March 13, 2006

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Interested Parties Respond to Challenge to Improve Dirigo Health
Responding to a request from top Democratic leaders in the Legislature, a number of organizations put forth ideas the past week to improve the funding and operation of Governor Baldacci's Dirigo Health initiative. Among the proposals was one submitted by the Maine Hospital Association, the Maine State Chamber of Commerce and the Maine Association of Health Plans. The Maine Medical Association did not submit a proposal but continues to follow the legislative action on Dirigo with great interest.
The proposal submitted jointly by the hospitals, the health plans and the business community contained three major revisions:

  • Replace the controversial savings offset payment (SOP) with existing and new funding to provide immediate financial stability to Dirigo.
  • Repeal the statutory provisions regarding the savings offset payment.
  • Create an Independent Commission to focus on improving the Dirigo Health program's ability to meet the needs of Maine's uninsured population and to identify other public and private initiatives that would further the mutual goals of improving the affordability of health insurance and reducing the number of uninsured in Maine.

In the short-term, the group identified a one-time funding source to replace the 2006 SOP of $43.7 million with no reduction in enrollment and no new taxes to carry the program through March of 2007, at which time a sustainable, long-term funding mechanism would be put in place.  The one-time money would come from cutting the administrative expenses of the Dirigo Health Agency and eliminating plans to cover more people in MaineCare.  In addition, Anthem, the private carrier for DirigoChoice, would take full risk for enrollees in 2006, a move that could save the state funds.

The proposed Independent Commission would recommend a more sustainable, reliable approach to funding the Dirigo Health program, in addition to re-examining the structure of the program and its benefits.

Reaction to the proposal was mixed, with the Consumers for Affordable Healthcare expressing outrage and announcing a plan to have health plans use reserves and "excess profits" to fund Dirigo, along with an "excess compensation assessment on Maine's highest paid corporate executives in the health care sector."  MMA released a statement noting that the MHA, MAHP and the Chamber should be congratulated for coming up with some alternatives to the current funding, and stating that the original goals of Dirigo were laudable and should not be lost in the discussion over funding.

It will be difficult to reconcile the dramatically different view points in the four weeks left in the legislative session, a problem further complicated by election year politics.

In other Dirigo-related news, Republican lawmakers on Thursday (March 9) called for several changes to the program, including an end to the savings offset payment.  Outlining some basic Republican goals, Rep. Wesley Richardson of Warren urged a commitment to the private marketplace and to financial fairness to providers around the state, including specifically hospitals.  The Republicans stated that the program had become too dependent on public funds and that it could not sustain itself.

"We put a lot of energy and thought into this and we really think this is a proposal that can work," said Katherine Pelletreau, Executive Director of the Maine Association of Health Plans. 

Legislature Continues Work on Supplemental Budget and Hears More on MaineCare Problems
The Maine Medical Association and the Maine Osteopathic Association send a joint letter to Governor Baldacci this week expressing continued dismay with the slow pace of corrections to the MECMS problem.  Signed by MMA President Jacob Gerritsen and MOA President Thomas DeLuca, the letter was strong and to the point. 

The legislature's Appropriations Committee met on Friday to hear recommendations from the Health and Human Services Committee.  The members of the HHS Committee strongly defended the $4 million requested to reimburse providers for some expenses incurred by them as a result of the state's inability to process MaineCare claims in a timely manner.  There is still concern about support for the proposal by some members of the Appropriations Committee and MMA members and staffs are encouraged to contact Appropriations Committee members to discuss their individual MaineCare stories.  Members can contact legislators through the Legislature's website a

MMA representatives will meet this Thursday (March 16)  with top MaineCare officials as part of the bi-weekly meeting of the Governor's Advisory Committee. On the agenda will be the expedited processing of Part B cross-over claims submitted on paper, the continuing delay of electronic processing of such claims and a new problem with the processing of anesthesia claims.  The on-going recovery of interim payments will also be re-visited.  Perhaps most significant of all, will be an update on the slowdown of claims payments because of the shortage of funds.  Watch for the information coming out of this meeting in Maine Medicine Weekly Update next week, March 20. [return to top]

Applications Available for 2006 Rural Medical Access Program Support
Applications are now available from the state for physicians eligible for malpractice insurance premium subsidies through the state's Rural Medical Access program.  The Program promotes obstetrical and prenatal care in federally designated medically underserved areas and Health Professional Shortage Areas of Maine through assistance with insurance premiums for eligible obstetricians and family physicians.  To be eligible, physicians must be practicing in Maine as of May 1, 2005 and have malpractice insurance for prenatal care and/or obstetrical services.  The legislature last year increased the amounts of the subsidies available up to a maximum of $15,000. 

Eligibility is determined in two categories:

     1.  Physicians whose practices are located in federally designated medically underserved areas or Health Professional Shortage Areas, who practice at least 50% of the time in underserved areas, and whose practice includes at least 10% MaineCare clients.

     2.  Physicians whose practices are not located in federally designated medically underserved areas or Health Professional Shortage Areas but are located in Primary Care Analysis Areas of under 20,000 population and at least 50% of the visits are patients from federally designated underserved areas and/or MaineCare.

Applications are available from the state and must be returned to the Maine Office of Rural Health and Primary Care by May 5, 2006.  The state contact for applications or questions is Matthew Chandler, Manager, Maine Rural Health and Primary Care, #11 State House Station, 286 Water St., 6th floor, Augusta, Maine 04333-0011.  Tel. 287-5524.

The Program was established in legislation enacted as part of a liability reform bill in the early 1990's.  Since its establishment, hundreds of family physicians and obstetricians have benefited from the subsidies.  The program is essential to the survival of rural obstetrics, particularly for family physicians who would otherwise be dividing the higher liability premium by only a small number of deliveries. [return to top]

CarePartners Assistance Nears 4,000 Persons
A report released last week by the Muskie School (USM) on the CarePartners program states that the program has helped more than 3800 Mainers receive low-cost health care since it was established in 2001.  The program  operates in Cumberland, Lincoln and Kennebec Counties and includes both hospital and physician services.  The program was established by MaineHealth.

The program also has helped another 5,000 individuals apply for coverage by MaineCare, the Veteran's Administration or private insurers.

Both primary care physicians and specialists participate and to date, more than $12 million of medical care has been donated.  Pharmaceutical companies have also assisted, providing more than $5 million in free medication.

"This has been a program that can help fill the gaps in coverage and it is nice to see the participating physicians, hospitals and pharmaceutical manufacturers receive some recognition for it,  stated MMA President Jacob Gerritsen, M.D.   "The six free clinics in the state also provide an increasingly valuable service to non-insured patients.  At a time when the health care system is under great stress in Maine, the physicians, nurses and hospitals supporting these clinics also deserve recognition." [return to top]

MMA President and President-Elect in Washington for AMA Advocacy Conference
MMA President Jacob Gerritsen, M.D. and President-elect Kevin Flanigan, M.D., along with EVP Gordon Smith are in Washington D.C. Monday and Tuesday, attending the annual AMA Advocacy Conference  and visiting with Maine's Congressional delegation.  Governor John Baldacci will address conference attendees on Tuesday morning as part of a panel presentation on expanding access to care.  Other speakers include Senator Hilary Clinton and HHS Secretary Michael Leavitt. 

The major issue being discussed with representatives is Medicare payment.  Although Congress restored the anticipated 4.4% reduction in payments  this year, without further action, another 5% cut is scheduled for Jan. 1, 2007.  Unbelievably, the sustainable growth rate formula will produce cuts totaling 34% through 2015.  The AMA is advocating for a positive update of 2.8% next year as recommended by the well-respected Medicare Payment Commission (MEDPAC).  This shift of 7.8% would cost the government $17 billion even for a one-year fix.

MMA representatives will tell congressional representatives that it will simply not be possible to move the health care system in the direction being asked without additional resources.  Investments in technology, such as electronic health records, and quality improvement interventions (including chronic disease management) just are not realistic when payments from the largest payor in the country are reduced by a third.

Physicians have consistently faced Medicare updates which fall well below inflation, while other Medicare providers have  come closer to keeping pace with their costs through annual updates.

The issue of MaineCare will also be brought up, as Medicaid is a joint state -federal program and the federal government is financially supporting the MECMS system with an enhanced match approaching 90%.  The federal government did an assessment of the situation last August and determined that the system was worth its continued investment.  But another six months has now gone by without major improvement. [return to top]

Looking for a New Product or Service? MMA May Be Able to Help!
If you are looking for a new product or service, the Maine Medical Association may be able to save you some time.  The MMA Corporate Affiliate program was designed with our members in mind.  MMA staff has done the research, alleviating the need for our members having to spend their valuable time evaluating the options.  All our members need to do is remember that when they are in need of banking services, insurance, medical transcription, collections, billing, consulting services, car rentals or purchases, office products, travel assistance, medical supplies, telephone and internet access, legal services, real estate, marketing, recruitment, computers and information technology, payroll services, investment services, secure prescriptions, HIPAA Training, Coding assistance, etc., all they need to do is contact an MMA Corporate Affiliate. 

The Maine Medical Association currently has 102 Corporate Affiliates, all of which have been carefully reviewed for their quality, service, and pricing.  The complete list of MMA Corporate Affiliates can be found on the MMA website ( under Corporate Affiliates.  You can search by a particular product or service, or click "all" to view a complete listing.  At the bottom of the home page you will also find that a corporate affiliate is highlighted upon each entry into the MMA site.   Take a minute to discover the products and services available to MMA members....let your MMA membership work for you!   Should you have questions regarding the MMA Corporate Affiliate program, please contact Buell Miller, M.D. at 622-3374 ext: 228 or or Lisa Martin at 622-3374 ext: 221 or

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Annual Sentinel Event Report Available
The state's 2005 Sentinel Event Report is available at  The report, which is submitted annually to the Legislature, indicated 28 reportable events in 2005, up from 24 events in 2004.  Only one of these events occurred in a facility other than a hospital.

There were 20 unanticipated deaths, five losses of function and three incidents of wrong surgery. Thirty-five percent of the events involved patient falls, which was significant compared to the previous year, when no such events were fall related. [return to top]

American Cancer Society Offers Colorectal Cancer Prevention and Early Detection Seminar

Join the American Cancer Society and area health care providers for a timely educational presentation on colorectal cancer prevention and early detection.

Colorectal Cancer Screening: Prevention and Early Detection
An educational opportunity for health care professionals

Wednesday, March 29, 2006, 5:30 – 8:00 PM
Spectacular Events Center, Bangor, ME
Speaker:  Mark Lena, M.D., FACG,   Gastroenterology Associates of Eastern Maine

Thursday, March 30, 2006, 5:30 – 8:00 PM
The Senator Inn and Spa, Augusta, ME
Speaker: Phillip Amidon, M.D., FACP, Mid-Maine Gastroenterology

The event is free of charge and dinner will be provided.  For more information and to register for the event, contact Rob Werner at the American Cancer Society at or (603) 471-4138. Registration deadline is March 22, 2006.

Maine Medical Association Trust is accredited by the Maine Medical Association’s Committee on Continuing Medical Education to provide Continuing Medical Education (CME) to physicians.

Maine Medical Education Trust designates this activity for a maximum of 1.0 credits towards the AMA Physicians Recognition Award.  Each Physician should claim only those credits that he/she actually spent in this activity.

This program is presented by the American Cancer Society and is supported by an unrestricted educational grant from Pfizer, Inc.
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Medicare Beneficiaries Urged to be on the Look-out for Phone Scams

CMS warns seniors and people with disabilities to be aware of a scheme that asks Medicare beneficiaries for money and checking account information to help them enroll in a Medicare Prescription Drug Plan. This scheme is called the "$299 Ring" for the typical amount of money Medicare beneficiaries are talked into withdrawing from their checking accounts to pay for a non-existent prescription drug plan. Consumers can report these cases to their local law enforcement agencies or 1-877-7SAFERX (1-877-772-3379).  Medicare has received complaints from Indiana, Michigan, Pennsylvania, Massachusetts New Jersey and Georgia. Complaints have been made against a number of different companies, but authorities believe that the companies are the same and are typically based outside the U. S. As soon as CMS receives these complaints, they are investigated and referred to federal law enforcement authorities. No Medicare drug plan can ask a person with Medicare for bank account or other personal information over the telephone. No beneficiary should ever provide that kind of information to a caller. They should contact their local police department if they believe someone is trying to take money or information from them illegally.

  • No one can come into your home uninvited.
  • No one can ask you for personal information during their marketing activities.
  • Always keep all personal information, such as your Medicare number, safe, just as you would a credit card or a bank account number.
  • Whenever you have a question or concern about any activity regarding Medicare, call 1-800-MEDICARE.

In addition, legitimate Medicare drug plans will not ask for payment over the telephone or the Internet. They must bill the beneficiary for the monthly premium. Typically, that amount is set up as an automatic withdrawal from the beneficiary's monthly Social Security check. Beneficiaries may also opt to pay the monthly premiums in other ways such as writing a check or setting up automatic payments from their checking accounts. [return to top]

Coding Center Coding Tip of the Week
·Modifier 57:Decision for Surgery

  • When a patient is evaluatedfor a problem which is significant enough to result in immediate surgery or surgery within 24 hours, the physician can report his/her E/M visit, consultation, or initial hospital care code with a -57 modifier (decision for surgery) appended to the visit code

  • Medicare and most other payors consider this a decision for MAJOR surgery (90 day postop)

Questions? Call the Coding Center, 1-888-889-6597.

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