Maine Hospital Association,

Testimony of David Winslow,
Vice-President, Maine Hospital Association
Regarding
DRAFT 2008-2009 State Health Plan
March 18, 2008

Good morning, my name is David Winslow, and I am the Vice-President of Financial Policy at the Maine Hospital Association. The Maine Hospital Association represents all of Maine's 39 acute care and specialty hospitals and their affiliates. Maine is one of only a handful of states in which all of its acute care hospitals are non-profit.

We appreciate being given an opportunity to review the DRAFT State Health Plan that was issued on March 8, 2008. The Plan is comprehensive as shown by its 100-page length and mentions almost all of the relevant health care issues in Maine today.

Overall Focus on Chronic Illness, Page 15

We applaud the overall focus of the State Health Plan on chronic illness. As is mentioned throughout the Plan, Maine has a huge and costly problem with chronic diseases - the 3 C's and a D as Dr. Mills has taught us all so well. Focusing our efforts on preventing chronic health problems from occurring at all and treating them more effectively when they do occur is something that all parties can agree on and where we should focus our joint efforts to produce real results.

HealthInfoNet, Page 5

An interconnected electronic medical records system for our State will improve patient care and eventually save money for our health care system but there needs to be a sizable upfront investment. As is noted on Page 5 of the Plan, the State's four largest Health Systems have provided initial funding and cooperation for the project but there will be more funding needed for the system to become fully operational. Hospitals are acutely aware of the State's current budget problems and recognize that appropriating state funds for the project at this point is unrealistic, but funding for HealthInfoNet needs to be a priority for funding as we go into the future.

Medicare Equity Project, Page 46

We appreciate the recognition that Maine's consistently low Medicare reimbursement rates create cost shifting to other purchasers of health care and the recognition that the current wage index system is a contributor to the problem. Page 46 indicates that the latest data you have available is from the report that MHA published in 2001 showing Maine being reimbursed at 86 cents on a dollar of cost. Although we have not published a report since 2001, current data is now readily available through a number of sources and consistently shows reimbursement between 86-89 cents compared with a national average of approximately 96-98 cents on a dollar of cost.

Unfortunately, the State Health Plan makes no mention of the Medicaid cost shift which is even more severe at 76 cents on a dollar of cost (when adjusted for Maine's tax & match scheme). Again, we fully understand the State budget situation and are not here asking for a rate adjustment, however, it would seem to makes sense to at least refer to the problem in this document.

Patient Centered Medical Home, Page 31

The concept of a Patient Centered Medical home is one that we support and look forward to working with you to expand. This in an effective and economical way to treat patients and we look forward to its statewide implementation.

Understanding Emergency Department Use, Pages 19 and 40

Now is an appropriate time to look at some of the data regarding emergency room use that is captured in the MHDO claims database. It is always dangerous to try and reach sweeping conclusions from any type of claims data - so first we need to look at how accurate this data is on a hospital specific basis. Next, we need to look at how we compare with the State of Vermont which has seen a similar apparent increase in ED visits during the same period as Maine.

We also need to think about what is the best way to provide off hours health care in rural Maine. In some cases we may find that it is appropriate to staff primary care practices in the evenings and on weekends but in some cases I suspect we will determine that this is an added expense and simply a waste of money.

Hospital Bed Capacity, Page 16

The chart on Page 16 seems intended to imply that Maine has an oversupply of hospital beds. It has been established by multiple studies that Maine has approximately the same number of beds per thousand as the rest of the country. Making a comparison with only the southern New England states is misleading and ignores the geographic size of Maine.

Variation Chart, Page 21

We have all seen the variation in the hysterectomy chart on page 21. This chart was done using data from 1998-2002. We don't know what the result would be if the same analysis was done using more current data but it seems like an exercise worth attempting at this point if we are going to continue to use the chart.

Sentinel Event Reporting, Page 56

The Maine Hospital Association has been supportive of the sentinel event reporting law since it passed in 2002. We do not, however, agree with the statement that "This year's (sentinel event) report concludes that Maine significantly under-reports sentinel events" and ask that the statement be removed because it is unsupported and inaccurate.

Capital Investment Fund, Page 59

You have heard our testimony on the Capital Investment Fund many times so I won't repeat it here today other than to ask you once again to fix this unpredictable and arbitrary formula. Investing in our health care system in a rational manner is too critical to be left to a flawed formula. A better CIF also does not mean that we cannot retain and even expand the $22 million in savings cited on Page 61.

Thank you for the opportunity to offer testimony today and I would be happy to answer any questions that you have.

Advocacy