March 3, 2008

 
Subscribe to Maine Medicine eNewsletters
Manage Your Subscriptions
Email our Editor...
Maine Medical Association Home Page
. Search back issues
. Plain Text Version
Printer Friendly

Advisory Council on Health Systems Development to seek Public Comment on Long Awaited Draft State Health Plan

The Advisory Council on Health System Development met on Friday (Feb. 29) to finalize the draft State Health Plan.  The draft plan will be available online on March 6 and a public hearing has been scheduled for March 18th.  Written comments will be accepted until March 28th.    The draft plan exceeds 80 pages and contains a number of provisions of interest to physicians.

Members of the ACHSD, chaired by Lani Graham, MD in the absence of Brian Rines, met last week to finalize their input on the draft State Health Plan, which exceeds 80 pages.  During the 3 ½ hour walk through of the draft plan, committee members diligently discussed various sections of the plan and emphasized that Preventative Practices and Improving Rural Health Care in Maine components should be integrated into the overall state plan, as well as the integration of linkages between public health and acute care.  The Draft Plan will be available online at www.dirigohealth.maine.gov on March 6th, for comments.  The Public Hearing is scheduled on March 18th and will be held at the Augusta Civic Center, Augusta Room from 8:00 am – 12 Noon.  Written comments will be accepted until March 28th

ANNUAL KIDS COUNT DATA BOOK UNVEILS: 1 in 5 Mainers under 5 in Poverty

During a Statehouse Press Conference, attended by AAP, Maine Chapter President, Donald Burgess, MD a report was released by the Maine Children’s Alliance which shows that one in five Maine children under the age of five lives in poverty, a problem made worse by a lack of federal money.   Poverty among Maine's pre-school children has reached 20%, according to the 14th Annual KIDS COUNT data book, while 17% of children under age 18 live in poverty.  There is good news in the KIDS COUNT report as well. The number of teens who are neither working nor attending school dropped from 7% to 5% in one year, while the rate of high school students attempting suicide dropped from 6% to 5% over two years.

Teens also report a reduction in their use of cigarettes, alcohol, and marijuana, continuing recent trends. Over six years, cigarette use has dropped from 25% to 14%, alcohol use from 48% to 39% and marijuana use from 27% to 22%.

Governor John Baldacci, who participated in the press conference, linked the need to do more for children with his efforts to cut administrative costs in schools and to consolidate four state natural resource agencies.

House Speaker Glenn Cummings, said “efforts to pass laws to get toxic chemicals out of toys, strengthen lead paint regulations and work toward clean air and clean water are ways the legislature is trying to help children.”

"Maine has lower than average incomes, so we're feeling the weight of continuing cuts in federal programs that serve children," said Elinor Goldberg, Maine Children's Alliance president and CEO. "While the state has tried to maintain as broad a safety net as possible for our most vulnerable children, given our budget constraints we are having a very difficult time keeping up the levels of assistance these children need." [return to top]

MMA Executive Committee Meets on Wednesday, March 5

MMA's Executive Committee, chaired by David McDermott, M.D., of Dover-Foxcroft, meets on this coming Wednesday (March 5) to consider a full agenda of both external and internal matters.  Priority items for discussion include the Physician Health Program and the Voluntary Practice Assessment Initiative.  On the internal side, members will consider a proposal for group membership for members of the Maine Academy of Family Physicians.  Externally, the members will hear an update on current legislative matters including the bill to license lay midwives (MMA is opposed) and the bill to prohibit hospitals from billing patients for care related to 27 different "never"" events.  MMA remains concerned about the language in the bill.

Proposed changes to the 2008 budget will be considered as will plans for the 155th Annual Session being held Sept. 4-7, 2008 at the Samoset Resort. 

Rounding out the meeting will be an update on Medicare payment reform and a re-structuring of the "Professionalism" Initiative.  Committee reports will also be heard from the Payor Liaison Committee, the Committee on Physician Quality, the Committee on Physician Health, the Public Health Committee, the new Senior Section, the Legislative Committee, the Operations Committee and the AMA delegation. 

Wednesday's meeting will be the first meeting of the committee since its Annual Retreat held back in mid-January.   [return to top]

Blues Outline Health Reform Goals

The Blue Cross Blue Shield Association last month unveiled a five-point health system reform proposal - the Pathway to Covering America.

The 48-page plan calls for an independent institute to conduct comparative effectiveness research on medical treatments, more incentives for better quality care, and health and wellness initiatives.  The plan is available online at http://www.bcbs.com/issues/uninsured/pathway-to-covering-america.

Anthem Blue Cross and Blue Shield of Maine is a member of the Association.  Anthem recently announced the departure of its general manager Erin Hoeflinger who will now operate the plan in Ohio.  No replacement has yet been named. [return to top]

The Power of Women: Maine Women’s Legislative Caucus HEART Luncheon

MMA staff attended the, “Go Red for Women” Legislative Caucus HEART Luncheon, held February 26th, hosted by Kim Block, WGME 13.  The American Heart Association’s national movement to make women aware of their risk of heart disease, the No. 1 cause of death among women, and take action to reduce their risk.  Brief remarks were also made by Honorary Hostesses, Senate President Beth Edmonds, Senate Majority Leaders Elizabeth Mitchell, Senate Minority Leader Carol Weston, and House Majority Leader Hannah Pingree.  The 11 minute DVD, hosted by Kim Block “Wisdom Gained from the Heart” was showcased.  This DVD features discussions by experts about CVD including signs and symptoms of heart attack and stroke and major risk factors for CVD in women, including diabetes and smoking.  Dr. Dervilla McCann, the Chief of Cardiology Services at St. Mary’s Regional Medical Center and chair of the Maine Health Cardiovascular Workgroup served as Keynote whose message of raising awareness and ensuring that women truly understand that heart disease is something to pay attention to.  Currently, only 21% of women view heart disease as a health threat.  To receive a free copy of the DVD, contact Elizabeth Foley, Chair, Maine Women and Heart Health Committee at 207-622-7566, ext 297 or email efoley@mcd.org . [return to top]

Pathways to Excellence Steering Committee Meets

The Pathways to Excellence Steering Committee met on Thursday (Feb. 28) and reviewed plans for the 2008 reporting by primary care practices.  Over forty persons attended the meeting, which was followed by a meeting of individuals working on the development of a reporting program by some of the specialties, including cardiac surgery and orthopedic surgery, among others.

Practices participating in the 2008 program will again have the opportunity to achieve blue ribbon status by completing the office system survey (for those practices who achieved Blue Ribbon Status in 2007, the status will be carried over to 2008), by reporting on diabetes process and outcomes and cardiac process and outcomes; adult practices, and immunizations and asthma process and outcomes:  pediatric practices.  Practices receiving blue ribbons for 2007 in the adult or pediatric categories will be carried over to 2008.  Practices who do not submit data to PTE, may achieve the blue ribbon status by participating in the NCQA recognition program or the Bridges to Excellence program.  (No options are currently available regarding NCQA or BTE with respect to pediatric practices.)

Attendees also heard a presentation on the Multi-Payor Pilot for the Patient Centered Medical Home.  Quality Counts, the Maine Quality Forum, and the Maine Health Management Coalition have developed a proposal to lead a multi-stakeholder effort to develop, implement, and evaluate a Maine Multi-payer Pilot of the Patient Centered Medical Home model, as the first step in achieving the goal of statewide implementation of a patient centered medical home model throughout the state.  Following a 6 month planning period, the group hopes to launch a 3-year pilot to implement the PCMH model with 5-10 primary care practices from across the state. 

The effort will seek to engage all major private and public payers in the state to support this pilot, and to provide an alternative reimbursement model to practices that recognizes the infrastructure and system investments needed to deliver care in accordance with the PCMH model and rewards practices for demonstrating high quality and efficient care.  The pilot will be evaluated using a comprehensive approach that includes nationally recognized measures of quality, efficiency, and patient-centered measures of care that reflect the six aims of quality care identified by the Institute of Medicine (i.e. safe, effective, timely, efficient, equitable, and patient-centered care).

The proposal has been developed by an ad hoc planning  group led by Quality Counts (Lisa Letourneau, M.D., MPH),; the Maine Quality Forum (Josh Cutler, M.D., Jim Leonard); the Maine Health Management Coalition (Doug Libby, Ted Rooney)); MaineCare (Rod Prior, M.D); Anthem BCBS of Maine (Jeff Holmstron, D.O.), and Martins Point Health Care (David Howes, M.D. ).

Questions or comments regarding the Pilot should be directed to Lisa Letourneau, M.D. at lmlmd@maine.rr.com[return to top]

Quality Counts Board Holds Strategic Planning Retreat

The Board of Quality Counts! "retreated' to the Maple Hill Farm and Conference Center in Hallowell on this past Friday to conduct a periodic Strategic Planning Meeting.  The discussion was facilitated by Jim Kupel of Crescendo Marketing in Portland. 

Quality Counts! is a regional healthcare improvement alliance working collaboratively across the state of Maine to achieve the following mission:

       Quality Counts is committed to working together across organizations and across communities to improve healthcare systems and outcomes with the people of Maine.  Quality Counts! will coordinate existing but disparate efforts across the state that support local, patient centered, and coordinated systems of care AND the resources that support them.  Its goals are to promote consistent delivery of high quality care, improve health status, improve access to healthcare, and contain healthcare costs.

Strategic questions addressed during the day-long retreat included:

  •      What is the appropriate business model.
  •      What are the core capabilities.
  •      Who are the QC customers and what are the QC product lines/key functions.
  •      Where are the short-term wins.
  •      What does the business model imply about QC governance and staff roles.

Following the day's discussion, the Board members participating agreed that the organization has a bright future and many important tasks to accomplish, in order to advance its mission.  MMA is a member of Quality Counts and is represented on its Executive Committee. [return to top]

Political Pulse: Legislative Highlights of the Week

1.  Governor's Supplemental Budget, L.D. 2173 

Following a new revenue forecast last week, the Appropriations Committee now faces a budget shortfall that has doubled to more than $200 million.  The Committee expects to receive the Governor's plan to address this shortfall some time this week.  A new series of public hearings on the revised plan may be scheduled during the week of March 10th.  Among the many health and social service spending cuts of concern to the MMA are the $20 million reduction in reimbursement to hospital-based physicians and a new $3 million cut anticipated in graduate medical education.  

The MMA urges you to contact members of the Appropriations and HHS Committees about these items.

Joint Standing Committee on Appropriations & Financial Affairs:  http://janus.state.me.us/house/jt_com/afa.htm.

Joint Standing Committee on Health & Human Services:  http://janus.state.me.us/house/jt_com/hum.htm.

2.  BRED Committee to Consider Staff Report on Licensure of Lay Midwifery on Tuesday

After scheduling problems prevented presentation of the report last week, the Business, Research & Economic Development Committee will receive a report recommending against licensure of lay midwives on Tuesday, March 4, 2008.  The presentation of the report and work session on L.D. 1827 will take place about 1:30 p.m. following a work session on another bill.  In addition to the MMA, professional societies representing pediatricians, OB/GYNs,.and family physicians have opposed licensure.  Proponents of licensure have argued that a licensing framework is necessary not to protect the public, but to give these practitioners legitimacy.

You can find the report from the Department of Professional & Financial Regulation on the web at:  http://mainegov-images.informe.org/pfr/legislative/documents/MidwivesSunriseReviewReport.pdf.

If you would like to communicate with members of the Business, Research & Economic Development Committee, you can find them on the web at:  http://janus.state.me.us/house/jt_com/bec.htm.

3.  HHS Committee Considers Bill Prohibiting Payment for So-Called "Never Events" 

The HHS Committee held a public hearing last Tuesday and has scheduled a work session for tomorrow afternoon on L.D. 2044, An Act to Prohibit Payment to Health Care Facilities for Treatment to Correct Mistakes or Preventable Adverse Events.  The Maine Hospital Association had been negotiating with prime sponsor Rep. Patsy Crockett (D-Augusta) and Rep. Crockett had agreed to the following language in place of the original bill.

 An Act To Prohibit Payment to Health Care Facilities Hospitals from Charging for Treatment To Correct Medical Mistakes or Preventable Adverse Events

Be it enacted by the People of the State of Maine as follows:

Sec. 1. 22 MRSA §1721  is enacted to read:

§ 1721.  Prohibition on payment charging for health care facility mistakes or preventable adverse events

1.  Definitions.     As used in this section, unless the context otherwise indicates, the following terms have the following meanings.

A.  “Health care facility” means a hospital or ambulatory surgical center licensed under chapter 405.

B.  “Mistake or preventable adverse event” means any of the following events that is within the health care facility’s control to avoid includes but is not limited to:

(1) Surgery performed on the wrong body part;

(2) Surgery performed on the wrong patient;

(3) The wrong surgical procedure performed on a patient;

(4) Unintended Retention of a foreign object in a patient after surgery or another procedure;

(5) Intraoperative or immediately postoperative preventable death of a patient classified as a normal healthy patient under guidelines published by a national association of anesthesiologists;

(6) Patient death or serious disability associated with caused by the use of contaminated drugs, devices or biologics provided by a hospital or ambulatory surgical center;

(7) Patient death or serious disability associated with caused by the use or function of a device in patient care in which the device is used for functions other than as intended;

(8) Patient death or serious disability associated with caused by an intravascular air embolism that occurs while being cared for in a health care facility;

(9) An infant’s being discharged to the wrong person;

(10) Patient death or serious disability associated with caused by a patient’s elopement for more than 4 hours;

(11) Patient suicide or attempted suicide resulting in serious disability while being cared for in a health care facility;

(12) Patient death or serious disability associated with caused by a medication error such as an error involving the wrong drug, wrong dose, wrong patient, wrong time, wrong rate, wrong preparation or wrong route of administration;

(13) Patient death or serious disability associated with caused by a hemolytic reaction due to the administration of incompatible blood or blood products;

(14) Maternal death or serious disability associated with caused by labor or delivery in a low-risk pregnancy, labor and delivery while being cared for in a health care facility;

(15) Patient death or serious disability associated with caused by hypoglycemia, the onset of which occurs while the patient is being cared for in a health care facility;

(16) Death or serious disability associated with caused by failure to identify and treat hyperbilirubinemia in neonates prior to discharge;

(17) Stage 3 or 4 pressure ulcers acquired after admission to a health care facility;

(18) Patient death or serious disability due to spinal manipulative therapy;

(19) Patient death or serious disability associated with caused by an electric shock while being cared for in a health care facility;

(20) Any incident in which a line designated for oxygen or other gas to be delivered to a patient contains the wrong gas or is contaminated by toxic substances;

(21) Patient death or serious disability associated with caused by a burn incurred from any source while being cared for in a health care facility;

(22) Patient death associated with caused by a fall by a patient who was or should have been identified as requiring precautions due to risk of falling while being cared for in a health care facility;

(23) Patient death or serious disability associated with caused by the use of restraints or bedrails while being cared for in a health care facility;

(24) Any instance of care ordered by or provided by someone impersonating a physician, nurse, pharmacist or other licensed health care provider;

(25) Abduction of a patient of any age;

(26) Sexual assault of a patient within or on the grounds of a health care facility; and

(27) Death or significant injury of a patient or staff member resulting from a physical assault that occurs within or on the grounds of a health care facility.

2.  Prohibition.     A health care facility is prohibited from knowingly charging a patient or the patient’s insurer for health care services it provided as a result of or to correct a mistake or preventable adverse event caused by that health care facility a mistake or preventable adverse event committed while the patient is in the care of that health care facility or for the care provided by that health care facility to correct the mistake or preventable adverse event.

The bill drew significant interest from legislators with Reps. Patsy Crockett (D-Augusta), John Brautigam (D-Falmouth), Marilyn Canavan (D-Waterville), and Sharon Treat (D-Hallowell) all speaking in favor of the bill.  The MHA also spoke in favor of the bill.  There was no opposition, but Trish Riley from the Governor's Office of Health Policy & Finance spoke "neither for nor against" it.  The MMA submitted testimony "neither for nor against" the bill, but raised concerns about the scope of the list of events and the scope of the prohibition on non-payment. 

The key provisions of the MMA testimony are: 

           The MMA takes a “neither for nor against” position on the amended version of L.D. 2044 presented to you today.  While we concur that no payment for “mistakes or preventable adverse events” is the appropriate legal and ethical standard, we see reason for caution in implementing such a law because of the potential unintended consequences of aggressive implementation of it. 

            We acknowledge the sponsors of the bill for their commitment to patient safety and thank them for being responsive to the concerns raised by the Maine Hospital Association in revising the original bill.

            As you enter your work sessions on L.D. 2044, please consider the following concerns of the medical community:

  1. Is the list of “mistakes or preventable adverse events” in the proposed §1721(1)(B) appropriate.  The members of the MMA Legislative Committee who recently reviewed the revised list believe that the items in subsections (1), (2), (3), (4), (6), (7), (9), (12), (13), (19), (20), (21), and (24) are appropriate for the proposed law.  They were considerably less comfortable with the following subsections because none of the procedures involved may be reduced to zero risk:  subsections (5), (8), (14), (15), (16), (17), and (18).  Finally, they felt that in a majority of situations the following events would not be preventable by facility staff:  subsections (10), (11), (25), (26), and (27).  As Dr. Wachter points out in the January 7, 2008 article mentioned above, “never events such as pressure ulcers or patient falls are not always preventable and ‘there will be lots of unintended consequences and challenges in the implementation phase that should push us to go slowly with a small number of events.”  (emphasis supplied)
  2. Is there an appropriate limit to the extent of follow up treatment without payment?  As drafted, the bill would hold the health care facility responsible for unlimited follow up care without payment forever.  Without doubt disputes will arise regarding the relationship of requested treatment in the future to some prior “mistake or preventable adverse event.”  Should this bill provide some “bright line” limit, such as a certain amount of time following an incident, or should it include a dispute resolution mechanism? 

These are just two examples of the challenges we will face in implementing L.D. 2044.

The MMA urges you to contact members of the HHS Committee to ask them to consider narrowing the list of "mistakes or preventable adverse events" in accordance with the MMA testimony.

Joint Standing Committee on Health & Human Services:  http://janus.state.me.us/house/jt_com/hum.htm.

4.  Public Health Update: Chemicals in Products Subject of Public Hearing Last Week in Natural Resources Committee.  A Public Health Committee priority for 2008.

During a three and one-half hour long hearing, the MMA’s Public Health Committee joined several other supporters testifying in support of two bills protecting children by adopting new disclosure rules for toxic chemicals in household products.  Dr. Lani Graham represented the MMA Public Health Committee, along with the AAP, Maine Chapter, in support of creating a list of chemicals in consumer products that have been found to cause cancer or hormonal imbalances that interfere with development.  (A copy of her testimony can be located on the MMA Website at www.mainemed.com)  Manufacturers would have to notify the state if products sold here contain the listed chemicals, and state officials could ultimately ban them.  Those in opposition to the bills included the Maine State Chamber of Commerce and representatives of chemical and product manufacturers. The two bills were called L.D. 2048, An Act to Protect Children’s Health and the Environment from Toxic Chemicals in Toys and Children’s Products and, L.D. 2210, An Act to Promote the Use of Safer Chemicals in Consumer Products.

Global climate change is the greatest environmental threat of our generation.  This past week, the Natural Resources Committee heard a bill to take immediate action to dramatically reduce greenhouse gas emissions.  Dr. Norma Dreyfus, member of the Maine Medical Association’s Public Health Committee testified in support of L.D. 2126, An Act to Minimize Carbon Dioxide Emissions from new Coal-Powered Industrial and Electrical Generating Facilities in Maine.  Dr. Dreyfus indicated that, “[c]limate change threatens the health, welfare, and future of current and subsequent generations of children.  Governments at all levels should implement aggressive policies to halt man-made contributions to climate change to mitigate its impact on children’s health.”  The American Academy of Pediatrics issued a policy statement this past November on Global Climate Change and Children’s health, and can be found at http://pediatrics.aappublications.org/cgi/content/abstract/120/5/1149 .  A copy of Dr. Dreyfus’s testimony will be posted on the MMA Website.

5.  More than 20 People Testify on Bill to Repeal the Capital Investment Fund

On Tuesday, February 26, 2008, the HHS Committee also conducted a lengthy public hearing on L.D. 2152, An Act to Ensure Access to Necessary Health Care Services in Maine by Repealing the Capital Investment Fund.  The Maine Hospital Association and a number of hospital representatives spoke in favor of the bill.  Representatives of EMMC, CMMC, and St. Mary's all participated in the hearing along with contractors and contractors' associations.  Representatives of the Advisory Council on Health Systems Development, BIW, UNUM, the Maine State Chamber of Commerce, the Governor's Office of Health Policy & Finance, and Consumers for Affordable Health Care spoke in opposition to the bill.  Opponents acknowledged problems with the administration of the CIF, but argued that it is too important a cost containment tool to eliminate it.  The Committee plans a work session on the bill for tomorrow afternoon.

6.  HHS Committee Hears Two Bills on Lead Poisoning

On Friday, February 29, 2008, the HHS Committee held a public hearing on L.D. 2053, An Act to Ensure that Children's Toys and Products are Free of Lead and L.D. 2172, An Act to Protect Children from Lead Poisoning.  L.D. 2053 would restrict the sale or distribution of a lead-containing children's product in this state, including a toy, child care article, lunch box, or children's jewelry.  L.D. 2172 would require a blood lead level assessment for all children from age one through 5 and would require certification of an assessment to enter school.  The MMA and the Maine Chapter of the American Academy of Pediatrics joined Maine CDC Director Dora Ann Mills, M.D., M.P.H. in opposition to L.D. 2172.  Both Dr. Mills and the MMA raised concerns about various obstacles to screening and blood draws in the primary care setting.  The bill is scheduled for work session this Friday.

7.  More Legislative Information

Please remember that you can find more legislative information, including the legislative history search tool, on the web at:  http://janus.state.me.us/legis/

You can leave a message for Senators at the State House by calling toll free 1-800-423-6900.

You can leave a message for Representatives at the State House by calling toll free 1-800-423-2900
[return to top]

Hanley Center Seeking Nominations for Second Health Leadership Development Class

The Daniel Hanley Center for Health Leadership is seeking its second class of participants in its Health Leadership Development course.  The inaugural HLD class is quickly coming to a close with just two more sessions left in March and April.  The current class has nominated more than fifty (50) prospective candidates but the Hanley Center is anxious to have as large a recruitment pool as possible for the second year of this program, which is partnered with the Portland-based Institute for Civic Leadership.

The Hanley Center website at www.hanleyleadership.org  contains a fact sheet describing the range of individuals for whom the course has been designed and a nomination form that can be quickly completed and returned to the Center.  It is hoped that most of the nominees will be identified by the end of this week. 

Questions about the program may be directed to James Harnar, Executive Director of the Center at 523-1501 or via e-mail to jharnar@maine.rr.com

The Maine Medical Association remains an enthusiastic supporter of the Hanley Center and its programs.  The Center has truly become a lasting legacy of Dr. Hanley and his leadership which included serving as Executive Director of MMA from approximately 1955 until his retirement in l979. [return to top]

Maine HFMA Presents 10th Annual Behavioral Health Summit, March 14, 2008

The10th Annual Healthcare Financial Management Association (HFMA) Behavioral Health Summit will be March 10, 2008, at the Augusta Civic Center in Augusta, Maine.

As MaineCare begins its move to managed care, behavioral health providers will need to prepare their programs and their management systems for this new era.

The 10th Annual HFMA Behavioral Health Summit will focus on important developments in Maine's behavioral health sector:

  • MaineCare's move to managed care
  • State budget challenges
  • commercial payors seeking continued cost savings
  • increasing trends toward self-funding (exempt from state benefit mandates)
  • growing focus on the need to integrate Primary Care/Medical Care with Behavioral Care

For more information, and to register, visit the hfma website [return to top]

MMC 6th Annual Perinatal Conference, May 1 in South Portland

On Thursday, May 1st, Maine Medical Center's 6th Annual Perinatal Conference will be held at the University of Southern Maine in Portland.  This year's topic is Perinatal Mood and Anxiety Disorders, including postpartum depression.  The featured speaker is Dr. Jeanne Watson Driscoll, PhD, APRN, BC.  This program is approved for both nursing and medicine continuing education credits.  For more information contact Beth Turner at 662-2696 or by e-mail at turneb@mmc.org [return to top]

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