May 26, 2003

 
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Work Continues on Dirigo Health Plan; MMA Negotiates - Outcome Uncertain
The Legislature's Joint Select Committee on Health Care Reform held work sessions for several hours over three days this past week. Committee members seemed to acknowledge that a number of difficult issues with L.D. 1611 became apparent at the public hearing and that further negotiations would be required between the Governor's Office of Health Policy and Finance and the physician, hospital and insurance communities before the Committee could complete work on the bill.
     At the work session on Thursday afternoon, Senate Chairman Michael Brennan reviewed the most contentious items and directed MMA, the Maine Hospital Association, and the Maine Association of Health Plans to meet with the Governor's staff to attempt to negotiate the key issues for each group. These issues include the CON issue for physicians, the global budget issue for hospitals and physicians and the 4.1% premium assessment for insurers.

     This list of issues is by no means exhaustive of the issues still being discussed.  At a 7:00am meeting tomorrow (Tuesday) morning,  MMA representatives will discuss with the Governor's representatives the following items:

                                   l.  Expanding medicaid eligibility without increasing reimbursement

                                   2.  Global budgets, both overall and in connection with annual CON approvals.

                                    3.  Expansion of Certificate of Need to not only Ambulatory Surgical Centers but also to private physician offices,  subject to state-imposed monetary thresholds.

                                     4.  Mandated disclosure of fees and average amounts received per service or procedure

                                      5.  Mandatory electronic billing, regardless of practice size

                                       6.  Mandatory reporting of 'quality' data from the physician office to the Maine Health Data Organization, with subsequent publication of the data in order to compare providers on performance measurements developed by the Maine Quality Forum.

                                          7.  Lack of physician representation on the Dirigo Health Board and the Maine Quality Forum Advisory  Council  (one M.D. among 15 representatives.)

             While there is much to be admired and commended in the Governor's Plan, such as the attempt to cover more individuals, MMA can not and will not support the proposal unless adequate amendments can be negotiated or otherwise achieved dealing with the above issues.

                Work sessions will continue on the bill this week on Tuesday, Wednesday and Thursday afternoons and presumably next week as well.  While many Republican legislators are urging for the bill to be held over to the next session,  there continues to be strong Democratic support for passing an amended version of the bill this session.  The session is scheduled to adjourn in mid-June.

                  House members may be called by leaving a message at 1-800-423-2900 or 287-1400.  Members of the State Senate can be reached by calling 1-800-423-6900 or 287-1540.  A call to your legislators to discuss your thoughts on the Governor's plan would be very helpful.

Legislators Seek Details on Federal Approval of Dirigo Health
       On Tuesday, May 27, the 15 member-joint select committee reviewing the Governor's Health Plan will hear from the Attorney General's office regarding the legality of drawing down federal medicaid funds by using premiums  paid by private employers for employees who are medicaid eligible. 

     Republicans on the committee sent a letter Friday to U.S. Health and Human Services Secretary Tommy Thompson asking him to expedite a review of the medicaid provisions in the proposal.  Trish Riley, DIrector of the Governor's Office of Health Policy and Finance has continually stated that the use of the federal funds is consistent with federal law and practice.

     If the feds were to disapprove the use of the voluntary payments from private employers as a match for  federal medicaid funds, the proposed funding for Dirigo Health would be short by $70 to $180 million depending upon how many eligible persons enrolled. [return to top]

Public Forum on Dirigo Health draws 100 people in Lewiston
     Even the Memorial Day Weekend did not damper interest in Lewiston Friday in getting out and hearing more about the Governor's Dirigo Health Plan.  Area legislators and Trish Riley from the Governor's Office of Health Policy and Finance heard from many citizens regarding concerns about the plan.  While some encouraged legislators to pass the proposal expeditiously, most expressed concern about the ultimate impact.  Physicians speaking against the proposal included David Stuchiner, director of emergency services at Central Maine Medical Center and Evan Ramser, a Lewiston pulmonologist.

     The Lewiston session was one of several held throughout the state last week.  Some of the forums were organized by legislators, others by hospitals or consumer groups. [return to top]

Legislature Poised to Enact Electronic Prescription Monitoring Bill
     The Legislature this week is expected to enact and send to the Governor L.D. 945, An Act to Facilitate Communication between Prescribers and Dispensers of Prescription Medication.  The bill creates a database to track prescriptions of Schedule 11, 111, and 1V drugs.  The bill, which was presented but not passed last session, was amended on the House floor to strike out any use of General Fund money for the program.  The bill was also amended to move the program from the Bureau of Health to the Office of Substance Abuse (OSA) in the Department of Behavioral and Developmental Services.  OSA is in the process of applying for grants to fund the program.

     The program would operate by having pharmacies send the prescribing data electronically to the state.  If the script failed one of several screens, the prescribing physician would be notified.  Over a dozen states have developed similar programs with some success.  MMA supported the concept but adamantly opposed having physicians or pharmacists pay for the system.  The current plan is for all the funding to come from OSA through federal grants.  But we do worry about the on-going operational expense once the program is up and running. [return to top]

Federal Tax Cut Bill Helps Maine in Medicaid but drops Medicare Geographic Equity Amendment
    On Friday, May 23rd, the U.S. House and Senate passed the 'Jobs and Growth Tax Relief Reconciliation Act of 2003'.  THe bill passed the House by a vote of 231-200 and the Senate by a vote of 51-50 with Vice President Cheney casting the tie-breaking vote.  THe legislation now goes to the White House for the President's signature.

     The final legislation includes a Senate provision authored by Maine Senator Susan Collins authorizing relief to the states by establishing a temporary fund to provide $10 billion divided among the states to be used for essential government services and $10 billion for enhanced medicaid match payments.  Maine's share of the medicaid piece is $65.6 million.  Although this is a one-time appropriation, MMA will advocate for a substantial portion of these funds to be used to increase physician reimbursement under the medicaid program.  At a minimum, the Legislature should restore the recent cuts that have taken place in the Physician Incentive Program.  A badly needed across the board increase in the fee schedule should also be adopted.

     Also of critical importance to Maine physicians is the fact that the Congress dropped Senator Grassley's (R-IA) amendment on geographic equity which set a floor of 1.0 on geographic adjustments to the work, practice expense and professional liability insurance components of the physician payment schedule.  The entire Grassley amendment was dropped in conference.  However, the White House released a May 22, 2003 letter from the President to Sen. Grassley memorializing their agreement 'on the need to address issues faced by rural hospitals, skilled nursing facilities, home health agencies and physicians.'  President Bush continued, 'I support the increased Medicare payments for rural providers contained in your amendment as a part of a bill that implements our shared goal for Medicare reform.'

       MMA participates in the Geographic Equity Coalition (GEM) which has been working with Sen. Grassley to narrow the gap in Medicare payments between the urban and rural states.  Twenty-six  states participate in the Coalition along with the American Academy of Family Physicians. [return to top]

New Guidelines on Categorizing Hypertensive Patients Issued by NIH
     On May 14, the NIH's National Heart, Lung and Blood Institute released new guidelines that categorize as "prehypertensive" some persons who were previously classified as having normal blood pressure levels.  The Institute's National High Blood Pressure Education Program created the new prehypertensive category based on evidence that suggests that blood vessel damage begins at blood pressure levels once considered normal.

      Under the new guidelines, a blood presure reading of less than 120 over 80 is considered normal; a reading of 120 to 139 over 80 to 89 is considered prehypertensive; a reading of 140 to 159 over 90 to 99 is considered stage 1 hypertension and a reading of 160 or higher over 100 or higher is considered stage 2 hypertension.  The new guidelines classify 45 million US adults who were previously considered to have normal blood pressure as prehypertensive, along with the 50 million adults who have already been diagnosed with high blood pressure.

      The new classification system is designed to improve public awareness and medical treatment, and to help physicians and patients better manage hypertension and motivate individuals to take early action against high blood pressure.  The report is available at http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf

     The report recommends an "aggressive approach" to diet and exercise modifications for people with prehypertension, including losing weight, increasing servings of daily fruits and vegetables, limiting salt, increasing physical activity and reducing alcohol intake.  The report does not recommend drug treatment for those with prehypertension unless required for another physical condition.  The guidelines state that for people diagnosed with high blood pressure, diuretics should be used as a first-line therapy, and if diuretics and lifestyle changes do not lower blood pressure, physicians should prescribe as many other drugs as needed to reduce blood pressure levels.

        In Maine, do you suppose that the cost of  treatment for the thousands of patients previously considered normal but now considered at risk will be considered a pass-through in the global budget proposed in the Dirigo Health Plan?  [return to top]

Not Too Late to Register for Annual Physician Survival Seminars
      If you hurry, there is still time to register for one of MMA's popular Annual Physician Survival Seminars offered this year in both Bangor (May 28th - so hurry on this one) and Portland (June 25th).

       In addition to the scheduled program, there will be a discussion on the major provisions affecting physicians in the Governor's Dirigo Health Plan.  You may register by phone for the Bangor program this week by calling Susan Feener on Tuesday, at 622-3374.  The program will be held from 8:30am to 4:00pm at Spectacular Event Center on Griffin Road. [return to top]

Upcoming County Medical Society Meetings in Aroostook, Cumberland and Washington Counties
    The Aroostook County Medical Society will meet this Wednesday (May 28th) evening at the Aroostook Country Club in Fort Fairfield.  Gordon Smith, EVP at MMA is the speaker.  Reception at 6:00pm, dinner at 7:00pm.  If you would like to attend and no arrangments have been made, call Dr. Chester Husted's office in Houlton, 532-9521.

     The Cumberland County Medical Society will meet this Thursday, May 29th at the Marriott in South Portland at 6:00pm.  Contact Carol Foster 772-6802.

      The Washington County Medical Society will meet on Wednesday eveing June 4th in Machias.  Contact Tom McHugh, M.D. at 427-3344.  Speakers are Kellie Miller, Executive DIrector of the Maine Osteopathic Association and Gordon Smith of MMA. [return to top]

Help Us with Price Disclosure Provision in Health Reform Bill
     Several bills earlier in the legislative session and the Governor's reform package indicate a strong interest in the Administration and the Legislature to educate patients and the medical community about the price and cost of medical services and prescription drugs.  Accordingly, it is clear that the final version of L.D. 1611 will require hospitals and individual health care practitioners to disclose to patients information about charges and payments received from third party payors.

          How should physicians be required to communicate this information?  What means would you consider the most effective but least intrusive?

                      +   By posting a "price list" of common services?

                       +   By requiring office staff to discuss financial information with patients before the physician-patient relationship is established?

                         +   Would you rather simply be required to inform all patients of the price for the service they are receiving or would you prefer to respond only to specific requests?

                 We need your feedback on this.  Please send any thoughts or suggestions that you may have to Gordon Smith at gsmith@mainemed.com or to Andrew MacLean@mainemed.com  THANKS! [return to top]

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