May 25, 2009

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Still Time to Register for June 3rd Practice Education Seminar

For the 18th consecutive year, MMA is presenting an annual practice education seminar focusing on the topics that have been most frequently requested over the last year.  Being presented at the Augusta Civic Center on Wednesday, June 3rd, the seminar will feature presentations on technology, compliance, and quality improvement.  Four morning plenary presentations will be followed by a dozen breakout sessions in four tracks.  Registration is available on the MMA website at or by calling the MMA office at 622-3374, ext. 219.

Presenters at the seminar include Attorney General Janet Mills, Insurance Superintendent Mila Kofman, J.D.,  David McDermott, M.D., MPH, Lisa Letourneau, M.D., MPH, Joshua Cutler, M.D., Sue Butts Dion, Kenneth Lehman, Esq., Michael Duddy, Esq., Shaun Alfreds, PhD, Daniel Mingle, M.D., Brett Witham, Esq., Kathleen Healy, J.D., Vaughn Clark, James Harner, Noel Genova, PA-C, Daniel Eccher, MPH, Cheryl Peaslee, Erika Pierce, PA-C, Jennifer Reck, MA, Andrew Finnegan, Gina Hobert, CPC, MBA, Gordon Smith, Esq., and attorneys from the Health Law firm of Kozak & Gayer.  Officials from MaineCare will speak over lunch regarding pending changes to the physician fee schedule and the transition to the new management information system scheduled for February 2010.

The full-day program runs from 8:30 am to 4:30 pm with registration beginning at 8:00 am.

The breakout track on the topic of technology would be of particular interest to any practice that is just beginning to consider transitioning to an electronic medical record system.  In addition to Shaun Alfred's presentation discussing the various federal and state incentives, Daniel Mingle, M.D. will discuss how to prepare a practice for new technology and attorneys from Kozak & Gayer will discuss legal issues surrounding the use of EMR, including a discussion of questions to ask the vendor.

More than one hundred registrants and guests are expected to attend.

Maine CDC H1N1 After Action Survey - MMA Members Input Requested!

The Maine CDC H1N1 Team is conducting some debriefings on the response to H1N1, using some existing meetings and conference calls for in-person qualitative debriefings as well as the online survey below.  By following the web link below, you will be taken to an on-line survey designed to help the Maine CDC H1N1 Team understand the strengths and gaps in our recent response to the H1N1 outbreak.  Although we certainly have not seen the last of this illness, the Maine CDC H1N1 Team would very much like to hear your input and improve our state's ability to reduce the impact of H1N1 in Maine, especially as the virus continues to spread and potentially mixes in with seasonal influenza.  The survey should take less than five minutes to complete.  The team asks that you complete only one survey, even if you receive multiple invitations to participate through cross-posting.  

If possible, they would like you to complete your response by Friday, May 29th.   

Below is the link: [return to top]

Members and Staffs Invited to Attend Payor Liaison Committee June 10 on Medicare RAC Audits

MMA's Payor Liaison Committee will meet on Wednesday evening June 10th at the Association offices in Manchester to hear from Medicare officials and contractor representatives regarding the Medicare RAC audits that will begin in Maine in the second half of 2009.  The meeting will begin at 6:30 pm with dinner available at 6:00 pm.  The Committee is chaired by Nancy Cummings, M.D., an orthopedic surgeon practicing in Farmington.

All are welcome but please communicate with Diane McMahon at MMA if you are planning to attend so that we can plan adequately for dinner ( or call 622-3374, ext. 216).

The Payor Liaison Committee meets periodically with each of the major health plans, including MaineCare and Medicare, directs the activities of the Coding Center, and provides input to the Legislative Committee regarding any legislation in the area of managed care or insurance regulation.  Any member or practice manager interested in membership on the Committee should contact Gordon Smith at or  David McDermott, M.D., MPH, the Chair of the Association's Nominating Committee. [return to top]

DHHS Anounces New Office of Health Reform, Directed by Jeanne Lambrew

HHS Secretary Kathleen Sebelius recently announced the establishment of the HHS Office of Health Reform, which will work closely with the White House Office of Health Reform created by President Obama last month.  The focus of this office will be to coordinate and support efforts aimed at ensuring the passage of health care reform legislation in Congress.  The office will be directed by Maine's own Jeanne Lambrew,PhD, who served in the Clinton administration and most recently was a senior fellow at the Center for American Progress.  Jeanne is the daughter of Costas "Gus" Lambrew, M.D., retired cardiologist from Portland.

Last year, Dr. Jeanne Lambrew co-authored with former Senator Tom Daschle the book entitled, Critical, What We Can Do About The Health-Care Crisis.

Until accepting a position in the Obama administration, Dr. Lambrew was an associate professor at the Lyndon B. Johnson School of Public Affairs at the University of Texas.  She also was a senior fellow at the Center for American Progress.  Previously, she worked on health policy at the White House (Clinton administration) as the program associate director for health at the Office of Management and Budget and as the senior health analyst at the National Economic Council. [return to top]

More Information on 2nd Annual Quality Symposium, June 24, in Rockport

As noted in last week's Update, The Maine Hospital Association, Maine Medical Association and Maine Osteopathic Association will jointly present the 2nd Annual Quality Forum on Wednesday, June 24, 2009 at the Samoset Resort in Rockport.  The Symposium is also sponsored by the Maine Quality Forum.

The program runs from 8:00 am to 2:30 pm.  During the morning session, featured speaker Brian Wong, MD, MPH will present a workshop entitled, "Hospital-Physician Relations:  Building a Foundation of Trust and a Shared Vision of Excellence."  Following a networking lunch, a panel of Maine speakers will present some success stories on how physicians and hospitals can work together to improve quality and enhance access.  Presenters in this segment include Frank LaVoie, M.D., MBA, Doug Salvador, MD, Julian Kuffler, MD, MPH, Ralph Gabarro, Marie Vieneau, Brian Miller, M.D. and Barbara Crowley, M.D.

Registration is being handled through the Maine Hospital Association but is also available on the MMA website at  A registration fee of $100 per person covers a continental breakfast, breaks, lunch, and all program materials.

The target audience includes chief executive officers, other senior level executives, physicians, and board members, but all interested persons are welcome.  It is hoped that most hospitals will send an interdisciplinary team.

"At a time of great change in the healthcare delivery system, hospitals and physicians must work together to improve quality, enhance access and reduce costs,"  stated Gordon Smith, Esq.,  EVP of the Maine Medical Association.  "This type of program is aimed at providing helpful examples of how this is being done throughout the state.  MMA is proud to be a part of this program." [return to top]

Looking for A Few Good Volunteers; Serve on an MMA Committee

David McDermott, M.D., MPH, President-elect of the Association and Chair of the 2009 Nominating Committee, is soliciting volunteers for membership on MMA's Standing Committees which include the following:

  • Committee on Legislation

  • Committee on Physician Quality

  • Payor Liaison Committee

  • Committee on Loan and Trust Administration

  • Committee on Membership and Member Benefits

  • Committee on Constitution and Bylaws

  • Committee on Public Health

  • Committee on CME and Accreditation

A professional association is only as strong as its volunteer membership.  Please think about becoming more active in your professional association and volunteering for membership on one of the above committees.  Interest can be expressed to either Dr. McDermott at or Gordon Smith at [return to top]

Public Health Committee Forms Subgroup to Develop Wind Energy Resolution

The Public Health Committee met last week and formed a subgroup to work throughout the summer months to develop a robust wind energy resolution for consideration by the membership.  Assessing the potential health impact of wind turbines has been a difficult and arduous process.  The advocates on both sides have made passionate presentations and have provided voluminous amounts of references.  The proper setback appears to be one of the most significant emerging issues as it relates to topography and weather.  The MMA’s Public Health Committee will be moving this issue forward in reference to the four points below:


  • Encourage the development of government energy policy and improved generation methods that mitigate direct and indirect health effects;


  • Discourage the granting of waivers by the Maine DEP regarding noise and light effects;


  • Assist in the development and encourage the use of a “Code of Conduct” used voluntarily by the industry; and


  • Encourage studies on health effects of wind turbine generation by independent qualified researchers at entities such as schools of public health.


The subcommittee will meet periodically throughout the summer to develop a draft resolution for consideration by the Public Health Committee members at the August 19, 2009 meeting.

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Menu Labeling Bill Expects Tight Vote in Senate - Member Action Requested


The menu labeling bill, LD 1259, An Act to Increase Access to Nutrition Information was voted out of committee with a majority of 10 to 3 in favor.  In addition to support from the HHS Committee, the Governor has indicated his support for this bill as well.  This is first time that this bill has made it out of committee with a report in favor.

However, we expect a very tight vote in the Senate and we need to take action this week  to ensure that LD 1259 is enacted.  Please keep in mind that the Maine Restaurant Association has already activated restaurant owners throughout the State (including small businesses that won’t be affected) and they have actively been flooding the Senate with messages about how this is bad for business.  We can’t let them win and further deny us the information that we want and have a right to!  Please contact your Senator this week and urge him or her to support this bill.  We are only focusing our attention on the Senators below whose position we have yet to learn or they are undecided.  If your Senator is on the list, please contact him or her.  For your convenience, each Senator’s name is linked with his or her contact information and have included the talking points at the bottom.

Senators whose position we don’t know:

Senators that likely will support, but are on the fence:

Highlighted Talking Points:

  • There is a strong link between obesity and eating out…people eat large quantities of higher calorie food than they do when dining at home
  • In order for people to take personal responsibility, they must have information at the point of purchase.
  • Chains have already done the caloric analysis in other states and municipalities, so accessing  this information shouldn’t be an added burden for businesses.
  • In fact, the bill has been amended to make it much easier to comply with as it is phased in, in the region (Massachusetts just passed a similar bill) and menus and menu boards don't need to be customized for Maine. 
  • This bill gives chain restaurants until Feb 1, 2011 to comply with this regulation.  Massachusetts is requiring calories to be on boards beginning November 1, 2010 and California is requiring posting by January 1, 2011.  That is plenty of time for restaurants to phase this in as they replace or update their materials and many chains will have compliant menu materials designed and readily available by that time. 
  • This bill focuses on chains of 20+ because they have standardized menus and train employees to replicate a menu item in a standardized manner, however this bill does allow for human error and exempts custom or special orders. 
  • “Mom and pop” restaurants have a far greater degree of variation in food preparation from day to day and order to order.  That is why this policy does not apply to them and why it should not apply to them.

If you are able to reach one of the Senators above, please advise Kellie Miller, Director of Public Health Policy, know what you learn by emailing her at


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Annual Milliman Study Says Average Medical Spending Increase is Lowest in 5 Years

On May 18, 2009, the Seattle actuarial firm Milliman, Inc. released its annual Milliman Index concluding that the average medical spending for a family of four in this country increased 7.4% from a total cost of $15,609 in 2008 to $16,771 in 2009.  This is slightly lower than the 2008 rate increase of 7.6%.  The spending total includes both costs paid by an employer-sponsored plan and out-of-pocket costs paid by employees.  The report anticipates higher costs for inpatient and outpatient facility care, but slightly lower physician costs in 2009.  Milliman surveyed more than 4000 employee benefit plans in 14 major U.S. metropolitan areas in preparing the Index.

 You can find more information about the 2009 Milliman Medical Index on the web at:
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POLITICAL PULSE: MMA & MOA Host Successful Physicians' Day at the Legislature


The MMA and the Maine Osteopathic Association collaborated to host a biennial grassroots advocacy event, Physicians' Day at the Legislature, on Thursday, May 21, 2009.  Approximately 50 physicians, residents, and medical students and more than 15 medical specialty or other physician organizations participated in a successful day that began at 7 a.m. with a run/walk with Governor Baldacci to highlight organized medicine's public health and healthy weight initiatives and concluded with a conversation with the Governor in his Cabinet Room lasting almost an hour.  Committee work had concluded, but physicians had the chance to observe proceedings in both the House and Senate, to mingle with legislators in the Hall of Flags, and to tour the State House complex.  Maine's two physician legislators, Senator Lisa Marrache, M.D. (D-Kennebec County) and Representative Linda Sanborn, M.D. (D-Gorham), welcomed colleagues to the State House and the physician leadership of the MMA, the MOA, and the University of New England College of Osteopathic Medicine also offered opening remarks.  Governor Baldacci and DHHS Commissioner Brenda Harvey were very generous with their time, spending nearly an hour with our group and responding to questions or comments on issues ranging from public health (the Governor mentioned his support for L.D. 1259, the menu labeling bill) to MaineCare reimbursement and claims processing.  Throughout the morning, the Hall of Flags was full of displays, some interactive, highlighting for legislators the role of physicians in our health care system today.

Thanks to all physicians and specialty society or practice staff who participated in the event.  Please contact Andrew MacLean, Deputy EVP, with any further feedback, positive or negative, on the day so that we can improve it in the future.


Early last Tuesday morning, the Appropriations Committee completed its work on L.D. 353, the $5.8 billion budget for State FY 2010-2011 with a unanimous bipartisan committee report.  Rank and file legislators had a deadline of 10:00 am this morning to submit floor amendments and the House is expected to take initial action on the budget late this afternoon.  The Senate likely will follow suit tomorrow.  A 2/3 vote on the budget permitting it to become effective immediately upon the Governor's signature is expected.


Last Thursday, the Senate debated and ultimately defeated L.D. 453, An Act Requiring Motorcyclists to Wear Helmets, a bill supported by the MMA and the Maine Chapter of the American College of Emergency Physicians.  The Senate vote was 9-25 in favor of the minority "ought to pass as amended report" following a 118 - 20 House vote in favor of the majority "ought not to pass" report from the Transportation Committee.  You can see the legislative history of the bill, including the roll call votes on the web at:

Earlier this session, the legislature passed and the Governor signed a bill advanced by the Maine Chapter of ACEP requiring any minor, whether rider or passenger, to wear a helmet while on a motorcycle.  The bill is L.D. 437, An Act to Require a Person under 18 Years of Age to Wear a Helmet While on a Motorcycle


Also last week, the legislature enacted L.D. 683, Act Act to Promote Cost-effective and Broad-based Vision Care for Maine Citizens by Clarifying the Scope of Prescription Authority by an Optometrist , a bill negotiated over many months by the Maine Society of Eye Physicians & Surgeons and the Maine Optometric Association.  Governor Baldacci signed the bill on Friday, May 22, 2009.

The bill clarifies that optometrists may not administer therapeutic drugs by injection, other than for emergency treatment of anaphylaxis, provides optometrists with the authority to dispense or sell contact lenses that contain and deliver pharmaceutical agents, removes restrictions on prescribing certain oral therapeutic drugs, and provides an optometrist with an advanced therapeutic license the authority to use and prescribe any therapeutic pharmaceutical agent, including any drug identified in schedules III, IV, and V as described in 21 United States Code, Section 812, for any purpose associated with ocular conditions and diseases, except for oral chemotherapeutic agents, oral immunosuppressive agents, and oral immunostimulantagents, and except that an optometrist who has received an advanced therapeuticlicense may prescribe one 5-day supply of any analgesic identified in schedules III, IV, and V as described in 21 United States Code, Section 812.  The bill also provides the standards pursuant to which optometrists are authorized to independently treat glaucoma.


Following lengthy negotiations among stakeholders including the MMA and several work sessions in the HHS Committee, the legislature is poised to consider an 8-6 divided report on L.D. 1395, An Act to Amend the Maine Certificate of Need Act of 2002, a bill submitted by DHHS to address issues it's identified in administering the CON program. The MMA was most concerned about a proposal to remove the inflation indexing and to lower the thresholds for CON review.  Both the majority and minority reports eliminate the inflation indexing from the statute and set the thresholds for review slightly higher than they are currently:

  • Major medical equipment:  $1.6 M
  • New technology:  $1.6 M
  • Capital expenditures:  $3.1 M

HHS members on the minority report wish to establish a dollar threshold for CON review of replacement equipment.  Replacement equipment currently is exempt from CON review, but the Department has proposed to eliminate this exemption.  Both reports also eliminate a provision in the original bill to require CON review of medical office buildings built by hospitals.






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

The next regular Legislative Committee conference call will be this Thursday, May 28, 2009 at 8:30 p.m.  The conference call number is 800-989-2842 and the access code is 6223374#.  The Committee work is finished for this session, but the MMA staff will provide an update on floor action on the biennial budget (L.D. 353) and other legislative highlights of the week. [return to top]

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