September 8, 2003

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MMA Adjourns Successful Annual Meeting
More than 400 members & guests convened at The Balsams Grand Resort in Dixville Notch, NH this past weekend to conduct the Association's 150th Annual Session. It was the best attended Annual Session in nearly twenty years!
     At the Annual Membership Meeting held on Saturday morning, members rejected one proposed Resolution and adopted four others.  Rejected was a proposal submitted by the Aroostook Medical Society to allow oral surgeons to become members of MMA and of a county medical society.  Supported were resolutions calling for re-establishment of MMA's Hospital Medical Staff Section, opposition to casino gambling in Maine, recognition of Representative Sean Faircloth for his efforts in the legislature to combat the epidemic of obesity and support for a public relations campaign to make patients aware of the dangers of keeping old prescription drugs in their possession.

     Highlights of the meeting included talks by Dr. Beck Weathers, who had endured a life-altering experience on Mt. Everest, John Tooker, M.D., FACP, Executive Vice President of the American College of Physicians, and Michael LaCombe, M.D., FACC, MACP.  Also featured were several talks on the history of medicine in Maine, as this year's meeting was the one hundred fiftieth meeting in the history of the Association.  Out of state delegations attending included representatives from the State Medical Societies in Wyoming, New Hampshire, Rhode Island, Connecticut, Massachusetts, and Vermont.  Barbara Drew, Assistant Secretary and Chief Operating Officer of the Canadian Medical Association also attended representing the CMA.  The American Medical Association and the American Medical Political Action Committee were also represented.

     Receiving the President's gavel from out-going President Krishna Bhatta was Maroulla S. Gleaton, M.D. , a practicing ophthalmologist from Augusta who will serve as the Association's 154th President and who will hold the distinction of being MMA's first woman President.  Dr. Gleaton spoke in her inaugural address of the need to broaden the appeal of the Association to a diverse group of physicians.  She also spoke of the need to work with state officials to implement the Dirigo Health Plan.  Dr. Bhatta spoke of the need to continue the current interest in improving the quality of health care.

     Receiving Association awards were the following:

                  Special Recognition Award:    Roger Renfrew, M.D.., of Skowhegan,  recognizing his exceptional stewardship in chairing the final years of the Maine Medical Assessment Foundation Board.

                    Mary Cushman, M.D. Humanitarian Award:  Charles Hendricks, M.D., of Bar Harbor, for his on-going medical mission work in Ecuador.

                     President's Award:    Gordon H. Smith, Esq., the Association's Executive Vice President who is completing his twenty-fifth year of service to MMA and Maine's physicians.

                  Lawrence B. Mutty, M.D., a retired psychiatrist from Castine, was elected President-elect of the Association and Jacob Gerritsen, M.D. of Camden was elected to Chair the Association's Executive Committee for the coming year.

      Next year's Annual Meeting will be held Sept. 10-12 at the Colony Hotel in Kennebunkport.

Governor Taps Dr. McAfee to Chair Dirigo Health Plan Board
Last Friday, Governor John Baldacci announced the 5 public, voting members of the Dirigo Health Plan Board of Directors, the group having broad authority for implementation of the Governor's health care reform plan. 

The Governor chose Dr. Robert McAfee, a former MMA and AMA President, to be the Chair of the Board.  The other 4 voting members are Dana Connors, President of the Maine State Chamber of Commerce; Mary Henderson, a public interest lawyer with the Maine Equal Justice Project; Carl Leinonen, Executive Director of the Maine State Employees Association; and Charlene Rydell, a former legislator and Health Policy Advisor to Congressman Tom Allen.

Ex-officio, non-voting members of the Board are Commissioner Robert Murray of the Department of Professional & Financial Regulation which includes the Bureau of Insurance, Commissioner Rebecca Wyke of the Department of Finance & Administration which includes the State Employees Health Insurance Program, and Trish Riley, the Director of the Governor's Office of Health Policy & Finance.

The nominations are subject to review by the Joint Standing Committee on Health & Human Services and to confirmation by the Senate.

The MMA congratulates Dr. McAfee on this important appointment! [return to top]

MMA's Legislative Summary Now Available - New Laws Effective 9/13/03!
The MMA's summary of nearly 300 health care bills of interest to the physician community is now available on the legislative and regulatory section of the web site, or from the MMA office.  If you would like a copy sent to you, please contact Charyl Smith, Legislative Assistant, or Andrew MacLean, General Counsel & Director of Governmental Affairs,

The MMA staff also will have copies available at specialty society, county society, and medical staff meetings throughout the fall. 

Most of the new laws covered in the summary are effective this Saturday, September 13, 2003, 90 days following the adjournment of the Legislature.  The new laws include the Governor's Dirigo Health Plan and bills limiting your charges for medical records, encouraging timely credentialing by MCOs, restricting retrospective denials of previously paid claims by MCOs, and requiring better notice by MCOs of changes to provider agreements, such as fee schedules and procedural coding rules. [return to top]

The AMA's Top 12 Fictions & Facts About Medical Liability Reform: #3
Fiction #3:  There is no medical liability insurance crisis.  Medical liability insurance rates are stable according to both AMA data and the Center for Justice and Democracy.

Fact:  Those desperate to argue that the medical liability insurance market is stable point to AMA survey data from 1988-1998, which show relatively stable medical liability insurance premiums by specialty for that time period.  The picture is very different if this time frame is brought up to present.  Indeed, the Medical Liability Monitor survey results demonstrate that medical liability insurance rates have increased dramatically since 1998 in most parts of the country.

Notwithstanding its assertion of a stable medical liability insurance market, the Center for Justice and Democracy "study" concludes that the insurance industry needs medical liability insurance rate increases of about 20% to 25% to return to an economic break-even level.  The CJD also acknowledges that the severity of insurer's losses (in other words, claims paid in settlements or judgments) is the major underlying factor in the market's deterioration. [return to top]

Medicare Conferees to Meet Tuesday, 9/9/03 to Vote on Staff Agreements
The 17-member House-Senate conference trying to resolve issues in the Medicare prescription drug benefit debate is scheduled to meet on Tuesday, 9/9 to review the staff agreements reached during the August recess and to discuss the rural issues that have threatened to split the conference. 

The staff aides to the conferees reached agreements last month on a number of issues, such as regulatory reform and the prescription drug discount card provisions.  The issues of concern to rural health care providers, however, remain unresolved.

Senator Charles E. Grassley (R-Iowa), Vice Chairman of the conference, has been dissatisfied with the attention devoted to rural issues.  The House bill (H.R. 1) provides approximately $27 billion over 10 years for rural providers, but the Senate bill provides about $25 billion.  Among Grassley's key concerns are provisions affecting physicians practicing in rural areas. [return to top]

Cigna Settles $540 Million Class Action Suit
On Sept. 4th, a $540 million settlement was announced between Cigna HealthCare and lawyers representing more than 700,000 physicians across the Country.  The class action suit alleged that Cigna, the nation's third largest health insurer, violated federal statutes against conspiracy, aiding and abetting claims, breach of contract, unjust enrichment and violations of various state prompt pay laws.  Cigna's cash payout is guaranteed on claims up to 12 years old.

The class action suit was being heard by U.S. District Judge Federico Moreno, of the Southern District of Florida in Miami.  The new rules for transparent claims processing, billing, and coding are expected to lead to a greater level of integrity in the relationship between physicians and health insurers.

The Sept. 4th settlement requires Cigna to:

     1.  Establish a $40 million settlement fund for physician class members who complete a claim form.

     2.  Allow physicians who chose to resubmit claims for payment filed during the class period.

      3.  Eliminate the requirement that doctors must submit copies of their medical records to be paid for most office visits occurring on the same day as surgeries and other procedures.

      4.  Name external parties to review and resolve billing or payment disputes.

       5.  Pay a fee to physicians who administer vaccines and other injectable drugs, along with paying for the drugs themselves.

        6.  Establish a physician advisory committee that allows doctors to offer input to Cigna.

          7.  Develop a website that gives physicians detailed information about Cigna coding policies and payment guidelines.

          8.  Create e-mail procedures that enable physicians to find out about fee schedules and coding information.

          9.   Pay interest on fully documented claims which were not paid within the time limits set in the  agreement.

           10.  Provide $15 million to a foundation governed by state medical society parties to the settlement.

Physicians can choose one of two ways to seek money under the settlement.  They can request reimbursement from a $40 million fund based on actual claims, or $30 million will be split among physicians who pick an alternative not tied to claims.

A final fairness hearing will be held in December. [return to top]

CMS Posts Correct Coding Initiative Edits on Internet
This past week, the Centers for Medicare and Medicaid Services made it easier for physicians to bill properly and to be paid promptly for their services provided to persons with Medicare coverage.  CMS has posted on its website the automated edits used to identify questionable claims and adjust payments to reflect what would have been paid if the claim had been filed correctly.  The edits, known as the National Correct Coding Initiative, identify pairs of services that normally should not be billed by the same physician for the same patient on the same day.  The Medicare Physician Fee Schedule Look-up provides both the unadjusted payment rates, as well as the payment rates by geographic location.

The NCCI includes two types of edits.  One set - the comprehensive /component edits - identifies code pairs that should be billed together because one service inherently includes the other.  The other - the mutually exclusive edits - identifies code pairs that, for clinical reasons, are unlikely to be performed on the same patient on the same day.  Until this past week, the NCCI edits have been available to physicians on a paid subscription basis, but not they are available to anyone with the computer capacity to retrieve them.  The edits are posted at  The Medicare Physician Fee Schedule Look-up can be seen on the Physicians Resource Page, [return to top]

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