February 2, 2009

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Legislature Quickly Passes Supplemental Budget

The final bill did not include a 16% cut to Critical Access Hospitals, as proposed by Governor Baldacci.  The bill did reduce hospital-based physician reimbursement from 89% of the Medicare hospital rate to 70% of Medicare as paid in the MaineCare fee schedule.  This cut results in an annualized reduction of about $12 million, less than the $20 million cut originally proposed.  The proposal also includes an increase for physicians paid under the private fee schedule from the current 56% of Mediare to 70% of Medicare effective July 1, 2009.

Part of the rationale for the reduction in provider-based reimbursement was to comply with a pending federal rule that required physicians to be paid the same amount relative to professional fees (hospitals utilizing provider-based reimbursement will still receive an additional facility fee).  However, the proposed Medicaid hospital outpatient rule is one of the proposals subject to a potential moratorium sought by the Obama Administration and included in the federal stimulus package currently being developed.

Because the proposed cuts also were included in the Governor's proposed biennial budget, MHA and MMA will continue to work on this issue to assure that the positive changes in the Supplemental Budget, including the increase in MaineCare fees July 1, 2009, are included in the biennial budget.  The Legislature will begin working on the biennial budget the week of February 9th with public hearings on the HHS portions of the budget scheduled for the week of February 16th.

The Supplemental Budget also included language that makes payments of the hospital settlements for 2005 and 2006 the first priority for funds received in the federal stimulus package for state fiscal year 2009.It is intended also to include similar language in the biennial budget for settlement payments for 2007.  The considerable amount of money still owed by the state to Maine's hospitals for MaineCare patients served in the years 2005-2007 remains a critical issue for the hospitals and there are many legislators who are advocates for getting these past due bills paid.

Physicians for Social Responsibility Hosts Fond Farewell for Peter Wilk, M.D.

The Maine Chapter of the Physicians for Social Responsibility (PSR) hosted a dinner on Friday night, January 30th honoring Peter Wilk, M.D., who is leaving Maine to become Executive Director of the national organization.  The Maine Medical Association was proud to be represented on the host committee and presented Dr. Wilk with an Honorary Lifetime Membership in MMA, recognizing his exemplary leadership of the Maine Chapter of PSR over the past 27 years.  MMA Executive Committee Chair Jo Linder, M.D. and EVP Gordon Smith made the presentation which noted the shared agenda that PSR/Maine and MMA have in the areas of preventing domestic violence and regulating toxins in children's toys.

Dr. Wilk has practiced psychiatry in Portland since 1981.  He is a graduate of Harvard University and received his medical degree from the University of Vermont.

The evening event, held at the Mariner's Church Banquet facility, celebrated the past and future accomplishments of both Dr. Wilk and the Maine Chapter of PSR.  Beginning as a small chapter in 1981, the Maine Chapter of PSR now has a professional staff and more than 200 members. 

Dr. Wilk has been active for the past 27 years in local, national, and international organizations that work to prevent nuclear war and address other global threats to human survival.  He was President of PSR/Maine from 1983 to 1994 and again from 1998 to 2008.  Beyond Maine, Dr. Wilk has served on the national board of directors of PSR for many years and was President in 1995 and 2000.  He has also been involved in International Physicians for the Prevention of Nuclear War, acting as the Co-Vice President for North America from 1996 to 2000 and Speaker of the International Council from 2004 to 2008. 

Dr. Wilk became PSR's Executive Director on February 1, 2009.  MMA wishes him well in his new position. 

The voluntary leadership of PSR/Maine will now be provided by Co-Presidents Lani Graham, M.D., M.P.H. and Daniel Oppenheim, M.D.  The Executive Director is Paul Santomenna.  For more information on the organization, see psrmaine.org

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Plans for 2009 Pathways-to-Excellence (PTE) Program

Primary care physicians recently received a mailing dated January 13, 2009 from the Maine Health Management Coalition (MHMC) detailing changes to the Pathways-to-Excellence Program effective on April 1, 2009. 

In 2007, at the recommendation of the physician, health plan, and employer members of the PTE Steering Committee, the MHMC decided to make the PTE program more consistent with national quality measures, and to transition away from a local recognition program to national recognition programs.  Since that time, primary care practices have been able to achieve PTE "blue ribbon" recognition through either their last submission of clinical data to PTE (in 2007) or through the national recognition programs.

Simultaneously, the MHMC's PTE program has been gearing up for this change and encouraging practices to apply for national recognition using national programs such as Bridges-to-Excellence (BTE) or the National Committee for Quality Assurance (NCQA) Physician Recognition programs.  There are exceptions for pediatric outcomes.

Recognizing that changing fully to national recognition programs will take considerable time and effort from practices, the MHMC has endorsed the PTE Steering Committee's recommendation to continue supporting this transition to national programs in the 2009 PTE program.  In 2009, PTE will award both "blue ribbons" for practices achieving national recognition (BTE or NCQA), and "Maine-specific green ribbons" for practices recognized within the past two years by the MHMC PTE program.  However, 2009 will be the last year of the 3-year period in which PTE blue ribbons obtained from previous (2007) data submissions will be recognized.  Beginning in 2010, adult practices choosing to submit clinical data for PTE recognition will need to use one of the national programs.

PUBLIC REPORTING.  Results from the PTE program will be publicly reported on the internet (www.mhmc.info) and, in some cases, integrated into health plan financial incentive programs and/or employer benefit programs. Historically, several Maine health plans and employers have elected to use PTE data as the basis for their preferred provider networks and/or performance payments to providers.  Initial indications from several of the large employer groups and the four major commercial health plans in Maine suggest that they will recognize both PTE blue ribbons and green ribbons in their 2009 network and performance payment programs.  Providers looking for more specific information on how PTE data will be used in these programs should contact their health plans and employer groups directly.

Over the past several years, more than 300 primary care practices have participated in the PTE program.  For more information, or to receive e-mail updates regarding the PTE program, you may contact Ted Rooney or Sue Butts-Dion at trooney@mhmc.info or sbutts@maine.rr.com respectively. [return to top]

Maine Society of Anesthesiologists Meets February 14-15 at Sugarloaf/USA

The meeting will kick off with an MSA business meeting from 3-6pm on Saturday, followed by a reception and dinner. The keynote this year will be Ron Szabat, JD, LLM, Executive Vice President - External Affairs and General Counsel of the American Society of Anesthesiologists.

Sunday morning's CME presentation will focus on ultrasound and run from 7am -10am.

For more information, or to register, call Anna Bragdon at 207-441-05989 or email msainfo@roadrunner.com [return to top]

Welcome to Pines Health Services, MMA's Newest Group Practice Member

MMA welcomes this week Pines Health Services of Caribou as the newest Group Practice member.  Pines Health Services is affiliated with Cary Medical Center and is structured as a Federally Qualified Health Center.

MMA's group practice program, that provides an enhanced array of services and a group dues discount, is available to any physician practice with ten or more physicians.  In order to be eligible, all the physicians in the group must currently belong to MMA or agree to become members under the group arrangement.  For more information on the program or to discuss your group's eligibility, please contact MMA EVP Gordon Smith, Esq. at 622-3374, ext. 212 or via e-mail to gsmith@mainemed.com. [return to top]

MeHAF Teams up with FAME to Offer Low Interest Loans for EMR

The Maine Health Access Foundation (MeHAF) recently announced that it would offer low interest loans to medical practices to assist primary care practices in purchasing electronic medical record systems.  The loans will be offered through the Finance Authority of Maine (FAME) that already administers several loan programs assisting various business sectors in the state. 

The loans are intended to help practices defray the expense of technology acquisition and the initial loan fund will be established with $750,000 of MeHAF funds.  Practices participating in the CMS EMR demonstration project (administered through the Maine Quality Forum) will be given preference for the loans.

For more information, visit http://www.mehaf.org/mehaf-news-events.aspx.

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MMA's Payor Liaison Committee to Meet with Direct Contract Providers on February 11th

The Association's Payor Liaison Committee, created several years ago to meet periodically with the health plans and to advocate for fairness in health insurance, will meet on February 11th to look at alternatives to health insurance.  The Committee, chaired by Nancy Cummings, M.D., a practicing orthopedic surgeon in Farmington, has invited physicians who are practicing without health plan contracts to attend and discuss their experiences.  Any MMA member is welcome to join us for the meeting which begins with dinner at 6:00 pm.  The meeting itself will begin at 6:30 pm.  The location is the MMA offices in the Frank O. Stred Building in Manchester.

While all are welcome, please let Diane McMahon know if you are attending so that we can be sure to have enough food and materials.  Diane can be reached at 622-3374, ext. 216 or via e-mail to dmcmahon@mainemed.com. [return to top]

Maine CDC Seeks Physician for Infectious Disease Division

The Maine CDC is advertising to hire a physician with strong clinical experience and the ability to learn.  The position will serve in the Infectious Disease Division and provide a link with th Public Health Emergency Preparedness.  This person will serve as a member of the Medical Epidemiology Team that includes 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.  Training in these areas is available to qualified candidates. 

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 February 13th.  [return to top]

Senate Passes SCHIP Reauthorization

The U.S. Senate passed its version of H.R. 2, the Children's Health Insurance Program Reauthorization Act of 2009 on January 29, 2009 by a vote of 66 to 32.  The current authorization for the State Children's Health Insurance Program (SCHIP) expires at the end of March 2009.  The bill reauthorizes the program through Fiscal Year 2013 and is expected to increase SCHIP enrollment by 5.7 million people.  It also provides states with the option of covering pregnant women, as well as legal immigrant children and legal immigrant pregnant women.  The package is offset by an increase in the federal tobacco tax.  The AMA sent a letter to the Senate in support of the bill as reported by the Finance Committee, but expressed opposition to any potential amendments that would add House-passed provisions to restrict physician hospital ownership.

The House passed a similar version of the bill on January 14, 2009 by a vote of 289-139.  That bill included restrictions on physician-owned hospitals.  The two chambers are expected to agree upon a final version of the bill in the near future. [return to top]

House Passes Economic Stimulus Bill; Senate Takes Action

On January 28, 2009, the U.S. House of Representatives passed H.R. 1, the American Recovery and Reinvestment Act, by a vote of 244-188.  This $819 billion economic stimulus package includes $526.5 billion in federal spending and $275 billion in tax provisions.  With respect to health care issues, H.R. 1 makes a $30 billion investment in infrastructure and incentive payments for the development and implementation of a nationwide health care information (HIT) system, provides states with additional Medicaid funding to address budget shortfalls, creates a federal comparative effectiveness research structure, and expands COBRA eligibility and subsidization to address health needs of unemployed individuals and their families.  The bill also includes a long list of public health investments, including $600 million to support the training of primary care providers, $550 million to modernize Indian Health Service facilities, and $50 million for injury prevention and control.

Portions of the Senate's emerging economic stimulus bill were adopted by the Finance and Appropriations Committees on January 27, 2009, by votes of 14 to 9 and 21 to 9, respectively.  The two committee packages will be combined into a single bill that the full Senate is expected to consider during the week of February 2nd.  The House and Senate bills differ slightly in the allocation of spending and tax provisions.  The two chambers hope to agree on a final bill that can be sent to the White House before the President's Day recess begins on February 14th. 

You can find more information about action on health care issues in Washington on the AMA's web site, http://www.ama-assn.org/.


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MIHMS Next Provider Forum, February 5

The next Provider Forum for the Maine Integrated Health Management Solution (MIHMS) will be held on Thursday, February 5 from 9:00 a.m. to 12:00 noon.  This meeting will once again be held in Florian Hall at the Central Maine Commerce Center on Civic Center Drive, Augusta.  The agenda for this Forum will include:

  • An update on Phase 1 – Provider Re-enrollment
  • The process for Pilot Provider Testing and User Acceptance Testing
  • A discussion of the concept and schedule for Phase 2 of the MIHMS project

The Central Maine Commerce Center (CMCC) is located on Civic Center Drive, just past the MaineCare Services office, traveling away from Augusta.  Traveling away from Augusta on Civic Center Drive (north on Routes 8 and 27), turn left into the CMCC campus (Commerce Drive) and proceed to the large office building on the right.  Enter the main entrance to the building and follow the signs to Florian Hall. 

The link to use for Live Meeting, to view the presentation remotely, is below and instructions for using Live Meeting are attached.  A conference call number is listed, as well.  Those participating remotely will need to link to Live Meeting to see the PowerPoint slides and call the conference number to hear the presentation.   Audio will not be streamed in to your computer.

If you have not used live meeting before call in between 8:30 to 8:55 to be sure you can connect before the meeting begins at 9:00 a.m.

The sign-in to the conference will be with your name and organization, e.g., Jane Doe and XYZ Healthcare

Please mute your phone for the entire call.  The Live Meeting instructions include what to do if you have problems connecting.  Once connected, questions for the presenters can be emailed using the Live Meeting screens (this is also included in the instructions).

Join the meeting.

Audio Information:
Conference Call Number:  1-800-394-6604
Participant Passcode:  934057

First Time Users:
To save time before the meeting, check your system to make sure it is ready to use Microsoft Office Live Meeting.

Unable to join the meeting? Follow these steps:

1.       Copy this address and paste it into your web browser:

2.       Copy and paste the required information:
Meeting ID: 55WQK5
Entry Code: N{?N7bM
Location: https://www.livemeeting.com/cc/unisys

If you still cannot enter the meeting, contact support [return to top]

Dr. David Howes Elected Chair of HealthInfoNet Board

The Board of Directors for HealthInfoNet, a Maine nonprofit corporation working to build a statewide health information exchange, has elected David H. Howes, MD, president and CEO of Martin’s Point Health Care, as its new chairman.   HealthInfoNet was founded to construct, test and implement a new statewide system that will provide patients with safer, better coordinated, and more efficient health care through the sharing of vital health information.
Widely recognized for his leadership role in the adoption and use of health information technology systems to improve health care delivery, Dr. Howes has served as a board member of HealthInfoNet since the organization’s inception in January of 2006.   He will serve as chairman during 2009.

Dr. Howes succeeds Chuck Hewett, Ph.D., who has served as HealthInfoNet’s board chair for the past three years. Hewett is Chief Operating Officer of the Jackson Laboratory in Bar Harbor. Hewett will remain on the board of directors as immediate past chair. Other officers elected to new terms on the board include Dan Coffey, Executive Vice President, Eastern Maine Healthcare Systems in Brewer (Vice Chair); Nona Boyink, President of HealthReach Network and MaineGeneral Rehab and Nursing Care in Waterville (Secretary); and Richard “Skip” White, Market Service Leader, Cigna Healthcare of Maine in Falmouth (Treasurer).

Also elected to the HealthInfoNet Board of Directors was Barry Blumenfeld, M.D., Chief Information Officer at MaineHealth in Portland and attorney and state legislator Peter Mills of Somerset County.

During Dr. Howes’ tenure as chairman, health care providers participating in HealthInfoNet are expected to begin using the statewide health information exchange to support patient care. This is part of a two-year demonstration phase that will involve sharing of patient medical information across six Maine health care provider organizations which together care for half of those seeking medical care in Maine each year.  The project is supported by patients, physicians, state government, businesses and insurers. Supporters believe a health information exchange will improve patient safety, improve health outcomes and decrease growth in health care costs.  

Dr. Howes received his medical degree from Dartmouth Medical School in Hanover, NH, and began his medical career as a family physician serving the residents of a fishing community along the Maine coast. He joined Martin's Point in 1989 as Unit Medical Director in Bath and became President and CEO in 1996.  He is Board Certified in Family Practice. [return to top]

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

The following are bills printed and referred to committees last week for your review and consideration.  Please note that clicking on the highlighted "LD XXX" will take you to a PDF version of the bill.

LD 239, An Act To Eliminate the Repeal Date on Nonhospital Expenditures in the Capital Investment Fund (MMA bill; support)

LD 251, An Act To Protect the Safety of Maine Children by Requiring the Express Consent of a Legal Guardian To Dispense Prescription Medication to a Minor (oppose; pediatricians,OB/GYNs, Public Health Committee)

LD 255, An Act To Allow Persons Licensed for the Practice of Manicuring To Provide Treatment for Diabetics (monitor)

LD 257, An Act To Establish the Health Technology Clinical Committee (monitor until review with MQF)

LD 274, An Act To Require That Insurance Contracts Include a Plain Language Summary (monitor or support)

The next MMA Legislative Committee conference call is scheduled for 8:30 p.m. on Thursday, February 5, 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.

We again will discuss the timing of the calls on Thursday evenings.  Last week, members expressed an interest in having the calls a bit earlier than 9 p.m.  We will try to lock in a regular time each week very soon.



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