May 14, 2007

 
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Hearing on Governor's Dirigo 2.0 Initiative on Wednesday at the State House

Governor Baldacci's legislative proposal encompassing his Dirigo Health changes will be the subject of a public hearing Wednesday, May 16 before the Legislature's Committee on Insurance and Financial Services.  L.D. 1890, An Act to Make Health Care Affordable, Accessible and Effective for All, has been introduced by House Majority Leader Hannah Pingree with Senate President Beth Edmonds being the Senate lead.  While the bill contains over a dozen substantive proposals, much of the focus is likely to be on sections of the bill requiring "shared responsibility" for coverage and imposing a "play or pay" choice for employers who currently don't offer coverage and requiring individuals to purchase insurance after Jan. 1, 2009.

MMA's testimony will focus on Part I of the bill which establishes a health care shared responsibility program to require certain employers and individuals who do not offer to take up health insurance to pay a fee toward coverage of the uninsured.  Part I directs Dirigo Health, in consultation with representatives from the business, labor, economic development, taxation, consumer, insurance and health care communities along with other interested stakeholders, to adopt major substantive rules to implement this program and to address the concerns for affordability and fairness and the impact on the business climate.

Employers would be required to pay into the fund July 1, 2008 if coverage isn't provided.  Individuals would be covered by Jan. 1, 2009 or be required to pay a financial penalty.  Details, including exceptions, would be developed through rule-making with the final rules to be voted upon by the Legislature. 

The Maine Medical Association has supported an individual coverage mandate as one of the building blocks to universal coverage since 2003 when it released a White Paper on Health System Reform.  MMA will testify in favor of 1890 and express support for the individual mandate and other parts of the bill which we support.  We will also present testimony opposing some of the other parts of the bill which raise difficult issues, including  Part L which replaces the savings offset payment with a surcharge on payments made to hospitals by health plans.  MMA would prefer to fund the program by using the financial revenues recommended in the Dirigo Health Blue Ribbon Commission Report, including additional taxes on cigarettes, alcohol, sweetened beverages and snacks.

Pathways to Excellence Looks to Specialty Reporting

The Maine Health Management Coalition project known as Pathways to Excellence, which has reported on quality data on primary care practices in Maine for the past five years, will begin to collect data on certain specialty practices.  Within the next month, the Coalition, acting through regional PHO's, will sit down with specialists in the fields of cardiology, cardiovascular surgery, gastroenterology, general surgery, neurosurgery and orthopedic surgery and begin a discussion on what can be measured in each specialty.  Each specialty has been paired with a PHO in order to facilitate the discussion.  The elected leaders in each state specialty society representing the above noted groups will also be asked to participate.

The PTE specialty initiative will be structured around the guiding principles of the American Quality Alliance.   The members of the Alliance include the NCQA, the AMA and the American Osteopathic Association, CMS, several major health plans and the major national specialty societies.

The purpose of the initial meetings will be the begin a dialogue among specialty physicians, plans and employees on the cost and quality issues of the specialty and to familiarize physicians with the cost and efficiency metrics which are being utilized by plans and through the ProfSoft project.  It is hoped that these meetings will eventually lead to self-reported quality metrics to be included in state-wide reporting on these specialties by the Maine Health Management Coalition.

The Maine Health Management Coalition is a non-profit coalition of fifty-seven Maine employers founded in 1994.  These employers sponsor health plans covering 175,000 covered lives which represents approximately 35% of Maine's commercial market.  The member employers purchase over $1 billion in healthcare annually. [return to top]

MMA Becomes Administrative Home for Quality Counts!

The Maine Medical Association has been selected to become the administrative home for Quality Counts.  Quality Counts is among the newest healthcare quality improvement organizations with a statewide focus in Maine.  The Quality Counts mission statement is as follows:

Quality Counts is committed to working together across organizations  and across communities to improve healthcare systems and outcomes with the people of Maine.  Quality Counts will coordinate existing but disparate efforts across the state that support local, patient centered, and coordinated systems of care AND the resources that support them.  Its goals are to promote consistent delivery of high quality care, improve access to healthcare, and contain healthcare costs.

Quality Counts traces its origins to a diverse group of stakeholders including healthcare providers, employers, payers and policymakers, who came together in the fall of 2003 to promote the need for improved systems of care for chronic illness.  This group initially planned and conducted a series of Quality Counts conferences in December 2003, April 2004, and December 2005.  These statewide conferences introduced attendees to the Chronic Care Model and provided specific examples of Maine providers using population-based approaches and information systems to improve care.  The effort also forged collaborative relationships between providers, employers, and payers to speed broader adoption of the Planned (Chronic) Care Model in Maine and support its sustainability.  In April 2006, the original Corporators endorsed the creation of Quality Counts as an independent not-for-profit corporation to be supported by membership contributions, as well as available contracts and grants.

Quality Counts has been designed to provide the following key functions:

  1. Serve as statewide organizational champion and provide visible collective leadership for improving chronic illness prevention and care in Maine.
  2. Promote the spread of best practices through annual statewide Quality conferences or "Best Practice Colleges."
  3. Promote the spread of best practices through the creation of a statewide chronic illness prevention and care "learning network."

In June 2006, Quality Counts was established as an independent corporate entity.  The organization undertook an initial campaign to solicit supporting organizational memberships, and successfully enrolled 36 Member organizations and/or individuals.  Quality Counts organizations represent a diverse group of stakeholders and contributed $63,500 in membership dues to support the first year of Quality Counts activities.

Quality Counts also has received a grant from the Robert Wood Johnson Foundation "Aligning Forces for Quality" program.  Quality Counts will receive $200,000 per year for each of three years. 

As the administrative home of Quality Counts, MMA will provide a physical and administrative infrastructure for the organization.  Approximately 900 square feet of office space in the Association's Frank O. Stred headquarters building will be made available to Quality Counts and Quality Counts employees will become employees of MMA for payroll and benefit purposes.  The arrangement is for two years, but may be continued on a mutually acceptable basis.

As of May 11, Quality Counts Director John Barry is located in his new office and has been welcomed by MMA staff.  Mr. Barry is also the Project Director for the MMA/MOA Voluntary Practice Assessment Initiative.  MMA looks forward to a mutually beneficial relationship with Quality Counts. MMA EVP Gordon Smith is a member of the QC board.  [return to top]

MaineCare/MECMS Update

The Governor's MECMS Provider Advisory Group met on Thursday, May 10.  Highlights of the discussion included the following:

  • Weekly capping of claims. The week's cycle totaled $33.5 million.  $32.1 million were paid, along with Medicare Part A, B and D payments.  Capped claims were increased by $1.4 million.  As a result, OMS is carrying approximately $49.2 million (total state/federal) due to capping cycles.  When the department caps a cycle, those claims held as a result of the cap are processed first in the next week's cycle (as long as there hasn't been more than a full cycle capped). There is a plan to have all claims clear when the new fiscal year begins July 1.  There is no intent for the capping to continue into the 08 fiscal year.
  • Return of interim payments.  Interim recoveries through 4/27/07 total $345.2 million (66%), of which $104.6 million has been recovered in fiscal year 07. Total interim payments to providers stands at $522.9 million, this represents a $252,000 increase from the previous week.  During the week ending April 27, the State recovered $l.9 million in interim payments.
  • Schedule for transition to a new fiscal agent.  (See comments below) 
  • Naming of new Medical Director .  OMS hopes to name a new Medical Director for MaineCare by the end of May.
  • Weekly Metrics .  For the week ending May 6,  95.3% of new claims were either paid or denied.  When recycled claims were included, 88.65 % of claims were processed through MECMS (paid or denied).
  • Reimbursement of interest expense.  Deputy DHHS Commissioner Kirsten Figueroa reported on response to the letter sent by DHHS at the request of MMA inviting providers to communicate relative to any interest expense they may have incurred because of the performance of the MECMS system.  Over 300 providers have responded, although most have indicated that they did not have any such expense to be reimbursed.

The transition to a new fiscal agent, which is expected to lead to a fully functional MMIS system, will begin in December of 2007 with the release of a Request for Proposals. By the time a vendor is chosen and a new system is put in place, it may be well into 2009 or beyond.  In response to a comment by Gordon Smith, MMA EVP, about the perceived lack of urgency in the face of current  provider suffering, Maine Care Director Anthony Marple stated that the expected duration of the transition was based upon experience in other states and the Department's desire not to repeat the mistakes of the last transition , where the system was prematurely deployed without keeping in place a legacy system as a backup.

Providers are reminded that there is a current hold on claims with service dates prior to Oct. 1, 2006 for any provider with a balance owed due to interim payments.  If you are holding interim payments but your current claims are not processing regularly or if you still have claims in suspension, you should consult with your MaineCare provider relations staff.  MMA staff can sometimes be helpful if you are not getting through to the MaineCare staff.

The Governor's Provider Advisory Committee will meet next on May 24 at which time a "visioning" session will be held to obtain provider input into the new system.  The session will be facilitated by an outside party.  MMA representatives will attend so if a member has a comment to present, please contact Gordon Smith via e-mail to gsmith@mainemed.com. [return to top]

June 1 First Friday CME Program Features Coding Issues with Jana Purrell

On Friday morning, June 1, MMA will present its fifth "First Friday" educational offering of the year with a program entitled, "Jazzing Up Your Coding Skills" presented by Jana Purrell, CPC, Director of The Coding Center.

Jana will answer your questions and address Common Coding Issues - How to prevent costly coding errors.  Topics will include:

  • Evaluation and Management Services
  • Global Surgical package
  • Use of Modifiers - E/M and surgical

Jana will also present information regarding reporting quality measures, including what physicians and staff need to know about the CMS PQRI (Physician Quality Reporting Initiative).  Attendees are encouraged to bring any coding questions with them for discussion.

Jana Purrell has over twenty years experience in medical offices, management companies, hospital, and emergency medicine settings including both clinical and administrative roles.  Prior to joining the Coding Center, Jana worked for Maine Cardiology Associates for eleven years in the role of Business Office Manager.  She received her Certified Professional Coder Certification in 1999 and her CPC Instructor Certification in 2001.

Persons interested in registering for the program may call MMA at 622-3374 and Press O to be assisted and you may register on the MMA website at www.mainemed.com.  There is a $60 fee which covers breakfast and all materials. [return to top]

Maine Continues to Experience High Health Care Spending

According to a recent survey by the Kaiser Family Foundation, Maine ranked second among the 50 states in 2004 for health care spending as a percentage of the state's economic output.  The costs of all privately and publicly funded health care services and products in Maine represented 19.4% of the gross state product, compared to the national average of 13.3 percent.  Only West Virginia's health care costs were higher, at 20.3 percent.

  [return to top]

Lay-Midwifery Bill Sent for "Sunrise" Review

Following a lengthy public hearing, L.D. 1827, which would license lay midwives practicing in the state, was referred by the Committee on Business Regulation and Economic Development to the Department of Professional and Financial Regulation for completion of a review under the state's "sunrise" statute.  The Department has been asked to report back to the committee by Feb. 15, 2008.

Over one hundred persons attended the hearing, including many midwives and women and children they have successfully assisted in home births over the past many years. 

Opposing the bill in addition to MMA were the Maine Chapter of the American College of Obstetrics and Gynecology, The Maine Academy of  Family Physicians and the Maine Chapter of the American Academy of Pediatrics.  Several certified nurse midwives testified in the "neither for, nor against" category but expressed concern about the likelihood of public confusion if two types of midwives were licensed.  All of these groups are expected to be active participants in the sunrise review process.

The legislation would establish a licensing board to license lay, or so-called direct-entry, midwives who would be permitted to prescribe medication and essentially establish their own scope of practice. [return to top]

Register Today for June 20 Practice Education Seminar in Auburn

Register today for the Association's 16th Annual Practice Education Seminar to be held on Wednesday, June 20th at the Hilton Garden Inn in Auburn.  The all-day program, featuring plenary sessions in the morning and a choice of twelve break-out sessions in the afternoon, will run from 8:30am to 4:00p.m.  The keynote presenter is Erik Steele, D.O. of Eastern Maine Healthcare  System, a well known columnist for the Bangor Daily News and a health administrator for the EMHS.  An update will also be provided by the new MaineCare Director.  Federal officials will present information on the new CMS Physician Quality Reporting Initiative, which begins on July 1.

The Annual Practice Education Seminar, which regularly attracts about one hundred attendees, presents the Association with an annual opportunity to share with practice managers and members the major issues affecting medical practice in Maine.

Call the MMA office at 622-3374 to register or register online at the MMA website at www.mainemed.com. [return to top]

Update on Voluntary Practice Assessment Initiative

Practices interested in the MMA/MOA Voluntary Practice Assessment Initiative can still participate as the project has been extended through June 30, 2007.  The Initiative provides a confidential, statutorily protected, quality assessment report looking at how the practice cares for patients with diabetes or cardiovascular disease (for adults) or asthma for children as well as examining vaccination records.  A patient satisfaction survey is also part of the review which is offered free of cost.  The project is funded by the Maine Quality Forum.  We hope to review one hundred physicians by the end of June and so far, approximately seventy physicians have been reviewed or scheduled for review.

Persons interested may contact Gordon Smith via e-mail to gsmith@mainemed.com or call 622-3374.  The Project is now directed by John Barry, the new Executive Director of Quality Counts who may be reached at jbarry2040@gmail.com. [return to top]

Taxation Committee Considers Taxing "Elective Cosmetic Medical Procedures"

The Legislature's Taxation Committee has been discussing various aspects of "tax reform" during this session, including the elimination of many current sales and use tax exemptions.  The Committee has been considering taxing various personal and professional services and last week, the MMA became aware of draft language to tax certain medical procedures.  The language follows:

    2-D.  Elective cosmetic medical procedure.  "Elective cosmetic medical procedure" means any medical procedure on an individual that is directed at improving the individual's appearance and that does not meaningfully promote the proper function of the body or prevent or treat illness or disease.  "Elective cosmetic medical procedure" includes but is not limited to cosmetic surgery, hair transplants, cosmetic injections, cosmetic soft tissue fillers, dermabrasion, and chemical peel, laser hair removal, laser skin resurfacing, laser treatment of leg veins, sclerotherapy, and cosmetic dentistry.  "Elective cosmetic medical procedure" does not include reconstructive surgery or dentistry.  "Cosmetic surgery" means the surgical reshaping of normal structures of the body to improve the body image, self-esteem or appearance of an individual.  "Reconstructive surgery or dentistry" includes any surgery or dentistry performed on abnormal structures caused by or related to congenital defects, developmental abnormalities, trauma, infection, tumors or disease, including procedures to improve function or give a more normal appearance.

The MMA and Maine's plastic surgery practices urge you to contact your own legislators and members of the Taxation Committee to express your objections to this proposal.  Here's a link to the members of the Taxation Committee with their contact info.:  http://janus.state.me.us/house/jt_com/tax.htm

The following are talking points provided by the American Society of Plastic Surgeons:

Cosmetic Surgery and other Physician Taxes:

Talking Points  

 

  • The tax on plastic surgery and cosmetic procedures places additional strains on physicians who provide charity care to the state’s citizens including critical trauma and reconstructive care.  Physicians offering cosmetic medical procedures rely on this revenue to perform reconstructive work on uninsured and underinsured patients. 
    • For example, 90% of plastic surgeons perform both cosmetic and reconstructive surgery in their practices.
    • Plastic surgeons and otolaryngologists (ear, nose and throat surgeons) routinely perform a variety of life-changing reconstructive surgery beyond elective cosmetic surgery.  Procedures include facial reconstruction, breast reconstruction following cancer, cleft lip and palate repair, and burn and hand surgery following trauma and work-related accidents.
    The cosmetic surgery tax discriminates against women.  Moreover, contrary to popular belief, cosmetic surgery is no longer an exclusive luxury afforded by the very wealthy.  In fact, 86 % of cosmetic surgery patients are working women between the ages of 35 and 50 with an average income of $55,000 per year.
    Patients may understandably choose neighboring states for untaxed procedures, leaving the state’s health care system to shoulder the loss.  In many states, physicians have left under the weight of increased practice costs, skyrocketing medical liability premiums, and decreasing reimbursement.  Decreasing patient volume will only force physicians to leave the state or close their practices, taking revenue, job opportunities, and their charitable care out of the state.
    There are legitimate concerns regarding medically necessary covered services and patients’ privacy. State Tax Departments are in the business of collecting money, not determining medical necessity or ancillary services, or protecting patient confidentiality.  It is unclear how state agencies will put safeguards into place when handling sensitive patient information.  The State Tax Department will be forced to make recurring determinations about cosmetic and reconstructive care, related preoperative work, and the many other gray areas of implementation given the complexities of medical practice.
    The administrative burden to determine application of this tax will be enormous.  There will be challenges to the tax on thousands of medical procedures which will adversely impact consumers, medical professionals, and the state.  This can be a potential auditing nightmare for physicians and the state; implementation of this subjectively imposed tax will require an inordinate amount of time to interpret and administer with questionable return.
[return to top]

Judiciary Committee Recommends Increase in Damage Cap in Wrongful Death Actions

At a public hearing before the Judiciary Committee earlier in the session, the MMA, the Maine Hospital Association, and Medical Mutual Insurance Company of Maine all spoke against L.D. 866, An Act to Amend the Wrongful Death Laws, a bill that would have raised the cap on wrongful death noneconomic damages from $400,000 to $600,000 and requires regular future adjustments according to the CPI.  It also would have required the court to inform the jury about the damage limits.  In a work session last week, the Judiciary Committee voted unanimously to increase the damage cap to $500,000, but it declined to include the automatic inflation adjustment or the provision to require jury notification about the damages. [return to top]

MMA Supports Bill to Authorize Physicians to Report Suspected Drug Diversion to Law Enforcement

On Wednesday, May 9 2007, the MMA and the Maine Chapter of the American College of Emergency Physicians testified in favor of L.D. 1425, An Act to Facilitate the Reporting of the Crime of Acquiring Drugs by Deception before the Criminal Justice & Public Safety CommitteeThe bill would amend the provision of the Maine Criminal Code on acquiring drugs by deception to permit a prescribing practitioner or someone working under the supervision of such an individual who "knows or has reasonable cause to believe that a person has committed deception" to report that information to a law enforcement official.  It also would provide immunity from civil or criminal liability for that action.  Rep. Jonathan McKane (R-Newcastle) submitted the bill on behalf of Miles Memorial Hospital and Mark Fourre, M.D., an emergency physician practicing there.  Sen. Lisa Marrache, M.D. (D-Kennebec) and Rep. Bob Walker, M.D. (R-Lincolnville) spoke in favor of the bill as did the Maine Hospital Association and Geoff Rushlau, the District Attorney for the midcoast counties.  The bill would remove the uncertainty many practitioners feel about the ability to make such reports to law enforcement under the current health information privacy laws.  The MMA thanks Dr. Fourre for his initiation of this bill and for traveling to Augusta to testify in favor of it. [return to top]

MMA Legislative Committee Conference Call This Thursday, 7:30pm

The MMA Legislative Committee will hold its weekly conference call Thursday at 7:30 p.m.  Any member may participate.  The conference call number is 1-800-989-2842 and the code is 6223374#.  These calls will not have a formal agenda.  Mr. MacLean and/or Mr. Smith will provide an update on current advocacy activities and participants are welcome to pose questions or make comments about any bill being tracked by the MMA.  The calls usually will take about a half hour, though some will be shorter. 

If you have questions or comments about the Legislative Committee's communications process, please contact Andrew MacLean, Deputy EVP, at amaclean@mainemed.com. [return to top]

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