February 25, 2008

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Political Pulse: MMA Legislative Forum on State Budget Issues Scheduled for Monday Evening

The MMA Legislative Committee Chair Katherine Pope, M.D. and Vice Chair Samuel Solish, M.D. invite any member interested in the current State Supplemental Budget and its implications for the health care system in Maine to participate in an informal forum with key members of the legislature's Joint Standing Committees on Appropriations & Financial Affairs and Health & Human Services Committees on Monday, February 25, 2008 from 5:30 to 8 p.m. at the MMA office in Manchester.

This legislative forum will follow the same format as two (on MaineCare & Dirigo) held during the 123rd Legislature's First Regular Session in 2007.  Member feedback on the 2007 events was very positive.

The featured topic for this forum will be the health care issues in the State Fiscal Year 2008-2009 supplemental budget, L.D. 2173, including the proposed $20 million (state and federal) savings resulting from changes in the way physicians will be reimbursed through the MaineCare program depending on whether they are paid according to the MaineCare fee schedule or through "provider-based" reimbursement.

Senator Kevin Raye (R-Washington), Representative Gary Connor (D-Kennebunk), and Rep. Pat Jones (D-Mt. Vernon) will be our guests from the Health & Human Services Committee.  Senator Peggy Rotundo (D-Androscoggin) and Rep. Jeremy Fischer (D-Presque Isle), chairs of the Appropriations Committee, also will be our guests.

The schedule for the forum on Monday, February 25, 2008 is:

5:30 - 6:15 pm               Social hour (wine, soft drinks, & heavy hors d'oeuvres)

6:15 - 6:30 pm               Welcome and introductions by Dr. Pope, Dr. Solish, & MMA staff

6:30 - 8:00 pm                Forum (Each legislator will make brief remarks and then there will be an opportunity for Q&A and discussion).  Following the departure of thelegislators, members will discuss two bills up for public hearing this week with Maine Hospital Association representatives:  L.D. 2044 An Act to Prohibit Hospitals from Charging for Treatment To Correct Medical Mistakes and L.D. 2152 An Act to Ensure Access to Necessary Health Care Services in Maine by Repealing the Capital Investment Fund.

Any MMA member is welcome.  The forum is an opportunity for a discussion about the state budget and Maine's health care system while the legislature is grappling with difficult state finances in an uncertain economic climate.

If you plan to attend, please RSVP to Andrew MacLean, Deputy EVP, at amaclean@mainemed.comor 622-3374, ext. 214. 

Deputy Secretary of HHS Comes to Portland to Announce Chartered Value Exchange

On Wednesday, Feb. 20, Tevi P. Troy, Deputy Secretary of the federal Department of Health and Human Services conducted a forum with invited guests in Portland to announce Maine's designation as a Chartered Value Exchange (CVE), a status that will allow the applicants of the Exchange status to receive Medicare quality data and to apply for more grants to move Maine's medical practices a step closer to a fully integrated system of Electronic Medical Records.

Governor Baldacci attended the event and acknowledged the efforts of HealthInfoNet and the Maine Quality Forum, Quality  Counts and the Maine Health Management Coaltion, all of whom had worked together to seek the status of a CVE.  There are only 14 such collaboratives in the nation and Maine's application was chosen as one of the 14 after a peer review process of 38 applications.  D. Joshua Cutler, M.D., Director of the Maine Quality Forum accepted the recognition award on behalf of the collaborating organizations. 

CVE's will participate in a nationwide Learning Network sponsored by the federal Agency for Healthcare Research and Quality.  This network will provide peer-to-peer learning experiences through facilitated meetings, both face to face and on the Web, and will also feature tools, access to experts, and an ongoing private Web-based knowledge management system.

CVE's will also gain access to information from Medicare that attempts to measure the quality of care physicians provide to patients.  These performance measurement results can be combined with similar private-sector data to produce a comprehensive consumer guide on the quality of care available.  CMS will begin providing the information by the summer of 2008.  It will be based on consensus-based quality measures adopted by the AQA Alliance - a broad-based collaborative of physicians, consumers, purchasers, health insurance plans and others - and endorsed by the National Quality Forum

Maine's CVE intends to also appply for funding through a new grant initiative through HHS involving $150 million to assist physicians in purchasing, implementing and fully utilizing EMR's.  Only 12 applicants will be selected with each applicant being able to assist about 200 physicians.  Over a five year period, the grants could provide as much as $58,000 per physician.  In an interview on Friday, Dr. Cutler indicated that the Maine Quality Forum intended to proceed with an application to compete for these funds.  Presumably this application as well would be joined in by the partners making up the collaborative which achieved the CVE status.

MMA congratulates the four organizations that competed for the designation:  the Maine Health Management Coalition, Quality Counts, HealthInfoNet and the Maine Quality Forum.  MMA is a member of Quality Counts and represented on its Board. [return to top]

Legislature's BRED Committee to Meet on Lay Midwives Thursday, Feb. 28

Following a 1:00pm public hearing on an unrelated bill, the Legislature's Business, Regulation and Economic Development (BRED) Committee will hear from state officials who prepared the "sunrise review" report on lay midwives which recommended that the state not establish a licensing board for the midwives.  MMA, the Maine Chapter of ACOG, the Maine Academy of Family Physicians, the Maine Chapter of the American Academy of Pediatrics and the March of Dimes all opppose the licensing of non-nurse midwives, most of whom function exclusively in connection with home births.

The report will be heard in Room 208 of the Cross State Office Bulding in Augusta.

Despite the independent state report recommending against licensure, the sponsor of the original bill, Rep. Nancy Smith (Monmouth) indicated in an article in the Kennebec Journal this past week that she was still inclined to support licensure.  Links to the state report and the KJ article follow.



 Members interested in this issue should contact their legislators as a floor fight is now anticipated.  Watch for updates on the issue in the Weekly Update as circumstances can change quickly. [return to top]

Deadline for MaineCare Tamper-Proof RX is April 1, 2008

By now, most physicians are aware that Congress passed a law last year requiring use of tamper-resistant prescription pads for most Medicaid prescriptions (there are exceptions for faxed scripts, e-prescribing and nursing home patients).  Maine already requires secured scripts for Schedule II medications but the new MaineCare requirement involves all schedules.  When Congress first enacted the law last year, the AMA and other medical organizations were successful in getting a six month extension, until April 1, 2008.  No further extension is likely.  As orders may take up to four weeks to process, practices should order scripts now in order to have enough available come April for MaineCare patients.  Several vendors are available that have been certified to be in compliance with Maine's law, including RX Security, Standard Register and Bangor Letter Systems.  Information on these vendors can be found on the MMA website at www.mainemed.com. (Check on Corporate Affiliates under the term "secured prescriptions."

Under the federal law, each state Medicaid agency must implement its own requirements regarding what tamper-resistant features will be required in that state. MaineCare has made clear that scripts meeting the requirements of the existing state law will be deemed to meet the new federal requirement.

A letter from the National Council for Prescription Drug Programs provides detailed information about the new requirements, the types of tamper-resistant features that a prescription pad can have, a sample prescription, and other information that physicans who have not yet received detail information from their state Medicaid agency may find helpful.  Additional information and link to the letter can be found on the AMA web site at www.ama-assn.org/ama/pub/category/15559.html [return to top]

Critical NPI Date Approaching for Medicare Billing

Beginning March 1, all Medicare claims must contain a National Provider Identifier (NPI).  You may submit claims with a legacy number and an NPI or just an NPI, but no longer will Medicare accept claims with just the legacy number.  Physicians who bill Medicare and are being paid for claims submitted with both an NPI and a legacy number are strongly urged to test their ability to get paid using just their NPI.  To test this, they should submit one or two claims as soon as possible.  This step is critical to ensuring that their claims will be processed without interruption beginning March 1. [return to top]

Agenda for March 7 Annual HIPAA Update Now Available

MMA has been able to bring together some important resources for the Annual HIPAA Update being held at the MMA office on Friday, March 7, 2008. The program provides an exceptional opportunity to train new staff or to update existing staff.  The program will run from 9:00am to noon and is part of the Association's First Fridays CME series.  The agenda for the morning is as follows:

9:00am   Introduction and overview of current HIPAA Privacy and Security Regulations and Maine Confidentiality Law       Gordon Smith, Esq

10:00am  Kenneth Lehman, Esq.  HIPAA Trouble Spots:    1.  Business Associate Agreements

                                                       2.  Responding to Subpoenas

                                                       3.  Dealing with Inadvertant Breaches

                                                       4.  Mandatory Disclosures Not Requiring Authorization

10:45am;  Break

11:00am      Kate Healey, Esq.   HIPAA Audits

11:45am      Potential Legislative Solutions and Q & A;    Andrew MacLean, Esq.

While the program is filling up quickly, there are still some seats available.  The $60 fee covers breakfast, and all course materials.  While the program attracts mostly staff, three hours of category one  CME credit is available for physicians wishing to attend.  You may register on-line at the MMA website at www.mainemed.com or by calling the MMA office at 622-3374.

  [return to top]

Report on MECMS Provider Advisory Group Meeting, Feb. 21

The Governor's MECMS Provider Advisory Committee continues to meet on a monthly basis to work with MaineCare staff on MECMS issues, including the collection of interim payments, continuing fixes to the existing system and the transition to a new system, scheduled to be operational by Jan. 1, 2010.

The Group met last Thursday (Feb. 21) and received an overview of the new system from Unisys staff Tim Skeen.  While the contract with Unisys has not yet been signed, it is in the state of final review by CMS and is expected to be signed.  Work has already begun on the transition and some functions will be established prior to 2010, such as re-enrollment of providers.  The new system will be largely duplicative of the existing functioning system in W. Virginia.  While the Unisys work will be substantial, three major subcontracts are also anticipated with Thompson-Medstat, Goold Health Systems and Public Consulting Group respectively.

Relative to the topic of interim payment recovery, the materials distributed showed that 18% of the interim payments remain to be recovered, representing slightly over $93 million.    The federal government, which receives back its share of the funds as they are collected, was pushing to have all of the inteirm payments collected by Dec. 31, 2007.  Relative to physicians, for the first time it now appears that more is owed in interim payment recovery ($5,206,790) than is owned to practices in suspended claims ($4,787,740).

MMA staff has assisted many members in negotiating return of the interim payments.  If you need assistance, contact Gordon Smith at gsmith@mainemed.com.

The Group meets again on Thursday, March 20 at 10:00am at the offices of MaineCare on Civic Center Drive in Augusta.

  [return to top]

Ethics and Professionalism Online Fellowship

The American Medical Association (AMA) Institute for Ethics and the Graduate Program in Bioethics at the Medical College of Wisconsin are offering the AMA-MCW Online Fellowship in Physician Ethics and Professionalism.

The program will provide formal online training designed for physicians currently involved with an institution's ethics endeavors.

Physicians can receive graduate degree credits for each course, which may be transferable toward a master's degree in bioethics.  Some courses may offer continuing medical education (CME) credit as well.

For more information, call 312-464-5260, visit www.mcw.edu/display/router.asp?docid=12286 or e-mail ethicsfellowship@ama-assn.org. [return to top]

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