March 24, 2008

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Political Pulse: BRED Committee Divided on Licensing of Midwives/Appropriations Committee Reports Out Budget

The Legislature appears poised this week to debate a budget divided along party lines and it must enact a "majority budget" by the end of the month in order to have a balanced budget in place at the end of the fiscal year.  Legislators must address bills on the Dirigo Health Program, licensure of "direct entry" midwives, and many other issues before adjournment scheduled for mid-April. 

1.  Direct entry or "lay" midwife licensing 

Following a public hearing and work session last Tuesday, the Legislature's Business, Research & Economic Development Committee was deeply divided after spending 3 hours discussing the proposal to license "direct entry" or "lay" midwives who call themselves Certified Professional Midwives.  Ultimately, a bare majority of the Committee (7 to 6) voted to approve an amended version of L.D. 2253, An Act to License Certified Professional Midwives that would license such midwives through the existing Board of Complementary Health Care Providers. 

A strong minority (6) of the Committee rejected licensing, supporting the recommendation contained in the recently-concluded independent sunrise review study by the Department of Professional & Financial Regulation.  In lieu of licensing, the minority report will contain a provision authorizing the midwives access to a limited number of medications to have available in connection with a home birth.  The medications include pitocin (for post-partum hemorrhage only), oxygen, vitamin K, prophylactic eye ointment  (for the newborn), local anesthetics (for lacerations only), and IV fluids.  While the MMA and the Maine Section of ACOG would prefer not to go this route, support of the minority report was necessary as a compromise in order to provide an opportunity to avoid licensing.

MMA and the Maine Section of ACOG believe that licensure would put the state's imprimatur or "stamp of approval" on home births and would lead pregnant women to believe that home birth and delivery assisted by a lay midwife is safe.  The public would most certainly be confused about the education, training, and experience of "licensed certified professional midwives," (LCPM) compared to "certified nurse midwives" (CNM).  The Maine Nurse Practitioner Association, representing the interests of certified NURSE midwives, joined MMA and other medical organizations Tuesday in opposing the licensing proposal.

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.

MMA urges members of the medical community to contact legislators now urging them to reject the majority recommendation to license lay midwives.  As a full floor debate is expected by mid-April, 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: 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 your own legislators on the web at:  

If you have further questions or comments about this effort, please contact Gordon Smith, EVP at or 622-3374, ext. 212 or Andrew MacLean, Deputy EVP at or 622-3374, ext. 214.

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

Last Thursday evening, the Appropriations Committee voted 8-3 in favor of a Committee Amendment to L.D. 2173, the FY 2008-2009 supplemental budget.  The Committee divided along party lines (with 2 Republicans absent) setting up a spirited and likely partisan floor debate this week and likely enactment by a simple majority without much, if any, Republican support.  The budget will have to be enacted by a majority soon so that it can take effect 90 days from adjournment and be in effect before the end of the fiscal year on June 30, 2008.

The majority budget includes the Governor's proposed $20 million cut in reimbursement to hospital-based physicians.  Earlier last week, the MHA had negotiated with Democratic leadership to remove the cut through a modification to the "tax & match" provisions in current law, but Appropriations Committee Democrats withdrew support for this fix following a veto threat from the Governor.  Appropriations Committee Republicans always had been cool to this proposal.

The full legislature will take up the budget this week, so now is the time to communicate with your own legislators about your opposition to the $20 million cut!

The majority budget includes $65 million in cuts to health and social welfare spending, but it rejects $27 million in such spending proposed by the Governor.  It includes no new broad-based revenue and takes nothing from the Rainy Day Fund. 

3.  Insurance Committee To Take Up Dirigo Legislation Tomorrow

The Insurance & Financial Services Committee has scheduled a work session for tomorrow afternoon, but it is far from clear that any version of L.D. 2247, An Act to Continue Maine's Leadership in Covering the Uninsured will have sufficient support to pass the full legislature.  Following a work session last week, it appeared that 6 Democrats will support the bill as proposed by House Majority Leader Hannah Pingree (D-North Haven).  All 5 Republicans likely will vote against the bill.  Senate Chair Nancy Sullivan (D-York) may report out her own version of the bill with modifications to the funding mechanism and more aggressive insurance market reforms.  The Committee negotiations on Dirigo broke down in similar fashion at the end of the last legislative session.

4.  Legislative Committee Conference Call 

The next Legislative Committee conference call is scheduled for tomorrow evening, March 25, 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.

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

Update on HealthInfoNet

The Board of HealthInfoNet met on Wednesday (3/19) and received a series of reports on the progress of the project.  The Board also engaged in an extensive discussion of the rules that would apply regarding privacy interests of patients when the demonstration phase of the project is implemented over the next 24 months,  Shenna Bellows, Executive Director of the Maine Civil Liberties Union was a guest of the Board as members struggled with issues related to the concerns of consumer groups regarding medical privacy.

Dev Culver, Director of the project presented an update on the current status of the demonstration phase of the project which still needs an additional $2.5 million to be completed.  A contract with 3M Orion should be completed within the next couple weeks.

Mr. Culver also provided information on the attempt to receive more public funding through the legislature.  A legislative proposal which would have provided finding through a fee assessed to each prescription did not receive enough legislative support to advance and was replaced with a Resolve that directs a Stakeholders group to meet and discuss funding options.  The Resolve is being prepared by legislative staff and is expected to be passed by the legislature before the end of the legislative session (currently scheduled for April 16). [return to top]

Report on Committee on Physician Quality Meeting, March 20, 2008

The Association's Committee on Physician Quality met this past Thursday to consider a full agenda of items.

1.  MMA President William Strassberg, M.D. presented to the Committee on the elements of the Professionalism Program which deal directly with patient safety and quality improvement.  The importance of integrating this initiative with the several other similar projects in the state was expressed by committee members.  The use of the MMA's bully pulpit to encourage physicians to be more active in these areas was also noted.

2.  Maine Osteopathic President Douglas Jorgenson, D.O. gave an informational presentation on a software product, Patient 360, a chronic management tool capable of tracking critical aspects of a patient's care and make appropriate adjustments to all levels of their total treatment.  Its focus is patient medical education and information management.  For more information, readers may go to

3.  MMA EVP Gordon Smith presented an update on the Voluntary Practice Assessment Initiative, funded by the Maine Quality Forum.  About 65 physicians have been assessed to day.  It is hoped to review 150 physicians by Sept. 1, 2008.

4.  CPQ Chairman David McDermott, M.D. announced a unique program being held on Sept. 4, 2008 as part of the MMA Annual Session involving MMA and the Maine Hospital Association.  The day-long educational program will feature presentations on improving quality, including a key note presentation by Elliott Fisher, M.D. from Dartmouth Medical School.

5.  The Committee accepted applications from Neurology Associates of Eastern Maine and Spectrum Medical Group to join the MMA Office-based Quality Improvement Program. 

The Committee meets again on May 8th at the Frank O. Stred Building in Manchester (offices of MMA).  [return to top]

Plan to Attend MMA 155th Annual Session, Sept 4-7, 2008 at the Samoset Resort

In 1853, a hearty group of Maine physicians conducted the first Annual Meeting of the Maine Medical Association, the organization having been formed a few months earlier at a meeting of the Tontine Hotel in Brunswick.  Every year since that time, MMA members have met to conduct the business of the Association and to hear lectures and receive CME.  This year, the 155th meeting will be held at the Samoset Resort in Rockport, Maine Sept. 4 through Sept. 7th.

On Sept. 4th, The Association will join with the Maine Hospital Association in presenting a day long educational conference focusing on improving quality through hospital-based teams.  The quality improvement theme will continue through the weekend in CME sessions on Friday, Saturday and concluding on Sunday morning.  The Association will hold its general membership meeting on Saturday morning which will feature an "open mic" session where any member can speak, challenge or question MMA leadership and staff.

On Saturday evening, Sept. 6, President William Strassberg, M.D. will pass the gavel to in-coming President Stephanie Lash, M.D., a practicing neurologist in Bangor who will serve as the 2nd female President in the history of the Association.

Mark Sept. 4-7 off on your calender and join your colleagues in participating in an important 155 year tradition.  Registration materials will be mailed in the Spring but an early bird registration form is included in your March-April issue of Maine Medicine which should arrive in your office about April 2. [return to top]

BEP Proposes Amendments to Biomedical Waste Management Rules

The Board of Environmental Protection is proposing revisions to Rule Chapter 900, Biomedical Waste Management Rules.   Chapter 900 identifies biomedical waste subject to regulation, requires the registration of biomedical waste generators and establishes packaging, labeling, handling, storage, transportation, and treatment requirements.  The proposed revisions focus on 5 areas.

First, outdated standards for the incineration treatment method of biomedical waste are being eliminated and replaced with biological efficacy and performance standards for non-incineration treatment technologies for biomedical waste, such as autoclaving.  As part of this revision, treated biomedical waste will be handled as a special waste to prevent commingling with solid waste.

Second, all language referring to the disposal of biomedical waste has been removed.  This is proposed because the Department has never allowed the disposal of biomedical waste without treatment.  Treated biomedical waste is disposed of as a special waste.

Third, an annual fee is proposed for all generators of biomedical waste.  The proposal includes a 3-tiered fee structure.  Generators producing less than 10 pounds per month will be assessed $25 per year.  Generators producing 10 or more pounds but less than 50 pounds will be assessed $50 per year.  Generators producing more than 50 pounds per year will be assessed $500 per year. 

Fourth, Chapter Two of the Department rules Concerning the Processing of Applications and Other Administrative Matters has been incorporated by reference to govern the application requirements for facility licensing and advisory rulings.

Fifth, a provision is added to specifically allow biomedical waste generators to use the U:S. Postal Service for the handling of waste sharps.  This is proposed to align the Department rules with an existing statutory provision authorizing its use.

The deadline for written comments is Friday, April 11, 2008.  No public hearing has been scheduled.  

You will find a copy of the proposed rule on the web at:

If you have questions or comments on the proposed revisions, please contact Andrew MacLean, Deputy EVP, at or 622-3374, ext. 214.

You may direct written comments to Scott Austin, Biomedical Waste Program Coordinator, Maine DEP, State House Station 17, Augusta, Maine 04333-0017, Fax (207) 287-7826, email:  [return to top]

Resources for Managing Chronic Pain Now on MMA Website (

With financial support provided from the Board of Licensure in Medicine, MMA has dedicated a section of its website to information on treatment for chronic pain and preventing prescription drug abuse and diversion.  Power point presentations from the Association's educational programs on this topic (sponsored by the Office of Substance Abuse), clinical articles, and links to other resources are included.

Go to  to review these materials. [return to top]

Don't Forget April 1 Deadline for Use of Tamper-Resistant Prescription Pads for MaineCare

Members and their office staff are reminded of the federal requirement to use tamper-resistant prescription pads for all MaineCare scripts which takes effect on April 1.  The requirement, enacted in early 2007, had been subject to a six month delay, but that delay expires on April 1.

Because Maine law already requires the use of such prescription paper for all schedule II prescriptions (regardless of payor), most Maine practices have the pads readily available.  The difference now is that for MaineCare patients, the requirement applies to all prescriptions.  There are, however, some important exceptions.  The federal law does not apply to electronic, faxed or phoned prescriptions, and does not apply to most nursing home prescriptions where patients never handle the script.

For information on how to order such pads, go to MMA's website, click on corporate affiliates and look under prescriptions, secure.   The vendors approved by MMA include RX Security, Standard Register and Bangor Letter Shop.  [return to top]

Report on MaineCare Provider's Advisory Group (from Meeting March 20)

The Governor's MaineCare Provider's Advisory Group met with MaineCare officials last Thursday for its regular monthly meeting.  In addition to operational updates (claims processing, customer service, interim payment recovery, MECMS), Group members heard an update on the impact of potential budget cuts from Patti Dushuttle. The most significant impact would be in the non-categorical population, which is likely to be subject to higher co-pays for pharmacy benefits.  There will also be more prior authorization for podiatry services and durable medical equipment.

Relative to the new claims processing system being delivered by Unisys (the new fiscal agent), information was provided on the NPA crosswalk and provider re-enrollment.  More information will be provided at the next meeting in April.

Metrics distributed at the meeting showed that 84% of the interim payments had been recovered.  Physicians and other professionals billing with physician codes still owe about $4.9 million in interim payments.

There are currently over 78,000 claims in suspension, representing over $90 million in billed charges. $5.1 million of these represent physician charges. [return to top]

Physicians’ Foundation Sending Survey to Every Primary Care Doctor in America

The Physicians’ Foundation for Health Systems Excellence (PFHSE), a not-for-profit group composed of medical societies and physician leaders, is seeking answers to these questions by undertaking one of most ambitious physician surveys ever attempted.   Beginning in May, 2008, PFHSE will send over 300,000 surveys to primary care physicians and selected medical specialists throughout the country.   The survey will be sent to virtually every active primary care physician nationwide, and to specialists in small, independent practices.  

       “We have heard from the pundits about the state of medical care in the United States,” notes Louis Goodman, Ph.D. president of PFHSE and executive vice president of the Texas Medical Association.  “It’s time we heard what physicians have to say.”

       According to Dr. Goodman, the survey asks primary care physicians about the state of their practices and whether or not they can maintain patient care services in light of regulatory and financial burdens.   The key question posed by the survey, Dr. Goodman observes, is can doctors meet the needs of patients under current practice conditions? 

        “If the survey indicates that medical practice itself is in jeopardy, that urgent message needs to be heard by policy makers and the public,” states Walker Ray, M.D., vice president of PFHSE and former president of the Medical Association of Georgia. 

       PFHSE has partnered with national physician search and consulting firm Merritt, Hawkins & Associates to develop and mail the survey.   Tim Norbeck, executive director of PFHSE and longtime former executive director of the Connecticut State Medical Society, notes that physicians around the country will soon be receiving the survey and he urges them to participate. [return to top]

Senator Stabenow introduces the Save Medicare Act of 2008 (S. 2785) to stop Medicare physician cuts

On March 13, Senator Debbie Stabenow, D-Mich., introduced the Save Medicare Act of 2008 (S.2785). This legislation would replace Medicare cuts totaling over 15% with positive physician payment updates from July 1, 2008 through December 31, 2009. Specifically, S. 2785 would extend the 0.5% update through December 31, 2008, averting the 10.6% cut scheduled to occur on July 1, 2008. It would also provide physicians with a 1.8% update for 2009 and extend provisions benefiting rural payment levels. Further, S. 2785 would fund the Medicare “Physician Quality Reporting Initiative” (PQRI) through 2010, providing participating physicians with an additional 1.5% payment bonus. This temporary fix would inject some stability into the system for seniors and physicians, who would otherwise be forced to make difficult practice decisions as a result of the pending payment cuts. This bill would also give Congress time to work on a long-term solution to the broken payment system without having to take multiple actions over the next 18 months to stop the pending cuts. [return to top]

Maine Radiological Society to Meet Tuesday, April 8th, 6pm - 8pm

Under the direction of the Maine Radiological Society's (MRS) three immediate Past Presidents, Dr. Eric Stram, Dr. Jeffrey Kugel, and Dr. Jeffrey Young have convened a meeting of the MRS to bring forward radiology's most pressing issues and to coordinate their activities for the year ahead.  The business section of the meeting will focus on the election of officers:  President, Vice President, Treasurer and Councilors to the American College of Radiology (ACR).  The proposed Slate of Officers are:  President:  Dr. Martin Kernberg; Vice President: Dr. Jeffrey Young; and Treasurer:  Barbara Biber, MD.  ACS Councilors up for election are:  Dr. Jeffrey Kugel, Dr. Paul Gagliardi and Alternate Councilor:  Dr. Charles Grimes.   A representative of the ACS has been invited to discuss issues of importance to our Maine members, as the MRS moves forward in their endeavors.  This discussion will provide a foundation on which to build  upon our efforts in Maine to support the practice of radiology.

Teleconferencing will be available and to participate by conference call, the Dial-In Number is:  1-800-989-2842, access code:  6223374#  

If you are a member of the MRS and would like to attend, please contact Kellie Miller, MMA staff for MRS at 622-3374, ext. 229 or   [return to top]

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