February 21, 2011

Subscribe to Maine Medicine eNewsletters
Manage Your Subscriptions
Email our Editor...
Maine Medical Association Home Page
. Search back issues
. Plain Text Version
Printer Friendly

Happy Presidents' Day. MMA Office is Open for Business

Despite the state and federal holiday today (Feb. 21), the MMA office will be open from 7:00am to 5:00pm as it is each working day.  The legislature is not having general sessions this week although some of the committees are meeting.  All members are reminded of the opportunity to participate in the weekly conference calls each Tuesday evening at 8:00pm to review legislative proposals and determine MMA's position (note article below).

The 125th Legislature is now in full swing and over 700 legislative proposals have been printed.  Before the session adjourns in mid-June, over 1700 proposals will be printed and referred to committee and most will be resolved in this session but many will also be held-over to the Second Regular Session which will begin in January, 2012.

Each Tuesday evening, the MMA Legislative Committee, chaired by Lisa Ryan, D.O., a pediatrician practicing in Bridgton, conducts a conference call to discuss new bills printed and to review the legislative action of interest to physicians during the past week.  The list of new bills is published each Monday in the Weekly Update.  It is particularly important that representatives of major specialties participate in the calls so that MMA leadership and staff are aware of any particular interest of the specialties.

The calls have been well attended this year but all members are welcome.  The toll-free conference call number is found in the article below listing the new bills being discussed tomorrow (Feb. 22).


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 22nd 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.

Priority bills for discussion:

L.D. 505, An Act to Align State Standards Pertaining to Food and Beverages Outside of the School Lunch Program to Federal Standards (monitor; check MPHA position, pediatricians, Public Health Committee)

L.D. 508, An Act to Adjust Certain Age Limits in the Laws Concerning Sex Offenses to Further Protect Minors (monitor; pediatricians)

L.D. 517, An Act Regarding Prescription Drug Step Therapy and Prior Authorization (monitor)

L.D. 523, An Act to Modify the Regulation of Fireworks (oppose; ophthalmologists, Public Health Committee)

L.D. 531, An Act to Specify Qualifications for the Director of the Office of Adult Mental Health Services within DHHS (support; MAPP bill, psychiatrists)

L.D. 536, An Act to Help Deter Youth Smoking and to Help Smokers Quit (support; Public Health Committee)

L.D. 540, An Act to Implement the Insurance Payment Reform Recommendations of the Advisory Council on Health Systems Development (support)

L.D. 544, An Act to Eliminate Duplication of Paint Disclosure and Radon Requirements (monitor; Public Health Committee)

L.D. 572, An Act to Amend the Laws Governing the Maine Health Data Organization Relating to Retail Pharmacies (oppose)

L.D. 577, An Act to Limit Taxes on Hospitals (monitor)

L.D. 581, An Act to Repeal the Laws Governing the Capital Investment Fund (support)

L.D. 582, An Act to Amend the Maine Certificate of Need Act of 2002 (support)

L.D. 596, An Act to Allow Medical Records to Contain an Option Regarding HIV Status Disclosure (monitor)

L.D. 605, An Act to Require Random Drug Testing for MaineCare Recipients (monitor)

L.D. 612, An Act to Provide Reimbursement for Medication Therapy Management Services (monitor)

L.D. 639, An Act to Protect Medical Care Providers and Hospital Staff (Maine Chapter, ACEP bill; support; emergency physicians)

L.D. 645, Resolve, to Replace Maine's Health Insurance System with the Type of System Used in New Hampshire (oppose)

L.D. 646, An Act to Ensure the Safety of Children in the MaineCare Program Who are Prescribed Antipsychotic Medications (oppose; pediatricians, psychiatrists)

L.D. 658, An Act to Modify the Requirements of a Permit to Carry a Concealed Weapon (oppose; Public Health Committee)

L.D. 670, An Act to Prohibit Certain Uses of Cellular Telephones and Handheld Electronic Devices While Operating a Motor Vehicle (monitor; Public Health Committee)


Consent bills for discussion only if raised by call participant:

L.D. 499, An Act to Protect Persons in Residential Care Who are Under Limited Guardianship (monitor)

L.D. 512, An Act Regarding the Disposition of Mercury-added Lamps (support; Public Health Committee)

L.D. 515, An Act to Review State Water Quality Standards (monitor; Public Health Committee)

L.D. 537, An Act to Expand Recertification Options for Certified Nursing Assistants (monitor)

L.D. 547, Resolve, Directing the Maine Center for Disease Control and Prevention to Conduct a Review of Public Health Nuisance Laws (monitor; Public Health Committee)

L.D. 553, An Act to Reduce Maine's Dependence on Oil (monitor; Public Health Committee)

L.D. 555, An Act to Utilize a Dental Complaint Review Panel (monitor)

L.D. 567, An Act to Prevent Insurer Limits on Certain Dental Fees (monitor)

L.D. 578, An Act to Allow Municipalities to Restrict the Possession of Firearms in Certain Circumstances (monitor; Public Health Committee)

L.D. 587, An Act to Reduce the Cost of Delivering Certain State Services (monitor)

L.D. 589, An Act to Increase the Legal Age to Purchase, Use or Sell Tobacco Products (monitor; Public Health Committee)

L.D. 636, An Act to Ensure Proper Health Information Management (monitor)

L.D. 654, An Act to Amend the Occupational Disease Reporting Laws (monitor)

L.D. 660, An Act to Clarify the Responsibilities of Pharmacy Benefits Managers and Preferred Provider Organizations (monitor)

L.D. 674, An Act to Authorize the DHHS to Administratively Suspend or Revoke Facility Licenses (monitor)

[return to top]

President Presents 2012 Proposed Federal Budget; Proposes Spending $54 Billion to Freeze SCR Payments for Two Additional Years

President Obama released his 2012 budget this past week, notwithstanding that the 2011 Budget was never approved by the Congress resulting in the need for another continuing resolution to be passed by March 1st or the federal government will shut down!

In the proposed 2012 Budget, the President proposes to spend $54 billion to temporarily freeze physician payments at current levels for two years following the current freeze which expires on Jan. 1, 2012.  The two-year fix is paid for by reducing payments to hospitals, physicians and other providers as well as increasing the use of generic medications.

The specific proposed offsets include:

  • Reducing the Medicaid provider tax threshold beginning in 2015 (savings of $18.7 billion)
  • Recovery of inappropriate payments to Medicare Advantage Plans (savings of $6.2 billion over 10 years)
  • Strengthening Medicaid third-party liability (savings of $1.6 billion)
  • Tracking high prescribers and high prescription drug users in the Medicaid program to reduce waste, fraud and abuse (savings of $3.5 billion)
  • Creating a system to validate high risk services ordered by physicians and others (savings of $1.8 billion over 10 years)

The President also proposed allocating $100 million in 2012 for medical liability reform initiatives provided for in the Affordable Care Act.  This would be followed by $50 million more each year through FY 2015.

In the area of medical research and public health, the President proposed increasing NIH funding by $1 billion, but proposed cutting CDC funding by 9% and cutting AHRQ by 8%. [return to top]

POLITICAL PULSE: Legislative Highlights of the Week


This was a busy week for the Health and Human Services Committee, as they held hearings and work sessions on a number of issues.  

Among the bills the Committee took up was L.D. 29, which would have capped the annual salary and compensation package of hospital administrators to the level of the Governor's salary.  While some Committee members and individuals who testified stated that health care spending, hospital transparency and administrator compensation are serious issues, all agreed that this was not the proper mechanism to use to address these concerns.  The Committee voted unanimously that the bill ought not to pass.  

The Committee voted unanimously that two bills ought to pass.  One, L.D. 121, would extend to the federally recognized Indian nation, tribe and bands in Maine the laws regarding public health infrastructure. Among other changes, this would create a ninth pubic health district in the State.  Organizations including the Maine Public Health Association and the Maine Primary Care Association testified in favor of the measure, emphasizing the health disparities that face the tribes and the hope that this bill will lead to better data collection and targeted interventions.   The Committee also unanimously passed L.D. 70, which would extend MaineCare coverage to independent practice dental hygienists.  


Following public hearings, the Insurance and Financial Services Committee held work sessions last week to consider L.D. 57, Resolve, to Update the Study Regarding the Feasibility of Establishing a Single Payer Health Care System and L.D. 60, An Act to Extend Coverage under the State's Mini-COBRA Law.  The Committee voted that both bills ought not to pass by a vote of 7-6.  They now proceed to the House floor.  

L.D. 57 would require the Legislature to hire a consultant to update a single payer feasibility study that was orginally completed in 2002.    While similar bills passed both the 124th and 125th legislatures, necessary outside funding was not secured to fund the work.  The Committee minority will recommend to the House that they pass the bill and fund the study out of a $1 million grant the State received to implement a health insurance exchange. 

L.D. 60, as introduced, would have extended COBRA eligibility under both the state's "mini-COBRA" law (that covers employers with fewer than 20 employees) and the federal COBRA law for up to 36 months.  Insurance companies testified against the measure, citing the potential to increase insurance premiums due to adverse selection of those who elect COBRA coverage.  The minority will recommend passage of an amended version of the bill which only extends coverage up to 18 months under the state COBRA law. 

[return to top]

Family Physicians Needed for Malpractice Screening Panels

MMA has recently been contacted by chairs of Medical Malpractice Screening Panels seeking family physicians for panel proceedings occurring in the next few weeks.  At least one of the volunteers needs to have a background in obstetrics.  If you are able to commit a day to volunteer for one of the panels, please contact Gordon Smith at gsmith@mainemed.com or give him a call at 622-3374 ext. 212.

Maine law has mandated the use of screening panels since l987 and the system has been successful because of the willingness of physicians and attorneys to volunteer their time to participate.  Each panel normally consists of a physician in the relevant specialty, an attorney and a chair who must have judicial experience.  The panel proceedings are normally accomplished in one day.  If a panel decision is unanimous, the decision is admissible in court should the case proceed in that direction.


  [return to top]

Paul H. Sighnolfi, Esq. Nominated as Executive Director of Workers' Compensation Board

Bangor Attorney Paul H.Sighnolfi has been nominated by Governor LePage as the next Executive Director of the Maine Workers' Compensation Board.  His confirmation hearing was held before the Joint Standing Committee on Labor, Commerce, Research and Economic Development on last Wednesday (Feb. 16) and the Maine Medical Association testified in favor of the nomination.  The position of Executive Director is of great significance as statutory changes two years ago reduced board membership to three labor members, three management members and the Executive Director who is the chair.  Historically, the Board has been rendered powerless by the inability of the two sides to agree on major policy items.  Now the Chair can break any such deadlock.

Attorney Sighnolfi will replace Paul Dionne who has lead the Board for the last several years.  Sighnolfi is a graduate of St. Anselm's College, Trinity College and Columbus School of Law at Catholic University of America.  He is currently a senior partner at Rudman & Winchell in Bangor but will be leaving the practice to accept the new position.

Sighnolfi has represented both employers and employees in workers' compensation cases for over 30 years.  He also has served on the Board of Overseers of the Maine Bar where he served terms as both Vice Chair and Chair.

The appointments to the Board are of particular significance to physicians currently because of the controversy regarding the updating of the medical fee schedule.  Business/Insurance/Employer interests for years have been seeking a significant reduction in the fees paid to medical providers under current law, claiming that the differential between these fees and fees paid by Medicare and commercial health insurance carriers is not warranted.  MMA, the Maine Hospital Association and other medical groups (particularly some orthopedic practices) have successfully defended against these proposed reductions.  But with the new climate in Augusta more favorable to business interests, it will take effective advocacy and the full participation of the medical community to withstand the continuing attack.

Attorney Sighnolfi addressed the need for changes to the fee schedule in his remarks before the Committee.  He also noted the need to work with MMA in finding more physicians willing to be independent examiners under the provisions of section 312 of the workers' compensation statute.

Sighnolfi is well known to MMA as his wife, Vickie Sidou, M.D. is an anesthesiologist and they are frequent attendees at MMA events.  They also have a son in the Tufts-MMC Medical School.  MMA wishes Paul well in his new position.  We look forward to working with him, as was noted in the testimony delivered by Gordon Smith on behalf of MMA at the confirmation hearing.   The vote of the Committee was unanimous in favor of the nominee.  A Senate vote is expected soon. [return to top]

Report on 2011 MHA Small or Rural Hospital Conference, Feb. 16-18

Nearly two hundred hospital administrators and other interested firms and individuals (including MMA respresentatives) attended last week's Maine Hospital Association Small or Rural Hospital Conference at the Jordan Grand Hotel & Conference Center at Sunday River.  This popular conference annually attracts representatives from nearly all of Maine's hospitals, regardless of size or rurality.  This year, there were representatives from 36 of the 39 hospitals in the state.

The keynote presentation was from consultant Jamie Orlikoff. entitled, Healthcare Reform:  Implications for Rural Hospitals & Strategies for Success. In a two-hour presentation, Mr. Orlikoff discussed the current status of healthcare reform in Washington and in the states.  He made the following points:

  • Among the areas of consensus (there are some!) are the need to reward value rather than volume, to focus on reducing hospital readmissions, the need for transparency in cost and quality, the need for evidence-based care and the need to deal with waste, fraud and abuse.
  • Bundled payments and Accountable Care Organizations will gradually replace fee for service, although there will always be some fee-for service depending upon the service.
  • The Affordable Care Act (ACA) is mostly about insurance reform, not reform of the delivery system.
  • For providers, the clearest aspects of the bill spell out payment reduction schedules.

Orlikoff noted that the impact of the law on rural hospitals, particularly critical access hospitals will remain cloudy until final rules are adopted, and there are lots of them.  He also advised attendees to focus on costs of Medicare patients and gave his opinion that Medicare payments will never be any more generous than they are now.

Following the keynote presentation, Patti Goldman, Senior Associate Director of Federal Relations for the American Hospital Association (AHA) presented a post-election analysis on health reform.  She noted that legislative gridlock was likely, given the results of the election and the need to get 60 votes in the Senate to accomplish anything significant. She also noted the new emphasis on deficit reduction and the implications of this climate for medical providers and healthcare interests.  Potential hospital risks in the current environment include reductions for medical education, potential elimination of Medicaid provider taxes and increasing Medicare bad debt.

Other presentations during the two day conference included Dev Culver talking about "meaningful use"' and a panel of Maine hospital representatives sharing best practices around the state.  Ken E. Mack, FACHE, President, Mack Voyten and Associates spoke on the topic of "Hospital-Physician Alignment and Integration:  Critical to Success in an Era of Health Reform."  His presentation focused on bundled pricing, clinical co-management, physician employment and physician relationship management.

More next week on the concept of Physician Relationship Management (PRM).  Certainly an interesting concept.



  [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]

MEMGMA March 23 Educational Program Presented by Medical Mutual



Location: Maine Medical Association, Manchester, ME


More info to follow!

March 23, 2011


Improving System Performance in the Office Practice


9:00-10:00   Test Tracking and Appointment Management Systems


        9:00-9:30     Risk Management:  Order from Chaos

        9:30-10:00     Claims Review


10:00-11:00   Liability and the EMR


        10:00  - 10:30  Risk Management:  Where is the risk?

        10:30 - 11:00   Claims Review


11:00-11:45  Hot Topics in Risk Management      



11:45-12:00  Q&A





MEMGMA Membership Chair

Marcia Turcotte, Practice Manager

Mid Coast Medical Group - Surgical Care



  [return to top]

MMA Has 2000 Toyota Camry for Sale: 308,000 Miles: Need $3000 or BO

The Maine Medical Association office vehicle, a 2000 Toyota Camry with 308,000 miles on it is being retired.  It is in good shape and would be ideal for a new teenage driver getting back and forth to school etc.  The Kelly Blue Book shows the value at between $2600 and $3900.  It is an automatic transmission with the usual amenities such as air conditioning and power windows.  It is inspected through Sept. 2011.

The primary driver of the vehicle, Mr. Smith, indicates that the vehicle has had regular servicing and tune-ups, but no major repairs.  Really no minor repairs either.  "It is been a tremendous workhorse and I regret the need to upgrade. May have at least another 100,000 miles in it.  It has provided reliable transportation for me from Kittery to Fort Kent and back for nearly eleven years and has never left me stranded."

Should any reader be interested in purchasing the vehicle, contact Gordon Smith at the office at 622-3374 ext. 212 or via e-mail to gsmith@mainemed.com or Heidi Lukas, CPA at hlukas@mainemed.com. [return to top]

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