April 14, 2003

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MMA Ad Hoc Committee on Health System Reform Working on Guiding Principles
The Association's Ad Hoc Committee, chaired by Maroulla Gleaton, M.D., has completed a draft of its Guiding Principles for reform. The next step in the charge given the Committee by the Association's House of Delegates last Fall is to draft a White Paper on Reform which is to put the meat on the bones of these principles.
The Draft Guiding Principles are as follows:

  • Universal coverage which ensures access. 
  • Mandate individual participation
  • Emphasize prevention, e.g., recommendations of U.S. Preventive Task Force
  • Systemic support for healthier lifestyles, through incentives for identified health risk avoidance.
  • Individual responsibility, including responsibilities for one's own behaviors affecting health and well-being
  • Eliminate cost shifting
  • Educate patients and providers as to the price of services, products, and valid quality outcome data
  • Hold all stakeholders accountable for working together to make the health care system better and health insurance more affordable
  • Maximize the percent of health care dollars that support direct provision of patient care
  • Provide patients with choice in the selection of physicians
  • Improve quality and minimize errors by relying upon evidence-based medicine, benchmarking and outcome measures.
  • Build an organizational structure that provides ongoing quality improvement and support of quality initiatives.
  • Provide ongoing stakeholder monitoring of governmental initiatives in universal coverage programs.

    These Principles are still in draft form and are subject to change upon further review by the Ad Hoc Committee or the Association's Executive Committee.  Members are welcome to provide input and make comments on the draft principles.  Contact either Dr. Gleaton at atleegleaton@earthlink.net or Gordon Smith at gsmith@mainemed.com

HIPAA Privacy Rule Now In Effect
     Monday, April 14th was the effective date of the HIPAA Privacy Rule.  Many medical practices in Maine are exempt from the rules if they do not bill electronically and otherwise do not transmit personal health information electronically.

     While some commentators have stated that the HIPAA Privacy Rule represents the most significant change in American Medicine since the advent of Medicare, others believe that HIPAA hype is largely driven by consultants and commentators who want to cash in on the uncertainty and fear brought on by the comprehensive rule.

      One of the biggest misconceptions, notes attorney Gordon Smith, Executive Vice President of the Maine Medical Association, is that HIPAA affects all health care providers and institutions.  'Despite its language making clear that you become a covered entity only by performing certain electronic functions, many physicians have been led to believe that all physicians and medical practices are covered.  That is simply not the case.'

       During the many HIPAA compliance seminars MMA conducted, we found many physicians who have not yet transitioned to electronic billing.  If they still bill on paper and do not otherwise perform electronic functions, such as sending or receiving e-mail from their patients or transmitting medical records online etc., the practice is simply not covered by HIPAA. 

       If your practice is covered, now is the time to be in compliance and you should be giving your patients a new Notice of Privacy Practice which is required by HIPAA.  The new notice may be the biggest change in the law, as the exemption from patient consent to disclosure of medical information for the purposes of treatment, payment or health care operations covers most of the day-to-day disclosures that take place.

      The Association has materials from the seminars available for sale at the price of $25.00.  The HIPAA packet includes 7 different HIPAA privacy forms and Powerpoint presentations on the privacy rule, the transaction rule and the security rule.  In addition, some additional documents, such as frequently asked questions, are also included.  MMA members or non-members may order the packet by calling Julie Banta at 622-3374 or by contacting her via e-mail at jbanta@mainemed.com.  Either Mr. Smith or MMA General Counsel Andrew MacLean are available to answer members' HIPAA-related privacy questions. [return to top]

Maine Maritime Vessel Looking for One Good Physician
       The Maine Maritime Training Vessel, the State Of Maine, is looking for a physician to accompany the training vessel this summer as it cruises the seas from Maine to the Canary Islands, Belgium, Halifax, and points in between.  The voyage begins May 4th and concludes July 3rd.  The ship is 730 feet long and carries 200 students and a crew of 50.  A nurse is on board to assist the physician.

        The physician receives accommodations of a single room and a stipend of $10,000.  Malpractice insurance is required and a primary care physician is preferred but not required.

         A physician has always been on board but this year a new physician is needed.  This opportunity appears perfect for perhaps a recently retired physician with an interest in travel.  Previous military experience could be useful as the ship is a former military vessel.  We are told the ship rides particularly well but can not personally confirm such.  Very positive comments have been made about the quality of the dining on board as well.

     Anyone interested may contact Gordon Smith at the Association office or via e-mail at gsmith@mainemed.com [return to top]

Dan Hanley Trust Seeks Nominees for 2003 Leadership Award
     The Dan Hanley Trust has been established to remember Dr. Dan Hanley and the important difference his work has made to so many people, patients, and organizations.  The trust has three objectives: to honor Dan and remember his accomplishments; to recognize similar courage and innovation in health care; and to develop a foundation of leadership that  recognizes the values that made his accomplishments possible.  These values are Collaboration and Inclusion, Courage, Hard Work, Innovation, Kindness, and Leadership.  The goal of the Trust is to shape programs that build a foundation of health care leaders that share Dan's values and are motivated to apply them to improve health and health care in Maine and beyond.

      Any individual may submit a nomination for the 2003 Leadership Award by completing the Hanley Leadership Award nomination form and sending it, with a cover letter and the nominee's curriculum vitae to the Maine Health Information Center.  Additional information about the Dan Hanley Trust may be obtained through the Trust web site, http://www.hanleytrust.org/.  Nominations and accompanying supporting materials may be submitted electronically through the site.

      Dr. Hanley served as Executive Director of the Maine Medical Association for twenty-five years, retiring in l979.  He then was instrumental in creating the Maine Medical Assessment Foundation which he served in one capacity or another until his death in 2001. [return to top]

Medicaid Physician Incentive Program Takes Another Hit
      As another gap has opened up in the existing year (2003) state budget, the physician incentive program which compensates primary care physicians on a quarterly basis an additional amount in Medicaid reimbursement, over and above the fee for service payments, based upon a series of measurements, has taken another hit.   L.D. 1574, proposed by the Baldacci administration, proposes to reduce the Medicaid budget by another $200,000 to be taken from the incentive program.  This amount of de-appropriation would appear to eliminate any remaining payment for this year, as the previous budget bills had already taken even larger amounts from the program.  As the federal government provided a nearly 2 to 1 match for these funds, each dollar cut from the state budget results in a loss of two federal dollars as well.

      Association representatives will be discussing the future of the incentive program with Eugene Gessow, the Director of the Bureau of Medical Services and Laureen Biczak, D.O., the Medicaid Medical Director. [return to top]

Governor's Office of Health Policy and Finance Drafting Health Care Reform Bill
     Trish Riley and Ellen Schneiter, the principal staff in the Governor's Office of Health Policy and Finance, are presently drafting the Governor's health reform bill and are expected to share the document with the Health Action Team, the advisory group of stakeholders, on Friday, April 25 or perhaps the following week.  Interest groups and legislators are anxiously awaiting the draft but expect that it will contain some very comprehensive proposals dealing with each of the proverbial legs of the three-legged stool representing cost, quality and access.

      In a recent meeting with MMA representatives, the Governor reiterated his strong support for a comprehensive measure this legislative session.  The Association hopes to have its own White Paper on reform completed in time to share with the Governor's team working on the legislation. [return to top]

Legislative Pace Quickens on Health Care Bills
    The Association is now following well over 200 pieces of health care related legislation pending in Augusta.  Each Friday, MMA Director of Governmental Affairs and General Counsel Andrew MacLean prepares a document called Maine Medicine Political Pulse that updates members on the legislative events of interest the past week and previews what is in store for the next week.  Rather than repeat in Maine Medicine Weekly Update what is already in the political pulse,  we will simply link to the Political Pulse.  Readers wishing more information on legislative items may simply click on the link. [return to top]

MMA Committee on Membership and Member Benefits Looking for Value
     The MMA Committee on Membership and Member Benefits met on April 10th and reviewed proposals from three leading payroll companies, an internet company and a long distance carrier.   The Committee, chaired by Kevin Flanigan, M.D., and assisted by Buell Miller, M.D., actively looks for corporate benefits that would be of value to members.  Generally, the benefit, product or service must meet the following three criteria to be considered for an endorsement.

  1. It must be better or, at least as good as, any other product of its kind in the marketplace.
  2. It must be offered to MMA members at a discount.
  3. It must produce revenue for MMA in order to enhance the Association's non-dues revenue.

         The Committee will meet again in May to complete its discussion of the proposals currently on the table.  Members with thoughts on this subject are free to communicate with either Dr. Miller at bmiller@mainemed.com or Dr. Flanigan at flanmansvpc@pol.net [return to top]

12th Annual Physician Survival Seminars
     The Association's 12th Annual Physician Survival Seminars are being held in Bangor in May and in Portland in June.  The Bangor seminar will be at Spectacular Event Center on Wednesday, May 28th from 8:30am to 4:00pm.  The Portland program will be held at the Portland Marriott at Sable Oaks on Wednesday, June 25th from 8:30am to 4:00pm.  Registration materials have been included with the March and April monthly issues of Maine Medicine.  More information is available from Susan Feener at sfeener@mainemed.com

      This year's breakout sessions feature a range of topics, including HIPAA privacy , transactions, and security.  The plenary sessions feature talks from the employer community discussing what purchasers of healthcare are looking for from physicians.  Other topics covered include an employment law update, prescription drug abuse, fraud and abuse, the use of data to market your practice, physician employment contracts, maximizing collections and the usual Medicaid update.  The Portland program features a Keynote Presentation by W. Robert Wright of the Starlight Group discussing 'The Characteristics of a Healthy and Successful Medical Group.' [return to top]

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