April 20, 2009

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Happy Patriots Day! MMA Office is Open

Today is Patriots Day in Maine and Massachusetts.  The MMA Office is open from 7:00 am to 5:00 pm, recognizing that most physician offices are open.  While the Maine Legislature is not holding general sessions this week, some key committees will continue to meet for public hearings and work sessions.  With just over two months left in the session, the 124th Legislature still has a lot of work in front of it, including passing a biennial budget in the face of a growing deficit.  MMA is currently following more than one hundred legislative bills impacting on medical practice or public health.

While the last couple of weeks has seen the resolution of some of the bills, many significant ones remain.  Among those bills not yet resolved are proposals to allow pharmacists to administer flu shots and immunizations, bills changing the funding mechanism for the Dirigo Health Agency, and several bills affecting health insurers, certificate of need and public health infrastructure.  A bill imposing very detailed reporting of expenditures by drug companies on behalf of physicians and other prescribers has been held over until the next legislative session in 2010.

The Association has been pleased to be able to have a physician of the day for all but one day of session so far.  If you have not yet volunteered in this capacity and would like to do so, there are still openings in May and June.  Contact Maureen Elwell at MMA if you are interested (melwell@mainemed.com or 622-3374, ext. 212).  Any physician, regardless of specialty, is welcome.

On Thursday, May 21, MMA and the Maine Osteopathic Association will jointly host a Physician's Day at the Legislature.  All specialty societies and any interested physician are invited to participate.  Contact Maureen Elwell at the address above if you, your specialty society, or your group practice is interested in participating.

MaineCare May Run Out of Money May 8, 2009

Members of the Legislature's Appropriations Committee were told recently that the MaineCare program may run out of money as early as May 8.  They had previously been told that the program was looking at a $65 million shortfall for the fiscal year ending June 30th, but the recent announcement caused great concern among hospitals, physicians, and other MaineCare providers. 

Federal stimulus funds could be used to bridge the gap from May 8 to June 30, but those funds have not yet arrived.  If these funds do not arrive by May 8, there are several other scenarios that could provide funds to carry the Department over, including appropriating funds from elsewhere in the Department or by passing an emergency spending measure.  Another option would be to enact the biennial budget and include a provision dealing with the shortfall.

A more serious problem is that the state is now expecting a bigger budget gap than originally anticipated, perhaps by as much as $300 to $500 million.  Now that the individual state tax returns are in, it is expected to be about another week before that final shoe drops.  If the deficit increases by this magnitude, it is difficult to see how a balanced budget could be passed by July 1 without increasing revenues or enacting deep cuts in the areas of education and health care - where most of the money is spent.

We will continue to report on this issue in the Weekly Update. [return to top]

All Speakers Confirmed for June 3rd Practice Education Seminar in Augusta

The Association presents its 18th Annual Practice Education Seminar on Wednesday, June 3rd at the Augusta Civic Center.  Keynote presenters are the Honorable Janet Mills, Attorney General and the Honorable Mila Kofman, Superintendent of Insurance.  Other presentations during the morning plenary sessions include a panel on current quality improvement initiatives in the state and a talk on the various incentives being offered to e-prescribe or move to an electronic medical record.  MaineCare officials will provide an update on the fee schedule and the new computer system over lunch.  The first talk begins at 8:30 am and the last set of breakout sessions concludes at 4:30 pm.

Twelve breakout sessions in the afternoon are organized around the four topics of Technology, Compliance, Practice Management, and "Hot Topics."  The individual subjects cover the following areas:

  • Incentives to Automate
  • Legal Issues Surrounding EMR
  • HealthInfoNet
  • HIPAA Update (highlighting the changes in the federal Stimulus bill)
  • FTC "Red Flag" Rules (intended to prevent identity theft, effective date May 1, 2009)
  • Update in Employment Law (including recent federal changes in the Family Medical Leave Act)
  • Collections
  • Coding and Documentation
  • Prescription Drug Abuse
  • Academic Detailing (What is it?  What impact may it have)
  • Risk Management 2009
  • Medicare RAC Audits (coming soon to Maine through contracts with outside auditing firms)

Watch your mail (regular mail, e-mail and fax) for registration materials later this week.  This program is offered just once a year and has become a regular event for many practices.  If you want to reserve a spot even before receiving the registration materials, just call the MMA office at 622-3374 and press 0. [return to top]

May 1 "First Friday" Program on Legal Issues Regarding EMR

The Augusta health law firm of Kozak & Gayer will present the next MMA "First Friday" presentation on Friday morning, May 1, at the MMA offices in Manchester.  The topic will be Legal Issues Regarding Electronic Medical Records and the program will run from 9:00 am to noon.  There is a $60 registration fee which covers breakfast and all written materials.  Watch your e-mail for a flyer with the complete agenda later this week.

This program would be of particular interest to any practice beginning to think about EMRs now that the federal stimulus package has provided financial incentives for such through increased Medicare reimbursement.

A briefer, one-hour version of the program will also be included during the June 3, 2009 Annual Practice Education Seminar at the Augusta Civic Center (See other article in this week's Update).

For more information or to reserve a spot at the program, call Maureen Elwell at 622-3374, et 219.  [return to top]

CMS Recovery Audit Program Readying for Nationwide Rollout

The Centers for Medicare and Medicaid Services (CMS) confirmed recently that its Recovery Audit Contractors (RAC) will be operational in all fifty states by the end of the calender year.  The stated objective of the Program is to identify underpayments from and overpayments to Medicare providers.  Despite considerable efforts by CMS to introduce the program via educational sessions and other outreach, the Program is very unpopular as it provides a financial incentive for the RAC contractors to find errors in Medicare billing.  The incentive involves the contractor receiving a portion of any overpayments recovered.  This idea was so unpopular a few years ago when introduced by MaineCare, that the legislature enacted legislation at the request of MMA prohibiting MaineCare from providing such a financial incentive once the current contract had expired.  Unfortunately, this Maine law does not apply to the federal government.

The contractor operating in Region A, which includes Maine, is Diversified Collection Services Inc. of Livermore, California.  CMS issued some initial parameters recently for the record requests that the RAC's might make.  For 2009, the limits for Part B providers are as follows:

  • Ten medical records per 45-day period for solo providers

  • Twenty medical records per 45-day period for offices with 2 to 5 providers

  • Thirty medical records per 45-day period for groups of 6 to 15 providers

  • Fifty medical records per 45-day period for groups of 16 or more providers

The RAC program limits the medical record review period to three years and audits on claims paid prior to October 1, 2007 are prohibited.  The RAC must also have a physician medical director, and the contractor must make certified coders available to discuss denials.  RAC auditors must also provide clinical credentials upon request.

At the MMA Annual Practice Education Seminar on June 3, 2009 at the Augusta Civic Center, Andrew Finnegan  of CMS will present further details about the program (See other article in this Update about the June 3 program).  Mr. Finnegan's breakout session will be in Track Four at 3:30 pm. 

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FTC Red Flag Rules Aim at Identity Theft

On November 9, 2007, the Federal Trade Commission (FTC) published the so-called Red Flag rules, which define what a creditor must do to implement an identity theft prevention program.  These rules apply to any entity that allows for payment of services after the services are provided or over a period of installment payments.  Therefore, a medical practice that does not require payment of all charges at the time of services, or prior to, is likely to be considered a creditor under the rule.  The AMA and several other medical organizations have attempted to change the interpretation of the definition of creditor, but so far the FTC has declined to exclude physicians and other medical professionals from the rule.  Compliance is required by the effective date of May 1, 2009.

The Red Flag rules require a creditor to make reasonable attempts to detect and prevent identity theft and to respond appropriately when it suspects identity theft has occurred.

Developing an identity theft prevention program involves a three-step process:

  1. Identify relevant "red flags" -- patterns, practices, or specific activities that indicate the possible existence of identity theft.

  2. Watching out for a patient who refuses to provide personal identifying information or documents, or who provides suspicious documents or information.

  3. Implement a plan to respond appropriately to any red flags. 

Appropriate responses may include notifying the patient or law enforcement.

Brett Witham, Esq., of Verrill & Dana, who authored an article in the March-April Maine Medicine, will present a one hour breakout session on this topic at the 18th Annual Practice Education Seminar being held Wednesday, June 3 at the Augusta Civic Center (See other article in this Update for additional information on the Seminar).  Brett's talk will be at 2:15 pm as part of the Track II Breakout Sessions on Compliance.

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Kim Block Wow's Attendees at Annual Corporate Affiliate Breakfast

Long-time WGME News anchor Kim Block addressed nearly one hundred guests at the Annual MMA Coporate Affiliate breakfast last Wednesday at the Portland Country Club.  Kim talked about her team's travel to China last Fall to document the work of Portland surgeon Reed Quinn, M.D. and his team of medical professionals that travels to China periodically to treat Chinese children and teach Chinese physicians under the auspices of the Maine Foundation for Cardiac Surgery

The WGME story, The China Journey, recently won an Edward R. Murrow Award  from the Radio-Television News Directors Association.

Kim Block is the most recognized news anchor in Southern Maine and has been at the station for twenty-seven years.  Her late father practiced surgery in Virginia and was active in the AMA, a connection she noted during her talk.  Retired Portland surgeon and former AMA President Robert McAfee attended the breakfast and presented Kim with some photos of her father at AMA functions.

MMA's Corporate Affiliate Program provides an opportunity for businesses, firms and other vendors interested in Maine's medical community to network with MMA members and to support MMA activities through joint marketing.  The program is operated under the auspices of MMA's Committee on Membership and Member Benefits.  The Committee is currently chaired by Kevin Flanigan, M.D. of Pittsfield, a former MMA President.

MMA will make a contribution in Kim's name to the Foundation. [return to top]

Wanted: A Few Good Men and Women to Serve on MMA Committees

A voluntary association is only as strong as its volunteers.  The MMA Committee on Nominations is seeking nominations for committee positions to commence with the MMA Annual Meeting on September 12, 2009.  In addition to Executive Committee vacancies in Waldo, Lincoln-Sagadahoc, and Oxford Counties, committee positions are available for the following committees:

  • Legislative Committee
  • Committee on Physician Quality
  • Payor Liaison Committee
  • Public Health Committee
  • Bylaws Committee
  • Committee on Loan and Trust Administration
  • Committee on CME and Accreditation

The Committee on Physician Quality and the Payor Liaison Committee include both members and non-physicians who are practice managers of member-related groups.

Members/practice managers interested in a committee appointment should communicate with Diane McMahon at MMA via e-mail to dmcmahon@mainemed.com or by calling her at 622-3374, ext. 216.  [return to top]

Looking for Physician Runners

Physician's Day at the Legislature on Thursday, May 21st will begin early with a 7:00 am run with Governor Baldacci along the new Kennebec River Rail Trail between Augusta and Gardiner.  If you run or know of physicians who do, please pass on this information.  We are not sure yet how long this run will be, but will communicate that critical information between now and the 21st.  We hope to have some legislators run with us as well.  We hope to have showers available at the nearby YMCA for those physicians who are not local and who may be staying for other activities at the legislature that day.

A morning run, or a brisk walk for those of you so inclined, is a great way to highlight the Association's public heath agenda focusing on physical activity and nutrition. 

The Maine Osteopathic Association is a co-host of the events of the day.

If you are interested in participating in the morning run, please contact Andrew MacLean, Deputy EVP, at amaclean@mainemed.com or call the MMA office at 622-3374, ext. 214. [return to top]

Maine CDC Medical Epidemiologist Position

The Maine CDC is advertising for a Medical Epidemiologist to work in the Division of Infectious Disease to provide guidance and support to approximately 12-15 epidemiologists for disease investigations and outbreak control, surveillance activities, and planned epidemiologic studies. The person is expected to be involved in the development of disease investigation protocols and the review of case investigations as well as to consult with physicians and other health care professionals on disease prevention and control measures. The person is also expected to respond to inquiries from the public and media as well as interact with staff in the Office of Public Health Emergency Preparedness, the Health Inspection Program, and the Health and Environmental Testing Laboratory. On call duties are rotated among several physicians, and primarily consist of phone call support for on-call epidemiologists.  Requirements for the position include:  graduation from an accredited school of medicine or osteopathy with board certification in an appropriate medical specialty; a twelve year combination of training and experience in medicine and public health, to include a minimum of four years experience as an epidemiologist, or a Masters Degree in Public Health or a related field and six years experience in the field of medicine and public health, to include a minimum of four years of experience as an epidemiologist. Current license or eligibility to be licensed to practice in the State of Maine is also required.  The position is open until May 22nd.  Salary range is up to about $141,000.  Additional benefits include comprehensive health and dental insurance as well as retirement.  For more information:  http://www.maine.gov/tools/whatsnew/index.php?topic=dhhs_direct_hire_jobs&id=71243&v=dhhs

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Political Pulse: Legislative Highlights of the Week


The State House will be relatively quiet this week as the legislature has scheduled no general sessions during the school vacation week.  Some committees are meeting for public hearings or work sessions, but even the committee schedules are pretty light.  The Judiciary Committee has scheduled its hearing on the gay marriage bill, L.D. 1020, for Wednesday afternoon at the Augusta Civic Center.


 The FY 2010-2011 biennial budget (L.D. 353) remains in work session in the Appropriations Committee, but some members of leadership expressed the hope last week that the biennial budget would be closed by the end of the first full week of May.  The hospital and physician reimbursement issues very much have been part of the behind-the-scenes negotiations.  Last Thursday afternoon, these issues came back to the Health & Human Services Committee when the Maine Hospital Association presented an alternative proposal to the HHS Committee recommendations that would, at least in part, cover the $9.1 million General Fund cuts in hospital reimbursement by reducing hospital prospective interim payments (PIPs).  Senator Lisa Marrache, M.D. also offered an alternative proposal that would change hospital reimbursement to a DRG/APC payment methodology in FY 2010-2011 (earlier than planned by the Department) and also reducing hospital PIPs.  The HHS Committee may meet on this issue some time this week.


Last week, the HHS Committee had another busy week of public hearings and work sessions.  Members considered two bills on medical marijuana, L.D. 975, An Act to Establish the Maine Medical Marijuana Act, the citizen-initiated bill, and L.D. 1070, Resolve, Directing the University of Maine at Orono to Conduct a Pilot Project Regarding the Benefits of Medical Marijuana.  The MMA testified "neither for nor against" the bills, but urged caution in expanding the list of qualifying conditions under the act.  Mark Publicker, M.D. testified in opposition to L.D. 975 on behalf of the society of addiction medicine.  The university system strongly opposed L.D. 1070, saying that it would jeopardize federal and other funding.  The Committee rejected both bills and L.D. 975 will be before the voters in November.  While L.D. 975 does expand slightly the list of qualifying conditions under the act, most of the bill deals with a registry of qualified individuals, dispensaries, and an increase the allowed amount of marijuana under the act.

The Committee also considered and rejected a bill that would have required specific screening for and mandatory CME on domestic violence:   L.D.1116, An Act to Ensure Health Care Practitioners Understand and Screen for Domestic Abuse for Pregnant Women and New Mothers.  The MMA, the Maine Chapter of the American Academy of Pediatrics, and the Maine Division of the American College of Obstetricians & Gynecologists opposed the bill.

The Committee addressed several more bills dealing with prescription drug diversion.  Members seem inclined to proceed with L.D. 821, An Act to Support Collection and Proper Disposal of Unwanted Drugs, a bill that would require the pharmaceutical industry to develop a process for collection of drugs under a "product stewardship" theory.  The Committee plans another work session on the issue.  The Committee will broaden access to the Prescription Monitoring Program by including the Office of the Chief Medical Examiner in L.D. 1359, An Act to Improve the Use of Data from the Controlled Substances Prescription Monitoring Program.  The Committee declined to proceed with L.D. 1354, Resolve, Directing the DHHS to Limit Prescriptions for Narcotic Drugs under MaineCare without Prior Authorization, a bill opposed by the MMA.


Last week, the Insurance & Financial Services Committee addressed a number of health care reform bills.  The MMA spoke in support of L.D. 1205, An Act to Establish a Health Care Bill of Rights, a bill sponsored by IFS House Chair Sharon Treat (D-Hallowell) that would, among other things, require health plans to provide additional due process rights for physicians in pay-for-performance or network tiering programs.

The Committee heard from representatives of Maine's strong minority of single-payer advocates on L.D. 1365, An Act to Establish a Single-Payer Health Care System and L.D. 1002, Resolve, to Conduct an Updated Study of the Feasibility of Establishing a Single-Payor Health Care System in the State.  The MMA has standing policy in opposition to a single-payer system, but a recent member poll indicates that the physician community in Maine is evenly divided on the issue.  There currently is insufficient support in either the legislative or executive branches of Maine government to proceed with a single-payer initiative.

The MMA also testified in favor of L.D. 1264, An Act to Stabilize Funding and Enable DirigoChoice to Reach More Uninsured, a bill that would replace the "savings offset payment" or SOP with an assessment on paid claims.


The Education & Cultural Affairs Committee last week finished its work on L.D. 853, An Act to Encourage Maine Residents to Attend Medical School and Practice in Maine. The bill restructures the FAME medical education loan program to support students at Maine-based medical schools at the University of New England, Maine Medical Center, and Eastern Maine Medical Center.


The Judiciary Committee last week held a public hearing on L.D. 1192, An Act to Change the Statute of Limitations for Health Care Practitioners, sponsored by Senator Peter Mills (R-Somerset).  MMA EVP Gordon Smith testified against the bill and gave the Committee the history of tort reform in Maine.  The Maine Trial Lawyers Association did not speak on the bill.  The Committee also heard L.D. 1209, An Act Regarding the Consent of Minors to Receive Substance Abuse and Mental Health Treatment.  The MMA and the Maine Chapter of the American Academy of Pediatrics both spoke against this bill.  The MMA does not expect the Judiciary Committee to recommend passage of either bill.



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REMINDER: Legislative Committee Conference Call this Thursday at 8:30 p.m.

There are no new bills for review this week.  However, the Legislative Committee still will hold its regular weekly conference call for a brief update at 8:30 p.m. on Thursday, April 23, 2009.  The conference call number is 800-989-2842 and the access code is 6223374#.  Any interested MMA member or specialty society representative is welcome to join the call. [return to top]

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