April 27, 2009

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New Flu Strain of Increasing Concern to WHO and Maine CDC

A new flu strain that has killed up to 68 people in Mexico could become a pandemic, the World Health Organization warned on Saturday, as health experts tried to track the spread of the disease. Maine CDC Director Dora Anne Mills, M.D., MPH also spent the weekend in conference calls with staff and the CDC in order to receive the latest information and prepare a Health Alert.  The new flu strain -a mixture of swine, human and avian flu viruses- is still poorly understood and the situation is evolving rapidly.

" It has pandemic potential because it is infecting people," WHO Director-General Margaret Chan said in Geneva.  "However, we cannot say on the basis of currently available laboratory, epidemiological and clinical evidence whether or not it will indeed cause a pandemic."

According to the Maine CDC, there are 21 confirmed cases in the U.S. (Southern CA and Texas), average age is 16, most are teenagers, with no known contact with swine and only one with recent known travel to Mexico.

The virus is thus far resistant to two antivirals (amantadine and rimantidine) and susceptible to two (tamiflu and relenza).

Following is Updated Guidance from Maine CDC for Laboratory Testing of Persons with Suspected Swine Influenza A (H1N1) Virus:

Situation Update: No cases of swine influenza (H1N1), known as swine flu, have been detected in Maine as of April 26, 2009.  Maine CDC urges health care providers to increase surveillance for acute febrile respiratory illness to identify early any cases of swine influenza (H1N1) in Maine.

As part of their ongoing investigation into the outbreak, CDC yesterday announced confirmation of an additional 13 human cases of infection with swine flu in the U.S, bringing the total number of cases to 21 so far. At this time, cases of swine influenza have been confirmed in California, Kansas, New York City, Ohio and Texas. Based on the rapid spread of the virus thus far, public health officials believe that more cases will be identified over the next several weeks. Case counts are updated daily and available at http://www.cdc.gov/swineflu/investigation.htm_63" value="" />.

Yesterday the Acting Secretary of the U.S. Department of Health and Human Services declared a public health emergency in the United States. U.S. CDC and Maine CDC’s goals are to reduce transmission and illness severity, and provide information to assist health care providers and the public in addressing the challenges posed by this newly identified influenza virus. To this end, U.S. CDC has issued a number of guidance documents in the past 24 hours. In addition, U.S. CDC’s Division of the Strategic National Stockpile (SNS)  is releasing one-quarter of its antiviral drugs, personal protective equipment, and respiratory protection devices to help states respond to the outbreak.  Maine CDC is working closely with U.S. CDC to arrange for these materials to be delivered to and distributed in Maine, primarily for the care of hospitalized patients seriously ill with swine flu. 

Additionally, Maine CDC’s laboratory, the Health and Environmental Testing Laboratory, has increased its capacity to test for swine influenza.  Maine CDC senior and epidemiology staff have been in close and frequent contact with U.S. CDC and other New England states, making preparations to address this expanding outbreak. 


Surveillance for Swine Influenza
Maine CDC is prioritizing its surveillance efforts for swine influenza on identifying potential cases of febrile, respiratory illness in order to rapidly identify and confirm potential cases in Maine (Figure 1). Maine CDC requests that providers report and test patients with acute febrile respiratory illness who traveled to an affected area 7 days prior to their illness or who have been in contact with confirmed cases of swine flu.   Health care providers may choose to perform a rapid antigen test in-house; however, a separate specimen is recommended for testing at the State Health and Environmental Testing Laboratory (HETL).  Expedited transportation of clinical specimens to HETL is recommended. Instructions for collecting and submitting laboratory diagnostic specimens for swine influenza testing are available at http://www.maine.gov/dhhs/etl/micro/submitting_samples.htm. Nasopharyngeal swabs are the preferred specimens for influenza testing in the current swine influenza context.

Maine CDC requests that providers also immediately report any clusters of influenza-like illness in medical facilities, congregate settings such as longterm care facilities, or schools.   

Disease Reporting and Consultation
To contact Maine CDC, including to report suspected cases of swine influenza and arrange for specimen testing, please call the 24/7 Disease Reporting and Consultation Line at 1-800-821-5821.

For More Information:
This is a rapidly evolving situation and guidance should be considered interim.  Updated information will be available on the websites below

Maine CDC Swine Flu Website:  http://www.maine.gov/dhhs/boh/swine-flu-2009.shtml

US CDC Swine Flu Website:  http://www.cdc.gov/swineflu

New US CDC guidance is available at: http://www.cdc.gov/swineflu/recommendations, including:

Congresswoman Chellie Pingree to Address Penobscot County Medical Society Meeting

First District Congresswoman Chellie Pingree will be the guest speaker at an upcoming meeting of the Penobscot County Medical Society.  The dinner meeting will be held at the new Hilton Garden Inn at 250 Haskell Rd. in Bangor on Friday evening, May 8.  A reception will begin at 6:30pm with dinner following at 7:00pm.  The cost is $35 per person and persons wishing to attend are asked to RSVP to Lisa Martin at MMA by April 29.  Lisa may be reached by calling 622-3374 ext. 221 or via email to lmartin@mainemed.com

Congresswoman Pingree was elected in November to represent Maine's First District in the United States House of Representatives.  She has formerly served in the Maine Senate and until announcing her candidacy for Congress served as President of Common Cause in Washington D.C.  She is well known nationally for her advocacy in the areas of health reform and pharmaceutical costs.  No doubt she will address both subjects in her presentation.

You need not be a member of the PCMS or MMA to attend.  All are welcome and invitations have been sent to all MMA members in Penobscot, Aroostook, Piscataquis, Hancock, Washington and Somerset counties. [return to top]

Final Program Announced for 18th Annual Practice Education Seminar on June 3 at Augusta Civic Center

Registration materials will be available this coming week for MMA's 18th Annual Practice Education Seminar being held on Wednesday, June 3, 2009 from 8:30am to 4:30 pm at the Augusta Civic Center.  A PDF of the program will be emailed to practice managers and physicians early this week and the printed brochure with the final program and registration materials will be mailed by the end of the week.  Registration will be available on the MMA website as well, beginning on Tuesday, April 28.

In addition to Keynote Presenters Attorney General Janet Mills and Insurance Superintendent Mila Kofman, J.D., other speakers in the morning plenary session include Shaun Alfreds, PhD, Dan Mingle, M.D., David McDermott, MD., MPH, Josh Cutler, M.D., Lisa Letourneau, M.D., and Sue Butts-Dionne.

Following lunch where attendees will hear from MaineCare officials, a choice of twelve breakout sessions will be available in four tracks focusing on Technology, Practice Management, Compliance and Hot Topics.  These dozen sessions will be led by the following faculty:

Michael Duddy, Esq.
Brett Witham, Esq.
Kate Healy, J.D.
Vaughn Clark
Noel Genova, PA-C
Erika Pierce, PA-C
Jennifer Reck
Daniel Eccher
Kozak & Gayer
Kenneth Lehman, Esq.
Andrew Finnegan

The exhibit area will feature technology vendors but other exhibitors are welcome as well.  Contact Gail Begin at MMA is your firm or company is interested in exhibiting (622-3374 ext. 210 or gbegin@mainemed.com). [return to top]

Augusta Health Lawyers from Kozak & Gayer to Present EMR Program on Friday, May 1

MMA's next First Fridays educational program will feature the topic of, "Electronic Health Records, Possibilities and Pitfalls."  The program will be held at the MMA offices in Manchester and will begin at 9:00am and end at noon.  A sixty dollar fee covers breakfast and all course materials.  Three hours of category one CME are available but the program will be of interest to physicians, practice managers and medical records personnel.

The program is particularly valuable for a practice which intends to get into an electronic medical records system in the next few years, in time to take advantage of the additional reimbursement available as a result of the federal Stimulus legislation.  The federal bill authorized up to $19 billion in HIT funding.  That is serious money, even by federal standards.

Several lawyers from the Health Law firm of Kozak & Gayer in Augusta will participate in the program. 

A brochure was emailed or faxed to many of you last week but if you need one to register, call the MMA office at 622-3374 and press ext. 219 for Maureen Elwell.  Or email her at melwell@mainemed.com.  Registration is also available on the MMA website at www.mainemed.com. [return to top]

Maine Society of Eye Physicians and Surgeons Spring Meeting Friday, May 1

The Maine Society of Eye Physicians and Surgeons, the professional association of seventy two ophthalmologists in the state, will hold its annual Spring meeting at the Harraseeket Inn in Freeport this Friday, May 1.  The meeting will begin with lunch at noon.  Following a business meeting, two presentations will occupy the balance of the afternoon, including a discussion of HIT by Dan Mingle, M.D. of MaineMSO. 

At the business meeting, members will be appraised of the current status of L.D. 683, introduced at the request of the Maine Optometric Association.  The bill as originally presented would have greatly expanded the scope of practice of optometrists in the state.  It is currently pending before the Business, Research and Economic Development Committee. 

The Society President is Lawrence Piazza, M.D., of Blue Hill, who practices in Ellsworth. [return to top]

MMA Senior Section Hears Report on Tufts-MMC Program

This past Wednesday, April 22, MMA's Senior Section heard from Robert Trowbridge, M.D. regarding the details of the curriculum for Maine's first allopathic medical school program since the Maine Medical School closed in 1920.  Dr. Trowbridge informed over thirty attendees of the detailed plans for orientation for the thirty plus students in the first year class beginning this summer. 

One of the primary features of the orientation is the opportunity to observe medical practice in a number of practices throughout the state. 

Opportunities for currently practicing physicians to serve as proctors also were discussed as were voluntary mentoring opportunities for retired physicians.

The Senior Section will meet next on August 12.  The Section is chaired by Buell Miller, M.D. [return to top]

Maine CDC Seeks Medical Epidemiologist

The Maine CDC is advertising for a Medical Epidemiologist to work in the Division of Infectious Disease to provide guidance and support to approximately 12-15 epidemiologists for disease investigations and outbreak control, surveillance activities, and planned epidemiologic studies. The person is expected to be involved in the development of disease investigation protocols and the review of case investigations as well as to consult with physicians and other health care professionals on disease prevention and control measures. The person is also expected to respond to inquiries from the public and media as well as interact with staff in the Office of Public Health Emergency Preparedness, the Health Inspection Program, and the Health and Environmental Testing Laboratory. On call duties are rotated among several physicians, and primarily consist of phone call support for on-call epidemiologists.  Requirements for the position include:  graduation from an accredited school of medicine or osteopathy with board certification in an appropriate medical specialty; a twelve year combination of training and experience in medicine and public health, to include a minimum of four years experience as an epidemiologist, or a Masters Degree in Public Health or a related field and six years experience in the field of medicine and public health, to include a minimum of four years of experience as an epidemiologist. Current license or eligibility to be licensed to practice in the State of Maine is also required.  The position is open until May 22nd.  Salary range is up to about $141,000.  Additional benefits include comprehensive health and dental insurance as well as retirement.  For more information:  http://www.maine.gov/tools/whatsnew/index.php?topic=dhhs_direct_hire_jobs&id=71243&v=dhhs [return to top]

Professor Aaron Lazare, M.D. is Keynote Speaker for Maine Association of Mediators Spring Conference

Interested physicians are welcome at the Maine Association of Mediators Spring Conference scheduled for Wednesday, May 13, 2009 at the Hilton Garden Inn in Freeport.  The conference schedule runs from 8:30 a.m. to 4:30 p.m. and includes not only the keynote address by Dr. Lazare, but a series of workshops including an Advanced Workshop on Apology led by Dr. Lazare.  Dr. Lazare is a Researcher, Professor of Psychiatry and Medical Education.  He is currently Chancellor and Dean Emeritus at the University of Massachusetts Medical School in Worcester. 

In 1982, Dr. Lazare became a professor of psychiatry and Department chair at the University of Massachusetts Medical Center.  There, he initiated an entirely new sphere of scholarly activity on the subject of shame and humiliation in medical encounters.  Many consider him a national leader in this area and his research is ongoing.  His thesis suggests that the doctor-patient relationship can give rise to shame experiences for both parties, and that physicians can be taught ways to enhance the patient's dignity while minimizing humiliation.  Dr. Lazare's groundbreaking research shows that an apology is not "an admission of liability or fault," and in fact, can work to the opposite effect.  

The non-MAM-member rate for the conference is $125 and registration is available online at www.mainemediators.org.

  [return to top]

Maine Healthcare Information Technology Symposium, June 12


Maine Healthcare Information Technology Symposium


Sponsored by the Franklin Community Health Network and HealthInfoNet

Mark Your Calendars


Friday, June 12, 9 a.m. to 3 p.m.

Franklin Memorial Hospital, Bass Room 

111 Franklin Health Commons
Farmington, Maine


Registration is limited to 100 participants. The registration fee for this event is $10 and includes lunch. http://www.fchn.org/registration/it-symposium

Topics will include:

  • The Impact of the Economic Stimulus Package for Maine's Healthcare IT Community - Pat Morin, Principal, Baker, Newman and Noyes
  • HealthInfoNet Update on the Pilot Project - Dev Culver, Executive Director, HealthInfoNet
  • Show me the HIT Grant Money - Cathy Bruno, VP and CIO and Jean Mellett, Director of Planning, Eastern Maine Health System
[return to top]

Political Pulse: Appropriations Committee Announces Plan for Hospital/Physician Reimbursement Issues in Biennial Budget


As reported last week, the legislature scheduled no general sessions during the school vacation week and the leadership permitted committee chairs to determine public hearing and work session schedules for their committees depending on the workload and progress in meeting deadlines for processing bills.  Most committees other than the Judiciary Committee had very light schedules.

THE FY 2010-2011 BIENNIAL BUDGET (L.D. 353)

Late Friday afternoon, the Appropriations Committee staff announced that the Committee would meet at noon on Sunday, April 26, 2009 to discuss the hospital and physician reimbursement issues in the FY 2010-2011 biennial budget.  Committee members spent most of Sunday afternoon caucusing with legislative leadership, but some time after 4 p.m., the Committee came into a public work session to address these issues.

Representative Lisa Miller (D-Somerville) outlined the following 4-part plan.  Since Sunday afternoon the plan has been modified several times as the DHHS and Appropriations Committee staffs continue their analyses.  The Committee has worked throughout the day today and is in a work session as this edition goes to publication.

  1. Reductions in hospital reimbursement.  The plan begins with a $9.1 million cut in hospital reimbursement in FY 2010, the General Fund amount representing the Governor's original proposal for cuts in reimbursement for critical access hospitals and hospital-based physicians.  Reimbursement for critical access hospitals would be reduced from 117% of costs to 109% of costs.  Outpatient services would be reduced from 89.7% of costs to 83.7% of costs.  Inpatient and ER services would be reduced from 100% of costs to 92.8% of costs.  The TEFRA rate would be reduced 7.2% overall and would affect each hospital differently.
  2. Reimbursement for physicians paid according to the MaineCare fee schedule.  The proposal maintains a 3% increase in PIP payments ($2.2 million) in FY 2010, but apparently uses projected PIP increases in FY 2011 to move the fee schedule towards 70% of Medicare rates.  The total amount planned for the fee schedule is $7.6 million with $2.9 million being applied to the fee schedule in FY 2010 and $4.7 million being applied in FY 2011 to bring the rates up to approximately 70% of Medicare rates effective February 1, 2010.
  3. Implementation of an APC/DRG payment system for hospitals.  The plan would direct DHHS to begin implementation of an APC/DRG  payment system for hospitals beginning April 1, 2010.  The conversion of the payment system is designed to be budget neutral.  Each hospital would move to the new payment system at the beginning of its first fiscal year after April 1, 2010.  DHHS will re-weight the APC/DRG system to increase reimbursement for preventive services and chronic disease management.  The Department will report back to the HHS Committee on the conversion in January 2011.
  4. Report on hospital efforts to reduce ER use and to manage chronic conditions.  The plan also would require the Governor's Office of Health Policy & Finance to report to the HHS Committee in January 2010 on hospitals' efforts to reduce ER use and to manage chronic conditions.


The Judiciary Committee had the highest profile last week as it held a day-long public hearing at the Augusta Civic Center on two bills dealing with gay marriage and civil unions, L.D. 1020, An Act to End Discrimination in Civil Marriage and Affirm Religious Freedom and L.D. 1118, An Act to Expand Rights for Maine Families.   The press reported that more than 3000 people turned out for the hearing.  While the MMA did not take a position on L.D. 1020, the Maine Chapter of the American Academy of Pediatrics and the Maine Association of Psychiatric Physicians both supported the bill.  Pediatricians Dan Summers, M.D. and Norma Dreyfus, M.D. both submitted testimony on behalf of the Maine Chapter of the AAP.  The Judiciary Committee has scheduled a work session on the bills for Tuesday, April 28, 2009.


  [return to top]

REMINDER: Legislative Committee Conference Call this Thursday at 8:30 p.m.

Again this week, there are no new bills for review.  However, we will still hold the regular Legislative Committee conference call this Thursday, April 30, 2009 at 8:30 p.m.  The conference call number is 800-989-2842 and the access code is 6223374#.  We will use the time to provide an update on biennial budget deliberations in the Appropriations Committee and other legislative highlights of the week. [return to top]

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