May 5, 2003

 
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Governor Baldacci Announces Health Reform Plan
Maine Governor John Baldacci today announced his much anticipated plan for reforming Maine's health care system. Watch MMA President-elect Maroulla Gleaton respond to questions about the Plan at 8:00pm this Thursday night on MaineWatch, on the stations of Maine Public Television.
     The Governor presented his plan at a public event held at 10:00am this morning in Jewett Hall on the campus of the University of Maine in Augusta   The details of the Plan are contained in a 72 -page document that focuses on all three legs of the proverbial three-legged stool of access, cost and quality.   The Governor's Office of Health Policy and Finance has an overview and detailed summary of the plan on its website.  It is expected that the entire proposal will be placed on the site soon.  The address for the site is http://www.state.me.us/governor/baldacci/healthpolicy/index.html.

     After quickly reviewing the proposal,  MMA offers this brief analysis focusing particularly on those issues and provisions of interest to physicians.  More details will be forthcoming and MMA's response to the provisions will be developed quickly through the committee process of the Association.  Member's views and reactions are always welcome.  The Governor's proposal contains the most significant reform of state health policy  since Governor Brennan proposed creating the Maine Health Care Finance Commission in the 1980's.  It will be important for physicians to become familiar with the proposal and to provide input into the details.

     1.  Access

              Governor Baldacci proposes to create Dirigo Health, a new non-profit state health insurance plan offering coverage to eligible individuals, families, the self-employed, and small business workers who work at least 15 hours per week in a small business that pays at least 60% of a family's premium costs.  The plan would offer a comprehensive benefit package with premiums subsidized on a sliding scale to those persons with annual incomes up to 300% of the Federal Poverty Level (FPL).  This would equate to subsidies for individuals earning under $27,000, $46,000 for a family of three and $55,000 for a family of four.  Uninsured persons earning 300% of FPL or higher and workers in large, fully insured businesses also may participate in the Plan.

                The Governor suggests that Dirigo Health will be able to cover all of Maine's uninsured within 4 years.  The plan will be funded through a 4.1% premium assessment on private health insurance and through additional federal matching funds.  It will not be supported through state General Fund revenue.

 2.  Cost

                  Governor Baldacci prefaced his cost containment strategy by stating that Maine ranks 11th among the states in health care spending.  He proposed a one-year moratorium on capital investment requiring a certificate of need and called on physicians and hospitals to work with state officials to develop a state health plan and to review the CON process.  Significantly on this last point, the Governor proposes to give some antitrust protection to physicians and hospitals in order to develop such a plan.   He also proposed a budget for investments approved through the CON process.  He also proposes subjecting out of hospital expenditures to CON, including a physician's office under some circumstances.

          The Governor also asks providers and insurers to voluntarily limit price increases and margins to 3% through 2004 and states that the State will act through regulation if spending targets are not met.  A global budget is suggested for the hospital sector, trending from the 1999 expense level forward to 2004 with adjustments annually for CPI.  He also requires hospitals and physicians to publicly disclose average charges for common procedures.  Finally, he suggests that the Bureau of Insurance will now regulate insurance rates in the small group (2-50) market.  Under current law, the Bureau regulates rates only for individual and Medicare supplement policies.

3.  Quality

       The Governor's plan includes a new Maine Quality Forum, an independent state agency under the direction of  the Dirigo Health Board of Directors, to measure the quality of medical care in Maine and to educate providers and patients with quality data.  Finally, the Governor framed as a quality initiative his recommendation of a constitutional amendment to permanently protect the Fund for a Healthy Maine, which includes Maine's share of the national tobacco settlement.  The change in the constitution would ensure that the tobacco settlement funds are used exclusively to support the State's long-term tobacco control and public health goals.

        The Governor's staff has indicated that legislation to implement the Governor's proposal may be delivered to the Legislature later this week.  The Governor is very committed to the idea of passing the legislation this session, which means that it would all be accomplished in less than a month's time. The MMA staff will continue to analyze the proposal and will report our findings to you on a regular basis.  Member input can be directed to Andrew MacLean or Gordon Smith at a amaclean@mainemed.com and gsmith@mainemed.com.

Maine Medical Association Releases "White Paper" on Health System Reform
     On Friday, May 2nd, MMA released to the media, legislators and the public a 'White Paper' containing the Association's recommendations on how to achieve universal access of Maine citizens to health care insurance.  The Paper was prepared by an Ad Hoc Committee chaired by MMA President-elect Maroulla Gleaton, M.D.  and grew out of a Resolution considered at the MMA Annual Session last September.  The Resolution had been submitted by the Association's Public Health Committee and called on MMA to endorse the concept of universal coverage, to be built upon the existing system of public and private payors.

     The Paper, now endorsed by the Association's Executive Committee, sets forth a series of Guiding Principles and then sets forth a number of specific reforms designed both to reduce the cost of health insurance and to expand coverage to the more than 140,000 persons lacking coverage in Maine.  A central feature of the plan is requiring persons to purchase coverage, once it becomes more affordable.  Public subsidies would be made available to those persons who could not afford coverage on their own.

     On the cost side, the Paper recommends that both patients and physicians become more familiar with the costs of the products and services ordered.  'Insulating the patients from the cost  of the products and services has contributed both to the spike in utilization and in the general trend away from a true insurance model to something more akin to prepaid healthcare,' said Gordon Smith, Executive Vice President of the Association.

       'While all of our recommendations are not likely to find favor with the Legislature and the Governor, it is hoped that the Paper will contribute significantly to the discussion about to take place in Augusta,' noted  Dr. Gleaton, a practicing ophthalmologist with an office in Augusta.  Dr. Gleaton also served on the Governor's Health Action Team, chairing the Team's subcommittee on costs, planning and regulation.

        The Association expresses its appreciation to the twenty-five physician members who worked on the Ad Hoc Committee.  The members are as follows, recognizing that each recommendation does not necessarily represent the opinion of every member.

  • Maroulla Gleaton, M.D., Chair
  • Lisa LeTourneau, M.D.
  • Jacob Gerritsen, M.D.
  • Katherine Pope,M.D.
  • Robert McAfee, M.D.
  • Richard Wexler, M.D.
  • Daniel Morgenstern, M.D.
  • Nancy Hasenfus, M.D.
  • Richard Evans, M.D.
  • Krishna Bhatta, M.D. (ex-officio)
  • Sydney Sewall, M.D.
  • Jo Linder, M.D.
  • Douglas Jorgensen, D.O.
  • Robert Keller, M.D.
  • Ronald Bailyn, M.D.
  • Lawrence Mutty, M.D.
  • Mitchell Ross, M.D.
  • John Makin, M.D.
  • Paul Cain, M.D.
  • James Haley, M.D., MBA
  • Robert Becker, M.D.
  • Dieter Kreckel, M.D.
  • Donald Smith, M.D.
  • Joel Franck, M.D.

      The 8 page Paper can be accessed via the Association's website.  Click here to take a look. [return to top]

HIPAA Transaction and Code Sets - Another Delay?
     On April 15, the Workshop for Electronic Data Interchange (WEDI) sent a letter to HHS Secretary Tommy Thompson advising him on how the industry will be making short-term transition from its current state to a successful implementation of the HIPAA Transaction and Code Set standards.  WEDI believes that a substantial number of covered entities are not far enough along to achieve compliance by the Oct. 16, 2003 deadline.  In its letter, WEDI identifies several courses of action which may avoid the 'train wreck' that will result from reversion to paper claims (to avoid the rule) or stoppage of payment flows.

    In a related announcement, the HHS Office of Inspector General (OIG) recently reported that about one in five state health agencies say that they will not be compliant by the Oct. 16th, 2003 deadline.

      You may read more about this, including OIG's reports and WEDI's letter at http://www.hipaadvisory.com/news/index.cfm#0421wediI.)II.)/PM.MT-M.

     You may also find value in visiting the Maine HIPAA Transaction Standards Task Force site at http://www.bnncpa.com/hfma/  [return to top]

Emergency Response Training for Primary Care Providers
     Maine's community of primary care providers is invited to an upcoming training session on medical counter terrorism preparedness.  On May 16th in Augusta and May 17th in Houlton the program will be presented without cost to participants.  It will focus on public health emergency response for primary care practices, biological threats, chemical threats, and the response system for an incident or outbreak whether induced by humans or nature (e.g. SARS).  4.5 CME hours are anticipated.  Presenters include Anthony Tomassoni, MD, MS, the Medical Director for the Office of Public Health Emergency Preparedness in the Bureau of Health, Steve Trockman, Coordinator in the Maine Bureau of Health's Office of Public Health Emergency Preparedness and Anthony Carbone, M.D., MPH who is a research fellow in Biosecurity at the Harvard Center for Public Health Preparedness.

      The workshop is being sponsored by the Maine Primary Care Association, Maine Center for Public Health, Harvard School of Public Health and the Maine Bureau of Health. 

     For more information or registration materials, call the Primary Care Association at 621-0677. [return to top]

Projected Negative Medicare Payment Update in 2004 Could Cost Maine Physicians $13 million
    Recent figures released by the AMA show Maine physicians losing $13 million, or an average of $4,500 for each Maine physician seeing Medicare patients if the negative update of 4.2 % announced by CMS is permitted to stand.  The negative update is the result of an unsound and unworkable Sustainable Growth Rate (SGR) formula that cuts payments if growth in Medicare patients' use of services exceeds growth in the gross domestic product (GDP). At the same time, however, the government induces greater use of physician services through new coverage decisions, quality improvement initiatives and a host of other quasi-regulatory decisions that are good for patients but not reflected in the SGR. 

     The Medicare Payment Advisory Committee (MedPAC) established by  Congress recommends replacing the SGR with an update process similar to the approach used for Medicare hospital updates.  For 2004, MedPAC has recommended an update of plus 2.5 instead of the negative 4.2% cut.

     Quite simply, physicians must again communicate to their federal representatives the unfairness associated with the formula and the need for a realistic update.  Many Members of Congress will initially be reluctant to allocate funds this year to another physician payment fix because the Congressional Budget Office scored the 2003 update as costing $54 billion over ten years.  We must start now our campaign to have Congress adopt the MedPAC - recommended 2.5% increase update for 2004.  Talking points and sample letters are available from Gordon or Andy at MMA. (622-3374 or gsmith@mainemed.com or amaclean@mainemed.com [return to top]

MMA Executive Committee to Meet May 7th
     The 26 member Executive Committee of MMA will meet on this Wednesday, May 7th at the Frank O. Stred Building in Manchester.  Major items on the agenda include reaction to MMA's "White Paper" on Health System Reform, Governor Baldacci's Health Reform Package and a continuation of a discussion on Governance.  The latter topic currently involves the role of the County Medical Societies in nominating and electing members of the Executive Committee.  The issue of de-unifying with the County Societies is also under discussion.

     The meeting begins at 2:00pm and is open to any MMA member.  Following the meeting, the Budget and Investment Committee will meet at 5:00pm. [return to top]

AMA Medical Liability Reform Physician Action Kits Now Available
     Starting this week, physicians can request "Physician Action Kits" with promotional materials for physicians to use to enlist their patients in the battle to pass medical liability reform in the U.S. Congress.

      The Physician Action Kit, provided at no cost to any physician in the country, is a key component of the AMA's campaign to mobilize physicians and patients across the country in the fight to pass real medical liability reform legislation in the Congress.  It includes everything needed to educate and motivate patients on this issue, including talking points, sample letters to patients, posters, brochures  for patients and other informational items.

     The easiest way to request a Physician Action Kit is through the AMA  in Washington Web Site at www.ama-assn.org/grassroots.  Physicians may also call the AMA Grassroots Hotline to request a free kit; 1-800-833-6354.

     Additionally, to provide patients with up-to-date information on the crisis and solution, the AMA is introducing the "Patient Action Network" that enables patients to sign-up for regular e-mail and fax issue updates and directly contact their legislators to urge them to support medical liability reform legislation.  The patient hotline number is 888-434-6200. Patients can access the new PAN Web Site at www.ama-assn.org/go/patients. [return to top]

New Satellite Broadcast on SARS Thursday, May 8th; 1-2:30pm, EDT
A new satellite broadcast is scheduled for Thursday, May 8th from 1:00pm-2:30pm EDT.  This program will provide information to clinicians to increase awareness of Severe Acute Respiratory Syndrome (SARS) and reinforce concepts of early recognition, diagnosis, and containment.  Upon successful completion of the course, participants will be able to:  Describe key strategies for early clinical recognition and management of patients with SARS; determine appropriate clinical and laboratory diagnostic tests for SARS; articulate patient education messages regarding infection prevention and control.  The program is being conducted by the Centers for Disease Control.

More information is available at the following web site:

           http://www.phppo.cdc.gov/PHTN/SARSII/default.asp

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