November 1, 2004

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Professional Liability Reform Coalition Holds Press Conference

As noted in last week's Maine Medicine Weekly Update, The Coalition for Health Care Access and Liability Reform (CHCALR) held a press conference in Portland this past Thursday to announce formation of the coalition and its agenda for professional liability reform.   Over fifty medical students, residents and physicians attended to hear presentations by Lee Thibodeau, M.D., Chair of the coalition,, Jacob Gerritsen, M.D., President-elect of MMA, Thomas DeLuca, D.O., President-elect of the Maine Osteopathic Association and William Strassberg, M.D., President of the Maine Society of Orthopedic Surgeons.  Nineteen organizations participated in the press conference including the Maine Hospital Association and fourteen medical specialty organizations.

The Coalition purchased nearly full-paid advertisements in the state's leading newspapers announcing the effort on Wednesday and Thursday.  The theme of the ads centered around the potential unavailability of critical medical services if the liability issue was not addressed.  The primary reform being sought by the Coalition is the establishment of a limit on non-economic damages in professional liability cases of $250,000.

Organizations involved in the coalition will meet with MMA's legislative committee on Tuesday evening, November 9 to continue the work on this effort.  The meeting will be held at 6:30pm at the Frank O. Stred Building in Manchester.  Any MMA member wishing to attend may RSVP to Charyl Smith at or simply call MMA at 622-3374.  Dinner will be available at the meeting.  Note the related article in this newsletter containing the full agenda for the meeting.

Bureau of Health Continues to Deal with Flu Vaccine Shortage
The Bureau of Health continues to try  to get a handle on the amount of flu vaccine available in the state and direct it toward the most high-risk individuals. The Bureau has been asked by the medical community to narrow their recommendations in order to give physicians more guidance in choosing the priority order for access to the vaccine. These recommendations are expected early this week..  The same advisory will include recommendations on antiviral use and flu testing guidelines.

While there has been some talk in the country about purchasing a supply from Canada, the Bureau warned that the Canadian vaccines are not FDA-approved. If your patients are going to Canada to get their vaccine, tell them not to bring the vaccine back but to instead have it administered by a Canadian doctor. It is not realistic to think that our shortage can be addressed by a Canadian supply.  However, after a Wednesday meeting of health provider organizations with the Bureau, on Thursday the U.S. Department of Health and Human Services announced on Thursday that it could import as many as 5 million doses of flu vaccine from Germany and Canada by mid-December.  This announcement will presumably modify the Bureau's recommendations with respect to vaccine acquired in Canada.

The Bureau is working with the provider professional associations to get their health alerts to adult providers. At present, their system is set up to fax only to the pediatric community. For up-to-date information on the flu vaccine, go to

The Bureau plans to release a flu vaccine redistribution plan next week, the plan having been delayed pending completion of an accurate inventory of vaccine.  The inventory process was facilitated this week when the CDC allowed the state to access Aventis' list of vaccines supplied to each Maine provider.

The Bureau has ordered FluMist for healthcare workers, with between 1,500 and 3,000 doses expected. 

The Bureau considered imposition of an Executive Order directed at health professionals which would have  required adherence to BOH recommendations, record keeping and potentially financial penalties.  MMA, MOA and MHA all spoke strongly against such an Order at Wednesday's meeting and the Bureau seemed to take the comments to heart.  One of the purposes of the Order was to deal with perceived liability issues for physicians who had to make difficult choices among patients, but attorneys for the associations noted that adherence to the state's or CDC recommendations would provide the same protection as an Executive Order, and that the Executive Order would be seen as punitive by many physicians.  In the absence of reports of misuse of vaccine, the order was simply not seen as necessary.

The Bureau will, however, issue an emergency rule amending the current immunization  requirements for healthcare workers to make clear that facility requirements for vaccinating employees would be subject to any potential contrary order by the Bureau.  All organizations at Wednesday's meeting were in agreement with this amendment to the current rule. 

As of this week, no cases of influenza had been reported in Maine, although New Hampshire and Rhode Island reported sporadic activity.


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BMS Issues PDL Update Alerts
The Bureau of Medical Services is improving its alert system to providers who have access to the Internet. They will begin this week to email notices of changes to the Preferred Drug List as they occur. To sign up for those email alerts, go to, click on MaineCare Pharmacy Services on the left. Scroll down to GHS Pharmacy Services Newsletter/Alert. They have also created a PDL Tracking Changes sheet which can also be found on the GHS website. [return to top]

Prior Authorization Subcommittee Sees Positive Changes
The Prior Authorization Subcommittee continues to work to improve the PA process for providers and MaineCare members. This week, they met with the GHS website staff, along with BMS, to address the need to make changes to the provider website ( GHS agreed to the following changes: (1) They will put a link from the PDL to the correct form. For the hard copy they will list the correct form and number them; (2) They will more quickly update the forms when changes are made to the PDL; (3) They will put together a short online training document on prior authorization for providers; (4) They will mark the most current PDL "current" unlike now where it says 7.01.04; (5) They will make the PDL sortable; (6) They will send email alerts to providers who sign up, making them aware right away of approved changes to the PDL.

BMS also announced to the group that the cost of the anti-psychotics went up 15 percent after the Bureau no longer required a PA for them. The Psychiatry Working Group is looking at the numbers and will make a recommendation to the Bureau. For now, the Bureau will continue the program and not require the PA.

One member noted a problem with week with the requirement of a new approval if the patient took advantage of the mail order option.  Use of the existing form, re-faxed to Goold with an appropriate comment that mail order is being used, will be permitted. [return to top]

Jude Walsh Leaves BMS for Governor's Office; Chris Gianopoulos named Acting Director
Jude Walsh, currently the Director of the Division of Health Care Management and Member Services for the Bureau of Medical Services, will begin her new job as the Special Assistant to the Governor for Pharmacy Services starting Monday. The State will post the Director's position, which oversees the prior authorization program for the state. Jude will continue to sit on the Drug Utilization Review Committee.

Christine Zukas-Lessard has returned to her former position at the Bureau and Chris Gianopoulos has been named acting Director.  Chris was formerly the Director of the Bureau of Elderly and Adult Services. 

MMA staff will be meeting with Ms. Gianopoulos on Thursday to discuss issues of  particular interest to physicians pending at the Bureau, including the medicaid fee schedule and prior authorization in the MaineCare drug program. [return to top]

MMA Legislative Committee/Liability Coalition Meet at MMA on 11/9


The MMA Legislative Committee, chaired by Katherine S. Pope, M.D., will meet at the MMA office at 6:00 p.m. on Tuesday, November 9, 2004 to begin planning the Association's legislative agenda for the 122nd Maine Legislature that will start work in Augusta in early January 2005. 

The Legislative Committee will be joined by the Coalition for Health Care Access & Liability Reform because a focus of the next legislative agenda will be the liability reform effort. 

The Legislative Committee welcomes any physician with an interest in advocacy to attend.  As you may remember, any physician may participate in the weekly conference calls in which the Legislative Committee develops a position on each bill identified by the MMA staff as relevant to the practice of medicine in Maine.  Representatives of each organized specialty society in Maine also are encouraged to attend this meeting and to participate in the MMA's advocacy. 


Dinner will be available at 6 p.m. and the meeting should run from approximately 6:30 p.m. to 8:30 p.m.  If you would like to attend, please contact Charyl Smith, Legislative Assistant, at or by phone at 622-3374.  If you have further questions about the agenda for this meeting or the MMA's advocacy activities, please contact Andrew MacLean, Vice President & General Counsel, at

A draft agenda for the meeting appears below:






Frank O. Stred Building, Manchester, Maine

Tuesday, November 9, 2004




1.            Welcome and Introductions (Dr. Pope, Chair)


2.            Administrative Items (Dr. Pope)


        Update email addresses for Political Pulse

        Legislative Committee meetings:  monthly on Tuesday, 6-9 p.m. at MMA; Proposed dates:  1/11, 2/8, 3/8, 4/12, 5/10 (second Tuesday)

        Legislative Committee conference calls:  Wednesdays in weeks when Committee doesn't meet in person, 7-8 p.m. (conference call number:  800-989-2842, code 6223374)

        Political Pulse publication begins Friday, 1/14

        Doctor of the Day Program

        Physicians' Day at the Legislature:  Wednesday, March 23, 2005

        Likely bill cloture deadline:  Friday, December 17, 2004


3.         Review of 2004 Election Results (Mr. Smith/Mr. MacLean)


4.            Discussion of key issues before Commission to Study Maine's Community Hospitals (Dirigo initiative) (Dr. Cutler)


5.         Update on Maine Quality Forum activities (Mr. Smith/Mr. MacLean)


6.         Update on Coalition for Health Care Access & Liability Reform (Dr. Thibodeau & Mr. Smith)


        Kick-off ads & press conference of October 28, 2004

        Bureau of Insurance study

        Communication with Maine Trial Lawyers Association

        Content of Coalition bill


7.         2006-2007 Biennial State Budget (Mr. MacLean)


8.            Anticipated Legislation from Others of Interest to MMA (Mr. MacLean)


        Baldacci Administration health care package:  primary seat belt enforcement, new Dirigo proposals - CON

        MaineCare Advisory Committee's DUR/PDL proposal

        Bureau of Health:  maternal death registry, child safety package

        Maine Rivers:  water quality standards

        Maine Coalition on Handgun Violence:  assault weapons ban

        Maine Coalition on Smoking OR Health:  ?

        Standards for brain donations


9.            Discussion of potential MMA/specialty society legislation for the 122nd Maine Legislature - other than medical liability reform (All)


        MaineCare reimbursement rates

        NP/PA prescribing authority

        Anthem confidentiality agreement


10.       Other


11.       Adjourn


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Anthem, Inc. Earnings Rise 23% in Third Quarter; Company Seeks Rate Increases in Maine
Growing enrollment in its national health insurance plans drove earnings at Anthem, Inc. up 23% during the third quarter, the company announced last Wednesday.  The company, the fourth-largest health insurance company in the country, earned $242.1 million, or $1.70 per share, for the three months ending Sept. 30, compared with $196.5 million, or $1.38 per share, for the third quarter of 2003.  Revenues rose 13% to $4.8 billion from $4.3 billion.

The Maine Bureau of Insurance has announced two separate public hearings to review the company's requests to increase rates on its Companion Plan Medicare supplement product and its individual HealthChoice products.  Companion Plan is Anthem's supplement to Medicare.  The proposed increase in Anthem's individual rates will affect subscribers in HealthChoice, and HealthChoice standard and basic plans.  HealthChoice is Anthem's individual PPO product.

Anthem is requesting an average rate increase of 5.8% for its Companion Plan Medicare supplement business.  Proposed increases vary by plan from 4.3% to 6.8%.  The proposed rate increase will affect approximately 40,876 subscribers.

The Companion Plan public hearing will take place at 1:00pm on Thursday, Nov. 4, 2004 in the Kennebec Room of the Maine Department of Professional and Financial Regulation office building, Gardiner.

Anthem is also requesting an average rate increase of 14.7% for its individual HealthChoice products.  However, proposed rate changes vary by plan from a decrease of 4.7% to an increase of 106.5%.  The proposed rate increase for HealthChoice will affect approximately 19,230 subscribers.

The HealthChoice rate hearing is scheduled for 9:00am on Friday, Nov. 12, 2004 in the Utilities Committee hearing room (room 209) of the Cross State Office Building, Augusta.

The purpose of both hearings is to consider whether the rates requested are excessive, inadequate or unfairly discriminatory as determined by Maine law.  Members of the public are invited to attend and to participate in either hearing.

The requested effective date for both proposed increases is January 1, 2005. [return to top]

Nov. 3 Survival Seminar Postponed; Coding Center Program in Bangor Affirmed
MMA regrets that the Nov. 3rd CME program entitled, "Best of the 2004 Physician Survival Seminar" has been postponed to a future date as yet to be determined.  The MMA program on HIPAA on Nov. 17  in Augusta and the DIrigo Update on Nov. 30 in Portland will be held as scheduled.

The program on the business of the office practice, co-sponsored by The Coding Center and MMA in Bangor on Nov. 3rd will also be held, as scheduled.

MMA appreciates the loyalty of our members and office staff in connection with our CME programs.  It is unusual for us to cancel or postpone a program.  We hope it will not happen again and we will keep you posted on when the canceled program can be re-scheduled.  We hope to present it in December, again in the Portland area. A calender of all of our 2005 courses will be available by year-end.

Members or office staff having any ideas for subject matter of future CME offerings may share them with Chandra Leister at [return to top]

CMS to Host Town Hall Meeting on November 16, 2004, 2:00pm
The Centers for Medicare and Medicaid Services (CMS) will be hosting a Town Hall meeting on November 16, 2004, from 2:00pm to 3:00pm.  The meeting will be held in the auditorium at CMS in Baltimore but Maine physicians or office staff can participate via teleconference.  The goal of the meeting is to solicit the experience of individual Medicare Fee for Service providers to help educate CME staff on how to better serve them.  At the meeting, CMS staff will explain the CMS design for getting individual provider feedback on CMS provider communications and other topics.

On-line registration is available for individuals to participate in the meeting, whether in person or by teleconference.  The on-line registration will capture contact information and practice characteristics; such as name, email address, and provider/supplier type.  Providers and other interested parties may speak or ask questions during the meeting, either as a participant in the auditorium or via teleconference.

Registration for the meeting opened on Oct. 25 and is accessible at:  The on-line registration will generate a confirmation page to indicate the completion of your registration.  Persons participating by teleconference should dial: 1-877-357-7851 and reference id: 1040512.

Encore is a digital recording of the call, which will be available hours after the meeting and can be accessed by dialing 1-800-642-1687 and entering the conference id number 1040512.

You may contact Keri Boston at for further information about registering for the meeting.  [return to top]

David Simmons, M.D. Elected Chair of New England AMA Delegation
At its meeting in Waltham, MA., on Oct. 16, the New England delegation to the American Medical Association elected Maine internist  David J. Simmons, M.D. as Chair of the group for the 2004-2006 term.  Michael Migliori, M.D. of Rhode Island was elected Vice-Chair.

Dr. Simmons began his chairmanship by paying tribute to Barbara Chase, M.D. of Massachusetts, past Chair of the Delegation.  Dr. Simmons thanked Dr. Chase for her dedicated commitment and service to the Delegation and her superb leadership over the past two years.

The delegation at the meeting considered several resolutions for presentation to the interim AMA meeting to be held in December, including a resolution from Maine entitled: "Ethics of Physician Participation in Reality Television for Entertainment."  Following a brief discussion, a motion was made and seconded to support the resolution with a minor addition in the resolve.  As supported, the resolution reads as follows:

               Ethics of Physician Participation in Reality Television for Entertainment

                Whereas, Popular television programming has adopted the "reality television" model in many forms including a recent series entitled "The Swan" in which contestants become patients and then compete for financial incentives; and

                 Whereas, Physicians participate by operating on these patients for the purpose of radical physical appearance change for the purpose of improving the contestant's chances of being competitive in the "game" show; and

                  Whereas, There are significant ethical issues that confront the physicians involved; therefore, be it,

                   RESOLVED, That the Council on Ethical and Judicial Affairs of the American Medical Association be asked to evaluate existing opinions on advertising and informed consent and render new opinions as appropriate to guide the participation of professionals in the emerging commercial medical practice of reality television for entertainment. [return to top]

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