January 3, 2005

 
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Coverage Begins for 1800 DirigoChoice Enrollees
The new year marked a milestone for the Dirigo Health program with 1,800 enrollees receiving coverage as of Jan. 1, 2005. While the program fell well short of its goal of having 10,000 enrollees by Jan. 1, Dirigo staff remained upbeat stating that they were off to a solid start and noting that it takes time for small business owners to decide whether they can make the minimum 60% employer contribution required or find enough employees willing to participate, despite considerable subsidies for those employees earning under $28,000 as an individual or $56,550 for a family of four.
As recently as two months ago, Dirigo Health staff had hoped to have at least 10,000 enrollees by Jan. 1 and 31,000 by the end of the year. 

DirigoChoice, administered by Anthem Blue Cross and Blue Shield, is using most of the $52 million in start-up funds to offer subsidies to those individuals eligible for the product.  But those funds are expected to be utilized in the first year of the program and thereafter a portion of the subsidies will be paid for by an assessment on health insurance companies doing business in Maine, up to 4% of premium collected.  But to determine the assessment, the Dirigo Board must determine that savings in that amount have actually occurred to the insurers as a result of a reduction in bad debt and charity care of providers whose charges would then be reduced  resulting in lower charges to health insurance carriers which then would reflect these lower charges in lower health insurance premiums. Many observers believe that such a determination will be impossible.  Nonetheless, other revenue to support the program will be available through employer contributions and MaineCare contributions.  Employers enrolling MaineCare eligible employees in DirigoChoice will draw down federal funds.

Dirigo Choice offers 100 % coverage for many preventive services and the discounts offered for those eligible can be applied to monthly premium costs, deductibles and co-payments.

An aggressive advertising campaign had been conducted the last few weeks and is scheduled to resume after the holidays.

The Dirigo Board of Directors is scheduled to hold its monthly Board meeting on Monday, Jan. 3rd in Augusta.  At that time, the Board will hear from staff regarding the current enrollment and any other issues relevant to the startup Jan. 1.  Robert McAfee, M.D., former MMA and AMA President, chairs the Board which is made up of five voting members and three ex-officio members from relevant state agencies.

Commission to Study Maine's Hospitals Holds Hearings this Week on Draft Report
The Commission to Study Maine's Hospitals holds hearings this week to hear public comments on its draft report which became available in mid-December.  The hearings will be held on Thursday, Jan. 6 and Friday, Jan. 7 in Portland, Augusta and Bangor.  The specific times and locations are as follows.

  • Thursday, Jan 6, 9:00am to noon, DoubleTree Hotel, Congress St., Portland
  • Thursday, Jan 6, 2:00pm to 5:00pm, Calumet Club, Augusta
  • Friday, Jan 7, 9:00am to noon, Bangor Motor Inn, Hogan Rd., Bangor

MMA representatives will attend each hearing and will present the Association's comments on the draft.  At the Augusta hearing, MMA President Larry Mutty, M.D. will express concern about the lack of integration with the VA system and the omission of the state and private psychiatric hospitals in the Commission's work.

The MMA's specific comments and recommendations are still being prepared but will be posted on the MMA website (www.mainemed.com) by the end of the week.  Members wishing to input into the Association's comments should communicate with EVP Gordon Smith at 622-3374 or via e-mail to gsmith@mainemed.com.  MMA can expect to make specific comments on the sections of the draft report dealing with medical malpractice, certificate of need, electronic medical records,  Bureau of Insurance Rule 850,  anti-trust, wellness and governance.  Other sections may warrant a comment as well, but the sections noted have the most impact on physicians.  MMA will advocate for a stronger recommendation relative to medical malpractice, which, while included as a separate chapter, falls far short of the Association's agenda in the professional liability area.  MMA can be expected to support much of the chapter on EMR which recommends that the state provide considerable support for the transition to such a system, through the issuance of state bonds.

As noted in last week's Maine Medicine Weekly Update (MMWU), the report represents a year's work of effort by the nine member commission which included two physicians, D. Joshua Cutler, M.D., of Portland and Louis Hanson, D.O., also of Portland.  Dr. Cutler is a cardiologist and Dr. Hanson a family physician.  The Commission met over 30 times and focused primarily on the issue of cost, although several recommendations in the draft report touch on issues of quality and access.

In addition to recommending that hospitals provide standardized cost reports to the state annually, which then would be made available to the public, the Commission also recommends retaining the voluntary limits on hospitals' operating margins.

The MMA's testimony will be included in next week's MMWU.  The draft report itself is available at http://www.dirigohealth.maine.gov/12-22-04%20 DRAFT%20CSMH%20rpt.pdf. [return to top]

Save the Dates: 2005 Physician Survival Seminars on May 18th in Portland and June 8 in Bangor
The fourteenth annual MMA Physician Survival Seminars have been scheduled for May 18th in Portland at the Sheraton and June 8 in Bangor at the Spectacular Events Center.  These day- long programs, designed for practice managers and physicians, will feature presentations and materials on Pay-for-Performance, Quality Improvement, Practice Management and Dirigo Health, along with break out sessions on employment law, HIPAA security, chronic disease management, physician "profiling", MaineCare, Medicare, and a dozen other topics.  We will repeat a popular offering from last year entitled, "Dealing with the Disruptive Patient."

Registration materials will be included with the bi-monthly Maine Medicine being mailed in February and April.  You may receive assured seating by communicating with Chandra Leister at 622=3374 or via e-mail at cleister@mainemed.com. [return to top]

122nd Maine Legislature Begins Business this Week
Although it was formally organized and sworn-in in early December, the 122nd Maine Legislature gets down to serious business this week when it convenes on Tuesday to begin a session that is expected to last into June. While tax-reform is considered its top priority, there will be plenty of other important action including dealing with a $700 million deficit in the upcoming biennium beginning July 1, 2005.

Lots of health care issues will be deliberated upon, including MMA's package of pills involving professional liability, MaineCare reimbursement and certificate of need.  The legislature will also consider a package of health care bills to be submitted by the Governor, many of which can be expected to come directly from the Commission to Study Maine's Hospitals.

Over 2100 bill titles have been submitted to the legislature and a list of the titles and sponsors will be available by the end of this week.  We will highlight some of the offerings in next week's newsletter. 

MMA offers members many ways to participate in its advocacy agenda including serving as Physician of the Day at the capitol, attending Physician's Day at the Legislature on March 23rd, serving on the MMA Legislative Committee or participating in weekly MMA conference calls on Wednesday evenings. Member's interested can also receive, via e-mail, Mr. MacLean's "Political Pulse" which is prepared every Friday and summarizes the legislative activity of interest that week and the schedule the following week. 

Virtually every issue we have in medicine could be assisted by efforts in Augusta or Washington.  If you are willing to be more involved, contact Charyl Smith at MMA at 622-3374 or via e-mail to csmith@mainemed.com. [return to top]

MMA Names Heidi M. Lukas, CPA as Finance Director
MMA is pleased to announce the hiring of Heidi M. Lukas, CPA as MMA's Finance Director.  Heidi lives in Poland, Me and comes to us from CommTel, a telecommunications company based in Winthrop where she worked in finance for five years.  From 1992 to 1997 she served as Director of Finance and Administrative Operations for NorDx, an affiliate of Maine Medical Center.  From 1987 to 1992 she worked for KPMG in Virginia as a Supervising Senior Accountant/Auditor.

Heidi received her undergraduate degree at the University of Maine and an M.S. in accounting at Old Dominion University.  She is a licensed Certified Public Accountant and a member of the AICPA and the Maine Society of CPAs.

The position of Finance Director is a new position necessitated by MMA's growth, its relationship to the two 501 (c) 3 foundations and the increasing complexity of managing a non-profit organization and a dozen specialty societies.

Heidi will be responsible for all finance and accounting functions at MMA and will also be responsible for the financial aspects of the Maine Medical Education Trust and the Maine Medical Education Foundation. Ann Verrill, who previously handled bookkeeping, will continue with MMA in the capacity of specialty society coordinator.  Ann will be responsible for the Maine Section of the American Society of Obstetrics and Gynecology, the Maine Urological Society, the Maine Chapter of the American College of Emergency Physicians, the MMA Public Health Committee and will assist with Annual Session and special projects.

Heidi begins her duties with us on Monday, Jan. 3rd.  We welcome her to MMA and look forward to having her as a strong member of our management team. [return to top]

Coalition for Health Care Access and Professional Liability Reform Grows
The Maine Coalition for Health Care Access and Professional Liability Reform (CHCALR), announced in late October and chaired by Lee Thibodeau, M.D.,  recently received two substantial pledges of financial support and in total has now received over $50,000 in cash and pledges.  Most recently, the Maine Osteopathic Association pledged $10,000 toward the Coalition's efforts.  A check has also been received from the Maine Section of the American College of Obstetrics and Gynecology in the amount of $10,000.  The Maine Society of Orthopedic Surgeons has prepared a request for matching funds from the American Society of Orthopedic Surgeons and has pledged to raise at least $20,000 from its members in Maine, to be matched, hopefully, by the national organization.

These funds will be used to secure additional lobbying assistance and for grassroots lobbying and for educating the public and the legislature about the professional liability problem and the solutions to it.  The coalition recently hired lobbyist James Mitchell to assist with the effort.  Jim is a well-known Democratic lobbyist who at one-time ran for Congress, coming in second in a crowded Democratic primary to John Baldacci.  He has since become an important informal advisor and confidant of the Governor.  Jim now lives in Winthrop.

The legislative package of tort reform bills, prepared by MMA VP and General Counsel Andrew MacLean, on behalf of the Coalition, has been submitted to the legislature and is expected to be referred to the Judiciary Committee for action in the Winter or Spring.

The Coalition expects to send out a solicitation for funds to every Maine physician and allied health provider within the month.  In the meantime, any individual or organization can contribute by sending a check to:

Coalition for Health Care Access and Liability Reform
P.O. 190
Manchester, Maine 04351 [return to top]

MaineCare Voice Response System

MaineCare is experiencing difficulties with its new Interactive Voice Response System (IVR).  Technicians are working to resolve problems with inaccurate and slow responses.  While those repairs are being done, providers may access the old voice response system by calling 1-800-321-5557 Option 2.  We apologize for any inconvenience that you may have experienced during this transition.  If you have any questions regarding the new system you may call Julie Tosswill at 287-9360. [return to top]

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