Hospital Study Commission Begins Deliberations on Monday
The nine-member Commission to Study Maine's Hospitals will meet in Augusta on Monday, Nov. 30th, and again on Dec. 1 to complete a draft of its report to the Governor and the Legislature. Dates of public hearings on the report are likely to be changed to mid-to-late December.
The Commission will consider recommendations in eleven general areas. The following represents a synthesis of several of the key areas raised by the Commission, its chair William Haggett and its workgroups. These items, at this point, do not represent Commission recommendations, but represent a working draft that the Commission will work from. Although there are nearly fifty items on the document, entitled, "Summary of Issues/Proposals," only those of particular interest to physicians are listed here. For a copy of all the recommendations, and drafts of some of the potential chapters of the report, MMA members may call Julie Banta at MMA (622-3374) or communicate via e-mail to firstname.lastname@example.org.
A. QUALITY IMPROVEMENTS
1. Revise Bureau of Insurance Rule 850 to:
- Extend quality incentive program from 7/1/01 to 7/1/10
- Require Bureau of Insurance to consult with Maine Quality Forum in connection with any applications for the incentive program
- Allow hospitals (all services) to be designated as superior quality institutions for purposes of Rule 850 if they comply with all of the most current National Quality Forum voluntary consensus standards for safe practice institutions.
- Designate MQF as the final arbiter of measures that define superior quality.
- Modestly expand travel limits for incentives based on quality and protect choice to travel or not and pay patient's travel expense.
2. Clinical Protocols
All Maine hospitals should work with MQF to assure best practices are consistently employed.
B. ELECTRONIC MEDICAL RECORDS
1. Expedite transition to electronic medical records for all Maine's hospitals and physicians.
- Statewide implementation within 3 years.
- Increase MaineCare rates by 15% for 12 months for physicians requesting same during transition.
- Under leadership of MQF, Committee will be created to determine protocols;
- Seek at least $75 million bond for startup, $50 million for hospitals and $25 million for physicians.
- Revise licensing laws to require all licensed providers employ EMR by 2008.
C. WELLNESS INITIATIVES
1. Encourage hospitals to be local leaders in promoting healthy behavior, while continuing primary focus on acute care.
2. Require local collaborations with employers and others and may require specialized staff, new programs and new facilities.
3. Propose a modest tax on processed food and beverages to finance wellness programs and continuing health related costs in programs like MaineCare.
4. Legislature should appoint a committee to plan implementation.
D. ADMINISTRATIVE STREAMLINING
1. Governor's Office of Health Policy and Finance leads an initiative with Maine's hospitals to facilitate voluntary joint purchasing of pharmaceuticals and utilities if savings can be documented; standardize insurance eligibility/verification procedures among payers; and identify and resolve barriers that exist to maximize savings.
2. Legislature identifies an independent body to annually assess and report publicly on hospital and payer efforts to advance efficiency of administrative and overhead operations.
3. Hospital Boards and CEO's should review administrative overhead to assure they operate at maximum levels of efficiency and at appropriate compensation levels.
4. Full time hospital employees should generally work at least 36 hours/week.
E. PUBLIC DISCLOSURE OF HOSPITAL EXPENDITURES/FINANCES
1. Each hospital should annually disclose total compensation (all sources) of 5 most highly compensated executives, beginning in 2005.
2. Hospitals should annually submit to MHDO (Maine Health Data Organization) in electronic format standardized financial information on individual hospitals in the format proposed by the Commission and developed by Nancy Kane.
3. Amend MHDO Rule Chapter 120 to allow MHDO to release data showing prices and payments for services in each hospital.
F. VOLUNTARY COST CONTAINMENT
1. Voluntary targets on operating margins should continue (Individual? Systems? Both?) (How defined?)
2. Hospitals should be held to annual limits on cost increases for 2005 and beyond. (How defined?)
These recommendations above are from the workgroups. The Chair has also proposed the following ideas:
3. Phased pricing reductions each year.
4. Maximum operating margins and total margins on hospitals and systems with a 5-year sunset to review effectiveness.
5. Voluntary caps on annual operating expenditure increases. Utilization measures would be developed in negotiation with MHA (Maine Hospital Association) to account for changes and allow utilization to adjust cap.
6. Encourage hospital boards in certain areas to consider mergers; transition to critical access status.
G. INCREASING PUBLIC PAYMENTS
1. Every effort should be made with Congress and the federal government to increase Medicare payments to Maine's hospital immediately.
2. When the State's finances improve, MaineCare payments to Maine's hospitals should increase.
H. INCREASE EFFECTIVENESS OF CERTIFICATE OF NEED PROGRAM
1. Develop plan (who?) to strengthen staff of CON unit including capacity to follow up to assure CON goals are met, and develop budget to finance it.
2. Increase CON application fees to finance expanded CON staffing.
3. Require hospitals and non-hospital providers to report to CON unit certain projects whose costs are below current thresholds for review.
4. Strengthen CON criteria in State Health Plan (how?).
5. Use independent hearing officers for contested projects to report directly to Commissioner of DHHS.
I. INCREASE OPPORTUNITIES FOR HOSPITALS TO COLLABORATE/AFFILIATE OR CONSOLIDATE
1. Amend the Hospital Cooperation Act to strengthen the ability of hospitals and non-hospitals to collaborate.
2. Decisions whether or how to collaborate will be made by Hospital Trustees.
3. Formalize proposal to stimulate collaboration:
a) Collaboration will be encouraged to create a team of Maine hospitals serving the State to achieve lowered cost growth, program excellence, avoidance of inappropriate duplication, consolidation of business function, creation of centers of excellence, meet State Health Plan goals, increase access and strengthen all hospitals through improved management and economies of scale.
b) Hospitals that enter into formal relationships and can demonstrate tangible quarterly improvements and cost savings would have Medicaid payments increased as an award fee incentive plan beginning in 2007.
c) Groups of hospitals that agree to collaborate would create a Board of Overseers to plan and facilitate collaboration.
d) Boards of Overseers will include one senior representative of each participating hospital, GOOF (Governor's Office of Health Policy and Finance) will serve in a non-voting capacity. Consumers and payers will serve on the Boards but a majority will remain hospitals. It is anticipated that there will be three such Boards--southern, central and northern but specific affiliations are not required. (Need to review structure with Attorney Generals Office)
e) Boards of Overseers will:
- Improve communication and cooperation;
- Provide guidance
- Develop annual plans for hospital collaboration among participating members; and
- Will NOT have management or fiduciary responsibility over individual member hospitals. Member hospitals retain governance responsibility.
f) GOOF will create an oversight committee of 5 skilled and objective experts to review semi-annually implementation, operation and accomplishments of cooperating hospital teams/Boards of Overseers. This committee would recommend the Award for incentive payment for participating hospitals. (How can this approach be integrated into the State Health Plan? How would goals, measures of success by determined? Would anti-trust protections in revised legislation be sufficient?)
J. MEDICAL MALPRACTICE
Following submission in January "05 of the Bureau of Insurance's study on malpractice, GOOF should convene a work group of all interested and affected parties to make a recommendation in March to address malpractice concerns.
K. LEGISLATIVE OVERSIGHT
The Legislature should appoint a committee to conduct oversight of all Commission recommendations it adopts to determine if action is taken and if voluntary actions should continue or if more state regulatory intervention is required.