February 16, 2009

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Political Pulse: Legislative Highlights of the Week

Although the legislature is only in general session two days a week, committee hearings are held five days a week and several bills of interest to physicians were considered last week in various committees.  More hearings are upcoming this week, including continued hearings on the biennial budget.  On Tuesday afternoon, the Joint Standing Committee on Appropriations & Financial Affairs will hear testimony on the MaineCare portion of the Budget and MMA representatives, including President-elect David McDermott, M.D., M.P.H., will oppose cuts to critical access hospitals and provider-based reimbursement.  As an alternative, MMA will advocate for an increase in the private fee schedule which is currently one of the lowest in the country. 

Last week, the Appropriations Committee held its first week of hearings on the Governor's FY 2010-2011 biennial budget, L.D. 353, and it will reach health care and mental health issues this coming week.  On the afternoon of Tuesday, February 17, 2009, MHA and MMA representatives will speak in opposition to proposed cuts to critical access hospitals (approximately $12 million over the biennium) and in hospital-based physician reimbursement (approximately $40 million over the biennium).  On Wednesday, February 18, 2009, the committee will hear testimony on other health care issues, including prescription drug issues.  On Thursday, February 19, 2009, the committee will hear testimony on the Fund for a Healthy Maine and mental health, mental retardation, and substance abuse policy matters.

Last week, the Education & Cultural Affairs Committee held a public hearing on L.D. 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, a bill submitted on behalf of the Administration by the Department of Education.  Maine CDC Director Dora Anne Mills, M.D., M.P.H. participated in development of the legislation.  The MMA and the Maine Chapter of the American Academy of Pediatrics testified in favor of elimination of the scoliosis screening requirement in the schools noting that there is no evidence supporting screening in the school setting rather than the medical home and that school-based health screening resources should be devoted to problems related to learning, such as sight and hearing screening, and our major public health problem today - obesity.  No one opposed this aspect of the bill.

On Monday, February 9, 2009, the Insurance & Financial Services Committee held a public hearing on L.D. 257, An Act to Establish the Health Technology Clinical Committee, a bill directing the Maine Quality Forum to establish a 5-clinical-member committee to make determinations as to which health technologies and health care services will be included as covered benefits in publicly funded health care plans.  The MMA, MHA, and most of the state's health insurers opposed the bill.  The Governor's Office of Health Policy & Finance and Consumers for Affordable Health Care spoke "neither for nor against" the bill.  The opposition was based not on the concept of the bill, endorsing "comparative effectiveness research," but on a concern about the adequacy of resources to do this work well at the state level and about duplication of national efforts such as those being pursued by the AHRQ.

The Health & Human Services Committee held a public hearing on a second bill about smoking on public beaches, L.D. 155, An Act to Ban Smoking on Public Beaches and in Public Parks.  L.D. 155 is broader in application than L.D. 67, An Act to Protect Beaches in Maine's State Parks in that it would apply to many other beaches to which the public is invited, such as municipal beaches.  The Maine Municipal Association testified in opposition to L.D. 155, citing concerns about municipalities' enforcement abilities.  At a work session on Wednesday, February 11, 2009, the committee voted unanimously in favor of L.D. 67, but killed L.D. 155.  The committee will, however, send a letter to the Maine Municipal Association urging its members to consider similar ordinances.

The HHS Committee also considered and rejected L.D. 163, An Act to Require Health Care Practitioners to Distribute Free Samples of Medications in Certain Circumstances.  At the public hearing, only the sponsor, Rep. Paulette Beaudoin (D-Biddeford) spoke in favor of the bill.  The MMA and Anthem opposed it.  At the work session, the committee's 2 physicians, Rep. Linda Sanborn, M.D. (D-Gorham) and Sen. Lisa Marrache, M.D. (D-Kennebec) both spoke quite forcefully against the bill.  The committee unanimously voted "ought not to pass" on the bill.

Finally, the Business, Research & Economic Development Committee unanimously endorsed passage of 2 bills supported by the MMA the week before:  L.D. 89, An Act to Amend the Laws Concerning Informal Conferences as Part of the Board of Licensure in Medicine's Disciplinary Proceedings and L.D. 94, An Act to Authorize the State Board of Nursing to Request Mental and Physical Examinations and to Establish a Nurse Health Program.

2009 MHA Small or Rural Hospital Conference Looks at Medical Staff Models

Nearly two hundred hospital CEO's, physicians, nurse leaders, and quality improvement professionals met this past week for the 2009 Maine Hospital Association Small or Rural Hospital Conference at Sunday River.  Over the years, the conference has become a "must attend" event for many persons involved in health care in Maine.

On Thursday morning, Kenneth H. Cohn, M.D., MBA., FACS presented various models of medical staff structure.  Dr. Cohn is a practicing surgeon and serves as President of Healthcarecollaboration.com in Natick, MA.  He is also a consultant to the Cambridge Management Group. 

After presenting several different models of medical staff structure, Dr. Cohn reviewed current challenges to hospital administrators and physicians working together.  Noting that improving communications and building trust were critical, Dr. Cohn presented the following conclusions:

  • Physicians and hospital leaders display different perspectives as a result of their training and outlook;

  • The pace of change and the need to balance the interests of different stakeholders make conflict inevitable;

  • Both groups have influence but not control of each other's behavior; and

  • The journey to "alignment" begins with engagement.

Other topics presented during the two-day meeting included physician recruitment and retention strategies, the challenge of chronic care management, the Wall Street financial crisis and its impact on hospitals and health systems, and eliminating waste in the system. [return to top]

President Obama Plans to Sign Economic Stimulus Bill Tomorrow

Tomorrow, President Obama is scheduled to sign the $787 billion economic stimulus bill worked out during a brief House/Senate conference committee last week.  On Tuesday, February 10, 2009, the U.S. Senate passed its version of the economic stimulus bill, H.R. 1, the American Recovery and Reinvestment Act of 2009, by a vote of 61-37.  Maine's two Senators and Senator Arlen Specter (R-PA) were the only Republicans to vote for the bill.  The House approved its version of the bill by a vote of 246-183 with no Republican votes.  The final bill includes $87 billion in additional Medicaid money for the states and $19 billion for health information technology.

You can find additional summary information and analysis of the House and Senate versions of the bills on the web at:  http://www.ama-assn.org/ama/no-index/news-events/senate-passes-economic.shtm.  The AMA site also has a link to a document clarifying the health information technology (HIT) and comparative effectiveness research (CER) provisions of H.R. 1 and addressing concerns raised by former New York Lieutenant Governor Betsy McCaughey in a commentary issued through the Bloomberg news service on February 9, 2009. [return to top]

D.C. Circuit Court of Appeals Rules in Favor of Physician Privacy in Consumers' Checkbook Case

On January 30, 2009, the U.S. Court of Appeals for the D.C. Circuit ruled in favor of physician privacy in a request for physician claims data by a consumer group under the Freedom of Information Act (FOIA) request.  Consumers' Checkbook, Center for the Study of Services v. HHS, D.C. Circuit No. 07-5343.  Consumers' Checkbook had pursued the data to become the basis for "measures of physician experience, quality, and efficiency."  The court majority found no public interest in disclosure of the data and found physicians to have a significant privacy interest in non-disclosure.  You can read the AMA's press statement on the decision on the web at:  http://www.ama-assn.org/ama/no-index/news-events/privacy-court-case.shtm. [return to top]

Maine Judiciary Publishes Civil Court Rule 80M, Medical Malpractice Screening Panel Procedures

On January 13, 2009, the Maine Judiciary published Maine Rule of Civil Procedure 80M, Medical Malpractice Screening Panel Procedures to be effective February 1, 2009.  A Medical Malpractice Subcommittee of the Maine Civil Rules Advisory Committee composed of two Superior Court Justices and seven lawyers representing both the plaintiff and defense perspectives drafted the rule.  The new rule, Advisory Committee's Note, and Report of the Medical Malpractice Subcommittee are worth reading and may be found on the web at: http://www.courts.state.me.us/rules_forms_fees/rules/MRCivP80MAmend1-09.pdf.

 The MMA hopes that the new rule will improve the panel system for all participants. [return to top]

MMA Looking for a Physician Member of the Maine Health Data Organization (MHDO)

As announced a few weeks ago, MMA and the Maine Health Data Organization (MHDO) are looking for a physician to serve on the Board of the MHDO.  The term for existing Board member Sydney Sewall, M.D., M.P.H. has expired and while Dr. Sewall has graciously agreed to serve until an a new physician is appointed, it is important to have a new member soon.  The MHDO Board meets six times a year on a Thursday morning at its offices in Augusta.

The MHDO was established in the mid-1990's to be the custodian of the hospital discharge data set when the Maine Health Care Finance Commission was abolished.  It now also is the repository of the all-payor claims data set which it manages through the Maine Health Data Processing Center, a joint project with the Maine Health Information Center.

Any physician interested in the position should contact Gordon Smith, Esq., MMA's Executive Vice President at 622-3374, ext. 212 or via e-mail to gsmith@mainemed.com. [return to top]

DHHS Proposes Permanent Rule on Fee Increase Authorized by 123rd Maine Legislature

The Department has proposed amendments to the MaineCare Benefits Manual, Chapter II, Section 90, Physician Services, Section 55, Laboratory Services, Section 75, Vision Services, Section 95, Podiatry Services, and Section 101, Medical Imaging.

The Department proposes an increase in the MaineCare reimbursement rate for non-hospital based physician services from 53% to 56.94% of the Medicare rate as of July 1, 2008.  This rulemaking permanently adopts an emergency rule currently in effect.  Furthermore, the Department is proposing to remove some prior authorization requirements for services including, but not limited to hyperbaric oxygen therapy, cochlear implants, circumcision, septoplasty, and skin tag removal.

Finally, the Department is proposing changes to Sections 55, 75, 95, and 101 to amend language under the reimbursement sections of these areas of policy to clarify that the increase mentioned above does not apply to these services.  MaineCare will reimburse the lowest of 53% of 2005 Medicare rates, the provider's UCR, or the allowed amount of the Medicare Part B carrier for these services.  Providers can visit the Office of MaineCare Services' website for a list of MaineCare covered services and rates.  This proposed rule change clarifies what the current rate is; the rate is not being decreased.

The Department is holding a public hearing on the proposed amendments at 1 p.m. on Wednesday, February 25, 2009 in Conference Rooms 1A/1B at the DHHS office at 442 Civic Center Drive, Augusta, Maine.  You can find the proposed rules, background information, and contact information for comments on the web at:  http://www.maine.gov/bms/rules/proposed.html. [return to top]

Maine PCMH Pilot - Practice Applications Due February 28

Reminder that the Maine Patient Centered Medical Home (PCMH) Pilot has launched a call for applications from primary care practices interested in applying for participation in the Pilot.   Please note that the deadline for practices to complete their applications is February 28, 2009

Please see additional information below, including specific steps for interested practices:

Application Process - Interested practice sites are asked to complete the following steps in sequence by February 28, 2009:

1.    Review the “Maine PCMH Pilot – Background & Application Process” summary available in the “Resource Library” section of the Quality Counts website at www.mainequalitycounts.org.  This document outlines the details of the application process, including eligibility criteria and timeline.

2.    Complete the TransforMED “Medical Home IQ” (MHIQ) online practice assessment, available online at: http://www.transformed.com/MHIQ

3.    Contact Maine PCMH Pilot project staff to register intent to apply; contact Dr. Lisa Letourneau at tel. 415.4043, or Letourneau.lisa@gmail.com.

4.     Complete the Maine PCMH Pilot Application for Participation – available online http://www.surveymonkey.com/s.aspx?sm=mF9e1z_2bssYQ6ucmIZzVLwg_3d_3d

5.    Complete and return a printed, signed copy of the Maine PCMH Pilot Memorandum of Agreement, available under the “Resource Library” section of the Quality Counts website, www.mainequalitycounts.org. [return to top]

Autism: Bridging the Gap Between Knowledge and Practice for Clinicians

Are you a health care professional who is confused by all the information swirling around you about Autism?  Are you challenged by the struggles and frustrations that children with autism and their parents bring to you?  We encourage you to consider attending a one-day conference sponsored by the Maine CDC/DHHS on Autism on Tuesday May 12th at the Augusta Civic Center.  Co-sponsored by the Maine Medical Association, the Maine Osteopathic Association, the Maine Chapter of the American Academy of Pediatrics, Maine Emergency Medical Services, Downeast Association of Physician Assistants, and the Autism Society of Maine, we are applying for 7.0 hours of CMEs/CEUs for physicians, nurses, nurse practitioners, physician assistants, and EMS providers.  

This conference features a cadre of Maine’s developmental pediatricians and several nationally-known speakers.  Developmental pediatricians Victoria Dalzell, MD, from MMC, Mary Ellen Gellerstedt, MD, from EMMC, Carol Hubbard, MD, from MMC and immediate past president of the Maine Chapter of AAP Don Burgess, MD, will start the day with an Autism 101 from a medical standpoint.  Tim Buie, MD, pediatric gastroenterologist from Massachusetts General Hospital and Harvard Medical School will review medical co-morbidities, including the role of diet and supplements.  Martha Herbert, MD, PhD pediatric neurologist from Massachusetts General Hospital and Harvard Medical School will review genetic and environmental theories on the causes of autism.  Jon Poling, MD, PhD, adult neurologist from Georgia, whose daughter with autism made national news last year when her parents successfully sued the US DHHS for compensation under the Vaccine Injury Compensation Program, will share his views about vaccines and autism.  All keynotes will include a question and answer session with the audience. 

Are you interested in the conference but can’t make it?  It will be available as a webcast a few days after the conference, and we will be making some DVDs available to parent groups.  

Online Registration, a full conference brochure is available at both the following websites:  Maine CDC’s homepage www.mainepublichealth.gov (upper right hand corner under “Hot Topics”)

 Autism:  Bridging the Gap Between Knowledge and Practice for Clinicians Conference site: http://www.maine.gov/dhhs/boh/autism_conference_5_12_09.shtml [return to top]

Save the Date! Oct. 18-20: 2009 Symposium on Pharmaceuticals in the Home & Environment

Reserve Time on Your Calendar Now to Attend the Premiere Conference on Prescription Drug Use, Abuse, Return, and Disposal 

Sunday-Tuesday, October 18-20, 2009
2009 International Symposium on Pharmaceuticals in the Home & Environment*
Point Lookout Resort and Conference Center, Northport, Maine

  • Meet with the leading authorities on prescription drug use, abuse, return and disposal
  • Attend cutting edge educational symposia and panel sessions
  • Build your skills at expert-led, pre-conference technical assistance and program design workshops
  • Participate in lively specialized topic interest group discussions
  • Enjoy the special networking opportunities, exhibits, and annual film festival

And do it all at one of the most beautiful conference and retreat venues in the United States on the coast of Maine!

Call for presentation proposals, films, and exhibitors coming soon!

*Formerly the Annual Maine Benzodiazepine Study Group Conference and the Annual Unused Drug Return Conference

FOR A SAVE-THE-DATE POSTER ANNOUNCING THE CONFERENCE SUITABLE FOR  POSTING PLEASE GO TO: http://www.umaine.edu/mainecenteronaging/documents/2009MBSGSavetheDatefinal.pdf


For more information contact:

Maine Benzodiazepine Study Group & Drug Disposal Group
University of Maine Center on Aging
mbsg@mainebenzo.org [return to top]

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

The following are bills of interest to the physician community 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 405, An Act To Reevaluate the Scope of Coverage for the Childless Adult Waiver Program (monitor or support)

LD 408, An Act To Clarify the Term of a Retail Tobacco License (Public Health Committee; monitor)

LD 419, Resolve, To Increase Access to Dental Care in Rural Areas through Encouraging Distance Learning for Dental Hygienist Training (monitor)

LD 421, An Act To Amend the Laws Concerning Licensure Qualifications of Independent Practice Dental Hygienists (monitor)

LD 423, An Act To Provide a Safe Sleeping Environment for Children with Disabilities To Enable Them To Remain in Their Homes (pediatricians; monitor)

LD 424, Resolve, Directing the Department of Education and the Department of Health and Human Services To Adopt Rules Requiring a Tetanus, Diphtheria and Pertussis Booster Vaccination in School-age Children (pediatricians; support)

LD 425, An Act To Require Private Insurance Coverage for Certain Services for Children with Disabilities (pediatricians; monitor)

LD 427, An Act To Require School Bus Drivers and School Bus Attendants To Report Suspected Child Abuse (pediatricians; monitor)

LD 428, An Act To Amend the Intestate Succession and Wills Laws Concerning Wrongful Death (monitor or oppose)

LD 437, An Act To Require a Person under 18 Years of Age To Wear a Helmet While on a Motorcycle (emergency physicians' bill; Public Health Committee; support)

LD 453, An Act To Require Motorcyclists To Wear Helmets (Public Health Committee; monitor)

LD 462, An Act To Amend the Retail Tobacco and Liquor Licensing Laws (Public Health Committee; monitor)

LD 478, An Act To Add 2 Mental Health Advocates to the State Board of Corrections (psychiatrists; support)

The next MMA Legislative Committee conference call is scheduled for 8:30 p.m. on Thursday, February 19, 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 of bills listed above and other legislative highlights.
[return to top]

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