April 12, 2004

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Partisan Budget Adopted in Committee: MaineCare Basic included
The Legislature's Appropriations Committee split along party lines late last week in making recommendations to the full legislature to resolve the $160 million supplemental budget package. THe proposals are expected to be voted on early this week.
Majority Democrats on the committee support the proposal, which would fill a $137 million gap in the MaineCare program.  But Republicans continue to oppose the proposal .  Republicans argue that the MaineCare cuts are not deep enough and that the budget is too dependent on new taxes and fees.

While the Governor's proposal does not increase any broad-based tax, it does increase taxes on hospitals, impose a tax on boarding homes and other residential care facilities and raise some fees. 

The proposal reduces MaineCare spending by nearly $60 million, rather than the nearly $80 million originally proposed by the Governor.  More significantly for physicians, the proposal scales back 15 adult MaineCare services, such as rehabilitation services, instead of eliminating those services entirely.  There is also a delay of three months in the scheduled expansion of MaineCare coverage to an additional 13,000 persons.  Cuts to nursing homes are reduced to $1 million from the previously proposed $5.8 million.  Of the previously proposed $5 million cut to mental health providers, only $600,000 is now to be cut.

One of the more controversial proposals in the new document is a voluntary mail-order prescription drug program for MaineCare recipients.  While the program is voluntary, it is being bitterly opposed by the state's pharmacists.

The proposal may yet be amended in legislative action during the week.  While physicians have escaped direct fee reductions, the medical community will nonetheless be impacted by the various limits, such as prior authorization, likely to be part of the MaineCare Basic program for adults.

Acupuncture Bill Fails 44-81 in First House Vote

In floor action last Wednesday, 4/7/04, the Senate passed L.D. 263 by a vote of 24-11.  On Wednesday evening, a persuasive debate lasting approximately 45 minutes led to a convincing 44-81 defeat of the bill in the initial House vote.  The bill now is back in the Senate where it likely will be taken up again on Tuesday, 4/13/04.

The MMA's goal now will be to kill the bill in "non-concurrence."  In other words, if the Senate & House stick with their initial votes, the bill will die because they don't agree.


Click here to read the Committee Amendment to L.D. 263, An Act to Define a Scope of Practice for Acupuncture.

Click here to read the Senate Roll Call Vote

Prime Sponsor Senator Lynn Bromley (D-Cumberland) and Senator Michael Brennan (D-Cumberland) spoke in favor of the bill during the debate.  Senator Kevin Shorey (R-Washington) spoke in opposition to it.

A "nay" vote is a vote against the bill and in favor of the MMA's position.  You can leave a message for any Senator at the State House by calling 1-800-423-6900.  We anticipated support from all members of the Republican caucus and hoped to persuade a couple members of the Democratic caucus.  Accordingly, please contact the following members to remind them of our concerns:

Senator Richard Bennett (R-Oxford)

Senator David Carpenter (R-York)

Senator Kenneth Lemont (R-York)

Senator Arthur Mayo (R-Sagadahoc)

Senator Betty Lou Mitchell (R-Penobscot)

Senator Tom Sawyer (R-Penobscot)

Senator Lloyd LaFountain (D-York)

Senator Peggy Pendleton (D-Cumberland)


Click here to read the House Roll Call Vote.  Again, a "nay" vote is a vote against the bill and in favor of the MMA's position.  Please focus on members who voted with us and urge them to hold their positions despite the acupuncturists' lobbying that is sure to be intense today.  You can leave a message for any House member at the State House by calling 1-800-423-2900.

During the House debate the following members spoke in favor of the bill:

Rep. Nancy Sullivan (D-Biddeford)

Rep. Arthur Lerman (D-Augusta)

Rep. Nancy Smith (D-Monmouth)

The following members spoke in opposition to the bill:

Rep. Thomas Shields, M.D. (R-Auburn)

Rep. Lisa T. Marrache, M.D. (D-Waterville)

Rep. Anne Perry (D-Calais)

Rep. Peter Mills (R-Cornville)

Rep. Mary Black Andrews (R-York)

Rep. David Bowles (R-Sanford)


Read the MMA's Talking Points on the Acupuncture Bill



  • L.D. 263's OTP-AM recommendation is contrary to Commissioner of Professional & Financial Regulation Robert Murray's sunrise review conclusion that the State should not license "oriental medicine"


  • L.D. 263 would permit licensed acupuncturists "to diagnose and treat illness, injury, pain and other conditions by regulating the flow and balance of energy to restore and maintain health" (emphasis added).  Licensees would accomplish such energy regulation through:


    • oriental diagnostic procedures

    • electrical and magnetic stimulation

    • moxibustion and other forms of heat therapy

    • sound, light and vibrational therapy

    • cupping techniques and gua sha

    • recommendation and dispensing of Chinese patent remedies or Chinese pre-made herbal remedies and lifestyle and dietary counseling

    • formulation and dispensing of custom-made Chinese herbal combinations

    • sotai, shiatsu, gi gong, zero-balancing, tui na, and acupressure


  • These techniques are not acupuncture & the public should not be led to believe they are - each of these techniques needs its own sunrise review, analysis, and legislation


  • Research on these techniques to date has not met the evidence-based standards governing the evaluation of conventional medicine - a scientific basis is 1 of 6 indicators of "high quality" health care in the Institute of Medicine's 2001 Crossing the Quality Chasm report


    • "[P]ublic health and safety demand rigorous research evaluating complementary and alternative medicine [(CAM)] therapies, research on CAM should adhere to the same ethical requirements for all clinical research, and randomized, placebo-controlled clinical trials should be used for assessing the efficacy of CAM treatments whenever feasible and ethically justifiable."  (Miller, et als., "Ethical Issues Concerning Research in Complementary and Alternative Medicine," JAMA, 2004; 291:599-604)


  • Patient safety may be compromised if patients are encouraged to pursue these techniques while delaying a medical diagnosis & health care costs may be increased at a time when our system can least afford them

[return to top]

Consumer Reports Issues Warning on Supplements Including Herbal Meds




LD 263, An Act to Define a Scope of Practice for Acupuncture?


Consumer Reports Issues WARNINGS Over

Herbal Supplement Use

(May 2004 Issue)


  • Consumer Reports magazine has identified a dozen dietary supplements that according to government warnings, adverse-event reports, and top experts are too dangerous to be on the market, although they remain there.  This is why the state shouldn’t be endorsing these practices by giving them the legitimacy of state licensure.


§         Acupuncturists were identified in the article as supplying these supplements in two of the highlighted cases of adverse outcomes:


“Donna Andrade-Wheaton’s acupuncturist prescribed more than a half dozen Chinese herbal supplements to treat health conditions, including endometriosis. At least one of the products listed Aristolochia as an ingredient, even after the FDA issued a nationwide Aristolochia safety warning in 2001. She underwent a kidney transplant in September 2002 and must take anti-rejection drugs for life.”


“Beverly Hames (50) went to an acupuncturist in 1992 seeking a “safe, natural” treatment for an aching back. She got a selection of Chinese herbal products, at least five of which were later found to contain aristolochic acid. By mid-1994, she had symptoms of kidney failure, and in 1996 she underwent a kidney transplant. She must take anti-rejection drugs for life.”


  • Herbal and dietary supplements do not have to be approved by a government agency before they can be sold to the public.  The FDA must prove that the supplement is dangerous once it is already on the shelves, in a very rigorous process.


  • Some supplements act like drugs and thus have similar risks.


  • Supplement makers don’t have to report adverse events.


Metabolife International, a leading ephedra manufacturer, did not let the FDA know that it had received 14,684 complaints of adverse events associated with its ephedra product, Metabolife 356, in the previous five years, including 18 heart attacks, 26 strokes, 43 seizures, and 5 deaths.” [return to top]

U.S. Senate Cloture Vote Fails 49-48 on Latest Medical Liability Reform Bill
On Wednesday, 4/7/04, the U.S. Senate failed to reach the 60 votes necessary for cloture on the Pregnancy & Trauma Care Access Protection Act of 2004 (S. 2207).  Both of Maine's U.S. Senators voted in favor of the bill.  The bill would establish federal damage limits in malpractice actions against emergency room personnel & OB/GYNs.  Like an earlier bill (S. 2061) targeted on OB/GYNs, the bill would permit unlimited economic damages, but it would limit non-economic damages at $250,000 & it would limit punitive damages to the greater of twice the economic damages or $250,000.

Quoted in the New York Times on Thursday, 4/8/04, Senate Majority Leader Bill Frist, M.D. (R-TN) said that he would continue to try to push malpractice reform legislation through the Senate this year.  "We are going to keep bringing this issue back," Dr. Frist said, "because the crisis is getting worse." [return to top]

Senator Collins Introduces Bill to Prevent Drug Diversion
On Tuesday, 4/6/04, U.S. Senator Susan Collins introduced the Prescription Drug Stewardship Act in an effort to help prevent illegal prescription drug diversion.  The bill would amend the U.S. Public Health Service Act to provide grants to help states in "establishing, maintaining, and improving systems to -

     (1)  track the distribution of prescription drugs from the prescribing health care providers to the pharmacy and, finally, to the patient;

     (2)  provide continuing education programs for health care providers concerning issues pertaining to prescription drug abuse among patients and colleagues; and

     (3)  provide education programs for the public on the problem of prescription drug diversion and abuse."

As a result of legislation passed by the Maine legislature last year, the MMA is involved with government agencies & other advocacy groups in implementing a prescription drug monitoring program in our state. [return to top]

Dirigo Health Quality Forum Advisory Committee Update
The Dirigo Health Quality Forum Advisory Committee met on Friday, April 9th.  Chairman Robert McArtor, M.D. introduced members to the recently named Executive Director of the Quality Forum, Dennis Shubert, M.D.  Dr. Shubert practiced neurosurgery in Bangor for a number of years before pursuing a degree in public health and making a mid-career shift.  He is a long-time MMA member.

Committee members reviewed a proposed Mission Statement for the Forum and heard updates on Certificate of Need, the Provider Group Advisory Committee and Performance Measures.  Dirigo Health Executive Director Tom Dunne also gave members an update on other Dirigo activities, including the plans to launch the insurance product.

Members spent quite a bit of time discussing what the role of the committee would be relative to new technology, which is part of its responsibility under the Dirigo Health statute.  Following some discussion, a subcommittee was appointed and asked to report back some recommendations to the full committee at the next meeting May 14..

The committee also discussed the reporting of performance measurements.  It was announced that an initial meeting of committee leadership, the Maine Health Management Coalition and the Maine Hospital Association had taken place and that all three organizations had agreed to work together toward development of a single set of reportable performance measures for hospitals.

Finally, Dr. Shubert shared with committee members a presentation he had given to the Dirigo Board earlier in the week.  The presentation represented Dr. Shubert's views on where the Quality Forum should be headed.  A hard copy of the slides from the presentation are available from MMA. (Call 622-3374 and ask for Julie or Charyl). [return to top]

Maine Health Access Foundation 2004 Annual Meeting
The Maine Health Access Foundation will hold its 2004 Annual Meeting on Thursday, April 22 at the Augusta Civic Center (Washington/York Room).  The Annual Meeting begins with an open business meeting for the MHAF Board of Trustees at 2:00p.m.  The Plenary Program follows at 5:00pm and will feature keynote speakers Dr. Catherine McLaughlin and Dr. Lawrence D. Brown.

Dr. McLaughlin is Professor of Health Management & Policy, and Director of the Economic Research Initiative on the Uninsured, University of Michigan.  Dr. Brown is Professor of Health Policy & Management, The Joseph L. Mailman School of Public Health of Columbia University.

The title of the plenary session is: "Addressing the Uninsured;  Strategies That Work (and Some That Don't)"  The session is expected to address such issues as:  Can communities create system-wide change to improve access to care for low-income, uninsured individuals?  Can they implement sustainable delivery systems that manage care, promote prevention and early intervention and integrate services for the uninsured?  The two speakers will share the outcomes from a national consortium of innovative projects funded by the Robert Wood Johnson Foundation to describe the lessons learned on what local initiatives can and can't do to improve coverage and care for the unisured.

The public is invited to attend any of the above.  Please RSVP to Cathy Luce at the MHAF by April 15 (620-8266) [return to top]

Maine Small Business Alliance Forum on Dirigo Health: In Auburn April 15, Bangor April 27
The Maine Small Business Alliance has received funding from the Maine Health Access Foundation to engage small businesses in learning more about Dirigo Health-CareWorks and provide feedback to policy makers about the needs of small businesses.  The Alliance is partnering with a number of organizations and the staff from Dirigo Health and the Governor's Office of Health Policy and Finance to hold informational forums around the state. Upcoming forums in Auburn and in Bangor, are as follows:

April 15 from 7:15am to 9:00am in Auburn at the Auburn Inn and Conference Center, 1777 Washington St (at Turnpike Exit 12).  This program is being held in conjunction with the Androscoggin Chamber of Commerce.

April 27 from 9:00am to 10:30am in Bangor at Bangor Savings Bank, 99 Franklin St.

If you are interested in attending, as a provider or as a small business person, please contact Deb Cook, Executive Director of the Alliance at 622-6500 or via e-mail to dcook@msb-alliance.org. [return to top]

MHMC Pathways to Excellence Update
The Maine Health Management Coalition is seeking participation of primary care practices in Phase II of its Office System Survey.  The initiative is now called "Pathways to Excellence", (it was formerly called, "Informing Patients, Rewarding Providers").  The goal of the project is to recognize and reward systemic, best practice, chronic disease care management in primary care.

The Coalition is an organization of 32 employers that includes large businesses, public employers, hospitals, health plans and physician groups.  Collectively, these employers provide health benefits to over 250,000 people in Maine.

Early in April, each primary care practice should receive a letter from the Coalition, soliciting participation.  Each practice will be asked to complete an online survey for each practice location in the organization.  The survey consists of eight sections and is expected to take approximately 30 minutes to complete.  Surveys must be completed and submitted electronically by June 1, 2004 in order to be included in this year's project.  The survey data will be compiled by the Maine Health Information Center which will analyze the results and report them back to the practice.  Each practice will receive a report of how it rated relative to practice systems and how its rating compared with all other primary care practices completing the survey.  The survey is expected to be done annually.

The Health Management Coalition has worked with a number of health plans and responses to the survey are expected to be considered as part of financial incentive programs utilized by Cigna and Anthem in 2004 and in future years.  While no physician is expected to be paid less, future increases are likely to be based upon surveys such as this.  Anthem representatives will meet with members of the MMA's Payor Liaison Committee on April 21st to discuss what types of arrangements will be offered to participating physicians during the coming year.  Any MMA member or office staff wishing to attend the evening meeting on the 21st should contact Chandra Leister at 622-3372 or via e-mail to cleister@mainemed.com.

Participation in the project will also be publicly reported to coalition employees and their families through the MHMC website as www.mhmc.info.  THOSE PRACTICES WHICH DO NOT REPORT RESULTS WILL BE NOTED AS 'DID NOT PARTICIPATE.'

A physician advisory committee provides direction to the coalition on the project.  Technical or process questions may be addressed to Ted Rooney, Project Leader (720-4929 or trooney@mhmc.info) or Jan Wnek, M.D., Clinical Advisor (janicewnek@mhmc.info)

While not currently scheduled to participate in the MMA's Physician Education Programs on May 26 and June 23, efforts are currently being made to have an update on the project, or at least to have Ted or Jan available to discuss the project with attendees. [return to top]

Maine Chapter AAP Searching for Executive Director
The Maine Chapter of the American Academy of Pediatrics is searching for a part-time Executive Director. The job description follows:

The Executive Director shall assist the Executive Committee in establishing chapter policies, in planning CME programs, maintaining the chapter's membership, and communicating with its officers, task force members, key contacts, Executive Committee and other related outside organizations.  The Executive Director shall oversee the day-to-day financial affairs of the Chapter.  The Executive Director shall be an ex-officio member of the Executive Committee.


  • Communicate with officers and the membership according to the needs of the Chapter.
  • Assist the President in developing agendas and other organizational documents.
  • Provide support to the Task Force Chairpersons as needed.
  • Maintain the minutes and other official records of the organization.
  • Liaison with the state medical association and related organizations.
  • Assist the President with the development of the annual report of the Chapter's activities.
  • Coordinate Chapter mailings.
  • Coordinate with other AAP Chapter Executive Directors.
  • Attend national AAP meeting with Chapter officers (i.e., Annual Leadership Forum, District I Meetings)


  • Maintain an accurate membership database.
  • Work with Vice-President on membership recruitment and retention activities.
  • Provide membership information to new members as requested.


  • Manage the day-to-day financial affairs of the Chapter.
  • Assist the Treasurer in developing an annual budget and additional program budgets as necessary.
  • Work with the President to develop non-dues sources of revenue.


  • Assist with development of Chapter programs through planning, grant-writing, tracking and reporting, and general oversight.
  • Participate in short and long-term planning.


  • Coordinate with the Practice Support Task Force in meeting planning.
  • Coordinate meeting location details, pre-registration and on-site registration and on-site technical support as needed.
  • Coordinate all vendor/exhibit needs.
  • Arrange continuing medical education credits.


  • Compile, edit and make arrangements for publication of a regular edition of the Chapter newsletter of the assistance of the newsletter editor.
  • Publish other materials as necessary.


  • Coordinate legislative activities with the Legislative Task Force.
  • Arrange press conference/releases as necessary.
  • Coordinate and oversee public relations programs of the Chapter.

The Executive Director will perform other duties and deemed necessary by the Chapter President and Executive Committee.

Interested persons should contact the Chapter's President, Lisa Ryan, D.O., at 207.647.4232, fax 207.647.6016. [return to top]

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