November 22, 2004

 
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Commission to Study Maine's Hospitals Meets Today
The nine member Commission to Study Maine's Hospitals meets today (Monday, Nov. 22) in Augusta and will hear presentations from the Maine Association of Health Plans and Nancy Kane, D.B.A. , of the Harvard School of Public Health. Dr. Kane is a consultant to the Commission. The Association of Health Plans will present comparative data on charges paid for selected medical services in Maine, MA and N.H.
The meeting will be held at 9:00am in Room 105 of the Cross Office Building.  Following today's meeting,  the Commission plans to meet for full-day meetings on Monday, Nov. 29 and Wednesday, Dec. 1.  At these future meetings, the Commission will review the draft reports prepared by the subcommittees and vote on a final report to go to public hearings in December.   The Report will go to the Legislature in early January.

The December issue of Downeast Magazine features a multiple- page article on the Commission entitled, "Which Maine Hospitals Must Go?"   The article, by senior Downeast Editor Jeff Clark,  focuses on an early draft of a paper by  Commission Chairman William Haggett which was not approved by the full commission.  In that paper, Haggett recommends cutting 3,500 hospital jobs and closing Parkview Hospital in Brunswick and Inland Hospital in Waterville.  He also suggests merging Cary Medical Center in Caribou with Aroostook Medical Center in Presque Isle.  Few observers expect these recommendations to be in the final Commission report.  Commission members have expressed outrage at the Downeast article, expressing concern that the article focuses almost exclusively on the leaked draft of the Chairman's draft and talks very little of the Commission's deliberations on several other issues, including certificate of need, state planning, administrative issues, anti-trust,  standardized reporting and Insurance Rule Chapter 850.

The Subcommittee working on Rule 850, Certificate of Need and Maine Health Data Organization Rule 120 met on Monday, Nov. 15 to complete its draft report.  Committee members were not in unanimous agreement on virtually any aspect of the report, but a majority did vote to recommend changes to Rule 850 that would permit health plans to seek approval of the Bureau of Insurance in providing incentives for patients to travel beyond the previously designated areas to seek treatment from hospitals and specialists the plans would designate as high quality.  The Bureau of Insurance, with input from the Maine Quality Forum, would still have to approve such arrangements and apply a number of statutory criteria before approving them.  Primary care, maternity and preventive services and emergency services would be kept under the existing rule which requires such services to be available within a 30 minute travel time.

On certificate of need, the subcommittee did not recommend lowering the thresholds for inclusion of projects within the law, but did recommend expanded reporting of such projects so the state could track such expenditures.

For hospitals, the Commission, with advice from the Maine Quality Forum Advisory committee appears likely to recommend using the National Quality Forum "Endorsed Set of Safe Practices" as its initial indication of high quality.  There are currently 30 such practices specified and no Maine hospital currently is compliant with all 30. 

To receive a one-page list of the 30 NQF safe practices, contact MMA at 622-3374 or via e-mail to jbanta@mainemed.com.  Include your fax number.

November is National Healthy Skin Month
November is National Healthy Skin Month.  Still, more than one million new cases of skin cancer will be diagnosed in the U.S. this year.  Visit the American Academy of Dermatology's website at www.aad.org to learn about skin cancer and other conditions affecting the skin, hair, and nails.  The site includes a tool for finding a dermatologist, features on the latest research and treatment options, and links to sites focusing on specific skin conditions such as acne, eczema, and psoriasis.  The Public Resources section includes information on topics such as actinic keratoses and how to maintain healthy skin during the dry winter months. [return to top]

MMA Group Health Plan to Renew Feb. 1, '05 with 12.3% Increase
MMA's Executive Committee met on Nov. 17 and approved a renewal of the current group health plan with Anthem.  Anthem had originally presented a renewal quote with an 18.2% increase, based on experience for the last twelve months in the plan.  By narrowing some of the several options in the plan and by instituting a new prescription drug card with a $10/$50 co-pay generic/brand, the increase has been reduced to 12.3% overall.  An individual or sub-group within the plan may experience a greater or lesser increase depending upon age banding and plan option selection.

Other plan changes include:

  • Maine Partners being eliminated as an option as Anthem is merging the plan into its other offerings
  • Eliminating from current options HMO Choice, CompCare $1,000 and Blue Choice $5000.
  • Adding a Health Savings Account option with a $2000 deductible
  • Adding HMO $1000, at an increase of only 4.2% from the current HMO $500.

Anthem has also received approval of the Bureau of Insurance to limit the impact of any change in rates by age-banding to only one band, thus limiting the impact.

Any questions from existing group members or members interested in joining the plan should be directed to Judy Conley at HRH,  brokers for the plan.  Judy can be contacted at judy.conley@dunlap.com. [return to top]

MMA Presents "Dirigo Update" as CME Offering Nov. 30 in Portland
MMA's Fall Seminar Series concludes on Tuesday, Nov. 30th with a program in Portland on the innovative Dirigo Health Plan enacted in 2003 by the Maine Legislature and which will be available beginning Jan. 1, 2005.  The program is being held from 1:00pm to 5:00pm at the Dana Center at the Maine Medical Center in Portland. 

Presenters include the Director of the Dirigo Health Agency, Karynlee Harrington, Sharon Roberts from Anthem, the carrier offering the plan, Robert McAfee, M.D. the Chairman of the Board of Dirigo Health and Tarren Bragdon of the Maine Heritage Policy Center.

The state hopes to enroll over 150,000 persons in Dirigo over the next five to nine years.  Attend this program to hear what impact Dirigo Health may have on your practice.

Registration is $75 and can be achieved via communication with Chandra Leister at MMA at 622-3374 or via e-mail to cleister@mainemed.com. [return to top]

Classified Ad: Experienced OB Looking for Part-time Work as OB Hospitalist
Experienced OB-GYN, recently moved to Yarmouth area, searching to continue part-time work as "OB-Hospitalist."  Have been working with midwives in busy, indigent practice, managing labor and delivery and working closely with perinatologist to manage high risk patients.  Also have experience teaching medical students and residents.  Prefer 12 hour in-hospital shifts, but can be flexible.

Interested persons may contact wdriley@verizon.net or call 846-3332 or cell phone 653-8902. [return to top]

MMA Executive Committee Vacancy in Franklin County
In Oct., Michael Parker, M.D., Farmington urologist and a long-time member of the MMA Executive Committee representing Franklin County, was elected Secretary-Treasurer of the Association.  There is therefor now a vacancy for the executive committee slot from Franklin County and MMA is calling for any volunteers who wish to be considered for the appointment.

The MMA Executive Committee consists of approximately 25 physicians who meet once every six weeks, usually on Wednesday afternoons at 2:00pm, to oversee the Association's activities. [return to top]

Lung Association Web Site Features Flu Materials
The home page of the American Lung Association of Maine (ALAM) features materials and links that may be helpful to you as you work through the challenges of this influenza season.  Go to www.mainelung.org. [return to top]

Maine Rivers Focuses on River Restoration at Fall Conference, 12/4/04
Maine Rivers, begun in 1998 as a project of the Natural Resources Council of Maine, became an independent organization in the spring of 2003.  The organization's mission is to protect, restore, and enhance the health and vitality of Maine's Rivers. 

Maine Rivers' 7th Annual Fall Conference entitled, Restoring Maine's Rivers, will take place on Saturday, December 4, 2004 at the Bates Mill in Lewiston.  The day-long conference will include workshops, presentations, and an announcement of a major citizens' initiative to help restore one of Maine's largest rivers.

You can register for the conference and find more information about Maine Rivers at www.mainerivers.org.

At the annual meeting in September, the MMA adopted the following resolution on water quality in Maine's rivers:

Maine Medical Association

Resolution RE: Water Quality in Maine Rivers

September 11, 2004

 

Resolution #8, “Resolution supporting water quality in substandard rivers in Maine”, submitted by the Public Health Committee, was amended and approved as follows:

 

WHEREAS, proper stewardship of our home planet is a certain mark of advancing wisdom and maturity in our species, and

 

WHEREAS, a clean and healthy environment is vital to the maintenance of physical and spiritual health in our patients, and

 

WHEREAS, improvement in our river water quality tends to favor economic improvement for our citizens, and

 

WHEREAS, river cleanliness standards have been established on a national and state level designed to promote continued improvement in water quality. These standards include statements in the Clean Water Act of 1972 supporting “the protection and propagation of fish, shellfish, and wildlife and recreation in and on the water,” and

 

WHEREAS, two Maine Rivers (Androscoggin and St. Croix) are, despite these standards, allowed to remain in an unhealthy condition, below Class C status, and

 

WHEREAS, Class C status if the lowest acceptable category of water quality, and

 

WHEREAS, our children swim in Maine rivers as part of their summer activities, and

 

WHEREAS, Mainers catch and eat fish from Maine’s bodies of waters,

 

Therefore be it resolved that the Maine Medical Association promote the passage of legislation and support other efforts designed to quickly improve water quality in the Androscoggin and St. Croix rivers so that they meet or exceed Class C standards. [return to top]

Guidance on the Aetna & CIGNA Class Action Settlements
During the past several years, several state and county medical societies brought class action lawsuits against a number of large for-profit managed care companies, including the three companies doing substantial business in Maine:  Anthem, Aetna, & CIGNA.  The lawsuits claimed improper and illegal reimbursement practices used by the industry to delay or deny payment by bundling, downcoding, recoding, failure to recognize modifiers, lack of disclosure, and breach of state prompt payment laws.

The federal cases were consolidated in U.S. District Court in Florida on October 23, 2000.  The component of the action dealing with providers' claims became certified as a national class action on September 26, 2002.  A settlement with Aetna became final on November 6, 2003 and a settlement with CIGNA became final on April 22, 2004.  The settlements include a class of all physicians (more than 950,000 physicians and physician organizations) who have submitted claims to any of the defendants.

While the most important goal of the litigation in the long run may be changes in the way the managed care industry does business, you may be eligible to recover some money as well.

The period to submit claims in the CIGNA settlement is August 23, 2004 through February 18, 2005. 

You can find more information about both the Aetna and CIGNA settlements on the web at www.hmosettlements.com.  You can obtain claim forms for the CIGNA settlement on the web at www.cignaphysiciansettlement.com or by calling 1-877-683-9363.  CIGNA claim forms should be submitted to Poorman-Douglas Corporation, CIGNA Physician Settlement Administrator, P.O. Box 3170, Portland, OR 97208-3170.

Finally, the MMA has a CD-Rom with a presentation entitled, The Aetna/CIGNA Settlements:  What They Mean to You and Your Practice.  If you would like a copy of the disk, please contact Charyl Smith, Legislative Assistant, at 622-3374 or by email at csmith@mainemed.com. [return to top]

Family Practice Opportunities in Maine's Community Health Centers

Maine:

Practice the way you Want It;

Life the Way you Need It.

You can get There.

 

Family Practice Opportunities in

Maine’s Community Health Centers:

South, North and (Down) East.

Please Contact Jim Dowling

Maine Primary Care Association

207-621-0677

Jrdowling@mepca.org

  [return to top]

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