July 9, 2012

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Presentations on ACA Added to Practice Education Seminar on July 25 in Augusta

It is not too late to register for the Association's 21st Annual Practice Education Seminar being held on Wednesday, July 25th  at the Augusta Civic Center.  In addition to breakout sessions on the Supreme Court decision on the ACA and what it means to Maine physicians, the Seminar features three keynote presentations by national speakers including the President of the Medical Group Management Association, Susan Turney, M.D. and the President of the Physician Insurance Association of America, Brian Atchinson, Esq.  

In the aftermath of the Supreme Court decision, MMA has added an additional ACA track to the 21st Annual Practice Education Seminar being held at the Augusta Civic Center on Wednesday, July 25th from 8:30 a.m. to 4:30 p.m. During each of the three breakout sessions an ACA session will occur, beginning with an overview of the recent Supreme Court decision and what it means for Maine's physicians, hospitals, and patients.  The second presentation will focus on the Medicare annual wellness visit provided for in the law and the final break out will be a limited-enrollment  focus group with practice staff and physicians on how ACA implementation should proceed in Maine.

Registration is available on the MMA website or by calling Lisa Martin at MMA at 622-3374, ext. 221 or via e-mail to lmartin@mainemed.com.  The full brochure is available here

The keynote presenter for the event is Susan Turney, M.D., President of the Medical Group Management Association (MGMA) in Englewood, Colorado.  Prior to accepting the MGMA position, Dr. Turney served as Executive Vice President of the Wisconsin Medical Society.  Dr. Turney will share with attendees the trends she sees across the country now that the Supreme Court has issues its ruling.  She is also expected to comment upon the recently established CO-OP in Maine, Payment Reform, and Health Information Exchange.

Maine's former Insurance Superintendent Brian Atchinson, Esq. is the luncheon speaker.  Mr. Atchinson is now serving as President of the Physician Insurers Association of America and will update attendees on medical liability trends across the country.  He was instrumental in the enactment of Maine's pre-litigation screening panels in the 1980s when he served as legal counsel to Susan Collins when she was Commissioner of Professional & Financial Regulation in the McKernan Administration.

The afternoon keynote presentation will be given by Suzan Oran, a national speaker on the subject of engaging staff in the delivery of excellent patient care.

Nine breakout sessions are also scheduled on the following topics:

  • Employer Expectations of Maine Physicians
  • Maine's New CO-OP Health Plan
  • MaineCare Update
  • Update on State HIT and Health Information Exchange
  • Responding to Complaints to State Licensing Boards
  • Tools for Medical Professionals in Assessing Senior Drivers
  • Update on Actions of the 125th Legislature
  • Prescription Drug Abuse and the Prescription Monitoring Program
  • What's New in Academic Detailing

The program runs from 8:30 a.m. to 4:30 p.m. and we hope to see you there!

What the Supreme Court Decision Will Mean for Maine's Physicians

One of the major areas of speculation involves the establishment and operation of the so-called health insurance exchanges which are to be operational in 2013 and ready to accept enrollments in 2014.  The Maine Legislature adjourned this year without taking action to create the infrastructure to create an exchange, setting up the very real possibility that the exchange in Maine will be operated by the federal government.  This speculation increased with the release Saturday, July 7ht of Governor LePage's weekly radio address in which he stated that his administration would not move forward with establishment of an exchange until the proposed $800 million tab to pay for them passes Congress.  "With these looming uncertainties circling around this issue, Maine cannot move forward right now with Obamacare," LePage said.  

 A number of Republican-led states gambled on delay and as a consequence, face the prospect of the federal government taking over responsibility for the health insurance marketplace, where people will be able to choose among policies for their coverage.  Under the law, which was almost entirely upheld by the court in a 5 to 4 vote, individuals must be able to buy insurance coverage through the new state exchanges by January 1, 2014.  But a more immediate deadline occurs on January 1, 2013, when states must demonstrate to HHS that the exchanges will be operational the next year.  Otherwise, the federal government will take steps to establish a federal exchange. 

The other speculation involves whether Maine will participate in the significant Medicaid expansion in 2014, which is paid for with 100% federal dollars from 2014-2016 with federal participation gradually decreasing to 90% in 2020.  While a majority of the Court ruled that the Medicaid expansion was constitutional, it also ruled that the federal government could not penalize states for noncompliance by withholding their existing federal Medicaid dollars. Also in his weekly radio address, the Governor said he needed more answers before making a decision about the Medicaid expansion.

Without this penalty, many states, such as Maine, may simply refuse the money for the expansion.  After the decision, Governor LePage released a very negative statement about the court decision and DHHS Commissioner Mary Mayhew released a statement announcing that the LePage administration no longer believed it was necessary to seek federal approval to implement the action of the legislature earlier this year to remove up to 14,000 MaineCare enrollees from the program.

The federal government estimates that eventually an additional 32 million Americans will gain health insurance through public or private coverage by 2019, with 24 million obtaining coverage through the exchanges and about 16 million qualifying for Medicaid coverage through the Medicaid expansion.  The majority of individuals buying through the exchanges will be eligible for subsidies available to persons earning up to 400% of the federal poverty level. If the exchanges are successful and Medicaid is expanded in Maine, hospitals, physicians, and other health professionals will face a significant influx of new patients.

The nuances of the decision and the dissenting opinions are still being reviewed.  And, of course, the election in November will provide the opportunity for the voters to express their opinion at the ballot box.  

MMA's full press statement on the decision is available here on the MMA webpage.  MMA has added a track on ACA implementation at the July 25th Practice Education Seminar, see the article below.  Registration is available for the Seminar on the MMA website.

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MMA Nominations Committee Seeking Volunteers for Board and Committee Positions

Any membership association is only as strong as the engagement of its voluntary leadership.  The new MMA Nominations Committee, established in the new bylaws adopted last September and chaired by former President Stephanie Lash, M.D., is seeking volunteers for seven Board of Director positions and several committee positions, including positions on the Legislative Committee, the Public Health Committee, and the Membership & Member Benefits Committee.  If you are interested in being considered for one of these positions, or would like more information, please contact Diane McMahon at 622-3374, ext. 214 (or via e-mail to dmcmahon@mainemed.com) or EVP Gordon Smith at 622-3374, ext. 212 (or via e-mail to gsmith@mainemed.com).

The Nominating Committee report will be considered at the Association's 159th Annual Meeting on Saturday morning, September 8th at the Bar Harbor Club in Bar Harbor.  Registration for the Annual Meeting is available on the Association website at www.mainemed.com.

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MaineCare Gathers Input on Opioid Benefit Redesign

Kevin Flanigan, MD, Medical Director of MaineCare Services, convened an advisory committee today to provide input on how to implement the changes to MaineCare opioid coverage and other pain management issues contained in the supplemental budget that passed by the legislature in May.  As a reminder, a summary of the provisions in the budget can be found on the MMA website, here, and include limits on prescriptions of opioid medication for acute pain, requirements for patients to participate in alternative interventions before receiving prescriptions for chronic pain, prior authorizations before patients with certain diagnoses can receive opioid medications, and generating reports for prescribers showing how their prescribing patterns compare to their peers. 

The advisory committee meeting was well attended, including a number of physicians and MMA staff.  The committee largely discussed its process for reviewing draft recommendations and began to discuss in more detail the issue of generating reports with prescribing data.  The group will meet regularly to discuss each of the elements in the budget proposal and Dr. Flanigan plans to present a draft policy to MaineCare administration this fall.  The policy will have to go through formal rulemaking and Dr. Flanigan did not give a final effective date for the changes.  The advisory committee has scheduled its next meetings for July 30th and August 20th.  

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AMA Takes Next Step Toward Automating PA Process

At the 2010 AMA Annual Meeting, Resolution 729-A-10 (Mandate for Standardized Preauthorization Forms) highlighted physician concerns regarding the burdensome, time-consuming prior authorization (PA) process and its adverse health consequences for patients.  The workflow challenges referenced in this resolution were confirmed by the AMA's Council on Medical Service Report 4-I-10, as well as by a national online survey of 2400 physicians conducted by the AMA in May 2010.  In this survey, physicians reported frustration with the hassle factors related to PA requirements, and an overwhelming majority indicated that an electronic PA process would streamline administrative procedures, as well as potentially reduce denials and allow physicians to stay current with the latest payer rules.

Empowered to take action on this issue, the AMA hosted several meetings with key stakeholders to identify ways to streamline the PA process.  The most recent meeting in April 2012 focused on gaining support for the AMA's proposed end-to-end automated PA workflow for all types of authorizations including medical, pharmacy, laboratory, radiology, and durable medical equipment services.  The AMA's proposed electronic PA workflow uses the 5010 version of Accredited Standards Committee (ASC) X12 transactions.  It is also quite flexible:  (1) it is vendor agnostic; (2) it allows payers to use any desired information source; and (3) it offers several formats for PA information requests and questions, including an HL7 attachment, active HTML, and a URL portlet.  

The AMA is moving forward on implementation of this unified PA workflow.  A proof of concept to confirm the feasibility of the workflow and readiness of the market is well underway and on track for completion by the end of June.  All stakeholders will be invited to a webinar demonstration of the proof of concept and use cases for various service types.  The AMA will also host an onsite meeting with interested organizations to discuss the specifics  and logistics of pilot projects, which will be initiated by late summer or early fall of 2012.

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New Process for Code and Rate Additions or Changes at MaineCare

According to the Office of MaineCare Services, there is now a MaineCare Code and Rate Change Committee that reviews all requests for code or rate inquiries, additions, changes, and deletions in MIHMS.  With the formation of the new committee, there is an email box specifically for code or rate inquiries and requests.

HIPAA Compliant Code Requests Form must now be completed to add, change, or delete a HIPAA Compliant code in MIHMS.  The form is not required for rate requests. This form will give the committee enough information to process your request.

If your code inquiry, addition, or change is related to unclassified codes or the miscellaneous supply code 99070, you will need to include the supporting documentation as an attachment with your email and the HIPAA Compliant Requests Form.  Supporting documentation should include evidence of medical necessity, frequency of treatment, efficacy of treatment, and explanation of why another currently open code would not be appropriate.

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OMB Extends Review of Omnibus HIPAA Rule, Delaying Issuance of Final Regulation

The White House Office of Management and Budget (OMB) has extended its review of the final rule that will update Health Insurance Portability and Accountability Act regulations.

The agency's review of the final rule was expected by late June, but OMB has updated its website that gives the status for rules under review, noting the extension. OMB does not publish a date for when reviews are expected to be completed.

OMB received the final rule from the Department of Health & Human Services Office for Civil Rights on March 24th, and the review had been expected to take about 90 days, according to OCR officials. OMB review marks the final stage of the rulemaking process.

The rule covers four previously released proposed and interim final rules:

  • a final breach notification rule,

  • a final HIPAA enforcement rule,

  • a final rule implementing changes to HIPAA's privacy and security standards, and

  • a final rule modifying HIPAA's privacy rule in accordance with the Genetic Information Nondiscrimination Act.

When the final rule is released, the Maine Medical Association will be publishing an updated sample Business Associates Agreement and Notice of Privacy Practices. 

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CMS Releases Proposed Medicare Physician Fee Schedule for 2013

As expected, the Centers for Medicaid & Medicare Services (CMS) on Friday, July 6th released the Proposed Medicare Physician Fee Schedule for next year.  Also as expected, the proposed reduction in physician fees because of the sustainable growth rate formula is 27%. The AMA, national medical specialty organizations, and state medical societies, including MMA, will all be busy the remainder of this year advocating to members of Congress that access to care for Medicare patients would be severely impaired by fee reductions of this magnitude.  In previous years, facing similar draconian cuts, Congress has stepped in at the last minute and restored the cut (most recently in December 2011).  But, it is becoming more and more difficult to do so given the current D.C. climate and the focus on the increasing federal deficit.  A link to the full regulation can be found here

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Judge Grants Permanent Injunction in Florida Firearms Counseling Case

On June 29, 2012, US District Judge Marcia G. Cooke (Southern District of Florida-Miami) granted a permanent injunction blocking enforcement of a Florida law that would have restricted pediatricians from asking about firearms in the home, citing the law as unconstitutional.

The legislation, signed into law by Florida Governor Rick Scott in June 2011, would have restricted physicians, nurses, and other medical staff from asking a patient and patient’s parents about firearms and would have sent physicians accused of violating the law before the Florida Board of Medicine for disciplinary action.  Following the passage of the law, the Florida chapters of the American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), and the American College of Physicians (ACP), along with 6 individual physicians filed suit against the law, because it substantially curtailed their First Amendment rights to exchange information with patients about gun safety.

In her ruling, the judge sided with the AAP, AAFP, and ACP by ruling that the law interfered in the patient-physician relationship by limiting physician's ability to their counsel patients and patient’s parents on the importance of storing firearms safely. The judge ruled that the law also harmed patients by imposing restrictions that prevent them from hearing important preventive health messages from their physicians. 

Partially in response to the law that passed in Florida, in 2011 the Maine Medical Association passed a resolution opposing government interference in patient counseling.  

Proponents of the Florida law have vowed to appeal the recent decision. 

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MeCDC Releases 2011 Infectious Disease Report

Maine Center for Disease Control & Prevention (Maine CDC) has published an annual report on infectious diseases in Maine for the last 18 years. The report is prepared by the Division of Infectious Disease and is intended to provide an overview of notifiable infectious diseases of public health importance in Maine.  

The full report is available by clicking here

2011 Infectious Disease Surveillance Highlights Include: 

  • Pertussis cases increased four-fold in 2011 due to community-wide outbreaks in Penobscot and Piscataquis counties. Targeted prevention and intervention occurred in those areas. 

  • Reported cases of shigellosis increased from 8 cases in 2010 to 32 cases in 2011 due to a small community wide outbreak in Androscoggin County in which 83% of cases were reported in children less than 18 years old.

  • Reported cases of gonorrhea increased in 2011.  The highest rates of infection occurred in Androscoggin and Cumberland counties. 

  • The first case of hantavirus pulmonary syndrome in Maine was identified.

  • Two laboratory confirmed cases of influenza A virus H3N2v associated with exposure to pigs were identified in children in Maine.

  • A northeastern regional outbreak of Salmonella typhimurium var copenhagen included four Maine residents.  A traceback led to a USDA recall.  The Maine Health and Environmental Testing Laboratory (HETL) isolated the matching strain of Salmonella from a patient’s leftover ground beef, confirming the link between human illness and ground beef exposure. 

  • More than one thousand (1,006) cases of Lyme disease were reported in 2011.  Two other tickborne diseases, anaplasmosis and babesiosis, also increased in 2011.  

  • Chlamydia remained the most commonly reported infectious disease in the state with 3,094 cases.  Seventy percent of reported infections were in persons 15-24 years of age. 

  • Twelve cases of confirmed acute hepatitis C were reported to Maine CDC in 2011, compared to 2 cases in 2010. The numbers of newly reported cases of chronic hepatitis C infections increased from 1,142 in 2010 to 1,184 in 2011.

  • Maine had the lowest rate of tuberculosis in the country, for the second year in a row, at 0.7 per 100,000 persons.

  •  Despite reported cases of giardiasis decreasing in 2011, the rate of giardiasis in Maine (12.9 per 100,000 persons) is twice the national rate (6.4 per 100,000 persons). 

  • 66 animals tested positive for rabies (32 raccoons, 12 skunks, 11 foxes, 5 bats, 2 feral cats, 2 sheep, 1 horse and 1 bobcat). Maine has not had a human case since 1937.

  • Diseases associated with international travel (such as malaria and shigellosis) occurred  in Maine residents in 2011.  As international travel becomes more common and residents visit areas with endemic infectious diseases, there is a need to emphasize preventive strategies among travelers.

  • Healthcare associated infections, especially Clostridium difficile, are an increasing focus of public health.  Hospitals are now reporting healthcare associated infections because of MRSA and C. difficile. Clusters of C. difficile were reported in three nursing homes in 2011.

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GlaxoSmithKline to Pay $4.4 Million to MaineCare Program

Attorney General William J. Schneider announced last week that Maine, various other states, and the federal government reached an agreement for the largest healthcare fraud settlement in U.S. history.  Under the terms of the settlement, GlaxoSmithKline (GSK) has agreed to pay $3 billion to resolve allegations of unlawful promotion of certain prescription drugs, failure to report certain safety data, and false price reporting practices.

GSK will pay to the states and the federal government a total of $2 billion in damages and civil penalties to compensate various federal healthcare programs, including Medicaid, for harm allegedly suffered as a result of the illegal conduct.  In addition, GSK has agreed to plead guilty to federal criminal charges relating to drug labeling and FDA reporting and will pay a $1 billion criminal fine in connection with those allegations.

As part of this settlement, Maine will receive a total of $4,402,994.

“This worldwide pharmaceutical heavyweight put the health of patients at risk and imposed enormous costs on Medicaid and taxpayers,” said Attorney General Schneider.  “Today’s outsized multi-billion dollar settlement should alert even the largest corporations that they will be held accountable for healthcare fraud.”

The state and federal governments alleged that GSK engaged in a pattern of unlawfully marketing certain drugs for uses for which the drugs were not approved by the Food and Drug Administration (FDA); making false representations regarding the safety and efficacy of certain drugs; offering kickbacks to medical professionals; and underpaying rebates owed to government programs for various drugs paid for by Medicaid and other federally-funded healthcare programs. Specifically, the government alleged that GSK engaged in the following activities:

• Marketing the depression drug Paxil for off-label uses, such as use by children and adolescents;

• Marketing the depression drug Wellbutrin for off-label uses, such as for weight loss and treatment of sexual dysfunction, and at higher-than-approved dosages;

• Marketing the asthma drug Advair for off-label uses, including first-line use for asthma;

• Marketing the seizure medication Lamictal for off-label uses, including bipolar depression, neuropathic pain, and various other psychiatric conditions;

• Marketing the nausea drug Zofran for off-label uses, including pregnancy-related nausea;

• Making false representations regarding the safety and efficacy of Paxil, Wellbutrin, Advair, Lamictal, Zofran, and the diabetes drug Avandia;

• Offering kickbacks, including entertainment, cash, travel, and meals, to healthcare professionals to induce them to promote and prescribe Paxil, Wellbutrin, Advair, Lamictan, Zofran, the migraine drug Imitrex, the irritable bowel syndrome drug Lotronex, the asthma drug Flovent, and the shingles and herpes drug Valtrex; and

• Submitting incorrect pricing data for various drugs, thereby underpaying rebates owed to Medicaid and other federal healthcare programs.

The settlement is based on four qui tam actions brought by private individuals pursuant to state and federal false claims acts and filed in or transferred to the United States District Court for the District of Massachusetts, as well as investigations conducted by the U.S. Attorney’s Office for the District of Massachusetts and the Civil Frauds Division of the U.S. Department of Justice.

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Job Openings

MHMC Provider Database Specialist

The MHMC Provider Database Specialist will oversee quality, completeness, and currency of the MHMC Provider Database.  Works with the MHMC database, external provider directories and other sources of provider information, and develops relationships with key contacts at Physician-Hospital Organizations, large physician groups, hospitals, health plans, etc.  Some data entry and editing will be required.  Does not maintain the technical aspects of the database implementation or design, nor is responsible for Coalition or Foundation activities which use the database.  However, understanding the business needs of both internal and external customers of the database is required to insure the database can meet those needs to the highest standards possible.

For more information, visit www.mehmc.org/employment.html, or email Lindsay Hartford at lhartford@mehmc.org.  


Psychiatrist Position in Rockport

Midcoast Medicine seeks psychiatrist for thriving half time practice in Rockport.  2-3 days per week established panel for many years inside family medicine group setting.  Please call Chris McIntosh (207) 230-0698 for more information.


Family Practitioner Position in Jonesport

Busy rural practice located in Jonesport seeking a Family Practitioner to join our successful, well-established practice.  Coverage would include a four day work week, nursing home coverage, and shared call for the practice.  We are currently not looking at any hospital coverage.  We offer a competitive salary and benefits with the possibility of loan repayment through the National Health Service Corps.  This is an excellent opportunity to practice in a gorgeous ocean community.  For more information, please contact Laurie Charbonneau, Administrator at lauriec@ammc.us207-497-5614.


Medical Director for Treatment Center in Rockland, Maine

Colonial Management Group, LP (CMG) operates a number of nationally recognized and accredited methadone treatment centers dedicated to helping these individuals and their families regain control of their lives. We take great pride in treating our patients with dignity and respect in each phase of their treatment experience.

Colonial Management Group, LP, is currently searching for a licensed physician to be the Medical Director for our treatment center in Rockland, Maine.

This position is a part time position for physicians, offering convenient work hours. Experience in substance abuse field is not required per specific state standards. ASAM (American Society of Addiction Medicine) certification preferred but not required. Qualified candidates must have current license to practice medicine in the state, board eligible or board certified. A valid DEA license is also required. Candidate must be able to prescribe schedule 2 and 3 drugs. Candidates must be able to pass a credit check, background check and drug screening.

Candidate will provide direct care, medical evaluation and consultation for patients on a daily basis. Candidate will need to cover approximately 9-12 hours per week between the hours of 5:30am-2:00pm. Hours can be built flexibly around physician’s current schedule.  For more information, contact Karen Millsap at kmillsap@cmglp.com or 407-351-7080 ext: 136.

7/30/12 [return to top]

Upcoming Events & Conferences

CMS Region 1 National Medicare Training Program 2012

August 7-9, 2012

Sheraton Framingham Hotel and Conference Center, Framingham, MA

Information about key aspects of Medicare, Medicaid, Children's Health Insurance Program (CHIP), and pertinent legislation

Registration information available by clicking here


Maine Immunization Program Regional Trainings 

July 27, 2012 – Houlton Regional Hospital – Houlton

August 3, 2012 – Hilton Garden Inn – Bangor

August 9, 2012 – Fireside Inn – Portland

Augusta 10, 2012 – Maine Principals Association – Augusta

Open to all health professionals responsible for managing and supporting childhood vaccine programs including physicians, nurse practitioners, physician assistants, and practice managers.

For more information or to register, click here


3rd Annual Maine Telehealth Conference 

August 14, 2012

Colby College, Waterville

The conference will feature talks on new and emerging clinical telemedicicne programs, Legal and Regulatory issues related to Tele-healthcare programs, IT and Management, Telehealth options for primary care, Updates on Reimbursement for Telehealth Services. 

For more information, or to register, click here


Rewiring the Brain

August, 20, 2012

Samoset Resort, Rockport 

This seminar will examine the use of brain-based interventions to enhance outcomes with a variety of client populations.  Keynote presenter John Arden, PhD. 

More information will be posted here as the date approaches. 


2012 New England Clinical Symposium & Workforce Summit 

August 23, 2012 

Holiday Inn By the Bay, Portland

Maine Primary Care Association and the Maine Office of Rural Health and Primary Care will host their first Summit  featuring two prominent keynote addresses, an 'Ask the Expert' Roundtable/World Café, a clinical track on caring for aging New England and a workforce development track. Target audience includes the clinicians and administrators of New England's critical access hospitals, community health centers, rural clinics and tribal health centers.

For more information or to register, click here


17th Annual Northern New England Conference on Child Maltreatment 

September 13 & 14, 2012

University of New England Campus Center, Biddeford, ME 

The goal of this conference is to provide multi-disciplinary training to increase professional skills and knowledge of professionals who are involved in child abuse prevention, recognition, evaluation, reporting, investigation, treatment and all forms of child maltreatment. 

For more information, email spec@spurwink.org or call 207-321-6080 x 3311. 


First Annual Let's Go 5210 Childhood Obesity Conference 

September 27 & 28, 2012

Maine Health Conference Center, 110 Free Street, Portland 

For anyone who works 1:1 with patients and families.  Learn how to build capacity in your practice, in your community and for your patients. 

For more information, click here.


11th Annual Downeast Ophthalmology Symposium

September 28-30, 2012

Harborside Hotel & Marina, Bar Harbor, Maine

The Maine Society of Eye Physicians and Surgeons will host the 11th Annual Downeast Ophthalmology Symposium in beautiful Bar Harbor, Maine once again this year.  Offering 15.25 AMA PRA Category 1 Credits to ophthalmologists across the country.  

For more information and registration information, click here[return to top]

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