November 3, 2008

 
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Does YOUR Voting Make a DIfference on Tuesday

In the 2006 general election for state representatives in Maine one race was won by less than 5 votes and 7 races were won by less than 25 votes.  Eleven races were won by less than 50 votes and 16 races were won by less than 100 votes. Yes, voting makes a difference when you get involved.  It can make a big difference in state policies that impact your profession and your life.  Please vote on Tuesday.  For those of you who have not made a decision about Question One, which is opposed by MMA, the Maine Academy of Family Physicians, the Maine Chapter of the Academy of Pediatrics, the Maine Chapter of the American College of Physicians, and the Maine Primary Care Association, please read the third article below.

Also make a point of encouraging your family and the rest of your employees to vote.  You may wish to allow employees to arrive late or leave early or do something creative to encourage them to cast their ballot.

After Tuesday, take a moment to call or otherwise communicate with your winning candidates.  Congratulate them, tell them you appreciate the sacrifices they make to serve and offer to share your opinion and expertise should any issues arise during the session that your medical expertise would be relevant to. 

You cannot imagine the positive impact of your communicating to your new legislators in this way, without a specific issue to lobby but just offering your congratulations and your future opinions.

If you need contact information for your state representative or state senator, contact Gordon, Andy or Kellie at MMA at 622-3374.

Maine Immunization Program (MIP) Changes Jan. 1, 2009; Children Likely to Suffer

The Maine Medical Association and pediatric interests are alarmed at the recent announcement that the Maine Immunization Program as of Jan. 1, 2009 will supply all recommended vaccines ONLY to Vaccines for Children-qualified (VFC) Children. VFC-qualified children are those who are younger than 19 and fall into any one of the following categories:

  • Have MaineCare for insurance
  • Are Native Americans
  • Have no insurance, or
  • Have insurance but the insurance does not cover the vaccine.  However, this does not include children whose insurance carrier will deny the claim because of the plan's deductible.

All providers will have all recommended vaccines for all VFC-qualified children in any clinical settings.  Uninsured children do not need to be referred to federally-qualified health centers or rural health centers for these vaccines.

MIP officials at the Maine Centers for Disease Control and Prevention stated in a letter to physicians that they realized the changes will increase workloads and will put the financial burdens of purchasing vaccines on some providers.

"Because of funding shortages and not being able to offer vaccines to all Maine children, we are not allowed to use the funding mechanism that has allowed us to use HMO funds to provide vaccines for children they insure." the letter stated.  "We therefore ask that you work with insurance companies that carry policies to cover your patients to obtain reimbursement of your vaccine costs and administration fees.  This will need to also take effect on Jan. 1, 2009."

Persons with questions or comments should call the Immunization Program at 1-800-867-4775. 

The state's Immunization Coalition, which includes MMA, has been meeting regularly to examine the immunization situation.  Legislation is likely to be introduced in the coming legislative session to improve the situation.  The situation has also been the subject of discussion by the MMA Committee on Public Health, chaired by pediatrician Charles Danielson, M.D. [return to top]

No on One Campaign Gains Traction; Fed Up with Taxes Group Fined

Highlights of the No on One campaign this past week included two Monday press conferences featuring Joseph Annis, M.D., AMA Trustee.  Dr. Annis, an anesthesiologist in New Hampshire and Texas, came to Maine to speak against the ballot question and noted the support of the American Medical Association for taxes on beverages. In other highlights:

  • Three No on One television advertisements aired widely throughout the week, one featuring Amy Madden, M.D., a family physician who completed her residency at Maine-Dartmouth in Augusta and who practices family medicine in Belgrade.
  • Editorial writers acted adversely to the news that the state Chamber of Commerce and other business organizations had filed a lawsuit in Augusta last week asking that the current funding for the Dirigo Health Agency be declared unconstitutional.  This, after stating publicly for months that no person would lose coverage if the new funding formula is repealed, as proposed in Question One.
  • The Fed Up with Taxes Coalition, funding the repeal effort, was fined $10,000 by the state's Commission on Governmental Ethics and Election Practices on Thursday for failing to file their finance report on a timely basis.  When finally filed, the report showed that the beverage industry and related interests have contributed over $3.7 million to support the repeal effort, with over $2 million alone coming from Coca Cola and Pepsi Cola.  In the last few months, nearly all of these funds were from outside the state.

Why does MMA and the other health care organizations, joined by the AARP and others oppose the repeal effort?  Here is the story on this, succinctly put:

  1. The funds raised from the revenue supports no only Dirigo and its 18,000 enrollees, but also the 40,000 Mainers who purchase health insurance coverage in the individual market.  The new law broadens the community rating bands, allowing better pricing for younger people but protects the older insureds by creating a reinsurance pool which will reimburse insurers for one-half the cost of high cost claims.
  2. While opponents of the new law criticize the 1.8% assessment on paid claims (paid by insurers), this assessment is actually LESS than the current assessment which has averaged 2.1% and can legally go as high as 4.0%.
  3. Voters have heard repeatedly that the new taxes would bring in $75 million.  The only tax which is new is the beverage tax which is estimated by the Maine Revenue Service to bring in $16.7 million.  The remaining revenue from the assessment on paid claims is certainly not new, and is actually a reduction from the existing assessment. 
  4. The DirigoChoice product is offered through Harvard-Pilgrim and pays commercial rates to healthcare providers.

When persons are uninsured, we all pay for their care through our own health insurance premiums, because those costs are shifted to us.  It is fairer and far more cost effective to assist in paying for comprehensive coverage for those individuals and families who can not afford coverage on their own.

Vote No on One, and help Maine continue its leadership in ensuring health coverage for individuals, families and children in Maine. [return to top]

Who is Looking at Your Data and Why? First Friday CME Program on this Friday, Nov. 7

It is not too late to register for the next First Friday education program featuring the topic of, Public Reporting of Physician Data:  The Move Toward Transparency.  The program will be held from 9:00am to noon on this coming Friday, November 7 at the offices of the Maine Medical Association in Manchester.  A $60 fee covers breakfast and all course materials.

The faculty includes Doug Libby, Executive Director of the Maine Health Management Coalition, Andrew MacLean, Esq., Deputy Executive Vice President of MMA and D. Joshua Cutler, M.D., Executive Director of the Maine Quality Forum.

Objectives of the program are as follows:

  1. Learn of the efforts by employers, health plans and public agencies in the state to publish comparative physician-identifiable data.
  2. Learn what physicians and practices can and should do now to be prepared for transparency.
  3. Learn of the data sources in Maine driving the transparency movement.

You may register on-line at www.Mainemed.com or by calling the MMA office at 622-3374 (press  0 for assistance).

 

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Electronic Health Records (EHR) - CMS Demonstration Project Update

The Maine Quality Forum (MQF) staff apprised interested PHO staff, MMA staff, Hospital representatives and others on the status of the CMS EHR demonstration project in Maine.  The goal of the project is to foster the implementation and adoption of EHRs and health information technology (HIN) more broadly as effective vehicles to improve the quality of care provided and transform the way medicine is practiced and delivered.  Currently, there are 12 sites (states/region) in the country participating.  Up to 2,400 practices will be recruited, with 200 practice sites expected to be recruited throughout Maine.  The project has two phases of implementation and Maine will begin recruitment and identification of primary care practices in the fall of 2009, under the direction of MQF,through Dr. Josh Cutler and Jim Leonard.  MQF's role as the community partner will be to assist with outreach, education and recruitment of practices.  They will also be involved in facilitating leveraging of demonstration and private sector activities to maximize impact.   Dr. Cutler indicated that this demonstration is an opportunity to get started and get help before it may be mandated.  It was also noted that there are significant financial incentives are available now; there is no impact on current Medicare payments; it is a contribution towards future policy development; and, improves quality of care for your patients.

Minimum Required EHR Functionalities:

Demo practices must, by end of 2nd year, be utilizing EHR to perform minimum functionalities in order to remain in demonstration:

  • Patient visit notes
  • Recording of lab/diagnostic tests orders & results
  • Recording of prescriptions

Clinical Quality Measures are:

  • The same measures and data collection process used for Medicare Care Management Performance (MCMP) Demonstration.
  • Clinical measures not reported until after the end of the 2nd year ("Pay for Reporting").
  • Pay for Performance on clinical quality measures in years 3-5.

For details on measure specifications, see MCMP Demo website:http://www.cms.hhs.gov/DemoProjectsEvalRpts/downloads/2006_Medicare_Care_Management_Performance_Demonstraton.pdf.

 Incentive payments include two separate per-beneficiary incentive payments:

  1. HIT incentive payment as measured by the completion of an Office Systems Survey (OSS).
  2. Quality incentive payment for reporting or performance on 26 clinical measures:                                      
  • Diabetes
  • Congestive Heart Failure
  • Coronary Artery Disease
  • Preventive Services

Incentive Payments are in addition to and do not affect regular Medicare Claims Payments.

To inquire about the CMS Demonstration Project and find out if your primary care practice could be involved, contact:

Jody Blatt - EHR_Demo@cms.hhs.gov or 410-786-6921. 

 

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SAVE THE DATE: MMA Legislative Committee Schedules Organizational Meeting for November 18th

Samuel P. Solish, M.D. and Lisa D. Ryan, D.O., chair and vice chair of the MMA Legislative Committee, invite Legislative Committee members, specialty society legislative liaisons and officers, and any interested member to the Committee's organizational meeting for the 124th Maine Legislature on Tuesday, November 18th from 6 to 9 p.m. at the MMA office in Manchester.  The agenda for this meeting will include:

  • a review of election results and the composition of the 124th Maine Legislature;
  • an overview of the Legislative Committee's process for the coming session;
  • a discussion of the MMA's legislative agenda for the 124th Maine Legislature;
  • a discussion of specialty society legislative priorities; and
  • a briefing on pharmacists' provision of vaccinations by pharmacy and pharmacist representatives with discussion to follow.

Maine medical specialty societies are strongly encouraged to send a representative to this important meeting.  Dinner will be available at 6 p.m.  Please RSVP to Andrew MacLean, Deputy EVP, at amaclean@mainemed.com or 622-3374, ext. 214.

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AMA Survey Results Say Doctors Think CMS' PQRI Initiative Needs Improvement

On October 29, 2008, the American Medical Association (AMA) released the results of its survey of physicians on Medicare's Physician Quality Reporting Initiative (PQRI).  The MMA included the link to this survey tool in previous editions of Maine Medicine Weekly Update.

The survey results present the views of physicians who participated in the first year of the PQRI.  The voluntary PQRI enacted in 2006 makes physicians and other practitioners eligible for bonus payments of as much as 1.5% of their Medicare charges by submitting quality data for services provided between July and December 2007.  Similar incentive payments are available based on the entire year in 2008 and the incentive payment will be increased to 2% in 2009 and 2010.

The survey results include the following:

  • 6 out of 10 physicians rated the program "difficult;"
  • just 22% were able to download the feedback report for their practice;
  • physicians want more emphasis by CMS  on early education and feedback;
  • physicians want CMS to develop a process for appeal of CMS judgments on inaccurate reporting;
  • of those who were able to download their feedback reports, fewer than half found the information instructive;
  • of those who asked for assistance from CMS, 59% rated the agency's responsiveness as "none to low;"
  • physicians who began reporting in July 2007 did not receive a feedback report until 12 months later, making it nearly impossible to fix any problems during the second year.

A Medical Group Management Association (MGMA) survey of physicians from September 2008 also revealed strong physician dissatisfaction with the program.

You can read the AMA's press release on the survey results on the web at:  http://www.ama-assn.org/ama/pub/category/print/20208.html. [return to top]

CMS to Announce 8 Sites for Medicare Medical Home Demo in December

On October 28, 2008, CMS announced that in December it will choose 8 sites for a 3-year demonstration project to investigate whether the medical home concept can reduce Medicare costs by avoiding unnecessary care, increasing preventive care, improving patient adherence, and avoiding hospitalizations.  CMS hopes to include 400 practices (50 per site) involving 2000 physicians and 400,000 beneficiaries.  The project will offer physicians a monthly "care management fee" of $40.40 per enrollee and a portion of any savings to the program.

The draft design of the project would require eligible practices to meet 17 capabilities for "tier one" of the project expected to begin in January 2010.  The 17 standards include creating written standards for patient access to care and using data to track patients.  "Tier two" of the project, for which applications will be accepted in October 2010, will require the 17 standards and additional capabilities including use of a certified EMR.  CMS plans to use the "Physicians Practice Connections/Patient-Centered Medical Home" instrument.

You can find a fact sheet on the medical home demo on the web at:  http://www.cms.hhs.gov/DemoProjectsEvalRpts/downloads/MedHome_FactSheet.pdf. [return to top]

Information for Your Patients on Heating/Energy Assistance this Winter

During the most recent MMA Annual Session at The Samoset Resort in September, the MMA General Membership passed Resolution #3, Addressing Cost Burdens to Patients.  In this Resolution, the MMA committed to provide information to physicians regarding assistance for their patients regarding energy costs as we approach the winter of 2009 in an economic slump.

The principal federal heating assistance program is known as LIHEAP, the Low Income Home Energy Assistance Program.  As a result of the work of Maine's congressional delegation and others, Maine will get nearly $80 million of the $5 billion being distributed nationwide, a 72% increase over the $46 million Maine received in 2007.  Maine has increased eligibility for the program from 170% of the federal poverty level (FPL) to 200% ($20,800 for an individual), or in some cases for the very young or very old to 230%.  The average LIHEAP benefit will be $940 this year up from $757 last year.  Applications for the benefit are handled by your local community action program (CAP).  You can find a list of the CAP agencies in the state on the Maine State Housing Authority web site, www.mainehousing.org.

The MMA has been participating in a regional group in the capitol area organized by the United Way of Kennebec Valley as a forum for assessment of needs in the community and for a determination of resources available.  The following are some key points from the work of this group.  While some of this information is specific to southern Kennebec County, you may have similar agencies or resources in your area.

  • The Kennebec Valley CAP agency may be reached at 800-542-8227;
  • The statewide human services hotline, 211, will have a special track for heating assistance;
  • Citizens Energy or 1-800-JOEFOROIL will be available again beginning in January 2009.  LIHEAP eligibility makes one automatically eligible for this program that makes 100 gallons of heating oil available.
  • The "Keep ME Warm" fund accepts donations from businesses and may be accessed through 211;
  • The United Carpenters Union in the Kennebec Valley is making volunteer labor available for winterization; call Wanda at KVCAP;
  • The Kennebec County Sheriff's Department is making firewood available for the needy;
  • The "Energy Crisis Intervention Program" (ECIP) is a DHHS program that makes a maximum of $400 in heating assistance available for those who have exhausted their LIHEAP benefit.
  • Central Maine Powers' (CMP) "Electric Lifeline" low income assistance program is based upon LIHEAP eligibility and has a maximum annual benefit of $600.  The number for this program is 800-750-4000.  As most physicians probably know, a physician's documentation of a "medical emergency" can delay disconnection for 30 days and this may be renewed 2 times.
  • The Salvation Army in Augusta (623-3752) has heat, rent, and electric assistance available for those in eligible communities on a first come, first served basis and the heating assistance typically is 100 gallons at a time.
  • Good Will Industries in Augusta (contact Dan, 626-0170) expects to have resources available in January.  Good Will will be the agency processing requests for assistance from the United Way of Kennebec Valley Emergency Fund.  This fund is intended to be the fund of last resort in the capitol area.  The "Heat Helpers" cannister campaign in the Augusta area will support this fund and anyone who wishes to make a tax deductible contribution to heating assistance may contact the United Way of Kennebec Valley at 626-3400.  United Way agencies in other parts of the state may be engaged in similar efforts.

The MMA will bring you other information about energy assistance as it becomes available.  Please encourage your patients not to wait until after business hours or weekends to ask for assistance! [return to top]

Aetna Backs Off '09 Forecast

Wall Street Journal, October 30, 2008
After posting a 44% drop in its third-quarter net income earlier this week, Aetna announced a revised 2008 outlook and significantly altered its long-term earnings growth goal for 2009.  The managed care company pared down its full-year earnings view to $3.90 to $3.95 a share, from the target of $4.00, and is now projecting a 3% to 5% growth in operating earnings per share for next year.  (The company typically forecasts annual operating EPS growth of at least 15% and analysts had been projecting growth of 11 percent.) Aetna cited uncertain economic conditions for the changes. [return to top]

Americans blame insurance companies for increasing healthcare costs

Healthcare Finance News, October 29, 2008
A recent survey conducted by The Harris Poll found that people in all demographic groups are more likely to blame the insurance industry than anyone else for the rising costs of healthcare.  Specifically, 41% of the 2,119 adults surveyed, believed that insurance companies are to blame for increasing healthcare costs, while 16% blamed pharmaceutical companies, 16% blamed the government, 6% blamed hospitals, and 4% blamed physicians.  The survey also found that 67% of the adults surveyed believe it is more important to provide basic health insurance to the uninsured, rather than better benefits to those already with health insurance. [return to top]

Maine Public Employees Retirement System (MainePERS) Medical Board Seeks Consulting Physicians

The MainePERS is seeking consulting physicians to join its Medical Board.  "We are particularly interested in physicians with certifications in internal medicine, orthopaedics and neurology.  MainePERS administers a disability retirement program for eligible members.  The primary purpose of the MainePERS Medical Board is to review medical records of adults who are applying for disability benefits, and to advise the System on the types and status of the applicant’s conditions.  A team of Specialists, who coordinate the administrative case management aspects of the program, assists the Medical Board.  The Medical Board consists of retired, semi-retired and active practice physicians representing internal medicine, psychiatry, cardiology, orthopaedics, otolaryngology, neurology and occupational medicine.

Consulting physicians receive records a week in advance for review and analysis.  Medical Board meetings are scheduled on Thursdays at MainePERS Augusta office.  Reimbursement on an hourly basis includes case review, travel and board attendance time. "

Physicians interested in exploring this opportunity are encouraged to contact MainePERS directly:
Marlene McMullen-Pelsor
MainePERS
46 State House Station
Augusta, Maine 04333-0046
Marlene.McMullen.Pelsor@mainepers.org [return to top]

MeMGMA Presents Full Day Educational Seminar, November 12th

The Maine Medical Group Management Association is Pleased to Present:  Maine Employment Law Updates By Lawrence Winger, Esq. and How to Keep Your Employees on Track By Nicole Morin-Scribner, MBA, SPHR

Date: Wednesday, November 12th
Location: The Hilton Garden Inn - Freeport, Maine
Time: 8:30 AM to 4:00 PM

Employment Law Updates - By Lawrence Winger, Esq.
Lawrence C. Winger, Esq., has over twenty-four years of experience in the area of Labor and Employment Law. He has handled labor and employment law litigation matters such as: NLRB unfair labor practice trials, union picketing injunction litigation, age, sex, and handicap discrimination trials, sexual harassment jury trials, litigated wage and hour cases, wrongful discharge jury trials, severance pay litigation, NLRB unit determination hearings, NLRB unit clarification hearings, non-competition agreement litigation, unemployment compensation
litigation, and arbitrations.  Lawrence Winger has been on retainer with the MEMGMA for several years to answer questions regarding employment law as a benefit of membership.

How To Keep Employees on Track - By Nicole Morin-Scribner
Nicole Morin-Scribner, MBA, SPHR has been the Director of Human Resources at St. Mary’s Health System since 1997.  She has over 20 years of experience in HR and has achieved Senior Professional in Human Resources certification. Nicole has served in a number of HR leadership positions including President of the Maine Society for Healthcare Human Resources and is currently on the national board of directors for the American Society for Healthcare Human Resources.  Nicole has published articles and made presentations on HR topics at the state, regional and national level.

Congratulations! You have all your positions filled!! Your staffing challenges are over, right? But…is everyone working full speed ahead to help your organization meet its goals? There are tools managers can use (REALLY! You DO have some options!) to help employees who are not meeting your expectations.  In this interactive session, you’ll learn some helpful hints on how to best utilize the performance evaluation process as well as a new approach to progressive discipline.  We’ll also cover some of the “newer” challenges experienced in the workplace with the blurring of work/personal life presented by cell phones, e-mail, myspace etc.  Our goal is for you to walk away with some concrete ideas you can take back to your workplace!

If you have questions concerning this seminar, or for late registration, please contact Pamela Beaulé at (207) 777-8553 or by E-mail: pbeaule@stmarysmaine.com [return to top]

H.O.P.E. of Kennebec Valley Presents SoulCircling and H.O.P.E. Guide Training

H.O.P.E. of Kennebec Valley offers SoulCircling and H.O.P.E. Guide training, November 7, 8, 15.

H.O.P.E. grew out of the influences of the businessman, Earl Nightingale, and the physicians, Barry Wood, MD, Bernie Siegel, MD, and Jerry Jampolsky, MD, on the surgical career of Ken Hamilton, MD. Nightingale’s lifelong study of human development and the essence of success had strongly influenced Hamilton since 1975. Wood’s, Siegel’s, and Jampolsky’s experiences with support groups en-couraged Hamilton to call together the first H.O.P.E. supportive group in February, 1987. The demand for more groups of this success-oriented support led to the creation of the 501(c)(3) not-for-profit H.O.P.E. corporation in December, 1988.
The years have shown the continued effectiveness of H.O.P.E. and its programs, including training people in the H.O.P.E. process. Some trainees are interested in guiding groups, and the center sup-ports them with their groups. The founder’s thirty-plus years of experience in attitudinal and behavioral healing provides ongoing support for the groups. If you would like more information about H.O.P.E. groups and the H.O.P.E. process, please click here [pdf]
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For more information or to contact us directly, please visit www.mainemed.com l ©2003, Maine Medical Association