July 13, 2009

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Board of Licensure in Medicine to Develop Clinical Protocols for Prescribing of Narcotics

As the result of legislation filed by Senator Peter Mills, the Board of Licensure in Medicine has invited a group of stakeholders to meet at 10:00 am on July 21st in Augusta to begin work on a set of common protocols for the use and administration of controlled substances for use by licensed prescribers.  The protocol must be developed by Feb. 1,2010.  

L.D. 1193, An Act to Establish Uniform Protocols for the Use of Controlled Substances, was considered this past session by the Committee on Business, Research and Economic Development.  As originally presented, the proposal would have prohibited any narcotic from being prescribed beyond thirty days for the treatment of chronic pain arising from a noncancerous or nonterminal condition except by a prescriber with specialized training and expertise in managing a patient suffering from chronic pain.  It proposed additional restrictions on such patients as well, such as restricting them to one prescriber and one pharmacist.

Following a public hearing at which MMA and other organizations opposed the restrictions without further consideration of the consequences, the Committee eventually recommended that the legislature pass the following Resolve, in lieu of the bill.

                   Resolve, To Establish Uniform Protocols for the Use of Controlled Substances

          Board of Licensure in Medicine to convene stakeholders to develop common protocols for the use and administration of controlled substances.  Resolved:  That the Board of Licensure in Medicine shall convene a group of stakeholders, including but not limited to representatives from the State Board of Nursing, the Board of Osteopathic Licensure, the Board of Dental Examiners, the Maine Board of Pharmacy, the State Board of Veterinary Medicine and the Board of Licensure in Podiatric Medicine and the Director of Substance Abuse within the Department of Health and Human Services, to develop common protocols for the use and administration of controlled substances, as defined in the Maine Revised Statutes, Title 22, section 7246, for use by licensed prescribers.  The protocol must be developed no later than Feb. 1, 2010.  The Board of Licensure in Medicine shall notify the Joint Standing Committee on Business, Research and Economic Development of the protocol.  The joint standing committee is authorized to submit legislation regarding the protocol to the Second Regular Session of the 124th Legislature.

        The Legislature enacted the Resolve and the July 21st meeting is the beginning of the process.  MMA representatives and interested physicians will attend the meeting and provide input, along with representatives of hospice care and other interested parties.  Any MMA member or specialty society wishing to provide input through MMA should direct comments to EVP Gordon Smith, Esq. via e-mail to gsmith@mainemed.com.

Maine CDC Makes Plans for H1N1

On Thursday, July 9, the Maine Center for Disease Control and Prevention gathered several stakeholders, including MMA, to discuss plans for the remainder of the year relative to the H1N1 flu.  On Friday, Health and Human Services Secretary Kathleen Sebelius announced that Maine would receive more than $1.5 million in federal grants to prepare for the fall flu season and a possible vaccination campaign targeted at the H1N1 virus.  Secretary Sebelius said that no final decision has been made about whether or not to have an H1N1 vaccination program this fall, "but we're taking all the steps to be prepared for one, feeling that that's the likely recommendation of the scientists."

As of Thursday, 168 persons in Maine had tested positively for the H1N1 flu, with 9 hospitalizations and no deaths.  But it is estimated that at least ten times that number have been infected.  The priority over the past month for the Center has been the summer youth camps, which have been hard hit, and other institutional settings.  Surveillance is also focused on high-risk individuals such as pregnant women.  Preliminary data in the U.S. (and Maine data are consistent with this) indicate that young adults and children with underlying conditions and pregnant women are disproportionately affected with much higher hospitalization and death rates than with seasonal flu.

Mitigation strategies are focused on:

  • Prevention (respiratory etiquette - covering coughs, washing hands, staying home if ill)
  • Screening (of fever with respiratory symptoms for early detection of H1N1)
  • Isolation (people with symptoms need to stay home for at least 7 days)
  • Antiviral Medications (Tamiflu ad Relenza) especially for those at high risk for complications.

Priority setts for Mitigation Educational Efforts in Maine include youth camps, jails and prisons, day care centers, shelters, pregnant women, long-term care facilities; employment settings, schools and persons with underlying medical conditions.

Much of the discussion on Thursday focused on the plans for vaccination clinics in the fall.  Clinics will be conducted for the seasonal flu, which will not protect against H1N1 but will protect overall health.  The Maine CDC/HHS is using federal stimulus finds and the Fund for a Healthy Maine to purchase 180,000 pediatric and 100,000 adult doses of seasonal influenza vaccine which will be offered to any interested school, with private-sector health care providers partnering to administer the vaccine.

The possibility of an H1N1 vaccine certainly exists, but it is still in the early manufacturing stages.  Such a vaccine could be available in the Oct.-Nov. timeframe.  Currently, it is anticipated that two doses per individual, given one month apart, would be required.  The federal CDC would make the vaccine free to all states with the Maine CDC planning for distribution and administration of the vaccine.  Because of federal requirement, and the need for refrigeration, all health care practices wishing to receive the vaccine may need to register as Maine Immunization program (MIP) providers.  MMA is advocating for a significant change in the application form currently utilized in the MIP, in order to encourage more practices to participate.

Reimbursement issues and payment of an administration fee for administering the vaccine are yet to be worked out.

MMA will continue to provide updates on this important public health issue through the Weekly Update and the bi-monthly Maine Medicine. 


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MMA/Quality Counts Partner to Make Docsite Licenses Available at No Charge for PQRI Reporting

Ever thought about participating in the CMS Physician Quality Reporting Initiative (PQRI) but didn't know where to begin?  MMA has partnered with Quality Counts to offer practices a new option for participating in PQRI by using the alternative reporting allowed through the DocSite reporting tool, available at no cost through a grant from the Physicians Foundation.  Interested practices can use the PQRI "Alternative Reporting Methods and Criteria", which allows physicians to track and report data for 30 consecutive patients with one of seven conditions, including Diabetes, Back Pain, Prevention, Chronic Kidney Disease and Rheumatoid Arthritis.

Successful reporting to PQRI makes the practice available for bonus Medicare payments based upon the total Medicare reimbursement received by a practice during 2009.

Both primary care practices and specialty practices are eligible to receive the coupons, so long as they treat one or more of the seven conditions.  But there are only 75 coupons available, and each physician in the practice needs one to report, so don't delay.  MMA is making the coupons available to members on a first-come, first-serve basis.

To order your coupon number, contact Diane McMahon at dmcmahon@mainemed.com or via phone to 622-3374 ext. 216 until July 15.  On July 15 and following, contact Warene Eldridge at weldridge@mainemed.com or via phone to 622-3374 ext. 227.  For further information, see http://www.mainequalitycounts.org/library/2009-6216005705.pdf [return to top]

Update on National Health System Reform Efforts

As efforts to pass comprehensive health system reform in Washington continue, MMA will continue to inform its members and their staffs of these efforts, and their potential impact on medical practices in Maine, through regular reports in this Weekly Update and in the bi-monthly Maine Medicine.  Our reports are drawn from several sources, including the AMA, national specialty societies, the media and conversations with Maine's Congressional delegation and their staffs.

This past week, most of the focus was on the efforts in the U.S. House to finalize a house bill and to get it passed prior to the August recess.  Efforts in the Senate continued as well, with the focus again being on the Senate Finance Committee and the efforts of the bi-partisan group of seven Senators, including Olympia Snowe, to agree on the details of a bill drafted under the guidance of Committee Chair Max Baucus.

The timetable for passage of a bill continues to be threatened by serious disagreement, even among Democrats, regarding both the "public option" and plans to pay for the reforms and the significant expansion of coverage.  On the left, advocates want a strong government insurance option consumers could choose to buy into instead of private insurance, forcing private plans such as Anthem/Wellpoint to compete.  But opponents believe that a government supported public option would eventually lead to the demise of private health insurance.  While single payor advocates would welcome such a result, the majority of Americans who are not Medicare-eligible receive their coverage through employer-sponsored private plans.

The other issue emerging this week as a potential deal-breaker is the dilemma of how to pay for the reform plan which is likely to cost over $1 trillion over the next ten years.  Senior House Democrats settled this week on a proposal to cover a significant portion of the cost by raising income taxes on the highest earners.  Married taxpayers earning more than $350,000 a year in adjusted gross income and single filers making more than $280,000 a year would pay a surtax of about 1 percent, generating as much as $540 billion over the decade.  The added tax would be higher, under the House plan, for people in higher income brackets. 

Senate leaders have shown much less interest in a new income tax, and "Blue Dog" Democrats, including Mike Michaud, have expressed concern about a number of the provisions in the House bill.  President Obama has proposed raising more than $300 billion over 10 years by limiting the deductions that wealthy Americans take on their income taxes.

The "Blue Dogs" have also expressed concern that the proposed house bill does not do enough to reduce costs, protect small businesses or to improve access in rural areas.  Boosting payments to rural health care providers is a priority for these moderate to conservative Democrats.

As efforts slowed and at times even the Democrats seemed in disarray, President Obama found it necessary to send a message from the G8 summit in Italy, insisting that health care reform legislation was still on track despite the difficult week.  He also noted that he would be working in the next month to allay fears about the impact of the reform efforts.

"We have a long history in America of scaring people that they're going to lose their doctor, they're going to lose their health care plans, they're going to be stuck with some bureaucratic government system, that's not responsive to their needs, "  the President said.  "And overcoming that fear, fear that is often actively promoted by special interests who profit from the existing system, is a challenge."

MMA will continue to advocate for responsible reforms that emphasize the need to cover all persons.


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Coding Center to Offer CPC Coding Course in Lewiston

The Coding Center, a subsidiary of the Maine Medical Association, will present a eighteen-week coding course, qualifying a student to then sit for the AAPC exam, beginning in Lewiston in August.  The classes will be held at Central Maine Medical Center's Conference Room and will be taught by Gina Hobert, CPC-I, CPC, CPC-H.

This 18-week course, developed by the American Academy of Professional Coders (AAPC), will take students through the 2009 Current Procedural Terminology (CPT), International Classification of Disease (ICD-9), and HCPCS books to address proper coding in physician practices. This class is intended to educate students on proper techniques and rules of coding and will also prepare them to sit for the AAPC Certified Professional Coder (CPC) exam.

The Program includes the following:
- One year membership in the  AAPC
- Student workbooks
- CPC exam
- Group discussion and networking opportunities

Prerequisites: Two years coding experience, understanding of anatomy and medical terminology is strongly recommended

Course Requirements:
- 2009 Current Procedural Terminology (CPT) Book  (Professional Edition strongly recommended)
- 2009 ICD-9-CM Book
- 2009 HCPCS Book

$1650 MMA members & affiliates
$1750 non-MMA members

For more information on the course, please contact Maureen Elwell at 622-3374 Ext. 219 or via e-mail to melwell@mainemed.com, or click here for a registration form .[pdf] [ [return to top]

Make Plans Now to Attend 156th Annual Session, Sept. 11-13 in Bar Harbor

Your May-June issue of Maine Medicine contained a brochure with registration materials for the Association's Annual Meeting, being held this year at the Harborside Hotel & Marina in Bar Harbor.  Friday's educational program and opening night reception will be held at the Jackson Laboratory, also in Bar Harbor.  The theme of this year's meeting is Personalized Medicine, Translating Science to Clinical Practice, with clinical researchers from Jackson Laboratory being paired with practicing clinicians in each field to present one of our strongest educational programs.

The Meeting begins at 2:30pm on Friday, Sept. 11 with a keynote presentation by Richard P. Woychik, PhD., President and CEO of Jackson Laboratory.  The presentation will be in the auditorium at the Laboratory facilities.  A world-renowned geneticist with a background in both academia and industry, Dr. Woychik came to Jackson Laboratory in 2002. Dr. Woychik's wide-ranging interests include the molecular genetics of obesity and insulin-dependent diabetes, hearing loss and polycystic kidney disease.

If you are interested in attending and can not find the brochure, either give the office a call at 622-3374 or register on-line on the MMA website at www.mainemed.com[return to top]

MMA and MaineCare Launch Academic Detailing Program (MICIS)

The Maine Medical Association has received a state contract to develop and implement an academic detailing program designed to provide independent clinical information to Maine physicians and other prescribers of medication.  By aligning prescribing practices with the best scientific evidence on the treatment of common clinical problems, it is hoped that patient outcomes can be improved.  And while the primary goal of the program is to improve quality, the experience in other states has demonstrated that academic detailing also helps to control costs, which obviously has important implications for access to care.  The program has been named the Maine Independent Clinical Information Service or MICIS.

Academic detailing focuses on clinical topics where there are gaps between evidence-based guidelines and typical practice patterns.  Educational modules are developed after synthesizing the findings of the best available studies into key messages for practicing clinicians.  These training materials, developed by physicians associated with Harvard Medical School, form the basis of face-to-face discussions between the academic detailers and physicians.

MICIS was mandated by the Maine Legislature and is funded by fees collected from pharmaceutical companies as a cost of doing business in the state.  The Legislature wanted to create a mechanism where physicians and other providers could be exposed to clinical content created by an independent group of experts not swayed by financial concerns.  The Program is overseen by an advisory committee chaired by family physician Noah Nesin, M.D. of Lincoln.  MMA is represented on the Academic Detailing Advisory Committee (ADAC)  by Kellie Miller, M.S.and Gordon Smith, Esq.  Other participants include representatives of Goold Health System, MaineCare, pharmacists, physicians and consumers. Two physician assistants have been trained to conduct the detailing presentations.  Noel Genova, PA-C of Portland has practiced primary care in Portland, in Kentucky and in Birmingham, England and also provides consultations on prescribing for chronic pain, funded by the Board of Licensure in Medicine and provided through MMA.  Erika Pierce, PA-C is a native of Central Maine and has practiced in primary care settings in the Central Maine area since 2005.

The first two modules prepared deal with the clinical topics of anti-coagulants and Type II Diabetes.  Detailing visits will begin by early fall.  To schedule a visit to your practice, contact Noel Genova directly at noelpac@aol.com or 207-671-9076 or Kellie Miller at kmiller@mainemed.com or 622-3374 ext. 229.

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26 Primary Care Practices Selected to Participate in the Maine Patient Centered Medical Home Pilot Project

The Dirigo Health Agency’s Maine Quality Forum, Quality Counts, and the Maine Health Management Coalition have announced the 26 primary care practices selected to participate in the Maine Patient Centered Medical Home Pilot project. This pilot, with initial funding from the Maine Quality Forum and the Maine Health Access Foundation, received a boost recently when the Legislature enacted Governor John Baldacci’s biennial budget. The budget includes $500,000, eligible for federal matching funds, in support of pilot practices caring for MaineCare patients under the new primary care model.

“I am pleased that the Legislature recognized the value of this investment to make our entire system more efficient and serve Maine people better,” said Baldacci. “The pilot will help advance the broad goals of the original Dirigo Health Reform to make affordable, quality health care available to all Mainers and to work to make Maine the healthiest state.”

The Patient Centered Medical Home aims to achieve better patient outcomes at a lower cost by coordinating care, integrating behavioral and public health services with medical practice, emphasizing prevention, and compensating primary care practices for providing these services. Pilot practices, which were selected in a competitive application process, demonstrated a commitment to disease prevention, efficient care of patients with chronic conditions and patient education. Patient Centered Medical Homes include enhanced access to the practice for its patients, comprehensive services within the practice, “first contact care” for new problems and continuity of care over time by a physician and a health care team.

Participating practices will receive support to transform their systems of care and will periodically join together to share experiences and knowledge, including better ways to partner with their patients to understand their needs and preferences, manage their health care, and facilitate care needed from specialists.

Lisa Letourneau, M.D., M.P.H., executive director of Quality Counts, provides staff support to the Pilot. “While our work will be primarily with the Pilot practices, we also plan to share the learnings and communicate with the rest of the primary care community in Maine, in hopes that we can spread these concepts throughout the state,” said Dr. Letourneau.

The Maine Health Management Coalition is an employer-based coalition that purchases health care benefits for nearly 250,000 Maine workers and their families. “Our employers are looking for ways to improve the value of the healthcare they and their employees are purchasing, and believe that the medical home model is one part of the solution,” noted Elizabeth Mitchell, CEO of the Coalition.

“The Coalition is at the table to make sure that we keep this moving ahead. We can’t afford to wait any longer”.
An important next step in the pilot is to work with insurance carriers and MaineCare, all of whom have expressed support for the pilot. By re-directing payment to support improved primary care, the pilot will examine whether and how additional costs can be avoided over time. “We have a motivated, enthusiastic group of physicians,” said Joshua Cutler, M.D., Director of the Maine Quality Forum. “Important negotiations between the practices and commercial health insurance plans now need to be done.”

Practices participating in the pilot include Belgrade Regional Health Center, Belgrade; Blue Hill Family Medicine, Blue Hill; Central Maine Family Practice, Lewiston; the Community Health Center, Southwest Harbor; Court Street Family Practice, Auburn; Dexter Family Practice, Dexter; D.F.D. Russell Medical Center, Leeds; Eastern Maine Medical Center’s Center for Family Medicine, Bangor; Four Seasons Family Practice, Fairfield; Helen Hunt Health Center, Old Town; Husson Internal Medicine, Bangor; Husson Pediatrics, Bangor; Lifespan Family Healthcare, Newcastle; Maine Medical Center Family Medicine Center, Portland; Maine Medical Partners Westbrook Internal Medicine, Westbrook; Maine Medical Partners Westbrook Pediatrics, Westbrook; Mid-Maine Internal Medicine, North Vassalboro; Newport Family Practice, Newport; Penobscot Community Health Center, Bangor; Penobscot Pediatrics, Bangor; Seaport Family Practice, Belfast; Southern Maine Medical Center PrimeCare Physicians, Biddeford; Swift River Health Care, Rumford; Wilson Stream Family Practice, Farmington; Winthrop Family Practice, Winthrop; and Winthrop Pediatric and Adolescent Medicine, Winthrop. [return to top]

MMA Executive Committee to Meet on Wednesday, July 15

The twenty-eight member MMA Executive Committee, chaired by Jo Linder, M.D., will meet at the home of MMA President Stephanie Lash, M.D. on Wednesday, July 15.  Items for discussion include federal health care reform (particularly the notion of a public option), the Medical Professional Health Program (and the prospect of the program including nurses) and support for the Magnet School for Science & Math in Limestone.  Final plans for the 156th Annual Session will also be presented.  The Committee will also consider the MMA position on referendum questions on the ballot this fall, including TABOR II, expansion of the medical marijuana law and the effort to repeal the law authorizing same-sex marriage. 

Informational reports will be provided by staff on the current activities of The Coding Center, the Academic Detailing Program, and Chronic Pain Consultation Project.

Agendas and minutes of all MMA committees can be found on the MMA website at www.mainemed.com.

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