December 13, 2010

 
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Congress and the President Act to Protect Medicare Payments Through 2011

Last week, the U.S. Senate, House, and President Obama acted to continue the 2.2% increase in Medicare payments established in 2010 and to delay the 25% reduction in payments scheduled for January 1, 2011.  The delay is for twelve months, giving the Congress approximately one year to develop an alternative to the deeply flawed sustainable growth rate (SGR) formula developed in the 1990's as part of the Balanced Budget Amendment.  Please join MMA in thanking members of Maine's Congressional delegation in supporting the effort to delay the cut.  The delay cost $19 billion which was paid for by making adjustments to the Affordable Care Act that provides for subsidies to persons who can not afford the offered health plan options.

MMA had joined with the Maine Chapter of AARP to advocate for a delay in the cuts and for a long term solution to the SGR formula.  Both organizations met with the editorial board of the Portland Press Herald last Tuesday to describe the serious consequences to the state if a 12 month delay was not achieved during the lame-duck session of Congress.  Among the points made:

  • There are more than 260,000 Medicare patients in Maine and more than 42,000 Tricare patients whose providers receive payments under the Medicare fee schedule.

  • In Maine, three out of ten (29%) Medicare beneficiaries are living below 150% of the federal poverty level.

  • Maine is one of 29 states that have imposed cuts in services for low-income elderly, such as home care and rehabilitation.

  • If the cut were to take place on January 1, 2011, over $90 million in reimbursement would have been lost to the physicians and other health providers in the state.

  • Twenty percent of Maine residents rely on Medicare for health insurance.  This is a higher percentage than the national average of 15 percent.

  • Nearly half (46%) of Maine's Medicare patients live in rural areas, with less access to physician servces.

  • There are only 14 practicing physicians for every 1,000 Medicare beneficiaries in Maine.  This is well below the national average of 17 physicians per 1,000 beneficiaries.

  • About half (49%) of Maine's practicing physicians are over the age of 50.  Recent surveys have shown that it is typically around this age when physicians consider reducing the number of patients they treat.

A recent survey of Medicare beneficiaries in Maine showed that eighty-six percent of respondents said they'd be either "very concerned" or "somewhat concerned" that physicians might stop treating Medicare patients because of the anticipated cut.  In addition, 85 percent said they'd have trouble finding a new doctor that would take Medicare should the looming cut take effect.

The MMA, the AMA, and other state and national medical organizations, along with our partners such as the AARP, will be working with the new Congress early in 2011 to identify potential solutions to the SGR formula which, without further action, will again result in a deep cut on January 1, 2012.

 

ACHSD and Health Reform Steering Committee Holds Hearing Tomorrow on Draft Report on ACA Implementation

On Wednesday, December 8th, the Advisory Council on Health Systems Development (ACHSD) and the Governor's Health Reform Steering Committee released a draft report entitled, Options and Opportunities for Implementing the ACA in Maine.  The report is supported by a grant from the Health Services Resources Administration (HRSA) and reflects the works of both groups which began a process in April 2010 to understand the Affordable Care Act (ACA) and its implications for Maine and to recommend next steps in implementation for Governor-elect LePage and the 125th Maine Legislature.

The draft report includes a description of the major aspects of the ACA and considers potential policy options and recommendations for next steps for the implementation of the ACA in Maine.   Public comments on the report will be accepted through December 14th at 9:00 a.m.  At that time, the Steering Committee and the ACHSD will jointly accept public comment at a public hearing on the report.  The hearing will be held in room 228 (the Appropriations Committee room) of the State House.  Following the hearing, the Steering Committee and the Advisory Council will hold a joint meeting to discuss the public comment received orally at the hearing or submitted in writing.  The report will be finalized at the regularly scheduled meeting of the Council on Friday morning, December 17th.

The draft report and each of the presentations made to the Council over the April-December period can be found on the state's health care reform website at www.maine.gov/healthreform.

You can read the press release on the hearing on the web at:  http://www.maine.gov/tools/whatsnew/index.php?topic=Portal+News&id=163739&v=article-2008.

 

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MMA Executive Committee Re-Affirms Support for Individual Mandate

At its regularly scheduled meeting on December 8th, MMA's 28 member Executive Committee reconfirmed its support for an individual mandate for citizens to purchase health insurance, with an appropriate waiver for those individuals who can not afford such insurance, even with a public subsidy.  In the face of action by legislators and others to attack the logic behind requiring individuals to purchase insurance, committee members believed it was important to review the 2003 MMA White Paper on Health System Reform and to re-confirm the important role of the individual mandate in it.

The White Paper can be found on the MMA website at www.mainemed.com, in the section of Health System Reform.

The Association will be communicating with Maine Congressional delegation, Governor-elect LePage's transition team, and Attorney General William Schneider regarding support for the principles of universal coverage and the role of mandates in getting there.

The MMA's role in the health care reform debate was the subject of an article in today's Portland Press Herald:  http://www.pressherald.com/news/maine-doctors-advise-against-seeking-repeal_2010-12-13.html. [return to top]

House Follows Senate in Narrowing Application of FTC "Red Flags" Rule

On November 30th, the Senate passed the Red Flag Program Clarification Act of 2010 (S. 3987) narrowing the scope of the Federal Trade Commission's (FTC's) "red flags" rule on identify theft.  The bill amends the definition of "creditor" to exempt one "that advances funds on behalf of a person for expenses incidental to a service provided by the creditor to that person."  On December 7th, the House passed S. 3987 on a voice vote and the bill awaits Presidential action.  AMA President Cecil Wilson, M.D. expressed support for the action in saying, "We hope that the FTC will now withdraw its assertion that the red flags rule applies to physicians."  FTC Chairman Jon Leibowitz also expressed support for the Congressional action.  He said, "We can go forward with less litigation and more consumer protection." [return to top]

Dr. Dora Mills to Become MaineCare Medical Director

Dr. Dora Mills, the current Director of Maine CDC, announced in an email today that she will become the Medical Director of MaineCare beginning January 4, 2011.  

In her email, she stated that her "focus will be to assure the health care paid for by MaineCare is high quality and is improving the health status of its members.  With MaineCare moving to managed care, I will be working closely with the managed care contractors, MaineCare staff and other Maine DHHS staff, health care providers, policymakers including the Administration-elect, and people with MaineCare insurance.  I look forward to working for my longtime colleague, Tony Marple, MaineCare’s Director, as well as with Dr. Rod Prior, who will continue his leadership role on federally-funded health information projects."

Dr. Mills explained that Stephen Sears, MD, MPH, the current State Epidemiologist, will serve as Maine CDC Acting Director until a permanent director is hired by the LePage administration.   She thanked the people of Maine and organizations around the state for working with her as Director of the Maine CDC to help improve the health of Maine people from cutting youth smoking in half, to nearly doubling of some of the cancer screening rates to overhauling the State's public health infrastructure.

Also announced Monday, Brenda Harvey, outgoing commissioner of the Maine Department of Health and Human Services, has been named executive director of a non-profit group aimed at maximizing policy and cost-effectiveness of Medicaid programs in New England.  Harvey, who served as commissioner for five years during Gov. John Baldacci's administration, will begin her new job at the New England States Consortium Systems Organization on January 6th, according to a release issued on Monday.

 


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2010 Physician's Guide to Maine Law Now on MMA Website

Published until 2002 in a printed form, it has been our goal for several years to get an updated copy of the Guide on-line so that appropriate links could be provided and the document could be updated frequently.  It has been updated through the Second Regular Session of the 123rd Legislature and in the next six months will be updated through the actions of the 124th Legislature.  Several of the more significant health items approved by the 124th legislature have already been added to the Guide, such as the laws on the medical use of marijuana.

If you or your staff have not accessed the member's only section of the website, simply go to the site at www.mainemed.com and click on the member's only section.  You will then be asked for a user name which will be your e-mail address.  Our staff then will receive notification that you wish access and you will be sent an e-mail authorizing your use of the section.  You will continue to use your e-mail address as your user name but will be able to choose your own password.

At the December 3rd First Friday CME program entitled, "Current Topics in the Medical-Legal World," MMA attorney Jessa Barnard, Esq. presented an overview of the Guide.  Other topics during the three hour program included informed consent, the FTC Red Flag rule relating to identity theft (taking effect on January 1, 2011) and the Maine Health Security Act

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Free In-Office Hypertension Education Available Through MMA's Academic Detailing Program

The Maine Medical Association and the Maine Independent Clinical Information Service Present: 

Academic Detailing Visits at No Cost

NEW Hypertension Module Available Now!  

Schedule your visit today: 207-622-3374 or academicdetailing@mainemed.com 

The "Silent Killer" - Still at Large 

Most Americans over age 60 have hypertension.  Even among those whose blood pressure are normal at age 55, the lifetime risk of hypertension is 90%.  Despite the availability of dozens of effective treatments and decades of data, less than two-thirds of patients in the U.S. with hypertension are receiving treatment, and less than half are adequately controlled.

Effective hypertension control is one of the best ways a physician can make a real difference in patients' health by preventing myocardial infarction, stroke, renal damage, and premature death.  

Meet with our academic detailers to learn more about key steps that can improve current management, such as: 

  • Low-dose thiazides should play a central role as initial therapy for many patients, and as part of combination treatment for others; 
  • Choose other medications based on compelling indications; 
  • Combination therapy will often be needed;
  • When choosing agents, consider cost and compliance. 

For more information, visit www.mainemed.com/academic/.  Three academic detailers have been trained in the new hypertension model and they are ready to go!  Put them to use in your practice. [return to top]

CMS to Host December PQRS Open Door Forum

On December 15th, CMS will host a special Open Door Forum on the 2011 PQRS and eRx Incentive programs from 1:00 p.m. to 3:00 p.m. ET.  CMS will provide an overview of changes to the Group Practice Reporting Option (GPRO) for the 2011 program year, and will discuss the eRx 2012 payment adjustment.  Group practices interested in participating in the 2011 GPRO for PQRS and/or the GPRO for eRx Incentive Program must submit a self-nomination letter to CMS no later than January 31, 2011.  Following CMS presentations, telephone lines will be opened to allow participants to ask questions of CMS staff.  The number for the Open Door Forum is 1-800-837-1935 and the Conference ID is 24749053.  Additional information regarding the Open Door Forum can be found at:  http://www.cms.gov/PQRI/04_CMSSponsoredCalls.asp#TopOfPage. [return to top]

DEAPA Seeks Nominations for Annual Awards

Downeast Association of Physician Assistants

Seeking 2011 Award Nominations

The Downeast Association of Physician Assistants (DEAPA) presents awards each year in recognition of outstanding service to the PA Profession and to DEAPA.  The award categories are:

Robert J. Lapham Award for Outstanding Service - This award is presented each year to a Maine physician assistant in recognition of outstanding service to the PA profession and to the Downeast Association of Physician Assistants.

Rural Physician Assistant of the Year - This award is presented to a Maine physician assistant in recognition of dedicated service to a rural community, both as a health care provider and as a citizen.

Physician of the Year - This award is presented to a Maine physician who has demonstrated outstanding support of physician assistants and the PA Profession by precepting, educating, and legislating, or by exemplifying the PA/Physician team approach to medicine.

Outstanding Health Care Professional - This award is presented to a health care professional who has demonstrated exceptional clinical knowledge and teaching skills, promoting the PA profession, and contributing to the health of Maine.

To make a nomination, click here to download the nomination form. Please complete the form and return no later than March 4, 2011.  You can mail or fax to:  DEAPA, 30 Association Drive, Manchester, Maine 04351; Fax:  207-622-3332. If you prefer to send your nomination by email, please send it toinfo@deapa.com or bfarrell@mainemed.com


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