August 4, 2003

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Register Now for 150th Annual Session, Sept. 5th-7th
The Maine Medical Association will hold its 150th Annual Session at the Balsams Grand Resort Hotel in Dixville Notch, N.H. on Sept. 5th -7th, 2003. The room block expires August 8th so it is important to get your reservation form in as soon as possible. Reservations will still be taken after the 8th on a space available basis.
     This Sesquicentennial Meeting promises to be one of the best meetings in recent history.  The program begins with an opening talk at 1:30 pm Friday (Sept. 5) afternoon by John Tooker, M.D., Executive Vice President of the American College of Physicians.  Dr. Tooker practiced in Portland for several years before being asked to join the ACP staff in Philadelphia.  His talk will be entitled, "The Current Status of American Medicine."  Following John will be Michael LaCombe, M.D., presenting "Legacies of Medicine." The remainder of the afternoon consists of several talks on the history of the Association and of medicine in Maine.  These talks continue on Saturday afternoon as well.

     On Saturday morning, the Association will hold its first Annual general Membership Meeting, which replaces the traditional House of Delegate's sessions. (The House of Delegates was abolished last year in favor of a town-meeting like session where all members can vote and participate).  At 4:00 pm Saturday, Beck Weathers, M.D.,  will give a keynote talk describing his ordeal on Mount Everest.  Dr. Weather's book entitled, "Left for Dead", is a remarkable description of his preparation for the climb, its tragic consequences and its aftermath.  Dr. Weathers practices pathology in Dallas, Texas, despite the lose of his nose and much of his hands from frostbite.

     The Annual Banquet Saturday evening will feature the bestowing of fifty-year pins on a number of our senior physicians and the unveiling of a video/documentary film highlighting the history of the Association.  Other awards will also be given.

     The CME program ends on Sunday morning with a second talk by Dr. LaCombe entitled, "Last Words."

      The educational and business parts of the meeting will be complimented by the social and recreational activities including the traditional 2.6 mile road race, golf, tennis, hiking, mountain biking and boating.  The golf, tennis and road races are again sponsored by Medical Mutual Insurance Company of Maine.

      Over 300 people are expected at the meeting.  You may call the Balsams for a reservation form (toll-free at 1-800-255-0800) or download it from the MMA website at  Please complete a registration form to send to MMA as well.

     You work hard.  Give you and your spouse or family a break and join your colleagues for a celebration of 150 years of Maine physicians caring for Maine patients. The Balsams resort is a very special place.   You will not be disappointed!

HIPAA Expert Warns of an Approaching Compliance Meltdown
John L. Phelan, HIPAA expert and health care consultant from Milliman U.S.A., contends that many organizations which should be in compliance will actually fail to meet the October 16th, 2003 deadline for the Transaction and Code Set mandates of the Health Insurance and Portability and Accountability Act of 1966 (HIPAA).  "It's a procedural melt down," says Phelan.   "The government has not backed off its deadline but a great number of payors and providers are still trying to find their way through the thicket of technical requirements, code sets and other regulatory challenges.  Many are seriously behind on their implementation processes and there will be consequences."

In last week's issue of Maine Medicine Weekly Update, it was announced that the Maine Bureau of Medical Services would not meet the deadline in its MaineCare (formerly Medicaid) program. 

The intent of the HIPAA transaction requirements is to enable health plan payors, and physician and hospital providers to communicate cost-effectively and securely using electronic transactions, similarly to the way transactions are handled today in the banking industry. There is a fear in the health care industry that many practices are relying upon their vendors to deal with compliance and that the vendors are not able to do so.  While the government may suspend fines or other enforcement activities for a time, the implementation deadline itself is not likely to be moved.

Just as significantly, practices which are covered by the law may face disastrous results with delayed third-party payments if they are not in compliance.  Offices unprepared or unable to submit claims electronically by Oct. 16th and then go back to paper claims, multiplied by thousands of offices doing the same thing, are likely to receive significantly delayed payments.

What should practices do now?  Check with your contracted health plans to learn whether they will continue to accept paper claims or if they will be HIPAA-compliant by Oct. 16th.  Also check with software vendors, billing services, eligibility verification vendors, clearing-houses and others with whom you conduct business electronically.

Code sets are an integral part of electronic transactions, and HIPAA refers to them as either medical (clinical) codes or non-medical (non-clinical) codes.  These include HCPCS, CPT-4, HCPCS for durable medical equipment and supplies, ICD-9-CM for diagnosis and ICD-9-CM for inpatient procedures and also "Explanation of Benefits" (EOB) reason codes, Remittance Advice remark codes and other claims status codes.

Numerous Web sites offer you a way through the maze of HIPAA rules.  Check any of the following sites:

From the AMA;

From the CMS;

From wedi-snip: [return to top]

Aids, HIV on the Increase in Maine
State Health officials this week announced that the number of aids cases and HIV cases are increasing in the state.  Mark Griswold, an epidemiologist with the state Bureau of Health, said 33 new cases of HIV were reported between Jan. 1 and July 24 of this year.  Nineteen cases were reported in the same period last year with 39 reported for all of 2002.

There have been 28 new cases of AIDS reported so far in 2003, compared with 21 during the same period last year and 42 for the full year.

The increases mark the first time in several years that AIDS and HIV cases have increased.  Cases of other sexually transmitted diseases also have increased substantially.  Cases of gonorrhea have increased from 66 in the first half of 2002 to 123 during the same period this year.  Chlamydia cases rose from 829 to 1,121.  There have also been nine syphilis cases reported so far this year, up from one in the first six months of last year.

Public health experts have attributed the increase to a combination of "prevention fatigue" in older gay and bisexual men, and a lack of awareness in younger men who are seeing patients with HIV infection and AIDS living for many years and looking healthy. 

Currently, the Bureau of Health says that there are more than 500 people with AIDS in Maine and another 700 who are HIV-positive.  Officials say the numbers have never been higher because people with AIDS and HIV are living longer and healthier lives. [return to top]

Anthem Posts $177 Million Profit
Health Insurer Anthem Inc. reported a 67% jump in second quarter earnings last week, coming in ahead of Wall Street expectations on the strength of membership gains.  Anthem also increased its projection of future earnings.

For the April-June period, Anthem reported net income in its nine states of $177.3 million, or $1.25 per share.  That compared with a profit of $106.2 million or $1.01 per share, for the year-ago period.

Anthem is the nation's fifth-largest publicly traded health benefits company.  The company also raised its forecast of 2003 membership growth to the 7 percent to 8 percent range, up from an earlier 5% to 7%. [return to top]

Checklist Promotes Men's Health
The federal agency for Health Research and Quality (AHRQ) has compiled current recommendations on men's health screenings into a pocket-sized brochure that men can take with them to their doctors' visits.  The "Checklist for your Next Checkup" lists health tips for men and recommendations on screening tests for cholesterol, high blood pressure, colorectal cancer, diabetes, depression, sexually transmitted diseases, and prostate cancer.  The checklist is available on the AHRQ website, and copies may be ordered by calling 1-800-358-9295 or sending an e-mail to [return to top]

Flu Vaccine Supply to be Adequate in 2003, CDC Official Says
The supply of the influenza vaccine will exceed demand in 2003, according to a CDC official.  During testimony before the CDC Advisory Committee on Immunization Practices, Dr. Dennis O'Mara, associate director of the CDC's National Immunization Program, said that an estimated 84.5 million to 91 million doses of the vaccine will be manufactured this year, down from a record 95 million doses  last year, which ended up being a relatively mild flu season.  About six million of this year's doses will be FluMist, a nasal flu vaccine approved by the FDA last week. [return to top]

Senate Finance Committee Staffers To tackle GPCI's This Week: Call Your Senator!
Senate Finance Committee staffers are expected to meet this week on the geographical disparity issue in Medicare Part B payments. As a member of the Geographic Equity in Medicare Coalition (GEM), the Association urges its members to contact Senator Snowe's office this week to ask that the Senator urge her colleagues on the Conference Committee to give a high priority to fixing the geographic disparity problem.  Specifically, we are aiming at a permanent fix of establishing a floor of 1.0 on the physician work GPCI and the practice expense GPCI.

More information on the topic can be found on the Iowa Medical Society  website located at

Senator Snowe can be contacted through e-mail to snowe@senate .gov or via fax to 202-224-1946.  A phone call can make the point, as well.  The Washington number is 202-224-5344. [return to top]

More on Medical Malpractice Rate Filings in Maine
We reported in Maine Medicine Weekly Update last week that Medical Mutual Insurance Company of Maine had filed for an 8% rate increase, effective Oct. 1.  Recently, another carrier, GE Medical Protective Company also filed for an increase in rates with the Bureau of Insurance.  GE Medical Protective, which has relatively few insureds in the State, filed for an overall increase of 7%. 

MMA legal staff reviewed both filings at the Bureau last week.  Because of the relatively small amount of increase, particularly when compared to other states, it is unlikely that physicians or anyone else will oppose the filings.  Medical Mutual's increase was predicated upon a rate indication of 9.9%, based upon a 6/20/30 Tillinghast Towers Perrin study.  The current average premium for Medical Mutual is $11,380.   The 8% increase will bring the average premium to $12,291.

The GE filing is designed to produce a 10% return on surplus/after tax return on premium.  It is based upon an analysis of Medical Mutual's 2001 rate filing as GE does not have enough insureds in Maine to make its own experience credible.

Members wishing a copy of the proposed rate change indication by class should contact Andrew MacLean at [return to top]

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