December 15, 2003

 
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Bureau of Insurance Fines Cigna Healthcare of Maine for Violation of Prompt Payment Law
The Maine Bureau of Insurance announced on last Friday that it had fined Cigna Healthcare of Maine a record $900,000.00 for poor payment practices including paying claims late, not paying interest as required, failing to keep appropriate documentation and not having management systems in place to catch these errors.
The consent agreement between the state and Cigna also requires the payment of $915,000.00 in interest on late payments made in connection with claims in 2001 and 2002.  This amount will increase considerably when audits of late claim payments in l999 and 2000 are completed.  These payments will go largely to physicians and hospitals.

Maine's prompt payment law, enacted with MMMA support in l999, requires health insurers to pay claims within 30 days after receiving a clean claim.  If payment isn't made within the 30 day period, the company is required to pay interest on the claim to the health care provider at the rate of 1.5% per month. The original legislation leading to enactment of the law as part of the Bureau of Health legislation in l999 was filed by State Representative Thomas Shields, M.D. , of Auburn.  Representative/Dr. Shields is a former President of MMA.

The Bureau of Insurance also took Cigna to task for faulty claim denials, noting that 71% of its denials were overturned during the company's own grievance procedure.  In the Consent decree, Cigna is required to file a plan to correct denial problems by the end of the year.

The action by the Bureau follows up on earlier action this year fining Anthem Blue Cross Blue Shield $350,000.00 for late payments and requiring $1.2 million be paid in interest.

 

Dirigo Health Quality Forum Advisory Council Holds Second Meeting
The Maine Quality Forum Advisory Council met last week for the second time and began to get organized.  The Council elected Robert McArtor, M.D., as chairman for a one-year term.  Dr. McArtor is a member of MMA's Committee on Peer Review and Quality and is Chief Medical Officer at Maine Health.  The Council also formed three sub-committees to perform the tasks of providing input to the interim executive director of Dirigo Health in connection with the hiring of an executive director for the Forum, to prepare a mission statement and to begin consideration of the advisory group of providers.

The Council will meet again on January 16th from 9:00am to noon, location in Augusta to be announced.  That meeting will include presentations by the Maine Health Information Center, the Maine Health Management Coalition and the Maine Health Data Organization.

Several MMA members are on the Council, including Karen Bell, M.D., Jan Wnek, M.D., Laureen Biczak, D.O.  and Dr. McArtor.  MMA will attend all Council meetings and report Council activities to the membership via this e-newsletter and through the pages of Maine Medicine. [return to top]

Quality Counts! Nearly 200 Persons Attend Educational Program on Quality
A large crowd of physicians, other healthcare providers, employers and consumers attended the Dec. 9th symposium in Augusta aimed at showcasing some of the current quality improvement initiatives in Maine and at familiarizing stakeholders with the elements of the Chronic Care Model.  It was the first of several conferences aimed at sharing information about structures, processes, and outcomes to improve chronic illness care and prevention.  A collaborative group of physicians, hospitals, payors and employers sponsored the program, including the Maine Medical Association.

Anthem Blue Cross and Blue Shield Medical Director Karen Bell, M.D. moderated the physician presentations highlighting what is now happening in Maine.  Physician presenters included Jennifer McConnell, MD of Winthrop Health Center, William Ervin, M.D. of Intermed and NovaHealth, John Yindra, M.D. of DFD Russell Medical Center, N. Burgess Record, M.D. of the Western Maine Center for Heart Health, David Schall, M.D. of Bowdoin Medical Group and Peter Bates, M.D. of the MMC Thoracic Oncology Center.  Dr. Bates is also the Chief of Medicine at Maine Medical Center.

These presentations discussed both the value of, and barriers to, effective disease management through the use of disease registries, including both web-based and paper systems.  Electronic prescribing was also featured.

The same parties are collaborating on a second program to be held on Wednesday April 7th at a location to be announced.  Further details and registration information will be included in this publication at a later time. [return to top]

Maine Health Alliance Receives Grant Aimed at Disease Management
The Maine Health Alliance recently announced receipt of a $1.1 million grant from the federal Office of Primary Care aimed at improving the management of chronic disease.  In conjunction with Penquis Community Action Program, the Alliance is preparing a three-year pilot project that in the first year alone will provide the equivalent of 12 additional full-time staff to physician offices, hospitals, clinics and Penquis CAP offices in the northern Maine counties of Aroostook, Penobscot, Piscataquis, Hancock and Washington counties.

The additional staff will connect patients to appropriate support services and will maintain regular contact with patients with the hope of achieving better outcomes through prolonged periods of wellness and productivity.  If the first year of the project results in fewer emergency room visits, fewer hospital admissions and shorter inpatient stays, the grant can be renewed for two additional years.

The grant will also support the purchase of handheld electronic devices to allow physicians to e-prescribe.  The technology will allow the physicians to electronically check for drug interactions, side effects, pricing information and the availability of any generic form of the medication.

The Maine Health Alliance consists of 11 hospitals and 325 physicians in northern and eastern Maine. [return to top]

Office of Substance Abuse Preparing RFP on Prescription Monitoring Program
The Maine Office of Substance Abuse is getting prepared to issue a Request for Proposals (RFP) for the establishment of a prescription monitoring program as required by L.D. 945 which was enacted by the Legislature.  The legislation requires the state to develop a database for Schedule ll, lll, and lV medications.  The database would contain the patient and prescriber name, along with the prescription information, including dosage.  The database would be used to produce periodic reports on drug usage which would be sent to the physician's office.  If a patient was acquiring narcotics from an additional prescriber, the physician would be notified on a timely basis.  OSA hopes that the system will eventually be web-based, accessible at all times by physicians and pharmacists, but with appropriate safeguards for privacy and security.  A final copy of the RFP is expected to be issued witin the next month.  It is the intent that the system be designed and ready for testing by July, 2004.  About 15 states have a similar system in place presently.

The primary goal of the Program will be to reduce the quantity of controlled substances obtained by fraud from physicians and pharmacists and to reduce the adverse effects of such abuse of controlled substances.  A secondary goal of the program, as described in the draft RFP, is to assist law enforcement officers, specifically investigoators for the Maine Board of Pharmacy and the medical licensing boards, in the identification of prescription drug diverters, inappropriate prescribers or inappropriate dispensers of prescription drugs.

This system, while well-intended, may also have the unintended consequence of making it more difficult for patients who are in pain to acquire the appropriate treatments.  MMA and other organizations, such as the Maine Hospice Council, will be vigilent in trying to ensure the appropriate balance between preventing drug abuse and ensuring the adequate treatment of pain.

 

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New Executive Director Named by Hanley Trust
Alice Chapin of Falmouth has been hired as the new Executive Director of the Dan Hanley Memorial Trust.  The Trust has been established in honor of the late Daniel  F. Hanley, M.D., a former Executive Director of the Maine Medical Association, and is a project of the Maine Medical Education Trust.

Dr. Hanley, who resided in Brunswick for over 40 years, passed away in May of 2001 following a long and distinquished career.  In addition to serving as MMA's Executive DIrector for nearly 25 years, he served as Bowdoin College's physician for 22 years and served as Chief Physician for several U.S. Olympic teams between l960 and l972.  Dr. Hanley was instrumental in the establishment of the Maine Health Information Center, Medical Mutual Insurance Co. of Maine and the Maine Medical Assessment Foundation.

The Dan Hanley Memorial Trust has been formed by Dr. Hanley's family and a consortium of health care organizations including MMA, the Maine Osteopathic Association, Anthem Blue Cross Blue Shield, Medical Mutual Insurance Company of Maine, Maine Health Information Center, MaineHealth and others to carry on his ideals and to help develop new leaders through the establishment of an annual healthcare leadership Forum, an annual award for outstanding leadership in the healthcare field, and a Hanley Fellow program to assist young professionals in developing leadership potential.  For more information on the Trust, log on to www.hanleytrust.org.

Ms. Chapin, a graduate of the University of Maine, was formerly President of the Maine Health Information Center for 18 years.  She brings to the Trust a great deal of experience in working with healthcare leaders in Maine.

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Draft "Sunrise Review" of L.D. 263 on Acupuncture expansion Recommends Defeat of Bill
The Draft Report of the Commissioner of the Department of Professional and Financial Regulation on Sunrise Review of L.D. 263, "An Act to Define a Scope of Practice for Acupuncture" recommends defeat of the legislation.  The Maine Medical Association had opposed the bill during its consideration during the first legislative session and had requested that a sunrise review report be prepared as it was the Association's belief that the bill significantly expanded the scope of practice of both acupuncturists and purveyors of oriental medicine.  The Draft Report now goes to the Joint Standing Committee on Business, Research and Economic Development  which will hold work sessions on the proposal during the second regular legislatve session which convenes on January 7.

When any legislation is submitted which significantly expands the scope of practice of a health profession, state law (popularly called state sunrise review law) requires the commissioner to engage in a two-step evaluation process guided by 13 evaluation criteria.  FIrst, the commissioner must evaluate the information provided by the applicant group in support of its proposal to regulate or expand regulation of a profession.  Second, the commissioner must recommend whether the committee should take action on a proposal.  If the commissioner's recommendaton supports regulation or expansion, the report must include any legislation required to implement that recommendation.  The recommendation must reflect the least restricitve method of regulation consistent with the public interest.

L.D. 263, as presented, would amend the current scope of practice of acupuncture by specifically listing several techniques associated with Oriental medicine, including Chinese herbology, that do not involve the traditional technique of insertion of fine metal needles into the body.  The proponent of the bill, the Maine Associaiton of Acupuncture and Oriental Medicine testified at the committee's public hearing that the bill was necessary to clarify the scope of practice for licensed acupuncturists.  MMA asserted in opposition to the bill that the proposal would permit activity by licensed acupuncturists that went far beyond the education and training of most acupuncturists and that the additional modalities described, while relating to oriental medicine, were not acupuncture.

In his Draft Report, Commissioner Robert E. Murray, Jr., concludes that:  1) Oriental medicine materials and techniques other than acupuncture as it is currently defined and regulated by Maine law, are available in an unregulated environment; 2)  the public safety is not unreasonably jeopardized by the use of these additional modalities; and 3) complaint records do not reflect any Oriental medicine-related complaints.  The Draft Report goes on to state,  "Whatever specialized skills may be necessary to practice the components of Oriental principles other than acupuncture, the lack of specific statutory reference to those skills has not resulted in public confusion, alarm,or harm; therefore, current licensure requirements appear to be adequate to provide public protection."

While MMA does not necessarily agree with all the opinions stated in the Draft, the Association does support strongly the conclusion that the current definition of acupuncture does not need to be expanded to include over a dozen additional types of oriental medicine modalities.

The Draft Report will be considered by the Association's Legislative Committee in January.  Copies of the Draft Report are available from the MMA office (622-3374).

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MMA Committee on Membership and Member Benefits Meets to Consider Dental Insurance
The Association's Committee on Membership and Member Benefits met on December 11th to hear updates on membership recruitment and retention and to consider the possiblity of offering group dental insurance to members.  The Committee is chaired by Kevin Flanigan, M.D. of Pittsfield.

Representatives of the Dunlap Agency presented a proposal from Anthem on group dental insurance which is fequently mentioned by members in surveys asking for what additional benefits MMA might consider offering to them.  A previous proposal had been made by Delta Dental.  It was determined that group practice managers would be asked about the desirability of such a plan prior to the matter being considered by the MMA Executive Commmittee.  If you might have an interest in offering group dental insurance to your staff through MMA, please contact MMA through e-mail to Dr. Buell Miller, consultant to the Committee at bmiller@mainemed.com or by communicating with Gordon Smith via e-mail at gsmith@mainemed.com. [return to top]

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