December 8, 2003

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Dirigo Health Moves Ahead
Dirigo Health initiatives moved forward last week with the second meeting of the Board of Directors, the first meeting of the Quality Forum Advisory Committee and the second meeting of the Commission to Study Maine's Hospitals

The Dirigo Health Board of DIrectors held its second meeting on Dec. 1.  Chaired by Robert McAfee, M.D., the Board heard an update from interim Executive Director Tom Dunne and agreed to meet on the first Monday afternoon of each month.  Mr. Dunne re-capped the first meeting of the Quality Forum Advisory Council held in the morning and gave an overview of recent events in other related initiatives.

Most of the meeting's discussion focused on tasks required to keep to the timelines established in the legislation.  In discussing the insurance product to be sought through the issuance of an RFP (Request for Proposals), Board members noted the importance of having a product that was both desirable and attractive to small business.  Gino Nalli of the Muskie School of Public Service (part of USM) presented a comparison between the original Dirigo Health Plan and current major products offered by Maine health plans.

In mid-December, focus groups will be conducted with small business owners in an attempt to establish trigger points for an attractice price and benefit structure.  He also presented some data on trends in the health insurance market in Maine.

The Board also received a paper from Mathematica Policy Research, Inc., presenting some options regarding disease prevention and  health promotion currently used by many health plans and employers.  It is anticipated that some of these features will be included in any Dirigo Health insurance product.

Recogning the difficulty in hiring a trained staff in time for the RFP process, the Board authorized Mr. Dunne to continue discussions with consulting firms which had appropriate experience and which had capacity to assist the Board in its task.  The importance of an effective communications campaign was also noted.  Additional staff has been hired recently to assist with the communications effort.

Throughout the meeting, participants emphasized the importance of talking about all  three features of Dirigo Health, rather than just presenting the insurance product.  While important, the product itself must be aligned with the quality and cost initiatives if Dirigo Health is ultimately to be successful.


The first meeting of the Maine Quality Forum Advisory Council was held on December 1.  Robert McArtor, M.D. of Portland had been asked by staff to serve as interim Chair of the Council and he and Thomas Dunne took members through the mission of the Council,  the tasks before it, and the obligations of Council members. There was considerable discussion of the relationship between the Forum, the Council, its professional advisory committee and the Dirigo Health Board of DIrectors. The urgent need for staff to the Council was noted and members were presented with the text of an advertisement that had already been placed for the Maine Quality Forum DIrector.  It is anticipated that staff for the Forum will consist of a Director, a comprehensive health planner and an Epidemiologist.  The advertisement stated that a clinical PHD was preferred and some members questioned whether that preference should have been stated.

Thomas Dunne presented the Council with a draft work plan which calls ofr a chair to be elected next meeting and for a complete work plan to be developed during December.  In January, the council would begin hearing from potential partners and begin to narrow the list of potential Directors.  By Spring, the Council would be looking at its first quality initiative.  In May, the COuncil is due to provide input into the State Health Plan required by the legislation.

The Council voted to meet again on Tuesday, Dec. 9th at 8:30am.  The meeting will be held at the Augusta Civic Center in the Kennebec Room.  One of the items of business will be to set a regular time each month for a meeting of the Council.

At both meetings noted above, time had been set aside for any members of the public to make a comment.

The Advisory Council consists of 17 members but is also charged with naming a provider group to give input to the Council.  The tentative work plan calls for appointment of the provider group in Feb. and March.  The Forum itself has an appropriation of nearly $1,000,000 for its first year.  Mr. Dunne proposed to the Council that approximately $300,000 be dedicated to hiring staff and that the remaining funds be used for and outside assistance and various quality projects.

For more information about the Dirigo Health Program, go to:

Frank O. Stred 1931-2003
Last week, the Association learned, with great sadness, of the death of former Executive Vice President Frank O. Stred.  Frank died on Sunday, Nov. 30, 2003 in Leesburg, Florida following a brief illness.  Frank had made his home in Leesburg since his retirement from MMA in l993.  At memorial services on Dec. 3, the Association was represented by former MMA and AMA President Robert McAfee, M.D.   Remarks were also made by former MMA President Gilbert Grimes, M.D.  who also makes his home in Leesburg.

Frank is survived by his wife of 48 years, Priscilla, and daughters Susan E. Stred, M.D. and Kristin H. Stred, J.D.

Frank was born August 8, 1931 in Chambersburg, Pa., the son of Frank and Helen Evans Stred.  He graduated from Chambersburg High School, Bates College and received a Master's degree from Bradley University.

Frank served as Executive Vice President of MMA from l979 until Sept. l993.  When he retired, the Association's office building in Manchester, Maine was named in his honor.  Previous to serving at MMA, Frank had worked with the Bates College Alumni Association, Central Maine Power and the Gorton Corporation of Gloucester, MA.

In his retirement, Frank participated in the Highland Lakes Musicale Chorus and the local tennis organization.

Frank provided extraordinary stewardship to the Association during an important time in its 150 year history.  He re-located the Association offices from the infirmary at Bowdoin College to the state capitol in Augusta, overseeing personally the remodeling of a residence at 524 Western Ave. into an office and conference room.  In the early l980's, he had the vision to have MMA purchase a 30 acre parcel of farmland just over the Augusta line in Manchester. During the remainder of the l980's, Frank saw his vision of a health-related Association office park achieve reality with four buildings now existing housing the MMA, the Maine Dental Association, and Maine Osteopathic Association and the Maine Health Information Center.

Frank saw both the staff and reserves grow substantially during his tenure, and he was able to successfully merge staff from the pre-Augusta move with new staff and saw very little turnover of staff during his years of service.  During this period, the Association also stopped publishing the Journal of the Maine Medical Association and instituted a monthly Bulletin, sent to all members.  He was also instrumental in MMA hiring its first full-time attorney in l981.  That attorney, Gordon Smith, later went on to succeed Frank as EVP, having been well-mentored by Frank during their 13 years working together.

One of Frank's most significant achievements came with the electoral successes of Robert McAfee, M.D.  at the highlest level of the AMA.  Frank's legendary organizational skills and public relations background proved invaluable to Dr. McAfee in his AMA campaigns.  While his victories were not landslides (margins of 1 vote and 17 votes come to mind), certainly Frank's skill and efforts helped to make Dr. McAfee the first AMA President from Maine.  Frank will be fondly remembered by all members of the MMA family.  What MMA is today is, in no small measure, due to his efforts and the work of Dr. Dan Hanley, whom he succeeded. 

The family has requested that any remembrances be sent to Hospice of Lake and Sumter, 12300 Lane Park Road, Tavares, FL 32778, Bates College, or the charity of one's choice.  MMA will be annoucing an appropriate gift in the near future that members may participate in if they wish.

The Association offers its condolences to Priscilla, Susan and Kris.  Members wishing to send a note may send it to Mrs. Priscilla Stred, 27117 Racquet Circle, Leesburg, FL 34748.  Special thanks also to Bob McAfee and Gil Grimes, who not only represented the Association well, but both of whom were very special friends of Frank's. [return to top]

First Meeting of Commission to Study Maine's Community Hospitals
The Commission to Study Maine's Community Hospitals held its second meeting on  Dec. 4 and heard a two-hour presentation by Harvard Professor Nancy Kane.  Professor Kane is a well-known researcher and frequent lecturer on health policy and hospital costs.  She is Professor of Management in the Department of Health Policy and Management at the Harvard School of Public Health.  She has been retained by the Governor's Office of Health Policy & Finance  to assist the Office and the Commission in its review and analysis.

Facing a Nov. 1, 2004 reporting date to the Legislature, the Commission had agreed at its first meeting to spend its first six months gathering information and fact-finding, the next two months evaluating the data, discussing it and making recommendations and the final two months writing the report.  The Commission is chaired by William Haggett, the former CEO of Bath Iron Works. 

Professor Kane distributed a 17 page handout that contained hospital cost data from various sources, including the Almanac of Hospital Financial and Operating Indicators, 2002, CMS and some IRS 990's.   The presentation focused on hospital costs, rather than reimbursement.  She noted the difficulty of Maine hospitals demonstrating compliance with the Dirigo Health-imposed 3% voluntary limits on consolidated operating margins.  One of the difficulties is that there is no standard reporting format among hospitals.  Revenue and income is re-defined from hospital to hospital.  Even the definition of "operating margin" differs.  She noted that standardized reporting of accounting practices could be an area for the Commission to recommend.  One Commission member noted that one benefit of standardization would be a more level playing field between one institution and another.

Although the presentation and ensuing discussion was very general, the clear implication left by the speaker was that Maine hospital costs were higher than in comparable institutions in comparable states, that Maine's bed supply was generous and that there was a queston as the whether the complexity of some of the hospital systems was beneficial.  The Maine Hospital Association is expected to take on these issues very aggressively, beginning at the next meeting.

The Commission agreed to meet the first and third Mondays of each month, in the morning.  The next meeting will be on January 5th and will feature a presentation by the Maine Hospital Association.  MHA's presentation will include background on the roles and services of Maine hospitals, data on hospital costs and reimbursement, utilization data, quality initiatives and hospital staffing. 

The two physicians on the Commission are Richard Wexler, M.D., an internist and Josh Cutler, M.D., a cardiologist.  Hospital representatives are John Welsh of Rumford and Scott Bullock at Maine General in Waterville and Augusta.

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"Pediatric Palliative Care" Program Offered at Maine Medical Center
Billed as a multidisciplinary conference for all interested in enhancing the care of children with advanced illness, "Pediatric Palliative Care" is being presented on Tuesday, Jan. 13, 2004 at the Dana Learning Center at the Maine Medical Center in Portland.  The program runs from 7:30am (Registration and Welcome) to 4:00pm.  CME is available.

The program is presented by:  The Pediatric TIME Team, the MMC Department of Family Practice, the Department of Pediatrics, the Department of Psychiatry, the Department of Outreach Education and the Department of Critical Care.

Faculty includes, Janet Duncan, MSN, RN from Dana Farber, Marsha Joselow, LICSW from Children's Hospital in Boston, Christine Mitchell, RN, MS, FAAN, Director of Clinical Ethics, at Children's and Joanne Wolfe, M.D., with the Department of Pediatric Oncology and PACT, Dana Farber Cancer Institute and Children's Hospital.  Dr. Wolfe is also an Associate Professor of Pediatrics at Harvard Medical School.

There is a conference fee of $35.  MMC employees are exempt from fees, but are required to register.  For more information call 207-842-7352 or email  Checks should be made payable to MMC-Department of Family Practice and sent to Laneay Yates, Department of Family Practice, Maine Medical Center, 272 Congress St., Portland, Maine 04102. [return to top]

Interventional Pain Representative Needed for CMS Carrier Advisory Committee
The Association has been notified by NHIC Carrier Medical Director Craig Haug of the desire of CMS to include an interventional pain representative from each state on the Medicare Carrier Advisory Committee.  The Association has been asked to nominate such an individual and is seeking interested volunteers.

The Carrier Advisory Committee meets four times a year.  While the meeting is located in Waltham,MA.,  Maine attendees are able to videoconference in from sites in Bangor and Portland.  The meetings are usually held on Monday afternoons, at around 3:00pm.

Any MMA member interested in being nominated for this position should send a CV to Gordon Smith at MMA, fax  622-3332 or via e-mail at [return to top]

Aroostook County Medical Society to Meet Thursday, Dec. 18th
The Aroostook County Medical Society will meet on Thursday evening, Dec. 18th at the Presque Isle Inn and Convention Center.  MMA President Maroulla Gleaton , M.D. and EVP Gordon Smith will be speaking.  The meeting begins with a reception at 6:00p.m. followed by dinner at 7:00pm.  Those members wishing to attend should RSVP to Dr. Imbesat Daudi's office at 760-9456.

The meeting will also feature the video prepared for MMA's 150th Anniversary Gala in Portland.  This 23 minute video features many of the highlights of MMA's history.

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Workers' Compensation Board Tables Action on Physician Fee Schedule
The Maine Workers' Compensation Board met on Tuesday, Dec. 2nd.  While the 8 member Board was expected to act on the proposed changes to the physician fee schedule, the Board ultimately tabled the proposed rule until the next meeting.

The proposed changes, which primarily update the CPT codes to 2003 codes and makes no changes to the existing $60 conversion factor, have been pending since summer.  Business interests have argued that the fee schedule is too high, while MMA and other provider groups have argued that the fees are unchanged since the l990's and should be increased to account for higher practice costs and changes in the CPI.  We have also presented data establishing that there are higher costs associated with treating workers' comp patients.

The four labor representatives appear to support the rule change as proposed (no change in conversion factor).  While the position of the management members is somewhat fluid, one member, David Gauvin,  indicated during the public session last week that he had no problem with the proposal but that the management representatives wanted more time to review it.  An affirmative vote of a majority of the Board is needed to enact the Rule.  In the absence of such a vote, the fee schedule would remain unchanged.

While we must continue to be very vigilant on this, at this point the Association is reasonably confident that the conversion factor will not be reduced. [return to top]

MMA Executive Committee Meets
The MMA Executive Committee met on December 3 and considered a full agenda of business items.  In addition to hearing a presentation on the Group Health Plan renewal from representatives of the Dunlap Agency (see next article for details), committee members heard staff reports on the recent Medicare reform package, recent meetings with MaineCare officials on the preferred drug list and the Medifax EDI contract, and Dirigo Health.  Plans for the upcoming legislative session were also discussed.

Members elected York County ophthalmologist Edward Jaccoma, M.D.  to a three-year term on the committee.  Dr. Jaccoma currently serves as a trustee of the Maine Physician Action Fund and is a past President of the Maine Society of Eye Physicians and Surgeons and of the Medical Staff at Goodall hospital in Sanford.  He also recently served a multi-year term on the Secretariat for State Affairs at the American Academy of Ophthalmology. [return to top]

MMA Group Health Plan Renewal: Important Information for Participants
The Association has completed negotiations with Anthem Blue Cross and Blue Shield on the renewal of the Group Health Plan, effective Feb. 1, 2004.  Compared with the significant premium increases of the past, this year's premium increase is quite modest for most participants in the Group.

Anticipated rate increases have also been reduced by making benefit design changes, the most significant being to establish a $500 deductible for outpatient surgery and in-patient stays for HMO Maine and Maine Partners enrollees.  In addition, most options will have changes to the co-insurance percentage and out-of-pocket maximums.  The popular drug card will remain unchanged.

With these benefit design changes, the rate increase at renewal will be:

                              HMO Maine ($500 Deductible, 70% to $2500)         1.4%

                              Maine Partners (same as above)                                1.4%

                              Blue Choice $2500 (80/60)                                           11.0%

                               HMO Choice (No change)                                             12.9%

                               Blue Choice $1000 (80/60)*                                           6.8%

                               CompCare Carve Out (retirees)                                     12.9%

                                CompCare $1000                                                             12.9%

                          *  This is a new option and the indicated increase is from the existing CompCare $1000 option.


Complete information on the renewal will be sent to participating practices this month from the Dunlap Agency and Anthem.

Members not in the Plan who are interested in getting a premium quote for their group should contact Judy Conley at the Dunlap Agency, 1-800-479-3041 ext. 143. [return to top]

Apologies for Phone Service Failure December 8, 2003
The Maine Medical Association exists to serve its members.  Therefor it is particularly frustrating for us when we are unable to serve members because of a failure of technology.  Such a failure occurred today, Dec. 8th, when our phone system was out and we were unable to receive in-coming calls or make out-going calls.  As this last article is being written, all efforts are being made to get us back up and running but we are still without service.  Cell phones can take care of the out-going calls, but we are unable to answer your in-coming calls.  Hopefully, relief is only minutes away.  In the meantime, please bear with us and understand that we are as frustrated as you with the circumstances.

Under normal circumstances, MMA staff are happy to assist you with your phone calls from 7:00am to at least  5:00pm and frequently as late as 6:00pm [return to top]

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