October 12, 2009

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Critical Senate Finance Committee Vote Expected Tuesday; Snowe Undecided

The eyes of the nation will be on Maine's Senior Senator, Olympia J. Snowe, tomorrow (Tuesday) as the Senate Finance Committee is expected to vote on America's Healthy Future Act of 2009, the comprehensive health care reform proposal offered by Committee Chair Senator Max Baucus.  The proposal gained some momentum this past week with the release of a report by the independent Congressional Budget Office (CBO) indicating that the proposal would cost $829 billion over the next decade and cover 94% of all eligible Americans.  Senator Snowe asked for a delay in the vote until Tuesday in order to give her and her colleagues a chance to examine in detail the CBO report.  She has not yet indicated whether she will support the proposal, but she has been successful in several committee votes in amending the orginial language in order to move the proposal to a point where she may be comfortable with it.

The CBO report also indicated that the legislation as proposed by Sen. Baucus and amended during the mark-up process would reduce federal deficits by $81 billion over the next decade and probably lead to "continued reductions in federal" red ink in the years beyond.

The report boosts the odds that the bill will receive favorable Committee action leading to efforts by Senate Democratic leadership to merge the bill with an alternative proposal passed by the Senate Health, Education, Labor and Pensions Committee.  Once that process is complete, the merged bill would be the subject of debate and vote in the full Senate where 60 votes would be required to overcome any filibuster by opponents of the proposal.  On the House side, House Speaker Nancy Pelosi will begin to merge the proposals passed through three different House committees and begin debate on the House floor within the next month.

The SFC bill is largely in line with President Obama's call for an overhaul of the delivery and financing system.  But, the bill does not include a "public" option or an employer mandate.  The bill would require all individuals to purchase health insurance, beginning in 2013.  But, the penalty for not being insured was pared back significantly during the committee's mark-up so that the maximum penalty is now $750 annually per family.  Subsidies would be provided to those individuals and families who can not afford to purchase coverage. 

There are several provisions in the SFC proposal that the AMA and other medical organizations will be seeking to change in the coming weeks as the proposals are considered by the House and Senate and then if successfully reconciled and passed in both bodies, sent on the the President for his signature.  Among the most significant problems with the bill are the following:

  • Increased penalties for physicians not participating in the Medicare PQRI program.

  • The establishment of an independent Medicare Advisory Commission with authority to set payment rates under requirements to reduce Medicare expenditures.

  • A limited one year fix to the sustainable growth rate (SGR) formula, providing for a one year increase of 0.5% in 2010 but resulting in a significant decrease in physician payments rates beginning in 2011.  In contrast, the House bill, H.R. 3200, provides a permanent 10-year fix to the SGR problem, resulting in positive updates at a cost of $230 billion over the decade.

MMA representatives have been in touch with Senator Snowe and her health staffers over the last few days and have discussed the problems with the provisions noted above.

MMA will continue to provide regular updates on the effort to pass comprehensive health reform legislation during the coming weeks, through the Maine Medicine Weekly Update.  You can also track coverage of the health care reform debate on the AMA web site at:  http://www.ama-assn.org/ama/pub/health-system-reform/townhalls-09302009.shtml.

Free Annual Exams to Eligible Women During National Breast Cancer Awareness Week

Recognizing October as National Breast Cancer Awareness month, the Maine CDC, through its Maine Breast and Cervical Health Program will continue to provide free annual exams and mammograms to eligible women.  Now in its 15th year, the program helps women age 40 and older obtain care if they meet certain income guidelines and have no medical insurance that covers such exams.  The program also offers assistance to qualifying women ages 35-39 who have seen a physician and need additional tests for possible breast cancer or cervical cancer or have not had a Pap test in five or more years. 

For more information, call 800-350-5180 or 287-8068 or go to www.maine.gov/dhhs/bohdcfh/bcp. [return to top]

Maine Health Management Coalition and HSD Advisory Council Work on Payment Reform

This past Thursday, October 8th, the Maine Health Management Coalition and the state's Health System Development Advisory Council held a second session on payment reform, bringing national experts to Portland to discuss similar efforts across the country.  In the morning session, more than 200 people heard from representatives of Kaiser Permanente, the Geisinger Clinic in Pennsylvania, and a panel of Maine providers and policy makers.  In the afternoon session, a smaller group, including MMA representatives, participated in a facilitated discussion focusing on what a new payment system might look like and how to achieve it.

Although several payment models were mentioned, most of the attention was focused on global payments and the notion of Accountable Care Organizations (ACOs).  Accountable Care Organizations envision communities coming together to receive payments from health plans, Medicare, and Medicaid to work with patients to both treat and prevent disease. [return to top]

MMA Executive Committee to Meet on Wednesday, October 14th

The MMA Executive Committee, chaired by Nancy Cummings, M.D., will meet at the MMA offices in Manchester at 2:00 pm on Wednesday, October 14.  Among the agenda items are the following:

  • MMA activities regarding national health system reform;

  • Review of 2009 Annual Session, including Resolutions passed;

  • Review of current membership and 2009 finances through September 30th;

  • Decision regarding applying for one of the federal grants available through the Patient Safety and Medical Liability Reform Demonstration; and

  • Update on Medical Professional Health Committee's efforts to work with nurses in recovery.

The Executive Committee consists of 28 physicians, including two residents, and meets approximately every 6 weeks, usually on Wednesday afternoons at 2:00 pm.

MMA members are welcome to attend any MMA Committee meeting, but we always appreciating knowing in advance if non-members of the committee are planning to attend.  Any member interested in observing the Executive Committee meeting should call Diane McMahon 622-3374, ext. 216 or via e-mail to dmcmahon@mainemed.com. [return to top]

Maine Health Information Center Is Now OnPoint Health Data

On October 1st, the Maine Health Information Center (MHIC) became OnPoint Health Data.  Given the organization's work around the country, with contract work recently in Vermont and Minnesota, MHIC management and its Board engaged in a strategic effort to rebrand and position itself for the future.  OnPoint Health Data is a tenant in the Hanley Building in Manchester, owned by the Maine Medical Education Foundation (MMEF).  The MMEF is a foundation recognized as a 501(c)(3) tax exempt entity founded for the sole purpose of loaning funds to medical students from Maine.

The MHIC was founded over 25 years ago with support from MMA, MHA, Blue Cross Blue Shield of Maine, and other organizations interested in having a non-profit data organization in the state, controlled by a group of stakeholders. [return to top]

Vermont Medical Society Hosts Annual Meeting

The Vermont Medical Society (VMS) hosted their 196th Annual Session the weekend of October 3rd at the Basin Harbor Club in Vergennes, Vermont.  Your MMA President Dave McDermott attended the meeting representing Maine physicians along with Dr. David Simmons, who is the medical director of their physician health program.  In addition to recognition of life and 50 year members the VMS discussed and approved resolutions addressing public health, immunizations, administrative burdens of practice, health care costs and access, and pediatric obesity.  Dr. McDermott shared with them some of the success we have had in Maine with the Maine Youth Overweight Collaborative and invited Vermont physicians to use the tools developed here in Maine to address youth overweight in the Green Mountain State.

Dr. Robert Tortolani, a family physician from Brattleboro, was installed as president for the 2009-2010 year, succeeding Dr. John Brumsted of Burlington.  A keynote address was delivered to the members over lunch on Saturday by Governor Jim Douglas, who is the chairman of the National Governor's Association and very active in national health policy debate through that role.

Participation by your leadership in the annual sessions of the other New England medical societies is just one way we share ideas across the region and develop an understanding of where some of our pressing concerns may have already been addressed. [return to top]

Have You Joined Our Growing Online Community?

Your Maine Medical Association is going online!  Have a burning question you want to share with colleagues?  Want feedback on an issue that is current in your professional life?  Want to share your thoughts with the MMA leadership?  If so:  join our group (Maine Medical Association) on Linkedin ® and post your questions in the discussions.  If you don't have questions you can still join in the discussions started by other members.  You can also follow some of our activity on Twitter!

For Linkedin, go to www.linkedin.com and join the group Maine Medical Association.  Instructions are here. For Twitter, follow the tweets from Dr. McDermott @MMAPresident.  If you have not done this before, then click here  for more information.

Please help us build our online community.  Maine is a big state geographically and these tools can help to make it smaller. [return to top]

MIHMS Re-Enrollment Update

It is important that Providers submit their re-enrollment applications during their assigned cycles. This will allow MaineCare to process all providers in time for them to submit claims in the first MIHMS financial cycle and will avoid a bottleneck at the end of the re-enrollment process. 

MaineCare reports that over 60% of Cycle 1 providers have not re-enrolled in the MIHMS (Maine Integrated Health Management Solution) system as of September 24, 2009. You must re-enroll in MIHMS to remain a billable MaineCare provider at full MIHMS implementation scheduled for March2010. Although the official Cycle 1 deadline is over, it is not too late for you to re-enroll! 

All providers need to re-enroll by the end of the scheduled cycles; otherwise, their ability to receive payments for claims processed in MIHMSmay be delayed. MaineCare requires a block of time set aside to prepare the provider file for implementation. Providers not enrolled by November 13 , 2009, may be unable to submit claims or to request Prior Authorizations for Dates of Service 3/1/2010 forward until their re-enrollment application is approved. 

Please follow this link https://mainecare.maine.gov to the Health PAS provider re-enrollment portal to complete your re-enrollment application as soon as possible. [return to top]

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