May 24, 2004

 
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Draft State Health Plan, Capital Investment Fund for CON Unveiled
The Governor's Office of Health Policy and Finance on Tuesday released a 24 page draft State Health Plan and a 10 page proposed rule establishing the CON Capital Investment Fund. Release of these documents begins a process involving public comment that ultimately will result in important and no doubt, controversial limits being placed on the investment of capital in healthcare in Maine.
The Advisory Council on Health Systems Development, the committee created by Dirigo Health to draft the State Health Plan, met last Tuesday to review a draft, " State Health Plan" presented by Trish Riley and Ellen Schneiter of the Governor's office. The Governor's Office of Health Policy and Finance  will be posting the draft Plan on its website soon and MMA will  make the link available to MMA members.  The Council only began meeting four months ago and immediately faced a May 31, 2004 deadline for a finalized State Health Plan.  So, given the limited time, Council members through staff have devised a one-year plan and will be using recent grant money to do the research and get the public input needed to do a more comprehensive, two-year plan, as required by statute.  MMA President Maroulla S. Gleaton, M.D. is a member of the Council.  Other physician members include Lani Graham, M.D. and Robert Keller, M.D.  

Several Council members expressed their concern at the meeting that the plan seemed more like a financial plan rather than a real state health plan.  Indeed, the CON law is supposed to take guidance from the new state health plan which was the Administration's argument for including so much cost containment strategy.   The plan is divided into four sections: Cost, Quality, Access and Public Health.  It seemed clear at the meeting that most members had already given their comments to Trish and therefore much of the meeting was devoted to determining the best way to get public input, the importance of and the type of data needed, and the process for going forward with a two-year plan.

The Council also released more information on the draft rule for the Capital Investment Fund.  This Fund was established in the Dirigo Health legislation. The Fund is not really a pool of money, rather it is simply a financial number which serves as an annual limit on new CON approved expenditures.  The Fund is divided into hospital and non-hospital projects which are again then divided into big projects and small.  The proposed rule, when finalized, will  be posted and will go through the rule-making process, which means it will have a public comment period and will need to go to the Legislature for final approval.  Again, we'll make the link available to MMA members when it is posted which is scheduled for this Wednesday, May 26.

The Governor's Office of Health Policy and Finance has proposed that the Capital Investment Fund be established at approximately $4.9 million for the first year.  As the limit is a limit on the total amount of third-year operating costs associated with all the approved CON projeccts for the year, it is difficult to know the potential impact of the limit on capital investment in health care in the state.  We do know, however, that the proposed limit is less than the third-year operating costs approved in 2003 ($7.9 million) and is less than the five-year average of $5.5 million per year.

The Maine Hospital Association has already expressed concern about the sizing of the fund, noting in its recent Friday Report that not only is the limit lower than the expenditures associated with projects in prior years, but also noting that the limit will be for projects that would normally have been proposed over a 24-month period (because of the one year moratorium just ended).

The proposal from the Governor's office is consistent with comments made by staff concerning their belief that Maine's health care expenditures are higher than the national average and unsustainable given Maine's poor economic climate.  MMA and MHA representatives will offer comments at the June 4th meeting and because the rule is a major substantive rule, the public and all interested parties will have an opportunity to comment on any final proposal at further public hearings.  The MMA Executive Committee will consider the proposal at its June 9th meeting.

Any MMA member wishing to offer input into the MMA's comments should communicate with either Andrew MacLean, Gordon Smith or Anna Bragdon at 622-3374 or at amaclean@mainemed.com; gsmith@mainemed.com; abragdon@mainemed.com.

The Council agreed to meet every two weeks throughout the summer.  At their next meeting, June 4, Councio members will review the final draft of the State Health Plan and take public comment.  They expect to vote on the plan at their June 15 meeting.  The June 4th meeting will begin at noon at the DHS Office, 442 Civic Center Drive, Augusta (Conference Rooms 1A& 1B.)

At the meeting, Trish Riley, Director of the Governor's Office of Health Policy and Finance, laid out an agressive plan of public participation in development of the two-year State Health Plan intended to take effect in June 2005.  The process would have the following five components:

             *   A base line of credible, regionalized data on cost, quality, access and health status.

             *   A regional process, involving at least three regions in the state, to engage all stakeholders in examining data and setting regional goals and benchmarks.

              *   A statewide campaign called, "Tough Choices" to receive public input on the proper allocation of limited resources for healthcare.

              *   A global budet, also referenced as Expenditure Targets.

               *   A review of State Health Plans and planning efforts by other states and regions.

Late Additions to Physician Survival Programs Wednesday and June 23
Nearly one hundred physicians and practice managers are expected to attend MMA's educational program at the Hilton Garden Inn in Auburn on Wednesday (May 26).  Seven and one-half hours of category one credit of CME is being offered on topics such as HIPAA security,  Health Care Fraud Enforcement, Disease Management, MaineCare, Dirigo Health and Prescription Drug Abuse (partial listing).

U.S. Attorney for the DIstrict of Maine Paula SIlsby is the keynote speaker at the day long conference.  Recent additions to the program include Karen Harrington, sales manager for the DIrigo Health program and a presentation on the Medicare Prescription Drug and Modernization Act.

It is not too late to register for the Wednesday conference and the presentations will be repeated in Bangor on June 23rd.  Contact Chandra Leister at MMA at reigister for either day and location (622-3374 or cleister@mainemed.com).

These annual "Physician Survial" seminars give MMA the opportunity once a year to bring members up-to-date on the many legislative and regulatory issues affecting medical practice in Maine.  They are low-cost, and frequently scheduled at a location close to you.  Please consider taking advantage of them. [return to top]

Bidders Conference Held on Dirigo Health Insurance Product
At least four major insurance companies attended the bidders conference on the DIrigo Health Insurance Plan held last Monday in Augusta.  MMA representatives attended to assess the current level of interest among the potential bidders and to hear the questions asked and answered.

Tom Dunne, DIrector of Dirigo Health and Karen Harrington, marketing manager reviewed the Request for Proposals assisted by consultants from Mercer. MMA noted attendees from Anthem, Aetna, Harvard Pilgrim and United Healthcare. 

Proposals are due from potential bidders on June 11th.  If no bids are received, the state has the authority in the Dirigo Health legislation to go back to the legislature and establish its own insurance company to offer the product.  While it is assumed that that provision alone is likely to spur enough interest among existing carriers to make a bid to be the state's partner in this effort, the RFP is a very complex document, with many technical and financial provisions that may discourage even the most avid suitor. Further complicating the negotiations is the state's arcane and diificult contracting law, which makes it difficult to "negotiate" with a proposed vendor without risking an appeal by a rejector bidder (the recent award regarding the state's liquor business is a good example).

MMA staff will continue to follow the development of Dirigo Health and inform members and practice staff of its progress (or lack thereof) through the pages of this weekly electronic newsletter.  Dirigo Health continues to attract much attention from both the local press and national outlets.  Friday's Bangor Daily News contains another front page story on the Plan, commenting on a recent presentation by Trish Riley to Bangor area businesses. [return to top]

Nearly One-hundred Persons attend Second Annual MMA Corporate Affiliate Breakfast
Nearly a hundred persons attended MMA's second annual corporate affiliate breakfast on Friday, May 21.  Held annually to thank the many vendors, firms and companies supporting MMA and Maine physicians through this program, this year's breakfast at the Haraseeket Inn in Freeport featured a presentation on DIrigo Health by Robert McAfee, M.D.

In introducing Dr. McAfee, MMA President Maroulla S. Gleaton, M.D. noted that Dr. McAfee, now serving as Chairman of the Board of DIrigo Health, has provided a lifetime of service to his native state and its citizens.  Now retired after over 30 years of surgical practice in Portland, Dr. McAfee served as Prsident of the Maine Medical Assocaition in the 1980's and went on the serve as President of the American Medical Association in the l990's, playing a pivotal role in the nation's consideration of the Clinton Health Plan in l994-95.

Dr. McAfee since his retirement has focused Maine's attention on tobacco-control, prevention of domestic violence and more recently, on access to care.  He is a tireless advocate on behalf of public health.

In his presentation Friday morning, Dr. McAfee noted the five major determinants of a person's health, noting the relatively small impact that the healthcare delivery system has  compared to the additional factors of genetics, the environment, social-economic status and personal responsibility.

The MMA Corporate Affiliate Program currently has one hundred four participants. Congratulations to MMA Membership Coordinator Lisa Martin who coordinates the program, Buell Miller, M.D. consultant to the Program and Kevin Flanigan, M.D. Chairman of the MMA's Committee on Membership and Member Benefits for another successful year promoting the Program. [return to top]

Hospital Study Commission Hears Update on Medical Errors
The Hospital Study Commission established in the Dirigo Health legislation met again on Monday, May 17 to hear presentations on medical errors.  Presenters included Louis Dorogi, DIrector of the DHS Division of Licensing and Certification, Jill Rosenthal, of the National Academy of State Health Policy and Rebecca Martins from the National Patient Safety Foundation. 

Of particular interest was Mr. Dorogi's presentation, as it contained the first known publicly available data on reports under the Maine reporting law which took effect in 2003.  Dorogi reported that so far, there have been 15 events, 9 of which were found to be reportable under the statute and 7 of which resulted in the death of a patient.  Under the law, only institutional errors are reported and the reports made available to the public may not identify the institution which filed the report.  After the completion of each year, the Division will issue an annual report with aggregate data.

Ms. Rosenthal provided information on medical errors across the country and re-hashed data from the well-known Institute of Medicine reports.

Rebecca Martins, a Maine resident, has become a patient advocate since an unfortunate experience involving the care of her father in l998.  She was an advocate for passage of Maine's reporting statute and has continued to be involved in the issue of medical erros in both Maine and outside the state.  She is a board member of the National Patient Safety Foundation, representing the public.

The Hospital Study Commission meets again on Monday, June 7th, at an all-day retreat at the Daniel Stone Inn in Brunswick.  The Commission intends to begin serious deliberations on the issues it intends to make recommendations on in its report to the legislature in November.  To date, the Commission has been just receiving information from various parties.  Physician members on the Commission are Drs. Johua Cutler and RIchard Wexler.

Unfortunately, Dr. Wexler informed MMA and the Commission this week of his need to step down from the Commission as he has accepted a new position.  While the position is in Maine, Dr. Wexler has indicated that the time demands of the new position will preclude him from giving the time necessary as the Commission heads into a fairly intense, deliberative period.  Dr. Wexler has served ably as a very conscientious and influential member of the Commission and will be missed.

MMA assumes that the Commission, through the Governor's office of Health Policy and FInance, will be looking for a replacement for Dr. Wexler.  If any MMA member has an interest and time to serve, please communicate directly with Gordon Smith, EVP of MMA at gsmith@mainemed.com. [return to top]

Medical Staff Leaders Gather at Sunday River
Leaders of several Maine medical staff met on May 13th at Sunday RIver to hear presentations and to discuss matters of mutual interest.  Held in connection with a major two-day educational program organized by the Maine Association of Medical Staff Services, staff leaders heard presentations from Elizabeth Snelson, Esq. on medical staff bylaws and on "disruptive" physicians.  Ms. Snelson is considered by many observers to be the most experienced health law attorney who focuses only on medical staff representation.  In other words, she represents only medical staff/physician interests, as opposed to representing hospitals.  Her practice is based in St. Paul, Minnesota.

At a lunchtime business meeting of MMA's Hospital Medical Staff Section, Bangor physician John "Jack" McGill presented AMA materials on operation of a self-governing medical staff.  Governance issues around the state were discussed and members of the section agreed to meet again in the Fall. The Chair of the section, Charles "Tom" McHugh, M.D.  welcomed members and presented a proposal which would advance the ability of MMA to better serve the legal interests of medical staffs in the state.  The next meeting of the section  is likely to be on Wednesday, Oct. 27th at the Frank O. Sred Building in Manchester (the MMA's office building).

The MMA Hospital Medical Staff section is made up of elected medical staff officers of Maine's hospitals.  Twice a year, members are invited to participate in the AMA's meeting of its Organized Medical Staff Section.  The next AMA Section meeting is in Chicago, June 9-11, 2004.   Interested physicians may receive registration materials from MMA or the AMA.  Contact Gordon Smith at gsmith@mainemed.com.  Elected officers of a medical staff may attend at least an initial meeting of the section without being an AMA member. [return to top]

Update on Pathways to Excellence; A Project of the Maine Health Management Coalition
The Pathways to Excellence (PTE) Project , sponsored by the Maine Health Management Coalition (MHMC), is about to launch its third of three components of its Primary Care Initiative - Clinical Outcomes.  The  sponsors are asking for primary care practices to participate and report clinical outcomes on diabetic patients as well as assisting in framing the outcomes component of PTE in 2005 and beyond.

The MHMC is an organization of 32 employers in Maine that includes large businesses, public employers, hospitals, health plans, and physician groups as members.  Collectively, these employers purchase health benefits for over 250,000 persons in Maine.  The three components of the PTE initiative are to measure practice systems for chronic illness care, measure practice process measures using HEDIS criteria and gathering and reporting on clinical outcomes.

The two main goals of the PTE initiative are to:

           * Measure quality with a goal of sharing this information with MHMC member employers and their employees and families.

            * Recognize and Reward practices that are able to demonstrate they offer high quality care and outcomes.

Maine employers are insisting that good information be made available to their employees to aid them in the selection of health care providers and services, and to assist them in becoming educated on approaches to self-care and wellness habits which will assist them in staying healthy and self-managing chronic illnesses.  The Coalition believes that educated consumers using health care providers who demonstrate high quality care delivery can result in better outcomes for patients and significant savings in health expenditures which can then be shared with both the patients and their doctors.

Certainly one incentive for practices to participate involves the notion of Pay for Performance.  At least one major payer, Cigna, is working with the Coalition this year and may link its quality bonus to the measurements developed by the PTE Project.  Anthem has indicated an interest in linking its 2005 payment increases to PTE criteria.

While an ultimate intent of the program is certainly to make data publicly available, the Project has agreed not to publish the data on a particular practice unless the practice agrees.  Because this program is new,  the Project will be going slow with respect to the release of the data.

All primary care practices will be receiving a mailing from the Project inviting participation.  It is anticipated that the mailing will go out around June 1st.  Practices will have until July 15th to submit data electronically to the Maine Health Information Center, an independent data organization, which will collate the results.  Practices will receive a blinded report of all responses and a practice code to indentify the practice.  Each practice will also receive a report which displays the format which will be used for public reporting on the MHMC website this fall. (but again, each practice will have an opportunity to prevent its data from public release).  The Coalition hopes to repeat the outcomes measurement process on an annual basis and undoubtedly will be adding additional measurements over time.

Since the results of the survey will be publicly reported and will influence pay by some payers, a percentage of practices will have their work process and results verified through visits from independent nurse reviewers hired by the MHMC.  This will help ensure that practices are reporting outcomes information accurately and appropriately.

The Maine Medical Association neither endorses nor opposes this Project.  MMA was invited to participate in the originations of the PTE Program two years ago, but declined believing that the more appropriate role of the Association would be to educate its members about various measurement projects and pay for performance initiatives.  This article is part of that educational effort., as were the presentations on PTE at the Physician Education seminars last spring.   As always, MMA welcomes input from its members who are participating in these types of projects.  The Pay for Performance movement is in its infancy and it will take many months, if not a few years, to determine whether the measurements are appropriate, fairly applied and whether the financial incentives are sufficient to induce participation.

MMA has appreciated the opportunity to be kept well-informed of the project and the open invitation to attend the meetings of the clinical advisory committee.  Virtually all of the physicians on the clinical advisory committee are MMA members.

The Project's Clinical Advisor is Jan Wnek, M.D. (janicewnek@mhmc.info) and the Project Leader is Ted Rooney (729-4929 or trooney@mhmc.info).  Technical or procedural questions may be addressed to either Dr. Wnek or Mr. Rooney.

The current President of the Maine Health Management Coalition is Peter Hayes, of Hannaford Brothers.  Mr. Hayes was a member of the Health Care Reform Commission appointed by Governor John McKernan in the early 1990's.  That Commission was chaired by Robert Keller, M.D. [return to top]


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Maine Hospice Council Celebrates 20 Years
The Maine Hospice Council is celebrating its 20th anniversary on Thursday, June 17 at its annual meeting.  The meeting, which is being held at the Cliff House in York, begins with registration at 9:00am and will end around 3pm.  Everyone is invited to attend.   The keynote speaker is William H. Colby, JD, author of Long Goodbye:The Deaths of Nancy Cruzan.  To register, call 800-438-5963, by June 7. [return to top]

Feds Scrutinize Anthem Provider Contracts
The U.S. Justice Department recently announced that it is investigating Anthem, Inc.'s use of "most-favored nation" clauses in provider contracts in the Indianapolis market.  The clauses, which at one time were common in managed care contracts, essentially require health professionals to offer their lowest rates charged for medical services to the health plan's insureds.  Anthem officials claim the request for "lowest comparable rates" is common.  However, physicians believe the clause eliminates competition from other carriers in the market because "nobody can undercut them."  "Learning the investigation exists is a positive step, noted David Wilson, M.D., President of Multi-County Physicians based in Columbus, IN. The physician group had unsuccessfully lobbied in the past for state laws banning the clause. [return to top]

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