January 31, 2005

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Hospital Study Commission Fails to Achieve Consensus
At its final meeting on Jan. 24, the Commission to Study Maine's Hospitals voted 7 to 2 to issue a divided report, including a majority report and a minority report containing its recommendations to the Maine legislature. The two hospital representatives will file their own minority report, while the other 7 members will sign the majority report.
The two hospital representatives,  Scott Bullock of Maine General Medical Center and John Welsh of Rumford Hospital distributed a four-page document to Commission members indicating their support for 14 of the 20 major recommendations in the draft report.  The three most significant objections that the hospital members had were about the creation of the Consortium for Hospital Collaboration, what they perceived as the overall negative tone of the report and the alleged misleading use of statistical information that appears throughout the report (the dueling data issue described in previous issues of MMWU).

After meeting over 30 times over the course of a year, Commission members were clearly disappointed not to reach consensus on a final report.  Exchanges were, at times, testy as members discussed the more controversial aspects of the report.  A number of editorial changes were voted to the distributed draft and a new majority draft, and likely the minority draft as well, should be available this coming week.

One significant addition to the majority report, which was added at the request of Chairman William Haggett, was a section recognizing the underpayments to hospitals that have resulted in over $120 million in prior MaineCare settlements owed to Maine hospitals for fiscal years 2003 and 2004.

The majority and minority reports will be presented to the Legislature in late February or early March and public hearings will be held on any legislation resulting from the reports sometime during the first regular session of the 122nd Legislature.

The two physician representatives on the Commission, D. Joshua Cutler, M.D. and Louis Hanson, D.O. both signed the majority report.  Dr. Cutler is willing to speak to physician groups regarding his experience on the Commission and the recommendations in the majority report.   He can be reached at Maine Cardiology Associates at 774-2642.

Physician's Foundation for Health Systems Excellence Seeks Applications
The Physician's Foundation for Health Systems Excellence, the non-profit organization that was established as a part of the settlement of the multi-district class actions suits against Aetna, Inc, has announced that funds are now available for projects that will assist physicians to improve health care quality for their patients.  The Foundation will fund programs that focus on the areas of practice management, physician education and patient safety/disease management.  Grants will be given to organizations that meet the 501(c) (3) tax exempt requirements or medical societies that are tax-exempt under other provisions of law. 

    To meet the first cycle of the grant making deadline, grant applications must be received by March 1, 2005.  Additional information about the grant guidelines and application forms may be found on the Foundation's website:  www.physiciansfoundation.org. [return to top]

State Prescription Monitoring Program (PMP) Off and Running
The Prescription Monitoring Program authorized by the Maine Legislature two years ago is now accepting applications from physicians and other prescribers who wish to see the data on their patients and is about to send its first wave of reports to physicians on patients who have failed the established screens. The initial screen involves patients who have seen four or more prescribers or filled scripts at four or more pharmacies during the requisite time period.  The program was established as another approach to battling Maine's substantial problem with illegal diversion of prescription drugs and drug abuse generally.  The program is operated through the Office of Substance Abuse (OSA) and is initially funded from federal grants.

The first reports will go to over 1400 prescribers.  As the data will only be as good as the information entered at the pharmacy and reported to GHS, please review your report carefully and you are encouraged to contact the contractor if the information sent to you is erroneous, such as attributing patients to you who are not your patients.

The reports will be sent by the state's contractor for the program, GHS Data Management.  While all prescribers may receive the periodic reports, a physician or practice must file a registration form with GHS in order to request a report on a patient.  The form is available from the GHS website at www.ghsinc.com/pmppage.php.  Other information on the PMP is available on the OSA website at www.maineosa.org/data/pmp.

One of the documents on the OSA website is a privacy guide prepared by MMA Counsel Andrew MacLean which gives guidance to prescribers as to what can be done with the data once received.

Chris Baumgartner is the PMP Coordinator at OSA and will present a program on this topic at the 14th Annual MMA Physician Survival Seminar in Bangor on June 8th.  Program registration materials will be included in the next issue of Maine Medicine, or interested persons may contact Chandra Leister at MMA for advance registration materials.  A similar seminar will be held in Portland on May 23, but this particular presentation on the PHP will be available only at the Bangor session.  Ms. Leister is available at 622-3374 or via e-mail to cleister@mainemed.com.

Registrations were accepted beginning on Jan. 3 and, so far, 52 prescribers and 29 pharmacies have registered.  Again, the registration is for physicians and other prescribers who wish to file requests for the data on a given patient.  Even if you do not register, you may still receive reports periodically on your patients who have failed the screen.

Further information is available on PMP from Chris Baumgartner at 287-3363 or via e-mail at chris.baumgartner@maine.gov. [return to top]

State Receives Favorable Court Ruling on Maine Rx
In a 35-page decision, U.S. federal District Court Judge William E. Smith on Friday dismissed the lawsuit filed by the Pharmaceutical Research and Manufacturers of America (PHRMA) against Maine's discount drug program.  Judge Smith, of the District of Rhode Island, was assigned to the case after the federal judges in Maine recused themselves because of various conflicts.

Essentially, Judge Smith decided the case on the basis that the innovative program was so new that concerns about it from the industry were premature.  A major premise of the complaint, that MaineCare patients would be punished via prior authorization requirements for the failure of a manufacturer to successfully negotiate with the state, has been rendered moot as the state has not used the prior authorization tool under the statute.  Instead, the state has "voluntarily" secured discounts of up to 15% for brand-name products and 60% for generics through agreements with the manufacturers.

Should the state begin using the PA tool as authorized by the statute, PHARMA is not precluded from initiating the complaint again.

119 pharmacies and 20 manufacturers currently participate in Maine RX Plus which is available to persons earning under 350% of the federal poverty level.  139,000 prescriptions were filled under the program in 2004.

PHARMA had successfully delayed the program earlier in a case that went to the U.S. Supreme Court.  In a widely watched decision, the Supreme Court lifted the previously granted injunction and sent the case back to the federal District Court for review.  The decision announced Friday terminates the proceedings for the time being. [return to top]

Advisory Council on Health Systems Development Resumes Meetings
The Advisory Council on Health Systems Development, established in the Dirigo Health legislation, met on January 28 and will continue to meet every other Friday morning, with the next meeting on Friday, Feb.11 at 9:00am in Augusta.  The Council on the 28th received a comprehensive presentation from Lisa Letourneau, M.D. entitled, Overview of Maine's Care Model Initiative.  Dr. Letourneau had been one of several persons from Maine invited to attend the National Governor's Association (NGA) program on the chronic care model last fall in New Orleans. 

The Governor's Office of Health Policy and Finance convened a "Maine Chronic Care Workgroup" last fall to begin development of a model for Maine.  Eight individuals, including Dr. Letourneau, attended the NGA program, including representatives of MaineCare, the Bureau of Health, the Maine Center for Public Health, the Dirigo Health agency and the Governor's Office of Health Policy and Finance.

In developing a model for Maine, the work group has recognized the need to:

  • Build upon current resources and improvement efforts across the state
  • Look to relevant experience in other states (Indiana, North Carolina)
  • Reflect current realities, challenges of Maine population, culture and geography.

There is obviously interest in linking the State Health Plan with the Care Model and Dr. Letourneau's presentation to the Advisory Council was the first step toward that linkage.  The overall goal is to link the Plan with clinical practice in communities and regions.  Initial steps will include:

  • Receiving visible endorsement of the Care Model by key State leadership (ACHSD, GOHPF, DHHS)
  • Incorporating specific goals for chronic illness prevention and care in State Health Plan
  • Ensuring that benefit structure and provider reimbursement of state-directed health plans supports care in accordance with the Care Model
  • Creating structures for ongoing evaluation and monitoring, perhaps through the Maine Quality Forum.

Included in the concept is the creation of "Regional Chronic Care  & Prevention Networks" in several designated regions.  Each Regional Network would convene a local steering committee, ensuring adequate representation by key community and clinical players in the region.  The Regional Network would link State Health Plan priorities to the community and community priorities to the Plan.  In addition, each Network would identify any additional health priorities for the region and would be accountable for improving regional outcomes.

Each Regional Network would contract with the state to support:

  • Actively promoting linkages between community resources and clinical community
  • Practice-based nurse care management for chronic illness (MaineCare, Dirigo Health, state employees)
  • Technical assistance to physician practices to promote systems enhancements for improved chronic care.

There are still many key questions left to answer regarding the operation of such a model in Maine, including the setting of statewide goals and the establishment of measurable benchmarks.  A copy of Dr. Letourneau's power point slides are available from MMA  (call Julie Banta at 622-3374 or via e-mail to jbanta@mainemed.com).

The Council also received updates on the "Tough Choices" campaign and statewide forums being organized for March 12,  the Hospital Study Commission and  Certificate of Need activities.

MMA Past President Maroulla Gleaton, M.D. is a member of the Council, as is Lani Graham, M.D., the acting Director of the Bureau of Health.  Robert Keller, M.D. has resigned from the Council so an additional specialty physician will be recruited. [return to top]

Governor Highlights Health Care in State of the State Address
Health care remains at the top of the Governor's agenda as he announces his intention to seek a second term.  In his State of the State address to a joint session of the Maine Legislature last Tuesday evening, Jan. 25, Governor Baldacci pointed to further work in the health policy arena as one of  three priorities for the coming year.  He highlighted the "Maine Care Model" and announced that he had convened a task force of physicians, hospitals, nurses, consumers and policymakers to charge them to work with Maine's communities and its health providers and businesses in order to have the model practiced everywhere in the state.

The Governor also highlighted the cost of prescription drugs and his continuing efforts to lower costs through group negotiation and by purchasing drugs through Canada.

The Governor noted the progress of the Dirigo Health agency but noted that Dirigo Health reform continues to be a work in progress.

More on the Governor's presentation is included in Mr. MacLean's Political Pulse published last evening.  Here is the link to this weekly electronic publication made available to MMA members and their staffs throughout the legislative session. [return to top]

Important Bills Being Heard by Legislature This Week; Your Input Needed
The Legislature considers several bills this week of interest to physicians.  On Monday, L.D. 17, An Act to Ensure Fair Reimbursement for the Medical Care Provided to State Inmates, will be heard by the Criminal Justice Committee.  Sponsored by Rep. Rector of Thomaston, the bill repeals the language in last year's budget document that established MaineCare rates as the reimbursement rate for medical services provided to state inmates.  By repealing the provision, the bill would require the State or its contracted medical provider to negotiate fair reimbursement rates for medical care provided to state inmates.

This change to MaineCare rates has adversely impacted physician practices, particularly in the area of the state prison.  Both MMA and the Maine Hospital Association Will testify in favor of the legislation.

On Tuesday afternoon, Feb. 1, 2005, the Joint Standing Committee on Transportation will hold a public hearing on L.D. 80, An Act to Amend the Law Governing the Use of Seat Belts, sponsored by Sen. Christine Savage (R-Knox). The bill proposes "primary enforcement" of the seat belt law, meaning that law enforcement officials can stop an individual for failure to use a seat belt alone not incidental to another reason for the traffic stop.  This bill is a high priority for the MMA Public Health Committee and MMA will testify for the bill and vigorously lobby for its enactment.

A complete list of the bills of interest being considered this week and the bills being presented to the MMA Legislative Committee at its conference call at 7:00pm on Wednesday night are noted in the Political Pulse published last evening. 

Any MMA member is welcome to call in on the conference call Wednesday night.  The number for the call is 1-800-989-2842; code 622-3374#.  It is particularly important that representatives of the various specialties participate, otherwise, the voice of that specialty is not heard as MMA takes its positions on these various bills.  Congratulations to the pediatricians and the psychiatrists who have been most active on these calls.  Where are the rest of you! [return to top]

Update on New MaineCare Claims Management System (MECMS)
DHHS began processing MaineCare claims using the new system on Jan. 24, 2005.  As with any large system implementation, the Department anticipates problems during the transition phase as the BMS staff and providers adjust to the new requirements.  Phase one of the new system replaces all the claims payment functions and requires new provider numbers.

MMA representatives talked with MaineCare officials several times last week regarding the transition.  In response to one contractor's advice to a practice that it go back to filing paper claims until the transition is complete, Bureau officials stated emphatically that they did not believe that going back to paper would assist in getting payment promptly.  The Bureau believe that any delays for clean claims will be relatively brief, as long as the provider has the new provider number.

Please let MMA know if you experience undue delays with the system, so that we can monitor the situation on your behalf.  Communicate directly with gsmith@mainemed.com after you have queried the Bureau inquiry unit at 1-800-321-5557, option 9 or 207-287-3094. [return to top]

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