December 20, 2004

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Hospital Study Commission Finalizes Draft Report
The nine-member Commission to Study Maine's Hospitals is completing its work and met on Dec. 13th to finalize its 61-page Report. Hearings will be held on the draft Report on January 6 in Portland and Augusta and on Jan. 7 in Bangor. The draft report makes a number of significant recommendations, which if accepted by the Legislature, would change the environment for hospitals, and impact on physicians, around the state.

The Commission to Study Maine's Hospitals met on Dec. 13 and reviewed its draft report prior to it being released to the public.  The Commission took final votes on the various recommendations contained in the report and the final language is expected to be released to the public before the end of the month.  Public hearings are still tentatively scheduled for Jan. 6 in Portland (am) and Augusta (pm) and Jan. 7 in Bangor.  Specific times and locations for the hearings have not yet been announced.  Unless the dates change, the specifics should be included in next week's Maine Medicine Weekly Update.

The draft Report contains about 60 pages and is divided into fourteen (14) different chapters, as follows:

  1. Introduction
  2. Wellness Program Support
  3. Cooperation, Collaboration, Affiliation and/or Consolidation
  4. Electronic Medical Records
  5. Bureau of Insurance Rule 850
  6. The Health Care Payment System
  7. Governance
  8. Controlling Costs and Passing Savings to Consumers
  9. Special Situations
  10. Malpractice Issues
  11. Health Insurance
  12. Standardized Reporting and Voluntary Targets
  13. The Certificate of Need Program
  14. Continuing Oversight

While most of the report appears to have the unanimous support of the commission members, the two hospital representatives, Scott Bullock and John Welsh, dissented on a number of the critical recommendations, including those dealing with Bureau of Insurance Rule 850.  Rule 850 involved provisions enacted in the early 1990's designed to reign in abuses associated with aggressive managed care practices.  Insurers, business groups and even some physicians have argued for a relaxation of the Rule now that the insurance market has changed or evolved over the past dozen years.  The commission does recommend modest changes to the Rule.

Some of the provisions affecting physicians which appeared in earlier drafts and which MMA has opposed have been removed.  These include tying use of an electronic medical record to licensure, lowering the dollar thresholds triggering certificate of need review, and recommending the closures of certain hospitals. 

MMA will support a number of the recommendations including the chapter on malpractice reform (modest but at least acknowledges the problem) and the recommendation that the current Hospital Cooperation Act be amended to include other health care providers.  The Hospital Cooperation Act was enacted in the 1990's and provided a means by which hospitals could propose to collaborate without violating the state and federal antitrust laws.  Few, if any, projects have gone through the process delineated in the Act.  It is generally acknowledged that the law has failed because of the level of complexity and state oversight required, as well as the cost involved. The language regarding electronic medical records also is likely to be deserving of support. (See article following on this topic)

D. Joshua Cutler, M.D. and Louis Hanson, D.O. represented the interests of physicians on the Commission which has met weekly since the summer.

MMA members will be notified when the final report is available.  In the meantime, copies of the draft report considered by the Commission on the 13th are available, but one must keep in mind that a number of the provisions in the draft were significantly changed at Monday's five hour session.  The chapter changed the most significantly was the chapter on health insurance as that language had never previously been reviewed by commission members.  With this caveat in mind, e-mail if you wish the early draft.  Getting the early draft may be the only way to ensure ample time to read the document and be prepared with comments by the time of the hearings. Copies of the draft have been provided to MMA Executive and Legislative Committee members. These committees will be consulted prior to the MMA providing testimony at the public hearings. 

As the report is simply advisory to the Governor and the Legislature, any changes in law will have to be submitted to the current session of the legislature, at which time physicians and other interested parties will, again, be given an opportunity to comment.

Dirigo Health Agency Board Meets
The Board of the Dirigo Health Agency met on December 13 to hear updates on the work of the various commissions.

Dennis Shubert, Executive Director of the Maine Quality Forum, noted that Gordon Smith of the MMA felt that most physicians were not aware of the Forum and suggested that communications be a priority in the coming year.  The forum was charged with looking at the issue of nurse to patient ratios and determined that a ratio is not an effective tool to manage quality care.  Trish Riley reported that the Hospital Commission is currently planning to hold public hearings on their draft report January 6 and 7.  The Commission has decided to create a consortium of state goverment, businesses, consumers, and the health care industry to work on ways to bring down costs.  The group charged with coming up with a two-year State Health Plan (Committee on Health Systems Development) has scheduled a town hall meeting on March 12 as part of their "Tough Choices" campaign to hear Maine voices on their priorities for health care.  Randomly selected Mainers will come together to offer their opinions.  The plan will then go to the Legislature and they hope to finalize it by June. (See article below entitled "Tough Choices" campaign)

Applications for a January 1 effective Dirigo insurance product were accepted up until December 1. The Agency received 1175 of them, representing 2100 members. Of those, 131 are small businesses. It is clear that the most recent goal of having 10,000 members in January will not be met. The agency is now accepting applications for February 1. The withdrawal rate is 5%, which was expected and thought due to people hoping for a greater discount. The DirigoHealth website will soon have a discount estimator calculator on it.

Dirigo Health is considering a proposal from Franklin Health Access (subsidiary of the hospital parent) to help fund small business's participation in Dirigo. The pilot program would fund the employer's contribution to the employee's insurance plan, though only for employers who have not offered insurance to their employees to date. $400,000 has been pledged by Franklin to fund the program. [return to top]

Hospital Study Commission Pushes EMR
The draft report of the Hospital Study Commission includes a four-page chapter on electronic medical records and concludes that, "the potential to improve quality and lower cost is so great that the Commission is urging Maine's hospitals to move in that direction with all reasonable haste."  The Commission goes on to state, "Consistent with that recommendation, the Commission also proposes that every Maine doctor and medical provider convert to EMRs using technology compatible with that employed by the hospitals."

Acknowledging that shifting from paper to EMR is an expensive, time consuming process, the Commission makes a series of positive recommendations designed to assist providers with the change.  Among these recommendations are the following:

  • Creating a committee under the leadership of the Maine Quality Forum to assist in determining the specific hardware and software which will best fit the needs of Maine.  The committee would be directed to determine the scope of issues to be addressed by EMR's within the initial three to four year period.
  • Providing a significant amount of state bonding to cover startup EMR costs - to help fund expensive infrastructure related to statewide interconnectivity and developmental and implementation costs, for both hospitals and physicians.
  • Providing a modest increase in Medicaid rates for up to twelve months for physicians to recognize the "temporary efficiency loss" during the transitional period of moving to an EMR.

The Commission acknowledged that for many physicians and small hospitals, the prospect of beginning the transition into EMRs without outside guidance and financial help poses an overwhelming challenge.  Members therefore argued for a coordinated statewide effort that is financially supported by the state and federal government.  The Commission noted that it, "views this recommendation as a high priority undertaking for its hospitals and other health care providers."


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Dirigo Health to Present "Tough Choices" Campaign
As part of the Dirigo Health effort, the Governor's Office of Health Policy and Finance is presenting a "Tough Choices" campaign designed to receive public opinion about health care in Maine. 

On Saturday, March 12, 2005, one thousand (1,000) Maine citizens will gather in three different locations to conduct an interactive Town Meeting on Tough Choices in Healthcare.  The sessions will last from 9:00 am to 4:00 pm and will be held in Portland, Augusta, and Brewer. 

The public will not be invited to attend these sessions.  Rather, a random group of citizens, intended to represent an accurate cross section of Maine citizens, will be invited to participate in sort of a giant focus group.  Initially, a randomly selected group of up to 24,000 citizens will receive a mailing explaining the event and be asked to complete a brief questionnaire if they are interested in participating.  The responders will gradually be whittled down to a select 1,000 people, based upon demographics.  These participants will then receive a briefing document in the mail that is intended to present the major issues to be worked on at the event. 

The three sites will be linked by video-conferencing and each table will have a laptop for note taking and each participant will vote on different options with an electronic, handheld, voting device.  The program will be professionally facilitated.  In fact, each table of ten individuals will also have a facilitator.

This past week, on Dec. 14, representatives of several health-related organizations had an opportunity to work with the organizations hired by the state to run the event and to provide input into the briefing document.  Among the participants were, MMA, MHA, MOA, The Maine Equal Justice Project, Consumers for Affordable Healthcare, and Eastern Maine Medical Center.  While it is difficult to summarize the briefing document being prepared, the 6 page document will attempt to present the current status of healthcare financing and delivery in Maine and many of the challenges facing the system in the coming years.  Much of the discussion on the 14th involved attempts to try to present the information in the briefing document in a neutral way which does not prejudice the participants' opinions.

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MMA Submits 4 Bills for 122nd Legislature; Committee Assignments Made
The 122nd Maine Legislature's cloture deadline for filing bills for consideration during the next two years passed on Friday, December 17, 2004 at 4 p.m.  The MMA has submitted 4 bills on the following subjects:

  • Medical liability reform:  The bill proposes a $250,000 cap on non-economic damages, requires the pre-litigation screening panels to specify the damages they find, eliminates joint & several liability, & proposes to prevent statements of sympathy or "apology" by a health care practitioner from being used against the practitioner or facility in a civil action.  The prime sponsor of the bill is Senator Karl Turner (R-Cumberland).
  • MaineCare reimbursement rates:  The bill proposes to increase Medicaid reimbursement rates for individual health care practitioners by $3 million (will be nearly $10 million with additional federal match) immediately & directs DHHS to adopt the Medicare fee schedule (the highest permitted by federal law) as the Medicaid fee schedule by January 1, 2006.  The prime sponsor of the bill is Representative Edward Dugay (D-Cherryfield).
  • Capital Investment Fund:  The bill proposes to extend the sunset provision in the CIF division between hospital and non-hospital pools from 7/1/07 to 7/1/10.  The prime sponsor of the bill is Senator Karl Turner (R-Cumberland).
  • Mandated health benefits:  In reaction to a change in CIGNA's national coverage policy for 2005, this bill proposes a health insurance mandate that all health insurance carriers doing business in Maine cover medically necessary breast reduction and symptomatic varicose vein surgery.

These 4 bills are just a few of the important issues at the Maine State House that will occupy the MMA staff during the next two years.  The MMA usually monitors more than 300 pieces of health care legislation during the 2-year cycle & other important issues in the 122nd Legislature will be the 2006-2007 biennial budget, the Dirigo Health plan, tobacco taxes, & primary seat belt law enforcement.

Late last week, the Legislature's presiding officers announced appointments to the various joint standing committees that will carry out the bulk of the Legislature's work on these bills.  You can find the joint standing committee list on the Legislature's web site at:

The chairs & minority leads of some key committees are:

Appropriations & Financial Affairs:  Senate Chair - Margaret Rotundo (D-Androscoggin), House Chair - Joseph Brannigan (D-Portland), Senate R - Richard Nass (D-York), House Lead R - Sawin Millett (R-Waterford)

Business, Research & Economc Development:  Senate Chair - Lynn Bromley (D-Cumberland), House Chair - Nancy Smith (D-Monmouth), Senate R - Dana Dow (R-Lincoln), House Lead R - Christopher Rector (R-Thomaston)

Health & Human Services:  Senate Chair - Arthur Mayo (D-Sagadahoc), House Chair - Hannah Pingree (D-North Haven), Senate R - Richard Rosen (R-Penobscot), House Lead R - Thomas Shields, M.D.

Insurance & Financial Services:  Senate Chair - Nancy Sullivan (D-York), House Chair - Anne Perry (D-Calais), Senate R - Peter Mills (R-Somerset), House Lead R - Kevin Glynn (R-South Portland)

Judiciary:  Senate Chair - Barry Hobbins (D-York), House Chair - Deborah L. Pelletier-Simpson (D-Auburn), Senate R - David Hastings III, House Lead R - Roger Sherman (R-Hodgdon) [return to top]

Sign up for PDL Email Alerts
The Bureau of Medical Services is improving its alert system to providers who have access to the Internet.  They will now be emailing notices of changes to the Preferred Drug List as they occur.  To sign up for those email alerts, go to, click on MaineCare Pharmacy Services on the left. Scroll down to GHS Pharmacy Services Newsletter/Alert.  They have also created a PDL Tracking Changes sheet which can also be found on the GHS website. [return to top]

MedPAC Recommends 2.7% Increase in Medicare Physician Reimbursement
In early December, the Medicare Payment Advisory Commission, a group that advises Congress on Medicare issues, developed a preliminary recommendation that Congress increase physician reimbursement by 2.7% in 2006.  The Commissioners will vote on this recommendation at their meeting in January 2005 and the result will go to Congress in their March report.  Despite the MedPAC recommendation, the sustainable growth rate (SGR) methodology found in the Balanced Budget Act of 1997 is the basis for physician reimbursement in the Medicare program.  The SGR would have resulted in cuts in 2004 and 2005 if Congress had not made an adjustment in the Medicare Prescription Drug, Improvement, & Modernization Act of 2003.

You can find the MedPAC reports on the web at:

At a forum sponsored by the Alliance for Health Care Reform and the Kaiser Family Foundation on December 10, 2004, Congressional aides suggested that there likely will be bipartisan support for revising the Medicare physician payment formula in the incoming Congress.  A Republican Senate Finance Committee aide estimated that a permanent solution to the SGR will cost $25 billion over 5 years and $90 billion over 10 years. [return to top]

Flu Vaccine Update: Expanded Recommendations for Vaccination

Because of the recently increased availability of influenza vaccine, the Centers for Disease Control and Prevention (CDC) and the Maine DHHS Bureau of Health can now recommend that all persons considered to be at higher risk for complications from influenza and those persons likely to transmit influenza to persons at higher risk should receive influenza vaccine. Earlier restrictions related to the vaccine shortage have now been lifted. While the CDC will announce today that the official implementation of these new guidelines will be delayed until January 3rd  (because of the fact that some states have not yet been able to reach out to their highest-risk groups), we believe that in Maine  there now appears to be sufficient vaccine available in the provider community to permit an immediate expansion of the groups.  


Persons for whom vaccine should be recommended include the following:


        Persons > 50 years of age

        All women who will be pregnant during the influenza season

        All persons with chronic medical conditions

        Residents of nursing homes and long-term care facilities

        All children aged 6-23 months

        All health care workers involved in direct patient care

        Out of home caregivers and household contacts of children <6 months of age and of other persons at high risk


It is also important to note that children under age 9 years of age (who were not    vaccinated in a previous season) who received the first of two recommended pediatric vaccine doses this season should now be able to receive a second dose if at least one month has elapsed since the first dose.


Vaccine Availability: Providers who do not currently have sufficient vaccine to meet the needs of their patients should call the DHHS Bureau of Health Vaccine Provider Hotline at 800-867-4775 so that any needed redistributions can me made. In addition, the Bureau of Health will be providing influenza vaccination by appointment at special clinics during the week of December 27th. The dates and locations of these clinics, with appropriate contact information, are included on the attachment sent with this Advisory. Also included in this list is information on several other special vaccine clinics that will be held during the week of December 20th, for which no appointments are needed.


While influenza A has been documented in Maine since late November, widespread activity has not yet occurred. High-risk persons should be told that it is not too late to get a flu shot, and should be encouraged to get immunized. For further information on vaccine concerns, please call 800-867-4775.


You can read the Bureau of Health's press release from December 17, 2004 on the web at:


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