March 5, 2007

 
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MECMS Update: Letters Exchanged with CMS, Decision on Transition Expected Soon

The difficulties with the state's MaineCare claims processing system (MECMS) continued to be in the news this past week as the legislature continues work on the state budget and as the existing state contract with CNSI expires this coming week.  Important letters were exchanged between the state and CMS (Centers for Medicare and Medicaid Services) suggesting that the federal government will sign off on a plan that moves the processing to a new vendor, after a competitive bidding process that will probably involve at least three different vendors.  A full transition could take between 18 and 26 months, leaving open the question of how claims will be processed in the meantime.  Unfortunately, it appears that the enhanced functionality needed to perform tasks such as processing the Part B cross-over claims could be delayed for several years.

Several activities took place this past week regarding the MECMS issue.

  • HHS released an exchange of letters with CMS outlining the options for transitioning to a new claims processing system, a transition which could take between 18 to 36 months before deployment.  The state has indicated an intent to contract with a new vendor for development of a customized system which would be built in Maine and run on software which the new vendor would locate in Maine.
  • Maine's planned procurement will ask each vendor to identify a state (or states) among their existing customer base with substantial similarity to Maine, in terms of program design and governmental infrastucture.  The State will ask each vendor to present opportunities for containing costs by using one of these existing systems as a baseline development platform which would then be adapted to address Maine's unique needs.
  • The State must obviously retain some core capacity to process Medicaid claims from providers during this period.  The most viable prospect for retaining this core capacity is negotiation of a contract that commits the existing vendor CNSI to operation and routine maintenance of the existing MECMS system during this period.
  • The existing contract with CNSI expires this week and it is not clear whether it will be renewed.  In preparing for the contingency of CNSI leaving the state, state employees were shadowing CNSI employees in Maine and in Maryland this past week in order to learn as much about operating the system as possible.
  • MMA is seeking to obtain a copy of a document entitled, "Managing the Transition" which the state has filed with CMS.  This document apparently provides details on the approach for management going forward and the human resources (current and planned) to be available for the operation of the current system and to support the new MMIS acquisition and development process.

The Governor's MaineCare Providers' Advisory Committee met on March 1 and much of the discussion focused on the current MECMS initiatives rather than the transition.  MMA's request for an update on the disbursement of the $1 million appropriated last year for reimbursing providers for interest costs incurred as a result of the MECMS problem was delayed as Deputy Commissioner Kirsten Figueroa was unavailable.

The weekly metrics showed that the suspended claims inventory stands at about 62,000 claims.  Processing of paid and denied "fresh" claims was 95%. 

At the meeting, OMS officials indicated that no changes are planned currently for MECMS to support the new National Provider Identification number.  Therefor, legacy provider ID's will need to be submitted to MaineCare until further notice.  The new CMS 1500 form does allow space for using both numbers.

The weekly capping of claims continues at $36.5 million.  Since the cap was first imposed the last week of January, the cap was met in weeks 3, 4 and 5.  It is still not anticipated that any claim would remain delayed by more than one week's cycle.  The state claims it is taking this action to ensure that funds do not run out before the end of the state's fiscal year (June 30, 2007).

2007 PQRI Website Now Available

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that the 2007 Physician Quality Reporting Initiative (PQRI) webpage is now available.

On December 20, 2006 the President signed the Tax Relief and Health Care Act of 2006 (TRHCA). Section 101 under Title I authorizes the establishment of a physician quality reporting system by CMS. CMS has titled the statutory program the 2007 Physician Quality Reporting Initiative.

PQRI establishes a financial incentive for eligible professionals to participate in a voluntary quality reporting program. Eligible professionals who successfully report a designated set of quality measures on claims for dates of service from July 1 to December 31, 2007, may earn a bonus payment, subject to a cap, of 1.5% of total allowed charges for covered Medicare physician fee schedule services.

This newly established webpage will be updated regularly, so check it often for information from CMS.

For more information on 2007 PQRI, visit http://www.cms.hhs.gov/pqri/ on the CMS website.

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Edward David, M.D., J.D. Nominated to Dirigo Health Agency Board

Former MMA President and Board of Licensure in Medicine Chairman Edward David, M.D., J.D. was nominated this past week by Governor John Baldacci to a position on the Board of the Dirigo Health Agency Board of Directors.  Former MMA President Robert McAfee, M.D. chairs the Board.  Dr. David's nomination must be confirmed by the Maine Senate.  Dr. David lives in Holden.

Dr. David until recently practiced neurology in Bangor.  He has served on the Board of Licensure in Medicine for nearly twenty years and has served as chairman for the past fifteen years.  His term on the Board of Licensure ends in June and he has announced his intention to leave the Board at that time.

"Ed David is uniquely qualified to serve on the Board of Dirigo", noted Gordon H. Smith,  EVP of MMA.  "As a practicing physician and attorney, he certainly understands the nuances of health care politics and we look forward to working with him in this new capacity," Smith added.

In l982, Dr. David ran unsuccessfully for the Maine House of Representatives.  He also has served the state for many years as a Deputy Chief Medical Examiner. [return to top]

Developmental Behavioral Pediatric Conference, May 5-6, 2007

Save the Date!  Special Kids, Special Needs: Topics in Children with Special Health Care Needs and Developmental Behavioral Pediatrics

May 5th and 6th, 2007, Samoset Resort, Rockport, ME. 

Don't miss the Spring Conference of the American Academy of Pediatrics, Maine Chapter with Support from The Barbara Bush Children's Hospital

Keynote Speaker: Jefferson Prince, MD, Child Psychiatrist from Massachusetts General Hospital speaking on ADHD and depression.  Other topics include Potty University, Tourette Syndrome, transition from child to adult care, and more! 

 Click here for full Save the Date Information! [pdf] [return to top]

MMA Advocates for Re-Authorization of SCHIP Program

The Maine Medical Association participated this past week in press conferences focusing attention on the value of the Children's Health Insurance Program in Maine and the need for it to be re-authorized by the Congress.  The press conferences were organized by Maine Equal Justice Partners and the Maine Children's Alliance.  Speaking at the press conference in Portland was Dr. Chris Stenberg, Director of Ambulatory Pediatrics at the Barbara Bush Center at the Maine Medical Center.   Dr. Stenberg was speaking on behalf of the Maine Chapter of the American Academy of Pediatrics.

In Maine, the SCHIP provides funding for 14,50 children in the state's MaineCare program.  These children live in working families who earn too much to be eligible for traditional MaineCare, but cannot afford to purchase health insurance for their families. The program was enacted by the Congress ten years ago and has had a very positive impact in decreasing the number of children living without health insurance coverage.  In Maine, the uninsured rate for children has been cut in half  )to 7%),  giving Maine one of the lowest rates of uninsured children in the nation.

But approximately 19,000 children still remain uninsured in Maine, with 58% of those kids eligible for MaineCare.

For more information and to review data sources, please visit www.mejp.org

At the press conferences, advocates released the results of a poll, sponsored by the New England Alliance for Children's Health that demonstrated strong public support for the SCHIP program.  The survey results reinforce research findngs from other states across the country - that health care and affordable coverage is a top priority and concern among voters. [return to top]

Three Large Hospital Systems Announce Cooperative Agreement

Maine Health, Eastern Maine Healthcare and Maine General Medical Center announced this past Thursday that they will collaborate and improve medical services and reduce health care spending across the state.  The cooperative agreement was formalized in a "memorandum of Agreement."   In a nutshell, the three major areas of collaboration are as follows:

  • An information technology group will work on connecting the system's respective electronic medical records so physicians at one facility can share information with another.
  • A second work group will work on maximizing purchasing power for medical equipment and supplies.
  • A third group will focus on improving public health, both by standardizing clinical care and through public health campaigns.

The Maine Hospital Association, Governor Baldacci and other hospitals all reacted favorably to the announcement.  Trish Riley, Director of the Governor's Office of Health Policy and Finance stated that she was encouraged by the announcement and she commended the administrators for supporting the goals of the state health plan.

Probably the most significant impact of the announcement for Maine physicians will be the opportunity presented to the physicians associated with three systems (which include over one-half of the physicians in  the state) to work together on quality improvement activities such as the development of clinical guidelines, chronic disease registries and community health assessments. [return to top]

MMA Executive Committee to Meet Wednesday

The 28-member MMA Executive Committee will meet at 2:00pm on Wednesday (March 7) in Manchester.  The primary internal issue on the agenda is a discussion of the appropriate role of the existing Steering Committee and the Executive Committee.  As a result of the Executive Committee retreat held in January, it has been suggested that the seven member Steering Committee take more responsibility of the oversight of day to day management of MMA leaving the larger committee to focus on strategic planning and high-level oversight of management.  The Committee will also receive recommendation from the Personnel Committee relative to the contract of the Executive Vice President and review financial reports for the 2006 budget year.

On external issues, the focus will be on pending legislative proposals, various quality initiatives and upcoming MMA events including the June 18th golf tournament, the June 20 Practice Education Seminar and the 2007 Annual Session (Sept. 7-9, 2007 in Bar Harbor).

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MMA Payor Liaison Committee Hears from Peter Hayes on Care Focused Purchasing

Members of the Association's Payor Liaison Committee met this past Thursday night and heard from Peter Hayes of Hannaford Brothers on the topic of Care Focused Purchasing.  Care Focused Purchasing is being promoted by a group of large employers across the country, including Hannaford Brothers.

Mr. Hayes presented a detailed power point presentation which included a comparison of health care costs in Maine with costs in other states.  Maine's costs were represented as being much higher than most other states.

Care Focused Purchaing involves employers trying to empower their employees to make wise choices in the purchasing of their health care by providing them with data derived from health care claims and other data. [return to top]

Legislative Committee Holds Successful Forum on MaineCare Issues

On Tuesday, February 27, 2007, the MMA Legislative Committee held its first "issue-oriented" meeting in an effort to generate interest among the general membership and to bring guests to discuss contemporary health care issues with physicians.  This meeting was a forum with DHHS representatives and members of the legislature on MaineCare issues, particularly the MECMS transition issues and the Governor's proposed $3 million General Fund fee increase.  MMA Legislative Committee Chair Katherine S. Pope, M.D. welcomed approximately 20 colleagues and MMA staff to the forum that featured as guests:

  • Acting Office of MaineCare Services Director Tony Marple;
  • MaineCare Medical Director Laureen Biczak, D.O.;
  • Senator Karl Turner (R-Cumberland), the Republican Senator on the Appropriations Committee;
  • Representative Janet Mills (D-Farmington), a member of the Appropriations Committee;
  • Senator Lisa Marrache, M.D. (D-Kennebec), a member of the Health & Human Services Committee;
  • Representative Bob Walker, M.D. (R-Lincolnville), the lead House Republican on the Health & Human Services Committee.

Each guest gave his or her perspective on the two principal MaineCare issues and then the group engaged in an informal discussion and "Q&A" on these and other issues, including the state's medical liability climate.

The Legislative Committee has scheduled another forum for Tuesday, April 24, 2007 and the topic likely will be the Dirigo Health Program and the health care reform debate in Maine. [return to top]

Topics in Gastroenterology for Primary Care, April 28 in Freeport

The Maine Gastroenterology Society is pleased to announce they will hold the 4th annual "Topics in Gastroenterology for Primary Care on Saturday, April 28th, 2007 at the Harraseekett Inn, Freeport, Maine. Dr.ís James Morse and Jay Bosco will co-direct the conference this year. The conference will focus on nutritional issues including obesity management, inflammatory bowel disease and new technologies in gastrointestinal endoscopy. Faculty will present several instructive cases with expert discussion. The conference emphasizes practical clinical issues in patient care. Please join us for what promises to be an exciting and educational day in Freeport! Please contact Gail Begin at the Maine Medical Association at 207-622-3374 x210 for registration materials or more information. [return to top]

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