February 14, 2011

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Governor LePage Presents Proposed Two-Year Budget

Governor Paul LePage released his proposed two-year budget this past week.  Among the proposed cuts to eliminate an approximate $800 million deficit were about $50 million in MaineCare savings.  But overall, the budget would increase spending on MaineCare by more than $200 million.  The net increase would cover rising costs and a reduction in federal reimbursement.  The $1.3 billion in state funds for MaineCare over the two-year period amounts to about 21% of the state general fund budget.

The MaineCare cuts include eliminating eligibility for non-citizen immigrants ($16 million), more cost sharing by recipients ($20 million), and freezing enrollment of parents earning more than 133% of the federal poverty level ($8.5 million).

Governor LePage stated in his budget address to the Legislature on Thursday that he would have liked to have proposed further cuts in MaineCare but that federal laws did not allow further cuts without risking substantial loss of federal funds.  The proposal also includes an additional $11.3 million in funding for community mental health services.  Of particular interest to MMA, the budget retains MaineCare funding for increased reimbursement to practices participating in the Patient Centered Medical Home pilot.  Without such funding, the recently announced Medicare participation in the project would have been lost.

The budget also includes eliminating some programs within the Fund for a Healthy Maine, resulting in $18 million moving from the Fund to help cover MaineCare expenses.  The programs would lose ten positions.

Most of the savings in the budget come  from changes to the state pension system, asking state retirees to forgo cost of living increases for the next three years, and limiting increases in the future beyond the three years.  The budget also would increase the state retirement age from 62 to 65 for new state employees and for those with fewer than five years of service.

Other items of interest include lowering the top income tax bracket from 8.5% to 7.95%.

The Joint Standing Committee on Appropriations & Financial Affairs will begin hearings soon on the budget.

You will find more information about the biennial budget proposal on the web at:  http://www.maine.gov/budget/budgetinfo/2012biennial.htm.

Physician Signature on Lab Requisitions Rule Revoked

The American Medical Association (AMA) has learned that the Center for Medicare & Medicaid Services (CMS) is withdrawing the controversial requirement for physician signatures on lab requisitions.  The requirement was included in the Final Physician Fee Schedule published in early November and was originally scheduled to go into effect on January 1, 2011.  The AMA worked with colleagues in the lab community to successfully secure a delay on implementation of the policy until April 1st.  In the meantime, the AMA continued to work to get CMS to reverse it's position.  Fortunately, the agency listened and recently let the AMA know that it would not be including this provision in any final rule. [return to top]

Human Resources in a Medical Practice the Topic of March 4 First Friday Webinar

Two of the state's leading attorneys on employment law and health law will be participating in MMA's March 4th First Friday Webinar on the topic of Human Resources in the Medical Practice.

James Erwin, Esq., Chair of the Employment Law Group at Pierce Atwood and John Gleason, Esq., of the Health Law Section of Curtis Thaxter will bring attendees up to date on the latest trends in employment law and on current trouble spots.  MMA attorneys Andrew MacLean and Gordon Smith will also participate.  The program will close with a panel of experienced practice managers providing first hand advice and discussing difficult situations they have encountered.  These issues include the tricky use of social media.  What do you do, for instance, when an employee posts unfavorable comments about your worksite on their personal Facebook account?  It is a new world out there.

Program materials are included in the Winter issue of Maine Medicine which will arrive on your desks this week.  You may also register on the MMA website at www.mainemed.com.  There is a $60 per person cost for the three hour program which runs from 9:00 a.m. to noon at the MMA office or via Webex.

For further information, contact Gail Begin or Maureen Elwell at the MMA office (622-3374) or via e-mail to gbegin@mainemed.com or melwell@mainemed.com. [return to top]

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 15th 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. 346, An Act To Reimburse Pharmacies under the MaineCare Program Based on Wholesale Acquisition Costs (monitor)

L.D. 351, An Act Concerning Motorcycle Safety (support; Public Health Committee)

L.D. 353, An Act Regarding Agencies Contracted by the Department of Health and Human Services To Provide Regulatory Oversight and Billing Services (monitor)

L.D. 364, Resolve, Directing Updated Review and Evaluation of Maine's Mental Health Parity Law (support; Parity Coalition bill; psychiatrists)

L.D. 360, An Act to Repeal the Maine Certificate of Need Act of 2002 (monitor or support)

L.D. 376, Resolve, Directing the DHHS to Complete the Redesign of a Shared Living Program for Adults with Intellectual Disabilities (monitor; psychiatrists, pediatricians)

L.D. 381, An Act to Establish a New Method of Determining the State Budget (monitor)

L.D. 386, An Act to Implement the Recommendations of the Working Group Concerning Domestic Violence and Firearms (support; Public Health Committee)

L.D. 388, An Act to Allow a Personal Representative to Obtain a Copy of a Death Certificate and to Direct the DHHS to Amend its Rules Governing Vital Records Fees (monitor)

L.D. 390, Resolve, to Implement Certain Recommendations of the Governor's Task Force on Expanding Access to Oral Health Care for Maine People (support; Public Health Committee)

L.D. 398, An Act to Require Criminal History Record Information for Licensure of Nurses (monitor)

L.D. 399, An Act to Authorize a General Fund Bond Issue to Fund LifeFlight (monitor or support)

L.D. 405, An Act to Clarify Charitable Status for Property Tax Exemption (monitor)

L.D. 406, Resolve, to Clarify the Scope of Practice of Licensed Alcohol and Drug Counselors Regarding Tobacco Use (monitor; Public Health Committee)

L.D. 409, An act to Authorize a General Fund Bond Issue for Research and Development for Technology Advancement (monitor)

L.D. 410, An Act to Repeal the Provisions in the Insurance Laws Governing Guaranteed Issue and Community Rating (oppose)

L.D. 412, Resolve, Regarding Legislative Review of Portions of Chapter 882: Designation of Bisphenol A as a Priority Chemical and Regulation of Bisphenol A in Children's Products, a Major Substantive Rule of the Department of Environmental Protection (support; Public Health Committee)

L.D. 435, An Act to Improve the Rate of Organ and Tissue Donation by Establishing the Organ Donation Advisory Council (monitor)

L.D. 443, An Act to Require Prompt MaineCare Decisions on Care for Children with Life-threatening Conditions (support; pediatricians)

L.D. 446, An Act to Allow Law Enforcement Officers from Out of State to Carry Concealed Weapons (monitor; Public Health Committee)

L.D. 452, An Act to Provide MaineCare Reimbursement for Pastoral Counselors (monitor; psychiatrists)

L.D. 455, Resolve, Directing the Superintendent of Insurance to Form a Compact with Other State Commissioners of Insurance on the Purchase of Insurance Out of State (monitor or support)

L.D. 456, An Act to Create a Temporary Disability Parking Permit (monitor)

L.D. 466, An Act to Require Hospitals to Adopt Employee Illness and Injury Prevention Programs and to Provide Lift Teams and to Require Reduced Workers' Compensation Insurance Rates for those Hospitals (monitor)

L.D. 472, An Act to Enhance the Security of Hospital Patients, Visitors and Employees (monitor)

L.D. 473, An Act to Enable Maine Residents to Purchase Health Insurance over State Lines (monitor or support)

L.D. 475, An Act Regarding Private Health Insurance Purchased by the State for Recipients of MaineCare (monitor)

L.D. 492, An Act to Ensure that Children's Products are Free of Cadmium (support; pediatricians, Public Health Committee)

L.D. 496, An Act to Amend the Laws Governing Financial Incentives and Geographic Accessibility of Services Covered by Health Insurance Providers (monitor or support)


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MMA Attends AMA 2011 National Advocacy Conference

MMA representatives, including President Jo Linder, M.D., last week attended the AMA's 2011 National Advocacy Conference in Washington D.C.  The conference was again combined with the Presidents' Forum. 

Much of the Advocacy Conference focused on implementation of the Affordable Care Act (ACA) and the Medicare Sustainable Growth Rate formula.  Keynoting the Conference was Donald Berwick, M.D., M.P.P., Administrator for the Centers for Medicare & Medicaid Services.   Dr. Berwick was recently nominated by President Obama to serve as Administrator beyond his interim appointment and a confirmation hearing is expected to be scheduled soon before the Senate Finance Committee.  He began his interim appointment eight months ago.

In his keynote address, Dr. Berwick, who founded and directed the Massachusetts-based Institute for Healthcare Quality until he accepted his present position, stressed the need for physician participation in the health reform discussion and what he considered the positive aspects of the ACA.  Following are some comments from his hour-long presentation. 

  • "My full journey in my professional life really has been about my belief that improvement is possible."

  • "CMS can be a helpful partner in striving for better care, better health and lower costs through improving quality."

  • "We have a tool now - the ACA -which I have come to respect more every day.  It is full of possibilities."

  • "One of the major changes today is the way we treat chronic illness.  We have taken many of the traditional killers and made chronic diseases of them."

  • ""For doctors practicing solo, there is great anxiety that physicians will lose control.  But if we embrace the opportunity together, then doctors across the country will have more control, not less."

  • The key to the future health system will be simplicity, modernization, security and pro-activity."

Berwick noted that his father had practiced as a GP in a small town in central Connecticut and that he would be disoriented if he were to stumble across contemporary medicine.  He noted, for instance, that there are more than 40,000 clinical trials underway in the world today, and that no physician can simply absorb all the knowledge available.  "We now practice as a team and dad never needed to be a team player.  Nor did he have to know about the human genome and the notion of predictive modeling, both of which are critical today."

During the conference Dr. Linder and EVP Gordon Smith had an opportunity to visit with Senator Collins and Representatives Michaud and Pingree.  The need to fix the SGR before the next cut of 27% on January 1, 2012 was emphasized.  There are more than 262,000 Medicare patients and more than 42,000 TriCare patients in the state and the cut would represent a loss of over $100 million in Maine alone.  Senator Snowe was back in Maine because a change in Senate scheduling resulting from Senate Democrats meeting off site in a retreat setting.  An attempt will be made to schedule a meeting with her in Maine. [return to top]

POLITICAL PULSE: Legislative Highlights of the Week


Last Thursday afternoon, the Transportation Committee held its work session on L.D. 64, An Act to Make a Violation of the Laws Governing Seat Belts a Secondary Offense.  After discussion, the Committee voted 8 to 5 that the bill ought not to pass.  Several Committee members cited information presented by MMA members Drs. Erik Steele, Ted Walworth, and Ken Christian - such as the cost of caring for those injured while not wearing their seat belts and how this is a public health issue - as their reason for not supporting the bill.  While this is wonderful news in our quest to uphold such an important public health measure, we need members to call your own legislators to reinforce our message when it comes to the floor for a vote.


In other news of last week, the supplemental budget, L.D. 100, passed easily in the House and Senate on Tuesday.  The Governor signed the emergency measure into law on Tuesday evening.  Also, the Senate confirmed the Governor's nomination of Mary Mayhew as Commissioner of the Department of Health & Human Services.

[return to top]

Concussion Symposium, March 9th

The New Hampshire Medical Society Presents: 


Concussion Symposium II:  State of the Art Review 

Grappone Conference Center 

70 Constitution Ave. Concord, NH 

March 9, 2011

7:30 am - 5 pm 

This conference will be educational,  informative and engaging. Leave with valuable tools you can use in your practice to recognize, evaluate and treat concussions. Don’t miss it! 


For more information or to register, visit http://www.nhms.org/calendar/2011/03-09-2011.pdf or contact Catrina Watson at NHMS. 603.224.1909.


Program topics include: 

  • Developing a School-based Youth Sports Related Concussion Management Program:  The Role of the Concussion Specialist 

  • Academic Issues in the Concussed Student Athlete

  • The NCAA Experience: Concussion Management in the College Level Athlete 

  • Neurocognitive Outcomes Following Sports Concussion

  •  Head Accelerometer Data and Assessment of Concussion Risk: Implications for the Future   

  • Community Based Concussion Treatment Programs and Vestibular Rehabilitation

  • Military Concussions: Epidemiology, Evaluation, Treatment and Future Research 

  • Management of Occupational Concussions 

  •  Chronic Traumatic Encephalopathy: What We Have Learned from Athletes 

  • Medical Legal Issues in Concussion Care: Physician, School System Risk   

SAVE THE DATE:  In related news, the Maine Concussion Management Initiative is planning trainings for 2 dates this spring - April 2nd at a location TBD in Portland and May 7th at the University of Maine at Presque Isle.  The MMA will pass along more information on these when available.

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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.

  [return to top]

Downeast Association of Physician Assistants Seeks Annual Award Nominations

Downeast Association of Physician Assistants

Seeking 2011 Award Nominations

The Downeast Association of Physician Assistants (DEAPA) presents awards each year in recognition of outstanding service to the PA Profession and to DEAPA.  The award categories are:

Robert J. Lapham Award for Outstanding Service - This award is presented each year to a Maine physician assistant in recognition of outstanding service to the PA profession and to the Downeast Association of Physician Assistants.

Rural Physician Assistant of the Year - This award is presented to a Maine physician assistant in recognition of dedicated service to a rural community, both as a health care provider and as a citizen.

Physician of the Year - This award is presented to a Maine physician who has demonstrated outstanding support of physician assistants and the PA Profession by precepting, educating, and legislating, or by exemplifying the PA/Physician team approach to medicine.

Outstanding Health Care Professional - This award is presented to a health care professional who has demonstrated exceptional clinical knowledge and teaching skills, promoting the PA profession, and contributing to the health of Maine.

To make a nomination, click here to download the nomination form. Please complete the form and return no later than March 4, 2011.  You can mail or fax to:  DEAPA, 30 Association Drive, Manchester, Maine 04351; Fax:  207-622-3332. If you prefer to send your nomination by email, please send it toinfo@deapa.com or bfarrell@mainemed.com

[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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Governor Names Joe Bruno Chair of Dirigo Health Board of Trustees

At the regular meeting of the Maine Quality Forum Advisory Council last Friday, DHA Executive Director Karynlee Harrington announced that Governor LePage has asked pharmacist, businessman, and former House Republican leader Joe Bruno to Chair the Dirigo Health Board of Trustees.  Joe is a current member of the Board.  He will replace Governor Baldacci's Chair, Portland lawyer Jon Beal, who will remain a member of the Board.  Joe chaired his first regular meeting of the Board this morning.  The Governor may appoint the Chair of the Board at any time.  You can find the statute establishing the Board of Trustees and the appointing authority on the web at:  http://www.mainelegislature.org/legis/statutes/24-A/title24-Asec6904.html [return to top]

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