June 2, 2003

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Negotiations on Governor's Dirigo Health Produce Compromise
An intense week of negotiations on the Governor's Dirigo Health Plan among the Governor's staff, MMA, the Maine Osteopathic Association, the Maine Hospital Association and the Maine Association of Health Plans culminated in a tentative agreement on Thursday, May 29th.
     As you may recall, the Legislature's Joint Select Committee on Health Care Reform had sent the Governor's staff to negotiate with the three principal opponents of the plan (physicians, hospitals and insurers) before the Memorial Day Weekend.  MMA and MOA staff and representatives of the state's 17 ambulatory surgical facilities began negotiations at 7:00am Tuesday,  May 27th and significant progress was made by day's end.  On Wednesday and Thursday, the MMA and MOA joined the other two stakeholder groups to review and approve compromise language offered by the Governor's office. 

     By Thursday afternoon, the group had reached consensus on the outline of the Governor's proposed compromise and physician, hospital and insurer representatives joined GOHPF Director Trish Riley in presenting the outline to the Committee.  The three groups also attended the Governor's announcement of the compromise at a press conference in the Cabinet Room on Friday.

     Like all compromises, there are aspects of the proposal that MMA would oppose if contained in a single bill.  But the opportunity to go forward with the Governor, the Legislature and other interested parties in an innovative attempt to provide many of Maine's uninsured citizens with health insurance was a sufficient impetus to compromise on those aspects of the bill that we originally opposed, once the Governor indicated a real interest in negotiating acceptable language.

     For physicians, the principle concessions made by the Governor's office are;

                      l.  Restoration of the MaineCare Physician Incentive Program and a commitment to work on increasing MineCare reimbursement rates for all physicians.

                       2. Restoration of the exemption in the CON law for physician's offices and the division of the annual CON capital investment fund into a hospital and non-hospital pool.

                        3.  Establishment of an inflation adjustment each year in the dollar thresholds for CON review.

                          4.  Changes in the language in the bill easing the administrative burden associated with price disclosure, electronic billing and collection of quality data.

                           5.  Acknowledgment that the 3% voluntary 'price' cap for physicians would apply only to net revenue.

                            6.  Elimination of  a global budget for Maine's hospitals, and elimination of that portion of the legislation calling for creation of a plan for the future of Maine's hospitals.

     While this compromise is likely to survive and be enacted, several groups have announced concerns about one or more portions of the compromise.  Foremost among these are business groups opposing the 4% assessment on current premiums (which the compromise permits to be passed on to subscribers) and consumer groups who believe the Governor sacrificed too much of the cost contaiment element in the negotiations.  Many Republican legislators also continue to oppose the legislation, for a variety of reasons.  But whether any of this opposition,  in the face of the lukewarm support of proponents, will be sufficient to actually threaten the bill's passage is anyone's guess at this point.

      The three groups will now work with the Governor's staff and the Health Care Reform Committee to develop amendment language to implement the compromise.  We begin with a drafting session at 9:00am on Monday morning.  The Legislative Committee will return to work on the bill on Tuesday, after adjournment of the morning legislative session.

       For a more detailed analysis of the compromise, including the concessions made to the hospitals and insurers, see the most recent  Maine Medicine Political Pulse.

Urge Health Care Reform Committee to Support Fund for a Healthy Maine
     While progress has obviously been made on the Dirigo Health Plan aspect of the Governor's health care reform package, significant work remains on L.D. 1612 which calls for a Constitutional Amendment to protect the Fund for as Healthy Maine.  The Committee will hold a work session on the bill on Monday afternoon, June 2nd.  Talking points for legislators appear in the Association's Political Pulse available at the following link. [return to top]

Ban on Smoking in Bars Headed for Floor Debate
     This week, the House and Senate are expected to vote on L.D. 1346 An Act to Protect Workers from Secondhand Smoke and to Promote Worker Safety.  This bill would extend the current clean indoor air act to bars and taverns.  While the bill received a strong 12-1 "ought to pass" recommendation from the HHS Committee, the bill is expected to be heavily debated.

     Maine would follow the lead of California, New York  and Delaware in enacting this progressive legislation.  Please consider calling your legislators and urging a vote for this attempt to protect bar employees from the risks of second-hand smoke. [return to top]

AETNA Settlement with Physicians Receives Preliminary Approval
     An agreement valued at up to $470 million, which would settle class action claims brought by medical associations and 700,000 physicians against Aetna, Inc., gained preliminary approval from a federal judge in Florida on May 29th. (In re Managed Care Litigation, S.D. Fla., Multi-District Litigation No. 1334.)  The agreement, entered into on May 21st, 2003, includes improvements to business practices, claims payments and includes establishment of a National Advisory Committee of Practicing Physicians to provide advice to Aetna on issues of significance to physicians.

      U.S. DIstrict Court Judge Federico Moreno granted preliminary approval of the settlement agreement on May 29th and set Oct. 13th as the date for the hearing on final judicial approval.  Other important deadlines established by the Court include an August 29th deadline for 'opt-out' determinations and a Sept. 12, 2003 deadline for all objections.

     The settlement comes in resonse to a lawsuit filed to combat widespread and chronic abuses by some of the nation's largest for-profit health plans.  The agreement calls for Aetna to pay physicians $100 million, to pay $20 million to establish an independent foundation for studying critical health care issues, to pay up to $50 million in attorneys' fees and to undertake significant business practice commitments worth an estimated $300 million to the settling physicians.

     The proposed settlement does not address the remaining claims against six other plans, including Anthem, Inc., who, with the exception of CIGNA, vowed to continue a vigorous fight against the claims.  Cigna had agreed to a previous settlement which was opposed by many of the plaintiffs in the multi-district litigation.  Cigna is attempting to gain approval of its proposed settlement through court-ordered mediation.  A hearing on the status of those negotiations is scheduled for June 10, also before Judge Moreno.

      The Maine Medical Association voted in December to participate in the class action suits in order to ensure that the concerns of Maine physicians were addressed in any possible settlement.  Unfortunately, we have not been able to come to an agreement with the plaintiff attorneys on acceptable language in the contingent fee retainer agreement, although discussions continue.  All physicians who treated a patient insured by Aetna are considered part of the class of plaintiffs, unless a physician choses to 'opt out' of the agreement, regardless of whether MMA directly participates.

       For additional information concerning the HMO litigation, visit www.hmocrisis.com.  That site includes a complete copy of the settlement agreement as well as the joint press release announcing the settlement on May 21, 2003. [return to top]

Maine Chapter, American College of Surgeons Meet in Northeast Harbor
      Nearly fifty Maine surgeons and their guests met this past weekend in Northeast Harbor for the Chapter's Annual Scientific Meeting.  Preceded by a Practice Management Seminar on Friday, attendees were welcomed late Friday afternoon by Chapter President Fred Radke, M.D., FACS and then were presented over the next two days with a dozen clinical presentations on topics ranging from breast imaging to the genetics of obesity.  Other topics included interval appendectomy for complex appendicitis, laparoscopic gastric bypass, laparoscopic band procedure for obesity and ovarian cancer.  Presentations were also made on LifeFlight of Maine, crash mechanics and on "Building Teams in the OR."

     At the Annual Banquet, psychiatrist Linda Austin, host of Maine Public Radio's, "What's on Your Mind" spoke on the topic of  "Love and Stress in Medical Marriages."

      Congratulations to the Chapter on a successful meeting and a successful year.  The in-coming President of the Chapter is William Horner, M.D., FACS, who practices in Bangor. [return to top]

Federal Senate and House Panels Preparing Prescription Drug Bills
      Returning from congressional recess, federal lawmakers are faced with attempting a Medicare reform bill, including a prescription drug benefit, before the next recess scheduled to begin on June 27th.

      In the Senate, leadership is expecting the Senate Finance Committee, which includes Maine's Senator Olympia Snowe, to discuss the issue this coming week and to mark up a bill the week of June 9th.  The bill cold then be debated on the floor the last two weeks of June.  The House is following a similar schedule with both the Energy and Commerce and Ways and Means committees working on parallel tracks.

      Majority Leader Frist is working on a bill that closely follows the plan developed last year by Senator Snowe and a group of bi-partisan Senators.  Actually the group was Tri-partisan as Senator Jeffords was involved, as well.  However, the plan is said to also include some elements of the President's plan that calls for incentives for seniors to leave  traditional fee-for-service care.

      The prospects for passage of any reform that might need 60 votes to overcome a Democratic filibuster would have to beconsidered slim. [return to top]

You are Invited to The First Annual Dan Hanley Leadership Forum Luncheon
One of Maine's most respected physician leaders, Dan Hanley, M.D. (1916-2001) stood for innovation, collaboration and courage.  Plan to join health care leaders and others from across the state to recognize Dr. Hanley's legacy at the presentation of the first annual Dan Hanley Leadership Award.  The Award will be presented at a luncheon at Bowdoin College at noon on Friday, June 20th, 2003. 

The luncheon will also feature a presentation by Gerald O'Connor, Ph.D., D.Sc., a colleague of Dr. Hanley's who groundbreaking use of data in recent years has led to significant improvements in health care delivery and medical outcomes throughout New England and across the nation. Dr. O'Connor  currently serves as Professor of Medicine and of Community and Family Medicine at Dartmouth Medical School and as Research Director of the Northern New England Cardiovascular Disease Study Group.  Today, as Maine considers new ways to address health care cost, quality and access issues,  there is much to learn from the values and approaches which Dr. O'Connor brings to leading change and which were so important to Dan Hanley.  The luncheon is sponsored by the Dan F. Hanley Memorial Trust, of which MMA is a supporter.

Cost of the luncheon is $25 and registrations need to be received by June 6th.  You may receive further information at www.hanleytrust.org.  Or you may simply send your check and registration to the Maine Health Information Center, P.O. Box 360, Manchester, Maine 04351.  The check should be made payable to the Dan Hanley Memorial Trust.

Dr. Hanley served as Executive Director of the Maine Medical Association for nearly 25 years, until retiring in l979.  He went on to direct the Maine Medical Assessment Foundation and remained involved in several other medical organizations that he had played a major role in creating, including Medical Mutual Insurance Co. of Maine and The Maine Health Information Center until his death in 2001. [return to top]

CMS Proposes New Enrollment Policy for Medicare
The Centers for Medicare and Medicaid Services has proposed a new enrollment policy that will require health care providers to re-enroll in Medicare every three years.

The proposed new process would take an average of eight hours to complete and is in response to what HHS Secretary Tommy Thompson refers to as the need to simplify requirements and to continue to ensure that only qualified providers and suppliers provide services to Medicare beneficiaries.  If you don't think that eight hours every three years is going to make enrollment easier, you are invited to respond to the CMS proposal which was published in the April 24th Federal Register. Responses need to be received within 60 days of the publication.  You may find the policy also at: www.access.gpo.gov/su_docs/fedreg/a030425c.html.  Go to CMS and then to Medicare Billing Privileges. [return to top]

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