March 30, 2009

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MMA Releases Results of Membership Opinion Survey

On Tuesday, March 31st, the Association will release to the media the results of the membership survey conducted during November and December of 2008.  During these months, the survey research firm enertrix, now part of the Gallup organization, conducted a survey of all MMA active members.  Many thanks to the 605 members who responded, representing an excellent participation rate of greater than 34%.  This response represented the best percentage of any of the seven state societies where similar surveys have been conducted by the firm.  Members identified expanding access to care for the uninsured as the issue they felt was of the greatest concern to the future of American medicine.

When asked to identify the issue that currently has the most impact on day to day practice, members cited most frequently (in order of preference):

  • Health plan policies
  • Inadequate or no insurance coverage for patients
  • Medicare reimbursement
  • Mainecare reimbursement
  • Healthcare workforce shortages

When asked to identify what issues MMA should focus on in 2009, 79% of respondents cited the need to work to reform the healthcare system in Maine and nationally.  Addressing the workforce shortage also ranked high with a 57.5% response.

The 21st question elicited a response likely to attract some media attention.  When asked the question, When considering the topic of health care reform would you prefer to make improvements to the current public/private system or a single-payer system such as a "Medicare for all approach," members expressed a preference for a single-payer system 52.3% versus 47.7%.  A large percentage of primary care physicians favored single payer, while a significant percentage of most of the other specialties opposed single payer.

Copies of the complete survey results, broken down by specialty, years of practice, size of practice, employment/private practice, and gender are available from the MMA office and will be available on the MMA website at in the members only section. 

Thanks to all of the members who took the time to complete the comprehensive survey.

MMA Recognizes Doctor's Day

Today, March 30th, is National Doctor's Day, a day to show appreciation for the role of the nation's physicians in caring for the sick and advancing the art and science of medicine.  March 30th was chosen as Doctor's Day because that is the anniversary of the date that anesthesia was discovered.  On that day, in 1842, a Georgia physician, Dr. Crawford B. Long, administered ether to a patient for the removal of a tumor on his neck.  Many years later, a formal resolution was introduced encouraging recognition of physicians on that date. 

In 1990, legislation was introduced in Congress which recommended the observance of Doctor's Day on March 30th.  In 1991, President George W. Bush issued an executive order officially proclaiming that date as Doctor's Day. 

Many hospitals around the state will hold events recognizing Doctor's day this week.  The leadership and staff of the Maine Medical Association pause today to express our appreciation to all Maine physicians for the important work that they do.  [return to top]

Political Pulse: Legislative Highlights of the Week


The pace of work at the legislature has been hectic for the last week and will continue for the next few weeks as committees try to get their bills scheduled for public hearings.  Now that the HHS Committee has made its recommendations to the Appropriations Committee on the FY 2010-2011 biennial budget (L.D. 353), its public hearing schedule is very full.  For example, on Monday, March 30, 2009, the HHS Committee has 7 bills scheduled for hearing in the morning followed by 6 more in the afternoon.  

The Appropriations Committee continues its work sessions on the biennial budget and while members have had some preliminary discussions about the DHHS portions of the budget, they have made no final decisions yet.  The Committee plans to caucus on Monday morning and to be in public work session in the afternoon.  We will keep you posted on developments in the hospital and physician reimbursement aspects of the biennial budget.


On Monday, March 23, 2009, the MMA joined representatives of the University of New England College of Osteopathic Medicine and emerging medical school programs at Maine Medical Center/Tufts University School of Medicine and Eastern Maine Medical Center/UVM Medical School, the MHA/Maine Recruitment Center, the Finance Authority of Maine (FAME), and other interested parties in support of L.D. 853, An Act to Encourage Maine Residents to Attend Medical School and Practice in Maine.  The bill had no opposition.

The MMA also testified in opposition to L.D. 735, An Act to Allow Unimmunized Children to Attend School Upon Parental Waiver on behalf of the Maine Immunization Coalition, the Maine Chapter of the American Academy of Pediatrics, and the MMA.  Maine CDC Director Dora A. Mills, M.D., M.P.H. also spoke in opposition to the bill.


Last week, the Labor Committee held a work session on two workers' compensation bills of interest to MMA.  The Committee voted against passage of L.D. 578, An Act Regarding Repayment of Subrogation or Lien Claims in Workers' Compensation Actions, a bill opposed by the MMA because of concern that it could have resulted in a reduction in reimbursement in certain cases.  The Committee also asked the MMA to work with the Workers' Compensation Board staff and representatives of both the business community and organized labor to see if the group can develop recommendations to improve the independent medical examiner (IME) system (section 312 of the Act).  This initiative came out of the public hearing on L.D. 617, An  Act to Amend the Maine Workers' Compensation Act of 1992 to Remove Independent Medical Examiners.


The Maine Society of Eye Physicians & Surgeons (MSEPS) and the MMA have been in negotiations with the Maine Optometric Association for several months on a piece of legislation offered by the optometrists to expand their prescriptive authority.  The bill, L.D. 683, An Act to Promote Cost-Effective and Broad-based Vision Care for Maine Citizens by Clarifying the Scope of Prescriptive Authority by an Optometrist, is scheduled for a public hearing in the Business, Research & Economic Development Committee on Tuesday, March 31, 2009.



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Wind Farm Developers and Health Experts Face Off at the Public Health Committee Meeting last week

Last week, the MMA Public Health Committee, chaired by Dr. Charles Danielson held a forum to discuss research on wind turbine-related health problems.  Dr. Michael Nissenbaum, a radiologist at Northern Maine Medical Center, Dr. Albert Aniel, an internist at Rumford Community Hospital, former Governor Angus King, a partner in Independence Wind and Dr. Dora Ann Mills, Director, Maine Centers for Disease Control, DHHS all weighed in on the subject.

Dr. Nissenbaum and Dr. Aniel have repeatedly requested that additional studies and research be gathered on the effects of turbines on people’s health, citing examples of sleep disturbances, headaches, dizziness, hypertension, weight changes and increased prescriptions. Former Governor Angus King (his company is developing a wind farm in Roxbury) stated that it would be poor science to base a statewide moratorium for all wind projects, based on the Mars Hill experience, and not look at what the differences between the projects are.  He indicated that the nearest homes to his proposed project would be three times farther away from turbines than the nearest homes to the project in Mars Hill.  The industry side stated that with proper planning concerns about “shadow flicker,” the effect of the blades spinning through sunlight and casting flickering shadows, and sound pollution – audible and low frequency, can be avoided, thus eliminating health effects. 

The MMA’s Public Health Committee will meet again on May 20th from 4pm - 6pm, and is expected to make recommendations for public health policy initiatives.  The meeting is open to all interested members. [return to top]

In Washington, House and Senate Committees Pass Budget Resolutions

In Congressional action this past week, both the House Budget Committee and the Senate Budget Committee passed Budget Resolutions which are expected to be voted upon by each body in the coming weeks.  For medicine, the House Resolution is better, as it follows the President's budget proposal relative to the issue of rebasing the sustainable growth rate (SGR) which has caused annual reductions in Medicare reimbursement for physicians.  The House Resolution in effect wipes out the 2010 reduction and the 40% reduction over the next six years, by providing $285 million over ten years.  Increases beyond the current rates would have to be paid for by offsets somewhere else in the budget, but at least the proposed reductions would be eliminated.

MMA will communicate with Congresswoman Pingree and Congressman Michaud urging support for the House Resolution.  The AMA has provided the following talking points on these budget matters.

House Budget Resolution Paves the Wayfor Permanent Medicare Physician Payment Reform

  • The House version of the FY 2010 Congressional Budget Resolution contains  provisions that will facilitate replacement of the fatally flawed Sustainable Growth Rate (SGR) formula with a new incentive based Medicare physician payment system.
    • The current CBO baseline is unrealistic.  It assumes that Medicare payments to physicians will be cut by 21percent in 2010 and by 40 percent over the next decade, creating an artificial, but insurmountable cost to permanently eliminating the SGR.  Congress has ignored the CBO baseline by interceding 6 times since 2003 to temporarily stop Medicare physician payment cuts.  Members of Congress, on a bipartisan and bicameral basis, have stated support for eliminating the SGR.
  • The House Budget resolution would provide budgetary and procedural protection to legislation that would permanently replace the SGR.
    • It would immunize from 5 and 10-year budget points of order legislation that would have the budgetary effect of maintaining current physician payment rates (freeze current physician payment rates).
      • CBO scored the cost of freezing Medicare physician payments at $87 billion over 5 years and $285 billion over 10 years.
      • The Budget Resolution does not intend or propose that Medicare physician payment rates be frozen.  Rather,it allows Medicare physician payment reform legislation to be scored against a baseline that reflects current policy – which means a baseline that assumes the payment rates in effect for physicians for 2009  will stay in effect through 2019.
    • Consequently,subsequent legislation that replaces the SGR with a new more sustainablepayment methodology would be much less expensive since $285 billion inoffsetting cuts would not need to be made before a new system is enacted.
  • Theseprovisions in the House Budget Resolution are consistent with and have thesame effect as the “rebasing” proposal that was included in thePresident’s FY 2010 budget.
    • The Administration’s Budget included funds in it to account for “expected Medicare payments to physicians.”
    • It assumed a more realistic baseline in accordance with its “best estimate of what the Congress has done in recent years.”
  • The AMA is committed to working with Congressional committees to design a new Medicare physician payment system that promotes delivery reforms,including increasing efficiency and improving the quality of care for all patients.
  • This is the first time that a Congressional Budget Resolution has fiscally accounted for the need to eliminate the SGR.   If the Medicare payment provisions in the House version of the Budget Resolution are not included in the final version of the Budget Resolution, it would be virtually impossible, due to the immense cost, to replace the SGR with a new payment system and pursue other important heath care delivery system reforms this year.

Key points about the House Budget Resolution:

  • While recent Medicarebills have provided temporary relief from Medicare cuts, they have made thesituation worse by simply moving the cuts to the next year.

  • The cut required by the SGR formula for January 1, 2010 is 21%. In the next several years, the cuts will total 40%.  Access to care will suffer.

  • If we don’t act now to provide permanent relief, cuts will continue to grow and a solution will become even more expensive.

  • Unless this provision providing budgetary protections for Medicare reform passes, it will be virtually impossible to permanently replace the SGR.

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Health Systems Development Advisory Council Looks at Cost Drivers

The Advisory Council on Health System Development met this past Friday (March 27) to review and receive comments from the public on its draft Report and Recommendations to the Maine Legislature, dated April, 2009.  The report provides a summary of the recent study on cost drivers and then contains ten recommendations, as follows:

  1. Develop efficiency measures that can be used to offer incentives for patients to choose efficient, high quality providers.
  2. Modify Maine law to allow small businesses and other fully insured businesses to offer incentives.
  3. Mandate that payers and purchasers in Maine support informed medical decision making as a benefit in health insurance plans in Maine.
  4. Enact legislation to formally establish the public health infrastructure that has emerged under the State Health Plan as a prevention strategy for universal wellness, and use the new infrastructure as a base to invest Prevention and Wellness funds from the American Recovery and Reinvestment Act (ARRA).
  5. Continue support for an interconnected electronic medical record sysem in Maine through HealthInfoNet.
  6. Continue support for the Patient Centered Medical Home pilot.
  7. Use the Certificate of Need program to help achieve an efficient delivery system.
  8. Support fundamental payment reform to bring about a more efficient system of health care delivery.
  9. Reduce Emergency Department use through twelve different initiatives, including a Phase 2 ED study to perform an in-depth analysis of six HSA's representing high use and low use areas.
  10. Increase transparency through initiatives of the Bureau of Insurance.

MMA EVP Gordon Smith testified during the public comment period and made the following points:

  • Relative to recommendation 2, recommending modifications to Bureau of Insurance rule chapter 850 and encouraging employers and health plans to create tiered networks of providers, Mr. Smith noted the importance of transparency and the ability of physicians to review the data and appeal the decisions.  "The track record of the health plans relative to tiering has  been very spotty,"  Smith noted.  "At the end of the day, all the physician has is his or her reputation and suggesting that one physician is not a good as another is potentially a libelous and defamatory statement, unless there is sound data upon which to make that conclusion."
  • Relative to CON, MMA continues to oppose any expansion of CON, and the CON office remains understaffed for even its current workload.
  • MMA supports reform of the payment system and has been working with the Patient Centered Medical Work work group as well as the Coalition for the Advancement of Primary Care.
  • The study of ED use and the work by Health Dialogue should continue.

The Council, chaired by Brian Rines, PhD of Gardiner, expects to make its recommendations to the Legislature by the middle of April.

MMA members may call the office (622-3374) for a copy of the Draft Report and Recommendations or may review same on the MMA website at

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MeHAF Annual Meeting Announcement

Maine Health Access Foundation (MeHAF), Maine’s largest private health funder, will hold its Annual Meeting on Wednesday, April 15th 2009 at the Augusta Civic Center – North Wing, 2nd Floor.  It is free and open to the public.  Registration deadline: April 7.


12:30 – registration

1:00 – Keynote Address by Kathryn Power, M. Ed. of the US Dept. of Health and Human Services: Integrated Care: Transformation through Collaboration, followed by a panel discussion by Maine health experts

2:45 – Reception

3:30 – MeHAF Trustees and Community Advisory Committee business meeting (open)

For more information or to register, click here. [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.  For each bill, MMA Deputy EVP Andrew MacLean has proposed a position and any MMA committee or specialty society that might have a particular interest in the bill.  You are welcome to provide feedback about any of the bills and the proposed position by participating in the weekly conference call or by contacting Andy at or 622-3374, ext. 214.

LD 1091, An Act To Reduce the Cost of Health Insurance (monitor)

LD 1102, An Act To Establish the Maine Science Advisory Board (monitor; Public Health Committee)

LD 1106, Resolve, To Establish a Schoolchildren's Well-being Stakeholder Group (monitor; pediatricians; Public Health Committee)

LD 1116, An Act To Ensure Health Care Practitioners Understand and Screen for Domestic Abuse for Pregnant Women and New Mothers (oppose; pediatricians; OB/GYNs; Public Health Committee)

LD 1117, An Act To Create a Statewide Breast-feeding Resource System at Women, Infants and Children Offices (monitor; pediatricians)

LD 1122, Resolve, Regarding Legislative Review of Portions of Chapter 101: Establishment of the Capital Investment Fund, a Major Substantive Rule of the Governor's Office of Health Policy and Finance (monitor)

LD 1138, Resolve, To Provide Assistance to Private Sellers of Firearms (support; Public Health Committee)

LD 1140, Resolve, Directing the Department of Education and the Department of Agriculture, Food and Rural Resources To Convene a Work Group To Strengthen Farm-to-school Efforts in the State (monitor or support; pedicatricians; Public Health Committee)

LD 1142, Resolve, To Ensure Access to Speech and Hearing Services (monitor)

LD 1146, An Act To Authorize Municipalities To Impose Service Charges to Tax-exempt Property Owned by Certain Organizations Whose Primary Activities Are Not Charitable (monitor)

LD 1153, An Act To Require the Department of Health and Human Services To Procure an Equal Supply of Vaccine from Each Manufacturer of That Vaccine under Certain Circumstances (monitor; Public Health Committee)

LD 1163, Resolve, To Reduce Childhood Obesity in Schools by Adding to the Physical Education Curriculum (support; pediatricians; Public Health Committee)

LD 1164, An Act To Amend the Maine Certificate of Need Act of 2002 To Change Nursing Facilities Review Thresholds for Energy Efficiency Projects and for Replacement Equipment (monitor)

LD 1166, An Act To Implement the Recommendations of the Ad Hoc Task Force on the Use of Deadly Force by Law Enforcement Officers Against Individuals Suffering From Mental Illness (support; psychiatrists)

LD 1167, An Act To Limit the Work Week of Doctors and Medical Residents (oppose)

LD 1171, An Act To Institute Voluntary Emissions Standards for Outdoor Wood Boilers (monitor or support; Public Health Committee)

LD 1177, An Act To Establish the Maine Emergency Services Institute (monitor or support; emergency physicians)

LD 1180, An Act To Clarify and Update the Laws Related to Life and Health Insurance (monitor)

LD 1183, An Act To Prevent Predatory Marketing Practices against Minors Regarding Data Concerning Health Care Issues (monitor or support; pediatricians)

LD 1192, An Act To Change the Statute of Limitations for Health Care Practitioners (oppose)

LD 1193, An Act To Establish Uniform Protocols for the Use of Controlled Substances (oppose; anesthesiologists)

LD 1194, An Act To Establish a Reinsurance Mechanism To Expand Health Insurance for Individuals and Groups (monitor)

LD 1198, An Act To Reform Insurance Coverage To Include Diagnosis for Autism Spectrum Disorders (monitor; pediatricians)

LD 1200, An Act To Streamline the Process for Court-ordered Mental Health Examinations in Criminal Cases (support; psychiatrists)

LD 1205, An Act To Establish a Health Care Bill of Rights (support)

LD 1206, An Act To Fund the Dirigo Health Program through a High-risk Pool (monitor or oppose)

LD 1209, An Act Regarding the Consent of Minors To Receive Substance Abuse and Mental Health Treatment (oppose; pediatricians)

LD 1215, An Act To Correct Administrative Procedures Regarding the Dental Care Access Credit (monitor)

LD 1223, An Act To Allow Pharmacists To Administer Certain Immunizations (position being negotiated with pharmacy representatives; Public Health Committee)

LD 1228, Resolve, To Direct Action on Health Disparities of the Passamaquoddy Tribe and Washington County (monitor)

LD 1229, Resolve, Directing the Department of Health and Human Services To Extend MaineCare Dental and Oral Health Services (monitor)

LD 1230, An Act To Prohibit the Delivery of Tobacco Products to Consumers To Prevent the Sale of Tobacco Products to Minors (support; Public Health Committee)

The next MMA Legislative Committee conference call is scheduled for 8:30 p.m. on Thursday, April 2, 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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