June 12, 2006

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More Bad News on MaineCare Part B Crossover Payments
While the current processing of crossover claims reduced to paper is going well, the Part B electronic crossover process going into effect on July will work only for the previous claims, and OMS officials stated this past week that they do not intend to be able to test the new CMS format and go live until early next year. This means that the continuing processing of the claims on paper will be the only way to get them paid in a timely manner.
The Governor's Provider Advisory Committee met this past Thursday for its regular meeting and heard an update on the performance of the MECMS system.  The MaineCare Advisory Committee also met last week and heard from several of the new CMS staff who have been hired to improve customer service, communications and training.

The new Part B crossover payments have now encountered a new obstacle with the CMS change to a new format on July 1.  Instead of coming from the individual carriers and intermediaries, a single file will be sent, beginning July 1, to each Medicaid agency, from GHI.  MaineCare has not yet tested that format and OMS staff anticipates that it will be into 2007 before the tests can be completed.

Other information presented at the meeting:

  • Recovery of Interim Payments as of May 26 was slightly more than $255 million.
  • Weekly metrics for 6/4/06 showed fresh claims being processed at a rate of 88.64% (paid and denied).
  • Suspended claims inventory was 208,268 which is up slightly from previous weeks (a very troubling development)
  • The increase in the time period for filing a claim has been increased to 20 months, effective 6/8/06. A letter sent to providers has been posted on the MaineCare website at http://www.maine.gov/dhhs/bms/providerfiles/mainecare advisories.htm 

Laureen Biczak, D.O., Medical Director for MaineCare and Deputy DHS Commissioner J. Michael Hall will both be present at the MMA's Practice Education Program on Wednesday, June 21, 2006 in Bangor at Spectacular Event Center.  If you have not yet registered for this annual program, call MMA at 622-3374 (Press "0" for assistance) for a registration form.  Six and one-half hours of CME are available.

AMA Holds Annual Meeting in Chicago
Maine delegates to the American Medical Association traveled to Chicago this week to participate in the AMA Annual Meeting.  Delegates are David Simmons, M.D., an internist from Calais, and Richard Evans, M.D. a general surgeon from Dover-Foxcroft.  Alternate delegates are Maroulla Gleaton, M. D., an ophthalmologist from Augusta and John Makin, M.D., an Ob-Gyn from Waterville.  Also attending are former AMA President Robert McAfee, M.D., MMA President Jacob Gerritsen and several physicians from Maine who represent their national specialty societies including John McGill, M.D. (plastic surgery). Samuel Solish, M.D. (ophthalmology), Jo Linder, M.D. (emergency medicine) and Francis Kittredge, M.D., (neurology).  Also attending was Manisha Punwani, M.D., a child psychiatrist practicing in Fort Kent, who represents MMA in the AMA Young Physician Section and Charles "Tom" McHugh, general surgeon from Machias who is active in the Organized Medical Staff Section (OMSS).

Resolution 509, calling for the FDA to place science over politics, was authored in its original form by MMA President Jacob Gerritsen and is being presented with the support of the entire New England delegation. 

Among the other business of the House of Delegates are resolutions calling for taxing soda and using the proceeds to fight obesity and for support for a 50% reduction in salt in processed foods, fast foods and restaurant meals over the next decade.

Other proposals:

  • Urge health insurers to cover stomach-stapling surgery for weight loss.
  • Oppose beer ads on college sports broadcasts.
  • Prepare a report summarizing video game research, including emotional and behavioral effects and addictive potential.
  • Push to ban smoking in all public places and workplaces.
  • Urge school health classes to discuss the importance of routine pap smears in the prevention of cervical cancer.
  • Support mandatory school instruction on the dangers of internet pornography.

Primary on the advocacy agenda are correcting the sustainable growth rate (SGR) formula which is causing annual reductions in Medicare reimbursement.  The AMA is calling upon Congress this year to pass legislation authorizing a 2.8% increase, rather than the 4.3% reduction currently anticipated.  The cost for the one-year fix is $11 billion.

The meeting concludes on Wednesday morning.  On Tuesday evening, William Plested, M.D., a thoracic surgeon from Los Angeles, California, will be installed as President of the AMA.  Dr. Plested has been to Maine on two different occasions in the past three years to assist in the tort reform area and to attend MMA's Sesquicentennial Gala.

The AMA has over 1000 members in Maine and last year enjoyed a small increase in membership across the country for the first time in a decade. [return to top]

U.S. Supreme Court Rejects Challenge to Maine RX Law
The United States Supreme Court last Monday rejected an appeal from pharmaceutical interests of a Court of Appeals decision upholding a Maine law designed to provide patients with information about discounts granted by manufacturers to health insurers and pharmacy benefit manufacturers.

The 2003 law had been challenged by the Pharmaceutical Care Management Association, a trade association representing pharmacy benefit managers. [return to top]

AMA Prescribing Data Restriction Program Effective July 1, 2006
In response to concerns about the inappropriate use of such information by some pharmaceutical sales reps, the AMA will launch a new web-based Prescribing Data Restriction Program (PDRP) on July 1.  The program will address physician concerns, while ensuring that the data continues to be available for evidence-based medicine and research.

The PDRP allows physicians, regardless of whether they are AMA members or not, to make informed decisions about whether they want to deny all pharmaceutical sales representatives access to their prescribing habits or register a complaint regarding specific companies, or individuals' inappropriate use of prescribing data.  Go to www.ama-assn.org/go/prescribingdata if you wish to exercise your new right to opt-out of providing this information.  While the decision would not be effective until the new system is up and running on July 1, you may pre-register now to restrict your your prescribing information.

While most physicians oppose the use of individual prescribing data for sales and marketing purposes,  the database is valuable for public health purposes, recall of products, etc. [return to top]

Charlene Rydell 1941-2006
The Maine Medical Association was saddened to learn this week of the death of Charlene Rydell, of  Brunswick.  Charlene was a former member of the legislature, and while there, served at one time as Chair of the Committee on Insurance and Financial Affairs and on the Health Committee.  She also served on the Board of the Dirigo Health Agency and was an original trustee of the Maine Health Access Foundation board.

After serving in the legislature, Charlene served as a staff member for Congressman Thomas Allen, advising him on health issues and working with constituents who were struggling with health issues or access to health care.

Charlene was an effective, dedicated and tireless advocate for health care for the disadvantaged.  Our thoughts and condolences go out to her family including her husband Lars and her son, Dr. David Rydell, a surgeon on staff at Eastern Maine Medical Center. [return to top]

3rd Annual MMA Benefit Golf Tournament, June 19, to Benefit Free Clinics
The Association's 3rd Annual Benefit Golf Tournament will benefit seven free clinics operating in the state.  The tournament will be held on Monday, June 19th at the Augusta Country Club in Manchester with lunch beginning at 11:00am and a shotgun start at noon.   If you are interested in playing as an individual or in fielding a team, please call Gail Begin at MMA at 622-3374 ext 210 or gbegin@mainemed.com. [return to top]

Conference on Involuntary Commitment, June 13, in Hallowell
An important conference on involuntary commitment hearings will be held in Hallowell on June 13, 2006 from 8:30am to 4:00pm, sponsored by the DHHS Office of Adult Mental Health Services & the Office of the Attorney General in collaboration with the University of Southern Maine, Muskie School, Center for Learning.

Through panel presentations, video vignettes, and group discussions, this conference will explore legal and clinical issues to be considered in involuntary commitment, including alternatives to hospitalization, and will provide strategies for how best to represent an individual in an involuntary commitment hearing.  Presenters and panelists will include lawyers who represent hospitals and patients in commitment proceedings, clinicians who treat involuntary patients, consumers of mental health services, and Active Retired Judge Courtland D. Perry, who drafted Maine's original commitment law and routinely hears involuntary commitment hearings.

The program is designed for lawyers, doctors, judges, mental health professionals and other individuals involved in or interested in the mental health commitment process.

The cost for the conference is only $20 which includes lunch.  For questions or registration materials call Linda Kinney at 626-5231 at the Muskie School in Augusta. [return to top]

Practice Self-Assessment Project and Quality Counts Seek Project Manager
MMA, MOA and the Quality Counts Executive Committee are advertising for a Project Manager for the Medical Practice Self-Assessment Project with an expectation that the same individual would support the establishment and operation of a learning network developed by Quality Counts!   The two positions could consume as much as four days per week and the position could be structured as either part-time or full-time.  Office space would be located at the MMA offices in Manchester, Maine.

The job description which has been posted on-line and advertised appears below.  Persons interested in receiving more information may contact Gordon Smith at MMA at gsmith@mainemed.com or Kellie Miller at MOA at kmiller@mainedo.org.

The position is available immediately.

Program Director 
Job Description:
Quality Counts, a statewide non-profit organization whose mission is to improve chronic illness care and prevention and to forge collaborative relationships between healthcare providers, employers, payers and policymakers, is seeking a Program Director to manage the ongoing activities of the organization.  Responsibilities include serving as the organization’s key contact and advocate; supporting and coordinating the development of a statewide “learning network”, managing the annual conference, coordinating fundraising activities, and working with members and key interested parties throughout the state. 
In addition to managing the activities of Quality Counts, the Program Director will spend one to two days per week managing a one-year-long special project addressing the quality of care being delivered in medical practices across the state for the Maine Medical Association and the Maine Osteopathic Association.  The qualified candidate will conduct special assessments, respond to inquiries about the project and prepare necessary reports to the state and other funding sources.

Job Requirements:
The successful candidate will have a minimum of five years experience in healthcare quality or performance improvement with demonstrated project management and program development expertise.  Excellent oral and written communications skills and a proven ability to work independently while collaborating with teams of individuals in diverse settings are essential.  Strong relationship management skills and experience working with committees and boards comprised of healthcare providers is preferred. The position also requires excellent organizational skills and a working knowledge of computer software, including Microsoft Office (Word, Excel, PowerPoint, and Outlook.)  Experience in grant writing and fundraising will be a plus.

Education Requirements:
A bachelor’s degree in public health, health education, healthcare communications, non-profit management or related field is required.  Masters degree preferred.

Other Information:
Post on Site:               May 25 to June 25, 2006
Categories:                 Healthcare—administration
                                      Healthcare—public health
                                      Non-profit organization management
Full/Part Time:            Full time
Salary:                         Annual

Location Notes:  As a newly created position, the position is flexible regarding physical location of the work site; travel and on-site work 1 to 2 days per week in Augusta are required.

Benefits: Competitive salary and benefits.

Contact Information:
Linda Salvesen
Crescendo Consulting Group
48 Free Street
Portland, ME 04101
Fax:  207-774-2343
E-mail: lindas@crescendocg.com  [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 Banquet 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]

Additional Session on EMR Added to June 21 Education Program in Bangor
Two 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.

For more information or to register, visit the MMA website, or call 207-622-3374. [return to top]

Dirigo Board Votes on Savings Offset Payment for Year Two
The Dirigo Board of Directors last Tuesday formally decided that the program created year-two cost savings of $42 million. The decision will be forwarded to the Superintendent of Insurance who will hold a hearing in mid-July.

Meanwhile, the interveners in the appeal of the first year savings amount have filed for a stay for collecting the first year savings offset payment (SOP). But because the judge has yet to rule, the Dirigo Health Agency has sent out quarterly bills with a mid-July deadline. So far, they've received $1.8 million of the estimated $43.7 million which will be collected over a 12-month period.

As of May, the Dirigo Health program has 10,111 members of whom 5,091 are MaineCare members. The average contract size is 1.6 people. Individuals make up 36 percent of members, followed by small group at 35 percent and sole proprietors at 29 percent.

This week Governor Baldacci is expected to name the members of a 15-member Blue Ribbon Commission to look at future financing alternatives for Dirigo. [return to top]

Maine Hospice Council Presents "From Cruzan to Schiavo: What Have We Learned?", June 14 and 15
The end of March 2006 marked the first anniversary of Terri Schiavo’s death. While the complex situation around her was extraordinary, it raised significant questions and challenges that each of us must consider when we think about end of life. To gain a deeper understanding of the legal, medical, ethical and spiritual issues that now surround this important issue, the Maine Hospice Council’s Maine Center for End-of-Life Care is bringing nationally acclaimed speaker and author Bill Colby to Maine on June 14-15, 2006 for two public events.

“From Cruzan to Schiavo: What Have We Learned?”

♦       Weds., June 14, 6:00 p.m. dinner, 7:00 p.m, presentation, Colby College, Waterville
(fundraiser dinner and presentation, $79, presentation only, $25 suggested donation)
For info or to RSVP: 800-438-5963

♦       Thurs., June 15, 6:00 p.m., University of New England, Biddeford (free)
For info: call 207-602-2511 or email PSkoczenski@une.edu

BILL Colby is an acclaimed author and national leader in understanding the complex legal, ethical, medical, and personal issues surrounding the right to die in America. An engaging and dynamic speaker, he has appeared on many national news programs. Mr. Colby represented the family of Nancy Cruzan in the nation’s first right-to-die case heard by the U.S. Supreme Court. He will offer a first-hand account of the Cruzan family’s journey through the courts, discussing precedents set and lessons learned. He will explore the rapid changes brought on by medical technology and a new set of questions raised by Terri Schiavo’s death last year. He will shed light on the current state of the right to die in America and offer guidance on navigating the new reality that affects us all.  

Colby’s newly-released book, Unplugged: Reclaiming the Right to Die in America will be available for sale and signing at each event.

Bill Colby’s presentation kicks off an educational conference sponsored by the Maine Hospice Council on June 15 focused on increasing access to end-of-life care in Maine. For more information on this conference, visit our website at www.mainehospicecouncil.org or call 800-438-5963. [return to top]

Physician Access to Clinical IT Growing
Between 2000 and 2005, physician access to practice-based clinical information technology (IT) grew significantly (at least 5 percent each year), according to a nationally representative Community Tracking Study Physician Survey released by the Center for Studying Health System Change (HSC). The survey focused on use of IT for five clinical activities that have been shown to improve patient care,  rather than on specific technologies. The greatest growth occurred in using IT to obtain treatment guidelines. Although more physicians have access to clinical IT, 16.8 percent do not. Generally, the reasons that physicians do not adopt clinical IT are costs of start-up and maintenance, and the significant effort and costs required to change work flow to effectively use the technology. For more information: 
http://www.hschange.org/CONTENT/848/ [return to top]

The Coding Center's Coding Tip of the Week
Can I bill for an E/M visit for a patient who comes in for vaccinations for travel and I spend 30 minutes discussing potential areas of concern, hygiene, prevention, and precautions?
You can bill for a preventive counseling visit 99401-99404 based on time and you could bill for the administration of the vaccines and if appropriate the vaccine itself.  You cannot bill the “problem” E/M codes (99201-99215) since the patient does not have an existing medical problem.

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

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