June 27, 2011

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Governor Signs $6.1 Billion Biennial Budget; Legislature Re-convenes Tomorrow

Governor Paul LePage this past week signed the two-year budget sent to him following two-thirds votes in the House and Senate.  The state's fiscal year begins on July 1, 2011.  For health care interests, the budget was quite positive, particularly when compared to what the Governor had originally proposed.  The spending package restored the proposed cuts to MaineCare eligibility and most of the cuts to the Fund for a Healthy Maine.

The Legislature will reconvene tomorrow to finish up work on several bills and to take action on several bills the Governor has vetoed.  

In comments to the press following the signing of the budget, Governor LePage criticized legislators for only doing "half the job" and stated that he would seek further changes in January, 2012.  He singled out the lack of significant welfare reform as one area where the legislature had fallen short.  He also indicated that the $150 million in tax cuts were not enough in the long run and that further spending cuts would be needed to ensure that the state can recover from the economic slowdown. His original budget had proposed $200 million in tax reductions.

In passing the budget, legislators rejected the Governor's proposal that would have eliminated MaineCare benefits for parents who earn between 133 and 200 percent of the federal poverty level and for childless adults.

Several bills of interest to physicians are still pending before the current session of the 125th Legislature and final action on them is expected to be completed this week.  Among the most significant are the following:

L.D. 360 regarding Certificate of Need (MMA now comfortable with either the majority or minority reports)

L.D. 1583 prohibiting most favored nation clauses in health plan contracts with providers (MMA supports)

L.D.  83 allowing for the sale of some types of consumer fireworks in the state (MMA opposes, as does the Maine Society of Eye Physicians and Surgeons)

The Legislature is expected to complete its business by the end of the week and adjourn. But several bills will be worked on between the end of the session and January 2012 including L.D. 1502 regarding opioid addiction and prescribing for chronic pain.

MMA's Legislative Committee and staff have supported, opposed or monitored over three hundred bills introduced in the First Regular Session.  A final report on these bills and their disposition will be available from MMA over the summer and will be presented at the Annual Session Sept. 9-11 in Bar Harbor.





A.M. Best Upgrades Medical Mutual Rating to A- (Excellent)

On June 15,  A.M. Best Co. announced an upgrade to the financial strength rating of Medical Mutual Insurance Company of Maine (MMIC) from B++ (Good) to A- (Excellent).  The upgrade also included the issuer credit rating (ICR) which moved from bbb+ to a-.   The outlook for both ratings has been revised to stable from positive.

The rating upgrade reflects Medical Mutual's excellent capitalization, strong underwriting profitablity and leadership position in the medical professional liability market in its home state.  The upgrade also recognizes the group's favorable reserve development and continued support for its physician members through strong patient safety and risk management programs.  An additional favorable factor cited was the company's dedication to sharing its financial success with its members through dividends.

Partially offsetting these factors are the market risks inherent within the medical professional liability insurance sector including tort reform, price competition and regulatory trends.  

The outlook is based on the group's ability to maintain excellent underwriting results and favorable loss reserve trends through strong cycle management processes.

Congratulations to President Terry Sheehan and the Board of Directors and staff of Medical Mutual for getting this important rating level restored. The Maine Medical Association endorses Medical Mutual as the preferred professional liability carrier for its members.

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Supreme Court Strikes Down Vermont Prescription Data Law

Last Thursday, the Supreme Court struck down Vermont's law that barred the sale of doctors' prescription data to drug companies, ruling the law interfered with the pharmaceutical industry's First Amendment right to market its products. The Vermont law  provided that, absent a prescriber’s consent, prescriber-identifying information could not be sold by pharmacies and similar entities, disclosed by those entities for marketing purposes, or used  for marketing by pharmaceutical manufacturers. The Maine Medical Association, Vermont Medical Society and New Hampshire Medical Society, among other groups, filed a brief with the Court in support of the law. 

The Supreme Court, in a 6-3 opinion written by Justice Anthony Kennedy, said the law was an unconstitutional restriction on drug makers' free speech rights.  The Court found that the statute must be subject to heightened review because it disfavors speech with a particular content (marketing) and by particular speakers (detailers engaged in marketing) while allowing prescriber-identifying information to be purchased, acquired, and used for other types of speech and by other speakers.  Because of this distinction, Vermont was required to show that the statute directly advanced a substantial governmental interest and that  the measure was drawn to achieve that interest.  The Court found that the state was unable to meet this burden.  

In the meantime, Maine's prescribing data law still stands.  In August 2010, a federal appeals court held that Maine's law that allows physicians and other prescribers to opt out of having their prescribing data sold to health information firms and drugmakers for marketing purposes is constitutional. In contrast to the recent Supreme Court holding, First Circuit Court of Appeals Chief Judge Sandra Lynch wrote in her August 4th opinion that "the statute regulates conduct, not speech, and even if it regulates commercial speech, that regulation satisfies constitutional standards."  IMS Health filed an appeal of that decision to the U.S. Supreme Court, which is meeting today to consider whether to grant the request for an appeal or take other action in the case. A decision is expected within the next two weeks.    

Physicians are also currently able to restrict the data available to pharmaceutical representatives through the AMA Physician Data Restriction Program (PDRP).  The PDRP offers physicians the option to withhold their prescribing data from pharmaceutical sales representatives while still making it available for medical research purposes. In addition, the program allows physicians to register complaints against sales representatives or pharmaceutical companies who they believe are using their prescribing data inappropriately.  You can learn more or register to opt-out at: www.ama-assn.org/go/prescribingdata

Read the recent Supreme Court decision (Sorrell v. IMS Health) at http://www.supremecourt.gov/opinions/10pdf/10-779.pdf

The  First Circuit Court of Appeals decision on the Maine law (IMS Health v. Mills) is available at: www.ca1.uscourts.gov/cgi-bin/getopn.pl?OPINION=08-1248P.01A


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AMA Reaffirms Support for Individual Responsibility for Health Insurance to Cover the Uninsured

The American Medical Association at its Annual Meeting this past week in Chicago voted to continue its policy supporting individual responsibility for health insurance with assistance for those who cannot afford it.  Support for the so-called "individual mandate" had been challenged by a group of state and national medical societies.  The New England Delegation to the AMA had supported the mandate as one means to achieve universal coverage.

"The AMA has strong policy in support of covering the uninsured, and we have renewed our commitment to achieving this through individual responsibility for health insurance with assistance for those who need it, said AMA President Cecil Wilson, M.D. "The AMA's policy supporting individual responsibility has bipartisan roots, helps Americans get the care they need when they need it and ends cost shifting from those who are uninsured to those who are insured.  Important insurance market reforms, such as an end to coverage denials based on pre-existing conditions, are only possible by having broad participation in the health insurance market."

The AMA reviewed alternatives and concluded that any approach to covering the uninsured that is in line with AMA policy cannot be fully successful in covering the uninsured without individual responsibility for health insurance.

The policy was affirmed by a vote in the AMA House of Delegates last Monday (June 20).  The House also reaffirmed support for AMA policy supporting health insurance tax credits and health insurance market regulation, health savings accounts and direct subsidies for the coverage of high risk patients.

Former AMA President Robert McAfee, M.D., of Portland,  testified in favor of the existing policy on the floor of the House.  Alternate Delegate Maroulla Gleaton, M.D. of Palermo had testified on behalf of the Maine delegation to the AMA in favor of the same position in the reference committee receiving testimony on the various resolutions and Council report on the subject. 
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MeCDC Hosts Universal Immunization Program Regional Trainings

Maine Immunization Program Regional Trainings 

Vaccines for Children: Public Law 595 - Implications for Maine Immunization Providers

These workshops will provide an overview of the new Universal Childhood Immunization Program and provide information to help Maine immunization providers prepare for implementation in January 2012. The training will focus on vaccine management, ordering and accountability; provider requirements; Maine Immunization Registry and information on vaccines that will be available through the Universal Childhood Immunization Program. There will also be information on the ACIP schedule, vaccine administration, vaccine usage and vaccine myths.

July 28, 2011- Presque Isle

August 4, 2011 - Bangor

August 11, 2011 - Portland

August 12, 2011 - Augusta

8:30 am - 3:30 pm; Registration begins at 8 am 

Sponsor: Maine Department of Health and Human Services, Center for Disease Control and Prevention, Division of Infectious Disease, Immunization Program

Space is limited.  For more information or to register, see http://www.maine.gov/dhhs/boh/ddc/immunization/

For an overview of the Universal Childhood Immunization Program, see the presentation available at:  http://www.maine.gov/dhhs/boh/ddc/immunization/providers

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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. Jo Linder during her term as MMA 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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Marie Vienneau, RN Installed as Maine Hospital Association Board Chair at Summer Forum

MMA extends congratulations to Marie Vienneau, CEO and Chief Nursing Officer of Millinocket Regional Hospital, who was installed as Chair of the Maine Hospital Association Board of Trustees at the MHA Summer Forum this past week in Rockport.  Ms. Vienneau succeeds Jud Knox, CEO of York Hospital.  William Caron, President of MaineHealth, was installed as Chair-elect.  Art Blank, CEO of Mount Desert Island Hospital, is treasurer and Michelle Hood, CEO of Eastern Maine Health Systems, is the board's new secretary.  

Also joining  the board for the first time will be Sylvia Getman, CEO of The Aroostook Medical Center; Chuck Hays, CEO of MaineGeneral Medical Center; Michael Lally, CEO of Calais Regional Hospital; and Rebecca Ryder, CEO of Franklin Memorial Hospital. [return to top]

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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Treatment of Tobacco Dependence: The Latest AMA Therapeutic Insights Online Topic

The American Medical Association (AMA) announces the release of Treatment of Tobacco Dependence, the latest AMA Therapeutic Insights newsletter

Take a quick look - read an overview of the tobacco dependence issue.

 Maine physicians can access their personal prescribing profile showing their individual prescribing patterns alongside state, national and specialty prescribing patterns. Just select the Maine newsletter and click Personal Prescribing Profile

AMA Therapeutic Insights 

  • is free and online

  • highlights one disease condition per issue

  • features individual, state, national prescribing data* and evidence-based treatment guidelines

  • is written by top disease experts in collaboration with the AMA

  • offers AMA PRA Category 1 CreditTM

While most treatment-oriented CME programs focus solely on disease management, AMA Therapeutic Insights takes it one step further. This program delivers the actual prescribing patterns for the disease.

Visit AMA Therapeutic Insights to read this issue, as well as previous newsletters on COPD, Hypertension, Migraine, Alzheimer’s Disease and more.


*The prescribing data in AMA Therapeutic Insights are provided by IMS Health. The AMA does not collect or have access to physician prescribing data in any form. 

The AMA is accredited by the ACCME to provide continuing medical education for physicians.

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Stefanie Nadeau Appointed Director of MaineCare Services

Stefanie Nadeau has been appointed by HHS Commissioner Mary Mahew as Director of MaineCare Services.  She had been serving as acting director of the program since mid-February following the departure of Tony Marple.  Nadeau is a graduate of Thomas College and has been with MaineCare for seven years.  Prior to accepting the position of acting director, she was the Director of Program Management.

MMA expects an announcement regarding a new Medical Director for MaineCare soon.

 A recent Report from the Office of Fiscal and Program Review noted that although the MaineCare caseload has increased by over 3% in the past year, that there has been a moderation in the growth of the program in the past two years.  The 12-month growth rate peaked at 6.5% annual growth in December 2009.  Since that time, growth in the program has slowed.


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Maine Health Insurance Reform Breakfast Briefing

Health Insurance Reform: 
A Breakfast Briefing on the Impact of LD 1333

Maine's new health insurance reform law (Public Law, Chapter 90, LD 1333) will drive significant changes in health insurance regulations that will affect payers, insurers, health care providers and consumers. 

To learn more about the impact of the law you are invited to attend a special breakfast briefing on July 20th from 8:00 to 9:30 am at the Maine Hospital Association (33 Fuller Road, Augusta ).  Jointly sponsored by the Maine Health Access Foundation, Maine Medical Association, Quality Counts and Maine Development Foundation, the briefing will feature five expert panelists who will discuss their analysis of the law and answer questions from participants.  The panelist include:

  • Joel Allumbaugh, Chief Executive Officer of National Worksite Benefit Group and Director of Maine Heritage Policy Center's Center for Health Reform Initiatives
  • Jeffrey A. Austin, Vice President of Governmental Relations & Communications, Maine Hospital Association
  • Eric Cioppa, Acting Superintendent, Maine Bureau of Insurance
  • Peter Gore, Vice President of Governmental Affairs, Maine State Chamber of Commerce
  • Garrett Martin, Associate Director, Maine Center for Economic Policy

Seating is limited so attendees are requested to register in advance using our online registration form.  There is no charge for this briefing. [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]

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