July 11, 2005

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MMA Initiates "First Fridays" Educational Programs
"First Fridays" is a new series of educational seminars presented by MMA on socio-economic issues, CME and practice management. The seminars will be held the first Friday morning of each month, from 9:00a.m. to noon at the MMA offices in the Frank O. Stred Building in Manchester. The first program is Sept. 2 on the subject of Minors' Rights to Health Care; Consent and Privacy Issues.
The Sept. 2 program is co-sponsored by the Maine Chapter of the American Academy of Pediatrics and features healthcare attorneys Kenneth Lehman, Andrew MacLean and Gordon Smith discussing some of the more complex and sensitive issues of caring for minors.  While anyone is welcome, the program will be of particular interest to staff in a pediatric or family practice setting and an additional mailing of program materials will be sent to such practices.

The Oct. 7 program is entitled, "Preventing Prescription Drug Abuse" and will include a description of the information available to practices through the new state Prescription Drug Monitoring Program.  MDEA Director Roy McKinney will also provide an update on the current status of prescription drug abuse in Maine.

On Nov. 4, speakers will present on The Medicare Modernization Act, particularly emphasizing the Part D drug benefit which begins on Jan. 1, 2006.  Seniors will be asking physicians about the program and this educational effort is intended to assist office staff and physicians in responding to these questions.  CMS officials will be included in the presentations.

Closing out the 2005 series on Dec. 2 will be "The Best of the 2005 Physician Survival Seminar."  MMA has imposed on the most highly rated speakers from our May and June programs and asked them to present again on Dec. 2.  This will give those practices in the central Maine area an opportunity to benefit from the best of the earlier programs if staff had not been able to attend the Bangor or Portland programs.

The fee per program is $60 per attendee which includes a light breakfast and all course materials.  Registration materials will be included in the July/August issues of Maine Medicine but interested persons may also contact Chandra Leister at MMA for a registration flyer or additional information (622-3374 or cleister@mainemed.com).

MMA members and their staffs are encouraged to make suggestions for future topics for this series of programs.  Send your suggestions to Gordon Smith at gsmith@mainemed.com.-

Save the Date of Wednesday, Sept. 28 for Technology Program
The Maine Chapter of MGMA (Medical Group Management Association) and the Maine Medical Association team up in September to present a technology program designed for physicians and office staff interested in exploring how to improve their practice through technology.  While much of the day will feature information on Electronic Medical Records (EMR), information will also be available on e-prescribing and other technological advances.  The program will be held on Wednesday, Sept. 28 at the Augusta Civic Center.

With several federal and state initiatives pushing practices to adopt more aggressive strategies for using technology to improve data collection and enhance quality improvement efforts,  medical practices in Maine have an acute need for assistance in the technology area. 

The Sept. 28 program is intended to be very "hands-on" and to assist practices in a very practical way.  Vendors who have successfully implemented projects in Maine will be invited to present and demonstrate their products.  Plenary sessions on the topics of vendor-selection and the roll of technology in Pay for Performance will be included.  Physicians, vendors and practice managers who have successfully implemented a project will present in a panel format and discuss what they would do differently if they had the chance to do it again.

Registration materials will be mailed by the end of July but members or staff (or vendors) wishing to get a head start on this program can contact Chandra Leister at 622-3374 or via e-mail to cleister@mainemed.com. [return to top]

It's Not Too Late to Submit Resolution to MMA Annual Meeting
You still have time to submit a resolution for the 152nd MMA Annual Session meeting Sept. 10 in Bar Harbor.  Resolutions should include a few "Whereas" statements that provide information about the issue and a "Resolved" statement that specifies action from the MMA.

The deadline for resolutions is July 31.  MMA staff would be happy to assist you.  Call MMA at 622-3374 or 1-800-772-0815.

The business portion of the two-day meeting is on Saturday morning, Sept. 10 beginning at 9:00am at the Harborside Hotel and Marina.  The meeting follows the 25th Annual Edmund Hardy, M.D. Road Race.  The Road Race is approximately 2.6 miles and is named after a well-known and much admired Falmouth  internist, Edmund Hardy, M.D. who served yearly as the physician for the road race until his death.

The Race is sponsored by Medical Mutual Insurance Company of Maine.  Andrew MacLean, Esq. is Race Director. [return to top]

Angus King Named Vice-Chair of Federal Medicaid Advisory Commission
On Friday, July 8, HHS Secretary Mike Leavitt announced the membership of the advisory commission charged with identifying reforms necessary to stabilize and strengthen the Medicaid program.  Former Maine Governor Angus King will serve as vice-chair of the commission, which will be chaired by former Tennessee Governor Don Sundquist.  The commission is made up of 13 voting members and 15 non-voting members.

Consisting of health policy leaders from both sides of the aisle, state health department officials, public policy organizations, individuals with disabilities and others with special expertise, the commission will submit its first report to Secretary Leavitt by Sept. 1.  Through the FY 2006 budget agreement, HHS agreed to create this commission to develop proposals on the future of the Medicaid program.

The commission must submit two reports to Secretary Leavitt.  By Sept. 1, the commission will outline recommendations for Medicaid to achieve $10 billion in reductions in spending growth during the next five years as well as ways to begin meaningful long-term enhancements that can better serve beneficiaries.  The commission, for its first report, also will consider potential performance goals for Medicaid as a basis of longer-term recommendations.

The second report, due Dec. 31, 2006, will provide recommendations to help ensure the long-term sustainability of Medicaid.  The proposal will address key issues such as:

  • How to expand coverage to more Americans while still being fiscally responsible
  • Ways to provide long-term care to those who need it;
  • A review of eligibility, benefits design, and delivery; and
  • Improved quality of care, choice and beneficiary satisfaction.

The Reuters news agency reported on July 9 that leaders of both political parties were invited to appoint four nonvoting members to the commission,  but that Democrats refused to do so, charging that the panel will be one-sided.

The escalating cost of the Medicaid program is a recurring issue in Washington and in state capitals across the country.  In Maine, the average annual growth in Medicaid spending was 8.6% from l994 through l999 and 12.1% from l999 through 2004.  The program cost approximately $2 billion to operate in fiscal year 2004 with nearly two-thirds of the funds coming from the federal government.  The program serves about 275,000 Mainers currently.

A full copy of the commission's charter is available at http://www.cms.hhs.gov/faca/mc/default.asp.

The HHS press release listing all members of the commission is available at http://www.hhs.gov/news.


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Mark McClellan,M.D., CMS Director to be in Maine Wednesday
Dr. Mark McClellan, CMS Administrator,  will be at the Southern Maine Agency for Aging in Scarborough on Wednesday, July 13 to meet with persons interested in hearing about  Medicare Part D, the Medicare prescription drug benefit which begins on Jan. 1, 2006.  Dr. McClellan will meet with MMA representatives and about 30 other state and community leaders from 8:30am to 9:00am, then join others for a larger event from 9:00am to 10:00am. 

The visit is part of a "Mobile Office Tour" which is part of a national HHS initiative to spread  awareness of Medicare's new prescription drug benefit.

More information on the event can be obtained from Mary Walsh, Manager of Community Programs for the Bureau of Elder and Adult Services at 287-9207 or via e-mail to Mary.Walsh@maine.gov. [return to top]

David Brailer, M.D. Outlines 10-Year Plan for Health IT
David Brailer, M.D., national coordinator for health information technology, outlines a 10-year plan to implement an interoperable network of electronic health records (EHR's) during a Webcast last week sponsored by the Kaiser Family Foundation.  Dr. Brailer indicated that he wants the government to use its purchasing power to act as a "market mover" for EHRs and other health IT Applications.  Winston Price, president of the National Medical Association, encouraged the establishment of incentives to encourage physicians to adopt IT and called for systems that can be upgraded without having to be replaced and that do not quickly become obsolete.  For more information, and a video link to the Web cast:

     http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=1462 [return to top]

State DHHS Seeking Comments on Anatomical Gift Rules
The state Department of Health and Human Services is seeking comments and participation in a meeting regarding a proposed rule amending the process of obtaining informed consent for organ donation.  Earlier this year, the legislature passed a resolve directing the Department to review its rules as a result of the controversy over the harvesting of brain tissue which was then sent to an out-of-state research facility.  That practice has led to the filing of over a dozen lawsuits from family members claiming that informed consent was not given for the donation.

The Department will meet with interested parties on Thursday, August 4 in Augusta at the Maine Hospital Association from 1:00 pm to 4:00pm to provide an opportunity for comment and suggestions.   Interested persons should call Sue Dowdy at 287-3796.  Lani Graham, M.D., MPH, Medical Director of the Office of Public Health Emergency Preparedness, is responsible for the review of the existing rule. [return to top]

What to Expect to Pay for EMR
An article in the July 11, 2005 of American Medical News provides an overview of technology issues.  According to the article, consultants say that initial set-up costs for a comprehensive EMR system ranges from $48,850 to $30,000 per physician.  That price bracket will give physicians the option to purchase a system that includes coding, decision support, charting, document management, electronic prescribing, internal messaging and patient summaries.

Another consultant suggests that physicians should expect to spend between $1,000 and $2,000 per-month per physician for an EMR system when acquisition costs are taken into consideration and the costs are spread over a five-year period.  According to the article, physicians in small practices who cannot afford the large up-front costs for an on-site system should consider using an application service provider (ASP) model.  When using an ASP, physicians do not own the software but pay a $250 to $600 monthly subscription fee per-physician to access it remotely through the Internet.  There is some risk to such an arrangement, particularly if the ASP company should fold.

These issues and other related to EMR will be presented at the Sept. 28th Technology Conference in Augusta, discussed elsewhere in this Weekly Update.  The conference is being held at the Augusta Civic Center and is co-sponsored by the Maine Chapter of the Medical Group Management Association. [return to top]

Medicare Part B Outreach and Education Offers One-on-One Sessions at Your Office

Representatives from National Heritage Insurance Company, the Medicare B carrier for Maine, Massachusetts, New Hampshire and Vermont, are available to meet with your office staff and assist you on site with any billing questions you may have.


This service is offered free of charge, and provides you the opportunity to meet your Medicare representative and discuss specific issues and questions for your practice .  We are able to review claims, help understand your remittance advice and provide one-on-one assistance and recommendations for quicker and more accurate claims processing.


If you are interested in having an N.H.I.C. representative visit with your office, contact Thelma Woods at thelma.woods@eds.com or call 1-781-741-3492. [return to top]

Help on the Way with MaineCare Prior Authorizations
The MaineCare prior authorization process continues to be a significant administrative hassle for MMA members and their staffs.  Due to MMA and Maine Osteopathic Association efforts, aided significantly by the MaineCare Advisory Committee, the legislature enacted a Resolve, Chapter 113, entitled "Resolve, To Increase the Quality of Care and Reduce Administrative Burdens in the Pharmacy Prior Approval Process."  The Resolve has nine paragraphs detailing improvements to be made in the PA process.  The Resolve reads as follows:

  • The department shall specify on the preferred drug list and on the prior authorization form the number, titration if required and classes of preferred drugs that must be determined to be clinically inappropriate or ineffective before the department will permit the use of a nonpreferred drug.
  • In the next changes to the MaineCare Benefits Manual, but no later than January 15, 2006, the department shall adopt a provision to articulate the current standards for off-label drug use of prescription drugs for children.
  • The department shall change the prior authorization forms to provide examples of clinical conditions and functional limitations that could support a waiver of prior authorization.
  • By Jan. 2006, the department shall amend its rules regarding prior authorization to include the criteria for approving special exception overrides.  The department shall arrange to modify the message screen to include a reminder that overrides may be available.  The message format must comply with National Council for Prescription Drug Programs standards.
  • By Oct. 1, 2005, the department shall minimize the burden on providers of submitting duplicative medical records on behalf of a MaineCare member.  In order to reduce the submission of duplicate information, the department shall work to provide notice to providers of the types of documentation required and to create a prior authorization file for each member.
  • The department shall provide prompt notice of changes to the preferred drug list through postings on its website, its group electronic mailings regarding pharmacy issues and notices to provider organizations.
  • The department shall arrange to allow submission of the prior authorization form and other required documentation as an e-mail attachment when such submissions are feasible.
  • By January 15, 2006, the department shall amend its rules regarding the drug utilization review committee under the MaineCare Benefits Manual, Chapter ll, section 80.01-13 to establish conflict-of-interest standards for members of the committee.
  • The department shall consult with the MaineCare Advisory Committee on the design of future studies related to pharmacy prior authorization, including a survey of MaineCare members.  The department shall report to the Joint Standing Committee on Health and Human Services by Feb. 1, 2006 on its progress in implementing this subsection.
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Health Systems Development Advisory Council Update
The Governor's Advisory Council on Health Systems Development held a regularly scheduled meeting on July 8 and continued its work toward a new State Health Plan.  Council staff provided a confidential overview of the data from the "Tough Choices" campaign and presented preliminary plans for follow-up focus groups and community forums.  It is hoped that the focus groups could be held in August in order to keep the schedule for the development of the State Health Plan on track.

Members had been distributed a draft of the so-called "data book" and asked to provide comments on it.  Entitled "The State of Maine's Health", the data book is intended to include a wealth of information such as comparisons of Maine with other states and national averages in both the cost and quality of care. Comparisons of regions within the state will also be included.  The data book is intended to be an important resource for the development of the State Health Plan.

The Council will continue to meet every other Friday, from 9:00am to 11:00am.  The next meeting is July 22 in Room 300 of the Cross Office Building at the State House.  Maroulla Gleaton, M.D. and Josh Cutler, M.D. are on the Council representing practicing physicians. [return to top]

Hanley Health Care Memorial Trust 2005 Health Care Forum A Success

On June 16 and 17, 2005, nearly 50 Maine health care leaders gathered on the campus of Bowdoin College in Brunswick, Maine for the 2005 Dan Hanley Memorial Trust Health Care Forum's Program "A Statewide Information Technology Strategy to Advance Support of Quality Care and Improved Patient Outcomes in Maine".  Fifteen physicians were among the participants, including President Larry Mutty, M.D., MMA Technology Committee Chair Paul Klainer, M.D. and EVP Gordon Smith.


The Dan Hanley Memorial Trust was established to remember Dr. Dan Hanley and the important difference his work made to the Maine health care community. Building on Dan Hanley’s lifelong values of inclusion and collaboration, courage, hard work, innovation, kindness, and leadership, the goal of the Trust is to shape programs that build a foundation of health care leaders who share those values and are motivated to apply them to improve health and health care in Maine and beyond. MMA is a financial contributor to the Trust and has a representative on the Trust Steering Committee.


The 2005 Forum began with a review of the work that has been accomplished to date by the Maine Health Information Network Technology (MHINT) Project.  The goal of the MHINT Project is to develop a statewide health information system that will support improvements in clinical decision making and the quality and administrative efficiency of care, the identification of potential threats to the public health, and enhanced access to their personal health information for consumers.


The Forum participants explored the issues associated with the development and operation of a statewide clinical information system for Maine, including the Federal context and plans, which were described by the Forum’s keynote speaker; the role of clinical information systems in supporting guideline implementation and improved patient outcomes; governance and financing; statewide interconnectivity; and consumer support and empowering patients.  The diverse mix of leaders and stakeholders participating in the Forum made for nuanced and lively discussions.


In preparation for the 2005 Forum, the Hanley Trust asked participants to complete a web-based survey to gather their opinions and concerns about the promise of a statewide health information system for Maine and the challenges associated with its development and operation. The survey had an excellent response rate:  33 people out of a total of 47 registrants completed the survey.


The high-level leadership group convened by the Hanley Trust at its 2005 Health Care Forum overwhelmingly endorsed the proposition that a statewide, interconnected data system to allow providers and patients to access patients’ clinical information regardless of where they live or receive care should be developed in Maine.  Although creating this system would likely make Maine the first in the U.S. to do so, the assembled group was clear that it was both the right thing to do and feasible as well.


Breakout sessions and the overall group were asked to generate a set of strategic action recommendations regarding the areas of governance, statewide interconnectivity, financing, information technology and clinical decision making, and public support/empowering patients. This summer, the Hanley Trust will be releasing the Executive Summary Report of the Forum including the action recommendations and associated commentary for each topic area and overall vision. [return to top]

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