AMA & Other Health Care Groups Meet with President Obama to Discuss Health Care Reform
This morning, James Rohack, M.D., President-elect, and Rebecca Patchin, M.D., Chair-elect, represented the AMA at a meeting with President Obama, DHHS Secretary Sebelius, and other senior Administration officials at the White House. The other organizations participating in the meeting included the American Hospital Association, America's Health Insurance Plans, Advanced Medical Technology Association, Pharmaceutical Research & Manufacturers of America, and the Service Employees International Union.
This coalition agrees on the need for health reform that provides coverage and high quality, affordable health care for all Americans, but recognizes that this goal cannot be attained without curbing the rate of growth in health care spending. During the meeting, participants committed to the President to work together to help reduce annual health care spending growth by 1.5% or $2 trillion over a ten year period.
The AMA discussed the role that defensive medicine continues to play in rising health care costs and the need for medical liability reforms. The AMA representatives also mentioned an initiative to address medication reconciliation and efforts underway by the Physician Consortium for Performance Improvement to develop measures to address inappropriate utilization and hospital readmissions, as well as efforts by specialty societies to develop appropriateness criteria.
Obama Budget Includes $311 Billion Over 10 Years for Medicare Physician Payment
In his proposed FY 2010 budget formally released on May 7, 2009, the President includes $311 billion over 10 years, a figure apparently based upon Congress' spending on the SGR problem in recent years. The White House acknowledged that the payment system needs to be reformed, saying it would support "comprehensive, but fiscally responsible, reforms to this payment policy." On the same day, the Congressional Budget Office (CBO) released an analysis of options to fix the SGR problem that shows just how difficult the payment fix is. CBO estimated that a zero percent annual update from 2010-2019 would cost $285 billion, while a 1% annual increase over this period would cost $333 billion. Congress is expected once again to intervene to avoid a 21% cut in Medicare reimbursement for physicians under the SGR effective January 1, 2010, but a long-term fix still seems difficult to achieve.
In a policy paper released April 28, 2009, Senate Finance Chairman Max Baucus (D-MT) and ranking member Chuck Grassley (R-IA) discussed two ways they are considering to cancel the 21% cut. One option would be to update the fee schedule by !% in 2010 and 2011 and freeze it in 2012. Payments would then return to current law in 2013. The other option would follow the same update schedule for 2010-2012 as under the first option, but when the update calculation reverted to the SGR for 2012, there would be a floor of -3%. The Senate Finance Committee continues to explore options to address the Medicare physician payment issues. [return to top]
Maine CDC Director Provides Overview of the State’s Public Health Response to H1N1 & On-going Efforts
First, the Maine CDC received a notice from U.S. CDC two weeks ago Thursday, April 23rd about an urgent US CDC-conducted conference call on a novel virus they had detected in southern California, southern Texas, and in Mexico. After the phone call, we convened a team at Maine CDC to operationalize our pandemic influenza plan. Staff worked hard that first weekend to set things up, including some specific actions such as posting a website on H1N1 on Friday, issuing a health advisory on Saturday, and mobilizing additional staff. Monday morning April 27th staff implemented our incident command system with the main goal of minimizing H1N1’s impact in Maine.
From the beginning, a large number of Maine CDC staff have worked hard together to accomplish a great deal. Our laboratory (HETL=Health and Environmental Testing Laboratory) identified the first cases of H1N1 on Wednesday April 29th. Since then we have identified a total of 13 Maine people with H1N1, along with 24 people with seasonal influenza. Dr. Mills stressed the importance of the state’s epidemiologists who have done a superb job conducting case investigations on the 13 identified patients, which have included communication with a large number of contacts, other suspicious cases, and institutions involved. Fortunately, all H1N1 patients are recovering or have already recovered.
Additionally, over the past two weeks:
Nearly 1,200 samples have been tested by Maine CDC’s HETL microbiologists for influenza, and all results have been faxed or called to the health care provider and/or patient. This is the equivalent of about 3 years’ worth of tests – all in one 2-week period.
Almost 900 phone calls have come through the 24x7 toll free health care provider clinical consultation line, which has also served as a resource for schools.
About 2,000 calls have come through the public information toll-free hotline in 10 days, including over 1,300 calls in one day. A number of Maine CDC staff quickly volunteered to staff the phone bank and for the Office of Public Health Emergency Preparedness (OPHEP) staff for setting it up and coordinating it.
Maine CDC’s H1N1 website has been updated daily, including nights and weekends, and had almost 10,000 hits on one day (Wednesday, April 29).
Maine CDC has provided almost daily conference calls for stakeholders to learn updates and have questions answered (many questions being emailed ahead of time). Maine CDC hosted several such calls for health care providers, one for university and college administrators, two for non-clinical public health stakeholders (including Maine CDC staff). Maine CDC also participated in several such calls hosted by MEMA for the emergency management community. At times over 250 people participated on the health care provider calls.
25% of Maine’s share of the federal strategic national stockpile arrived before dawn a week ago Saturday morning. The two large truckloads of antiviral medications, masks, and N95 respirators was unpackaged, sorted, repackaged, and delivered to 9 hospital distribution centers within a few hours. This stockpile comprised of about: 50,000 treatment courses of antivirals (Relenza and Tamiflu) for potentially hospitalized patients; 57,000 masks; 115,830 N95 respirators; 57,500 gloves; 3,400 surgical gowns; and 3,648 disposable face shields.
Dr. Mills is extremely grateful for the ongoing work and collaboration of the Maine CDC H1N1 Teams including:
H1N1 Leadership Team, which includes Chris Zukas-Lessard, Peter Smith, Kris Perkins, Mark Griswold;
Maine CDC H1N1 Extended Leadership Team that also includes Ken Pote; Sara Robinson, Anne Sites, Don Ward (pulled in from retirement in Florida!), Mary Jude (newly hired this last week!), Jennifer Gunderman-King;
Maine CDC H1N1 Clinical Team that includes Andy Pelletier, Kathy Gensheimer, Peter Smith, and Anne Sites;
Maine CDC H1N1 Communications Team headed by Mark Griswold and includes staff from the Office of Local Public Health, including our District and Tribal Liaisons. They are spear-heading creating much of the content and coordination of public health communications, including answering hundreds of emails, drafting daily updates, updating FAQs for the phone bank staff, maintaining the website, and assuring communication to various stakeholder groups. Lisa Sockabasin worked closely with this team as well as with stakeholders such as the Maine Migrant Health Program, tribal health centers and liaisons, health leaders from Maine’s immigrant populations, and others to make sure Maine’s minority communities and other vulnerable populations such as those with disabilities are engaged.
Additionally, a large number others have held all the pieces together, including Elaine Lovejoy, Tammy Duguay, Michelle Monroe, Sue Dowdy, and Cori Dionne.
Governor Baldacci made it possible for the state to purchase a state antiviral stockpile. About 27,000 doses of it has arrived, and much more is expected in the coming days.
Dr. Mills continues to point out that our successes in Maine could not have been accomplished without the hard work and collaboration of many many partners throughout the state, including the work of our sister agencies, especially others in DHHS, the Department of Education, Maine Emergency Management Agency, and particularly the Governor’s Office. Our statewide systems of health care (hospitals, health centers, private practices, and a myriad of other health care providers), regional resource centers, emergency management, education, county, tribal and municipal governments, and yes, our emerging public health system all continue to work wonderfully together at the local, regional, and state levels to minimize H1N1’s impact in Maine.
Over the coming days and weeks Dr. Mills and Maine CDC staff will continue these and other efforts to minimize H1N1’s impact in Maine. However, Dr. Mills warns us that we also must look ahead. Because H1N1 is now found to be circulating in various parts of the globe, including places in the southern hemisphere where the time for seasonal influenza is beginning, we also need to prepare for what could be a more severe fall and winter with seasonal influenza since both H1N1 and seasonal influenza viruses could be circulating simultaneously. Such preparations include:
Reviewing successes and lessons learned from the last two weeks and adjusting our pandemic influenza plans appropriately;
Reviewing and adjusting our pandemic plans for a higher severity index; and
Preparing for mass vaccinations, and with possibly 3 vaccines!
Overall Update of H1N1 in Maine
As of the morning of May 10th, Maine has identified 13 people with H1N1 through testing, including 8 adults, 1 young adult, and 4 children or youth. They reside in York (5), Cumberland (4), Kennebec (3), and Penobscot (1) Counties. Three of the identified patients are students – one at the Lunt Elementary School in Falmouth, one at Bridgton Academy, and one early identified patient at the Kennebunk Elementary School. A recently identified patient is a young adult (with chronic underlying illness) who is hospitalized. 4 of the 13 test results have been confirmed by U.S. CDC; all 4 are in York County. 6 out of the 13 patients traveled to an area with confirmed H1N1. Of the 7 who did not travel out of state, 5 have no known contact with an identified case. Out of the almost 1,200 influenza tests that have been conducted by the Maine CDC’s laboratory since April 27th, 13 have been positive for un-subtypeable type A influenza (probable H1N1), and 24 have been positive for seasonal influenza, mostly type A Influenza viruses (and mostly known subtypes of H1 or H3).
These cases provide some important insights:
As the infection spreads and re-circulates, the numbers of cases and specific locations become less meaningful. There clearly are other people with H1N1 in Maine and probably other specific locations (such as other schools and counties) involved as well. The number of identified cases simply indicates the presence of H1N1 in Maine.
As the infection spreads we expect to see some increase in severity, as has been seen nationally.
There appears to be a high spread among children and young adults.
The strategies recommended the last 2 weeks continue to be very important.
Because recommendations from U.S. CDC are being updated very frequently, we strongly urge clinicians, school officials, and others to review the most updated guidance before making clinical or other decisions. We will not be issuing a health advisory for every update. There are several resources for information:
Maine CDC’s website has Maine-specific information, including daily updates and press updates as well as links to federal information. It is located at: http://www.maine.gov/dhhs/boh/swine-flu-2009.shtml and is found on the Maine CDC’s homepage: www.mainepublichealth.gov
Maine Department of Education’s website has resources and information for schools. It can be found at: http://www.maine.gov/education/h1n1/index.html
Health care providers or school officials needing updated clinical guidance should call Maine CDC’s 24-hour clinical consultation line (1-800-821-5821). This is also the resource to report a suspected case and obtain testing information including expediting the transportation of samples for testing. Maine CDC’s Health and Environmental Testing Laboratory (HETL) will perform influenza RT-PCR tests and subtyping for influenza A positive specimens. Instructions on collecting and submitting laboratory diagnostic specimens for H1N1 influenza testing are available at http://www.maine.gov/dhhs/etl/micro/submitting_samples.htm.•
The public information line with questions about H1N1 may also call our information support line at 1-888-257-0990 weekdays from 9am to 5pm.
The overall goal of Maine’s efforts to address H1N1 is to minimize its impact in our state.
Strategies to slow the spread of this infection include:
Having easily available tools (soap/water, hand sanitizer, tissues, reminder posters, etc) for maintaining respiratory etiquette in workplaces, schools, daycares, and wherever people are gathered;
Isolating people with symptoms such as a fever and respiratory symptoms (whether they have had a test for influenza or not);
Isolating appropriate household contacts;
Encouraging people at high-risk for complications to take precautions;
Implementing other community mitigation strategies such as closures and cancellations when appropriate.
These strategies can: delay the peak of the disease in order to “buy time” for the production and distribution of a vaccine against this new virus; decrease the number of people who get sick from this virus in a given community, thus reducing the “surge” on healthcare systems; and reduce the total number of people who get sick or die.
Because H1N1 is now found to be circulating in various parts of the globe, including places in the southern hemisphere where the time for seasonal influenza is beginning, we also need to prepare for what could be a more severe fall and winter with seasonal influenza since both H1N1 and seasonal influenza viruses could be circulating simultaneously. Such preparations include:
Reviewing successes and lessons learned from the last two weeks and adjusting one’s pandemic influenza plans appropriately;
Reviewing and adjusting one’s pandemic plans for a higher severity index; and
If applicable, preparing for mass vaccinations.
The most important strategies to minimize H1N1’s impact in Maine continue to be:
Maintain vigilant respiratory etiquette: covering coughs and sneezes with sleeves or a tissue; washing hands frequently; and staying home if ill, especially with a fever.
Stay informed since this event is changing and so is the resulting guidance.
Make preparations. If one does not have a pandemic influenza plan, then preparation check lists for a variety of settings can be found at: http://www.pandemicflu.gov/plan/checklists.html. These plans generally call for such measures as ensuring adequate critical supplies are on hand and preparing for higher than normal absenteeism.
Federal Judge in Vermont Upholds Law Banning Sale or Use of Prescriber Data for Marketing
In a decision handed down in late April, a federal judge in Vermont has upheld a state law banning the sale or use of prescriber-identifiable data for prescription drug marketing (IMS Health, Inc. v. Sorrell, D. Vt., No. 07-CV-188, 4/23/09). Judge J. Garvan Murtha of the U.S. District Court for the District of Vermont held that the state was able to support its "limited restraint on commercial speech" by showing that the law likely would lower pharmaceutical costs and protect public health. The law is scheduled to become effective on July 1, 2009. Last November, the U.S. Court of Appeals for the First Circuit upheld New Hampshire's law on data mining overturning a decision of the U.S. District Court for the District of New Hampshire. The federal court in Maine struck down Maine's law prior to the First Circuit decision in November. The New Hampshire case has been appealed to the U.S. Supreme Court. [return to top]
New Medicare Enrollment Toolkit
The AMA and the Medical Group Management Association (MGMA) have jointly developed a toolkit for physicians on the Medicare enrollment process. The toolkit provides a comprehensive overview of the process, as well as information on several recent changes in enrollment procedures. The AMA continues to advocate strongly against many of these changes. For example, as of April 1, 2009, physicians who do not report an address change to Medicare within 30 days could face revocation of their billing privileges for at least one year. The toolkit contains checklists, pointers, and examples to help physicians get enrolled as efficiently as possible to diminish the chances of cash flow interruption. The AMA's new web page on Medicare enrollment is http://www.ama-assn.org/ama/no-index/legislation-advocacy/medicare-enrollment-process.shtml.[return to top]
18th Annual Practice Education Seminar Scheduled for June 3 at Augusta Civic Center
Registration materials are now available for MMA's 18th Annual Practice Education Seminar being held on Wednesday, June 3, 2009 from 8:30 am to 4:30 pm at the Augusta Civic Center.
In addition to Keynote Presenters Attorney General Janet Mills and Insurance Superintendent Mila Kofman, J.D., other speakers in the morning plenary session include Shaun Alfreds, PhD, Dan Mingle, M.D., David McDermott, MD., MPH, Josh Cutler, M.D., Lisa Letourneau, M.D., and Sue Butts-Dionne.
Following lunch where attendees will hear from MaineCare officials, a choice of twelve breakout sessions will be available in four tracks focusing on Technology, Practice Management, Compliance and Hot Topics. These dozen sessions will be led by the following faculty:
Michael Duddy, Esq.
Brett Witham, Esq.
Kate Healy, Esq.
Noel Genova, PA-C
Erika Pierce, PA-C
Kozak & Gayer
Kenneth Lehman, Esq.
The exhibit area will feature technology vendors but other exhibitors are welcome as well. Contact Gail Begin at MMA is your firm or company is interested in exhibiting (622-3374, ext. 210 or email@example.com).
The Maine CDC is advertising for a Medical Epidemiologist to work in the Division of Infectious Disease to provide guidance and support to approximately 12-15 epidemiologists for disease investigations and outbreak control, surveillance activities, and planned epidemiologic studies. The person is expected to be involved in the development of disease investigation protocols and the review of case investigations as well as to consult with physicians and other health care professionals on disease prevention and control measures. The person is also expected to respond to inquiries from the public and media as well as interact with staff in the Office of Public Health Emergency Preparedness, the Health Inspection Program, and the Health and Environmental Testing Laboratory. On call duties are rotated among several physicians, and primarily consist of phone call support for on-call epidemiologists. Requirements for the position include: graduation from an accredited school of medicine or osteopathy with board certification in an appropriate medical specialty; a twelve year combination of training and experience in medicine and public health, to include a minimum of four years experience as an epidemiologist, or a Masters Degree in Public Health or a related field and six years experience in the field of medicine and public health, to include a minimum of four years of experience as an epidemiologist. Current license or eligibility to be licensed to practice in the State of Maine is also required. The position is open until May 22nd. Salary range is up to about $141,000. Additional benefits include comprehensive health and dental insurance as well as retirement. For more information: http://www.maine.gov/tools/whatsnew/index.php?topic=dhhs_direct_hire_jobs&id=71243&v=dhhs[return to top]
Board of Licensure in Medicine seeking PA to serve on the PA Advisory Committee
The Board of Licensure in Medicine's PA Advisory Committee currently has a vacancy for a Physician Assistant (PA) to serve on the committee, to review complaints, and to make administrative decisions. The BOLIM is accepting applications from actively-licensed PA’s in the state of Maine. If you are interested, or know of any interested PA's, for more information contact Dan Sprague, Assistant Executive Director, Maine Board of Medicine at 207-287-6930 or firstname.lastname@example.org .
The PA Advisory Committee next meets on June 2, 2009 at the BOLIM offices.
The Maine Workers’ CompensationBoard is searching for physicians to perform independent medical exams under Section 312 of the Workers’ Compensation Act. An independent medical examiner shall render medical findings on the medical condition of an employee, which may be binding if adopted by the Board. Applicants must be licensed by the State of Maine, have an active, treating practice, be Board-certified and demonstrate experience in the treatment of work-related injuries. Various specialties are needed, including orthopedics, physiatry, neurology, and general medicine. This is an opportunity to receive reasonable compensation for issuing fair and objective opinions while providing a public service to the workers’ compensation community. For additional information, please contact Betty Inman at (207)941-4557 or e-mail your CV to email@example.com
Political Pulse: HHS & IFS Committees Address Key Bills as Deadline for Committee Work Looms
THE FY 2010-2011 BIENNIAL BUDGET (L.D. 353)
On Monday, May 4, 2009, the Appropriations Committee held a public hearing on the Governor's proposal to address the new $569 million budget gap reported in last week's Maine Medicine Weekly Update. Reimbursement for children's PNMI services was the subject of much public comment at the hearing. The Committee held work sessions on the budget for the rest of the week and through the weekend.
SAME SEX MARRIAGE BILL ENACTED AND SIGNED BY THE GOVERNOR
Following a debate that delayed the afternoon committee schedule last Tuesday, the House voted 89-57 in favor of L.D. 1020, An Act to End Discrimination in Civil Marriage and Affirm Religious Freedom. The Senate enacted the bill on Wednesday, May 6, 2009 and the Governor signed it the same day. You can see a summary of the legislative action, including roll call votes, on the web at: http://janus.state.me.us/legis/LawMakerWeb/summary.asp?ID=280031932.
HHS COMMITTEE UNANIMOUSLY VOTES AGAINST BILLS INTRUDING ON PHYSICIAN DISCRETION TO TREAT MINORS CONFIDENTIALLY
Last week, the HHS Committee heard two bills on minors' rights to confidential health care services prompted by the highly-publicized 2007 debate about contraceptives dispensed at the school-based health center at the King Middle School in Portland: L.D. 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 and L.D. 802, An Act to Require Reporting on Medical Services or Treatment Provided to Minors Without Parental Consent. The testimony in favor of the bills was weak and the amount and quality of the testimony in opposition was very strong. The testimony of the several clinicians who made the effort to attend the public hearing was a key to a successful outcome. The MMA thanks Dora A. Mills, M.D., M.P.H., Pat Patterson, M.D., Jay Naliboff, M.D., Connie Adler, M.D., and Lisa Belanger, FNP for their testimony on the bill. To the surprise of most observers, the HHS Committee voted unanimously "ought not to pass" on both bills.
At a work session last week, the Committee also approved a compromise negotiated between the Baldacci Administration and the Maine Hospital Association on L.D. 1435, An Act to Amend Sentinel Events Reporting Laws to Reduce Medical Errors and Improve Patient Safety, amending the language the MHA found most objectionable.
Last Thursday, the Committee held a work session on several bills dealing with the state's certificate-of-need (CON) laws, including L.D. 1395, An Act to Amend the Maine Certificate of Need Act of 2002. The MMA and the MHA both opposed the bill and the MMA has expressed particular concern about lowering the thresholds for CON review. The Committee will consider this bill again at a work session tomorrow.
The Committee also voted to carry over to the next session, L.D. 1408, An Act to Establish the Universal Childhood Immunization Program, a bill that has been a focus of work of the Maine Immunization Coalition and the MMA Public Health Committee for much of the last year.
Finally, the Committee held a public hearing on L.D. 1259, An Act to Increase Access to Nutrition Information, a bill to require calorie count labeling on the menus of certain Maine restaurants. Sponsored by House Speaker Hannah Pingree, L.D. 1259 is a priority of the MMA and other advocacy groups working on healthy weight policy in Maine. MMA President Stephanie Lash, M.D. has been passionate about these issues and she presented the MMA's testimony on the bill. The HHS Committee will hold a work session on the bill tomorrow.
BRED COMMITTEE APPROVES NEGOTIATED SETTLEMENTS ON OPTOMETRY/OPHTHALMOLOGY AND PHARMACIST VACCINATION BILLS
During work sessions last week, the Business, Research & Economic Development Committee gave its approval to L.D. 683, An Act to Promote Cost-Effective and Broad-based Vision Care for Maine Citizens by Clarifying the Scope of Prescription Authority by an Optometrist and L.D. 1223, An Act to Allow Pharmacists to Administer Certain Immunizations. Both bills were the subject of extensive negotiations between the MMA and specialty organizations on the one hand and other stakeholders on the other.
IFS COMMITTEE ADDRESSES DIRIGO AND OTHER HEALTH INSURANCE REFORM BILLS
On Friday, May 8, 2009, the Insurance & Financial Services Committee held a day-long work session on the following bills dealing with funding for the Dirigo Health Program and other health insurance issues.
L.D. 1264, An Act to Stabilize Funding and Enable DirigoChoice to Reach More Uninsured;
L.D. 1205, An Act to Establish a Health Care Bill of Rights;
L.D. 1358, An Act to Implement Shared Decision Making to Improve Quality of Care and Reduce Unnecessary Use of Medical Services;
L.D. 1397, An Act to Allow Efficient Health Insurance Coverage;
L.D. 1444, An Act to Protect Consumers and Small Business Owners from Rising Health Care Costs; and
L.D. 257, An Act to Establish the Health Technology Clinical Committee.
At the end of a lengthy day of deliberations, the Committee had agreed unanimously to pass L.D. 1397 (pilot programs beyond Rule Chapter 850 geographic access standards)), to carry over to the second session L.D. 257 and to turn L.D. 1358 into a study resolve. The Committee split along party lines on L.D.s 1264 (funding for Dirigo Health), L.D. 1205 (due process rights for physicians in health plan pay-for-performance and tiering programs), and L.D. 1444 (health care payment reform).
Physicians' Day at the Legislature, May 21, 8 am - 1 pm
Physicians' Day at the Legislature will be May 21 from 8 am - 1 pm this year. We will meet in the Hall of Flags. Speak with your legislators and be heard on issues of significance to physicians, such as Medicaid funding; scope of practice issues; state budget priorities, physician workforce shortages, childhood obesity prevention efforts, childhood immunization funding, motorcycle helmet regulation, and more. We strongly urge you to attend and invite your colleagues. Our State House visits make a very positive impact on legislators.
In addition to the traditional events in the Hall of Flags, the MMA & MOA will start the day at 7am with a Walk/Run, along the Kennebec River Rail Trail, led by Governor Baldacci. All physicians and legislators are welcome. The Kennebec Valley YMCA will be available to all participants before and after the walk/run. The starting point and ending point will be the Kennebec River Rail Trail Message Board located west of the YMCA on the opposite side of the football field. The participants will walk/run along the trail to Hallowell and back. The distance is approximately 2 miles. Changing facilities and showers are available at the YMCA located a 31 Union Street in Augusta (on the southeast side of Capitol Park behind the DHHS headquarters at 221 State Street). You can find out more information about the Kennebec Valley YMCA on the web at: http://www.kvymca.org/.[return to top]
REMINDER: Legislative Committee Conference Call this Thursday at 8:30 p.m.
The next regular Legislative Committee conference call will be this Thursday, May 14, 2009 at 8:30 p.m. The conference call number is 800-989-2842 and the access code is 6223374#. There are no new bills for review this week, but the MMA will provide an update on the FY 2010-2011 biennial budget deliberations and other legislative highlights of the week.