April 5, 2010

Subscribe to Maine Medicine eNewsletters
Manage Your Subscriptions
Email our Editor...
Maine Medical Association Home Page
. Search back issues
. Plain Text Version
Printer Friendly

President Obama Defends Health Care Bill in Visit to Portland

President Barack Obama visited Portland last Thursday and defended the recently signed health care reform bill against the claims of critics that it represents a government takeover.  Introduced by Karen Mills of Brunswick, Director of the Small Business Administration, the President emphasized the benefits of the bill to small businesses, seniors, and those individuals currently without insurance.  Obama told the enthusiastic audience of more than 2000 at the Portland Expo that the new law will soon provide tax credits to small businesses, improve benefits to seniors, and protect individuals from being denied insurance because they are ill or have a chronic disease.

The President took on the critics directly, stating that he hoped the Republicans would campaign on a platform of repeal in November noting that, "my attitude is, go for it.  I want these members of Congress to come out of Washington, come to Maine and say 'We're going to take away your tax breaks.' "  Attending the President's speech representing MMA were Richard Evans, M.D., senior AMA delegate, President-elect Jo Linder, M.D., Kellie Miller, and Gordon Smith.  Also seen in the audience were Laurel Coleman, M.D. of Manchester, Lisa Letourneau, M.D. of Scarborough, Jeff Aalberg, M.D. from MaineHealth, and Barbara Crowley, M.D. of Maine General Medical Center.

Obama praised Gov. Baldacci and thanked Congresswoman Chellie Pingree and Congressman Mike Michaud for their support of the bill that finally passed.  He also thanked Senator Olympia Snowe for contributing to the bill, although she ultimately voted against it.  In media interviews on the same day, Senator Snowe said she considered the President a friend and that they had a good relationship in communicating.  And while she noted that some of her ideas were incorporated into the bill, she stated, "but not enough of them and then the bill started to take a new direction."

Once Senator Snowe had supported the bill which came out of the Senate Finance Committee, Senate Majority Leader Harry Reid took the process behind closed doors and any hope of bi-partisanship was gone.  Senator Snowe expressed particular concern about the Medicare payroll tax. 

Provisions in the reform law which take effect this year include:

  • The ability of state of set up high risk pools to provide coverage to those persons with significant medical conditions and high costs.  The law appropriates $5 billion to be used by the states for this purpose.

  • Most of the insurance reforms take effect this year, such as the prohibition on lifetime caps and cancellation provisions.  Young adults will be able to stay on their parents policy until age 26.

  • Small businesses employing less than 25 individuals will be eligible for tax credits up to 35% of the cost of providing health insurance to its employees.  The amount of the credit increases as the number of employees decreases.

  • The so-called donut hole for seniors participating in the Medicare drug program will start to shrink immediately, but would not be fully closed until 2020.  But in the meantime, seniors in the gap would receive a 50% discount on brand-name drugs.  Preventive benefits for seniors will also be improved under Medicare.

Of particular value to Maine are provisions benefitting care in underserved areas, better reimbursement for primary care, and studies of geographic differences in reimbursement across the country.  Many of the insurance reforms are already part of Maine law.

Record Crowd Attends MMA's Annual HIPAA Update last Friday

More than 75 office managers and staff participated in last Friday's Annual HIPAA update, with more than 50 in the Manchester office and another 25 participating via webinar.  In addition to reviewing the state and federal privacy laws, faculty focused on the changes to HIPAA included in the American Recovery and Reinvestment Act of 2009.  These changes were included in that part of the federal "stimulus" bill entitled, the Health Information Technology for Economic and Clinical Health (HITECH).   In its most significant provision, the Act mandates how health care providers must respond when patients' protected health information is breached.

Under the original HIPAA law, which took effect in April of 2003, there was no obligation to advise a patient of a breach of their privacy.  Under HITECH, providers and other covered entities are required to notify an individual whose unsecured protected health information (PHI) has been accessed, acquired, or disclosed as a result of a breach of privacy or security within 60 days of the discovery of the breach, and perhaps sooner if feasible.

The federal Department of Health & Human Services issued rules, effective Sept 23, 2009, that dictate the content and methodology of the notification.  In most instances, notification must be in writing and mailed directly to the individual.  If the personal health information of 500 or more patients is involved, then notification to the media must occur, along with a notice to the Secretary of HHS.  Providers must keep a log of any breaches and annually report them to HHS not later than 60 days after the end of each calender year.

There are some exceptions to the requirement to notify a patient, including in the rule a provision that the definition of  compromises the security or privacy of PHI means "poses a significant risk of financial, reputational, or other harm to the individual."  Thus, to determine if an impermissible use or disclosure is a breach, health care providers must engage in a risk assessment that should be fact specific and documented.  If the risk assessment reveals that no harm occurred, a notification may not be necessary.

Additional changes to HIPAA took effect in February 2010, including:

  • Access in an electronic format must be provided to individuals whose PHI is part of an electronic health record.

  • An individual has a right to request that no disclosure of PHI be made to a Payer, and have it honored, if the individual self paid for the relevant medical care.

  • Business Associates are directly subject to the HIPAA Privacy and Security Regulations and the civil and criminal penalties for non-compliance.

  • The secretary of HHS is required to periodically audit Covered Entities and Business Associates for compliance with the HITECH Act and the HIPAA Privacy and Security Regulations.

Later this year, the DHHS Office of Civil Rights (OCR) plans to finalize its interim final rule on breach notification and to publish an omnibus package of regulations to clarify aspects of the Privacy and Security Regulations.

MMA members and their practice staff are welcome to contact either Andrew MacLean, Esq. or Gordon Smith, Esq. at MMA with HITECH or HIPAA questions (amaclean@mainemed.com; gsmith@mainemed.com).   MMA staff can also come to your office and present an abbreviated version of the program offered Friday.  There is a $200 charge which covers travel and all materials.  A HIPAA training certificate is included.  Contact Gail Begin at MMA (gbegin@mainemed.com) to schedule a presentation.

  [return to top]

16th Annual KIDS Count Report Released; Poverty Rate still High

Many children in Maine continue to live in families with incomes under the federal poverty level, according to the 16th annual Kids Count report.  The report is used to identify pubic policy issues and to advocate for children's issues at the state house and around the state.  The Report also identified a high incidence of juvenile mental and behavioral issues.  The Report was officially released at a state house event last Monday, March 29th.

According to the Report, about 16.5% of children under 18 years of age in 2008 were living in families with incomes of 100% or less of the federal poverty level.  This was one percent more than in 2007.  The poverty level for a family of four in 2008 was $21,200. 

The Maine Children's Alliance, an advocacy group for children, annually compiles the data and published the report.

The Maine Kids Count report is available online at www.mekids.org.

  [return to top]

AMA Coordinates Health IT Meaningful Use Comments

The AMA has continued its efforts to bring medicine together to respond to the Obama Administration's health IT initiative.  A joint comment letter, signed by 47 specialty and 48 state medical societies, was sent on March 15th to CMS regarding the proposed rule on the Medicare/Medicaid EHR program.  The letter maintained that the criteria CMS outlined in the proposed rule is too aggressive and, if adopted, will deter many physicians from participating in the Medicare and Medicaid incentive programs.  The letter urged CMS:

  • Abandon its "all or nothing" approach and require physicians to meet five objectives and measures instead of 25;
  • Eliminate objectives/measures that were not germane to EHR adoption, such as checking insurance eligibility electronically;
  • Broaden the proposed definition for hospital-based physicians; and
  • Reduce the number of quality measure reporting requirements.

You can find materials related to the AMA's advocacy on these HIT issues on the web at:  http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/health-information-technology/hit-resources-activities.shtml.
[return to top]

Obama Administration Announces New Fraud Control Initiatives

On March 10th, President Obama announced expanded fraud and abuse control initiatives for Medicare, Medicaid, and other federal programs, including an Executive Order that directs all federal agencies (not just health care agencies) to expand and intensify their use of "payment recapture audits," otherwise known as the Recovery Audit Contractors (RACs) program, which currently operates only in the Medicare fee-for-service program.  The President also announced support for the bipartisan Improper Payments Elimination and Recovery Act, introduced by Senators Tom Carper (D-DE) and Tom Coburn, M.D. (R-OK), that would expand the government's ability to fund these audits with recaptured payments.  While the AMA has taken no position on this legislation, AMA policy opposes expansion of the RAC program and the AMA continues to express strong concerns about the program to Congress and the Obama Administration.

Preventing health care fraud will be a major focus of the Administration moving forward.  The AMA is actively engaged in discussions with the Department of Health & Human Services, Department of Justice, and CMS about these efforts and the government has assured the AMA that there will be a significant role for the physician community to work on the design and implementation of these efforts.   [return to top]

Health, Culture & Literacy Conference Scheduled for April 30th in Hallowell

A 1-day skill-building conference for primary healthcare providers entitled, Health, Culture & Literacy:  Solutions for Clear Health Communication is scheduled for Friday, April 30th from 8:30 a.m. to 4:00 p.m. at the Maple Hill Farm B&B and Conference Center in Hallowell.  

The program sponsors include:

  • MaineHealth Learning Resource Center
  • University of New England
  • Eastern Maine Health System
  • Harvard Pilgrim HealthCare Foundation

and the following collaborators:

  • Central Maine Medical Center
  • Maine CDC, Minority Health Program
  • Maine Medical Center
  • MaineGeneral Medical Center
  • Mercy Hospital
  • Stephens Memorial Hospital
  • Waldo County General Hospital

Depending on category, the program fee runs from $30 to $85 with a $10 per person discount for practices who wish to have 2 or more staff participate.

For physicians & nurses, 5.5 hours of CME is available.

For more information, please visit www.mainehealth.org/healthliteracy.


  [return to top]

MaineGeneral Spring Coding & Compliance Conference Scheduled for May 7th

MaineGeneral Health is holding its Spring Coding & Compliance Conference on Friday, May 7th from  8:00 a.m. to 4:00 p.m. at the Augusta Civic Center, North Wing.  

The speakers and topics for the conference include:

  • Steven L. Johnson, Esq. of Kozak & Gayer, P.A. with a presentation entitled, Taking the Mystery Out of Healthcare Research, What Trumps What?
  • Elliot Sarantakos, CPHQ, CPHRM with a presentation entitled, Hot Risk Management Topics for Physician Practices
  • Laurie Desjardins, CPC, PCS with an afternoon Interactive Hands On Coding Workshop covering primary care and general surgery coding and specialty coding with a focus on gastroenterology, neurology, and pulmonary medicine coding 

The program is approved by the AAPC for 6.5 CEUs.

The registration deadline is April 30th.

The program is free for MaineGeneral Health employees and the cost for others is $75.00.

For more information, please contact Lisa Beeckel, CPC, MGMC Physician Liaison by phone at 626-1094 or by email at lisa.beeckel@mainegeneral.org. [return to top]

Neonatal Care is Focus of Maine Chapter, AAP Spring Conference May 1st & 2nd at Sunday River

The Maine Chapter of the American Academy of Pediatrics is holding its Spring 2010 Conference featuring Things You Need to Know Tomorrow to Take Care of Neonates on May 1st & 2nd at Sunday River in Bethel, Maine.  

The Maine Chapter has some exciting new plans for this year's conference:

  • Shorter days with free time for lunch on your own or other family activities
  • Family Fun Fest Activities
  • Shorter Business Meeting
  • Sunday breakfast included for each conference registrant
  • Reduced-price children's meals
  • Childcare room available during the entire conference (unstaffed)
  • Saturday dinner includes musical entertainment

Online registration for this conference is very easy by going to www.maineaap.org/conferences.htm.   You will receive a $10 discount if you register by April 9th.

For more information, please contact Aubrie Entwood, Chapter Executive Director

Phone:  207-782-0856

Fax:  866-286-3818



[return to top]

124th Maine Legislature Expected to Adjourn Sine Die by Wednesday

Members of the 124th Maine Legislature returned from the Easter/Passover holiday weekend to finish the work of their Second Regular Session that began just after the New Year.  Bonds, energy policy, tax reform, and gambling are among the issues remaining before the legislature.  Although the statutory adjournment deadline is April 21st, the MMA expects adjournment to take place either Tuesday or Wednesday of this week.

Awaiting debate in the House is L.D. 1611, An Act to Ensure Humane Treatment for Special Management Prisoners, a bill addressing the use of solitary confinement in the Department of Corrections.  The debate on this bill produced 3 reports from the Criminal Justice & Public Safety Committee.  A 7-member majority of the committee recommend that the bill "ought not to pass."  Four members of the Committee recommend passage of a Resolve.  The amendment replaces the title and the bill and creates a resolve directing the Commissioner of Corrections, in consultation with the mental health and substance abuse focus group of the State Board of Corrections, to review due process procedures and other policies related to the placement of special management prisoners.  The amendment also requires the commissioner to consider an appropriate timeline for regular reporting to the joint standing committee of the Legislature having jurisdiction over corrections matters and to report all recommendations, including any suggested policy or legislative changes, to that committee by January 15, 2011.  Upon receiving that report, the committee may report out a bill to the 125th Legislature.  Two members of the Committee recommend passage of an amendment that would establish by statute minimum standards for special management prisoners.

Tomorrow, MMA representatives will attend the Governor's signing ceremony for L.D. 1620, An Act to Protect Health Care Consumer from Catastrophic Debt, a bill that prohibits health insurers in Maine from imposing lifetime or annual caps on coverage in their policies.  Consumers for Affordable Health Care brought the bill forward and it received support from the MMA and other groups.  Dr. Paul Liebow took an active role in lobbying for passage of this bill.

Last Thursday evening, the MMA Legislative Committee held its final conference call of the season.  The MMA thanks Committee Chair Lisa Ryan, D.O., a Bridgton pediatrician,. for her leadership of the committee and to every physician, physician assistant, or staff member who assisted in our advocacy efforts during the past two years.  The Committee will organize for the 125th Maine Legislature next fall.  It's not too early to be thinking about the MMA's legislative agenda for the next legislature.  If you have suggestions, please contact Andrew MacLean, Deputy EVP, at 622-3374, ext. 214 or at amaclean@mainemed.com.

  [return to top]

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