Activity Robust at AMA Annual Meeting

The American Medical Association House of Delegates opened its Annual Meeting Saturday, June 7 in Chicago.  Among the hundreds of reports and resolutions being considered are topics involving maintenance of certification (MOC), physician identity theft, CMS release of physician specific Medicare data, and development of AMA policy regarding e-cigarettes.  Maine's two AMA delegates, Richard A. Evans, M.D. of Dover Foxcroft and Maroulla Gleaton, M.D. are participating in the meeting.

As the House of Delegates continues to meet through Wednesday morning, it is not possible to know with certainty how some of the deliberations will ultimately be resolved.  But concern over maintenance of certification has been broadly expressed as has disappointment with the decision of CMS to release physician identifiable data without adequate explanatory information.

The New England Delegation introduced a resolution calling the AMA's attention to the significant physician identity theft which led to the fraudulent filing of thousands of tax returns effecting over fifty physicians in Maine.  The resolution asked the AMA to urge the Internal Revenue Service to apply additional protections to the filing of returns and to work with other organizations and agencies to limit the use of social security numbers.

Maintenance of Certification  In addition to receiving a report on MOC from the Council on Medical Education, the House of Delegates also considered no less than five resolutions that were expressions of physician frustration over many aspects of MOC and the related topic of Maintenance of Licensure (MOL).  Resolution 313 called upon the AMA to oppose any state implementation of Federation of State Medical Board Maintenance of Licensure program and MOC participation as a condition of licensure.  Resolution 314 asked the AMA to categorically oppose any qualifiers or restriction on ABMS lifetime certification.  Resolution 316 asked the ABMS to halt MOC until specific conditions are met including demonstrated efficacy in patient care, cost assessment is complete and possible impact on physician workforce shortage is assessed.  Resolution 319 asked the AMA to oppose FSMB MOL program and any barriers to physicians and Resolution 320 endorses replacing mandatory recertification with specialty specific CME alternatives.

Medicare Claims Data Release  Several resolutions also asked for specific AMA action regarding future CMS release of Medicare data.  The actions requested ranged from outright condemnation of CMS (204) to asking that AMA to work with CMS to identify appropriate modifications that might improve the usefulness and accuracy of any existing or future provider-specific data released by that agency.

In election results, Steven Stack, M.D. was unopposed in his race for President-elect.  Dr. Stack is an emergency medicine physician practicing in Louisville, Kentucky.  Dr. Stack attended the AMA meeting in 2013 in Portland.  On Tuesday evening, Robert Wah, M.D., an obstetrician, will be installed as AMA President for the coming year. The installation will be on Tuesday evening and MMA President Guy G. Raymond will be present at the ceremony to represent Maine's physicians.

Report on Maine Health Exchange Advisory Committee

As reported in last week's Update, the state's Health Exchange Advisory Committee met on June 3rd to resume its role in advising the Legislature regarding the interests of individuals and employers with respect to the health exchange operated by the federal government.  All materials distributed at the meeting are available on the Committee's website.  

Committee members made positive comments about the actual experience in Maine in enrollment (over 44,000 individuals) despite the technological difficulties prevalent in the early months of the federally facilitated marketplace (FFM).  Most of the meeting focused on expectations and plans for the next open enrollment period which begins in November.

During a telephone conference with Region One HHS Administrator Christie Hager, J.D., members raised a few issues related to needed improvements to healthcare.gov for the 2015 open enrollment period in terms of identity verification and delays related to SCHIP eligibility assessments; use of federal marketing materials to promote the marketplace in Maine; and early guidance on essential health benefits for the 2016 plan year.  Also, federal funding has not been renewed for Maine's designated health insurance assistance program (operated by Consumers for Affordable Healthcare). The Advisory Committee agreed to send a letter to Ms. Hager and other federal officials about these issues.  It is also hoped that Ms. Hager will attend the August meeting of the Committee (not yet scheduled).

Follow-up Requests to DHHS.  The Maine Department of Health and Human Services (DHHS) submitted a written summary with some information about the interaction of the MaineCare program with the Federally Facilitated Marketplace.  Committee members asked for additional information and poised the following questions to the Department:

• The summary indicates that Maine DHHS has electronically transferred files for 55,069 applications for applicants deemed ineligible for MaineCare to the FFM.  Do you have any information on how my of these applicants would have been eligible for MaineCare under prior eligibility rules?
• How many would have been eligible if Maine had elected to expand eligibility for MaineCare as permitted by the ACA?
• Please provide copies of any notices and communications provided to MaineCare applicants by DHHS who are determined ineligible for MaineCare and whose information is forwarded to FFM. 
• Please provide copies of notices and communications used by MaineCare to engage MaineCare applicants referred from the FFM.  The summary indicates 6680 individuals were assessed as likely eligible.
• Please provide more information about Hospital Presumptive Eligibility and the State Plan Amendment process to implement the change.

Prepare for the Road Ahead; Not Too Late to Register for MMA's Practice Education Seminar, June 18

The Augusta Civic Center will once again be the site of the Association's 23rd Annual Practice Education Seminar which is intended to present physicians and practice managers with the information and trends in medical practice in Maine and across the country.  The program will be held on Wednesday, June 18 from 8:15am to 4:00pm.

The theme of this year's program is "Preparing Your Practice for the Rough Road Ahead."  The focus will be on payment reform and best practices.  Carol Vargo from the American Medical Association will present data from the Rand survey conducted for the AMA which asked physicians questions about their level of satisfaction with their work and also elicited opinion about practice sustainability.  Kevin Flanigan, M.D., Medical Director for MaineCare will present a keynote luncheon talk on the State Innovation Model grant and its role in reforming the payment and delivery system in the state.  CMS Regional Medical Director William Kassler, M.D., MPH will also speak and bring attendees up to date on current CMS initiatives in both Medicaid and Medicare.

The full agenda, speaker list and registration are now available on the MMA website. 

This year's program is supported by a Payment Reform grant from the Maine Health Access Foundation (MeHAF). [return to top]

MMA Announces Departure of Associate General Counsel, Jessa Barnard

It is with great regret that the Maine Medical Association shares the news with members and colleagues that Jessa Barnard, Esq., who served as MMA's Director of Public Health Policy from 2010-2012 and Associate General Counsel since 2012, will be leaving the Association at the end of the month. 

Ms. Barnard has provided government relations and legal support to the Association and has led Association public health and health care reform education efforts.  "I would to thank my coworkers at the MMA, MMA Board members, all of our coalition partners and the many physicians and office staff with whom I have worked for making the past four years of my career so rewarding," Ms Barnard said of her departure.  MMA EVP Gordon Smith praised Ms. Barnard's contributions to the MMA's advocacy work stating, "She is a very talented attorney and advocate and we have been very fortunate to have had Jessa as part of the MMA team for the past four years."  Mr. Smith continued, "We wish Jessa and her family well in the return to Vermont and all the best in her future career."  

She will be moving to her home state of Vermont to be closer to family and will be taking time off to care for her children before looking for opportunities to return to practicing health law and policy.  Her last day in the office will be June 25th. 

After her departure, you can contact Andrew MacLean at amaclean@mainemed.com or 622-3374 x 214 for assistance with issues you would have directed to Jessa.   [return to top]

MMA Public Health Committee to Meet Wed, June 11

The Maine Medical Association Public Heath Committee will be holding a regularly scheduled meeting this Wednesday, June 11, from 4-6 pm at the MMA Headquarters in Manchester or via phone.  Topics on the agenda include discussing which projects the Committee should prioritize for 2014-2015 and ideas for resolutions to present at the MMA Annual Business Meeting in September.  The Committee is currently poised to prioritize access to health care, integrating public health into the health care setting and physician wellness over the next year and continues to plan ways to most effectively address these crucial issues.  

Any MMA member is encouraged to join Committee meetings and consider joining the Committee.  For more information, please contact Jessa Barnard at jbarnard@mainemed.com or 622-3374 x 211.  The Committee is co-chaired by Lani Graham, MD and Daniel Oppenheim, MD.  [return to top]

Jackson Lab and MMA Looking for Primary Care Physicians Interested in Learning about Genetic Testing

Jackson Lab has received a grant from the Maine Cancer Foundation to develop and present educational modules (on-line) that will be used to educate primary care physicians on the information they need to know to advise patients about screening for genetic factors for cancer.  At this point, MMA is working with Jackson Lab to implement the program and we need a small number of physicians to be interviewed for 30 minutes and asked a series of questions about this topic.  The interviews would be by telephone and physicians would be paid $200 for their time.  Interviews would be scheduled for June but could be done in the evening if necessary.

Any primary care physician interested in being interviewed should communicate with Gail Begin at MMA (gbegin@mainemed.com). [return to top]

New Laws Impacting Your Practice: LD 390 & 386, MaineCare Coverage for ASCs, Tobacco Cessation

Each week MMA will be running articles highlighting new laws passed by the 126th Legislature that impact the practice of medicine in Maine.  We are also happy to present an overview of new laws to your medical staff, practice or specialty society and have posted a slide presentation overview of all health care-related legislation enacted by the 126th Legislature on the MMA website.

Two years ago, as part of the budget process, the administration and legislature cut MaineCare reimbursement for both ambulatory surgical centers and tobacco cessation services.  Following two years of hard work, funding for both services was restored by the legislature this session.  

The MMA and Spectrum Medical Group succeeded in restoring MaineCare coverage of services provided in ambulatory surgical facilities (L.D. 390).  DHHS will need to adopt emergency rules to put the regulations governing reimbursement at ACSs back in place, and the rules adopted are required to take effect by July 1, 2014.  The full text of the law can be found here. 

In addition, the legislature restored funding for tobacco cessation services provided to MaineCare recipients.  The program will now cover all pharmacotherapy that is approved by the FDA for tobacco dependence treatment or is recommended as effective in the United States Public Health Service clinical practice guideline on treating tobacco use and dependence; and both individual and group tobacco cessation counseling.   There can be no copayments or other out-of-pocket cost sharing, including deductibles for the services and the department may not impose annual or lifetime dollar limits or annual or lifetime limits on attempts to quit.  The full text of the law can be found here.  The change will go into effect August 1, 2014. 

With any questions or concerns, please contact MMA Attorneys Gordon Smith, Andrew MacLean or Jessa Barnard via email or at 622-3374.   [return to top]

CMS Administrator Remains Firm on Future Medicare Data Releases

CMS Administrator Marilyn Tavenner argues in a paper posted on May 28 by the New England Journal of Medicine that physician fears that the Medicare data dump would create false impressions of their work were outweighed by the value of disclosure.  And she noted that more releases were coming.  The data, which revealed how much Medicare pays individual physicians, has drawn the anger of physicians who say it fails to reveal anything about the quality of care and only factors in fee-for-service payments, which did not acknowledge such things as the cost of drugs purchased by the physician. 

"All these points have some merit, but we concluded that these issues did not outweigh the overall benefit of releasing the data," Tavenner argues.  "In particular, we view this data release as an important first step in building greater understanding, on the part of a diverse community of policymakers, data entrepreneurs, and consumers, about the way in which Medicare pays physicians and other providers."

In Maine, there was an initial slew of media articles and an identification of the physicians who had received the most Medicare reimbursement, primarily ophthalmologists and rheumatologists.   [return to top]

Burwell Wins Confirmation as HHS Secretary, to be Sworn in Today

Sylvia Mathews Burwell won confirmation this past week as Secretary of the Department of Health and Human Services on a vote of 78 to 17.  Even several of the 17 Republicans who voted against the President's nominee indicated that they were not so much voting against Ms. Burwell but against the Affordable Care Act.  She is expected to be sworn into office today (June 9).

Ms. Burwell replaces Kathleen Sebelius who resigned following a controversial time during which she was the primary point person for implementation of the ACA. [return to top]

Surescripts Study Finds Majority of Prescriptions Transmitted Electronically in 2013

In a report released on May 21st, Surescripts has found that efforts to promote electronic prescribing of prescription drugs in the country is producing results.  The report entitled, "National Progress Report on E-prescribing," 58% of all presriptions in 2013 - approximately 1 billion - were transmitted electronically.  In the study, Surescripts used both its own proprietary data and public data.  The company's own database showed a 32% increase in electronic prescribing over the previous year.  The report says that 73% of physicians used e-prescribing in 2013.  Delaware, Minnesota, and Vermont are the top three states for e-prescribing with 81% of physicians in Delaware using such technology.  Wisconsin, North Dakota, and Connecticut also are in the top ten states for e-prescribing.  All states transmitted at least 45% of eligibile prescriptions electronically according to the report.  [return to top]

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