September 27, 2010

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Medicare Cuts Scheduled for December 1, 2010 and January 1, 2011; Congressional Action Needed

The American Medical Association and many national specialty societies will ask Congress this week to enact, during its anticipated lame-duck session following the election, legislation that will again postpone the cuts and provide a positive update through 2011.  MMA will sign on to the letter and ask Maine's Congressional delegation to support this approach.

The Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 (P.L. 111-192) stabilized Medicare physician payments only until November 30, 2010.  After that, Medicare payments for physician services will be slashed by more than 23%.  To make matters worse, an additional cut of 6.5% will follow on January 1, 2011.  Physician practices in Maine simply cannot absorb cuts of this magnitude in a program as important as Medicare, particularly in a state with the greatest percentage of seniors in the nation.  Congress must act to break the cycle of forestalling a crisis in patient access to physician care for only a few months at a time, and take action during the upcoming lame-duck session to act on legislation to provide stability and predictability for the program at least through 2011.

Throughout 2010, Congress enacted short-term, stop-gap measures for durations as short as one month.  On three occasions, Congress failed to act in time and Medicare payments were cut by more than 20%.  The Centers for Medicare and Medicaid Services (CMS) reacted by ordering carriers to hold payments until legislation was passed.  Importantly, these steps did not protect physician payments from all the consequences of the repeated Congressional delays.  On the contrary, payment uncertainties and delays were highly disruptive.  Some practices were forced to seek loans to meet payroll expenses, lay off staff, or cancel capital improvements, and investments in electronic health records and other technology.  Furthermore, when payments resumed, many physicians experienced long delays in receiving retroactive adjustments.  This is not the way to manage a program that seniors rely on.

The next payment reduction is scheduled to occur during the period when physicians may change their status from a Medicare participating physician who accepts Medicare's allowance as payment in full to a non-participating physician who may bill patients more than the Medicare allowance.  We can anticipate that many physicians will be examining whether it makes any sense to continue their current relationship with Medicare given the severe disruptions of the past year.

The American Medical Association and many of the national specialty societies are writing to Congress this week, asking for  a statutory payment update that lasts at least through the end of 2011.  Such action will provide time for Congress and the physician community to develop a long term solution to ensure that seniors can count on finding physicians to care for them, and that physicians will not view Medicare as a threat to the viability of their practice.  Congress will be asked in the letter, which MMA will join in, to take action during the first week of its lame-duck session, before the massive cuts take effect yet again.

Please ask Maine's four members of Congress to support at least this temporary solution to the SGR crisis.  You can communicate with Maine's Congressional delegation through the AMA's grassroots action center:



Several Coverage Provisions in ACA Took Effect September 23rd

Last Thursday was the effective date of several of the consumer protection provisions included in the Affordable Care Act signed by President Obama last March.  These included:

  • The ability of young adults to remain on their parent's insurance policies until their 26th birthday, regardless of where they live or if they are married.
  • Children with pre-existing health conditions cannot be denied insurance.
  • Commercial insurers must cover selective preventive screenings such as immunizations, mammograms, and colonoscopies without subjecting them to co-payments or deductibles.
  • No lifetime limits on coverage, and insurers must notify people who exceeded their lifetime limits before September 23rd that those limits no longer apply.
  • Insurance companies with annual limits on essential health benefits must provide an increasing amount of coverage.  Initially, their annual limit can be no less than $750,000, rising to $1.25 million in September 2011 and $2 million in 2012.  Annual limits are prohibited in 2014.  But these restrictions do not apply to grandfathered plans (see note below on grandfathered plans).  It also does not apply to limited plans that provide coverage for just certain diseases and conditions.

With respect to young adults remaining on their parents' policies, in most cases parents will not be able to add an adult child to their existing employer-based coverage until the policy's annual open enrollment period.  And the new preventive screening benefits do not apply to some "grandfathered" policies.  Grandfathered policies are policies that existed before the new law and which haven't substantially changed.  Note also that children are not eligible to go on their parents' plans if the children have access to coverage through their own workplace.

Consumers may call the insurance bureau's Consumer Assistance Division at 1-800-300-5000 and ask for information on the details of the reform bill.  Consumer-friendly information also is available on the website of the Bureau at  Further details are also available on the federal website at  


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MMA Ad Hoc Committee on Governance Holds Second Meeting

MMA's ad hoc Committee on Governance, chaired by current President Jo Linder, M.D., met this past Wednesday night.  The primary topic was the selection of the members of the Executive Committee, who currently represent geographical areas (15 counties).  Given that there are not many functioning county medical societies, the committee is considering whether to recommend an alternative means of member selection.  Looking at specialty societies or medical staffs were alternatives considered.  But, specialty societies are asked to participate actively in the Association's legislative committee and have never asked for direct Executive Committee representation.  While medical staffs could be asked to nominate committee representatives, it has traditionally been felt that medical staffs exist for purposes directed to the institution.  Another model would involve representatives selected from medical groups of various size, as well as representatives of solo practice physicians.  But in the end, the ad hoc committee members determined that the better method of selecting Executive Committee members would be to have a robust nominating committee work year-round to recruit physician leaders of various backgrounds and specialties, regardless of their geography.  This recommendation will be made to the Executive Committee in January 2011 and could not be voted upon and implemented until the General Membership Meeting on September 10, 2011.

The Executive Committee currently has 28 to 32 members, with the county representatives supplemented by the officers, the AMA delegates, up to three past presidents, and several committee chairs.

In addition to the make-up of the Executive Committee, the ad hoc committee also will recommend that the Committee be re-named the Board of Directors or the Board of Trustees, recognizing the division of work currently undertaken by the Committee and the smaller Operations Committee which functions more like a traditional executive committee.

In addition to the make-up of the Executive Committee, the ad hoc committee will also consider how frequently the committee should meet and when.

The ad hoc committee will meet next on October 12th from 6:00 pm to 8:00 pm at the MMA offices in Manchester. Following additional meetings in November and December, final recommendations will be made by the group to the Executive Committee at the annual retreat in January.

The ultimate purpose of the ad hoc committee is to assure that the governance of the Association is fairly representative of MMA's 3400 members. [return to top]

View Recent Gubernatorial Forum at

As part of the Association's recently concluded Annual Session in Bar Harbor, the five gubernatorial candidates all appeared for a 90-minute Public Health Forum.  The candidates each answered six questions prepared by the MMA's Committee on Public Health and made closing statements.  More than 200 people attended the event held at the Bar Harbor Club.  The event was videotaped and is available for viewing on the Association's website at  Click on "Annual Session."

MMA encourages all members to vote on or before November 2nd (absentee ballots are already available in most communities) and further encourages members to be active in their support of candidates of their choice.  If you are interested in a list of legislative candidates that the Maine Physician Action Fund has contributed to, please contact Andrew MacLean, Deputy EVP, at  The Association does not take a position in gubernatorial campaigns.  And, the Fund is not a federal PAC so does not contribute to candidates for Congress, although the PAC trustees do make recommendations to AMPAC, the political action fund of the American Medical Association.



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Bates College Presents CME on African Refugee Health from October 15-17th

Bates College presents a program on African refugee health October 15-17, 2010 on the Bates College Campus.  The program is jointly sponsored by Bates, the Central Maine Medical Family, St. Mary's Health System, and the National Center for Emerging and the Zoonotic Infectious Diseases, Centers for Disease Control & Prevention.  The conference will present best practices in immigrant health care in the medical, nursing, public health, behavioral/mental health, and administrative fields from nationally and internationally recognized experts in these fields.  

You can find registration information for the conference on the web at:

The event begins on Friday evening, October 15th at 6:30 p.m. and concludes on Sunday, October 17th at 12:30 p.m.    There is a registration fee of $200 for physicians and category one CME has been approved.  For more information, contact Brenda Pelletier at [return to top]

Maine CDC Awarded $8.8 Million Over Five Years to Improve Public Health System

Last week, the Maine Centers for Disease Control and Prevention in the Department of Health and Human Services announced that it had received an award of $1.76 million per year for five years from the U.S. Department of Health and Human Services for improvements to Maine’s public health system.

Funded by the Affordable Care Act of 2010, the goal of these funds includes improving health departments’ performance management capacity and the ability to meet national public health standards.  In Maine, these funds will: complete an electronic death certificate system; make necessary updates to an electronic birth certificate system; build systems to allow health care providers to more easily transfer information on immunizations to Maine CDC; apply public health performance management principles in Maine CDC and its work; improve capacity for health planning at the state and district level; and make public health data more accessible. 

 "As a result of this grant’s work, public health data and information will be more available more quickly to those who need it,” said Brenda Harvey, Commissioner of Maine DHHS.  “This will improve the ability for health care providers and public health professionals to make decisions.  As a result, the quality and efficiency of healthcare will improve.”

More than 140 applications from health departments were received by the CDC since its original funding announcement in July 2010.  Seventy-five state and other health departments were awarded the performance management component of these funds, which amounts to $100,000 in Maine.  Only 14 states and five other health departments received the highly competitive second component of these funds.  Maine received $1.66 million in this component.

For more information, please visit

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MMA Testifies on Health Insurance Exchanges

The Legislature's Joint Select Committee on Health Care Reform Opportunities and Implementation met last Tuesday to discuss key policy issues and questions raised by the health insurance exchange provisions of the Affordable Care Act (ACA).  

Chaired by Senator Joseph Brannigan (D-Cumberland) and Representative Sharon Treat (D-Hallowell), the Committee first heard a presentation by Amy Lischko of the Tufts University School of Medicine outlining what the "Exchange" actually is, how the ACA Exchange compares to insurance exchanges currently operating in other states, what it will take to create an exchange in Maine, and opportunities and challenges an exchange will present to Maine.  She summarized that an exchange is a one-stop portal, typically web-based, for determining health insurance eligibility and purchase.  Individuals and businesses can use the exchange to compare the cost and quality of health plans and also attain subsidies and tax credits for the purchase of insurance.  

 Following the overview presentation, the Committee heard from the Small Business Majority and Community Catalyst for a business and consumer perspective on exchanges.  Gordon Smith, Esq., Executive Vice President of the MMA, testified as part of a provider panel.  In response to questions posed in advance by the Committee, Mr. Smith stated that MMA is in support of the exchange as an additional method to increase health insurance coverage.  The MMA believes that Maine should operate a state-based exchange, rather than having the federal government establish the exchange in Maine.  The MMA position is also that, building off of the state's experience with HealthInfoNet and the Dirigo Health Agency, the exchange should be housed in a nonprofit organization.  Finally, Mr. Smith emphasized that consumer accessibility will be key to the success of the exchange and the state should not simply rely on a website portal, but will need as many access points as possible including phone and in-person assistance.  

The Committee also heard from panels of insurers, businesses, and consumers to gather additional stakeholder input on the development of an exchange operating in Maine.  Maine has applied for a $1 million health exchange planning grant and would need to implement an exchange by January 1, 2014.

 For more information on the Joint Select Committee, visit:

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CMS Names GEMs as Crosswalk for ICD-10 Implementation

Beginning October 1, 2013, the current ICD-9 code set named under HIPAA will be replaced with the ICD-10 code set.  Physicians who submit claims electronically  will be required to update to the ICD-10 code set when submitting diagnosis codes.  CPT remains the approved code set for reporting procedures done in the outpatient and office settings, while the ICD procedure code stet will continue to be used to report hospital inpatient procedures.  Because of the new structure and format of the ICD-10 codes, there is not always an exact match of an ICD-9 code to an ICD-10 code (i.e., there can be multiple ICD-10 codes that correspond to a single ICD-9 code).

 To facilitate the transition from ICD-9 to ICD-10, a method for crosswalking codes between the two code sets was needed.  CMS and the National Center for Health Statistics (NCHS) developed the "General Equivalency Mappings" (GEMs), that provide an equivalency mapping of ICD-9 to ICD-10, as well as ICD-10 to ICD-9.  The AMA advocated strongly for naming the GEMs as the crosswalk required by CMS for use by the industry.  CMS just announced that the data files known as the GEMs are the "crosswalk" referred to in the ACA.  It is expected that the use of GEMs will help reduce variability for physicians and payers during the transition to ICD-10 as use of multiple proprietary crosswalks by payers could add significant complexity for physicians.  For more information on ICD-10, visit the AMA web site at:

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Reminder About Medicare Enrollment & PECOS

Physicians are strongly urged to keep their Medicare enrollment information up to date to avoid inadvertent termination from the program.  Also, physicians who refer or order services for Medicare patients but do not bill Medicare themselves are required to have been enrolled in the Internet-based Provider Enrollment, Chain & Ownership System (PECOS), the Medicare enrollment system by July 6, 2010.  If physicians have not yet enrolled or updated their information, they are strongly urged to do so immediately.  While Medicare is not yet rejecting claims where the legal name and NPI of the referring/ordering physician is listed but not yet enrolled in PECOS, this action is expected at some point in the future.  The only physicians who are not required to enroll in PECOS are those who have a valid opt-out affidavit on file with their local Medicare contractor.

Physicians should be aware that because of scheduled maintenance, the online PECOS system will be unavailable from Wednesday, September 29th through Sunday, October 3rd.  The AMA has information on the Medicare enrollment process on the web at: under "Medicare Enrollment."  For more information about Internet-based PECOS, see the appropriate "Getting Started" guide available in the Downloads section at:

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CMS Issues Self-Referral Disclosure Protocol (SRDP)

As required by the ACA, on September 23rd CMS issued a Medicare self-referral disclosure protocol (SRDP) intended to assist providers with self-disclosure of any possible violations of the physician self-referral or Stark law.  The protocol may be useful to providers in resolving a potential Stark violation with reduced penalty exposure, but it is not intended that providers will be able to obtain an opinion in advance of a possible violation from CMS.  Under the provision of the ACA, the DHHS Secretary has the discretion to reduce penalties for providers submitting a SRDP based upon factors including the nature of the violation, the timeliness of the SRDP, cooperation by the party submitting the SRDP, litigation risk, and the finances of the party submitting the SRDP.

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Advisory Council on Health Systems Development Considers Exchange Options

The Advisory Council on Health Systems Development (ACHSD), a key player in Maine's effort to comply with the ACA, spent most of its meeting on Friday, September 24, 2010 considering options for setting up the insurance exchanges required under the federal health care reform law.  The Council discussion was based upon a presentation by Amy Lischko of the Tufts University School of Medicine, a consultant to the Governor's Office of Health Policy & Finance.  You can find the meeting agenda along with a link to the exchange presentation on the web at:

The presentation raised 5 questions or "early considerations" for the State in structuring its exchange(s) within the federal framework.  The Executive Branch Health Reform Implementation Steering Committee considered these 5 questions and made recommendations on each.  The Steering Committee recommendations are:

  1. Maine should manage its own exchange.

  2. Maine should create one exchange serving both individuals and businesses

  3. Maine should have one exchange serving the entire state

  4. Maine should explore collaboration with New England states on some exchange functions

  5. Maine's exchange should be housed in an independent or quasi-state agency.

The presentation includes the Steering Committee's list of "pros" and "cons" of each recommendation. The Advisory Council members engaged in a spirited discussion of these recommendations and indicated initial leanings on each.

The Council also heard a report on a recent National Governor's Association meeting in Vermont involving 30 states comparing notes on their ACA implementation efforts.

The Council has scheduled its meetings for the rest of the year.  The next meeting is Friday, October 22nd and the topic is the Medicaid eligibility aspects of the ACA.  The Council also will meet on November 19th and December 17th.

You can follow Maine's ACA implementation efforts on the web at:

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Athenahealth Offers Webinar on Replacing Your EHR for Better Results on October 13th

Replacing Your EHR for Better Results: Top Tips for Making the Switch

Thursday, October 13, 2010, 12:15 PM EDT

Despite 30 years of availability, electronic health records (EHRs) have failed to live up to expectations. Widespread adoption has been undermined by long and costly implementations, unwieldy formats and high costs. Rather than improve efficiency and productivity in a practice, some EHRs have generated so much frustration that physicians are looking for the exits.

In an effort to overcome these problems and encourage adoption, the federal government is offering physicians up to $44,000 in Medicare incentives for demonstrating “meaningful use” of an EHR. For doctors stuck with an underperforming EHR, this presents financial motivation and a window of opportunity to make the switch to a system that meets practice needs and can guarantee incentives.

Learn how a web-based system can reach beyond just serving as an electronic version of a paper chart and produce tangible results in your practice, providing more money and more control of your workflow. Find out how replacing your current EHR with athenaClinicalsSM can deliver:

•             Quick and easy implementation

•             Smooth data migration

•             Improved workflow

•             Measurable cost savings and ROI

•             Guaranteed HITECH Act incentives

With the guidance provided in this webinar and the accompanying whitepaper, you’ll learn how the right EHR solution can make your practice more competitive by minimizing the huge costs of implementation and maintenance, uncovering and banking new incentive revenue, and removing the burden of clinical paperwork starting on day one. And you’ll leave with key tips and considerations to make switching your EHR system as smooth and seamless as possible.

Join us on Wednesday, October 13th at 12:15 PM ET for a live Webinar, and bring your questions - we’ve set aside plenty of time for Q&A. Register today!

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