May 23, 2005

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Medical Liability Legislation Compromised; Cap on Non-Economic Damages Killed
The Legislature's Judiciary Committee on Friday killed all of the pro-tort reform legislation and the opposition bills promoted by the trial bar after hearing presentations by the interested parties indicating that a compromise had been reached. Only the MMA's "I'm sorry" legislation survived. It will be enacted this session.
The MMA, MOA, and MHA supported Coalition for Health Care Access and Liability Reform agreed to the compromise after a series of meetings with legislators and after considering the likely outcome of floor votes.  While all of the Republicans on the Judiciary Committee were supportive of voting a bill with a limit on non-economic damages out of the committee, there were no Democratic votes in the committee for the proposal.  Outside of the Judiciary Committee in the Legislature at large, there were several Democrats who supported the cap and a few Republicans who had announced opposition to a cap.

Furthermore, there was concern that if the cap was even considered by the House and Senate, opposition interests would retaliate by passing one of the bills that would have actually expanded liability or compromised the current confidentiality protections regarding peer review and sentinel event reporting.  In the final analysis, the medical mantra of  "First, do no harm" prevailed and while only modest assistance will be available through enactment of the "I'm sorry" legislation, at least no damage will be done to the existing laws. 

"There was, quite simply, insufficient support for the cap to ensure its passage.  That being the case, it seemed logical to protect our existing laws on the downside," noted MMA EVP Gordon Smith.  "It is disappointing certainly, particularly considering the significant increases in liability premiums soon to be announced, but the votes were just not there," Smith added.

In presenting the compromise to the Judiciary Committee members on Friday afternoon, both Smith and trial lawyer lobbyist Richard Thompson stated that the groups would continue to meet throughout the summer and fall and could bring back to the committee in January any legislative initiatives agreed to by the parties.

The "I'm sorry" legislation protects from discovery in a medical liability case comments made by a defendant indicating remorse following an injury.  It would not, however, make inadmissible an admission of fault.  A recent report by the Maine Bureau of Insurance indicated that such legislation would have a positive impact on liability premiums via a reduction in total claim costs of 3.5% to 5.9%.

The Coalition for Health Care Access and Liability Reform will continue its efforts to educate legislators and the public about Maine's medical liability climate.  If you would like to be more involved in the Coalition and its activities, please contact Gordon Smith at, Lee Thibodeau, M.D. at, or Hector Tarraza, M.D. at

Pay for Performance, Quality Improvement and MaineCare Lead Topics at 14th Annual Physician Survival Seminar
Over 50 practice managers and physicians attended last week's 14th Annual Physician Survival Seminar in Portland last week.  The same program will be held in Bangor on Wednesday, June 8 and space is still available for the program.  Contact Chandra Leister at 622-3374 or via e-mail to if you would like to register.

In addition to plenary sessions in the morning, the program features three tracks of breakout sessions in the afternoon focusing on technology, compliance and practice management.  The annual education program, which has 7 and one-half hours of CME available for physicians, gives MMA an opportunity in one setting to share with practices the latest information on topics of relevance to running a medical practice today.  MMA realizes that the operation of a medical practice today is both complex and expensive.  It is our intention in this program to give practices the information necessary to operate a practice in Maine more efficiently and in full compliance with the myriad laws and regulations now in effect. [return to top]

Prescription Monitoring Program Issues Second Round of Threshold Reports
The state's new Prescription Monitoring Program (PMP) issued its second round of threshold reports last week.  1118 prescribers were sent a report that included at least one patient who had failed the threshold screen.  In the first round of reports, 1283 reports had been sent out.  The same thresholds were used for the second round of reports.

As of last week, 128 physicians had registered with the program to be able to request PMP data (as opposed to simply waiting to receive the quarterly reports.)  If you would like to register and haven't yet done so, contact Chris at

Chris Baumgartner, who directs the Program for the state, will present a breakout session on the Program at the Physician Survival Program in Bangor on June 8th. (See related article on Seminar in this newsletter.)

The PMP is one of several initiatives undertaken by the state to respond to the state's epidemic of drug abuse, a significant percentage of which involves prescription drugs. [return to top]

MMA Nominations Committee Meets; Volunteer to Serve Your Association
The MMA Committee on Nominations, chaired by President-elect Jacob Gerritsen, M.D., met recently to begin its process of nominating committee members and officers for MMA for the coming year.  The elections take place at the 152nd Annual Session in Bar Harbor on Sept. 9-11.

The Committee is seeking volunteers for all MMA Committees and positions.  If you would like to serve MMA in any capacity, please let Dr. Gerritsen know at

Positions are available on all of the following committees:

  • Committee on Membership and Member Benefits
  •  Budget and Investment Committee
  • Committee on Quality Improvement and Peer Review
  • Payor Liaison Committee
  • Committee on Constitution and Bylaws
  • Legislative Committee
  • Public Health Committee
  • ad hoc Committee on Technology
  • Committee on CME and Accreditation
  • Committee on Nominations

Other positions can be sought, regardless of whether the positions are currently filled.  MMA has term-limits for most positions and needs to develop new leadership on a regular basis if it is to thrive.  We know that your time is limited, and that you have many competing interests, but if you have any interest in MMA and would like to serve, we would love to have you.

Committee on Nominations: Drs. Gerritsen, Mutty and Gleaton [return to top]

Important Meeting on MaineCare Fee Increase Wednesday, May 25, 4:00pm
On this coming Wednesday, May 25, the Bureau of Medical Services will host a meeting at 4:00pm to discuss the MaineCare physician fee increase.  The $8.3 million increase will be available at the beginning of the state's fiscal year on July 1, 2005 and the Bureau wants to update the fee schedule with the increase ASAP.  The purpose of Wednesday's meeting is to allow specialty society leaders to preview the work already done by the Bureau on the increase and to offer comments.

At a preliminary meeting this week with representative of MMA, MOA and the Maine Academy of Family Physicians, Bureau Medical Director Laureen Biczak, D.O. presented some preliminary figures which will be further refined for Wednesday's meeting.  At first blush, it appears that there are sufficient funds to increase all codes to a minimum of 53% of Medicare without decreasing any current payments.

The meeting will be held at the DHHS office on Civic Center Drive in Augusta.  Physicians can also call into the meeting by calling 1-888-727-6732 and using the passcode 810486.

As this is a planning meeting, it is designed for specialty society leaders.  Others interested will be updated through MMA and MOA or their specialty society. [return to top]

MMA Fees Increase for Contract Analysis and Medical Staff Bylaws Work
For several years MMA staff has provided a contract review service, analyzing employment contracts and managed care agreements for members.  As the fees have not changed for many years, we have found it necessary to increase the fees for this type of work, effective immediately.  The new fees will be $250 for review of a contract and a minimum of $2,000 for bylaws reviews.  The medical staff bylaws review is generally done to review compliance with the new state regulations and to draft bylaw amendments which bring the current documents into compliance.

MMA regrets these increases but believe members will still find the fees to be very competitive.  We don't wish to discourage members from utilizing the service, as we believe it is one of the many valuable services that MMA provides. [return to top]

Governor's Bill on Dirigo Hospital Study Commission Proposals Printed
Last week, the Legislature received L.D. 1673, An Act to Implement the Recommendations of the Commission to Study Maine's Community Hospitals.  The bill has been scheduled for a public hearing in the HHS Committee on Tuesday, May 31, 2005 at 1 p.m.  The bill includes the following provisions:

  • It amends the Hospital Cooperation Act to include other health care providers and to make it easier for health care providers to collaborate by reducing antitrust concerns.
  • It requires hospitals to submit to the MHDO their annual financial information using electronic standardized accounting template software.
  • It continues voluntary financial targets for hospitals.
  • It directs the MHA and the Governor's Office of Health Policy & Finance to agree by January 1, 2006 on a timetable, format, and methodology for the hospital association to measure and report on outpatient cost-efficiency.  The methodology must use the ambulatory payment classification system as the unit of cost.
  • It requests that the MHA develop, by January 1, 2006, standardized definitions of various administrative cost categories that hospitals may use when establishing budgets and reporting spending on administrative costs.
  • It instructs the GOHPF to convene a health care administrative streamlining work group to facilitate the creation and implementation of a single portal through which hospitals can access and transmit member eligibility, benefit, and claims information from multiple insurers.  This section includes a required report to the HHS & IFS Committees by November 1, 2006.
  • It instructs the DHHS to review the existing hearing process provided in the CON laws to determine whether that process ensures that the Commissioner of HHS has all the information needed to make a fair and accurate determination of whether each project proposed for certification meets the needs of Maine citizens.  It also requires DHHS to review and make recommendations on the CON program's staffing needs and fee structure.  The Department must report to the HHS Committee on both topics by January 1, 2006.
[return to top]

Legislature Receives Bill to Continue DHHS Transition
On Wednesday, May 18, 2005, the HHS Committee held a public hearing on L.D. 1642, An Act to Further the Transition to the New Department of Health & Human Services.  The bill describes the following structure for the new department resulting from the merger of the former DHS and DBDS:

The Department of Health & Human Services includes the following units:

1.  The Health, Integrated Access and Strategy Unit, which includes:

  • The Office of MaineCare Services;
  • The Maine Center for Disease Control and Prevention, which includes minority health services; and
  • The Office of Integrated Access and Support.

2.  The Operations and Support Unit

3.  The Finance unit, which includes:

  • The Office of Budget Planning and Analysis;
  • The Office of Audit for MaineCare and Social Services; and
  • The Office of Accounting and Cash Management.

4.  The Integrated Services Unit, which includes:

  • The Office of Adult Mental Health Services;
  • The Office of Adults with Cognitive and Physical Disability Services;
  • The Office of Advocacy Services;
  • The Office of Child and Family Services;
  • The Office of Elder Services;
  • The State Forensic Service;
  • The Office of Substance Abuse Services; and
  • The Office of Integrated Services Quality Improvement.

You can read the Administration's press release on the new DHHS structure on the web at: [return to top]

DHHS Proposes Amendments to MaineCare Physician Services Rule
The DHHS, Bureau of Medical Services recently has proposed amendments to the MaineCare Benefits Manual, Chapter II, Section 90, Physician Services.  The BMS summary of the rule follows:

The Department proposes to require that physicians and their servicing providers performing services also covered under other Sections of MaineCare policy, such as chiropractic care, occupational therapy, physical therapy, and speech therapy, must meet requirements as specified in those sections.  The Department has also added language instructing physicians how to document rehabilitation potential, an eligibility requirement for some services for adults.  The Department proposes to remove psychological services from covered services; while physicians may still counsel members regarding specific health concerns, this section is not intended to cover long-term psychotherapy services that are routinely offered by mental health providers.  The Department has also added prior authorization criteria for some procedures.  The proposed rules clarify that physicians may not bill members or other providers for documentation fees for completion of paperwork required to complete prior authorization, or for documentation of rehabilitation potential, medical necessity, or other required services.  The Department has also proposed other updates, such as requiring use of standardized industry-wide Common Procedure Code (CPT) codes and modifiers. 

You can find the rulemaking notice and the proposed amendments to the rule on the BMS web site at:

The Bureau has scheduled a public hearing on the proposed rule amendments for Wednesday, June 8, 2005 at 1 p.m. at the BMS Office, 442 Civic Center Drive, Augusta, Maine 04333-0011.  Written comments must be received by midnight on June 19, 2005.  You may submit written comments on the BMS web site listed above. 

If you would like your comments included in the MMA's comments, please contact Andrew MacLean, Vice President & General Counsel, at or 622-3374. [return to top]

"Part II" Biennial Budget Printed; Hearings Scheduled this Week
Last week, the Governor's proposed "Part II" budget for the 2006-2007 biennium was printed as L.D. 1677.  As described in last week's Political Pulse, the Governor proposes to fill the gap created by the change in the federal Medicaid match rate in 3 principal ways:

  • Achieving an additional $20 million in General Fund savings ($8.1 million in SFY 06 and $12.5 million in SFY 07) in the MaineCare drug budget by "establishing a modified drug formulary in the Medicaid program."  This concerns the MMA since we and other advocates have worked hard during the last several years to stabilize the current PDL/PA process.  Last week, the HHS Committee recommended passage of L.D. 1404, An Act to Increase the Quality of Care and Reduce Administrative Burdens in the Pharmacy Prior Approval Process, a bill to implement some of the recommendations of the MaineCare Advisory Committee subcommittee on the drug management program.
  • Reducing the money available for hospital PIPs and settlements.  The MHA projects a $341 million payment shortfall to hospitals as a result of this budget.  You can find the MHA's perspective on the budget on the web at:
  • Proceeding with a plan to achieve further savings in the MHMR budget by instituting certain managed care cost containment mechanisms.

The Appropriations and HHS Committees will hold a public hearing on the DHHS portions of this budget on Tuesday, May 24, 2005 beginning at 11 a.m. in the Appropriations Committee room, Room 228 of the State House. [return to top]

Meeting on MaineCare Fee Increase, Wednesday, May 25, 4:00 pm at DHHS Office
There will be an important meeting this coming Wednesday to discuss the distribution of the MaineCare physician fee increase.  The additional $8.3 million in funds will be available on July 1, 2005 and the Bureau of Medical Services wishes to increase the fees ASAP, but needs input into the methodology.

At a preliminary meeting attended this past week by MMA, MOA and the Maine Academy of Family Physicians, MaineCare officials shared preliminary data showing how the increase could be applied in a way that would increase all MaineCare fees to 54% of Medicare, with no current payments being reduced.  Laureen Biczak, D.O., Medical Director for MaineCare is the person primarily responsible for determining how the funds will be allocated.

While the Bureauís work to date is a good start, the impact by specialty varies greatly and the Bureau wishes to give each specialty an opportunity to comment on its proposal.

I apologize for the short notice but this is how things operate in Augusta.

If you canít attend the meeting in person, you may call into the following number and participate by phone.

1-888-727-6732 passcode:  81048

I will send out a summary of the results of the meeting to those unable to attend.  If you have any questions about any of this, donít hesitate to give me a call at 622-3374.

[return to top]

MECMS Update May 18, 2005
System and Interim payments:

System Payments

Claims paid on 05/06/05

Claims paid on 05/13/05

# providers paid through MFASIS



# claims processed in MECMS



# claims sent to MFASIS for payment



amount paid through MFASIS



claims paid as percent of processed



Note:Claims processed in the system are released for payment by EFT on Friday and checks are mailed on the following Monday.Claims processed for payment through MECMS and sent to MFASIS average 1.4% higher than actually paid.This results in an average 0.7% inflation of ďclaims paid as a percentage of processed.ĒClaims processed and paid through the system include both new claims and suspended claims which were recycled and paid.

Interim payments

Payments for 05/09/05

Payments for 05/17/05

# providers paid interim payment



amount paid interim



Note:Interim payments are released for payment by EFT on Tuesday and checks mailed on Wednesday.The interim payment for 05/17/05 was higher due to the addition of school districts who had not been receiving an interim payment.

Stabilization metrics

CNSI Responsibility

System defects resolved.Resolve the March 15thbaselined defect list.Provide adequate resource contingency to resolve additional emergency defects within the constraints of the contingency period.Emergency defects are defined as:

1)A defect that prevents the system (MECMS) from processing claims; i.e., system, database or network failure.

2)A functional defect for which no workaround exists that results in over 5% of total claims processing improperly (or claims processing of a critical provider group(s) as determined by the Steering Committee)

3)A defect that compromises the ability to meet state or federal financial/audit requirements.

Status:Over 65% (up 15% over the last two weeks) of the emergency baselined defect list is implemented or in final test.A number of additional defects in the system have been identified since the list was baselined.Work on defects continues daily.

State Owner Responsibility

Data cleanup. Resolve major provider file and permissions matrix issues within 30 days including a process to make ongoing updates within 5 days.

Status:Deloitte has issued their report on the permission matrix and has validated the changes identified by DHHS are required following testing.Testing has commenced and the changes should be implemented by June 1st resulting in payments for claims held in the system for fund allocation.The process changes defined by Deloitte to implement future permission matrix changes will be followed by DHHS.

CNSI/State Shared Responsibility

Suspended Claims.Reduce suspended claims in the system to under 40,000 through updates to billing instructions, outreach to providers, system data improvements, and correction of system defects.

Status: As reported on May 5th the suspended claims rate and volume are stabilizing.As a result of additional emphasis in this area, the suspended claim count was temporarily reduced by nearly 20% to under 300,000 by recycling the claims through corrected software. Most of the reduction was from the denial of duplicate claims and corrected pricing logic. Much of this reduction has been eroded by new claims processed in the system. The team is working to a weekly plan for implementation of prioritized system corrections to reduce and sustain suspended claims reductions.

Paid claims volume.Increase paid claims volume through resolution of system defects, reduction of suspended claims, and data clean-up.Increase paid claims volume to 60% of processed claims.

Status:Processed claims are now paying at approximately 55%.This represents a 5% increase since the last update.

Other IT Points

System Operations Transfer.A plan is developed for the transfer of MECMS operations from CNSI to state staff.This will be a staggered transition throughout the remaining effort to fully implement the system.Added state IT staff positions have been identified to support the transfer and the recruitment process to fill the positions is underway.

Enhanced Voice Response System.The voice response system used by providers for MaineCare eligibility and claim status will be enhanced on June 13th.The system will extract eligibility information directly from MECMS and provide more detail on payment status for a claim.

Telephone System update

For the weeks ending May 6th the Public Consulting group (PCG) Inquiry Unit received approximately 2,129 calls.BMS Inquiry during the same time period received approximately 1,486 calls from providers. For the week ending May 13th PCG Inquiry received 1,273 calls and transferred 217 to BMS Inquiry.BMS Inquiry during the same time period received approximately 1,185 calls from providers.Call volume in the last week dropped dramatically from a call volume of 723 calls a day down to 492 calls a day.

Through our daily and weekly analysis of the telephone calls it has helped internally target areas that providers are having difficulty with, and to ensure the staff is trained to address those issues.Through the Governorís Advisory Commissionís and the Departmentís Technical Committeeís outreach we now have providers sitting down with the Departmentís Financial and Computer personnel to work on specific problems with the payments and the remittances.In addition individual providers have volunteered to assist in testing aspects of the system.

Since our last report we have begun the recoupment process which is being run outside of the normal call centers.The Department informed the provider community through the Governorís Advisory Commission, the Technical Advisory Group, the Departmentís List Serve, and emails to the Associations and a letter to each provider part of the initial recoupment process.The recoupment call center began receiving calls on May 13th.The staff has been trained to answer providersí questions, ask for documentation to demonstrate why the provider should be exempted from recoupment or have a lower amount recouped.The providers have until May 18th at 5:00 pm to ask for reconsideration and document the reasons why they should be exempted.Pending your questions, this concludes my update.

  [return to top]

MHINT Interconnectivity Project Begins Phase II
The Maine Health Information Network Technology (MHINT) Steering Committee* has announced that it has begun the Phase II Planning and Development process necessary to establish a statewide interconnected clinical information sharing system for Maine.
In recent weeks the Maine Health Access Foundation, the Maine Quality Forum and Maine Bureau of Health have provided additional funding to allow Phase II to begin. This current support will allow the MHINT project to proceed through mid-October. The Steering Committee is actively pursuing additional funding to complete a full 12-month Phase II process required to lay the essential foundation for the sharing of clinical data.
The planning and development process will be led by the Maine Health Information Center (MHIC), which conducted the Phase I feasibility study in the fall and early winter of 2004.
Based on input from a wide range of providers, government officials, insurers and others during MHINT Phase I Feasibility Study, the Steering Committee has identified key questions that will be answered early in Phase II. These include:

  • What is the preferred technical model for a statewide system?
  • If implementation begins among a small group of providers, possibly as early the winter of 2006-2007­what form will this initial clinical information sharing take and how will it be funded?
  • Who will provide the statewide leadership and coordinating as we move the project through planning stages toward implementation?
  • How will implementation be funded?
  • How can we engage consumers so the MHINT can adequately address concerns regarding privacy and security?
  • How will Maine's system fit into the emerging national health information infrastructure?

The Steering Committee is deeply committed to continuing an inclusive process aimed at engaging providers, payers, consumers, government agencies, employers and others in addressing these and other questions.

Joining the MHINT Technical Planning Team for Phase II will be Jerry Edson, who has just retired after a long and distinguished career as CIO at Maine Medical Center. Former MHIC President Alice Chapin, who served as a network consultant in Phase I, has been named MHINT Project Coordinator.

Phase II plans call for quickly assembling key clinical and IT leaders to address the many technical issues that need to be resolved. The leadership of consumer groups also will be convened early in Phase II. In mid-June a group of stakeholders from across the state at the Hanley Leadership Forum at Bowdoin College to begin the process of developing an implementation plan and discuss system governance, financing, consumer engagement and other important elements of the MHINT project.

The MHINT Phase I feasibility study found that there is now rapid growth taking place across the state in health IT systems, including electronic medical records. However, the study verified that this development is occurring independently at the local and hospital-system levels. Until the MHINT project began, little has been done to explore how patient-specific clinical data can be quickly and efficiently shared with providers outside the local community or across systems and state lines. Before the MHINT project began, there was no mechanism in place to monitor and coordinate any collaboration among these traditional institutional silos of patient medical record information.

Through the MHINT process, steps are now being taken to ensure that patient level medical information can be electronically shared across systems in a way that will ensure the protection of privacy and allow clinicians and patients timely access to the most accurate medical information available.

The clinical information sharing infrastructure now under consideration would involve building a system that would allow for the secure and immediate point-of-care sharing of key patient-specific clinical information to:

  • improve patient safety
  • improve quality of care
  • reduce duplication of services and increase efficiency and decrease cost
  • allow connectivity with emerging health care provider and public health IT infrastructure; and
  • provide consumers with access to their personal health information.

A series of advisory committee and work group meetings took place in October through December of 2004. Health care CEOs, physicians and IT leaders took part in a process aimed at developing a unified clinical information sharing "vision" for the state and a list of criteria that can be used in assessing technology solutions that might be considered for Maine.

Wendy Wolf, MD, MPH
Executive Director
Maine Health Access Foundation

Dennis Shubert, M.D.,Ph.D.
Maine Quality Forum

Paul Kuehnert, R.N., MS.
Acting Deputy Director
Maine Bureau of Health

Karynlee Harrington
Executive Director
Dirigo Health

Jim Harnar
Maine Health Information Center

To Learn more about MHINT and review the Phase I report , pleaes visit or  contact Alice Chapin at or Jim Harnar at [return to top]

Bill to Fix Medicare Physician Payment Formula Introduced in U.S. Senate
In last week's Maine Medicine Weekly Update, the MMA notified you that H.R. 2356, a bill to fix the Medicare physician payment formula, was introduced in the U.S. House.  On Thursday, May 19, 2005, Senators Jon Kyl (R-AZ), Jim Talent (R-MO), & Debbie Stabenow (D-MI) introduced a companion bill in the U.S. Senate.  The Preserving Patient Access to Physicians Act of 2005 (S. 1081) provides for a 2-year fix of the impending Medicare physician payment cuts by requiring positive payment updates of 2.7% in 2006 and an estimated 2.6% in 2007.

Please contact Senators Snowe & Collins to encourage them to co-sponsor the bill.

Senator Olympia J. Snowe:; 202-224-5344

Senator Susan M. Collins:; 202-224-2523

You can find more information about the Medicare physician payment issue on the AMA web site at:

  [return to top]

CMS releases information on National Provider Identifier
The Centers for Medicare and Medicaid Services (CMS) will begin enumeration for the National Provider Identifier (NPI) on May 23.  The NPI is the standard unique health identifier that must be used by covered entities under HIPAA to identify health care providers in standard transactions such as claims, referrals and remittance advices.  The NPI must be used in standard electronic health care transactions and will replace different provider identifiers under various health plans.  Transitioning to the NPI will begin this year and must be used on all standard transactions no later than May 23, 2007.  CMS has issued a "Dear Health Care Provider" letter that describes how to obtain an NPI;  to access his letter and links to additional information and application materials:  (Acrobat Reader required) [return to top]

The Health and Human Service Secretary says the use of health information technology should be an an urgent priority
On May 11, Health and Human Services Secretary Mike Leavitt issued a new report citing investment in information technology (IT) as   an essential, high priority for the American health care system and the U.S. economy.  The report  discusses the burden of rising health care costs and the role of health IT in managing these costs.  Among the report's six conclusions, which are to  guide health IT adoption by the federal government and the private sector are that the potential benefits of health IT far outweigh manageable costs and that stakeholder incentives must be aligned to foster health IT adoption.  The report is part of President Bush's national goals of assuring that most Americans have electronic health records within 10 years and developing a national Health Information Infrastructure. [return to top]

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