November 9, 2009

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Reps. Michaud & Pingree Support Health Reform Bill Enacted in the House

On Saturday evening, the prospects for comprehensive health reform improved with passage by the U.S. House of Representatives of the Affordable Health Care for America Act by a narrow 220-215 margin.  The bill was supported by the AARP and the American Medical Association.  Only one Republican voted for the bill and 39 Democrats voted against it.  Both Maine representatives Chellie Pingree and Michael Michaud voted in favor of the bill.  The Senate is expected to vote on its proposal in December or perhaps even as late as January.

The House bill would require nearly all Americans to obtain health insurance and would create a so-called "public option" as one choice they could make.  The new public plan available through insurance exchanges would be set up and run by HHS.  The proposal originally was going to pay physicians Medicare rates plus 5%, but the final version would let HHS negotiate rates with providers, a position favored by the AMA and other medical groups.  While the passage of the bill in the House increases the likelihood of success, the inclusion in any final law of items such as the public option is unlikely because of significant opposition in the Senate.

 In the Senate, Majority Leader Harry Reid (D-NV) is finalizing legislation merging the work of two committees and making other changes that have not yet been made public.  Last week, Maine's senior Senator Olympia Snowe complained that the Senate process was now going on behind closed doors.  If a bill is passed by the Senate, a conference committee would be established to work out differences in the bills.  If an agreement is reached by a majority of that committee, the final bill would be voted upon by each body and if passed by both, sent on to the President for his signature.  Probably the biggest barrier to ultimate passage is the need to achieve 60 votes in the Senate in order to overcome a threatened filibuster by Senate Republicans.

The MMA staff discussed the House bill several times with Rep. Michaud last week prior to the vote.  Rep. Michaud had expressed concern about the impact on his House district of the proposed cuts to Medicare and Medicaid, totalling $400 billion nationally over ten years.  Ultimately, Rep. Michaud was satisfied that enough changes could be made in the bill to make it palatable.  He also believes that CMS can make adjustments to certain formulas and policies that discriminate against Maine and other states that provide care to Medicaid and Medicare patients more efficiently than high cost states.  These geographic variables have long been of concern to the MMA and the Maine Hospital Association. 

The total cost of the bill is $1.055 trillion, with a net cost of $894 billion, factoring in penalties on individuals and employers who don't comply with the new requirements.

In addition to creating the so-called "public option" government-run insurance program, the House bill would bar insurers from denying coverage because of pre-existing conditions and set up "exchanges" where people could shop for coverage.  This latter feature has been a major factor in Massachusett's recent experience in covering more than 400,000 previously uninsured individuals.

The House bill pays for the expanded coverage by increasing income taxes on individuals making more than $500,000 per year and on couples making more than $1 million annually.  There are also the Medicare and Medicaid cuts noted above and a new $20 billion fee on medical device makers; $13 billion from limiting contributions to flexible spending accounts, and sizable penalties paid by individuals and employers who don't obtain coverage.  Individuals would have to purchase coverage which would be enforced through a tax-penalty of 2.5 % of income.  People could apply for hardship waivers if coverage to them is deemed unaffordable.  A similar process applies currently in Massachusetts.  Employers would be required to provide insurance to their employees or pay a penalty of 8 % of payroll.  Companies with payrolls under $500,000 are exempt.   Small businesses - those with 10 or fewer workers - get tax credits to help them provide coverage.

Individuals and families with annual income up to 400% of the federal poverty level, or $88,000 for a family of four, would get sliding scale subsidies to help them buy coverage.  The subsidies would begin in the year 2013.

You can find more information about the national health system reform debate on the AMA's web site at:

You can also find more information about health system reform at a web site set up by the federal government at:

MMA will continue to inform members and their staffs of the significant issues surrounding national health system reform, through the Weekly Update and Maine Medicine.  We are always happy to receive input from our members on their thoughts regarding this complex issue.  Feel free to communicate with President David McDermott, M.D., MPH at or the EVP Gordon Smith, Esq. at



More on Blue Cross Blue Shield Association Security Breach

The MMA has heard from several members expressing concern about the security breach by the national Blue Cross Blue Shield Association (BCBSA).  Many Maine physicians were notified by Anthem BCBS of Maine, a licensee of the national plan, by letter dated October 23, 2009, that a BCBSA employee transferred certain provider data, including provider name, address, tax ID number, Social Security number, and NPI from the BCBSA Provider Data Repository to a personal laptop.  The employee's laptop was subsequently stolen.  There is no evidence at this point that the information in the stolen laptop has been accessed for illegal purposes.  On the other hand, the laptop has not been recovered,

Physicians whose social security number may have been in the file received the notification and were offered free credit monitoring services for one year provided by  The October 23rd letter provided specific instructions on how to take advantage of the free offer and that enrollment was required by January 31, 2010 in order to take advantage of it.  The October 23rd letter was signed by Vincent Liscomb, Jr., Executive Director, Provider Engagement and Contracting at Anthem BCBS of Maine.  The majority of Anthem's network physicians are potentially impacted by the breach.

Many physicians have expressed their opinion that the credit monitoring services offered are inadequate protection for the physicians impacted and have further expressed concern that while the breach took place in August, Maine physicians were not notified until late October.  The MMA shares that concern, as does the AMA.  At the AMA interim meeting taking place presently in Houston, a late resolution offered by the Michigan delegation is being considered for adoption.  The proposed resolution reads as follows:

RESOLVED, That our American Medical Association demand that Blue Cross Blue Shield of America (BCBSA) offer expanded protections for physicians affected by the BCBSA security breach in August 2009 by extending the credit protection plans to at least five years, offering more than one company for credit protection, increasing the amount of identity theft insurance to adequately protect physicians, and publicly reporting confirmed cases of identiy theft linked to this security breach; and be it further

RESOLVED, That our American Medical Association demand that Blue Cross Blue Shield of America notify physicians immediately should a data breach or any other security issue involving sensitive physician information occur in the future; and be it further

RESOLVED, That our American Medical Association seek federal legislation imposing sanctions against insurance companies and their employees similar to those imposed on physicians by the Health Insurance Portability and Accountability Act (HIPAA).

The MMA will inform members in the Update next week as to the outcome of the AMA Resolution.  In addition, the MMA has been in communication with the Maine Bureau of Insurance as to the adequacy of the remedies offered and more discussions are scheduled.  A meeting between Anthem officials and Bureau staff is scheduled for this week.

It should be noted that the breach itself occurred at the level of the national plan, and not at the Anthem level, and the national BCBS plan is taking responsibility for the action.  Nonetheless, Anthem BCBS of Maine is the licensee of the national plan and its responsibility to notify those affected promptly is one issue to be discussed.  The adequacy of the response from the national plan is another.

As noted in the October 23rd letter, Maine physicians receiving the notice can call the Provider Services number at 1-800-832-6011 for further information. [return to top]

Pain Management CME Program Offered in Farmington on Friday, Nov. 20 (Free!)

On Friday, November 20th, physicians and others who prescribe will have a unique opportunity to receive, at no cost, four hours of category one CME and to learn of Maine's efforts to prevent diversion of narcotics and at the same time, receive information on state of the art treatment for pain.

Comprehensive Management of Patients with Acute & Chronic Pain While Preventing Diversion is being offered by Franklin Memorial Hospital and Medical Rehabilitation Associates, with financial support from the Maine Office of Substance Abuse.  The program is accredited by the Maine Medical Education Trust and the MMA staff is providing content on the medical-legal aspects of the issue.

The program runs from 12:30 pm to 5:00 pm at the Franklin Memorial Hospital Ben Franklin Center in Farmington.  A complementary lunch will be available at noon.

The faculty for the programs includes Daniel Eccher of the Maine Office of Substance Abuse, John Guernelli, M.D. of Medical Rehabilitation Associates (MRA), Gene Guinti, D.O. also of MRA, Gordon Smith, Esq. of MMA, and Douglas Pavlak, M.D. of MRA.

Anyone  interested in the program may RSVP by fax to Karen Rogers at Franklin Memorial Hospital (Fax is 779-2496) or via e-mail to Karen at [return to top]

Expansion of Editing for Ordering/Referring Providers

Change Request (CR) 6417, requires Medicare implementation of system edits to assure that Part B providers and suppliers bill for ordered or referred items or services.  Physician and non-physician practitioners who order or refer must be enrolled in the Medicare Provider Enrollment, Chain and Ownership System (PECOS) and must be of the type/specialty who are eligible to order/refer services for Medicare beneficiaries.  Be sure billing staff are aware of these changes that will impact Part B provider and supplier claims for ordered or referred items or services that are received and processed on or after October 5, 2009.  For more information refer to<>

Please attend the Part A Teleconference for PECOS on December 8th and the Part B Teleconference on December 10th.

Go to the following links to register:
Part A-
Part B- [return to top]

Our Public's Health - Climate Change, Energy Efficient Hospitals/MESHnet and Environmental Toxins Panel Discussion Scheduled for December 9th

The MMA Public Health Committee is hosting a two-hour panel presentation on Our Public's Health - Climate Change, Energy Efficient Hospitals/MESHnet and Environmental Toxins on Wednesday, December 9th, 4:00 pm - 6:00 pm at the MMA office in Manchester.  It will also be broadcast via video-conference link to the MMC Dana Health Education Center, Classroom 10.

Norma Dreyfus, MD, Chair, MMA Public Health Committee will serve as moderator and the panelists include:

Lani Graham, MD providing an overview of health care and environmental toxins, which will include findings from the Hazardous Chemicals in HealthCare report, (detailing the first investigations ever of chemicals found in the bodies of health care professionals, including MMA Past President Stephanie Lash, MD).

Paul Santomenna, Executive Director of Physicians for Social Responsibility will talk about hospitals' contribution to greenhouse gas emission and the work of the Hospital Network.

Matt Prindiville of the Natural Resources Council of Maine, will provide an update on federal and state legislation including TSCA reform.

Syd Sewall, MD will provide information on the use of the Pediatric Environmental Toolkit in clinicians' offices.

An application for two hours of educational credits is pending.  For more information and to pre-register for this free educational offering, contact MMA at 207-622-3374, ext. 219 or via email to Maureen Elwell at .  Members and nonmembers are welcome to attend.  The registration deadline is December 4, 2009. [return to top]

Portland Commmunity Health Center Seeks Family MD/DO

The new Portland Community Health Center, located at 180 Park Ave., is seeking a Family MD/DO, to provide direct primary medical care to patients and medical oversight for the Center.  The Portland Community Health Center is a newly-funded Federally Qualified Health Center, the first of its kind in Cumberland County.  The Center is open to individuals of all ages, offering affordable health care to those who need it. The Center accepts all insurances as well as MaineCare and Medicare; for those with no insurance, a sliding fee scale is available based on income.  Presently, the Health Center is open 8-4:30, M-F, with expanded hours planned.  No in-patient care is required.  Will consider part-time or full-time possibilities.  Applicants should be board certified in either Family Practice or Internal Medicine, and must maintain an active medical license in the State of Maine.  Interested applications should mail a cover letter and resume to:

Carol Schreck, Executive Director, Portland Community Health Center, 180 Park Ave., Portland, ME. 04102.  For further information, call 207-482-5004.  Accepting applications/resumes 11/06/2009 through 11/30/2009. [return to top]

Chronic Narcotic Use Guideline Education in MaineCare

Because of increasing concerns regarding the appropriate, safe use of long-term narcotics, the Pharmacy Unit of the Office of MaineCare Services will expand the scope of its chronic narcotic prescription monitoring efforts starting January 1, 2010.  The specific goal is to promote the widespread adoption of key elements of the existing standards of care (most notably the joint Rule 11 of the Boards of Licensure in Medicine and Osteopathy) as they pertain to “new” chronic narcotic patients.  This effort will require a prior authorization (PA) for any member who has had 90 days of narcotics in the past 100 days (and no chronic, sustained narcotic prescriptions in the previous nine months; i.e. new chronic starters).  A PA will not be required for hospice patients or for those members being actively treated for a life threatening illness such as AIDS or cancer.  It is expected that 100 to 130 MaineCare members per month would meet the criteria requiring such a PA. Providers will be given thirty days to complete the Prior Authorization.  Pharmacies will be granted overrides to continue dispensing narcotics during this time period for all affected patients.

The PA will concentrate on determining how thoroughly the following principles of pain management have been addressed:

  • Confirming an appropriate indication for chronic narcotics;
  • Reviewing non-pharmacologic and non-opioid drug treatments considered and/or tried;
  • Verification that a narcotic/controlled substance contract exists;
  • Reviewing the intended monitoring plan (such as whether Urine Screens and Random Pill Counts may be appropriate); and
  • Verification that Prescription Monitoring Program reports are used routinely and not misinterpreted.

It is anticipated that only a handful (minimum of 1 to maximum of 5) of Chronic Narcotic Use Prior Authorizations will be required of each provider.  Some patients will require a follow-up PA 3 to 12 months later to see how well actual monitoring results and contract violations are handled.  Exemptions will be granted quickly once it is clear that appropriate selection and reevaluation/monitoring of chronic narcotic patients is occurring.

Providers may wish to take advantage of a consultation program for chronic pain jointly sponsored and supported by the Maine Medical Association and the Maine Board of Licensure in Medicine.  This program provides free, professional consultations.  To schedule a visit to your practice contact Noel Genova directly at or 207-671-9076, or Kellie Miller at or 622-3372, ext. 229.

The Office of MaineCare Services will soon publish a list of Narcotics that will be included in the monitoring program.   Please bring your questions, concerns or comments to the Drug Utilization Review Committee on November 10th.  The meeting begins at 6 pm with the open session closing at 7:30 and is located at the Office of MaineCare Services, 442 Civic Center Dr. Augusta.  Or, you can email, Pharmacy Unit Manager, Office of MaineCare Services.  [return to top]

MGMA Presents "Professional Renewal - Both In & Out of the Office," December 3

Everything about today’s work environment can cause stress—a poor economy, cutbacks, technologies that provide us more information but not more time, draining interactions with colleagues and customers, having to do more with less, plus many other factors.  Often, stress “creeps up on us” over time and we are not aware of how great it has become until we are nearly frantic.  You are not alone… in fact; you are in the vast majority.  You need to step back and take an objective look at where you are, how you got there, and what you need to do to reduce the stress in your professional and personal lives.  This course also delves into how you can embark on “new beginnings” in your career, taking control of its direction and your contentment on the journey.

Learning Objectives
Upon successful completion of this course, participants will be able to:

  • Assess their personal levels of stress;

  • Determine the root causes of their stress;

  • Recognize their own patterns of stress reaction;

  • Apply practical tips and techniques for reducing & relieving stress;

  • Employ new ways of dealing with stressful situations, people and attitudes; and

  • Identify how to live more balanced & productive lives.

Date: Thursday, December 3, 2009
Location: The Carriage House - Lewiston
Time: 8:00 AM to 4:00 PM

For more information, or to register, click here [pdf].

[return to top]

Governor Creates Medical Marijuana Task Force Following Passage of Ballot Question 5

On Election Day last week, Maine voters overwhelmingly approved a revised Maine Medical Marijuana Act that expands the list of eligible "qualifying medical conditions" and directs DHHS to take steps to improve access to marijuana for legitimate patients.  The MMA took no position on Question 5 and the MMA staff has provided compliance advice to physicians and patients since the original medical marijuana passed in the early part of the decade.  The MMA recognizes that members have differing views on the value of medical marijuana, just as the public at large does.

The "debilitating medical conditions" now covered by the Act include: 

  1. Cancer, glaucoma, HIV/AIDS, hepatitis C, amyotrophic lateral sclerosis (ALS), Crohn’s disease, agitation of Alzheimer’s disease, nail-patella syndrome or the treatment of these conditions;
  2. A chronic or debilitating disease or medical condition or its treatment that produces intractable pain, which is pain that has not responded to ordinary medical or surgical measures for more than 6 months;
  3. A chronic or debilitating disease or medical condition or its treatment that produces one or more of the following:  cachexia or wasting syndrome; severe nausea; seizures, including but not limited to those characteristic of epilepsy; or severe and persistent muscle spasms, including but not limited to those characteristic of multiple sclerosis; or
  4. Any other medical condition or its treatment approved by DHHS by administrative rule (none as of 11/6/09).

Some risks remain for physicians in treating medical marijuana patients, even in the 14 states that have enacted medical marijuana legislation:

  1. The uncertain status of marijuana under federal law.  Use of marijuana remains illegal under federal law.  During the Bush Administration, it was never clear how aggressive federal authorities would be towards so-called "medical marijuana," although their focus seemed to be on dispensaries in California that were perceived by some to be pushing the limits of the law.  Recently, Attorney General Eric Holder issued a statement indicating that the Obama Administration had no desire to pursue those involved in legitimate use of medical marijuana under state law.
  2. Drug regulatory concerns.  The standard for prescribing drugs by practitioners is FDA approval.  Because marijuana, even for medical purposes, is not approved by the FDA, the MMA  staff recommends that you not use the term "prescribe" with respect to medical marijuana and that you not use a prescription blank with such patients.  Should you decide to work with medical marijuana patients, it is better framed as a matter of patient choice - that the physician is willing to work with the medical marijuana patient as he or she uses marijuana for medical purposes.
  3. Liability concerns.  While the degree of risk may be debatable, physicians who work with medical marijuana patients cannot eliminate all risk because they are treating a patient who is using an unregulated drug, a drug that does not meet the standard in this country of FDA approval and that may include unknown amounts of active ingredient and impurities.  Again, the MMA staff recommends that you include in your documentation of the relationship with the medical marijuana patient that he or she is aware of and assumes responsibility for these risks.

The MMA staff has developed a model Physician's Certification of Eligibility for Medical Use of Marijuana/Consent to Treatment with Marijuana for Medical Purposes form to assist you in compliance.  The MMA staff revised the form in accordance with the new law last Friday.  If you would like a copy of the form, please send an email to Andrew MacLean, Deputy EVP, at

The Governor's Executive Order 04 FY 10/11, An Order Establishing the Committee on the Implementation of the Maine Medical Marijuana Act  may be found on the web at:  The 14 members of the Committee include "a representative of physicians," a position likely to be filled either by MMA EVP Gordon Smith or Deputy EVP Andrew MacLean.  If you have further questions about the new medical marijuana law, please contact either Gordon (622-3374, ext. 212) or Andy (622-3374, ext. 214).

  [return to top]

SAVE THE DATE: Legislative Committee Organizational Meeting Scheduled for Tuesday, December 1st

MMA Legislative Commmittee Chair Lisa Ryan, D.O. invites all Committee members and any interested member to an organizational meeting for the Second Regular Session of the 124th Maine Legislature from 6 to 8:30 p.m. on Tuesday, December 1st at the MMA office in Manchester.

You can find various documents regarding legislators' bill requests for the second session on the web at: .

The Second Regular Session of the 124th Maine Legislature will begin on Wednesday, January 6, 2010 and is expected to conclude in mid-April.

All are welcome, but please RSVP to Maureen Elwell, Legislative Assistant, at or 622-3374, ext. 219, so we can have an accurate count for food. [return to top]

REMINDER: Workers' Compensation Board Increased IME Rates; Defers Consideration of Fee Schedule

Effective October 11, 2009, the Maine Workers' Compensation Board has increased the maximum charges for independent medical examinations from $200 to $300 per hour for a maximum of 5 rather than 4 hours.  Also, the Board's draft agenda for its regular meeting tomorrow, November 10th, indicates that discussion of draft revisions to Rule Chapter 5, the medical fee schedule is deferred to a future meeting.  The primary revision to the rule is the institution of a facility fee schedule for hospitals and ambulatory surgical facilities. [return to top]

Commonwealth Fund Report Says Primary Care Quality in U.S. Trails Other Countries

On November 5th, the Commonwealth Fund released a report entitled, A Survey of Primary Care Physicians in Eleven Countries, 2009:  Perspectives on Care, Costs, and Expectations.  It concludes that the U.S. falls behind the other countries in the survey in pursuing innovative health care strategies, such as after-hours care, information technology, quality reporting and feedback, and medical error tracking systems.  The survey included 10,000 primary care physicians in Australia, Canada, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, the U.K., and the U.S.  

You can find the report on the Health Affairs web site at: [return to top]

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