November 19, 2012

 
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Maine Legislatures Selects Leadership

While the outcome of some House and Senate races are still being determined, the Democrats and Republicans met internally to begin organizing and selecting their leadership.  Congratulations to Justin Alfond, who will become one of the youngest Senate Presidents in Maine history and to Mark Eves, of North Berwick, who will become Speaker of the House.  Representative Eves is a family therapist whom MMA has worked closely with in his previous role on the Health and Human Services Committee.

The internal races for leadership of the Maine House and Senate have concluded and for the first time in a very long time, there are no women in Legislative leadership.  While the vote for Speaker and Senate President will not be finalized until the full legislature is sworn in, the results are all but guaranteed because of the significant Democratic majorities. 

Senator Justin Alfond of Portland will be the next Senate President.  Justin is involved in many ventures, including owning a bowling alley in Portland.  The Democratic floor leaders will be Sen. Seth Goodall of Richmond as majority leader and his assistant will be Senator Troy Jackson of Allagash in far northern Maine.   Seth is a lawyer practicing land use law primarily in Augusta and Troy is a logger in the north Maine woods.

The Senate Republicans have chosen Senator Mike Thibodeau of Winterport as their leader and his assistant will be Senator Roger Katz of Augusta.  Mike is part  owner of a heavy equipment dealership in Bangor and Roger is a veteran and successful  trial attorney in Augusta.

In the House, the Democrats selected Rep. Mark Eves, a family therapist of North Berwick to be Speaker. They chose Rep. Seth Berry as their floor leader and Rep. Jeff McCabe as his assistant.  Seth is a former teacher and is a developing exporter.  Jeff is a Maine Guide and also currently serves as Director of Lake George Regional Park, a 320-acre park, which is located in the towns of Skowhegan and Canaan. McCabe is also the former Executive Director of the Somerset County Soil and Water Conservation District. 

The House Republicans chose Rep. Ken Fredette to be their floor leader and Rep. Alex Willette as the assistant.  Rep. Fredette is a successful attorney from the Newport area and is only in his 2nd term.  He previously served on the Appropriations Committee as a freshman.  Alex is also entering his 2nd term and is from the northern Maine town of Mapleton.

This group will now make up the Legislative Council, the group that actually runs and manages the Legislative branch of Maine’s government.  It is these 10 individuals that will control the flow of after deadline bills, all bills in the 2nd session as well as mange the employees of the branch.  It will also fall to them in many instances to negotiate with the Chief Executive over the tough issues likely to be debated starting in January.

Thank you to Charlie Soltan of Charles C. Soltan, LLC for providing MMA with this summary.

Governor LePage Annouces No State-Based Exchange for Maine

Maine Gov. Paul LePage said he has no plans to set up a state exchange where residents who don’t receive health insurance through their employer can shop for subsidized plans. He plans to cede that power to the federal government.

“I’m not lifting a finger,” he said in an interview with Bloomberg News last week. “We’re not going to get involved. We’re going to let Mr. Obama do a federal exchange. It’s his bill.”

In two other recent actions, the Department of Health and Human Services extended until December 14th the deadline for states to both submit their intent to create a health insurance exchange and to submit the actual details on such an exchange.

Department of Health and Human Services Secretary Kathleen Sebelius November 15th wrote Virginia Gov. Bob McDonnell (R) and Louisiana Gov. Bobby Jindal (R), extending the deadline for states to declare their intention of creating a state-based exchange.  As reported in last week's Maine Medicine Weekly Update, on November 9th, Sebelius had sent a letter to all governors extending the deadline for submitting an actual plan for a state exchange, known as a “blueprint,” until December 14th, though they would have had to announce their intent by November 16th.

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AMA Divided on State Plans for Expansion Of Medicaid Under Health Care Reform Law

The governing body of the American Medical Association declined to broadly advocate for Medicaid expansion at the state level under the Affordable Care Act, endorsing a policy statement Nov. 13 that merely permits the association to work on the issue at the invitation of state medical societies.

The AMA House of Delegates (HOD), gathered in Honolulu for its interim policy-setting meeting, also approved guidance, AMA Principles for Physician Employment. The ethical principles statement is designed to enhance professional standards and steer members from conflicts of interest.

In other action, the HOD addressed barriers to prescribing generic medications and the application of genomic sequencing technologies.

On the Medicaid issue, delegates debated the wisdom of ACA's plan for expanding eligibility in the 50 states. ACA remedies current gaps in coverage for needy Americans by expanding eligibility to those younger than 65 with income below 133 percent of the federal poverty level (FPL) beginning in January 2014. In June, however, the U.S. Supreme Court ruled the federal government could not require states to participate in the expansion.

The HOD was divided on the issue, with many physicians favoring state-level Medicaid expansion as originally envisioned under ACA. But a large group of delegates argued against an association position that failed to account for the Supreme Court's views, state autonomy, and budgetary considerations that might preclude some states from participation.

Consensus was reached after an amendment was drafted permitting AMA to “work with state and specialty medical societies in advocating for Medicaid expansion only at the invitation of the state medical societies.’’ The policy also calls on the association to advocate for higher Medicaid payments to physicians and reforms that would minimize administrative burdens for physicians.

“Medicaid provides a safety net for our most vulnerable patients and allows them to access the health care they need,’’ AMA board member Dr. Carl A. Sirio said in a statement. “By expanding Medicaid eligibility at the state level, we can reduce the number of uninsured Americans who live sicker and die younger.”

With respect to employment, the HOD approved guidelines, available here, that respond to the growth of direct employment of physicians by hospitals, group practices, and other types of health networks. The guidelines are divided into six potentially difficult qualities in such employer-employee relationships:

  • conflicts of interest;
  • advocacy for the patient and the profession;
  • contracting;
  • hospital medical staff relations;
  • peer review and professional evaluations; and
  • payment agreements.

The HOD also approved a resolution demanding an end to so-called pay-for-delay tactics employed by pharmaceutical companies where prescription drug manufacturers pay generic drugmakers to pass up opportunities to manufacture and market generic versions of blockbuster drugs. [return to top]

Suboxone Limits Informational Forum & Webcast, Today Nov. 19

Effective January 1, 2013, MaineCare will implement a 24 month lifetime limit for members prescribed Suboxone for the treatment of opioid addiction.

MaineCare is hosting public forums for Suboxone providers to discuss this change. The second informational forum will be held today, Monday, November 19th from 5:30 – 7:00 PM at the University of New England in Portland (716 Stevens Ave) in the Blewett  Room 027.  Email MIHMSNews.DHHS@maine.gov with questions.

The forum will also be broadcast via webinar. You can listen to the meeting presentation and participate by typing into the questions and answers section of the webinar. You can join the Suboxone Limits Information Forum by webinar by going to: https://stateofmaine.adobeconnect.com/mainecaresuboxonelimitsinformationforum/.  Select “Enter as a Guest” and enter your first and last name to sign in. After you enter the meeting room, the “Join the Audio Conference” screen will pop up. Enter your telephone number including the area code, in the “Dial-Out” box and select “Join.” The Adobe computers will call your telephone number. When you answer the call, press 1 to connect to the conference.

If you choose to call-in option, without participating in the webinar, call 1-877-455-0244 and enter code 1127267168.

These changes are part of the Department of Health and Human Services’ Supplemental Budgets and Administrative Savings Initiatives that were signed by Governor LePage. See Public Law 2011, c. 477 and c. 657.

You can find emergency, proposed and adopted rules at: http://www.maine.gov/dhhs/oms/rules/index.shtml. Select the link for the emergency, proposed or adopted rules webpage.

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Window Closing Soon for New Dirigo Enrollment

The health insurance that has helped Mainers with limited incomes get coverage over the last few years will take its last new applications on December 10, 2012 for coverage to start on January 1, 2013 (but read about exceptions below). If your patients need insurance but have a limited budget there are only two weeks left to get applications through the Dirigo door. Note that DirigoChoice policies do not exclude pre-existing conditions, and they are open to anyone, even if they don't need a subsidy.

Call the Dirigo Health Agency at 1-877-892-8391 or 287-9900 for any assistance needed.  Patients or practices can also call the Consumers for Affordable Health Care HelpLine at 1-800-965-7476 with general questions about this coverage or other coverage opportunities.

EXCEPTIONS: The following people will still be able to enroll in Dirigo coverage after December 10th:

  • Current individuals and small businesses already enrolled in DirigoChoice will be able to renew their coverage and add dependents or employees to that coverage through 2013.
  • People who have been uninsured for 6 months or more AND who have one of 48 pre-existing conditions are eligible to enroll in Dirigo through the Pre-Existing Condition Insurance Plan through 2013.
  • People who are receiving Trade Adjustment Assistance or payments from the Pension Benefits Guaranty Corporation will still be eligible for Dirigo's Health Coverage Tax Credit program through 2013. 
  • Employees of businesses already enrolled in the Part-Time Worker Coverage Voucher Program will be able to renew their coverage and add dependents through 2013. Employers will also be able to enroll new employees in the program.
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Flu Season Begins in Maine; Health Care Workers Urged to Get Vaccinated

Influenza has officially arrived in Maine. The first positive influenza A cases were detected by Affiliated Laboratory Inc. several weeks ago. These cases were in a young adult from Aroostook County, a teenager from Penobscot and an adult from Cumberland County. Neither patient was vaccinated or required hospitalization.

A long term care facility in Penobscot County also reported an outbreak of influenza on October 31. Maine's Health and Environmental Testing Laboratory (HETL) confirmed influenza A in an employee and a resident from the facility on Friday November 2.

The Maine Center for Disease Control and Prevention (Maine CDC) recommends an annual flu vaccine as the first and best way to protect against influenza.  The MMA Public Health Committee and MeCDC also encourage all Maine physicians to receive the influenza vaccination this fall and to create policies regarding vaccination among your staff.  For more information, visit: http://www.preventinfluenza.org/profs_workers.asp
 
The State of Rhode Island recently put in place a first-of-its-kind requirement that all health care workers get flu shots by Dec. 15. Rhode Island's Department of Health launched its flu vaccination mandate in October. Those health care workers who refuse shots are required to wear surgical masks when interacting with patients during periods of declared flu emergencies; failing to do so can incur a $100 fine per violation and possible loss of license.

While Rhode Island is the only state with a flu immunization requirement for all health care workers, Colorado's Board of Health issued a rule in February that set minimum vaccination rates for employees at hospitals and other health care facilities. The rates increase from 60 percent this year to 75 percent in 2013, and finally 90 percent in 2014 and every year thereafter.
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Pew Survey Highlights Lack of Knowledge About Serious Threat of Antibiotic Resistance

Although most Americans understand that taking antibiotics when they are not needed can endanger their health, many do not understand that doing this also can harm others, according to a survey released November 12th by the Pew Charitable Trusts.

Pew conducted the survey, Americans' Knowledge Of And Attitudes Toward Antibiotic Resistance, in collaboration with the Centers for Disease Control and Prevention to gauge American's understanding of proper antibiotic use. The survey of 1,004 adults was released as part of CDC's “Get Smart About Antibiotics Week,“ recognized by the Maine Medical Association and other health organizations in Maine.

Most adults surveyed (79 percent) said they understood that taking antibiotics when they are not needed can endanger their health, although only 47 percent said they understood that doing this also can harm others.

Nearly nine in 10 (87 percent) of those surveyed said they recognize that antibiotics are effective treatments for fighting bacterial infections such as strep throat, but more than a third (36 percent) mistakenly think the drugs also are appropriate treatments for viral infections such as the common cold, Pew said.

The survey also found the following:

  • Most adults surveyed (58 percent) have heard either a “fair amount” or a “great deal” about antibiotic resistance. Of those who have heard a great deal, 68 percent say it is a “very big problem.”
  • Eight-six percent of those surveyed recognize that it is better to take the full course of antibiotics than to stop taking the drugs, even after symptoms have disappeared. In focus groups, however, many of the participants admitted that they often ignore their doctors' advice in this regard.
  • More than half (52 percent) of those surveyed say it is likely that they or someone they know will contract an antibiotic-resistant illness.

Driven by antibiotic overuse, superbugs pose a growing threat to human health, Pew said. In 1993, for example, 1,900 Americans were hospitalized with methicillin-resistant Staphylococcus aureus (MRSA) infections, but by 2005, that annual number skyrocketed to 368,000 in the United States. Each year, drug-resistant infections are responsible for about 60,000 deaths, 8 million additional days in the hospital, and an extra $26 billion in health care costs, Pew said.

At the same time, however, drugmakers have cut back antibiotic research and development programs because their limited income tends to discourage investment, Pew said. Twenty-nine new systemic antibiotics came to market in the 1980s, but that number dropped to 23 in the 1990s and then to just nine in the 2000s.

The full survey is available here.

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CME Activity on Screening and Treatment for Bath Salts Abuse Released

The Lunder-Dineen Health Education Alliance of Maine, is pleased to invite clinicians in Maine to view their brand new, CME-certified educational activity on screening and treatment for bath salts abuse -- a critical epidemic facing Maine healthcare professionals.

This activity is completely free and easy to use, and features experts from Maine who have unique expertise in dealing with the bath salts epidemic. Responding to Patients Abusing Bath Salts contains four webinars that focus on characteristics of bath salt users, teamwork strategies to minimize morbidity and maximize the safe management of acute bath salt intoxication, effective treatment modalities for acute bath salt intoxication, and prevention strategies to limit bath salt use and its deleterious consequences.

Faculty represent Eastern Maine Healthcare System’s Acadia Hospital and Eastern Maine Medical Center, the Bangor Department of Health and Community Services, and the Bangor Police Department.

Simply visit this link to learn more about the activity and register: http://www.mainehealtheducation.org/bathsalts/

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AMA, MMA and other Medical Organizations Work in Washington to Delay or Eliminate SGR Cut
Pressure is now on to take care of the looming 27% reduction in Medicare physician fees and the additional 2% cut in Medicare from the impact of sequestration.  Even a one year delay in the SGR cut will cost $40 billion and a permanent repeal will cost upwards of $350 billion. But even the AARP has joined the AMA and other medical organizations in suggesting that the $350 billion of the projected military savings generated by earlier than anticipated departures from Iraq and Afghanistan should be applied to wipe out the SGR off the map permanently.

 
MMA staff will join AMA chief lobbyist Richard Deem tomorrow (Nov. 20) to discuss strategy for the lame duck session.
 
The impact of the cuts on Maine and its large elderly population would be devastating, with the physician cuts alone approaching $100 million annually.  If you have relationships with any of the existing Congressional delegation, please communicate with them and indicate the fragile nature of our health care system in Maine and the significance of Medicare to your elderly patients, and to you!
 
  
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December First Friday Program & Webinar - The Medical Practice as a Small Business Under the ACA

MMA December First Fridays 

DECEMBER 7, 2012 • 9:00 AM - 12:00 PM

The Affordable Care Act (ACA) Post-Election:  What your practice needs to know in the aftermath of the election, including a segment on the role of the medical practice as a purchaser of health care for its employees. 

8:30am Registration and breakfast for those in the office

9:00 Welcome and Introductions

9:10 The Affordable Care Act Post-Election.  What’s Hot, What’s Not, Benjamin Townsend, Esq.

10:15 BREAK

10:30 Small businesses as purchasers of health care under the ACA provisions, Ellen McPherson and Rick Morrone, Holden Agency. 

11:30  Discussion and Q & A

Click here to register online or click here to download a program and registration form. 

 

MMA Special Webinar: Implementing the Annual Wellness Visit in your Practice: Tips from the Field 

DECEMBER 11th, 12-1 pm 

Join the Maine Medical Association and Maine Primary Care Association for a webinar sharing tools and best practices for implementing the Medicare Annual Wellness Visit in your practice.  Dr. Roger Renfrew of Redington Medical Primary Care and Dr. Laura Jett with Norway Family Medicine will address why they find the visits useful, how they describe the visit to their patients, workflow issues and how they integrate the visit into their practice.  Certified Professional Coder Laurie Desjardins from Baker Newman Noyes will answer your billing and coding questions.   We will also share checklists, sample patient letters and other tools to use in your practice.  

Register today by sending your name, email and practice name to Ashley Bernier, abernier@mainemed.com or 207-622-3374.   There is no cost to participate. 

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MMA Announces 2013 First Fridays Seminars; Mark Your Calendar!

MMA 2013 First Fridays Education Sessions

8:30 AM – Registration and Breakfast; All sessions 9:00 – Noon with breakfast included

TWO WAYS TO ATTEND These programs are available 9:00 am - noon, both live in Manchester and over the web via Webex. Because of the substantial course materials, the per person $70 fee is the same whether attending in Manchester or participating through Webex.  Webex capacity is limited to 25 sites, so don’t delay!

Click here to register online or download a program and registration form here

FEBRUARY 1 Preventing Prescription Drug Abuse While Treating Chronic Pain

MARCH 1 Protecting Professional Reputation in an Age of Social Media

APRIL 5 Annual Coding Seminar

presented by the Learning Center at Baker Newman & Noyes

MAY 3 Update on the Affordable Care Act

JUNE 7 Annual HIPAA Update

SEPTEMBER 6 Risk Management Seminar

- presented by Medical Mutual Insurance Company of Maine

NOVEMBER 1 Annual Compliance Seminar: Preventing Allegations of Fraud & Abuse

DECEMBER 6 Accountability, Transparency & Public Reporting: The Importance of Your Data

For questions or more information, please contact Lisa Martin at lmartin@mainemed.com or 207-622-3374 x 221. 


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Job Openings

CLINIC MANAGER - Orthopaedic

Central Maine Orthopaedics (CMO) is a successful orthopaedic practice in Central Maine and we are currently recruiting for a full-time Clinic Manager for our Ambulatory Clinic. The foremost duty of this position is to ensure that the day-to-day operations and management of the clinic run smoothly and efficiently.  This position requires a professional with strong leadership characteristics with an associated broad skill set who will serve as role model, mentor, and coach/facilitator. This is a CMO senior manager role responsible for both organizational and operational outcomes.  This position ensures CMO's continuing compliance with our organizational standards and policies in the areas of human resources, fiscal management, purchasing, medical records, facilities management, and clinical operations.  This position is responsible for delivery on the organization's strategic plans, benchmarks, and critical success factors  and therefore must demonstrate accountability and responsibility for own work and expected outcomes for those supervised.  Central Maine Orthopaedics is an Equal Opportunity Employer.

For additional information regarding this position, please view the full posting on our web site at www.cmogroup.org or contact Janine Valliere at 207-783-1328 or JValliere@cmogroup.org

11/26/12

NURSE PRACTITIONER - Dexter, Maine

Sebasticook Family Doctors is a Federally Qualified Health Care Center currently accepting applications for a Full Time Nurse Practitioner for our  Dexter location.  Ideal candidate will have two or more years experience with exceptional clinical, interpersonal and EMR skills.    Maine License and DEA registration required.  Excellent compensation, benefits and working environment.  

Send resume and cover letter to:  Melanie  Knowles, Human Resources, Sebasticook Family Doctors, 18 Moosehead Trail, Suite 5, Newport, ME 04953, mknowles@sfdchc.org.  

12/3/12

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.

12/10/12

PSYCHIATRIC NURSE PRACTITIONER Position Available in Dexter, Maine

Sebasticook Family Doctors is a Federally Qualified Health Care Center currently accepting applications for a Full Time Psychiatric Nurse Practitioner for our Dexter location. Position includes assessment, medical management, therapy and group work. Ideal candidate will have 3 or more years experience in a busy community health outpatient setting delivering high quality care. Excellent compensation, benefits and working environment.

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.

12/10/12 

PSYCHIATRIST – Tri-County Mental Health Services – Lewiston, Maine

Our Assertive Community Treatment (ACT) Team has an exceptional opportunity available for a full-time Psychiatrist. Under the direction of the Director of Psychiatry, the Psychiatrist is responsible for outpatient psychiatric management of individuals with severe and persistent mental illness with an emphasis on medication management.  Additional duties include assessments, development of the plan of treatment, recommendation of consultations and referrals, participation in discharge planning, and on-call coverage.

Position Requirements:  Must possess active State of Maine Medical Doctor license, Board Certification (ABPN or AOBNP) in Psychiatry, and DEA Certificate.  Computer proficiency and valid driver's license are also required.  Equal Opportunity/Affirmative Action Employer.

For consideration, forward resume with cover letter to:  resume@tcmhs.org

As one of Maine’s largest and most comprehensive agencies providing services addressing mental health, substance abuse and intellectual disabilities, this year Tri-County Mental Health Services celebrates 60 years of giving home to Maine people.

Visit us at:  http://www.tcmhs.org

12/17/12 [return to top]

Upcoming Events & Conferences


 The Waiting Room

Portland Museum of Art, Portland

Friday, November 30, 6:30 p.m. *  Saturday, December 1, 2 p.m. * Sunday, December 2, 2 p.m.

The Waiting Room is a character-driven documentary film that uses extraordinary access to go behind the doors of an American public hospital struggling to care for a community of largely uninsured patients. The film--using a blend of cinema verité and characters' voiceover--offers a raw, intimate, and even uplifting look at how patients, staff, and caregivers each cope with disease, bureaucracy, and hard choices.

Tickets are $7 and sold on the day of the show at the Admissions Desk

For more information, click here.

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 Graceful Synergy: Defining the Partnership between Public Health and Accountable Care

December 6, 2012, 5 pm 

Grace Restaurant, Portland

Support the Maine Public Health Association while hearing from Lisa Harvey McPherson, RN, MBA, MPPM, Vice President of Continuum of Care and Chief Advocacy Officer of Eastern Maine Health Systems and Barbara Crowley, MD, Executive Vice President and MaineGeneral Health pediatrician, who will deliver a presentation examining the relationship between public health and accountable care.     

 For more information or to register, click here

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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

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Save the Date: 2013 Quality Counts Conference 

April 3, 2012

Augusta Civic Center, Augusta 

QC 2013 will feature Dr. Donald Berwick, former CMS Administrator, as keynote speaker highlighting the theme of reaching the Triple Aim of improvement.  Registration materials and detailed agenda will be available January 2013.

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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