September 26, 2005

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Medicare Prescription Drug Program to Offer 16 Choices in Maine
Senior Citizens in Maine face a broad array of choices among prescription drug plans that were announced by the Bush Administration last Friday. The Administration named 10 insurers to provide the drug program nationally but also noted that bids had been received for regional contracts, driving the number of companies approved by CMS to 16 in Maine and New Hampshire. Enrollment begins Nov. 15 for the voluntary program which starts Jan. 1, 2006.
Insurers can begin marketing their plans Oct. 1.  A significant effort is underway through CMS to educate physicians and their office staff about the program, as it is anticipated that many Medicare recipients will inquire of their physician what option they should take, or whether they should purchase the voluntary coverage at all.

The choices will be even greater because of the presence in Maine of at least one Medicare Advantage Plan.  These plans, which operate like HMO's, offer comprehensive Medicare coverage in addition to the drug program.

The state and federal government are presenting an educational conference for providers on Tuesday, Nov. 1 at  the Augusta Civic Center from 8:30am to 3:30pm.   The conference is entitled:  "The New Medicare Prescription Drug Program:  Time to Act."  Registration materials for the conference are not yet available, but for more information you may contact the University of Maine Dept. of Conferences at 780-5960.

WSJ Reports Significant Interest in Offering Medicare Drug Benefit
On September 23, 2005, the day that CMS announced its approval of companies to offer prescription drug coverage, the Wall Street Journal reports that in an effort to capture the largest portion of the Medicare market through the new Medicare prescription drug benefit that begins on January 1, 2006, many private health insurers have proposed premiums that are almost 14% lower on average than what Medicare officials predicted.  Executives and analysts are still waiting for CMS officials to disclose which companies have been awarded contracts.  While investors are now only predicting a 2% to 3% margin on the drug benefit business, health plans are banking on making money through the sheer volume of Medicare customers who sign up for the program.  Health insurers also are hopeful that they can sell more Medicare customers on their other programs with more profit potential such as Medicare Advantage.  Through their existing programs that cater to seniors, Humana, Inc., and PacifiCare Health Systems, Inc., are already well poised to secure the largest portions of the Medicare market.  Humana has disclosed that it successfully bid below each regional benchmark for all of its prescription drug plan bids submitted to Medicare.  According to analysts, the challenge of building new Medicare networks from the ground up will make it difficult for new rivals to compete.

The MMA is hosting a half-day educational session on the new Medicare drug benefit as part of its "First Fridays" CME series on Friday, November 4, 2005.  For more information, please contact Chandra Leister at or at 622-3374. [return to top]

Space Still Available for Wednesday, Sept. 28 "Tech Talks" Program

The Maine Chapter of MGMA (Medical Group Management Association) and MMA team up on Sept. 28 to present a technology program designed for physicians and office staff interested in moving to electronic health records (EHR). The all-day program will be held at the Augusta Civic Center and will feature vendor presentations as well as lectures from several physicians and vendors who have successfully implemented an EHR system in Maine. Carol Male, CPC, MBA from Baker, Newman & Noyes will start the day off with a presentation on what to look for in a vendor.

In addition to Carol Male, presenters include Daniel Mingle, M.D., Daniel Friedland, M.D., Joel LaFleur, M.D., Roderick Prior, M.D., Michael Parker, M.D., Maureen Kenney of Bath Iron Works, Mike Duddy, Esq. and Lawrence Ramunno, M.D., M.P.H. from the Northeast HealthCare Quality Foundation.

Private payors as well as the federal and state governments are encouraging physicians to invest in technology.  Pay-for-Performance (P4P) initiatives and the ability to improve the quality of care through technology make it imperative for physicians to at least begin thinking about EHR systems.  This Sept. 28th program would be a great place to start.

Registrations are being handled by Kim Anderson at Maine Eye Center (774-8277), but MMA members may call the MMA office at 622-3374 to receive a brochure or more information.  The cost of registration is only $40 which includes lunch and all program materials. [return to top]

Next "First Fridays" Program Features "Preventing Prescription Drug Abuse", Oct. 7
 The second "First Fridays" CME program will be held on Friday morning, Oct. 7, 2005 from 9:00 am to noon at the Frank O. Stred Building in Manchester, the MMA headquarters.  The topic is "Preventing Prescription Drug Abuse" and features a faculty of Roy McKinney, Director of the Maine DEA, Daniel Onion, M.D. from the Board of Licensure in Medicine, Chris Baumgartner of the Office of Substance Abuse, Gordon Smith, Esq. and Andrew MacLean, Esq.

One of the most frequent calls to MMA is from practices seeking assistance with handling patients who are demanding narcotics.  This three-hour seminar is intended to provide members and their office staffs with practical information to assist with this problem.  Some of the topics covered will include the information available to practices from the new Prescription Monitoring Program, licensing board regulations on the subject, the use of narcotics contracts, and confidentiality and reporting requirements.

Registration material is available from Chandra Leister at MMA at 622-3374 or via e-mail to [return to top]

MaineCare MECMS Provider Advisory Group Met This Morning
The Governor's MaineCare Providers Advisory Group met this morning (Monday, September 26) and heard from DHHS Deputy Commissioner Michael Hall on the current status of the payment system.

The key weekly metrics sheet for the week ending 9/18/05 showed that 307,319 claims were processed with 53.10% being paid, 9.97% being denied and 36.94% being suspended.

In positive news, the total suspended inventory has decreased to 355,853 (down from over 500,000 two months ao). In addition, the percent of new claims paid was 71.18% which approaches the standard in the prior system. (Based on 2004 figures, the average percentage of claims paid was 75.96%, with 12.99 being suspended and 11.05% denied).

About $25 million was paid out for the week. Through-put is consistently getting better.

On the negative side, crossover payments are not being paid and may not be paid until February. "The Department is determined to pay these claims earlier than this," noted Michael Hall, and updates will be provided to MMA on a biweekly basis.

The State, at MMA's request, is providing information on the total number of crossover claims and their total value.

There continues to be a sense of frustration regarding the information being provided on the status of claims processing and what is actually being experienced in the physician office. Thanks to those MMA members and billing staff who have kept MMA apprised of their experience. These reports can be sent directly to

Other issues on the agenda this morning were:

  • online portal (5 claim inquiry limit)
  • HIPAA compliance
  • status of interim payments

A new portal is being developed and is expected to be available in a few weeks. This will help the providers who need a robust and timely means of determining whether a claim has been paid. This may be available in two to four weeks, but no absolute date was committed to. This will not help in determining eligibility but it is hoped that the eligibility determination system will also be improved eventually.

The number of interim payments is decreasing and repayment will be phased in eventually. Most interim payments will be offset against remittance advances. A fixed percentage of each remittance will be deducted for as long as necessary to recover total interim payments.

The next Provider Advisory Committee meeting will be held at 10:00am on October 13th at the OMS office on Civic Center Drive in Augusta. [return to top]

New York Times Reports on Health Information Technology in Small Practices
In an article on September 19, 2005, the New York Times reported that physicians in small practices often say they don't have the money to invest in health information technology.  However, a coalition of 500 physicians, hospitals, insurers, and employers in rural upstate New York has worked to remove many of the barriers preventing physician practices from investing in new technology.  The initiative, the Taconic Health Information Network and Community, has developed a Web-based, central database approach, which means that physicians need only a standard PC with a high-speed Internet connection to participate.  The monthly subscription fee is $500 to $600 per month, which does away with the thousands of dollars physicians usually need to pay upfront to invest in a new health care information technology system.  In order to launch the project, the Taconic group initially received a grant of $100,000 from the eHealth Initiative, a national nonprofit organization that focuses on helping the medical profession invest in technology.  With this web-based program, physicians can log onto a secure Web site to obtain laboratory results, x-ray and other imaging results for their patients from four local hospitals and two large lab companies in the area.  Later in the year, physicians will have the capacity to send prescriptions electronically, and view patients' electronic health records online.  [return to top]

2005 Dan Hanley Leadership Award To Be Presented to Sandra and Burgess Record
Two of Maine's most accomplished health care professionals will be honored next month with the 2005 Dan Hanley Leadership Award.

Sandra and Burgess Record of Wilton will be presented  the prestigious Hanley Award at a statewide Leadership Luncheon on October 7 at Bowdoin College in Brunswick.  The keynote speaker at the Luncheon will be former Maine Governor  Angus King.

The Records have been key leaders in a successful effort over the past 25 years to improve the health of residents of Western Maine.  Sandra Record, R.N. and Burgess Record, M.D. have long been associated with the Western Maine Center for Heart Health at Franklin Memorial Hospital in Farmington.

"Burgess and Sandy Record's unique work has made a demonstrable difference in the health of the citizens of Franklin County." said former Maine Bureau of Health Director, Dr. Lani Graham, who nominated the Records for this honor.  "Having worked as a team for over two decades employing a combination of good patient care and population-based   public health approaches, they have now developed a model of success in the prevention and treatment of heart disease."

"Their work has been successful," Graham explained, "Because the Records have been able to combine the best that evidence-based medicine and public health can offer."

The Dan Hanley Leadership Award was established in 2003 to recognize outstanding achievements in health care.  The Award is named for Dr. Dan Hanley, who passed away in 2001 following a long and distinguished career as the physician at Bowdoin College, Executive Director of the Maine Medical Association and physician for the U.S. Olympic Committee.  Dr  Hanley helped found a number of organizations, including the Maine Health Information Center, th e Maine Medical Assessment Foundation and Medical Mutual Insurance Company.  Please  visit for more information about the Hanley Memorial Trust, which sponsors the annual award.  MMA is a founding member and contributor to the Trust.

The Hanley Leadership Award was presented to University of New England School of Medicine Dean Steve Shannon, D.O. in 2003 and to John Wennberg, M.D., a nationally known health care researcher based at Dartmouth University in New Hampshire.

Tickets for the awards are available for $25 per person.  Those wishing to attend the awards luncheon may contract Hanley Memorial Trust Executive Director Jim Harnar at or by calling 207-807-6646.  The deadline for registration is September 23. [return to top]

Assisting After Hurricane Rita
The AMA and MMA are closely monitoring the situation in Gulf-area states bracing for Hurricane Rita and have received many inquires about where physicians can turn for support.

The AMA is working with David J. Brailer, MD, PhD, National Coordinator for Health Information Technology, and numerous other groups to expand to provide physicians access to prescription records of patients displaced by Rita.  A final determination on expanding this important resource  will made as soon specific specific needs are determined.

If you are a licensed physician are treating a Hurricane Katrina evacuee, you are permitted to use To receive a login and password, please contact the AMA's Unified  Service Center at (800) 262-3211, which is available 24 hours a day.  Physicians will be asked specific questions to validate their identity and credentials.

The AMA will offer online updates and links to information about volunteer opportunities, physician licensing, liability protection issues, evacuees' health insurance issues and other matters that result in the wake of Rita.

Bookmark for updates on the relief effort surrounding Rita and Katrina.

In addition, residents should visit the Association of American Medical Colleges'  Web site at for information on residency issues that Rita might impact.

Medical students, meantime, should review the Accreditation Council or Graduate Medical Education's Web site at for information on arrangements  for students at schools that might be affected by Rita, as well as how those schools will handle residency applications. [return to top]

Cancer Society PAC Hosts Reception for Senators Snowe & Collins
The American Cancer Society  Cancer Action Network, Inc. is holding a reception honoring Maine's U.S. Senators Olympia Snowe and Susan Collins for their dedication to cancer prevention, early detection, and research at the Pavilion, 188 Middle Street, Portland, Maine on Saturday, October 8, 2005.  The event includes a VIP reception beginning at 6 p.m. ($350 per person, $500 per couple) and a general reception at 7 p.m. ($200 per person).

The ACS Cancer Action Network is fighting cancer on 4 fronts:

  • Support cancer research and programs that prevent, detect, and treat cancer;
  • Expand access to quality cancer care, prevention, and awareness;
  • Reduce disparities in cancer prevention and cancer treatment; and
  • Reduce and prevent suffering from tobacco related illness.

To RSVP, please contact Eileen Silvestri at 207-373-3717.  You can find more information about the ACS Cancer Action Network at

  [return to top]

State Board Says Dirigo Health Saved $134 Million; Recommends "Savings Offset Payment" of 4% of Paid Claims
The Board of Directors of the Dirigo Health Program, by a 3 to 1 vote, last week determined that Governor Baldacci's Dirigo Health Program created at least $134 million in savings during its first year and that the estimate was a conservative one.

The Board also determined that the savings justifies a premium tax of 4% of paid health care claims.

The Board heard a presentation from Mercer Human Services Consulting, the actuary hired by the Dirigo Health Agency, which informed the Board that they had calculated $233 million in savings associated with various Dirigo-related initiatives. This number is compared with an analysis done by the Lewin Group, the actuary hired by the State Chamber of Commerce, which showed a maximum savings of $35 million with less than half of it attributable to Dirigo Health.

By determining that there was $134 million in Dirigo savings, the Board was therefore able to justify recommending a 4% premium tax on all paid health care claims in the state. This premium tax will generate approximately $50 million and will be paid by all insurance carriers and self-insured businesses in Maine.

The Superintendent will make the final Dirigo savings determination and officially set the level of the premium tax by November 1. Hearings on the issue have been scheduled for October 24, continuing to October 27, if necessary. MMA staff will monitor the hearings and report to members via MMWU. [return to top]

Aetna Sends New Provider Agreements to Physicians
In an article in today's American Medical News, the AMA reported that Aetna is mailing new provider agreements to participating physicians across the country.  The new contracts reflect the changes that were mandated in Aetna's settlement of lawsuits brought by physicians and state and county medical societies.  One of the most notable changes in the contract is the provision that defines "medically necessary care."  The contract states that "patients are entitled to medically necessary care as determined by a physician who follows generally accepted medical practice standards."  The new contract also has a definition of what constitutes a "clean claim," which is part of Aetna's agreement to implement changes in its business operations to make the claims process less onerous for physicians.  Physicians who think that Aetna is violating the settlement can file a compliance dispute by submitting a form that is available on the HMO Settlements website at[return to top]

Changes at MHIC and Hanley Trust
Suanne Singer has been named President of the Maine Health Information Center (MHIC), Maine's primary nonprofit health data research organization.  Singer, who has served as the MHIC's Vice President of Operations since 2003, joined the organization in 1979.  Singer will succeed James Harnar, who leave the MHIC at the  end of this month to become the Executive Director of the Dan Hanley Memorial Trust.    Harnar has served as MHIC President since 2002 and is expected to remain involved in several MHIC  projects on a consulting basis.  In other news, John LaCasse, President of Medical Care Development, will assume the Chairmanship of the MHIC Board October 1 succeeding Lisa Miller. LaCasse was an original member of the MHIC Board and previously served as MHIC Chair  in the early 1980's and mid-1990's.  Maine Medical Association Executive Vice President Gordon Smith, a long time member of the MHIC Board, will continue as Vice Chair. [return to top]

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