June 14, 2010

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Senate Considers Tax Extenders Package; This Week is Critical for SGR Resolution

Last week, the Senate began consideration of H.R. 4213, the American Jobs and Closing Tax Loopholes Act of 2010, which includes provisions to suspend the Medicare physician payment cuts produced by the sustainable growth rate (SGR) for 19 months.  The Senate version of this legislation would reverse the 21 percent cut that went into effect on June 1, 2010.  It would provide a 2.2 percent update to physician payment rates for the rest of this year, and an additional 1 percent update for 2011.  This proposal is identical to one included in the extenders package that passed the House shortly before Memorial Day.  In 2012, the underlying SGR payment formula would resume again, and physicians would face a 33 percent cut in Medicare payment rates. This proposal is estimated to cost $22.9 billion over 10 years.  The Senate package also restored a six-month extension (through June 30, 2011) of increased federal Medicaid funding that was originally included in the stimulus legislation. This provision costs $24.2 billion over 10 years.  Maine physicians are encouraged to communicate with Senators Snowe and Collins emphasizing the importance of Senate action immediately to reverse the cut which will probably be implemented today or early this week. 

At the request of Majority Leader Harry Reid (D-NV), Senator Stabenow (D-MI) considered offering an SGR-related amendment to the Senate extenders package.  Elements of the amendment under discussion included a 1.5 percent Medicare physician payment update for the remainder of 2010, a 1.0 percent payment update in 2011, and updates for 2012-13 established under two expenditure targets--one for evaluation and management services and one for all other physician services.  The SGR formula would resume in 2014 to reflect current law and physicians would face cuts of approximately 35 percent.  The AMA has consistently communicated to the Congress that it would not support any legislation that relies on a financing scheme that produces steeper cuts in the future and grows the cost of a permanent repeal of the SGR.  Senator Stabenow decided not to pursue this amendment.

On Thursday, June 11th, Senator Thune (R-SD) offered a complete substitute amendment to the entire package on behalf of Senate Republicans.  This proposal would provide 2 percent Medicare physician payment updates for the remainder of 2010, and in 2011 and 2012.  While CBO has not provided information on the size of the 2013 cut, we estimate that it would exceed 33 percent.  Additionally, this proposal would cut Medicare physician payments by an additional 4 percent in 2014.  The provision is estimated to cost $43.3 billion over 10 years, offset by a variety of medical liability reforms, including caps on noneconomic damages, expert witness qualifications, alternative dispute resolution provisions, and a fair-share rule for multiple defendants.  CBO scored these provisions as saving $49.7 billion over 10 years.

Wednesday was the only day last week that the Senate voted on amendments to H.R. 4213.  The Senate was not in session on Friday and no votes will be held on Monday, so this Tuesday is the earliest that the Senate will resume voting on amendments to H.R. 4213.  There are reports that the Senate will hold a cloture vote on Wednesday in an attempt to end debate on H.R. 4213.  Thus, final Senate action on this package can not occur until well into this week.  Given that the Senate legislation differs from the House-passed bill in several respects, the House will have to pass the Senate version before the June 1st physician payment cut can be reversed.  Given controversy surrounding some of the Senate’s changes to the House-passed legislation, the House could also decide to amend the Senate passed version and send it back to the Senate.

As noted previously, The Centers for Medicare & Medicaid Services (CMS) instructed its carriers to hold Medicare claims for services provided on or after June 1st for 10 business days.  That claims hold expires on June 14th.  As a result, any further delay in passage of a common legislative proposal by the House and Senate will likely result in Medicare claims being processed at the 21 percent lower payment rates starting on June 15th or shortly thereafter.  

The Senate's failure to take action on this problem is unacceptable.  Three times this year, the Senate has allowed a 21 percent cut to go into effect.  This week will exceed CMS' claims holding deadline, so the cuts will be implemented.   This inaction will cause significant disruption for patients and physicians.  All physicians are urged to call Congress and urge them to take immediate action to stop the cuts now and address the SGR in a meaningful and responsible manner.  It is imperative that Congress understands how its mismanagement of the Medicare program is wreaking havoc on physician practices and jeopardizing access to care for seniors and military families.  Physicians should use the AMA Grassroots Hotline, at 
1.800.833.6354.  Or, you may send an email via:  http://www.capwiz.com/ama/issues/alert/?alertid=15086046&type=CO.


President Obama Calls on Senate Republicans to Allow a Vote to Protect Medicare Reimbursements

In last week's radio address, President Barack Obama called on Senate Republicans to stop blocking a vote to prevent a 21% pay cut for doctors who see Medicare patients - a pay cut that will hurt American's seniors and their doctors.  Since 2003, Congress, under Republican and Democratic leadership, has deferred these cuts in Medicare reimbursements from going into effect.  The President is committed to finding a responsible, long term solution to this problem, but it is not acceptable to punish American's seniors or the physicians who treat them.  If Congress does not act, then doctors will start receiving lower Medicare reimbursements this week, which could lead to seniors losing their doctors.

The above statement is from a White House press statement issued Saturday, June 12th. 

A video of the President's statement is available online at www.whitehouse.gov.

The President's remarks follow:

More than a decade ago, Congress set up a formula that governs how doctors get paid by the Medicare program.  The intent was to slow the growth of Medicare costs, but the result was a formula that has proposed cutting payments for America's doctors year after year.  These are cuts that would not only jeopardize our physicians' pay, but our seniors' health care.

Since 2003, Congress has acted to prevent these pay cuts from going into effect.  These votes were largely bipartisan, and they succeeded when Democrats ran Congress and when Republicans ran Congress, which was most of the time.

This year, a majority of Congress is willing to prevent a pay cut of 21% - a pay cut that would undoubtedly force some doctors to stop seeing Medicare patients altogether.  But this time, some Senate Republicans may even block a vote on this issue.  After years of voting to defer these cuts, the other party is now willing to walk away from the needs of our doctors and our seniors.

Now, I realize that simply kicking these cuts down the road another year is not a long-term solution to this problem.  For years, I have said that a system where doctors are left to wonder if they'll get fairly reimbursed makes absolutely no sense.  And I am committed to permanently reforming this Medicare formula in a way that balances fiscal responsibility with the responsibility we have to doctors and seniors.  In addition, we're already taking significant steps to slow the growth of Medicare costs through health insurance reform - not be targeting doctors and seniors, but by eliminating 50% of the waste, fraud, and abuse in the system by 2012.  This not only strengthens Medicare, it saves taxpayer dollars.

I'm absolutely willing to take the difficult steps necessary to lower the cost of Medicare and put our budget on a more fiscally sustainable path.  But I'm not willing to do that by punishing hardworking physicians or the millions of Americans who count on Medicare.  That's just wrong.  And that's why in the short-term, Congress must act to prevent this pay cut to doctors.

If they don't act, doctors will see a 21% cut in their Medicare payments this week.  This week, doctors will start receiving these lower reimbursements from the Medicare program.  That could lead them to stop participating in the Medicare program.  And that could lead seniors to lose their doctors.

We cannot allow this to happen.  We have to fix this problem so that our doctors can get paid for the life-saving services they provide and keep their doors open.  We have to fix this problem to keep the promise of Medicare for our seniors so that they get the health care they deserve.  So I urge Republicans in the Senate to at least allow a majority of Senators and Congressmen to stop this pay cut.  I urge them to stand with America's seniors and America's doctors. [return to top]

American Medical Association House of Delegates Convenes for Annual Meeting

The AMA House of Delegates convened in Chicago on Saturday, June 12th to begin its Annual Meeting which will conclude on Wednesday morning.  Maine physicians are represented at the meeting by delegates Richard Evans, M.D., a general surgeon practicing in Dover-Foxcroft, John Makin, M.D., a retired ob-gyn from Waterville and alternate delegates Maroulla Gleaton, M.D., an ophthalmologist practicing in Augusta and MMA President David McDermott, M.D., M.P.H., a family physician who is Director of Emergency Medicine at Mayo Regional Hospital in Dover-Foxcroft.  MMA President-elect Jo Linder, M.D. is also attending as an alternate delegate for the American College of Emergency Physicians as is EVP Gordon Smith, Esq.

More than 200 policy proposals will be considered on emerging issues in science, ethics, government, public health, and business.  Physicians will vote on which proposals will be incorporated into the AMA health care agenda.

Avoiding an impending Medicare meltdown as a result of the pending reduction in reimbursement is a highlight of the meeting, as is continuing discussion of the AMA's role in federal healthcare reform.  The AMA will highlight the Congress' mismanagement of the Medicare program at a news conference at 11:30 am (CT) today, June 14th.

Among the proposals to be discussed during the meeting:

  • Enhancing personalized medical care using genetic technologies
  • Regulating e-cigarettes as drug delivery devices
  • Banning Bisphenol A from plastic children's products
  • Opposing the "purging" of targeted patients by health insurance companies
  • Increasing physician practices in underserved areas

For a comprehensive list of the items to be considered by the House of Delegates, please visit the AMA Web site at:  http://www.ama-assn.org/ama/pub/meeting/index.shtml 

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Volunteers Needed for MMA Committees, 2010-2011

Watch for your May-June issue of Maine Medicine which will contain an insert listing the MMA committees and a request for volunteers.  The Committee on Nominations, chaired by Jo Linder, M.D., will be meeting this summer to prepare a report for the Annual Session being held in Bar Harbor September 10-12, 2010.   The Committee would welcome volunteers to serve on the following committees during the MMA election year which runs from September 2010 to September. 2011:

Committee on Legislation

Public Health Committee

Committee on Physician Quality

Committee on Membership and Member Benefits

Committee on Bylaws

Committee on Loan and Trust Administration

Committee on CME and Accreditation

Ad Hoc Committee on Technology

There also are vacancies currently on the Executive Committee from Oxford County, Lincoln-Sagadahoc Counties, and Waldo County. 

Any member interested on serving on a committee or desiring more information on a committee should contact EVP Gordon Smith at 622-3374, ext. 212 or via e-mail to gsmith@mainemed.com.

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AHRQ Releases Liability Grants

The US Department of Health and Human Services (HHS) Agency for Healthcare Research and Quality (AHRQ) announced the recipients of the medical liability reform and patient safety grants last Friday.  These grants are the result of strong AMA advocacy for physicians and close collaboration with the state medical associations, as we continue to work for comprehensive medical liability reform. 

The grants fall into two categories:

  • Grants to jump-start and evaluate efforts. Three-year grants of up to $3 million to states and health systems for implementation and evaluation of medical liability and patient safety demonstrations.
  • Planning grants. One year grants of up to $300,000 to states and health systems in order to plan to implement and evaluate medical liability and patient safety demonstrations.

The grant recipients are:

Demonstration Grants:


  • Timothy McDonald, M.D., J.D., University of Illinois at Chicago, IL, $2,998,083.
  • Stanley Davis, M.D., Fairview Health Services, Minneapolis, MN, $2,982,690.
  • Eric Thomas, M.D., M.P.H., University of Texas Health Science Center, Houston, TX, $1,796,575.
  • Ann Hendrich, M.S., R.N., F.A.A.N., Ascension Health System, St. Louis, MO, $2,990,612.
  • Thomas Gallagher, M.D., University of Washington, Seattle, WA, $2,972,209.
  • Judy Kluger, J.D., New York State Unified Court System, New York, NY, $2,999,787.
  • Alice Bonner, M.S., APRN, BC, Massachusetts State Department of Public Health, Boston, MA, $2,912,566.

Planning Grants:

  • Lynn Marie Crider, J.D., Office for Oregon Health Policy and Research, Portland, OR $299,458.
  • Richard David, M.D., John Hopkins University, Baltimore, MD, $293,225.
  • Dianne Garcia, J.D., Multicare Health System, Tacoma, WA, $291,810.
  • Wendell Hoffman, M.D., Sanford Research, Sioux Falls, SD, $294,137.
  • Elizabeth Guenther, M.D., M.P.H., University of Utah, Salt Lake City, UT, $299,999.
  • Karen Domino, M.D., M.P.H., University of Washington, Seattle, WA, $295,837.
  • David Baker, Ph.D., Carilion Medical Center, Roanoke, VA, $280,924.
  • Kenneth Sands, M.D., M.P.H., Beth Israel Deaconess Medical Center, Boston, MA, $273,782.
  • Nicoletta Tessler, M.A., Psy.D., Jackson Memorial Hospital, Miami, FL, $299,576.
  • Cynthia Shellhaas, M.D., M.P.H., Ohio State University, Columbus, OH, $187,437.
  • John Buckley, M.D., Wishard Health Services, Indianapolis, IN, $154,124.

AMA will work with the state medical associations to help implement these new programs to determine if they have a positive effect.  For more information, please see the AHRQ Web site:  http://www.ahrq.gov/qual/liability/

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Medical Mutual Offers Free Practice Management Seminar Later This Month

Medical Mutual Insurance Company of Maine (MMICOM) is offering a practice management seminar entitled, Improving Systems Performance in the Office Practice at the Marriott Sable Oaks in South Portland from noon to 4 p.m. on June 29, 2010.  The seminar is open to managers of practices insured by Medical Mutual and there is no charge for these practices.  The seminar will take a closer look at test tracking and appointment management systems, as well as liability and the EMR. [return to top]

MMA Offering CME Programs on HIPAA, the Federal Health Reform Bill (PPACA) and Medicinal Marijuana

MMA is now offering CME presentations on the following topics:

  • HIPAA Update;
  • Treating Chronic Pain While Preventing Diversion of Narcotics (offered in conjunction with the Maine Office of Substance Abuse);
  • Federal Health Care Reform Law; and
  • Medicinal Marijuana Law.

MMA offers these programs to various audiences, including specialty societies, office staff, and other interested groups.  A fee of $200 is normally charged to cover travel and copying costs for the materials.  If your practice or group is interested in a presentation, contact Gail Begin at 622-3374, ext. 210 or via e-mail to gbegin@mainemed.com. [return to top]

MMA and OSA Team Up for Free CME in Wells this Friday!

The Maine Medical Association and the State Office of Substance Abuse will present Comprehensive Management of Patients with Acute & Chronic Pain While Preventing Diversion, a three hour CME seminar in Wells on Friday, June 18th.  The program will be held from 9:00 a.m. to noon at the Village by the Sea on Rt. 1 (1373 Post Rd.) in Wells.  There is no cost for the program.

Faculty for the program include Mark Publicker, M.D., an addiction specialist and Director of the Recovery Center at Mercy Hospital, Daniel Eccher of the Office of Substance Abuse, and Gordon Smith, Esq., Executive Vice President of the Maine Medical Association.  Dr. Publicker will share best practices in the areas of pain control, addiction treatment, and prevention.  He will also discuss how to manage pain without causing addiction.

Registration materials are available from the MMA office (call 622-3374, ext. 219) or you may register on the MMA website at www.mainemed.com

The program is made possible through a grant by the Maine Office of Substance Abuse. [return to top]

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