September 25, 2006

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Blue Ribbon Commission on Dirigo Health Holds Third Meeting

The Blue Ribbon Commission on Dirigo Health met for the third time on Sept. 18 to continue its discussion and search for alternatives to the current financing scheme utilized to support the DirigoChoice insurance product being furnished to just over 11,000 individuals at this time.  Commission members, including Robert McAfee, M.D., Peter Toussaint,M.D. and MMA EVP Gordon Smith, received an overview of the Dirigo Health Agnecy from Director Karynlee Harrington and a presentation on the role of Medicaid in expanding access by Cindy Mann, J.D. of Georgetown University.

The Commission had been scheduled to receive a summary of the comments received from legislators but that report was delayed, apparently because of several legislators being tardy in their response to a survey that was sent to them.

Commission members agreed to schedule a meeting in addition to the four already scheduled.  These future meetings will be held on Oct. 5, Oct. 24, Nov. 9, Nov. 29 and Dec. 11.  The Commission's report is due to be presented to the Governor on Dec. 15, 2006.

At the Oct. 5 and Oct. 24 meetings, cost containment initiatives will be reviewed as well as the existing formula known as the Savings Offset Payment.  Commission members noted that they needed a lot more information about the exisitng financing before beginning to think about alternatives.

After the Oct. 5th meeting, each Commission member will be asked to respond to a survey similar to the one conducted with legislators.  The survey questions will address what principles and priorities should guide the development of Dirigo in the future.  The Commission staff will prepare a presentation for the November 9th meeting that reflects the range of opinions of the Commission.  Staff will develop initial projections of the funding required to support the range of proposed target populations and enrollments.

In representing MMA members, MMA representatives will be cognizant of the importance of maintaining that provision in the Dirigo legislation that provides for commercial insurance rates to be paid for physician services.

Watch this publication and the pages of Maine Medicine for updates on the work of the Commission.  Any comments and suggestions can be directed to Mr. Smith at

Prescription Monitoring Program Medical Advisory Committee Meeting

The Medical Advisory Committee to the state's Prescription Monitoring Program met on Sept. 21 and reviewed data from the first two years of the program.  The program, which began on July 1, 2004, collects data from all state paharmacies, including now the VA, for schedule II, III, and IV drugs.  Threshold reports are then prepared on any patients receiving these drugs from five or more prescribers or five or more pharmacies.

The reports, received each quarter, as well as requests that can be made for an individual report on a patient or person who wants to become a patient, have become an important tool for physicians who are trying to decrease the risk of abuse and diversion of prescription drugs.  The diversion of prescription drugs continues to be a serious public health problem in the state.

Some of the interesting information presented at the meeting:

  • Of scheduled drugs prescribed in Maine, 54.60% are narcotics, 34.63% are tranquilizers and 9.88 are stimulants.  (the first year's data, the second year's data did not vary significantly).
  • The age cohort representing ages 46-60 received the most scripts per age group.
  • The most scripts per county was in Penobscot County where 1.74 scripts per person were written.
  • Of the top ten drugs, by script counts, hydrocodone/acetaminophen (vicodyn) was the most frequently prescribed.
  • For the second quarter of 2006, 1,523 prescribers were sent a report on a patient who failed the threshold, representing over 700 patients.  The third quarter reports will have similar numbers.
  • 1.932 patients were identified as receiving more than 4 gm per day of acetaminophen (April 2006).

Many more prescribers have registered to receive reports since the information has been available in real-time on line.  This has helped appreciably in emergency rooms, for instance.  To register with the PMP program, go online at: UseRegistration.aspx.  If you have any difficulty, contact the Program Coordinator, Chris Baumgartner at 287-3363. [return to top]

MaineCare MECMS Problems Draw Attention of Inspector General

A report issued this week by the Office of the Inspector General of the federal Department of Health and Human Services criticized the new billing and management system for lacking effective controls to ensure proper spending of the $2 billion plus annual state and federal funds that go into the program.

The inspector general's report was conducted for the period from Jan. 21, 2005, when the system was first turned on, to Dec. 31, 2005.  While the system still performs poorly, the audit was limited to the first year of the problem.  State officials now openly acknowledge that the problems will not be completely fixed before some period into 2007.

One recommendation  in the report has drawn objection from the Department. The disagreement is on the recommendation that once the system is fully certified by the federal government, all claims be processed again to make sure they are accurate.  State officials including Commissioner Brenda Harvey, do not believe they have the capacity to reprocess all the claims while continuing to process exisitng claims.

The Legislature's Committee on Health and Human Services will meet on Oct. 10 to receive further information on the issue.

The report now goes to the federal DHHS's Centers for Medicare and Medicaid Services which will ultimately decide what action to take based on the report. [return to top]

CDC Urges Routine HIV Testing

All adolescents and adults should routinely be tested for HIV infection in hospitals, clinics and doctors'  offices, the federal government said last week, signaling a radical shift in the public health approach to the 25 year old epidemic.  Under the new recommendations from the Centers for Disease Control and Prevention, patients would no longer have to sign a consent form and get extensive pre-test counseling.  But they would have to be told they were being tested for the AIDs virus, asked if they have any questions and given the opportunity to "opt out." [return to top]

Valuable MMA Program Offering Long Term Care Insurance for Members and Their Families

When you’re doing your financial planning have you considered how you will pay for care if you need it? This is an often-overlooked area in planning. Most of us will rely on assets that we are accumulating to provide us with a secure retirement. A long-term care need that could easily require sixty thousand dollars per year or more could have a devastating impact on the quality of life in our retirement years.

The MMA is pleased to announce that we have partnered with affiliates to help our members and their families properly address this issue. Three professional planners have formed an alliance to help you address this critical planning need. They can provide you with advice and access to a program that offers a discount to MMA members and their family members. For further information you may contact:
Marcus Barresi at 1-866-764-5639 or e-mail
Scott Davis at 1-800-938-9441 or e-mail at
James McAllister 1-207-232-1590  or e-mail at 
[return to top]

The Coding Center's Coding Tip of the Week

“Nurse Visits”—What is different about 99211?

  • Only visit code that does not require a practitioner (physician, PA, NP) to be present
  • Physician’s can use this code, however
  • CMS “incident to” criteria should be met
  • Must be an employee or have contractual relationship, who is trained and competent to render the service
  • Physician/PA/NP MUST be immediately available in the office if required must review and sign the chart
  • Orders for service should be in patient’s chart
  • Staff must document who order is from and who is “supervising” to bill for service

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

NHIC, Corp. Offers Free Ask-the-Contractor Teleconference Sept. 27, 1:00EST

NHIC, Corp.  Ask-the Contractor Teleconference (ACT)
Topic: NPI
Time:  September 27th, Wednesday, 10:00 a.m. PST, 1:00 p.m. EST

NHIC, Corp. is hosting a free one-hour ACT on the topic of NPI for Medicare Part B providers.  Providers and their staff are encouraged to participate on the conference call.

We will discuss this topic and provide important information to help you expedite the efficient acquisition of your National Provider Identifier number.  Representatives from the Provider Enrollment department will also be on the call to answer questions that you may have.

We invite you to call in with your questions or comments about the NPI, toll-free, at  1-800-475-0212, Pass code:  NPI.  There is no registration needed for your participation on this call; however, there are a limited number of lines available.

PLEASE NOTE: For providers billing electronically, beginning October 2, 2006 through May 22, 2007, CMS systems will accept an existing legacy Medicare number and/or an NPI. 
For providers billing on the paper CMS-1500 form, beginning January 2, 2007 through May 22, 2007, CMS systems will accept an existing legacy Medicare number and/or an NPI.  Beginning May 23, 2007 all CMS systems will only accept an NPI. [return to top]

Study Finds Declining Acceptance of Medicaid Patients by Doctors

On August 17, 2006, the Center for Studying Health System Change (HSC) released physician survey findings suggesting a decline in physician participation in the Medicaid program.  In 2004-2005, 21% of doctors accepted no new Medicaid patients, compared with 20.9% in 2000-2001 and 19.4% in 1996-1997.  The current data shows that the rejection rate for Medicaid patients is 6 times higher than for Medicare patients and 5 times higher than for privately insured patients.  Demonstrating the problem with Medicaid payment rates, the survey found that 14.6% of doctors reported receiving no Medicaid revenue at all in 2004-2005.  The study also found that Medicaid patients increasingly are being served by large physician practices and community health centers, although it is unclear whether this concentration is having a negative impact on access to care.

More information about HSC and the survey may be found on the web at: [return to top]

AMA Urges Congressional Action on Medicare Payment Cut Before Election Recess

The AMA is making a 2-week push and is launching a $1.5 million ad campaign to urge Congress to put the Medicare physician payment issue on the agenda before recessing for the November elections.  In accordance with the sustainable growth rate (SGR) formula, physician payments under Medicare will be cut by 5.1% on January 1, 2007, if no action is taken.  While many lawmakers are sympathetic to organized medicine's case, they face a major cost hurdle.  The Congressional Budget Office (CBO) estimates to fix the payment problem range from $13 billion over 5 years for a 1-year fix to a complete overhaul of the SGR system costing $58 billion over 5 years and $218 billion over 10 years.

You can find the AMA's estimate of the payment cut's impact on Maine on the web at:

You can find more information about the AMA's campaign, including a link to the AMA's grassroots action center that will allow you to contact Maine's congressional delegation, on the web at: [return to top]

Kaiser Report on Medicare Part D Finds Mixed Views Among Pharmacists & Physicians

A Kaiser Family Foundation report issued September 7, 2006 finds that while most pharmacists and physicians surveyed believe the new Medicare Part D drug benefit is helping their patients, most are experiencing some problems navigating the system to get their drugs.  Nearly 60% of physicians surveyed stated that they had patients who had experienced problems accessing prescribed medications and 15% said that most of their patients with Part D had experienced such problems.  Ten percent of doctors said that they had a patient who had suffered a "serious medical consequence" because of such problems.  Most pharmacists and physicians reported a willingness to help their patients with problems with the Part D benefit, but they feel that they lack sufficient expertise.  You can access the report and the survey on the web at:

As the MMA has pointed out in past editions of Maine Medicine Weekly Update, a good local source of information on the Medicare Part D drug benefit is the web site of Legal Services for the Elderly, Inc.,

  [return to top]

Need More Information on Advanced Directives?

Join us at the Maine Medical Association on October 6, 2006

The Maine Medical Association invites you to attend the Advanced Directives: End of Life Care seminar on October 6, 2006 at the Maine Medical Association located in Manchester, Maine.  The 122nd Legislature enacted legislation changing the laws regarding "Do Not Resuscitate" orders in Maine (Resolves 2005, Chapter 169) and considered other important changes to Maine's laws on Advanced Directives.  Advanced Directives were also in the news last year with the widespread reporting of the tragedy surrounding the Terry Schiavo case.

The Advanced Directives faculty includes, Beth Dobson, J.D., partner in the law firm of Verrill and Dana, Leo Delicata, J.D., senior attorney with the office of Legal Services for the Elderly, Gordon Smith, Esq., Executive Vice President of the Maine Medical Association, and Andrew MacLean, Esq., General Counsel and Deputy Executive Vice President of the Maine Medical Association.

For further information or registration materials please call Gail Begin at 622-3374 ext. 210 or visit us on the website at [return to top]

Quality Counts! Board Elected

Members of Quality Counts (having made dues commitments prior to 7/31/06) returned their ballots to the Nominating Committee and the results were finalized at the Executive Committee meeting on September 13th .  The new Directors have been notified and the first meeting of this new Board is being scheduled.

 Our thanks to all who have supported Quality Counts, and to the new Board of Directors who will work to advance the organization and its purpose:   Measurably Improving Health & Healthcare for Maine!

Steve Ryan
Secretary, Quality Counts
President/CEO, Maine Network for Health
(207) 942-2844


Board of Director Election Results

Presented to Quality Counts Executive Committee on September 13, 2006

Physical Medicine Providers (at least 3 for this category):

  • Barbara Crowley MD, MaineGeneral Health
  • Josh Cutler MD, Maine Heart Center
  • Holly Gartmayer, Harrington Family Health Center
  • Lisa Letourneau MD, MaineHealth
  • Steve Ryan, Maine Network for Health

Behavioral Providers (at least 1 in this category) 

  • Wesley Davidson, Aroostook Mental Health Services, Inc.

Private Payor Representatives (at least 1 in this category):

  • Bob Downs, Harvard Pilgrim Health Care
  • Jeff Holmstrom DO, Anthem BCBS of Maine

Employer Representatives (at least 1 in this category):

  • David White, MDI Imported Car Services, Inc.

Health-related Associations (at least 1 in this category):

  • Ellen Farnsworth NP, Maine Nurse Practitioner Association
  • John LaCasse, Medical Care Development
  • Gordon Smith, Maine Medical Association

At-Large (at least 1 in this category):

  • Ted Rooney, Health & Work Outcomes

Appointed Board Positions (2) (Not Elected)

  • Jim Leonard, Maine Center for Disease Control (BOH)
  • MaineCare: Brenda McCormack
[return to top]

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