June 23, 2008

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Congress Still Working on Medicare Fee Fix

Both the U.S. House and Senate are still working on a proposal to restore the 10.6% reduction in Medicare physician fees, but time is getting short.  Following discussions with Senate Finance Committee Chair Max Baucus (D-MT), House leaders introduced a House bill that contains many of the same provisions that the Baucus-Snowe bill contained.  Although time is short, many observers believe the House and Senate will, in fact, enact legislation this week to restore the cut and replace it with a 0.5% increase effective July 1, 2008 and a 1.0% additional increase Jan. 1, 2009.

Following a number of conversations this week between Senate Finance Committee Chair Max Baucus (D-MT) and Democratic committee leaders in the House, late Friday afternoon, June 20, 2008 Ways and Means Committee chair Charles Rangel (D-NY) and Energy and Commerce Committee chair John Dingell (D-MI) introduced H.R. 6331, the "Medicare Improvements for Patients and Providers Act of 2008."  This bill is modeled after the Baucus bill that was subject to an unsuccessful cloture vote in the Senate last week.

H.R. 6331 extends the 0.5 percent update through 2008 and provides a 1.1 percent update for calender year 2009.  It also extends the non-controversial provisions such as the GPCI floor on physician work, which is very important in Maine.  Incentive payments for electronic prescribing, funding for the medical home demonstration, improved payments for anesthesia teaching programs, and adjustments to payments for mental health services are also included.  H.R. 6331 has been modified to include bipartisan legislation that halts for 18 months the DME competitive bidding program with important exemptions for physicians who would have had to obtain accreditation to continue to provide off-the-shelf orthotics in their offices.  It also includes Medicare Payment Levy language that would require CMS to garnish payments to health care providers who are delinquent in their income taxes.  The extension of the Medicare scarcity bonus for primary care is not included in the House bill.

H.R. 6331 will be considered on the suspension calender.  This process limits the debate on the legislation but requires a two-thirds vote of members to vote yes in order for the bill to pass.

In the Senate, negotiations continue between Senator Baucus and Finance Committee  ranking member Charles Grassley (R-IA).  Because of the differing priorities between Senate Democrats who want to maintain certain benefit enhancements in the bill and Senate Republicans who want to preserve Medicare Advantage payments, the negotiations are proceeding slowly.  There have been some reports that the physician update in 2009 may be lower than the 1.1%  that was proposed by both Senators earlier this month, but no legislative language or bill summaries are available yet to confirm that.  At this time, Senators Baucus and Grassley are still committed to an 18-month payment fix.  The Bush Administration and many Senate Republicans continue to oppose reductions to private fee for service Medicare plans.  The elimination for these "pay-fors" will put negative pressure on spending items, including the size of the physician update.  The difference between a freeze and a one percent update is only $300 million in additional spending.

Senate staff will continue to talk throughout this weekend with the hope of finding common ground by Monday.  The AMA has been told that a Senate vote on Medicare legislation is planned for this coming Thursday. 

David Dumont, M.D. Apppointed to Board of Licensure in Medicine

David Dumont, M.D., a family physician now directing the Emergency Medicine Department at Penobscot Valley Hospital in Lincoln, was appointed last week by Governor John Baldacci to the Maine Board of Licensure in Medicine.  Dr. Dumont's term begins immediately and he is expected to be at the next Board meeting on July 8th.  He replaces Kimberly Gooch, M.D., a Farmington internist who completed her second six-year term on the Board and who asked not to be reappointed.

Dr. Dumont becomes one of six physicians on the Board who are joined by three public members.  Other physician members currently include Sheri Oldham, M.D., Chair, a general surgeon from Waterville; Gary Hatfield, M.D., an internist from the Lewiston-Auburn area; Daniel Onion, M.D., a family physician from Mt. Vernon who formerly was Director of the Maine-Dartmouth Family Practice Residency program in Augusta; George "Joe" Dreyer, a psychiatrist associated with the Maine Medical Center; and Maroulla Gleaton, M.D., an ophthalmologist practicing in Augusta.  The three public members are Bettsanne Holmes, David Nyberg, Ph.D., and Cheryl Cluckey.

The Board meets the second Tuesday of each month at its offices on Capital St. in Augusta. [return to top]

AMA Concludes Annual Meeting in Chicago

The Annual Meeting of the American Medical Association concluded on Tuesday, June 17, completing its business a half-day early which had apparently never previously happened at the Annual Session.  Major issues discussed included the pending Medicare fee cut, medical "tourism," and the report by the Council on Ethical and Judicial Affairs recommending that there be a complete separation between pharmaceutical support and medical education (undergraduate, graduate and CME).  The CEJA report was referred to the Board of Trustees rather than being adopted.   Regarding medical tourism, delegates approved a set of nine principles to ensure the safety of patients seeking medical care outside the country.  These include calls for such care to be voluntary and not mandated by an insurance company or employer and that patients be referred only to institutions that have been accredited by recognized international accrediting bodies.  In Maine, Hannaford Brothers has announced an intention to pursue international hospitals in an attempt to lower its employee health care costs.

Physicians at the meeting also supported the AMA's proposal to cover the uninsured and to study the impact of free clinics on improving access to health care for the uninsured.  According to AMA Board member Cyril Hetsko, M.D., "While we work to cover the uninsured, we need to find ways to care for those in need now."  During the meeting, the AMA also unveiled two new campaign television ads that will air across the country in the fall.

News releases covering the highlights of this year's Annual Meeting are available on the AMA Web site at http:www.ama-assn.org/ama/pub/category/1578.html.  Additional highlights and video, including speeches by AMA President Nancy H. Nielsen, MD, PhD and Immediate Past President Ronald M. Davis, MD are available at http:www.ama-anns.org/ama/pub/category/1187.html.

Physicians from Maine attending the meeting representing MMA or their specialty society societies included Drs. William Strassberg (MMA President), Robert McAfee,  David Simmons, Richard Evans, John Makin, Maroulla Gleaton, Francis Kittredge, Sam Solish, Jo Linder, Daniel Spratt, and Charles T. McHugh. 

In-coming President Nancy Nielsen has been a frequent visitor to Maine and is an internist and medical educator in Buffalo, N.Y.  Out-going President Ronald Davis is a public health physician who has carried out a very public battle with pancreatic cancer during his year as President. [return to top]

MaineCare Fee Increases Effective July 1, 2008

Tony Marple, Director of the Office of MaineCare Services, has sent a letter to all primary care providers this past week, explaining the details of the much anticipated fee increase effective July 1, 2008.

While the letter was directed to primary care physicians, the rate increase, representing a total of $8.3 million annually, will affect most physicians billing professional physician services, including cognitive and physician-performed procedure services that are billed with CPT codes as fee-for-service.  The increase moves physician rates from 53% to 61.7% of Medicare's January 2008 rates.

Federally Qualified Health Centers (FQHC's) and Rural Health Centers (RHC's) will not see a rate change as they are already paid at higher levels.  Radiology services, which are also already paid at a higher percentage of Medicare rates than 61.7% will also not see a rate change.  Hospital employed primary care physicians will be paid on an interim basis on the new fee table, but settled to 89.7% of cost.  Hospitals will also be able to continue to charge a facility fee with respect to such services.

"The Maine Medical Association worked hard on behalf of its members to accomplish this fee increase in 2007 and was successful in protecting it this past session.  But we would not have been successful without the support of MaineCare officials and the Governor.  While it is still a modest fee schedule which will continue to need increases each budget cycle, it is at least a good faith downpayment.  It is particularly significant given what a mess the budget was, " noted MMA EVP Gordon Smith.

Because rulemaking on the increase is not yet completed, payment of the new rates will not occur until the rulemaking is complete in mid-August.  But the increase will be retroactive to July 1 and providers will get a single check for the difference between the new and old rates for the claims filed for services provided on and after July 1.  For the adjustment feature to work, providers need to submit claims using their usual charges, unless specifically instructed by other policy.  You may refer to the MaineCare CMS 1500 billing instructions on the web at http://www.maine.gov/bms/providerfiles/provider_billing_mauals.htm.

The new rates by procedure code are posted on the MaineCare website.  These can be viewed by selecting the News and Provider Meetings tab from the home page and then the Primary Care Physician Rates headline under "News You Can Use."  The direct link to these is http://www.maine.gov/dhhs/bms/member/innerthird/mecms_portal_news.html#PRIM. [return to top]

MaineCare Officials Attend Payor Liaison Committee Meeting and Ask for Input on Prior Authorization Process

MMA's Payor Liaison Committee met last Wednesday (June 18) and heard presentations from MaineCare officials on the prior authorization process and from Lisa Letourneau, M.D., M.P.H. on the attempts in Maine to establish a pilot project promoting the concept of a patient-centered medical home.

MaineCare officials are asking for feedback on the current processes requiring prior authorization for several medications and medical procedures (circumcisions, bariatric surgery, etc.).  Some of the suggestions offered at the meeting were the need to move to an on-line approval system (not possible with the current MECMS system) and a longer approval period for medications for persons with chronic conditions.

Physicians or office staff having suggestions should forward them to MMA EVP Gordon Smith at gsmith@mainemed.com.

  [return to top]

Senate Finance Committee Holds Health Reform Summit

This past Monday (June 16), the Senate Finance Committee held a Health Reform Summit to discuss the nation's health care system.  Speakers included Congressional Budget Office Director Peter Orzag and Federal Reserve Chairman Ben Bernanke.  In his remarks to the Finance Committee, Orzag identified the growth rate in health care costs as the "single most important factor influencing the federal government's long term fiscal balance" and pointed to two major healthcare programs - Medicare and Medicaid as "the most determinant of long term trends in federal spending."

Under current law, the Congressional Budget Office predicts a significant increase in total healthcare spending citing a "rise from 16 percent of the gross domestic product in 2007 to 25 percent in 2025 and 49 percent in 2082, and a net federal spending on Medicare and Medicaid will rise from 4 percent GDP to almost 20 percent over the same period."  Chairman Bernanke also called attention to the urgent need for health care reform, stating that, "At some point the healthcare spending as a share of GDP will stop rising" and, "healthcare will become increasingly unaffordable," as a result of the outpacing of income with health care expenses   He recommended that Congress take an "eclectic approach" to overhaul the healthcare system as opposed to waiting for a one-shot solution to fix its problems.  There is bipartisan agreement in the Senate that major health care legislation will be necessary in 2009 to deal with the nation's health care condition. [return to top]

UnitedHealth Group Chief of Medical Affairs Reed Tuckson, MD, Participates in Senate ''Health Reform Summit''

Reed V. Tuckson, MD, Executive Vice President and Chief of Medical Affairs for UnitedHealth Group (United) participated in the U.S. Senate Finance Committee’s “Prepare for Launch: Health Reform Summit” in Washington, DC recently.  The summit is part of a year-long series of events focusing on health care reform in 2009.  Dr Tuckson stressed the importance of making sure that the tools that are given to physicians and consumers are suitable to deliver useable information on cost-effective, high-quality care. Dr. Tuckson also noted that United has programs in development that address many of these issues. [return to top]

DHHS Interim Payment Recovery Team Continues to Pursue $52.5 M in Outstanding Payments

At the MaineCare Provider Advisory Group meeting last Thursday, DHHS officials advised participants that the balance outstanding in interim payments made to providers during the MECMS crisis is approximately $52.5 M.  The Department paid out approximately $530.6 M in such payments.  The DHHS staff also said that the State has filed liens in the respective registries of deeds in instances where providers have not communicated with the Department to make repayment arrangements.  The next enforcement step after the property liens will be referral to Maine Revenue Services.  The Department paid approximately $18 M in interim payments to 877 physicians and nurses.  The balance to be collected for this group is approximately $4 M.  In contrast, the State still owes approximately $5.8 M to this group in unpaid claims.  The MMA has heard from several physicians who have received lien notices.  If you have received such a notice, please notify Andrew MacLean, Deputy EVP, at amaclean@mainemed.com or by phone at 622-3374, ext. 214.

In other news from the Provider Advisory Group, the Department stated that it will not be able to make a MaineCare payment during the week of June 23, 2008, but that it will make it up during the first week of July.  The MaineCare staff also is working on a project to eliminate local codes as the Department pursues HIPAA compliance.  Approximately 33 MaineCare policies now include local codes.  Finally, departing DHHS finance chief Kirsten Figueroa announced that Russ Begin would take over as acting finance administrator. [return to top]

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