January 12, 2009

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MMA Joins MHA in Opposing Supplemental Budget Cuts for Hospital-Based Physicians

Hospital administrators, physicians, and physician representatives made a strong showing in opposition to the cuts at a joint hearing of the Appropriations and HHS Committees on Monday, January 5, 2009.  The line-up of witnesses included David Proffett from Acadia Hospital, Ned Claxton, M.D. and Chuck Gill from CMMC, Frank Bragg, M.D., Erik Steele, D.O., and James Raczek, M.D. from EMMC, Michael Lalle from Calais hospital, Dave Shannon from Penobscot Valley hospital, Ron Bryant from Goodall Hospital, Mary Mayhew from the MHA, and Andrew MacLean from the MMA.  Both the MMA and the MHA urge you to contact members of the HHS Committee this week to encourage them to recommend that the Appropriations Committee reject the proposed cuts.  See contact information and talking points at the end of this article.

The Appropriations & Financial Affairs Committee began public hearings on the Governor’s SFY 2008-2009 supplemental budget, L.D.45, on Monday, January 5, 2009 before the full legislature returned on the 7th.  Among the $37.7 million in cuts from the Department of Health & Human Services is a reduction of $3.5 million in the General Fund for reimbursement to hospital-based physicians.  The Governor’s supplemental budget proposal also transfers $45 million from the so-called “rainy day” fund, reduces General Purpose Aid to local education by $27 million, and cuts public higher education by $11.8 million. 

On Monday, January 5, 2009, the MMA joined the Maine Hospital Association and eight other hospital representatives in opposing these cuts before a joint meeting of the Appropriations and HHS Committees.  You can find a summary of the Governor’s supplemental budget proposal on the web at:  http://www.maine.gov/legis/ofpr/appropriations_committee/materials/efy09_summary_governor.pdf.  This supplemental budget, L.D. 45, is necessary to balance the State’s finances between now and the end of the current fiscal year, June 30, 2009.  The legislature hopes to act quickly on the supplemental budget so that it can get to work on the bigger budget problem, the $840 million gap anticipated in the budget for the two state fiscal years beginning July 1, 2009.  The HHS Committee has budget work sessions scheduled from Tuesday through Thursday of this week and it must report its recommendations to the Appropriations Committee this Friday at 9 a.m.

During a press conference on Friday, January 9, 2009, Governor Baldacci outlined his SFY 2010-2011 biennial budget.  This biennial budget proposal is about $200 million less than the $6.3 billion two-year budget adopted for the 2008-2009 biennium.  The Governor’s proposal includes some increased funding for childhood immunizations and counts upon supplemental Medicaid funding of approximately $98.8 million from the anticipated economic stimulus package from Congress following the inauguration of President-elect Obama.  You can read the Governor’s press statement on the biennial budget on the web at:  http://www.maine.gov/tools/whatsnew/index.php?topic=Portal+News&id=66244&v=article-2008.

 Talking Points on Cuts to Hospital-Based Physicians

Reducing reimbursement to physicians at Maine hospitals that receive enhanced reimbursement through a legitimate federal program called “provider-based reimbursement” will damage the primary care safety net provided by such hospitals in many parts of Maine, particularly the rural areas, and will present further challenges to physician recruitment and retention – already very difficult – as Maine tries to compete in a national market for physicians in all medical specialties.

  • The physician recruitment and retention situation in Maine is worse than it was a year ago.  The Maine Recruitment Center now needs to fill 250 physician positions with 100 in primary care.  
  • The State continues to struggle to meet its obligations to Maine hospitals.  The 123rd Legislature avoided a similar cut in the 2008 supplemental budgets (L.D. 2173/L.D.2289) by re-basing the hospital tax (L.D. 2290).  This legislature should not change this one part of a“two-part deal.”
  • The Commission to Study Primary Care Medical Practice spent months analyzing the technical aspects of the financing of physician services in our health care system and rejected such reductions in physician reimbursement.
  • Those hospitals with “provider-based” practices do incur additional costs because of the obligations of the program, especially in clinical integration and quality improvement, thereby justifying the enhanced reimbursement.  42 C.F.R. §413.65, Requirements for a determination that a facility or an organization has provider-based status describes these additional obligations.
  • As a result of previous legislative debates about this issue, hospital-based practices in Maine now accept all MaineCare patients who come to them.

You can find members of the Health & Human Services Committee and their contact information on the web at:  http://www.maine.gov/legis/house/jt_com/hum.htm.

Maine's Own Jeanne M. Lambrew, Ph.D., an Important Part of Obama Healthcare Team

Jeanne Lambrew. PhD, formerly of Portland, has recently been named Deputy Director of the Office of Health Reform at the White House, second only to DHHS Secretary-designate Tom Daschle.  Jeanne is the daughter of long-time MMA member and former Chief of Cardiology at Maine Medical Center Costas "Gus" Lambrew, M.D.

Jeanne is a Senior Fellow at the Center for American Progress and Associate Professor of Public Affairs at the Lyndon B. Johnson School of Pulic Affairs at the University of Texas.  Previously, she was an Associate Professor at the Department of Health Policy, George Washington University School of Public Health.  From 1997-2001, she served in the Clinton White House.  She is a former program associate director for health at the Office of Management and Budget and senior health analyst at the National Economic Council.

Jeanne earned a Master's degree and a Ph.D. in Health Policy at the School of Public Health at the University of North Carolina - Chapel Hill and received her undergraduate degree at Amherst College.

Jeanne and former Senate Majority Leader Daschle co-wrote a book a year ago entitled, Critical, What We Can Do About the Health Care Crisis that details the current case for reform.  She is widely considered to be the second most important player on the Obama team when it comes to health care, second only to Daschle himself. [return to top]

MedPAC Approves Recommendations for 1.1% Hike in Physician Payments in 2010

On January 8, 2009, the Medicare Payment Advisory Commission (MedPAC) voted to increase Medicare reimbursement for physicians in 2010 by 1.1%.

The commissioners vote annually in January on physician payment updates for the following year.  Their vote was supported by staff reports that Medicare beneficiaries generally have adequate access to physicians and their ability to receive doctor care is comparable to privately insured individuals ages 50-64.  Their recommendation was still based on utilizing the existing Sustainable Growth Rate (SGR) formula that, without action by the Congress in 2009, requires a 20% reduction in reimbursement, effective also in January 2010. Legislation canceling the scheduled reimbursement cut due in January is expected to be considered this year.  It is fair to say that restoration of the cut is the highest priority for organized medicine in the coming year.  Even in Maine, a 20% reduction in Medicare would translate to tens of millions of dollars in reimbursement given the high number of Medicare patients within Maine's aging demographic. [return to top]

18 Week Certification Course Being Offered by Coding Center March 2-June 29

The Coding Center is pleased to announce the offering of an 18-week AAPC Professional Medical Coding Curriculum (PMCC) course leading to eligibility to sit for the CPC exam to be held in Portland on Monday afternoons from 3:00 pm to 7:00 pm from March 2, 2009 through June 29th, 2009.  The course will be taught by Jana Purrell, CPC and Gina Hobert, CPC and will be held at the Maine Health Center at 901 Washington Ave., Portland.

For more information on the course, visit the Coding Center website at www.thecodingcenter.com or call Maureen Elwell at MMA at 207-622-3374, ext. 219.  Maureen provides staff support to the Coding Center now directed by Gina Hobert, CPC. [return to top]

Maine Section, ACOG Winter Meeting January 23-25, 2009

Maine's obstetricians and gynecologists are cordially invited to attend the winter meeting of the Maine Section of he American College of Obstetricians & Gynecologists (ACOG) at Sugarloaf scheduled for January 23-25, 2009.  Please contact Cindy Croteau at 207-662-2749 for more information.                                                                                                                                                                                                                                        [return to top]

CMS Report Indicates Modest Slowing of Growth in U.S. Health Spending

A CMS study released January 6, 2009 and published in Health Affairs reports that spending on health care in the U.S. grew by 6.1% in 2007, the slowest increase since 1998.  The study attributes the slowing to a steep decline in retail drug spending and in a reduction in Medicare administrative costs.  Overall health care spending in the U.S. in 2007 reached $2.2 trillion or about $7421 per person.  The study also found that Medicare spending increased 7.2% and Medicaid spending increased 6.4% in 2007.  Health care spending still is rising at a faster rate than annual GDP growth.  The study entitled, National Health Spending in 2007:  Slower Drug Spending Contributes to Lowest Rate of Overall Growth Since 1998  may be found on the web at:  http://content.healthaffairs.org/cgi/content/abstract/28/1/246. [return to top]

Next MMA Senior Section Meeting Scheduled for February 11, 2009

The next meeting of the MMA Senior Section will take place at MMA Headquarters in Manchester, Maine on Wednesday, February 11, 2009.  Lunch is available at 11:30 am followed by a 12 noon - 2 pm presentation on Hospice Volunteering.  If you are interested in attending, please contact Lisa Martin at 207-622-3374, ext. 221 or email: lmartin@mainemed.com [return to top]

2009 Physician Quality Reporting Initiative National Provider Call with Question & Answer Session

The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host the first in a series of national provider conference calls on the 2009 Physician Quality Reporting Initiative (PQRI).  This toll-free call will take place from 1:30 p.m. – 3:30 p.m., EST on Wednesday, January 14, 2009.

The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) made the PQRI program permanent, but only authorized incentive payments through 2010.  Eligible professionals who meet the criteria for satisfactory submission of quality measures data for services furnished during the reporting period, January 1, 2009 - December 31, 2009, will earn an incentive payment of 2.0 percent of their total allowed charges for Physician Fee Schedule (PFS) covered professional services furnished during that same period.  The 2009 PQRI consists of 153 quality measures and 7 measures groups.

Following a short presentation on what’s new for the 2009 PQRI, the lines will be opened to allow participants to ask questions of CMS PQRI subject matter experts.

Educational products are available on the PQRI dedicated web page located at, http://www.cms.hhs.gov/PQRI, on the CMS website, in the Educational Resources section.  Feel free to download the resources prior to the call so that you may ask questions of the presenters, Dr. Michael Rapp and Dr. Daniel Green.

 Conference call details:

Date:                           January 14, 2009      

Conference Title:      2009 PQRI- National Provider Call          

Time:                          1:30 p.m. EST

In order to receive the call-in information, you must register for the call.  It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data.  This registration is solely to reserve a phone line, NOT to allow participation.  If you cannot attend the call, replay information is available below.

Registration will close at 1:30 p.m. EST on January 13, 2009, or when available space has been filled.  No exceptions will be made, so please be sure to register prior to this time.

  1. To register for the call participants need to go to: http://www2.eventsvc.com/palmettogba/011409

  2. Fill in all required data. 

  3. Verify your time zone is displayed correctly the drop down box.

  4. Click "Register".

  5. You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter.   Note: Please print and save this page, in the event that your server blocks the confirmation emails.  If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.

For those of you unable to attend, a replay option will be available shortly following the end of the call.  This replay will be accessible from 2:30 p.m. EST 1/14/2009 until 11:59 p.m. EST 1/21/2009.  The call-in data for the replay is (800) 642-1687 and the passcode is 79451256.

If you require services for the hearing impaired please send an email to: Medicare.TTT@PalmettoGBA.com. [return to top]

A Revolution in Primary Care Delivery: Direct Medical Practice Networks, January 29

The Martin’s Point Innovators Series next guest presenter will be Michael Fine, M.D.
Thursday, January 29
Ballroom, Eastland Park Hotel, 147 High Street, Portland, ME

The Martin’s Point Innovators Series presents nationally-recognized leaders and innovators in the delivery and financing of health care to health care providers and policy leaders in Maine and New Hampshire.

Michael Fine, M.D. is a family physician and Managing Director of HealthAccessRI, the nation’s first statewide organization making prepaid, reduced fee for service primary care available topeople without employer provided insurance and those with health savings accounts.  On January 29, 2009, Dr. Fine will discuss the recently established Direct Medical Practice Network.  This structure by-passes the insurance payment model and offers to create new financial underpinnings to the primary care system.

The schedule for the event is:

5:00 pm Networking Reception
6:00 pm Dinner
8:15 pm Event Adjourns

Reply by January 23rd to ina.levasseur@martinspoint.org or 207-253-6170.
Please indicate any dietary restrictions. [return to top]

New Bills for Your Review & Comment/Legislative Committee Conference Call Schedule

MMA Deputy EVP Andrew MacLean has reviewed LDs 1 through 115 and has identified the following list for tracking by the MMA on behalf of the physician community and, in some cases, for specific medical specialties.  Mr. MacLean also has proposed a position (support, oppose, monitor) and any medical specialty for which the bill is relevant.  Those proposals may be changed by the Legislative Committee.  Physicians and their staffs have two options for providing feedback to the MMA staff about these bills and the MMA's position.  First, you can participate in the weekly conference calls of the Legislative Committee.  These will begin next week on a day and time to be announced in next week's Maine Medicine Weekly Update and are open not only to Legislative Committee members but also to any individual physician or specialty society representative who wishes to express an opinion on a bill.  Second, you can call or email Deputy EVP Andrew MacLean and/or EVP Gordon Smith with your thoughts.

If you click on the highlighted LD number below, you will go directly to the text of the bill.  You can find any information you may want about the bill by using the "Bill Status" search on the legislature's web site, http://janus.state.me.us/legis/LawMakerWeb/search.asp.

LD 13, An Act to Expand the Diagnostic Functions of Independent Practice Dental Hygienists (monitor)

LD 17, An Act to Prohibit the Sale of Energy Drinks to Minors (support or monitor; pediatricians; Public Health Committee)

LD 18, An Act to Ensure Access to MaineCare Services (monitor)

LD 20, An Act to Require Insurance Companies to Cover the Cost of Prosthetics (monitor; orthopaedic surgeons; physical medicine & rehab physicians)

LD 21, An Act to Encourage the Diagnosis and Treatment of Autism Spectrum Disorders (monitor; pediatricians)

LD 40, An Act to Prohibit Certain Uses of Cellular Telephones and Handheld Electronic Devices While Operating a Motor Vehicle (monitor; Public Health Committee)

LD 41, An Act to Prohibit the Use of a Handheld Cellular Telephone While Operating a Motor Vehicle (monitor; Public Health Committee)

LD 45, the Governor's FY 2009 Supplemental Budget (oppose proposed cuts in hospital-based reimbursement)

LD 63, An Act to Reduce Registration Fees for Certain Generators of Biomedical Waste (monitor; Public Health Committee)

LD 67, An Act to Protect Beaches in Maine's State Parks (support; pediatricians; Public Health Committee)

L.D 81Resolve, Regarding Legislative Review of Portions of Chapter 10: Exemptions to the Ban on Flavored Cigarettes and Cigars, a Major Substantive Rule of the Office of the Attorney General (monitor; Public Health Committee)

LD 89An Act To Amend the Laws Concerning Informal Conferences as Part of the Board of Licensure in Medicine's Disciplinary Proceedings (support)

LD 94, An Act To Authorize the State Board of Nursing To Request Mental and Physical Examinations and To Establish a Nurse Health Program (support)

LD 98, Resolve, To Direct the Department of Education and the Department of Health and Human Services To Require the Teaching of Mental Health Awareness in Middle Schools Based on a National Curriculum (monitor or support; psychiatrists)

LD 99An Act To Allow Authorization for the Release of HIV Information on a General Medical Information Release Form (support or monitor)

LD 100., An Act to Improve Oral Health Care for Maine's Children (support or monitor; pediatricians; Public Health Committee)

LD 101,  An Act To Extend the Operation of the Maine Health Data Processing Center and To Amend the Maine Health Data Organization Statutes (support)

LD 112, An Act to Prohibit the Use of Handheld Cellular Phones While Driving (monitor; Public Health Committee)








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