December 21, 2009

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Senate Health Care Reform Bill Receives 60 Votes to Proceed

At approximately 1:15 a.m. this morning, all 58 Democrats and the 2 Democratic leaning independents in the United States Senate voted to invoke cloture so that the Patient Protection & Affordable Care Act (H.R. 3590) can continue to be debated with a final vote expected on or before Christmas eve.  All 40 Republicans voted against invoking cloture, including Maine's senior Senator Olympia Snowe who announced on NBC's Meet the Press on Sunday that she could not vote for the bill given that the process precluded a full understanding and debate on its provisions. "This beat the clock is overriding legislative sanity," she noted.

The early Monday morning vote essentially ensures that the bill will pass the Senate this week, modified by a 383-page "manager's amendment" (S. Amdt. 3276) offered by Majority Leader Harry Reid and prepared just a day or two prior to the vote.  Among the provisions in the amendment is a section deleting the one-year delay in the Medicare payment reduction for physicians brought about by the Sustainable Growth Rate (SGR) formula.  Majority Leader Reid stated that he dropped the one-year fix in order to prepare legislation in January that would provide for a permanent fix, as is included in the House bill.

The Senate bill, once passed, will have to be reconciled with the House bill.  That process is expected to begin once the Congress returns from a three-week holiday recess.  Although there are very significant differences between the the bills, most observers believe that a final bill will pass both bodies, and that the bill will look a lot more like the Senate bill than the House bill.  The notion of a "public option" included in the House bill is effectively dead as its inclusion would likely preclude the final bill from receiving the necessary 60 votes in the Senate.

At its core, the Senate bill would cover an additional 31 million people or 94% of the eligible population, at a cost of $871 billion.  The bill is paid for by new taxes on high cost health plans, taxes on businesses and fees charged to persons who do not purchase coverage.  It has been the subject of vigorous debate and has been attacked by both conservatives who believe it constitutes a government takeover of health care and liberals who believe it doesn't go far enough in providing coverage and in reigning in private insurance companies.  Physicians and physician organizations have been split as well, with the AMA supporting reform and many of the specialty societies opposing the bill.

The debate will continue through the recess and the process of reconciliation and the final vote.  MMA will continue to report on the health system reform debate through the Maine Medicine Weekly Update.

You can find the AMA's coverage of the latest Senate action in the health system reform debate on the web here:





U.S. House and Senate Both Pass 2-Month Delay in Medicare Physician Payment Cut

On Saturday morning, December 19th, the U.S. Senate followed the House's action on December 16th and passed the Department of Defense appropriations bill (H.R. 3326), a bill that would freeze Medicare physician payment rates for two months, avoiding a 21% cut scheduled to become effective on January 1, 2010.  The postponement gives organized medicine the opportunity to fight for a permanent fix as part of the health reform bill.  Earlier this year, the House passed a permanent SGR repeal and new Medicare payment structure, but the Senate has not acted on this bill.  The House bill did not contain a financing mechanism for the 10-year fix, which costs $210 billion.  Many Senators, including Maine Senators Olympia Snowe and Susan Collins support a permanent fix, but believe that it should be linked to a firm payment mechanism rather than increasing the deficit.

In a move that surprised many, Senate Majority Leader Harry Reid removed the langauge in the Senate health reform bill providing for a one-year SGR fix, stating that physicians deserved a permanent fix to the Medicare SGR issue and promising to work on a permanent fix in January.  The MMA also understands that the funding slated for the 1-year fix was instead applied to removal of the Medicare enrollment fee and elective plastic surgery tax in the manager's amendment to the Senate bill.

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Governor Baldacci Announces Plan to Close $438 Million Budget Gap

On Friday, December 18th, Governor Baldacci announced his plans to make further reductions in the current state budget in order to match projected revenues.  The cuts are intended to close a gap of approximately $438 million between now and June 30, 2011.  In total dollars, the budget for the 2011 fiscal year that begins July 1st will be nearly the same as it was in 2003-2004 - about $2.6 billion.  The reductions are required because state revenues are not keeping pace with projections.

Cuts within the Department of Health & Human Services make up nearly $68 million of the package of reductions.

The following are the major items of interest to physicians:

  • Reductions in reimbursement to critical access hospitals from 109% of costs to 101%.  The critical access hospitals were reduced earlier this year from 117% to 109%. 

  • Reductions in hospital inpatient reimbursement of $4.1 million (state and federal).

  • Reductions in hospital outpatient reimbursement of $3.2 million.

  • Increases the hospital tax through re-basing the tax to 2008, increasing revenues by $10.7.

  • Reduces funding for psychiatric hospitals by reducing reimbursement by $500 per discharge for a total cut of $1.2 million in fiscal year 2011.

  • Cuts mental health and substance abuse outpatient hospital services $3.1 million in 2011.

  • Reductions to non-hospital based physicians by $5 million, state and federal.  We understand that this cut impacts non-employed, hospital-based physicians providing imaging and related services.

  • Limits outpatient visits to 15 per year with the exception of HIV, cancer, prenatal, kidney failure, and transplant services.

  • Limits inpatient services to 5 per year.

  • Limits lab and x-ray to 15 per year.

  • Limits mental health outpatient visits to 18 per year.

  • Institutes an across-the-board 10% reduction in reimbursement to MaineCare providers, except for hospitals, physicians, dentists, and pharmacies.

  • The budget eliminates 22 state positions, including 12 that are currently filled.  Among these positions are two and one-half psychiatric physician positions within the Department.

The entire text of the budget can be found at:

You can find the Governor's budget comments on the web at:

MMA will continue to report on the budget action through the Maine Medicine Weekly Update.  Hearings on the budget are expected to begin during the first week of the legislative session, which convenes on January 6th.  MMA's first legislative conference call will be held on Thursday evening, January 14th at 8:00 pm.  The call is open to any MMA member interested in participating.  Contact Maureen Elwell at MMA for further information regarding the weekly calls (622-3374, ext. 219 or via e-mail to

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Report on MMA Executive Committee Meeting

The MMA Executive Committee met on December 16th for its regularly-scheduled meeting.  Priority topics for the meeting included the on-going discussion of federal health system reform and potential MMA participation in some federal grants.  The two federal grant opportunities involve academic detailing as part of the comparative effectiveness grant and medical liability reform.  An application for a $1.5 million, three-year grant to expand MMA's academic detailing project has been submitted to the federal Agency for Health Research & Quality.  An announcement on the grants is expected by early Spring.  Any grant application for the medical liability/patient safety grants would have to be submitted by the state or a health system.  Some interest has been expressed by the research institutes associated with Eastern Maine Healthcare and MaineHealth.

The meeting also featured a presentation on the current work of the Daniel Hanley Center for Health Leadership.  The Center has embarked on a capital campaign in a attempt to hire a full-time Executive Director.  Currently, James Harnar serves in a similar capacity on a half-time basis.  The presentation was made by Mr. Harnar and Sean Hanley, M.D., Dr. Hanley's son.

Internal issues discussed included plans for the upcoming Executive Committee Retreat in January and current membership and budget information.  Mr. Smith reported on the current status of the Medical Professionals Health Program and the Coding Center.

Richard Flowerdew, MBBS was welcomed as a new member to the committee representing Cumberland County.  Dr. Flowerdew is an anesthesiologist practicing with Spectrum Medical Group.

Agendas and minutes of all MMA committees are posted in the member's only section of the MMA website at

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Annual Report From The Trust for America's Health on States Emergency Preparedness

The Trust for America's Health issued its annual report on states' emergency preparedness this past week.  The report uses 10 indicators, which can change every year, and ranks each state by scoring it a point if the state does well and by denying it a point if it does not.  The top score is 10.  This year, state scores ranged from a low of 3 to a high of 9.  The full report can be found at:

Maine scored a 5, but a careful review of the report reveals that a 7 may have been a fairer assessment.

Although not part of the official ranking, Maine was one of the very few states cited in the report for having increased adult influenza and pneumococcal vaccination rates significantly the last five years and for scoring high on the strategic national stockpile distribution evaluation conducted by the US DHHS. 

Summarizing her comments on the report, Maine CDC Director Dora A. Mills, M.D., M.P.H. stated, "It is always a challenge when an entity tries to rank such a complex system such as emergency preparedness with 10 indicators, and although I disagree with several of their scores, as I know my colleagues and many others do in their states, I still applaud the Trust for America's Health for trying to at least measure a critical part of our nation's response to emergencies.
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Special Open Door Forum: 2010 Physicians Quality Reporting Initiative (PQRI) and Electronic Prescribing (eRx) Initiative Programs: Group Practice Reporting

The Centers for Medicare & Medicaid Services (CMS) will host a Special Open Door Forum on the 2010 PQRI and eRx Incentive programs.  This Special Open Door Forum will focus on a new reporting option, available for the 2010 PQRI and eRx Incentive Program, known as the Group Practice Reporting Option (GPRO).  Group practices that are interested in participating in the GPRO for PQRI and/or the eRx Incentive Program must submit a self-nomination letter to CMS by no later than January 31, 2010.  Once a group practice (Tax Identification Number or TIN) is selected to participate in the GPRO for PQRI or eRx, this is the only method of PQRI or eRx reporting available to the group and all individual eligible professionals (National Provider Identifier or NPI) who bill Medicare under the group’s TIN for 2010.

During this call, CMS will:

  • Provide information on the eligibility requirements for participating in the 2010 PQRI GPRO  and/or the 2010 eRx Incentive Program GPRO;
  • Provide instructions for self-nominating to participate in the 2010 PQRI GPRO and/or 2010 eRx Incentive Program GPRO;
  • Provide an overview of the data submission process for PQRI and the eRx Incentive Program;
  • Describe the measures for the 2010 PQRI GPRO;
  • Discuss the criteria for satisfactory reporting of PQRI quality measures under GPRO; and
  • Discuss the criteria for successful reporting of the eRx measure under GPRO.

Following the presentation, the telephone lines will be opened to allow participants to ask questions of the CMS subject matter experts as well as of individuals who have experience with the data submission process that will be used for quality reporting under the PQRI GPRO.

The 2010 GPRO for the PQRI and eRx Incentive Programs was finalized in the 2010 Physician Fee Schedule final rule with comment period.  The final regulation was published in the Federal Register on November 25, 2009.  To view the entire 2010 PFS final rule with comment period, go to the CMS PQRI website and click on the “Statute/Regulations/Program Instructions” section page.  PQRI GPRO information is also available by clicking on the “Group Practice Reporting Option” section page of the CMS PQRI website. eRx Incentive GPRO information is available by clicking on the “Group Practice Reporting Option” section page of the CMS eRx Incentive Program website located at .

Special Open Door Forum Participation Instructions:

Dial: 1-800-837-1935 Conference ID 45243499

Note: TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will A Relay Communications Assistant will help.

An audio recording and transcript of this Special Forum will be posted to the Special Open Door Forum website at, and will be accessible for downloading beginning on or around January 27, 2010. [return to top]

MaineCare Re-enrollment Deadline of December 23rd Looming; Take Action Now!

The Health PAS portal for re-enrollment in the new Maine Integrated Health Management Solution (MIHMS), the MaineCare claims management system scheduled to go online in 2010, is now open for all health care practitioners and providers.  DHHS and MMA both are concerned that many current MaineCare practitioners and providers have not completed the necessary re-enrollment steps and that payment delays may be the result of a failure to re-enroll by the deadline.

The current claim system, MeCMS, will automatically deny any claims with dates of service beyond February 28, 2010.  YOU MUST RE-ENROLL IN MIHMS TO REMAIN A BILLABLE MAINECARE PROVIDER AT FULL MIHMS IMPLEMENTATION SCHEDULED FOR MARCH 1, 2010.  Practitioners and providers not re-enrolled by December 23, 2009 risk delays in claims processing and prior authorization approvals when MIHMS goes live.

Please follow this link, , to the Health PAS provider re-enrollment portal to complete your re-enrollment application today! 

If you need help with or have questions about your re-enrollment, please call 1-800-321-5557, option 6, or e-mail  Staff is available to assist you from 8:00 a.m. to 5:00 p.m.  One-on-one appointments also may be scheduled to help you with your online re-enrollment application.

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CME Home Study Course on Prescribing for Chronic Pain Now Available on MMW Web Site

With funding provided by the Board of Licensure in Medicine, MMA last year developed a home study course on the subject of prescribing for chronic pain.  The course was accredited for two hours of CME.  The course has now been updated and can be completed on-line.  There is no cost.  A physician interested in taking the course should go to the MMA website at:  The links to access the course and the post-test are under "Resources for Management of Pain," then "CME."

The materials were assembled by Noel Genova, PA-C, who is also available for in-office consultations.  These consultations also are funded by the Board of Licensure in Medicine.  The consultations are confidential.  To request an in-office consultation, call Noel directly at 207-671-9076.

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MMA Joins Other Public Health Advocates to Urge Increase in Tobacco Taxes During 2010 Legislative Session

MMA EVP Gordon Smith joined Maranacook High School students and representatives of the American Lung Association of Maine and the American Heart Association today at a State House news conference to push for a $1 increase in the cigarette excise tax.  The current $2 per pack tax puts Maine at the second lowest cigarette excise tax in New England after New Hampshire.  A $1 per pack increase in the cigarette excise tax is expected to generate approximately $26.2 million annually.  The MMA always has advocated relatively high tobacco taxes as a key public health tool to prevent young people from becoming the "replacement smokers" necessary to the tobacco industry's financial future.  Given the nature of cuts in the Governor's proposed supplemental budget facing the legislature when it returns in January and the likely outcry from the public, a tobacco tax increase will be very attractive in March or April when the legislature tries to close the budget gap.

The MMA will continue its advocacy for this tobacco tax increase along with its coalition partners in the Health Policy Partners of Maine.  MMA President-elect Jo Linder, M.D., an emergency physician from Falmouth, is the current chair of the HPP. [return to top]

DHHS Withdraws Controversial Approach to Provider Debt Collection

In an announcement issued December 17th, DHHS stated that it will not proceed with proposals to seek personal guarantees from owners, officers, directors, or members of financial liabilities to the Department incurred by provider entities doing business in the corporate or limited liability company form.  DHHS had proposed to amend the MaineCare Provider Agreement and the MaineCare Benefits Manual, Chapter I, Section 1, General Administrative Policies & Procedures to enable it to do so.  The MMA appreciates that the Department heard the concerns expressed by it and the Maine Hospital Association in comments on the proposed rule. [return to top]

NOTE: Physicians Must Accept Credit Monitoring Offer in Wake of BCBSA Security Breach by January 31, 2010

MMA President-elect Jo Linder, M.D., EVP Gordon Smith, and Deputy EVP Andrew MacLean met with representatives of Anthem Blue Cross Blue Shield of Maine today to discuss a variety of issues, including the data security breach at the Blue Cross Blue Shield Association and the national health system reform debate.  During the meeting, the Anthem representatives alerted the MMA that the 2-year credit monitoring offer must be accepted by January 31, 2010.  You may find more information about the response to the security breach and you may register for the credit monitoring on the web at: [return to top]

New AMA Web Page Devoted to Regulatory Relief Topics

The AMA has created a new webpage devoted exclusively to regulatory relief issues.  The website,, contains information on medical liability reform, Medicare Advantage, Medicare enrollment, Medicare contracting reform, Recovery Audit Contractors, Red Flags rule, patient safety and quality improvement, as well as on Drug Enforcement Administration and Food and Drug Administration issues.  The site also contains links to other hot areas like Medicare Fee for Service reimbursement, HIPAA, Health IT, and administrative simplification. [return to top]

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