March 7, 2005

 
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MaineCare Claims Management System (MECMS) Woes Continue; Governor and Legislature Demand a Fix
The disastrous MaineCare transition to a new claims management system reached front page news this week while many medical practices and other providers went another week without a check. Some practices received interim prospective payments and all practices owed over $1,000 should receive such a payment within the next 7 days. On Tuesday, the Governor demanded that the DHHS come up with a plan to resolve the mess within 30 days. The Legislature also got in on the act when the Chairs of the Committee on Appropriations and Financial Affairs wrote to the Commissioner on March 2 expressing the Committee's "strong concern" regarding the problem.
In addition, the Committee expressed strong support for the Department's efforts to make interim estimated payments to MaineCare providers while the delays in processing claims continue.  The Committee also requested that the Commissioner and his staff update the Committee on a weekly basis regarding progress on the Department's plan of correction.  At a meeting on Wednesday, the Commissioner told Committee members that the new system should be working effectively by the end of March.  In the meantime, the Department has taken a number of steps to assist with the situation.

  • Interim prospective payments, based upon a practice's average weekly MaineCare volume will be paid by the end of next week.
  • A new schedule of training and information sessions for providers is being announced on Monday (March 7)
  • By the end of next week, additional staff will be available to answer provider inquiries
  • By the end of the week, a new lead consultant for the project will be in place.

The Department intends to increase the percentage of claims paid through MECMS by 5% weekly until the system reaches expected performance levels.  The system was provided by CNSI-Solutions, a Maryland-based company.

Providers have complained bitterly about not only the late payments, but also about the failure of the provider relations staff to even return their phone calls. Even when you get a call back, the information available is sparse.   Even senior staff seems to now acknowledge that the provider relations staff is severely understaffed.  Bringing in temporary outside help will at least help with returning the calls, but it will take some time before a well-versed staff can be put in place.

In the meantime, please let MMA know your status so we can relay that information to the Bureau.  We have been successful in some instances in getting practices on the list for an interim prospective payment.  Such a payment is not ideal, as it will come without an EOB indicating the claims paid, but it is at least cash for those practices who prefer this temporary, emergency approach.

MaineCare Physician Fee Increase Recommended by HHS Committee; Now in Hands of Appropriations Com.
The $3 million General Fund increase proposed for increases in the physician fee schedule for MaineCare has survived round one which took place in the Health and Human Services Committee.  The Committee has unanimously recommended the increase in its proposals made to the Appropriations Committee.  Many thanks to those MMA members who made contact with one or more Committee members.  With federal matching funds, this initiative would infuse nearly $10 million into the MaineCare fee schedule, representing the first substantial increase in nearly 30 years.

Round two of this battle is taking place now in the Appropriations Committee and calls and contacts need to continue with this group.  The names and contact information for the Committee members are as follows:

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Protect Your Future: Rally for Liability Reform on March 23!
Physicians'  Day at the Legislature on March 23, 2005 presents a unique opportunity for the physicians of Maine to join together as colleagues and promote the cause of medical liability reform.  Over 200 physicians are expected to come to Augusta and speak with legislators about the impact of liability on their careers.  The medical liability climate im Maine is eroding rapidly and this year the legislature has a chance to act before a full-blown crisis erupts, as obviously has happened in many other states.  In addition to liability reform, the proposed increase in MaineCare needs to be supported.

Two bus loads of medical students and physicians are coming from Southern Maine and plans are emerging for buses from other locations as well.  The day begins with coffee and refreshments with legislators at 8:00am, a press conference at 10:30am, a noontime lunch with legislators and presentations and a 2:30pm meeting with the Governor at the Blaine House.

The President of the American Osteopathic Association will be joining us as well as officials from the AMA.

Consider taking a day or at least part of day from your practice to join your colleagues in Augusta.  White coat attire is suggested for maximum impact.  Your future in medicine in Maine will be the direct beneficiary.  RSVP to Charyl Smith at MMA by fax at 622-3374 or via e-mail to csmith@mainemed.com. [return to top]

Not too Late to Participate in Medicare GPCI Review in Manchester on Wednesday, March 9
On Wednesday, March 9, 2005 Maine physicians have a unique opportunity to present cost data to CMS officials and contractors on practice expenses as part of the Congressionally mandated review of the practice expense GPCI  (geographic practice cost index).  The results and ideas from this meeting, and a similar one held in Iowa in December, will form the starting point for a review of alternative data sources for the practice expense GPCI and a report to Congress.

The review was included in the Medicare Modernization Act of 2003.

The Practice Expense GPCI is used to adjust the component of Medicare physician fees related to the Practice Expense RVUs for geographic differences in practice input prices.  Specifically, the Practice Expense GPCI takes into account geographic differences in employee wages, office rents and miscellaneous expenses.  Together, these three components of practice expenses account for 42.3 per cent of total practice revenues.

The weaknesses of the PE GPCI that have been noted over the years relate more to the data used to capture input price differences than to the components of the index and weights.  There has also been criticism of the impact on physicians practicing in rural area.  Issues of rural physician travel time to multiple offices and clinics, higher costs due to lower volume of patients and stand-by capacity need to be examined.  Furthermore, physicians in rural areas may be paying higher prices for office equipment and supplies due to shipping costs and/or reduced bargaining power.  There may also be some services that rural physicians provide that urban physicians do not.  It is hoped that we can present data that will call for potential adjustments to the Practice Expense GPCI.

If your practice is willing to participate and provide some data, please e-mail Gordon Smith at MMA at gsmith@mainemed.com or call him at 622-3374.  The meeting will go from 9:00am to 4:00pm Wednesday but office staff would not have to be present for the entire meeting in order to provide input. [return to top]

March is Colon Cancer Awareness Month
On Thursday, March 3, 2005, Bureau of Health Director Dora Mills, M.D., M.P.H. and representatives of the Maine Comprehensive Cancer Control Program, the American Cancer Society, and the Maine Cancer Foundation kicked off a campaign to raise public awareness about colon cancer with a press conference in the Governor's Cabinet Room.  Current guidelines urge all Mainers aged 50 and older to undergo regular colon cancer screening.

You can read the press release on the campaign on the web at:  http://www.maine.gov/tools/whatsnew/index.php?topic=Portal+News&id=5622&v=article-2004. [return to top]

Invitation: A Clean & Healthy ME Environmental Policy Forum
You are invited to attend A Clean & Healthy ME, a forum on clean air, clean water, open spaces, and healthy Maine families sponsored by:

  • Maine Conservation Voters Education Fund
  • Androscoggin Lake Improvement Committee
  • Maine Rivers
  • Androscoggin River Alliance
  • Environmental Health Strategy Center
  • L/A Lead Hazard Control Program
  • Androscoggin Land Trust

Join area legislators for coffee, snacks, and an informative discussion about important issues including land conservation, water quality, and child lead-poisoning prevention efforts.

Thursday, March 10, 2005, 7:30 - 9:00 p.m.
Lewiston-Auburn College, Room 108/109
51 Westminster Street, Lewiston

Admission is free, but space is limited so RSVP to info@protectmaine.org or 207-373-1221 by March 7, 2005. [return to top]

MaineCare Drug Utilization Review Committee Meets on Tuesday, March 8 in Augusta
The MaineCare Drug Utilization Review Committee will meet on Tuesday, March 8, 2005 in Conference Room 1A&B, at the Department of Human Services/Bureau of Medical Services offices, 442 Civic Center Drive, Augusta from 6:00p.m. to 8:00p.m.  A public comment period will begin at 6:00p.m.

The draft agenda is as follows:

  • Call to Order 6:00p.m.
  • Public Comments/Questions regarding Preferred Drug List and Prior Authorizations
  • Old Business 6:30p.m.
  • Approval of DUR Agenda
  • Approval of Feb. 8, 2005 Minutes
  • New Business
  • Conflict of interest disclosures for DUR members and speakers/commenters
  • Break

DUR

  • 1. Dementia therapies
  • 2. Actos/Avandia
  • 3. Cox-2 update/FDA
  • 4. Pediatric psych study
  • 5. Behavioral Drug (Atypical) Education Program Update: Psych work group report

End Public Portion of Meeting

          6.  PDL April meetings - divide up categories for review and determine what net cost and utilization data can be made available

     Meeting format 2005:  April-PDL, May-DUR, June-PDL, Sept. DUR, Oct-PDL, Nov-DUR.

     Adjournment 8:00pm [return to top]

Tsunami Relief
In the aftermath of the catastrophic tsunami, many people are looking to assist those who have been affected by the massive flooding, damage and loss of life.  The U.S. Agency for International Development (USAID), an independent government agency that provides economic, development and humanitarian assistance around the world, has a listing of over 50 relief organizations and multiple donation options.  Visit www.usaid.gov/locations/asia_near_east/tsunami/ngolist.html for more information on how you can help. [return to top]

MedPAC Report Moves Closer to Pay-for-Performance for Medicare
In its March Report to the Congress, the Medicare Payment Advisory Commission (MedPAC) made several recommendations that shift policy toward pay-for-performance measures.  The report recommends higher payments for higher quality performance, quality measures that reflect the use and function of information technology systems, establishment of "quality standards" for providers who perform imaging studies and physicians who interpret them, and measurement of resource use of physicians serving Medicare beneficiaries.  In addition, MedPAC recommended an update to the physician fee schedule equal to the projected change in input prices less an allowance of 0.8 percent for productivity.  The report can be accessed at : http://www.medpac.gov/publications/congressional_reports/Mar05_TOC.pdf (Acrobat Reader required) [return to top]

Liability Coverage of Volunteer Health Professionals in Free Clinics
Back in 1996, Congress authorized medical liability protection for volunteer health professionals working in free clinics through Section 194 of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). If a volunteer health care professional meets certain requirements, the related free clinic can sponsor him/her to be a "deemed" federal employee for the purpose of medical liability coverage under the Federal Tort Claims Act (FTCA).

Implementation of the Free Clinics Federal Tort Claims Act Medical Malpractice Program (the Program) began on September 24, 2004. Under the Program, administered by the Health Resources and Services Administrations' (HRSA) Bureau of Primary Health Care (BPHC), HHS will deem a volunteer free clinic health care professional to be an employee of the Public Health Service for purposes of FTCA medical malpractice coverage if the free clinic and health care professional meet certain requirements. An application process must be followed, and approval granted by HHS, before liability protection is granted.

Detailed information on the Free Clinics FTCA Medical Malpractice Program, as well as application instructions and eligibility requirements, can be found on the HRSA/BPHC website at www.bphc.hrsa.gov/freeclinicsftca/application.htm. Please feel free to contact Debra Cohn, J.D., AMA Washington Counsel,, (202-789-7423; debra_cohn@ama-assn.org) if you have questions about this program. [return to top]

2005 Rural Medical Access Program Application
The Rural Medical Access Program promotes obstetrical and prenatal care in federally designated underserved areas of Maine through assistance with insurance premiums for eligible obstetricians and family or general practice physicians. To be eligible for this program, physicians must be practicing in Maine as of May 1, 2005 and have malpractice insurance for prenatal care and/or obstetrical services.

Eligibility is determined in two categories:

  1. Physicians whose practices are located in federally designated underserved areas, who practice at least 50% of the time in underserved areas, and whose practice includes at least 10% MaineCare clients.
  2. Physicians whose practices are not located in federally underserved areas but are located in Primary Care Analysis Areas of under 20,000 population and at least 50% of the visits are patients from federally underserved areas and/or MaineCare.

The 2005 application for the Maine Rural Medical Access Program is available from

Matthew Chandler, Manager
Office of Rural Health and Primary Care
#11 SHS, 286 Water Street, 6th floor
Augusta, ME 04333-0011

If you have any questions or need additional applications, please feel free to call Matthew at 287-5524. [return to top]

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