June 11, 2007

 
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MMA Opposes Proposed Sales Tax on Elective Cosmetic Procedures

The Maine Medical Association on Friday issued a legislative alert asking Maine physicians to communicate to state legislators expressing opposition to a proposed expansion of the state sales tax to elective cosmetic procedures.  If enacted, Maine would be only the second state in the nation to tax such procedures, following the lead of New Jersey which is now considering repealing the tax.  The proposed expansion of the sales tax also includes health club memberships. 

"We remain disappointed that a legislature which refuses to raise taxes on cigarettes is prepared to tax activities that are healthy such as health club memberships and cosmetic procedures many of which will be difficult to distinquish from medically necessary procedures," stated Gordon Smith, MMA Executive Vice President.

The administrative burden to determine application of the tax on cosmetic procedures could be enormous.  There will be challenges to the tax on thousands of medical procedures which will adversely impact consumers, medical professionals and tha state.  This can be a potential auditing nightmare for physicians and the state, implementation of the subjectively imposed tax will require an inordinate amount of time to interpret and administer with questionable return.  The tax in New Jersey has raised only one-quarter of the revenue anticipated.

In addition to plastic surgeons, the tax will impact on many other specialties such as dermatology, ENT and many primary care physicains who provide skin care and hair removal.  Cosmetic dentistry is incuded and every orthodontist may be at risk.  The precedent of applying a sales tax to medical procedures is also of grave concern.

The cosmetic surgery tax also discriminates against women.  Eighty-six percent of cosmetic surgery patients are working women between the ages of 35 and 50.

If you would like to help defeat this proposal and are not sure how to contact your legislator or what other action you might take, please contact Andy MacLean, Charyl Smith or Gordon Smith at MMA via e-mail to amaclean@mainemed.com, csmith@mainemed.com or gsmith@mainemed.com respectively.

The Legislative Alert sent on Friday will be posted on the MMA's home page, www.mainemed.com, very shortly. 

MaineCare Update: Providers Advisory Group Meeting and MECMS "Visioning" Session

The MaineCare Governor's Provider Advisory Group met on Thursday, June 7 and in addition to its regular meeting, conducted a "visioning" session relative to the new MMIS system facilitated by personnel from Deloitte consulting.

Last week's payment cycle totaled $41.4 million but only $26.6 million was paid, thereby increasing the capped claims by $14.8 million.  The cycle payment was lower adjusted to account for Medicare payments made the previous week.  As a result, the state is carrying approximately $75.8 million total state/federal funds due to capping cycles.  These payments are expected to be caught up quickly once the state reaches the new fiscal year on July 1st.  There is no capping of claims anticipated after July 1, 2007.

Interim recoveries thorugh May 25, week # 47, total $355.8 million (68%), of which $115.2 million has been recovered in FY07.

Suspended claims inventory is at 72,772, an increase from previous weeks.  The increase was partially caused by a hick-up in claims processing last week occasioned by implementation of a patch which stopped processing of claims for two days.

MaineCare customer service division received a record number of calls in May, with an abandonment rate of 3%, which is considered to be within industry standards.

VISIONING SESSION

The visioning session facilitated by personnel from Deloitte Consulting which has been contracted by the Office of MaineCare Services to assist with the preparation of the Request for Proposals for a new MMIS system.  There are four potential vendors interested in repsonding to the document which is not expected to be issued until December of this year.

The goal of the visioning session was to give providers an opportunity to consider the following questions:

  • What are the business and operational functions that need to be supported by the new MMIS system?
  • What functionality is missing currently that providers need to operate their offices more effectively and efficiently?
  • Is critical information providers need to provide services to MaineCare patients readily available from the system?

Much of the discussion focused on eligibility, including problems with retroactive denials, inconsistent eligibiity determinations  and problems with the current web portal.

The need for void functionality was repeatedly noted.  MMA representatives noted the need for the new system to be able to handle electronic processing of the Medicare tapes for patients eligible for both MaineCare and Medicare (so-called cross-over claims).  We also expressed concern about the potential delay of another 2 to 3 years before this functionality is employed.

Providers were encouraged to think about the functionality that commercial payors provide that has been found to be useful.  Processing refunds on line was suggested, as well as adding void functionality and re-billing.  Also the ability to batch bill and to correct a single claim on line, without effecting the entire batch of claims.

It was noted that the new system needs to be nimble enough to adjust quickly for new items such as NPI (National Provider Identification).

The "vision" developed is expected to be in writing by June 22 and will then be shared with OMS and DHHS staff.  The document would then become part of the requirements of the procurement process. 

Although MMA has argued for an accelerated process, the federal government through CMS has apparently demanded a traditional RFP, which is why is is likely to take as much as 3 years to fully transition to a new system.  CMS is baring much of the cost of the new system.

OMS is looking at the possibility of using a work-around which would permit the electronical processing of the cross-over claims, without the fix being done through the current MECMS system built and operated by CNSI.  CNSI is currently operating under an 18-month contract with the state, requiring the company to continue to operate the existing system.  It is anticipated that the contract willl have to be extended once or twice before the new system can be developed, tested and implemented.  The goal is to virtually import a system from another state which has been certified by CMS.

The Provider Advisory Committee meets again on Friday, June 22 at 10:00am at OMS offices in Augusta. [return to top]

Report on Maine Quality Forum Advisory Council Meeting on June 8

The Maine Quality Forum Advisory Council met this past Friday in Augusta.  Following a presentation by Director Joshua Cutler, M.D. relative to future quality metrics and State Health Plan priorities, the remaining meeting consisted of a discussion of what would be included in any new contract with Health Dialog.

It was determined not to expand the number of specialty projects this current year.  Currently primary care and cardiology are involved.  The possibility of doing something with imaging remains, however.

Most of the discussion focused on how to engage the physicians and it was suggested that two or three representatives from each involved organization be invited to a meeting to discuss the project.

Discussion also took place regarding the desirability of releasing data to the public currently which would include the individual data but not the physician's name.  There seemed to be a consensus for this approach until such time as policy could be implemented ensuring the sharing of the data with the physician and the vetting of any specialty data by a group of specialists in that field.  The policy for the public release of such physician-specific identifiable data from the all-payor claims data base has been previously negotiated with MMA and other organizations.

The group acknowledged the importance of maintaining credibility with the physician community and is likely to move slowly with respect to the release of the data.  MQF staff noted that under the best of circumstances, the release of such data, utilizing the policy negotiated with MMA, would likely be at least one year away.

The group discussed the relationship between the national movement called Care Focused Purchasing, which Hannaford Brothers and other large employers participate in and the effort by the regional PHO's to utilize the ProfSoft program to look at costs arranged by ETG (Episodic Treatment Groups.)  Many health plans are now using ETG's for tiering purposes (organizing their physician networks by tiers with the top tier being designated as preferred).

The Council meets next on Friday, July 13 at the offices of Dirigo Health in Augusta. [return to top]

MMA Loan and Trust Committee to Vote on Medical Student Loans on Thursday

MMA's Committee on Loan and Trust Administration will meet this coming Thursday, June 14, to review up to 40 applications from medical students from Maine who seek funds annually from the Maine Medical Education Foundation.  The Foundation was started nearly 50 years ago by Dr. Dan Hanley and others in order to assist Maine students in their medical school financing.  The Foundation now has assets exceeding $5 million and last year loaned over a half a million dollars to students.

These loans are offered to Maine students in approved schools and are based upon the student's needs.  The Committee does not consider the parent's income in determiing need.  No interest is charged on the loan while the student is in medical school.

If you know of a student from Maine who is entering medical school or currently in school who may benefit from this program but not be aware of it, please contact Gail Begin at MMA at gbegin@mainemed.com.  Late applications can be accpeted.

The Committee is chaired by Mark Bolduc, M.D., a surgeon from Waterville.  Members of the committee include several former MMEF recipients. [return to top]

Biennial State Budget Signed; MaineCare Fee Increase Secured!

On Wednesday, June 6th, the Legislature enacted L.D. 499, the FY 2008-2009 budget bill, by votes of 112 - 29 in the House & 28 - 7 in the Senate.  Governor Baldacci signed the bill into law as P.L. 2007, Chapter 240 on Thursday, June 7, 2007.  Because it was an emergency measure, the bill takes effect immediately.  The $3 million MaineCare fee increase for physicians is in the second year of the biennium so it will become effective on July 1, 2008.  The MMA will keep you informed of the Department's plans to allocate the total amount of the fee increase, expected to be something more than $8 million with the federal match, as the effective date approaches.

 Again, the MMA thanks all of you who helped to pass this important provision.  Please take a moment to thank you legislator & the Governor for recognizing the need to improve MaineCare rates in order to maintain broad access to care for MaineCare beneficiaries.  You can email Governor Baldacci at governor@maine.gov.  You can find your legislators & their contact information on the web at:  http://janus.state.me.us/house/townlist.htm.
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Dirigo Legislation Remains in Debate in Insurance Committee

Last week, the Legislature's Insurance & Financial Services Committee spent several work sessions on L.D. 1890, An Act to Make Health Care Affordable, Accessible & Effective for All, the Governor's Dirigo 2.0 reform proposal.  Consistent with the schedule in the 122nd Legislature, it appears likely that Dirigo issues will be the last voted out of committee & among the last issues considered by the legislature prior to adjournment scheduled for Wednesday, June 20, 2007. 

As of last Thursday afternoon, the Committee was considering 3 separate proposals presented in outline form only.  Senate Chair Nancy Sullivan (D-York) supports some more aggressive insurance market reforms, including modifications to Maine's community rating & guaranteed issue laws, & establishment of a reinsurance high-risk pool, along with some modifications to the Dirigo Health Program.  Sen. Sullivan proposes to repeal the savings offset payment (SOP) & fund the program through a hospital tax not to exceed 1% of net patient service revenue & a health insurance premium tax not to exceed 1%.  She also proposes a modest voluntary assessment on Dirigo participants.  The proposal is market-oriented enough to have drawn the interest of the Republican caucus on the committee & to have drawn the ire of the committee's House Democratic caucus.

House Chair John Brautigam (D-Falmouth) proposed more modest insurance market reforms, modifications to the Dirigo Health Program, & repeal of the SOP.  He proposes to fund the program through increased tobacco taxes & a hospital surcharge. 

The Republicans on the committee also issued a draft proposal with insurance market reforms matching Sen. Sullivan's, some modifications of the Dirigo Health Program, & a future funding mechanism that continues to change.  Initially, they proposed state General Fund revenue, but by the end of the discussion last Thursday afternoon, they suggested that they might allow the SOP to continue.

The Committee is expected to meet for final votes on Tuesday, June 12th at 1 p.m. [return to top]

Law Court Issues Favorable Opinion in Malpractice Screening Panel Case

On June 7, 2007, Maine's Supreme Judicial Court, sitting as the Law Court, issued its second opinion in the ongoing litigation of James Edward Smith et al. v. Catherine Hawthorne, M.D., 2007 ME 72.  In a 4 - 2 decision, the Court determined that the defendant has the authority, under the Maine Health Security Act, to determine whether the screening panel findings will be presented to the jury when those findings are "split" on the issues of negligence & causation.  In this matter, the screening panel found negligence on the part of the physician, but also found that the negligence was not the proximate cause of the patient's injuries.  In the Court's first opinion, Smith I, 2006 ME 19, a majority determined that both findings must be submitted for consideration by the jury, if any findings will be submitted.  In a re-trial following this decision, the plaintiff offered, & the trial court admitted over the defendant's objection, both aspects of the panel findings.

In this opinion, the Court determined "that neither the constitutional right to a jury trial nor the Health Security Act require the admission of the panel's findings when the panel has decided negligence in favor of the claimant but causation in favor of the practitioner defendant and when the defendant objects to the admission of the findings."  The Court concludes that it is the defendant who has the right under the Health Security Act to determine whether panel evidence is submitted to the jury.  Three justices from the majority opinion also wrote two concurring opinions.  One justice took issue with the dissenting justices' opinion.  Two justices wrote that the complex & lengthy litigation of this matter (the case will now go back for a 4th jury trial) suggests that the legislature should revisit the Health Security Act & the screening panel process.

The MMA submitted a brief of amicus curiae in this matter, written by Christopher C. Taintor, Esq. of Norman, Hanson & DeTroy, LLC of Portland.  The MMA thanks Chris & congratulates him as the Court essentially adopted the analysis in his brief.

You can find the full opinion on the web at:  http://www.courts.state.me.us/opinions/2007%20documents/07me72sm.pdf. [return to top]

AMA Issues Survey Results on Latest Medicare Payment Cut

On June 4, 2007, the AMA released results of a survey suggesting that physicians will significantly reduce services to Medicare beneficiaries if a 10% payment cut scheduled for 2008 takes place.  The AMA is working to ensure a 1.7% fee increase as recommended by the Medicare Payment Advisory Commission.

The AMA surveyed 8955 physicians, both members & non-members, & found that 28% would stop seeing new Medicare patients & 8% would stop seeing established patients.  Thirty-two percent said they would reduce the number of new or established patients they would serve if such a cut went into effect.

The AMA has updated its Medicare payment advocacy materials on the web at:  http://www.ama-assn.org/.
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Calls will discuss National Physician Quality Reporting Initiative

The National Physician Quality Reporting Initiative (PQRI) will start July 1, 2007,  therefore the Centers for Medicare & Medicaid Services (CMS) has announced that three National Provider Calls will be held on the following dates:

 

June 13, 3 to 5 p.m. - This toll-free call will be a technical discussion of quality measures.  Following the presentation, callers will have an opportunity to ask questions of CMS subject matter experts.

 

June 20, 3:30 to 5:30 p.m. - This toll-free teleconference will be the first of two open Q&A sessions for eligible professionals to ask questions of CMS PQRI subject matter experts.

 

June 27, 3 to 5 p.m. - This toll free teleconference will be the second open Q&A session for eligible professionals.

 

Visit the PQRI web page at, www.cms.hhs.gov/PQRI, on the CMS website for up-to-date information on all National Provider Calls.  Go to the “CMS Sponsored Calls” section of the page and scroll down to the Downloads section for instructions on how to register for a call.

  

PQRI reporting begins with services provided as of July 1, 2007 and will continue through December 31, 2007. [return to top]

National Government Services announces draft policies

National Government Services announces the posting of 22 new draft policies. 

 

The draft policies are: 

Acid Phosphatase 

Biologic Products for Wound Treatment and Surgical Interventions 

Cardiac Computed Tomography (CCT) and Computed Tomography Coronary Angiography (CTCA) 

Cardiac Output Measurement Thoracic Electrical Bioimpedance 

Category III CPT Codes 

Drugs and Biologicals, Coverage for Labeled and Off-Labeled Indications 

Endoscopy by Capsule 

Erythrocyte Sedimentation Rate (ESR)

Erythropoietin Stimulating Agents (ESA)

Homocysteine Level, Serum 

Hospice – Determining Terminal Status

Hyperbaric Oxygen Therapy (HBO) 

Infrared Coagulating IRC of Hemorrhoids 

Inpatient Rehabilitation Services Provided in Inpatient Rehabilitation Facility 

Magnetic Resonance Angiography (MRA) 

Neuromuscular Junction Testing 

Ophthalmic Angiogram (Fluorescein and Indocyanine Green) 

Ophthalmology: Posterior Segment Imaging 

Psychiatric Inpatient Hospitalization 

Surgical Decompression for Peripheral Polyneuropathy 

Varicose Veins of the Lower Extremities 

Virtual Colonoscopy 

 

To view these policies on the Maine/Mass website, click on: http://www.ahsmedicare.com/provider/review_appeals/view_draft_policies.aspOn disclaimer page, click “ACCEPT.”  On the right hand side, click on "View Draft Policies". 

 

All 22 draft policies are listed.  At the bottom of each policy, there is an option to send comment.

 

They will also host three open door meetings on these policies.  For information on this link for information on the open door meetings and the guidelines for submitting new scientific information or to make comment at the open meetings visit http://www.ahsmedicare.com/provider/toolbox/bulletins_detail.asp?MediMessageID=4048  

 

Those who plan to attend should bring a copy of the policy/policies that interest them.   [return to top]

MMA Members and Staff Eligible for Discount to AAPC Conference, June 28-30

The American Academy of Professional Coders (AAPC) has offered a $50 discount to all MMA members and their staff to their conference in Hartford, June 28-30, 2007 using the following discount code: medsoc.  Learn more or register at the AAPC website. [return to top]

Don't Miss the MMA Annual Golf Tournament, June 18

The tournament will be held on Monday, June 18, 2007 at the Augusta Country Club, a superb Donald Ross designed course that is considered one of the best in Maine. The event will begin with registration and lunch at 11:00 a.m. followed by a shotgun start at noon. An awards program will conclude the day’s events.

The format for the Tournament will be an 18 hole, four person traditional scramble. More detailed rules will be distributed on the day of the tournament.

A generous number of prizes will be awarded to both net and gross winners, as well as for longest drive and closest to the pin. More prizes than ever before, including a new car for a hole in one! [return to top]

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