June 21, 2010

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Senate Passes SGR Legislation; House May Act This Tuesday Evening

House action this week would delay the Medicare physician payment cut for six months, from June 1 through Nov. 30, 2010.  While a delay is absolutely necessary in the short term, the legislation unfortunately does nothing to replace the SGR formula that is driving annual reductions in reimbursement.  Maine physicians and their office staff should continue to send the message to Congress that the current situation is unacceptable and threatens access to care for Maine's most vulnerable seniors. 

Last Friday afternoon, the Senate passed an amended version of H.R. 3962, now called the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010, by unanimous consent.  This legislation provides a 2.2 percent Medicare physician payment update for six months, from June 1 through November 30, 2010, in lieu of the scheduled 21 percent cut. 

Unfortunately, the House of Representatives is not scheduled to hold any floor votes until Tuesday (tomorrow) evening.  As a result, the Centers for Medicare and Medicaid Services (CMS) is instructing its carriers to lift the hold on processing claims for services provided on or after June 1, and to begin processing them under the law’s negative update requirement.  In other words, claims will start to be paid today at the 21 percent lower rate, on a first in/ first out flow basis.

Once H.R. 3962 is passed by the House and signed by the President, CMS will retroactively adjust any June claims that have been paid.

MMA staff was in contact with the offices of Senators Snowe and Collins on almost a daily basis last week.  Unfortunately, staff for the Senators indicated that they were not hearing from many physicians regarding the issue.  It is important the Maine physicians and their office staff communicate their concern to our Senators about the urgent need to find a permanent replacement to the SGR formula that is driving yearly reductions in reimbursement to physicians and threatening access to care for Maine's seniors and military families whose Tri-Care plan pays Medicare rates.Physicians should use the AMA Grassroots Hotline, at 1.800.833.6354.  Or, you may send an email via:  http://www.capwiz.com/ama/issues/alert/?alertid=15086046&type=CO.


Advisory Council on Health Systems Development to Finalize State Health Plan This Friday

The Advisory Council on Health Systems Development (ACHSD), a stakeholder advisory group established in the Dirigo Health Program legislation with a role in developing the State Health Plan, overseeing the certificate-of-need (CON) program, and considering the State's options in cost containment and payment reform, will meet this Friday from 9:00 a.m. to noon to finalize the most recent State Health Plan.  The draft agenda for the meeting follows:



JUNE 25, 2010

9:00 AM – 12:00 NOON


1)         Call to Order – Chairman Rines

2)          Approval of Draft Minutes - 5-21-10 

2)         Review & Comment on State Health Plan 2010-2012 Revisions

(Matrix summarizing comments and responses as well as a revised State Health Plan will be sent under separate cover)

3)         Final approval of State Health Plan 2010-2012

4)         Review and Advise on proposed Criteria to guide decisions regarding funding opportunities under the Affordable Care Act  (Attachment)

5)         Next Steps

6)         Public Comment

7)          Adjourn

The MMA recently joined other stakeholders in commenting before the ACHSD on the State Health Plan and in commenting on payment reform before the ACHSD Payment Reform Workgroup.  Jean Antonucci, M.D. and Lisa Letourneau, M.D., M.P.H. were the two physician representatives on the payment reform panel. [return to top]

Medical Mutual Offers Free Practice Management Seminar Next Week

Medical Mutual Insurance Company of Maine (MMICOM) is offering a practice management seminar entitled, Improving Systems Performance in the Office Practice at the Marriott Sable Oaks in South Portland from noon to 4 p.m. on June 29, 2010.  The seminar is open to managers of practices insured by Medical Mutual and there is no charge for these practices.  The seminar will take a closer look at test tracking and appointment management systems, as well as liability and the EMR. [return to top]

AMA's National Health Insurer Report Card Shows Potential Savings in Administrative Costs

On June 14th, the AMA's Immediate Past President Nancy Nielsen, M.D. released the AMA's 2010 National Insurer Report Card that benchmarks the overall claims processing accuracy of the 7 largest commercial health insurers in the country:  Aetna, Anthem Blue Cross Blue Shield, CIGNA Corp., Coventry Health Care, Health Care Services Corporation, Humana, Inc., and UnitedHealth Group.  Dr. Nielsen stated that health insurers currently process inaccurately 20% of all medical claims, contributing to the $210 billion spent each year on claims processing in this country.  According to Dr. Nielsen, improving claims processing accuracy by even 1% could save nearly $780 million, and improving accuracy to 100% could save the insurers up to $15.5 billion in administrative costs.  In this report, Anthem BCBS ranked last among the 7 insurers measured with an accuracy rating of 73.98%.  You can find more information about the Report Card on the AMA web site:  http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/heal-claims-process/national-health-insurer-report-card.shtml. [return to top]

2010 MMA Annual Session Registration Materials are in Your Mail

Watch for MMA Annual Session registration materials in your mail.  The materials were mailed last week for the meeting which will be held September 10-12, 2010 at the Harborside Hotel & Marina in Bar Harbor, with the Friday educational sessions being held at Jackson Laboratories.

Registration is also available on the MMA website at www.mainemed.com.

Don't miss the opportunity this year to visit with your colleagues, pick up some quality CME, and learn about the activities of your professional association.

Any questions regarding the meeting should be directed to Diane McMahon at MMA at 622-3374, ext. 216 or via e-mail to dmcmahon@mainemed.com. [return to top]

Maine Legislature's HSR Committee Holds Second Meeting Tomorrow

The joint select committee established to implement the federal health system reform (HSR) legislation by the 124th Maine Legislature has scheduled its second meeting for tomorrow, Tuesday, June 22nd.  The draft agenda follows:

Joint Select Committee on Health Care Reform

Opportunities and Implementation


Tuesday June 22, 2010

10am to 3pm
Taxation Committee Room 127

Draft Agenda

1.       Welcome and introduction from chairs and members  

2.       Update on Executive Branch Planning Activities (10:15 am to 11:00 am)

·         High-risk pool program

·         Grant opportunities and criteria

o        Maternal, Infant and Early Childhood Home Visiting Program grant

o        Health Insurance Rate Review grant

·         DHHS planning and impact

Trish Riley, Commissioner Brenda Harvey and Steering Committee  

3.       Early Retiree Reinsurance Program (11:00 am to 11:30 am)

Frank Johnson, State Employee Health Insurance Program

4.       Insurance Coverage of Dependents (11:30 am to 12:00 pm)  

Bureau of Insurance, Maine Association of Health Plans

LUNCH BREAK (12:00 pm -1:00 pm)

5.       Impact of Health Reform Law on Maine Employers (1:00 pm – 1:30 pm)

John Dorrer, Department of Labor

  1. Information on Business Outreach and Tax Provisions (1:30 pm – 1:45 pm)

 Department of Economic and Community Development

Maine Revenue Services (invited)  

7.       Medicare Provisions (1:45 pm – 2:00pm)

Nancy Kelleher, AARP-ME

8.       Timeline and Decision points for Legislature (2:00 pm – 3:00 pm)


·         Committee Discussion and Planning  

·         Public outreach

·         Organization of workload

·         Scheduling future meetings

9.       Adjourn


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REMINDER: Deadline for Direct Deposit/EFT for MIHMS Re-enrollment is Tomorrow

DHHS reminds Maine practitioners that you must sign up for EFT to continue to receive EFT payments from MaineCare's Maine Integrated Health Management Solution (MIHMS) after the new system is fully operational.

EFT information that currently exists in AdvantageME under MeCMS cannot be transferred to the MIHMS' Pay-to Accounts.

If you are not currently using Direct Deposits/Electronic Fund Transfer (EFT) payments at this time, it is strongly encouraged that you sign up.  Although it is not required at this time, we expect EFT to be mandated by MaineCare Policy in the near future.

Please visit:  http://www.maine.gov/dhhs/oms/fiscal_agent_project_index.html for more information.

To assure readiness for "go-live," you should submit these forms no later than June 22nd.

If you do not submit your forms by June 22nd, changes to your EFT accounts must be completed at the Office of the State Controller's web site:  http://www.maine.gov/osc/accounting/eft.htm.  This will be available only after the MIHMS "go-live" scheduled for August 1st. [return to top]

ONC Releases Rule on Temporary Certification of EHR

The Office of the National Coordinator for HIT within DHHS recently released a rule on temporary certification of EHR technology, a key standard for obtaining incentive payments authorized in the HITECH Act.  The rule is scheduled to be published in the Federal Register on June 24th, but you can find information on the ONC web site:  http://healthit.hhs.gov/portal/server.pt?open=512&objID=1196&parentname=CommunityPage&parentid=6&mode=2.

The temporary certification program will establish the standards providers will need to meet in order to be authorized by the ONC to test and certify EHR technology. [return to top]

FTC Close to Agreement with Provider Groups on "Red Flags" Rule Until Litigation Resolved

On June 15th, a Federal Trade Commission (FTC) attorney stated that the agency is close to concluding an agreement that would exempt health care providers from the commission's "red flags" rule regarding identity theft until litigation challenging the inclusion of health care providers in the rule.  On May 21st, the AMA and other provider groups filed an action in the U.S. District Court for the District of Columbia to prevent the FTC from applying the rule to physicians. [return to top]

CMS Schedules Open Door Forum on Use of ACOs to Improve Quality for June 24th

CMS has scheduled a special Open Door Forum conference call on the use of accountable care organizations (ACOs) to improve the quality and efficiency of physician services.  The purpose of the call is to solicit input from stakeholders on the implementation of the new Medicare Shared Savings Program, part of the Patient Protection & Affordable Care Act.

Among the topics up for discussion during the Forum are:

  • Joint accountability among providers in the formation and use of accountable care organizations;
  • Cost and quality measures to assess performance;
  • Risk adjustment;
  • Attribution of Medicare beneficiaries to ACOs;
  • Benchmarks for purposes of defining shared savings;
  • Coordination with other value-based purchasing initiatives; and
  • Medicare beneficiary protections.

The Forum is scheduled for this Thursday, June 24th from 2:00 - 4:00 p.m. (EDT).  You can find more information about the Forum on the CMS web site:  http://www.cms.gov/OpenDoorForums/Downloads/ACO062410.pdf. [return to top]

MMA Offering CME Programs on HIPAA, the Federal Health Reform Bill (PPACA) and Medicinal Marijuana

MMA is now offering CME presentations on the following topics:

  • HIPAA Update;
  • Treating Chronic Pain While Preventing Diversion of Narcotics (offered in conjunction with the Maine Office of Substance Abuse);
  • Federal Health Care Reform Law; and
  • Medicinal Marijuana Law
  • Health Care Highlights of the 124 Legislature

MMA offers these programs to various audiences, including medical staffs, specialty societies, office staff, and other interested groups.  A fee of $200 is normally charged to cover travel and copying costs for the materials.  If your practice or group is interested in a presentation, contact Gail Begin at 622-3374, ext. 210 or via e-mail to gbegin@mainemed.com. [return to top]

Volunteers Needed for MMA Committees, 2010-2011

Watch for your May-June issue of Maine Medicine which will contain an insert listing the MMA committees and a request for volunteers.  The Committee on Nominations, chaired by Jo Linder, M.D., will be meeting this summer to prepare a report for the Annual Session being held in Bar Harbor September 10-12, 2010.   The Committee would welcome volunteers to serve on the following committees during the MMA election year which runs from September 2010 to September. 2011:

Committee on Legislation

Public Health Committee

Committee on Physician Quality

Committee on Membership and Member Benefits

Committee on Bylaws

Committee on Loan and Trust Administration

Committee on CME and Accreditation

Ad Hoc Committee on Technology

There also are vacancies currently on the Executive Committee from Oxford County, Lincoln-Sagadahoc Counties, and Waldo County. 

Any member interested on serving on a committee or desiring more information on a committee should contact EVP Gordon Smith at 622-3374, ext. 212 or via e-mail to gsmith@mainemed.com.

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