April 11, 2005

 
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MMA Reestablishes Office-based Quality Improvement Program
Utilizing provisions of state law which protect quality improvement and peer review materials, deliberations and reviewers when review is performed "under the auspices of a state professional society," MMA has re-established its office-based QI program.
A medical practice may voluntarily elect to participate in the Program by developing and implementing a written QA or QI Plan that is approved by the MMA Committee on Peer Review and Quality Improvement. In addition, the practice agrees to submit reports to the Committee, to participate in periodic audit surveys and to pay a participation fee of five hundred dollars.

Because of the increasing emphasis on improving quality and the linkage to pay for performance reimbursement mechanisms, most practices will feel the need to develop a QI program for the office setting. Two provisions in Title 32 make this type of program particularly appealing. One statute protects the materials of such a program from discovery in a professional liability case, the second provides immunity for participants. this protection is provided only for hospital QI and peer review or for programs offered through the auspices of a statewide professional society.

Although MMA developed this program originally a few years ago, it has been "on the shelf" for a bit. One practice is currently in the program, a second has applied and a third has expressed an interest to apply.

If your practice is interested in receiving a document describing the program, contact Warene Chase-Eldridge at 207.622.3374 or via email at weldridge@mainemed.com, or Gordon Smith at 207.622.3374 or via email gsmith@mainemed.com

New Resources Available To Prepare for HIPAA Security Compliance

The National Institute of Standards and Technology (NIST) has issued a new guide detailing the minimum requirements for providers to secure health information and systems. The guide recommends the type of systems that are needed to comply with the security regulations mandated by the Health Insurance Portability and Accountability Act (HIPAA). Providers have until April 20, 2005 to meet the mandates. It provides resources relevant to each specific security standard included in the HIPAA rule and provides implementation examples for each. To read the guide:
 
On April 6, the Centers for Medicare and Medicaid Services (CMS) will sponsor a FREE teleconference to help you gauge your progress in complying with the HIPAA Security rules. The hour-long teleconference "Are you on track with HIPAA Security compliance?" will begin at 1 p.m. (Eastern time). To participate, call (877) 203-0044 and provide the conference identification number: 4880424
 
The AAOS Practice Management Center has a number of resources orthopaedic surgeons can use to ensure that their practices are compliant with the regulations. You can search the center or scroll down to "Compliance." To access the Practice Management Center (password protected):
 
In addition, the AAOS has published several Bulletin articles that outline the requirements of the HIPAA Security regulations (December 2004) and describe how to conduct a risk analysis (February 2005). To access the Bulletin online:
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2005 Medicare Trustees Report Offers Mixed Outlook for Physician Pay
The annual report on the program's overall financial outlook shows a smaller than expected cut in physician pay - 26 percent for 2006-2011, rather than the 31 percent cut predicted last year. Although a 4.5 percent physician pay cut was predicted for 2006, the Centers for Medicare and Medicaid Services (CMS) last week released a preview of the physician payment update for 2006 that sets the update at -4.3 percent and the conversion factor at $36.2679. At the same time, monthly Medicare Part BB premiums will jump from $78.20 to $87.70 next year, a 12 percent increase for patients who pay premiums. If Congress acts to block the planned 4.5 percent physician pay cut for 2006, the premium increase will rise to 14 to 15 percent, making relief for physicians politically more difficult. CMS Administrator Mark McClellan says CMS will be looking into accelerated growth areas, noting that growth in Part B costs is due to increased use of services - office visits (higher levels billed) and lab and diagnostic tests.

In its letter to the Medicare Payment Advisory Committee explaining the rationale for the reduction, CMS points to five areas that account for most of the 2004 spending growth: longer, more intensive office visits (accounting for 29 percent of overall spending growth [OSG]); more use of minor procedures (26 percent of OSG); more frequent and complex imaging (18 percent of OSG); more laboratory and other tests (11 percent of OSG), and more utilization of prescription drugs in doctors' offices (11 percent of OSG). The letter can be accessed at:
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Congress Considers Bill Regulating Medical Imaging Exams
A bill introduced earlier this month, H.R. 1426, the Consumer Assurance of Radiologic Excellence bill, would direct the U.S. Department of Health and Human Services to establish minimum educational and credentialing standards for personnel who plan and deliver radiation therapy and perform all types of diagnostic imaging procedures except medical ultrasound. States would be required to meet federal minimum standards or risk losing federal reimbursement for imaging procedures. This bill is backed by the Alliance for Quality Medical Imaging and Radiation Therapy, a coalition of 17 radiology technician-related science organizations. Although a similar bill introduced last year was not acted on, it may get more attention this time due to MedPAC's recent recommendation calling on CMS to "establish quality standards for the provision and interpretation of imaging services."  [return to top]

MaineCare Drug Utilization Committee

The MaineCare Drug Utilization Review (DUR) Committee will review drug classes for the annual preferred drug list update on Tuesday and Wednesday, April 12 and 13, 2005 in Conference Room 1A&B, at the Department of Health and Human Services / Bureau of Medical Services offices, 442 Civic Center Drive, Augusta, Maine. These meetings will take place from 1:00 to 9:00 p.m. each day.

The initial drug classes scheduled for Tuesday, April 12, include the treatments for anxiety, depression, schizophrenia, mood disorders and ADHD. The treatments for heart disease, hypertension, pulmonary diseases, gastrointestinal diseases, diabetes and other non-psychiatric drug classes will be considered on Wednesday, April 13, in the order posted on the Goold Health Systems web site at www.ghsinc.com.  As the preliminary PDL is compiled during April through June, a "draft" PDL will be posted and periodically updated on the Goold Health Systems web site. Public comments may be offered at the onset of each meeting. 

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MMA Committee on Peer Review and Quality Improvement Meets
The MMA Committee on Peer Review and QI met on April 5th under the leadership of Krishna Bhatta, MD, Chair and William Strassberg, MD, Vice-Chair.

The Committee reviewed an application for the reinvigorated Office-based Quality Improvement Program and discussed the current program and ways to market the program.

The Committee received updates on several of the various quality-improvement initiatives going on in the state, as follows:

  • Maine Quality Forum: Dennis Shubert, MD
  • Quality Counts: Lisa Letourneau, MD
  • Pathways to Excellence, Jan Wnek, MD

The Committee discussed what the MMA's role should be relative to improving quality, in addition to the office-based QI program and the Association's nearly twenty year old Peer Review Program.

Committee members agreed that because of the convergence of the following trends, MMA members would be receptive to MMA's increased role in improving quality:

  • Emergence of Hospitalists (making the office setting the only place of practice for many primary care physicians)
  • Pay for Performance
  • Federal and State initiatives pushing QI and error-reduction
  • Demand for Increased State Transparency and Accountability
  • Data Initiatives (MHDO, MQF)
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MMA Ad Hoc Committee on Technology Established
MMA has created an Ad Hoc Committee on Technology to examine what the role of MMA should be in assisting its members with the technology imperative which currently exists in health care.

The Committee is chaired by Paul Klainer, MD of Rockland and volunteers are welcome (contact Gordon Smith at gsmith@mainemed.com)

The Committee met for an initial meeting on April 5th to discuss the purpose of the Committee and to review various technology initiatives in the state. These include the Maine Health Information Network (MHINT), the work of the Maine Quality Forum ad several local EMR (Electronic Medical Records) initiatives such as those advanced by Maine Health, Eastern Maine Healthcare, Central Maine Health Care and MaineGeneral.

Gordon Smith described the "Technology Track" at the upcoming Physician Survival Seminars in May and June and reminded Committee members that technology was the theme of the educational programming at the 2004 Annual Session.

The following possible initiatives were discussed as ways to assist MMA members with their technology needs.

  • Offering educational programming, with appropriate vendor participation.
  • Developing a list of reputable EMR vendors doing business in Maine, with emphasis on those that have actually successfully installed and supported a system.
  • Create enhanced offerings from the MMA website, including online surveys and links to EMR resources.
  • Promote technology usergroups in local areas.
  • Develop a portion of the MMA website dedicated to technology issues

The Ad Hoc Committee will continue to meet throughout the year. If you are interested in these issues and would consider participating in the Committee, please contact Gordon Smith or Lauren Mier at gsmith@mainemed.com or lmier@mainemed.com. [return to top]

MMA & BOLIM Reach Compromise on Residency Time for Licensure
 

On Thursday, April 7, 2005, the Joint Standing Committee on Business, Research & Economic Development held a public hearing on L.D. 398, An Act to Make Technical Changes to the Medical Licensure Laws.  While the MMA agreed with most of the bill, the Legislative Committee had some difficulty reaching a consensus position on a section of the bill that would change the required time for residency prior to licensure from 2 years to 3 years for graduates from U.S. medical schools.  Under current law, graduates of foreign medical schools must complete 3 years of residency before licensure, but graduates of osteopathic medical schools must complete only 1 year of residency prior to licensure.  In late March, MMA EVP Gordon Smith met with a group of residents from FMI in Augusta to gauge their reaction to the proposed change in residency requirements.

Prior to the public hearing, MMA EVP Gordon Smith met with Board of Licensure in Medicine (BOLIM) Chair Edward David, M.D., J.D. and Executive Director Randal Manning to discuss the proposed change in residency requirements.  Following the meeting, the MMA and BOLIM officials were able to agree that a graduate of a U.S. medical school could continue to receive a license after 2 years of residency, if he or she has "received an endorsement from the director of a graduate education program in Maine."  A third-year resident from FMI represented the concerns of residents at the public hearing.  The MMA and BOLIM will present final language on the compromise at the work session on L.D. 398.  [return to top]

Room still available for "Topics in Gastroenterology for Primary Care"

The Maine Gastroenterology Society is holding its second annual day-long conference for primary care providers, nurses and anyone interested in issues in Gastroenterology. Talks will focus on Colon Disorders, Pancreatic Cancer and Liver Disorders. The meeting will be Friday April 29, 2005 from 7:30 am - 3:30 pm at the Harraseeket Inn, and has been approved for 6 credits of Category 1 CME. Nursing credits are also available. Please call Chandra Leister to reserve your spot. (207.622.3374, cleister@mainemed.com ).

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HHS Committee Hears CON Bills
 

At a public hearing on Wednesday, April 6, 2005, the Health & Human Services Committee held a public hearing on a series of bills dealing with the CON program in Maine.  Among the bills was L.D. 742, An Act to Postpone the Repeal Date on Nonhospital Expenditures in the Capital Investment Fund, sponsored on behalf of the MMA by Senator Karl Turner (R-Cumberland).  The bill seeks to extend the sunset date on the division in the Capital Investment Fund (CIF) between hospital and non-hospital expenditures by 3 years from 7/1/07 to 7/1/10.  Proponents of the bill were Andrew MacLean for the MMA, Leisa Goodwin for Maine Eye Center, and Christine Burke for the Maine Ambulatory Surgical Center Coalition.  The proponents argued that more than 3 years was necessary to gather the data on which to make an informed decision whether this division in the CIF is necessary to ensure that physician and other non-hospital projects get fair consideration in the CON process.  The Maine Hospital Association opposed the bill.

The Committee also heard the following CON bills:

  • L.D. 16, An Act to Amend the Certificate of Need Process; and
  • L.D. 33, Resolve, Regarding Legislative Review of Chapter 101:  Establishment of the Capital Investment Fund, a Major Substantive Rule of the Governor's Office of Health Policy & Finance.

The MHA supported L.D. 16, a bill intended to speed up CON review, but opposed L.D. 33, the bill seeking final legislative approval of the administrative rule establishing the Capital Investment Fund (CIF), the annual cap on expenditures in the CON program established in the Dirigo Health reform bill. [return to top]

REMINDER: Legislative Committeee Meets Tuesday, April 12th
The MMA Legislative Committee will hold its monthly meeting in-person at the MMA office on Tuesday, April 12, 2005 from 6 p.m. to 8:30 p.m.  The MMA encourages all Legislative Committee members, specialty society legislative chairs, and any interested member to attend.  Please RSVP to Charyl Smith, Legislative Assistant, at csmith@mainemed.com to ensure that we have an accurate head count for food.

Please remember that because of the Legislative Committee meeting, we will have no conference call on Wednesday, April 13th. [return to top]

Rollout: National Provider Identifier (NPI)

The Centers for Medicare & Medicaid Services (CMS) announced last week it has taken an important step in helping health care providers obtain the new standard unique health care provider identification (NPI) with selection of Fox Systems, Inc. as the contractor to perform the support operations for the project. Attached is the press release.

The standard unique identifier for health care providers is mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and will eventually become the primary health care provider identifier for standard transactions.

Additional information on NPIs can be found at http://www.cms.hhs.gov/hipaa/hipaa2/regulations/identifiers/default.asp, by calling the HIPAA Hotline: 1-866-282-0659, or by writing to AskHIPAA@cms.hhs.gov

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Website Compares States' Health Care
Which state ranks highest in giving flu vaccines to the elderly? That would be Minnesota. And which state ranks last in the percentage of women receiving prenatal care in the first three months of pregnancy? Answer: New Mexico.

Such examples represent the federal government's latest effort to improve health care in the United States by making public comparisons.

Last week, the government unveiled a new website comparing the nation's hospitals to each other when it comes to treating patients with cancer or heart problems. Last Mondy, it released data from 2003 showing where states and the District of Columbia rank in 14 categories.

Besides prenatal care and flu vaccines for the elderly, the categories also include the percentage of Medicare patients hospitalized for pneumonia who got the right antibiotics and percentage of nursing home residents who have moderate to severe pain.

www.qualitytotals.ahrq.gov/qualityreport/state [return to top]

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