November 19, 2007

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Maine Medical Center Selects Tufts University School of Medicine as New Undergraduate Medical Education Partner

After months of work, the Maine Medical Center and its Undergraduate Medical Education Steering Committee announced Friday to its medical staff that Tufts University School of Medicine has reached a verbal agreement with MMC to be its partner in going forward to develop a new vision for undergraduate medical education that will best serve the future needs of MMC and the State of Maine.  The partnership would include the development of an innovative curriculum for students who would spend a significant portion of their medical school experience at MMC, and who would receive a degree specific to this experience in Maine.

The Steering Committee, chaired by Peter Bates, M.D., had also considered the University of Vermont School of Medicine and Dartmouth Medical School as potential partners and had been in very active discussion with all three regional medical schools.  Of particular interest to MMA is the likelihood of this new program enhancing the opportunity for Maine students to attend medical school and to have that experience based largely in Maine.  That opportunity exists now only at the University of New England School of Osteopathic Medicine.  This new opportunity will hopefully impact favorably on Maine's growing shortage of physicians.

In addition to working together on the development and management of the new undergraduate medical education program, the new relationship may also give more opportunities for collaboration in research and other venues.

The final agreement must receive the approval of the MMC Board of Trustees.

In July and again in September, MMC leaders on this project, including Dr. Bates and Robert Bing-You, M.D. have presented updates on the project to the MMA Executive Committee and to the membership at the Annual Meeting.  MMA members passed a resolution at the Annual Meeting related to this subject, giving support for any such initiative that would show promise in addressing the medical education needs of Maine students, thereby hopefully increasing the supply of physicians in the state.

Challenges to Private Practice In Maine Featured in this Week's Medical Economic's Article

The Nov. 16, 2007 issue of Medical Economics magazine features an article highlighting the challenges in Maine currently to private practice and examines the trend toward hospital employment.  Several primary care physicians in Maine are quoted in the article, including State Senator Lisa Marrache, M.D. (D - Waterville), State Representative Robert Walker, M.D. (R-Lincolnville), Jean Antonucci, M.D., of Farmington and David McDermott, M.D. of Dover-Foxcroft.  MMA Deputy Executive Director Andrew MacLean is also quoted in the article as is Mary Mayhew of the Maine Hospital Association.

The article notes many of the challenges to private practice, including poor reimbursement from MaineCare and Medicare and the administrative issues associated with private practice.

The entire article can be accessed at

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GSK Revises US Labeling for Avandia®

GlaxoSmithKline announced today that it is implementing changes to the US product label for Avandia® (rosiglitazone maleate), based on an extensive and thorough review by the FDA of myocardial ischemia data on Avandia, the most widely studied oral anti-diabetic medicine available. The new label is available as a pdf here.

The existing boxed warning has been revised to add the FDA’s conclusion that, while an FDA metaanalysis of short-term studies – mostly against placebo - showed an association between Avandia and an increase in myocardial ischemic events, that risk was not confirmed or excluded in three long-term clinical trials comparing Avandia against both placebo and other oral anti-diabetes medicines. The box will state that the available data on the risk of myocardial ischemia are inconclusive.

The FDA has also concluded there is insufficient information available to determine whether any oral anti-diabetic medicine reduces cardiovascular risk. The FDA has directed that the sentence - “There have been no clinical studies establishing conclusive evidence of macrovascular risk reduction with Avandia or any other oral antidiabetic drugs” - will be added as a warning on the labels of all oral antidiabetic medicines.

The Avandia label also has been updated to add that Avandia is not recommended - though not contraindicated - for use with patients who are taking insulin or nitrates. The label summarizes the data on myocardial ischemia to help doctors continue to evaluate which patients could benefit from taking Avandia, and those for whom alternative treatment should be considered.

The changes are now included in labeling for Avandia, and will be incorporated into future revised labeling for all approved rosiglitazone-containing products, including Avandamet (rosiglitazone maleate and metformin hydrochloride), and Avandaryl (rosiglitazone maleate and glimepiride). GSK is also preparing a Medication Guide to help educate patients about potential benefits and risks and to provide other information on Avandia.

“Avandia remains a safe and effective medicine for most patients with type 2 diabetes when used appropriately,” said Dr. Ronald Krall, GSK Chief Medical Officer. “Given the severity of this disease and the importance of Avandia in helping patients manage their diabetes, we will continue to work with the FDA to conduct more studies about the safety and benefits of our medicine.”

As previously stated by GSK, two long-term trials in diabetic patients comparing Avandia to other oral anti-diabetic medicines show no increased risk for cardiovascular events compared to other commonly used medications, other than the well-known risk of congestive heart failure with TZDs. One trial – ADOPT - shows no increased myocardial ischemic risk compared to metformin or sulfonylurea. The interim results of a second long-term trial – RECORD - also show no increased risk of major cardiovascular events (death, heart attack and stroke) between Avandia and other medications; however, firm conclusions cannot be drawn because the trial has not yet been completed. The updated label includes data from ADOPT and RECORD plus a third long-term trial in pre-diabetic patients (DREAM) which show there was no increased risk of Avandia over comparators with regard to myocardial infarction, mortality, or other non-heart failure cardiovascular events.

GSK believes data from ongoing and future clinical trials will provide additional scientific support for both the benefit and safety of Avandia. GSK has agreed to work with the FDA to plan and carry out a clinical trial to further investigate the cardiovascular effects of Avandia. Avandia has been prescribed to more than seven million people over the last seven years to help them control their blood sugar levels. Importantly, Avandia has been shown to control blood sugar for longer than the most commonly used oral anti-diabetic medicines – up to five years. Long-term glycemic control is important to help prevent the serious complications of diabetes, especially microvascular complications leading to blindness, amputation and kidney failure. Avandia is an important treatment option for physicians, since two-thirds of diabetic patients suffer with uncontrolled disease and many require two or three medicines to maintain their blood sugar. [return to top]

AG, Aetna Cut Doctor Rankings Deal

Attorney General Andrew Cuomo, with the support of the AMA and the Medical Society of the State of New York (MSSNY), reached an agreement for physician ranking programs with Aetna, Inc. Aetna is the second insurer to adopt the Attorney General’s model and the first to apply it nationwide. As previously noted in the PSA Update, the model reforms physician ranking programs by compelling insurers to fully disclose to consumers and physicians all aspects of their rating systems. Its existing program, known as “Aetna Aexcel,” designates physicians in 12 specialty categories who have passed certain clinical quality and cost efficiency measures. Prior to reaching the agreement with Cuomo, Aetna did not identify to its consumers how much of the evaluation process was based on cost efficiency and how much on quality measures. With the changes, Aetna will fully disclose to consumers and physicians all aspects of their preferred physician system including how much of a physician’s quality is measured by cost efficiency and how much is attributed to skill. The model will use nationally recognized standards to measure the quality of care. Empire Blue Cross Blue Shield has also agreed to implement these changes to its physician ranking program. Empire Blue Cross Blue Shield, a subsidiary of WellPoint, Inc., will alter its program to ensure that its rankings for physicians are not based solely on cost and that it uses national standards to measure quality of care, Cuomo said. It will also disclose to consumers how the program is designed and how doctors are ranked. For more information regarding the settlements with insurers CIGNA, Aetna and Empire Blue Cross Blue Shield please visit the AMA PSA Web site. [return to top]

Don't Miss Upcoming Conferences: Quality Counts! 5 and the Physical Activity and Nutrition Training Series

Dec. 7, 2007 - Quality Counts! Part 5: Aligning Partners for Quality, Augusta Civic Center. This will be a great opportunity to bridge clinical/community programs.
Go to this site for registration:

December 11, 2007 Physical Activity and Nutrition Training Series -  Make Change Happen: Implementing Evidence-Based PAN Practice, Bangor Civic Center. This is part 1 of a 4-part series to explore evidence based physical activity and nutrition evidence based programs to bring to your organizations and communities.  Go to this site for registration: [return to top]

MQF proposes using RAND measures

The Maine Quality Forum (MQF) is proposing to use RAND’s proprietary measures rather than National Quality Forum-endorsed ambulatory care consensus measures in producing quality information from claims data.

At a presentation before the MQF Advisory Council, a consultant with Health Dialogue (hired by MQF to create quality reports using claims data) said that RAND had deliberately not submitted their measures to the National Quality Forum (NQF) to protect their intellectual property rights.  Health Dialogue has purchased the rights to use the RAND metrics.

Using nonNQF-endorsed measures would be a stark departure for the MQF.  Following pointed questioning from MHA, the Advisory Council recommended that the MQF convene the MQF Provider Group to get their endorsement for using the RAND measures.

Also at last week’s meeting, Trish Riley, director of the Governor’s Office of Health Policy and Finance, reviewed the State Health Plan development process and asked the MQF to identify “a few” priority quality matters for inclusion in the plan, expected to be published in March 2008.  The Advisory Council scheduled a December meeting to devote to developing that input.  Early suggestions from council members for consideration included examining emergency room utilization and the critical importance of assuring consumer access and use of a “medical home” primary care practitioner.

MQF announced that they expected to fill Chris McCarthy’s position prior to next month’s Advisory Council meeting. [return to top]

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