February 10, 2003

 
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Governor Baldacci Proposes Flat Funding for Maine Care
Governor Baldacci addressed a joint session of the Legislature last Wednesday on the budget document he was to make available early this week.
In addressing the impact of the nearly $1 billion state budget deficit on Maine Care (formerly called Medicaid), the Governor indicated that he would not reduce the number of people eligible for Maine Care and Cub Care.  Instead, providers would be asked to accept current levels of funding.  He also indicated that Maine Care participants will be asked to make modest payments toward their care and alluded to 'some targeted service reductions.'

The Governor also indicated that he expected some administrative savings from combining the Departments of Human Services and Behavioral and Developmental Services. 

Drug costs continue to be a focus of budget cutters as the Governor stated that he will tighten controls on prescription drug costs.

The Governor noted that funds from the national tobacco settlement will continue to be used exclusively for health care.

Next week's Maine Medicine will contain more details on the budget, which is expected to be delivered to the Legislature by today.

While flat funding for providers continuing to participate in the Maine Care program is not good news, it was feared that the Governor might actually decrease reimbursement.

Flat funding for the program also serves to bring to people's attention the difference between those providers, such as physicians, who are paid on a fixed fee schedule which is not adjusted yearly and those institutional providers, such as hospitals, which receive updates each year.

License Fees Grabbed by Legislature
As reported previously in Maine Medicine, the Governor had proposed taking money from state licensing boards in order to help balance the budget.  On Wednesday, February 5th, the Legislature accepted the Governor's supplemental budget which contained this provision.  This action will cost the Board of Licensure in Medicine over $57,000 in dedicated funds.

The Association is reviewing its legal options regarding this action as license fees are dedicated under current law. [return to top]

Governor's Health Action Team to Meet Tuesday
The Governor's recently announced Health Action Team will meet Tuesday, February 11 at 9:30 a.m. at the Maine State Principals Association in Augusta.  The meeting is open to the public.

The Team was established by the Governor's new Office of Health Policy and Finance and is made up of 24 individuals appointed by various stakeholder groups, including MMA.  The Team has been charged with the task of advising the Office of Health Policy and Finance in implementation of the Governor's health reform plan.

The Governor's health reform plan includes:

  • Creating an affordable health plan administrated by a new, non-profit insurance company;
  • Maximizing value purchasing collaboratively among public purchasers of health care;
  • Creating a state health plan and revitalized certificate of need program to effectively and equitably allocate health care resources;
  • Maximizing Medicaid and other federal programs;
  • Supporting evidence-based medicine and preventive and public health care and;
  • Building sustainable cost containment and quality improvement.

Maroulla Gleaton, MD, will serve as MMA's appointment to the Team.  Dr. Gleaton is an Augusta ophthalmalogist and currently serves as MMA's President-elect.

For a list of the other members of the Governor's Health Action Team, call MMA at 622-3374 or click on mainemed.com and ask for the list via email. [return to top]

President Proposes Medicare Payment Update Fix
President Bush on February 3rd pledged as part of his 2004 budget to fix the mistake in the Medicare physician payment rates.  Although other details of the President's $400 billion proposal for Medicare modernization have not yet been released, the budget documents include a proposal to adjust the Medicare payment formula 'to use actual data instead of estimates in current and previous updates.'

The AMA first identified the erroneous estimates in the formula when the 1998 formula seriously underestimated gross domestic product (GDP) for that year.

A correction to fix the mistake would result in higher updates for physicians over the next several years.

MMA and the AMA are still working vigorously to halt the 4.4% reduction in Medicare fees due to take effect March 1st.  Action must be taken by Congress by the end of this week if the cut is to be delayed.  A joint conference committee named late last week is working this week on the issue. [return to top]

AMA Continues Work on Organization of Organizations
Nearly 200 physicians convened in Los Angeles last weekend to continue work on the effort to transform the American Medical Association into an organization made up of other organizations rather than individuals.  Richard Evans, M.D., a Machias surgeon and one of Maine's two delegates to the AMA represented the states of Maine, New Hampshire, Vermont, and Wyoming in the discussions.

The next meeting of the Committee on the Organization of Organizations will be held in Washington D.C. on March 1st and 2nd. [return to top]

Economic Credentialing Gets OIG Attention
In early December, the U.S. DHHS Office of Inspector General solicited comments on new areas of regulation for the OIG's focus.  The AMA has urged the OIG to focus attention and to develop regulations on hospital credentialing based on referrals, known as "exclusive credentialing."  Exclusive credentialing is a subset of economic credentialing which evaluates economic factors completely unrelated to clinical competency.  The MMA and the AMA oppose the use of economic criteria unrelated to quality to determine an individual physician's qualifications for medical staff membership or privileges.  Call Diane at MMA (622-3374) to receive a copy of the AMA's comments. [return to top]

Coverage/Call Obligations in the News
Several recent skirmishes around the state suggest that physician obligations to take call and cover hospital emergency rooms are becoming a major issue in Maine.  This past week, a group of oral surgeons dropped ER coverage obligations at the Maine Medical Center, resulting in MMC not having this specialty service available on an emergency basis from February 13-27th

Across the country, physicians and other health professionals are expressing discomfort with low fees (or no fees), liabilities, EMTALA obligations, and quality of life issues as they relate to covering an emergency room.  Some hospitals have responded by adopting specific policies regarding call.  These policies range from simple statements setting forth basic EMTALA requirements to multi-page policies addressing, in detail, the obligations of physicians to take call and the procedures to be followed in determining, for instance, whether to come to the emergency room and how quickly.

Several hospitals around the country are now paying physicians to take call, although this has not become common in Maine. [return to top]

Mobile Health Screenings Being Offered in Maine
Physicians are expressing concern with the proliferation of mobile health screenings being offered to Maine's seniors by out-of-state organizations.  One recent offering in the Augusta area offered the four following tests to the general public, without regard to symptoms:

  • Stroke Screening/Carotid Artery ($45)
  • Abdominal Aortic Aneurysm Screening ($45)
  • Peripheral Arterial Disease Screening ($45)
  • Osteoporosis Screening ($35)

Only cash is accepted at the screenings and the company offering the tests does not like insurance claims.  Even if it did, most health insurance carriers would not cover such tests for asymptomatic patients.

Frequently, these screenings are introduced into an area through the efforts of a church or even a business.  (The Augusta offering is being sponsored by Shaw's Supermarkets).

The Maine Medical Association has previously complained to the Board of Licensure in Medicine about such programs, both because they are offered without any Maine physician (although at least one of the out-of-state physicians associated with the company has obtained a Maine license) and because of the number of false positive readings which create unnecessary anxiety in the patients.

Should you become aware of these programs in your area, the most appropriate recourse at this time appears to be discussing the screenings with your own patients.  MMA will continue to look at other options.

  [return to top]

MMA Legislative Committee to Consider 30 Bills on Tuesday
The MMA Legislative Committee chaired by Katherine Pope, MD, of Portland, will meet on Tuesday evening, February 11th at the Association office in Manchester.

Thirty pending legislative proposals will be discussed.  A list of these proposals can be obtained from Charyl Smith at MMA. They are also contained in Andrew MacLean's newsletter, the Political Pulse, emailed each Friday.  Should you wish to receive Mr. MacLean's report electronically each Friday during the legislative session, please call Charyl Smith at 622-3374, or follow this link to our subscription management page.  The report is available to all MMA members. [return to top]

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