January 25, 2010

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AMA President-elect Cecil B. Wilson, M.D. Comes to Maine for "House Call" Highlighting Impending Medicare Crisis

Focusing on looming Medicare physician payment cuts of 21% that begin on March 1, 2010, the AMA, AARP, and the Military Officers Association of America (MOAA) joined together last Thursday in an unprecedented multi-state press event.  With advocates in Washington, D.C., Madison, WI, Norfolk, VA, Bismarck, N.D., and Portland, ME, the three groups urged the U.S. Senate to permanently fix the Medicare physician payment problem before seniors, military families, and baby boomers face a limited choice of physicians and limited access to care.  Representing the AMA at the press event at the new Intermed building on Marginal Way in Portland was AMA President-elect Cecil B. Wilson, M.D., an internist from Winter Park, Florida.

"As advocates for older Americans, military families and physicians, we are jointly calling on patients and physicians to contact their senators and let them know it's important they repeal the broken payment formula to preserve access to care, " said Dr. Wilson.

Without congressional action on permanent Medicare physician payment reform, Medicare rates will be cut 21% on March 1, 2010, with more cuts over the next few years, while practice costs continue to rise.  These cuts come at a time when Medicare physician payment updates already lag far behind increases in the costs of caring for our seniors.  During the last eight years, Medicare rates have been flat, but the cost of running a medical practice is up more than 20%.  In 2011, the leading edge of the baby-boom generation will start enrolling in Medicare, with enrollment growing from 44 million in 2011 to 50 million by 2016.  Military members and their families covered by the TRICARE program also face physician access problem because of the Medicare cuts because, by law, TRICARE payment rates are limited to Medicare rates.

Maine seniors need Congress to act on Medicare cuts formula:

Choice of physicians at risk!

  • Maine residents face several issues with choice of physicians and access to care:  5.9% of the state's residents live in a designated primary care shortage area; 9.9% report that they could not see a doctor in the last 12 months because of cost; there are 545 emergency department visits per 1000 population in the state, among the nation's highest; and 28% of the state's Medicare beneficiaries age 65 and older live below 150% of the federal poverty level.
  • On March 1, 2010, Maine physicians face an across-the-board cut of 21.2%, with more cuts likely to follow during the next several years because of a flawed payment formula, the Sustainable Growth Rate (SGR).
  • By repealing the SGR formula, Congress can avert these cuts.  SGR repeal would prevent a loss of $60 million in 2010 for the care of elderly and disabled patients in Maine.  On average, legislation to repeal the SGR would prevent cuts of $14,000 to each Maine physician this year. 
  • 14,133 employees, 223,962 Medicare patients, and 47,343 TRICARE patients in Maine will be helped by the legislation that averts these cuts.
  • Compared to the rest of the country, Maine, at 17%, has an exceptionally high proportion of Medicare patients and, at 18 practicing physicians per 1000 beneficiaries, Maine has a below-average ratio of physicians to Medicare beneficiaries, even before the cuts take effect.
  • 47% of Maine's practicing physicians are over 50, an age at which surveys have shown many physicians consider reducing their patient care activities.
  • Legislation also is needed to reinstate a temporary increase in Medicare geographic adjustments for certain areas which expired at the end of 2009.  In 2010, therefore, the legislation would prevent an additional 1.1% cut in payment rates for Southern Maine physicians' Medicare services and an additional 2.1% in the Rest of Maine payment area, on top of the 21.2% cut across the country.

You can find more information about the AMA's Medicare physician payment reform advocacy on the web at:  http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/medicare/payment-action-kit-medicare.shtml.

You can communicate with Senators Snowe and Collins on these issues through the AMA's grassroots advocacy network:  http://capwiz.com/ama/home/.

Future of Health Care Reform in Grave Jeopardy

President Obama and Democratic leaders in Congress are regrouping on health care reform in the wake of Republican Scott Brown's win in last week's special election to fill former Senator Ted Kennedy's Massachusetts Senate seat.  With that Republican win, the Senate Democrats lost their filibuster-proof majority in the upper chamber of the U.S. legislature.  While the Senate bill would appear to represent the outer boundaries of legislation that could pass both houses, House Speaker Nancy Pelosi (D-CA) has said that the Senate bill cannot win sufficient support in her chamber to pass.  Maine Senator Olympia Snowe (R) said this about the status of health care reform:  [They] need to “peel back the layers of the onion, so to speak, and go back to the drawing board.”

“People are really very much concerned, if not opposed, to the size and scope of this legislation, and the uncertainty that emanated from it,” she told reporters.

The AMA continues to track the health care reform debate in Washington on the web at:  http://www.ama-assn.org/ama/pub/health-system-reform/resources/resources-archives/our-vision.shtml .

The MMA will keep you posted on the developments in the health care reform debate through this Maine Medicine Weekly Update.

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Executive Committee Retreat: MMA Continues Experiment with Social Media

During this past weekend, the MMA Executive Committee conducted its annual strategic planning retreat.  Following a brief business meeting on Friday afternoon, MMA President David B. McDermott, M.D., M.P.H. and EVP Gordon Smith planned sessions for Saturday and Sunday morning addressing current issues and challenges in membership recruitment and retention, member communications, and fundraising.  A representative of the American Society of Association Executives (ASAE) presented ASAE's survey results on membership issues and the Communications Director of the Massachusetts Medical Society presented the MMS' experience with new forms of member communications, particularly social media.  The Committee members also discussed fundraising strategies, fundraising for specific programs such as the Medical Professionals Health Program (MPHP), and the long-term sustainability of the MMA.  Finally, the group discussed ways to improve the annual meeting and priorities for the year ahead. 

The MMA is trying to improve its communication with members by employing social media platforms.  For several months now, MMA President David McDermott, M.D., M.P.H. has had a Twitter account, @MMAPresident.  Now, MMA Deputy EVP Andrew MacLean has established a Twitter account, @abmaclean, from which he will send periodic updates and legislative alerts as legislative action develops at the State House.  We urge you to follow these MMA representatives on Twitter! [return to top]

Free Webinar: What Does Chemical Contamination Cost Health Care? on January 28th at 1pm (EST)

Free Webinar: What Does Chemical Contamination Cost Health Care?

New report details how to reduce disease and save billions by overhauling the U.S. chemical management system

January 28, 1:00 pm Eastern

A new report released by Safer Chemicals, Healthy Families outlines the role of chemical contaminants in cancer, asthma, reproductive disorders, and other conditions.  Learn about the report from a co-author and other leading researchers.  Estimates of the proportion of the disease burden that can be attributed to toxic chemical exposures vary, ranging from 1 percent of all disease to 5 percent of childhood cancer, 10 percent of diabetes, Parkinson’s disease, and neurodevelopmental deficits, and 30 percent of childhood asthma.  A conservative estimate puts the health care cost savings attributable to a decline in the incidence of chronic disease due to reductions in chemical exposures at $5 billion per year.  The report illustrates the opportunity to prevent disease and reduce health care expenditures by overhauling the chemical management system in the United States. 


Charlotte Brody, RN, National Field Director, Safer Chemicals Healthy Families

Richard Clapp, DSc, MPH, Professor of Environmental Health, Boston University School of Public Health

Ted Schettler, MD, MPH, Science Director of the Science and Environmental Health Network

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MGMA Offers Second Third Party Payer Seminar in Brewer

The Maine Chapter of the Medical Group Management Association (MGMA) is presenting the second of two 2010 Third Party Payer Seminars this coming Wednesday, January 27, 2010 at Jeff's Catering, 5 Coffin Avenue in Brewer, Maine.  Representatives from CIGNA, Aetna, Harvard Pilgrim, Anthem, Medicare, MaineCare, Martin's Point, MEDNET, and Maine Network for Health are expected to present on claims processing and reimbursement issues.  Registration begins at 8:30 and the meeting will conclude by 4:00 p.m.  The cost is $25.00 for MeMGMA members and $45.00 for non-members and the cost includes both a continental breakfast and buffet lunch.

FMI, please contact Karen Wheeler at 873-6173 or karenkay@roadrunner.com. [return to top]

AMA Offers 2010 Medicare Payment Schedule Summary

Every year the 2010 Medicare physician payment schedule contains numerous policy changes that will affect different practices in different ways.  Some of the major changes this year include revised practice expense relative values, elimination of Medicare payment for consultation codes, new quality reporting options, and simpler reporting requirements for the e-prescribing incentive program.  To learn more about these changes, including projected payment impacts for each specialty, go to http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/medicare/payment-action-kit-medicare/2010-medicare-physician-payment-schedule.shtml.

The AMA has strongly urged CMS to delay for a year the implementation of its new consultations billing policy.  The AMA efforts have included multiple conversations between the AMA Board Chair Rebecca Patchin, M.D. and DHHS Secretary Kathleen Sebelius.  The DHHS legal staff has advised the AMA that CMS cannot delay a single section of the final Medicare Physician Fee Schedule Rule (MPFS).  Rather, CMS must either delay or move forward with the implementation of the entire rule.  Consequently, CMS decided to implement the final MPFS.  Since CMS implemented the MPFS, the AMA has continued to press senior CMS officials to clarify the consultation policy and educate physicians.  The AMA expects CMS to provide more information on this issue soon.  [return to top]

AMA Develops Worksheet Tools Based on 2010 PQRI Requirements

Physicians may now access their 2007 re-run and 2008 Physician Quality Reporting Initiative (PQRI) through a new tool.  CMS has created the "Verify Report Portal" which is available on the PQRI Qualitynet Portal.  In addition to PQRI information, these reports will provide individual physicians with information on their Medicare Part B Physician Fee Schedule allowed charges for the 2007 or 2008 PQRI reporting period, upon which an incentive payment is based.  The tool is available at https://www.qualitynet.org/portal/server.pt.

Revised CMS 2010 specification manuals for both the PQRI and e-prescribing (eRx) incentive programs are now available.

For PQRI, please go to http://www.cms.hhs.gov/PQRI/15_MeasuresCodes.asp#TopOfPage.

For eRx, please go to http://www.cms.hhs.gov/eRxincentive/.

To facilitate the reporting of claims-based PQRI measures, the AMA has developed worksheet tools based on the 2010 PQRI requirements for individual and group measures.  For each measure, a measure description document and data collection sheet has been developed.  The data collection sheet facilitates the capture of allowable clinical codes in addition to basic patient demographics.  For individual measures, a clinical coding specification document is also available.  The 2010 PQRI worksheet tools are available on the web at http://www.ama-assn.org/ama/pub/physician-resources/clinical-practice-improvement/clinical-quality.shtml. [return to top]

Advisory Council Discusses Payment Reform Report & Schedule for Updating State Health Plan

The Advisory Council on Health Systems Development, chaired by Brian Rines, Ph.D., held its most recent regular meeting in the State Office Building on Friday, January 22, 2010.  The two principal topics of discussion were the Council's draft Payment Reform Report to Legislature and the process for updating the State Health Plan.  You can view a copy of the agenda from Friday's meeting at http://www.maine.gov/tools/whatsnew/index.php?topic=Gov_Health_Policy_Meetings&id=89014&v=article.  The group spent considerable time discussing the intent of the following paragraph from the payment reform report:

"3.  There is a strong preference and argument for payment reform to 'bubble up' from the community rather than mandated from state government.  Given that a single model will not address all needs, local community momentum and leadership are likely to be the springboard to payment reform in Maine.  The state should neither duplicate these efforts nor unnecessarily impede their progress."

In particular, some members of the Council wanted to ensure that this paragraph was not interpreted to absolutely prohibit a single payer approach to payment reform.  While there presumably is a range of opinions on the subject among members, there appeared to be general consensus that such a prohibition was not the intent of this paragraph.  

The group also engaged in a wide ranging discussion of the content of the next State Health Plan.  Finally, members reviewed a draft timetable for preparation of the next State Health Plan that includes opportunity for input from the public as well as further input from members of the Council.  The Council anticipates reviewing a draft State Health Plan in April 2010, public release and opportunity for comment in May, and final adoption of the 2010-2012 Plan in June.

The physician members of the Advisory Council are MQF Director Josh Cutler, M.D., Maine CDC Director Dora Mills, M.D., M.P.H., Lani Graham, M.D., and Maroulla Gleaton, M.D.

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MUA 2010 Annual Winter Conference Highlights Role of Robotic Partial Nephrectomy

Join the Maine Urological Association for a winter vacation get-a-way over President's Day Weekend!
The Maine Urological Association's Annual Winter CME Conference for Physicians and Mid-Levels interested in Urology Issues occurs on:

February 12-14, 2010
Grand Summit Resort Hotel, Sugaroaf, Carrabassett Valley, Maine

Registration Fee for Physicians: $ 75

Registration fee for mid-levels:  $50
CME hours anticipated - 6.0

The 2010 Conference will showcase Lisa T. Beaule, MD's technique on "The Role of Robotic Partial Nephrectomy."
With the recent published AUA Guidelines on management of small renal masses, the role of minimally-invasive nephron-sparing surgery has taken center stage and should be considered as part of the practicing urologist's surgical repertoire.

Register now by contacting the MUA  (at the Maine Medical Association at 207-622-3374, ext. 219 or by email at kmiller@mainemed.com.  To download a brochure, go to www.mainemed.com.!

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POLITICAL PULSE: HHS Committee Works the Supplemental Budget


The members of the Health & Human Services Committee spent most of last week working line-by-line through the DHHS portions of the supplemental budget without voting on much, if any of it.  For a work session on Thursday, January 21st, the Maine Association of Psychiatric Physicians (MAPP) submitted a memo to follow up its public hearing testimony in opposition to the elimination of 2.5 psychiatric physician positions in the Department.  In addition to the MAPP memo, committee members, including House Chair Representative Anne Perry, N.P. (D-Calais), commented that they had received a number of communications from advocates and members of the public on these position cuts.  Commissioner Harvey addressed the Committee on these cuts and said that she regretted these cuts, as well as many other position cuts in her Department, but that they were necessary in the current environment.  She said that it had nothing to do with the performance of the individuals currently in the positions, at least one of whom she hired.  While she believes that these physician salaries are reasonable, she mentioned that the Department had been criticized by the Maine Heritage Policy Center for the number of highly-paid positions in the Department.  She acknowledged that psychiatric clinical input in the Department's policy making is important, but that this function would have to be fulfilled by the clinical staff at the state hospitals.  She agreed that the liaison function between the medical associations and the Department is important, but that it would have to be fulfilled by the remaining medical director in the Department. 

The HHS Committee continues its work on the supplemental budget this week and is scheduled to report back to the Appropriations Committee with its recommendations on Tuesday, February 2nd at 1:00 p.m.

While the HHS Committee was focused on the supplemental budget, it did conduct a work session and final vote on L.D. 821, An Act To Support Collection and Proper Disposal of Unwanted Drugs , a drug disposal bill carried over from the previous session.  The Committee voted 8-5 "ought to pass" on the bill.  Senators Lisa Marrache, M.D. (D-Kennebec) and Peter Mills (R-Somerset) along with three Republican House members voted against the bill.  This means there will be vigorous debate about the bill in the Senate.


Last Thursday, the Business, Research & Economic Development Committee held a public hearing on L.D. 1608, An Act to Establish an Office of Administrative Law Judges for Licensing Boards.  The MMA spoke in favor of the bill, pointing to concerns the organization has expressed to the Board of Licensure in Medicine and its counsel from the AG's office about fundamental due process before the licensing boards.  Two lawyers in private practice with experience before the licensing boards, John Paterson from Bernstein, Shur and Charlie Dingman from Preti, Flaherty, Ed Phillips, a representative of the Regulatory Fairness Board, and Joseph Benedetto, a dentist who had a bad experience before the dental board all spoke in favor of the bill.  Representatives of realtors, modular home builders, and electricians spoke in opposition to the bill, as did DPFR Commissioner Head.  AAG Andrew Black spoke "neither for nor against" the bill.  Because of cost concerns, the bill as drafted is not likely to proceed, but Commissioner Head has agreed to bring together a group of stakeholders to determine if there is common ground to address the issues raised in the public hearing. [return to top]

Legislative Committee Conference Call Information

MMA Legislative Committee Chair Lisa Ryan, D.O. invites any interested physician or physician staff member to participate in the weekly conference call on Thursday, January 28, 2010 at 8:00 p.m. using the following toll-free call-in number and access code:  call 1-877-669-3239; access code 23045263. [return to top]

New Bills for Review & Consideration This Week

The following are bills of interest to the physician community identified by the MMA staff.  By clicking on the highlighted "LD XXXX," you will go to the summary page for the bill on the legislature's web site.  You can find the text of the bill by following the tabs on the left side of the summary page.  These bills will be on the agenda for the weekly Legislative Committee conference call this week, or you may provide feedback directly to Andrew MacLean, Deputy EVP, by phone at 622-3374, ext. 214 or by email at amaclean@mainemed.com.  You will note that the MMA staff has suggested a position for each bill along with a MMA committee or specialty society that may have a particular interest in the bill.

LD 1727, Resolve, Regarding Legislative Review of Portions of Chapter 11: Rules Governing the Controlled Substances Prescription Monitoring Program, a Major Substantive Rule of the Department of Health and Human Services, Office of Substance Abuse (monitor)

LD 1738, An Act To Establish a Duty To Report Serious Injuries (monitor)

It is likely that relatively few new bills of interest will be printed between now and the end of the session, but we will continue the weekly conference calls for quick legislative updates and as an opportunity for you to provide the staff with feedback as bill work sessions progress. [return to top]

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