May 30, 2011

 
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MMA's L.D. 1222 Falls Victim to First LePage Veto, Votes to Over-Ride Veto Expected Tuesday

L.D. 1222, An Act to Promote Fairness in Negotiations between Health Insurance Carriers and Health Care Service Providers on Thursday was the subject of the first veto ever issued by Governor LePage.  The legislation had been introduced at the request of MMA in order to prohibit the continued use of so-called "most favored nation" clauses in contracts between providers and health plans.  These clauses are anti-competitive and allow a health plan to reduce reimbursement to a provider if that provider has provided a greater discount to another insurer.  The bill had received a unanimous "Ought to Pass" Committee Report and had been enacted without debate in both the House and Senate.

In his veto message delivered to the legislature, Governor LePage stated that the bill would adversely impact business practices in the state.  "Blanket 'one-size-fits-all' laws prevent businesses from pursuing novel and creative approaches to achieve competitive advantages," the Governor wrote.  "New laws forcing requirements on business are not necessary to ensure that fair play occurs in Maine's insurance marketplace," he said.

"Most favored nation" clauses have been challenged nationally as anti-competitive and two Wall Street Journal articles earlier this year reported the ongoing investigation of Blue Cross Blue Shield plans in six states and the District of Columbia for violation of antitrust laws through use of unfair contracting practices including the use of most favored nation clauses. 

In commenting on the veto, the bill's sponsor Representative Sharon Treat (D - Hallowell) stated that the use of such clauses primarily benefits for-profit insurers while undermining small private medical practices that lack the negotiating clout of larger groups.

In addition to physicians, other providers supporting the bill included physical therapists.  While all the supporters of the bill are encouraging their members to communicate with legislators urging an over-ride of the veto, such action will be particularly difficult to achieve this week given the hyper-partisanship being exhibited daily at the State House.

"Of particular concern," noted MMA COO Andew MacLean, "is the fact that we were never asked by the Governor for any information regarding the bill nor forewarned that he had any concern with it.  In previous administrations, the Governor's opposition would normally be presented at the public hearing or work session on the bill.  We heard nothing until Thursday, and then only from the bill's sponsor who had been notified."

The votes to over-ride the veto may be considered as early as today.

Register Today for Friday's Webinar on Risk Management Including Social Networking, Medical Records Review, and Health Literacy

The next MMA First Fridays program is scheduled for Friday, June 3rd at the MMA office in Manchester and via Webex.  The program is entitled, Physician Practice Risk Management.  The faculty for the program are three experts in risk management from Medical Mutual Insurance Company of Maine (MMICOM):  Cheryl Peaslee, V.P. of Risk Management; Nancy Brandow, Sr. Risk Manager; and Sue Boisvert, Sr. Risk Manager.  The topics are:

  • Performing a Comprehensive Medical Record Review for Patient Safety;

  • "You want me to do what?"  Health literacy and your patients; and

  • "Tweet me?!"  Social networking considerations.

You may register for the program on the MMA web site at:  http://www.mainemed.com/calendar/details.php?IDMeet=1103.  For more information, contact Maureen Elwell at 622-3374, ext. 219 or melwell@mainemed.com.

 

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LAST CALL FOR GOLFERS: MMA's Annual Golf Tournament is Monday, June 6th

The MMA's annual golf tournament is scheduled for next Monday, June 6th at the Augusta Country Club and there are a few spots for golfers open and, of course, sponsorship opportunities remaining.  The tournament benefits the MMA's Medical Professionals Health Program (MPHP).  Registration begins at 11:00 a.m. and the shotgun start begins at noon.  You can find more details and registration information on the MMA web site at:  http://www.mainemed.com/calendar/details.php?IDMeet=1288.  For more information, you may call Gail Begin at 622-3374, ext. 210. [return to top]

MMA Featured in New York Times Article on the Changing Priorities of Physicians

In a front page article in the New York Times yesterday, May 30th entitled, As Physicians' Jobs Change, So Do Their Politics, the Maine Medical Association is featured.  While the story is accurate, there are a lot of nuances that do not fit neatly into an article this size.  There are actually several reasons why MMA did not pursue further tort reform this year, in addition to the reasons noted in the article.  Not the least among these is the generally favorable experience with respect to claims over the past seven years.  We encourage you to read the article (the link follows) and share your reaction and thoughts to MMA EVP Gordon Smith at gsmith@mainemed.com.

http://www.nytimes.com/2011/05/30/health/policy/30docs.html?_r=1&nl=todaysheadlines&emc=tha23

     

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Register Now for MMA's 158th Annual Session in Bar Harbor, September 9-11

Registration materials for MMA's 158th Annual Session are now available and were included as an insert in the recent issue of Maine Medicine which arrived in members' offices the week before last.  You may also register on the MMA website at www.mainemed.com.  The meeting will be held September 9-11 in Bar Harbor with the Friday educational program being held again this year at the Jackson Laboratory and the Saturday and Sunday morning events being held at the Bar Harbor Club adjacent to the Harborside Hotel.

The theme of this year's educational program is INNOVATION and 8 hours of CME category 1 credits are being offered.  The educational program begins at 1:00 p.m. Friday, September 9th with a keynote presentation by Carol Bult, PhD.  Dr. Bult is a Principal Investigator in the Mouse Genome Informatics database consortium at the Jackson Laboratory.   Tours of the Lab will again be available at 3:00 p.m. following the two lectures.  The Friday evening reception will be held at the Laboratory as has been the case the last two years.

Saturday's events will be held back at the Bar Harbor Club with the Annual Meeting in the morning, featuring the presentation of 50 year pins at 10:30 a.m.  At noontime, J. Randy Darby, M.D. of Spectrum Medical Group will keynote the afternoon educational session with a presentation entitled, Innovations in Medical Education and Team Building.  Dr. Darby's presentation will be followed by a panel on clinical technology innovation and a presentation on nanotechnology. 

Saturday evening will feature the annual President's Reception and Annual Awards Banquet at which time President Jo Linder, M.D. will pass the President's gavel to President-elect Nancy Cummings, M.D. 

Sunday morning will begin bright and early at 6:30 a.m. with the 31st running of the Edmund Hardy Road Race, again sponsored by Medical Mutual Insurance Company of Maine.  Following brunch at 8:00 a.m., a panel focusing on Innovations in Physician Wellness, moderated by Dr. Cummings, will inform attendees on how to incorporate mindfulness, wellness and balance into busy lives.

DONATIONS NEEDED!  We will once again be conducting a silent auction to benefit one or more programs falling under the Maine Medical Education Trust (MMET).  If you have something you'd be willing to donate as a silent auction item, please contact Dee DeHaas at ddehaas@mainemed.com.

We look forward to seeing you in Bar Harbor! [return to top]

CMS Announces HIPAA Version 5010 Testing Day

Physicians who submit claims and other HIPAA health care transactions electronically should note that the deadline to comply with the next version of HIPAA transactions, Version 5010, is less than eight months away. On the compliance date of January 1, 2012, these physicians (or the clearinghouses they use) will be expected to send and receive their health care transactions according to the updated standards.  To help physicians and others in the industry prepare, CMS, in conjunction with the Medicare fee-for-service contractors, announced a national testing day on June 15th.  National 5010 Testing Day is an opportunity for physicians and others to come together and test compliance efforts that are already underway with the added benefit of real-time help desk support and direct and immediate access to Medicare Administrative Contractors.  CMS encourages all physicians and those with whom they do business electronically (clearinghouses, vendors, Medicare contractors) to participate so that transaction problems can be identified early.  It can also help physicians avoid serious cash flow interruptions after January 1, 2012.  More details concerning the transactions to be tested are forthcoming from each Medicare contractor.  For more information on HIPAA Version 5010, please visit http://www.cms.gov/Versions5010andD0/ or the AMA web site at:  http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/hipaahealth-insurance-portability-accountability-act/transaction-code-set-standards/version-5010-electronic.page. [return to top]

BNN Learning Center & MMA Offer Upcoming Coding Certification Course at USM

The Learning Center at Baker Newman Noyes in conjunction with the Maine Medical Association is offering a AAPC Approved Coding Certification course.

´  Thursdays, June 9, 2011 to September 22, 2011

´  4:00pm – 8:00pm

´  University of Southern Maine in Portland (#1 Payson Smith Room)

Click Here for the link to the Learning Center’s website for additional details and a Registration form.

Should you have any questions, please don’t hesitate to contact either the Learning Center or Hayat Freeman-Lutes, CPC, CEMC at 207-791-7126 begin_of_the_skype_highlighting            207-791-7126      end_of_the_skype_highlighting. [return to top]

SAVE THE DATE: Pierce Atwood Labor & Employment Seminars, Co-sponsored by MMA, June 10th & 17th

Save the Date! Pierce Atwood Program in your area June 10 & 17:

Labor & Employment Issues for the Maine Healthcare Industry

Locations:
 Brewer & Portland, Maine

Date: June 10 and 17, 2011
Time: 8:30 AM - 3:00 PM

The Pierce Atwood Employment Group, with our co-sponsor Maine Medical Association, is pleased to invite you to a program on Labor & Employment Issues in the Healthcare Industry.  We will be offering this program twice.

  • June 10, also sponsored and hosted by Eastern Maine Healthcare Systems, at the EMHS Brewer office 
  • June 17, also sponsored by Martin's Point HealthCare, at The Woodlands Club in Falmouth

Our tentative agenda includes the following topics:

  • Managing the impaired worker
  • Wage-hour challenges for healthcare employers
  • The latest on union activities around the state including, Maine State Nurses Association/California Nurses Association, Teamsters and others
  • Significant developments in Augusta and Washington
  • Immigration issues in the healthcare industry
  • HIPAA, privacy and technology, including duties of employers and employees
  • Special guest Short Fuse Theater: "Coping with the high performing, high risk healthcare employee". (Portland only) 
  • Rapid-fire round - questions and answers on topics across the labor & employment spectrum

Our agenda is tentative because we want your help in shaping it.  When you register, please use the box on the registration screen to suggest questions or topics you'd like to see us address.  We'll synthesize your responses and incorporate as many as we can into our presentation.

Also, when registering, please indicate which program you wish to attend.

This program will be of interest to senior management, human resources management and staff, in-house counsel, risk managers and upper level supervisors.  Please forward to any interested persons in your organization.

The program will run from 8:30 am to approximately 3:00 pm.  There is no charge to register, and lunch will be served.  Our sincere thanks to our co-sponsors for helping to make these events possible.

Please check your email box for a reminder in the next couple of weeks.

If you have any questions, please contact Amber Elliott at aelliott@pierceatwood.com or 207-791-1143.

Copyright � 2011. Pierce Atwood LLP. All rights reserved.


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CMS Releases Proposal to Exempt Some Physicians from 2012 Penalty for not E-prescribing

The Centers for Medicare and Medicaid Services (CMS) this past week released a proposal that exempts some practitioners from the 2012 Medicare penalty that will be levied against those who are not e-prescribing by June 30th.  The proposal would create new categories for hardship exemptions, making the total list of exemptions as follows:

  • Individual practices in rural areas without high speed internet access
  • Individual practices in areas without sufficient available pharmacies for electronic prescribing
  • Practitioners who have registered to participate in the Medicare or Medicaid EHR Incentive Program and have adopted certified EHR technology
  • Practitioners who are unable to electronically prescribe due to local, state, or federal law or regulations. (Designed primarily to assist practitioners who prescribe controlled substances)
  • Practitioners who infrequently prescribe (For 2012, this means a practitioner must not have had the opportunity to e-prescribe at least 10 times between January and the end of June 2011 in order to qualify for the exemption.)
  • Practitioner has e-prescribing system, meets the threshold requirements for the program and e-prescribes; however, those e-prescriptions generally are not associated with the types of visits contained within the e-prescribing measure denominator.     

Under the proposal, practitioners would have until October 1, 2011 to claim a hardship exemption.  CMS is working to create a web portal to allow for easy filing of the exemption requests and supporting documentation.  Comments on the rule are due July 25th. [return to top]

CMS Innovation Center Announces New Initiatives on ACOs

On May 17th, the Center for Medicare and Medicaid Innovation (CMI) announced three new initiatives to augment the Medicare ACO Shared Savings program:

1.  A "Pioneer Program" request for applications (RFA) - CMI will select up to 30 "ACO ready" organizations that already have at least one cotnract with a private payer around incentives for care coordination to contract directly with CMS and Medicare.  The target audience for this RFA is organizations such as those who participate in the Physician Group Practice (PGP) Demonstration project who already have significant experience with the accountable care model.

2.  A Request for Comment on an "Advanced Payment Initiative" for ACOs entering the Medicare Shared Savings Program.  Eligible organizations could receive an advance of the shared savings they are expected to earn as a monthly payment for each aligned Medicare beneficiary.  ACOs would need to provide a plan for use of these funds to build care coordination capabilities, and meet other organizational criteria.  Advanced payments would be recouped through the ACO's earned shared savings.  Comments on the proposal are due June 17th.

3.  A series of four accelerated development sessions that will provide organizational "executives" (up to four individuals from each organization, including one with clinical responsibility) witih the opportunity to learn the core functions of an ACO and ways to build their organization's capacity to succeed as an ACO.  The first of these sessions will be three days and is already scheduled for June 20-22 in Minneapolis.

The AMA has been urging the CMI to adopt strategies to assist physicians in small practices in transitioning to ACOs through technical assistance and the provision of up front capital.  The Advanced Payment Initiative is one specific program in this direction.  The AMA will comment on the Request for Comments on the Advanced Payment Initiative and will continue to suggest other initiatives, such as Small Business Administration-backed loans.  The AMA also has urged CMI to provide mentoring and technical assistance directly to physicians through grants to entities such as state and specialty societies, to provide ongoing, local training. 

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Legislative Committee Conference Call Tonight

The MMA's Legislative Committee will hold its next weekly conference call this Tuesday, May 31st at 8:00 p.m.  Legislative Committee members and specialty society legislative liaisons are strongly encouraged to participate.  Any physician, practice manager, or other staff member who is interested in the MMA's legislative advocacy also is welcome to participate.  It is not necessary to RSVP for the calls.

Please use the following conference call number and passcode.  These will remain the same for every weekly call during the session:

Conference call number:  1-877-669-3239 

Passcode:  23045263

The purpose of the weekly conference calls is to review and finalize the MMA's position on bills printed that week, to hear the views of specialty societies on the new bills or their concerns about any health policy issues, and to discuss the highlights of legislative action that week.  The calls rarely last longer than an hour and usually we can accomplish our business in much less time.

If you have any questions about the conference calls, please contact Andrew MacLean, Deputy EVP at amaclean@mainemed.com or 622-3374, ext. 214.

There are no new bills for review this week.  The MMA staff will provide an update on the most recent activities at the State House.

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POLITICAL PULSE: Legislative Highlights of the Week
 

APPROPRIATIONS COMMITTEE CONTINUES BIENNIAL BUDGET WORK SESSIONS THIS WEEK

The Appropriations Committee is expected this week to continue its work sessions on the FY 2012-2013 biennial budget (L.D. 1043).  The Committee hopes to report the bill out by the middle of next week.  The legislature continues to work towards a June 15th adjournment date.

You can find the Appropriations Committee materials, including the change package update of May 11th, on the web at:  http://www.maine.gov/legis/ofpr/appropriations_committee/materials/index.htm.

THANKS TO ALL "PHYSICIANS' DAY AT THE LEGISLATURE" PARTICIPANTS

The MMA and Maine Osteopathic Association jointly sponsored Physicians' Day at the Legislature last Thursday, May 26th and nearly 50 physicians, residents, and medical students participated in some of the days' events, beginning with a run on the Kennebec River Rail Trail and followed by opening ceremonies with speakers including Representative Linda Sanborn, M.D. (D-Gorham), Representative Anne Graham, N.P. (D-North Yarmouth), Representative Meredith Strang Burgess (R-Cumberland), MMA President Jo Linder, M.D., and MOA President Joel Kase, D.O., M.P.H.  Following staff briefings on current legislative activities, participants were able to observe proceedings in the House and Senate in the latter half of the morning.  After lunch, the Blaine House hosted a tea for participants during which State Historian Earl Shuttleworth made a presentation on the history of the Blaine House.  Later in the afternoon, some participants observed some Health & Human Services committee work on bills dealing with medical marijuana and certificate-of-need, among others.  Thanks to all who took the time to join us in this important aspect of our advocacy work.

ONE OF TWO "MINORS' RIGHTS" BILLS PENDING DEBATE IN THE HOUSE

L.D. 746, An Act Regarding the Consent of Minors for Mental Health and Substance Abuse Aid, http://www.mainelegislature.org/LawMakerWeb/summary.asp?ID=280039990, an 11-2 "ought not to pass" report from the Judiciary Committee is tabled pending debate in the House.  The bill's sponsor, Representative Kathleen Chase (R-Wells), plans to offer a floor amendment that does not improve it in our view.  The MMA urges you to contact your own Senator and Representative to encourage them to support the majority "ought not to pass" report on this bill.  It is important that practitioners retain the discretion in current law to provide behavioral health care treatment to minors confidentially in situations where a requirement of parental consent is a barrier to treatment.  You can find your legislators and their contact information on the web at:  http://www.maine.gov/legis/house/townlist.htm.

You can also leave a message at the State House for your legislators by using the following toll free numbers:

Call your Senator:  1-800-423-6900

Call your Representative:  1-800-423-2900

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