December 6, 2004

 
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Hospital Study Commission Prepares Draft Report
The Commission to Study Maine's Hospitals met for two full days this past week and voted on several recommendations related to the draft report being prepared. Public hearings will be held on these recommendations later this month.
During two day-long meetings on Monday and Wednesday last week, Commission members went through each of the recommendations in the eleven substantive areas spelled out in the working draft described in last week's Maine Medicine Weekly Update.  Below are the major recommendations that are of most interest to physicians.

  1. Electronic Medical Records:  In an effort to expedite transition to EMR for all Maine hospitals and physicians, the Commission members voted to have the Maine Quality Forum determine appropriate protocols and to encourage statewide implementation within five years.  While there was much discussion concerning using state funds and possibly the proceeds of a bond issue to assist facilities and physician practices in the transition, it was not clear exactly what financial incentives might appear in the final report.
  2. Certificate of Need:  Commission members rejected a proposal to expand the scope of the existing certificate of need law by lowering the dollar thresholds which trigger review.  Instead, the Commission adopted a recommendation that requires providers to simply notify the CON office if capital improvements are planned which exceed one-half of the current threshold.  With the current threshold for new equipment at $1.2 million and for other capital expenses at $2.4 million, the notification requirements would kick in at $600,000 for equipment and $1.2 million for other capital construction.  Other CON recommendations include increasing the staff at the CON unit and increasing CON application fees to pay for the expanded staff.  A proposal to use independent hearing officers in an attempt to "depoliticize" the CON process was defeated.
  3. Medical Malpractice: The Commission voted to have the Governor's Office of Health Policy and Finance convene a workgroup of all interested and affected parties to make recommendations in March '05 to address professional liability concerns.
  4. Bureau of Insurance Rule Chapter 850 Geographic Access Standards:  Commission members recommended that the quality incentive program adopted earlier this year be extended through July 1 of 2010 (the legislation had a sunset date in 2007).  In addition, the Commission is recommending that the Bureau of Insurance consult with the Maine Quality Forum regarding the quality issues inherent in the legislation and voted to designate the Maine Quality Forum as an arbiter of measures that define services or facilities of high quality.  Finally, the Commission also voted to recommend that the legislature expand the current travel limits for incentives based on quality as long as consumers were protected if they chose not to travel.  These two recommendations were opposed by the two hospital representatives.
  5. Increase Opportunities for Hospitals to Collaborate/Affiliate or Consolidate.  The Commission reviewed a draft of amendments to the current Hospital Cooperation Act by a private anti-trust attorney hired to consult with the commission.  Members were generally supportive of the draft, which also adds physicians and other licensed heath care providers as protected parties under the law.  Representatives of  the Maine Office of the Attorney General were present at the meeting and did not appear to oppose the draft, although more information was expected to be received from federal anti-trust authorities.  In one of the most controversial sections of this chapter, commission members chose not to recommend mandatory regionalization, but proposed instead a series of recommendations relative to regional efforts.  Any regional board of overseers would be strictly voluntary.  Hospitals which do collaborate would have an opportunity to achieve enhanced Medicaid reimbursement.

Commission members will meet again on December 13th to review final language of the report which will go to the Legislature in January.  The Commission has tentatively scheduled public hearings on the draft report for January 6th and 7th, likely in Portland, Augusta, and Bangor.

 

American Medical Association Holds Interim Meeting in Atlanta
Maine physicians are well represented at the AMA's Interim Meeting being held in Atlanta through Tuesday.  Maine's delegation of two delegates and two alternates is enhanced by the presence of MMA President Lawrence Mutty, M.D. and five specialty society representatives.  In addition to the list of delegates and alternates in last week's report, American Psychiatric Association Speaker-elect Joseph Rubin, M.D., a Portland psychiatrist, also attends as a representative of the APA.

Major issues at the meeting include professional liability reform, fixing the flawed Medicare payment formula, scope of practice, and health care reform.  Watch MMWU next week for a full report on actions taken at the meeting.

Because of the flawed Medicare physician payment formula, physician payments are scheduled to be decreased by 31 percent between 2006 and 2013, while physician costs are expected to increase by 19 percent over the same period.  After adjusting for inflation, Medicare payments to physicians in 2013 will be less than one-half of what they were in 1991!  These reductions begin in 2006 unless stopped by an act of Congress.  Every Maine physician will have an opportunity to communicate with the Maine Congressional delegation about the significance of these cuts.  Watch your mail early in 2005 for advocacy information on this important issue. [return to top]

Anthem/WellPoint Deal Complete
Anthem, Inc.'s acquisition of WellPoint Health Networks has been completed.  The two companies made this announcement last week following Georgia Insurance Commissioner John Oxendine's final approval of the transaction.  Prior to his approval, Commissioner Oxendine was able to obtain $126.5 million in concessions from Anthem to improve rural care in Georgia.  Specifically, Anthem committed $11.5 million to finance telemedicine centers in 36 rural hospitals or clinics and the state's 4 teaching hospitals.  Anthem also agreed to cover telemedicine procedures in its policies.  Also, Anthem pledged that current WellPoint subscribers in Georgia would not see an increase in their premiums as a result of the merger or these new financial commitments.

Anthem, Inc., the corporate parent, will be renamed WellPoint, Inc. and its stock began trading under the sign WLP on December 1, 2004.  The transaction has created the country's largest health insurance company which will be directed by Larry C. Glasscock, the former Chairman, CEO, & President of Anthem, Inc.  Former WellPoint Chairman & CEO Leonard D. Schaeffer is the chairman of the board.

Earlier in November, California Insurance Commissioner John Garamendi reversed his opposition to the deal because of Anthem's agreement to conditions and commitment to programs aimed at improving the health care of low-income California residents.

WellPoint subsidiaries include Blue Cross of California, Missouri-based HealthLink, and the BCBS plans in Georgia, Missouri, and Wisconsin.  Anthem operates BCBS plans in Colorado, Connecticut, Indiana, Kentucky, Maine, Nevada, New Hampshire, Ohio, and Virginia.  Anthem provides health care coverage for more than 12 million people and WellPoint covers almost 15.5 million people. [return to top]

Save the Date: Home Visitation Conference Scheduled for 2/10/05
The Maine Department of Health & Human Services and the Maine Children's Trust are sponsoring a Home Visitation Conference at the Augusta Civic Center from 8:00 a.m. to 4:00 p.m. on Thursday, February 10, 2005.  MMWU will bring you more information on the conference when it becomes available.

For more information, please contact Richard A. Aronson, M.D., M.P.H., Medical Director of the maternal and child health program at 287-5345 or richard.aronson@maine.gov. [return to top]

Flu Update: Two Adult Cases Confirmed in Maine

Physicians are being asked to evaluate their need for their priority patients and transfer any extra vaccine amongst their community/county offices by December 10.  If you still have a need for vaccine for individuals in the priority groups, you should call the Maine Immunization Program at 1-800-867-4775.  Also, you should use that number if you cannot find facilities in your area who still need the vaccine and have available doses.  An informational Immu-Fax was faxed this week by the Bureau of Health to physician offices on their list which spells out these details.  If you have not received this fax, please contact Charyl Smith at 622-3374 or csmith@mainemed.com and she will provide it to you.

As always, the most current recommendations, advisories, and other influenze-related resources can be found at www.MainePublicHealth.gov.  If your supply allows, the Bureau has revised its recommendations to include health care workers involved in direct patient care and out-of-home caregivers and household contacts of children aged less than six months.

The Bureau has distributed 138,000 doses, with 22,000 remaining.  The State does not have the money to purchase more vaccines.  They have committed to completing shipment to the long-term care facilities.  There were two confirmed cases of influenza in Northern Maine last week.  You can read the DHHS press release on confirmation of the flu in Maine at http://www.maine.gov/tools/whatsnew/index.php?topic=Portal+News&id=4676&v=article-2004.

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DirigoChoice to Pay for Health Risk Assessments
You may have heard that the DirigoChoice products provide a potential $100 incentive for new members.  If the member choose a primary care practitioner, he or she will receive a $25 reward.  If the member goes to the PCP for a health risk assessment, he or she will receive an additional reward of $75 for a $100 total.

In contrast to the current practice in the marketplace, Anthem wants physicians to understand that they may bill Anthem for the health risk assessment (using CPT code 99420) in addition to the E&M code usually billed for new patients.  This is intended as a reward for the PCP spending some additional time with the patient for the HRA.  DirigoChoice does not mandate the type of HRA form to be used by practitioners. [return to top]

U.S. DHHS Secretary Tommy Thompson Steps Down
At a press conference last Friday, Secretary of Health & Human Services Tommy Thompson announced his resignation and indicated his intention to return to the private sector.  He did not, however, rule out the prospect of running for the Wisconsin U.S. Senate seat now held by Herb Kohl (D) that opens up in 2007. 

Mark B. McClellan, M.D., a physician and economist who heads the Centers for Medicare & Medicaid Services (CMS), is a leading candidate to succeed Secretary Thompson, but Deputy Secretary Claude A. Allen, former Senator John B. Breaux (D-LA), and former House Speaker Newt Gingrich (R-GA) also may be interested in the job. [return to top]

Bill on J-1 Visa Requirement Waiver Headed to President's Desk
On November 17, 2004, the U.S. House approved S. 2302 by a vote of 407-4 following the U.S. Senate's unanimous consent on October 11, 2004.  S. 2302 would waive a requirement of the J-1 visa program that foreign physicians who obtain their medical training in the U.S. return to their home countries for at least 2 years.  A current waiver expired May 31st and the bill would extend the waiver for 2 years from that date.  In order to take advantage of the waiver, physicians must agree to work in a physician shortage area for 3 years.  Also, the bill would exempt foreign graduates of U.S. medical schools from the numerical cap on H-1B visas for highly skilled foreign workers is they wish to change their J-1 visas to H-1B visas.  Each state is permitted 30 J-1 visa physicians per year and 49 states now participate in the J-1 visa program. [return to top]

122nd Legislature Convenes, Elects Leaders & Constitutional Officers
During a lengthy opening session on Wednesday, December 1, 2004, the members of the 122nd Maine Legislature participated in opening ceremonies, elected their caucus leaders and constitutional officers, and established a Joint Select Committee on Property Tax Relief to focus on tax reform.

The results of the legislative leadership elections were not a surprise.

House of Representatives

  • Speaker of the House:  John Richardson (D-Brunswick)
  • Majority Leader:  Glenn Cummings (D-Portland)
  • Assistant Majority Leader:  Robert Duplessie (D-Westbrook)
  • Minority Leader:  David Bowles (R-Sanford)
  • Assistant Minority Leader:  Joshua Tardy (R-Newport)

Senate

  • President:  Betheda Edmonds (D-Cumberland)
  • Majority Leader:  Michael Brennan (D-Cumberland)
  • Assistant Majority Leader:  Kenneth Gagnon (D-Kennebec)
  • Minority Leader:  Paul Davis (R-Piscatiquis)
  • Assistant Minority Leader:  Carol Weston (R-Waldo)

Constitutional Officers

  • Attorney General:  G. Steven Rowe
  • Treasurer:  former State Representative David Lemoine (D-Old Orchard Beach)
  • Secretary of State:  former State Representative Matthew Dunlap (D-Old Town)
  • State Auditor:  former State Senator Neria Douglas (D-Androscoggin)

Maine is unusual in its method of choosing constitutional officers.  They are elected by majority vote of the legislature.  Because of term limits, the positions have been filled with former legislators for the past several years.

At the opening session, the Legislature also named members of the Joint Select Committee on Property Tax Reform:

  • Senator Dennis Damon (D-Hancock), Chair
  • Senator Joseph Perry (D-Penobscot)
  • Senator Richard Rosen (R-Penobscot)
  • Senator Peter Mills (R-Somerset)
  • Representative Richard Woodbury (I-Yarmouth), Chair
  • Representative Nancy Smith (D-Monmouth)
  • Representative Jacqueline Norton (D-Bangor)
  • Representative Arthur Lerman (D-Augusta)
  • Representative Edward Dugay (D-Cherryfield)
  • Representative Leonard Berman (R-Sorrento)
  • Representative Earle McCormick (R-West Gardiner)
  • Representative Patrick Flood (R-Winthrop)
  • Representative Vaughn Stedman (R-Hartland)

The Committee is expected to hold an organizational meeting this week and to develop a reform proposal by the end of January.

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FDA Survey Finds Mixed Reactions Among Physicians About DTC Drug Ads
In a report entitled, Patient and Physician Attitudes and Behaviors Associated with DTC Promotion of Prescription Drugs - Summary of FDA Survey Research Results released November 19th, the FDA said that of 500 physicians surveyed, 1/3 said that drug ads had a positive effect, 1/3 said that the ads had a negative effect, and 1/3 said that the ads had no effect on their practice or on patients.

The report concludes that drug ads seem to increase patient awareness about diseases and potential treatments and encouraged patients to ask informed questions, but it also concludes that most physicians feel at least some pressure to prescribe what the patient requests.  You can find the report on the web at http://www.fda.gov/cder/ddmac/Final%20Report/FRfinal111904.pdf. [return to top]

MMA/Medical Mutual Address Mercy Medical Staff on Medical Liability Reform
On Thursday evening, December 2, 2004, Medical Mutual President & CEO Patrick Dowling, M.D. and MMA V.P. & General Counsel Andrew MacLean attended a quarterly meeting of the Mercy Hospital Medical Staff to discuss the medical liability climate in Maine and the work of the Coalition on Health Care Access & Liability Reform.  Dr. Dowling provided a national perspective on the issue and Mr. MacLean spoke about the current public relations and legislative campaign of the MMA, MOA, MHA, and other Coalition partners.

The MMA understands that the forthcoming study on the medical malpractice market in Maine being conducted by the Bureau of Insurance (due to the Legislature on January 1, 2005) will include premium rate comparisons for internal medicine, general surgery, and OB/GYN for the 6 New England states.  The report's likely conclusion is:

  • Vermont's rates are lowest in New England
  • Maine's rates are second lowest and close to Vermont (although Vermont's rates apparently have been rising faster than Maine's)
  • Massachusetts, New Hampshire, and Rhode Island are next and nearly double Maine's rates
  • Connecticut's rates are highest in New England

The December 13th online edition of American Medical News reports that a recent study indicates that the number of medical liability claims is starting to level off, but settlement costs still are rising.  The 2004 Hospital Professional Liability and Physician Liability Benchmark Analysis by the Aon Corp. finds that claims costs are increasing at about 8%, the lowest level in the 5-year history of the study.  You can read the article at http://www.ama-assn.org/amednews/2004/12/13/prsd1213.htm. [return to top]

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