March 31, 2008

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A Special Thank You Following Doctor's Day, March 30, 2008

This week's Maine Medicine Weekly Update is published in recognition of all Maine's physicians in honor of Doctor's Day, Sunday, March 30, 2008.  On this day in 1842, anesthesia was first used to reduce pain and help save a life during a surgical procedure.  Doctors before and since have carried out a mission to alleviate suffering and promote good health.  Each and every day, the physicians of Maine touch lives, demonstrate compassion, and provide quality health care for their patients.  Many also work to broaden the base of scientific knowledge from which new treatments become available.  To physicians all across Maine, we thank you for your dedication, your skill, your services, and your compassion!

In 1933, a county medical auxiliary in the state of Georgia, led by Eudora Brown Almond, a physician's spouse from Winder, Georgia, selected March 30 as a fitting day to pause and honor the physicians in their community.  The idea caught on and spread across the country.  In 1958, the U.S. House of Representatives adopted a resolution commemorating Doctor's Day and in 1990, the House and Senate approved legislation establishing National Doctor's Day.  Today, March 30 is a day celebrated by many hospitals and other organizations in recognition of the contributions made daily by their medical staffs and individual physicians. 

In approximately one month, on April 28, 2008, the Maine Medical Association will celebrate its 155th birthday, having been founded at the Tontine Hotel in Brunswick on that day one hundred fifty five years ago (1853).  On the occasion of the Assocation's sesquicentennial in 2003, a monument and plaque were erected in Brunswick on the site of the former hotel (now known as the Tontine mall) on Maine St. in Brunswick.  The names of the original founding members of the society are acknowledged on the plaque.  You are cordially invited to stop by and visit the site the next time you are in Brunswick.

Thanks for all you do for your patients, your state, and the Association.

Invitation to Annual Corporate Affiliate Breakfast, April 16, 2008 at Portland Country Club

Representatives of MMA's Corporate Affiliates are reminded of the annual Corporate Affiliate Breakfast, being held this year at the Portland Country Club in Falmouth on Wednesday morning, April 26.  There is no cost to attend the event, which begins at 7:30am.  The presenter this year is Joshua Spurling, M.D., who will discuss his experiences in Iraq as part of the United States military.

Invitations were mailed early this month but if you have not received one and responded, call Lisa Martin at MMA (622-3374 ext. 221 or via e-mail to  and let her know you would like to attend.

The annual breakfast gives MMA an opportunity once a year to thank our corporate affiliates for their support of MMA and for the services they provide to MMA members, their families and staffs.

Members of the MMA's Executive Committee and Committee on Membership and Member Benefits have also been invited to attend.

Last year, nearly one hundred persons attended the breakfast and heard a talk by best selling author Tess Gerritsen. [return to top]

Revived Ethics Committee Meets; Looking for a Few New Members

MMA's Ethics Committee held its first meeting of the 2008 calender year last Thursday night.  The agenda included a discussion of the proposed Resolution presented at the 2007 Annual Session which was referred to the Committee   The Resolution dealt with the issue of the release from incarceration of mentally ill individuals who might be dangerous to the public.

Committee members also discussed the topic of physician-industry (pharmaceutical industry) relationships.  The Executive Committee had referred the issue to the committee.  The Ethics Committee members believed that MMA should undertake some or all of the following activities relative to this issue:

  • Educate members of the AMA Code of Ethics and the PHARMA Code of Ethics.
  • Develop a CME Program on the topic
  • Continue participation in the Tri-state Academic Detailing Initiative.
  • Put resources on this topic and appropriate links on the MMA website.

The committee is looking for additional members.  MMA members interested in serving should contact Gordon Smith at 622-3374 or via e-mail to [return to top]

Watch Your Mail for the March-April issue of Maine Medicine

The March-April Issue of Maine Medicine will be in your mail this week.  You may have noticed in the last issue that the publication is now larger which gives MMA the opportunity to explore more topics and issues in  depth.    We are interested in knowing reader's reaction to the new size, whether you receive the publication as a member, practice manager or corporate affiliate.  Please send your comments to the Association's EVP Gordon Smith at

The upcoming issue also contains inserts pertaining to the May 28th Practice Education Seminar at the Augusta Civic Center, the September Annual Meeting (Sept. 4-7, 2008 at the Samoset Resort) and a special April 11th presentation by Health Care futurist Jeffrey Goldsmith, PhD.  You may also register for any of these events on the MMA website at [return to top]

Health Care Futurist Jeff Goldsmith, PhD. Presents "The Changing of the Guard in Medicine" at MMA on April 11

MMA is pleased to present as part of its 2008 "First Friday" Educational Series a special "Second Friday" presentation on Friday, April 11 by Jeffrey Goldsmith, PhD., one of the nation's best known health care futurists.  Dr.  Goldsmith will speak on the topic of "The Changing of the Guard in Medicine; Generational Transition in Medicine." 

Dr. Goldsmith presented to an audience of nearly 400 persons at the Hanley Center event in the Fall in South Portland and MMA is delighted to bring him back to Maine for the Friday morning program that will run from 9:00am to noon at the Frank O. Stred Building in Manchester, location of the MMA offices.

In appreciation for all the support of members and practice managers of the "First Friday" Educational Series, MMA is pleased to offer this program at no cost.  But it is limited to the first 50 persons to register so call the MMA office at 622-3374 to reserve your spot. [return to top]

SAVE THE DATE: Sept. 4, 2008 for MMA-MHA Program on Improving Quality

The Maine Medical Association and the Maine Hospital Association join up for an innovative educational program on quality improvement on Thursday, Sept. 4, 2008 at the Samoset Resort in Rockport.  Sept. 4 is the first day of the MMA Annual Meeting.  It is hoped that teams of physicians, nurses and administrators working on quality improvement will attend from each hospital.

The featured presenter is Elliot Fisher, M.D. from Dartmouth Medical School.  Robert Keller, M.D., chairman of the Advisory Committee of the Maine Quality Forum and former Director of the Maine Medical Assessment Foundation will also speak.  In addition to these presentations, breakout sessions will feature best practices in Maine's hospitals.

While the schedule is still being finalized, a few of the topics being considered include:

  • The role of coding in documenting and reporting quality care
  • Staff citizenship
  • The role of a medical staff in an era of physician employment
  • Improving communication, focusing on the different ways in which administrators and physicians process information and come to decision making points.
  • MMA's Office-based QI program and the Voluntary Practice Assessment Program

Watch for further notices from MMA and MHA.  The program is being put together by the MMA Committee on Physician Quality and the MHA Quality Council. [return to top]

Update on Tamper-Proof Prescriptions for MaineCare

As you may remember, a new federal requirement for tamper-proof prescriptions for the Medicaid program was delayed from October 1, 2007 to April 1, 2008.  The Maine DHHS pharmacy program has provided the following update on its efforts to comply with the new federal requirement. 

In response to the amendment in Section 7002(b) - U.S. Troop Readiness, Veterans' Care, Katrina Recovery, and Iraq Accountability Appropriations Act, the State of Maine has put into place a tool to assist you during this change. The tool is a web site; this site contains mailings that have been sent out to providers to ensure their compliance with the new requirements of the act, information about the law and links to vendors that supply tamper resistant prescription pads.

We have also put into place an audit procedure. Starting April 7, 2008, the Pharmacy Help Desk will be contacting pharmacies and asking for copies of ten random prescriptions, if the script is compliant then further information will not be needed. However, if the pharmacy helpdesk determines the script is not compliant then additional information or contact may be needed. Prescriptions found non-compliant are subject to reversal.

Exceptions to section 1972(k) (2) are provided in section 1972(k) (3) of the act. These exceptions include drugs provided in nursing facilities, intermediate care facilities for the mentally retarded, and other specified institutional and clinical settings. The tamper-resistant pad requirement does not apply to refills of written prescriptions presented at a pharmacy before April 1, 2008. It does not apply to e-prescriptions, faxed prescriptions, or prescriptions communicated to the pharmacy by telephone.

To be considered tamper resistant on April 1, 2008, a prescription pad must contain at least one of the following three characteristics:

  1. one or more industry-recognized features designed to prevent unauthorized copying of completed or blank prescription form;
  2. one or more industry-recognized features designed to prevent the erasure or modification of information written on the prescription by the prescriber;
  3. one or more industry-recognized features designed to prevent the use of counterfeit prescription forms.

By October 1, 2008, a prescription pad must contain all three to be considered tamper resistant. Please refer to for more information on Tamper resistant pads and vendors that supply the pads.

If you have any questions or concerns please feel free to contact the Pharmacy Help Desk at 1-888-420-9711 or Jennifer Cook at 207-287-2705 and email [return to top]

MMA Delegation Attends AMA National Advocacy Conference/Medicare Reimbursement Issue at Top of Agenda

MMA EVP Gordon Smith, AMA Delegate David Simmons, M.D., and President-elect Stephanie Lash, M.D. have traveled to Washington, D.C. this week for the AMA's annual National Advocacy Conference.  During the conference the Maine contingent will meet with each member of Maine's Congressional delegation.  At the top of the federal advocacy agenda this Spring is the Medicare SGR issue, as the 6-month fix passed late last year expires on June 30, 2008.

The following talking points address the impact of Medicare physician payment cuts in Maine:

  • Maine physicians will lose $50 million for the care of elderly and disabled patients over the 18 months from July 2008 through December 2009 as a result of a 10.6% cut in Medicare payments in July 2008 and an additional 5% cut in 2009.  On average, each Maine physician faces a Medicare cut of $13,000 during this 18-month period.  In addition, the state's physicians will lose $1 billion for the care of the elderly and disabled patients by 2016 because of nearly a decade of cuts for this important medical care.
  • 14,133 employees, 223,962 Medicare patients, and 47,343 TRICARE patients in Maine will be affected by these cuts.
  • Compared with the rest of the country, Maine, at 17%, has an exceptionally high proportion of Medicare patients and, at 18 practicing physicians per 1000 beneficiaries, has a below-average ratio of physicians to Medicare beneficiaries, even before the cuts take effect.
  • 47% of Maine's practicing physicians are older than 50, an age at which surveys have shown many physicians consider reducing their patient care activities.
  • In July 2008, physicians in the southern Maine Medicare payment area (Cumberland and York counties) face cuts of an additional 1.1% on top of the 10.6% cuts across the country and the rest of Maine faces an additional cut of 2.1%.  The 2003 Medicare law provided a temporary increase in geographic payment adjustments for certain geographic areas.  This increase also will expire on June 30, 2008 under current law.

Maine's Congressional delegation always has been very supportive of physicians on this issue, but it is important that you contact members to thank them for their support and to urge them to fix the problem, yet again, before June 30, 2008.

Senator Olympia Snowe:  202-224-5344;
Senator Susan Collins:  202-224-2523; 
Representative Tom Allen:  202-225-6116;
Representative Mike Michaud:  202-225-6306; [return to top]

Political Pulse: Legislative Highlights of the Week

 1.  Direct entry or "lay" midwife licensing 

On Friday, the Legislature's Business, Research & Economic Development Committee finalized its 7 to 6 majority and minority versions 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.  The bill could be printed and appear on the House calendar at any time.  The MMA has mailed a sheet of talking points to all members.

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) 

As of late today, the supplemental budget remains in a state of flux.  Last Thursday afternoon, Representative Janet Mills (D-Farmington) offered an amendment to the budget (House Amendment "W," H-848) that would address the $20 million cut to hospital-based physicians by rebasing the hospital tax.  The Senate debated the budget until after midnight on Thursday and by a 19-16 vote passed a version of the budget including House Amendment "W," but differing from the House version in a variety of ways.  A group of 6 moderates on either side of the aisle negotiated a proposed compromise in an effort to gain bipartisan support for the budget.  The Senate Democratic leadership could not find sufficient votes for the Appropriations Committee majority report by the end of the day on Friday, so both chambers adjourned for the weekend.  Among the matters in the negotiations towards a bipartisan budget were restoration of funding for the oversight agency, the Office of Program Evaluation & Governmental Accountability (OPEGA), and further cuts to the so-called MaineCare "non-categoricals."  As of the end of last week, the Governor was still threatening a veto of the budget if it includes the hospital "tax & match" proposal.  Today, it appears that the Governor may accept the "tax & match" approach to "fixing" the $20 million cut if it is contained in a bill separate from the budget.  Budget negotiations have been going on behind the scene all day long and just after 4 p.m. the House began debating a new bill, L.D. 2289, that presumably is the Appropriations Committee majority report.  L.D. 2173 remains tabled in the Senate.  It appears that the legislature will work into the evening.  Since it does not seem likely that a 2/3 supermajority can be achieved on this supplemental budget, the Democratic majority will have to pass their budget, have the Governor sign it, and adjourn sine die before midnight on Tuesday, April 1, 2008.

3.  Bill Banning Smoking in Cars Passes in Initial Votes in Both Chambers

Last Tuesday, March 25, 2008, the House voted 92-46 to pass L.D. 2012, An Act to Protect Children in Vehicles from Secondhand Smoke.  The Senate followed suit on Thursday, March 27, 2008 passing the bill on a vote of 23-12.  This means that enactment is all but assured.

4.  Legislative Committee Conference Call 

The next Legislative Committee conference call is scheduled for tomorrow evening, April 1st, 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:    [return to top]

MMA Staff Attends Mass. Medical Society Public Health Forum to Seek Solutions to the Obesity Problem

The problem of obesity has been widely reported in the media, as have the impacts of obesity on individual health and on the health care system.  In recent years, many health experts have researched and published on the issue.

Studies have predicted that by the year 2050, obesity will shorten life expectancy in the U.S. by two to five years.  Popular magazines with diet and weight loss tips abound, and state and federal governments have programs focused on obesity.  Physicians are beginning to receive education and guidelines for treating overweight and obese patients.  Yet the weight problem continues to plague children and adults.

On March 27th, MMA staff attended the Mass. Medical Society’s fourth Annual Public Health Leadership Forum that addressed this question.  At the forum, Christina Wee, M.D., Director of the Health Services and Behavioral Research Program in Obesity at Beth Israel Deaconess Medical Center and Deputy Editor of the Journal of General Internal Medicine, stated that, “The cause is multifactorial, so the solution will also need to be multipronged.”

Dr. Wee spoke about the challenges physicians face in addressing obesity in the clinical setting.  As the primary deliverers of health care, “she indicated that physicians need to play an active role in addressing this problem.  Dr. Wee also added, that physicians, payers, public health officials, and policymakers must all work together to promote healthy behaviors, create health-oriented environments, and improve the food supply and the market for healthier foods.

Representatives from health plans, employers, industry, and state and local government, joined Dr. Wee to discuss programs that seek to address obesity and the barriers, costs, and benefits involved and they included: 

  • JudyAnn Bigby, MD, Massachusetts Secretary of Health and Human Services
  • John Cawley, Ph.D., Cornell University Economist
  • Christina Economos, Ph.D., Assistant Professor of Nutrition Science and Policy, Tufts University
  • Julie Green, Director of Healthy Living, Hannaford Supermarkets
  • Roberta Herman, M.D., Chief Medical Officer, Harvard Pilgrim Health Care
  • Madge Kaplan, Institute for Healthcare Improvement
  • Howard Koh, M.D., Harvard School of Public Health’s Division of Pubic Health Practice

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

-Immunization Supply & Vaccines

- Obesity/Management

- Toxics and Health

For more information on the committee’s activities, contact Kellie Miller, staff at or 207-622-3347, ext. 229.

  [return to top]

USM Accepting Applications for New Certificate of Graduate Study in Practice Management

Professional medical practices are increasingly characterized by larger  size, greater institutional affiliations and a broader array of professional, diagnostic and therapeutic services.  With this evolution,
there is a growing need for astute and capable managers to serve as the non-clinical leadership within a practice.

In response to this evolving market need, the Graduate Program in Health Policy and Management is pleased to announce that it is accepting applications for a NEW Certificate of Graduate Study in Practice Management for the Fall, 2008 semester.

This certificate provides comprehensive training in the strategic and operational management of physician and other professional health care practices.  Students will (i) understand the organizational, financing
and policy environment that characterizes the American health care system, (ii) acquire necessary leadership skills to facilitate strategic and long-term development of a professional practice and (iii) acquire the necessary administrative skills to effectively manage the day-to-day activities that advance the short term clinical, financial and operational objectives of a professional practice.  The Practice
Management Certificate is awarded upon  successful completion of five courses (14 credit hours) which include the American Healthcare System, Fundamentals of Leadership in Health Care, Human Resources Management in Public, Nonprofit and Health Organizations, Health Care Finance I and Topics in Practice Management. This last course will address a range of operational issues specific to
managing a professional practice.  

If successfully completed with a grade of B or better, course work can be applied to degree requirements for students who are admitted to the master’s degree program. Courses are scheduled in the late afternoon and evening for the convenience of working students, and are held at the Muskie School on the USM Portland campus.  Some courses are accessible at other University of Maine campuses through the distance education network.

For an application, interested students are referred to:

Interested students are also invited to contact Gino Nalli, Assistant Professor at or Susan Moore, Director of Student Affairs at to discuss their specific interests and career objectives.  [return to top]

The Burden of Obesity was Focus of the Public Health Committee Meeting Last Week

The Public Health Committee met on Wednesday, March 26th at the MMA and had a very productive discussion on the Burden of Obesity in Maine.  The presentation was provided by David Crawford, MPH, Program Manager for the Maine Physical Activity, Nutrition and Health Weight Program, MeCDC.  As one of the PHC’s three major initiatives, committee members discussed the need to create a Public Health “Tool Kit Section” on the MMA website that provides resources for physicians about the recognition and treatment of overweight, obesity and eating disorders, as well as “best practices” for talking with parents. 

The Maine Child health Survey in 2003 and 2004 indicated that children entering kindergarten in 2003:

  • 18% with Bmi’s 85-94% or overweight
  • 15% with BMI’s greater than 95% or obese
  • 33% have high BMI’s!

Obesity has doubled in Maine children in 20 years and tripled in Maine teens in 20 years!

David s. Ludwig, MD, PhD, in his New England Journal of Medicine article “Childhood Obesity – The Shape of Things to Come" (12-6-07) outlined four phases of the childhood obesity epidemic.  He stated, “that the economic costs could become catastrophic and that like global warming, the obesity epidemic is a looming crisis requiring action before all the scientific evidence is in.”

The Public Health Committee will be formulating policy recommendations on this issue for consideration by the MMA and its membership and encourages input from all members.  Other topics discussed for future action by the committee were: 1) formulating a  workgroup on toxics and environmental health concerns; 2) Immunization and current activities surrounding funding issues; 3) brief discussion of other public health policy issues in the legislature; and 4) an update on the Annual Session, "Public Health Forum on Obesity – Addressing the Epidemic", occurring on September 7th, which will provide take home tools for physicians.

The next Public Health Committee meeting is scheduled for May 28th, 2008, from 4-6pm at the Maine Medical Association.  All meetings are accessible via conference call or videoconference at the MaineHealth Board Room location in Portland.  For more information on PHC meeting activities, contact MMA staff, Kellie Miller at or (207) 622-3374, ext 229.  (All meeting agendas and minutes are posted on the MMA website) [return to top]

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