August 8, 2005

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Room Block for MMA's 152nd Annual Session Ends Tomorrow!
Don't delay making your reservations for "Emerging Threats in Infectious Disease" at the Harborside Hotel and Marina in beautiful Bar Harbor from September 9 - 11, 2005. Governor Baldacci and DHHS Commissioner Nicholas will address the General Session on Saturday morning. 11.0 CME credits are available at this meeting!

Please plan to join your colleagues for the MMA's 152nd Annual Session at the Harborside Hotel and Marina in Bar Harbor from September 9 - 11, 2005.  You can find the program agenda and registration materials on the MMA web site at:

The educational sessions, Emerging Threats in Infectious Disease, include presentations on pandemic influenza, pertussis, hepatitis C, and skin infections among other topics and feature the following speakers:  Kathleen Gensheimer, M.D., M.P.H., Lani Graham, M.D., M.P.H., Elsie Freeman, M.D., M.P.H., Dora Ann Mills, M.D., M.P.H. (all representing the State of Maine) and Alfred DeMaria, Jr., M.D., Syd Sewall, M.D., M.P.H., Lorna Seybolt, M.D., M.P.H., Stephen Sears, M.D., M.P.H., Geoff Beckett, PA-C, M.P.H., Stephen Larned, M.D., Nathan Nickerson, MSN, and Andrew Pelletier, M.D.  MMA Public Health Committee Chair Jo Linder, M.D. is the Course Director.

The General Session scheduled to begin at 9 a.m. on Saturday morning will include a business meeting, consideration of resolutions, the President's address, and a briefing on current public policy issues affecting medical practice.  DHHS Commissioner Jack Nicholas will provide a MaineCare update and respond to questions from physicians during the General Session and Governor Baldacci is scheduled to address participants at 11:30 a.m.

The Annual Session also will include exhibitors of products and services that may help your practice, a road race, and the annual awards banquet on Saturday evening.

For more information, please contact Diane McMahon at 622-3374 or by email at



AMA CEO Reports on 2006 Medicare Physician Payment Schedule Rule
In a memo to medical society CEOs dated August 5, 2005, AMA CEO Michael Maves, M.D., M.B.A. addressed the 2006 Medicare Physician Payment Schedule Proposed Rule.  The following is an edited version of the memo.

On August 1st, the Centers for Medicare and Medicaid Services (CMS) released the 2006 Medicare physician payment schedule proposed rule.  The rule contains a number of policy proposals that are likely to generate considerable controversy and division within the physician community.  The text of the rule suggests that CMS is continuing to explore potential strategies for averting the looming conversion factor cuts but the rule does not propose any specific policy  changes that would lower the cost of legislation to repeal the Sustainable Growth Rate (SGR).  It is notable, however, that in his press release on the rule Dr. McClellan said, "The current system of paying physicians is simply not sustainable." 

Practice Expense

CMS is proposing to revamp the methodology that it has been using to set the practice expense relative values.  It has also accepted practice expense survey data gathered by a number of specialties.  CMS has proposed a four-year phase-in of the new practice expense relative values beginning in 2006.  Dermatology, urology, radiation oncology, gastroenterology, pathology, and physical therapy will see the biggest increases due to the practice expense proposals, whereas anesthesiology,  neurosurgery, cardiac surgery, thoracic surgery, ophthalmology, and rheumatology face the steepest cuts, as do several nonphysician practitioners, including audiologists and chiropractors.

The proposed change in methodology and the adoption of specialty survey data are generating considerable controversy.  AMA staff will carefully analyze the proposal and work with the specialties in preparing an appropriate response.


CMS is still forecasting a - 4.3% physician update for 2006 and additional cuts in subsequent years.  It indicates that it is seeking to better understand recent utilization increases and states that it is still evaluating information that the AMA supplied toward that end, after the AMA worked with the RVS Update Committee (RUC) to analyze data on 2004 utilization increases.  CMS mentions the idea of excluding drug payments from SGR calculations but notes that this would increase Medicare costs, and seeks comments on steps that would avert the cuts without increasing overall Medicare costs or disrupting Medicare Modernization Act implementation.  Recently 89 Senators sent a letter to CMS urging that it act on the recommendation to remove drugs.  The AMA will continue its aggressive advocacy efforts to push the Administration to remove drugs and take other steps to lower the cost of legislation to repeal the SGR.


The rule proposes to apply a multiple procedure payment methodology to the technical component of imaging services such that imaging of contiguous body areas would be paid at 100% for the highest paid service but 50% for the second area, for example, if pelvic and abdominal CT scans are done.  In addition, CMS proposes to add nuclear medicine to the list of procedures where physicians are prohibited from referring to facilities in which they have an ownership interest, reversing the policy adopted previously under the Stark self-referral law.  CMS seeks comments  on how to minimize the impact of the change on nuclear physicians whose current business practices would become illegal, but this is a troubling question.

Professional Liability Insurance (PLI) Expense

CMS is accepting only part of a unanimous RUC recommendation to more fairly distribute PLI values to the specialties most affected by the PLI crisis.  The RUC recommended excluding data from specialties performing less than 5% of the overall utilization of each CPT code, even though this would direct PLI spending away from visits and other services to those services performed by specialties with the highest PLI costs.  Despite the unanimity on the RUC, CMS decided not to accept the full RUC recommendation.  While cardiothoracic surgery and neurosurgery will see some increase in their 2006 PLI values, therefore, it is not as much as if CMS had adopted the RUC recommendation in full.


The proposed rule contains a number of other provisions related to payments for end-stage renal disease (ESRD) services, the methodology to be used by manufacturers for drug price calculations, additions to the list of telehealth services, private contracting, payment for teaching anesthesiologists, and expanded coverage of screening for glaucoma.  In addition, CMS is seeking input related to continuation or termination of its oncology demonstration project.  The proposed rule has a 60-day comment period with comments due on September 30, 2005.

The proposed rule is 302 pages long, but you can find it on the web in PDF format at: [return to top]

Penobscot Pediatrics Joins Penobscot Community Health Care
Penobscot Pediatrics, a group of 5 physicians and 3 nurse practitioners with a panel of approximately 15,000 children in the Bangor area, soon will merge with Penobscot Community Health Care, a federally-qualified health center established in 1992.  Meg Haskell covered the merger in an article for the Bangor Daily News on Saturday/Sunday, August 6 - 7, 2005.  This merger is yet another example of how the challenges facing physicians in private practice are changing the structure of medical practices in Maine and around the country.  In her article, Ms. Haskell cites "increased Medicaid and Medicare payments, protection against malpractice suits, stable salaries, expanded time-off coverage, and an in-place administrative office" as recruiting strengths for federally-qualified health centers such as PCHC.  She also mentioned the facilities' advantage in acquiring expensive technologies such as electronic medical records.

The following excerpt from the article contains MMA EVP Gordon Smith's comments on the merger.

Gordon Smith, executive director of the Maine Medical Association, said the pediatric group's move to the nonprofit clinic is a good deal for both entities.

"In one fell swoop [Penobscot Pediatrics] deals with two of the biggest issues of any private practice:  medical liability and MaineCare," Smith said this week.  "And PCHC gets a group of great doctors without any significant recruitment effort."

As the health care system responds to mounting pressures from many quarters, Smith said, the attraction of practicing in subsidized clinics will grow, expecially for primary care providers.

"We can expect to see more of the private doctors in Maine moving into these FQHCs and community clinics," Smith predicted.  Time will tell, he added, whether there are drawbacks to a system of health care that depends more and more on the kind of subidies and soft money that support such clinics.

"We just don't know yet whether it should be a concern or not," he said. [return to top]

Governor Proposes Amendment to NGA Medicaid Reform Proposal
The federal Medicaid Commission, created in an amendment to a budget resolution last spring, has met once for an organizational session and is scheduled to meet again in Washington, D.C. on August 17th and 18th.  The Chair of the Commission is former Tennessee Governor Don Sundquist and the Vice Chair is former Maine Governor Angus King.  The AMA's Immediate Past President John C. Nelson, M.D. is a non-voting member of the group.  The group is under a very tight timeframe to make recommendations to Congress by September 1st to cut $10 billion over 5 years from the DHHS budget. 

The AMA submitted a 2 1/2 page Statement for the Record to the Medicaid Commission on July 27, 2005.  The Statement lists 3 key points as priorities for the AMA:

  • Ensuring Appropriate  Benefit Packages for Vulnerable Populations:  Children, Adolescents, Pregnant Women, Seniors and the Disabled - in response to the National Governor's Association (NGA) proposal for more "flexibility" in benefit design.
  • Ensuring that Medicaid Changes Do Not Increase the Number of Uninsured - in response to proposals to eliminate coverage for "optional" categories under Medicaid.
  • Ensuring Adequate Physician Participation Rates - expressing concern about inadequate reimbursement and increasing administrative burdens.

On August 1, 2005, Governor Baldacci issued a statement about the NGA proposal.  You can read the Governor's statement on the web at: [return to top]

Maine Primary Care Association Holds 2005 Annual Conference, 10/5 - 7
The Maine Primary Care Association, representing Maine's federally-qualified health centers, presents its 2005 Annual Conference and Clinical Symposium, Innovations in Quality Care:  Advancing Access for All in Maine from October 5 - 7, 2005 at the Marriott Sable Oaks in South Portland.  The meeting offers 23 hours of CME. 

The mission of the Maine Primary Care Association is to advance the strength and sustainability of its membership of safety net providers and facilitate access to primary care for the medically underserved or uninsured in Maine.

For more information, call the MPCA at 621-0677. [return to top]

Buprenorphine Prescribing Limit Lifted
According to the American Psychiatric Association, on August 2, 2005, President Bush signed into law S. 45, a bill that lifts the 30-patient group limit on buprenorphine prescribing.  The bill is now Public Law 109-56 and is effective as of August 2nd.  [return to top]

Congressman Michaud to Examine Veterans' Health Care
On August 22, 2005, Maine's Second District Congressman Mike Michaud will hold a field hearing in Bangor to examine rural veterans' access to primary care.  The hearing will begin at 9 a.m. and will be held in Room 501 of Rangeley Hall at the Eastern Maine Community College.  Congressman Michaud is the ranking Democrat on the House veteran's affairs subcommittee on health.  He will be joined at the hearing by the subcommittee's chairman, Representative Henry Brown (R-SC). [return to top]

MMA PAC Co-sponsors Tom Allen Fundraiser
The MMA's Political Action Committee, the Maine Physicians Action Fund, joins the Maine Hospital Association, the Maine Osteopathic Association, the Maine Health Care Association, Anthem Blue Cross and Blue Shield, and the American Hospital Association in sponsoring a fundraising event for Maine's First District Congressman Tom Allen (D).  The event will be held from 6 to 8 p.m. on Wednesday, August 31, 2005 at the Regency Hotel in Portland.  The suggested donation is $100 per individual or $1000 per PAC. 

You can call Congressman Allen's campaign office at 774-9696 or email at, if you would like to be placed on the guest list.

Congressman Allen is a co-sponsor of H.R. 2356, the Preserving Patient Access to Physician Act, the AMA-backed legislation to fix the Medicare payment problem, the sustainable growth rate (SGR). [return to top]

PhRMA Unveils New DTC Advertising Guidelines
On August 2, 2005, PhRMA President & CEO Billy Tauzin (a former Congressman from Louisiana) announced 15 new voluntary "guiding principles" for direct-to-consumer advertising of prescription drugs, including a commitment to educating physicians about new drugs before advertising them to the public.  Twenty three manufacturers already have agreed to follow the new guidelines while some consumer groups such as Public Citizen and Consumers Union and some members of Congress are criticizing the new guidelines.  Senate Majority Leader Bill Frist (R-TN) expressed disappointment that the guidelines do not include a prohibition on DTC advertising of new drugs for the first two years they are on the market.

You can find the document, PhRMA Guiding Principles:  Direct to Consumer Advertisements About Prescription Medication on the web at:


  [return to top]

National Health IT Network to Cost $156 Billion Over 5 Years Study Says
 According to a study published in the August 2, 2005 Annals of Internal Medicine, the construction of a national health information network could cost as much as $156 billion over 5 years and could require $48 billion in annual operating costs.  The article, entitled "The Costs of a National Health Information Network," estimates that the $156 billion would represent 2% of annual health care spending for 5 years and that approximately 2/3 of the amount would be for "acquiring functionalities" and 1/3 would be for "interoperability."  Annual operating costs would be more evenly distributed to "functionality" and "interoperability."

You can find an abstract of the article on the web at: [return to top]

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