April 21, 2003

 
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Governor to Unveil Major Health Initiative April 25
The Governor's much anticipated healthcare reform package is expected to be presented on this Friday, April 25th, to his own Health Action Team.
     Maine Governor John Baldacci is expected to unveil his comprehensive health reform initiative on Friday, April 25th to the members of his Health Action Team.  The members of the Team have been advising the Governor's Office of Health Policy and Finance concerning the details of the plan.  Legislators will be briefed when they return to Augusta on April 28th following a week long break for most of the committees.

      The Governor's proposal has been the source of much speculation in recent weeks as the Governor's staff and members of the Health Action Team (HAT) have reviewed certain concepts but very few details of the package have been revealed.  While the Governor promised during the campaign to develop a plan to provide some type of coverage for the state's large uninsured population, the state's budget deficit is seen as a significant barrier to making much headway on that front.  The package instead is likely to be heavy on cost controls including a strengthening of the state's Certificate of Need law,  re-institutionalizing a state health planning process, and requiring disclosure of cost and price information to consumers.  There may be incentives for 'quality' but most observers understand the difficulty of  differentiating providers based on quality when appropriate measurements of quality are still in their infancy.

         Once the Governor's package is released, the proposals must still be considered by the legislature.

Happy Patriot's Day, MMA Office Open for Business
     The states of Maine and Massachusetts will celebrate Patriot's Day on Monday, April 21st.  The Maine Medical Association will be open for business, despite the Holiday, from 7:00am to 5:00pm to serve the needs and interests of our members. [return to top]

Maine Medical Association to Commemorate Anniversary of its Founding on April 28th, 1853.
     On Monday, April 28th, the Maine Medical Association will kick-off its Sesquicentennial Celebration by honoring those physicians who founded MMA in l853.  A ribbon cutting ceremony will take place at the location of the old Tontine Hotel in Brunswick, where the first meeting was held.  The site is now the location of the Tontine Mall.  Exactly 150 years to the day from its founding,  a monument will be dedicated to the physician pioneers who were at the first meeting on April 28th, l853. 

      The ceremony will take place at noon and all members as well as the public are invited.  Thanks to the Lincoln-Sagadahoc County Medical Society which initiated this recognition and paid for its cost.

       The celebration of this historical event kicks off a series of events recognizing the Association's Sesquicentennial Year  culminating with a Gala in Portland on Saturday Evening, Nov. 8th.  A video of the highlights of the Association's history, and marking many of the important events in the history of Maine medicine, is being prepared and will be seen at the Annual Session in September and at the Gala.  Members or family members who have a favorite anecdote or remembrance to share should contact George Bostwick, M.D. at 832-4318 or Gordon Smith at 622-3374.  Other physician/historians assisting with the events include Richard Kahn, M.D. of Rockland, Loring Pratt, M.D. of Fairfield, Charles Burden, M.D. of Dresden, Ruth Endicott, M.D. of Ogunquit and Marion Moulton, M.D. of  West Newfield. [return to top]

Senate Finance Committee Hearing on Medicare Geographic Equity
     Senate Finance Committee Chairman Charles Grassley (R, Iowa) held a Committee Field Hearing in Iowa on Monday, April 14th.  The hearing was called, "A Fair Deal for Rural America,:  Fixing Medicare Reimbursement" and dealt with the subject of Medicare equity.  The focus of the testimony was on why Medicare pays rural providers in states like Iowa and Maine less than it pays for the same service in more populated states. 

     The witness list included Gail Wilensky, former HCFA Director now with Project Hope, Nancy Ann DeParle, also a former HCFA Director and now a Commissioner on the Medicare Payment Advisory COmmission, and four representatives of providers in Iowa.

     Senator Grassley will soon introduce a new version of earlier legislation that aims to reduce the geographic inequities in physician payments under Medicare.   The bill would eliminate all negative geographic adjustment of the physician work component, reflecting the view that the value of a physician's work is no less in Iowa and Maine than in other states.  The bill would also require the General Accounting Office to report to Congress on whether Medicare's current geographical adjustment of the two other elements of physician payment (practice expense and malpractice insurance) is fair and accurate.

     For F.Y. 2001, Medicare payments per enrollee by state showed northern New England and the rural Western States to be at the bottom of the distribution chain.  The bottom six states, and the dollar amounts paid per Medicare enrollee were:

                                 New Hampshire  $4,135

                                   Vermont    $4,019

                                     MAINE    $3,993

                                      Alaska    $3,864

                                       New Mexico    $3,689

                                        Iowa   $3,414

     The top state was Louisiana with a whopping $8,099 per enrollee.  Second from the top was Florida at $7,603, nearly twice the amount of Maine. 

      The Maine Medical Association is dedicated to bringing about reform of the payment formula and is a member of the Geographic Equity in Medicare Coalition (GEM) made up of 26 state medical societies and the American Academy of Family Physicians.  Senator Olympia Snowe's membership on the Senate Finance Committee makes Maine's participation in the coalition particularly important.

 

 

 

 

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Prescription Drug Monitoring Program Endorsed by Committee
On April 18th, the Legislature's Business, Research and Economic Development Committee unanimously passed L.D. 945, An Act to Facilitate Communication between Prescribers and Dispensers of Prescription Medication.  The bill, presented initially two years ago, would create a prescription drug monitoring database.  Each dispenser (primarily pharmacists) of a controlled substance would electronically provide information on the script to the Bureau of Health which would collect and analyze the information.  If the patient were filling scripts at multiple pharmacies through Doctor shopping or via other means, the prescriber would be notified.

      The Committee stressed the need for the prescribing information of be available to both prescribers and dispensers in "real time" in order to avoid duplicative scripts.

       The details of the program will be spelled out in rules that must be brought back before the Committee next session.  While the legislation does not specify how the monitoring program will be funded, there is general agreement that funding will not come from pharmacists and physicians, a position not clear last year.  The Office of Substance Abuse is in the process of applying for available federal grant money to establish the program.

      Much of the impetus for this legislation, strongly supported by the Attorney General's Office, came from the report last Fall detailing the increasing number of deaths in the state caused by overdoses of controlled substances, usually combined with the use of non-prescription drugs.

       One of the difficult issues yet to be dealt with involves the role of the physician once he or she is notified of the potential abuse.  While there is no physician-patient priviilege that protects pure illicit drug seeking, rarely do cases present strictly on that basis and the confidentiality accorded patients may preclude much intervention except with the patient.  The Association's legal staff will have to give this question some careful thought over the next 12 months while the rules are being developed.

     Questions on this legislation or on this general subject matter can be addressed to either Andrew MacLean, Esq. or Gordon Smith, Esq., at the MMA office (622-3374).

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Thirteen-Year-Old Human Genome Project Completed
     The Human Genome Project, a publicly funded international consortium of academic centers, on April 17th announced the completion of the human genome map.  The Project, which began in Oct. 1990, has produced a sequence of more than three billion units of DNA of the human genome that is considered 99.99% accurate and 99% complete.

     The Project, estimated to cost the United States $3billion and to last 15 years, cost $2.7 billion and ended two years early.  Dr. Francis Collins, head of the National Human Genome Research Institute, which led the U.S. effort, announced a plan for future studies of the human genome.  One of the studies, the three-year HapMap project, will catalog the 100,000 genetic differences between individuals to help locate genes linked to complex traits, predispositions and diseases. [return to top]

Johnson & Johnson Sending Warning Letters about Risperdal
Officials at Johnson & Johnson announced plans last week to send letters to U.S. physicians to warn about potential increased risk of stroke for elderly patients who take the antipsychotic medication Risperdal.  The FDA approved Risperdal as a treatment for schizophrenia, but physicians often prescribe the medication to control delusions, aggression and anxiety in elderly patients with dementia and Alzheimer's disease.  The Risperdal label includes information about stroke risks, but the company will add more specific information about risks in elderly patients. [return to top]

MMA Payor Liaison Committee to Meet Wednesday
     MMA's Payor Liaison Committee will meet on Wednesday evening, April 23rd.  The Committee will hear from Katherine Pelletreau, Director of the Maine Association of Health Plans.  Other items on the agenda include a updates on the Coding Center, legislation involving payor issues and class action litigation against the health plans.  The Committee, which is the primary liaison between MMA and the various health plans, is chaired by Thomas Hayward, M.D. of Each Corinth. [return to top]

MaineCare DUR Committee Develops Preferred Drug List
     The MaineCare DUR Committee met every day last week to develop a Preferred Drug List.  THe Department of Human Services has received permission from the Centers for Medicare and Medicaid Services to establish a supplemental rebate program with pharmaceutical manufactureres.  Placement on the preferred list and the existing prior authorization program is expected to encourage manufacturers' participation.

     The Committee will hold a public hearing on the draft list from 2:30pm to 6:30pm on THursday, April 24th, 2003 at the Bureau of Medical Services offices, 442 Civic Center Drive, Augusta.  MMA will collect comments and attend the public hearing.  THe link to the draft list is below.  SHould you have comments, please contact Andrew MacLean, General COunsel & Director of Governmental Affairs at 622-3374 or at amaclean@mainemed.com

                        http://www.ghsinc.com/Japps/upload/PDL-Draft.pdf [return to top]

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