March 29, 2010

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President Obama Scheduled to Visit Maine this Thursday

As you are aware, after signing the federal health care reform legislation, President Obama will be traveling the country to explain to voters the benefits of health care reform.  In conjunction with an apparent fundraising trip to Boston, the President is scheduled to be in Maine this Thursday, April 1st to participate in a health care reform event with Congresswoman Chellie Pingree, a strong supporter of the reform effort.  The MMA knows little about the President's visit, but you may sign up for more information about the visit as it becomes available on Congresswoman Pingree's web site:  Described as The Unabashed Liberal, Congresswoman Pingree is one of 6 House members from around the country profiled in the aftermath of the health care reform vote following an article in today's New York Times by Adam Nagourney.  The President's visit is scheduled for the Portland area.

The national health care reform debate continued in Washington, D.C. last week with the debate on the health care reform reconciliation bill, H.R. 4872.  This bill makes changes to the new health care reform law, the Patient Protection & Affordable Care Act (Pub. L. No. 111-148).  On Thursday, March 25th, the Senate voted 56-43 in favor of the reconciliation bill with 3 Democrats joining all Republicans.  The House voted for passage that same day by a vote of 220-207.  The President is scheduled to sign H.R. 4872 tomorrow.

The AMA has produced a document entitled, How the Passage of Federal Health System Reform Legislation Impacts Your Practice on the web at:

The White House web site also has information about health care reform here:

Celebrate National Doctor's Day Tomorrow, March 30th

Tuesday, March 30th is National Doctor's Day.  It is a time for patients, friends, family, colleagues, and physician organizations to express gratitude to physicians for their continuing commitment to their patients and to the health of the public.

In observance of this day, the Maine Medical Association gratefully acknowledges the dedication of its members to their patients and to the medical profession. 

The idea of setting aside a day to honor physicians was originally conceived by Eudora Brown Almond, wife Charles B. Almond, M.D., of Winder, Georgia.  The first observation was on March 30, 1933, a date chosen to coincide with the anniversary of the first use of general anesthesia during surgery.

Twenty-five years later, on March 30, 1958, a resolution commemorating Doctor's Day was adopted by the U.S. House of Representatives.  In 1990, both houses of Congress adopted a resolution to establish a National Doctor's Day.  The following year, President George H.W. Bush signed the resolution designating March 30th as National Doctor's Day. 

For those readers who are physicians, please accept the gratitude of your professional association for all that you do for your patients, the public's health, and the medical profession.  For those readers who are not physicians, please take a moment today to express your gratitude for those persons to whom we entrust our health and the health of our families. 

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Great Response for Annual HIPAA Privacy/Security Training this Friday!

The federal HIPAA privacy and security rules require physician office practices and other practitioners to train their staffs annually in compliance with these laws.  This Friday, April 2nd from 9:00 a.m. to noon, the MMA will present a 3 hour CME program on the topic as part of the First Fridays seminar series.  This year's update will include 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 it 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.

As usual, the response for our annual HIPAA update has been very strong, but there still is room for a few more people at the MMA office and through WebEx.

For more information, please contact Maureen Elwell (622-3374, ext. 21; or Gail Begin (622-3374, ext. 210; [return to top]

Congress Fails to Prevent April 1st Cut in Medicare Physician Payments

On Thursday, March 25th, the Senate held floor debate on a bill, H.R. 4851, that would extend a number of expiring programs through April.  That bill, which had already passed the House, includes a 30-day extension of current Medicare physician payment rates, postponing once again the 21.3 percent cut scheduled to take effect in 2010.  It also addressed a number of other programs such as extensions of COBRA benefits and unemployment insurance benefits for Americans who have lost their jobs.  

In a replay of the standoff that occurred a month ago, this time it was Senator Tom Coburn (R-OK) who objected to the bill’s consideration, on the basis that it should not be considered emergency spending that would be exempt from budgetary offsets.  As a result, Congress will adjourn for its two-week spring recess without taking action to stop these programs from expiring.  We are told that the Senate plans to hold a cloture vote after the recess which, if supported by 60 Senators, will allow a vote to occur on the legislation.  That vote could occur as early as April 12.

Congress failed to act yet again and, as a result, the 21.3 percent Medicare physician payment cut will take effect on April 1st.  The AMA has contacted the Centers for Medicare and Medicaid Services (CMS) and they will be making an announcement shortly about their plans for handling the situation.  Judging from past experience, CMS will not be forced to process claims at the reduced payment rates for 10 business days.

This repeated game of brinksmanship is wreaking havoc with physician practices, and is causing both physicians and patients to lose confidence in the Medicare program.  It illustrates in stark terms why medicine can no longer support short-term “fixes” to a formula that we knew would not work at the time Congress created it.

You can communicate with members of Maine's Congressional delegation on this issue through the AMA's grassroots action center: [return to top]

Update on Work of Shared Decision Making Study Group

The Shared Decision Making Work Group, established by the Maine Quality Forum pursuant to a Resolve passed by the 124th Legislature, held its fourth meeting on March 23, 2010.  The stated goals for the meeting were:

  1. Update on Shared Decision Making activities in Maine;

  2. To learn about national perspectives going forward;

  3. To review the interim report of the Work Group prepared for the legislature.

Regarding the current SDM activities, Neil Korsen, M.D., presented an update on the work in the Clinical Integration Division of MaineHealth.  Dr. Korsen serves as the Medical Director of the Division.  Richard Wexler, M.D., Director, Patient Support Strategies for the Foundation for Informed Decision-Making, presented on National Research Perspectives on Shared Decision Making.  And, Nananda Col, M.D., Senior Scientist, Center for Outcomes Research, Maine Medical Center, presented information on a proposed pilot project for which MMC is applying for grant support from the federal government.  The project involves comparing the cost effectiveness of different approaches to SDM. 

Josh Cutler, M.D., the Director of the Maine Quality Forum, presented for discussion the Interim Report prepared for the legislature entitled, "The Practice and Impact of Shared Decision-making."   The interim report must be submitted to the HHS Committee of the Legislature by early 2010 with a final report due in 2011. 

Specifically, the Resolve required the Maine Quality Forum to establish the study group to consider:

  1. The appropriate preference-sensitive health care services for use in a shared decision-making program and an accepted protocol for shared decision-making;

  2. The availability of approved patient decision aids relating to each health care service and the effectiveness of patient decision aids;

  3. The payment method to be used by health insurance carriers and public programs to reimburse for services provided by a shared decision-making;

  4. The appropriate incentives to encourage use of a shared decision-making program by providers and patients;

  5. Evidence-based studies that evaluate shared decision-making; and

  6. Any barriers to implementation of a shared decision-making program.

Based on the parameters established in the Resolve, the Study Group organized its activities to address four major questions:

  • What is shared decision-making?

  • What is the current state of practice?

  • What are the challenges to implementation?

  • How does shared decision-making impact health care quality and cost?

To inform its understanding of the current and proposed use of shared decision-making in Maine, a survey was administered to major health systems, hospitals, provider groups, and payers.  Major findings of the Study Group's efforts are described in the interim report.

During its deliberations, the Study Group spent considerable time establishing a working definition for shared decision-making, based on the literature and current practice, to guide its work.  While definitions vary, researchers generally agree that three essential factors must be present for a process to be considered shared decision-making:

  • The patient is faced with two or more treatment options with no clear best choice in terms of survival, outcome, or functionality.

  • The patient's own preferences and values drive decisions.

  • The patient and clinician share information with each other, take steps to participate in the decision, and agree on a course of action based on the patient's preferences.

The Study Group plans to have one or two more meetings prior to completing its final report.  The next meeting will be held in May. [return to top]

AMA Offers Guidance on Medicare Enrollment Issues

Readers of the Weekly Update are urged to take note of two Medicare enrollment policies.

First, physicians who have not updated their enrollment information since the Medicare Provider Enrollment, Chain and Ownership System (PECOS) database was created in 2003 should be on the lookout for a letter from their Medicare contractor requiring them to "revalidate" their information.  Physicians are required to respond within 60 days to revalidation requests, or they risk having their billing privileges revoked for up to a year.

Second, the AMA was able to again delay an onerous referring/ordering physician enrollment policy until January 3, 2011.  Medicare requires that all submitted claims contain the name and NPI of the referring/ordering physician.  Under the new policy, if a physician who is not enrolled in PECOS orders services or refers patients to another physician who bills Medicare, then the claims submitted by the billing physician will not be paid.  In other words, if Doctor A refers a patient to Doctor B, and Doctor A is not enrolled in the PECOS system, then Doctor B's claims to Medicare will be rejected starting January 3, 2011.  The CMS enrollment program contains a significant number of problematic policies and the AMA will continue to advocate on behalf of physicians so they can spend more time with their patients and less time on their paperwork.  

You can find more information about these Medicare enrollment issues on the AMA web site at: [return to top]

Harvard Professor Berwick Likely to be Named Next CMS Administrator

The MMA has learned that Dr. Donald M. Berwick, a clinical professor of pediatrics and health care policy at the Harvard Medical School and the Harvard School of Public Health, is likely to be named the Administrator of the Centers for Medicare & Medicaid Services (CMS) some time during the Easter Congressional recess that begins today.  A prominent voice in the health care quality improvement effort in this country, Dr. Berwick also is President and CEO of the Institute for Healthcare Improvement, an organization based in Cambridge, Massachusetts that focuses on health care quality improvement.

Dr. Berwick would replace Charlene Frizzera, who has served as Acting CMS Administrator since President Obama took office.


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AMA Provides Overview of HIT Incentives in HITECH Act

The AMA has posted a number of health information technology (HIT) resources and advocacy materials on its web site here:

You may be particularly interested in this overview of the Medicare incentives: this overview of the Medicaid incentives: [return to top]

Topics in Gastroenterology 2010 Update - April 24, 2010

WHAT:  Topics in Gastroenterology

WHEN:    April 24, 2010

WHERE: Hilton Garden Inn, Freeport, Maine

Primary Care Physicians and Family Practitioners that want to broaden their knowledge of Gastroenterology

Allied Health Professionals  


Expand your knowledge of Gastroenterology

Evaluation tools for patients with suspected obstruction

Bowel preparations for colonoscopy
Current management recommendations of Hepatitis C patients

For more information please call or email Gail Begin -; Tel: 207-622-3374, Ext. 210.
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Maine CDC/DHHS Public Health Update Highlights

March 26, 2010 -  Maine CDC/DHHS Public Health Update Highlights included the following:

What’s New with Flu?

  • Maine CDC is conducting numerous in-person debriefings across the state with stakeholders on their H1N1 efforts.  In addition, this Maine CDC H1N1 Feedback Survey is being distributed widely.  To complete the Feedback Survey, click on:
  • Maine CDC will be able to purchase sufficient seasonal flu vaccine for the 2010/2011 season for:
    • All Maine children ages 6 months to 18 years-old
    • Employees of schools that are providing onsite vaccine clinics on school days
    • Pregnant women and their partners
    • Nursing home employees and residents
    • High risk adults in limited public health settings, the scope and number of such settings determined by their vaccine supply

The 2010/2011 seasonal flu vaccine will contain the pandemic Type A H1N1 component, as well as a strain of Type B and Type A H3N2.  Those who received the pandemic H1N1 vaccine will need to also receive the seasonal flu vaccine this coming season.  More details about ordering will be coming soon.

  • Disposing of and Reporting of Unused/Expired Vaccine – unused or expired H1N1 vaccines may not be returned to the distributor.  If vaccine cannot be redistributed prior to expiration, the health care provider is responsible for disposing of the vaccine appropriately, in compliance with Maine’s biomedical and/or hazardous waste rules.  However, US CDC is working on a possible centralized national system for disposal of vaccine, and Maine CDC will know more about this later this Spring.

Tuberculosis – Maine CDC has recently identified TB among two people who are homeless in Cumberland County.  More information on this can be found at:

Rabies – US CDC has established a new rabies webpage, which includes updated ACIP recommendations on human rabies post-exposure prophylaxis and new content organization: .  Maine CDC provides a quarterly update on animal rabies to veterinarians and other animal health professionals, which may be used to increase the understanding of pet owners and other members of the public regarding the risk of rabies in Maine.  The 4th quarter update is available at:

FDA Recommends Temporary Suspension of Rotarix Vaccine - The US Food and Drug Administration (FDA) has learned that DNA material from porcine circovirus type 1 (PCV1) is present in Rotarix, a vaccine used to prevent rotavirus disease.  Although there is no evidence at this time that this DNA materials poses a safety risk finding the material was unexpected and FDA is assessing the situation.  As a result, FDA is recommending that clinicians temporarily suspend the use of Rotarix.  FDA will keep the public and clinical community updated through

Maine Awarded Federal Obesity Prevention Funds - First Lady Michelle Obama and US DHHS Secretary Kathleen Sebelius announced last week that Maine is one of 9 states to receive American Recovery & Reinvestment Act funds focused on preventing obesity.  Maine's award is $4.28 million over a 2-year period.  Maine CDC's Division of Chronic Disease conducted a mini-RFP process prior to submitting the federal application, which resulted in the selection of two Health Maine Partnerships - Healthy Portland and Communities Promoting Health Coalition, which serves the Sebago Lakes region.


 Follow Maine CDC’s Social Media Updates:

Facebook (search for “Maine CDC”)

Twitter (

MySpace (

Maine CDC’s Blog (

·         For clinical consultation and outbreak management guidance, call Maine CDC’s toll free 24-hour phone line at:  1-800-821-5821.

·         For general questions on flu, call 2-1-1 from 8 a.m. to 8 p.m. seven days per week [return to top]

DEAPA Offers $1000 Student Scholarship Opportunity

The Downeast Association of Physician Assistants (DEAPA) is pleased to announce its 17th Annual Susan Vincent Memorial Scholarship in the amount of $1000.  Eligible students are enrolled and are planning to attend a PA program following graduation this Spring of 2010.  The student must:

  • Submit a letter from an accredited PA program verifying current enrollment and provide anticipated completion date;

  • Verify that s/he was a Maine resident at the time of acceptance into that program. (driver’s license or other form of state ID);

  • Provide a brief statement detailing why s/he deserves and is requesting this scholarship. (Usually 1-2 pages).

The deadline to submit this information is June 1, 2010.  Following notification to the successful applicant, the check will be mailed directly to the school to be placed into that student’s account.  All inquiries and application letters are to be sent to:

Scholarship Committee


30 Association Drive

Manchester, Maine  04351

Ph:  207.620.7577

Email: [return to top]

DEA Releases Proposed Rule Permitting E-Prescribing of Controlled Substances

The federal Drug Enforcement Administration (DEA) released an interim final rule that amends current policy for prescribing controlled substances to allow pharmacies, hospitals, and physicians to send prescriptions for controlled substances electronically while maintaining "closed system controls" on dispensing.  The rule also would permit pharmacies to receive, dispense, and archive electronic prescriptions for controlled substances.

The rule is an addition to current DEA guidance on prescribing controlled substances, not a replacement.  It is the result of a collaboration among the DEA, the Office of the National Coordinator for HIT, CMS, AHRQ, and other DHHS staff and is in response to complaints from provider groups that current rules are a significant barrier to adoption of e-prescribing.

The rule is scheduled to be published in the Federal Register on March 31st. [return to top]

Legislative Committee Conference Call Information

The MMA Legislative Committee's next weekly conference call will take place this Thursday, April 1st 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.  

The 124th Legislature is expected to adjourn its Second Regular Session sine die either this week or next, so we will decide Thursday night whether to hold a call next week. [return to top]

POLITICAL PULSE: Legislature to Take Up Unanimous Budget Recommendation Tomorrow


Following months of hearings and work sessions, the Appropriations Committee early last week reported out a unanimous Committee Amendment to L.D. 1671, the FY 2010-2011 supplemental budget.  This budget closes a gap of approximately $310 million, down from the $438 million estimate at the beginning of the session.  The legislature's presiding officers gave members until noon today to prepare any amendments to the budget and the full legislature is expected to debate the budget tomorrow.


During a work session last week, a strong majority of the Insurance & Financial Services Committee voted to proceed with an amendment to L.D. 1819, An Act to Implement the Recommendations of the Advisory Council on Health Systems Development Related to Payment Reform  to eliminate controversial changes to the Hospital Cooperation Act that would have permitted consideration pursuant to the Act, vertical integration between a physician practice and a hospital or hospital system.  The bill does direct the Advisory Council to bring forward to the next legislature recommendations and proposed legislation on payment reform.


L.D. 821, An Act To Support Collection and Proper Disposal of Unwanted Drugs died in conflict between the House and Senate on Friday, March 26th.

L.D. 1672, Resolve, Regarding the Dispensing of Antiepileptic Drugs passed both chambers in amended form today.

L.D. 1408, An Act To Establish the Universal Childhood Immunization Program - committee amendment has not yet come to the floor from the Revisor's office.

L.D. 1811, An Act To Amend the Maine Medical Marijuana Act  - committee amendment has not yet come to the floor from the Revisor's office.

L.D. 1706, An Act To Create the Children's Wireless Protection Act died in conflict between the House and Senate on Thursday, March 25th.





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