March 22, 2010

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House Narrowly Passes Senate Bill and Fixes to it: Process Ugly but Nearly Done

At approximately 11:30 p.m. Sunday evening, the United States House of Representatives voted 219 to 212 to enact the Senate version of the health reform legislation (H.R. 3590), and then moments later, voted 220 to 211 to enact a reconciliation bill (H.R. 4872) that made changes to that bill that now will be forwarded to the Senate.  During the historic debate yesterday, Senate Majority Leader Harry Reid (D-NV), presented to House Democrats the commitment of 52 Democratic Senators to accept the changes to the bill passed in the House.  As the Senate consideration of the changes will be done through the process of reconciliation, only a simple majority will be required to pass it.  Therefore, it looks as if, after more than a year of work, comprehensive health reform legislation will soon become law.

Both of Maine's House members, Representative Mike Michaud (D-2nd District) and Representative Chellie Pingree (D-1st District), voted for the bills.  For details of the provisions in the bill, refer to the Special Alert sent to members last Friday afternoon.  But in a nutshell, the bill eventually provides health insurance coverage to 32 million people now uninsured, bars insurance companies from denying coverage to individuals in poor health, and sets up health insurance exchanges where self-employed individuals and small businesses can pool together to buy coverage. 

President Obama is expected to sign the bill within two days.  And within another week or two, upon completion of the Senate's work, he is expected to sign the second bill making the important changes to the bill.

On Friday, after reviewing the provisions in the bill, the American Medical Association announced its qualified support for it.  Most of the primary care groups had announced support for the bill, while most of the surgical specialties opposed the Senate bill and the announced changes to it.

Watch the Maine Medicine Weekly Update for more detailed analysis of how the provisions in the legislation will impact on the State of Maine and on your practice. 

"Passage of the bill is not the end of this process," noted Gordon Smith, MMA EVP, "rather it is the beginning of a long period of assessment and implementation.  MMA will be prepared to help its members understand it and deal with it.  After more than a year's effort, the bill is not as good as it might have been, but it is certainly not the unmitigated disaster that critics have made it out to be.  In fact, when reviewed in the context of other reform efforts, it is pretty middle-of-the-road building as it does on the existing system of employer paid health insurance and relying on for-profit commercial insurers to provide the bulk of coverage.  If the process had not been so infected by the toxin of partisanship, it would be seen as containing as many Republican approaches to reform as Democratic."

You can find the AMA's statement on last night's vote on the web at:

There is still the immediate need to fix the Medicare payment system for physicians, and legislation is expected to deal with that issue prior the end of April.  While the AMA and virtually all other medical organizations are calling for a permanent repeal of the sustainable growth rate (SGR) formula, but at a cost of over $200 billion, permanent repeal may simply not be possible.


MMA to Provide Annual HIPAA Privacy/Security Training on April 2nd

The federal HIPAA privacy and security regulations require office practice staff to be trained annually in the provisions of the regulations.  On Friday, April 2nd from 9:00 a.m. to noon, the MMA will present a 3 hour CME program on the subject, including an emphasis on the new breach notification requirements of the HITECH Act which are enforceable as of February 22nd.  The program will be available live at the MMA office, but also will be available remotely through WebEx.  Registration is available on the MMA web site at:

Faculty for the program includes Kenneth Lehman, Esq. of Bernstein Shur in Portland, MMA attorneys Gordon Smith and Andrew MacLean, and John Coolong from Systems Engineering. 

The annual HIPAA update is the most popular First Fridays program we have, so sign up now as there is limited space in the conference room and only 25 sites available through WebEx.  Three hours of category one CME is available for participation.

For more information, please contact Maureen Elwell (622-3374, ext. 219; or Gail Begin (622-3374, ext. 210;


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House Passes Bill to Delay Medicare SGR Cut

On March 17th, the U.S. House passed the Continuing Extension Act of 2010 (H.R. 4851), a bill that would delay the Medicare SGR cut of more than 21% through April 30th.  The bill also would extend the COBRA subsidies for laid off workers.  As reported last week, on March 10th the Senate passed the American Workers, State, & Business Relief Act of 2010 (H.R. 4213) that delays the Medicare SGR cut until October 1st.  The Senate must also pass H.R. 4851.  The House isn't expected to act on H.R. 4213 before April 1st, so this short term measure was necessary.  It is anticipated that the House and Senate will go to conference committee on this issue. [return to top]

William F. Pewen, Ph.D., M.P.H. Leaves Senator Snowe's Washington D.C. Staff

William F. Pewen, Ph.D., M.P.H.,  Senior Health Policy Adviser for Senator Olympia Snowe, resigned two weeks ago to pursue other opportunities.  Dr. Pewen had been with the Senator's staff for more than six years and had spent the last year and a half intensely immersed in the health system reform discussion.  MMA staff had met with Dr. Pewen at least a dozen times over the years and we will miss his broad base of knowledge and his accessibility. 

Dr. Pewen wrote an op-ed piece on the health reform situation in Washington which was published in the New York Times on March 16th.  In the commentary, Dr. Pewen lamented the breakdown of bi-partisan efforts that, in his view, could have let to a better bill and certainly an improved process.  In the last paragraph of the article, he notes that the core of the Senate's legislation closely resembles the very bill the Republicans offered in l993 as an alternative to the Clinton plan.  He notes that there were points in the process where a bi-partisan approach could have been achieved, and he is clear in blaming both parties and the Congress itself for its failure to realize that goal.

MMA wishes Dr. Pewen all the best in whatever his future holds. [return to top]

MeMGMA Offers "Preparing for ICD-10" this Thursday at MMA

The Medical Group Management Association, Maine affiliate (MeMGMA) is offering a half day educational session entitled, Preparing for ICD-10 this Thursday, March 25th from 8:30 a.m. to noon at the MMA office in Manchester.  The presenter for this program is Laurie Desjardins, C.P.C., P.C.S.  The program has been approved for continuing education credit by the AAPC and the ACMPE.  The cost is $25 for members, $45 for non-members, and $50 per computer for WebEx.  For more information or late registration, please contact Karen Wheeler at 873-6173 or by email at [return to top]

David H. Dumont, M.D. of Lincoln Selected as 2010 DEAPA Physician of the Year

The Downeast Association of Physician Assistants selected David H. Dumont, M.D. of Lincoln as DEAPA’s 2010 Physician of the Year.  This award is bestowed to a Maine physician who has demonstrated outstanding support of Physician Assistants and the PA profession by precepting, educating, and legislating; or by exemplifying the PA/physician team approach to medicine.   Additional 2010 award recipients are:

  • William Sheppard, PA-C of Dover-Foxcroft, Rural Physician Assistant of the Year in recognition of his dedicated service to a rural community, both as a health care provider and as a citizen;
  • Ingrid Sherrill, PA-C of Damariscotta, Outstanding Health Care Professional of the Year.  This award is presented to a Maine health care professional who has demonstrated exceptional clinical knowledge and teaching skills, promoting the PA profession, and contributing to the health of Maine.

The 2010 Awards will be presented at DEAPA’s Annual Membership Meeting on April 10th at 9:00 a.m. – 10:30 a.m. at the Maine Medical Association.  DEAPA's President, Bill Bisbee, PA-C, and fellow board members welcome all to attend and congratulate the awardees on their work, commitment, and dedication to patient care.  To RSVP, contact Kellie Miller, DEAPA Staff Liaison at or 207-620-7577 before April 5th.  For more information on the awards and past recipients, go to

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May 19th Practice Education Seminar to Include Sessions on Federal Health Care Reform and Medicinal Marijuana

MMA will hold its 19th Annual Practice Education Seminar on May 19th at the Augusta Civic Center.  The program will begin at 8:30 a.m. and will conclude at 4:00 p.m.  Although the general theme of the program this year will be focused on what patients, employers, health plans, hospitals, regulators, and policy makers expect from physicians now and in the future, there will be educational sessions available on the impact of federal health reform bill and the new state law on medicinal marijuana on the State of Maine and its physicians.

The complete agenda for the conference and registration materials will be available in early April and registration will also be available on-line at once the program is completed.  For more information, contact Gail Begin at 622-3374, ext. 210 or via e-mail to [return to top]

MMA and OSA Present Free Program in Ellsworth on May 21st on Pain Management and Diversion

The Maine Medical Association, with grant support from the Maine Office of Substance Abuse, presents Comprehensive Management of Patients with Acute and Chronic Pain while Preventing Diversion on Friday morning, May 21, 2010 from 9:00 a.m. to noon at the Acadia Park Hotel in Ellsworth.  The Acadia Park Hotel was until recently the Holiday Inn on 215 High Street in Ellsworth.

Faculty for the program includes Todd Mandell, M.D., Medical Director, Division of Alcohol & Drug Abuse Programs, State of Vermont, Daniel Eccher of the Maine Office of Substance Abuse, and Gordon Smith, Esq. from MMA.

There is no cost for the program and 3 hours of category one CME will be available for physicians and PA's.

Registration materials for the program will be mailed with the March-April issue of Maine Medicine  or you may register by calling 622-3374 or e-mailing Gail Begin at [return to top]

Next MIHMS Provider Forum Scheduled for March 29th


The next Maine Integrated Health Management Solution (MIHMS) Provider Forum will be held from 1:00 pm to 3:00 pm on Monday, March 29th.  The meeting will be held at Florian Hall at the Central Maine Commerce Center, 45 Commerce Drive in Augusta, Maine.

The agenda for this meeting includes:

·         MIHMS Project update

·         Questions  and Answers from Provider Training

·         Provider Transition Guide Update

·         Provider Readiness Overview

To attend the Provider Forum remotely via Live Meetingclick here to send an e-mail.  Additional details will be sent to you.   

To attend the Provider Forum in person, click here to send an e-mail.  

Meeting space is limited! 

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AMA President Calls on Insurers to Abandon Flawed Physician Rating Programs

According to a recent report by RAND Corporation published in the New England Journal of Medicine, insurance companies frequently are mis-classifying physicians as high or low cost providers.  Researchers found that profiling methods used to classify physicians by costs in a two-tiered system mis-classify physicians 22% of the time.  Only 41% of physician cost profile scores were at least 70% reliable, and only 9% of profile scores were at least 90% reliable.  The authors of the RAND study wrote that their findings bring into question both the utility of cost profiling tools for high stakes uses, such as tiered health plan products, and the likelihood that their use will reduce health care spending.  AMA President J. James Rohack, M.D. stated in a news release that the study shows that physician ratings conducted by insurers can be wrong up to 2/3 of the time for some groups of physicians.  Dr. Rohack continued that given the potential for irreparable damage to the patient-physician relationship, the AMA calls on the health insurance industry to abandon flawed physician evaluation and ranking programs, and join with the AMA to create constructive programs that produce meaningful data for increasing the quality and efficiency of health care.

You can read Dr. Rohack's statement on the web at:

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Confidential Feedback on H1N1 Efforts Requested

Dora Anne Mills, MD, MPH, FAAP, State Health Officer & Director, Maine CDC and Maine CDC H1N1 Executive Team is in the process of conducting numerous in-person debriefings across the state with stakeholders on the H1N1 efforts.  She hopes that physicians have had a chance to participate in these.  However, she has recognized that some physicians are unable to attend these forums, and even if physicians have been able to, certain types of feedback are easier to provide by responding to a survey. 

Therefore, the H1N1 Executive team has provided the link below to a Survey Monkey as a mechanism to provide confidential feedback on the H1N1 efforts.  Dr. Mills encourages all physicians to participate in this survey, which should take no longer than 15 - 30 minutes.  Additionally, she asks that the survey be forwarded to other stakeholders.  Dr. Mills is eager to have as many physicians as possible to complete the survey to obtain as broad feedback as possible. 

Thank you ahead of time for taking the time to provide this important information.  To complete the survey, go to:  

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DHHS Publishes MCBM Provision Establishing MaineCare Fee Increase

On March 9th, the DHHS Office of MaineCare Services published a rule amending Chapter 101, Ch. II, Section 90, Physician Services to increase the MaineCare reimbursement rate for physician services from 56.94% to 70% of Medicare rates, effective March 1, 2010.  This increase will not include reimbursement for procedures performed by radiologists, radiation oncologists, and pathologists who currently receive a higher rate of reimbursement.  No procedure codes are decreased as a result of this rulemaking.  The Department will hold a public hearing on the proposed amendment at 9:00 a.m. on Monday, April 5th and will accept written comments until April 15th.  

You can find the rulemaking materials, including instructions for comment, on the web at: [return to top]

Legislative Committee Conference Call Information

The MMA Legislative Committee's next weekly conference call will take place this Thursday, March 25th 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.  As usual, the MMA encourages any interested physician or physician staff member to participate. [return to top]

POLITICAL PULSE: Bill Amending Medical Marijuana Law Receives Unanimous Support in HHS Committee


At a work session last Thursday afternoon, March 18th, members of the HHS Committee voted unanimously "ought to pass as amended" on L.D. 1811, An Act to Amend the Maine Medical Marijuana Act.  While not all members were present, the final vote is expected to be unanimous.  Of particular interest to physicians were the provisions applying to minors' eligibility under the law.  Reacting to comments at the public hearing, MMA EVP Gordon Smith prepared a proposed amendment that would permit a minor of any age to be certified eligible under the law, if the case is reviewed and approved by the medical advisory committee.  A minor certified for hospice care, however, would be exempt from this requirement.  Also, the provision treating minors differently from adults would sunset in 2 years.  The Committee accepted this proposal as presented with no comment.  Some of the more conservative members of the Committee voted for it grudgingly and only because of the people's referendum vote.  They remain concerned about the conflict with federal law.  The Committee is scheduled to review the final language tomorrow afternoon.


The Appropriations Committee met until 2:00 a.m. this morning on the FY 2010-2011 supplemental budget, L.D. 1671, and appears close to a final vote on a package to fill a budget gap of approximately $310 million.  The Committee was scheduled to reconvene this afternoon.


In keeping with the direction outlined here last week, the Senate today adopted without debate or objection, a floor amendment to L.D. 1672, a bill that would have required notice to and consent of a physician before an anti-epileptic drug is switched.  The new title of the bill will be Resolve, Regarding the Dispensing of Antiepileptic Drugs and will direct action to address this issue by the Maine Board of Pharmacy, the Governor's Office of Health Policy & Finance, the Board of Licensure in Medicine, and the Office of MaineCare Services.  

You can see the proposed language of the amendment on the web here:

The bill next will see action in the House, but approval of this approach is likely.


Last week, the Insurance & Financial Services Committee held a lengthy public hearing on a late bill to amend the Hospital Cooperation Act to permit consideration of a transaction proposing a vertical integration among physician groups and hospitals.  The bill, L.D. 1819, An Act to Implement the Recommendations of the Advisory Council on Health Systems Development Relating to Payment Reform, has divided the hospital community.  The MMA took no position on the bill and spoke "neither for nor against" the bill at the hearing.  The IFS Committee is in a work session on the bill at this time.




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