May 29, 2006

 
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Legislature Adjourns Without Fixing Dirigo; Blue Ribbon Commission to be Formed
The Legislature adjourned last week without passing either of the bills designed to move the DirigoChoice product forward. The first bill would have allowed the Dirigo Health Agency Board to utilize the option of self-insuring if an acceptable extension of the current contract with Anthem is not achieved. The second bill, which had been expected to pass, represented a temporary compromise by several interested parties on the controversial "Savings Offset Payment". In the aftermath of the failure to enact either bill, Governor Baldacci announced plans to form a 15-member Blue Ribbon Commission to make recommendations on how to continue to finance the DirigoChoice program. The Commission would report back by January 2007.
MMA expects to be represented on the 15-member commission.  All 15 appointments will be made by the Governor.  To review the Governor's statement and the full text of the Executive Order, go to:

http://www.maine.gov/tools/whatsnew/index.php?topic=Gov+News&id=16817&v=Article

In an editorial in the Maine Sunday Telegram May 28, the paper supported the establishment of a commission, noting:

This is the right appproach.  While the merits of Dirigo Health are a worthy topic for debate, it's best that any changes be made after the heat of the campaign subsides.  No matter who wins in November, a studied examination of how well this program has worked will help come January.   

In the meantime, the issue of the legality of and the amount of the savings found to support the current year's savings offset payment is still in court, with the amount of the assessment being challenged by heatlh insurers and business interests.

While the Association is supportive of the DirigoChoice product, which reimburses physicians for care based upon commercial insurance rates, we remain frustrated with the attention focused on Dirigo that takes energy away from the MaineCare issue.  While the DirigoChoice product has just over 10,000 insureds, MaineCare still covers over 260,000 Mainers, the highest per capita percentage in the country.  The combination of historically low fees and the MECMS claim management disaster have combined to make the past year the most difficult one for MaineCare providers.

For more detail on the conclusion of the 122nd Legislature, read the latest issue of MMA's Political Pulse.

Medical Mutual Announces Rate Freeze for Physicians and Hospitals in Maine
In an announcement being made today to insureds, Medical Mutual Insurance Company of Maine will inform them that the company will not file for increased rates on its Maine physician and hospital lines of business in 2006.  Those insureds who have monthly renewals through September '06, will still be seeing the increases filed and effective Sept. 30, 2005, but can renew with the knowledge that there will not be another increase this year.

The company announced that its independent actuaries, Milliman USA, believed that the current rate structure was adequate to support projected losses.  The key factors in achieving rate adequacy are the continuing moderation in frequency and severity of claims and rate increases filed in the past, the company noted.

New Hampshire physicians will see a modest 3.9% increase, effective July 1. 2006.  No decision has yet been made with respect to Vermont. [return to top]

Watch for Mailing for MMA's 153rd Annual Session, Sept. 8-10, 2006
The Maine Medical Association will hold its 153rd Annual Session on Sept. 8-10, 2006 at the Fairmont Algonquin Hotel in St. Andrews-by-the Sea, New Brunswick, Canada.  The resort is located about 20 minutes from Calais.  The CME program is entitled,  Medicine in Extreme Environments and will feature former NASA astronaut Story Musgrave, M.D. and Donald Palmisano, M.D., J.D.  Six  hours of CME are available, beginning early Friday afternoon with Dr. Story's keynote presentation.

The brochures for the meeting are currently at the printer and will be mailed to each MMA member in early June. 

MMA welcomes the attendance of any of its members or their staffs at the meeting.  Nearly 300 members and guests are expected to attend the weekend meeting.  Among the Resolutions to be considered at the general membership meeting on Saturday morning will be a resolution recommending changes to the Association's White Paper on Health System Reform which was first released in May of 2003. 

At the Annual Dinner on Saturday evening, MMA President Jacob Gerritsen, M.D. will pass the gavel to current President-elect Kevin Flanigan, M.D.  Dr. Flanigan practices internal medicine and pediatrics in Pittsfield.  [return to top]

"First Friday" Educational Program June 2 on Common Coding Errors
The final "First Friday" Education program prior to summer break will be held this coming Friday, June 2 and the topic is Common Coding Errors.  The three-hour program will be presented by Coding Center Director Jana Purrell.  "First Friday" programs are held the first Friday of each month in the conference room at the Frank O. Stred Building in Manchester, which houses the MMA offices.  We will not be offering programs in July and August, but resume the series in September.  The programs, initiated last Fall, have been quite successful with several programs attracting 30 to 40 attendees.

If you have any suggestions for topics you would like to see covered in a future "First Friday" program, please contact either Gail Begin or Gordon Smith at MMA (gsmith@mainemed.com or gbegin@mainemed.com).

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The Coding Center's Coding Tip of the Week
The following billing guides are available thru National Heritage Insurance Company (NHIC), our local Medicare carrier.These contain useful information and reminders about billing for services in the particular area listed:

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

Additional Session on EMR Added to June 21 Education Program in Bangor
Tow additional speakers have been added to the June 21 Practice Education Seminar being held at Spectacular Event Center in Bangor.   Mark Stone of Reliable Networks of Maine will discuss the common problems associated with the introduction of technology into a practice, large or small.  A second speaker will present state of the art information on issues to consider in shopping for an electronic medical record.  These programs will be part of the breakout sessions in the afternoon.

The annual practice education program formerly called the Physician Survival Seminar, gives MMA an opportunity to discuss the nuts and bolts of what physicians and practice managers need to know to operate a medical practice in Maine today. [return to top]

Maine Public Health Alert Network System Issues Alert on Syphilis
On May 24, the Maine Public Health Alert Network System was activated to issue a statement/alert  regarding the recent increase in syphilis in Maine.  The alert was signed by Dora Anne Mills, M.D., MPH., Director of the Maine CDC.

Since January 1, 2006, health professionals in Maine have diagnosed 9 cases of syphilis among seven males and two females, ages 24-48, in Cumberland, Kennebec, Waldo and Somerset Counties.  Two cases were primary syphilis, two cases were secondary syphilis and five cases were early latent syphilis.  Three of the cases were among males with HIV infection.

These numbers represent an increase compared to the same period in 2005, when there was only one case reported.  In fact, during the last ten years, the annual average number of reported syphilis cases is two, except for 2003 when the state experienced an outbreak of 15 cases.  As the Alert notes, "Because syphilis is rarely reported in Maine, the nine reported cases so far this year are cause for concern."

The Alert contains six suggestions for screening for the disease, including following the most recent CDC recommendations available at http://www.cdc.gov/std/default.htm.

For more information, please contact Jennah Godo at the Maine CDC at 287-3916. [return to top]

MMA 3rd Annual Benefit Golf Tournament to Benefit Free Clinics
The net proceeds of the Association's 3rd Annual Golf Tournament will be distributed equally among the six free medical clinics in the state.  Each year, the Association's Executive Committee selects an appropriate charity to recognize.  The tournament will be held this year on Monday, June 19th at the Augusta Country Club in Manchester.  Lunch will begin at 11:00am with a shotgun start at noon.  A scramble format will be utilized, although there is some thought of moving to a "Bramble" format.  In a "Bramble", each player plays their own ball from the position of the best drive of the foursome.

The Chair of this year's tournament is Brian Jumper, M.D.  If you or your practice would like to participate and are not yet registered, call 622-3374 for a registration materials.  Items are also being accepted for a raffle after golf. [return to top]

HHS Secretary & House Committee Push Health Information Technology
On May 16, 2006, HHS Secretary Michael O. Leavitt approved most of 30+ recommendations from the American Health Information Community (AHIC), an advisory committee asked to advance health information technology through demonstration projects.  President Bush has urged that most health information to be electronic and available through a national electronic network by 2014, but AHIC research indicates that about 17% of physicians are using electronic health records today and that most EHRs can be accessed only locally.  Four types of demonstration projects recommended by the AHIC have been deemed "breakthrough" projects meaning that they will show how health IT can improve the quality and reduce the costs of care.  These projects would:

  • allow patients' current and historical lab test data to be accessed remotely for clinical care by authorized parties, a forerunner of full EHRs;
  • foster electronic communication between clinicians and the chronically ill, including secure messaging to promote wise self-care and clinicians' remote monitoring of vital signs;
  • allow rapid communication of patient health information (in which identifying data have been removed) from doctors' offices and hospital emergency rooms for public health purposes; and
  • create a personal health record for patients, allowing them to instantly register for medical care and containing their primary diagnoses and current and historical medication information.

These demonstration projects are scheduled to be at least partially operational in 2007.

On May 24, 2006, the House Ways & Means Health Subcommittee passed the Health Information Technology Promotion Act of 2006 (H.R. 4157) by a party-line 8-5 vote.  The bill is intended to urge providers' adoption of health IT.  Subcommittee Chairwoman Nancy L. Johnson (R-CT) and House Energy & Commerce Health Subcommittee Chairman Nathan Deal (R-GA) introduced the bill.

The bill would:

  • codify the Bush Administration's national coordinator office for health IT;
  • create statutory safe harbors to allow hospitals and other providers to provide physicians with health IT software and hardware; and
  • require DHHS to develop a health IT strategic plan.

The bill would not provide any federal funding for health IT, but would leave it to larger institutions to help smaller institutions.

Democrats criticized the bill for a variety of reasons, saying that it gives health IT vendors too much power, that is jeopardizes patient privacy, and that it fails to set deadlines for adoption of health IT, for example. [return to top]

Inappropriate Testing Drives Up National Medical Bill

According to Newsday, a new study reveals that about one in three patients receives diagnostic tests--including urinalysis, X-rays or electrocardiograms (EKGs)--not recommended under professional guidelines, resulting in annual direct medical costs of between $47 million and $194 million.  The tests were ordered even though patients did not have any symptoms. Researchers also said that because tests such as EKGs can produce false-positive results 20 percent to 30 percent of the time, the result is still more tests, increased patient anxiety and additional medical expenses of about $683 million. For their benchmark of “usefulness,” researchers relied on standards issued by the U.S. Preventive Services Task Force, specifically its “C” and “D” tests. A “C” means no recommendation in patients who do not have symptoms that suggest the test might be helpful. A “D” means no test for patients without symptoms because risks outweigh benefits.  For more information:

http://www.newsday.com/news/health/ny-hstest224751699may22,0,4848465.story?coll=ny-health 

 An abstract of the study is available at:

http://tinyurl.com/nes8d [return to top]

Reminder: MMA Reviews Contracts for Members and Prospective Members
One of the many services that MMA offers its members is a legal analysis of the terms of a contract, be it an employment contract or a managed care/health plan contract.  The fee to members for this service is $250 per review.  In a given year, the Association's lawyers review dozens of contracts for members who have taken advantage of this unique service.  While the majority of reviews used to be of managed care contracts, now the vast majority of contracts reviewed are employment contracts.

If you have a contract that you would like reviewed, please contact Gordon H. Smith, Esq. at MMA via gsmith@mainemed.com. [return to top]

Proposed Timetable for 2007 Medicare Physician Fee Schedule
At a CMS "Open Door" forum on May 16, 2006, federal officials said that the agency in May would publish a special notice of proposed rulemaking on the 5-year review of physician work relative value units (RVUs) and the change in methodology for calculating practice expense RVUs.  The Social Security Act requires Medicare reimbursement rates to be based on national RVUs for physician work, practice expense, and malpractice expense.  The federal government reviews the work RVUs every 5 years.  The first took place in 1996, the second in 2001, and this will be the third.  The special rulemaking proposal also will include changes to the practice expense RVUs.  In July, CMS will propose the 2007 physician fee schedule, including the Medicare payment update and other changes to physician regulations.  The final 2007 fee schedule will be published in November and will include information from both the May and July proposals.

You can find more information on the CMS web site, http://www.cms.hhs.gov/default.asp?.

You can search rulemaking proposals on the web at:  http://www.gpoaccess.gov/fr/index.html.

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