August 7, 2006

 
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Less than Two Weeks to go to Register for MMA Annual Session

The room block at the Fairmont Algonquin Hotel will expire in less than two weeks so members and guests interested in attending the meeting need to get their registrations in to MMA and their hotel reservations in to the hotel soon.    Registration materials were sent earlier this summer to all members and will be included in the July-August issue of Maine Medicine.  Registration is also available on the MMA web site at www.mainemed.com.  Six hours of category one CME are available at the meeting which will feature keynote presentations by former NASA astronaut and surgeon Story Musgrave, M.D.  and New Orlean's surgeon and former AMA President Donald Palmisano, M.D., J.D.

A summary of the Resolutions to be considered at the meeting will be highlighted in next week's Maine Medicine Weekly Update.

The Association's 153rd Annual Session is being held this year Sept. 8-10, 2006 at the Fairmont Agonquin Hotel in St. Andrews by the Sea, New Brunswick, Canada.  St. Andrews is located approximately 20minutes across the border from Calais.

In addition to the regular Association activities, including the annual membership meeting on Saturday morning, there will be separate meetings of the Maine Society of Orthopedic Surgeons and the Maine Urological Association.  The Aroostook County Medical Association will hold its annual dinner meeting on Friday night, Sept. 9, as part of the meeting.

Recreational opportunities at the meeting include the 26th Annual Edmund Hardy, M.D. Road Race (2.6miles), golf, tennis and kayaking in the Atlantic. The athletic events are once again sponsored by Medical Mutual Insurance Compnay of Maine.

Any questions about the meeting may be directed to Gordon Smith or Diane McMahon at MMA at 622-3374 or dmcmahon@mainemed.com or gsmith@mainemed.com.

Cumberland County Superior Court Rejects Appeal of Dirigo Assessment Decision

In a decision issued Friday, August 4, 2006, Superior Court Justice Roland Cole rejected an appeal by the Maine Association of Health Plans, the Maine Automobile Dealers, and the Maine State Chamber of Commerce of the Superintendent of Insurance's 2005 decision that the Dirigo Health Program had achieved $43.7 million in "aggregate measurable cost savings" in the first year of the program.  The Superintendent had reduced the "aggregate measurable cost savings" to this figure from $136.8 million found by the Dirigo Board.

In his decision, Justice Cole rejected two constitutional arguments by the petitioners:  1.  that the Dirigo statute is void for vagueness because it provides no standards to guide the Board in the calculation of the "aggregate measurable cost savings;" and 2.  that the "savings offset payment" is an unconstitutional delegation of the legislature's taxing powers.  Also, he determined that the Superintendent's conclusion is supported by substantial evidence in the record.  The MMA has not heard whether the petitioners will appeal to the Law Court.

On July 21, 2006, Insurance Superintendent Alessandro A. Iuppa issued an order finding $34.3 million in savings in the second year of operation of the Dirigo Health Program.  The Superintendent again reduced the $41.8 million savings claimed by the Dirigo Board.  The $34.3 million in savings includes $14.5 million in hospital savings initiatives, $5.5 million in uninsured savings initiatives, and $14.3 million in health care provider fee savings initiatives. 

You can review the Superintendent's order on the web at: 

http://mainegov-images.informe.org/pfr/ins/Dirigo2006/INS-06-900_Decision_and_Order.pdf


 


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MMA Event for U.S. Senator Olympia J. Snowe August 15 in Penobscot County

MMA members in northern and eastern Maine should have recently received an invitation to a fundraising event benefitting the re-election campaign of Senator Olympia Snowe.  The event is being hosted by several physicians in the Bangor area and will be held at the Penobscot Valley Country Club on Tuesday evening, August 15 from 6:00pm to 7:30pm. A contribution of $100 per person is requested.

Hosts for the event include Drs. Krishna Bhatta, John McGill, Richard Long, Jordan Shubert, Stephanie Lash, John West, Francis Kittredge, and Thomas Palmer.  Among other hosts are Gordon Smith, Esq., and Andrew MacLean, Esq.

Members may contact either Gordon or Andy for more information about the event.(gsmith@mainemed.com; amaclean@mainemed.com). [return to top]

Dirigo Board, HHS Committee and Dirigo Blue Ribbon Com. Meet this Week

Despite it being August, a number of important meetings are happening this week where MMA will be representing the physicians of Maine.  The Dirigo Health Agency Board meets Monday (8/7) at the Agency offices on Water St. in Augusta.  The meeting begins at 1:00pm and the Board is expected to review the recent decision of Insurance Superintendent Alessandro Iuppa on the amount of the "Savings Offset Payment" for 2007.  The decision on the amount is ultimately established by the Board but is likely to be appealed by interested parties as was the case earlier this year on the SOP for 2006.  That litigation is still pending.

The Legislature's Health and Human Services Committee will meet in Augusta from 10:00am to 3:00pm on Tueday (8/9) to hear reports from the Department of Health and Human Services on a number of items, including the MaineCare program.

On Wednesday, August 9, the recently appointed Blue Ribbon Commission on Dirigo Health will meet at 10:00am in the Cabinet Room at the State House.  MMA Executive Vice President Gordon Smith, former MMA and AMA President Robert McAfee, M.D. and retired surgeon Peter Toussaint, M.D. are all member of the 19-member Commission.

As always, MMA members or office staff with questions or who wish to provide input into any of these meetings may contact Gordon or Andrew MacLean via e-mail to gsmith@mainemed.com or amaclean@mainemed.com.  Your input is not only welcome but actively solicited. [return to top]

Access to Care, Physician Profiling, Professional Liability, Health Plan Practices and Scope of Practice top Issues at AMA Advocacy Cnference

Thirty-five state medical societies and over 15 national medical specialty societies met this past week in California at the 2006 State Advocacy Roundtable meeting.  The annual conference brings together medical society lobbyists from around the country to discuss the current enviornment and the priorities for the legislative sessions beginning in January of 2007.

The major issues discussed were as follows:

  • Medical liability reform
  • Managed care payment practices
  • Comprehensive healthcare reform; improving access to care
  • Scope of Practice
  • Certificate of Need

Maine's efforts at health system reform (Dirigo Health), along with the recently enacted legislation in Massachusetts and Vermont were prominently featured.  There was significant interest in the future of an individual health nsurance mandate, which was included in the MA legislation and which the AMA endorsed in June for individuals earning more than 500% of the Federal  Poverty Level.  The Maine Medical Association has endorsed the concept of an individual mandate since issuance of its White Paper on Health System Reform n 2003. (The 2003 White Paper is currently under revision through the work of the ad hoc Committee on Health System Reform, chaired by MMA President Jacob Gerritsen).

Perhaps the most contentious discussion took place over the issue of physician profiling and the continuing efforts of health plans and self-insured groups to rank hospitals and physicians by tiered groups, utilizing ETG's (episodic treatment groups) and other methodologies attempting to measure quality and efficiency.  Most participants in the conference acknowledged the inevitability of such measurements and encouraged physician leadership in this area.  The AMA division of Private Sector Advocacy has prepared some excellent materials on the topic which are availalble from MMA.

MMA Executive Vice President  Gordon Smith chairs the AMA's Executive Committee of the Advocacy Resource Center which sponsors the annual conference. [return to top]

CMS Releases Five-Year Review and Practice Expense Methodology Changes re Medicare Physician Payment

Medicare physician payments were released by the Centers for Medicare and Medicaid Services (CMS) and published in the Federal Register on June 29, 2006. An additional NPRM with other payment policy changes for the 2007 Medicare Physician Payment Schedule will be released later this summer.

Five-Year Review of the RBRVS
The physician work relative value unit (RVU) changes stem from recommendations made by the AMA/Specialty Society RVS Update Committee (RUC) as part of the third 5-year review of work values. The RUC, working with national specialty societies, reviewed the physician work component for more than 700 individual physician services and recommended increasing work values for 266 codes; maintaining current values for 289 codes; decreasing values for 30 codes; and referring 136 codes to the CPT Editorial Panel. The most significant increases involved Evaluation and Management (E/M) services, including the visits that are part of surgical postoperative care.
CMS accepted 100% of the RUC recommendations related to the E/M services and the great majority of the remaining RUC recommendations. Overall, CMS has proposed to increase the values for 225 physician services, although not always to the level the RUC had requested.
The work value for an intermediate office visit would rise by 37% as a result of the changes. The total cost of recommended increases is about $4 billion.

Revisions to Practice Expense Methodology
CMS has also proposed a four-year transition to a new practice expense payment methodology. Due to problems with some of the original practice expense data for individual services, CMS currently uses a “top-down” methodology which begins with data from the AMA’s Socioeconomic Monitoring Survey and supplemental surveys from some specialties and then allocates this data down to the service level. Now that the RUC has refined the original data, however, CMS concluded that it is possible to use a “bottom up” methodology that begins with the inputs for individual services to calculate direct expenses (clinical staff, medical supplies, and medical equipment). However, the agency intends to continue using data from a multi-specialty survey in the calculation of indirect expenses.

Budget Neutrality
Unfortunately, the law requires budge neutrality for both the work value changes and the practice expense changes. As a result, increases for some services must be offset with reductions elsewhere. For the 5-year-review work value changes, CMS is proposing to achieve budget neutrality by applying a negative 10% “work adjuster,” which equates to an average payment cut of about 5% for most services. Practice expense related changes will range from cuts of 5% to an increase of 12% over four years. However, no specialty would be cut by more than 1% in 2007, the first year of the transition.
The changes proposed in this rule would create debate within the medical profession under the best of circumstances. The fact that they come at a time when physicians face SGR-related cuts of 5% in 2007 and 37% over the next nine years will surely heighten emotions and create the potential for substantial disagreement.
CMS has pledged to work with medical specialties and the RUC during the four-year practice expense transition to correct anomalies in the data and to collect additional data as needed. The AMA will continue to press the case that Medicare payments for all physicians are not keeping pace with practice expense. The rule itself includes data that demonstrates that CMS is only covering 2/3 of the labor, supply and equipment costs that go into each service. The AMA is also coordinating a multi-specialty practice expense survey effort to help with this effort.
The proposed rule is available on the CMS website at www.cms.hhs.gov/PhysicianFeeSched/ Final changes for both this rule and the one to be released later this summer will be published as a single rule in late October or early November. These changes will be implemented on January 1, 2007, after review of public comments submitted by August 21, 2006.
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Governor's MaineCare Provider Advisory Group (on MECMS) Highlights

The most recent of the bi-weekly meetings of the Governor's MaineCare Provider Advisory Group took place on Thursday, August 3, 2006.  Medical Director Laureen Biczak, D.O., Communications Director Patricia Negron, & Customer Service Director Norm Curtis were the principal OMS staff conducting the briefing.  Deputy Commissioner Mike Hall attended some of the meeting & focused his comments on the status of the upcoming biennial budget preparations.

Interim payments

As of mid-July, the current balance of interim payments to providers was $507.5 million, including a $400,000 increase in the last 2 weeks.  During the previous week, the State recovered $3.6 million in interim payments & as of mid-July the State has recovered a total of $251 million in interim payments.  Again by mid-July, providers representing $85.2 million in interim payment balances had agreed to a recovery method or had been defaulted to an offset against current billings.

MECMS Release Management

Dr. Biczak briefed members on difficulties encountered in Release 1 & emphasized the importance of regression testing in Release 2.  Release 2 is now in testing.  The PAG will receive an updated release schedule at the next meeting.  Barbara McGill discussed void processing & reminded members that providers should not attempt to submit void transactions until OMS announces that MECMS is ready.

Weekly metrics

OMS reported the following key statistics for MECMS as of July 30, 2006.

  • Total fresh claims submitted were 149,906;
  • The suspended claims inventory is at 206,623;
  • Processing of paid & denied "fresh" claims is at 91%;
  • The percentage paid of fresh claims is 76.59%;
  • The percentage suspended of fresh claims is 9.15%; &
  • The percentage denied of fresh claims is 14.26%.

On Sunday, August 6, 2006, the Kennebec Journal began a 3-part reprint of an article by Allan Holmes on the MECMS issues that first appeared in CIO Magazine.  The KJ also provides an update on the status of the MECMS implementation.

Biennial budget preparations

Governor Baldacci's staff is preparing a budget proposal for the 2008-2009 biennium for submission to the 123rd Maine Legislature in January 2007.  Deputy Commissioner Hall invited members of the PAG to submit their input on the new budget.  The MMA will urge DHHS to ask the Governor to include another MaineCare fee increase for physicians in the next biennial budget. [return to top]

Partnership for Prescription Assistance Bus Tour Demonstrates Success

In May, the Partnership for Prescription Assistance's "Help is Here Express" bus tour made 3 stops in Maine - in Portland, Augusta, & Bangor.  Of 948 Maine residents who contacted the partnership, 864 or 91% initially qualified for programs that will help them get their medicines for free or nearly free.  That brought the number of Mainers who have found help through the partnership in the last 14 months to more than 10,000.  To date, more than 2.4 million people across the country have been matched with assistance programs through the partnership.

For more information about the Partnership for Prescription Assistance, call 1-888-477-2669 or visit www.pparx.org.

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Committee on Loan and Trust Administration Approves Loans to Maine Medical Students

The Maine Medical Education Foundation is a 501(c)3 entity designed to loan funds to Maine residents enrolled in or accepted by approved medical schools.  The MMEF Committee on Loan and Trust Administration met on Thursday, June 22, 2006 to review 31 loan applications.  Listed below are the students who will be receiving loans from the MMEF this year.  Congratulations!

 RECIPIENT 

 SCHOOL

 AMOUNT 

 Letizia Alto 

 UVM

 $21,000

 Jonathan Ashcroft

 St. George University

 $10,000

 Jessica Aslam

 Saba University

 $20,000

 Sunny Aslam

 Saba University

 $20,000

 Catherine Avener

 UVM

 $10,000

 Carl Barus

 UVM

 $15,433

 Kathryn Barus

 UNE

 $10,000

 Michael Bowley

 Boston University

 $17,875

 Christopher Bloomberg

 UNE

 $10,000

 Joseph Conte

 UNE

 $10,000

 Jessica Deane

 UVM

 $10,000

 Kendra Emery

 UNE

 $25,000

 Natasha Frederick

 UVM

 $10,000

 Megan Greenleaf

 UVM

 $10,000

 Brian Hagan

 UVM

 $20,000

 Clota Heazel

 Tufts

 $10,000

 Cullen Jumper

 University of Connecticut

 $25,000

 Stephen Kelleher

 Dartmouth

 $10,000

 Kurt Kelly

 UVM

 $  5,000

 Brandon Libby

 UVM

 $10,000

 Brad MacKinnon

 UVM

 $20,000

 Matthew Malek

 University of Rochester

 $10,000

 Sandra Maruszak

 Dartmouth

 $25,000

 John Martel

 UVM

 $20,000

 Matthew Morgan

 UNE

 $10,000

 Emily Parent

 UNE

 $10,000

 Dwight Pringle

 Jefferson Medical

 $20,000

 Heather Robins

 Tufts

 $20,000

 Jacob Stinson

 UNE

 $20,000

 Heather Tory

 Tufts

 $25,000

 Nicholas Viens

 Duke University of Medicine

 $25,000

Dr. Mark Bolduc, Chairman of the Committee on Loan and Trust Administration, would like to encourage Maine medical students to submit late applications for loans.  While funds are limited consideration will be given to late applicants.  If you are interested in information on how to submit your application, please contact Pat Capozza at Maine Educational Services at 1-800-922-6352. [return to top]

Anthem Health Care Leadership Conference on Workplace Wellness October 19, Augusta Civic Center

Anthem Blue Cross and Blue Shield is sponsoring the second in a series of conferences on “Reversing the Tide: Creating a Healthier Maine.” “The business case for workplace wellness” will explore what employers can to do to help their bottom line and their employees’ health.
The daylong, statewide conference will be held at the Augusta Civic Center on October 19, 2006 and will bring together national and state experts on workplace wellness. Two of the nation’s foremost experts on workplace wellness will deliver keynote addresses: Dee Edington, PhD, Director, Health Management Research Center, University of Michigan and Michael O’Donnell, PhD, President and Editor-in-Chief, American Journal of Health Promotion.
The full conference agenda and registration information will be available on September 8.  If you have questions before then, please contact Liz Bedard at elizabeth.bedard@anthem.com [return to top]

Health Information Technology Promotion Act of 2006 Passes House

Last week, the House of Representatives voted 270 to 148 to approve H.R. 4157, the Health Information Technology Promotion Act of 2006. All six of the amendments offered passed.

As we have previously reported, the bill:

  • Codifies the duties and responsibilities of the Office of the National Coordinator for Health Information Technology.
  • Promotes an interoperable, secure, national health information system.
  • Provides grants – including grants to small physician demonstration projects – to facilitate implementation of a national HIT system.
  • Replaces ICD-9 with ICD-10 on or after October 1, 2010.
  • Requires the Secretary of HHS to conduct a comprehensive medical records privacy study, to determine whether greater commonality in privacy laws is needed “to better protect, strengthen, or otherwise improve the secure, confidential, and timely exchange of information . . .” and to recommend in legislative form the changes – if needed – to implement such changes.
  • Maintains current rules protecting state privacy laws that are more protective of privacy than applicable federal HIPAA rules.
  • Provides for congressional review, amendment, and approval of the Secretary’s privacy recommendations.
  • Promotes the use of telehealth services.
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Lewiston Physician Practice Seeks Physician Practice Administrator

A privately owned, Lewiston physician practice of 4 nephrologists, 1 surgeon, 1 nurse practitioner, 5 nursing staff, and 5 office staff is searching for a Physician Practice Administrator.

This position serves as the administrative lead to all non-physician staff and reports directly to the physician partners. 

We are looking for the “right” person who fits our culture and who can provide sensitive, insightful, and confident leadership while directing the daily operations of the Practice.  The Practice Administrator also develops, plans and directs administrative policies and procedures of the Practice to ensure the actualization of the Practice Philosophy.  The Practice Administrator directs financial operations of the Practice, oversees the operation of the facility and equipment, and serves as staff to the Practice Partners, advising them on administrative and operational issues related to the Practice.

Qualifications:
5+ years of physician practice management is essential. 
A bachelor’s degree in business or healthcare management is required/master’s degree preferred.
High level of organizational and management skills.
Statistical analysis and skillful financial administration.

Please send CV and references to:
 DocExecutive
 1115 Intervale Road 
 New Gloucester, Maine  04260
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Resources For Flu Planning Available on Web

A variety of organizations have posted resources for pandemic and bird flu planning.

The American Hospital Association (AHA) has reports, planning tools and links to government sites at http://www.aha.org/aha/key_issues/disaster_readiness/resources/flu.html.

In Maine, the Maine Center for Disease Control (CDC) has a flu pandemic site at www.maineflu.gov.  That site includes local planning resources, information for health care workers, the general public and businesses.

Franklin Memorial Hospital has put its pandemic influenza plan on its web page at www.mainebirdflu.org, hospital President Richard Batt announced at a recent Avian Influenza/Pandemic Influenza Advisory Committee meeting.

Franklin’s site also includes links to pandemic-related resources such as articles and web sites.  Batt said that hospitals are welcome to download his hospital’s plan and link to its site.

Meanwhile, MHA recently added a pandemic influenza related web page to its site.  Hospitals that have posted their flu plans are urged to send those links to Becky Schnur, director of communications, at rschnur@themha.org, and she will include the links on http://www.themha.org/resources/flu.htm. [return to top]

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