June 22, 2009

 
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AMA Clarifies Position on Health System Reform & Public Plan Option

The presentation by President Obama to the AMA House of Delegates one week ago continues to generate discussion and debate.  As does the announcement by the Senate Finance Committee last week that it would not be likely to successfully mark up a bill on health system reform until after the July recess.  The CBO ten year cost estimates (>$ 1 trillion) also is problematical.  No one ever said this was going to be easy...

The national health care reform debate and President Obama's speech on Monday at the AMA's 158th Annual Meeting in Chicago continue to be at the forefront of the news.  In a statement released on Wednesday, June 17th, the AMA stated that the organization will "support health system reform alternatives that are consistent with AMA principles of pluralism, freedom of choice, freedom of practice, and universal access for patients."

"The AMA is committed to health reform this year, and we are focused on ending our nation's uninsured crisis," said AMA Immediate-Past President Nancy H. Nielsen, M.D.  "We will stay engaged with Congress and the administration to ensure that health reform proposals meet the AMA's criteria so that health reform makes a positive difference in the lives of our patients."  

"We welcome and will thoughtfully consider all proposals consistent with AMA principles to provide Americans with affordable, high-quality health coverage," said Dr. Nielsen.  "We look forward to the day when all Americans have health care coverage."

You can find materials related to the recent AMA meeting, including the President's speech on the web at:  http://www.ama-assn.org/ama/pub/about-ama/our-people/house-delegates/2009-annual-meeting/speeches.shtml.

The AMA has developed the following documents on national health care reform following the annual meeting.

AMA FRAMEWORK FOR HEALTH SYSTEM REFORM

AFFORDABLE COVERAGE FOR ALL

We want all patients to have health insurance, with subsidies (in the form of tax credits or vouchers) for those who can't afford it.

We want patients to be in the driver's seat rather than government or employers.

We want families and individuals to be able to choose from a variety  of affordable health insurance options.

We want those choices to be more affordable than they are now, and insurance market reforms are needed to make that happen.

Patients must retain the ability to choose their own doctor and be permitted to enter into private contracting arrangements with their physicians.

Medical decisions should be made by patients and their doctors, using the best possible information.

No one should be denied health insurance because of pre-existing conditions.

Ideally, we want patients to own their health insurance even if it's financed through their employer, so if they leave that job, the insurance isn't lost, just paid for differently.

PREVENTION AND PERSONAL RESPONSIBILITY

We want greater investment in prevention and wellness, so that preventable diseases attributed to obesity and smoking are avoided, thereby lowering future costs.

We want everyone to take responsibility for their own health, insurance protection for their family, and choosing a personal physician.

We want everyone to make and carefully document their wishes about end of life care - even those who are now young and healthy.

QUALITY IMPROVEMENT

Through the AMA convened Physician Consortium for Performance Improvement (PCPI), the medical professionl will continue and intensify efforts to develop evidence-based guidance for quality improvement.

Providing physicians and patients with real time data for decision-making at the point of care should be the driving force for quality improvement.

DELIVERY REFORM

We support efforts to improve care coordination and management of chronic disease, including the patient-centered medical home and greater support for primary care.

Current antitrust policy must be modified to enable small physician practices to pursue quality improvement, care coordination and health information technology initiatives to achieve greater clinical integration in the delivery system.

REDUCING COSTS

The AMA has pledged to do its part to help reduce the rate of growth in health care spending.  The AMA convened PCPI is developing measures to reduce unnecessary utilization by focusing on services, treatments and conditions that entail high variation, high volume, and high cost, and have the potential for improving quality and efficiency of care.

We are also working with policymakers and other health stakeholder organizations to streamline the insurance claims processing system, reduce time and resources devoted to paperwork and lower costs for patients, physicians and payers.

Medical liability reforms will reduce costs by reducing the practice of defensive medicine.  We urge policymakers to authorize health courts, administrative compensation systems, early offer models, and "safe harbors" for physicians who follow best practice guidelines, and to adopt other proven medical liability reforms.

FISCAL RESPONSIBILITY AND SUSTAINABILITY

Health system reform must be achieved in a fiscally responsible manner in order to maintain a sustainable health care delivery system.

KEY HEALTH SYSTEM REFORM ACTIONS TAKEN

AT THE 2009 ANNUAL MEETING OF THE AMA HOUSE OF DELEGATES

HEALTH SYSTEM REFORM PRINCIPLES

Adopted policy supporting health system reform alternatives that are consistent with AMA principles of pluralism, freedom of choice, freedom of practice, and universal access for patients.

MEDICARE PHYSICIAN PAYMENT REFORM

Adopted a set of principles that should be upheld in the development of any Medicare physician payment reform efforts, including ensuring that reform efforts:

  • promote improved patient access to care;
  • are designed with input by the physician community;
  • ensure payment rates that cover the full cost of sustainable medical practice;
  • include participation options for all physicians; and
  • ensure an appropriate level of physician decision-making authority over any shared-savings distributions. 

PATIENT-CENTERED MEDICAL HOME

Clarified AMA support for the patient-centered medical home as a model for providing care to patients without restricting access to specialty care, and will urge the Centers for Medicare & Medicaid Services to work with the AMA and specialty societies t design incentives to increase care coordination among all physicians.

RIGHT TO PRIVATELY CONTRACT

Included in the AMA's top advocacy priorities in 2009:  the right of patients to privately contract with physicians; and the ability of physicians to collectively negotiate with health plans.

MEDICAL LIABILITY REFORM

Adopted policy to press for effective medical liability reforms as part of comprehensive health reform legislation.

ELIMINATING RESTRICTIONS ON PRE-EXISTING CONDITIONS

Adopted policy to support health insurance coverage of pre-existing conditions with guaranteed issue in the context of an individual mandate.

INCENTIVES RATHER THAN PENALTIES FOR HIT ADOPTION

Adopted policy cautioning policy makers on the high costs of adopting health information technology (HIT) and advocating for greater adoption of HIT through incentives to e-prescribe and implement and maintain electronic medical records (EMR), without penalty for non-adoption of these systems.

PHYSICIAN WORKFORCE

Adopted policy that enhancements to bolster the physician workforce must be part of any comprehensive federal health system reform, including advocating for expanded funding for entry and continued training positions in specialties and geographic regions with documented medical workforce shortages.

MEDICAL STUDENT DEBT RELIEF

Adopted policy advocating for student debt relief through 100% tax deductibility of student loan interest.

FOLLOW ON BIOLOGICS

Adopted policy to make follow on biologics more available to patients and physicians (as a lower-cost alternative), while protecting patient safety and allowing a reasonable timeframe for FDA exclusivity and patent expiration.

HEALTH INSURANCE UNDERWRITING POLICIES

Adopted policy that urges insurance companies to make underwriting decisions based only on the presence of conditions that are valid predictors of morbidity and mortality.

PREVENTION AND PERSONAL RESPONSIBILITY

Adopted policy to improve health and preventive care efforts by advocating for increased physical activity, proper diet and personal responsibility, and working with concerned organizations to achieve this goal.

PRINCIPLES FOR PUBLIC RELEASE OF PHYSICIAN DATA

Adopted a series of principles addressing the public release and accurate use of physician data, including patient privacy safeguards, data accuracy and security safeguards, transparency requirements, review and appeal requirements, physician profiling requirements, quality measurement requirements, and patient satisfaction measurement requirements.



 



 



 



 



 



 



 



 



 



 



 

 



 



 



 



 



 



 



 

Payor Liaison Committee Hears About Medicare RAC Audits

Andrew Finnegan from the Region I office of CMS met with MMA's Payor Liaison Committee on June 10 to discuss the Medicare Recovery Audit Contractors (RAC) program which will be operational in Maine by this Fall.  The contractor for Maine and the rest of Region I has been selected  (DCS) and the underlying federal law and contract allows the contractor to collect a contingent fee for every overpayment it identifies (State law introduced at the request of MMA prohibits such a payment arrangement by MaineCare).

Mr. Finnegan discussed the underlying rationale for the program being authorized by Congress.  In 2008, the Medicare program led all federal programs with errors in payment, representing over $10 billion through an error rate of 3.6%.  Medicare receives more than 1.2 billion claims per year.

Any physician or practice in Maine which bills Medicare is subject to these audit reviews, which are either automated (without review of any medical record) or complex (where medical records will be requested).  The RAC reviews are done only on a post-payment basis.  In planning for these audits, the following points should be kept in mind:

  • RACs will not be able to review claims paid prior to Oct. 1, 2007.
  • Subject to the Oct. 1, 2007 provision, RACs will be able to look back only three years from the date the claim was paid.
  • RACS are required to employ a staff of nurses, or therapists, certified coders, and a physician medical director.
  • Once an overpayment is identified, repayment will be by offset from future payments unless the provider has sent in payment by check or has filed an appeal.
  • Once a demand letter is received, the provider will be given an opportunity to discuss the improper payment determination with RAC staff (this is prior to the more formal appeal process).
  • Underpayments also may be identified and paid.

CMS has limited the number of medical records that can be reviewed in any 45 day period, as follows:

  • Sole Practitioner: 10 medical records per 45 days per NPI
  • Partnership of 2-5 individuals:  20 medical records per 45 days per NPI
  • Group practice of 6 to 15 individuals:  30 medical records per 45 days per NPI
  • Large group of 16 plus providers:  50 medical records per 45 days per NPI.

Different limits apply to hospitals.

Mr. Finnegan suggested three things that practices could do to get ready for these audits:

  • Know where previous improper payments have been found.
  • Know if the practice has had previous issues arise resulting in improper payments or payment denials.
  • Prepare to be able to respond to RAC medical record requests.

MMA's Coding Center may be useful if the practice wishes to have some chart audits performed prior to the federal program beginning.  The Coding Center is accessible by communicating with Director Gina Hobert, CPC, MBA at ghobert@thecodingcenter.org.

In determining what issues have arisen in previous audits, go to www.cms.hhs.gov/rac.  The Office of Inspector General also provides similar information at www.oig.hhs.gov/reports.html.

To appeal a RAC overpayment decision, you must file an appeal letter within 120 days after receiving the demand letter.

MMA will continue to look for opportunities to provide presentations by the contractor itself, DCS out of Livermore, CA. [return to top]

Maine Concussion Management Initiative Plans Conference on Sports-related Concussions

The Maine Concussion Management Initiative will be hosting a wide range of medical professionals for the Maine Concussion Management Conference on July 31, 2009 from 9 a.m. to 4 p.m. in the Diamond Building at Colby College in Waterville.  Attendees will learn the newest advances in the treatment of sports-related traumatic brain injuries and may have the opportunity to be certified in one of the best computerized cognitive testing tools on the market.  This is a great opportunity for Maine to establish a network of certified concussion management medical practitioners.

 The Initiative is especially excited to have three highly-qualified lecturers for the conference:  Dr. Paul Berkner, Dr. William Heinz, and Dr. Michael "Mickey" Collins, one of the founders of the ImPACT testing battery, which currently is in use by the NFL, NHL, MLB, and NBA, among other sports organizations.

Continuing professional education credits will be available - up to 6 CME hours and up to 0.6 CEUs.  Registration materials will be available soon.  For more information, please contact Kate Vasconi at 859-5314 or by email at concussionmanagement@gmail.com. [return to top]

Second Annual Quality Symposium: Wednesday, June 24 in Rockport

The Maine Medical Association, the Maine Hospital Association and the Maine Osteopathic Association are presenting the second annual Quality Symposium, featuring Brian Wong, M.D., MPH presenting, "Hospital-Physician Relations:  Building a Foundation of Trust and a Shared Vision of Excellence," at the Samoset Resort on June 24.   A board certified family physician with a 30 year career in the healthcare industry, Dr. Wong is widely recognized as an innovator in healthcare strategy.  The afternoon features a panel discussion entitled, "Hospitals and Physicians Working Together - Sharing Success Stories Here in Maine."  The program has been approved for 6.5 hours of category one CME.

The target audience for this program includes chief executive officers, other senior-level executives, physicians and board members.  While any physician, executive or board member from any healthcare organization will benefit from participating, interdisciplinary team attendance is highly encouraged.

Registration information is available at http://www.themha.org/education/QualitySymposiumflyer.pdf.  Questions about the program may be directed to the Maine Hospital Association at 622-4794.  The registration fee is $100 per person and includes a continental breakfast, lunch and program materials.

For those persons wishing to stay overnight, rooms are available at the Samoset Resort at a discounted rate for Tuesday, June 23.  You may call the Samoset directly at 1-800-341-1650 and ask for the MHA rate. [return to top]

DHHS Seeks State Epidemiologist

CURRENT VACANCY INFORMATION: The Department of Health and Human Services (DHHS) is driven by its vision of Maine people living safe, healthy and productive lives.  Its goal is to assist the people of Maine in meeting their own needs, as well as the developmental, health and safety needs of their children.  It serves the public in an environment that reflects a caring, responsive and well-managed organization.  The Maine Center for Disease Control & Prevention, Infectious Disease Division, is charged with decreasing morbidity and mortality through the prevention and control of infectious disease.  Program areas within the Division include Infectious Disease Epidemiology, the Maine Immunization Program and the HIV/STD/Viral Hepatitis program.

JOB DESCRIPTION: As State Epidemiologist in the Division of Infectious Disease, you will provide guidance and support to approximately 12-15 epidemiologists for disease investigations and outbreak control, surveillance activities, and planned epidemiologic studies.  You will also be involved in formulation of statewide public health policy including providing legislative testimony for the Department.  You will be involved in the development of disease investigation protocols and the review of case investigations.  You will consult with physicians and other health care professionals on disease prevention and control measures. You will respond to inquiries from the public and media on a regular basis.  You will interact with staff in the Office of Public Health Emergency Preparedness, the Health Inspections Program, and the Health and Environmental Testing Laboratory.  You will be part of the on-call rotation for nights and weekends (for telephone consultation, not on-site work) and provide technical support to other staff as needed when they are on-call.  The State Epidemiologist will report to the Director, Division of Infectious Disease.

REQUIREMENTS:  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.

SPECIAL REQUIREMENT:  Current license to practice medicine in the State of Maine.

To apply, please send a completed direct hire application, and resume to:

                                                        Department of Health and Human Services
                                                        221 State St.  Attn: V. Roussel, Human Resources Div.
                                                        11 State House Station
                                                        Augusta, ME  04333-0011 [return to top]

Maine Board of Licensure Seeks Applicants for BOLIM Medical Director

This Physician III position will serve as the Medical Director of the Board of Licensure in Medicine.  The primary role of the Medical Director will be to provide clinical consultation to Board staff and legal counsel, and analysis of complaints against licensees in order to determine the investigative information necessary for review by the Board.   Responsibilities include, but are not limited to providing initial case review and guidance to investigative staff regarding special materials which are required to satisfy initial case status; performing initial analysis of materials collected for relevance to the complaint and identifying critical relevant investigative factors to board member reviewers; sitting as a participating member of the Board Case Review Committee to review and recommend complaint disposition to Board Members; assisting the Attorney General’s Office as an expert consultant in case review and hearing preparation; serving as an expert witness in complaint hearings as appropriate; providing clinical consultation to investigative staff.

Minimum Qualifications:  In order to qualify, applicants must have (1) a current active Maine allopathic medical license, (2) five (5) years of active fulltime medical practice within the past nine (9) years, (3) ABMS Board certification, with preference given to family practice, internal medicine or emergency medicine, and (4) no disciplinary history.  Experience in quality assurance or medical staff peer review helpful.  History of medical practice in Maine desired.

To apply:  Qualified candidates should send a letter of interest and C.V. postmarked by June 24, 2009 to:

Mary Jayne W. Monroe
Personnel Specialist
Security and Employment Service Center|
45 Commerce Drive, SHS# 108
Augusta, Maine 04333-0108
(207) 623-6736

Questions regarding this position should be directed to Randal Manning, Executive Director, Board of Licensure in Medicine at 287-3605 or Randal.C.Manning@maine.gov. [return to top]

CMS Warns of Scam Targeting Physician Offices

The Centers for Medicare & Medicaid Services (CMS) has become aware of a scam where perpetrators are sending faxes to physician offices posing as the Medicare carrier or Medicare Administrative Contractor (MAC). 

 

The fax instructs physician staff to respond to a questionnaire to provide an account information update within 48 hours in order to prevent a gap in Medicare payments.  The fax might have the CMS logo and/or the contractor logo to enhance the appearance of authenticity.

 

Medicare fee-for-service providers, including physicians and non-physician practitioners, should be wary of this type of request.  If you receive a request for information in the manner described above, please check with your contractor before submitting any information.  Medicare providers should send information to a Medicare contractor using only the address found in the download section of the CMS.gov website found at http://www.cms.hhs.gov/MLNGenInfo/ or http://www.cms.hhs.gov/MedicareProviderSupEnroll. [return to top]

Webinars Offered on Prescription Monitoring Program

The state Office of Substance Abuse (OSA) is offering webinars to provide information on registration and use of the Prescription Monitoring Program (PMP) web portal.

 

The sessions will be at noon on July 8, Aug. 4, and Sept. 3.  Clinicians and anyone interested in promoting registration and use of the site among clinicians are urged to participate.  The first session will include an introduction to the web site, step-by-step instructions on registering, step-by-step instructions on running a patient history report, and time for questions and answers.

 

Detailed information on how to log on to the Webinar will be provided to people who sign up for the sessions by emailing Daniel J. Eccher, MPH, PMP’s project coordinator, at daniel.eccher@maine.gov.  Information about the program is available at www.maine.gov/pmp.

 

The sessions will be posted on OSA’s web site at www.maine.gov/dhhs/osa, the Maine Prevention Calendar www.mainepreventioncalendar.org, and possibly to the “external portal,” www.maine.gov/pmp. [return to top]

Pediatric Rheumatologist joins Rheumatology Associates in Portland

Rheumatology Associates in Portland is pleased to announce that Edward Fels, M.D. will be joining the practice on September 1, 2009. Dr. Fels received his M.D. from State University of New York at Brooklyn College of Medicine, completed his residency at Maine Medical Center, and his Fellowship at Duke University Medical Center. He is Board certified in Pediatrics and Internal Medicine and Board eligible in Pediatric and Adult Rheumatology.
Appointments for pediatric and adult patients can be made by contacting Rheumatology Associates at (207) 774-5761. [return to top]

MaineCare Payment Notice for MeCMS Claims

Last week's MeCMS payment cycle included a higher than normal claims volume because of rate adjustments.  As a result, additional time was required for claims processing.  This has resulted in a delay for payments.  EFT payments will begin to be received on Friday, June 19, 2009 and check payments and RAs will be mailed on Wednesday, June 24, 2009. [return to top]

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