Anthem and WellPoint to Merge
Anthem, Inc. and WellPoint Health Networks Inc. announced on Monday that they have signed a definitive merger agreement that will create the nation's leading health benefits company. The combined company will serve nearly 26 million medical members. No immediate changes are expected in the way Anthem Blue Cross and Blue Shield of Maine does business.
Under the terms of the agreement, which is expected to close by mid-2004, WellPoint's shareholders will receive $23.80 in cash and one share of Anthem common stock per  WellPoint share.  The total value of the transaction is approximately $16.4 billion on Anthem's October 24, 2003 closing stock price.

The combined company's name will be WellPoint, Inc. and the corporate headquarters will be located in Indianapolis, Indiana.  After the closing, the Board of Directors of the combined company will include 12 members from Anthem's Board and 8 members from WellPoint's Board.  Leonard Schaeffer will serve as Chairman of the Board and Larry Glasscock will be President and Chief Executive Officer.

In a lengthy conference call with the investor community on Monday morning, company leaders kept emphasizing the financial strength of the companies and the synergies that the merger can bring to the two organizations.  At least $50 million pre-tax synergies are expected to be realized in 2004 and approximately $175 million in 2005, with annual pre-tax synergies of at least $250 million expected to be fully realized on an annual basis by 2006.

Anthem Blue Cross Blue Shield of Maine will continue to operate in Maine under its current brand name.  Officials in South Portland informed MMA representatives Monday afternoon that no personnel changes are planned in Maine, at least in the short term.

Anthem is the Blue Cross and Blue Shield licensee for Indiana, Kentucky, Connecticut, New Hampshire, Maine, Colorado, Nevada and Virginia.  WellPoint operates through Blue Cross of California, Blue Cross and Blue Shield of Georgia, Blue Cross and Blue Shield of Missouri, Blue Cross and Blue Shield United of Wisconsin, HealthLink and UNICARE.

Not all observers were happy to hear of the proposed merger.  The American Medical Association (AMA) announced that it was alarmed about the announced merger, stating that it would create a giant company seen in an industry where competition has already been drastically reduced.  The entire AMA statement , which urged that the merger be scrutinized by regulators to ensure that it is in the best interest of patients, can be viewed at http://www.ama-assn.org/ama/pub/article/1617-8128.html.

Upon hearing of the proposed merger, MMA President Maroulla Gleaton, M.D. noted that her major concern initially was the possibility that decision making would be one more step removed from Maine.  "When MMA opposed the sale of Blue Cross Blue Shield of Maine to Anthem, Inc, we were concerned that decision makers in Indianapolis, or even in Connecticut at the Anthem East office, would not be fully informed of the needs of insured in the State of Maine.  We are concerned now, once again, that the fragility of the health care delivery system in our state will not be fully considered when decisions are made by the officers of what will be the largest or second-largest health care plan in the country," noted Dr. Gleaton.

MMA Executive Vice President Gordon H. Smith added, "While MMA will keep an open mind until we hear more about the merger plans, the track record of large national firms taking over traditional Maine firms has not, in my opinion, been favorable to Maine citizens."  "Does anyone seriously think that the successors to UNUM and CMP are furnishing a higher level of service to Maine customers than the companies purchased?"

Smith also noted that it was ironic that antitrust officials have recently taken action against Maine physician/hospital organizations that gave Maine providers some ability to negotiate with health plans, but now would likely force individual providers to negotiate their own participation agreements with one of the two largest for-profit health plans in the world. "At a time when the very financial viability of  medical practice is at risk, it may become even more difficult for our members to negotiate fair contracts.," Smith added.

The AMA's Top 12 Fictions & Facts About Medical Liability Reform: #10
FICTION #10:  Physicians are trying to cover up medical errors.

Fact:  Organized medicine has been on the forefront of the patient safety movement, which focuses on improving the delivery of medical care and reducing the number of medical errors that occur.  The American Medical Association formed the Patient Safety Foundation in 1996, which has pioneered this movement and played a pivotal role in advancing this cause.  Physicians across the nation are working with hospitals, drug companies, private organizations and other health care professionals to develop and implement "best practices" that avoid systemic errors that might otherwise occur in the course of delivering medical care.  The AMA supports creating a climate where reporting of errors will occur so that the information can be used to improve the system and avoid repeating in the future.  To this end, the AMA continues to actively lobby for strong federal legislation creating patient safety programs. [return to top]

Psychologist Prescribing Bill Leads List of Concerns for Second Session

Last Wednesday, the members of the Legislature's leadership, known as the Legislative Council, considered the list of bill requests for the Second Regular Session of the 121st Maine Legislature scheduled to run from January 7, 2004 to early April.  The bills listed below are those of interest to Maine physicians.  An asterisk (*) means that the bill was admitted.  Legislators may appeal denials of admission by November 3rd and the Council will meet to consider appeals on November 12th. 

Leading the list of admitted bills of concern to the MMA is Sen. Michael Brennan's bill to allow psychologists to prescribe psychotropic medications, LR 2443.  Three other bills MMA is watching closely were not admitted on the first round:  LR 2308, An Act to Amend the Laws Governing the Statute of Limitations for Medical Malpractice (Lemont, York); LR 2373, An Act to Require that Medicare Payments be Equal in Rural and Urban Areas of the State (Stanley, Penobscot); and LR 2447, An Act to Prohibit Health Care Facilities from Discriminating Against Physicians Based on Group Practice Affiliation (Simpson, Auburn).

The Maine Psychiatric Association and MMA have already begun their work in opposition to LR 2443 with a planning meeting before the MPA general membership meeting last Friday.  Click here to see the American Psychiatric Association's current talking points on psychologists' scope of practice.

ABORTION ISSUES

None

BLOOD & HIV ISSUES

None

BUDGET ISSUES

LR 2305, An Act to Correct the Maine Biomedical Research Program Definition of "Academic Medical Center" (Cathcart, Penobscot)

CHILDREN’S ISSUES

*LR 2286, An Act to Authorize Certain School Children to Carry Asthma Inhalers on their Persons (Barstow, Gorham)

LR 2213, An Act to Create the Task Force on Early Childhood (Craven, Lewiston)

LR 2364, An Act to Require Mandatory Hearing Screening for Infants (Stanley, Penobscot)

FIREARMS & DOMESTIC VIOLENCE ISSUES

*LR 2454, An Act to Restore the Violence Intervention and Prevention Program

            (Colwell, Gardiner)

LR 2509, An Act to Allow the State to Enter into Reciprocal Agreements with Certain Foreign Jurisdictions Regarding Concealed Firearms (Shorey, Washington)

HEALTH CARE REFORM PROPOSALS

LR 2599, An Act to Create a Medical Savings Account Product in Maine (Woodbury, Yarmouth)

HEALTH CARE INFORMATION & CONFIDENTIALITY ISSUES

*LR 2334, An Act to Provide an Exemption to the Laws Governing Patient Confidentiality Regarding Certain Former Patients of the AMHI (Brannigan, Portland)

INSURANCE MANDATES

LR 2537, An Act to Require Health Insurance Policies to Provide Coverage for Physical, Occupational & Speech Therapy (Dudley, Portland)

LR 2369, An Act to Require Insurance Companies to Cover the Cost of Dentures Made by Denturists (Stanley, Penobscot)

INSURANCE PRACTICES

*LR 2375, An Act to Guarantee that Consumers Receive Notification of Insurance Policy Cancellation (Hall, Lincoln)

*LR 2536, An Act to Amend the Law Relating to Insurance Contracts (O'Neil, Saco)

LR 2373, An Act to Require that Medicare Payments be Equal in Rural and Urban Areas of the State (Stanley, Penobscot)

LR 2580, An Act to Provide Consumer Representation in Health Insurance Coverage Matters (Treat, Kennebec)

LR 2581, An Act to Clarify Health Care Cost-sharing Limits (Treat, Kennebec)

LONG-TERM CARE ISSUES

*LR 2469, Resolve, to Require Cost Neutrality and Population Appropriateness for Assisted Living Medication Courses (Lerman, Augusta)

*LR 2419, An Act to Restore Funding for Certain Nursing Facilities and Residential Care Facilities (Richardson, Brunswick)

*LR 2544, An Act to Ensure Adequate Home-based Care Services and Provide the Most Cost-effective Long-term Care for Maine Seniors (Richardson, Brunswick)

MANAGED CARE ISSUES

None

MEDICAID ISSUES

LR 2391, Resolve, Directing the DHS to Study Ways for Private Nonprofit Agencies and Community Action Project Agencies to Work Collaboratively with the DHS to Deliver Certain Services (Kneeland, Aroostook)

MEDICAL ETHICS/MEDICAL RIGHTS ISSUES

LR 2395, An Act Regarding Powers of Attorney (McKee, Wayne)

LR 2424, An Act to Allow Inmates to Donate Organs to Relatives Who Reside Outside the State (Strimling, Cumberland)

MEDICAL LIABILITY ISSUES

LR 2422, An Act to Discourage Frivolous Lawsuits by Nonprofit Organizations

                  (Joy, Crystal)

LR 2308, An Act to Amend the Laws Governing the Statute of Limitations for Medical Malpractice (Lemont, York)

MENTAL HEALTH, MENTAL RETARDATION, & SUBSTANCE ABUSE ISSUES

*LR 2256, An Act to Encourage Efficient Facilities for Persons with Mental Retardation (Daggett, Kennebec)

LR 2508, An Act to Maintain Level Funding for Children's Mental Health Grant Services (Faircloth, Bangor)

PRESCRIPTION DRUG ISSUES

*LR 2440, An Act to Encourage the Proper Disposal of Expired Pharmaceuticals (Bromley, Cumberland)

*LR 2556, An Act to Ensure Access to Life-sustaining Pharmaceuticals (Dudley, Portland)

*LR 2434, An Act to Modify State Investments in Pharmaceutical Manufacturers (Lemoine, Old Orchard Beach)

LR 2471, Resolve, to Study the Availability of Pharmaceutical Resources in Rural Maine (McKee, Wayne)

LR 2574, An Act to Coordinate Discount Cards from Pharmaceutical Companies and the Maine Low-cost Drug Program to Ensure the Lowest-priced Prescription Drugs for Maine Citizens (Paradis, Frenchville)

*LR 2528, Resolve, Directing the Department of Labor and the Executive Department, Office of Substance Abuse to Study the Prevalence of Drug and Substance Abuse in Maine's Workforce (Perry, Calais)

*LR 2275, An Act to Amend the Random Drug Testing Laws (Saviello, Wilton)

*LR 2548, An Act to Ensure the Lowest-priced Prescription Drugs for Maine Seniors (Treat, Kennebec)

PUBLIC HEALTH & SAFETY ISSUES

*LR 2220, An Act to Improve Awareness of Meningococcal Meningitis Vaccination (Bryant, Oxford)

LR 2601, An Act to Facilitate the Recycling of Cathode Ray Tubes (Colwell, Gardiner)

*LR 2228, An Act to Ban the Sale of Novelties Using Mercury-containing Batteries (Cowger, Hallowell)

LR 2330, An Act Concerning Statewide Medical Services Needs (Daggett, Kennebec)

LR 2579, An Act to Enhance Statewide EMS Trauma System Coordination (Daggett, Kennebec)

LR 2583, An Act to Enhance Emergency Services Provider Communications (Daggett, Kennebec)

LR 2560, An Act to Modernize Birth Certificates (Dudley, Portland)

LR 2290, An Act to Monitor the Public Health and Social Services Impact of a Casino in Maine (Percy, Phippsburg)

*LR 2562, An Act to Correct an Oversight in Maine's Homestead Exemption for the Blind (Richardson, Brunswick)

*LR 2324, An Act to Prohibit Female Genital Mutilation (Simpson, Auburn)

LR 2365, An Act to Prohibit the Introduction in Maine of Mercury Intended for Use in a Dental Filling (Stanley, Penobscot)

REGULATION OF HEALTH CARE FACILITIES

*LR 2345, An Act to Revise the Frequency of Home Health Licensing Surveys (Colwell, Gardiner)

LR 2463, An Act to Amend the Laws Governing Free Care Provided by Hospitals (Mills, Cornville)

LR 2237, An Act to Repeal Changes to the Certificate of Need Program (Shields, Auburn)

LR 2447, An Act to Prohibit Health Care Facilities from Discriminating Against Physicians Based on Group Practice Affiliation (Simpson, Auburn)

SCOPE OF PRACTICE, LICENSING, & DISCIPLINARY ISSUES FOR INDIVIDUAL PRACTITIONERS

*LR 2443, An Act to Allow Psychologists to Prescribe Psychotropic Drugs (Brennan, Cumberland)

LR 2433, An Act to Waive Fees for Background Checks for Certain Emergency Medical Services Personnel (Clough, Scarborough)

*LR 2570, An Act to Permit the Refilling of a Prescription Prior to the Exhaustion of the Original Prescription (Dudley, Portland)

LR 2368, An Act to Amend the Laws Governing Denturists (Stanley, Penobscot)

TOBACCO ISSUES

LR 2230, An Act Regarding Smoking in Stores that Primarily Sell Tobacco or Tobacco-related Products (Clough, Scarborough)

LR 2336, An Act to Repeal the Smoking Ban in Beano Halls (Gagnon, Kennebec)

LR 2269, An Act to Lower the Cigarette Tax (Snowe-Mello, Poland)

LR 2531, An Act to Create the Office of Alcohol and Tobacco Enforcement (Suslovic, Portland)

WORKERS’ COMPENSATION ISSUES

LR 2584, An Act to Amend the Fees Paid to Attorneys for Lump-sum Settlements in Workers' Compensation (Bryant, Oxford)

LR 2477, An Act Relating to Witnesses in Workers' Compensation Cases (Perry, Calais) [return to top]

Medicare Conferees Push Toward Conclusion for Compromise Drug Bill for Seniors
The Medicare Conference Committee, working toward reconciling the differing versions of a Medicare prescription drug benefit passed by the House and Senate earlier this year, are racing the legislative clock to conclude a final agreement and bring a compromise bill back to each chamber for final approval before Thanksgiving.  Among the items still being negotiated are the level of premium support for low-income beneficiaries, the level at which catastrophic coverage begins and the shape of private insurer competition with the Medicare program.  Also included in the discussions, of particular interest to physicians, is a proposal from the House to forestall Medicare physician payment cuts for the next two years (a cut of 4.2% has been announced for 2004) and guarantee a minimum positive update of 1.5% for 2004 and 2005. 

In addition, the conferees are discussing a proposal to mandate electronic prescribing by 2006 and to institute a new, and much more complicated coding system, known as ICD-10.  MMA has been working with the AMA and medical specialty societies in advocating for the positive payment update, against any absolute mandate for electronic prescribing and for retention of ICD-9 coding for physicians.  Members interested in more information on this topic may go to www.ama-assn.org/grassroots. [return to top]

Judge Approves $470 Million Aetna Settlement
United States District Court Judge Federico Moreno has given final approval to an estimated $470 million settlement between Aetna, Inc. and 19 state and county medical societies and over 700,000 physicians across the country.  Less than 1% of the physicians in the class opted out of the settlement.  Tens of thousands of physicians did not return their forms to the court, resulting in their small payments going to the non-profit Foundation established as part of the Settlement.

Donald J. Palmisano, MD, JD, President of the AMA, said in reference to the settlement, "We commend the leadership, courage and perseverance of the individual physicians and state and county medical associations involved in this settlement and the remaining litigation against additional health insurers.  The fact that this lawsuit has advanced to the current stage in the settlement process is proof positive that these physicians and their medical associations have not worked in vain."

The Maine Medical Association voted nearly a year ago to be a non-named party to the litigation, but ultimately was not able to come to agreement with the attorneys handling the litigation for the other medical societies on the issue of potential liability for legal fees.  The attorneys were awarded $53 million in fees as part of the settlement. [return to top]

MaineCare to Give ID Cards
MaineCare officials have announced that the program will give permanent plastic identification cards to enrollees beginning in December.  These plastic cards will replace the paper ID cards now sent monthly to each enrollee.  These cards can be swiped by a medical office, but to use the system, practices must purchase a machine from the contracted vendor,( Medifax) which costs approximately $600.  In addition, there is a $25 per month service charge to use the system and a .25 cent charge per transaction.  Many providers have objected to the arrangement, noting particularly that most credit card processing fees are in the .02 to .04 cent range.  A secondary complaint has been that given the very low reimbursement paid to physicians for MaineCare patients, expecting a practice to pay for the new system is unfair.

While physicians can continue to use the existing system and verify eligibility by phone, this option is slow and the Bureau has actively discouraged participating providers from using it.

MMA representatives are in the process of scheduling a meeting with MaineCare representatives to discuss the matter.  This past week, MMA and representatives of the Maine Chapter, Maine Academy of Pediatrics, met with Jude Walsh and Dr. Timothy Clifford  on continuing concerns about implementation of the preferred drug list (PDL).  MMA is in the process of putting together a small task force of physicians to work with the Bureau on the PDL issues.  Contact Andrew MacLean or Gordon Smith at MMA if you are interested in volunteering for this interesting task.  (amaclean@mainemed.com; gsmith@mainemed.com) [return to top]

EMTALA Final Rule Effective Nov. 10, 2003
The Centers for Medicare and Medicaid Services (CMS) has issued its Final Rule regarding policy clarification of the Emergency Medical Treatment and Labor Act (EMTALA).  The Final Rule largely addresses the concerns of the AMA which worked in partnership with several national medical specialty societies to ensure that key EMTALA burdens would be lifted.  Highlights of the Final Rule include clarifications of the on-call requirements, what patients trigger EMTALA,  and prior authorizations in the ER.

The Final Rule also makes clear that EMTALA never applies to an individual who: (1) has begun to receive outpatient services from the hospital; or (2) has been admitted in good-faith as an inpatient.  The Final Rule also notes that EMTALA obligations end once an individual is stabilized, appropriately transferred to another hospital/facility or admitted to the hospital as an inpatient.  No material changes were made to the "transfer" rule under EMTALA.

MMA has available to members a two-page explanation of the Final Rule prepared by attorneys for the AMA.  E-mail us at jbanta@mainemed.com or call 622-3374 and ask for Julie Banta if you would like to receive the document. [return to top]

MMA Hospital Medical Staff Section to Meet Wednesday
Medical staff officers from around the state will meet Wednesday, Oct. 29th, at the offices of the Maine Medical Association in Manchester.  The purpose of the meeting is two-fold.  At 3:00pm, Mary Dufort from the Division of Licensing and Certification will present a two hour CME program on the proposed medical staff chapter of the licensing regulations, the quality improvement aspect of the proposal and the medical errors reporting legislation and regulations about to be implemented.  At 5:00pm, a light dinner will be served and attendees will hear from Mike Vitek who staffs the AMA's Organized Medical Staff Section in Chicago.  Attendees will also discuss the possibility of re-invigorating the HMSS in Maine and will have an opportunity to share with one another any events of interest going on within their staffs.

The meeting is being held as the result of a Resolution considered and supported at the MMA  General Membership Meeting in early September.  While special notices have been sent to all medical staff officers in the State, any physician in the state interested in medical staff issues is welcome to attend.  There is no registration fee for the educational component or the business meeting.  We would appreciate a quick call just letting us know you are coming so that we can plan adequately for the meal and handouts.  Just call the MMA office at 622-3374. [return to top]

Tickets for Sesquicentennial Gala Going Fast
Response to the invitations sent to all MMA members and corporate affiliates for the Nov. 8th Sesquicentennial Gala has been very positive but a limited number of tickets remain.  The evening will be of particular interest to those members interested in the history of medicine in Maine although there will be ample opportunity for those persons just wishing to attend an elegant dinner-dance.  A silent auction will be held and medical artifacts from the Maine Medical Center Archives collection will be on display.

The evening begins with a reception at the Portland Museum of Act, beginning at 5:30 p.m.  By 7:30 p.m. we will be at the Holiday Inn by the Bay for the program and dinner.  Dancing to the popular Tony Boffa Band follows at approximately 9:15p.m.  Guests include Governor Baldacci and his wife Karen, Congressman Tom Allen, AMA President Donald Palmisano, M.D., J.D., and the entire Board of Trustees of the AMA!

During the Program, a special video on the history of medicine in Maine will be shown.  Net proceeds from the event will benefit the Maine Medical Education Trust, a 501-c-3 Foundation established by MMA in the 1980's to support a variety of educational and charitable endeavors.  One of the recipients of the evening proceeds will be the Physician Health Program.  Tickets are available by calling Susan Feener at MMA at 622-3374 or via e-mail at sfeener@mainemed.com [return to top]