September 11, 2006

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MMA Successfully Concludes 153rd Annual Meeting

MMA concluded its 153rd Annual Meeting yesterday following two days of business and educational sessions around the theme of "Medicine in Extreme Environments."  The talks were very well received and participants were unanimous in their comments about the program being the best the organization has ever presented.  From the riveting presentation of former NASA astronaut Story Musgrave, M.D. on Friday to the concluding panel discussing medical relief work in Louisiana, Pakistan and Indonesia, attendees were presented with attention-getting information.  Watch for more information in next week's Update on the meeting.

At the annual banquet on Saturday evening,  out-going  President Jacob Gerritsen, M.D. presented the gavel to in-coming President Kevin Flanigan, M.D.  Dr. Flanigan is a practicing internist and pediatrician in Pittsfield.  William Strassberg, M.D., an orthopedic surgeon at Mount Desert Island Hospital in Bar Harbor was elected to the position of President-elect.  Stephanie Lash, M.D., a practicing neurologist in Bangor, Maine was selected by the Executive Committee to be its chair for the coming year.


At the annual business meeting, the members present passed 10 resolutions addressing various practice and public health issues.  The resolutions in their original form are available on the MMA website at  Members also approved a budget for 2007 which includes a $15 dues increase.  Although expenses from year to year have actually decreased due to staff changes and budget-cutting, a shortfall in dues collection and in corporate affiliate dues has created a significant gap between revenue and expenses. 

At the meeting, DHHS Deputy Commissioner J. Michael Hall updated those present on the MECMS problem and announced plans to include a MaineCare fee increase in the Governor's budget for next year.  Medical Mutual President Terry Sheehan, M.D. presented an overview of the status of medical liability in Maine and Maine CDC Director Dora Anne Mills spoke on the Bureau's current activities.

On Saturday evening, Maine CDC Director Dora Anne Mills , M.D. was presented with the President's Award for Distinquished Service.  A Special Recognition Award was presented to Dr. Thomas McDermott in recognition of his past years chairing the Committee on Physician Health.  Recipients of the Annual Mary Floyd Cushman, M.D. Awards were Josette Hunter, M.D. (International) and Nancy Knapp, M.D. (Domestic).

Guests at the meeting included representatives of the AMA, AMPAC, The Ohio State Medical Association, the New Brunswick Medical Society, The New Hampshire Medical Society and The Maine Osteopathic Association.

More detailed information will be included in next week's update.

Volunteers Needed in Oxford and Penobscot Counties

There is an existing vacancy on the MMA Executive Committee in Oxford County, occasioned by the completion of Dr. Deiter Kreckle's three three-year terms.   Any MMA member living or practicing in Oxford County who may be interested in the position should contact Gordon Smith at

There is also a need for volunteers to fill some positions in the Penobscot County Medical Society.  County Society President Richard Long, M.D. is looking for a Vice President.  Again, any MMA member practicing or residing in the county who may be interested should contact Gordn Smith at [return to top]

Speculation About Successors to CMS Administrator McClellan

Administrator of the Centers for Medicare & Medicaid Services (CMS) Mark McClellan, M.D. recently announced that he will soon leave his post.  A replacement for McClellan has not yet been named, but potential nominees include CMS Deputy Administrator Leslie Norwalk; Herb Kuhn, director of the Center for Medicare Management at CMS; and Julie Goon, a special assistant to President Bush and former director of Medicare outreach at HHS.  McClellan's successor faces two major challenges:  increases in the number of people without health insurance and funding for Medicare and Medicaid.  The next administrator will have to address a scheduled cut in Medicare reimbursement for physiciains. [return to top]

Maine Chapter AAP 2006 Fall Conference November 4, 2006 in Orono

Maine Chapter, American Academy of Pediatrics Fall Conference & Open Forum on Early Childhood: From Risk to Resilience to Practice
November 4, 2006 Black Bear Inn, Orono, Maine

Interactive Discussions
Following the morning presentations and discussion, audience members representing parent or individual professional groups from around the state will have lunch together to discuss the advocacy or professional role each group can play. After lunch, participants and pediatricians will re-group by community to learn some practical steps they all can take in their own work.
The groups will then develop plans to inform and recruit others in a community-wide effort to prevent ACEs and enhance Protective and Resilience factors within each household with a particular focus on infants, toddlers and their parents.

Learning Objectives
Participants will be able to:

  • understand and utilize their skills in helping to create protective households and communities for the children of Maine.
  • describe the relationship between Adverse Childhood Experiences and adult health and mental health risks and outcomes.
  • describe the factors needed in a child’s life to help them become more resilient.
  • identify key people in their community to work together with to reduce the likelihood of Adverse Childhood Experiences and increase resilience for children in their community.


Questions? Contact the Chapter office at 207-685-9358 or [return to top]

Maine Public Spending Research Group Announces Maine Budget Workshop September 25


Monday, September 25th
8:30 AM-4:00 PM
Maple Hill Farm Conference Center

Click here to register.

The Governor and legislative leaders celebrate every "good" report as proof that Maine is on the right track, calling more negative reports inaccurate or incomplete. Advocates for smaller government and lower taxes tout each piece of "bad news" as evidence that special interest groups are in control of state and local government and that the voice of the typical Mainer is not being heard.

What are the numbers and facts behind these arguments? It's hard to say because current, easy-to-use information about taxes and spending is hard to find. Reasonable people can certainly disagree about the effect of particular choices on families and businesses. Much of the recent debate, though, has been about fundamentals: whether or not taxes are increasing, whether or not government is shrinking, and the relative size of education and health spending as the two biggest slices of the budget pie. Maine voters deserve easy access to good budget information and ways to track changes to spending and taxes over time.

These indicators would include:

  • Complete "financial statements" which include the state's long-term commitments
  • Revenue and spending summaries by program
  • Benchmarks against other states
  • Indicators of tax impact on families and businesses
  • What's the truth about Maine taxes and spending?

The Budget Workshop will ask:

  • What is Maine's tax burden?
  • Is Maine government getting larger or smaller?
  • Did LD1 reduce taxes as promised?
  • What will the state's long-term commitments cost?

Experts and elected officials will get a chance to debate the state budget, how it's built, and where it's headed. Based on this debate, MPSRG will release financial statements for the state budget and the first annual set of benchmarks and indicators which will be used to track decisions made by local and state governments.

MPSRG is a non-partisan, non-profit educational organization. Its mission is to reduce Maine's tax burden to the national median through objective budget analysis and public education. We thank the Bangor Daily News for serving as host for this event.

  [return to top]

Time Running Out to Reverse Medicare Payment Cuts

It's crunch time for stopping Medicare payment cuts! Time is running out for Congress to reverse the 5.1 percent cut in Medicare physician payments for 2007 scheduled to take effect Jan. 1. The across-the-board cuts would reduce payments for all physician services and trigger an access-to-care crisis for America's seniors.

All physicians and medical students are urged to get in touch with their members of Congress, who are scheduled to adjourn Sept. 29. Tell them to take action before then to stop the 5.1 percent cut in Medicare physician payments for 2007 and provide a positive update that reflects practice costs, as recommended by the Medicare Payment Advisory Commission. Explain that if Congress doesn't act, the current system will reduce patients' access to care.

Visit   or call (800) 833-6354 to be connected with your members of Congress. [return to top]

Reminder: Medicare Will Hold Payments from September 22 - 30

Reminder, Medicare will hold payments from Sept. 22 to Sept. 30, the last nine days of the federal fiscal year. Medicare will pay all claims held during this period on Oct. 2.

The payment delay is mandated under the Deficit Reduction Act (DRA) of 2005 and affects all fee-for-service providers, including physicians and hospitals. Congress included the provision in the DRA to move some Medicare spending from fiscal year 2006 to fiscal year 2007.  This delay is one of several mechanisms Congress used to replace the 2006 Medicare physician payment cut with a one-year freeze. It is also important to note that no interest will accrue during this period nor will any late penalties be paid.  View   to read more from Medicare about this issue. [return to top]

The Coding Center's Coding Tip of the Week

The Time Factor – If more than 50% of the time spent face-to-face with the patient is for counseling or coordination of care then time can be used as the determining factor for coding the service.

Documentation requirements for using Time as the key factor include:

  • Indicate the total face-to-face time spent with the patient
  • Indicate the time spent in counseling or coordinating care
  • A brief description of what was discussed must also be documented


Place of Service: Subsequent Hospital Visit
Chief Complaint: Discussion of Prognosis

Discussed prognosis regarding metastatic cancer and the apparent failure of treatment with patient and family. Hospice, respite care, pain management, etc…
35 mins face-to-face & on floor with patient and family. Greater than 50% of time spent in discussion above.

Code: 99233

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

Evidence-based Care Yields Mixed Results in Pilot

According to an article in the August 31, 2006 issue of Modern Healthcare, Hospital Alliance Premier and CMS have released findings of the first year's results of a 3-year pay-for-performance demonstration project.  Premier found that when caregivers followed the suggested processes for heart attacks, heart bypass, hip and knee replacements and pneumonia, the recommended steps did lower costs and improve outcomes.  However, using evidence-based interventions to care for heart-failure patients increased costs and increased complications.  The analysis is based on 2004 data from 250 hospitals. [return to top]

Medical Mutual Insurance Company of Maine Requests No Rate Increase

In a letter to insureds dated August 31, 2006, MMICOM President & CEO Terrance J. Sheehan, M.D. announced that physician and hospital accounts renewing with effective dates after September 30, 2006 will not have their premiums impacted by changes in filed rates for the coming year.  Dr. Sheehan stated that the company's independent actuarial firm, Milliman USA, performed a comprehensive annual review of the Maine rate structure and concluded that the currently filed rate structure is adequate to support projected losses. [return to top]

OMS Provider Relations Representatives Available for One-on-One Visits

Provider relations' representatives are planning to visit with providers at DHHS regional offices beginning September 18.  Bring questions, issues and suggestions; bring samples of claims and remittance advices!

Appointments are available in one-hour time slots beginning between 8:00 and 9:00 am, depending on the location.  The last appointments of the day begin between 2:00 and 4:00 pm, also dependant on location.  The schedule of dates and locations, along with appointment start times is below. 

Enrollment is on a first-requested, first-registered basis and is limited to a one-hour session per provider.  

 Please schedule your appointment soon.  We look forward to assisting with any billing or claims questions you may have!

Monday, September 18th

  • Augusta 8:00 am - 4:00 pm
  • Sanford 9:00 am - 3:00 pm

Tuesday, September 19th

  • Skowhegan       9:00 am - 3:00 pm
  • Biddeford       9:00 am - 3:00 pm

Wednesday, September 20th

  • Calais  8:30 am - 3:30 pm
  • Lewiston        8:30 am - 3:30 pm

Thursday, September 21st

  • Machias 8:30 am - 2:30 pm
  • Bangor  9:00 am - 3:00 pm

Monday, September 25th

  • Portland        9:00 am - 3:00 pm
  • Bangor  9:00 am - 3:00 pm

Tuesday, September 26th

  • Rockland        9:00 am - 3:00 pm

Wednesday, September 27th

  • South Paris     9:00 am - 3:00 pm
  • Ellsworth       9:00 am - 2:00 pm

Thursday, September 28th

  • Farmington      9:00 am - 3:00 pm
  • Portland        9:00 am - 3:00 pm

Provider Outreach Request Form




Enrollment is on a first-requested, first-registered basis and is limited to a one-hour session per provider. You will receive an e-mail reply to confirm your registration. You may register by e-mail, mail, or fax.

















Your Preferred Meeting Time (we will work with you to accommodate your preferred time to the extent possible, however, it will be assigned on a first-requested basis):






Person(s) Attending:





Provider/Billing Agency:


Billing Number:


Phone Number:






CONTACT INFORMATION (In case we need to contact you.)


Call Back Name:

Call Back Phone Number:







Please send request form to:




Deborah Thomas


Institute for Public Sector Innovation


295 Water St.


Augusta, ME 04330


Fax: 626-5210

Phone: 626-5036



[return to top]

U.S. Drug Enforcement Administration Publishes Proposed Rule on Schedule II Prescriptions

On Wednesday, September 6, 2006, the U.S. Drug Enforcement Administration issued a press release, a proposed rule, and a guidance document entitled, Dispensing Controlled Substances for the Treatment of Pain regarding Schedule II prescription practices. 

The proposed rule, 21 C.F.R. section 1306.12, states that:

  • refilling Schedule II prescriptions is prohibited;
  • but, a practitioner may issue multiple prescriptions authorizing a patient to receive a total of up to a 90-day supply of a Schedule II drug if the practitioner has determined that there is a "legitimate medical purpose" for the patient to be prescribed the drug and the practitioner is "acting in the usual course of professional practice;"
  • and if, the practitioner "writes instructions on each prescription (other than the first prescription, if the prescribing practitioner intends for that prescription to be filled immediately) indicating the earliest date on which a pharmacy may fill the prescription"
  • and if, the practitioner concludes that providing the patient with multiple prescriptions "does not create an undue risk of diversion or abuse."

You can read the DEA press release on the web at:

You can read the proposed rule on the web at:

You can read the guidance document on the web at:

These documents are intended to clarify confusion created by a document entitled, Clarification of Existing Requirements Under the Controlled Substances Act for Prescribing Schedule II Controlled Substances published on August 26, 2005 at 70 F.R. 50408.

  [return to top]

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