June 7, 2004

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Governor's Draft State Health Plan Receives Mostly Favorable Comments
Representatives of Consumers, Businesses & Insurers, and Providers generally praise the proposal, but some call it incomplete and others object to portions; hospitals say their costs are unfairly characterized in the cost portion of the plan.

On Friday afternoon 6/4/04, the Dirigo Health Advisory Council on Health Systems Development held a public hearing on the Governor's draft State Health Plan, available on the web at http://www.maine.gov/governor/baldacci/healthpolicy/05-26-04%20Draft%20to%20Web%20One-Year%20State%20Health%20Plan.pdf.

Despite a full hearing room, few people provided public comment on the draft plan.  The speakers were:

  • Joe Ditre, Consumers for Affordable Health Care
  • David White, small business owner
  • Mary Henderson, Maine Equal Justice
  • David Brenerman, UNUMProvident/Maine Health Care Purchasing Collaborative
  • Dan McCormick, Anthem Blue Cross Blue Shield
  • Katherine Pelletreau, Maine Association of Health Plans
  • David Winslow, Maine Hospital Association
  • Andrew MacLean, Maine Medical Association
  • Frank McGinty, MaineHealth
  • Tim Ferentz, Mercy Hospital
  • Bob Long, Kennebec Valley Mental Health Center/Maine Association of Substance Abuse Programs
  • Pat Philbrook, Maine State Nurses Association
  • Judd Knox, York Hospital
  • Cathy Gallant, Maine Nurse Practitioners' Association
  • Rep. Ann Perry
  • Doug Carr, Rite Aid
  • Megan Hannan, American Cancer Society

The Council will accept written comments until 5 p.m. on Tuesday, 6/8/04.  You can submit them through the Governor's Office of Health Policy & Finance web site mentioned above.  The Council will then make its recommendations to the Governor before this one-year plan is finalized.  In the future, the Governor will submit a biennial State Health Plan.  See the following article for the MMA's comments on the draft plan.

Read the MMA's Comments on the Draft State Health Plan







Advisory Council on Health Systems Development

Bureau of Medical Services Office, 442 Civic Center Drive, Augusta, Maine

Friday, June 4, 2004


            Good afternoon Chairman Rines, members of the Advisory Council on Health Systems Development, and members of the Governor's staff.  My name is Andrew MacLean and I am General Counsel & Director of Governmental Affairs for the Maine Medical Association, a professional organization representing more than 2600 Maine physicians.  The MMA appreciates the opportunity to comment on the draft State Health Plan required by the Dirigo Health legislation, L.D. 1611, P.L. 2003, Chapter 469.

            Drafting a state health plan is a daunting task, particularly in the midst of all the activities necessary to implement the Dirigo Health plan and to manage the MaineCare program, and we acknowledge the effort that went into the draft document.  We agree with much in the "case statement" portion of the plan, the Introduction (Part 1) and Maine's Major Health Issues (Part 2, Section 1).  We support the ambitious goal of "making Maine the healthiest state in the nation."  Providing Maine citizens with access to high quality health care services at an affordable cost will help us to achieve this goal, but Dr. Robert McAfee has aptly noted that genetics, social circumstances, environmental factors, and personal responsibility collectively have a greater impact on one's health.  Still, we agree that the initial State Health Plan properly emphasizes public health and preventive care, management of the major chronic illnesses, and treatment of mental health and substance abuse disorders.

            While we support a public process of strategic planning for our health care system, we do take issue with the presumption of the draft plan that "[n]o vehicle exists to plan for the orderly and economic development of health facilities and resources in the state and to match the supply of services to specific health needs."  (Draft State Health Plan, page 6).  On the contrary, the boards of directors of Maine's community hospitals, health centers, and mental health and substance abuse facilities, as well as the owners of privately-owned facilities certainly do consider their communities' health care needs in determining whether to invest in a new service or facility.  Indeed, planning does take place in the private sector because the market requires it.

            Next, we have brief comments about the cost (Part 2, Section 2), quality (Part 2, Section 3), and access (Part 2, Section 4) sections of the draft plan.

            Cost.  We are sure that it is no mistake that cost is the first substantive portion of the draft plan and cost is an important consideration.  But, we believe that the final State Health Plan must strive for a balance among the cost, quality, and access aspects of our health care system.  It should not be simply, or even primarily, a cost containment plan.  Also, we are concerned that the draft plan does not fully acknowledge the real tension that exists among these three prongs.  As difficult as it will be to accomplish, the plan must address consumer expectations and the current incentives for all stakeholders in our health care system.  Our system never will be able to provide everyone with unlimited access to the best care at minimal cost.  As Bruce Bates, D.O. asked in his comments before the Commission to Study Maine's Community Hospitals, "Cost, quality, and access - - which two do you want?"

            The Capital Investment Fund and the Certificate-of-Need program are key components of the Governor's cost containment efforts in the Dirigo Health plan.  We recognize this fact despite our well-known disagreement with the approach.  We remain convinced that the CON program is a barrier to competition that could provide patients with cost, quality, and access benefits.  Regarding the development of the Capital Investment Fund, we reiterate our recommendation that the State Health Plan provide an open and public process for establishing the amount of the Fund annually.  Regarding the CON program, we are concerned that the draft plan includes several new standards that were not in the original CON statute and are not in the P.L. 2003, Chapter 469 amendments, such as "the voluntary price and cost targets" of Chapter 469.  (Draft State Health Plan, page 23).  We do not believe that this is relevant to a determination of need and it is not appropriate as part of the CON criteria.  Also, we believe that the Maine Quality Forum should have a voice in CON decisions, but it should not have the veto authority implied by the statement, "[p]rojects must be recommended by the Maine Quality Forum."  (Draft State Health Plan, page 23). 

            Lastly, the cost section of the plan should include an examination of the impact of professional liability costs on our health care system.  P.L. 2003, Chapter 469 requires the State Health Plan to examine work force issues.  Any such study should include an analysis of the impact of high professional liability premiums on physician recruitment and retention.

            Quality.  We support the quality section's emphasis on improving Maine's data and information technology systems to facilitate improvements in the quality of care and patient safety.  The plan must, however, address the financial and cultural barriers to the acquisition of new technology for physicians and other individual practitioners.  Quality initiatives and the technology necessary to support them must not add to the administrative burden that already overwhelms medical practices today.  The plan should establish reasonable timeframes for new quality initiatives and should specify when and how the State will make available to practitioners who need new technology the loan fund and technical assistance included in P.L. 2003, Chapter 469.

            Access.  We support the access section's focus on implementation of Dirigo Health coverage and have long supported MaineCare as the safety net for Maine's lowest income citizens.  We disagree, however, with the "rosy" assessment of the MaineCare program in the second paragraph on page 33 of the draft State Health Plan.  After the last half dozen or so state budget bills, the MMA suggests that the MaineCare program is under great stress and is becoming an increasingly difficult environment in which to practice medicine.  Continuing low reimbursement rates and increasing administrative burdens are significant discouragements to participation in the MaineCare network.

          Thank you for considering the views of the Maine Medical Association on the draft State Health Plan.  We congratulate the drafters on the good work this draft represents and we will continue to help improve it so that Maine can achieve its health care goals. [return to top]

Update on Pathways to Excellence
Last week, the Pathways to Excellence (PTE) steering committee mailed a final reminder to primary care practices regarding participation in its Phase III Office Systems survey.  The project is sponsored by the Maine Health Management Coalition and its goals are to measure quality and recognize and reward practices demonstrating quality.  While the MMA does not endorse the project,  many of the physicians on the Steering Committee are MMA members and the Association does believe it is important to inform members of the project and to present its potential implications.

The current survey consists of eight sections and is expected to take approximately 30 minutes to complete.  The survey is completed online at www.mhic.org (website for the Maine Health Information Center, an independent data agency). Practice ID's and passwords are being mailed to practices currently.  They can also be obtained from Meg Cary at the Maine Health Information Center at 623-2555 or mcary@mhic.org).  Because of the nature of the content,  the survey is best completed by a practice manager or managing physician.

Practice responses will also be part of a financial incentive program used by CIGNA Healthcare and Anthem Blue Cross and Blue Shield health plans as soon as 2004 and in subsequent years.  The reward programs used by health plans and employers in Maine will include performance criteria involving the "structure, process and outcomes" of care delivery in each practice.

If members have questions about this survey or the project, they may contact Ted Rooney, Project Leader at 729-4929 or trooney@mhmc.info or Jan Wnek, M.D. at janicewnek@mhmc.info. [return to top]

Maine Chapter, American College of Surgeons 2004 Annual Meeting
The Maine Chapter of the American College of Surgeons held its 2004 Annual Scientific Meeting this past weekend at the Asticou Inn in Northeast Harbor. Nearly forty members attended the meeting which included the following clinical presentations:

     The Dirigo Plan:  Medical Overview;   Robert McAfee, MD

      The Dirigo Plan-Outcomes and Quality Data Applicatons:  Dennis Shubert, MD, PhD

      Northern New England Cardiovascular Disease Study Group;  How and Why We Did It.  Jeremy Morton, MD, FACS

     Northern New England Vascular Surgery Study Group: How and Why We are Dong It.  Jeb Hallett MD, FACS

     Bariatric Model for a collaborative Study:  Northern New England General Surgical Study Group:  A Proposal-How and Why to do It.  Sam Finlayson, MD, MPH

    Colon Surgery Model for a General Surgery Collaborative Study:  How to do It.  Frank Opelka, MD, FACS

     National Surgical Quality Improvement Program, Tom Russell, MD, FACS (Executive DIrector, AMerican College of Surgeons)

     Total Mesorectoral Exicision for Carcinoma (panel)

In addition to the clinical talks, a practice management seminar was presented as well as an ACS Panel on Advocacy and Political Action.  On Saturday evening, David Rockefeller, Jr. gave a keynote presentation on the Future of Our National Park Service.  Mr. Rockefeller serves as VIce-Chairman of the National Park Foundation.  His talk discussed a number of the barriers existing to the continued use and survival of the national park system. Members asked several questions, engaging the speaker in an interesting and entertaining discussion.

The meeting was chaired by Chapter President William Horner, MD, FACS.  At a business meeting of the Chapter held on Sunday morning, Robert Hawkins, MD, FACS was elected President of the Chapter for the folowing year.  Congratulations to Dr. Horner and the officers of the Chapter for a very successful meeting.  Joel LaFleur MD, FACS will remain in his position as Secretary-Treasurer of the Chapter. 

  [return to top]

Dirigo Health Meetings this Week
The Commission to Study Maine's Hospitals will meet Monday, June 7, from 9:00am to 4:00pm at the Daniel Stone Inn in Brunswick.  The meeting has been billed as a "retreat" and members hope to focus on the most critical issues for them to include in the Commission report due to the Governor in November.

Unfortunately, Richard Wexler, M.D. has resigned from the Commission, due to a change in jobs.  MMA has proposed additional names of physicians to replace Dr. Wexler, who served with distinction on the Commission, but the administration has made it clear that they would like the second physician to be from the osteopathic community.  The Maine Osteopathic Association is extected to put forth a nomination soon if it hasn't already done so.  Joshua Cutler, MD, a Portland cardiologist remains on the commision in the other physician slot.

On Monday afternoon, the Dirigo Health Board of DIrectors will meet at 2:30pm in Augusta.  The Board will be making contingency plans for the follow-up to this coming Friday's deadline for any bidder who wishes to submit a bid to offer the DIrigo Health product.

On Friday morning, the Advisory Council to the Maine Quality Forum will meet at 9:00a.m. in Augusta. 

All of the meetings are open to the public, except when the need for an executive session arises.  This would normally only happen at the Dirigo Board meetings.

  [return to top]

Nonprofit BlueCross Plans Record Record Profits
Nonprofit BlueCross BlueShield plans across the country have been reporting record quarterly and annual profits. Two health care industry analysts warned that publicly traded HMOs need to be more than concerned about their nonprofit rivals record profits.  In 2003, earnings at nonprofit Blues plans grew by 116%, more than three times the rate of their for-profit competitors.  "The Blues" profits will hurt the (for-profit) HMO sector," said Matthew Borsch, analysat with Goldman Sachs.  "I believe the (nonprofit Blues) are pricing fairly aggressively and illing to accept lower margins."

After several years of double-digit health insurance premium increases and several quarters of reporting significant financial gains, many Blues Plans across the country promised that rate increases for 2004 would be minimal.  Health insurance agents, brokers and employer groups say that so far, the Blues appear to have stood by their promise. However, other factors could still come into play - such as employee demographics and an employer's claims history - that could cause rate increases of 20 to 30%  this year for select groups.

The New York Times reported on May 27, 2004 that insurance premium increases this year are likely to be around 10 per cent, compared to increases of 14 to 18 per cent over the past few years.  However, the annual increases are still predicted to be more than double the rate of inflation. [return to top]

MMA Executive Committee to Meet Wednesday, June 9
The MMA Executive Committee will face a full agenda when it convenes at the Frank O. Stred Building in Manchester on this coming Wednesday.  Items on the agenda include a presentation on the current status of CarePartners and a presentation by Laurie Desjardins regarding the work of the Coding Center.  Ms. Desjardins is DIrector of the Center which is jointly owned by the state medical societies in Maine, New Hampshire and Vermont.  The Center is in its second full year of operation.

The Committee will also review the MMA's comments on the Governor's proposed Health Plan and consider any resolutions to be presented at the upcoming AMA meeting in Chicago next week.  Currrent advocacy items regarding MaineCare and Dirigo Health will also be discussed. Final plans will also be presented for the 151st Annual Session to be held this year at the Colony Hotel in Kennebunkport, Sept. 10-12.  The Committee is chaired by Jacob Gerritsen, M.D.  of Camden.

MMA members are welcome to attend any MMA Committee meeting. [return to top]

Medicare Carrier Advisory Committee to Meet at MMA
The Maine Medical Association is very pleased to be hosting the Medicare Carrier Advisory Committee meeting on Monday, June 21.  It is a distinct privilege for us to host the meeting, which is usually held at the Massachusetts Medical Society in Waltham, MA.  We hope that CAC members from Maine and specialty society leaders interested in Medicare issues will attend.  The CAC meeting is scheduled for 2:30pm at the Frank O. Stred Building in Manchester, Maine, which houses the offices of MMA. 

As a number of NHIC officials will be present, we have scheduled a working lunch and pre-CAC meeting for 1:00pm preceding the CAC meeting.  The pre-CAC meeting will be held next door to MMA at the Dan Hanley Building.  We have invited the NHIC Medical Director, Craig Haug, M.D. to join us for lunch.

The CAC meeting will include presentations from John Birkmeyer, M.D. from the University of Michigan and Charlotte Yeh, M.D. from the CMS regional office.  Carol Cherry and Jeannine Bouchard from Associated Hospital Service will also be present.  Dr. Birkmeyer's presentation will be, "Making Surgery Safer;  Volume and Beyond."  Dr. Yeh will speak on the Medicare Modernization Act.  Ms. Cherry and Ms. Bouchard will talk about SNF's and consolidated billing.

CAC members or guests attending may RSVP through the CAC web site, www.medicarenhic.com/cac or by fax to Maria Petruziello at 781-741-300l.  Questions from Maine attendees can be directed to Gordon Smith at MMA (622-3374 or gsmith@mainemed.com).  Because the meeting is in Maine, this meeting will not be videoconferenced to other sites in Maine.  It is being videoconferenced from MMA to sites in Vermont, New Hampshire and Massachusetts.

  [return to top]

Watch for May/June Maine Medicine for Annual Session Materials
The May/June issue of Maine Medicine will be arriving at offices early this week.  Included as an insert is advanced registration materials for MMA's 151st Annual Session which will be held this year in Kennebunkport, Maine at the Colony Hotel on September 10-12, 2004.

This year's scientific program, under the direction of Laural Coleman, M.D., is called, "Medicine Rewired:  Putting Technology into Practice," and will feature presentations and demonstrations on various technology including e-prescribing and Electronic Medical Records.  Members and office managers will both benefit from this year's emphasis on presenting a first-rate educational program.  Most of the educational programming is Friday afternoon and Saturday afternoon.  The General Session will be on Saturday morning.  More details are in your issue of Maine Medicine.

All members will also receive an additional mailing with full registration materials in mid-to late June.  [return to top]

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