July 12, 2004

 
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Dirigo Health Agency Board Approves Tentative Anthem Contract
At its meeting on July 6, the Dirigo Health Agency Board of Directors voted to tentatively approve a contract award to Anthem to offer the Dirigo Health product The Board authorized formation of a negotiating team to determine if an acceptable final contract can be reached.
The negotiations will be lead by Trish Riley of the Governor's Office of Health Policy and Finance.  The focus of the negotiations will be on material deviations between what was in the Request for Proposals and what was in the Anthem bid.  As Anthem was the sole bidder, it is likely that the two parties will come to a successful conclusion and that Anthem will start accepting applications for the product around Oct. 1 with coverage available around January 1, 2005 (the State would like an earlier date). 

In its initial evaluation of the Anthem proposal, the state relied on recommendations of a team derived from DHHS, Dirigo Health Agency and other state agencies.  The evaluation involved several work sessions, including a site visit to Anthem's offices in South Portland.  After several rounds of clarifications, the team members developed a consensus on an overall score, as well as the recommended next steps. 

The state still hopes to enroll up to 40,000 people in the first year of the program.

Medical Mutual Files for 8% Rate Increase Effective 10/1/04
On June 7, 2004, Medical Mutual Insurance Company of Maine submitted its annual Physicians & Surgeons liability insurance rate filing to the Bureau of Insurance.   The company has requested an overall rate increase of 8% effective October 1, 2004.  The rate increase will apply uniformly across all rate classes.  The filing includes an actuarial study suggesting that a 28.5% increase could have been justified.  Given the difficult liability climate across the country and the rate increases facing physicians in states like Florida, Pennsylvania, and Nevada, the MMA is pleased that Medical Mutual has been able to request a relatively modest increase in its rates.  Dick Johnson of the BOI staff is reviewing the filing.

Any questions regarding the filing can be directed to the Company or to Andrew MacLean or Gordon Smith at MMA (622-3374 or amaclean@mainemed.com; gsmith@mainemed.com). [return to top]

Maine Quality Forum Meeting Focuses on Web Site, Nurse Staffing Ratios
The Maine Quality Forum, created by the Dirigo Health legislation, has divided its initial work plan into 4 major categories:

  • Promoting Electronic Technology
  • Publishing Comparative Data
  • Promoting Best Practices; and
  • Technology Assessment

The Forum has established milestones in each category to be completed  between now and September 2004.

In its effort to promote electronic technology,  the Forum is developing a revolving loan fund through which funds will be available to help practitioners acquire the technology necessary for electronic billing, electronic medical records, and other technology to improve the efficiency and quality of medical care.

At the center of the Forum's efforts to publish comparative data and promote best practices is the development of a MQF web site.  One of the sections of the web site will be a "Consumer's Guide to Choosing Quality Care Providers" that will include:

  • What to expect from your health care provider
  • How to evaluate your provider
  • How to give feedback on your provider; and
  • Average rates in Maine.

In the technology assessment area, the Forum has been working on a response to the Legislature's directive (L.D. 616) to study nurse staffing levels in Maine hospitals and to determine whether staffing ratios may be appropriate.  Two subcommittees are looking closely at nurse-sensitive quality indicators developed by the National Quality Forum.

The next meeting of the Maine Quality Forum Advisory Council is Friday, August 13, 2004 at the Dirigo Health Agency offices, 211 Water Street, Augusta, Maine. [return to top]

Commission To Study Maine's Hospitals Hears From Three Largest Systems
At its meeting on July 6, the Commission to Study Maine's Hospitals heard presentations from the three largest health systems in Maine. 

Norman Ledwin, CEO, Eastern Maine Healthcare described the purpose of the EMH Systems, as follows: "To develop a state of the art, contemporary organizational structure which provides for the horizontal and vertical integration of health care services, across a region."  He noted the important distinction among Members, Strategic Partners and Strategic Affiliates  of the System.

Guy Orne, Executive Vice President, Finance, Treasurer and CFO, Central Maine Healthcare described the CMH vision and philosophy and noted the considerable savings associated with consolidation and regionalization. Among the benefits of regionalization noted were avoidance of unnecessary duplication of services and improvement of quality through volume and standard protocols. He closed by noting the challenges to the system, including insufficient Medicare and Medicaid reimbursement, labor shortages creating inflationary cost pressures and the need for capital resources, particularly for IT, new medical technology and routine capital and physical plant replacement.

Frank McGinty, COO and Treasurer, MaineHealth, described the MaineHealth system and presented information on its budget and financial performance over the past two years.  He noted clinical integration goals and described a number of clinical integration initiatives.  These included chronic disease management programs (asthma, diabetes, heart failure and depression), acute MI/PCI improvement program, referral communications improvement project, women's health program and a pharmacy work group.  He also discussed community health improvement initiatives and administrative integration.  He discussed the system's strengths and challenges and closed with the following observations on statewide and regional planning.

                       *     Statewide and regional planning efforts that bring all stakeholders together to chart a course to improve the health of Maine people should be strongly supported.

                       *      To be most effective, regional planning efforts should build on established relationships between communities, health care organizations, and the professionals who provide medical care.

                        *     We (MaineHealth) believe there are very few instances in which community hospitals are providing services that are unnecessary or of poor quality.  Decisions to centralize services based on economic considerations should be made only after careful consideration of their impact on the populations served, the ability of the organizations affected to continue to provide essential services, and the likelihood that the expected savings will be realized.

                         *     We believe every Maine hospital is continually seeking ways to reduce its administrative expenses, either to help make ends meet or to free resources for other worthy purposes.  While "administrative integration" efforts such as those described today should be encouraged, the key to making Maine healthier and keeping our health care systems affordable will be our efforts to reduce the burden of illness through greatly expanded public health activities, improvements in the care of individuals with chronic diseases such as diabetes and heart failure, and helping those we serve assume greater responsibility for protecting their health.

                           *     Fundamental changes to large, complex systems rarely occur quickly or easily.  Our experience tells us that anyone who would change hospital's role in our health system would be well advised to choose as the outset strategies and tactics that hospitals can embrace, that can be implemented within a year or two, and that will produce tangible benefits for the public almost immediately.  Doing so will help create a solid foundation for the discussion and acceptance of more difficult steps that may need to follow.

                             *     Finally, our experience also tells us that those who advocate change have an obligation to help those involved see how that change can happen.  If you (the Commission) conclude that there are new or different roles that hospitals must play in Maine's health care system, we hope that you will also identify the changes in public policy, financing, or expectations that will be required to make such change possible.

                  MMA members interested in each presenter's power point presentation can obtain a copy by calling Julie Banta at MMA (622-3374 or by e-mail at jbanta@mainemed.com..)

                  The Commission meets again on Monday morning, July 12 at DHHS offices on Civic Center Drive in Augusta.  MMA representatives will attend. [return to top]

Group Begins Work on MaineCare Prior Authorization Improvements
Language inserted into this year's state budget created a subcommittee of the Medicaid Advisory Committee to work with DHS to improve the prior authorization process, as well as look into the workings of the Drug Utilization Review Committee. Subcommittee members include Anna Bragdon of the Maine Medical Association, Kellie Miller of the Maine Osteopathic Association, Laurel Coleman, MD, and representatives from Maine Equal Justice Program, Child Ombudsman Program, Long-term Care Ombudsman Program, Maine Alzheimer's Association,  Maine Primary Care Association, DHS and more.

The group met for the first time this week and started to identify key areas of concern.  The legislation directs the subcommittee to look at consumer education, the prior authorization process, quality assurance, the DUR, and whether new rules need to be promulgated. DHS is required to report to the Joint Committee on Health and Human Services in February 2005 on the findings of the subcommittee and its response.

One of the first issues the group identified was the 34-day emergency supply being switched to a four-day supply.  That change is in a proposed rule and the comment period closes on July 25.  If you have come across that change in your practice and would like to comment, go to http://www.maine.gov/bms/MaineCareBenefitManualRules.htm, and look up Chapter 80 - Pharmacy Benefits under proposed rules.

If you'd like to be part of the subcommittee or if you'd like to share your concerns regarding the prior authorization process with Anna Bragdon , please call her at 207-622-3374. [return to top]

Maine Chapter, American Academy of Pediatrics Hires Executive Director
The Maine Chapter of the American Academy of Pediatrics recently hired an Executive Director, J. Alex Hildebrand. Hildebrand will work with the Chapter from his home office in Portland. He is the first Executive Director in the Chapterís history. Part of his responsibilities will be to assist in the administration of the Healthy People 2010 national grant the Chapter was awarded in May.  Despite the change in staffing,  the Maine Chapter will continue its close ties with the Maine Medical Association and will hold its Fall meeting at the Augusta Civic Center on November 13, 2004. Any questions may be directed to Lisa Ryan, DO, Chapter President at ryanlisa@bh.cmhc.org.

Mr. Hildebrand has worked on children's issues in the past and most recently worked on projects for the Maine Association of Non-Profits.  The Chapter E.D. position is a half-time position. [return to top]

"Lawful Prescribing and the Prevention of Diversion" Presented In Brunswick on August 10
The Brunswick Police Department, Bowdoin College Security and Purdue will present a course for physicians and pharmacists from 1:00pm to 4:00pm on Tuesday, August 10, 2004 entitled, "Lawful Prescribing and the Prevention of Diversion."  The program, which is offered at no cost, includes information on doctor shopping, alteration of prescriptions, and other illicit drug seeking behavior.  The program will be held on the Bowdoin College campus.

To register for the program, call Judy Bean at the Brunswick Police Department at 725-6622.  For more information about the program, contact Det. Sgt. Mark Waltz at 725-6623, ext. 162.  [return to top]

Looking to Share Office Space in Yarmouth
Two physicians In Yarmouth are looking to share space and staff.  Good location and nice space available immediately.  Looking for part-time primary care physician or physical therapist.  Option of just subletting space also a possibility.  If interested, call Stephanie at 846-7666 or Vickie at 846-6212. [return to top]

MMA, MHA and Maine Health Care Association Event for Congressman Tom Allen
The Maine Medical Association, the Maine Hospital Association, the American Hospital Association and the Maine Health Care Association will sponsor an event for Congressman Tom Allen on Wednesday, August 18th.  The event will be held from 6:00p.m. to 8:00p.m. at the Center for Maine History, 589 Congress St., Portland.  $100 is the suggested donation.  RSVP by August 6th to rsvp@tomallen.org or call 774-9696. [return to top]

MMA EVP Gordon Smith to Chair AMA Advocacy Resource Center Executive Committee
MMA Executive Vice President Gordon H. Smith was recently appointed as Chair of the AMA's Advocacy Resource Center (ARC) Executive Committee.  The Center encompasses what used to be the division of state legislation at the AMA and focuses its campaigns on areas determined to be of priority.  A fundamental purpose of the Executive Committee of the ARC is to determine the priorities for the Center.  Of late, professional liability reform and scope of practice issues have dominated the Center's agenda.  Private Sector advocacy is also an important part of the Center's work and many campaigns have focused on payer issues such as the need to enact a Patient's Bill of RIghts.

The Executive Committee is made up of several state medical society CEO's and a similar number of state medical society lobbyists.  Smith succeeds D. Brent Mulgrew, Executive Director of the Ohio State Medical Association who has chaired the ARC since its inception.  Mulgrew will continue to serve as a valued member on the Committee.

The position of ARC chair is a voluntary position and does not alter Mr. Smith's responsibilities as EVP of MMA. [return to top]

Watch for Mailing this Week on Annual Session and Charity Golf Tournament
All MMA members will receive in the mail this week registration materials for the Association's 151st Annual Session being held this year at the Colony Hotel in Kennebunkport Sept. 10-12, 2004.  In addition to the usual array of business and recreational activities, this year's meeting features 9.5 hours of category one CME.  The CME program is entitled, "Medicine Rewired:  Putting Technology into Practice" and includes presentations on e-prescribing and electronic medical records.  Several vendor presentations are also scheduled.  Laurel Coleman, M.D. is the course director.

On Saturday evening, Sept. 11, President -elect Lawrence Mutty, M.D.  will be installed as President by outgoing President Maroulla Gleaton, M.D.  Fifty year pins recipients will be recognized and several annual awards will be presented.

Also included in the mailing is a flyer and registration form for the Association's First Annual Charity Golf Tournament to be held at the Augusta Country Club on Monday, August 30, 2004.  This year's tournament will benefit the Physician Health Program.  The format for the tournament is a traditional four-person scramble beginning at noon.  Registration and lunch begins at 11:00am.

Information on either event can be obtained by calling MMA at 622-3374. [return to top]

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