November 23, 2009

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Senate Votes to Begin Debate on the Patient Protection and Affordable Care Act

Last Saturday evening, fifty-eight Senate Democrats and two Independents cast the 60 yea votes required to begin debate on the Senate Democrat's version of health system reform.  The debate is scheduled to begin next week following the Thanksgiving recess. All thirty-nine Republicans voting opposed the motion to proceed, including Maine Senators Olympia Snowe and Susan Collins.  The American Medical Association urged Senators to proceed with the debate, believing that any final bill signed by the President could be improved through the amendment and reconciliation process.

Earlier in the week, the House of Representatives passed H.R. 3961, the "Medicare Physician Payment Reform Act of 2009".  This legislation would permanently repeal the Sustainable Growth Rate (SGR) formula that calls for annual cuts in Medicare physician payments, and replace it with a new, more rational payment system.  Without this legislation, or something like it, Medicare payments will be reduced by more than 21 percent on Jan 1, 2010 because of the SGR formula. H.R. 3961 would replace the cut with an update based upon the Medicare Economic Index.  For 2011 and subsequent years, the bill would establish updates based on two new targets with significantly higher utilization growth allowances than the SGR.  The new targets would apply to:

  • E&M and preventive services, which would be based on GDP plus 2%.
  • All other services, which would be based on GDP plus 1%
  • These service categories would apply without regard to the specialty of the physician providing the service.

The bill would re-set the new targets after five years to help reduce the likelihood of accumulated debt and future steep cuts under the new targets.  But similar legislation was defeated in the Senate earlier this month so the risk of the deep Medicare payment cut is still present until both bodies pass a fix and have any differences reconciled into one solution which is then again passed in both bodies and sent on for the President's signature.  How to pay for the $240 billion cost over ten years is the major sticking point.

Both Congressman Michael Michaud and Congresswoman Chellie Pingree voted in support of the bill. 

The Senate reform measure is similar in scope to legislation the House approved earlier this month.  It would require most people to purchase insurance, and if their employers did not offer coverage, they would be able to shop for policies on new state-based insurance exchanges that would function as marketplaces for individual coverage.  Insurance companies would have to abide by new rules that would ban practices such as denying coverage based on pre-existing conditions.

MMA Welcomes Newest Group Member: Mercy Medical Associates

MMA enthusiastically welcomes its newest group member, the physicians of Mercy Medical Associates, associated with Mercy Hospital in Portland.  All of the physicians employed at Mercy Hospital will now have the opportunity to benefit from MMA membership through the benefit membership purchased by the hospital.  Forty five new members are included in the group, as well as sixteen physicians who are currently members.

"We are thrilled to be able to provide the considerable array of MMA services to all the physicians employed in the Mercy system," noted MMA EVP Gordon H. Smith, Esq.  "We wish to acknowledge the important roles of Eileen Skinner, Stephen Sears, M.D., Mike Hachey and Jeffrey Heckert, M.D. in bringing this group membership to fruition and to thank them for their support."

Mercy joins several other hospitals in Maine in providing this benefit to its employed physicians, including Goodall Hospital, Maine Medical Center, Southern Maine Medical Center, Pen Bay Medical Center, MDI Hospital, MaineCoast Memorial Hospital, MidCoast Memorial Hospital, Cary Medical Center, Mayo Regional Hospital, Franklin Memorial Hospital,  Maine General Medical Center,Northern Maine Medical Center and Inland Hospital.  Similar memberships are also available to private groups and Spectrum Medical Group, Martin's Point Healthcare, Intermed, and Sunbury Primary Care all have taken advantage of this opportunity.

Group memberships are available to groups of ten or more physicians where all of the physicians are MMA members.  Contact Gordon Smith, Esq., EVP for more information. 

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Update: Blue Cross and Blue Shield Association Provider File Data Security Issue

The following statement was provided for the Update by Anthem BCBS of Maine.  Note particularly that the offer to provide free credit and fraud monitoring has been extended to two years for physicians in Maine impacted by the security breach.  MMA has advocated for at least five years of monitoring and additional protections.  Following the BCBS statement is a summary of the provisions of the Substitute Resolution on this subject passed at the recent AMA Interim meeting.



As you may have heard or read, a Blue Cross and Blue Shield Association (“Association”) employee’s laptop was stolen from the employee’s car. While the laptop was protected with a complex password, it did contain information on networks of participating providers for the Association’s local licensees.  

The Association has assumed full responsibility for the incident. However, as Anthem is the local licensee for the Association in Maine, we are working closely with the Association to inform and educate local providers about the issue.  

Please note: 

The Association will provide credit and fraud monitoring for two years - free of charge - to all impacted providers who elect this service. (Please note: In our mailing to affected providers dated October 23, we advised that the Association would provide one year of credit monitoring. The length of time for free credit monitoring has been increased to two years for providers who participate with Anthem Blue Cross and Blue Shield in Maine).


The breach did not include Protected Health Information or Member personal information.


The Association has received no reports of misused data. The laptop did have a complex password, restricting direct access to this data, or any other information on the computer.


The theft occurred in a residential parking lot; other vehicles in the parking lot were also broken into and valuables stolen. This appears to be a random theft and it was reported to the Chicago Police Department. The employee self-reported this incident.


We are working to facilitate your access to our phone lines with a minimum of wait time. We apologize for any inconvenience you might experience.


Providers with specific questions can contact our Provider Call Center at (800) 832-6011.


AMA Resolution:


RESOLVED, That our American Medical Association urge the Blue Cross and Blue Shield Association (BCBSA) to 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 identity theft linked to this security breach; and be it further


RESOLVED, That our AMA urge the BCBSA to provide physicians affected by the BCBSA breach easy access to credit monitoring reports without cost; and be it further


RESOLVED, That our AMA strongly urge the BCBSA to provide legal protection and indemnification to physicians for any losses that result from this or any data security breach; and be it further


RESOLVED, That our AMA request that health insurers involved in a future data breach or any other security issue immediately notify physicians; and be it further


RESOLVED, That our AMA advocate that the personal information of physicians and other health care practitioners be stored electronically only in encrypted form to reduce the likelihood for future breach and loss of data; and be it further


RESOLVED, That our AMA study the issues of breaches of physicians' sensitive personal information with recommendations for further action and report back at the 2010 Annual Meeting of the House of Delegates.

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Members and Guests Invited to Dedication of John C. Dalco, M.D. House on Dec. 4

MMA members and guests are cordially invited to attend the opening celebration of the John C. Dalco House, which will serve as the new home for the Medical Professionals Health Program, Friday, Dec. 4, 2009.  The house, owned by the Maine Medical Education Foundation, is being named in memory of Dr. John C. Dalco, the first Medical Director of the Medical Professionals Health Program.  Dr. Dalco, who was  hired as Medical Director in 1987, performed his duties with enormous dedication and compassion.  He retired in 2000 and unfortunately died in Feb., 2006.  His widow, Claire and his son, John, Jr. will be present at the dedication ceremony.

Tours of the Dalco House at 20 Pelton Hill Drive, Manchester, Maine will begin at 11:00am on Friday, Dec. 4 and the dedication ceremony will begin at 11:30am, to be followed by a luncheon at the Augusta Country Club. This property location is adjacent to the Association Drive leading to the MMA offices in the Frank O. Stred Building.  There is a charge for the luncheon.  For further information, please contact Dee deHaas at the MMA at 622-3374 ext. 215 or e-mail Dee at 

Interested persons may also contribute to the John C. Dalco Fund which was established previously to support impaired medical professionals who were engaged as participants in the Physician Health Program.   Checks should be payable to the Maine Medical Education Trust, F.B.O. Dalco Fund and sent to MMA at P.O. Box 190, Manchester, Maine 04351. [return to top]

H1N1 continues to expand and worsen amid increasing vaccine shortages

H1N1 continues to expand and worsen amid increasing vaccine shortages relative to demand for it as well as under-utilization of antiviral medicines. There have been a total of 143 schools with reported high absentee rates, including 44 this past week; ER visits for flu account for about 1 in 6 ER patients; there have been 50 hospitalizations this week, with half of them among children; and there have been 2 deaths (both previously reported), for a total of 5 since August. (two additional deaths were just announced today, 11/23/09)  Vaccine administered appears to be very under-reported by health care providers, with only about 45% of doses distributed having been reported as administered.  Flu infections can make people more likely to develop pneumococcal infections, which can cause serious complications, including death. All children younger than 5, all people between ages 5 and 64 with certain high risk conditions, and all people age 65 and older should receive a pneumococcal vaccine.  Information on treatment with intravenous antiviral medicines is available.

Continued Surge of Flu Activity in Maine and the US

Two deaths this week were reported publicly over the weekend, bringing the total deaths due to H1N1 in the state since August to five. Four of these have been in the past two weeks. The average age among those who have died is 47; by comparison, 90% of deaths related to seasonal flu are among those older than 64.  (two additional deaths were just announced today, 11/23/09)

There were 50 hospitalizations this week, accounting for more than half of the hospitalizations due to H1N1 since April. Half of the new hospitalizations were children, two of whom have been or currently are in intensive care; 23 were adults ages 19-65, seven of whom were or are in intensive care; and 2 people were older than 65, neither of whom needed intensive care.  Counties of those hospitalized this past week are:  Androscoggin and Penobscot both 11; Cumberland 9; York 8; Hancock 3; Kennebec, Oxford, Piscataquis all 2 each; Aroostook and Washington 1 each. 

One in every six visits to an emergency department this week was flu-related, and rates of visits to other outpatient settings continue to be elevated.

A total of 143 schools have reported high absenteeism (> 15%) due to flu, and 44 of them were from this past week.  A school in Kennebec County and another in Washington County chose to close as a result of absenteeism. An outbreak of H1N1 in a long-term care facility was reported over the weekend. There were five other institutional outbreaks this week.

The timing, spread, and severity of flu viruses is uncertain with outbreaks often occurring in waves. In past pandemics, the first wave is usually a smaller wave followed by a larger peak wave, which can be followed by subsequent waves. Even after flu activity peaks during the current wave, it is possible that other waves of activity may occur – caused by either H1N1 or regular seasonal flu viruses.

There have been confirmed cases of H1N1 in every county in Maine. People should assume that they will be exposed to the flu at some point, and with vaccine for less than one-third of those most prioritized to receive it in the state, we should all take precautions to prevent serious illness by staying home when sick, covering coughs and sneezes, washing hands frequently, and getting vaccinated against both seasonal and H1N1 flu when vaccine is available.

Maine has 210,500 doses of vaccine in Maine – which is about 30% of what is needed for priority populations in the state. For this reason, Maine CDC has had to prioritize within US CDC’s priority groups for vaccine, based on trends in infections, the type and amount of vaccine available, and readiness of partners to administer vaccine.

Currently, Maine CDC priority groups for vaccination are:

  • All children 6 months – 18 years of age
  • Pregnant women
  • Caregivers and household members of infants younger than 6 months old
  • Adults 18 – 64 years of age with the most severe chronic medical conditions**
  • Health care personnel with frequent direct contact with infectious materials and hospital inpatients who are at high risk (pregnant women, children, and high-risk adults older than 65)

**At this point in time MeCDC is only distributing vaccine for this category to some specialists who care for adults with the most severe chronic medical conditions.  Chronic medical conditions that confer a higher risk for influenza-related complications include chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, cognitive, neurologic/neuromuscular, hematologic, or metabolic disorders (including diabetes mellitus) or immunosuppression (including immunosuppression caused by medications or by human immunodeficiency virus).

Maine CDC continues to distribute vaccine in K-12 schools; among health care providers who care for children, pregnant women and/or very high-risk adults; colleges and universities for their high-risk students; and some pre-school settings such as preschool programs for high-risk children and Head Starts.

By the end of the week, Maine CDC expects:

  • About 95% of all K-12 schools, which is all schools that signed up to provide H1N1 vaccines, will have administered their first doses to children.  The second doses for children ages nine and younger we anticipate will begin to be distributed in the next several weeks, but not until sometime in December.  US CDC recommends that the two doses of H1N1 vaccine for children 9 years of age and younger be separated by 4 weeks, but there is no maximum number of days between doses.
  • All health care providers that ordered H1N1 vaccine for pregnant women will have received some supply for their pregnant patients.

Over the next several weeks, Maine CDC expects that it will be easier for household members of infants younger than six months old, pre-school aged children, and people younger than 65 at high risk due to underlying medical conditions to access vaccine through several channels:

  • Vaccine has been shipped to pediatric health care providers that placed orders for H1N1 vaccine. Public Health Nurses are conducting vaccine clinics in preschool settings for high-risk children and will soon be conducting vaccine clinics in Head Start locations. Other organizations are also starting to organize clinics for preschool aged children.
  • The limited amount of vaccine formulation that is ideal for adults is being distributed to specialists serving those adults who are at the highest risk – pulmonologists, cardiologists, oncologists, neurologists, rheumatologists, infectious disease physicians, and dialysis centers.  Maine CDC hopes in the next week to be able to distribute increasing amounts of vaccine to other adult practices, such as internal medicine physicians. In addition, clinics for high risk groups will be starting in the coming weeks, and will be posted on the flu clinic locator at
  • Maine CDC hopes to provide more vaccine for health care workers in the next several weeks as the vaccine formulations for adults become more available. Any health care worker who fits into another high-risk group (pregnant, household member of an infant younger than six months, younger than 65 with an underlying health condition) should try to access vaccine now.    

Once all of the prioritized groups have been vaccinated, Maine CDC anticipates that there will be enough vaccine for anyone who wants it. However, vaccine may not be available to those not included in the priority groups until early in 2010.

Holiday Distribution

Please note that CDC is not delivering vaccine the day after Thanksgiving. Maine CDC’s Immunization Program has asked all registered H1N1 vaccine providers about holiday closings into February so that holiday closings will not affect vaccine shipment.

Reporting Vaccine Administration

Maine CDC asks all H1N1 vaccine providers and/or administrators to submit the vaccine administration data into the Maine CDC’s weekly vaccine reporting system. Currently, only 45% of doses distributed have been reported as administered. This may start impacting the flow of vaccine, since it indicates low uptake of the vaccine.  Maine CDC believes at this point in time these data are an indication of under-reporting and how busy health care providers are taking care of people sick with H1N1 as well as administering vaccine. 


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

MMA Legislative Committee Chair Lisa Ryan, D.O. invites all Legislative Committee members and any interested physician to the organizational meeting of the Committee on Tuesday, December 1, 2009 from 6 to 8:30 p.m. at the MMA office in Manchester.

The Committee will discuss its plans for the Second Regular Session of the 124th Maine Legislature that will convene on January 6, 2010 and is expected to adjourn in mid-April.

You can find documents relating to bills to be considered during the Second Regular Session on the web at:

All are welcome, but please RSVP to Maureen Elwell, Legislative Assistant, at or 622-3374, ext. 219 so that we have an accurate count for food.
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Governor Baldacci Names Task Force to Implement New Medical Marijuana Law

Governor John E. Baldacci last week announced the names of the appointments to the Committee on the Implementation of the Maine Medical Marijuana Act.  The Governor created the task force by Executive Order on Nov. 6, following the medical marijuana law approved by Maine voters.  The Governor said the task force would advise him on the appropriate way to implement the new law with safeguards to protect public health and safety.

The Governor appointed 10 members of the 14-member task force.  In addition, two members of the Senate have been appointed by the President of the Senate and two members House of Representatives by the Speaker of the House.

The following people have been appointed by the Governor, representing the interests as outlined by the Nov. 6 issued Executive Order:

  • Commissioner Brenda Harvey, Department of Health and Human Services
  • Commissioner Anne Head, Department of Professional and Financial Regulation
  • Commissioner Anne Jordan, Department of Public Safety
  • Attorney General Janet Mills
  • Faith Benedetti, currently self-employed and former Program Coordinator of the Dayspring AIDS Support Services, representing patients who would be qualifying patients under the direct initiative
  • Gordon Smith, Executive Vice President, Maine Medical Association, representing physicians
  • Dan Walker, partner at Preti Flaherty, a supporter of the Direct Initiative “An Act to Establish the Maine Medical Marijuana Act”
  • Kandyce Powell, Executive Director, Maine Hospice Council, representing the hospice movement in Maine
  • Ken Altshuler, partner at the firm Childs, Rundlett, Fifield, Shumway & Altshuler, representing the public
  • John McElwee, retired District Court judge, representing the public

The Legislative Members are Sen. Joe Brannigan and Rep. Anne Perry, chairs of the Health and Human Services Committee, and Sen. Stan Gerzofsky and Rep. Anne Haskell, chairs of the Criminal Justice and Public Safety Committee.

“This group of people will help the State follow the intent of the law, which Maine voters approved earlier this month,” Governor Baldacci said. “There are complicated issues that must be addressed as we create a new pharmaceutical distribution system, and we must ensure that these issues are thoughtfully addressed to ensure that the law is followed and that Maine people are protected from any unintended consequences that could create serious problems in the future.”

The task force will meet Dec. 1, Dec. 8 and Dec. 15.  The task force is charged with reviewing the implementation of similar laws in other states; making recommendations on the implementation of the law in Maine, including recommendations for changes in the enacted law that are deemed necessary to ensure effective implementation and ongoing monitoring of the medical marijuana program, and protection of public health and safety; and advising the Department of Health and Human Services in its development of proposed rules and fee schedules.

The task force will make its recommendations by Dec. 31, 2009.

Task force member Gordon Smith, Esq., EVP of MMA noted that while no physician was apppointed to the group, he would endeavor to have physicians provide input into the group's deliberations.  "Since the original law was enacted ten years ago, MMA has been consistent with its advice to members who either wish to assist their patients who desire the medicinal use of marijuana or those members who don't want anything to do with this," Smith said.  [return to top]

CMS Extends 2010 Annual Participation Enrollment Program

Due to recent revisions that were made to the 2010 Medicare Physician Fee Schedule (MPFS), the Centers for Medicare & Medicaid Services (CMS) has extended the 2010 Annual Participation Enrollment Program end date from December 31, 2009, to January 31, 2010 – therefore, the enrollment period now runs from November 13, 2009, through January 31, 2010.

 The effective date for any Participation status change during the extension, however, remains January 1, 2010; and will be in force for the entire year.

 Contractors will accept and process any Participation elections or withdrawals, made during the extended enrollment period that are received or post-marked on or before January 31, 2010.

 Note:  This is an extension of the annual participation enrollment period dates in CR 6637 (Transmittal 1832 -- Calendar Year (CY) 2010 Participation Enrollment and Medicare Participating Physicians and Suppliers Directory (MEDPARD) Procedures), dated October 16, 2009.

 The Participation Agreement (CMS-Form 460) is available on the CD-ROM that is sent out annually by your Medicare contractor during the Annual Participation Enrollment period.  Your contractor will also make the Participation Agreement available to you by placing it on their Websites with Participation enrollment (and termination) instructions.


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December 9th Public Health Committee Presents "Our Public's Health"

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.  Educational Credits are pending.  This is the December meeting of the Public Health Committee and if time permits, business items will be discussed after the panel presentation.

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

Lani Graham, MD, MPH 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, MPH 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 for all members and nonmemberrs, contact MMA at 207-622-3374, ext. 219 or via email to Maureen Elwell at .  Members and nonmembers are welcome to attend. 

Registration deadline is December 4, 2009. [return to top]

MIHMS Companion Guides (Electronic Claims Filing Guides) are available on-line

MIHMS Companion Guides (Electronic claims filing guides) are now posted on the Unisys Provider Portal.  (Maine Integrated Health Management Solution, "MIHMS") Six guides appear on the site:

  • 270 Eligibility Benefit Inquiry
  • 276 Claim Status Request
  • 278 Health Services Review
  • 837 Dental
  • 837 Institutional
  • 837 Professional

The purpose of these Companion Guides is to clarify, supplement and further define specific data content requirements to be used in conjunction with the HIPAA Implementation Guides (version 004010-A1) created for the electronic transactions standards mandated by the HIPAA regulations.  Additional information will be forthcoming in another listserve with the HIPAA EDI claims file testing and approval time frames.  Questions:  MaineCare   Is your mailing address up to date with MaineCare?  You will need to keep MaineCare up to date so your Remittance Statements and checks arrive on time.  Call Provider Enrollment at 1-800-321-5557, Option 6. [return to top]

Reminder to Re-Enroll in MaineCare by Dec. 23, 2009

Because of the transition to the new MIHMS (Maine Integrated Health Management Solution) on March 1, 2010, MaineCare providers are asked to re-enroll in MaineCare by Dec. 23, 2009.  You must re-enroll by this date in order to keep billing MaineCare on or after March, 1, 2009.

The current claim system, MeCMS, will automatically deny any claims with dates of service after Feb. 28, 2010.

The Health PAS portal for re-enrollment is now available for all providers.  Please follow this link to the Health PAS provider re-enrollment portal to complete your re-enrollment application soon.  Click on the appropriate provider enrollment link in the middle of the left pane of the portal to begin.

If you have difficulty re-enrolling or have questions about your re-enrollment, call 1-800-321-5557, option 6, or e-mail  Staff is available to assist you from 8:00am and 5:00pm.  One-on-one appointments may also be scheduled to help you with your on-line re-enrollment application. [return to top]

More Physicians Received Incentives in 2008 Under PQRI

CMS announced on November 13, 2009, that 85,000 eligible practitioners succeeded in reporting quality data to the Medicare Physician Quality Reporting Initiative (PQRI) in 2008 and they received more than $92 million in incentive payments.  The program paid $36 million to 56,700 eligible practitioners in 2007.  In response to complaints about difficulties with data reporting during the first year of the program, CMS worked to improve the program and to promote education and outreach efforts to practitioners.

You can find more information about the PQRI program on the web at:
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