June 5, 2006

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MMA Executive Committee to Meet Wednesday, June 7
The 28-member MMA Executive Committee will meet on Wednesday at the Frank O. Stred Building in Manchester. The primary items on the agenda involve the Governor's appointment of a new 15-member commission to make recommendations on Dirigo Health, the Association's contract with the Maine Quality Forum to offer confidential practice self-assessments, and pending issues with the Maine Board of Licensure in Medicine, and the Association's Annual Meeting to be held Sept. 8-10. The Committee is Chaired by William Strassberg, M.D.
The Executive Committee meets about every six weeks and oversees the work of the Association.  The majority of the Committee members represent geographical areas with the remaining members being officers, committee chairs or members of the delegation to the AMA.

Wednesday's agenda also includes a review of the first five months of the '06 budget, consideration of a committee vacancy from Knox County and an update on the work of the ad hoc Committee on Health System Reform which is proposing changes to the MMA White Paper on reform which was first released in May of 2003.

Minutes and agenda of the Committee can be found on the Association's website at www.mainemed.com.

New Maine Coalition for Healthcare Access Established to Push for Liability Reform
The coalition formerly known as the Coalition for Health Care Access and Liability Reform has recently been formally established as a new group to be called the Maine Coalition for Health Care Access.  The group has been formed by MMA, the Maine Osteopathic Association and the Maine Hospital Association to follow-up on the important work of building support for more liability reform in Maine.  A new website has been designed and will be operable soon.

The physicians on the board of the new coalition are Lee Thibodeau, M.D., Hector Tarraza, M.D., Thomas DeLuca, D.O. and Douglas Jorgenson, D.O.  Hospital representatives are Vincent Conti of Maine Medical Center and Roy Hitchings of Pen Bay Medical Center.  Remaining board members are Andrew MacLean, Esq., of MMA, Kellie Miller of the Maine Osteopathic Association and Mary Mayhew of MHA.

A primary goal of the coalition is to build public support for liability reform and to establish an organization of patients to assist healthcare providers in pushing for the types of reforms that will ensure continued access to health professionals in Maine during an era of declining professional resources. [return to top]

Join MMA for Annual Corporate Affiliate Breakfast on Wednesday, June 7
MMA Corporate Affiliates are reminded of the annual Corporate Affiliate Breakfast  being held this year at the Harraseeket Inn in Freeport on this coming Wednesday morning, June 7.  Breakfast will be served beginning at 7:30am with entertainment by the Maine Hysterical Society at 8:30am.  Nearly 100 attendees are expected for the annual event.

There is no cost for representatives of a Corporate Affiliate to attend.  If you have not RSVP'd and you are planning to attend, call Lisa Martin at 622-3374 ext. 221. 

MMA appreciates the continuing support of our ninety Corporate Affiliates. [return to top]

People: Robert McAfee, M.D.; Brian Jumper, M.D.; Douglas Jones; Vaughn Collett, M.D.

On June 10, the Bates College Alumni Association will present its 2006 Alumni Community Service Award to Robert E. McAfee, M.D.  Dr. McAfee is a former President of both MMA and the AMA and currently serves as Chairman of the Board of the Dirigo Health Agency Board of Directors.   Among Dr. McAfee's many community activities were the American Cancer Society, Ingraham Volunteers, the Medic Alert Foundation and the Daniel Hanley Center for Health Leadership.

Brian Jumper, M.D. of Portland was recently elected as President of the New England Urological Association.  In that capacity, Dr. Jumper will chair the Association's upcoming meeting in September in Providence, Rhode Island.  Dr. Jumper is associated with Portland Urologic Associates and is a former President of MMA.  He currently serves as Chair of the MMA Committee on Budget and Investments.

Douglas T. Jones, President and CEO of Maine Coast Memorial Hospital, will assume leadership of the Maine Hospital Association on June 21.  Jones will succeed Roy Hitchings, CEO of Northeast Health, the parent organization of Penobscot Bay Medical Center.  Jones has been at the Maine Coast Memorial Hospital in Ellsworth for the past seven years.  He came to Maine from Genesee Memorial Hospital in Batavia, N.Y. where he had served as CEO since 1990.

Vaughn Collett, M.D., of Orthopedics Ltd. of Waterville is the new chief of staff at Inland Hospital.  He has been on the Inland Medical Staff for eight years and is chair of the hospital's Quality Improvement Committee. [return to top]

3rd Annual MMA Benefit Golf Tournament, June 19, to Benefit Free Clinics
The Association's 3rd Annual Benefit Golf Tournament will benefit the six free clinics operating in the state.  The tournament will be held on Monday, June 19th at the Augusta Country Club in Manchester with lunch beginning at 11:00am and a shotgun start at noon.   If you are interested in playing as an individual or in fielding a team, please call Gail Begin at MMA at 622-3374 ext 210 or gbegin@mainemed.com. [return to top]

Conference on Involuntary Commitment, June 13, in Hallowell
An important conference on involuntary commitment hearings will be held in Hallowell on June 13, 2006 from 8:30am to 4:00pm, sponsored by the DHHS Office of Adult Mental Health Services & the Office of the Attorney General in collaboration with the University of Southern Maine, Muskie School, Center for Learning.

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 proceedings, 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.

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

The cost for the conference is only $20 which includes lunch.  For questions or registration materials call Linda Kinney at 626-5231 at the Muskie School in Augusta. [return to top]

Maine DEP Seeks Comment on Requests for Exemption from Mercury Product Ban
Recently, the MMA has received notice from the Maine Department of Environmental Protection that two entities have applied for exemptions to Maine laws prohibiting the sale of products, including medical devices, containing mercury.

Mercury-added sphygmomanometers

W.A. Baum Company seeks approval to continue to sell mercury-added sphygmomanometers in Maine.  Maine law, 38 M.R.S.A. sec. 1661-C(6), prohibits the sale of sphygmomanometers and other mercury-added devices beginning July 1, 2006 unless an exemption is obtained from the DEP Commissioner.  The Commissioner may grant an exemption if Baum shows that:

  • Technically feasible non-mercury alternatives are not available;
  • The available alternatives are too costly; or
  • The mercury sphygmomanometers are more beneficial to public health than the non-mercury alternatives.

Baum seeks the exemption on the premise that non-mercury sphygmomanometers, while available, are not technically feasible for all applications because they are not as accurate and require more frequent calibration.  The DEP is particularly interested in physicians' views on the performance of mercury sphygmomanometers as compared to non-mercury, aneroid sphygmomanometers.

X-ray equipment with mercury switches

The National Electrical Manufacturers Association (NEMA) seeks an exemption from Maine law that bans the sale of new X-ray equipment containing one or more mercury switches.  Maine law prohibits the sale of mercury switches effective July 1, 2006 unless an exemption is granted by the DEP Commissioner who may grant an exemption if NEMA shows that:

  • Technically feasible non-mercury alternatives are not available; or
  • The available alternatives are too costly.

The DEP is particularly interested in physicians' knowledge about the availability of mercury-free X-ray equipment in the marketplace.  NEMA's exemption request is limited to the sale of new X-ray equipment after July 1, 2006.  Maine law does not require an exemption to sell replacement mercury switches for use in X-ray equipment sold before July 1, 2006.

If you have comments on these two exemption requests, you may direct them to Andrew MacLean, Deputy EVP, at 622-3374, ext. 214 or amaclean@mainemed.com.

If you wish to send comments directly to the DEP, you may send them to the attention of John James, DEP-BRWM, State House Station 17, Augusta, Maine 04333-0017 or by email to john.james@maine.gov.

The deadlines for comment are:

mercury-added sphygmomanometers:  Friday, June 23, 2006

mercury switches in X-ray equipment:  Friday, June 30, 2006. [return to top]

Maine Chapter of American College of Surgeons Meets in Northeast Harbor
Despite wet weather, nearly sixty of Maine's surgeons met over the weekend for a discussion of some critical issues facing the profession in Maine and to participate in 14 hours of CME.  Congratulations to Robert Hawkins,M.D., FACS, Joel LaFleur M.D. FACS and Charles "Tom" McHugh, M.D. for a very successful meeting.

On Friday, a seminar entitled, "Challenges Facing Maine Surgeons" explored a series of issues of current interest, including surgical call coverage and surgical manpower.  A growing number of facilities are offering compensation for taking call and several options were explored by a panel moderated by MMA EVP Gordon Smith, Esq.  Thomas Russell, M.D., FACS who is the Executive Director of the College participated in the panel to provide a national perspective.  Nationally, it is estimated that about 20% of physicians are being compensated for taking call.  The role of EMTALA and medical staff bylaws were also discussed.

The work of the ED Call Task Force established at the Maine Medical Center was presented by George Higgins, M.D., VPMA at MMA and Alan Harmatz, M.D. of Plastic and Hand Surgical Associates in South Portland.  The work of the Task Force is not yet complete but an effort is being made to recognize the considerable contributions made by individuals and groups of physicians. Roy Hitchings, CEO of Penobscot Bay Medical Center, presented an enlightened approach from the perspective of a hospital administrator.  The perspective of a rural surgeon was presented by Clare Wilmot, MB, ChB, of Littleton, New Hampshire.  Among her other responsibilities, Dr. Wilmot is Chairman of the Board of the Northeast Health Care Quality Improvement Foundation, the Medicare QIO for Maine, New Hampshire and Vermont.

On Saturday evening, attendees were treated to a talk by author "Tess" Gerritsen who discussed her transition from practicing internist to successful writer of medical thrillers.  Her first novel, Harvest, marked her debut on the New York Times best selling list.  Her next book will be released in August.  [return to top]

CMS Announcements: Medicare Payments Online, Extension on Physician Participation in Medicare Part B Drug Purchasing Program

The Centers for Medicare and Medicaid Services (CMS) is posting online its payments for 30 common elective procedures--including hip and knee replacement surgery and spinal fusion--as part of the government's first attempt to provide hospital price information for consumers. The data show the range of what Medicare pays for procedures in each county, not what patients with private insurance or the uninsured might pay. Additionally, data are not hospital-specific nor do the figures reflect what an individual Medicare member would pay. For more information and a link to the data:
CMS also has announced an extension to June 30 for physicians to elect to participate in the Medicare Part B Drug Competitive Acquisition Program (CAP). The Medicare Drug CAP is a voluntary program that offers physicians an option to acquire many drugs they use in their practice from approved vendors, with the vendor being responsible for billing Medicare for the drug and collecting the coinsurance from the beneficiary. Physicians must return their completed election forms to their local Medicare carrier by mail. Physicians whose completed physician election forms are postmarked on or after June 3, but no later than June 30, 2006, will begin participation in the Medicare Drug CAP starting on August 1. For more information about the Medicare Drug CAP program, physician election of the Medicare Drug CAP, and to download a form, visit: 
[return to top]

Practice Self-Assessment Project and Quality Counts Seek Project Manager
MMA, MOA and the Quality Counts Executive Committee are advertising for a Project Manager for the Medical Practice Self-Assessment Project with an expectation that the same individual would support the establishment and operation of a learning network developed by Quality Counts!   The two positions could consume as much as four days per week and the position could be structured as either part-time or full-time.  Office space would be located at the MMA offices in Manchester, Maine.

The job description which has been posted on-line and advertised appears below.  Persons interested in receiving more information may contact Gordon Smith at MMA at gsmith@mainemed.com or Kellie Miller at MOA at kmiller@mainedo.org.

The position is available immediately.

Program Director 
Job Description:
Quality Counts, a statewide non-profit organization whose mission is to improve chronic illness care and prevention and to forge collaborative relationships between healthcare providers, employers, payers and policymakers, is seeking a Program Director to manage the ongoing activities of the organization.  Responsibilities include serving as the organization’s key contact and advocate; supporting and coordinating the development of a statewide “learning network”, managing the annual conference, coordinating fundraising activities, and working with members and key interested parties throughout the state. 
In addition to managing the activities of Quality Counts, the Program Director will spend one to two days per week managing a one-year-long special project addressing the quality of care being delivered in medical practices across the state for the Maine Medical Association and the Maine Osteopathic Association.  The qualified candidate will conduct special assessments, respond to inquiries about the project and prepare necessary reports to the state and other funding sources.

Job Requirements:
The successful candidate will have a minimum of five years experience in healthcare quality or performance improvement with demonstrated project management and program development expertise.  Excellent oral and written communications skills and a proven ability to work independently while collaborating with teams of individuals in diverse settings are essential.  Strong relationship management skills and experience working with committees and boards comprised of healthcare providers is preferred. The position also requires excellent organizational skills and a working knowledge of computer software, including Microsoft Office (Word, Excel, PowerPoint, and Outlook.)  Experience in grant writing and fundraising will be a plus.

Education Requirements:
A bachelor’s degree in public health, health education, healthcare communications, non-profit management or related field is required.  Masters degree preferred.

Other Information:
Post on Site:               May 25 to June 25, 2006
Categories:                 Healthcare—administration
                                      Healthcare—public health
                                      Non-profit organization management
Full/Part Time:            Full time
Salary:                         Annual

Location Notes:  As a newly created position, the position is flexible regarding physical location of the work site; travel and on-site work 1 to 2 days per week in Augusta are required.

Benefits: Competitive salary and benefits.

Contact Information:
Linda Salvesen
Crescendo Consulting Group
48 Free Street
Portland, ME 04101
Fax:  207-774-2343
E-mail: lindas@crescendocg.com  [return to top]

MMA Urges Workers' Comp. Board to Increase Anesthesia Conversion Factor
In last week's Maine Medicine Weekly Update, the MMA reported that the Maine Workers' Compensation Board had published proposed amendments to its Rule Chapter 5, the medical fee schedule.  The proposed amendments include updating the fee schedule to include the 2005 CPT and RBRVS methodology, clarifying that the general physician conversion factor is $60.00, and other technical changes.  The proposed rule maintains the current $40.00 conversion factor for anesthesia services.  At the public hearing on the rule on Wednesday, May 31, 2006, the MMA urged the Board to increase the anesthesia conversion factor to be in the range of commercial payers in the state - between $47.00 and $52.00.  Representatives of the Maine Hospital Association, the Workers' Compensation Coordinating Council, and a health care auditing company also provided comments of various aspects of the proposed rule.

The written comment deadline is Monday, June 12, 2006.  If you have information that may help support the request for an increase in the anesthesia conversion factor or if you have other comments on the proposal, please contact Andrew MacLean, Deputy EVP, at 622-3374, ext. 214 or by email at amaclean@mainemed.com.  Also, you may contact Andy if you need a copy of the proposed rule - it is not on the WCB web site. [return to top]

Watch for Mailing for MMA's 153rd Annual Session, Sept. 8-10, 2006
The Maine Medical Association will hold its 153rd Annual Session on Sept. 8-10, 2006 at the Fairmont Algonquin Hotel in St. Andrews-by-the Sea, New Brunswick, Canada.  The resort is located about 20 minutes from Calais.  The CME program is entitled,  Medicine in Extreme Environments and will feature former NASA astronaut Story Musgrave, M.D. and Donald Palmisano, M.D., J.D.  Six  hours of CME are available, beginning early Friday afternoon with Dr. Story's keynote presentation.

The brochures for the meeting are currently at the printer and will be mailed to each MMA member in early June. 

MMA welcomes the attendance of any of its members or their staffs at the meeting.  Nearly 300 members and guests are expected to attend the weekend meeting.  Among the Resolutions to be considered at the general membership meeting on Saturday morning will be a resolution recommending changes to the Association's White Paper on Health System Reform which was first released in May of 2003. 

At the Annual Banquet on Saturday evening, MMA President Jacob Gerritsen, M.D. will pass the gavel to current President-elect Kevin Flanigan, M.D.  Dr. Flanigan practices internal medicine and pediatrics in Pittsfield.  [return to top]

Additional Session on EMR Added to June 21 Education Program in Bangor
Two additional speakers have been added to the June 21 Practice Education Seminar being held at Spectacular Event Center in Bangor.   Mark Stone of Reliable Networks of Maine will discuss the common problems associated with the introduction of technology into a practice, large or small.  A second speaker will present state of the art information on issues to consider in shopping for an electronic medical record.  These programs will be part of the breakout sessions in the afternoon.

The annual practice education program formerly called the Physician Survival Seminar, gives MMA an opportunity to discuss the nuts and bolts of what physicians and practice managers need to know to operate a medical practice in Maine today. [return to top]

The Coding Center's Coding Tip of the Week
Can I bill for Critical care on the day of admission?
Medicare allows you to code for both a hospital admission and subsequent critical care that occur on the same day as long as you submit the appropriate documentation. According to CPT, "critical care and other [evaluation and management] E/M services may be provided to the same patient on the same date by the same physician." The Medicare Carriers Manual states that "if there is a hospital or office/outpatient [E/M] service furnished early in the day and at that time the patient does not require critical care, but the patient requires critical care later in the day, both critical care and the [E/M] service may be paid."
Add modifier -25 to indicate that it was a significant, separately identifiable E/M service, and link the specific diagnosis for each service to the CPT code.

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

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