Maines Acting Insurance Superintendent, Eric Cioppa, ruled last Monday (17 September) that the Dirigo Health Program saved the health care system $32.8 million in its third year of operation; roughly only one-third of the original $92.7 million savings estimate released on 8 July 2007.

Despite Karynlee Harrington, executive director of the Dirigo Health Agency, previously stating in the _Portland Press Herald_ that the agency had refined the methodology used to determine the savings amount based on past decisions of the superintendent, it appears the agency needs a new mathmagician in accounting.

On 27 July, the Dirigo Health Board of Director had reduced the estimated $92.7 million to $78.1 million. The September 17 ruling of $32.8 million is the lowest savings figure, to date, in the agencys short, but beleaguered history; a possible indication that the agency has lost its steam. Last years savings were $34.2 million and the first year savings were ruled to be $43.7 million.

Of the $32.8 million, Cioppa found that the program provided $25 million in hospital savings, $6.3 million in uninsured and under-insured initiatives, and $1.5 million in provider fee savings. The savings form the basis of the Savings Offset Payment (SOP), the sole funding mechanism for the program.

At a Dirigo Board meeting held after Cioppas ruling, members discussed the possibility that the decrease in funding may result in the elimination of the subsidies currently paid to a majority of DirigoChoice program participants.

The Maine Dirigo Health program was established in 2003. Dirigo stopped accepting new enrollees July 1, 2007.■

I have to apologize for the abrupt shortage of articles in August, but the month was an absolute flurry of activity, behind the scenes.

In addition to maintaining _BLOG Medicine_, we operate a parent company (Maynard & Company) that provides healthcare consulting and management services. Thanks to the steady increase in clients throughout New England, the services provided through Maynard & Company have transitioned to a new entity called Origin Health Group, recently taking on clients in the additional regions of the Mid-Atlantic and Deep South. The stretch goal for 2008 is for Origin Health Group to have a presence coast-to-coast.

Also, after 11 months of brainstorming and hard work, weve created MedBay, the on-line auction community for healthcare equipment and services. MedBay is wrapping up testing and is targeted for general release October 1. Given the heightened awareness about health insurance and reform, MedBay will provide the ideal community mix for patient, provider, and purchaser. I think MedBay will offer an exciting and attractive alternative to the current more restrictive and cost-prohibitive approach to paying for healthcare. Well be providing more information over the next few weeks as we approach our "go-live" date.

Finally, _BLOG Medicine_ is evolving. Over the next few months, _BLOG Medicine_ will integrate into a larger blog platform that will include a mix of topics written by contributors from throughout the blogosphere. Although my dedication hasnt changed, due to the other time commitments, my _BLOG Medicine_ entries will now be biweekly on Mondays and Thursdays. Bloggers interested in contributing to _BLOG Medicine_ and/or the larger platform (including suggesting a name for it) are welcome to comment/contact me here.

Exciting times, indeed. Expect _BLOG Medicine_ to be back on schedule (and topic) with todays submission and watch for appropriate updates regarding MedBay over the coming weeks and [_Insert New Blog Platform Name Here_] over the coming months. As always, Id like to thank the readers of _BLOG Medicine_ and especially those who have taken the time to comment -- were nothing without you.■

The Saturday, 4 August 2007 New Orleans _Advocate_ reported that while the city is still facing the same significant healthcare needs and large racial disparities in health that existed prior to 2005s Hurricane Katrina, the storms also had a leveling affect across many health access and utilization measures, creating new access to care barriers for many still living in the region.

The basis for the article is the recently released report by the Kaiser Family Foundation, "Health Challenges for the People of New Orleans," that acknowledged that Katrina has made life more difficult for everyone in the area.

The Kaiser report is the result of a door-to-door survey of 1,500 residents in Orleans, Jefferson, St. Bernard, and Plaquemines parishes in Fall 2006.■

With no new enrollment as of July 1 and stated savings estimates and membership numbers gyrating up and down faster than a turkey trot, one has to wonder if Maines Dirigo Health is made up of con artists, liars, and thieves or if they actually believe their mathmagical accounting.

On 8 July 2007, Dirigo Health released a 2006 estimated savings amount of $92.7 million. By Friday, 27 July Maines Dirigo Health Board of Directors had reduced the amount they claim the Dirigo Health program has saved the states healthcare system in 2006 to $78 million, still more than twice the amount determined in 2005 that required a ruling by the State Supreme Court to be settled. The recently reduced $78 million figure will now be submitted to the state superintendent of insurance, who has historically reached a lower number than the board, for final determination.

Karynlee Harrington, executive director of the Dirigo Health Agency, was quoted in the _Portland Press Herald_ stating that the agency has refined the methodology used to determine the savings amount based on past decisions of the superintendent seemingly oblivious as to why it should be objectionable that Dirigos accounting methodologies are changeable, year-to-year and seem to conveniently eliminate Dirigos earlier cost concerns. However, not only do Dirigos accounting methodologies change based on the needs of the day, but the membership numbers experience dramatic unexplained leaps, as well.

On 1 July 2007, when Dirigo stopped accepting new enrollees stating cost concerns, they quoted membership of 14,400, many of whom already had insurance and less than half of the 31,000 Dirigo said they would cover in 2003 and nowhere near the 130,000 Dirigo forecast for coverage by 2009. By 28 July 2007, only 27-days after halting enrollment, Dirigo mathmagically claims 26,000 Maine residents have been helped.

For their part, as expected, Maine insurance carriers plan to dispute the boards figures, adding that its a conflict of interest for the Dirigo board to make a determination on savings that will translate into income for its program.

Dirigos annual attempt to be more than just another failed attempt at healthcare reform with lingering delusions of grandeur is similar, in its own way, to the frivolousness, fantasy, and mathmagical fiction that might be found in a Harry Potter book -- too bad, unlike JK Rowling, Dirigo doesnt know when to end the fairy tale.■

For the second time in ten years, Lifespan and Care New England, Rhode Islands two large health systems, plan to merge into a single entity to be called Lifespan.

In 1998, the two entities applied for regulatory approvals needed to merge, but pulled their applications in 2000. If allowed to combine, the resulting entity will control nearly three-fourths of Rhode Islands hospital system.

Lifespan President and CEO George Vecchione expects _this_ regulatory process to only take six to nine months and for the merger to result in some efficiencies, specifically in central-office operations and alignment of system-wide services, but without substantial job cuts.

According to Lifespan, clinical enhancements that would occur under the merger include:

* Butler Hospital will create the state’s first Brain Sciences Institute, which will support research, education and behavioral health treatment. In addition, the Butler campus would be sold or otherwise developed to fund a new Butler Hospital facility on or near the RIH campus * Kent Hospital will apply to become a level II trauma center and will also seek to create an emergency medicine residency program. Together, these improvements will enhance statewide disaster responsiveness * Women & Infants will retain its leadership role in neonatal and women’s reproductive health. There will also be a greater opportunity to develop services for conditions that disproportionately affect women and to maximize Women & Infants’ referral network and strong regional presence * Continuation of Care New England’s VNA under the Lifespan system Mixed responses to the merger plans include Rhode Island Governor Donald L. Carcieri (R-RI) who notes that the creation "of such a dominant healthcare network" raises "a number of important concerns" and Lt. Governor Elizabeth H. Roberts, who states that she will "advocate for a focus on the core mission of hospitals to serve the public and recognize the importance of this proposal’s potential for economic growth in the state.”■

At the request of Governor Deval L. Patrick (D-MA), the states largest health insurer, Blue Cross and Blue Shield of Massachusetts, scrapped a new policy that would have allowed owners of small businesses to contribute just one-third of the cost of their employees health plan premiums. Blue Cross is the states largest health insurer with about 3 million members.

Prior to 1 July, Blue Cross required a minimum 50 percent contribution to premiums from employers with 50 or fewer workers. The average contribution by Massachusetts employers is about 75 percent.

On 1 July, Massachusettss healthcare reform law took effect, under which, if a company does not offer health insurance, low income works can receive subsidized coverage under the states Commonwealth Care plan. They are ineligible for assistance, however, if their employer offers a company health plan, regardless of the companys contribution to premiums.

Companys not offering health insurance to their employees or contributing less than what the state deems "fair and reasonable" toward their employees health plan premiums are required to pay an annual fee of $295 per employee.

Harvard Pilgrim Health Care, the states second largest health insurer with about 1 million members, has said that the insurer will retain its 50 percent contribution after earlier reviewing its policies as a result of Blue Crosss lowering its minimum contribution to 33 percent.■

The American Medical Association (AMA) must once again don its armor, this time preparing to go to battle on behalf of its approximately 240,000 members over pending cuts to Medicare reimbursement. Physicians received below-inflation updates in 2004 and 2005 and zero percent updates in 2006 and 2007.

Without congressional action, Medicare physician payment rates will be reduced 10 percent effective 1 January 2008. By 2016, the cuts will total about 40 percent, while practice costs are expected to increase by 20 percent.

In addition to steep pay cuts, the AMA charges that the Medicare physician payment update formula:

* has kept average 2007 Medicare physician payment rates about the same as they were in 2001 * prevents physicians from making needed investments in staff and health information technology to support quality measurement * punishes physicians for participating in initiatives that encourage greater use of preventive care in order to reduce hospitalizations * has led to a severe shortfalls in Medicare’s budget for physician services that have driven Congress to enact short-term interventions with funding methods that have increased both the duration of cuts, as well as the cost of a long-term solution * hurts access to care for America’s military families, has payment rates in the Department of Defense’s TRICARE program are tied to Medicare rates An AMA Physician Payment Action Kit is available for more information and the AMA Physician Grassroots Network to receive updates on physician payment rate legislation.

The impacts of Medicare physician payment cuts in New England are significant:

* New England physicians will lose $306 million for the care of elderly and disabled patients in 2008 due to the 10 percent cut in Medicare payments beginning 1 January. The regions physicians will lose $12.1 billion for the care of elderly and disabled patient by 2016 due to eight years of cuts * 149,461 employees, 2,007,382 Medicare patients and 234,343 TRICARE patients in New England will be affected by these cuts * 42 percent of New Englands practicing physicians are over 50, an age at which surveys have shown many physicians consider reducing their patient care activities

CT

ME

MA

NH

RI

VT

LOSSES IN 2008

$92 million

$27 million

$137 million

$22 million

$18 million

$10 million

LOSSES BY 2016

$3.7 billion

$1 billion

$5.4 billion

$860 million

$720 million

$380 million

AFFECTED:

EMPLOYEES

39,803

13,671

63,187

14,144

11,613

7,043

MEDICARE PATIENTS

485,970

220,081

884,894

170,937

155,540

89,960

TRICARE PATIENTS

51,403

46,849

70,159

28,786

24,818

12,328

PHYSICIANS AGED 50+

42%

46%

38%

43%

37%

43%

* Compared to the rest of the country, Connecticut, Massachusetts, Rhode Island, and Vermont, each at 14%, has an above-average proportion of Medicare patients * Compared to the rest of the country, Maine, at 17%, has the second highest proportion of Medicare patients and, at 17 practicing physicians per 1,000 beneficiaries, has a below-average ratio of physicians to Medicare beneficiaries, even before the cuts take effect * In 2008, on top of the 10 percent cuts across the country, the "Southern Maine" Medicare payment area faces cuts of an additional 1.1 percent, the "Rest of Maine" Medicare payment area faces cuts of 2.1 percent; New Hampshire faces cuts of an additional 1 percent; and, Vermont faces cuts of an additional 1.7 percent Countering the congressional inaction and the resulting 10 percent rate cut, the AMA is advocating a 1.7 percent increase in reimbursement in 2008, in line with the estimated practice cost increase; long-term, the AMA wants Congress to create a new reimbursement formula.

Over-stepping their role as a payment mechanism and forgetting that theyre not actually providers of medical care, the talking-heads of the health insurance industry charge that physicians are partly to blame, contributing to costs by ordering unnecessary and expensive services. Mohite Ghose, spokesman for the insurance trade association, Americas Health Insurance Plans, was even disingenuous enough to question whether physicians are always providing "appropriate services at the right setting at the right time."

_BLOG Medicine_ must concur with the AMAs statement that, "utilization of physician services is not the cause of the Medicare programs financial predicament, and cuts in physician payment rates are not the way to improve Medicares financial sustainability." Congress needs to bring up the house-lights and call a close to this "annual dance of death" -- its time to pay the piper.■

On Tuesday, 17 July, Governor John Baldacci (D-ME), joined by the states legislative Democrats, signed into law 18 new health care bills meant to protect the health and welfare of the people of Maine.

You couldnt see the rose-colored glasses on his face, but Baldaccis "Pollyanna" was definitely showing in his prepared statement: "What all these have in common is that they provide further evidence that Maine is the leader in health care reform and in efforts to expand access to quality, affordable health care."

Maine, already heavily burdened with healthcare legislation, has added laws that require health insurers to extend coverage to policy-holders adult children until age 25, to require health insurers to cover hearing aides, to prohibit advertising of prescription drugs on software sold in Maine, to ensure sterile supplies for needle exchange programs, and to regulate access and screening for HIV and cancer.

Increasing health care costs, postpartum depression, eating disorders, and the role of dental hygienists are all to be reviewed by study groups. November will be Lung Awareness Month, Free Health Clinics will have lower taxes and, disturbingly, despite widely being viewed as an expensive failure and having stopped accepting new enrollees as of 1 July due to cost concerns, Dirigo Health will now be allowed the even more expensive proposition of self-insurance.

Noticeably absent from Tuesdays "Glad Game" shenanigans was a resolution for the much-needed reform to MaineCare, Maines overloaded and very broken Medicaid program and a new, functional, self-supporting funding-mechanism for Dirigo Health.

The Maine Legislative Documents signed into new law include:

LD 4 -- An Act to Amend the Prescription Privacy Law

LD 101 -- An Act to Enhance Screening for Breast Cancer

LD 144 -- An Act to Support Maines Free Clinics

LD 243 -- An Act to Establish November as Lung Cancer Awareness Month

LD 429 -- An Act to Improve Access to HIV Testing in Health Care Settings

LD 431 -- An Act to Enable the Dirigo Health Program to be Self-Administered

LD 792 -- An Act Concerning Postpartum Mental Health Education

LD 807 -- An Act to Prevent Overcharging for Prescription Drug Copayments

LD 839 -- An Act to Establish a Prescription Drug Academic Detailing Program

LD 841 -- An Act to Extend Health Insurance Coverage for Dependent Children up to 25-Years of Age

LD 995 -- An Act to Reduce the Expense of Health Care Treatment and Protect the Health of Maine Citizens by Providing Early Screening, Detection and Prevention of Cancer

LD 1044 -- An Act to Address Eating Disorders in Maine

LD 1129 -- An Act to Increase Access to Oral Health Care

LD 1440 -- An Act to Prohibit Inappropriate Software Advertising of Prescription Drugs

LD 1514 -- An Act to Require Health Insurance Coverage for Hearing Aides

LD 1786 -- An Act to Reduce the Spread of Infectious Disease through Shared Hypodermic Apparatuses

LD 1812 -- Resolve, Regarding the Role of Local Regions in Maines Emerging Public Health Infrastructure

LD 1849 -- An Act to Protect Consumers from Rising Health Care Costs.■

Weve all experienced it -- calling customer service only to be put on never-ending hold, or, worse, having to listen to the numerous prompts, pressing all the appropriate keys only to be disconnected.

Paul English, founder of Gethuman.com, figured out a better way. He and his core group of supporters tracked down and have published the shortcuts that cut out the computerized telephone middle-man and get you to a human operator.

Englishs site allows you to jump to specific categories (e.g., Insurance) as well as sort individually through the more than 500 companies to find both toll-free telephone numbers and the shortcuts that get you off hold and connected to a live person. The site also has a link if you prefer a printer-friendly format rather than electronic version of the information.

In a corporate world dominated by impersonal, unhelpful, computerized interactive voice response, Englishs site is much-needed relief for an all-too-human frustration.■

According to March 2007 data released by the U.S. Bureau of Labor and Statistics, among the four regions of the United States, the average cost per hour to employers for health insurance benefits ranges from $1.59 to $2.04.

The Compensation Cost Trends program reports that the proportion of total compensation represented by health benefits was 6.7 percent in the West, 6.9 percent in the South and Northeast, and 7.8 percent in the Midwest.

Nationwide, the average cost for health benefits was $1.83 per hour worked, accounting for 7.1 percent of total compensation.■