March 23, 2009

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Political Pulse: Hospital Payment Issues & Other Legislative Highlights of the Week

On Tuesday, March 17, 2009, Governor Baldacci held a press conference to announce payments of $373.7 million to Maine hospitals to cover past due MaineCare settlements.  On Thursday, March 19, 2009, the HHS Committee presented its biennial budget report and recommendations to the Appropriations Committee including several cuts in hospital reimbursement and an increase in the MaineCare fee schedule for private practitioners from 57% to 70% of Medicare rates.  Also, the Transportation Committee voted 11-2 in favor of a bill submitted on behalf of the Maine Chapter of the American College of Emergency Physicians (ACEP) to require individuals under age 18 to wear a helmet as a rider or passenger on a motorcycle.


Hospital reimbursement issues were prominent in the State House news last week.  In a press conference on Tuesday, the Governor announced plans to pay Maine hospitals $373.7 million in state and federal dollars in 2009 and 2010 to address past due MaineCare settlements.  While this has been portrayed by some legislators as a "windfall" to hospitals, it is payment for services to MaineCare beneficiaries for at least four years in the past.  You can read  the Governor's press statement about this matter on the web at:

While this news was positive for Maine hospitals, the HHS Committee report to the Appropriations on two key issues in the FY 2010-2011 biennial budget (L.D. 353) was not good news for Maine hospitals.  The Governor had proposed a $9.1 million General Fund cut in hospital reimbursement ($2.1 million in reducing critical access hospital reimbursement from 117% to 101% of cost and $7 million in reducing reimbursement for hospital-based physicians) in his biennial budget proposal.  Based upon a decision made in the supplemental budget (L.D. 45), the HHS Committee seemed inclined to continue a revenue neutral policy decision to shift some money from hospital-based practices to the MaineCare fee schedule for private practitioners such that both groups would be reimbursed at approximately 70% of Medicare rates.  In order to do this, however, the HHS Committee would have to find at least $7 million in General Fund savings.  A bipartisan subcommittee composed of HHS House Chair Anne Perry (D-Calais), Rep. Sarah Lewin(R-Eliot), Rep. Pat Jones (D-Mt. Vernon), Rep. Linda Sanborn (D-Gorham), Sen. Lisa Marrache, M.D. (D-Kennebec), Sen. Peter Mills (R-Somerset) discussed these policy issues at length during the past two weeks and developed the following proposal in place of the Governor's recommendations which was incorporated in the Committee's report to the Appropriations Committee on Thursday, March 19, 2009.

  • Reduce the reimbursement rate for critical access hospitals to 106% of MaineCare allowable costs to save $2.1 million in the General Fund in each year of the biennium;
  • Reimburse hospital emergency room physician services at 70% of Medicare rates to save $2 million in the General Fund in each year of the biennium; 
  • Reimburse hospital physicians and other professionals for inpatient services at 70% of Medicare rates.  In conjunction with this, continue reimbursement of hospital-based physicians and other professionals for outpatient services at 70% of Medicare and begin reimbursement of non-hospital-based physicians at 70% of Medicare rates as stated in P.L. 2009, Chapter 1.  This saves $2.9 million in the General Fund in each year of the biennium.
  • Rebase the hospital tax to 2007 to achieve a net revenue increase of $3.6 million in each year of the biennium; and
  • Invest in a program of quality incentives in conjunction with the Maine Quality Forum that will provide financial rewards to hospitals for evidence-based practices that increase the quality of patient care and safety, reduce unnecessary hospital admissions and inappropriate patient use of the emergency department, and reward high quality, cost-effective patient-centered care.

The HHS Committee proposed savings from these initiatives yields an additional $1.5 million for the quality incentives mentioned in the last bullet above.  This could result in an additional $4.5 million per year in federal matching funds.

The Appropriations Committee continues work sessions on the biennial budget this week.


Last Thursday afternoon, the Transportation Committee held work sessions on the two motorcycle helmet bills heard the week before:  L.D. 437, An Act to Require a Person Under 18 Years of Age to Wear a Helmet While on a Motorcycle and L.D. 453, An Act to Require Motorcyclists to Wear Helmets.  The Committee voted by an 11-2 margin in favor of enactment of L.D. 437, a bill submitted on behalf of the Maine Chapter of the American College of Emergency Physicians (ACEP).  The Committee voted by a similar margin to kill L.D. 453.


At a work session last week, the Insurance & Financial Services Committee unanimously voted to reject L.D. 255, An Act to Allow Persons Licensed for the Practice of Manicuring to Provide Treatment for Diabetics and L.D. 782, An Act to Require Health Insurers to Provide Coverage for Nutritional Wellness and Prevention Measures and Products.




April 3rd HIPAA Update to Include New Provisions in ARRA

The House of Representatives and United States Senate passed the American Recovery and Reinvestment Act of 2009 (ARRA) on Feb. 13th and President Obama signed the bill on Feb. 17, 2009.  This federal Stimulus bill contains a number of important changes to the HIPAA laws regarding privacy of patient medical information.  These changes will be highlighted at the MMA's Annual HIPAA Update program on Friday morning, April 3rd from 9:00am to noon at the Association's offices in the Frank O. Stred Building in Manchester.  A $60 registration fee covers the cost of breakfast and all materials.  Three hours of category one CME are available for physicians and each office manager will receive a certificate of HIPAA training.  The faculty includes Gordon Smith, Esq., Kenneth Lehman, Esq. and John Coolong of Systems Engineering.

Registration is available through the MMA website at or by calling Maureen Elwell at 622-3374 ext. 219. [return to top]

Parkinson Disease Latest AMA Therapeutic Insights Online Program Topic

The American Medical Association announces the release of Management of Early Parkinson Disease, the latest AMA Therapeutic Insights newsletter.  


Take a quick look!  View one-page overview of the Parkinson newsletter.


Maine physicians can access their FREE Personal Prescribing Profile showing their individual prescribing patterns for Parkinson Disease alongside state, national and specialty prescribing patterns for the condition. Just select the Maine newsletter and click Personal Prescribing Profile.  


AMA Therapeutic Insights

□        is free and online

□        highlights one disease condition per issue

□        features individual, state and national prescribing data* and evidence-based treatment guidelines

□        is written by top disease experts in collaboration with the AMA

□        offers AMA PRA category 1 creditTM


While most treatment-oriented CME programs focus solely on disease management, AMA Therapeutic Insights takes it one step further. This program delivers the actual prescribing patterns for the disease. Never before have physicians been able to see exactly which medications are being prescribed for the featured conditions.


Visit AMA Therapeutic Insights to read this issue, as well as previous newsletters covering BPH (enlarged prostate) pediatric asthma and overactive bladder.


*The prescribing data in AMA Therapeutic Insights are provided by IMS Health. The AMA does not collect or have access to physician prescribing data in any form.

The AMA is accredited by the ACCME to provide continuing medical education for physicians. [return to top]

SAVE THE DATE: Quality Counts 6, April 17

Mark your calendars and plan to join us for Quality Counts 6 on Friday, April 17 at the Augusta Civic Center, "Raising the Bar: Crossing the Chasm to Achieve Breakthrough Improvements in Maine". This annual QC conference is a great opportunity to learn from state and national experts, and this year’s conference offers a particularly extraordinary opportunity as (in addition to Maine’s own Dr. Erik Steele), it features both Janet Corrigan, CEO of the National Quality Forum (NQF), introducing a set of national priorities for improvement, and Paul Plsek, author of Appendix B of the IOM’s "Crossing the Quality Chasm", as well as several Maine providers sharing their stories of quality improvement best practices from across the state (click here for conference brochure).

We look forward to hearing more regarding the NQF’s National Priorities Partnership, which establishes consensus around six major aims for the health care system ( These aims include:

PATIENT AND FAMILY ENGAGEMENT: Engage patients and families in managing their health and making decisions about their care.

POPULATION HEALTH: Improve the health of the population.

SAFETY: Improve the safety and reliability of America’s healthcare system.

CARE COORDINATION: Ensure patients receive well-coordinated care within and across all healthcare organizations, settings, and levels of care.

PALLIATIVE AND END-OF-LIFE CARE: Guarantee appropriate and compassionate care for patients with life-limiting illnesses.

OVERUSE: Eliminate overuse while ensuring the delivery of appropriate care.

With the Augusta Civic Center reserved for April 17th, we will have the capacity to again host 300+ participants. We are looking forward to reaching out and connecting again with physicians, nurses, practice managers, health educators, community health professionals, mental health professionals, benefit managers, payors and policymakers who will attend this conference.

Go Paper-Free! Register online at:

You can help participate in making dramatic improvements in quality and costs in Maine’s health care delivery system! Please join us and be a part of what will be a significant and valuable step towards improving health and healthcare in Maine. [return to top]

Maine MGMA Presents "Faced with a Difficult Conversation? Be Prepared!" and "De-stress with Humor"

Maine MGMA presents a half-day educational session, Wednesday, April 8, 2009, 8am- 12pm at the MMA headquarters in Manchester. There will be two presentations:

Faced with a Difficult Conversation? Be Prepared!- By Nicole Morin-Scribner, MBA, SPHR

Nicole Morin-Scribner, MBA, SPHR has been the Director of Human Resources at St. Mary’s Health System since 1997. She has over 20 years of experience in HR and has achieved Senior Professional in Human Resources certification. Nicole has served in a number of HR leadership positions including President of the Maine Society for Healthcare Human Resources and is currently on the national board of directors for the American Society for Healthcare Human Resources. Nicole has published articles and made presentations on HR topics at the state, regional and national level.

Do you ever find yourself dreading the need to have a difficult conversation with a challenging a non-compliant provider for example? This session will let you try out a tool you that will help you be better prepared. Might not make it easy, but it will help you feel more in control and improve your ability to achieve a more productive and desired outcome.

De-Stress with Humor- By Sue Poulin

Sue Poulin was a professor of Social Sciences for 16 years and College Administrator for 2 years. She has an undergraduate degree in Psychology and a Graduate degree in Adult Education. Sue also was the Staff Development Specialist in the Education and Training Services Department at St. Mary’s Regional Medical Center from 1995 to July of 2008. Sue completed one unit of CPE (clinical pastoral education), also obtained her LSW license in order to expand her experiences into the area of social work, and has recently returned to an academic setting and is now a faculty member at the Central Maine Medical Center College of Nursing and Health Professions. Sue is also on the Distance Education faculty at St. Joseph’s College in North Windham Maine and she has developed 3 study guides in Education and Training for the General and Professional Studies Program at the college.

This interactive session helps all of us re-visit the importance of laughter and play in our lives. Laughter breeds health, creativity and above all more laughter! Let’s prove to ourselves that, no matter what IT is, IT can be fun. Researchers tell us over and over again that laughter is the best (and cheapest) form of medicine. We’ll talk about the physical, mental and emotional benefits of having a ‘sunny’ disposition and being able to look at the ‘lighter side’ of life. Promise yourself you’ll at least try it...for the ‘health’ of it!

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

Mark Your Calender for 18th Annual Practice Education Seminar June 3, 2009

MMA's popular practice education seminar (formerly called the "Physician Survival Seminar") will be held at the Augusta Civic Center on Wednesday, June 3, 2009 from 8:30 am to 3:00 pm.  The Annual Seminar is intended to inform physicians and practice managers of the major new laws and market trends affecting Maine medicine.  This year's program focuses on health care reform, technology, and compliance issues, as well as some of the hottest topics from around the state's healthcare community.

Watch your mailbox in April for a flyer containing the full agenda and faculty information or check the MMA website at for updates.  You may also call Maureen Elwell at MMA at 622-3374 ext. 219 or via e-mail to to reserve a space for yourself or for others from your office. [return to top]

Annual MMA Golf Tournament on June 22 to Benefit Medical Professionals Health Program

MMA will hold its Annual golf tournament on Monday, June 22, at the Augusta Country Club in Manchester.  A traditional scramble format will be followed with a shot-gun start at noon.  Net proceeds from this year's tournament will be contributed to the Medical Professional's Health Program.

A flyer with registration information will be mailed shortly to all previous players and corporate affiliates.  If you would like to receive registration materials, or if your firm or company is interested in sponsoring a hole in the tournamnet, please contact Gail Begin at MMA at 622-3374 ext. 210 or via e-mail to [return to top]

Obama Administration Announces National Coordinator for Health IT

On March 20, 2009, the Obama Administration announced David Blumenthal, M.D. as its National Coordinator for Health Information Technology at DHHS.  Dr. Blumenthal is a Massachusetts physician who has served as Director of the Institute for Health Policy at the Massachusetts General Hospital/Partners Health Care System, as a professor of medicine and health care policy at Harvard Medical School, and as a Senior Vice President at Brigham & Women's Hospital and Executive Director of the Center for Health Policy & Management and a lecturer at the John F. Kennedy School of Government.  Dr. Blumenthal will have the responsibility to carry out the implementation of the health IT provisions of the American Recovery & Reinvestment Act. [return to top]

Obama Administration Announces New Leadership at FDA

On March 14, 2009, the Obama Administration announced the appointment of Margaret Hamburg as the Commissioner of the Food & Drug Administration (FDA) and of Joshua Sharfstein as her principal deputy.  Dr. Hamburg was the Nuclear Threat Initiative's first vice president for its biological program and prior to this role, she was an assistant secretary for planning and evaluation at DHHS.  She served as New York City's health commissioner for 6 years and as assistant director of the National Institute of Allergy & Infectious Diseases of the NIH.  Dr. Sharfstein currently is the health commissioner for the city of Baltimore and he previously served as a staff member for Rep. Henry Waxman (D-CA).  Both nominees have strong public health credentials and appear to have support from the industry and on Capitol Hill. [return to top]

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

The following are bills of interest to the physician community printed and referred to committees last week for your review and comment.  Please note that clicking on the highlighted "LD XXX" will take you to a PDF version of the bill.  For each bill, MMA Deputy EVP Andrew MacLean has proposed a position and any MMA committee or specialty society that might have a particular interest in the bill.  You are welcome to provide feedback about any of the bills and the proposed position by participating in the weekly conference call or by contacting Andy at or 622-3374, ext. 214.

LD 1020,  An Act To End Discrimination in Civil Marriage and Affirm Religious Freedom (monitor or support)

LD 1027, Resolve, Directing the Department of Education To Include the Study of Family and Consumer Science in the System of Learning Results (pediatricians, Public Health Committee, monitor)

LD 1038, An Act Regarding the Prevention and Reporting of Methicillin-resistant Staphylococcus Aureus (Public Health Committee; conference call with MHA scheduled this week; monitor)

LD 1039, An Act Concerning Advanced Directives To Give Effect to a Person's End-of-life Health Care Decisions (monitor or support)

LD 1040, An Act Relating to Health Benefit Plan Coverage of Chemotherapy (support)

LD 1042, An Act To Continue To Reduce Mercury Use and Emissions (Public Health Committee; monitor)

LD 1050, An Act To Establish a Waiting Period for MaineCare Participants (pediatricians; monitor)

LD 1055, An Act To Alter MaineCare Benefits as Allowed by the Federal Deficit Reduction Act of 2005 (pediatricians; oppose)

LD 1057, An Act To Require Hospitals To Make Publicly Available the Cost of Medical Procedures (monitor)

LD 1067, Resolve, To Establish a Blue Ribbon Commission To Study Methods of Protecting Emergency Medical Services Personnel during the Transportation of Persons with Mental Illness (emergency physicians; monitor)

LD 1070, Resolve, Directing the University of Maine at Orono To Conduct a Pilot Project Regarding the Benefits of Medical Marijuana (monitor)

LD 1071, An Act To Add a Member to the Advisory Council on Health Systems Development (Public Health Committee; monitor or support)

LD 1073, An Act To Provide for Insurance Coverage of Telemedicine Services (psychiatrists; support)

LD 1076, An Act To Create a Statewide Training and Protocol for Responding to Mental Health Crises (emergency physicians; monitor)

LD 1084, Resolve, To Improve Continuity of Coverage for Participants in Medicare Advantage Plans (monitor)

LD 1086, Resolve, Directing the Department of Health and Human Services To Implement an Oral Health Capitated Care System for Children Covered by MaineCare and the Children's Health Insurance Program (pediatricians; Public Health Committee; monitor or support)

LD 1088, An Act To Modernize the Tax Laws and Provide over $75,000,000 to Residents of the State in Tax Relief (plastic surgeons; monitor)

The next MMA Legislative Committee conference call is scheduled for 8:30 p.m. on Thursday, March 26, 2009.  The conference call number is 800-989-2842 and the access code is 6223374#.  Any MMA member or specialty society representative is welcome to join the discussion of bills listed above and other legislative highlights.
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