May 13, 2013

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Regional Forums Scheduled on State Innovation Model (SIM) Grant

The Department of Health and Human Services has announced four regional forums in early June to present an overview of the recently announced SIM grant including specific goals, project timelines, the governance structure and the next steps moving forward.

The dates and locations for the four forums are:
June 3rd, Presque Isle-Hampton Inn
June 4th, Bangor-Dorothea Dix Psychiatric Center
June 10th, Augusta-Augusta Civic Center (Penobscot Room)
June 12,  Portland-Fireside Inn and Suites (Sebago Room)
The forums are all scheduled from 9:00am to noon and more information will be available at the Maine State website. The website will continue to serve as a source of the most recent information regarding the grant.
The purpose of testing the Maine Innovation Model is to work with state partners and the healthcare community to align healthcare payment and delivery system reform in the state across MaineCare, Medicare, and commercial payers to improve quality of care and patient satisfaction, while also achieving and sustaining lower costs.  These goals will be accomplished through public and private collaboration with providers, purchasers, and payers to connect important work that is underway and gaining traction across the state. 
Grant funds will also support the development of new workforce models, the formation of multi-payer Accountable Care Organizations that commit to value and performance based reform and will establish data measures that will be publicly reported.  Some examples of what the initiative will hope to achieve include:
  • Behavioral health providers will have access to needed resources to enable them to securely access and, where appropriate, share both behavioral and physical health information through electronic health records:
  • Care management staff will receive real-time notification for when their highest-utilizing patients use the Emergency Department or are admitted to or discharged from the hospital, so they can follow-up with patients in the most appropriate time; and,
  • There will be further integration of physical and behavioral health services by utilizing the skills of direct service workers who understand the importance of assuring both are taken into consideration during treatment.

MMA Legislative Committee Conference Call, Tuesday, May 14th, 8 p.m.

**PLEASE TAKE NOTICE - THE CALL IN NUMBER HAS CHANGED (due to technical difficulties)**

The MMA Legislative Committee weekly phone calls will continue tomorrow, Tuesday, May 14th at 8 p.m..  They will be held every Tuesday at 8 pm through the session. 

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:  1-877-668-4493  NOTE THAT THIS IS A NEW CALL IN NUMBER

Passcode:  23045263

The following are bills of interest to the physician community printed last week.  We will discuss the priority bills marked with an asterisk (*) first:

LD 1500, An Act Regarding the Cost of Copies of Medical Records (support; MMA has negotiated this compromise with HHS Committee & other stakeholders)*

LD 1509, An Act Making Unified Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2014 and June 30, 2015 (oppose cuts in hospital reimbursement)

LD 1513, Resolve, Directing the Department of Corrections, Department of Education, Department of Health and Human Services and Department of Labor To Support the Statewide Coordinated Services District System (monitor or support; pediatricians)

LD 1515, An Act To Increase the Availability of Mental Health Services (hearing 5/13; likely will testify NFNA; psychiatrists)

LD 1519, An Act To Update the Maine Insurance Code To Maintain Conformance with Uniform National Standards (monitor)

LD 1523, An Act To Strengthen the Laws Governing Mandatory Reporting of Child Abuse or Neglect (oppose; pediatricians)*

LD 1525, An Act To Streamline Billing for Mental Health Services (monitor; psychiatrists)*

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POLITICAL PULSE: Legislative Highlights from the Week

Here are some highlights of what MMA's advocacy team followed at the State House the week of May 6th.   


On Wednesday, the LePage Administration released its proposed changes to the biennial budget, which itself has yet to be approved by the legislature.  The Governor's two-year spending proposal was assembled in late fall 2012.  Since that time, things have changed, most notably, the revenue forecast for the biennium was reduced by $60 million dollars.  Also, the 600-page budget document had errors and miscalculations of various initiatives and those needed correction.  Among those items noted by the MMA: 

  • Recalculation of 10 percent Hospital Outpatient Cut - The Department of Health and Human Services (DHHS) miscalculated the amount of savings it would achieve by cutting Prospective Payment Hospital System (PPS) hospital outpatient rates by 10 percent.  The change package recalculates that amount.  The next impact is an increase in the cut from $4.9 million to $6.1 million per year (state share).
  • Opioid Policy.  The change package adds a new section, Part AAAAA of the biennial budget, that revises the MaineCare opioid policy following a year of review of the restrictive policy adopted last year.   The changes would:
    • clearly identify that the second opinion provision applies to a "condition" that is typically known to have a poor response to opioids, rather than, a "member" who is typically known to have a poor response to opioids;
    • clearly identify that the second opinion provision only applies to chronic conditions that are not typically known to have a good response to opioids; 
    • include nursing facilities as one of the groups exempted from this policy; and
    •  revise the term "alternative intervention treatments" to "therapeutic treatment options."


Last Monday, the Taxation Committee held public hearings on LD 1326, a bill that would equalize the tax on "other tobacco products" (roll your own tobacco, snuff, little cigars, etc) with cigarettes, and LD 1406, a bill that would increase the tax on cigarettes by $1.50 per pack.  The goal of both bills is to reduce youth smoking rates and decrease health costs.  MMA testified in favor of both bills and submitted testimony on behalf of Dr. Amina Qazi, a cardiologist from Bangor and incoming president of the Northern New England Chapter of the American College of Cardiology.  The bills were supported by many public health and health care organizations and opposed by the tobacco and convenient store industries.  On Friday, the Committee took up LD 1496, the proposal from the bipartisan group of lawmakers - the "Gang of Eleven" - to make major change to Maine's tax code, such as reducing the income tax and increasing sales and excise taxes.   MMA opposed the aspect of the proposal that would institute a tax on elective cosmetic medical procedures.  The MMA also submitted letters in opposition to the proposal from the American Medical Association, American Society of Plastic Surgeons,  American Society for Dermatologic Surgery Association, and the American Academy of Otolaryngology - Head and Neck Surgery.   It is unexpected for the bill to proceed this session given the timing in the session and the cool reception it has received from both parties and the Governor. 


The Insurance and Financial Services Committee last week approved LD 547, a bill to create an advisory council to evaluate the implementation and operation of the federal exchange that will be operating in Maine. The duties of the Council include advising the Governor, Legislature, Bureau of Insurance and federal government regarding the interests of individuals and employers with respect to the exchange.  The Council will be made up of 20 members, including legislators, health providers, insurance carriers and producers, individuals and small businesses.  The Bureau of Insurance will appoint the public members. 

The Committee also held a public hearing on LD 1466, a bill that would apply additional standards to entities engaged in the secondary sale of physician networks, also known as "rental network PPOs" or "silent PPOs."  MMA testified in favor of the bill.   


Last Tuesday, the Labor, Commerce, Research and Economic Development Committee held a work session on a Board of Licensure in Medicine bill (LD 1437) that would make several changes to physician and physician assistant licensing.  For example, it provides that physician assistants have the same duty as physicians to report acts of a physician's misconduct, it clarifies that a health care provider or health care entity is required to report disciplinary action taken against an employee, even if that person is employed by a 3rd party, and it allows the board to specify individuals other than physicians for the purpose of conducting examinations of physicians and physician assistants to determine whether a physician or physician assistant is mentally and physically competent.  The bill also seeks to address the issue of MD-DMD maxilliofacial surgeons not being able to receive a medical license.   The Committee voted unanimously that the bill ought to pass as amended with the major change folding the intent behind L.D. 1196 which MMA prepared to resolve the MD-DMD issue into language drafted by the BOLIM that was seen to accomplish the same purpose more artfully in statute. 


The Criminal Justice Committee held a public hearing last week on LD 1491, An Act To Strengthen the Laws Regarding Certain Crimes Committed by a Person in a Position of Authority.  The bill would eliminate the statute of limitations that applies to civil cases brought against mental health professionals for sexual acts with a patient, and would change the statue of limitations for criminal cases to 10 years.  MMA opposed the bill, citing the action the Judiciary Committee took two weeks ago to support LD 744,  extending the statute of limitations  to 6 years for professional negligence cases involving sexual acts by health care personnel providing therapy for individuals who are suffering from a mental health condition. 

The Committee also approved unanimously L.D. 1044, An Act to Amend the Laws Governing Prosecution of Individuals Possessing a Controlled Substance under Certain Circumstances, prepared by MMA and introduced by Rep. Ann Dorney, M.D. The bill is seen as essential to the introduction of an overdose prevention program in the state utilizing naloxone kits.  A similar proposal was defeated last session but both the Judiciary Committee and the Criminal Justice Committee have given favorable votes to the two companion bills this year.


The Health and Human Services Committee continues its busy pace with a number of hearings and work sessions every week.  The following were of particular interest to MMA: 

  • LD 968, An Act To Provide Needed Psychiatric Hospitalization for Persons with Mental Illness.  The bill requires the Commissioner of Health and Human Services to make psychiatric hospitalization available to a person with mental illness who is experiencing a psychiatric crisis and who has been determined by a health care practitioner to be in need of hospitalization. Dr. Karen Rice, the Chief Psychiatry Resident at Maine Medical Center and Executive Committee member of the Maine Association of Psychiatric Physicians testified in favor of the measure, along with many other mental health providers and advocates.  On Friday, the Committee voted to carry this bill over to the Second Regular Session.
  • LD 534, An Act To Improve Care Coordination for Persons with Mental Illness. This bill provides an exception to the health care information confidentiality laws that protect mental health information for the purposes of care management and coordination of care.   MMA testified in favor of the bill, though it was opposed by many mental health advocates and patients.  The Committee voted 9-1 in favor of an amended version of the bill with Representative Peter Stuckey (D-Portland) voting in opposition to the bill because he favors greater protection for mental health information than provided in the HIPAA Privacy Rule.
  • LD 1166, An Act Regarding Records Retention by Mental Health Practitioners. This bill requires mental health agencies and mental health professionals to plan for and provide secure and private retention of client records and record destruction after specified terms or when an agency or facility ceases to operate or a professional ceases to practice. MMA testified neither for nor against the bill and submitted information for the work session educating the Committee on the guidance available to physicians on records retention and closing a practice.  The Committee voted unanimously "ought not to pass" on the bill.
  • Price transparency bills: LD 755, An Act To Require Estimates of Patient Costs Prior to Treatment and LD 990, An Act To Require Public Disclosure of Health Care Prices.  The Committee voted that LD 755 (opposed by the MMA) ought not to pass and supported an amended version of LD 990 that will require hospitals to have in their possession paper lists of the costs of their most common charges and to include on that paper list a reference to the Maine Health Data Organization pricing Web site.
  • LD 1065, An Act Regarding Patient-directed Care at the End of Life.  This bill includes a number of provisions regarding care at the end of life but most notably would authorize physician assisted suicide.  MMA had opposed the bill.  A majority of the Committee voted "ought not to pass" on the bill.
  • LD 754, An Act To Encourage Transparency in the Disclosing of the Ingredients in Vaccinations for Children.  This bill is identical to a bill introduced last session and would require a health care provider or clinic staff person to disclose the ingredients of the immunizing agent or agents to the parent or guardian of the child. It also requires the health care provider or staff person to notify the parent or guardian of the option of refusing immunization of the child based on religious or philosophical beliefs. While a majority of Committee members voted against the bill, at least four members voted to support the bill, thus allowing a debate and vote on the floor of the House and perhaps the Senate. 
  • LD 753, An Act To Prohibit the Sale of High-caffeine Energy Drinks to Persons under 18 Years of Age.  Maine Medical Association and Maine Osteopathic Association testified in support of the measure.  A majority of the Committee voted against the ban but to create a work group to study the health impacts of energy drinks, taking into account the results of a pending FDA review of the beverages. 
  • LD 882, An Act To Amend the Laws Governing Confidentiality of Health Care Information To Enhance Public Safety.  This intent of the bill is to make Maine law consistent with federal regulations and preserve a practitioner's ability to report private health care information to law enforcement officials and other governmental entities in order to protect public health and welfare.  The Committee unanimously voted to support an amended version of the bill.
  • LD 1064, An Act To Improve and Modernize the Authority of Local Health Officers.  The bill would have changed the requirements for Local Health Officers and allowed them to conduct local inspections.  The Committee voted unanimously that the bill ought not to pass. 
  • The Committee unanimously rejected LD 1029, Directing the Department of Health and Human Services To Amend Its Rules Pertaining to a Request for Mental Health Records, which would have allowed a recipient of mental health services to review their records on a daily basis rather than allowing access within a "reasonable" amount of time. 
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MaineCare Health Homes Initiative: Extension of NCQA Recognition Deadline & Re-opening of Application for Participation

The Office of MaineCare Services is pleased to announce a deadline extension for NCQA PCMH recognition and the re-opening of the application process for primary care practices interested in participating in the MaineCare Health Homes initiative.  This extension is an effort to include as many eligible primary care practices as possible in the Health Homes initiative.

The deadline for achieving full NCQA PCMH recognition for practices in the Health Homes initiative is extended to December 31, 2013.The application process for MaineCare Health Homes is now open.  Practices will need to complete the online application by Fri, May 24, 2013. For practices with more than one location, a separate application must be completed for each location.

For more information about the Health Homes initiative, see MaineCare’s Health Homes webpage.

Questions about the MaineCare Health Homes initiative should be referred via email to Kitty Purington or to Lisa Letourneau. [return to top]

Friday, June 7, Let MMA Train Your Staff on HIPAA/HITECH Provisions

The June 7 First Friday educational session, offered both on site and through webex features the Annual HIPAA Update.  This year's Update is particularly important as the final HITECH rules are enforceable as of Sept. 23, 2013.  Registration is available at

The program runs from 9:00am to noon and the faculty includes Stacey Mondshein Katz,Esq. and MMA attorneys Gordon Smith, Andrew MacLean and Jessa Barnard.

MMA's updated model forms, including the Notice of Privacy Practices and the Business Associate Agreement will be distributed at the program.

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Dorothea Dix Award Presented To Former Medical Director Roger Wilson, M.D.

 Dr. Roger Wilson of Bar Harbor, former Medical Director of Dorothea Dix Psychiatric Center, was recently honored as the 2013 recipient of the Dorothea Dix Award for Community Service. The award, created by an act of the Maine Legislature in 2005, recognizes individuals for, "outstanding achievement in promoting recovery and or improving quality of life of people living with mental illness or mental disability."

Dr. Richard Brown, Advisory Board member of DDPC and a former award recipient, presented the award to Dr. Wilson earlier this month. Wilson was recognized for spending his entire adult life caring for and meeting the needs of those individuals facing the life challenges of mental illness. DHHS Deputy Commissioner of Programs Bonnie Smith also participated in the ceremony.

Dr. Wilson began his career at the Dorothea Dix Psychiatric Center in 1978 and served in many positions including Clinical Director, unit psychiatrist and acting superintendent. He retired from DDPC in 2002.

As Clinical Director, Dr. Wilson had a vision of how active treatment could be provided in a recovery focused way and created what has become known as the Wilson Treatment Mall. He researched best practices across the U.S. and instituted those practices. Dr. Wilson was also instrumental in creating outpatient services to include medical and dental care, medication management and day treatment for adults and elderly. 

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Medicare Physician Payment Reform Update

On Tuesday, May 7, the Committee on Ways and Means held a hearing on Medicare Physician Payment Reform. During the hearing, members on both sides of the aisle expressed support for replacing the SGR this year. Both the Committee on Ways and Means and the Committee on Energy and Commerce have released draft concepts for replacing the SGR beginning with a period of stability and then moving to a model the promotes quality, efficiency and value.  The committees are now working with draft legislative language, a good sign of the progress that is being made.  It is anticipated that legislation repealing the SGR will be marked up later in the summer.

On May 10, Senate Finance Committee Chairman Max Baucus (D-MT) and Ranking Member Orrin Heath (R-UT) wrote to health care providers, including physician groups, expressing their agreement that SGR must be repealed and that it remains a top priority for the Committee.  While they expressed their support for the identification of alternative models for the future, they recognized that for a period of time most physicians will continue to be paid under a fee-for-service arrangement.  In order to prevent duplication with the efforts in the House, Sens. Baucus and Hatch are soliciting specific recommendations that affect the FFS program.  The request focuses on the validity of resource inputs in determining service prices, volume control, and how best to incentivize physicians to prepare to engage in alternative payment models.

The AMA will be convening conference calls soon to discuss this request and provide further information on the progress toward eliminating the SGR this year.

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1,000 Signatures Needed this Week - Accept Federal Funds for Maine’s Health

As a member of the Cover Maine Now! coalition, the Maine Medical Association has been working to bring new federal funds to Maine to cover tens of thousands of uninsured Mainers.  

Accepting these federal dollars, which have already been set aside to cover Maine’s uninsured, will benefit all Maine people and boost Maine’s economy.  

Polling shows that nearly 70% of Mainers support accepting federal funds, but we need action to back those numbers up.  The bill to bring federal funds to Maine in 2014, LD 1066, could move at any time, so this week the Cover Maine Now! Coalition (  is setting a goal of 1,000 additional signatures on its petition.

Please send a message to your legislators today. 

Accepting federal funds will save lives and save money.  Please help us keep the momentum going!

Urge your legislators to support accepting the federal money.  

To learn more about our efforts, visit Cover Maine Now. [return to top]

Accountable Care Organizations Educational Forum for Primary Care, June 10

June 10, 2013

Accountable Care Organizations Educational Forum

Guest speaker: John Freedman, MD, MBA

 Hilton Garden Inn, Freeport

6:00 buffet dinner, 6:30-8:30 presentation and discussion

With generous support from the Maine Health Access Foundation, the Maine Medical Association is pleased to offer an educational forum with John Freedman, MD, MBA. He will be discussing the emerging role of accountable care organizations (ACOs).  This event will be targeted toward primary care providers, particularly those in independent practice seeking to better understand the potential impacts of payment reform models such as ACOs.          

John Freedman is Principal at Freedman HealthCare in Newton, MA and has 20 years' experience in systems management, managed care, health care quality measurement and quality improvement, clinical laboratory development, health economics, and medical informatics. His experience comes from leadership roles at nationally recognized organizations, such as Kaiser Permanente, Tufts Health Plan, MA Health Quality Partners, Focused Medical Analytics, and the MA Quality and Cost Council.

If you are a physician and would like to participate in this event, please reply to Jennifer Reck at, including notice of any dietary restrictions, by June 3.  There is no cost to attend. [return to top]

Prostate Screening Review - What the PCP Needs to Know, May 22

Maine Center for Cancer Medicine Presents Educational Lecture Series:  Screening & Treatment

4th Wednesday of Each Month (with exceptions), 6 pm – 7 pm

100 Campus Drive, Conference Room, Scarborough, Maine

Note: To attend the live presentation or join a lecture via Webex, contact Betsy Chase

at 207-396-7634 or

FREE CME Credit Available

May 22, 2013:  Prostate, Treatment Update  Dr. Aronson

June 26, 2013:  Lung, Screening & Treatment Update  Dr. Thomas

July 24, 2013:  Breast, Screening Update  Dr. Weisberg

August 28, 2013:  Breast, Treatment Update  Dr. Weisberg

September 18, 2013:  GI, Screening Update   Dr. Benton

October 23, 2013:  GI, Treatment Update   Dr. Dugan

November 13, 2013:  Melanoma Review and Update for the PCP   Dr. Aronson

December 18, 2013:  Palliative Care Review  Dr. Keating

January 22, 2014:  Brain, Screening and Treatment Dr. Evans

February 26, 2014:  Clinical Research Overview  Dr. Thomas

March 26, 2014:  Hematologic, Treatment Update  Dr. Ryan [return to top]

Introduction to Lesbian, Gay, Bisexual & Transgender (LGBT) Health

Looking to improve care for your patients who are lesbian, gay, bisexual or transgender?

The Maine Primary Care Association is excited to bring you this webinar training on health care for lesbian, gay, bisexual and transgender populations (LGBT), featuring Harvey J. Makadon, MD, Director of the National LGBT Health Education Center, Fenway Institute.

Date: Tuesday, May 21, 2013

Time: 12:00 PM - 1:00 PM EDT

Fee: $15.00


"Ending Invisibility, Overcoming Health Disparities" will provide an overview of LGBT health disparities, demographics, and terminology, as well as key strategies for bringing high quality care to LGBT people at health centers and other health care sites. Participants will also learn about creating LGBT inclusive environments of care and about the intersections of LGBT health, population health and patient centered medical homes.

 At the end of this webinar, participants will be able to:

  • Describe terminology and concepts related to lesbian, gay, bisexual, and transgender (LGBT) populations
  • Describe LGBT population demographics
  • Explain what it means to provide effective, high quality and culturally responsive care for LGBT populations
  • List strategies for creating a safe and welcoming environment for LGBT patients in health centers and patient centered medical homes

This is one of many special populations that MPCA will highlight via technical assistance throughout the year. For more information, contact Caroline Zimmerman, Director of Health Initiatives, and MPCA's point of contact for special populations.

This webinar is brought to you by The National LGBT Health Education Center. They provide educational programming and consultation for health care organizations throughout the nation and the world with the goal of eliminating health disparities among lesbian, gay, bisexual, and transgender (LGBT) people. The Education Center is a part of The Fenway Institute, the research, training, and health policy division of Fenway Health, a Federally Qualified Health Center, and one of the world’s largest LGBT-focused health center [return to top]

Upcoming Events

AMDA Maine State Chapter 2013 Medication Safety Conference 

May 17, 2013

11:30 am - 3 pm 

DiMillo’s Floating Restaurant

25 Long Warf Portland, ME 

No cost to Healthcare Professionals

Topics include reducing adverse drug events related to Coumadin and practical approaches to reducing antipsychotic use in dementia. 

Attendees may registration online at or by contacting Tammy Wing directly at (207) 780-6565 or email


Advancing Change:  Healthcare System Transformation in Northern New England 

Keynote Speaker:  Jay Want, MD, Center for Improving Value in Health Care

May 21, 2013

8:00 am - 5:00 pm

University of New Hampshire, 75 Main Street, Durham, NH

For more information or to register, click here


Save the Date: Enhancing Healthcare for Persons with Intellectual Disabilities

June 11, 2013

Holiday Inn by the Bay, Portland

This one-day program will provide information valuable for improving clinical and systemic capabilities for the effective delivery of healthcare to persons with intellectual disabilities.


Save the Date: 

Maine Public Health Association 29th Annual Meeting 

October 22, 2013 

8:30 am - 4 pm 

Augusta Civic Center 

For more information, click here. 

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Job Openings

Emergency Department PA

Full time summer position, mid-May to mid-October.  Emergency Department practitioner.  Primary duties are direct patient care in the emergency room setting; diagnosis and treatment; meeting with physician supervisor in a timely manner.  Graduate of approved Physician Assistant's program.  Certification in BLS, ACLS, PALS, and ATLS or equivalent.   Current Maine licensure.  Medical Practice maturity as evidenced by at least two years of mid-level practitioner experience within an emergency department setting or by completion of an ER specific residency training program.

For more information or to apply please visit us at or contact Charlotte Skiff at 207-288-5081, ext. 1165 or


Behavioral Health Consultant

Sacopee Valley Health Center is seeking a full time LCSW to join our Medical Team as the Behavioral Health Consultant.  This position involves working with patients in a busy integrated primary care setting to more effectively manage the behavioral aspects of their physical/mental illnesses and/or chronic medical conditions.

Applicant must possess valid State of Maine license or be license eligible.  Experience in a health care setting preferred.  Anticipated start date for this position:  June 3, 2013.

Send resume to or mail to:  Human Resources Coordinator, Sacopee Valley Health Center, P.O. Box 777, Parsonsfield, ME 04047.  Sacopee Valley Health Center is an equal opportunity provider and employer.


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