October 18, 2006

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Maine Hospitals and Baldacci Administration Agree on Re-Payment of MaineCare Debt

The Maine Hospital Association and Governor John Baldacci announced an agreement last Wednesday designed to pay off hundreds of millions of dollars in MaineCare debt for services provided to MaineCare patients.  Under the plan, the state would raise weekly hospital payments by adding $82 million in state funds during fiscal years 2008 and 2009.  That would produce $221 million in combined state and federal funds.

During these same two years, the state would also include $20 million to pay for 2004 hospital debts.  That would produce a total of $54 million in state and federal money, noted the joint statement released by the Governor's office and MHA.

The agreement also calls for another $102 million in state money, for a total of $275 million in state and federal funds, to be budgeted for fiscal years 2010 and 2011 so that all remaining MaineCare hospital debts would be covered.

MHA and the Baldacci Administration have agreed on a plan to increase MaineCare hospital payments and pay the outstanding MaineCare hospital debt for care already provided.


Beginning in 2007, the state will pay hospitals increased monthly Prospective Interim Payments (PIP) that will reflect current MaineCare patient volume.  In just over three years, the state also will pay off the outstanding MaineCare hospital debt for care already provided.


The agreement reflects a commitment to budget an additional $551 million in state and federal money to Maine’s hospitals to pay for the state’s ongoing MaineCare obligations and for care provided by Maine’s hospitals to MaineCare patients dating back to 2003. 


In the agreement with MHA, the Governor’s office has agreed to pay off the debt and avoid such rapid accumulation of debt in the future.  According to the agreement:

·         The state will raise hospitals’ weekly PIP payments to reflect patient volume by including $82 million in state funds ($221 million state and federal) for hospitals in state fiscal year 2008-2009, meaning, beginning in July 2007, hospitals will start being paid for most of the MaineCare patients they treat.

·         Also during fiscal year 2008-2009, the state will include $20 million in state funds ($54 million state and federal) to pay for 2004 hospital settlements.

·         A second $102 million in state money ($275 million state and federal) will be included in the fiscal year 2010-2011 budget to pay all remaining MaineCare debt owed to Maine’s hospitals.

New England Council Health Care Committee Meets in Maine

First District Congressman Thomas Allen opened up the meeting with a presentation on what is going on in Congress regarding health care.  Following Congressman Allen's talk, MMA EVP Gordon Smith and MOA Executive Director Kellie Miller talked with Council members about the issues currently facing Maine's medical community.  William Pewen, PhD. from Olympia Snowe's office and Ron Deprez, Executive Director of UNE's Center for Health Policy, Planning & Research rounded out the morning's agenda.

The New England Council is a non-profit membership organization made up of many companies and organizations located in New England which have an interest in health care.

The meeting in Biddeford was the first meeting the health committee of the Council had met in Maine. [return to top]

Update on MaineCare MECMS Project

The Governor's Provider Advisory Committee to MECMS met on Oct. 14 and heard updates from MaineCare staff on the continuing problems with the MECMS billing and information system.  Because of the problems related to so-called Release 1 on July 1, 2006, other releases, including the one previously scheduled to fix the Part B cross-over problem have not been scheduled.  It is now likely that the fixes anticipated for this Fall, including both the Part B crossovers and HIPAA compliance will take place sometime during 2007.

The weekly metrics sheet for the week ending Oct. 8 showed that of all claims processed during the week, 72% of claims were paid, 12% were denied and 15% were suspended.  Suspended claims were at 124,028, up slightly from the previous week but still down over 40,000 from five weeks ago.

Deputy Commissioner Mike Hall was questioned by MMA staff about the Inspector General's Report and the recommendation that all of the 2005 claims be reprocessed to ensure that they were paid accurately.   A discussion ensued relative to whether the reprocessing recommended by the feds would be strictly internal or would require some effort on the part of the provider community.  As the feds recommendation is being challenged by the state, no definitive plans are being made for how such a significant task would be accomplished, Mr. Hall noted.  But all in the room conceded that the reprocessing of all the claims would result in even more delay in the processing of current claims, a result that all agree should be avoided.  CMS has not yet responded formally to the Department's request to be relieved of this recommendation.  In any case, any such reprocessing of claims would not take place until after the system has been certified by the federal government as complete.  This step also remains several months off.

The committee meets again at 10:00am on Oct. 26. [return to top]

Seven Persons Appointed and Re-appointed to Maine Quality Forum Advisory Committee

The Maine Quality Forum Advisory Council met on Friday (Oct. 13) and welcomed four new appointees, approved earlier in the week by the Legislature's Health and Human Services Committee.  The four new members include Steve Gefvert, D.O., a retired gastroenterologist from Portland, James Case, Esq., a well-known labor lawyer in the state, Maureen Kenney of Bath Iron Works and Kathy Boulet.  Reappointed to the Council were Charles "Chip" Morrison of the Lewiston-Auburn Chamber of Commerce, Laureen Biczak, D.O., Medical Director of MaineCare and David White, a small business owner from Hancock County.

At the Friday morning meeting, members reviewed a presentation by Director Dennis Shubert, M.D., PhD., on the utilization of advanced imaging in the state, by hospital service area.  The presentation on variations in the utilization of CT and MRI scanning elicited the usual questions about what led to the variations and whether there was a correct rate.  The data utilized for the study came from the all-payor claims data base.

The Council normally meets the second Friday morning of each month at the offices of the Dirigo Health Agency on Water St. in Augusta. [return to top]

Update on Voluntary Practice Assessment Initiative (VPAI)

The Voluntary Practice Assessment Initiative, providing no-cost practice assessments to 50 primary care practices in the state was recently endorsed by both the Maine Chapter of the American College of Physicians and the Maine Chapter of the American Academy of Pediatrics.  The Maine Academy of Family Physicians had endorsed the Initiative earlier this year.

Currently, chart abstractors are being hired and the first assessment will be conducted in November.  Welcoming kits are being sent out to the volunteer practices in late October.

Practices will be assessed according to the patient care offered to patients with diabetes or CVD (adults) or asthma and inoculations (children).  Lisa Letourneau, M.D. is the physician consultant to the project which is directed by Jean Eichenbaum.  The project is funded through a contract with the Maine Quality Forum.

Practices are still being recruited for participation.  If you or your practice is interested in this service, contact either Jean Eichenbaum via jeaneichenbaum@aol.com or Gordon Smith via gsmith@mainemed.com. [return to top]

CME Program on Preventing Drug Diversion/Treating Pain/Avoiding Addiction Nov. 17 in York

MMA, with support from the state Office of Substance Abuse, will present a three-hour CME program focused on preventing drug diversion, treating pain and avoiding addiction at the York Harbor Inn on Friday, Nov. 17 from 4:00pm to 7:00pm.  Speakers will include Nathan Paul Katz, M.D., of Tufts University Medical School, Gordon Smith, Esq., of MMA and Chris Baumgartner of OSA.  A local DEA agent will also be present to help set the stage for medical and legal presentations.  The state's two-year old Prescription Monitoring Program will be featured.  Three hours of category one CME will be available.

The cost is just $45 for the program which includes a light supper and all course materials.  For registration materials, call MMA at 622-3374 (Press 0). [return to top]

MMA 28-Member Executive Committee to Meet Wednesday in Manchester

MMA's Executive Committee will meet this coming Wednesday, Oct. 18, at 2:00pm at the Frank Stred Building in Manchester.  Included on the agenda is a discussion of TABOR and further work on the Committee retreat taking place in mid-January.  Following the meeting, the ad hoc Committee on Long Term Development will meet over dinner.  That Committee is charged with developing a long term plan to strengthen and grow MMA's financial reserves.

The meeting will be chaired by newly elected Chair Stephanie Lash, M.D. of Bangor. [return to top]

Medicaid Spending Rises Only Slightly

According to a new survey conducted by the Kaiser Family Foundation, Medicaid spending has, for the first time since 1998, risen at a rate lower than states' overall tax revenue growth. An improved economy and the Medicare prescription drug benefit combined to produce a Medicaid-spending growth rate of 2.8 percent in fiscal 2006-the lowest rate of growth in 10 years, while state tax revenues increased 3.7 percent. As a result, 26 states plan to restore Medicaid benefits cut in previous years, expand benefits to new populations or make positive changes to the Medicaid enrollment process. Pressure remains, however, to contain Medicaid spending, as increased health care costs and a reduction in employer-sponsored health care plans are predicted to result in a 5 percent increase in Medicaid spending for fiscal 2007. Links to the complete report along with a summary can be found at:
[return to top]

Maine Cardiovascular Health Program and Partners Release Updated Strategic Plan

Heart Healthy and Stroke-Free in Maine: Updated Strategic Plan for Cardiovascular Health in Maine, 2006 - 2010. 

This updated strategic plan was facilitated by members of the Maine Cardiovascular Health Program and Maine Cardiovascular Health Council in collaboration with members of six workgroups, as well as reviewers who served as limited participants.   It is only with the work of countless Partners such as these joining forces across the state that we will be able to achieve the vision “Heart Healthy and Stroke-Free in Maine”.  Won't you please review the plan and assist all of us in reaching our vision? The plan is available at:  http://www.healthymainepartnerships.org/mcvhp/resource_library.aspx then scroll down to "Reports" to find the link.

We hope that this plan motivates you to think about and implement strategies that promote programs, policies and environments that help Maine children and adults lead healthier lifestyles. The continued collaboration of many partners throughout the state will be necessary to achieve 2010 goals and move us forward in becoming a heart healthy and stroke-free Maine.  The Maine Cardiovascular Health Council and Maine Cardiovascular Health Program look forward to providing leadership as this plan moves forward.  Please join us in supporting this work.   If you would like a hard copy of the plan sent to you, please contact Barbara Durand at 207-287-5388 or barbara.e.durand@maine.gov [return to top]

The Coding Center's Coding Tip of the Week

Significantly, Identifiable Services  (Modifier 25)

  • Every invasive or manipulative procedure includes some element of exam to determine the patient is healthy and can withstand the procedure. If the evaluation is above and beyond this exam then it can be considered “significant, separately identifiable.”
  • Note for evaluation and management services should be distinct from the procedure note
  • Evaluation and Management must be greater than the pre/post service work for the minor procedure
  • Document the visit (e.g. SOAP format)
  • Part of the assessment and plan will be the decision to do the procedure
  • Document the treatment/procedure separate from SOAP note

S (History)
O (Exam)
A (Assessment – Medical Decision Making)
P (Plan – Medical Decision Making)

Procedure Note:  (consent obtained, medications used, area procedure is being performed on, description of procedure, status of patient)

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

Kaiser Report Says Medicaid Spending Growth Lowest in 8 Years

On October 10, 2006, the Kaiser Family Foundation's Commission on Medicaid & the Uninsured released a report entitled, Low Medicaid Spending Amid Rebounding State Revenues that says for the first time since 1998, state revenues grew faster than Medicaid spending.  Medicaid spending grew an average of 2.8% in 2006 and average state revenue growth was 3.7%  The report attributes this data to an improving economy and relief of state budget pressures.  The report found that a significant number of states plan increases in provider payments in 2006 (46 states) or 2007 (43 states).  Most states believe that the new citizenship documentation requirements of the Deficit Reduction Act will increase administrative costs and reduce enrollment.  As previously reported in Maine Medicine Weekly Update,  Governor Baldacci has indicated to the MMA that he plans to include another $3 million General Fund increase in the MaineCare fee schedule in his proposed SFY 2008-2009 budget.

The Kaiser report is available on the web at:  http://kff.org/medicaid/upload/7569.pdf. [return to top]

New Report Cites Barriers to Adoption of Health Information Technology

On October 11, 2006, the Robert Wood Johnson Foundation and the Office of the National Coordinator for Health Information Technology released a report entitled, Health Information Technology in the United States:  The Information Base for Progress.  The joint study suggests that only 10% of physicians and 5% of hospitals were using an electronic medical record in 2005.  Cited among "formidable barriers" to the adoption of health information technology are:

  • initial high cost of investing in IT systems and their ongoing maintenance;
  • short-term loss of staff productivity as staff adapts to new technology;
  • possible legal hurdles, such as federal fraud & abuse and privacy laws;
  • lack of integration in many health IT systems;
  • the likelihood that payers of health care services will benefit more from the savings generated by health IT than will providers; and
  • concern that IT systems will become obsolete soon after they are adopted.

The study is available on the web at:  http://www.rwjf.org/files/publications/other/EHRReport0609.pdf.

Another study, highlighting the findings above, How Common are Electronic Health Records in the United States?  A Summary of the Evidence was published in Health Affairs on October 11, 2006 and is available on the web at:  http://content.healthaffairs.org/cgi/content/abstract/hlthaff.25.w496.

The U.S. Congress will return to Washington after the election recess to try to reach a compromise on conflicting health IT legislation passed by the House (H.R. 4157) and the Senate (S. 1418).  The principal point of contention seems to be a provision in the House bill that would create statutory safe harbors in the federal anti-kickback laws that would allow hospitals to provide health IT hardware and software to physicians. [return to top]

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