July 2, 2007

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Recent Action on Medicare SGR; AMA/MMA Plan "House Call" in Portland July 17

  • As Congress prepares to deal with the re-authorization of the Children's Health Insurance Program (SCHIP), House committees of jurisdiction are working on a proposal to replace the Medicare sustainable growth rate (SGR) with a system of six expenditure targets.  Physicians would receive positive updates of approximately 0.5% for 2008 and 2009, eliminating the scheduled 10% and 5% cuts expected in each of those years.

In 2010, the updates would differ for six categories of codes based on growth of expenditures:

  • primary care and preventive services
  • all other evaluation and management (E & M)
  • major  procedures (10 and 90 globals)
  • minor procedures
  • imaging and anesthesia

Democratic staff for the House Energy and Commerce and Ways and Means Committees briefed staff for the AMA and other medical specialty societies last week on the proposal but made it clear that the proposal would not advance without the support of organized medicine.  The Senate is also a potential problem in that the Senate Finance Committee has no immediate plans to include an SGR fix in the SCHIP legislation and might well take issue with the House proposal which also would repeal authority to pay the new PQRI (Physician Quality Reporting Initiative) bonus.  Maine Senator Olympia Snowe is a member of the Senate Finance Committee.

Because of the significance of the Medicare physician payment issue, the MMA and the American Medical Association will conduct a "House Call" in Portland on Tuesday, July 17 in order to bring attention to the need for Congress to take action to avert the scheduled 10% reduction in Medicare reimbursement for physicians and other health professionals.

Nancy Nielsen, M.D.,PhD,  President-elect of the American Medical Association will join MMA officials in meeting with representatives of the news media in Portland and Augusta.  Dr. Nielsen practices in Buffalo, N.Y.  Prior to being elected as President-elect this past week, she served as Speaker of the AMA House of Delegates. 






MaineCare MECMS Update

The Governor's MECMS Provider Advisory Committee met on June 22 and heard updates from MaineCare staff on various outstanding issues and new action items.  For the week ending 6/17, 94.7% of "fresh" claims were successfully processed, meaning they were either paid or denied.  Suspended claims inventory currently stands at 72,697 claims.  The usual weekly metrics report was not distributed as a project is currently underway to address data reporting.

The current claims hold for claims with service dates prior to Oct. 1, 2006 has recaptured $4.3 million in interim payments.  The Oct. 1, 2006 date will be moved forward to April 1, 2007 on July 11.   This offset only impacts practices which are holding interim payments.

In the week ending June 8, $67.1 million in capped claims were paid, eliminating all but $2.3 million of previously capped claims.  Now that the new state fiscal year has begun, no further capping of claims is anticipated.

Discussion occurred at the meeting regarding the requirement effective July 1 for hospitals to bill for hospital-employed primary care physician services on a CMS 1500 form rather than the UB 92.  The purpose of the change in the law is to allow for better tracking of data.  Hospital representatives asked if the State could handle the volume of providers that need to be credentialed.  Staff replied that the Provider Enrollment Team has been turning enrollments around within a day and staff was increased to support these efforts. 

The next Provider Advisory Committee meeting is scheduled  for July 19th from 10:00am to noon at the MaineCare Offices in Augusta.

The plan for transitioning to a new fiscal agent continues to move forward with an anticipated date of December, 2007 for release of a Request for Proposals. The complete transition may take as long as two years before a new system is fully tested and operational.


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Governor Signs Law Allowing Dirigo Program to Self-Insure

Gov. John Baldacci on last Wednesday (June 27) signed into law the bill that authorizes the Dirigo Health program to self-insure rather than to rely on Anthem or other insurers to contract with the agency to offer the subsidized health plan.

Despite the new law, it is unlikely that the Dirigo Health Agency will take any immediate action to move to self-insure.  The health plan, which now provides comprehensive health insurance to over 14,000 Mainers, is currently marketed by Anthem Blue Cross/Blue Shield.  At a meeting of the Dirigo Board of Directors on Thursday, Board members voted to authorize agency staff to negotiate a new contract with Anthem to continue beyond the current Dec. 31, 2007 expiration date. 

Board members and staff expressed concern with moving to proposals to self-insure given the uncertainly of future funding because of the legislature's failure to pass legislation providing for an alternative to the controversial "Savings Offset Payment (SOP). "  In the absence of such action, the agency is limited to funds received through the SOP which at its current level is not sufficient to accomodate more enrollees in the subsidized categories.  That being the case, the Board also voted, at the request of staff, to suspend enrollment in the subsidized categories.  The program will stop enrolling individuals immediately and small businesses and self-employed persons as of Sept. 1, 2007.  The agency will continue to enroll applicants who are not eligible for subsidies and eligible parents. The current funding through the SOP is approximately $33 million for 2007.  The agency would need at least $60 million to pay for current subsidies, the expansion to parents and the Maine Quality Forum. 

In addition to accepting new applications from applicants who do not need a subsidy, exceptions will also be made for infants born to women who are already covered by Dirigo and new employees of small businesses currently enrolled.  Because of federal legislation, workers who lose their job because of competition from other countries may also continue to enroll.

Individuals now make up 50% of the participants, with 30% being sole proprietors and 20% small businesses.  When the program began, each group represented about one-third of enrollees. 

As the program loses about 300 participants a month, it may be possible to open up enrollment for a limited time in the Fall.  Currently, about 89% of the participants are in the subsidized category.

The Dirigo Board and the Bureau of Insurance will be conducting hearings later this summer to determine the  3rd year SOP to be assessed for the period July 2008 through June 2009. The Board also affirmed Thursday that the Year 2 SOP would be collected beginning July 1, 2007.

In the meantime, legislative leaders and representatives of the Governor will continue to discuss alternatives to the SOP and "market-based" reforms to the current health insurance laws.  If consensus can be achieved, a special session of the legislature could be called in an attempt to provide alternative funding for the agency.  [return to top]

Monthly Member Website Question: What Do You Think?

The first day of each month we place a new question on the home page (directly under the calendar of events) of the MMA website, www.mainemed.com, to get member opinions on issues.  This month's question is:  On July 1, 2007, physicians can voluntarily begin reporting to Medicare as part of the Physician Quality Reporting Initiative.  Do you plan to submit the data required to participate in this "pay for reporting" program?

Please take a moment to go to www.mainemed.com and place your vote.  The questions are for members-only, so you will need to enter your username and password and then it is as easy as toggling on a button indicating your choice and pressing submit.  If you haven't registered as a member, you can do so easily by clicking on "Register" in the upper right hand corner of the home page under MMA Member Access.

Your opinion matters....please take time to vote today! [return to top]

New MaineCare Citizenship Verification Requirement Begins August 1st
As a result of a new federal law, many MaineCare members and applicants will now have to provide documents to prove both their citizenship and their identity.  (This new law does not apply to legal immigrants or foster children, nor to people with Medicare, Social Security Disability Insurance [SSDI], or Supplemental Security Income [SSI].)  For most MaineCare members and applicants, this means they will have to show the Department of Health and Human Services (DHHS) an original birth certificate and an original form of photo identification, such as a driver’s license, state ID, or school photo ID.  (There is also an option to show these documents to an “Outstation.”  For information about how your office can become an Outstation, call one of the numbers below).  If unable to show documents proving citizenship and identity, MaineCare applicants will not be able to get MaineCare, and current members may be at risk of losing their MaineCare.  Maine is committed to preventing this from happening.  DHHS has worked closely with several social service and advocacy agencies to increase awareness of this new requirement and to help MaineCare members and applicants get the documents that they need.  For more information, please call:  

Maine Department of Health and Human Services Citizenship and Identity Hotline

1-800-701-1887   Maine Equal Justice  626-7058

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Register NOW to Take Advantage of Annual Session "Early Bird Discount."

Substantial savings are available by registering for MMA's 154th Annual Session by July 9.  The Annual Session is beging held this year at the Harborside Hotel and Marina in Bar Harbor on Sept. 7 through 9.  We have a strong educational program with seven and one-half hours of CME available.  The theme of the meeting is Maine Medicine 2020, with presenters exploring what medicine will look like in our state 13 years from now.  All members recently received a brochure with registration materials but registration is also available on the MMA website at mainemed.com. 

Charles Baker, CEO of Harvard Pilgrim Healthcare will keynote Friday's opening session.  Before rescuing the health plan from financial difficulties, Baker had served in the Weld administration and was a participating architect of the Massachusetts law aimed at achieving universal access.  Responding to his talk witll be Kelly Kenny, J.D. of the AMA Advocacy Resource Center and Paul Harrington, Executive Vice President of the Vermont Medical Society.

Members wishing to submit a Resolution to the Annual Session, to be considered at the "town meeting" style business meeting Saturday morning, should contact Gordon Smith, the Association's Executive Vice President at gsmith@mainemed.com

Firms wishing to exhibit at the meeting should contact Lisa Martin at MMA via lmartin@mainemed.com. [return to top]

President Bush Names Surgeon General Nominee

Presdient Bush recently nominated James W. Holsinger Jr., MD to become the nation's next Surgeon General.  The previous surgeon general was Richard Carmona, MD, whose term expired last summer.  The appointment awaits confirmation by the United State's Senate.

Dr. Holsinger is a cardiologist who served at one time as Secretary for Health and Family Services for the Commonwealth of Kentucky, chancellor of the University of Kentucky Medical Center and has served in numerous other academic and administrative appointments.  In addition, he worked for 26 years for the U.S. Dept. of Veterans Affairs and, in 1992, was appointed undersecretary for health. 

If confirmed, Dr. Holsinger has stated he would focus his efforts on educating parents and children about childhood obesity.

In response to the nomination, the AMA released a supportive statement, as follows:  "As an experienced physician, educator and adminsistrator, Dr. Holsinger is in an excellent position to raise awareness on issues vital to public health and preventive care, including childhood obesity," said AMA President William G. Plested,M.D.

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Medicare Quality Reporting Initiative Began Yesterday!

The Medicare Physician Quality Reporting Initiative began July 1.  No enrollment is necessary and physicians simply need to begin reporting on the quality measures in their specialty on the current claims forms. 

Physicians who report data on claims from July 1 through December 2007 will be eligible for a 1.5 percent bonus (subject to a cap) on total allowed charges for covered Medicare physician fee schedule services.

To learn more about reporting measures, go to www.cms.hhs.gov/PQRI.

The site now includes a Tool Kit of resources and worksheets to walk physicians and office staff through the reporting process for each measure. 

MMA has presented two educational sessions on this topic, the most recent being included as part of the 16th Annual Practice Education Seminar on June 20th in Auburn.  [return to top]

MMA Logo-Wear Now Available at On-line Store

MMA members, corporate affiliates and friends may now purchase quality clothing with the MMA logo through a new on-line store available at the Association's website at www.mainemed.com.

Clothing for both men and women in a variety of colors and sizes are included in the store.  These items would make perfect gifts for your family or office staff.  Medical practices may also co-brand items with the MMA Logo and the practice name. 

The store is operated by Premier Marketing, a Manchester- based company which is a corporate affiliate of the MMA. [return to top]

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