September 3, 2007

 
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MMA Annual Meeting this Weekend to Consider Nine Resolutions

Over three hundred persons are expected in Bar Harbor this coming weekend (Sept 7-9) for the Association's 154th Annual Session.  In addition to offering seven and one-half hours of CME, the members on Saturday morning will consider nine different resolutions introduced by various MMA committees and individuals.  See below for the title of each of the resolutions.  Anyone wishing to attend the Saturday morning business meeting at the Harborside Hotel conference center need only show up.  There is no registration fee for attending just the three hour business session which begins at 8:30am.  We welcome your joining us.

List of Proposed Resolutions: 

Resolution #1:  "Resolution Supporting Legislation Resulting in Assisting Medical Student Education within the State of Maine," submitted by MMA Executive Committee

Resolution #2:   "Resolution Promoting Passage of Legislation Assuring More Effective Gun Sales Regulations,"  submitted by the MMA Public Health Committee

Resolution #3:   "Resolution Endorsing and Supporting the Maine Oral Health Plan," submitted by the MMA Public Health Committee

Resolution #4:   "Resolution Urging the Awareness, Education and Treatment of Mentally Ill Behaviors," submitted by the Maine Association of Psychiatric Physicians

Resolution #5:    "Resolution Advocating for Funding of the Maine Immunization Program and Supporting Research Examining Barriers to such Funding," submitted by the Public Health Committee

Resolution #6:     "Resolution Supporting Education and Aawareness of the Issue of Body Burden in the State of Maine," submitted by the MMA Public Health Committee

Resolution #7:      "Resolution Commending Benjamin Lounsbury, M.D., for the "Why Don't We Do it in Our Sleeves" Video and Future Public Health DVD's," submitted by the MMA Executive Committee

Resolution #8:       "Resolution Supporting Transition to a New MaineCare Billing System," submitted by the MMA Executive Committee

Resolution #9:       "Resolution Supporting SCHIP Reauthorization and Medicare Payment Reform," submitted by the Maine Medical Association AMA Delegation

The full text of each Resolution will be placed on the MMA website at www.mainemed.com early this week.

MaineCare Bids for Radiology PA Services

As previously reported in MMWU, the FY 2008-2009 biennial budget (L.D. 499, P.L. 2007, Chapter 240) includes projected savings of $2 million from subjecting MaineCare radiology services to prior authorization.  DHHS plans to require prior authorization for MRIs, MRAs, PET scans, & CAT scans based upon the rationale that most other insurers require prior authorization for these services.  DHHS received two responses to its RFP by its deadline on Monday, August 24, 2007.  The two bidders are HEPRO, a Pennsylvania company, and ACS, a Texas company.  The Department expects a selection to be made within the next two weeks and work on the initiative will begin once an agreement is reached with the successful bidder.  The Department anticipates that the PA program will begin in October.  The MMA will work with the Maine Radiological Society, Spectrum Medical Group, and other interested physicians to ensure that implementation of the PA initiative is as respectful of physicians as possible.


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MaineCare Staff Updates Providers on Fiscal Agent Schedule

During a joint meeting of the Governor's MaineCare Provider Advisory Group (PAG) & Technical Advisory Group (TAG), both designed to keep providers informed about the MaineCare claims management systems transition process, on Friday, August 31, 2007, the MaineCare staff presented an update on the fiscal agent procurement schedule approved by CMS.

The procurement schedule has the following 4 phases:

  • Phase I:  An 8-member site visit team is conducting vendor site visits to states where the 4 potential vendors now are doing business during the weeks of August 20th through September 17th.  The visits are with First Health in Virginia, EDS in Kentucky, Unisys in West Virginia, & ACS in Mississippi.  The MMA will check in with the medical societies in those states for the physician perspective on system performance in their states.
  • Phase II:  This phase will be a more detailed evaluation of vendor finalists.  The Department is preparing a "functionality matrix" outlining what tasks the State plans to retain & what it will ask the vendor to do.  A clear functional deficiency may disqualify a vendor, but all 4 potential vendors could remain under consideration until the final decision.
  • Phase III:  Phase III will include selection of a vendor, contract negotiations, and CMS approval
  • Phase IV:  Phase IV is implementation of the new claims processing system by January 2010
The Department has assembled a 14-member Fiscal Agent Project Team that will move from their current jobs to this work for the next 2 years until the implementation phase is complete.


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IMS and Other Data Mining Companies Sue Maine to Halt New Law

IMS and its competitors filed suit in federal district court this past week to halt implementation of the state's new law which allows physicians and other prescribers to restrict access to their individual prescribing data.  The law was due to take effect this Fall.  The companies also filed suit against the state of Vermont which enacted similar legislation, although the Vermont law does not permit the dissemination of such data unless the physician "opts in" while the Maine law is based on an "opt out" choice which was first advanced by the AMA in its Physician Data Restriction Program (PDRP). 

The same companies were successful in challenging a New Hampshire law that banned the sale of such data by the pharmacies, although the lower federal district court opinion is on appeal to the First Circuit Court of Appeals in Boston.

Maine's law requires the licensing boards of any prescribers (MD's, DO's, PA's, NP's, Dentists, Podiatrists and Verterinarians) to send a packet of information to each licensee at the time of licensure renewal.  The packet would include a description of the program and contain a form that would allow the licensee to "opt out", thus prohibiting the pharmacies from selling their prescribing data.  The form would be completed and sent on to the Maine Health Data Organization (MHDO).  The MHDO would maintain the list of prescribers which the data mining companies or pharmaceutical companies would have to access periodically before marketing to prescribers using an individual prescriber profile.

The Maine Medical Association supports the notion of an opt out but is not involved, at this time, in the litigation.  The AMA maintains a program allowing for physicias to opt out.  The program is called the Physician Data Restriction Program.  Members or non-members may opt out by logging on to the AMA website at www.ama-assn.org/go/prescribingdata.

 

 

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Over Three Hundred Expected at MMA Annual Session this Weekend in Bar Harbor

Over three hundred members, guests and exhibitors are expected in Bar Harbor this weekend to participate in the Association's 154 Annual Session.  Seven and one half hours of CME are available with the theme being the future of Medicine in Maine, looking ahead to the year 2020.

Over forty exhibitors will participate in the meeting which will be held in the conference center associated with the Bar Harbor Hotel and Marina in downtown Bar Harbor.

The meeting begins with a keynote luncheon on Friday, Sept. 7 and concludes with a Sunday morning brunch.  Saturday morning's business meeting will feature consideration of nine Resolutions (see article in this Update on the Resolutions), presentations by Medical Mutual Insurance Company of Maine, MaineCare officials and Second District Congressman Michael Michaud.  Bylaw amendments and officers for the next year will also be considered.  The First Annual MMA"Excellence in Healthcare Reporting" Award will also be presented on Saturday morning.

Saturday evening's annual banquet will feature the traditional presentation of 50 year recognition awards to members who are celebrating the 50th anniversary of their graduation from medical school.  Other awards to be presented include the President's Award for Distinguished Service, a Special Recognition Award and the Mary Cushman Humanitarian Award.  Following award presentations, President Kevin Flanigan, M.D. will present the traditional gavel to President-elect William Strassberg, M.D., signaling the beginning of Dr. Strassberg's one year term as President.

Although the hotel is sold out, other accommodations in the area are available and we encourage you to register and attend.  It promises to be one of the best Annual Meetings in recent history.  Registration materials are on the Association's website at www.mainemed.com.  More information is available by calling the MMA office at 622-3374.

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MaineCare MECMS and Managed Care Initiative Update

The Governor's MECMS Provider Adviosry Committee met on Friday, August 31 to hear reports from MaineCare staff.  Brenda McCormick, who heads up the various care management functions for MaineCare, presented an update on the managed care initiative which the care management firm of Schaller Anderson has been contracted to direct.  The firm, located in Phoenix but recently purchased by Aetna, has been conducting a series of meetings around the state with PHO's and other interested parties.  Representatives of MaineCare and Schaller Anderson will attend the Association's Annual Meeting this coming weekend in Bar Harbor.

See article in this Update regarding the transition to a new claims management system, now schedule to be completed by Jan., 2010.  In the meantime, several patches and enhancements to the current system are being prepared including establishing the ability to void a claim.  The void functionality function, which has been a long time coming, is scheduled to be implemented in early October.  A series of instructional seminars have been scheduled for October to assist providers in utilizing the new function.  The list of training sessions is available on the MaineCare website.

Weekly metrics for the week ending August 26 included the following:

  • Total claims for the week were 133,814
  • 93.6% of "fresh claims" were processed to either pay or deny status
  • Suspended claims inventory stands at 72,115
  • In addition to suspended claims, there are unresolved claims in MECMS with status of Edits Process Failure (28,221 claims totaling $35,539,186 in billed charges) and Fund Allocation Failure (11,348 claims totaling $5, 640,553 in billed charges) as of August 13, 2007.  Additionally, hospital crossover claims, electronic professional crossover claims, voids and adjustments cannot be processed at this time.

Relative to interim payments which totaled over $527 million, $379.8 or 72% has been recovered, with another $47.3 in a recovery plan. [return to top]

Register Now for Oct. 5 Program "Using Data to Improve Quality and Public Reporting"

With "transparency" being the rage in health care circles today, physicians need to know their own data and also where their claims data is going and how it is being used.  By being pro-active, physicians can be ahead of the game when the physician identifiable data in the all-Payor claims database is released.  MMA's next "First Fridays" CME program on Friday, Oct. 5 will feature this topic and we have lined up the following all-star team to present the information Maine physicians need to know.

  • D. Joshua Cutler, M.D., Director of the Maine Quality Forum
  • Alan Prysunka, Director of the Maine Health Data Organization
  • William Perry, Vice-President of the Maine Health Information Center
  • Ted Rooney, Consultant to the Maine Health Management Coalition, and Director of the Pathways to Excellence project.

The Maine Legislature at the behest of the Maine Quality Forum and the Maine Health Data Organization, has authorized the release from the all-claims database of physician-identifiable data, subject to a set of rules and safeguards.  This three-hour educational program will help prepare you and your practice for the quickly approaching release of this data and the use of similar data by health plans and data-mining companies.  The program runs from 9:00am until noon and the location is the Frank O. Stred Building in Manchester, the location of the MMA office.

You may register on the MMA website at www.mainemed.com or call MMA (622-3374) for a reigstration form giving more details on the program.  There is a $60 registration fee which includes breakfast and all course materials.

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Maine Law Court Decision Supports Adoption by Unmarried, Same Sex Partners

In a unanimous opinion in Adoption of M.A. et al. written by Justice Jon Levy and released on August 30, 2007, Maine's Supreme Judicial Court advised the Cumberland County Probate Court that it does have jurisdiction to consider joint petitions for adoption of two special needs children in DHHS custody filed by two unmarried individuals.

The relevant provision of the Maine Probate Code, 18-A M.R.S.A. section 9-301 provides that "[a] husband and wife jointly or an unmarried person, resident or nonresident of the State, may petition the Probate Court to adopt a person, regardless of age, and to change that person's name."  The Probate Court found that it lacked jurisdiction based upon its interpretation of this statute. 

Based upon a detailed review of the legislative history of Maine's adoption statutes, consideration of principles of statutory construction, and reading of the purpose of the adoption laws - to find a permanent home for the adopted child as quickly as possible - the Law Court concluded that section 9-301 does not bar two unmarried individuals from filing a joint petition for adoption. 

The MMA, the Maine Association of Psychiatric Physicians, and the American Academy of Pediatrics, Maine Chapter joined a number of other health care and child welfare advocacy organizations in filing a brief of amicus curiae in this case. 

You can find the full opinion on the web at:  http://www.courts.state.me.us/opinions/2007%20documents/07me123ma.pdf.
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Study Indicates Abbreviations Pose Threat to Patient Safety

Although abbreviations in health care may be efficient, their use comes at the expense of patient safety, according to a new study published in the September 2007 issue of The Joint Commission Journal on Quality and Patient Safety. The findings of this study provide further support for The Joint Commission's "Do Not Use" list of abbreviations that is part of its National Patient Safety Goals. The study also suggest the need to consider additions to the "Do Not Use" list. Although abbreviations are known causes of medication errors, the study - The Impact of Abbreviations on Patient Safety - is the first to examine the exact characterization and impact of these errors. The study collected and analyzed data through a retrospective review of errors resulting from abbreviations as reported to the United States Pharmacopeia's MEDMARX©, a national database for medication errors, from 2004 through 2006. The study found that nearly 5 percent of all errors reported to MEDMARX© during this time period were attributable to abbreviations. This analysis of nearly 30,000 medication error reports involving abbreviations suggests that health care organizations should consider additions to the "Do Not Use" list. The Joint Commission Journal on Quality and Patient Safety, published monthly by Joint Commission Resources, features peer-reviewed research and case studies on improving quality and safety in health care organizations. See the news release at http://www.jcrinc.com/26426/ [return to top]

MMA Has Work for Chart Abstractors and Pain Control Specialists

As a result of the continuation of the Voluntary Physician Assessment Initiative (VPAI), funded by the Maine Quality Forum, the Association has a need to contract with qualified persons who are able to review a medical chart and abstract information from it.  Certified coders will be considered but other health professionals may apply for this work as well.  We hope to contract with as many as five or six individuals around the state.  A competitive hourly rate will be paid for the work.

MMA also has entered into a contract with the Maine Board of Licensure in Medicine to enhance the education efforts in the state relative to prescribing for pain and preventing diversion.  Part of the work involves a health professional directly visiting medical offices and educating providers.  A Physician Assistant or Nurse Practitioner with a background in pain treatment would be ideal for this part-time position. 

Persons interested in any of these opportunities should communicate with MMA EVP Gordon Smith via e-mail to gsmith@mainemed.com or send a CV to his attention at Box 190 in Manchester, Maine 04351. [return to top]

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