August 1, 2011

 
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Kevin S. Flanigan, M.D. Named MaineCare Medical Director

Kevin S. Flanigan, M.D. of Pittsfield was named last week by HHS Commissioner Mary Mayhew as the Medical Director of MaineCare.  An internist and pediatrician, Dr. Flanigan has practiced in Maine in a variety of settings since 1997, including his own private practice, a federally qualified health center and an urgent care clinic.  He is a graduate of the Medical College of Virginia and completed internship and residency at the University of Louisville Hospital in Kentucky. Dr. Flanigan is a former President of MMA and currently chairs the Association's Budget & Investment Committee.

In making the announcement last Thursday, Commissioner Mayhew stated that, "Dr. Flanigan's years of experience serving MaineCare patients in a variety of settings and his understanding from a provider's perspective of Maine's healthcare system is extremely valuable."  

According to the press release announcing the appointment, Dr. Flanigan's goals for the MaineCare program include reducing the use of hospital emergency departments for nonemergency care and enhancing the statewide care management of MaineCare patients.  He has also been asked to review the current prior authorization policies of the program, which currently has approximately 350,000 enrollees.

The position has been vacant since the termination of  Dora Mills, M.D., MPH from the position in February of this year.

Dr. Flanigan began work at the Office of MaineCare Services on July 18th.

Medicare QIO Contract Stays with Northeast Healthcare Quality Improvement Foundation

The federal government last week announced that the Medicare Quality Improvement (QIO) contract will stay with the existing contractor for the next three years.  Quality Counts had partnered with Quality Insights of Rhode Island to apply for the contract.  Over five hundred Maine physicians had signed statements in support of the competing application.  In its communication to Quality Counts, Medicare contracting officials noted that the competing application was considered very strong and that the decision was largely based upon cost.

The so-called 10th Scope of Work in the three-year contract begins today, August 1st. [return to top]

Watch for Your Invitation to the Re-dedication of the Frank O. Stred Building, August 24 in Manchester

MMA will recognize the leadership of the late Frank Stred, who served admirably as Executive Director of the Association from l979 through August of 1993, on Wednesday, August 24th.  From 11:00am until 2:30pm, we will celebrate Frank's history with MMA and re-dedicate the Building which was named for him in l993 when he retired.  Priscilla Stred and other members of the family will join in the activities.  Lunch will be served and entertainment will be provided by the Blue Hill Brass Band.

Remarks will be offered by former MMA leaders who worked closely with Frank, particularly those who played a  role in the  construction of the Stred Building which now houses the offices of the MMA and Quality Counts staff.

Invitations have been mailed to all MMA members.  For more information on the event, call MMA at 622-3374 ext. 0. Proceeds from the event will be used to establish a maintenance and improvement fund for the Stred Building. [return to top]

New Report Shows U.S. Health Spending Growing by 5.8% Annually Through 2020

A report issued last Thursday by the Medicare Office of the Actuary estimated that health spending will grow by an average of 5.8% a year through 2020, compared to 5.7% without the health care reforms included in the Affordable Care Act.  With that growth, the nation is expected to spend $4.6 trillion on health care in 2020, nearly double the $2.6 trillion spent last year.

The report also noted that in 2010 national health care spending grew at its slowest rate ever recorded - 3.9%.  In 2009, health spending in the country grew 4.0 percent.  The spending slowed, noted the report, because of people foregoing treatment because of the loss of their jobs and health insurance coverage.

The report was published online last Thursday by the Journal Health Affairs.

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MMA Executive Committee Meets On Wednesday, August 3

The MMA Executive Committee will meet on Wednesday at the home of President Jo Linder, M.D., in Falmouth.  Much of the agenda will focus on business needing to be accomplished prior to the Annual Session being held in Bar Harbor from September 9-11th.  These items include recommending a budget for 2012 and presentation of a nominating committee report. 

The Executive Committee is chaired by Kenneth Christian, M.D., an emergency physician residing in Holden and practicing emergency medicine at Maine Coast Memorial Hospital in Ellsworth.

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CMS Hosting ICD-10 National Physicians Provider Call, August 3

To assist physicians prepare for a smooth transition to ICD-10 on October 1, 2013, the Centers for Medicare & Medicaid Services (CMS) will host a National Provider Call on "ICD-10 Implementation Strategies for Physicians"  on August 3rd from 1:00 – 3:00 pm Eastern Time.  CMS subject matter experts will discuss ways that physician offices can prepare for the change to ICD-10 for medical diagnosis and inpatient procedure coding.  Topics to be discussed on the call include an ICD-10 overview, update on claims spanning the implementation date, national ICD-10 implementation issues, and laboratory conversion process.  A question and answer session will follow the presentations.  Physicians, medical coders, office staff, billing staff, and health records staff should plan to attend this call.

For registration go to the CMS website.  Registration will close on Tuesday, August 2 at 1pm ET or when available space has been filled.  No exceptions will be made.  Please register early. [return to top]

Medicare Preventative Benefits Information

The MMA has received several questions and comments about preventative benefits available under the Medicare program.  Medicare currently provides beneficiaries with a one-time "Initial Preventative Physical Exam" and subsequent "Annual Wellness Visits."  The following information will help clarify which services are covered under these visits and how to code for the service.  

Initial Preventive Physical Exam

The IPPE is a one-time benefit that must be provided within 12 months of the effective date of a beneficiary’s Medicare Part B coverage. The IPPE is a preventive wellness visit and not a routine physical examination.  Medicare does not provide coverage for routine physical exams.

This one-time visit includes:

  • Review of medical and social history
  • Review of potential (risk factors) for depression
  • Review of functional ability and level of safety
  • Measurement of height, weight, body mass index, blood pressure, visual acuity screen, and other factors deemed appropriate
  • Discussion of end-of-life planning, upon agreement of the individual 
  • Education, counseling and referrals based on results of review and evaluation services performed during the visit, including a brief written plan such as a checklist, and if appropriate, education, counseling and referral for obtaining an electrocardiogram (a/k/a EKG, ECG)

More information: 

  • Code G0402 must be used to report the IPPE.  
  • Medicare providers should chose an appropriate ICD-9-CM diagnosis code.
  • CPT  Modifier 25  may be appended to claims denoting a separate Evaluation and Management (E/M) service furnished with an IPPE.
  • Effective for dates of services on or after January 1, 2011, the coinsurance or copayment and deductible are waived for the IPPE (G0402) only.
  • Cost sharing (coinsurance, copayment and deductible) applies to the additional (E/M) service.

The Annual Wellness Visit 

The AWV is a preventive wellness visit and not a routine physical examination. It is available after a beneficiary has had Part B for longer than 12 months and can be performed once every 12 months. 

The visit includes:

  • Medical/family history
  • List of current providers/suppliers
  • Blood pressure, height, weight, and other routine measurement
  • Detection of any cognitive impairment
  • Review potential (risk factors) for depression, functional ability, and level of safety.
  • Establishment of:
    • Written screening schedule (such as a checklist) for next 5-10 years.
    • List of risk factors and conditions where interventions recommended.
  • Personalized health advice and referrals for health education and preventive counseling.

 More information:

  • The following G-codes identify the AWV for Medicare payment:
    • G0438 (Annual wellness visit, first visit), and
    • G0439(Annual wellness visit, including Personalized Prevention Plan Service, subsequent visit).
  • Medicare providers should chose an appropriate ICD-9-CM diagnosis code or contact the local Medicare contractor for guidance.
  • Copayment or coinsurance and the Medicare Part B deductible are waived 

 For more information on which services are included in these visits, who can provide the services and appropriate codes, visit:  the CMS Provider Resources Page, including a CMS presentation on the topic and informational chart.  Contact the MMA for additional information, including patient brochures and more information on preventative benefits available to your patients under the Affordable Care Act: Jessa Barnard, jbarnard@mainemed.com, 207-622.3374 x 211.

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CMS Announces 5010 Testing on August 22-26th

The January 1, 2012 Version 5010 compliance date is fast approaching.  Physicians should be taking steps now to get ready, including conducting testing with their payers, either directly or through their clearinghouse and/or billing service, to ensure timely compliance.  CMS will be holding a National 5010 Testing Week Monday August 22nd through Friday August 26th.  National 5010 Testing Week is an opportunity for physicians, including their clearinghouse and/or billing service, to test the Version 5010 transactions with the added benefit of real-time help desk support and direct and immediate access to the Medicare Administrative Contractors (MACs). 

Visit the AMA’s version 5010 Web page or the CMS Website for more information.

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MeCDC Flu Vaccine Update

Maine CDC has issued a letter to health care providers who have registered with the Maine Immunization Program  to offer state-supplied flu vaccine. The letter is available here: http://www.maine.gov/dhhs/boh/maineflu/2011-2012-ProviderInfluenza-Letter%20Final.pdf

For the 2011-12 season, Maine CDC plans to provide seasonal influenza vaccine for: 

  • All Maine children ages 6 months to 18 years-old 
  • Employees of schools that provide onsite vaccine clinics on school days 
  • Pregnant women and their partners (through health care providers who routinely care for pregnant women) 
  • Nursing home employees and residents 
  • Any underinsured or uninsured adult in any setting (for patients who do not have insurance or whose insurance does not cover vaccines) 
  • All individuals served by Tribal health centers and Municipal Health Departments  

Information on the vaccine ordering process will be posted at www.maineflu.gov in August. Tools and resources for those conducting school-located vaccine clinics (SLVC) will also be updated in August.  

 FDA has approved the 2011-12 influenza vaccine formulation for all six manufacturers licensed to produce and distribute flu vaccine for the US. For more information: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm263319.htm?utm_source=twitterfeed&utm_medium=twitter

US CDC has updated its online flu information, including: 

  • Key Facts about Influenza (Flu) and Flu Vaccine 
  • 2011-12 Seasonal Influenza Vaccine Updates Questions and Answers
  • Children, the Flu, and the Flu Vaccine 
  • Questions and Answers about Seasonal Influenza

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Amendments to Medical Marijuana Law Effective Sept. 28, 2011

Perhaps surprisingly, the legislature this past session significantly amended the medical marijuana legislation which had been originally adopted by the voters in November 2009 and significantly amended by the legislature in 2010.  The amendments, embodied in L.D. 1296, "An Act To Amend the Maine Medical Use of Marijuana Act To Protect Patient Privacy," were passed unanimously in the Health and Human Services Committee and passed without debate in the House and Senate.

For physicians, the most significant changes are as follows:

  1. The written certification prepared by the physician will no longer specify the qualifying patient's debilitating medical condition.
  2. Registration of patients with the state will be voluntary.
  3. The physician certificate will have to be prepared on tamper resistant paper.  "Tamper-resistant paper" means paper that possesses an industry-recognized feature that prevents copying of the paper, erasure or modification of information on the paper and the use of counterfeit documentation."  MMA will inform members of appropriate sources of such paper prior to the effective date of the law.  You will likely be able to purchase such paper from whomever you purchase tamper-resistant prescription pads from.
  4. Prior to providing written certification for the medical use of marijuana by a minor qualifying patient, a physician must consult with a consulting physician.  The consulting physician must be from a list of physicians who may be willing to act as consulting physicians maintained by the Department of Human Services.  The consultation may consist of examination of the patient or review of the patient's medical file.  This opinion is simply advisory to the treating physician.

Physicians who are willing to serve as consultants may contact the Department or Gordon Smith at MMA (gsmith@mainemed.com).

Changes to the law become effective on September 28, 2011. [return to top]

Monthly Member Website Question: What Do You Think?

The first day of each month we place a new question on the home page (directly under the Calendar of Events) of the MMA website, http://www.mainemed.com, to get member opinions on issues.  This month's question is:  Governor LePage recently established a Fraud and Abuse Prevention Team to investigate MaineCare and other welfare fraud.  Do you believe that there is widespread abuse of MaineCare benefits by beneficiaries?

Please take a moment to go to http://www.mainemed.com and place your vote.  The questions are for members-only, so you will need to enter your username and password and then it is as easy as toggling on a button indicating your choice and pressing submit.  If you haven’t registered as a member, you can do so easily by completing the following the brief registration form at https://www.mainemed.com/register.php and pressing submit. 

Your opinion matters….please take time to vote today! [return to top]

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