September 28, 2009

Subscribe to Maine Medicine eNewsletters
Manage Your Subscriptions
Email our Editor...
Maine Medical Association Home Page
. Search back issues
. Plain Text Version
Printer Friendly

New England AMA Delegates and Medical Societies Meet in Waltham

On this past Saturday, September 26th the delegates from Maine and other New England states to the American Medical Association and all six New England State Medical Societies met at the offices of the Massachusetts Medical Society in Walthem, MA.  In addition to receiving an update on the deliberations in Washington on health system reform from past AMA Board Chair Joseph Heyman, M.D., the delegation considered three resolutions for submission to the AMA House of Delegates at the upcoming interim meeting in November and heard comprehensive reports from each of the six State Medical Societies.

The report from the Maine Medical Association was presented by MMA's senior AMA delegate David J. Simmons, M.D.  Others in the Maine delegation attending the meeting included delegate Richard Evans, M.D., alternate delegate John Makin, Jr., M.D., and EVP Gordon Smith.  MMA President-elect Jo Linder, M.D. and Sam Solish, M.D. also attended in their roles as alternate delegate and delegate respectively from their specialty societies.  In his report from MMA, Dr. Simmons noted the work of MMA related to health system reform and presented materials on the Academic Detailing initiative.  He also discussed the Association's work with the Board of Nursing to offer the Medical Professionals Health Program to nurses in recovery.

Dr. Heyman noted the work of the AMA Board and staff in advocating for some essential provisions to be included in any health reform proposal ultimately considered by the full Congress.  These essential provisions include fixes to the sustainable growth rate (SGR) which governs physician reimbursement from Medicare, medical liability reform, and initiatives to cover all Americans with an appropriate insurance product.  He also noted the reasons why the AMA supported H.R. 3200 but has withheld support from the Baucus proposal currently being marked up in the Senate Finance Committee.  The group acknowledged the very important and unique role of Maine's Senior Senator Olympia Snowe, a member of both the Senate Finance Committee and the informal "Gang of Six" which continues to work on a bi-partisan approach to reform.  The importance of communicating the AMA's approach to rank and file members and non-AMA members was emphasized.

The three resolutions presented and approved for submission to the AMA House of Delegates with support from the New England delegation involved the following:

  • Guaranteeing Due Process for Employed Physicians;

  • Quantifying Tort Reform; and

  • Transition to ICD-10 Code Sets.

The Maine Report was preceded by a moment of silence in honor of John West III, M.D., husband of MMA's Immediate Past President Stephanie Lash, M.D.   Dr. West died unexpectedly earlier this month.


Academic Detailing Advisory Committee Meets

The Academic Detailing Advisory Committee (ADAC) met on Thursday evening, September 24th, to review the status of the academic detailing project and to make plans for its future.  The medical leadership of chairman Noah Nesin, M.D. was enhanced with the additions to the Committee of Benjamin Schaefer, M.D., a Bangor cardiologist, and Kevin Wallace, M.D., a medical toxicologist.  Other individuals on the Committee are Laureen Biczak, D.O., Laurie Roscoe, R.Ph., Kellie Miller, M.S., Director of Public Health Policy for MMA, Gordon Smith, Esq., EVP of MMA, Jennifer Cook, Director of the MaineCare Pharmacy Unit, and Jennifer Reck, of Prescription Policy Choices.

Also attending the ADAC meetings are the two academic detailers, Noel Genova, PA-C and Erika Pierce, PA-C, Michael Ouellette, R.Ph. from Goold Health Systems, Inc., and Brenda McCormick of MaineCare.

Business items discussed during the meeting included the new web page (at, the evaluations forms completed at the end of each detailing session, a review of the clinical Powerpoint and the recent federal settlement with Pfizer and the use of the settlement funds.

The academic detailing visits began on August 11, 2009 and nearly a dozen visits have already been completed, representing nearly fifty prescribers.  The first module being presented deals with the subject of Adult Type 2 Diabetes.  The detailing visits are tailored to present to a larger group of prescribers using a Powerpoint presentation, along with printed clinical module materials or can be provided on a one or one basis.  Category I CME credits are available.

The detailing visits are carried out by the two detailers through the Maine Independent Clinical Information Service (MICIS) using materials developed by the Independent Drug Information Service of Harvard Medical School.  The detailers also engage physicians and other prescribers in clinical discussions to share their accumulated experience and wisdom with each other. 

The detailing presentations are offered at no cost to medical practices in Maine, regardless of the setting or ownership.  For more information, or to request a presentation, contact Kellie Miller at MMA at 622-3374, ext. 229 or via e-mail to

This program was developed as the result of a 2007 legislative mandate intended to improve health care quality and clinical outcomes.  It is administered by the Maine Medical Association in partnership with the Department of Health and Human Services.

  [return to top]

Senate Finance Committee Continues Mark-Up; Spotlight Continues on Maine Senator Olympia Snowe

The following is a brief summary of the week's activities related to health system reform:.

The Senate Finance Committee continued to mark-up Chairman Baucus' draft, with more than 500 amendments to be considered last week and this coming week.  Most amendments were resolved on a partisan basis, with only Senator Snowe sometimes siding with the Republicans and sometimes agreeing with the Democrats.  The Committee hopes to complete its work in the next week which could lead to a full Senate vote by the middle of October.

President Obama spent much of the past week focused on international and economic issues, but on Saturday he resumed his advocacy for comprehensive health system reform, telling the Congressional Black Caucus that there comes a time when "the cup of endurance runs over."  In the speech, Obama described his plan as one that would not require people with coverage to change anything but would make health insurance affordable for the millions of people who don't have any.

MMA staff interacted with Senator Snowe's staff on issues ranging from medical liability reform to the individual mandate.  Senator Snowe was also encouraged to support an amendment which would narrow the gap in the practice expense of the Medicare payment formula, so that rural states would come closer to the payment rates of urban areas.  MMA also is trying to arrange a stakeholder forum with Senator Collins.

MMA President David McDermott, M.D., MPH has submitted an op-ed piece to the Bangor Daily News responding positively to its recently editorial stating that the public would be well advised to pay attention to physicians' views and opinions on health system reform.  The op-ed piece emphasized the need for all Americans to have health insurance coverage, and noted the opinion of MMA members as reflected in the survey conducted late last year and reported earlier this year.  The notion of a "public option" should still be on the table, as a counterbalance to the for-profit insurance carriers now dominating the Maine market.

MMA EVP Gordon Smith spoke on health system reform to the Portland Rotary Club on Friday, September 25th and emphasized that the various options pending before the Congress should be compared not only with each other but also with the status quo.  "When comparing the various proposals to the existing system regarding coverage and cost, the status quo pales in comparison," Smith noted.  "The existing system simply leaves too many persons without any coverage, provides thousands of others with inadequate coverage, and subjects all Americans to escalating costs that are unsustainable."  From a physician standpoint, failure to pass a reform bill leaves in place the Medicare payment formula (SGR) that will result in a 40% reduction in Medicare payment rates over the next five years - an outcome that is unacceptable.  Without Congressional action, the first reduction of 21.5% will be effective January 1, 2010.

Once again, you can follow the AMA's coverage of the health system reform debate and learn more about the positions espoused by the organization on the web at:

  [return to top]

Health System Development Advisory Council Holds Forum on Payment Reform

On Friday morning, the Health System Development Advisory Council presented two panels on payment reform.  Addressing the Council during the first panel were:

  • Frank Johnson, Executive Director of the State Employee Health Commission

  • Tony Marple, Director of MaineCare

  • Richard "Skip" White, of CIGNA Healthcare

  • Elizabeth Mitchell, President, Maine Health Management Coalition

  • Joe Ditre, President, Consumers for Affordable Healthcare

Among the ideas discussed were global budgets, Accountable Care Organizations, Patient-centered Medical Homes, Shared-savings models, and capitation.  No one approach would serve all interests and providers and some fee-for service reimbursement would remain in any new model.

It was generally acknowledged by all presenters that even radical change had to begin incrementally and that some of the approaches required changed to the anti-trust laws.

The importance of primary care was emphasized and it was repeatedly noted that it would be important to hear from primary care physicians.  Although two physicians are on the HSD Advisory Council (Josh Cutler, M.D. and Maroulla Gleaton, M.D.), the interests of primary care and primary care organizations were not presented on the panels except for David Howes, M.D., President of Martin's Point.

The second panel consisted of provider interests, but were limited to hospitals and Martin's Point.  Panelists were:

  • Frank McGinty of MaineHealth

  • Eileen Skinner of Mercy Health System

  • Rebecca Ryder of Franklin Memorial Hospital

  • David Howes, M.D. of Martin's Point

  • Dan Coffey of Eastern Maine Heathcare

This panel addressed many of the same issues as the first.  The presenters each gave their perspective on the potential benefits and challenges of delivering care in a capitated or global budget payment model.  Several speakers emphasized that the notion of an "accountable care organization" must be flexible enough to address different health care markets and to give the leadership of provider organizations the tools to deliver care in a cost-effective manner in such a model.  Ms. Ryder acknowledged her recent service as an administrator in McAllen, Texas, the subject of a critically-acclaimed commentary by Atul Gawande, M.D. about the cost problems in our health care system entitled, The Cost Conundrum published in The New Yorker magazine within the last year.  She expressed her pleasure to be back in Maine after her career had taken her away for about 15 years.  Trish Riley, Executive Director of the Governor's Office of Health Policy & Finance, told the group that she appreciated its candor about the issues in our health care delivery system and its willingness to discuss payment reform as an important aspect of the health care reform debate.

[return to top]

Join MMA’s Growing Online Community!

If you have not yet joined the online community for MMA please consider taking time to do that this week.  Dr. David McDermott of Dover-Foxcroft, the current MMA president, has set up a group for MMA members for online discussions on the web site LinkedIn ® ( as well as established a twitter presence for MMA (  These second-generation web-tools will be developed and used more by your MMA over the coming year to provide timely information of interest to Maine physicians about issues of importance to you, your practice, and your patients.  Please take a few minutes to sign up to be a part of this next phase in MMA communications.  Attached to this are links that can show you how to start the process of becoming a participant on the social networking sites and

How to Use Twitter

How to Use Linkedin [return to top]

List of Drugs Subject to MaineCare 15-day Limit Increases this Week

Valuable research has suggested that lack of adherence to medication and other variables contribute to unused and discarded medication.  Closer evaluation of side effects and efficacy during the first two weeks of treatment may lead to better patient outcome and better safety.

MaineCare previously announced that it was instituting additional measures designed to increase cost effectiveness including Drug Benefit Management, Drug-Drug editing promoting education and patient safety, recent PPI limitations and Intensive Benefit Management of controlled substances.

In response to this research, MaineCare instituted new 15-day limits on initial prescriptions for various medication that have been identified with high side effect profiles, high discontinuation rates, or frequent dose adjustments.

Effective 8/6/09, MaineCare began limiting initial prescriptions to 15 day supplies on the following medications: Suboxone, Subutex, Chantix and Nicotine replacement products. On 9/11/09, the following medications were included in the initial prescription limits: Bladder antispasmodics: Bethanechol, Detrol, Flavoxate, Oxybutynin, Sanctura, Urispas, Vesicare, Detrol LA, Ditropan XL, Enablex, Oxytrol, Toviaz, and Narcotics: Opana, Oxycodone, Avinza, Duragesic, Fentanyl, Kadian, Methadone, Morphine sulfate, Opana ER, Oramorph, and Oxycontin. Beginning 10/02/09, the following medications will be included as the third phase of the Initial Presciption Limits: Anti-depressants; Cymbalta, Effexor, Effexor XR, Lexapro, Luvox CR, Paxil CR, paroxetine ER, Pristiq, Anti-Psychotics; Abilify, Geodon, Invega, Risperdal, risperidone, Seroquel, Seroquel XR, Zyprexa, Stimulants; Adderall, amphetamine combo’s, Concerta, dextroamphetamine, Dextrostat, Focalin, Focalin XR, Metadate, Methylin, methylphenidate, Provigil, Ritalin, Ritalin LA, Vyvanse, Strattera, Cafcit, and Miscellaneous; Ultram ER, Equetro.

Initial prescriptions for preferred products over the initial 15-day supply will require prior authorization. Subsequent refills of these products will be allowed at the usual MaineCare allowable days supply.  Any non-preferred medications within this list that obtain priorm authorization will also require the 15-day initial prescription limitations. These new limitations will help ensure cost effectiveness without “wasting” or “discarding” of used medications and assist MaineCare in controlling the cost of health care.

For further questions please contact Goold Health Systems at 1-888-420-9711. [return to top]

A Few Spots Still Left for October 9th Program on Legislation, Regulations and The Physicians Guide to Maine Law

On Friday morning, October 9th, MMA resumes its First Friday Educational programs (OK, we realize that October 9th is the 2nd Friday, but we will go back to the first Friday for November and December).   The October program deals with the actions of the legislature in its most recent session that are of interest to physicians, new federal and state regulations (Red Flags rules, HIPAA breach notifications, etc), and the new edition of the Physician's Guide to Maine Law, published by MMA.   Each attendee will receive a CD containing the Guide and a copy of the 47-page summary of legislative actions impacting on health care in Maine.

The program runs from 9:00 am to noon at the offices of MMA in the Frank O. Stred Building on Association Drive in Manchester.  A continental breakfast will be available at 8:30 am.

Faculty for the program will be Andrew MacLean, Esq., Deputy EVP and Gordon Smith, Esq., EVP.

You may register on line at or by calling MMA at 622-3374.  [return to top]

The Coding Center Offers E/M Chart Auditing CME in Portland & Damariscotta

The Coding Center, TCC, a service of the MMA, has planned E/M Chart Auditing CME courses on two Wednesdays and two Fridays in October and November.  The dates and locations of these courses are:

  • Wednesdays, from 10/14/09 - 11/11/09, The Dana Center, Maine Medical Center, 22 Bramhall Street, Portland, Maine 04102, 3:00 to 7:00 p.m.
  • Fridays, from 10/16/09 - 11/13/09, Lincoln County Healthcare Education Center, 66 Chapman Street, Damariscotta, Maine, 3:00 to 7:00 p.m. 

Presenting the courses will be TCC's Director, Gina L. Hobert, MBA, CPC-1, CPC, CPC-H.  The cost for the course is $600 and will offer participants 20 CEUs through the American Academy of Professional Coders.

For more information, contact Maureen Elwell at MMA at 622-3374, ext. 219 or  You can find information about TCC and all of its offerings on the web at: [return to top]

New H1N1 Updates from US CDC

6 New Updates from the US CDC:

For any other questions or additional resources, go to  The Maine CDC has all updates posted on this website. [return to top]

Anthem Parent Wellpoint May Cut More Jobs

As reported by Yahoo Finance on September 22, 2009, WellPoint has indicated that it may eliminate more jobs this year in an effort to trim cost and become more efficient.  The insurer cut about 1500 jobs earlier this year and current employment is now at nearly 42,000 people.  A WellPoint spokeswoman said the company has no total for the number of cuts or when they may happen and that WellPoint is looking at all areas of the company, not just employment totals, in its push to become more efficient.  Other ways to trim costs may include technology upgrades or reductions in administrative expenses.  WellPoint has said its total medical enrollment fell by 1.1 million people, or 3%, to 34.2 million in the second quarter as compared to last year.  The insurer has also predicted year-end medical enrollment to decrease to about 33.6 million members, a 4% drop. [return to top]

Introducing the Maine Diabetes Pathway

From: Lisa Letourneau, MD, MPH
To:  Stakeholders Interested in Improving Diabetes Care & Outcomes in Maine

I am pleased to introduce the Maine Diabetes Pathway, a statewide communication and education tool for people with diabetes.  The Pathway is a collaborative effort of the Maine Aligning Forces for Quality (AF4Q) initiative, and is part of a larger effort to promote improved care and outcomes for Maine people with diabetes.  This effort is supported by the Robert Wood Johnson Foundation, the Maine Center for Disease Control and Prevention, and numerous diabetes educators, clinicians, and other key stakeholders around the state.

The Maine Diabetes Pathway was created to provide a common messaging tool that can be used across healthcare and community settings to promote consistent, action-oriented messaging for patients with diabetes across the state of Maine to support people with diabetes by helping to build confidence and self-management skills; support adherence to evidence-based (ADA) treatment guidelines; and encourage patients with diabetes to partner with their care team to achieve best results.

Background:  The Pathway was adapted from a tool developed by the Cincinnati AF4Q community through a careful process that used a series of focus groups to develop and test a set of effective messages.  With permission from the Cincinnati team, the tool was shared with Maine diabetes educators and other key stakeholders. We used the feedback from our initial stakeholder group to adapt the tool for use in Maine, and created a draft Pathway that was piloted and tested with patients in 7 diabetes education programs around the state in early 2009.  We collected feedback from the pilot site diabetes educators and patients using a structured feedback process, and used that feedback to create a final version of the Maine Diabetes Pathway.

Distribution:  We are now beginning to disseminate the Pathway both electronically and in print copy through multiple channels around the state, including healthcare providers, community groups, churches, and retail partners, and welcome suggestions for additional avenues or contacts.  By now you may have received a hard copy of the Pathway brochure.  We encourage you to share the Pathway with people with diabetes in your community; additional print copies can be requested by emailing

The Pathway is also posted on the Quality Counts website ( <> ), along with separate PDFs of patient and provider “checklists” that can be printed as 1-page documents.  Please feel free to share it electronically through your own e-newsletters or email distribution lists.

We are grateful to the many stakeholders who have contributed to the creation of the Pathway, and are pleased to share it with you.   We consider it to be a work in progress and plan to review and update it annually.   Please send any feedback or suggestions to [return to top]

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