November 15, 2010

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Congress Re-convenes on November 15th and Must Address Medicare SGR

     If Congress fails to act by Nov. 30, Medicare and TRICARE payments to physicians will be cut by 23%.  It is time NOW to cure this chronic problem.  Join colleagues from around the country in calling Congress this week and urging your patients to do the same.  The Maine Medical Association and the Maine Chapter of AARP will be engaged in a number of advocacy activities this week to bring attention to this issue.  Call the AMA's grassroots hot line at 800-833-6354 to be put in touch with the offices of Senators Snowe and Collins.  Help send a loud and clear message that the broken Medicare payment system must be fixed.

If Congress fails to act by November 30th, Medicare and TRICARE payments to physicians will be cut by 23% on December 1st with an additional cut of 2% on January 1, 2011. 

On November 17th, the AMA has called for a White Coat Wednesday, when physicians from across the country will call their U.S. Senators to urge them to act on this issue.  Call the AMA grassroots hot line at 800-833-6354 to be put in touch with the officers of Senator Snowe and Collins.  Please express to them our appreciation for their past efforts while advocating strongly for a thirteen month delay in the cuts so that the new Congress can have time to develop a permanent plan to replace the sustainable growth rate formula.  Even a delay of thirteen months will cost fifteen billion dollars ($15 billion).  A total repeal of the sustainable growth rate formula at this time would cost $330 billion.  While another delay rather than a repeal is disappointing to many physicians, the Congress needs some time to work with CMS to develop a new payment formula, one likely to focus more on prevention and quality than on volume.

You should also get your patients engaged in this issue.  Inform them about the damage Medicare cuts could have on access to care.  Visit to print 50 patient-focused fliers and distribute them in your waiting area.  Give your patients accurate information and encourage them to call Senators Snowe and Collins to ask for assistance.  Your patients can also sign up for e-alerts on the impact of the Medicare cuts through the AMA's Patients' Action Network.

The Maine Chapter of the AARP will be mailing tens of thousands of informational postcards to seniors in Maine and will hold a tela-townhall.  Op Ed pieces are being distributed by both MMA and the AARP.  Help us help you by making a call to Congress this week.



Free In-Office Hypertension Education Available Through MMA's Academic Detailing Program

The Maine Medical Association and the Maine Independent Clinical Information Service Present: 

Academic Detailing Visits at No Cost

NEW Hypertension Module Available Now!  

Schedule your visit today: 207-622-3374 or 

The "Silent Killer" - Still at Large 

Most Americans over age 60 have hypertension.  Even among those whose blood pressure are normal at age 55, the lifetime risk of hypertension is 90%.  Despite the availability of dozens of effective treatments and decades of data, less than two-thirds of patients in the U.S. with hypertension are receiving treatment, and less than half are adequately controlled.

Effective hypertension control is one of the best ways a physician can make a real difference in patients' health by preventing myocardial infarction, stroke, renal damage, and premature death.  

Meet with our academic detailers to learn more about key steps that can improve current management, such as: 

  • Low-dose thiazides should play a central role as initial therapy for many patients, and as part of combination treatment for others; 
  • Choose other medications based on compelling indications; 
  • Combination therapy will often be needed;
  • When choosing agents, consider cost and compliance. 

For more information, visit  Three academic detailers have been trained in the new hypertension model and they are ready to go!  Put them to use in your practice. [return to top]

Final First Friday Presentation of 2010 Features "Current Topics in the Medical Legal World"

On Dec. 3, 2010, MMA presents the final First Friday Presentation of 2010 with a program entitled, "Current Topics in the Medical-Legal World."  The program runs from 9:00am to noon and features presentations from five health lawyers on the following topics:

  • The 2010 Physicians Guide to Maine Law
  • Maine Laws on Informed Consent
  • The Federal Trade Commission "Red Flag" Rules, effective Jan. 1, 2011
  • The 2007 Medicare Law requiring reporting of waiving of co-payments
  • The Maine Health Security Act

Attorneys Stephen Johnson and Benjamin Townsend of the Augusta Health Law Firm of Kozak and Gayer and MMA lawyers Andrew MacLean, Jessa Barnard and Gordon Smith will all participate.  The program promises to be a fitting conclusion to a very successful series of programs in 2010.  The program can be attended live in Manchester or via WebEx.  There is a $65 dollar fee and anyone interested can register on the MMA website at  Persons interested in attending through WebEx may register by e-mailing

Watch for an insert in the November-December Maine Medicine which will list all the First Friday programs for 2011.  The series begins on Friday, Feb. 4, 2011 with a program on the future of health system reform.  Nine programs have been scheduled, not including the 20th Annual Practice Education Seminar being held on Wednesday, May 18, 2011 at the Augusta Civic Center. [return to top]

DEA Issues Policy Statement on Prescribing for LTC Patients

The AMA recently responded to a request for information from the DEA on delays in dispensing controlled substance medications for patients at long term care facilities.  The AMA also worked with other medical societies on a "tip sheet" for physicians to help expedite dispensing.  Both the tip sheet and the AMA letter are available by selecting "DEA issues" at

On October 6th, the DEA published in the Federal Register a statement of its policy at on the role of authorized agents in communicating controlled substance prescriptions to pharmacists.  The policy statement includes a sample written agreement between a DEA-registered physician and an agent, such as a nurse at the long term care facility.  It provides clarification that communication by facsimile or oral communication of a valid prescription for a Schedule III, IV, or V controlled substance may be delegated to an authorized agent, and that an agent may not call in an oral prescription for a Schedule II controlled substance on behalf of a practitioner, even in an emergency situation.  However, for patients in a hospice program or a long term care facility, a practitioner or a practitioner's authorized agent can transmit a valid practitioner-signed prescription for a Schedule II controlled substance to a pharmacy via facsimile.  The DEA statement of policy is helpful but it does not fully address the AMA's concerns about dispensing delays for urgently needed Schedule II drugs that may occur when physicians are neither available to sign a written prescription nor able to get in touch quickly with the pharmacist by phone. 

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RUC Completes 5-Year Review of RBRVS

The AMA/Specialty Society RVS Update Committee (RUC) met from September 29th to October 2nd to review more than 200 physician services identified by CMS and public commenters under the 4th 5-year Review of the Resource-based Relative Value Scale (RBRVS).  CMS will review the RUC recommendations and publish the proposed changes in a Notice of Proposed Rulemaking in Spring 2011.  Implementation of any changes will occur on January 1, 2012.  Outside of this formal 5-year Review process, the RUC continues to identify and address potential misvaluations within the RBRVS.  The Final Rule on the 2011 Physician Payment Schedule is expected to be released in a few weeks and will include CMS decisions on a number of these RUC recommendations. [return to top]

Medical Marijuana Patients Need State ID Card by January 1; Fifty Physicians have Completed Medical Certificates

The State Department of Human Services reported this week that fifty different physicians have completed medical certificates for patients under the new medical marijuana law.  Twenty-nine of these physicians were family physicians with the remaining certifiers representing a mix of other specialties. Several hundred patients are expected to have ID cards issued by the state by Jan 1, 2011, although the first state-licensed dispensaries are not likely to be open before March. 

MMA and the Maine Osteopathic Association are soliciting names of physicians interested in serving on the state mandated advisory board.  To be eligible to serve on the board, which is likely to meet only once or twice a year, a physician must be board certified and have a current Maine license and a DEA license.  One position each is available in family medicine, pediatrics, psychiatry, addictionology, pain management, neurology, palliative care, gastroenterology, medical oncology, infectious disease, gynecology and internal medicine.

MMA has resources on its website at for physicians desiring more information on the law and the risks and benefits of physicians and patients participating.

MMA also has a one hour course on the law, certified for CME, delivered by one of our three health lawyers.  If your medical staff, group practice or specialty society would like a presentation, contact Gail Begin at the MMA at There is normally a $200 charge to cover travel and copying costs.  The power point presentation is located on the MMA website.

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MQF Advisory Council Gets Update on New Director Search & Various Initiatives

The Maine Quality Forum Advisory Council, a multi-stakeholder advisory group to the Maine Quality Forum (MQF) and the Dirigo Health Agency chaired by Robert Keller, M.D., held a regular meeting on Friday, November 12th.  

DHA Director Karynlee Harrington provided an update on the work of the Agency, particularly in light on the new political landscape.  She reported lots of positive energy within the Agency and several pieces of good news, including the conclusion of a 3-year agreement with Harvard Pilgrim Healthcare and small group rate increases considerably lower than competitors.  The MQF staff also provided members with an update on the status of various MQF projects, including the MRSA Prevalence Study, the Patient Experience of Care Project, the Maine Multi-Payer Advanced Primary Care Practice Demonstration, and the MONAHRQ initiative.  Ms. Harrington and Dr. Keller reported that the Agency is beginning its search for a new MQF Director following the resignation of Dr. Cutler.  The Agency may consider a non-physician for the position, but if the leadership does move in this direction, they will ensure continued physician input through a Medical Director who likely would be part-time.

The next meeting of the MQF Advisory Council will be Friday, January 14, 2010 from 9:00 a.m. to noon.

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Nov. 18th Dinner Meeting Features Maine MSO's: Ambulatory EHR for a Connected Maine Healthcare Community

You don't have to be a large healthcare system or employ a staff of information technology professionals to have full featured affordable EHR.  Dan Mingle, M.D., extends this invitation to any practice for dinner, discussion, and a product demonstration at the Marriott Residence Inn on the Portland waterfront at 6:00 p.m. on Thursday evening, November 18th.

Maine MSO has teamed with Allscripts to put enterprise-class EHR and Practice Management software into the hands of private practices and small to medium sized healthcare organizations.  The EHR is locally operated and locally supported.  Maine MSO will provide connectivity, content, and data meaningful to Maine.  Do not miss this opportunity to see how Maine MSO's One-Patient One-Chart EHR strategy will provide you with unparalleled patient safety and practice performance.

The dinner and product demonstration are free of cost.  Space is limited so call today to reserve your seat for November 18th or for an alternate date and location.  Contact Ashley Picard at Maine MSO via e-mail to or call 207-370-6445, extension 223.

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Register Now for Hanley Leadership Forum Featuring T.R. Reid on November 30th

The Daniel Hanley for Health Leadership, Quality Counts, & the World Affairs Council of Maine are collaborating on a Quality Healthcare Forum at the Holiday Inn by the Bay on Tuesday, November 30th.  The afternoon session is entitled, The Affordable Care Act and Opportunities for Improving Healthcare.  The evening program includes the 2010 Hanley Leadership Recognition Dinner with a keynote address by T.R. Reid, noted journalist, NPR commentator, and author of The Healing of America:  A Global Quest for Better, Fairer, Cheaper Health Care.

You can find registration information on the web at:

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Physicians Invited to Meet with Aetna Officials on Dec. 13 to Discuss Medicaid Managed Care

The Maine Medical Association and Aetna will host a dinner meeting at the offices of MMA in Manchester on Monday evening, December 13th, beginning at 6:00pm.  Aetna officials would like input from Maine physicians regarding MaineCare's plans to move patients into a managed care contract in 2011.  Aetna is providing managed care under contracts in other states, along with United, Wellpoint and other insurers.

Attending the meeting will be Judith Chamberlain, M.D., Virginia Cate, Senior Network Market Lead and Lynda Grajeda, Network Operations Market Head.

Physicians wishing to attend may rsvp to Diane McMahon at [return to top]

First Flu Case Reported this Past Week in Sagadahoc County - Do Your Part to Get Vaccinated

Recognizing that influenza infection in health care workers can lead to outbreaks with serious consequences for patients, the Maine Medical Association's Public Health Committee and the Maine Center for Disease Control and Prevention are committed to increasing influenza immunization rates among Maine's medical staff.  

The MMA Public Health Committee and MeCDC therefore encourage all Maine physicians to receive the influenza vaccination this fall and to create policies regarding vaccination among your staff.  For more information, visit: or

- Norma Dreyfus, MD, MMA Public Health Committee Co-Chair

- Lani Graham, MD, MPH, MMA Public Health Committee Co-Chair

- Stephen Sears, MD, MPH, State Epidemiologist, MeCDC  [return to top]

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