August 31, 2009

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HSD Advisory Committee and Health Management Coalition Address Payment Reform

The state's Advisory Council on Health Systems Development and the Maine Health Management Coalition joined forces on Friday (August 28) in introducing a large public audience at the Augusta Civic Center to the topic of Payment Reform.  Promoted as, Introduction to Payment Reform:  Issues and Options, the three hour session included speakers from the Commonweath Fund, Health Dialog, CMS and the Division of Health Care Finance and Policy of the Commonwealth of Massachusetts.

Following an introduction by Council Chairman Brian Rines, PhD., Trish Riley of the Governor's Office of Health Policy and Finance introduced the panel of four speakers, including:

  • Cathy Schoen, Sr. VP for Research and Evaluation, The Commonwealth Fund
  • David Wennberg, M.D., MPH, Chief Science & Products Officer, Health Dialog
  • Jon Blum, Director for Medicare Management & Acting Director, Center for Drug and Health Plan Choice, CMS
  • Sarah Iselin, Commissioner, Division of Health Care Fiance ad Policy, Massachusetts

Several common themes emerged from the talks, including the need in the current system to better align incentives and to acknowledge the value of primary care.  Alternatives to the current payment models were discussed, including:

  • Medical homes
  • Accountable Care Organizations
  • Bundled payments
  • Global budgets
  • Bonus payments for meeting evidence-based quality measures

Of particular interest was the report from Massachusetts where a Special Commission on the Massachusetts Health Care Payment System recently concluded its work and recommended that global payments with adjustments to reward provision of accessible and high quality care become the predominant form of payment within a period of five years.  Ms. Iselin was co-chair of the ten member Commission.

Dr. Wennberg provided information from the work Health Dialog had done for the Maine Quality Forum.  He addressed the question of whether payment reform could address unwarranted variations, i.e., variations that cannot be explained on the basis of illness, scientific evidence or well-informed patient preferences.

A copy of the each speaker's powerpoint presentations are posted on the GOHPF website at

Both sponsoring organizations plan to continue their work on this difficult issue.  MMA representatives will monitor their deliberations and report to MMA members through the Weekly Update and the pages of Maine Medicine.

Not Too Late to Register for MMA Annual Session, Sept. 11-13 in Bar Harbor

Members and guests are encouraged to make plans to attend the Association's 156th Annual Session being held next week, Sept. 11-13, 2009, at the Harborside Hotel and Jackson Laboratory in Bar Harbor.  The CME program offers several hours of CME on the topic of Personalized Medicine.  Sunday morning's CME program features a Public Health Forum on the topic of the physicians' role in the potential H1N1 flu epidemic and other emerging public health threats.

Several special events are planned over the course of the meeting, including an event celebrating the effective date (Sept. 12) of the new law banning smoking on restaurant patios, the 29th Annual Edmund Hardy, M.D. Road Race (Sunday morning) and an appearance by Governor John Baldacci.  Out of state guests representing other state medical societies are expected from New Hampshire, Vermont, Massachusetts, Conneticut, Rhode Island and Ohio.

Saturday morning's business meeting will include an "open Mic" session where any MMA member can discuss issues of interest including the very contemporary topic of national health system reform.

Give yourself a break and join your professional colleagues in a relaxed and scenic setting and participate in the business of your Association.  While the roomblock at the Harborside Hotel has expired, MMA has a very good list of alternative places to stay at very affordable prices.  Just call Diane McMahon at 622-3374 ext. 216 to obtain the list or information from the list or e-mail Diane at

 We hope to see you all in Bar Harbor!


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CMS Says Some Physicians Will Receive 2007 PQRI Payments & Reports in November

The MMA has heard from many practices who faced great difficulty in participating in the first year of the CMS Physician Quality Reporting Initiative (PQRI), either because it was very difficult to submit the performance data or to download reports, or both.  During a provider call on August 20, 2009, CMS' Director of Quality Measurement and Health Assessment, Michael T. Rapp, said that because of the reporting failures, CMS will recalculate the data for 2007 and some participants who failed initially may receive some payments.

Participants in the 2008 PQRI should receive payments and reports in October.  Also in response to concerns raised by physicians, CMS will post guides this fall to help in comprehending the reports.  Individual practitioners will be able to obtain the feedback reports on their own without using a group's tax ID number.

For 2009, practitioners are submitting data on 153 individual claims measures, seven measure groups, and 32 approved registries.  Eligible practitioners can earn an incentive payment of 2% of their total allowed charges.

The changes proposed for 2010 would have practitioners submit data on 172 measures, including 50 registry-only measures.  The new measures address thrombolytic therapy, referral for otologic evaluation, cataracts, coronary artery disease, heart failure, cancer staging, HIV/AIDS, preventive care, and functional communication.  In 2010, CMS will allow large practices to submit data on measures that are not among the 172 but are approved by CMS and targeted at high-cost chronic conditions.  In 2010, CMS also expects to accept data from qualified EHR products on 10 individual PQRI measures.  Incentive payments will be available to those who submit data on at least 3 of the 10 EHR-based measures.

Other proposed changes for 2010 include:

  • As an alternative reporting criteria, practitioners can report at least one individual measure for at least 15 patients seen during the January-December 2010 reporting period (or one measure for at least 8 patients for the July-December 2010 reporting period.
  • Practitioners reporting "measures groups" would be able to report each group for at least 30 patients seen during the reporting period (15 for a half year), but they no longer need to be consecutive patients.
  • In order to be considered a successful e-prescriber, a practitioner must one e-prescribing measure in at least 25% (down from 50%) of cases in which the measure is reportable.
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VP/HHS Secretary Announce $1.2 Billion in EHR Grants

Speaking in Chicago On August 20, 2009, Vice President Joe Biden and HHS Secretary Kathleen Sebelius announced the availability of $1.2 billion in ARRA funding available to assist providers with implementation and use of EHRs.  Nearly $600 million will establish approximately 70 Health Information Technology Regional Extension Centers to provide technical assistance to providers in the selection, acquisition, implementation, and meaningful use of EHRs.  The first grant awards likely will be made in 2010.  Another $564 million in grants will be available to states and Qualified State Designated Entities to support the development of the means of sharing information within a nationwide system of networks.  The Vice President called this effort one of "modernizing" the health care system, not one of "socializing" or having the government take over the health care system. [return to top]

Health Professions Licensing Boards Meet to Draft Joint Rules on Use of Controlled Substances

The licensing boards in the State which license health professionals with prescribing privileges met at the Board of Licensure in Medicine office last Thursday  to continue work on the common protocols for the use and administration of controlled substances for chronic pain. The various boards had previously agreed in July to work from a redraft of the existing joint rules of the BOLIM and the Board of Osteopathic Licensure which the two boards had in progress.  Copies of the draft are available from MMA by calling 622-3374 ext. 219.  

At this point the draft tracks the existing joint rule, but brings it up to date by including references to urine monitoring (urine/serum medication levels) and pill counts.  This level of monitoring and the execution of a Controlled Substances Contract with the patient would be virtually mandatory in any case where the patient was at high risk for medication abuse or had a history of substance abuse.  Appropriate referrals and consultations would also be recommended.

This work of the boards is the result of a Resolve from the Legislature requiring the BOLIM to convene stakeholders to develop common protocols for the use and administration of controlled substances.  The protocol must be developed by Feb. 1, 2010 at which time it will be submitted to the Legislature for its review.

MMA will continue to monitor the work of the stakeholders group and to report to the membership through the Weekly Update and Maine Medicine.  Any comments on the work can be sent to MMA EVP Gordon Smith via e-mail to




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Over One Hundred Persons Turn Out for Quality Counts! Maine Healthcare Forum

Over one hundred persons attended the Maine HealthCare Forum, Local Lessons, National Reform,  organized by Quality Counts last Thursday (August 27).  The Forum was held at the Ramada Lewiston-Auburn Conference Center in Lewiston.  After receiving state updates from Maine Senate President Elizabeth Mitchell and State Senator Peter Mills, participants then heard from Ted Rooney, RN, MPH, Project Leader of the Maine Aligning Forces for Quality Project, funded by the Robert Wood Johnson Foundation.

 A panel presentation included speakers on the topics of:

  • Consumer Engagement
  • Disparities
  • Quality Improvement - Hospitals
  • Quality Improvement - Doctors' Offices
  • Performance Measurement & Public Reporting 

Breakout sessions on the above topics followed with a final plenary session offering closing remarks by Ted Rooney. [return to top]

Congressman Michaud Hosts Forum on Health Care Reform

Congressman Mike Michaud (D-2nd District) held a forum on the national health care reform debate from 8:30 a.m. to 12:30 p.m. on Friday, August 28, 2009 at the Eastern Maine Community College in Bangor.  For more than 3 1/2 hours Congressman Michaud and members of his staff listened to members of Maine's health care provider community express their views about the national health care reform debate generally and H.R. 3200, the one bill voted out of committee in the House so far, specifically.  Most speakers seemed supportive of health care reform in concept, but many expressed concern that Congress not act hastily and mentioned concerns specific to a particular provider type.  Physicians were well represented in the list of 25 or so witnesses and the following testified:

  • Gary Palman, D.O., Maine Society of Anesthesiologists
  • Stephanie Lash, M.D., MMA
  • Jon Fanburg, M.D., Maine Chapter, American Academy of Pediatrics
  • Julie Balaban, M.D., Maine Association of Psychiatric Physicians/Maine Association of Child & Adolescent Psychiatry
  • Joel Kase, D.O., Maine Osteopathic Association
  • Larry Piazza, M.D., Maine Society of Eye Physicians & Surgeons
  • Larry Mutty, M.D., M.P.H.
  • Charles Pattavina, M.D., St. Joseph Hospital

Congressman Michaud and his Health Legislative Assistant, Jill Brimmer, also heard testimony from representatives of hospitals, community health centers, nursing homes, pharmacists, nurses, psychologists, physical therapists, dental hygienists, ambulance companies, community mental health centers, chiropractors, and hospice providers.

Physicians who wish to communicate with Congressman Michaud's office about the national health care reform debate may reach out to Jill Brimmer at [return to top]

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