May 2, 2011

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Another Busy Week at the State House: Health Insurance Reform, Medical Marijuana, CON, Abortion, and other Issues to be Reviewed

The 125th Maine Legislature continues this coming week to work on hundreds of legislative proposals, including many impacting on physicians and medical practice.  Several of the proposals are discussed in the articles below, including L.D. 1501, An Act To Reduce Opioid Overprescription, Overuse and Abuse.  The bill would establish mandatory protocols for prescribers to follow in prescribing opioid drugs for chronic, non-cancer pain.  A hearing on the bill will be held before the Health & Human Services Committee on Monday, May 9th.

The legislative action this past week is described more fully below in the Political Pulse and the bills to be discussed during the weekly call of the MMA Legislative Committee Tuesday night are described in the pertinent article below.

Of particular concern the next couple weeks are the anticipated favorable committee action impacting negatively on the Worker's Compensation facility fee schedule (L.D. 1244, An Act to Clarify Usual and Customary Charges under the Workers' Compensation Laws), L.D. 1333 adversely affecting providers and patients in health insurance regulation, and L.D. 1501 noted above.  But, these are only the tip of the iceberg, given that MMA is still following the action of nearly 300 bills still pending in the various committees of jurisdiction as well as watching the state budget for the next two years as it continues to be worked on by the Committee on Appropriations & Financial Affairs.

The First Regular Session of the 125th Legislature is scheduled to adjourn by June 15th.


Quality Counts to Partner with Quality Partners of Rhode Island to Compete for QIO 10th Scope of Work

Quality Counts, the Maine-based, regional quality improvement collaborative which includes the Maine Medical Association and many other organizations announced last week that it has formed a new organization, Maine Quality Partners, LLC to compete for the Medicare QIO contract for the next three year period.  CMS recently released the requirements for the so-called 10th Scope of Work and applications to respond to the RFP are due on May 18th.  The contract is currently held by the Northeast Health Care Quality Improvement Foundation, a New Hampshire-based organization that also holds the contracts for N.H. and Vermont.

Maine Quality Partners will form a 14 to 19 member board, including a majority of Maine providers and consumers, to direct the work under the contract.  Its application is being supported by MMA, the Maine Osteopathic Association, the Maine Primary Care Association, and many other health-related organizations and several consumer groups in the state, including the Maine Association of Area Agencies on Aging and the AARP.

Maine Quality Partners will complete as a physician-sponsored organization and needs 400 Maine physicians to become members in order to apply for the contract.  There is no cost to this membership.  Physicians willing to support an in-state organization to do the work of the QIO may go to the following link and complete a very simply form in order to demonstrate their support.


Additional information is available on the Quality Counts website at

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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, May 3rd 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 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. 1497, An Act to Comply with the Health Insurance Exchange Provision of the Patient Protection and Affordable Care Act (support with reservations compared to L.D. 1498)

L.D. 1498, An Act to Phase Out Dirigo Health and to Establish the Maine Health Benefit Exchange for Small Businesses and Individuals (support, though anticipate merger with L.D. 1497)

L.D. 1501, An Act to Reduce Opioid Overprescription, Overuse and Abuse (oppose)

Consent bills for discussion only if requested by a call participant:

L.D. 1504, Resolve, to Ensure a Strong Start for Maine's Infants and Toddlers by Extending the Reach of High Quality Home Visitation (monitor; pediatricians)

L.D. 1505, An Act to Clarify the Scope of Practice of Licensed Alcohol and Drug Counselors Regarding Tobacco Use (monitor; Public Health Committee)

L.D. 1511, An Act to Impose a Lifetime Maximum on the Receipt of Welfare Benefits (monitor)

L.D. 1519, An Act to Allow the Board of Dental Examiners to Issue Dental School Faculty Licenses (monitor)

L.D. 1520, An Act to Improve MaineCare and Promote Employment (monitor; psychiatrists)

L.D. 1525, An Act to Expand Reciprocity by Allowing Certain Nonresidents to Possess a Firearm in Maine (oppose; Public Health Committee)

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POLITICAL PULSE: Legislative Highlights of the Week


The Appropriations & Financial Affairs Committee continues its work sessions on the Governor's proposed FY 2012-2013 biennial budget (L.D. 1043).  Last Friday morning, MMA staff participated in a briefing by the committee chairs, Senator Richard Rosen (R-Penobscot) and Representative Patrick Flood (R-Winthrop) during which they said their goal is to report the budget out of the committee by Friday, May 13th.  The most difficult provisions left to be resolved are the state employee compensation issues, the taxation and welfare reform proposals, and the Fund for a Healthy Maine.  

You can find the Appropriations Committee materials on the web at:


The Insurance & Financial Services Committee held a public hearing on a series of insurance regulation bills (L.D.s 410, 1333, 1436, 934, and 1030) on Wednesday afternoon and MMA participated in this hearing through the coalition, Health Care for Maine (HC4ME).  The group expressed concern about wholesale changes to health insurance regulation in Maine prior to ACA implementation.  

The Committee held a day-long work session on Friday in which they considered the bills mentioned above, along with the bills on sale of health insurance across state lines (L.D.s 226, 445, 473, 645, 1162, and 1200).  The Committee voted to kill all the "across state lines" bills except L.D. 1200 which it will retain as a vehicle should members decide later this session to pursue the concept.  

The Committee killed all of the insurance regulation bills except L.D. 1333 and spent several hours of debate, heated at times, on a revised version of the bill that had been presented by the chairs just that morning.  In the end, the Committee divided evenly along party lines with the Republicans supporting the amended version of the bill.  The majority report will do the following:

  • It changes the maximum rate differential for individual health plans on the basis of age from 1.5:1 to 5:1.  The changes in rating for individual health plans are phased in over a period of 4 years.
  • It changes the maximum rate differential for small group health plans on the basis of age and occupation or industry from 1.5:1 to 5:1.  The changes in rating for small group health plans are phased in over a period of 4 years.
  • It authorizes a maximum rate differential on the basis of smoking status from 1.5 to 1.
  • It allows rating on the basis of geographic area outside of the rating bands for age.
  • It repeals guaranteed issue and renewal requirements for individual health insurance.
  • It creates a high-risk pool called the Maine Guaranteed Access Plan Association funded through an assessment on insurers.
  • It permits insurers authorized to transact individual health insurance in any state to offer their individual health plans for sale in this state if certain requirements of Maine law are met, including minimum capital and surplus and reserve requirements, disclosure and reporting requirements and grievance procedures.  
  • It adopts the federal definition of medical loss ratio and the minimum medical loss ratio requirements of federal law.  It allows individual health insurance rates to be filed for informational purposes without prior approval by the Bureau of Insurance if the insurer maintains a minimum 80% medical loss ratio.
  • It repeals the requirement for a State Health Plan and the Advisory Council on Health Systems Development.  It also deletes all statutory references to the Governor's Office of Health Policy & Finance.
  • It repeals the geographic access standards.  It repeals the authorization for the Superintendent of Insurance to establish standardized individual health plans by rule.  
  • It authorizes the issuance of short-term health insurance policies for a term not to exceed 24 months.
  • It provides a tax credit to employers of 20 or fewer employees for the expense of developing, instituting and maintaining wellness programs for their employees in the amount of $100 per employee, up to a maximum of $2000.
  • Finally, the bill would establish new standards for captive insurers to provide health insurance coverage.

In other action, the Committee unanimously recommended passage of a bill submitted by Representative Sharon Treat (D-Farmingdale) on behalf of the MMA that would prohibit the use of so-called "most favored nation" clauses in health insurance provider agreements.  The bill is L.D. 1222, An Act to Promote Fairness in Negotiations between Health Insurance Carriers and Health Care Service Providers.


Last week, the Labor, Commerce, Research & Economic Development Committee held work sessions on 3 workers' compensation bills of interest to MMA.  The Committee voted to kill L.D. 1065, An Act to Amend the Laws Governing the Determination of Permanent Impairment under the Maine Workers' Compensation Act of 1992.  The MMA opposed this bill to codify the use of an outdated version of the AMA Guides to Permanent Impairment.  The Committee voted in favor of L.D. 1056, An Act to Increase the Availability of Independent Medical Examiners uner the Workers' Compensation Act of 1992.  The MMA supported this bill that relaxes the restrictions of physicians' performing both Section 207 and 312 examinations in the workers' compensation system.  Finally, after 2 work sessions on L.D. 1244, An Act to Clarify Usual and Customary Charges under the Workers' Compensation Laws, the Committee asked the Workers' Compensation Board to review a proposed amendment presented by John Lambert, a lawyer representing the Maine State Chamber of Commerce.  The Board will discuss this proposal at its meeting on Tuesday, May 10th.  The MMA opposes L.D. 1244 and this approach to addressing the facility fee schedule issue.


After spending weeks on budget issues, the Health & Human Services Committee returned from the school vacation week to a week of hearings on approximately 70 bills.  They are following up with another busy week of work sessions on these same bills.  The following is an overview of just some of the bills in which the MMA was involved last week.

On Monday, the Committee held hearings on two bills (L.D.s 150 and 605) requiring drug testing of MaineCare recipients.  During a work session this morning, the Committee killed both of these bills.  The MMA and the Maine Association of Psychiatric Physicians (MAPP) supported a revised version of L.D. 646, An Act to Ensure the Safety of Children in the MaineCare Program Who are Prescribed Antipsychotic Medications.  This morning, the Committee voted in favor of a Resolve proposing a study group on these issues.  Also on Monday, the Committee heard three bills (L.D.s 887, 1159, and 1296) on medical marijuana.  The MMA supports some aspects of these bills and opposes other aspects.  L.D. 1296 would make substantial changes to the current medical marijuana law.

On Tuesday, the Committee heard two bills (L.D. 1331 and 1337) regarding patient choice to participate in a statewide health information exchange (HealthInfoNet).  The MMA supported L.D. 1331 and opposed L.D. 1337 as a general approach to these issues.  A group of stakeholders, including the MMA, are working to reconcile the differences in the bills.

On Wednesday, the Committee heard three bills on price disclosure (L.D.s 806, 1131, and 1393) opposed by the MMA because we believe current law is sufficient on this subject.  The Committee also heard two bills (L.D.s 267 and 1212) on screening for MRSA.  The MMA supports L.D. 1212 submitted on behalf of the Maine Hospital Association.

On Thursday, the Committee heard L.D. 1023, An Act to Authorize the Board of Licensure in Podiatric Medicine and the State Board of Veterinary Medicine to Establish a Podiatrist Health Program and a Veterinarian Health Program.  The Committee seemed supportive of this MMA initiative to give these professionals the opportunity to come into the MMA's Medical Professionals Health Program.


Beginning at 1 p.m. tomorrow, Tuesday, May 3rd, the Judiciary Committee will hear three bills seeking to amend current law relating to abortion that will affect the physician-patient relationship.  The bills are:

  • L.D. 116, An Act to Require a 24-Hour Waiting Period Prior to an Abortion (Rep. Clark, R-Easton)

  • L.D. 924, An Act to Educate Women on the Medical Risks Associated with Abortion (Rep. Espling, R-New Gloucester); and

  • L.D. 1457, An Act to Strengthen the Consent Laws for Abortions Performed on Minors and Incapacitated Persons (Rep. Crafts, R-Lisbon)

While the MMA understands that physicians may have differing opinions on the moral aspect of the abortion issue, since it currently is a constitutionally-protected right under certain circumstances, the legislation submitted in state legislatures, like the three bills listed above, can only try to discourage the procedure by interfering with the physician-patient relationship.  MMA opposes such bills and will be testifying in opposition to these tomorrow.  Judy Chamberlain, M.D. also will be testifying in opposition.  The MMA already has received one brief statement in opposition to these bills to be included with the MMA testimony and we would be happy to include comments from others who wish to weigh in.  Please send them before 11 a.m. tomorrow to Andrew MacLean, Deputy EVP at or by fax to 622-3332.

You will find the members of the Judiciary Committee and their contact information on the web at:

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L.D. 1501 Proposed to Respond to Problem of Opioid Addiction and Prescription Drug Diversion

State Representative Jon Hinck  (D-Portland) is the prime legislative sponsor of L.D. 1501, An Act to Reduce Opioid Overprescription, Overuse and Abuse.  The bill is intended to address the very serious problem of opioid addiction in the state as well as the problem of diversion of legitimate medication to illicit, non-medical use.  The bill is partially based upon a similar law enacted in the State of Washington about a year ago.

Representative Hinck shared early drafts of the comprehensive proposal weeks ago with the medical licensing boards and several physicians specializing in the treatment of pain or addictions.  While several organizations and physicians have provided input, the bill itself is very comprehensive and, if enacted, would fundamentally alter the approach that many physicians take with respect to treatment for chronic pain.  The bill does not impact prescribing for cancer pain, end of life care, or short-term pain relief (such as post-surgical).

The bill would require use of the prescription monitoring program (PMP) in most cases and includes provisions on physical examinations, health records, periodic review of patient health, and consultations with and referrals to pain management specialists.  It requires the Department of Health & Human Services to review and evaluate the efficacy of comprehensive pain management, including physical therapy and cognitive behavioral therapy and report back to the Joint Standing Committee on Health & Human Services no later than December 7, 2011.

The public hearing on the bill will be held on Monday, May 9, 2011 before the HHS Committee.  The Maine Medical Association will be receiving input on the proposal from many sources (primarily its members) and will present testimony on the bill.  Input may be sent directly to Andrew MacLean or Gordon Smith via e-mail to or [return to top]

Let MMA Do Your Annual Staff Training on HIPAA: This Friday, May 6th

The May First Friday CME program this coming Friday features our annual HIPAA staff training.  This three-hour program features the state's leading health lawyers and can serve as a refresher course or first time training for your new staff.  The program is offered both live in the Manchester office of MMA and through Webex  ($65 fee is the same).

In addition to the basics, the course will include the amendments to HIPAA that were part of the federal HITECH Act in 2009, including the requirement of breach notifications and expanding patient rights to an accounting of disclosures.  Faculty includes Stacy Mondschein Katz, Kenneth Lehman, Gordon Smith, and Andrew MacLean.

Registration is available through the MMA website or by calling 622-3374, ext. 219 or by e-mail to Maureen Elwell at




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Congress Passes Current Year Budget Agreement, but Continues Policy Debate Over Long Term

The House of Representatives and Senate passed the Full-Year Continuing Appropriations Act of 2011, H.R. 1473, on April 14th.  This legislation will fund the federal government for the remainder of fiscal year 2011 and it reduces current spending levels by approximately $38.5 billion.  H.R. 1473 affects two specific programs in the Affordable Care Act.  It rescinds $2.2 billion of the $6 billion in start up funds for the formation of not-for-profit health insurance cooperatives and it eliminates a voucher program to allow low-income workers to opt out of their employer-sponsored health plans and obtain coverage through the state-based health insurance exchanges.  This legislation also requires the federal government to conduct four studies on the effects of he health reform law, including a GAO audit of comparative effectiveness research funding as well as a GAO report on the costs and processes of implementing the law.

Multiple proposals to significantly cut spending and reduce the federal budget deficit and debt have been unveiled during the last several weeks.  Of note, House Budget Committee  Chairman Ryan introduced the Fiscal Year 2012 Congressional Budget Resolution (H.Con.Res. 34), which was approved by the House on April 15th by a mostly party-line vote of 235 to 193.  While the function of the Budget Resolution is to establish budgetary levels for the next 10 years, the accompanying document to the resolution, known as "The Path to Prosperity," makes specific policy recommendations for cutting discretionary and mandatory spending.  On April 13th, President Obama offered his proposal for reducing spending in "The President's Framework for Shared Prosperity and Shared Fiscal Responsibility."  Both of these proposals would significantly reform the Medicare and Medicaid programs with the intent of making them fiscally sustainable and reducing the budget deficit.  President Obama has asked Vice President Biden to lead a bipartisan, bicameral panel composed of 16 lawmakers to engage in deficit reduction negotiations.  The first meeting of the panel will be held on May 5th.  In the Senate, a bipartisan group of Senators known as the "Gang of 6," is also drafting  legislation based on the December 1, 2010 recommendations of the National Commission on Fiscal Responsibility and Reform.  Members of the "Gang of 6" include Senators Conrad (D-ND), Durbin (D-IL), Warner (D-VA), Crapo (R-ID), Coburn (R-OK), and Chambliss (R-GA).  

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New England AMA Delegation and N.E. Council of State Medical Societies Meets in Freeport

Physicians representing the six New England states in the American Medical Association House of Delegates and the New England Council of State Medical Societies met this past Saturday, April 30th in Freeport to discuss business being presented at the AMA Annual Meeting in June in Chicago and comparing notes on what is happening in the states.

More than 60 physicians participated in the four-hour meeting which included the following highlights:

  • Reviewed ten proposed Resolutions for presentation to the AMA House of Delegates, with topics ranging from prior authorization to support for the individual mandate in the Affordable Care Act.

  • Supported repeal of the current federal restrictions on the use of health reimbursement accounts to purchase prescription over the counter medication.

  • Supported H.R. 1409, pending federal legislation which would provide important anti-trust relief to physicians.

In the New England Council part of the meeting, each state's President or designee presented the major issues facing physicians in each respective state.  Many of the issues focused on legislation as all the state legislatures in New England are still in session.  Common issues included state budget challenges (and the difficulty of maintaining access to coverage), health insurance reform, and the challenges of association membership in this time of great change and scarce resources.

The AMA House of Delegates will gather for its Annual Meeting June 18-22, 2011 in Chicago.  Richard Evans, M.D., a general surgeon practicing privately in Dover-Foxcroft is the chair of the Maine delegation to the AMA, which also includes John Makin, M.D. of Skowhegan and Maroulla Gleaton, M.D. of Palermo.  Dr. Makin practiced ob-gyn in central Maine and Dr. Gleaton is the owner of a private ophthalmology practice in Augusta.

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Attend the EHR Educational Events For Critical Access Hospitals and Primary Care Providers

MEREC, in partnership with Quality Counts, will be hosting the second in a series of free regional forums about electronic health records, meaningful use, and related federal and state incentive programs.  The forums are specifically targeted for primary care providers and staff of small independent practices as well as clinical and administrative staff in Maine’s rural and critical access hospitals.  The events will include a panel of health information technology experts, both local and national, a specific discussion on the integration of HIT in the patient centered medical home, and as group breakout sessions focused on using EHRs (inpatient and outpatient) to improve health care quality and outcomes, reduce costs and ultimately achieve federal meaningful use requirements.  Hope to see you at one of the following events:

•       Franklin Memorial Hospital:  Tues, May 10, 1:30 - 5:30 p.m.
•       Mt. Desert Island Hospital:  Wed, May 11, 2 - 6 p.m.
•       Mayo Hospital:  Wed, May 25, 2 - 6 p.m.
•       Goodall Hospital:  Wed, Jun 1, 2 - 6 p.m.

Register online at or by calling Maria Stevenson at 207-541-9250, ext 201.

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Register this Week for 20th Annual Practice Education Seminar being held on May 18 at Augusta Civic Center

MMA's 20th Annual Practice Education Seminar, being held again this year at the Augusta Civic Center, will feature presentations on a number of topics that members say are difficult for them to get their hands around.  The program will be held on Wednesday, May 18, 2011 from 8:30 a.m. to 4:30 p.m.  Registrations materials were mailed to all MMA members and practice managers this past week. 

Among the topics are the following: 

  • Measuring Quality in a physician practice;
  • What's New at Medicare;
  • Achieving Meaningful Use in a Meaningful Way;
  • Preparing for Accountable Care Organizations;
  • Addressing Issues with Elderly Drivers;
  • Social Media in Your Practice:  Friend or Foe; and
  • Preventing Prescription Drug Abuse

 Speakers include Insurance Superintendent Mila Koffman, J.D., John Freedman, M.D. of Freedman HealthCare, Thomas Arnold, Deputy Secretary of State and Elizabeth Mitchell, President of the Maine Health Management Coalition. 

Interested individuals may also register now on the MMA website at  For one information on the Annual Seminar, contact Gail Begin at MMA via e-mail to




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MaineHealth, Eastern Maine Health Care & MaineGeneral Complete Community Needs Assessment

Three years ago, Maine Health, Eastern Maine Health Care Systems, and MaineGeneral Health formed a collaborative venture called OneMaine Health to address statewide health issues.  A health needs assessment was the first project and last week the results of the comprehensive study were released to the public.  In a 262 page report based upon hospital data and a survey taken last fall of more than 6,400 households in the state, several interesting patterns are revealed, including county -by-county variations. 

The study included information on several public health topics, including the prevalence of chronic disease, rates of cancer, levels of obesity, tobacco use and substance abuse.  Information was also collected on access to dental health and mental health services.  Among the findings:

  •      Mainers continue to have higher rates of cancer than the national average.

  •      Cancer patients in Aroostook County are more likely to die from the disease than patients in Cumberland county.

  •      Rural Maine counties tend to have higher rates of heart attacks, diabetes and asthma than their urban  counterparts.

  •     Cumberland county leads all other counties in chronic alcohol abuse.

  •     Smoking rates are highest in Aroostook, Oxford, Somerset, Washington and York counties.

  •     Mental heath issues are  most prevalent in Franklin, Kennebec & York counties.

  •     Prescription drug abuse is highest in Knox, Piscataquis & Washington counties.

  •     Obesity rates are highest in Oxford, Penobscot, Piscataquis and Washington counties.

The study was conducted by the University of Southern Maine and the University of New England.  The OneMaine Health Collaborative hopes to repeat the study every five years in order to measure the progress of prevention efforts and to identify new areas of concern. [return to top]

SAVE THE DATE: Pierce Atwood Labor & Employment Seminars, Co-sponsored by MMA, June 10th & 17th

Save the Date! Pierce Atwood Program in your area June 10 & 17:

Labor & Employment Issues for the Maine Healthcare Industry

 Brewer & Portland, Maine

Date: June 10 and 17, 2011
Time: 8:30 AM - 3:00 PM

The Pierce Atwood Employment Group, with our co-sponsor Maine Medical Association, is pleased to invite you to a program on Labor & Employment Issues in the Healthcare Industry.  We will be offering this program twice.

  • June 10, also sponsored and hosted by Eastern Maine Healthcare Systems, at the EMHS Brewer office 
  • June 17, also sponsored by Martin's Point HealthCare, at The Woodlands Club in Falmouth

Our tentative agenda includes the following topics:

  • Managing the impaired worker
  • Wage-hour challenges for healthcare employers
  • The latest on union activities around the state including, Maine State Nurses Association/California Nurses Association, Teamsters and others
  • Significant developments in Augusta and Washington
  • Immigration issues in the healthcare industry
  • HIPAA, privacy and technology, including duties of employers and employees
  • Special guest Short Fuse Theater: "Coping with the high performing, high risk healthcare employee". (Portland only) 
  • Rapid-fire round - questions and answers on topics across the labor & employment spectrum

Our agenda is tentative because we want your help in shaping it.  When you register, please use the box on the registration screen to suggest questions or topics you'd like to see us address.  We'll synthesize your responses and incorporate as many as we can into our presentation.

Also, when registering, please indicate which program you wish to attend.

This program will be of interest to senior management, human resources management and staff, in-house counsel, risk managers and upper level supervisors.  Please forward to any interested persons in your organization.

The program will run from 8:30 am to approximately 3:00 pm.  There is no charge to register, and lunch will be served.  Our sincere thanks to our co-sponsors for helping to make these events possible.

Please check your email box for a reminder in the next couple of weeks.

If you have any questions, please contact Amber Elliott at or 207-791-1143.

Copyright � 2011. Pierce Atwood LLP. All rights reserved.

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