December 28, 2009

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U.S. Senate Conducts Final Health Care Vote on Christmas Eve

Voting on Christmas Eve for the first time since 1895, last Thursday the U.S. Senate passed its version of health care reform (H.R. 3590) by a party-line 60-39 tally just after 7 a.m.  The $871 billion bill is expected to cover an additional 31 million individuals, reform the health insurance industry, and cut Medicare spending by almost $500 billion.  The Senate Democratic leadership is expected to cut its Christmas break short and return to Washington to begin negotiations with the House leadership in hopes of delivering a final bill to the President by the State of the Union address, usually the third Tuesday in January.

Following the Christmas Eve vote, Senate Finance Committee Chairman Max Baucus (D-MT) said differences over how to pay for new federal health insurance subsidies and abortion coverage limits will be two of the biggest issues in the conference.  Most observers believe that the final version of the health care reform bill will look more like the Senate bill than the House bill (H.R. 3962) because reform proponents cannot lose one vote for final enactment in the Senate.

The AMA issued a detailed memo outlining its rationale for supporting the Senate bill on December 23, 2009 which may be found on the web at:

The Kaiser Family Foundation has a side-by-side chart comparing aspects of the House and Senate bills on the web at:

Though overshadowed by the latest terror threat, the health care reform debate remained a focus of the news media in the days following the debate.  The New York Times, its editorial board a strong supporter of reform efforts,  included an analysis of the House and Senate bills on its editorial page yesterday: .

The MMA will keep you posted on the House and Senate conference committee negotiations through the Maine Medicine Weekly Update.


CMS to Hold Claims for 10 Business Days & Extends Participation Deadline

This past week Congress acted to avert the 21.2% Medicare physician payment cut and on December 19, the President signed into law the Department of Defense Appropriations Bill (H.R. 3326) which will stop the cuts until March 1, 2010.  Other changes reflected in the 2010 Medicare Physician Fee Schedule final rule will still take effect on January 1, 2010 and may have a slight impact on the conversion factor used for the first two months of 2010.  Similar to other years, since Congress acted so late in the year to avert the cut, the Center for Medicare and Medicaid Services CMS will hold claims for the first 10 business days of January (January 1 through January 15) for 2010 dates of service to allow its contractors time to update their systems and pay claims based on the updated rates CMS does not anticipate any cash flow problems for physicians since by law no claims are paid prior to 14 days after receipt anyway . 

In addition, CMS has extended the 2010 Annual Participation Enrollment Program end date from January 31, 2010, to March 17, 2010. Physicians still have time to consider their participation options with the Medicare program. Additional information can be found on the AMA’s web site  The effective date for any participation status change during this extension remains January 1, 2010, and will be in force for the entire year.  Medicare contractors will accept and process any participation elections or withdrawals made during the extended enrollment period that are received or post-marked on or before March 17, 2010.

CMS announced the claims processing delay and extended participation enrollment period December 21 communication that was developed prior to the Congressional action and therefore inaccurately suggests that payments may still be cut on January 21. The AMA is concerned that the announcement will prove confusing to physicians and has  asked CMS to update and clarify the notice.  If they do, we will forward it to the Federation.

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AMA Urges CMS to End Physician Fraud Training Requirements

On December 8th, medical societies representing all 50 states and 35 physician groups and specialties joined the AMA in a comment letter to CMS urging the agency to finalize its proposal to exempt physicians from requirements that Medicare Advantage (MA) plans provide fraud, waste, and abuse compliance training to their "downstream entities."  The AMA has heard complaints from state medical societies about MA plans indicating that physicians must complete an online compliance training program by the end of this year.  Each plan seems to have its own training program and some even charge physicians to access it.  Especially for physicians who contract with multiple MA plans, the training demands have generated a substantial amount of confusion and increased administrative burdens.  In a proposed rule, CMS indicated it would deem any physician who had enrolled in the Medicare program as in compliance with the training requirement.  The AMA's coalition letter urged CMS to finalize this proposal, and to take immediate action to clarify that physicians who have enrolled in the Medicare program need not comply with the plans' 2009 compliance training deadlines.

The comment letter also addressed MA plan audits of physician practices.  Physicians have noted that MA plans, or their agents, demand far more patient charts than justified by CMS validation requirements, without offering compensation for the staff time involved in pulling, copying, and re-filing them.  The joint comment letter urged that methods be employed to ensure that physicians can identify the entity that is requesting information and the reasons for the request, and that the same practices are not required either to comply with repeated audit demands from one plan or with demands from multiple plans within the same timeframe.

You can see the joint comment letter on the web at:
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REMINDER: MMA's Public Health Committee presents, "Our Public's Health" Rescheduled for January 6th
Originally scheduled for December 9th, the MMA Public Health Committee is hosting a two-hour panel presentation on Our Public's Health - Climate Change, Energy Efficient Hospitals/MESHnet and Environmental Toxins on Wednesday, January 6th, from 4:00 p.m. to 6:00 p.m. at the MMA office in Manchester.  It also will be broadcast via video-conference link to the MMC Dana Health Education Center, Classroom 10.   

Norma Dreyfus, MD, Chair of the MMA Public Health Committee, will serve as moderator and panelists include:

  • Lani Graham, MD, MPH providing an overview of health care and environmental toxins, which will include findings from the Hazardous Chemicals in HealthCare report, (detailing the first investigations ever of chemicals found in the bodies of health care professionals, including MMA Past President Stephanie Lash, MD).
  • Paul Santomenna, Executive Director of Physicians for Social Responsibility, will talk about hospitals' contribution to greenhouse gas emission and the work of the Hospital Network.
  • Matt Prindiville of the Natural Resources Council of Maine, will provide an update on federal and state legislation including TSCA reform.
  • Syd Sewall, MD, MPH will provide information on the use of the Pediatric Environmental Toolkit in clinicians' offices.

This program has been approved for two hours of CME.  To register for this free educational offering for all members and nonmembers, contact MMA at 207-622-3374, ext. 219 or via email to Maureen Elwell at .  Members and non-members are welcome to attend. 

In case of inclement weather, please contact the MMA office at the above number for information about the status of the program. [return to top]

Medicare Conducting Provider Satisfaction Survey

CMS is surveying physicians and other Medicare providers in its annual Medicare Provider Satisfaction Survey (MCPSS) on their attitudes about seven different areas of the Medicare fee-for-service program.  The seven areas include:  Inquiries, Provider Outreach & Education, Claims Processing, Appeals, Provider Enrollment, Medical Review, and Provider Audit & Reimbursement.  The survey will be sent to a random sample of approximately 30,000 Medicare fee-for-service providers and suppliers.  Those who are selected to participate will be notified starting in January.  Providers and suppliers can complete the survey on the Internet via a secure website or by mail, fax, or telephone.  To learn more about the MCPSS, you can visit the CMS web site:

 The two lowest ranking areas are enrollment and appeals.  The AMA has used this Medicare data to advocate for more streamlined processes and fewer administrative burdens for physicians. [return to top]

AMA Creates Comparison Chart on Physician Profiling Programs

The AMA has created a comparison chart of up-to-date information on the physician profiling programs sponsored by Aetna, CIGNA, and UnitedHealthCare.  This chart is a straightforward tool to help you analyze these programs on key elements common to programs that measure physician performance based on quality and cost-of-care standards.  

You can find the chart under "physician profiling" on the web at:
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UNE Maine Geriatric Education Center (UNE-MGEC) conducting survey
The UNE Maine Geriatric Education Center (UNE-MGEC) is conducting a needs assessment to identify the educational needs of Health Professionals  throughout Maine who impact the lives of older adults.  As part of this process we are asking that you take a survey which can be accessed at

The survey should only take 5-7 minutes to complete and will provide valuable information to assist the UNE-MGEC staff in developing relevant and useful educational programs.  

All those who complete the survey by January 29th, 2010 will be eligible for a $50 L.L. Bean gift certificate.

Responses must be received by Friday, January 29th, 2010.
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AMA Convenes Discussions on ICD-10 Implementation

The AMA recently has convened a meeting of industry-wide stakeholders including those representing payers, coders, vendors, labs, pharmacies, billers, and others to discuss operational challenges associated with moving from ICD-9 to ICD-10, as well as opportunities to work together toward meeting the October 1, 2013 compliance date required under HIPAA.  Shortly after the AMA meeting, CMS held a meeting with industry stakeholders to discuss issues ranging from educational efforts to operational challenges.  The AMA also testified before the National Committee on the Vital and Health Statistics, which advises the Secretary of the Department of Health & Human Services, regarding the AMA's educational efforts, ICD-10 implementation challenges, and ideas for further simplifying health care administration for physicians.  

You can find more information about the AMA's efforts on ICD-10 on the web at:
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Maine CDC H1N1 Update


Maine CDC/DHHS Update on 2009 H1N1 Influenza Virus

December 23, 2009


Flu Activity in Maine and the US

Data indicate that H1N1 flu has been relatively mild in Maine compared with other states, and continues to decline. There have been no new deaths since the last update.

There were 9 new hospitalizations last week, down from 11 last week, and across all age groups. There were no new admissions to intensive care. Individuals were hospitalized in Cumberland, Franklin, Kennebec, Oxford, Penobscot, Washington, and York counties.

Outbreaks were reported in one long term care facility and two K-12 schools. The outbreaks occurred in Penobscot, Somerset, and York counties.

Flu comes in waves. Protect yourself and those you care about by getting vaccinated before the next wave.

To remind people of the importance of washing hands, covering coughs, staying home when sick, and getting vaccinated, order flu posters and magnets for your organization, workplace, or health care practice:

H1N1 Vaccine Supply and Prioritization

To date, we have received a total of about 575,000 doses of H1N1 vaccine in Maine, and by the first week of January we expect to have about 675,000 total cumulative doses – enough for about half of the state’s population. Based on recent demand, Maine CDC is now recommending that H1N1 vaccine be offered to anyone who wishes to receive it when local supplies allow.

If you are an H1N1 vaccine provider and are running short of vaccine, please contact to inform us of your needs.  This will help our short terming planning and distribution of vaccine.

The focus for vaccine will still be the five high priority groups as defined by US CDC, but in many places public clinics will not need to turn others away.  We are encouraging health care providers with sufficient supplies to provide vaccine to all who want it, and those without sufficient vaccine to focus their vaccine supply to those in the high priority groups: pregnant and recently pregnant women; household members and caregivers of infants younger than six months old; all people ages 6 months through 24 years; people ages 25 through 64 with underlying health conditions; and health care and EMS workers.

The nasal spray vaccine is available in slightly greater quantities than injectable vaccine. We request that nasal spray vaccine be given to anyone who is eligible to receive it. The nasal spray vaccine is a safe and effective vaccine option for healthy people ages 2 through 49 who are not pregnant. For more information on nasal spray vaccine, please see our Fact Sheet at:

The benefits of getting the H1N1 vaccine far outweigh the very small risk of serious complications from vaccination.  Some people getting vaccinated will have mild side effects such as pain, redness or swelling in the arm where the shot was given or a runny nose and headache after the nasal spray vaccine. US CDC and FDA carefully monitor vaccine reports. After millions of doses of H1N1 vaccine being administered in the U.S., the number, pattern and types of adverse event reports are similar to what we see for seasonal influenza vaccine. More than 90% of adverse event reports nationwide have been classified as not serious.


We expect vaccine to be more readily available in retail pharmacies over the next several weeks, in addition to public clinics, doctors’ offices, and through occupational health and certain large-scale employers. To find vaccine in your area: check the clinic locator at, call 211, or call your health care provider.

Vaccine Recall

On December 18 and 21, MedImmune notified CDC and FDA that the potency of 13 lots of  monovalent 2009 (H1N1) nasal spray vaccine had decreased below a pre-specified limit or were at risk of falling below that limit in the next week. This slight decrease in vaccine potency is not expected to have an impact on the protective response to vaccination. There are no safety concerns with these lots of 2009 H1N1 vaccine. This is not a safety recall.  All lots successfully passed pre-release testing for purity, potency and safety. However, because their potency is now or might soon be below the specified lower limit, MedImmune will send providers directions for returning any unused vaccine from these lots.


The potency of these lots is now or might soon be slightly below the specified range for the product. CDC and FDA are in agreement that the slight decrease in vaccine potency is not expected to have an impact on the protective response to vaccination. For this reason, there is no need to revaccinate persons who have received vaccine from these lots.

People who received vaccine from the recalled lots do not need to take any action. Children and adults aged 10 years and older who received the vaccine do not need any further doses of vaccine. As is recommended for all 2009 H1N1 vaccines, all children younger than 10 years old should get the recommended two doses of 2009 H1N1 vaccine approximately a month apart. Therefore, children younger than 10 years old who have only received one dose of vaccine thus far should still receive a second dose of 2009 H1N1 vaccine. It is best to use the same type of vaccine for the first and second doses.

The 13 lots subject to the recall include approximately 4.7 million doses. These doses were shipped to CDC’s contract distributor in October and early November. Approximately 90 vaccine providers in Maine received these doses, primarily in late October. Most of the doses are believed to have already been administered while fully potent and within specifications. However, there may be some doses that have not yet been used.

The potency issue described here is specific to 13 lots of nasal spray 2009 H1N1 influenza vaccine. Subsequent lots of the vaccine were produced with a slightly higher initial potency to decrease the chance that the potency would fall “below specification” before their expiration dates. Following its routine practice, the manufacturer will continue to monitor the stability of these subsequent lots.

Maine CDC will be contacting all Maine providers who received doses from any of the 13 lots of vaccine so that they can return any unused vaccine.

·         For Questions and Answers related to the withdrawn vaccine see

·         Call CDC’s toll-free information line, 800-CDC-INFO (800-232-4636) TTY: (888) 232-6348, which is available 24 hours a day, every day.

·         For manufacturer’s information about the recall, see

·         For manufacturer’s instructions to providers on actions to be taken, see

Important Information for Vaccine Administrators

All public clinics must be posted on Maine CDC’s clinic locator: If you have questions about completing this form, please e-mail

All H1N1 vaccine providers and/or administrators must submit the vaccine administration data into Maine CDC’s weekly vaccine reporting system. The weekly vaccine reporting form can be found at:

Detailed instructions are also available at:

Vaccine Return:

The only vaccines that should be returned to McKesson are those that arrive non-viable or appear to be damaged during transit. Providers with concerns about vaccine viability during transit from McKesson should call 877-836-7123 immediately upon receipt of the package.

Once a provider takes receipt of the vaccine as a usable product, it is that provider’s responsibility to ensure proper disposal of any damaged, expired, or un-used vaccine unless it has been recalled.

Vaccinating Small Children:

Due to national production delays and the recent recall of .25 mL pre-filled syringes, Maine CDC makes the following recommendations for vaccinating small children:

Use the Sanofi or CSL multidose vial for all children ages 6 months to 2 years of age

Use the nasal spray vaccine for healthy children ages two and older, when available and appropriate

Use the Sanofi or CSL multidose vial for children ages two and older who are not eligible to receive nasal spray vaccine, or when nasal spray is unavailable


Vaccine Dose Spacing and Administration:

Those who have questions about H1N1 vaccine dose spacing and administration with seasonal flu or other vaccines should consult this table from US CDC:

Additional vaccine-related information for health care providers can be found on our web site at:


Updates from Federal Partners

US CDC has updated its recommendations for clinicians regarding H1N1 and severely immunosuppressed patients:

US CDC has updated its H1N1 Fact Sheet for people age 65 and older:

If you think 2009 H1N1 flu can't affect you, your family, or your friends—think again. Take 60 seconds to watch this reminder on why vaccination is so important. All of the excuses any of us make don't stand a chance against this serious disease.

This USDA study ( confirms that people cannot get H1N1 from eating or preparing pork from pigs exposed to the H1N1 virus.

From the US Department of Health and Human Services: H1N1 Year in Review:

CDC has not implemented a state vaccination program requiring registration on Users who click on e-mails directing people to create a personal H1N1 vaccination profile are at risk of having a computer virus installed on their system. For more information:

How to Stay Updated

·        Flu News: View current Maine CDC press releases, Thursday weekly updates, and urgent updates from our Health Alert Network (HAN) by visiting: RSS feeds are available for the weekly updates and HAN.

·        Follow Maine CDC’s Social Media Updates:

o        Facebook (search for “Maine CDC”)

o        Twitter (

o        MySpace (

o        Maine CDC’s Blog (

·        Please note that weekly conference call updates will not be held for the next several weeks. Any future calls will be listed in advance in these updates.

·        For clinical consultation, outbreak management guidance, and reporting of an outbreak of H1N1 call Maine CDC’s toll free 24-hour phone line at:  1-800-821-5821.

·        For general questions:

o        call 2-1-1 from 8 a.m. to 8 p.m. seven days per week

o        e-mail

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CMS Releases Educational Materials for 2010 PQRI and ERX Programs

On December 14, 2009, CMS announced the release of 2010 measure specifications and other participation information for both the Physician Quality Reporting Initiative (PQRI) and the Electronic Prescribing (ERX) Initiative.  Physicians should familiarize themselves with these educational materials to better understand how to participate in both of these programs. 

You can find information about the PQRI measure specifications on the web at:

You can find information about the ERX initiative on the web at:

Reporting for both the 2010 PQRI and ERX programs begins January 1, 2010. [return to top]

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