Medical Liability Reform Vote in U.S. Senate this week!
This week, the U.S. Senate is expected to move the debate on medical liability reform forward by voting on a Motion to Proceed. Passage of a Motion to Proceed would allow the Senate to vote on medical liability legislation and stop an anticipated filibuster by allies of the trial lawyers. Maine physicians need to be in contact with Senators Olympia Snowe and Susan Collins urging support for medical liability reform.
The Patients First Act of 2003, S. 11, sponsored by Sen. John Ensign (R-NV), imposes a flexi-cap of $250,000 on non-economic damages awarded in medical malpractice cases.  This cap would put an end to the multi-million dollar jury awards that are contributing to the skyrocketing cost of medical malpractice insurance.

Senator Collins and Senator Snowe are considered critical votes in this contentious debate.  You have seen both television ads and print ads (yesterday's in the Maine Sunday Telegram  apparently paid for by Joe Bornstein) asking Maine citizens to communicate with our Senators urging them to vote against medical liability reform.

Maine physicians should communicate with the Senators and urge them to support reasonable caps on liability.  While Maine has not felt the brunt of the med mal crisis, your rates are going up and Maine is not immune from the same forces affecting physicians in the rest of the country.  There is no question but that a federal cap on non-economic damages would have a very favorable impact on medical liability premium rates in Maine.

For more information, talking points and ways to communicate with our Senators, click here to access the Maine Medicine Political Pulse on this issue which was prepared on Thursday, July 3rd.

Maine Attorney General Settles Fee-Fixing Case with Maine Health Alliance
The Maine Attorney General's Office has settled State antitrust claims against the Maine Health Alliance, the Office announced in a press release late last week.  The State alleged that the Alliance and its members entered into impermissible collective pricing agreements and refused to deal with health care purchasers except on collectively agreed terms.

The Alliance had done its health plan contracting under what it believed to be legally permissible and common practices and to the extent the settlement changes what had previously been understood by health lawyers as acceptable practices, it could have a very significant impact on all providers in Maine.  As soon as more details are released, MMA will provide more direction and information to its members.

The Alliance is a network of eleven hospitals and approximately 325 physicians in five northern and eastern counties. It contracts with health insurers and self-funded employers to provide health services to their enrollees. It is one of the largest Physician-Hospital Organizations (PHO's) in the State.

The State alleged that the Alliance's joint contracting activities resulted in higher fees that the Alliance's physician and hospital members would otherwise have been able to negotiate, causing purchasers of health care services to pay more for health care.  The settlement, which has been approved by the Superior Court, contains an order designed to prevent recurrence of the concerted actions that the State believes violated antitrust laws.

While some collective actions are permissible where the joint activities of the providers have a real potential to increase quality of care and reduce cost,  and where the joint contracting appears reasonably necessary for the achievement of those benefits to patients and consumers, the state concluded that the Alliance activities did not meet the necessary legal threshold.  The state did, however, acknowledge that the Alliance had some commendable programs in place aimed at increasing quality of care, but went on to state that these programs did not require joint pricing to be successful.  The State also alleged that the Alliance and its members collectively agreed not to deal with payors except through the Alliance.

The Federal Trade Commission has reached a similar agreement with the Alliance and the lawyers and the staffs of the two agencies worked closely together on the case.

While not directly related to this settlement, recent pronouncements by the antitrust enforcement agencies have led to wide-spread speculation about the future also of the so-called "messenger model" of contracting.  It is now apparent that the authorities have begun interpreting the model differently than in the past and this change could also have enormous implications for provider contracting in Maine.  We will continue to bring to the attention of MMA members and staffs the latest thoughts on this important topic, both in this e-mail weekly publication and in the printed monthly version of Maine Medicine.

The Maine Health Alliance was established in 1995 Members include St. Joseph Hospital in Bangor and hospitals in Calais, Caribou, Machias, Houlton, Dover-Foxcroft, Millinocket, Bar Harbor, Fort Kent, Lincoln and Ellsworth. [return to top]

NHIC Names Craig E. Haug, M.D. Carrier Medical Director
National Heritage Insurance Company, the Medicare Part B Carrier for Maine, New Hampshire, Vermont and Massachusetts, has announced that Craig E. Haug, M.D. has accepted the position of NHIC New England's Carrier Medical Director.  The vacancy in the position was occasioned by the appointment of the previous Director Charlotte Yeh, M.D. to the position of Regional Administrator of CMS.

Dr. Haug received his undergraduate and medical education at Duke University.  After completing a combined surgery residency and transplantion biology fellowship at the University of  Colorado Health Sciences Center, he moved to Boston for a Transplant fellowship at the Massachusetts General Hospital.  He then practiced as Assistant Professor of Surgery at New England Medical Center, first in the Transplant Surgery Division, then as Chief of Surgery at the Lemuel Shattuck Hospital, an affiliate.  Elected President of the Medical Staff, Dr. Haug fostered a collaborative environment between physicians and administration.

Dr. Haug then joined InterQual (now part of McKesson) to lead clinical development of their Procedures and Imaging Criteria.  He was responsible for setting product direction, overseeing clinical content integrity among the team of physicians and nurses, and responding to questions from MCO medical directors.

Dr. Haug also has a long-standing interest in medical informatics.  As Chief of Surgery, he created a relational database for the operating room automating diagnosis, procedure, and physician code entry.  At McKesson, he  introduced and served as system administrator for a bibliographic database and organized the adoption of electronic consultant packets.

Dr. Haug and NHIC are committed to continuing the strong working relationship between the Medicare Program and the physician community supported by the CAC through New England.

Dr. Haug started his new position on July 1, 2003. [return to top]