July 3, 2006

 
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Governor Baldacci to Annouce Blue Ribbon Commission on Dirigo Health on July 5
Governor John Baldacci is expected on Wednesday to announce the members of a 15-person Commission appointed to deliberate on the future of Dirigo Health. The Commission is expected to report back to the Governor by Dec. 15, 2006.
The Commission is the result of an Executive Order signed by the Governor following the conclusion of the Legislative Session which failed to resolve several Dirigo-related issues.  Foremost among the issues are the Savings Offset Payment and the possibility of self-insuring.

Bills to address these issues were narrowly defeated in the closing days of the legislature. 

 

Pandemic Flu Stakeholders/Advisory Committee Meeting June 27
At a meeting Tuesday hosted by the Maine CDC, Franklin County officials discussed their experience in developing a comprehensive plan for respond to a pandemic influenza, should such a catastrophic event occur.  Franklin Memorial Hospital led the effort and is believed to be the first hospital in Maine to release a fully developed plan.

In discussing their experiences, Franklin Memorial Hospital CEO Richard Batt made the following points:

  • The preparation of the plan took a lot longer and was far most complex than originally envisioned.
  • The entire community needed to come together to work on the plan, not just the immediate health care community.
  • Motivation is an issue because of the uncertainly as to whether or not the plan will ever be used.
  • Regardless of the probability of such an event, we all must prepare for it because of the catastrophic consequences,should it happen.

A pandemic event would challenge many of our assumptions and normal processes, such as transferring critically ill patients.  The facilities we normally refer to will be as overhelmed with capacity issues as our own facility.  Absenteeism will be high as employees fear for their own health or stay home to care for family members with the illness.  It is important to get physicians and other health professionals engaged in the planning.

 

 

  • We need to fully engage pysicians and other health professionals in the preparatory activities.
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Maine Academy of Family Physicians Endorses MMA/MOA Voluntary Practice Assessment Project
On Monday night, July 26, the Maine Academy of Family Physicians voted to endorse the Voluntary Practice Assessment Project being conducted by MMA and the Maine Osteopathic Association.  The Project, funded by the Maine Quality Forum, is assessing the quality of care being provided to a subpopulation of patients in fifty primary care practices across the state.  To date, over forty practices have volunteered to participate in the confidential assessment.

Lisa Letourneau, M.D., MPH, has been named physician consultant to the project.  Dr. Letourneau will be presenting suggested measures to be used in the assessments on July 18 when the MMA/MOA Committee on Quality Improvement and Peer Review meets.

A part-time project manager for the project is expected to be hired this week.  This individual will also work part-time staffing the learning network of Quality Counts!

Persons interested in hearing more about the Project or interested in volunteering to be assessed should contact Gordon Smith at gsmith@mainemed.com. [return to top]

Study Shows That Pay-For-Performance Programs Improve Quality and Save Money
According to a study done by the Centers for Medicare & Medicaid Services (CMS), applying recommended quality of care measures would have saved Medicare $1 billion and would have resulted in 3,000 fewer deaths, 6,000 fewer medical complications and re-admissions and 500,000 fewer days in the hospital from October 2003 to November 2005. In a three-year demonstration project, CMS evaluated pay-for-performance data for 75,000 Medicare beneficiaries using 260 hospitals in 38 states. While the study focused on quality of care measures related to pneumonia and to heart bypass surgery, CMS will use the data when determining how to implement pay-for-performance across the entire Medicare program. For more information:
http://www.kaisernetwork.org/daily_reports/rep_hpolicy_recent_rep.cfm?dr_cat=3&show=yes&dr_DateTime=22-Jun-06#38074 [return to top]

Maine State Government Announces Pandemic Influenza Summit, September 20, 2006 at Augusta Civic Center

Maine State Government is announcing its Pandemic Influenza and Avian Influenza Preparedness Summit to be held on September 20th at the Augusta Civic Center. 

More information will follow in the near future. 

For more information at this time, please contact www.neias.org/maineflu.html

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Results of June 19th MMA 3rd Annual Golf Tournament
One hundred eight enthusiastic golfers teed up on June 19th at the Augusta Country Club to compete in MMA's 3rd Annual Benefit Golf Tournament.  The weather  cooperated and the competition was vigorous.  Congratulations to the following winners and thanks to all the participants whose efforts will benefit the six free medical clinics operating in the state.

  • First Gross:  Team Sullivan.    Harold Sullivan, M.D., Nick Dalfonso, Doug Ertman, and Alan Carter, D.O. (62)
  • Second Gross:  Norman Hanson and Detroy.  Jon Brogan, Matt Mehalic, Ted Westerfield and Mark LaVoie (65)
  • Third Gross:  Team Cummings.  Nancy Cummings, M.D., Mike Cummings, Eric Omsberg, M.D., Byron Dunbar  (66)
  • First Net:  Team Calligan:  Chuck Calligan, Dave Hastings, Mike Whitman and Dale Prescott  (44)
  • Second Net (tie)  Team CTC:  Tom Sabanis, Tony Vermotte, Scott Thibeau and Kevin Labree and Peter Allen, Gus Siragusa, M.D., Gerry Markoff and Brinton Darlington, M.D.(46)
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State Employee Health Plan Hospital Tiering Presented at Payor Liaison Committee
The MMA Payor Liaison Committee meeting on June 30 featured a discussion with the Director of the Maine State Employee Health Plan Frank Johnson.  Mr. Johnson explained the "value-based" purchasing strategy the State Employee Health Commission (SEHC) has adopted as an enhancement to the Point of Service health plan.  One strategy includes designated certain hospitals as preferred and waiving the applicable deductible for the employee is they use a hospital from the preferred tier.

To be preferred, a hospital must meet all of the following three standards:

  • The hospital must earn a score of one-half "pie" or greater on the Maine Health Management Coaltion Spotlight Systems Review survey.A score of onehalf "pie" shows that a hospital has "made a good early stage effort in implementing recommended safety practices."
  • The hospital must complete the Leapfrog safe practices survey.  This survey is based on 27 safe practices identified by the National Quality Forum.  Leapfrog gathers and reports information on hospital quality and patient safety to help patients make informed decisions about where to receive hospital care.
  • The hospital must meet or exceed Maine and national benchmarks in selected clinical measures related to acute coronary syndrome, heart failure, pneumonia, and surgical infections.

The effective date of the tiered network is July 1, 2006.  Also effective July 1, the Point of Service benefit design will be enhanced to exempt preventive care services from the deductible.  Preventive services exempt from the deductible include:

  • Immunizations
  • Lab and pathology services
  • Radiology (i.e. mammograms, electrocardiograms)

The list of Preferred hospitals is available at www.anthem.com (See State of Maine Members)

The State Employee Health Plan is self-insured and therefor not subject to the provisions of Bureau of Insurance Rule, Chapter 850 which limits the distance that an insured must go to receive care.  Anthem serves as the TPA (third party administrator) but the State Employee Health Commission determines the benefit design.                                                                                    sssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssss [return to top]

CMS Proposes Increase in Medicare Payments For Time Spent With Patients
The Centers for Medicare & Medicaid Services (CMS) has issued a notice proposing changes to the Medicare Physician Fee Schedule (MPFS) that will improve the accuracy of payments to physicians for the services they furnish to Medicare beneficiaries. The proposed notice includes substantial increases for evaluation and management services. The changes reflect the recommendations of the Relative Value Update Committee (RUC) of the American Medical Association. The proposed notice will appear in the June 29 Federal Register. Comments will be accepted until August 21, 2006. The RVU revisions in this proposed notice would be fully implemented for services to Medicare beneficiaries on or after January 1, 2007, while the practice expense revisions would be phased in over a four-year period. To view the entire press release, go to: http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1887

To view the display copy of the proposed notice (CMS-1512-PN), go to: http://www.cms.hhs.gov/PhysicianFeeSched/PFSFRN/itemdetail.asp?filterType=none&filterByDID=0&sortByDID=4&sortOrder=descending&itemID=CMS1183724
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MaineCare Officials Report to HHS Committee on Interim Payments and Other MECMS Issues
Michael Hall and Richard Thompson presented an update on the recovery of interim payments and other MECMS related issues at a briefing before the Health and Human Services Committee of the Legislature on June 26.  It was also reported that CMS office representatives would be meeting with OMS officials in July to discuss next steps for federal certification of the MECMS. 

The status of interim payment recovery has been elevated from red to yellow, which means that they are now categorized as being "in transition" rather than an "issue."  To date, interim payments total approximately $505 million.  Recaptures and returns total approximately $206 million.  This leaves an outstanding balance of $299 million and repayment agreements for approximately $103 of this balance have been reached with providers.

The percentage that has been repaid or recaptured has steadily increased each week since March 17 when only 22% of the interim payments made to providers had been repaid.  My May, 40% of payments had been recovered and in June, almost 41% have been recovered.

Currently there are providers with approximately $143 million in outstanding payments that are unwilling to repay at this time.  (This may be because of the failure to electronically process the cross-over payments, the high number of claims still left in suspension, or other provider specific issues).  Suspended claims increased in June, up 9% over April's figures but the most recent figures show a trend downward.  Physicians, PA's and nurses continue to be the provider types most affected by suspended claims with 30% of claims suspended longer than 180 days.  62% of all suspended claims are less than 90 days old, indicating that the issue is as much related to fresh claims as old claims. [return to top]

Listening Session on Falls Prevention July 13 in Hallowell
A Listening Session on Falls Prevention will be held at Maple Hill Farm in Hallowell, Maine from 9:00am to 3:30pm.  The session is sponsored by the Maine Falls Prevention Coalition and the Maine Injury Community Planning Group.

You are invited to join in this discussion to share your insight on the effects of falls on older adults and the most effective strategies to reduce falls and decrease associated health care costs.

The session is partially in response to L.D. 1707 which directed the Commissioner of HHS to develop strategies to keep senior citizens safe from falls.  The Coalition will submit a report to the Commissioner and the HHS Committee by no later than Nov. 2, 2006.

There is no cost to attend.  Meals and summit materials will be provided.  For more information contact  Mary Walsh at 287-9200. [return to top]

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