November 3, 2003

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The Doctors Company Exiting Maine
The Doctors Company, a California-based professional liability company that has provided liability insurance to several physicians and physician groups in Maine has notified the Maine Bureau of Insurance that it will withdraw from the Maine market and over 20 other state markets over the coming 12 months.
The Bureau was notified in mid-October.  By law, the company must give at least 60 days notice of its withdrawal so that physicians insured by the company whose policies renew beginning in January will be notified of the intent not to renew.  Policies will be non-renewed as of the date of their expiration. 

The decision of the Doctors Company to leave Maine was not made as a result of an unfavorable liability climate in Maine.  Rather, the company recently had a reduction in its AM Best rating and is concentrating on those states where is writes a significant amount of business.  Its premium volume in Maine is about $1.5 million.

Physicians insured by the Doctors Company would be well advised to look for other coverage now, rather than waiting until the policy expiration gets closer.  In the current "hard" market for physician liability insurance, physicians with any claims history are finding it difficult to purchase coverage.  When St. Paul pulled out of Maine, some physicians arguably waited too long and became virtually uninsurable.

Options for professional liability insurance are now quite limited. MMA endorses the insurance offered by Medical Mutual Insurance Company of Maine.  The company can be reached at 207-775-2791. As a mutual company owned by its insureds, Medical Mutual holds the AM Best rating of A- (Excellent).  ProMutual Group, of Massachusetts, offers insurance in Maine under the name of ProSelect but has had a moratorium in Maine for a few months because of capacity issues.  The moratorium has recently been lifted, however.  ProMutual can be reached directly at 1-800-225-6168 or through your local agent.  The insurance firm of Kilbride and Harris in Portland (774-7919) is an agent for ProMutual and can sometimes assist in difficult placements.  Medical Mutual can also sometimes be helpful in placing business with an excess lines carrier if it is not able to write the policy itself.  MMA attorneys Andrew MacLean and Gordon Smith are always available to consult with Association members who may have professional liability insurance issues.  They may be reached at 622-3374 or via or

Physicians Making Headway on Medicare Payment Issue
Although there are still a few rounds to go, physicians achieved at least hope this week when Senate Finance Chairman Chuck Grassley (R, Iowa) confirmed that Medicare conferees had reached a tentative agreement to eliminate the scheduled 4.5% cut in Medicare physician fees beginning Jan. 1.  Congress earlier this year thought it had fixed the physician payment problem when it added $54 billion over 10 years to the omnibus spending bill in February.  But even while individual payments declined in 2002, the volume of Medicare physician services increased, prompting another cut for the coming year under the existing flawed formula.

Prior to Senator Grassley's announcement, CMS had announced that the final 2004 Medicare Fee Schedule due out this coming week includes a 4.5% fee cut, even worse than the 4.2% cut anticipated. 

From numbers prepared by the American Medical Association, it appears that fixing the fee cut would have a favorable impact of about $14 million in Maine in 2004 alone.  This would amount to approximately $4,700 per Medicare participating physician.

Other provisions in the bill of concern to physicians, such as a mandate to prescribe electronically, also seem to be moving in a positive direction.  It appears that the e-prescribing mandate will at least be pushed back a few years.  Perhaps best of all is a provision  that narrows the payment gap between urban and rural areas of the country by raising the floor for the work gypcies (geographical indices).

Passage of a Medicare bill including the favorable fee fix is still contingent upon the conferees, and indeed, the entire Congress, agreeing on a prescription drug benefit for seniors prior to adjournment later in November.  Physicians need to keep pressure on their elected representatives to successfully conclude these matters before adjournment. [return to top]

OneStar to Discontinue Local Telephone Service
Physician practices utilizing OneStar for local telephone service should have received notice from the company that it is discontinuing local service, effective Nov. 7.  The company discontinued long distance service on Oct. 9.

The Public Utilities Commission has been in negotiations with OneStar and Verizon in an attempt to prevent a disruption in telephone service for OneStar customers.  Verizon has agreed to accept customers from One Star and has provided an 800 number for customers to call.  The number is 1-800-941-9900.  Other carriers may be available as well. MMA members may wish to call Innovative Network Solutions which offers discounts to MMA members on a variety of telco services, including both local and long distance.  The number for Innovative is 772-1800.

Here's a link to the Office of the Public Advocate's Rate Watcher Guide that provides information regarding carrier options.   Or call the toll free number for the Public Advocate's Office: 800-941-9900. [return to top]

The AMA's Top 12 Fictions & Facts About Medical Liability Reform: #11
FICTION #11:  Doctors are wealthy; liability insurance rate hikes don't matter to them - they'll simply pass them along to their patients.

Fact:  Opponents to reasonable civil justice reform like to use physicians' incomes as argument against creating a fairer and more predictable system for redressing medical malpractice.  However, they ignore the fact that in certain areas of the country, and for certain types of specialists, double-digit hikes in professional liability insurance rates make it difficult for these physicians to continue providing services (or certain types of high-risk services) to their patients.

The increased prevalence of public and private price controls and the lopsided bargaining climate between physicians and managed care plans have essentially eliminated the ability of medical practices to pass on cost increases.  A number of businesses, such as airlines and freight delivery companies, were recently able to assess surcharges on their customers in response to increased fuel costs.  Given the prevalence of third-party payors, physicians do not have the same ability to pass on sharply  increased liability premiums. [return to top]

Youth Smoking Rates Decline in Maine
In the area of good news, the Bureau of Health announced last week that the rate of teenage smoking in Maine has been cut in half in the last six years.  In 1997, 39 percent of Maine high school students smoked.  That rate has dropped to 20 percent this year.  This drop means that 22,000 fewer teenagers are smoking today than in 1997!

A significant drop has also taken place at the middle school level, with middle school smokers dropping from 21 percent in 1997 to 8 percent this year.

As several newspaper editorials noted last week, this significant reduction is no accident.  Maine's aggressive program of advertising anti-tobacco messages and forming community health coalitions, through the Partnership for a Tobacco-free Maine, has made a difference.  The Legislature's support for using the tobacco lawsuit settlement funds for health related programs has kept the program nearly fully-funded.

Congratulations to the Maine Coalition on Smoking OR Health, chaired currently by MMA member and Public Health Committee Chair Jo Linder, M.D., and to Dora Mills, M.D. and the Bureau of Health.  The path that MMA, Blue Cross and the major voluntary health organizations took back in 1979 to put such a coalition together has paid off handsomely.

The Coalition holds its Annual Meeting today at 1:00pm to 4:00pm at the Senator Inn in Augusta. [return to top]

Important Issues Facing Maine Voters Tomorrow
Maine voters face an array of important issues on election day tomorrow.  At its Annual Meeting in September, the Maine Medical Association voted to oppose Ballot Question 3 which states, "Do you want to allow a casino to be run by the Passamaquoddy Tribe and Penobscot Nation if part of the revenue is used for state education and municipal revenue sharing."  The Association's opposition was requested through a resolution submitted by the Public Health Committee.  In its Resolution, the Committee cited  problem and pathological gambling as public health issues.

Whatever your personal decision on this issue, please take the time to vote and encourage your family and staff to do likewise. It is a civic responsibility. [return to top]

The Coding Center Offers Coding Roundtables Nov. 7 (Bangor) and Dec. 4 (Portland)
The Coding Center, a collaborative effort by the state medical associations in Maine, New Hampshire and Vermont, is offering two Fall Coding Roundtables in Maine.  The morning portion offers E & M Coding while the afternoon portion of the program is entitled, "Using the Internet as a Coding Resource." The morning program runs from 9:00am to noon and in the afternoon from 1:00pm to 4:00pm. 

The Nov. 7th Roundtable is in Bangor at Spectacular Events.  The December 4 Program is in Portland at Keeley's Banquet Center.  Registration material is available from Charyl Smith at MMA at 622-3374 or via e-mail at [return to top]

Dirigo Health Board of Directors Confirmed and Holds First Meeting
The members of the Dirigo Health Board of Directors were confirmed by the Legislature last week and held their first meeting this morning.  Chaired by MMA former President Robert McAfee, M.D.,  the Board got right down to business following a brief swearing-in ceremony.  The Board reviewed key milestones for the anticipated July 2004 launch of the insurance product.  During the next two months, the draft insurance product will be prepared and contacts made with prospective business suppliers.   The current plan is to also conduct focus groups to test attractiveness of the product.  The Board must also fill key staff positions, including hiring an Executive Director and supplement staff with any necessary contract resources.

The Board will meet again on Monday, December 1 and on that day will also convene the Maine Quality Forum.  The Forum is an important group to MMA and all Maine physicians and MMA will follow the progress of this group.

Materials from today's meeting are available to MMA members by calling Andy MacLean or Gordon Smith at MMA at 622-3374 or via e-mail to or [return to top]

Legislature's Health and Human Services Committee to Meet Wednesday
The Legislature's Health and Human Services Committee will meet on Wednesday (11/5) from 10:00am to 4:00pm in Room 201, Cross State Office Building in Augusta.  At 10:00am, Trish Riley, Director of the Governor's Office of Health Policy and Finance will present to the Committee for its approval the Governor's appointees for the Advisory Council on Health Systems Development and the Maine Quality Forum Advisory Council.

The Quality Forum Advisory Council consists of 17 members, including several physicians.  A key duty of the Council is to research and disseminate performance measures aimed at improving the quality of health care services.   The Advisory Council on Health Systems Development assists in establishing the state health plan and advises on Certificate of Need issues.  Physicians appointed by the Governor to the Advisory Council on HSD include Maroulla Gleaton, M.D., MMA President;  Robert Keller, M.D., former Executive Director of the Maine Medical Assessment Foundation and a practicing orthopaedic specialist;  Lani Graham, M.D., former Director of the Bureau of Health and Dora Mills, M.D., M.P.H., the current Director of the Bureau of Health. [return to top]

Not Too Late to Join AMA Board of Trustees, Governor Baldacci and MMA Leadership at Sesquicentennial
Less than a week now remains before MMA's 150th Anniversary Celebration being held this Saturday evening (11/8) at the Portland Museum of Art and the Holiday Inn by the Bay in Portland.  This event marks the conclusion of a year-long celebration of the history of medicine in Maine and of the history of the Association which was founded on April 28th, 1853, in Brunswick.

Saturday evening promises to be a very special event and we are proud to have among our guests the entire Board of Trustees of the American Medical Association, AMA President Donald Palmisano, M.D., J.D., and Governor and Mrs. Baldacci.  Congressmen Allen and Michaud will be attending the reception at the Art Museum as well.

One highlight of the evening will be the debut of a 23 minute video documentary that has been prepared for the event.  The reception begins at the Art Museum at 5:30 p.m. with a 7:30pm dinner and program following next door at the Holiday Inn by the Bay.  The evening will conclude with dancing to the popular Tony Boffa Band.

Several exhibits will also be displayed at the event, including artifacts from the Maine Medical Center Library Archives.  A silent auction will also be conducted simultaneously during the course of the evening.

Don't miss this chance to join your professional colleagues and our guests in celebrating 150 years of Maine medicine.  The profession has a lot to be proud of and its many achievements will be acknowledged and celebrated at the event.  Over four hundred persons have registered but there are still tickets available by calling Susan Feener at 622-3374 or via e-mail at [return to top]

For more information or to contact us directly, please visit l ©2003, Maine Medical Association