August 22, 2005

 
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More on MaineCare MECMS Problems/Solutions
The Legislature's Health and Human Services Committee met on August 9th and heard from DHHS officials regarding the MaineCare computer systems problems that have proved costly to physicians and taxpayers alike. For nearly two hours, the Committee bantered back and forth with Deputy Commissioner Mike Hall and others, with Hall acknowledging that the system is not yet fixed or even stabilized. He did, however, note that the state is moving toward providing predictable and accurate payments to MaineCare providers. It now appears that the system is not expected to be performing as intended until 2006 which is completely unacceptable to Maine's physicians. Some offices have not been paid for services rendered to dual-eligible patients since Dec. 2004.
The state is now candid in acknowledging that the new system was designed and built by a vendor with little experience in such a system and that both project management skill at the vendor and state level were not sufficient to carry out a transition of this magnitude.  "The project management skill at the vendor and state level were inexperienced at best, and nonexistent at worst on both sides," said Hall, who was assigned to oversee the project in June.

At the time of the meeting, over 475,000 claims were still in suspension, representing about $500 million in claims.  Well over 100,000 of the claims have been in suspense for more than 90 days.  As part of the overall re-prioritization efforts associated with suspended claims, and in conjunction with the focus on system stabilization suggested by the federal office (CMS), a detailed suspended and aged claims analysis is being conducted by OMS Claims processing staff in collaboration with Deloitte Consulting.  The analysis and recommendations will be completed by the end of August.

The total amount of claims paid through the system for July was $175,851,254.  The total amount of interim payments issued during the month was $34,067,017.

The results of a recent CMS review and the lack of measurable progress in a number of critical areas have required a shift in focus for the system stabilization efforts.  CMS did declare that the system was indeed "viable" and that the system's potential, in combination with a new management structure, warranted CMS' continued investment in the MECMS project.

The report to the legislature was the second monthly update as promised at the end of June.  Members of the Appropriations Committee and the Health and Human Services Committee have become increasingly concerned about the delays in claims processing and the impact on providers.  Below are some quotes from legislators during the day:

"I feel there's incompetence and it's costing us taxpayers millions of dollars."  Rep. Carol Grose, D-Woolwhich, who asked the department officials to provide the committee with an accounting of how much the state has spent to fix the problem.

"My concern is down the road, and this fiasco ought not to be repeated.  In private business, this never would have happened." Sarah Lewin, R-Eliot.

MMA has called upon the Department to reimburse providers for the additional costs incurred in having to deal with the delays in payment.  This would, most likely, have to be done through a state appropriation in January of '06. 

The MaineCare Provider Advisory Committee continues to meet every two weeks to discuss the problem and the next meeting will be held this coming Thursday (August 25) at 10:00am at the DHHS offices on Civic Center Drive in Augusta.  MMA staff will attend the meeting and report on the results in next week's Maine Medicine Weekly Update.

As always, it is valuable to hear from member offices regarding your individual situation with MaineCare payments.  Feel free to bring any issues you are having to the attention of Gordon Smith at gsmith@mainemed.com.

Updated MaineCare Physician Fee Schedule Now Available on OMS Website
The physician fee schedule, with the edits needed to incorporate the $8.5 million increase effective July 1, 2005, is available in Excel format.  It is posted on the OMS website at http://www.maine.gov/dhhs/bms/providerfiles/codes.htm.  Note that the spreadsheet includes only codes billed to MaineCare in 2004.  OMS staff is currently working to update the infrequently billed physician codes.  Once that task has been completed, a revised spreadsheet will be posted. [return to top]

Aetna and Cigna Specialty Networks Effective Jan. , 2006: List of Affected Specialties Attached
In response to an earlier notice in Maine Medicine Weekly Update, several specialists have called MMA to ask what specialties will be included in the networks.  The Aetna product, called Aexcel, includes the following twelve specialties:

  • cardiology
  • cardiothoracic surgery
  • gastroenterology
  • general surgery
  • neurology
  • neurosurgery
  • obstetrics and gynecology
  • orthopedics
  • otolaryngology
  • plastic surgery
  • urology
  • vascular surgery

The Cigna Network will consist of the following 21 physician specialties:

  • Allergy/Immunology
  • Cardiology
  • Cardiovascular Surgery
  • Dermatology
  • Endocrinology
  • Gastroenterology
  • General Surgery
  • Hematology/Oncology
  • Infectious Disease
  • Nephrology
  • Colon & Rectal Surgery
  • Neurology
  • Neurosurgery
  • Obstetrics/gynecology
  • Otolaryngology
  • Ophthalmology
  • Orthopedics
  • Pulmonary Medicine
  • Rheumatology
  • Urology
  • Vascular Surgery

As noted in a previous edition of Maine Medicine Weekly Update, MMA will host a meeting of its Payor Liaison Committee on Wednesday evening, Sept. 21 with Aetna and Cigna officials present to discuss the details of these new specialty networks.  Any MMA member is welcome to attend but please communicate with Chandra Leister at 622-3374 or via e-mail to cleister@mainemed.com for meal planning purposes.  Dinner is available at 6:00pm with the meeting beginning promptly at 6:30pm.

 

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Eating Disorders Workgroup Looking for Treatment Input

Some of you may have recently received a letter and a survey, asking for input on treatment and prevention of eating disorders. We are encouraging those who have not yet completed the survey to do so. We have extended the response deadline so that we can gather as much information as possible for the Legislative Report we are writing.

During the past legislative session, the Legislature considered LD 239 and since requested a list of currently available resources for preventing and treating eating disorders in Maine. The Eating Disorders Workgroup is assessing these resources. The workgroup is a public/private partnership consisting of State agency personnel, health care providers, and concerned citizens. To that end, the workgroup created a brief survey that was sent to hospitals, medical practices, and mental health providers across the state. Information gathered will be used to determine the necessity of the creation of future resources to better serve Maine residents.

Please take a moment to complete our survey designed for medical practice/rural health centers. This survey can be found online at http://www.surveymonkey.com/s.asp?u=4919211905777 or you can request a paper copy by contacting the Teen & Young Adult Health Program within the Department of Health & Human Services. You may call Bridget Bagley at 287-5364 or e-mail her at bridget.bagley@maine.gov We are asking that there be only one respondent from each facility and/or individual practice. All information returned to us will be de-identified for reporting purposes and to ensure confidentiality is maintained.

The Eating Disorders Workgroup Treatment Subcommittee would like to thank you in advance for helping us collect and report accurate information regarding Maine’s systems of prevention and treatment of eating disorders. [return to top]

Practitioner Data Bank Falls Short of its Goals

The National Practitioner Data Bank, the nation's central repository for hospital-based disciplinary actions against U.S. physicians, has received nowhere near the amount of reports that medical experts expected, Modern Physician reported. When the data bank debuted in 1990, the medical community predicted that it would receive as many as 10,000 reports each year. However, so far it has received only about 720 reports a year, for a total of about 10,800 reports in its 15 years of existence. Most U.S. hospitals have never filed a report with the data bank even though they are required to do so when a doctor loses privileges or is suspended for more than 30 days. Critics of the data base suspect widespread underreporting, and some suspect hospitals avoid the reporting requirements by suspending a doctor's privileges just under the threshold of more than 30 days. For more information:

http://www.modernphysician.com/news.cms?newsId=3813 (site registration required) [return to top]

Proposed Medicare Physician Payment Rule for 2006 Sees Drop in Payments
Physicians treating Medicare patients will experience a negative 4.3 percent update on January 1, 2006. The update is applied to the conversion factor that is used to calculate physician payments. The Federal Register published the Centers for Medicare and Medicaid Services' (CMS) proposed rule on the Physician Fee Schedule for the calendar year 2006 in the August 8, 2005 issue. The update is applied to the conversion factor that is used to calculate physician payments. The conversion factor is currently set at $37.8975, which would drop to $36.2679 in 2006 according to the proposed rule. 

To read the PDF of the proposed rule

To read the text version of the proposed rule [return to top]

Brand Name Drug Prices Increased Twice as Fast as the Rate of Inflation

The wholesale prices of brand-name prescription drugs increased by an average of 6.6 percent between 2004 and 2005, more than twice the rate of inflation, according to a study released by the Public Policy Institute at AARP. Researchers analyzed wholesale prices of 195 brand name medications commonly taken by seniors over a 12-month period that ended in March. They found that prices for these medications increased an average of 6.6 percent, down from the 7.1 percent increase in the year that ended Dec. 31, but still well above the 3 percent general inflation rate. According to the study, an average older patient who takes three brand-name medications daily would have experienced a $144.15 increase in prescription drug costs between 2004 and 2005. The Pharmaceutical Research and Manufacturers of America accused AARP of using "fuzzy math" in its study.

AARP news release

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Registration Materials now Available for MMA/MGMA "Tech Talks", Sept. 28, 2005, Augusta Civic Center
In response to member's expressed needs for more educational materials on electronic medical records (EMR) and other technological issues for the physician practice, MMA has teamed up with the Maine Medical Group Management Association to present "Tech Talks" at the Augusta Civic Center on Wednesday, Sept. 28th.  Intended to provide physicians and practice managers with a "hands on" experience, this program is designed with the small and medium size practice in mind.  There will be ample time to meet with vendors and see products in action.  In one session, a panel of physicians, with their vendors and practice administrators, will discuss the good, the bad and the ugly about their experience with implementation of EMR and other technology.

Per person registration is only $40 which includes breakfast, lunch and all program materials.

Call MMA at 622-3374 for registration materials. [return to top]

DNR Orders Working Group to Meet Monday in Augusta
MMA has been asked to participate in a meeting in the Judiciary Committee Room at the State House on Monday morning (August 22) to discuss a series of issues regarding advance directives and DNR orders, as applied to EMS personnel.

Because of concern over the issues, the Judiciary Committee was asked by State Senator Bruce Bryant (D-Dixfield) to examine the issues over the summer and fall to see how the existing laws, regulations and practices could be improved.

Watch the pages of MMWU for a report on the results of the meeting and any potential changes. [return to top]

Opportunities to Serve MMA in Androscoggin, Hancock and Waldo Counties
Because of  term limits imposed on MMA Executive Committee members, there are vacancies in the Executive Committee representation for the counties of Androscoggin, Hancock and Waldo counties, beginning in September.  Any MMA members interested in serving on the Executive Committee would have their names placed in nomination at the Annual Meeting Sept. 10 in Bar Harbor.  Any member interested in so serving should contact the chairman of the Nominating Committee, Jacob Gerritsen, M.D. at jacobg@adelphia.net or Gordon Smith, MMA EVP at gsmith@mainemed.com.

The Executive Committee meets about 8 times per year, with most meetings being held on Wednesday afternoons at the Frank O. Stred Building in Manchester. [return to top]

Make Reservations Now for MMA Annual Session and "Protecting the Public/Restoring the Professonal", Sept 8-11, Bar Harbor
There are a limited number of rooms still available for the Association's Annual Meeting coming up Sept. 9-11 at the Harborside Hotel and Marina in downtown Bar Harbor.  The theme of the clinical talks, which offer 11 hours of CME, is, "Emerging Threats in Infectious Disease".  The meeting begins with a kickoff luncheon at noon on Friday, Sept. 9.

This year, the Annual Session is preceded by a one-day conference sponsored by the Committee on Physician Health entitled, "Protecting the Public/Restoring the Professional".  This conference is offered on Thursday, Sept. 8, also at the Harborside Hotel and Marina.  Seven hours of CME are available on Thursday.

Registration materials for both meetings have been sent on more than one occasion to all MMA members (included with your Maine Medicine in both June and August).  But if you misplaced yours or never received it, call Diane McMahon at MMA at 622-3374 or via e-mail to dmcmahon@mainemed.com and she would be happy to send you information and registration materials.  If you are interested in just the Annual Meeting, you may register also register on-line at www.mainemed.com.

We would love to see you in Bar Harbor! [return to top]

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