March 3, 2003

 
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Maine Health Performance Council Announces Performance Indicators
On Feb. 26th, The Maine Health Performance Council announced the 63 performance measurement indicators it has selected to determine annually how well Maine's health care system is working.

On Feb. 26th, The Maine Health Performance Council announced the 63 performance measurement indicators it has selected to determine annually how well Maine's health care system is working.

Former Governor Angus King created the 14 member Maine Health Performance Council in Sept. 2001.  The members consist largely of business leaders and government officials. No health care providers were included in Council membership, although several physicians participated in the workgroups which assisted in the project.   The Council's mission was described as follows:

              ...to strengthen Maine's health care system by informing the decisions of policymakers, purchasers, and providers.

Described as a unique model, the Council intends to achieve its mission by setting and promoting a vision and goals, and developing reliable indicators that measure the performance of Maine's health care system over time.  The Council's initial work was financed by a grant from the Robert Wood Johnson Foundation's State Coverage Initiatives Program and administered by the Maine Development Foundation.

The report issued last week is described as a preliminary report, it does not include data for each indicator, nor does it include comparables with other states or specific targets to achieve in future years.  The Council intends to include such information in its report one year from now if additional funding becomes available.

While the Council itself is made up of only fourteen individuals, over 100 persons participated on workgroups which developed the performance measurement indicators, which are divided into three sections including cost, participation, and quality.  The group worked over an 18 month period to narrow its focus from a possible 400 topics to 63.  Of those, it has been successful in gathering the data for 22 of them.  For instance, information gathered so far demonstrates that Maine's health care expenditures in l998 were the third highest percentage of any state's gross state product at 15.2%.  The national average is 11.6%.  Data collected also established that 11.2% of Maine people surveyed in 2000 said they were unable to get needed health care because of cost. Governor John Baldacci attended the news conference at which the indicators were released and stated that his new office of Health Care Policy and Finance will work with the Council.  He also thanked the members of the Council for their efforts.

Among the indicators of particular interest to physicians are the following (indicator numbers following each title are the numbers assigned by the Council, they are not intended to reflect any prioritization).

          Malpractice Premium Expenditures (9)

          Availability of Price Information to Consumers (11)

          Health Care Workforce Capacity (24)

          Health Care Providers Who Advise Smokers to Quit (41)

          Systems to Reduce Medical Errors (45)

          Quality of Surgical Outcomes (46)

          Quality of Preventive Services (47)

          Availability of Public Information about Quality (48)

          Quality of Medication Management (52)

          Quality of Clinical Information Systems (57)

          Quality of Primary Care for Children (27)

          Availability of Information for Clinical Decision-Making

Copies of the full Report are available from the Maine Development Foundation, Tel. 622-6345.  MMA members may also obtain a copy by calling Julie at the MMA office at 622-3374.

Baldacci Health Action Team Update

Governor Baldacci's Health Action Team met on Feb. 28th with its subcommittees meeting in the morning preceding the full Team meeting in the afternoon.  Discussion at the afternoon session focused on Phase 1 of the HAT's work-creating a new non-profit insurance company and establishing a reinsurance mechanism.  Staff proposed a stop-loss like mechanism, similar to reinsurance, rather than a traditional high risk pool.  These vehicles are intended to be used as a means to jumpstart coverage for workers eligible for federal funding under the federal Trade assistance Act which has a provision dealing with health insurance coverage for workers adversely affected by trade issues.

The new non-profit insurance company, tentatively dubbed, Dirigo Health, would have a Board of Directors appointed by the Governor and would offer both a non-subsidized plan and a subsidized plan.  It would initially be the vehicle to provide stop loss coverage for carriers that participate.  Under the federal trade law, the federal government will match up to 50% of the losses incurred by states that create a qualified risk pool arrangement.  The company would also offer a benefit plan to the federally eligible subsidized workers.

At the afternoon meeting, several members of the HAT questioned the need for and the viability of such a state-formed company.  It was also clear from the discussion that some members of the HAT are uncomfortable with the speed at which the issues are moving forward toward legislative consideration.  However, other HAT members opined that these plans would likely go forward with or without their support and by the end of the afternoon, the majority of members seems inclined to support the Governor's proposals.

Future meeting of the HAT and its subcommittees will be held every other Friday as follows:  March 14, March 28, April 11 and April 25.  Subcommittees normally meet at 9:30am at the State Office Building with the HAT meeting from noon to 3:00pm at the Augusta Civic Center.  As these times and places are subject to change, it would be prudent to check in with the Governor's Office of Health Policy and Finance prior to attending.  [return to top]

President Bush to Address AMA Advocacy Forum

President Bush will speak at the AMA Advocacy Forum in Washington D.C. tomorrow (Tuesday).   The President is expected to call for federal tort reform to assist physicians in the current crisis in medical malpractice insurance.  Proposals are pending in Congress that would impose reforms similar to California's MICRA law on a national level.  While Maine has enacted several reforms, it does not have a cap on non-economic damages in medical liability actions.  Therefore, enactment of such legislation on a federal basis would be a significant benefit to Maine physicians, and to their patients who depend upon physicians to be available despite high premiums and high risk.

Representing Maine physicians at the conference are Krishna Bhatta, M.D., MMA President, Richard Evans, M.D., one of Maine's AMA delegates and Gordon Smith, Esq., MMA Executive Vice President. They will meet with members of Maine's congressional delegation on Tuesday and Wednesday to discuss liability reform and Medicare's payments disparity between rural and urban states. [return to top]

Geographic Equity in Medicare Coalition Presses its Case

The Geographic Equity in Medicare Coalition (GEM) met with Congressional staffers this morning (March 3rd) to discuss the need to reform the Medicare payment schedule to eliminate the significant variations in physician reimbursement between rural states and urban states.  The coalition currently consists of 22 state medical societies, include MMA, and the American Academy of Family Physicians.  All of these states are on the losing end of the geographic disparity which is the result of different values assigned for physician work, expense, and malpractice expense in the RVS formula.  These geographic factors result in a physician in Florida, California, New York or even Massachusetts receiving up to 40% more for a given Medicare service than a physician in Maine.

The coalition hopes to work with the Congressional delegations from each of the losing states to incrementally move to a national fee schedule.  Medicare beneficiaries from Maine pay the same part B premiums as seniors from other states.  Their benefits should also be the same. [return to top]

Anthem Inc. Reports 2002 Annual Earnings

Health insurer Anthem, Inc., parent company of Anthem Blue Cross Blue Shield of Maine, announced recently its annual 2002 earnings of $549.1 million, or $4.51 per share, up from $342.2 million or $3.30 a share in 2001.  For 2003, Anthem is forecasting earnings of $4.75 to $4.85 a share.  [return to top]

Maine Physicians to Gather for Physicians Day at the Legislature

Dozens of Maine Physicians will move from the bedside to politics Thursday as the Maine Medical Association and the Maine Osteopathic Association hold their biennial Physicians' Day at the Legislature.  Beginning with a program in the Hall of Flags at 9:00am, the day concludes with a tea at the Blaine House with Governor John Baldacci.  In between, attendees will have an opportunity to attend sessions of the House and Senate and to attend work sessions of the health-related committees.  Many bills of interest to physicians are being worked on Thursday in Committee work sessions.  A lunch will be served for attendees and legislators and key committee staffers.

Already this session, the MMA Legislative Committee has identified over 170 bills of direct interest to physicians.  Please consider joining your colleagues for all or a part of the day Thursday toward the goal of letting members of the Maine Legislature know what Maine physicians are thinking. [return to top]

Promutual Insurance Company files for Rate Increase

MMA attorneys last week had an opportunity to review a filing at the Maine Bureau of Insurance by Promutual Insurance Company asking for a significant increase in professional liability premium for its insured physicians in Maine.  Offering medical liability insurance in Maine under its Proselect line, the company is requesting increases of between 18 and 26% depending upon the category and levels of coverage.  The Bureau has not yet ruled on the filing.

Maine's liability climate, while not in the crisis stage of many other states, is nonetheless in some stress as the severity of claims continues to increase.  MMA's top priority in this area is to maintain the positive tort laws we have against the annual assault by the trial lawyers who continually try to minimize the impact of our pre-litigation screening panels and increase the statute of limitations.  Working with our liability partner, Medical Mutual Insurance Company of Maine, MMA has through the years been successful in defeating these trial lawyer actions.  We need the continued assistance of members to continue to be successful in this area.  Please let your legislators and the Congressional delegation know that liability issues continue to be of concern.

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