March 19, 2007

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Dirigo Health Back in the News

The Dirigo Health Program anchored by the Dirigo Choice health insurance plan, is once again in the news as the Governor and the legislature determine how to fund the program during the coming years.   Signed into law in June 2003, the program currently insures about 13,500 persons.  The estimated cost of the program for 2008 is $57 million. 

The Dirigo Health Agency Board of Directors met last Monday and began to consider the implications of a lack of solid funding beyond the existing fiscal year.  The Board and staff acknowledged that even if the controversial Savings Offset Payment is assessed at the established $34.3 million, that amount of funds is insufficient to support the agency at existing funding levels.  If no additional funds are found, such as those recommended by the Blue Ribbon Commission on Dirigo, membership in the Dirigo Choice program would have to be closed almost immediately and membership would be expected to decrease to less than 10,000 enrollees by July 1, 2008.

The Blue Ribbon Commission recommended additional funding from the the general fund, through increased taxes on cigarettes, beer and wine, snacks and sweetened beverages. The Governor indicated to the media this week that he expected to make announcements about the future funding for Dirigo by the end of the month.

"You have to deal with the budget, health care, tax reform and bond packages," the Governor said.  "We have three more months to go here.  We're going to take it step by step and get the job done.  We recognize there's a lot of issues and challenges and we've got to meet them one at a time.

An additional task force focusing on some of the other Blue Ribbon Commission recommendations began meeting this week at the request of the Governor's Officer on Health Policy and Finance.  Created to look at potential insurance reforms, an individual mandate and an employer mandate, the group is expected to make further recommendations to the Governor on these important issues.  MMA EVP Gordon Smith is a member of the new group.

Report on MMA Committee on Quality Improvement

MMA's Committee on Quality Improvement and Peer Review, chaired by Dr. David McDermott of Dover-Foxcroft, met on March 15 and heard from a number of individuals involved in various QI projects around the state:

  • John LaCasse of Medical Care Development updated committee members on the Maine Practice Improvement Network.
  • Ted Rooney and Jan Wnek, M.D. updated members on Pathways to Excellence, focusing chiefly on the specialty initiative.
  • Jean Eichenbaum and Gordon Smith updated members on the status of the MMA/MOA Voluntary Practice Assessment Project, funded by the Maine Quality Forum.

Committee members also discussed the CMS Physician Quality Reporting Initiative which will begin on July 1.  MMA will offer an educational program on Friday, May 4th featuring information on the CMS initiative as part of MMA's First Friday CME programming.

The Committee is charged with leading the Association's efforts to assist members with efforts to improve quality and oversees both MMA's External Peer Review program and the Office-based Quality Improvement program.  The Committee meets again on May 10 at 4:30pm.  A portion of that meeting will be dedicated to a discussion of the Association's Office-based QI program which currently has four participating practices.  [return to top]

Primary Enforcement of Seatbelts Survives First Test in State Senate

By a 20-14 vote last Thursday, the State Senate gave initial approval to a bill supported by MMA which makes non-use of seat belts a primary offense, allowing law enforcement officials to stop a driver for violating the seatbelt law. Maine's present seatbelt law prohibits enforcement of the seat belt law unless the driver has been stopped for for violation of another law.

Seat belts and child safety seats are now mandatory and primary offenses for persons under age 18.

Maine's current seat belt usage is about 77.2 %, which is below the national average.

The bill will move to the House of Representatives before it is presented to the Senate for final enactment.

For more information, check on the web at [return to top]

MECMS Update

The Governor's MECMS Advisory Committee did not meet this past week as planned but will meet again on March 29th.  MaineCare officials consulted with committee members in postponing the meeting.  As MaineCare officials are still negotiating with CNSI, the present system vendor, regarding the circumstances under which CNSI will stay in the state to operate the new system until it is transitioned to a outside "fiscal agent", it was agreed by all concerned that it made no sense to meet this week if no new information was forthcoming.

In other MECMS news the past week, MMA officials met with representatives of EDS, one of the firms likely to compete for the new contract for claims processing.  EDS has the current contract in Vermont, Connecticut . and Rhode Island, and until recently, New Hampshire.  It is anticipated that it will take several weeks to prepare a lengthy RFP and even longer for firms to respond.  Once a contractor is chosen, the federal government and MaineCare officials will spend many more weeks finalizing a contract.  Once a contract is signed, it is likely to take between 18 to 30 months to fully transition the system to the new fiscal agent.

Because of this long time frame, it is critical that the state be able to operate the existing system until a complete transition is accomplished.   

MaineCare officials will be present at the Association's Annual Practice Education Seminar on June 20th in Auburn and will be prepared to address questions the attendees may have about the transition. Registration materials for the program will be included in the March-April issue of Maine Medicine or you may call Gail Begin or Jess Violette at MMA (622-3374) to reserve your spot. [return to top]

Voluntary Practice Assessment Initiative (VPAI) Requesting Volunteers

The Voluntary Practice Assessment Initiative, offered through MMA and the Maine Osteopathic Association and funded by the Maine Quality Forum, is still looking for primary care practices to participate in this innovative quality improvement project.  The target practices for the project include private practices not affiliated with a PHO, but all interested groups will be considered.  The project involves a PA or physician reviewing 25 charts per physicians relative to their treatment of diabetes and CVD for adults and asthma and vaccinations for children. A patient satisfaction survey is also provided. 

The project anticipates performing reviews in 50 different practices with at least 100 physicians.  The project was expected to terminate on April 30 but is now likely to be extended for a few months.

Call the Maine Medical Association for an application (622-3374). [return to top]

MGMA Presents "Efficiency Techniques for Your Practice", April 11 in Portland

The Maine Medical Group Management Association is Pleased to Present "Efficiency Techniques for Your Practice," a half day educational session, Wednesday, April 11, 2007 from 8:30 - 11:30 am at the DoubleTree Hotel in Portland. The featured presenter will be Nick Fabrizio, Ph.D., FACMPE, FACHE.

Session 1: Staff Right - How many, what should they do & how to keep them on task.
Upon completion of this session, participants should be able to: Assess staffing levels in selected specialities according to MGMA benchmark data. Participants will also understand various techniques for improving staff performance including motivation, evaluations, and discipline.
Session 2:  Improving Patient Scheduling and Access 
Upon completion of this session, participants should be able to: Identify the basic scheduling methodologies to improve patient access and reduce wait time. Weigh their current scheduling methodology with alternative options and identify solutions to improve patient access in your practice.

Registration Information:
Space may be limited so please register as early as possible by phone or mail.
The cost for this seminar is only $40.00 for MEMGMA members or $60.00 for non-members. 
If you have questions concerning this seminar, or for late registration, please contact Anita Maheux at
(207) 784-3711 or by e-mail: [return to top]

Please Attend Physicians' Day at the Legislature on Thursday, March 29th

The MMA and the Maine Osteopathic Association will hold "Physicians' Day at the Legislature" in the State House Hall of Flags on Thursday, March 29, 2007.  This event is a wonderful grassroots opportunity to mingle with the members of Maine's 123rd Legislature.  You will have an opportunity to meet your legislators and to talk with them in an informal setting about any health care or health policy issue that may concern you - whether it's MaineCare reimbursement, the MECMS claims management situation, the Dirigo Health Program and health care reform, or other matters. 

The MMA will have a display table set up with information about our advocacy work and the services we provide.  Any medical specialty society or medical practice is welcome to set up a display table as well to showcase your specialty or the nature of your practice.  As he has done many times in the past, Dr. Jan Berlin will sing the national anthem at the opening of the legislative session for the day.  In addition to informal mingling with legislators in the Hall of Flags, you will have a chance to watch the legislative session, to participate in visits with members of the legislative leadership and the Governor, and to attend committee public hearings on bills in the afternoon.

A draft agenda is listed below.  Please feel free to participate in part or all of the event.

  • 8:00 - 9:00 a.m.        Arrive:  Set up Displays (Hall of Flags)
  • 9:00 - 9:30 a.m.        Welcome and Orientation (Hall of Flags)  
    Remarks by:
    • Senator Lisa T. Marraché, MD (D) Kennebec County
    • Representative Bob Walker, MD (R) Lincolnville
    • Thomas DeLuca, DO, President, MOA
    • Kevin Flanigan, MD, President,  MMA
    • Andrew MacLean, Deputy Executive Vice President, MMA
    • Jack Ginty, Executive Director, MOA
  • 9:30 - 11:30 a.m.           Mingle with Legislators; Attend House/Senate Sessions (Schedules TBA)
  • 11:30 - 1:00 p.m.           Refreshments in the Hall of Flags with Legislators,
                                                staff and representatives from relevant state agencies
  • 1:00 p.m.                        Appropriations and Financial Affairs (Room 228, State House)
                                             Work Session – Budget, LD 499, 2008-2009 Biennial Budget
  • 1:00 p.m.                        Education and Cultural Affairs (Room 202, Cross State Office Building)  
                 Public Hearing - LD 334, Resolve, Regarding Legislative Review of Portions of Chapter 182: Formula for Distribution of Funds to Child Development Services Regional Sites
  • 1:00 p.m.                         Health and Human Services (Room 209, Cross State Office Building)
                                              Public Hearings –  
    • LD 436, An Act To Postpone the Expiration of the Required Nonhospital Expenditures Component in the Capital Investment Fund
    • LD 615, An Act To Authorize the Use of the Department of Health and Human Services Staff as Hearing Officers
    • LD 902, An Act To Amend the Maine Health Data Organization Laws
    • LD 984, Resolve, To Evaluate MaineCare Finances
  • 2:30 - 3:00 p.m.                Meet with Governor John E. Baldacci (Cabinet Room - State House)

Please Feel Free to Join Us for Part or All of This Event !

For more information about Physicians' Day at the Legislature, please contact Charyl Smith at or 622-3374, ext. 211.

[return to top]

MMA Joins Press Conference in Support of Fluoridation of Public Water Supplies

The MMA joined Maine CDC Director Dora Anne Mills, M.D., M.P.H. and many other health care and public health advocates at a press conference in support of fluoridation of public water systems as a public health and dental health measure at the State House Welcome Center today at noon.  Maine's public health, medical, and dental communities have become alarmed by the recent decision by a community on Mount Desert Island to cease water fluoridation.  Also, advocacy by Bangor pediatrician Leo Leonidas, M.D., including an op-ed in last weekend's edition of the Bangor Daily News, is prompting the Bangor City Council to review the city's fluoridation policy.  In response to these actions, more than 20 health care organizations spoke out to make it clear to the public that the weight of medical evidence still favors a comprehensive program to ensure fluoridation of public water supplies to a the optimal level for public health and good dental health. 

The MMA thanks Donald Burgess, M.D., President of the Maine Chapter of the American Academy of Pediatrics, for traveling from his York County office to speak at the event. 

The following is the Maine CDC press release and some talking points on the issue.

  Maine Health Organizations Proclaim Their Support of Community Water Fluoridation

      AUGUSTA - Representatives from 20 major Maine health, public health, and dental health organizations reiterated their support for fluoridation of community drinking water at a press conference Monday at the State House.  “In light of recent concerns arising from misinformation about fluoride disseminated in some Maine communities, we stand here together to assert our long-standing support for what the U.S. CDC declared as one of 10 most successful public health achievements of the 20th Century – community water fluoridation,” announced Dora Anne Mills, MD, MPH, Director of the Maine CDC in the Department of Health and Human Services. “The single most effective way to prevent tooth decay is fluoridation of public water,” said Don Burgess, MD, FAAP, President of the Maine Chapter of the American Academy of Pediatrics.  “Tooth decay is the most common chronic disease among our children.  It can interfere with children’s ability to learn and do well in school and can lead to a lifetime of ill health, including tooth loss, pain, infections, and poor nutrition.  Dental disease is increasingly linked with other illnesses and chronic conditions such as heart disease.”  Burgess said the tragedy is that with about half of Maine children suffering from dental disease, virtually all of this is preventable.  “Prevention strategies include fluoride, dental sealants, and regular visits to a dental professional,” he added.   “Fluoride is found naturally in most water supplies, since it is one of the most common elements in the earth’s crust.  Community water systems that fluoridate simply adjust the concentration to the optimal level of fluoride we require for dental health,” said Jonathan Shenkin, DDS, MPH, representing the Maine Dental Association.   “The first use of adjusting fluoride in water to prevent dental caries was 62 years ago – in 1945.  As a result, tooth decay and tooth loss saw dramatic declines in the United States these past decades.  Fluoride in drinking water is effective because it supplies a low dose of fluoride to the surface of teeth that reduces tooth decay, along with incorporation into enamel during early tooth development.”  Brian Tarbuck, Assistant General Manager of the Augusta Water District said that Maine’s challenge of assuring adequate fluoride for children is complicated by the number of private wells in the state.  “About half of our population gets its drinking water from private wells, not public water supplies,” he said.  “Although some private water supplies have sufficient naturally-occurring fluoride, most do not, and supplementation is needed.  Public drinking water is the simplest and most cost-effective to assure that our children receive the optimum levels of fluoride for dental health.” Representative Lisa Miller (D-Somerville), who is also a public health professional, noted that all of Maine’s 16 counties deal with a shortage of dental health providers.  “This means we in Maine especially need to rely on community prevention measures such as fluoridation.”  “Recently, a 12-year-old boy, Deamonte Driver, of Maryland, died from a severe brain infection that appeared to have resulted from untreated dental disease,” added Andrew MacLean, JD, Deputy Executive Vice President of the Maine Medical Association.  “This is a tragic wake-up call to the nation that dental disease is an important part of our overall health and very preventable with basic public health measures such as fluoridation and dental care.” “Indeed, if we don’t have good dental health, we’re not healthy, and dental health begins with the basic long-standing proven public health measure of community water fluoridation,” concluded Dr. Mills.    For more information: and    

De-Bunking Fluoride Myths Fluoride works to prevent caries in several ways, including:  fluoride in plaque and saliva inhibit demineralization of enamel and improves recovery of damaged enamel; and fluoride reduces the activity of bacteria that causes caries.   

Some say fluoride is mass medication.  Fluoridation of community drinking water is analogous to adding folic acid to some wheat and cereal products to prevent some birth defects, to adding iodide to salt to prevent hypothyroidism (goiter), to adding chlorine to water to disinfect it, and to adding vitamin D to milk for bone health.  These are all public health measures.  In the case of community drinking water fluoridation, the public health measure is a matter of assuring that this naturally-occurring element is found in concentrations in public drinking water that is optimal for dental health.     

Some say that countries in Europe are discontinuing community water fluoridation.  A number of European countries (France, Germany, Spain, Switzerland, Hungary, for example) choose to add fluoride to their salt rather than their water.  Salt fluoridation can be as effective as water fluoridation.  Therefore, these countries are fluoridated – simply by using salt rather than water.   

Some have said that the National Research Council report does not support fluoridation of community drinking waterThe latest report from the National Research Council, “Fluoride in Drinking Water”, from March 2006 has been grossly misrepresented.  This report did not examine or call into question the safety of community water fluoridation.  The report was conducted for the U. S EPA and focused on those with high exposure (four times the exposure from community fluoridated water sources) to fluoride from naturally-occurring fluoride (>4 mg/L) found in some occasional areas of the country.  Those drinking water systems that adjust the fluoride for dental health purposes maintain concentrations of 0.7 – 1.2 mg/L.  The report states: “Because fluoride is well known for its use in the prevention of dental caries, it is important to make the distinction here that EPA's drinking-water guidelines are not recommendations about adding fluoride to drinking water to protect the public from dental caries.”  There is nothing in this report to support dangers from the lower intake of fluoride that occurs when an appropriate amount is in the water, entire naturally or after being adjusted for intentionally to assure dental health.  (

Some have said that the American Dental Association’s recent report does not support giving fluoride to infants.  The American Dental Association’s report from November, 2006 has also been misrepresented.  This report also did not examine or call into question the safety of community water fluoridation.  The report addressed some simple and effective ways to reduce fluoride intake from reconstituted infant formula for those infants whose diet is primarily from formula and whose parents may be concerned about a possible increased risk of fluorosis (cosmetic mottling) before primary teeth have erupted.  Once the tooth is formed and in the mouth, fluorosis cannot progress.  The first year of life, therefore, is the time when teeth can be most affected.  This is why monitoring exposure to fluoride for infants is recommended.  The occasional use of fluoridated water will not harm a baby’s developing teeth.  The American Dental Association continues to recommend fluoridation of water. (

Some make claims there is a relationship between cancer, especially bone cancer, and fluoridation.  However, the American Cancer Society states emphatically, “Scientific studies show no connection between cancer rates in humans and adding fluoride to drinking water.” (, page 32 and

Some have said that topical fluoride is just as effective, so there is no reason to add it to the drinking water.  Fluoride works both ways – by ingesting it and by applying it topically.  However, ingesting it is important because it not only helps strengthen teeth that are still forming but it also becomes present in saliva, and therefore provides teeth frequent small exposure, rather than relying solely on frequent teeth brushing.   (, page 10 and

Some say that fluoride is rat poison.  We are not aware of fluoride being used as rat poison.  Stating this ignores the fact that poison is usually a matter of dose.  Large amounts of most substances – including pure water – can poison people.  The amounts of fluoride contained in fluoridated community water are not poisonous, and in fact, is very beneficial. 

Some say there is no correlation between low cavity rates and water fluoridation.  Caries levels have been shown repeatedly to be lower with fluoridation - both among children when community water is fluoridated and compared with non-fluoridated communities. [return to top]

Maine Benzodiazepine Study Group Meeting Tuesday March 20th, 5pm

The March video-conference meeting of the Maine Benzodiazepine Study Group is scheduled for
Tuesday, March 20th from 5:00 - 6:30 p.m. 
Approximately the first 45 minutes will address more general MBSG issues while the last 45 minutes will focus on issues surrounding unused drug returns. 
Telephone codes for the televideo conference may be requested via email from: 
Bill Flagg Public Relations
Cary Hospital
Caribou, ME
Bill's e-mail is:  
Please include the following in your request: First Name, Last Name, Title, Organization, Address, City, State  Zip, E-mail, Telephone
Video Sites: 
(Note: St. John's Newfoundland now via Telephone Conference call) 
EMMC Bangor (Brown Room, or check with security) 
Cary Hospital, Caribou 
NNEPC, Portland 
BDS, Augusta (Come early as door locks at 5 pm sharp)  [return to top]

WellPoint Announces Retirement of Larry C. Glasscock as President & CEO

WellPoint, Inc. (formerly Anthem Inc.) recently announced that Larry C. Glasscock is retiring as President and Chief Executive Officer, effective June 1, 2007.  Glasscock will continue to serve as Chairman of the Board.  Angela F. Braly has been named President and Chief Executive Officer and a member of the Board of Directors, also effective June 1, 2007.

 “For family reasons, it is important for me to retire from the day-to-day leadership of the company at this time,” said Glasscock.  “We are fortunate to have a leader of Angela’s caliber ready to assume the President and CEO position. She brings the right combination of intellect, health policy knowledge, business experience, strategic vision and execution.  In my ongoing role as WellPoint’s Chairman, I look forward to continuing to work closely with Angela and our outstanding management team.”

Since 2005, Braly has served as a WellPoint Executive Vice President, with operational responsibility for the nation’s largest Medicare claims processing business, the federal employees’ health benefits business, public policy development, government relations, legal affairs, marketing, and social responsibility initiatives.  Prior to that, she was the President and CEO of Blue Cross Blue Shield of Missouri.  Earlier in her career, Braly was Executive Vice President and General Counsel at RightChoice, Inc., and a partner in the law firm of Lewis, Rice & Fingersh.

Glasscock has served as President and CEO of WellPoint, Inc. since 1999 and as Chairman since November 2005.  Under his leadership, WellPoint and its predecessor companies grew from 6 million medical members and $6 billion in revenue to more than 34 million medical members and more than $60 billion in revenue today. [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]

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