February 12, 2007

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State Asks CMS to Approve Moving MaineCare Claims Processing to Outside Vendor

One week ago, on Feb. 5, DHHS Commissioner Brenda Harvey sent the Center for Medicare and Medicaid Services a plan for transitioning its MMIS activities from the current MECMS platform to a certified replacement claims processing system supplied by a mainstream vendor (Electronic Data Solutions, Affiliated Computer Services or Unisys).  Moving to such a system is expected to take between 18 and 27 months.  While the plan calls for CNSI, the current vendor, to stop further development but to provide maintenance and continue to process claims until a transition is complete, CNSI has balked at that request and on Wednesday gave the state notice that it would leave the state in 30 days.  By Thursday, state workers were being trained to operate the complex system. 

The federal government is expected to respond to the state's plans within 30 days and CMS participation in financing the transition and continuing operation of a new system is considered critical.  Without federal certification and financial participation, the state would be out of compliance with the federal Medicaid program and would also have to bear the cost of the new system alone.

No doubt that these activities caused new Acting MaineCare Director Tony Marple to have a busy week.  He may well be wondering what he has gotten himself into. 

The Commissioner's 19 page letter to Acting Associate Regional Administrator Richard McGreal was presented to the Legislature's Health and Human Services Committee on Tuesday.  The plan articulates the following:

  • The history of Maine's efforts to replace its legacy MMIS system, back to 2001
  • Exploratory meetings that Maine has conducted with MMIS vendors
  • The path that Maine proposes to follow to obtain a certified MMIS; and
  • The need for federal participation to support the State's MMIS efforts to date as well as to support the acquisition and deployment of the plan going forward

As the letter states, any new system will require providers to make significant administrative adjustments.  This is bad news for Maine's 7000 health providers who have suffered for the past two years with the flaws MECMS system.  Moving to an outside vendor, referred to generally as a fiscal agent, will mean that Maine will join with 32 other states that are using such outside vendors, rather than attempting to have an in-house system built.  Maine has invested $56 million dollars in the system.

The Provider Advisory Group will meet on Thursday, Feb. 15, as it has every other week for the past two years, to hear from MaineCare officials and to discuss the details of the plan.  Watch for a report on this meeting in next week's Weekly Update.

Maine Quality Forum Advisory Council Hears Presentation from Health Dialog

A much anticipated report from the vendor Health Dialog was received by the Maine Quality Forum Advisory Council on Friday morning (Feb. 9).  Health Dialog had been asked by the Council to review the data in the state's all payer claims database and see if it was sufficient and accurate enough to provide for a measurement of certainly quality indices.  After several months of work, the conclusion presented by Health Dialog staff was that the database was reliable and that most claims were able to be verified by the testing.

In the pilot phase of the study, claims of PCP's and cardiologists were reviewed.  A large number of measurements were used, including 19 supply sensitive cost measures and 8 effective care measures for each specialty.  Data from July 1, 2005 to June 30, 2006 was examined.  For PCP's, 31,507 patients were attributed to 67 PCP's.  For cardiology, 12,900 patients were attributed to 86 cardiologists.  Efficiency measurements were risk adjusted; effectiveness measurements were not.

Overall, the data showed wide variations in both cost and effectiveness measures. 

Council members were clearly impressed with the presentation and pleased to hear that the all payer claims database, which will become a source of reports of the MQF website, was reliable enough to use for measuring quality and efficiency in at least some context. 

There was a lot of discussion at the meeting about the need for physicians to be on board with the project and to weigh in on the data, particularly on the variations.  While Maine has been in the lead on practice variation analysis for the past 25 years, there are still considerable barriers to adoption of best practices.  The council expects to invite physicians to vet the data now that the technical analysis has initially established that the data, while based on claims, does have some value beyond claims payment. [return to top]

CMS Physician Voluntary Reporting Program

A few years ago, the Bush administration renamed the Healthcare Financing Administration in order to give it a new lease on life.  In a similar fashion, the Centers for Medicare and Medicaid Services (CMS) has renamed the Physician Voluntary Reporting Program (PVRP).  The PVRP has been recast as the Physician Quality Reporting Initiative (PQRI).  CMS is consulting with its General Counsel regarding some questions about the statute and some operational details for the program that is slated to start in July of 2007.  The agency plans to have a dedicated web site up within the next few days to outline plans for implementation of the PQRI.

It is anticipated that sign-up for the program will take place in April.  As the financial incentive for participating in the Program is 1.5% annually, it is likely that many physicians will decline to participate until the experience of the program is better known and the financial incentives enhanced.

The Ambulatory Quality Alliance (AQA) met last week and considered additional measures for the 2007 PQRI.  Under the recent Medicare legislation all measures had to go through a consensus process such as AQA or National Quality Forum (NQF) by January 31.  The AQA adopted Consortium developed measure sets for emergency medicine, hematology, and GERD.  Additional measures related to oncology were adopted on a provisional basis, pending further development and approval by the Consortium.  These measures will now be available for implementation in the PQRI beginning July 1.

Unrelated to the PQRI, the AQA also adopted a prioritized list of seven "cost of care conditions " for future measure development.  Although the AQA does not develop measures, it wil encourage measure developers to focus cost of care measures development in the following clinical areas:  Diabetes, AMI, CHF, CAD, Asthma, Depression, and Low Back Pain.  While there was general consensus regarding the first six, the AQA was sharply divided regarding Low Back Pain.  Concern centered on the need to always pair clinical quality measures with cost measures for payment and public reporting purposes  Although development efforts are planned, currently there are no AQA adopted clinical quality measures for Low Back Pain. [return to top]

Annual HIPAA Update - Need a HIPAA checkup? Staff need the annual HIPAA training?

The Maine Medical Association's First Friday Seminar will present the Anuual HIPAA Update on March 2, 2007 at the Maine Medical Association's office in Manchester, Maine.  The Health Insurance Portability and Accountability Act mandates that all office staff be trained annually on the HIPAA Privacy and Security rules.  This seminar is intended to serve as the annual training session of new or existing staff.  Topics covered during the interactive three hour (3 Category 1 CME) session include; State medical confidentiality law, HIPAA Privacy Rule, HIPAA Security Rule, and Three years experience with enforcement of the Privacy Rule.  Faculty presenting will be Gordon Smith, Esq., Executive Vice President, Maine Medical Association, the primary author of the state's medical confidentialty law and Andrew MacLean, Esq., Vice President and General Counsel, Maine Medical Assocaition.  Mr. MacLean is an experienced healthcare healthcare attorney who prepares the annual legislative update.  This program is co-sponsored by OfficeMax. [return to top]

President's FY 2008 Budget Proposal Hits Health Care Providers

President Bush released his proposed FY 2008 budget on Monday, February 5, 2007 and his DHHS Secretary Michael O. Leavitt faced tough questioning about it from Congressional Democrats during hearings from February 6 - 8, 2007.

The Bush proposal would reduce Medicare funding by $76 billion over 5 years and would reduce Medicaid funding by $27.5 billion over 5 years.  It would fund the State Children's Health Insurance Program (SCHIP) at $5 billion over 5 years which is $10 billion less than the Program needs to continue coverage for current enrollees.

The budget does not address the Medicare SGR formula as advocated by the AMA and other physician organizations and it reduces the annual update for many other Medicare providers.  For example, hospitals, hospices, and ambulance services would receive a reimbursement update of market basket minus 0.65% beginning in FY 2008, rather than a full market basket update.  The payment update for ambulatory surgical centers would be market basket minus 0.65% beginning in FY 2010.  From FY 2008 through FY 2012, it is likely that hospital payments would be reduced by $13.8 billion, nursing home payments would be reduced by $9.2 billion, and home health agency payments would be reduced by $9.7 billion.

 The President's proposals for the Medicaid program would seek $11.3 billion in savings over 5 years from legislative proposals and $12.7 billion in savings over 5 years from administrative proposals.  One legislative proposal would save $5.3 billion over 5 years by setting the administrative match rate at 50%.  Now states can qualify for 75 to 90% reimbursement for activities requiring skilled clinicians or information technology.  The proposal would save $210 million in the Medicaid drug program by requiring physicians to use tamper-resistent prescription pads.  One administrative savings proposal would bar the use of Medicaid funding for graduate medical education for physicians to save $1.8 billion over 5 years.

The President's budget proposal likely will be a key part of the discussion this week at the AMA's National Advocacy Conference in Washington, D.C.  MMA EVP Gordon Smith, President Kevin Flanigan, M.D., and the MMA's AMA delegation will be on Capitol Hill on Wednesday, February 14, 2007 to meet with Maine's Congressional delegation on this and other topics important to organized medicine.  You can find the agenda and other information about the National Advocacy Conference on the AMA web site at:  http://www.ama-assn.org/ama/pub/category/14350.html. [return to top]

Few Doctors Are Web M.D.s

USA Today, February 6, 2007
New data suggests that physicians are not utilizing e-mail frequently or consistently as a means of communication with their patients. Only 8% of adults stated that they had received e-mail from their physicians in an online survey conducted in 2005 by Harris Interactive for The Wall Street Journal Online. Adoption of electronic communication with patients has been slow because physicians are worried that patient confidentiality will be compromised in communications over the Internet. Doctors are also concerned that they may be inundated with e-mails adding hours of uncompensated labor. However, the industry is taking steps toward ensuring confidentiality by securing Web sites and promoting the use of electronic health records. Those physicians who do use e-mail are receiving positive feedback from their patients who appreciate the efficiency of electonic communication. [return to top]

CIGNA 4Q Profit Rises 10 Percent

Associated Press, February 7, 2007
CIGNA Corp.’s fourth-quarter profit increased more than 10% with a net income of $232 million or $2.28 per share. The primary contributor to increased revenue for the quarter was a much better than expected medical-loss ratio, which reflects how much money the insurer spends on health care for members as a percentage of premiums collected. [return to top]

Aetna 4Q Profit Rises 4 Percent

Associated Press, February 8, 2007
Increased medical membership contributed to Aetna, Inc.’s fourth-quarter 4% profit increase. The medical membership increased by 50,000 in the fourth quarter to 15.43 million, an increase of 5% over 2005. Net income was $434.1 million, or 80 cents per share up from $416.3 million and 70 cents per share a year earlier. The medical-loss ratio was 79.2% compared with 78.1% a year ago. [return to top]

SAVE THE DATE: 5th Annual Maine Benzodiazepine Study Group International Conference, Oct 31-Nov 1, 2007

The Fifth Annual Maine Benzodiazepine Study Group International Conference
Fourth Annual Unused Drug Return International Conference

Wednesday, October 31 and Thursday, November 1, 2007

in beautiful downtown Portland, Maine.

The Holiday Inn by the Bay will be the site of this year's conference.

Centrally located, the Inn is at the heart of the historic district, shopping and sight-seeing.  You won't want to miss out on attending this year's dynamic two-day Conference - with an opportunity to enjoy the area. 

 More information to follow soon!  [return to top]

NCQA Releases Expanded Physician Performance Measurement Standards for Public Comment

Last week the National Committee on Quality Assurance (NCQA) released for public comment their expanded Physician Performance Measurement standards (cost and quality).  The public comment period runs through March 5, 2007 and I encourage any of you to provide a Maine voice to NCQA.  Below is a link to NCQA’s press release from last Monday.  To get to the publication itself, click on the submit comment link in the NCQA Seeks Your Input box on the side of the press release.

This publication stems from ten years of collaboration between NCQA and their measurement advisory panels, with physician organizations, including the American Medical Association-Physician Consortium for Performance Improvement (AMA-PCPI), with health plans, employers, CMS, the AQA, the National Quality Forum and others. 

NCQA writes in their press release (http://www.ncqa.org/Communications/News/HEDISphys-pc07.htm):

Consumers, employers, health plans and public policymakers have been calling for objective, reliable information about the quality of care delivered in physician offices. Physicians have also sought objective information and clear, standardized methods of measurement to guide quality improvement.  The new volume introduces 25 new measures of clinical quality at the physician level, sets standards for the measurement of the cost of care and provides standardized methods of data collection that account for such emerging and widely-used technologies as electronic medical records (EMRs) and episode-grouping software.” [return to top]

AMA: President's 2008 Budget Ignores Medicare Physician Payment Problem; Cuts Funding to Cover Uninsured

“The AMA is deeply disappointed that President Bush has once again ignored an opportunity to right the wrongs in the current Medicare physician payment system by failing to call on Congress to stop the cuts and provide payments in line with practice costs.  Current average Medicare payments to physicians are about the same as in 2001, and next year’s reimbursement will be cut 10 percent – unless Congress intervenes," says AMA Board Chair, Cecil B. Wilson, M.D.
“Over the next eight years, Medicare payments to physicians will be slashed nearly 40 percent, while practice costs increase about 20 percent.  Without adequate funding, physicians cannot make needed investments in health information technology and quality improvement, and seniors’ access to health care is placed at risk. 
“As we work to provide health care coverage to all Americans, cutting funding for SCHIP is the wrong way to go.  Currently there are nine million uninsured children, and nearly seven million of these kids are eligible for enrollment in government health care programs.  This proposal ties states’ hands by narrowly focusing the program as they work on innovative ways to provide health care coverage for more of the uninsured.
“The AMA will continue its work with the Administration and Congress on public health issues to benefit the American people.”  [return to top]

Psychiatry Day at the Legislature, Thurs., March 15, 2007

On Thursday, March 15th 2007, The Maine Association of Psychiatric Physicians will again host Psychiatry Day at the Legislature in the Hall of Flags in the State House.  MAPP will present information relevant to treatment of affective disorders, psychotic disorders, suicide, and substance abuse, and to highlight efforts to work with primary care physicians, families and advocates for individuals with serious and persistent psychiatric illness, and with other groups in our state working to increase the safety of people receiving prescriptions for medications.

MAPP is pleased to announce an unused drug return event will be held between 12 and 2 pm at Psychiatry Day at the Legislature with the assistance of the Maine Drug Enforcement Agency and the Augusta Police Department.  Legislators and state employees will all be invited to bring their unused and/or expired pharmaceuticals for safe destruction courtesy of the MDEA. Psychiatrists who are attending may bring their own unused and/or expired drugs for destruction as well. For further information call Stevan Gressitt, M.D. 441-0291 or gressitt@uninets.net

We will begin to set up displays about 8 AM.  Most of the activity occurs between 8:30 AM and  noon.  We will be packing up to leave about 2 PM.  If you would like to participate in this year’s Psychiatry Day, please call Dr. William Matuzas, during the day, 872-4396. [return to top]

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