July 7, 2008

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Register Now for 155th MMA Annual Session to Receive "Early Bird" Discount

Members registering for the Association's Annual Session on or before Wednesday, July 9, will receive an "Early "Bird" discount off the conference registration fee.  The meeting this year will be held at the Samoset Resort in Rockport from Sept. 4-7, 2008.  On Thursday, Sept. 7, MMA and the Maine Hospital Association will jointly present a symposium on quality improvement.  The traditional meeting begins with a keynote presentation on Friday, Sept. 8 at noon. 

The Quality Improvement Symposium on Thursday will feature two presentations by Elliott Fisher, M.D., MPH of Dartmouth Medical School.  Other presenters that day include Robert Keller, M.D., Chair of the Maine Quality Forum Advisory Council.  The day-long program is co-sponsored by the Maine Quality Forum, Quality Counts! and Aligning Forces for Quality.  Hospitals are encouraged to send teams of representatives while individual physicians and other providers are welcome to attend as well.

On Friday, Gregory Carroll, PhD., of the Institute of Healthcare Communication will keynote the afternoon CME program for which education credits have been applied for.  The opening night reception will be held with exhibitors in the spacious State of Maine Exhibit Hall.

On Saturday morning, the Association will hold its general membership meeting which will consider Resolutions presented by MMA members and MMA committees and conduct the Association's business for the year, including electing officers, adopting a budget for 2009 and consider amendments to the Constitution and Bylaws.  Following the meeting, best-selling author Kate Braestrup of the Maine Warden Service will present a lunch-time talk on the subject of communicating bad news.  Kate's 2007 book entitled, Here If You Need Me, has received widespread acclaim.

On Saturday evening, current President William Strassberg, M.D. will present the President's gavel to in-coming President Stephanie Lash, M.D.  Dr. Lash practices neurology in Bangor and is President of Neurology Associates of Eastern Maine.  Annual recognition awards and 50 year-pins will also be given out on Saturday evening.

On Sunday morning, the program will close with brunch and a Public Health Symposium featuring the issue of  obesity, presented by the Association's Committee on Public Health.

Members and guests may register by using the registration form mailed to all members in June or by going on-line at www.mainemed.com.  Reservations at the Samoset must be made by July 21 and can be obtained by calling 1-800-341-1650. \

Congress Back in Session to Address Medicare Physician Payment Issue

Congress returns today (Monday, July 7) from its Fourth of July recess and the Senate is expected to immediately take up H.R. 6331, the "Medicare Improvements for Patients and Providers Act of 2008".  Ten days ago, the Senate failed to achieve cloture, which would have allowed a vote on the bill, by one vote.  As Senator Kennedy is expected to return to the Senate today, it is hoped that the 60 votes required to take up the measure will be achieved.  Senators Snowe and Collins were among the nine Republicans who joined all the Democrats present in voting for cloture. House members Tom Allen and Mike Michaud both previously supported the House bill which passed overwhelmingly in the House.  This issue is critically important in Maine where over $50 million dollars is at stake over the next 18 months in a state which has the highest percentage of elderly in the nation and 17% higher Medicare population than average.

H.R. 6331 restores the 10.6% reduction in physicians payments and extends the 0.5%  positive update through 2008 and provides a 1.1 % update for calender year 2009.  It also extends the non-controversial provisions such as the GPCI floor on physician work, which assists providers 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.  The extension of the Medicare scarcity bonus for primary care is not included in the House bill.

While the July 1 cut has legally taken effect, CMS will hold claims for services rendered on and after July 1 for the usual 14 days, thus fortuitously allowing time for Congress to act prior to the reduction being felt by physicians.  Meanwhile, all claims for services delivered on or before June 30 will be processed and paid under normal procedures.

After 10 business days, contractors will begin releasing claims into processing under the fee schedule which implements current law.  This, of course, could result in claims being processed with the negative 10.6 percent update.  If a new law is enacted which changes the negative update, retroactive to July 1, CMS is prepared to automatically reprocess most of those claims which have already been processed.

Under the Medicare statute, Medicare pays the lower of submitted charges and the Medicare fee schedule amount.  Claims with dates of service July 1 and later billed with a submitted charge at least the level of the January 1-June 30, 2008, fee schedule will be automatically reprocessed if Congress retroactively reinstates the update that was in effect for that time period.  Any lesser amount will likely require providers to re-submit a revised claim.

To the extent possible, providers may hold claims in-house until it becomes clearer as to whether new legislation will be enacted or until cash flow becomes problematical.  This will reduce the need for providers to reconcile two payments (i.e., the initial claim and the reprocessed claim), and it will simplify provider billings of beneficiary coinsurance and payment calculations for payers which are secondary to Medicare.

Attempts to restore the payment reduction which is the result of the flowed Sustainable Growth Rate formula have been unsuccessful to date primarily because of the disagreement between the parties (and the White House) over how to pay for the restoration of the cut.  Republicans and the White House want to preserve Medicare Advantage payments levels while Democrats are willing to make modest cuts in the payments to the plans which many observers believe are generous, particularly when compared to the penurious payments offered to physicians.

MMA staff will participate in a conference call with the AMA Washington office on Monday along with all the major national specialty representatives and other state medical societies.  The purpose of the call is to discuss the current status of the legislation and to discuss next steps.  Information to pass on to members and staff regarding submission of claims will also be offered. [return to top]

MMA Loan and Trust Administration Committee to Meet on Wednesday

The Association's Loan and Trust Administration Committee will meet on Wednesday (July 9) to consider applications from medical students for loans from the Maine Medical Education Foundation.  The Foundation has offered low-interest loans to students from Maine in medical school for nearly 50 years.  This year, over 60 applications have been received which is a significant increase from previous years. 

The Committee is chaired by Mark Bolduc, M.D., a general surgeon from Waterville and a former MMEF recipient.  Several additional former recipients also serve on the committee.

The meeting will begin at 2:00pm.  All MMA committee meetings are open to any MMA member. [return to top]

U.S. Attorney Paula Silsby Convenes Interested Parties on Prescription Drug Abuse Issue

U.S. Attorney for the District of Maine, Paula Silsby, has asked interested parties to meet in her office this Wednesday (July 9) in Portland to review the results of a recent study of drug-related deaths in 2007 and to discuss further steps that can be taken to decrease the incidence of prescription drug abuse in the state.  This will be the third member of interested parties convened by Attorney Silsby, who also spoke on this topic at the MMA Education Seminar in Augusta on May 28.  At that time, she encouraged all physicians to register for and regularly utilize the state's Prescription Monitoring Program (PMP) which was established in 2004. 

The recent study of the deaths resulting from drug overdose in Maine in 2007 showed that methadone was the drug resulting in the most deaths, closely followed by cocaine.

Deaths from drug overdose in Maine spiked in 2002 and have stayed at a relatively high level ever since.

MMA has conducted nearly twenty educational programs sponsored by the Maine Office of Substance Abuse since 2005, presenting information on the PMP and offering tips on how to prevent diversion.

If you or your office has a question about this topic, or are presented with a related issue in your office, feel free to contact either of the MMA's attorneys, Gordon Smith (622-3374 ext. 212) or Andrew MacLean (622-3374 ext. 214) or via e-mail to gsmith@mainemed.com or amaclean@mainemed.com. [return to top]

MMA Office-based Quality Improvement Program Offers QI Protection

Two additional practices recently joined the MMA's Office-based Quality Improvement Program which provides protection from discoverability for a practice's internal quality improvement program.  While hospital peer review and quality assurance activities have traditionally been protected, the ability to protect the documents of a practice are not well-known, although the Association's program has been in existence for several years.  In the absence of such protection, a practices runs the risk that QI documents could be discovered in a case where the QI work was determined relevant to the case.

Provisions of the state's Health Security Act in Title 24, enacted at the time of the first medical liability crisis in the late 1970's, state that such documents can not be discovered or otherwise used by plaintiff attorneys if the quality improvement documents are part of a QI program conducted under the auspices of a state professional association to which the physician belongs.

Practices participating in the program file a quality improvement plan (we can provides samples) with the MMA Committee on Physician Quality which then makes a determination as to whether the plan is acceptable.  Once approved into the program, the practice then submits data on an annual basis to the Committee utilizing a template furnished by MMA.  There is a small fee to participate, which is used to administer the program.

Practices interested in better protecting their QI documents should contact Gordon Smith, Esq., MMA's EVP at 622-3374 ext. 212 or via e-mail to gsmith@mainemed.com. [return to top]

MMA Committee on Nominations Seeking Volunteers for MMA Committees

Stephanie Lash, M.D., President-elect of the Association and chair of the MMA Committee on Nominations is soliciting volunteers for any of the following MMA committees.  Persons interested should communicate with Diane McMahon in the MMA office at 622-3374 ext. 216 or via e-mail to dmcmahon@mainemed.com.

Committee on Legislation

Committee on Physician Quality

Committee on Constitution and Bylaws

Committee on Membership and Member Benefits

Committee on Public Health

Payor Liaison Committee

Committee on Nominations

Committee on Loan and Trust Administration (administers loans to medical students through the Maine Medical Education Foundation)

Committee on Ethics and Discipline

Committee assignments normally become effective following the Association's Annual Meeting, being held this year Sept. 4-7 at the Samoset Resort in Rockport. [return to top]

Acting Surgeon General, Rear Admiral Steven K. Galson, MD, MPH visits Portland

This past Tuesday at MMC’s Frost Street location, home of the Kids Co-op and Countdown, Acting Surgeon General, Rear Admiral Steven K. Galson, MD, MPH hosted a roundtable discussion with public health/health care/educational/early childhood leaders in Portland to focus on stemming the tide of the rise of childhood obesity in the nation as part of his nationwide tour promoting the DHHS’ Childhood Overweight and Obesity Prevention Initiative.  This initiative “targets prevention of overweight and obesity prevention, and the promotion of healthy lifestyles, for young people.”

The "Healthy Youth for a Healthy Future" initiative focuses on recognizing and showcasing those communities throughout the nation that are addressing childhood overweight and obesity prevention by helping kids stay active, encouraging healthy eating habits, and promoting healthy choices."

Dr. Galson appreciated the 2 hour opportunity to meet with key community stakeholders to discuss childhood obesity prevention and learn about existing prevention programs.  He was able to meet and discuss the “Let’s Go” initiative in the Portland area with Dr. Victoria Rogers and also with MMA member, Jonathan Fanburg, MD, who is currently serving as the President of the Maine Chapter of the American Academy of Pediatrics, indicating that physicians are willing to jump on board and are really searching for tools to assist them in their practices.

The Surgeon General stated, “There evidently is tension between academic performance vs physical education activity time allowance in the schools.  There is no reason to separate the two – kids who are less stressed are more focused and their academic performance increases.”

The MMA Public Health Committee is answering that call to ensure that our member physicians have access to the tools to help them work with their patients.  Fall 2008 marks the date for the newly developed public health web page (at www.mainemed.com) to be unveiled to provide that needed one-stop search for the most up to date tools to deal with childhood obesity in the clinical setting.   For more information, contact Kellie Miller, Director of Public Health Policy at kmiller@mainemed.com or 622.3374, ext. 229.

Dr. Fanburg addressing the Acting US Surgeon GeneralDr. Victoria Rogers and Acting US Surgeon General discuss healthy weight initiatives in the Portland area [return to top]

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