February 1, 2010

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MaineCare MIHMS "Go Live" Date Delayed

MaineCare officials announced this week that the scheduled date for conversion of the MECMS system to the new Maine Integrated Health Management System (MIHMS) will be delayed at least a month beyond March 1. 

The MaineCare announcement follows:

We recently learned that the "go live" date for the claims processing portion of the Maine Integrated Health Information System will be delayed.

As Unisys has moved through the testing process, they determined they need more time for testing to assure that the system works well and meets federal requirements when it is launched.  In the meantime, claims will continue to be processed through the MECMS system.

Unisys is doing a thorough analysis to determine the amount of additional time it needs before announcing a new "go live" date.  We expect that analysis to be completed by mid-February and we will share the date once it is scheduled.

Given the five years that physicians and other MaineCare providers have lived with the flawed MECMS system, including the inability of the system to process cross-over claims electronically (to say nothing about the hassles of dealing with interim payments and interim payment recovery), it is critical that the conversion to the new MIHMS system go well.  We are surprised with the delay, as the information provided at the monthly Provider Advisory Group meetings was very positive relative to the progress being made as the March 1 "go live" date approached.  But the priority needs to be assurance that the end-to-end systems testing has been completed and that the conversion will be smooth and not disruptive to physician practices. 

MMA acknowledges the hardship that the disasterous MECMS experience has been to the State ($60 million), DHHS staff (virtually all the staff at MaineCare in 2005 is now gone), and to MaineCare providers.  We look ahead to a new claims processing system that is certified by the federal government, HIPAA compliant, and able to process all claims electronically in an expeditious way. 





President Urges Congress to Keep at HSR Discussion; Congressional Democrats Look for Path to Reform

During the President's State of the Union address last week, President Obama encouraged the Congress to continue its efforts at health system reform, but he offered no real guidance on how to accomplish that.  "Don't walk away from reform.  Not now.  Not when we are so close.  Let us find a way to come together and finish the job for the American people.  Let's get it done," he said.  In the aftermath of the Republicans win in the race for the Massachusetts Senate seat formerly occupied by the late Ted Kennedy, Democratic leaders in Congress have been examining several strategies to move health system reform forward with two options appearing the most likely - moving forward on a scaled-back bill or bills, or pass the Senate bill in the House and have both chambers agree to a package of amendments to Senate bill passed under budget reconciliation.  Maine's two Senators have encouraged the Democrats to return to bipartisan negotiations, but that seems to be a remote possibility at this point.  

The AMA continues to post current information about the HSR debate in Washington on its web site at:  http://www.ama-assn.org/ama/pub/health-system-reform/index.shtml.   [return to top]

Opportunities to Support the Work of Maine Physicians in Haiti

MMA is aware of at least three substantial initiatives in Haiti led by Maine physicians and other health professionals who are unselfishly donating their time and talent to assist the victims of the recent earthquake.  Previous articles in this Weekly Update have reported on the continuing work of Konbit Sante and the efforts of Calais surgeon Robert Chagrasulis, M.D. assisting the Good Samaritan Hospital and its Mission Council in the Dominican Republic.  Dr. Chagrasulis reports that donations to The Good Samaritan Mission Council can be made through the website www.laromana.org or can be mailed to GSMC 800, 126 Main St., Holden, MA 01520.  The funds raised now are going directly to the current Haiti relief effort, i.e., supporting the teams that go from La Romana, DR to Port-au-Prince weekly and the weekly food delivery, as well.  There also are opportunities to join one of the teams, including another team led by him during the first two weeks of April.  Any physician, PA, or nurse practitioner interested should contact him directly at bobchagrasulis@aol.com.

This week, we wish to also acknowledge the work of Cynthia DeSoi, M.D. and her colleagues who are supporting Pwoje Espwa (Project Hope) outside of Les Cayes, Haiti.  Dr. DeSoi is a past recipient of the Association's Mary Cushman Award in recognition of her efforts through many years in Haiti.  Konbit Sante also has received the Cushman Award, accepted on its behalf in 2008 by Steven Larned, M.D. 

Pwoje Espwa, led by Lewiston native Father Marc Boisvert, has 680 children in an orphanage outside of Les Cayes, about 140 miles away from Port-au-Prince.  The orphanage did not sustain damage in the earthquake, but food and fuel have been difficult to come by in the aftermath of the quake.  Dr. DeSoi was expected to arrive in Haiti early this past week to work out of a hospital in Les Cayes.  In addition, she will work at the orphanage which has agreed to take 100 more children from an orphanage that collapsed during the earthquake.  Accompanying Dr. DeSoi are several physicians and nurses from the Lewiston-Auburn area including Ronald Chicoine, M.D. (anesthesiologist), Hector Rosquete, M.D., and Steven Katz, M.D. (orthopedic surgeons).  Dr. DeSoi is a nephrologist who has asked for an extended leave of absence from Nephrology Associates of Central Maine in order to stay as long as she is needed in Haiti.  Individuals  wishing to donate to the Project or to learn more may go to www.freethekids.org and follow Fr. Marc's blog for daily developments.

In addition to the initiatives described above and last week, MMA has learned of the work of three mid-coast surgeons currently in the Haitien port town of Leogane which was at the epicenter of the earthquake.  Drs. Douglas Cole, Lars Ellison, and Kevin Ohlehnik are volunteering their services through InterVol, a humanitarian nonprofit organization started by Dr. Ralph Pennino of Rochester, N.Y.  All three of these surgeons, based at PenBay Medical Center, have been to Haiti before on similar missions, but none as challenging as this trip.  An excellent article on their mission can be found at www.freepressonline.com

Two other MMA members, Laurel Coleman, M.D. and Leslie West, M.D., also just returned from a week in Haiti as part of a mission trip planned prior to the earthquake.  Drs. Coleman and West were part of a group from the Fayette Baptist Church which spent time volunteering in Cap Haitien.  In addition to volunteering at a hospital, Dr. Coleman visited orphanages which were accepting orphans from areas which had been directly impacted by the quake.  To help orphans, she suggests contributing through Children of the Promise at www.ChildrenofThePromise.org and Eternal Hope in Haiti, found at www.EternalHopeInHaiti.org.

MMA is happy to promote the efforts of any of our physicians or other health professionals in Maine assisting the victims of the earthquake.  If you know of efforts of which we may not be aware, please send a note to EVP Gordon Smith at gsmith@mainemed.com.

The MMA Executive Committee at its recent retreat voted to contribute $1000 to these efforts and to encourage members to do as much as they can to support other members who are donating their time and talent.  Tax deductible contributions made to the Maine Medical Education Trust (MMET) will be equally divided among the three primary projects noted above.  One hundred percent of such contributions, marked for Haitian relief will be contributed, without any administrative costs deducted.  Checks may be made payable to the trust and mailed to MMET, Maine Medical Association, P.O. Box 190, Manchester, Maine 04351. [return to top]

Volunteers Needed for MMA Ad Hoc Committee on Technology

If you have a knack for technology or are interested in social networking tools such as Twitter, Linked-in, or Facebook, please consider volunteering to serve on MMA's Ad Hoc Committee on Technology.  The Committee historically has advised MMA on EMR and health information exchange issues, but recently has been re-energized by the issue of communications and social networking.  Recognizing that MMA must constantly work at improving communications with members, non-members, and the public, the Executive Committee, with leadership from President David McDermott, M.D., M.P.H., has charged the Technology Committee with reviewing current communications vehicles and recommending changes aimed at broadening the ways that MMA shares and receives information.  Committee members are presently beta testing a new web site that would be interactive and include blogs, discussion groups, and other communication tools.  The intent is not to replace the existing site at www.mainemed.com, but to complement it.

Physicians wishing to join the Committee in this work should communicate with the Committee chair, Paul Klainer, M.D. (pklainer@knoxclinic.org) or Gordon Smith at gsmith@mainemed.com.   Appropriate to its mission, Committee meetings are conducted in a virtual mode using MMA's new Webex product.  [return to top]

With Medicare Cut Scheduled for March 1, AMA and Others Increase Advocacy Efforts

Without Congressional action in the next 30 days, physicians and other health professionals will see a 21.5% reduction in Medicare payments for services beginning March 1, 2010.  The reduction is even deeper in Maine because of the sunset on the practice expense limit of the geographical indices.  The American Medical Association is running a media campaign in Maine and other key states raising the visibility of the issue.  The AARP also has joined in the campaign, not wishing to see Medicare recipients lose more physicians from the Medicare program.

The reduction is the result of the SGR (sustainable growth rate) payment formula, established in the late 1990's and deeply flawed from the perspective of physicians.  AMA and virtually all other national medical organizations are seeking a permanent repeal of the formula rather than advocating for a one-year fix as has been accomplished in the past.  Single-year fixes have been partially paid for by deeper cuts in the following years, thus simply delaying and compounding the problem.

The issue is critical to Maine physicians because of Maine's distinction as having the oldest population in the country.  We are also on the low side of reimbursement already because of the geographical factors applied to the formula.  The cut will cost Maine physicians $60 million in the first year alone and nearly a billion dollars between now and 2017. 

The Senate is expected to vote soon on the House bill that provided a permanent repeal of SGR, at a cost of $210 billion.  The Senate vote on the bill previously received only 47 votes as all the Republicans and more than a dozen Democrats objected on the grounds that there were no offsets in the bill to pay for the ten-year fix (in other words, the bill would increase the deficit by $210 billion).  Maine Senators Snowe and Collins both voted against the bill for the same reason.  Both Senators have expressed support for repealing the existing formula permanently, but have insisted that it be paid for by increasing revenues or making cuts in other places.

Now is the time to call our Senators and remind them of the need to get this done before March 1.

You can find more information about the AMA's Medicare physician payment reform advocacy on the web at:  http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/medicare/payment-action-kit-medicare.shtml .

You can communicate with Senators Snowe and Collins on these issues through the AMA's grassroots advocacy network:  http://capwiz.com/ama/home/ .

In action from last week, on Thursday, January 28th, the Senate passed H.J. Res. 45, a resolution to raise the federal debt limit.  Included in the Resolution was a provision that reinstitutes PAYGO rules for new spending.  Any new spending or tax cuts would have to be offset by corresponding  spending cuts or tax increases.  Several limited exemptions were made to the PAYGO rule, including one for the SGR.  Some have characterized the SGR exemption as a five year freeze.  While the exemption is in the amount that could fund a five year freeze with larger cuts and a higher cost in the out years, the actual exemption does not implement new Medicare physician payment policy.  Instead, this action means that up to $82 billion in spending for a SGR fix would not be required to offset by other revenue or cuts.  The House is expected to take up H.J. Res. 45 this week.

It will still be up to Congress to enact separate legislation to stop the SGR cuts prior to March 1st.  The AMA will continue to insist that Congress pass legislation that will permanently repeal the SGR.  In conjunction with the PAYGO exception, an additional $130 billion in offsets still will be required. [return to top]

Anesthesiologists and Urologists Head for Sugarloaf, February 12-14

The Maine Society of Anesthesiologists and the Maine Urological Association will share the Grand Summit Hotel at Sugarloaf for their winter meetings from February 12-14, 2010.  These meetings provide an important opportunity to meet with colleagues and get updated on what is going on in Augusta and Washington.

The MSA will have as guests the current ASA President Alex Hannenberg, M.D. and Ronald Szabat, J.D., LL.M from the ASA Washington D.C. office.  The MSA meeting begins at 3:00 p.m. on Saturday, February 13th.

The MUA meeting begins with an evening event on Friday night, February 12th. 

For more information on the MSA meeting, contact Anna Bragdon at abragdon@roadrunner.com.

For more information on the MUA meeting, contact Kellie Miller at kmiller@mainemed.com.

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HIPAA Breach Notification Requirements Effective February 22, 2010

HHS officials announced last Fall that they would delay enforcement of the new HIPAA breach notification requirements until February 22, 2010.  These requirements were part of the federal economic stimulus bill passed early last year.

MMA has lots of resources to assist members and their staffs with HIPAA compliance.  To access our updated forms and briefing materials on the new requirements, contact Gordon Smith or Andrew MacLean via e-mail to gsmith@mainemed.com and amaclean@mainemed.com.

MMA will present its Annual HIPAA training program at MMA on Friday morning, April 2nd.  Flyers for the program will be included in the January/February issue of Maine Medicine or you may register on-line at the MMA website at www.mainemed.com.

If you have at least ten staff members to be trained in your office, or who need an annual update, MMA will bring a 90 minute training presentation to your office at a cost of $200.  Contact Gail Begin at MMA for details (gbegin@mainemed.com).

 The AMA also has information about the breach notification requirements on the web at:  http://www.ama-assn.org/ama1/pub/upload/mm/368/hipaa-breach.pdf .
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Governor Launches KeepMEWell Initiative as Part of Universal Wellness

MMA representatives joined Governor John Baldacci at a press conference last Wednesday, January 27th to announce that the KeepMeWell initiative (KeepMeWell.org) is now available for Maine residents.  KeepMeWell is designed to help Mainers assess their risk for chronic diseases, improve their health through education, and link them to local resources and supports that can help them decrease their risk of chronic disease and improve their health.

KeepMeWell.org was noted in the Governor's State of the State address the previous week and is part of the Governor's Universal Wellness Initiative aimed at helping Maine reach its goal of becoming the healthiest state in the nation.  Supported by statute, the initiative is part of a strategy aimed at ensuring that all people in Maine have "access to resources and evidence-based interventions in order to know, understand, and address health risks and to improve health and prevent disease." 

The program has two main web components.  The first is an assessment that Maine residents, 18 years or older, can complete.  Based on their answers to a series of health questions, a personalized report will be generated that positively reinforces areas of low risk, encourages the individual to take steps to improve areas of high risk, and provides links to local resources that can help with disease prevention and management.   The second is a tool to help Mainers, especially those who are uninsured or under-insured, learn about low-cost health care services in their local area.  By selecting a health service, such as medical care or prescription drugs, and their zip code, they will receive a list of low-cost health care services near them.

While the KeepMeWell assessment tool is available only to individuals 18 years of age and older, the second tool can be used by anyone, no matter the age, who is looking for low-cost health care services in the state.

The local Healthy Maine Partnerships, in partnership with 2-1-1 Maine, are working in local communities to support the on-line tools.   KeepMeWell is a free public service offered by the Maine Center for Disease Control and Prevention, Maine Department of Health and Human Services.

For more information, go to the website at www.KeepMeWell.org.  


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Downeast Association of Physician Assistants Holds Successful 20th Annual Winter CME Conference

DEAPA's 20th Annual Winter CME Conference, January 27-30, 2010 at Sunday River was a success at the new location with 20 speakers, 92 registrants, 13 exhibitors, and income that met the proposed budget goal of $40,000 according to early estimates.  Congratulations to CME Chair Cheryl DeGrandpre, PA-C and the CME committee for putting together another excellent program. 

Former Maine Congressman Tom Allen ended Friday's session at 6:15 p.m. with more than 90 attendees in the room discussing the current health care reform situation.  His talk was sponsored by the "Sandy Christman Memorial Fund" organized by Larry Adrian, PA-C.  Following Tom's remarks, because of the raging winds and -45 degree (with the wind chill) temperatures, the Chondola Dinner Banquet provided by Genzyme was reworked and held at the Jordan Hotel with flying colors!   Also, Sunday River donated a pair of downhill skis, which were raffled off and raised  a total of $530 for the Susan Vincent Student Scholarship Fund!  A big thank you to Sunday River staff for the donation!  Paul O'Connor, PA-C, was the lucky winner!  Next year, DEAPA is organizing to hold a silent auction with all proceeds going to the scholarship fund.  If anyone has an artistic talent or not, and would like to donate an item for the 2011 Susan Vincent Scholarship Fund Silent Auction, let DEAPA know!  We can't start too early!

A big thank you goes out to the UNE PA Alumni Program for their excellent reception and remarks by UNE Program Director, George Bottomley, DVM, PA-C on the current affairs of the program and its strategies for growth.  It was an excellent opportunity for alumni and others to find out more about the workings of the program. 

The conference speakers were excellent all around and provided an array of expert talks.  Dr. Dervilla McCann ended the conference emphasizing the Advances in MI Management, A Maine Success Story.

The CME committee has already begun work on the 2011 program.  Finally, we thank the members of the CME Committee who worked on-site at the conference.  Through their help, assistance, leadership it made it possible for staff to attend to conference details and troubleshoot issues.  They are:  Kristina Kramer, PA-C, Ann Norsworthy, PA-C, Linda Wentworth, NP, and Cheryl DeGrandpre, PA-C, Chair, specifically for her hours of dedication to the program content and for her leadership at the conference to ensure that all of our speakers were well cared for.

The Downeast Association of Physician Assistants' 21st Winter CME Conference is scheduled for February 2-5, 2011 at Sunday River!  For more information, go to www.deapa.com.  Also, if any MMA member is interested in speaking, please contact DEAPA staff, Kellie Slate Miller at kmiller@mainemed.com or 207-622-3374, ext. 219. [return to top]

December 2009 National Survey of H1N1 and Seasonal Flu Vaccine Coverage Statistics

US CDC has released data from a national survey conducted through much of December on H1N1 and seasonal flu vaccine coverage.  Maine stood out as having an H1N1 vaccine rate among children that is more than twice the national average - 60% versus 28%.  Although the Maine CDC doesn't know Maine's formal ranking, they know only 4 states had pediatric coverage rates of greater than 40%.  

Maine also had higher rates of H1N1 vaccine in health care personnel working with high-risk patients (46% vs. 27% nationally) and of seasonal flu vaccine coverage among children (52% vs. 34% nationally).

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New AMA Resource on Physician Practice Arrangements

The AMA has completed a new resource on physician practice arrangements.  The Practice Arrangements of Patient Care Physicians, 2007-2008:  An Analysis by Age Cohort and Gender provides the latest data on physician ownership and employment, the size of physician practices, and the settings in which physicians deliver most of their patient care.  The report finds that physicians over the age of 55 are significantly more likely to be practice owners (69%) than are physicians under age 40 (47%).  The report is available only on the "members only" portion of the AMA web site, www.ama-assn.org[return to top]

Legislative Committee Conference Call Information

MMA Legislative Committee Chair Lisa Ryan, D.O. invites any interested physician or physician staff member to participate in the weekly conference call on Thursday, February 4, 2010 at 8:00 p.m. using the following toll-free call-in number and access code:  call 1-877-669-3239; access code 23045263.

There are no new bills for review this week, but the MMA staff will provide an update on legislative action of the week and will seek further input from physicians about bills scheduled for public hearing in the near future.


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The HHS Committee spent last week continuing its work sessions on the Governor's FY 2010-2011 supplemental budget proposal, L.D. 1611.  Late last week, the Committee voted 10-3 against cuts to critical access hospitals, but 7-6 in favor of re-basing the hospital tax to 2008 levels.  The Committee also accepted proposed cuts to hospital inpatient and outpatient reimbursement, to mental health and substance abuse outpatient services, and to inpatient psychiatric services.  Instead of an annual limit of 18 mental health visits, the Committee will recommend that the Appropriations Committee adopt an annual limit of 72 units with a PA process.  Various other annual service limits remain tabled, as does a 10% across-the-board cut in MaineCare reimbursement for many providers, excluding physicians.  The Committee accepted the elimination of 2.5 psychiatric physician positions in DHHS, leaving the Department with no psychiatric physician representation in the central office.  The Appropriations Committee will receive budget reports from all of the policy committees and then will be working the supplemental budget itself for much of the month, if not longer.

You can find the Appropriations Committee membership and individual members' contact information on the web at:  http://www.maine.gov/legis/house/jt_com/afa.htm.

It is important that you communicate your concerns about the health care, mental health, and substance abuse cuts in the budget with Appropriations Committee members and your own members.

You can find your own legislators on the web at:  http://www.maine.gov/legis/house/townlist.htm.

You can reach legislators through the contact information provided in their individual listings or you can leave a message for them at the State House during the week as follows:

 Senators:  1-800-423-6900

Representatives: 1-800-423-2900


The Insurance & Financial Services Committee (IFS) is considering L.D. 1709, An Act Concerning the Use of Long-Term Antibiotics for Treatment of Lyme Disease, sponsored by Representative Edward Legg (D-Kennebunk), a member of the Committee.  Thanks to conversations with several physicians specializing in infectious disease, including Tom Courtney, M.D., Representative Legg came to the public hearing last Wednesday afternoon with a conceptual amendment to the bill that eliminates the insurance mandate and focuses instead on further education about the disease and outreach to the public and provider community.  A number of Lyme disease patients and family members testified in support of the bill.  The primary opponents of the bill were Maine CDC Dora Mills, M.D., M.P.H. and the MMA.  Dr. Mills told the Committee that she was still concerned about aspects of the "educational" concept for the bill in that it would require the State to promote the advocacy agenda of the patient rights groups which includes long-term antibiotic therapy.  Dr. Mills also expressed frustration that the Maine CDC makes a tremendous amount of information about Lyme disease available to the public and provider community on its web site and through the annual infectious disease conference, but that the legislature continues to pass bills that are "unfunded mandates" for her agency to do more.


House Chair Nancy Smith (D-Monmouth) is the sponsor of L.D. 1608, An Act to Establish an Office of Administrative Law Judges for Licensing Boards heard before the Business, Research & Economic Development Committee the week before last.  The bill comes from a group called the Regulatory Fairness Board and was supported at the public hearing by that group, the MMA, and several attorneys who represent professionals in licensing actions.  While the DPFR Commissioner, Ann Head, opposed the bill and expressed concerns about the cost of such an initiative, among others, she did agree to convene a group of stakeholders to discuss the issues raised by the bill last Friday.  The MMA participated in the meeting along with a number of licensing board representatives and professional association representatives, as well as attorneys who represent individuals in professional licensing matters.  The group spent an hour and a half discussing issues of fairness and due process in licensing board matters and Commissioner Head was receptive to some of the concerns.  The bill may be changed to a Resolve that provides a vehicle for the stakeholder group to continue the discussion to search for common ground.

In other business last week, the BRED Committee also held a public hearing on L.D. 1702, An Act to Amend the Laws Governing Advanced Practice Registered Nurses.  The bill proposes to eliminate a provision included in the original APRN licensing statute to ensure that nurse practitioners who wanted to continue working under the delegation of a physician could continue to do so.  The APRN community and the Board of Nursing pursued this bill apparently in an effort to avoid regulation by both the nursing and physician licensing boards.  No one spoke in opposition to the bill and the Board of Licensure in Medicine, the MMA, and a representative of the CRNAs all spoke "neither for nor against" the bill.  The practical impact of removal of this language is still being discussed among the interested parties.



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