December 26, 2005

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Procedural Technicalities Halt Medicare Physician Fee Fix
Because of some technical amendments to the budget reconciliation legislation made in the Senate, the Congress adjourned for the holidays without accomplishing final passage of the law which would have negated the pending 4.4% decrease in the Medicare fee schedule scheduled for Jan., 2006. Unfortunately, the House must pass the Senate version of the bill when they return to Washington late in January, in order for the cut to be averted.
Despite a majority of both the House and Senate voting in support of the legislation which would have restored the cuts, the fix will have to await a final vote by the House as the Senate added some technical amendments to the bill.  Because any legislation must be passed in identical form by both houses of Congress prior to the bill being presented to the President for his signature, final enactment has been delayed.  We assume, at this point, that the reduction will take effect Jan. 1 as planned and that the existing fee schedule will be restored early in the year.

There is some concern that the House will not pass the bill, as the original vote was very close and there are several interest groups opposing final passage.  On the other hand, most observers and the media are calling the final House action to be take a mere formality.  Only time will tell. 

The bill passed by the Senate and House freezes physician payments for one year and cuts Medicaid by $4.7 billion over five years, which is significantly less than proposals made earlier this year.

Coalition for Health Care Access and Liability Reform Establishes Board
Last Tuesday, the Board for the Coalition for Health Care Access and Liability Reform held its first meeting and focused on preparation of a long-term plan to advance medical liability reform in Maine.  The Maine Medical Association, The Maine Osteopathic Association and the Maine Hospital Association have joined together to establish a Board for the Coalition consisting of two MD's, two DO's. two hospital CEO's and three staff from the organizations.  Board members are:

  •        Lee Thibodeau, M.D.
  •        Hector Tarraza, M.D.
  •        Douglas Jorgenson, D.O.
  •        Thomas DeLuca, D.O.
  •        Roy Hitchings
  •        Vince Conti
  •        Andrew MacLean, Esq.
  •        Mary Mayhew
  •        Kellie Miller

The purpose of the Coalition is to advance the cause of tort reform in Maine through patient education, grass-roots advocacy and lobbying.  A website for the coalition is under construction and educational materials for physicians and patients will be developed.  Every physician and hospital in the state will be invited to join the coalition and additional advisory committees may be organized to provide for participation by other provider groups, the business community and insurers.

Given the experience with the tort bills presented to the legislature in 2005, the three associations have concluded that only a sustained effort over time will create the circumstances necessary to pass liability reform in Maine, despite the clear public support for such reform.  To match the efforts of the personal injury lawyers who aggressively oppose even modest reforms aimed at protecting patient access to healthcare, significant efforts must be made to involve physicians, hospitals and patients in the campaign.  As many other states pass significant reform, including this past year South Carolina, Georgia, Mississippi, Missouri and Illinois, Maine will find it harder to attract and retain physicians.  The problem will be even more significant given the shortage of physicians predicted over the coming decade.

Physicians wishing to be involved  in the Coalition may contact Andrew MacLean at MMA via e-mail to

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MMA Ad Hoc Committee on Health System Reform Meets
MMA's ad hoc Committee on Health System Reform met last Wednesday night in order to review the existing White Paper on Health System Reform.  The original White Paper, which endorses the concept of universal access to coverage, was first released in May of 2003, prior to enactment of the Dirigo Health legislation.  MMA President Jacob Gerritsen asked the Committee to meet to review the Paper and consider any changes in it, as well as to specifically consider an employer mandate for employers of significant size.

At the meeting, Deborah Friedman and Rick  McCarthy from the office of Senate President Beth Edmonds presented legislation prepared by the Senator that would require employers of more than 50 employees to provide information to the state regarding the medical insurance coverage offered.  Committee members voted to recommend to the MMA Legislative Committee and the MMA Executive Committee that they support the legislation.

Committee members volunteered to serve on three different subcommittees to look at the issues of an individual mandate, an employer mandate and potential insurance reforms.

The Maine Osteopathic Association joined in the Committee deliberations and will continue to participate in the subcommittee work.

MMA members wishing to participate may communicate with Dr. Gerritsen at, Gordon Smith at or Andrew MacLean at

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MaineCare Claims Processing Update (MECMS)
Both the Provider Advisory Committee and the MECMS Technical Advisory met on Dec. 21 to hear updates on the Department's plans to process crossover payments and to begin recouping interim payments in January.  The Department has stated that it will not attempt to recoup any overpayments until a provider is receiving regular claim payments and is ready to reconcile the interim payments with claims submitted. 

While the weekly metrics shows that more claims are being successfully put through the system, about 20% of the claims are being denied and another 10% put in suspension.  Nearly 300,000 claims remain in suspension although the total number does decline each week.. MMA continues to advocate for a quicker fix and has urged that more state resources be dedicated to the problem.

"While we greatly appreciate the effort that Deputy Commissioner Hall and others are making toward a permanent fix, it has been nearly a year now and the system is not getting fixed fast enough to avoid extreme hardship on the part of many providers", said Gordon Smith, MMA Executive Vice President.  "After a year, MaineCare providers of all types want to know that there are three shifts of workers in the DHHS building working 24 hours a day to fix the problem.  The credibility of the MaineCare program is at stake and will be difficult to restore"', he added.

The Department is expecting to process Medicare Part A crossover claims in late January and Part B claims in March.  A team has been working on these payments since November and paper claims are being paid currently.

A series of letters regarding interim payments will be sent to all providers early in the year.  Providers will be given an opportunity to elect how they would like to pay any alleged overpayment back.  Appeal rights will also be explained in the letters.

The Department has also circulated a draft memo regarding how it will pay for claims that have not been properly processed within the one year time frame from the date of service.  A final memo explaining this issue will be sent to providers in early January. [return to top]

Jan. 1, 2006 First Friday Program on Medical Practice Compliance
It is not too late to register for the next educational program in the "First Fridays" series.  The three hour program on compliance plans in a medical office will be held on Friday morning, Jan. 6 at the MMA office in Manchester.  Speakers are Michael Cunnif, Esq., Kenneth Lehman, Esq., and Dennis Smith, Esq.  Attorneys Cunnif and Lehman are experienced healthcare attorneys and Mr. Smith is an assistant attorney general assigned to the Board of Licensure in Medicine and the Board of Dental Examiners.

While compliance plans are normally considered relevant to the issue of Medicare reimbursement, the intent of the seminar is to consider medical office compliance in a broader context.  A compliance plan for your office today should include protocols to ensure compliance with Board of Licensure rules, all federal and state laws, medical ethics and regulatory requirements, as well as reimbursement issues such as the Medicare anti-kickback laws and  Stark provisions. 

The program will be held from 9:00am to noon and the $60 registration fee includes breakfast and al the course materials. 

First Fridays will be held the first Friday of every month at the MMA office.  To register use the form that was included in your Maine Medicine or contact Gail Begin at MMA via e-mail to [return to top]

Joint Commission Sentinel Event Statistics Update
As of Sept. 30, the Joint Commission on Accreditation of Healthcare Organization's sentinel event statistics have been updated and are available on the Joint Commission website,  Since the sentinel event database was implemented in January 1995, the Joint Commission has received 3,343 reports of sentinel events.  A total of 3,462 patients were affected by these events, with 2,554 or 74% of those resulting in patient death.  The 10 most frequently reported sentinel events are:

  • Patient suicide
  • Operative/post-operative complication
  • Wrong-site surgery
  • Medication error
  • Delay in treatment
  • Patient fall
  • Patient death or injury in restraints
  • Assault, rape or homicide
  • Perinatal death/loss of function
  • Transfusion error
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Task Force to Study Homeland Security Needs to Hold Public Hearing in Saco, Jan. 9
The legislatively established Task Force to Study Homeland Security Needs will hold a public hearing focusing on emergency preparedness in health care from 3:00pm to 9:00pm, Monday, Jan. 9 at Saco City Hall.

The task force is charged with evaluating Maine's homeland security and emergency preparedness needs.  This is the fourth of six meetings of the task force and the second hearing to focus on health care. 

The hearings include a panel invited to discuss the issues associated with emergency preparedness.  Invited to participate on the panel in Saco are  Larry Hopperstead, MD, chief medical officer at Central Maine Healthcare, Ted Lewis, CEO at Parkview Adventist Medical Center, Dora Mills, M.D., Director, Maine Center for Disease Control and Prevention and Art Cleaves, Director, Maine Emergency Management Agency.

Lawrence Mutty, M.D., immediate Past President of the Maine Medical Association serves on the Task Force.

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Happy Holidays and Happy New Year from the Maine Medical Association
MMA takes this opportunity to wish our members and their staff a most happy, healthy and prosperous New Year.  We appreciate your membership and involvement.

The Association has had a busy but productive year and will begin 2006 with a renewed commitment to serve the needs of Maine's physicians, as the organization has done for the past 152 years.  While we begin 2006 with a smaller staff than we started with in Jan. of 2005, your officers and staff are confident that we can continue to serve the members'  needs and operate under a balanced budget.

Thank you for your support. [return to top]

Dirigo Saving Offset Payment still in the News
The two percent fee assessed by the state on health insurers to help fund the Dirigo Health program continues to receive a lot of  public comment and media attention.  An  Associated Press story today appearing in the Blethen Newspapers states that some health insurers intend to add the assessment to premium rate increases already expected to average 8 to 16 percent.

While the Baldacci administration claims that the fee is justified because of the savings that Dirigo Health reform has generated, critics question whether the savings comes close to the $43.7 million claimed.  For instance, the administration, the Bureau of Insurance and the Dirigo Health Agency have included in the $43.7 million the MaineCare physician fee increase which took effect July 1, 2005.  Many observers have argued that the fee increase of $8.3 million  was long overdue and not related to Dirigo initiatives.  Inclusion of the increase in the SOP may result in insurers actually trying to "recapture" the amount of the increase by reducing commercial insurance reimbursements to physicians.

Insurers will either try to add the assessment to existing premiums or will try to recapture the amounts as noted above.  The Governor has endorsed legislation to be considered in January that would prohibit insurers from increasing premiums to cover the cost of the assessment.  Such legislation, if passed, would put even more pressure on health plans to recoup the "savings" through fee negotiations with hospitals, physicians and other providers. [return to top]

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