January 18, 2005

 
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New MaineCare Claims Management System Operational in Late January
The DHHS new claims management system, MECMS, will be operational in late January. AFTER NOON ON JANUARY 19, providers must use the new provider number recently sent by MaineCare, for all claims. This must be done even for claims for services delivered prior to Jan. 12. If you have not received your new provider number, you should contact the Provider File Unit at 800-321-5557, option 6.
When submitting paper claims during the transition period, you should mark clearly on the envelop whether the claims are in the old or new format.

During October and November,  MaineCare staff presented updated billing instructions at several regional provider trainings.  The instructions are also available on the BMS website at www.maine.gov/bms, under the "MECMS" tab.  If you still need assistance, contact the Provider Relations Specialist at 800-321-5557, option 9.

During the transition, there will be a blackout period.  During this period, there may be a delay in the first payment processed in MECMS.  There will be some information that will either be limited or not available via the Interactive Voice Response or the MaineCare Information and Research Unit, including updated claims information.

MaineCare staff are still adding the new 2005 HCPC and CPT codes, so there may be some codes that will not be immediately available.

Continue to check your remittance statements and the BMS website for more information on the conversion, which has been many years in the making.  The website is www.maine.gov/bms.  The Bureau has promised additional provider training in the Spring.

A new listserv is available to provide you with the latest MECMS information.  You may sign up for this free service at www.maine.gov/DHHS/EMC/mailing/

After full implementation, the new system should be more responsive than the previous one, but MMA expects significant difficulties as the transition takes place.

MMA/AMA Voice Concerns to DEA Over Pain Medication Prescribing Policy
The MMA and the AMA will work with state and federal DEA officials to address physician concerns that an interim policy statement published by the agency in November could interfere with the way physicians prescribe opioid analgesic medications to some patients.

Physicians worry that the statement could make it illegal to write multiple pain medication prescriptions for a patient on the day of a visit and evaluation.  Physicians also worry that they no longer could legally write directions for dispensing additional medication on future, specified dates.

At the AMA Interim Meeting in Atlanta in December, delegates called on the Association to support interpreting the federal law in a way that would allow doctors to continue to write pain medication prescriptions for patients in need, while letting the government provide oversight and regulation to minimize risks to patients' health and safety.

In a rural state such as Maine, many physicians have traditionally provided multiple scripts to patients who otherwise would have to drive long distances for monthly appointments.  Requiring these patients to return for an office appointment each month will add millions of dollars to healthcare costs with no commensurate benefit.

MMA has heard from many members about this problem, and the difficulty it presents for patients in MaineCare,  for instance, which does not allow for more than a 30 day supply of scheduled drugs.  MMA will work with MaineCare and the DEA to find a solution to this problem. [return to top]

Hospital Commission Continues! To Meet Again on Jan. 24, 2005
The Commission to Study Maine's Hospitals, which was expected to conclude its work and issue a final report on January 10, will instead continue to amend its draft report and look at final language again at a meeting to be held in Augusta on January 24.

At the Jan. 10 meeting, several members of the Commission reacted to the comments from the public, particularly Maine's hospital community, offered at the two days of public hearing.  The public comments, for the most part, had been very critical of the tone of the report and many commentors objected to even the recommendation that the state form a consortium of hospital interests to continue a theme of collaboration and cooperation.

Commission member Scott Bullock, CEO of MaineGeneral Medical Center, stated that he would have to see some significant changes to the report before making the recommendations unanimous.  Previously, it had been assumed that he and John Welsh, the two hospital representatives to the Commission would prepare their own minority report on several key points, including the issue of the Consortium.

By the end of the meeting, Commission members agreed that Chairman Bill Haggett and staff from the Governor's office would make a number of changes to the report, including changes to the introduction to the report providing data, clarify the role and membership of the Consortium, redraft the section on health insurers and add cost information from CMS quality studies that show Maine hospitals as third in the country for Medicare quality.  The Commission would then look at this language on Jan. 24. [return to top]

Medicare Payment Advisory Commission (MedPAC) Recommends Payment Changes
The Medicare Payment Advisory Commission (MedPAC) finalized recommendations to Congress on physician payment at its January 12-13 meeting.  The Commission recommended that Congress institute a "pay for performance" system to encourage physicians to follow best practices, thereby controlling volume and improving quality.  The system would take funds from the general physician pool to reward high performing physicians.  The AMA and other organizations have expressed concern that some specialties don't currently have measures that neatly fit into a scorecard approach, making physicians in those specialties less likely to be rewarded bonuses.

MedPAC also recommended that Congress update payments for physician services by 2.7% in 2006.  However, unless Congress intervenes, physician payments are expected to be cut by 5% in 2006 and by a total of 31% between 2006 and 2013, due to a flawed payment formula based upon a sustainable growth rate (SGR).  While the MedPAC commissioners discussed the failed SGR formula, they did not, unfortunately, make recommendations on how it could be fixed.

MedPAC also approved recommendations calling for Congress to set quality standards for physicians interpreting imaging exams, including ultrasound, in their offices.  These standards may involve accreditation of equipment and physician privileging.  MedPAC also recommended coding edits that would reduce payments for multiple imaging services on contiguous body parts.

A full (355 page) transcript of the session is available at: http://www.medpac.gov/public_meetings/transcripts/0105_allcombined_trans.pdf [return to top]

122nd Legislature Begins Two-year Session; Focuses on Tax Reform and Budget
The 122nd Session of the Maine Legislature began its work on Jan. 4 and is expected to complete the first year session in early to mid-June.  This month, the session is focused almost entirely on tax reform and the supplemental and recently released two-year budget, beginning July 1.  As reported in MMWU last week, the Governor's budget does include about $18 million in new funds for a long awaited physician fee increase under MaineCare.  The $18 million is derived from $3 million in state funds in each year of the biennium, to be matched with a total of approximately $12 million in federal funds.

The MMA Legislative Committee, chaired by anesthesiologist Katherine Pope, M.D. of Falmouth, met on Jan. 11th to review the MMA package of bills and to consider the first group of bills dealing with some aspect of healthcare.  The Committee will meet monthly during the session, but will hold a weekly conference call each Wednesday evening at 7:00pm (except for those weeks the Committee meets face-to-face).  The weekly conference calls are a good opportunity for any MMA member to participate in a direct way in the MMA's legislative advocacy.  If you are interested in participating in these calls, contact Charyl Smith at MMA at 622-3374 or csmith@mainemed.com.  Any member is welcome to participate.

During the session, MMA Vice President and General Counsel Andrew MacLean publishes a weekly summary of legislative/healthcare activities on Fridays, called "Political Pulse."  The publication is available only electronically but will be sent to any member who would like to receive it.  Contact  Charyl Smith, Legislative Assistant at MMA, to subscribe.  The service is free to MMA members.  The publication can also be accessed through the MMA website at www.mainemed.com

For a complete listing of the proposed bills for this session, you may visit http://janus.state.me.us/legis/lio/publications.htm  You can download the entire list of titles or search the list for bills submitted by your own representative or senator.

For more information about  MMA legislative advocacy, including the Physician of the Day Program and the Physician's Day at the Legislature (March 23), contact Andrew MacLean Esq. at 622-3374 or at amaclean@mainemed.com.  Your involvement would be greatly appreciated and your input valued. [return to top]

MMA Executive Committee Holds Strategic Planning Retreat
Feeling too warm for comfort, the MMA Executive Committee this past weekend journeyed north to Quebec City to conduct a strategic planning session and to hear from a leading physician in the Provincial Ministry of Health.

Twenty-two members of the Committee met and in a self-facilitated session reviewed the strengths, weaknesses, opportunities and threats to MMA.  Members also were asked to indicate the three most critical issues they believed faced MMA.  Among the top issues internally were membership, the changing face of membership and medicine and the role of employment.  Externally the issues of reimbursement, particularly from public payors and professional liability were most frequently noted.  Many other issues, both internally and externally were noted as well.  Lack of adequate financial resources was continually noted as a challenge.  The issue of improving the quality of care and responding to the various quality initiatives was also noted as critical., as was the need to embrace technology and particularly the use of electronic medical records.  The importance of working with Maine's hospital community was highlighted, as well.

Despite the considerable challenges, members seemed to believe that MMA had many strengths, including a long history of success and professionalism and that the organization was well-positioned to assist Maine's physicians with the considerable challenges faced.  Continuity of staff and strong elected/volunteer leadership have also been advantages.

The Committee will continue to develop a strategic plan through a planning process and a portion of the next few Committee meetings will be dedicated to this effort.  The Committee would welcome the input of any member regarding the issues facing MMA and the needs of members in the current environment and into the future.  Your thoughts can be provided to any Committee member or to staff through e-mail to Gordon Smith, EVP at gsmith@mainemed.com. [return to top]

Bridgton Hospital Becomes 11th Critical Access Hospital in Maine
Bridgton Hospital has been approved by the Centers for Medicare and Medicaid Services as a "Critical Access Hospital," effective Jan. 1, 2005.

The CAH designation means the hospital will be reimbursed by Medicare and Medicaid (MaineCare) for 101% of allowable costs.  Other Maine hospitals with this designation are Rumford Hospital, Blue Hill Memorial Hospital, CA Dean Memorial Hospital, Calais Regional Hospital, Houlton Regional Hospital, Mayo Regional Hospital, Millinocket Regional Hospital, Mount Desert Island Hospital, Penobscot Valley Hospital and St. Andrews Hospital.

Critical access hospitals can have up to 25 beds and are limited by the average length of stay.  But the experience of those hospitals which have been in the program appears to be quite favorable, with positive financial implications and no significant disadvantages. [return to top]

Volunteers Needed for Pre-litigation Screening Panels
The Association is continuing to hear from panel chairs and the judiciary that it is becoming more difficult to find physicians to serve as the voluntary panel members under Maine's pre-litigation screening panel system.  Given that the panel system has been a primary cause of Maine's liability situation not going the way of Florida, New York and Pennsylvania (although more reform is needed), it is essential that this situation be rectified.

If you are asked to serve on a panel, please consider doing so.  If each physician served, no one physician would be called upon more than once every few years.  Certainly we will face legislative challenges to the panels if we are unable to find enough physicians willing to serve.  Although there is no compensation, the panels usually last only one day and sitting on a panel can be a very good learning experience.  And besides, you will be taking part in an activity that directly impacts on your liability premium.  The lawyers on the panel are also asked to serve without compensation and how embarrassing it will be to medicine if their participation is more robust than ours! (The panel chairs do receive modest compensation but not the volunteer lawyer on the panel.)

If you are fired up about this and want to volunteer without waiting to be asked, please let Gordon Smith know 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