January 30, 2006

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MMA President-Elect/ MaineCare on MaineWatch Friday, Feb. 3
MMA President -Elect Kevin Flanigan, M.D. will be featured on MPBN's "Mainewatch" this coming Friday, Feb. 3, barring any exceptional news event in Maine that might bump the program which will be taped on Wednesday. The one-half hour television program, to be shown at 8:30 p.m. on Friday, will discuss the current status of the MaineCare claims management system. The MECMS system on January 21 reached the one year anniversaryof its initiation. While gradually improving, the system is not expected to be fully stabilized until mid-year. Crossover claims for Part B are now not expected to be paid before April. These claims have not been paid, unless reduced to paper, since December of 2004.
MPBN host Charlotte Albright (formerly Charlotte Renner) will moderate the discussion which is expected to include a representative of DHHS.  If  DHHS declines to appear or is unavailable, the entire one-half hour would then feature an interview with Dr. Flanigan about MaineCare and other issues facing Maine's physicians.  Dirigo Health, Medicare, liability and the non-competitiveness of the commercial insurance market will be discussed unless the entire program ends up being devoted to the MaineCare issue.

Dr. Flanigan is double-boarded in pediatrics and internal medicine and practices privately in Pittsfield.  He has active medical staff privileges at Sebasticook Valley Hospital, also located in Pittsfield.

"Great Grades for Maine" for Tobacco Control Featured in Jan. Newsweek
A January issue of Newsweek Magazine featured in its "Periscope" section the efforts of the state of Maine in tobacco-control.  With a title of "Great Grades for Maine", the section features a still photo of one of the anti-smoking ads prepared by the Partnership for a Tobacco-Free Maine and notes that no state previously had ever received straight A's for its efforts until Maine did so this year.  In the 2005 State of Tobacco Control study issued in January by the American Lung Association, Maine got top grades in all four areas:  cigarette taxes, youth access, smoke-free air and anti-tobacco spending.

Maine sets aside $15.3 million for tobacco prevention and control annually, which is 36 percent more than the minimum recommended by the Centers for Disease Control and Prevention.  Although there has been some nibbling away at Maine's share of the tobacco settlement funds, there will be an effort to restore the full-funding in this year's supplemental budget.

Maine's increase in the cigarette tax in 2005 from $1.00 per pack to $2.00 per pack certainly contributed to the high ranking, the best in the country, as our tax is now $1.08 more than the national average.

In 1997 nearly 30 percent of Maine's adults smoked; by 2005 just 21 percent did.  While this is still higher than the national adult rate of 20%, the reduction is the largest seen in any state recently.  Among high-school students, the reduction is even more dramatic with a 60% reduction to 16.2%.

ALA's CEO John Kirkwood summed it all up in the following statement, "Maine's the poster boy for the country.  It's been very aggressive, and the policies are having an impact."

MMA is a founding member of the Maine Coalition on Smoking OR Health which was established in 1980.  Congratulations to the Coalition for its extraordinary efforts.  MMA and the Coalition continue these efforts this week with testimony Tuesday in favor of strengthening the law regarding smoking in private clubs.  MMA EVP Gordon Smith will present the Coalition's testimony of both L.D. 1901 An Act to Amend the Law Regarding Smoking in Private Clubs (which would weaken the law) and L.D. 1926 An Act to Clarify the Workplace Smoking Laws (which would strengthen the law).  The testimony will be presented at 1:00pm before the Health and Human Services Committee. [return to top]

Maine Report on Future of MaineCare Available; Federal Commission Update
The final report of the Blue Ribbon Commission on the Future of MaineCare, established by legislation in the first session of the 122nd Maine Legislature, is available on the web at:  http://mainegov-images.informe.org/legis/opla/mecarerpt.pdf.

The federal commission reviewing the Medicaid program met on January 25, 2006 to continue its work on recommendations to make the program sustainable in the long term.  The commission is scheduled to make a second report by December 31, 2006.  At this meeting, the group focused on separating the country's long term care financing from the Medicaid program, reviewing the disproportionate share hospital (DSH) program, and considering Medicaid subsidization of the purchase of private health insurance.

Diane Rowland, Executive Director of the Kaiser Commission on Medicaid and the Uninsured, told commission members that 4% of those covered by Medicaid consumed 48% of program expenditures in 2001.  Nina Owcharenko, a policy analyst with the Heritage Foundation, advised the group that Medicaid now represents about 22% of state budgets.

Former Maine Governor Angus S. King, Jr. (I) is the Vice Chair of the commission.

You can find more information about the federal commission on the web at:  http://www.cms.hhs.gov/faca/10_mc.asp#topofpage[return to top]

Physicians' Day at the Legislature to Highlight Quality Improvement Efforts
The MMA and the Maine Osteopathic Association will again host a Physicians' Day at the Legislature on Thursday, March 2, 2006 at the Maine State House from 9 a.m. to approximately 3 p.m.  The focus of last year's Physicians' Day was professional liability and legislation submitted on behalf of the Coalition for Health Care Access & Liability Reform.  This year the two professional societies will highlight the profession's efforts to improve the quality of medicine in Maine. 

All physicians are invited to participate in this event.  You are welcome to simply attend to mingle with legislators.  Specialty societies may exhibit, if they wish.  Any physician involved with a quality improvement initiative is encouraged to coordinate an exhibit to educate legislators about that quality initiative.

A more detailed agenda will be available closer to the event, but the following is a tentative schedule for that day:

  • 9 a.m. to 10 a.m.:  Gather at State House Hall of Flags, mingle with legislators; refreshments available;
  • 10 a.m. to noon (approximately):  House & Senate are in session;
  • noon to 2 p.m. (approximately):  Meetings with legislative leadership; refreshments available;
  • 2 to 3 p.m. (approximately):  Blaine House Tea with Governor Baldacci (tentative).

For more information, please contact Charyl Smith, Legislative Assistant, at csmith@mainemed.com. [return to top]

Congress Considers Medicare Part D Problems; Local Resources Available for Physicians
The new Medicare Part D prescription drug benefit became effective on January 1, 2006.  Beneficiaries, physicians, and other health care providers are adjusting to the new program.  Maine Legal Services for the Elderly, Inc. has a wealth of information about the new program oriented toward the provider community on its web site at:  http://www.mainelse.org/partd/Providers.

The web site also is a good resource for your patients.  It lists the organization's toll free assistance line, 1-800-750-5353.

Twenty-six states, including Maine, have stepped in to pay drug costs for individuals eligible for both Medicare and Medicaid ("dual eligibles").  Last week, CMS Administrator Mark McClellan, M.D. said that the federal government can without additional legislation, and will, reimburse states for drug and administrative costs incurred by the states.  McClellan and DHHS Secretary Michael Leavitt last week briefed Senate Finance Committee members on the Department's response to problems with the Part D benefit.  Secretary Leavitt told committee members that HHS officials are focusing on seven problem areas in the implementation of the new benefit:

  • dual eligibles' problems getting drug coverage;
  • data transmission problems between the states and CMS;
  • customer service problems, including difficulty in reaching telephone assistance;
  • problems with health plan compliance with the CMS rules on providing the benefit;
  • lack of training for pharmacists;
  • state reimbursement for providing drug coverage;
  • anticipation of future problems, such as beneficiaries who wish to switch plans.
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Two Coding Center Courses Being Offered Beginning in February
The Coding Center continues its popular education series with the following offerings:

     E/M Chart Auditing:  Offered six consecutive Thursdays from 8:00am to noon Feb. 23 through March 30 at the offices of the Maine Medical Association in Manchester, Maine.  The instructor is Jana Purrell, CPC, Director of the Coding Center.  24 CEU's are pending from the American Association of Professional Coders.  The cost is $600 per student.


  • Understand the elements of an audit
  • Issues surrounding documentation
  • Step by step auditing:  the key components
  • Helpful information about a variety of visit codes
  • Develop a template for your audit program


  • Basic knowledge of E/M principles
  • Experience with chart auditing helpful but not required
  • Coding Certification NOT necessary
  • Please bring CPT books to class!

AAPC Approved Professional Medical Coding Course:  Offered Wednesday mornings, March 1, 2006 through June 7, 2006 from 8:00am to noon at the MaineHealth Audit and Compliance office, 901 Washington Ave., Suite 104, Portland, Maine.   The certification exam will be held on Tuesday, June 13th at the same location.

This 15 week course, developed by the American Academy of Professional Coders (AAPC) will take students through the current 2006 Current Procedural Terminology (CPT), International Classification of Disease (ICD-9), and HCPCS books to address proper use and proper coding.  The class is intended to educate students on proper techniques and rules of coding and will also prepare them to sit for the AAPC Certified Procedural Coder (CPC) exam.

The cost is $1500 inclusive and includes the fees for the exam.  There is a prerequisite of two years coding experience.

Persons interested in either course may receive registration materials from the Maine Medical Association by calling 207-622-3374 and asking for the Coding Center. [return to top]

Date Changes in "First Fridays" Education Programs
Because of speaker availability, the Feb. 3 program on Physician-specific data is being postponed and will now be part of a program previously scheduled for June 2nd on quality.  Because of the program being offered by the Maine Chapter of the American College of Surgeons on June 2nd, we have moved the June 2nd program on data and quality to Friday, May 5.  The Coding Center program on Common Coding Errors, originally scheduled for May 5th will be held on June 2nd.  The April 7 offering on HIPAA will be moved to April 14, again because of speaker scheduling issues.

We have appreciated member and office practice support for the "First Fridays" educational programs offered at MMA and apologize for these changes in scheduling.  You may always receive the latest information on the schedule of seminars by simply calling MMA at 622-3374 or by e-mailing Gordon Smith at gsmith@mainemed.com or Gail Begin at gbegin@mainemed.com. [return to top]

Assessing Medical Practices for Quality; Any Volunteers?
MMA's Committee on Peer Review and Quality Improvement met on Jan. 17 and heard a presentation from Dennis Shubert, M.D. and Chris McCarthy from the Maine Quality Forum.  The Forum has asked MMA and the Maine Osteopathic Association to partner with it on a project involving asking medical practices in Maine to self-assess the quality of the care provided based on a series of metrics developed from various sources.  The assessments would be strictly voluntary and most importantly, the data derived shared only with the practice except for aggregate data that would be de-identified. At least initially, we would be working only with primary care practices.

Knowing how difficult it is for a practice to find the time to do such an assessment, the work would essentially be done for the practice by a health professional (probably a nurse hired to work on the project).  There would be no cost to the practice.  In fact, there may be sufficient funds to pay a practice for some of the administrative time spent on the project (which should be minimal given the role of the outside reviewer).

Before MMA enters into a potential contract to partner with the forum on this project, we are seeking practices to volunteer to be one of the practices participating.  This may be an ideal opportunity for some of the smaller primary care practices not currently participating in Pathways to Excellence.  Any practice that might be so interested should e-mail Gordon Smith at gsmith@mainemed.com. [return to top]

For Women Physicians Only: A Seminar Designed for You: March 3, 2006
Well over one-half of medical students currently enrolled are women.  Over one-half of the applications to medical school are from females.  In some specialties, notably Ob-Gyn, the percentage of women is even higher.  The Maine Medical Association has, for some time now, recognized the need to better relate to our women members.  As part of this effort, we are pleased to present a seminar designed just for women, entitled; "Negotiating for the Future:  Strategies, Tools and Skills You Didn't Learn in Medical School," presented by Harriet Nezer, PhD.

This highly interactive, women-only, seminar focuses on the power of aligning personal and professional goals and priorities with one's vision and values.  It will be presented on Friday morning, March 3rd at the offices of MMA in Manchester, Maine.  Enrollment will be limited to forty persons and the registration fee is only $60 which is the regular fee for our First Friday's CME programs.

Dr. Nezer is the founder and prinicipal of Metamorphosis Consulting and has over 20 years experience as an entrepreneur, learning specialist, consultant and coach assisting clients in health care, public safety, higher education and other fields.  Dr. Nezer earned her Doctorate in Education and Public Administration from Boston College and is currently adjunct professor and thesis advisor for Emmanuel College's Masters in Management Program.

Registration materials will be included in an insert in your Jan.-Feb. issue of Maine Medicine, but you can reserve a space today by calling Gail Begin at 622-3374 (ext. 210) or by e-mailing her at gsmith@mainemed.com. [return to top]

The Coding Center's Coding Tip of the Week
Use of Modifier 24: Unrelated E&M Service by the Same Provider During a Postoperative Period--

An E&M service coded with modifier 24 indicates a visit in the postoperative period that is unrelated to the original procedure (surgery). This modifier is only to be used with an E&M visit. It is not valid when used with surgeries or other types of services. It is not used with tests done in the postoperative period. When using modifier 24, ensure that the supporting documentation clearly indicates that the E&M visit is unrelated to the original procedure. [return to top]

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