April 4, 2011

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Sheila Pinette, D.O. Appointed to Lead Maine Center for Disease Control and Prevention

DHHS Commissioner Mary Mayhew on Thursday named Cape Elizabeth physician Sheila Pinette, D.O. as Director of the Maine Center for Disease Control & Prevention.  Interim Director Stephen Sears, M.D., M.P.H. is expected to return to his previous position as the State Epidemiologist.  An internist who most recently has operated an independent internal medicine practice in Cape Elizabeth, Dr. Pinette graduated from the University of New England College of Osteopathic Medicine in 2000 and completed a residency in internal medicine in 2003.  Prior to medical school, she worked as a physician assistant in Connecticut.  She will begin her work in Augusta on May 1st.

The Maine CDC is a division of the Department of Health & Human Services and employs nearly 400 individuals and is responsible for virtually all aspects of public health in the state, including prevention of infectious disease, food inspections, vaccine administration, and emergency medical response.  The Center was responsible for establishing a new public health infrastructure in the state which consists of eight public health districts and is in the process of securing national accreditation for the system.  Dr. Pinette follows Dora Anne Mills, M.D., M.P.H. who served 14 years as the Director prior to resigning late last year.

In announcing the appointment, Commissioner Mayhew cited Dr. Pinette's "well-rounded professional experience, commitment to public health, and her knowledge of the health care system." 

Dr. Pinette moved to Maine in 1989 with her husband, Michael Pinette, M.D., a native of Aroostook County and Director of the maternal-fetal medical program at the Maine Medical Center.  He is one of the best known ob-gyn physicians in the state.

In an interview with the Bangor Daily News following the announcement, Dr. Pinette (Sheila) described herself as conservative and pro-life, but noted that she did not consider herself a political person and that she did not intend to become embroiled in the current anti-abortion bills pending before the state legislature.  She stated that she did not believe her personal faith (she serves as a Eucharistic minister at the Saint Bartholomew Catholic Church in Cape Elizabeth) would affect her professional work at the Center.

MMA congratulates Dr. Pinette on her appointment and will invite her to share her vision for the Center at the May 18, 2011 20th Annual Physician Practice Education Seminar at the Augusta Civic Center.

AMA Releases CPT App; Issues "App Challenge" Contest

On March 29, 2011, the AMA announced its first physician "app," one that would allow physicians to quickly find a appropriate CPT codes.  You can read the AMA's press release on the app and the related "App Challenge" on the web at:  http://www.ama-assn.org/ama/pub/news/news/app-challenge-physician-app.page?.

You can find more information about the "App Challenge" on the web at:  http://amaidealab.org/.

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Much Anticipated Proposed Federal Rules on Accountable Care Organizations (ACO's) Issued

On this past Thursday, March 31st, the Centers for Medicare & Medicaid Services (CMS) proposed new rules under the Affordable Care Act aimed at allowing physicians, hospitals and other health care providers to better coordinate care for Medicare patients through ACO's.  ACO's, which were first promoted as part of the Affordable Care Act, create incentives for health care providers to work together to treat an individual patient across care settings - including doctor's offices, hospitals, and long-term care facilities.  The Medicare Shared Savings Program will reward ACO's) that lower growth in health care costs while meeting performance standards on quality of care.  Patient and provider participation in an ACO is purely voluntary.  Participation is expected to begin on Jan. 1, 2012 but the proposed rules are subject to a 60 day comment period.

Virtually every medical organization in the country, including the AMA and national specialty societies are currently reviewing the proposal which is 540 pages long.  But some of the highlights are obvious, such as:

  • ACO's can receive a portion of shared savings, but also would have to pay back Medicare for failing to achieve such savings.

  • Hospitals, physicians and networks are eligible for participation, as well as other Medicare providers and suppliers as determined by the Secretary.

  • Certain critical access hospitals are eligible to participate in the Shared Savings Program.

  • If accepted, an ACO would service at least 5,000 Medicare patients and agree to participate in the program for three years.

  • Medicare providers who join an ACO that participates in the Program would continue to receive payment under the existing Medicare fee for service rules.

  • The proposed rule outlines a monitoring and reporting plan that includes analyzing claims and specific financial and quality data, producing quarterly and annual aggregated reports, performing site visits and conducting beneficiary surveys.

CMS has proposed to measure quality of care using nationally recognized measures in five key areas:  patient experience, care coordination, patient safety, preventive health, and at risk/frail elderly health.  There are 65 different measures across the five domains.

The proposed rule is expected to be published in the Federal Register on April 7, 2011.  It can be found under Special Filings at http://www.ofr.gov/inspection.aspx?AspxAutoDetectCookieSupport=1.  Comments on the proposal will be accepted until June 6, 2011.

You can read the AMA's press release on the ACO rule release on the web at:  http://www.ama-assn.org/ama/pub/news/news/proposed-medicare-aco-rule.page?.

ACO's are likely to become the most visible component of what is loosely defined today as payment reform.  It is important for physicians to understand the opportunities and risks presented.  MMA will present an educational forum on ACO's as part of the 20th Annual Practice Education Seminar at the Augusta Civic Center on Wednesday, May 18th.  Watch for the materials on that program in the next issue of Maine Medicine or check on the MMA website at www.mainemed.com.  Final registration materials and an agenda are expected by April 15.  For more information, contact Gail Begin at MMA at 622-3374 ext. 210 or via e-mail to gbegin@mainemed.com. [return to top]

Annual Coding Seminar Postponed until Friday, April 8

Because of the April 1st snowstorm, the "First Fridays" Annual Coding Seminar was postponed and has been rescheduled for this coming Friday, April 8th from 1:00 p.m. to 4:00 p.m.  The faculty has been altered because of a conflict that Laurie Desjardins, CPC, PCS has, but Jana Purrell, CPC-I, CEMC will anchor the program with assistance from coding staff at Baker, Newman & Noyes.  Gordon Smith, Esq. will moderate the program.

The location has been changed to the Maine Dental Association conference room, right next door to MMA.  Lunch will be available for those attending, beginning at 12:30 p.m.  For those registered who can not attend in person or via Webex on Friday, MMA will send a link to the recorded program and all the materials.

For further information, or to register at this point, call or communicate with Maureen Elwell or Gail Begin at MMA. at 622-3374 or via e-mail to melwell@mainemed.com or gbegin@mainemed.com.


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AMA Continues to Press Administration on e-Rx Penalty

In November, CMS announced in the Final Physician Fee Schedule that in order to avoid a penalty in 2012, physicians must participate in the e-prescribing program during the first six months of 2011.  The AMA has been stressing to the Administration that the vast majority of physicians are unaware of this requirement.  In addition, there are inconsistencies between the e-prescribing and the electronic health records incentive programs.  AMA President Cecil Wilson, M.D. recently discussed the matter with Dr. Donald Berwick, CMS Administrator, and Dr. David Blumenthal, Director of the Office of the National Coordinator.  Dr. Wilson urged Drs. Berwick and Blumenthal to follow the President's January 18th Executive Order to reduce regulatory burden and significantly ease the e-prescribing penalty policy. [return to top]

Let MMA Train Your New Staff on HIPAA, Friday, May 6th

MMA will present its annual HIPAA staff training on Friday, May 6th at the MMA office or via WebEx.  The program will be from 9:00 a.m. to noon and the cost per person is just $65 which includes substantial materials for all attendees and breakfast for those persons attending the live presentation in the office in Manchester.

This program would be most valuable for staff you may have hired in the past year but have not provided with any HIPAA training. The Faculty will consist of Kenneth Lehman, Esq., Stacey Mondschein, Esq. and Gordon Smith, MMA EVP.

The Annual HIPAA staff training is one of MMA's most popular programs so don't delay in registering.  Registration is available now on the Association's website at www.mainemed.com.

For questions, contact Gail Begin or Maureen Elwell at MMA at 622-3374 or via e-mail to gbegin@mainemed.com or melwell@mainemed.com , respectively. [return to top]

AMA Offers Comments on Proposed Medicaid HAC Program

On February 17, 2011, CMS issued a proposed regulation implementing section 2702 of the ACA.  This provision directs the Secretary of DHHS to issue Medicaid regulations effective as of July 1, 2011 prohibiting federal payments to states under section 1903 of the Social Security Act for any amounts expended for providing medical assistance for health care-acquired conditions.  It also proposes to authorize states to identify other provider-preventable conditions for which Medicaid payment would be prohibited.  In a formal letter to the agency, the AMA communicated its strong concerns about the existing inpatient hospital-acquired conditions (HAC) policy, outlining its concerns about simply extending this policy, as is, as a floor for the Medicaid program.  The letter also expressed concerns about states extending the existing HAC policy beyond the conditions currently included in the Medicare HAC policy or conducting any in-depth study of the impact of the policy on patient access and total cost to the health care system.  The AMA also expressed serious concerns about CMS' proposal that states extend the HAC policy to other provider settings. [return to top]

Maine Radiological Society to Meet at MMA on April 11th

Members of the Maine Radiological Society are invited to attend the Maine Radiological Society (MRS) Annual Meeting on April 11th, 2011 from 6:00 p.m. – 8:00 p.m. at the Maine Medical Association.  In an effort to bring forward radiology’s most pressing issues and to coordinate our activities for the year ahead, this meeting is of utmost importance and we invite you to be an active part of it.   

Our business section of the meeting will focus on the election of officers, namely President, Vice President, Secretary/Treasurer, and Councilors to the ACR.  According to the By-laws, elections shall be by ballot at the annual meeting of the chapter, and the nominee for each office designated, who received a majority of votes cast shall be declared elected.  Each shall serve a term of one year, or until their successors are elected and qualified.  All Chapter officers shall be members of the American College of Radiology.  

We look forward to your involvement, input and ideas, as we re-energize our state chapter, to ensure that Radiologists in Maine have the foundation on which to be represented. 

We want to hear from you regarding your intention to attend this important meeting.  Please RSVP prior to April 8th by emailing or calling the MRS staff, Maureen Elwell; melwell@mainemed.com or 207-622-3374, ext. 219.  

Members can also participate via conference call by calling:  1-877-669-3239, followed by the access code:  23030608.

These are exciting times for the medical profession, the radiology profession, and the health care arena in general.  We look forward to seeing you on April 11th.  
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LAST CALL: Topics in Gastroenterology - Updates for 2011, April 9th

Harraseekett Inn  April  9th, 2011

“Topics in Gastroenterology- Update for 2011”

Please contact Gail Begin for registration materials at gbegin@mainemed.com or 207-622-3374, ext. 210

Course co-directors:  Jay Bosco MD,  Gilbert Wilcox MD


7:30-8:00 Registration

8:00-8:15 Opening remarks Dr. Bosco

Session I- Esophagus- Moderator Dr. Erkinnen

8:15-8:45 Esophageal reflux- diagnosis, and management –Dr. John Erkinnen

8:45-9:15 Esophageal testing what’s new? –Dr. Chris Kleeman

9:15-9:45 Esophageal reflux complications and treatments – Dr. Bosco

9:45-10:00 Questions and Answers, panel discussion

10:00-10:15 Break, visit exhibits.

Session II-Pancreatic Cancer symposium-  Moderator Dr. Stefan

10:15-10:45 Coordinated statewide strategies for management in Maine,–Dr Rutstein

10:45-11:15- Chemotherapy in the era of neo-adjuvant treatment.- Dr. Hertler

11:15-11:45- Radiation therapy – what and when. Dr. McGinn

11:45-12:00 Questions and Answers, panel discussion

12:00-12:45 Lunch (provided)

State of the Art Lecture- “MGS distinguished Lectureship  Award”

12:45-1:30- Natural orifice transluminal endoscopic surgery ((NOTESTM).- Dr. Rothstein

AGA interactive learning symposium- Moderator Dr. Wilcox

1:30-3:30 – Agenda to be determined, per Dr. Wilcox/AGA.

3:30- Adjourn Drs. Bosco and Wilcox

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AMA Submits Comments on New Co-op Program

On March 4, 2011, the AMA submitted a comprehensive response to the DHHS request for comments concerning the CO-OP program that was created by section 1322 of the ACA.  Under section 1322, the ACA makes $6 billion available in federal grants and loans for the formation and operation of nonprofit health insurance companies.  A health insurer, or a "related entity" of a health insurer that existed prior to July 16, 2009, is not eligible for assistance under section 1322.  Section 1322 presents an opportunity for physicians and other health care providers to take an essential role in the development and operation of health insurance with the advantage of federal financial assistance.  In its comments, the AMA noted that private health insurance markets are not competitive and accordingly argued that it is imperative for HHS to interpret section 1322 in a flexible manner that will maximize physicians' ability to play a leading role in the formation of section 1322 nonprofit health insurers, thereby increasing the likelihood of successful new entrants into the health insurance marketplace. [return to top]

SAVE THE DATE: 33rd American Cancer Society Living with Cancer Conference Scheduled for May 4th

The American Cancer Society invites you to the 33rd Living With Cancer Conference scheduled for Wednesday, May 4, 2011 at the Augusta Civic Center.  Volunteers and staff from the American Cancer Society created the first Living With Cancer Conference in 1979.  Since then, cancer patients, family members, caregivers, and health care professionals come together to attend this annual event.

This year, please join us for Facing Cancer Together, a day of personal stories and medical information designed to help cancer patients and their families as they continue along their cancer journeys.

Thomas Keating, M.D., M.S., the Medical Director of Palliative Care and Hospice at MaineGeneral Health and a medical oncologist at the Harold Alfond Center for Cancer Care and a long-time ACS volunteer, is a keynote speaker for the event.

You can find more information about Living With Cancer Conferences in New England, including more details about the Maine event, on the web at:  http://www.cancer.org/InYourArea/NewEngland/LocalStories/ne-living-with-cancer-conferences.

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POLITICAL PULSE: Legislative Highlights of the Week


The HHS Committee plans to spend the coming week in continued work sessions on the health and social service portions of the budget.  The HHS Committee is tentatively scheduled to make its report back to the Appropriations Committee this Friday, April 8th.  The biennial budget now has been printed as L.D. 1043:  http://www.mainelegislature.org/LawMakerWeb/summary.asp?ID=280040546.  You also can find the Appropriations Committee materials on the biennial budget on the web at:  http://www.maine.gov/legis/ofpr/appropriations_committee/materials/index.htm.


On Wednesday, March 30th, the Insurance & Financial Services Committee held public hearings on L.D. 867, An Act to Amend the Laws Governing Insurance as They Relate to Civil Penalties Imposed for Violations of Those Laws and L.D. 892, An Act to Establish an Insurance Fraud Division within the Department of Professional & Financial Regulation, Bureau of Insurance.  L.D. 867 would establish limits on the Superintendent's authority to institute civil penalties on health insurance companies for violations of the insurance laws.  The insurance industry supported the bill while consumer advocates opposed it.  The legislature has, from time-to-time, considered establishing a Fraud Division within the Bureau of Insurance, but has never recommended moving forward with the concept.  The Bureau conducted a study on the concept during the last legislature, but it did not result in legislative action.


On Thursday afternoon, the Criminal Justice & Public Safety Committee held a work session on L.D. 639, An Act to Protect Medical Care Providers and Hospital Staff.  Current law provides for an enhanced classification for the crime of assault (Class C, a felony) when the victim is an emergency medical care provider.  The purpose of the bill is to ensure that the law covers all those working in the hospital emergency department, whether clinical or not, and those providing emergency services on the hospital grounds.  After a lengthy discussion about the extent of the problem in Maine and the deterrent effect of enhanced penalties for crimes, the Committee decided to issue a resolution on the topic of violence in hospitals and to send a letter asking the district attorneys association to convene a work group of stakeholders including the Maine Chapter of the American College of Emergency Physicians, the Maine Hospital Association, MMA, and nursing organizations.


On Tuesday, March 22nd, the Judiciary Committee heard two bills that would change current law giving the treating health care practitioner the discretion to treat a minor patient confidentially without parental consent if he or she believes it is in the best interest of the child:  L.D. 31, An Act to Protect the Safety of Maine Children by Requiring the Express Consent of a Legal Guardian to Dispense Prescription Medication to a Minor and L.D. 746, An Act Regarding the Consent of Minors for Mental Health and Substance Abuse Aid.  The bills have not yet been scheduled for work session.

The MMA expects these bills to be closely divided coming from the Judiciary Committee and will be vigorously debated on the floor.  We encourage you to contact your own two legislators to urge them to oppose the bills now.  You can find your legislators through the following tool on the legislature's web site:  http://www.maine.gov/legis/house/townlist.htm.  Also, if you are a constituent of a Judiciary Committee member or have a relationship with a member, we ask you to contact him or her.  You can find the members of the Judiciary Committee and their contact information on the web at:  http://www.maine.gov/legis/house/jt_com/jud.htm.

Here's the link to L.D. 31:  http://www.mainelegislature.org/LawMakerWeb/summary.asp?ID=280038923.

Here's the link to L.D. 746:  http://www.mainelegislature.org/LawMakerWeb/summary.asp?ID=280039990.

Remember, you can leave a message for a legislator during the week at the State House as follows:

Senators:  1-800-423-6900

Representatives:  1-800-423-2900


Last Thursday, the Education Committee held a work session on L.D. 98, Resolve, Directing the Commissioner of Education to Adopt a Policy Regarding Management of Head Injuries in Youth Sports.  As reported last week, there was no opposition to the bill, but numerous proponents questioned whether the legislation is necessary given what's happening in the field and expressed concern about the narrow scope of those authorized to certify a student athlete's return to play following a head injury.  The Committee recommended passage of the bill and the MMA believes that the Committee asked its staff to amend the provision on those authorized to certify return to play.


Last Tuesday, the Environment & Natural Resources Committee held a public hearing on two bills to modify the Toxic Chemicals in Children's Products law, the underlying statute for the BPA rule approved by this same committee in L.D. 412 the week before.  The two bills are L.D. 1129, An Act to Provide the Department of Environmental Protection with Regulatory Flexibility Regarding the Listing of Priority Chemicals and L.D. 1185, An Act to Amend the Process for Prioritizing Toxic Chemicals in Children's Products.  As you have heard regularly in the press, the business community, led by the Maine State Chamber of Commerce, has made this law a focus of its "regulatory reform" effort with the new Governor and legislative majority.  The MMA joined most of Maine's environmental and public health community in opposing L.D. 1129 and supporting L.D. 1185.


Those of us involved in health policy in Maine recognize that the state faces a shortage in many of the health professions, but most of those speaking at a hearing on L.D. 947, An Act to Encourage Professionals to Move to the State seemed to feel that this bill probably goes too far.  It would allow a professional who possesses a license in any other jurisdiction, not just any other U.S. state, to practice in Maine with no further review.  It would essentially provide complete reciprocity with consumers left to pursue any complaint against the professional in the jurisdiction of licensure.  The MMA joined representatives of many other professions in opposing the bill.  Even the reform-minded LePage Administration opposed this bill.  This bill is before the Labor, Commerce, Research & Economic Development Committee.

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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, April 5th 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. 1314, An Act to Standardize the Definition of "Independent Contractor" (monitor)

L.D. 1331, An Act to Increase Health Care Quality through the Promotion of Health Information Exchange and the Protection of Patient Privacy (OSC for HIT/HealthInfoNet bill; support)

L.D. 1333, An Act to Modify Rating Practices for Individual and Small Group Health Plans and to Encourage Value-based Purchasing of Health Care Services (monitor)

L.D. 1337, An Act to Ensure Patient Privacy and Control with Regard to Health Information Exchanges (MCLU bill; oppose)

L.D. 1346, An Act to Enhance Access to the Workplace for Minors (monitor; pediatricians)

L.D. 1361, Resolve, to Ensure Patient Safety in the Use of Certain Imaging Equipment (monitor; radiologists)

Consent bills for discussion only if requested by a participant:

L.D. 1309, Resolve, to Encourage Reciprocity between Maine and New Hampshire in the Reporting of Rabies Vaccinations by Veterinarians (monitor)

L.D. 1326, An Act to Allow School Administrative Units to Seek Less Expensive Health Insurance Alternatives (monitor)

L.D. 1347, An Act Relating to Locations where Concealed Weapons May be Carried (monitor; Public Health Committee)

L.D. 1349, An Act to Amend the Laws Governing the Handling of Medical Examiner Cases (monitor)

L.D. 1353, An Act to Amend the Discovery Rule Laws (oppose)

L.D. 1364, An Act to Improve the Quality and Reduce the Cost of Health Care (monitor)

L.D. 1372, FY 2011 Supplemental Budget #2 (monitor)

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