January 28, 2013

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State's Prescription Drug Abuse Task Force Meets on Tuesday, Jan. 29 in Augusta

The state's Prescription Drug Abuse Task Force will meet at the State House on Tuesday to hear reports from four subcommittees working in the areas of education, the prescription monitoring program, proper drug disposal and the diversion alert program. Attorney General Janet Mills appears interested in continuing the work of the Task Force which was created more than a year ago by Governor LePage and former Attorney General William Schneider.

The meeting will be held from 10:00am to noon in room 208 of the Cross Office Building in Augusta.  One of the more interesting items on the agenda is the possible expansion of the current diversion alert program so that prescribers from throughout the state would have access to the arrest and conviction information.  Some Task Force members have expressed concern about patients being terminated inappropriately based upon arrest information.  The alerts, which are sent by law enforcement to any prescriber interested in receiving this public information, have been well received by physicians in the three areas of the state where they have been utilized, including Waterville, Piscataquis County and Aroostook County.

Joe Bruno, a pharmacist and former legislator is chair of the Task Force.  He also currently chairs the state Pharmacy Board.  The only physician on the group is Steven Gressitt.  Gordon Smith represents MMA on the Task Force.

Important Notice Regarding MaineCare PCP Rate Increase Self Attestation Form

If you faxed a form to MaineCare applying for an increased rate for your primary care services in calendar years 2013 and 2014, you may need to refax your Self Attestation form.  MaineCare's fax machine was out of order from Wednesday, January 16th through Tuesday, January 22nd.  If you faxed your form during this timeframe, MaineCare did not receive it and you should resend it as soon as possible. 

As reported in previous issues of the Update, the Office MaineCare Services (OMS) is implementing Section 1202 of the Affordable Care Act, effective January 1, 2013 which requires Medicaid programs to pay “for primary care services furnished by certain physicians in calendar years (CYs) 2013 and 2014 at rates not less than the Medicare rates in effect in those CYs or, if greater, the payment rates that would be applicable in those CYs using the CY 2009 Medicare physician fee schedule conversion factor.” 

In order to receive the increased rate, providers must fill out and submit a Self Attestation form. By completing the form, providers attest that s/he meets the criteria established by the ACA – specifically, that:

  • they are appropriately Board certified; OR 
  • that 60 percent of their Medicaid claims are for evaluation and management (E&M) and vaccine administration codes as specified in the federal rule.  

The Self-Attestation form can be found here (downloadable Word document) and provides detail on each of the above criteria.

Provider files will be updated once OMS has approved your form, and OMS will send you a confirmation via email. Please note that the increase will not occur until OMS has approved your form, and that payments will be retroactive to 1/01/13. 

If you have any questions, please contact Donna Sutter at OMS at (207) 629-4280. [return to top]

Breach, Business Associate Obligations Biggest Changes in New HIPAA Rule

The long-awaited final rule updating several provisions in Health Insurance Portability and Accountability Act regulations was released Jan. 17 by the Department of Health and Human Services Office for Civil Rights.

A change to how covered entities must evaluate whether they are required to notify individuals when their personal information has been breached is being described as one of the most significant new provisions in the long-anticipated rule.  OCR removed the so-called risk of significant harm standard that, in the interim version of the rule required covered entities to notify individuals their protected health information (PHI) had been breached only if they determined through a risk assessment that the individuals could suffer financial, reputational, or other harm.

Although a majority of public comments to OCR on the data breach rule supported the standard, concerns were raised that the standard was too subjective and gave covered entities, in some instances, too much latitude to avoid notification.

OCR replaced the risk of significant harm standard with a provision that requires covered entities and business associates to notify individuals of a breach unless a risk assessment determines a “low probability” that the breached data were compromised.

OCR described four factors that risk assessments must consider:

  • the nature and extent of the PHI involved, including the likelihood data could be reidentified;
  • the unauthorized person who used the PHI or to whom an improper disclosure was made;
  • whether the PHI was actually acquired or viewed; and
  • the extent to which the risk to the PHI was mitigated.

The new standard is intended to be more concrete and leave less wiggle room for when a notification must be made.  There will now be a  presumption that a breach has occurred unless there is a demonstration of low probability of compromised PHI through a formal risk assessment, even if an entity does not believe a breach rises to a notifiable event.  A 60-day limit for notifying individuals of a breach is also retained in the final rule. 

The rule's broad requirements for business associates and their contractors also are among now-final HIPAA regulations, making  business associates, those organizations that do business with covered entities, liable for complying with many of the Privacy and Security rule and data breach notification obligations. The rule likewise finalized the definition of business associates to include subcontractors of business associates whose work involves PHI.

The final rule also will mean covered entities must rewrite all their business associate agreement to reflect obligations of those organizations.

Other changes include: 

  •  the right for patients to request electronic copies of their health records
  • prohibiting covered entities from sharing treatment information with health plans when the patients pay out of pocket

The rule becomes effective March 26, but covered entities and their business associates have until Sept. 23 to comply with most provisions. In the case of existing business associate agreements, covered entities have until September 2014 to make changes.

At a minimum, physician practices will have to update and redistribute their Notice of Privacy Practices and modify Business Associates Agreements to reflect changes in the rules.  The MMA will be preparing sample policies and will post them on www.mainemed.com when they are complete.  MMA attorneys are also available to provide on-site staff training on the rules. 

The final rule is available here[return to top]

MMA Legislative Committee Conference Call Tuesday, Jan. 29, 8 pm

The MMA Legislative Committee weekly phone calls will continue tomorrow, Tuesday, January 29th.  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:  1-877-669-3239

Passcode:  23045263

The purpose of the weekly conference calls is to review and finalize the MMA's position on bills printed that week, to hear the views of specialty societies on the new bills or their concerns about any health policy issues, and to discuss the highlights of legislative action that week.  The calls rarely last longer than an hour and usually we can accomplish our business in much less time. 

If you have an opinion about any of these bills, but cannot participate in the call, please call or email Andrew MacLean, Deputy EVP at 622-3374, ext. 214 or amaclean@mainemed.com.

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 87, An Act to Improve Community Mental Health Treatment (monitor; psychiatrists)

LD 88, An Act to Update the Maine HIV Advisory Committee (monitor)

LD 95, Resolve, to Create the Task Force on the Prevention of Sexual Abuse of Children (monitor; pediatricians)

LD 102, An Act to Improve Health Insurance Transparency (support)*

LD 104, An Act to Amend the Law Governing Public Records (monitor)

LD 111, An Act to Restrict the Sale, Purchase and Use of Fireworks in the State (support; Public Health Committee)*

LD 117, An Act to Change the Composition of the Board of Dental Examiners (monitor)

Two lists of bills submitted by legislators by the deadline now are available on the legislature's web site:

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Aroostook County Medical Society Meets Wednesday Evening, in Presque Isle

The Aroostook County Medical Society will hold a dinner meeting at the Crow's Nest restaurant in Presque Isle at 6:30pm on Wednesday evening, Jan. 30.  The current officers of the Society, Jay Reynolds, M.D. and Stuart Wyckoff, M.D. hope to find other members to take on leadership roles in the Society. In the absence of such leadership, a serious discussion will take place about the future of the organization.

Also attending the meeting with be Guy Raymond, M.D., of Fort Kent, President-elect of the Maine Medical Association and Gordon Smith, Esq., MMA's Executive Vice President.  Dr. Raymond will discuss some of MMA's current activities and Mr. Smith will be prepared to answer any questions about the legislative activities of interest to physicians taking place in Augusta or Washington.  He will also discuss the new MaineCare opiate limits, which took effect on Jan. 1.

 Physicians interested in attending should contact Dr. Wyckoff at forthdown@aol.com.

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Volunteers Sought for MMA Audit Committee

When the MMA's new bylaws were adopted by the membership in Sept., 2011, one of the changes called for the establishment of an audit committee.  The committee was charged with meeting at least annually with the MMA Finance Director and its outside auditor to review MMA finances.  The committee is being formed at this time and the association is seeking volunteers.  A majority of the committee needs to come from outside the 25 member Board of Directors.

If you are an MMA member with an interest or expertise in finance, please consider serving on this committee which is expected, at least initially, to meet only once or twice a year.  Interested members should furnish their name and CV to EVP Gordon Smith, Esq., at gsmith@mainemed.com.  For more information, contact Mr. Smith or Heidi Lukas, CPA, the Association's Finance Director (hlukas@mainemed.com).

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FDA Advisory Panel Recommends Resctrictions on Hydrocodone

An FDA advisory panel of experts voted on Friday (Jan. 25) to toughen the restrictions on pain medication containing hydrocodone, the most widely prescribed pain medication in Maine according to data from the Prescription Monitoring Program (PMP).  The recommendations of the advisory panel, which would still have to be approved by the Agency, would limit access to the drugs by prohibiting refills by fax or phone and by requiring special storage containers.  Significantly, the proposal would also prohibit nurse practitioners and physician assistants from prescribing the drugs.

The vote of the panel was 19 to 10 with several panel members arguing that the recommendations would do little to slow down the epidemic of prescription drug abuse in the country.  The FDA turned down a previous request by the DEA to tighten up the restrictions in 2008, but put together the advisory panel following another request by the DEA.  The panel was made up of scientists, physicians and other experts specializing in pain management.

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Value-based Insurance Design the Focus of MMA, MHMC and MCHP Program

MMA, the Maine Health Management Coalition and Maine Community Health Options sponsored a program in Lewiston last Thursday night featuring a discussion of value based insurance design.  Mark Fendrick, M.D. directs the Center for Value-Based Insurance Design at the University of Michigan (www.vbidcenter.org), the leading advocate for development, implementation, and evaluation of innovative health benefit plans.  Dr. Fendrick presented a fascinating approach to benefit design based upon clinical nuances, noting that high value services should continue to be paid for on a fee for service basis so that there is a positive incentive to provide them.  On the other hand, he argues that the low value services should be subject to more cost sharing so that patients are discouraged from receiving them.  One example of a low value service, he noted, is screening for colon and rectal cancer in persons over 85 years of age (currently, $1.5 billion spent annually).  Dr. Fendrick closed his talk by stating that more is not always better, but there are certainly places in today's medicine where more is better.

Following Dr. Kendrick was Barbara Crowley, M.D., Executive Vice-President of Maine General Health.  Dr. Crowley presented a summary of the Choosing Wisely Campaign, a project originated by the American Board of Internal Medicine.

Dr. Fendrick's work is expected to be utilized as Maine Community Health Options (MCHO), Maine's new consumer owned and operated health plan, puts its benefit plan together later this year.   MCHO is a private, non-profit entity and will be governed by a subscriber-based board of directors.  Its mission is to partner with Maine people, businesses and health professionals to provide affordable, high-quality benefits that promote heath and wellbeing.  Twenty-four such plans are being organized around the country as provided for in the Affordable Care Act.

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Upcoming AMA Webinars - Physician Employment Principles & Is Employment the Only Alternative

Webinar to examine AMA physician employment principles

The newly adopted AMA Principles for Physician Employment provide guidance for employed physicians. Physicians can learn how the principles apply to real-world situations by participating in a webinar jointly sponsored by the AMA and the American Bar Association at 8 p.m. Eastern time Jan. 30.

Participants can earn continuing medical education credit in the form of 1.5 "AMA PRA Category 1 Credits"™. Registration is free for AMA members; nonmembers can sign up for $45.

Click here to register.

Is Employment the Only Alternative? Improving Care Coordination through Clinical Integration

As part of its offerings of payment model resources for physicians, the AMA is hosting the following webinar from 7-8 pm EST on January 31:

Is Employment the Only Alternative? Improving Care Coordination through Clinical Integration

The focus on value-based care has shined a bright light on how physicians and other providers deliver care. Is care delivered in a highly coordinated manner that minimizes duplication, fosters appropriate care transitions, and ultimately saves resources? All too often comparisons are drawn between highly integrated healthcare systems and the rest of healthcare that is practiced at the community-level. This webinar on January 31 at 7 pm EST will provide the perspectives of early physician innovators who were able to improve care coordination and build integrated systems without sacrificing their practice autonomy.

Learning objectives:

  1. Identify a path toward more integrated care delivery that does not involve employment.
  2. Define what it means to provide virtually, vertically, and horizontally integrated care.
  3. Discuss the operational structure of independent physician associations and cloud-based data sharing systems.
  4. Use technology solutions to improve coordination within and outside of their practice.

Free for AMA members ($30 for non-members). 

1 Credit> AMA> AMA PRA Category 1 Credit™

Register for this webinar.

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Limited Number of Remote Sites Available for Feb. 1 Program on Opiates, Still Room to Attend in Manchester

The MMA's First Fridays Educational Series for 2013 begins on Friday, Feb. 1 from 9:00am to 1:00pm and includes an unusual feature:  THERE IS NO COST to attend, either in person at the MMA offices in Manchester or via webex from a laptop or desktop.  Because of grant funding by the state Office of Substance Abuse and Adult Mental Health Services, we are able to present the program without charge.  The number of sites available for webex have filled up, but there is space available to attend at the office in Manchester.

Faculty for the program includes Tamas Peredy, M.D. of the Northern New England Poison Center, John Lipovsky, the new coordinator of the Prescription Monitoring Program, Noel Genova, PA-C of the Chronic Pain Consultation Program, Stephen Kelleher,  and Gordon Smith, Esq. of MMA.  MaineCare Medical Director Kevin Flanigan will also be available to describe the MaineCare limits on opiate medication, effective Jan. 1, 2013.

Registration is available on the MMA website at www.mainemed.com.  Although the registration form notes that a fee is charged, just complete your registration form without including that portion.  A new form with a full agenda and goals and objectives will be available shortly and will be distributed electronically to all of the e-mail addresses we have available for members and their staffs.

Only twenty five remote sites are available so sign up as soon as possible if you know that your facility or practice would like to attend.

A complete list of all the 2013 First Friday programs is also on the website and was included with your Fall issue of Maine Medicine. [return to top]

MaineCare Limits on Opioid Pain Medication In Effect; PA Forms for Chronic Pain Management Now Available

The limits impact both prescriptions for acute pain and chronic pain and will be effective retroactively.  The  proposal, which is being put into an emergency rule, is posted on the MMA website at www.mainemed.com (in Spotlight section).  There are also new limits on methadone and Suboxone prescribed for treatment of addiction and those limits are discussed below in a separate article.

The proposal is divided into sections dealing with acute pain (pain expected to be resolved within 60 days) and non-acute or chronic pain.   Exceptions to the limits are made for the following categories:

  1. A MaineCare member who is receiving opioid medications for symptoms related to HIV, AIDS and cancer and other qualifying diseases and conditions, as set forth on the Department's Preferred Drug List.
  2. A MaineCare member who is receiving opioid medications during inpatient treatment in a hospital, in a nursing facility or during hospice care.
  3. A MaineCare member who is receiving 30 milligrams or less of morphine sulfate equivalents on a daily basis.
  4. A MaineCare member for whom MaineCare reimbursement for opioid medications for the treatment of addiction is restricted by limits applicable to methadone and buprenorphine and naloxone combination medications.

While prescribers impacted by the limits are encouraged to review the details of the proposal on the MMA website, the essence of the proposal is a limit of 15 days of medication for acute pain, with the ability to receive up to three 14 day renewals through prior authorization so long as there is a face to face visit with the patient.  A renewal beyond 57 days would require a treatment plan consisting of incorporation of non pharmacologic treatments and functional assessment of the member by the physician or other prescriber.  In essence, treatment beyond 57 days will move the patient to the non-acute, or chronic pain limits.

For treatment for chronic pain, opioids will be covered by MaineCare only after one or more non-pharmacologic treatment alternatives are attempted.  The proposed rule includes as such alternatives physical therapy, occupational therapy, chiropractic therapy, osteopathic manipulative treatment, cognitive behavioral therapy, and acceptance commitment therapy. Note that the Department may waive the requirement of a non pharmacologic intervention treatment through prior authorization when participation is not feasible and opioid treatment is medically necessary.

The following forms are now available in the Authorizations and Referrals folder of the Provider Forms page of the Health PAS Online Portal:

  • PA for Physical Therapy (PT) Services for Chronic Pain Form
  • PA Fax Cover Sheet for Therapy Services Review

The forms can also be found on the Pain Management Program webpage on the MaineCare website.

Post-surgical pain is treated as acute pain, but a more liberal provision applies as after the first fifteen day script, the surgeon may renew the script for a total of 60 days, in one or multiple prescriptions through prior authorization.  But there is a requirement that the patient be seen by a provider (not necessarily the surgeon).

MMA staff is available to present CME programs on this topic to medical staffs and other interested groups.  If your practice or staff is interested in a presentation, contact Gordon Smith, Esq., at gsmith@mainemed.com or by calling 622-3374, ext. 212.  Dr. Flanigan is frequently able to present as well and he can be reached at his MaineCare office at 287-1827.

Finally, physicians are reminded that these limits imposed by the Legislature are limits on the ability of MaineCare to pay for the medication.  The physician is free to write for whatever medication he or she believes is appropriate for the patient and the patient may pay cash for the medication if it is not covered by MaineCare. But in doing so, the prescriber may wish to consider whether these limits will eventually be considered the appropriate standard of care for treatment of pain. [return to top]

Job Openings

MEDICAL DIRECTOR - Mercy Recovery Center, Westbrook, Maine

The Mercy Recovery Center offers the largest substance abuse treatment center in Maine for adults treating the entire spectrum of substance abuse from alcoholism to drug addiction. Treatment services include detoxification, group therapy, treatment of withdrawal symptoms, and long term therapies.

We are seeking a Psychiatrist specializing in addiction medicine to serve as Medical Director for the Recovery Center. Suboxone certification is required. Previous experience running an addiction clinic is strongly desired. This position oversees four physicians and 8 physician extenders. Direct care responsibilities include a combination of office visits, inpatient, and partial hospitalization coverage. Mercy offers a competitive compensation and benefits package.

Mercy is the Greater Portland regional health care system representing the highest standards of clinical excellence and compassionate care. Because of a commitment to excellence, the nursing, clinical and support services have consistently achieved superior patient satisfaction ratings, and remain committed to providing the highest quality healthcare for all.

FMI and to apply online, please visit our website: www.Mercyhospital.org 

Please send your CV to Alison Salerno, Provider Recruiter, at salernoa@mercyme.com, or Mercy Hospital, 144 State St., Portland, ME 04101.  207-879-3804 E.O.E.  


MEDICAL DIRECTOR/PHYSICIAN - Health Access Network - Lincoln, Maine

Health Access Network (HAN), a Federally Qualified Health Center (FQHC) in Lincoln, Maine, is seeking a dynamic physician leader to serve in the role of Medical Director to provide overall direction and oversight of our clinical team, as well as provide part-time direct patient care. The Medical Director will join the health center’s leadership team in meeting the goals and objectives of the health center’s mission. Responsibilities include, but are not limited to administrative and on is two days a week administrative and three days providing direct patient care.

Qualifications: Board Certified in family medicine, Maine License, and have at least five years primary care and leadership experience. A practicing physician wishing to transition to a part time medical-administrative/management role is encouraged to apply. Community health center experience a plus. Familiarity with disease registries and electronic medical records is required. Must have exceptional verbal and written communication skills, and possess compassion, innovation, integrity, and excellence which are the health center’s values.

For more information or to forward your curriculum vitae' contact:  Sonia Maxwell, HR Director/Compliance Officer, P.O. Box 99, Lincoln, ME  04455, 207-794-6700, smaxwell@hanfqhc.org.



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.  


MD/DO Position Available - 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.


PSYCHIATRIC NURSE PRACTITIONER Position Available - 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.


FAMILY PRACTICE PHYSICIANS SOUGHT - Millinocket and Patten Maine Locations

Katahdin Valley Health Center is recruiting dedicated Family Practice Physicians that are committed to providing quality health care services to the people in Central/Northern Maine.  Join our practice in one of the newly expanded facilities.  We are seeking physicians for our Millinocket and Patten locations.  KVHC is a fully electronic medical record site and offers a competitive salary and benefits package which includes sign on bonus, generous amounts of paid time off, health insurance, life and disability insurance as well as Federal Torts Claims Act (FTCA) malpractice coverage.  No nights, no weekends, either limited or no inpatient care and limited call coverage.  Physicians who join KVHC are eligible to apply for NHSC Loan Repayment.

Physicians that join KVHC will be providing quality care in a dynamic, cutting edge environment, within a patient focused team of 11 Providers and 90 Staff Members.  As one of New England’s highest performing Federally Qualified Health Centers (FQHC), KVHC has a mission to provide community accessible, quality healthcare with compassion and dignity. 

To learn more about KVHC and Practitioner Opportunities, please contact Michelle LeFay at mlefay@kvhc.org or visit our website at http://www.kvhc.org.  KVHC is an equal opportunity employer.


HOSPITALIST - Belfast, Maine

Multi-specialty community hospital on the coast of Maine seeks full-time BC/BE Hospitalist to join an established group and provide full medical oversight of hospital inpatient and critical care activities. Belfast offers beautiful views of Penobscot Bay and is ideal for outdoor enthusiasts. Exceptional family environment with excellent schools.

Send CV to Dan Bennett, Director of Operations, Waldo County General Hospital, P.O. Box 287, Belfast, Maine 04915. Tel. 207-930-6741, Fax 207-338-6207, e-mail: dbennett@wcgh.org.



Mayo Regional Hospital, located just 35 miles northwest of Bangor in Dover-Foxcroft, is seeking a VP of Physician Practices for its well-established hospital-based primary care practices. The VP of Physician Practices leads all aspects of the practices, and reports directly to the CEO.  Responsibilities include planning and coordination for six offices in Dover-Foxcroft and surrounding communities.  The position ensures that patients, providers, staff, insurance agreements and facilities meet the goals and objectives of the hospital.  Provider recruitment and retention experience is desired.  A degree in Business Administration or related field is required, with experience managing multiple physician office practices.  Knowledge and understanding of RHCs and the Patient Centered Medical Home Model is a plus.  This opportunity offers a competitive wage and benefits package that includes:  Group health/dental/life, 403(b) retirement plan with employer match, tuition assistance, educational loan payback eligibility, relocation assistance and a generous paid time off program.  Please send resume and cover-letter to: Mayo Regional Hospital, Attn: Joanne Leonard, Dept. B, 897 W. Main Street, Dover-Foxcroft, ME 04426 or E-mail to jleonard@mayohospital.com.  EOE  

2/25/13 [return to top]

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