March 8, 2010

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Medicare Payment Cut Delayed (again) Until April 1, 2010

President Obama signed the bill just hours after the Senate voted 78-19 to approve the $10.3 billion extension package on March 2nd.  Both of Maine's Senators voted with the majority to further delay the Medicare physician payment cut.

The bill, H.R. 4691, also extends unemployment insurance and COBRA continuation coverage subsidies for individuals who have been laid off, highway funding, and a 1-month delay in implementation of a financial cap on Medicare Part B outpatient therapy services.  The Senate currently has an amendment on the subject drafted by Senate Majority Leader Harry Reid (D-NV) and Senate Finance Committee Chairman Max Baucus (D-MT) to a bill (H.R. 4213) passed by the House in December.  The proposal would extend the Medicare physician payment freeze through September 30th.  

In related action, on March 1st, the Medicare Payment Advisory Commission (MedPAC) included in its semiannual report to Congress a recommendation that physicians and other Medicare Part B providers receive a 1% fee increase in 2011.

You will find more information about the continuing efforts to advocate a permanent fix for the Medicare SGR problem on the AMA web site at:

Governor John Baldacci Receives 2010 Nathan Davis Award from AMA

On March 2nd, during the American Medical Association's annual National Advocacy Conference, the AMA Board of Trustees honored Maine Governor John E. Baldacci as "Outstanding Governor."  The "Outstanding Governor" is one of several Dr. Nathan Davis Awards for Outstanding Government Service presented each year for outstanding contributions "to promote the art and science of medicine and the betterment of public health."  

Named for the founding member of the AMA, the Dr. Nathan Davis Awards for Outstanding Government Service include:

  • Outstanding Governor
  • Outstanding Member of the Executive Branch in Career Public Service
  • Outstanding Elected Statewide Official
  • Outstanding U.S. Representative
  • Outstanding State Senator
  • Outstanding Career Public Servant at the Local Level
  • Outstanding Member of the Executive Branch in Career Military Service
  • Outstanding State Representative
  • Outstanding Career Public Servant at the State Level

The Master of Ceremonies for the awards dinner on March 2nd was Dr. Nancy Snyderman, the chief medical editor for NBC News.  Dr. Snyderman's reports appear on Today, NBC Nightly News with Brian Williams, Dateline NBC and MSNBC.  Snyderman has reported on wide-ranging medical topics and has traveled the world extensively, reporting from many of the world's most troubled areas.  Prior to joining NBC News, Snyderman served as vice president of consumer education for the health care corporation at Johnson & Johnson.  There she led an independent educational initiative focusing on educating and informing the public about health and medicine.  She currently is on staff in the department of the otolaryngology-head and neck surgery at the University of Pennsylvania.

The awards program booklet included the following biography of Governor Baldacci.

Since his election in 2002, Governor John E. Baldacci has made health, education, and the well-being of Maine citizens his top priority.  He has worked toward providing health insurance coverage to all state residents and improving the quality of health care delivered in the state, including successfully leading the effort to redesign and enhance Maine's public health infrastructure.  In addition, he created the Dirigo Health Agency, appointing former AMA President Robert E. McAfee, M.D. as its chair.  Governor Baldacci also raised tobacco taxes to fund a multi-faceted campaign aimed at reducing tobacco consumption, decreasing youth smoking rates from 40% to 14% since 2002.  Prior to serving as governor, Baldacci was elected to the Maine State Senate in 1982 and to the U.S. House of Representatives in 1994.  He was re-elected to Congress in 1996, 1998, and 2000, and served as a member of the House Agriculture Committee and the Committee on Transportation  and Infrastructure.

During his remarks, Governor Baldacci recognized the individual efforts of Dr. McAfee as the founding chair of the Dirigo Health Agency Board and of Dr. Maroulla Gleaton, the MMA Past President and Augusta ophthalmologist who chaired one of the "health action teams" involved in the development of the Dirigo program and who has served on the Advisory Council on Health Systems Development.  The Governor also pointed to the leadership role of the MMA in improving the quality of health care in Maine.


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White House, Congressional Democrats Hope for Action on Health Care Reform Before Easter Recess

In recent days, Obama Administration officials and representatives of the Democratic leadership in Congress have suggested that they hope to take action on health care reform before a scheduled 2-week recess on March 29th.  With Republican Scott Brown's election to the U.S. Senate from Massachusetts to fill the late Ted Kennedy's seat, the path to health care reform now means that the House must first pass the Senate bill.  Then, both the House and Senate would use the so-called "budget reconciliation" process to make changes to the Senate bill so that the Senate could ultimately enact a bill by simple majority.  According to the Congress, the budget reconciliation process has been used 22 times since 1980, 16 times while the Republicans controlled Congress and 6 times while the Democrats controlled.  Congressional Republicans continue to insist that President Obama and the Democratic leadership in Congress scrap the entire health care reform effort to date and to start over, something the President and the Democratic leadership have consistently rejected.  President Obama has indicated a willingness to consider four Republican proposals:

  • a proposal by Senator Tom Coburn (R-OK) to conduct random investigations of providers receiving reimbursement under the federal health care programs;
  • expanded medical malpractice demonstration projects;
  • higher Medicaid reimbursement for physicians; and
  • permit health savings accounts to be offered through the health insurance exchanges.

This offer was insufficient to bring along Congressional Republicans.  

Yesterday's Sunday New York Times included the following editorial captioned, If Reform Fails: . [return to top]

Maine Gastroenterology Society Presents "Topics in Gastroenterology Conference" - April 24, 2010

Topics in Gastroenterology

DATE: April 24, 2010

TIME: 8:00 - 4:00 p.m.

VENUE:  Hilton Garden Inn, Freeport, Maine

WHO SHOULD ATTEND: Primary Care Physicians, Family Practitioners, Gastroenterologists and other Allied Health Professionals that want to broaden their knowledge of Gastroenterology


To increase attendees understanding of Medical evaluation of abnormal liver function tests.

Radiologic evaluation of liver masses.

Evaluating the patient with suspected obstructive jaundice.

Surgical approaches to liver masses.

Cardiovascular effects of proton pump inhibitors.

Monitoring options during the endoscopic procedures.

Issues surrounding anticoagulation and antiplatelet therapy during endoscopic procedures.

Bowel preparations for colonoscopy.

Current management recommendations of patients with Hepatitis C.

Please email or contact Gail Begin regarding this conference at or call 207-622-3374 ext. 210 for more information.   [return to top]

AMA & Grassley Increase Heat on Insurance Companies

Amid continuing pressure on health insurers, the AMA recently released a report showing that the largest insurers had a combined market share of 70% or more in 24 of the 43 states surveyed.  Last year's report showed 18 or 42 states had two insurers with a combined market share of 70% or more.  The study also found that in 54% of metropolitan markets, at least one insurer had a market share of 50% or greater, up from 40% of metropolitan markets last year.  With the release of the report, AMA President J. James Rohack, M.D. stated that the near total collapse of competitive and dynamic health insurance markets has not helped patients.  Dr. Rohack said the AMA has urged the Department of Justice and state agencies  to more aggressively enforce antitrust laws that prohibit harmful mergers.  Meanwhile, Senate Finance Committee Ranking Member, Senator Charles Grassley (R-IA) sent a letter last week demanding an explanation for Wellmark's rate hike in Iowa of as much as 22%. [return to top]

U.S. Surgeon General Dr. Regina M. Benjamin Visits Maine to Deliver QC7 Keynote on Social Determinants of Health

The U.S. Surgeon General, Regina M. Benjamin, MD, MBA,  joins previously confirmed keynote speaker John R. Lumpkin, MD, MPH, Senior Vice President & Director, Health Group, for the Robert Wood Johnson Foundation (RWJF) as a keynote speaker at the upcoming Quality Counts 7 conference, “Transforming Health and Healthcare in Maine’s Communities," being held on April 16th at the Augusta Civic Center.  Don't miss this unique opportunity to hear Dr. Benjamin talk about community health and how social determinants contribute to our health, and to hear Dr. Lumpkin address health care reform and working together as a community.  The conference will also feature information on Maine-specific health data, including the recently released "County Health Rankings," and the upcoming State Health Plan and plans for reporting Maine's Public Health District Data.  Please visit to view the full agenda, read the keynote speaker’s bios, and see the list of ten breakout sessions being offered at the conference.

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DHHS Proposes Changes to MCBM Ambulatory Surgical Facility Rule Affecting Ophthalmology

The DHHS Office of MaineCare Services recently has proposed changes to the MaineCare Benefits Manual, Chapter II, Section 4, Ambulatory Surgical Centers.  It has proposed changes to several sections to update and clarify policy language.  In Section 4.04-A, the Department is adding language to state that payment for implanted presbyopia-correcting intraocular lens and astigmatism correcting intraocular lens will be paid at the rate of a conventional intraocular lens.  In section 4.04-B, the Department is eliminating website information that is stated in 4.04-Covered Services and adding language that states that ASC covered services may be billed in addition to the surgical procedure.  In Section 4.05, Non-Covered Services, the Department is deleting the 3rd and 4th paragraph "Payment for" Presbyopia-Correcting Intraocular Lens, etc., as this is clarified in Section 4.04-A.  In Section 4.07-2, the Department is proposing to change the language to clarify that when there are multiple procedures in the same operative session MIHMS will pay for one procedure, which has the highest payment amount.

No public hearing has been scheduled, but the Department is accepting comments until April 14, 2010.  You may direct comments to Cindy Boucher, Comprehensive Health Planner, Office of MaineCare Services, State House Station 11, Augusta, Maine 04333-0011.

You can find the rule proposal and make comments on it online at:
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MGMA/Maine Offers "Preparing for ICD-10" on March 25th

The Medical Group Management Association, Maine affiliate, will present a half-day educational session by Laurie Desjardins, CPC, PCS entitled, Preparing for ICD-10 on March 25, 2010.  The program will take place from 8:30 a.m. to noon at the Maine Medical Association office in the Frank O. Stred Building, 30 Association Drive, Manchester, Maine 04351.  You may also participate by WebEx.  The cost of the program is $25 for MeMGMA members and $45 for non-members.  The webinar price is $50 per computer.

For more information, contact Karen Wheeler at 873-6173 or [return to top]

Legislative Committee Conference Call Information

The MMA Legislative Committee's next weekly conference call will take place this Thursday, March 11th at 8:00 p.m. using the following toll free number and access code:  1-877-669-3239; access code 23045263.  The MMA staff will provide an update on the week's activities at the legislature.  We anticipate that March will be the last month of this legislative session.  As usual, the MMA encourages any interested physician or physician staff member to participate. [return to top]

POLITICAL PULSE: Large Turnout Expected for Medical Marijuana Hearing This Thursday


Last week, the legislature received from the Revisor's Office L.D. 1811, An Act to Amend the Maine Medical Marijuana Act, a Governor's bill that amends the new medical marijuana statute enacted by Initiated Bill 2009, Chapter 1.  It reflects the recommendations of the Committee on the Implementation of the Maine Medical Marijuana Act and the Criminal Law Advisory Commission.  MMA EVP Gordon Smith was a member of the implementation committee representing physicians.  The bill clarifies many of the provisions of the statutes, clarifies the process to add new debilitating conditions and conforms the language of the statutes to other Maine laws.  

The HHS Committee has scheduled a public hearing on the bill for 1 p.m. on Thursday, March 11th in Room 209 of the Cross State Office Building.  MMA EVP Gordon Smith will testify on the bill to address MMA's concerns and those raised by certain medical specialties, including psychiatry and gastroenterology.  The MMA intends to suggest the following amendments that did not make the consensus recommendations of the implementation committee:

  • that eligibility under the law should be prohibited for minors under age 13; and
  • that a physician's certification of eligibility for a minor from age 13 to age 17 is subject to review by a subcommittee of the Medical Advisory Committee.

The HHS Committee has scheduled a work session on the bill for Tuesday, March 16th.

The following is a memo MMA included in the Maine Medicine Weekly Update shortly after Election Day in November.

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).


In late February, the State increased its General Fund revenue forecast by $51 million for the year.  This positive news, along with an additional $27 million from the extension of enhanced Medicaid rates to Medicare “clawback” payments amounts to a $78 million reduction in the $408.4 million budget shortfall. 

On March 3rd, Governor Baldacci released his second “change package” of the session in which he outlined his priorities for restoration of funds to areas of state government he proposed to cut in the original version of L.D. 1671.  He proposed to restore $37 million in health and human services, including increased support for nursing homes, assisted living facilities, disability services, mental health crisis intervention, and home-based services.  He also proposes $13 million in alternative cuts and $5.3 million in new initiatives.  The change package restores little, if any, of the funding cut from acute care services such as hospitals and does not restore the cut for critical access hospital reimbursement from 109% to 101% of costs.  You can read the Governor’s press release on the budget change package on the web at:   The HHS Committee held work sessions on the change package during the first week in March and was scheduled to have another discussion with the Appropriations Committee during the second week of March.  The Appropriations Committee members have been holding partisan caucuses on the budget weekly since mid-February.  The legislature hopes to adjourn the second session sine die prior to the start of the Easter weekend on April 2nd.


As previously reported, the MMA is supporting the minority "ought to pass as amended" report from the HHS Committee on L.D. 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.  The MMA understands that the bill could be up for debate in the Senate as early as tomorrow.

 Interested physicians or epilepsy patients or their family members who have not yet done so, should contact their Senator.  You can find your legislators and their home contact information here:

If you would like to reach your Senator during the day tomorrow, you may leave a message at the State House using this toll free number:  1-800-423-6900.  Tomorrow's session begins at 10:00 a.m. and the debate could take place any time between 10 and their lunch break.





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