November 28, 2005

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MMA Testifies on Draft State Health Plan

MMA Executive Vice President Gordon Smith testified on behalf of the Association at one of three public hearings on the 67-page draft State Health Plan issued earlier this month by the Governor's Office of Health Policy and Finance (GOHPF).  At the hearing in Portland on Nov 22, Smith made the following points to members of the Advisory Council on Health Systems Development, which conducted the hearings.  The Association will also submit written comments to the GOHPF by December 2 which is the deadline for such comments.  These comments may be viewed on the MMA website ( once they have been submitted.  To read the draft plan and other related materials, go to

  • The purpose of the Maine Medical Association is to unite and support the physicians of Maine in promoting the health of Maine's citizens, protecting and promoting the quality of medicine, and supporting the physicians'  function as advocates for their patients.  These purposes overlap significantly with the priorities stated in the draft Plan.
  • The drafters of the Plan are to be commended for its emphasis on prevention and public health, personal responsibility and quality.  The portion of the plan calling for the integration of mental health with physical illness is superb and will be appreciated by the Maine Association of Psychiatric Physicians.
  • The Association is able to support enthusiastically the vast majority of the document, but we have concerns about some of its lack of specificity and its omissions.
  • Our concern is not so much what is in the Plan as it is with what is left out.
  • One major omission concerns the MaineCare program, which covers more than 20% of the state's population and continues to grow.   As it is the safety net for more than a quarter of a million Mainers, any plan for the state's health should devote a substantial portion of its recommendations to this program which is struggling so to meet its mission.  The financial pressures that Maine physicians and hospitals are currently experiencing, due largely to the MaineCare program, make it much more difficult for them to devote resources to many of the positive areas addresses in the draft, such as electronic health records, adoption of the chronic illness model, etc.
  • The Association wishes to be involved with the Public Health Working Group named on p. 21 of the draft.  The Association's Public Health Committee is very active and supports the goal of  the working group to improve the public health infrastructure in the State.
  • A second major omission is the failure to note medical liability reform as an area of concern for the provider community.  On October 1, 2005, medical liability premiums for many Maine physicians increased by an average of 25%, and as much as 79% for emergency physicians.  Legislators and many others like to sweep this issue under the rug because it is contentious, complex, and difficult, but in a state that will always have a shortage of physicians, it is essential that the liability climate remain reasonable.
  • A final omission is the failure to note the danger of losing all the private practice/primary care capacity in the state.  With more than one-third of Maine physicians being employed by hospitals, and hundreds of other employed in health centers and other facilities, patients and payors are quickly losing the choice of receiving care under a private practice model.  The draft Plan should call for an examination of this issue, to determine if the death of private primary care has any implications to the state and patients, financially or otherwise.

Most of the Association's comments were reserved for that portion of the draft Plan dealing with the state Certificate of Need law and program.  While the Association believes that the CON law should be repealed, we acknowledge that that view has not prevailed in Augusta.  That being the case, if the state is going to have what has been called the strictest CON law in the country, at least it should be competently implemented and the CON office adequately staffed.

The CON law should also be limited to the need for the project applied for.  Therefore,  we oppose the 1% provision on page 60, no matter how well intended.  Giving priority to projects which "devote 1% of the total value or cost of the project to new investment in a related public health effort that is aimed at reducing the demand for the service proposed under the application," is a perversion of the certificate of need law and could lead to further requirements and conditions unrelated to the pure issue of  the medical need for the project.

Smith also noted that the strict certificate of need law will exacerbate the trend toward a two-tier system of care, as persons of means will simply travel out of state to take advantage of the latest technology and MaineCare recipients and other citizens of modest means will go without.

In closing, Smith noted that Maine is a small state and that we are all in this together and have an obligation to look for collaborative ways of improving a system that is clearly broken in many respects.  In that spirit, the Maine Medical Association stands ready to work with all interested and affected parties on the many positive initiatives outlined in the draft Plan.  The drafters, again, are to be commended and our criticisms and suggestions and not meant to draw attention away from this very significant effort at laying out a framework for improving healthcare in Maine.

Next First Friday CME Program is this Friday, Dec. 2nd in Manchester: Learn about Angry Patients and Angry Physicians
MMA presents the final program for 2005 in the "First Fridays" CME series this Friday morning (Dec. 2) at the Association offices in Manchester.  This three hour program, from 9:00 am to noon features the three most popular programs from the 2005 Physician Survival Programs offered in So. Portland and Bangor earlier this year.  The schedule for the morning is set forth below.  There are still spaces available so reserve your place today by calling Gail Begin at 622-3374 (X-210) or via e-mail to

9:00 am  Managing the Unruly Patient (Michael Duddy, Esq.)

               Addressing one of the most frequent problems physicians and staffs are faced with, Attorney Duddy will give guidance on:

               1.    Competing rights and duties

               2.    Possible repercussions

               3.    Abandonment

               4.    Concepts in defense

               5.    Protocol

10:00 am  Employment Law Developments (John Gleason, Esq.)

               In this popular update, Attorney Gleason will bring attendees up to date on:

               1.    Wage and hour developments

              2.    Family Medical Leave Act

              3.    Developments under USERRA

              4.    Update on Disability Law

11:00 am  Managing the Angry Physician (Margaret Palmer, Ph.D.)

             Dr. Palmer, an organizational  psychologist, offers a practical approach in dealing with physicians who are angry or hostile.  In a talk punctuated with humor, Dr. Palmer will show attendees how to defuse hostility with a series of steps that have a proven track record of success.

         The cost per registration is only $60 which includes breakfast and all course materials. While the program is particularly designed for office staff, three hours of CME are available for physicians wishing to attend.  As noted above, call 622-3374 to register. [return to top]

Dirigo Health Agency Votes for $44 Million in Savings Offset Payments
The Dirigo Health Agency Board voted last Tuesday to collect from insurance carriers nearly $44 million in assessments resulting from alleged savings generated by the Dirigo Health legislation, paving the way for the Dirigo program to insure up to 23,000 Mainers next year.  The board voted 4 to 1 to make the assessments at this level, rather than assessing a smaller amount ($31 million) which had been recommended by the staff.

Assessments to be made beginning next year represent 2.4% of paid claims.

The controversy over whether the assessments will be passed on to premium payers (largely employers) or whether carriers will attempt to collect the "savings" from providers continues, with Governor Baldacci announcing that he would support legislation to prevent insurers from passing on the assessment through increases in health insurance premiums.  Carriers claim they have no choice as they have not "recouped" any such savings.  Providers claim that there has been little savings, and that what savings there has been, has been more than offset by increases in costs, including particularly substantial increases in liability premiums and increased costs of personnel and supplies.  The controversy will likely be resolved in the legislature or in the courts.

The implications for physicians are significant, as Anthem and other carriers may attempt to "recoup" this amount from hospitals and physicians, even though physicians have seen no net savings from the legislation.  While the Superintendent of Insurance found that a portion of the $44 million in savings was from the MaineCare fee increase which took effect on July 1, that  modest increase was not evenly distributed among all physicians, so it would be impossible to recoup on that basis.  And as noted above, any benefit of the increase has been more than offset by the additional expenses associated with the MECMS problem and other increases in costs.

You can read the Administration's press release on the Board's decision on the web at: [return to top]

Update on Pathways to Excellence, 2005 Survey, Process and Outcome Measures
The Maine Health Management Coalition, sponsor of the Pathways to Excellence project, notified practices on Nov. 21, 2005 that the blinded results of the 2005 Phase IV Office System Survey, 2005 Phase III Process Measures (HEDIS) and 2005 Outcomes Measures are available on the P to E section of the Maine Health Information Center's website at  Each participating practice has a unique code which is needed to access the blinded data.

Like last year, the unblinded results will be made available to the MHMC's employees and family members in December on  The results are sent out ahead of time in order to give practices the chance to review the data and ask any questions about its presentation.  The 2005 results are likely to be used by Cigna and perhaps other payers in Pay for Performance programs.

252 of 430 plus primary care practices responded to the survey this year, representing what is believed to be about 75% of the primary care physicians in Maine.  On the MHMC website, the coalition will use shaded pies to display the scores of the practices responding, and will list the names of the practices that did not return a survey.

The process measures based upon HEDIS were determined from the 500,000 claims from Maine insurers that the MHMC has in its database.  Claims were used from 2003-2004, utilizing the same algorithms and methodology as last year.  Measures included HbA1c for diabetes, LDL for diabetes and cardiovascular disease, asthma medications for adults and children, and well visits for teens and infants.

A majority of practices covering a large majority of Maine primary care physicians had at least one measure reported. 

In the clinical outcomes portion of the project, adult practices reported on diabetes measures against standards established by the "Bridges to Excellence" national quality program (see  Pediatric practices reported on immunization measures against national and New England averages.  Over 165 primary care practices reported their diabetes outcomes or immunization results.

Primary care practices also could submit data on one or more optional measures.  These included Cardiovascular disease, Depression, and BMI measurement for adult practices, and Pediatric BMI and pediatric asthma for pediatric practices.

As was done last year, some practices may be visited by a nurse reviewer to verify responses.

Persons interested in the project or practices wishing to participate next year should contact one of the following Project Directors:

While the Maine Medical Association does not participate in or endorse the Pathways to Excellence project (nor do we "oppose" the project), we do feel it is important for Maine physicians to know about the project and its potential ramifications.  The Association has an open invitation to sit with committees of the project   which has contributed to a sense of transparency with respect to its operation. [return to top]

Medicare's New Physician Voluntary Reporting Program
Beginning in January, physicians can volunteer for Medicare's "Physician Voluntary Reporting Program" (PVRP) and report to the Centers for Medicare and Medicaid Services (CMS) about their compliance with 36 quality measures, such as prescribing beta blockers for heart attack patients.

CMS has stated that the quality measures were the result of collaboration among physicians, physician organizations and others, including the National Quality Forum.  More measures are being developed.

The AMA Board of Trustees voiced "strong objections" to the CMS program.  Delegates at the AMA interim meeting Nov. 5-8 supported the Board and offered to help rectify deficiencies in the program.   A 29 page Board Report includes a description of the measurements and is available by calling MMA at 622-3374 (press "0" for assistance.)

Physicians who participate in the PVRP will receive, by the summer, feedback to assist in improving their data accuracy, reporting rate and clinical care, according to CMS.  However, at this point, volunteers will not receive any higher reimbursement.

A similar voluntary initiative for hospitals resulted in Hospital Compare, an online tool for Medicare patients intended to facilitate comparisons to make the "best hospital care decisions."  See[return to top]

County Medical Society Meetings this Week and Next in Androscoggin, Kennebec and Aroostook Counties
Three County Medical Societies are holding meetings or events in the next two weeks, as follows:

Androscoggin County Medical Society will hold its Annual Meeting on Thursday evening, Dec. 1 at the Hilton Garden Inn in Auburn.  Reception at 5:30 pm, dinner at 6:30 pm, and at 7:30 pm  Dr. Robert E. McAfee will speak on the topic of, "Can Healthcare be Insured - Is Dirigo the Answer?"  One credit hour of CME is offered.  There is no charge for physicians in the county.  Guests are $25.00.  RSVP to Lisa Martin at MMA via phone 622-3374 or e-mail to

The Aroostook County Medical Society will meet at Slopes in Presque Isle on Wednesday evening, Nov. 30.  The purpose of the meeting is to review the mission and purpose of the society and its organization and funding.  There will be no speaker so as to provide adequate time for business.  Gordon Smith, EVP at MMA will be a guest.  To RSVP, call Carole St. Pierre-Engels at 540-1135 or via e-mail to

The Kennebec County Medical Society will meet at the Village Inn in Belgrade for a holiday event on Tuesday night, Dec. 6.  RSVP to Lisa Martin at MMA via phone at 622-3374 or via e-mail to [return to top]

Legislature's Health and Human Services Committee and Appropriations Committee to Meet Wednesday
MMA representatives will be present on this coming Wednesday (Nov. 30) when the Legislature's HHS Committee and the Appropriations Committee meet on several issues of interest to physicians, including hearing an update on the MaineCare MECMS problem.  MMA staff has also been invited to meet with senior DHHS staff on the issue of the MaineCare crossover payments.  Last week, the Office of MaineCare Services began processing some Part B crossover claims on paper.  Watch for more instructions on these claims in the Maine Medicine Weekly Update next week.

On Wednesday morning, the HHS Committee will also review the draft State Health Plan and have an opportunity to provide comment. [return to top]

MMA Payor Liaison Committee to Meet Thursday Night (Dec. 1) on Cigna/Aetna Networks
MMA's Payor Liaison Committee, chaired by Thomas Hayward, M.D., will meet on this Thursday night, Dec. 1 and discuss again the issues involving the decisions by both Cigna and Aetna to develop, effective Jan. 1, 2006, subspecialty networks in Maine.  The Committee first met on this issue with plan representatives on Sept. 21.  But with several practices now having received notification as to whether the practice was designated as part of the preferred network, many MMA members have requested an opportunity to continue to discuss the programs, the methodology/ criteria used for selection and options for non-designated physicians and practices.

Recently, a specialty practice billing manager notified the MMA staff about significant year-end accounts receivable from the 3 principal health plans in Maine, Anthem, CIGNA, and Aetna.  The MMA is trying to get a sense of the extent of this problem.  If you are experiencing similar delays in payment from the private payers in the state, please contact Gordon Smith ( or Andrew MacLean (

The meeting, beginning at 6:15 pm with dinner, is open to any MMA member, but please give us a call so that we can have an accurate count for dinner.  Just call 622-3374 (press "0") or e-mail Gail Begin at [return to top]

MMA Looking for Nominees for MHINT Governing Board
The Association has been asked to make recommendations for members of the governing board of the new company likely to be formed to operate the Maine Health Information Technology Project  (MHINT) or its successor organization.  Physicians interested should have an interest , and background, in medical technology and medical information systems.

The mission of the Board of Directors of the MHINT NEWCO (as it is called presently) is to establish and sustain a statewide integrated clinical health information sharing infrastructure to improve the quality of health care, enhance patient safety, moderate the growth of costs and make healthcare information available to patients.

The MHINT NEWCO will operate as a non-profit organization responsible for overseeing the implementation and operation of a statewide health information technology network.  MHINT NEWCO will manage all aspects of the governance of the system including the funding and financial management of the organization, hiring and management of an Executive Director, approval of an annual budget and workplan, and promotion of the MHINT statewide and nationally.

The Board of Directors shall have the responsibility for the oversight and control of the property and affairs of MHINT NEWCO.  It will consist of not less than twelve, nor more than 15 persons drawn from geographically diverse regions of the state.

Board members shall be individuals who are recognized high level leaders in their field and who represent major stakeholders.  These individuals must be willing to:

  1.     Assure a high level of commitment and buy-in for the MHINT from their peers
  2.     Provide leadership and opportunities in working with major stakeholders and   potential  funding sources.
  3.     Provide experience and expertise in developing a MHINT business plan
  4.     Provide and/or raise funding to sustain the MHINT
  5.     Participate in discussions regarding the MHINT Technology System based on experience and expertise
  6.     Represent a potential MHINT user or data source
  7.     Represent a consumer as an individual or association

The existing Steering Committee, MHINT staff and a subset of the Governance Committee will serve as the Nominating Committee.  They will contact selected candidates to determine level of interest and a list of candidates for the Board will be presented to the Governance Committee at its next meeting.  The approved list of candidates will be invited to attend a kick-off meeting of the MHINT NEWCO in early January, 2006.

Any MMA member interested in serving on the Board of Directors should contact MMA EVP Gordon Smith at 622-3374 (X-212) or via e-mail to [return to top]

MMA Legislative Committee to Meet Tuesday night, Nov. 29
MMA's Legislative Committee, chaired by Katherine Pope, M.D., will meet on Tuesday night, Nov. 29, at 6:00 p.m. at the Association offices in Manchester to review the legislation submitted to the 2nd Regular Session of the Legislature and to discuss other pending legislative and regulatory issues.

Among the items to be discussed is the proposal expected to come out of the Ad Hoc Committee on Sentinel Event Reporting which is a subcommittee of the Maine Quality Forum Advisory Committee.  The subcommittee, although divided in its opinion, appears headed toward a recommendation that would amend the existing law which was enacted two years ago.  Dennis Shubert, M.D., Director of the Maine Quality Forum,  will be a guest at the meeting to discuss his position on the reporting as will Mary Mayhew, Vice President for Governmental Affairs for the Maine Hospital Association.  MHA opposes opening up the statute for amendments during the coming session, believing the law is working well and that any changes would be premature.

Other issues on the agenda include the Dirigo Health Agency's Savings Offset Payment decision  and the draft State Health Plan.

The Legislature reconvenes the week of Jan. 2 and is expected to adjourn in mid-April.  Because it is an election year which features a gubernatorial election, the session is expected to be contentious with health care policy and finance being perhaps the most difficult issue.

All MMA committee meetings are open to all members.  We do ask that you call ahead to let us know you will be coming, so that we can accurately plan for meals.  Dinner will be available at this meeting.  Just call 622-3374 and press "0" to let us know you are coming. [return to top]

MMA and Public Health

The MMA’s Public Health Committee recently identified several priority areas for the coming year, and is encouraging Maine physicians to get involved through one of several ways.  The Public Health Committee is a joint partnership with the Maine Osteopathic Association, and has often been the starting point of many of the resolutions passed at the MMA’s annual session. 


The Public Health Committee's priority areas for the year include:

·        Health literacy

·        Injury prevention (protective head gear)

·        Preserving Maine’s tobacco settlement funds for tobacco treatment

·        Monitoring of the State Health Plan and its support for public health issues

·        Emergency preparedness

·        Youth overweight


Physicians can also stay informed about public health issues by signing up for “PHMed” (Public Health and Medicine), an electronic listserv set up to improve the link between practicing physicians and public health efforts in Maine.  After a hiatus in listserv postings over the past year, due to staffing changes, PHMed is back on line and is available to any interested MMA physician.


The primary goals of the PHMed listserv are:

  • To create a connection among Maine physicians who have an interest in public health.
  • To inform Maine physicians about key public health issues by sharing information on vital public health topics, current activities, and critical issues.
  • To build advocacy for public health issues among the physician community of Maine.

Oversight and leadership for PHMed is provided by the MMA’s Public Health Committee, with dedicated staff support from the MMA.  All interested Maine physicians are invited to participate in the listserv.   Questions about the Public Health Committee or PHMed can be directed to Lisa Letourneau, MD, Public Health Committee, at  Physicians interested in joining the Committee or PHMed should contact Charyl Smith at the Maine Medical Association, , or tel. 622-3374, ext. 211. [return to top]

Urge Maine's Congressional Delegation to Fix Medicare Payment Formula
Congress now returns to work in Washington after the Thanksgiving break and will focus on budget reconciliation efforts.  Urgent action on the Medicare SGR formula is necessary as part of this work.  The U.S. Senate has acted to increase Medicare payments to physicians by 1% in 2006, but the House has not yet acted.  If Congress does not act soon, Medicare will cut physician reimbursement by 26% during the next 6 years - including a 4.4% cut on January 1, 2006.  These cuts threaten patients' access to care, as many physicians will be forced to decrease the number of new Medicare beneficiaries they can treat.

Please contact members of Maine's Congressional delegation to urge their support for the Medicare SGR fix.  You can compose an email message on the AMA's Grassroots Action Center website at:

Or, you can call the members' offices at the following numbers:

Senator Olympia Snowe:  202-224-5344

Senator Susan Collins:  202-224-2523

Representative Tom Allen:  202-225-6116

Representative Mike Michaud:  202-225-6306 [return to top]

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