July 28, 2003

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Medical Mutual Insurance Company of Maine Files for 8% Rate Increase, Effective Oct. 1, 2003
Earlier this month, Medical Mutual Insurance Company of Maine filed with the Maine Bureau of Insurance a request for an 8% increase in professional liability rates, effective Oct. 1, 2003. The proposed increase, which the Bureau now has the opportunity to examine, is across the board, affecting all classes of insureds. While no increase would be preferable, a single digit increase in Maine in the face of the growing crisis in many states is continued testament to the success of Maine's previously enacted tort reforms and the the success of the company's loss prevention programs.
     The modest 8% increase is in stark contrast to the alarming double digit increases in many states, including several states even in New England.  "While we would prefer no increase at all, " said Gordon Smith, Executive Vice President of the Maine Medical Association,  "we recognize that the trends in claims severity warrant an increase and we are pleased that the proposed increase is in single digits."

      Maine's three previous initiatives in tort reform in medical liability cases appear to be the major factor in Maine's liability climate not being in the same poor condition as many other states.  Reforms in  the late 70's, the mid 80's and the early 90's have all contributed to a stable situation. The changes in the statute of limitations and the establishment of the prelitigation screening panels in 1987, have been particularly helpful.

      Smith also noted that the language authorized by the Maine Legislature in the Dirigo Health bill (Part E, Sec. E-22) calling upon the Superintendent of Insurance to prepare a report, by Jan. 1, 2005, regarding medical malpractice lawsuits, damage awards for noneconomic damages in those lawsuits and the cost and availability of medical malpractice insurance in the state should be helpful.  At a minimum, the report must address the impact on the cost of malpractice insurance of a cap on noneconomic damages of $250,000 in medical malpractice cases.

     Medical Mutual Insurance Co. of Maine is a physician mutual company, domiciled in Maine, and is the endorsed carrier of professional liability insurance for members of the Maine Medical Association.

U.S. House Passes Bill to Permit Cross-Border Drug Importation
The U.S. House on Friday, July 25th, approved legislation allowing prescription drugs to be purchased by U.S citizens in other countries at prices lower than those offered in the U.S.   Maine Congressman Tom Allen has been a leading proponent of the legislation which passed 243 to 186.  The bill would allow individuals, pharmacies, and whole-salers to "re-import" US-made drugs from 25 countries, including Canada.  A Senate version of the Medicare Reform bill would allow drug reimportation only from Canada.  The Senate measure would also require that the health and human services secretary first certify that the drugs are safe and that consumers would save money.  In the past, both Democratic and Republican HHS Secretaries have refused to make such certifications.

Before becoming law, the proposal would need to be passed in the Senate or reconciled with the Senate version of the bill in the pending Medicare Reform bill.  Drug manufacturers, the FDA and the American Medical Association have opposed the bill on the grounds that efficacy and safety of the drugs could be compromised. Fifty-three senators have signed a letter opposing the House bill.  Neither Senator Olympia Snowe nor Susan Collins signed onto the letter and both have expressed publicly the need for seniors and others to have access to lower cost pharmaceuticals.

On Friday, the Canadian government and retail pharmacy representatives defended their system of ensuring drug safety, noting that the Canadian system has a very similar approach to that of the U.S. in terms of the approval of clinical trials, the approval process for drugs and the monitoring of the import and export of drugs.  Health Canada, the nation's healthcare agency, is charged with oversight of packaging, labeling, and distribution of prescription drugs.  The rules apply to most drugs, including all drugs shipped to Canada by U.S. manufacturers and then exported to the United States by Canadian pharmacies and Internet mail-order houses.

The AMA's full statement on the bill can be read at: http://www.ama-assn.org/ama/pub/article/1616-7901.html

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AMA Applauds Passage of Patient Safety Bill in Senate Committee
Last week the Senate Committee on Health, Education, Labor and Pensions approved the bipartisan Patient Safety and Quality Improvement Act which establishes a system for reporting and analyzing health care errors to improve patient safety and health care quality.

"This bill will prevent health system errors by transforming the existing culture of blame, which suppresses information about errors, into a culture of safety, which focuses on sharing information in order to prevent future errors," said AMA President Donald J. Palmisano, MD, JD.  The unanimous Committee vote on July 22nd allows the bill to move to the full Senate for vote.  A similar bill (H.R. 663) passed the House of Representatives in March.

"When physicians can report errors in a voluntary and confidential manner, everyone benefits.  Future errors can be prevented as we learn from past mistakes," Dr. Palmisano noted.  "This legislation strikes the proper balance between confidentiality and the need to ensure accountability throughout the health care system.  Patient Safety Organizations (PSOs) would analyze problems, identify solutions and provide feedback to avoid future errors."

The AMA went on to commend Sens. Gregg and Kennedy for working together for unanimous, bi-partisan approval of the bill. [return to top]

Positive Response to Rx Cares for ME
The Rx Cares for ME website and toll-free number received over 13,000 inquiries within the first 36 hours of operation.  The program was launched at a press conference held on July 22 at the Iris Network in Portland.  The intent of the program is to create a one-stop shop for Mainers to access prescription drugs at reduced cost or free.  The service is the result of Senator Olympia Snowe and Congressman Michael Michaud working with the Pharmaceutical Research and Manufacturers of America (PhRMA) to better publicize and make available the many free drug programs provided by manufacturers and others.

Over 325 assistance programs can be accesses from the web site and toll-free number and more than 1,400 different medications are available to those who qualify.  The program is free and confidential and is sponsored by a number of healthcare organizations in Maine including the Iris Network.  The website is www.RxCaresForME.org, and the toll-free number is 1-877-Rx-For-ME (1-877-793-6763). [return to top]

House-Senate Conference Agrees on Physician Regulatory Relief
Conferees have begun working to reconcile differences in the House and Senate Medicare bills.  The first issue taken up involves one of long-standing interest to physicians:  Regulatory relief. 

On July 25th, conferees announced that they had reached agreement on the regulatory relief provisions.  Conference Chair Representative Bill Thomas (R-CA) said,"Physicians are spending too much time struggling with paperwork and not enough time on patient care."

While exact details of the language to be included in the final conference report is not yet known, the agreement reached by the Conferees will;

     l.  Limit the use of the process of extrapolation to only those cases where there is a sustained or high payment error rate or documented education efforts have failed.

     2.  Eliminate penalties and interest for physicians faced with alleged overpayments who have relied on written guidance from Medicare.

     3.  Educate physicians about incorrect billing practices and allow an opportunity to correct errors before repayment demands are made.

      4.  Delay repayment demands until physician appeals have been considered.

       5.  Offer physicians installment plans for repayment instead of withholding payment of their claim.

        6.  Ensure that any new documentation guidelines for evaluation and management codes are thoroughly pilot tested before they can be implemented as national policy.

        7.  Prohibit retroactive application of Medicare rules.

         8.  Require carriers to provide physicians with clear, concise, and accurate answers to their billing questions.

          9.  Ensure that prepayment reviews are terminated in a timely manner instead of continuing endlessly.

          10.  Give physicians the right to appeal if their application for a Medicare billing number is denied.

           11.  Ensure that services furnished under the prudent layperson standard and according to EMTALA requirements are covered by Medicare.

Staff and Members of Congress will be working throughout the August recess in an attempt to resolve the other numerous issues that are still in dispute between the House and Senate bills.  Staff will be doing the bulk of the work, but Members are expected to be available during August as their input and approval is needed.  The schedule for Conferees this week includes work on the prescription drug card provisions.  Members are expected to resolve outstanding issues by Sept. 13th.

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Number of Caesarean Sections Requested by Patients Coming Down in Maine
A new study released this past week showed Maine as one of only two states with a drop in "patient-choice" C-sections.  Between 1999 and 2001, the incidence of first -time, "patient-choice" C-sections dropped nearly 10% in Maine.  During the period, 502 of the 34,715 women who delivered babies in Maine had a C-section without a medical reason.  The number would have been 538 if the previous year's rate had not changed. [return to top]

Busy Week at Maine Medical Association
It will be a busy week at the Maine Medical Association with meetings of the Executive Committee, the Committee on Peer Review and Quality Improvement and the Payor Liaison Committee.  Conference calls are scheduled for the MMA Steering Committee and the Budget and Investment Committee.    The meetings are scheduled as follows:

Steering Committee (via conference call)     Monday evening, 9:00pm

Budget and Investment Committee (via conference call)  Tuesday evening, 8:30pm

Executive Committee meeting:         Wednesday afternoon; 2:00pm

Peer Review and Quality Improvement Committee  Wednesday evening;, 5:30pm

Payor Liaison Committee  Wednesday evening, 6:15pm

All meetings will be held at the Frank O. Stred Building in Manchester. [return to top]

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