December 22, 2008

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Obama-Biden Transition Team Health Care Listening Session December 30

The December 30th Obama-Biden Transition Team Health Care Listening Session announced in last week's Maine Medicine Weekly Update has been moved to the Augusta Civic Center in order to provide a handicapped accessible space for the public.  The session is one of nearly 5000 scheduled the last two weeks of December across the country.  The purpose of the sessions is to hear from anyone interested in the issue of health care reform.  The session is open to the public and begins at 4:00 pm.

The latest ABC News/Washington Post poll showed that 77% of Americans want major changes in our health care system.

The session is sponsored by MMA, the Maine Osteopathic Association, and the Downeast Association of Physician Assistants (DEAPA).  It will be moderated by Gordon Smith, Esq., EVP of MMA and Joel Kase, D.O., MPH, President-elect of the Maine Osteopathic Association.

Comments offered at the session will be recorded and forwarded to the transition team for its use in efforts to prepare health care reform legislation.

Persons not able to attend but who wish to enter into a dialogue with the transition team can do so by posting questions about health care policy at or they can submit their own personal health stories at

This issue-focused outreach by President-Elect Obama's health transition team is viewed as an effort to educate the public and build momentum for enacting comprehensive health system reform legislation in the coming year.

The public is invited, but please let Maureen Elwell at MMA know if you are planning to attend.  She may be reached at 622-3374, ext. 219 or via e-mail to  You may also request as advance copy of the five page "Participant Guide for Health Care Community Discussions."

The Participant Guide includes policy background and key questions to be answered as the nation considers again the issue of health system reform.   As stated in the Participant Guide:

The President-elect believes that every American should have high quality and affordable health care, and to reach this goal, we must modernize our health care system in order to:

  •  Improve health care quality and cut costs;

  • Expand coverage and access; and

  • Increase the emphasis on primary care and prevention.

The Participant Guide contains brief background information to assist as we begin a discussion that will guide collective efforts to reform the U.S. health system.


Dirigo Health Agency Board of Directors Sets Year 4 Savings Offset Payment

This past Thursday, the Dirigo Health Agency Board of Directors met and established the year 4 Savings Offset Payment  (SOP)at $42.1 million, representing a 2.14% assessment on paid claims.  Insurance Superintendent Mila Kaufman had approved an amount of $48.7 million but the Board backed out $6.6 million in savings associated with insurers exceeding the medical loss ratio and returning some premium back to insureds. 

Ironically, the 2.14% assessment is more than the assessment that was included in the legislation repealed in the so-called People's Referendum resulting in Question One on the November 2008 ballot.  That assessment was 1.8% but was attached to the tax on beverages which led to the repeal effort.  The 2.14% assessment is likely to be challenged, once again, by the State Chamber of Commerce, Anthem, and other plaintiffs. 

The $42.1 million is expected to be sufficient to allow the Agency to continue to offer the DirigoChoice product to the existing enrollees and to add some persons from the existing waiting list of approximately 2000 persons. 

Premiums for the plan will increase on January 1, 2009 by 5% for small groups and 10% for individuals and sole proprietors.  The existing contract with Harvard-Pilgrim has been extended for six months. [return to top]

Governor Hits Provider-Based Reimbursement and Critical Access Hospitals in Supplemental Budget Cuts

Governor Baldacci last week released his proposed supplemental budget for the remainder of the state fiscal year that ends June 30, 2009 and that addresses a $145 million shortfall.  The supplemental budget documents can be found at:

Included in the package of cuts is a $20 million annual reduction in MaineCare reimbursement for hospital-based physicians who are currently reimbursed on a provider-based system that pays for physician services using a percentage of the hospital outpatient reimbursement schedule.  Note that not all physicians employed by hospitals receive such "provider-based" reimbursement, an election made under federal law that requires the practice to meet certain criteria regarding integration with the hospital's quality improvement and other systems.  The Governor's proposal is the same as one rejected by the 123rd Legislature earlier this year.  It would reduce payment to provider-based physicians by paying such facilities using the existing MaineCare physician fee schedule.  MMA opposed this cut last year, as did the Maine Hospital Association, with both groups advocating for equalizing reimbursement by increasing the fee schedule for physicians in private practice to the rate of reimbursement of the provider-based physicians, rather than by bringing the latter down to the private fee schedule.

During the most recent legislative session, the MHA was able to restore the cut by agreeing to rebase the existing hospital tax.  The MMA staff will meet with the MHA staff to discuss this proposal and to prepare an advocacy strategy for dealing with it.  Watch for next week's update for more details on the MMA's and MHA's advocacy on this issue.

As the legislators will be under considerable pressure to enact the supplemental budget quickly upon their return to Augusta on January 7, 2009, any effort to reduce or eliminate this cut will have to begin almost immediately, despite the holiday schedule.

While the Bush Administration also has sought a reduction in provider-based reimbursement through federal rule-making, that proposed rule is likely to be challenged both in Congress and potentially in the courts.  And in any case, the proposed federal rule does not require a reduction in provider-based reimbursement, rather it simply requires state Medicaid departments to reimburse all physicians off the same fee schedule.

The supplemental budget also reduces reimbursement for Critical Access Hospitals from 117% to 101% of their costs.  The legislature authorized the higher reimbursement several years ago as a means of paying these fifteen Maine hospitals their "match" under the state's "tax and match" program.  This cut would annually amount to $12 million considering both the state payment and federal match.

The MMA is concerned with these cuts, given the difficult economic times and the severe shortage of physicians currently in the state.  On the other hand, we are not unaware of the difficult situation faced by Maine lawmakers given the deficit in both the existing budget and the nearly $1 billion deficit in the next biennial budget.  We will work closely with our members, the MHA, and Maine's hospitals to try to make the best of a difficult situation. 



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Legislative Leaders Announce Committee Assignments for 124th Legislature

On Friday, December 19, 2008, the presiding officers of the 124th Maine Legislature announced assignments to the joint standing committees through which the legislature will carry out its policy work.  The Chairs and Leads of the four committees having some jurisdiction over health care matters and the two committees having jurisdiction over financial matters are:

Joint Standing Committee on Business, Research & Economic Development

  • Senate Chair: Senator Elizabeth M. Schneider (D-Penobscot)
  • Senate R Lead:  Senator Christopher W. Rector (R-Knox)
  • House Chair:  Representative Nancy E. Smith (D-Monmouth)
  • House R Lead:  Representative Jayne Crosby Giles (R-Belfast)
Joint Standing Committee on Health & Human Services
  • Senate Chair:  Senator Joseph C. Brannigan (D-Cumberland)
  • Senate R Lead:  Senator Peter Mills (R-Somerset)
  • House Chair:  Representative Anne C. Perry (D-Calais)
  • House R Lead:  Representative Sarah O. Lewin (R-Eliot)

Joint Standing Committee on Insurance & Financial Services

  • Senate Chair:  Senator Peter B. Bowman (D-York)
  • Senate R Lead:  Senator Earle L. McCormick (R-Kennebec)
  • House Chair:  Representative Sharon A. Treat (D-Hallowell)
  • House R Lead:  Represenative Wesley E. Richardson (R-Warren)

Joint Standing Committee on Judiciary

  • Senate Chair:  Senator Lawrence Bliss (D-Cumberland)
  • Senate R Lead:  Senator David R. Hastings III (R-Oxford)
  • House Chair:  Representative Charles R. Priest (D-Brunswick)
  • House R. Lead:  Representative Joan M. Nass (R-Acton)

Joint Standing Committee on Appropriations & Financial Affairs

  • Senate Chair:  Senator G. William Diamond (D-Cumberland)
  • Senate R Lead:  Senator Richard W. Rosen (R-Hancock) 
  • House Chair:  Representative Emily Ann Cain (D-Orono)
  • House R Lead:  Representative H. Sawin Millett, Jr. (R-Waterford)
Joint Standing Committee on Taxation
  • Senate Chair:  Senator Joseph C. Perry (D-Penobscot)
  • Senate R Lead:  Senator Richard A. Nass (R-York)
  • House Chair:  Representative Thomas R. Watson (D-Bath)
  • House R Lead:  Representative Kathleen D. Chase (R-Wells)

Three other committee assignments are noteworthy for the physician community.  The new legislature's two physicians, Senator Lisa T. Marrache, M.D. (D-Kennebec) (also the Assistant Senate Majority Leader) and freshman Linda F. Sanborn, M.D. (D-Gorham) have been assigned to the Health & Human Services Committee.  Former MMA Director of Governmental Affairs Joan F. Cohen, Esq. (D-Portland) has been assigned to the Business, Research & Economic Development Committee.

The 124th Maine Legislature will commence the work of its First Regular Session on Wednesday, January 7, 2009.

You can find a complete list of committee assignments on the web at:



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Maine Patient Centered Medical Home Pilot Continues to Take Shape

Two significant meetings occurred last week regarding the effort to establish a multi-payer patient centered medical home pilot in the State.  On Tuesday evening December 16, 2008, the MMA, Quality Counts!, and the major primary care organizations in the state hosted a forum at MMA with the state's specialty society leaders to provide an overview of the project and to discuss issues associated with it. 

The Maine Quality Forum, Quality Counts!, and the Maine Health Management Coalition are leading the multi-stakeholder effort to implement and evaluate the Maine Patient Centered Medical Home Pilot as the first step in achieving statewide implementation of the PCMH model.  The Pilot is planned as a 3-year effort to implement the PCMH model in 10-20 primary care practices from across the state beginning early next year. 

On Wednesday, the PCMH Working Group met to approve a Memorandum of Agreement for Participation in the Pilot and an application form.  The Memorandum of Agreement serves to outline the anticipated benefits and expectations for participating primary care practice Pilot Sites.  One of the primary decisions made on Wednesday was to include pediatric practices in the Pilot. 

Among other requirements, primary care practices interested in participating in the pilot project are asked to commit to the following:

  • To participate in the full duration of the Pilot, anticipated to be a 6-month pre-Pilot "Ramp Up" period, the 3-year Pilot, and a 3-month post-Pilot practice reassessment as part of the overall Pilot evaluation.  Participation of Pilot practice sites means active participation of all health care professionals and staff in the practice.

  • To complete an application for Patient Centered Medical Home certification using the National Committee for Quality Assurance's "Physician Practice Connection-Patient Centered Medical Home" assessment tool within four months (or sooner) of being notified of selection as a Pilot site and aiming to achieve "Level 1" certification within six months of being selected.

  • To complete 1-2 additional tools assessing practice culture, such as the Practice Staff Questionaire Microsystems Assessment Tool.

  • To submit an authorization for release of claims data to PCMH Pilot staff and evaluation team for analysis of cost and quality measures both at baseline and over the course of the Pilot.

  • To track and report the full set of Pilot clinical measures (yet to be determined) using the practice's electronic medical record or registry and to report clinical outcomes to the PCMH Pilot staff and evaluation team monthly.

  • To fully implement the PCMH model, including achieving all PCMH "Core Commitments" within 12 months of beginning participation in the Pilot.

  • To identify a "Leadership Team" within the practice to serve as champions for PCMH improvement efforts and to attend PCMH Learning Sessions.  The Leadership Team at the practice must include (at a minimum) a lead physician or nurse practitioner, a practice administrator, and a clinical support staff.

  • To participate in the PCMH Learning Collaborative, including consistent attendance by all members of the practice Leadership Team at 1-day Learning Sessions three times per year for the duration of the Pilot.

  • To continually assess and improve care processes and structures within the practice, working in partnership with a Pilot Quality Improvement Coach.

  • To participate actively in collaborative learning with other Pilot practices through sharing learning with other teams in Learning Sessions and participating in PCMH Pilot listserv discussions and Leadership Team conference calls.

  • To negotiate and sign a contract amendment outlining the PCMH Pilot payment model with each payer participating in the Pilot.

  • To participate in post-Pilot evaluation activities, including surveys and interviews with the evaluation team, to be completed within three months of completion of the Pilot.

It is anticipated that applications would be submitted by February 28, 2009.

The exact number of practices participating in the Pilot will depend upon how many practices the health plans and MaineCare agree to support.

It is anticipated the payment model for the Pilot will consist of a combination of fee for service, a per member per month fee, and shared savings.  The health plans participating in the Pilot have not agreed on a uniform model of payment.

Interested practices wishing further information may contact Dr. Lisa Letourneau at 415-4043 or via e-mail at [return to top]

Influenza Arrives in Maine: Cough Safe, Wash Your Hands and Stay Home if ill

The 2008-2009 flu season has begun in Maine with Dr. Dora Anne Mills, Director of the Maine CDC, announcing Friday that two laboratory-confirmed cases of influenza have been identified.  The cases were in Androscoggin and Cumberland counties. 

The CDC recommends that all adults 50 and older and all children over 6 months and anyone with a chronic illness should have a flu shot.  It is not too late for a vaccine to be effective for most of the season and there is plenty of vaccine available.

Nationally, influenza results in the death of approximately 36,000 people each year. [return to top]

MeMGMA Presents 2009 Third Party Payer Seminars

The Maine Medical Group Management Association is Pleased to Present:  2009 THIRD PARTY PAYER SEMINARS

Two Dates and Convenient Locations:
Wednesday, January 14, 2009 Keeley’s Banquet Center, 178 Warren Avenue 5 Coffin Avenue Portland, Maine
Wednesday, January 21, 2009 Jeff’s Catering, Brewer, Maine

Provider representatives from the major payers will be speaking at this seminar and providing updates as to the status of claims processing. Representatives from the following insurance companies have been scheduled to attend:  CIGNA, MAINE CARE, AETNA, MARTIN’S POINT, HARVARD PILGRIM, MEDICAL NETWORK (MEDNET), MEDICARE, MAINE NETWORK FOR HEALTH, ANTHEM

Participants will have the opportunity to ask questions concerning reimbursement issues affecting physician practices in general, but should not expect answers to questions concerning individual account situations.

For more information, or to register, click here [pdf] [return to top]

Important PMP Web Site Change!

Access to the online PMP database may be denied unless users “re-register” during “business” hours, 8:30 AM to 7:00 PM, the week of January 5, 2009.

One of the unanticipated consequences of the planned changes to the PMP online database interface, scheduled for January 5, 2009, is that if practitioners attempt to log on the PMP web site outside of business hours during the week of January 5, (or over the weekend of January 10th and 11th) without having “re-registered” earlier in the week, they will be denied access until the next business day!  This scenario is actually very likely for clinicians who work in emergency or urgent care settings.

If you want access to PMP data outside of business hours during that week, you will need to attempt to log on to the new web site during business hours, once the new site is up and running.  All accounts, after re-registration, will have to go through a MANUAL approval process, so you should expect to have to wait for access.

Please spread the word among your colleagues that having an email address on file with GHS prior to January 5th will expedite the re-registration process.  Anyone who is uncertain should be instructed to call the Maine PMP Helpdesk at 866-749-7838. [return to top]

Governor's Task Force on Expanding Access to Oral Health Care Update

From MMA member William Alto, MD, the MMA's representative to the Governor's Task Force on Expanding Access to Oral Health Care for Maine People, a year-end update on the Task Force's activities:

The Governor’s Task Force on Expanding Access to Oral Health Care for Maine People met 11 times between November 2007 and November 2008.  Its final report was recently submitted with 14 recommendations under six categories to expand access to oral health care in Maine.

The strategies included:

  • Increasing MaineCare reimbursement rates to the 75th percentile of the New England average and financially reward dental providers who preferentially serve MaineCare patients.
  • Integrate oral health care into overall health care through a coordinated public health campaign providing dental care for pre-school children, supporting required dental screening at school entry, facilitating school-based disease prevention and oral health promotion programs, and expanding MaineCare Dental coverage to nursing home patients and pregnant women.
  • Increased of dental professionals in Maine with enhanced loan and loan repayment opportunities.
  • Support of community water fluoridation.

MaineCare currently reimburses dentists at less than the 25th percentile of regional fees while spending 2.5 million dollars in 2007 and 2008 in emergency room dental management.

The Task Force recommended that all third party payers cover fluoride varnish applied in physician’s offices. MaineCare already covers these services for everyone under 21.  All children should establish a dental home by age one. [return to top]

Senate Finance Committee Could Mark Up Economic Stimulus Package as Early as January 8th

Senate Finance Committee staffers recently have stated that the Committee may mark up an economic stimulus bill as soon as January 8, 2009.  While the exact size and details of the package have not yet been determined, it likely will include some tax measures, some infrastructure spending, and some health care priorities.  Consumer advocacy groups and others, such as the National Governors Association, are pushing for at least $40 billion in additional Medicaid spending over 2 years and reauthorization of the State Children's Health Insurance Program (SCHIP) that expires on March 31, 2009.  The package may also include spending on health information technology, a part of the infrastructure portion endorsed by the President-elect. [return to top]

FDA Commissioner Announces Resignation Effective January 20, 2009

In a memo sent to FDA employees on December 15th, FDA Commissioner Andrew von Eschenbach, M.D. has stated that he will resign his position effective January 20, 2009.  Dr. von Eschenbach has served during a turbulent time for the agency during which the public has lost considerable trust in the agency.  While PhRMA praised Dr. von Eschenbach's tenure, the consumer group Public Citizen criticized him for being a weak regulator and urged the Obama Administration to pick a strong outsider to run the agency in the future.  Janet Woodcock, chief of the FDA's drug division, has been mentioned as a possible interim commissioner. [return to top]

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