President Signs the Pathways for SGR Reform Act of 2013

On Thursday, Dec. 26, President Obama signed into law the Pathway for SGR Reform Act of 2013.  This new law prevents a scheduled payment reduction for physicians and other practitioners who treat Medicare patients from taking effect on Jan. 1, 2014.  The new law provides for a 0.5 percent update for such services through March 31, 2014.  Chances have never been better for achieving a permanent repeal of the SGR by the end of March.

The new law also extends several provisions of the Middle Class Tax Relief and Job Creation Act of 2012 as well as provisions of the Affordable Care Act.  Specifically, the following Medicare fee-for-service policies have been extended:

Section 1101 - Medicare Physician Payment Update - the new law provides for a 0.5 percent update for claims with dates of service on or after Jan. 1, 2014 through March 31, 2014. CMS is currently revising the 2014 Medicare Physician Fee Schedule to reflect the new law's requirements as well as technical corrections identified since publication of the final rule in November.  The 2014 conversion factor is $35.8228. 

Section 1103 - Extension of Medicare Physician Work Geographic Adjustment Floor - The existing 1.0 floor on the physician work geographic practice cost index is extended through March 31, 2014.  As with the physician payment update, this extension will be reflected in the revised 2014 Medicare Payment Fee Schedule. This provision is of particular interest and value to Maine physicians.

Section 1105 - Extension of Medicare Inpatient Hospital Payment Adjustment for Low-Volume Hospitals - The Affordable Care Act allowed qualifying low volume hospitals to receive add-on payments based on the number of Medicare discharges from the hospital.  To qualify, the hospital must have less than 1,600 Medicare discharges and be 15 miles or greater from the nearest like hospital.  This provision extends the payment adjustment through March 31, 2014, retroactive to Oct. 1, 2013.

Section 1106- Extension of the Medicare-Dependent Hospital Program - The MDH program enhanced payment to support small hospitals for which Medicare patients make up a significant percentage of inpatient days or discharges.  This provision extends the MDH program until March 31, 2014 and is retroactive to Oct. 1, 2013. 

MMA will be working with the AMA and other medical associations toward the goal of achieving permanent repeal of the SGR prior to the next deadline of April 2014.  All of Maine's Congressional delegation are committed to a permanent repeal.  

Transparency of Pricing Law Takes Effect on Jan. 1, 2014

Public Law Chapter 332 (L.D. 990) was enacted during the First Regular Session of the 126th Legislature but its effective date was delayed beyond October in order to give medical practices and hospitals an opportunity to come into compliance.  The law replaces an earlier statute requiring the posting of prices.  The new law, which is expected to be further clarified this coming session, requires all health care practitioners to provide copies of a price list of all services and procedures performed at least 50 times during the preceding calendar year.  The prices must be those that the practitioner charges patients directly when there is no insurance coverage.  The prices must be accompanied by the applicable standard medical code listed by diagnosis.  Practitioners must inform patients about the availability of the price list and provide copies of the list upon request.  Practitioners also must inform patients of information that may be obtained from the Maine Health Data Organization web site.  The new law was featured in a front page article in the Bangor Daily News this past week on Dec. 26.

The Legislative Council has allowed a bill to be introduced this coming session that is expected to amend Chapter 332.   MMA staff is working with the bill's sponsor, State Senator Richard Woodbury (I, Yarmouth) and the Maine Hospital Association to draft amendments that will clarify some of the provisions of the current law.  While there are no guarantees in the legislative world, there appears to be wide-spread agreement to remove the reference to diagnosis codes and to eliminate the requirement to furnish the entire list.  Other helpful clarifying amendments may be added as well.

MMA staff is available to help member practices comply with the new law.  Transparency of pricing is an important component of health system reform and is seen as essential to patients knowing more about the cost of care.  For more information, contact gsmith@mainemed.com, amaclean@mainemed.com or jbarnard@mainemed.com. [return to top]

HHS Extends EHR Donation Exception/Safe Harbor Rules through 2021

The U.S. Department of Health & Human Services (HHS) Office of the Inspector General (OIG) and the Centers for Medicare and Medicaid Services (CMS) have published companion rules which extend the ability for physicians to accept donations of almost free (must pay at least 15% of the cost of the technology) electronic health records (EHRs) from certain health care entities without violating STARK and Anti-kickback rules.  The exception/safe harbor was scheduled to sunset on December 31, 2013.  The American Medical Association is pleased to announced that due to the AMA's advocacy, HHS has extended the time physicians can accept donated EHRs under this exception/safe harbor through 2021.  They had proposed 2016 as an earlier date but recognized that this was too soon.  While the AMA advocated for a permanent exception, the extension of the sunset through 2021 brings welcomed relief for physicians as they continue to adopt EHRs and struggle to with the high cost of implementation.  The rules also made several other notable changes:

• Excludes labs from the types of entities that may donate EHRs
• Updates the definition of what type of software is considered interoperable for the purposes of donations
• Clarifies the requirement prohibiting any action that limits or restricts the use, compatibility, or interoperability of donated items or services
• Removes from the exception the requirement related to electronic prescribing capability

HHS accepted the argument made by several others that labs should be removed from those types of entities permitted to donate EHRs to physicians due to concerns that EHR donations are being used to secure inappropriate referrals.  The AMA, however, advocated that a preferable approach would be one that focused more on the need for better education around the limits of the safe harbor and exception for EHR donations. 

The CMS rule can be found here and the OIG rule can be found here. [return to top]

Advisory Committee Maintains Protection for Sentinel Event Reports

At their meeting on Dec. 17 an advisory committee charged with reviewing and making recommendations on Maine's Freedom of Access Laws voted not to weaken Maine's confidentiality protections for sentinel event reporting.  The vote capped several years of advocacy by the Maine Medical Association, Maine Hospital Association and Medical Mutual Insurance Company of Maine to maintain the protection, arguing that the protection has increased patient safety and created a culture of no-blame investigation of quality concerns.  Maine Statue currently states that sentiel event reports are confidential and privileged although data from the reports that do not identify or permit identification of the health care facility can be shared publically. In 2012, subcommittee of the Right to Know Advisory Committee proposed to abolish the protection. After many meetings of the subcommittee at which they received information on how other states treat such reports, written testimony from advocates and comments of hospital staff and others, the subcommittee voted Dec. 10 not to eliminate the protection and the full committee accepted that recommendation on Dec. 17.  [return to top]

MMA Legislative Committee Conference Calls to Begin Jan. 14

In keeping with past practice, the MMA Legislative Committee will hold weekly conference calls every Tuesday at 8:00 p.m. during the session beginning on Tuesday, January 14th.  Look for the conference call information each week in the Maine Medicine Weekly Update beginning January 13th.

For more information about the activities of the MMA Legislative Committee, please contact Andrew MacLean, Deputy EVP at amaclean@mainemed.com or 622-3374, ext. 214. [return to top]

Payment Reform Readiness Webinar Series: Connecting to HealthInfoNet, Jan 21

Payment Reform Readiness Webinar Series: Connecting to HealthInfoNet for Better Care Coordination and Outcomes

January 21, 2014, 12-1pm

Shaun Alfreds, MBA, COO, HealthInfoNet

David Hallbert, MD,  & Molly Stevens, RN, Martin’s Point Health Care

Data is at the heart of payment reform efforts intended to reward outcomes rather than volume. Practices preparing for payment reform are making improvements to their systems for data collection, exchange and analytics. Within this spectrum, HealthInfoNet is a valuable tool for exchanging data necessary for informed decision-making, care coordination and improved outcomes.

Shaun Alfreds, MBA, COO of HealthInfoNet will give an overview of HealthInfoNet, emphasizing its practical value for primary care.

David Hallbert, MD and Molly Stevens, RN will explain how they put HealthInfoNet into practice at their work site, Evergreen Woods Primary Care in Bangor.

To join this webinar, please email Jennifer Reck at jreck@mainemed.com.  This webinar was made possible through a generous grant from the Maine Health Access Foundation. Other payment reform related resources are available at: http://www.mainemed.com/cme-education-info/payment-reform-resources [return to top]

First Friday's Programs Resume in Feb. and April; New Program on Employment Contracts Announced

MMA's educational programs offered the first Friday of selected months and available at the office in Manchester or via Webex will resume in February.   On Friday, Feb. 7, Attorney Ben Townsend of the firm of Kozak & Gayer will lead a program entitled, Payment Reform and the Legal Toolkit.  The program will be presented from 9:00 am to noon and will feature a toolkit exploring how physician practices can prepare for payment reform.  The program is presented with grant support from the Maine Health Access Foundation (MeHAF).

On Friday, April 4th, the topic has been changed from ICD-10 (which is the subject of a two-day program being held March 25-26) to physician employment contracts.  With many residents and physicians already in practice receiving new contracts, the need for education in this area has become clear.  A balanced panel of attorneys working on these contracts will present to attendees the common elements in these contracts and the pros and cons of having a contract at all versus being treated as an employee at will.

The cost of each First Friday program is $70 per attendee ($60 if attending three or more programs in one calendar year).  Registration is available on the MMA website or by calling Lisa Martin at 622-3374 ext. 221. A list of all the First Friday programs for 2014 is included on the website. [return to top]

One Hundred Years Ago Today in the Maine Medical Journal

(Editor's note:  In continuing celebration of the Association's 160th anniversary, we will periodically publish in the Update and in Maine Medicine notes of interest from the Maine Medical Journal of 1914).

From Cumberland County:  Although the membership of the Cumberland County Medical Society at the beginning of 1913 was 140 physicians,  97 members attended the April county society meeting, which was a record attendance.  At the Dec. 19th, 2013 meeting, the speaker was Dr. J. Madison Taylor of Philadelphia who read a paper written by a Dr. Sajous (who was to attend but fell ill).  The subject of the paper was "The Various Forms of Goitre and their Treatment."

Also at the meeting, the following resolution was read:  Resolved that the Cumberland County Medical Society, with its guests, assembled from all parts of the State, disapprove of any action directed against Dr. Henry Miller, superintendent of the Insane Asylum at Augusta, as detrimental to the interest of the insane of our State."  (It is not clear from the minutes whether the Resolution was passed).

More, next week.  [return to top]

Medical Practice Insider Features Content from MMA Payment Reform Readiness Webinar Series

Ben Townsend, JD, of Kozak & Gayer and Beverly Neugebauer, Executive Director for Coastal Women’s Healthcare spoke Nov. 21 on “How to Prepare Your Practice for Payment Reform" as part of the MMA’s Payment Reform Readiness webinar series.  Their thoughts and expertise were captured in the following article that appeared in Medical Practice Insider on Dec. 19:  http://www.medicalpracticeinsider.com/best-practices/how-prepare-your-practice-payment-reform.  [return to top]

Assister Regional Roundtables: Marketplace Enrollment in Maine

Starting in January, Consumers for Affordable Health Care will convene Assister Regional Roundtables for navigators, certified application counselors, and others assisting with Marketplace enrollment in seven regions throughout the State: Sagadahoc, Penobscot, Cumberland, Washington/Hancock, Androscoggin, York, and Aroostook counties.

Come to your local roundtable and you will:

• Hear Marketplace updates and enrollment best-practices,
• Troubleshoot problems, and
• Network with other assisters in the area.

There may also be opportunities to be part of public information or enrollment sessions in the afternoon after these sessions. Details about these opportunities will be available in early January.  

Who should attend:

• Navigators
• Certified Application Counselors
• Insurance agents and brokers

When and where:

*Details to follow for the Washington/Hancock, Androscoggin, York, and Aroostook regional roundtables in early 2014.

Sagadahoc Regional Roundtable   
Midcoast Maine Community Action   
34 Wing Farm Pkwy, Bath   
Conference Room  
9 am- 12:30 pm  
Wednesday, January 8th (Snow date: Thursday, January 16th) 
 
Penobscot Regional Roundtable  
Penquis  
262 Harlow Street, Bangor  
Piscataquis Room  
9 am- 12:30 pm  
Tuesday, January 21st (Snow date: Tuesday, January 28th) 
 
Cumberland Regional Roundtable  
The Opportunity Alliance  
50 Lydia Lane, South Portland  
Timbers Room  
9 am- 12:30 pm  
Monday, February 3rd   (Snow date: Wednesday, February 5th) 

Questions? Please contact Kate Ende, Consumers for Affordable Health Care, kende@mainecahc.org, 207-622-7083. Registration will be available starting January 2, 2014. [return to top]

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