June 13, 2005

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Timing of MaineCare Physician Fee Increase at Risk
MMA staff has monitored the actions of the Appropriations Committee all weekend to advocate for protection of the provision in the Part 1 budget, which provided state funds to seed an $8.5 million increase in physicians' fees paid by MaineCare. Unfortunately, the fee increase showed up unexpectedly on a list of proposed cuts being proposed by the Committee as it attempts to find savings of some $250 million.
Over the weekend, the Appropriations Committee considered a proposed list of savings as part of an alternative to more than $400 million in borrowing in the Part 1 biennial budget for 2006-2007.  One item on the list was a proposal to delay the $3 million seed for the $8.5 million MaineCare physician fee increase until the second year of the biennium - meaning it would become effective 7/1/-6 instead of 7/1/05.

MMA General Counsel and Lobbyist Andrew MacLean was able to present to the Committee on Friday evening the Association's strong opposition to any delay in the fee increase which was already long overdue.  Gordon Smith was given an opportunity to speak to the Committee on Saturday morning and again reiterated MMA's dismay with the suggestion of a delay.  Mr. Smith noted that for many years physicians had remained in the MaineCare program with no increase.  He also stated that many practices had already been presented with the figures for the increase, as the tentative plan for distribution had been distributed by the Bureau of Medical Services.  Both Andy and Gordon also noted that the increases would be barely enough to even pay for the additional costs to practices made necessary by the failure of the new claims management system (MECMS).

At one point during the weekend, it also looked as if the Committee might leave the fee increase alone, but take funds from the hospital-owned "provider-based" practices to help pay for it.  Both MHA and MMA opposed this approach, as it is inconsistent with the agreement made two years ago which established a working group to look at the impact of the conversions to "provider-based" practices and which required such practices to accept MaineCare patients in exchange for receiving the higher reimbursement.

Late Sunday night, the Committee took tentative votes ensuring that the fee increase would not be delayed and that the funds would not come by reducing fees paid to the "provider-based" practices.  This was very good news delivered around 11:00pm Sunday.

While the situation looks much better now than it did the end of last week, it is by no means certain that the Republicans and Democrats will actually agree on the final elements of the budget revisions.  Therefore, it is important to continue our vigilance and for Maine physicians and their staffs to continue to discuss with legislators the needs for making the increase available as soon as possible.  Thirty years is enough!


More on Medical Mutual Proposed Rate Increase
As noted previously, Medical Mutual Insurance Company of Maine recently filed for a request for a physician rate increase with the Maine Bureau of Insurance.  The average increase is 25% and the target effective date is Oct. 1, 2005.

In a letter sent to its insured physicians dated June 8, 2005, Medical Mutual Board Chairman William Medd, M.D. described in some detail the basis for the request and urged physicians to contact the company or their insurance broker if they had questions.

Medical Mutual is, by far, the largest carrier of professional liability insurance for physicians and hospitals in the state, with nearly 2500 physicians, 23 hospitals, 59 nursing homes and nearly 700 mid-level providers.  In 2004, its combined loss ratio was 147%, meaning that $1.47 was paid out for each dollar collected.  Insurance rating agency A.M.Best also downgraded the company from A - to B++.   While most of the country's physician mutual companies have similar ratings, certainly the downgrading is of concern and the company needs to collect a sufficient amount of premium to pay claims in the future. 

As Dr. Medd noted in his letter, Maine is not insulated from the extreme volatility that presently plagues the medical professional liability insurance industry.  The severity of claims is growing, although the frequency of claims has been flat over the last few years.

As a mutual (member-owned) company, Medical Mutual pays dividends back to insureds when actual losses fall short of actuarial expectations.  Over the years, over $15 million has been paid in dividends.  Hopefully, the climate can improve and dividends can resume in the future.  For the time being, the situation is difficult and with the legislature refusing to enact significant tort reform to respond to the problem, the problem is likely to get worse before it gets better.

In the proposed filing, some specialties with considerable loss experience, such as emergency medicine, urology, radiology and internal medicine will see increases of 79.9%, 45.9%, 41.4% and 40.5% respectively. The minimum increase for any specialty will be 10.2%.  As the proposed rates are considered confidential until effective Oct. 1, 2005, insureds wishing to know their individual rates should call the company or consult with their insurance broker.  Individual rates may also differ because of the availability of loss-free and longevity discounts.

The Maine Medical Association endorses Medical Mutual as the provider of choice for medical liability insurance in Maine.  The Association was instrumental in the creation of the company in l978.  The company has a 27 year track record of continuous, uninterrupted service to Maine's healthcare community.  While commercial companies have come and gone, Medical Mutual has persevered and provided Maine's physician and hospitals with solid risk management expertise and claims management and defense. We have every expectation that this high level of service will continue for many years into the future.  Should any MMA member have a question about the filing, we recommend calling the company or your insurance broker.

The Bureau of Insurance is likely to examine the filing closely, given the legislative debate on the topic of medical liability  generally.   It has been nearly 20 years since a med mal rate filing has been contested by any party. [return to top]

MECMS Update - System Still Not Performing Well
It has been nine weeks since the recovery team of DHHS and the Department of Administrative and Financial Services began a renewed effort to stabilize and improve the claims payment process, the MECMS program and the provider response system.   While significant work has been completed, much remains to be done.

A report dated June 2, 2005 from Richard B. Thompson, CIO for the state, to the Joint Standing Committee on Health and Human Services, makes the following points:

  • True stabilization, while anticipated at mid-June, will not be achieved by that date.  The resources necessary, particularly from the State side, are not available, but DHHS is identifying staff to augment existing BMS personnel on user acceptance testing and implementation of changes completed by the contractor (CNSI).  The suspended claims number is decreasing, but requires additional action to reduce this to the expected numbers.
  • The changes and fixes to the system that impact the highest number of claims are nearly complete.  Additional work is underway but the paid claims numbers will be slower to increase.
  • DHHS has scheduled provider group training by type through the summer to September.  The training is held every other week, focusing on a different provider type each week, and is believed to be very effective.
  • Phase II - A detailed plan for the work in this final phase is under development. A final completion/certification date can be estimated once this work plan is produced.  It was originally due this week, but actual receipt of the plan is now scheduled for June 06, 2005.

There has actually been a decrease in the cumulative paid claims rate since the last report, however, as a result of more accurate feedback on claims status to providers, the paid rate is expected to increase over the next several cycles.

The enhanced voice response system to be used by providers for MaineCare eligibility and claim status is installed and being tested with a projected implementation date of June 13th.  The system will extract eligibility information directly from MECMS and provide more detail on payment status for a claim.

For the week ending May 20th, the Public Health Consulting Group (PCG) Inquiry Unit received approximately 2,425 calls.  BMS Inquiry during the same period received approximately 1,652 calls from providers.  Combined, the two call centers received approximately 816 calls per day.  Staffs have begun to see a leveling off of the call volume.

As always, MMA appreciates hearing from office staff regarding their particular status so that we may independently monitor the situation.  Send your thoughts to gsmith@mainemed.com. [return to top]

MMA Annual Corporate Affiliate Breakfast this Wednesday, June 15, 2005 in Manchester
The Maine Medical Association will hold its Annual Corporate Affiliate Breakfast this coming Wednesday, June 15 at the Augusta Country Club in Manchester.  The event begins at 7:30am and there is no charge for a participant in MMA's Corporate Affiliate program.

Following breakfast, attendees will be entertained by "The Odd Company."  The event will be concluded by 10:00am.

MMA has over 100 corporate affiliates who provide services and products to MMA members ranging from legal services to automobiles.  We appreciate their support of MMA and the Maine physician community.

Special thanks to TD BankNorth and Bank of America for sponsoring the breakfast.

Any corporate affiliate wishing to attend whom we have not yet heard from may attend by simply communicating with Lisa Martin at 622-3374 or via e-mail to lmartin@mainemed.com. [return to top]

Chris Gianopoulos to Leave Bureau of Medical Services
Christine Gianopouos, acting Director of the Bureau of Medical Affairs, announced her resignation this past week from the position.  She is being named the Deputy Director of the State Retirement System.

Prior to her work at BMS, Christine was Director for many years at the state's Bureau of Adult and Elder Services.

Maine providers have come to appreciate Christine's efforts the past year in a very difficult and challenging position.  MMA wishes her well but regrets her loss to the Bureau at a critical time.  DHHS Deputy Commissioner John Michael Hall, in speaking to attendees at the MMA's Physician Survival Seminar last week, indicated that the Commissioner was looking at a couple very strong candidates and that he anticipated a short vacancy.  The Bureau has had only "acting" Directors for the past couple years. [return to top]

14th Annual Physician Survival Seminar a Success
The MMA's 14th Annual Physician Survival Seminar was held this year in both Portland and Bangor.  Last Wednesday's program in Bangor attracted nearly 100 attendees and featured presentations on Pay for Performance, Quality Improvement, Dirigo Health, MaineCare, Medicare and 10 afternoon breakout sessions.  The afternoon sessions were in three tracks featuring technology, compliance and practice management.

The Association expresses thanks to the many presenters who volunteered their time and to the following sponsors of the program:

  • Boise/Officemax
  • HRH Northern New England
  • Integrity LLC
  • Medical Mutual Insurance Co. of Maine
  • Network Systems, Inc.
  • Northern Data Systems, Inc.
  • The Coding Center
  • The Thomas Agency

MMA members or office staff are always welcome to send any suggestions for future topics for CME programs to either Chandra Leister or Gordon Smith at MMA (cleister@mainemed.com or gsmith@mainemed.com).

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Maine Health Access Foundation Names Maroulla Gleaton, M.D. Foundation Chair
The Maine Health Access Foundation recently elected Maroulla Gleaton, M.D. of Palermo as Chair of the Foundation.  Kevin Gildart, vice president of human resources at Bath Iron Works, was elected vice chair; Warren Kessler, retired President of MaineGeneralHealth in Augusta was elected treasurer and Wesley Davidson, CEO, of Aroostook Mental Health Center in Caribou was elected secretary.

Dr. Gleaton is immediate past-president of the Maine Medical Association and serves as an alternate delegate to the American Medical Association.  She practices ophthalmology in Augusta at Atlee Gleaton Eye Care. [return to top]

2006 National Patient Safety Goals Announced by JCAHO
The Joint Commission announced its 2006 National Patient Safety Goals (NPSGs) and related requirements. Two new requirements have been adopted under existing goals:

  • 2e: Implement a standardized approach to "hand off" communications, including an opportunity to ask and respond to questions. (Applicable to the ambulatory, assisted living, behavioral health, disease-specific care, hospital, laboratory, long term care, office-based surgery and home care programs)
  • 3d: Label all medications, medication containers (e.g., syringes, medicine cups, basins), or other solutions on and off the sterile field in perioperative and other procedural settings. (Applicable to the ambulatory, hospital and office-based surgery programs)

There are two new goals, each with one new requirement, with applicability to various accreditation programs:

  • Goal 13: Encourage the active involvement of patients and their families in the patient's care as a patient safety strategy.
  • 13a: Define and communicate the means for patients and their families to report concerns about safety, and encourage them to do so. (Applicable to the assisted living, disease-specific care, laboratory and home care programs)
  • Goal 14: Prevent health care-associated pressure ulcers (decubitus ulcers).
  • 14a: Assess and periodically reassess each patient's risk for developing a pressure ulcer (decubitus ulcer) and take action to address any identified risks. (Applicable to long term care programs)

The 2006 NPSGs for each program are available at www.jcaho.org/accredited+organizations/patient+safety/npsg.htm

(Contact: Rick Croteau, rcroteau@jcaho.org) [return to top]

Justices Say Federal Pot Laws Trump State Medical Marijuana Laws
In a 6-3 decision, the U.S. Supreme Court has ruled that Congress has the power to prohibit and prosecute the possession and use of marijuana for medical purposes, regardless of state laws that permit it. To date, 11 states have passed medical marijuana laws. The decision overturned a 2003 federal appeals court ruling that said Congress did not have the constitutional authority to regulate the noncommercial cultivation and use of marijuana that does not cross state lines. The case now returns to the Ninth Circuit Court of Appeals for consideration of other challenges to the application of the federal drug law.
For more information
(site registration required)
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HHS Announces Plans For National IT Network

At a meeting of the Healthcare Information and Management Systems Society, Secretary of Health and Human Services Mike Leavitt announced plans for creating a national health information network and a federal advisory commission on standards for healthcare information technology. The cornerstone of this effort is a private-public collaboration called the American Health Information Community (AHIC), which will help nationwide transition to electronic health records -- including common standards and interoperability. The department is also issuing four requests for proposals that will create processes for setting data standards, certification, and architecture for an Internet-based nationwide health information exchange, as well as assess patient privacy and security policies.
For more information:
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For more information or to contact us directly, please visit www.mainemed.com l ©2003, Maine Medical Association