CMS Release of Medicare Data Attracts Lots of Attention; Provides Little of Value

The release last Wednesday of Medicare payment data for individual physicians drew much media attention in Maine and throughout the nation.  The data showed that nearly 5800 Maine physicians and other health care practitioners and providers were paid a total of $300 million for services provided to Medicare patients in 2012.  

The data set was released following several years of litigation with the AMA challenging the release contained information on how much money was received under Medicare's fee-for-service program which covers the vast majority of the twenty plus percent of Mainers who are Medicare recipients.  Nationally, the data release was huge, containing data on more than 880,000 providers who received $77 billion in Medicare payments.

Of the fourteen top individual physicians identified, eight were ophthalmologists, four were oncologists/hematologists, and two were rheumatologists.  In media interviews with the Portland Press Herald, the Lewiston Sun Journal and the Bangor Daily News, MMA representatives emphasized the following points:

• The amounts paid as reimbursement were gross figures, not net figures and the highest amounts generally included amounts reimbursed for expensive medication (such as Lucentis injected for treatment of macular degeneration at $2,000 per injection per eye.
• That physicians had no ability to challenge the accuracy of the data.  In at least one case brought to our attention, there were substantial errors in the data.
• In some cases, payments to one physician may include reimbursements for other practitioners as well who bill under the physician's billing number (this could include residents, physician assistants and others).
  

The data allows some comparison between specialties, geographic location and individual physicians.

MMA emphasized that the physicians who appear to have received the most reimbursement should not be targeted for fraud investigations but rather should be congratulated for seeing Medicare patients and for accepting the Medicare payments as payment in full for the patients.  "Transparency is a good thing and the release of this data, in and of itself is not a bad thing.  But it is unfortunate that the public was not provided with much context to fully understand the data and the physicians given no opportunity to check the data for accuracy", noted Gordon Smith, Executive Vice President of MMA.

You can read the AMA's statement on the data release here and the AMA's media guide on the data release here.

POLITICAL PULSE: Governor's Veto of MaineCare Expansion Holds, Options Remain

As reported last week, the focus of legislative activity has largely moved to the floor of the House and Senate where unanimous bills will make their way through the process and divided reports will accumulate on the calendar as the 126th Maine Legislature aims towards an April 16th adjournment.

Veto of Medicaid Coverage Bill Sustained, Two More Bills Remain

The Senate voted 22 to 13 last Friday in an attempt to override the Governor's veto of LD 1487, Senator Katz's bill seeking to expand Medicaid coverage to an additional 70,000 uninsured Mainers through federal funds and implementing managed care - just two votes shy of the necessary two-thirds to override the veto. The Maine Medical Association is disappointed in the failure to override the veto of this compromise bill.  MMA believes it is critical to continue to pursue legislative options to accept federal funds to ensure nearly 70,000 Mainers have access to health care.  The MMA encourages legislators to keep working to pass MaineCare expansion this session via other legislative vehicles tabled in both the House and the Senate, and encourages MMA members to contact your legislators to voice support.   You can find your legislators here.

Appropriations Committee Closes Budget Gap for 2015
Early Wednesday morning, after working through the night, the Appropriations Committee closed its second supplemental budget, focused on the remaining FY 2015 issues.  There is approximately $29 million in new spending and $30 million in savings initiatives for FY 2015 in this budget.  The largest spending item was to increase Medicaid payments to providers by $17 million (state share). The largest savings initiative is an adjustment in the timing of Medicaid payments to some providers by requiring DHHS to look at its payment process and stretch the turnaround time for processing claims from the current 7-10 days to approximately 21 days.  There will be exemptions for some providers.  The budget also includes $3.5M (state share) in savings from more intensive Medicaid audit, includes a plan to reduce waitlists for people with developmental disabilities and provides more funding to nursing homes.

Legislature Overrides Veto of Price Transparency Bill, Will Become Law 

Last week, overwhelming majorities of the House and Senate voted to override the Governor's veto of LD 1642.  LD 1642 was Senator Woodbury's bill that attempted to improve upon the bill that passed last legislative session, LD 990, requiring that health care practitioners provide patients with price information.  The new law clarifies that the prices should be listed by CPT code and that the practice needs to notify patients of the list but does not need to provide the full list to every patient. The law also clarifies that a health care entity that does not routinely render services directly to patients in an office setting may satisfy the requirements by providing information on its publicly accessible website. The full text of the final law can be found here.  It will become effective 90 days after the legislature adjourns, or mid-July.  The Governor had vetoed the bill stating that it did not go far enough to provide price information to patients. The House voted 138-4 and the Senate voted 31-3 in favor of the override. 

House Passes Naloxone Bill Unanimously; Governor Threatens Veto

This morning, the House voted in favor of an amended version of L.D. 1686, the widely reported bill to expand access to the anti-overdose drug, naloxone, by a vote of 147-0.  The bill would permit a prescriber to issue a prescription for the drug to a family member of someone at risk and also would permit law enforcement and EMS personnel to carry the drug.  The Governor apparently opposes use by law enforcement personnel.  The measure has not yet been considered by the Senate, but it is likely to pass with sufficient votes to withstand a potential veto.

Physician Identity Theft Through Fraudulent Tax Returns Surfaces in Maine

Following a trend identified earlier in Indiana, South Dakota, and Puerto Rico, last week the MMA learned that as many as a dozen Maine physicians have been the victims of identity theft through the fraudulent filing of tax returns using their names, addresses, and social security numbers to obtain a tax refund.  Physicians usually discover the problem when they try to electronically file their tax returns but are rejected because a return already has been filed using their social security number.  The MMA would like to understand the scope of the problem in Maine, so if you have been victimized in this way, please contact Gordon Smith, EVP, at gsmith@mainemed.com or 622-3374, ext. 212. 

Also, the MMA encourages all Maine physicians to be alert to this problem during this tax-filing season.  You’ll find more information about the Internal Revenue Service’s (IRS’) recommendations to address this threat here: http://www.irs.gov/uac/Taxpayer-Guide-to-Identity-Theft. [return to top]

Announcing Single Sign-On Access from HealthInfoNet (HIN) to the PMP

To promote use of the Maine PMP and HIN, effective Thursday, April 10th, the PMP is accessible directly from the HIN clinical portal through a single sign-on process. This will provide health care providers throughout Maine easier access to comprehensive patient data and assist them in providing effective patient treatment.
 
This single sign-on process will allow HIN users to bypass the whole PMP login process and launch directly from the HIN clinical portal to the PMP Practitioner/Pharmacist query portal patient look up site. All prescribers, dispensers and their delegates who are interested in using this feature must be registered to use both the PMP and HIN.

Important: If you want this service, you must request it.
You can sign up for single sign-on one of two ways.

1. Request access through the HIN portal using the “Request PMP Access” link on the Links Menu.
2. Contact HealthInfoNet at customercare@hinfonet.org or 207-541-9250. Please include your PMP user name, first name, last name and date of birth in your message.
   

Need to register with the PMP?
If you are not registered with the PMP, please submit a completed and signed registration request form to the Office of Substance Abuse and Mental Health Services (SAMHS), Prescription Monitoring Program. Registrations forms can be found on www.maine.gov/pmp. For any PMP technical issues, contact the Help Desk at mepmp-info@hidinc.com or 1-866-792-3149.
 
Need a HIN user account?
If you do not have a HealthInfoNet user account and your organization is connected, contact your organization’s IT Help Desk. If your organization is not connected to HealthInfoNet, please visit the website at www.hinfonet.org or call 207-541-9250 to learn more.
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New Laws Impacting Medical Practice the Subject of May 2 First Friday Presentation

 With the 126th Maine Legislature scheduled to adjourn its Second Regular Session this coming week, MMA will present an educational session on the laws passed by the 126th Legislature on Friday morning, May 2 from 9:00am to noon as part of the First Friday educational programming.

New laws from both sessions will be discussed by a distinguished group of faculty including:

Ann Robinson, J.D., of Preti-Flaherty

Dan Morin,  Government Relations staff at MaineHealth

Charles Soltan, Esq. of the Law Offices of Charles Soltan

MMA Attorneys Gordon Smith, Andrew MacLean and Jessa Barnard.

Among the subject matters discussed will be the new price disclosure laws, the truth in advertising laws enacted in 2013 and the laws enacted amending the Medical Practice Act.

Registration is available on the MMA's website at www.mainemed.com or by calling Ashley Bernier at MMA at 622-3374 ext. 213.   [return to top]

MMA Legislative Committee Weekly Conference Call, Tues., 4/15/14, 8 p.m.

The next MMA Legislative Committee weekly conference call will take place tomorrow night, Tuesday, April 15th 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:  1-619-326-2772 

Passcode:  729-7185

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.  The MMA staff lists a suggested position for each bill and any medical specialty particularly affected by the bill.

If you have an opinion about any of these bills, but cannot participate in the call, please contact Andrew MacLean, Deputy EVP at amaclean@mainemed.com or 622-3374, ext. 214.

There are no new bills for review this week, but the MMA staff will brief participants on the latest news from the State House. [return to top]

Save the Date: MMA's 23rd Annual Practice Education Seminar June 18 in Augusta

The Augusta Civic Center will once again be the site of the Association's 23rd Annual Practice Education Seminar which is intended to present physicians and practice managers with the information and trends in medical practice in Maine and across the country.  The program will be held on Wednesday, June 18 from 8:15am to 4:00pm.

The theme of this year's program is "Preparing Your Practice for the Rough Road Ahead."  The focus will be on payment reform and best practices.  Carol Vargo from the American Medical Association will present data from the Rand survey conducted for the AMA which asked physicians questions about their level of satisfaction with their work and also elicited opinion about practice sustainability.  Kevin Flanigan, M.D., Medical Director for MaineCare will present a keynote luncheon talk on the State Innovation Model grant and its role in reforming the payment and delivery system in the state.  Other speakers will be announced shortly and the complete program will be included with the April-May-June issue of Maine Medicine. Registration will also be available on the MMA website at www.mainemed.com after May 1.

This year's program is supported by the Payment Reform grant from the Maine Health Access Foundation (MeHAF). [return to top]

Maine Takes Part in National Drug Return Day April 26

Maine is participating in another national drug return day on Saturday, April 26.  In previous years, Maine has led the nation in the number of pills collected on a per capita basis  These twice a year events have made it possible for seniors and others to return unused medication to a central secure site in their community and thus ensure their proper disposal.  Many community police departments maintain secure drop sites throughout the year.

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Over 7 Million Enroll in Health Insurance Marketplace - Special Enrollment Still Available for Some

Health Insurance Marketplace Enrollment Information

Over 7 million people chose a Marketplace plan during the ACA's first open enrollment period which ended on March 31.  As of late February, Maine had surpassed goals for ACA enrollment with the highest number of people enrolled per capita for any federally-facilitated state.  The next open enrollment period to sign up for insurance coverage through the Healthcare Marketplace for 2015 is November 15, 2014 through February 15, 2015.

New Funding Opportunity: Improving Access to Quality Care for Uninsured Individuals

The Maine Health Access Foundation (MeHAF) announces the availability of grants under round two of the Improving Access to Quality Care for Uninsured Individuals (A2QC) program.  Grants under this program will support the advancement of a sustainable system of care that delivers comprehensive, high-quality health care services to improve the health of uninsured, low-income individuals, and reduces the time spent in poorly-coordinated, inefficient and costly care.

The A2QC program is an effort to support and work with health systems, health care and social services providers to minimize disruptions in established provider relationships as patients cycle on and off public or private coverage, and advance collaborative, community-based systems of care.

This second round of A2QC planning grants will provide an opportunity for communities in areas of the state where no round one A2QC award was made to apply. Eligible areas: Northern, Eastern, Western, and Central Public Health Districts, Piscataquis County and Northern Penobscot County. Each project's service area may vary from County-wide to individual communities.

Up to three one-year planning grants of up to $50,000 will be available. In 2015, A2QC planning grantees will be eligible to compete for three-year implementation grants.

Informational sessions will be held on 4/15 in Presque Isle, 4/16 in Ellsworth, and 4/17 in Farmington. An informational webinar will also be offered on 4/17.  For more information on the A2QC program, informational sessions and application schedule, go to the A2QC New Funding Opportunity page on the MeHAF website, or contact Program Officer Charles Dwyer.
 
Deadline for online applications is May 21, 2014 by 4:00 p.m. (EDT).
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President Nominates OMB Director to Replace Sebelius at DHHS

As reported widely in the press over the weekend, on Friday, April 11th, President Obama announced the resignation of DHHS Secretary Kathleen Sebelius and his plan to nominate Sylvia Mathews Burwell, the Director of the Office of Management & Budget (OMB) as her replacement.  Sebelius has been DHHS Secretary since early in the President's first term in 2009.  The President acknowledged Sebelius' hard work in implementing the ACA, but observed that there is more work to be done and that Burwell is an excellent choice to take the helm at DHHS.  The President called Burwell a proven manager who has demonstrated the ability to field great teams, forge strong relationships, and deliver excellent results at the highest levels in both the private and public sectors.  Burwell worked previously as chief operating officer and later president for global development at the Gates Foundation, where she worked on the world's most pressing health challenges.  President Obama also said that Burwell gained experience in how health insurance markets work as the head of the Walmart Foundation and a board member of MetLife. [return to top]

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