December 4, 2006

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Maine CDC Makes Flu Vaccine Available to All

The Maine Centers for Disease Control and Prevention announced on Friday that there is now enough flu vaccine available for the Center to make it available to any physician to administration to any patient.  A simple fax back form sent to the Center, available here, is all that is needed.  Although originally, the Center announced it would only furnish adult vaccine to hospitals, health centers and nursing homes, returns from providers, and the late arrival of some of supply have now made it possible to open up the supply to private officers.  MMA met with Dora Mills, M.D., MPH, the Director on Nov. 1 and advocated for a fairer distribution process for next season. Read on for the fax request form.

Influenza vaccine available for all Providers December 1, 2006 The Maine Immunization Program is now opening up the State supplied influenza vaccine to any patient seeking vaccination. Due to provider cancellation we are now able to accept orders from all providers for influenza vaccine. Please complete the following information and fax back to 1-800-437-5743 or 207-287-8127 by 12/8/2006 Pin:______________ Facility Name:___________________________   Contact Person:____________________________________________   These are the following presentations that we have available:  

Manufacturer Brand Name Presentation Thimerosal Preservative Age
Doses Requested
Sanofi Pasteur, Inc. Fluzone® 5.0 mL Multi-dose vial Yes 6 months and older  
GlaxoSmithKline Fluarix™ 0.5 mL single-dose syringe TRACE 18 years and older  
  Orders will be approved on a first serve basis We will send a confirmation on when to expect your vaccine shipment

Medicare Posts Physician and Hospital Outpatient Information

As part of a continuing government initiative to increase transparency for health care consumers, the Centers for Medicare & Medicaid Services (CMS) has made available Medicare payment information for physicians and hospital outpatient departments. The data covers payment rates for 19 typical in-office physician services, more than 70 out-of-office physician services and 81 common outpatient hospital procedures. Among the orthopaedic in-office physician services listed are injections or withdrawal of fluid from hip, knee or shoulder joint, knee x-rays (one or two views) and bone density scan of hips, pelvis and/or spine. The out-of-office orthopaedic services include open repair of a rotator cuff, open surgical treatment of a wrist fracture (radius) and total hip and total knee replacements. Information includes the number of allowed services, the average submitted charge, the average allowable charge and the average payment. The information has been released on the Web as a series of downloadable files in Microsoft Excel format, with supporting files available as Adobe PDFs. For more information:

The CMS data can be accessed at: [return to top]

Report on John Agwunobi, M.D., Assistant Secretary for Health, DHHS, Visit to Maine

The highest ranking physician in the federal government paid a visit to Maine last Tuesday (Nov. 28) and met with several Maine physicians to discuss issues ranging from Medicare payment to the President's desire for more transparency in healthcare pricing.  Assistant Secretary for Health at the U.S. Department of Health and Human Services, John Agwunobi, M.D., MPH, MBA, is the only physician in Secretary Leavitt's cabinet.  Prior to being confirmed in his current position by the United State's Senate, Dr. Agwunobi served as the top health official in the state of Florida.

Proving to be a good a listener as a presenter, Dr. Agwunobi spoke candidly about the remaining two years of the Bush administration.  He promised to do what he could to push for realistic improvements in the healthcare system and to protect the patient-physician relationship, a relationship he described as sacrosanct. 

DHHS Secretary Michael Leavitt and Dr. Agwunobi are on a national listening tour with physicians.  Topics discussed have included the need for electronic medical records and the need for more transparency regarding the cost and quality of health care.  Pay for Performance programs have been among the targets physicians have talked with federal officials about.

The meeting was hosted by MMA.  Representatives also attended from the Maine Osteopathic Association, the Maine Quality Forum, Medical Mutual Insurance Company of Maine,  the Greater Portland PHO and Maine Health.  The visit generated a front-page article in the Portland Press Herald. [return to top]

Anthem Blue Cross and Blue Shield to Increase Premiums in the Individual Market by an Average of 16.7%

Maine's attempt to have more of its citizens covered by health insurance was dealt another blow this week with the decision of the Insurance Superintendent to allow Anthem Blue Cross Blue Shield to increase rates for its Heatlh Choice product by an average of 16.7%.  Under Anthem's original filing, rates would have increased by an average of 20.5%.  Superintendent of Insurance Alessandro Iuppa denied the original rate increase on Nov. 9 but gave Anthem an opportunity to submit a revised filing.  Anthem submitted the new filing on Nov. 13, proposing rate increases from 0 percent to 25.6 percent, depending upon the benefit design of the plan selected.  That plan was approved this week.

The Superintendent did, in denying the original request, require the company to lower its profit margin for the product from 5% to 3%.  Based on its filings with the Bureau, in 2005 Anthem made a profit in Maine of over $50 million when all of its products are considered, although it lost $3 million in the individual market.  It is now writing nearly a billion dollars worth of premium.

Superintendent Iuppa also announced his resignation this past week, effective Jan. 13.  He was appointed acting Superintendent in 1997 and was appointed to a full term in l998.  He oversaw the sale of Blue Cross Blue Shield of Maine to Anthem shortly after he took office. [return to top]

Schedule of 2007 First Friday Series of Educational Programs Announced

MAINE MEDICAL ASSOCIATION 2007 First Friday’s Schedule

Mark your calendars!




February 2, 2007 

Collections Seminar     

Vaughan Clark 

March 2, 2007 

Annual HIPAA Training 

Gordon Smith, Esq.

Andrew MacLean, Esq. 

April 6, 2007 

Risk Management 

Cheryl Peaslee 

May 4, 2007 

Physicians Guide to Maine Law 

Gordon Smith, Esq.

Andrew MacLean, Esq. 

June 1, 2007 

"Jazzing Up Your Coding Skills" 

Jana Purrell, CPC 

September 7, 2007 

Collaboration Skills for Healthcare Professionals 

Beth Boynton 

October 5, 2007 

Using Data to Improve Quality and Public Reporting 

Maine Health Information Center   Maine Quality Forum                      Maine Health Data Organization  Maine Health Management Coalition

November 2, 2007 

Family Planning Association of Maine 

Cheryl Daggett 

December 7, 2007 

Best of Physician Practice Seminar 


[return to top]

Dirigo Blue Ribbon Commission Considers Cost-Reduction Strategies and SOP Alternatives

The Governor's Blue Ribbon Commission on Dirigo Health, charged with looking at alternatives to the Savings Offset Payment for funding the program, met again on last Wednesday (Nov. 29).  The Commission has only two scheduled meetings left, one on Dec. 11 and another on the 19th.  The Commission was originally scheduled to present its report to the Governor by Dec. 15 so obviously that deadline is not going to be met.

A list of funding options was distributed at the meeting but not discussed.  Instead, the Commission spent most of the meeting considering some strategies that would decrease the costs of the program.  These options were presented by consultant Steve Tringale and included items such as more cost-sharing with enrollees (co-pays and deductibles), benefit re-design, moving to a self-insured model and adoption of the planned care model.

Members were also presented with a list of strategies that would reduce costs throughout the healthcare system (as opposed to affecting only Dirigo).  This list included provider rate-setting, stricter Certificate of Need controls, reform of Insurance Rule Chapter 850 and several types of insurance reform.

While some Commission members wanted to focus on the proposals that related only to Dirigo, at least until the Commission's essential purpose was accomplished, others insisted that they would not support changes to Dirigo without consideration of changes across the board.

So far, the only discussion about funding has involved support for use of the general fund, which would meet the goal of spreading the cost among the broadest possible base.  But because use of the general fund would require that the program compete in each budget cycle with other programs, a result unlikely to be supported by Governor Baldacci and other Dirigo supporters, at a minimum, the Commission will need to make recommendations concerning enhancements to the general fund.  These enhancements could include so-called "sin" taxes, a snack tax, higher income or payroll taxes, fines for motor-vehicle violations, provider taxes, or higher employer and employee contributions. [return to top]

Your MMA Dues Can Be Paid Securely Online

Busy?  Well, MMA is working to save you time.  If you haven't yet had the opportunity to pay your MMA Dues, you can now easily and securely pay with Visa or MasterCard on the MMA web site,  Just click on the "Pay Your Dues Online" button in the upper right hand corner of the home page.

If you have misplaced your invoice and are not sure of the amount you owe, contact Lisa Martin at 622-3374 ext: 221 or email her at

Thank you for your continued membership in the Maine Medical Association! [return to top]

December Members-only Poll Question Posted on Web Site

We want MMA member opinions on topics of interest to the practice of medicine, and therefore post a new members-only poll question on the home page (directly under the Calendar of Events) on our web site, the first day of each month.

The poll question for December is:  The Board of Licensure in Medicine is considering a proposal to require the fingerprinting of new physician applicants for licensure.  Would you support such a process?

Please take a moment to visit and place your vote today.  The questions are for members-only, so you will need to enter your username and password and then it is as easy as toggling on a button indicating your choice and pressing submit.  If you haven't registered as a member, you can do so easily by clicking on "REGISTER" in the upper right hand corner of the home page under MMA Member Access.

We want your opinion, so please take time to vote today! [return to top]

Hearing on Friday on Sizing of CON Capital Investment Fund

A public hearing will be held on Friday, Dec. 8, from 9:00am to 11:00am at the University of Maine Center for Community Inclusion and Disability Studies at 225 Western Ave., Augusta on the Baldacci administration's proposal for the sizing of the so-called Capital Investment Fund.  The proposed amount for the fund in the next twelve months is $8.7 million, with 12.5% being set aside for non-hospital projects.  Because of credits debited from the existing year, the total amount available is approximately $7.2 million.

Under the provisions amending the CON law which were included in the Dirigo Health legislation, the Capital Investment Fund is a limit on the total third year operating costs that may be approved under the CON program each year.

Written comments on the proposed rule will be accepted through 5:00pm Dec. 18. [return to top]

Jean Antonnuci, M.D. Featured in Medical Economics Article

The Dec. 1, 2006 edition of Medical Economics includes a substantial article on what the writer calls "micro-practices" or practices which feature a smaller number of patients and an older, leaner style of practice.  Among the physicians profiled is Jean Antonnuc, M.D.i of Farmington who began a "micro-practice" over a year ago.  Jean is an MMA physician who is marching to a different drummer and enjoying it.

To read the article go to:  For more information on similar practices, go to [return to top]

MMA Legislative Committee Develops Agenda for 123rd Maine Legislature

The MMA's Legislative Committee, chaired by Katherine S. Pope, M.D., held its organizational meeting for the 123rd Maine Legislature on Tuesday, November 28, 2006.  Approximately 20 members and guests attended the meeting and participated in the discussion about issues on organized medicine's agenda for the new state legislature. 

The meeting agenda follows:




 Frank O. Stred Building, Manchester, Maine

Tuesday, November 28, 2006, 6 – 9 p.m.


1.            Welcome and Introductions (Dr. Pope, Chair)

2.         Revised Legislative Committee Process (attachment:  Dr. Pope’s outline of process) (Dr. Pope)


3.            Administrative Items (Dr. Pope)



·        Update email addresses for Political Pulse

·        Legislative Committee meeting schedule & topics

·        Legislative Committee conference calls as needed

·        Political Pulse publication begins Friday, 1/5/07

·        Doctor of the Day Program

·        Physicians' Day at the Legislature:  Thursday, March 29, 2007

·        Likely bill cloture deadline:  Friday, December 15, 2006


3.         Review of 2006 Election Results (Mr. Smith/Mr. MacLean)

(attachments - election results/MPAF results)


·        Maine Senate:  18 D, 17 R

·        Maine House:  89 D, 60 R, 2 U

·        Leadership races


o       Senate President:  Beth Edmonds (D-Cumberland


o       Senate Majority Leader:  Libby Mitchell (D-Kennebec)


o       Assistant Senate Majority Leader:  John Martin (D-Aroostook)


o       Senate Minority Leader:  Carol Weston (R-Waldo)


o       Assistant Senate Minority Leader:  Richard Rosen (R-Penobscot)


o       Speaker of the House:  Glenn Cummings (D-Portland)


o       House Majority Leader:  Hannah Pingree (D-North Haven)

o       Assistant House Majority Leader:  Sean Faircloth (D-Bangor)


o       House Minority Leader:  Josh Tardy (R-Newport)


o       Assistant House Minority Leader:  Robert Crosthwaite (R-Ellsworth)



4.         Update on the Blue Ribbon Commission on the Future of the Dirigo Health Program (Mr. Smith) (attachments:  materials from recent Commission meetings)


5.         Update on Coalition for Health Care Access & Liability Reform – web site is live (Mr. MacLean)



6.            Discussion of potential MMA/specialty society legislation for the 123rd Maine Legislature (attachments:  list of resolutions & list of bill proposals) (All)



7.         Other


8.            Adjourn

The following is a list of issues discussed at the meeting and the Committee's recommendation:



Committee on Legislation



List of Issues for Consideration by the Committee for Inclusion in the MMA Legislative Agenda for the 123rd Maine Legislature







1.            MaineCare fee increase (Gordon Smith/MMA Executive Committee).  Baldacci Administration expected to include in biennial budget proposal; MMA will submit separate stand-alone bill proposing a $3 million General Fund increase.  LEGISLATIVE COMMITTEE UNANIMOUSLY RECOMMENDS GOING FORWARD WITH BILL.



2.         CON Capital Investment Fund (Gordon Smith/ASUs).  Extend the sunset on the provision setting aside 12.5% of the CIF for non-hospital projects from 7/1/08 to 7/1/09 or 7/1/10.  LEGISLATIVE COMMITTEE UNANIMOUSLY RECOMMENDS GOING FORWARD WITH BILL.



3.            Minute Clinics (Kevin Flanigan, M.D.).  Codify AMA guidelines for in-store clinics.  LEGISLATIVE COMMITTEE LEANS TOWARDS GOING FORWARD WITH BILL, BUT AWAITS EXECUTIVE COMMITTEE DISCUSSION.



4.            Retrospective insurance denials/requests for refunds (John Makin, M.D.).  Shorten the look-back period in current law from 18 months to 180 days in accordance with AMA policy.  LEGISLATIVE COMMITTEE SEES NO COMPELLING REASON TO GO FORWARD; EXPRESSES CONCERN ABOUT SHORTENING OF TIME FOR SUBMISSION OF CLAIMS.



5.         Sales tax exemption for free clinics (Peter McGuire, M.D.).  Andy drafted proposed language earlier in the summer; check with Senator Sullivan’s staff to ensure that she will submit bill.  LEGISLATIVE COMMITTEE EXPECTS MMA TO WORK WITH SPONSOR & OTHER SUPPORTERS OF BILL.



6.         Jury duty exemptions (NP/PA associations).  Extend exemption from jury duty to NPs/Pas.  LEGISLATIVE COMMITTEE EXPRESSED NO CONCERN ABOUT BILLS IF NP/PA ASSOCIATIONS WISH TO SUBMIT BILLS, BUT NOT A PRIORITY FOR MMA.



7.            Liability protection for specialty consultations provided by regional resources  (Stephanie Lash, M.D.).  Seek liability protection for tertiary care center specialists who provided regional or statewide consultations based upon limited information to practitioners at facilities beyond the specialist’s network and medical staff obligations.  LEGISLATIVE COMMITTEE WANTS STAFF TO EXPLORE THIS MORE WITH DR. LASH TO CLARIFY ISSUES & ATTEMPT TO IDENTIFY A POSSIBLE LEGISLATIVE SOLUTION, SUCH AS AMENDMENT OF GOOD SAMARITAN LAW.



8.            Establish medical expert witness standards/permit licensing board to discipline (Stephanie Lash, M.D.).  Seek protection against unqualified expert witnesses.  LEGISLATIVE COMMITTEE SEES THIS AS A COMPLICATED ISSUE & IDENTIFIES ARGUMENTS ON BOTH SIDES – SEES NO COMPELLING CASE FOR ATTEMPTED LEGISLATIVE SOLUTION.



9.            Primary enforcement of seat belt laws (Public Health Committee; Bill Strassberg, M.D.).  MMA will work with coalition including Maine DOT & Department of Public Safety, AAA of Northern New England, & others.  AAA has been coordinating the coalition work.  Resolution #7 passed at the 2006 annual session directs MMA to support this.  LEGISLATIVE COMMITTEE EXPECTS MMA TO WORK WITH COALITION SUPPORTING THIS BILL TO BE SUBMITTED BY SEN. SAVAGE.



10.            Informed consent for HIV testing (John Makin, M.D.).  Conform informed consent standards to new CDC guidelines.  Maine CDC plans to submit legislation to do this.  LEGISLATIVE COMMITTEE EXPECTS MMA TO SUPPORT THIS BILL TO BE SUBMITTED BY MAINE CDC.



11.            Minors’ consent to health care treatment (Maine Chapter, AAP).  Block EOB from going to parents when minor consents to care.  LEGISLATIVE COMMITTEE SUGGESTS EXPLORING A FUND TO PAY PRIVATELY FOR SUCH SERVICES TO AVOID SUBMITTING CLAIMS TO PAYERS.



12.            Vaccine funding.  Increase funding for the Maine Immunization Program.  Dr. Mills estimates that approximately $6 million over the biennium will be necessary to cover the budget gap in the program that has resulted in a reduction in vaccines being supplied to private practices and the inability to cover new vaccines for children.  We are not certain whether Dr. Mills has requested that this be included in the Governor’s proposed biennial budget.  Resolution #5 passed at the 2006 annual session directs MMA to pursue this.  LEGISLATIVE COMMITTEE UNANIMOUSLY RECOMMENDS GOING FORWARD WITH BILL.



13.            Committee on Physician Health (Committee proposal).  Expand the program to include the Board of Pharmacy.  Unclear whether MMA or Board will submit bill drafted by Gordon Smith.  LEGISLATIVE COMMITTEE UNANIMOUSLY RECOMMENDS GOING FORWARD WITH BILL.



14.            Funding for unused drug program (Stevan Gressitt, M.D.).  Increase funding for unused drug return program.  Estimated cost is $300,000 to move forward.  Senator Lynn Bromley and Representative Anne Perry are potential sponsors.  LEGISLATIVE COMMITTEE IS MODESTLY SUPPORTIVE OF GOING FORWARD WITH BILL.



15.       Maine Controlled Substances Act (Stevan Gressitt, M.D.).  Regain clinical/professional control of controlled substances in Maine.  Senator Lynn Bromley and Representative Anne Perry are potential sponsors.  LEGISLATIVE COMMITTEE RECOMMENDS AGAINST GOING FORWARD WITH BILL – SEES NO COMPELLING CASE FOR ACTION.



16.            Privacy of Physician Prescribing Data (David McDermott, M.D./Charles Zacks, M.D.).  Pursue legislation similar to that passed in New Hampshire last year to protect the privacy of physician prescribing data.  LEGISLATIVE COMMITTEE RECOMMENDS AGAINST GOING FORWARD WITH BILL IN FAVOR OF PUBLICIZING AMA’S “OPT OUT” PROVISION FOR PHYSICIAN MASTER FILE.






18.       Center on Aging, University of Maine (Stevan Gressitt, M.D.).  Address prescription drug abuse among the elderly.  LEGISLATIVE COMMITTEE UNDERSTANDS THIS TO BE SIMPLY A “FYI” ITEM.




The MMA must submit proposed legislation to the Office of the Revisor of Statutes by the "cloture deadline," anticipated to be Friday, December 15, 2006.  If you have comments about this list of issues or other issues to bring to the Committee's attention, please contact Andrew MacLean, Deputy Executive Vice President at [return to top]

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