August 1, 2005

 
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MaineCare MECMS System Still Underperforming
At a meeting of the Provider Advisory Committee last Thursday, July 28, Commissioner Jack Nicholas and Deputy Commissioner Mike Hall told committee members that it would be another few weeks before the MECMS system got to the point of Phase I stabilization. Phase I stabilization would be getting the system to the point where the number of suspended claims is stable and not increasing (currently more than 550,000 claims are in suspension) and a high percentage of the current claims are being paid automatically on an ongoing basis.
 

The meeting elicited a number of comments and complaints from provider representatives, including MMA.  When is "Enough is Enough" was the tone of the meeting and while the Commissioner and Deputy Commissioner were forthright and direct in responding to the questions and issues, there is a palpable sense of frustration on the part of both the providers and bureau staff.

The weekly tracking sheet of claims processing data, for the week ending July 17, showed that the number of suspended claims had increased significantly in recent weeks, after leveling off in June.  Of 204,684 claims processed during that week, only 43.20% were paid.  43.38% were suspended, 13.42% were denied and 3.05% were adjudicated but not released.

MMA representatives continued to press the issue of the unpaid cross-over payments.  The automatic payment of the MaineCare/Medicare cross-over payments has not taken place since this past December, creating hardship for a number of practices with large numbers of patients who are dually eligible for both programs.  At a previous meeting, it was reported that the cross-over issue might not be resolved until January of 2006, but with pressure from the provider community (MMA specifically) there has been a new time-table put together that will be announced at the next Provider Advisory Committee meeting on August 11.  It was clarified that paper claims can be submitted for the cross-over payments and will be paid but that the exact submission instructions need to be followed.

An important meeting took place with vendor (CNSI) representatives last week and the CNSI team has been re-structured into three different functioning units.  The teams are currently working on 57 different critical issues that have been identified.

Bureau staff acknowledged that the current problems are the result of a malfunctioning system, but exacerbated by years of under-resourcing of the former Bureau of Medical Services.  It is clear that the Bureau does not have enough staff or the right staff and that much of the existing staff is demoralized and angry.  The Bureau is burning through the best people at an alarming rate and it was reported at the meeting that a poisonous work environment existed in some of the Bureau units.

The "Transformation Project" announced by the Governor on July 13th is intended to address the staffing issue.  Stabilization of MECMS and the initiation of the reorganization process are the highest priorities of Deputy Commissioner Hall and OMS staff currently.

MMA will continue to report weekly on the status of the problem and progress in fixing it.

Registration Information Available for Pain Symposium

Registration information for the Maine Pain Initiative's 11th Annual Symposium: Pain Management: A Human Right, is available on the Maine Hospice Council's web site at http://www.mainehospicecouncil.org/MPI/registration.htm.

 

The conference will be 8 a.m. to 4:30 p.m., Friday September 30, at the Samoset Resort in Rockport.  Topics include: Tools for Re-Building a Life with Persistent Pain and Pain in Nursing Homes.  For the complete program visit: http://www.mainehospicecouncil.org/MPI/program.htm 

 

Registration is $129 for individuals, $69 for students.  A number of scholarships are available.  Information about scholarships is on the web site.

 

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HIV Screening Now Recommended for All Pregnant Women

A U.S. Preventive Services Task Force supported by the Agency for Healthcare Research and Quality (AHRQ) issued a new recommendation calling for all pregnant women - not just those identified as at risk - be screened for HIV infection.

Task force members are private-sector experts in prevention and primary care.

The recommendation is based on evidence that currently available tests accurately identify HIV-infected pregnant women.  Treatment strategies can dramatically reduce chances an infected mother will transmit HIV to her infant.

An estimated 850,000 to 950,000 Americans with HIV are unaware they have the virus.  Data from AHRQ's Healthcare Cost and Utilization project indicate that of the 4.7 million women hospitalized for pregnancy or childbirth in 2002, nearly 6,300 were infected with HIV.

Find recommendations and materials on the AHRQ website at www.ahrq.gov/clinic/uspstf/uspshivi.htm.  Other information is available by calling (800) 358-9295 or emailing ahrqpubs@ahrq.gov. [return to top]

Registration Materials Available for Sept. 8 CME Program on Impaired Professionals
Registration materials for the September 8, 2005 Program entitled, "Protecting the Public/Restoring the  Professional" are now available from MMA.  The day-long program offers 7 hours of CME and is being held at the Harborside Hotel and Marina in Bar Harbor, Maine the day before the MMA's 152nd Annual Session.

A registration fee of only $50 is being charged which includes lunch and all course materials.  The program is a collaboration of the MMA Committee on Physician Health and the Maine Lawyer's Assistance Program.  The Program is co-sponsored by the health professions licensing boards and the Maine Office of Substance Abuse.

Call Diane McMahon at 622-3374 for a registration brochure or contact her via e-mail to dmcmahon@mainemed.com [return to top]

Second-Quarter Results For Wellpoint, Aetna
WellPoint Profit Up On Merger
Reuters, July 27, 2005
WellPoint, Inc., announced that its net income more than doubled to
$559.4 million for the second-quarter 2005, beating Wall Street analyst forecasts. Stabilization in medical costs and membership gains were cited as reasons for the boost in income.

Aetna Posts Higher Second-Quarter Results
The Associated Press, July 28, 2005
Aetna, Inc., announced that its earnings rose 43% for the second-quarter 2005. Net income increased to $409.7 million from $286.3 for the same quarter last year. An increase in membership and continued cost controls were cited as reasons for the financial gains. Aetna officials said that its membership increased by 60,000 to nearly 780,000 members year-to-date. [return to top]

MMA Executive Committee Holds Summer Meeting
The MMA Executive Committee held its summer meeting last Friday, July 29th at the home of President Lawrence B. Mutty, M.D., M.P.H.  Committee members focused their attention on three major items:

  • Continuation of strategic planning discussion.  The Committee continues to focus on the Association's agenda in the areas of quality improvement and technology assistance.
  • 152nd Annual Session.  Committee members discussed the need to attract more members to this meeting.  This year's theme is "Emerging Threats in Infectious Disease."
  • MaineCare Restructuring.  Committee members were briefed by MMA staff on the continuing problems with the new claims management system and of the Department's efforts to fix both the immediate problem and the deeper cultural problems around customer service and provider relations.

The Committee nexts meets on September 9th in connection with the Annual Session. [return to top]

Federal Medicaid Study Commission Holds First Meeting
The Medicaid Commission recently created by Congress to study the sustainability of the Medicaid program held its first meeting on July 27th.  The group is charged with submitting to the DHHS Secretary by September 1st, at least 2 recommendations to cut $10 billion from the Medicaid program over 5 years and by December 1st, a second set of recommendations on the long-term sustainability of the program.  Former Maine Governor Angus King is the Vice Chairman of the Commission.

Several commissioners complained about the short time frame imposed on the group.  Several consumer advocacy groups, including Families USA and the Leadership Council of Aging Organizations, urged the Commission not to cut benefits for beneficiaries but to focus on fraud and abuse in the system and on provider reimbursement.  Some groups also expressed concern about giving states more flexibility in determining the benefit framework in the program because of the potential negative effect on beneficiaries.

The Medicaid Commission is expected to make its initial recommendations during a meeting in Washington, D.C. on August 17th and 18th.

You can find more information about the Medicaid Commission on the web at:  http://www.cms.hhs.gov/faca/mc/details.asp.

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CMS Program to Offer Low-Cost EMR Software
The Centers for Medicare & Medicaid Services soon is expected to announce a program to offer physicians low-cost electronic health record software based upon VistA, a hospital-based technology used in the Department of Veterans Affairs, for a number of years.  The product, the VistA-Office EHR system, would cost physicians about $37 plus an additional $10 licensing fee for use of the AMA's codes.  The product, designed in conjunction with Daou Systems and the Iowa Foundation for Medical Care, will support disease management and will permit interface with practice management applications, such as patient registration and billing systems.  David Brailer, the national health IT "czar," testified before the House Ways & Means Subcommittee on Health on July 27th that the government must provide incentives and must work to lower the cost of technology if it wants small physician practices to adopt health information technology.

You can find more information about the CMS initiative on the web at:  http://www.cms.hhs.gov/quality/VistAQsAs.pdf.

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Roundup of Federal Health Care Legislation
The following is an update on some key health care legislation in Congress:

1.  Medical Errors.  On July 29th, the President signed the Patient Safety & Quality Improvement Act of 2005 (S. 544), a bill supported by the AMA and AHA that passed unanimously in the Senate and by a vote of 428-3 in the House.  The bill creates a voluntary medical error reporting system that makes health care provider reports to DHHS certified patient safety organizations (PSOs) confidential and prohibits them from being used in civil or criminal litigation.

2.  Medical Liability Reform.  On July 28th, the House passed the Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2005 (H.R. 5) by a vote of 230-194.  The provisions of H.R. 5 include:

  • limiting non-economic damages in medical malpractice cases at $250,000;
  • limiting punitive damage awards to the greater of twice economic damages or $250,000;
  • allowing courts to restrict the payment of attorney contingency fees based upon the size of the award;
  • setting a statute of limitations of three years after the date of manifestation of injury or one year after the claimant discovers the injury, with certain exceptions;
  • limiting the liability of manufacturers, distributors, suppliers, and providers of medical products that comply with FDA standards; and
  • providing periodic payments of future medical damages.

While Senate Majority Leader Bill Frist (R-TN) said in March that he would get medical malpractice legislation through the Senate this year, Senate Judiciary Chairman Arlen Specter (R-PA) recently has stated that the malpractice legislation is stalled in the Senate.

3.  Association Health Plans.  On July 26th, the House passed the Small Business Health Fairness Act of 2005 (H.R. 525) by a vote of 263-165.  Association Health Plans (AHPs) are group health plans sponsored by trade or business groups that would be governed by ERISA and exempt from most state insurance regulation and consumer protection laws.  Business lobby groups support AHPs, but the Blue Cross and Blue Shield Association and consumer advocacy organizations such as Families USA oppose them.  The AMA has not yet taken a firm position on them.  A companion Senate bill (S. 406) is co-sponsored by Senator Olympia J. Snowe (R-ME) and Senator Jim Talent (R-MO).  AHP legislation has passed several times in the House, but has received little interest in the Senate.

4.  Prescription Drug Importation.  On July 21st, the Senate Committee on Commerce, Science, and Transportation voted 14-8 in favor of an importation amendment to a funding bill reauthorizing the Federal Trade Commission (S. 1392) offered by Senator Olympia J. Snowe (R-ME) and Byron Dorgan (D-ND).  The amendment is similar to the Snowe/Dorgan importation bill, the Pharmaceutical Market Access & Drug Safety Act of 2005 (S. 334).  The sponsors took this action in an effort to force the Senate to deal with the importation issue, action that has been blocked by the Bush Administration and Congressional leadership.

You can find out more information about action in Congress at the AMA in Washington web site:  http://www.ama-assn.org/ama/pub/category/13097.html.

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