August 25, 2008

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Medical Mutual Insurance Company of Maine Announces Premium Reduction

Medical Mutual Insurance Company of Maine, Maine's largest provider of professional liability insurance for physicians, announced on August 18th that it had filed for and received approval from the Maine Bureau of Insurance to reduce physician base rates and modify the relativity factors medical specialty loss plan for all new and renewal business effective Oct. 1, 2008.  This combined impact will result in an overall average "net" rate reduction of 10.8 percent.  As some class relativities have changed, a physician's premium change may be more or less than the average "net" change, depending upon the specialty.

In its letter to all insureds this past week, MMIC stated that the new rates reflect improvements in claim frequency trends over the past few years both in Maine and in the nation.  This rate reduction and change in class relativities is independent of the $4 million dividend declared by the company this past Spring.

Medical Mutual celebrates is 30th anniversary this coming week and is the endorsed insurer for members of the Maine Medical Association.

"This is another piece of good news for Maine's physicians," noted Gordon Smith, EVP of MMA.  "Along with the pending MaineCare increase and the successful advocacy enacting a new Medicare payment increase in place of the proposed cut, this decrease in a major expense category may help to stabilize the physician workforce in Maine."

Maine currently has over 235 physician vacancies, as reported by the Maine Recruitment Center.  Over one hundred of these vacancies are in primary care.


Maine Physicians Report Errors in Medicare PQRI Reports

Established by legislation signed in late 2006, the Medicare Physician Quality Reporting Initiative (PQRI) is a voluntary quality reporting program.  During the first phase of the program, physicians reported 74 unique measures for dates of service from July 1 to December 31, 2007 and thereby were eligible for a bonus payment of 1.5% of total allowed charges for covered Medicare Physician Fee Schedule services.  In recent weeks, MMA has reported aggregate data about payments made during the first phase of this P4P program.  More information about the program is available on the CMS website at

 During the past week, the MMA has received the first call from a physician practice complaining about significant inaccuracies in the quality reports.  The practice also reported substantial difficulty in accessing the web-based reports.  Moreover, the practice stated that representatives of a CMS subcontractor for the program, Quality Net, said that there is no formal appeal rights or means of challenging the accuracy of the quality data.  The Quality Net representative described only an "informal inquiry" process that CMS may employ in situations where a physician practice challenges the data.  Because the credibility of the data and due process rights in challenging inaccurate data have always been the physician community's greatest concerns about these quality initiatives and P4P programs, the MMA is troubled by these reports.  If your practice has had similar experience, please contact Gordon Smith, EVP ( or Andrew MacLean, Deputy EVP ( by email or phone at 622-3374 (ext. 212 for Gordon or 214 for Andy) with your experience. [return to top]

Board of Pharmacy Considers Proposed Rules for Midwifery Prescribing

At its monthly Board meeting this past Wednesday, the Maine Board of Pharmacy reviewed a draft rule that would implement the provisions of recently enacted Maine law which would permit pharmacists to dispense a limited category of medication to lay (non-nurse) midwives.  When signing the legislation, Governor Baldacci, after expressing reservations about the law, directed the acting Commissioner of the Department of Professional and Financial Regulation to take steps to ensure the safety of homebirth by working with the Board of Pharmacy to enact rules implementing the legislation.

Phamacy Board members had a number of suggestions regarding the proposed rule and a work group will reconvene to review the recommendations.  The Board will consider these recommendations at its next Board meeting.  Once proposed, the rule would still have to go through formal rule-making, including an opportunity for public comments.

The medications, to be used in connection with home births, include oxytocin (excluding its use to hasten labor), vitamin K, eye ointment for the infant, a local anesthetic and oxygen.  The draft proposed rule would require that midwives report the use of the medications to officials at the Maine CDC. Under the legislation, pharmacists are permitted, but not required, to dispense the listed medications to midwives certified by their national organization.

The Maine legislature defeated a proposal this past session to license lay midwives, but did narrowly enact legislation allowing dispensing of the medications. MMA continues to oppose the licensing of lay midwives, believing that the public would confuse the CPMs and CNMs and further believing that their level of educaton and training is not sufficient to provide the safest environment for home birth. 

There are approximately 25 lay midwives providing midwifery services during home birth in Maine.  As the result of an attorney general opinion in the late 1970's, the assistance provided to a woman in natural childbirth is not considered the practice of medicine.  Therefor, midwives can practice midwifery and charge for their services. [return to top]

State Panel Examines Healthcare Workforce Shortage

The State's Health Workforce Forum met for its monthly meeting on August 20.  There were four meeting objectives, as follows:

  1. Review comments and select a goal statement for the Forum
  2. Establish the working framework for the Forum
  3. Review and prioritize the Forum themes and recommendations
  4. Identify the strategic approach and action steps for each priority

The Forum was originally established in 2005 by the legislation that created the Health Occupations Report (An Act To Ensure an Adequate Supply of a Skilled Health Care Workforce) and amended in 2009.  The legislation states that:

     The department shall convene at least once annually a health workforce forum to review the latest report developed under section 256-A and discuss current health care workforce issues.  The forum must include representatives of health professionals, licensing boards, employers, health education programs and the Department of Labor.  The department shall use the information gathered through the forum to develop its health policy and planning decisions authorized under this Title and to make appropriate policy recommendations based on its analysis of the health care workforce.  The department shall post the report and recommendations on a publicly accessible site on the Internet maintained by the department by December 31st, beginning in 2009.

The Forum was convened in 2006, met intermittently through 2007 to review the first Health Occupations Report and was reconvened in 2008 to renew its commitment to address workforce issues and to establish a plan for addressing them.  Through discussions and based on the extensive involvement of members in the the state's health workforce issues the Group developed a more comprehensive definition of the role, membership, purpose and process for the Forum.  The major themes for the Forum's work include:  Leadership, Data, Collaboration, Planning, Strategy and Communication.

Concurrent work on health care reform in the state also references the workforce as a focus area, as in the current and previous State Health Plan.  Forum participants were provided by staff with a four page summary of the provisions in the State Health Plan that will be impacted by the adequacy of the workforce.  In addition, an Appendix was prepared for the meeting with references and citing fourteen source documents providing information on Maine's healthcare workforce.

Much of the discussion at this meeting focused on the seriousness of the healthcare worker shortage in the state and frustration was expressed regarding prior reports and recommendations that were not implemented.  Problems previously identified have become worse during the meantime.

The Forum is staffed by the Muskie Center at the University of Southern Maine and hopes to make a report to the Legislature by the end of 2009.  The next scheduled meetings are September 15 and Oct. 17, from 1:00pm to 3:30pm.

MMA representatives participate in the Forum and will continue to provide reports on its progress through the Weekly Update.

  [return to top]

Legislature Approves Governor's Nominees to Dirigo Health Agency Board

Governor Baldacci's three nominees to the Dirigo Health Agency Board of Trustees were confirmed by the State Senate this past week.  Sarah Gagne Holmes, Marianne Ringel and Joseph Bruno are all expected to be participants at the next Board meeting in September.  One other nominee, former State Representative Judy Foss of Yarmouth, withdrew from consideration this past week because of a schedule issue.  She is expected to be confirmed at a later date.

Also confirmed at the Senate Session was Anne Head as Commissioner of the Department of Professional and Financial Regulation.

MMA EVP Gordon Smith offered testimony on behalf of MMA in favor of all of the above nominees at the public hearing on Tuesday. [return to top]

Democratic National Convention Begins Tomorrow: Platform Includes Quality Affordable Health Care for All

The Democratic National Convention opens tomorrow in Denver, Colorado.  Earlier this month, the platform standing committee met and approved "Renewing America's Promise," a 56-page draft document addressing a variety of issues in the party's platform. 

The document begins its section on health care with the following statements.  "The American people understand that good health is the foundation of individual achievement and economic prosperity.  Ensuring quality affordable health care for every single American is essential to children's educations, workers' productivity and business competitiveness." 

Other health care provisions of the platform are:

  • Modernize the health care system (through adoption of information technology, electronic medical records, provider reimbursement incentives, and comparative effectiveness research;
  • Stop cost-shifting;
  • Promote prevention and wellness;
  • Stop insurance discrimination;
  • Help eliminate health care disparities;
  • Achieve savings through competition, choice, innovation and higher quality health care;
  • Expand insurance coverage for children; and
  • Oppose "underpayments to our nation's doctors" and "overpayments to insurers."

The document suggests that health care should be a shared responsibility among employers, workers, insurers, providers, and government, but it does not call for an individual mandate to have health insurance.  It also states that "families should have health insurance coverage similar to what members of Congress enjoy." [return to top]

Thomas E. McDermott, M.D., 1949-2008

The Association was shocked and deeply saddened to learn Thursday of the death of Dr. Thomas McDermott of Waterville who died unexpectedly as the result of a whitewater rafting accident on the Kennebec River.

Dr. McDermott, 58, was a family physician at Kennebec Medical Associates in Waterville and also certified in chemical dependency treatment by the American Society of Addiction Medicine. 

Dr. McDermott was a former chair of the Association's Committee on Physician Health and was an active member of the committee to the present time.  He provided important leadership to the committee at an important time in its transition. 

"As stated well in his obituary, Tom helped countless people through the years, and he always put the needs of others before himself." noted Gordon Smith, EVP of MMA. 

Our thoughts go out to Tom's wife, Dayle McDermott and his son and two daughters.  Funeral services are being conducted this morning in Waterville. [return to top]

Massachusetts Considers Rules to Expand Number of Employers Subject to Assessment for Health Care Reform

On August 11, 2008, regulators in Massachusetts proposed new rules to change the so-called "fair share employer contribution" standard for the $295 per employee per year assessment to support the recent health care reform initiative.  The current standard requires employers of 11 or more workers to either provide health care coverage to at least 25% of their workforce or pay at least 33% of the premium cost.   The proposed rule, scheduled to take effect on October 1, 2008, would require employers to meet both standards to avoid the assessment.  The proposed rule is estimated to raise an additional $45 million per year.  A hearing on the proposed rule is scheduled for September 5, 2008.  Business groups, including the Retailers Association of Massachusetts and Associated Industries of Massachusetts, are expected to oppose the plan. 

On August 8, 2008, Governor Deval Patrick (D) signed legislation (Chapter 302) that will increase funding for the health care reform initiative by approximately $89 million (a $33 million assessment on excess reserves of health insurers, $20 million from hospitals, and a $35 million transfer from a state fund that holds contributions from employers to cover insurance for the unemployed). [return to top]

Maine Physician Action Fund Trustees to Meet On Wednesday Night

As reported in last week's Update, the trustees of the Maine Physician Action Fund, a political action committee organized by the Maine Medical Association, will meet this coming Wednesday evening (August 27) from 6:00pm to 9:00pm.  One of the main items of business is to interview by telephone First District Congressional candidates Charles Summers and Chellie Pingree.  Following the interviews, trustees will make a recommendation to the American Medical Political Action Committee for an endorsement and financial contribution in the race.  Trustees will also review state legislative races and review previous contributions.

All trustees, Public Health Committee members, Legislative Committee members and any interest MMA member is cordially invited to attend the meeting which will be located at the MMA office building in Manchester. [return to top]

Draft Resolutions to be Presented at Annual Session Available on Website

Nine draft Resolutions to be considered by MMA members at the Annual Session are now available for review on the MMA website at  The Resolutions will be presented, discussed and voted on at the General Membership Meeting on Saturday morning, Sept. 5 beginning at 8:30am.  This year's Annual Meeting is being held at the Samoset Resort in Rockport.

It is not necessary to register or pay a registration fee to attend just the business meeting at the Session. But,  in order to prepare enough materials for the meeting, we would appreciate your giving us a call at 622-3374 to let us know.  Or e-mail Gordon Smith at [return to top]

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