February 2, 2004

 
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Guidance on New Charge Disclosure Law
The Governor's Dirigo Health Legislation requires physicians and all other health practitioners in Maine to disclose to patients charges for their most common services. All other healthcare facilities are under a similar obligation.

MEMORANDUM

 

To:                   Maine Medical Association Members

 

From:               Gordon H. Smith, Executive Vice President & Andrew B. MacLean,

                                    General Counsel & Director of Governmental Affairs

 

Date:                January 28, 2004

 

RE:                 GUIDANCE ON CHARGE DISCLOSURE PROVISION OF

                        DIRIGO HEALTH PLAN

 

 

Summary

            A provision of Governor Baldacci's Dirigo Health Plan legislation (L.D. 1611, An Act to Provide Affordable Health Care Insurance to Small Businesses and Individuals and to Control Health Care Costs, P.L. 2003, Chapter 469, effective 9/13/03) enacted during the 2003 legislative session requires all individual health care practitioners (physicians, dentists, therapists, and others) to provide patients with written notice of their charges for common services provided.  We understand that Governor Baldacci has written a letter in early January to all of Maine's individual health care practitioners advising them of the new law.  The MMA has prepared this memo to assist you in complying with the new disclosure requirement.

The Disclosure Provision Applicable to Physician Practices

            The following paragraph is the disclosure provision applicable to physician practices:

Sec. C-30. 24 MRSA ß2987 is enacted to read:

ß2987. Consumer information

     A health care practitioner shall notify patients in writing of the health care practitioner's charges for health care services commonly offered by the practitioner. Upon request of a patient, a health care practitioner shall assist the patient in determining the actual payment from a 3rd-party payor for a health care service commonly offered by the practitioner. A patient may file a complaint with the appropriate licensing board regarding a health care practitioner who fails to provide the consumer information.

            A separate and more specific disclosure provision (Section C-15) applies to hospitals and ambulatory surgical facilities.  If you would like to review Section C-15, you can find it on the internet at http://janus.state.me.us/legis/ros/lom/LOM121st/10Pub451-500/Pub451-500-111.htm#P8162_893762.

Background

            Educating consumers about the cost of health care services - seeking more informed consumers of health care services - was an important element of the cost containment effort in the Dirigo Health bill.  In the development of the bill, the MMA sought to minimize the burden on medical practices and to give physicians wide latitude in how this disclosure would be accomplished depending on type of practice.  Accordingly, the MMA lobbied against the provision in the original bill that would have required physicians to post a list of charges and another proposal that would have required physicians to provide a written statement of the charge for a service in advance of providing any service to any patient.

Compliance Options

            Your approach to compliance with this law probably will depend on your specialty and practice setting.  Keep in mind that the purpose of the new law is consumer education and that a reasonable or "good faith" effort to comply should allow you to avoid any state enforcement action.  We suggest 3 principal options for compliance with the law:

            1.            Facility-based practitioners.  Physicians who practice only in a facility setting, such as anesthesiologists or radiologists, and who have no office practice should have no disclosure obligation under this provision and should be covered by the facility disclosure provision.

            2.            Posting a list of common charges.  Physicians with office practices might choose to post a list of charges for common procedures or services provided.  As you can see, the law does not specify how many procedures or services must be listed or the parameters of any posting.  Again, this will vary by specialty.  An "office visit" may be a common procedure for many practices.

            3.            Including the list with intake paperwork.  This seems to be the most attractive option to us for most physicians.  The disclosure statement can be included with the usual paperwork presented to the patient at the beginning of the physician-patient relationship:  consent to treatment, financial obligations, consent to use or disclosure of protected health information (PHI), and medical history form.

        Either of us are happy to assist with your practice compliance with this provision.  You may call us at 622-3374 ir communicate via e-mail at gsmith@mainemed.com or amaclean@mainemed.com

      

 

Dr. Maroulla Gleaton Testifies Before Hospital Study Commission
On Monday, Feb. 2, MMA President Maroulla S. Gleaton provided testimony to the Hospital Study Commission established as part of the Dirigo Health legislation.  Participating on a panel consisting of representatives of physicians, (MMA and the Maine Osteopathic Association), nurses and ambulatory surgical facilities, Dr. Gleaton led off the morning's testimony and emphasized that Maine's hospitals face a complex set of challenges today and that physicians and hospitals must work collaboratively if the difficult issues of cost, quality and access are to be addressed successfully.

The panel presentations and subsequent questions and discussion occupied nearly two hours of the three hour meeting.  The Study Commission meets again on Feb. 17.  It has a rather daunting task to make recommnedations to the Legislature and the Governor by November of this year.  Dr. Gleaton's testimony follows:

Good Morning Chairman Haggett and Members of the Study Commission
I am Dr. Maroulla Gleaton, President of the Maine Medical Association. As most of you know, the Maine Medical Association is a professional organization representing nearly 2600 Maine physicians, medical students and residents in training, founded in 1853. In my local practice, I am an ophthalmologist in private practice in Augusta.

I appreciate the opportunity to share with you this morning the Associationís thoughts on the two questions that have been posed to us; those being ďwhat are the compelling needs of Maineís hospitals and what issues of concern relating to hospitals do we have from our perspective.Ē Because it is impossible in the six to eight minutes allotted to give a comprehensive view of the topic, I have attached some relevant materials including the Associationís testimony on the original Dirigo Health legislation, the Associationís White Paper on Healthcare Access and a comparison of MaineCare, Medicare and Anthem reimbursement rates for twenty primary care codes. In one way or another, these attachments elucidate some of the points that I will be making in this testimony. I have also enclosed a copy of my curriculum vitae because I did not want to take from the time allotted to share with you some of my history on these issues, including chairing the Cost-containment Committee of Governor Baldacciís Health Action Team. The teamís work product that ultimately led to the Dirigo Health legislation.

Before answering the two questions presented, let me state at the outset on a day-to-day basis, the relationship between Maineís physicians and hospital administrators and governing boards is reasonably sound. Every day, in the vast majority of hospitals around the state, physicians, nurses and hospital administrators work cooperatively and collaboratively to provide quality health care to thousands of Maine people. And the smaller the hospital, the more likely there is to be a true inter-dependent relationship with the physicians not wanting to lose or harm the hospital, and these hospitals, being very dependent on the physicians as well. So please keep in mind, when I identify what we believe the needs and the issues of concern are, that it is difficult to make statements that are generally applicable to all hospitals. There are thirty-nine hospitals and while there are some overriding issues in all of them, there are very different issues between the four largest systems and the remainder. With that, let me try to identify what we consider the compelling needs of Maineís hospitals.

We believe that the two overriding issues for Maineís hospitals are financial issues and work force issues. Obviously, the two are related. If you donít have enough funds, or you donít have the right mix of patients to provide sufficient revenue to continue the services that you are providing in the community, then you donít have the revenue to pay for nurses, physicians and other ancillary personnel. You donít have the money to invest in capital expenditures to stay on top of advances in technology. And as with the physicianís office, patient mix is critical. With Maineís high percentage of patients on Medicaid and Medicare, any shortfall from those programs not paying their reasonable cost is necessarily shifted unfairly onto commercially insured and self-pay patients.

Because Maineís hospitals have become the center for community health throughout the state and have become the facilities that we rely upon for everything from emergency access to defense against bioterrorism, the physicians of Maine worry about the financial viability our rural hospitals. We cannot overstate the healthcare system reliance on hospitals for community public health activities, specialty care and primary care. This is essential to provide continuity of care to patients in rural areas. According to the figures from the Maine Hospital Association, hospitals employ 1500 physicians in Maine, which would be over a third of all the practicing physicians. It has become necessary for many physicians, even in primary care, to become employed by the hospitals because their patient mix and low Medicaid and Medicare reimbursement have made it impossible to run a private practice. In addition, for physicians coming out of training, the high debt and lack of practical education in running a practice, compels this choice. So whether we like it or not, the availability of physicians, the economic stability of physician practices and the ability to attract and retain physicians in many parts of the state is inextricably linked to the financial viability of the hospital.

We also worry about the ability to attract and retain nurses, physicians and other personnel. Every Maine resident deserves a ďmedical homeĒ and we encourage you to review Dr. Burtt Richardsonís research on this subject. At any one time, the Maine Recruitment Center has vacancies for 150 physicians. While we appreciate the presence and quality of our osteopathic medical school, Maine remains one of only five states in the country without an allopathic school and we remain, to our knowledge, fiftieth in the nation in the number of college graduates who go on to medical school. We have lower professional salaries in Maine than physicians are paid in many other parts of the country. We tolerate, as do all of you, a harsh winter climate. We are unable to give as many teaching positions, although we are able to do some through the residency programs. My point is that Maine is not now and will likely never be in a position to competitively attract new physicians. We will be dependent upon our state access program with the out of state medical schools, our state loan programs, our loan forgiveness programs, and our efforts to increase student aspirations in science in order to have physicians who will come back to Maine or attract others to come to Maine to practice. A lot of this issue is economic and therefore the squeezing of reimbursement to physicians, hospitals and other facilities certainly impairs our ability to attract and retain physicians. The attached reimbursement information speaks for itself. While the hospitals receive about 78 percent of their costs from Medicaid, physicians receive much less. There is a compelling need to increase Medicaid reimbursement for both.

Next for issues of concern. There are several issues of concern regarding Maine hospitals from the perspective of Maine physicians. I will start with the issue of quality.

Quality Ė We are concerned that Maine hospitals may not have the financial stability to invest in the latest technology. It takes an enormous amount of money, as well as time, to convert from a paper medical records system to an electronic medical record, for instance. In addition, all the new medical technology that Maine people have come to expect in Maine could be impaired significantly by the current efforts in the certificate of need law to put a cap on certificate of need expenditures. Today, unlike the 1950s, Maine people generally consider healthcare in our state to be of high quality and to be comparable to the services that they could receive in Boston or other major metropolitan areas. We, in fact, believe that our healthcare in many settings in Maine is superior to the major teaching hospitals across the country. But, an artificial cap to be imposed on technology cost and other capital costs would in a relatively short time, put Maine behind. And we canít build a wall around Maine. If healthcare in Maine is held back because of a lack of resources, then all we will have accomplished is to create a two-tier system where persons with resources will go to centers of excellence that will be developed around Portsmouth, New Hampshire and other border towns to attract patients from Maine.

The quality issue also raises two questions that need to be examined by your Commission.

1. What is the relationship between volume and quality?
2. What is the relationship between supply and utilization?

In other words, does the mere presence of equipment, beds or services induce utilization? We donít know the answers, but we know these are important questions. These questions are important as a foundation for the kinds of decisions that need to be built into any comprehensive State Health Plan.

Collaborative Relationships - A second issue of concern, is the necessity to develop and maintain appropriate, respectful and collaborative relationships between physicians, medical staffs, administrators and boards of trustees. In far too many instances, we see hospital decisions made with little, if any, input from physicians, nurses and other health professionals. Some administrators view the staff as something to control, rather than recognizing their contribution. In Maine, we will always struggle to have enough money to pay for the legitimate healthcare needs of patients. We should not expend scarce resources fighting with one another, and we must ensure that we donít compete inappropriately and waste money on duplication of services. In most places in this state, the hospitals cooperate with one another and the physicians cooperate with the hospital. But, there are places in Maine where unhealthy competition exists that does lead to unnecessary cost and duplication. Despite the enactment of the Hospital Cooperation Act in the early 1990s, collaborative efforts in the competitive zones are all too rare. There needs to be further change in the antitrust laws to permit true collaboration, if we expect such collaboration. The recent prosecution of the Maine Health Alliance, a collaborative relationship among eleven hospitals and their eleven medical staffs is a case in point: the Alliance was a model of cooperation in northern and eastern Maine; some of the most difficult places to recruit and practice in the state. But when the Alliance, arguably within the existing guidelines of law, sought to contract with major third party payors on behalf of their members, the enforcement authorities came down on them like a ton of bricks. Health care being the unique service it is, I would submit to you that with appropriate state supervision, cooperation and collaboration should be permitted or even required.

Given our time constraints, I have not had the opportunity to explore all the issues that should be on the table but I have tried to highlight a few. Our ancillary materials will raise others. I have not raised the issue of appropriate setting of services, as I know that this will come in connection with the ASU presentation. I will simply add that it makes no sense in areas that can support patient choice among facilities to require all the services to be provided in the highest cost setting. There should perhaps be zones of competitions where the physicians can compete with hospitals, while at the same time protecting our rural infrastructure. The appropriate model for Portland is not necessarily the model for Aroostook and Washington counties.

I want to close by congratulating Maineís hospitals. As I said at the outset, most hospitals are trying very hard to deliver appropriate services at the lowest cost possible. We have seen a real effort in our institutions to try to live within the Governorís voluntary cap of three and a half percent. This should be acknowledged.

I would be happy to answer any questions that you might have. [return to top]

New England Journal of Medicine Features Article on Dirigo Health
The current issue of the New England Journal of Medicine (Vol. 350:330-332; Jan. 22, 2004, Number 4) contains an article in its "Perspective" section entitled, "Health Coverage in the States - Maine's Plan for Universal Access."  The article was authored by Trish Riley, M.D. of the Governor's Office of Health Policy and Finance and Elizabeth Kilbreth, PhD. of the Muskie School.of Public Service, University of Southern Maine. 

Acknowledging that the success of Dirigo Health will depend on the collaborative efforts of all constituencies, the authors state that the proposal represents an attempt to link comprehensive health system reform with an effort to achieve universality of coverage.   The article traces the history of the law and details some aspects of the complex negotiations that let to its enactment last Spring.  The article follows:

New England Journal of Medicine, Volume 350:330-332

January 22, 2004, Number 4

Health Coverage in the States - Maine's Plan for Universal Access

Trish Riley, M.S., and Elizabeth Kilbreth, Ph.D.



For at least 25 years, states have served as laboratories for health care reform initiatives, advancing strategies that have later been enacted by the federal government. In the 1970s, Hawaii led the way when it required most employers to provide health care coverage for workers or to pay a tax so that the government could do so. Hawaii received an exemption from Congress when the Employee Retirement Income Security Act (ERISA) was enacted, allowing it to continue its pay-or-play experiment, which substantially reduced the number of uninsured in that state. In the 1980s and 1990s, states advanced Medicaid reforms and the federal government responded, making it easier to secure Medicaid waivers in order to expand coverage of the uninsured. Forty-six states had enacted insurance reforms before Congress passed the Health Insurance Portability and Accountability Act (HIPAA), which protects consumers from insurance practices that left them vulnerable to the loss of coverage when they needed it most. A quarter of the states had established children's health insurance programs before Congress enacted the State Children's Health Insurance Program (SCHIP), aimed at reducing the number of uninsured children in the country. States also enacted patients' bills of rights before the Congress took up that debate.

States have a long tradition of laying the groundwork for incremental federal reforms but have had less success in winning federal support for comprehensive approaches that achieve universal access. Now the wave of state reforms seems to be building again. California recently enacted a pay-or-play law like that in Hawaii. And in Maine, the new Dirigo Health Reform Act promises reforms in terms of cost, quality, and access that are intended to make universal access possible there within five years. Such initiatives at the state level require federal attention and action if they are to realize their promise fully, just as federal action on SCHIP has allowed all states to provide health coverage for children. Although more than 40 million Americans remain uninsured, that number would surely be even larger were it not for these state reforms.

Maine has long been a hotbed of debate about health care reform, which has been stimulated in recent years by double-digit increases in premiums, poor health status among many citizens, and growing numbers of uninsured persons. Maine has little competition in its insurance and provider systems and has more hospital beds per capita, higher utilization rates, and higher rates of chronic illness than any other state in New England. Over the past decade, Maine has led the nation in growth in per capita personal spending on health care. Its hospital cost per discharge (adjusted for the case mix) is higher than the U.S. average. One of every eight citizens is without coverage, which results in $275 million each year in bad debt and charity care.

It is no surprise, then, that during the most recent gubernatorial campaign, health care reform was a major issue. On his election in January 2003, Governor John Baldacci appointed a "health action team," including more than 60 representatives of business and government, consumers, providers, and purchasers. Working on a volunteer basis in open meetings, the team reviewed plan designs and developed recommendations, many of which were incorporated into the governor's final proposal. Ultimately, Dirigo Health, named in reference to the state's motto, meaning "I lead," was created as a new independent state agency to provide a health care program targeted initially to small businesses, self-employed persons, and other individual consumers. Subsidies will be provided to families and individuals with incomes of up to 300 percent of the federal poverty level.

The new agency will determine eligibility and conduct enrollment, arrange health coverage through either a private plan or Medicaid, pay subsidies, monitor and provide information on quality, conduct disease management and health promotion programs, and serve as a model "health and wellness" plan. Dirigo will contract with private insurers, maintain authority over the design of health care benefits, and define allowable administrative costs.

All of this work will be funded through a combination of employer and employee payments, Medicaid dollars for those who are eligible, and an assessment on the gross revenues of health insurers. Employers who choose to participate will be required to contribute a portion of the costs in an amount to be determined by the agency (but not more than 60 percent). Medicaid will be expanded to include parents with incomes of up to 200 percent of the federal poverty level and single adults with incomes of up to 125 percent of this level, many of whom are employed by small businesses. The assessment on gross revenues of insurers, including reinsurers and third-party administrators, is designed to recapture savings from reductions in bad debt and charity care, as well as other cost reductions.

Maine will limit health care costs through close state oversight. The new law includes voluntary budget limits and margins for insurers, hospitals, and providers and creates a state health plan with limits on global expenditures and a process for addressing key public health problems. A one-year moratorium, with an emergency exception, has been placed on certificate-of-need (CON) review. Future projects requiring review can be approved only up to the limits of a capital investment fund that has been established to budget for and solicit capital projects. The CON program is also being extended to cover some nonhospital services, such as ambulatory surgical units, with the goal of controlling the growth of outpatient costs. For the first time, insurance regulation in the small-group market and the disclosure of prices by providers are required. The law also establishes the Maine Quality Forum, funded in part by the assessment on insurance companies. It will serve as a watchdog, stimulate the diffusion of evidence-based medicine, provide consumer education about wellness and health promotion, and conduct assessments of technology.

The Dirigo law was enacted after an outpouring of public concern - the hearing on the bill lasted nine hours - and long hours of "shuttle diplomacy" between the governor's staff members and key stakeholders. Initial support came from the Maine State Chamber of Commerce, the Alliance for Small Businesses, numerous individual consumers and consumer advocacy groups, unions, and the Maine State Nurses Association. Hospitals, physicians' organizations, and insurers all registered substantial concerns about specific features of the proposed bill, but after extensive negotiations, the primary objections of each constituency were addressed.

Specifically, voluntary hospital planning and the global hospital budget that had originally been proposed were eliminated. The hospitals made it clear that, with or without a budget, they were not interested in a hospital-only discussion regarding the realignment of hospital services statewide. Instead, the state health plan, which includes a global budget, and the capital investment fund were retained, and the creation of a commission to study Maine's hospitals was added to the bill.

The proposed assessment on insurers' gross revenues became contingent on a demonstration of savings through the avoidance of bad debt and charity care and reductions in the growth of health care costs. This savings-offset payment should provide the necessary revenues for subsidies for employees and individual insurance purchasers. Unless and until the cost-containment goals are met, funding for the subsidies will not be available - a provision that directly links the goal of health care access to effective cost containment.

Physicians' groups resisted being included in the CON program and objected to requirements for electronic billing and for all providers to post the prices of common services. However, they supported the plan to address payment inequities between the Medicaid reimbursement rates and those negotiated for commercial carriers; Dirigo will pay physicians at the latter rates. In addition, the state has launched a study to determine the costs of incremental Medicaid increases for physicians' services.

Dirigo Health will be phased in over a period of five years to cover all of Maine's uninsured residents, and state funds made available through federal fiscal relief will provide first-year financing, which will allow the early experience to determine the amount of insurers' assessments. This agreement helped to resolve a serious problem: an assessment in the first year, before any savings had been realized, would most likely have been passed on to other payers in the form of increased premiums. Since the assessments will be linked to demonstrated savings, insurers should recover the assessments through their contract negotiations with providers - not payers.

Like any compromise, Dirigo Health does not please all parties. Two key issues continue to surface. First, advocates of single-payer plans, among others, argue that because Dirigo Health is a voluntary system, it cannot achieve its goal of universal coverage in five years. Supporters of the voluntary program stress that there is considerable transparency in the bill that will result in a better-informed buying public, that subsidies will ensure affordability and encourage enrollment, and that unless and until cost growth is tamed and an affordable insurance product is available on the market, it is inappropriate to discuss mandates.

Second, a new conservative think tank has emerged in Maine that is aggressively resisting the law's requirement to build expansions of Medicaid into the program, arguing that Maine's budget cannot afford even limited expansion. Supporters of the plan note that securing federal financing for Medicaid-eligible enrollees is critical to the plan and that Dirigo has the tools to control the growth of health care costs, including those of Medicaid. This debate may be a precursor to a reemerging national interest in reducing the growth of Medicaid by converting the program to a block grant.


Built on earlier work in Maine and many other states, Dirigo Health represents an attempt to link comprehensive health system reform with an effort to achieve universality. The implementation of the program is now under way. Its success will depend on the collaborative efforts of all constituencies.

Source Information
From the Governor's Office of Health Policy and Finance, Augusta, Maine (T.R.); and the Muskie School of Public Service, University of Southern Maine, Portland (E.K.). [return to top]

Sharply Divided Legislature Adopts 04 Supplemental Budget
After a week of intense negotiations in the Appropriations Committee and among the Legislature's leadership, Republicans and Democrats failed to reach agreement on a supplemental spending plan capable of achieving the support of 2/3rds of both chambers.  By the end of the week, the Governor's package had passed with the support of fellow Democrats but creating a rift with Republicans that will make consensus on the supplemental budget plan for 05 even more difficult.  In order to balance state finances for the present fiscal year (04), the spending package relies upon a mix of one-time cuts in various programs and on a new tax on Maine's hospitals. 

For more information on this topic and other current legislative and regulatory activity, link to MMA's Political Pulse prepared by Andrew MacLean, Esq. at the conclusion of each legislative week.  The publication is available at http://www.mainemed.com/members/Me-Med/index.html. Once on this page, go to the most current issue. [return to top]

CMS Now Has Your Number
After years of discussion, last week the Federal Register published the final rules regarding the issuance of unique National Provider Identifier (NPI) numbers for all healthcare providers in the country.  The number will be a 10 digit identifier which, when implemented, will replace all legacy numbers such as UPINs, Blue Cross and Blue Shield numbers, CHAMPUS numbers, Medicaid numbers and numbers assigned by individual health plans.  HHS claims that the use of a single identifier will simplify processing of claims.  The system is slated to go into effect on May 23, 2005. The compliance date for all covered entities except small health plans is May 23, 2007.   Physicians need not apply for their number until that date.   Further information on how to apply for the number will be available later this year.  The NPI is expected to last indefinitely.

The rule is available at:   http://a257.g.akamaitech.net/7/257/2422/14mar20010800/edocket.access.gpo.gov/2004/pdf/04-1149.pdf [return to top]

MaineCare Drug Utilization Committee to Meet on Tuesday, Feb. 10, 2004
The MaineCare Drug Utilization Review Committee will meet on Tuesday, February 10, 2004 in Conference Room 1A&1B at the Department of Human Services/Bureau of Medical Services offices, 442 Civic Center Drive, Augusta, from 6:00pm to 8:00pm.  A public comment period will begin at 6:00pm. 

The agenda for the meeting includes a review of letters received regarding the Preferred Drug List and criteria since last meeting; a discussion of the current status and implementation dates for Atypical Anti-psychotic and GI provider education program; and a review of recent studies/criteria for Risperdal Consta and Provigil (ADHD).

Additional new business will include asthma disease management and a discussion of the next steps for PDL;

                                   *  Annual review of PDL in April

                                    *  Discuss;  Namenda, Pexeva, Symbyax and Prevacid NapraPAC

                                     *  Parameters for PDL performance exemptions, lst PDL exemption report.

The members of the MaineCare DUR Board are:

DUR Board Members (Voting)

William Alto, M.D.

Laureen Biczak, M.D.

Timothy Clifford, M.D

Andy Cook, M.D.

Jabbar Fazeli, M.D.

Jessica R. Osterheld, MD

Robert Weiss, M.D.

Reggie Gracie, R.Ph.

John Grotton, R.Ph.

Mike Ouellette, R.Ph.

Laurie Roscoe, R.Ph.

DUR Board Members (Non-Voting)

Jude Walsh, J.D.

Michael Tocco RPh, MEd

     

      [return to top]

Rules Adopted for Maine RX Plus
The Bureau of Medical Services on January 17, 2004 announced the adopted rule for the Maine Rx Plus Drug Benefit Program.  The rules implement a State-operated pharmacy benefit for Maine residents who are not otherwise eligible for pharmacy or MaineCare benefits.

Maine Rx Plus participants will receive a discounted price on prescriptions, through participating pharmacies. Members will be required to reapply annually and will be subject to application and financial guidelines set forth by the Bureau of Family Independence.  In order to participate, pharmacy providers must be approved as Maine Rx Plus providers. 

Rules and related documents may be reviewed or printed from the BMS website at http:   www.state.me.us/bms/rulemaking/  or for a fee, interested parties may request a paper notice and copy by calling the Division of Policy and Provider Services at (207) 287-9368. [return to top]

National Patient Safety Awareness Week, March 7-March 13, 2004
The National Patient Safety Foundation announces its annual National Patient Safety Awareness Week, March 7-March 13, 2004.  The Patient Safety Awareness Week is a national education and awareness-building campaign for improving patient safety at the local level.  Hospitals and healthcare organizations across the country are encouraged to plan events to promote patient safety within their own organizations.  Educational activities are centered on educating patients on how to become involved in their own health care, as well as working with hospitals to build partnerships with their patient community. [return to top]

MMA's 13th Annual Physician Survival Progams to be Held May 26 and June 23
The Maine Medical Association's popular Physician Survival educational programs continue this year with programs scheduled in Auburn on May 26th (Hilton Riverwatch) and in Bangor on June 23rd (Spectacular Events).  This year's programs will feature some of the same topics offered in past years, such as the employment law update and legislative and regulatory update, but will also feature talks on Dirigo Health and legal and regulatory compliance.  The increasing threat of the criminalization of medical practice will also be presented and discussed.  Presenters will also deal with the increasing demands of data collection, payor audits and the push toward more effective use of technology.

Save the date on your calender now.  Registration materials and a complete agenda of speakers and topics will be included with the March-April edition of Maine Medicine.  A special mailing will be sent to all past attendees, as well.  Questions about the programs may be directed to Chandra Leister at MMA (622-3374 or cleister@mainemed.com) or Gordon Smith (622-3374 or gsmith@mainemed.com). [return to top]

Maine Attorney General to Sponsor "Listening Conference" on End of Life Care
Maine Attorney General Steven Rowe last week convened representatives of various organizations interested in End of Life Care in Maine in the interest of holding a Maine "Listening Conference" on the topic on September 28th, 2004 at the Samoset Resort in Rockport.  The day long conference would be held in connection with the annual Maine Pain Symposium.

Noting that the Attorney General does have an important, pro-consumer role in improving End of Life Care, Mr. Rowe noted the increasing involvement of attorneys general in bridging the gap between the consumer's vision of how they want to die and the harsh reality.  As noted by him, "when expectations of competent healthcare for advanced illness are thwarted by failure to provide adequate treatment of pain or reluctance to honor advanced directives, terminally ill patients are the ultimate consumers seeking protection at a most vulnerable time." [return to top]

Advisory Council on Health Systems Development/ Update from Today
The Advisory Council on Health Systems Development met today (2/3) in Augusta and continued its work on the process of developing a State Health Plan.  The Council is under the gun to get its work completed before the existing moratorium on certificate of need approvals expires in early May.  The Dirigo Health legislation requires that future CON decisions factor in the provisions of a State Health Plan.

The Council also discussed the existing CON process and asked for presentations by MMA and other interested organizations at its next meeting to be held on Feb. 27th (afternoon).  MMA members wishing to input into MMA's testimony may contact EVP Gordon Smith at 622-3374 or via e-mail at gsmith@mainemed.com.  MMA President Maroulla S. Gleaton serves as one of several physicians on the Council. [return to top]

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