April 25, 2005

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MaineCare Claims Management System Transition Work Continues
Governor Baldacci creates MaineCare Provider Advisory Group to help improve the MECMS implementation and to recommend improvements to the Bureau of Medical Services' provider relations efforts.

On Thursday, April 21, 2005, the MMA joined other provider organizations at the first meeting of a new MaineCare Provider Advisory Group convened by Governor Baldacci.  The two tasks assigned to the group are:

  • To participate in improving the Bureau of Medical Services' implementation of its new claims management system; and
  • To consider and recommend improvements to provider relations with the Bureau of Medical Services.

The group includes the principal health care trade associations in the state and four legislators.  The legislative members are Senator Arthur Mayo (D-Sagadahoc), Senate Chair of the HHS Committee, Senator Richard Rosen (R-Penobscot), the lead Senate Republican on the HHS Committee, Representative Kevin Glynn (R-South Portland), a member of the HHS & IFS Committees, and Representative Arthur Lerman (D-Augusta), a member of the Appropriations Committee with a strong interest in the MECMS conversion issues.

Representing the Administration at the meeting were DHHS Commissioner Jack Nicholas, Bureau of Medical Services Acting Director Chris Gianopoulos, Pat Damon from the Department of Administration & Financial Services, and Pat Ende, Senior Policy Advisor in the Governor's Office.

At the first meeting, the Administration representatives provided some history about the MECMS conversion process and described the following "next steps:"

1.  Near term (30-45 days)

  • Stabilization and consistency of message to process stakeholders
  • Improve quality of data in the system and reduce system errors
  • Ensure consistent messaging to the various participants
  • Perform integrating and fine tuning of business processes and system events

2.  Short term (30-75 days)

  • Integration of pharmacy and medical claim remittance advices (RAs)
  • HIPAA testing and migration
  • Provider portal:  online status checks, online review and management of areas such as PA, provider data, etc., and online claims submission

3.  Other subsystems (60-120 days)

  • Implement decision support system
  • Implement other components such as drug rebate, SURS, security

The Administration officials reported that the percentage of claims paid through the new system now is 30-50% depending on the provider category.  The Department and its new consultant, Xwave, have met their goal to clear the claims backlog by the end of April.  They hope to clear the suspended claims by mid-May and to correct the "baseline defects" by mid-June.  Also, they reported that they have contracted with Deloitte-Touche to advise the Department on how to handle the reconciliation process that will be necessary after the interim payments.  The interim payments are based upon your average weekly payments for October and November 2004.

You can find current information about the MECMS implementation process on the BMS web site at:  http://www.maine.gov/dhhs/bms/innerthird/mecms_home_page.htm.

Christine Bruenn Named DPFR Commissioner
On Friday, April 22, 2005, Governor Baldacci named Christine A. Bruenn, currently the state securities regulator, to be the Commissioner of the Department of Professional & Financial Regulation (DPFR).  This department contains the state regulatory agencies for insurance, banking, securities, and consumer credit as well as the professional licensing boards.  Ms. Bruenn, a lawyer, is married to psychiatrist Bogan Brooks, M.D.

You can read the Governor's press release on the appointment on the web at:  http://www.maine.gov/tools/whatsnew/index.php?topic=Portal+News&id=6580&v=article-2004. [return to top]

Federal Budget Still Stalled Over Medicaid Cuts
This week will be a critical one in the budget negotiations between the U.S. House and Senate as they hope to consider a conference report before the Senate departs for a one-week recess on April 29.  The principal obstacle in the negotiations continues to be restraints in the growth of entitlement programs - reductions that would have a significant impact on the health care system.

Last month, Senator Gordon H. Smith (R-OR) succeeded in a 52-48 floor vote to remove $15 billion in cuts over 5 years from health and social welfare programs and to establish a commission to consider entitlement spending in the future.  Both Senator Snowe and Senator Collins voted for the Smith amendment.  The current debate about this commission is the composition of the commission and who has the authority to appoint members to it - the President or the Legislature.

Before the floor amendment by Senator Smith, the budget resolution would have directed the Senate Finance Committee to cut $15 billion over 5 years from its programs with $14 billion coming from Medicaid.  The House version would direct the House Energy & Commerce Committee to cut $20 billion over 5 years.  At this point, the Senate has focused on $12 billion as the upper limit for Medicaid cuts, while the House has established no limit.

The latest press accounts of the budget negotiations indicate that House and Senate negotiators may be nearing an agreement including as much as $8 billion in Medicaid cuts over 5 years.  Maine's health care system cannot sustain Medicaid cuts of this magnitude.  PLEASE CONTACT SENATOR SNOWE & SENATOR COLLINS TO URGE THEM NOT TO SUPPORT THESE MEDICAID CUTS IN THE CURRENT BUDGET RESOLUTION!

Senator Snowe:  202-224-5344; olympia@snowe.senate.gov

Senator Collins:  202-224-2523; senator@collins.senate.gov [return to top]

"First Friday" Seminar Series to begin on May 6
The first program will be held on Friday, May 6 and the topic will be Preventing Prescription Drug Diversion.  Speakers include Roy McKinney, Director of the Maine Drug Enforcement Agency, Chris Baumgartner of the Office of Substance Abuse, and MMA EVP Gordon Smith.  Roy will give an update on activities around the state, Chris will describe the new Prescription Drug Monitoring Program, and Gordon will offer practical tips on preventing diversion.  One additional speaker will be announced.  The program will be held from 9:00 am to noon at the MMA office and the cost is $60.00 which includes a light breakfast and course materials.

Registration materials were included in the Maine Medicine and can be obtained by contacting Chandra Leister at 622-3374 or via e-mail to cleister@mainemed.com. [return to top]

ACEP Members Hear Key Lawmakers Support Fixing Medicare SGR
During the recent American College of Emergency Physicians 2005 Leadership and Advocacy Conference, attendees heard from Rep. Nancy Johnson (R-CT), Chair of the House Ways & Means Subcommittee on Health, and from Sen. Jeff Bingaman (D-NM), a member of the Senate Finance Committee, who expressed their support for preventing the 4.3% cut in Medicare payment rates scheduled to go into effect on January 1, 2006 and to replace the sustainable growth rate (SGR) with a payment system that reflects the increasing costs of physician care for Medicare beneficiaries.

The AMA estimates the following impact on Maine from the current Medicare payment formula:

  • From 2006-2014, Medicare payments in Maine will be cut by $570 million;
  • For Maine physicians, the cuts over this period will average $15,000 per year for each physician in the state;
  • The first of the 6 annual Medicare pay cuts is slated to occur on January 1, 2006.  Medicare physician payment rates in Maine will be cut by $12 million in 2006.

Unfortunately, the price tag for the SGR fix is high.  In late March, the Congressional Budget Office estimated that it could cost $154.5 billion over 10 years to eliminate the SGR and replace it with the Medicare Economic Index (MEI).

You can find more background and talking points on the Medicare payment issue on the AMA in Washington web site:  http://www.ama-assn.org/ama/pub/category/6583.html. [return to top]

Payor Liaison Committee to hear from David Howes, MD
The MMA's Payor Liaison Committee, chaired by Thomas Hayward, M.D., will hold its next meeting on Wednesday night, April 27 at 6:30 pm.  The program will feature a presentation by David Howes, M.D., President of Martin's Point Health Care.

Any MMA member wishing to attend may do so by calling Chandra Leister at 622-3374 or via e-mail to cleister@mainemed.com.  Dinner will be available beginning at 6:15 p.m. and the meeting will be at the Frank O. Stred Building in Manchester. [return to top] [return to top]

Survey Says HIPAA Privacy Rule Compliance is High, Security Rule Lags
On April 18, 2005, the American Health Information Management Association released a survey entitled, The State of HIPAA Privacy and Security Compliance April 2005.  Most of the survey respondents were from hospitals or health systems so it reflects the resources of larger organizations.  91% of the 1140 respondents claimed to be at least 85% with the privacy rule, up from 23% a year ago.  Only 17% claimed to be completely compliant with the security rule, although the survey took place before the April 20, 2005 compliance date.

Respondents cited the most difficulty with compliance efforts in the following areas:

  • accounting for disclosures;
  • access and release of information to law enforcement;
  • access and release of information to relatives or patients' significant others;
  • release of information for research protocols;
  • access and release of information for subpoenas versus court orders; and
  • business associate agreements.

They cited access and tracking access as the biggest issues in complying with the security rule.

You can find the report on the web at:  http://www.ahima.org/marketing/email_images/2005PrivacySecurity.pdf.

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Survey Suggests Further Growth of Pay-for-Performance Programs
On April 19, 2005, Med-Vantage, a health information company in San Francisco, and business consulting firm ViPS announced the results of a survey of pay-for-performance (P4P) programs around the country.  The survey noted the following growth trend:

  • March 2005:  104 P4P programs
  • March 2004:  84 P4P programs
  • March 2003:  39 P4P programs

The survey results indicate that there may be as many as 160 P4P programs by 2006.  The survey found that the major reason for P4P programs is improvement of clinical outcomes and the biggest problem for the programs is concern about statistical and data results when patient numbers are small.  The survey included responses from 50 of 84 P4P program sponsors.

You can find an executive summary of the survey on the web at:  http://www.medvantageinc.com/Pdf/MV_2004_P4P_National_Study_Results-Exec_Summary.pdf.


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Golf Tournament to be held June 6, 2005
The 2nd Annual Maine Medical Association Charitable Golf Tournament will be held on Monday, June 6, 2005 at the Augusta Country Club.  A four person scramble will begin at noon, and an awards reception with a raffle will take place immediately following.

Registration flyers were included in the most recent edition of the Maine Medicine.  Please contact Chandra Leister (207-622-3374 cleister@mainemed.com) with any questions.  Hole Sponsorships also are available. [return to top]

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