June 25, 2007

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Legislature Adjourns Without Action on Tax Reform or Dirigo

Maine's 123rd Legislature adjourned its First Regular Session around 10:30 p.m. last Thursday evening, June 21, 2007, a day later than scheduled.  Legislators have returned to their districts for the summer and fall and will return to Augusta in January for their Second Regular Session - unless momentum builds for a special session on tax reform and/or Dirigo.

The tax reform proposal (L.D.s 1925 & 1819) dominated the news headlines, the legislative debate, and the State House gossip during the last days and hours of the session.  By mid-day on Thursday, it became clear that the Senate was one vote short of the majority needed to pass the package of statutory changes in L.D. 1925.  After about an hour and a half of commentary from Senators about the impending demise of the bill, the Senate voted to "indefinitely postpone the bill and all its accompanying papers" by a vote of 26 - 9.  The House later passed an amended version of the bill by a vote of 80 - 59, but the debate on tax reform was over for the time being.  After the votes, several legislators said that this legislature's only realistic opportunity to return to the tax reform project would be in a special session later this year because action on the subject is unlikely in the next regular session with the 2008 elections looming.

Despite intense negotiations among the Governor's Office of Health Policy & Finance, key legislators, and stakeholders during the final week of the session, no consensus emerged on amendments to the Dirigo Health Program so the legislature never brought L.D. 1890 up for debate.  The legislature did finally enact L.D. 431, a proposal to permit the Dirigo Health Program to be self-insured.  The Dirigo board will next meet at 1 p.m. on Thursday, June 28, 2007, when members likely will discuss the funding and other challenges presented by these circumstances.

In post-session comments, the Governor and members of the legislative leadership pointed to bipartisan agreements on the budget, bonds, and school reorganization as successes of the recent session.  You can read the Governor's remarks to the legislature just before adjournment sine die on the web at: http://www.maine.gov/tools/whatsnew/index.php?topic=Portal+News&id=39327&v=Article-2006.

The MMA staff is working on an interim summary of the action from this legislative session that will be available later this summer.

Last CMS PQRI Q&A Conference Call, June 27, 3pm-5pm

Ready for PQRI? CMS will have its last call June 27 from 3 p.m. to 5 p.m. EST. before the program begins on July 1. The call is toll-free and a question and answer session will follow. Materials to download before the call will be posted on CMS’s PQRI Web site , in the “educational resources” section. To register, go to the “CMS sponsored calls” section and scroll down to downloads for instructions.
A new tool kit is available on CMS’s PQRI Web page for download and consists of the 2007 PQRI quality measures, 2007 Coding for Quality Handbook , 2007 Code Master, MLN Matters Article and sample worksheets, along with an article from Thomas Valuck, MD, for CMS. [return to top]

Legislature Considers Primary Care Commission

The Legislature is considering a joint order  that would establish a commission to study primary care medical practice and examine hospitals’ increasing control of those offices.

The commission’s duties include:

  • Identifying the causes of the loss of independent ownership of primary care medical practices due to financial, regulatory or business-related reasons;
  • Seeking input from independent primary care physicians on payer mix, reimbursement and Medicaid regulatory changes and the effects of such factors on the ability of independent primary care physicians to practice in Maine;
  • Determining the effect of hospital control of primary care offices on health care costs, access to health care and medical treatment of patients;
  • Review how comparable states manage physician-hospital relationships with respect to health care costs, patient advocacy and access to health care.

The commission shall submit a report with its findings, recommendations and suggested legislation, by Dec. 5, 2007. [return to top]

Peter Chalke, President of Central Maine HealthCare, Installed As MHA Chair

Peter Chalke, president and CEO of Central Maine Medical Center (CMMC) and Central Maine Healthcare Corporation (CMHC) in Lewiston, was installed as chair of the Maine Hospital Association Board of Directors at the Association’s Summer Forum at the Samoset Resort Wednesday night.

Chalke succeeds Doug Jones, CEO and president of Maine Coast Memorial Hospital in Ellsworth, who becomes the board’s immediate past chair.  The current immediate past chair, Roy Hitchings, President and CEO of Penobscot Bay Medical Center in Rockport, will leave the board, as will Deborah Johnson, CEO of Eastern Maine Medical Center; Dee Hopper, executive director of the Cancer Care Center of York County; Arthur Blank, CEO of Mount Desert Island Hospital; Amy Morse, CEO of New England Rehabilitation Hospital; Peggy Pinkham, CEO of St. Andrews Hospital; Jack May, CEO of Sebasticook Valley Hospital; and Carolyn Kasabian, chief financial officer of St. Mary’s Regional Medical Center.

Joining the board are Ralph Gabarro, CEO, Mayo Regional Hospital; Tim Garrity, CEO, Blue Hill Memorial Hospital; Michelle Hood, president, Eastern Maine Healthcare Systems; Darlene Stromstad, CEO, Goodall Hospital; Jeanne Fortier, vice president of clinical services, Mount Desert Island Hospital; and Robert McCue, chief financial officer, Mid Coast Hospital as chair of the Health Care Finance Council.

Chalke has been president and CEO of CMMC since 2000 and CMHC since 2002.  He joined CMMC in 1983 as assistant director for Ancillary Services.  In 1986, he became senior vice president and, in 1988, was appointed executive vice president and chief operating officer for CMHC and CMMC. [return to top]

MHA Board Gets New Officers

New officers were inducted onto the MHA Board of Directors Wednesday night at the Association’s annual Summer Forum:

Immediate Past Chair:  Doug Jones, CEO & president, Maine Coast Memorial Hospital
Chair-Elect: Thomas Moakler, CEO, Houlton Regional Hospital
Treasurer:  Kris Doody, CEO, Cary Medical Center
Secretary:  Jud Knox, CEO, York Hospital [return to top]

Maine Physicians Well Represented at AMA Annual Meeting

The American Medical Association opened its Annual Meeting in Chicago on Saturday (June 23) and among the 555 delegates and several hundred alternate delegates are two delegates and alternate delegates from MMA as well as several other physicians from Maine who serve as representatives of their specialty societies.

The Chair of the Maine delegation is David Simmons, M.D., an internist from Calais who currently serves as clinical director of the Physician Health Program.  The second delegate is Richard Evans, M.D., a general surgeon from Dover-Foxcroft.  Alternate delegates are Maroulla Gleaton, M.D., ophthalmologist from Augusta and John Makin, M.D., Ob-gyn from Waterville.   Other physicians attending from Maine, representing specialty societies, include Francis Kittredge, M.D. (neurology), Daniel Spratt, M.D. (endocrinology), Sam Solish, M.D.,(ophthalmology), Jo Linder, M.D. (emergency medicine) and John McGill, M.D. (plastic surgery).  Former AMA President Robert McAfee, M.D. also attends. 

The major issues being discussed at the meeting include the AMA position on pay for performance and the absolute necessity of fixing the sustainable growth rate (SGR) formula which is causing annual cuts to physician reimbursement under Medicare.  There is a plan being promoted in the Congress which would provide for a two-year fix with small annual updates.  The cost associated with such a fix would be about $40 billion dollars with the Medicare Advantage Plans or a tobacco tax increase being the likely ways to pay for it given that the "pay as you go" rules are still in effect.

The Maine delegation, with the support of the other New England states, has submitted a resolution calling for the AMA to put more teeth into the Prescription Data Restriction Program (PDRP).  If passed, the Resolution would require the AMA to allow a physician to opt out of the system which currently allows pharmacies to sell individual prescribing data to data mining companies which in turn, through the AMA master file, sell the data back to drug manufacturers.  Under the PDRP currently, if a physician opts out, the data is still sent to the manufacturer but the company, under contracts with the AMA, agrees to not share the data with the sales and marketing division within the company.  The MMA resolution would allow the physician to opt out of the data being shared with the company, period.

Dr. Simmons presented the testimony in favor of the Resolution before reference committee F on Sunday morning.  It will not be known until Monday or Tuesday what the Reference Committee recommended.  Look for a report on the final resolutions in next week's Weekly Update.

At Saturday's Opening Session, AMA President William G. Plested III, M.D. challenged delegates to work toward creating a brighter reality and future, one in which physicians steer reform in America's health care system, continue to lead quality improvement efforts and receive equitable reimbursement for their care.

More than 250 reports and resolutions will be acted upon at the meeting.  For a comprehensive list of items to be considered, visit the AMA web site at http: www.ama-assn./org/ama/pub/category/17616.html [return to top]

Maroulla Gleaton, M.D. Appointed to Board of Licensure in Medicine; Gary Hatfield, M.D. Re-appointed

Maroulla Gleaton, M.D. of Palermo, a practicing ophthalmologist in Augusta, has been appointed by Governor Baldacci to a six-year term as one of the six physician members of the Board of Licensure in Medicine.  Gary Hatfield, M.D. of Auburn, an internist practicing in Lewiston, was also re-appointed to a second six-year term.  Dr. Gleaton replaces Edward David, M.D., a neurologist from Bangor who served the Board with distinction for some twenty years, serving as Chair for most of that time.

Dr. Gleaton is a past President of the Maine Medical Association and a past President of the Maine Society of Eye Physicians and Surgeons.  She is the mother of four children and has served on the school board in Palermo.  She is a member of the Health System Development Advisory Committee and just completed a term as Chair of the Maine Health Access Foundation.  She also served as chair of one of the Health Action Teams organized by Governor Baldacci upon his first election.  The work of those teams led directly to the creation of the Dirigo Health initiatives.

MMA supported Dr. Geaton's nomination, as well as Dr. Hatfield's re-appointment and congratulates both physicians upon the occasion of their appointments. [return to top]

Over One Hundred Physicians and Practice Managers Attend 16th Annual MMA Seminar

Over one hundred physicians and practice managers traveled to Auburn last Wednesday (June 20) to attend the Association's sixteenth annual physician practice education seminar.  Following a keynote talk by Erik Steele, D.O., attendees heard informative talks on Pathways to Excellence, the Maine Health Access Foundation, characteristics of a successful medical practice and workforce shortages.  Breakout sessions were held on topics ranging from physician employment contracts to HeatlhInfoNet.

Sponsors of the program included OfficeMax, Northern Data, Network Systems, Cerner PowerWorks, Premier Marketing (sponsor of the new MMA on-line store), Physician Billing and Consulting, HRH New England and Medical Mutual Insurance Co. of Maine. 

MMA thanks the sponsors and all those persons attending.  It was the most successful of the sixteen programs.  Watch for an upcoming announcement of next year's program. [return to top]

Provider Advisory Group Continues to Monitor MaineCare Claims System Conversion

On Friday, June 22, 2007, the Governor's MaineCare Provider Advisory Group met jointly with the Technical Advisory Group for an update by DHHS staff and discussion on the MeCMS metrics, MeCMS repair initiatives and patches, interim payment recovery, and fiscal agent activity.  As of June 17, 2007, DHHS staff pointed out the following highlights of the MeCMS metrics:

  • Total claims for the week = 146,200
  • 94.7% "fresh" claims processed to pay or deny status
  • suspended claims inventory is 72,697

The Department has recovered $360.4 million of $525.7 million paid out in interim payments (69%).  $165.3 remains to be collected.  $10.2 million in interim payments to physicians and other individual practitioners remains to be collected, but this category of providers also has the largest amount of suspended claims at $16.2 million.

In the Department's effort to move the MaineCare claims management system to a fiscal agent, the staff presented a summary of the provider community visioning session held on June 7, 2007 in which the MMA participated.  The purpose of the visioning session was to:

  • Develop a shared provider community vision regarding desired functionality and requirements for the new Maine MMIS
  • Identify functionality and processes used by other payers that should be considered for inclusion in the MMIS project

The results of the session will be used to:

  • Serve as the foundation for underlying guiding principles for a new MMIS
  • Focus efforts as business requirements are developed
  • Help establish the business and technology needs to meet the vision of the future of the program
  • Initiate discussions on potential activities to be considered for outsourcing

The Department hopes to have the fiscal agent RFP completed by mid-October. [return to top]

Medicare Claims Submitted on “Old” CMS-1500 (12/90) Paper Forms Will Be Returned If Received After June 29

Medicare has issued a notice that the new CMS-1500 (08/05) forms must be used beginning of July 1, 2007. Since July 1 is a Sunday, that means that any of the old (12/90 version) paper claims forms not delivered to Medicare contractors by Friday, June 29, the last business day in June, will be returned to submitters for resubmission on the new CMS-1500 (08/05) form. The “new” CMS-1500 and the UB-04 forms have fields for reporting of both the provider NPIs and the legacy IDs (PINs, UPINs, NSC or OSCAR numbers on Medicare claims as applicable. For the time being, pending the announcement of the date for mandatory submission of all forms with the NPI only, the new forms can be submitted with legacy identifiers only, if that is all that a claim submitter has available. Even if a submitter cannot report NPIs for all providers on a paper claim form, it would still be able to submit a claim using the new CMS-1500 (08/05) claim form. There is no need to continue to use the “old” forms. A PDF file of the notice can be viewed at:

http://www.cms.hhs.gov/ElectronicBillingEDITrans/Downloads/Webterminateold1500.pdf [return to top]

Maine Chapter AAP Offers "Keep Me Healthy 5-2-1-0 Power Up" Flip Charts

The Maine Chapter of the American Academy of Pediatrics has printed 60 copies of the Overweight Clinical Guidelines from the "Keep Me Healthy: 5-2-1-0 Power Up" campaign that is part of the Maine Youth Overweight Collaborative.  These Flip Charts have been very useful to physicians who have been involved in the overweight collaborative and we are now able to bring them to your office!
The cost for the charts is $45 per chart (includes shipping and handling) or $43 per chart if you order 6 or more.  The charts are printed on a heavy weight paper with a laminate-type finish to make them sturdy and then spiral bound at the top.  They are in full color and include the following sections:

  • Guidelines for Prevention and Management of Overweight in Children 2-18 years
  • Guidelines for Medical Evaluation of Overweight Child 3-18 years
  • Web Resources
  • Co Morbidity Quick Reference
  • Treatment Interventions for the Overweight Child
  • Tips for Busy Clinicians
  • Brief Negotiation

To order a chart, contact Aubrie Entwood:

Aubrie Entwood
Executive Director
American Academy of Pediatrics, Maine Chapter
160 Fifth Street
Auburn, ME  04210
ph: 207-782-0856
fax: same, please call ahead

Please include how many charts you would like, the address to mail them to, and to whom to send the invoice. [return to top]

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