July 25, 2011

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Bi-partisan Talks Stall as Debt Ceiling Deadline of August 2 Approaches

Only slightly more than a week remains in the critical effort underway to achieve a vote in the U.S. House and Senate to increase the debt ceiling so that the federal government does not default on its financial obligations, a result that most observers believe would create havoc and instability in the financial markets. MMA has joined with the AMA and virtually all other medical organizations in advocating for the Medicare Sustainable Growth Rate (SGR) to be fixed as part of any increase in the debt ceiling.

The so-called "Gang of Six" in the Senate has recommended that the SGR fix be included in any legislative action that would increase the debt ceiling.  The bigger the package, the more likely that the Medicare payment problem could be included at a cost of nearly $300 billion.  If not fixed, either temporarily or permanently, Medicare payments to physicians and other providers will be reduced by 29.5 percent on January 1, 2012.

On the negative side, it is highly likely that some reductions in Medicare related services, including some imaging services, will be part of cuts adopted as part of any package.  But at this point, there is no package of cuts and revenue enhancements that have been agreed to.  Democrats continue to insist upon some revenue increases (at a 1 to 3 ratio)  but Republicans have refused to support any tax increases.  As the impasse continues, leaders of both parties and the President appear frustrated and acknowledge that the American  people have little patience for the partisanship and posturing with a view toward the 2012 election.

If the debt ceiling is raised, and Medicare payment reform is not part of the package, it will be that much more difficult to fix during the remainder of the year as virtually all of the possible "offsets" needed to finance the fix will have been used in the deficit reduction package.  Therefore, it is important to communicate to Maine's congressional delegation the need to include the Medicare SGR fix in any package put together to raise the debt ceiling.

Passage of any such package is likely to make it more difficult also to abolish the unpopular Independent Payment Advisory Board (IPAB) as the Congressional Budget Office has associated considerable savings with the Board.

Contact our delegation to ask for the Medicare SGR fix:

Senator Susan M. Collins

413 Dirksen Senate Office Building

Washington, D.C. 20510-1904

(202) 224-2523

Senator Olympia J. Snowe
154 Russell Senate Office Building 
Washington, D.C. 20510-1903
(202) 224-5344 

Representative Chellie Pingree

(1st District) 
1037 Longworth House Office Building
Washington, D.C. 20515
(202) 225-6116 

Representative Michael Michaud

(2nd District)

1724 Longworth House Office Building
Washington, D.C. 20515-1902
(202) 225-6306


Report on MeHAF, MMA, QC and Maine Development Foundation Forum on L.D. 1333

Last Wednesday, July 20, MMA along with the Maine Health Access Foundation, the Maine Development Foundation and Quality Counts sponsored a panel discussion on the likely impact of Maine's new health insurance reform law (L.D. 1333).  The forum was held at the Maine Hospital Association and included panel members representing regulators, providers, employers, policy experts and consumers. 

The law was enacted during the last session of the legislature and was passed largely with Republican support.  The two major parties continue to express dramatically different views and opinions regarding the likely impact of the law.  The new law represents the most significant changes to Maine's health insurance landscape in over twenty years and includes significant changes to community rating, establishment of a high risk pool and provisions to allow Mainers to purchase health insurance from other New England states beginning in 2014. The law also repeals the geographic access standards in so-called rule 850 which protect the rural providers and facilities in the state.

The forum was intended to be informational and was attended by nearly one hundred invitees and the press.   Among the points made by panel members were the following:

  • The reforms are intended to assist people who buy health insurance on an individual basis or in the small group market, representing about 135,000 Mainers (Eric Cioppa, Acting Superintendent of the Bureau of Insurance).
  • One major goal of the law is to increase competition and lower the cost of health insurance for younger citizens.  Currently, the cost of a policy is three times more in Maine than in New Hampshire (Joel Allumbaugh, Director of the Health Reform Initiatives for the Maine Heritage Policy Center).
  • While the law may lower rates for younger Mainers, it will likely increase rates for those who are older and live in rural areas (Garrett Martin of the Maine Center for Economic Policy).
  • While the impact of the changes can be debated and are uncertain, the status quo was unacceptable and difficult to defend (Jeffrey Austin of the Maine Hospital Association)

The cost to premium payers to fund the high risk pool will be $4 to $6 per month.  A $4 assessment is expected to raise $25 million annually to support the re-insurance pool.  A lot of the theory behind the law was based upon a law and experience in the state of Idaho.

MMA will continue to participate in educational forums on the new law.  If your practice, medical staff or facility would like an educational presentation regarding the new law, or on the federal Affordable Care Act, contact Gordon Smith, Esq., Executive Vice President of MMA at gsmith@mainemed.com.  Category one CME credit can usually be arranged for the talks. [return to top]

Patient Safety Academy August 1st

Patient Safety Academy 2011

All healthcare professionals are invited to attend this interdisciplinary educational event packed with thought-provoking sessions and practical workshops.

Date: Monday, August 1, 2011

Place: USM Portland Campus, Abromsom Center, 88 Bedford Street, Portland

Time: 9-3:30 (Registration/check-in begins at 8:30)

Cost: $60; student rate $25. Includes lunch and snacks

Plenary sessions include: 

Talking with Patients and Families About Medical Error

Presenter: David M. Browning, MSW, BCD, Senior Scholar and Co-Director, Patient Safety and Quality Initiatives, Institute for Professionalism and Ethical Practice, Boston Children’s Hospital and Harvard Medical School

Positive Deviance: Succeeding Against All Odds

Presenter: Roger Conrad Swartz, MPH, Executive Director, Positive Deviance Initiative, Tufts University

Click here for the link to the online registration; it is also available on the Maine CAH Patient Safety website.  For more information, contact Judy Tupper at jtupper@usm.maine.edu or 207.228.8407 or visit http://www.mainecahpatientsafety.net

Sponsored by: Maine Center for Disease Control and Prevention, Office of Rural Health and Primary Care

Hosted by: Maine CAH Patient Safety Collaborative

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Watch for Your Invitation to the Re-dedication of the Frank O. Stred Building, August 24 in Manchester

MMA will recognize the leadership of the late Frank Stred, who served admirably as Executive Director of the Association from l979 through August of 1993, on Wednesday, August 24th.  From 11:00am until 2:30pm, we will celebrate Frank's history with MMA and re-dedicate the Building which was named for him in l993 when he retired. Priscilla Stred and other members of the family will join in the activities.  Lunch will be served and entertainment will be provided by the Blue Hill Brass Band.

Remarks will be offered by former MMA leaders who worked closely with Frank, particularly those who played a  role in the  construction of the Stred Building which now houses the offices of the MMA and Quality Counts staff.

Invitations have been mailed to all MMA members.  For more information on the event, call MMA at 622-3374 ext. 0. Proceeds from the event will be used to establish a maintenance and improvement fund for the Stred Building. [return to top]

Governor LePage Announces Intention to Reduce MaineCare Eligibility in 2012

Having failed to achieve his goal during the 2011 legislative session, Governor Paul LaPage announced in a recent interview with veteran State House Reporter Mal Leary that he would again propose a reduction in eligibility that would reduce MaineCare rolls by about 30,000 adults without children.  Currently, such adults can be eligible for MaineCare if they earn less than 200% of the federal poverty level.  The Governor has proposed reducing eligibility to 133% of the FPL which is currently $14,484 for an individual and $29,726 for a family of four. The proposal was rejected by the legislature this past session, through the work of the Joint Standing Committee on Appropriations and Financial Affairs.

MMA opposed the reduction this past session, noting that these patients would most likely be uninsured and their costs shifted to bad debt and charity care.  Recent studies have also shown that persons without health insurance do not access preventive and primary care services until  their health has deteriorated to the point of urgency. Finally, the ability to have the federal government pay two dollars for every state dollar invested needs to be considered. [return to top]

MMA Weighs in on Deficit Reduction Talks During State of the State Cable Show

Last Thursday, the MMA participated in a round table discussion on the impact on patient access to care of deficit reduction proposals currently being debated in Washington.  The conversation was hosted by Christopher St. John of the Maine Center for Economic Policy for their State of the State cable television show.  Jessa Barnard, MMA Director of Public Health Policy, participated along with John Penn, a member of the AARP National Board of Directors, and Sarah Gagne-Holmes, Executive Director of Maine Equal Justice Partners. 

Ms. Barnard explained that while the MMA is not opposed to sensible approaches to reducing costs in the Medicaid and Medicare programs, those savings should not come at the expense of patient access to care for vulnerable seniors and low income Mainers.  Both increasing participants' cost sharing,  which would likely be uncollected by health care offices,  and decreasing already low physician reimbursement rates could harm patients' ability to access necessary services.  She also emphasized that any deficit reduction plan should include the "doc fix" or a permanent solution to the Medicare Sustainable Growth Rate formula.  

Time Warner Cable affiliates statewide air State of the State on Channel 9. Standard air times are Tuesdays at 7:30 p.m., Thursdays at 6:30 p.m., Saturdays at 11:30 a.m. and Sundays at 1:30 p.m. For more information, or to listen to the audio file of the show, visit: http://www.mecep.org/state_of_the_state.asp

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Looking for a Board Certified Ob-Gyn to Serve on a Peer Review Panel on August 19

For over twenty-five years, the Maine Medical Association has offered statutorily protected peer review services to health care providers and facilities throughout Maine and occasionally beyond the borders of the state.  This service, offered for a fee, has proved valuable to many institutions. Recently the Maine CDC, through the Office of Primary Care and Rural Health has supplied grant funding to expand the program and to improve a number of its features.  We have been fortunate to have Peggy Pinkham, RN, a former hospital administrator in the state act as a consultant to the program through the Maine CDC grant.

As we continue to grow the program, many reviews are being performed throughout the state.  Currently, we are in need of a board-certified Ob-Gyn to join a three member team performing a routine review of an obstetrics department in the state.  The review has been scheduled for August 19th.  Compensation is paid for the services rendered.  If you are interested in participating in this or any other review in the future, please contact Gordon Smith at gsmith@mainemed.com or Warene Eldridge at weldridge@mainemed.com. [return to top]

MeCDC Flu Vaccine Update

Maine CDC has issued a letter to health care providers who have registered with the Maine Immunization Program  to offer state-supplied flu vaccine. The letter is available here: http://www.maine.gov/dhhs/boh/maineflu/2011-2012-ProviderInfluenza-Letter%20Final.pdf

For the 2011-12 season, Maine CDC plans to provide seasonal influenza vaccine for: 

  • All Maine children ages 6 months to 18 years-old 
  • Employees of schools that provide onsite vaccine clinics on school days 
  • Pregnant women and their partners (through health care providers who routinely care for pregnant women) 
  • Nursing home employees and residents 
  • Any underinsured or uninsured adult in any setting (for patients who do not have insurance or whose insurance does not cover vaccines) 
  • All individuals served by Tribal health centers and Municipal Health Departments  

Information on the vaccine ordering process will be posted at www.maineflu.gov in August. Tools and resources for those conducting school-located vaccine clinics (SLVC) will also be updated in August.  

 FDA has approved the 2011-12 influenza vaccine formulation for all six manufacturers licensed to produce and distribute flu vaccine for the US. For more information: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm263319.htm?utm_source=twitterfeed&utm_medium=twitter

US CDC has updated its online flu information, including: 

  • Key Facts about Influenza (Flu) and Flu Vaccine 
  • 2011-12 Seasonal Influenza Vaccine Updates Questions and Answers
  • Children, the Flu, and the Flu Vaccine 
  • Questions and Answers about Seasonal Influenza

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Obama Administration Announces Proposed Rules on Insurance Exchanges

The U.S. Department of Health & Human Services (DHHS) has issued proposed rules on insurance exchanges under the ACA.  The first rule addresses the establishment of health insurance exchanges and the second addresses standards for reinsurance, risk corridors, and risk adjustment.  Comments are due 75 days after publication.  You can see the HHS press release on the web at:  http://www.hhs.gov/news/press/2011pres/07/20110711a.html. [return to top]

Potential Exposure to Measles in Southern Maine

Quebec Resident Had the Disease While Vacationing in Old Orchard Beach.

The Maine Center for Disease Control and Prevention (Maine CDC) has been notified of the potential for measles exposure in Southern Maine.

Maine CDC was contacted by the Quebec Ministry of Health and Social Services on Thursday and informed that a Quebec resident who recently traveled to the Old Orchard Beach and Saco areas has been diagnosed with measles. Quebec has been experiencing an increase in measles cases recently and the ill Quebec resident had not been vaccinated against the disease.

The Quebec native diagnosed with measles was vacationing in Southern Maine from July 15-18.

Health care providers who treat patients with suspected cases of measles should call the Maine CDC at 1-800-821-5821 for consultation and to arrange testing.

In a press release issued last week, Dr. Stephen Sears, State Epidemiologist, tells the public, "If you or your children are at risk for measles and become ill with the symptoms of this disease, you should tell your health care provider so that precautions can be taken to avoid exposing anyone else. If you or your family members are not up to date with vaccine or you have questions about whether you are immune, you should contact your healthcare provider.”

Most people in the United States and in Maine have been vaccinated and are immune to measles. The MMR vaccine is routinely given to toddlers when they are 12 to 15 months of age and a second dose is required for all Maine school children. Persons who are at risk for the disease include infants less than age 1 and persons born after 1957 who have not received two doses of MMR vaccine.

Measles is a highly contagious respiratory disease caused by a virus. Symptoms usually begin one to two weeks after exposure and include high fever, cough, runny nose, watery eyes, and a rash. An individual infected with measles can transmit the virus to others who are not immune from four days before their symptoms start until four days after the rash resolves. The virus is spread through the air by breathing, coughing or sneezing. [return to top]

Save the Date: Chemicals, Obesity, and Diabetes, Oct. 14 in Waterville


How Science Leads Us to Action


Colby College, Waterville, Maine

Registration Fee: $50 • Lunch included • Time: 8:30am-5:00pm

Presented by the Environmental Health Strategy Center (EHSC), in partnership with the Goldfarb Center at Colby College

Critical, ongoing public health efforts to reduce obesity are addressing multiple societal factors through policy, environmental and social justice system changes to address contributing factors which include inadequate nutrition and physical inactivity. Recent scientific research shows that chemical exposures may also be a risk factor.  Our conference will explore two questions about chemical “obesogens:”

  • What is the current state of the science that links chemical exposures to obesity, diabetes and other diseases?
  • What public health policy actions are appropriate based on the current evidence?

Keynote Speaker: Bruce Blumberg, PhD: University of California-Irvine, Department of Developmental and Cell Biology. National expert on the role of chemical exposures as a contributing factor for obesity and diabetes.

For more information, see the flyer at http://www.preventharm.org/Images/443/Conf%20STD%20Email.pdf or contact Michelle Surdoval, Project Manager, 207-650-8704, msurdoval@preventharm.org



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Amendments to Medical Marijuana Law Effective Sept. 28, 2011

Perhaps surprisingly, the legislature this past session significantly amended the medical marijuana legislation which had been originally adopted by the voters in November 2009 and significantly amended by the legislature in 2010.  The amendments, embodied in L.D. 1296, "An Act To Amend the Maine Medical Use of Marijuana Act To Protect Patient Privacy," were passed unanimously in the Health and Human Services Committee and passed without debate in the House and Senate.

For physicians, the most significant changes are as follows:

  1. The written certification prepared by the physician will no longer specify the qualifying patient's debilitating medical condition.
  2. Registration of patients with the state will be voluntary.
  3. The physician certificate will have to be prepared on tamper resistant paper.  "Tamper-resistant paper" means paper that possesses an industry-recognized feature that prevents copying of the paper, erasure or modification of information on the paper and the use of counterfeit documentation."  MMA will inform members of appropriate sources of such paper prior to the effective date of the law.  You will likely be able to purchase such paper from whomever you purchase tamper-resistant prescription pads from.
  4. Prior to providing written certification for the medical use of marijuana by a minor qualifying patient, a physician must consult with a consulting physician.  The consulting physician must be from a list of physicians who may be willing to act as consulting physicians maintained by the Department of Human Services.  The consultation may consist of examination of the patient or review of the patient's medical file.  This opinion is simply advisory to the treating physician.

Physicians who are willing to serve as consultants may contact the Department or Gordon Smith at MMA (gsmith@mainemed.com).

Changes to the law become effective on September 28, 2011. [return to top]

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