August 15, 2011

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Federal Appeals Court Strikes Down ACA's Individual Mandate; Supreme Court Likely Next Step

The 11th Circuit was reviewing a decision of the U.S. District Court for the Northern District of Florida declaring the entire ACA invalid.  There is now a split in the Circuit Courts of Appeal since the 6th Circuit found the individual mandate constitutional in a decision handed down on June 29th.  This split makes it more likely that the U.S. Supreme Court will grant review of one of these cases.  The most recent case is Florida v. HHS, 11th Cir., No. 11-11021, 8/12/11.  The case in the 6th Circuit is Thomas Moore Law Center v. Obama.

The 11th Circuit Court of Appeals last week struck down the requirement in the federal health care reform (ACA) that most Americans purchase health insurance beginning in 2014.  In a 2-1 opinion written by Chief Judge Joel Dubina and Circuit Judge Frank Hull, the Court concluded that Congress overstepped its authority in including this provision in the landmark health care reform law enacted more than one year ago. 

The 207-page opinion found that lawmakers cannot require residents to "enter into contracts with private insurance companies for the purchase of an expensive product from the time they are born until the time they die."  In a dissenting opinion, Circuit Judge Stanley Marcus accused the other two Judges of ignoring the "undeniable fact that Congress' commerce power has grown exponentially over the past two centuries."  He concluded that Congress generally has the constitutional authority to create rules regulating large areas of the national economy.

The Justice Department can now ask the full 11th Circuit to review the panel's decision and also likely will appeal to the Supreme Court.  A request for a full 11th Circuit review would likely take any Supreme Court action beyond the 2012 election.  In reaction to the opinion, White House adviser Stephanie Cutter stated that, "Individuals who choose to go without health insurance are making an economic decision that affects all of us - when people without insurance obtain health care they cannot pay for, those with insurance and taxpayers are often left to pick up the tab."

While the court's opinion was seen as a significant setback to the President's health care reform initiative, there was a positive aspect in the decision for the President as well.  The 11th Circuit was reviewing a sweeping decision by Federal District Court Judge Roger Vinson who not only had struck down the individual mandate but had found the remaining provisions of the law to be so connected to the mandate that he struck down the whole law.  However, the Circuit Court decision left the remainder of the law intact, finding that the "lion's share of the act has nothing to do with private insurance, much less the mandate that individuals buy insurance."

Governor Paul LePage applauded the appeals court decision and said the ruling illustrates that the federal government's powers are not limitless.  He stated that the decision was a step forward in "upholding our liberties" under the Constitution.



MMA and OSA Offer Free CME on Preventing Prescription Drug Abuse in Bangor, August 30

Through funding provided by the State Office of Substance Abuse, the Maine Medical Association is presenting three CME programs in Bangor, Lewiston, and Manchester on August 30th, September 14th, and October 7th, respectively focusing on the very serious problem of prescription drug addiction and diversion.

The August 30th program will be held at EMMC in Mason Auditorium from 4:00 p.m. to 8:00 p.m.  Dinner will be provided. The faculty for the Bangor program includes local DEA agent Chris Gardner, PMP Coordinator Trish Lapada, MMA EVP and attorney Gordon Smith, and Tamas Peredy, M.D.  The September 14th program will be held at St. Mary's General Hospital, also from 4:00 to 8:00 p.m. with dinner provided.  The October 7th program will be held as part of MMA's popular First Fridays educational series from 9:00 a.m. to noon and will also be offered as a webinar.  There is no cost for these programs.

The format for each program is identical, although the faculty varies.  Each program will begin with a review of the problem by a local DEA agent, followed by presentations by program staff for the prescription monitoring program, legal staff for MMA, and a clinical talk by a physician experienced in addiction and diversion.

Watch for further information on the programs but you may reserve a seat now by registering with Gail Begin at MMA through e-mail to or call the MMA office at 622-3374 and press 0 for the attendant.  Registration is also available on the MMA website at [return to top]

MMA Legislative Summary from First Session Now Available

MMA Director of Public Health Policy Jessa Barnard, J.D. has completed a 50-page summary of the actions of the First Session of the 125th Maine Legislature which concluded in late June.  The report includes a discussion of all the actions which impacted on medical practice and public health.  MMA members or their staff may obtain a copy of the summary by communicating with Maureen Elwell at 622-3374, ext. 219 ( or by accessing the report from the MMA website at   Copies of the report will also be available at the MMA Annual Session being held in Bar Harbor from September 9-11.

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New Appointments to Board of Licensure in Medicine

Governor Paul LePage recently appointed Louisa Barnhart, M.D. to fill the remainder of the unexpired term on the Board of Licensure in Medicine of George "Joe" Dreher, M.D. who resigned.  Dr. Barnhart is a psychiatrist who practices at Maine General Medical Center in Augusta and Waterville.  The Governor also appointed as a public member of the Board Dana Dyer of Round Pond.

As previously reported in the Update, Portland anesthesiologist David Andrews, M.D. was appointed to a full six- year term on the Board last month.  Dr. Andrews practices primarily at Mercy Hospital and is associated with Spectrum Medical Group.

 With these appointments, the licensing board now has a full complement of members.  The Board meets monthly on the second Tuesday of each month at its offices in Augusta.  While the meetings are open to the public, much of the work regarding complaints is done in Executive Session.  Agendas for the meetings are available on the Board's website. [return to top]

Care About Your Care & Dr. Oz Broadcast, September 14

Join us at the Spectacular Event Center in Bangor to learn about what you can do to identify and receive better health care.

On Thursday, September 15th, the Care About Your Care event will include a live national noontime broadcast featuring popular health author and television host Dr. Mehmet Oz.  The live broadcast will be preceded by a health fair with exhibits and screenings beginning at 10 a.m. and will be followed by a panel discussion about what quality care entails, how to find it, and how to be a more engaged patient. 

Care About Your Care is a coordinated effort led by the Robert Wood Johnson Foundation to increase awareness about what consumers can do to identify and receive better health care.  

Hosted by the Aligning Forces for Quality initiative in Maine, led by Maine Quality Counts in close collaboration with the Maine Health Management Coalition and the Dirigo Health Agency's Maine Quality Forum, in partnership with the Bangor Beacon Community.

 For more information, visit Maine Quality Counts.

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Tonight - Public Forum on Health Insurance Reforms

Are you worried or confused about upcoming changes in state and federal health insurance regulation? 

Bangor area residents are invited to bring their questions to a community forum from 5 to 7 p.m. on Monday, August 15 at the Bangor Public Library. Organized and hosted by the Bangor Daily News with support from the nonpartisan, nonprofit Maine Health Access Foundation, the event is free.

The forum will feature experts Joel Allumbaugh, director for Health Reform Initiatives for the Maine Heritage Policy Center; Mitchell Stein, policy director at Consumers for Affordable Health Care; and Dr. Sheila Pinette, director of the Maine Center for Disease Control and Prevention.  The three panelists will provide factual information on health insurance changes and discuss the role of the state in promoting good health among all Maine residents.  An audience question-and-answer and discussion period will follow.

Reservations are not required, but seating is limited. 

For more information, please contact BDN Health Editor Meg Haskell at or 990-8291.

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2011 ALA Annual Meeting - The Clean Air Act - 40 Years Protecting Public Health

The American Lung Association in Maine

2011 Annual Meeting Awards Ceremony & Luncheon   


 Friday, October 14th ~ 11:00 a.m. to 2:00 p.m. 

Sable Oaks Marriott, South Portland, Maine


 The Clean Air Act

40 Years Protecting Public Health  


Keynote:   Curt Spalding, Administrator

                     New England (Region I), US Environmental Protection Agency  

Space is limited, register today!


Contact:  Michelle Edwards,  207.624.0304 or 

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CMS Reports Physician Group Practice Demonstration a Success

The Centers for Medicare & Medicaid Services (CMS) announced last week that its Physician Group Practice (PGP) demonstration increased quality of care while reducing costs for the 10 participating physician groups. The five-year PGP was designed to determine whether altered provider payment structures could increase care coordination and quality while concurrently decreasing costs to the program by reducing the need for expensive but potentially unnecessary care, such as re-hospitalizations. 

On top of regular Medicare payments, physician groups received incentive payments to practices that met certain benchmark scores on quality measures and achieved savings to Medicare.  All 10 of the participating groups reached benchmark performance scores on 30 out of 32 measures, with 7 of 10 meeting the benchmark on all 32 measures.  All participants achieved significant improvements on quality measures for conditions such as diabetes and heart failure.  Overall, the program saved Medicare around $134 million, about $107 million of which was paid to qualifying physician groups as incentive payments.

All 10 groups will participate in the two year PGP transition demonstration, enacted to build upon the initial PGP program.  The PGP demonstration is thought to provide lessons for newer models built on similar principles, including Accountable Care Organizations.

Read the CMS press release on the PGP demonstration.

Read the CMS PGP fact sheet.

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HHS, Treasury Issue Proposed Exchange Rules

Last Friday, the U.S. Departments of Health & Human Services and Treasury released three proposed rules regarding implementation of new state-based health insurance exchanges.

The rules detail enrollment and eligibility standards, including small employer participation, and how premium tax credits for low-income individuals will be administered.

The HHS rule on Exchange Eligibility and Employer Standards proposes standards and procedures for enrolling individuals in the online insurance exchanges through a simplified, coordinated system that verifies income and eligibility in “near real-time.”

The same proposed rule also sets out standards for employer participation in the Small Business Health Options Program (SHOP), which permits small employers to purchase health insurance on the exchange.

The proposed HHS rule on Medicaid Eligibility covers the eligibility determination process for low-income individuals, ensuring the process is coordinated and “seamless” among state Medicaid programs, the Children’s Health Insurance Program, and the exchanges.

The same rule also attempts to ensure that the exchanges provide a “one stop” enrollment process that will correctly place low-income applicants into Medicaid or provide them with premium tax credits that are available to allow low-income individuals to purchase insurance on the exchanges.

The proposed Treasury rule on Health Insurance Premium Tax Credits explains the administration process for the premium tax credits that will be available to help individuals with incomes between 100 percent and 400 percent of the federal poverty level purchase health insurance on the exchanges.

Under the Affordable Care Act, states are expected to have health insurance exchanges in operation by January 1, 2014.  If they choose not to do so, or if HHS determines they are not prepared to operate an exchange, the ACA directs HHS to run the state exchange.

More information about the proposed rules is at [return to top]

Universal Vaccination Program Updates

Maine's Universal Childhood Immunization Program was established by P.L. 2009, Chapter 595 to provide all children from birth until 19 years of age in the state with access to a uniform set of vaccines as determined by the Maine Vaccine Board.   Vaccine purchase is funded by an assessment on health insurance carriers and 3rd-party administrators.  Patients will not be charged for the cost of the vaccine.  Therefore, financial barriers, (e.g. high insurance deductibles and out-of-pocket expenses), will no longer be an obstacle for children to receive vaccine.

The Program has recently launched a website with FAQs for physician practices -  providing information about vaccination purchasing, office procedures and other changes practices and patients will see under the program -  and the list of vaccines that will be covered in for the program year commencing on July 1, 2011.

In answering what changes you might see in your office under the program, the FAQs state that the Maine Immunization Program will operate much the same as it currently does.  Availability of state supplied vaccines will be expanded to all children and more vaccine choices will be available.  Vaccine ordering and accountability processes are expected to remain relatively the same.  All providers who receive state supplied vaccine will be required to use the ImmPact2 Immunization Information System for ordering and vaccine accounting.  The program also recommends that physician practices evaluate their upcoming vaccine need for privately insured patients from now until January.  Pre-planning will help offices deplete private inventory and prepare for universal vaccine supply in January 2012.  Practices will still bill insurers normally for vaccine administration. 

For additional information, please contact the Maine Immunization Program at 1-800-867-4775 or or the Maine Vaccine Board at: or

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Primary Care Practice Managers Needed as Volunteers for Focus Groups August 23 and 29

As part of the Association's efforts to improve coverage opportunities for patients, MMA is conducting a series of focus groups of practice managers of primary care practices.  The intent is to learn more about how MMA can be more effective in assisting practices with finding better coverage and increased benefits for patients.  The effort is funded through a grant from the Maine Health Access Foundation (MeHAF).

Two focus groups are planned for Portland on Tuesday, August 23rd, with the first in the afternoon and the second in the evening.  A session in Bangor is planned for the evening of Monday, August 29th.  Eight to ten individuals are needed for each session.  Meals will be provided and a $100 gift card given to each participant to recognize their time. The focus groups will be conducted professionally by Sam Surprise of Surprise Advertising, a MMA Corporate Affiliate.

If you or a colleague are interested in participating, please contact EVP Gordon Smith at [return to top]

Ideal Medical Practices Announces Annual Conference, October 14-16
Ideal Medical Practices (IMP) announces its Annual Conference in Silver Spring Maryland, October 14-16, 2011. IMP is a 501(c)(3) non-profit corporation working on behalf of those who want to deliver ideal medical care.  The goal of the organization is to become a trustworthy resource for unbiased, evidence-based, patient-centered care by providing the roadmap, tools, and community needed for clinicians and organizations to develop their own Ideal Medical Practices.

For more information contact or go to
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Federal Joint Deficit Reduction Committee Members Named

Congressional leaders now have completed assignments to the 12-member joint Senate/House committee tasked with making recommendations to reduce the federal deficit by at least $1.2 trillion.  The panel includes the following members:


  • Senator Max Baucus (D-MT), Senate Finance Committee Chairman

  • Senator Patty Murray (D-WA)

  • Senator John F. Kerry (D-MA)

  • Senator Jon Kyl (R-AZ)

  • Senator Patrick J. Toomey (R-PA)

  • Senator Rob Portman (R-OH)

  • Representative Fred Upton (R-MI), House Energy & Commerce Committee Chairman

  • Representative Dave Camp (R-MI), House Ways & Means Committee Chairman

  • Representative Jeb Hensarling (R-TX)

  • Representative James E. Clyburn (D-SC)

  • Representative Xavier Becerra (D-CA)

  • Representative Chris Van Hollen (D-MD)

If this committee cannot agree on deficit reduction recommendations, or if Congress fails to approve their recommendations, then automatic cuts become effective, including reductions in provider payments and defense spending.


The AMA, MMA, and other medical organizations will be following this committee's work closely and will be urging Congress to address the Medicare physician payment problem, the "sustainable growth rate" (SGR) formula.  The following are the AMA's talking points on the issue.

The Joint Select Committee on Deficit Reduction Must Address the SGR

• The AMA strongly urges the Joint Select Committee on Deficit Reduction to include

a provision to permanently reform the Medicare physician payment system.

• Any serious proposal to confront the fiscal challenges facing our nation, and the

Medicare program in particular, must address the massive shortfall in funding

for Medicare payments for physician services.  The current Sustainable Growth

Rate (SGR) formula calls for cuts of 29.5% on January 1, 2012.  There is unanimous

agreement that cuts of this magnitude will result in massive disruptions for the

nation’s elderly and disabled populations.

• Failure to act now will dramatically INCREASE the cost of necessary action in

the future.  Had Congress acted as recently as 2005, the ten-year cost of preventing

future cuts would have been $48 billion.  Today, it is estimated that averting currently

scheduled cuts would cost nearly $300 billion over the next ten years.  If Congress

were to wait until 2016 to eliminate the SGR, the combined score for providing

temporary patches through 2016, and then eliminating the SGR, is estimated to

approach $600 billion.

• Continued short-term interventions are creating instability in physician

practices and are jeopardizing seniors’ access to care.  Since 2002, the SGR

formula has annually called for reductions in Medicare reimbursements.  Payments

were cut by 5 percent for 2002.  Congress has intervened on 12 separate occasions

since then to prevent additional cuts from being imposed.  Five separate bills were

passed to stop a 22 percent cut in 2010 alone.  Over the last decade, temporary

patches have not kept up with the growth in physician practice costs real inflation-adjusted

Medicare payment rates have been cut 16 percent.

• Eliminating the SGR is an essential element of any effort to reform Medicare.

Congress should ensure that the necessary funding is provided, in a credible and

fiscally responsible manner, to ensure beneficiaries’ continued access to physicians.

Growth in health care costs can be better restrained by appropriate program design

and delivery system reforms that incorporate new payment models that align payment

policies to improve efficiency, quality of care, and care coordination.  These goals

and other aspects of health system reform are sabotaged by the SGR.

• A credible deficit/debt agreement should not include a Medicare budget baseline

that assumes draconian physician payment cuts of almost $300 billion.  The final

report released by the National Commission on Fiscal Responsibility and Reform

(Simpson-Bowles) on December 1, 2010 as well as the recommendations of the

Senate bipartisan “Gang of Six” included funding to permanently reform the SGR

while also achieving $4 trillion in overall deficit reductions.  It can be done.

Allowing this problem to mushroom undermines the Medicare promise of access and

choice of physician and is contrary to achieving the fiscal discipline sought by voters

and the financial markets.

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Secretary of State Issues Notice on 21-Day Temporary Disability Parking Permits

Recently, the Maine Legislature passed L.D. 456 (P.L. 2011, Chapter 117), An Act Relating to Temporary Disability Parking Permits.  This new law establishes a 21-day temporary disability parking permit for use by individuals eligible for disability parking placards and plates pursuant to 29-A M.R.S.A. section 521.  This 21-day permit will be issued directly to patients by those medical professionals authorized to certify disability parking applications and can be used while the patient is waiting to receive their permanent placard or plate from BMV.  

The placards will be available on or before October 1, 2011 at no fee to you.

If you are interested in providing these placards to your eligible patients, or for more information, please contact Vicki Lawry at, or by telephone at 624-9193.

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