February 22, 2010

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MMA Legislative Committee Holds Forum on State Budget on Thursday Night

MMA's Legislative Committee will dedicate its entire upcoming meeting on Thursday evening, February 25th to a forum on the legislature's decisions about the FY 2010-2011 supplemental budget (L.D. 1671) and the impact of those decisions on the state's health care system.  In an informal setting the MMA hopes will encourage dialogue, attendees will have a chance to hear from several lawmakers and DHHS officials as the Legislature heads into its final deliberations on the Governor's supplemental budget proposal aimed at reducing proposed state expenditures by $438 million.

The MMA's Legislative Committee, chaired by Lisa Ryan, D.O. of Bridgton, has met via conference call every Thursday evening since mid-January to review the various bills affecting the practice of medicine in Maine.  While members say that they have appreciated the convenience of the conference calls, we know that members also enjoy an opportunity to see each other on occasion.  Members of the House and Senate from both the Health & Human Services Committee and the Appropriations Committee plan to attend.  DHHS Commissioner Brenda Harvey also has been invited and is expected to attend.

The forum is scheduled for 6 p.m. to 8 p.m. at the MMA offices in the Frank O. Stred building in Manchester.  Hot and cold hors d'oeuvres, wine, and soft drinks will be available at 6 p.m.

Any MMA member, physician office staff member, or guest is welcome to attend, but please contact Maureen Elwell, Legislative Assistant, so that we can be sure to have enough food.  Maureen can be reached at 622-3374, ext. 219 or via e-mail to melwell@mainemed.com.

In order to avoid significant cuts in the MaineCare budget and in other health care service areas, MMA has advocated for a $1.00 increase in the tobacco tax.  The Association also has worked with Maine's Congressional delegation to encourage action to extend the current enhanced federal medicaid payments into the next federal fiscal year.

You may participate in the meeting by webinar as well.  See below.

Maple Room invites you to attend this online meeting.

Topic: Legislative Committee Forum
Date: Thursday, February 25, 2010
Time: 6:00 pm, Eastern Standard Time (New York, GMT-05:00)
Meeting Number: 737 507 002
Meeting Password: 1234

To join the online meeting (Now from iPhones too!)
1. Go to https://mainemed.webex.com/mainemed/j.php?ED=132277642&UID=915285267&PW=NYzczNjBlOGZm&RT=MiMxMQ%3D%3D
2. Enter your name and email address.
3. Enter the meeting password: 1234
4. Click "Join Now".

To view in other time zones or languages, please click the link:

To join the audio conference only
To receive a call back, provide your phone number when you join the meeting, or call the number below and enter the access code.
Call-in toll-free number (US/Canada): 1-877-669-3239
Call-in toll number (US/Canada): +1-408-600-3600
Global call-in numbers: https://mainemed.webex.com/mainemed/globalcallin.php?serviceType=MC&ED=132277642&tollFree=1
Toll-free dialing restrictions: http://www.webex.com/pdf/tollfree_restrictions.pdf

Access code:737 507 002

For assistance
1. Go to https://mainemed.webex.com/mainemed/mc
2. On the left navigation bar, click "Support".

You can contact me at:

To add this meeting to your calendar program (for example Microsoft Outlook), click this link:

The playback of UCF (Universal Communications Format) rich media files requires appropriate players. To view this type of rich media files in the meeting, please check whether you have the players installed on your computer by going to https://mainemed.webex.com/mainemed/systemdiagnosis.php

Sign up for a free trial of WebEx


IMPORTANT NOTICE: This WebEx service includes a feature that allows audio and any documents and other materials exchanged or viewed during the session to be recorded. By joining this session, you automatically consent to such recordings. If you do not consent to the recording, do not join the session.  



President Reveals New Health Care Proposal Today in Advance of Thursday Summit

Today, the White House is expected to release on its website a new health care reform proposal in advance of the televised bi-partisan summit being held on Thursday, February 15th.  The bill is said to be somewhat of a compromise based on the previously passed House and Senate bills.  At this point, it is not clear the extent to which invited Republicans will participate or be willing to advance their own proposal in lieu of the President's. 

Also, there still is the very real possibility that the Democratic leadership in the House and Senate will seek to pass a health care reform bill through the budget "reconciliation" process which does not require the super-majority 60 votes in the Senate.  Only a simple majority is required, but the rules regarding reconciliation limit the contents of such a bill to items affecting the federal budget.  While many of the provisions in the previously considered House and Senate bills certainly impact the budget, many others do not.  Some observers have even suggested that the controversial  "public option" could be included under this scenario.

The Congress returns to Washington today following its President's Day holiday.  In interviews with Maine newspapers last week, Senator Susan Collins stated that she believed a reform bill could be passed within six weeks if Democrats took a bi-partisan approach to the subject.  She noted that there continues to be widespread support in both parties for provisions that assist small business, reform commercial insurance practices, and promote wellness and health promotion programs.  Her advice to Republican leaders was to view the invitation to the summit as a good faith effort and to arrive there with a consensus list of provisions that Republicans could support.

Maine's senior Senator Olympia Snowe has consistently stated that she believes the status quo is unacceptable and that passage of a reform bill is essential.  Both she and Senator Collins are seen as key players in any possible bi-partisan approach. 

You can find information about the President's proposal on the web at:  http://www.whitehouse.gov/Issues/health-Care.


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Physician Medicare Payment Cuts Coming March 1st Unless Congress Acts this Week

Physicians and other medical professionals across the nation will see a 21.5% reduction in Medicare reimbursement on March 1, 2010.  With only a week to go before the cut takes effect, it is imperative that physicians communicate with all four members of Maine's congressional delegation and urge action this week to delay or restore the cut.  While a permanent fix to the SGR formula problem is being sought by the AMA and most national specialty societies, the likelihood that a permanent fix can be found this week is slim.  Because of "pay-go" rules in the Congress, the $230 billion cost of restoring the cut permanently must be paid for by raising revenue or cutting expenses someplace else in the budget.

On at least one previous occasion, a similar cut took place and was restored a few weeks later, with physicians paid retroactively based upon the restored amount.  A similar approach is becoming increasingly likely this year.

All four members of Maine's congressional delegation have previously stated their support for eliminating the flawed sustainable growth rate formula, but Senators Snowe and Collins have insisted that the cost of changing the formula (restoring the cuts) be paid for, rather than increasing the deficit further.

MMA representatives will participate in a nationwide call with the AMA lobbyists on Wednesday to  discuss the strategy going forward on this critical issue.  In addition to physicians, hospitals, and other medical professionals, advocacy on this issue has also been provided by the AARP and other organizations representing seniors.  There is grave concern on the part of seniors and their advocacy organizations that such a significant cut will cause physicians and other medical professionals to restrict access to Medicare patients.

 You can find information about the AMA's advocacy on the Medicare SGR issue on the web at:  http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/medicare/payment-action-kit-medicare.shtml.

You can communicate with Maine's Congressional delegation through the AMA's grassroots advocacy center at:  http://capwiz.com/ama/home/.

You can find the AMA President's letter to Senate Majority Leader Harry Reid (D-NV) sent today at:  http://www.ama-assn.org/ama/pub/health-system-reform/sgr-letter-22feb2010.shtml.

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DHHS Sets MIHMS "Go Live" Date for August 1, 2010

Citing the need for further testing, DHHS last week announced that its new MaineCare claims management system MIHMS (Maine Integrated Health Management System) will begin processing claims on August 1, 2010.  The original date scheduled for the switch was April 1, 2010.  A planned increase in MaineCare reimbursement rates from approximately 57% to 70% of Medicare rates will be effective March 1, 2010. [return to top]

Haiti Work of Doctors Fitz & Broaddus Featured in Portland Press Coverage

Dr. David Fitz, a surgeon with Plastic & Hand Surgical Associates in South Portland recently returned from 2 weeks with Operation Smile International (http://www.operationsmile.org/) assisting with the Haiti relief effort.  He worked in Fond Parisien about 25 miles outside of Port-au-Prince.  Operation Smile has been going to Haiti for many years, and went to Fond Parisien 3 days after the earthquake looking for a site to set up a disaster response team.  The team arrived at an orphanage with a walled facility perfect for organizing a field hospital.  At the same time, people from the Harvard Humanitarian Initiative (http://www.hhi.harvard.edu/) arrived and decided on a joint effort.  Dr. Fitz was at the Love a Child Orphanage and Health Center, now called Love a Child Disaster Recovery Center.  Basically, it was a tent hospital with operating rooms.  Dr. Fitz was there with initially one orthopedic surgeon and was acting chief of surgery when there.  They performed wound drainage, skin grafts, amputations, orthopedic procedures, and some acute trauma (facial trauma) not related to the earthquake.  When he left he passed the baton to a cardiac surgeon, plastic surgeon, and orthopedic surgeon.  Dr. Fitz now is on a clinical advisory council for the Operation Smile Haiti Effort in trying to improve the operating facility and continue with the ongoing effort.  Operation Smile has a blog in the website about the Haiti work.  

Dr. Fitz was featured in an article in the Maine Sunday Telegramhttp://www.pressherald.com/news/helping-in-haiti-maine-surgeon-describes-difficulties_2010-02-20.html.

Yesterday's Maine Sunday Telegram also includes a letter from Dr. Sam Broaddus, Director of the Division of Urology at Maine Medical Center, and a long term volunteer with Konbit Sante.  Dr. Broaddus recently returned from a 10-day trip to Cap Haitien during which he led a 7-member surgical team from Maine.  See http://www.pressherald.com/news/haiti-needs-long-term-commitment-from-all-of-us-portland-doctor-says_2010-02-20.html.

Members who would like to make a tax-deductible donation to relief efforts by Maine health care practitioners may send a contribution to one of the MMA's affiliated 501(c)(3) entities, the Maine Medical Education Trust, P.O. Box 190, Manchester, Maine 04351. 


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HIPAA Breach Notification Requirements Enforced this Week

The federal stimulus package of February 17, 2009 included The Health Information Technology for Economic and Clinical Health Act ("HITECH"), legislation designed to encourage accelerated adoption of electronic health record systems ("EMR").  It is predicted that the HITECH Act, with its systems of incentives and penalties, will induce 90% of American physicians to implement electronic health record systems by 2019.  The incentives include more than $17 billion earmarked for hospitals and health care professionals.  

But in addition to providing incentives for "meaningful use" of electronic health records systems, the Act also included important changes to the HIPAA privacy and security requirements.  These changes significantly expand the privacy and security rules and increase penalties for failure to comply.  The most significant change is the requirement to notify patients and the federal department of Health and Human Services of any breaches of security as that term is defined in the law.  In addition, HIPAA privacy and security requirements will apply directly to both covered entities and business associates.  Finally, there are also some changes in the accounting requirements for disclosures made through electronic medical record systems.

MMA has updated its HIPAA forms to comply with the provisions of HITECH.  Copies of the updated forms are available from MMA Deputy EVP Andrew MacLean at amaclean@mainemed.com.

Civil penalties for violation of HIPAA rules also have been significantly increased.  Depending upon the nature of the violation, civil penalties now may range from $100 to $50,000 per violation with a maximum penalty per year from $25,000 to $1.5 million.

On Friday, April 2nd, MMA will hold its Annual HIPAA Update for physicians and office staff as part of the "First Fridays" educational sessions.  The program will be held from 9:00 a.m. to noon at the MMA offices in the Frank O. Stred Building in Manchester.  A fee of $65 per person is charged and registration is available on the MMA website at www.mainemed.com.  For more information, call Gail Begin or Maureen Elwell at MMA (622-3374).

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MMA Opens 2010 First Friday Education Programs on March 5th

MMA's popular "First Fridays" Educational programs, offered the first Friday of each month (excluding some winter and summer months) begins its 2010 season on Friday, March 5th with a two hour program on the topic of the disruptive patient.  Participants will have a choice to participate in the program at the MMA office in Manchester or to log in on their computer and participate via webex.  The program runs from 9:00 a.m. to 11:00 a.m. 

Faculty for the program includes Michael Duddy, Esq., of Kelly, Remmel & Zimmerman in Portland.  Michael is an experienced health care attorney who is consistently among the highest rated presenters at MMA's programs.  MMA's attorneys Gordon Smith and Andrew MacLean also will present.

In addition to providing practical information on how to deal with difficult patients, the program will provide information on how to legally and ethically terminate the physician-patient relationship without triggering a claim of abandonment.  The program also will include a discussion of appropriate steps to take to protect staff.

Registration is available on the MMA website at www.mainemed.com or by calling Maureen Elwell at the office at 622-3374, ext. 219.  There is a $65 cost for the program.
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County Health Rankings Released

The University of Wisconsin's Population Health Institute and the Robert Wood Johnson Foundation on Wednesday, February 17th released a first-ever report ranking Maine's sixteen counties according to a set of factors leading to a conclusion of healthiest and least healthy county.  To review the report, go to www.county-healthrankings.org/maine.

According the the report, Franklin County is Maine's healthiest county while neighboring Oxford County is the least healthy, based upon the factors considered.  Researchers considered five factors to rank a county's overall health.  The rate of premature death - those before age 75 - was the most heavily weighted, accounting for half a county's score.  Of the remaining factors, low birth weight accounted for 20% and the other three - the percentage of residents in fair or poor health and the number of days individuals reported being in poor physical and mental health - were weighted equally at 10%.

The reports also examined key issues that figure into health, including information about smoking, obesity, drinking, pollution, access to health care, and socioeconomic data.  That information was analyzed to compile a second set of rankings, of health factors, for the counties.  In this ranking, Cumberland County received the highest ranking and Somerset County the lowest.  The health factor ranking was not always an accurate predictor of a county's position on the overall health ranking. 

Because Franklin County was at the top of the rankings in overall health, but seventh in terms of the health factors, many observers have credited the work of its Healthy Community Coalition, led by MMA member Burgess Record, M.D. and his wife Sandra as being a significant positive factor.  Dr. Dora Anne Mills, Director of the Maine CDC, cited the Coalition as positively impacting health status in Franklin County through its efforts against heart disease, cancer, diabetes. and lung disease.  So, while Franklin County's socioeconomic situation remained similar to those of its neighbors, Oxford and Somerset counties, its overall health improved.

Trish Riley, Director of the Governor's Office of Health Policy & Finance, noted upon release of the report that it ranks only counties within a state and does not compare counties across the country.  She noted that the new rankings should be seen in the light of Maine's overall health status as the 9th highest in the nation.

Dr. Mills noted that the effectiveness of the coalition in Franklin County was a major impetus for the recent creation of a public health infrastructure consisting of eight districts.  Each district receives state funds to coordinate and promote local efforts aimed at improving health status in the region.

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MMA Executive Committee Meets this Wednesday, February 24th

MMA's 28-member Executive Committee, chaired by Nancy Cummings, M.D. of Wilton, will hold its regularly scheduled meeting this coming Wednesday, February 24th at the Association offices in the Frank O. Stred Building in Manchester.  The meeting is scheduled from 2:00 p.m. to 5:00 p.m.  Any MMA member is welcome to attend.

Priority topics for the meeting include the following:

  • Pending legislation on both the federal and state level;

  • Future of the Coding Center;

  • Continuation of discussion regarding MMA's communications to members in the context of social media.

On the legislative side, the situation in Washington relative to the pending Medicare cut and the upcoming health care reform summit will be front and center.

Staff will also provide updates on the Medical Professional Health Program, the Academic Detailing project and the Small Hospital Peer Review Collaborative.  Financial results for 2009 will be presented by Kevin Flanigan, Chair of the Budget and Investment Committee and Heidi Lukas, CPA, Finance Director. [return to top]

Maine Independent Clinical Information Service (MICIS) announces availability of the Antiplatelet Therapy Module

The Maine Independent Clinical Information Service (MICIS) announces the availability of the Antiplatelet Therapy Module.  Academic Detailers Noel Genova, PA-C and Erika Pierce, PA-C are available upon request to meet with prescribers on the most up to date evidence-based prescribing information.

Antiplatelet Agents:  When, which one, how much?  Antiplatelet Therapy 2010:  What is the role of prasugrel?  When is clopidogrel better than aspirin?  When is it not?  When should aspirin be prescribed for primary prevention of MI or Stroke?  Are some patients resistant to antiplatelet medications?  Do PPI’s reduce the effectiveness of clopidrogrel?

“Academic detailing” uses the drug industry model of “face to face contact” in physicians’ offices to promote prescribing practices that are NOT biased on commercial interests.   MICIS addresses the challenge of finding readily available, unbiased, evidence based patient outcome measures that can guide you in your prescribing practices.  MICIS addresses that challenge in two important ways:

  1. The best and most current, non-proprietary evidence based information on the treatment of common and important clinical problems, is presented in a pleasing and easily accessible format by very capable Academic Detailers.
  2. Using the pharmaceutical industry model, our detailers bring this resource to the your office to meet personally with you and your colleagues for formal or informal presentations.

The intent of MICIS is straightforward:  by providing prescribers with the information they need for evidence based prescribing in the real world of internal medicine and primary care, patient outcomes can be improved.  And while the primary goal of this program is quality, the experience in other states has demonstrated that academic detailing also helps to control costs, which has important implications for access to healthcare.

To request an Academic Detailing visit on the Antiplatelet Therapy module and/or Adult Type 2 Diabetes module, contact MMA staff, Kellie Slate Miller at kmiller@mainemed.com or 207-622-3374, ext. 229, or www.mainemed.com/academic/index.php.  For more information and resources on Academic detailing go to Independent Drug and Information Service at www.rxfacts.org and the Drug Effectiveness Review Project at  www.ohsu.edu/ohsuedu/research/policycenter/DERP. [return to top]

Maine HAN Alert on Travel Related Conditions

Maine HAN Alert, February 22, 2010 - Travel-Related Disease Conditions

The Maine Center for Disease Control & Prevention (Maine CDC) has investigated multiple cases of travel related illness in 2010.  Cases of dengue fever, typhoid fever, cryptosporidiosis, salmonellosis, and giardiasis have been reported to Maine CDC in persons who have recently traveled or have moved to Maine from another country.  During school vacation weeks in February and April Maine residents travel outside of the United States, often to warmer climates putting them at risk of mosquito borne diseases, especially dengue fever. A full version of this advisory may be downloaded from the Maine CDC website as a Microsoft Word document (.doc) or Adobe PDF (.pdf) by clicking on http://www.mainepublichealth.gov/.  For additional information, contact the MaineHAN Help Desk at HAN@maine.gov. [return to top]

CMS Again Delays Enforcement of PECOS Enrollment for Medicare Providers

On February 17th, CMS announced the postponement of a policy requiring rejection of claims by those not enrolled in the Provider Enrollment, Chain, and Ownership System (PECOS) from April 5 to January 3, 2011.  Soon CMS plans to mail letters to those practitioners who have not updated their Medicare enrollment record since November 2003, the date when CMS began using PECOS.  Even if there's been no change in enrollment data since that time, it is important that practices complete an initial enrollment application to establish a current record in PECOS.  [return to top]

POLITICAL PULSE: Coverage of Hearings on MRSA & Solitary Confinement Bills


Last Wednesday, the Health & Human Services Committee held a public hearing on L.D. 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.  The bill proposes to define in statute the high-risk population for screening purposes and requires hospital reporting of positive test results.  This legislature addressed both screening and reporting in two pieces of legislation enacted during the last session (Resolves 2009, Chapter 82 and P.L. 2009, Chapter 346).  The Maine Hospital Association, the MMA, the Maine Osteopathic Association, and others opposed the bill because these issues are better resolved in an ongoing collaboration among the Maine Quality Forum, the Maine Health Data Organization, and professional groups and entities making up the Maine Infection Prevention Collaborative.  Infectious Disease specialists August Valenti, M.D. and Robert Pinsky, M.D. spoke in opposition to the bill.  State Epidemiologist Stephen Sears, M.D. and MQF Director Josh Cutler, M.D. spoke “neither for nor against” the bill.  Proponents of the bill included those who supported last session’s bills and who do not believe they went far enough.  Organized labor, the Maine People’s Alliance, and Consumers for Affordable Health Care also testified in support of L.D. 1687. 

The HHS Committee has scheduled a work session on the bill for Wednesday, March 3d at 1:30 p.m.  If you would like to communicate your concerns about this legislation to committee members before the work session, you can find contact information for the members on the web here:  http://www.maine.gov/legis/house/jt_com/hum.htm.


Also last Wednesday, the Criminal Justice & Public Safety Committee conducted a public hearing on L.D. 1611, An Act to Ensure Humane Treatment for Special Management Prisoners.  The bill was sponsored by Representative James Schatz (D-Blue Hill) on behalf of the Maine Civil Liberties Union (MCLU).  The public hearing began at 1:00 p.m. and lasted well into the evening.  In addition to the MCLU, proponents included the Maine Association of Psychiatric Physicians (MAPP) represented by its President, Janis Petzel, M.D. of Hallowell.  Opponents included the Department of Corrections and representatives of the correctional officers.  The MMA delivered testimony acknowledging the adverse health effects of a lack of socialization in the "neither for nor against" category.  The Criminal Justice Committee has scheduled a work session on the bill for this Friday, February 26th at 10:00 a.m.


The HHS Committee recently voted 11-2 "ought to pass as amended" on L.D. 1408, An Act To Establish the Universal Childhood Immunization Program.

This legislation has been the top priority of the Maine Immunization Coalition and one of the MMA Public Health Committee's top legislative priorities for the past year.  This bill streamlines vaccine management at the point of care, reduces total costs per child for vaccine acquisition, and, most importantly, provides unfettered access to life-saving childhood vaccine for every child in Maine.  The work group under the guidance of the bill’s sponsor, Representative Gary Connor (D-Kennebunk), has since continued working with vested partners and HHS committee staff to finalize the technical language of the bill and will finalize those today to prepare L.D. 1408 for a House vote in the coming weeks. 
The bill reflects consensus among all stakeholders involved in negotiations thus far, notably the Maine Medical Association, Maine Primary Care Association, Maine Osteopathic Association, Maine Center for Disease Control & Prevention, the Maine State Chamber of Commerce, Maine Association of Health Plans (representing private insurers), the Maine Chapter of the American Academy of Pediatrics, and the Maine Children's Alliance.
Even with such a strong vote out of the HHS Committee we continue to  receive challenges from the vaccine manufacturing community.  Although a couple of manufacturers (e.g., GlaxoSmithKline and MedImmune) have participated in the discussions and refinement of the bill over the previous months, others have taken a stand against the bill, such as Sanofi Pasteur’s citing concerns about undercutting the private sector. 

As this legislation continues to move forward, advocates for the Universal Childhood Immunization Program will need to continue to voice their support of the bill to our policymakers that L.D. 1408 is a win-win for Maine's public health infrastructure.  
For additional information regarding L.D. 1408, contact Kellie Slate Miller, Director of Public Health Policy at kmiller@mainemed.com or 207-622-3374, ext. 229. 


 Following many work sessions on a bill carried over from the first session, the HHS Committee last week voted 7-3 (not all members were present) "ought to pass as amended" on L.D. 1360, An Act to Allow Law Enforcement and Family Members to Petition the District Court to Initiate Assisted Outpatient Treatment.  As with most bills of this type, the Committee has struggled to find the appropriate balance between individual patient rights and public safety.  While the vote is a partisan split with the Committee Republicans in the minority, there was widespread agreement about many of the issues and both the majority and minority reports will recommend further action in this area.


Work on the Governor's FY 2010-2011 supplemental budget, L.D. 1671, continues in both the HHS & Appropriations Committees.  Last week, the HHS Committee spent hours discussing some of the more controversial aspects of the budget bill, particularly in the area of services for individuals with mental illness or mental retardation.  The HHS Committee is scheduled to meet once again with the Appropriations Committee this Wednesday afternoon.  It is unlikely that any final decisions will be made about the DHHS portion of the budget until it is known how much additional money may be coming from Washington, D.C.



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