July 19, 2010

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You now can comment on 2011 Medicare fee schedule proposal

The proposed rule governing Medicare payments to physicians in 2011 was published in the Federal Register on July 13.  This 1250 page rule implements certain provisions in the Patient Protection and Affordable Health Care Act of 2010, including reduced out-of-pocket costs for preventive services, bonus payments to some general surgeons and primary care physicians, changes in the geographic practice cost indexes, and cuts in payments for advanced imaging services.  The rule proposes several potentially helpful provisions, but also projects a 6.1% cut in the conversion factor.  This would come on top of a budget neutrality adjustment tied to rebasing the Medicare Economic Index and the expiration of the recent law averting the 21.3% cut, leading to a conversion factor of only $26.76 in 2011.  Comments on the proposed rule will be accepted prior to an August 24 comment deadline.

The Centers for Medicare & Medicaid Services (CMS) will accept your comments until Aug. 24 on these proposed policies for the Medicare Physician Fee Schedule for services provided on or after Jan.1, 2011.  CMS will respond in a final rule to be issued on or about Nov. 1

The proposed rules for next year would implement key provisions in the Affordable Care Act of 2010 to expand preventive services for Medicare beneficiaries - including a new annual wellness visit - improve payments for primary care services and promote access to health care services in rural areas.

The proposed rules would also implement a payment incentive program for general surgeons performing major surgery in areas designated as Health Professional Shortage Areas. 

Find the proposed rule at www.federalregister.gov/inspection.aspx#special.   See Relative Value Units (RVUs) listed beginning on page 803. 

See page 2 and 3 for details on how to submit comments.

CMS issued Fact Sheets with additional details; find those at www.cms.gov/apps/media/fact_sheets.asp.

For updated information on the Physician Quality Reporting Initiative (PQRI), visit: www.cms.gov/pqri.  

For details on the E-Prescribing Incentive Program, see www.cms.gov/erxincentive. 

Find an AMA summary and analysis of the proposed 2011 fee schedule at www.ismanet.org/pdf/news/2011-MPPPR-AMA-summary.pdf. 



"Self-Policing" in the Medical Profession: Current JAMA Paper, Local Editorial, Ethical Standards, & Maine Law

A paper entitled, Physicians' Perceptions, Preparedness for Reporting, and Experiences Related to Impaired and Incompetent Colleagues published in the current issue of JAMA has attracted some local press attention and produced an editorial in the Kennebec Journal on Friday, July 16th entitled, Physicians: Squeal Thyselves.

The JAMA article concludes, "[o]verall, physicians support the professional commitment to report all instances of impaired or incompetent colleagues in their medical practice to a relevant authority; however, when faced with these situations, many do not report."

You can find an abstract of the JAMA article on the web at:  http://jama.ama-assn.org/cgi/content/short/304/2/187.

You can find the KJ editorial on the web at:  http://www.kjonline.com/opinion/editorials/OUR-OPINION-Physicians-Squeal-thyselves.html.

The following are the ethical basis and grounds under Maine law for the obligation to report an impaired or incompetent colleague.

Opinion 9.031, Reporting Impaired, Incompetent, or Unethical Colleagues

Physicians have an ethical obligation to report impaired, incompetent, and unethical colleagues in accordance with the legal requirements in each state and assisted by the following guidelines:

Impairment. Impairment should be reported to the hospital’s in-house impairment program, if available. Otherwise, either the chief of an appropriate clinical service or the chief of the hospital staff should be alerted. Reports may also be made directly to an external impaired physician program. Practicing physicians who do not have hospital privileges should be reported directly to an impaired physician program,such as those run by medical societies, when appropriate. If none of these steps would facilitate the entrance of the impaired physician into an impairment program, then the impaired physician should be reported directly to the state licensing board.

Incompetence. Initial reports of incompetence should be made to the appropriate clinical authority who would be empowered to assess the potential impact on patient welfare and to facilitate remedial action. The hospital peer review body should be notified where appropriate. Incompetence which poses an immediate threat to the health of patients should be reported directly to the state licensing board. Incompetence by physicians without a hospital affiliation should be reported to the local or state medical society and/or the state licensing or disciplinary board.

Unethical conduct. With the exception of incompetence or impairment, unethical behavior should be reported in accordance with the following guidelines:

Unethical conduct that threatens patient care or welfare should be reported to the appropriate authority for a particular clinical service. Unethical behavior which violates state licensing provisions should be reported to the state licensing board or impaired physician programs, when appropriate. Unethical conduct which violates criminal statutes must be reported to the appropriate law enforcement authorities. All other unethical conduct should be reported to the local or state medical society.

Where the inappropriate behavior of a physician continues despite the initial report(s), the reporting physician should report to a higher or additional authority. The person or body receiving the initial report should notify the reporting physician when appropriate action has been taken. Physicians who receive reports of inappropriate behavior have an ethical duty to critically and objectively evaluate the reported information and to assure that identified deficiencies are either remedied or further reported to a higher or additional authority. Anonymous reports should receive appropriate review and confidential investigation. Physicians who are under scrutiny or charge should be protected by the rules of confidentiality until such charges are proven or until the physician is exonerated. (II) Issued March 1992 based on the report "Reporting Impaired, Incompetent, or Unethical Colleagues," adopted December 1991; Updated June 1994 and June 1996.

The relevant Maine statutory provision is 24 M.R.S.A. §2505:

Any professional competence committee within this State and any physician licensed to practice or otherwise lawfully practicing within this State shall, and any other person may, report the relevant facts to the appropriate board relating to the acts of any physician in this State if, in the opinion of the committee, physician or other person, the committee or individual has reasonable knowledge of acts of the physician amounting to gross or repeated medical malpractice, habitual drunkenness, addiction to the use of drugs or professional incompetence. The failure of any such professional competence committee or any such physician to report as required is a civil violation for which a fine of not more than $1,000 may be adjudged. 

Except for specific protocols developed by a board pursuant to Title 32, section 1073, 2596-A or 3298, a physician, dentist or committee is not responsible for reporting misuse of alcohol or drugs or professional incompetence or malpractice as a result of physical or mental infirmity or by the misuse of alcohol or drugs discovered by the physician, dentist or committee as a result of participation or membership in a professional review committee or with respect to any information acquired concerning misuse of alcohol or drugs or professional incompetence or malpractice as a result of physical or mental infirmity or by the misuse of alcohol or drugs, as long as that information is reported to the professional review committee. Nothing in this section may prohibit an impaired physician or dentist from seeking alternative forms of treatment.

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Contact Congress about FMAP Enhancement Extension

Physicians are encouraged to contact Maine's Congressional delegation urging support this week for the FMAP extension which is vital to ensure necessary funding for Maine's Medicaid program, which has experienced enrollment increases of more than 19,000 new beneficiaries in the last 12 months, presumably because of the recession.  If Congress fails to extend the enhanced payment for another six months, the state will face a $100 million hole in the current state budget (the one that began on July 1, 2010).

While all four members of the delegation have expressed support for the FMAP extension, physician communication with the Congressional offices is still critical to underscore the significance of this issue for Maine's physicians and hospitals.

Time is of the essence as the extension, currently part of the federal "jobs bill", may be separated from the unemployment benefits extension part of the bill and voted on as a stand alone item.  As part of the Senate negotiations, offsets have been identified to pay for a compromise version of the extension bill.

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State Health Plan Declares Maine the Ninth-Healthiest State in the Nation

The 2010-2012 State Health Plan released earlier this month ranks Maine as the ninth-healthiest state, up from 16th healthiest in 2003.  The Plan also ranks Maine sixth best in covering the uninsured, up from 19th in 2002.  The Plan states that health care costs remain too high, but growth in premium costs for workplace insurance is lower than the national average.

The Plan proposes reducing health care costs by strengthening public health and prevention of health problems, finding ways to avoid unneeded hospitalizations and emergency room use, and finding ways to reward efficiency and prevention.

Preparation of a State Health Plan is mandated by state law.  The Health System Development Advisory Council oversees preparation of the Plan.  Drs. Lani Graham, Maroulla Gleaton, and Josh Cutler are all voting members of the Advisory Council which is chaired by Brian Rines, Ph.D. [return to top]

State Representative Joan Cohen, former MMA General Counsel, Withdraws from Legislative Race

MMA was saddened to learn last week of the withdrawal of Joan Cohen (D, Portland) from her legislative re-election race.  Joan withdrew to spend more time with her family, which we certainly understand.  But Joan's withdrawal will be a loss for Maine's physicians and the citizens of Maine as she was an exceptional legislator.  This came as no surprise to MMA given her years of work with us.

 We wish Joan, Jim and their boys all the best. [return to top]

MaineCare Managed Care Stakeholder Advisory Group Convenes

The MMA participated in the first meeting of the MaineCare Managed Care Stakeholder Advisory Group at the State House on Thursday, July 15th.  The 124th Legislature directed the formation of the Advisory Group in the most recent supplemental budget, L.D. 1671 (P.L. 2009, Chapter 571) as follows:


Sec. QQQQ-1. MaineCare managed care stakeholder advisory group. The Department of Health and Human Services shall convene a stakeholder advisory group composed of MaineCare members, provider representatives, advocacy groups and Department of Health and Human Services clinical program directors to provide guidance to the department regarding the transition to managed care for the MaineCare program. The department shall invite the Maine Medical Association, the Maine Osteopathic Association, the Maine Hospital Association, the Maine Primary Care Association, the Maine Dental Association and the Maine Association of Mental Health Services and any other entities it considers necessary to participate in the stakeholder advisory group. The department shall, at a minimum, convene quarterly meetings of the stakeholder advisory group, with the first meeting occurring no later than July 1, 2010. The department shall provide quarterly reports to the joint standing committee of the Legislature having jurisdiction over appropriations and financial affairs and the joint standing committee of the Legislature having jurisdiction over health and human services matters regarding the department’s efforts to implement managed care for the MaineCare program, with the first report occurring no later than October 1, 2010.

In accordance with the legislature's directive, DHHS is planning a major initiative that will change the MaineCare program and its relationship to members, providers, and other stakeholders.  The initiative will move MaineCare away from its traditional role of approving and paying for individual services, toward a role of holding contractors accountable for the delivery of high-quality health services to members.

The goals of the initiative are:

  • Enhance the quality of MaineCare services; and
  • Reduce the growth rate in per person spending.

The Department aims to achieve these goals by forging a new partnership with members, providers, and health plans.  Collectively, all stakeholders must share incentives to improve the quality and reduce the growth rate of the MaineCare program.  Objectives of this new approach are:

  • Align the incentives of members, providers, contractors, and MaineCare; and
  • Measure and reward quality.

During the first Advisory Group meeting, DHHS officials and consultants from the Muskie School of Public Service at USM provided background and an overview of the Maine initiative in the context of Medicaid program trends nationally and the national health care reform law.  The Department has proposed a timeline that includes the first RFP being issued in April 2011 and the first enrollment to take place in January 2012.

A section of the DHHS, Office of MaineCare Services web site has been dedicated to information about the MaineCare Managed Care Initiative (MMI):  http://www.maine.gov/dhhs/oms/mgd_care/mgd_care_index.html.

The MMA will keep you informed of the progress of this initiative through Maine Medicine Weekly Update. [return to top]

Athenahealth Offers HIT Webinars on July 28th & August 5th

Athenahealth is offering the following two webinars on timely HIT topics in the next few weeks:  HITECH & Successful EHR Adoption on July 28th and Decoding Meaningful Use on August 5th.

The HITECH Act and Your Practice: 8 Tips for Successful EHR Adoption

Wednesday, July 28, 2010, 12:15 PM EDT

The Obama administration has made electronic health record (EHR) adoption a major health policy objective. With the Health Information Technology for Economic and Clinical Health (HITECH) Act, their goal is for all physicians to begin using EHRs over the next decade.

But many physician practices are troubled by the huge upfront costs many EHRs require - hardware, software, interfaces and IT support – without a clear return on investment (ROI). Practices also worry about disruption during EHR implementation.

A successful EHR can dramatically improve patient care, profit, and workflow. What’s more, EHR implementation can be a smooth (and practice-strengthening) process.

In this Webinar get clear guidance – in eight steps – on doing the right planning and choosing the right vendor.

With this information you’ll be prepared to reap the rewards of successful EHR adoption (as well as the incentives currently outlined in the HITECH Act). Register today!



Decoding “Meaningful Use”: What Do the New Rules Mean for Your Practice?

Thursday, August 5, 2010, 12:00 PM PDT

Now that the federal Centers for Medicare and Medicaid Services have published the final rules for “meaningful use” and certification criteria for electronic health records, medical practices need to know what the rules mean for you. Join athenahealth and Manatt Health Solutions for a Webinar that will answer questions such as:

·         What are the differences between the Final Rule and the earlier draft rules released in December 2009?

·         What are the basic requirements for achievement of incentive payments under the Medicare and Medicaid programs?

·         What are the implications for care coordination and connectivity?

The Obama administration has made EHR adoption a major health policy objective—with the proposal to make all medical records electronic by 2014. Along with the mandate, the government is offering up to $44,000 in Medicare and $63,750 in Medicaid incentive payments for demonstrating meaningful use of an EHR under the Health Information Technology for Economic and Clinical Health (HITECH) Act.

This Webinar will walk you through the details of the new meaningful use rule and explore its implications for physician practices seeking to secure federal stimulus dollars. It will also identify the ways that athenahealth is addressing meaningful use requirements and guaranteeing federal stimulus Medicare payments for eligible physicians.

A Q&A session will follow the presentation. Register today!

http://event.on24.com/r.htm?e=228346&s=1&k=A323B7D9016041F890EC9FEB585215B8&partnerref=mma. [return to top]

AMA Seeks Feedback on PQRI

The AMA continues to engage the Obama Administration and Congress regarding improvements to the Medicare Physician Quality Reporting Initiative (PQRI).  To help inform these efforts, the AMA has prepared the following feedback form requesting physician input on specific program improvements.

Please submit your completed form via email to Jennifer.Shevcheck@ama-assn.org by the close of business on Friday, July 23rd.


The purpose of the form is to solicit your feedback regarding improvements to the Medicare Physician Quality Reporting Initiative (PQRI).  Specifically, the identification of approaches the Centers for Medicare & Medicaid Services (CMS) should adopt to improve successful participation.  We seek your top three detailed recommendations to include in our communications with the Administration.  Comments are due to the AMA by July 23

Name of Specialty/State:_________________________________________________________

Point of Contact:_______________________________________________________________

Contact email and phone number:_________________________________________________

Recommendation #1: ___________________________________________________________________


Recommendation #2: ___________________________________________________________________



Recommendation #3: ___________________________________________________________________



Please return completed forms to jennifer.shevchek@ama-assn.org. [return to top]

CMS to Host July National Provider Call on PQRI & ERX Programs

CMS will host a national provider conference call on the 2010 Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (eRx).  The call is scheduled to take place from 3:00 - 4:30 p.m. EDT on Tuesday, July 20, 2010.  CMS staff will provide a few PQRI and eRx program announcements and updates, and allow participants to ask questions of CMS PQRI and eRx subject matter experts.  In order to receive the call-in information, you must register for the call at  http://www.eventsvc.com/palmettogba/register/d5cc1dca-f975-4ff7-a807-973a7dfe79e0.  Registration will close at 3:00 p.m. EDT on Monday, July 19, 2010. [return to top]

Searching for an "Academic Detailer"

The Maine Medical Association is in need of one or more health professionals interested in training to become "academic detailers" and to provide education to medical practices in the state through a grant from the Maine Department of Health and Human Services.  These would be part-time positions and involve, on average, a few hours each week depending upon the number of practices requested the service.

MMA's academic detailing project is an innovative pilot program that delivers up-do-date, evidence-based prescribing information to health care providers throughout the state.  The program uses data and guidelines developed by non-commercial sources, with the primary goal being to improve clinical outcomes.

Any physician, PA or nurse practitioner who may be interested in this type of work should contact Gordon Smith, Esq., MMA's EVP at 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