June 9, 2008

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Quality Counts One of 14 Programs Selected for Robert Wood Johnson Grant

The Robert Wood Johnson Foundation on Thursday announced a major new investment in Maine and 13 other community-based programs around the country as part of a $300 million initiative to spearhead health care quality reforms through regional collaboratives.  Known as Aligning Forces for Quality, the initiative is the largest effort of its kind ever undertaken by a U.S. philanthropy.

Maine's Quality Counts program, in which MMA participates, was selected for the initiative in a competitive process to find the states and communities best positioned to make fundamental and cutting-edge changes to rebuild their health care systems.  In addition to providing expertise, technical assistance, and training from national experts, RWJF will provide Quality Counts with more than $1 million over three years and access to additional grants for specific projects.

"Everyone in the health care system wants to deliver high-quality care, but the fragmented nature of our health care markets and delivery systems often prevents key players from working together toward that common goal," said Dr. Lisa Letourneau, Quality Counts Board Chair.  "We are excited to be selected for this initiative so we can bring all the parties together - those who get care, give care, and pay for care - to drive real improvement in  Maine."

Aligning Forces for Quality was originally launched by the Foundation in 2006.  In the first phase, the communities began efforts to improve health care for patients with chronic illness in outpatient settings, such as doctors' offices and clinics. 

With the expansion, Aligning Forces for Quality community teams will now strive to improve care for all patients across all settings by:

  • Helping physicians improve the quality of care for patients;
  • Giving people information that helps them be better partners with their doctors in managing their own health and making informed choices about their health care;
  • Improving care inside hospitals, with a special focus on the central role that nursing plays; and
  • Reducing inequality of care for patients of different races and ethnicities.

In Maine, Ted Rooney is the project Director for the grant.

For more information about Aligning Forces for Quality,  see www.rwjf.org/qualityequality.


2008 Hanley Forum Focuses Attention on Preserving Primary Care

The 2008 Hanley Forum was held this past Thursday, June 5 at the University of Southern Maine.  The topic for the Forum this year was, "Charting A Course Toward Improved Quality & Greater Financial Sustainability . . . What Will It Take to Preserve Primary Care in Maine?"

Allan Goroll, M.D. of Harvard Medical School presented the keynote talk and highlighted the history of reimbursement over the past twenty years.  He noted the mis-alignment currently between the payment system and the quality movement.  He encouraged the invited attendees to look at the payment system in a fresh way and encouraged a new contract between payers and primary care physicians.  He noted that a business case cannot be made for the status quo.

Dr. Robert Berenson of the Urban Institute tied the issue of primary care payment reform with the notion of a Medical Home.  Following Dr. Berenson, three different projects were described that were providing an alternative to the current payment system.

The afternoon session consisted of facilitated roundtable discussions with the morning speakers.  Jeffrey Holmstrom, D.O., Medical Director of Anthem BCBS of Maine, provided an update on plans in Maine for a Multi-Payer Pilot Project on the Patient-Centered Medical Home.

The Hanley Center is named for Dr. Dan Hanley (1916-2001) who headed the Maine Medical Association for 24 years and who earned an international reputation for his courage, innovation, collaboration, compassion, and hard work.  The mission of the Center is to catalyze a sustainable culture of collaboration, innovation, and values-driven leadership across the broad health community in Maine and beyond.

  [return to top]

Final Academic Detailing Planning Initiative Meeting Occurred June 6th

The Northern New England working group met from 10:30 am  – 2:00 pm in Concord, NH last Friday to discuss and further refine the draft template for establishing and administering a prescriber support and education (Academic Detailing) program.  This program provides objective, evidence-based information, and represents a unique opportunity for improving care in which the physician’s and patient’s concern with quality and cost and the payers interest in cost and access can all be advanced at once.

“The program's goal is to provide optimal patient care through quality, safety, efficacy, and cost-effectiveness.”

The draft template catalogs opportunities for collaboration and represents a planning document which can then be adapted to suit the needs of specific programs.  Although this planning document was created as guidance for Northern New England, it will be of use to any emerging program in the country.  The program components are comprised of the following:

  • Clinical Modules (i.e., management of upper gastro-intestinal symptoms, diabetes management, managing hypertension, depression and elevated cholesterol);
  • Program Delivery (i.e. determining which physicians to approach regarding the availability of the service);
  • Program Administration (i.e. the recruitment, training of academic detailers); and
  • Financing the program (i.e. identifying the financing structure that is most effective for each state).

Federal legislation has also been drafted that amends the Public Health Service Act to provide grants for prescription drug education and outreach for health care providers and their patients, and is structured as a two-prong grants program at this time.

Next steps:  1)  Review changes and edit program template for final draft, 2) disseminate program template to respective professional organizations for educational purposes, 3) leverage existing channels of providing prescriber education services, and, 4) advocate for the passage of the Federal Legislation for grant support through the Public Health Service Act.  [return to top]

Harvard Pilgrim Health Care Foundationís Released Summary Report on Childhood Obesity for MA, NH and ME Last Week.

Charlie Baker, President and CEO of Harvard Pilgrim Health Care spoke to the group of public health policy leaders from all three states at the JKF Library and Museum on Harvard Pilgrim Health Care’s commitment to “Tipping the Scales in Favor of Our Children.”  He also shared a compelling personal story regarding the weight difficulties one of his children is experiencing.  He emphasized that one of three kids in America is overweight or obese and we need to do something about it.  

The Harvard pilgrim Health Care Foundation, in partnership with Harvard Pilgrim Health Care, launched Growing Up Healthy in 2007, a five-year leadership and funding initiative to help prevent childhood obesity in Maine, Massachusetts, and New Hampshire.  The company has committed to a leadership role in advancing that understanding and promoting changes that will be necessary to turn the tide on childhood obesity.  The Foundation commissioned the Friedman School of Nutrition Science and Policy at Tufts University to survey existing data on overweight and obese children, as well as programs that address weight and lifestyle; collect and evaluate school wellness policies and summaries of legislative action over the past five years; and speak with leaders from the business, government, media, advocacy, and education sectors.

Suggested next steps from their report:  1) Generate consistent state-level data (monitoring BMI), 2) Focus on schools and on how to use available resources more effectively (review local school wellness policies), 3) Create a broad alliance of advocates to bring about legislation and policy changes that offer creative and cost-effective solutions, 4) Engage the business community, 5) Create consistent, coordinated, engaging, accessible, and effective messages about the value of healthy eating and exercise, 6) Health insurers must support the delivery of obesity prevention and treatment services, and 7) Engage philanthropy to serve as a key integrator and coordinator of multifaceted efforts.

For more details and information on the childhood obesity crisis, visit www.harvardpilgrim.org/foundation [return to top]

Quality Counts Seeks Executive Director

Quality Counts, a statewide non-profit organization whose mission is to improve chronic illness care and prevention and to forge collaborative relationships among health care providers, employers, payers, and policymakers, is seeking an Executive Director to manage the ongoing activities of the organization.  Under the direction of the Quality Counts Board, the Executive Director is responsible for working to fulfill the Quality Counts (QC) mission and leading the successful management of the organization.

Duties include:

  • managing relationships with the QC Board, QC Member organizations, and key stakeholders throughout the state;
  • leading QC operations;
  • ensuring fund development; and managing staff and budgets within the policies and guidelines established by the QC Board.

In addition to managing the activities of Quality Counts, the Executive Director will spend one to two days per week managing a one-year-long special project addressing the quality of care being delivered in medical practices across the state for the Maine Medical Association and the Maine Osteopathic Association.  The qualified candidate will conduct special assessments, respond to inquiries about the project, and prepare necessary reports to the state and other funding sources.

To view the full listing, visit JobsinME.com [return to top]

The Coding Center Offers a New Professional Medical Coding Course, July 23

The Coding Center will offer another edition of its popular AAPC-certified Professional Medical Coding Course (PMCC), Wednesdays, 7/23/08 - 11/19/08, 1pm - 5pm, at the Anchorage Inn in Portsmouth, NH.

This 20-week course, developed by the American Academy of Professional Coders (AAPC), and taught by Jana Purrell, CPC-I, will take students through the 2008 Current Procedural Terminology (CPT), International Classification of Disease (ICD-9), and HCPCS books to address proper coding in physician practices.  This 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.

The Program includes the following:

  • One year membership in the  AAPC;
  • Student workbooks;
  • CPC exam; and
  • Group discussion and networking opportunities.

Click here for more information or to register. [return to top]

Work to Implement New Medicaid Claims Processing System Has Begun

As previously reported in MMWU, the State of Maine, Department of Health and Human Services, Office of MaineCare Services has begun work to implement a new Medicaid claims processing system.  During the past year, the Centers for Medicare and Medicaid Services (CMS) approved the State’s plan for transitioning MaineCare to a fiscal agent model of operation.  This includes contracting with a fiscal agent vendor for some MaineCare operations, including a new HIPAA compliant, CMS-certified, claims processing system. 

Unisys was selected to be the fiscal vendor in December 2007.  Unisys brings to MaineCare its transfer claims processing system known as “HealthPAS.”  The new system is scheduled to begin processing claims in early 2010.  Between now and then, the team will fully design and test the system.

The first phase of the new system’s implementation, provider re-enrollment, will take place during 2009.   Re-enrollment is vital to the overall project because it will ensure that the most up-to-date provider information is in the new system.  The re-enrollment process is being designed to minimize any short-term negative impact on providers.  MaineCare is working to make the process of collecting all the required information as easy as possible.

Once a provider re-enrolls in MaineCare and also enrolls as an Electronic Data Interchange (EDI) Trading Partner, he or she will be able to submit electronic claims, as well as batch claims, to MaineCare.  Electronic claims will be submitted through the Unisys HealthPAS OnLine (the new claims processing provider web portal).  Providers that re-enroll will also be able to add their National Provider Identification (NPI) number(s) to claims.  Even providers who won’t be using NPI numbers can re-enroll and submit electronic claims beginning in 2009.  Prior to the new system starting in 2010, the current MeCMS system will continue to process claims and generate paper Remittance Advice statements as well as Electronic Remittance Advice statements.

With the re-enrollment, MaineCare plans to kick-off some of the HealthPAS OnLine functions.  In 2009, once providers re-enroll they will be able to go to the web site to: 

  • Enroll, re-enroll, and change their enrollment information;
  • Get Electronic Data Interchange (EDI) claim submission companion guides;
  • Submit HIPAA compliant 837 Professional, Institutional, and Dental claim transaction files (batch upload) or onto a claims entry screen for transfer to submission in MeCMS for processing (anticipated in mid-2009).

Once the new claims system is fully implemented in 2010, the provider portal web site will provide: 

  • Member eligibility;
  • Prior authorization;
  • Claim status and history;
  • Payment status and history; and
  • Member rosters.

At all levels there will be look-up tables, pull down menus, tools to drill down to detailed information, and help screens.

MaineCare will send additional re-enrollment information in the coming months.  Watch for the MaineCare Matters newsletter, other updates like this and listserv announcements.  Please visit http://www.maine.gov/dhhs/bms/member/innerthird/listserv.shtml to sign up for the MaineCare listserv.  The MaineCare Providers’ Advisory and Technical Advisory groups will also be discussing this and other fiscal agent activities in their future meetings.  In the meantime, if you have questions, please send them to MaineCare2010.DHHS@maine.gov or contact 1-800-321-5557, option 8. [return to top]

Welcome to Newest MMA Group Member: The Employed Physicians at Maine Coast Memorial Hospital

MMA welcomes the employed physicians of Maine Coast Memorial Hospital as the newest MMA members taking advantage of the Group Membership program.  Forty physicians are employed in the group.  Many thanks to the hospital CEO Douglas Jones, the Vice President for Physician Services Dana Fadley, and the MMA Executive Committee member for Hancock County Ken Christian, M.D. for making this possible.  Welcome to one of the fastest growing medical societies in the country!

If your medical group practice is interested in talking with MMA about a group membership, please contact Gordon Smith, MMA EVP via gsmith@mainemed.com or by calling 622-3374, ext. 212. [return to top]

Alternative Bills on Medicare SGR Payment Issue Likely to Emerge from Senate Finance Committee

Senate Finance Committee Chairman Max Baucus (D-MT), along with Maine Senator Olympia J. Snowe (R), have developed a $20 billion Medicare bill that would increase Medicare physician reimbursement by 1.1% for 18 months paid for primarily by reducing payments to managed care plans.  An early draft of the Baucus plan would extend the Physician Quality Reporting Initiative (PQRI) until January 2011 with an increase in PQRI bonuses in 2009 and 2010.  It also would include financial incentives and/or penalties to promote electronic prescribing.  Based upon a procedural update provided today by the AMA, the earliest that Senate Majority Leader Harry Reid (D-NV) could try to call up the bill would be tomorrow, Tuesday, June 10, 2008.  Assuming that there will be objection, Senator Reid will file for cloture and the cloture vote could occur on Thursday, June 12, 2008, but depending on other legislative action the cloture vote could be delayed until next week.  Ranking Republican on the Senate Finance Committee, Senator Chuck Grassley (R-IA), recently released a proposal that would increase Medicare physician payment by 0.5% through the last 6 months of 2008 and by 1.1% for 2009.

The following is additional background on the Medicare pay cut scheduled for July 1, 2008.

The 0.5% update in Medicare payment rates approved by Congress late last year will expire on June 30, 2008.  Unless Congress acts before that date, a 10.6% cut will become effective on July 1, 2008 and an additional 5% cut is projected for January 1, 2009.

OUR MESSAGE TO CONGRESS:  Act quickly to extend the current 0.5% update through the remainder of 2008 and provide a 2009 update that reflects the increase in medical practice costs to give Congress the time necessary to pave the way for longer-term reform of the Medicare “sustainable growth rate” (SGR) physician payment formula.

Impacts of the Medicare Payment Cuts in Maine

  • Maine physicians will lose $50 M for the care of elderly & disabled patients over the 18 months from July 2008 through December 2009 if projected cuts become effective.  On average, each Maine physician faces a Medicare cut of $13,000 during this period.  Also, the state’s physicians will lose $1 B for the care of elderly & disabled patients by 2016 because of nearly a decade of cuts for this important care.
  • 14,133 employees, 223,962 Medicare patients and 47,343 TRICARE patients in Maine will be affected by these cuts.
  • Compared to the rest of the country, Maine, at 17%, has an exceptionally high proportion of Medicare patients and, at 18 practicing physicians per 1000 beneficiaries, has a below-average ratio of physicians to Medicare beneficiaries, even before the cuts take effect.
  • 47% of Maine’s practicing physicians are older than 50, an age at which surveys show many physicians consider reducing their patient care activity.
  • In July 2008, physicians in Cumberland & York Counties face cuts of an additional 1.1% on top of the 10.6% cuts across the country and the rest of Maine faces additional cuts of 2.1%.  The 2003 Medicare law provided a temporary increase in geographic payment adjustments for certain geographic areas.  This increase also will expire on June 30, 2008 under current law.

Senator Debbie Stabenow (D-MI) has submitted S. 2785, the Save Medicare Act of 2008 as a vehicle to provide an 18-month “fix” for this problem & Senator Stabenow has attracted 18 co-sponsors for the bill, including Maine’s junior Senator Susan Collins.

While all 4 members of Maine’s Congressional delegation have historically been supportive of organized medicine’s position on this Medicare payment issue, it is important that you contact them to reiterate how important a Medicare payment fix is to your ability to continue providing care to Medicare beneficiaries & to thank them for their continuing support!

Contact Senator Olympia J. Snowe (R):  202-224-5344; Olympia@snowe.senate.gov

Contact Senator Susan Collins (R):  202-224-2523; senator@collins.senate.gov

Contact Representative Tom Allen (D, 1st District):  202-225-6116; rep.tomallen@mail.house.gov

Contact Representative Mike Michaud (D, 2nd District):  202-225-6306; rep.mikemichaud@mail.house.gov

You can find more information about the Medicare physician payment campaign, including a link to the “grassroots action center” where you can send a message to members of Congress, on the AMA web site at:  http://www.ama-assn.org/ama/pub/category/6583.html. [return to top]

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