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 jbanta@mainemed.com.

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.

122nd Maine Legislature to Convene on Wednesday, December 1st
The 186 members of the 122nd Maine Legislature will convene for their first session on Wednesday, December 1, 2005 at 10:00 a.m.  The schedule for the first session is largely ceremonial with members being sworn and orientation activities.  Three House races that were subject to recounts are still disputed meaning that the apparent winners will be seated provisionally and a bipartisan House committee will make a final decision about the winners.  As it stands today, the Maine Senate will be comprised of 18 Democrats and 17 Republicans.  The House likely will include 76 Democrats, 73 Republicans, 1 Green, & 1 Unenrolled.

You can find information about the 2004 House races at the House web site:  http://janus.state.me.us/house/122_cand.htm.

You can find information about the 2004 Senate races at the Senate web site:  http://www.state.me.us/legis/senate/.

At caucuses during the last several weeks, the parties have chosen their leaders for the next two years.  The leadership of the 122nd Maine Legislature will include:

Senate Democrats

President:  Betheda Edmonds (D-Cumberland)

Majority Leader:  Michael Brennan (D-Cumberland)

Majority Whip:  Kenneth Gagnon (D-Kennebec)

Senate Republicans

Minority Leader:  Paul Davis (R-Piscataquis)

Minority Whip:  Carol Weston (R-Waldo)

House Democrats

Speaker:  John Richardson (D-Brunswick)

Majority Leader:  Glenn Cummings (D-Portland)

Majority Whip:  Robert Duplessie (D-Westbrook)

House Republicans

Minority Leader:  David Bowles (R-Sanford)

Minority Whip:  Joshua Tardy (R-Newport)

Following the session on Wednesday, legislators will return home for the holidays and will reconvene during the week after the New Year's holiday. [return to top]

World Aids Day to Focus on Women and Girls: Wednesday, Dec. 1
World AIDS Day is being held on Wednesday, Dec 1, 2004 with several events being presented in the Greater Portland area.  Created by the World Health Organization in 1988, World AIDS Day each year spotlights the HIV/Aids pandemic..  The focus of this year's World Aids day is on women and girls.  They make up nearly half of the 39.4 million people who are infected with HIV worldwide and are the fastest-growing group of new HIV infections in many countries.

An estimated 1,200 people are living with HIV in Maine, according to the Bureau of Health.  Just a small percentage, however, are women.  In 2003, women represented just six of the 55 new HIV diagnoses.  Partly because of these small numbers, however, there is a fear that women are not seeing AIDS as a risk.

As part of AIDS Day, the City of Portland is expanding access to free and anonymous HIV testing to four sites.  A new alternative to the traditional blood test, involving  taking a simple swab from the inside of the mouth, makes screenings faster and less invasive.  Marty Sabol, Portland's manager of the infectious disease program, noted that the screening results are now available in just 20 minutes.

The free, anonymous test sites are as follows:  510 Congress St., Portland, 10:00am to 4:00pm Thursday, 10:00am to 6:00pm Friday; 103 India St., all day by appointment; University of New England, Portland, noon to 2:00pm, by appointment; University of Southern Maine, 9:00am to noon by appointment.  Call 874-8446. [return to top]

Commission to Study Maine's Hospitals Hears from Consultants
At a meeting held on Monday, Nov. 22, the Commission to Study Maine's Hospitals was presented with a report from Nancy Kane, a management professor at Harvard University's School of Public Health.  Dr. Kane was hired by the state to analyze financial data from Maine's 39 hospitals and to make recommendations.  A copy of the report is available to MMA members by calling Julie Banta at 622-3374 or via e-mail to jbanta@mainemed.com.

In short, the report found that two-thirds of Maine's hospitals were profitable, but that nearly one-third averaged operating losses from 1997 to 2003.  These twelve hospitals are found in all parts of the state, but tend to be small, rural hospitals.  While conventional wisdom has always been that payor mix distinguished the profitable hospitals from the non-profitable ones, Dr. Kane reached the conclusion that it was not payor mix, but the volume of patients and the types of services provided that determined the difference. What sets low-performing hospitals apart from the rest, Dr. Kane, concluded, appeared to be their inability to bring in new patients.

 Dr. Kane noted that according to her analyses, the groups of medium and low hospitals have the same proportion of public payors.  And bad debt and charity care also did not explain the difference.  In fact, the better performing hospitals (financially) were found to absorb a greater burden of bad debt over the past ten years, while the weight of charity care is spread pretty evenly across all hospitals.

In addition to the presentation by Dr. Kane, members also on Monday received a report from Milliman USA that claimed that health insurers paid more for procedures in Maine than in New Hampshire and Massachusetts.  That report is also available from MMA. [return to top]

Maine Rx Plus Increasing Discounts Voluntarily
The state announced late last week that it was negotiating with about 20 pharmaceutical companies about offering discounts of 5 to 10 percent on top of the discounts already being offered by pharmacies - 15 percent for brand-name and as much as 60 percent for generics,  for products offered in the Maine Rx Plus program.  The discounts may be available as early as January, '05.   Maine Rx Plus is the landmark prescription drug program launched by the state which allows Maine citizens with incomes below 300 percent of the poverty level to receive a discount card for use in most of the state's pharmacies.

While the law allows the state to require prior approval in the MaineCare program for the products of a company that does not negotiate a discount in Maine Rx Plus, the provision had never been used as many companies are now  "voluntarily" participating because prior authorization in MaineCare has become so prevalent in any case. [return to top]

Martin's Point Hosts Joseph Newhouse on "Health Care Quality; Can the Quality Movement Cure the Health Care Crisis?"
On Nov. 16, Martin's Point Health Care hosted more than 130 physicians, business, government, and healthcare professionals for a dinner seminar entitled, "Health Care Quality;  Can the Quality Movement Cure the Health Care Crisis?" at the Marriott at Sable Oaks in South Portland.

The keynote speaker was Dr. Joseph P. Newhouse of Harvard University, author of "Pricing the Priceless;  A health Care Conundrum.".  Dr. Newhouse is professor of Health Policy and Management and is also Director of the Health Policy Research & Education Division in the Department of Health Policy and Management at Harvard.

 "The most plausible explanation of most of the increase in rising costs is due to the new capabilities of medicine. Aging cannot explain much.  A management consultant might say the medical industry keeps developing new lines of business - think of dialysis, transplants, angioplasty, non-invasive imaging, joint replacements and the entire biotech industry.  Couple with an increase in life expectancy over the past 30 years from 70.8 to 77.2, the demands for these new lines of business in medicine are unlikely to change," said Dr. Newhouse.

Established in 1981, Martin's Point is a not-for-profit health care provider with facilities in Portland, Brunswick and Windham, Maine and in Portsmouth, N.H.  Martin's Point serves patients in the areas of family practice, internal medicine, pediatrics, surgery, radiology, cardiology and mammography, as well as other fields.   For additional information, visit the organization online at www.martinspoint.org. [return to top]

Board of Licensure in Medicine Adopts New Fee Schedule, Renewal Fee Remains the Same
The Board of Licensure in Medicine has adopted a new fee schedule, effective 1/1/05.  The current $400 renewal fee - biennial remains unchanged.  The other fees are as follows: 

•      Initial licensure and registration;   $700 (increase from $600)
•      Temporary License: $300 (increase from $200)
•      Locums License:  $300
•      Educational Certificates:  $100 (increase from $50)
•      PA Application $200 (increase from $100)
•      PA Renewal - biennial:  $200 (increase from $100)
•      PA/NP Initial Registration:  $50 (increase from $25)
•      PA/NP transfer registration:  $50 (increase from $25)
•      PA/NP multiple site registration: $50 (increase from $10)

AMA/CDC Want Your Concerns About this Flu Season
The AMA is collaborating with the Centers for Disease Control & Prevention and others to address influenza issues and wants to know your number one concern about caring for patients this flu season.  Is it about use of antivirals or rapid influenza tests?  Or something else?

     The AMA will work with CDC experts to ensure that answers are provided to these important questions via as many communication methods as possible.  Fax or e-mail concerns to:

                                         L.J. Tan

                                         AMA Director, Infectious Diseases

                                         Fax: 312-464-5841

                                         E-mail: srt@ama-assn.org

Please type "Influenza Concern Question" in the subject line:  reply by Dec. 4. [return to top]

Spaces Still Available for CME Program, "Dirigo Update", Tuesday at Dana Center, Portland
Spaces are still available for the one-half day CME program on Dirigo Health being presented by MMA in Portland on Tuesday (Nov. 30).  The program begins at 1:00pm at the Dana Center at the Maine Medical Center.  Speakers include Robert McAfee, M.D.,  Chairman of the Board of Dirigo Health, Karynlee Harrington, Executive Director of Dirigo Health Agency, Sharon Roberts of Anthem and Tarren Bragdon of the Maine Heritage Policy Center.  The program will be moderated by MMA EVP Gordon Smith, Esq.

The registration fee for the four hours of CME is $75.  You may register through Chandra Leister at MMA (622-3374 or via e-mail to cleister@mainemed.com) [return to top]

AMA House of Delegates to Convene on Dec. 4 in Atlanta for Interim Meeting
The AMA House of Delegates will convene in Atlanta on Saturday, Dec. 4 to begin its interim meeting.  Delegates from Maine are David Simmons, M.D., an internist from Calais and Richard Evans, M.D., a general surgeon from Dover-Foxcroft.  Alternate delegates are John Makin, M.D., an ob-gyn from Waterville and Maroulla Gleaton, M.D., an ophthalmologist from Augusta.

Dr. Simmons currently chairs the New England delegation to the AMA.  Any MMA member wishing to provide input to the delegation may do so through any of the above individuals.

Maine is fortunate to also have several physicians who represent their specialty in the House of Delegates.  These include Samuel Solish, M.D., for the American Academy of Ophthalmology, John McGill, M.D. for the American Society of Plastic Surgeons,  Francis Kittredge,  M.D. for the American Association of Neurology and Jo Linder, M.D.  for the American College of Emergency Physicians.  Robert McAfee, M.D., former President of the AMA also sits in the House of Delegates. [return to top]