October 4, 2004

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Critical Eye Turned on Medicaid
At a conference held in South Portland on Thursday, Republicans and conservative analysts took exception to the state's planned expansion of Medicaid, stating that Maine cannot afford to grow its MaineCare program at a time when cuts in services are being implemented to make up for a budget shortfall.
A conference sponsored by the Maine Heritage Policy Center this past week took on the behemoth problem of Medicaid at an afternoon conference in Portland. Through presentations by Tarren Bragdon, Director of Health Reform Initiatives at MHPC, James Frogue, Director of Health and Human Services Task Force for the American Legislative Exchange Council out of Washington, DC, Nina Owcharenko, Senior Policy Analyst at the Heritage Foundation, also in DC, and  State Senator Rick Bennett, the conference laid out the current problems with Medicaid, using national data to compare our program with the rest of the country. Maine spends more per member on Medicaid than most of the country, yet it's poverty level is not comparable. They pointed to Medicaid's rapid growth, increases in eligibility and rich benefits as the problems affecting its sustainability.  Senator Bennett reminded the group that legislation passed during his tenure which would create a portable health product for consumer and noted that it would be wise to give some more attention and funding to that plan, as it has sat unnecessarily dormant for a couple years. A panel consisting of two Republican legislators and one Democrat discussed the state's problems with Medicaid at the end of the conference. Cuts are expected next year, due to yet another large shortfall in the Medicaid budget, they noted.

Another Medicaid expansion will take place on April 1, 2005 unless altered by legislative action in January.  The expansion is scheduled to go into effect ninety days after the DirigoChoice product becomes available in January.  Enrollment for DirigoChoice begins today (Monday, Oct. 4). 

The expansion includes eligibility for parents of Medicaid eligible children with incomes up to 200% of the federal poverty level, and for single adults with incomes up to 125% of the poverty level.  As many as 14,000 persons are expected to enroll, which would give Maine one of the largest percentages of population on Medicaid in the country.

Listening Conference on End-of-Life Care
The Maine Hospice Council and the Maine Attorney General's Office recently held a "Listening Conference"  to gather ideas for improving end-of-life care here in Maine. Three panels tackled issues such as "Will my Wishes be Honored?","Will my Pain be Managed?" and "Will I Receive Competent Care?" Panelists included a consumer and reaction by physicians (including  Laurel Coleman, MD, Tom Keating, MD, Lauren Michalakes, MD), nurses, hospice volunteers, lawyers and many others. In breakout sessions, groups identified their priority concerns with current hospice care and their responses fell primarily into the same categories: the need for greater education of the public to promote the use of hospice, the need for greater education of providers to refer to hospice, and the need for the system to flow better for all those involved at each step of the process. [return to top]

Jeffrey Holmstrom, D.O. named Medical Director at Anthem Blue Cross Blue Shield
Jeffrey Holmstrom, D.O. has been named the new Medical Director of Anthem Blue Cross Blue Shield.  The position has been vacant since the resignation of Karen Bell earlier this year, although Maxwell Barus, M.D. has filled in on a part -time basis.

Dr. Holmstrom, a member of MMA, most recently served as Medical Director in Maine for Aetna.

Anthem has recently convened an advisory committee of physicians to provide input into its provider relations and medical policies in Maine.  The committee met last week in Freeport for its initial meeting.  Much of the discussion at the meeting focused upon Anthem's new DirigoChoice product, expected to be available January 1, 2005. [return to top]

Governor Baldacci Announces Pair of Programs Aimed at Lowering Drug Prices
Governor Baldacci announced last Thursday a pair of programs aimed at lowering prescription drug prices in the state.  The first program would involve in porting drugs from Canada through an arrangement with the Penobscot Indians.  The Governor has sent a letter to HHS Secretary Tommy Thompson seeking a federal waiver to reimport drugs from Canada.  The drugs would in turn be distributed by the Penobscot Indian Nation, which would operate a warehouse on its reservation in Old Town.  The Governor presented the Penobscot Nation with a $400,000 grant to begin the project.

Other states have requested similar federal waivers but, to date, no state has been granted one. A spokesperson for the tribe declined to indicate whether the business could operate without the federal waiver.  The tribe is getting advice from the Pequot tribe in Connecticut which has run a similar program for a number of years.

The second program is called "Rural Rx"' which is intended to provide savings of 25 to 50% to uninsured and under insured Mainers through the community health centers in the state and other outlets. [return to top]

Merck Voluntarily Withdraws VIOXX; Provides Info for Physicians/Patients
In a surprising statement,  Merck & Co., Inc. announced on Sept. 30 its voluntary withdrawal of VIOXX, based upon new data from a three-year clinical study.   In the study, there was an increased risk for cardiovascular events, such as heart attack and stroke, in patients taking VIOXX 25 mg compared to those taking a placebo.  While the incidence of CV events was low, there was an increased risk beginning after 18 months of treatment.

Merck encouraged patients currently taking the drug to contact their health care provider to discuss discontinuing use of the drug and possible alternative treatments.  In addition, patients and physicians were given a toll-free number to call from more information: 1-888-368-4699.  Additional information can also be found at merck.com and vioxx.com.

Merck will reimburse all patients for their unused VIOXX. [return to top]

Maine's Gastroenterologists Form State Specialty Society
At a business meeting on Thursday, September 30, 2004, founding members of the Maine Gastroenterology Society approved bylaws governing this new specialty society.  Approximately 20 gastroenterologists have joined the Society formed "to increase and propagate the understanding of gastroenterology among physicians engaged in the ongoing practice of gastroenterology and the socio-economic issues involved in the treatment of gastrointestinal diseases and hepatology, and other lawful purposes including prevention of disease and education of the public."

The initial Executive Committee of the organization is composed of Alroy A. Chow, M.D. of Brunswick, President, Michael J. Monzel, M.D. of Lewiston, Vice-President, John J. Bosco, M.D. of Brunswick, Secretary-Treasurer, Daniel Cassidy, M.D. of Bangor, At-Large, and Alan E. Kilby, M.D. of Portland, At-Large.  All gastroenterologists in Maine are welcome and encouraged to join.  For more information, please contact Chandra Leister at the MMA at 622-3374 or cleister@mainemed.com.

The Maine Medical Association was pleased to assist the Society in its organization and development of its bylaws.  The Society intends to hold at least two meetings/ conferences a year with the next conference being held at the Bethel Inn and Conference Center March 11-13, 2005.  Ms. Leister may be contacted for information on this upcoming meeting. [return to top]

Revised CON Procedures Manual is Proposed for Public Comment
The Maine Department of Health & Human Services (DHHS) has published a revised CON procedures manual in accordance with the Administrative Procedures Act and the Dirigo Health Plan.  This revised rule will receive a public hearing on Tuesday, October 21, 2004 at 10:00 a.m. at the Bureau of Medical Services Conference Room, 442 Civic Center Drive, Augusta.  The written comment deadline is Friday, November 1, 2004.  The draft rule has not been published on the State's web site, but you may obtain a copy from the MMA office.  Please call Andrew MacLean at 622-3374 or send your request by email to amaclean@mainemed.com. [return to top]

Hospital Study Commission to Focus on Subcommittee Work in October
At its meeting on Monday, October 4, 2004, the Commission to Study Maine's Community Hospitals received a briefing from its Anti-trust Workgroup which had met just prior to the meeting of the full Commission.  Commission Chairman Bill Haggett identified 6 key issues that he suggested need substantial and in-depth work before the Commission could make final recommendations.  He suggested that this work should be conducted at a sub-committee level rather than the full Commission.  Accordingly, he suggested that Commission meetings be suspended during October to allow sub-committee work in the following 6 areas:

  • Anti-trust
  • Regionalization
  • Administrative streamlining
  • Rule Chapter 850
  • Standardized reporting
  • Certificate-of-need

Chairman Haggett proposed that the sub-committees report back to the full Commission during the first week of November and that the Commission finalize its report and recommendations by the first of December.  He further suggested that public hearings on the Commission report be scheduled for 9 a.m. to 12 noon on December 6, 9,  and 13 in Portland, Augusta, and Bangor respectively. [return to top]

Maine Coalition on Smoking OR Health Reviews Wins/Faces Challenges
At its annual meeting on Monday, October 4, 2004 at the Senator Inn in Augusta, the Maine Coalition on Smoking OR Health (of which the MMA is a founding member) celebrated its victories of the past year - - extending the workplace smoking ban to include most bars and taverns, protecting foster children from second-hand smoke, and preventing further diversions from the Fund for a Healthy Maine, for example - - and faced the challenges of the future, such as a new tobacco industry advertising blitz aimed at youth, the potential of FDA regulation of tobacco, and the "obesity" challenge.

Approximately 40 attendees heard presentations from Anthony Anderson, the school health coordinator in MSAD #11 (Gardiner, West Gardiner, Randolph, & Pittston), on school-based strategies to prevent tobacco use and obesity; Lori Fresina, a field representative with the Campaign for Tobacco Free Kids, on the FDA regulation of tobacco; and MaryEllen Fitzgerald, Principal with Critical Insights, a nationally-known market research organization, on public support for Maine's "bar bill."

During the meeting, MCSOH leaders, including Jo Linder, M.D., the Board Chair, presented special recognition awards to the following for their efforts in the state's tobacco control, treatment, and prevention efforts:

  • the Maine Tobacco-Free College Network
  • CD & M Communications
  • the American Lung Association of Maine, the American Cancer Society, New England Division, Inc., and the American Heart Association, Northeast Affiliate; and
  • Governor John Baldacci

On Monday evening, and perhaps later this week, a joint U.S. Senate-House conference committee is scheduled to discuss the FDA regulation of tobacco.  Senator Snowe, who has already committed her personal support on this issue, is considered a key player in the conference committee discussion.  The MCSOH and the MMA urge you to call Senator Snowe's office at 202-224-5344 to urge Senator Snowe to not only support the FDA regulation of tobacco, but to tell Senator Grassley (R-Iowa) and Senator Baucus (D-Montana) that she will not sign a conference committee report on this legislation that does not include the provision on FDA regulation of tobacco. [return to top]

Workers Comp Summit 2004 Discusses Medical Fee Schedule
MMA representatives were present on Monday (Oct. 4) at the 2004 Workers Comp Summit to defend attempts by Maine's business community to lower the conversion factor (presently $60) in the medical fee schedule.  There has been no increase in the fee schedule since the existing conversion factor was established in 1997, despite statutory language calling for an annual update.

Representatives of the business community argued again on Monday that the fee schedule should not provide for reimbursement any greater than that paid by the private insurance companies.  However, MMA EVP Gordon Smith pointed out to conference attendees that  it would be unfair to decrease physician reimbursement under the fee schedule while much of the provider community is not covered by the fee schedule, and that there is demonstrable evidence that patients who are injured at work require far greater administrative work in the physician office than other patients.  A study published in the Journal of Bone and Spine Surgery was provided to participants which quantified the additional administrative costs.  Comparison to private insurance was not appropriate, Smith added, because of the additional burden and because of the state's obligation to protect access to quality medical care for its injured workers.

The fee schedule is currently the subject of a consensus rule-making proceeding before the Workers Compensation Board.  Mr. Smith stated at the conference that the Maine Medical Association would not agree to any reduction in the fee schedule and instead would advocate vigorously for a cost of living adjustment in the schedule. [return to top]

Dirigo Health Board Met Monday to Hear Updates
The Board of Directors of Dirigo Health met yesterday (Oct. 4) and heard updates on the marketing of DirigoChoice and the activities of the Maine Quality Forum.  The Dirigo Health product is being marketed first to small businesses employing less than 50 persons which have not offered health insurance in the recent past.  Anthem is offering the product which will be available beginning in January. Information is available by calling 1-888-243-8731.

Dr. Dennis Shubert shared with board members the Forum's "Request for Proposals to Develop and Run Measures of Healthcare Quality" which is intended to provide assistance to the Forum in generating valid, reliable clinical indicators that:

  •   Measure medical care
  •   Create actionable analyses
  •   Improve healthcare quality and efficiency
  •   Cover breadth and depth of medical care
  •   Support specific analysis plans
  •   Assess post operative infection

The RFP is expected to be released in early October with an informational hearing to be held in November.  It is hoped that a contract can be awarded by December with an initial analysis being presented by the contractor in April.

The measures would be applied to the paid claims database that includes all non-Medicaid/Medicare claims for the year 2003.  The Forum hopes to use the paid claims data to publish measures of medical care that providers, patients and payers use for establishing and improving the quality and efficiency of care.

This data would be available through the website of the Forum which is currently being beta tested but is not yet fully operational. [return to top]

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