January 26, 2009

 
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Appropriations Committee Closes Work on Supplemental Budget

Late last Friday afternoon, the Appropriations Committee took votes on various tabled aspects of the Governor's FY 2009 supplemental budget proposal, L.D. 45, including the proposal to avoid the $4.5 million General Fund cut in reimbursement to hospital-based physicians and critical access hospitals.  The Committee sends the budget to the floor of the House with a unanimous "ought to pass as amended" report.  The MMA appreciates the work of the Maine Hospital Association in resolving these reimbursement issues and thanks those physicians who took the time to weigh in on the issues with their legislators.  The supplemental budget will go to the floor this weeks and the Appropriations Committee soon will tackle an even bigger problem - a biennial budget with a gap of approximately $840 million.

The joint Appropriations/HHS subcommittee on the hospital reimbursement issues met for several hours on Wednesday afternoon, January 21, 2009 and again engaged in a wide ranging discussion with DHHS Commissioner Brenda Harvey and her staff, as well as the interested parties.  By the end of the discussion, the subcommittee decided to recommend to the Appropriations Committee that it find the $4.5 million in the General Fund that was needed to avoid both the critical access hospital and the hospital-based physician cuts by pushing the last hospital periodic interim payment (PIP) for FY 2009 from June into July to save $2.6 million and to move hospital-based physicians to a fee schedule with rates approximately 70% of Medicare payment rates for physicians to save $1.9 million.  The positive news for those practitioners now paid on the MaineCare fee schedule is that the rates will be increased from approximately 57% of Medicare rates currently to approximately 70% effective July 1, 2009.  The subcommittee also has recommended the establishment of a more formal subcommittee to take a closer look at the hospital reimbursement issues in the biennial budget.  Finally, the subcommittee recommended that 60% of any federal economic stimulus funds Maine receives in excess of the $98.8 million incorporated in the Governor's biennial budget proposal be dedicated to past due hospital MaineCare settlements.

The AFA/HHS subcommittee that developed this compromise was composed of Senators Lisa Marrache, M.D. (D-Kennebec), Peter Mills (R-Somerset), and Richard Rosen (R-Penobscot) as well as Representatives Anne Perry, NP (D-Calais), Bob Nutting, R.Ph. (R-Oakland), and Lisa Miller, MPH (D-Somerville).

AMA Efforts Vital in Blocking Merger Plan to Create Sixth Largest Health Insurer in the U.S.


On January 21, 2009, Highmark and Independence BlueCross announced the withdrawal of their proposal to merge.  This announcement came only days before Pennsylvania Insurance Commissioner Joel Ario planned to issue a disapproval order based on the Pennsylvania Insurance Department’s concerns over the merger’s likely anticompetitive effects

In testimony before both the Pennsylvania Insurance Department and a subcommittee of the U.S. Senate Judiciary Committee, the American Medical Association (AMA) stressed that the merger would eliminate the potential for health insurer competition in southeastern Pennsylvania.  The AMA’s testimony highlighted the injury to the physician marketplace that results when a health insurer acquires “monopsony” power such that it can purchase physician services below competitive market rates.  Patients also suffer, facing higher premiums, decreased access to care and weaker provider networks.

The Pennsylvania Insurance Department’s conclusions, based on a thorough 21-month review process, are remarkable and deserve national respect.  The Department held three public hearings, in which 101interested parties offered comments, and compiled a Web site that hosted nearly 50,000 pages of commentary.  Based on this extensive record and the analyses of financial and economic experts, the Department found the merger to be“anticompetitive,” in large part because it would grant the merged health insurer undue leverage over physicians and other health care providers.  The Department observed that there is a “careful balance to be struck between insurer power and provider power.”  AMA testimony and written submissions were specifically quoted in the Department’s press release.  Visit the Department’s Web site at http://www.ins.state.pa.us/ins/cwp/view.asp?a=1347&Q=549692&PM=1to view the statement from Commissioner Ario and the excerpts from the public record, which include AMA testimony used as background for the Department’s conclusions.

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Public Health Committee 2009 Meeting Dates - February 24th First 2009 Meeting

The Public Health Committee meeting dates have been confirmed for 2009 and will meet on the following dates at the usual time from 4pm -6pm at the Maine Medical Association, Manchester, Maine.

Through the assistance of Dr. Jim Schneid, we will have access to the Maine Medical Center, Dana Center Video-Conferencing to allow our physicians to connect into the meeting. An agenda and meeting packet will be emailed to all committee members a few days prior to each meeting. Dr. Danielson, Chair, asks that if you have any agenda items for our upcoming meeting, please send them to MMA Staff, Kellie Miller, at kmiller@mainemed.com.  Any interested MMA members are welcome to join the Public Health Committee.  We welcome your involvement! 

2009 Meeting Dates

February 24, 2009 (Dana Classroom - 7)

March 25, 2009 (Dana Classroom - 2)

May 20, 2009 (Dana Classroom - 4)

August 19, 2009 (Dana Classroom - 4)

October 21, 2009 (Dana Classroom - 4)

December 16, 2009 (Dana Classroom - 4) 

The legislative session is off to a strong start with hearings already occuring next week on the following:

Wednesday, February 4, 2009

Health and Human Services (287-1317)

1:00 PM Room 209, Cross State Office Building

L.D. 17 An Act To Prohibit the Sale of Energy Drinks to Minors (Sponsor: Rep. PENDLETON of Scarborough)

2:00 PM Room 209, Cross State Office Building

L.D. 81 Resolve, 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 (Emergency) (Introduced By: Rep. PERRY of Calais) (Submitted by Office of the Attorney General)

L.D. 67 An Act To Protect Beaches in Maine's State Parks (Emergency) (Sponsor: Sen. NUTTING of Androscoggin)

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Thursday, February 5, 2009

Education and Cultural Affairs (287-3125)

2:00 PM Room 202, Cross State Office Building

L.D. 100 An Act To Improve Oral Health Care for Maine's Children (Sponsor: Rep. SMITH of Monmouth)

L.D. 136 An Act To Require the Provision of Unstructured Recess Time for Elementary School Students (Sponsor: Rep. HASKELL of Portland)

Health and Human Services (287-1317)

2:00 PM Room 209, Cross State Office Building

L.D. 17 WORK SESSION: An Act To Prohibit the Sale of Energy Drinks to Minors (Sponsor: Rep. PENDLETON of Scarborough

L.D. 81 WORK SESSION: Resolve, 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 (Emergency) (Introduced By: Rep. PERRY of Calais) (Submitted by Office of the Attorney General

L.D. 67 WORK SESSION: An Act To Protect Beaches in Maine's State Parks (Emergency) (Sponsor: Sen. NUTTING of Androscoggin) [return to top]

Maine Urological Association 2009 Winter CME Meeting - February 6-8 at Sugarloaf

Registration is still open for the Maine Urological Association's 2009 Winter CME Meeting, February 6-8 at Sugarloaf, Grand Summit Hotel.  Course objective:  To provide participants with a better understanding of a variety of treatent regimens and their associated risks. 

The extensive Program Agenda includes lectures on:

  • Tumor Markers, presented by Thomas Kinkead, MD, Maine Medical Partners, Portland, Maine

  • The Future of LHRH Therapy, presented by Eric Gwynn, MD, Wake Forest University of Medicine

  • PSA Testing -- What have We Learned in the Past 20 Years?, presented by Peter Albertsen, MD, University of Connecticut Health Center

  • Bipolar Treatment for Prostate and Bladder Tumors, presented by Arthur Mourtzinos, MD, Lahey Clinic Medical Center

  • Radiation Therapy for Positive Surgical Margins after Radical Prostatectomy, presented by Glenn Healey, MD, Maine General Medical Center

  • Deposition Preparation Program, presented by Peter Mosseau, Medical Mutual Insurance Company of Maine

  • Domestic Violence Screening Training Workshop for all Physician Specialties, presented by Elizabeth Weiss, MD, Physicians for Social Responsibility

Who should attend?  Urologists, Physician Assistants, Residents and interested medical students.

For more information and to register, contact MUA staff, Kellie Miller at kmiller@mainemed.com or 622-3374, ext. 229.

 

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White Mass Scheduled for February 8th in Lewiston

The Roman Catholic Bishop of Portland cordially invites caregivers and members of the healing professions to the annual White Mass celebrated by Bishop Richard Malone at the Basilica of Saints Peter and Paul in Lewiston on Sunday, February 8, 2009 at 10:00 a.m.  February 11th each year is the World Day for the Sick.  The observance gives the Catholic Church in Maine the opportunity to remember the sick and all those who care for them. [return to top]

U.S. Health Care Spending is Greater than 12 Other Developed Countries

According to a study released by the McKinsey Global Institute on January 16, 2009, the United States spends almost $650 billion per year more than a dozen other developed countries, even adjusting for wealth disparities.  Using data from the Organization for Economic Cooperation and Development (OECD) that adjusts spending on health care to per capita GDP, McKinsey found that the U.S. should have spent approximately $1.4 trillion in 2006 instead of $2.1 trillion.  Outpatient care is responsible for 2/3 of the excess spending according to the report.  The study cited the following factors driving outpatient spending:

  • the judgment-based nature of physician care;
  • technological advances that increase rather than decrease costs;
  • demand growth that seems related to supply; and
  • relatively price-insensitive patients with limited out-of-pocket expenses. 

U.S. health care spending is approximately 16% of GDP.  The U.S. also spends more according to wealth for inpatient care, drugs and nondurables, and health administration and insurance.  The study also found that the U.S. has a lower life expectancy and higher infant mortality rate than the other developed countries in the study.

You can find the study on the web at:  http://www.mckinsey.com/mgi/publications/US_healthcare/index.asp. [return to top]

ICD-10 Transition Delayed Until October 2013

Responding to recommendations by the AMA and other provider and insurer groups, the U.S. DHHS issued a final regulation on January 16, 2009 delaying implementation of the ICD-10 from October 2011 to October 2013.  The agency also issued a related rule updating the standards for certain electronic health care transactions under HIPAA.  The expanded code sets are expected to:

  • support comprehensive quality data reporting;
  • ensure more accurate payments for new procedures, fewer rejected claims, improved disease management, and harmonization of disease monitoring and reporting worldwide; and
  • allow the U.S. to compare its data with international data to track the incidence and spread of disease and treatment outcomes.

You can find a CMS Fact Sheet on ICD-10 on the web at:  http://www.cms.hhs.gov/MLNProducts/downloads/ICD-10factsheet2008.pdf.
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Senators Kohl & Grassley Submit Bill on Drug Firm Disclosure of Payments to Physicians

On January 22, 2009, Senators Herb Kohl (D-WI) and Chuck Grassley (R-IA) introduced the Physician Payment Sunshine Act of 2009, a bill that would require drug, medical device, and biologics companies to report any payments, including CME and research grants, to physicians if they exceed $100 annually.  The bill is similar to legislation submitted in 2007 (S. 2029) but not considered.  The bill is yet another example of the continuing push for greater transparency in health care.  Maine's Representative Sharon Treat (D-Hallowell), Executive Director of the National Legislative Association on Prescription Drug Prices, praised the bill as an improvement on S. 2029 and a benefit for consumers since most states do not have such transparency laws.  Maine enacted legislation on this subject in 2003, P.L. 2003, Chapter 430, An Act to Require Full Disclosure of Prescription Drug Marketing Costs:  http://janus.state.me.us/legis/ros/lom/LOM121st/9Pub401-450.  Massachusetts, Minnesota, Vermont, West Virginia, and the District of Columbia also have similar laws. [return to top]

Advisory Council on Health Systems Development Holds Regular Meeting

On Friday, January 23, 2009, the Advisory Council on Health Systems Development, chaired by Brian Rines, Ph.D., held its regular meeting at the State House.  Physicians Lani Graham, M.D., M.P.H., Maroulla Gleaton, M.D., and Josh Cutler, M.D. serve on the group.  

Members received a final report entitled, A Plan for Improving Rural Health in Maine, a report from the Telemedicine Committee, and a report from a group working on health workforce issues.  The health workforce working group anticipates having a report and recommendations to the Council in December 2009.

Dr. Cutler provided a review of the approach to and progress on the 2008 health care cost driver study and his presentation will be posted on the Maine Quality Forum web site, http://mainequalityforum.gov/.

The group discussed difficulties in collecting race and ethnicity data and ways to address the problem.  They acknowledged that this data is critical to effective cost and quality analysis.  

Members received an update on the Emergency Department Use Workgroup and expect to receive a more formal report from this group in February or March.  The ED group already has discovered that Maine has a 30% higher ED usage rate than other states and that we have particularly high usage by children and young adults.  It is noteworthy that the excess use of emergency room services is uniform across payers, contrary to the conventional wisdom that this is a problem of the uninsured.

Governor's Office of Health Policy & Finance Director Trish Riley provided a state and federal legislative update, mentioning in particular public health infrastructure legislation to be submitted in the state legislature and an overview of the anticipated health care aspects of the federal economic stimulus legislation.

The Council confirmed that it intends to revise the State Health Plan every 3 years, rather than every year, consistent with moving the Capital Investment Fund (CIF) to a 3-year cycle.  The next State Health Plan then should be due in April 2010.

GOHPF's Peter Kraut presented a memo summarizing the Administration's response to public comments on the most recent Capital Investment Fund (CIF) rule from December 2008.  The group spent some time discussing the threshold for distinguishing between large and small projects in the CIF review cycles.

At the next meeting of the Council, members will receive a report from Christine Burke, Chair of the Public Purchasers Working Group. [return to top]

Maine CDC Seeks Public Health Emergency Preparedness Medical Director

The Maine CDC is advertising to hire the Medical Director in the Infectious Disease Division, Public Health Emergency Preparedness.  This person will serve as a member of the Medical Epidemiology Team and provide support to the State Epidemiologist.  He or she will provide consultation to the Infectious Disease (ID) epidemiologists on clinical issues that arise in the area of infectious diseases that have strong public health emergency implications, such as in the investigation of disease reports and outbreaks and in the implementation of disease control measures.  The physician will provide guidance and support to the ID epidemiologists in decision making around disease investigation and control in situations that involve severe disease or large outbreaks.  He or she will provide quality assurance for Program protocols and activities.  The physician will consult with physicians and other health care professionals on disease prevention and control measures and serve as the primary subject matter expert for vector borne diseases, hepatitis B, hospital infections and blood borne pathogens exposure issues and vaccine-preventable diseases as well as enteric and respiratory disease control issues as necessary. The physician will be a liaison between the Division of Infectious Disease and the Office of Public Health Emergency Preparedness as well as a liaison on science and clinically-related issues with the Health and Environmental Testing Lab, provide oversight of arboviral surveillance issues and assist in the development of responses to legislative concerns related to various infectious disease issues.

REQUIREMENTS:  Graduation from an accredited school of Medicine or Osteopathy.  A twelve (12) year combination of post-graduate training and experience in public health, health administration, emergency preparedness, and/or emergency medicine, to include a minimum of four years of related administrative or managerial experience, OR a Masters Degree in Public Health, Health Care Administration, or a related field and six years experience in the field of public health or emergency preparedness, to include a minimum of four years of related administrative or managerial experience.

SPECIAL REQUIREMENT:   Applicants must be eligible for a license to practice medicine in the State of Maine and must be licensed prior to attaining permanent status in the position.

To apply, please send a completed direct hire application, and resume to:

Department of Health and Human Services
221 State St.  Attn: V. Roussel, Human Resources Div.
11 State House Station
Augusta, ME 
04333-0011

The closing date is January 30th, 2009, though this may be extended.  [return to top]

Quality Counts! Part 6, April 17, Augusta Civic Center

Quality Counts! Part 6 (QC6) is the latest in a series of dynamic conferences to promote the transformational changes needed to create dramatic and sustainable improvements in health and healthcare in Maine.

QC6 will build off the success of previous QC conferences and will link with the Aligning Forces for Quality (AF4Q) initiative in Maine to examine a set of bold and ambitious goals for improving health and healthcare in Maine. The conference will provide an opportunity for a diverse set of stakeholders to consider a bold set of statewide quality goals identified through AF4Q, and examine them in the context of our complex healthcare system. Participants will have an opportunity to identify challenges to reaching these goals, and to identify ways to overcome barriers and to create transformative and sustainable change in Maine.

Sign up at  http://www.mcdregistration.org/signup.asp?ID=122

Contact conferences@mcd.org for more information or visit: http://www.mainequalitycounts.org [return to top]

New Bills for Your Review & Comment/Reminder of Legislative Committee Conference Calls

The following are bills printed and referred to committees last week for your review and consideration.

LD 161, An Act To Amend the Special Education, School Health and School Nutrition Laws Regarding Scoliosis Screening, the School Lunch Program, Transitional Services, Gifted and Talented Education Programs and the Maine Mentoring Partnership Grant Program (support; Public Health Committee; pediatricians)

LD 162, An Act To Clarify Child Abuse and Neglect Information Disclosure (monitor; pediatricians)

LD 163, An Act To Require Health Care Practitioners To Distribute Free Samples of Medications in Certain Circumstances (oppose)

LD 177, An Act To Modify the Maine Dental Education Loan Program (monitor)

LD 191, An Act Regarding Insurance Copayments for Short-term Prescriptions (monitor)

LD 206, Resolve, To Fund the Nursing Education Loan Repayment Program (monitor or support)

LD 217, Resolve, To Increase Transparency in the Long-term Care Planning and Delivery Process To Ensure Maine's Elderly Can Make Informed Choices (monitor)

LD 221, An Act To Modify the Laws Regarding Seat Belts (monitor; emergency physicians; Public Health Committee)

LD 228, An Act To Prevent Teenage Substance Abuse and Suicide (monitor or support; psychiatrists)

LD 232, An Act To Require Businesses To Make Toilet Facilities Available to Individuals with Certain Medical Conditions (monitor)

LD 233, An Act To Include Independent Practice Dental Hygienists in MaineCare (monitor or oppose)

LD 234, An Act To Expand Access to Oral Health Care (monitor or oppose)

The next MMA Legislative Committee conference call is scheduled for 9 p.m. on Thursday, January 29, 2009.  The conference call number is 800-989-2842 and the access code is 6223374#.  Everyone should join as "participants."  Any MMA member or specialty society representative is welcome to join the discussion. 

Some members have expressed opinions about the day and/or time of the calls.  We will discuss the scheduling this week and will attempt to meet the needs of most participants in the scheduling of these calls.



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