August 9, 2010

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Cigarette Sales on the Rise in Maine

In a startling development, cigarette sales are increasing in Maine for the first time in many years.  As measured by the sale of tax stamps that are on every pack of cigarettes sold in the state, in the first six months of this year, tax stamps were up 5%.  For the budget year that ended June 30, 2010, sales were also up 1% over a year ago.  Survey data also has showed teen smoking on the rise.

Previous to this new trend, tax stamp sales had decreased virtually every year by one or two percent.  In a news report, Mike Allen, the research director at the Maine Revenue Service is quoted as stating, "No one in the office could remember when we had an increase, year over year."

Results reported earlier this year by the American Lung Association New England office showed that teen smoking in Maine increased to 18% from 14% in the previous year. 

It is not known whether the increase in sales is attributable to more Mainers smoking or to current smokers buying more cigarettes than previously.  It is also possible that more Mainers are buying cigarettes in Maine following a substantial increase in tobacco taxes in neighboring New Hampshire.

Maine CDC Director Dora Mills, M.D., M.P.H. noted that the apparent increase in smoking is a "wake-up call" that the public health community needs to recognize.  "A lot of other health issues in the last few years have taken a lot of attention away from tobacco," she said.  "We still need to keep our eye on the single biggest underlying cause of death and disability in this state and across the country, which is tobacco."

Dr. Mills also noted that a number of anti-tobacco programs are up for renewal and that the state needed to be changing strategies to assure that they are meeting the needs of those that are still smoking at high rates.

MMA joined the Lung Association and other public health advocates in supporting higher tobacco taxes in the last session of the Legislature.  Ultimately, the budget was balanced without increasing the tax.  The evidence is irrefutable that raising the price of tobacco products decreases consumption.  MMA will continue to be an active participant in Health Policy Partners which advocates for public health specifically in the areas of tobacco control and obesity.  The organization was formerly known as the Maine Coalition on Smoking OR Health.


First Circuit Court of Appeals Upholds Maine's Prescriber Data Restriction Law

As you will remember, several legislative sessions ago, Maine, New Hampshire, and Vermont each enacted prescriber data restriction legislation.  While the three laws took slightly different approaches, each limited access by so-called "data mining" companies to prescriber-identifying pharmaceutical data.  The laws have been in litigation brought by the data mining companies since enactment, with Maine and New Hampshire's litigation in the First Circuit and Vermont's in the Second District.  The First Circuit has already upheld New Hampshire's law and it handed down its opinion upholding Maine's law on August 4, 2010.  


The MMA still is analyzing the 30-page opinion and concurrence by Judge Kermit Lipez, a former Justice of the Maine Superior and Supreme Courts, but the following three paragraphs excerpted from the opinion will give you a sense of the matter.


This case comes to us in an unusual posture.  Maine is not the only state to have restricted plaintiffs' use of prescriber-identifying data, and this is not the first time plaintiffs have made these constitutional claims.  On November 18, 2008, after the district court granted plaintiffs a preliminary injunction in this case, this court upheld a similar, but not identical, New Hampshire statute against plaintiffs' constitutional challenges, a ruling that binds this panel.  See IMS Health Inc. v. Ayotte, 550 F.3d 42 (1st Cir. 2008), cert. denied, 129 S. Ct. 2864 (2009).  In the meantime, the district court's injunction has remained in effect during this appeal, and Maine has never implemented section 1711-E(2-A).


We reject all of plaintiffs' constitutional challenges to section 1711-E(2-A).  Plaintiffs' First Amendment challenges fail for the reasons stated in Ayotte:  the statute regulates conduct, not speech, and even if it regulates commercial speech, that regulation satisfies constitutional standards.  They also fail for reasons not present in Ayotte.  The Maine statute constitutionally protects Maine prescribers' choice to opt in to confidentiality protection to avoid being subjected to unwanted soliciations based on their identifying data.  We also reject the argument that the statute is void for vagueness.  


Plaintiffs' argument that section 1711-E(2-A) is unconstitutional under the dormant Commerce Clause if applied to plaintiffs' out-of-state use or sale of opted-in Maine prescribers' identifying data also fails.  We interpret the Maine statute using Maine's principles of of statutory construction and hold that section 1711-E(2-A) regulates prescription drug information intermediaries' out-of-state use or sale of opted-in Maine prescribers' data.  We hold that this interpretation does not raise constitutional concerns under the dormant Commerce Clause, which might necessitate a narrower reading of the statute under the doctrine of constitutional avoidance.


In his concurrence, Justice Lipez agreed with the majority's result, but disagreed with the majority finding that the challenged law regulated "conduct" not "speech."  Justice Lipez believes that the law does regulate speech, but that the State has identified a compelling state interest that justifies some limit on this type of commercial speech.  He suggests that the U.S. Supreme Court is going to have to resolve the First Amendment issues raised in these types of cases across the circuits.


The case is IMS Health Incorporated, Verispan, LLC, and Source Healthcare Analytics, Inc., a subsidiary of Wolters Kluwer Health, Inc., Plaintiffs/Appellees v. Janet T. Mills, as Attorney General for the State of Maine, Defendant/Appellant, No. 08-1248, U.S. Court of Appeals for the First Circuit, 2010 U.S. App. LEXIS 16129, August 4, 2010.


The Maine law was L.D. 4, An Act to Amend the Prescription Privacy Law in the 123rd Maine Legislature, P.L. 2007, Chapter 460).

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Senate Passes FMAP Extension; House Expected to Vote this Week

Maine Senators Susan Collins and Olympia Snowe joined all of the Senate's 57 Democrats and 2 Independents to produce a 61-38 margin in favor of ending debate on the measure to extend $16 billion in enhanced medicaid funding to the states.  Sixty votes were needed for cloture and Senators Snowe and Collins were the only Republicans to vote in the affirmative.

In response to this action, Speaker Pelosi has recalled the House, which was on its August break, to vote on the bill this coming week.  A vote is expected on Tuesday and the bill is expected to pass.   The impact on Maine includes approximately $77 million in federal Medicaid funds and an additional $39 million in education funding.  The budget passed by the 124th Legislature anticipated $100 million from the Medicaid enhanced match, so there will still be a deficit of more than $20 million to deal with.  Nonetheless, that amount will be far less of an issue than if the Congress had not acted on this legislation.

The larger federal match will exist through June 30, 2011.  The Maine Medical Association, the Maine Hospital Association, the Maine Children's Alliance, and many other health and consumer groups in Maine had advocated for passage of the legislation, recognizing that deep cuts in health care in Maine would likely have been the result of a failure to act.

Maine's two House members, Mike Michaud and Chellie Pingree, have previously voted for a similar provision and are expected to support the bill on Tuesday.

Maine physicians should take the time to thank the delegation for their support of this important legislation.





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Maine Medical Center-Tufts University School of Medicine Welcomes Class of 2014

In a ceremony last Monday, August 2nd, 31 students were welcomed into the Maine Medical Center - Tufts University School of Medicine Class of 2014.  The ceremony concluded with a reception in the lobby of the Dana Center for students, their parents, and guests.  The students, most of whom are from Maine, were welcomed by Richard Petersen, President and CEO of Maine Medical Center and Harris A. Berman, M.D., Interim Dean at Tufts.  The students were each introduced by Peter Bates, M.D., Vice President, Medical and Academic Affairs, MMC, Amy B. Kuhlik, M.D., Dean of Student Affairs at Tufts, Robert Bing-You, M.D., Associate Vice President, Medical Education, MMC, and Scott K. Epstein, M.D., Dean of Educational Affairs at Tufts.

The introductions were preceded by the 2nd Annual Victor A. McKusick, M.D., Lecture which this year was presented by John Tooker, M.D., MBA, FACP, EVP and CEO of the American College of Physicians.  Dr. Tooker practiced in Portland before moving to Philadelphia to accept his current position.  THe title of Dr. Tooker's talk was "Policy and Politics:  The Role of the Profession in Health Care Reform."

The students and their home towns follow:

Bethany Bartley, Greenville Junction

Tyler Bernaiche, Fort Fairfield

Christopher Buttarazzi, Scarborough

Amy Case, Brunswick

Jacquelyn Crane, Cape Elizabeth

Andrew Crouter, Portland

Johnathan Cyr, Biddeford,

Elidsabeth Deeran, Falmouth

David Douin, Hollis Center

Gwendolyn Downs, Auburn

Samuael Giles, Bath

Jasmine Hanifi, Falmouth

Grady Hedstrom, Yarmouth

Corina Hopkins-Vacca, Lunenburg, MA

Caitlin Hynes, Owl's Head

Andrew Kelner, Needham, MA

Dara Knapp, Cherryfield

Chelsea Kotch, Cape Elizabeth

Justin Li, Falmouth

Michael Neilson, South Paris

Thatcher Newkirk, Waterville

Katherine Nichols, York Harbor

Bethany Roy, Cape Elizabeth

Daniel Schupack, Mahtomedi, Minnesota

Sarah Sedney, Underhill, Vermot

David Sobel, Portsmouth, NH

Gillian Stevens, Chicago, Ill.

Renee Thibodeau, Fort Kent

Lynsey Waite, Cape Elizabeth 

Rebecca Wood, Eagle Lake

Jennifer Zuar, Auburndale, MA

MMA wishes the students all the best as they become the second class in the innovative MMA-TUSM program.






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MMA Ad Hoc Committee on Governance to Meet Wednesday, August 11th

The Association has recently formed an Ad Hoc Committee on Governance that will look at a number of issues during the coming months, all intended to ensure that MMA is properly constituted and governed to best represent the interests of Maine physicians.  The Committee will be chaired by President-elect Jo Linder, M.D. and will include members from the Executive Committee and the membership at large.  The organizational meeting of the committee will be held this coming Wednesday evening at 6:15 p.m. at the Association offices in Manchester.

Among the issues to be discussed is the current make-up and size of the MMA Executive Committee which is currently made up of 28 individuals, most of whom represent members in the counties in which they practice.  Most committee chairs are also on the committee.  All the current committees will also be reviewed for relevance.

The Committee will make an interim report at the Annual Meeting in September and is expected to complete its work by January 2011, at which time its recommendations will be reviewed by the Executive Committee at its annual retreat, being held this year from January 21-23, 2011.

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Dirigo Health Agency Board of Trustees Met This Morning

The Board of Trustees of the Dirigo Health Agency met this morning, August 9th for its monthly board meeting.  Following an update on activities from the Governor's Office of Health Policy & Finance by its Director, Trish Riley, the remaining portion of the agenda focused on the proposed budget of the Agency for the next biennial state budget, beginning July 1, 2011.  The proposed budget is due to the State Budget Office by September 1st.  The new Governor has until February 11, 2011 to submit a budget to the 125th Legislature.

A proposed budget, prepared by staff, was presented by Agency Director Karynlee Harrington.  She noted that the purpose of the DHA budget was to support its legislative mission:  to arrange for the provision of comprehensive, affordable health care coverage to eligible small employers, including the self-employed, their employees and dependents, and individuals on a voluntary basis and for monitoring and improving the quality of health care in the State.  This latter purpose involves the work of the Maine Quality Forum, which is part of the DHA.  Ms. Harrington felt that the proposed budget accurately reflected the Agency's goal as it relates to both access and quality.

ACCESS:  The goal is to maintain the enrollment levels in its programs established in Fiscal Year 2011.  The expansion for parents is the exception as the budget assumes current growth levels continue in both years.  However, the level of membership in DirigoChoice will depend on the group's experience over the course of fiscal years 2011, 2012, and 2013.  The same is true for the Voucher program which is funded by the federal government through a HRSA grant.

QUALITY:  The goal is to move the agenda forward as it relates to improving the quality and safety of health care in the State.  The Agency will continue to build off the work it will begin in fiscal year 2011 as it relates to comparative provider specific cost/quality measurement and reporting in a consumer friendly way, continued efforts toward advancing the goals of the Patient Centered Medical Home Pilot and preparing for the evaluation as well as working through the tasks assigned to the Maine Quality Forum (MQF) in the State Health Plan.

The proposed budget shows approximately $97 million in revenue in FY 2012 increasing to more than $99 million in FY 2013 (about a 2% increase).  Most of the revenue comes from health plan payments (based upon 2.14% on paid claims) and employer and individual premium payments.  Other funds include grants, membership fees and a yearly allocation from the Fund for a Healthy Maine.  Proposed expenses also approach nearly $100 million annually with most funds being used to subsidize coverage.  Approximately $1 million per year is allocated to the Maine Quality Forum to continue its initiatives.

Several of the MQF initiatives are of particular interest to physicians.  In each year, $115,000 supports the Patient Centered Medical Home pilot.  $260,000 each year will be used for practice level claims analysis.  The results of this analysis, which will be competitively bid, will be publicly reported.  Similarly, $300,000 per year is proposed to conduct a statewide survey of patients of both primary care and specialist physicians used to gauge the quality of care from the patient perspective.  These results will be reported publicly as well.

Following a detailed presentation, the Board voted unanimously to send the proposed budget to the State Budget Office.

The Board will meet next on September 20, 2010.  That agenda will focus on the contract with Harvard Pilgrim Health Care for a three year period beginning October 1, 2010.  The existing contract ends on September 30th.  Harvard-Pilgrim won the right to negotiate a new three year contract through a competitive bidding process.

MMA staff monitors all the meetings of the Dirigo Health Agency Board and reports in the Weekly Update on the Board's activities.





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Annual Session Hotel Deadline Extended to August 13, 2010

Members, Corporate Affiliates, and guests wishing to attend the Association's 157th Annual Meeting in Bar Harbor, from September 10-12, 2010 need to make hotel arrangements at the Harborside Hotel & Marina by August 13th.  Rooms may not be available after that date, although there are a variety of other housing options available on the island ranging from $50 per night to $300 per night.  Reservation forms may be faxed to the hotel or you may call 1-800-328-5033.  Be sure to state that you are attending the MMA Annual Meeting.

With a theme of Life Transitions for Patients, Families and Communities, this year's meeting offers 6.5 hours of CME in collaboration with The Jackson Laboratory. 

With a beautiful location, high quality CME, and ample recreational opportunities, this meeting presents a unique opportunity to spend time with professional colleagues and friends, and to participate in your professional association.  We hope you will join us in Bar Harbor!

David McDermott, M.D., MPH                                Jo Linder, M.D.

President                                                                   President-elect

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AMA & MGMA Offer Toolkit to Assist in Practice Management System Software Selection

The upcoming transition to the government's modified electronic transaction standards, coupled with the Medicare and Medicaid  electronic health record incentive program, will require physician practices to upgrade or replace their current practice management software.  To help you select and purchase the most appropriate software for your practice, the AMA and the Medical Group Management Association (MGMA) collaborated to develop a new online toolkit.  The new toolkit provides a roadmap to make this process easier for your practice.  You can use this information to establish your practice needs and take advantage of recent improvements in automation.  The toolkit resources include:

  • A 5-step guide to practice management system software selection.

  • A comprehensive checklist that helps you determine which practice management system software features and functionalities are essential to your practice and which will enhance your revenue cycle management.

  • A sample request-for-proposal (RFP) that you can use in your communications with practice management system software vendors.

You can find more information about the toolkit on the web at:

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SAVE THE DATE: UNECOM Alumni Reunion & Fall CME Weekend, October 7-10

The UNE College of Osteopathic Medicine Alumni Association, the University of New England College of Osteopathic Medicine, and the New England Osteopathic Association are pleased to invite you to attend the 2010 Alumni Reunion & Fall CME Weekend, October 7-10, 2010 held on the UNECOM campus in Biddeford.  Please go to for more information and to register.

The Annual alumni Reunion & Fall CME Weekend provides high quality, affordable Primary Care CME, while celebrating this year class reunions for 1985, 1990, 1995, 2000 and 2005!  You don't have to be an Alumni in order to take advantage of our quality CME program.  All physicians and physician assistants are welcome!  At least 10 hours of CME will be available, covering topics, such as:

- Traumatic Brain Injury

- Urinary Incontinence

- Defacatory Disorders

- Infectious Diseases

- Venous Insufficiency

- Chronic Headaches

- Cardiology Update for the PCP

- OMM workshop and more!

If you have questions, please don't hesitate to contact the following:

For Reunion and Social Events (all non-cme activities) - 207-602-2329 or 

For the CME program and to register, call 207.602.2589 or 

Please pass this onto your physician colleagues and encourage them to attend!  The detail registration brochure will be available soon
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NHIC Corp. Offers Web Site Customer Satisfaction Survey

Visitors to the NHIC Corp. web site,, who click on the J14 A/B MAC web site, will see a "pop-up" of its Foresee Customer Satisfaction Survey.  NHIC, the Medicare intermediary contractor for Maine, would like to hear your comments and suggestions for the web site through this survey.  The survey will allow you to browse the web site and then complete the survey before exiting. [return to top]

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