January 16, 2012

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Governor's Supplemental Budget Dominates Activity Early in Legislative Session

The Second Regular Session of the 125th Maine Legislature opened  January 4th and is expected to conclude in mid-April.  Please join the weekly conference call of the Legislative Committee to review the new bills listed below and to discuss further the supplemental budget debate and other current issues before the Maine legislature.  The calls are completed in an hour or less.  Please see the call information below.  There is a lot at stake for physicians, hospitals, and patients in the discussion of the supplemental budget (L.D. 1746) that focuses exclusively on MaineCare and social services.

The Appropriations & Financial Affairs Committee held work sessions last week on the Governor's supplemental budget proposal (L.D. 1746) and heard more details from Commissioner Mary Mayhew and her staff.  But, there were still many questions unanswered and HHS officials will be back before the committee tomorrow to continue the dialogue.  At some point this week, MaineCare Medical Director Kevin Flanigan is expected to be before the committee explaining the proposal to limit Suboxone to two years, with exceptions being available with prior approval.

The MMA's Legislative Committee began its weekly conference calls last week and we appreciate the individuals and specialty societies that took the time to participate in the call. 

The next call is tomorrow, Tuesday, January 17th at 8:00 p.m.  Legislative Committee members and specialty society legislative liaisons are strongly encouraged to participate.  Any physician, practice manager, or other staff member who is interested in the MMA's legislative advocacy also is welcome to participate.  It is not necessary to RSVP for the calls.

Please use the following conference call number and passcode.  These will remain the same for every weekly call during the session:

Conference call number:  1-877-669-3239

Passcode:  23045263

The purpose of the weekly conference calls is to review and finalize the MMA's position on bills printed that week, to hear the views of specialty societies on the new bills or their concerns about any health policy issues, and to discuss the highlights of legislative action that week.  The calls rarely last longer than an hour and usually we can accomplish our business in much less time.

If you have any questions about the conference calls, please contact Andrew MacLean, Deputy EVP at amaclean@mainemed.com or 622-3374, ext. 214.

The following are bills of interest to the physician community identified by the MMA staff.  By clicking on the highlighted "LD XXXX," you will go to the summary page for the bill on the legislature's web site.  You can find the text of the bill by following the tabs on the left side of the summary page.  These bills will be on the agenda for the weekly Legislative Committee conference call next week, or you may provide feedback directly to Andrew MacLean, Deputy EVP, by phone at 622-3374, ext. 214 or by email at amaclean@mainemed.com.  You will note that the MMA staff has suggested a position for each bill along with a MMA committee or specialty society that may have a particular interest in the bill.

L.D. 1719, An Act To Update the Powers and Duties of the Bureau of Maine Veterans' Services (monitor)

L.D. 1720, An Act To Increase the Membership of the Homeland Security Advisory Council (monitor; Public Health Committee)

L.D. 1728, An Act To Strengthen the Integrity of Nonresident Concealed Handgun Permits (monitor; Public Health Committee)

L.D. 1743, Resolve, Regarding Legislative Review of Portions of Chapter 270: Uniform Reporting System for Quality Data Sets, a Major Substantive Rule of the Maine Health Data Organization (monitor)

L.D. 1744, An Act To Require Carbon Monoxide Detectors in Additional Residential Facilities (support; Public Health Committee)

L.D. 1746, An Act To Make Supplemental Appropriations and Allocations for the Expenditures of State Government and To Change Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2012 and June 30, 2013 (oppose; this is the Governor's supplemental budget proposal)

L.D. 1760, An Act To Ensure Notification to Victims of Domestic Violence, Sexual Assault and Stalking When Defendants Are Released on Bail (support; Public Health Committee)

L.D. 1769, An Act Regarding Subrogation of Medical Payments Coverage (monitor)


POLITICAL PULSE: Legislative Highlights of the Week


As described in the lead article above, the Appropriations Committee continued with supplemental budget work sessions last week.  This week, both the Appropriations and HHS Committees will hold work sessions on the supplemental budget and the HHS Committee is scheduled to report back its recommendations to the Appropriations Committee on Thursday, January 19th at 3 p.m.  Budget documents can be found on the Appropriations Committee website.  Should you wish to communicate with members of the Appropriations Committee about the proposed cuts to DHHS programs, you will find the members and their contact information on the web at:  http://www.maine.gov/legis/house/jt_com/afa.htm.


The Education Committee met last Monday to take up L.D. 1237, An Act to Prohibit Bullying in Schools, and L.D. 980, An Act to Prohibit Cyberbullying in Public Schools.  Both bills had been taken up last session but in the end were not adopted and were carried over for further work this year.  Outstanding issues include whether the bills are a mandate to public schools and whether and how they can address behavior that occurs off of school property.  The Committee continues work on L.D. 1237 this week. 


The MMA needs physicians to serve as "Doctor of the Day" for this session.  In particular, we are looking for a physician able to serve on January 24th.  The session begins at 10:00 a.m. and you would likely be finished by noon.  FMI, contact Maureen Elwell, Legislative Assistant, at 622-3374, ext. 219 or melwell@mainemed.com, or see the MMA web site at:  http://www.mainemed.com/legislation/drday.php.

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Conference Committee to Address SGR Issue Expected to Begin Work this Week

A 20-member conference committee is expected to begin meeting this week on a full-year extension of the payroll tax holiday and to ensure physicians' Medicare reimbursement is not cut at the beginning of March, congressional aides said January 3rd.

The aides expect House Ways & Means Committee Chairman Dave Camp (R-MI) to chair the conference committee and convene the group's first meeting after the House returns from its winter recess on January 17th. The conference committee is made up of eight House Republicans, five House Democrats, four Senate Democrats, and three Senate Republicans.

A majority of conferees from each chamber is needed for the conference report to be approved and sent for a floor vote in each chamber.  Lawmakers in both houses of Congress agree on the need to extend the Social Security tax rate at the current 4.2 percent for individuals, but finding a way to pay for the $100 billion tax cut has been the key sticking point.

It is important for all of medicine to communicate the need for a long-term fix to the SGR problem.  Each physician in Maine should communicate with Maine's Congressional delegation as soon as possible and emphasize what this cut now scheduled for March 1, 2012 would mean to them and their patients.  Find contact information and a sample letter at the AMA Advocacy website.

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MMA Board Retreat Being Held this Weekend

Each year, the 28-member MMA Board of Directors holds a President's Retreat which this year will be held this coming weekend, January 20-22, 2012 at the Jordan Grand Resort Hotel at the Sunday River ski area in Newry.  The annual retreat provides the Board and staff the opportunity in a more relaxed setting than is available during the bi-monthly meetings to review the most recent strategic plan and to discuss priorities for the coming months.  Guests this weekend include Scott Colby, CEO of the New Hampshire Medical Society, Travis Harker, M.D., President-elect of the New Hampshire Medical Society, and Luis Sanchez, M.D., Director of the Physician Health Program for the Massachusetts Medical Society. 

On Saturday morning, Mr. Colby and Dr. Harker will share with Board members results of a strategy planning process conducted by the NHMS this past fall and on Sunday morning, Dr. Sanchez will present some of the strategies employed in Massachusetts to keep physicians healthy.  

Nancy Cummings, M.D. of Wilton currently serves as President of MMA.  Dieter Kreckel, M.D. of Rumford is President-elect and Kenneth Christian, M.D. of Holden chairs the Board.

Results of the weekend sessions will be reported in next week's Update


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MMA Welcomes the Employed Physicians at Blue Hill Memorial Hospital as Newest Group Members

MMA welcomes the physicians employed at Blue Hill Memorial Hospital as the newest members joining through a group membership supported by the hospital.  The physicians voted last week to accept a proposal from MMA that will make it possible for all the employed physicians to belong at a discounted dues rate.  In addition, the hospital will receive special pricing on some select MMA services such as educational programs and external peer reviews.  

Many thanks to Medical Staff President Dr. Arthur Newkirk and hospital CEO Gregory Roraff for their support in making the group membership possible.

MMA offers membership on a group basis to any group of physicians of ten or more, so long as all the physicians join and the dues are paid in one check.  Anyone interested in a group membership should contact MMA's Executive Vice President, Gordon Smith, Esq., at 622-3374, ext. 212 or via e-mail to gsmith@mainemed.com.

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CMS Reports Lowest Increase in Health Care Spending in History for 2009

Analysts at the Centers for Medicare & Medicaid Services (CMS) reported earlier this month that the increase in health care spending for the year 2009 represented the lowest rate of increase in the 51 year history of the National Health Care Expenditures report.  The low rate of growth, the data show, reflects lower utilization than in previous years.  The report notes that U.S. health care spending grew only 3.9 percent in 2010, reaching $2.6 trillion or $8,402 per person, just 0.1 percentage point faster than in 2009. 

In 2010, as health spending growth remained low, growth in the U.S. economy rebounded, as reflected in gross domestic product (GDP) at 4.2%.  As such, in 2010, the health spending share of the overall economy was unchanged at 17.9%.  In the past, this share has increased, rising over time from just 5.2% of the GDP in 1960.

Key findings from the new report include:

  • Household healthcare spending equaled $725.5 billion in 2010 and represented 28% of total health care  spending, slightly lower than its 29% share in 2007.  Growth in total private health insurance premiums slowed in 2010 to 2.4% from 2.6% in 2009, continuing a slowdown that began in 2003.
  • Retail prescription drug spending (10% of total  health care spending) grew only 1.2% to $259.1 billion in 2010, a substantial slowdown from 5.1% growth in2009 and the slowest rate of growth for prescription drug spending recorded in the annual report.
  • The federal government financed 29% of the nation's health care spending in 2010, an increase of six percentage points from its share in 2007 of 23%, and reached $742.7 billion.  Part of that increase came from enhanced federal Federal matching funds for State Medicaid programs under the American Recovery & Reinvestment Act which expired in 2011.  Medicare spending grew 5.0% in 2010, a deceleration from growth of 7.0% in 2009.  
  • Medicaid spending increased 7.2% in 2010, slowing from 8.9% growth in 2009.
  • Hospital spending, which accounted for roughly 30% of total health care spending, grew 4.9% to $814 billion in 2010, compared to growth of 6.4% in 2009.
  • Physician and clinical services spending, which accounted for 20% of total health care spending, grew 2.5% to reach $515.5 billion, slowing from 3.3% growth in 2009.

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Maine PCMH Pilot Notice of Phase 2 Expansion

Conveners of the multi-payer Maine Patient Centered Medical Home (PCMH), the Dirigo Health Agency’s Maine Quality Forum, Maine Quality Counts, and the Maine Health Management Coalition, announce plans to expand the Pilot to include an additional 20 adult practices in January 2013.  An application process will be announced and made available online on or before February 1, 2012.  This information is being made available as an introduction to the expectations for application and selection.

Interested practice sites are advised to read the full “Notice of Plan for Phase 2 Expansion” posted on the Maine Quality Counts website (www.mainequalitycounts.org/major-programs/patient-centered-medical-home.html), and should register their intent to apply by completing the “Phase 2 Intent to Apply” form online at http://www.surveymonkey.com/s/ME_PCMH_Pilot_Phase2_Intent_to_Apply.

Timeline for Pilot Practices

  • January 12, 2012 – Pilot Conveners communicate plans for Phase 2 expansion broadly within state

  • January 2012 – Interested practices are asked to submit online Intent to Apply.

  • February 1, 2012 –Maine PCMH Pilot Phase 2 practice application posted online

  • March 31, 2012 - Deadline for practices to submit online application

  • April – May, 2012 – Review of applications by Pilot staff, PCMH Pilot Selection Committee

  • May 1, 2012 – Phase 2 Community Care Team (CCT) application posted online

  • May 31, 2012 -  Phase 2 practices selected

  • July 15, 2012 – Deadline for CCTs to submit online application

  • August 1, 2012 – Phase 2 CCTs selected

  • January 1, 2013 – Phase 2 practices and CCTs begin participation in Maine PCMH Pilot

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Maine Society of Anesthesiologists Sugarloaf Meeting, February 11-12th

The Maine Society of Anesthesiologists Sugarloaf meeting is coming right up – February 11-12, 2012!  You can register by going to the Society website and paying through PayPal (www.maineanesthesia.org) or contact Anna Bragdon at mesahq@gmail.com

We have three excellent speakers lined up for you.  First, ASA’s Executive VP and General Counsel, Ron Szabat, JD, LLM, will be presenting a federal update (which is as entertaining as it is informative!).  Then, on Saturday night our key note is Dr. Randy Darby, Director of Medical Simulation at the Maine Medical Center’s Hannaford Center for Safety, Innovation and Simulation.  On Sunday morning, Dr. Andreas Taenzer from Dartmouth Hitchcock will give us an educational presentation on post-operative respiratory monitoring.   Also, Gordon Smith of the Maine Medical Association will join us as he always does to brief us on the happenings at the Maine State House. [return to top]

National Health Service Corps Loan Repayment Application Now Open

Recently, the National Health Service Corps (NHSC) Loan Repayment Program (LRP) opened its 2012 application cycle.  The application cycle will be open until May 2012, however providers are strongly encouraged to apply early.

The National Health Service Corps (NHSC) loan repayment program  offers primary care medical, dental, and mental and behavioral health providers the opportunity to have their student loans repaid, while earning a competitive salary, in exchange for providing health care in urban, rural, or frontier communities with limited access to care.

NHSC participants serve at one of more than 17,000 NHSC-approved sites located in Federally Designated Health Professional Shortage Areas (HPSAs).  A higher HPSA score indicates greater community need so the program offers two levels of loan repayment awards: 

  • Up to $60,000 to primary care providers practicing at an NHSC-approved site with a HPSA score of 14 or above in return for a 2-year full-time commitment or 4-year half-time commitment.

  • Up to $40,000 to primary care providers practicing at an NHSC-approved site with a HPSA score of 13 and below in return for a 2-year full-time commitment or 4-year half-time commitment. 

With continued service, all providers may be able to pay off all their student loans.

Visit NHSC.hrsa.gov and click on “loan repayment” for more information or to apply. [return to top]

Downeast Association of Physician Assistants Winter CME Meeting, Feb 1-4th

22nd Annual Downeast Association of Physician Assistants

Winter CME Conference

February 1-4, 2012

Grand Summit Resort Hotel & Conference Center

Sunday River, Newry Maine

This conference offers a wide range of topics for all PAs!

           Visit www.deapa.com/conference

Visit www.sundayriver.com for all hotel, skiing/winter activities and directions!

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AMA Offers Grassroots Advocacy Training Webinar on February 7th

On February 7, 2012 at 8 p.m., EST, the AMA will host a grassroots training webinar as part of the Very Influential Physician (VIP) program entitled, "Communicating with Congress:  How to be an Effective Citizen Advocate."

Led by Brad Fitch of the Congressional Management Foundation (CMF), this webinar will focus on the SGR cuts scheduled to take effect on March 1st, and how physicians can act as leaders in successfully influencing  lawmakers to permanently eliminate the SGR.  Brad and CMF have conducted exhaustive research on how Congressional offices process and respond to all the communications they receive, and what specifically impacts their thinking.

Take part in this webinar and learn:

  • What congressional staff believe are the most effective communications tactics for influencing members of Congress;

  • The differences between different forms of grassroots communications (email, mail, phone calls, in-person visits, etc.);

  • How to conduct effective in-person meetings, influence legislators at town hall meetings and other effective advocacy techniques that you can apply in your state/congressional district;

  • Where the AMA stands with current efforts to repeal the SGR once and for all, and how physicians can best leverage their relationships in Congress to amplify the repeal message.

Mark your calendars for this important webinar and stay tuned for registration and call-in details.  If you are not already a member of the VIP program, please visit the following page on the AMA web site to join:  https://www.surveymonkey.com/s.aspx?sm=NqXN8aqmcgUhAXC04fHeVg_3d_3d.

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New CMS Program to Assist Physician ID Theft Victims

A physician who has been victimized by an identity thief now has a new federal option to restore his or her financial integrity and clear bad debts.

The Centers for Medicare & Medicaid Services (CMS) has created the provider victim validation/remediation initiative for physicians whose identification has been stolen and used to defraud federal health programs.

Physicians can seek resolution from Medicare program safeguard and zone program integrity contractors through the new initiative.  These contractors, which operate according to region and state, can investigate instances of identity theft after being notified by a potential victim.  The American Medical Association (AMA) lists contact information for the contractors on its website: www.ama-assn.org/resources/doc/washington/identity-theft-victim-program-letter-oct2011.pdf.

These contractors would investigate a physician's complaint and generate a report to CMS for "a final decision whether to relieve providers of liability based upon the evidence."

Physicians who believe they are victims of identity theft but have not yet suffered any financial liability should call their Medicare administrative contractors or the HHS Office of Inspector General.  The OIG hotline is 800-HHS-TIPS. [return to top]

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