January 16, 2007

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MECMS Future Attracts Much Public Attention

The hints in the Governor's budget regarding the future of the flawed MECMS system have attracted front page articles in the Bangor Daily News (Jan. 8), the Lewiston Sun Journal (Jan. 9), the Ellsworth American and editorials in several newspapers including the Sun Journal (Jan. 11).   The current system, built at a cost of $56 million so far, may be replaced by a contract with a company that would process the claims externally or by a new system.  A hybrid approach of using some of the existing system and outsourcing other functionality is also being considered.  A final decision on the path the Department of Health and Human Services will take should be made by the end of January. 

       Continuing with the flawed equipment or starting over with an outside processor are both bad options, noted Gordon Smith, MMA EVP.  "Unfortunately, there is no third option so we are going to have to help the Office of MaineCare Services make the change in a way that limits the disruption that the transition would otherwise bring," Smith added.

Many legislators expressed surprise with the prospect of an abrupt change from what they were hearing from DHHS officials just months ago.  State Representative Hannah Pingree was perhaps the most chagrined, as she had been a supporter of the system as Chair of the HHS Committee which had oversight responsibility and heard repeatedly from the Department that the system was getting better.  "This is a huge turnaround from what they were telling us," she said. "But, while it is incredibly painful and costly and it is troubling, we do have to go back to the drawing board."

Legislators and physicians also expressed concern about the provision in the proposed budget that projects over $20 million in savings in the first year of the biennium (beginning July 1, 2007) in MaineCare through implementation of managed care.  Several observers noted that the last budget included over $10 million in savings by implementing managed care practices in the behavioral health area.  The savings haven't begun yet and have been delayed by at least a year.

DHHS Commissioner Brenda Harvey noted that without the savings anticipated from the managed care initiative, MaineCare costs would have significantly exceeded the 6 percent annual increases in the proposed budget.

More details on the managed care initiative will be presented when hearings are held on the proposed budget beginning in February.

As noted in last week's Update, the second year of the budget includes a $3 million appropriation to increase MaineCare payment rates to physicians.  That amount would be matched with over $5 million in federal funds.

MMA Offers Summary of Bill Titles of Interest to Physicians

As reported in the most recent Weekly Update, the 123rd Maine Legislature has published lists of the bills by title filed by legislators and Executive Branch agencies by subject matter and by legislator.  You can find these lists on the web at:  http://janus.state.me.us/legis/lio/publications.htm.

The MMA staff now has summarized and categorized the bills of likely interest to the physician community and, once again, this legislature will face many important health care issues. 

The MMA's bill list includes the following:

  • 5 bills on childhood obesity and physical activity
  • 2 bills on thimerosal in vaccines
  • 5 bills on pharmaceutical prescribing data
  • 16 bills on health care reform, including those on the Dirigo Health Program, single-payer health care, and a state-sponsored health insurer
  • health insurance mandates on infertility treatment, hearing aids, and cancer screening
  • 47 bills on insurance practices, including the regulation of insurance
  • 16 bills on medical liability, including bills on the timeliness of the screening panels, to shorten the statute of limitations in some instances, to study the medical malpractice situation, and to consider the health court concept
  • 27 bills on mental health and substance abuse issues
  • 14 bills on prescription drug issues
  • 27 bills on public health & safety issues
  • 23 bills on the regulation of health care facilities
  • 29 bills on scope of practice, licensing, and disciplinary issues for individual health care practitioners, including a bill to license lay midwives
  • 14 bills on tobacco issues, including several bills on "fire-safe" cigarettes
  • 12 bills on workers' compensation issues

You can obtain a copy of the MMA's summary by contacting Andrew MacLean, Deputy EVP, at amaclean@mainemed.com or by calling him at 622-3374, ext. 214.  The list soon will be on the MMA website, www.mainemed.com, as well. [return to top]

MMA Executive Committee Advances at Weekend Retreat

The Association's Executive Committee met over the past weekend in a retreat format.  For several years, the committee has chosen the Martin Luther King memorial weekend to stop and reflect on the "big picture." Working hard to be a "knowledge-based" organization with state of the art governance, your leadership has examined the landscape upon which Maine physicians practice today and developed strategies and processes to meet the Association's mission:

The Maine Medical Association, established in 1853, is a voluntary association of physicians united to promote the health of Maine citizens, the quality of medicine in Maine, and physicians' role as advocates for their patients.

While the mission of MMA remains intact, the existence of constant change in the delivery and financing of health care require that the association continually examine what its members needs are, its capacity to meet those needs and the ethical imperatives associated with its actions.  The weekend retreat gave committee members the opportunity to examine the current influences on the profession and the association, the ability of the association to meet the challenges presented and the action plans required.  Among the priorities identified for the coming years are assisting members in improving quality of care, improving public health and improving the environment of medical practice in Maine.  Improving access to care remains an important priority as well.

One important theme highlighted was that of "Professionalism", and of the need to help members and non-members return to the roots of the profession dedicated to service to others and to a culture of duty, honor, truth, integrity, education and compassion.  In the current environment it is too easy to forget the reason one went into medicine to begin with.

A great deal of the retreat time was spent reviewing the exsting processes of the committee, including meeting agendas and the role of the smaller, seven member Steering Committee.  The 28 member Executive Committee hopes to focus more on strategy, policy and high level management, while the Steering Committee is likely to become more of an "Operations" commiittee to oversee staff and association activities on a regular basis (without micro-managing).

A constant theme for the weekend was how to acquaint the 45% of Maine physicians who do not belong to MMA with the value that MMA provides to its members.  The need to attract students, residents and young physicians also was noted.

The bottom line:  MMA will continue to grow and provide value to individual physicians and groups of physicians on a daily basis and will be governed by a group of volunteers dedicated to governing this venerable association with knowledge, integrity and compassion being ever cognizant of the non-profit mission stated above. [return to top]

Next "First Friday" CME Program Feb. 2 Features Accounts Receivable Management and NPI

The first of the 2007 "First Friday" CME Programs will be held on Friday, Feb. 2nd from 9:00am to noon at the offices of the MMA in the Frank O. Stred Building in Manchester.  Breakfast will be available to attendees beginning at 8:30am.

Presenting at the Program are Vaughn Clark, President of the Thomas Agency, an accounts receivable management organization with offices in Portland and Brewer, Andrew J. Finnegan, a Health Insurance Specialist with the Center for Medicare and Medicaid Services (CMS) and Gordon Smith, Esq., MMA Executive Vice President.

While Mr. Clark will focus on effective collection techniques, Mr. Finnegan will discuss the process of obtaining an NPI number (National Provider Identifier), which every physician must do by May 23rd.

Mr. Smith will discuss the requirements of state and federal law in performing collection activities.

There is a $60 charge which includes all course materials and breakfast.  Registration is available through the MMA website at www.mainemed.com or though calling the office at 622-3374 (Press O and ask for Jessica or Gail). [return to top]

Study: Productivity Incentives Still Far More Common than Quality Incentives

A report released by the Center for Studying Health System Change (HSC) finds that, while physician compensation based on quality is rising, productivity incentives continue to dominate the medical landscape. Compared to a survey conducted from 2000 to 2001, the percentage of physicians eligible for quality incentives rose from 17.6 to 20.2 during 2004 to 2005, yet productivity incentives have consistently affected approximately 70 percent of physicians in each survey since 1996 to 1997. Among other things, the study also found that quality incentives are more common among primary care physicians than specialists, and that physicians in larger practices are more likely to be receiving quality-based compensation than those in medium-sized practices. For more information: http://www.hschange.org/CONTENT/906/

The complete study, including a link to a downloadable PDF version, can be viewed at: http://www.hschange.org/CONTENT/905/ [return to top]

Time's Running Out For Obtaining Your NPI

Health care providers who have not yet obtained their HIPAA National Provider Identifier (NPI) are encouraged to submit an application as soon as possible. Those who wish to apply using the paper form must specifically request the application, as CMS is now encouraging the use of its Web-based form. There is expected to be a 30-day processing time for Web-based applications, with paper applications taking longer. All providers are required to have an NPI by May 23, 2007, and CMS expects a rush of applications as the deadline approaches. To apply for your NPI online:https://nppes.cms.hhs.gov/NPPES/ [return to top]

Health care Spending Nearly $2 Trillion in 2005

CNN Money, January
Spending on health care in the U.S. hit almost $2 trillion in 2005. The National Health Statistics Group, part of the Centers for Medicare and Medicaid Services (CMS), released its annual report, finding that health care spending grew 6.9% to $1.99 trillion from $1.86 trillion in 2004.  This spending growth was slower than in previous years.  The report stated that the increase in spending was due primarily to hospital services which accounted for 31% of health care dollars in 2005.  Physician and clinical services rose 7% while prescription drug spending increased 5.8%. [return to top]

Nation's Leading Physician Groups Join Together to Announce Principles for Reforming the U.S. Health Care System

Ten of the nation's leading physician associations speak with one voice to release principles to reform the U.S. health care system. This unity among physician groups is intended to help provide the impetus for bipartisan Congressional action to cover the uninsured. Recognizing that many newly elected Members of Congress campaigned on fixing the heath care system, the Principles serve as a guide for Congress to improve both individual health and the collective health care system in the U.S.

The Principles For Reform of the U.S. Health Care System released today call for the following actions:

  1. Health care coverage for all is needed to ensure quality of care and to improve the health status of Americans.
  2. The health care system in the U.S. must provide appropriate health care to all people within the U.S. borders, without unreasonable financial barriers to care.
  3. Individuals and families must have catastrophic health coverage to provide protection from financial ruin.
  4. Improvement of health care quality and safety must be the goal of all health interventions, so that we can assure optimal outcomes for the resources expended.
  5. In reforming the health care system, we as a society must respect the ethical imperative of providing health care to individuals, responsible stewardship of community resources, and the importance of personal health responsibility.
  6. Access to and financing for appropriate health services must be a shared public/private cooperative effort, and a system which will allow individuals/employers to purchase additional services or insurance.
  7. Cost management by all stakeholders, consistent with achieving quality health care, is critical to attaining a workable, affordable and sustainable health care system.
  8. Less complicated administrative systems are essential to reduce costs, create a more efficient health care system, and maximize funding for health care services.
  9. Sufficient funds must be available for research (basic, clinical, translational and health services), medical education, and comprehensive health information technology infrastructure and implementation.
  10. Sufficient funds must be available for public health and other essential medical services to include, but not be limited to, preventive services, trauma care and mental health services.
  11. Comprehensive medical liability reform is essential to ensure access to quality health care.

"Doctors want Congress to take action on health system reform this year," said Rick Kellerman, MD, president of the American Academy of Family Physicians and a practicing family physician in Wichita, Kansas. "Physicians are coming together to support these principles because they want the best care for their patients and if these principles are adopted, patients will be the main beneficiaries."

"As orthopaedic surgeons, we see the successes - but also the dilemmas, strains and unmet needs - in American healthcare on a daily basis," said Richard F. Kyle, MD, president of the American Academy of Orthopaedic Surgeons and a practicing physician in Minneapolis, Minnesota. "The American Academy of Orthopaedic Surgeons strongly supports the Principles for Reform of the U.S. Health Care System for its multi-faceted approach to significant lapses of access and funding. We recognize the strong clinical, educational and research foundation on which to base the prescribed improvements. These principles reflect the mandate we feel as physicians, and we are committed to making certain that all Americans enjoy the healthcare they deserve, no matter their economic resources."

"All patients deserve access to quality care, and national efforts to address health care quality must proceed in parallel to efforts to expand coverage and access," said Steven E. Nissen, MD, FACC, president of the American College of Cardiology (ACC). "We have an obligation to improve health care by delivering appropriate and quality medical services using evidence based medicine. The ACC is committed to this fundamental principal and, in turn, ensuring that all employers, individuals and families have access to affordable health coverage."

"Emergency physicians serve as the safety net for America's troubled medical care system, and we see firsthand how the lack of health insurance coverage affects everyone, not just the uninsured" said Brian Keaton, MD, FACEP, president of the American College of Emergency Physicians. "In June, the Institute of Medicine issued reports on the future of emergency care and found a fragmented system, unable to respond to disasters. The causes included the lack of health insurance for 46 million Americans as well as the medical liability crisis. The need for change is urgent, which is why the American College of Emergency Physicians strongly supports the Principles for Reform of the U.S. Health Care System."

"Nearly 13 million reproductive-age women, and 13% of all pregnant women, in the US are without health insurance, which prevents them from receiving critical preventive care and screening tests," said Douglas W. Laube, MD, MEd, president of the American College of Obstetricians and Gynecologists (ACOG). "ACOG believes that providing pregnant women and infants with full insurance coverage and access to care is an important step in providing health care for all Americans."

"As osteopathic family physicians, we believe that every American should have appropriate health care, and these principles certainly support that goal," said Thomas N. Told, DO, FACOFP dist., president of the American College of Osteopathic Family Physicians. "It is our duty to make sure only the highest quality of care is being delivered in the health care marketplace, and we hope to work with Congress this year on making these principles a reality."

"The American College of Physicians believes that immediate steps must be taken to expand health insurance coverage, with the goal of providing coverage to all Americans. Proposals to expand health insurance coverage should also assure that patients have access to a core set of benefits," said Lynne M. Kirk, MD, FACP, president of the American College of Physicians.

"These principles are consistent with the position of the American College of Surgeons that all parties concerned - physicians, other health care providers, payers, and patients - must share responsibility for the appropriate provision and financing of quality health care," said Thomas R. Russell, MD, FACS, executive director of the American College of Surgeons. "The American College of Surgeons sincerely supports these principles and the future efforts of the coalition to provide Congress with viable options for providing all Americans with quality health care."

"Providing health care coverage to the uninsured is a top priority of the American Medical Association, and we are proud to join together with other physician organizations to present a cohesive set of principles to guide reform of the U.S. health care system," said Jeremy Lazarus, MD, board member of the American Medical Association.

"Congress must address the growing problems facing the nation's health care system," said John A. Strosnider, DO, president of the American Osteopathic Association. "We are pleased to join with our physician colleagues in putting forth these principles for health system reform. We believe that they provide the framework for all stakeholders- patients, physicians, payers, employers, and the federal government-to come together to improve the health care system." [return to top]

The Coding Center's Coding Tip of the Week

Billable services during the global post-op period
The following services may be billed during the postoperative period for Medicare patients:

  • The initial consultation or evaluation of the problem by the surgeon
  • The history and physical performed more than a day before the surgical date
  • Any surgeries that require the patient and physician to return to the operating room
  • Treatments for conditions unrelated to the surgery or for an added course of treatment that is not part of the normal recovery from surgery
  • Immunosuppressive drug therapy for organ transplants
  • Dialysis, both outpatient and inpatient 
  • Critical care services (99291, 99292) that are unrelated to the surgery and that require constant attendance of the physician
  • Diagnostic tests and procedures, including diagnostic radiology procedures
  • When a less extensive procedure fails and a more extensive procedure is necessary, it is separately billable 
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