December 1, 2003

 
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President to Sign Medicare Reform Bill that Stops 4.5% Pay Cut in 2004
On November 25, the United States Senate passed the "Medicare Prescription Drug and Modernization Act" on a vote of 54 to 44, following House approval the previous weekend. The landmark legislation now goes to President Bush, who has indicated he will sign it.
Passage of the legislation means that the 4.5% cut in physician Medicare fees will be replaced with a 1.5% increase for 2004 and another 2.5% increase in 2005.  In Maine, the 2004 adjustment means an additional 14 million dollars in Medicare reimbursement to Maine physicians, or approximately $4600 per physician.   In addition, provisions of the legislation favoring rural areas will mean another  7 million dollars in additional reimbursement in Maine.  MMA participated in the 25 state GEM (Geographic Equity in Medicare) coalition which fought successfully for the increase in the Geographic Practice Cost Index work floor to 1.0 of the national average.  The result is a $1 billion increase nationwide.

Several portions of the AMA-backed "Medicare Education and Regulatory Fairness Act" (MERFA) were also included in the legislation:

                -  no re-payments by physicians until appeals are heard

                -  restricts the use of random audits and extrapolation (where a small sample of claims are used to generate large repayment claims) in Medicare recoupment proceedings

                 -  results in no penalties when the physician relies on guidance from Medicare carrier

                 -  prohibits retroactive application of substantive changes in regulations, manuals, instructions, guidelines, etc.

The legislation also sets forth some voluntary provisions regarding e-prescribing and provides financial incentives to encourage movement to e-prescribing.

Of particular interest to Ambulatory Surgery Centers, the legislation did not include a proposal to cap ASC payments at the hospital outpatient department level.  Instead, an ASC fee update of approximately minus 1% is set for 2004 and a freeze in payments for 2005-2009.  A General Accounting Office study will compare the costs of procedures in ASCs to those in hospital outpatient departments, evaluate the accuracy of ASC payment categories, and consider whether special adjustments should be made for certain types of services.

Most importantly, the legislation secures a Medicare prescription drug benefit for American's seniors, providing special assistance to those with low incomes and/or exceptionally high drug costs.  While certainly not perfect, the drug benefit nonetheless closes a gaping whole in the Medicare safety net.  If the available $400 billion dollars had not been committed this session, it is unlikely that coverage could have been achieved in the next few years.

The payment fix for physicians is a tribute to the AMA and all the national specialty corganizations which spoke with one voice and tenaciously about the problem of access to medical care if fees were allowed to continue dropping.

 

"Quality Counts!" Symposium to be Held Dec. 9th in Augusta
"Quality Counts!", Part I of a collaborative symposium sponsored by Maine physicians, hospitals, payors, and employers will be held on Dec. 9, 2003 at the Augusta Civic Center from 11:00am to 5:00pm.  Subtitled "Measurably Improving Health and Healthcare for Maine", the program is designed to share information about structures, processes, and outcomes to improve chronic illness care and prevention. 4.50 Category 1 CME credits are available.

The conference may also be viewed from two videoconferencing sites, in Bangor at the Maine Health Alliance and in Houlton at the Houlton Regional Hospital.  Registration is only $25 per organization or clinical team.  For qestions concerning registration contact Sue-ann Sanford at Medical Care Development, 622-7566 x232.  For questions conerning the content of the program, call Deborah Silberstein at 822-7654.  Internet access to the conference brocure is available at www.mcd.org/domestic/training.htm.

The Maine Medical Association is a Sponsor of the program, along with a dozen other health-related organizations. [return to top]

Ambulatory Surgical Centers form Organization
Last week, a group of approximately 12 licensed ambulatory surgical centers (ASCs) met to form an organization of ASCs in Maine.  Several of the facilities had been active in the lobbying and negotiations related to passage of the Dirigo Health legislation in the Spring and believed that forming such an organization was essential to protecting the interests of these facilities for the benefit of patient choice. The organization will be incorporated as a non-profit organization. 

John Wipfler, J.D. of EyeCare Medical Group was selected as President of the group, John Callinan of Central Maine Orthopeadics VIce President and Mark McAuliffe of Orthopaedic Associates Treasurer. 

There are currently 19 licensed ASCs in Maine,  all having been built under the physician office exemption in the Certificate of Need law.  That exemption was significantly eroded in the Dirigo Health legislation. [return to top]

More on MaineCare "swipe" Card
MMA representatives last week met with representatives of MaineCare and Medifax-EDI to discuss the new ID cards being issued to MaineCare enrollees.  MaineCare officials emphasized that the option of purchasing the POS machine/swipe care terminal was voluntary and that the Interactive Voice Response  (IVR) lines would not only continue but would be enhanced.

The Medifax POS is available for $595 until March 31st, 2004 and can be used to verify eligibility for other third party payors as well.  Credit card payments can also be processed through the same terminal.  There is a 25 cent fee per transaction and a $10 dollar monthly service fee which will increase to $25 per month after March.

Over 1000 physicians, practice managers and other providers attended one or more of the seminars offered early this Fall to learn about the new plastic cards and to hear of the contract with Medifax EDI which is the largest provider of this type of service.  The company has contracts with over 40 state Medicaid agencies.  The Maine contract is for 2 years with the state having the option to renew for three additional one-year terms. 

While voluntary, the electronic system does provide a much faster way of determining eligibility than the toll-free Interactive Voice Response system.  MaineCare is also expected to have a website available sometime during 2004 where eligibility can be checked, in addition to the IVR and the POS terminal.  The website interface would be free of charge.

Bryan Hamel is the district sales manager responsible for the medical services division of Medifax-EDi in Maine.  He can be reached at 1-800-444-4336, Ext. 2174.  The company website is www.medifax.com.

By Dec. 1, all MaineCare patients should be receiving the new  plastic cards.  MaineCare members exempt from co-pays will receive both paper and plastic cards.

WebMD recently announced its intention to purchase Medifax EDI.  The purchase is not expected to affect the company's operation here in Maine relative to the MaineCare contract. [return to top]

The Coding Center Presents Coding Roundtable Thursday, Dec. 4th in Portland
The Coding Center will offer two coding roundtables Thursday, Dec. 4th, in Portland.  Both will be held at Keeley's Banquet Center.  The morning session is on E&M Coding and will be from 9:00am to noon.  The afternoon session is entitled, "Using the Internet as a Coding Resource" and runs from 1:00pm to 4:00pm.  The fee for members and/or their staff is $75.00 per session or $125.00 for both sessions.  Persons wanting to register should contact Charyl Smith at MMA, 622-3374.

The Coding Center is a wholly-owned subsidiary corporation of the Maine, New Hampshire and Vermont Medical Societies.  It is staffed by Laurie Desjardins, CPC and Jana Purrell, CPC.  Laurie is the Director of the Center.  Both Laurie and Jana are available to assist MMA members and their staffs with coding and reimbursement questions, free of charge as a benefit of MMA membership.  They may be reached, toll-free, at 1-888-889-6597. [return to top]

Busy Week for Dirigo Health
It will be a busy week for Dirigo Health as several councils and commissions meet at the State House, as well as the Board of Directors.  The Board of DIrectors meet on Monday, Dec. 1, at 11:30am in the Legislative Council Chambers (Rm 334).  Earlier in the day, the Maine Quality Forum Advisory Council meets in the same room.  On Friday, Dec. 5th, the Commission to Study Maine's Hospitals will meet at 9:00am, also in room 334 of the State House.

MMA representatives will attend all of the Dirigo Health meetings and report to the membership regarding the actions of the Board, the Councils and the Commission. THe schedule of meetings can generally be found on the Governor's website at:  http://www.maine.gov/governor/baldacci/healthpolicy/Meeting%20Schedules.html. [return to top]

Message from the Friends of the Fund for a Healthy Maine

The following message on the status of the Fund for a Healthy Maine and the proposed constitutional amendment to protect it is from the Friends of the Fund for a Healthy Maine, a coalition that includes the Maine Coalition on Smoking OR Health and its individual members.

 

Maine leads the nation, again and we need your help to continue our success!  With the close of the 2003 legislative session, we applaud the passage of many pieces of legislation such as Dirigo Health, Maine RX and legislation that will finally eliminate tobacco smoke from virtually all public places.  We are miles closer to a healthier Maine.  Now more than ever, we need to underscore the importance of disease prevention and the promotion of healthy lifestyles.

 

A key piece of the Governorís health plan, LD 1612 will amend the Maine Constitution to permanently preserve the Fund for a Healthy Maine (FHM), Maineís share of the tobacco settlement money.  This special fund was created to prevent and respond to the devastating effects Maine people experience as a result of using tobacco products.  All of the FHM monies Maine receives were intended to go directly to critical disease prevention and prevention-related treatment initiatives to keep Maine people healthy.   Today, the FHM funds many successful programs statewide that provide services in the following eight areas: smoking prevention and cessation, prenatal and young children care, childcare, dental care, health coverage, substance abuse and prevention, comprehensive school health programs and prescription drugs for the elderly and disabled.

 

So, if Maine has already designated this money for health programs, why is there a need to amend the State Constitution to preserve it for these purposes? While the Legislature had the best intentions when creating the Fund for a Healthy Maine, when faced with budget shortfalls, this money has been extremely tempting. Since 1999, nearly 40% of the $220 million that Maine has received has been diverted to the General Fund to fill budget shortfalls. Thatís $86 million in lost prevention and treatment investment opportunities!

 

Many organizations throughout the state feel strongly that protecting the Fund for a Healthy Maine through a constitutional amendment is a critical step to assure health promotion and disease prevention efforts continue statewide.  As a member of a coalition called the Friends of the Fund for a Healthy Maine we are committed to working diligently throughout the upcoming legislative session to see this happen, and we strongly encourage your support.  Protecting the Fund for a Healthy Maine is an investment in Maineís future. Helping Maineís people get and stay healthy will save us money and lives for generations to come.

 

To find out how you can help protect the Fund for a Healthy Maine, please call Megan Rice at 207/373-3730. We will be successful with your help! Your elected officials need to hear that you support preserving this money for health-related purposes only!

  [return to top]

Reminder About Congressman Michaud's Augusta Fundraiser on December 8
Maine's Second Congressional District Representative Mike Michaud will hold a fundraising reception at the Senator Inn in Augusta on Monday, December 8th from 5:30 - 7 p.m.

Suggested contribution levels are $500, $250, & $100, payable to "Michaud for Congress," P.O. Box 1119, Lewiston, Maine 04243.  For more information, contact Andrea at 207-721-0972 or by email at RSVP@michaudforcongress.com.

Other invited guests include Governor Baldacci, Former Governor Joseph Brennan, A.G. Steve Rowe, Treasurer Dale McCormick, Secretary of State Dan Gwadosky, Sen. President Beverly Daggett, & Speaker of the House Pat Colwell.

This would be an opportunity to register your disappointment with his vote on the Medicare drug bill conference report!  [return to top]

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