September 17, 2007

 
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Board of Licensure in Medicine to Review Disciplinary Process

The Maine Board of Licensure in Medicine will convene a panel on Tuesday to conduct a review of its disciplinary procedures, in order to satisfy a legislative request.  The purpose of the study  is to review the current investigatory and disciplinary practices of the Board and to compare best practices from the Federation of State Medical Boards'  Model Practice Act.  The study panel will make recommendations for improvements.  The group will also review compliance with current statutory requirements and the board's transparency of operations.  Finally, the group will review the board's observance of due process rights of the public, complainants, and licensees. 

Gordon Smith, Esq., MMA EVP is one of the members of the review panel.  Others include Leslie Gallant, Executive Administrator of the Alaska State Medical Board of Licensure in Medicine, Nancy Kerr, Executive Director of the Idaho State Board of Medicine, Dale Austin, past Senior Vice President of Operations at the Federation of State Medical Boards, Lisa A. Robin, Vice President of Leadership Services at FSMCB and David Nyberg, PhD., one of three public members of the Board. 

During the past legislative session, two bills were introduced dealing with the Board's disciplinary processes.  A bill sponsored by House Majority Leader Hannah Pingree asked for a review of the Board's processes from the complainants' point of view.  A second bill proposed changes to the Board's processes from the point of view of the licensee.  Ultimately, the Business, Research and Economic Development Committee, which has jurisdiction of all the licensing boards, accepted a proposal by the Board to do a self-assessment of its disciplinary processes.

The review is expected to be completed this month and to be presented to the Board at its October meeting.  Results will be shared with the legislature during the upcoming session which begins in January.

The 2006 Annual Report of the BOLM to the Legislature indicated that 182 complaints were filed with the Board in 2006.  In the previous year, 171 complaints were filed against licensees. 

Physicians wishing to provide input into this review process may send their comments to Mr. Smith at gsmith@mainemed.com.   

"Using Data to Improve Quality and Public Reporting" First Fridays, Oct 5, 2007

Don't miss the next-to-last First Friday session of 2007: Using Data to Improve Quality and Public Reporting, October 5, 2007. Register online today!

Be proactive and learn how to collect and use your own practice (clinical) data to:

  • Improve quality
  • Market your practice
  • Prevent errors
  • Successfully compete with competitors
  • Enhance revenue by participating in Pay for Performance programs

The Maine Legislature at the behest of the Maine Quality Forum and the Maine Health Data Organization (MHDO), has authorized the release from the all-claims database of physician-identifiable data, subject to a set of rules and safeguards. Among the safeguards are the ability of the physician to see and review his or her data prior to publication.

This three- hour program will prepare you for the fast approaching release date onto the Maine Quality Forum website.

Register online today!

Faculty
Joshua Cutler, MD, Director, Maine Quality Forum
Ted Rooney, RN, Consultant to Pathways to Excellence, a project of the Maine Health Management Coalition
Alan Prysunka, Executive Director, Maine Health Data Organization
William Perry, Maine Health Information Center [return to top]

Primary Care Commission Holds First Meeting

The Legislature's Commission established to review the difficulties associated with private primary care in the state held its initial meeting this past Friday (Sept. 14) at the State House.  Chaired by Sen. Lisa Marrache, M.D., herself a family physician in private practice, and Rep. Gary Cooper of Kennebunk, the Commission heard from MaineCare Director Tony Marple and Medical Director Rod Prior in the morning and heard from a panel of Association representatives in the afternoon, including MMA's Gordon Smith and Andrew MacLean.  Others presenting their perspectives on the difficulties facing primary care included Mary Mayhew from the Maine Hospital Association, Kevin Lewis and other representatives of the federally qualified health centers speaking for the Maine Primary Care Association, Paul Pelletier,M.D, President of the Maine Academy of Family Physicians and Louis Hanson, D.O., speaking on behalf of the Maine Osteopathic Association.

Mr. Smith noted the following factors accelerating the trend of physicians moving from private practice to employment:

  • Poor MaineCare reimbursement, combined with large MaineCare enrollment
  • Poor MaineCare administration (MECMS)
  • Poor Medicare reimbursement, with more reductions anticipated, combined with a high elderly population
  • Complex administrative requirements for running a practice (hassle factors)
  • Necessity of investing in technology, such as electronic medical record systems

The Commission meets again on Oct. 26 and has received approval from the Legislature to meet a total of four times.  Kevin Flanigan, M.D., immediate past  president of MMA represents MMA on the Commission.  Other physicians on the panel include Jeffrey Aalberg, M.D., a family physician with Maine Medical Center and John Irwin, D.O. of Waterville. 

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Maine Care Provider Advisory Committee Meets: MECMS Void Functionality Coming in October

The Governor's MaineCare Provider Advisory Group met on Sept. 13 for its regular bi-weekly meeting.  MECMS weekly metrics showed the following:

  • Total claims for the week:  135,618
  • 91.6% of "fresh" claims were processed to either pay or deny status
  • Suspended claims inventory increased to 80,048

Relative to interim payments, as of August 31, 2007:

  • Total paid to providers in interim payments:  $527.1 million
  • Total recovered: $382.8 million (73%)
  • $1.6 million in interim payments were recovered during the week
  • As of August 31, providers accounting for $44.7 million were in a recovery plan for all, or a portion, of their interims
  • ON OCTOBER 1, 2007, THE HOLD OF CLAIMS FOR INTERIM PAYMENT RECOVERY WILL MOVE TO INCLUDE ALL CLAIMS WITH SERVICE DATES PRIOR TO JULY 1, 2007.
  • With respect to physicians, there is still more owed to physician practices in suspended claims than is owned by physicians in interim payments ( $15,128,054 vs. $8,980,1776).

Committee members were asked to review a proposed letter to be sent to all MaineCare providers by MaineCare Director Tony Marple regarding the anticipated Oct. fix in MECMS that will introduce void functionality back into the claims processing system.  This initiative will allow providers to void claims billed in error, and re-submit incorrectly paid claims as a work-around for adjustments.  The letter, whcih is now on the way to providers, outlines the implementation process for the new functionality.

The letter states that, "In order to protect your cash flow, it is extremely important that you NOT submit any voided claims until you have received official billing instructions and official notification of the dates when voids can be submitted."

A number of training/education sessions have been scheduled thorughout the state and it is recommended that provider staff attend one of the void functionality training sessions that are scheduled for early October.  The target audience for the training sessions is:  Chief Financial Officers, Patient Account Managers and Billing Specialists.

Note that the void functionality will not address all MECMS claims payment issues.  Examples of issues that will not be resolved with voids include inaccurate copays, certain limit problems, modifiers, etc.  For this reason, there are some claims that should not be voided and rebilled when the void functionality is implemented in October.  A general rule of thumb is that if your claims are paying correctly now, then a void of a previous incorrectly paid claim followed by a re-bill should result in a proper payment.

Voids that are in MECMS today (voids submitted by providers and not reported on remittance or system initiated voids) will automaticially process upon the implementation of the void functionality. 

Billing instructions are located at http://www.maine.gov/bms/providerfiles/provider_billingmanuals.htm.  This includes instructions for all paper claim forms.  Information for Electronic Media Claims (EMC) submissions is located at http://www.maine.gov/bms/provider/emc_downloads.html.

Information for the training sessions is available by calling 1-800-321-5557, Option 9 or contact Valerie MacKenzie at vmackenzie@usm.maine.edu. [return to top]

Maine Health Management Coalition Specialty Initiative

For the last four years, the Maine Health Management Coalition, a statewide collaboration of providers, employers, and insurers, has been engaged with primary care physicians in a quality improvement initiative called Pathways to Excellence (PTE).  The coalition is now developing a comparable specialty program.

Initially, the participating specialties are cardiology, cardio-thoracic surgery, orthopedics, gastroenterology, neurosurgery and general surgery.  Various PHO's in the state are taking the lead in bringing the specialists together, with appropriate invitations to the specialty societies representing the physicians in each specialty (the Maine Society of Orthopedic Surgery, the Maine Society  of Gastroenterology and the Maine Chapter of the American College of Surgeons).  Each specialty involved is being asked to develop one or more quality measures to report publicly.

According to national data, specialists account for approximately 85% of healthcare costs, including inpatient hospital care. [return to top]

Legislature's Health and Human Services Committee Meets Tuesday to Review MaineCare

The Health and Human Services Committee will hold its second MaineCare review meeting on Tuesday (Sept. 18), as part of its 6-session review of the MaineCare program.  Meeting from 10:00am to 4:00pm, the Committee  will review financing and the budget, including a review of expenditures by enrollment category.  The committee will also review expenditures by highest costs and/or volume, by type of service.  The presentations will be made by Commissioner Brenda Harvey and Deputy Commissioner for Finance Kirsten Figueroa.   From 3:30pm to 4:00pm a presentation will be made by State Auditor Neria Douglass on her report related to DHHS.

The meeting will be held in Room 202 (the Education Committee room), in the Cross State Office Building in Augusta. [return to top]

Newest Tess Gerritsen Medical Thriller Debuts on Tuesday

As readers may already know from reading the very flattering article in the Maine Sunday Telegram yesterday (Sept. 16), best-selling novelist Tess Gerritsen (we know her as Terry, spouse of MMA former President Jacob Gerritsen, M.D.) releases her next book, The Bone Garden, on Tuesday (Sept. 18). 

Over the past 12 years, "Tess" has become one of the world's most popular novelists, selling 15 million books that have been translated into 31 languages.  Her newest novel is a historical thriller that features Oliver Wendell Holmes and his medical school classmates in 1830 Boston.

"Tess" spoke to MMA's corporate affiliates at the annual Corporate Affiliate Breakfast this past Spring and regaled attendees with how she gets story ideas and some background of the publishing industry.

She and Jacob live in Camden where they moved after visiting the area on vacation in 1990.  They moved here from Hawaii where Terry was writing romance novels and Jacob was practicing internal medicine.  Terry had practiced medicine until deciding to stay home with her two young children in the 80's. [return to top]

Congress Reaches Compromise on SCHIP - Delays Medicare Physician Fee Fix

With the State Children's Health Insurance Program (SCHIP) set to expire September 30, 2007, House & Senate negotiators worked through the weekend & apparently have developed an outline of a compromise bill.  The compromise would provide $60 billion for the program over the next 5 years, an amount that is about the same as the Senate bill - $35 billion more than the current funding level.   It is $15 billion less than the House bill & $30 billion more than President Bush has said he would support.  The proposed compromise does not include the House provisions on Medicare policy, including the Medicare SGR fix.  Failure to include the Medicare fix in the SCHIP legislation would mean that either a separate bill would have to be passed or another legislative vehicle would have to be found by the end of the year. 

In a letter dated September 13, 2007,. more than 270 consumer advocacy organizations, unions, & elected officials urged the President not to veto the SCHIP reauthorization bill because of its strong bipartisan roots. 

In Maine, physicians in Cumberland and York Counties would see an 11% reduction and physicians in other counties would see a 12.1% reduction, resulting in payments rates similar to those paid in 2001.

The MMA, the AMA, and virtually all national medical societies are working with the Congress to find a vehicle to restore the cut, which would cost approximately $20 billion to fix for two years. [return to top]

CMS Issues Q&A on Tamper-Resistant Scrips for Medicaid/MMA's Corporate Affiliate Can Help

On August 17, 2007, CMS issued a State Medicaid Director Letter offering guidance to State Medicaid agencies on section 7002(b) of the U.S. Troop Readiness, Veterans' Care, Katrina Recovery, and Iraq Accountability Appropriations Act of 2007, regarding use of tamper-resistant prescription pads, which was signed into law on May 25, 2007.  In follow-up to this letter, CMS received a number of questions from States about the details of the implementation.  CMS has developed a Frequently Asked Questions document to respond to these questions to assist the States as they implement this requirement for October 1, 2007.

You can find this document on the web at:  http://www.cms.hhs.gov/DeficitReductionAct/Downloads/MIPTRPFAQs9122007.pdf

MMA's corporate affiliate, RX Security, Inc., is prepared to help you with compliance with the new law.  You can find more information about RX Security, Inc. on the MMA's web site at:  http://www.mainemed.com/affiliates/listCorp.php.


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Bureau of Insurance Issues Proposed Amendments to Rule Chapter 850 Geographic Access Standards

The Maine Bureau of Insurance has proposed amendments to its Rule Chapter 850, Health Plan Accountability, a component of Maine's so-called patient/provider "Bill of Rights" that addresses principally health insurance carrier access requirements, utilization review standards, & grievance procedures.  These proposed amendments deal with the controversial geographic access standards in sections 7(C) and (H).  The proposed amendments are the product of a "consensus-based rulemaking group" convened by the Superintendent of Insurance last winter because of ongoing discussion & debate in the Insurance & Financial Services Committee about these issues.  The "consensus-based rulemaking group" included the MMA, the MHA, MaineGeneral Health, health insurance carrier representatives, & consumer advocates.  The MMA believes that the consensus changes proposed are quite modest.

The Bureau has scheduled a public hearing on the Rule Chapter 850 amendments for 1 p.m. on Wednesday, September 26, 2007 in the Kennebec Room at the Gardiner Annex, 124 Northern Avenue, Gardiner, Maine.  The deadline for written comments is 5 p.m. on Tuesday, October 9, 2007.  Written comments should be directed to Vanessa Leon, Maine Bureau of Insurance, State House Station 34, Augusta, Maine 04333-0034.  If you have comments or questions about the proposed amendments, please contact Andrew MacLean, Deputy EVP, at amaclean@mainemed.com or 622-3374, ext. 214. 

You can view the proposed changes on the web at:  http://www.maine.gov/pfr/insurance/rules/850.htm.

 
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Invitation: Program on Substance Abuse Issues for Professional Women

The Women's Law Society, an association of female attorneys, invites interested female physicians to its fall program entitled, Depression and Substance Abuse affects Female Professionals, scheduled for November 1, 2007 at Bowdoin College in Brunswick.

The facts are undisputed:  Attorneys and other professionals have a high risk of suffering from depression or substance abuse during the course of their professional lives.

Attorneys have the highest rate of depression among any profession and women generally have twice the depression rate of men.  Attorneys have twice the substance abuse rates of the general population and alcohol abuse affects women in physiologically different ways than men.  But most lawyers know very little about the symptoms of these diseases or the successful treatments available to address these problems and so, all too frequently lawyers remain untreated, trudging alone through a most difficult illness.  The WLS Fall Program will increase your awareness of these illnesses, educate you to your ethical obligations with respect to impaired attorneys and open a discussion of how we as women professionals can help support each other.

Our special guest speaker is Dr. Susan Blank, a board certified psychiatrist specializing in addiction medicine, who has extensive experience with the treatment of impaired professionals.  Dr. Blank is the Executive Director of Psychiatric and Psychological Services at the Caron Center in Pennsylvania, one of the leading treatment centers in America.

Dr. Blank was awarded her medical degree at the Medical College of Georgia in 1985, receiving both the awards for “Best Psychiatry Student” and “Top 5 Surgical Students.”  Following her four year residency, Dr. Blank was employed by several prestigious medical facilities, including the Talbott Recovery Center which specializes in the treatment of impaired professionals as well as achieving post graduate certification in Advanced Forensics and addiction medicine.  Not only are her paper credentials outstanding, but Dr. Blank’s combination of professional experience with a family life is a story we as women professionals will find inspiring.  Susan grew up in Idaho, has four children: 2 children born during undergraduate school, one baby in medical school and the final baby during her residency ( exhausted yet?).  In her “spare” time, Susan is a huge sports fan and loves hockey, football, baseball, soccer, and has even been known to watch sport fishing on TV.

The ethics component of the program will be provided by Louise Thomas, Esq., an attorney at Pierce Atwood, who has done significant lecturing on the problems of attorney impairment both in Maine and nationally.   Louise was just appointed to the ABA Standing Committee on Substance Abuse.

For more information, please contact Melinda J. "Mindy" Caterine, Esq. with Moss Shapiro at 775-6001 or mcaterine@moss-shapiro.com. Click here for the agenda and registration materials. [return to top]

Cost Of Health Insurance Rises Again, But At A Slightly Slower Rate

From The New York Times, September 12, 2007
The Kaiser Family Foundation released its annual employer health benefits survey this week. According to the Kaiser study, the cost of employer-sponsored health premiums increased 6.1% this year, far ahead of wage trends and consumer price inflation. The total average annual cost for family coverage premiums increased to $12,106. The study, conducted by Kaiser and the Health Research and Educational Trust, surveyed 3,078 public and private employers and found that employers are still slow to embrace high deductible health plans, with only 3.8 million workers enrolled in health savings accounts. Other findings included a growing awareness of the cost effectiveness of preventive care, with most PPOs now paying for services such as immunizations and mammograms without charging the employee. [return to top]

Online renewals are now available for MD’s

The Maine Board of Medicine’s online renewal system is now available. MD’s with licenses due for renewal can now renew their license by pointing their browser to:
www.maine.gov/online/doclicensing
MD’s with licenses due for renewal will no longer be receiving paper applications from the Board. Instead, licensees will be mailed a postcard similar to the sample below notifying them that their license is due to expire. If they choose to renew by paper, or if the online system will not allow them to renew online, then they must return the postcard to the Board’s office to receive a paper application, or they can print out a paper copy of the MD renewal form by downloading one from the Board’s website at: http://www.docboard.org/me/licensure/MD_Renewal_App.pdf [return to top]

Kala Ladenheim, PhD, Named President and CEO of Maine Center for Public Health

Kala Ladenheim, PhD, has been named President and Chief Executive Officer of the Maine Center for Public Health, Maine’s sole public health institute and a leader in public health evaluation, research, and programming.  In this position, Dr. Ladenheim will be responsible for providing vision and leadership to ensure the Center’s successful operation and strategic growth, and to achieve the MCPH’s mission to improve the health of Maine citizens by increasing knowledge, influencing policy, and advancing high quality public health practice.

“We are very fortunate to have a leader of Dr. Ladenheim’s caliber to advance the very promising and exciting work of the Center,” said Leah Binder, Chair of the Center’s Board of Directors, “Dr. Ladenheim brings a strong background in public health, powerful connections with health policymakers throughout the country, and a passion for Maine.”

According to Dr. Lisa Letourneau, Search Committee Chair and Senior Director of Clinical Integration at MaineHealth, “As a physician and public health advocate, I am very excited about the MCPH's success in bringing Dr. Ladenheim to the Center.  Her experience working in health policy and health information technology offers new opportunities to build connections between public health and clinical care to improve the health of our communities in Maine.”

“I don’t know whether people in Maine realize the state has been a leader in health over the years.  There is a willingness to try things out and tinker with them until they work. MCPH exemplifies that combination of vision and pragmatism.  I am thrilled at the opportunity to lead this talented group,” said Dr. Ladenheim.

Dr. Ladenheim has an extensive background in public health and health policy, and brings a wealth of experience to the MCPH.  She earned her Ph.D. in Health Services Management and Policy from the George Washington School of Business and Public Management, and a Masters in Public Health from the University of North Carolina at Chapel Hill.  She has strong links to Maine and has previously served in several roles in the state, including the Executive Director for the State of Maine’s Health Policy Advisory Council from1988-1992.  She also has extensive experience in working with public health programs and policymakers nationally, and most recently served as Program Director for the National Conference of State Legislators in Washington D.C. where she worked with legislators from around the country on a variety of health-related policy issues.

The Maine State Legislature established the Maine Center for Public Health, a private non-profit organization, in 1996.  The organization was founded to improve the health of Maine Citizens through an organized program of policy analysis, education / training, technical assistance, and research.   Dr. Dora Mills, Maine’s Director of Public Health says that “we are fortunate to have the Maine Center for Public Health as a partner in promoting health across the State.  We in state government look forward to continuing our productive relationship with the Center.”

For more information visit the Maine Center for Public Health web site at www.mcph.org or contact Kala Ladenheim at 207-629-9272 or at kladenheim@mcph.org. [return to top]

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