April 2, 2007

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MaineCare/MECMS Update

DHHS officials announced this past week that the current MECMS vendor, CNSI, has signed an agreement with the state to continue processing claims through the MECMS system for another 18 months while a new vendor/fiscal agent is selected through an RFP/Contracting process. As selection of a new vendor and the transition to a new system is likely to take up to two-years, even the 18-month extension may not be sufficient.

A combined meeting of the Governor's Provider Advisory Committee and Technical Advisory Committee was held on March 23. Much of the discussion focused on the "cap" on the weekly payment of claims and on the transition to a new vendor/fiscal agent. It is becoming increasingly apparent that there may not be sufficient funds in the MaineCare account to pay all claims through June 30, which will, among other things, put increased pressure on DHHS to recover remaining interim payments. Physicians remain about the only provider category which still has more money tied up in suspended claims than is owed back in interim payments. MMA will continue to point this out at upcoming meetings. In addition, we continue to be concerned with the following:

  • The continuing failure of the state to set up a process to refund interest costs caused by the MECMS failure. The legislature had previously, at MMA's request, appropriated $1 million to reimburse physicians and other providers who had to borrow funds to preserve cash flow.
  • The weekly capping of claims payments at $36.5 million now may delay payments for two weeks, as the cap is being reached each week with a backlog of claims resulting.
  • There is little if any work being done to improve the functionality of the system, despite the fact that it is now expected to be another two years before a full transition can occur to a new fiscal agent

MMA representatives met this past week with representatives of ACS, another potential bidder on the RFP expected to be released in the coming weeks. Wile MMA does not intend to endorse one potential vendor over another, we do hope to provide substantial input into the selection process. The failure to involve providers and policy experts in the design and implementation of the MECMS system has been cited as a major cause of its failure.

DOJ Study Examines Medical Liability Claims in Seven States

The U.S. Department of Justice (DOJ) has published a report reviewing medical liability claims in Florida, Illinois, Maine, Massachusetts, Missouri, Nevada and Texas from 2000 through 2004. The study found that about 2/3 of cases in Maine, Missouri and Nevada closed without any compensation being paid, while in Illinois, only about 12 percent of cases ended with a payout. In Florida and Missouri, claimants who suffered major or grave permanent injury received median payouts ranging from $278,000 to $350,000, while claimants who suffered temporary or emotional injury received median payouts ranging from $5,000 to $79,000.  Fewer than 10 percent of claims in Florida, Maine, Missouri and Nevada paid $1 million or more. For more information, along with links to the complete report, Medical Malpractice Insurance Claims in Seven States, 2000-2004 (NCJ-216339), and supporting documents go to: http://www.ojp.usdoj.gov/bjs/abstract/mmicss04.htm [return to top]

Maine Health Access Foundation Presents 'Advancing Health Reform' Summit April 30

On April 30, 2007, MeHAF will hold a day-long summit that will bring together health care leaders, policy makers, researchers and consumers to hear from national and local experts about the changing landscape and opportunities to advance health reform.  Recent innovations have placed states front and center in defining approaches to comprehensive health reform.  The purpose of the summit is to inform, provoke ideas, debate and outline a path for the next steps in Maine’s efforts.

Maine is committed to comprehensive health reform and MeHAF is committed to continuing the conversation about getting there.  Dr. Stuart Altman of Brandeis University will begin with a keynote on "The Changing Landscape of Health Reform."  Researchers from the Urban Institute will discuss new studies commissioned by MeHAF, including an analysis of costs and revenue sources to care for people who are uninsured.

Alan Weil of the National Academy for State Health Policy will present innovative approaches and lessons from the current state health reform initiatives.  The discussion will be informed by recent focus group data on what Maine people value in health care.  Join us to help frame the next steps for Maine's health reform agenda.  The Summit will be held at the Samoset Inn in Rockport on April 30th.  Registration will begin at 8:00 a.m.

Register online or view the agenda [pdf link]. [return to top]

HealthInfoNet Chooses 3M For Statewide Health Information Exchange

HealthInfoNet, Maine’s health information exchange (HIE), has selected 3M Health Information Systems as vendor of choice to provide the interoperability solution needed to build one of the nation’s first statewide health information-sharing networks. Following an extensive national search, 3M and its partners, Orion Health and Connectria, were chosen to create an integrated health information system designed to improve the quality and efficiency of healthcare delivery in Maine and, over time, make personal health information more available to patients. The parties are currently negotiating a definitive agreement.

“A growing number of physicians and other leaders in Maine are convinced that the creation of a statewide clinical information-sharing network is one of the most important steps Maine can take to improve the quality of health care,” said Devore S. Culver, executive director for HealthInfoNet, the independent nonprofit organization formed in 2006 to build the state’s HIE. “We believe this technology will give clinicians the information they need—when they need it most—to make better and more informed treatment decisions.”

Culver further noted, “The advanced technology provided by 3M and its partners makes it possible to achieve the highest level of data interoperability. It also provides a high degree of security in a network that has patient privacy as its number one priority.”

Following a three-year planning and development process, HealthInfoNet’s first-stage implementation phase will permit rapid access to patient-specific healthcare data at the point of care and across networks, hospital systems, and state lines. Maine is one of nine states chosen by the Office of the National Coordinator for Health Information Technology to gather and report information to help establish best practices for HIE projects and Regional Health Information Organizations (RHIOs).

Under the proposed agreement, 3M Health Information Systems will deliver a highly scalable, interoperable system that includes the 3M™ Clinical Data Repository, 3M™ Enterprise Master Person Index, and 3M™ Healthcare Data Dictionary. Orion Health will provide its Concerto™ Medical Applications Portal, Rhapsody™ Integration Engine, and Concerto Forms solution. Connectria will supply remote hosting services.

“We are delighted to be part of HealthInfoNet’s groundbreaking initiative,” said Ray Terrill, government business unit manager for 3M Health Information Systems. “Our products and services have been proven in large-scale implementations, such as the Department of Defense’s electronic medical record. 3M’s focus on interoperability enables our customers to exchange data at regional, state, and national levels. We share HealthInfoNet‘s commitment to improving healthcare quality.”

HealthInfoNet is a public-private partnership governed by a multi-stakeholder board of directors that includes providers, employers, consumers, payers and state government. More information about HealthInfoNet is available at www.hinfonet.org.

Orion Health will provide Maine HealthInfoNet with its Concerto™ Medical Applications Portal to review and report patient data and its Rhapsody™ Integration Engine to ensure smooth communication between new and existing information management systems and partner applications. Orion Health’s Concerto Forms will provide a customizable solution for the entry, storage, and recall of clinical documents. Worldwide, Orion Health is implementing health information communities involving over 35 million patients with tens of thousands of active users. More information can be found at www.orionhealth.com.

Connectria is a profitable, growing and privately held Managed Services provider that delivers a comprehensive range of enterprise hosting and infrastructure outsourcing solutions to over 200 large and mid-sized organizations worldwide. More information can be found at www.connectria.com.

3M Health Information Systems, part of the 3M Health Care family, is a leading provider of advanced software tools and services that help healthcare organizations capture, classify, and manage accurate healthcare data. 3M Health Information Systems products help ensure the quality of data, which drives an organization's ability to manage revenue, comply with regulations, improve quality of patient care and manage resources effectively. 3M Health Care is dedicated to improving the practice, delivery and outcome of patient care. 3M Health Care is a leading provider of solutions for medical, oral care, drug delivery and health information markets.

3M's brands include Scotch, Post-it, Scotchgard, Thinsulate, Scotch-Brite, Filtrete, Command and Vikuiti. Serving customers around the world, the people of 3M use their expertise, technologies and global strength to lead in major markets including consumer and office; display and graphics; electronics and telecommunications; safety, security and protection services; health care; industrial and transportation. For more information, including the latest product and technology news, visit www.3M.com. [return to top]

Physicians' Day at the Legislature Highlights MaineCare Fee Increase

The MMA and the Maine Osteopathic Association hosted a successful Physicians' Day at the Legislature on Thursday, March 29, 2007 in the State House Hall of Flags.  Approximately 50 physicians and medical students participated in this grassroots advocacy event.  Maine's two physician legislators, Senator Lisa Marrache, M.D. (D-Kennebec) and Representative Robert Walker, M.D. (R-Lincolnville), kicked off the day with a welcome to their colleagues.  MMA President Kevin Flanigan, M.D., MOA President Thomas DeLuca, D.O., and UNECOM Dean Boyd Buser, D.O. also presented opening remarks touching upon the key health policy issues of the day and encouraging physicians to be involved in politics and government. 

For several hours during the morning, participants mingled with legislators over coffee and food provided by Bay Wrap, a business venture in which Augusta physician and MMA member Laurel Coleman, M.D. is a part-owner.  The MMA, the MOA, the Maine Society of Eye Physicians & Surgeons, the Maine Chapter of the American Academy of Pediatrics, the Maine Chapter of the American College of Emergency Physicians, the Maine Academy of Family Physicians, and Spectrum Medical Group each developed table displays in the Hall of Flags to showcase their work.  In the early afternoon, physicians participated in meetings with the legislative leadership and attended committees' public hearings on bills.  The Health & Human Services Committee conducted a public hearing on L.D. 436, An Act to Postpone the Expiration of the Required Nonhospital Expenditures Component in the Capital Investment Fund, a bill submitted by Senator Karl Turner (R-Cumberland) on behalf of the MMA.  In addition to representatives of the MMA and the Maine Ambulatory Surgical Center Coalition, InterMed CEO Dan McCormack, in Augusta for Physicians' Day, spoke in favor of the bill.

 At the conclusion of the day, Governor John Baldacci spent about a half hour chatting with physicians in the Cabinet Room.

The MMA thanks all physicians and staff who contributed to making this day a success.
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Census Bureau Revises Estimated Number of Uninsured Downward

On March 23, 2007, the Census Bureau announced that in 2005, 44.8 million or 15.3% of the population were without health insurance.  This figure is about 1.8 million fewer than the Census Bureau reported in August 2006.  Conversely, the Census Bureau estimates that 249 million Americans had health insurance coverage in 2005. [return to top]

Small Group Physicians Testify to Congress on Costs of Health Care IT

On March 28, 2007, physicians from small practices in Texas and Georgia spoke to the House Small Business Subcommittee on Regulation, Health Care and Trade about the cost barrier, estimated to be as much as $50,000 per physician, to accessing health care IT.  While everyone acknowledges the potential for IT to cut costs and improve patient care over the long term, the conversion process is expensive, requires additional staff training, and reduces the efficiency of the practice for some period of time after implementation of the new system.  Subcommittee Chairman Charles A. Gonzales (D-Texas) said that he would introduce legislation to provide financial and other resources to prompt the adoption of health care IT.  In 2006, the House and Senate could not agree during an effort to reconcile two health care IT bills.  Legislative aides on Capitol Hill have speculated that Congress will not take up health care IT legislation again at least until 2008 because of a lack of money and other pressing health care issues, such as the reauthorization of the SCHIP and addressing the Medicare physician payment formula.


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Senator Snowe Announces SCHIP Reauthorization Legislation

Senator Olympia Snowe has joined with Senator John D. Rockefeller IV to submit the Children's Health Insurance Program (CHIP) Reauthorization Act of 2007.  The bill would extend the program beyond its September expiration and would give states the federal resources, financial stability, and flexibility necessary to sustain their current programs, reach the children who are already eligible for CHIP and Medicaid, but unenrolled, and pursue efforts to cover more children.  You can read a press release about the bill at:  http://rockefeller.senate.gov/news/2007/pr033007a.html.

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MMA Participates in Working Group on Geographic Access Standards Rule

About a month ago, the Bureau of Insurance convened a "consensus-based rulemaking group" to consider changes to the geographic access standards contained in Section 7 of Bureau of Insurance Rule Chapter 850, Health Plan Accountability.  Enacted in the mid-1990s as part of the patient/provider rights movement as a consumer protection measure, the geographic access standards have been criticized for having an unintended impact on negotiations between health plans and providers in some parts of the state and for interfering with some quality improvement or "pay-for-performance" programs.  The MMA is participating in this group along with the Maine Hospital Association, Anthem, the Maine Association of Health Plans, MaineGeneral Health, Maine Equal Justice, and Consumers for Affordable Health Care.  The group has been sharing opinions on the impact of this portion of the rule in the marketplace and comparing Maine standards with those of other states.  A week ago, MMA EVP Gordon Smith participated in a panel briefing on the subject before the Joint Standing Committee on Insurance & Financial Services.  No "consensus" has yet emerged in the group, but the likely options to be considered will be modifications to the access standards for specialty and hospital care and/or the process for seeking an exception to the access standards.  If you would like to share an opinion on this subject, please contact Andrew MacLean, Deputy EVP, at amaclean@mainemed.com or Gordon Smith, EVP, at gsmith@mainemed.com.

The working group is scheduled to meet weekly on Mondays until the end of May.
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MMA and Medical Mutual Team up for Risk Management Seminar This Friday, April 6

The Maine Medical Association First Fridays Presentation for the April 6 will be "Risk Management in the Physician Office Practice".  Speakers for this program will be Nancy Brandow, Cheryl Vacchiano, Cheryl Peaslee and Georgia Downs, all employed by Medical Mutual Insurance Company of Maine.

Because many malpractice claims originate from system failure in the physician office practice, physicians and practice managers alike will benefit from a discussion of risk prevention strategies.

At the conclusion of the program the participants will be able to:

  • Describe areas of risk in physician office practices
  • Identify at-risk systems in their own office practice
  • Acknowledge implementation strategies to mitigate the identified risks

This program has been approved for 3 CME credits and will be held at the Maine Medical Association office in Manchester, Maine.  If you have any questions, please contact Gail Begin at 622-3374 ext. 210. [return to top]

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