May 3, 2010

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Act Now to Help Preserve Medicare Physician Payments!

With the Medicare payment cut for physicians now delayed only until May 31, 2010, Maine physicians need to take action now to advocate that the Congress once and for all repeal the flawed sustainable growth rate (SGR) formula and establish a new payment system that reimburses physicians fairly for the cost of providing services to Medicare recipients.  Pushing the payment cut down the road year-to-year and now month-to-month is as unfair to physicians and their Medicare patients as it is financially irresponsible.  Each month that passes without repeal adds to the ultimate cost of replacing the formula.

The cost to repeal the formula and freeze payment rates is estimated by the independent Congressional Budget Office (CBO) to be nearly $250 billion.  But by 2015, the cost is estimated to be $500 billion.  Maine physicians and MMA staff made the point to Maine's congressional delegation in meetings in Washington this past week that it will never be less costly that it is right now to permanently repeal the formula.  Maine Senators Olympia Snowe and Susan Collins are critical to the effort to permanently repeal the formula as it will take sixty votes in the Senate and therefore any solution must have an element of bi-partisanship.

Maine is uniquely unsuited for the payment cut, as we have the oldest population in the country and thus a higher percentage of Medicare patients than other states. And we have a large number of Medicaid patients (MaineCare) and a significant shortage of physicians.  While physicians in some other states may simply choose not to accept Medicare patients, that solution is not available in many areas of the state, nor is it the solution most Maine physicians would prefer.

As it is essential that the permanent solution to the SGR be enacted before the May 31st deadline, physicians need to communicate to Senators Snowe and Collins the urgency of the situation and urge them to support legislation that would permanently repeal the sustainable growth rate and replace it with targets similar to those included in the House bill last Fall. 

Republicans do not currently support a permanent repeal of the SGR without the cost of such a solution being paid for, as opposed to increasing the already burgeoning federal deficit.  Senators Snowe and Collins should be encouraged to find sufficient offsets in the President's budget to pay for the SGR fix.

You can help with this important effort as follows:

1.  Communicate with Maine's congressional delegation (Senators Snowe & Collins, in particular) through the AMA's grassroots action center:

2.  MMA is also participating in a petition drive initiated originally by the Texas Medical Association but now supported by all fifty state medical societies and several national specialty societies.  The goal is to deliver a petition with more than a million signatures to members of Congress stating support for a permanent solution to the SGR problem.  The petition is available for your signature on line at:

We can't emphasize enough the importance of contacting our influential Senators and encouraging them to help bridge the partisan gap that is making this issue so difficult to resolve.



First Friday Program on Risk Management is this Week!

The next MMA First Fridays seminar this Friday, May 7th from 9:00 a.m. to noon features two experienced risk managers from Medical Mutual Insurance Company of Maine speaking about two important aspects of risk management in the physician office. 

  • Sue Boisvert, B.S.N., M.H.S.A., Senior Risk Manager will offer a presentation entitled, Workplace Violence:  Are You Prepared? 
  • Nancy Brandow, M.S., Senior Risk Manager will follow with a presentation entitled, Telephone Triage Tips to Reduce Risk and Improve Patient Safety.

Registration is available on the MMA web site at:

You also may participate by WebEx.

For more information, please contact Maureen Elwell at MMA by phone at 622-3374, ext. 219 or by email at [return to top]

Watch for May 19th Annual Practice Education Seminar Registration Material

Every MMA active member and office managers last week were mailed a brochure for the Association's 19th Annual Practice Education Seminar being held this year at the Augusta Civic Center on Wednesday, May 19th.  The program runs from 8:30 a.m. to 4:15 p.m. and registration is available beginning at 8:00 a.m.  The annual seminar provides an opportunity for MMA to present to members and their staffs the practical information that can assist in operating a practice in today's environment and to note the many trends about which physicians should be aware.

Registration is also available on the MMA website at  

For further information or to discuss exhibit opportunities, call Gail Begin at 622-3374, ext. 210.  [return to top]

New Campaign to Emphasize the Importance of Childhood Vaccinations

Protect Tomorrow Campaign is a national education awareness campaign that reminds parents about the importance of childhood immunizations.  The campaign encourages parents to talk with their pediatricians about the benefits of vaccines, the importance of the recommended immunization schedule, and how to best protect their children.

This public service announcement (PSA) from the American Academy of Pediatrics (AAP) contains a powerful message – a message that can have a real impact on our children and their future.  The PSA reminds parents about the devastation of diseases of the not-so-distant past and urges them to talk with their pediatricians about immunizing their children so that history does not repeat itself.  The PSA features several people who tell their true stories of watching loved ones struggle with, and even succumb to, diseases that can now be prevented by vaccines.

These eyewitnesses want to tell today’s parents to take advantage of one of the greatest advances in modern medicine – immunizations.  Through these voices of wisdom and experience, the AAP wants to remind parents to vaccinate their children according to the recommended schedule as provided by the CDC and its Advisory Committee on Immunization Practices, the AAP, and the American Academy of Family Physicians.

To view the PSA’s go to:

On the Heels of National Infant Immunization Week, April 24 to May 1st  - Maine’s Groundbreaking Law to establish a universal childhood immunization program will be ceremonially signed by Governor John E. Baldacci on May 7th [return to top]

Not Too Early to Plan for MMA's 157th Annual Meeting, September 10-12, in Bar Harbor

MMA's 157th Annual Meeting will be held in Bar Harbor from September 10-12, 2010.  The educational sessions will begin again at Jackson Laboratories on Friday afternoon, September 10th at 1:00 p.m.  The theme for this year's meeting is Life Transitions for Patients, Families and Communities  and features presentations on aging and related topics, including scientists from Jackson's Center for Aging matched with practicing clinicians.  Sunday morning will feature a Gubernatorial Forum with candidates addressing issues related to public health.

Following the Friday sessions at Jackson Laboratories, the Saturday and Sunday morning sessions will be held at the conference center (The Bar Harbor Club) associated with the Harborside Hotel and Marina. The Saturday afternoon CME session is entitled, Transitions in Health - Transitions in Care and will feature a panel moderated by Laurel Coleman, M.D. highlighting some of the challenges faced by patients and health care providers when health status changes.

On Saturday evening, MMA President David McDermott, M.D., M.P.H. will turn the Presidential gavel over to Jo Linder, M.D.  The Mary Cushman Humanitarian Award will also be presented during the Annual Banquet.

On Sunday morning, preceding the Gubernatorial Forum, interested attendees will run the 30th Annual Edmund Hardy Road Race.  MMA is making an attempt to invite all previous runners to join us for this special anniversary race.  Andrew MacLean, Deputy EVP, will once again serve as the Race Director.

Watch for registration materials which will be in the mail to members later this month.  Registration will also be available on the MMA website at after June 1st.  For more information contact Diane McMahon at 622-3374, ext. 216 or via e-mail to  For information on exhibiting, contact Lisa Martin at 622-3374, ext. 221 or via e-mail to


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Health Professions Team up with Scientists to Discuss Health Impacts of Climate Change on May 20th

Health Professions Team up with Scientists to Discuss Health Impacts of Climate Change 


May 20th                                                                                                                                                                                   8:30am-11:30am                                                                                                                                                                   Holiday Inn by the Bay, Portland, Maine                                                                                                                         Limited to 50 attendees  (There is no registration fee)                             

The earth's climate is in the midst of significant change and with it comes the impact upon human health.  Increased respiratory allergies, asthma attacks, days lost from work due to respiratory disease, emergency room visits, hospitalization rates, and mortality are all symptoms of climate changes.

Physicians, Physician Assistants, Nurse Practitioners and Nurses are being called upon to increase their involvement in educational efforts on the impending health problems due to climate change and the adaptive and mitigating actions that can be taken in the public health policy arena. 

A limited number of seats (50) are available for clinicians to attend this forum that will address the scientific underpinnings of climate change and identify human health effects and implications for public health.

Expert Faculty to include:

Paul R. Epstein, MD, MPH, Associate Director Harvard Center for Global Health and the Environment.  Dr. Epstein received recognition for his contributions on the work of the Intergovernmental Panel on Climate Change (IPCC), awarded the Nobel Peace Prize in 2007.

Paul A. Mayewski, PhD, Explorer and Scientist Director & Professor, The Climate Change Institute, University of Maine.  Dr. Mayewski has developed integrated understanding of multiple controls on climate and unique role of human impact, demonstrated associations between climate and disruptions to civilization.

The program will conclude with a reactor panel of experts to facilitate an in-depth discussion with attendees.

To register, email and indicate in the subject line that you would like to register for the Climate Change Forum on May 20th.  When your registration is received, a detailed agenda with directions will be sent to you via email prior to the forum.

This forum will provide 2.0 hours of CME and CEU credits.

The American Medical Association is sponsoring only three Climate Change forums across the country on Climate Change and this program is one of the three. [return to top]

Free Online Environmental Health Continuing Education Course

In 2007, the Maine Medical Association approved the Safe and Healthy Approach to Chemical Release in the Environment Resolution, ensuring that physicians and patients alike are informed about toxic exposures.  Physicians for Social Responsibility (PSR) announces three opportunities for you to learn more about the chemicals that Maine children and families are exposed to every day, as well as the impact of environmental toxins on pediatric health.

Free Online Environmental Health Continuing Education Course

Based on PSR’s Pediatric Environmental Health Toolkit, this course features an introduction to environmental health, environmental health case studies, taking an environmental health history, and much more.  This course was developed by the Centers for Disease Control and Prevention, the Agency for Toxics Substance and Disease Registry, UCSF Pediatric Environmental Health Specialty Unit, and Physicians for Social Responsibility.

Free 1 ½ Credit Hours for Physicians, Nurses, Nurse Practitioners and Other health professionals (check the course site for details).  For more information and to take the course, visit .

Download the Pediatric Environmental Health Toolkit

The Toolkit is a combination of easy-to-use reference guides for health providers and user friendly health education materials on preventing exposures to toxic chemicals and other substances that affect infant and child health.  The Toolkit is endorsed by the American Academy of Pediatrics (AAP).  Download Toolkit materials at

Toolkit Training Opportunity

Designed for conferences, grand rounds, and other professional gatherings, PSR has developed a one-hour presentation, complete with case studies, that equips health care professionals with the knowledge and tools they need to provide parents of pediatric patients with anticipatory guidance on identifying and avoiding toxic chemical exposures.  The Pediatric Environmental Health Toolkit Training uses case examples to highlight the relationship between environmental exposures and children’s health.

To schedule a presentation at your practice or conference, contact Susan Kring at 207-772-6714 or [return to top]

AMA Describes Coverage Provisions in Health Care Reform Law

Health insurance market reforms

  • Immediate reforms to be implemented within six months, include:
    • Creating temporary high-risk pool with subsidized premiums for certain people with pre-existing conditions
    • Ending health insurance rescission abuse
    • Banning coverage exclusions of pre-existing health conditions for children
    • Requiring public disclosure of overhead/benefit spending by health insurance issuers
    • Providing coverage of certain preventive health services without cost-sharing
    • Eliminating lifetime limits on benefits and restrictions on annual limits on benefits
    • Requiring insurers that offer dependent coverage to allow children to be covered on their parents' insurance policy up to age 26
    • Developing uniform explanation of coverage documents for enrollees
  • Bans coverage exclusions of pre-existing health conditions or rating or coverage restrictions based on health status for adults
  • Provides standards for medical loss ratios to ensure premiums pay for benefits
  • Requires guaranteed issue and guaranteed renewability of coverage
  • Allows states to form compacts for the interstate sale of insurance
  • Increases transparency by requiring health insurers to provide a summary of coverage to applicants and enrollees
  • Allows enrollees to select their primary care provider (pediatrician for a child); no prior authorization or increased cost-sharing for emergency services; direct access to obstetrical and gynecological care

Insurance exchanges

  • Creates by 2014 state-based and state-administered health insurance exchanges (marketplaces) for the individual and small group market; states may be granted a waiver to opt out of this requirement if they provide coverage at least as comprehensive as that required under the Patient Protection and Affordable Care Act; only qualified health benefit plans meeting specific criteria can be sold in the exchange; insurers may sell policies outside the exchange; large employers would be phased into the exchanges in 2017
  • Prohibits health plans from discriminating against any health care provider acting within their state scope of practice law that wants to participate in the plan, but plans are not required to contract with any willing provider
  • Requires health plans to implement a process for appealing coverage determinations and claims
  • Allows qualified health plans to provide coverage through a qualified direct primary care medical home that meets requirements established by the secretary of the U.S. Department of Health and Human Services
  • Requires health plans to publicly disclose information on claims payment policies, enrollment, denials, rating practices, out-of-network cost-sharing and enrollee rights
  • Requires health plans to implement activities to reduce health disparities, including the use of language services, community outreach and cultural competency trainings

CO-OP and multi-state health plans

  • Creates the Consumer Operated and Oriented Plan (CO-OP) program to foster the creation of non-profit, member-run health insurance companies in all states
  • Specifies that a CO-OP organization may not be an existing organization; substantially all of its activities must consist of the issuance of qualified health benefit plans in each state in which it is licensed; governance of the organization must be subject to a majority vote of its members; any profits must be used to lower premiums, improve benefits or improve the quality of care delivered to its members
  • Provides initial grants to enable CO-OP organizations to meet state solvency requirements; precludes insurer or insurance industry involvement; organizations cannot operate until state has implemented the individual and small group insurance market reforms required under the Patient Protection and Affordable Care Act
  • Authorizes the Office of Personnel Management to contract with private health insurers to offer at least two multi-state qualified health plans (at least one non-profit) to provide individual or small group coverage through state-based exchanges

Long-term care

  • Creates a national, voluntary long-term care insurance program to help purchase services and supports for people who have functional limitations, in order to help them maintain personal and financial independence (CLASS program); financed through voluntary payroll deductions

Medicaid and CHIP

  • Expands Medicaid to all individuals under age 65 with incomes up to 133 percent of the federal poverty level
  • Provides 100 percent federal funding to states for costs of newly eligible individuals for 2014-2016
  • Increases payments for primary care services provided by primary care physicians (family medicine, general internal medicine or pediatric medicine) to 100 percent of the Medicare payment rates for 2013 and 2014; states will receive 100 percent federal funding for increased payment rates
  • Maintains current structure of the Children's Health Insurance Program (CHIP), with a 23 percent increase in the match rate in 2015 through 2019

Individual mandate

  • Requires most individuals to have minimum acceptable coverage or pay a tax penalty beginning in 2014; exemptions allowed for those who cannot afford coverage, religious objectors or if the individual has income below the tax filing threshold

Employer requirements

  • Requires employers with more than 50 full-time employees to provide health care coverage or pay a penalty
  • Requires employers that offer coverage and make a contribution to provide free choice vouchers to qualified employees for the purchase of qualified health plans through exchanges

Premium subsidies to individuals

  • Provides refundable, advanceable, and sliding-scale premium credits for individuals and families with modified gross incomes up to 400 percent of the federal poverty level

Small employer tax credits

  • Provides tax credits to small employers with 25 or fewer full-time employees and average annual wages of no more than $50,000 that purchase health insurance for their employees.
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New US DHHS Office To Implement Health Insurance Reforms

Effective April 19th, DHHS has a new office called the Office of Consumer Information & Insurance Oversight to enforce the new insurance market reforms in the law, as well as providing oversight for the state-based insurance exchanges and the temporary high risk pool program.  The Office will work closely with CMS to ensure coordination of the public and private health insurance in the country.  The Director of the Office is Jay Angoff, a lawyer and former insurance commissioner in Missouri.  Some physicians may recognize that Mr. Angoff is a long term antagonist of organized medicine on tort reform issues and ally of the trial lawyers. [return to top]

Study Says Streamlining Billing Could Save Physician Offices $7 Billion Annually

A study published online in Health Affairs on April 29th concludes that streamlining the billing and payment process in physician offices could save as much as $7 billion annually.  Entitled, Saving Billions of Dollars - And Physicians' Time - By Streamlining Billing Practices, the study examined the administrative complexity in the billing and payment processes of the physician organizations associated with Massachusetts General Hospital.  The study also estimated savings in physician time of 4 hours and in support staff time of 5 hours each week.

The study is available on the web at: [return to top]

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