May 17, 2004

 
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MeHAF Awards Major Grant to Governor's Office for Dirigo Health Plan
Dirigo Health Plan receives its second financial boost to its implementation process since passage of the legislation last year.
 

The Maine Health Access Foundation has awarded $877,133 to the Governor's Office of Health Policy and Finance (GOHPF) to fund key implementation activities within Dirigo Health.  This is the second major grant to GOHPF.  The first one, awarded last year, helped fund the creation of the office and the research which went into drafting the Dirigo plan. 

The grant is expected to fund three key activities:  (1) Research, fact finding, and public input for creating the State Health Plan, (2)  Hiring external consultants for the Commission to Study Maine's Hospitals, and (3)  Marketing the Dirigo Health Plan.

You can read the Governor's statement at http://www.maine.gov/tools/whatsnew/index.php?topic=Portal+News&id=2360&v=Article

Update on Maine Quality Forum Advisory Council
The Maine Quality Forum Advisory Council met on Friday, May 14th.   Dirigo Health Executive DIrector Tom Dunne gave an overview of the current Dirigo activities, highlighting the fact that the Request for Proposals (RFP) to insurers interested in offering the Dirigo Health Product had been released a week ago.  A bidder's conference was held on May 17th and bids are due to be returned to the DIrigo Board by June 11th.  Prior to releasing the RFP, the Dirigo Board had refined the target health insurance program, including setting eligibility guidelines for part-time employees.

While the Dirigo Health statute does not preclude the Board from working with more than one insurance carrier, it is expected that the Board will choose to work with only one vendor initially.  If no bid is forthcoming, the state will consider forming its own insurance company to offer the product.

Following the report from Mr. Dunne, the Advisory Council heard from the subcommittee organized to solicit nominations for the MQF Provider Group.  The Council accepted the recommendations of the subcommittee and the nominations will now move to the Dirigo Board.  Physicians nominated include Drs. Stephen Sears, Philip Elkin, Bruce Bates, and Douglas Jorgensen.  The Provider Group is advisory to the Council and is expected to meet about four times a year and make recommendations on issues referred to it by the Council.

In the area of Technology Assessment, it was announced that Council member and attorney Jonathan Beal of Portland has agreed to lead the MQF Advisory Council Technology Assessment Sub-group.  Mr. Beal will help lead the effort to look at health technology assessment as it pertains to the State Health Plan and in  the Certificate of Need process.

Most of the reminder of the meeting consisted of Executive Director of the Forum Dennis Shubert, M.D., PhD, informing the Board of the opportunities to improve quality through advancing information technology in the delivery system.  The need for connectivity was emphasized and the Council approved Dr. Shubert utilizing some of the Forum's funds and his time to work with other parties in planning for a connected system of electronic medical information.  The planning process would be led by the Maine Health Information Center and all major stake-holders (including MMA) would be involved.

Dr. Shubert also noted an anesthesia "best practices" project as one example of how the Forum can work on more focused, best-pratices.  The difficulty of working more broadly on best-practices across the system was noted and Dr. Shubert commented that he did not feel it was the role of the Forum to do so.  David White, a member of the Council, had asked for a general "best-practices" review.

The Council meets next on Friday morning, June 11 in Augusta.

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Commission to Study Maine's Hospitals Briefed on Maine Patient Safety Law
At its meeting yesterday morning, the Commission to Study Maine's Community Hospitals received a briefing about state patient safety and medical error reporting laws including Maine's P.L. 2001, Chapter 678, An Act to Reduce Medical Errors & Improve Patient Health (120th Maine Legislature, L.D. 1363).  Lou Dorogi and Mary Dufort from the  BMS staff provided a summary of the Maine law and its implementation.  Jill Rosenthal, a project manager with the National Academy of State Health Policy, presented an overview of state patient safety initiatives around the country.  You can find more information about state quality and patient safety initiatives at the National Academy for State Health Policy web site, www.nashp.org.

The Commission has planned a day-long retreat for Monday, June 7th at the Daniel Stone Inn in Brunswick.  Frank O'Hara will facilitate the retreat which has 3 goals:

  • to focus on the issues for further study and research;
  • to determine the process for the Commission to reach its conclusions--whether by consensus, majority, etc.; and
  • to discuss how the Commission will prepare its final report due in the Fall.
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New PDL to be Released This Week
The Bureau of Medical Services will be including the new Preferred Drug List in this week's quarterly mailing to providers.  It will include a summary of all the changes to the list with explanations.  You will be able to save the new PDL as an EXCEL spreadsheet.  They have also included a table of contents by category this year.  The mailing will also inform providers if they qualify for the coveted PDL exemptions.  BMS also announced that they are working on making the PDL available on ePocrates by mid-September.  [return to top]

AMA Proposes to Expand Health Coverage
An article in the May 12, 2004 issue of JAMA outlines the AMA's plan to increase health insurance coverage.

Under our current employer-based system, much of the $188 billion federal tax subsidy favors relatively wealthy employed people and their families, but does little for those without employer-based coverage and those in the lowest-income tax brackets.

The centerpiece of the AMA proposal is a federal tax credit system that would replace the current federal tax exclusion of employer-based health insurance.  The credits would be inversely related to income, refundable, and advanceable - - and large enough for most individuals and families to be able to afford insurance.  Employers' spending on employee health benefits would remain fully deductible as a business expense, but employer-based plans would no longer be the only group coverage option.  A health insurance market with a variety of choices would increase satisfaction and access to care.  The AMA plan would reform the health insurance market with incentives to offer a wider range of new, affordable, and permanent insurance options.

You can read more about the AMA plan at:  http://ama-assn.org/go/insurance.

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AMA Responds to Concerns About Prescribing Data
The AMA has recognized that the inappropriate use of prescribing data is a growing concern among physicians.  As part of a multi-phased plan to address these concerns, the AMA, advocating on physicians' behalf, has created an internet-based resource, the Prescribing Data Information Center.  It contains information on how pharmaceutical companies use prescribing data, the AMA Use of Prescribing Data Guidelines, and a newly created physician feedback form.

"The feedback form has been developed to give physicians a place to express their opinions on the use of prescribing data and to register specific concerns," said AMA Trustee Cecil B. Wilson, M.D.  "This is the first step of many the AMA plans to take to address this important issue."

The AMA is committed to ensuring that prescribing data is used responsibly and ethically.  In 2001, the AMA developed Best Practice Guidelines for the Use of Physician Specific Prescribing Data which calls upon the pharmaceutical industry to respect the confidentiality of prescribing data, while recognizing its usefulness.

Visit http://www.ama-assn.org/ama/pub/category/12054.html to learn more. [return to top]

NIST Explains HIPAA Security Rule
The National Institute of Standards & Technology recently released draft guidance on the HIPAA security rule.  NIST Special Publication 800-66 (May 2004) provides a summary of the security rule standards and "explains some of the structure and organization" of the rule.  The deadline for compliance with the rule is April 2005.

You can find the draft guidance on the web at http://www.csrc.nist.gov/publications/drafts/DRAFT-sp800-66.pdf.

 

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U.S. House Again Passes Tort Reform Bill
On May 12, 2004, the U.S. House passed the Help Efficient, Low-cost, Timely Healthcare (HEALTH) Act of 2004 (H.R. 4280, Greenwood, R-PA) by a vote of 229-197.  The bill is almost identical to H.R. 5, a bill that passed the House in 2003.  It includes the following elements:

  • a $250,000 cap on non-economic damages;
  • punitive damages reform;
  • a 3-year statute of limitations;
  • a "fair share rule" so that damages are allocated in proportion to a party's degree of fault (joint & several liability reform);
  • a sliding scale on contingency fees;
  • periodic payments of judgments that equal or exceed $50,000; and
  • a provision that allows the introduction of collateral source benefits into evidence.

Consistent with their voting records, neither Congressman Allen (D-1st District) nor Congressman Michaud (D-2nd District) voted for the bill.

The House plans to package this bill with a bill on flexible spending accounts (H.R. 4279) and another on association health plans (H.R. 4281) to go to the Senate for consideration. [return to top]

Some Physicians to be Reimbursed for Online Consultations
Two health plans recently have announced that they will begin reimbursing physicians for online consultations with patients.  New York-based Group Health, Inc. will offer the software to area physicians that will enable patients to communicate via the web to request appointments, prescription refills, lab test results, and other simple messages.  Physicians using the software will pay a monthly maintenance fee of roughly $50 to use the software.  Group Health anticipates, but has not yet finalized, paying physicians a $25 fee for the appropriate, non-emergency, online consultations.

Also, Oregon-based Providence Health Plan has become the first health insurer in the state to begin reimbursing physicians for electronic visits with their patients.  Under the reimbursement plan that began in January, physicians receive $40 for e-visits, $10 of which is paid by the patient. [return to top]

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