November 14, 2011

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Super Committee Deadline Fast Approaching

The so-called Super Committee has only a handful of days left to agree on a package of revenue increases and spending decreases amounting to at least $1.2 trillion in order to reduce the rapidly increasing federal deficit.  The legislation establishing the Committee requires that their report be scored by the Congressional Budget Office by November 23rd.  If no agreement is reached, the legislation provides for an automatic reduction by means of sequestration.  The AMA, MMA and other medical organizations continue their advocacy regarding the need for the Committee to include in its recommendations a permanent fix to the Medicare Sustainable Growth Rate formula.

At the AMA Interim meeting this week in New Orleans, AMA advocacy staff expressed some optimism that the Committee would come up with a package of savings and that the scheduled reduction of nearly 30% in Medicare fees will be fixed, at least temporarily.

With Congress facing a historically low approval rating of 9%, the Congress would face an even more hostile electorate if a bipartisan agreement is not reached.

Watch future editions of the Update to stay informed on this important topic.  If the 30% reduction takes place, it would cost each physician in Maine or their employer approximately $30,000 per year.

Also see the article below for further information on the AMA interim meeting.



Report on Interim Meeting of AMA House of Delegates

The American Medical Association House of Delegates convened for its Interim Meeting Saturday (Nov.12) in New Orleans.  Attending from Maine were AMA delegates Richard Evans, M.D. of Dover Foxcroft, Maroulla Gleaton, M.D. of Palermo, MMA President Nancy Cummings, M.D. of Farmington and Executive Vice President Gordon Smith.  Specialty society representatives from Maine included Jo Linder, M.D., Sam Solish, M.D., Jack McGill, M.D., and Daniel Spratt, M.D.

The Interim Meeting in recent years has been limited to advocacy issues with other business of the House taking place at the Annual Meeting in June. This meeting was dominated by discussing the implications of the pending Medicare payment reduction as a result of the sustainable growth rate formula and the steps physicians and seniors need to take to help prevent it.  In Maine, the cut would exceed 27.5% and would be devastating for seniors, physicians, hospitals and other health professionals who treat Medicare patients.

Notwithstanding the daily news stories of the difficulty the so-called Super Committee is having meeting its deadline of November 23rd, there is some optimism being expressed by AMA advocacy staff that at least a partial solution to the Medicare cut will be found.  A one to two year delay is likely.  While the Super Committee process gives the Congress a good opportunity to permanently fix the SGR formula, the most that can be hoped for now is probably another delay. The larger the package is that the Committee recommends, the more likely it is that all $300 billion needed to permanently fix the formula could be found.

The meeting also included some excellent educational sessions regarding issues ranging from prescription drug abuse to Accountable Care Organizations.  Transformation of health care delivery:  Navigating the challenges and opportunities was of particular interest. The program looked at different and new practice models that focused on coordinated care, accountable multispecialty groups and large integrated systems of care. [return to top]

Save the Date: MMA Legislative Committee Meeting, Dec. 6

Save the Date: MMA Legislative Committee Meeting 

Tuesday, December 6, 2011

6:30-8:30 p.m. 

MMA Headquarters, Association Drive, Manchester

All MMA members, specialty society leadership and legislative liaisons, and interested parties are welcome to join.  The Committee will discuss priorities for the second session of the legislature, MMA advocacy work related to the Affordable Care Act and Maine's health insurance reform law (Chapter 90) and organizational issues.  Dinner will be served. 

RSVP to Maureen Elwell, or (207) 622-3374x 219.


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Commission to Study Fund for Healthy Maine Holds First Meeting

A Commission appointed by the legislature to study the allocations within the Fund for Healthy Maine held its first meeting Friday, November 4th.   The Fund was created after a settlement with the major tobacco companies over health care related costs to the State.  It is the State's largest sources of prevention dollars.  

The Commission is charged with the following tasks: 

  1. Identifying and reviewing the State's current public health care and preventive health priorities and goals;

  2. Identifying and reviewing strategies for addressing priorities and goals; 

  3. Assessing the level of resources needed to properly pursue the strategies identified; 

  4. Recommending how Fund for a Healthy Maine funds should be allocated to most effectively support the State's current public health and preventive health priorities, goals and strategies; and

  5. Recommending the processes to be used to ensure that Fund for a Healthy Maine allocations stay aligned with the State's health priorities and goals.

The Fund is currently used to support smoking prevention, cessation and control; prenatal and young children's care; child care; health care for children and adults; prescription drugs for adults; dental and oral health; substance abuse; and comprehensive school health and nutrition programs. 

The Commission is made up of three members of the Maine Senate, four members of the House, public health representatives and representatives of programs that are funded through the Fund for Healthy Maine.   At their first meeting, the Commissioners reviewed their charge and the history of the Fund and began to hear from the Department of Health and Human Services about their priorities for prevention.   They also heard public comment from a number of public health organizations about the needs to fund prevention in the state.   

The Commission has two additional meetings scheduled, for Thursday, November 17th and Tuesday, November 29th.  They will report their recommendations to the legislature in December.  Commission materials, including the members of the Commission, can be found here.  

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T.R. Reid Discusses Health System Reform with Study Group

As a part of his week-long visit to Maine, last Wednesday journalist T.R. Reid met with members of the Maine Health Policy Study Group for a dynamic discussion about the U.S. health care delivery system.   Reid is known for his book The Healing of America in which he describes how countries including France, Germany, Japan and the U.K. have been able to provide greater access to health care at lower cost compared to the United States.  The Health Policy Study Group grew out of last years Physicians Day at the Legislature and is comprised of of health care professionals dedicated to the study of health care policy and financing.  They had read and discussed Reid's book before the evening. 

In a wide ranging discussion, physicians, physician assistants and current Bates pre-medical and public health students asked Reid about how to improve access to care, address health system costs and financing and improve incentives to provide primary and preventive care.  Reid also described what he learned in researching his newest documentary, U.S. Health Care: The Good News, in which he profiles locations around the country that have been able to reduce cost while improving care though various mechanisms including improved information sharing, setting prices, standardizing care plans and a commitment to the fiscal health of the community.  The documentary airs on PBS stations on February 16th.

Wednesday's event was jointly sponsored by the Maine Medical Association, Maine Osteopathic Association, Bates College and University of New England College of Osteopathic Medicine.

The Health Policy Study Group will next be reading Getting Health Reform Right: A Guide to Improving Performance and Equity by Marc Roberts, Peter Berman and William Hsiao.  If you are interested in joining the group, contact Angela Westhoff, Executive Director of the Maine Osteopathic Association, 623-1101 or

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U.S. Supreme Court to Hear Health Reform Case

The U.S. Supreme Court decided today that they will hear a challenge to the Patient Protection and Affordable Care Act.  The justices will hold over five hours of oral argument in March.  They have agreed to consider five issues: whether Congress overstepped its constitutional authority in passing the individual mandate that requires virtually all citizens to purchase health insurance or pay a penalty; whether the mandate can be severed from the balance of the law, if it is found unconstitutional;  whether Congress had the authority to expand the eligibility and coverage thresholds that states must adopt to remain eligible to participate in Medicaid; and whether the Anti-Injunction Act, which bars suits that seek to restrain the IRS's assessment and collection of taxes, prevents the individual mandate from being challenged before an individual has actually been subject to the penalty for not purchasing insurance.  

A decision is expected in June.  All of the issues that the Supreme Court will decide stem from cases decided before the U.S. Court of Appeals for the Eleventh Circuit in Atlanta. 

Just days earlier the U.S. Court of Appeals for the District of Columbia Circuit declared that Congress had the authority to adopt the individual mandate in the ACA.  That decision can be found here [return to top]

MeCDC, DHHS Organizational Changes

In an effort to streamline operations, the Maine Centers for Disease Control and Prevention announced last Thursday that they were undertaking an internal reorganization. 

The have made the following changes:  

  1. The Office of Local Public Health will be the Division of Local Public Health.  This Division will house the Public Health District Liaisons, WIC, Public Health Nursing and Rural Health and Primary Care.  The intention is to strengthen the local public health infrastructure.

  2. The Division of Chronic Disease and the remaining programs in the Division of Family Health will be merged into the Division of Population Health.

  3. The Women’s Health Program will be part of the Office of Minority Health.

 No programs have been eliminated with this reorganization. The changes take effect today, November 14th. 

This week, the Department of Health and Human Services also updated legislators on staffing changes.  Ron Welch and Don Chamberlain with the Office of Adult Mental Health Services, Diana Scully with the Office of Elder Services, and Jane Gallivan with the Office of Adults with Cognitive and Physical Disabilities Services were all removed from their positions in August.  Guy Cousins is serving as acting director of the Office of Adult Mental Health Services. Ricker Hamilton is now director of the Office of Elder Services and is also serving as acting director for the Office of Adults with Physical and Cognitive Disabilities Services.

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FDA Releases Draft Blueprint for Opioid Prescriber Education

November 7th, the Food and Drug Administration announced the availability of a draft document entitled “Blueprint for Prescriber Education for the Long-Acting/Extended-Release Opioid Class-wide REMS." The draft Blueprint contains core messages intended for use by continuing education providers to develop educational materials to train prescribers of long-acting and extended-release opioids under a required risk evaluation and mitigation strategy (REMS) for these products.

The FDA has required all companies that market long-acting and extended-release opioids to submit a risk evaluation and mitigation strategy.  The central component of the strategy is education program for prescribers so that the medications can be prescribed and used safely. The FDA expects the education to be conducted by accredited, independent continuing education providers funded by unrestricted grants from the companies. 

FDA seeks stakeholder input on the Blueprint. After comments are received, FDA will revise the Blueprint as appropriate, incorporate it into the Opioid REMS when it is approved, and post it on FDA’s Web site for use by continuing education providers. 

Links of interest:

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Free ACA & Maine Health Insurance Reform Law Webinar, Nov 18

The MMA is pleased to announce a series of free webinars covering health care reform updates. 

The Affordable Care Act and Maine's New Health Insurance Law (Chapter 90) 

Hear from MMA staff attorneys about important updates impacting Maine patients and physician practices from the national Affordable Care Act and Chapter 90, Maine's new health insurance law. 

November 18th, 12-1 pm 

The Medicare Wellness Visit

What practices need to know about billing and coding for the new Medicare Wellness visit.  Make sure your office is taking advantage of the opportunity to bill for this new service. 

December 16th, 12-1 pm 

Speaker: Laurie A. Desjardins, CPC, PCS

Laurie joined Baker Newman Noyes in 2006. She is a Senior Manager in the Healthcare Management Consulting Division specializing in revenue management including physician coding, provider based implementation, chargemaster analysis, fee schedule analysis, chart review, and coding and billing education.

For more information or to register for any of the sessions, contact Jessa Barnard, MMA Associate General Counsel, at or  207-622-3374 x 211 

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Upcoming Events & Conferences

Fall is conference season!  Take advantage of the many upcoming learning opportunities, including: 


2011 Infectious Disease Conference 

Tuesday, November 15, 2011 ~ 8:30 a.m. - 4:00 p.m. 

Augusta Civic Center, Augusta, Maine 

Since 1983, the Maine Center for Disease Control and Prevention, Division of Infectious Disease, Department of Health and Human Services has organized an annual infectious disease conference targeting public health issues of emerging concern to medical practitioners throughout the State.

For more information, or to register, click here


Chemicals and Our Health: Consumer Choices & Policy Decisions 

Tuesday, November 15, 2011 ~ 7:00 p.m. - 8:00 p.m. 

Central Maine Medical Center, Conference Room B, 12 High Street, Lewiston, Maine 

The Patrick Dempsey Center for Cancer Hope and Healing is pleased to announce a joint presentation with the Environmental Health Strategy Center on toxic chemicals and their impact on human health. What are some choices we can make as consumers to avoid toxic chemical exposure? When is toxic chemical exposure out of our control, and what policies do we need to enact in order to protect our health? Each of our panelists, including a parent, health professional, and policy advocate, will offer insights on this challenging public health issue.  The event is free to attend. 

To Register: (207) 795-8250 or 

Maine Medical Group Management Association Half Day Educational Session 

Wednesday, November 30, 2011 ~ 8:00 a.m. - 12:00 p.m. 

Maine Medical Association, 30 Association Drive, Manchester, Maine or via Webex 

Collection Law presented by William Lund & Confidentiality in the Office presented by Medical Mutual 

$25 for MEMGMA members and $40 for all non-members

For for information, contact:

 Karen Wheeler at (207) 873-6173 or

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Final 2011 First Friday Program on Dec. 2 Focuses on Supervising Mid-level Providers and Delegation

MMA concludes its 2011 educational programs on Friday morning, December 2nd when health lawyers, risk managers, regulators and physician assistants will discuss the requirements of supervising mid-level providers and the standards and risks associated with delegating medical tasks to medical assistants. Standards of practice will be addressed from the point of view of risk management, state regulations and payor requirements.  This three hour program will be available live and via webex.  The cost is $65 per person and the program will run from 9:00am to noon.

Watch your e-mail this week for a flyer on the program, which will also be included as an insert with the Fall issue of Maine Medicine.

Any questions about the program should be addressed to Gail Begin at MMA.  Gail can be reached at 622-3374 ext. 210 or via e-mail to  
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Medicare Shared Savings/ACO Program Application Released

CMS has posted the application for the 2012 Medicare Shared Savings/ACO program.  The 21 page application can be submitted between December 1st and January 20th for participation beginning April 1, 2012 and between March 1st through March 30th for participation beginning July 1, 2012

CMS will host a National Provider call on Tuesday, November 15, 1:30 to 3:00 pm ET, to provide more details about the program application process. In order to receive the call-in information, you must register for the call.  Registration will close at 12:00 pm on Tuesday, November 15th or when available space has been filled.  No exceptions will be made.  Please register early.  To registerplease visit
The AMA is also hosting a free webinar on the ACO final rule on Monday, November 21st at 7:00 pm ET. AMA President-elect Jeremy Lazarus, MD, and national expert Harold Miller will host a 60-minute webinar that will outline the significant improvements and opportunities for physicians in the final ACO rule, describe application information, and answer physicians’ questions about ACOs and other payment innovations.   Click here to register for this program.
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Results of MMA Survey Monkey Poll

Thanks to those MMA members who took the two minutes required to complete the survey monkey sent out last week, asking for answers to four short questions. We plan to send out similar short surveys every three moths. 

The results are as follows:

1.  Two other New England states are now considering the prospect of legalizing physician-assisted suicide.  Is It time for MMA to reconsider its opposition to this practice?

Yes     45.1%

 No      54.9%

2.  Governor LePage announced last week he intends to require drug testing or welfare recipients.  Would you support such testing?

Yes     44.7%

No       55.3%

 3.   The recent summit on prescription drug abuse sponsored by Attorney General Schneider explored a number of potential requirements before a physician can prescribe narcotics?  Please check any of the following requirements that you would support.

Require a portion of CME requirements to be devoted to the topic of prescription drug abuse, diversion and addiction.   39.3%

Require that physicians prescribing above a fixed threshold enroll in the prescription monitoring program.  61.5%

Require that all patients receiving a controlled substance for treatment of chronic pain sign a treatment contract containing elements recommended by the Maine Board of Licensure in Medicine.   85%

4.  A proposal has recently surfaced which would provide a two-year limit for Suboxone users on Maine Care, unless a prior authorization is obtained.  Would you support or oppose such a requirement?

Support  59.8%

Oppose  40.2%


Thank you for your participation.        [return to top]

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