June 30, 2003

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House & Senate Pass Medicare Reform Bills, Rural Provisions Intact
Late Thursday night (6/27), both the U.S. House of Representatives and the U.S. Senate passed versions of Medicare reform legislation. The House narrowly passed H.R. 1, the "Medicare Prescription Drug and Modernization Act of 2003," by a vote of 216-215. This bill provides for Medicare physician updates of at least 1.5% in 2004 and 2005. H.R. 1 also included regulatory relief requirements that the AMA and MMA have advocated to address physician concerns regarding Medicare carrier audits and payment increases for physicians in rural and underserved areas.
The Senate also overwhelmingly passed its version of Medicare reform legislation (S.1) by a margin of 76-21. Both Olympia Snowe and Susan Collins voted for the bill. "Sense of the Senate" resolutions were offered regarding the physician payment formula and were included in S.1 as passed. These resolutions, which passed by voice vote, urge Congress to fix the payment formula to prevent additional cuts in physician payments.

While the primary purpose of both bills was to provide prescription drug coverage to Medicare recipients, beginning in 2005, the bills contain several provisions of vital interest to physicians.  Now that both bills have passed, a conference committee must meet to work out  differences in the two bills before a final bill can be enacted and passed on to the President for his signature.  Senators Snowe and Collins supported the Senate bill; Congressmen Allen and Michaud opposed the House Bill.

Conference committee work will begin when Congress returns from the Fourth of July recess on July 7.  Efforts will be made to complete a conference agreement before the August recess which begins on August 4th and extends until Sept. 3rd.  The top priority issues for physicians in the conference are:

    *  A two-year payment formula fix, resulting in positive updates in 2004 and 2005, rather than the 4.1% reduction in payments that will otherwise take place.

      *  geographic payment adjustments which will result in Maine physicians being paid better in relationship to others around the country

        *  Defeating inclusion in the bill of the creation and use of an ICD 10 set of codes.

         *  Regulatory relief.

         *  Eliminating electronic prescribing requirements.

          *  Adequate financing of both traditional Medicare and private plan options.


Maine Senator Olympia Snowe was successful in obtaining Senate support to restore $2.7 billion to the State Children's Health Insurance Program which will bring an estimated $13 million to the State of Maine through the program that extended Medicaid to more low-income children. 

Bot the Senate bill and the House bill contain provisions enhancing reimbursement to rural physicians by establishing a floor for the work geographic practice cost index for 2004 and 2005.


New Guidelines Help Physicians Ensure Safe and Secure Internet Prescribing
In an effort to help physicians safely and securely prescribe medications to patients via the Internet, the AMA House of Delegates recently adopted new guidelines stating that physicians should obtain medical history information and perform a physical examination before prescribing  medications online.

Based upon recommendations prepared by the AMA's Council on Medical Service, the new guidelines suggest physicians transmit prescriptions over a secure network that includes features such as password requirements and prescription encryption.  In addition, the guidelines stress that physicians who prescribe medication using the internet should either be licensed in the states where their patients live or meet the regulatory requirements of individual state medical boards.  Prior to this action, AMA policy supported Internet prescribing, but stressed the need for appropriate safeguards to ensure that online communications did not replace the interpersonal aspects of patient- physician relationships.  For more about the AMA's new Internet prescribing guidelines, go to http://www.medem.com. [return to top]

MaineCare Preferred Drug List to Take Effect Tuesday
Tuesday, July 1st  promises to be a busy day at the Bureau of Medical Services and Goold Health Systems as the greatly expanded drug program in MaineCare takes effect.  The new drug list covers 24 pages and more categories are to be added in August, September, October and November.  Materials describing the new list and explaining the enhanced prior authorization requirements were mailed to each MaineCare provider on May 27th.

As noted in last week's Maine Medicine Weekly Update, there is a one-time override in the system the pharmacist can use to dispense a one-month supply.  The Mainecare member also always has access to a 96-hour emergency supply.

For questions on prior authorizations, call 1-888-445-0497.  For pharmacy claims submissions, call 1-888-420-9711 and for policy questions, call 1-800-321-5557.

As the program is rolled out, MMA will continue its advocacy for MaineCare patients.  If you have an experience that you can share with us, please call Gordon Smith or Andy MacLean, at 622-3374. [return to top]

Outpatient Surgeon Needed
Fully equiped office based surgical practice seeking Maine licensed surgeon to provide limited, part-time outpatient services.  Opportunity particularly suitable for semi-retired physician or surgeon seeking turn-key satellite office with mature referral base.  Potential access to hospital procedures now befing referred out is available , if desired.  Remuneration is negotiable and customized based upon interest and availability.

Contact Mr. RIchard Roy, 207-854-1544 or droy@maine.rr.com [return to top]

Part Time Primary Care Position Wanted
Maine licensed physician desires a 20-25 hour per week position in a primary care setting.  Resume and references available upon request.  Contact Mr. RIchard Roy, 207-854-1544 or droy@maine.rr.com. [return to top]

Casinos in Maine?
Not surprisingly, Maine physicians have been asked to get involved in the referendum campaign involving casinos.  While the Maine Medical Association has not yet taken a formal position on the issue of allowing Indian tribes to operate a gambling casino in Maine, individual physicians are involved on both sides of the campaign.  If you have an interest and would like to contribute or get involved, please contact Gordon Smith at gsmith@mainemed.com.  Gordon would then forward your name to the appropriate parties. [return to top]

12th Annual Physician Survival Seminar
The 12th Annual MMA Physician Survival Seminar was held in two locations in May and June.  On May 28th, attendees in Bangor heard from fifteen different presenters on subjects including healthcare costs, Medicaid, fraud and abuse, employment contracts, collections, data, HIPAA, and reimbursement.

On June 25th in Portland, nearly 100 attendees heard presentations on all of the above plus presentations on "Dirigo Health" and a keynote presentation on "The Characteristics of  a Healthy and Successful Medical Group," by [return to top]

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