August 23, 2004

 
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Maine Quality Forum Website to Include Variation Data
At the August 13 meeting of the Advisory Council to the Maine Quality Forum, members were presented with data and suggested templates for the anticipated MQF website. Forum Executive Director Dennis Shubert, M.D., Ph.D. hopes to have the website operating by early Fall, perhaps as early as September.
The data being discussed is derived from the hospital inpatient discharge data collected by the Maine Health Data Organization and put together by the Maine Health Data Organization.  Because the data is adjusted for where the patient resides, it shows variations in the incidence of certain surgical procedures and medical admissions in Maine's 39 hospitals.  Both the Maine Hospital Association and the Maine Medical Association have been given an opportunity to comment on the data and the Association comments are set out below.  While the data, at this point, does not include the names of individual physicians, an attempt may be made in the near future to change regulations currently in place in order to permit the inclusion of such information.  Some members of the Advisory Council and staff to the Forum have indicated a strong interest in eventually including physician profiles in the information included on the website.     

DRAFT

 

 

GEOGRAPHIC VARIATIONS

 

 

            Maine is fortunate to have the best set of hospital inpatient data in the country.  This data set, culled from claims data over many years, is comprehensive and can tell us many things.  It is, however, based upon claims data and therefore has some important limitations.  The amount of data from any one hospital may be too small, particularly when broken into specific procedures, to be credible.  Because of the small volume, it frequently is more credible to look at five years of blended averages, rather than relying upon data from one year.

 

            Because of the important work of the Maine Medical Assessment Foundation, the discharge data can be sorted by patient residence and adjusted to account for patients where they reside.  This methodology allows for so-called, “small-area variation analysis,” and can be used to tell us which areas or regions are receiving more or less care, or particular procedures, compared to other regions.

 

            When reviewing this data showing regional variations, the following points need to be kept in mind:

 

1.      There is frequently no professional consensus as to what is the  

      “correct” rate for a given medical procedure.

 

2.      When the data is presented by town or region, it tells us little or nothing

      about an individual hospital or individual physician.

 

3.      Variability in the frequency of a medical or surgical intervention can be caused by many factors, including:

a.     patient preference

b.     physician preference

c.     disease incidence in the region

d.     environmental or demographic factors in the region

e.     lack of insurance coverage, including coverage for drugs

f.        lack of professional consensus

g.     availability of the service or procedure

h.      state policy has institutionalized some variation in treatment via payment policies.

 

The Maine Medical Association supports the collection of and appropriate distribution and use of such data.  The Association believes that such data, although limited, can be of substantial educational value to physicians, patients, and policy-makers.  But, the limitations noted above need to be kept in mind as the data becomes publicly available, as it is also subject to misuse and misinterpretation.  The data can tell patients a lot, but most patients will need to continue to rely upon a variety of information in order to be an educated patient.

 

The Maine Medical Association

August 2, 2004

        

Upcoming MMA Events: Golf, Annual Session, Sept. 18 Anniversary Celebration
The Maine Medical Association has three significant events upcoming in the next 30 days. 

The first is a charitable golf tournament being held on Monday, August 30, 2004 at the Augusta Country Club in Manchester.  Playing spots and sponsorships are still available by contacting Chandra Leister at MMA.  You can reach Chandra by phone at 622-3374 or by email at cleister@mainemed.com.

The Association's 151st Annual Session will be held  September 10-12, 2004 at The Colony Hotel in Kennebunkport.  Information on rooms still available can be obtained by checking in with Diane McMahon at MMA (622-3374 or dmcmahon@mainemed.com). 

Finally, on Saturday, September 18, 2004, the MMA and the Penobscot County Medical Association will celebrate their respective 150 year anniversaries with a Gala event at the Maine Center for the Arts in Orono.   Information on the Gala can be obtained by contacting Chandra Leister at MMA (see contact information above).   [return to top]

Governor Announces Dirigo Deal with Anthem - Resignation of Tom Dunne
At a press conference in the Cabinet Room yesterday afternoon, Governor Baldacci announced the conclusion of an agreement between the Dirigo Health Agency and Anthem Blue Cross Blue Shield of Maine to offer the Dirigo Health Plan product, to be known as DirigoChoice.  Joining the Governor at the podium for the announcement were Dirigo Board Chairman Robert McAfee, M.D. and Anthem's Maine General Manager Jim Parker.  The Cabinet Room was filled with other members of the Dirigo Board, the Dirigo staff, Anthem's product development team, and other interested parties.  The State expects to conclude formal agreements with Anthem shortly.

The Dirigo Health Agency will begin marketing the DirigoChoice product on October 1, 2004 and coverage will begin on January 1, 2005.

You can read the Governor's press announcement along with a preliminary description of the DirigoChoice product on the web at:  http://www.maine.gov/tools/whatsnew/index.php?topic=Portal+News&id=3076&v=article-2004.

The Dirigo Health Agency now has its own web page at:  http://www.dirigohealth.maine.gov/.

Just prior to the press briefing, Dr. McAfee announced the resignation of Tom Dunne as Executive Director of the Dirigo Health Agency and the appointment of Karynlee Harrington as Mr. Dunne's replacement.  A former CIGNA executive, Ms. Harrington becomes Executive Director after acting as the Dirigo Health Agency's Sales, Marketing, and Operations Director. [return to top]

Hospital Study Commission Meets with CEOs of "Independent" Hospitals
The weekly meeting of the Commission to Study Maine's Community Hospitals on Monday, August 23, 2004 was devoted to a discussion with 4 CEOs from hospitals that are "independent" or unaffiliated with one of the large integrated delivery systems in the state.  The 4 CEOs who made presentations to the Commission were:

  • Ron Victory, Penobscot Valley Hospital
  • Rick Batt, Franklin Memorial Hospital
  • Judd Knox, York Hospital
  • Sister Mary Norberta, St. Joseph's Hospital

Each CEO described his or her background and current facility, and each has extensive experience in health care administration in Maine and elsewhere in the country.  While there was some debate between the presenters and Commission members about the Commission's intentions or direction regarding "regionalization" or "consolidation" based upon its earlier work, the 4 presenters expressed concern that health care for Maine patients would not benefit from ever-increasing political and economic domination of regional markets by Maine's large integrated delivery systems.  Their comments all suggested that the Commission should not enhance the market power of these IDS.  While none of the featured hospitals is part of a large IDS, each is involved in a wide variety of affiliations when the relationship enables the institution to improve patient care.  At least 2 of the CEOs mentioned the importance of improving the medical liability climate in Maine in order to maintain high quality health care in our state. [return to top]

Initial Capital Investment Fund Amount of $6.6 M Goes to Public Hearing
In early August, the Governor's Office of Health Policy & Finance (GOHPF) established the Capital Investment Fund (CIF) at $6.6 million in third year operating costs.  The CIF is the annual limit on spending for health care projects subject to the certificate-of-need (CON)program.  12.5% of this amount ($823,000) has been set aside for non-hospital provider projects, leaving $5.8 million for hospital projects.

You can read the press announcement on the CIF amount on the web at:  http://www.maine.gov/governor/baldacci/healthpolicy/news/8_6_04.htm.

A public hearing on the initial amount for the CIF has been scheduled for Tuesday, August 31, 2004 from 9:00 a.m. to noon in the conference room at the Dirigo Health Agency, 211 Water Street, Augusta, Maine.  Written comments may be sent to the attention of Trish Riley, Director, Governor's Office of Health Policy & Finance, State House Station 15, Augusta, Maine 04333-0015 by 5:00 p.m. on Wednesday, September 15, 2004.  [return to top]

U.S. DHHS Secretary Tommy Thompson Visits Maine in Mid-September
The Bush Administration's top health care official, Secretary Tommy Thompson, will be in Maine for a fundraiser to benefit the Maine Republican Party at the Inn by the Sea, 40 Bowery Beach Road, Cape Elizabeth from 5:30 - 7:00 p.m. on Thursday, September 16, 2004.

The General Reception ticket price is $50 per person.  A VIP Reception begins at 5:15 p.m. for a price of $200 per person.  Contributions should be made payable to Maine Victory 2004, 9 Higgins Street, Augusta, Maine 04330.

For more information, please contact Gordon Smith, Andrew MacLean, or Anna Bragdon at the MMA at 622-3374. [return to top]

California Medical Staff/Hospital Board Dispute Settles
The California Medical Association (CMA) recently announced the successful settlement of the lawsuit brought by the medical staff of Community Memorial Hospital of Ventura against the hospital board of trustees following two years of litigation.  In a special newsletter to members, the CMA said, "[t]he settlement ends one of the most contentious battles between a hospital and its physicians in California history and preserves the medical staff's right to maintain control of quality of care and patient safety at the hospital."

The hospital trustees and medical staff board members recently approved the settlement and the 250-member medical staff is likely to approve it soon.

The CMA announcement continues as follows:

National attention focused on the sharp disagreements between physicians and administrators at the 250-bed hospital in April 2003 when the medical staff filed suit in Superior Court alleging that hospital trustees and its administrator were using threats and intimidation to control the medical staff and individual physicians. The suit was based on California law, which requires that medical staffs be independent and self-governing to carry out their highly complex quality assurance functions, and to help insulate them against non-medical and profit-driven influences of the hospital administration. The lawsuit alleged thehospital board and its long-time administrator engaged in a long-term plan to strip the medical staff of those duties in part to bring in a new but controversial cancer treatment program, silence medical staff critics of hospital policies, and punish medical staff members who have interests in outpatient surgery centers.

Organized medicine saw the battle as a bellwether case on the issue of self-governance and quality care, and contributed money and resources to ensure that the staff physicians were not defeated by the deep pockets of the hospital, which spent freely on public relations and hired three law firms to fight the physicians. CMA and AMA officials called the confrontation a test of whether a hospital board could use its so-called "ultimate authority" to override the self-governing legal status of the medical staff and its oversight of the professional work it performs in the hospital. As much as $1 million was spent by both sides on the litigation. The medical staff's legal costs were supported heavily by both CMA, through its Legal Defense Fund, and the American Medical Association's Litigation Center, based on mandates from both organizations' Houses of Delegates. Specialty societies, such as the California Society of Anesthesiologists and the California Academy of Family Physicians, as well as a multitude of medical staffs across the state, also contributed. [return to top]

Aetna Begins Migraine Management Program
Earlier this summer, Aetna, Inc. announced the creation of a new joint venture to manage specialty drugs for Aetna members for the following conditions:  cancer, multiple sclerosis, infertility, rheumatoid arthritis, hepatitis C, and Crohn's Disease.  Aetna now has introduced a new medical management program for members suffering from migraines.  The program is voluntary and is designed for patients and their physicians to "establish a preventive plan by identifying what triggers a migraine and use preventive medicines."  Aetna estimates that more than 80,000 of its 13.4 million members suffer from migraine headaches, costing the health insurer more than $70 million a year. [return to top]

Maine DHHS Receives Federal Grant to Improve Alzheimer's Services
Maine's Bureau of Elder & Adult Services within DHHS recently announced that it has been awarded a 3-year grant from the federal Administration on Aging to improve services for Alzheimer's patients and those who care for them.  The award for the first year is $440,599 with increases expected in the following two years.

The grant funds will be directed to expand services for Alzheimer's patients and caregivers in rural Maine, including a caregiver companion program, new mental health counseling services, and hospice support for families affected by Alzheimer's disease.  The funds also will support the Maine Personal Assistance Services Association, an organization representing paid caregivers.

The MMA submitted a letter in support of the grant request.

You can read the Department's press release on the web at:  http://www.maine.gov/tools/whatsnew/index.php?topic=Portal+News&id=3052&v=article-2004. [return to top]

$268 Million Recovered in Medicaid Fraud Actions in FY 2003
Last week, the U.S. DHHS, Office of the Inspector General released its report, State Medicaid Fraud Control Units:  Annual Report for Fiscal Year 2003, claiming that state Medicaid Fraud Control Units recovered $268 million in restitution, civil settlements, and fines and penalties as a result of 1096 convictions.  47 states and the District of Columbia have Medicaid Fraud Control Units that received $119.8 million in funding to carry out their activities in FY 2003.

New Jersey achieved the highest rate of recovery by obtaining $42.6 million in recoveries and 15 convictions.  California recovered $39.3 million with 132 convictions, Texas recovered $31 million with 38 convictions, and New York recovered $24 million with 78 convictions.

The annual report is available on the web at:  http://www.oig.hhs.gov/publications/docs/mfcu/MFCU2003.pdf.

  [return to top]

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