December 15, 2008

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Patient Centered Medical Home the Focus of Tuesday Night Event at MMA

On Tuesday night, December 16, 2008, MMA along with Quality Counts! and the major primary care organizations are hosting a meeting at MMA to discuss efforts in the state to establish a multi-payer pilot project to demonstrate the benefits of a patient-centered medical home.  The meeting will begin at 5:30 pm and dinner will be available.  Leaders of all the state medical specialty societies have been invited to attend.

Any interested physician is welcome to attend, but please call Diane McMahon at MMA at 622-3374, ext. 216 or via e-mail to so that we will know how many to expect. 

Ten to twenty medical practices are expected to participate in the pilot project which is expected to begin in early 2009.  To be selected, a practice is expected to be NCQA accredited in one or more fields such as diabetes.

The evening will begin with an explanation of the project by representatives of the major primary care organizations in the state, including the Maine Academy of Family Physicians, the Maine Chapter of the American College of Physicians, the Maine Chapter of the American Academy of Pediatrics, and the Maine Osteopathic Association.  

Lisa Letourneau, M.D., MPH, Executive Director of Quality Counts! and Elizabeth Fowlie Mock, M.D., MPH, FAAFP, President-elect of the Maine Academy of Family Physicians and Chair of the Coalition for the Advancement of Primary Care will lead the discussion. 

There is a lot of energy behind the pilot, from the primary care groups as well as from payors and the government.  Give up an evening to come to MMA and learn more about it and how the PCMH payment model may impact you. 

Physicians Urged to Screen Patients for Domestic Abuse

At a well publicized press event this past Tuesday, December 9, 2008, Governor John Baldacci and Maine CDC Director Dora Anne Mills, M.D., MPH urged physicians and other health care providers in Maine to more regularly screen patients for signs of domestic violence and to ask their female patients if they are safe. 

Driven by recent domestic violence-related homicides, the Maine CDC issued a public health advisory, noting that domestic violence and sexual assault are public health problems that are unacceptable in any form.  Sixty percent of Maine's homicides are related to domestic violence and domestic violence-related homicides in the state have risen from 8 in 2007 to 17 so far this year.  On average, every one and one half hours a domestic assault is reported to police departments in Maine.  Nearly one in five adults report they have been the victim of rape or attempted rape during their lifetime.

In response to these sobering statistics, the Maine CDC recommends routine screening in all health care settings for domestic violence and sexual assault victimization.  Providers should be appropriately trained on how to do domestic violence and sexual assault screening and referrals for both victims and perpetrators.    Screening itself can be a powerful intervention, even if no immediate disclosure results.  It lets someone know that violence is unhealthy and unsafe, that it does not have to be tolerated, that it is not the fault of the victim, and that there is a safe and private place for disclosure should the time and circumstances ever feel right.

The Maine Chapter of Physicians for Social Responsibility (PSR) offers a one hour training session, with CME credit, on how to integrate domestic violence screenings into clinical practice.  To hold a training at your medical facility, or at your specialty society meeting, call PSR at 207-772-6714 or visit:

MMA participated in the press conference and offered a statement from Charles Danielson, M.D., MPH, as chair of the Association's Public Health Committee in support of increased screening. [return to top]

Anthem Officials Meet with MMA Payor Liaison Committee

MMA's Payor Liaison Committee met this past Wednesday night to hear a presentation on several programs from representatives of Anthem BCBS of Maine.  One of the programs discussed was Anthem Care Comparison that allows Anthem subscribers to gain access to cost and quality data via the Anthem website.  Anthem Care Comparison displays total costs for an episode of care (i.e. knee replacement) using facility specific rates.  It includes 39 total medical procedures (inpatient and outpatient), diagnostic tests and common office visits.  The tool was first unveiled in Maine in April of 2008.  The product had been piloted previously in the Dayton, Ohio area during 2006.

Anthem Care Comparison also includes a section on Talking to Your Doctor that provides the insureds with more information. 

Anthem representatives also discussed the Anthem Pay for Performance program which again this year will provide fee updates of 2, 4, or 6%, depending upon performance.  The updates take effect on July 1, 2009.

Anthem representatives included Vincent Liscomb, Manager of Provider Network, Jeffrey Holmstrom, D.O., Medical Director, and Martha Ridge.

Committee members will be surveyed regarding topics and meeting dates for 2009. 

  [return to top]

Report on Pathways to Excellence Steering Committee Meeting of November 20th

The Pathways-to-Excellence (PTE) Primary Care Steering Committee met for its final meeting of 2008 on November 20th at the MMA offices in the Frank O. Stred Building in Manchester.  Following are notes from the meeting, prepared by Ted Rooney, RN, MPH, and Sue Butts-Dion, staff to the Committee which is sponsored by the Maine Health Management Coalition.

1)  Updates:

     a)  National Partnership Priorities update

          i)  The National Priorities Partnership (NPP) is gaining steam:

         ii)  On November 17th, there was a national launch in Washington D.C. with a multi-stakeholder list of speakers supporting the Partnership, including the American Board of Medical Specialties (ABMS).  The purpose of the NPP is to bring together leading national stakeholders to take action on coordinated priorities designed to advance safety and quality in the U.S. health care system.  The NPP highlights the importance of providing the public and other stakeholders with standardized information on patient experience.

     b)  NSQIP

           i)  The Maine Chapter of the American College of Surgeons is working closely with PTE to implement the National Surgical Quality Improvement Program in Maine hospitals as one of two national demonstration projects (the other is in Portland, Oregon). 

          ii)  Dr. Letourneau and Mr. Rooney are working with the Maine Chapter leadership on the initiative.

          iii)  A letter soliciting interest is being distributed to all Maine hospitals.  A copy of the letter was distributed.

2)  PTE Steering Committee Update

   a)  Staff is recommending combining the PTE Primary Care and PTE Specialty initiatives.  While there was initially only one committee, eventually the committee was split between primary care and specialty care.  The recommendation to go back to one committee is made at this time because:

       i)  Most of the individuals attending PTE Specialty meeting also attned the PTE Primary Care Steering Committee.

       ii)  It is rare for a specialty physician to attend the PTE Specialty meetings

       iii)  Currently, many specialty physicians are meeting outside the PTE meetings (e.g. orthopedics, gastroenterology, surgeons, cardiology)

       iv)  Holding three PTE meetings in one day is becoming a resource issue for staff (and participants)

        v)  In the future, one of the main customers of specialty and quality metrics will be PCP's

    b)  Discussion

          i)  Change can only come by primary care and specialties working together

          ii)  Do we know why specialty physicians don't attend the PTE Specialty Steering Committee meetings?

         iii)  Can't have an us vs. them focus

         iv)  MMA is hosting a joint PCP-Specialty meeting around the Patient Centered Medical Home on December 16 at 5:30pm.

    c)  The Steering Committee believed that it could adequately combine the two groups.

         i)  Current attendees from PHO's also represent specialties

        ii)  We can use the end of PTE Physician Steering Committee meetings if there is an opportunity for specialty physicians to attend.  This will also make it possible for PTE Hospital Steering Committee members to attend, since specialty issues overlap both primary care and hospitals.

        iv)  Steering Committee members unanimously endorsed this change, effective 2009

3)  Health Plan/Employer updates:

     a)  The State Employee Health Commission will continue to use both green and blue ribbons in their tiered networks so any practice with two ribbons, either blue or green, will qualify for the enrollee co-pay waiver.

     b)  Cigna, Aetna, and Harvard Pilgrim are continuing to use both blue and green ribbons in their Pay for Performance programs for 2009

     c)  Anthem presented on their national program which will be rolled out throughout Wellpoint states.  It is based on the model they have used in Maine and some other states for several years.

4)  PTE to Bridges to Excellence/National Committee on Quality Assurance Update

    a)  Current numbers

          i)  Office System Survey

               (1)  PTE:  300 blue ribbons

               (2)  NCQA recognition:  30 physicians in 7 practices

         ii)  Diabetes:

              (1)  PTE:  208 blue ribbons

              (2)  NCQA:  135 physicians in 45 practices

        iii)  Cardiovascular

               (1)  PTE:  130 blue ribbons

               (2)  NCQA:  108 physicians in 31 practices

        iv)  Discussion

              (1)  Expect flurry of activity

              (2)  NCQA giving some conflicting information to practices

              (3)  Even with EMR, there is a burden on the practices

              (4)  GE now is uploading data directly to BTE so practices using its service do not have to do anything additional to have data submitted to BTE

  b)  Pediatrics Criteria

       i)  Steering Committee unanimously approved:

      ii)  Practices with a PTE blue ribbon for immunization and asthma care...

           (1)  If previously achieved a score of 75 points or more within the past three years, PTE blue ribbon will automatically carry over to 2009 for one more year

           (2)  If previously achieved a score of 60-74 points within the past three years, previous PTE ribbon will carry over in 2009 for one additional year, but will be converted to a "Maine-specific" green ribbon.

       iii)  Practices which did not submit or did not previously receive a blue ribbon for PTE immunization and asthma care outcomes and would like to achieve a blue ribbon for 2009, or would like to improve their existing score for immunizations and/or asthma (1) Can submit outcomes information directly to PTE  (2) Targets for obtaining a green or blue ribbon for immunizations will be based on updated national and New England immunization averages.

  c)  POL, update

       i)  Jennifer Herman from MassPro/BTE has been in Maine conducting sample office system survey site visits

      ii)  Physician practices involved report a very positive experience

5)  Website update

      a)  Draft website link was reviewed with positive comments

9)  Special Focus Group on PCP-Patient Communications

      (a)  Beth Austin from Crescendo Consulting and Lisa Letourneau, M.D. reviewed consumer engagement approaches being used in MHMC Employee Activation, Aligning Forces for Quality and Patient Centered Medical Home Initiatives

     (b)  Group provided positive feedback

     (c)   Group was interested in continuing this process and future sessions will be scheduled .

Committee will meet next on Thursday, Feb. 26, 2009 at MMA. [return to top]

In Memoriam: Paul A. Genova, M.D. 1954-2008

The Maine Medical Association family mourns the loss over the weekend of long-time MMA member Paul A. Genova, M.D. of Portland.  Paul was a psychiatrist, husband of Noel Genova, PA-C, and father of three children.  Paul had bravely battled cancer for several years.  Our thoughts are with Noel and their family over this Holiday period.

Visiting hours will be Friday, December 19th, at Jones and Rich Funeral Home, Woodford Street, in Portland from 6:00 to 8:00 pm.  A memorial service will be held at the Allen Avenue Unitarian Universalist Church, on Sunday, Dec. 21st at 1:30 pm. [return to top]

MMA's Public Health Policy Web Page Goes Live for Quick and Easy Access to Clinical Tools

The MMA Public Health Committee members, under the direction of Chair Charles Danielson, M.D., M.P.H. and staff Kellie Miller, M.S., have been working diligently to ensure that our member physicians have access to the necessary clinical tools for their patients.  The Public Health Policy web page at is ready and available 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 to provide information on initiatives in local school districts and communities.  MMA President Stephanie Lash, MD is working in conjunction with the Public Health Committee's efforts on a Healthy Weight Initiative 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.  On the public health web page, you will find 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 health weight initiatives.  To get started on healthy weight initiatives in your office:  order your Free "Let's Go" Toolkit for use in the clinical setting by visiting the MMA web site at  It's as easy as one click away!

The Public Health Policy web page will gradually incorporate more in-depth information on childhood immunization issues and pediatric environmental health.  Currently, the website has the Pediatric Environmental Toolkit available for download!

The MMA Staff and the members of the Public Health Committee look forward to receiving your feedback on the new Public Health Policy web page, as well as your ideas on what we should consider adding to the page.  You can contact the MMA's Director of Public Health Policy Kellie Miller at or by calling 207-622-3374, ext. 229. [return to top]

Obama-Biden President-Elect Transition Team Health Care Community Discussion on December 30th

Obama-Biden President-Elect Transition Team Health Care Community Discussion

Tuesday, December 30, 2008, 4:00 – 6:00 pm

Maine Medical Association

This forum, that is open to the public, is being hosted by the Maine Medical Association President Stephanie Lash, MD,  Downeast Association of Physician Assistants (DEAPA) President Bill Bisbee, PA-C, and Maine Osteopathic Association President Douglas Jorgensen, DO.

The President-elect believes that every American should have high quality and affordable health care and to reach this goal his team has indicated that we must modernize our health care system in order to:

  • Improve quality and reduce costs;
  • Expand coverage and access to all Americans; and
  • Improve Prevention and Public Health

And as they work to revamp our health care system, they want to hear from the people.  The Obama-Biden President-Elect Transition Team wants to hear from all of us throughout the country and it is through these Health Care Community Discussions that we can provide feedback directly to his team.  The Presidential Transition Health Policy Team is encouraging Americans to host and attend Health Care Community Discussions across the country between December 15th and December 31st.  These Community Discussions are part of the President-elect’s continuing efforts to reach out and directly involve the American people in their own government.  Health care is a top priority for President-elect Obama and he wants our help in designing a system that provides quality, affordable health care for all Americans.  His nominee to be Secretary of Health and Human Services, former Senate Majority Leader Tom Daschle, is attending several Health Care Community Discussions.  He and his Team will review the submissions from all of these discussion groups.  President-elect Obama wants to bring the voices and health care concerns of all Americans to Washington.

Gordon Smith, Esq., EVP of the Maine Medical Association, and Joel Kase, D.O., President-Elect of the Maine Osteopathic Association, will serve as co-moderators to flesh out key issues around health care and provide the team with our collective innovative ideas to ensure the reality of quality, affordable health care for all Americans.

In Maine, we have a very active and progressive physician community, working diligently on quality, affordable health care, as well as building a solid public health infrastructure to invest in community-based prevention that will lead to healthier communities.   Our local experience can certainly help define the outcomes of our future National health care plan.  Please join us on December 30th to ensure that Maine’s experienced voice is heard at the national level to make a difference for all Americans. To access your participant guide go to

Please RSVP your attendance plans to Maureen Elwell at or by calling at 207-622-3374, ext. 219.

Not able to attend the meeting in person?  The MMA’s conference call line will be available for participants to call in and be a part of the discussion.  The call in number is:  1-800-989-2842, Passcode:  6223374#. [return to top]

Member Survey: Help Us Set a New Record!

As of Friday, we have received more than 500 responses to the MMA's membership survey, giving us a 29.3% response rate.  Thank you to all who have participated so far!  The survey is intended to provide MMA with important information regarding its member services and member priorities. 

The highest response rate ever for a state medical society is 32.5%, so we're definitely contenders for the highest ever -  We only need 65 more respondents to achieve 33%.  Help us achieve that goal!

We will be accepting paper submissions through Monday, December 22nd, so please take a few minutes to fill it out and send it in if you haven't already, and if you need a copy, please email to request one.

Thank you!   [return to top]

Overactive bladder? Latest AMA Therapeutic Insights Online Program topic


The American Medical Association announces the release of Recognizing and Managing Overactive Bladder, the latest AMA Therapeutic Insights newsletter.  

NEW!  View a one-page overview of the OAB newsletter.

 Maine Medical Society physicians can access their FREE personal prescribing profile showing their individual prescribing patterns for overactive bladder alongside state, national and specialty prescribing patterns for the condition by signing into the AMA Therapeutic Insights Web site.

 AMA Therapeutic Insights

        is free and online

        highlights one disease condition per issue

        features individual, state and national prescribing data* and evidence-based treatment guidelines

        is written by top disease experts in collaboration with the AMA

        offers AMA PRA category 1 creditTM

 While most treatment-oriented CME programs focus solely on disease management, AMA Therapeutic Insights takes it one step further. This program delivers the actual prescribing patterns for the disease.  Never before have physicians been able to see exactly which medications are being prescribed for the featured conditions.

 Visit AMA Therapeutic Insights to read this issue, as well as previous newsletters covering osteoporosis, BPH (enlarged prostate) and pediatric asthma.

 *The prescribing data in AMA Therapeutic Insights are provided by IMS Health. The AMA does not collect or have access to physician prescribing data in any form.

 The AMA is accredited by the ACCME to provide continuing medical education for physicians.

  [return to top]

Maine CDC Seeks Input on New Electronic Death Registration System

The Maine Center for Disease Control & Prevention is conducting this survey of potential users of a new Electronic Death Registration (EDR) online system for Maine in order to understand your technical capabilities for participation.  Your responses to the questions will help us develop a system that will work for you!

Please take a moment to participate in the survey by following the link below:

[return to top]

Workers' Comp. Board Likely to Proceed to Rulemaking on Hospital/ASU Fee Schedule

On Tuesday, December 9, 2008, a so-called "consensus-based rulemaking group" established by the Maine Workers' Compensation Board more than a year ago in an effort to address concerns of the business community about the lack of a fee schedule for hospital and ambulatory surgical unit facility fees in Maine's workers' compensation system completed its work.  The Board engaged a consultant from Ingenix named Eric Anderson to provide an objective analysis of Maine's current facility payments in the workers' compensation system and to make recommendations to address the business community's cost concerns.  Mr. Anderson recommended a modified Medicare approach for hospital inpatient and outpatient, and ambulatory surgical facility rates.  He estimated that the recommended approach would save between $500.000 and $1M per year.  At a meeting in September 2008, the MMA and representatives of the state's ambulatory surgical facilities agreed to such a fee schedule.  The business community continued to push for more cuts into the meeting on December 9th where no "consensus" was reached.  It is now likely that a majority of the Workers' Compensation Board will vote to send Mr. Anderson's recommendation out to the formal rulemaking process at its January 2009 meeting.  This means that the Board probably will have a public hearing on the formal proposal in April or May 2009.  The MMA will keep you posted on continued developments on the facility fee schedule issues. [return to top]

CMS Reviewing 2007 PQRI Scoring & Payments

On December 8, 2008, CMS announced that it is recalculating its PQRI data and that based upon this data, additional participants may receive a bonus payment.  The MMA, the AMA, and other medical societies pointed out physicians' concerns with the roll-out of this program and CMS has said that it is confident that more doctors will receive bonus checks after it reruns the data with modifications to the analytics.   [return to top]

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