August 17, 2009

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Make Plans Now for MMA Annual Session Sept. 11-13 in Bar Harbor

The Association's 156th Annual Meeting is only three and a half weeks away (Sept. 11-13, 2009).  The room block at the Harborside Hotel in Bar Harbor has been extended until August 20 so be sure to make your room reservations this week.  For the list of alternative housing, please contact Diane McMahon at MMA (  You may register on-line for the meeting at and we encourage members and guests to use this convenient way of registering. In addition to seven hours of CME, there will be an opportunity to discuss the current status of health system reform with your colleagues and the MMA leadership.  This is an important year to attend the annual meeting of your professional society to keep informed about what is happening at the national and state levels.

Lately, headline after headline presents the status of health care reform.  Everyone seems to have an opinion about the health care delivery system of the future.  How about you!  Come and let MMA hear your thoughts.

Don't let change happen without you.  Perhaps there has never been a more important time to engage with your physician colleagues to influence the future of your profession.

The Friday and Saturday afternoon CME features the topic of Personalized Medicine:  Translating Science to Clinical Practice and is presented jointly by MMA and The Jackson Laboratory.  The CME on Sunday morning features a Public Health Forum with the topic of, Public Health, Swine Flu & You:  The Practicing Physician's Role in Emerging Public Health Threats.

The Association's annual business meeting will be held on Saturday morning, Sept. 12 and will feature consideration of Resolutions presented by MMA committees and individual members and presentations by Medical Mutual Insurance Company of Maine and AMPAC.  There will also be an "open microphone" session to allow any member to present issues of concern, including health system reform.  Governor Baldacci will attend some of Saturday's session as well.

Nearly twenty-five exhibitors have registered to exhibit in the Exhibit Hall.

Should you have any questions about the Annual Meeting, please contact Diane McMahon at or by calling 622-3374 ext. 216 or Gordon Smith, Esq., at or via phone to 622-3374 ext. 212.

Update on Health System Reform; MMA Activities Accelerate

Last week proved to be a busy one in the very public effort to lobby the Congress to pass comprehensive health system reform.  Among the highlights:

  • President Obama signaled Sunday that he may be ready to abandon the idea of giving Americans the option of a "public plan" as part of any new health care system.
  • President Obama appeared at a health care forum in Portsmouth, New Hampshire and acknowledged the critical role of Maine's Senior Senator Olympia Snowe in the health care reform debate.  Senator Snowe is a member of the Senate Finance Committee's "gang of six" - three Republicans and three Democrats selected by committee chairman Max Baucus, D-Montana, and ranking Republican Charles Grassley of Iowa.  Many observers believe that it is the group of six who hold the key to enactment of a bill, as Senate Democrats are likely to need at least a couple Republican votes in order to avoid a potential Republican filibuster.  The six Senators continue to meet over the August recess and are still hoping to have a draft bill agreed to by Sept. 15.
  • In lieu of a "public option", a network of private, nonprofit cooperatives is gaining support.

In Maine, Families USA released a study claiming that family health insurance premiums grew more than four times faster than income in Maine over the past decades.  Health insurance premiums rose by 101 percent compared to a 22 percent increase for median income from 2000 to 2009. The average annual family health insurance premium rose from $6,915 to $13,927 over the ten-year period. 

MMA's health system reform activities this past week included an op ed piece written by MMA Executive Committee chair Jo Linder, M.D. and published in the Maine Sunday Telegram.  Dr. Linder noted her disappointment in the deteriorating tone of the debate and encouraged readers to communicate with public critics, asking the question, "What is their solution?"

On August 28, MMA President Stephanie Lash, M.D. will participate in a provider forum organized by Maine's Second District Congressman Mike Michaud.  The forum will be held in Bangor and participation is by invitation only.  About twenty-five organizations are expected to participate.

Tomorrow, MMA will assist the AMA by sending a message from the AMA to the physicians in Maine.  As there is a lot of misunderstanding in both the public and provider community, it was felt important to clarify the AMA's position. 

Visit the MMA website at for the latest developments in the health care reform debate.
















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Workers' Compensation Board Holds Hearing on Proposed Revisions to Medical Fee Schedule

At 9:00 a.m. this morning, the Maine Workers' Compensation Board held a public hearing on revisions to its Rule Chapter 5, Medical Fees; Reimbursement Levels; Reporting Requirements.  In addition to updating the fee schedule to the current Physician CPT and Medicare RBRVS report, the revised rule would establish a fee schedule for facility fees for hospitals and ambulatory surgical faciltiies. While pointing out several areas of concern, the MMA did speak in favor of a fee schedule for ASCs.  The MMA's testimony will be posted shortly on the MMA web site at:

Representatives of the Maine AFL-CIO, Maine Hospital Association, and Maine Association of Athletic Trainers spoke generally in support of the revised rule.  A BIW representative spoke against the rule.  No representative of the Maine State Chamber of Commerce spoke at the hearing, but the MMA expects it and other business interests in the state to submit written comments in opposition to the rule.

You can find the Board's rulemaking materials on the revisions to Chapter 5 on the web at: .

The Board will accept written comments on the rule until Thursday, August 27, 2009 at 5:00 p.m.

Written comments should be directed to the attention of John C. Rohde, General Counsel, Workers' Compensation Board, State House Station 27, Augusta, Maine 04333-0027. [return to top]

Bureau of Insurance Convenes Working Group on Insurance Fraud Unit

At the request of the legislature's Joint Standing Committee on Insurance & Financial Services, the Bureau of Insurance convened the first meeting of a Working Group to Examine the Creation of a Dedicated Fraud Unit on Tuesday, August 11, 2009.  Deputy Superintendent Tim Schott, a former prosecutor, is chairing the group.  At the first meeting, the Bureau staff posed the following questions:

1.  Does Maine need an Insurance Fraud Unit?

2.  What are the model states for the Bureau to look at?

3.  How would the Insurance Fraud Unit be staffed?

4.  How would the Insurance Fraud Unit be funded?

5.  What types of cases or investigations could be emphasized by the unit?

Apparently, 41 or 42 states have a dedicated insurance fraud unit and in 15 states the unit is funded solely by the industry.  Superintendent Mila Kofman made it clear that the legislature would not be receptive to a proposal for General Fund support for such an effort.  

Most of the insurance industry representatives at the meeting seemed to support the concept of a dedicated fraud unit, but the Maine Trial Lawyers Association expressed skepticism.  The Bureau last examined this issue in 2005 and produced a report favoring establishment of such a unit.

This working group must make its report and recommendations to the IFS Committee by November 13, 2009.  The next meeting of the working group has been scheduled for Thursday, August 20th from 1-4 p.m. in Room 216 of the Cross State Office Building.  The last meeting of the group has been scheduled tentatively for Thursday, September 10th. [return to top]

Dirigo Health Agency Board Gives Staff Guidance on Re-design of DirigoChoice Product

At its meeting this morning, the Dirigo Health Agency voted unanimously in favor of guidance to its staff to re-design the DirigoChoice product in a way to expand the program by 30-40% within the $38 million in funding resources expected next year.  The agency staff will bring preliminary recommendations back to the board at its meeting scheduled for Monday, September 14th at 9:00 a.m.  

Expanding the program by 30-40% would increase DirigoChoice membership from approximately 10,000 to something between 13,000 and 14,000.  The board asked the staff to develop a plan design that would adjust eligibility and would target pmpm premium and subsidy rates to meet the 30-40% membership expansion.  Finally, it would "wrap around" the following "guiding principles:"

1.  Include robust prevention, wellness, and disease management benefits.

2.  Include mental health parity.

3.  Do not include pre-existing conditions.

4.  Reduce over-use and under-use of health care by aligning quality and efficiency incentives among providers across the continuum of care so tht physicians, hospitals, and other health care providers are encouraged and enabled to work together towards the highest standards of quality and efficiency.  For example, provide tiered networks based on quality metrics and/or pay for performance (P4P) incentive models.

5.  Adhere to evidence-based best practices and therapies that reduce hospitalization, manage chronic disease more efficiently and effectively, and implement proven clinical prevention strategies.

6.  Do not pay for "never" events.

7.  Target a medical care ratio of 90% (i.e., at least 90% of every dollar must go toward medical services as opposed to the carrier's administrative costs or profit).

8.  Include strong incentives to promote the use of generic medications when available.

9.  Promote the use of medical homes and primary care.

Today's vote concludes several meetings devoted to discussions of structuring the program to do the most to improve insurance coverage within its limited resources.  Following the discussion in September, the board expects to issue an RFP for an insurance carrier in October. [return to top]

MMA Senior Section Hears Pitch for Outreach Assistance for Healthy Aging Initiatives

The MMA's Senior Section met for one of its quarterly luncheon meetings last Wednesday, August 12th at the MMA office in Manchester.  The speakers were Laurence Gross, Executive Director of the Southern Maine Agency on Aging and Peggy Haynes, MPA, Director of the Partnership for Healthy Aging at MaineHealth.  Mr. Gross and Ms. Haynes spoke about opportunities for retired physicians to help educate the seniors in their communities about healthy aging.  

Among the programs highlighted during the program was Healthy Choices for ME!   Maine's Office of Elder Services (OES) was awarded a three-year competitive grant from the Administration on Aging (AoA) in October 2006 to build upon current efforts to advance evidence-based prevention and wellness programs in Maine.  In collaboration with MaineHealth's Partnership for Healthy Aging, the area agencies on aging, and other community partners, the OES will implement and disseminate evidence-based programs statewide through October 2009.  Each program empowers older people to take more control of their own health through life style and behavioral changes.  Priority will be given to expand program access to rural areas and selected under-served areas.

You can find more information on the Partnership for Healthy Aging on the web at:

You can find more information about the programs of the OES, including the Healthy Choices for ME! on the web at:

The next meeting of the MMA Senior Section is scheduled for Wednesday, October 28, 2009.  The MMA Senior Section is the vision of Buell Miller, M.D., a retired OB/GYN from greater Portland.  For more information about the Senior Section, please contact Dr. Miller at or the Section's staff, Lisa Martin, at [return to top]

MMA Staff Involved in MeCDC's H1N1 Updates and Statewide Planning

MMA staff participated in the noon H1N1 Conference call today, which focused on the role for health care providers focusing on seasonal influenza vaccine and H1N1 vaccine.  Updates can be found at  MMA staff will also attend the H1N1 Summit held later this week on August 20th at the Augusta Civic Center.  Staff will participate in the Statewide Planning Breakout to assist our members at the district and regional levels.  The Regional Resource Centers and the local Emergency Management Agencies will be coordinating efforts with the health care community to assist with local planning efforts.  Additional information will be available in the August 24th issue of the Maine Medicine Weekly Update.  If you are interested in attending the H1N1 Summit, there is still room to register.  Online registration can be done at   The cost is $15, which includes lunch.

Sign up to receive urgent updates from Maine CDC's Health Alert Network (HAN).  The easiest and quickest way is to sign up through the HAN Alert RSS feed at (midway down the center of the homepage).

Consider following Maine CDC's updates and other information on:

For Clinical consultation, outbreak management guidance, and reporting of an outbreak of H1N1 call Maine CDC's toll free 24 hour phone line at:  1-800-821-5821

Basic Websites:

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Governor's Provider Advisory Group (PAG) on Mainecare to Meet on Thursday

The Governor's Provider Advisory Group (PAG), established in 2005 to deal with the MECMS crisis, continues to meet on a regular basis in order to receive input from physicians and others relative to the transition to a new claims information system.  The next meeting will be on this coming Thursday, August 20 at 10:00am at the MaineCare offices in Augusta.  All meetings are open to the public.  MMA staff monitors these meetings and shares the relevant information with members through the pages of this e-newsletter and the bi-monthly Maine Medicine.

The new MaineCare information system, being developed by Unisys, is expected to be operational in Feb., 2010. [return to top]

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