March 16, 2009

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Gov. Baldacci Proposes New Healthcare Spending in State of the State Message

Governor John Baldacci proposed some new spending on healthcare in his State of the State message this past Tuesday.  Funds for assisting medical education, paying down the MaineCare debt to hospitals, encouraging Mainers to have a no-cost health risk assessment and using federal stimulus funds to create a voucher system for newly unemployed workers who need additional help to keep their health insurance were all part of the ambitious agenda.

In a 40 minute State of the State address to the Legislature last Tuesday (March 10), Governor John Baldacci proposed some important new initiatives involving healthcare. 

1.  He announced that he would use federal stimulus funds to create a voucher system for newly unemployed workers who need additional help retaining health insurance.

2.  He unveiled a Universal Wellness program, a preventive health program that will offer at no cost, confidential risk assessments and connect individuals to local resources for health improvement. 

3.  He announced that he would use $500,000 of federal stimulus funds for the Patient Centered Medical Home pilot project already underway through the efforts of Quality Counts, the Maine Quality Forum and the Maine Health Management Coalition.

4.  He announced a proposal to use $3.5 million in stimulus funds to support medical education scholarships for Maine residents at the new Medical School associated with Tufts-MMC and a collaborative effort taking shape between the University of Vermont Medical School and Eastern Maine Medical Center and at the University of New England.  (See related article in this issue of Weekly Update)

    The Governor also proposed utilizing a large amount of the stimulus payments to pay the MaineCare debt owed to Maine's hospitals.  With the federal match, it appears that over $350 million of the debt could be paid.

Thomas H. Palmer, M.D., 1924-2009

The MMA family was sorry to learn this week of the death Tuesday of Dr. Tom Palmer of Bangor.  Dr. Palmer, 84, died from a recurrence of lung cancer.  He practiced general surgery in Bangor for thirty four years until his retirement in 1989. Toward the end of his life, the publication of his book, Cracked Marbles, brought him great joy with its message of the primacy of the physician-patient relationship.  MMA was thrilled that Dr. Palmer was able to attend last year's Annual Session in the Fall to sign copies of his book and to renew acquaintances with many colleagues. 

Dr. Palmer is survived by his five children, all of whom are in Maine.  Gifts in his memory may be made to the Thomas H. Palmer Fund to benefit CancerCare of Maine, sent to Healthcare Charities, P.O., Box 931, Bangor, ME 04402-0931 or to St. Joseph Healthcare, P.O. Box 1638, Bangor, ME 04402-1638. 

"Dr. Palmer was a Doctor's Doctor," noted MMA President Stephanie Lash, M.D. of Bangor.  "He will be greatly missed by his family, his many patients and hundreds of friends and colleagues.  The medical community has lost one of its true champions." [return to top]

Governor Proposes Support for Medical Education in State of the State Message

As reported this week by Meg Haskell in the Bangor Daily News, two new medical school programs, along with the existing University of New England College of Osteopathic Medicine are among a number of health care programs in line for a share of the federal stimulus payments coming to Maine.  Governor Baldacci announced the support in his annual State of the State address Tuesday night.  The proposal involves providing $3.5 million in the form of scholarships for Maine students who attend one of these three schools. 

"Research shows that doctors tend to settle near the hospitals where they complete their training." The Governor stated in his State of the State address on Tuesday night.  "And I know, given the chance, young doctors will stay in Maine." 

It is hoped tht the stimulus funds, in combination with funds to be raised by the insitutions, could help offset tuition by as much as 50 percent.

The Maine Medical Center-Tufts Medical School is expected to enroll 36 students this Fall, with 20 of those students being from Maine.  Students accepted into the four year degree program will send much of their first two years in Boston, but will finish the clinical requirements of their third and fourth years in Maine.  The program will focus on developing primary care physicians interested in serving rural areas.

"The Maine Medical Association has recognized for some time now the shortage of physicians in Maine, particularly in primary care,"  said Gordon Smith, EVP.  "We congratulate the insitutions themselves and the Governor for addressing this problem."   [return to top]

Political Pulse: Legislative Highlights of the Week


The HHS subcommittee formed to consider the Governor's FY 2010-2011 biennial budget (L.D. 353) proposals on MaineCare reimbursement for critical access hospitals and hospital-based physicians met three times last week and appear determined to find savings in hospital reimbursement to cover at least the General Fund gap created by continuing the supplemental budget (L.D. 45) decision to reimburse both hospital-based physicians and those paid according to the MaineCare fee schedule at approximately 70% of Medicare rates.

The subcommittee will meet again in the afternoon of Tuesday, March 17, 2009.  The HHS Committee must report its budget recommendations back to the Appropriations Committee at 1 p.m on Thursday, March 19, 2009.  The members of the subcommittee are Senator Peter Mills (R-Somerset), Senator Lisa Marrache, M.D. (D-Kennebec), Rep. Anne Perry (D-Calais), Rep. Linda Sanborn, M.D. (D-Gorham), Rep. Sarah Lewin (R-Eliot), and Rep. Meredith Strang Burgess (R-Cumberland).

The General Fund savings represented by the Governor's original proposal to cut critical access hospital reimbursement from 117% to 101% of costs is $2.1 million in each year of the biennium and by the cut to hospital-based physicians is $7 million in each year of the biennium.  The decision to bring both hospital-based physicians and those paid according to the MaineCare fee schedule yields no savings.

By the end of the subcommittee meeting last Friday afternoon, the subcommittee had identified the following options for seeking between $7 million and $9.1 million in General Fund savings:

  • Reducing critical access hospital reimbursement from 117% to 106% of costs (approximately $2 million GF);
  • Reducing inpatient physician reimbursement from 100% of costs to 70% of Medicare (approximately $2 million GF for emergency physicians and $2.9 million GF for other inpatient physician services);
  • Again rebasing the hospital tax year (generated approximately $3.5 million GF in L.D. 2290 in the 123rd Legislature); and
  • Some savings through Schaller Anderson claims edits and/or the Katie Beckett waiver program)

Two other significant MaineCare issues seem to have influenced the subcommittee discussions.  In his State of the State speech on Tuesday evening, Governor Baldacci committed renewed efforts to bring the State current on its hospital settlements.  On Friday, Commissioner Harvey explained that the Department hoped to settle up with hospitals through 2007 from additional funding from the federal stimulus package.  Department of Administration & Finance Commissioner Ryan Low disclosed to the HHS Committee that there's a new $65 million General Fund gap in the MaineCare budget for the current fiscal year ending June 30, 2009 as a result of increased utilization.  The substantial payment on the past due hospital settlements seems to make some legislators believe that Maine hospitals can tolerate some cuts in reimbursement in the next biennial budget.

Physicians who wish to communicate their concerns about these subcommittee options should contact members of the HHS Committee and their own legislators this week.

You can find your own legislators on the web at:

You can find members of the HHS Committee and their contact information on the web at:

You can call toll-free and leave a message at the State House for any legislator as follows:

  • Senators:  1-800-423-6900
  • Representatives:  1-800-423-2900 


On Thursday, March 12, 2009, the Transportation Committee heard the following two bills on motorcycle helmets:  L.D. 437, An Act to Require a Person under 18 Years of Age to Wear a Helmet While on a Motorcycle (initiated by the Maine Chapter of the American College of Emergency Physicians) and L.D. 453, An Act to Require Motorcyclists to Wear Helmets.  As expected, members of the United Bikers of Maine and other motorcycle clubs filled the committee room.  Maine ACEP President Michael Gibbs, M.D., an emergency physician at Maine Medical Center, testified in favor of L.D. 437 and Lani Graham, M.D., M.P.H. testified on behalf of the MMA in favor of both bills.  The Committee has scheduled a work session on Thursday, March 19, 2009. 

You can find the members of the Transportation Committee and their contact information on the web at:  For talking points, see Dr. Graham's testimony posted on the MMA web site,


Last week, Michele Ghim, M.D., a pediatric resident at the Maine Medical Center, came to Augusta to testify in favor of L.D. 373, An Act to Facilitate Lactation in the Workplace by New Mothers on behalf of the Maine Chapter of the American Academy of Pediatrics. The business community's opposition was modest and it appears there may be room for compromise.  Proponents of the bill primarily want some option other than a rest room stall available.  Several of the speakers made the point that no adult would want their meal prepared in a rest room.  The business community seemed concerned that there should be some sort of hardship exemption for certain businesses.

The Labor Committee also heard the following two workers' compensation bills:  L.D. 578, An Act Regarding Repayment of Subrogation of Lien Claims in Workers' Compensation Actions and L.D. 617, An Act to Amend the Maine Workers' Compensation Act of 1992 to Remove Independent Medical Examiners.  L.D. 578 concerns the MMA because its proponent, the Maine Trial Lawyers Association, testified that its purpose was to apply the "common fund" doctrine to workers' compensation actions.  The MMA brought a legal action all the way to the Maine Supreme Judicial Court in 2000 (Doucette v. Pathways, Inc.) to successfully challenge the application of the doctrine to permit an attorney for a workers' compensation claimant to take a portion of a physician's fee to cover his costs.  The MMA also expressed concern about the potential loss of an IME option in the workers' compensation system and committed, as we have in the past, to work with others to try to improve the IME program.


Last Tuesday, Laurel Coleman, M.D., an internist and geriatrician from Manchester, testified before the IFS Committee on behalf of the MMA in opposition to L.D. 255, An Act to Allow Persons Licensed for the Practice of Manicuring to Provide Treatment for Diabetes.  Professional organizations representing podiatrists and physical therapists also opposed the bill.


On Thursday afternoon, March 12, 2009, the MMA also spoke in favor of a $10 million bond proposal to support HealthInfoNet, L.D. 729, An Act to Authorize a General Fund Bond Issue to Create a New Health Care Internet Infrastructure, sponsored by Senator Lisa Marrache, M.D.  HealthInfoNet Board Member Dan Coffey and Executive Director Dev Culver, and AARP representative Nancy Kelleher also spoke in favor of the bill.  David Howes, M.D. presented written testimony on behalf of Martin's Point Healthcare.  [return to top]

Report on AMA National Advocacy Conference Last Week in D.C.

MMA representatives, led by President-elect David McDermott, M.D., MPH, attended the AMA's National Advocacy Conference last week in Washington D.C.  Following briefings by AMA staff and presentations by Congressman Henry Waxman, Ezekial Emmanual, M.D., PhD., and commentator Chris Matthews (Hardball), the MMA delegation met with Congressman Michaud and Senators Snowe and Collins.  Congresswomen Pingree had been called over to the White House and was unavailable for our visit.  Senator Snowe will play a major role in reform efforts as the result of her position on the Senate Finance Committee.  But all members of the Maine delegation are engaged in the debate and are expected to contribute.

In addition to advocating for changes to the Sustainable Growth Rate formula which is producing yearly decreases in physician reimbursement in Medicare, the AMA is working with the Obama administration to present the outline of a plan for comprehensive healthcare reform to the Congress for action this year.  All the committees of jurisdiction have indicated that they are interested in a timeline that calls for Senate and House votes before the August recess, a conference committee report in the Fall and final passage and the President's signature before the end of the year.

Many speakers at the conference noted the significant differences between the current situation and the situation faced by the Clinton White House in 1993.  And the Obama administration appears to have learned from the Clinton's experience and is seeking to avoid a number of the problems that arose in those failed efforts.  Notable among the changes is the current attempt to include all the major players in the discussion and to leave up to the Congress the details.  At the White House Summit on Health Care Reform ten days ago, the AMA was invited as well as the Health Plans, Hospitals, nurses, business and pharmaceutical interests and consumers.  And there is much agreement on the major themes of reform, including expanding coverage, improving quality and lowering costs.

The President's inclusion in his federal budget proposal of $634 billion over ten years as a "down payment" for health system reform, was also another positive indication that significant reform may be coming.  It is believed that as much as one-half of that amount could be used to rebase physician payments under Medicare and make it possible to eliminate the SGR formula.  While it is anyone's guess what the new payment system would look like, it is clear that different buckets may exist for primary care, surgery, imaging etc., and that rewards are likely to be available for the use of electronic medical records.

Watch the pages of Maine Medicine and Maine Medicine Weekly Update for regular updates on the progress the Administration and Congress is making toward systemic and comprehensive reform. [return to top]

Reminder: No-Cost Chronic Pain Consultations Available Until June 30, 2009

MMA reminds physicians and practice managers that free in-office consultations are now available to assist prescribers in balancing the needs of chronic pain patients with the risk of diversion and misuse of opiate medications. The consultations are funded by the Board of Licensure in Medicine BOLIM) but administered independently by the Maine Medical Association.  Noel Genova, PA-C, performs the confidential consultation and can be reached to schedule a session at 671-9076 (cell) or via e-mail to  Category one CME is available to physicians for the consultation.

Noel has helped many practices these past few months.  If your practice is struggling with this issue, we suggest you give Noel a call.

In April, Noel and Gordon Smith, Esq., MMA EVP will present a report to the BOLIM on the results of the project and it is hoped that the contract can be renewed beyond June 30, 2009.  Other aspects of the project involved placing appropriate educational resources on the MMA website at and offering a CME home study course which is also available through registration on the website. [return to top]

April 3rd HIPAA Update to Include New Provisions in ARRA

The House of Representatives and United States Senate passed the American Recovery and Reinvestment Act of 2009 (ARRA) on Feb. 13th and President Obama signed the bill on Feb. 17, 2009.  This federal Stimulus bill contains a number of important changes to the HIPAA laws regarding privacy of patient medical information.  These changes will be highlighted at the MMA's Annual HIPAA Update program on Friday morning, April 3rd from 9:00am to noon at the Association's offices in the Frank O. Stred Building in Manchester.  A $60 registration fee covers the cost of breakfast and all materials.  Three hours of category one CME are available for physicians and each office manager will receive a certificate of HIPAA training.  The faculty includes Gordon Smith, Esq., Kenneth Lehman, Esq. and John Coolong of Systems Engineering.

Registration is available through the MMA website at or by calling Maureen Elwell at 622-3374 ext. 219. [return to top]

Message from Tony Marple to All MaineCare Providers

The following information is a letter from Tony Marple, Director of MaineCare Services to all MaineCare providers.

Dear Provider,

Maine’s Department of Health and Human Services and MaineCare have embarked on a very significant project for us, for you and for our mutual clients, MaineCare members.  We are now mid-way through the project to build a new Medicaid claims processing system.  As you probably know, the new system is named the Maine Integrated Health Management Solution and is referred to as “MIHMS.”

The first outward phase of this project is a full provider re-enrollment.  This is being done to ensure the accuracy of provider data in the new system and to allow use of National Provider Identifiers (NPI).  It is important that all MaineCare providers of health care services complete their enumeration and receive their NPI prior to re-enrolling for MIHMS.  A wealth of NPI information is available on the MaineCare web site and can found by scrolling to the “NPI Links” header on the MIHMS Projectpage.  If you still have questions, you can forward those to

Providers have been scheduled, by provider type, for one of three re-enrollment cycles in July, August and September.  Training will be available in locations across the state in the month prior to each cycle.  The first set of provider training will take place in June. Training for the second cycle will be held in July and the third and final set of training will be held in August and the first week of September. 

Current MaineCare provider organizations will receive individual notices of their training timeframe and re-enrollment cycle.

The grouping of provider types by cycle is also available on the MaineCare web site at MIHMS Provider Re-enrollment.  Training locations and dates will be confirmed soon.  This information will be posted to the site and providers notified.  Once this occurs, electronic registration for training will also be available at this link.  If your organization does not yet receive information from MaineCare by listserv, I encourage you to sign up for this at MaineCare provider listserv.

This is an exciting time for Maine’s Medicaid program.  We are building a fully HIPAA-compliant claims processing system that will adhere to the certification standards from the Centers for Medicare and Medicaid Services (CMS).  MIHMS will offer you the ability to file all claims electronically and to monitor claim status on-line.  You will have the ability to update provider data and to access member eligibility information via a web portal.  Operation of the MIHMS system will allow MaineCare to join with you in focusing on the health and well-being of our members.

Thank you for your commitment to the well-being of Maine’s residents and for your participation in the MaineCare program.

Anthony F. Marple
Director, Office of MaineCare Services
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Maine MGMA Presents "Faced with a Difficult Conversation? Be Prepared!" and "De-stress with Humor"

Maine MGMA presents a half-day educational session, Wednesday, April 8, 2009, 8am- 12pm at the MMA headquarters in Manchester. There will be two presentations:

Faced with a Difficult Conversation? Be Prepared!- By Nicole Morin-Scribner, MBA, SPHR

Nicole Morin-Scribner, MBA, SPHR has been the Director of Human Resources at St. Mary’s Health System since 1997. She has over 20 years of experience in HR and has achieved Senior Professional in Human Resources certification. Nicole has served in a number of HR leadership positions including President of the Maine Society for Healthcare Human Resources and is currently on the national board of directors for the American Society for Healthcare Human Resources. Nicole has published articles and made presentations on HR topics at the state, regional and national level.

Do you ever find yourself dreading the need to have a difficult conversation with a challenging a non-compliant provider for example? This session will let you try out a tool you that will help you be better prepared. Might not make it easy, but it will help you feel more in control and improve your ability to achieve a more productive and desired outcome.

De-Stress with Humor- By Sue Poulin

Sue Poulin was a professor of Social Sciences for 16 years and College Administrator for 2 years. She has an undergraduate degree in Psychology and a Graduate degree in Adult Education. Sue also was the Staff Development Specialist in the Education and Training Services Department at St. Mary’s Regional Medical Center from 1995 to July of 2008. Sue completed one unit of CPE (clinical pastoral education), also obtained her LSW license in order to expand her experiences into the area of social work, and has recently returned to an academic setting and is now a faculty member at the Central Maine Medical Center College of Nursing and Health Professions. Sue is also on the Distance Education faculty at St. Joseph’s College in North Windham Maine and she has developed 3 study guides in Education and Training for the General and Professional Studies Program at the college.

This interactive session helps all of us re-visit the importance of laughter and play in our lives. Laughter breeds health, creativity and above all more laughter! Let’s prove to ourselves that, no matter what IT is, IT can be fun. Researchers tell us over and over again that laughter is the best (and cheapest) form of medicine. We’ll talk about the physical, mental and emotional benefits of having a ‘sunny’ disposition and being able to look at the ‘lighter side’ of life. Promise yourself you’ll at least try it...for the ‘health’ of it!

For more information, and to register, click here [pdf] [return to top]

New Bills for Your Review & Comment/Reminder of Legislative Committee Conference Call

The following are bills of interest to the physician community printed and referred to committees last week for your review and comment.  Please note that clicking on the highlighted "LD XXX" will take you to a PDF version of the bill.

LD 912, An Act To Authorize a General Fund Bond Issue for Capital Projects for Hospitals (monitor)

LD 913, An Act To Authorize Bond Issues for Ratification by the Voters for the November 2009 and June 2010 Elections (monitor)

LD 914, An Act To Combat Childhood Obesity through the Creation of Recreational and Athletic Fields (pediatricians; Public Health Committee; support)

LD 916, An Act Regarding Trans Fat (pediatricians; Public Health Committee; monitor or support)

LD 919, An Act To Prevent and Treat Cancer in Maine by Implementing Critical Portions of the Comprehensive Cancer Program (Public Health Committee; monitor or support)

LD 940, An Act To Estimate the Financial Costs to Providers in Implementing MaineCare Rules (monitor)

LD 941, Resolve, To Assist Families with Substance Abuse Issues (psychiatrists; monitor)

LD 943, An Act To Reduce Lung Cancer Rates in Maine (Public Health Committee; monitor)

LD 960, Resolve, Requiring Rulemaking by the Maine Quality Forum Regarding Clostridium Difficile and Methicillin-resistant Staphylococcus Aureus (Public Health Committee; monitor)

LD 966, An Act To Amend the Licensing Requirements for Marriage and Family Therapists (psychiatrists; monitor)

LD 973, An Act To Provide for the Safe Collection and Recycling of Mercury-containing Lighting (Public Health Committee; monitor)

LD 975, An Act To Establish the Maine Medical Marijuana Act (Public Health Committee; oppose)

LD 985, An Act To Increase Public Safety by Requiring a Federally Licensed Firearms Dealer To Facilitate the Transfer of Firearms (Public Health Committee; support)

LD 986, An Act To Protect the Public Health and the Environment by Prohibiting the Sale of Wheel Weights Containing Lead or Mercury (Public Health Committee; monitor)

LD 1002, Resolve, To Conduct an Updated Study of the Feasibility of Establishing a Single-payor Health Care System in the State (monitor)

LD 1003, Resolve, Directing the Office of Program Evaluation and Government Accountability To Perform a Performance Evaluation and Cost-benefit Analysis of the Dirigo Health Program (monitor)

LD 1004, An Act Relating to Self-insurance (monitor)

LD 1005, An Act To Continue Access to Dirigo Choice Health Insurance by Reducing Administrative Costs and Replacing the Savings Offset Payment (support)

The next MMA Legislative Committee conference call is scheduled for 8:30 p.m. on Thursday, March 19, 2009.  The conference call number is 800-989-2842 and the access code is 6223374#.  Any MMA member or specialty society representative is welcome to join the discussion of bills listed above and other legislative highlights.


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