Maine Medicine Weekly Update - 10/21/2019  (Plain Text Version)

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In this issue:
•  Celebrating 65 Years of MMA Leadership Gala Headlines Week of Activities at MMA
•  Vaccine "Skeptics" Qualify for March 3rd Ballot
•  Surprise Medical Bills: Physicians Want Market-Based Fixes
•  This Week's Public Health Updates from the AMA
•  News From The Healthcare Purchaser Alliance of Maine
•  MMA Gala October 26th - Tickets Still Available
•  MaineCare Adds Buprenorphine/Naloxone Tablets to Preferred List
•  Still Time to Register for MICIS/Qualidigm Opioid Webinars
•  MMA "Listening Session" in Portland on Friday, October 25
•  Celebration for Our Healthy Future Thursday, October 17th Honors Lani Graham, M.D.
•  From The Alzheimer's Association: Diagnosing Patients with Dementia
•  MMA Legislative Calls Finished for the Session
•  Maine Legislature's List of Bill Titles Proposed for 2020 Session
•  Upcoming Specialty Society Meetings
•  CDC to offer webinar on new law requiring Lead Testing for all 1 & 2 year olds - October 21
•  MICIS: 2019 Clinical & Legal Opioid Update 10/24 Dedham, 10/30 Portland, 3 November Dates
•  Qualidigm Rapid Induction Starting in the ED (RISE) Training
•  Celebrate 65 Years of MMA Executive Leadership on Oct. 26. Tickets Available Now
•  Obesity Medicine: There is no 'one size fits all' - Monthly Lecture Series Beginning November 13th
•  MMA partners with the Maine Suicide Prevention Program and the Maine CDC/Sweetser to offer training for clinicians.
•  Northern Light Sebasticook Valley Hospital seeks a BC/BE General Surgeon
•  Family Medicine Opportunity in Beautiful Western Maine
•  Outpatient Internal Medicine Physician Bangor, Maine
•  BC/BE Family Medicine or Internal Medicine Physician
•  Physician
•  Nurse Practitioner
•  Physician Director of Primary Care
•  Full-time, Part-time and Leadership Opportunities for Physicians
•  Medical Director - Bucksport, ME
•  Opportunities at the VA for Volunteer Physicians
•  Volunteer Opportunity with Partners for World Health


Surprise Medical Bills: Physicians Want Market-Based Fixes

See a summary of efforts by the AMA, MMA, and many other physician organizations around the country to inform the U.S. Congressional debate on "surprise medical billing."


The AMA and 110 other organizations representing hundreds of thousands of American physicians have signed onto a letter urging Congress to refine surprise billing legislation to ensure the final version targeting unanticipated out-of-network care "represents a fair, market-based approach that treats all stakeholders equally while protecting patient access to care."

There are instances when unanticipated coverage gaps happen "and patients unknowingly or without a choice receive care from an out-of-network physician or other provider."

In those cases, the physicians' letter says, "patients should be held harmless for any costs above their in-network cost-sharing, and their cost-sharing should count toward deductibles and out-of-pocket maximums. Patients should be completely removed from any subsequent payment disputes between their health insurance company and an out-of-network provider when they experience an unanticipated coverage gap," says the letter, sent Oct. 15 to Congressional leaders and broadly shared with members of the U.S. House and Senate.

However, "rate-setting provisions in current bills further shift marketplace leverage to health insurers at the expense of providers." That "will likely lead to access problems for patients seeking hospital-based care from on-call specialists, as well as precipitate staffing shortages in rural areas and other underserved communities."

More than 80% of the budgetary impact of the rate-setting mechanism in the "Lower Health Care Costs Act" (S. 1895) "would arise from changes to in-network payment rates," according to the analysis conducted by the Congressional Budget Office, which reached a similar conclusion regarding another bill, the "No Surprises Act" (H.R. 2328).

The end result? "In-network providers who have not contributed to the problem will bear the impact of the rate-setting scheme," says the letter sent by the AMA and the other physician organizations.

Physicians point to the success that New York state has had with a law mandating an independent dispute-resolution (IDR) process to deal with medical bills arising from unanticipated out-of-network care. New York patients have saved $400 million-plus on emergency care alone and out-of-network billing has fallen 34% since 2015, according to New York State Department of Financial Services Supervisor Linda Lacewell.

The AMA and the other physician organizations signing onto the letter recommend specific fixes to the "No Surprises Act" to:

  • Lower the $1,250 threshold to trigger an appeals process.
  • Allow for IDR batching of claims involving identical plans and providers, and the same or similar procedures that happen within a reasonable time frame.
  • Change the initial payment to reflect a commercially reasonable rate based on actual local charges determined through an independent claims database.
  • Establish measurable and enforceable network adequacy requirements.

Congress is expected to act in the coming months.