October 2, 2006

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Congress Neglects to Restore Medicare Payment Reduction; Lame Duck Session the Next Chance

The Congress failed this past week to take action to avert the proposed 5.1% decrease in reimbursement effective Jan. 1, 2007.  There was a hearing held before the House Committee on Wednesday on the issue of the reimbursement formula.  This followed the introduction of various proposals to fix the problem, none of which have even made it to the House floor.

The best chance to fix the sustainable growth rate formula will now take place in November or December during a so-called "lame duck" session.  Even a freeze in payment rates wil cost the federal government 6 to 8 BILLION dollars, a fact that has undoubtedly caused concern.  A permanent fix by scrapping the SGR formula would cost over $200 BILLION over ten years.

House Energy and Commerce Chair Joe Barton of Texas indicated that his bill would allow for a .5% increase each year from 2007-2009,  but he also offered an additional .25 % increase for physicians who "voluntarily" reported to CMS on some performance measures.  Most physician groups opposed the Barton fix.

Maine First District Congressman Thomas Allen is a member of the Committee and his office kept in contact with MMA last week while the issue was being discussed.  Congressman Allen, Senator Snowe and indeed all the members of the Maine Congressional delegation are in support of legislation to avert the cut.   Nonetheless, it remains to be seen whether in a lame duck session the Congress can find the support and off-setting cuts to enact a bill to block the cut.  If you have not communicated your concern to the Maine delegation, you should do so between now and the election. 

The Congress has now adjourned until after the election.

You will find more information about the Medicare payment campaign, including a link to the AMA's grassroots action center, on the web at:  http://www.ama-assn.org/ama/pub/category/14332.html.

AAFP States that Maine Needs 34% More Family Physicians by 2020

The American Academy of Family Physicians released a report last Wednesday showing the need the country will have for many more family physicians (39%) over the current number by the year 2020.  The need in Maine would be 34% from the existing number of 438 to 589. 

Maine ranks in the middle of the states regarding the increasing need, with Nevada needing a 79% increase and Delaware needing a 5% increase.

According to the Maine Recruitment Center, the state is facing its greatest shortage of physicians since the Center began, with 206 positions being available.  Ninety-two of these positions are for primary care physicians.

Family physicians from 15 Maine communities were in Washington for the announcement and participated in a rally for health care reform.  Rick Kellerman, president-elect of the AAFP, stated that major health reforms are needed at the federal level in order to attract more physicians to the practice of family medicine.  Dr. Kellerman noted poor reimbursement for medicaid and medicare patients and higher liability insurance costs as causative factors for the shortage.  He also noted that Congress is currently cutting family physician training programs. [return to top]

Monthly Member Website Question: What do you think?

The first day of each month we place a new question on the home page (directly under the Calendar of Events) of the MMA website, www.mainemed.com, to get member opinions on issues.  This month's question is:  Last month, the MMA held a successful 153rd Annual Session in St. Andrews-by-the-Sea in New Brunswick, Canada.  Do you believe that future annual meeting sites should be limited to Maine?

Please take a moment to go to www.mainemed.com and place your vote.  The questions are for members-only, so you will need to enter your username and password and then it is as easy as toggling on a button indicating your choice and pressing submit.  If you haven't registered as a member, you can do so easily by clicking on "Register" in the upper right hand corner of the home page under MMA Member Access.

Your opinion matters.....please take time to vote today! [return to top]

Medicare Releases Data on 2007 Drug Plan Options in Maine

FOR IMMEDIATE RELEASE                                               Contact: HHS Press Office
(202) 690-6343

More Plans with Coverage in the Gap

Seniors and people with disabilities who are satisfied with their current Medicare prescription drug coverage will not have to take any action when the Medicare Open Enrollment period begins November 15th, but those who wish to make a change will find new options with lower costs and more comprehensive coverage available for 2007.  Surveys consistently show over 80 percent of Medicare beneficiaries are satisfied with their current coverage and drug plans. As a result of the Medicare prescription drug benefit, more than 38 million seniors and people with disabilities now have some form of drug coverage.

The monthly premium beneficiaries will pay in 2007 will average $24 if they stay in their current plan -- about the same as in 2006.  While some people will see an increase in their current plan premiums, they have the option to switch plans. Nationally, 83 percent of beneficiaries will have access to plans with premiums lower than they are paying this year and beneficiaries will also have access to plans with premiums of less than $20 a month. 

Beneficiaries will have more plan options that offer enhanced coverage, including zero deductibles and coverage in the gap for both generics and preferred brand name drugs. Plans are adding drugs to their formularies. Nationwide the average number of drugs included on a plan formulary will increase by approximately 13 percent, and plans will also use utilization management tools at a lower rate.

“The Medicare prescription drug benefit, passed by Congress and signed into law by the President, is saving seniors an average of $1,200 a year, and it just keeps getting better,” HHS Secretary Mike Leavitt said. “In 2007, there will be more plans with coverage in the gap, more drugs covered, and more help from Medicare in choosing the plan that’s best for you.”

During the 2007 bidding process, strong competitive pressure resulted in bids (costs of coverage) that average 10 percent less than in 2006. According to guidance from the Centers for Medicare & Medicaid Services (CMS), each drug plan or health plan needed to show meaningful variation in their plan choices, including only two basic coverage options per region.  CMS also encouraged plans to offer a third option only if it included enhanced benefits, such as providing coverage in the coverage gap (“donut hole”) or covering excluded drugs.

“With next year’s drug coverage, we want to build on the high level of beneficiary satisfaction in 2006 by strengthening the drug benefit in key ways,” said CMS Administrator Mark B. McClellan. M.D., Ph.D.  “As a result of robust competition and smart choices by seniors, plans are adding drugs, removing options that were not popular, and providing more options with enhanced coverage.”

“If you’re satisfied with your coverage, you do not have to do anything during the Open Enrollment period. If you are considering a change, Medicare has new tools to help,” Dr. McClellan said.

In Maine, nearly all beneficiaries enrolled in Medicare prescription drug plans will be able to remain in the plan in which they enrolled for 2006 since almost all Part D sponsors are either continuing their current plans in 2007 or streamlining and consolidating their 2006 plans. They will be able to choose from 26 plans that offer enhanced benefits or services, such as coverage in the gap and little or no deductible.  This represents an increase of nine more choices of enhanced plans than in 2006.  There are 32 plans that have zero deductibles, some of which also offer other enhanced benefits.  The lowest premium in Maine is $13.70, and one plan has a premium below $20 a month.  With these options, 100 percent of beneficiaries in Maine have access to coverage with a lower premium than they are paying in 2006.  There are also options that cover generics and preferred brand name drugs through the coverage gap for as low as $41.80, and generally for under $50.

Beneficiaries with limited incomes who qualify for the extra help will have a range of options available for comprehensive coverage.  Beneficiaries who qualify for the full Medicare subsidy will pay no premiums or deductibles in these plans.  In Maine, 97 percent of low-income beneficiaries will not need to change plans to continue to receive this coverage for a zero premium. 

There are eight new national organizations offering drug plans to beneficiaries, in addition to the nine national plans that were available in 2006.  The list of national plans can be found at www.medicare.gov/medicarereform/local-plans-2007.asp.

In general, beneficiaries in Maine will also have greater access to Medicare Advantage health plans next year, generally with lower costs for drug coverage. These plans offer an opportunity for additional benefits beyond those covered in the original Medicare program, with savings that average around $82 a month nationally for hospital and physician benefits.  In addition to these savings, Medicare Advantage plans provide overall care coordination, and more effective use of drugs that lead to savings in other health care costs. As a result, the cost of drug coverage in Medicare Advantage plans is about $6 a month lower on average nationally in 2007 than in 2006.  In addition, Maine will have at least one Medicare Advantage plan that provides basic drug coverage for $0, and will also have at least one Medicare Advantage plan that provides coverage in the gap for $0.

Beneficiaries who want to consider other options will have access to help from many sources in the fall including:

  • A notice of any coverage changes from their drug plan, coming at the end of October;
  • The enhanced Medicare Drug Plan Finder will be available in mid-October;
  • 1-800-Medicare (1-800-633-4227) which will be available 24/7;


    Note: All HHS press releases, fact sheets and other press materials are available at http://www.hhs.gov/news.

[return to top]

MaineCare Officials Report to Appropriations Committee/MECMS Update

DHHS Commissioner Brenda Harvey and Deputy Commissioner Michael Hall reported on Thursday to the Legislature's Joint Standing Committee on Appropriations and Financial Affairs regarding the current status of the MECMS system.  Here are the highlights:

  • There has been a significant drop in the number of MaineCare claims, to a low of 128,000 as of Sept. 27.  At the height of the problem in 2005, over 600,000 claims were in suspension.
  • The major fixes associated with Release 1, which took place beginning July 1, 2006, are not yet operational.  On this coming Tuesday, the contractor (CNSI) is due to deliver some new code that will be tested and will be implemented if the testing is successful.  The three major functional components of the Release were part A cross-overs, 837 I and void functionality. Until the problems with Release I are fixed, future Releases are not being scheduled.  Therefor, there is no longer even a date for implementation of electronic payment of the Part B cross-overs claims.  Certainly this will not be happening before sometime in 2007.  There is now even the prospect of some of the fixes not happening until 2008, a full three years since the system was made operational.
  • The Office of the Inspector General of the federal Department of Health and Human Servivces issued a report in August entitled, "Review of the Maine Claims Management System", which includes a recommendation that MaineCare reprocess all of the claims put through MECMS once the system is fully operational and certified by the feds as complete.  Maine officials have taken exception to this recommendation in the report, stating that they do not have the capacity to reprocess millions of claims and continue to process current claims.  The Inpector General's office made the recommendation "to ensure that the claims were accurately reimbursed and that claims histories were correctly established."
  • The best quote of the day was from OMS Medical Director Laurren Biczak, D.O. who stated that the office is now "facing the reality of a delay far longer than we thought," in reference to the attempts to fix MECMS.

The Governor's MECMS Provider Advisory Committee met on this past Thursday, as well, and heard updates on the new provider relations staff and other process related issues.  There was a lot of discussion about the various communication vehicles the OMS is using to communicate with providers, including the MECMS Update, the list serve, the Technical Advisory Group and the Provider Advisory Group.  MMA staff asked that there be no change, at this point, in the various communication methods but that there be an attempt to advise providers in a more timely manner.  Of particular note was the delay in notification of the basic failure of Release 1 and the total absence of any comment about the Inspector General's report and the Commissioner's response, which was apparently dated in early August.

The next meeting of the committee will be on Oct. 12th at 10:00am at the OMS office in Augusta.  [return to top]

Fall's Initial First Friday CME Program On Living Wills on Friday, Oct. 6

MMA's new series of CME programs held the first Friday morning of each month start up again this coming Friday with a three hour program on advanced directives.  The program will feature a presentation on the history of advanced directives in Maine as well as a discussion on the recent legislation considered by the legislature regarding DNR (do not resuscitate) orders.

The faculty for the program includes Beth Dobson, J.D. of Verrill-Dana, Leo Delicata, Esq. of Legal Services for the Elderly and Gordon Smith and Andrew MacLean of MMA.

The program will be held from 9:00am to noon at the MMA offices in Manchester.  Call 622-3374 (Press 0) to register or go register on-line at www.mainemed.com.

Watch for an insert in the September-October  Maine Medicine for registration material for the November and December programs. [return to top]

The Coding Center's Coding Tip of the Week

Medical Record Documentation

  • Be sure that the record clearly indicates all services performed and the medical necessity for the level of service you are billing for. 
  • Diagnostic tests should be documented in the patients chart not just on the Super Bill.
  • Legibility – if you can’t read it how do you expect others to?
  • Coder’s Mantra: if it’s not documented, it was not done (no credit for inference)

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

Muskie School Hosts 2nd Annual Forum for Health Care Leaders, October 18-19

Muskie School Forum for Health Care Leaders, October 18-19, 2006, "Building an Integrated, High Quality & Evidence-Based Mental Health Program"

Next month, on October 18th and 19th, the Muskie School’s Graduate Program in Health Policy and Management is hosting its 2nd Annual Forum for Health Care Leaders.

This year’s program will focus on “Building an Integrated, High Quality and Evidence-Based Mental Health Program”.  There are a number of very significant policy and program changes occurring in Maine around the delivery of mental and substance-use services by the State, as well as by private organizations and professionals.  These changes will have profound impact on how consumers access and receive care.  The Forum provides an important and timely opportunity for all stakeholders to convene around these issues and developments.

On Wednesday evening, October 18th, Dr. Mary Jane England will present a keynote address based on her work as chair of the Institute of Medicine’s committee: Improving the Quality of Health Care for Mental and Substance-use Conditions.  This work is part of the IOM’s continuing series entitled: “Crossing the Quality Chasm.”  Following Dr. England’s comments, Senator Michael Brennan, Dr. Andy Cook, Dr. Girard Robinson and Dr. Wendy Wolf will provide additional context and insights as they apply to Maine.  All attendees are also invited to a reception including an hors d’oeuvres buffet prior to Dr. England’s address.

Other venues that will be featured over the two days include a seminar in current mental health topics and a research agenda setting meeting.   Registrations are underway for all these sessions and interest is high.  Indeed, we have already been petitioned to increase the maximum number of registrants for the topics seminar. 

We think you will find these sessions to be important and engaging.  To register, please visit the Forum website at: www.muskie.usm.maine.edu/healthforum.
[return to top]

MMA Looking for Physicians Voluntarily Reporting to CMS

The federal Centers for Medicaid and Medicare Services earlier this year initiated a voluntary reporting system allowing physicians to report on some performance metrics using "g" codes.  We are interested in learning if any Maine physicians are participating in this reporting.  Please let Gordon Smith, MMA EVP know if you or someone you know is participating (gsmith@mainemed.com). [return to top]

MMA Executive Committee Seeks Member from Oxford County

The 28-member MMA Executive Committee is seeking a member to represent physicians in Oxford County.  Dieter Kreckle, M.D. has served ably on the Committee for 9 years but is term-limited under the provisions of the MMA Bylaws.  Any physician residing in or practicing in Oxford County who may be interested in serving on the committee should contact Gordon Smith, MMA EVP at gsmith@mainemed.com or by calling 622-3374 ext. 212.

The Committee meets on Wednesday afternoons at MMA offices in Manchester, about 8 times per year.  The committee also meets during the Annual Session and holds a weekend retreat each January. [return to top]

IOM Issues Report on FDA's Role in Ensuring Drug Safety

On September 22, 2006, the Institute of Medicine released a report on the Food & Drug Administration's role in ensuring drug safety entitled, The Future of Drug Safety:  Promoting and Protecting the Health of the Public.  In it, the IOM cited chronic underfunding, lack of clear regulatory authority, and a perception that the agency and its employees are too closely tied to the pharmaceutical industry as the principal problems facing the federal agency.  The report includes approximately 25 recommendations including:

  • a 6-year term for FDA commissioners;
  • clarified authority and new enforcement mechanisms for the agency;
  • labeling requirements and advertising limits for new medications;
  • required registration of clinical trial results to promote public access to drug safety information;
  • increased funding for the agency; and
  • clarification of the agency's role in collecting and disseminating information on products' risks and benefits.

The report is available on the web at:  www.nationalacademies.org. [return to top]

Norwalk & Kuhn Named to Top CMS Posts in Acting Capacity

On September 25, 2006, U.S. Health & Human Services Secretary Mike Leavitt announced that Leslie Norwalk would become acting administrator of the Centers for Medicare & Medicaid Services (CMS) and that Herb Kuhn would become acting deputy commissioner of CMS on October 15, 2006, immediately after Administrator Mark McClellan's departure.  Norwalk and Kuhn both have been part of the senior leadership of CMS. 

Norwalk currently is the deputy administrator and formerly has served as COO and acting director of the Center for Beneficiary Choices.  Prior to her tenure at CMS, Norwalk practiced law in Washington with Epstein, Becker & Green P.C. and served in the first Bush administration in the White House Office of Presidential Personnel.  She received her law degree from George Mason University and her bachelor's degree from Wellesley College.

Kuhn has served as the director of the Center for Medicare Management for the past two years.  Before coming to CMS, Kuhn was a senior executive with advocacy responsibilities for Premier, Inc., a non-profit hospital alliance.  Prior to that post, he served as vice president for federal relations in the Washington office of the American Hospital Association and worked on Capitol Hill for former congressman Bob Whittaker (R-Kansas). [return to top]

Insurance Superintendent Receives DirigoChoice Rate Filing

On September 29, 2006, Insurance Superintendent Alessandro Iuppa issued a Notice of Pending Proceeding and Hearing regarding Anthem Blue Cross and Blue Shield's 2007 Individual/Self-Employed Employer Rate Filing for DirigoChoice Products.  Anthem has proposed revised rates for the DirigoChoice individual/self-employed employer producst that it claims will produce an average incease of 23.1%.  In a separate filing, Anthem also proposes certain benefit design changes in some copayments that, if approved, Anthem says will reduce its proposed rate increase resulting in an average increase of 18.2% for the DirigoChoice products.  Anthem has requested an effective date of January 1, 2007 for the new rates.  The Superintendent has scheduled a public hearing on the rate request for 8 a.m. on Tuesday, November 28, 2006 in Room 127 (the Taxation Committee room) of the State House in Augusta.

 You can find more information about the rate filing on the Bureau of Insurance web site at:  http://www.state.me.us/pfr/ins/Anthem_2007_rate_filing.htm. [return to top]

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