August 30, 2004

 
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Public Health Physicians Meet with Governor Baldacci
A group of physicians representing MMA's Public Health Committee met with Governor John E. Baldacci on Friday to discuss a number of resolutions on public health measures being considered by MMA members at the upcoming Annual Session Sept. 10-12.
A contingent of physicians representing the Maine Medical Association's Public Health Committee, including Erik Steele, DO, Jacob Gerritsen, MD, and our president Maroulla Gleaton, MD, met with Governor Baldacci on Friday.  The purpose of the meeting was to discuss the various resolutions that the committee is bringing to the MMA's General Session at the Annual Meeting September 11.

The three issues that we brought to his attention were the need for a primary seatbelt enforcement law, a motorcycle helmet law, and a continued ban on assault weapons. The Governor spent an hour with the group and felt that these were three quite substantive issues and advised us to only take one on at a time.  He felt that of the three resolutions, he could be most supportive of a primary seatbelt enforcement law in Maine. The cost in lives and the potential for savings to the state were compelling arguments.

While it was clear that the Governor thought the primary seatbelt law had greater chance of passage than the motorcycle helmet law, Dr. Steele did take the opportunity to make a pitch to the Governor that he be more public in his encouragement of helmet use.  The Governor in turn asked that we continue to be supportive of gun legislation which targets domestic violence.

The Governor also discussed MMA's role in his Dirigo Health initiative.

Future of Bond Bills Uncertain
The Legislature met this week to act upon various nominations made by the Governor since the end of session.  The talk, however, was all about whether there would be agreement between the Democrats and the Republicans over the future of the bond bills. Right now, the two parties remain at a stalemate.  There isn't much time left to act because the Secretary of State has said he needs the ballot questions by the end of the month.  Don't bet the farm on legislative approval of a bond package this Fall. [return to top]

Phil Elkin, M.D. Appointed Chair of Provider Group for MQF
At a meeting of the Maine Quality Forum Provider Group on Thursday afternoon, 8/26/04, MQF Chair Robert McArtor, M.D. announced the appointment of Phil Elkin, M.D. as Chair of the Provider Group.  Dr. Elkin is an active primary care physician in the Blue Hill area.  The MQF Provider Group is an important sounding board for the MQF that will react to proposals of the MQF from a provider perspective.  The MQF Provider Group is composed of physicians, physicians' assistants, nurses, and mental health professionals.  The rest of the Provider Group meeting was devoted to a discussion of the nurse staffing ratio study required by L.D. 616. [return to top]

Maine Physicians Meet with Aetna's National Medical Director, Bill Popik, M.D.
Last Wednesday evening, Aetna's Maine leadership hosted about a dozen Maine physicians representing primary care and specialty practices from around the state at a dinner meeting with Aetna's national Medical Director, William C. Popik, M.D.  Dr. Popik is a primary care physician and a member of the American Academy of Family Practice.  The group heard presentations from MMA President Maroulla Gleaton, M.D. on the MMA's work and priorities and from Lisa Letourneau, M.D., M.P.H. on the Quality Counts! initiative.  The group discussed health care quality and information technology issues, Maine's Dirigo Health Plan, and other issues of importance to health care practitioners and policymakers in Maine.

The meeting was evidence of Aetna's new efforts to improve its relationship with physicians and organized medicine, in the aftermath of the settlement of the class action lawsuits brought against the company by physicians and physician organizations three years ago. [return to top]

Information on Prescribing for Controlled Substances by Physician Assistants and Nurses in Advanced Practice

Submitted by Noel J. Genova, MA, PA-C

President-Elect, Downeast Association of Physician Assistants.

As a primary care PA, I am occasionally asked by local specialty physicians to take over prescribing of stable, shared patients’ Schedule II medications.Examples include stimulants to treat ADD, or opiates to treat chronic pain.These physicians are surprised when I tell them that I cannot write Schedule II prescriptions.The confusion arises because of differences in rules for NPs and CNMs, and PAs,and even differences in privileges within the professions.Our shared patients deserve accessible care, delivered with an understanding of these rules.

PAs and their supervising physicians (if MDs) must petition the Board of Licensure in Medicine, on the appropriate form, for Schedule II prescribing privileges.The relevant rules, and the form, are available on the BOLIM’s website at www.docboard.org.(PA/DO teams should check with the Osteopathic Board.)Questions may be directed to Dan Sprague, Assistant Executive Director, at 207-287-6930.His e-mail address is dan.sprague@maine.gov.

To date, five Physician/PA teams have been granted Schedule II prescribing privileges.The PA must demonstrate adequate training and continuing education on the medications used, and the disorders for which the medications are prescribed.

Unlike PAs, whose practice is regulated by either the BOLIM or the Board of Osteopathic Licensure, NPs and CNMs derive their prescribing privileges from the State Board of Nursing.NPs or CNMs practicing under delegation from physicians licensed by the BOLIM may not prescribe Schedule II medications.NPs or CNMs who are not practicing under physician delegation may prescribe Schedule II medications as long as the following requirements are met:

  • The NP or CNM must be approved to practice as an advance practice registered nurse by the Maine State Board of Nursing.
  • The bylaws of some institutions require that employed NPs and CNMs practice under physician delegation, and not as independently licensed providers.Physicians with questions on this issue should contact the Board of Medicine or the Maine Medical Association.NPs or CNMs with questions should contact the Board of Nursing.
  • The NP or CNM must practice within her/his scope of practice, as approved by the Board of Nursing.
  • The NP or CNM must have obtained a DEA number covering Schedule II prescriptions from DEA.

A word of caution regarding DEA approval to prescribe Schedule II medications—prescribing authority derives from state authority, not DEA authority.Therefore, whether the prescriber is a PA, NP, or CNM, simply obtaining DEA approval to prescribe Schedule II medications is necessary, but not sufficient, for initiating writing of these prescriptions.

Thanks to Dan Sprague, and to Virginia deLorimier, Assistant Executive Director of the Maine State Board of Nursing, for their help with this article.Mr. Sprague’s contact information is listed above.Ms. deLorimier can be contacted at 207-287-1147, or 1133.Her e-mail address is Virginia.e.delorimier@maine.gov.

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Update on Commission to Study Maine's Hospitals
The Commission to Study Maine's Hospitals continues to meet every Monday (it will meet next Tuesday because of the Labor Day holiday).  At the meeting on this Monday (8/30), the Commission divided into two subcommittees, one dealing with issues regarding Bureau of Insurance Rule 850, and the second focusing on regionalization/anti-trust issues. 

The anti-trust group, which included Drs. Cutler and Hanson, struggled with the issue of how much regulation would be required by the federal enforcement officials in order to permit hospitals in Maine to engage in collaborative activities that would otherwise be considered violations of the anti-trust laws.  Commission Chairman William Haggett has made it clear in his remarks that he favors a very minimal regulatory approach, presumably only as much as is absolutely required.

The anti-trust subcommittee also struggled with whether to include regionalization as a topic for this subcommittee.  Staff to the committee had prepared an agenda for the meeting which included regionalization, and which even went so far as to present for discussion an option involving setting targets for revenue growth for hospitals within each region.

Subcommittee members discussed with hospital representatives the types of cooperative activities the institutions would like to have which are currently not pursued because of a fear of the anti-trust laws.  Among the activities identified were allocating services and partnering with physicians and physician entities.

The Commission, while it has had several meetings and lots of discussion, has not yet made a single recommendation.  Several draft papers have been circulated, involving the topics of Regionalization, "Cooperation, Collaboration, Affiliation and Consolidation'", Economic Impact, Governance and the Payment System.  These are all draft documents, but have been circulated widely enough outside of the Commission that MMA feels comfortable sharing the drafts with members.  Call Julie Banta at 622-3374 or e-mail her at jbanta@mainemed.com if you would like a copy of the drafts. [return to top]

Congress Returns to Unfinished Business
Congress returns to Washington on Sept. 7, following a month-long recess with a number of unfinished issues of concern to physicians.  With only 20 legislative days remaining and the majority of Congress focused on Election Day,  resolution of key issues, such as medical liability reform, and Medicare physician payment, is unlikely. 

Progress on medical liability reform has completely stalled in the Senate and will likely not be readdressed until the beginning of the 109th Congress.  Physicians, however, do have reason to hope that patient safety legislation will be sent to President Bush this year for his signature.  Prior to the August recess, the Senate unanimously passed S. 720, the "Patient Safety and Quality Improvement Act."  The legislation, which is in response to a 1999 Institute of Medicine report, would establish organizations to which physician and other health care providers could report medical errors without fear of retribution.  The information would be collected and used to develop best practices and procedures to help avoid similar errors.  In March 2003, the House passed the companion legislation, H.R. 663, by a vote of 418 to 6.  The legislation awaits a House-Senate conference to work out the differences between the two bills.  Despite the limited number of legislative days remaining in the 108th Congress, this is the closest Congress has come to passing legislation addressing this important topic. [return to top]

Maine Physicians for Medical Liability Reform to Meet at MMA Sept. 14
Leaders of Medical Specialty Societies in Maine have been invited to a meeting to be held at MMA on Tuesday evening, Sept. 14 to discuss the formation of a new campaign aimed at enacting liability reform in Maine. Lee Thibodeau, M.D., a Portland neurosurgeon will share the campaign which will be led by MMA with  important assistance from Medical Mutual Insurance Company of Maine, the Maine Hospital Association and the Maine Osteopathic Association.  All physicians will be asked to assist.  If you would like to be included in this inaugural meeting, contact Diane McMahon at 622-3374 or via e-mail at dmcmahon@mainemed.com.  The meeting will be held at the MMA office in Manchester.  Dinner at 6:30pm with the meeting beginning at 7:00pm. [return to top]

151st Annual Session to Consider Resolutions and Constitutional Amendments
The Association's 151st Annual Session, being held this year at the Colony Hotel in Kennebunkport  Sept. 10-12 will feature nine and one-half hours of CME as well as the usual items of business including 6 to 8 resolutions and an important constitutional amendment which would de-link MMA and the county medical societies.  Please make an effort to attend.  The business meeting, at which time the resolutions will be considered and the amendments voted upon,   There is no charge for attending just the general membership meeting which will held on Saturday morning, Sept. 11.

There are only a few rooms left in the hotel.  If you would like one, contact Diane McMahon at MMA at 622-3374 or via e-mail at dmcmahon@mainemed.com. [return to top]

Historical Moments: Nov. 13th, 1877
On Nov. 13th, 1877, Ralph K. Jones, M.D., President of the Penobscot County Medical Association, presented an annual address to members of the Association entitled, "The Dangers to the Profession from Malpractice Suits."  Wonder what Dr. Jones would think about the liability climate today.

Dr. Jones and other colleagues will be honored as part of the Anniversary Celebration of the County Society and MMA being held on Saturday evening, Sept. 18th at the Maine Center of the Arts in Orono.   A great night is planned, recognizing physicians with names like Woodcock, Shubert, Wood, Palmer, Stitham, Pritham, Lightbody, Schumann, MacBride, Robinson, Moulton, Larson and others.  Over 400 persons attended a similar event in Portland last Fall.  This event is focused on the history of medicine in Northern and Eastern Maine.  For more information, or to obtain a ticket, call Chandra Leister at 622-3374 or via e-mail at cleister@mainemed.com. [return to top]

MMA First Annual Charitable Golf Tournament An Unqualified Success
Sunny skies, a quality golf course in great shape, and over 90 enthusiastic golfers all combined to make the Association's First Annual Charitable Golf Tournament a success. The tournament was held this Monday at the Augusta Country Club and proceeds benefited the Physician Health Program.  Governor Baldacci played, anchoring a Dirigo Team consisting of Dr. Bob McAfee, Dennis Shubert, M.D., Tom Dunne and the Governor.  13 -time Maine Amateur Champion Mark Plummer also played in the tournament which was chaired by Dr. Brian Jumper.

Results of the tournament will be shared in Maine Medicine.  Thanks to our sponsors which included Anthem, Pfizer, Lightship and H.M.Payson.  Sam Surprise was voted best-dressed, with David Simmons, M.D a close runner-up.  Both looked better than they played.

Planning will start immediately for next year's tournament and a date will be announced in October.  Thanks to all the players, MMA staff and the sponsors which made the event a success. [return to top]

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