January 5, 2009

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Obama Transition Team Health Care Listening Session Draws a Crowd

Approximately seventy persons, including physicians, consumer advocates, and patients attended the December 30th Health Care "Listening Session" sponsored by MMA, the Maine Osteopathic Association, and the Downeast Association of Physician Assistants and held at the Augusta Civic Center.  During the course of nearly three hours, attendees spoke of problems with the existing system and lamented the lack of a true health care "system."  A summary of the comments is available on the MMA website at www.mainemed.com and a link is also available to a video of the session. 

The MMA has sent the summary of comments to the Transition Team to be combined with the comments from more than 4000 such listening sessions held across the country between mid and late December 2008.  The comments will inform President-elect Obama and his health care team as they attempt to craft legislation to reform the way health care is financed and delivered in our country.

MMA Executive Vice President Gordon Smith opened the session by encouraging participants to respect the views of one another and by expressing the hope that patients would come forward with their stories.

MOA President-elect Joel Kase, D.O., MPH moderated the discussion and asked for feedback on seven different questions prepared by the Transition Team.  The first question was the broadest and asked participants to identify the biggest problem with the system.  Responses included the comment that there was no "system," that care was fragmented, and that costs are too high.  A lot of comment focused on the current base of employer-sponsored coverage and the need for more transparency of costs and price.  Several speakers advocated for more focus on public health and individual responsibility.

State representatives Lisa Miller, MPH and Sharon Treat, JD attended the session and noted some of the attempts the state had made to address cost and transparency.  Representative Miller is now on the Appropriations Committee and Representative Treat serves as House Chair of the Joint Standing Committee on Insurance & Financial Services.

MMA to Testify Today Against MaineCare Provider-based Reimbursement Cuts

As noted in last week's Update, MMA representatives will testify today, Monday, January 5, 2009 at the public hearing before the legislature's Appropriations and HHS Committees in opposition to the Governor's proposed cuts to hospital-based physician practices that receive "provider-based reimbursement" in the MaineCare budget.  This annualized reduction of nearly $10 million would negatively impact many of Maine's smaller hospitals at a time when other financial pressures are beginning to appear as well.  The eventual impact on the nearly 1500 physicians employed by hospitals could be significant.

A similar cut was proposed last year but was restored when the Maine Hospital Association offered a funding solution by rebasing the current tax on hospitals.  While the supplemental budget now proposes to decrease the MaineCare reimbursement to provider-base physicians, it does not lower the tax increased last year.

The cuts proposed would technically apply only between the effective date of the legislation and June 30th, but the Department is expected to carry the cuts forward into the next biennial budget beginning July 1, 2009. 

Although the full Legislature does not convene until this coming Wednesday, committee hearings on the supplemental budget begin today.  The longer it takes to impose some savings in the current year the more difficult it is to effectuate the savings in the months left in the fiscal year.

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Thanks to MMA Members Who Completed Membership Survey

More than 33% of active MMA members completed the recent membership survey conducted by Enertrix, a division of the Gallup organization.  In professional survey circles, this is considered an excellent response and is the highest response achieved in any of the state medical society surveys conducted by the firm (six state medical societies and two statewide specialty societies have had similar surveys conducted).  Preliminary results of the survey data are being shared with MMA staff and will be the subject of Executive Committee discussion at its upcoming retreat being held from January 16-18, 2009.  The results will be considered seriously as the Committee determines the MMA's priorities for 2009.

Full survey results will be shared with members through the Weekly Update and the pages of Maine Medicine.

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More on New Coding Center Director, Gina Hobert, CPC

As announced in last week's Update, Gina Hobert, CPC of Farmington has been named Director of the Coding Center, succeeding Jana Purrell, CPC who accepted a position with MidCoast Hospital last June but has been working part time for the Center during the search for a new director.  As of January 5th, Ms. Hobert will be directing the Coding Center on a full-time basis.  Her previous position was at Franklin Memorial Hospital where she was employed for nineteen years.

The mission of the Coding Center is to be a source of accurate and reliable coding and reimbursement information for physicians and their office staffs and to act as an advocate for physicians with payers to ensure appropriate reimbursement.

Established as a joint venture of the state medical societies in Maine, New Hampshire, and Vermont, the Coding Center now is wholly owned by the Maine Medical Association and operates as a program within the umbrella of services offered by MMA.

MMA members and members of the Vermont and New Hampshire state medical societies are able to receive responses to inquiries via telephone and e-mail inquiries without charge as a benefit of membership.  In addition, the Coding Center provides on-site education and consultation services, chart auditing services, and offers various educational programs (including the popular fifteen week course leading to eligibility to sit for the CPC certification exam).  These educational and consultation services are provided under a fee schedule.  A full description of the services and courses are available at www.thecodingcenter.org.   Ms. Hobert can be reached toll free at 1-888-889-6597.

MMA welcomes Gina Hobert to our staff and wishes to acknowledge the excellent work of Jana Purrell, CPC in directing the Center, particularly in the last six months while transitioning to her new position.  We wish her all the best in her position in the hospital community at MidCoast. [return to top]

MMA Completes 2008 with the Highest Membership Level Ever at 3100 Members

MMA closes a very positive year on December 31, 2008 with 3100 members, the most ever at year end.  While it will take most of January to know precisely how we did from a budget perspective, we do know that we collected more than $25,000 in dues beyond that anticipated in the budget.  However, we also suffered a $28,000 loss in the Annual Session account.  That portion of the Association's reserve invested in the stock market not surprisingly took a serious hit as well.  A full report of income and expenses will be included in Maine Medicine in the near future.

Programatically, the Association had a very successful year with programs and services such as the Medical Professionals Health Program, the Coding Center, and the External Peer Review program all having active years.  We are beginning to see significant growth in the office-based Quality Improvement Program as well.  State contracts with the Maine Quality Forum, the Office of Substance Abuse, and the Board of Licensure in Medicine also provided important non-dues income and allowed MMA to provide services and programs that dues alone could not support.  While advocacy for physicians, led by Andrew MacLean, Esq., remains the core of our work, MMA has a growing menu of services for which there appears to be demand.  And our public health advocacy, now in the capable hands of Kellie Miller, MS, Director of Public Health Policy has never been stronger.  In 2008, the MMA also established a new "Senior Section" to give our retired members opportunities to continue their work with MMA.  Thanks for Buell Miller, M.D. for the inspiration for this section.  Dr. Miller rightfully serves as the first Chair of the Section that held three successful meetings in 2008 and has four sessions lined up for 2009.

2009 promises to be a challenging but exciting year.  The deepening recession, state budget issues, and a new administration in Washington provide an interesting context for MMA's work the coming year. 

Whether you are reading this as a member, a practice manager, a corporate affiliate, or just an interested party, thank you for your support and interest in MMA.  We believe we have the best members anywhere and that they are deserving of strong support every day of the year.  A special thanks as well to the current officers and members of the MMA Executive Committee and other committees who volunteer their time to lead.  The organization could not have existed for 155 years without this support.  Happy New Year!

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124th Maine Legislature Returns to a Challenging 2009 Session on Wednesday

As pointed out in another article in this newsletter, the new legislature's Appropriations and HHS Committees begin public hearings on the Governor's proposed supplemental budget for the current state fiscal year ending June 30, 2009, L.D. 45, tomorrow - before the full 124th Maine Legislature returns to work at the State House on Wednesday, January 7, 2009.  "Money issues," both revenue and expenditures will be key issues for the MMA and other health care advocates during the 2009 legislative session.  

The MMA Legislative Committee, under the direction of Samuel P. Solish, M.D. and Lisa D. Ryan, D.O., will do its best to represent all physician interests before the Maine legislature and executive agencies in 2009.  Any member or medical specialty society representative who is interested in the MMA's advocacy work is welcome to participate in our decision-making.  The MMA staff will solicit feedback on each bill determined to be of interest to the physician community through the Maine Medicine Weekly Update.  The MMA staff also will provide highlights of the previous week's work in the legislature and "Legislative Alerts" or "calls to action" for the coming week through the Weekly Update.  The Legislative Committee also plans several legislative forums on current legislative topics during the 2009 session.  The first likely will be scheduled during February.  For the most current legislative updates, the MMA Legislative Committee will begin weekly conference calls every Tuesday at 7 p.m. on Tuesday, January 13, 2009.  These calls will use the MMA's regular conference call line:  800-989-2842.  The access code is 6223374#.  For more information about the MMA's advocacy work, please contact Andrew MacLean, Deputy EVP, at amaclean@mainemed.com or 622-3374, ext. 214. [return to top]

Maine Patient Centered Medical Home Pilot Now Accepting Applications

please note that the Maine Patient Centered Medical Home (PCMH) Pilot is launching a call for applications from primary care practices interested in applying for participation on the Pilot.   Please see additional information, below (also attached as PDF), including specific steps for interested practices:

Application Process - The Maine PCMH Pilot will begin accepting applications from interested primary care practices on January 5.  Interested practice sites are asked to complete the following steps in sequence by February 28, 2009:

1.    Review the “Maine PCMH Pilot – Background & Application Process” summary available in the “Resource Library” section of the Quality Counts website at www.mainequalitycounts.org.  This document outlines the details of the application process, including eligibility criteria and timeline.

2.    Complete the TransforMED “Medical Home IQ” (MHIQ) online practice assessment, available online at: http://www.transformed.com/MHIQ

3.    Contact Maine PCMH Pilot project staff to register intent to apply; contact Dr. Lisa Letourneau at tel. 415.4043, or Letourneau.lisa@gmail.com.

4.     Complete the Maine PCMH Pilot Application for Participation – available online http://www.surveymonkey.com/s.aspx?sm=mF9e1z_2bssYQ6ucmIZzVLwg_3d_3d

5.    Complete and return a printed, signed copy of the Maine PCMH Pilot Memorandum of Agreement, available under the “Resource Library” section of the Quality Counts website, www.mainequalitycounts.org.

The Dirigo Health Agency’s Maine Quality Forum, Quality Counts, and the Maine Health Management Coalition have convened a multi-stakeholder effort to develop, implement, and evaluate the Maine Pilot of the Patient Centered Medical Home (PCMH) as the first step in achieving statewide implementation of a PCMH model.  Following completion of a 6-month planning period, the conveners are now launching a 3-year Pilot with a call for interested practices to submit applications by February 28, 2009. 

Practices wishing to participate in the PCMH Pilot will need to be able to demonstrate structures and processes consistent with the medical home model, and will need to commit to targeted quality improvement and waste-reduction initiatives that demonstrate the value of the enhanced payment model.  A set of 10 to 20 Maine primary care practices will be selected for the Pilot by mid-March, based on their demonstrated ability to meet the core eligibility requirements for participation, and their demonstrated commitment to the medical home model.  Selection principles for the Pilot include a plan to select practices representing a range of geographic locations, practice types and size, and populations served.  Practices will be selected for participation by mid-March, and following a 6-month “ramp-up” period, are expected to be active in the Pilot by fall 2009. 

Anthem BCBS, Aetna, CIGNA, Harvard Pilgrim Health Care, and MaineCare have participated in the planning of the Pilot, and have committed to working with Pilot practices to provide alternative payment for primary care that recognizes the infrastructure and system investments needed to deliver care in accordance with the PCMH model and rewards practices for demonstrating high quality and efficient care. The Pilot will be evaluated using a comprehensive approach that includes nationally recognized measures of quality, efficiency, and patient-centered measures of care.

A wide range of stakeholders have supported development of the Pilot.  Implementation of the Pilot is being supported by the Maine Quality Forum and Quality Counts.  Major funding is being provided by the Maine Health Access Foundation (MeHAF), with additional support from Martins Point Health Care, and Anthem BCBS.  The ultimate goal of this effort is to sustain and revitalize primary care both to improve health outcomes for all Maine people and to reduce overall healthcare costs. [return to top]

MeMGMA Presents 2009 Third Party Payer Seminars

The Maine Medical Group Management Association is Pleased to Present:  2009 THIRD PARTY PAYER SEMINARS

Two Dates and Convenient Locations:
Wednesday, January 14, 2009 Keeley’s Banquet Center, 178 Warren Avenue 5 Coffin Avenue Portland, Maine
Wednesday, January 21, 2009 Jeff’s Catering, Brewer, Maine

Provider representatives from the major payers will be speaking at this seminar and providing updates as to the status of claims processing. Representatives from the following insurance companies have been scheduled to attend:  CIGNA, MAINE CARE, AETNA, MARTIN’S POINT, HARVARD PILGRIM, MEDICAL NETWORK (MEDNET), MEDICARE, MAINE NETWORK FOR HEALTH, ANTHEM

Participants will have the opportunity to ask questions concerning reimbursement issues affecting physician practices in general, but should not expect answers to questions concerning individual account situations.

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

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