November 8, 2004

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Maine Quality Forum Web Site Goes Live
The Maine Quality Forum website went live on Nov. 5 offering claims data from Maine's hospitals in 32 charts of data presenting questions such as, "Should where you live in Maine decide the treatment or surgery you get?" Check out the site at
The website has been in the development stages for the last few months and both MMA and the Maine Hospital Association have had an opportunity to make comments and suggestions.  In fact, the site has a section called, "Other Opinions" which includes comments from the two associations about the charts.  These comments are available at

On the day the site debuted, MQF Executive Director Dennis Shubert, M.D., PhD. held a press conference at which time he described the goals of the Forum as well as the purpose of the website.  He noted that the site was developed with input from the Maine Quality Forum Advisory Council, a stakeholders group of 17 members, including several physicians.

Dr. Shubert noted that the website is intended to present reliable information for the public and to answer common questions about health and healthcare.  The information is specific to Maine but links are also provided to other resources, such as, and the Maine Health Management Coalition.

Dr. Shubert went on to state, " For many years, health services experts have told us that where we live often determines what treatment we receive.  Many experts agree that when there are large differences,from town to town, in recommending surgery we often end up having operations that may not make us healthier.  Experts conclude that where you live should not determine what treatments you receive.  On our web site we look at Maine communities that show significant variation in surgeries such as spinal fusion, hysterectomy, and clearing of blood vessels to prevent stroke."

The public release of the data presents issues reminiscent of the work of the Maine Medical Assessment Foundation, which closed shop in 2002 after a twenty year existence.  During nearly its entire history, the Foundation struggled with how to present variations in surgical and medical procedure rates.  Researchers, particularly Jack Wennberg, M.D. at Dartmouth, have pointed out the wide variation in some types of procedures, while at the same time not declaring what rate is appropriate.  These discussions will continue, but now in a more public mode given the release of the data by community and by institution. 

Current law and rules of the Maine Health Data Organization do not permit the release of physician specific data, but several interest groups are seeking to take the debate to that next level. 

Hospital Study Commission Subcommittees Approach 11/15 Deadline
The subcommittees of the Commission to Study Maine's Community Hospitals are trying to finalize their recommendations before a November 15, 2004 deadline for subcommittee reports. 

On Friday afternoon, the CON/Rule Chapter 850 Subcommittee met to discuss potential amendments to the geographic access standards compromise in the Dirigo Health legislation.  The health plans and the business community believe that the requirement that any product providing incentives for members to seek care beyond the geographic access standards ensures that certain quality standards are met is too complex and burdensome to be feasible.  Subcommittee Joe Ditre of Consumers for Affordable Health Care urged the group to continue to refine the role of quality measures in products that may relax the access standards, including the role of the Maine Quality Forum in determining those quality measures. 

During Friday's meeting, the group also discussed Mr. Ditre's proposal to "depoliticize" the CON process by including the opportunity for an adjudicatory hearing before an administrative hearing officer prior to the Commissioner of DHHS making a final decision.  Finally, the subcommittee also discussed the consumer advocates' recommendation that the thresholds for CON review be reduced.  Mr. Ditre specifically suggested that the $1.2 M threshold for CON review of acquisitions of "major medical equipment" be reduced to $600,000.  Members of the subcommittee reached no consensus on either of these issues.  MMA and the Maine Hospital Association both oppose any lowering of the thresholds.

The full Commission is scheduled to meet on Monday, November 8, 2004 from 9 - noon at the BMS Conference Room in Augusta.  The CON/Rule Chapter 850 will meet next on Monday, November 15, 2004 at 9:30 a.m. in Conference Room 3 of the BMS building in Augusta. [return to top]

Democrats Appear to Maintain Control in 122nd Maine Legislature
The Democratic Party appears to have maintained control of both the State House and Senate following last Tuesday's elections. 

As in the 121st Legislature, the Democrats will have a slim 18-17 edge in the State Senate.  Four incumbent Democratic Senators and two incumbent Republican Senators lost their re-election bids.

The composition of the House likely will be 76 Democrats, 73 Republicans, 1 Independent, and 1 Green.  Eight incumbent Democrats lost their seats and three incumbent Republicans lost their seats.  The Democrats control of the House has narrowed from the 121st Legislature. Physicians Thomas Shields (R-Auburn) and Lisa Marrache (D-Waterville) both retained their seats.

You can view the list of apparent Senate winners at:

You can view the list of apparent House winners at: [return to top]

Bureau of Health Flu Vaccine Redistribution Plan to be Announced Early this Week
The Bureau of Health announced on Friday that its flu vaccine redistribution plan will not be issued until early this week.  The Bureau issued another flu vaccine update on Nov. 3 that included more defined guidelines for prioritizing high risk patients and describing what constitutes high risk.  The update also advised about the use of FluMist for healthy health care workers, described the protocol for using antivirals, provided information about testing for the flu and outlined infection control procedures for health care facilities.

The Bureau's most current flu vaccine information can be found at: www.MainePublicHealth.Gov. [return to top]

Revised Schedule for Commission to Study Maine's Hospitals
The Commission to Study Maine's Hospitals has again changed its schedule of meetings and reporting deadline.  The Commission will meet this morning (Monday, Nov. 8) from 9:00am to noon.  Charlotte Yeh, M.D., Regional Administrator for CMS will present, via video link, on the subject of Medicare reimbursement to Maine's hospitals.  Dr. Yeh on Sunday gave MMA staff a preview of her presentation.  The Commission is also expected today to begin discussion of the chapters in its report and to review issues surrounding electronic medical records.

The Commission has set the date of Nov. 15 for receipt of all subcommittee reports.  The Administrative Streamlining subcommittee and the Anti-trust workgroup will also meet the morning of the 15th.

While the Commission had called for two full days of meetings on Sunday, Nov. 21 and Monday, Nov. 22, several members are unavailable on the 21st and that date could change.  The Nov. 22nd date is likely to hold.  On that day, Harvard researcher Nancy Kane will present her final report on the relative financial health of Maine's hospitals.  The Commission is also expected to take its final votes on the draft chapters to be released to the public for comment.

On December 1, the draft report will be released to the public.  Public hearings have been scheduled for Portland (Dec. 9, 9:00am to noon), Augusta (Dec. 9, 1:30pm-4:30pm) and Bangor (Dec. 13, 9:00am to noon.)  Specific locations of the hearings have not yet been announced.

The Commission has scheduled a final meeting for Dec. 20 to review and approve any changes to the reports in response to public comment.  On January 4, 2005 the Commission is expected to release its final report to the Legislature.  The Commission then will disband, unless action to the contrary is taken by the Governor or the Legislature.

Two physicians sit on the nine member commission.  They are D. Joshua Cutler, M.D., a  Portland cardiologist and Louis Hanson, D.O., a family physician practicing in the Portland area. [return to top]

New MaineCare Requirements for Chiropractic Referrals
A change in Chapter II, Section 15 of the MaineCare Benefits Manual, effective Nov. 1, 2004, requires referring physicians to supply rehabilitation potential documentation to chiropractors for MaineCare members seeking chiropractic care.

Rehabilitation potential is the documented expectation by a member's physician or PCP that the member's condition will improve significantly in a reasonable predictable period of time as a result of the prescribed treatment plan.  The physician's documentation of rehab potential must include the reasons used to support this expectation.

Adult members (age twenty-one and over) must have an initial evaluation by a physician that documents the member's rehab potential.  This requirement will not apply to members with Medicare coverage or other third party health insurance until the coverage for services by the other payor has been exhausted.

The rehab potential assessment and documentation requirement is also included in new rules that will soon go into effect for occupational, physical and speech therapy services. [return to top]

MMA Presents CME Program on HIPAA Privacy and Security on Nov. 17 in Augusta
As part of its Fall Seminar Series, MMA presents a 3 hour CME program on HIPAA privacy and security on Wednesday morning, Nov. 17 at the MMA offices in Manchester.  The program runs from 9:00am to noon and features presentations by Sari Greene of Sage Data Security and attorney Gordon H. Smith from MMA.  Ms. Greene will discuss the security requirements which become effective in April 2005 and Mr. Smith will discuss developments in the privacy rules since they became effective in April 2003.

Cost for the program, which includes substantial materials and refreshments, is $75.  To register, call Chandra Leister at MMA at 622-3374 or via e-mail at  MMA's conference room can only accommodate about 40 persons classroom-style so don't delay! [return to top]

Dirigo Health Board Hears Update on DirigoChoice
At its monthly meeting on Nov. 1, the Dirigo Health Board of Directors heard an update from Karynlee Harrington, Executive Director of the Dirigo Health Agency, on enrollments for DirigoChoice.  DirigoChoice is the insurance product sponsored by the state and offered by Anthem which will be available to employees of small businesses January 1 and to individuals April 1.

Although fewer than 1,000 persons are enrolled currently, Ms. Harrington expressed hope that 10,000 might be enrolled by Jan. 1 and that the original goal of 31,000 for the first year might yet be achievable.   One of the complexities slowing up enrollment is the dual nature of the enrollment process with Anthem receiving the applications but the state determining eligibility for discounts.  It is the availability of a discount, based upon income, that is likely to be the most definitive factor in an employee taking advantage of DirigoChoice.

While provider workshops are expected at some point,  MMA is offering a Dirigo Update with Ms. Harrington and representatives of Anthem participating.  The program, highlighted by Dr. Robert McAfee (Dirigo Bd. of Director's Chairman) will be held on Friday afternoon, Nov. 30 at the Dana Center at Maine Medical Center in Portland from 1:00pm to 5:00pm.  Registration is available by contacting Chandra Leister at MMA at 622-3374 or via e-mail at  There is a fee of $75 for the program, which includes all materials and refreshments.  The program has been approved for 4 hours of category one CME. [return to top]

MMA Meets with DHHS Officials on MaineCare Issues
MMA President Larry Mutty, M.D., Gordon Smith and Andrew MacLean met with Department of Health and Human Services Commissioner Jack Nicholas last Tuesday.  The MMA delegation shared data with the Commissioner showing that for many MaineCare codes, reimbursement for physicians is less than 10% of charges.  Noting that an across the board increase in rates has not occurred in nearly 30 years, MMA called for a "good faith" down payment of $3.5 million dollars which with the federal match would bring all codes up to 60% of Medicare.

With the state facing a $700 million deficit, these funds will not be easy to find, but access to care for MaineCare patients is clearly at risk if even the cost of providing the service is not met.

Later in the week, Mr. Smith and Mr. MacLean met with the new acting Director of the Bureau of Medical Services Chris Gianopoulos, to make the same point.  The administrative burdens of dealing with prior authorization was also discussed during the two meetings. [return to top]

MMA Legislative Committee Meets Tuesday Night-Needs Your Input
MMA's Legislative Committee will meet on Tuesday night, Nov. 9, at 6:00pm at the Frank O. Stred Building in Manchester to discuss legislative initiatives for 2005.  The 122nd Maine Legislature convenes in December, 2004 and any legislation to be submitted must be presented before the December cloture date.  If you or your specialty have any anticipated legislation, please contact MMA staff (Andy MacLean or Gordon Smith) prior to Tuesday night.  Or you may attend the meeting by simply calling Charyl Smith at 622-3374 or via e-mail at

All of MMA's Committee meetings are open to any MMA member. [return to top]

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