BANGOR – The latest commission studying Maine’s ailing health care system listened to a parade of medical and policy experts Wednesday describe the issues the state faces.

Five speakers described stark problems, and in some cases provided examples of efforts they are undertaking in their medical or hospital groups to improve care provided to patients.

The Maine Health Care Performance Council, funded by a Robert Wood Johnson Foundation grant, has 13 members representing business, consumer and state government. All were appointed to 18-month terms by Gov. Angus King, and were charged with developing a long-range vision related to judging the efficiency and quality of health care services in Maine.

Eastern Maine Healthcare CEO Norman Ledwin said that despite state efforts to urge Mainers to improve their health by stopping smoking or by exercising more, the number of people using health care services is rising. As the region ages it will continue to “go up and up and up,” he said.

Ledwin said he expects Mainers soon will have to decide between a competitive health care system and one regulated by the state. He criticized the state system that determines what services hospitals should offer, because it doesn’t use a regularly updated health plan showing regional needs to base those decisions upon. Because the state won’t use such a plan, EMH has hired an outside firm to create one for the region EMH serves to guide its decision-making, he said.

He said that EMH hospitals, which cover patients from Waterville north, see more and more patients with insurance policies having high deductibles. People without the means to pay the deductible are going to add to the rolls of individuals receiving free or charity care from hospitals, he said.

Ledwin said state programs such as Cubcare, which provide state-federal insurance for children without private insurance, frequently don’t reimburse enough to cover the cost of the care. Consequently, some hospitals might have difficulty serving such people, he said.

Ledwin described the technical means that EMH is using to streamline costs, while improving patient outcomes. He said Eastern Maine Medical Center in Bangor would go “paperless” by about 2004. The hospital has dedicated $32 million to developing electronic medical records. The systems reduce medication errors and trim administrative costs, he said.

One way to trim state health care costs would be to conduct an audit of the state’s repetitive documentation requirements, Ledwin said. “It’s amazing how many functions are duplicative and a waste of money,” he said.

Robert Woodbury, chair of another governor-appointed commission on health care that completed its work last year, said he thought the latest commission should keep a broad focus because performance is just one portion of what should be considered in looking at the ailing health care system.

He listed some key items of his commission’s report which he said merit consideration including:

. Increased hospital costs are partly a result of “mission ambition.”

. There’s a growing affordability gap in obtaining insurance.

. Mainers’ poor choices harm their health.

. Maine’s health care problems aren’t unique.

. Administrative excess and clinical excess are driving up costs.

Woodbury explained that when a patient asks a doctor for an MRI, neither has a stake in the cost of the procedure, whether needed or not.

Woodbury said few Mainers are actually doing anything to improve their diets or fitness. He said he believes the state snack tax shouldn’t have been repealed by the Legislature, but should have been tripled.

He also said he’s thought food taxes should be based on caloric totals. Such a system would levy a higher tax on a fast-food meal with higher calories than on one with lower calories.

The council got a primer on health care financial operations from Andrew Coburn, director of the Health Policy Institute at the Muskie School of Public Affairs at the University of Southern Maine.

He explained that health care accountability can be difficult to measure and it can’t be shoehorned into normal economic models.

“Measuring performance is difficult,” he said. “This is not a market based system – the price is indeterminable [in a true economic sense].”

Coburn also said the challenge in Maine is heightened because there is no data collection system that will be able to cleanly feed information to the council as it tries to measure performance.

Dr. David Simmons, a primary care physician from Calais, warned that data could be meaningless when collected in rural areas because of the small number of procedures done. That creates a sample that isn’t always statistically reliable.

He said that in some cases it might take five years of medical experience to gather enough to compare fairly how one doctor’s practice is doing in relation to similar groups elsewhere.

On top of that, the data can have other flaws. Emergency referrals, for instance, may be attributed to him for patients he’s never seen, he said. This can occur when a rural physician, who by necessity wears several job hats, has a covering physician send a patient to the emergency room.

“I think it’s really dangerous to use bad data,” he said.

Simmons said changes in health care have made it harder for doctors to take the time to educate patients.

Profit margins are tighter than they once were, he explained. “We’ve got to see 25 patients a day, if we’re going to pay staff,” he said.

Bruce Cummings, CEO, and Dr. Dan Rissi of Blue Hill Memorial Hospital described efforts within that system to standardize services.

Dr. David Howes, president and CEO of Martin’s Point Health, a physicians practice with offices in Portland and elsewhere, also spoke during the afternoon meeting. Howes described efforts to standardize care.