Health care panel suggests cost cuts

Posted March 29, 2009, at 7:17 p.m.

AUGUSTA, Maine — Drawing from a number of recent studies and surveys, a health care panel is preparing policy recommendations aimed at reducing the cost of providing health care services in Maine.

The Advisory Council on Health Systems Development met Friday at the Cross State Office Building to review and take public comment on a new report and 10 recommendations, which will be fine-tuned and presented to the state Legislature by mid-April.

According to the cost driver report, Maine has the second-highest per-person medical spending in the nation — 24 percent higher than the national average and second only to Massachusetts. The difference is only partially attributable to the state’s aging population. Health insurance premiums paid by Maine employers also cost more than the U.S. average.

The report attributes the higher spending to several factors, including greater consumer demand for health care; high fees charged by doctors, hospitals and other providers; an elevated rate of chronic illness such as diabetes, lung disease and heart disease; a rate of emergency room use 30 percent higher than the national average; and unjustifiable variations and inefficiencies in the amount and quality of care provided from one provider to another and in different geographic areas of the state.

Among the draft recommendations reviewed at Friday’s meeting:

· Allow Maine businesses to offer their insured employees financial incentives to seek care from providers that have demonstrated a high level of quality. This “tiering” of medical providers drew criticism from Gordon Smith of the Maine Medical Association, who cautioned the practice could be considered defamatory and libelous.

· Make use of federal economic stimulus funds to expand Maine’s public health system with an emphasis on disease prevention and healthful lifestyles.

· Provide financial support to expand Maine’s Health InfoNet, a statewide electronic system for sharing essential medical data between health care providers, aimed at reducing unnecessary testing, drug errors and other costly and potentially dangerous inefficiencies. Health InfoNet is entering the second phase of a two-year pilot program and is expected to “go live” with data-sharing in June.

· Build Maine’s primary care provider system — family doctors, for example — by supporting the Patient Centered Medical Home model, which provides closer management of patients both in and out of the medical office. The sticking point in adopting the model is the current reimbursement system, which pays doctors for performing medical procedures rather than for spending time counseling and educating their patients.

· Expand the authority of the state’s Certificate of Need office to regulate a broader range of health care spending. David Winslow of the Maine Hospital Association said current CON regulation is effective at controlling capital investments in Maine’s health care system, but expanding that authority would be counterproductive.

· Continue studying emergency room use and reduce visits by expanding the hours of primary care practices, requiring insurance companies to offer telephone screening to divert inappropriate emergency visits and expanding access to clinics in public schools.

· Expand public reporting of insurance industry information, including clarification of health policy benefits, premium increases and other factors of interest to consumers and regulators.

The Advisory Council on Health Systems Development, created by the Dirigo Health Reform Act of 2004, is expected to submit the report and final recommendations to lawmakers on the Health and Human Services Committee and the Insurance and Financial Services Committee by mid-April.

On the Web: www.maine.gov/gohpf

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