March 14, 2005

 
Subscribe to Maine Medicine eNewsletters
Manage Your Subscriptions
Email our Editor...
Maine Medical Association Home Page
. Search back issues
. Plain Text Version
Printer Friendly

Reminder: Physicians' Day at the Legislature is Next week!
Join your professional colleagues and spend all or part of the day at the State Legislature next Wednesday, March 23, 2005 to rally for medical liability reform. The event is sponsored by MMA and the Maine Osteopathic Association and this year over 200 physicians, residents and students are expected because of the growing unrest about the medical liability situation in Maine.
The day begins with coffee with the legislators before the House and Senate convene at 10:00am.   Several medical specialties and the Coalition for Health Care Access and Liability Reform  will have exhibits available beginning at 8:00am.  At 9:30am attendees will be briefed on the day's activities by staff and the two physicians in the Legislature, Reps. Thomas Shields and Lisa Marrache.  A press conference will be held at 10:30am to announce the liability legislation.  At noon, the President of the American Osteopathic Association, AMA representatives and the Co-Chair of the Coalition, Lee Thibodeau will speak in the Hall of Flags during a lunch for the legislators. Several committees have hearings of interest beginning at 1:00pm and at 2:30pm we will meet with Governor John Baldacci at the Blaine House.

The Maine Medical Center will be providing a bus to assist with transportation.  The bus is expected to leave MMC around 9:00am and return early in the afternoon.  Details on the bus can be obtained by calling Shelley in Bud Higgins, M.D. office at 662-2776.

Yesterday's Maine Sunday Telegram contained an op-ed article authored by Coalition Co-Chairs Lee Thibodeau, M.D. and Hector Tarraza, M.D.  detailing the need for medical liability reform in Maine.  Please make plans to join us in Augusta on next Wednesday, March 23rd for this important event.  If you would like more information about how your practice or specialty can participate, please contact Charyl Smith at MMA by e-mail to csmith@mainemed.com or by phone at 622-3374.

MMA Hosts CMS Review of Medicare Practice Expense GPCI
On Wednesday, March 9, the Maine Medical Association hosted an important review meeting of physician practice expense geographic adjustment data for Medicare.  Representatives of the Centers for Medicare and Medicaid Services, the Urban Institute and RTI International attended and heard presentations on practice expense data from several medical practices in Maine.  Many thanks to those practices which shared data and responded to questions regarding some of the unique issues associated with practicing in rural Maine.

Congress included a provision in the Medicare Modernization Act of 2003 mandating a demonstration-based review of the practice expense geographic adjustment data and as part of the review, required a meeting with organizations representing physicians and other appropriate persons to review alternative data for the practice expense Geographic Practice Cost Index (GPCI).  An earlier meeting had been held in December in Iowa.  The results and ideas from these meetings will form the starting point for a review of alternative data sources for the practice expense GPCI and a report to Congress.

Among the issues discussed were the considerable costs associated with recruiting physicians to a practice, the difficulty of spreading fixed costs among a small patient base leading to higher per physician costs and the higher costs occasioned by the inability to receive volume driven discounts.  The costs of office supplies, medical supplies and equipment and transportation were all explored in depth.  Even the additional expense of CME necessitated by travel was noted, as were the additional costs of legal, IT and other consultants coming from a distance to service the provider.

It is hoped that this meeting, and the earlier one in Iowa, will play a positive role in convincing CMS and the Congress to adjust the GPCI's to better recognize some of the unique aspects of practice in rural areas.  As Maine's Medicare population continues to grow, these adjustments will become even more critical to the operation of a practice in Maine. [return to top]

Maine Gastroenterology Society Presents Topics in Gastroenterology for Primary Care April 29 in Freeport
The Maine Gastroenterology Society presents its second annual CME program for primary care physicians on April 29th, 2005 at the Haraseeket Inn in Freeport.  Six credits of category 1 CME are available and the program runs from 8:00am through 3:30pm.  The course directors are Jay Bosco, M.D. of Brunswick and Michael Saletta, M.D. of Waterville.

General topic areas are Colon Disorders, Pancreatic Cancer and Liver Disorders.  The conference fee for MMA members is $50.  Registration materials and any other information is available from Chandra Leister at MMA (622-3374 or cleister@mainemed.com).

Sponsors for the program include Novartis, Roche Labs, Salix, Schering Plough  and TAP. [return to top]

Patient Safety Legislation Moves Forward in U.S. Senate
Last year, during Patient Safety Awareness Week, the U.S> Senate took an important step toward passage of patient safety legislation.  The Senate Health, Education, Labor and Pensions (HELP) Committee passed the bipartisan Patient Safety and Quality Improvement Act of 2005.  The bill is supported by the AMA.

The legislation establishes a system for reporting and analyzing health care errors to improve patient safety and health care quality.  Health care errors would be prevented by transforming the existing culture of blame, which suppresses information about errors, into a culture of safety, which focuses on sharing information in order to prevent future errors.

Donald J. Palmisano, M.D., AMA Immediate Past_President noted, "When physicians can report errors in a voluntary and confidential manner, everyone benefits.  Future errors can be prevented as we learn from past mistakes.  This legislation strikes the proper balance between confidentiality and the need to ensure accountability throughout the health care system.  Patient Safety Organizations (PSOs) would analyze the problems, identify solutions and provide feedback to avoid future errors."

Versions of the same legislation had been passed in both the Senate and House last year but were never reconciled and sent to the President for his signature.

Maine's current system of reporting of sentinel events is in its second year, with about 30 errors being reported in the first year. [return to top]

MaineCare Claims Management System (MECMS) Payment Schedule and Status
The poor transition by MaineCare to its new claims management system continues to cause significant distress to practices and has attracted the attention of the legislature and the media. The Bureau of Medical Services has been required to give an update to the Appropriations Committee each week.  The following are highlights of the Bureau's March 11 report:

  • DHHS first priority continues to be payment for services provided to members.  When claims cannot be processed through the MECMS billing system, DHHS will make interim payments.
  • Over $26 million was paid through the MECMS system for the week ending March 11.  In addition, 2,082 providers were paid over $35 million in interim payments.
  • The amount of money paid through the system doubled from the previous week.
  • The Department will "recapture" interim payments by offsetting future claims as they process through the system successfully.

Actions to Improve Provider Feedback & Stabilize the System

  • Contracting with outside vendor to add staff to assist with answering provider inquiry calls.  State staff have been authorized to work overtime.
  • Mailing to providers scheduled for March 14 that outlines basis for interim payments and reconciliation.
  • Arranging locations for regional provider meetings to review claims submission issues and process for reconciliation, as recommended by Appropriations Committee.
  • Upgrading system to improve performance and staff ability to answer provider inquiries on March 12.
  • Reduced backlog of claims in the system resulting in increase of claims processed and paid with remittance advices.  Remaining backlog should be eliminated by March 25.
  • Contracted with Xwave for project management support effective March 9.
  • Met with vendor CEO to address system performance, configuration management, and project management issues.  Vendor CEO became acting project manager effective March 7 until replacement is hired.
  • Established regular software release strategy to address critical software problems and enhance stabilization of system on March 11.

It is still very valuable for MMA to hear from members as to the MaineCare amounts received versus the amounts owed.  Thanks for the very valuable feedback to date.  Send the information to gsmith@mainemed.com. [return to top]

Bill, Code Properly to Earn New Rural Bonuses from Medicare
Concern about attracting and retaining physicians in rural areas drove Congress to boost pay for rural physicians in the Medicare Modernization Act of 2003. As a result, physicians in newly designated Physician Scarcity Areas (PSAs) began earning a five percent bonus payment from Medicare in January.

Physicians practicing in regions designated as Health Professional Shortage Areas (HPSAs) receive a ten percent bonus.

To determine if you are practicing in either a PSA or HPSA, go to www.cms.hhs.gov/providers/bonuspayment

Information on this link is divided into primary care and either specialty care or mental health. In order to find your zip code you may have to look in more than one area. Instructions on how to bill for the bonus payment can be found on the above website by clicking on Instructions on the HPSA/PSA Specialty page.

Here are some important additional details:

HPSA

  • Pays 10% bonus on professional services.
  • Your CPT code must be split between the professional (26) and technical (TC) components.
  • The bonus payment is determined by zip code.
  • If zip code is not on the automated payment list, follow directions under www.cms.hhs.gov/providers/bonuspayment in order to determine if you must use the QU/QB modifier to receive the bonus payment.
  • Claims filed with global fee in a HPSA area will be denied.

PSA

  • Pays 5% bonus on professional services.
  • The bonus payment is determined by zip code.
  • No modifier is needed.
  • Claims filed with global fee will be denied.
  • If you are not on the zip code list ad your county is on the list under the CMS website at www.cms.hhs.gov/providers/bonuspayment, you must use the AR modifier to designate your eligibility.

[return to top]

Nominations Sought to Fill Vacancies of Dirigo Health-related Commissions
The Governor's Office of Health Policy and Finance is seeking nominations for several vacancies on Dirigo Health-related boards. Please forward names, citing specific qualifications and information required to contact potential nominees to:

Trish Riley, Director
Governor's Office of Health Policy and Finance
15 State House Station
Augusta, ME 04333
Laurie.E.Halligan@maine.gov

All nominations must be received in the office no later than the close of business on March 31st.

Vacancies

Maine Quality Forum - (3)
Advises Maine Quality Forum, the State's quality watchdog, and assists in promoting wellness-based practices and adoption and distribution of quality measures for the public.

  • 1 Position representing behavioral health
  • 1 Position representing business
  • 1 Position representing physicians

Advisory Council on Health Systems Development
To advise the Governor in establishing the State Health Plan and Capital Investment Fund.

  • 1 Position representing physicians
[return to top]

MMA to Partcipate in AMA National Advocacy Conference this Week
This week, the MMA's President, Lawrence B. Mutty, M.D., M.P.H. and President-elect, Jacob Gerritsen, M.D., will attend the annual American Medical Association (AMA) National Advocacy Conference in Washington, D.C. this week.  At this meeting, attendees will focus on the AMA's two top national legislative initiatives - medical liability reform and fixing the Medicare payment methodology, the sustainable growth rate (SGR).  MMA Vice President & General Counsel Andrew MacLean will join Dr. Mutty and Dr. Gerritsen for visits with the four members of Maine's Congressional delegation on Wednesday, March 16, 2005. [return to top]

Update: Anthem Maine Physicians Advisory Committee
Anthem Blue Cross Blue Shield of Maine has a Physician Advisory Committee which works with Anthem officials on a variety of issues. The current members are as follows:

  • Lisa Letourneau, MD
  • Charles Grimes, MD
  • Maroulla Gleaton, MD
  • Neil Korsen, MD
  • Louis Hanse, DO
  • John Yindra, MD
  • Barbara Crowley, MD
  • Leonard Keilson, MD
  • Ed Pontius, MD
  • Richard Evans, MD

The Committee meets quarterly. Subcommittees are being formed around the issues of Guidelines and Diagnostic Imaging.

For more information, contact Maxwell Barus, MD at Maxwell.Barus@anthem.com [return to top]

Payor Satisfaction Survey
The Maine Medical Center Physician Hospital Organization payor satisfaction survey for 2004 has been completed. The PHO sent surveys to each practice within the Maine PHO ad 98 practice sites (representing 35% of all Maine PHO physicians) completed and returned the surveys.

Practices were asked to rate each payor on a scale of 1-5 (1 - Poor; 5 - Very Good). The results are as follows:

 2004 Results

CIGNA

AETNA

HMO Maine

Maine Partners

Harvard Pilgrim 

 Overall Satisfaction with Plan

 2.9

 3.0

 4.1

 4.1 

 3.3 

Responsiveness of Provider Representatives

 3.0

 3.1

 3.8

 3.8

 3.2

Timely Notification of Policy Changes

 3.3

 3.4

 3.8

 3.8

 3.5

Satisfaction with Referral/ Auth process

 3.5

 3.0

 4.2

 4.2

 3.4

Claims Processing

 3.0

 3.1

 4.0

 4.0

 3.3

 

2003 Results

CIGNA

AETNA

HMO Maine

Maine Partners

Harvard Pilgrim 

 Overall Satisfaction with Plan

 2.5

2.9

 3.7

 3.7

 3.0

Responsiveness of Provider Representatives

 2.4

2.7

 3.6

3.6

2.6

Timely Notification of Policy Changes

 2.8

 3.1

 3.6

3.6

3.2

Satisfaction with Referral/ Auth process

 3.2

 2.9

 3.9

3.9

2.9

Claims Processing

 2.6

 2.9

 3.5

3.6

2.7

[return to top]

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