June 4, 2012

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Report on State and HIPAA Privacy Law Presented Last Friday, June 1

Over sixty practice managers, physicians and office staff participated last Friday, June 1st in MMA's Annual HIPAA Update presented by MMA attorneys MacLean, Barnard and Smith and compliance attorney Stacey Mondschein Katz.  In addition to an overview of state and federal patient privacy laws and regulations, the attorneys also presented the substance of what is expected to be included in the final HITECH regulations due later this month and the special rules in Maine regarding minors, HIV and mental health.

The Annual HIPAA Update is traditionally MMA's most popular First Fridays program and this year was no exception.  In addition to the content presented at the MMA office in the Frank O. Stred Building in Manchester and via webinar, participants received updated sample forms from MMA.  These forms will be available on the MMA website at www.mainemed.com.  Two additional forms, the Notice of Privacy Practices and the Business Associate Agreement will be updated and added to the website shortly after final HITECH regulations are published later this month.  Watch the Weekly Update for a report on the final regulations and the availability of the updated forms.

Because of changes in the federal regulations, patients will need to receive an updated Notice of Privacy Practices form after the effective date of the amendments.  The updated form will not need to be sent to each current patient, rather patients can be given the form at the time of their next appointment or encounter with  the physicians, hospital or other health professional.

Other areas of interest discussed Friday morning were the new requirements of accounting for disclosures and notifying patients of a breach, handling requests for personal health information by law enforcement and the continuing privacy rights of deceased patients.  The limits on marketing to patients was also a hot topic.

Members and practice managers are also reminded that MMA attorneys are available to come to the practice site to provide a similar program.  Normally, a $200 fee is charged for an on-site program which can be one hour or more if the practice is able to commit that much time to the education.  Recent  HIPAA presentations have taken place in Lubec, Waterville, Harrington, Vinalhaven and Eagle Lake.

MMA's First Fridays Education Sessions will resume on Friday, September 7th following a summer hiatus.  The topic in September is Risk Management, specifically the handling of patient complaints, and the program is presented by the Risk Management Department at Medical Mutual Insurance Company of Maine.  The October 5th program is on physician compensation, recruitment and retention, including employment contracts.  The  November 2nd program is on compliance and the December 7th program will cover the Affordable Care Act, anticipating that something of it will be left following the Supreme Court decision and the Presidential Election.  If the ACA is gone, the speakers will discuss what happens in the health reform world without it.

Any questions about the MMA's educational offerings can be directed to either Gordon Smith, EVP at gsmith@mainemed.com or Gail Begin via e-mail to gbegin@mainemed.com.

Political Pulse: 125th Legislature Adjourns

The Legislature returned to Augusta last Thursday for one final day in order to consider several vetoes by Governor LePage.  Lawmakers attempted to find the votes to override the Governor's veto of a $20 million research and development bond and three other bills that had been approved by the legislature.  While they did not find the 2/3 majority necessary to override a veto of the bond measure or two other bills, they did override the veto of a bill that supports teacher training.  After a half-day session, the legislature adjourned and ended the second year of the 125th legislative biennium. 

As a reminder, changes approved by the legislature as part of the Fiscal Year 2013 budget package for the Department of Health and Human Services go into effect August 14th.  Among other things, the newly-approved DHHS budget ends MaineCare coverage for young adults and some parents; reduces or ends Fund for a Healthy Maine dollars and MaineCare coverage for certain preventive services; and redesigns MaineCare coverage for opiates.  It also finds some savings in other areas of government outside of the DHHS and includes several spending initiatives as well as income tax reductions.  While the effective date of the budget bill is August 14th, the state needs to apply for and receive federal approval before implementing the MaineCare eligibility cuts, and many advocates expect that the state will not receive this sign-off.  For a detailed summary of the budget, including an outline of the changes to MaineCare's opioid coverage, click here.  

Other non-emergency bills passed during the session go into effect August 30th.  MMA advocacy staff are happy to visit your medical staff meeting, specialty society or practice to provide an overview of the outcomes of the 125th legislature and will be posting a summary of the session to the MMA website.  With the end of the legislative session, the MMA advocacy team now shifts focus to the upcoming elections. Primary elections are being held next Tuesday, June 12th.  A list of the candidates can be found on the Secretary of State's website by clicking here

MMA Legislative Committee conference calls have ended for the summer. The calls were quite well attended and we are very grateful to the physicians and specialty society staff who took time out of their busy evenings to review proposed legislation and share their comments with us.  The MMA advocacy team could not be effective without your input.  The Committee will next hold an in-person meeting sometime after the November election and before the 126th legislature convenes.  

For more information about our advocacy activities, please contact Andrew MacLean at amaclean@mainemed.com or 622-3374 x 214. 
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Trial Concludes in Case Compelling Disclosure of Peer Review Materials

The trial in a case followed closely by the MMA continued this past week with final arguments in Cumberland County Superior Court.  The Defendant Mr. Weidul was convicted of manslaughter in connection with the beating and subsequent death of Roger Downs in December of 2011.  The Jury found that the defendant's actions were responsible for the death of Mr. Downs, as opposed to accepting the theory that the medical care of the victim caused his death.  Despite the pre-trial order described below which authorized a limited release of peer review documents, the defendant's strategy shifted during the course of the trial and the chief defense presented was self defense, as opposed to subsequent medical treatment.  So, while very little of the peer review documents were disclosed in open court, it will still be important to seek to repair the damage to the statutory peer review protections.

The defendant, through his attorney Thomas Connolly, claimed that Mr. Downs in fact suffered from streptococcal pneumonia in both lungs and that it was this undiagnosed pneumonia that caused the victim's death. Attorney Connolly sought internal documents from Mercy hospital that would normally be privileged pursuant to two Maine statutory privileges:  22 MRSA Section 8754 (3), concerning sentinel event notification and reports, and 24 MRSA Section 2510-A, concerning professional competence review records.  The provision in title 24 states that all professional competence review records are privileged and confidential and not subject to discovery, subpoena or other means of legal compulsion for their release to any person or entity and are not admissible as evidence in any civil, judicial or administrative proceeding.  Attorney's for Mercy Hospital argued what MMA's position has been for years, that the reference to judicial proceedings includes a criminal trial.

Unfortunately, Justice Wheeler disagreed and found that the defendant's Sixth Amendment right guaranteeing a criminal defendant the right "to have compulsory process for obtaining witnesses in his favor" took priority over the peer review privilege.  She wrote in her pre-trial order, Mr. Weidul's right to confrontation is implicated in Mercy's request because Mr. Downs was treated and died while a patient at Mercy Hospital and Mercy Hospital conducted reviews because of his apparently "unanticipated death."

The attorneys for the hospital appealed the ruling to the state's highest court on an interlocatory basis during the trial, but the law court refused to overturn the order, stating that not all of the requirements for an exception to the rule that appeals are only heard after a final judgment were met.

Given that the hospital was not a party to the criminal case, it is not clear whether there will be an additional opportunity to appeal the ruling.  If there is no further opportunity to get the case before the law court, the only recourse may be to go to the legislature in January to clarify the statute.

Following the preliminary ruling on the peer review issue,  MMA and the Maine Hospital Association released a statement to the media criticizing the breach of the peer review protections and supporting Mercy Hospital's work in connection with protecting the statute.  The statement can be read in its entirety on the MMA website by clicking here.

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Ninth Annual MMA Benefit Golf Tournament Postponed to July 30, 2012

Continuing inclement weather and a very wet golf course have forced the postponement of the MMA Annual Golf Tournament scheduled for today to Monday, July 30th.  The tournament will still be at the Augusta Country Club which has graciously provided us another day later in the summer to hold the tournament.  So if you did not register to play because of a conflict in scheduling, please re-consider the tournament which this year will benefit the medical student scholarship fund within the Maine Medical Education Trust. 

Hole sponsorships are also available for $500.

Registration will remain available on the MMA website or by communicating with Lisa Martin at 622-3374 ext. 221 or via e-mail to lmartin@mainemed.com.


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MMA Member Benefit of the Month

The member benefit the Association wishes to highlight in June is the Office-Based Quality Improvement Program which protects from discovery the quality improvement or peer review discussions and documents in an office-based practice.  Without such protection, these records from any practice outside the setting of a hospital are vulnerable to disclosure.  For over ten years, the Association has made available to medical practices participation in a program, overseen by the Committee on Physician Quality, that is very economical and offers the protection noted above as well as review of a quality improvement plan.

The initial fee for a practice applying to join the program is only $200 and an additional $100 per physician with a maximum application fee of $3000.  Annual renewal is only $100.  In other words, a practice with three physicians would pay $500 to join.  It is a very modest investment to get help with QI AND protect QI and peer review documents from discovery in a malpractice case.

This program is now overseen by Dianna Poulin at MMA.  For application materials or more information, contact Dianna at 622-3374 ext 223 or via e-mail to dpoulin@mainemed.com. [return to top]

MMA Board of Directors to Meet Wednesday, June 6

MMA's Board of Directors, chaired by internist and emergency medicine physician Kenneth Christian, M.D. of Holden, will hold its regularly scheduled meeting this coming Wednesday, June 6 at 4:00pm in the Frank O. Stred Building in Manchester.  Guests will include Kathleen Hickey, M.D. and Neil Korsen, M.D.  Dr. Hickey will present information on a mindfulness-based stress reduction program being offered in Franklin County.  Dr. Korsen, MMA's representative to the Maine Health Data Organization Board will discuss the recent changes at the MHDO and the workgroup organized by the legislature to review how health care data through the all payor claims data base is handled in the state.

Other items on the agenda include reviewing Executive Committee recommendations to the Nominations Committee for officers in 2012-2013, hearing an update on the conclusion of the 125th Legislature and considering providing any input to the Maine Health Management Coalition Health Care Cost Workgroup.  AMA delegates Richard Evans, M.D. and Maroulla Gleaton, M.D. will discuss preparations for the AMA Annual Meeting in Chicago June 16-19th.

Board meetings, and all MMA committee meetings, are open to any MMA member, whether they are a member of the particular committee or not.  We do ask that any member wishing to attend call the office at 622-3374 and let us know so that we can be sure to have enough room and food.


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Prepare for Version 5010 - Enforcement Deadline Approaching

Version 5010 refers to the standards that HIPAA-covered entities (health plans, health care clearinghouses, and certain health care providers) must use when electronically conducting certain health care administrative transactions, such as claims, remittance, eligibility, and claims status requests and responses.

All covered entities should have been fully compliant with Version 5010 by January 1, 2012; however, an enforcement delay is in effect until June 30, 2012.

Regional CMS staff are hosting an informative webinar for healthcare providers, clearinghouses and vendors on Version 5010 on June 20th from 10:00 am - 11:00 am.  Topics include:  Current Conversion Statistics, Final Preparations for 5010/D.0 Cutover, Operational Concerns and Future of EDI Communications.  CMS will be distributing call registration information as the date approaches. 

MaineCare also reminds practices that If your organization submits electronically in batches to MaineCare, you must complete certification testing by June 30, 2012. To certify, log in to the MIHMS Health PAS Online Portal. If you are unable to submit HIPAA Version 5010 transactions after June 30, 2012, you will be required to submit via Direct Data Entry (DDE) or through paper claims. On July 1, 2012, any HIPAA Version 4010 transactions submitted electronically in batches to MaineCare will be rejected.  Testing resources are available. Visit the HIPAA Version 5010 webpage for background information, testing instructions, and Frequently Asked Questions about testing HIPAA Version 5010 transactions with MaineCare. [return to top]

Anthem Submits 2012 Rate Filing for Its Individual Customers - Seeks Rate Increases

Anthem Health Plans of Maine, Inc. (Anthem) last week filed its proposed 2012 individual rate increase with the Maine Bureau of Insurance. The rate increase will carry an overall impact of 1.7 percent for Maine consumers. While the number may not appear overly excessively, health care advocates argue that Anthem's numbers are less than transparent. Consumers For Affordable Health Care maintains that Anthem's increase was reached on a combined product line basis, making it difficult to determine whether any of the company's individual insurance product increases exceed the 10 percent set by federal law for unreasonable rate hikes.  It is especially hard to know the impact as Anthem also added a new product called HealthChoice Plus into the mix of rates.   More information along with the complete filing is posted on the Consumers for Affordable Health Care Web site here. You can also read or listen to MPBN's coverage of the issue by clicking here


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Medical Groups Offer Ideas for Reforming Provider Payment System Under Medicare

On April 27, 2012, the House Committee on Ways and Means wrote to more than 70 physician organizations requesting information on quality and efficiency improvements, alternative payment models, patient involvement and regulatory relief as part of their efforts to find a long term replacement for the sustainable growth rate (SGR) formula. 

In response, the American Medical Association submitted a 26-page letter answering specific questions put forth by the committee. Specifically, the AMA outlined strategies that the physician community could support to both reduce the growth in costs and improve patient outcomes, including a broad rage of payment reform options.  AMA also outlined the extensive activities of the Physician Consortium for Performance Improvement® and other activities that are already underway, as well as regulatory relief that is needed in order for new payment methodologies to succeed. View the complete letter here

The Medical Group Management Association—representing administrators of medical group practices— also responded and called for more flexibility from CMS to allow physicians to experiment with new payment models for delivering and reimbursing care. View MGMA's letter here

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New MedPAC Appointments Announced

Three of the five new appointees to the Medicare Payment Advisory Commission (MedPAC), announced late last week, are physicians. They include: Alice Coombs, MD, a critical care specialist and anesthesiologist at South Shore Hospital in Weymouth, Mass.; Rita Redberg, MD, professor of clinical medicine at the University of California, San Francisco; and Craig Samitt, MD, president and chief executive officer of the Dean Health System in Madison, Wis. 

They will join two other new commissioners: Jack Hoadley, PhD, a research professor at Georgetown University in Washington, D.C., and David Nerenz, PhD, director of the Center for Health Policy and Health Services Research at the Henry Ford Health System in Detroit, Mich. 

Glenn Hackbarth, JD, will continue as MedPAC chair. Vice chair Bob Berenson, MD, who chose not to seek another term, will be replaced in that position by Harvard economist Michael Chernew, PhD. Two other physicians -- Ron Castellanos, MD, a Florida urologist, and Karen Borman, MD, general surgery residency program director at Abington Memorial Hospital in Pennsylvania -- retired after completing their second terms. 

Dr. Coombs, who was supported by the AMA, is a former president of the Massachusetts Medical Society (MMS) and a member of the AMA Commission to Eliminate Health Care Disparities. Her term as MMS president coincided with the enactment and implementation of the Massachusetts comprehensive health reform legislation.

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Part D Beneficiaries Saved $3.5 Billion On Rx Drugs Under Reform Law

Medicare beneficiaries have saved $3.5 billion on prescription drugs under the health care  reform law, the Centers for Medicare & Medicaid Services announced May 24th. In the first four months of 2012, more than 416,000 seniors and people with disabilities in Medicare saved an average of $724 on prescription drugs purchased after they hit the prescription drug coverage gap, or “doughnut hole,” saving $301.5 million, CMS said in a release.  In 2010 and 2011, more than 5.1 million people in Medicare saved more than $3.2 billion on prescription drugs under provisions of the Patient Protection and Affordable Care Act, CMS said. 

Under PPACA, Medicare beneficiaries who hit the coverage gap received one-time rebates of $250 in 2010. In 2011, they received 50 percent discounts on covered brand-name drugs and 7 percent coverage of generic drugs in the doughnut hole, CMS said. This year, Medicare coverage for generic drugs in the coverage gap has risen to 14 percent. Coverage for both brand-name and generic drugs will increase until 2020, when the coverage gap will no longer exist under PPACA.

In addition, CMS said, from January through April, 12.1 million people in the traditional Medicare program received at least one preventive service without paying out-of-pocket fees. That included more than 856,000 people who have taken advantage of annual wellness visits under the reform law, CMS said.  However, these benefits are still being underused.  According to a poll released in April by the John A. Hartford Foundation, only about 32% of seniors polled had heard about the Medicare wellness visit and only 17% were sure they had taken advantage of it. 

Practices that are interested in assistance in implementing the annual wellness visit and educating their patients about Medicare-covered preventive benefits should contact Jessa Barnard at the MMA: jbarnard@mainemed.com or 622-3374 x 211. 

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Upcoming Events & Conferences

22nd Annual Maine GERIATRICS Conference

June 7-8, 2012 

Harborside Hotel & Marina, Bar Harbor, ME

Registration Open.  CME Available. 

 For more information or to register visit http://www.une.edu/com/cme/


Medical Mutual Practice Manager Seminar: 

Caring for our Seniors - Complex medical & liability issues

June 13, 2012

DoubleTree by Hilton Hotel, South Portland, ME 

Agenda and registration information available here


Maine Quality Counts and the Maine Primary Care Association Present:

Partnering, Engaging and Transforming Healthcare

Tuesday, June 12 - Bangor
Wednesday, June 13 - Freeport

These events will provide guidance for creating and successful patient and family engagement activities within the Medical Home model of care. This event will build on statewide, collaborative efforts to partner with patients and families in sustained and effective ways.

For more information or to register, click here


MaineCare Physician Advisory Committee

Thursday, June 14, 2012, 3:00-5:00pm

Conference Room 103A, Cross State Office Building, Augusta, Maine or 1-800-394-6604, with passcode 959468#

MaineCare topics on the agenda for this meeting will be follow-up to March’s Opioid discussion and Health Homes. MaineCare providers are also invited to present issues in the community they would like MaineCare to address.

RSVP to Charyl Malik at 207-287-3320 or charyl.malik@maine.gov


Save the Date: 

CMS Region 1 National Medicare Training Program 2012

August 7-9, 2012

Sheraton Framingham Hotel and Conference Center, Framingham, MA

Information about key aspects of Medicare, Medicaid, Children's Health Insurance Program (CHIP), and pertinent legislation

More information to be distributed via CMS later in May


Maine Immunization Program Regional Trainings 

July 27, 2012 – Houlton Regional Hospital – Houlton

August 3, 2012 – Hilton Garden Inn – Bangor

August 9, 2012 – Fireside Inn – Portland

Augusta 10, 2012 – Maine Principals Association – Augusta

Open to all health professionals responsible for managing and supporting childhood vaccine programs including physicians, nurse practitioners, physician assistants, and practice managers.

For more information or to register, click here[return to top]

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