April 26, 2004

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Dirigo Health Hospital Study Commission Update
The Commission to Study Maine's Hospitals met in Augusta on Tuesday, April 20, and heard presentations from Andrew Coburn of the Institute for Health Policy at the Muskie School of Public Service and John Welsh, President of Rumford Community Hospital.

Dr. Coburn (PhD) presented an overview of the Medicare Rural Hospital Flexibility Program, including its origins, its implementation, and its impact.  The key feature of the program is the ability of some hospitals to be designated as critical access hospitals, allowing such facilities to receive enhanced reimbursement from Medicaid and Medicare.  Recent changes to the federal law permit more flexibility and increase the permissible number of inpatient beds to 25.  There are currently 882 hospitals in the U.S. with critical access status with over 100 more in the pipeline.  Eight hospitals in Maine have converted and another five or six are potentially eligible.  The impact of the federal law on these hospitals has generally been favorable, as described by Dr. Coburn.  Among the benefits of conversion to critical access status has been better access to capital, improved profitability, and better integration of emergency medical services.

Following Dr. Coburn's talk, commission members heard a presentation from John Welsh, President of Rumford Community Hospital (RCH).  RCH has converted to critical access status and also is linked organizationally to Central Maine Medical Center in Lewiston.  Mr. Welsh, who is a member of the commission, also spoke very  favorably of the federal law, but did note the importance difference between costs, as paid by the hospital and "allowable" costs as defined by the government.  While theoretically, critical access hospitals are paid the cost of treating publicly insured patients, not all costs are "allowable" by the government.

Mr. Welsh also spoke very positively about the financial benefits of consolidation, noting the funds saved by RCH by sharing administrative expenses and some personnel expenses with Central Maine Medical Center.

Following these two presentations, Nancy Kane, PhD, a consultant to the commission spoke briefly on the survey she is conducting of Maine hospitals.  She is gathering data on financial information, bad debt, charity care, and other related issues.  Her findings will be presented at the June 21st meeting of the commission.

Commission Chairman William Haggett noted that the commission has many outstanding issues and further recognized that members have heard many presentations but have not had much opportunity to mull things over and discuss where they stand on some of these important issues.  He proposed having a retreat with a facilitator to go over the issues with the group and to assist in gathering the group's views.  The need to meet away from Augusta was expressed and it was agreed to conduct retreats on the two meeting dates in June, those dates being June 7 and June 21.  Following these June meetings, the members would determine whether to meet on a weekly basis for the remainder of the time they are together.  They are due to report to the Governor and the Legislature in November of this year.

Joint Commission Wants Your Input on 2005 National Patient Safety Goals
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is currently conducting a field review of the proposed 2005 National Patient Safety Goals.  The field review deadline is April 30, 2004.

All of the information that you need to participate in the field review can be found on the JCAHO website at: http://www.jcaho.org/accredited+organizations/05npsgfr.htm (If the link is not active, cut and paste the text into the address bar of your browser). [return to top]

Reminder of CCMEA Annual Dinner Program, April 29th, 2004
The MMA's Committee on Continuing Medical Education & Accreditation will hold its annual dinner and program on Thursday, April 29 at the Senator Inn, Augusta.  A social half hour will be held from 4:45pm until 5:15pm.  At 5:15, Steven Strode, M.D., Director of the Telemedicine Program, University of Arkansas for Medical Services, will speak.  Following his presentation, The CME Award of Excellence will be presented, by MMA President Maroulla Gleaton.  A seafood dinner will be served at 6:30pm.

There is no charge to attend this event for physicians involved with CME or staff coordinators.  For meal planning purposes, please let Gail Begin at MMA know if you are planning to attend. (gbegin@mainemed.com)

The Maine Medical Association accredits 27 providers of CME in Maine through the Committee on Continuing Medical Education and Accreditation.  The Committee is chaired by Peter Leadley, M.D. of Rangeley and staffed by Gail Begin.

Earlier in the day on the 29th, the Committee will hold a regular meeting at 2:00pm at the MMA office in The Frank O. Sred Building in Manchester.  Any physician or staff CME coordinator is also invited to attend the meeting.  Following the meeting, at approximately 3:30pm, interested physicians and coordinators are invited to meet with Dr. Strode and ask questions regarding CME matters. [return to top]

MMA Payor Liaison Committee Meets with Anthem
MMA's Payor Liaison Committee met with representatives of Anthem Blue Cross and Blue Shield of Maine on April 21 regarding the company's new "pay for performance" initiative called "Quality Insights."  Representing Anthem were Patricia Richards, RN, Vice President, Health Care Management, Daniel McCormack, Executive Director, Provider Network Contracting, and Deborah Silberstein, RN, Quality Mangement.

The new initiative is modeled loosely on the work of the Pathways to Excellence Program, sponsored by the Maine Health Management Coalition.  While the program is voluntary and a physician or medical practice can only increase its reimbursement by participating in the program which will measure certain clinical performance, over time, reimbursements will grow in disparity based upon performance.

While all the details have not been worked out, the program is likely to begin on July 1, 2004 with the payment for performance not being available until after the first year of data is available in the summer of 2005.  Initially, only primary care practices will be included, with measurements being taken in the area of diabetes care, asthma treatment, adolescent well-care, ADHD, childhood and adolescent immunizations, and coronary artery disease.

The program will be implemented in all three of the Anthem East states, Maine, New Hampshire, and Connecticut. 

Committee members posed several questions to the Anthem representatives.  Details will be sent soon to all Anthem participating primary care physicians.

The MMA's Payor Liaison Committee is made up of interested physicians and practice managers and meets bi-monthly.  The Committee is chaired by Thomas Hayward, M.D. Persons interested in being members of the committee should communicate that interest to Chandra Leister at MMA, who serves as staff to the committee (cleister@mainemed.com).

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Governor Signs Acupuncture Bill; Legislature Returns Tomorrow
Today, the Governor's Office called to inform MMA that Governor Baldacci has signed L.D. 263, An Act to Define a Scope of Practice for Acupuncture, a bill permitting acupuncturists to provide a number of techniques known as "oriental medicine."  The MMA opposed the bill because of concerns that state licensure will put the State's imprimatur on techniques having little or no scientific basis and is, therefore, a threat to public safety.  MMA's leadership also believed that the Legislature was applying a "double standard" by heavily emphasizing patient safety and evidence-based medicine for traditional medicine, but not doing the same for practitioners of alternative medicine.  While we are disappointed, we are not surprised at this result.  Next week, we will share with you the Governor's letter explaining his decision on this bill.

The Legislature returns to Augusta this week for sessions on Tuesday, Wednesday, & Thursday in which it will try to resolve the remaining issues, including the second supplemental budget of this year (L.D. 1919), bonds, and tax reform. [return to top]

AMNews Article Provides National Overview of Medicaid PDL Programs
Maine physicians are not alone in dealing with the administrative and patient safety issues raised by a drug management technique increasingly adopted by state Medicaid programs to contain costs - - the "preferred drug list" or PDL.  According to the National Conference of State Legislatures, 26 states now have a PDL and 10 others are considering this approach.  Read "Medicaid short list:  Prescribing a hassle factor" in the 5/3/04 edition of American Medical News.  It provides a good overview of PDL programs nationwide. [return to top]

AMNews Article Highlights Franklin Memorial's Contract for Care Program
American Medical News describes Franklin Memorial Hospital's Contract for Care program in which indigent patients can meet their financial obligations to the hospital by doing volunteer work in the facility.  Read "Maine program offers new option for paying hospital bill" in the 5/3/04 edition of American Medical News. [return to top]

DHS/BMS Proposes Amendments to Hospital Licensing Regulations
The DHS Bureau of Medical Services has proposed changes to the hospital licensing regulations governing the Medical Staff and Allied Health Staff and Pharmacy services in Maine's hospitals.

According to the Bureau's summary of the medical staff changes, they "more clearly define the staff categories as reflective of the change in the title, and organize the chapter into three (3) distinct areas addressing organization and structure, membership and privileges, and quality improvement.  These changes eliminate duplication and promote organization of the regulations into clearly identified areas, identify the appointment/reappointment and privileging requirements and timeframes, and address the quality improvement responsibilities of the Medical Staff."

According to the Bureau's summary of the pharmacy changes, they "organize the regulations into clearly identified areas of Personnel, Physical Facilities, Policies and Procedures, Pharmaceutical Preparation, Dispensing and Medication Order Review, Automation, and Quality Improvement.  The reformatting of the regulations into these areas eliminates duplication and more clearly addresses the responsibilities while emphasizing error reduction and safety."

You may download the proposed amendments for review from the following page on the BMS web site:  http://www.state.me.us/bms/rulemaking/lic_c_112_p_complete/lic_c_112_p_complete.htm

The public hearing on the rule is tomorrow, 4/27/04 at 1:30 p.m. in Conference Room 1A/1B at the BMS office, 442 Civic Center Drive, Augusta, Maine.  The MMA will attend.  The written comment deadline is Friday, 5/7/04.  You may forward any comments you may have to MMA EVP Gordon Smith at gsmith@mainemed.com for inclusion in the MMA's written comments or you may submit them directly to the BMS by sending them to:

Louis T. Dorogi, Director, Division of Licensing & Certification, State House Station 11, Augusta, Maine 04333-0011.

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