U.S. Senate Blocks President's Plan to Cap Non-economic Damages
On July 9th, the U.S. Senate, on a vote of 49 to 48, failed to proceed on S. 11 which would limit damages in medical malpractice cases to $250,000 and institute other necessary reforms. The 49 votes, which included Maine Senators Olympia Snowe and Susan Collins, was 11 votes shy of the 60 votes needed to invoke cloture and cut off debate, in the face of the democrat's threat to filibuster.
       In the procedural vote, two Republicans, Senator Lindsay Graham of South Carolina and Senator Richard Shelby of Alabama joined the democrats in  voting against the motion to proceed.  No democrats voted for the measure.  Maine physicians should thank Senators Snowe and Collins for their support.

     While the ultimate result is disappointing, 49 votes is the most support that has ever been achieved in the Senate on a medical malpractice reform bill and physicians can now say with confidence that a majority of the U.S. House, the U.S. Senate and the President of the United States all support reform of the medical liability system.  Unfortunately, the archaic rules of the Senate allowing for a filibuster requiring 60 votes to invoke cloture have denied this needed reform at this time.  Majority Leader and Doctor William Frist has indicated that he intends to have another vote on the legislation, perhaps as early as this Fall. 

     Republicans are now using the medical liability debate to emphasize voters' concerns about rising health care costs, particularly in states like Pennsylvania, Nevada, Florida and West Virginia, where is problem is acute.  While Maine's medical liability climate is relatively stable, we are not immune from the same trends that affect the rest of the nation, notes Gordon Smith, Esq., of the Maine Medical Association.  "We are very fortunate that the three phases of liability reform and the establishment of a physician- mutual insurance company have served Maine physicians well," said Smith following the Senate vote,  "but we must not be complacent."  "Particularly, our prelitigation screening panels and short statute of limitations seem to be helping to distinguish our situation from that in the so-called crisis states," he noted.

Physicians Sought for Dirigo Health Appointments
       The Maine Medical Association and no doubt, many other health-related organizations, has received a communication from Governor Baldacci dated June 25th asking for input into the make-up of the new health organizations established in the Dirigo Health legislation.  Although the Dirigo Health law does not take effect until September, the administration has already begun its search for individuals to nominate to serve on the following bodies:

1. Dirigo Health Board of Directors
2. Maine Quality Forum Advisory Committee
3. Advisory Council on Health System Development
4. Commission to Study Maine's Hospitals
5. Task Force on Veterans' Health Services

     The Maine Quality Forum Advisory Council, the Commission to Study Maine's Hospitals and the Task Force on Veterans'  Health Services all require at least two physicians and physicians are not precluded from serving on the Dirigo Health Board of Directors or the Advisory Council on Health System Development.   However, in the case of the five voting members of the Board, the physician could not be practicing or otherwise have an affiliation with a health or health-related organization.

     A fuller description of each vacancy and nomination forms are below.  Nominations must be filed by July 30th.  Some of the boards require a list of physicians to be submitted by the Maine Medical Association and the Maine Osteopathic Association.  MMA's Executive Committee will meet on July 30th to consider nominations for such lists.  In the case of the Quality Forum Advisory Council, the three physician members must represent allopathic physicians, osteopathic physicians, primary care physicians and specialist physicians.  MMA staff will meet with MOA staff on July 22nd to begin work on the lists.

     Physicians interested in an appointment to one of the boards and wishing to be on the MMA and MOA list of submitted nominations should send a CV to the attention of Gordon Smith at MMA.  E-mail address is gsmith@mainemed.com.  Regular mail is P.O. Box 190, Manchester, Maine 04351.  Questions may be directed to Mr. Smith or Andrew MacLean, MMA's Director of Governmental Affairs (amaclean@mainemed.com).

List of Boards and Commissions

Dirigo Health Board of Directors Qualifications – 5 persons needed

            A.  Must have knowledge of and experience in one or more of the following areas:

                        (1)  Health care purchasing;

                        (2)  Health insurance;

                        (3)  MaineCare;

(4)  Health policy and law;

(5)  State management and budget; or

(6)  Health care financing; and

            B.  Except as provided in this paragraph, may not be:

(1)  A representative or employee of an insurance carrier authorized to do business in Maine;

(2)  A representative or employee of a health care provider operating in Maine; or

(3) Affiliated with a health or health-related organization regulated by State 

Government.

A nonpracticing health care practitioner, retired or former health care administrator or 

retired or former employee of a health insurance carrier is not prohibited from being considered for board membership as long as that person is not currently affiliated with a 

health or health-related organization.

            Key Duties.  Establish and administer Dirigo Health; hire executive director; collect savings offset payments; develop benefit and subsidies; and, establish and operate the Maine Quality Forum.

Maine Quality Forum Advisory Council – 17 persons needed

A.  Seven members representing providers, including 3 physicians, one registered nurse, one representative of hospitals, one mental health provider and one health care practitioner who is not a physician.  The 3 physician members must represent allopathic physicians, osteopathic physicians, primary care physicians and specialist physicians;

B.  Four members representing consumers, including one employee who receives health care through a commercially insured product, one representative of organized labor, one representative of a consumer health advocacy group and one representative of the uninsured or MaineCare recipients;

C.  Four members representing employers, including one member of the State Employee Health Commission, one representative of a private employer with more than 1,000 full-time equivalent employees, one representative of a private employer with 50 to 1,000 full-time employees and one representative of a private employer with fewer than 50 employees;

D.  One representative of a private health plan; and

E.      One representative of the MaineCare program.

Key Duties.   Guides the research and dissemination, quality performance measurers, data coordination and public reporting of data; consumer education and technology assessment; convene provider advisory group.

Advisory Council on Health System Development – 11 persons needed

A.  Two individuals with expertise in health care delivery;

B.  One individual with expertise in long-term care;

C.  One individual with expertise in mental health;

D.  One individual with expertise in public health care financing;

E.  One individual with expertise in private health care financing;

F.  One individual with expertise in health care quality;

G.  One individual with expertise in public health;

H.  Two representatives of consumers; and

I.  One representative of the Department of Human Services, Bureau of Health program that works collaboratively with other organizations to improve the health of the citizens of this State.

Key Duties.  To guide the Governor's Office in establishing the state health plan and capital investment fund; conducting hearings; synthesizing data and research.

Commission to Study Maine's Hospitals – 9 persons needed

A.  Two persons representing community hospitals chosen from a list submitted by a statewide association representing hospitals;

B.  One person representing consumers of health care services;

C.  Two persons representing physicians chosen from lists submitted by statewide associations representing allopathic and osteopathic physicians;

D.  One person representing employers;

E. One person representing insurers or other 3rd-party payors of health care services;

F.  One economist familiar with econometric modeling of health care systems and the analysis and forecasting of health care costs; and

G.  One person who has expertise in public health issues.

Key Duties.  To conduct a report on a comprehensive analysis of hospital costs, roles, reimbursement, capital needs, and opportunities to make policy recommendations.

Task Force on Veterans’ Health Services – 13 persons needed

A. One member of the Senate appointed by the President of the Senate;

B.  One member of the House of Representatives appointed by the Speaker of the House of the Representatives;

C. Nine members appointed by the Governor:

(1)  Three members who are military veterans, including one military veteran representing the Maine Veterans Coordinating Committee, one military veteran representing the Department of Defense, Veterans and Emergency Management Services, Bureau of Maine Veterans' Services and one military veteran representing the Maine Veterans' Homes;

(2)  Two members representing state agencies that provide health care services; and

(3)  Four members representing health care providers, including one allopathic physician, one osteopathic physician, one representative of hospitals and one provider of mental health services;

D.  A representative of the federal Department of Veterans Affairs; and

E.  The Director of Maine Veterans' Homes or the director's designee.

Key Duties.  Analyze and assess health services to veterans and make recommendations to more effectively organize those services.

The Coding Center to Offer Fall Courses
The Coding Center, established by MMA and the state medical societies in Vermont and New Hampshire, will offer two AAPC Approved Professional Medical Coding Courses in the Fall.  This 16-week course, developed by the American Academy of Professional Coders (AAPC), will take students through the 2003 Current Procedural Terminology (CPT), International Classification of Disease (ICD-9), and HCPCS books to address proper use and proper coding. The course is intended to educate students on proper techniques and rules of coding and prepares students to sit for the AAPC Certified Procedural Coder (CPC) exam. 

Instructors for the course are Laurie Desjardins, CPC and Jana Purrell, CPC.  One course will be offered on Wednesdays starting Sept. 3rd from 3:00 p.m. to 7:00 p.m. at the offices of Primecare in Biddeford.  The second course will be held at the Maine Medical Association in Manchester on Thursdays starting Sept. 4th, also from 3:00p.m. to 7:00p.m.   The Thursday course will be available also in Bangor via videoconferencing to the offices of the Maine Health Alliance.

The cost for the course is $1895 which includes student workbooks, a one-year membership in the AAPC and the cost of the CPC exam.  Registration materials are available from Charyl Smith at MMA (csmith@mainemed.com or 622-3374.  Class size is limited so persons interested should contact Charyl as soon as possible. [return to top]

Resolutions Sought for MMA Annual Meeting
     The Maine Medical Association's 150th Annual Meeting will be held Sept. 5th through 7th at the Balsam's Grand Resort Hotel in Dixville Notch, N.H.  Any MMA member may submit a Resolution to the Annual Meeting, which would be considered at the Association's Business Meeting on Saturday morning, Sept. 6th (9:00a.m.).  MMA Committees may also submit Resolutions.  Resolutions should be submitted to the MMA Office by July 30th for inclusion in the material for the meeting.  However, late Resolutions can be considered upon a favorable vote of two-thirds of the members voting at the meeting.

     Is there some issue worrying you?  Have you and your colleagues discussed a situation you wish you could take action to correct?  Submit a Resolution to request support from MMA.  If you need assistance drafting your resolution, both Andy MacLean and Gordon Smith at MMA are available to assist you. (amaclean@mainemed.com, gsmith@mainemed.com ) [return to top]

Medicare Prescription Drug Conferees to be Finalized Today
Today, Speaker of the House J. Dennis Hastert (R-Ill.) is expected to nominate House members to the conference committee that will attempt to resolve the conflicts in the House and Senate Medicare prescription drug bills (H.R. 1, S. 1).  S. 1 passed by a vote of 76-21 in the Senate, but the House bill passed by a slim margin 216-215.  These pieces of legislation also contain the physician Medicare fee "fix" that would prevent the anticipated 4.1% reduction in Medicare fees in January 2004 and contain the improvements for Maine physicians in the geographical disparities in Medicare reimbursement.

Agreement between the House and Senate on a final compromise bill is far from certain and the magnitude of the task has already delayed the expected completion of the work to September or later, rather than late July, as the White House had hoped.  While the major stumbling block involves the different philosophies regarding how to structure the Medicare prescription drug benefit, the other issues to be resolved are contentious as well.  As one prominent Senator has noted, now that people have read the 700-plus pages of the House bill and the 1,000 pages in the Senate bill, they are beginning to understand just how many technical issues there are to be resolved, in addition to the political and philosophical issues.  Maine physicians should follow the work with interest and communicate to all four members of Maine's congressional delegation that progress needs to be made in these important areas, and that the flawed fee formula based upon sustainable growth rate must be fixed.  A drug benefit for seniors will be of no value if there are not physicians to write the prescriptions!

The Senate conferees are:

• Senate Majority Leader Bill Frist (R-Tenn.)
• Senate Minority Leader Tom Daschle (D-S.D.)
• Senate Finance Committee Chairman Charles Grassley (R-Iowa)
• Ranking finance Committee member Sen. Max Baucus (D-Mont.)
• Sen. Orrin Hatch, (R-Utah)
• Sen. Don Nickles (R-Okla.)
• Sen. Jon Kyl (R-Ariz.)
• Sen. John D. Rockefeller IV (D-W.Va.)
• Sen. John Breaux (D-La.)

The House members are expected to be:

• Ways & Means Committee Chairman Bill Thomas (R-Calif.)
• Energy & Commerce Committee Chairman Billy Tauzin (R-La.)
• Rep. Nancy Johnson (R-Conn.)
• Rep. Michael Bilirakis (R-Fla.)
• House Majority Leader Tom DeLay (R-Texas)
• Ranking Ways & Means member Rep. Charles Rangel (D-N.Y.)
• Ranking Energy & Commerce member Rep. John Dingell (D-Mich.)

and

• Pete Stark (D-Calif.) or Sherrod Brown (D-Ohio)

Tort Reform Efforts by "Common Good"
MMA would like to alert you to efforts being made by Common Good, a new bi-partisan coalition addressing tort reform issues.  Common Good is seeking reforms that will make the legal system reliable and thereby reduce the fear of litigation that is immobilizing so many common institutions.  On March 2, 2003, in the New York Times, 70 leaders of health care organized by Common Good petitioned Congress by calling for an entirely new system of medical justice.

MMA encourages you to visit Common Good's website at http://cgood.org to read the petition and add your name electronically.  Krishna Bhatta, M.D., as President of the MMA will appear on a list of supporters in another newspaper ad to run shortly.

In adding your name to the petition, you will be joining a distinguished group of doctors, medical professionals, and leading citizens who are supporting this effort.  Signatories include Troyen Brennan and Don Berwick of Harvard, Bill Brody of Johns Hopkins, Herb Pardes of New York-Presbyterian, Michael Woods of the Mayo Clinic, Charles Hammond, President, American College of Obstetricians & Gynecologists, and James C. Martin, President, American Academy of Family Physicians.

Other supporters of Common Good's efforts include former attorneys general Griffin Bell and Dick Thornburgh, Chris DeMuth of AEI, Bob Litan of Brookings, and many others.

MMA also encourages you to share this website with your patients and others and to urge them to add their names to this important effort. [return to top]

MMA Announces Preferred Supplier Program with Boise Office Solutions
The Maine Medical Association in conjunction with Boise Office Solutions is proud to announce a preferred supplier program offered exclusively to MMA members.  MMA members and their staffs may purchase office supplies from the Boise Office Products Catalog and receive an additional 10% off the lowest listed price.  Boise also offers FREE delivery with next-day service to most areas in Maine.  You may order by phone or on-line.  Boise also guarantees the lowest price, so if you can find a lower price, they will match it.

To activate your account and to receive your first catalog, simply contact our sales representative:  Rhonda Williams, Boise Office Solutions, Tel. 1-800-244-9750 x 776 or e-mail Rhonda at rhondawilliams@boiseoffice.com.

Maine Medical Association is proud to offer this money-saving program to its members as a value added benefit of membership.  Start enjoying your buying power today with BOISE. [return to top]

RFP for MaineCare Mail Order Drug Program Raises Quality Issues
On June 4, 2003, DHS issued a RFP for the MaineCare Mail Order Drug Program in which the Department seeks to consolidate injectable and high cost prescription drugs to one single-source mail order pharmacy provider.  MMA has joined a coalition of stakeholders concerned about the impact of this program on patient care.

Several disease states, such as those outlined below, require disease management expertise and specialty pharmacy support in order to achieve successful treatment outcomes. 

• Home Infusion
• Hepatitis
• IVIG
• RSV
• Oncology
• Growth Hormone
• Endometriosis
• Multiple Sclerosis
• Endocrinology
• Infectious Disease
• Transplants
• Gaucher Disease
• Hemophilia
• Wound Healing
• Pain Management

These patients require an intense level of medical care, including hands-on support, ongoing monitoring for drug compliance and adverse reactions, education and training, and coordination with prescribers, as well as timely and accurate handling and delivery of medications.  A mail order pharmacy simply cannot provide the level of service, expert pharmacy care, and personalized patient care required for this population of chronically ill patients.

MMA encourages you to communicate with Governor  Baldacci about the changes to the mail order pharmacy program.

Governor John E. Baldacci, State House Station 1, Augusta, Maine 04333-0001, 287-3531, governor@maine.gov.

The coalition is asking for the following:

• To delay implementation of the MaineCare Mail Order Drug Program changes;
• With a team of medical and pharmacy experts and the Administration, carefully and thoroughly assess the value of disease state management and its impact on clinical outcomes;
• Review currently available treatment outcomes data to quantify the potential cost increases if this program is implemented as well as the deterioration of patient care;
• Identify alternative means of managing costs more effectively without risking patient lives; and
• Carve out those drugs prescribed in certain disease states where we currently know that mail order pharmacy would not only negatively impact patient care, but also would increase costs beyond the anticipated savings because of poor treatment outcomes.