July 9, 2007

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MMA's Coding Center Offers Two Certification Courses Beginning in July

MMA's Coding Center, directed by Jana Purrell, CPC, will offer two 15 week certification courses beginning in July.  The courses will be offered in Lewiston and in Dover-Foxcroft.  This 15 week course, developed by the American Academy of Professional Coders (AAPC) will take students through the 2007 Current Procedural Terminology (CPT), International Classification of Disease (ICD-9), and HCPCS books to address proper coding in physician practices.  The class is intended to educate students on proper techniques and rules of coding and will also prepare them to sit for the AAPC Certified Professional Coder (CPC) exam.  Both programs begin the last week of July.  For more information or for registration materials, call the MMA office at 622-3374.

The cost of the course is $1600, which includes all course materials, the cost of the CPC exam and a one year membership in the AAPC.  The course in Dover-Foxcroft will be offered  weekly at Mayo Regional Hospital from 1:00pm to 5:00pm on Tuesday afternoons, beginning on July 24.  The course in Lewiston will be offered on Thursdays at St. Mary's Regional Medical Center from 3:00pm to 7:00pm, beginning  on July 26.  The test to achieve certification at both locations will be held the week of Nov. 5, 2007. 

These course offerings present a unique opportunity for coding personnel in the Lewiston and Piscataquis County areas to get certified.  These opportunities don't come along very often.  Hospitals, medical practices or individual coders interested may receive more information or may register by calling MMA at 622-3374 (Press 0 and ask for Lisa Dennison). 

As coding and reimbursement issues become more prominent and complex, having certified coders is one of the most effective means of reducing risk to a medical practice.

Both courses will be taught by Jana Purrell, CPC, the Director of The Coding Center.   Jana continues to be one of the most popular and respected coding instructors in the country.

CMS Releases Physician Payment Rule for 2008

The Centers for Medicare and Medicaid Services last week announced the Medicare physician payment rule for 2008.  In response to the release that specifies a cut in payment to physicians of 10% effective Jan. 1, 2008, AMA Trustee Cecil B. Wilson, M.D., pointed out that Congress last year set aside $1.3 billion that could be used to reduce the scheduled cut.  The American Medical Association and 85 other organizations strongly urged the Bush administration to use this money to help Medicare physician payments keep pace with increases in practice costs.  The Medicare Payment Advisory Commission (MedPac) made a similar recommendation recently.  Instead, CMS has chosen to spend all of the funds to rpovide a 1.5% to 2.0% bonus to physicians who report on certain quality mmeasures (PQRI).  "The AMA is extremely disappointed in this short-sighted decision," said Dr. Wilson.  "Today, Medicare pays doctors the same as it did in 2001.  More than 60% of doctors say they will be forced to limit the # of new Medicare patients they can treat when the cut goes through.  Senior's access to health care is in jeopardy." [return to top]

Maine and Feds Concerned with Physician Shortages

The federal government would spend millions enticing newly licensed physicians to practice in underserved areas or specialties, under legislation recently introduced by Rep. Michael Burgess, MD (R, Texas) one of a handful of physicians in Congress. 

Factors such as low pay, long training and high medical liability costs drive many new doctors from underserved areas or specialties,  Dr. Burgess warned in a June 12 congressional speech.  "Young people...who want to consider a career in health care are looking at the crisis we face in medical liability in this country and it's keeping them out of the game," he said.  Rural and inner-city hospitals cannot afford the $100,000 cost to train a resident, he added.

So Dr. Burgess, who practiced obstetrics-gynecology, introduced the Physician Workforce and Graduate Medical Education Enhancement Act of 2007.  The bill would set aside $25 million to make interest-free loans to rural or urban hospitals for starting a residency program.  The program would have to be in family medicine, pediatrics, obstetrics-gynecology, or general surgery.

In Maine, The Medical Advisory Committee of the Finance Authority of Maine recently formed a work group to look at the shortages of health professionals in the state.  The work group met last week to discuss potential solutions to the current and on-going shortage.  The efforts of the work group will be presented to the FAME Medical Advisory Committee at its next meeting in September.  The work group discussed a number of potential initiatives, including more residency slots, more clinical rotation locations for medical students and more state support in the way of loans and scholarships. [return to top]

New MaineCare Citizenship and Identity Verification Requirement

Starting August 1, in order for your patients to get or keep MaineCare, they may have to prove both their citizenship and their identity.  This requirement is the result of the 2006 federal Deficit Reduction Act (DRA), which contained provisions requiring Medicaid applicants and current enrollees to show certain documents in order to receive coverage.  Concern, albeit unfounded, that illegal immigrants were fraudulently receiving Medicaid benefits led to this legislation.  Unfortunately, in those states that have already implemented the new requirement, tens of thousands of American citizens—children and adults—have been unable to get or maintain their Medicaid coverage due to the difficulty of obtaining and paying for the necessary documents.

Maine is committed to preventing this from happening here, and there are many efforts targeted at helping MaineCare members and applicants understand and comply with this new law.  An important resource to share with your patients is a special Citizenship and Identity Hotline run by the Maine Department of Health and Human Services (DHHS):


What you should know about the new requirement:
First of all, it does not apply to everyone seeking MaineCare coverage.  The following people are exempt:

  • People on Medicare
  • People receiving Supplemental Security Income (SSI)
  • People receiving Social Security Disability Insurance (SSDI)
  • Foster children
  • Legal immigrants (legal immigrants must continue to show their immigration paperwork)

If someone is not currently receiving Medicare, SSI, or SSDI, but he or she received one of these benefits at any time in the past, this person will also be exempt.  However, the exemption won’t happen automatically.  The MaineCare member or applicant will have to call their DHHS Eligibility Specialist and note that he or she used to receive one of these benefits in the past.  Exemption may also be possible for someone who was in foster care in Maine in the past.

Special rules for infants and pregnant women:
Infants born to women who were on MaineCare at the time of the birth will be exempt until their first birthday.  Pregnant women will be given an additional period of time to provide the necessary documents.

How can someone prove their citizenship and identity?
There are many documents that prove citizenship and identity.  A passport proves both citizenship and identity with just one document.  Otherwise, people will have to show one document to prove citizenship (a birth certificate is the most common document) and another to prove identity (most commonly, a driver’s license, state ID, or school ID with a photo.  For children 15 and younger, parents can also fill out an identity affidavit).  These documents must be either originals or certified copies from the issuing agency (such as a birth certificate issued from the state or town of birth).  Copies are not acceptable—not even notarized copies.

Some people born in Maine or who have or had a Maine driver’s license or state ID may be electronically “matched” because DHHS is crosschecking records with the Bureau of Vital Statistics and the Bureau of Motor Vehicles.  Someone whose birth certificate or license/ID is “matched” will not have to provide that document to DHHS.

How does this requirement work for MaineCare applicants?
MaineCare applicants will not be able to receive MaineCare until they have provided the necessary documents.  Once they provide the necessary documents, their MaineCare coverage will be retroactive to the date of application.

How does this requirement work for current MaineCare members?
MaineCare members will be asked to provide proof of their citizenship and identity at their annual review.  People who are unable to provide the documents at the time of review who are making an effort to obtain the documents will be offered an additional period of time to do so.  However, they must be sure that DHHS is aware of their “good faith effort” to get the needed documents.  They can call their Eligibility Specialist or the Citizenship and Identity Hotline (1-800-701-1887) to establish this.

How can you help?

  • Ask all of your patients with MaineCare if they are aware of this new law.  If not, refer them to the Citizenship and Identity Hotline (1-800-701-1887).
  • Visit www.mejp.org/mainecare_citizen.htm for a PDF flier that can be posted in your office.
  • Schedule a training for your staff so that they will be able to help people learn if they must prove their citizenship and/or identity, and even help people fill out applications for a birth certificate or form of identification.  Call Maine Equal Justice (626-7058) for more information about this hour-long training.
  • Serve as an Outstation.  This means you will have trained staff who can verify documents that prove citizenship and identity, and then share this information with DHHS.
  • Call Maine Equal Justice (626-7058) to share stories of how this law has impacted your patients.  This information will help us with our federal lobbying efforts to change this law and its negative impact upon providing health care to some of our most vulnerable citizens.

For more information:
DHHS Citizenship and Identity Hotline: 1-800-701-1887. Hotline staff may also be able to help provide funding to get needed documents.

Maine Equal Justice Partners: 207-626-7058; www.mejp.org [return to top]

MMA First Yard Sale Saturday, July 21

MMA's offices at the Frank O. Stred Building located just off busy Route 202 in Manchester present an ideal location for a weekend yard sale.  In order to eliminate some excess office equipment and furnishings, MMA will take advantage of this location and conduct a yard sale on Saturday, July 21.  Offerings from MMA will include some office chairs, file cabinets and office equipment.  MMA staff and members may contribute materials for the sale, either as a donation or on a commission basis.  Call Gordon Smith at MMA if you have something to contribute to the sale (622-3374 or via e-mail to gsmith@mainemed.com.  Proceeds will benefit MMA. [return to top]

Baldacci Administration and Maine Hospital Association Working on MaineCare Shortfall

Because the state concluded its fiscal year on June 30th without a significant surplus, the $82 million anticipated surplus ear-marked to help fund the outstanding MaineCare liabilities will not be available.  The state's new two-year budget includes a provision to direct the bulk of any surplus (called the "cascade") toward catching up with the shortfall owed to Maine's hospitals because of the failure of the state to increase MaineCare payments commensurate with the increase in MaineCare enrollment.  If it had been available, the $82 million would have leveraged matching federal funds to raise a total of $221 million. 

The state previously had come up with $20 million to cover hospital settlements for the year 2004.

The Govenor is likely to now try to cover the shortfall as part of a supplemental budget request in January of next year. [return to top]

Dr. Sewall to Speak About Meningococcal Disease in Adolescents

Sydney R. Sewall, M.D., M.P.H. of Kennebec Pediatrics will be presenting a talk entitled, Understanding and Reducing the Risk of Meningococcal Disease in Adolescents in a "teleroundtable" format on the following dates:

From 12:15 to 1:00 p.m. on:
July 27th (participant #879284)
August 2nd (participant #879285)
August 9th (participant #879286)
August 15th (participant #879287)

From 6:00 to 7:00 p.m. on:
August 1st (participant #879288)
August 8th (participant #879289)
August 13th (participant #879290)

The dial in number for all the calls is:  1-866-233-3845

The program objectives are:

  • Review meningococcal disease epidemiology
  • Review the morbidity and mortality of meningococcal disease in adolescents
  • Discuss the differences of conjugate v. polysaccharide vaccines
  • Review new recommendations to prevent meningococcal disease in adolescents

This educational program is sponsored by sanofi pasteur and is presented in accordance with the company's policies and the PhRMA Code of Interaction with Healthcare Professionals.  Attendance is limited to health care professionals.

Please RSVP to Jennifer Thivierge with sanofi pasteur at 603-767-1461 or by email to jennifer.thivierge@sanofipasteur.com. [return to top]

Calling Physicians Interested in Serving on Legislature's Primary Care Study Group

Near the end of the First Regular Session of the 123rd Legislature, members enacted a Joint Order creating a Commission to Study Primary Care Medical Practice and to report its findings and recommendations by December 2007 for consideration by the Joint Standing Committee on Health & Human Services in 2008. 

Among the 13 members of the Commission are:

  • Two independent primary care physicians, one of whom is appointed by the President of the Senate and one of whom is appointed by the Speaker of the House; and
  • One member of an organization representing physicians in the State, appointed by the Speaker of the House.

The Commission has the following duties:

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

To the best of our knowledge, this initiative had its genesis within the legislature and not in an advocacy organization.

If you are interested in serving in one of the 3 physician positions specified in the Joint Order, please contact Andrew MacLean, Deputy EVP, at amaclean@mainemed.com or 622-3374, ext. 214. [return to top]

CMS Proposes Revision of MPFS Payment Rates and Policies

The U.S. Centers for Medicare and Medicaid Services (CMS) plans to pay about $58.9 billion to 900,000 physicians and health care professionals during 2008, under a proposed rule that would revise payment rates and policies under the Medicare Physician Fee Schedule (MPFS). According to the acting CMS administrator, the proposal will build on changes “to pay more appropriately for practice expenses and to transform Medicare into an active purchaser of higher quality services, rather than just paying for procedures.” Among other things, the proposed rule would update the Geographic Practice Cost Indices to reflect more recent data; modify a number of physician self-referral provisions to close loopholes that have made the Medicare program vulnerable to abuse; and eliminate the exemption for computer-generated faxes from e-prescribing standards. For more information: http://tinyurl.com/2pkzct [return to top]

Upcoming Events Around the Region

MaineHealth Learning Resource Centers will host “Health, Culture and Literacy:  Solutions for Clear Health Communications” on Friday, Oct. 26 at the Hilton Garden Inn in Freeport.  The program will feature Ann Fadiman, author of “The Spirit Catches You and You Fall Down.”  The conference will also discuss the latest research on adult literacy in the United States.  Participants will gain skills needed to improve patient and client outcomes.  For more information and the preliminary agenda, go to www.healthliteracyinmaine.org...

Fadiman will also speak at the Maine Humanities Council’s conference “Caring for the Caregiver: Perspectives on Literature and Medicine” November 9 and 10 in Manchester, NH.  This conference, part of the council’s Literature & Medicine: Humanities at the Heart of Health Care®.  The conference will survey the wide range of innovative programs that support health care professionals through the use of literature and writing.  It will focus on one particular feature of the literature and medicine movement: its ability to renew and energize health care professionals’ connection to their work.  For more information, visit http://www.mainehumanities.org or call 1-888-MEReader.

Save the date for Quality Counts! Part 5:  Aligning Partners for Quality on December 7 at the Augusta Civic Center.  Sign up information is available at www.mcdregistration.org/signup.asp?ID=21

The Mount Sinai School of Medicine presents “Intensive Update with Board Review in Geriatric and Palliative Medicine”  Sept. 30 to Oct. 3.  This practical and comprehensive review of geriatric and palliative medicine offers participants intimate workshop sessions, fostering one-on-one mentoring and networking opportunities with nationally recognized experts in both fields. Case-based workshops include specialized content ranging from geriatric assessment and pain management to hip fracture and urinary incontinence.  These are complemented by twenty plenary sessions on major geriatric and palliative medicine topics. For more information contact geried.programs@mssm.edu or visit http://mssm.edu/geriatrics/education/courses/geriatric_medicine/index.shtml. [return to top]

Study Finds Personal Disclosures by Physicians May Disrupt Patient Care

The New York Times (6/26, Kolata) reports that a new study "showed that many doctors waste patients' time and lose their focus in office visits by interjecting irrelevant information about themselves." In the study, published in the June 25 issue of the Archives of Internal Medicine, 100 primary-care "doctors agreed to allow two people trained to act as patients come to their offices sometime over the course of a year. The test patients would surreptitiously make an audio recording of the encounter. The investigators analyzed recordings of 113 of those office visits, excluding situations when the doctors figured out that the patient was fake." The researchers found "that doctors talked about themselves in a third of the audio recordings and that there was no evidence that any of the doctors' disclosures about themselves helped patients or established rapport. Nor, in the vast majority of cases, did the doctors circle back to the personal conversation or try to build upon it." The Times continues, "Four out of five times when a doctor interjected personal information, the doctor never returned to the topic under discussion before the interruption." Dr. Howard B. Beckman, medical director of the Rochester Individual Practice Association and an internist and geriatrician who was an author of the study, said, "We found that the longer the disclosures went on, the less functional they were. ... Then the patient ends up having to take care of the doctor and then the question is who should be paying whom."

HealthDay (6/26, Gordon) adds that "when physicians share personal information with their patients, patient care may suffer." The study was conducted "using actors posing as new patients unbeknownst to the doctors" and "found that physicians disclosed personal information in about one-third of office visits, and 85 percent of these disclosures weren't helpful to the patient." The study's lead author, Susan H. McDaniel, associate chairwoman of the department of family medicine, and director of the Wynne Center for Family Research, said, "We were quite surprised at how much personal disclosures functioned as distractions to patient-centered care." Dr. McDaniel added that "in some cases, these disclosures may stem from the doctor's need for human contact and interaction. It's an understandable social interaction, but it's clearly a distraction." She also suggested that "physicians join -- or start -- consultation groups, where doctors get together to discuss the stresses and challenges of practice in health care today." [return to top]

Kennebec County Healthcare Practitioner Fundraiser for Susan Collins, Friday July 21

As you know, the MMA encourages its members to participate in political campaigns for the candidates of their choosing. MMA leadership has been asked to participate in an upcoming Kennebec County healthcare practitioner fundraising event for the Susan Collins campaign. If you are interested in attending, please see this invitation [pdf link] for further details and RSVP information. [return to top]

DHHS Emergency Rule Places 4-brand Name Limit for MaineCare Recipients, Increases Prescription Co-Pay

The following rulemaking(s) has recently been adopted.

CHAPTER NUMBER AND TITLE:  MaineCare Benefits Manual, Chapter II, Section 80, Pharmacy Services

The Department of Health and Human Services (“the Department”) has placed a 4-brand name limit (with the 5th and subsequent brand names requiring PA) for all MaineCare members over age 18 who are not eligible for Medicare Part D, with the exception of those taking drugs for the treatment of cancer and HIV and atypical antipsychotic drugs.  Additionally, these emergency rules increase the member co-pay from $2.50 to $3.00 per prescription, not to exceed $30 per member per month.

Pursuant to 5 MRSA sec. 8054, the Department has determined that immediate adoption of these rules is necessary to avoid an immediate threat to public health, safety or general welfare.  Absent immediate corrective action, the funding available to the Department would soon be inadequate to meet various expenditures of the Department, threatening both members and providers in the MaineCare program. 

Rules and related rulemaking documents can be found at: http://www.maine.gov/bms/rules/gen_other_rules.htm

EFFECTIVE DATE: July 1, 2007 – September 28, 2007

This rule has recently been adopted as an emergency rule.  The text of the rule and other information will be on the MaineCare website shortly.  The link to that website is: http://www.maine.gov/bms/rules/provider_proposed_mcare.shtml [return to top]

Save the Dates: November 1 & 2, 2007, Fall Pediatric Conferences

SAVE THE DATES for two great conferences back-to-back!
November 1 & 2, 2007, Sheraton South Portland
A Special Collaborative Opportunity for the Health of Maine‛s Children
VARIETY OF TOPICS from School Health, Pediatric & Adolescent Medicine to Bully Prevention for Primary Care Physicians

November 1, 2007
Joint Fall Conference of Maine Academy of Family Physicians

American Academy of Pediatrics, Maine Chapter
Maine Association of School Nurses
Coordinating School Health Programs
Practical Take-homes on topics ranging from School Health, Pediatric & Adolescent Medicine to
Bully Prevention for Primary Care Physicians For more information: MAFP (207) 938-5005 or
MAAP (207) 782-0856

Friday, November 2, 2007
The Owen W. Wells Annual Pediatric Conference for the Barbara Bush Children's Hospital at Maine Medical Center
Taking Care of Children:
Topics in Pediatric Acute Care
For more information, contact Jill Prescott prescj@mmc.org or (207) 662-6914

Watch your mail at the end of August for the Registration Brochure! [return to top]

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