The old maxim, "Your heart will last as long as you live," is no longer true. Organ transplants are one of many technological advances that have opened new medical doors and, in turn, created questions for a panel that provides direction to Utah's Medicaid program.

"The rationing of health care is a significant issue," said Charles Doane, chairman of the Medical Care Advisory Committee, a federally mandated panel that helps provide direction for the Medicaid program. "We have to do more. The sophisticated procedures now possible have to be weighed against serving a large number of people in less dramatic ways. We have to determine the best use of limited resources."Utah's Medical Care Advisory Committee has a reputation for being responsible and thoughtful. Last year, the Legislature accepted MCAC's budget recommendations over those of the governor and the fiscal analysts. "The MCAC's become a significant factor in the budgeting and policymaking procedure for Medicaid," Doane said.

Doane is a large part of the MCAC's success, according to Rod Betit. The director of Health Care Financing, which administers Medicaid, presented Doane with an award last week for outstanding service to health care for Medicaid patients in Utah. "I've worked with MCACs before," Betit said. "But never one that functioned as well as this one does."

In the past two years, the panel has saved Medicaid $20 million to $25 million by helping make the delivery system more efficient. It also worked with the Health Department to strengthen managed health care and to get providers to accept reduced rates during tough economic times.

But the panel's job is just beginning, according to Doane, who, when he's not conducting MCAC meetings, is the director of government relations for Intermountain Health Care.

He said the program will have to adopt a program for mental health and pharmacy services, where Medicaid would pay the provider a specific amount to provide services to a patient for a year.

"That would be good, because it enables the provider to look at care on a continuum basis," he said. "For instance, with mental health, the physician would not be restricted to just acute care in a hospital. He could provide a broad range of care."

The most critical issue may be increased payments to physicians. "We need to keep payments up so we can keep doctors in the program," Doane said. "Right now, we're paying at a 55-60 percent rate. That doesn't cover the cost of the overhead, let alone leave a margin.

"Physicians want very much to handle the caseload. We hear that they make a lot of money and should be happy to provide this care, because they don't do things for people. Most provide charity care we never hear about. I think people would be astounded if they knew about all the donated care."