September 6, 2004

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Dirigo Physicians Meet to Share Ideas
Nearly twenty physicians involved on the various boards and commissions related to Dirigo Health met last Tuesday evening at MMA to compare notes and to discuss the work of each group. Convened at the request of MMA President Maroulla Gleaton, M.D., who is a member of the Health Systems Development Advisory Council, participants included Robert McAfee, M.D., Chairman of the Board of Dirigo and Dennis Shubert, M.D., PhD., Executive Director of the Maine Quality Forum.
The Dirigo Health initiative included establishment of five new  councils or commissions of varying responsibilities and lifespans, each with one or more physician members, some meeting as often as once a week. With such an enormous workload for each committee, communication between committees at the member-level is often non-existent. With this missing piece in mind, the Maine Medical Association brought together all of the physicians associated with Dirigo Health last week to allow them to share information and ideas with their colleagues on the progress of their piece of the pie.

Dr. Robert McAfee, Chair of the Dirigo Board, reviewed for the group some of the more salient points of the recent agreement signed with Anthem to create an insurance product. It covers all prevention at no cost to the policy holder; It includes mental health parity; It allows for a subsidy for qualifying individuals and their families (a family of four could earn $56,000/year and quality for the subsidy, and an individual, $29,000); It includes wellness incentives for both the patient and the provider (i.e. discounts on gym memberships, bicycle helmets). Dr. McAfee was impressed with the commitment on Anthem's part and noted that they had set aside $500,000 to give as bonuses to sales and marketing staff to bring in previously uninsured individuals and businesses.
The product is expected to be rolled out in January.

Physicians from each of the other commissions briefed attendees on the status of their work. Lani Graham, MD, reported for the Health Systems Development Advisory Council that the State Health Plan had been submitted for one year and would become a true biennial plan next year. They were late getting started and felt that a one-year plan would give them more time to create a more comprehensive state health plan, as was expected of them. Bob McArtor, MD, and Dennis Shubert, MD, briefed the group on the work of the Maine Quality Forum, which has been funded with $1m from the state. They are working on a website for consumers to research and compare providers in Maine. They also have made electronic medical record systems a priority and are looking at nurse-patient ratios. Larry Mutty, MD, updated the group on the work of the Veterans Task Force, noting that many physicians are unaware whether their patients are veterans or not, something which if fixed could increase their access to prescriptions through the VA program. Both Dr. Hanson and Dr. Cutler reported from the Hospital Study Commission, which has recently circulated a very rough draft of their work, including papers on governance and the payment system. Both noted that some of the concepts included in the paper and reported on in the press had actually not been covered by the commission. Their report is due to the Legislature and the Governor in early November.

The group was pleased to be able to meet and find out what their counterparts on the various commissions were doing. There was general agreement that many of them only hear about the other commissions through the MMA's weekly email update.  Participants seemed interested in meeting again and a date will be set for mid to late Fall.

State Hires Lani Graham, MD, for Emergency Preparedness
Lani Graham, MD, MPH, has been hired by the state to be the Medical Director of the Bureau of Health's Office of Public Health and Emergency Preparedness starting this week. This is a part-time position. Her primary responsibility will be to work with the Regional Medical Officers to enhance emergency response capacity through strengthening Maine's public health infrastructure and integrating it with the Maine health care system.

Dr. Graham is a native of Maine and previously directed the Bureau of Health for six years. She was also the Director of the Division of Disease Control for four years prior to that. More recently she has continued her public health work as a volunteer and consultant. A graduate of the Medical College of Pennsylvania, the Tulane School of Public Health and Tropical Medicine, she is board certified in Family Practice.

Dr. Graham is a longstanding member of MMA and we extend our heartiest congratulations to her on her appointment. [return to top]

Newest MMA Membership Benefit is Group Dental Insurance
MMA is pleased to announce its latest member benefit:  a group dental offering through Anthem and brokered through HRH (formerly the Dunlap Agency).  The Committee on Membership and Member Benefits, chaired by Kevin Flanigan, M.D. of Pittsfield, has considered the addition of such a benefit for some time, but beginning early this year explored in depth the options available.  Two firms made proposals, Anthem and Dental Dental.  The Anthem offering was deemed to be superior to the Delta Dental proposal and the Committee and subsequently the MMA Executive Committee approved the offering of the benefit.  Fifty covered lives were required to enroll in order for the plan to be established and that minimum number of participants was achieved through the efforts of HRH, particularly Judy Conley. 

All MMA members, their staff and families of members and staffs are eligible.  For more information, contact Judy at 1-800-479-3041 or 657-3040 ext. 143. [return to top]

President Gleaton Speaks to Augusta Kiwanis on Health Care Costs and Challenges
Maroulla Gleaton, M.D., President of MMA spoke to the Augusta Kiwanis Club on August 19th and presented an overview of health care, health care costs and healthcare reform efforts in Maine.  Among the facts she cited:

  • Healthcare spending in Maine in l998 was $5 billion - or 15.5% of the gross state product.  In 2004, only 6 years later, healthcare spending in Maine is $7.7 billion or 17.9% of the gross state product.
  • Despite this very sgnificant level of spending, 1 in 8 people in Maine have no health insurance - about 136,000 persons, at any one time.  Over eighty % of these uninsured persons are working.
  • Between l991 and l998, Maine's per capita healthcare spending increased faster than any other state in the nation.  Maine is now in the top ten states in terms of per capita spending on healthcare.  Maine is sixth in the nation relative to health care spending as a share of personal income.
  • Between l996 and 2002, the cost of a family policy for Maine businesses and employees increased 77%.  Yearly increases continue to be in double digits - despite a modest slowing of the costs of medical care nationally.

Dr. Gleaton noted the attempt through the Dirigo legislation to expand access, control costs and improve quality.  She also shared the MMA's view that only through compulsory health insurance could the number of insured be significantly decreased.

Dr. Gleaton also noted the limited impact that health care per se has on a person's health, with the alternative factors of genetics, social issues, the environment and personal responsibility having a much greater collective impact.

On the issue of quality, Dr. Gleaton stated that most physicians acknowledge that medicine needs to improve the quality and consistency of the care delivered.  She discussed the important role that technology could play in reducing errors and in improving quality.  She also discussed the need for more liability reform. 

Copies of Dr. Gleaton's entire remarks are available from MMA by calling 622-3374 (Julie or via e-mail to [return to top]

Dirigo Health Meetings this Week
The Commission to Study Maine's Hospitals will meet on Tuesday morning, Sept. 7, at 9:00am  at the Department of Human Services building on Civic Center Drive in Augusta.  The Commission can be expected to consider any recommendations from the two subcommittees that met last week, one working on rule chapter 850 and the other working on anti-trust issues. 

The Dirigo Health Board of Directors will meet for its regular monthly meeting at 9:00am on Tuesday, Sept. 7 at 211 Water St., Augusta.

The Maine Quality Forum Advisory Council will hold its regular monthly meeting on Friday, Sept. 10 at the Dirigo Health offices at 211 Water St., Augusta.

Because the meeting schedule can change quickly, persons attending should check in on the website to see if the scheduled meeting is occurring at the time and place indicated.  The Dirigo web site is at [return to top]

Eight Resolutions to be Considered at 151st Annual Session this week in Kennebunkport
MMA members and committees have submitted eight resolutions to be considered at the general membership meeting being held this Saturday morning, Sept. 11, in connection with the MMA's 151st Annual Session which convenes at noontime on Friday.  All sessions will be held at the Colony Hotel in Kennebunkport.  Over 300 members, guests and exhibitors will be in attendance.  There are just a couple rooms left in  the hotel if you are interested in attending and staying overnight, but many other accommodations are available in the area.  In addition, day-trippers are more than welcome and an equitable per day registration fee is available.  Nine and one-half hours of CME are also being presented on topics relating to the use of technology in medical practice.

The text of each resolution will be available by Wednesday (call MMA at 622-3374 or e-mail Anna Bragdon at, but the general thrust of each resolution is as follows:

  • Resolution Supporting a Primary Seatbelt Law in Maine.  Submitted by the MMA Public Health Committee.  This Resolution asks that the MMA pro actively advocate for passage of a primary safety belt law in Maine. Existing Maine law provides only for secondary enforcement of the seatbelt law, meaning that a police officer can only cite a motorist for failure to wear a seat belt if the motorist is stopped for some other reason.
  • Resolution Supporting the Renewal of the Federal Assault Weapons Ban.  Submitted by the MMA Public Health Committee.  This Resolution asks that MMA support the renewal of the assault weapons ban at the federal level, advocate for the ban before Maine's Congressional Delegation as well as throughout the medical community and promote the passage of a state assault weapons ban before the Maine legislature in the event that the federal law is not passed.
  • Resolution Supporting the Required Use of Motorcycle Helmets.  Submitted by the Public Health Committee.  This Resolution asks that the MMA support legislation to require all users of motorcycles in the State to wear helmets while riding.
  • Resolution Supporting the APHA (American Public Health Association) Position on Nuclear Weapons.  Submitted by the Public Health Committee.  This Resolution asks that the MMA support an APHA Resolution calling upon the United States government to : 1. explicitly reaffirm its historical commitment to international treaties aimed at curbing the development and proliferation of nuclear weapons and all other weapons of mass destruction, and 2. abandon plans to modernize its nuclear weapons arsenal and to abandon its plans to initiate a new era of nuclear testing, and 3. to reverse its new doctrine of pre-emptive war in favor of internationally sanctioned approaches towards resolving conflicts through negotiations under the auspices of peaceful global mechanisms such as afforded by the United Nations.
  • Resolution Supporting Water Quality in Substandard Rivers in Maine.  Submitted by Gregory D'Augustine, M.D. and the Public Health Committee.  This Resolution calls upon MMA to support legislation and other efforts designed to quickly improve water quality in the Androscoggin and St. Croix rivers so that they meet or exceed Class C standards under the Clean Water Act of l972.
  • Resolution to Reduce Medicaid Expenditures without Reducing Reimbursement to Providers.  Submitted by Kevin Flanigan, M.D.  This Resolution calls upon MMA to address with the legislature the eligibility requirements for medicaid, particularly addressing residency requirements.
  • Resolution to Initiate a Campaign for Further Professional Liability Reform in Maine.  This Resolution asks that MMA, in partner with other allies, embark on an aggressive campaign to secure more professional liability reform in Maine, including a limit on non-economic damages.
  • Resolution Advocating for a State CDC within DHHS. Submitted by the Public Health Committee.  This Resolution calls upon MMA to advocate and lobby for the creation of a high-level CDC within the new DHHS, in order to elevate the status of public health within the newly merged Department.

These Resolutions, as well as proposed amendments to the Constitution and Bylaws and the election of MMA officers for the year, will take place at the general membership session beginning at 8:30am on Saturday morning, Sept. 11.  There is no charge for attending the general membership meeting.  Congressman Thomas Allen will address members at 8:45am.   The general membership session is scheduled to conclude by noon, as CME sessions begin again at 1:00pm.  The Association's Annual Dinner, where President Maroulla Gleaton, M.D. will pass the gavel to President-elect Larry Mutty, M.D. will take place Saturday evening.

We would love to have you join us at the Colony!


  [return to top]

Celebrate One Hundred Fifty Years of Medicine in Northern and Eastern Maine
As we have noted before in the Weekly Update, 2004 marks the one hundred fiftieth anniversary of the Penobscot County Medical Association, the Association having been the first County Medical Society organized in the State in 1854.  It is remarkable that the Association has met continually for a century and a half.

On Saturday evening, Sept. 18th, the remarkable work of the physicians of Penobscot County, and adjacent counties, will be recognized in a Sesquicentennial Gala at the Maine Center for the Arts on the University of Maine campus in Orono.  The evening will consist of a reception beginning at 5:30pm, a dinner at 7:00pm and a program at 8:00pm.  Tickets are available for the modest sum of $50 each and the 8:00pm program is open to the public, without charge.  At the program, a video will be unveiled commemorating the history of the Society and a number of "Sesquicentennial Physicians" will be recognized.  Among physicians to be recognized are Fred "Doc" Pritham (and the subsequent three generations of Dr. Prithams following Doc), George Wood, Thomas Palmer, Warren Strout, George Bostwick, Charles Lightbody, Linus Stitham, Robert MacBride, Francis Schumann, Hadley Parrot,  Rowland French, James Bates,  and several medical families (along with the Prithams) including the Shuberts, the Moultons, the Strouts, the Cutlers, the Boones and the Woodcocks.

The program will be narrated by former AMA and MMA President Robert McAfee, M.D., MMA President Lawrence Mutty and MMA EVP Gordon Smith.  Richard Long, M.D., current President of the County Society will also be present to assist. 

The reception will include access to the Hudson Museum and a silent auction and historical exhibits. The Hudson Museum is the only Museum of non-Western cultures in Maine. 

Please join us for the important evening, in recognition of those who have walked the walk before us.  If you have lost your invitation, call MMA at 622-3374 to secure your attendance. Sponsorship opportunities are available, as well.  Also watch for a special Bangor Daily News Supplement to be published on Wednesday, Sept. 15 promoting the event and including much of the historical information. [return to top]

How Many Physicians are Practicing in Maine?
The state Office of Data, Research, and Vital Statistics within the Bureau of Health recently released a summary of its physician surveys, from 2002.  The data shows that in 2002, 3,119 physicians worked in Maine: 2,736 allopathic physicians and 383 osteopathic physicians.  This resulted in a ratio of 1 physician for every 415 Mainers, a ratio significantly smaller than in l992 when there was 1 physician for every 528 residents.

Although the rate of physicians to the population in Maine was smaller than in l992, Maine's rate was still significantly higher than the U.S. rate of 1 physician for every 319 residents.

During 1992-2002, two counties had an increase in the ratio of physicians to population.  Sagadahoc county had the biggest increase with 1 physician for every 790 residents in l992 compared to 1 physician for 1028 residents in 2002.  Oxford county had 1 physician for every 835 residents in l992 compared to 1 physician for 927 residents in 2002.  Washington county had the biggest decrease in ratio, where the number of residents served by each physician went from 945 to 484.

Beginning in July of 1997, the Federal J1 Visa program, developed to bring physician to underserved areas, began in Maine.  Through the program, foreign trained physicians were placed in underserved areas for a three to six year obligation.  By Dec. 2002, 69 physicians had been placed in Maine; 52 were still practicing here, but 17 had relocated.

For further data on this topic, contact the Office of Data, Research and Vital Statistics at 207-287-5500 (Kim Haggan) or visit their website at [return to top]

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