August 25, 2003

 
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Clarification on Aetna Settlement Advice
The Association wishes to clarify advice presented in the August 19th Memo to all members from Mr. Smith and Mr. MacLean regarding the appropriate response to the legal notice sent to all physicians announcing the proposed settlement of the federal multi-district class action litigation brought by 18 state and county medical societies against Aetna.
In the Memo, it was stated that if a physician wished to participate in the settlement, nothing further needed to be done until the settlement was approved.  Actually, physicians received a claim form with the legal notice and do need to complete it and sign the form and mail it to;

Aetna Managed Care Litigation

P. O. Box 3656

Portland, OR 97208-3656

The envelope returning the claim form must be postmarked by no later than Sept. 30th, 2003.  If a physician is entitled to the modest settlement amount and does not file the claim form, that share of the settlement fund will be contributed to the Foundation established in the Settlement Agreement.   

As noted in the Memo, physicians wishing to opt out of the settlement must send a signed statement to that effect to the same address, and do so by AUGUST 29, 2003.  Such notice should contain your name, business address, telephone number and Federal Tax Identification Number. 

The August 19th Memo was intended to respond to members'  questions about the settlement.  It can be accessed on the MMA website  here

Medicare Payment Cut; MMA Fights for Payment Increases
Due to the flaws in the physician payment update formula, the physician payment problem relative to Medicare continues.  In March, Medicare officials projected a cut of 4.2% in 2004 payment rates for physicians and other health professionals.  Even steeper cuts are possible and an August 15 proposed rule noted that the estimated update is "highly likely" to change before it is finalized later this year.  This cut would be the fifth cut since 1991, and would be on top of an actual reduction of 5.4% in 2002.  Without any action by Congress, additional cuts are also estimated for 2005, 2006 and 2007.  From 1991-2003, payment rates for physicians and health professionals have already fallen 14% behind practice cost inflation, as measured by Medicare's own estimates.

The House-passed Medicare bill (H.R. 1) would provide relief to the continuing physician payment crisis by establishing positive updates for 2004 and 2005 of not less than 1.5% in each of these years.  These provisions would help avert a Medicare meltdown and allow physicians to continue to treat the health care needs of the elderly population. 

Now, the House and Senate are negotiating over what to include in their final version of Medicare legislation.  Although none of the Maine Congressional delegation is on the Conference Committee, it is important to communicate with all four representatives to strongly urge that the Medicare physician payment legislation passed by the House in H.R. 1 be included in the final conference report on Medicare.  Physicians can access Congressmen Allen and Michaud and Senators Snowe and Collins by phone using the AMA's Grassroots Hotline at 1-800-833-6354.  Encourage our representatives to make changes as well in the geographic variables that discriminate against physicians in Maine and in other rural states. [return to top]

Special Notice - 2004 Participation Enrollment and Fee Schedule
National Heritage Insurance Company is entering into a pilot project with CMS (Center for Medicare and Medicaid Services) regarding distribution of the 2004 Participation Enrollment and Fee Schedule.  In November of 2003, the 2004 information will be sent to physicians on CD-ROM instead of the usual paper format.  NHIC alleges that there are some advantages to having the material on CD-ROM, including the ability of the physician to complete the application on line.  The CD will include the fee schedules for all of California, Maine, New Hampshire, Vermont and Massachusetts.  Guides for topics such as EDI, HIPAA, and the CMS 1500 claim form will be included on the CD-ROM.

Providers who have billed Medicare in the past year will be mailed a CD-ROM automatically.  If, after receiving the CD-ROM, a physician finds that he or she cannot access the data properly or cannot download the information from the website, a paper copy of the fee schedule for their area can be mailed to them.  Further information on ordering a paper copy will be published in the Medicare B Resource Preview in September.

Physicians or office staff with questions should contact Richard Hoover, EDS - -National Heritage Insurance Company, Manager, Medicare Education and Outreach, 75 Sgt. William Terry Drive, Hingham, MA 02043., Phone: 781-741-3134. [return to top]

Massachusetts Insurer to Raise Payments to Obstetricians
(From Boston Globe, August 16, 2003)

BlueCross BlueShield of Massachusetts has announced that it will increase reimbursements to obstetricians next month by 8% in response to the malpractice crisis. BCBS-MA intends to increase all other physician reimbursement by 2.1% in September.  The increases for obstetricians were higher because they have been among the hardest hit specialties with respect to rising medical malpractice costs.

"We're very pleased that the health plans are beginning to recognize the seriousness of the problem," said Thomas Sullivan, M.D. President of the Massachusetts Medical Society.  "But it's not enough in the longer term to compensate for the high premiums.  We're in a fight for the soul of some specialties in medicine." [return to top]

JCAHO Issues 2004 National Patient Safety Goals
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) set National Patient Safety Goals for 2004 that include all of the 2003 goals plus an additional goal to reduce the risk of  health care-acquired infections.  The recommendations were based in part on data from the JCAHO's Sentinel Event Database and other established sources.

"The expert panel which developed the recommendations to the Board felt strongly that the current six National Patient Safety Goals require the continued close attention of America's health care organizations." said Dennis O'Leary, M.D., President of JCAHO.  "They, and we, feel just as strongly that reduction of unanticipated deaths related to nosocomial infections must become a top priority for hospital and other health care organization leaders."

The 2004 goals are as follows:

Goal 1:  Improve the accuracy of patient identification

Goal 2.  Improve the effectiveness of communication among caregivers

Goal 3.  Improve the safety of using high-alert medications

Goal 4:  Eliminate wrong-site, wrong patient and wrong-procedure surgery.

Goal 5: Improve the safety of using infusion pumps

Goal 6:  Improve the effectiveness of clinical alarm systems

Goal 7:  Reduce the risk of health care-acquired infections [return to top]

Maine Chapter of the Healthcare Financial Management Association Annual Meeting, Sept. 18th and 19th
The Maine Chapter of the Healthcare Financial Management Association presents "Health Care Reform;  Everybody's Getting Into the Act" , at its 2003 Annual Meeting.  The meeting will be held Sept. 18th and 19th at Sebasco Harbor Resort at Sebasco Estates, Maine.  Speakers include Trish Riley, Director, Governor's Office for Health Policy and Finance;  Peter Hayes, Health Benefits Strategist, Hannaford Brothers; and Joyce Zinowski, Chair-Elect, HFMA National Board of Directors.

A registration fee is charged.  Persons interested in attending may register online at www.mainehfma.org or by contacting Jim Puiia at 232-4613. [return to top]

Don't Forget New Law Limiting Charges for Copies of Medical Records, Effective Sept. 13, 2003
L.D. 363, An Act to Ensure Patient Access to Medical Records (P.L. 2003, Chapter 418) takes effect on Sept. 13.  The law limits charges for copying medical records to $10 for the first page and 0.35 cents for each additional page.  This is the same charge limit that applies currently to records copied for workers compensation purposes.

MMA opposed this bill which was presented by an attorney and supported by the Maine Trial Lawyers Association.  The only example offered at the hearing before the Health and Human Services Committee was of one Maine hospital charging a patient $700 for a 700 page inpatient medical record.  The legislation received a divided report in the committee, but was voted out with a favorable ought to pass report which was accepted by the full legislature. [return to top]

Sesquicentennial Annual Meeting Nears Record Numbers
The Association's 150th Annual Session, being held Sept. 5th through the 7th at the Balsam's Grand Resort Hotel in Dixville Notch, New Hampshire is proving to be popular with members.  Only a few rooms remain and nearly 400 persons are expected to attend some portion of the meeting.  Krishna Bhatta, M.D., a urologist from Skowhegan will preside over the session and on Saturday night will hand over the President's gavel  to the Association's first female President, Maroulla Gleaton, M.D.  Dr. Gleaton practices ophthalmology in Augusta and resides with her family in Palermo. 

Presenters at the meeting include John Tooker, M.D., EVP of the American College of Surgeons; Beck Weathers, M.D., author of, "Left for Dead, My Journey Home from Everest", and Michael LaCombe, M.D.  Several talks on the history of medicine in Maine are also scheduled, as are talks on the history of public health n Maine, the history of the state forensic service, and the history of the licensing of physicians.

Don't let the popularity of the meeting discourage you from coming.  If you haven't made a reservation but would like to attend, call Susan Feener at 622-3374 or via email at sfeener@mainemed.com.  We'll make every effort to make a place for an MMA member! [return to top]

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