October 27, 2008

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Moving Toward Transparency the Subject of 11/7/08 First Friday Program

The November 7th First Friday CME Program will feature the topic of transparency in the healthcare delivery system.  As it becomes easier for employers and patients to find and compare local health care information on the internet, Maine physicians need to be aware of what information is available and how to respond to questions from their patients.  Featuring presenters from the Maine Health Management Coalition, MMA, and the Maine Quality Forum, participants will learn what to expect on such websites as www.mhmc.info, www.mainequalityforum.gov; and www.hospitalcompare.hhs.gov.   As physician-specific data held by the Maine Health Data Organization is now available to the public under some circumstances, it is incumbent on physicians and practices to know what to expect in the coming months and beyond as employers and the public are encouraged to use this data in choosing their physician and hospital.

The program will be held on Friday morning, November 7th, from 9:00 am to noon at the offices of the MMA in the Frank O. Stred Building in Manchester.  Presenters include Douglas Libby, R.Ph. of the Maine Health Management Coalition, Andrew MacLean, Deputy EVP of MMA, and D. Joshua Cutler, M.D., Director of the Maine Quality Forum.

Businesses in Maine are already being encouraged to comparison shop for physicians and hospitals in a series of workshops being held by the management coalition in the service area of Eastern Maine Health Care.  Workshops have been held in Palmyra and Brewer with two more scheduled for employers in Presque Isle and Waterville.

There is a registration fee of $60 which includes breakfast and all course materials.  Three hours of Category One CME are available.

Registration is available on the MMA website at www.mainemed.com or by calling MMA at 622-3374, ext. 219.

AMA Trustee Annis Headlines "No on One" Coalition Efforts Monday

Joseph P. Annis, M.D., a Member of the Board of Trustees of the American Medical Association (AMA), an anesthesiologist from Austin, Texas, came to Maine today to lend the AMA's support to the MMA's efforts to defeat Ballot Question One regarding funding for the Dirigo Health Program health care reform initiative. 

Dr. Annis headlined well-attended press conferences in Portland and Bangor in support of the "No on One" coalition's campaign.  In Portland, Dr. Annis addressed reporters prior to comments from former MMA and AMA President and current Dirigo Board Chair Robert McAfee, M.D., Consumers for Affordable Health Care Executive Director Joe Ditre, and "No on One" campaign consultant Edie Smith.  In Bangor, Dr. Annis spoke to the press prior to Joe Ditre and MMA President Stephanie Lash, M.D., a neurologist with Neurology Associates of Eastern Maine.  Mr. Ditre specifically addressed the Maine State Chamber of Commerce's lawsuit filed last week challenging not only the current Superintendent of Insurance's determination of the "savings offset payment" or SOP, but also the constitutionality of the SOP methodology. 

Mr. Ditre, Dr. McAfee, and Dr. Lash all roundly criticized the Maine State Chamber of Commerce and the business community for their advocacy against Question One - - telling voters that defeat of Question One would not jeopardize those covered by the Dirigo Health Program because the SOP would remain in effect while contemplating and now filing a lawsuit challenging not only the current SOP calculation, but also the SOP methodology generally.

The following is Dr. Annis' statement:

Statement of Joseph P. Annis, M.D.

Member, Board of Trustees

American Medical Association


On behalf of the No on One Coalition


Oct. 27, 2008



Good morning.  I am Joseph Annis, a physician and anesthesiologist from Austin, Texas.  I am a member of the Board of Trustees of the American Medical Association and am here at the invitation of the Maine Medical Association to convey the AMA’s support for the No on One Coalition’s campaign to defeat the effort of the national beverage industry to repeal important provisions of Chapter 629. 


One of the three pillars of the AMA’s proposal for health system reform is providing subsidies for those who most need financial assistance obtaining health insurance.  We have watched with great interest as your state has led the nation in developing a strategy to provide coverage and quality care to all its citizens.  Dirigo Health has been watched with great interest by health reformers across the county.  And while it has not met its full potential, it has succeeded in providing health insurance coverage to thousands of Mainers who otherwise would, in all likelihood, remain uninsured or underinsured.  As evidence of this, Maine’s percentage of uninsured residents dropped in recent years from the highest in New England to next to lowest, at 9.4%.


The legislature’s attempt to tax beer, wine and sweetened beverages makes sense for two important reasons:


1.    It reduces the assessment of health insurance premiums from a potential high of 4% to a flat 1.8%.

2.     It replaces the loss created by lowering the insurance assessment by taxing products that contribute to high health care costs and chronic illness.


In 2006, The AMA Board of Trustees adopted a report entitled, “Imposing Taxes on Sugar-Sweetened Soft Drinks, Update”, which was itself in response to a previous BOT Report 32, with the same title.  The original Resolution leading to the report had been introduced by the American College of Preventive Medicine in 2005.  The report supports the adoption by states of taxes on soft drinks sweetened with caloric sugars, with a substantial portion of the revenue from these taxes being earmarked for the prevention and treatment of obesity, as well as public health and medical programs that serve vulnerable populations.  The report provides background information on the conclusions that were reached in the previous report and on why the recommendation to support taxes on sugar-sweetened soft drinks was made.


Since the 2006 Annual Meeting of the AMA, additional evidence has been presented that demonstrates the relationship between the consumption of sugar-sweetened soft drinks and increasing obesity rates.  While the primary purpose of a tax on sugar-sweetened beverages is to raise money for prevention, access or public health, there is now data that suggests that states that have placed taxes on soft drinks have experienced a decrease in the prevalence of obesity.  Therefore, the AMA recommends that states, localities and the federal government adopt taxes on sugar-sweetened soft drinks as an important public health strategy.  I have copies of the Board of Trustees Report 11 for anyone interested.


Loss of these taxes in Maine will hurt reform efforts in Maine and across the country.  I hope Maine voters will reject the repeal effort and keep true to Maine’s motto of Dirigo.  Continue to lead.  Certainly an effort to assist Maine’s hard working citizens with health care coverage is more important than a few pennies on these beverages.


I would be happy to answer any questions you may have before I turn the podium over the next speaker.

For more information about the "No on One" coalition and opportunities to contribute to the cause, please see healthcoveragemaine.org.



  [return to top]

FTC Delays Enforcement of Controversial "Red Flag" Rule

Last week, the Federal Trade Commission (FTC) announced that it would delay enforcement of the so-called "red flag" rule from November 1, 2008 to May 1, 2009.  The rule requires that "creditors," a term that may be interpreted to include health care providers, adopt programs to identify and respond to certain indicators, or "red flags," of identity theft.  

The FTC issued the "red flag" rules on November 9, 2007 requiring financial institutions and "creditors" to develop and implement written identity theft prevention programs, as part of the Fair and Accurate Credit Transactions (FACT) Act of 2003.  According to the rule, a "creditor" is "any person who regularly extends, renews, or continues credit; any person who regularly arranges for the extension, renewal or continuation of credit; or any assignee of an original creditor who participates in the decision to extend, renew or continue credit."  The rule specifically mentions lenders such as banks, finance companies, auto dealers, mortgage brokers, utility companies, and telecommunications companies, but it does not mention health care providers or any other professionals such as lawyers, accountants, or consultants.

The American Medical Association (AMA) has sent a letter to the FTC objecting to the suggested application of the law to physicians and the MMA has joined in this letter.  The AMA's legal argument is consistent with advice MMA attorneys have given members over the years.  " . . . if a physician's billing to a patient is due when invoiced, the physician should not thereafter become a creditor fo purposes of the final rule simply because the physician agrees, after the fact, to let the patient pay in installments as opposed to turning the matter over to a collection agency or suing the patient."

The AMA letter continues:  "Likewise, physicians should not be considered creditors simply because they accept insurance and hold the patient responsible for the amount(s) unpaid by insurance, as the patient's indebtedness to the physician is not fixed or certain, and there is no extension of credit, while the claim is being processed by the insurance company."

You can read more about this issue from the FTC's perspective in a FTC Business Alert on the web at:  http://www.ftc.gov/bcp/edu/pubs/business/alerts/alt050.shtm. 

The MMA will keep you informed of further developments on this subject before May 1, 2009.  [return to top]

Advisory Council on Health Systems Development Continues its Work

The Advisory Council on Health Systems Development, established by the original Dirigo Health legislation enacted in 2003, met on Friday, October 24th to work through an agenda that included:

  • Consideration of a draft rule for establishing the Capital Investment Fund (CIF)  which is utilized in the state's Certificate of Need process;
  • Discussion of the hospital financial data collected by the Maine Health Data Organization;
  • Review and discussion of the cost containment strategies suggested during meetings with various stakeholders; and
  • Review of the anticipated November 14th meeting with McKinsey Global.

Council members voted to proceed with a new proposal for the Capital Investment Fund that will be the subject of a public hearing on December 11th and a comment period ending on December 22nd.  As the rule would be a major substantive rule, it is subject to legislative review as well.

The proposal would put the CIP on a three-year time frame, in order to accommodate concerns that the current rule impedes sound hospital planning. 

Several cost containment strategies were included in a handout prepared by staff following the meetings with stakeholders.  Those of particular interest to physicians include:

  • Do more regarding the use of evidence-based guidelines: (1) Tort Reform- physician should be exempt from liability if he has followed evidence-based guidelines; (2) payers should not have to pay if a physician provides more than the evidence warrants.  In either case, guidelines would be set in rule and regularly updated as the evidence base evolves. 
  • Maine Quality Forum should convene a clinical standards board to decide on an ongoing basis what technology, Rx, etc. is worth the cost, as well as what is the right way to treat different diseases (and provide decision support to physicians).  This could be informed by the Commonwealth Fund's "Bending the Curve" report and IOM's "Knowing What Works in Health Care:  A Roadmap for the Nation."  In terms of using this information, there would be a spectrum of voluntary to regulatory approaches, ranging from: (1) publicly stating the findings and nothing more and leaving it to the market place to decide how and whether financial incentives are used by payors and providers to do things according to the findings; to (2) mandates (e.g., the legislature's authorizing the Bureau of Insurance to require that payors use this information to structure how providers are reimbursed.)
  • Tiered insurance benefits.
  • Expanding scope of practice of mid-level providers

The Council will meet next on November 14th. [return to top]

MMA Looking for Physician to Serve on Maine Health Data Organization

Augusta pediatrician Syd Sewall, M.D. has resigned from the Maine Health Data Organization (MHDO) board after many years of solid service.  As the statute establishing the MHDO requires the appointment of a physician or physician representative to the board, MMA is seeking a volunteer from the ranks of MMA members.  Currently, the MHDO Board meets six times a year, that meeting being on the first Thursday morning of odd numbered months.  The Board meets in Augusta.

Any physician interested in serving in this capacity should contact Gordon Smith by phone at 622-3374, ext. 212 or by email at gsmith@mainemed.com. [return to top]

Academic Detailing in Action - November 17th, 9:00 am - 12 Noon in Concord, NH

On Monday, November 17, 2008, hear what national experts have to say about the pharmaceutical industry’s impact on prescribing practices, learn about academic detailing, observe it in action, and get an update on state and federal academic detailing legislation.  Featuring Marcia Angell, MD, the author of The Truth About the Drug Companies and former editor in chief of the New England Journal of Medicine, and Jerry Avorn, MD, Professor of Medicine at Harvard Medical School, chief of the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women’s Hospital, and author of Powerful Medicines.

This program will be held at the Centennial Hotel in Concord, New Hampshire beginning at 9:00 am and concluding with Lunch at 12 Noon.  This activity has been approved for AMA PRA Category I Credit.  If interested in attending, please make your reservations soon because space is limited.  For reservations and/or more information, contact Tina Duffany at Prescription Policy Choices by calling 207-512-2138 or emailing tduffany@policychoices.org.  This program is sponsored by the New Hampshire Medical Society in conjunction with the Maine Medical Association and Prescription Policy Choices. [return to top]

Maine Primary Care Association Annual Conference "The Patient Centered Medical Home Starts with You," Oct 29-30

"MPCA invites you to attend our 2008 Annual Conference . . . "The Patient Centered Medical Home Starts with You."  Plan to join us October 29th & 30th at the Holiday Inn by the Bay in Portland and check out our pre-conference sessions on October 28th!

Our 2008 Annual Conference offers participants the opportunity to learn from, network, and collaborate with health care professionals and exhibitors from around the state and across the country.

In bringing together administrators, clinical staff, and support staff, with an expert faculty of speakers, we aim to examine:

  • The trends affecting all aspects of health care;
  • The clinical and administrative tools and applications necessary to move forward with alleviating Maine's health care crisis; and
  • The challenges and opportunities Maine's primary care safety net faces in the months ahead.

Last year's event was our most expansive conference to date and this year's event is expected to be equally as diverse and will offer sessions to an array of audiences, including:

  • CEO's, CFO's & Medical Directors;
  • Medical, Clinical, Dental, Mental Health and Pharmacy Directors;
  • Community Health Center & Safety Net Provider Board Members;
  • Outreach, Emergency Preparedness and Recruitment Staff;
  • Purchasers and Payers;
  • Policy Analysts, State and Local Partners and allied agency staff; and
  • Foundation Staff and Grant Makers with an interest in the health care safety net.

For more information or to register, click here
If you are interested in sponsorship or exhibitor opportunities, click here. [return to top]

"Cutting Edge Pediatrics," Fall Maine AAP Conference, November 15th

Register for the fall Maine AAP conference 11/15   --  Cutting Edge Pediatrics
Gregory J. Connolly, M.D. from MMC will be talking about "Probiotics."  
Mark Korson, M.D. from Tufts-New England Medical Center will be speaking on "Metabolic Clue: What a Urinalysis Can Really Tell Us" as well as "Metabolic Emergencies."  

Also, the Chapter dinner at New Moon Restaurant will highlight Chief Attorney for the US Department of Education (Northeast District) will be talking about his work arbitrating cases between parents of disabled children and their school system.
Don't miss this one-of-a-kind conference!  Visit www.maineaap.org for conference brochure. [return to top]

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