December 29, 2003

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Flu Widespread in Maine; Has Yet to Peak; First Death Reported
Dora Anna Mills, M.D., Director of the Maine Bureau of Health, announced late last week that the flu has become widespread in Maine and has yet to reach its peak. The first death from the flu, an elderly man in Aroostook County, was also noted. Up to 8 % of visits to heatlh care providers last week were for flu symptoms.
Dr. Mills said that the flu outbreak in Maine is now considered widespread with outbreaks in at least one-half of Maine's counties.  She also stated that flu vaccine is still available for high-risk individuals.  These include anyone over 65, children under two 2 years of age, pregnant women and adults with chronic diseases.  FluMist, from Wyeth pharmaceuticals, is also still available.  The use of this live attenuated intranasal vaccine is recommended for healthy persons ages 5 to 49.  Though more expensive than the traditional vaccine, Wyeth is offering a $25 rebate for most patients.  If, for example, the patient pays $50 in the office for the vaccine, the patient will receive a rebate form which, along with a receipt, can be used to receive $25 back in the mail from Wyeth.

The Bureau of Health's Maine Immunization Program continues to work with physicians to identify vaccine for their high risk populations.  If you are experiencing a shortage for your high-risk patients, contact the Program at 1-800-867-4775.  For further information on influenza, see

Sentinel Event Reporting Begins TODAY!
As reported in last week's Maine Medicine Weekly Update, the DHS Division of Licensing and Certification has declared today, December 29th, as the effective date for enforcement of the legislation enacted in 2001 requiring the reporting of certain "sentinel events" to be reported.  A significant delay has occurred in the enforcement of the provision because of the legislature's failure to fund the staff positions associated with the law.  Initial staff has now been hired and the draft rule giving details of the reporting mechanism will be the subject of a public hearing today.  Association staff will attend the hearing and either comment on the draft rule or submit written comments which can be filed until Jan. 8, 2004. The draft rule can be located on-line at

The public hearing will be held today at 1:30p.m. at the Bureau of Medical Service's office at 442 Civic Center Drive in Augusta.  That protion of the rule involving Ambulatory Surgical facilities will be held tomorrow, Tuesday, Dec. 30, also at 1:30 p.m. at the same location.  Written comments on the ASC rule will be accepted until Jan. 9, 2004.  Written comments on either rule should be directed to Louis T. Dorogi, Director, Division of Licensing and Certification, DHS/BMS, State House 11, Augusta, Maine 04333-0011.

The underlying legislation and the draft rules do NOT require the reporting of any errors in a medical office.  Rather, the rules impact only licensed health care facilities such as hospitals and ambulatory surgical centers.  The underlying legislation, which sets forth the types of events that need to be reported can be found on-line at [return to top]

Two Sides Apparent in CON Debate on Outpatient Surgical Needs
The State Certificate of Need Unit held a public information gathering session on Monday, Dec. 22 in Portland to gather, "information on the need for ambulatory surgical services in the greater Portland area."  In attendance were several physicians, hospital representatives, health plan representatives and consumers organized by the Maine People's Alliance and Consumers for Affordable Healthcare.  Although the meeting was not held in connection with any particular CON application, there is a current proposal by local surgeons to build a multi-specialty ASC in the Portland area and both Maine Medical Center and Mercy Hospital are expected to file applications later this year to expand their outpatient surgical capacity.  The last time a similar project was proposed, it was turned down by state regulators when local hospitals opposed the project.

There is currently a one-year moratorium on acceptance of any Certificate of Need applications.  The moratorium is due to expire in May.  The proposal by the Portland area surgeons was filed prior to the moratorium and is not subject to it.  Most of the surgeons involved in the project attended the public meeting, as did representatives of both the Maine Medical Association and the Maine Hospital Association.

Although no evidence or data was presented, several self-designated consumer representatives offered comments to the regulators opposing any increase in capacity.  The one point that both hospital and physician representatives agreed upon, however, was the very real need for additional outpatient capacity  in the Portland area.  The difficulty of scheduling cases in the Greater Portland area was noted by virtually all of the surgeons who spoke.  Many speakers noted the significant increase in the percentage of surgeries that are now done on an outpatient basis.  The following additional points were made, as well:

    * The significant % of patients who have a procedure done in the area but who are not residents of the immediate area.  Representatives of one existing ASC noted that 40% of their patients come from beyond Cumberland and York Counties.

     *  The aging of the population.  It was stated that Maine is the 10th oldest state in the nation, demographically.

     *  That in recent history, there has been virtually no growth in the capacity for outpatient services in the region.

       *  That in some parts of the country,  80% of surgeries are done on an outpatient basis.

        *  Maine has one of the lowest penetrations of ASC's in the Country.  Patients in many other states have far more choices available for their surgery.

          *  In some instances, patients in Maine who are unable to be scheduled in a timely manner are going to Boston for their procedures.

           *  There is increasing demand for endoscopy services, demand that is far outstripping supply.

             *  One hospital representative noted that in his facility, in l995, 60% of cases were done outpatient.  Now the percentage has grown to 75%.

             *  Outpatient capacity needs to be increased if physicians are to be successfully recruited to the area.

              *  A study done for the Maine Health Management Coalition showed a substantial monetary savings could be achieved by doing more sugeries in  free-standing facilities.

     Despite these assertions, consumer representatives continued to say they would oppose any expanded ASU development in Greater Portland.  Joseph Ditre' of the Consumers for Affordable Healthcare claimed that the problem was simply one of scheduling and that his organization would continue to oppose additional capital development in this area.

      Defenders of free-standing centers noted that competition could drive down costsand improve access.  They noted that  hospital monopolies now control access.  Hospital representatives responded with their traditional allegation that the free-standing ASC's did not have 24 hour access and did not have the flexibility of full-service hospitals.  Consumer representatives added their allegation that the ASC's would "cherry pick" the paying patients.

        All in all, the meeting presented little real data justifying one position over another, although clearly the physicians and hospitals believe additional capacity is needed.  Written comments can be submitted until Jan. 7, 2004 at 5:00pm.  MMA expects to submit comments in favor of the need for more outpatient capacity and in favor of patients having a greater choice of facilities. [return to top]

Maine Bars Smoke-Free January 1st, 2004
On January 1st, (this Thursday), a law enacted by the legislature earlier this year takes effect prohibiting smoking in bars and pool halls in the State.  Lighting up a cigarette in a bar or pool hall could result in fines for the smoker as well as the bar owner.  Only fully enclosed areas of the bar are affected, so some of the bars most resistant to the new law have built open patios to accomodate their patrons who smoke.

The law, L.D. 1346, An Act to Protect Workers from Secondhand Smoke and to Promote Worker Safety (P.L. 2003, Ch. 493), was a priority of  Maine Coalition on Smoking OR Health.  MMA is a Founding Member of the Coalition which is presently chaired by Jo. Linder, M.D.  GOrdon Smith, MMA Executive VIce President and a former Chairman of the Coalition gave the lead testimony on the bill during the legislative session last Winter.  His testimony was followed by testimony from many bar employees, musicians and bar owners who supported the proposal. 

On January 1, Maine will join California, Delaware, Connecticut, and New York in having a statewide ban on smoking in bars and taverns.  Maine is widely recognized nationally for having among the most stringent clean air laws in the Country.  The state has come a long ways since then-Governor Joseph Brennan in l979 vetoed a bill that would have prohibited smoking in JURY ROOMS unless all jurors consented.  The veto was sustained by the Legislature and it was this failure that proved to be the impetus for the formation of the Maine Coalition on Smoking OR Health.  The Coalition has continually existed since that time and is the most successful of any such coaltion in the Country. [return to top]

Cigna Lawsuit Clears Final Hearing on December 18
A proposed settlement in a national class-action lawsuit filed by several hundred thousand physicians against health insurer Cigna cleared a final hearing on Dec. 18th in US District Court in Miami.  US District Court Judge Federico Moreno indicated, following testimony, that he will approve the negotiated deal. 

The lawsuit, filed by class-action plaintiff attorneys on behalf of up to 600,000 physicians, charged that eight health plans, including Cigna, engaged in a conspiracy by delaying or denying reimbursement for health services and illegally rejecting claims for medically necessary treatments.  Cigna received initial court approval to settle the claims back in September.  The settlement requires Cigna, which claims it has already spent $400 million on internal changes, to pay physicians at least $70 million of the settlement amount.  The settlement allows physicians to seek funds -an average of about $100 per physician - by either requesting reimbursement from a $40 million fund based on actual claims or splitting $30 million among physicians who choose an alternative not tied to claims.  Cigna will also establish a new $15 million foundation administered by state medical societies participating in the litigation to deal with health-related issues.

The settlement amount includes cash payments for previously disputed claims, attorneys' fees and Cigna's investment in changing some of its reimbursement practices.  Overall, the terms of the settlement are valued by experts for the plaintiffs at $1.3 billion. 

After notice was given to the class, only seven objections were filed to the proposed settlement.  As of Dec. 19th, 699 physicians had opted out of the settlement in order to retain their right to sue on an individual basis.

In the remaining cases, seven defendant health plans remain, including Anthem, Inc.  A trial is anticipated for the remaining defendants in June 2004. No one would be surprised, however, if the remaining cases get settled as well, on terms similar to what Aetna and Cigna agreed to.

  [return to top]

Happy New Year from MMA. Office Open Jan. 2nd
The officers and staff of MMA wish all the members, corporate affiliates and friends all the best for a properous and healthy New Year in 2004.  The MMA office will be closed on Thursday, Jan. 1, 2004 but will re-open on Friday, Jan. 2. [return to top]

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