October 3, 2005

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Three Hour CME Program on Prescribing for Pain while Preventing Diversion on Friday in Manchester
MMA will present its second CME program in the new "First Fridays" series on this Friday, Oct. 7, at the MMA offices in Manchester. The topic is "Preventing Prescription Drug Abuse while Adequately Treating Pain" and involves a discussion of protocols for prescribing narcotics for chronic pain, the use of narcotic contracts, regulatory requirements and the extent of the diversion problem in Maine and what physicians can do about it. The state's new prescription monitoring program will be explained by those persons operating it. To register, call Chandra Leister at 622-3374 or contact her at cleister@mainemed.com. A registration fee of $60 is charged, which includes all materials and refreshments.
Faculty for the program are Roy McKinney, Director of the Maine Drug Enforcement Agency, Chris Baumgartner from the Maine Office of Substance Abuse, Daniel Onion, M.D. from the Board of Licensure in Medicine and Gordon Smith and Andrew MacLean from MMA (both attorneys).

Handling patients use of narcotics continues to be a difficult issue in many medical practices.  Adequately treating chronic pain while not contributing to addiction and diversion requires a delicate balance.  Let this experienced faculty assist you and your practice in this difficult area.

The MMA conference space has a capacity of about 40 persons classroom style, so call today for your space. (622-3374).

Update on MaineCare MECMS Issues: Your Input Needed
DHHS officials provided an update on MECMS to the Legislature's Joint Standing Committee on Appropriations and Financial Services last Thursday.  In the Department's own words, "MECMS continues to trend toward more stable claims processing performance in recent weeks."

84-87% of new "clean" claims are being adjudicated (paid or denied) as of last week and this percentage apparently exceeds the percentage of claims that were successfully adjudicated in an average week under the previous MMIS system.  The number of suspended claims is also decreasing, week by week, with the total down to 347,181 as of the week ending Sept. 25.

However, the system is still doing poorly on the recycled claims with only 6.14% of over 100.000 recycled claims last week paid.  Nearly 70% were suspended again and the other 25% were denied.  In addition, the Department still has not been able to advance the planned date for processing of the Part B cross-over claims now scheduled for February.

Maine Hospital Association officials sent a letter to the Appropriations committee disputing the numbers relative to claims submitted by Maine hospitals.

MMA received a request from DHHS officials last week to provide any information available, even anecdotal information, relative to actual costs incurred by physician practices directly due to the MECMS problems.  These costs could include temporary labor, interest costs on borrowing and the additional costs associated with submitting claims multiple times.  If you have ANY information you are willing to share, please send it today to Gordon Smith via gsmith@mainemed.com.

MMA continues to ask the state to compensate practices for these additional costs. [return to top]

Time Ticking Away to File Your Claim in the Wellpoint/Anthem Class Action Settlement Fund
To be a claimant in the Wellpoint/Anthem Settlement Fund, you must mail in your claim form by Nov. 17, 2005.  Active, retired or estates of deceased physicians who treat or treated Anthem patients since 1990 are entitled to a portion of the Settlement Fund.  To access the necessary form and settlement information, go to: http//wellpointphysiciansettlement.com/documents.htm [return to top]

Letter from a Medical Volunteer in New Orleans
(Editor's Note:  In appreciation for all the volunteer work Maine physicians and other health care providers are doing in the areas affected by Hurricane Katrina, we are publishing the following first hand account sent to friends from Maine psychiatrist Michael Tofani, M.D.)  

                            Date: Mon, 19 Sep 2005 21:30:29 -0400

I am about to end my two week rotation here outside of New Orleans.

On arrival I lived with about 150 others in a local homeless shelter. In fact every public buiding with floor space is being used for housing. The guy on the next cot is a professor of psychiatry at Yale, MD, PHd all kinds of publications and brilliant but he had not done front line clinical work in years. We learned a great deal from each other and I am sure we will be friends for a long time.

Two VA medical centers were taken out by the storm, one in New Orleans and the other in Gulfport , Miss. Most of those patients came here. My first day the hospital had 97 admissions... and that was after the initial influx. The census on all of the med-surg units nearly tripled over night. The psych dept folded their two 30 bed units into one to provide housing for evacuees so the acute unit ended up with 54 patients and 41 beds. After three days at the shelter they moved me on to the unit and thatís where I have lived since. It certainly cut down on the commute.

I covered inpatient consultations and some out patient services. I also got referrals from the three local shelters. These were challenging due to the intensity of the emotional pain pouring from parents separated from their children. Social workers from all over the country were here working 24/7 tracking family members, making the calls, and finding the people, often in another state. Once the "find" was made a call went out to local church and civic groups and within minutes a community member shows up with a vehicle to take the parent to the child and bring them back. The reunions helped bring some happiness to the shelters.

Many in the shelters found themselves going through an unanticipated detoxification from polysubstances. That was a difficult management issue and I now know I felt a little panic at times, but if I needed an inpatient bed I got one in any one of five states... no questions asked. It is ironic that it was easier to get someone in the hospital than it has been at home for years. Most of the people I saw came from New Orleans and many had, aside from their psychiatric illness, bilateral cellulitis of both lower extremities. The organism was thought to be a variety of Vibrio that usually causes GI problems but I guess the water got nasty in the city.

I was impressed from day one by how kind people are to one another here. I have not heard a bitter word from anyone, patients or staff. It was not uncommon to do a consult on a floor and discover that the attending was here from Anchorage, the nurse was from New Hampshire and the social worker was from Chicago. The head nurse would take it all in stride and staff was pleasant and efficient. The hospital rolled out and scrubbed up some old crank hospital beds and some of the younger nursing staff did not know what the handle was for!

The histories were horrific and it is a testament to the resilience of the human body and the human spirit that people were able to summon the bravery to survive and care for each other.

Saturday I accompanied a convoy into the city to take VA employees to get their cars from the garage. We were only allowed in under escort and the trip was very emotional. As we approached the New Orleans, the trees of the wetlands became speckled with small bits of the city looking like tinsel on a discarded Christmas tree. Then gradually the trees were bent over and had larger items caught in them. suddenly the trees were straight upright, stripped of their bark and cut off about ten feet above ground as if some giant bush hog had come through.

Everyone was silent until Lake Pontchartrain opened up in front of us and there was a collective sigh "we're home" from the people on the bus.

The only other vehicles were military and helicopter were overhead at all times. The outskirts of the city were frightening. Strip malls, shopping centers, motels, gas stations but not one person in sight. The highway was cluttered with small boats now resting on the mud leaning against retaining walls with the brown high water mark about ten feet above them. I-10 dips down to clear a number of overpasses just before entering downtown. As it rises, the Superdome comes into view and then we reach the elevated section where so many people suffered waiting for rescue. The remnants of their battle to survive speaks to the desperate chaos of the situation and the extreme bravery of the people.

The VA hospital sits in a cluster of four other medical centers. The damage was severe and all are shut down. The streets are filled with debris and everything is covered by a fowl smelling brown/black slime which makes it difficult to walk . The staff who spent five days in those hospitals did remarkable things to save lives. I have listened to the first hand. Some staff had put some of there cherished possessions in their cars before going to work that last day before the storm. It was good to see them smile as they drove out of the garage.

The trip back was lighter. I was the only passenger on a bus for sixty! We had a full siren, flashing light escort for our fifty car caravan with state troopers holding open intersections and screaming down lanes on both sides of us. They seemed to be having a good time.

Leaving tomorrow is going to be bittersweet for me but it is time to leave. . The two week rotation is necessary to avoid fatigue, I guess. I haven't been frightened or felt this tired since I was an intern. But I wasn't alone and I was surrounded by good people. I guess I think most people are good. When you ask someone how they are here they respond: "I be blessed.

Mike Tofani, MD [return to top]

Anthem Proposes More Rate Increases for Companion Plan and HealthChoice
Anthem Blue Cross Blue Shield of Maine is proposing an average rate increase of 13.6% for about 39,000 Medicare Companion policyholders.  The plans, which last increased 3.4% in 2004, cover gaps in the Medicare program.

Rate increases averaging 15.5% are also proposed for another 35,000 people enrolled in the HealthChoice program.  Rate increases are subject to approval by the state insurance superintendent, who will take public testimony on the Medicare Companion Plan on Oct. 17 and the HealthChoice increase on Nov. 9.

It was also reported last week that the Attorney General's office was likely to intervene in the hearings on behalf of consumers. [return to top]

Follow-up On Aetna and Cigna Specialty Networks; Meeting Oct. 19th, 6:30p.m.
There was a lot of interest in the presentations by representatives of Aetna and Cigna on their announced specialty networks made at the MMA Payor Liaison Committee meeting on Sept. 21.  Because there was not time to discuss the proposals after the presentations were made, the Committee voted to meet again on the evening of Oct. 19 (Wednesday) to examine the proposals in more detail.  Many physicians have now had an opportunity to go to the respective web sites to see if they are in the preferred network or not.

Although the preferred networks will be offered first only to self insured employers, as an option attached to their existing benefit package, many practices are concerned that that if they are not in these preferred networks, other tiered-products may also be denied their participation.

Any member wishing to attend the Payor Liaison Committee meeting on the 19th is invited to do so.  Just call Chandra Leister at 622-3374 or via e-mail to cleister@mainemed.com so that we will expect you and have plenty of dinner available. [return to top]

Maine Health Forum a Valuable Resource

  • Looking for resources to help provide access to care?
  • Need information on Medicare D?
  • Want to voice your opinion about Dirigo?

Visit the Maine Health Forum (www.mainehealthforum.org) for all the latest in health care news, information, and opinions. Sponsored by Franklin Community Health Network, the Maine Health Forum is part of FCHN's efforts to foster informed dialogue throughout the process of developing creative, collaborative and practical ways of providing high-quality, cost-effective health care. [return to top]

Dirigo Health Board Declares Savings of $136.8 million From Dirigo Health Initiatives
With only Maine State Chamber President Dana Connors dissenting, the Dirigo Health Board of Directors made its first determination of savings under the Dirigo Health reform initiatives on Sept. 14th, finding that the program had resulted in $136.8 million in savings.  This number is hotly disputed by the business community and will be the subject of a hearing before the Bureau of Insurance Oct. 24 and Oct. 27.  The Superintendent has indicated his intent to announce a decision by Oct. 29.

If the Superintendent of Insurance finds that the Dirigo Board's methodology is sound, the law provides that a "savings offset payment" (SOP) of up to 4% of paid claims can be levied on all health insurance premiums in the state.

Of particular interest to hospitals and physicians is the inclusion in the estimated savings of $12.3 million in increased physician fees paid by MaineCare.  The physician fee increase was an item worked on by MMA and others for over twenty years, and it would be a stretch to call in a Dirigo initiative.

The business community is also concerned that the methodology proposed by the Board only looks at those hospitals that saw some savings or reduction in their costs, and does not include those hospitals that experienced an increase.

MMA has some concern that if the full 4% is assessed, the health plans may try to get this amount from the providers in new contract negotiations, notwithstanding that cost increases for many items, including certainly professional liability insurance, have more than offset any benefit from the modest physician fee increase under MaineCare.  And let's not forget about the pending Medicare reduction of 4.3% come January 1, 2006.

MMA will report on the SOP hearings in MMWU. [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 www.acscan.org. [return to top]

All Electronic Medicare Claims Must Be HIPAA Compliant Beginning Tomorrow

Starting Oct. 1, Medicare carriers will no longer accept electronic Medicare claims that do not meet the guidelines required by the Health Insurance Portability and Accountability Act (HIPAA). Non-compliant claims submitted to Medicare on or after Oct. 1 will be rejected and returned to the provider. Although HIPAA transaction and code-set regulations took effect on Oct. 16, 2003, the Centers for Medicare and Medicaid Services (CMS) implemented a "contingency plan" that allowed more time for providers to make the transition to HIPAA-compliant billing systems. CMS decided to end the contingency plan because most physicians are now submitting compliant claims. In June 2005, 96 percent of physicians were in compliance, compared to only 80 percent to 85 percent in 2004. For more information:


(Acrobat Reader required)

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CMS Director Sees Possible Physician Quality Reporting Initiative in 2006
CMS Administrator Mark B. McClellan, M.D., M.B.A. participated in a hearing on physician quality before the House Ways & Means Committee Health Subcommittee on September 29, 2005.  In comments to the Subcommittee and to reporters afterwards, McClellan said that the agency may be prepared to begin a voluntary Medicare physician quality reporting intiative in early 2006, an effort that would lead to a pay-for-performance system for doctors.  McClellan told the Subcommittee that P4P was the best way to increase physician pay and to improve the quality of physician care at the same time.

During these discussions, Dr. McClellan also addressed the SGR situation.  He said that CMS may not make a decision about removing prescription drugs from the SGR formula until at least November when CMS is expected to publish the final 2006 Medicare payment rule for physicians.  Once again, Congress is considering a two-year temporary fix in the Medicare physician payment formula, for 2006 and 2007.  A 1.5% increase for two years will cost $20 billion over 5 years, according to a House Republican staffer.

Dr. McClellan told the Subcommittee that CMS is translating quality measures into a system of temporary "G-codes" as a means of reporting the measures without imposing a significant new reporting burden.  Because CMS is building upon the current billing system, the agency's leadership believes it can begin the quality reporting effort in 2006.

You can find more information about the subcommittee hearing on the web at:  www.waysandmeans.house.gov/.

Earlier in the month, CMS reported that Medicare Part B premiums will increase approximately 13% in 2006, following a 17% increase last year.  The premium for 2006 will be $88.50 per month.  The increase is necessary to cover increased costs for physician services, DME, and physician-administered drugs.  CMS said that rapid growth in the intensity and utilization of these services, especially physician office visits, lab tests, minor procedures, and hospital outpatient services, made the increase necessary. [return to top]

State Does Not Expect Flu Vaccine Shortage

Maine Department of Health and Human Services (DHHS) Public Health office does not anticipate a shortage of influenza vaccine this year.

DHHS is recommending that the following priority groups receive injectable vaccine before Oct. 24:

  • People over 65 with or without underlying health conditions;
  • Residents of long-term care facilities;
  • People aged 2 to 64 with underlying health conditions;
  • Children aged 6 to 23 months;
  • Pregnant women;
  • Health care personnel who provide direct patient care; and
  • Household contacts and out-of-home caregivers of children under six months.

All others wishing to receive vaccine should be able to after Oct. 24. The state is encouraging all eligible health care professionals under age 50 to consider taking the live nasal flu vaccine (Flu Mist) now.

Posters detailing ways to prevent influenza by washing hands and covering coughs are available at mainepublichealth.gov, as are further details about influenza in Maine.

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Muskie School's Forum for Health Care Leaders

The Graduate Program in Health Policy and Management at the Muskie School of Public Service is sponsoring a conference on quality monitoring and improvement. This 1Ĺ day conference will describe current trends and initiatives in both Maine and nationally, the importance of leadership and teaming at all levels within an organization as well as informational and administrative strategies that can be brought back to your organization.

The conference is organized around an instructional format that encourages participation, networking and application of lessons learned to each participant's individual organization.

Join us on Monday, October 17th at the beautiful USM conference facility in Freeport Maine. More specific information can be found at our website: http://muskie.usm.maine.edu/events/healthcare/index.jsp

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Employer Healthcare Costs Will Rise More Slowly in 2006

Health care expenses for U.S. companies will rise 8 percent next year, a smaller increase than in recent years, according to the 17th annual Towers Perrin Health Care Cost Survey released yesterday. Employers will pay about $600 more per employee in 2006, and they will pass about $155 of that increase to their employees, a 10 percent rise from 2005. While the rate of increase over the last two years has dropped from the double-digit increases of years past, sustained increases at this level are still a burden for most employers. Employers are paying 64 percent more for health care than they did five years ago. In flat dollar terms, next yearís gross health care expenditure is expected to rise by an average of $597 per employee, to an average total cost of $8,424órepresenting a 140 percent increase over the last 10 years. For more information

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