May 22, 2006

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MMA Ad Hoc Committee on Health System Reform Meets with Insurance Superintendent
Last Tuesday evening, members of the MMA Ad Hoc Committee on Health System Reform met with Insurance Superintendent Alessandro Iuppa to discuss the impact of current insurance regulations on the health insurance market in the state. The committee is charged with reviewing the Association's White Paper on Healthcare Reform, which was issued in May 2003, shortly before Governor Baldacci unveiled his Dirigo Reform initiative. Tuesday's discussion focused around the issues of community rating, guaranteed issue and high risk pools. MMA's current White Paper endorses the concept of universal access based upon an individual mandate, similar to the proposal that recently passed in Massachusetts.
The Ad Hoc Committee intends now to recommend changes to the White Paper with the changes being considered for adoption by the MMA membership at the Annual Meeting in September (Sept. 8-10, 2006 at the Fairmont Algonquin in St. Andrew's by the Sea, New Brunswick, Canada).  The changes will be presented as part of the Annual Membership meeting to be held on Saturday morning during the 153rd Annual Session.

Superintendent Iuppa discussed the consolidation of the health insurance market place in Maine and stated his desire to have a more competitive marketplace with more companies interested in writing in Maine.  The current market is dominated by Anthem with only Aetna, Cigna, Harvard Pilgrim and United Health Care having any significant impact beyond Anthem.

Committee members were able to enjoy a frank exchange of ideas with the Superintendent.  Insurance regulation involves a number of complex subjects such as community rating, guaranteed issue, health savings accounts, adverse selection, coverage mandates and federal/state issues.  The Committee received a great deal of background information from Superintendent Iuppa which can now be utilized as members seek to update the Association's positions as established in the original White Paper.

One idea that seemed to enjoy widespread support was the notion of all health insurance carriers collaborating on development and use of an electronic "smart card", similar to a bank debit card, that insureds could carry and have swiped at various facilities, including the physician office.  The card would work for all carriers and would help reduce the significant transactional costs associated with our current fragmented system.

Members also had a vigorous discussion regarding the appropriateness of coverage mandates.

All MMA members are welcome to participate in the development of the Association's position on universal access to coverage or care.  If you have an idea that you would like the ad hoc Committee to consider or would like to participate on the Committee, contact the Committee Chair, Jacob Gerritsen, M.D., at or Gordon Smith at

Voluntary Medicare Quality Reporting Initiative to be Featured at June 21 Program
MMA's 15th Annual Practice Education Seminar will be held on Wednesday, June 21 from 8:30am to 4:00pm at Spectacular Event Center in Bangor.  This year's program is co-sponsored by the Maine Health Alliance.  Each MMA member and office should have received a full brochure on the program last month but an additional copy will be included in the upcoming May-June issue of Maine Medicine.  The program was recently approved for seven hours of category one CME.

The Keynote presentation will be by Eric G. Handler, M.D., Chief Medical Officer for the Boston Regional Officer of CMS (Centers for Medicare and Medicaid Services).  Dr. Handler will discuss the current Medicare quality reporting initiative, which is currently voluntary but likely to be a precursor for a mandatory program.  CMS has gone through a similar progressive reporting program for hospitals, which are now financially penalized for failing to report.

In additional to Dr. Handler's presentation, other topics during the morning plenary sessions include:

  • Panel on current quality improvement projects in Maine
  • Update on HealthInfoNet  Project (formerly MHINT)
  • MaineCare Update (Deputy Commissioner J. Michael Hall and Laureen Biczak, M.D., Medical Director)
  • Dirigo  Health Update (Gordon Smith, Esq. and Tarren Bragdon)

The afternoon offers a full dozen breakout sessions on topics of interest to practice managers and physicians.   A session on evaluating technology for your practice has recently been added, presented by Reliable Networks.

The annual education seminar offers MMA members and their staffs an opportunity during one day to get up to date on the myriad laws and regulations making medical practice in Maine today complicated and expensive.  For further information, contact either Gail Begin (622-3374 ext. 210 or Gordon Smith (622-3374 ext. 212) at MMA.  You may also register on-line for the conference at the MMA Website at   [return to top]

Maine Quality Council Advisory Council; May 12 Meeting
The Maine Quality Forum Advisory Council met on May 12 for its regular monthly meeting.  After hearing an update on the current status of DirigoChoice, The Council heard updates on several of the current MQF initiatives, including the development of quality metrics, the review of the paid claims data base analysis, the cardiac project (In a Heartbeat), the MMA/MOA practice self-assessment program, and the Safety Star program.

The cardiac project, designed to encourage people to call 911 when they experience symptoms of a heart attack, was the subject of a meeting in Augusta on April 11.  Approximately 60 persons attended representing EMS, hospitals and cardiac programs across the state.  The Quality Forum has organized a leadership group for the project, chaired by Costas Lambrew, M.D. Additionally, MQF will form a data group to determine what data will be collected for the project.

At the previous meeting of the Council, Dr. Martin Merry, Senior Advisor for Medical Affairs at the New Hampshire Hospital Association and Foundation and Adjunct Associate Clinical Professor of Health Management and Policy at the University of New Hampshire, provided a presentation entitled, "The Future of Community Health Care:  Our First-to-Second Curve Journey,"  Dr. Merry outlined and discussed four hypotheses:

  • The Institute of Medicine's  To Err is Human  symbolized the "beginning of the end of an era."
  • Our health care system is locked into first curve training.
  • The second curve health care system is well underway.
  • Maine can take the lead in second curve health care and be successful.

Dr. Merry stated that today's health care system is based on a pre-industrial craft-based (first curve) culture and must move to a systems-based (or second curve) culture; this move will transition the health care system from a hierarchical culture of blame to a team model designed around patients' needs.

At the conclusion of the meeting, it was announced that there are two current vacancies on the Council because of the resignations of Portland lawyer Jonathan Beal (who has moved to the Dirigo Board) and Steve Shannon, D.O. [return to top]

Avian and Pandemic Flu: What Mainers Need To Do
The Maine Center for Disease Control and Prevention (Maine CDC), formerly the Bureau of Health, issued a public statement on May 18 informing Mainers of the steps they should take in preparing for the possibility of the outbreak of avian or other pandemic influenza. The Maine CDC, the Maine Emergency Management Agency (EMMA), the Maine Departments of Agriculture, Inland Fisheries and Wildlife and the Maine EMS/Department of Public Safety are working together to help prepare Maine for the arrival of avian influenza and the possibility of a pandemic influenza.  Although it is unknown whether the current circulating strain of H5N1 avian influenza will cause a human pandemic or  not, the Center advises that we all need to do our part to prepare for both the arrival of avian influenza and the possibility of a pandemic.

In the statement, the Center encourages all citizens to take two steps in order to be better prepared; first to stay informed through resources such as www.MaineFlu.Gov and second, to utilize a personal checklist and become involved with local preparedness efforts.  The statement also notes that personal hygiene is important and that washing hands frequently, covering coughs and sneezes and staying home when ill, all can help stop the spread of harmful germs.

Hopefully the current H5N1 strain of avian influenza will not mutate to allow person-to-person transmission and a resulting pandemic.  However, all of us need to do our part to prepare for both the probable arrival of avian influenza in birds as well as the possibility of a human pandemic.

MMA now links to the MaineFlu.Gov website.  Additional information is also available [return to top]

Legislative Session Re-Convenes Monday; Dirigo on the Agenda
The Second Regular Session of the 122nd Maine legislature will re-convene Monday after a three-week recess.  Among the matters to be resolved before final adjournment anticipated at mid-week are two bills critical to the future of  the DirigoChoice product.  The first, an amended version of L.D. 1935, contains the compromise negotiated between the Democratic legislative leadership and the Maine Association of Health Plans, the Maine State Chamber of Commerce, and the Maine Hospital Association regarding the controversial "savings offset payment" (SOP) funding mechanism.  The SOP would be nearly cut in half and the issue of the "pass through" of the cost of the SOP resolved - at least for the short term.  A Blue Ribbon Commission would be established to consider long-term funding mechanisms for DirigoChoice.  L.D. 1845, which would allow the Dirigo Board to self-insure DirigoChoice if it became necessary, is the subject of a 7-6 "ought to pass as amended" report from the Committee on Insurance & Financial Services and its fate remains unclear.  Both L.D.s 1935 and 1845 await action in the House today.

MMA lobbyists will be monitoring these last fews days of the session and we will continue to report to members and their staffs through this weekly publication and through Maine Medicine. [return to top]

FDA Advisory Panel Recommends Approval of Gardasil to prevent Cervical Cancer
A federal advisory panel last week recommended that the FDA approve a vaccine that has been shown to be effective in preventing cervical cancers caused by the human papilloma virus (HPV).  Tests in more than 17,000 girls and women have shown that the vaccine, manufactured by Merck & Co., is nearly 100 percent effective in blocking such cancers.

The vaccine is most effective when given to girls before they become sexually active, which would require administration between the ages of 9 and 13.  Public health organizations testified in favor of approval of the vaccine.

A vaccine utilization committee of the CDC is scheduled to meet on June 29, at which time it could vote on whether to recommend universal use of Gardisal.  A draft proposal recommends vaccinating all girls ages 11 and 12.  Actual requirements for its use can only be mandated by individual states.

The FDA generally follows the recommendations of its advisory panels, and is expected to do so in this case, probably by June 8.

MMA has submitted a resolution to the American Medical Association directed at ensuring that the current administration and future administrations base such decisions on science. [return to top]

Workers' Comp. Board Issues Proposed Revisions to Medical Fee Schedule
The Maine Workers' Compensation Board has issued proposed amendments to its Rule Chapter 5, Medical Fees; Reimbursement Levels; Reporting Requirements.  The rule updates the Medical Fee Schedule by incorporating the 2005 Current Procedural Terminology (CPT) codes and portions of the 2005 Medicare RBRVS Report.  It also defines inpatient, clarifies procedures relative to CPT disputes, and standardizes reimbursement for travel, lodging, and meals.  The rule repeals and replaces Appendix III, the actual fee schedule.

You may obtain a copy of the proposed revisions to Chapter 5 by contacting Andrew MacLean, Deputy EVP at or 622-3374, ext. 214.

The rule will have a public hearing on Wednesday, May 31, 2006 at 10:00 a.m. in the first floor conference room, Room 170, at the WCB Central Office in the Deering Building on the AMHI grounds, Hospital Street, Augusta, Maine.  The written comment deadline is June 12, 2006.  The MMA will gather and submit any comments we receive.  If you wish to comment directly, contact John Rohde, General Counsel, WCB, State House Station 27, Augusta, Maine 04333-0027. [return to top]

Maine Cancer Consortium Releases 5-Year Plan
The Maine Cancer Consortium on Thursday released its Five-Year Plan for reducing the incidence of and mortality from cancer.  Currently, every day, 22 Mainers are diagnosed with cancer and 9 people die from the disease.  More than 3,000 of Maine residents are expected to succumb to cancer this year.

The consortium consists of more than 130 organizations, facilities and cancer survivors and emphasizes prevention, early detection and, if cancer strikes, appropriate care.  Among the recommendations in the report are more screening for colorectal, breast and other cancers, increasing primary care physician awareness of the benefits of early detection, more awareness of the dangers of sun exposure, and more emphasis on exercise, controlling weight, reducing tobacco use and other healthy practices.

The initial Consortium five-year plan was released in 2001 and many of the strategies and goals set forth in that document have been achieved.

Maine currently has the highest cancer mortality rate in New England, and a higher cancer death rate (214 deaths per 100,000 people) than the national average of 192 deaths per 100,000.  The four leading cancer diagnoses in Maine are lung, breast, prostate and colorectal, which together account for more than one-half of all cancers in Maine. [return to top]

MaineCare Proposes Policy Change on Coverage of Cochlear Implants
The Office of MaineCare Services is proposing changes to Section 90.05 of the MaineCare Benefits Manual, Chapter II, Section 90, Physician Services.  The changes propose that MaineCare cover cochlear implants for prelinguistically and postlinguistically deafened children ages one and older.  The proposed rule also updates the criteria for cochlear implants for all members and makes technical corrections for clarification. 

You can find a copy of the proposed rule and rulemaking documents on the web at:

The proposed rule will have a public hearing on Thursday, June 8, 2006 at 11:00 a.m. in Conference Room 4 at the OMS office, 442 Civic Center Drive, Augusta, Maine.  The written comment deadline is June 20, 2006.  If you have comments on the rule, you can provide them to Andrew MacLean, Deputy EVP ( or 622-3374, ext. 214) for inclusion in the MMA's comments or if you wish to send them directly to the Department, the agency contact person is:  Wendy M. Alley, Comprehensive Health Planner II, OMS, State House Station 11, Augusta, Maine 04333-0011.

  [return to top]

Committee on Loan and Trust Administration Meeting, June 22
The Committee on Loan and Trust Administration will be meeting on June 22, 2006 at the Maine Medical Association from 2:00 - 4:00 p.m.  The main purpose of this meeting will be to approve student loans for new and previous borrowers of the Maine Medical Education Foundation loan program.  If you have any questions regarding this committee meeting or on the MMEF loan program, please contact Gail Begin at 207-622-3374 extension 210. [return to top]

Maine Selected for Health Information Project

Maine’s HealthInfoNet, formerly known as MHINT, is one of nine state-level regional health information organizations (RHIO) selected to participate in the first phase development of consensus on best practices for state-level RHIOs, the American Health Information Management Association (AHIMA) has announced.


The project, under contract to the Office of the National Coordinator for Health Information Technology (ONC), will produce public information on “best practices” in the areas of governance, structure, financing, operations, and health information exchange policies.  Under the terms of the contract, the selected RHIOs were required to have an established form of public-private governance and be operating at the state-level, either as a single organization or in a coordinating role bringing together multiple local health information exchanges. 


The project includes site visits and interviews and will be guided by a steering committee comprised of representatives from the nine state-level RHIOs.  The steering committee will develop a framework for describing and disseminating best practices and model(s) and encouraging adoption and coordination among state-level RHIOs.  For a complete list of steering committee members, visit


The resulting best practices will inform the work of projects addressing state-level privacy and security issues administered the Agency for Research and Quality (AHRQ) and ONC.  The estimated project completion date is August 31, 2006.  For more information about the project, visit [return to top]

Next "First Fridays" Educational Program on Common Coding Errors: Friday June 2
The next MMA First Friday program will be presented on Friday, June 2 and will feature the staff of The Coding Center discussing common coding errors.  Jana Purrell, Director of the Center will share with attendees the most common problems found out in the practices and will discuss techniques on how to keep your coding complaint with the regulations of payors.

The programs runs from 9:00am to noon and will be held at the MMA offices in Manchester.  For registration materials, contact Jess Violette at 622-3374 (press 0).  The cost for the program is $60 which covers breakfast and all course materials. [return to top]

"Involuntary Mental Health Commitment Hearings: Protecting Civil Rights" Seminar, June 13
Involuntary Mental Health Commitment Hearings: Protecting Civil Rights
June 13, 2006, 8:30 - 4:00
Maple Hill Farm Conference Center, Hallowell, Maine
Sponsored by
The DHHS Office of Adult Mental Health Services & the Office of the Attorney General
in collaboration with the USM, Muskie School, Center for Learning

Maine's commitment law allows an individual to be admitted involuntarily to a psychiatric hospital when it has been determined that the individual poses a likelihood of serious harm due to a mental illness.   Involuntary commitment is a serious infringement of an individual's civil rights and, by statute, should be available only as a last resort. 

Through panel presentations, video vignettes, and group discussions, this conference will explore legal and clinical issues to be considered in involuntary commitment, including alternatives to hospitalization, and will provide strategies for how best to represent an individual in an involuntary commitment hearing.  Presenters and panelists will include lawyers who represent hospitals and patients in commitment hearings, clinicians who treat involuntary patients, consumers of mental health services, and Active Retired Judge Courtland D. Perry, who drafted Maine’s original commitment law and routinely hears involuntary commitment hearings.

This program is designed for lawyers, doctors, judges, mental health professionals and other individuals involved in or interested in the mental health commitment process.

For questions regarding registration, call Linda Kinney at 626-5231 [return to top]

The Coding Center's Coding Tip of the Week
Level of Specificity in diagnosis coding
Diagnosis codes must be reported to the highest level of detail known at the time of the encounter.   ICD-9-CM diagnosis codes have either 3, 4, or 5 digits:

  • A three-digit code is to be used only if it is not further subdivided.
  • If a fourth-digit subcategories and/or fifth-digit subclassifications are provided, they must be assigned.
  • A code is invalid if it has not been coded to the full number of digits required for that code.
    For example, Acute myocardial infarction, code 410, has fourth digits that describe the location of the infarction (i.e. 410.3 “of inferoposterior wall”), and fifth digits that identify the episode of care (i.e. 410.31 “acute myocardial infarction of inferoposterior wall, initial episode of care”).   It would be incorrect to report a code in category 410 without a five digit code.

Questions? Call the Coding Center: 1-888-889-6597. [return to top]

Daniel Hanley Center for Health Leadership Announces Hanley Fellows
The Daniel Hanley Center for Health Leadership is honored to introduce three emerging healthcare leaders who have been selected to as Hanley Fellows.   These distinguished individuals are highly experienced healthcare professionals who hold great promise for assuming greater leadership roles in Maine and beyond in the coming years.

Each Hanley Fellow will soon be paired with an experienced healthcare Mentor who will provide one-on-one guidance aimed at helping their Fellow build the skills necessary to be more effective leaders in Maine's increasingly complex, challenging and competitive healthcare marketplace.  Fellows also will be enrolled this fall in the Institue for Civic Leadership's highly-regarded 15-day Collaborative Leadership Intensive program. 

The first class of Hanley Fellows includes:

Dr. "Ned" Claxton, Jr. is a family practice physician has headed CMMC's Family Medicine Residency program since 2001, where he has played an active role in the education of nearly three dozen family practitioners.  A graduate of Princeton University and the University of Cincinnati School of Medicine, Dr. Claxton was in private practice in Androscoggin County for 22 years.  He was named Maine's Family Practice "Doc of the Year" in 1987 and won the annual CMMC Family Practice Residency Outstanding Teaching Award four times. He served on the CMMC Board of Directors for nearly a decade and has long been active in policy and advocacy issues with MMA.  Dr. Claxton plans to use his tenure as a Hanley Fellow to learn more how healthcare public policy is shaped toward the goal of becoming more involved in improving Maine's health delivery and coverage systems in the years to come.

"Dr. Claxton has had a long and distinquished involvement with the Maine Medical Association, which he joined when beginning practice in Maine.  His advocacy for primary care and access to care is well known thorughout the state.  The Maine Medical Association is thrilled to have Ned in the group of initial Hanley fellows." - Gordon Smith, Esq., Executive Vice President, Maine Medical Association

Maureen Kenney is a widely-respected leader among Maine employers who have become increasingly engaged in issues relating to healthcare cost, quality and access across the state.  She began her career as a rehabilitation and psychiatric social worker, working in hospitals in Texas, California and Maine. Today, she is responsible for benefit plans, family medical leave and health and wellness initiatives at Maine's largest private employer.  Maureen currently serves on the board of directors of the Maine Health Management Coalition, the Maine Health Data Organization and the Maine Health Information Center. She is a Phi Beta Kappa graduate of Texas Christian University and holds a master of science in social work degree from the University of Texas in Arlington.  As a Hanley Fellow, Maureen plans to learn more about key healthcare issues so she can become a more informed and effective leader.

"Maureen's unique ability to bridge the chasm between a very complex medical care system and the everyday consumer of care has allowed BIW and our employees to succeed in improving outcomes,quality and cost. I am confident that this opportunity will allow her to increase those skills and therefore benefit an even larger community." - Kevin Gildart, Vice President, BIW.

A Maine native, Dr. Lisa Letourneau has broad clinical and management experience in a wide variety of healthcare settings. As a board-certified internist who began her career in emergency medicine, she went on to a succession of positions with managed care organizations. Her strong interest in building connections between public health and clinical care has led to several leadership positions, including the Board of the Maine Center for Public Health, the Cardiovascular Health Council, and the Maine Medical Association's Public Health Committee. Since 2000, Dr. Letourneau has been a key leader in MaineHealth's system-wide clinical quality improvement initiatives and currently serves as Senior Director for Clinical Integration, overseeing a range of healthcare imrpovement initiatives. She has been instrumental in establishing the statewide Quality Counts organization and many other collaborative initiatives, including serving as physician advisor to the Maine Youth Overweight Collaborative. Dr. Letourneau holds an undergraduate degree (magna cum laude) from Brown University, a medical degree from the Dartmouth-Brown Joint Program in Medicine and a masters in public health from the Harvard School of Public Health. She hopes to use her time as a Hanley fellow to further develop her personal and organizational leadership skills.

"Lisa's leadership in bringing public health and medicine together throughout Maine has changed the way both medicine and public health are practiced.  And, as a result, Maine people are healthier.  She has made a real difference in improving the health of Maine people!  I am very excited for her as she becomes a Hanley Fellow." - Dr. Dora A. Mills, Director, Maine Center for Disease Control and Prevention.

The Hanley Fellows Selection Process

The Hanley Fellows program invited applications from emerging leaders from across the state earlier this year.  How did we define emerging leaders?  An emerging leader has ten or more years of professional experience in healthcare, has demonstrated substantive leadership in their current position and holds great promise for assuming greater leadership roles in the next several years.  A committee of highly regarded health leaders reviewed Fellows applications and made recommendations to the Hanley Center Board in early May. Applications were received from physicians, public health leaders, hospital and physician practice administrators, employers, government officials and others.

What Is the Hanley Center?

Founded in 2002, the Center is dedicated to building a solid foundation of leaders who are committed to improving health care in Maine and beyond. Formerly known as  the Dan Hanley Memorial Trust, the Center's new name reflects the organization's focus on leadership development.  Plans are under way for a new statewide health care leadership training program in 2007. To learn more, contact Jim Harnar at or 207-523-1501. [return to top]

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