November 27, 2006

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John Agwunobi, M.D., Assistant Secretary for Health, DHHS, in Portland Tuesday (Nov. 28) at 2:00pm

Dr. Agwunobi will meet with a group of Maine physicians at the offices of Maine Health at 465 Congress St. (Suite 600) to discuss the plans of the Bush Administration through CMS to impose more transparency in pricing, reportability and quality initiatives.  The meeting is at 2:00pm and anyone interested in attending should contact Gordon Smith, MMA EVP at
John O. Agwunobi was confirmed by the U.S. Senate on December 17, 2005 to be Assistant Secretary for Health (ASH), U.S. Department of Health and Human Services and an Admiral in the US Public Health Service Commissioned Corps. As the ASH, Dr. Agwunobi serves as the Secretary's primary advisor on matters involving the nation's public health. He also oversees the US Public Health Service and its Commissioned Corps for the Secretary.

Dr. Agwunobi is a seasoned public health professional with experience in health care delivery, managed care, and health policy. Prior to becoming the ASH, Dr. Agwunobi served as Florida's Secretary of Health and State Health Officer, under Governor Jeb Bush, from October 2001 to September 2005. Dr. Agwunobi confronted many public health challenges during his tenure, including leading the state's public health and medical response to the unprecedented four major hurricanes that struck Florida in 2004. In addition, the day after being named Secretary, Dr. Agwunobi led the Florida Department of Health in its response to the nation's first-ever intentional anthrax attack. He subsequently guided the state's nationally-recognized efforts to prepare for, prevent, respond to, and mitigate the effects of a bioterrorism attack.

As Secretary, Dr. Agwunobi moved the Department toward increased efficiency, customer focus, and productivity. He led the call for a healthier Florida, advocating for improved nutrition and exercise in an effort to address the state's epidemic of overweight and obesity. His Department's many successes included responses to West Nile, SARS, and numerous other infectious disease outbreaks, efforts to decrease the state's infant mortality rate, lowering tobacco use among young Floridians, addressing racial and ethnic health disparities, and improving overall access to medical and dental care.

As a pediatrician, Dr. Agwunobi dedicated himself to working with underserved populations. Before moving to Florida, Dr. Agwunobi was Medical Director and Vice President of Medical Affairs and Patient Services at the Hospital for Sick Children, a Washington, DC-based pediatric rehabilitation hospital and community health care provider. He simultaneously served as medical director for an affiliated managed care plan, where he maintained a network of more than 2,300 physicians and specialists.

Dr. Agwunobi completed his pediatric residency at Howard University Hospital in Washington, DC, rotating between Children's National Medical Center and the District of Columbia General Hospital--then one of the nation's busiest inner-city hospitals. In addition to his medical degree, Dr. Agwunobi holds a Master of Business Administration degree from Georgetown University in Washington, DC, and a Master of Public Health degree from the Johns Hopkins School of Public Health in Baltimore, MD. He is also a certified managed care executive.

Dr. Agwunobi has been the recipient of numerous honors and awards, including Public Administrator of the Year, APHA Public Health Hero Citation, and Honorary Doctorate of Humane Letters. He previously served as Chair of the Centers for Disease Control and Prevention Advisory Committee to the Director, and on the Board of Directors of the National Quality Forum--an advisory group formed at the recommendation of the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry.

Dr. Agwunobi has a passion for leadership and innovation and sees his role as Assistant Secretary for Health as an opportunity to enhance the Secretary's efforts to further the mission of HHS and the health of the nation by building, strengthening, and leveraging relationships across the public health community and the US Public Health Service.

Dennis Shubert, M.D., PhD., Resigns Position at Maine Quality Forum

Neurosurgeon Dennis Shubert, M.D., PhD. announced his resignation as Director of the Maine Quality Forum last Monday at a meeting of the Dirigo Health Agency.  Dr. Shubert had served in the position since 2003.  He has agreed to continue to consult to the Forum, particularly on issues requiring Forum input into the Certificate of Need process.  His resignation is effective Jan, 1, 2007

As financing for the Forum is somewhat in flux awaiting the decisions on the funding for the overall Dirigo program, it is not clear when a replacement may be in place.

When Dr. Shubert was selected as the first Director of the Forum, he planned at that time to serve for at least two years.  He has completed approximately a three year experience with the Forum where he has lead an effort to provide more data on quality measurements to the public.

Dr. Shubert had previously practiced neurosurgery at Eastern Maine Medical Center in Bangor. [return to top]

Update on Pathways to Excellence

The Pathways to Excellence (PTE) Physician Steering Committee met on November 16.  Following a presentation on activities on the national level through the AQA,  committee members discussed the 2006  PCP data.  It was estimated that 40% of practices in Maine receiving 2 or 3 blue ribbons probably account for about 50% of physicians in Maine.  Practices receiving one ribbon represent another 25%, meaning that 75% of Maine PCP's would get at least one blue ribbon.  The blue ribbon distribution was tested with a number o BIW employees, and it made sense to them.

Members want to recognize/reward more for outcomes.  Although this year (20006) only 1 of 3 ribbons were for outcomes, next year it will be 2 of 3.  The blinded data is targeted to be posted on the Maine Health Information Center website Nov. 22.  A letter will be sent to all PCP practices notifying them of the data being available.  The letter will also update physicians on the metrics for 2007.  PHO's and large practices will be sent identified data for all their practices.

Steering Committee members discussed the issue of outcomes denominators and concluded that Jan Wnek, M.D. and Ted Rooney would consult with a statistician at the MHIC to come up with a recommendation.   Essentially, this issue involves the problem of practices not having a sufficient number of patients in the denominator.  For the outcomes and process metrics this year, any practice with less than 40 patients per family medicine practitioner and 80 patients per internal medicine practitioner were required to submit reasons why they had fewer than this number.

2007 quality metrics will be very similar to this year but with some changes to the pediatric registry section.  CVD and pediatric asthma will be moving to reporting of outcomes and the entire timetable will be moved up.  Information about cost/efficiency measurements will be sent in 2007.

With respect to moving the effort to specialties, the plan is to have specialty work groups involving physicians, employers and insurers beginning with cardiology, orthopedics, radiology, surgery and neurosurgery.  The MMA and MOA will be approached about assisting with getting the specialies together to learn about his initiative and to provide feedback.

Perhaps the most contentious discussion involved the potential use of cost-efficiency measurements in 2007, through efforts such as Care Focused Purchasing (CFP) and the MHIC/ProfSoft initiative.  As providers are likely to be resistant to the episodic treatment groups (ETG) methodology used in these cost/efficiency measurements, 2007 is likely to be a more difficult year for the coalition's activities than when the focus was on primary care and quality measures.

CFP is being pushed by both the health plans and the insurers and are put together on a national as opposed to a local basis, although Anthem representatives noted that CFP would be used for its national accounts but that other data could be used for its Maine accounts, which are the majority of its business in Maine.

MMA's Payor Liaison Committee and Committee on Quality Improvement and Peer Review will continue to review these various initiatives and report to members on a periodic basis. [return to top]

Quality Counts! Part 4, December 6, 2006 at Augusta Civic Center

To register for the conference, please complete the form available online at

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"Tiered Networks" the Topic at Payor Liaison Committee Meeting Thursday Night

The Association's Payor Liaison Committee, which meets on a bi-monthly basis to deal with various payor issues, will meet on Thursday evening, Nov. 30.  The guest will be Frank Johnson who serves as Executive Director of the Maine State Employee Health Commission, which operates the health plan for state employees, their dependents and state retirees.  Mr. Johnson also serves as a member of the Maine Quality Forum Advisory Council.

The State Employee Health Commission is a 22-member labor/management group that serves as trustee to the State employee health plan covering approximately 40,000 employees, dependents and retirees throughout Maine.

The Commission introduced a tiered hospital benefit effective July 1, 2006.  Hospitals that met certain patient safety and clinical measures were designated as "preferred" hospitals, based upon three different criteria.  As an incentive to encourage members to be aware of patient safety and quality issues, services billed by a "preferred" hospital are exempt from the annual deductible.  As of July 1, 2006, fourteen hospitals met the three criteria for "preferred" status.

The plan is now planning to have a tiered network of Maine physicians.  Mr.Johnson will describe the plan and the criteria  intended to be used to separate physicians into the two tiers.

The meeting will be held at 6:30pm with dinner available at 6:00pm at the offices of MMA in the Frank O. Stred Building in Manchester.  Any MMA member or office staff is welcome to attend, but please let Diane McMahon know so we can be certain to have enough food for dinner.  Diane can be contacted at or called at 622-3374 ext. 216.  [return to top]

Medicare's New Open Enrollment & Partner Center on

As you know, Medicare’s open enrollment period started earlier this month.  CMS is very encouraged by the level of response we have seen already, including almost 10,000 online enrollments.  We are very grateful for all your assistance in this process – together we can make a real difference in the lives of people with Medicare by helping them make the most of their Medicare by making confident decisions about their coverage.

CMS has consolidated information and dedicated two areas on the web for your use, including an Open Enrollment Center and a Partner Center on  We are committed to assisting you with your outreach and work with people with Medicare. We hope this one-stop shopping centralization of information on these two sites will be helpful. 

You can locate these sites at and

CMS has been developing standardized performance metrics for the Medicare Part D prescription drug plans. These metrics will provide you with information to make informed choices about your health care by allowing you to compare the performance of these plans. To access the performance information:

  1. Go to
  2. Click on “Compare Medicare Prescription Drug Plans”
  3. Click on “Find and Compare Plans”
  4. Click on “Begin General Search”
  5. Enter the requested information and click “Continue”
  6. Review Current Coverage and Consider Options and click “Continue”
  7. Decide if you want to get drug costs for your plans and either enter your drugs or click “Continue.” If you enter your drugs, you will be prompted to go through several additional steps to enter drugs, save you drug selection, and choose a pharmacy.
  8. Once you reach your personalized plan list, you will see a button on the right side of the page that says “Get Plan Performance Information.” Click on this button.
  9. When you click on “Get Plan Performance Information” a new window will pop up. This page provides an overview of the type of information available, which includes ratings concerning:
  • Telephone Customer Service
  • Complaints
  • Appeals
  • Sharing Information with Pharmacists
  • Drug Pricing
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Flu Vaccine Slow to Arrive

Across the country and throughout Maine, physician offices, as well as hospitals, nursing homes and health centers have been waiting for several weeks for  flu vaccine ordered months ago.  The delay this year is due chiefly to problems manufacturing the large number of doses using the traditional egg-based production that takes time.  In particular, one vaccine strain, prepared early in the year once the CDC identified which flu strains could be a problem, was slow to grow.

The Maine CDC distributed its adult vaccine this year only to nursing homes, hospitals and health centers.  MMA has expressed concern about this and held a meeting with Dora Mills, M.D. and Bureau staff three weeks ago to discuss how the process could be improved for next year.  Even the Maine CDC supply was very late in coming with the final allotment arriving just before Thanksgiving.  Therefor, pediatric vaccine for pediatric offices and family practices should be arriving immediately.  The Maine CDC purchased 145,000 doses this year and accounts for about one-fifth of the state's supply.  Most physician offices still purchase privately directly from manufacturers.

Hannaford Brothers conducted 50 flu clinics earlier this Fall distributing nearly 4000 shots.  Because the grocery chain uses Maxim Health Systems which conducts the clinics, supply is not an issue.  Maxim purchases its supply by the millions of doses and receives priority from the manufacturers.  Maxim will also conduct clinics for physician offices, as they do for some Maine hospitals.  In fact, it was Maxim Health System that provided the flu clinic for physicians attending the recent AMA meeting in Las Vegas. [return to top]

Alzheimer’s Association, Maine Chapter Seeks Executive Director

The Alzheimer’s Association, Maine Chapter seeks an Executive Director to take this fast growing, non-profit organization and its small, highly motivated staff and strong volunteer core to its next level of excellence

Candidates must have a strong background in management, fundraising, finance, staff development, and strategic planning, and be able to effectively communicate the Association’s mission of serving the growing number of families affected by Alzheimer’s disease and related dementias to diverse audiences.
Please send letter of interest, resume and three references to:

Search Committee Chair
c/o Maine Alzheimer’s Association
163 Lancaster St.  Ste#160B
Portland, ME 04101

Applications will be accepted until the position is filled.  First consideration of applicants will take place on Dec. 4, 2006.

For more information, visit
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Internal Medicine Position Available in Mid-Coast Area

Spectacular ocean sailing, unspoiled lakes.  Growing coastal town close to cities, tertiary care center.  Mentoring partnership with experienced, BC internist.  One provider retiring, the other dedicated to seeing you succeed and carry on legacy before cutting back.  Prestige practice of >20 years, cited for quality patient care, teaching and office systems which generate P4P bonuses.  EMR over 8 years. Local College. Office attached to community hospital, steps from ER, ward and ICU, ½ block to ocean. 1 in 7 call. [return to top]

The Coding Center's Coding Tip of the Week

Medical Necessity and ICD coding

  • Diagnosis codes justify and identify the medical necessity of services provide
  • Principles of diagnosis coding:
    •  List the primary diagnosis, condition, problem or reason for the procedure or service.
    • Assign the code to highest level of specificity (to the fourth and fifth digits when available).
    • Never use or code a “rule-out”, “suspected” or “probable” as a diagnosis if a definitive diagnosis has been confirmed.
    • If definitive diagnosis has not been determined do not use “R/O”.  Instead code the signs and symptoms the patient presented with
    • Be specific: (Example: diabetes, Type II, insulin dependent)
    • Distinguish between “acute” and “chronic” conditions
Questions? Call the Coding Center, 1-888-889-6597
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LAST CALL: MMA Legislative Committee Meets Tomorrow Night to Set Agenda

As mentioned in previous communications, the MMA's Legislative Committee will hold its organizational meeting at the MMA office on Tuesday, November 28, 2006 from 6 to 9 p.m.  At this meeting the Committee will review the election results and will discuss the MMA's legislative agenda for the new legislature.  Any member or specialty society liaison who wishes to raise an issue to be considered for incorporation into the MMA's legislative agenda is urged to attend.  Please RSVP to Charyl Smith, Legislative Assistant, at  The meeting will include dinner available at 6 p.m. [return to top]

Secretary Leavitt Describes 4 "Cornerstones" of Health Care

Addressing a National Association of State Medicaid Directors' conference on November 15, 2006, US DHHS Secretary Michael O. Leavitt described the Bush Administration's vision to create a cohesive health care system.  The federal government represents 40% of the country's health care market through its various programs and it is changing the way it purchases health care services.  It is beginning to require the following 4 "cornerstones of health care" from health insurance carriers:

  • interoperable electronic records;
  • a series of standards on quality;
  • aggregate claims data on episodes of care to measure value; and
  • enhanced quality incentives for consumers and providers.

These 4 cornerstones will be incorporated in the federal government's requests-for-proposal (RFPs) for the 2008 procurement year. [return to top]

Don't Miss Final "First Fridays" Program of 2006: The Best of 2006 Practice Education Seminar

The final "First Fridays" CME program will be held on Friday morning, Dec. 1, 2006 at the office of MMA in Manchester from 9:00am to noon.  The program consists of the most highly rated presenters or topics from the Practice Education Seminar held in June in Bangor.  Barbara Crowley, MD, of Maine General Health Associates will present on the topic of improving the quality of care provided on an ambulatory basis.  Tarren Bragdon will update attendees on Dirigo Health and other Health Policy issues in Maine post-election, and attorney Mike Duddy will repeat his very popular talk on "Fair Market Value and Physician Compensation."  The program will be moderated by MMA EVP Gordon Smith, Esq.

You may register on-line at the MMA website at or call Jess at 622-3374.  There is a $60 charge which includes breakfast and all course materials.  The program has been approved for three hours of CME.

Watch this publication and the Nov/Dec. issue of Maine Medicine for a complete listing of the 2007 "First Fridays" offerings which will be held the first Friday morning of each month at MMA.  Among the offerings will be a risk management program, the annual HIPAA update for office staff and a repeat of this year's program on the use of data to improve practice.

"First Fridays" was established in 2005  as a source of education for members and staff.  We welcome suggestions for programs topics.  Send your ideas and needs to Gordon Smith at or to Gail Begin at [return to top]

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