October 11, 2010

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Federal Judge Upholds Individual Health Insurance Mandate; Appeals Likely

A federal judge this past Thursday upheld the right of the federal government to require everyone to have health insurance, dealing a setback to those states and advocacy groups which have sued to prevent implementation of the Patient Protection and Affordable Care Act (ACA). The national issue leaked over to the state side late in the week when Republican Gubernatorial candidate Paul LePage stated that Maine should join with the states that are suing to block the law, noting that he believed the law to be unconstitutional.

On the state side, Democratic candidate Libby Mitchell responded that she did not believe that Maine should  pursue such a law suit.  Independent candidate Eliot Cutler also indicated his opposition to such a tactic.  Each candidates' position on health care reform can be accessed through their campaign websites.  Maine Attorney General Janet Mills has expressly stated her opposition to suing to prevent the law from being implemented.

The federal court ruling came in response to a complaint filed in the state of Michigan by a Christian legal group and four individuals claiming that the Congress exceeded its power under the Constitution's commerce clause.  Federal District Court Judge George Caram Steeh ruled that the mandate to purchase insurance by the year 2014 and the financial penalty for avoiding coverage are constitutional.  He noted in the opinion that Congress was trying to reduce the cost of coverage by requiring participation by everyone.

     "Without the minimum coverage provision, there would be an incentive for some individuals to wait to purchase health insurance until they needed care, knowing that insurance would be available at all times,"  noted Judge Steeh.  "As a result, the most costly individuals would be in the insurance system and the least costly would be outside it.   In turn, this would aggravate current problems with cost-shifting and lead to even higher premiums."

The decision affects only the parties in the lawsuit and is not binding on other federal judges hearing other challenges to the law.  But, as the U.S. Department of Justice was quick to point out following the ruling, it was the first time a court had considered the merits of any challenge to the law and found that the minimum coverage provision was a reasonable means for the Congress to take in reforming the health care system. 

The four individual plaintiffs stated that they do not have private insurance and object to being forced to pay for it.

MMA has supported the concept of an individual mandate since issuing its White Paper on Health System Reform (entitled Coverage for All) in 2003.

Today is Discoverer's Day (Columbus Day) and MMA Office is Open

Today, Monday, Oct. 11, 2010 is a state and federal holiday but the MMA office is open for business from 7:30am to 5:00pm.  As most physician offices are open today, we felt it important to provide members with the same service you normally receive 5 days a week, from 7:00am to 5:00pm.  Call today to 622-3374 if there is a need we can fulfill.  And thank you for your support all year long. [return to top]

Maine Medical Center Opens the Hannaford Center for Safety, Innovation and Simulation

This past Tuesday, the Maine Medical Center held a Grand Opening of its Hannaford Center for Safety, Innovation and Simulation at its Brighton Campus on Brighton Ave. in Portland.  The event featured remarks by Richard Peterson, President of MMC, David Warren, Chairman of the Board, Beth Newlands Campbell, President of Hannaford and Randy Darby, M.D. the Medical Director of the Center.  Tours of the facility, located on the 3rd floor of the building which was formerly the Brighton Osteopathic Hospital, featured three rooms with computer operated, life-like mannekins.  The medical mannequins, at a cost of over $300,000 each, mimic humans.  "These mannequins are incredibly life-like," said Dr. Darby. "They breathe, bleed, and exhibit symptoms of minor or major injury, as well as mild to life-threatening diseases -almost anything we see in live patients from kids to adults.  They will provide invaluable experience to our future caregivers."

"Evolving medical education research data indicates that simulation centers may turn out to be one of the best, most efficient, and safest ways to learn medical techniques and gain medical knowledge," added Dr. Darby.  "We'll be able to teach students in a controlled -but completely realistic -environment.  In the same way the pilots learn to fly and sharpen their skills through simulation drills, our students and staff can practice deliberately and repeatedly, fully learn a concept, perfect a technique, and be much more skilled when they treat patients in the real world."

The opening of the Center opens a new era of medical education and technology in Maine.  Built at a cost of more than $5.82  million, the Center provides a new learning environment for medical students, residents and attendings.  The mannekins can be transported and presentations at other healthcare facilities are anticipated. To learn more, visit www.mmc.org/simulation.

MMA President Jo Linder, M.D. and EVP Gordon Smith both attended the opening. [return to top]

Office of Inspector General Releases 2011 Work Plan, Effective Oct. 1, 2010

In September, the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services published its 2011 Work Plan, which became effective on Oct. 1, 2010.  The Work Plan describes the areas in which the OIG will focus specific audit, investigation, enforcement and compliance activities.  The OIG indicated that it will review the extent of potentially inappropriate payments for evaluation and management (E&M) services.  The OIG stated that Medicare contractors have noted an increased frequency of medical records with identical documentation across services.  Visit the OIG website at http://oig.hhs.gov/publications/workplan/2011 to access its Work Plan.

MMA attorneys are currently going through the 150 page Plan to see what particular aspects may be of interest to MMA members and their staffs.  We will report our results in the Weekly Update.  Updates will also be available on the MMA website at www.mainemed.com.

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Next First Friday Educational Program Features the Topic of Medical Records, Nov. 5, 2010

MMA's next First Friday Educational Program will be presented on Friday morning, Nov. 5 from 9:00am to noon and the offices of the Association in the Frank O. Stred Building in Manchester.  Interested persons may attend by joining us in Manchester or by participating via webex from their personal computers.  The topic is, "Medical Records, Everything You Always Wanted to Know" and the faculty represents a collaboration between MMA legal staff (Andrew MacLean, Jessa Barnard and Gordon Smith) and the health law firm of Kozak and Gayer (Ben Townsend and Steve Johnson).  In addition to dealing with the areas of preparation, retention, disclosure and destruction, the program will also cover the transition to electronic records.

The cost is $65 per person and registration is available on the MMA website at www.mainemed.com.  Fliers more fully describing the program will also be included in the just mailed September-October issue of Maine Medicine.

The last First Friday program of 2010 will be held on Friday morning, Dec. 3 and will feature Medical Legal topics such as consent to care and compliance. [return to top]

Dirigo Health Rates in the Nongroup Market to Remain Unchanged

The Dirigo Health Agency, which recently re-opened enrollment in DirigoChoice, announced Oct. 7 in a press release that it would not raise its rates in the nongroup market in January, 2011.  DirigoChoice is offered by Harvard Pilgrim Health Care and pays physicians commercial market rates when they provide services to DirigoChoice patients.

In addition to a premium freeze, enrollees will also be advantaged by not having to pay co-pays for many preventive services as a result of the provisions of the new federal health care reform act (Affordable Care Pact). 

Harvard Pilgirm recently signed a three year contract with the Agency to be the carrier of the state product.  "Harvard Pilgrim is committed to serving the people of Maine and we are honored to partner with the Dirigo Health Agency to offer affordable health-care solutions to the individual market throughout the state," said Ed Kane, Harvard Pilgrim's vice-president in Maine.  "As a nonprofit health plan, Harvard Pilgrim shares the Dirigo Health Agency's goal to reduce costs and improve quality and access for Maine's residents."

DirigoChoice represents approximately 16 percent of the individual, nongroup market in the state.  The agency's current funding will permit an additional 1500 individuals and their families to be covered by DirigoChoice.  The other primary carrier in the individual market is Anthem Blue Cross Blue Shield of Maine, a subsidiary of Wellpoint.

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Celebrate National Physicians Assistant Week, Oct. 6-12.

Nationally and in Maine, Physicians Assistant Week is being recognized from Oct. 6 through Oct. 12.  In Maine, over 600 physician assistans are licensed and are valuable assets to our physicians and hospital practices.  The Maine Medical Association provides administrative support to the Downeast Association of PA's (DEAPA) and encourages MMA members to support DEAPA by encouraging PA's to belong to their professional association.  Membership is available through the DEAPA website at www.deapa.org[return to top]

MAPP Past-President Janis Petzel, M.D. to Receive MCLU Roger Baldwin Award Oct. 15 in Orono

Janis Petzel, M.D., immediate past president of the Maine Association of Psychiatric Physicians will be honored Oct. 15 in Orono by the Maine Civil Liberties Union as one of three recipients of the 2010 Roger Baldwin Awards.  The awards will be presented at the MCLU Annual Membership Meeting which is open to all at no cost.  But an RSVP is preferred to the MCLU at 207-774-5444.

Dr. Petzel is being honored for her advocacy this past legislative session on a bill to limit the use of solitary confinement in Maine's prison system. 

     "As then-President of the Maine Association of Psychiatric Physicians (MAPP), she mobilized the medical community and provided powerful expert testimony to legislators about the psychological effects of solitary confinement on prisoners.  Petzel's expertise and her calm persistence made her an invaluable resource through all aspects of the legislative process.  Petzel continues to work on issues of access to mental health services, particularly in prisons, as Chair of MAPP's Legislative and Governmental Affairs Committee."  (As stated by the MCLU in a brochure prepared for the event.)

The Meeting will be held at 7:00pm on Friday, Oct. 15, 2010 at the Wells Conference Center at the University of Maine in Orono.  In addition to the awards, the meeting will feature guest speaker David Fathi, Director of the ACLU Prison Rights Project.  From 2007 to 2010, Fathi was Director of the US Programs at Human Rights Watch.  He has lectured nationally and internationally on criminal justice issues.  He is a graduate of the University of Washington and the Boalt Hall School of Law at the University of California, Berkeley.

MMA congratulates Dr. Petzel on this well-deserved award.

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Hanley Center Seeks Nominations for Health Leadership Awards to be Presented November 30th

You're Invited To Nominate 
a Maine-based Organization or Health Care Professional For...

The 2010 Hanley Center Honors
for Leadership in
Medical & Humanitarian Relief

Recognition Dinner on November 30, 2010

Keynote Speaker
T. R. Reid

Popular NPR commentator and author of

The Healing of America
A Global Quest for Better, Cheaper, 
and Fairer Health Care

Mark Your Calendars for this Special Event! 

Tuesday, November 30, 2010

Holiday Inn by the Bay, Portland
Learn more about Dan Hanley and his achievements by visiting The Dan Hanley Center For Health Leadership
Or Call Jim Harnar

Nomination Form

To request the form in MS Word:


The Hanley Center-Honoring Leadership, Collaboration, Courage, Kindness & Hard Work 

Dear Colleague,

This year, the Daniel Hanley Center for Health Leadership will recognize four Maine-based organizations and one individual who have provided outstanding voluntary medical relief and humanitarian service outside our state. Those honored will embody the values that made Dr. Dan Hanley one of Maine's most effective-and respected-healthcare leaders. 

I hope you'll take a few minutes to submit a nomination.  This is an excellent opportunity for you to recognize an organization for its achievements in helping others in the US or abroad. You also are encouraged to nominate a colleague for his or her outstanding personal commitment to medical relief or humanitarian efforts.

Follow the links to download the Nomination Form or request to have the forms sent to you via email.

Don't delay. Nomination deadline is Friday, October 29.

I'm looking forward to receiving your nomination(s)!


James Harnar
Executive Director
Daniel Hanley Center for Health Leadership

Save The Date:
Tuesday, November 30, 2010
Hanley Center Honors for Leadership in Medical & Humanitarian Relief
Holiday Inn by the Bay, Portland

Keynote Speaker 
T.R. Reid
The Healing of America
A Global Quest for Better, Cheaper, and Fairer Health Care
This recognition dinner is part of an exciting afternoon and evening event co-hosted by the Hanley Center andQuality Counts with support from the Maine World Affairs Council.
More information about the event will follow.
For more information, including award criteria and nomination forms please visit www.hanleyleadership.org or  contact Jim Harnarjamesharnar@hanleyleadership.org or 207-523-1501

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Save the Date: Northern New England State Medical Societies Join with the AMA to Present Nov. 13 Program on Payment Reform

Watch for next week's Update which will include registration materials for a Nov. 13th (Saturday) program in Concord, N.H. on payment reform.  Sponsored by the American Medical Association and co-sponsored by MMA and the state medical societies in Vermont and New Hampshire, the program will feature a presentation by Harold Miller, M.D. and include presentations from each state.  The program will run from 10:00am to 3:00pm. [return to top]

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