March 17, 2008

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Political Pulse: New Lay Midwives Licensing Bill Scheduled for Hearing Tomorrow

The Legislature's Business, Research & Economic Development (BRED) Committee will hold a public hearing on a new draft of the lay midwifery licensing proposal, L.D. 2253, An Act To License Certified Professional Midwives on Tuesday afternoon, March 18, 2008 at the State House.  Jay Naliboff, M.D., Chair of the Maine Section of the American College of Obstetricians & Gynecologists will present the position of the Section and several other medical organizations, including MMA, in strong opposition to the legislation.

1.  Direct entry or "lay" midwife licensing 

While the bill has a new L.D. number, the language of the proposal is identical to the legislation presented in 2007 (L.D. 1827) that was the subject of "sunrise review" by the Department of Professional & Financial Regulation.  The Department's Report recommended against the licensing of lay (non-nurse or direct-entry) midwives but a majority of the members of the so-called BRED Committee have rejected the conclusion of the report and are preparing legislation that would license midwives through the current Board of Complementary Health Care Providers.  That Board currently includes naturopathic doctors and acupuncturists.

Six or seven members of the BRED Committee have rejected licensing, but are supporting a compromise that  would make certain pharmaceutical products and oxygen available to midwives who are certified by the North American Registry of Midwives, an international certification agency that is controlled by the midwives themselves.

The licensing proposal is opposed by MMA, the Maine Section of ACOG, the Maine Academy of Family Physicians, the Maine Chapter of the American Academy of Pediatrics, the Maine Osteopathic Association, the Maine Chapter of the American College of Emergency Physicians, and the March of Dimes.  Nonetheless, the proposal has a lot of legislative support and is supported by a strong national movement that has accomplished licensing for the midwives in 24 states.

Assistance in defeating the proposal is welcome.  As a full floor debate is expected by the end of the month, a call to any legislator is appropriate.  You may leave a message at the State House asking a member to call you back as follows: 

                      Senators:  1-800-423-6900

                      Representatives:  1-800-423-2900

You can find the members of the BRED Committee and their contact information on the web at:

You can find your own legislators on the web at:  

In your recorded message, you may also just reference your strong opposition to L.D. 2253 regarding the midwives. 

In your conversations with legislators, you may wish to make the following points:

  1. Double Standard.  At a time when the public and the Legislature have ever-increasing expectations of physicians and hospitals in quality improvement and patient safety, the promotion of home deliveries by under-trained and unsupervised practitioners is illogical and contradictory.

  2. Confusing the Public.  MMA believes that licensure would put the State's "stamp of approval" on the practice of home births, thereby encouraging a practice that does not meet current safety and quality standards, and would confuse the public about the education, training, and experience of  "licensed certified professional midwives" (LCPM) compared to "certified nurse midwives" (CNM).

  3. Independent Study Rejects Licensing.  The state Department of Professional & Financial Regulation prepared a Sunrise Review report that recommended against licensure.
  4. Inadequate Training.  L.D. 2253 would delegate the licensing standards to the North American Registry of Midwives (NARM), an organization that grants certification through apprenticeship and self-study.  Requiring virtually no pre-requisites, the bill would allow individuals who have never had a college level class, never passed an accredited program of study, and never been formally trained in medicine or science to:

  •  Obtain and administer prescription medications;

  •  Perform certain interventional procedures;

  •  Perform cancer screenings;

  •  Diagnose the health and wellness of mothers and babies.

If you need further information or would be willing to provide feedback to the Association's lobbyists following your contact with your Senator or Representative, please communicate with any member of the MMA Governmental Relations team of Andrew MacLean, Esq., (, Kellie Miller ( or Gordon Smith, Esq., (

2.  State FY 2008-2009 Supplemental Budget (L.D. 2173) 

The Appropriations Committee held two days of public hearings on the Governor's proposed "change package" to L.D. 2173 on Tuesday and Wednesday last week.  The MMA testified against the health care and social services cuts in the budget generally and addressed the following three areas of particular concern:

  • the $20 million plus cut to hospital-based physicians;
  • the elimination of prescription drug coverage and increased cost sharing provisions for the Medicaid "non-categorical" population; and
  • the diversion of tobacco settlement money in the Fund for a Healthy Maine from its intended preventive health care purposes. 

The Health & Human Services Committee spent the rest of the week in work sessions on the budget and made their report back to the Appropriations Committee on Friday afternoon and evening.  The HHS Committee split 5-5 with 3 members absent on the hospital-based physician reimbursement cut.  The Appropriations Committee worked all day on Saturday and from mid-day until about 10 p.m. yesterday on the budget.  The Committee will continue its work sessions this week. 

3.  MMA Testifies in Favor of Dirigo Legislation 

At a public hearing on Thursday afternoon in the Insurance & Financial Services Committee, MMA EVP Gordon Smith spoke in favor of L.D. 2247, An Act to Continue Maine's Leadership in Covering the Uninsured.  The Governor surprised the Committee and members of the public by delivering a letter to the Committee just before the hearing in which he apparently suggested that the legislature should not be distracted by a debate on the Dirigo legislation until it completes the budget.  In addition to the MMA, other health care and consumer advocacy organizations testified either in support of or "neither for nor against" the bill.  Some business groups spoke in opposition to the bill because of the tobacco tax increase and/or the "health access surcharge." 

The substance of Mr. Smith's prepared testimony follows:

In the interest of time, I will focus our testimony on a limited number of provisions, while noting that we are in support of all the provisions in the bill.

  1. Replacement of the savings offset payment.  We feel strongly that the savings offset payment needs to be replaced and that the proposal for a health access surcharge of 1.8% on paid claims is a fairer and more transparent means of financing.  The sop has been a serious distraction to well meaning attempts to improve our serious situation in Maine and needs to be changed.  Let’s take the money that is currently paid to lawyers to fight over the elements of the sop and take the time the agency spends in dealing with it and devote these to more constructive pursuits, such as covering more people with the DirigoChoice product.
  2. Increasing the tobacco tax.  The 50-cent increase per pack is a step in the right direction but should be a full dollar.  Enactment of the increase itself is an important public health measure, regardless of what is done with the revenue.  While MMA would have preferred to see a broader tax measure which included snacks, beer, alcohol, and sweetened beverages, we do support this more limited approach.  As a member of the Blue Ribbon Commission on Dirigo, which met throughout 2006, I am personally pleased to see at least a consideration of some of our work and recommendations.
  3. The proposed establishment of a reinsurance association to improve the individual market and the changes in the community rating bands we support as a compromise.  We are hopeful that some young persons will come back into the market, as we believe strongly that all individuals need to be covered with an appropriate product.  Maine cannot solve its health insurance problem without getting more people insured.  In fact, MMA supports an individual health mandate, but recognize that it would not be possible to implement without significant moderation in cost.

This is not a perfect bill.  Very few proposals reforming health care are.  It is, rather, a practical bill.  One that nearly everyone will find something in to dislike, but that taken as a whole should be seen as an improvement over the status quo.

This 123rd legislature should not adjourn without some positive action in this area.  Maine has nearly the highest health insurance premiums in the country.  We do not serve the interests of Maine people by adding to the rolls of the uninsured.  And rest assured, failure to enact this bill, and provide this new funding to Dirigo, will in all likelihood lead to persons losing coverage.  These people will not be able to afford coverage in the commercial market.  After all, I just left the Maine Bar Association group health plan when my coverage for a very nuts and bolts Anthem product exceeded $21,000 dollars annually.  It is critically important that we begin these reforms that will result in more people receiving coverage.

Persons without health insurance wait too long for care, end up receiving it in the highest cost setting, and the cost is frequently shifted to commercial carriers, which is one of the primary reasons for our high premiums.  The status quo is simply unacceptable.

While the bill would enact modest reforms, these are important steps to moving toward the next round of reforms with a new president and new federal rules and policies.

4.  Legislative Committee Conference Call 

The next Legislative Committee conference call is scheduled for tomorrow evening, March 18, at 7 p.m.  The conference call number is 1-800-989-2842 and the access code is 6223374#.

5.  Legislative Schedule and Other Resources 

The Legislature's statutory adjournment deadline is Wednesday, April 16, 2008, but members have substantial work left, including the difficult supplemental budget and the State House is filled with rumors about the April schedule.

You can find more legislative information on the Maine State Legislature's web site:

MMA Committee on Physician Quality to Meet on Thursday, March 20

The Association's Committee on Physician Quality will meet at 4:00pm this coming Thursday (March 20) at the Frank O. Stred Building in Manchester.  The Committee is chaired by David McDermott, M.D., of Dover-Foxcroft.  The agenda for the meeting follows.  All MMA committee meetings are open to any MMA members, regardless of whether they are on the committee.  All are welcome.

20 March 2008, 4:00 PM to 6:00 PM, MMA Headquarters

                  Agenda Item                                                                               Budgeted Start Time
1. Call to Order, introductions                                                                                    4:00
2. Minutes of 24 Jan 2008 meeting:  Review and Approval*                                4:05
3. President’s Professionalism Initiative (Dr. Strassberg) *                                4:08
4. September 4th meeting with Annual Session CME Update *                         4:40
5. VPAI (Voluntary Practice Assessment Initiative) Update                                  4:50
6. Patient 360 Overview (Dr. Jorgensen)                                                                 5:00
7. Maine Regional Quality Strategy Project                                                             5:30
8. Update on Practice Quality Program                                                                    5:40 
a.  Neurology Associates (either handout or mailed before meeting)
b. Spectrum (either handout or mailed before meeting)
c. Review fee structure: ? try max 1K not 3K
Review of meeting                                                                                                       5:50
9. Agenda items for May meeting:                                                                            5:55
10.  Adjourn                                                                                                                   6:00

Next meeting:  May 8th, 2008, 4:30-6:30 PM, MMA.  With dinner.

·         * Indicates an attachment in the file
·         Please note that the Items held for next meeting:

11. Quality Counts! Learning Community (Dr. Letourneau)                                5:05
12. Update on Medical Home Pilots                                                                        5:25  [return to top]

Report on Maine Quality Forum Advisory Council Meeting March 14

The Advisory Council of the Maine Quality Forum (MQF) met this past Friday at the offices of the Dirigo Health Agency in Augusta.  In addition to receiving a report from Karenlee Harrington, Director of the Dirigo Health Agency, members of the Council received updates from Josh Cutler, M.D. and James Leonard on the following projects and activities:

  • "In a Heartbeat"
  • Robert Wood Johnson grants
  • Patient Centered Medical Home
  • Quality Improvement Organization
  • Chartered Value Exchange
  • Electronic Health Record Demonstration Project
  • State Health Plan

Dr. Cutler noted that the draft State Health Plan contained supportive language for several MQF priority initiatives including the patient centered medical home, reporting of hospital acquired infections and advancement of electronic medical records.  A public hearing on the draft plan is being held on Tuesday, March 18 at the Augusta Civic Center (9:00am to noon).  Written comments on the draft Plan will be accepted through March 30.  The following is a link to the draft Plan:

Council members also heard a presentation from Judy Tupper of the Muskie School at the University of Southern Maine.  Ms. Tupper explained the Maine Critical Access Hospital Patient Safety Collaborative 2008 the mission of which is to enhance patient safety at Maine CAHs through self-assessment, initiative development, and implementation, review of best practices, shared resources, benchmarking and policy development.

The Council, which is chaired by Robert Keller, M.D., will meet again on Friday, May 9 at 9:00am.  MMA staff attends all meetings of the Council in order to report to the membership on its projects and activities. [return to top]

Physician Profiling, Tiered Networks and Stark III all Part of May 28th CME Program

For the 17th straight year, MMA will present a day-long practice education seminar covering some of the hot topics in medicine today.  This year's seminar will be held on Wednesday, May 28 in Augusta at the Augusta Civic Center.  Watch your mail in the coming days for a complete flyer and registration materials.  These materials will also be included as an insert in the March-April issue of Maine Medicine which will arrive on your desk around April 1.

In addition to the customary updates on MaineCare and Medicare, Massachusetts attorney Dean Nicastro, one of the nation's leading experts on the new Stark III regulations will present a two-hour breakout session on this topic at 1:00pm.  Mr. Nicastro formerly served as counsel to the Massachusetts Medical Society before assuming an of counsel position with the Boston law firm of Pierce & Mandell. 

A breakout session will also be held on the topic of physician profiling and tiered networks.  This session will feature Matt Katz, Executive Director of the Connecticut Medical Society and formerly of the Private Sector Advocacy division of the AMA and Michael Hudson of Aetna who has responsibility for the Aetna AEXCEL network.  This session will be moderated by Gordon Smith, MMA's EVP who also serves as Chair of the AMA's Advocacy Resource Center Executive Committee.

Even prior to receiving the registration materials, you may register online at  We hope to see you and some of your staff on the 28th of May! [return to top]

Annual MMA Benefit Golf Tournament Monday, June 23, 2008 at Augusta

Once again, the Donald-Ross designed Augusta Country Club will be the site of the Association's annual benefit golf tournament being held this year on Monday, June 23.  We will have our traditional lunch on the deck at 11:00am with a shot-gun start at noon.  A traditional scramble will be the format with the details handled again by a committee chaired by tournament director Brian Jumper, M.D.

Proceeds of this year's tournament will benefit the John Dalco Fund which is a charitable fund associated with MMA's Physician Health Program.  The fund was established to assist physicians in recovery and resides within the Maine Medical Education Trust, a 501-C-3 non-profit and charitable organization.

More prizes will be awarded this year than ever before, including a prize for the lowest gross and net team consisting on a single medical specialty.  Teams from hospitals also are encouraged to join our regulars from Cary Medical Center and Franklin Memorial.

Registration materials will be sent out to previous participants within the next month. If you would like to be sure to be included, communicate with Gail Begin at MMA at 622-3374 ext. 210 or via e-mail to   [return to top]

Federal Medicare Fee Fix May be on the Way

Although it is a long path to ultimate enactment, the AMA and other national medical organizations are hopeful that a bill filed Thursday by Michigan Senator Deborah Stabenow (S-2785) may pave the way for a delay in the pending July 1, 2008 reduction in Medicare reimbursement for physicians.  Without legislation by the Congress, all physicians treating Medicare patients will have their reimbursement reduced by 10.6 %.

S-2785 would delay the reduction by 18 months and would provide for an increase of 0.5% on July 1, 2008 and an increase of 1.8% on Jan. 1, 2009.  It would also extend the voluntary reporting provision known as PQRI.  Adjustments to the geographical indices would also be made that would be favorable to rural areas.

As favorable as the proposal is, it does not eliminate the flawed "Sustainable Growth Rate" formula which is driving the cuts in reimbursement.  Also, the proposal does not yet identify how it would be paid for, something that will eventually have to be addressed under the current "pay as you go" rules the Democratic majority in the Congress is operating under.

At an event with physicians in Falmouth on Saturday night, Senator Susan Collins indicated that she would support and would co-sponsor any proposal that would delay or ultimately change the SGR.  MMA leaders will meet with Sen. Olympia Snowe on April 2nd and will seek a similar commitment.  Sen. Snowe is on the Senate Finance Committee, as is Senator Stabenow.  The Committee has jurisdiction over Medicare. [return to top]

Pediatric Environmental Health ToolKit Available

Pediatric Environmental Health Toolkit is now available to download for health care providers.  The San Francisco Bay Area Physicians for Social Responsibility (PSR) teamed up with sister chapter Greater Boston PSR to develop an exciting, new clinical tool for pediatric and family care practices that provides comprehensive information about preventing exposures to toxic chemicals.  The Pediatric Environmental Health Toolkit, which has been officially endorsed by the American Academy of Pediatrics (AAP), includes laminated desk and pocket reference guides for providers, patient handouts including "Prescription for Prevention" sheets and refrigerator magnets, and two colorful, bilingual Toolkit posters for clinics and exam rooms.

Pediatric Environmental Health is a relatively new field prompted by concerns about such things as pesticide residues on foods, mercury in fish, and arsenic in drinking water and on play structures.  Yet, numerous providers have hardly heard of it.  Studies have shown few environmental histories are taken, and that less than one-in-five pediatricians reports having received training in environmental history-taking even thought they strongly believe in the importance of environmental exposures in children's health.  The issue is a high priority with parents.  In a recent paper written by Dr.Sophie Balk, outgoing chair of the American Academy of Pediatrics environment committee and editor of the AAP "Green Book" for pediatricians,".......environmental exposures are among parents' top concerns for their children." 

Toolkit Materials Include and are available to download at website:

For Providers: 

Key Concepts in Pediatric Environmental Health

  •     A Summary of children's unique susceptibilities to toxic substances
  • Brief summaries of major toxicants and their potential health effects
  • A two-sided, laminated pocket reference care containing priority anticipatory guidance keyed to specific developmental stages to use during well-child visits
  • A two-sided, laminated environmental Health Reference Card
    • Brief descriptions of environmental toxins
    • Health Effects summaries of those toxins
    • Sources and routes of exposure information
    • Prevention Strategies

  • For Patients and their Families
    • "Rx for Prevention" prescription slips keyed to developmental stages
    • Magnets with "Tips for Prevention"
    • "Out of Harm's Way" Fact sheets 

The Powerpoint Training Program Document is available by download at   [return to top]

Toxics and Tomorrow's Children Conference Encouraged all to Be Vigilant

Staff attended the Conference on Toxics and Tomorrow's Children in Portland this past week, along with over 200 participants.  Maine is on the forefront in supporting changes in state and national chemical use in consumer products which present significant risk of adverse health consequences ranging from subtle cognitive development to chronic disease and premature death.  The Keynote address was given by Philip Landrigan, MD a pediatrician and Chair of the Department of Community and Preventive Medicine of the Mount Sinai School of Medicine in New York City, who directs the Mount Sinai Center for Children's Health and the Environment.  His report on pesticides and children's health was instrumental in securing passage of the Food Quality Protection Act of 1996, the major federal pesticide law in the United States.  Dr. Landrigan stated, that environmental change is the driving force behind asthma, cancers (i.e. 60% increase in testicular cancer in 15-30 year olds), birth defects and obesity and that developmental disabilities causation of  only 10-20% can be explained based on genetics.  David Littell, Commissioner of the Maine Department of Environmental Protection opened the conference and provided an introduction of toxins in our environment.   A few key facts from his presentation:

In a 2007 statewide survey - all 23 Maine birds species studied found known toxins in their eggs. 

In a recent national pesticides survey - 94% of fish were found with known toxins in urban areas and in "pristine environments" 57% of the fish were contaminated.

The Governor's Task Force to Promote Safer Chemicals in Consumer Products Key Conclusions & Recommendations:

  • There is inadequate federal regulation to assure that consumer products are safe
  • There are real concerns regarding pesticides found in consumer products
  • The health costs of toxic chemicals in consumer products are significant
  • Businesses want and need better information on the health impacts of chemicals in their workplace and in their products to help them create more sustainable workplaces and safer products
  • Adopt and publicize a list of chemicals of high and moderate concern.
  • Establish the authority to require consumer product manufacturers to report which chemicals of high and moderate concern are present in their products
  • Develop a publicly accessible database of readily available information that informs consumers
  • Establish the authority to restrict the use of chemicals of high concern in consumer products
  • Expand Consumer and Retailer Education

Suggested websites to visit to gain information on toxic chemicals and consumer products: [return to top]

Public Health Committee Meeting to Focus on Childhood Obesity - March 26th

The Public Health Committee (PHC) second meeting of 2008 has been scheduled for Wednesday, March 26th, 2008 from 4pm - 6pm at the Maine Medical Association Conference Room.  Video Conferencing will be available in the Portland area at the Maine Health Board Room at 465 Congress Street (in the Maine Bank & Trust Building and to participate by conference call the Dial-In Number is:  1-800-989-2842, access code:  6223374#. 

The PHC agenda will include a presentation on The Burden of Obesity in Maine, by David Crawford, MPH, Program Manager, Maine Physician Activity, Nutrition and Healthy Weight Program.

If you are interested in strengthening and broadening our public health policy initiatives in the year ahead and would like to serve on the PHC, please contact Kellie Miller, Director of Public Health Policy, MMA staff for the PHC at 622-3374, ext. 229 or

The next meeting of the PHC is scheduled for May 28, 2008, 4-6pm at the Maine Medical Association.

The Maine Medical Association Public Health Committee’s primary role, under the direction of Chair, Charles Danielson, MD is to support the MMA, the leadership and staff in enhancing the health of all Mainers.  The committee addresses issues of healthy communities and clinical preventive services and maintains and understanding of how core public health services, such as disease control, disaster response, environmental health, vital statistics and other public health data are provided in Maine.  

The PHC committee is focusing overall on three major policy initiatives in 2008:

-Childhood Immunization Supply & Vaccines

- Childhood Obesity/Management

- Toxics and Children’s Health [return to top]

MeMGMA Presents "Are You Tired of Being Tired", March 26, 2008

The Maine Medical Group Management Association presents a half-day educational session, "Are You Tired of Being Tired?", March 26, 2008 in South Portland, featuring speaker Lynne Richards, M.B.A..

Do you suffer from “hurry sickness,” “life in the fast lane,” or “superhuman syndrome?” Find out if you fit one of these profiles and what you can do about it before you reach burnout. Learn how to identify energy traps and how to avoid them. Discover the connection between brain dominance and energy. Learn how to reclaim childlike joy, zest and enthusiasm; identify what energizes you; and develop an energy plan. Start using a “whole brain” not “halfbrained” approach to balancing your life!
At the end of this workshop, you’ll be able to:

  • Describe “hurry sickness, life in the fast lane and superhuman syndrome”
  • Identify energy traps and how to avoid them
  • Discuss ways to generate new energy and incorporate balance in your life

For more information, or to register, click here [pdf] [return to top]

Latest AMA Therapeutic Insights online newsletter released: Managing Osteoporosis in Primary Care

The Maine Medical Association, in cooperation with the American Medical Association, announces the release of  Managing Osteoporosis in Primary Care, the latest AMA Therapeutic Insights newsletter. This free online quarterly newsletter spotlights one medical condition per issue and features state and national prescribing data along with evidence-based guidelines for treatment.

Read an excerpt from Managing Osteoporosis in Primary Care. 

Aimed at enhancing physician knowledge and practice—and ultimately, improving the quality of patient care—Continuing Medical Education credit is also offered for each newsletter.   

Visit to read this issue, as well as previous newsletters featuring Dyslipidemia, Type 2 diabetes and Depression.  [return to top]

13th Annual Howard R. Ives, MD Lecture, April 3 at Charles A. Dana Health Education Center

The 13th Annual Howard R. Ives, M.D. Lecture
Interdisciplinary Lecture on Topics in Healthcare
Sponsored by Maine Medical Center, Department of Nursing/Patient Services and Department of Surgery

“Beyond Headlines: What Americans can learn from the Canadian experience of single-payer healthcare”
Danielle Martin, M.D.
Thursday, April 3, 2008 8:00AM—10:00AM
Charles A. Dana Health Education Center Auditorium

The Howard R. Ives, M.D., Lecture Fund, in memory of a Portland Physician and Maine Medical Center Surgeon, supports an endowed multidisciplinary lecture focusing on broad issues in healthcare. “My father was an individual whose life and practice embodied the principles of humanity, charity, chivalry, and honor,” said Rollin Ives, his son. “His dedication to his profession, his standards for professional excellence, and his love of his
fellow man made him beloved in his relatively short lifetime. The lecture was established to honor both his memory and the standard of health care to which he was dedicated. Born in Portland on May 14, 1911, Dr. Ives
attended city schools and went on to Williams College and Yale Medical School.
He was a Senior Surgical Attending on the staffs at Maine Medical Center and Mercy Hospital, a member of the American College of Surgeons, and a Diplomat of the American Board of Surgery. His career was cut short by his untimely death in 1965.

The Howard R. Ives, M.D., Lecture Fund honors not only a man, but the style, quality, and principles of health care Dr. Ives practiced.

For more information or to register, please call or email: June Cameron, Department of Surgery
at 1-207-662-4078 or [return to top]

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