July 19, 2004

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QUALITY COUNTS! Report of Strategic Planning Session
Nearly forty individuals, including thirteen physicians, spent July 13th discussing the future of the "Quality Counts" initiative. This project, led initially by an Advisory Group put together by MaineHealth and Anthem, began in the fall of 2003 to communicate the business case for changing systems of healthcare and to expand on successful efforts to date to improve care across the state.
The strategic planning session, convened by Lisa LeTourneau and facilitated by Jim Kupel and Amy Weinschenk of Crescendo Consulting Group, was designed to determine the future of the project and to seek agreement on its mission and function.  The session objectives included:

  • Agree upon the mission and function of Quality Counts in the future
  • Suggest the organizational structure, capacity and financial model to fulfill the mission
  • Identify existing organizations and individuals who could be approached in developing structure, capacity and finances
  • Develop a short action plan to achieve the first few key objectives

As a result of the day's discussions, a favorable and productive outcome was realized and the Project is likely to continue under a new organizational structure.

The following mission for the Project was adapted from the second Quality Counts Conference Consensus Statement.

     "Quality Counts" is committed to working together across organizations and across communities, to improve healthcare systems and outcomes with the people of Maine and with Dirigo Health to coordinate existing but disparate efforts across the state that support local, patient-centered, and coordinated systems of care AND the resources that support them in order to:  Promote consistent delivery of high quality care, improve access to healthcare and strive to contain healthcare costs.

An organizational objective is comprehensive adoption and assessment of the Chronic Care Model across Maine.

Primary Organizational functions will include:

  • Provide Leadership and Serve as a Change Agent
  • Influence State Health Policy
  • Advocate and Promote
  • Coordination and Inventory of Existing efforts
  • Goal Setting and Prioritization
  • Improve Communications Between and Among Health Care Resources
  • Resource Identification and Gap Analysis
  • Facilitate Technical Assistant, e.g. Training and Education

The group agreed that Quality Counts did not need to be a separate 501 (c) 3 organization to achieve its mission, but did agree it should mirror how several entities are shaped in Maine today.  A broad group of corporators/partners would serve as founding members and a subset of this group would serve as an Executive Board.  The project will need to be housed at an existing 501 (c) 3 organization and several potential "homes" were nominated at the strategic planning session.  MMA's Maine Medical Education Trust is one possibility, although there are several other possibilities.

MMA will continue to inform members of the development of the "Quality Counts" Project through Maine Medicine and Maine Medicine Weekly Update.  The MMA Executive Committee will consider MMA's participation in the project at its meeting on July 28. 

Pharmacy Board Proposes Complete Recodification of Its Rules
The Maine Board of Pharmacy recently has proposed a complete revision of its rules.  The new rules include 5 parts:

  • Part 1, General Information
  • Part 2, Licenses and Registrations
  • Part 3, Operation of Drug Outlets
  • Part 4, Dispensing Prescription Drugs
  • Part 5, License Denial and Professional Discipline

The following chapters are likely of greatest interest to the physician community:

  • Part 2, Chapter 9, Registration of Rural Health Centers
  • Part 3, Chapter 14, Pharmacy Services at Rural Health Centers
  • Part 4, Chapter 19, Receipt and Handling of Prescription Drug Orders

You can find the proposed rules on the web at:  http://www.state.me.us/pfr/olr/bd/PHARMACY/Other/Proposed%20Pharmacy%20Rules3.pdf.

The deadline for written comments is Friday, July 23, 2004.  You may send your comments to Andrew MacLean, Vice President & General Counsel, MMA at amaclean@mainemed.com or you may send them directly to the Pharmacy Board:  Geraldine L. Betts, Office of Licensing & Registration, State House Station 35, Augusta, Maine 04333.

The proposed rule includes one change made at the request of the MMA - the length of PRN refills has been changed from 12 months to 15 months.  Chapter 19, Section 5 will read as follows:

5.  "PRN" Refills of Prescription Drug Orders

A pharmacist may fill a prescription drug order designated "PRN" by the practitioner on an as-needed basis for a period no greater than 15 months from the date written. [return to top]

Regional Public Health Medical Officers: Roles and Responsibilities
Due to questions regarding the duties of the Regional Public Health Medical Officers here in Maine,  MMA thought it might be helpful to share with readers the responsibilities assigned to these physicians.

The officers are expected to provide public health medical consultation services in their region to other health care providers in relation to:  public health emergencies, including bio-terrorism, and other weapons of mass destruction, reportable infectious diseases, outbreaks, and other issues of public health significance.  They are expected to develop and maintain public health liaison relationships with local medical personnel, emergency management agencies, regional public health epidemiologists, emergency departments, primary care providers, schools, etc.  Thy will provide public health and medical consultation to regional medical providers on an urgent/emergent situational basis under the direction of the State Health Officer or the Medical Director of the Office of Public Health Emergency Preparedness.

Northern Regional Medical Officer                       Central Regional Medical Officer
Ronald Blum, MD                                                       Stephen Sears, MD
Milliken Medical Center                                             MaineGeneral Medical Center
66 Sherman Street                                                     6 East Chestnut Street
Island Falls, ME 04747                                             Augusta, ME 04330
Tel:  207-463-2267                                                    Tel:  207-626-1236
email:  rblummd@ainop.com                                  email:  ssears@mainegeneral.org

Western Regional Medical Officer                       Eastern Regional Medical Officer
Kevin Kendall, MD                                                     Peter Millard, MD, PhD
Central Maine Medical Center                                Eastern Maine Medical Center
300 Main Street                                                          489 State Street
Lewiston, ME 04240                                                 Bangor, ME 04401
Tel:  207-795-2200                                                   Tel:  207-973-8386
email:  kendallk@cmhc.org                                    email:  pmillard@emh.org

Mid-Coast Regional Medical Officer                    Southern Regional Medical Officer
Chris Michalakes, DO                                              Jo Linder, MD
Penobscot Bay Medical Center                              Portland Public Health
6 Glen Cove Drive                                                     389 Congress Street
Rockport, ME 04856-4240                                      Portland, ME 04101
Tel:  207-596-8314                                                   Tel:  207-756-8016
email:  cmichalakes@nehealth.org                      email:  jel@ci.portland.me.us

Statewide Tribal Regional Medical Officer
Department of Human Services/BOH
103 Texas Avenue, Room 159
Bangor, ME 04401
Tel:  207-262-1033

The Medical Director's position is currently vacant and has recently been advertised by the State. [return to top]

Maine Receives Top Ranking in Fighting Cancer
In a report released Wednesday, July 14,  Maine was given the nation's top ranking in the ongoing fight against cancer.  The report was prepared by the American Cancer Society and is entitled, "How Do You Measure Up.?" 

Maine was the only state to meet the cancer society's benchmarks in four of five categories.  The categories were:  increasing cigarette excise taxes to fund anti-smoking programs, providing funding for smoking cessation campaigns, ensuring Medicaid coverage for smoking cessation, and mandating insurance coverage for certain routine screenings.

The only benchmark not met involved screening for colon cancer.  [return to top]

Snowe/Collins Support Sought on Latest Medical Liability Bill in Congress
Senator George V. Voinovich (R-OH) plans to introduce a new medical liability reform bill before the August recess and he is seeking the support of his moderate Republican colleagues, including Senators Snowe and Collins, in an effort to bring more Democratic supporters along.  Known as the "CPR" bill ("Comprehensive Provider Relief"), it is essentially the H.R. 5/S. 11 bills that have passed the House and passed the Senate but failed to reach cloture without provisions giving protection to HMOs and pharmaceutical/medical device manufacturers.  Observers in Washington are calling it a "provider only" approach to the liability issue.  The bill still faces a tough road with Senate Democrats who have said that they will only accept a cap on non-economic damages that is much higher than the $250,000 MICRA standard and that includes an exception to the cap for "catastrophic cases."  Still, the AMA and MMA are urging support for the bill to keep the liability issue at the forefront of the health care debate in Congress.

Senator Voinovich is expected to seek co-sponsorship from Senators Snowe and Collins this week.  THE MMA ENCOURAGES YOU TO CONTACT SENATOR SNOWE AND SENATOR COLLINS TO ASK THEM TO CONSIDER CO-SPONSORING THE VOINOVICH BILL!

Senator Olympia J. Snowe, 202-224-5344, olympia@snowe.senate.gov.

Senator Susan M. Collins, 202-224-2523, senator@collins.senate.gov. [return to top]

U.S. Senate Votes 78-15 to Give FDA Regulatory Authority Over Tobacco
On July 15, 2004, the Senate approved an amendment to an export tax repeal bill giving the Food & Drug Administration (FDA) authority to regulate tobacco while also giving tobacco farmers a $13 billion buyout.  The amendment is a combination of a tobacco buyout bill (S. 1490) sponsored by Senator Mitch McConnell (R-KY) and a bill on FDA regulation of tobacco (S. 2461) sponsored by Senator Mike DeWine (R-OH) and Senator Edward Kennedy (D-MA).

The bill would permit the FDA to:

  • require tobacco companies to list all ingredients added by them to the tobacco, paper, and filter of a tobacco product;
  • require tobacco companies to use stronger, more explicit language on tobacco packaging;
  • review the health risks associated with tobacco products;
  • require tobacco companies to submit health information to the FDA about those products claimed by the industry to be safer than ordinary products;
  • determine which tobacco products have lower health risk;
  • establish national product standards;
  • assure that tobacco products are not adulterated; and
  • deter the distribution of counterfeit, contraband, and other illicit tobacco products.

No action has taken place on companion legislation in the House. [return to top]

RAND Corp. Issues Report on California Jury Verdicts Under MICRA
On July 13, 2004, the Rand Corporation issued a medical liability report, Capping Non-Economic Awards in Medical Malpractice Trials:  California Jury Verdicts Under MICRA.  The report is available on the web at:  http://www.rand.org/publications/MG/MG234/MG234.pdf.

Following a study of 257 plaintiff verdicts (195 with non-fatal injury claims and 62 death claims) in medical liability trials from 1995 to 1999, the RAND researchers sought to answer the following questions:

  • How have MICRA's caps on non-economic damages affected the final judgments in California's jury trials?
  • What types of cases and claims are most likely to have an award cap imposed following trial?
  • What have been the effects of MICRA on plaintiffs' attorney fees?
  • What have been the effects of MICRA on plaintiffs' net recoveries (the final judgments minus estimated fees)?
  • If the MICRA cap had been adjusted for inflation, what would have been the effect on the final awards in the trials we examined?

The study concludes that MICRA appears to have succeeded in limiting medical liability defendant's expenditures, but it could not determine whether these savings have resulted in lower liability insurance premiums and greater availability of coverage.  While the study did not attempt to assess the adequacy of compensation, it did identify the types of cases and plaintiffs that lose the most under MICRA.  Also, the study finds that MICRA has has a significant impact on the medical malpractice bar - - plaintiff's attorneys lost 60% of what they would have obtained in fees without the MICRA reforms. [return to top]

Pathways to Excellence: Update
The Pathways to Excellence Steering Committee met in Augusta on July 15 and received updates from Cigna and Anthem on the provider rewards to be associated with provider participation.  The Committee also reviewed preliminary response data from the Phase III Office System Survey, looked at HEDIS based process measures and discussed using practice generated data in future initiatives.  Forty nine% of primary care physicians participated in the Phase III Office System Survey, which was an improvement of approximately 10% from the previous year.  Scores were generally higher than the previous year, with the participants being surveyed on criteria related to the use of technology and other factors.

Primary care physicians will be receiving a letter this week from the project announcing the third of three components of the PTE-Primary Care Initiative.  The Committee is asking for participation in reporting clinical outcomes on diabetic patients or pediatric admissions.  Practices are asked to respond by September 1, 2004.  Enclosed with the letter will be specifications for a set of diabetes indicators for family practice and internal medicine practices (immunizations for pediatric practices) and a data collection tool which outlines how to calculate the metrics requested and the general targets for each indicator for 2004.

The diabetes benchmarks are based on a national effort called Bridges to Excellence.  Further information on the benchmarks can be obtained from:


Data is requested for the last 12 months.  Participants will receive a blinded report of all responses and a practice code to identify the practice.  Participants will also receive a report which displays the format which will be used for public reporting on the project's website.  For this first phase of outcomes reporting, practices will have the opportunity to decide NOT to have their actual results publicly reported.  The outcomes measurement process is expected to be reported on at least an annual basis.

Since the results of the survey will be publicly reported and will influence provider compensation, a percentage of practices will have their work process and results verified by visits from independent nurse reviewers.

Results from the Office Systems Survey, Process Measures based on HEDIS, and Clinical Outcomes as reported to the Maine Health Management Coalition this year will form the basis of eligibility for a 2004 quality bonus from CIGNA.  The bonus will be distributed by the MHMC in December, 2004 for Cigna Healthcare patients.  Current plans are to base one-third of the reward amount based on performance results in each section (Office Systems results, Process measure results, Outcomes participation and results).  Anthem Blue Cross and Blue Shield is also working with the Coalition and is likely to have a bonus compensation program in place soon, if only on an interim basis.  Anthem had hoped to have a provider incentive program in Maine by July 1,2004.  Part of the reason for the delay involved developing an appropriate methodology for attributing patients to a physician and the necessity of Anthem of Maine working with colleagues in New Hampshire and Connecticut in order to have an Anthem East incentive program that is consistent among the three state Anthem Plans.  The amounts of bonus payments by Anthem have not been established.  CIGNA has put  $400,000 into its bonus pool which will be distributed through existing PHO contracts.

Technical or procedural questions may be addressed to Ted Rooney, Project Leader at 729-4929 or trooney@mhmc.info or Jan Wnek, M.D., Clinical Advisory (janicewnek@mhmc,info.)

While the Maine Medical Association neither endorses or opposes the MHMC PTE program, we do believe it is important for members to know of the project and its implications. [return to top]

Commission to Study Maine's Hospitals Focuses on AntiTrust Issues
The Commission to Study Maine's Hospitals met on Monday, July 19th and dedicated the entire morning meeting to the issues of the antitrust laws.  The Commission heard from representatives of the Attorney General's Office and from private anti-trust lawyers in an effort to learn more about ways in which the Commission could move along an agenda of cooperation, collaboration, affiliation and consolidation for Maine's hospitals.

The Commission has expressed interest in regionalized hospital systems and, implicit in that, moving away from hospital to hospital competition toward more regional and statewide collaboration and coordination among hospitals and between hospitals and physicians.

The Commission heard of many barriers to cooperation because of existing state and federal antitrust laws but agreed to put together a working group to discuss possible legislative approaches which might allow for more collaboration and take advantage of what is known as the "state action exemption" to the antitrust laws.  Private lawyers present  noted that federal antitrust enforcement officials interpret the exemption very narrowly and expressed doubt as to whether a legislative approach could gain much flexibility for hospital regionalization.

The Commission will meet again on Monday, July 26 at 9:00am in Augusta. [return to top]

Nomination Season: Volunteers Wanted
The Association's Committee on Nominations will meet on July 28th and will be nominating physicians to hold office in MMA and to fill committee memberships.  The organization is only as strong as its volunteer leadership.  If you or a colleague are interested in being more involved in your medical association, please communicate with EVP Gordon Smith at gsmith@mainemed.com or 622-3374. [return to top]

MMA Committee on Loan and Trust Administration Seeks Medical Student Loan Applicants
The Maine Medical Education Foundation provides low-interest loans to residents of Maine who are attending medical school.  These loan funds are provided courtesy of the many Maine physicians who have contributed to the Foundation over the years.  If you know of a student who may qualify and may need funds, please communicate with Gail Begin at MMA at gbegin@mainemed.com or call Gail at 622-3374.

The Committee which oversees the loans will meet on this Wednesday, July 21 to review applications for this year's loans.  However, the Committee generally sets aside funds, as well, for any late applicants. [return to top]

Bureau of Health, Division of Community Health Announces Grants for Primary Care Practice Sites
The State of Maine, Department of Health & Human Services, Bureau of Health, Division of Community Health is announcing the availability of funding for qualified primary care practice sites.  "Improving Care for Patients with Hypertension and High Cholesterol in the Primary Care Setting",  is seeking providers to promote system change around cardiovascular health.  The Bureau seeks proposals that will test innovative strategies for assisting providers to work as partners with their patients and the community to address hypertension and/or high blood cholesterol.  A bidders conference will be held July 26, 2004 at 1:00pm in room 400, 4th floor Cross Office Building, Augusta.

Letters of intent are required and due by 4:00pm on August 27, 2004 with completed proposals due by 2:00pm Sept. 27, 2004 at Division of Purchases, 111 Sewell St., Burton Cross Building, 4th floor, 9 State House Station, Augusta, Maine 04333-0009. 

Application packets may be obtained by calling Sheri Meucci at 287-4064. [return to top]

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