December 27, 2004

 
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Hospital Study Commission Releases Draft Report; Announces Public Hearings
On Dec. 22, the Commission to Study Maine's Hospitals released its draft report, after meeting over 30 times the past year and hearing from nearly 50 experts and witnesses. The Commission will hold public hearings on Jan. 6 and 7 and then meet again on Jan. 10 to incorporate the public comments into the final report to be given the Legislature later in January.
 

The public hearings will be held Thursday, Jan. 6 in Portland (9am-noon at the Double Tree Hotel, 1230 Congress St.) and Augusta (2pm-5pm at the Calumet Club, 334 Northern Ave.) and Friday, Jan. 7 in Bangor (9am-noon at the Bangor Motor Inn, Hogan Rd.)  MMA representatives will attend the hearings and provide comments on the Commission report on behalf of MMA members.

While acknowledging "the contributions physicians, nurses and other health professionals make each day and the tremendous results achieved by Maine's hospitals," Commission Chair William Haggett and Trish RIley, Director of the Governor's Office of Health Policy and Finance, noted that the current system has two problem: high costs and too much variability.  On the latter point, Ms. Riley observed, "too much variability in hospital profitability and financial health, variability in the care people receive, and variability in what hospitals are paid, even after adjusting for differences due to age of patients."

While the Commission concluded that cost-shifting - payment at rates lower than costs by Medicare and Medicaid - was one factor influencing the pricing of hospital care in Maine, the Commission also found that hospital costs (how efficient hospitals are at providing services) and profitability were also important factors.  The profit margins of two-thirds of Maine's hospitals are significantly higher than national and northeast region medians for hospitals, the report alleges.

A complete list of recommendations is included in the Executive Summary of the draft report: http://www.dirigohealth.maine.gov/12-22-04%20DRAFT%20CSMH%20rpt.pdf.

MMA Seeks Information on Free Clinics and Medical Mission Work
MMA President Lawrence Mutty, M.D. has established as one of his personal goals this year the creation of a database at MMA of free clinics operating in the state and a directory of opportunities for medical missionary work.  Humanitarian efforts of significant proportions are being performed daily by Maine physicians and it is MMA's hope to publicize these efforts both to provide information to the public and to encourage more physicians to participate and direct them to appropriate organizations.

MMA annually acknowledges this type of effort by presenting the Mary Cushman Humanitarian Award, named for Dr. Cushman who was one of Maine's early medical missionaries.  In 2003 the award was presented to Charles Hendricks, M.D. of Bar Harbor for his work in Honduras.  In 2004 the award was presented to Cynthia DeSoi, M.D. of Lewiston for her work in Haiti.  The award also includes a financial contribution to the entity supported by the recipient.  In the 1990's Francis Kleeman, M.D. of Biddeford was presented the Association's President's award for his efforts in establishing the Biddeford Free Clinic, one of the free clinics still operating in the state and meeting an important need.

If you or one of your colleagues is involved in such efforts, please communicate such to Gordon Smith at MMA (gsmith@mainemed.com) or directly to Dr. Mutty at lmutty@verizon.net. [return to top]

Erin Hoeflinger named Anthem Vice President and General Manager for Maine
Anthem Blue Cross and Blue Shield recently announced that Erin Hoeflinger will replace James Parker as VP and General Manager of operations in Maine.  Parker is leaving to lead the company's Federal Employees Benefits Unit in Indianapolis.

Hoeflinger will assume her new responsibilities effective Jan. 1, 2005.  As VP and General Manger, she will be responsible for local market leadership and service to the Anthem members throughout Maine.

Parker served four years in Maine and will be moving to a unit that serves more than 1.2 million federal employees across 13 states.

Hoeflinger is currently vice president of sales in Maine.  Previously, she served as Vice President of operations and health care management.  She joined the company in l995 and served in several leadership positions with Anthem Prescription Management, the company's pharmacy benefit management organization based in Ohio.  She earned an MBA from Xavier University and has served on the boards of a number of organizations in the greater Portland area since moving to Maine. [return to top]

Maine Health Information Network Technology (MHINT) Feasibility Study Moves Forward
The Maine Health Information Network Technology (MHINT) feasibility study appears to have survived Phase I and is moving ahead with Phase II.  The initial study was funded by the Bureau of Health, the Maine Health Access Foundation and the Maine Quality Forum. The project was led by the Maine Health Information Center and was intended to examine the feasibility of Maine putting together a statewide healthcare information network that would link electronically the various places where healthcare information currently  resides.

A draft report is now circulating representing the work of Phase I.  Although presented with many assumptions and disclaimers, the draft report estimates that statewide implementation costs would be $30 million to $35 million in capitalization and $2 million in ongoing annual operating costs.  Estimated cost savings are also presented, although there is general acknowledgment that substantial financial benefit would not accrue quickly to providers.

In Phase I, the project:

  • Inventoried current and planned IT systems, including 27 hospitals
  • Established the Provider Advisory Group and Chief Information Office Work group
  • Developed a statewide clinical information sharing vision
  • Developed criteria for an integrated clinical information sharing system
  • Sought substantial level support support among stakeholders (MHIC has received support from 34 hospitals)
  • Developed the business case for the MHINT
  • Identified feasible vendor systems

In Phase II, the MHIC will:

  • Begin vendor selection process
  • Develop planning and development funding sources
  • Develop a pilot plan
  • Develop capitalization funding sources
  • Refine preferred technical model
  • Develop capital and five-year operating cost model
  • Develop operating expense allocation plan
  • Work out any legal issues
  • Develop public communication plan
  • Identify governance model
  • Develop a Regional Health Information Organization, which is necessary to obtain federal grant funding

There are still many unanswered questions about the project, including how it would be governed and whether providers would use it.  At its meeting in Sept., the MMA Executive Committee was briefed by MHIC President Jim Harner about the project and expressed its support for the concept.

 

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AMA Applauds Nomination of New HHS Secretary
The AMA on Dec. 13 applauded President Bush's nomination of former Utah Governor Michael Leavitt as Secretary of the U.S. Department of Health and Human Services (HHS).

"We applaud President Bush for his choice of a well-seasoned leader to head this vital department," said AMA President John C. Nelson, MD, MPH, who served as the Utah Deputy Director of Health during Leavitt's tenure as Governor of Utah.

During Leavitt's 11 years as governor, Utah increased health care coverage for children and all its citizens through the Utah HealthPrint program, adding to Leavitt's credibility as a proven leader of health care reform, Dr. Nelson said.

"The AMA is eager to work with the new secretary to reform the broken medical liability system, improve Medicare and increase access to health care," emphasized Dr. Nelson. "Is is our hope that working together, we can make a difference for our patients."

Leavitt currently serves as Administrator of the Environmental Protection Agency.  His nomination as HHS Secretary requires Senate confirmation, but initial comments from Democrats as well as Republicans have been positive. [return to top]

Low Income Seniors Face Deadline for Medicare Drug Card
People with Medicare who have low incomes have until Dec. 31 to enroll in a Medicare-approved drug discount card to receive up to $1200 in savings on prescription medications.  The low-income benefit is a transitional measure that allows eligible seniors to purchase one of several different discount cards being offered by private companies.  For the very low-income seniors, the discount cards are free and provide an additional $600 drug credit for each of the two years between the time the Medicare Modernization Act went into effect and the startup of the actual prescription benefit.

"Time is running out," said James Firman, chair of the Access to Benefits Coalition, of which the AMA is a member organization.  "This is a real opportunity for those who need help the most to lower the costs of their medications.  Our online Medicare Card finder just made it easier and faster for people to find and enroll in the best Medicare-approved card.  Our local partners are standing by to help enroll as many people as we can between now and the end of the month."

People with incomes below $12,569 if they are single or $16,862 if married, may be eligible to save at least $1200 on their medications through a Medicare-approved drug discount card.  However, they need to appy for a card by Dec. 31 to get the full $1200 value.

"There is more than $6 bilion in savings available for 5.3 million people with Medicare who have not already signed up for a Medicare-approved card," Firman added.  "That is a lot of money to leave on the table."

Patients should visit http://www.AccesstoBenefits.org to find a Medicare-approved drug discount card that is right for them. [return to top]

OSA Announces Registration for Prescription Monitoring Program (PMP)
On January 1, 2005, the Office of Substance Abuse is making available the data collected by the Prescription Monitoring Program.  This data base collects all prescription transactions in the State for Schedule II, III, & IV drugs for all sources of payment.  Any prescriber or dispenser in the State is allowed to access this information free of charge in order to provide better patient care.

In order to request reports from the data base all prescribers and dispensers need to register by browsing to http://www.ghsinc.com/pmppage.php, then clicking on "Prescription Monitoring Program Files" and printing out the form, filling it out, and faxing it in.  They can also register online by browsing to http://www.ghsinc.com/pmppage.php, then clicking on "PMP Service Page" then "Submit Data."

GHS will then submit back to the prescriber or dispenser a User ID and Password which will be used on the request form for reports.  The request form is available for download at http://www.ghsinc.com/pmppage.php, then clicking on "Prescription Monitoring Program Files."  GHS' fax number is 207-629-6806.

Once you have received your User ID and Password please keep it in a secure location.  You may use your ID and Password to request PMP information as many times as you would like.  GHS will return the requested report within 24 hours of receiving your request except for weekends and holidays.

OSA hopes prescribers and dispensers will use this new tool to keep themselves better informed about their patients' prescription history in order to give Mainers the best possible care while being alert to the significant prescription drug misuse problem we face.

If you have any program or policy questions about the PMP, please contact the Project Coordinator, Chris Baumgartner, at 287-3363.  If you have technical questions, please contact GHS at 622-7153.  The 121st Maine Legislature created the PMP through L.D. 945, An Act to Facilitate Communication between Prescribers and Dispensers of Prescription Medication (P.L. 2003, Chapter 483) supported by the MMA.

The MMA has worked with the Maine Osteopathic Association and the OSA staff to develop a document to answer common privacy questions associated with the PMP.  The following is a draft of such a document.  If you have questions or comments about this draft, please contact Andrew MacLean, Vice President & General Counsel, at 622-3374 or amaclean@mainemed.com.

Privacy Issues and the PMP

Prescribers and pharmacists need to understand how the federal and state health information privacy laws, primarily the HIPAA privacy rule and Maine's confidentiality statute, affect their rights and obligations in the disclosure of information obtained from the PMP.  You can feel comfortable that the routine disclosures you will face most on a daily basis - to patients, to other health care practitioners involved in the patient's care, to public and private payers, and to regulatory authorities - are permitted either by the PMP statute itself or by the privacy laws.  The Maine Medical Association and the Maine Osteopathic Association staff have provided responses to the most common questions a prescriber or pharmacist is likely to face.

Q:  Can I share the information in a PMP report with the patient who is the subject of the report?

A:  Yes, the statute creating the PMP specifically permits the patient's access to the information in the PMP reports.  Also, under the federal and state privacy laws generally, a patient would have access to this information when it becomes part of the medical record.

Q:  Can I share the information in a PMP report with other health care practitioners involved in the patient's care, including pharmacists?

A:  Yes, the statute creating the PMP specifically permits any prescriber and any dispenser involved in the patient's care to have access to the information in the PMP reports.  Also, under the federal and state privacy laws generally, a health care practitioner has broad authority to disclose protected health information with all other practitioners, including pharmacists, involved in the patient's care, even without the patient's consent.

Q:  Can I share the information in a PMP report with representatives of the MaineCare program?

A:  Yes, MaineCare recipients must consent to MaineCare program staff having access to their protected health care information as a condition of participation in the program.  Also, under the federal and state privacy laws generally, a health care practitioner has authority to disclose protected health information to public and private payers for payment purposes and for utilization review activities.

Q:  Can I share the information in a PMP report with regulatory or law enforcement personnel?

A:  Yes, the statute creating the PMP specifically permits the health care licensing boards, having a reasonable need for the information to support an investigation, to have access to PMP information.  Health care practitioners may, but are not required to, disclose information about a patient's potential diversion or abuse of a prescription medication to law enforcement personnel as long as they are not treating the patient for substance abuse and they are judicious in the amount of information disclosed.

Q:  Can I be held legally responsible for doing nothing at all with the PMP report information?

A:  Yes, possibly.  A health care practitioner would have an obligation to take action on information about a patient suggesting substance abuse or diversion coming from the PMP, just as the practitioner would if the information came from another source.  As a clinician, the practitioner has a professional, ethical obligation to address the patient care aspects of this information.  Also, a practitioner would have an administrative obligation to communicate with the MaineCare staff about the potential misuse of program resources as part of the practitioner's participation agreement with the program.

If you have more questions about your rights and obligations regarding the information in a PMP report, please contact Andrew MacLean, Vice President & General Counsel of the Maine Medical Association, at 207-622-3374  or amaclean@mainemed.com. [return to top]

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