July 24, 2006

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Register NOW for 153rd Annual Session, Sept 8-10, 2006

Register online at www.mainemed.com for the Maine Medical Association's 153rd Annual Session from Sept. 8-10, 2006 at the Fairmont Algonquin Hotel in St. Andrews by-the-Sea, New Brunswick, Canada.  Join your medical colleagues for a weekend of CME, recreational pursuits and association business.  Bring your family, a children's program will be available.  The room block will expire in August so register soon!

MMA's 153rd Annual Session will be held this year from Sept. 8-10, 2006 at the beautiful Fairmont Algonquin Hotel in St. Andrews by-the-Sea, New Brunswick, Canada.  The location is only 20 minutes from Calais and offers a wide variety of recreational opportunities including ocean kayaking, tennis, golf, and whale watching.  The educational programming includes six and one-half hours of CME featuring the topic of "Medicine in Extreme Environments."  Program Chair Jo Linder, M.D. and her committee have put together an outstanding array of presentations, beginning with a keynote presentation on Friday noon by former NASA astronaut Story Musgrave, M.D..

Registration materials have been sent to each MMA member but registration is also available on-line at www.mainemed.com.

DHHS OMS Staff Reviews MaineCare PA Process

As part of the DHHS Office of MaineCare Services "transformation" project, the staff currently is reviewing the state's MaineCare prior authorization process in an effort to "rationalize" it.  The Office has established a working group composed of 3 Deloitte consultants, a nurse, a physician, a structural engineer, and 4 members of the OMS staff to review the current PA process and to make a series of recommendations to the DHHS senior management by mid-August.  This review does not include the prescription drug management program, but it does address the following services:

  • Physician services
  • DME
  • Vision services
  • Out-of-state services
  • EPSDT services
  • Dental services
  • Hearing aids
  • Transportation services

The MMA is participating in a subcommittee of the MaineCare Advisory Committee to consider recommendations to the Department.  If you have comments or suggestions about the PA process for any of these services, please contact Andrew MacLean, Deputy EVP, at amaclean@mainemed.com.  If you would like to send comments directly to the Department, the point-of-contact is Lucille Weeks at lucille.weeks@maine.gov.

The MMA will update you on the work of the PA subcommittee and the Department's proposed changes to the PA process. [return to top]

Administration Plans Sweeping Changes to Medicare Payment System

The U.S. Department of Health and Human Services (HHS) is proposing the biggest changes to Medicare payments since the current payment system was adopted in 1983. The New York Times reports that such changes could cut payments by 20 to 30 percent for many complex treatments and new technologies, including hip and knee replacements and cardiac procedures. HHS says the new system would be more accurate because it would be based on hospital costs rather than on charges and would be adjusted to reflect the severity of a patient's illness. Critics object on several counts: private insurers and state Medicaid programs could follow Medicare's example and cut payments; changes would affect many nonprofit academic medical centers; and, reimbursements could be less accurate because they were developed from older hospital cost reports and claims data that do not reflect the use of new technology.  Opponents also object to the fact that Medicare did not open the project to competitive bidding and instead relied on a proprietary system controlled by one company, 3M Health Information Systems. For more information:
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Update on Pathways to Excellence

The Physician Steering Committee to Pathways to Excellence, the quality improvement initiative of the Maine Health Management Coalition, met on June 29th for its quarterly meeting.  Highlightsof the meeting are as follows:

  • Rewards for 2005 should be paid out in July.  There will be $400,000 in rewards from Cigna/ Bath Iron Works/MMEHT (Maine Muncipal Employee Health Trust) for full year 2005 with an additional $150,000 from Aetna for the last six months of 2005.
  • Both groups above are planning to reward 3 blue ribbon practices with variable rewards based on member months and  to provide standard rewards for 2 blue ribbon practices.
  • Primary Care practice participation in the Office System Survey is running slightly ahead of last year.
  • All the PTE mailings are now available on the MHMC website.
  • Approximately 40 to 50 practices will have some component of the office system survey and/or process and outcomes data audited.
  • Quality metrics for 2007 will be determined by September, 2006 in order to accomodate practices which will be collecting data later this year for reporting in January, 2008.
  • While primary care participation is growing in PTE, the attempt to include specialties has lagged.  Reports were received at the meeting on cardiology and orthopedics.

The Maine Health Management Coalition website is available at www.mhmc.info [return to top]

AHRQ Study Finds Medical Liability Caps Limit State Health Care Expenditures

A new study by the Agency for Healthcare Research and Quality (AHRQ) indicates that state laws limiting malpractice damage awards reduce overall state health care expenditures. The report, which appears in the June issue of the American Journal of Public Health, estimates that the average reduction in health expenditures for states with caps on malpractice damage awards is $92 per capita (or 3 percent to 4 percent) over the time that the cap has been in place. The study specifically examines noneconomic damage caps  and recommends that future studies should expand the analysis to focus on whether the level of damage caps relates to health care expenditures; the variation in the effectiveness of these laws across States; and whether or not malpractice tort reform law is related to poorer health outcomes. An abstract of the article is available at:
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MaineCare/MECMS Update

The Governor's MaineCare Providers' Advisory Committee met on Thursday, July 20 and heard a series of reports on the continuing problems regarding the claims management system and on-going solutions to them.  The weekly metrics for the week ending July 16 showed that for "fresh" claims submitted, 75% were paid, 13% suspended and 12% denied.  For "recycled" claims, 29% were paid, 46% suspended and 25% denied.  Of particular concern is the increase in suspended claims to over 215,000.  The number of suspended claims has increased every week for the past five weeks, from a low of 187,000.   The MECMS "problem"  is now over a year and a half old and MaineCare providers deserve a sucessful resolution of the problem.

On a positive note, meeting attendees heard more information about the recent state financial order that will result in an additional $24 million being dedicated to assisting with the problem.  These funds have been used to double the Provider Relations staff (adding ten new employees) and triple the claims evaluation staff.  Ten additional staff have been added on the technical side to work exclusively with the design and development of the upcoming releases.  It is hoped that the larger team will help ensure that OMS move MECMS to completion and federal certification and keep the release plan moving on time and on schedule.

The impact of release 1 in early July is still unfolding, and a detail listing of specific changes with remark codes/provider actions etc. should be posted to the website this coming week.  The webinar that had been scheduled was cancelled because of a belief  that not enough detailed information was availalble to make the session worthwhile.  It will be rescheduled soon and improvements to the communications process are planned for release 2.

Additional items covered at the meeting included void functionality, crossover-Part A functionality, prior authorization, customer service, interim payments, and National Provider Identifier (NPI) outreach.

The next meeting of the Advisory Group will be held on August 3rd.  MMA staff attends each meeting and reports to the membership regularly via this Weekly Update.  We appreciate member feedback on how the MECMS system is operating from the provider end and welcome your comments at gsmith@mainemed.com.


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A.M. Best Upgrades Medical Mutual's Rating Outlook from Negative to Stable

On June 22, 2006 the A.M. Best Company affirmed Medical Mutual's Financial Strength Rating of B++  and upgraded the Rating Outlook from negative to stable.

In its Rating Rationale statement, A.M.Best indicated that "the rating reflects Medical Mutual Insurance Company of Maine's (MMIC) supportive risk-adjusted capitalization, recent operating earnings, leadership position within the medical professional liability markets in which it operates and its high policyholder retention rate.  The rating also recognizes the actions taken by management to restore and sustain operating profitability including the implementation of significant premium rate increases, and continued efforts to maintain prudent loss reserves in response to loss trends."

The Rating Outlook as described by A.M. Best "indicates that the company is experiencing stable financial/market trends and that there is a low likelihood that is rating will change in the near term."

Medical Mutual Insurance Company of Maine is located in Portland and is the endorsed carrier of the Maine Medical Association. [return to top]

MMA PAC Trustees Meet This Week

On Tuesday evening, July 25, 2006, the trustees of the MMA's political action committee (PAC), the Maine Physicians Action Fund, will meet at the MMA office in Manchester at 6 p.m.  The agenda includes a review of the candidates for the 186 seats in the Maine legislature and an interview with the Republican candidate for Maine's First Congressional District, Darlene Curley of Scarborough.  Ms. Curley currently is serving her second term in the Maine House of Representatives where she sits on the Appropriations Committee.

You can find lists of the candidates for the Maine legislature on the web at:  http://www.state.me.us/sos/cec/elec/2006.  The MMA encourages you to get to know your local candidates for the legislature and to offer yourself as a resource on health care issues.

Any interested member is welcome to attend the meeting.  For meal planning purposes, please contact Charyl Smith, Legislative Assistant, at csmith@mainemed.com if you plan to attend. [return to top]

CCHIT Releases First Round of EMR Certifications for Functionality, Interoperability, and Security

Below is the group of EMR's that last week received national certification for functionality, interoperability and security from the Certification Commission for Healthcare Information Technology (CCHIT). For more information, visit cchit.org

  • Misys EMR 8.0 (Misys Healthcare Systems)
  • mMD.Net EHR 9.0.9 (MCS-Medical Communication Systems)
  • myNightingale Physician Workstation 5.1 (Nightingale Informatix Corporation)
  • NextGen EMR 5.3 (NextGen Healthcare Information Systems)
  • Patient Records 9 (Practice Partner)
  • PowerChart 2005.02 (Cerner Corporation)
  • Record 2006 (V 3.0) (MedcomSoft)
  • TouchWorks Electronic Health Record 10.1.1 (Allscripts)
  • WebChart 4.23 (Medical Informatics Engineering)
  • The Coding Center's Coding Tip of the Week

    Key Components -- Some Evaluation and Management services require all three key components—history, exam, and decision making; while others only require two of the three.  Remember when providing consultations (hospital and outpatient), admissions to the hospital or nursing home, and Emergency Room services all three components must be documented. 

    · Subsequent hospital and established patients require two components and to support medical necessity, medical decision making should be one of those components along with either history or exam documentation

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

    CMS Issues Rule on Proof-of-Citizenship for Medicaid Eligibility

    As previously reported in Maine Medicine Weekly Update, the federal Deficit Reduction Act of 2005 (DRA) requires Medicaid applicants to document their citizenship effective July 1, 2006.  Beneficiaries previously could assert their citizenship or legal immigrant status by checking a box on a form.  The interim rule, published on July 12, 2006, exempts from the documentation requirement individuals who receive Medicare or Supplemental Security Income because they have already met certain documentation requirements.  The State of Maine plans to cross reference its databases to satisfy this requirement in as many instances as possible.  The rule then establishes a hierarchy of 4 tiers of acceptable documentation for identification and citizenship.  A U.S. passport or a U.S. birth certificate (with an identity document) are among the first and second tier forms of documentation.

    You can find more information about the new documentation requirements on the CMS website:  http://www.cms.hhs.gov/MedicaidEligibility/05_ProofofCitizenship.asp.

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