March 12, 2007

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MMA Endorses Higher Cigarette Tax

In testimony presented last week to a combined session of the Taxation Committee and the Appropriations Committee, MMA representatives presented information showing that a tax increase of $1.50  per pack would result in over 6,000 adults quitting and deter another 10,300 children from starting the deadly habit.  The tobacco lobby can be expected to vigorously oppose the tax.

MMA presented the lead testimony at a hearing this past week on the proposed increase in the state cigarette tax and participated in a press conference last Monday on the same subject.  Association EVP Gordon Smith presented testimony on behalf of MMA and the Maine Coalition on Smoking or Health showing that the health care costs associated with each pack of cigarettes exceeds $7.00 per pack.  The MMA and the Coalition advocated for an increase in the tax of $1.50 which would give Maine the highest tax in the nation at $3.50 per pack.

Even at $3.50 per pack, the tax would raise only about one-half of the funds needed to treat the adverse health consequences of tobacco use. 

Smith also noted that taxes on sweetened beverages, unhealthy snacks and alcohol were also long overdue and that the epidemics of obesity and alcoholism also needed to be addressed through sound tax policy.

On Friday, March 9, the Legislature's Taxation Committee was preparing a letter, purported to represent the unanimous opinion of the thirteen committee members, to be sent to the Appropriations Committee indicating that the Taxation Committee would not support an increase in the cigarette tax without it being part of a comprehensive tax reform package.

Failure of the Appropriations Committee to include at least a $1.00 increase in the tax in the budget would result in a gap of over $120 million over the two-year budget cycle.  That gap would have to be filled by finding other revenue or by cutting expenditures.

Ad Hoc Group Formed to Help Implement Dirigo Blue Ribbon Commission Recommendations

Eight members of the Blue Ribbon Commission on DIrigo Health and five additional individuals have been asked by Governor Baldacci to serve on an ad hoc group to help implement some of the recommendations of the Blue Ribbon Commission. 

The new group will have two tasks:

  • Provide advice to the Governor's Office on Health Policy and Finance of proposals to implement the Commission's recommendations regarding shared responsiblity - individual mandates and employer contributions for those who do not currently provide health coverage.
  • Review a Bureau of Insurance-sponsored study of high risk pools, the merger of the individual and small group market and re-insurance or a combination of all three.  The Bureau has contracted with an actuarial firm to conduct the study and will soon have an overview of its work to review.

The Ad Hoc Group will hold its first meeting this coming  Thursday, March 15 at 1:00pm.

Members of the group include MMA EVP Gordon H. Smith, who also served on the Blue Ribbon Commission.  Other participants include Maine Hospital Association President Steve Michaud and representatives of health insurers, business organizations, consumer groups and Dirigo Health. [return to top]

MMA Staff Promotions

MMA is pleased to announce two promotions within its staff of fourteen employees.

  • Diane McMahon has been named Office Manager.  Diane will also continue to provide administrative assistance to the Physician Health Program, the MMA Executive Committee, the Payor Liaison Committee and MMA EVP Gordon Smith.  Diane is also responsible for the Annual Meeting.
  • Lauren Mier has been named Director of Communications.  She will remain as staff to the Maine Society of Orthopedic Surgeons and will continue to provide graphic design and IT services to all MMA staff.  As MMA's first Director of Communications, Lauren will prepare the Weekly Update and prepare Op Ed pieces, press releases and letters to the editor.  She will also work with MMA officers on speaking style and content.

Congratulations to Diane and Lauren.

In other staff news, EVP Gordon Smith was recently re-appointed by the Executive Committee as EVP for an additional six years following a performance evaluation conducted by the Association's Personnel Committee. [return to top]

Dirigo Health Bad Debt and Charity Care Subcommittee Continues its Work

The Dirigo Health Bad Debt and Charity Care Subcommittee held its third meeting this past week and continued its discussion as to how the existing bad debt and charity care portion of the "Savings Offset Payment" could be retained through a vehicle which would be less controversial and more accurate in attempting to capture savings associated with the Dirigo Health Program.

At the most recent meeting of the group, the Maine Association of Health Plans advanced a proposal that would tie the amount recaptured to the actual amounts that the Dirigo Health Program paid to hospitals for Dirigo enrollees who were previously uninsured.  Staff from the agency promised to try to obtain the numbers requested and the group will look at these during the next meeting to be held on March 20th.

The subcommittee continues to struggle with the issue of whether there are additional providers who benefit from any reduced bad debt as a result of the increasing number of Dirigo enrollees. [return to top]

MMA Participating in Bureau of Insurance Consensus-based Rulemaking on Chapter 850

Bureau of Insurance Rule 850 provides a measure of protection to rural providers in Maine by requiring that health plans have a network of providers allowing for reasonable access to primary care and specialty services within a geographic area.  The business community has complained for years that the provisions in Chapter 850 result in increased health insurance costs. 

The final report of the Dirigo Health Blue Ribbon Commission called for a review of Chpater 850 and the Bureau of Insurance has begun a consensus-based rule-making proceeding designed to look at how the rule is working and to try to achieve consensus from the interested and affected parties regarding amendments. 

MMA is participating in the meetings, as are the Maine Hospital Association, The Maine State Chamber of Commerce, the Maine Association of Health Plans, Anthem Blue Cross Blue Shield and Consumers for Affordable Health Care. 

Weekly meetings are expected to take place for the next couple months.  [return to top]

Physician Quality Reporting Initiative (PQRI) to Begin July 1, 2007

The CMS Physician Quality Reporting Initiative(PQRI) replaced PVRP as a result of the Tax Relief and Health care Act of 2006, passed last December.  PQRI will begin July 1, 2007.. go to to learn more.  To receive e-mail updates on physician issues, including PQRI, sign up for the Physician Open Door listserve at:

On Friday, May 4, MMA will present a program aimed at educating physicians and office staff about the details of this program which will give physicians an opportunity to receive a small amount of additional reimbursement for seeing Medicare patients.  CMS officials will be present to share the latest information on the program and other presenters will be announced soon.  A flyer for the program will be included in the March-April issue of Maine Medicine or you may register on the MMA website at or by calling Jess at 622-3374 (press 0).  [return to top]

CBO Director Testifies that Restructuring SGR Is an "Opportunity"

The director of the U.S. Congressional Budget Office (CBO) recently testified before the U.S. Senate Committee on Finance, discussing the issues surrounding Medicare reimbursement as a rising percentage of U.S. gross domestic product. In his testimony, he reviewed the history behind the Medicare sustainable growth rate (SGR) and discussed the advantages and disadvantages of various alternatives. If SGR is allowed to operate as specified, CBO estimates that physician reimbursement will be reduced by approximately 10 percent in 2008, and 5 percent annually after that. The director stated that changing the SGR mechanism would provide an opportunity to encourage more efficient medical practices, while maintaining budgetary fiscal responsibility. A PDF file transcript of the director’s comments can be downloaded at: [return to top]

MedPAC Issues Reports on SGR, Medicare Payment Policy

According to the Kaiser Daily Health Policy Report, the Medicare Payment Advisory Commission (MedPAC) has issued two reports examining the sustainable growth rate (SGR) system, and current Medicare payment policies. With the SGR approach potentially cutting reimbursement by 40 percent over the next eight years, MedPAC recommends dropping that system in favor of one of two alternatives: an incentive-based approach to encourage prevention of more expensive ailments, or physician reimbursements apportioned on a regional basis with rewards for improvement in efficiency. The payment policy report recommends that Medicare reimburse Medicare Advantage plans at the same rate as the traditional fee-for-service program. For more information:

Links to PDF files of the MedPAC reports can be found at: [return to top]

Study: One in Three Americans Say Internet Changed the Way They Manage Health Care

A survey of 4,105 adults conducted by Illuminas for Cisco Systems finds that 62 percent of Americans have made use of online health tools, and 56 percent felt that there were health benefits to doing so. Respondents reported that their most common online health activities were accessing symptoms and diagnostic information (33 percent), accessing general wellness and fitness information (30 percent), attempting to self-diagnose (23 percent), managing prescriptions (15 percent), and self-assessing health (15 percent). However, a gap appears to exist between consumers’ desires for online health information and healthcare providers’ use of the technology, as only 27 percent of respondents felt that their providers “fully embraced the Internet to deliver health information and services.” For more information: [return to top]

MMA and Medical Mutual Team up for Risk Management Seminar on Friday, April 6

The Maine Medical Association First Fridays Presentation for the April 6 will be "Risk Management in the Physician Office Practice".  Speakers for this program will be Nancy Brandow, Cheryl Vacchiano, Cheryl Peaslee and Georgia Downs, all employed by Medical Mutual Insurance Company of Maine.

Because many malpractice claims originate from system failure in the physician office practice, physicians and practice managers alike will benefit from a discussion of risk prevention strategies.

At the conclusion of the program the participants will be able to:

  • Describe areas of risk in physician office practices
  • Identify at-risk systems in their own office practice
  • Acknowledge implementation strategies to mitigate the identified risks

This program has been approved for 3 CME credits and will be held at the Maine Medical Association office in Manchester, Maine.  If you have any questions, please contact Gail Begin at 622-3374 ext. 210. [return to top]

Maine Hospice Access and Utilization Workshop, March 30, Portland

The Maine Hospice Council presents "Medicare Hospice Access and Utilization: Collaborating for the Future," Friday, March 30, 2007, 8:00 a.m. to 4:00 p.m at the Eastland Park Hotel, Portland, Maine


  • Steven Rowe, Maine Attorney General
  • Nancy Kelleher, AARP
  • Judith Tupper, Muskie School of Public Service
  • Rep. Lisa Miller, Bingham Program
  • Cordt Kassner, Colorado Hospice Organization
  • Melanie Ramey, Hospice Organization of Wisconsin
  • Malene Davis, Capitol Hospice, Alexandria, Va.

For more information, please call 1-800-438-5963 or visit

Please RSVP by March 23, 2007.  Your $25 donation includes breakfast, lunch, break food and parking! [return to top]

Ben Franklin Center Presents Symposium on Transforming Office Practice

The Ben Franklin Center at Franklin Memorial Hospital presents "“Sweet Satisfaction: A One Day Symposium on Transforming Office Practice and Diabetic Care for the 21st Century”, March 23, 2007

The Physicians in Rural Practice Symposium has provided ongoing quality education through lectures and workshops on practical subjects for the last 5 years. The Keynote Lecture is named after Paul Brinkman, MD, a rural practice role model.

Keynote Speaker
L. Gordon Moore, MD is on the faculty at the University of Rochester Medical School in Rochester, New York and is faculty at the Institute for Health Care Improvement. His work includes: Idealized design of the clinical office practices: breakthrough improvements in access, interaction, reliability and vitality.

Learning Objectives
Upon completion of this educational activity, participants should be able to:

  • Describe ways to increase access for patients.
  • Analyze strategies that will improve office practice efficiency.
  • Discuss current trends and best practices in the management
  • of Pediatric Diabetes.
  • Discuss barriers and potential implementations of “Innovative Practices” in various office dimensions

For more information, or to register, download the brochure [pdf] [return to top]

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