June 20, 2011

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Legislature Adjourns Until June 28th, Several Bills Vetoed by Governor LePage

The Legislature adjourned temporarily this past Thursday and will return to Augusta on June 28th when it is expected to spend a day or two wrapping up the First Regular Session.  The primary purpose of the recess is to allow the Governor to complete his review of several enacted bills on his desk, including L.D. 1043, the biennial budget.  The House and Senate did not vote on the competing HHS Committee reports on Certificate-of-Need, but is expected to do so before final adjournment. 

In other legislative action this past week, the House and Senate both approved L.D. 83 authorizing the sale of consumer fireworks.  Both MMA and the Maine Society of Eye Physician & Surgeons opposed the legislation based upon safety and fire concerns.  The Criminal Justice Committee had voted 9 to 4 to support an amended form of the bill.  While additional votes will take place next week, it is a virtual certainty now that the bill will pass.  It was strongly supported by the LePage Administration and by lobbyists for the fireworks industry.

Also, the Governor vetoed another bill of significant interest to organized medicine in Maine - L.D. 531, An Act to Specify Qualifications for the Director of the Office of Adult Mental Health Services within the Department of Health and Human Services.  This bill had been drafted by MMA lawyers at the request of the Maine Association of Psychicatric Physicians (MAPP).  The Governor's veto was a surprise as representatives of DHHS had supported the language offered in compromise on the bill.  The Legislature recalled from the Governor's desk L.D. 646, An Act to Ensure the Safety of Children in the MaineCare Program Who are Prescribed Antipsychotic Medications after the Governor threatened to veto the bill.  HHS Committee House Chair, Representative Meredith Strang Burgess (R-Cumberland) arranged for the bill to be carried over to the second session and the Committee is expected to ask the DHHS Psychiatric Work Group to do some of the work required in the Resolve.

L.D. 1583, An Act to Provide Oversight in Certain Negotiations, which was introduced in the aftermath of the Legislature sustaining the Governor's veto of MMA's proposal to prohibit health plans from using "most favored nation" clauses in participating provider agreements, received initial approval in the House and Senate with final votes planned for the 28th.


Seventy-nine Cases of Lyme Disease Reported in the State this Year; Hundreds More Expected

In an article written by health reporter Meg Haskell last week, the Bangor Daily News reported that so far this year 79 cases of Lyme disease have been reported to the state.  But, based on past years, most cases are reported in late summer or fall.  Last year, the number of cases dropped to 734 from nearly 1000 cases being reported in 2009.  Lyme disease is most prevalent in Cumberland and York counties but it is becoming more common in more northerly counties.

Scientists at Maine Medical Center have studied Lyme disease and other tick-borne illnesses since 1989.  In addition to collecting ticks for their own studies, the Center's Research Institute provides free identification of any tick.  So far, about 27,000 ticks have been sent in for identification by doctors, veterinarians, and members of the general public.  For information and instructions for submitting a tick for identification, visit the MMCRI vector-borne disease lab website at www.mmcri.org.

The first case of Lyme disease in Maine was diagnosed in 1986 and by 2003 about 175 cases were being reported annually.  The disease was first identified in Connecticut in l975.

There are 14 varieties of ticks found in Maine, the most common being deer ticks, dog ticks, and woodchuck ticks.  Only the deer tick carries the microorganism which causes Lyme disease.

As reported in the BDN article, state epidemiologist Stephen Sears, M.D., M.P.H. of the Maine Center for Disease Control & Prevention noted  the disease can almost literally to be stopped before it starts, but diagnosed late in its progression it can cause long-term damage that resists the medications available.  Starting patients early on oral antibiotics usually kills the microbe that causes the disease. [return to top]

American Medical Association House of Delegates Meeting in Chicago, Today

The AMA's 2011 Annual Meeting continues today in Chicago, having opened on Saturday afternoon.  Representing Maine physicians are delegates Richard Evans, M.D. and John Makin, Jr., M.D. and alternates Maroulla Gleaton,M.D. and Jo Linder, M.D.  During the four and one-half day meeting, more than 200 reports and resolutions will be considered.  A comprehensive list of the items to be considered by the House can be found on the AMA web site at http://www.ama-assn.org/ama/pub/meeting/reports-resolutions.shtml.

The most contentious issue at the meeting appears to be the AMA's current policy supporting the responsibility of individuals to have health insurance coverage (individual mandate).  AMA Council Report 9 being considered by Reference Committee A recommends the reaffirmation of the policy, as well as current policies regarding health insurance tax credits and market regulation, health savings accounts, and direct subsidies for the coverage of high risk patients.  The Council notes that AMA policy on individual responsibility is not tied to the ACA requirement or its constitutionality.  In the report, the Council says it gave thoughtful consideration to alternatives to requiring individual responsibility, but found there currently are not alternatives that would be as effective in covering the uninsured and promoting a balanced risk pool of both healthy and sick individuals.

In more than three hours of testimony yesterday, Reference Committee A heard passionate testimony from AMA delegates both supporting and opposing the Council Report.   Two individual Resolutions had also been submitted, one in favor of reaffirming existing policy and a second asking that the policy be rescinded and new policy established that encourages but does not require the purchase of health insurance.  A lot of the testimony focused on the current reform law in Massachusetts which has resulted in 99% of children and 98% of adults being covered.  While the Massachusetts Medical Society offered a comprehensive defense of the law and its implementation, other state delegations from Kansas, Arkansas, Florida, Georgia, and Oklahoma declared the Massachusetts law a failure.

Dr. Gleaton offered testimony on behalf of the Maine delegation, in support of the existing policy, noting that a recent survey of Maine Medical Association members showed more than 75% support the individual mandate, a position the MMA has supported since its White Paper on Health System Reform was first published in 2003.

The Annual Meeting is scheduled to conclude on Wednesday.  Look for more information on the meeting and the results of the voting in next week's Update [return to top]

Register Now for MMA's 158th Annual Session in Bar Harbor, September 9-11

Registration materials for MMA's 158th Annual Session are now available and were included as an insert in the recent issue of Maine Medicine which arrived in members' offices the week before last.  You may also register on the MMA website at www.mainemed.com.  The meeting will be held September 9-11 in Bar Harbor with the Friday educational program being held again this year at the Jackson Laboratory and the Saturday and Sunday morning events being held at the Bar Harbor Club adjacent to the Harborside Hotel.

The theme of this year's educational program is INNOVATION and 8 hours of CME category 1 credits are being offered.  The educational program begins at 1:00 p.m. Friday, September 9th with a keynote presentation by Carol Bult, PhD.  Dr. Bult is a Principal Investigator in the Mouse Genome Informatics database consortium at the Jackson Laboratory.   Tours of the Lab will again be available at 3:00 p.m. following the two lectures.  The Friday evening reception will be held at the Laboratory as has been the case the last two years.

Saturday's events will be held back at the Bar Harbor Club with the Annual Meeting in the morning, featuring the presentation of 50 year pins at 10:30 a.m.  At noontime, J. Randy Darby, M.D. of Spectrum Medical Group will keynote the afternoon educational session with a presentation entitled, Innovations in Medical Education and Team Building.  Dr. Darby's presentation will be followed by a panel on clinical technology innovation and a presentation on nanotechnology. 

Saturday evening will feature the annual President's Reception and Annual Awards Banquet at which time President Jo Linder, M.D. will pass the President's gavel to President-elect Nancy Cummings, M.D. 

Sunday morning will begin bright and early at 6:30 a.m. with the 31st running of the Edmund Hardy Road Race, again sponsored by Medical Mutual Insurance Company of Maine.  Following brunch at 8:00 a.m., a panel focusing on Innovations in Physician Wellness, moderated by Dr. Cummings, will inform attendees on how to incorporate mindfulness, wellness and balance into busy lives.

DONATIONS NEEDED!  We will once again be conducting a silent auction to benefit one or more programs falling under the Maine Medical Education Trust (MMET).  If you have something you'd be willing to donate as a silent auction item, please contact Dee DeHaas at ddehaas@mainemed.com.

We look forward to seeing you in Bar Harbor! [return to top]

AMA Releases 2011 National Health Insurer Report Card

The AMA today revealed the results of its fourth annual National Health Insurer Report Card, which highlights the strengths and weaknesses of the claims processing systems used by eight of the nation’s largest insurers. This is a key initiative of the AMA’s “Heal the Claims Process”™ campaign, which seeks to eliminate waste from the claims process and free up time and resources to devote to patient care.

Visit www.ama-assn.org/go/reportcard to view the full report card results, access the supporting documentation and view an archived webinar.

Visit www.ama-assn.org/go/healthatclaim to learn more about the AMA’s “Heal the Claims Process” campaign and how you can get involved.

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Silent Auction Items Needed for Annual Session

Last year, MMA held its first annual silent auction to benefit the Maine Medical Education Trust and the John C. Dalco Fund, with proceeds totaling approximately $4,500.  There were 24 items donated by MMA members and corporate affiliates.  Donated items included event tickets, weekend and week-long stays at member’s vacation homes, golf packages, gift baskets, books, restaurant and spa certificates, and special items made by members and friends such as paintings, sculptures and carvings! 

The proceeds from this year’s auction will be directed to the MMET Scholarship Fund created by Dr. Linder during her term as President.  This fund will be used to provide scholarships for medical students who are Maine residents.  We encourage you to participate by donating an item to the auction to benefit this worthy cause, and by attending the event which is being held on Saturday, September 10th, during the MMA Annual Session in Bar Harbor.  

Look for the donation form to be mailed soon with annual session materials and for it to be posted soon on the MMA web site, www.mainemed.com.



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Maine Law Court Upholds Restrictive Covenant

Physicians and residents frequently ask questions about "restrictive covenants" or "non-compete" agreements in physician employment agreements during the MMA's presentations on employment law.  For years, MMA attorneys have pointed to Brignull v. Albert, 666 A.2nd 82 (Me. 1995) as the leading Maine case in the health care context supporting enforcement of these contract provisions if the terms are reasonable in duration, geographic scope, and the business interest to be protected.  The Maine Supreme Judicial Court recently considered a dispute involving three physicians who left employment with Sisters of Charity Health Care System, Inc. to be employed by Central Maine Healthcare System, Sisters of Charity Health System, Inc. v. Douglas Farrago et al. 2011 ME 62 (May 26, 2011).  In this case, the physicians challenged not the duration or geographic scope, but the legitimacy of the business interest protected.  They also challenged the $100,000 per physician liquidated damages provision.  The Law Court confirmed the Superior Court's conclusion that protecting the former practice's existing patient base and "good will" were legitimate business interests.  The Law Court also found the liquidated damages provision to be enforceable based on the precedents in Maine law.  

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Three Openings on Board of Licensure in Medicine

There are currently three openings on the nine-member Board of Licensure in Medicine, occasioned by the completion of the terms of Sheridan Oldham, M.D., the resignation of George "Joe" Dreyer, M.D., and the resignation of the newest public member of the Board, Meredith Baxter.  Qualifications for appointment to the Board include five years of continuous medical practice in the state immediately prior to appointment.  Terms are for six years.  The Board meets for a full day the second Tuesday of each month and at least one day of preparation for the meeting is generally required.  Compensation is nominal.

The appointments are considered personal appointments of the Governor, meaning that no confirmation hearings or legislative review is required.  Physicians interested in serving on the Board should send a current CV and a letter expressing interest to:

                                                                           Michael Hersey  (Att:  Scott Van Ormand)

                                                                           Director of Boards and Commissions

                                                                           1 State House Station

                                                                            Augusta, Maine 04333

While the Board is particularly interested in surgeons and psychiatrists, given the current mix of specialties represented, any physician meeting the above noted statutory requirements may apply.

In July, the Board will elect new officers for a term year period.  Dr. Oldham has chaired the Board for the last four years and has served two six-year terms. She has been a strong and effective leader at the Board during her tenure.  Likewise, Dr. Dreyer has served admirably during his term on the Board.



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Legislature Cannot Direct AG to File Suit Against ACA in New Hampshire

In a decision issued June 15th, the New Hampshire Supreme Court has ruled that a bill (H.B. 89) passed by the New Hampshire House directing the Attorney General to join a legal action against the Affordable Care Act (ACA) is unconstitutional because it violates the separation of powers of the state's constitution, Opinion of the Justices (Requiring Attorney General to Join Lawsuit), N.H., No. 2011-319, 6/15/11.

The Republican-controlled House voted 259-107 in favor of the bill.  The Democratic Attorney General, Michael Delaney, had urged the legislature not to take such action, citing the separation of powers.

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SAVE THE DATE: CMS' Boston Regional Office's 2011 National Medicare Workshop in Late August/Early September

The CMS Boston Regional Office invites you to attend the 2011 National Medicare Workshop scheduled for Tuesday, August 30th through Thursday, September 1st at the Sheraton Portsmouth Harborside Hotel & Conference Center in Portsmouth, New Hampshire.

The agenda includes:

  • A half-day basic track for those new to Medicare and those wanting a refresher;

  • Basic information and detailed casework - tailored to your needs;

  • Medicare training materials and information that are current, accurate, and consistent;

  • Opportunities to network with CMS staff and other partners who share your commitment;

  • Subject matter experts;

  • 2011 CD Suite/USB wafer card - with the training modules, videos, resource guide, and more!


Online registration is available at:  http://2011nationalmedicaretrainingprogram.blsmeetings.net/.  You must enter the password maureen1 (password is case sensitive) to register for the meeting.  Please register for each workshop participant individually.  If you have any questions, call Sydney Vranna at 301-577-0244 begin_of_the_skype_highlighting            301-577-0244      end_of_the_skype_highlighting, ext. 2800.

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Proposed Rule on Five-Year Review of the RBRVS

On May 24th, CMS released a Notice of Proposed Rulemaking (NPRM) on the 4th Five-Year Review of the Resource Based Relative Value Scale (RBRVS).  This review is required by law and provides the public with the opportunity to comment on potential misvaluation within the Medicare Physician Payment Schedule.  The AMA/Specialty Society RVS Update Committee (RUC) recommendations for the 4th Five-Year Review reflected a total of 292 services submitted to CMS from April 2010 through February 2011.  CMS has proposed to accept 2/3 of the RUC recommendations.  For the approximately 70% of those that were "rejected," CMS has proposed work values within 10% of the RUC recommendation.  A number of the rejections are the result of a major policy disagreement with CMS regarding payment for hospital observation services.  CMS has not yet accepted RUC recommendations to equate observation visits to hospital inpatient visits.  CMS does propose, however, to publish the RUC recommendations for significant increases to preventive medicine services.  These CPT codes are not covered by Medicare, but many Medicaid plans and private payers use the RBRVS to establish physician payment rates.  In addition, CMS states in the proposed rule that, "we greatly appreciate the considerable sustained efforts made by all members and staff of the AMA RUC to date, and we look forward to continuing our collaborative work with the AMA RUC toward our mutual goal of ensuring that CPT codes are appropriately valued."  Comments on the NPRM are due July 25th, and CMS is expected to convene a refinement panel in August to consider public comments on specific services. [return to top]

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