January 24, 2005

 
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25,000 Mainers to Receive "Tough Choices" Campaign Mailing
The Governor's Office of Health Policy and Finance is organizing a three-site forum on March 12th to receive input on state health priorities from a wide cross-section of Mainers. The meetings will be facilitated by a national organization, America Speaks, which has experience in organizing and implementing these types of public input sessions.
Twenty-five thousand Maine citizens will receive the mailing this week containing an invitation to participate in meetings Saturday,  March 12, 2005 to help develop a State Health Plan.  From the responses of these twenty-five thousand individuals, Dirigo Health will randomly select about 1200 persons anticipating that about 1000 individuals will eventually participate in the forums.

The March 12th meetings will be held simultaneously in So. Portland, Augusta and Brewer with the three sites being linked by videoconference.  Participants will electronically register their views, after discussing the issues and after receiving a written guide intended to help frame the debate.  A group of stakeholders, including MMA, have had an opportunity to provide input into the briefing document.

These meetings are intended to solicit opinion of a broad cross-section of Maine citizens.   They are one step of a five-step public process to develop the biennial State Health Plan.  The Health Systems Development Advisory Council advises the effort.

ProSelect Files for 8.5% Average Rate Increase Effective 5/1/05
In late December, 2004, ProSelect Insurance Company filed an 8.5% average premium increase request for its Physicians & Surgeons Professional Liability Program with the Bureau of Insurance.  The filing requests an effective date of May 1, 2005.  In 2004, ProSelect had 488 policyholders in Maine and brought in $4.27 million in premium.  The program's expected loss ratios for 2005 are:

  • Claims made:  82.03%
  • Occurrence:  90.99%

The filing also includes some classification changes.  The company is revising family practice and general practice class codes to more accurately reflect the risk of obstetrical services.  It establishes a new class code for Bariatric, Major Surgery.

The company is changing its vicarious liability charge policy for employed practitioners.  An independent contractor will be considered employed for purposes of the charge if the answer to two or more of the following questions is no:

  • has a written contract with the insured?
  • leases space from the insured?
  • uses own equipment?
  • uses own staff?
  • books own appointments?
  • bills patients separately?
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UnitedHealth Profit Up, But Shares Off
UnitedHealth Group, the second largest insurer in the country, reported that its quarterly profit increased nearly 46%, boosting its 2005 forecast.  United points to the stabilization of medical costs as the reason for the increase.  United is the first to report its quarterly earnings, which usually sets the tone for the entire health insurance sector.  However, while profits increased, United shares declined by 3% this week.  Even though United beat analysts' predictions by a penny, investors were still not happy.  [return to top]

Sign Up for MaineCare E-mail Listserv
The Bureau of Medical Services has created a new listserv for MaineCare providers in order to inform them of the status of its new claims management system.  The new system has been in the development stage for a number of years and is now "live."  The system replaces the current claims payment system.

As noted in last week's MMWU,  the communications mailed to each provider provided very little notice of the immediacy of the change, although advance notice was also provided last Fall. 

To sign up for the listserv go to www.maine.gov/dhhs/emc/mailing/. [return to top]

AMA Provides Opportunity to Volunteer for Tsunami Relief
The AMA Center for Disaster Preparedness and Emergency Response has been in ongoing communication with the leadership of Project Hope discussing ways in which physicians might support ongoing relief efforts in areas directly affected by the recent tsunami.  The USNS Mercy will deploy to South Asia and Project Hope will be responsible for the deployment of health professionals to support this humanitarian assistance mission.  Volunteer staffing to support a 100 bed, 2-10 ICU, medical facility will be required.  Deployments will be in 30 day increments, the first of three projected rotations is scheduled to begin on January 26, 2005.  The following physician specialties will be required for each of the rotations:

  • Vascular surgeon
  • Pediatric surgeon
  • Trauma/Critical Care surgeon
  • Plastic surgeon
  • OB/GYN
  • Ophthalmologist
  • Urologist
  • ENT
  • Anesthesiologist
  • Infectious Disease
  • Pediatrician
  • Psychiatrist
  • Dermatologist
  • Internal Medicine

If you are interested in applying for this opportunity, please reply by E-mail to;  recruitment@projecthope.org and note "tsunami relief," your specialty and your availability on the subject line.  For tracking purposes, we would appreciate it also if you would send a copy to james_james@ama-assn.org and gsmith@mainemed.com. [return to top]

George L. Higgins, III, M.D., FACEP, Named MMC VPMA/CMO
George "Bud" Higgins, MD, FACEP has been named Maine Medical Center's Vice President of Medical Affairs/Chief Medical Officer.  Dr. Higgins had previously been serving for about one year as interim VPMA.

Dr. Higgins has been a member of the MMC medical staff since 1977 and from 1986 to 2002 was chief of the department of emergency medicine.  In 2002, he was named associate vice president for performance improvement. [return to top]

122nd Legislature Passes Tax Reform Bill and Begins Other Business
The First Regular Session of the 122nd Maine Legislature moved quickly last week and enacted a compromise tax reform bill.  This week's schedule includes the Governor's annual State of the State speech tomorrow (Tuesday) evening at 7:00pm.  The speech can normally be seen on public broadcasting stations at 7:00pm.

Each week of the session, MMA publishes "Political Pulse", an electronic newsletter that informs readers of the legislative activities of that week.  There is also a weekly conference call of MMA legislative committee members each Wednesday evening at 7:00pm, except for those weeks that the committee meets in Manchester.

To subscribe to the "Political Pulse", click "Manage Your Subscriptions" at the top of this page. [return to top]

Pathways to Excellence Looks for Additional Performance Meaures
Pathways to Excellence, a project of the Maine Health Management Coalition, is looking for additional performance measurements in its annual survey of self-reported outcomes in primary care practices.  As these outcomes are now directly linked to several pay for performance programs, practices should keep well-informed of the discussion within the physician advisory group to the project.

A subgroup of the steering committee to the project met last Thursday (Jan. 20) and discussed some potential additions to the measurements surrounding care for diabetes used in 2004.  Among the disease states and conditions discussed for possible measurements were asthma, depression, cardiovascular disease, hypertension, anticoagulation, low back pain and obesity.

These discussions were very preliminary and not all of the above areas will be measured.  The recommendations of the sub-group will be presented to the full steering committee prior to any final decision being made.

The subgroup also discussed the need for a verification process for the self-reporting. [return to top]

Division of Licensing and Certification Seeks Physician Consultants
The Division of Licensing and Certification, Bureau of Medical Services, Department of Health and Human Services is seeking responses to a request for proposals from physicians for the following areas: Medical Consultant Services and Surgical Consultant Services to support the Health Facilities State Licensure Survey Program. Eligible candidates must be licensed to practice in Maine , Specialty Board Certified or eligible for certification, experienced in hospital practice and possess proven capabilities and experience in Quality Improvement and peer review. Further information may be obtained by contacting Louis T. Dorogi, Director, Division of Licensing and Certification, 442 Civic Center Drive, #11 State House Station, Augusta , Maine 04333 or Phone (207) 287-9300. Fax number is (207) 287-9304. Two (2) sealed copies of the proposal must be clearly marked Proposal: Division of Licensing and Certification-Physician Services Contract' and delivered to the Division of Purchases, Burton M. Cross Building, 111 Sewall Street, 4th Floor, Augusta, Maine 04333 no later than 2:00 p.m. local time on February 1, 2005. Please note that only proposals actually received in the Burton Cross Building prior to the stated time will be considered; bidders submitting proposals by mail are responsible for allowing adequate time for delivery. Proposals received after the 2:00 p.m. deadline will be rejected, without exception. [return to top]

The Coding Center Announces Spring Coding Course Dates
The Coding Center will offer 15-week professional Coding courses beginning February 15 at St. Joseph's in Bangor, and February 17 at Martin's Point in Portland.

The 15 week course, developed by the American Academy of Professional Coders (AAPC), will take students through the 2005 Current Procedural Terminology (CPT), International Classification of Disease (ICD-9), and HCPCS books to address proper use and proper coding.  This class is intended to educate students on proper techniques and rules of coding and will also prepare them to sit for the AAPC Certified Procedural Coder (CPC) exam.

The Program includes:

  • One year membership in the  AAPC
  • Student workbooks
  • CPC exam
  • Group discussion and networking opportunities

For more information, or to register, please visit the Coding Center's website, codingcenter.org. [return to top]

MeMGMA Presents Annual Third Party Payer Seminars February 9th & 16th

Maine Medical Group Management Association presents its annual Third Party Payer Seminars, Wednesday, February 9, 2005 at the Ramada Conference Center in Lewiston, and Wednesday, February 16, 2005 at Jeff’s Catering in Brewer.

Provider Representatives from the major payers will speak at this seminar and provide updates as to the status of claims processing. Representatives from the following companies are expected to attend:

  • CIGNA
  • AETNA
  • HARVARD PILGRIM
  • MEDICARE
  • ANTHEM
  • MAINE CARE/MEDICAID
  • * MEDICAL NETWORK
  • *MARTIN’S POINT
  • **MAINE NETWORK FOR HEALTH
  • ** MAINE HEALTH ALLIANCE

Participants will have the opportunity to ask questions concerning reimbursement issues affecting physician practices but should not expect specific answers to questions concerning individual account situations.

 * Lewiston only   **Brewer only

 

If you have any questions concerning this seminar, or to register, please contact Peter Allen at 1-800-640-0545.

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