March 1, 2010

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Congress Fails to Delay Medicare Physician Fee Cut - It's Effective TODAY

While Congress has had several months to fix the flawed Medicare payment system that results in a significant reduction in physician fees every year, it failed again to address the issue on Friday.  As a result, Maine physicians will see a reduction in Medicare fees of 22.6 % in Cumberland and York counties and 23.6% in the rest of Maine beginning today.  Because there is still hope that the cut will be restored retroactive to March 1st, CMS has instructed its contractors to hold physicians' claims for services provided March 1st and thereafter for at least 15 days.

As was explained in a Special Alert sent to MMA members and office staffs on Friday, the House did approve a further delay in the cut, but the Senate was unable to get unanimous consent to the delay because of the objection of ONE Senator, Jim Bunning (R) of Kentucky.  Senator Bunning objected to the legislation extending a number of the provisions because the cost was not covered, arguably increasing the federal deficit.

Late Friday afternoon, the MMA sent a letter signed by members of its Executive Committee asking them to urge their Senate colleagues to permit the delay in the cut.

MMA representatives will be in Washington the first three days of this week attending the AMA National Advocacy Conference and meeting with Maine's Congressional delegation.  Fixing the sustainable growth rate formula and the need for responsible federal health care reform will be the major topics of discussion.

The significance of the Medicare physician payment cut in Maine can not be overstated.  It represents a reduction of more than $60 million annually in the state in the amount Medicare reimburses physicians and other Medicare providers.

The MMA again urges physicians to contact Maine's Congressional delegation using the AMA's grassroots hotline (1-800-833-6354) and ask them to address the SGR problem immediately.

Maine Seniors Need Congress to Act on the Medicare SGR:  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 over live below 150% of the federal poverty level.
  • 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 would be helped by legislation to avert 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 is also needed to reinstate a temporary increase in the Medicare geographic adjustments for certain areas that expired at the end of 2009.  In 2010, therefore, physicians in southern Maine face an additional 1.1% cut, and those in the rest of Maine face an additional 2.1% cut, on top of the 21.2% cut across the country.

You can find more information about the Medicare payment issue on the AMA web site:


MaineCare Fee Increase Also Effective TODAY

The most recent increase in the MaineCare fee schedule enacted by the current legislature in last year's biennial budget (L.D. 353/P.L. 2009, Chapter 213) takes effect today, March 1st.  It will increase MaineCare rates from approximately 57% to approximately 70% of Medicare rates.  This is the third MaineCare fee increase enacted by the legislature during the administration of Governor Baldacci.  The 122nd Legislature included a $3 million General Fund increase in the FY 2006-2007 biennial budget (L.D. 468/P.L. 2005, Chapter 12) and the 123rd Legislature included another $3 million General Fund increase in the FY 2008-2009 biennial budget (L.D. 499/P.L. 2007, Chapter 240).  Governor Baldacci and his DHHS Commissioner and MaineCare staff deserve great credit for emphasizing to the legislature the importance of increasing Maine's Medicaid reimbursement rates for physician services to maintaining an adequate statewide physician network for the program. [return to top]

Dirigo Health Agency Staff/Board Honor Outgoing Chair Robert McAfee, M.D.

At the conclusion of its meeting on February 23, 2010, the staff and Board of Trustees of the Dirigo Health Agency recognized Dr. Bob McAfee for his service as Chair of the Board since its founding in 2003.  Dr. McAfee, a retired surgeon and past President of both the MMA and the AMA, has been a committed supporter of Governor Baldacci's Dirigo health reform initiative and of health care reform generally.  Dirigo Executive Director Karynlee Harrington and GOHPF Director Trish Riley presented Dr. McAfee with an engraved baseball bat and other baseball mementos honoring his service.  Portland attorney Jonathan Beal has assumed the role of Chair.

During the meeting, Ms. Harrington advised the Board that she expects the Agency to be able to repay the balance of a $25 million loan to the state general fund by the end of the fiscal year in June.  As of the end of February, the Agency has paid back $11 million and is on track to pay the remaining $14 million by June 30th.  Upon repayment of the loan, the Agency expects to expand eligibility again.  The Agency awarded the contract for the plan for next year to Harvard Pilgrim Health Care, the current underwriter, but the other bidder, Celtic Health Care, has appealed the award. [return to top]

REGISTER NOW: Dealing with Disruptive Patients is "First Friday" Topic on March 5th

The MMA's popular "First Fridays" seminar series begins its 2010 season this Friday with a presentation entitled, Caring for the Disruptive Patient with Attorney Mike Duddy of Kelly, Remmel & Zimmerman in Portland.  MMA attorneys Gordon Smith and Andrew MacLean also will contribute to the program addressing the legal and ethical aspects of discharging patients.  This is a 2-hour program with Mr. Duddy speaking for the first hour and Mr. Smith and Mr. MacLean speaking for the second.  

The program will run from 9:00 to 11:00 a.m. at the MMA office in Manchester.  The program also is available by WebEx.  You may register on the MMA web site, or by calling Maureen Elwell at 622-3374, ext. 219.  The cost of the program is $65. [return to top]

Impression of Health Care Summit Depends Upon One's Viewpoint

Partisan Democrats claim that last Thursday's Health Care Reform Summit convened by President Obama believe that momentum has once again shifted to the advantage of those legislators and interests that support comprehensive, broad-based reform.  Republican leaders believe that the Summit gave them an opportunity to showcase their reform proposals to a national television audience and to point out flaws in the President's approach.  But, most neutral parties have observed that the 7.5 hour session showed few areas of agreement between the parties but did display great ideological differences.  These differences all but guarantee that a bi-partisan approach to national health care reform is not possible in 2010 as time grows short in this election year.  Therefore, it is likely that Democrats will pursue a strategy that will not require any Republican support.

Maine's senior Senator Olympia J. Snowe shared a similar view in an interview on Friday with representatives of the Maine press.  Neither of Maine's Senators participated in the Summit, although Senator Snowe was invited by the White House at the last minute.  She felt that her presence would be not fair to the Republican leadership who had already picked representatives to the Summit.

Senator Snowe did believe that the Summit was constructive in the sense that it allowed the public to see "an unfettered and unfiltered discussion among both parties."  Both Senator Snowe and Senator Collins have opposed the notion of the Democrats using the budget reconciliation process to pass health care reform legislation.  This approach would not require a super majority (60 votes) in the Senate.

Senator Snowe has consistently expressed disappointment with the approach taken since her October 13th vote in favor of the Senate Finance Committee bill.  Since that vote, the process went behind closed doors and more than a thousand pages of provisions were added to the base of what the Senate Finance Committee had developed.  The Senator continues to believe that federal health care reform is essential, and noted on Friday that health insurance premiums in Maine had increased 349% in the last ten years. 

The President is expected to announce his next steps toward a comprehensive reform by the middle of this week.   [return to top]

Advisory Council on Health Systems Development: Report on 2/26 Meeting

The state's Advisory Council on Health Systems Development held its regularly scheduled meeting on Friday, February 26th at the State House.  The Council is chaired by Brian Rines, Ph.D. and physician members are Josh Cutler, M.D., Executive Director of the Maine Quality Forum, Dora Mills, M.D., M.P.H., Director of the Maine CDC, and Lani Graham, M.D., M.P.H., a former Director of the Bureau of Health. 

The major topic of discussion was the development of the new State Health Plan.  Council members reviewed a draft paper prepared by the Governor's Office of Health Policy & Finance proposing a vision and framework for the Plan which is intended to serve as a transitional document for a new administration and legislature, beginning in 2011.  The paper proposed six principles to shape the focus and strategies of this year's Plan:

  1. Evidence-based practices known to improve safety and quality must drive payment decisions.
  2. There must be measurable savings to return on the investments we make.
  3. Our strategies must be population-based and system-wide.
  4. We must balance the interests of consumers, payers, and providers.
  5. Health care professionals should practice to the full extent of their training, experience, and skills.
  6. System re-design should result in clear points of accountability for cost and quality.

The State Health Plan will set a priority course of action to fulfill the vision while building on the substantial progress  already made.  The Plan will focus on areas where there is an urgency, a path, and a substantial return, in hopes that the Plan will produce the sustainable foundation and savings needed to further advance improvements in the health care system and to help Maine claim the title as the healthiest state in the nation.

Other aspects of the Plan will include health promotion and prevention of illness, promotion of effective and efficient care and alignment of policies, payments, and supports.  In terms of alignment, the plan will attempt to integrate the separate but connected work in the following initiatives in the state:

  • Payment reform
  • Health information technology and telemedicine
  • Workforce development, including aligning scope of practice with skills, training and experience
  • Certificate of need and Capital Investment Fund (DHS staff already working on this section)
  • Data management and support

This year's Plan will incorporate report cards for each of the eight public health districts.  These District Performance Reports are intended to serve as a tool for improving the health in the districts and to provoke a community wide response by clinicians, public health experts, consumers, and community organizations.  One of the focuses of these reports will be preventable hospitalizations.  The State Health Plan in addressing prevention will focus on:

  • Performance measures to target efforts, track progress, and publicly report
  • Development of strategies that focus on the interface of public health and clinical care as it impacts preventable hospitalizations
  • Give priority to prevention and early detection of chronic disease

In promoting effective and efficient care, the focus is likely to be on:

  • Re-tooling and reinvigorating  primary care, including patient-centered medical homes and integration of mental health
  • Reducing inappropriate emergency room use
  • Reducing the rate of preventable hospitalizations

During the public comment portion of the meeting Wendy Wolf, M.D., M.P.H., President of the Maine Health Access Foundation, reported on the recent year one evaluation of the Foundation's Integration Initiative (integrating behavioral and physical health care services) and the evaluation of its Medical Assistance Initiative.  Both programs were found in the evaluations to be meeting their goals.

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Peer Review Collaborative Task Force to Meet on Thursday

For several months a dedicated group of physicians and staff have met regularly to discuss the need for external peer review resources for small hospitals, group practices, and other health care settings.  Out of these discussions, led by Roger Renfrew, M.D. of Redington Fairview Hospital in Skowhegan, arose the notion that the existing MMA Peer Review Program could be enhanced to meet the needs of these providers, particularly critical access hospitals (CAH's).  The plan for an enhanced program was presented recently to both the Maine Hospital Association Quality Council and the CAH's and was well received and supported.  The enhanced program would be expected to provide peer review services at a fee that is reduced from that currently charged and in a timeframe that would be expedited.  A broader menu of services also would be offered.  It is hoped that the enhanced program could be offering services by September 1, 2010.  In the meantime, the existing MMA peer review program continues, having completed a record number of reviews in 2009.  The program has been in existence for nearly 25 years.

The state Office of Primary Care and Rural Health (OPCRH) within the Maine Centers for Disease Control & Prevention, has been supportive of the plan and has agreed to apply for a federal grant that would support the program for 2 years at which time it would be expected to stand on its own financially and operationally.  Margaret Pinkham, RN, former CEO at St. Andrews Hospital in Boothbay Harbor, is acting as a consultant to the OPCRH on the project.

On this coming Thursday, March 4th, a further meeting of physicians and other interested individuals will be held at MMA offices in the Frank O. Stred Building in Manchester.  The meeting will be held from 10:00 a.m. to 12:30 p.m. and will include lunch.  The meeting is also available through WebEx if you would prefer to participate remotely from your own office and desktop or laptop.  Any interested MMA member or hospital quality improvement staff or CEO is welcome to attend.

Please RSVP to Michelle Pinkham at Redington Fairview if you plan to attend.  She may be reached at 858-2305 or  Once you indicate that you would like to use the webex connection, Maureen Elwell at MMA will e-mail the registration information for the WebEx.  [return to top]

Registration Now Open for Quality Counts Part 7 - April 16, 2010 - Augusta Civic Center

Registration is now open for Quality Counts Part 7 - April 16, 2010 - Augusta Civic Center

Transforming Health and Healthcare in Maine's Communities: 

 What's Your Role?

Quality Counts 7 (QC7), a 'best practice college' is the latest in a series of dynamic conferences to promote the transformational changes needed to create dramatic and sustainable improvements in health and health care in Maine.   The conference will link with the Aligning Forces for Quality (AF4Q) initiative in Maine to explore opportunities for improving health and health care by building effective partnerships across Maine communities. 

The conference will feature a range of data sources to examine indices of health and health care in our communities, including county-level health rankings across Maine.  It will also provide opportunities for stakeholders within and across communities to discover ways to work together to identify common goals and, by working together, overcome barriers to create transformative and sustainable change in Maine.

To Register and View the Agenda go to:


Who Should Attend?

Healthcare providers, including physicians and other clinicians; hospital and nursing leaders; employers; payers; consumers; health policy makers; public health workers, including Healthy Maine Partnership staff; health educators; healthcare administrators; and physician office staff, including practice managers, nurses, case managers, medical assistants.

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MGMA/Maine Offers Preparing for ICD-10 on March 25th

The Medical Group Management Association, Maine affiliate, will present a half day educational session by Laurie Desjardins, CPC, PCS entitled, Preparing for ICD-10 on March 25, 2010.  The program will take place from 8:30 a.m. to noon at the Maine Medical Association office in the Frank O. Stred Building, 30 Association Drive, Manchester, Maine 04351.  You may also participate by WebEx.  The cost of the program is $25 for MeMGMA members and $45 for non-members.  The webinar price is $50 per computer.  

For more information, contact Karen Wheeler at 873-6173 or [return to top]

CMS Announces Reorganization

The Centers for Medicare and Medicaid Services (CMS) has announced a proposed "modest realignment."  While the Secretary of Health & Human Services  has not yet officially approved the plan, the Administration anticipates that it will take effect in approximately 60 days.

 Under the realignment, CMS will establish the position of the Principal Deputy Administrator, an Office of External Affairs and Beneficiary Services, and four Centers led by Deputy Administrators (Center for Medicare; Center for Medicaid, CHIP and Survey & Certification; Center for Program Integrity; and Center for Strategic Planning).  The Center for Medicare combines Medicare fee-for-service, managed care, and the prescription drug benefit.  The Center for Medicaid and State Operations is renamed the Center for Medicaid, CHIP and Survey & Certification.  The Center for Program Integrity combines the Medicare Program Integrity Group and the Medicaid Integrity Group.  The Center for Strategic Planning realigns the Office of Research, Development, and Information and the Office of Policy.  The Office of External Affairs & Beneficiary Services combines the Office of Beneficiary  Information Services with the Office of External Affairs.

Within the CMS Administrator's office, there are 5 offices that will remain in place:  Office of Equal Opportunity & Civil Rights; Office of Legislation; Office of the Actuary; Office of Clinical Standards & Quality; and Office of Strategic Operations & Regulatory Affairs. [return to top]

Legislative Committee Conference Calls Resume this Week

Despite unpleasant weather last Thursday evening, a number of physicians participated in the MMA Legislative Committee's forum on the state budget situation and Maine's health care system.  Guests for the Forum included Commissioner Brenda Harvey and director of legislative and constituent services Lucky Hollander from DHHS and legislators Senator Lisa Marrache, M.D. (D-Kennebec), Senator Peter Mills (R-Somerset), Representative Lisa Miller (D-Somerville), Representative Pat Flood (R-Winthrop), Representative Linda Sanborn, M.D. (D-Gorham), and Representative Meredith Strang Burgess (R-Cumberland).  The legislators represented both the Appropriations and HHS Committees of the legislature.  The discussion was excellent with great interaction between the physicians and policymakers.  

The Committee will return to its weekly conference call this Thursday, March 4th at 8:00 p.m. using the following toll free number and access code:  1-877-669-3239; access code 23045263.  The MMA staff will provide an update on the week's activities at the legislature.  March should be the last month of this legislative session.  As usual, the MMA encourages any interested physician or physician staff member to participate. [return to top]

POLITICAL PULSE: HHS Committee Recommends Bond for HIT


In the wake of an unsuccessful effort last session, Senator Marrache submitted for consideration this year L.D. 1761, An Act To Authorize a General Fund Bond Issue To Create a New Electronic Medical Records Infrastructure, a bill that proposes a $10 million bond issue to assist health care providers to access the hardware and software necessary to the electronic exchange of health care information.  This funding is considered critical to the success of HealthInfoNet.  The MMA joined others in testifying in support of the bill at the public hearing last Tuesday afternoon and at a work session on Thursday afternoon, the HHS Committee recommended passage.  It will now go to the Appropriations Committee to await the conclusion of the biennial budget process.  The Appropriations Committee has not yet discussed whether they will support any bond issues this session.


Last Friday afternoon, the Criminal Justice & Public Safety Committee held an initial, lengthy work session on L.D. 1611, An Act to Ensure Humane Treatment for Special Management Prisoners without reaching a conclusion on the bill.  The Maine Association of Psychiatric Physicians (MAPP) supports the bill.


Last week, the Appropriations continued its work on the FY 2010-2011 biennial budget, L.D. 1671.  The HHS Committee reported back on its latest budget work on Wednesday afternoon.  The Committee received some good news last week when state revenue re-projections came in higher than expected thereby reducing the budget gap.  It still is unclear whether additional federal stimulus money may be available to help the Committee with this budget.  The National Governors Association continues to lobby Congress to extend the enhanced Medicaid match for the states included in the 2009 stimulus law.  The ARRA provided each state with a 6.2% increase in their federal matching rate with an additional increase based on unemployment.  The additional funding expires at the end of December, in the middle of most states' fiscal years.

You can find the Appropriations Committee materials on the web at: .


The HHS Committee will hold a work session on the MRSA bill opposed by MMA, MOA, MHA, and others (L.D. 1687) on Wednesday afternoon, March 3rd.

Tomorrow the Committee will hold a public hearing on L.D. 1706, An Act to Create the Children's Wireless Protection Act , a first in the nation bill sponsored by Representative Andrea Boland (D-Springvale) that would require a health warning on cell phones.  Maine CDC Director Dora Mills, M.D., M.P.H. plans to testify in opposition to the bill.  The MMA has decided not to testify on the bill, though it knows of no scientific evidence of the adverse health effects of cell phone usage.


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