maine Department of Labor.  The report serves as a valuable source of workforce information in the state, with data that is largely based upon surveys completed during the re-licensure process of various health care professsionals, including medical doctors.   Among interesting highlights of the Report relating to physicians are the following:

  • Only 26.4% of physicians surveyed completed their residency in Maine;
  • Roughly one our of every three surgeons in Maine is over the age of 60, and many physicians are at or near the typical retirement age;
  • Physician recruitment for rural areas is challenged by lower earning potential, long hours, and isolation from medical colleagues, coupled with heavy debt loads from over ten years of training, including college, medical school, internship, and residency.

MMA is represented on the Forum which will meet again on October 15, 2008 from 1:00 to 3:30 p.m. in Augusta.  At this meeting, the group will finalize its purpose statement and begin to prepare a plan to implement it.

The Maine Recruitment Center currently reports vacancies/positions available for physicians at 237, with more than 100 positions in pirmary care. [return to top]

Change in Scheduling of First Fridays for October/November 2008

The First Friday program scheduled for October 3rd regarding Tiered Networks and Public Reportability of Data is being moved to November 7. 2008.  Persons already registered will be personally notified of the change.  The December program on physician health and wellness will occur as previously scheduled on December 5th.

Members or practice administrators wishing to present ideas for CME programs in 2009 should contact Gordon Smith at [return to top]

Workers' Comp Consensus-based Rule-making on Facility Fees Fails

The Consensus-based Rulemaking Committee for the WCB Chapter 5 Medical Fee Schedule met for its final meeting on September 16th and failed to achieve consensus on the medical fee schedule.  The only issue before the group was the "facility fee" paid to hospitals and Ambulatory Surgical Centers (ASCs)

At the meeting, the consultant to the process, Ingenix, provided its recommendations for a new methodology for a facility fee schedule for inpatient, outpatient, and ASCs.  The methodology for ASCs resulted in a recommended base rate of $81.32 while decreasing the implantable threshold for additional payment from the current $5,000 to $250 and paying a % over cost.

The ASC representatives present as well as the Maine ASC Association supported the proposal.  However, the attorney for the employer community, John Lambert, Esq., objected based partially upon the fact that these rates would exceed the rates paid to other commercial third party-payers.

As the consensus rule-making has failed, the Workers Compensation Board may move ahead in May to propose a rule establishing a facility fee that would be consistent with the recommendation by Ingenix.  The proposed rule would go to rule-making where interested parties would again have an opportunity to comment.  Ultimately, it would be up to the 9 member Board to determine if a rule would become effective. [return to top]

Pathways to Excellence: Report of Steering Committee Meeting 9/18

The Primary Care Steering Committee of Pathways to Excellence met on Sept. 18th at the MMA offices in Manchester.   In addition to hearing updates on the Aligning Forces for Quality program, the Patient Centered Medical Home pilot and Quality Counts, participants discussed at length some of the options available in transitioning the PTE program to a National Recognition program through either Bridges to Excellence or NCQA (National Committee on Quality Assurance).  Blue Ribbons earned through PTE in 2007 will be converted to green for 2009, consistent with NCQA three year recognition.  As both BTE and NCQA have three levels of recognition, (good, better and best), there was much discussion concerning how many points each practice would need to earn to acquire the requisite recognition.

The PTE Specialty Steering Committee also met and received reports on the metrics being developed for reporting in the fields of cardiovascular surgery, cardiology, general surgery, orthopedics, gastroenterology and neurology. [return to top]

Momentum Continues to Build for "No on One" Campaign

The "No on One" campaign continues to grow as individuals and organizations learn more about what is at stake if the newly enacted taxes on beer, wine, and soda are repealed.  This past weekend, the Maine Society of Eye Physicians and Surgeons (MSEPS) voted to oppose the ballot initiative and to contribute to Health Coverage for Maine, the political action committee which has been organized to defeat the ballot initiative.

MSEPS represents virtually all of the ophthalmologists in the state.  It now joins MMA, the AARP, the SEIU, the Maine People's Alliance, the Maine Education Association, and several other organizations in opposing the repeal effort.  All of the medical specialty societies in the state will be asked to join the campaign effort.

Persons interested in volunteering or contributing may do so through the campaign's website at [return to top]

SAVE THE DATE: National E-prescribing Conference Sponsored by CMS & Industry Partners

October 6-7, 2008

Sheraton Boston Hotel

Boston, Massachusetts

Attention Health Care Professionals and Stakeholders:

Be part of a groundbreaking opportunity!  Find out how to earn incentives from Medicare, learn how e-prescribing can work for your business, and get answers to your questions about privacy, security, and risk management.

There is no registration fee, but space is limited, so register early.  For more information or to register, go to

[return to top]

Study Says Changes in Anti-Fraud Regulations Haven't Prompted Hospitals to Help Physicians Much with EHR

In 2006, CMS and the DHHS, OIG issued amendments to the physician self-referral and anti-kickback rules designed to encourage hospitals to provide financial help to physicians in adopting electronic health records and other health information technology.  In an issue brief released on September 18, 2008, the Center for Studying Health System Change says that few hospitals have provided such financial assistance citing a lack of interest on the part of physicians, especially when they find that they will still bear some financial responsibility for new hardware and software costs, hospital budget limits, and other hospital IT projects.  Those hospitals that have provided assistance reported providing it in three ways:  direct financial subsidies, extending hospital vendor discounts, and technical support.

You can find the report on the web at: [return to top]

US DHHS Office of Civil Rights Issues New Guidance Documents on HIPAA Privacy Rule

On September 17, 2008, the Office of Civil Rights released two new guidance documents designed to help practitioners and patients understand better when and how their protected health information (PHI) may be shared with family members and friends:

  • A Patient's Guide to the HIPAA Privacy Rule:  When Health Care Providers May Communicate About You with Your Family, Friends, or Others Involved in Your Care; and
  • A Health Care Provider's Guide to the HIPAA Privacy Rule:  Communicating with a Patient's Family, Friends, or Others Involved in the Patient's Care.

The guides address what the OCR calls some of the most misunderstood aspects of the privacy rule.  They address circumstances when the patient is present and has capacity to make health care decisions, when the patient is not present or is incapacitated, interpreter services, documentation requirements, and the rules for picking up someone else's prescription or medical supplies.

You can find these guidance documents and other helpful information about the privacy rule on the web at:  [return to top]

US DOJ & FTC Issue Joint Statement Criticizing Illinois' CON Laws

On September 12, 2008, the U.S. Department of Justice and the Federal Trade Commission issued a joint statement to the Illinois Task Force on Health Planning Reform saying that the state's certificate-of-need (CON) laws undercut consumer choice, stifle innovation, and weaken market ability to contain health care costs. 
The report also says that CON laws impede the efficient performance of health care markets by creating barriers to entry and expansion and that this hinders competition and hurts consumers.  The state task force is reviewing the CON laws and asked the federal agencies for their input.  

You can find the joint statement on the web at: [return to top]

The Maine Health Information Center Hires James Harrison as New President/CEO

The Maine Health Information Center (MHIC) of Manchester, Maine, has named James Harrison of Cape Elizabeth as its new president/CEO.

Harrison succeeds former MHIC president Suanne Singer, who is retiring after 29 years of service with the organization. Singer will continue to serve the MHIC in a consulting role, assisting with several key initiatives.

Harrison joins the MHIC with more than 20 years of experience in healthcare management, having served most recently as CEO for PrimeCare Physician Associates, a large multi-specialty group located in southern Maine. A native of Yarmouth, Maine, Harrison earned his undergraduate and graduate degrees in healthcare administration from the University of New Hampshire.

The MHIC is an independent, nonprofit health data organization that specializes in building and analyzing complex healthcare databases for government agencies, healthcare purchasers and providers, and health policy researchers. It has developed a national reputation for providing high-quality, reliable data services to clients, and was a front-runner in the development of statewide, comprehensive claims databases. The MHIC developed the first-in-the-nation, all-payor claims database through a public-private partnership with the Maine Health Data Organization, and has been selected by Massachusetts, New Hampshire, and Vermont to undertake similar work in their states.

Recent growth in the demand for the MHIC’s services has been fueled by the increased attention being paid to escalating healthcare costs and by the need to improve the quality of care. Because measurement and reporting are the cornerstones of improvement efforts, the MHIC is strongly positioned for continued growth.

For more information about the MHIC, visit [return to top]

Last Week to Submit Hanley Award Nominations

The 2008 Dan Hanley Leadership Award will be presented on November 10 at a luncheon keynoted by nationally known medical researcher Dr. Jack Wennberg.  The Daniel Hanley Center for Health Leadership is inviting nominees for the Award. The deadline for submissions is September 24.  You may visit for more information and nomination form.

Each year, the Award recognizes a healthcare professional, organization, team or initiative that embodies Dr. Dan Hanley’s values. Since the Award’s inception in 2003, honorees have included Stephen Shannon, D.O, M.P.H., at the time of the award, Dean of the University of New England College of Medicine (2003); nationally known medical researcher John Wennberg, M.D., M.P.H., Chair of the Center for the Evaluative Clinical Services at Dartmouth Medical School (2004); and highly regarded Franklin County clinicians Sandra Record, R.N. and Burgess Record, M.D. (2005) and diabetes treatment pioneer Ann Gahagan, F.N.P. of Caribou (2006); Robert Ritchie, M.D., the father of Maine’s biotech industry (2007).

Please note that the Hanley Center has expanded eligibility for the Hanley Leadership Award. Organizations, teams, partnerships and collaborative initiatives are now eligible for selection, as are individuals. Nominees must reside in Maine (or be based in Maine). Their achievements must have had an impact on improving health and healthcare at the community, region and/or state levels. The nominee’s work should reflect the values exemplified by Dr. Hanley.

For more information, contact Hanley Center Executive Director Jim Harnar at [return to top]

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