MMA's 152nd Annual Session A Success Sunny skies, beautiful surroundings and a good turnout all combined to make this year's Annual Meeting one of the best ever. At the general membership meeting held on Saturday morning, members passed eleven Resolutions, enacted amendments to the Constitution and Bylaws, passed a budget for 2006 and elected officers. On Saturday evening, President Larry Mutty, M.D. passed the gavel to Jacob Gerritsen, M.D. who became the 154th President in the Association's history. The educational program entitled, "Emerging Threats in Infectious Disease" attracted a large number of participants who heard talks on subjects ranging from Pandemic Influenza to Skin Infections in Athletes. On Friday evening, United States Senator Susan Collins spoke to attendees on Medicare physician payment reform and on her role regarding the gulf coast clean-up. On Saturday morning, DHHS Commissioner Jack Nicholas, Deputy Commissioner Michael Hall and Governor John Baldacci spoke at the general membership meeting, focusing primarily on MaineCare issues.
Kevin Flanigan, M.D., of Pittsfield was elected as President-elect and William Strassberg, M.D. of Belfast and Mount Desert Island was elected Chairman of the Executive Committee for the coming year. Dr. Gerritsen is an internist from Camden. Dr. Flanigan is an internist/pediatrician and Dr. Strassberg an orthopedic surgeon.
The Association's Executive Committee submitted a Resolution in Support of Hurricane Katrina Relief Efforts which was passed unanimously at the membership meeting. In addition to MMA sending $1,000 to the Louisiana Medical Society for relief efforts, members were encouraged to contribute both time and financial assistance to aid in the relief effort. Several hundred dollars were collected during the meeting which will be forwarded to charities of the member's choice.
The following resolutions passed, some with minor edits. A late resolution dealing with the issue of medication in jails and prisons in Maine was referred to the Executive Committee for review and action.
Resolution #1: "Resolution Supporting a Public Awareness Campaign Regarding Protective Head Gear for Sporting Activities," submitted by MMA Public Health Committee
Resolution #2: "Resolution Promoting Better Health Through Cleaner Car Emissions Standards Legislation," submitted by MMA Public Health Committee
Resolution #3: "Resolution Supporting Education to the Medical Community on Health Literacy," submitted by MMA Public Health Committee
Resolution #4: "Resolution Promoting Long-Term Support for Effective Tobacco Treatment and Prevention Programs," submitted by MMA Public Health Committee
Resolution $5: "Resolution Ensuring Universal Access to Flu Vaccine," submitted by MMA Public Health Committee
Resolution #6: "Resolution Assisting in the Development of State Health Plan for Maine," submitted by MMA Steering Committee and MMA Public Health Committee
A full report on the meeting will appear in the September/ October issue of Maine Medicine.
Maine Physicians Assisting with Hurricane Relief; How You Can Help
In the wake of Hurricane Katrina, a number of MMA members have expressed interest in volunteering with response efforts or in contributing financially toward those efforts. Toward that end, MMA, at its Annual Session this past weekend, enacted a resolution that will allow MMA to financially contribute directly but that will also encourage MMA members to contribute, with MMA acting as a conduit to getting assistance to the designated charity. If a member has already contributed, MMA will also record that information if the physician is interested. Many medical organizations, such as the Medical Staff at Maine General ($5,000) have also contributed to the relief efforts (The Maine General Medical Staff contribution was matched by a hospital contribution of the same amount).
What follows is the Resolution that was passed. Many contributions were received at the meeting and will be forwarded to the appropriate entity. Members wishing to volunteer should do so through the Maine Bureau of Health Website at: www.mainepublichealth.gov and a link to the registration form will be available at the MEMA website at: www.state.me.us/mema/
"Supporting Hurricane Relief Efforts"
Introduced by Executive Committee
WHEREAS, the devastating impact of Hurricane Katrina has caused immense suffering in the affected areas; and
WHEREAS, Many Maine physicians have volunteered to help with relief efforts in a variety of ways, and
WHEREAS, soliciting contributions of time and financial assistance through a single source will make it possible for Maine physicians to make a positive impact.
THEREFORE, BE IT RESOLVED THAT:
1. The Maine Medical Association recognize the hardship of the citizens of the affected states of Mississippi, Alabama and Louisiana and contribute one thousand dollars ($1,000) to the Louisiana State Medical Society to be used exclusively for Hurricane relief efforts, and
2. The MMA, through Maine Medicine, Maine Medicine Weekly Update, and other communication tools, encourage members and other Maine physicians to volunteer time and financial assistance to the relief efforts through charities and organizations of their choice, and
3. The MMA act as a conduit to assist in getting assistance and relief to the victims of this disaster. [return to top]
Drs. Hines, Davis, McGuire, Taylor and Simmons Honored at Annual Session
At the Association's Annual Dinner on Saturday evening, several Maine physicians were recognized for extraordinary effort and service. Receiving Special Recognition Awards were George Davis, M.D. of Augusta and Richard Hines, M.D. of Blue Hill. Dr. David was honored for his longtime service to patients at the Augusta Mental Health Institute, now Riverview Psychiatric Facility. Dr. Hines was honored for his recent work with the military in Afghanistan.
Receiving the annual Mary Cushman award for Humanitarian Service was Michael Taylor, M.D. of Portland (International Award) and Peter McGuire, M.D. of Brunswick (Domestic Award). Dr. Taylor has provided unique and exceptional leadership in his efforts to provide medical care to the residents of Haiti. Dr. McGuire was recognized for his establishment of the first free clinic in Maine in Brunswick.
David J. Simmons, M.D. of Calais was presented the President's Award for Distinguished Service, by Larry Mutty, M.D. Dr. Simmons has provided strong leadership as Clinical Director of the Physician Health Program and as Chair of the New England delegation to the AMA.
Present to receive 50 year pins from the Association acknowledging the 50th anniversary of their graduation from medical school were Drs. John Shaw (Augusta), Behzard Fakhery (Lewiston) and Paul Stucki (Waterville). [return to top]
MaineCare MECMS Update
In addition to the Commissioner and Deputy Commissioner presenting to the MMA's Annual Meeting in Bar Harbor on Saturday morning, the MaineCare Providers Advisory Group also met on Thursday, Sept. 8th to receive an update on the MECMS situation. Highlights from these presentations are as follows:
For the week ending Sept. 4, 2005, 198,344 claims were processed, with 57.67% being paid representing $32,659,453. 18.35% of claims submitted were denied and 23.97% were suspended. The total suspended inventory of claims still exceeds 400,000.
On the positive side, over 66% of the new claims were paid.
With respect to the crossover claims, the Dept. continues to assure us that they are aggressively engaged in review activities intended to reduce the current planned timeline for payment (which was Feb. of '06). MMA continues to request a date by which these claims will be processed, citing the hardship to those practices which have received no crossover payments since last year. Both Commissioner Nicholas and Deputy Commissioner Hall spoke to this issue on Saturday morning when addressing the MMA Annual Meeting. We anticipate getting a new date shortly.
The Department is currently evaluating the cost to providers occurring as a result of the 2-3 day lag that occurs with eligibility information moving from the current client eligibility system (ACES) through to MeCMS and into the Interactive Voice Response system. The intent is to provide relief for providers, when through no fault of their own and through due diligence of using the IVR, medical service is provided to an ineligible member.
The Department is planning to initiate a regulatory revision to the current timeline requirements for the submission of claims, to ensure that the one year submission requirement is extended, if the failure to meet these time requirements is through no fault of the provider.
The next Provider Advisory Committee meeting has been scheduled for Sept. 29th at the Bureau Offices in Augusta at 10:00am. [return to top]
Savings Offset Vote Likely This Week
The Dirigo Health Board of Directors heard presentations from Nancy Kane and Mercer Consulting Group last Tuesday, on behalf of the Dirigo Health Agency, that further explained their proposal for calculating the Savings Offset Payment.
They gave no numbers in their presentation, focusing instead on the types of items measured for calculating the tax on paid health insurance claims.
The Savings Offset Payment was enacted into law as part of the State's Dirigo health program. The SOP is an assessment scheduled to be paid by health insurance carriers and third-party administrators for self-funded health plans beginning in January 2006 and will be based on paid claims. This funding is critical to the financial viability of the State's DirigoChoice health insurance product and will be used to fund the subsidies to people who earn less than 300% of the federal poverty level and the budget for the Maine Quality Forum.
The law limits the SOP to a maximum of 4% of paid claims. The state budgeted $48 million in anticipated revenues from the SOP for 2006. The savings offset amount must reflect and may not exceed aggregate measurable cost savings, as determined by the Dirigo board -- including any reduction or avoidance of bad debt and charity care costs to health care providers as a result of the operation of Dirigo Health and any increased MaineCare enrollment due to an expansion in MaineCare eligibility occurring after June 30, 2004.
The payer representatives from insurance companies and businesses will make a presentation next Tuesday and the board will vote Wednesday on the Savings Offset Payment. The Dirigo Board has to make a decision on the size of the SOP by mid-September and file their decision with the Superintendent of Insurance for his approval or denial by the third week in October.[return to top]
State Health Plan "Listening Tour" Begins
A series of meetings to receive public input on the State Health Plan began this week.
The first three meetings, in Brewer, Presque Isle, and Calais were held last week.The remaining meetings are:
·September 12 - Lewiston, , University of Southern Maine/Lewiston-Auburn College, Room 170 (ABC), 51 Westminster Street;
MMA encourages members to provide feedback to the state by completing the form provided on the web site.
The Draft Maine Pandemic Influenza Plan with guidelines, resources, and other documents was developed to assist with the main components of planning, including:
·Command and Control
·Antiviral Medication Use
·Community-based Containment Measures
·Emergency Response: Health and Medical Maintenance of Critical Services
This plan outlines roles, responsibilities and key activities before, during, and following a pandemic influenza.The Bureau of Health notes that it is a work in progress that will be updated and added to as situations arise and dictate.
The plan notes that the best way to prevent the flu is an influenza vaccine and frequent hand washing. [return to top]
Preventing Prescription Drug Abuse Seminar in Manchester Friday, Oct. 7, 2005
The Association's second program in the "First Fridays" series is entitled, "Preventing Prescription Drug Abuse'". The program offers three credits of CME and will be held from 9:00am to noon at the Frank O. Stred Building in Manchester. Breakfast will be available.
Speakers for the morning program include the Director of the Maine Drug Enforcement Agency Roy McKinney, Chris Baumgartner of the Office of Substance Abuse and attorney Gordon Smith from MMA. Mr. Baumgartner will describe the state's new Prescription Drug Monitoring Program and the opportunities it offers medical practices for detecting illicit drug use or drug dealing among your patients. Mr. Smith will offer tips on preventing drug diversion and will discuss the use of narcotics contracts with your patients. He will also discuss the confidentiality issues involved when you need to report illicit drug diversion to law enforcement officials. Both practice managers and physicians (and allied health professionals) are welcome to attend. There is a $60 registration fee which covers refreshments and all course materials. To register, call Chandra Leister at 622-3374 or via e-mail to firstname.lastname@example.org. [return to top]
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.
More on Cigna Specialty Network, Effective Jan. 1, 2006
"The CIGNA Care Network enables employers to offer a network benefit plan option to their employees while encouraging the use of providers who meet or exceed quality of care and/or efficiency measures by offering lower copayments to members for choosing a CIGNA Care Network designated provider. The CIGNA Care Network will grow from eight to sixteen markets, including Maine, on January 1, 2006. All members will continue to have access to the current broad CIGNA network. The benefit plan design gives members the option to choose specialists designated as a CIGNA Care Network providers or they can select an in-network or out of network specialist for a higher co-payment amount.
CCN designation applies to 21 specialties that account for approximately 95 percent of total specialty care and 60 percent of all medical/pharmacy spending. Designation as a CIGNA Care Network provider is based on several widely accepted measurements, including board certification, performance against national quality standards established by the Ambulatory Care Quality Alliance to ensure that those who rank approximately the top five percent receive CCN designation. Specialists recognized by the NCQA in heart, stroke or diabetes care automatically receive CCN designation. Efficiency measures are based on Episode Treatment Group methodology, an industry standard. The 21 specialities reviewed include:
Allery / Immunology General Surgery Otolaryngology Cardiology Hematology / Oncology Ophthalmology Cardiovascular Surgery Infectious Disease Orthopedics Colon and Rectal Surgery Nephrology Pulmonary Medicine Dermatology Neurology Theumatology Endocrinology Neurosurgery Urology Gasteoenterology Obstetrics / Gynecology Vascular Surgery
CIGNA is committed to providing its members with robust information to help them make health care decisions particularly as we employers move more toward consumer directed health care products. In addition to information about specialists, CIGNA HealthCare also provides members a 24-hour Health Information Line, personalized health coaching through its CIGNA Health AdvisorSM program and access to WebMD Health's comprehensive suite of online health tools including an online health risk assessment.
CIGNA HealthCare looks forward to continuing our dialogue with the Maine Medical Association and Maine physicians as we roll out CCN." [return to top]
New State Laws Become Effective on 9/17: MMA Legislative Report Available
Many of the bills enacted during the First Regular and First Special Sessions of the 122nd Maine Legislature become effective on Saturday, September 17, 2005, 90 days following the adjournment of the legislative session. MMA Legislative Committee Chair Katherine S. Pope, M.D. presented the following report at the Annual Session in Bar Harbor this weekend.
2005 ANNUAL REPORT OF THE COMMITTEE ON LEGISLATION
Katherine S. Pope, M.D., Chair
The 186 members of Maine's 122nd Legislature conducted their First Regular and First Special Sessions at the State House in Augusta from early January through June 18, 2005.The MMA Committee on Legislation met 6 times since the last annual session, once in late 2004 to assess the election results and to finalize the MMA's legislative agenda and then monthly from January through May 2005.The Committee held conference calls to review and take positions on bills each week it did not meet in person.The MMA accomplished something with each of its four legislative proposals in the 122nd Maine Legislature:
MaineCare Reimbursement Rates. The clearest win of the session for the MMA and organized medicine generally is the $3 million General Fund increase in MaineCare reimbursement rates in the "Part I" biennial budget for 2006-2007 (L.D. 468). With the federal match, this initiative will infuse between $8 and $9 million in the physician fee schedule. This increase of 10-15% will bring Maine's rates up from approximately 40% of Medicare rates to approximately 53% of Medicare rates. The MMA was able to accomplish this, despite a late session proposal to delay implementation by one year in the borrowing replacement plan, with the strong support of the Baldacci Administration and the Maine Hospital Association.
Medical Liability Reform. While the MMA and its allies in the Coalition for Health Care Access & Liability Reform were unable to find the votes to pass a cap on non-economic damages in medical negligence actions, the group did succeed in enacting "I'm sorry" legislation (L.D. 1378), a provision the Bureau of Insurance estimates could save between 3.5% and 5.9% in total claim costs, and in obtaining a commitment from the Maine Trial Lawyers' Association to discuss other initiatives to improve the medical liability climate in Maine that may be presented to the Judiciary Committee in 2006.
Fairness in the CON program. With the agreement of the MHA, the MMA and the Maine Ambulatory Surgical Center Coalition extended the sunset from 2007 to 2008 on the provision of the Capital Investment Fund statute setting aside 12.5% for non-hospital projects (L.D. 742). Many physicians believe this provision is critical to ensuring that non-hospital projects receive fair consideration in the CON review process.
Access to Medically-Necessary Breast Reduction and Varicose Vein Surgery. With the help of Plastic & Hand Surgical Associates and the American Society of Plastic Surgeons, the MMA responded to a move by CIGNA to eliminate coverage for these services by enacting legislation to require health insurance carriers to offer coverage for these services through a policy rider (L.D. 596).
The MMA also is pleased to have worked through the Maine Coalition on Smoking OR Health to double Maine's cigarette excise tax from $1 per pack to $2 per pack.In addition to the MMA's legislative agenda, the Committee tracked more than 300 bills of interest to Maine physicians and patients, including 3 difficult biennial budgets (L.D.s 468, 1677, & 1691).In the regulatory arena, the MMA continued to monitor and to report to the membership on the implementation of the Dirigo Health Program and the DHHS MECMS transition.
I would like to thank all the MMA members who contributed to our advocacy activities this year - - Legislative Committee members, participants in our weekly conference calls to determine positions on bills, those who served as "Doctor of the Day" at the State House, witnesses at legislative public hearings, and contributors to the Maine Physicians Action Fund, the MMA's affiliated political action committee.All of you made substantial contributions to a successful year of advocacy for physicians and patients in the Maine legislature and executive branch agencies.Also, I would like to thank the MMA's government affairs staff for their excellent work during the past year.
For more information about the MMA's advocacy work during the first year of the 122nd Maine Legislature, please see the interim summary of health care legislation in your meeting binder.
The MMA's Interim Legislative Summary of Health Care Legislation is available at the MMA office and will be posted on the MMA website, www.mainemed.com. This document is a summary of all health care legislation tracked by the MMA during the 2005 session of the Maine Legislature.
For more information, please contact Charyl Smith, Legislative Assistant, at 622-3374 or email@example.com.[return to top]
MaineCare Administrative Policies & Procedures Rule Revisions Proposed
The Office of MaineCare Services is proposing changes to the MaineCare Benefits Manual (MCBM), Chapter I, General Administrative Policies & Procedures. The Department has proposed significant changes to the time limits on prior authorizations and administrative hearings. These changes reduce the time frame from 20 to 10 days on the preliminary notice for a hearing date. Additional clarifications have been proposed on the hearing process timeline.
Other significant language changes and additions to the policy are related to the Dirigo Choice benefit for members who are also eligible for MaineCare, and Katie Beckett eligibility criteria. The Department has also proposed changes regarding telemedicine/telepsychiatry enrollment and reimbursement guidelines for providers, and interpreter services coding and the addition of a new modifier. This rule proposes a change to allow a provider to bill a member when the member misrepresents his/her MaineCare status in writing. Reference has been made regarding the inability of the MaineCare Program to reimburse members directly, and new text has been added that states members do not have the authority to prohibit a provider from billing MaineCare.
Other changes include minor edits, reorganization of sections, name updates, and deletion of duplicative and obsolete material throughout the chapter.
A public hearing has been scheduled for 1 p.m. on Thursday, September 22, 2005 in Conference Room 1A/1B at the DHHS office at 442 Civic Center Drive, Augusta, Maine. The Department will accept written comments until October 2, 2005 directed to the attention of Janie Turner, Comprehensive Health Planner, Office of MaineCare Services, State House Station 11, Augusta, Maine 04333-0011. Also, you may make comments on the proposed rule to Andrew MacLean, Vice President & General Counsel (622-3374 or firstname.lastname@example.org), for inclusion in comments the MMA may make. [return to top]