February 7, 2011

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Legislature's HHS Committee Votes 10 to 3 to Endorse Mary Mayhew as the Commissioner of HHS

Following a three hour hearing, the Legislature's Health & Human Services Committee voted 10 to 3 this past week to endorse former MHA Vice President Mary Mayhew as the next Commissioner of the Department of Health & Human Services.  No one spoke in opposition to the nomination and many organizations and individuals, including MMA, testified in support citing Mary's deep background in health care policy, her work ethic, and her intelligence.  A copy of the MMA's testimony is available on the MMA website at www.mainemed.com.

Ms. Mayhew's confirmation is now all but assured when the Senate votes this coming week on the nomination.  Once confirmed, she will face a number of important decisions including Deputy Commissioner appointments, naming a MaineCare Director and a Director of the Maine Center for Disease Control & Prevention (Stephen Sears, M.D., M.P.H. is serving as interim Director).

In her testimony before the Committee, Mayhew discussed her experience at the Maine Hospital Association and said she would emphasize accountability and transparency at the Department while focusing on the needs of the most vulnerable individuals and families.  She was questioned, primarily by Democrats on the Committee, regarding her lack of management experience and her potential bias toward hospitals.  In response, she noted that she intended to form a management team at the top of the Department that would have experience and who would be experts in their fields of responsibility. 

She expressed a need to change the MaineCare program to create appropriate incentives and reward efficiencies.  She also spoke of the need to emphasize primary care.  And while Governor LePage has expressed his opposition to the federal Affordable Care Act, she acknowledged the importance of Maine continuing to prepare for implementation of the law during this period of uncertainty.

Among those persons and individuals speaking of behalf of the nominee were the following:

  • Gordon Smith on behalf of MMA
  • Lee Myles, CEO of St. Mary's Health System
  • Erik Steele, D.O., Vice President and Chief Medical Officer of Eastern Maine Healthcare
  • Rick Erb, President and CEO of the Maine Health Care Association
  • Glenn Cummings, Former Democratic Speaker of the House, now with the Hinkley School
  • Carol Carothers, Executive Director of the NAMI-Maine

The three Democrats on the panel voting against the nomination were Sen. Margaret Craven of Lewiston and State Representatives Mark Eves (D-North Berwick) and Peter Stuckey (D-Portland).



MMC Physician-Hospital Organization Seeks Associate Medical Director

The Associate Medical Director is a full-time position (with part time active clinical practice) on the staff of the MMC Physician-Hospital Organization.  The position reports to the Senior Medical Director. The individual in this position will work with a high degree of independence and must be able to effectively interact with his/her fellow physicians.  He/she should have good working knowledge of clinical technology and its applications.  He/she must be highly motivated to foster solid relationships with physicians to improve the delivery of high quality, efficient care through the application of evidence-based, best practices and supporting technology.  He/She will be expected to work as a team member with staff on programs and projects as assigned.  Must be Board Certified with active Maine license

Primary Responsibilities

In support of the Sr. Medical Director:

  1. Participate on the design and development of the clinical aspects of the Clinical Improvement Plan (CLIP)
  2. Implement CLIP by working closely with physicians and practice staff to support the introduction of the Clinical Improvement Registry (CIR); related clinical technology; and other clinical improvement related services; 
  3. Support physician offices in achieving any applicable incentive goals made available through the MMC PHO or other entities;
  4. Provide feedback to physicians on their performance relative to their peers or other measures and assist them in improving the delivery of care whenever possible utilizing the CLIP tool and resources;
  5. Provide general medical affairs support, including, but not limited to, medical information for the MMC PHO staff, consultation with physician members, review of payer policies relating to physicians; etc.
  6. Attend meetings on behalf of the Sr. Medical Director

In conjunction with the Sr. Medical Director:

  1. Provide feedback on the CLIP to the Health Care Value Steering Committee; the MMC PHO and MaineHealth on the progress of the CLIP implementation and identify opportunities for improvement;
  2. Provide input into evaluations of clinical technology,
  3. Provide support to the Care Managers and other clinical system support staff (Transition Coaches, etc.);

 Interested parties should contact Jeffrey Aalberg, MD (aalbej@mmc.org) or Peter Wood (woodp@mmc.org). [return to top]

2010-2011 Physicians Guide to Maine Law Now Available on Line and in Hard Copy

The latest edition of the popular Physicians Guide to Maine Law is now available on the MMA website (member's only section) and is available for purchase (hard copy and CD) from the MMA office.   The hard copy binder and CD are available for purchase for a fee of $125 plus tax.

Contact Diane McMahon or Maureen Elwell at MMA is you are interested in purchasing a binder.  The Guide is updated through the Second Regular Session of the 123rd Legislature.  Diane and Maureen are available by calling 622-3374 or via e-mail to dmcmahon@mainemed.com or melwell@mainemed.com.

Office staff are able to receive access to the member's only section of the website so long as a physician in the office is a member of MMA.  Just click on the member's only section in www.mainemed.com and follow the instructions to receive access.

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Legislative Committee Conference Call This Tuesday; New Bills for Review

The MMA's Legislative Committee will hold its next weekly conference call this Tuesday, February 8th at 8:00 p.m.  Legislative Committee members and specialty society legislative liaisons are strongly encouraged to participate.  Any physician, practice manager, or other staff member who is interested in the MMA's legislative advocacy also is welcome to participate.  It is not necessary to RSVP for the calls.

Please use the following conference call number and passcode.  These will remain the same for every weekly call during the session:

Conference call number:  1-877-669-3239

Passcode:  23045263

The purpose of the weekly conference calls is to review and finalize the MMA's position on bills printed that week, to hear the views of specialty societies on the new bills or their concerns about any health policy issues, and to discuss the highlights of legislative action that week.  The calls rarely last longer than an hour and usually we can accomplish our business in much less time.

If you have any questions about the conference calls, please contact Andrew MacLean, Deputy EVP at amaclean@mainemed.com or 622-3374, ext. 214.

The following bills of interest to the physician community have been printed since last week's call and will be discussed on Tuesday.  For each bill, MMA Deputy EVP Andrew MacLean has proposed a staff recommendation for the MMA's position (support, oppose, monitor) and any specialty society or MMA committee that may be particularly interested in the bill.  Clicking on the "L.D. XX" will take you to the summary page on the legislature's web site showing you the procedural status of the bill.  To find the bill text for review, click on the "Bill Text and Other Docs" tab on the left side of the page.

L.D. 216, Resolve, to Prohibit Smokers from Receiving MaineCare Benefits (monitor; Public Health Committee)

L.D. 218, An Act to Improve the Safety of Minors by Collecting Data on Vehicle Collision Rates (monitor; pediatricians; Public Health Committee)

L.D. 225, An Act to Authorize a General Fund Bond Issue in the Amount of $50,000,000 to Fund Research & Development (monitor)

L.D. 226, An Act to Authorize Maine Citizens to Buy Health Insurance Across State Lines (monitor; determine position of Insurance Superintendent)

L.D. 230, An Act to Allow Independent Practice Dental Hygienists to Work Within their Scope of Practice (monitor; radiologists; Public Health Committee; check with MDA)

L.D. 255, An Act To Provide an Income Tax Deduction for Amounts Received as Loan Forgiveness under the Maine Dental Education Loan Program (monitor; Public Health Committee)

L.D. 258, An Act Relating to Access to Vital Records (monitor; Public Health Committee)

L.D. 266, An Act to Improve Access to Oral Health Care (oppose; Public Health Committee; check with MDA - serious scope issues!)

L.D. 267, An Act To Strengthen the Laws on Methicillin-resistant Staphylococcus Aureus and To Improve Health Care (oppose; infectious disease specialists; Public Health Committee; check with MHA)

L.D. 280, Resolve, Reauthorizing the Balance of the 2005 Maine Biomedical Research Fund and Marine Infrastructure and Technology Fund Bond Issues (monitor)

L.D. 287, An Act To Provide Savings to the State by Contracting Out Certain Services (monitor)

L.D. 300, An Act to Increase the Availability of Lead Testing for Children (support; pediatricians; Public Health Committee)

L.D. 303, An Act to Improve Hospital Transparency (monitor or oppose; check with MHA)

L.D. 324, An Act To Authorize Parents with Power of Attorney To Make Decisions Regarding the Education of Their Adult Children (monitor; psychiatrists)

L.D. 332, Resolve, Regarding Legislative Review of Portions of Chapter 11: Rules Governing the Controlled Substances Prescription Monitoring Program, a Major Substantive Rule of the Department of Health and Human Services (monitor)

L.D. 334, An Act To Promote Further Stability within the Workers' Compensation System by Extending the Number of Terms That May Be Served on the Maine Employers' Mutual Insurance Company Board of Directors (monitor)

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Update on MaineCare's Managed Care Plans

The MaineCare Managed Care Stakeholders Group met this past Friday.  Dora Mills, M.D., M.P.H., the MaineCare Medical Director, is leading this initiative until a permanent replacement is named replacing Tony Marple. 

One important potential change announced at the meeting involves the Department considering a pilot project for York and Cumberland Counties that would involve all MainceCare populations in those two counties.  Other areas would continue to phase in.

The RFP is still scheduled to go out by May 1, although that date could be rolled back depending upon other Department priorities and the wishes of any new MaineCare Director and the new Commissioner.

Information on the initiative is kept up to date on the DHHS website page dedicated to this project:  http://www.maine.gov/dhhs/oms/mgd_care/mgd_care_index.html.

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Enforcement of Home Health Documentation Requirements Delayed

CMS recently has delayed enforcement of new documentation requirements for physicians ordering home health services until April 1st.  CMS is requiring physicians to document that they or an applicable non-physician practitioner has had a face-to-face encounter with the patient and the date of that encounter.  The physician must also document how the patient's clinical condition supports a homebound status and the need for skilled services.  The face-to-face encounter can occur up to 90 days prior or 30 days after the start of home health services.  You can find more information on the requirement on the web at:  http://www.cms.gov/MLNMattersArticles/downloads/SE1038.pdf. [return to top]

2011 Third Party Payer Seminar, February 23rd

The Maine Medical Group Management Association is pleased to present:


Wednesday,  February 23, 2011

8:30 am - 4 pm 

Waterville Elk’s Club

76 Industrial Street

Waterville , Maine  04091

Provider representatives from the major payers will be speaking at this seminar and providing updates as to the status of claims processing.  Representatives from the following insurance companies have been scheduled to attend:

CIGNA                            ANTHEM

AETNA                            MARTIN’S POINT



The cost for either seminar is  only $35.00 for MEMGMA members and their office staff or $65.00  for non-members.

For questions or registration, please contact Karen Wheeler at (207)  873-6173 or kwheeler@mmimvw.com.


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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 academicdetailing@mainemed.com 

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 www.mainemed.com/academic/.  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]

Karl Storz-Endoskope Presents Cadaver Workshop for Laparoscopic Surgeons Feb. 12 at Bates College

Karl Storz-Endoskope will offer a hands-on cadaver workshop for laparoscopic surgeons on Saturday, February 12, 2011 at Bates College in Lewiston.  The workshop is designed to provide and enhance the laparoscopic surgeon's knowledge of reduced port/single port access surgery.  Course attendees will participate in didactic and hands-on sessions to facilitate this working knowledge.  At the conclusion of the course, the participant will have a broad understanding of the following approaches as they relate to:

  • Adoption of reduced port techniques (including single port access surgery);

  • Techniques of accessing the abdomen for reduced port surgery;

  • Reduced port/single port access cholecystectomy; and

  • An understanding of the safety and applications of reduced port surgery.

The course is a single day, hands-on workshop.  For the didactic course, the facility has state of the art audio-visual equipment.  For the hands-on training, there will be 4 cadaver stations each with its own video tower.  There will be two to three participants at each of the four stations.

There is no cost for the course and coffee and lunch will be provided.  The course director is Jamie Loggins, M.D., FACS, Chief of Surgery at Central Maine Medical Center.  The guest instructor is Paul G. Curcillo II, M.D., FACS, Vice Chairman, Dept. of Surgery at Drexel University College of Medicine in Philadelphia.

To register for the course, contact any of the following:

Steve Fulton -  Cell:  207-210-8187

Tony Pollak - Cell:  603-566-2569

Tracy Nieuweboer - 508-248-1287 [return to top]

MaineCare Seeking Volunteers to Help Develop Methodology for Determining Eligibility for HITECH Funds

This article was carried forward from last week and we have been advised that MaineCare may be changing its approach to this issue.  We will pass along more information from the Department as it becomes available. [return to top]

EHR Incentive Registration Opens

Physicians interested in participating in the new Medicare/Medicaid Electronic Health Record (EHR) Incentive Program for 2011 can register now.  In order to register physicians will need:

  1. their National Provider Identifier (NPI); and 

  2. a record of their enrollment in the Medicare database known as the Provider Enrollment, Chain and Ownership System (PECOS).  

Of particular note, physicians participating in the Medicaid EHR program do NOT need to be in PECOS; additionally, Medicare physicians who are not yet in PECOS may still register for the EHR incentive program, but are encouraged to become enrolled in the database as soon as possible.

Physicians can maximize their incentive payments by starting their participation in either 2011 or 2012.  More information on registering for the program can be found at: http://www.cms.gov/EHRIncentivePrograms/20_RegistrationandAttestation.asp#

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POLITICAL PULSE: Legislative Highlights of the Week


Following work over the weekend, the Appropriations Committee has voted out a bipartisan, unanimous recommendation for the FY 2011 supplemental budget (L.D. 100) to balance the budget between now and June 30, 2011.

The following excerpt from the Office of Fiscal & Program Review's summary of the bill, published today, gives you a sense of its major initiatives.

The Supplemental Budget as amended proposes additional savings initiatives totaling $42.0 million, primarily from the appropriation balances, reserve funds and debt service savings to support $160.3 million of spending initiatives, committing all but $0.1 million of the FY 11 available budgeted balance.  Provided below is a brief summary of the major initiatives.

  • Net increase in hospital payments of $247.4 million (all funding sources);

  • Offsets General Fund MaineCare shortfalls from program growth and matching rate assumptions totaling $71.8 million;

  • Conforms to recent federal income tax changes decreasing General Fund revenue by $4.5 million in FY 11;

  • Increases by $2.9 million the fixed dollar reduction to revenue sharing, $1.0 million less than the amount of the budgeted increase in revenue sharing transfers for FY 11 budgeted transfer to the stabilization fund by $0.7 million.

Regarding the Doctors for Maine's Future Program, the summary states the following;

Adds language requiring that the cuts made to the Doctors for Maine's Future Scholarship Fund be restored no later than fiscal year 2012-13.

You can find the complete summary of L.D. 100 on the web at:  http://www.maine.gov/legis/ofpr/appropriations_committee/materials/efy11/

L.D. 100 likely will be considered on the floor of the House and Senate this week.


During a work session last week, the Committee voted unanimously "ought-not-to pass" on L.D. 23, An Act to Authorize the Inclusion of Information Regarding Blood Type on Drivers' Licenses.  The Committee discussion identified the same issues raised by the physicians who participated in our discussion of this bill - that a hospital is going to check the blood type as part of its intake procedures anyway and that if it's self-reported, no one would rely on it.  The Secretary of State's office also talked about the cost of adding a data field to the license - approximately $75,000 is the MMA staff recollection.

Last Tuesday afternoon, the Committee held a public hearing on L.D. 64, An Act to Make a Violation of the Laws Governing Seat Belts a Secondary Offense.  Legislators and individuals advocating libertarian sentiments supported the bill.  A number of individuals and organizations representing medical, public health, and highway safety interests opposed the bill, including the MMA.  We thank members Erik Steele, D.O., Ted Walworth, M.D., and Ken Christian, M.D. for taking time out of their busy schedules to speak out on this issue.

Like so many public safety issues in the current political environment, blocking passage of this bill will not be easy.  If you have an opinion on this issue, the MMA encourages you to contact your own 2 legislators and any member of the Transportation Committee whom you may know or may be in your area, if not your district.  You can find members of the Committee and their contact information on the web at:  http://www.maine.gov/legis/house/jt_com/tra.htm.  A committee vote could come as soon as this Thursday afternoon when a work session is scheduled.


This morning, the Criminal Justice & Public Safety Committee held a public hearing on L.D. 83, An Act To Legalize the Sale, Possession and Use of Fireworks.  Proponents once again sounded themes of individual rights, appropriate use of law enforcement resources, and business development.  The Maine Municipal Association, Maine Medical Association, Maine Osteopathic Association, the Maine Society of Eye Physicians & Surgeons, and the Maine Association of Professional Firefighters all opposed the bill, arguing that the public safety risks far outweigh any benefit from such entertainment.  The MMA provided the Committee with several policy statements and journal articles describing the risks, particularly for children.  Retired Augusta ophthalmologist William E. ("Ed") Atlee, M.D. spoke on behalf of the Maine Society of Eye Physicians & Surgeons.  

The State Fire Marshall's Office was not represented at the hearing, though the Governor's Counsel, Dan Billings, addressed the Committee.  He indicated the Governor approved of greater consumer access to fireworks, but acknowledged some drafting issues with the bill.  He did indicate that the Fire Marshall had some concerns about the bill.  In response to a question from Rep. Anne Haskell (D-Portland), Mr. Billings did say that the Governor's Office would make the Fire Marshall available for the work session.  

Based on our sense of the hearing today, this issue will be a fight, so any physician with an interest in this issue is strongly encouraged to contact your local legislators and members of the Criminal Justice Committee.  You can find the Committee members and their contact information on the web at:  http://www.maine.gov/legis/house/jt_com/crj.htm.

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