June 15, 2009

 
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President Obama Addresses AMA House of Delegates Moments Ago

President Barack Obama moments ago concluded a one-hour speech to the AMA's House of Delegates in Chicago.  In a very comprehensive address, asking for the physicians support of broad-based health system reform, the President addressed in a straightforward way the proposals he and key Congressional leaders have put forth.  He emphasized the need to provide cost-effective health insurance coverage for all Americans and he detailed his plans as to how to pay for it.  He reiterated his support for a public option to compete with private insurance plans and he challenged physicians and the AMA to address issues of over-utilization.  He promised reform of the payment system and stressed the need for a preventive-oriented system,  He specifically noted the need to encourage medical students to go into primary care fields.  He closed by noting the historic opportunity the Congress has to improve the system and implored the AMA to work with his administration and the Congress so that the next generation of Americans are not still talking about the crisis in health care fifty years from now.  To emphasize the point, he quoted from an article about the crisis in health care, written in Harper's Magazine in 1960.

Maine's AMA delegation, MMA President Stephanie Lash, former AMA President Robert McAfee, and EVP Gordon Smith are attending the meeting along with several specialty society delegates from Maine.  The President's talk seemed to be well-received by the delegates and other AMA guests, although debate at the meeting has been quite vociferous on the issue of the public option. 

We anticipating begin able to put the President's entire speech on the MMA website (www.mainemed.com) within a day or two so will limit today's report to the following highlights.

  • The President stated that he believed the total cost to achieve universal access, over the next ten years, would be about one trillion dollars, an amount, he also noted, less that the country is expected to spend on the war and recovery in Iraq.
  • He drew loud applause when he stated that it was his intent to fix only what was broken in the system, and that persons who were happy with their own doctor would be able to keep that doctor, and likewise with respect to their existing insurance coverage.
  • Those persons needing coverage would choose from several options through a health insurance exchange, similar to the process now extended to federal employees.  A public plan would be one option.
  • In order to cover everyone, the President said he was still open to the possibility of supporting a mandate that persons take responsibility for themselves and their families and be required to purchase coverage, so long as a waiver was available for those who could demonstrate that they could not afford any of the options.  The Maine Medical Association has supported an individual mandate since 2003, with similar limitations.
  • The President is also open to an employer mandate.
  • The President came down very hard on the practice of some health plans to deny coverage on the basis of preexisting conditions, and promised to end the practice.
  • Part of the payment for expanded coverage would come from reducing subsidies to Medicare Advantage plans and by limiting Medicare payments for preventable re-admissions to hospitals.
  • The President cited the recent article by Atul Gawande, M.D. in the New Yorker magazine, as evidence of overtreatment in the system.  While the article featured a town in Texas, President Obama stated that the pattern of overutilization was spreading across the nation.
  • While rejecting caps on awards, the President did express support for liability reform that would address the issue of defensive medicine.  That proposal is likely to be similar to the Liability Demonstration Project that Maine embarked on in the 1990's.
  • The President stated that the nation needs to rethink the cost of medical school education and reward students who go into primary care and work in underserved areas.  He cited his recent support for increased funding for the National Health Service Corps.
  • The President noted a number of times in his speech his support for health care technology, the need for electronic medical records, etc.
  • The President also noted his support for comparative effective research, in the interest of having physicians share with other physicians what works and what doesn't work.  He emphasized here that he did not see this research as dictating what care needed to be provided.
  • The President expressed support for expanding the membership and work of MEDPAC and promised to dust off some its previous reports to examine more closely over $200 billion in savings the Commission had recommended which had never been accepted by the Congress.

In an emotional closing, the President stated that he did not believe that we, as a nation, would allow over 46 million Americans to go without coverage and exhorted the audience to work with him to ensure affordable health care coverage for all Americans.  He noted that, for most Americans, their physicians are the health care system, and he asked again for the support of physicians at this historic juncture. 

Seasonal Influenza Vaccine Opportunities for Schools and Communities

Maine Public Health Alert Network System Advisory, June 11, 2009 - Maine CDC is working with the Maine Department of Education (Maine DOE) to provide communities an opportunity for their schools to offer seasonal influenza vaccine this fall for their students and possibly other children.  This is an excellent opportunity for physicians and health care providers to assist their schools with this effort.  Doing so may not only help protect the health of the entire community, but also ready the community for large scale vaccine clinics for H1N1.  CONTACT YOUR LOCAL SCHOOL IF YOU ARE INTERESTED IN ASSISTING WITH THIS EFFORT!

There are two overarching reasons why Maine DOE and Maine CDC are teaming up to provide this opportunity for Maine children to be vaccinated in local schools:

1.  The U.S. CDC now recommends that all children, 6 months through 18 years of age, receive annual vaccination against seasonal influenza.  There are several reasons for this recommendation, including:

  • Children are increasingly recognized at higher risk for complications from influenza than previously thought;
  • School-aged children have the highest rates of infection with seasonal influenza, and;
  • School-aged children are the major transmitters of influenza in a community, including to those at higher risk for complications.

In many communities it will be very challenging for all children to be vaccinated at their local health care provider offices this fall, and many retail vaccine clinics (such as supermarkets and pharmacies) do not vaccinate either minors or elementary school-aged children.

2.  Additionally, H1N1 at this point in time appears to be affecting children and young adults disproportionately.  Although seasonal influenza vaccine will not protect specifically against H1N1, it will help improve the overall health of a child during this coming influenza season when both seasonal and H1N1 influenza strains may be circulating.  The Maine CDC anticipates a vaccine against H1N1 may be available later in the year.

As a result of these two major factors, the Maine CDC expects there will be an increase in the number of parents who will want their children vaccinated against seasonal influenza.  Therefore, with some federal American Recovery and Reinvestment Act funds ("Stimulus Funds") the Maine CDC in the Department of Health and Human Services (DHHS), in partnership with the Maine Department of Education (DOE), is offering seasonal influenza vaccine for interested school districts for use in the fall of 2009.

Check with your school to encourage their participation in providing vaccines for their students.  The Maine CDC needs to order vaccine very soon and will need to know if a school will be participating before June 30th.  The school will have to ensure:

  • An existing Maine CDC Immunization Program vaccine provider, or someone who is able to become an Immunization Program vaccine provider, has adequate space to receive and store vaccine shipments;
  • The ability to maintain cold chain (recommended storage temperatures) during transportation of the vaccine and at the site of the clinic;
  • Adequate nursing staff to administer vaccine at the school/school district;
  • Sites to dispose sharps and biohazards during and after the clinics.

The Maine CDC is offering free pediatric formulation (thimerosal-free) vaccine, funds to purchase materials such as gauzes, band-aid strips, alcohol pads, gloves, disposal boxes and epinephrine, educational materials for students and parents as well as parental permission forms, any necessary training for staff and assistance from Maine CDC's Public Health Nurses, as their resources permit.

If your school/school district is interested in providing a vaccine clinic, encourage them to reach out to their local hospital/health care practices, health centers, Healthy Maine Partnerships, municipal health departments and emergency management agencies in order to assure adequate capacity for putting on such vaccine clinics.  They will need to contact Nancy Dube, School Nurse Consultant, Maine DOE at 207-624-6688 or nancy.dube@maine.gov before June 30th.  There is a memorandum of understanding that will need to be signed by the superintendent along with some estimates of vaccine need.

It is strongly encouraged to have these school-based vaccine clinics to be held as early as possible after vaccine is available, such as in September or October.  If you have additional questions, don't hesitate to contact Dora. A. Mills, MD, MPH, Public Health Director, Maine CDC at 1-800-821-5821 or dora.a.mills@maine.gov .   [return to top]

AMA Responds to NYT Article Concerning Position on Public Option

In response to an article in the New York Times on June 11, entitled, "Doctors' Group Opposes Public Insurance Plan", the American Medical Association on the same day released the following statement, attributable to Nancy H. Nielsen, M.D., President of the AMA.

Today's New York Times story creates a false impression about the AMA's position on a public plan option in health care reform legislation.  The AMA opposes any public plan that forces physicians to participate, expands the fiscally-challenged Medicare program or pays Medicare rates, but the AMA is willing to consider other variations of a public plan that are currently under discussion in Congress.  This includes a federally chartered co-op health plan or a level playing field option for all plans.  The AMA is working to achieve meaningful health reform this year and is ready to stand behind legislation that includes coverage options that work for patients and physicians.

In an article in Congressional Quarterly, also published June 11, Dr. Nielsen is quoted as saying, "The AMA is willing to consider other variations of a public plan that are currently under discussion in Congress."  She specifically noted a proposal by Senate Budget Chairman Kent Conrad (D-N.D.), that would create a system of publicly owned insurance cooperatives in place of a government run public plan.  The Senate Finance Committee, upon which Senator Olympia Snowe sits, is likely to include a version of Conrad's proposal in legislation it is developing, the committee's chairman, Max Baucus (D-Mont.), said on Thursday. [return to top]

Legislature Approves New Funding for Dirigo Health to Replace Savings Offset Payment

The state legislature last week gave final approval to a proposal put forth by the Baldacci administration to replace the so-called Savings Offset Payment (SOP).  The new law replaces the SOP with a fixed 2.14 percent payment on paid claims, to be paid by health plans and third party administrators.  The assessment is expected to generate income of approximately $43 million for the program.  The SOP generated about $38 million annually.

The SOP, which was also based upon a percentage of paid claims, has been continually challenged by business, some trade associations and health plans.  On average, it was costing upwards of a million dollars a year to defend the establishment of the SOP.

Replacing the SOP with the straight assessment is expected to allow the program to grow next year, with perhaps as many as 10,000 covered lives by the end of 2010.  Enrollment will continue to decrease this year, however, as the funds are used to pay back to state treasury the funds borrowed earlier in the year.  These funds are in the range of $17 to 20 million.

The House of Representatives passed the bill by a vote of 83-53 and the Senate 20-15. [return to top]

Patient Centered Medical Home Pilot Project Begins

Over a hundred physicians and practice staff converged on Maple Hill Farm and Conference Center on Friday to begin their orientation as participating practices in the Patient Centered Medical Home (PCMH) pilot project.  The project is sponsored by the Maine Quality Forum (Dirigo Health Agency), Quality Counts and the Maine Health Management Coalition.

Twenty-two adult primary care practices and four pediatric practices have been selected to participate in the project, chosen from among fifty applicants.  For a list of participating practices, or for more information, see "Resource Library" and "New " sections of the Quality Counts website at www.mainequalitycounts.org

Congratulations to those practices selected to participate in this innovative program. [return to top]

POLITICAL PULSE: 124th Legislature Adjourns First Regular Session

Following a relatively leisurely week by typical end-of-session standards, the 124th Maine Legislature adjourned its First Regular Session at approximately 2 a.m. on Saturday, June 13, 2009, four days ahead of the statutory adjournment deadline.  You can see the Governor's closing remarks on the web at:  http://www.maine.gov/tools/whatsnew/index.php?topic=Portal+News&id=74740&v=article-2008.

During the busy final two weeks, the legislature passed the following significant pieces of health care legislation:

  • L.D. 1259, An Act to Increase Access to Nutrition Information (the "menu labeling" bill);
  • L.D. 1264, An Act to Stabilize Funding and Enable DirigoChoice to Reach More Uninsured (the replacement of the SOP with an assessment on paid claims/see related article in this issue);
  • L.D. 1205, An Act to Establish a Health Care Bill of Rights (including due process protections for physicians in health plan profiling and "tiering" programs);
  • L.D. 1444, An Act to Protect Consumers and Small Business Owners from Rising Health Care Costs (including information on health plan profiling and "tiering" programs for patients); and
  • L.D. 1395, An Act to Amend the Maine Certificate of Need Act of 2002 (including the elimination of inflationary indexing in thresholds for CON review).

Also during the last week, the legislature enacted a revised tax reform bill that addressed Governor Baldacci's concerns with the first effort, L.D. 1088.  The second bill was L.D. 1495, An Act to Implement Tax Relief and Tax Reform.  The summary of the bill provides as follows:

SUMMARY

This bill incorporates the substance of Legislative Document 1088, "An Act To Modernize the Tax Laws and Provide over $50,000,000 to Residents of the State in Tax Relief," as amended by Committee Amendment "A" and House Amendment "A" to Committee Amendment "A" with the following changes.

1. It enacts an income tax surcharge equal to .35% on taxable income over $250,000, bringing the tax rate to 6.85% on Maine income over $250,000. The tax surcharge applies to tax years beginning on or after January 1, 2010.

2. It eliminates the Maine minimum tax credit for individuals that may be claimed on returns due for tax years beginning on or after January 1, 2010. The credit still applies with respect to taxable corporations.

3. It makes the earned income tax credit refundable for tax years beginning after 2009 up to $150 for taxpayers filing married joint returns and $125 for all other taxpayers. Under current law, the credit is not refundable.

4. It eliminates the proposed real estate transfer tax increase.

5. It eliminates the proposed sales tax exemption for businesses that make snow for skiing, snowmobiling or similar activities of electricity or fuel used to make snow, machinery or equipment that is used for making snow and snow-grooming equipment.

6. It eliminates the proposed sales tax on fees charged for golf courses, bowling alleys, swimming pools, skating rinks, ski lifts, gymnasiums and tennis and racquetball courts and on proceeds from arcade games.

7. It specifies that the exemption from sales tax applies to fees charged by health and fitness centers and lessons or training in dance, music, theatre, arts and gymnastics, martial arts and other athletic pursuits.

8. It increases the amount that is deposited into the Tourism Marketing Promotion Fund from sales tax on meals and lodging.

9. It allocates funds to the Tourism Marketing Promotion Fund due to the increase in the percentage of certain sales tax revenue that is transferred to the fund.

 While the MMA still is taking stock of the First Regular Session of the 124th Legislature, our leadership believes it has been a successful one for the organization and for all stakeholders in Maine's health care system.  The MMA made progress on aspects of its legislative agenda, including the provisions of L.D. 1205 cited above, various public health initiatives, and an increase in the MaineCare fee schedule.  While there were cuts in health care spending in the FY 2009-2010 biennial budget, those cuts were mitigated by the Baldacci Administration's use of federal stimulus funds.

The MMA thanks all physicians who participated in our advocacy efforts this session, as "Doctor of the Day," as a witness before a legislative committee, or as a participant in Physicians' Day at the Legislature.  

The MMA staff will prepare a summary of legislative activity and will have that available by the Annual Session in September.

The 124th Maine Legislature will return to Augusta for its Second Regular Session in early January 2010. [return to top]

Maine CDC/DHHS Preliminary Summer Plans to Address H1N1

Below is a brief summary of Maine CDC’s preliminary plans to continue to address H1N1 this summer, with likely revisions depending on the course of H1N1 and information gleaned from ongoing work with stakeholders.  Maine CDC also continues in close contact with U.S. CDC, including daily conference calls and emails, and this contact is also expected to inform and revise our summer work. 

The Maine CDC H1N1 Steering Committee includes:  Peter Smith, Kris Perkins, Mark Griswold, Chris Zukas-Lessard, and Dora Anne Mills.  Additionally, Kathy Gensheimer, Andy Pelletier, Anne Sites, Ken Pote, Sara Robinson, and Mary Jude serve on a broader H1N1 Leadership Team because of their technical expertise and ongoing intensive work on the issue.  A very large number of other Maine CDC employees are also very involved in carrying out the work, including many whose normal jobs do not include pandemic influenza work. 

AFTER ACTION REVIEWS (AAR):

  • Distributed an online survey monkey to stakeholders which has about 500 responses (will provide a summary of results to stakeholders);
  • Conducting or participating in several AARs with a variety of stakeholder groups, mostly using existing meetings in May and June;
  • Compiling information from AARs and survey to revise ongoing planning and action.

PANDEMIC INFLUENZA PLAN:

  • Reviewing and revising Maine’s State Pandemic Influenza Plan. 

LARGE SCALE VACCINATIONS:

  • Activating and updating plans for large scale vaccinations for H1N1 later this year.
  • Working with Department of Education on plans to offer seasonal influenza vaccines for school-aged children this fall. 

COMMUNICATION:

  • Reviewing and revising crisis communication protocols and plans;
  • Activating additional social media communication channels (Twitter, Facebook, Blog, etc);
  • Evaluating and revising outreach to vulnerable populations, especially people with disabilities and minority populations;
  • Preparing media outreach for later this year; and
  • Reviewing roles of and communicating with Local Health Officers, District and Tribal Liaisons, Municipal Health Departments, and other local and regional entities. 

EPIDEMIOLOGY (TRACKING AND CONTROL OF DISEASE):

  • Will continue fairly intensive influenza tracking throughout the summer, including daily or weekly tracking of: 
    • Absentee rates in schools (until adjournment);
    • Any long term care facility cases;
    • Nosocomial cases in acute care facilities;
    • Hospital admission data;
    • Emergency department visits for ILI (influenza like illness);
    • Sentinel health care providers’ reports of ILI;
    • Death records in major cities;
    • Laboratory data (including private labs – Nordex and ALI); and
    • Rapid antigen reports.
  • Conducting outreach to Maine’s youth camps to assure tracking of influenza outbreaks and mitigation among campers and staff;
  • Planning to shift into more intensive daily tracking of influenza if the situation warrants;
  • Contacting US CDC to review protocols for addressing possible influenza on cruise ships.

ANTIVIRAL MEDICATIONS:

  • Finalizing plans for use of and distributing state-purchased stockpile.

LEGAL ISSUES:

  • Reviewing and updating some pandemic influenza legal issues with AG’s Office. 

LABORATORY SURVEILLANCE:

  • HETL (Maine CDC’s Health and Environmental Testing Laboratory) received certification from U.S. CDC on Thursday May 28th to do our own H1N1 sub-typing;
  • Updating plans for future surges in influenza testing.
[return to top]

Second Annual Quality Symposium: June 24 in Rockport

The Maine Medical Association, the Maine Hospital Association and the Maine Osteopathic Association are presenting the second annual Quality Symposium, featuring Brian Wong, M.D., MPH presenting, "Hospital-Physician Relations:  Building a Foundation of Trust and a Shared Vision of Excellence," at the Samoset Resort on June 24.   A board certified family physician with a 30 year career in the healthcare industry, Dr. Wong is widely recognized as an innovator in healthcare strategy.  The afternoon features a panel discussion entitled, "Hospitals and Physicians Working Together - Sharing Success Stories Here in Maine."  The program has been approved for 6.5 hours of category one CME.

The target audience for this program includes chief executive officers, other senior-level executives, physicians and board members.  While any physician, executive or board member from any healthcare organization will benefit from participating, interdisciplinary team attendance is highly encouraged.

Registration information is available at http://www.themha.org/education/QualitySymposiumflyer.pdf.  Questions about the program may be directed to the Maine Hospital Association at 622-4794.  The registration fee is $100 per person and includes a continental breakfast, lunch and program materials.

For those persons wishing to stay overnight, rooms are available at the Samoset Resort at a discounted rate for Tuesday, June 23.  You may call the Samoset directly at 1-800-341-1650 and ask for the MHA rate. [return to top]

Special MMA Event at Portland Motor Club on June 18, 5:30-7:30pm

The Maine Medical Association and Portland Motor Club invite you to spend, "An Evening with the Cars", a unique and exciting social event for MMA members and their guests at the new Portland Motor Club at 275 Presumpscot Street in Portland.  This event follows very successful events with the Cumberland County Bar Association and other professional groups, which have been introduced to the Motor Club through similar events.  If you are a car enthusiast (a/k/a motorhead), don't miss this opportunity to visit with the cars and your professional colleagues who also enjoy cars.

The event includes:

5:30pm    Reception

6:30pm    Tour of Motor Club

6:45pm    A conversation with owner Bill Waldron about his classic car collection and Portland Motor Club.

Feel free to invite friends or associates who have a particular interest in cars and car collecting.

For directions, go to:  www.PortlandMotorClub.com/contact.php    RSVP to info@PortlandMotorClub.com or call 207-775-1770 and please indicate the number of guests in your party. [return to top]

Maine CDC Seeks Physician Input on New Electronic Death Registration System

From Donald Lemieux, State Registrar and Director, Office of Data, Research and Vital Statistics:

Dear Physician:

You may have heard that the Maine Center for Disease Control and Prevention (Maine CDC) will be implementing a new Electronic Death Registration System (EDRS) for the State of Maine.  We have selected VitalChek as the vendor for the new system and are proceeding with a number of activities required for successful implementation.

Our first major step will be a series of discussion sessions, whereby the vendor works with all anticipated parties who will use the system, to determine exactly how the system will need to work for Maine.  These “functional requirements” sessions are intended to document our work flow, data requirements, and processes for registering death records.  Information gathered from these sessions is used to customize the software to Maine requirements.

It is critical that physicians are part of this process and we invite you to attend these sessions in order to share knowledge and expertise as to the reality of completing death records for medical certification.  We anticipate that approximately one, and maybe up to two days, would provide us with helpful information.  Whatever time you could spare would be greatly appreciated.

If you would like to learn more about the new EDRS and would like more information about these sessions, please feel free to contact me directly.

Sincerely yours,

Donald R. Lemieux, State Registrar and Director
Office of Data, Research and Vital Statistics
Division of Public Health Systems
Tel: (207) 287-5468
Email: don.lemieux@maine.gov [return to top]

DHHS Seeks State Epidemiologist

CURRENT VACANCY INFORMATION: The Department of Health and Human Services (DHHS) is driven by its vision of Maine people living safe, healthy and productive lives.  Its goal is to assist the people of Maine in meeting their own needs, as well as the developmental, health and safety needs of their children.  It serves the public in an environment that reflects a caring, responsive and well-managed organization.  The Maine Center for Disease Control & Prevention, Infectious Disease Division, is charged with decreasing morbidity and mortality through the prevention and control of infectious disease.  Program areas within the Division include Infectious Disease Epidemiology, the Maine Immunization Program and the HIV/STD/Viral Hepatitis program.

JOB DESCRIPTION: As State Epidemiologist in the Division of Infectious Disease, you will provide guidance and support to approximately 12-15 epidemiologists for disease investigations and outbreak control, surveillance activities, and planned epidemiologic studies.  You will also be involved in formulation of statewide public health policy including providing legislative testimony for the Department.  You will be involved in the development of disease investigation protocols and the review of case investigations.  You will consult with physicians and other health care professionals on disease prevention and control measures. You will respond to inquiries from the public and media on a regular basis.  You will interact with staff in the Office of Public Health Emergency Preparedness, the Health Inspections Program, and the Health and Environmental Testing Laboratory.  You will be part of the on-call rotation for nights and weekends (for telephone consultation, not on-site work) and provide technical support to other staff as needed when they are on-call.  The State Epidemiologist will report to the Director, Division of Infectious Disease.

REQUIREMENTS:  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.

SPECIAL REQUIREMENT:  Current license to practice medicine in the State of Maine.

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 [return to top]

RUC Submits Recommendations to CMS

On March 31, the AMA/Specialty Society RVS Update Committee (RUC) submitted its 18th annual set of recommendations to the Centers for Medicare and Medicaid Services (CMS) for new and revised CPT codes. The majority of the more than 200 coding changes fro CPT 2010 will result from needed nomenclature revisions identified by the RUC's Five-Year Review Identification Workgroup. In addition, the RUC submitted recommendations for 160 services identified by the RUC or CMS as potentially misvalued. The RUC also submitted a formal proposal to CMS on the process and procedures to use in the formal Five-Year Review of the RBRVS to launch on November 1, with a CMS call for public comment on valuation within the RBRVS. [return to top]

For more information or to contact us directly, please visit www.mainemed.com l ©2003, Maine Medical Association