May 8, 2006

 
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U.S. Senate Vote on Medical Liability Reform Expected Tonight
The United States Senate is expected to vote tonight on two bills promoting medical liability reform, S. 22, the "Medical Care Access Protection Act of 2006" and S. 23, the "Healthy Mothers and Healthy Babies Access to Care Act of 2006." Both bills would impose limits on non-economic damages, with a physician being responsible for up to $250,000. While both Olympia Snowe and Susan Collins are expected to vote for the bills, calls from physicians and constituents can only help.
Medical liability reform legislation has been enacted previously in the U.S. House of Representatives, but a significant reform bill has never passed in the Senate.  Because of archaic Senate rules, sixty votes in support of the proposals must be achieved in order to pass a motion to invoke cloture which can end a filibuster.  Previous votes in the Senate have not reached the fifty vote margin.  Nonetheless, it is important to get as many votes as possible and to continue to build momentum on this important issue.  Medical liability premiums increased an average of 25% last year with emergency physician premiums increased by a whooping 79%.

MMA representatives were in Washington last week, as were Maine Hospital Association representatives, meeting with Maine's congressional delegation on this issue and others of interest to physicians.

S. 22 & S. 23 provide you an opportunity to contact Senators Snowe and Collins to remind them of physician interest in this issue and to thank them for their past support.

Senator Olympia J. Snowe:  202-224-5344; olympia@snowe.senate.gov

Senator Susan Collins:  202-224-2523; senator@collins.senate.gov.

Important Update from Dora Mills, M.D., M.P.H. on Pandemic Flu Preparation
Although it is unclear when the currently circulating H5N1 strain of avian influenza virus will arrive in Maine and it is unknown whether it will cause a human pandemic, one thing is clear:  we need to be prepared for both.  As we watch Europe struggle with avian flu’s spread and resulting fears about birds and eating poultry, we have some idea about the challenges ahead for us.  And, even if this current strain does not explode into a pandemic, we know from human history that at some point in time a microbe will challenge us with a pandemic.  Therefore, we all need to do our part to prepare. 

For Maine physicians, there are several resources and opportunities for avian flu and pandemic preparedness. 

1. There is a new website unveiled on May 9th by state officials and private sector partner organizations, including the Maine Medical Association.  www.maineflu.gov provides information on avian or bird flu, pandemic influenza, and seasonal flu for Mainers, including specific information for physicians.

2. Physicians are encouraged to review and use the preparedness checklists for health care settings.  The checklist for medical offices, for instance, provides a framework for physicians and their staff to review their practices’ preparedness.  Other checklists exist for home health care services, emergency medical services, and hospitals.  They can be found at www.maineflu.gov or www.pandemicflu.gov

3. The Maine CDC, with help from some federal funds, is asking each county and hospital to develop pandemic influenza preparedness plans this spring and summer.  Starting this fall, these plans are expected to be exercised and drilled.  Physicians are welcome and encouraged to become involved with this planning process.  Contact information for county and hospital efforts is available on the www.maineflu.gov website. 

4. This spring, the Maine CDC started a Flu email newsletter every Friday on timely local, state, national, and global issues related to pandemic preparedness, avian flu, and seasonal flu for interested Mainers.  You are welcome to sign up for this newsletter by either emailing Janet Austin at janet.austin@maine.gov or looking under the “Contact” tab on the www.maineflu.gov homepage. 

5. The Maine CDC will be soon hosting a Maine pandemic, avian, and seasonal flu list serve.  Sign ups will be available through the email newsletter as well as the
”Contact” tab on the www.maineflu.gov homepage.

6. Physicians can encourage their patients to take steps to be prepared, such as having a home emergency kit with at least three days’ of food and supplies.  Patient information can be found at www.maineflu.gov website. 

Hopefully the current H5N1 strain of avian flu will not explode into a pandemic, but all of us need to do our part to prepare.  Physicians are a critical component to this preparedness as well as any potential response.  [return to top]

Survey: Three-fourths of ED Directors Report Specialist Shortages

Nearly three-quarters (73 percent) of emergency department medical directors reported inadequate on-call specialist coverage in 2005, compared with two-thirds in 2004, according to a report issued by the American College of Emergency Physicians. A majority of level I and II trauma centers also cited on-call coverage as a problem. The top five shortages were among the specialties of orthopaedics, plastic surgery, neurosurgery, ear/nose/throat and hand surgery. In response to the shortages, more hospitals are paying stipends to specialists who agree to be on call, whether or not they see patients. In 2005, 36 percent of responding hospitals said they pay stipends, compared to just 8 percent in 2004. The report cites recent regulatory changes, continued reductions in payment to physicians by Medicare and other payers, the growing number of uninsured patients in America, and the increasing costs of medical liability insurance as factors affecting patients’ access to timely specialty care in emergency departments.The report is available online at the ACEP website.  (Acrobat Reader required)

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President Calls for Curbs on Health Care Costs

In a speech to the American Hospital Association, President Bush said that health care costs are increasing at an "unacceptable" rate. Private health insurance premiums have risen 73 percent in the last five years, leading to a decrease in employer-provided health care plans and an increase in employee co-payments and premiums. The President called on Congress to enact his proposed changes to slow Medicare spending by $36 billion during the next five years. For more information: http://abcnews.go.com/Politics/print?id=1912078

A transcript of the speech is available at the Washington Post [return to top]

Medicare Insolvency Projected for 2018

The Medicare Hospital Insurance Trust Fund will become insolvent in 2018 and Social Security will run out of money in 2040, based on current costs and population trends, according to the Social Security and Medicare Trustees’ Annual Report. This is two years earlier than predicted a year ago, and 12 years sooner than had been anticipated when President Bush first took office. Spending under the Supplementary Medical Insurance Trust Fund—which includes the new Medicare drug benefit—is projected to increase rapidly, resulting in growing pressure on future federal budgets and the U.S. economy as a whole. However, the report also reduced its projections on the cost of the drug benefit by about 20 percent. For more information and a link to the report:

http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1846 [return to top]

Celebrate National Nurses Week, May 6-12
National Nurses Week is being recognized this year May 6 through May 12.  Congratulations to all our nursing colleagues practicing in Maine.  Maine's physicians appreciate your work! [return to top]

Dora Mills, M.D., M.P.H. to Speak at Aroostook County Medical Society Meeting Wednesday Night
Maine Center for Disease Control and Prevention Director Dr. Dora Mills will speak to the Aroostook County Medical Society this Wednesday (May 10) evening at the Courtyard Cafe in Houlton.  Dr. Mills will speak on the preparations required for a pandemic flu.  The social hour begins at 6:00p.m.

All physicians are welcome to attend, whether members or non-members.  Members are also invited to bring a guest.  MMA President Jacob Gerritsen, M.D. and MMA EVP Gordon Smith, Esq. will also attend.

Persons wishing to RSVP should respond to Carol St.Pierre Engels, M.D. in Caribou. [return to top]

CIGNA Adds Outpatient Surgery & Radiology Costs to Its Online Tools
Early last year, CIGNA Healthcare began to provide average overall costs for certain procedures performed in the hospital setting as part of its suite of information tools to help its members gather cost and quality information about health care services.  CIGNA has expanded its suite of information tools by adding estimated cost information for certain outpatient surgery and radiology services.  Initially, this new cost data will be available in Wichita, Kansas and New Hampshire only but CIGNA expects to add additional areas in August 2006.

CIGNA posted a 19% decline in first quarter profits from a year ago but chief executive and board chairman H. Edward Hanway has stated that he expects performance to improve for the remainder of the year.  The company looks to improve its performance by taking several actions including raising premiums. [return to top]

Partnership for Prescription Assistance Bus Tour Visits Maine
The Partnership for Prescription Assistance’s big, orange bus, the “Help is Here Express,” will be back in Maine May 8-10 as part of its on-going effort to raise awareness and educate the public about patient assistance programs.  Events will take place in the three locations listed below.  

Patients needing assistance paying for their prescription medications are encouraged to come.  They should bring a list of their medications with them, as the bus is equipped with laptop computers and telephones for patients to find out if they may qualify for assistance.

Bangor -- Monday, May 8
10:00 a.m. to 12:00 p.m.
Eastern Maine Healthcare Mall
885-925 Union Street
Bangor, ME

Augusta – Tuesday, May 9
10:00 a.m. to 12:00 p.m.
Maine State Capitol
Parking lot between the Capitol Building and the State Museum
Augusta, ME

Portland – Wednesday, May 10
10:00 a.m. to 12:00 p.m.
Parking lot across from Department of Health & Human Services
(DHHS is located at 161 Marginal Way)
Portland, ME

The Partnership for Prescription Assistance has helped more than 8,500 Maine patients in the last year, and more than two million nationwide since its launch in April 2005.  PPA’s web site is www.pparx.org.  Maine residents can also visit www.rxcaresforme.org.  The toll-free number is 1-888-4PPA-NOW (1-888-477-2669). [return to top]

Office of MaineCare Services Reorganization - Staff Updates

At the MaineCare Advisory Committee meeting on Tuesday, May 2, 2006, the MMA and other MAC members received a briefing from DHHS Deputy Commissioner Mike Hall and Customer Services Division Director Norman Curtis on staff changes associated with the reorganization of the Office of MaineCare Services, formerly the Bureau of Medical Services.

 

Deputy Commissioner Hall introduced the following members of the senior management team at OMS:

 

  • Patricia Negron, Director of Communications.  Patricia comes from her position as National Director of Communications & Brand Marketing for Catholic Health System.
  • Ed Simms, Chief of Staff.  Ed formerly served as a regional director in the Department of Behavioral & Developmental Services and has been directing the State's MECMS interim payment recovery effort.
  • Steve Thompson, Director of Training.  Steve has spent much of his career in adult education and comes from positions with the state securities office and Director of Adult education for the City of Augusta.

Norm Curtis provided the following overview of the Customer Service Division.

 

Units in the Division of Customer Service and Health Care Management

 

Provider Enrollment (File) Unit:

 

1-800-321-5557, Option 6

TTY 1-800-423-4331

Fax 287-8450

This unit is responsible for verifying and enrolling healthcare providers who wish to service MaineCare members, including independent providers, facilities, group practices and organizations. This unit also handles additions and deletions of billing agencies. Provider Enrollment maintains and updates provider files to ensure all required documentation is on file and current. This includes updating the files to reflect changes such as name, address, licensing, and tax identification numbers. This unit can also assist providers with any rejections received regarding their MaineCare provider file.

 

Billing and Information Unit:

 

1-800-321-5557, Option 8

TTY 1-800-423-4331

Fax 287-1888

This unit receives calls from providers for a variety of reasons. Some of the most typical types of calls this unit handle include calls regarding:

 

                                                *            Billing questions and completing claim forms      

                                                *            Remittance Statements

*            Prior Authorizations

*            Interim/Claims

*            Third Party Billing, and

*            Rate Questions

 

1-800-321-5557, Option 9

TTY 1-800-423-4331

Please choose Option 9 if you are a provider calling with questions regarding:

 

*            Eligibility

*            Claims Status

*            Electronic Billing

*            Paper Billing Instructions, or

*            Questions about covered services

 

                                   

Provider Relations Unit:

 

1-800-321-5557, Option 8, OR by calling the telephone number of your specific Provider Relations Specialist.

TTY 1-800-423-4331

Fax 287-1888

Provider Relations Specialists work one-on-one with providers on MaineCare policy interpretation and to assist with complex billing problems. They can also schedule visits with providers to work with them on specific issues and needs regarding the billing and claims process.

 

Provider Relations Specialists now are assigned by county:

 

Aroostook, Washington, & Out-of-Country:  JoAnn Samon

 

Cumberland:  Donna Easterline-Johnson

 

Hancock & Penobscot:  Linda Leet

 

Piscataquis, York, & assisting with Cumberland:  Dawn Sevigny

 

Kennebec, Lincoln, Somerset, & Waldo:  Kathy Wadley

 

Androscoggin, Franklin, Knox, Oxford, & Sagadahoc:  vacant

 

Out-of-State, including providers within the 15-mile radius of the Maine border:  Erin Gilpatrick

 

 

Member Services:

 

1-800-977-6740, Option 3

TTY  1-800-970-6741

 

MaineCare members should call 1-800-977-6740, Option 3, if they have questions about the following:

 

*            MaineCare Managed Care Enrollment

*            Disenrollments, Transfers, or other Managed Care Questions

*            Benefits

*            Co-Payments

*            Assistance Finding a Provider

*            Checking Dates of Eligibility

*            Prior Authorizations

 

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The Coding Center's Coding Tip of the Week
Diagnostic and therapeutic tests along with “incident to” billing require different levels of physician supervision.  The following definitions apply:

  • General supervision means the procedure is furnished under the physician’s overall direction and control, but the physician’s presence is not required during the performance of the procedure. Under general supervision, the training of the non-physician personnel who actually performs the diagnostic procedure and the maintenance of the necessary equipment and supplies are the continuing responsibility of the physician.
  • Direct supervision in the office setting means the physician must be present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure. It does not mean that the physician must be present in the room when the procedure is performed.
  • Personal supervision means a physician must be in attendance in the room during the performance of the procedure.

Questions? Call the Coding Center: 1-888-889-6597
[return to top]

Alroy Chow, M.D. Recognized by American Gastroenterological Association
The American Gastroenterological Association (AGA) will name Alroy A. Chow, MD, a recipient of its 2006 Distinguished Clinician Award.  This award was established by the AGA to recognize members of the practicing community who combine the art of medicine with the skills demanded by science in service to their patients.  The award will be presented to Dr. Chow during the AGA plenary session on May 22, 2006, at Digestive Disease Week® (DDW®), the largest international conference devoted to the science and practice of gastroenterology, in Los Angeles. 

Dr. Chow became the first board certified gastroenterologist in Maine in 1972.  Before he retired last year, he was the founder and president of Brunswick Gastroenterology Associates in Brunswick, ME.  He received his medical degree in 1964 from Dalhousie University Medical School in Halifax, Nova Scotia.  Dr. Chow completed his postgraduate training at the Mayo Clinic, Rochester, MN;, Washington University School of Medicine, St. Louis; MO, and the University of Florida College of Medicine, Gainesville, FL. 

He returned to Maine in 1971 to join The Aroostook Medical Center in Presque Isle.  Since 1991, Dr. Chow, a Fellow of the Royal College of Physicians (Canada), has been medical director of gastroenterology services at MidCoast Hospital and chair of gastrointestinal services at Parkview Adventist Medical Center in Brunswick. 

The AGA is dedicated to the mission of advancing the science and practice of gastroenterology.  Founded in 1897, the AGA is the oldest medical-specialty society in the United States.  The AGA’s more than 14,000 members include physicians and scientists who research, diagnose and treat disorders of the gastrointestinal tract and liver.  For more information, visit www.gastro.org.

DDW is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.  Jointly sponsored by the American Association for the Study of Liver Diseases, the American Gastroenterological Association, the American Society for Gastrointestinal Endoscopy and the Society for Surgery of the Alimentary Tract, DDW takes place May 20-25, 2006 at the Los Angeles Convention Center.  The meeting showcases approximately 5,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology.  More information can be found at www.ddw.org. [return to top]

Maine Health Access Foundation Releases RFP Promoting Medication

On May 3rd, the Maine Health Access Foundation released a request for proposals (RFP) Promoting Medication Assistance. This RFP represents the first funding opportunity related to MeHAF's new priority of strengthening and expanding Maine's safety net. Through this RFP, MeHAF will award up to $250,000, allocated over three years, for projects which help people in Maine who are uninsured and medically under-served:

    • Apply for state and federal programs, as well as private programs that provide free or low-cost medications; and
    • Receive medication care management and patient education

Bidders' conferences and technical assistance workshops related to this RFP will be held in Orono on May 23 at the Best Western Black Bear Inn and in South Portland on May 24 at the Sheraton Tara Hotel. All applicants must discuss their project proposal prior to submission with MeHAF Program Officer, email Kim Crichton at call her at 620-8266, ext. 103. For complete information about this RFP and the application process, please visit the MeHAF website. [return to top]

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