December 1, 2008

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Legislature Convenes on Wednesday; Election of New Attorney General on Tap

The 124th Maine Legislature will convene at the State House for an organizational day beginning at 10:00 a.m. on Wednesday, December 3, 2008.  The MMA urges you to introduce yourself to your Senator and Representative before the new legislature's substantive work begins in January 2009.  You should be the first person your legislator thinks to consult when health policy issues come before him or her!

The 186 members of the 124th Maine Legislature will come to the State House in Augusta this coming Wednesday for an opening session that will include "pomp and circumstance," orientation and organizational matters, and election of the four so-called "constitutional officers," the Attorney General, the Secretary of State, the Treasurer, and the Auditor, all positions elected by the legislature.  House Democratic legislators Janet Mills (D-Farmington), John Brautigam (D-Falmouth), and Sean Faircloth (D-Bangor) are the contenders in the highly publicized race to replace Steve Rowe (D-Portland) as Attorney General.  AG Rowe is barred from running for re-election as AG by the term limits law and is expected to be a leading contender for the Democratic gubernatorial nomination to replace Governor Baldacci.

You can find your Senator and Representative on the web at:

As you've read in the popular press, the new legislature will be forced to deal with significant budget issues when they return to Augusta in early 2009.  You can find more information about the state budget situation on the web at:

The MMA would welcome your participation in our legislative advocacy activities in 2009.  If you have questions about opportunities to participate, please contact Gordon Smith, EVP (; 622-3374, ext. 212) or Andrew MacLean, Deputy EVP (; 622-3374, ext. 214). 

Avoid Burnout! Final 2008 "First Friday" CME Friday Morning 12/5

One of MMA's most popular presenters, Margaret Palmer, Ph.D., will present the final "First Friday" CME presentation for 2008 on this coming Friday, Dec. 5th from 9:00 am to noon at the MMA offices in Manchester.  Professional Burnout: A Legacy of Hard Work is a program appropriate for both physicians and practice managers.  It is particularly appropriate as we approach the year end and prepare for a new year. 

The three-hour workshop will address the issue of professional burnout . . . 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.

Objectives of the program are:

  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 health care organizations in reducing burnout among professionals.

Dr. Palmer holds a Ph.D. in organizational psychology.  She serves as a consultant to MMA's Medical Professionals Health Committee and specializes in supporting health care organizations, boards, and medical staffs with the re-establishment 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

Treat yourself to a morning of renewal.  You deserve it.

There is a $60 charge for the program which includes breakfast (available at 8:30 am) and course materials.  Registration is available through the MMA website at or by calling MMA at 622-3374. 


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Report on Aligning Forces for Quality Steering Committee Meeting

The Aligning Forces for Quality (AF4Q) Steering Committee met at the offices of MMA in Manchester on Tuesday, November 25, 2008.  Meeting objectives were:

  • To understand the Robert Wood Johnson Foundation (RWJF) evaluation plan to ensure the work plan will show progress in what is being measured and to add additional evaluation the committee sees as important and fitting within the project resources.
  • To review/edit/endorse the RWJF operational work plan to be submitted to the Foundation after the January 7, 2009 Executive Leadership Team meeting.
  • To help determine how the RWJF work plan should/could link with National Partner Priorities and the Quality Counts Strategic Planning Process.

The National Priorities Partnership was described in last week's Weekly Update.  It is made up of 28 Partner organizations that have significant influence over health care, including the AMA's Physician Consortium for Performance Improvement.  Three of the priorities of the Partnership link very well with the work of the AF4Q project.

The Steering Committee meets five times per year to oversee and advise the three year project which is designed to support initiatives which will sustain efforts to measure performance, publicly report results and engage consumers in quality improvement. 

The meeting concluded by reviewing the effort to engage consumers.  Three key messages discussed were:

  1. Helping consumers to understand what quality in health care means.
  2. Educating about the existence of and importance of information regarding quality.
  3. Partnering with physicians and other providers to improve the quality of health care.

The Project recently completed six focus groups of consumers, testing various messages to determine their efficacy.

Ted Rooney, RN is the Project Director.

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20th Anniversary of World AIDS Day Recognized Today

Several events are planned in Maine today (Monday, December 1, 2008) in recognition of the 20th Anniversary of World AIDS Day. 

In Portland, the Frannie Peabody Center will host a noontime service at One Longfellow Square that will feature music and guest speakers.  Free, anonymous, rapid HIV testing will also be available from the Center from 1:00 pm to 6:00 pm.

At 9:00 am, the Maine Medical Center will host a memorial service in honor of people living with HIV/AIDS and those who have died.  The program will be held at the Dana Center.  Speakers will talk about Greater Portland's role in the fight against the disease.  Speakers include Robert Smith, M.D., Director of the AIDS consultation service.  Two 12-foot sections of the AIDS Memorial Quilt will be on display at the Medical Center.  Sections of the quilt have been traveling around the world since 1987. [return to top]

AMA Principles on Comparative Effectiveness Research

On November 10, 2008, the AMA established as policy a series of principles on comparative effectiveness research that were jointly developed by the AMA Board of Trustees, the Council on Legislation, and the Council on Medical Service.  The principles are contained in Council on Medical Service Report 5 (I-08), "Comparative Effectiveness Research," which is available on the web at: [return to top]

AMA Analysis of Senator Baucus' White Paper on Health Care Reform

Call to Action:  Health Reform 2009

November 12, 2008

AMA Staff Analysis of Key Provisions


Senator Max Baucus (D-MT), Chairman of the Senate Finance Committee, released an 89-page outline of his comprehensive vision for health care reform on November 12, 2008.  Titled “Call to Action:  Health Reform 2009,” the document has been described as a white paper that presents many options for reform in varying degrees of specificity.  It represents a work in process intended to stimulate debate rather than a legislative proposal.  As such, the paper should be considered a vehicle for launching discussions that will ultimately help Senate policymakers draft more concrete proposals for legislation during the first months of the 111th Congress.

Briefly, the plan addresses the goals of expanding coverage, improving value, and insuring efficiency and stability by:

Creating a Health Insurance Exchange where those without coverage can purchase insurance regardless of pre-existing conditions;

Creating payment systems that emphasize primary care, prevention, wellness, and chronic care management;

Promoting comparative effectiveness research and health information technology; and

Eliminating fraud, waste, and abuse in the health care system, including reduced overpayments to Medicare Advantage plans, greater transparency, and "careful" malpractice reforms.

Key Areas of Agreement

When viewed as an aspirational document, there are a number of goals and concepts that appear supportable by the physician community.  For example, principles encompassed by the white paper include:

  • Health insurance coverage for all;
  • The concept of shared responsibility in which employers, individuals, and government all have a role and a contribution to make in reforming the health system;
  • Maintaining the safety net and increasing support for vulnerable populations served by SCHIP, Medicaid, and the Indian Health Service;
  • Phasing out the Medicare waiting period for the disabled;
  • Reducing racial, ethnic, and gender disparities;
  • Testing alternative medical liability reforms such as health courts, early disclosure, and administrative determination of compensation;
  • Providing a framework for comparative effectiveness research;
  • Emphasizing wellness and prevention;
  • Capping the tax exclusion for employer sponsored insurance;
  • Replacing the sustainable growth rate (SGR) with alternative means of physician updates―removing physician administered drugs from the formula as a first step;
  • Testing multiple innovative payment models for physician and other Medicare services; and
  • Strengthening the role of primary care and chronic care management.

Areas for Discussion

Other proposals set forth in the document raise questions or concerns for physicians and require some clarification.

  • Budget neutrality.  The white paper suggests that increased Medicare reimbursement for primary care services should be implemented in a budget-neutral fashion within physician payment pool, necessitating across-the-board payment cuts for other physician services.

Issues for Consideration:  While there is general agreement in the physician community that reimbursement for primary care services must be improved, there is little support for achieving this through broad, offsetting reductions in payments for other services.  Many other potential funding sources outside the physician pool have been identified and need to be explored.  Medicare payments for all physician services have failed to keep pace with increased practice costs and reductions would further threaten the stability of the program.

  • Multiple SGRs.  The option is presented of replacing the current SGR with a revised formula that creates multiple expenditure targets based on service category sub-sets.

Issues for Consideration:  While this proposal has supporters, permutations of a fundamentally flawed concept are unlikely to solve the problem of inequitable payments.  The SGR could be retained in some form during a transitional phase to a new payment system that incorporates other mechanisms for accountability.  If transitional targets are implemented, Congress should eliminate the cumulative aspect of the SGR and/or could design narrow corridors for annual payment increases and decreases to eliminate the compounding effect that triggers steeper cuts over the years that are increasingly expensive to remedy.

  • Medicare buy-in.  The paper proposes to create a Medicare “buy-in” option for individuals aged 55-64 who lack access to insurance on an interim basis until health insurance market reforms are implemented to make coverage more accessible.

Issues for Consideration:  Individuals in this age group need affordable health insurance options, and Medicare coverage is likely to be very expensive and attractive to only a few.  Further, there already are troubling negative financial projections for the Medicare program as it serves the existing senior population. 

  • Public plan option.  The paper suggests that the Health Insurance Exchange will include a public plan option for all who seek coverage through the exchange.

Issues for Consideration:  If individuals have choices among a range of high, medium, or low-benefit plans in a well-regulated market, there should be no need for a public plan option.  The exchange is intended to offer individuals the same type of private plan options that Members of Congress and federal employees enjoy in the Federal Employees Health Benefit Program.  Public plans can put private options at competitive disadvantage; they also have a history of price controls and cost shifting, and suffer from lack of innovative design.

  • Independent Health Coverage Council.  The discussion about the proposed Independent Health Coverage Council (IHCC) raises many questions about its composition and the scope of its authority.

Issues for Consideration:  Physicians would be concerned about adequate representation on the IHCC.  In particular, it would be important for the Council membership to encompass physicians with clinical and private practice experience, rather than relying only on those with policy backgrounds.  Authority to set standards for chronic care management and quality reporting require further discussion to address potential overlap or potential conflicts with efforts by PCPI, National Quality Forum, and other standard setting activities.  Clinical care standards should be developed by physician and other health professions organizations, not by government entities.

  • Quality reporting incentives.  The paper suggests that financial penalties will one day be imposed on physicians who fail to engage in quality reporting.

Issues for Consideration:  Considering the extensive and yet-to-be-resolved problems with the current Medicare physician quality reporting initiative (PQRI), it is premature to raise the potential for financial penalties for physicians who do not participate in this activity.  (The Baucus paper acknowledges problems with the PQRI program and the notion of penalties is couched as a downstream program change.)

Additional Recommendations

While a generally comprehensive document, the Baucus white paper omits a number of other potential reforms that should be considered.  These include:

  • Potential savings and efficiencies through administrative simplifications, such as a common claims form and real-time claims adjudication;
  • Application of cost transparency to health plans so individuals are able to determine their out-of-pocket costs;
  • Addressing workforce shortages in a number of specialties as well as in primary care; and
  • Focusing efforts to eliminate waste, fraud, and abuse on areas where problems have been well-documented.

Next Steps

Health system reform will be one of the top domestic priorities for the new Congress and the Obama Administration.  In addition to the Baucus proposal, other key House and Senate committees will be developing comprehensive health reform proposals, including the Senate HELP Committee, House Ways & Means Committee, and House Energy and Commerce Committee.  President–Elect Obama has a comprehensive proposal, as well.  An ongoing, coordinated strategy among physician groups needs to be established to ensure that physicians are represented among these key policy-making bodies as legislative proposals are released and modified over the next several months.  The AMA will convene meetings with the appropriate groups to explore and discuss strategies to communicate a common advocacy message, review and develop analyses of legislative proposals, seek opportunities to interact with congressional leaders and Obama Administration officials, and ensure our respective memberships receive timely and informative updates.

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Public Health Committee to Meet December 17th

The PHC committee will meet again December 17th  from 4-6 pm at the MMA, with one section of the meeting devoted to the public health considerations affecting the success, reach, and impact of menu-labeling laws.   Because the rate of consumption of away-from-home meals has increased dramatically, public health necessitates that nutrition labels must be included with restaurant menus as a strategy to educate consumers and address the escalation of obesity.  Menu-labeling laws are being considered at the local, state, and federal levels.  All members are welcome to attend in person or via conference call at 1-800-989-2842; PassCode:  6223374.  For more information, contact Kellie Miller at MMA at or 622-3374, ext 229.

Also,staff has been working diligently to ensure that our member physicians have access to the necessary clinical tools for their patients.  The new public health webpage at will be unveiled on Healthy Weight/Obesity Prevention to provide that needed one-stop search for the most up to date clinical tool-kits and resources for physicians on healthy weight/childhood obesity, as well as provide information on initiatives in local school districts and communities.  MMA President, Stephanie Lash, MD is working in conjunction with the Public Health Committee efforts on Healthy Weight initiatives to provide members with the most useful clinical tools and resources for office use regarding the recognition and treatment of overweight and obesity in our youth.  Go to for a copy of her Presidential Key messages and outcomes for healthier communities through MMA member involvement, as well as key links for members to access.  You will also be able to download the "10 Easy Things" that MMA members can do in their local community to become involved in healthy weight initiatives. 

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Diabetic Retinopathy Mailing Sent to Maine PCPs

The members of the Maine Society of Eye Physicians and Surgeons and the Maine Optometric Association are committed to quality eye care for the patients of Maine.  November was Diabetes Awareness Month, and ophthalmologists and optometrists took the opportunity to send out a mailing last week to all Maine PCP’s stressing the importance of timely dilated eye exams, appropriate treatment, and optimal communication between primary care doctors and eye care providers.    The mailing provides recommendations for the examination and management of patients who are at risk for diabetic eye disease (primarily retinopathy). 

As you know, diabetic retinopathy is the leading cause of new cases of blindness in Americans between the ages of 20 and 74. Diabetics have 50 to 80 times elevated risk for legal blindness in their lifetime (visual acuity 20/200 or worse in each eye).  More than four million Americans had some degree of diabetic retinopathy in 2004; 11% had some form of visual impairment (3.8% uncorrectable and 7.2% correctable, according to the National Health and Nutrition Examination Survey).  There are an estimated 100,000 new cases of diabetic macular edema per year and 40,000 new cases of proliferative diabetic retinopathy per year.  Examining our diabetic patients for retinopathy is especially important since these complications can be treated with good outcomes if detected at an early stage.   

Please be on the lookout for the educational materials sent to you from the Maine Society of Eye Physicians and Surgeons and the Maine Optometric Association.  If you would like an electronic copy of any of the information, please contact Shirley Goggin at 207-445-2260. [return to top]

MIHMS Provider Forum, December 4, 1-4 pm

This is a reminder of the second MIHMS Provider Forum on Thursday, December 4th from 1:00 to 4:00 pm.  The topic will be the re-enrollment process for MIHMS, including a preview of the online portal tool that will be used.

This meeting will be held at the MaineCare Services offices at 442 Civic Center Drive in Augusta.  And, a provider can join the meeting from their office through Live Meeting.  This is a connection through your web browser.  Simply click on “Join the Meeting” below this message.  We suggest that you try this prior to the meeting to ensure you are able to connect.

Providers joining remotely will also need to call a conference line for the audio portion of the presentation.  This number is 1-800-394-6604 and the participant passcode is 934057.

Join the meeting.

First Time Users:
To save time before the meeting, check your system to make sure it is ready to use Microsoft Office Live Meeting.

Unable to join the meeting? Follow these steps:

1.      Copy this address and paste it into your web browser:

2.      Copy and paste the required information:
Meeting ID: 5SJM2T
Entry Code: ATTEND
Location: [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]

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