Maine Medical Education Foundation Awards Loans to Maine Residents
At the July 21st meeting of the Committee on Loan and Trust Administration over $240,000 was approved for loans to Maine Residents enrolled in or accepted at approved medical schools.
The Maine Medical Education Foundation was established by the Maine Medical Association to provide loans to Maine Residents enrolled in or accepted at approved medical schools. This is a fund set up on a rotating loan basis. The recipient of the loan does not pay interest until graduation from medical school. Interest on the loan then starts at 1% for the first year after graduation and increases to 3% the second year and to 5% the third year and each year thereafter. Payments are designed to repay the principal and accrued interest no later than 10 years from the date of graduation.
The Committee on Loan and Trust Administration, chaired by Mark Bolduc, M.D., himself a former MMEF recipient,  is proud to announce this year's recipients of the loans and has also set aside additional funds for late applicants. The following is the list of recipients...

• Rebecca Bagley - UVM
• Carl Barus - UVM
• Thomas Cassidy - UNE
• Michael Kumin - Jefferson Medical School
• Brad MacKinnon - UVM
• Benjamin Mailloux - Dartmouth
• John Ney - Boston Medical School
• Michelle Pahl - UVM
• Gail Rowell - UNE
• Thomas Ryan - UNE
• Gregory Sawyer - Dartmouth
• Walter Schuyler, III - UVM
• Katherin Sproul - Dartmouth
• Jill Steinkeler - Tufts
• Kaili Temple - Weil Medical College
• Evangeline Thibodeau - Tufts
• Heather Tory - Tufts

If you know of a Maine Resident who is going to be attending medical school please have him/her call Maine Educational Services, Pat Capozza #731-3600 for assistance in attaining the Maine Medical Education Foundation loan application and instructions. Congratulations to our loan recipients.

Coalition on Smoking OR Health Looks for Funding
The Maine Coalition on Smoking OR Health previously relied heavily on the Smokeless States Grant from the Robert Wood Johnson Foundation. However, that Grant is set to expire this Fall.  The Coalition met last week to discuss future funding opportunities and have targeted a few appropriate foundations. The Coalition is still hoping to get RWJ money, as it has recently revamped its tobacco funding efforts and has released an RFP for Tobacco Policy Change: A Collaborative for Healthier Communities and States. Maine could get up to $150,000 for each of the next three years. The Coalition will respond to the RFP by the September 1 deadline and will hear about the grant by the end of October. Maine's solid track record of using the tobacco settlement money for its original purpose will increase the likelihood of being awarded the grant. [return to top]

Administration Holds FY 06/07 Budget Briefing for Providers & Consumers
On Thursday afternoon, July 22, 2004, the MMA joined other provider and consumer groups at a briefing on the next biennial budget conducted by Trish Riley, Director of the Governor's Office of Health Policy & Finance, and Jack Nicholas, Commissioner of the Department of Health & Human Services.  Most of the senior staff of the DHHS also were present.  Prompted by the negative public reaction to the Governor's second supplemental budget of 2004 (L.D. 1919), the Governor's staff is seeking suggestions from the provider and consumer groups on how to address a "structural gap" in the next biennial budget of approximately $785 million.

The Baldacci Administration officials stated that Maine's Medicaid spending per enrollee was third highest in the nation according to year 2000 data.  They described Maine's Medicaid spending by provider category in 2003 (in state and federal dollars) as follows:

• Hospitals:  13%
• Physicians & related practitioners:  6%
• Prescription drugs:  12%
• Long-term care:  31%
• Behavioral health services:  25%
• Other services:  13%

The MMA urged the Baldacci Administration to convert the Medicaid fee schedule for individual health care practitioners to a resource-based fee schedule in this biennial budget.  Most of the other groups asked questions about the Administration's approach to the next biennial budget, but did not offer suggestions.  Two administrators from the regional CMS office in Boston also attended the briefing. [return to top]

California Regulator Refuses to Approve Anthem/Wellpoint Merger
At a news conference in San Francisco on Friday, California Insurance Commissioner John Garamendi refused to approve Anthem, Inc.'s proposed $16 billion acquisition of WellPoint Health Networks, Inc.  He said that his position was based on his belief that the transaction would not be in the best interest of WellPoint policyholders and would not improve the availability or quality of health care in California.  Mr. Garamendi also raised concerns about the size of compensation packages due to the executives of the two companies as a result of the transaction.  Earlier in the day on Friday, the Department of Managed Health Care approved the deal.  The Director of the Department of Managed Health Care is an appointee of Governor Schwarzenegger (R).  Mr. Garamendi has been an unsuccessful Democratic candidate for Governor and has announced that he will be a candidate for Lieutenant Governor in 2006.

Mr. Garamendi's opposition may not  be enough to block the transaction, but it will delay the process. [return to top]

Many New State Laws Take Effect this Friday, July 30th
Many of the laws passed during the 2004 sessions of the 121st Maine Legislature will become effective this Friday, July 30, 2004, 90 days following the adjournment of the session.  These include the second (FY 05) supplemental budget bill (L.D. 1919), the bill authorizing collaborative practice for emergency contraception (L.D. 1152), and the bill expanding the scope of practice of acupuncturists to include various techniques known as oriental medicine (L.D. 263).

The MMA's comprehensive summary of health care legislation from the 121st Legislature should be available next week.  Look for an announcement in Maine Medicine Weekly Update. [return to top]

MaineCare Prior Authorization Subcommittee Gathers Information
The Prior Authorization Subcommittee of the Medicaid Advisory Committee has begun to gather information regarding consumer and provider education as part of its desire to improve the process. Many of you responded to our request for specific information two weeks ago and we have incorporated your comments into our work. One of the issues that the subcommittee is looking into is how the process differs when trying to prescribe something off (or newly on) the formulary from one of the plans (for a privately insured patient) as it does when the patient is a Medicaid patient. There may be something we can learn and some efficiency we can adopt from that. The subcommittee will continue to meet at least monthly and would welcome input from anyone interested. Please call or email Anna Bragdon from MMA staff, 622-3374 or abragdon@mainemed.com. [return to top]

Commission to Study Hospitals Tackles Administrative Costs
At its meeting on Monday, July 26, the Commission to Study Maine's Hospitals discussed streamlining administrative systems and listened to a presentation on possible approaches to administrative savings from Beth Kilbreth, Senior Research Associate and Assistant Professor, Institute for Health Policy, Muskie School, USM and Will Kilbreth, Program Coordinator , Dirigo Health Agency. An outline of Mr. Kilbreth's presentation is available by calling the MMA office (622-3374 or jbanta@mainemed.com).

Ms. Kilbreth stated that in an informal survey of a few hospital CEO's, administrative expenses associated with billing and collections was the most frequently mentioned administrative process that needed correction.  Commission members seemed to be enthusiastic about making recommendations to streamline the billing and collection process, in the hopes of lowering administrative costs, and a subcommittee will be named prior to the next Commission meeting to work on this area.  Subcommittees have previously named to work on antitrust/legal issues involved with the proposal to regionalize the hospital industry in Maine and to propose amendments to Bureau of Insurance Rule Chapter 850.

Chairman Haggett asked members to share their thoughts regarding whether the regionalization proposal should include two regions or three, but it was clear in hearing member responses that members were not as far along with their thinking on this point as the Chairman.  While members spoke positively about the presentations by Eastern Maine Health System, Maine Health and Central Maine Healthcare, it was noted that each system has competitors in its region and that it would be wise to hear presentations by the competitors, as well.

It is clear that the leadership of the Commission is seeking very fundamental change, some would call radical, with the expectation that there would be dramatic change.  However, Commission members noted that the issue of the authority granted to any regional entity and the governance of such entities would be problematical.  Incentives for any institution to participate in the region could include CON provisions, Medicaid reimbursement or even licensure considerations.

Commission Chairman William Haggett noted the need to conclude deliberations by the end of September so that a series of public hearings could take place on the Commission recommendations prior to their submission to the Legislature in November.

Commission members also reviewed a proposal by Commission consultant Nancy Kane, PhD, to require the reporting of standardized data from each hospital.  Commission members asked a number of questions about the proposal, including asking where the data would be reported to.  The Maine Health Data Organization was suggested, although at least one Commission member expressed doubt about the existing capacity within the MHDO to collect and interpret the reports.

The Commission meets again next Monday morning, August 2, from 9:00am to noon, at the DHHS Office at 442 Civic Center Drive, Augusta ( Conference Rooms 1A & 1B ). Regionalization is again on the agenda, along with critical access hospitals and physician credentialing. These items should be considered tentative.

D. Joshua Cutler, M.D., represents the Maine Medical Association and its members on the Commission.  Dr. Cutler is a practicing cardiologist in Portland and would welcome feedback and input from any Maine physician.  He can be reached via e-mail to cutledj@mainecardiology.com.  Comments on the proposal to create one or more regional health authorities in the state to move the hospitals toward regionalization would be particularly welcome. [return to top]

U.S. Senate Approves Patient Safety Legislation
On July 22, 2004, the U.S. Senate gave unanimous approval to the bipartisan Patient Safety and Quality Improvement Act (S. 720) developed in the Senate Health, Education, Labor, and Pensions Committee by Chairman Judd Gregg (R-NH) and Ranking Member Edward M. Kennedy (D-MA).  The bill creates a voluntary medical errors reporting system and establishes federal evidentiary privilege and confidentiality protections to promote error reporting.  A similar House patient safety bill (H.R. 663) passed in March 2003.  The bills now will go to a conference committee.

The AMA called passage of the patient safety bill a "victory for America's patients and physicians."  AMA Immediate Past President Donald J. Palmisano, M.D., J.D. said, "this legislation establishes a system for reporting and analyzing health care errors to improve patient safety and health care quality.  Health care errors would be prevented by transforming the existing culture of blame, which suppresses information about errors, into a culture of safety, which focuses on sharing information in order to prevent future errors.  The Aviation Safety Reporting System serves as a successful model for this system." [return to top]

Baldacci Administration Releases Final State Health Plan
On Monday, July 26, 2004, the Governor's Office of Health Policy & Finance released the final State Health Plan for the next year.  The Governor's press release on the State Health Plan follows:

July 26, 2004
Governor's Office

Contact: Joy Leach, 287-2531

Trish Riley, 624-7442

AUGUSTA – The Governor’s Office of Health Policy and Finance today released the one-year State Health Plan designed to move Maine to become the healthiest state in the nation. A requirement of the Dirigo Health Reform Act, the Plan sets out specific goals to bring down costs, improve quality and increase access to health care for all Maine citizens.

“Maine will spend roughly $7 billion on health care this year,” noted Governor Baldacci. “While there is much that is great about our health system, we need to re-direct some of that spending to invest in our health, not just in treating illness. Making Maine the healthiest state is a very big goal -- but we begin the work today with this health plan.”

The Plan builds on work currently underway throughout Maine’s communities and health care providers and embraces the recommendations of existing efforts, including but not limited to: the Maine Diabetes Control Program; HealthyMaine 2010; the Office of Substance Abuse’s State Prevention Plan; Maine’s Comprehensive Cancer Control Plan; Maine’s Cardiovascular Health Plan; and Maine’s Asthma Plan.

The State Health Plan is administered by the Governor’s Office of Health Policy and Finance. Trish Riley, Director of the Office, said, “The Plan is a roadmap for our State to improve health and health care delivery and asks all of us – consumers, providers and payers – to play a role.”

The plan was developed with guidance from the 11-member Advisory Council on Health Systems Development. The Council’s Chair, Brian Rines of Gardiner, noted that the plan reflected considerable public input but is a transitional one-year document. Said Rines, “In the year ahead we will launch a community based dialogue – ‘Tough Choices’ -- asking Mainers to help us design the health system for Maine’s future.”

Key goals and features of this year’s plan include:

1. Reduce the number of uninsured Maine people by 31,000;

2. Set priorities and target spending amounts for new investments in health care facilities and equipment;

3. Reduce the inappropriate use of hospital emergency departments by persons with mental illness and develop appropriate community options and prevention strategies;

4. Develop specific strategies to reduce the amount of chronic illnesses – notably heart disease, cancer, diabetes, lung disease and asthma;

5. Work to assure all Maine people, regardless of geography, receive best practices in medical care;

6. Streamline and simplify billing practices by Maine’s public purchasers and initiate payment methods that reward good performance;

7. Conduct a statewide community dialogue titled “Tough Choices” to engage private citizens in a discussion of their priorities in order to achieve a sustainable health care system.

The State Health Plan can be viewed at www.healthpolicy.maine.gov

###

Summary of Maine’s State Health Plan

GOAL: To help Mainers become the healthiest people in the US by strategically improving the allocation and coordination of our health care resources.

KEY FINDINGS

Cost

• Total health care spending is estimated to increase from $5 billion, 15.5% of the gross state product (GSP), in 1998 to over $7 billion, nearly 18% of GSP, in 2004.

• Between 1996 and 2002, the cost of a family policy for Maine businesses and employees increased by 77%, while median household income increased by only 6%; increases for small businesses have been even steeper.

Access

• The high cost of health care and health insurance results in decreased access.

• Maine has the highest rate of uninsured citizens in New England: about 136,000 (17%) of non-elderly Maine residents spent part of 2002 uninsured; on any given day, roughly 1 in 8 non-elderly Mainers were uninsured.

• Over 11 percent of Maine’s population reports not visiting a physician because of cost. Forty-two percent of families with uninsured children report delaying needed care for their children due to costs.

Quality

• A number of studies have shown that Maine has high quality hospitals.

• However, a quality health system is one that improves the health of the population.

• Despite our high level of spending, Maine has high rates of preventable diseases such as heart disease, diabetes and asthma.

• These diseases lower the quality of life for the people who suffer from them.

• These diseases also put unnecessary strain on our healthcare system: it costs far more to treat these diseases than it does to prevent them.

KEY OBJECTIVES INCLUDE:

1. Reducing the number of uninsured Maine people by 31,000;

2. Setting priorities and target spending amounts for new investments in health care facilities and equipment;

3. Reducing the inappropriate use of hospital emergency departments by persons with mental illness and develop appropriate community options and prevention strategies;

4. Developing specific strategies to reduce the amount of chronic illnesses – notably heart disease, cancer, diabetes, lung disease and asthma;

5. Working to assure all Maine people, regardless of geography, receive best practices in medical care;

6. Streamlining and simplifying billing practices by Maine’s public purchasers and initiate payment methods that reward good performance;

7. Conducting a statewide community dialogue titled “Tough Choices” to engage private citizens in a discussion of their priorities in order to achieve a sustainable health care system.

This State Health Plan is a One-Year Transitional plan. The Tough Choices campaign and work-plan included in the State Health Plan will result in the first biennial State Health Plan to be issued on July 1, 2005.

You can find the State Health Plan on the web at:  http://www.maine.gov/governor/baldacci/healthpolicy/reports/Maine%27s%20State%20Health%20Plan%2007-23-04.pdf. [return to top]