January 18, 2010

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The Tragedy in Haiti: How You Can Help

The devastating earthquake that struck Haiti on Tuesday has focused attention on this vulnerable country and its people.  With perhaps as many as 100,000 killed and many more injured, nations and people around the world are being generous in responding to the tragedy.  MMA members and staff want to help and share with readers of this Update some ways that they can be helpful, including assisting Maine physicians on their way to Haiti and the Dominican Republic.  Our hearts go out to the men, women, and children lost or suffering.

The medical community in Maine has many relationships with the people of Haiti, including the work of the Portland-based non-profit organization, Konbit Sante Cap-Haitien Health Partnership, which supports health and medical programs as well as other public health projects in the northern part of the country.  While Cap-Haitien did not suffer major physical damage, the Justinian Hospital there is now receiving critical patients from the areas more directly impacted by the quake. 

Konbit Sante has established an Earthquake Response Fund and the organization has contributed $25,000 from its reserves as an initial donation to the fund.  To contribute to this fund, please visit www.healthyhaiti.org and note that your contribution is for the Earthquake Response Fund.  These funds will be used to address long-term and short-term health needs related to the earthquake.

Many other reputable organizations are accepting contributions including the American Red Cross, International Response Fund at www.redcross.org,  Doctors Without Borders at www.doctorswithoutborders.org, The Salvation Army at www.salvationarmyusa.org or by check to The Salvation Army, "Haiti Earthquake," P.O. Box 3647, Portland, Maine 04104-3647 and Partners in Health at act.pih.org/earthquake or call 617-432-5298.

On a more personal level, Calais surgeon (and MMA Executive Committee member) Robert Chagrasulis, M.D. is traveling today to the Dominican Republic (DR) where he has previously volunteered at the Good Samaritan Hospital in Las Romana which has begun accepting injured patients from Haiti.  Bob is an experienced trauma surgeon and speaks Haitien Creole and French, making him uniquely qualified to assist.  Bob's team will go to Haiti from DR on Tuesday.  In order to directly assist the effort at the Good Samaritan Hospital, MMA has established an assistance fund within the Maine Medical Education Trust, a charitable foundation created by MMA.  MMA will contribute 100% of contributions received for the fund to the hospital and its medical team for use in treating victims from Haiti. Contributions can be made payable to the Maine Medical Education Trust (MMET) and are tax deductible. 

The financial needs associated with the many injuries will continue for a long time.  MMA itself will consider a contribution to the fund at an Executive Committee meeting this Friday. 


AMA Efforts Continue to Prevent Medicare Physician Payment Cuts: President-elect Wilson in Maine on Thursday

AMA President-elect Cecil Wilson, M.D. will be in Maine this week to advocate for Medicare payment reform.  Congress must act prior to March 1, 2010 to avert a scheduled 21% reduction in the physician fee schedule.  Dr. Wilson will be the primary speaker at a media event scheduled in Portland at 9:30 a.m. on Thursday morning.  A precise location for the event has not yet been selected.  The event will also be part of a satellite broadcast with other AMA representatives present in Wisconsin, North Dakota, Virginia, and Washington, D.C.

The theme for the event will be the potential access problem for seniors if physicians are unable to see Medicare patients. 

Maine Senators Olympia Snowe and Susan Collins have both publicly supported a long-term fix to the flawed sustainable growth rate formula, but have opposed any proposal to pay for a fix by increasing the federal deficit.  The cost of a ten-year fix is $210 billion.  You can find advocacy resources on the Medicare SGR issue, including details about the likely impact on the state of Maine, on the AMA's web site at:  http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/medicare/payment-action-kit-medicare.shtml. [return to top]

MMA President-Elect Receives the First HPP Annual Pamela M.B. Studwell Tobacco Policy Award

On January 14, 2010, The Health Policy Partners of Maine held their Annual Meeting to recognize achievements over the past year and to turn the helm of Chair from Jo Linder, M.D. to Dervilla McCann, M.D. 

Health Policy Partners of Maine bestowed the first annual award “The Pamela M.B. Studwell Tobacco Policy Award,"  which is given to an individual whose dedication, persistence, and passion for improving lives has significantly advanced best practice tobacco policies in Maine.  The award recognizes the efforts of Pamela Studwell who left this life way too early.  Everything Pam  created was perfect – meticulously correct, thorough, objective, strategic, and thoughtful.  Her legal and background work on so many critical pieces of legislation formed the foundation of their success.  It is always difficult to lose one member of Maine’s public health family, and it is especially difficult when that loss is so premature.  Pam’s legacy in tobacco control in Maine will certainly live on. 

This award was bestowed for the first time to Jo Linder, M.D. for her persistence, commitment and dedication to public health through Health Policy Partners of Maine efforts in tobacco control.  Her leadership over the past seven years has moved Maine forward in accomplishing a higher level of expectations for public health in Maine.  Thank you Pamela for your dedication to our public health efforts in Maine, for her family for sharing her expertise with us, and to Dr. Linder for her "on the ground" leadership skills that have propelled us to strengthen our  public health infrastructure in the state of Maine.

Dr. Dervilla McCann will assume the helm of Health Policy Partners of Maine.  She is currently the Co-Chair of Internal Medicine at St. Mary's Regional Medical Center, the Medical Director at Take Charge, and partner at Androscoggin Cardiology Consultants.  Dervilla received her medical degree from Tufts University and is a graduate of Bates College.  Dervilla spent 9 years as a Navy Officer, achieving the rank of Commander USNR.  She served as CCU Director at the National Naval Medical Center, Bethesda, MD.

In 1996, Dervilla transitioned to private practice in Central Maine and currently she is a partner at Androscoggin Cardiology Associates and Maine Research Associates, practicing non invasive cardiology, participating in clinical research, and providing administrative support to regional hospitals.

Health Policy Partners of Maine's goal for 2010 is to raise the price of tobacco products and help protect Maine kids.



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Medical Marijuana Task Force Completes its Work

The fourteen member Medical Marijuana Task Force appointed by Governor Baldacci held its fifth and final meeting on Friday, January 15th.  The Task Force was charged with reviewing the law enacted by direct initiative and approved by the voters last November and with making recommendations for changes to the law and DHHS regulations necessary to implement the law.  The Task Force agreed upon a series of significant changes to the law that will be presented to the Legislature's Joint Standing Committee on Health & Human Services in mid-February.  Members of the Task Force also agreed upon a set of proposed rules which will now go through the formal rule-making process.

Recommendations of particular interest to physicians include the following:

  • A requirement that physicians completing medical certificates have an active DEA license.

  • Clarification that the Board of Licensure in Medicine and the Board of Osteopathic Licensure may take action against a physician who does not meet appropriate standards of care in assessing or treating a qualified patient under the law.

MMA will continue to receive input from members and may present an amendment at the legislative hearing on the bill proposed by the Task Force.  The amendment would specific a minimum age for a qualifying patient and may include other provisions as well.  More control over the impact of the law on minors has been requested by the Maine Association of Psychiatric Physicians and several physicians active in the field of addictions. 

"As has been the case with the prior law, we believe that the role of MMA is to advise those physicians wishing to use the law while also assisting those physicians who are not supportive of it and not interested in preparing medical certificates for their patients," noted Andrew MacLean, Esq, Deputy EVP and General Counsel at MMA.  "As we get closer to implementation, we will provide educational programs and appropriate forms to assist members."

Any members wishing to provide input on this issue should contact MMA EVP Gordon Smith, Esq. who served as a representative of physicians on the Task Force.  He may be reached via e-mail to gsmith@mainemed.com or by calling 622-3374, ext. 212 or via cell phone 215-7461. [return to top]

POLITICAL PULSE: MMA Joins MHA and Others in Opposing MaineCare Cuts in Supplemental Budget


On Monday, January 11th, MMA representatives joined many other advocates in opposing cuts in the MaineCare budget contained in the Governor's FY 2010-2011 supplemental budget proposal, L.D. 1671.  MMA President David McDermott, M.D., M.P.H. presented the MMA testimony to the Joint Standing Committees on Appropriations and Health & Human Services.  Dr. McDermott's testimony has been placed on the MMA website at www.mainemed.com

On Tuesday, January 12th, MMA participated in a media event organized by the Maine Can Do Better Coalition, advocating for a more balanced package of cuts and revenue enhancements.  MMA has supported an increase in the cigarette tax, now the second lowest in New England.  MMA was represented at the press conference by Lani Graham, M.D., M.P.H., a former Director of the Bureau of Health.

Of particular concern are the arbitrary limits set on certain types of visits and services, including mental health outpatient visits.

Other organizations opposing the cuts included the Maine Hospital Association, the Maine Association of Psychiatric Physicians, NAMI-Maine, the Maine Hospice Council, the Maine Healthcare Association, and many others.

The HHS Committee on Tuesday will begin two weeks of deliberations on the cuts impacting on MaineCare and other health and human service programs.  At the conclusion of its deliberations, the Committee will submit its recommendations to the Appropriations Committee.  MMA staff will monitor the work of the Committee and will continue to communicate with MMA members and staff through the Weekly Update and other communication tools.


The Insurance & Financial Services Committee held a number of work sessions and public hearings last week.  Members tabled discussion of L.D. 1365, An Act to Establish a Single-Payer Health Care System, but voted unanimously "ought not to pass" on L.D. 257, An Act to Establish the Health Technology Clinical Committee, a bill that was considered premature in light of the national health system reform debate.  The Committee also faces several health insurance mandate bills:  L.D. 425, An Act to Require Private Insurance Coverage for Certain Services for Children with Disabilities and L.D. 1198, An Act to Reform Insurance Coverage to Include Diagnosis for Autism Spectrum Disorders. The Committee also held public hearings on L.D. 1498, An Act to Adopt a Drug Benefit Equity Law and L.D. 1510, An Act to Maintain Compliance of Maine's Insurance Laws with National Standards.  L.D. 1510 appears to be a non-controversial proposal to ensure that Maine's insurance laws are consistent with new standards of the National Association of Insurance Commissioners (NAIC), but L.D. 1498 is the result of a continuing dispute between insurance carriers and pharmacy benefit managers (PBMs) on one hand, and pharmacies (primarily independent pharmacies) on the other about reimbursement methodologies.


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Update on National Health Care Reform: Progress Continues

The efforts of the Democratic leadership in Congress to reconcile the House and Senate health care reform proposals continued last week as the climate for reform continued to deteriorate across the country.  As the political pundits watch the Senate special election in Massachusetts tomorrow, many observers believe that a Republican win could be the death knell for the bill.

But in a positive development, the White House, Congressional leaders, and labor unions announced on Thursday that they had reached agreement on the proposal to tax high-cost health insurance policies as one of the vehicles to raise revenue to pay for the costs of the proposal.  The imposition of this tax to partially fund the costs associated with the bill was one of the biggest obstacles to passage as many Democratic members of Congress and virtually all the labor unions strongly opposed the tax.  The tax was included in the Senate bill and the House Democrats strongly objected to it. 

The changes negotiated by the parties would lessen the impact of the tax and delay its effective date for many.  The thresholds for the tax also were increased so that only policies costing more than $8,900 for individuals and more than $24,000 for families would be subject to the tax.  And beginning in 2015, the cost of coverage for dental and vision care would be excluded from the value of the policies for the purposes of calculating the threshold.  Also, health plans covering state and local government employees and plans which are collectively bargained would be exempt from the tax until 2018. 

Because of these changes and others, the tax is now projected to raise $90 billion over ten years, rather than the $149 billion estimated from the provisions in the Senate bill.

Democratic leaders of the Congress still hope to enact a merged bill in each legislative body prior to the President's State of the Union address in early February.

You can continue to track the national health system reform debate on the AMA web site at:  http://www.ama-assn.org/ama/pub/health-system-reform/our-vision.shtml. [return to top]

Maine Concussion Management Conference Scheduled for January 29th at Colby College

The Maine Concukssion Management Initiative has scheduled another Maine Concussion Management Conference for January 29, 2010 from 8:30 a.m. to 4:00 p.m. at Colby College in Waterville.  Founded in 2009 through a grant from the Goldfarb Center for Public Affairs & Civic Engagement at Colby, the goal of the Initiative is "to enhance the health and safety of Maine high school athletes by educating medical practitioners and school administrators about the dangers of traumatic brain injury and the importance of consistent concussion management."  

The speakers for the January 29th conference are:  William Heinz, M.D., Kendra Bryant, Ph.D., Christopher Lutrzykowski, M.D., Michael Collins, Ph.D., Paul Berkner, D.O., Arlene Verre ATC, and Peter Sedgwick, M.D.  You can find registration materials for the conference on the web at:  http://wiki.colby.edu/display/GCMGrant/January+29th+Conference.

You can find more information about the Maine Concussion Management Initiative on the web at:    http://wiki.colby.edu/display/GCMGrant/Maine+Concussion+Management+Initiative. [return to top]

MQF Health Failure & Readmission Reduction Project Summit Scheduled for March 30th


Heart Failure and Readmission Reduction Project Summit:

“All my bags are packed: am I ready to go?”



The Maine Quality Forum is pleased to sponsor a quality improvement summit focused on developing strategies to ensure that heart failure patients receive appropriate instructions at discharge, improve care transitions, and reduce unnecessary readmissions.

Heart Failure (HF) is a major and growing public health problem, affecting 5.3 million people, mostly elderly, with 660,000 new cases diagnosed each year in the US.  HF is the underlying cause for 12 to 15 million office visits and 6.5 million hospital days each year.  The high HF rehospitalization rate drives burgeoning costs and also provides a signal that current management approaches to  are less than optimal.

Where:                                     Augusta Civic Center

When:                                      Tuesday, March 30, 2010

Who should attend:                 A team from each facility including Senior Nursing and Physician leaders able to effect change within the organization, staff involved in Direct Care and Discharge Planning/Care Management for Heart Failure patients and Process Improvement/Quality Improvement team members.  

Agenda items will include:

  • Heart Failure-Clinical implications/considerations
  • Data Analysis (Heart Failure Discharge Measures, Care Transitions Measures, and Readmission)
  • Out and About-process lessons/strategies learned from hospitals
  • Linking diagnosis to treatment and care transitions

This summit is made available at no cost.  Breakfast, lunch, and refreshments will be provided.

Heart Failure and Readmission Reduction Project Summit


All my bags are packed: am I ready to go?”

Date:                   Tuesday, March 30, 2010

Time:                   8:00 AM - 4:00 PM

Location:            Augusta Civic Center, 76 Community Drive, Augusta, ME  04330

Registration Form (Please Print)

Contact Name:________________________________________



Contact Phone Number:________________________________

Contact E-mail:_______________________________________

Please list names, titles and e-mail addresses of members attending:

Please E-mail or fax registration form to:

Maine Quality Forum, Attn:  Ruth Ann Burke

Fax:  207-287-5198



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CDC Says Physician Use of EHRs Increased in 2009

On January 8th, the U.S. C.D.C. reported that almost 44% of office-based physicians used some form of electronic health records in 2009, up from 42% in 2008 and 35% in 2007.  However, only 20% reported having basic EHR systems including patient demographic data, problem lists, clinical notes, prescription orders, and viewing of lab and imaging results.  Only 6% of physicians said they had a fully functional system that also included sending prescription and test orders, highlighted out-of-range test levels, provided patient medical history and follow-up information, and provided drug interaction warnings, along with reminders for guideline-based interventions.

This information came from the C.D.C.'s survey, Electronic Medical Record/Electronic Health Record Use by Office-based Physicians:  United States, 2008 and Preliminary 2009 available on the web at:   http://www.cdc.gov/nchs/data/hestat/emr_ehr/emr_ehr.pdf. [return to top]

CMS Says Slowdown in Health Spending is Result of Recession

In a report published January 5th in Health Affairs, the CMS Office of the Actuary said that national health spending grew at its slowest rate in decades in 2008, partly because of the economic recession.  The report concluded that U.S. health spending grew 4.4% in 2008 to $2.3 trillion, or $7681 per person.  Health spending grew 6% in 2007.  Although the rate of growth slowed, health care spending as a portion of the gross domestic product was up at 16.2% of GDP in 2008 compared with 15.9% of GDP in 2007.

CMS has tracked national health care spending since 1960 and the 2008 slowdown is the low during this time frame.  The CMS data is available on the web at:  http://www.cms.hhs.gov/NationalHealthExpendData/. [return to top]

Legislative Committee Conference Call Information: NOTE New Number & Access Code!

MMA Legislative Committee Chair Lisa Ryan, D.O. invites any interested physician or physician staff member to participate in the weekly conference call on Thursday, January 21st at 8 p.m. using the following toll-free call-in number and access code:  call 1-877-669-3239; access code 23045263. [return to top]

New Bills for Review & Consideration This Week

The following are bills of interest to the physician community identified by the MMA staff.  By clicking on the highlighted "LD XXXX," you will go to the summary page for the bill on the legislature's web site.  You can find the text of the bill by following the tabs on the left side of the summary page.  These bills will be on the agenda for the weekly Legislative Committee conference call this week, or you may provide feedback directly to Andrew MacLean, Deputy EVP, by phone at 622-3374, ext. 214 or by email at amaclean@mainemed.com.  You will note that the MMA staff has suggested a position for each bill along with a MMA committee or specialty society that may have a particular interest in the bill.

LD 1672, An Act to Require a Pharmacist to Provide Prior Notification to and Obtain Consent from the Prescribing Physician before Changing from One Formulation or Manufacturer of an Antiepileptic Drug to Another (support; neurologists)

LD 1677, An Act to Protect Minors from Pharmaceutical Marketing Practices (monitor; pediatricians)

LD 1680,  An Act to Assist in Reviewing Wind Energy Applications (monitor; Public Health Committee)

LD 1685, An Act to Clarify the Enforcement Role of the Mixed Martial Arts Authority of Maine (monitor; family physicians)

LD 1687, Resolve, to Define High-Risk Populations for the Purposes of Hospital Surveillance for Methicillin-resistant Staphylococcus Aureus and to Implement Public Law 2009, Chapter 346 (oppose; coordinate with MHA; Public Health Committee)

LD 1688, An Act to Update the Laws Affecting the Department of Health & Human Services, Division of Licensing & Regulatory Services (monitor)

LD 1702, An Act to Amend the Laws Governing Advanced Practice Registered Nurses (monitor; seeking review with licensing boards & NP association)

LD 1704, An Act to Amend the Laws Regarding Authority Over and Oversight of Certified Nursing Assistant Educational Programs (monitor)

LD 1706, An Act to Create the Children's Wireless Protection Act (monitor or oppose; pediatricians; Public Health Committee)

LD 1708, An Act to Expand the Opportunity for Persons to Acquire Health Care Coverage under the State's "Mini-COBRA" Program (support)

LD 1709, An Act Concerning the Use of Long-term Antibiotics for the Treatment of Lyme Disease (oppose; infectious disease specialists; Public Health Committee) [return to top]

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