November 5, 2007

 
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U.S. Attorney Convenes Interested Parties Group to Review Drug Diversion

Paula Silsby, U.S. Attorney for the District of Maine, convened a group of interested parties this past week to review the most recent data on drug overdoses and drug diversion in Maine.  Data was also presented on New Hampshire and Vermont.  Representatives of MMA participated in the meeting, along with representatives of the Maine Hospital Association, the Maine Osteopathic Association, the Maine Pharmacy Association, and representatives of law enforcement.  The data tended to show that the problem of diversion of prescription drugs continues to be a serious public health problem in the state, with methadone being a bigger concern in Maine than it is in the neighboring states.  With respect to illicit drugs, cocaine is increasing in use with a commensurate decrease in the use of heroin.   MMA will continue its series of educational programs on the topic of prescribing for pain while preventing diversion, in cooperation with the Maine Office of Substance Abuse.  Eight more programs will be scheduled for 2008.

The State's Prescription Monitoring Program (PMP) is one significant response to the problem.  Nearly 1500 prescribers have registered to be able to access prescribing information on their patients, but there is a concern among regulators and law enforcement that many physicians and other prescribers are not accessing the information as frequently as they should.

MMA has sponsored fifteen CME programs around the state featuring information on the PMP and has been funded to provide at least eight more programs in 2008.  If you would like to have a program in your area, contact Gail Begin at 622-3374, ext. 210 or by email at gbegin@mainemed.com.

The diversion of prescription drugs, leading to their illicit use and all too frequently, leading to death, has been a problem in Maine for some time, leading to increased scrutiny of prescribing practices by law enforcement and licensing boards.  Data from the state medical examiner's office shows that narcotics are implicated in more than 60% of  deaths caused by an overdose of drugs.  Both oxycodone and methodone are frequently factors in ER admissions and deaths.  Benzodiazepines are implicated in about 15% of overdose deaths.  There has been a 647% increase in the number of deaths in Maine attributed to drug overdose since 1997.  67% of such deaths are male with death occuring at the age of 34 on average.  The commensurate age for females is 38.

Other valuable points made at the meeting include the following:

  • Many patients start using narcotics for legitimate medical purposes, but end up abusing the medication;
  • Methodone in Maine appears to be an increasing problem;
  • It is likely that the increase in crime in Maine is related, at least partially, to drug trafficking;
  • While federal law allows prescribing of methodone just for pain (unless prescribed through a substance abuse clinic), enforcement officials believe that a increasing number of physicians are prescribing it (illegally) for treatment of substance abuse;
  • Reports of MaineCare patients paying cash for narcotics are increasing and of concern.  More frequent use of the PMP by prescribers could help with this.

All persons attending acknowledged that the problem is multi-faceted and no single solution will be effective.  Education of the public and of physicians and other prescribers will be one important part of the solution, however.

 

Judith Chamberlain, M.D. Takes New Postion with Schaller Anderson

Judith Chamberlain, M.D., currently practicing family medicine with Bowdoin Medical Group in Brunswick, has accepted a position with Schaller Anderson, the Phoenix-based company recently awarded a contract to provide care-management services to MaineCare patients.

Dr. Chamberlain, who recently narrowly lost an election for President-elect of the American Academy of Family Physicians, will begin work part-time today (Nov. 5) and begin full-time in February.  She will continue to work with Bowdoin Medical Group as she closes her practice.

Dr. Chamberlain practiced in the Dover-Foxcroft area for seventeen years before moving to the Brunswick area in 1997.  She is a graduate of Stanford University and Dartmouth Medical School, and she completed her residency at the Eastern Maine Medical Center Family Medicine Residency program.

MaineCare signed a contract with Schaller Anderson earlier this year expanding a pilot project which had involved the firm assisting with the medical management of 800 high cost MaineCare patients.  The new contract will involve as many as 17,000 high cost patients and is expected to result in savings of $23 million to the State in the current year.

MaineCare patients who qualify for the new management initiative will be notified by mail and may choose to participate or to opt out and stay in the traditional MaineCare program.  MaineCare enrollees who do join the program will be assigned a medical home - in a primary care practice -i f they do not already have an established provider.

Schaller Anderson manages health plans for Medicaid and Medicare as well as for commercial and employer self-funded plans for more than 1.3 million people in seven states.   More information on the initiative is available at www.mymainecare.com  [return to top]

MPCA Annual Conference Scheduled for November 14-16, 2007 in South Portland

The Maine Primary Care Association invites you to attend its upcoming Annual Conference, November 14 – 16, 2007 at the Sheraton in South Portland.  This year the meeting features a stellar group of faculty for the three days, including a strong focus on Risk Management, Emergency Preparedness, Mental Health Integration, Care Management, HIT, and Health Reform.  MMA members and members of any Maine PHO qualify for discounted rates.  Students – whether undergrad, or in medical professional schools – qualify for a 50% discount.  Come for the whole conference, or come for a single day, but don’t miss this opportunity!

This year's conference sessions focus on Maine's Healthcare Crisis from multiple points of view, offering both challenges and opportunities to our safety net in the months and years ahead.  In order to identify the issues and potential solutions, MPCA has coordinated a faculty of experts from across the country and across the state to address such timely and relevant topics as:

  • Health Care Strategies at the State and National Level-In Place, In Planning and In the Running for the Future (Thurs)
  • The Workforce Crisis - A View from a Training Perspective and Where do We go from Here (Thurs)
  • As Maine Goes, So Goes the Nation - Our Aging Population and What We Can do to Meet the Changing Needs (Thurs)
  • Health Information Technology - EPM and EMR as Another Tool in Improving Patient Outcomes (Wed & Thurs)
  • Strengthening the Continuum of Care-Coordinating Vulnerable Populations During an Emergency (Thurs).  Regional and Federal Updates - HRSA and the National Association of Community Health Centers (Thurs)

In addition to sessions addressing issues at the forefront of Maine's healthcare landscape, this year's conference will also include sessions on some of the staples in practice management, such as:

  • Risk Management - FTCA to the OIG - Assessing, Reducing and Managing Clinical Risk in our Health Centers (Wednesday)
  • Business Planning 101 - Why Do I Need One and What's In It (Wednesday)
  • Surviving and Thriving through Expansion-The Financial Implications of Undertaking a Capital Project (Wed.)
  • Emergency Preparedness Planning - Featuring an Incident Command Systems Training and discussions on Public Health Emergencies and Maine Law, and the New and Improved Maine Health Alert Network (MaineHAN) (Wed.)
  • Staff Retention and Recruitment Strategies - Featuring guest speakers Richard Smith, Associate Administrator of the new Bureau of Clinical Recruitment and Service and Director of the National Health Service Corps, Tim Skinner, Executive Director of 3RNet for National Rural Recruitment  and Retention, and a distinguished panel of In-State experts (Friday)
  • Outreach, New & Gold-New tools, programs and services from the ACS and Legal Services for the Elderly, in addition to best practices, programs and strategies garnering success in the health center setting (Friday)

Medical Staff can look forward to a clinical packed track occurring on Thursday, November 15th, which will  include sessions on:

  • ACE Scores - A Look at Childhoods Events and how they Impact Disease and Clinical Care
  • Environmental Medicine - A Closer Look at Health Risks posed by Contaminants Here in Maine
  • Skin Conditions - From Common Conditions to Cancer and What  You Can Do
  • Domestic Violence and Sexual Assault in Primary Care - Diagnosing , Responding and Referring

For more information about our conference, or to register, click here [pdf] [return to top]

Challenging Your Network Placement with Insurers?

"How to Challenge Your Profile or Placement in a Tiered or Narrow Network" is a new flyer created by AMA staff. The document offers physicians eight steps to follow to combat the use of claims data, inadequate risk adjustment, lack of an appeal mechanism and invalid ratings. The flyer is being distributed to the Federation and on the PSA Website at www.ama-assn.org/go/psa. [return to top]

Survey Finds Health Care Providers Often Backtrack On EHRs

According to a Medical Records Institute survey, nearly one out of five respondents said they have either uninstalled or are currently uninstalling an electronic health records (EHR) system.  The survey found that 8% of respondents said they have uninstalled their EHR system and returned to a paper-based system.  About 12% of respondents had an EHR in the past that some clinicians refuse to use and 18% said they currently have an EHR system that is facing some physician resistance.  The survey found that the top two priorities for “strategic decisions in IT” were to improve clinical processes and workflow efficiencies.  Three out of four respondents noted that in 10 years the effects of EHR systems on patient quality will be greatly improved, however, 6% indicated that EHR systems had a negative impact on the quality of patient care while 31% said EHRs had “no effect” on care. [return to top]

CMS Releases Final 2008 Medicare Payment Schedule

On Thursday, November 1st, CMS released the final rule with the 2008 Medicare physician payment schedule.  The rule will be published in the Federal Register on November 27th, but it is available on the CMS Web site in the interim at:

http://www.cms.hhs.gov/physicianfeesched/downloads/CMS-1385-FC.pdf

There is a 60-day comment period on the rule.

 

This final rule sets in motion a 10.1% cut in the Medicare conversion factor on January 1, 2008, meaning that the 2008 conversion factor will be $34.0682.

 

Payment rates for specific services in particular localities are likely to change by percentages that differ from 10.1% for several reasons:

·         The final rule includes the every-three-years update to the geographic adjustment factors or GPCIs.

·         Against the urging of the AMA and 75 specialty societies, CMS is continuing to employ a separate adjustment to the physician work relative values to achieve budget neutrality from the 5-year review instead of applying budget neutrality across-the-board through the conversion factor.  The work adjustment will increase from 10% in 2007 to 12% in 2008 and this will have differential effects on payment rates for different services and specialties.

·         2008 will be second year of a 4-year transition to revised practice expense relative values.

 

The final MEI for 2008 is 1.8%.  It is notable that the final MEI includes a reduction of 0.8% in professional liability insurance costs.  The MEI is also reduced by 1.4% for a productivity adjustment.  In comments on the proposed rule, the AMA urged CMS to reduce this adjustment but no action was taken in the final rule.

 

The AMA had also urged CMS to use the $1.35 billion Physician Assistance and Quality Initiative Fund established by the Tax Relief and Health Care Act of 2007 to help offset the 10.1% Medicare pay cut in 2008 but CMS has finalized its proposal to use these funds to instead pay for quality reporting.

 

The rule includes the final list of quality measures for the 2008 Physician Quality Reporting Initiative.  CMS plans to publish full specifications for each measure on its website in the near future.

 

The proposed rule also contained numerous changes to the physician self-referral regulations which the AMA urged CMS to withdraw and reevaluate.  In the final rule, CMS has finalized its “anti-markup” proposal for diagnostic tests but it has deferred taking final action on most of the remaining proposals until some later rulemaking process.

 

With respect to recommendations from the RUC, it appears that in principal CMS accepted all of the RUC’s 266 recommendations, but it made payment policy decisions related to non-coverage, bundling, and restricting payment for some of the new CPT codes for 2008.  [return to top]

MaineCare Determines that Radiology PA Proposal Not Cost-Effective

Following two rounds of proposals and discussions with potential vendors, the Department of Health & Human Services has decided that implementing prior authorization for certain radiology procedures does not have a financial return commensurate with the administrative expense required to pursue such a program at this time.  Accordingly, the Department will not be implementing this provision of the most recent biennial budget.  The Department had proposed to save $1 million annually through this initiative.


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NY AG Settles Investigation of Health Insurer Ranking of Physicians

On October 29, 2007, New York Attorney General Andrew M. Cuomo (D) announced the first settlement of investigations into health insurers' physician rankings - an investigation of the practices of CIGNA Healthcare.  The investigation also included a review of the practices of United Healthcare, Aetna, Empire Blue Cross Blue Shield, HIP Health Plans of New York/GHI, and Preferred Care of Rochester, NY.  The agreement requires CIGNA to disclose to physicians and patients all aspects of its ranking system, to engage an oversight monitor to oversee compliance with the agreement, and to provide a report to the NY AG every 6 months.

CIGNA agreed to ensure that the rankings were not based solely on cost and to disclose the extent to which they were based on cost , to use national standards for quality, and to include risk adjustment and valid sampling methods to ensure the credibility of the data.
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