May 10, 2004

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Dirigo Health Agency RFP Issued Friday
Late last week, Governor Baldacci announced the release of a Request-for-Proposals seeking bids from health insurance carriers to offer the Dirigo Health Plan. The deadline for responses is June 11, 2004 and a bidder's conference has been scheduled for May 17, 2004.

Governor  Baldacci's Dirigo Health Plan took a significant step forward on Friday with the release of this RFP.  Since the Governor signed the Dirigo Health bill, L.D. 1611, in the Spring of 2003, the Dirigo Health Board of Directors has focused on this milestone - developing a benefit framework for the DH product and preparing this RFP.  The DH Board gave its final approval to the RFP at its meeting on Monday, May 3rd.  At that meeting, the MMA expressed concern about a "key refinement" of the RFP suggesting that providers who accept DH patients would be required to accept MaineCare patients.  The DH Board and staff quickly clarified that providers who choose to participate in Dirigo will be required to accept patients who are eligible for both Dirigo and MaineCare (those individuals will have MaineCare benefits "wrapped" around the DH benefit), but they will not be required to participate in MaineCare.  Nor will there be any change in state policy on providers' ability to limit the number of MaineCare patients in their practices.

You can read the Governor's statement on the release of the RFP at  This article includes a link to the RFP.  The bidder's conference is on Monday, May 17, 2004 at 1 p.m. at the Augusta Armory.

MMA Executive Committee Updated on Maine Quality Forum
MMA's 26-member Executive Committee met on May 5th.  The Committee heard a presentation from Dennis Shubert, M.D., Ph.D., Executive Director of the Maine Quality Forum.  Dr. Shubert, who formerly practiced neurosurgery in Bangor, updated committee members on the work of the Forum, particularly as it relates to the use of data.  Claims data will soon become available from the State's all-payer claims database.  Dr. Shubert encouraged MMA to be pro-active rather than reactive concerning the release of data to the public, citing the trend for more accountability and transparency in the health care delivery system.

In the discussion following Dr. Shubert's presentation, committee members stressed the importance of the data being both accurate and timely.  Given the significance of this initiative, the Committee also voted to extend an invitation to Dr. Shubert to attend the next few meetings of the Committee in order to continue the dialogue. [return to top]

CON Moratorium Expires
Last week brought the end to a one-year moratorium on Certificate-of-Need (CON) applications.  The moratorium was imposed by Executive Order in May 2003 at the introduction of Governor Baldacci's Dirigo Health legislation (L.D. 1611).

The intent of the moratorium was to delay any necessary capital expenditures until completion of a comprehensive state health plan.  The plan was to have been prepared with input from the Advisory Council on Health Systems Development (ACHSD).  Unfortunately, the State Health Plan is not yet complete.  In fact, its preparation has barely begun, a point acknowledged by ACHSD Chairman Brian Rines, Ph.D.  Dr. Rines attributes the delay to the press of other business including the supplemental state budgets and the launch of the Dirigo Health plan.

MMA President Maroulla Gleaton, M.D. is a member of the ACHSD as are MMA members Robert Keller, M.D. and Lani Graham, M.D., M.P.H. [return to top]

Medicare Prescription Drug, Improvement, and Modernization Act of 2003
On December 8, 2003, President Bush signed into law the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.  The new law, 678 pages long, is most well-known for the addition of the controversial prescription drug benefit in the Medicare program, but it also will have a major impact on:

  • Medicare physician payment rates
  • Medicare covered preventive services
  • CMS regulatory requirements and paperwork
  • Drugs administered in physician offices, and
  • Medicare managed care

For a brief, 4-page summary of the provisions in the law of most interest to physicians, prepared by the AMA, contact Julie Banta at MMA at 622-3374 or  You also can find this document on the AMA web site at [return to top]

Medicare Drug Card Program Begins
On April 29th, the Medicare web site began providing drug price comparisons and indicating where Medicare recipients can use their new drug discount cards.  The same information is available at 1-800-MEDICARE.  Enrollment began May 3rd and the cards can be used starting in June.

For low-income patients ($12,569 in annual income for an individual and $16,862 for a couple), the drug card is free and provides $600 to spend on prescription drugs this year and another $600 in 2005.  Medicare beneficiaries not qualifying for the free card must pay up to $30 and will have a multitude of cards to choose from.  Seniors have been advised by both Medicare officials and the AARP to shop around for a while as the cards cannot be used until June anyway.  Medicare beneficiaries who already have prescription drug coverage through former employers. association plans (such as MMA's Group Health Plan), or governmental plans probably will not find the cards worthwhile, government officials and health care analysts have said.

The cards are expected to produce average discounts of 17% for brand name drugs and 35% for generic drugs.  More information is available at the CMS web site: [return to top]

Physician Survival Programs Filling Quickly
There is still time to register for the MMA's popular educational series, the Physician Survival Seminar.  This year, the MMA is offering the program in Auburn on Wednesday, May 26th and in Bangor on Wednesday, June 23rd.  An additional talk has been added on the provisions of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.  As your Medicare patients begin to ask you your opinion on the new drug cards or the broader drug benefit available in 2006, it will be important to have some answers.  Other topics on the agenda include Dirigo Health, MaineCare, third-party payment issues, HIPAA security, new laws and regulations, professional liability, relationships with drug representatives, certificate-of-need, electronic prescription drug monitoring, Board of Licensure in Medicine update, and other relevant topics.  The keynote speaker for the day is U.S. Attorney Paula Silsby.

For registration material, contact Chandra Leister at 622-3374 or [return to top]

Senator Collins Headlines 5/24 Fundraiser at the Woodlands
The Maine Medical Association, Maine Ambulatory Surgery Center Coalition, and the Maine Osteopathic Association invite you to a fundraising event for the Maine Senate Republican caucus from 5:30 p.m. to 7 p.m. at the Woodlands Club in Falmouth.  The cost is $100 per person. 

The event will include a roundtable discussion of current health care issues with U.S. Senator Susan Collins, 1st District Congressional candidate Charles Summers, and members of the Maine Senate Republican caucus.  Maine's Senate Republicans, including Senator Karl Turner (R-Cumberland) and Senator Art Mayo (R-Sagadahoc), were very strong in their support of physicians' views during the debate of Governor Baldacci's Dirigo Health Plan legislation (L.D. 1611).  Senator Turner and Senator Mayo were members of the joint select committee created to develop the Dirigo Health Plan.

Contributions should be made payable to Majority 2004, P.O. Box 15145, Portland, Maine 04112. [return to top]

FSMB Revises Pain Management Policy
As part of the ongoing effort within the medical community to strike a balance between undertreatment and overtreatment of pain, the Federation of State Medical Boards (FSMB) recently has revised its 1998 guidelines on appropriate pain management.

The current edition of American Medical News covers this action in the following article:  The article includes a link to the revised guidelines on the FSMB web site. [return to top]

AMA Update on Congressional Action

Last Thursday, the AMA's Washington, D.C. advocacy staff updated state medical society representatives on current Congressional action on 3 issues.  The following is a summary of the discussion.

1.  Medical Liability Reform

On Wednesday May 12th, the House has scheduled a vote on H.R. 4280, a bill that is identical to H.R. 5, the bill including a cap on non-economic damages that passed the House in 2003.  The AMA's goal is to hold the vote on H.R. 5 that included 15 members of the House Democratic caucus.  The House leadership is pursuing a multi-week health care strategy with individual bills that will be rolled into a single bill to go to the Senate. This week is health security week.  In addition to this liability bill, the House also plans to address association health plans (AHPs) and flexible spending accounts.

The Senate leadership apparently is reconsidering their incremental approach to this issue.  The AMA has been pushing a comprehensive approach.  The Senate leadership is feeling some pressure since several large state medical societies (CA, NY, TX) apparently are on record in opposition to specialty specific bills.  Sen. Durbin is interested in moving a tax credit bill (20% for hi risk; 10% for low risk; 15% for facilities), but this is unlikely because of the cost.  There is some talk about screening panels and a punitive damage cap as well.  Nothing is likely to happen before Memorial Day.

2.  Patient Safety

The House passed a voluntary patient safety/medical error reporting bill by a large margin in March 2003 and the Senate has S. 720 before it.  The AMA says that this is the one health care bill that may actually pass this year and seems to believe that this is important to deflect the medical error issue.  The AMA is working on the technical details and trying to work out a compromise - though all acknowledge that it's a poor atmosphere for compromise in D.C.

3.  Medicare Physician Reimbursement/Sustainable Growth Rate

The House Energy & Commerce Committee held a hearing on the issue last Wednesday.  Committee attendance was spotty.  The Congressional Budget Office (CBO) came in to give the history and size of the problem.  The AMA submitted a statement for the record.  The CBO estimates the cost to be $90-95 billion over 10 years. The discussion didn't get into solutions.  The AMA holds out no hope of a legislative solution this year, but will pursue some regulatory relief.  The AMA has met with the new CMS Administrator, Mark McClellan, M.D., on the subject and he seems sympathetic.  A rule this fall may have some administrative relief.

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20 Maine Libraries Now Offer Electronic Document Delivery Service
Are you in a hurry for information that will help you treat a patient?  Do you need to review an important article before submitting a grant application or an article?  A tremendous amount of information is available online, but much information still exists only in paper, in periodicals scattered in libraries all around the country and the world.  The Maine Health Science Libraries and Information Consortium (HSLIC) has received a National Library of Medicine grant to improve access to this information with the Ariel electronic document delivery service.  Twenty Maine health sciences and university libraries currently offer this service and another 21 libraries will offer it by the end of the grant period in two years.

Typically, it can take up to a week or even longer to get copies of paper articles from other libraries through the mail.  The Ariel document delivery service speeds up this process.  With Ariel document delivery, requests for articles are electronically transmitted to other libraries in the system.  Each library has a dedicated computer to receive requests.  The article is scanned by the library and transmitted to your library and then printed out on your library's own printer.  The result is a high-quality copy.  No more blurry numbers or clipped-off text.  Photos and images are also sharp.  Ariel even produces color images, photos and other graphics.  This is an especially important feature if the article you want has key information in color graphs, charts or photographs. 

More than 9000 libraries, corporations and other organizations around the world participate in the Ariel system.  Any article in the periodicals of any of these libraries is available on an expedited basis.  Once your library receives a copy of the article, you can choose to pick it up at the desk, have it mailed locally or faxed.  The library may also be able to e-mail it to you.  Libraries must purchase proprietary software and special equipment to provide the Ariel service.  The cost for Ariel is too high for most individuals.  It is a special service that is available only through your library.

The Maine Ariel Project is a statewide initiative by Health Science Libraries and Information Consortium, a non-profit coalition of 45 of Maine's medical, academic and research center libraries, to improve document delivery to library users in the state of Maine.  Libraries currently offering the service are:

Augusta:  MaineGeneral Medical Center and the University of Maine at Augusta library

Bangor:  EMMC and Husson College Library

Bar Harbor:  Jackson Laboratory

Biddeford:  SMMC Health Sciences Library

Farmington:  Franklin Memorial Hospital Medical Library

Fort Kent:  University of Maine at Fort Kent Blake Library

Lewiston-Auburn:  Bates College Ladd Library, CMMC Library, Central Maine Community College Library, and St. Mary's Regional Medical Center Health Sciences Library

Orono:  University of Maine Raymond Fogler Library

Portland:  MMC Library, Mercy Hospital Health Sciences Library, and USM Library

Norway:  Stephens Memorial Hospital Health Sciences Library

Rockport:  Penobscot Bay Medical Center Library

Standish:  St. Joseph's College Library

Waterville:  MaineGeneral Medical Center Waterville Library

For more information, contact Diana Sterne at 767-3262 or visit


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