September 2, 2003

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One Hundred Fiftieth Annual Meeting to Consider Five Resolutions
The 150th Annual Meeting of the Maine Medical Association will be held this weekend at the Balsams Grand Resort Hotel in Dixville Notch, New Hampshire. Over 400 persons are expected. Along with keynote talks and presentations on the history of the Association, the meeting will feature two important firsts, the first general membership meeting replacing the traditional House of Delegates and the installation of the first woman President. On Saturday evening, MMA President Krishna Bhatta will hand over the gavel to in-coming President Maroulla S. Gleaton. Dr. Gleaton is a practicing ophthalmologist in Augusta and resides with her family in Palermo.
The first-ever general membership meeting will be held Saturday morning, Sept. 6, at 9:00am.  Along with approving a budget for 2004,  bylaw amendments and electing officers, members at the meeting will consider five resolutions, as follows;

  1. Resolve to Allow Membership for Oral Surgeons in County Medical Societies and the Maine Medical Association.  (Submitted by The Aroostook County Medical Society)
  2. Resolve to Revitalize the Maine Medical Association Hospital Medical Staff Section.  (Submitted by Charles T. McHugh, M.D.)
  3. Resolve to Oppose Locating A Casino in Maine (Submitted by Public Health Committee)
  4. Resolve Supporting Efforts to Reduce Illegal Access to Prescription Drugs. (Submitted by Public Health Committee)
  5. Resolve Recognizing the Efforts of Representative Sean Faircloth on Physical Activity and Obesity During the 121st State Legislature (Submitted by Public Health Committee)

Copies of the Resolutions are available from the MMA office  ( or call 622-3374).   Members not able to attend the meeting who wish to express an opinion on any of the Resolutions may contact either Gordon Smith (, Andrew MacLean ( or Anna Bragdon (

A full report on the activities of the meeting will appear in Maine Medicine Weekly Update and in the monthly Maine Medicine.

Congress Re-Convenes. Physician Medicare Payment Update Must Be Fixed!
The United States Congress re-convenes this week with a full Fall agenda, including Medicare reform.  The Conference committee working on a Medicare reform package, including creation of a prescription drug benefit for seniors, also must deal with the impending Medicare physician payment cut that will take place in 2004 unless Congress acts.  The payment reduction is estimated to be about 4.2%. 

Senate Republican conferees are scheduled to meet on Thursday, Sept. 4.  While staff negotiations took place during the August recess, Thursday's meeting will be the first time these conferees have formally met since late July.

The AMA, state and national specialty societies are in total agreement on three top priority issues: 1) On the Medicare physician payment update, we urge the adoption of the House provision that would provide positive updates for physician payments of no less than 1.5% for 2004 and 2005 and stop a cut of 4% to 5% due to go into effect Jan. 1 under current law. 2) E-prescribing:  Adopt the Senate approach to develop standards for electronic prescribing, but do not mandate electronic prescribing.  (The House version includes the mandate).  3)  ICD-10:  We support the compromise alternative to the House provision to clarify that ICD-10 would not apply to physician services, which would force physicians to adopt a new coding system that leaves out fundamentals such as Evaluation and Management or anesthesia services. [return to top]

HIPAA Deadline Approaching - Begin Testing Systems Now
The October 16, 2003 HIPAA Electronic Transactions and Code Sets deadline is rapidly approaching.  A medical practice that is covered by the HIPAA Electronic Transaction and Code Set standard should already have started testing to determine the medical practice's state of readiness to comply with the standard.  According to some industry experts, if a medical practice does not begin testing by early September, the medical practice will not have enough time to meet the deadline.  Each medical practice covered under the HIPAA Electronic Transactions standard should contact its vendors regarding any updated software needed to comply with the standard, and should be testing its software with payers, including Medicare, Medicaid and commercial payers.  If a medical practice should obtain the assurance from the entity that it is able to comply with the standard by the October 16, 2003 deadline.

Under the HIPAA Electronic Transactions and Code Set standard medical practices covered by the regulations had until October 16, 2002 to comply with the standard.  However, the "Administrative Simplification Compliance Act" signed by President Bush on December 27, 2001 gave medical offices and other covered entities a one year extension - or until October 16, 2003 - if the medical practice or other covered entity submitted a "Compliance Plan" to the U.S. Department of Human Services before October 16, 2002.  If no compliance plan was filed, the medical practice or other covered entity is subject to penalties under HIPAA if it engages in non-compliant health care transactions after October 16, 2002.

The Centers for Medicare and Medicaid Services (CMS) is responsible for enforcing the Electronic Transactions standard.  On July 24, 2003, CMS issued guidance "Steps Toward HIPAA Compliance" on its website, According to CMS, it will use a complaint-driven approach for enforcement of HIPAA's electronic transactions and code set provisions.  When CMS receives a complaint, it will notify the covered entity that it has received a complaint and will ask the covered entity to 1) demonstrate compliance, 2) document its good faith efforts to comply with the standard, and/or 3) submit a corrective action plan.

The guidance provides that CMS will consider an entity's good faith efforts to comply when assessing individual complaints.  CMS states that it may decide not to impose a civil money penalty where the entity demonstrates it is making good faith efforts to comply and the failure to comply is not the result of "willful neglect."  The guidance also states that CMS recognizes that transactions often require the participation of two covered entities (e.g. electronic transactions between medical practice and health plan) and that noncompliance by one covered entity may place the second covered entity in a difficult position.  CMS, therefore, states that it intends to look at both covered entities' good faith efforts to come into compliance in determining, on a case by case basis, whether to impose penalties. [return to top]

Final EMTALA Rule to be Published Sept. 9th
The Centers for Medicare and Medicaid Services (CMS) recently announced their intention to publish a final rule on Sept. 9 that will clarify hospital obligations to patients who seek treatment for emergency conditions under the Emergency Medical Treatment and Labor Act (EMTALA).  The CMS press release suggests the rule will include some important clarifications of EMTALA  regulations advocated by organized medicine, including the AMA.  For example, physicians will be permitted to be on call simultaneously at more than one hospital, and to schedule elective surgery or other medical procedures during on-call times.  The rule also clarifies that EMTALA doesn't apply to individuals seeking care in off-campus outpatient clinics nor to patients who have been seen, screened and admitted for inpatient hospital services.  The new rules are scheduled to go into effect Nov. 10. 

When the Final Rule is published, MMA will include more analysis in this weekly update and in the monthly Maine Medicine. [return to top]

ACIP Proposes New Recommendations about the Timing of Influenze Vaccination
In response to delays in production and distribution of influenza vaccine in 2000, the Advisory Committee on Immunization Practices (ACIP) recently recommended that first-available supplies of vaccine be administered to health care workers and people who have an increased risk for complications from influenza.  this prioritization has been incorporated into ACIP's annual influenza recommendations.

To help vaccine administrators determine if administration of influenza vaccine should be prioritized in case of anticipated delays or shortages, ACIP requested that the Centers for Disease Control and Prevention (CDC) develop a process to assess the projected vaccine supply in advance of the influenza vaccination season.  Each year, this process will be conducted collaboratively by the CDC, the Food and Drug Administration and the manufacturers producing influenza vaccine.  Go to to read additional information on the ACIP recommendations. [return to top]

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