September 24, 2007

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More on Board of Licensure in Medicine Assessment Panel

The panel reviewing the investigatory and disciplinary processes of the Board of Licensure in Medicine met this past week and is preparing a report containing recommendations to be presented to the Board this Fall.  The review is the result of concerns expressed by both complainants and licensees, with some of these complaints finding their way to the legislature. 

"While resolution of some of the issues would require statutory changes, some issues are the result of Board policies which can be changed by the Board," noted Gordon Smith, EVP of MMA who was a member of the panel.

The Assessment Panel reviewing the disciplinary processes of the Maine Board of Licensure in Medicine held an all day meeting last Tuesday (Sept. 18) and discussed a number of issues as it reviewed the current investigatory and disciplinary practices of the Board.  Some of the issues considered address the concerns the Association has had in the past, including:

  • The Board policy of issuing press releases on every disciplinary action, including substance abuse and mental health cases.
  • The perception that the Board acts as both the investigator and adjudicator, thus becoming the proverbial "judge, jury, and executioner."
  • The practice of issuing Letters of Guidance which are not subject to appeal but are public documents and are sent to complainants.  The letters are also kept in the physician's file for ten years.
  • Failure of the board staff to regularly communicate with physicians during the disciplinary process.
  • The practice of the Board "pending" a renewal application if the physician has a complaint pending.
  • The statutory provision requiring the Board to consider every complaint, thus precluding the establishment of a screening process that would weed out frivolous complaints.

The review panel, consisting of seven individuals, will make a report of its findings to the Board.  While the review was requested by the Legislature primarily to respond to a complaint by a consumer, the review also dealt with issues raised by physicians.  The primary tool for the review was the FSMB's "Essentials of a Modern Medical Practices Act," and its "Elements of a Modern State Medical Board (revised 2006)."

Panel members were:

  • Leslie A. Gallant, Executive Administrator of the Alaska State Board of Licensure in Medicine
  • Nancy M. Kerr, Executive Director of the Idaho State Board of Medicine
  • Dale Austin, past Senior VP of Operations of the Federation of State Medical Boards (FSMB)
  • Lisa A. Robin, Vice President of Leadership Services at FSMB
  • David Nyberg, PhD., one of three public members of the Maine Board of Licensure in Medicine
  • Peter White, retired corporate executive and former public member of the Maine Real Estate Commission
  • Gordon H. Smith, Esq., EVP of Maine Medical Association

The panel had access to all Board staff and the Attorney General's staff during the process. While there is no assurance that any of the issues identified above will be resolved through this process, the issues have been identified and changes are at least being considered.

"I was very impressed with the review panel and its work," noted Gordon Smith, EVP of MMA.  "The panelists were all very committed to the process and to ensuring a fair process for both the public and licensees.   I also have great respect for the current Board and its staff.  But, there is always room for improvement and I hope the anticipated recommendations of this panel can be a catalyst for change."




Ten Slots Left for Oct. 5 CME Program "Using Data to Improve Quality and Public Reporting"

With less than two weeks to go, there are ten available slots left for members or office staff wishing to attend the next "First Friday" presentation, "Using Data to Improve Quality and Public Reporting."  Representatives of the Maine Health Data Organization, the Maine Health Information Center, the Maine Health Management Coalition and the Maine Quality Forum will speak.  The three hour program, to be held at the MMA offices in Manchester beginning at 9:00 am, will be moderated by Andrew MacLean, Deputy EVP of MMA.  The program has been certified for three hours of CME and there is a $60.00 fee which includes all course materials and breakfast.

With the state's all-payor claims database no longer ensuring confidentiality of physician identifiers, it is important for physicians and practice managers to know what the impact of the release of such data might mean for their practice.  Speakers will also share their thoughts on how this data can be used to both improve quality and market a practice in a competitive environment.

You may register on line at or call Lisa Dennison at MMA at 622-3374, ext. 219 and ask for registration materials. 

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Dirigo Health Savings Pegged at $33 Million, Acting Insurance Superintendent Rules

In its third year of operation, the state's Dirigo Health Program saved the health care system $32.8 million Acting Insurance Superintendent Eric Cioppa ruled last Monday (Sept. 17).  In his 23-page decision, Cioppa found that the program provided $25 million in hospital savings, $6.3 million in uninsured and underinsured initiatives, and another $1.5 million in provider fee savings.

The total savings found is substantially less that the savings calculated by the Dirigo Board of Directors which recommended $78.1 million. Last year's savings were $34.2 million and the first year savings were determined to be $43.7 million. 

The savings declared by the Acting Superintendent is the foundation for the "savings offset payment" (SOP) which is an assessment on health insurance companies in the state.  The SOP is the sole funding mechanism currently for the Dirigo Health Agency's DirigoChoice insurance program. 

At a meeting of the Board of the Dirigo Health Agency later in the week, Board members discussed the possibility that the likely decrease in funding may result in an elimination of the subsidies currently paid to a majority of the participants in the DirigoChoice program.

The Dirigo Health program was established in 2003.  [return to top]

CMS to Make Physician Quality/Cost Data Available on the Internet

The U.S. Centers for Medicare and Medicaid Services (CMS) has proposed the creation of a database that would allow Medicare beneficiaries to compare the quality and cost of healthcare services.  The Performance Measurement and Reporting System (PMRS) will be available to the public via the web and will be designed to assist consumers in making “informed choices among individual physicians, practitioners, and providers of services.”  Additionally, CMS states that PMRS would assist in developing strategies to improve quality and increase patient safety, and measure performance at the individual physician level.  The American Association of Orthopaedic Surgeons (AAOS) currently is investigating the potential implications of implementing the PMRS.  For more information: and [return to top]

Maine Public Health Association's 23rd Annual Meeting, October 23

The Maine Public Health Association's 23rd Annual Meeting will take place on October 23, 2007, at the Augusta Civic Center.  The title of this year's program is "Public Health Emergencies...for EVERYONE involved in the health of Maine people!"  Please visit for registration information. [return to top]

MEMGMA Presents "What Every Supervisor Should Know About Human Nature," October 17

Maine Medical Group Management Association (MEMGMA) is proud to present David Lee - Founder of Human Nature @ Work.  He will be speaking October 17th at John Martin's Manor in Waterville and we would like to invite managers and interested parties to come hear his "fascinating and captivating" presentation on "What Every Supervisor Should Know About Human Nature!"
Please see the linked brochure for more information and to register.
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"Health, Culture, and Literacy:" Solutions for Clear Health Communication Offered October 26 in Freeport

According to a recent report from the US government, billions of dollars are wasted every year as the result of poor communication between health care providers and patients.  The ability for patients and consumers to understand and act on complex health information affects patient safety and the quality of care, in addition to cost.

Act now to register for one of the most important and useful conferences of the year!  Health, Culture, and Literacy:”  Solutions for Clear Health Communication will take place on Friday, October 26th at the Hilton Garden Inn in Freeport, Maine for health care professionals (physicians, nurses, mental health and dental health providers, health professions students, public health professionals, health educators).  Go to for online registration and detailed  information about the conference.

This conference will kick off a year-long series of activities that are aimed at raising awareness of doctors and other health care workers about the scope of the problem and practical solutions.  Anne Fadiman, author of the best-selling "The Spirit Catches You and You Fall Down” will keynote the event.  Dr. Terry Davis from Louisiana State University will present findings from the recent national adult literacy study.  Dr. Mary Ann Abrams, Director of Quality for Iowa Health Systems, will discuss the results of a statewide rural health literacy collaborative among other regional and state experts.  Continuing education credits for physicians (allopath and osteopath), nurses, social workers, and health educators will be provided.  Registration is $75 for physicians, $50 for all others, and $25 for students; scholarships are also available.  Participants will be surveyed immediately after the conference to determine preferences for follow-up topics and venues.  [return to top]

Legislature's Insurance and Financial Services Committee Meets on Infant Formula and Lyme Disease

The Legislature's Joint Standing Committee on Insurance and Financial Services met on Thursday, Sept. 20 and held a work session on L.D. 658, An Act to Protect the Health of Infants and L.D. 1521, An Act to Provide Education Concerning and Insurance Coverage for Lyme Disease

After recommending passage of L.D. 658 on a vote of 12 to 1 (the bill deals with insurance coverage for special infant formula for infants with ingrown metabolic disorders or food allergies), the committee spent most of the rest of the afternoon hearing about the incidence of Lyme disease in Maine and its recommended course of treatment.  Following a comprehensive presentation by Maine CDC Director Dora Ann Mills, M.D., MPH., the committee heard from Robert Smith, M.D., who spoke of the recommendations for treatment of Lyme disease of the Infectious Diseases Society of America.  The committee also heard from Bea Szantyr, M.D., of Lincoln, who has taken a special interest in treatment of this disease.

Because of numerous complaints from the public regarding physician knowledge of the disease, committee members, and particularly Senate Chair Nancy Sullivan (D-Biddeford), suggested requiring mandatory education of Maine physicians about the diagnosis and treatment of Lyme disease.  Dr. Mills and MMA oppose mandatory education on any one disease, recognizing how difficult it would be to target the message to the right audience and because of the unlimited number of diseases and conditions that one advocacy group or another would want mandated.  Currently, the rules of the Board of Licensure in Medicine do not require any particular type of education within the required number of CME hours needed for re-licensure.

The committee meets again in October. [return to top]

Time to be Thinking about Flu Shots

Although the flu vaccination rate in Maine exceeds the rate for the nation as a whole, a significant number of Mainers is not receiving the recommended shot.  Unlike previous years, the flu vaccine should be plentiful this year, with manufacturers expected to ship more than 130 million doses in the coming months. 

Three-quarters of Mainers 65 and older received the recommended shot last season.  In the age 50 to 65 cohort,  more than 40% were vaccinated.  For high-risk individuals between the ages of 18 and 49, more than 32% were vaccinated.

By 2010, the government wants to have 90% of seniors and 60% of younger adults who are at high risk from flu to be vaccinated every season.

Flu vaccine for young children is more complex because of the need for two doses a month apart the very first year a child in vaccinated.  If a child missed the necessary second dose last year, the CDC recommends that he or she make it up this coming season with two shots.  This recommendation is not like to be very popular with Maine's children! [return to top]

Study Cites High Health Care Costs in Northeast & Maine in Particular

On September 18, 2007, CMS published a study on the Health Affairs web site entitled, Health Spending by State of Residence, 1991-2004.  In the period 1998-2004, the average annual growth rate of spending in Maine was the second highest in the country - second only to Vermont.  The study found that the New England and Midwestern states spent more than the national average on health care services.  Massachusetts, Maine, New York, Connecticut, Delaware, Rhode Island, Vermont, West Virginia, Pennsylvania, & Alaska spent 20% more than the national average in 2004.  Maine's per capital spending on physician services was cited as second in the nation.  The study's authors point to Medicaid spending, higher personal incomes, more physicians, & higher rates of coverage with more comprehensive benefits as reasons for higher spending in the Northeast.

The report is available on the web at:













































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President Again Threatens SCHIP Veto as Deadline Approaches & Congress Faces Vote

The U.S. Senate & House are likely to approve a $35 billion, 5-year reauthorization of the SCHIP this week.  The compromise bill is very close to the bill passed by the Senate, funded by a $0.61 per pack increase in the cigarette tax.  In remarks at the White House on September 20, 2007, President Bush urged Congressional leaders to send him a "clean" reauthorization of the SCHIP with a modest $5 billion per year increase in spending over current levels.  He accused Congressional Democrats of "playing politics" by sending him a bill they know he will veto.  Maine is one of 12 states that will run out of money in its program if the program is not reauthorized or extended by September 30, 2007.  Because of the popularity of the program, many observers expect at least an extension to keep the program running, if not a full re-authorization.  The AMA, MMA, & many other physician organizations continue to work towards a reversal of the expected Medicare SGR cuts before the end of the year.
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Anthem Works with NH Government & Private Advocacy Group Towards Statewide E-Prescribing

On September 20, 2007, Anthem in New Hampshire in conjunction with the administration of Governor John Lynch (D) & the New Hampshire Citizens Health Initiative announced a program to provide e-prescribing equipment & training to every physician in the state.  Anthem is offering free "ePrescribing" software, a free mobile pocket PC, & a discounted wireless telecommunications plan allowing physicians to access patient eligibility, formulary, & medication history information from the internet or a cell phone.  The program's goal is for all primary care practitioners to have electronic prescribing ability by October 2007 & for all specialists to have this ability by October 2008.  An Anthem Medical Director said that the company expects its costs to be a $0.16 - $0.18 charge per script transmitted, along with training & postage costs.  The company estimates that about half of New Hampshire physicians now have EMR systems.  Practitioners who use the "ePrescribing" system will benefit under the company's pay-for-performance program.  The parties cite 3 core components of the "ePrescribing" system that promote quality & efficiency:

  • medication history information;
  • drug interaction & allergy alerts; and
  • communication between practitioner & pharmacy.

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