November 17, 2008

Subscribe to Maine Medicine eNewsletters
Manage Your Subscriptions
Email our Editor...
Maine Medical Association Home Page
. Search back issues
. Plain Text Version
Printer Friendly

Partisan Caucuses in Maine Legislature Choose Leaders

The post-election political activity continues as the 124th Maine Legislature's four partisan caucuses met last week to choose their leaders.  REMINDER:  The MMA's Legislative Committee will meet at the MMA office in Manchester tomorrow evening to organize and plan for the coming session that will begin during the second week of January 2009.

Maine Senate and House Democratic and Republican caucuses met last week to choose their leadership for the next two years of the 124th Maine Legislature.

The Senate leadership race results are as follows:

  • Senate President:  Sen. Libby Mitchell (D-Kennebec)
  • Senate Majority Leader:  Sen. Phil Bartlett (D-Cumberland)
  • Assistant Senate Majority Leader:  Sen. Lisa Marrache, M.D. (D-Kennebec)
  • Senate Minority Leader:  Sen. Kevin Raye (R-Washington)
  • Assistant Senate Minority Leader:  Sen. Jonathan Courtney (R-York)

The House leadership race results are as follows:

  • Speaker of the House:  Rep. Hannah Pingree (D-North Haven)
  • House Majority Leader:  Rep. John Piotti (D-Unity)
  • Assistant House Majority Leader:  Rep. Seth Berry (D-Bowdoinham)
  • House Minority Leader:  Rep. Josh Tardy (R-Newport)
  • Assistant House Minority Leader:  Rep. Phil Curtis (R-Madison)

You can find the list of apparent winners in the Maine House on the web at:

You can find the list of apparent winners in the Maine Senate on the web at:

While these results are still unofficial because of some recount requests, most of the apparent winners ultimately will be seated.  The MMA urges you to introduce yourself to your Senator and your Representative before the end of the year and to offer yourself (and the MMA) as a resource on health care issues when they begin work in January.

The 124th Legislature will convene on Wednesday, December 3, 2008 for a swearing in ceremony, consideration of joint rules, and election of constitutional officers - Attorney General, Secretary of State, Treasurer, and Auditor.  Lawmakers will return to begin their First Regular Session during the second week of January 2009.

Tomorrow evening, November 18, 2008, the MMA Legislative Committee will hold its organizational meeting tor the coming session at the MMA office in Manchester from 6-9 p.m.  All members interested in the MMA's advocacy agenda for the next 2 years and representatives of the medical specialty societies in Maine are encouraged to attend.  Please RSVP to Maureen Elwell, Legislative Assistant at 

MQF & Dirigo Board Face Dirigo Funding Challenges

The Maine Quality Forum Advisory Council and the Dirigo Health Board of Directors both recently held their regular meetings and the financial challenges facing the Dirigo Health Program in the aftermath of the successful "People's Veto" of the alternative funding mechanism to the SOP were high on both agendas.

On Friday, November 14, 2008, the MQF Advisory Council received a Dirigo Update from Executive Director Karynlee Harrington.  Lisa Letourneau, M.D., M.P.H. next presented an update on current work in Maine on the Patient Centered Medical Home.  Finally, MQF Director Josh Cutler, M.D. provided the group with updates on 3 significant MQF programs:

  • Hospital acquired infections;
  • the Medicare electronic health record demonstration project; and
  • Variation analyses.

The MQF Advisory Council next will meet from 9 to noon on Friday, January 9, 2009. 

This afternoon, the Dirigo Health Board of Directors received similar updates from the Dirigo staff, but spent substantial time on the two key challenges facing the Dirigo Health Agency according to Executive Director Harrington:

  • Cash flow; and
  • Ongoing financing for the program.

The Agency's cash flow problems are caused primarily by the lag time between the timeframe in which current accounts payable are due and the collection of the "savings offset payment" (SOP), a lag time that can be as much as 6 months.  The staff and Board also are working hard to identify, once again, a sustainable, long-term financing mechanism for the various Dirigo programs either in the legislature or through administrative rulemaking.  The Agency's work is particularly complicated because it is simultaneously managing the involved and litigious process for determination of the SOP, the funding mechanism they have now, while also researching and developing another alternative funding mechanism.  

The Board has scheduled a very important meeting for 9 a.m. on Wednesday, December 17, 2008 for which the agenda will include an Executive Session for legal advice on the current SOP litigation, a discussion of renegotiation of the Harvard Pilgrim Health Care agreement, and the process for determining the SOP for Year 4 that must be effective July 1, 2009.  [return to top]

Senator Baucus Proposes Health Care Reform; AMA Responds

Senate Finance Committee Chairman Max Baucus (D-MT) last Wednesday formally outlined his ideas for health care reform in a 98-page White Paper entitled, Call to Action:  Health Reform 2009.  His proposals included creation of a nationwide insurance pool through which individuals and small businesses could buy insurance coverage and opening Medicare to those individuals ages 55 to 64 on a "buy-in" basis.  He also stressed the importance of health IT to support overall health care reform.

The three recommendations for encouraging health IT adoption are:

  • Assisting health care providers in choosing and implementing systems;

  • Providing financial incentives; and

  • Encouraging information sharing among health care providers.

The Senate Finance Committee, upon which Maine's senior Senator Olympia Snowe also sits, will play a key role in any health care legislation in Congress.  Some of the plans of Sen. Baucus are similar to those of President-elect Obama, but there are differences:  Baucus would eventually require all Americans to carry insurance (an individual mandate similar to that endorsed by MMA in 2003), the President-elect would require coverage only for children.  Senator Baucus also is considering changes to the federal tax rules that exclude workers from paying taxes on health benefits offered by employers.  President-elect Obama expressed opposition to a similar proposal offered by Sen. McCain during the campaign.

The Baucus plan aims to achieve universal health coverage within 10 years.

The White Paper is available on-line at:

The AMA released the following public statement regarding the Baucus proposal.

AMA Applauds Chairman Baucus' Commitment to Health System Reform

The AMA applauds Chairman Baucus for his important contribution today to the ongoing effort to reform the health care system.  The forums Chairman Baucus conducted earlier this year with the Finance Committee showed that he and members of the committee are determined to make real proress on health system reform.  The AMA looks forward to working with Chairman Baucus, other congressional leaders and the new administration to improve the healthcare system for the nation's patients and physicians who care for them.

In addition to advocating to cover the uninsured through our Voice for the Uninsured, the AMA is working hard to increase the quality and safety of patient care, reform Medicare and improve the value the nation gets from its health care spending. [return to top]

MMA Members: Please Complete Membership Survey

All MMA active members should have recently received a survey from Enetrix , a survey research firm recently puchased by the Gallup organization.  The survey is intended to provide MMA with important information regarding its member services and member priorities.  The survey can be completed online or by paper copy.

Please take the five to ten minutes it will take to complete the survey.  MMA cannot represent your interests effectively if we don't hear from you on a regular basis.

If you are an active MMA member and have not received the survey or an email message directing you to the website, please contact Gordon Smith, MMA EVP at

  [return to top]

Advisory Council on Health Systems Development Hears McKinsey Presentation on Costs

On Friday, November 14, 2008, MMA members, Dr. Gleaton, Dr. Cutler, Dr. Graham, and Dr. McAfee, all were in attendance to hear first hand, the McKinsey Global Institute researchers' report on US facts on health care spending during the Advisory Council on Health Systems Development two hour session, noting that the US spends 2 times as much on health care than food and more on health care than all of China’s 13 million consumers spend on all goods and services.  

Total US health care spending is currently at $650 billion, more than our peer countries after adjusting for wealth.  The US outpatient care accounts for 65% of this spending.  They briefly outlined where US spending is occurring (2003-2006):

  1. 9.3% annual growth rate in hospitals because of increased unit prices and more intensive care.  We do more procedures (i.e. knee replacements, more PCI, more coronary bypass, more cardiology procedures);

  2. Providers with an annual growth rate of 8% because of an increase in referral care;

  3. Diagnostic procedures – the US does more and we pay more for them.

Also, of interest, their research concluded that the US uses 10% fewer drugs and pay 50% more and use a more expensive mix of drugs.

 It was noted that 10% fewer drugs are consumed in the US than our peer countries:  Rank order:

  1. France

  2. United Kingdom

  3. Spain

  4. Germany

  5. USA

  6. Italy

In conclusion, the Institute indicated that a successful reform program in their view, would be characterized by incorporating the following:

  1. Realign existing incentives;

  2. Address both supply and demand;

  3. Sustain cutting edge research and innovation, which are defining characteristics of the current system; and

  4. Withstand reactions of existing stakeholders.

The McKinsey Global Institute’s final written report will be available in the near future.  If you would like to receive a copy, contact the MMA at 207-622-3374.


  [return to top]

Medical Experts Lead Discussion on Expanding Academic Detailing in the New England Region

Marcia Angell, MD, 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 & Women’s Hospital and author of Powerful Medicines:  The Benefits, Risks and Costs of Prescription Drugs presented detailed information on academic detailing as a method for aligning prescribing habits with the scientific evidence to clinicians and state association representatives in Concord, NH today.  Dr. Angell presented an overview of the world’s top 10 drug companies and prescription drug sales in 2007, where sales = $248 billion; marketing and administration= $79 billion (32%); profits = $38 billion (15%); and research and development accounted for $40 billion (16%).  The take home message from Dr. Angell’s presentation was that the drug companies' clinical trials results do not have to compare the new drug with the existing classes already on the market.  The FDA requires only that the drug must be safe and effective and thus the agency compare the new drug to the placebo.  During the past decade 667 new drugs were approved, with only 75 (11%) actually classified as innovative drugs.

 Dr. Avorn outlined the problem we are facing currently with the pharmaceutical delivery system:

  • Inadequate post-marketing safety surveillance of drugs;
  • Flawed reimbursement policies;
  • Minimal prescriber accountability, and
  • Irrational prescribing, resulting in sub-optimal outcomes for patients and unaffordable costs. 

Dr. Avorn indicated that our challenge is that little comparative data is available to adequately weigh Rx alternatives.  He stressed that we need independent, evidence-based, non-product driven research and communication about drugs through academic medical institutions.  He was clear in that Academic Detailing is NOT:

  1. Memos or brochures that are mailed to the physicians office;

  2. Lectures delivered in the doctor’s office;

  3. About formulary compliance;

  4. About cost reduction primarily.

For more information about the Harvard Medical School’s independent evidence-based program, you can go to and review the modules that they have developed for the Pennsylvania PACE program and of which other states are under contract to access the materials.  Maine is currently reviewing the materials for consideration. [return to top]

Wanted: Volunteers for 2009 Annual Session Program Committee

The MMA Executive Committee is seeking volunteers for the 2009 Annual Session Program Committee.  The last several Annual Sessions, now rotating between Bar Harbor and Rockport, have featured outstanding CME programs.  We want to retain that momentum and, toward that end, would like to expand the group of members working on the programming committee.

Participation in this committee would involve joining in on three or four conference calls.

If you are interested in serving, please contact Diane McMahon at MMA at

The 2009 Annual Meeting will be held September 11-13, 2009 at the Harborside Hotel and Marina in Bar Harbor. [return to top]

Process Change for MaineCare PA for Out-of-state Patients Effective December 1, 2008

The following update is provided by the DHHS Office of MaineCare Services. 

Effective December 1, 2008, Out-of-state prior authorization (PA) requests for hospital-based inpatient and outpatient services are to be sent to Schaller Anderson Medical Administrators, Inc. (SAMAI) at FAX:  1-877-861-2615, NOT the MaineCare PA Unit. 

Questions prior to the change may be directed to the Office of MaineCare Services, Prior Authorization Unit at 207-287-2033 or 1-866-796-2463.

We will keep you posted as we get further details. [return to top]

Dentist: Food Stamps Shouldn't be Used for Soda

Jonathan Shenkin, President-elect of the Maine Dental Association, the Bangor pediatric dentist who spearheaded a successful campaign to ban smoking in vehicles when children are present now wants to prohibit the use of food stamps to buy soda.  Shenkin said soda contributes to tooth decay and obesity.

"People have the choice of buying soda with their own money, but taxpayer dollars should only be used to buy nutritional foods," Shenkin told the Bangor Daily News.  His proposal also includes diet soda, which is acidic and low in nutritional value.

To read the rest of the article, click here [Bangor Daily News] [return to top]

eHealth Initiative Offers Webinar, "Bringing Electronic Prescribing into the Practice," November 19


Find out how to get e-prescribing up and running in your office and qualify for Medicare bonus payments.

The eHealth Initiative is proud to offer some of the technical guidance you need to become a successful e-prescriber.  Supplementing the heralded "A Clinician's Guide to Electronic Prescribing," developed by eHI in collaboration with the AMA, AAFP, ACP, MGMA, and the Center for Improving Medication Management, and released at CMS' October E-Prescribing Conference in Boston, our November 19th webinar will give you the "in the trenches," real world insights of three early physician adopters of e-prescribing.  Leading the e-prescribing vanguard for the medical profession, these physician champions can tell you precisely what you need to do to bring e-prescribing into your practice, and how to sidestep the many pitfalls and challenges that might stand in your way.  The goal of this webinar is to help make your transition to e-prescribing as painless and trouble-free as possible.

Clinicians: Bringing Electronic Prescribing into the Practice
Wednesday, November 19th, 5:30 p.m. - 7:00 p.m. ET

Recognizing that most practicing clinicians see patients during the day, we're scheduling many of these events late in the day.

Description: This webinar will offer clinicians the step-by-step guidance they need to make informed decisions on moving forward on e-prescribing, and how to make their experience implementing e-prescribing as successful as possible, with minimal disruption to their practice.  The webinar will also provide a brief overview of the new Medicare e-prescribing regulations and physician payment incentives that go into effect January 1, 2009.

Who Should Attend: Attendees should have a basic understanding of electronic prescribing.  This webinar will focus on clinicians.


  • Yul D. Ejnes, MD, FACP Chair, Medical Service Committee, Regent, American College of Physicians
  • Patricia Hale, MD, PhD, FACP, Author of "Electronic Prescribing for the Medical Practice: Everything You Wanted to Know But Were Afraid to Ask," Office of Health Information Technology Transformation, New York State Department of Health
  • Daniel B. Mingle, MD, MS, Family Physician and Recent Director, Ambulatory EMR Project Maine General Medical Center

To register, click here [return to top]

Last First Friday Program for 2008 - Professional Burnout: A Legacy of Hard Work

The MMA's final First Friday program for 2008 features a topic that is growing in importance as the health care workforce shortage becomes more acute.  Professional Burnout:  A Legacy of Hard Work will be presented Friday, December 5, 2008 at the MMA offices in Manchester from 9:00 am to noon.  A $60 fee covers CME, breakfast, and all course materials.  Registration is available on the MMA website at or by calling 622-3374, ext. 219.

The workshop will address the sensitive issue of burnout among professionals . . . what it looks like, what the causal factors are, what supports can be put in place to reduce the impact of burnout, and what an individual can do to replace burnout with healthy activity and balance.


1.  To identify the principal components of burnout.

2.  To discover personality factors that contribute to burnout.

3.  To identify work and family stressors.

4.  To learn ways to diffuse/treat burnout.

5.  To understand the role of healthcare organizations in reducing burnout among professionals.

Margaret Palmer, Ph.D., will present the seminar.  Dr. Palmer specializes in supporting health care organizations, boards, and medical staffs with the reestablishment of healthy work behaviors and relationships, reconstructive interventions, and the implementation of healthy work practices.  Dr. Palmer works closely with the individuals within the system or practice, identifying the issues that impact growth and professional and personal development. [return to top]

Business Week Reports on Medical Tourism; Notes Hannaford Brothers Experience

In its November 10th issue, Business Week examines the issue of medical tourism.  The uncertain economy is slowing down the momentum and major insurers are reluctant to reimburse for medical procedures overseas.  One article reports that Hannaford Brothers' "once promising plan to offer employees the option of less expensive overseas treatment is failing because of a lack of interest from employees.  As more U.S. companies latch onto medical tourism as a solution to their soaring health care costs, the Hannaford experience demonstrates the challenges they will face."

Hannaford Brothers began examining the possibility of encouraging employees to consider overseas treatment several months ago and company executives toured at least one hospital in the Far East.  Certainly many types of medical procedures, including major joint replacements, can be obtained overseas for several thousand dollars less than in the States.  But employees and health insurers are concerned about quality and follow-up care.  International accreditations may assist in the quality area, but many patients are reluctant to leave their families and friends behind and to put themselves in the hands of strangers, no matter how highly acclaimed.

"I have always believed that Maine people prefer to receive their care close to home, where family and friends can visit and where they know the medical professionals," noted Gordon Smith, EVP of MMA.  While medical tourism may be a niche for a few individuals who enjoy international travel, I do not think it is in any meaningful way a solution to the problem of high health care costs in Maine." 

With the election now behind us, it is now hoped that the stakeholders in Maine can begin meeting together to look for both short-term and long-term solutions.  MMA will be a leader in those discussions, which must include at a minimum all the healthcare providers, including hospitals, the business community, consumer interests, and public and commercial payers. [return to top]

33rd Great American Smokeout on Thursday, November 20th

Thursday, November 20th, will mark the 33rd annual American Cancer Society Great American Smokeout.  The Smokeout was started in 1976 to inspire and encourage smokers to quit smoking for one day.  It is an opportunity for people to make a long-term plan to quit and to celebrate the past successes, renewing the commitment to being tobacco-free. 

Tobacco use remains the single largest preventable cause of disease and premature death in the United States.  In Maine, seven people will die each day from a tobacco-related illness. 

"By participating in Health Policy Partners (formerly the Maine Coalition on Smoking OR Health), the Maine Medical Association continues to be actively involved in tobacco control and cessation issues in the state," noted Gordon Smith, MMA EVP.   "MMA members and indeed, all Maine physicians are encourged to use Thursday as another occasion to talk with their patients who still smoke about the health risks associated with the habit." [return to top]

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