October 10, 2006

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Update on Dirigo Health Blue Ribbon Commission

The Dirigo Blue Ribbon Commission held its fourth meeting this past Thursday and heard a presentation on cost containment from consultant Steve Tringale of Hinkley, Allen & Tringale.   Mr. Tringale, a former health insurance official, presented potential cost containment initiatives at the health system level, the product management level and at the level of administrative expense.  Product design, certificate of need, quality management and rate regulation were among the topics presented.  In additional to considering alternative financing sources for the Dirigo Health initiative, the Commission is charged with reviewing any ways to decrease the costs of the program.  The Commission meets again on Oct. 24 in Augusta.


The Commission also heard an initial report on interviews with legislators.  Forty-nine legislators were solicited and 14 had responded by the date of the meeting.  Legislators were asked to respond to the following questions:

  1. Given limited resources, who do you think should be Dirigo Health's highest priority for expanded coverage:
  • The uninsured only
  • Both the uninsured and under-insured

    2.   Given limited resources, which population group(s) do you think should be Dirigo Health's highest priorities

  • All adult individuals
  • Sole proprietors (self-employed)
  • Small businessess employers and their employees

     3.  What should the short term goals of the program be?  How should the program objectives and financing mechanisms evolve over time?

     4.  Given that use of MaineCare brings in federal dollars, should use of MaineCare be maximized.?  Why or why not?

     5.  What do you see as the strengths and weaknesses of the current funding mechanism?

     6.  Who should share in the responsibility for financing Dirigo Health?

  • Should employers be at least partially responsible?
  • Should the insured?
  • Should the uninsured?
  • Should insurers?
  • Should providers?
  • Should the state?

     7.  How should the responsibility be apportioned (on a percentage basis) amongst the groups listed in question # 6?

     8.  Additional ideas or comments.

Between now and the next Commission meeting, Commission members will be asked to answer the same set of questions and staff and consultants to the group will begin to look for areas of agreement.

MMA EVP Gordon Smith serves as a member of the Commission, as does Robert McAfee, M.D. and Peter Toussaint, M.D., of Fort Kent.  MMA members are invited to provide any input to the Commission through Mr. Smith at gsmith@mainemed.com.  All suggestions are welcome.




Aroostook County Nurse Practitioner to Receive Hanley Leadership Award

Family Nurse Practitioner and diabetes specialist Ann C. Gahagan of Caribou has been named the 2006 recipient of the Hanley Leadership Award.

The 4th Annual Hanley Leadership Award will be presented to Gahagan at the Hanley Center for Health Leadership Award Luncheon on Friday, October 13 at Bowdoin College.  Former Maine U.S. Senator George J. Mitchell will keynote the luncheon.

Gahagan, who practices at Cary Medical Center’s Pines Health Center, has devoted much of her 35-year career to improving diabetes care.   She has received national recognition for her leadership in developing innovative and effective treatment, care management and patient education programs that have made a real difference in improving the lives of diabetes patients in her community and beyond.

The Hanley Leadership Award is named for the late Daniel Hanley, M.D., a highly respected physician leader who earned an international reputation for his courage, innovation and collaboration.  Dr. Hanley headed the Maine Medical Association for 24 years, was the physician at Bowdoin College for more than three decades and was physician to the U.S. Olympic Committee.  Hanley founded the Maine Medical Assessment Foundation and was a pioneer in the use of data to improve the quality of medical care and outcomes. In the late 1980s he worked closely with Senator Mitchell on legislation that established the federal Agency for Health Research and Quality (AHRQ). The Hanley Center for Health Leadership was established in 2002 to carry on Dr. Hanley’s legacy of leadership.

Gahagan developed an interest in diabetes early in a healthcare career that began in 1972.  As a result of her leadership and innovation, Cary Medical Center in Caribou became a national model of disease management for patients with diabetes well ahead of the national focus on this growing disease.  Cary’s diabetes program subsequently was named as one of the top four programs in the nation by the American Public Health Association. Gahagan’s efforts to formalize protocols for the care of people with diabetes, including routine blood tests, foot care and eye exams have helped to establish practice guidelines that have greatly improved the lives of hundreds of the region’s diabetes patients. 

Gahagan also is founder and director of Camp Adventure, an innovative diabetes education camp that makes it possible for teenagers with Type I Diabetes to live in the wilderness while they learn the lifelong skills necessary to successfully live with diabetes. Young people from throughout Maine have attended the camp since its founding in 1996.  “In founding Camp Adventure, Ann saw a need, had an idea and has collaborated with staff, physicians and other healthcare professionals, local supporters, and parents to make this camp a reality" , explains Cary Medical Center CEO Kris Doody-Chabre.

In recognition of her leadership, Gahagan was named as the Maine Federation,  Business & Professional Women’s “Woman of the Year” in 2005.

While raising a family of three daughters and working as a licensed practical nurse at Cary Medical Center, Gahagan pursued certification as a registered nurse. She later earned an undergraduate degree in Nursing in 1998 and a Master of Science degree in Nursing and designation as a Family Nurse Practitioner in 2004.

Previous winners of the Hanley Leadership Award include Stephen Shannon, D.O., (then) Dean of the University of New England College of Osteopathic Medicine (2003);  nationally known medical researcher John Wennberg, M..D. of Dartmouth (2004); and Franklin County clinicians Sandra Record, R.N. and Burgess Record, M..D.

For more information, visit www.hanleyleadership.org or contact Jim Harnar at jharnar@maine.rr.com.
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"First Fridays" CME Program Focuses on Advanced Directives

The Fall's first CME program at MMA focused on Advanced Directives and their ability to improve end of life care.  Attendees heard  presentations on the law in Maine which has evolved since the l960's (Gordon Smith, Esq.),  current controversies in the law in Maine (Beth Dobson, J.D. and Kate Healy, J.D.) and consumer perspectives (Leo Delicata, J.D. of Legal Services for the Elderly).  Three hours of CME were available.

Attempts in Maine are being made to make it easier for EMS personnel to honor advanced directives.

If you missed this program but would like to have it presented at your medical staff or other location, contact Gordon Smith at gsmith@mainemed.com as many of our CME offerings can be brought to you and your institution for a modest fee. 

The two remaining programs in the 2006 "First Friday" series are November 3 regarding disability determinations and Dec. 1 which includes the most highly rated presentations from MMA's annual physician education seminar last June in Bangor.  Topics include improving quality of office based practices, Dirigo Health and "Fair Market Value and Physician Compensation." 

Each First Friday presentation is offered right at the MMA offices in Manchester and the cost is $60 for three hours of CME.  Practice managers as well as physicians are welcome to attend and breakfast and all materials are included in the fee.

Your Sept.-Oct. issue of Maine Medicine will include an insert containing registration materials for these sessions or you may register on-line at www.mainemed.com

The list of programs for next year is currently being prepared and members and their staffs are invited to provide any programming ideas to Gordon Smith at gsmith@mainemed.com. [return to top]

Happy Columbus Day. MMA Office is OPEN for Business

Today, Oct. 9, is Columbus Day and is a recognized state and federal holiday.  But knowing that many physician offices are open, the MMA office will be open from 7:00am to 5:00pm which are our normal hours during the week.  Our dedicated staff of twelve are available to assist members and their staffs on a day to day basis.  Services include access to two full-time health lawyers and our coding expert Jana Purrell who directs the Coding Center.

Call on MMA staff to assist you with the difficult and annoying issues that come up in your practice on a day to day basis.

Services can be accessed by calling the MMA office at 622-3374 (press O for assistance). [return to top]

It is Election Season: Get Involved!

The state and federal election will be held on Tuesday, Nov. 7.  MMA encourages its members and their families to not only vote on that day (or by absentee ballot earlier) but to get actively involved in campaigns of the candidates of your choice.  Involvement could mean contributing financially, writing a letter to the editor, hosting a coffee or reception in your home or actually assisting the candidate with their campaign.

With over 50% of health care in Maine being paid for by medicaid (MaineCare) and medicare, state and local office holders are in a position to really assist or hurt healthcare in the state.  Show the candidates that you realize how important they are, before having to approach them this winter in Augusta.

If you would like to know who MMA feels has been helping on issues of interest to you, give either Andy MacLean or Gordon Smith a call (622-3374 and press O) or inquire via e-mail to gsmith@mainemed.com or amaclean@mainemed.com.

Through its political action committee called the Maine Physician Action Fund, the MMA solicits PAC contributions and makes contributions to candidates for state office.  Through participation with the AMA's AMPAC, we also participate in the campaigns of  federal candidates.  This campaign season, AMPAC has contributed funds to U.S. Senator Olympia Snowe, and Congressmen Tom Allen and Michael Michaud. 

You can find information about the upcoming elections, including a list of the candidates for the state legislature, on the Secretary of State's web site, http://www.maine.gov/sos/cec/elec/2006elec.html.

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Welcome to MMA's Newest Group Member -INTERMED!

Intermed, a primary care medical practice with multiple offices in the greater Portland area is the latest practice to take advantage of MMA's Group Membership Program.  This program discounts dues for groups with more than ten physicians who make a commitment to have all the physicians in the practice join as members.  Intermed has fifty-four (54) physicians in internal medicine, ob-gyn, family practice, infectious disease, pediatrics and cardiology.  It is the largest physician-owned primary care practice in the state.

A welcome and thank you to Intermed President Tom Claffey, M.D., CEO Dan McCormack and its Board for approving the membership.  We welcome you to MMA.

In participating in MMA's group membership program, Intermed joins several other practices in the program such as PrimeCare, Sunbury Primary Care, Spectrum Medical Group, Central Maine Orthopedics,  Orthopedic Associates, Coastal Women's Health Care, Goodall Health Partners, Dahl-Chase Pathology Associates, Penobscot Community Health Center, the employed physicians at Pen May Medical Center, Mayo Regional Hospital  and Mount Desert Island Hospital, Northeast Cardiology Assoicates, Maine Cardiology Associates, Cardiovascular Consultants of Maine and Martin's Point.  Any group interested in the group program should contact Gordon Smith at gsmith@mainemed.com. [return to top]

Governor's Provider Advisory Committee on MECMS to Meet on Thursday

The Governor's Provider Advisory Committee on MECMS will meet on Thursday, Oct. 12, 2006 at 10:00am at the DHHS offices on Civic Center Drive in Augusta.  In addition to the usual updates, MMA has asked for the agenda to include the distribution of the $1 million appropriated by the legislature to reimburse practices which had to borrow money because of the MECMS failure.  We have also asked for a more detailed description of the MaineCare fee increase included in the administration's budget for the state fiscal year beginning July 1, 2007.

The most significant issue for MMA with MECMS currently is the continuing inability of the system to electronically process the Part B cross-over claims.  There is no longer even a date set for when the system may be able to do this.  In the meantime, MMA encourages members to reduce these claims to paper as the processing of the paper claims appears to be going well.  While we realize that it costs more to process a paper claim, it appears to be the only way to get reimbursed for these services.  We do not really expect that fix to take place until some point in 2007.

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MMA 2007 Dues Statement is in the Mail -or Will be Soon

Depending upon the county you live or practice in, your MMA invoice for 2007 is in the mail or will be soon.  The invoice includes a modest $15 increase which is the first increase in three years.  The new invoice is accompanied by a letter detaling some of the accomplishments of the past twelve months. The mailing also contains a "Member Profile" which is prepopulated with the information we have on each practice but which we would like to confirm as current. We hope you will fax back the profile to the office.  You can not imagine how difficult it is to keep current information on all 2700 members!

We appreciate your prompt attention to the invoice.  Should you have any question about  your invoice, please communicate them to Gordon Smith at gsmith@mainemed.com or to Lisa Martin, Membership Coordinator at lmartin@mainemed.com. [return to top]

Watch for your Sept.-Oct. Maine Medicine this Week

Your Sept.-Oct. issue of Maine Medicine will be mailed to you this week.  The front page articles deal with the recently completed Annual Session and the failure of Congress to fix the physician payment reimbursement formula.

While MMA relys on the Maine Medicine Weekly Update each Monday to keep members and their staffs up to date on what is going on in Medicine in Maine each week, the bi-monthly Maine Medicine continues to be an important means of communication as well.

MMA can only make the weekly e-newsletter available if you have given us your e-mail address.  If you have not done so but would like to receive the publication, please communicate with Lisa Martin at MMA at lmartin@mainemed.com. [return to top]

Colorado Pediatrician in Maine to Speak About TABOR this Week

The MMA has not taken a position on ballot question one before Maine voters on November 7th, the Taxpayers' Bill of Rights (TABOR), but the MMA does encourage members to become educated about the proposal.  You can read the two ballot questions on the Secretary of State's web site at www.maine.gov/sos/cec/elec/2006/refq.htm.  You can read the language in the legislation at www.maine.gov/sos/cec/elec/pets02/legbillr.htm.   The MMA Executive Committee at its upcoming meeting on Oct. 18th will consider the TABOR issue and may choose to take a position at that time.

Dr. Steven Berman will visit Maine on October 10th and 11th to share his experience and observations of TABOR's effects on children's health, public health, and Medicaid in Colorado between 1992 and 2005.  Dr. Berman is a past president of the American Academy of Pediatrics and is a Professor of Pediatrics at the University of Colorado Medical School. 

Dr. Berman will be speaking at the B Street Community Center at 57 Birch Street in Lewiston from 4:30 p.m to 6:00 p.m. on Tuesday, October 10th.  At 7:00 p.m. on the 10th, he will be at the Sanford Town Hall, 919 Maine Street in Sanford.  On Wednesday, October 11th, Dr. Berman will participate in a press conference at the Barron Center, 1145 Brighton Avenue in Portland at 10:00 a.m.  At noon on the 11th, he will speak at the Maine Dartmouth Residency Program at 15 East Chestnut Street in Augusta.  Space is limited at the residency visit, so please RSVP to Ann Byron at 626-1889 it you would like to attend.

You can find the perspective of TABOR's proponents on the web site of the Maine Heritage Policy Center, www.maineheritage.com.

As noted above,The MMA Executive Committee will discuss TABOR at its meeting on Wednesday, October 18th.
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CCHIT Offers Valuable Information on EHRs

MMA's ad hoc Committee on Technology, chaired by Paul Klainer, M.D. of Rockland, wishes to call members attention to the information available from CCHIT (Certification Commission for Healthcare Information Technology).  This independent commission, founded in 2004, is supported by the American Health Information Management Association, the Healthcare Information and Management Systems Society and the National Alliance for Health Information Technology.

In 2005, the federal Department of Health and Human Services (HHS) awarded the commission a contract to develop, create a prototyp, and evaluate certification criteria and inspection processes for Electronic Health Records ( EHRs) and the networks through which they interoperate.  The CCHIT certification process should greatly simplify choosing an EHR.

Currently, about 20 products have received this certification which harkens back to the days of the "Good Housekeeping Seal of Approval."    To earn certification, products must comply with 100% of the CCHIT criteria.  The criteria revolves around providing a broad foundation of functionality, evolving to be operable with other systems and including security features that protect the privacy of personal health information.

For the product listing and more information about CCHIT, go to www.cchit.org. [return to top]

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