August 9, 2004

 
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Bureau of Insurance to Study Professional Liability in Maine
MMA representatives met Monday (8/9) with Insurance Superintendent Alessandro Iuppa and his staff to discuss plans for the Bureau's upcoming study of the professonal liability climate in Maine and the need for a cap on non-economic damages. The Bureau's study must be presented to the Legislature by Jan. 1, 2005.
The Dirigo Health legislation (P.L. 2003, Chapter 469) directs the  Bureau of Insurance to conduct a study of the medical malpractice insurance market in Maine and the potential impact of a cap on non-economic damages on medical malpractice insurance rates.  Section E-22 of the legislation provides as follows:

Sec. E-22. Report on medical malpractice awards. The Superintendent of Insurance shall submit a report, no later than January 1, 2005, to the joint standing committee of the Legislature having jurisdiction over insurance and financial services matters regarding medical malpractice lawsuits, damage awards for noneconomic damages in those lawsuits and the cost and availability of medical malpractice insurance in this State. As part of its review, the superintendent shall consult with representatives of the medical community, legal community and medical malpractice insurance industry regarding these issues. At a minimum, the report must address the impact on the cost of malpractice insurance of a cap on noneconomic damages of $250,000 in malpractice lawsuits. The joint standing committee of the Legislature having jurisdiction over insurance and financial services matters may report out legislation to the First Regular Session of the 122nd Legislature in response to the report.

The Bureau intends to put out a request for proposals to several actuarial firms, one of which would be selected to conduct the study and prepare a draft report.  The Bureau has shared with interested parties several of the work specifications likely to be included in the study, including the following:

  • The number of medical malpractice lawsuits resulting in claims in Maine during the past ten years, and the results of those claims.
  • A break-down of the cost of the lawsuits closed into the categories of economic damages, non-economic damages and expenses.
  • An analysis and estimate of the impact on the incurred claims costs and malpractice rates of a cap om non-economic damages of $250,000.
  • The impact, if any, of a "physician apology" law that would permit a medical provider to communicate with patients with unfavorable outcomes without those statements being admissible as evidence of liability.
  • A survey of actuarial studies of the impact of caps of non-economic damages publicly available and concluded in recent years.
  • An analysis of the cost and availability of medical professional liability insurance for physicians and hospitals in Maine in the past ten years.
  • The distribution of claims and claim settlement costs by size of claim and the changes in distribution over the past 10 years.  Include a discussion of the medical specialties that are found to have a higher frequency of larger claims and claim settlement costs.
  • A discussion of the medical malpractice liability insurance market in Maine in the past ten years.
  • A comparison of Maine's rates with those of other New England states and country wide averages.
  • Changes in reinsurance costs and investment returns and the impact of these factors on liability insurance costs.

The firm conducting the study will consult with provider groups and parties opposing reform, including representatives of the Maine Trial Law Association.  Medical Mutual Insurance Co. of Maine is also specified in the draft specs as a party to be consulted with.

These specifications should be considered preliminary and may well change after input from interested parties and after final review by the Bureau.

Public Health Commission Makes Recommendations
The Commission to Study Public Health, commonly referred to as the Faircloth Obesity Commission, has finalized its recommendations for legislation to submit to the 122nd Legislature. The bulk of the recommendations come from the Subcommittee on Schools, Children and Nutrition. They include a recommendation that the Bureau of Health evaluate advertising of foods of poor nutritional value directed at children 12 or under and study whether they can be restricted. Much of the discussion centered around the issue of raising money to help combat obesity and physical inactivity in the State, including taxing advertising and/or soda. In the end, the Commission agreed to direct the Legislature to find roughly $12 million to develop a media campaign promoting healthy eating and physical activity but did not actually recommend a particular tax, thus softening the recommendation but perhaps making it more realistic.

A recommendation to prohibit advertising of food of minimal nutritional value on school grounds passed, with the support of the soda industry who argued that they are already working on this. This ban would be effective on December 2006.

A controversial provision which had failed to become law earlier this year was passed which would require chain restaurants to provide caloric information. Many other recommendations were passed regarding school physical fitness requirements and healthy food in state buildings.

These recommendations will get a public hearing sometime in September. The date has not yet been set. For a complete list of the recommendations, email Anna Bragdon at abragdon@mainemed.com. [return to top]

MMA PAC Trustees Interview Congressional Candidates
On Wednesday evening, August 4, 2004, the trustees of the Maine Physicians Action Fund (MPAF), the MMA's political action committee, and other interested members of the organization met to interview the four candidates for Maine's two Congressional seats.  The group met first with Tom Allen (D), the incumbent in the 1st Congressional District, and then with his challenger, Charlie Summers (R), a former State Senator and staff member for Senator Olympia Snowe.  Brian Hamel (R), the challenger in the 2nd Congressional District, next described his candidacy.  Mr. Hamel is trained as a C.P.A. and began his career with the accounting and consulting firm Arthur Anderson.  He went on to lead the Pease (A.F.B.) Redevelopment Authority and, most recently, the Loring (A.F.B.) Redevelopment Authority.  2nd District incumbent Mike Michaud (D) was the last to meet with the group on Wednesday evening.  The interviews lasted from a half hour to 45 minutes and touched on many issues of interest to the physician community, including the medical liability situation, Medicare and Medicaid reimbursement rates, and prescription drug issues.  The trustees soon will be recommending that the American Medical Association PAC, AMPAC, support one candidate in each Congressional district.

Leaders of the Maine Osteopathic Association also joined MMA members for the interviews.

The MPAF trustees also reviewed the candidates for the 122nd Maine Legislature.  You can find the list of General Election candidates on the Secretary of State's web site, http://www.maine.gov/sos/cec/elec/2004/gencan.htm.

The trustees of the Maine Physicians Action Fund are:

  • John B. Makin, Jr., M.D., OB/GYN, Waterville, Chair
  • William Atlee, M.D., Ophthalmology, Augusta
  • William Clark, M.D., Ophthalmology, Bangor
  • Russell B. Radcliffe, M.D., Radiology, Auburn
  • Brian M. Jumper, M.D., Urology, Portland
  • Edward Jaccoma, M.D., Ophthalmology, Sanford
[return to top]

Anthem Sues California Insurance Commissioner Garamendi
On August 3, 2004, Anthem, Inc. filed an action in California Superior Court to overturn Insurance Commissioner Garamendi's July 23, 2004 decision not to approve the proposed merger between Anthem and WellPoint Health Networks, Inc. because he believes the transaction is not in the best interest of WellPoint shareholders.  The suit seeks a judicial declaration that the proposed merger meets all the standards set out in the law and a permanent injunction preventing Garamendi from interfering with the transaction.  In addition to criticizing the transaction as a "bad deal" for California consumers, Garamendi has called the compensation to be awarded to executives involved in the deal "unconscionable" when so many Californians are without health insurance. [return to top]

The Doctor's Company Files for Average 29.9% Rate Increase
On July 23, 2004, The Doctor's Company of Napa, California filed with the Maine Bureau of Insurance a rate increase request averaging 29.9% across all specialties.  The proposed effective dates are October 1, 2004 for new business and November 1, 2004 for renewals.  The Doctor's Company currently covers 55 physicians in Maine and the MMA understands that the company will not renew 5 physicians as a result of a restructuring in which the company will focus on large national accounts.

The filing includes the following proposed percentage rate increases for $1 M/$3 M coverage by specialty:

  • Anesthesiology (18 physicians):  27.7%
  • Invasive Cardiology (1 physician):  25.1%
  • Family Practice (no surgery) (2 physicians):  41.7%
  • Family Practice (minor surgery, no OB) (2 physicians):  37.1%
  • Hand & Foot Surgery (1 physician):  0%
  • Internal Medicine (5 physicians):  29.4%
  • OB/GYN (1 physician):  27.4%
  • Occupational Medicine (2 physicians):  13.3%
  • Orthopaedic Surgery (5 physicians):  38.7%
  • ENT (no facial) (2 physicians):  31.6%
  • Pathology (6 physicians):  45.9%
  • Physical Medicine & Rehabilitation (minor procedures) (2 physicians):  19.0%
  • Plastic Surgery (4 physicians):  21.7%
  • Thoracic/Cardiovascular Surgery (1 physician):  31.7%

In addition, surgicenter per procedure rates will increase 29.5% and will have a minimum premium of $1800.00.

The Bureau of Insurance staff is reviewing the request. [return to top]

CMS Official to Present in Bangor August 31
William MacKenzie from the Boston Regional Office of CMS Medicare Division, will be speaking on the Medicare Modernization Act drug discount cards and HIPAA from 9:00am - 11:00am on Tuesday, August 31 at the Mason Auditorium at Eastern Maine Medical Center in Bangor.

Mr. MacKenzie will take questions following his presentation and any physician and office staff are invited to attend.  Please RSVP via e-mail to wmackenzie@cms.hhs.gov by Thursday, August 27. [return to top]

Alert of Interest to Physicians Posted from Attorney General's Office
Marci Alexander, an Assistant Attorney General who is Director of the Healthcare Crimes Unit of the AG's office,  has communicated to MMA the following alert and asked that the communication be forwarded to MMA members and other physicians.

SUBJECT:  AG ALERT

        I am sending you this Alert so that you can spread the word to MaineCare providers to watch out for this dubious entity "Doctor's Assistance Corporation" a/k/a U.S. Seminar Corporation of La Mesa, California.

     DHS is receiving calls from providers advising that a "Doctors Assistance Corporation" out of California has contacted providers regarding overpayments on behalf of the Medicaid/Mainecare program.  Per one provider, the Doctors Assistance Corporation is falsely representing that they are collecting money on behalf of the State of Maine and that providers must use them to return overpayments.  This of course is a false assertion.

    To be clear, the Doctor's Assistance Corporation is in no way affiliated with Maine DHS, MaineCare, Medicaid or Medicare.  In fact, the Office of Inspector General (OIG) has issued an advisory about this entity.  As you know, the proper way to return overpayments is set forth in Chapter One of the MaineCare benefits manual and does not involve an outside entity.

     Questions about overpayments should be directed to Marc Fecteau at: SURS/BMS, 11 State House Station, 442 Civic Center Drive, Augusta, ME 04333-0011.

     Ms. Alexander has added to her alert a desire to hear from any provider who may have received a call from this entity and recorded it on their answering machine. The AG's office would like to have a copy of the recoding for enforcement purposes. [return to top]

Hospital Study Commission Looks at Alleged Physician Monopolies
The Commission to Study Maine's Hospitals met on Monday (8/9) and discussed Bureau of Insurance Rule, Chapter 850, which imposes limits on the extent to which managed care plans and networks can incentivize patients to travel to receive care.  These limits have generally been called the geographical standards which require that care be available within a certain distance of a patient's home.  The standard is generally one- half hour travel time for primary care and one hour for specialty care.  If care is not available in the Plan's network within these geographical limits, insurers must pay charges to providers who treat the patients. Business and insurer interests have long called for an end to Chapter 850 but their pleas have been rebuffed by the legislature, based largely upon advocacy by the consumer groups and the provider community.

These same interests have now captured the attention of the Study Commission which formed a work group to look at Rule Chapter 850.  In presenting tentative recommendations to the Commission on Monday, the work group recommended, among other things, that specialist physicians who do not contract with a plan not be paid charges but be limited to receiving a fee based roughly on Medicare plus a percentage.

It is not yet known whether this radical fee setting could be part of the Commission's recommendation to the Legislature but physicians impacted by this provision should be vigilant in their advocacy.  It might well be wiser to amend Chapter 850 than to let the Commission regulate physician fees directly as contemplated by this proposal. 

MMA recognizes that some physicians support a change in the current rule, and might support setting fee limits in the case of non-participating providers.   MMA members wishing to weigh in on this issue should feel free to communicate with Gordon Smith or Andy MacLean at gsmith@mainemed.com or amaclean@mainemed.com.  Both Gordon and Andy can be reached at 622-3374.

The Commission schedule has changed somewhat since last week.  It will continue to meet on Monday mornings over the next two to three weeks before beginning public hearings. [return to top]

Register NOW for 151st Annual Session: Room Deadline Ahead
The Association's 151st Annual Session,  being held Sept. 10-12, 2004 at the Colony Hotel in Kennebunkport, promises to be one of the best in years.  Nine and one half hours of category one CME are available as well as presentations on professional liability in Maine and the Medicine and Literature Project.  Recreational activities include golf, tennis and the annual Edmund Hardy Road Race.

The room deadline for the hotel expires this week, so please do not delay in making your reservation if you are planning to attend.  We would hate for you to be disappointed and not be able to get a room at the Hotel.  If you don't have the rooming form and need one, call or e-mail Julie Banta at 622-3374 or jbanta@mainemed.com.  We will fax a form right out to you.  Registration is also available on line at www.mainemed.com. [return to top]

MMA PAC Co-Hosts Fundraiser for U.S. Representative Tom Allen
The Maine Medical Association's political action committee (PAC), the Maine Physicians Action Fund, is joining the Maine Hospital Association, and the Maine Health Care Association in co-hosting a fundraiser for Congressman Tom Allen (D - 1st District) on Wednesday, August 18, 2004 at the Center for Maine History, 589 Congress Street, Portland, Maine.  The suggested contribution is $100 per person.  This is a great opportunity to talk with Congressman Allen about medical liability reform, the Medicare payment formula, and other key issues for the medical community.

If you would like to attend, RSVP to rsvp@tomallen.org or call 774-9696. [return to top]

Celebrate 150 Years of Medicine in Penobscot County and the Region
The Penobscot County Medical Association was organized on February 15, 1854 at the home of Dr. Hosea Rich of Bangor.  The Association is the oldest county Medical Society in the State.

On February 15, 1954, a Centennial Anniversary was held at the Bangor House with Dr. Magnus F. Ridlon of Bangor presiding and Dr. Harry Butler of Bangor as Toastmaster.  An Address was given by Dr. Norman H. Nickerson of Greenville.  Dr. Nickerson was President, at that time, of the Maine Medical Association.

On Sept. 18, 2004, the Association will celebrate its Sesquicentennial Anniversary at a Gala evening event, sponsored by the Maine Medical Association and the county society.  Invitations have been sent to all MMA members in the region.  The event will be held at the Maine Center for the Arts in Orono and tickets for the reception, dinner and program are available for $50 each from Chandra Leister at MMA (622-3374 or cleister@mainemed.com).

As was stated by a member in 1954, "Let us all make a special endeavor to meet at the appointed reunion, and if by nothing more than our presence, assist in starting this venerable Association upon another successful one hundred years of usefulness dedicated to serve God and Country." [return to top]

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