September 27, 2004

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"Faircloth" Obesity Commission Hears from the Public
Friday's lengthy public hearing on our obesity problem is a preview of what is likely to be a lively legislative debate on the issue in the 122nd Maine Legislature.

The Commission to Study Public Health, created from legislation sponsored by Rep. Sean Faircloth (D-Bangor) to address the obesity crisis, met last week to hear from the public on the draft recommendations.  The Commission created more than 30 legislative and administrative recommendations this summer, such as increased physical activity in schools, caloric information on menus, and BMI checks in schools.  The Commission will make a final decision on the recommendations in October and will submit them to the Legislature by cloture in December.  Supporters of the recommendations included many health care entities, such as the American Cancer Society, the Maine Dental Association, the Maine Medical Association, American Lung Association, and more.  Also, many schools testified in support.  The opposition included the Maine Association of Broadcasters, who argued against the demonization of television when many other sedentary activities are prevalent in our lives.  The National Organization for Women and Weight Watchers testified to the perils of promoting a thin society to teenagers already sensitive about their body type.  Industry types representing restaurants, soda manufacturers, etc, testified against limiting choice.

Hospital Study Commission Reviews Voluntary Targets for Maine Hospitals
At its meeting this morning, the Dirigo Commission to Study Maine's Hospitals assessed Maine hospitals' compliance with the voluntary cost containment provisions of the Dirigo Health Plan and deferred a final decision on whether to recommend that these voluntary provisions be continued.  You can review the voluntary cost containment provisions of the Dirigo legislation on the web at:

Commission members heard presentations from David Winslow of the Maine Hospital Association, Jim Parker of Anthem, and Nancy Kane of Harvard University.  In their compliance efforts, the MHA used a cost per case-mix adjusted discharge formula used by the American Hospital Association, the Maine Health Management Coalition, and a national consulting firm.  Professor Kane's analysis used an alternative formula developed by another national consultant.  The primary difference in the two approaches is the use of a Medicare (MHA) or all payer (Kane) index for the calculation.  Also, Professor Kane's analysis showed how hospitals might manipulate their cost per case-mix adjusted discharge by altering their charge structures, though she stopped short of suggesting that Maine hospitals were currently doing this.  MHA representatives saw Professor Kane's methodology for the first time on Friday and will review it in greater detail.  Speaking on behalf of the Maine Association of Health Plans, Anthem General Manager Jim Parker stopped short of endorsing the voluntary cost containment provisions, but stated that in recent negotiations, some hospitals had requested increases from Anthem of 6-7%. 

Next week, the Commission will return to reviewing its draft report and recommendations. [return to top]

California Adopts Legislation Specifying Self-Governance of Medical Staffs
On September 22, 2004, California Governor Arnold Schwarzenegger (R) signed a bill (S.B. 1325) submitted on behalf of the California Medical Association that takes steps to confirm the self-governing status of hospital medical staffs.  You can find more information about this bill on the web at the California Senate's site:

S.B. 1325 came out of the Community Memorial Hospital of San Buenaventura dispute.  The bill does the following:

  • gives hospital medical staffs the right to retain legal counsel
  • gives state courts the right to issue injunctions against those who interfere with a hospital medical staff's exercise of its rights and responsibilities
  • gives hospital medical staffs the right to establish standards for credentialing physicians and for enforcing those standards
  • gives hospital medical staffs the authority to choose and remove medical staff officers, assess dues from members, and use that money for medical staff purposes
  • gives medical staffs the responsibility to determine clinical protocols and standards for oversight of quality assurance, utilization review, and other medical staff activities

After amendments assuring that the bill would not establish a contractual relationship between hospitals and medical staffs, the California Heathcare Association (CHA), the principal hospital trade group in the state, took a neutral position on the bill. [return to top]

Anthem Files for Average Rate Increase of 14.7% for Individual Products
On September 21, 2004, the Bureau of Insurance announced that Anthem Blue Cross Blue Shield of Maine has filed revised rates for its individual HealthChoice products that will result in an average increase of 14.7%.  The rate requests range from a 4.2% decrease to a 106.5% increase, depending on the deductible level and type of contract.  The proposed effective date is January 1, 2005.  The Bureau has scheduled a public hearing on this rate request at 9:00 a.m. on Friday, November 12, 2004 in the Utilities Committee Room, Room 209, of the Cross State Office Building in Augusta. [return to top]

Single Payer Study Group Defers to Dirigo
On September 22, 2004, members of the Health Care System & Health Security Board met at the State House to consider their role in a health policy debate dominated by Governor Baldacci's Dirigo Health Plan.  Established in the 120th Maine Legislature during Governor King's tenure, the Health Care System & Health Security Board was charged with exploring the viability of a state-based single payer health care system in Maine.  The Senate Chair of the group is Senator John Martin (D-Aroostook) and the House Chair of the group is former Representative and long-time single payer advocate Paul Volenik (D-Brookline).

This study group had been dormant for months before this meeting.  The Deputy Director of the Governor's Office of Health Policy & Finance (GOHPF), Ellen Schneiter, briefed members on the implementation of the Dirigo Health Plan.  Following the briefing, the group decided to submit legislation to extend the deadline for its final report so it can continue to monitor the progress of the Dirigo Health Plan.  The consensus seems to be that, if Dirigo is "successful," the group will not pursue the single payer agenda.  No further meetings are planned for this year. [return to top]

Prevnar Fourth Dose Reinstated

State supplies of Prevnar, Pneumococcal 7-valent Conjugate Vaccine (Diphtheria CRM197 Protein), have continued to improve, and the ACIP, AAP, and AAFP have now recommended reinstatement of the fourth dose (booster) of Prevnar to their immunization guidelines.  All eligible children should receive four doses of Prevnar at the routine infant immunization schedule of 2, 4, and 6 months of age with the fourth dose between 12 and 15 months of age.  The ACIP, AAP, and AAFP also recommend that children who previously had any doses of Prevnar deferred during the shortage now receive those doses. 

As you know, the CDC published interim recommendations during the period of shortage to conserve supply and help ensure the availability of existing doses of Prevnar for all eligible children.  In the September 17th issue of Morbidity & Mortality Weekly Report (MMWR), the CDC recommends resumption of the fourth dose of Prevnar and provides additional guidance on managing the administration of Prevnar to your patients.  This information can be accessed at

The MMA recommends that all physicians resume the four dose series for Prevnar.  Many children will need additional "catch-up" doses.  Please check your records and call those parents whose children need one or more doses.  You may want to consider a catch-up Prevnar dose when a child visits your office for their yearly flu shot.

  [return to top]

Safe Drug Returns Topic of October 5th Program
The Maine Benzodiazepine Study Group and the Maine Medical Association are co-sponsoring an all-day program to look into the safe return of unused and expired pharmaceuticals.  The program will be held on Tuesday, October 5th at the Four Points Sheraton in Bangor.  Panelists include groups who were involved in passing a drug returns law in Maine, as well as people from other states who are beginning their own returns programs.  Experts will share information that will be critical in getting the Maine program off the ground.

To register online, go to  There is a $25 dollar registration fee that can be paid at the door. [return to top]

Benzo CME Conference to be Held in Bangor
The Maine Benzodiazepine Study Group is holding an all-day conference with 6.5 hours of CME credit on Monday, October 4th at the Four Points Sheraton at the Bangor airport.  The conference will look at the national picture of benzos, the Medicare exclusion, the elderly, alternative treatments, and the creation of guidelines. 

To register for the conference online, go to [return to top]

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