October 22, 2012

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FDA Statement on Fungal Meningitis Outbreak: Additional Patient Notification Advised

While none of the injectable steroid medication from NECC was distributed in Maine, the FDA last week recommended that physicians who administered ANY drug produced by the New England Compounding Center after May 21, 2012 contact the patients and has provided a sample letter to assist.  The FDA acknowledged that it was acting out of an abundance of caution, as there have been no confirmed reports of infections linked to other products produced by NECC.  Many medical practices in Maine, mostly ophthalmology and cardiology practices, received products from NECC after May 21.

CDC and FDA have confirmed the presence of a fungus known as Exserohilum rostratum in unopened medication vials of preservative-free methylprednisolone acetate (80mg/ml) from one of the three implicated lots from NECC (Lot #08102012@51, BUD 2/6/2013).  The laboratory confirmation further links steroid injections from these lots from NECC to the multistate outbreak of fungal meningitis and joint infections. Testing on the other two implicated lots of methylprednisolone acetate and other NECC injectables continues. 

CDC and state health departments estimate that approximately 14,000 patients may have received injections with medication from three implicated lots of methylprednisolone and nearly 97% of these patients have been contacted for further follow-up. 

There is now available a Patient Notification Letter on the FDA "Update on Fungal Meningitis" webpage under the "Related Information" section. This letter template is for healthcare professionals notifying patients administered a drug produced by the New England Compounding Center (NECC) that has been recalled.

FDA advises healthcare professionals that if you administered an NECC injectable product to a patient after May 21, 2012, including an ophthalmic drug that is injectable or used in conjunction with eye surgery or a cardioplegic solution, you follow-up with that patient. Healthcare professionals and medical care organizations should inform patients who received the NECC products noted above of the symptoms of possible infection and instruct patients to contact their healthcare provider immediately if they experience any of these symptoms.

FDA advises healthcare professionals and patients to report adverse events or side effects related to the use of these products to the FDA's MedWatch Safety Information and Adverse Event Reporting Program. 

Read the MedWatch Alert, including a link to the FDA Statement here

Update on Maine EMS Community Paramedicine Steering Committee

During the most recent legislative session, pilot projects allowing for the introduction of community paramedicine in Maine were authorized, effective August 30, 2012.  L.D. 1837 (P.L. 2011, Chapter 562) authorized the Department of Public Safety, Emergency Medical Services' Board to develop and evaluate a community paramedicine pilot program. The projects are intended to enhance access to primary care services by allowing EMS personnel to check on patients in their home, with approval of the primary care physician and under medical direction.  At MMA's request, the EMS Board was limited to establishing up to 12 pilot projects.

Last Thursday, October 18th, the Maine EMS Community Paramedicine Steering Committee met for the second time to review applications from several EMS services in response to the CPPP application process.  Several physicians sit on the Steering Committee, including Drs. Matt Sholl, Steve Diaz, Timothy Pieh and Amy Madden. Gordon Smith, MMA EVP also serves on the committee, representing MMA.

Organizations submitting an application must commit to funding their project for a 3-year period as there is no external funding approved for the pilot projects.  Communication with existing facilities and healthcare agencies is considered paramount and the reviewers on the Steering Committee are paying particular attention to these issues.

About a half dozen applications have been submitted to date, and none have yet received final approval from the EMS Board.

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Report on Initial Meeting of MaineCare Methadone Prior Authorization Workgroup

MaineCare Medical Director Kevin Flanigan, M.D. convened the first meeting of the Methadone Prior Authorization Workgroup on October 17th.  The purpose of the group is to make recommendations to MaineCare officials on what criteria should be applied to requests for prior authorization to continue methadone maintenance treatment beyond a two year limit established by the 125th Legislature.  

In essence, the questions that will be addressed are:  

  1. Is there continuing medical/clinical necessity to extend methadone maintenance treatment (MMT), for MaineCare patients, beyond a lifetime treatment benefit of 24 months? 
  2.  What clinical and medical factors (criteria) justify ongoing MMT.

The workgroup's final recommendations will serve as a foundation for MaineCare policy writers as they create a proposed process for the PA, the criteria for approving or not approving MMT beyond 24 months and the PA process roll-out.

The PA process is expected to begin on January 1, 2013.  Benefits will continue through the entire period of time that an individual undergoes a medically supervised methadone taper, should the patient be found not to be eligible for an extension beyond two years.

The next meeting of the workgroup will be tomorrow, October 24th, from 1:00 to 3:00pm, location to be announced.  MMA staff was present at this initial meeting and will continue to monitor the progress of the workgroup.

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Smoking Declines Thanks to Higher Taxes

Smoking is at historic lows in the United States, 18.9 percent, according to the Centers for Disease Control. That’s about a full percentage point below where it was before the 2009 hike in the federal tax on a pack of cigarettes from 39 cents to $1.01 — a stunning victory for public health and the public purse.

In the 2000s, national smoking rates plateaued at around 20 percent, prompting calls for higher taxes to discourage smokers. Congress approved sharp increases, but they were twice vetoed twice by former President George W. Bush, who believed they would violate his no-new-taxes pledge. President Obama signed the hike in his first month in office. With cigarettes now costing about $5.75 a pack, a new analysis by USA Today found that there are now 3 million fewer smokers in the United States than in 2009.

The biggest drops occurred among the groups most price-sensitive to smoking. One million adults on Medicaid ceased smoking. Seniors and Latinos had declines of more than 15 percent. As for youth smoking, University of Illinois at Chicago researchers found that teen tobacco use dropped immediately after the tax hike, resulting in between 350,000 and 490,000 fewer young smokers and users of smokeless tobacco products. [return to top]

Upcoming Webinar: Providing Care for Service Members

Are you providing health care to service members or their families, in a community-based or primary care setting?  If so, join the Maine Primary Care Association on November 8, from 12 to 1pm,  for a webinar to learn about the unique stresses and challenges that many service members and their families face, as well as strategies for supporting them in attaining positive health outcomes.

 Mr. Hahna David Patterson, MA, LCPC, will speak to PTSD, Combat Operational Stress, suicide in the military, barriers for healing/military specific stigma, and practical techniques to improve communication Service Members. 

Title: Understanding Culture: Providing Care for Service Members in Primary Care and Community-Based Settings

When: Thursday November 8, 2012

Time: 12:00 – 1:00 PM

Registration: http://www.cvent.com/d/rcqxj5

For more information, learning objectives and to register, visit: http://www.cvent.com/d/rcqxj5 [return to top]

National Medical Staff Services Week Coming Nov 4-10

In 1992, President George Bush issued a proclamation designating the first week of November as “National Medical Staff Services Awareness Week,” to acknowledge and thank medical services professionals (MSPs) for playing “an important role in our nation’s healthcare system.”

What role do these professionals play? They are the people behind the scenes who make certain the credentials of all practitioners who are caring for patients are correct and have been verified. MSPs are experts in provider credentialing and privileging, medical staff organization, accreditation and regulatory compliance, and provider relations in the diverse healthcare industry. They credential and monitor ongoing competence of the physicians and other practitioners who provide patient care services in hospitals, managed care organizations, and other healthcare settings.

The American Medical Association-Organized Medical Staff Section also recognizes the medical services profession in a resolution that formally acknowledges “the importance and value of medical services professionals to the healthcare organization and its physician members, and recognizes their contribution and dedication in preserving quality patient care.”

MSPs are a vital part of the community’s healthcare team. They are dedicated to making certain that all patients receive care from practitioners who are properly educated, licensed, and trained in their specialty.

For more information about MSPs and the National Association Medical Staff Services (NAMSS), visit www.namss.org or the Maine Association Medical Staff Services (MeAMSS) at www.meamss.org. [return to top]

Sign Up to be the "Doctor of the Day" for the Maine Legislature

During the 1996 legislative session, the Maine Legislature asked the Maine Medical Association and the Maine Osteopathic Association to furnish a physician for each day of the legislative session to assist in the event of a medical emergency.  Now the “Doctor of the Day” program is well established and respected, and legislators are enthusiastic about it.  This is a unique opportunity to observe the legislative process in action and to interact with the lawmakers.  We need your help to continue our presence and to ensure the continued success of this program.

The scheduling of volunteers for the 126th Legislative Session has already begun.  We would like to invite you to participate in the upcoming session that is scheduled to convene in January and is expected to run through June. 

Upon receipt of your registration, MMA staff will contact you to arrange and/or confirm the most convenient date for you to serve.  The House Clerk’s office staff then will mail you a packet with a legislative parking pass and confirmation letter informing you about your scheduled date.  On the day of your participation, a Maine Medical Association or Maine Osteopathic Association staff representative will meet you at the State House and will be available to guide you throughout the State House.  

This is an effective grassroots contact program for organized medicine in Maine and it has established substantial "good will" for organized medicine at the State House.  The “Doctor of the Day” program gives you the unique opportunity to observe the process in which your legislators make decisions affecting you as a physician and as a citizen of the State of Maine.  

If you have any questions regarding the “Doctor of the Day” program, please feel free to contact the MMA legislative staff at 207-622-3374, or docoftheday@mainemed.com. You can also register on line at the MMA's website. We hope to see you at the State House for what is expected to be a very interesting session for the medical community. [return to top]

Planned MIHMS Disaster Recovery Testing Postponed

The Disaster Recovery Testing on MIHMS scheduled for November 10-12th has been postponed.   The Health Pas Online Portal will be available for normal activity during this time. MaineCare will notify practices with new dates for scheduled portal downtime in the near future. [return to top]

Medicare Open Enrollment Period Now Through Dec 7

Medicare Open Enrollment Period is now October 15 – December 7, so it is that one time of the year that your patients can look at their Part D and Medicare Advantage plans and assess whether it is serving their current needs.  In the course of a year, many things can change: new diagnoses, changes in prescription drug needs, among others.  While this is a very busy time of the year, we wanted to highlight some tips to help you and your patients:

  • Host a Part D enrollment clinic at your practice or facility
  • Connect with your local Area Agency on Aging, and advertise local Part D enrollment clinics at your practice or facility 
  • Let your front desk staff and patient assistance staff know what resources are available to patients who have questions (both at your practices as well as in the community) *This is critical for new staff members*

 While you’re having the discussion around Part D, it’s a great time to remind your patients how the ACA has lowered the cost of both their prescription drugs and preventive care.  Improvements include:

  • Improved coverage for preventive screenings, including: mammograms, colorectal cancer screening, depression screening and more. 
  • Discounted name brand and generic drugs, in the donut hole
  • New services, such as the Annual Wellness Visit, that are meant to keep your patients well, longer and engage in long term preventive care planning. 

For more information on Open Enrollment, you can refer your patients to your local Area Agency on Aging: 1-877-353-3771 or visit www.medicare.gov  

For online resources around changes to Medicare, visit Legal Services for the Elderly: http://www.mainelse.org/

For FQHC-specific materials and short videos on Medicare preventive services available to your patients, visit the MPCA Members Forum: www.mepca.org.

The development of this article was supported by the work of The Maine Health Access Foundation  as well as ten other nonprofits across the state, who are collaborating to disseminate accurate, direct and effective information about how the Affordable Care Act affects people in Maine. [return to top]

Job Openings

MD/DO Position Available in Dexter, Maine

Sebasticook Family Doctors is accepting applications for a MD/DO at our busy Dexter location.  Ideal candidate will have two or more years experience in a busy community health outpatient setting delivering high quality care.  Exceptional clinical, interpersonal and EMR skills are required.   SFD offers  excellent compensation, benefits and working environment.   Join our growing team!  

Interested applicants should send resume and cover letter to:  Melanie Knowles, Human Resources, Sebasticook Family Doctors, 18 Moosehead Trail, Suite 5, Newport, ME 04953 or at mknowles@sfdchc.org

10/29/12 [return to top]

Upcoming Events & Conferences

Risk Management Considerations When Using Social Media and Technology in Psychiatry

Maine Association of Psychiatric Physicians General Membership Meeting 

November 2, 2012

Waterville Hampton Inn, Waterville, ME 

Guest speaker: Moria Wertheimer, BSN JD, Assistant Vice President, Healthcare Risk Management, Allied World Assurance Company

For more information or to register, contact Dianna Poulin, dpoulin@mainemed.com or 622-3374 x 223. 


Maine Cardiovascular Summit 

Best Practice: Cardiovascular Care in the Field, in the Clinical Practice, and in the Community

November 8, 2012

Samoset Resort, Rockport 

National  and local cardiovascular health experts will come together to discuss best practice in cardiovascular care. 

For more information, or to register, click here


Maine CDC Infectious Disease Conference 

November 13, 12012

Augusta Civic Center, Augusta

Presenting a review of emerging issues in the field of infectious diseases, particularly as they impact the Maine medical community. 

For more information or to register, click here


Free Aging Advocacy Conference 

November 14, 2012

Augusta Civic Center, Augusta

Maine’s Aging Network is hosting a FREE Aging Advocacy Summit to prepare volunteers, staff and advocates to effectively participate in Maine’s health care redesign efforts at the local, state and national level.

For more information or to register, click here


Maine General Medical Center Fall Coding & Compliance Conference 

Achieving New Heights in Health Care Reform 

November 16, 2012

Waterville Elks Banquet & Conference Center, Waterville 

6.5 AAPC CEUs Covering: The Road to ICD 10, Vascular & Thoracic Procedural and Terminology Overview, Introduction to APC and more 

For more information or to register, contact Cindy Sturtevant, 872-4058


Women's Health 2012: Strengthening Partnerships to Improve Health Equity 

November 16, 2012

Senator Inn, Augusta

The Maine Women’s Health Campaign invites you to attend a day-long conference dedicated to women’s health. We will hear from distinguished national and state health policy leaders and experts on women’s health, health equity, health policy, and public health, including Paula A. Johnson, MD, a women’s health specialist and pioneer in the treatment and prevention of cardiovascular disease.

For more information or to register, click here. 


Maine HIV, STD & Viral Hepatitis Program HIV & Primary Care Conference 

December 7, 2012

Maine Principals' Association, Augusta 

For more information or to register, click here


Save the Date: First Annual Conference of the Medical Professional Health Program 

Health, Wellbeing and Awareness 

April 5, 2013

Holiday Inn By the Bay, Portland

This will be the first Medical Professionals Health Program Health Conference focusing on addiction, recovery and wellness. The conference is open to all licensed professionals.  [return to top]

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