March 28, 2005

 
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Record Physicians' Day Crowd Launches Medical Liability Reform Bill
More than 100 physicians and medical students representing the MMA, Maine Osteopathic Association, and UNE College of Osteopathic Medicine turned out, many in white lab coats, for Physicians' Day at the Legislature on Wednesday, March 23, 2005. In addition to meeting with legislators, the legislative leadership, and the Governor, attendees participated in a press conference formally announcing L.D. 1378, An Act to Preserve the Medical Liability Climate in Maine by Capping Non-economic and Punitive Damages.
 The MMA and MOA co-sponsored the biennial Physicians' Day at the Legislature on Wednesday, March 23, 2005 in the Hall of Flags at the Maine State House.  In addition to a very strong turnout of Maine physicians and medical students, two national guests flew in for the day:  American Osteopathic Association President George Thomas, D.O. of Ohio and AMA Immediate Past Board Chair William Plested, M.D. of California.

The MMA, MOA, and many of Maine's specialty physician organizations set up booths in the Hall of Flags prior to legislators arrival at the State House.  The 122nd Maine Legislature's two physicians, Thomas Shields, M.D. (R-Auburn) and Lisa Marrache, M.D. (D-Waterville), welcomed physicians to the capitol.  Physician of the Day Jan Berlin, M.D. sang the national anthem before the session began.  Physicians and students had an opportunity to observe the House and Senate in session in the morning and to attend public hearings or work sessions in the Health & Human Services, Insurance & Financial Services, or Judiciary Committees in the afternoon.  Participants also had an opportunity to attend meetings with Senate President Beth Edmonds (D-Cumberland), Speaker of the House John Richardson (D-Brunswick), and caucus leaders.  The day concluded with a Blaine House tea with Governor Baldacci who engaged attendees in a discussion of medical liability reform, the state budget debate, and other matters of interest to Maine physicians.

The highlight of the day was a mid-morning press conference organized to announce the printing of the medical liability reform bill offered by the Coalition for Health Care Access & Liability Reform, L.D. 1378, An Act to Preserve the Medical Liability Climate in Maine by Capping Non-economic & Punitive Damages.  Speakers at the well-attended press conference were the bill's prime sponsor Senator Karl Turner (R-Cumberland), Coalition Chairman Lee Thibodeau, M.D., a Portland neurosurgeon, MMA EVP Gordon Smith, Dr. Plested, and Dr. Thomas.  Representatives of the Maine Trial Lawyers Association (MTLA), including former Press Secretary to Governor King Dennis Bailey, were present throughout the day and set up press interviews with a couple of patients and families who had adverse medical outcomes.  The press coverage of their perspective emphasized their opposition to the cap on non-economic damages.  This press coverage confirms that this will be a tough legislative fight that will require every physician to be engaged in the debate if the Coalition is to be successful.

PLEASE DISCUSS YOUR CONCERNS ABOUT MAINE'S MEDICAL LIABILITY CLIMATE WITH YOUR LEGISLATORS NOW!  The MMA will alert you through the Political Pulse when the bill will be considered by the Judiciary Committee.

DHHS Continues to Tweak MECMS, Hundreds Attend Training Sessions
The new MaineCare claims management system, called MECMS, continues to operate at less than optimum capacity with new problems surfacing while some of the old ones get better.  For the most recent two week period, virtually all physician offices received overpayments when the system failed to reduce the charges submitted to MaineCare to the MaineCare fee schedule.  Even though the problem was identified quickly, it was apparently too late to fix for the second week.  At the training sessions held last week, DHHS officials stated that the problem had been fixed and that physicians would see an adjustment in this week's remittance, with the department taking back the overpayment.  The adjustments for any interim prospective payments, however, will be taken back more slowly.

Hundreds of provider staff attended last week's training sessions, facilitated by staff from the Muskie School of Public Service at USM.  MMA  representatives attended the session in Augusta on Friday (3/25) and asked a number of questions.  While most questions were answered, the DHHS staff made quite clear that the session was intended to be a training session and not a general gripe session about how the problem occurred.  Additional training sessions are planned for April 13 and 14 in Augusta, with possible video-conferencing to other sites.  These sessions are scheduled for 12:30pm to 5:00pm.

While DHHS staff maintains that nearly all of the steps of a 30-day correction plan presented to the Legislature at the beginning of March have been implemented, it was clear from the training sessions that many providers are still not satisfied that the system is functioning properly.  Many are frustrated with the aftermath of the technological glitch, including the significant delay in payment.  As one example, the tape with the crossover claims for dual-eligible patients (Medicare and MaineCare) has not been processed and there is no plan to do so for another three to four weeks.  Given that many of these claims were submitted in January, the result is a four month delay in payment.  When MMA EVP Gordon Smith inquired about MaineCare paying interest on these claims, as a commercial insurance carrier would be required to do under Maine's "prompt pay" law, MaineCare staff made clear that there were no plans to do so. 

Many providers say they are still not getting the regular, predictable interim payments the DHHS correction plan had promised. Furthermore, the longer the interim payments replace properly processed and paid claims, the more difficult the accounting problems will be when it's time to reconcile.

MaineCare officials advised provider staff this past week that the system should now alert providers within 24 hours of submitting an electronic claim whether it will be processed or has been bounced out.   To check the status of a claim, use the Voice Response Number 1-800-452-4694 (in-state only) or 207-287-3081.  Have your provider number and member ID# available when you call.  Providers can also receive assistance by phoning 1-800-321-5557, ext. 9 or by e-mailing BMS.inquiry@Maine.gov.

All the news is not bad.  More provider staff has been hired to augment the existing staff and training for the new staff is beginning this week.  The phone system was upgraded on March 21 to give providers automated claim status.  And the program continues to send interim payments, with over $11 million going out tomorrow (Tuesday 3/29).  MaineCare is sending out weekly updates to providers and MECMS Update 4 should be available today.  And while last week's figures seem to show fewer claims being processed than the week before,  the number of providers who received an interim payment increased to 1,716 from 1,428 the previous week.

As the program continues to struggle with this transition, it is still valuable for MMA to hear from individual practices concerning your experiences, whether bad or good.  This feedback gives us an opportunity to provide input to senior Department officials, who clearly remain concerned about the situation.  Send your information to Gordon Smith at gsmith@mainemed.com.

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Schiavo Case Fuels Requests for Advance Directive Forms
Since a single article appeared in the Bangor Daily News stating that Advanced Directive forms were available from the Maine Hospital Association website (www.themha.org)  or by calling the Maine Medical Association, well over 100 forms have been sent from MMA and the calls are still coming in.  Obviously the personal tragedy of Terri Schiavo has resonated with Mainers who have been reminded of the need to sign an advanced directive form, which in Maine includes both the elements of a living will and the appointment of surrogate decision-maker. 

Maine's laws on the subject of surrogate-decision making and end-of-life care are quite liberal and among the best in the nation, but it is still helpful to the medical team to have a signed document from the patient indicating their wishes or appointing a surrogate or hopefully, both.

Every physician office, particularly primary care practices, should have  the statutory forms available for patients.  If you do not have one and would like a sample from MMA to copy, communicate with Julie Banta at 622-3374 or via e-mail to jbanta@mainemed.com.  If you go to the MHA website, look for advanced directives under the resource box.

If the calls to MMA from the public are any indication, your patients are going to be asking for the forms. [return to top]

Happy Doctor's Day, Thursday, March 30, 2005
Traditionally, March 30th has been recognized as Doctor's Day around the country.  MMA congratulates all Maine physicians on this occasion and expresses its heartfelt thanks for the excellent care that you provide and the many sacrifices that you make.

As Larry Mutty, M.D., current MMA President, has focused attention this year on the many voluntary efforts that Maine physicians are engaged in both in Maine and abroad, it is particularly appropriate that we recognize those of you who, in addition to caring for your own patients, volunteer in free clinics and in developing nations around the world.  You are our heroes. [return to top]

HIPAA Security Requirements Enforced April 21, 2005
Over 100 persons attended the MMA's recent briefings on HIPAA security which also offered an update on the privacy regulations.  Security experts Sari Green of Sage Data Security and Bryan Michaud, Phd., of Integrity, LLC provided practical approaches to to the three pieces of compliance with the HIPAA security rule, those pieces being administrative, physical and technological. 

Contrary to some information that was presented, the deadline for compliance for all medical practices covered by HIPAA is April 21, 2005.  There is a one year delay for small health plans with gross revenues under $5 million, but that exception applies only to health plans and not to medical practices.

MMA has a few sets of the meeting seminar packets which are available for $25.00.  If you are interested, contact Chandra Leister at MMA at 622-3374 or via e-mail to cleister@mainemed.com.

The HIPAA privacy rules dealt primarily with patient rights and how a patient's Protected Health Information (PHI) could be used.  HIPAA security deals with how a practice will secure PHI in its electronic usage.  The security rule is much briefer than the privacy rule, but for some practices it is proving more difficult to implement.   The cornerstone of security involves conducting a risk assessment for the practice.  The regulations also have several implementation specifications.  Some are required, but others are "addressable," which means you must review the specification and make a documented decision about why you either did not implement it or chose to implement a lesser version.

Much of the security rule was based on documents from the National Institute for Standards and Technology (NIST).  The NIST Web site has information about HIPAA implementation at http://csrc.nist.gov/publications/drafts/DRAFT-sp800-66.pdf.  This draft version, however, is 96 pages long.

Another good resource is the Workgroup for Electronic Data Interchange (WEDI).  Good information for the physician practice can be found on the WEDI Web site at www.wedi.org/cmsUploads/pdfUpload/White Paper/pub/2004-04-20SmallPractice.pdf. [return to top]

JCAHO Issues New White Paper On Medical Liability
On February 10, the Joint Commission issued a call to action to reform the nation's medical liability system, urging that the current proposal for caps on non-economic damages be expanded to pursue intermediate and long term system changes which truly facilitate improvements in patient safety.  By its basic design, the current medical liability system "chills" the identification and reporting of adverse events in health care and thus undermines opportunities for leaning that could provide the basis for significant safety improvements.  The call to action is set forth in the Joint Commission's newest public policy white paper, :Health Care at the Crossroads: Strategies for Improving the Medical Liability System and Preventing Patient Injury."  The white  paper was developed in collaboration with an expert  round table whose 29 members represent a wide diversity of interests relevant to medical liability.  This report contains 19 specific recommendations and identifies accountabilities for each of those.  As with its other public policy initiatives, the Joint Commission intends to work in collaborating with other parties to see that the recommendations are eventually implemented.  A complete copy of the white paper  is available at http://www.jcaho.org/about+us/public+policy+initiatives/tort_resolution.htm.  See the news release at http://www.jcaho..org/news+room/news+release+archives/jcaho_0210_05.htm.  (Contact: Terry Tye, ttye@jcaho.org. [return to top]

Budget Debate Delayed in the House
During Wednesday and Thursday of last week, the legislature was going through the usual pre-budget debate ritual - waiting for amendments to be drafted and printed.  Because the Appropriations Committee divided along party lines, the majority Democrats must pass a budget by April 1st so that the new budget can take effect before the beginning of the new fiscal year on July 1, 2005.  The close partisan split in both chambers, however, means that the Democrats cannot afford any defections on the budget.  The budget debate was rumored to begin in the House on Thursday afternoon, but the House leadership abruptly cancelled the afternoon session and sent members home for the Easter holiday weekend.  It was clear that disagreement about the canoe and kayak fees, seat belt enforcement fines, and other issues meant that the Democrats did not have the votes to pass the budget.  Negotiations will begin again on Monday, March 28th. 

At this point, the MaineCare physician fee increase of $3 million per year still does not appear to be in jeopardy. [return to top]

National Sentinel Event Statistics Update
As of December 31, the Joint Commission's sentinel event statistics have been updated and are available on the Joint Commission website at http://www.jcaho.org/accredited+organizations/hospitals/sentinel+events/sentinel+event+statistics.htm[return to top]

Court Dismisses Claim of Physician's Duty to Rape Victim

In a decision issued January 12, 2005, Kennebec County Superior Court Justice Donald Marden dismissed a civil action brought by a rape victim against a Maine urologist who provided a penile implant to the rapist on the grounds that the action was one for medical malpractice and the plaintiff victim failed to comply with the notice of claim, statute of limitations, and screening panel provisions of the Maine Health Security Act, 24 M.R.S.A. 2501, et seq.  At the time of treatment, the rapist had spent 20 years in prison in three states for rape, sexual assault, and felony assault and battery involving four women and had been implicated in four other rapes for which he was not convicted.  The victim plaintiff argued that the physician owed a duty to the public to refuse to provide a non-medically necessary penile implant to the rapist given his past criminal history.  The Court did not reach the interesting legal question about the physician's duty to the public because it decided the case on the procedural matter of the plaintiff's failure to comply with the Maine Health Security Act.  The case is Pease, et al. v. Kester, Kennebec County Superior Court Docket #CV-04-67, 1-12-05. [return to top]

Labor Committee Hears Bills on Workers' Comp. Medical Fee Issues
 For more than a year, the MMA has brought you, through the Maine Medicine Weekly Update, news of the business community's (Hannaford & BIW in particular) efforts to cut the conversion factor in the Maine Workers' Compensation system fee schedule (W.C.B. Rule Chapter 5) and to institute a fee schedule for hospitals and ambulatory surgical facilities.  This debate has moved into the legislature.  On Tuesday, March 22, 2005, the Labor Committee held a public hearing on L.D. 916, An Act to Amend the Workers' Compensation Medical Fee Schedule to Include Hospital Charges and L.D. 996, Resolve, Establishing the Commission to Study Medical Expenses Under the Maine Workers' Compensation Act of 1992.

The Labor Committee also held a public hearing on L.D. 881, An Act to Amend the Maine Workers' Compensation Act of 1992 to Facilitate Timely Independent Medical Examinations and Benefit Payments, a bill that would make more physicians eligible to conduct independent medical examinations (Section 312 exams) by not disqualifying them for offering employer-requested second opinions (Section 207 exams).

The Labor Committee will hold a work session on these bills this week. [return to top]

Transportation Committee Majority Votes Against Motorcycle Helmet Bill
At a work session on Thursday, March 24, 2005, a majority of the Transportation Committee voted against L.D. 172, An Act Requiring Protective Headgear for All Operators and Passengers on Motorcycles, Motor-driven Cycles, and Mopeds.  Following the public hearing on this bill on February 8, 2005, it was clear that the bill had little support in the Transportation Committee.  Even the bill's likely supporters felt that the priority for this legislative session was the primary seat belt enforcement initiative. [return to top]

Hospital Study Commission to Present Report to HHS Committee Thursday
The Dirigo Commission to Study Maine's Community Hospitals will present its final report to the Health & Human Services Committee on Thursday, March 31, 2005 at 1 p.m.  You can read a press release about the final Commission report on the web at:  http://www.maine.gov/governor/baldacci/healthpolicy/news/2_2_05.htm.

If you would like to listen to the presentation, but you cannot be in Augusta on Thursday afternoon, you can hear the HHS Committee on the web at:  http://janus.state.me.us/legis/audio/committee_frameset.html. [return to top]

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