September 20, 2010

 
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First Fridays Education Programs Resume Friday, October 1st

MMA's popular practice education seminars resume on Friday, October 1st with Compliance in the Medical Practice, presented by John Gleason, Esq. and Laurie Desjardins CPC, PCS of Baker, Newman & Noyes.  The program will be presented at MMA's offices in Manchester from 9:00 a.m. to noon and you may attend live or via WebEx.  This program will assist physicians and their practice and compliance managers in understanding the issues surrounding the design and implementation of an effective compliance program.  Additional programs in 2010 include November 5th on Medical Records and December 3rd on Current Medical-Legal issues.

Given the increased level of scrutiny and enforcement at the federal and state level, this program offers a timely opportunity to discuss with experts the range of issues affecting medical practice compliance efforts, from the general development of the overall plan to the specific issues that may arise in a coding and billing audit.

John Gleason, Esq. is a member of the Portland law firm of Curtis, Thaxter, Stevens, Broder & Micoleau and chairs its Health Care Practice Group and its Employment Law Practice Group.  His practice includes the representation of physicians and other health care providers in the organization and operation of their practices and the antitrust and regulatory issues arising from the affiliation between medical practices. 

Laurie Desjardins, CPC, PCS joined Baker, Newman & Noyes in 2006 following a successful experience at directing the Coding Center, at that time a tri-state effort owned by the state medical societies in Maine, New Hampshire, and Vermont.  She currently is a Senior Manager in the Healthcare Management Consulting Division of BNN, specializing in revenue management including physician coding, provider-based implementation, chargemaster analysis, fee schedule analysis, chart review, and coding and billing education.  She currently serves as Regional Governor of the American College of Medical Coding Specialists.

MMA's Coding Center was conveyed in August to Baker, Newman & Noyes under an arrangement wherein MMA members and their staffs may continue to receive advice and counsel (in most instances without cost) on coding and billing questions.  The endeavor will now be called The Learning Center of Baker Newman Noyes.

The cost of the seminar is only $65 which includes breakfast (for those attending on site) and all course materials.  Those attending through WebEx may register by e-mailing webinars@mainemed.com.  Those persons coming to Manchester may register on-line at http://www.mainemed.com.

 

MeMGMA Presents Half-Day Session on Service Excellence at MMA on September 29th

The Maine Medical Group Management Association is pleased to present a program on Service Excellence by Dan Booth from 8:30 a.m. to noon on Wednesday, September 29th at the MMA headquarters in Manchester. 

 

Dan Booth is the Vice President of Operations and Chief Human Resource Officer at Inland Hospital in Waterville, Maine.  He has worked in this position for 10 years.  Prior to working at Inland, Dan has worked in several other healthcare organizations throughout New England for the past 20 years.  Dan started his healthcare career working for Marriott Management Services in their contract management division.  In his role as VP of Operations/CHRO, he has administrative responsibility for the employed physician practices, ancillary support departments and human resources.  He also is the service culture development point person for the organization.  Dan has a B.S. in Clinical Nutrition from Penn State University and a M.B.A. from Thomas College.  He lives in Oakland, Maine with his wife Joanne and 3 children and enjoys skiing and kayaking.

 

Dan's presentation on Service Excellence will address Establishing a Culture of Service and Key Service Behaviors.

 

The program cost is $25 for MeMGMA members and staff (whether live or by WebEx) and $50 for non-members (also live or WebEx).

 

For more information, please contact Karen Wheeler at 873-6173 or by email at karenkay@roadrunner.com.

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Maine Police Agencies & U.S. D.E.A. Plan Joint Drug Collection Effort for September 25th

As covered in the Maine Sunday Telegram of August 29th, police agencies in Maine are joining with the federal Drug Enforcement Administration (DEA) are collaborating on a public service effort to collect unwanted and unused medications on September 25th.  The article quotes Maine D.E.A. Director Roy McKinney saying, "The non-medical use of prescription drugs is at epidemic levels, not just in Maine now, but it's being recognized across the country."  Maine now joins 15 other states in which more people die from prescription drug overdoses than from car accidents.  Maine has been at the forefront of unwanted drug return efforts around the country, through the efforts of many interested individuals and organizations including Stevan Gressitt, M.D. and colleagues within the Maine Association of Psychiatric Physicians, the MMA Public Health Committee, M.D.E.A. Director McKinney, and Representative Anne Perry (D-Calais), House Chair of the legislature's Health & Human Services Committee and a nurse practitioner.

 

You can find out more information about this national collection effort on the web at:  http://www.justice.gov/dea/index.htm.

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M4A Presents 3rd Annual Conference on Aging on Friday, October 22nd

It is time to register for this year’s . . .

 The Maine Association of Area Agencies on Aging

                 3rd Annual Conference on Aging

          NEXT DECADE of HEALTHCARE REFORM

             Impact and Opportunities for Maine

Friday, October 22, 2010   ♦   8:30am – 3:30pm at Point Lookout, Northport

State-specific information on how the new Healthcare Reform legislation

will affect Maine’s growing baby boomer and senior population . . .

and the businesses and institutions that serve them.

 Target Audience:      Maine’s medical, business, insurance, legal, financial, civic, homecare, caregiver, and political leaders.

Keynote Speaker:      Ron Pollack , the Founding Executive Director of Families USA, the national organization for healthcare consumers.  [Frequent guest on The NewsHour with Jim Lehrer and CNN’s Lou Dobbs Tonight, and often quoted in The New York Times, The Washington Post, and the Wall Street Journal.]

For more information, call Holly Couture at 1-800-282-0764 or at hcouture@spectrumgenerations.org.


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MaineCare MIHMS Update

The MaineCare Provider Advisory Group (PAG) met this past Thursday, September 16th and received staff reports on the September 1st transition to MIHMS (Maine Integrated Health Management Solution).  For the period September 1-14, a document entitled, MIHMS Claims Statistics indicated that of the 22,525 claims submitted, 55% were successfully paid, 12% were in process, 15% were suspended, and 18% denied.  The 55% of claims paid made up 45% of total charges.  A lower % of the professional claims were paid than the institutional claims (46.4% vs. 67.9% respectively).

Several "go-live" risk mitigation strategies were discussed and the general consensus at the meeting was that, to date, the go-live conversion was going smoothly.  More than 30 State and Molina (the system vendor) quality assurance and operations staff are reviewing claims for accuracy as they are processed and Molina system architects and developers are onsite in Augusta through October to ensure timely remediation of any system defects. 

The state and Molina have implemented a controlled escalation process to handle any issues which are generally divided into three categories:

  • System Defects

  • Billing Errors

  • Provider Enrollment Update Not Completed

Relative to billing errors, if a claim denies or suspends appropriately, the provider receives an error message in the portal and/or on their remittance advice.  The State is tracking billing error trends and posting messages/updates for providers on the Provider Portal to clarify billing instructions.

If the provider has not successfully enrolled, Molina is reaching out to the provider and has added support staff to expedite resolution. 

The most frequent error reported to MMA by members involved specialist physicians not being able to see referrals.  This defect was corrected on September 13th.  Other reported errors have either been corrected or are being addressed.

MMA staff would still appreciate feedback from the members and their staffs on their experience during this crucial period.  Please communicate with Gordon Smith, Esq. via e-mail to gsmith@mainemed.com.  And thank you to those members and billing staff who have provided feedback to date.  This feedback has been very valuable in our communications with MaineCare officials. [return to top]

Board of Licensure in Medicine Renews Chronic Pain Consultation Contract

At its monthly meeting this past week, the Board of Licensure in Medicine renewed for a third year a contract providing financial support for MMA to consult with medical practices in the state on the difficult issue of prescribing for chronic pain and preventing diversion.  Renewal of the contract means that the four major components of the Association's activities in this area will continue without cost to participants, including:

  • The offering of the Chronic Pain Home Study Course, which will be updated but will remain available pending the update.  The monograph is available on the MMA website at www.mainemed.com and is available for two hours of CME category one credit, if the post-test is submitted and successfully completed.  The CME offering undertakes to give clinicians useful guidance in both the treatment of chronic pain, including use of opioid medication, along with safeguards to ensure that diversion is kept to a minimum.  The course also deals with issues of addiction.

  • In office consultation, to be performed by experienced health professionals.  These consultations continue to be very popular and it is anticipated that up to thirty consultations can be performed in the next twelve months.

  • The resource materials on the MMA website will be updated in order to assure that the information is timely and continues to be appropriate.

  • MMA will continue to offer educational presentations on this subject, in conjunction with OSA, the Tri-state Chapter of the American Society of Addiction Medicine, and the DEA.  Physicians on the BOLIM will be invited to participate where possible.

To access any of these programs, contact either Gordon Smith, Esq. at MMA via e-mail to gsmith@mainemed.com or Gail Begin, at gbegin@mainemed.com.

MMA appreciates the generosity of the Board in making these services available to the physicians of Maine. [return to top]

White House Health Reform Executive DeParle Visits Portland Today

Governor John E. Baldacci will welcome Nancy-Ann DeParle, Director of the White House Office of Health Reform, to Maine this afternoon at 1 p.m. at the Muskie School of Public Service in Portland.  DeParle will recognize Maine's leadership in implementing key early goals of the federal Affordable Care Act (ACA), signed into law by President Obama on March 23, 2010.  The federal law will extend access to affordable health insurance for all Americans.  Many provisions of the law do not go into effect until 2014, but Maine has already begun to implement a voucher program for part-time employees to help them afford their employer's insurance and new coverage for people with pre-existing conditions.  Both these groups have traditionally found health insurance too expensive to afford or difficult to obtain.  DeParle and the Governor will hear from two Maine people with pre-existing medical conditions who have recently been able to access affordable health insurance coverage.

 

The Muskie School is located at 34 Bedford Street (Wishcamper Center) in Portland.

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Bob Downs Takes New Position with Aetna in Maine

On September 14, 2010, Aetna announced the appointment of Robert Downs as Senior Network Leader in Maine.  In this position, Bob will manage and build Aetna's provider relationships and network, explore and create innovative programs to enhance health care quality and efficiency, and represent Aetna's business operations in the state.

Bob has extensive experience working in Maine's health care system.  He holds a bachelor's degree in nursing from Northeastern University and graduated from Northeastern's PA program.  He also holds a master's degree in community health from Boston University.

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MMA Seeks Volunteers for Medical Marijuana Advisory Committee

Maine's new medical marijuana law provides for an Advisory Board established, chaired, and staffed by the Commissioner of DHHS.  The membership includes at least 11 health care practitioners from various fields of practice, including neurology, gastroenterology, pain management, medical oncology, psychiatry, infectious disease, hospice medicine, family medicine, pediatrics, treatment of addiction, and gynecology.  The physicians must be:

  • Recommended by the MMA and the Maine Osteopathic Association;

  • Board certified; and

  • Knowledgeable about medical marijuana.

The membership of the Advisory Board also includes 2 public members, one of whom must be a registered patient.

The duties of the Advisory Board are to:

  • Accept, review, and evaluate petitions to add to the list of debilitating medical conditions;

  • Convene at least once a year to hold hearings on petitions;

  • Make recommendations to the Commissioner on additional conditions; and

  • Recommend quantities of marijuana necessary to constitute an "adequate supply."

If you meet the criteria mentioned above and would like to serve on the Advisory Board, please contact Gordon Smith, EVP, at 622-3374, ext. 212 or by email at gsmith@mainemed.com.

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US DHHS Seeks Public Comment on Quality Priorities

The new federal health care reform law includes many provisions aimed at improving health care quality and efficiency.  On September 9th, the US DHHS released its proposed National Health Care Quality Strategy and Plan and has asked for public comments on priorities for the strategy by October 15th.  You can find the announcement on the web at:  http://www.hhs.gov/news/reports/quality/nhcqsap.html.  DHHS must provide its initial National Health Care Quality Strategy and Plan to Congress by January 1, 2011. [return to top]

Census Bureau Reports 51 Million Uninsured in 2009

On September 16th, the Census Bureau reported that the number of uninsured people in the country was 50.7 million in 2009, up from 46.3 million in 2008.  This is the highest number of uninsured since the Census Bureau began collecting information on health insurance coverage in 1987.  The report entitled, Income, Poverty, and Health Insurance Coverage in the United States:  2009, found that the percentage of uninsured rose from 15.4% to 16.7% from 2008 to 2009.  The number of insured people decreased from 255.1 million in 2008 to 253.6 million in 2009, the first time since 1987 that the number of people with insurance coverage decreased.

You can find the report on the web at:  http://www.census.gov/prod/2010pubs/p60-238.pdf.

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Deloitte Addresses Patient-Centered Medical Home Concept in Issue Brief

On September 16th, the Deloitte Center for Health Solutions released an issue brief entitled, Medical Home 2.0:  The Present, the Future in which it analyzes work on the patient-centered medical home concept to date and the proposed expansion of the concept under the ACA.  The issue brief concludes that patient-centered medical homes are expensive to establish, but that pilot programs suggest that the concept eventually will lead to better outcomes and lower costs.  The issue brief also cites HIT costs and the cost of creating the multi-disciplinary team as substantial initial costs.  Physician acceptance of the concept is also mentioned as an initial challenge.

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