MINUTES 

MAINE HEALTH DATA ORGANIZATION
BOARD OF DIRECTORS MEETING
151 CAPITOL STREET, AUGUSTA, MAINE
THURSDAY, NOVEMBER 13, 2003

The meeting of the Maine Health Data Organization (MHDO) Board of Directors began at 9:15 a.m. with the following Board members present:  Richard Bruns, Chair, Dana Kempton, Vice-Chair, Theresa Bellmore, Robin Bickford, Cathy Gavin, Peter Gore, Mark Granzier, David Johnson, Dick Lowd, John Portela, Vicki Purgavie, and Sydney Sewall.  Absent members were Vaikko Allen, Lynn Davey, Doug Libby, Rebecca Martins, Diane Moongrove, and Lisa Tuttle.

The October 9, 2003 MHDO Board minutes were approved as written.

Executive Director Report
Financial Report:  There were no questions or comments regarding the MHDO monthly financial statement.

Coding Presentation:  As representatives of the State Uniform Billing Committee, Suzanne Menard of Southern Maine Medical Center and Kim Gray of Redington Fairview General Hospital gave a presentation on the data submission process.  Ms. Menard began by explaining the source of data and the differences in data elements required in the Inpatient, Outpatient and Emergency Department registration process.  She also outlined the different information required for the various insurance entities and the differences in DRG and HCPC coding, emphasizing how critical coding was for payment purposes.

Ms. Gray continued the presentation by explaining national coding guidelines.  A discussion ensued on determining the nature of potential medical errors and the complexity of interpreting codes due to the lack of detail.  Ms. Menard stated that charts offer detailed information and new electronic coding would include narrative to provide an even higher level of detail.  There was a discussion on how claims data could be used to measure quality.  Mr. Prysunka stated that an epidemiologist will be hired to assist in such analysis and report functions.

With respect to claims data, Mrs. Menard explained the revenue codes used in claims processing and the variance in coding requirements by the some insurers.  In closing, Chairman Bruns asked Ms. Menard and Ms. Gray to compile list of the top things they would like to see to streamline the system.  

MaineCare Update:   Mr. Prysunka stated that he has provided the Governor’s Office with an expanded list of benefits of MaineCare, as requested.  However, he is still waiting for CMS to provide him with a list of identifiable data elements, as promised during a recent conference call with the GOHPF, AG’s Office, BMS and CMS.  Mr. Prysunka also stated that in December, when he and Jim Harnar, President of the Maine Health Information Center are in the Washington area attending the annual NAHDO Conference, they plan to meet with 
MHDO Board Minutes
November 13, 2003
Page 2

Congressional Delegation staff and CMS.  Dr. Johnson requested that during this meeting Mr. Prysunka also inquire as to whether or not the federal government has approved any grants for the study of health data in the U.S., and what efforts are being made to obtain information for uniformity of provider codes.

Patient Advocates Update:   Paul Gauvreau, Board Legal Counsel gave the new Board members an update on the Patient Advocate’s issue, informed the Board that both parties are currently in discovery, which is the process of sharing documents and information, and gave a timeline of possible future scenarios depending on how the Federal District Court Judge in Portland rules. 

Mr. Gauvreau also informed the Board that all non-hospital providers, with the exception of VisionCare of Maine, have paid their assessment for last year.  Debora Tuck, MHDO staff explained that, due to possible bankruptcy proceedings VisionCare had originally been granted an extension in paying their assessment.  However, they have failed to respond to recent correspondence in which they were given a November 13, 2003, deadline to submit payment.  Upon determining that the policy for notification had been followed and agreeing that staff would first check to see if VisionCare had not listed the MHDO as debtor in bankruptcy proceedings, there was a motion and a second that VisionCare of Maine be referred to the Office of Attorney General for further action.  Motion passed unanimously.

Payer/Provider Codes Update:  Mr. Prysunka informed the Board that he will meet with hospital representatives to discuss altering the payer coding systems used to define and track payers in the hospital database.  Also, the Department of Health and Human Services plans to roll out the National Provider ID System by the end of 2003; however, there will be a two year, two month implementation schedule.  Mr. Prysunka will continue to find out more and report back to the Board.  

MHDPC Management Services Agreement Amendment:  The Board received a handout showing a scope of work and estimated costs associated with the MHDO and the Data Processing Center creating a master linked provider file, in absence of a National Provider Identification System.  Mr. Prysunka explained that the amounts listed on the handout indicated the most it would cost to implement the provider file system, which would consist of tables of names, addresses, and federal tax id numbers.  After some discussion there was a motion to expend the money necessary to implement a provider file due to the fact that the data would not be useful if providers could not be identified.  The motion was seconded and passed unanimously. 

Subcommittee Reports
Finance Subcommittee:  Dana Kempton informed the Board that the Finance Subcommittee had recently met to discuss the appropriate level of pricing user fees.  In recognizing the uniqueness of the claims database, in fairness to those paying assessments, and due to the fact that the MHDO is spending a fair amount of money to develop the claims database, it was decided that the large commercial groups and large research groups should be charged 
MHDO Board Minutes
November 13, 2003
Page 3

as much as the market would bear for utilization of the data and for gathering the data.  The Subcommittee also agreed on the feasibility of having different fee levels stating for instance, that those paying assessments would receive a discounted fee and those who want the entire database would pay less.  Also, individuals would have fees determined by the Board on a case-by-case basis.  Mr. Prysunka was directed to do a  market study of potential users and to enlist outside consultants to obtain a broad range of approaches.  

The planned approach of reducing assessments as a result of increasing user fees will be included in the report to the Health & Human Services Committee.  The Board discussed using the current database to better determine the non-hospital payer proportion; however, it was determined that because the data is not yet available they would propose to the H & HS Committee that the MHDO keep the current system one more year, but state that the most equitable and preferred method would be to go through the State licensing system.  There was some discussion regarding including in the report to the H & HS Committee that due to the fact that the MHDO is self-funded any increase in fees would be used specifically for reducing assessments.   Mr. Prysunka will soon provide the Board with a draft of Chapter 50 and at the next meeting they will further discuss how to present their position to the H & HS Committee.

Mr. Prysunka mentioned that revenue may also be derived from the licensing of editing software developed by the Data Processing Center.  Several states have expressed an interest in leasing such software and the MHDO would receive a 60% share of the licensing revenue. 

Data Processing Center Report
In the absence of a representative from the Data Processing Center, Mr. Prysunka gave the DP Center Report.  He stated that Aetna has submitted data through August and that the Center is working with Anthem to resolve the high percentage of claims they received from unknown providers.  Mr. Prysunka also stated that the DP Center has received a larger percentage of nonstandard procedure coding from TPA’s than anticipated.  

Chairman Richard Bruns suggested that the fourth item listed on Page 2 of the Retreat Summary be changed as written to state:  “producing data quality reports for the data currently collected”.  The Board agreed and MHDO staff will modify the summary accordingly.  

Public Comment
None provided.

The meeting adjourned at 11:15 a.m.

Respectfully submitted, Linda Adams, Administrative Assistant