August 6, 2007

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Register Now for 154th Annual Session in Bar Harbor: Room Block Expires August 10

Members wishing to attend the Association's Annual Session should make reservations soon as the room block at the Harborside Hotel in Bar Harbor expires on August 10.  Several excellent housing alternatives are close by, however.  Registration materials have been sent to each member and corporate affiliate.  Call MMA at 622-3374 if you have questions or would like a list of alternative housing choices.  For hotel reservations call 1-800-328-5033.  Be sure to indicate your are making your reservation in connection with the Association's meeting.

In addition to seven and one-half hours of CME, the meeting will feature presentations by several office holders, including U.S. Senate candidate Thomas Allen and a Saturday morning "Town Meeting" session where resolutions and other business will be considered.

The Association continues its 154 year tradition of conducting an annual meeting where a combination of education, social and recreational activities offer the opportunity to meet with colleagues and old friends. This year's Session will be held at the new Harborside Hotel and Marina in beautiful downtown Bar Harbor from Sept. 7 through the 9th.  At the Saturday evening dinner on Sept. 8, MMA will, once again, recognize several physicians celebrating the 50th anniversary of their graduation from medical school.  The Cushman award for voluntary work, the President's Award for Distinguished Service and one or more Special Recognition Awards will also be presented.  A Media award, recognizing exemplary efforts in the field of media and jornalism will also be presented for the first time.  Over 25 exhibitors have registered to exhibit in the exhibit hall which will be immediately adjacent to the meeting room.

Specialty society meetings involving orthopedic surgeons, urologists and psychiatrists will be held during the weekend meeting which begins at noon on Friday, Sept. 7.  The keynote luncheon speaker is Charles Baker, President and CEO of Harvard Pilgrim HealthCare.  Mr. Baker has been an influential player in the Massachusetts health care world since assisting HPHC in its financial recovery a few years ago.

Any MMA member wishing to submit a Resolution to be considered at the meeting should do so by August 20 and forward the resolution to Gordon Smith via e-mail to

Register today!

House and Senate Enact Different Versions of SCHIP/Medicare Bill; More Work to be Done

In action of critical importance to physicians, both the House and Senate this past week enacted different versions of federal legislation extending the State Children's Health Insurance Program (SCHIP) with the House version (The Children's Health and Medicare Protection Act, H.R. 3162) containing language derailing the scheduled Medicare payment cuts to physicians in 2008 and 2009 and providing for a positive .5 % update in those years.

The House passed the bill 225 to 204, mostly along party lines, with all but 10 Democrats supporting the bill and most Republicans opposing it. Both Congressman Thomas Allen and Congressman Michael Michaud voted in favor of the legislation.  Under the bill, which is likely to be signficantly changed in the conference committee or following a potential veto by the President, physicians would still face cuts of 11 to 12% in years 2010 and 2012.  Physician fees would be updated beginning in 2010 through a system of six separate target formulas, including primary and preventive care; all other evaluation and management services; imaging; major procedures; anesthesia; and minor procedures and other services.

On the coverage side, the bill would add 6 million lower-income children to the popular SCHIP program, while paying for the expansion and the Medicare physician fee fix through increases in tobacco taxes and by ending the current subsidy provided to insurance companies as part of the legislation creating Medicare Advantage Plans.   In a veto threat of the House bill issued also on Wednesday, the Bush administration said the legislation "clearly favors government-run health care over private heatlh insurance" and spends far too much.

On the Senate side, on Thursday, the Senate voted 68 to 31 to expand the SCHIP program by $35 billion.  Both Maine Senators, Susan Collins and Olympia Snowe broke ranks with the Bush administration and supported the bill.  The Senate bill is also financed with increased taxes on tobacco products, but does not contain any language dealing with the repeal of the Medicare SGR formula which is causing payment reduction for physicians. 

The Senate measure now must be reconciled with the House-passed SCHIP expansion before a final bill passes both chambers and goes to the President.  The veto threat appears to be the most significant roadblock to achieving both the SCHIP expansion to benefit children and the physician Medicare payment correction. 

Despite conern about some of the provisions in the legislation, the AMA and a number of other physician organizations supported passage of H.R. 3162 as the first, but certainly not the final step, in advancing two priorities - expanding health insurance coverage for children and averting the 10% across the board cut in Medicare physician payments.

A document summarizing key provisions in the CHAMP Act and another document comparing the House and Seante SCHIP legislation will be placed on the MMA website soon.  Access them at (Look for the What's New" section.) [return to top]

Meeting on Imaging Presentation Program Wednesday

Representatives of ACS, a national company with a focus on medical technology and medical management, will meet with interested radiology practices at the MMA office in Manchester on Wednesday, August 8, 2007 at 2:00 pm to receive input on how the new MaineCare imaging requirements might be structured.  The state budget, effective July 1, 2007, included a $2 million savings from implementation of a pre-certification program in MaineCare for imaging services, similar to what is required by commercial insurers.

ACS was the only company that attended a recent vendors' conference on the RFP that the Office of MaineCare services issued.

Any radiologist or other owners of imaging equipment are invited to attend, or representatives of such practices.  RSVP to Warene Eldridge at MMA at 622-3374 ext. 227 or via e-mail to if you are interested in attending this session.  Warene serves as the administrator of the Maine Radiological Society. [return to top]

MaineCare MECMS Provider Advisory Group Update

The Governor's MaineCare Providers Advisory Group held its bi-weekly meeting with MaineCare staff on Thursday, August 2, with MMA staff in attendance. 

The weekly MECMS metrics report for the week ending July 29, 2007 noted that total claims submitted for the week were 144,010 with 94.7% of the "fresh" claims processed either to payment or denied status.  The suspended claims inventory was at 76,268, a number that has remained fairly constant over the past few weeks.  When asked by Gordon Smith, MMA EVP about whether there was any concern among MaineCare staff regarding the failure to continue the downward progress in the number of suspended claims, staff noted that some of the suspended claims were intentionally suspended so that various manual work-arounds could be performed, such as in the case of some of the anesthesia claims.

In addition to suspended claims, there are other unresolved claims in MECMS with the status of:

  • Edits Processing Failure (21,324 claims totaling $34,014,720 in billed charges)
  • Fund Allocation Failure (10,568 claims totaling $8,975,748)
  • Additionally, hospital and physician cross-over claims,voids and adjustments cannot be processed at this time. (This has been the case since the new system came on-line in Jan. of 2005.)

As of July 13, interim payments made to providers totaled $526.7 million of which 71% has been recovered ($373.4 million).

There are several MeCMS repair initiatives and patches scheduled in the coming weeks.  Of particular interest to physician offices is the void functionality implementation set for Oct. 1, 2007.  Detailed provider communication and training on the use of the void functionality will take place in September and providers should not attempt to submit new voids in advance of receiving the billing instructions.

If a provider's claims are paying correctly today, then a void followed by a re-bill should result in a proper payment.  However, be advised that if a problem existed with the original claim, there is no guarantee that the same issue won't arise when re-billing the claim.

UPDATE ON NEW SYSTEM (Proposed New Fiscal Agent Activity)

The federal Centers for Medicare and Medicaid Services has recently given written approval for an accelerated procurement schedule that is designed to pick a vendor by Jan. 1, 2008 and have a new system operating by Jan. 1, 2010 (See Maine Medicine Weekly Update of July 23 for additional information on this topic).  MaineCare officials met with four potential vendors on August 1 in Augusta and each has been asked to confirm participation in the process by August 8.  The four potential fiscal agents are ACS, EDS, Unisys and First Health.  Each of these firms has previously built and is operating an MMIS system in one or more states.

There will not be an RFP (Request for Proposals) issued as part of the accelerated process.  Rather, there will be what has been described as a "fitting" process, involving an evaluation team of eight individuals from MaineCare visiting a state selected by each vendor.  The 3 to 4 day visits are intended to elicit information both on how the system is operating and how close the "fit" is to what is needed in Maine.  Federal certification of the system will also be an important factor to look at, under the Medicaid Information Technology Architecture (MITA) certification program.

The committee will meet next on August 16 and then again on August 31st in a combined meeting with the Technical Advisory Committee.  Brenda McCormick, Director of the Managed Care initiative will be in attendance on the 16th to discuss the managed care initiative that the state budgetting process has booked savings of $100 milliion in for the current fiscal year.  Negotiations with the Shaller-Anderson firm, to expand the current pilot project involving 300 high cost patients to thousands, are on-going.  When questioned about the lack of a competitive bidding process for the larger contract, OMS officials noted the aggressive time-line made it impossible to seek out alternatives at this point.  Attempts will be made over the next 24 months to transition as much of the effort to Maine-based initiatives as the program is rolled out.

MMA will continue to report on these important initiatives in the coming weeks.  Contact Gordon Smith at MMA if you have questions about these MaineCare initiatives ( [return to top]

Use of Medical Assistants in Hospital-owned Practices Draws DHHS Attention

As also reported in the August 3 Maine Hospital Association Friday Report, the Division of Licensing and Certification within DHHS is warning hospital-owned physician practices that because of a new interpretation the state is giving to an old statute, physicians practicing in such locations can not delegate medical acts to unlicensed medical assistants.  The use of such unlicensed assistants has become increasingly popular given the shortage of healthcare workers and the proliferation of training programs.

A provision in the Medical Practice Act, enacted at the time that the use of Physician Assistants was being authorized , allows physicians to delegate acts and tasks to their own employees if such acts have traditionally been delegated.  The law makes clear that the physician remains liable for the act and must be located on the premises.  The issue that has arisen is that the statute refers to delegation to the physician's employees, while most of the individuals delegated to in a hospital-owned practice are employees of the hospital, not of the physician.

When the state Division of Licensing and Certification first announced that they would begin citing hospitals that were permitting such delegation, MHA and MMA approached the Board of Licensure in Medicine asking for a clarification, perhaps through rule-making, that would not differentiate the employees of a hospital-owned practice from the employees of a privately owned practice.  Given the literal language in the statute, such rule-making doesn't appear likely.  Therefor, MHA and MMA have asked for an immediate meeting with DHHS officials to discuss how current practice can be preserved while legislation is prepared for consideration in Jan., 2008 to clarify the statute.  Staff at the state, through Denise Osgood, Director of the Division, has indicated a willingness to sit down with interested parties to discuss this important issue.

Given the current chortage of healthcare workers, and the fact that there have been few, if any, complaints about the delegation of medical acts to such individuals (so long as the physician remains responsible), I do not understand why the state has chosen at this time to be concerned about this", noted MMA EVP Gordon Smith. "The language in the statute hasn't changed in years and the state seems to be jumping on an issue which raises a distinction without a real difference.  MMA, in working with MHA, will do all it can to resolve this issue favorably in the interests of the practices." [return to top]

Report on Dirigo Health Agency Board of Directors Meeting, August 3, 2007

The Dirigo Health Agency Board of Directors met on August 3 to sign its decision on the Savings Offset Payment  and to conduct other regular business of the Agency.  The Board noted that two vacancies on the Board need to be filled and Board Chair Robert McAfee, M.D. expressed hope that the vacancies could be dealt with during a potential September session of the State Senate.

The decision  on the aggregate measurable cost savings for the third assessment year was $78.143,400, with $5.2 million being attribute to increases in the provider fees.  Most of the savings was attributable to the hospital savings initiative $70.6 million (Case Mix-Adjusted Discharge) or CMAD and to the Uninsured/Under-Insured Savings Initiatives ($6,343.400).  The Board reduced the total savings by $4.0 million as a result of overlap of the savings initiatives. 

In other business, Dr. Josh Cutler, Director of the Maine Quality Forum, presented a report on the current activities of the Forum, including:

  • On-going work with Health Dialogue on variation analysis
  • Work pursuant to L.D. 1849 on cost drivers
  • Work associated with health care associated infections
  • Continuing efforts with MMA on the Voluntary Practice Assessment Initiative
  • Integration of mental health and primary care

Agency Director Karynlee Harrington reported on current enrollment in the DirigoChoice product and asked for and received permission to negotiate a one-year contract to ensure continuation of the program for existing enrollees.

The Board will meet next on either Sept. 10 or Sept. 17. [return to top]

Third Annual Muskie School Forum for Health Care Leaders, Oct. 3-5

The 3rd Annual USM Muskie School Forum for Health Care Leaders will be held on October 3rd, 4th and 5th, 2007 at the Abromsom Community Education Center on the Portland Campus.  The theme for this year's Forum is:  Our Healthcare Workforce: Continuing to Care in the 21st Century.

Presented by the Graduate Program in Health Policy and Management, we will focus on the challenges that confront healthcare policymakers, practitioners and management in identifying, recruiting and retaining workforce resources.  Over three days, we will discuss these challenges, as well as identify policy and operational solutions. 

On Thursday evening, the keynote address will be presented by Arnold S. Relman, MD, Editor-in-Chief Emeritus, New England Journal of Medicine.

We are also convening two expert panel discussions that are open and free to the public. 

Due to the popularity of last year's program, we have expanded the number of day-long seminars that will be available.  These classes can be taken for graduate or CME credit, and will provide specific training in:

  • Managing the Changing Physician/Hospital Relationship
  • Identifying and Implementing Alternative Workforce Strategies
  • New Demands for Quality and Accountability: Engaging and Motivating the Workforce
  • Recruiting and Retaining a Direct Care and Direct Support Workforce.

Each of these courses will be limited to twenty-five students.

For more information contact Angela Foss at (207) 780-4014, or   You can now
also register online. [return to top]

Health Alert: Paralytic Shellfish Poisoning (Red Tide) Illnesses – Washington County

Four persons from a Washington County fishing household were hospitalized with symptoms of paralytic shellfish poisoning (PSP) on the evening of July 31th within several hours of sharing a meal of mussels. Preliminary testing of mussels taken from the home were highly contaminated with the toxin that causes paralytic shellfish poisoning.  These preliminary tests show toxin levels 200 times the threshold level used to close shellfish beds in Maine. Maine CDC is now assisting the Maine Department of Marine Resources (DMR) to determine the source of the implicated mussels and to assure that any harvested shellfish available to the public continue to be safe to eat.  Early information indicates the probable source of the mussels was a drifting barrel found by the lobsterman off the Washington County coast; not from a mussel bed.  This information also indicates the mussels taken off the barrel were for the lobsterman’s personal use.

Clinical providers should be aware of the signs and symptoms of PSP and should call the Northern New England Poison Center at 1-800-222-1222 if they need consultation on diagnosis and management problems. All suspect cases should also be reported immediately to the Maine CDC at 1-800-821-5821.

Background: Paralytic shellfish poisoning (PSP) – also called red tide – is a marine biotoxin that is associated with certain types of algae blooms in coastal waters. Bivalve shellfish eat and filter the toxic algae, and the concentrations of the toxin can cause serious illness or death if eaten by humans. The Maine DMR monitors shellfish beds closely and closes areas to shellfish harvesting if levels of PSP are noted to be high. Because of this well developed system, there have been no documented cases of human PSP in Maine since at least 1980. This testing and closure system coupled with law enforcement has a long history of successfully preventing consumers from being exposed to shellfish from areas closed because of red tide.  

Consumers concerned about obtaining safe shellfish should buy from certified shellfish dealers.

Clinical effects:
Mild:  paresthesias of tongue, lips and throat which may spread to face, neck, arms, fingers, toes; headache; nausea (gastrointestinal effects may not be noted)
Moderate:  weakness of limbs, ataxia, incoherent speech, difficulty breathing; floating sensation and giddiness; dizziness; rash; fever; tachycardia and hypertension; dyspnea;
Severe:  choking sensation, severe respiratory difficulty/failure (usually within 12 hours).

Onset: 30 minutes to 10 hours (usually within 2 hours)

Duration:  hours to days; muscle weakness may last weeks

Treatment:  if patients present soon after ingestion, consider lavage and activated charcoal; symptomatic/supportive; possibly IV fluids and sodium bicarbonate

Shellfish that may be unsafe: 

  • Clams [Soft Shell, Hard Shell (Quahogs), Surf or Hen]
  • Mussels
  • Oysters (both American and European)
  • Quahogs
  • Snails
  • Whelks

Odor and taste are unaffected.  The toxins are heat stable and water soluble.  Cooking/freezing will not destroy the toxins.  Cooking broth may contain toxins. 


Fish are usually safe (need to call the NNEPC to check, not all-inclusive): 

  • Crab (eat only cleaned and picked muscle tissue, not whole crabs)
  • Lobster (avoid tomalley)
  • Scallop meats
  • Shrimp
  • Finfish


  1. Clams, mussels and other bivalves should not be consumed unless they are known to have been harvested from shellfish beds that have not been closed for red tide.  Consumers concerned about obtaining safe shellfish should buy from certified shellfish dealers.
  2. Medical providers should be familiar with signs and symptoms of PSP and should maintain a high index of suspicion for persons who have consumed mollusks during the 10 hours preceding onset of illness. Clinical consultation is available 24 hours per day through the Northern New England Poison Center at 1-800-222-1222.
  3. Suspect cases of PSP should be reported immediately to the Maine CDC/DHHS at 1-800-821-5821.

FMI: [return to top]

NPI Registry Delayed

The NPI registry that was expected to be posted on the CMS Web site on August 1, 2007 has been delayed. The following message appeared on the CMS Web site on August 1 : CMS is delaying the deployment of the NPI Registry and the dissemination of FOIA-disclosable health care provider data from the National Plan and Provider Enumeration System (NPPES).  Additional information will be forthcoming on the CMS Web page [return to top]

Payor Glance

Health insurers reported second-quarter profits last week. Aetna, Inc. reported a 16 percent increase in second-quarter profits. Its medical-cost-ratio, a measure of claims costs as a percentage of premium revenue, recorded at 80.5 percent compared to 81.1 percent a year ago. Increases in membership and spending less on medical costs as a percentage of premiums contributed to WellPoint, Inc.'s 11 percent increase in second-quarter profit. Cigna Corp.'s second-quarter profits declined 27 percent. [return to top]

Free Online CME Program Offered: Late Effects of Cancer Treatment and Survivorship

Anthem Blue Cross and Blue Shield and UCLA are offering a FREE Online Continuing Medical Education (CME) program that is designed to meet the needs of clinicians who care for individuals with cancer or who have survived cancer.

“Late Effects of Cancer Treatment and Survivorship: Strategies for Primary Care and Oncology Care Providers”

This is a FREE ONLINE CME Program
To access the Online Program, go to:

The program will provide 3 AMA PRA category 1 credits & continuing education for nurses*

Program goal:  To promote provider understanding regarding late effects of cancer treatment and survivorship and their role in long-term surveillance in order to reduce adverse health outcomes of cancer survivors. 
Data has shown that many Primary Care Physicians (PCPs) do not feel prepared to monitor and manage the late health effects that may arise with patients following cancer treatment.  A PCP’s sense of being prepared to handle transitional care issues for cancer survivors increases as the frequency of receiving detailed treatment information from oncologists increases.  We encourage oncology practitioners to utilize End of Treatment summaries, similar to the example provided toward the end of this program.

Course Directors:

  • Patricia Ganz, MD, Professor of Health Services and Medicine, David Geffen School of Medicine at UCLA and UCLA School of Public Health
  • Lisa Diller, MD, Clinical Director of Pediatric Oncology, Dana Farber Cancer Institute; Associate Professor of Pediatrics, Harvard Medical School, Department of Pediatric Oncology
  • Betty Ferrell, RN, PhD, FAAN, Research Scientist, City of Hope National Medical Center

Educational Objectives:

  • Describe national trends and information related to late effects of cancer treatment and survivorship for pediatric and adult populations.
  •  Assess survivorship medical and psychosocial issues.
  • Recognize providers’ role/opportunity in monitoring and managing pediatric and adult patients’ late effects.
  • Understand long-term follow-up guidelines that provide recommendations for screening and management of late effects that may potentially arise as a result of therapeutic exposures used during cancer.
  • Manage strategies/issues surrounding transition of care to primary care after discharge from cancer treatment.
  • Understand the importance of communication between primary care and oncology care providers and potential barriers such as socioeconomic disparities.

The program must be completed by September 15, 2007.   An extension through September 15, 2008 is currently under consideration.   Please contact Lynn Stillman at 603.695.7848 with any questions.

* Nursing Attendees: When completing the renewal form or the online CE section, under the section labeled "Provider Number," you will need to enter CME Category 1, instead of a BRN Provider Number.
This activity is endorsed by the Northern California Cancer Center.
Late Effects of Cancer Treatment and Survivorship: Strategies for Primary Care and Oncology Care Providers is supported in part by educational grants from the following: American Cancer Society; Amgen Inc.; AstraZeneca; Anthem Blue Cross Blue Cross Blue Shield of Georgia; Blue Cross of California; Bristol-Myers Squibb Company; Genentech, Inc.; John Wayne Cancer Foundation; Lance Armstrong Foundation; Merck and Co., Inc.; Pharmion Corporation; Sanofi-Aventis; and the WellPoint Foundation.
  [return to top]

"Collaboration Skills for Healthcare Professionals" Offered Friday, September 7, 2007

MMA's popular "First Fridays" CME offerings will continue in September with a program entitled, "Collaboration Skills for Healthcare Professionals."  The program will be held on Friday, Sept. 7, 2007 from 9:00 am to noon at the offices of the Maine Medical Association in Manchester.  There is a $60 fee which includes all course materials and a light breakfast.

The program will be presented by Beth Boynton, RN, MS, who is an organizational development consultant who has worked with many health care organizations in Maine.  Beth has twenty years experience as an RN in consulting, management, or direct care positions and more than ten years as a Nurse Consultant to business and industry for workers compensation and employee heatlh issues.  She also served as Adjunct Faculty for both the New England Healthcare Administration Program and Antioch New England Graduate School's Certificate in Healthcare Management program.

For further information or registration materials, visit the MMA website at or call Gail Begin at 622-3374 ext. 210.  [return to top]

MMA and MDI Hospital Present CME Program on "Medical Responses to a Mass Casualty" Sept. 6

MMA and Mount Desert Island Hospital are pleased to announce a program in connection with the MMA Annual Session entitled, "Medical Reponses to a Mass Casualty Incident in Maine" on Sept. 6, 2007 in Bar Harbor.  The program is being held a day prior to the MMA Annual Session at the same location which is the Harborside Hotel and Marina.  The program will run from 9:30 am to 4:30 pm and is, in part, funded through a grant from the Maine CDC.  Six hours of category 1 CME is available. 

There is a $40 fee which includes lunch and all course materials.   A registration form will be included as an insert in the July/August issue of Maine Medicine.  For more information, please contact Melanie Modine at MDI Hospital at 288-5082 ext. 444.

Objectives for the course include:

  • Understand the challenges of caring for multiple trauma victims, especially in a small health care system.
  • Understand how to utilize state emergency assistance and legally use outside providers to assist.
  • Be able to develop practical strategies for coping with a public health or mass casualty disaster, both advance planning and when one occurs.

Speakers include Col. Robert McAleer, USMC-Ret., Director of the Maine Emergency Management Agency.  [return to top]

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