September 15, 2003

 
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New State Laws Became Effective Saturday, 9/13/03
Several new laws of interest to physicians took effect last Saturday, Sept. 13th, which was 90 days after the First Regular Session of the 121st Legislature adjourned. Bills limiting charges for copies of medical records and requiring disclosure of fees for common services and procedures top the list of new laws, along with the Dirigo Health Legislation.
L.D. 363, An Act to Ensure Patient Access to Medical Records (P.L. 2003, Chapter 418; ) limits the charge for copies of medical records to $10 for the first page and 35 cents for each additional page.  MMA, the Maine Hospital Association, and the Maine Osteopathic Association all strongly opposed this legislation as unnecessary but the legislation was passed over our objections.  It was introduced at the request of the Maine Trial Lawyers Association.

Section C-30 of the Dirigo Health Legislation, entitled "Consumer information" requires all licensed health care providers to notify patients in writing of the provider's charges for health care services commonly offered by the licensee.  Upon request of a patient, a health care practitioner is required to assist the patient in determiing the actual payment from a 3rd-party payor for a health care service commonly offered by the practitioner.

In explaining this disclosure provision, MMA attorneys Andrew MacLean and Gordon Smith have emphasized that the requirement does not mandate any particular type of disclosure and does not state which services to list.  The charges could be included in a patient brochure, posted somewhere in the waiting room, or otherwise supplied in writing to the patient.  A similar provision applies to hospitals and Ambulatory Surgical Facilities.  

Other new laws include bills requiring health insurance companies to perform more timely credentialing, restricting retrospective denials of previously paid claims by managed care organizations and requiring better notice by MCO's of changes to provider agreements, such as fee schdules and procedural coding rules.

A summary of the nearly 300 health care bills on interest to physicians is now available on the legislative and regulatory section of the MMA web site,  www.mainemed.com or by calling the MMA office at 622-3374.  Copies of the entire Dirigo Health Legislation are also available. 

 

The AMA's Top 12 Fictions & Facts About Medical Liability Reform: #4
Fiction #4:  Medical liability insurance premiums do not drive up health care costs because they account for less than 1% of all medical costs.

Fact:  Although it sounds impressive, a comparison between medical liability insurance costs and all health care expenditures has no bearing on the medical liability insurance reform debate.  The critical dynamic is how two factors - medical liability insurance costs and the threat of astronomical liability - impacts the practice of medicine and patients' access to quality care.

Medical liability insurance claims costs (litigation costs, jury awards, and settlements) are real and must be paid by someone.  Insurers raise medical liability insurance premiums to cover these increased costs.  Physicians and other providers who cannot absorb or pass on the cost of these steep premium increases are forced to restrict their services, avoid high risk patients, move their practices to lower risk areas, or retire.  Ultimately, patients will bear the costs of medical liability insurance claims by paying more for health insurance or by losing access to needed services, such as trauma care and obstetrics, as physicians restrict, relocate, or retire from their practices.

The indirect costs to the health care system from this growing culture of litigation are even more alarming.  Physicians, hospitals, and other health care providers who fear being sued adopt practice patterns to protect against the threat of litigation (so-called "defensive" medicine).  The costs associated with defensive medicine are difficult to calculate, but have been estimated at approximately $50 billion a year.

At at time when it is critical that we expand access to the millions of Americans without health care coverage, there are simply too many dollars spent on defending meritless suits, paying "lottery"-level judgments and defensive medicine.

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Committee Announces Medical Student Loan Awards for 2003/2004

Maine Medical Education Foundation

 

  Dr. Sheridan Oldham, Chairman of the MMA Committee on Loan and Trust Administration, announces the Committee’s decision to grant $257,000 in new loans during the 2003/2004 year to the following medical students from Maine.  These funds are available from the Maine Medical Education Foundation,  a 501(c)(3) corporation organized by the Maine Medical Association for the exclusive purpose of providing loans to medical students from Maine.

 

APPLICANT                                     MEDICAL SCHOOL

 

 

Aines, Jason                                        UVM

Bagley, Rebecca                                  UVM

Braden, Trevor                                    Dartmouth

Cassidy, Thomas                                 UNE

Chapin, John                                        UVM

Devlin, Heather                                    UVM

Dumont, Travis                                    Tufts

Edwards, Sonya                                  UVM

Knapp, Ryan                                       Dartmouth

Kumin, Michael                                   Jefferson Medical

MacKinnon, Brad                                UVM

Mailloux, Benjamin                              Dartmouth

Maloy, Alyson                                     UVM

Marcolini, Evadne                                UVM

Matthews, Cara                                   Dartmouth

Moffett, Katherin                                 Dartmouth

Noddin, Laura                                     Dartmouth

Pahl, Michelle                                      UVM

Rausch, Daniel                                     Tufts

Rowell, Gail                                         UNE

Ryan, Thomas                                      UNECOM

Sawyer, Gregory                                 Dartmouth

Steinkeler, Jill                                       Tufts

Temple, Kaili                                       Weill Med. College

Thibodeau, Evangeline                         Tufts

Weymouth, Holly                                 UVM

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GAO Releases Medical Malpractice Study
In August, 2003, the U.S. General Accounting Office released Medical Malpractice:  Implications of Rising Premiums on Access to Health Care (GAO-03-836) available on-line at http://www.gao.gov/new.items/d03836.pdf.

The GAO examined 5 states (Florida, Nevada, Pennsylvania, Mississippi, and West Virginia) that recently have been in a malpractice "crisis" and 4 states (Colorado, California, Minnesota, and Montana) that are not currently in crisis.

Some findings include:

  • Actions taken by health care providers in response to malpractice pressures have contributed to localized health care access problems in the 5 states reviewed with reported problems, but many of these actions were not substantiated or did not widely affect access to health care.
  • In response to rising premiums and their fear of litigation, research indicates that physicians practice defensive medicine in certain clinical situations, thereby contributing to health care costs; however, the overall prevalence and costs of such practices have not been reliably measured.
  • Limited available data indicate that rates of growth in malpractice premiums and claims payments have been slower on average in states that enacted certain caps on damages for pain and suffering - referred to as non-economic damage caps - than in states with more limited reforms.

The AMA questioned the GAO's finding that rising medical malpractice premiums have not contributed to widespread health care access problems, expressing concern that the scope of the GAO work limited its ability to fully identify the extent to which malpractice-related pressures are affecting consumers' access to health care.

If you would like a copy of the report, but do not want to download a lengthy document from the web, please contact Charyl Smith at csmith@mainemed.com and she will mail you a copy. [return to top]

CDC to Present Two Web Broadcast Training Programs on SARS
The Centers for Disease Control (CDC) will present two web broadcast training programs on SARS for healthcare workers and key state and local public health personnel on Sept. 23 and 30, 2003.  The programs will provide updated information on identifying and managing patients with SARS and on preventing transmission of the disease in healthcare facilities and the community.  These programs are being offered in anticipation of possible seasonal reemergence of the disease:

Tuesday, Sept. 23, 2003

1.  Infection Control for Hospitals and Other Healthcare Facilities

2.  Quarantine:  Community Response/Community Containment

3.   Legal Challenges of Quarantine and Isolation

Tuesday, Sept. 30, 2003

4.   What Every Clinician Should Know:  Basic Diagnosis and Patient Management

5.   What's New in SARS Laboratory Diagnostics?

6.   Surveillance:  How to Prepare the Clinician for Early Recognition and Diagnosis

For a full description of the program and faculty including links for registration and materials, go to;  http://www.phppo.cdc.gov/PHTN/SARS-return/.

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CMS Outlines Contingency Plan for Acceptance of Claims Post - HIPAA
Tom Grissom, the Director of trhe Center for Medicare Management within the Center for Medicare and Medicaid Services (CMS), sent a message on Sept. 4th to the health care community that further refines and improves CMS's own plans for compliance with the HIPAA Transaction and Code Set Standards scheduled to go into effect on Oct. 16.  The Grissom statement outlines that the CMS contingency plan for the Medicare fee-for-service operations would allow for the acceptance of "legacy" fee-for-service claims while HIPAA issues are worked out with the CMS' trading partners.  Legacy claims are electronic claims that physicians, providers and payers currently use that are not HIPAA compliant.  This announcement is important because the nation's largest payer is annoucing the likelihood that it will accept "legacy" claims after Oct. 15, 2003.  The American Medical Association has been urging CMS to take such a flexible approach.

CMS will make the decision whether to implement the contingency plan by Sept. 25 after CMS assesses the readiness of its trading partner community.  This important message by CMS claims operations will hopefully be precedent setting with other private and public payers.

 

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Sign Up for HIPAA Transaction and Code Set Standards Educational Program
Once the October transaction and code set deadline (Oct. 16) is past, practice managers will need information about how the standard is being applied.  Are you experiencing difficulty submitting electronic claims?  Are you saddled with cash flow problems?  Are billing services up to speed?  Are you seeing problems with state Medicaid programs or Medicare?   What are successful strategies for coping with uncooperative payers?  These topics will all be addressed during a one-hour Web conference., Oct. 29, sponsored by the AMA's Office of Group Practice Liaison.  Visit http://www.ama-assn.org/ama/pub/category/11003.html to learn more.  Join the listserv by typing subscribe and your e-mail address to subscribe-House. Calls@ama-assn.org. [return to top]

CMS Issues Interim HIPAA Rule on Medicare Paper Claims
The Centers for Medicare & Medicaid Services has released an interim final rule setting out the criteria and procedures for small physician practices to apply for a waiver that allows them to continue submitting paper claims to Medicare after the Oct. 16 deadline for new electronic transactions standards.  The new standards are mandated by HIPAA..

CMS receives approximately 139 million claims on paper per year,  representing 14% of the total claims the program processes.

Comments are being accepted through Oct. 14.  The interim final rule for electronic submission of Medicare claims can be viewed online at http://www.cms.gov/hipaa/hipaa2/ [return to top]

Make September a Healthy Month
The month of September has several national wellness and fitness designations;  September is National Cholesterol Education Month; the National Cancer Institute has designated the week of Sept. 21 for its 5 a Day Week Campaign; Sept. 24 is Women's Health and Fitness Day; and Sept. 27 is National Family Health and Fitness Day.  These observations are designed to encourage Americans to adopt healthy habits, such as eating five fruits and vegetables each day and including regular physical activity in their lives. [return to top]

2nd Downeast Ophthalmology Symposium a Big Success
Congratulations to The Maine Society of Eye Physicians and Surgeons and its President Samuel Solish, M.D. for a very successful 2nd Annual Downeast Ophthalmology Symposium held in Bar Harbor this past weekend.  Nearly one hundred ophthalmologists from Maine and 27 other states attended the program entitled, this year, "Practical Solutions in Ophthalmology."  Speakers included former Louisiana Congressman and ophthalmologist John C. Cooksey who spoke on, "Improving Healthcare Through Public Service." 

The 3rd Annual Downeast Opthalmology Symposium will be held Oct. 1-3, 2004, again in Bar Harbor.  Encourage your out-of-state ophthalmology friends and colleagues to consider this growing program which is destined to become one of the premier ophthalmology CME programs in the Country!  More information is available at www.maineeyemds.com. [return to top]

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