April 5, 2004

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FY 05 Budget Negotiations Continue Through the Weekend at State House
Consensus on the budget has yet to develop between legislative Democrats & the Baldacci Administration, or between the majority Democrats & minority Republicans on the Appropriations Committee.
The Legislature's leadership and the Appropriations Committee worked behind closed doors throughout the weekend trying to develop a viable budget plan.  As of 10 p.m. on Sunday evening, the Committee had made no final decisions public.  The Appropriations Committee will begin work again on Monday at 1 p.m.

While there was no indication during the weekend that physician services would be targeted for cuts, there was some discussion among members of the Democratic leadership of cutting approximately $3 million from the Fund for a Healthy Maine, primarily from the tobacco control media line.  If you wish to oppose this move, please contact the following members of the the Democratic leadership and/or their staffs.  The MMA & other members of the Maine Coalition on Smoking OR Health are lobbying against this budget balancing move.

Senate Majority Leader Sharon Treat (D-Kennebec) - or staff member Ann Woloson:  SenSharon.Treat@legislature.maine.gov; 287-1515 (O); 582-6702 (H).

Speaker of the House Patrick Colwell - or staff member Pat Damon (D-Gardiner):

RepPat.Colwell@legislature.maine.gov; 287-1300 (O); 582-5231 (H).

House Majority Leader John Richardson - or staff member Joan D'Arcangelo (D-Brunswick):

RepJohn.Richardson@legislature.maine.gov; 287-1430 (O); 729-5451 (H).

MMA President & President-Elect Visit with Maine's Congressional Delegation
From Monday 3/29 through Wednesday 3/31, the MMA's President, Maroulla Gleaton, M.D. (an ophthalmologist practicing in Augusta), President-elect Lawrence Mutty, M.D. (a retired psychiatrist living in Castine), Danielle Mutty, M.D. (a retired pathologist from Castine), & MMA General Counsel Andrew MacLean attended the AMA's National Advocacy Conference in Washington, D.C.  Drs. Gleaton & Mutty participated in several training sessions in interaction with elected officials on key health care issues during the first two days and then met with Maine's Congressional delegation and/or their staffs on Wednesday. 

The MMA delegation discussed a wide variety of issues with Maine's Congressional delegation, including medical liability reform, Medicaid & Medicare reimbursement, access to prescription drugs, use of genetic information, and veterans' eye care services. [return to top]

CMS Issues Stark II Final Regs: Provides Guidance on Self-Referral Issues
On 3/25/04, the Centers for Medicare & Medicaid Services (CMS) issued the long-awaited interim final rule on referrals to entities with which physicians or their family members have a financial relationship.  These so-called Stark II regs. were published in the 3/26 Federal Register (69 Fed. Reg. 16053).

Click here to view the CMS press release on the new rule along with the link to the Phase II rule. [return to top]

Dirigo Health Continues to Move Ahead
Despite discussions at the State House about its timing and scope, the Dirigo Health Plan continues to move forward.  On March 25th, the Dirigo Health Board, led by Dr. Robert McAfee, and Governor Baldacci held a press conference announcing a framework for the Dirigo Health insurance product.  At the Board's meeting yesterday (April 5), Tom Dunne, executive director of Dirigo Health, told board members that he expected the final Request for Proposals to go out to potential insurance partners as early as next week. 

At the press conference, the board released estimates showing that it is expected that the insurance product, to be offered to eligible individuals and small businesses by this summer, will cost from $260 per month to $846 a month for coverage, depending upon income, the number of persons in the family, the type of coverage selected and some demographic factors such as age.

While it was announced at the press event that the insurance product would be called, "Care-Works", at yesterday's meeting Tom Dunne noted a problem with the use of the name (a similar name being used by another entity) and a new name for the product will have to now be selected.

Dirigo Health will be funded by contributions from employers and employees, Medicaid funds for those who qualify for the Medicaid "wrap-around" coverage,and $53 million in federal funds that the state received last year as part of the President's fiscal package to shore-up state Medicaid programs.  The product is expected to cover 31,000 persons in the first year.  In the second year of the program, a controversial "savings offset payment" will help fund the program.  That payment, from insurers and self-insured plans, can be established by the board only if it can be demonstrated that health care costs have been reduced through a reduction in bad debt and charity care.

Elements of the plan released on the 25th include preventive services such as periodic physicals, immunizations, pap tests, blood tests, mammograms and well-baby care.  These preventive services will not be subject to a co-payment and will be covered 100 percent for all enrollees.  Physician visits (other than preventive) will be subject to a co-pay depending upon the enrollee's income.  For those individuals whose income is less than 125% of the federal poverty level, the co-pay will be $3 per visit; for all others, the co-pay will be $15 for visits to a primary care physician and $25 for a specialist.  Pharmacy benefits will be structured similarly.

A summary of the plan is available on the Dirigo Health website at www.dirigohealth.maine.gov/dirigo_overview.htm. [return to top]

More on Dirigo; Hospital Study Commission, Health Systems Dev. Adv. Council
The Commission to Study Maine's Hospitals and the Advisory Council on Health Systems Development held a combined meeting yesterday (April 5).  The meeting was consumed by two presentations, the first by Bureau of Health Director Dr. Dora Mills and the second by Ronald D. Deprez, PhD., MPH of the Public Health Resources Group.

Dr. Mills presented material from Healthy Maine 2010 and discussed the various public health data sets available in Maine.  These include the Behavioral Risk Factor Surveillance System, infectious disease reports and the Maine Cancer Registry.  Several other sources of Maine data were also noted, including the Maine Health Data Organization and the all-payor claims data base.

Dr. Deprez presented a talk entitled, "Discussion of Health Planning Framework and Methods."  He defined "Health Services Planning" as being concerned with the developing/reorganizing health services that meet the health needs of populations, whether comprehensively or for a particular population or health issue. An outline of the talk is available from MMA by calling 622-3374 (ask for Julie.)   His talk was particularly relevant to the Health Systems Development Advisory Council as it is charged with the task of preparing a State Health Plan.  The Plan would then be used as one of the more significant criteria for granting a Certificate of Need.

The Hospital Study Commission meets again on Tuesday, April 20 at 9:00am, in Augusta, but with the specific location yet to be determined.  The Health Systems Development Advisory Council meets again on Friday, April 30th, again in Augusta at noon but with no specific location yet announced. [return to top]

More on DirigoHealth - Update on Boards and Commissions - April 5, 2004
DirigoHealth Board of Directors

  • Decided on product details including plan components, discount structures, the incentive programs, and the negotiations strategy for the upcoming RFP
  • Publicly announced project details
  • Reviewed recent program of the Maine Quality Forum

Maine Quality Forum Advisory Council

  • Adopted definition of quality and mission
  • Started seeking nominations for provider group
  • Progress in defining the role of technology assessment in CON and in support of other State programs

Maine Quality Forum

  • Dennis Shubert, M.D., Ph.D. has joined the MQF as Executive Director
  • Drafted framework for the MQF action plan - will be presented to the Dirigo Board on 4/5/04, and to the MQF Advisory Council on 4/4/04
  • Initiated discussions with other organizations to cooperate in a core inpatient indicator project

Commission to Study Maine's Hospitals

  • Heard from representatives of the Attorney General's office on the laws governing hospitals cooperation, anti-trust, and hospital governance
  • Dr. David Wennberg, an expert on health care quality and efficiency, presented research suggestion (1) that supply can drive demand for health care services (2) savings associated with lower cost-per-unit are often erased by increased utilization (3) an increase in supply and expenditures doesn't necessarily equate to improved quality or outcomes

Advisory Council on Health Systems Development

  • Heard from Dr. Ken Thorpe of Emory University on the topic of global budgeting.  Dr. Thorpe presented models for possible use in the State health plan
  • Received a panel presentation on Maine's Certificate of Need program  - panelists included the Department of Human Services, the Maine Hospital Association, the Maine Ambulatory Surgical Center Coalition, and the Maine Medical Association

Public Purchasers' Steering Group

February meeting

  • 2003 consolidated expenditure report to the Governor was distributed as was the annual letter to the Advisory Council on Health Systems Development - both can be accessed by contacting GOHPF
    • total expenditures by the six reporting public entities are in excess of $2 billion, representing nearly 40% of Maine's total population and 40% of the state's total health care expenditures
  • discussed development of a work plan for 2004 based upon the seven goals identified in the report to the Governor

Task Force on Veterans' Health Services

  • Reviewed and refined the recommendations of a subcommittee formed to investigate (1) the ways in which veterans are currently informed by state and federal agencies of all health care options available to them (2) recommendations the Task Force may make regarding the VA's fee for service and prescription drug programs
  • Heard from a representative of Maine's Department of Defense, Veterans and Emergency Management regarding its "Operation I-Served" project to identify veterans in Maine
[return to top]

DHS Commissioner Denies CON to Portland Surgery Center LLC
In a decision issued April 5, DHS Commissioner John R. Nicholas again, on reconsideration, denied the application of Portland Surgery Center, LLC to construct a free-standing ambulatory surgical center in Portland.  Portland Surgical Center, LLC  is the effort of eleven Portland area surgeons and their corporate partner, ASCOA, to construct a two room outpatient surgical center off of Marginal Way in Portland.

The application was filed prior to the imposition of a moratorium being imposed on CON applications last May.  The application was handled under the law in existence at that time, which has been made even more restrictive through the Dirigo Health legislation. (Even prior to the change, Maine's CON law was described by national observers as the toughest in the country.) 

The application and decision are being closely watched by healthcare interests and observers as it represents the first significant decision by the new commissioner and may signal an intent by the Baldacci Administration to try to protect existing hospitals from competition.  Both Mercy Hospital and Maine Medical Center vigorously opposed the application and made detailed presentations at the hearings and public sessions.  Both hospitals claimed that the existence of the Center would decrease revenues at the hospital, with MMC arguing that its loss would be around $2 million.

The Commissioner's decision states that, "While I cannot determine the exact impact of these losses, it appears there will be a negative impact in the form of higher costs or loss of services to the community, or both."  The Commissioner also expressed concern regarding potential increases in rates of utilization, noting that, "While the record before me is mixed on this subject, in the end I am not satisfied that the applicant responded sufficiently to these concerns.  Overall, then, I remain concerned that the risk of possible increases in utilization rates would negatively impact the orderly and economic development of health facilities."

The Commissioner did conclude that one issue raised by the opponents, the application of federal Stark laws and the Maine Health Care Practitioner Self-Referral Act , would not stand in the way of the project if the other objections had been overcome.

The applicants had submitted hundreds of pages of testimony supporting the need for more outpatient surgical capacity in the Portland area.  They also testified to the favorable costs and convenience to patients.  In the end, none of this testimony was enough for the Commissioner.  An appeal to the courts is possible.

A copy of the Commissioner's decision is available from the MMA office (622-3374). [return to top]

Welcome to New Group Members Cardiovascular Consultants of Maine and Central Maine Orthopedics
The Maine Medical Association offers a group membership option to those practices with ten or more physicians, when all the physicians in the practice are MMA members.  An increasing number of medical practices in Maine are taking advantage of our group program, including Maine Cardiology, Northeast Cardiology, Spectrum Medical Group, PrimeCare, Orthopedic Associates and Coastal Woman's Healthcare, among others. 

This week, the Association is pleased to welcome two additional practices to our group program, Cardiovascular Consultants of Maine (Scarborough and Lewiston) and Central Maine Orthopedics in Auburn.  If your medical group is interested in learning more about our group program, please contact Lisa Martin, membership coordinator, Gordon Smith, Esq., EVP or Buell Miller, M.D., consultant to the Membership and Membership Benefits Committee.

Many thanks to these two new group members.  We appreciate their support.

  [return to top]

State Senate Confirms Nicholas as DHS Commissioner
Acting DHS Commissioner Jack Nicholas was confirmed by the State Senate on April 1 to become the Commissioner of the Department of Human Services.  The vote was 31 in favor and 4 opposed.  During his nomination hearing, there was considerable support from various colleagues of the Commissioner and a handful of legislators.  Several persons expressed some concerns that his background lacked experience in social services, although his financial background was lauded.  In Committee, only Senate Chair Mike Brennan and Representative Craven voted against his nomination.  Commissioner Nicholas is also expected to become the Commissioner of the merged departments, although the HHS Committee is currently working on the process for that transition.  Voting against the Commissioner in the Senate vote were Senators Brennan, Bromley, Daggett and Hall. [return to top]

CCMEA Annual Dinner for CME Providers, April 29, Senator Inn, Augusta
The Maine Medical Association is the accrediting body, through the ACCME, for 29 providers of CME in Maine.  Each year, MMA, through its Committee on CME and Accreditation holds an annual dinner and program for the coordinators and medical directors of the CME providers.  This year's dinner will be held on Thursday, April 29th at the Senator Inn in Augusta.  The Dinner will be preceded by a reception at 4:15pm and a presentation by  Steven Wayne Strode, M.D., MEd, Director of the Telemedicine Program, Regional Programs, University of Arkansas for Medical Sciences.  Dr. Strode is one of the nation's leading experts in distance learning programs.

The reception, program and dinner are offered without cost.  A meeting of the MMA Committee on CME and Accreditation will be held at 2:00pm on the 29th at the MMA office in Manchester.

Any CME coordinator and any MMA member or other physician involved in CME is welcome to attend any of the above.  Please contact Gail Begin at MMA( gbegin@mainemed.com)  to confirm your attendance or ask for more information.  The MMA Committee is chaired by Peter Leadley, M.D. of Rangeley.

The MMA appreciates the dedicated work of the coordinators and medical directors of these programs.  The Annual Dinner is one small way to show our appreciation. [return to top]

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