August 2, 2010

 
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Legislature's Appropriations Committee Informed of Potential $1 Billion Budget Shortfall

At a meeting of the Legislature's Appropriations Committee last Tuesday, July 27th, committee members heard from administration officials that the shortfall in the next biennial budget (July 1, 2011 - June 30, 2013) is likely to exceed $1 billion.  Of that total, the Department of Health & Human Services represents more the half of the anticipated shortfall.  If the Congress fails to pass legislation granting a six-month extension of Medicaid's enhanced Federal Medical Assistance Percentage (FMAP) for states, Maine will be one of 27 states that included the enhanced match in the current year budget, thereby facing a nearly a $100 million shortfall as a result. 

MMA has encouraged Maine's Congressional delegation to support legislation that will extend FMAP for six months beyond the current expiration date of December 31, 2010. 

Regarding the anticipated shortfall in the next biennial budget, other factors contributing to the deficit in addition to DHHS include payment to the state pension fund of $172 million toward the unfunded liability.

The budget information was presented by the newly appointed Commissioner of the Department of Administration & Financial Services, Ellen Schneiter, and Grant Pennoyer, Director of the Legislature's Office of Fiscal & Program Review.  Commissioner Schneiter in the 1990's served as Deputy Executive Director of the Maine Medical Assessment Foundation.

In response to questioning from committee members, Schneiter stated that the DHHS budget has been held to a zero growth trend even though the inflation trend for medical care has been approximately 8 percent.  She noted that the work on rate standardization and managed care could be helpful in the future.

The budget shortfall does not include the approximately $300 million state and federal dollars owed to Maine hospitals for MaineCare settlements for 2007 through 2010.

Commissioner Schneiter also indicated that there were no current plans for Governor Baldacci to call a special session of the Legislature to deal with the shortfall in the current budget, caused by the failure of Congress (to date) to pass the FMAP extension.  Instead, the Governor plans to provide a menu of options for the new administration to assist them in preparing a supplemental budget for state fiscal year 2011.

Thanks to Mary Mayhew of the Maine Hospital Association for assistance with this article.

 

Wal-Mart Opens Retail Clinic Operated by Inland Hospital in Waterville

On Saturday, July 31st, a retail health clinic opened in the Wal-Mart Supercenter in Waterviile.  The Clinic at Wal-Mart is operated by Inland Hospital and will be open seven days a week offering routine check-ups, immunizations, and screenings for minor illnesses.  The 550-square-foot facility will be staffed primarily by two nurse practitioners.  This is the fourth retail clinic opened up this year associated with Eastern Maine Healthcare Systems, the corporate parent of Inland Hospital.  The other clinics are operated in Bangor, Brewer, and Presque Isle.

John Dalton, Inland's President and CEO, stated in a press article that the hospital expected to break even financially on the clinic after about a year of operation.

According to the clinic's rate card, services include $14 for a pregnancy test, $29 for a flu vaccine, and $49 for treatment of a sinus infection or physical examination.  The most expensive services cost $69, for treatment of urinary tract and bladder infections and ear wax removal.

In the press article concerning the opening of the clinic, MMA EVP Gordon Smith is quoted as stating that MMA has no objection to such clinics operated by Maine providers.  "Competition is good and it's important that patients have an opportunity to find medical care at times and places that are convenient for them.  Such clinics may also help amid a shortage of primary care doctors."

Smith also noted that it would be important, in order to prevent fragmentation of care, for the clinic to share medical records of the visit with any primary care physician identified as the patient's regular physician, but the continuity of care issue was not dealt with in the news article, which appeared in both the Kennebec Journal and the Waterville Morning Sentinel.

The article did go on to state that MMA had noted that the handful of other clinics that had opened in Maine recently had not been very successful.  "There's not a lot of money to be made in health care in Maine," Smith said.  "So many patients are on Medicare or Medicaid, or are uninsured.  It's a difficult demographic.  We struggle up here to provide primary care as it is, and most people don't see it as a business opportunity."

The MMA has supported the AMA's position on retail clinics, outlined in House of Delegates Resolution 160.921, Store-based Health Clinicshttps://ssl3.ama-assn.org/apps/ecomm/PolicyFinderForm.pl?site=www.ama-assn.org&uri=/ama1/pub/upload/mm/PolicyFinder/policyfiles/HnE/H-160.921.HTM. [return to top]

MMA Executive Committee Meeting Report

The Executive Committee of MMA held its summer meeting this past Wednesday, July 28th at the Dover-Foxcroft home of President David McDermott, M.D., M.P.H. and his wife Ellen.  In addition to accepting a 2011 budget proposed by the Budget & Investment Committee, members discussed the need for a communications strategy that would encompass a re-design of the website and a review of MMA's various publications, including this Weekly Update.  More survey work will be done to determine how members receive MMA information now and how each member would prefer to receive it.

The proposed budget will be presented to MMA members for a vote at the Annual Membership meeting on September 11, 2010 in Bar Harbor.  The budget does not propose any dues increase and imposes a salary freeze for all staff.  Even with the salary freeze, the budget shows a deficit of more than $30,000 that would have to be made up from the Association's reserves.  Members expressed concern about the continued reductions in the reserves, which have eroded considerably in the past few years.  Further discussion of the budget can take place at the Annual Meeting.  The Annual Meeting is open to any MMA member and there is no charge for attending just the business meeting portion of the Annual Session on Saturday morning begining at 7:30 a.m.

On a more positive note, the Association's membership continues to increase, both in the active membership category and the non-dues category (students, residents, retirees).  Active membership now stands at 1958 members, the most ever in the history of the Association.  Overall membership exceeds 3300.

Executive Committee members also authorized formation of an ad hoc Committee on Governance that would review, among other things, the Executive Committee composition and appointment.  An initial meeting will be held in August with a final report due back to the Executive Committee at its retreat in January 2011.

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DHHS Announces MaineCare PDL Changes in Response to Federal Reform

The recent Healthcare Reform (HCR) Act will change the way certain medications are viewed by the Federal Government as product extensions of the original product.  Some extended release or strength versions of current drug products will now be affected more greatly under the Federal Rebate program and cause a negative impact on the MaineCare pharmacy budget.  These changes in HCR will bring multiple changes to the MaineCare Preferred Drug List.  MaineCare, with input from the Drug Utilization Review committee, will remove the following medications from preferred status on the MaineCare PDL effective July 30th, 2010, those in bold print will be allowed for current members until 10/1/10 for certain indications, please see below.

Seroquel XR                                      Sanctura XR

Tegretol XR                                       Maxalt MLT

Detrol LA Cap                                     Lescol XL

Focalin XR Cap                                  Keppra XR Tab

                                                                               

  • Detrol LA - Providers will need to transition to regular Detrol or other preferred antispasmodic bladder agents.
  • Focalin XR - Providers will need to transition to other preferred agents, while current users will be allowed to continue getting the Focalin XR until 10/1/10.
  • Keppra XR - Providers will need to transition to other preferred agents, while current seizure users will be allowed to continue getting the Keppra XR.
  • Maxalt MLT- Providers will need to transition new and current users to the preferred triptan which is generic sumatriptan.
  • Tegretol XR - Providers will need to transition to other preferred agents, while current seizure users will be allowed to continue getting the Tegretol XR.
  • Lescol XL - Providers will need to transition to other preferred products.
  • Seroquel XR - Providers will need to transition to regular Seroquel or other preferred products. Current users with diagnosis of schizophrenia, bipolar disorder or autism will be allowed to continue getting Seroquel XR until 10/1/10.

If you have any questions you may contact Goold Health System at 1-888-445-0497 or Jennifer Palow at Jennifer.Palow@maine.gov. [return to top]

MMA Family Mourns Passing of Dr. Charles H. "Harry" Lightbody

Long-time MMA member Dr. Charles H. "Harry" Lightbody passed away on Wednesday, July 21, 2010 in Winterhaven, Florida.  Dr. Lightbody was instrumental in the creation of the the Maine Medical Education Foundation (MMEF), a foundation of the MMA established to make low interest loans to medical students with a Maine connection in hopes that they will practice in Maine.  For many years, Dr. Lightbody brought student doctors to his practice in Guilford. 

Born and raised in Waterville, Dr. Lightbody served in World War II as a B-24 navigator.  He graduated from Colby College in 1948 and from the University of Maryland Medical School in 1952.  He completed his residency at Worcester (MA) City Hospital in 1954 and opened his practice in Guilford.  He served in many professional capacities at Mayo Memorial Hospital (now Mayo Regional Hospital) and also was very active in his community. 

Dr. Lightbody married his wife, Margaret "Peggy" (Horsch) Lightbody, also a Colby grad, in 1949.  He is survived by Peggy, two children, several grandchildren, and numerous special friends.

Dr. Lightbody also was an avid sportsman who enjoyed hunting, fishing, and skiing, and he was involved in the establishment of a ski resort on Squaw Mountain.

You can find the full obituary for Dr. Lightbody on the Morning Sentinel web site at:  http://www.legacy.com/obituaries/mainetoday-morningsentinel/obituary.aspx?n=charles-h-lightbody-harry&pid=144251632. [return to top]

AMA Reacts to DHHS Regulations on Medicare/Medicaid EHR Incentive Programs

In late July, CMS released the final regulation on the Medicare and Medicaid Electronic Health Record (EHR) incentive program often referred to as the "meaningful use" regulation.  This final rule pertains to Stage 1, which covers the first two years of adoption and meaningful use of certified EHR technology.  Stages 2 and 3 will be defined in future rulemaking.

The Office of the National Coordinator (ONC) published a separate final rule on required standards for certified EHRs.  While the Administration did make some positive changes, the AMA believes that it will be challenging for many physicians to participate successfully in the program.  This will be especially true for those physicians in solo or small group practices who have not previously used an EHR. 

You can find the AMA's press statement on the regulation on the web at:  http://www.ama-assn.org/ama/pub/news/news/ama-review-meaningful-use.shtml.

You can find more information to assist you in participating in the program on the AMA web site at:  http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/health-information-technology/hit-resources-activities.shtml. [return to top]

CMS Announces Imaging Demo

To test the ability of decision support systems (DSS) to improve quality of care and reduce inappropriate use of advanced imaging services, Medicare officials are soliciting  proposals from "convener" groups that would bring together networks of physicians to participate in a demonstration project.  The two-year demonstration, which is to start on January 1, 2011, will focus on 11 MRI, CT, and nuclear medicine procedures.

As mandated under the Medicare Improvement for Patients & Providers Act of 2008 (MIPPA), demo participants will use decision support systems that are based on appropriateness guidelines developed by medical specialties and that do not require prior authorization.  CMS is looking for up to 6 convener groups representing a total of 2500 to 3500 physicians from 500 to 650 physician practices that vary in size, specialty mix, type (academic, private), and location.  Potential conveners could include, but are not limited to, medical specialties, independent practice associations, health plans, radiology benefits managers, IT vendors, or combinations of these groups.  Participating physicians will be paid for using the DSS when they order covered imaging procedures and will receive immediate feedback on relevant appropriateness guidelines as well as periodic data comparing them to their peers.  The demo then will assess the effect of feedback on phyisians' ordering behavior.

The procedures involved in the demonstration are:  Spect MPI, MRI of the lumbar spine, knee and shoulder, and CT of the lumbar spine, brain, sinus, thorax, abdomen, and pelvis.  Bids are due by September 21, 2010.  

You can find more information about this demo, along with application instructions, on the CMS web site at:  http://www.cms.gov/DemoProjectsEvalRpts/MD/itemdetail.asp?itemID=CMS1222075. [return to top]

Maine Bureau of Insurance Conducts Outreach Initiative

Superintendent of Insurance Mila Kofman and her Bureau of Insurance staff have been conducting a Summer Consumer Outreach Program to help Maine people with insurance cases and to raise awareness about the Bureau’s resources.

In addition to encouraging consumers to visit the Bureau’s offices or the agency’s website, www.maine.gov/insurance, Superintendent Kofman invites the public and media to join Bureau staff at upcoming events in Greenville, Ellsworth, and Waterville.  Previous outreach sessions have been held in Kittery, Lewiston, Presque Isle, Bangor, Portland, Farmington, and Madawaska.

All sessions will take place from 5–7 p.m. They will include an overview of the Bureau’s services and ample time for questions.  Additionally, staff members will assist individual consumers with their specific cases.  Dates and location are listed below.

Monday, August 9th, Greenville:
Greenville Town Office
7 Minden Street

Wednesday, August 25th, Ellsworth:
Ellsworth City Hall Auditorium
1 City Hall Plaza

Thursday, September 16th, Waterville:
City Council Chambers, 3rd Floor
93 Main Street

The Bureau of Insurance is part of the Department of Professional and Financial Regulation, which encourages sound ethical business practices through regulation of insurers, financial institutions, creditors, investment providers, and numerous professions and occupations for the purpose of protecting the citizens of Maine.  Consumers can reach the Bureau through its website at www.maine.gov/insurance; by calling 800-300-5000 in state; or by writing to Bureau of Insurance, 34 State House Station, Augusta, ME  04333. [return to top]

FDA Sends New Plan for Opioids to Advisory Committees

Last year, in response to the Food & Drug Administration's (FDA's) plan to require industry development of a risk evaluation and mitigation strategy (REMS) for long-acting and extended-release opioids, the AMA recommended that the FDA solicit input from the public and its advisory committees on the plan before moving forward.  At a joint meeting of the Anesthetic and Life Support Drugs and the Drug Safety and Risk Management Advisory Committees on July 22-23, 2010, the FDA provided an opportunity for the public and advisory committee review that the AMA had sought.  In a comment letter to the FDA, the AMA commended the agency for the new proposal's thoughtful and deliberative approach, which is more likely to avoid unintended consequences for patients with chronic pain or terminal illness than the FDA's initial plan.  A major improvement is that, although companies are to provide additional training in pain management and substance use disorders, the new FDA proposal does not require physicians to complete training in order to continue prescribing long-acting and extended release Schedule II opioids.  The AMA also supports the FDA proposal requiring sponsors to provide FDA-approved education sheets for prescribers to use in their interactions with patients to promote safe use of opioids, and the AMA agrees with the FDA that no other mandatory elements are necessary.

You can find a copy of the AMA's letter to the FDA on the web at:  http://www.ama-assn.org/ama1/pub/upload/mm/399/fda-rems-letter.pdf. [return to top]

Senate Poised to Vote on FMAP Extension Package Worth $16.1 Billion

On July 29th, Senate Majority Leader Harry Reid (D-NV) filed an amendment to an aviation bill, H.R. 1586, that would provide an additional $16.1 billion in federal matching funds to the states.  A cloture vote on the amendment is expected to take place this evening.  Under the ARRA (the federal stimulus bill), states receive a 6.2% increase in their federal medical assistance percentage (FMAP) and an increase based on the unemployment rate through December 31, 2010.  State advocates including the National Governors Association (NGA) have been pushing for a 6-month extension of this ARRA funding, but Senate Republicans have objected because the $24 billion cost has not been offset.  The reduced extension in this bill is fully paid for.  It would phase out the enhancement by giving the states a 3.2% increase in the second quarter of FY 2011 and a 1.2% increase in the third quarter of FY 2011. [return to top]

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