May 3, 2009

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Political Pulse: Governor Baldacci Presents Plan to Address New Budget Shortfalls

Last Friday, the Governor released an overview of his plan to fill a $569 million budget gap.  The plan closes a $129 million budget gap for the current fiscal year ending June 30, 2009 and a $440 million gap in fiscal years 2010-2011, the biennium which is the subject of L.D. 353.  In January, the Governor released a $6.1 billion budget plan for the FY 2010-2011 biennium, a figure slightly below the $6.3 billion budget enacted for the FY 2008-2009 biennium.  The current proposal would reduce the General Fund budget to $5.8 billion.


Following the school vacation week, the legislature now is focused on completing the work of its First Regular Session by the statutory adjournment deadline of June 17, 2009.  Committee chairs are under great pressure to complete public hearings and work sessions on their bills and to vote them out onto the floor.

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

The new budget plan released by the Governor last week does not alter the Appropriations Committee decisions on physician reimbursement reported in last week's Maine Medicine Weekly Update.  Hospital-based outpatient services will be reimbursed at a rate of 83.6% of cost, a reduction from 89.7% ($9.6 million in state and federal funds).  The private MaineCare fee schedule will move from approximately 57% of Medicare rates to approximately 70% of Medicare rates effective February 1, 2010 (approximately $7.5 million).  

The Governor's press statement on the new budget proposal containing a link to the Governor's finance page may be found on the web at:

There appear to be no further cuts in DHHS programs in the current fiscal year (FY 2009).  The additional DHHS cuts for the next biennium are:

  • Eliminate targeted case management (TCM) for MaineCare members receiving care management from Schaller Anderson ($1.37 M in each year of the biennium);
  • Increase the eligibility requirement for TCM for children from a CAFAS score of 50 to 70 ($3.8 M in each year of the biennium);
  • Increase MR waiver residential reductions in rates from 5% to 7% ($1.7 M in each year of the biennium);
  • Move children's PNMI reimbursement rates to the New England average ($8.9 M in each year of the biennium);
  • Pharmacy savings ($1.7 M in 2010; $2.6 M in 2011);
  • Pay a portion of hospital payments by cascade ($15 M in the first year); and
  • Antivirals for influenza pandemic - paid for from ARRA funds ($2.2 M in the first year). 

According to an analysis prepared by the Maine Municipal Association, about $100 million of the $440 million gap is addressed with federal stimulus funds.  The remainder of the gap is addressed as follows:

  • Cuts to education, including higher education ($84 million);
  • Adjustments/increases to state income taxes/enhanced collections ($77 million);
  • Unidentified cuts or "efficiencies" to be developed by a special streamlining commission ($37.5 million);
  • Cuts to human services programs ($36 million);
  • Cuts to property tax relief programs ($28 million);
  • Cuts to state employees ($27 million);
  • Hospital reimbursement delays ($15 million); and
  • Capping state support for the milk price stabilization program ($14 million).


Following a strong majority vote of the Judiciary Committee last week, the Senate debated L.D. 1020, An Act to End Discrimination in Civil Marriage and Affirm Religious Freedom on Thursday, April 30, 2009 and voted in favor of enactment by a vote of 21-14.  You can see the Senate's roll call vote on the web at:

The bill will be on the House calendar this week.


Last week, the HHS Committee heard controversial and complex bills on the sentinel event reporting law and the certificate of need program:  L.D. 1435, An Act to Amend Sentinel Events Reporting Laws to Reduce Medical Errors and Improve Patient Safety and L.D. 1395, An Act to Amend the Maine Certificate of Need Act of 2002.  The MMA and the MHA opposed both bills and both are now the subject of negotiation among the affected communities and state officials.   The Committee voted to pass a bill submitted on behalf of MMA to eliminate the sunset provision in the statute setting aside 12.5% of the Capital Investment Fund (CIF) for non-hospital projects:  L.D. 239, An Act to Eliminate the Repeal Date on Nonhospital Expenditures in the Capital Investment Fund.

The Committee also voted to carry over to the next session bills on disposal of unused prescription drugs and pharmaceutical benefit managers:  L.D. 821, An Act to Support Collection and Proper Disposal of Unwanted Drugs and L.D. 1339, An Act to Improve Oversight of Pharmaceutical Purchasing.

Finally, the Committee held a public hearing on and then a work session at which it voted to enact L.D. 1363, An Act to Establish and Promote Statewide Collaboration and Coordination in Public Health Activities and to Enact a Universal Wellness Initiative, a bill supported by the MMA and other public health advocates after several years of work.


At a work session last week, the Labor Committee voted unanimously to kill L.D. 1167, An Act to Limit the Work Week of Doctors and Medical Residents, a bill opposed by the MMA, MHA, MaineHealth, and all of the residency programs in the state.

The Judiciary Committee also voted unanimously to kill L.D. 1209, An Act Regarding the Consent of Minors to Receive Substance Abuse and Mental Health Treatment and L.D. 1192, An Act to Change the Statute of Limitations for Health Care Practitioners.


Lastly, the MMA joined other public health advocates in submitting testimony in favor of L.D. 1407, An Act to Implement the Recommendations of the PE4ME Planning & Oversight Team, a priority bill in the healthy weight efforts this session.






State Public Health Officials & Medical Community Address H1N1 in Maine

As of Monday, May 4, 2009, seven cases of Mainers with the H1N1 virus had been identified and all are recovering.  The cases include two adults in Kennebec County, 3 adults and 1 youth in York County, and a youth in Penobscot County.  The latest press release from the Governor's Office on the status of the virus in Maine and the State's response is available at:

This site also has links to the Maine and federal CDC web site resources on the H1N1 virus.

The AMA has H1N1 resources on its web site at:
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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 6:30 pm with dinner following at 7:00 pm.  The cost is $35 per person and persons wishing to attend are asked to RSVP to Lisa Martin at MMA.  Lisa may be reached by calling 622-3374, ext. 221 or via email to

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]

AMA Continues to Press for PQRI Changes

The AMA recently hosted a meeting with Dr. Mike Rapp, CMS Director of the Office of Clinical Standards and Quality Measurement Group, to discuss changes to the PQRI.  The agency continues to improve the mechanics for quality data codes.  CMS is not only applying these modifications to the 2008 quality data submissions, but is also revisiting the 2007 submissions.  The initial data show these modifications are substantially increasing the number of physicians who successfully participated in the PQRI.  The agency anticipates these new analyses and any associated incentive payments for both 2007 and 2008 will be completed and paid by the Fall.

CMS soon will post revised aggregate feedback information by quality measure for the first nine months of the 2008 PQRI reporting period.  The agency hopes this information will help physicians and other health care professionals improve their reporting accuracy.  This information will be made available at  The agency also is considering ways to improve individual and group practice feedback report processes without compromising data security.  Feedback report formats are being redesigned for 2008 and CMS plans to share a draft mock-up with the AMA for review in the coming weeks. [return to top]

FTC Again Delays Enforcement of Controversial "Red Flag" Rule

On April 30, 2009, the Federal Trade Commission (FTC) voted to delay the so-called "Red Flags" rule from May 1, 2009 to August 1, 2009.  During this period the American Medical Association (AMA) and other medical societies will continue efforts to persuade the FTC and the Congress that physicians are not "creditors" and should not be subject to this rule.

AMA Board of Trustees member Cecil Wilson, M.D. recently met with the new Chairman of the FTC, Jon Leibowitz, and urged him not to define physicians as "creditors" subject to the FTC's "Red Flags" regulation to deter identity theft.  The AMA has developed guidance material to help physicians comply with the rule if compliance is required.  You can find the guidance on the AMA web site at:
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HIMSS Publishes Its Definitions of 'Meaningful Use'

On Monday, April 27, HIMSS published its definitions of ‘meaningful use of certified EHR technologies,’ as outlined in the American Recovery and Reinvestment Act of 2009 (ARRA). Approved by the HIMSS Board of Directors, the definitions resulted from consensus-building effort with input from HIMSS members (73 percent of which work in end-user settings), and the public at-large.  HIMSS represents more than 20,000 individual members and 350 corporate members.

In summary, HIMSS recommends the following:

  1. To ensure continuity, recognize CCHIT as the certifying body of EHRs.
  2. To achieve incremental maturation of “meaningful use,” adopt metrics that can be reasonably captured and reported beginning in FY11/2011,* and then made increasingly stringent using intervals of not less than two years.  HIMSS’ definitions include specific metrics to enact, in phases, over a multi-year period.
  3. To bridge existing gaps in interoperability of health information, coordinate with HITSP and IHE to create new harmonized standards and implementation guides.
  4. Reconcile the gap between “certified EHR technologies,” “best of breed,” and “open source” technologies.

As noted in the letter, HIMSS believes that the Act has tremendous potential to improve the quality, safety, and cost-effectiveness of patient care.

*ARRA requires the hospital-focused definition to be effective FY11 (October 1, 2010).  For meaningful users (physicians), the definition must be effective January 1, 2011. [return to top]

Public Health Committee to Meet May 20th, 4-6 pm at MMA

The MMA’s Public Health Committee will hold its next meeting from 4 pm to 6 pm on May 20, 2009 at the MMA.  Light refreshments will be available.  Please RSVP your attendance plans to by May 15th, and indicate whether you will be joining the meeting in person, by conference call, or by video-conferencing at the MMC Dana Center, in Portland, Maine. 

The agenda will include:

  • Finalizing the Public Health Forum Panel on “Environmental Toxins – the Economic Cost of In-Action,” to occur at the MMA's Annual Session on September 13, 2009;

  • Priority legislation updates regarding childhood immunization program in Maine and the cost barriers, as well as the healthy weight legislative priorities on menu labeling, increased physical education in schools (PE4ME), status of Body Mass Index data collection, and the physician role in local communities and school districts;

  • Discussion on the development and preparation of potential Public Health Resolutions for submission to the MMA’s General Membership Meeting;

  • Wind Turbine Issue - follow up action by the Public Health Committee;

  • Because of the most recent H1N1 influenza outbreak, we will allow time on the agenda for updates.

All MMA members are welcome to attend the Public Health Committee meetings and we encourage your participation to assist us in moving our Public Health agenda forward.  The full agenda and meeting packet will be emailed prior to the meeting to all committee members and to those members who are interested in receiving the agenda.

The conference call number is:  1-800-989-2842, Passcode:  6223374#.

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18th Annual Practice Education Seminar Scheduled for June 3 at Augusta Civic Center

Registration materials are now available for MMA's 18th Annual Practice Education Seminar being held on Wednesday, June 3, 2009 from 8:30 am to 4:30 pm at the Augusta Civic Center. 

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, Esq.
  • 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

Contact Maureen Elwell at 622-3374, ext. 219  or for registration materials or go to [return to top]

Mediators' Spring Meeting Features Professor Aaron Lazare, M.D. on Apologies

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

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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: [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.

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

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CIGNA Reduces Documentation Submission Requirement

CIGNA had announced that it would require supporting documentation for any procedures and services that are appended with a CPT modifier 25 or 59.  The AMA, the American College of Cardiology, and the Physician Advisory Institute (the entity created to enforce the CIGNA litigation settlement), and other medical societies expressed concerns about increased time and expense for processing these claims.  As a result, CIGNA reworked its policy.  Instead of requiring increased documentation on 17,000 NCCI code pairs, CIGNA is working to reduce the requirement to fewer than 500 code pairs. 

Beginning April 27, 2009, the code pairs that require supporting documentation will be significantly reduced.  This list will be available at under "Resources" and "Claim Editing Procedures."  Physicians who have not registered on the site will have to do so first. [return to top]

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

The Office of the Revisor of Statutes is reaching the end of the bills in the pipeline for this legislative session, but there are two new bills for review this week.  In accordance with the direction of the MMA Executive Committee, I have put the link to each bill's summary page.  In order to find the text you will have to use the "Bill Text and Other Documents" option on the left side of the page.  The next regular Legislative Committee conference call will be this Thursday, May 7, 2009 at 8:30 p.m.  The conference call number is 800-989-2842 and the access code is 6223374#.  We also will use the time to provide an update on biennial budget deliberations in the Appropriations Committee and other legislative highlights of the week.

LD 1452, Resolve, Establishing the Committee To Study the Feasibility of Instituting Testing for Sports-related Head Injuries (support; pediatricians)

LD 1464, An Act To Amend Licensing, Certification and Registration Requirements for Health Care Providers and Other Facilities (monitor) [return to top]

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