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Maine universal health care plan could burden physicians; state to collect quality data.

A universal health care plan that promises to cover Maine's uninsured in 5 years could mean added hassles for physicians.

They'll have to be more prudent about divulging medical records, disclosing charges to patients, and submitting claims under this ambitious program, Gordon Smith, executive vice president of the Maine Medical Association, told this newspaper.

The Maine legislature in June approved the nation's first universal health plan with a goal to cover the state's 180,000 uninsured citizens by 2009. The public-private insurance program, known as "Dirigo Health," will offer low-cost health plans to individuals, small businesses, and the self-employed through private insurance carriers. "Dirigo," part of Maine's motto, means "I direct" in Latin.

MaineCare, the state's Medicaid program, will be expanded to cover more low-income adults and children. Those with incomes below 300% of the federal poverty level are eligible for health care subsidies on a sliding scale based on ability to pay. The program would be supplemented by federal grants, federal Medicaid funds, and payments by subscribers and participating businesses. The state also expects to save $80 million annually by eliminating unreimbursed care for the uninsured.

The new plan isn't without its perks--it includes $500,000 to increase the physician incentive program within MaineCare--but some of the provisions have physicians worried, Mr. Smith said.

One provision requires physicians to submit claims electronically through the use of standardized forms. It also allows carriers to reject claims that are not submitted electronically. But the law does contain waivers and exceptions for offices with fewer than 10 staff, something that could soften the blow for rural offices that don't have ready access.

Physicians are especially nervous about a provision that allows the Maine Health Data Organization to collect quality data from their offices--something that's never been permitted before. There are concerns about the onerous administrative burdens and potential costs that are associated with this audit. "Doctors' offices that don't have electronic records may have to hire a new person to pull out each record and assess what the data organization is looking for," Mr. Smith said. It's unknown what type of data the organization will be looking for--and whether the data might get published somewhere.

If the patient requests it, health care practitioners also will be required to notify patients in writing of charges for commonly offered health care services and to assist the patient in calculating the amount of his or her copay. While this could be a hassle, it has a trade-off: The patient won't be as isolated from the cost and value of these services, Mr. Smith said. The hope is that this will produce more educated health care consumers.

As a cost-containment issue, physician practices were asked to voluntarily hold annual increases in profit to 3%, but this is not expected to have much of an impact, "since physician revenues and salaries have been flat for several years," he said.
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Author:Silverman, Jennifer
Publication:Internal Medicine News
Geographic Code:1U1ME
Date:Aug 1, 2003
Words:482
Previous Article:Uninsured cost up to $130 billion annually: Institute of Medicine study.
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