August 4, 2008

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MMA and Maine Hospital Association Present Quality Improvement Symposium on Sept. 4

The Maine Medical Association and the Maine Hospital Association, through the combined efforts of the MMA Committee on Physician Quality and the MHA Quality Council, present a Quality Symposium preceding the MMA's 2008 Annual Session.  The Symposium will be held on Thursday, Sept. 4 at the Samoset Resort in Rockport.  Registration is available on the MMA website at  The day-long program is co-sponsored by the Maine Quality Forum, Quality Counts and the Aligning Forces for Quality Project.

The featured presenter at the Symposium is Elliott Fisher, M.D., MPH, Director of the Center for Health Policy Research at Dartmouth Medical School.  Dr. Fisher will give two featured presentations, the first at 8:30 am entitled, "The Paradox of Plenty:  Challenging the Assumption that More is Better" and the second at 11:00 am entitled, "It Takes a Community - A Model for Shared Accountability & Rewards." 

A lunchtime presentation will feature Robert Keller, M.D., former Executive Director of the Maine Medical Assessment Foundation and currently the Chair of the Maine Quality Forum Advisory Council.  Dr. Keller will speak on the future of quality improvement and variation analysis in the state.

In addition to the plenary sessions, nine best practices workshops will be available on a variety of topics all aimed at assisting Maine's healthcare community in improving the quality of care provided to patients.

It is hoped that each Maine hospital will send a team of quality improvement professionals to the session.  Registration is available through the MMA website at  For more information, call the MMA office at 622-3374 and press 0 for assistance.

Patient Centered Medical Home Planning Group and Working Group Meet

On this past Tuesday, July 29, 2008, both the Planning Group and the Working Group established as part of the Maine Multi-Payer Pilot Patient Centered Medical Home project met at the MMA offices in Manchester to begin the complicated process of developing the Pilot which is expected to include at least ten primary care practices.  The Project is supported by the Maine Quality Forum and is directed by Lisa Letourneau, M.D., MPH.

The Planning Group consists of nearly fifty individuals representing interested stakeholders with the Working Group pared down to less than twenty individuals representing the following interests:

  • Conveners (Maine Quality Forum, Quality Counts, Maine Health Management Coalition)
  • Consumers
  • Physicians and other Providers
  • Self-insured Employers
  • Health Plans
  • MaineCare
  • Public Health

It is anticipated that additional committees and work groups will be formed around the issues of Practice Transformation and Measures and Evaluation.  The work of the Groups are is already assisted by the Maine Health Management Coalition (MHMC) Payment Reform Committee.

The Planning Group discussed its expectations and responsibilities the potential for an expanded charge involving advocacy for primary care and a proposed governance model.  An important part of the discussion of both groups involved a review of two draft documents:  The Guiding Priniciples for the Maine PCMH Pilot and Joint Principles for Maine PCMH Model.  Much of the discussion involved a provision in the draft Joint Principles which suggested that the definition of "the personal physician" in the AAFP-ACP-AAP-AOA Joint Principles be more broadly defined in the Maine Pilot to include a primary care nurse practitioner licensed to practice independently.  The issue of mid-levels was not definitively resolved and further discussion of the topic will take place at the next meeting on Sept. 24.  It is hoped that representatives of nursing organizations could participate in that meeting and in the work of the Working Group.

The Draft Guiding Principles and Joint Principles will be placed on the MMA website at for reference.

At the Planning Group meeting, Beth Austin from Crescendo Consulting presented an update on the MHMC's "Employee Activation Project" which is aimed at informing employees of the value of primary care and the importance of coordination of care.  Other issues addressed in the project include advice on how to get the most out of your primary care office visit and information the employee should know when receiving a new prescription.

A Resolution titled, "Commitment to Promote Primary Care as the Foundation for a High Quality, Safe, and Efficient Health Care System," to be presented at the MMA's upcoming Annual Meeting (Sept. 6) was shared and discussed.  All the Resolutions to be considered at the meeting will be placed on the MMA website.

Most of the remainder of the meeting discussed the criteria for selecting practices to participate in the pilot project and participants acknowledgment that it would be critically important to show a return on investment to the payers if the pilot were to be successful from the standpoint of changing the payment model and transforming primary care practice.

The criteria for serving as a "Patient Centered Medical Home" will be developed in the coming months, but based on the work nationally on this issue and on the Principles developed by the national organizations (AAFP, ACP, AAP and AOA), some or all of the following elements:

  • standards for access to care and communication for patients 24/7, including open access scheduling
  • systematic management of patient information and use of that information for population management to support patient care
  • effective care management and coordination of care
  • improving patient's ability to self-manage
  • electronic prescribing
  • test tracking
  • referral tracking
  • performance reporting and improvement
  • use of electronic communications with patients, i.e., e-mail, interactive website, etc.

The groups will meet monthly to continue the work in developing the details of the Pilot Project.  While it was hoped to have the basic model in place by January 1, 2009, that schedule was acknowledged Tuesday to be perhaps too ambitious.

MMA is represented on both the Planning Group and the Work Group and we will continue to report on these activities through the Weekly Update and Maine Medicine, our bimonthly newsletter. [return to top]

Dirigo Health Agency Board Nominees Announced

Governor John E. Baldacci has chosen Sara Gagné Holmes, Marianne Ringel, Judy Foss, and Joseph Bruno to serve on the Dirigo Board.

The composition and structure of the Dirigo Health Board was amended as a result of LD 431, "An Act to Enable the Dirigo Health Program to be Self-Administered," passed last year and signed into law by the Governor.  The legislation added four additional voting members.  These members are appointed by the Governor, but must be selected from candidates nominated for designated seats by the President of the Senate, the Speaker of the House, the Senate Minority Leader, and the House Minority Leader.

Sara Gagné Holmes, nominated by the Senate President, is executive director of Maine Equal Justice Partners.  Before that experience, Gagné Holmes served two years at the Office of the Governor, the last year of which she provided policy and legal expertise specifically related to Dirigo Health. 

Marianne Ringel, nominated by the Speaker of the House, is employed as a program specialist with Konbit Sante Cap-Haitien Health Partnership.  Ringel previously served as a special assistant to the Governor's Office of Health Policy and Finance and as a policy director and acting deputy director for the MaineCare Program.  She also has experience with local government, having served on the Gardiner City Council from 1997 to 2001.

Judy Foss, nominated by the Senate Minority Leader, is a retired consultant, having worked for six years with Stafford Business Advisors.  She was a state representative from 1984 to 1994, and was chief of staff to the Maine Senate President from 1995 to 1996. 

Joe Bruno, nominated by the House Minority Leader, is vice president of The Waldron Group of Falmouth.  He is also the founder, president and CEO of Community Pharmacies, LP in Augusta.  Bruno ran GHS Data Management Inc. from 1995 to 2004.  Bruno has served on the Board of Selectmen for the Town of Raymond and five terms in the Maine House of Representatives from 1999 to 2004, including service as the House Republican Leader. 

The nominations must be reviewed by the Joint Standing Committee on Insurance and Financial Services and confirmed by the Senate.  A confirmation session of the Senate has been scheduled for August 20, 2008. [return to top]

MMA Dues to Remain at Existing Level in 2009

While other practice costs increase, and personal expenses such as gasoline, heating oil, and groceries are a focus of attention, MMA's Budget & Investment Committee and Executive Committee at meetings in July decided that it was important for MMA to hold the line for the benefit of its members and voted not to increase dues in 2009.  In the past three years, dues have been increased by $15.

MMA has been fortunate to find several sources of revenue that assist in keeping dues at a reasonable level.  These sources of income (in no particular order) include:

  • Investment income;

  • State contracts (OSA, MQF, BOLIM);

  • Administrative contracts with specialty societies, the Downeast Association of Physician Assistants, and the American Society of Medical Association Counsel;

  • Review of member contracts (employment contracts and healthplan contracts);

  • Dues from Corporate Affiliates;

  • Royalty income from endorsements in the areas of collections, phone service, office supplies and merchant banking;

  • Voluntary contributions from dues-exempt senior members;

  • The Coding Center;

  • CME programs; and

  • Annual Session, including exhibitor fees and sponsorships.

MMA's dues for active members ($470) is around the middle of state medical society dues around the country.

  [return to top]

Cigna, Aetna Incomes Rise on Strong Overall Growth

Largely as a result of premium increases and membership growth, Aetna Inc reported last week that the company’s second-quarter net income rose 6.5% for a total a net income of $480.5 million, or 97 cents a share. This is up from $451.3 million, or 85 cents a share, a year earlier.  Revenue rose 15% to $7.85 billion, up from $6.84 billion, as Aetna’s total medical membership grew 0.2% from the first quarter to 17.5 million.  Many analysts are predicting that Aetna, compared with other insurance companies, stands well-positioned to navigate the potentially troubled managed-care market.

Cigna Corporation reported that its second-quarter net income increased by 37%.  The insurance company reported a net income of $272 million, or 97 cents a share, up from $198 million, or 68 cents a share, just a year earlier.  The company’s medical membership rose 19% during the first half of the year as Cigna acquired Great-West Healthcare and 1.8-million additional members.  Premium fees also increased by nearly 13% in the quarter, largely as a result of the take-over. [return to top]

Quality Counts Launches Website, Membership Drive

Quality Counts!, a nonprofit organization committed to working together to improve health care systems and outcomes, has launched a new web site

Quality Counts! began when a diverse group of stakeholders, including health care providers, employers, payers, and policymakers came together in the fall of 2003 to promote the need for improved systems of care for chronic illness.  This group initially planned and conducted a series of five statewide conferences around the Chronic Care Model and using population-based approaches and information systems to improve care.  In April 2006, the original corporators endorsed the creation of Quality Counts! (QC) as an independent not-for-profit corporation to be supported by membership contributions, as well as available contracts and grants.

The organization has just launched its annual membership drive and will be sending solicitation letters to physician groups, health centers, hospitals, health systems, payers, employers and others.  Newly elected board officers are:

Chair: Barbara A. Crowley, M.D., President, MaineGeneral Health Associates and Executive Vice President, MaineGeneral Health;
Vice chair: Gordon Smith, Esq., Executive Vice President, Maine Medical Association;
Treasurer: Jim Leonard, MSW, Program Manager at the Maine Quality Forum;
Secretary: Stephen Ryan, MS, President/CEO of Maine Network for Health.

As announced in last week's Update, Lisa Letourneau, M.D., MPH, the former Board Chair of the organization, recently was named the part-time Executive Director.  A search is going on now for a full-time Associate Director. [return to top]

Office of MaineCare Services Issues Proposed Consolidated Behavioral Health Care Rule

As anticipated for months, the Office of MaineCare Services has published a revised version of MaineCare Benefits Manual (MCBM), Chapter II, Section 65 to be entitled Behavioral Health Services.  This will incorporated the following current sections of the MCBM:

  • Section 58, LCSW, LCPC, & LMFT Services;
  • Section 65, Mental Health Services;
  • Section 100, Psychological Services; and
  • Section 111, Substance Abuse Services.

The following is the "Concise Summary" from the rulemaking notice:

The proposed rule consolidates Outpatient Services under one Section of the MaineCare Benefits Manual, ensuring better coordination of services.  Emergency Services, which used to be covered as a stand alone service, has been incorporated into Outpatient Services.  Comprehensive Assessment, which was incorporated into Outpatient Services, is being covered and coded for reimbursement as a stand alone service.  This rulemaking also adds proration language for partial months of Children's Assertive Community Treatment (ACT) in Chapter II.  Crisis Services have been renamed and redefined to better reflect current services being provided.  Child and Family Behavioral Health Treatment and Community Based Treatment for Children Without Permanency have been merged into one service and renamed Children's Home and Community Support Services for better coordination.  Collateral contacts have also been added as a stand alone service for children who receive Children's Home and Community Support Services.  Independent providers not employed by a Mental Health Agency will be able to provide within the scope of their licensure and be reimbursed for services provided to MaineCare members.  Additionally, the Chapter III of this new Section will contain HIPAA compliant coding.  Other than providers of these specific services, this rule is not expected to fiscally impact or create new recording burdens for other small businesses and is not expected to yield new costs for municipal or county governments. 

You can find the proposed rule on the web at:

The Department has adopted the proposed rule on an emergency basis effective August 1, 2008.  A public hearing on the rule has been scheduled for Monday, August 11, 2008 at 12:30 p.m. in Conference Rooms 1A&B at the DHHS, OMS Office at 442 Civic Center Drive, Augusta, Maine 04333.

The deadline for written comments is August 21, 2008.

The agency contact person for comments or questions is Ginger Roberts-Scott, Comprehensive Health Planner, State House Station 11, Augusta, Maine 04333-0011; 287-9369.

If you have further questions or comments about this rulemaking proposal, please contact Andrew MacLean, Deputy EVP, at or 622-3374, ext. 214. [return to top]

MMC and the Maine Board of Licensure Present "Prescribing Opioids for Chronic Pain," September 12

Maine Medical Center Department of Family Medicine

In Cooperation with the Maine Board of Licensure in Medicine


Prescribing Opioids for Chronic Pain: Pearls and Pitfalls - Strategies and Options, September 12, 2008

~  National Faculty ~
Dan Alford, MD, Boston University & John Hopper, MD, Wayne State University

6.0 hours AMA PRA Category 1 Credit

The presentation will be at the Maine Medical Center Dana Education Center, and also available at the following sites by video-conference:

Miles Memorial Hospital
Cathy Cole, Director of Educatiom,, 207-563-1234

The Aroostook Medical Center
Linda Menard, CME Coordinator, 207—768-4186

Calais Regional Hospital
Pam Ivey, CME Coordinator,, 207-454-9281

Franklin Memorial Hospital
Karen Rogers, Education Department,, 207-779-2575

Millinocket Regional Hospital
Donna  Kelly,, 207-723-7232

Registration:  7:00 – 8:00 AM
Conference:   8:00 AM – 1:00 PM [return to top]

UNE Physician Assistant Program Seeking Preceptors

Dr. Glen Askins, Jr., MD has joined the University of New England (UNE) PA Program faculty as the new Interim Director of the Physician Assistant Program.  Dr. Askins recently served as Chairman of the Department of Clinical Services at the Medical University of South Carolina (MUSC).  Dr. Askins has a long and distinguished career in clinical care, academic medicine, and PA education.  He will work with the PA faculty and staff to provide the highest quality education for our students during this year of transition.  In addition, UNE will use this interim time period to conduct a national search for a permanent director beginning in the Fall.

Dr. Askins met with the Board Members of the Downeast Association of Physician Assistants on July 26, 2008 and indicated that one of the major challenges for the UNE PA program as it continues to grow, is securing physician and physician assistant preceptors for pediatrics and women’s health student rotations.  If you are interested in serving as a preceptor, please contact Dr. Glen Askins directly by email at or by phone at 207-221-4527.


  [return to top]

Massachusetts Legislature Passes Funding Increase for Health Care Reform Initiative

On July 31, 2008, the last day of the current legislative session, the House and Senate enacted a funding package for the health care reform initiative that did not include $33 million in increased assessments on employers who do not provide health insurance.  Current law requires employers of 11 or more that do not provide health insurance to make a "fair share employer contribution" of $295 per employee.  Governor Deval Patrick (D) included the increased funding, estimated at $89 million for the next fiscal year, in a supplemental budget bill (H. 5022).  The legislation also provides that excess revenue from a $1 per pack increase in the cigarette tax (estimated to raise $175 million in the first year) recently approved will be dedicated to health reform.  [return to top]

CMS Adds 3 to "Never Event" No Pay List, Fewer Than Proposed

On July 31, 2008, CMS announced that it would proceed with 3 of 9 proposed so-called "never events" for which it will no longer pay reimbursement.  These amendments will be published in the FY 2009 Inpatient Prospective Payment System (IPPS) final rule.  The IPPS final rule is scheduled to be published in the August 19, 2008 Federal Register and will be effective October 1, 2008.  The 3 new hospital-acquired conditions are:

  • surgical site infections following certain elective procedures, including certain orthopedic surgeries and bariatric surgery for obesity;
  • certain manifestations of poor control of blood sugar levels; and
  • deep vein thrombosis or pulmonary embolism following total knee replacement and hip replacement procedures.

CMS also advised that it will more closely link Medicare payment to hospital-acquired conditions in the future and that it is encouraging state Medicaid programs to follow its lead.  According to CMS, nearly 20 states (including Maine) have enacted or are considering legislation to prohibit payment for some "never events."  [return to top]

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