July 27, 2009

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One Step Forward, Two Steps Back for National Health Care Reform

It was another busy week for efforts in Washington to reform the nation's health care system.  In what is considered by some to be a setback, Senate leaders agreed to delay a vote until after the August recess which is scheduled to begin on August 7th.  Discussion on the House side centered on a relatively new idea advanced by the President which would delegate important Medicare reimbursement decisions to an Independent Medicare Advisory Council or IMAC.  Critics are calling IMAC  "MedPac on steriods," a reference to the current advisory group that reports annually to Congress but which has no direct regulatory authority. 

The President, who on Wednesday night devoted his televised press conference to the topic of health system reform, is recommending that IMAC replace MedPAC, be reduced from the current 17 members to only 5, and that they serve five-year terms, with one of the members serving as the chairman. 

IMAC would annually have two primary responsibilities, first to set reimbursement rates and secondly to recommend broad reforms aimed at improving quality and reducing costs.  IMAC decisions would be sent to the President, who would have thirty days to act on them.  If the President approves the recommendations and sends them to Congress, it would have thirty days to approve or reject them.  But the President could act only on the entire set of recommendations (he could not pick and choose) and Congress could reject the recommendations only by joint action of both the House and Senate within 30 days of receiving the report.

Several national medical specialty societies have expressed opposition to the idea of delegating such responsibilities to an independent group and it is certainly not clear at this point if the Congress would be willing to yield that degree of control to IMAC.  But there is increasing pressure to focus on cost controls and the Congressional Budget Office (CBO) so far has been very conservative in its analysis of what items being considered might actually slow the growth trends in medical expenses.

The moderate House members organized as the "Blue Dog" caucus, which includes Maine Congressman Mike Michaud, have pressed for more cost controls in the package of reforms, expressing concern about the growing federal deficit.  MMA representatives joined representatives from organized labor this week in meeting with Congressman Michaud's staff to discuss his concerns and to encourage his support for reform.

In addition to the IMAC and the pace of development of legislation in the various Senate and House committees, other controversial issues include various funding proposals ("surtax on millionaires" and Senator Kerry's proposal to tax "Cadillac" health plans, for example), the income levels for which subsidies will be available, and the individual/employer mandate proposals.

In addition to the AMA's indication of support for H.R. 3200, the following medical societies have issued written comments on H.R. 3200 that are either supportive or neutral on the overall reform effort with comments addressing specific concerns of the specialty:  

  • the American Osteopathic Association
  • the Infectious Disease Society of America
  • the American Psychiatric Association
  • the American College of Surgeons
  • the Society of Hospital Medicine
  • the American College of Physicians
  • the American Academy of Pediatrics
  • the American Academy of Family Physicians

The following medical societies have issued statements in opposition to H.R. 3200:

  • the American Association of Neurological Surgeons/Congress of Neurological Surgeons
  • the Association of American Physicians & Surgeons

On July 22, 2009, the U.S. Chamber of Commerce launched a multi-million dollar advertising and grassroots campaign in 5 key states, including Maine (AR, CO, LA, ME, NC), arguing against the inclusion of a public option in the national health care reform effort.

You can continue to track the AMA's statements on the national health care reform developments on the web at:  http://www.ama-assn.org/ama/pub/news/news/ama-affirms-support.shtml .

The MMA will continue to update you on the national health care reform debate through the Weekly Update.

Register Now for MCMI Conference on Sports-related Concussions

The Maine Concussion Management Initiative has launched a new web page to publicize its work:  http://wiki.colby.edu/display/GCMGrant/Maine+Concussion+Management+Initiative;jsessionid=A481EB711ED6E2F088F0A815AA5FDAA2.

One of MCMI's initiatives highlighted on its home page is the Maine Concussion Management Conference scheduled for this Friday, July 31, 2009 from 9 a.m. to 4 p.m. in the Diamond Building at Colby College in Waterville.  

Attendees at this conference will learn the newest advances in the treatment of sports-related traumatic brain injuries and may have the opportunity to be certified in one of the best computerized cognitive testing tools on the market.  This is a great opportunity for Maine to establish a network of certified concussion management medical practitioners.

The MCMI is especially excited to have 3 highly-qualified lecturers for the conference:  Dr. Paul Berkner, Dr. William Heinz, and Dr. Michael "Mickey" Collins, one of the founders of the ImPACT testing battery, which currently is in use by the NFL, NHL, MLB, and NBA, among other sports organizations.

Registration information for the conference is on the MCMI web site at:  http://wiki.colby.edu/display/GCMGrant/July+31st+Conference. [return to top]

FTC "Red Flags" Regulations Compliance Deadline is August 1st

As previously reported in Weekly Update, the Federal Trade Commission's (FTC's) so-called "red flags" regulations (16 C.F.R. sec. 681) dealing with identify theft, first scheduled to take effect November 1, 2008 and delayed until May 1, 2009, will now become effective on August 1, 2009.  Despite the efforts of organized medicine to persuade the FTC not to apply the regulations to health care providers, the government has not conceded.  

The regulations require the development and implementation of a written compliance program with policies and procedures for:

  • Identifying patterns, practices, and specific forms of activity that signal red flags and incorporate them in the program;
  • Detecting red flags incorporated in the program;
  • Responding appropriately to any detected red flags to prevent and mitigate identity theft; and
  • Updating the program periodically to reflect changes in risk.

The FTC has provided some flexibility in implementing the regulations stating that the compliance program "must be appropriate to the size and complexity" of the covered entity and its activities.

The AMA has a discussion of the regulations and model compliance materials on the web at:  http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/regulatory-compliance-topics/red-flag-rules.shtml.

The FTC also has compliance guidance on its web site at:  http://www.ftc.gov/bcp/edu/pubs/business/idtheft/bus23.shtm.

If you have further questions about complying with the regulations, please contact Andrew MacLean, Deputy EVP (amaclean@mainemed.com) or Gordon Smith, EVP (gsmith@mainemed.com). [return to top]

Dirigo's Advisory Council on Health System Development Considers State Health Plan Amendment

The Advisory Council on Health Systems Development (ACHSD) created in 2003 as part of the Dirigo Health legislation, met on this past Friday, July 24th to accept public comments on an amendment to the State Health Plan and to conduct other business.  The amendment to the State Health Plan is intended to update plan recommendation #9 from the ACHSD's April 2009 cost driver report:

       Expand Certificate of Need criteria in the State Health Plan to address health care variation and high emergency department use.  The ACHSD should elaborate on the State Health Plan's CON criteria to specify that higher priority will be given to projects that explicitly address variation issues in the applicant's HSA as shown in the Health Dialog report and high ED-use in the ED report.   Further, the Department should use the Health Dialog and ED reports in assessing CON applications in regards to the statutory requirements of 22 MRSA section 335.  This should apply to reviews starting in January 2010.

Public comments were presented by the Maine Hospital Association, MMA, MaineHealth, and Consumers for Affordable Healthcare.  MHA, MMA, and MaineHealth representatives all noted that there would be some types of projects requiring Certificate of Need (CON) approval that would be irrelevant to the issues of variation and ED use.   A recent co-generation proposal by EMMC was given as an example.  All three organizations requested additional language that would limit the new criteria to projects that are relevant to them.

Council members had some discussion on the proposed amendment following the public comments.  Arthur Blank, a member of the Council and CEO of MDI Hospital, stated that he believed the plan amendment was premature with respect to the ED use issue, as the Phase II study regarding ED use has not yet been completed.

Written comments will be accepted on the Plan amendment until August 7th.  The final language will be reviewed by the Council at its next meeting.

Following the portion of the meeting devoted to the State Health Plan amendment, members received updates on the Payment Reform Subcommittee, the August 28th Council Meeting, the Oct. 8th Summit on payment reform to be presented by the Council and the Maine Health Management Coalition, and the Universal Wellness Update now underway through the Healthy Maine Partnerships.

Following the updates, Council members brainstormed on the question, "How can we build the best State Health Plan possible between now and April 2010."   Council members reviewed the existing criteria for the plan set forth in state law.  As a new Governor will inherit the new plan in January 2011, members discussed how to make the plan more actionable and how the plan could be utilized for the state to be in a position to benefit from any federal health system reforms, most of which are projected to roll out over a three to four year period.

The Council's Subcommittee on Payment Reform met following the Council meeting.  Ellen Schneiter, State Budget Director, has been asked by Council Staff to prepare a briefing paper on payment reform for the benefit of both subcommittee members and Council members.  Much of the discussion focused on how the briefing paper should be organized and what it should contain.  The Subcommittee is operating under a directive from the Legislature to prepare its recommendations for presentation to the Legislature by January 10, 2010.

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Report on MaineCare Provider Advisory Group Meeting, July 23rd

The MaineCare Provider  Advisory Group (PAG) and Technical Advisory Group (TAG) held a joint meeting on this past Thursday, July 23rd for a regular monthly meeting.  These meetings will become more important as the State heads toward implementation of the Maine Integrated Health Management System (MIHMS) in February 2010.  The current payment/information system, MECMS, will remain operating for some period of time after implementation of MIHMS, in order to have redundancy and to have additional time to clear up old claims.

MIHMS will be able to electronically process Medicare "cross-over" claims which have had to be submitted on paper since the MECMS debacle began in January 2005. 

MaineCare providers will have to re-enroll with MaineCare via MIHMS in preparation for future claims submissions to the new system.  Three re-enrollment cycles have been scheduled with each cycle lasting four weeks.

A complete listing of MIHMS Provider Types by re-enrollment cycle is located at http://www.maine.gov/dhhs/oms/pdfs_doc/fiscal_agent/alpha_pro_type_reenroll_sched070109.xls.

In addition, MaineCare has prepared a listing of all MaineCare providers, with their assigned re-enrollment cycles, based on information available to us in MeCMS and the NPI database.  This listing can be found at http://www.maine.gov/dhhs/oms/pdf_doc/fiscal_agent/prov_list_071009.xls

Re-enrollment will be accomplished via the MIHMS provider web portal.  The web portal will be available soon at www.mainemed.maine.gov.  MaineCare officials note that providers should not attempt to re-enroll prior to their assigned cycle dates.  Information requested during the re-enrollment is a dynamic process and is specific to provider types scheduled for each cycle.

Information from the Interim Payment Recovery Team (IPRT) indicated that more than 98% of the interim payments have been recovered.  Payment balances from physicians is collectively now under $2 million.

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Medical Board Convenes Stakeholders to Develop Common Narcotics Protocols

As previously noted in the Weekly Update, the Board of Licensure in Medicine (BOLIM) this past week convened other health-related licensing boards and other interested parties to begin the process of developing common protocols for the use and administration of controlled substances.  The Board was charged with this responsibility by the Legislature through enactment of L.D. 1193, Resolve, to Establish Uniform Protocols for the Use of Controlled Substances (Resolves 2009, Chapter 56). The original legislation was sponsored by State Senator Peter Mills (R-Somerset), who attended a portion of the meeting.

The meeting focused on the existing joint effort by the medical and osteopathic licensing boards to amend the current Chapter 11 rules entitled, Use of Controlled Substances for Treatment of Pain.  The existing rule has been in effect since 1999 and both boards are in the process of revising and updating the rules.  The proposed draft of the changes to the rule were shared with the other health-related boards and the question asked as to whether this effort could be the focus of the work under the Resolve.  Representatives of the other boards responded that they believed that an effort to have one set of rules issued by all the boards with regulatory authority over prescribers could be achieved and that the proposed revisions to the existing Rule was a reasonable place to start.  A second meeting has been set for Thursday, August 27 at 2:00 p.m. to continue this work.

The proposed draft of the changes to Rule Chapter 11 has been placed on the MMA website at www.mainemed.com or can be obtained by calling the MMA office at 622-3374, ext. 219. 

While the draft does not currently contain the following provisions, there was discussion about the possibility of them being added in order to respond more comprehensively to the Legislature's concern over prescription drug abuse.

  •      Mandatory CME related to prescribing for pain

  •      Requiring specialized education and training for licensees 

  •      Mandatory participation in the state's Prescription Monitoring Program

  •      Mandatory use of contracts with patients on controlled substances for long-term conditions


It is likely that most of the controversy regarding this effort will focus on these four areas, as there is little in the proposed draft currently which would cause much concern.  MMA members and office staff are welcome to share their views on this important issue with the Association by communicating with EVP Gordon Smith (gsmith@mainemed.com) or Deputy EVP Andrew MacLean (amaclean@mainemed.com).  MMA will follow this effort and report to members via the Weekly Update

Other health-related licensing boards having representation at the meeting included:

  • Board of Nursing

  • Board of Osteopathic Licensure

  • Board of Dental Examiners

  • Board of Pharmacy

  • Board of Veterinary Medicine

  • Board of Podiatric Medicine

Medicine was well represented at the meeting with both MMA representatives and several physicians attending, including Mark Publicker, M.D. of the Mercy Recovery Center, Douglas Pavlak, M.D. and John Guernelli, M.D., both of Medical Rehabilitation Associates, and David Dixon, M.D. of Franklin Memorial Hospital.  Gary Palman, D.O., an anesthesiologist and member of the Board of Osteopathic Licensure also attended.  Dr. Palman was the primary drafter of the revised Chapter 11 rules.    [return to top]

Report on Meeting of Academic Detailing Advisory Committee Meeting

The Academic Detailing Advisory Committee met on July 23rd to continue its work in order to roll out the academic detailing program to medical practices by fall.  The program, called the Maine Independent Clinical Information Service (MICIS), uses academic detailing to deliver up-to-date, evidence-based prescribing information to health care providers in order to assist physicians in improving quality and saving costs.  The first clinical topic to be addressed is diabetes and educational modules on the topic have been purchased from an affiliate of Harvard Medical School. 

At the meeting, chaired by Noah Nesin, M.D., members reviewed outreach efforts, reviewed the Powerpoint presentation which had been prepared based upon the clinical modules and reviewed a draft evaluation form that will be completed by each practice following the presentations.

If your practice would like to receive a presentation by our trained academic detailers, please contact the Program Director Kellie Miller at kmiller@mainemed.com.  There is no charge for the presentations.

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MMA to Support Regina Benjamin, M.D. for Surgeon General

On Monday, July 13th, President Barack Obama nominated Alabama physician Regina Benjamin, M.D. as the nation's Surgeon General.  Dr. Benjamin is an influential rural family physician who is well known to many physicians in Maine through her involvement with the American Medical Association.  Now 51 years of age, Dr. Benjamin became the first African-American woman to be named to the AMA Board of Trustees in 1995 when Robert McAfee, M.D. of Portland was serving as Immediate Past President of the AMA.

After graduating from the University of Alabama School of Medicine in l984, Dr. Benjamin worked in Alabama as part of her obligation to the National Health Service Corps.  She established a non-profit clinic in 1990 for a diverse community of 2500 near her home in Bayou La Batre, Alabama.  She has had to rebuild the clinic three times, twice the result of hurricanes and once after a fire. 

"And for all that she's seen and overcome, she represents what's best about health care:  doctors and nurses who give and care and sacrifice for the sake of their patients, those Americans who would do anything to heal a fellow citizen," President Obama said.  "When people couldn't pay, she didn't charge them.  When the clinic wasn't making money, she didn't take a salary for herself."

In a press release praising the appointment, the AMA noted among her many impressive accomplishments that Dr. Benjamin received a 2008 MacArthur Fellowship, commonly known as the "genius grant" and that she has just completed a term as chair of the AMA's Council on Ethical and Judicial Affairs (CEJA).

Her nomination requires confirmation by the United States Senate.  At its meeting on July 15th, the MMA Executive Committee voted to endorse Dr. Benjamin's nomination and to communicate the endorsement to Senators Snowe and Collins.

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'A Day Devoted to Immunizations," September 29th


A Day Devoted to Immunizations
September 29, 2009
Maple Hill Farm, Hallowell, Maine

Sponsored by the Maine Medical Association, American Academy of Pediatrics, Maine Chapter, and Maine Immunization Coalition

An entire day devoted to the topic of childhood Immunizations!  Join us in the morning to hear two national speakers discuss the benefits and safety of immunizations to assist physicians in responding to parents' questions.  The afternoon is a working group session on financing immunizations in the state.  A diverse group of stakeholders will be invited to the afternoon session to discuss immunization financing issues in large and small groups and to work towards a plan for immunization financing for Maine.

Space is limited for both portions.  To register for the morning CME or to express interest in the afternoon, go to www.maineaap.org/conferences.htm  

http://www.maineaap.org/conference_agenda.htm   [return to top]

Maine H1N1 Influenza Preparedness Summit, August 20, 2009

This H1N1 Influenza Preparedness Summit is sponsored by the Maine Center for Disease Control and Prevention, Maine Emergency Management Association, and Maine Department of Education.

Location: Augusta Civic Center, Augusta, ME
Date: 8/20/2009
Time: 8:30 AM -4:00 PM 

Experts forecast that the impact of H1N1 may well worsen in the Fall—when the regular flu season hits or even earlier when schools open. The goal of this Summit is to help Maine prepare for the fall and to plan for a statewide H1N1 vaccination campaign.

Our goal is to promote vigilance, preparation, and a shared responsibility to mitigate the effects of H1N1 and to offer H1N1 immunization to all people in Maine later this year.  Who Should Attend: School Nurses, Other Nurses, Physicians, EMS, and Other Health Care Providers; Local and County Emergency Management Officials; Local, County, and State Government Officials; Public Safety; Home Health and Social Services Agencies; Voluntary and Faith-Based Organizations; Educators; Other Interested Parties. 

Pre-registration is required and includes lunch and materials.  To register, click here: http://www.mcdregistration.org/signup.asp?ID=172

PLEASE NOTE:   Registration begins at 8:00 with the conference beginning promptly at 8:30.  Registrations will be confirmed by email and will be accepted on a first-come, first-served basis until the cutoff date, August 17th, or until the conference is full.

For questions about the Summit, please contact MCD Meeting Services at 207-622-7566, ext. 231 or 232. [return to top]

2009 International Symposium on Pharmaceuticals in the Home and Environment, Oct. 18-20



2009 International Symposium on Pharmaceuticals in the Home and Environment
October 18-20, 2009
Point Lookout Resort and Conference Center,
Northport, Maine

Attention: Drug and law enforcement personnel, pharmacists, environmentalists, health care practitioners, educators and researchers, policy makers and program planners and administrators  

  • Meet with the leading authorities on prescription drug use, abuse, return and disposal
  • Attend cutting edge educational symposia and panel sessions
  • Build your skills at expert-led, pre-conference, technical assistance workshops
  • Enjoy the special networking opportunities, exhibits, and annual film festival

And do it in one of the most beautiful places in the United States - Point Lookout at Ducktrap Mountain - on the spectacular Maine coast!


A great selection of pre-conference workshops, posters, symposia, panels, and plenary sessions have been scheduled on all aspects of drug use, misuse, abuse, return, and disposal.

To see the full conference program of presentations and speakers as well as registration materials please go to: 



Registration fees and information:
2 days: $199 (students = $150)
1 day:  $119 (students = $75)
Pre-conference workshops: $65 (students = $45)

For more information about registering: Contact Marolyn Bissonnette, CME Office Manager at mbissonnette@une.edu or 207-602-2589

To download an interactive conference registration form in MSWord table format in which information may be typed in empty boxes as indicated, saved to your computer, and 1) emailed as an attachment, or 2) printed, then faxed or mailed, please go to: http://www.mainebenzo.org/2009conference.htm


Exhibitors take advantage of the opportunity to reach a national audience at this prescription drug conference. The conference exhibitor application form and instructions can be found at:


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