February 8, 2004

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Bill on Psychologist Prescriptive Authority to Face Public Hearing Tuesday
The Legislature's Health and Human Services Committee will hold a public hearing Tuesday on L.D. 1713, Resolve, to Establish the Commission to Study Access to Prescription Drugs for Persons with Mental Illness. MMA and the Maine Psychiatric Association strongly oppose that portion of the Resolve which would authorize a study of whether additional categories of non-physicians should be able to prescribe medication.
The public hearing will take place at 1:00pm on Tuesday, Feb. 10 in Room 202 of the Cross State Office Building in Augusta.

While the MMA and MPA support studying access to mental health services in Maine, both organizations will oppose the part of the study asking whether prescriptive authority should be extended to mental health practitioners without comprehensive medical training.  The bill is sponsored by State Senator Michael Brennan (D-Cumberland).  At "Psychiatrists' Day at the Legislature"  this past Wednesday, MMA and MPA members held very productive discussions with Senator Brennan and other legislative leaders during which the legislators heard of physicians' concerns with the proposal.

Opposition to the proposal is also expected from the Maine Academy of Family Physicians, the Maine Osteopathic Association, the Maine Chapter of the Maine Academy of Pediatrics, the Maine Society of Anesthesiologists and many other medical organizations.

MMA's weekly Political Pulse, published Feb. 6, contains the MPA talking points on the legislation and a list of the Health and Human Services Committee. To view the talking points, go to: http://www.mainemed.com/members/Me-Med/index.html and click on the Feb. 6th issue.

A work session on the bill has been scheduled for Wednesday, Feb. 11, also at 1:00pm.  Just this past week, the New Hampshire Legislature defeated a proposal to study prescriptive authority for psychologists.  The Legislation, which called for such a study, was defeated in the New Hampshire House of Representatives on a vote of 266-68.  In defeating the measure, the House upheld the recommendation of the Executive Departments and Administration Committee which had voted 15-2 to defeat the bill.  Only the State of New Mexico has permitted psychologists to prescribe and that was enacted recently enough that the experiment has not yet begun.

Workers' Comp Medical Fee Schedule Remains Tabled at W.C. Board
The current medical fee schedule (W.C.B. Rule, Chapter 5) will remain in effect until members of the deeply divided Board can agree on a Consensus-based Rulemaking Process.  The Board was scheduled to meet on Tuesday, Feb. 3, but failed to achieve a quorum because of a dispute over whether labor or management had the authority to chair the meeting.

Because of concern in the business community (particularly Hannaford Brothers)  that the existing fee schedule is too high, the Board has failed to update the fee schedule and instead has asked staff to initiate consensus-based rulemaking.  Such a process would involve the input of a number of organizations, including MMA, the Maine Hospital Association, the Maine Osteopathic Association, the Maine Chiropractic Association, the Association of Ambulatory Surgical Centers, business and labor groups, Maine Employers' Mutual Insurance Company and other interested parties.

The current fee schedule utilizes a conversion factor of $60.00 for most medical and surgical procedures.  There has been no increase in the reimbursement in a number of years. [return to top]

Judge Approves CIGNA Settlement Agreement
U.S. Federal Court Judge Federico Moreno has approved the settlement agreement regarding the national class-action lawsuit filed against CIGNA on behalf of nearly 700,000 physicians and 19 state and county medical associations.

Donald J. Palmisano, M.D., J.D., President of the AMA remarked in a press statement, "This lawsuit, and others like it, have encouraged meaningful change to the current managed care environment.  Health plans are now starting to realize their business practices must permit fair and open dialogue with physicians, and foster relationships between physicians and the patients they serve.

The AMA is hopeful that the remaining defendants from the health insurance industry will end their reliance on unfair business practices by agreeing to additional settlements, or by resolution of the pending litigation.  The AMA will continue to support efforts to combat the unfair practices of health insurers."

Further instructions on how to participate in the settlement will be furnished in Maine Medicine Weekly Update. [return to top]

Joint Commission Issues Correction on Governance Conflicts
Given the recent action at Eastern Maine Medical Center, Maine physicians will be interested in the recent announcement from the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO).

The JCAHO has issued corrections to the 2004 Standards (Joint Commission Perspectives, Feb. 2004).  Revision - "Addition of EP 12 for standard LD.1.20.  This requirement corresponds to GO.2.6. in the 2003 Comprehensive Accreditation Manual for Hospitals and was inadvertently omitted from the 2004 standards.  This EP is effective for scoring July 1, 2004."

   "Governance provides a system for resolving conflicts among leaders and the individuals under their leadership."

The AMA's Organized Medical Staff Section introduced Resolution 842 at the December, 2003 Interim AMA meeting.  The House of Delegates adopted Resolution 842 that states:  "That our AMA work vigorously to immediately restore and expand the requirement in the JCAHO's Hospital Accreditation Standards that the governing body or authority, and the medical staff, provide for the impartial mechanism for conflict resolution that is satisfactory to both parties." [return to top]

Dirigo Health Council on Health Systems Development Meets
The Council on Health Systems Development, established in the Dirigo Health legislation, met again on Feb. 3 to hear from staff  and to continue its work as laid out in the legislation.  Documents shared with the members included a listing of approved Certificate of Need projects (by year); copies of the Maine Health Care Performance Council's final recommendations; background information on the planning process used in Oregon and the global budget for hospital expenditures used in Rochester, NY.  One member requested additional information regarding the manner in which other countries engage in health planning; it was suggested that the group consider Great Britain as that nation is in the midst of redesigning its National Health Service.

Trish Riley, Director of the Governor's Office of Health Policy and Finance presented the members with a proposal for a Council work plan, intended to result in an interim State Health Plan by May, as required in the statute.  The Plan is intended to have two primary uses.  The first would be use by the state to guide CON decisions and capital financing through MEHEFA, as well as to guide priority setting for state budgeting purposes.  The second would be for use by others to influence health systems change, establishing public health policy and to address cost issues. 

It was noted that, in the short term, there was an urgent need for guidance from the Council because of the end of the moratorium on CON applications, currently scheduled to take place in May, 2004. It was agreed that the next three Council meetings would be structured to assist the group in meeting its charge to provide advice and guidance for the short term planning issues.  The first meeting will be devoted to CON and the MMA and other organizations have been invited to present. The meeting will be held in Augusta on Feb. 27th at 1:00pm.  MMA members wishing to provide input into MMA's presentation should communicate with Gordon Smith, EVP at gsmith@mainemed.com..

The second session will focus on global budgeting and the third on synthesis of data relative to the needs of the population.  The data will be presented on a regional basis, to offer the opportunity to observe differences between various parts of the state. [return to top]

Federal Court Says TPAs Must Pay MHDO Assessment
The Maine Health Data Organization (MHDO), the custodian of the State's comprehensive health information database, has since its inception in 1995 had the authority to assess non-hospital providers and third-party administrators in addition to hospitals and insurers who have provided most of the agency's funding.  In conjunction with the MHDO's joint venture with the Maine Health Information Center (MHIC) during the 120th Maine Legislature, the MHDO expanded its assessments to reach certain non-hospital providers and TPAs.

A Portland-based TPA, Patient Advocates LLC, challenged this assessment arguing that the Maine law is preempted by ERISA, the Employee Retirement and Income Security Act.  In a decision dated 1/21/04, Magistrate Judge David Cohen granted summary judgment in favor of the State.  See Patient Advocates LLC v. Prysunka, D. Maine, No. 030118-P-H.  Judge Cohen rejected Patient Advocates' ERISA preemption argument because the assessment law and regulations "apply to a large number of entities that have no specific linkage to ERISA plans." [return to top]

New Study Suggests Medical Malpractice Insurance Rates Still Growing
A study released 1/27/04 by Aon Corp. estimates that medical malpractice claims costs will grow at a rate of 9.7% in 2004, on par with a rate of growth of about 10% during the last 3 years.  While the frequency of claims is increasing, claims severity is a bigger problem according to the study.  In 2004, hospital claims are expected to average almost $150,000, nearly twice the 1996 average of $79,000.  Physician claims in 2004 are expected to average $178,000 compared with $120,000 in 1996.

You may find more about the Aon study, The Hospital Professional Liability and Physician Liability Benchmark Study, at www.aon.com. [return to top]

Inpatient Charge Data for 2002 Listed on Governor's Web Site
In accordance with the Dirigo Health Plan legislation, P.L. 2003, Chapter 469, and based upon MHDO data, the Governor's Office of Health Policy & Finance has published the average charges for the 15 most common inpatient procedures in Maine's hospitals for 2002.  The averages include $3773 for normal childbirth, $13,377 for stroke, $23,607 for major joint replacement, and $4647 for drug overdose or alcohol withdrawal.

See the report at Statewide Average Inpatient Hospital Charges for 15 Most Common Diagnoses.

This provision of the Dirigo Health Plan and the companion requirement for individual health care practitioners are intended to make Mainers more educated consumers of health care services. [return to top]

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