May 31, 2004

 
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Draft State Health Plan Goes to Public Hearing
The Governor's Office of Health Policy & Finance has prepared a draft State Health Plan pursuant to the Dirigo Health legislation; MMA encourages you to review this document that will have a significant influence on the future of health care in Maine.

 

The Dirigo Health Advisory Council on Health Systems Development is holding a public hearing on the Governor's draft State Health Plan from noon to 4 p.m. on Friday, June 4, 2004 at the offices of the Bureau of Medical Services, 442 Civic Center Drive, Augusta.   A copy of the draft can be found on the Office of Health Policy's website http://www.maine.gov/governor/baldacci/healthpolicy/index.html.

The Council will hear from the public in the following order:

  • Consumers
  • Business and Purchasers/Insurers
  • Providers
  • Others

You may attend the public hearing yourself,  but we also welcome your comments on the draft plan.  The MMA staff will present testimony on the draft plan.  Either email or call Gordon Smith (gsmith@mainemed.com), Andy MacLean (amaclean@mainemed.com) or Anna Bragdon (abragdon@mainemed.com).  They can all be reached at 207-622-3374.

The Dirigo Health legislation (L.D. 1611, P.L. 2003, Chapter 469) directs the Governor to develop and issue a biennial State Health Plan with input from the Advisory Council on Health Systems Development, the Maine Quality Forum, and the Maine Quality Forum Advisory Council, a statewide health performance council, and others.  The plan must be "a comprehensive, coordinated approach to the development of health care facilities and resources in the State based on statewide cost, quality and access goals and strategies to ensure access to affordable health care, maintain a rational system of health care and promote the development of the health care workforce."

The legislation lists the following requirements for the plan.  It must:

  • Assess health care cost, quality and access in the State;
  • Develop benchmarks to measure cost, quality and access goals and report on progress toward meeting those goals;
  • Establish and set annual priorities among health care cost, quality and access goals;
  • Prioritize the capital investment needs of the health care system in the State within the capital investment fund;
  • Outline strategies to promote health system change; address the factors influencing health care cost increases; and address the major threats to public health and safety in the State, including, but not limited to, lung disease, diabetes, cancer and heart disease; and
  • Provide recommendations to help purchasers and providers make decisions that improve public health and build an affordable, high-quality health care system.

The legislation states that the plan must be used in determining the capital investment fund amount and must guide the issuance of certificates of need by the State and the health care lending decisions of the Maine Health & Higher Education Facilities Authority.  "A certificate of need of public financing that affects health care costs may not be provided unless it meets goals and budgets explicitly outlined in the plan."

As MMA President Maroulla Gleaton is a member of the Health Systems Development Advisory Council, MMA has already, through Dr. Gleaton, provided significant input and comment on the draft.  However, we will make additional comments on Friday and may submit written comments as well prior to the deadline for written comments which is June 8th.  We will express concern about the references to a global budget (this language was removed from the Dirigo legislation as part of the negotiations which led to passage), and will express concern about some of the conditions that have been proposed to be attached to the Certificate of Need law.  We will make copies of our comments available to MMA members through this weekly update.

MeMGMA Seminar on June 23; MMA Physician Survival Program in Bangor June 23
This MeMGMA seminar is a Myers-Briggs Type Indicator (MBTI) session being held at St Mary's Regional Medical Center in Lewiston on Wednesday, 6/23 from 12:30 to 4:30 pm. The cost is $75 per person which includes the pre-testing and individual analysis and all seminar materials.  The seminar leader is Candace Sanborn from Encompass Marketing & Design, LLC.  She has been a qualified MBTI administrator for 10 years. Registration inquiries should be directed to Peter Allen at 1-800-640-0545.

The MMA Physician Survival Program is a duplicate (nearly) of the successful program held this past week in Auburn.  Nearly one hundred physicians and practice managers attended the Auburn program.  Keynoted by U.S. Attorney Paula Silsby, the program offered information on chronic disease management, MaineCare, Dirigo Health, compliance, HIPAA, Medicare, Prescription Monitoring, Certificate of Need, Board of Licensure in Medicine, and other relevent and timely topics. 

Registration materials for the Bangor program on June 23rd (at Spectacular Events) are available from MMA through Chandra Leister (622-3374 or cleister@mainemed.com). [return to top]

Massachusetts Blue Cross Plan to Reimburse for "Web-Visits"
According to an article in the Boston Globe on 5/24/04, Blue Cross Blue Shield of Massachusetts (BCBSMA) is the latest health insurer to announce plans to reimburse network physicians for e-mail communications, or "web-visits," with their members.  Beginning in August, BCBSMA will begin paying primary care physicians at several area medical centers $24 for a web-visit - $19 from the health insurer and a $5 co-pay from the patient. [return to top]

Nominations Sought for MMA Annual Awards
Several MMA Awards will be given at the Association's 151st Annual Session being held this year at the Colony Hotel in Kennebunkport from Sept. 10th -12th.  Notable among these are the Mary Cushman Award for Humanitarian Service and the President's Award for Distinquished Service.  Other awards for special recognition or achievement are also sometimes given.  A new award for lifetime commitment to health and fitness is also being considered.  The awards are presented at the Annual Banquet on Saturday evening, Sept. 11th.

All MMA members are asked to consider nominating individuals for these awards.  The recipient need not be an MMA member.  A letter stating why you think the individual is deserving and a CV of the nominee is all that is required.  Please submit the information to Diane McMahon at MMA by June 15th.  Additional information is available from EVP Gordon Smith at 622-3374 or gsmith@mainemed.com. [return to top]

Maine Hospital Association Releases Clinical Quality and Patient Satisfaction Scores
The Maine Hospital Association last week released, "Caring for our Communities:  Quality Performance and Improvement in Maine's Hospitals."  The report includes the scores from MHA's Clinical Quality and Patient Satisfaction projects.  The report shows that Maine's hospitals collectively score better than 97% of hospitals nationally in treating heart attacks and heart failure and collectively scored above a national norm 175 times in 16 categories of patient satisfaction.

The report describes how Maine hospitals perform in the treatment of heart attack and heart failure and how satisfied patients have been with their hospital experience.  In the clinical quality project, independent evaluators measured how often hospitals administered certain evidence-based treatments for cardiac events and heart failure. The analysis of medical records was conducted by the Northeast Health Care Quality Foundation, based in New Hampshire.  In the patient satisfaction project, an independent organization surveyed patients on their opinions regarding their hospital stay.  Both projects compared Maine hospitals to national counterparts.

The records analysis measured whether hospitals dispensed appropriate drugs at specified times during the hospitalization.  It also measured whether heart failure patients had a diagnostic test for heart function and whether heart attack patients who smoke were advised as to how to cease the habit.

On the patient satisfaction side, patients were questioned on a range of topics from pain management to physician care and the quality of food preparation.

The Association, which represents 38 of the 39 hospitals in the state, voluntarily undertook the projects with the intention of releasing reliable and comparable data to the public.

The report is available on the MHA web site at www.themha.org. [return to top]

Anthem Only Possible Bidder to Offer Dirigo Health Product
Monday, May 24th was the deadline for health insurers to submit a letter of intent, informing state officials of their possible intention to submit a bid to offer the Dirigo Health Product when bids are due June 11.  Although Aetna, Cigna, Harvard Pilgrim and United Health Care all attended the bidder's conference earlier in May, only Anthem filed the requisite statement last Monday stating that it MAY bid on the program.

If no bid is submitted, or if an Anthem bid is found not to be satisfactory, Dirigo Health officials will approach the Legislature and seek authority to form a state nonprofit insurance company to directly offer the product.  While this action would be a last resort, it was contemplated when the law was enacted.

The state hopes to offer a $1,250 deductible plan to a single employee for $282 a month with $846 for full family coverage. Discounts would be offered to persons living under 300% of the federal poverty level (about $28,000 for a single adult and $56,500 for a family of four.)

In only 10 days, the state will know which track it will need to take to get the much-heralded plan off the ground.  Any need for legislation would necessarily delay the plan by several months. [return to top]

Hospitals Fail Price Information Law; Could Physician Offices be Next?
On Wednesday, May 26th at the Physician Survival Seminar in Auburn, MMA EVP Gordon Smith warned attendees at the breakout session on legislation that physician practices have not moved fast enough to comply with the provision in the Dirigo Health law to provide patients with written notice of charges for their most common services.  He stated that he feared that a consumer group would randomly audit practices and find many to be out of compliance.

In the newspapers the following Saturday, an AP story appeared stating that, "Many Maine hospitals have failed to comply with a state law that requires them to post a price list for the most commonly performed procedures, the Maine People's Alliance said Friday."

In the "report card" based on visits to 36 hospitals, The Alliance said 60% got a grade of C or worse, indicating that a price list was not readily available.  The survey was conducted by more than 30 volunteers from the self-designated citizen's group, all of whom visited the hospital in the past three months.

While the hospital disclosure law is a bit different than the law applying to physician and all other practitioner offices, the intent is the same and the risk is certainly the same that practices may be cited for noncompliance.  In the statute, consumers are directed to file a complaint with the practitioner's licensing board if the law is not complied with.

If your practice has not caught up with this requirement, which took effect LAST SEPTEMBER, give Gordon or Andrew MacLean a call at MMA and we will be happy to discuss compliance with you and send you a copy of the one paragraph law.  While it is one more annoying thing to deal with, the requirement is simple enough and not difficult to comply with. (622-3374 or gsmith@mainemed.com or amaclean@mainemed.com). [return to top]

Medicare Recipients Can Use Drug Cards June 1, But Will They?
As Tuesday's starting date approaches for the Medicare drug discount card program, the number of recipients enrolling for the new benefit has been disappointing, according to observers following the implementation of the program.  For instance, AARP had signed up only 400 persons as of a few days ago, after sending out 26,000 enrollment kits to members.

The Bush administration projected that 7.3 million Medicare recipients would sign up for the cards, which can be used beginning June 1.  That number includes 4.7 million recipients with incomes low enough to receive $600 from the federal government this year and again in 2005 to pay for prescription drugs.  Nearly all observers agree that, at least for this particular group, signing up provides a direct financial advantage.

For recipients earning over the amount required to be eligible for the low-income benefit, confusion, conflicting political claims and swamped phone lines at the Medicare hot line have all combined to reduce purchasing of the card.  Even the Medicare web site is apparently difficult to use, making picking the right card a cumbersome task.  In addition, some advocacy groups and Democratic critics of the new Medicare prescription drug law have questioned the benefit of the cards.  Today's news of higher drug prices cancelling out much of the monetary benefit of the cards will add further to the confusion.

In Maine, the state has picked McKesson Health Solutions as the vendor of the program for the 5,800 Mainers who are income eligible for the state's Drugs for the Elderly Program and the special $600 benefit.  The company will ensure that these individuals use their $600 credit before tapping into the state funds, thus saving the state money.  The Department of Human Services will automatically enroll the individuals with McKesson, unless the individual indicates otherwise. [return to top]

Medicare/Physician Reimbursement - Trouble Ahead
Despite two recent legislative "fixes" that prevented steep Medicare physician payment cuts in 2003, 2004 and 2005, additional cuts are expected in 2006 and beyond unless Congress takes further action.  Why?  Because the underlying formula that sets Medicare payments to physicians, known as the Sustainable Growth Rate (SGR), is fundamentally flawed, and leads to dangerous payment cuts that jeopardize Medicare beneficiaries' access to care.  The AMA and MMA, and virtually every other medical organization in the country,  believe the time has come to replace the flawed formula with an annual update system that reflects actual increases in physician costs.

MMA officers and many other specialty society leaders have been in Wasington this Spring meeting with Maine's congressional delegation on this issue.  While all four of our representatives are sympathetic to the need for a new formula, an appropriate legislative vehicle still needs to be identified before the end of next year.  Stay tuned.

The U.S. House and Senate are currently on recess for the Memorial Day break.  You may always contact your representative's offices through the AMA toll-free line at 800-833-6354. [return to top]

Medicare Carrier Advisory Committee to Meet at MMA on June 21st
A reminder to all Medicare Carrier Advisory Committee members that the quarterly CAC meeting in June will be held at the Frank O. Stred Building in Manchester, Maine, headquarters of MMA.  The CAC meeting will be held at the regular time, 2:30pm to 4:30pm, but will be preceeded by a 1:00pm luncheon meeting of all CAC members from Maine.  Prospective CAC members are invited to attend, as well.

The 1:00pm luncheon meeting will be held next door to MMA in the Dan Hanley Building, in order to free up the MMA conference room to prepare for the 2:30pm meeting which will be video-conferenced to additional sites in the four state region. Craig Haug,M.D., Medical Director for NHIC, will join us for the Pre-CAC meeting.  Because the meeting is in Maine, the video-conference sites will not include Portland and Bangor.  Members from those locations,  it is hoped, will come to Manchester (Maine).

It is an honor for MMA to host the meeting.  Please make plans to attend.  You may e-mail Julie Banta at jbanta@mainemed.com if you are planning to attend.  If a CAC member can not attend, please consider sending another representative of your specialty to represent you.

  [return to top]

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