November 13, 2006

 
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Forty-five % of Maine Physicians Face Total Medicare Pay Cuts of 6-20% in 2007

Time is running out for Congress to restore the proposed reductions in Medicare reimbursement due to take effect Jan. 1, 2007.  Congress returns to Washington for a lame duck session TODAY, Nov. 13 and physicians and patients need Congress to pass legislation to prevent Medicare physician payment cuts and preserve access for seniors.  While all Maine physicians would be impacted by the 5% reduction due to the application of the sustainable growth rate (SGR) formula, over 45% of Maine physicians would face total pay cuts of 6 to 20% due to the combined effect of the SGR cut and other changes in Medicare policy.  These policies include expiring geographic adjustments, imaging cuts due to the Deficit Reduction Act of 2005, and fee schedule adjustments based on the five-year review and changes in the practice expense methodology.

The proposed reductions in Maine would total $14 million in 2007 and would balloon to $840 million by 2015 due to 9 years of SGR cuts.  Part of the reduction is due to the expiration of the geographic adjustments which had been enacted previously due to efforts of the Geographic Equity in Medicare Coalition that MMA participates in.  Because these changes sunset this year, on Jan. 1, 2007 the "Southern Maine" locality will be cut an additional 1.06% and the "Rest of Maine" locality an additional 2.13%.

These reductions are grossly unfair and it is important for physicians to communicate with Maine's congressional delegation the importance of taking action during the lame duck session, which could conclude as early as Thanksgiving.

You may access congressional offices by using the AMA toll-free grassroots line at 1-800-833-6354.  All four members of the Maine delegation signed a letter this past summer asking congressional leaders to advance legislation to restore the cuts but it is important to keep the issue alive and help focus attention on it.  Full page advertisements will appear on Wednesday in USA Today and the Washington Post, paid for by the AMA.   These ads will emphasize the significance of the issue and urge action prior to adjournment of the lame duck session.

MMA/OSA Program on Preventing Prescription Drug Diversion in York on Nov. 17

The Maine Medical Association along with the Office of Substance Abuse will be offering a program entitled "Preventing Prescription Drug Abuse" on  this Friday,November 17th from 4:00 - 7:00 p.m. at the York Harbor Inn, York Maine.  The featured speaker is Nathaniel Paul Katz, MD, President of Analgesic Research in Needham, MA.  Dr. Katz will provide a provider's perspective and share "best practices" in the area of pain control, addiction treatment and abuse prevention.  Also presenting are Kim Johnson, Director of the Office of Substance Abuse, who will discuss the state's Prescription Monitoring Program and Gordon Smith, Esq. Executive Vice President of the Maine Medical Association who will explain the laws and regulations (state and federal), governing the sharing of prescribing information with other health professionals and law enforcement.  If you would like more information or registration materials for this program, please call Gail Begin at the Maine Medical Association at 622-3374 ext. 210 or visit us on our website at www.mainemed.com. [return to top]

Andrew MacLean Elected Mayor of Gardiner; Other Election Results Too

The Nov. 7th election is behind us and the job of governance lies ahead.  Of interest to MMA, in addition to the election of Andy MacLean as Mayor of Gardiner, was the election of 151 members of the Maine House and 35 members of the Maine Senate.  Although several races were close enough to conduct recounts, it is clear that the democrats will have a strong majority in the Maine house, having gained perhaps as many as 15 seats.  Republicans gained one seat in the Senate which will have an 18 to 17 democratic majority.

Given the re-election of Governor Baldacci, the legislature in January will likely focus on tax reform and continue work on health care reform.

Congratulations to Dr. Lisa Marrache who won a State Senate seat in Waterville.  The house bid of Dr. Robert Walker resulted in a very close vote and we are not certain of the result.  More on that one next week.  Dr. Walker is a practicing radiologist in Belfast and was a first time candidate in an open seat.  The seat previously was held by Barbara Merrill who gave it up to run for Governor.  The Maine Physician Action Fund (a political action committtee organized by MMA) supported both physicians with independent expenditures.

Mr. MacLean will succeed Brian Rines, PhD, who served as Mayor of Gardiner for 14 years.  This is a part-time position and Andy will continue his position as Deputy Executive Vice President and General Counsel of MMA.  [return to top]

MaineCare MECMS Update

The Governor's MaineCare Provider Advisory Group met on Thursday, Nov. 9 at the Office of Maine Care Services in Augusta.  The weekly metrics for the MECMS showed nearly 88% of total claims being processed through the system for the week ending Nov. 5, with about 12% of claims being suspended.  The total suspended inventory was down to 87,340, up slightly from the week before but down over 4,000 from two weeks ago.

The current balance of interim payments made to providers stood at $513.1 million, representing a $51,000 increase from the previous week.

The meeting for providers wishing to discuss the $1 million appropriation to reimburse providers for interest payments necessitated by the MECMS problem has been recheduled for Dec. 7 at 9:00am. 

Physicians, PA's and nurse practitioners represent about $24 million of the total suspended claims.  These categories continue to hold about about $13 million in interim payments.

Because of the Thanksgiving holiday, the next Advisory Group meeting will be held on Dec. 7 at 10:00am.  [return to top]

Update on Dirigo Blue Ribbon Commission; Next Meeting Nov. 29th

The Governor's Blue Ribbon Commission on Dirigo Health met this past Thursday (11/9) and finally began to get down to business.  It was the 6th meetingof the Commission but previous meetings were pretty much limited to receiving the background information necessary for the nineteen commission members to make its recommendations which are due to Governor Baldacci Dec. 15.

The meeting began with a review of the member's responses to a survey that had been presented to each members by consultants to the commission.  In a nutshell, the member's responses were as follows:

  • The members were divided on whether to focus on both the uninsured and underinsured or primarily on the uninsured.
  • The members generally proposed that the program focus on small business and sole proprietors as a way to increase program stability.
  • Members agreed that short term priorities include increasing small business enrollment in DirigoChoice, addressing the program's financing and maximizing use of available federal funds.
  • The biggest short term priority is growing the program through targeted marketing to small businesses, especially those not requiring a subsidy.  Expanding to part time and seasonal workers was included in this effort.
  • The second short term priority is addressing the financing of the program, including focusing on the goal of reducing bad debt and free care.  While not universal, many members supported replacing the controversial "savings offset payment"with a broader, more progressive funding base, supported by a variety of fees and assessments.
  • A third short term priority is to maximize the availability of federal matching funds, through converting as many members to the so-called "A" category as possible, marketing to small employers with workers in the "A" category, and making the program more user friendly.
  • Members generally agreed that, over time, the program should evolve to universal coverage, with broad based, progressive funding, with a continuing focus on cost containment and quality of care improvements.
  • MaineCare should be maximized within the DirigoChoice Program.

In responding to the survey question, "What do you see as the strengths and weaknesses of the current funding mechansim?", members stated that the basic concept of working to lower health care costs and redirecting savings within the system was a laudable goal.  It links costs, quality and access and is not dependent on the general fund.  The weakness of the system was seen to be the technical and political problems, making the SOP not feasible as a long term funding mechanism.

In response to a question regarding who should share in the responsibility for financing Dirigo Health, members agreed that the funding responsibility should be broadly shared.  The state, employers and the insured were most often cited as having at least partial responsibility for financing Dirigo Health, with insurers and the uninsured cited less frequently and PROVIDERS CITED LEAST FREQUENTLY.

Most responders all felt that broad based financing, drawn from multiple sources, would provide the most equitable and sustainable source of funding.

The afternoon session of the meeting included preliminary brainstorming of funding sources and cost containment strategies.  It was during this discussion that observers could begin to see certain factions or groupings within the commission beginning to take shape.

The commission meets again on Nov. 29. [return to top]

DHHS Assistant Secretary for Health to Visit Maine on Nov. 28

The Assistant Secretary for Health at the Department of Health and Human Services in Washington D.C. will visit Maine on Tuesday, Nov. 28th to meet with physicians to discuss CMS plans for increasing transparency, pay for performance and quality.  The meeting will be held in the Board Room at the Dana Center at Maine Medical Center in Portland and will be hosted by the Maine Medical Association.  The 90 minute meeting will begin at 2:00pm.

Attendance is by invitation only but if you would like to be included, contact Gordon Smith at MMA via e-mail to gsmith@mainemed.com or call Gordon at 622-3374 x212.  Anyone wishing to attend can probably be accomodated but we are particularly interested in inviting physicians involved in various local or statewide initiatives to improve quality.

This meeting was previously announced for Nov. 17th but the date has been changed to the 28th.

  [return to top]

Report on American Medical Association Interim Meeting

The 2006 Interim Meeting of the American Medical Association opened in Las Vegas with a Saturday afternoon (Nov. 11) presentation by Michael O. Leavitt, Secretary of the U.S. Department of Health and Human Services.  Secretary Leavitt spoke to the issues of quality and prevention, but also answered questions regarding the pending 5% reduction in Medicare reimbursement to physicians and other health care professionals. 

"I haven't got a clue what Congress is going to do," said Leavitt.  "It is clear to me that at some point, there will be many physicians who say,  'We can't do this anymore.'"  But,  he said, in the future, it is likely that "cost and quality are going to be part of the equation" when it comes to the way Medicare payments are structured.  He acknowledged that so far, his agency's pilot programs on quality reporting have shown him that, "We are not very good at this."

"I don't believe that physicians now, or in the future, will trust a quality measurement system that happens in Washington." he also stated.  He noted the tension and anxiety associated with measuring the performance of physicians.  Part of that tension, he said, is largely due to the fact that quality measurement is still in its infancy and many physicians are understandably wary of bearing the costs of electronic health records (EMR) systems that are expensive and not yet interoperable.

With the lame duck Congress convening on Monday (11/13), physicians attending the AMA meeting are very focused on advocacy regarding the Medicare issue.  If Congress does not act to restore the reduction before the end of this year, Maine physicians will lose $14 million in Medicare payments in 2007, and will lose $840 million by 2015 due to nine years of cuts under the sustainable growth rate (SGR)  formula.

All four members of Maine's congressional delegation signed a letter over the summer to House and Senate leadership, asking that the Congress take action this year to restore the cuts.

Compared to the rest of the country, Maine, at 17% has an above-average proportion of Medicare patients, but a below average ratio of physicians to Medicare beneficiaries.

Maine physicians should call their federal representatives today to express outrage at the current situation.  You can connect through the AMA  Grassroots Hot Line number at 1-800-833-6354.

All four members of Maine's AMA delegation are at the meeting, including David Simmons, M.D., the Chair of the delegation who also chaired Reference Committee K during this meeting.  Richard Evans, M.D. is Maine's second delegate with the alternates being Maroulla Gleaton, M.D. and John Makin, M.D.   At least six other Maine physicians are at the meeting representing national specialty societies including Judith Chamberlain, M.D. (family medicine), Daniel Spratt, M.D. (the Endocrine Society), Sam Solish, M.D. (ophthalmology), John McGill, M.D. (plastic surgery), Jo Linder, M.D. (emergency medicine) and Francis Kittredge, M.D. (neurology).  Robert McAfee, M.D., former MMA and AMA President also attends. [return to top]

Great American Smokeout is November 16, 2006

Nov. 16 marks the 30th annual Great American Smokeout.  The American Cancer Society designates this day to challenge people to stop using tobacco and to raise awaremenss about how to quit.  Information about the Smokeout can be found on the ACS website, www.cancer.org (Click on "Guide for Quitting Smoking" in the left navigation bar.)  The guide also includes information on how to quit; dealing with withdrawal, weight gain, and stress, and "staying quit." [return to top]

Upcoming MMA Committee Meetings: Legislation, Executive, Payor Liaison, Physician Health

The remainder of November will be busy for MMA as several committees meet to continue their work.  Among the meetings are the following:

  • Committee on Physician Health: Monday, Nov. 20, 6:00pm
  • Committee on Legislation; Tuesday, Nov. 28, 6:00pm
  • Executive Committee; Wednesday, Nov. 29, 2:00pm
  • Payor Liaison Committee; Thursday, Nov. 30, 6:00pm

All MMA committee meetings are open to all members.  Agendas and minutes are available for all committees in the members only section of the MMA website at www.mainemed.com.  Members have to register for the members only section just once, following the simply instructions on the homepage. [return to top]

The Coding Center's Coding Tip of the Week

Consults—Documentation must include:

 

 

 

·         A request for a consultation from an appropriate source and the need for consultation must be documented on the patient’s medical record.

 

·         The provider sees the patient and renders their opinion.

 

·         After the consultation is provided, the consultant prepares a written report of his/her findings, which is provided to the requesting physician.

 

See the Medicare Carriers Manual (MCM) section 15506 for more information—still paper-based manual for now (01/06)

 

·         The Three R’s of Consultation

 

Request is documented

 

Rendered opinion

 

Response is made in writing

 

Referral – this word negates that Consult in the eyes of the Office of Inspector General – remove it from you consult vocabulary

 

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

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