July 8, 2013

 
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Additional Presenters Named for July 24 Annual Practice Education Seminar

MMA will present its annual Practice Education Seminar at the Augusta Civic Center on Wednesday, July 24.  In addition to the previously announced presenters, including keynote speakers Jack Lewin, M.D., HHS Commissioner Mary Mayhew and Social Media guru Rich Brooks, Laurie Desjardins will handle the breakout session on preparing for ICD 10, Jeff Parsons, Esq will present the session on the Physician Payments Sunshine Act and Clare Desrosier, MSW and James Berry, M.D. will join the presentation on preventing prescription drug abuse.


The Augusta Civic Center will again be the site of the Seminar.  Being offered for the 22nd year, this program is designed to offer physicians and practice managers the information and tools they need to be successful in their practice setting, whether the physician is in private practice or employed and regardless of specialty.  As the program runs from 8:30am to 4:30pm with three keynote talks and a dozen breakout sessions, there is sufficient time to cover many of the topics that are in front of practices currently, such as:

  • Preparing for ICD 10
  • Using social media to market your practice
  • Accountable Care Organizations
  • State Innovation Model grant (SIM)
  • Preventing Prescription Drug Abuse
  • Board of Licensure in Medicine update
  • E-Prescribing of Controlled Substances
  • Physician Payments Sunshine Act
  • Legislation Impacting on Medical Practice Enacted by the 126th Legislature
  • Affordable Care Act, including Exchanges, Essential Benefits and Mandated Coverage

The keynote presenter is Jack Lewin, M.D., Chairman of the National Coalition on Health Care.  Dr. Lewin is a former CEO of the American College of Cardiology and the California Medical Association.

Registration materials have been mailed to each MMA member and practice managers or you may register on-line at www.mainemed.com.  Questions can be directed to Lisa Martin at MMA at 622-3374 ext. 221 or via e-mail to lmartin@mainemed.com.  Lisa will also handle any questions from potential exhibitors.

Three Hours of CME Available at Drug Abuse Education Offered TONIGHT in Machias/Calais

The Maine Medical Association will offer a three hour CME program on the subject of preventing prescription drug abuse in Machias on Monday evening, July 8, from 5:00 to 8:30pm.  Dinner will be available.  The program will be held in the Science Building (Room 102) at the University of Maine in Machias with videoconferencing to the Washington County Community College in Calais.  A light dinner will be available in Calais as well. The program is being presented at the request of the Washington County coalition working on preventing prescription drug abuse in the county.  The program is funded by the Maine Office of Substance Abuse and Mental Health Services and the Board of Licensure in Medicine.  Faculty announced to date include Tamas Peredy, M.D., State Senator David Burns (R, Whiting), John Lipovsky of the Prescription Monitoring Program, Clare Desrosier of the Diversion Alert Program and Gordon Smith, Esq., from MMA.

There is a $20 charge, payable to the Maine Medical Association.  You may register at the door.    [return to top]

POLITICAL PULSE: Legislature Set to Return Tomorrow

While the legislature has largely wrapped up their work for the session, they return to Augusta tomorrow for a day to consider vetoes that the Governor has issued since they met two weeks ago.  Bills that MMA will be following include: 

  • LD 1046, An Act To Provide Immunity for Prescribing and Dispensing Intranasal Naloxone Kits.  This bill was considered and passed by the Judiciary Committee and full legislature before being vetoed on June 28th.  The bill would authorize a health care professional to prescribe and dispense naloxone to a person at risk of experiencing an opioid-related overdose and a person who may be in a position to assist an individual during an opioid-related overdose.   In the Governor's veto message, he stated he did not support the bill because he believed it would give people addicted to opioids a false sense of security and more likely that they "push themselves to the edge."   His full veto message can be found here
  • LD 386, An Act To Reduce Tobacco-related Illness and Lower Health Care Costs in MaineCare.  This is a bill that restores the smoking-cessation benefit to the MaineCare program.  It was passed unanimously by the Senate and passed the House 140-1.  It is still sitting on the Governor's desk and may be vetoed.  
  • LD 1232, removing the provision of current law that allows the Legislature to approve transfers of funds from the Fund for a Healthy Maine to the General Fund.  This bill was vetoed by the Governor last week. His veto message can be found here
It is expected that tomorrow will be the last day that the legislature meets until they reconvene in January.  The MMA Legislative Committee is also taking a break until a pre-session meeting in the late fall that will be announced in the Update.  MMA staff will continue to include information on bills that will impact medical practice through the Update (see article below on drug importation) and presentations at the Practice Education Seminar and specialty society meetings.  We will also be posting a final legislative summary to the MMA website
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Not Too Late to Register for 10th Annual MMA Benefit Golf Tournament, July 22

Interested golfers may still register for MMA's 10th Annual Benefit Golf Tournament being held on Monday, July 22 at the Augusta Country Club (ACC).  The ACC is in superb shape and will be hosting the Maine Amateur tournament this coming week.  

The format for MMA's tournament will again be a traditional four-person scramble.  Registration and lunch on the deck begin at 11:00am with a shotgun start at noontime.  Prizes will be awarded to men and women for both net and gross prizes as well as for longest drive and closest to the pin on all par three's.  We are fortunate to have Brian Jumper, M.D. again chairing this year's tournament.

Net proceeds from the tournament this year will be to the scholarship fund of the Maine Medical Education Trust. This fund will be utilized exclusively for scholarships for Maine residents in medical school or to help repay loans awarded to same.

MMA is also soliciting hole sponsors ($500 per hole) and donations for the raffle.

To register or to offer a sponsorship or raffle item, e-mail lmartin@mainemed.com or call Lisa at 622-3374 ext. 221.   [return to top]

Health Law Employer Mandate to Be Delayed to 2015

In blog postings July 2, Obama administration officials said the administration will provide another year, until 2015, before key employer coverage and penalty deadlines of the Affordable Care Act take effect.

In the Treasury Notes blog, Mark J. Mazur, assistant secretary for tax policy at Treasury, said the administration “will provide an additional year before the ACA mandatory employer and insurer reporting requirements begin.”

Mazur said the administration recognizes that this transitional relief will make it impractical to determine which employers owe shared responsibility payments for 2014. “Accordingly, we are extending this transition relief to the employer shared responsibility payments. These payments will not apply for 2014. Any employer shared responsibility payments will not apply until 2015.”

He said that during this 2014 transition period, “we strongly encourage employers to maintain or expand health coverage. Also, our actions today do not affect employees' access to the premium tax credits available under the ACA (nor any other provision of the ACA).”

In addition, Valerie Jarrett, senior adviser and assistant to the president for intergovernmental affairs and public engagement, said in a posting titled “We're Listening to Businesses about the Health Care Law,” that “[w]e will convene employers, insurers, and experts to propose a smarter system and, in the interim, suspend reporting for 2014.”

Most large employers already provide coverage that meets the law’s requirements, the officials said.

The Obama administration also announced Friday that it would significantly scale back the health law’s requirements that new insurance marketplaces verify consumers’ income and health insurance status when applying for plans or subsidies through the marketplace. Instead, the federal government will rely more heavily on consumers’ self-reported information until 2015, when it plans to have stronger verification systems in place. [return to top]

State Allows Mail-Order Drugs From Certain Foreign Countries

A bill (L.D. 171) to allow Maine consumers to order prescription drugs from certain licensed pharmacies outside the United States became law June 27.

The mail-order drug bill passed the House June 13 (107-37) and the Senate June 14 (30-4). It then was sent to the desk of Gov. Paul LePage (R), but he took no action within the 10 days required and the bill became law by default on June 27.  It will go into effect 90 days after the legislature adjourns. 

Under the law, people in Maine may order drugs from licensed retail pharmacies and brokers in Australia, Canada, Great Britain, Northern Ireland, and New Zealand, which are considered to have safety and efficacy rules equivalent to U.S. rules. Specifically, the legislation amends the law (32 MRSA §13731, sub-§1), so as to exempt licensed pharmacies in Australia, Canada, Great Britain, Northern Ireland, and New Zealand from having to be licensed in Maine. It also exempts from the Maine licensing requirement brokers of prescription drugs from these countries.

Senate Assistant Majority Leader Troy Jackson (D), the sponsor of the bill, said during a Feb. 19 hearing before the Joint Committee on Labor, Commerce, Research and Economic Development that the bill addresses the ongoing problem of families lacking access to affordable prescription drugs. “Given that in some parts of rural Maine access to pharmacies can be limited, many folks turn to mail-order pharmacies to get the prescriptions they need.”

Law Reverses 2012 Ban on Importing From CanaRX

The law also is aimed at reversing a 2012 ban placed on the popular practice by then-Maine Attorney General William Schneider (R). The ban threw a monkey wrench into a benefit that had been offered by Maine and Portland to their employees, to purchase prescription drugs at mostly cut-rate prices from the Canadian company CanaRX, through its “MaineMeds’’ program. Maine had offered the benefit since 2004. Schneider defined CanaRX as a mail-order pharmacy required to be licensed in Maine. Since the Maine Board of Pharmacy lacked the statutory authority to license a pharmacy in Canada, a de facto ban was placed on importing the company's drugs.

CanaRX is a private company formed in 2002 for the purpose of supplying branded drugs at lower cost to U.S. residents. It serves more than 300 states, towns, and school boards, according to the CanaRX website.

“If the MaineMeds program which was operated by CanaRX could be restored it would be very helpful to us and to many others who had taken advantage of this helpful program,” said retired state employee, Ina Brann, of Windsor, Maine, in written testimony presented during the Feb. 19 hearing. Brann was able to avoid a $70 copayment by purchasing drugs through the program, she said.

Pharmacy, Drug Group Opposition

But the Maine Pharmacy Association and the Pharmaceutical Research and Manufacturers of America opposed the legislation.

“This bill would amend the Maine Pharmacy Act with a mere 13 words and yet would have enormous implications on public safety by circumventing the U.S. Food and Drug Administration and 75 years of federal and state regulations designed to protect our communities from unapproved drugs, adulterated and misbranded drugs, prescription drugs and controlled drugs without a valid prescription” or physician relationship, Kenneth McCall, president of the Maine Pharmacy Association, said in Feb. 19 testimony before the committee.

In response to a request for comment, Matt Bennett, the senior vice president of communications at PhRMA, said July 1 that considering PhRMA's “strong stance against counterfeit medicines and related importation concerns, we were very disappointed to hear that Governor Paul LePage has failed Maine's patients, by allowing L.D. 171 to become law. Opening our borders to unapproved, imported drugs could increase the flow of counterfeit drugs into the U.S., putting patients at senseless risk and with little recourse against their injuries.”

Bennett said that PhRMA will “continue our work advocating for safe medicines for patients in Maine and look forward to ongoing work with the Maine Legislature and the governor on this issue.”

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AMA Secured Key Provisions for IMGs in Immigration Bills

A bipartisan, comprehensive immigration bill that addresses several physician-related issues passed the Senate on June 27 by a vote 68 to 32, following its advancement from the Senate Judiciary Committee at the end of May.

The Border Security, Economic Opportunity and Immigration Modernization Act of 2013, introduced in the Senate in April, puts forth a number of provisions related to physician immigration that the AMA helped secure. The legislation proposes improvements to the Conrad 30 waiver program and the physician National Interest Waiver (NIW) green card program. It also makes several changes to other immigration laws that would help increase access to health care, especially for patients in underserved communities. The provisions include:

  • Permanent reauthorization of the Conrad 30 State J-1 Visa Waiver program. 
  • Increased transparency in employment contract terms (e.g., contracts would have to list hours and locations of work and could not include a noncompete provision).
  • Additional waivers per state for academic medical centers.
  • Establishment of a mechanism to increase the current cap on the number of visa waivers per state.
  • Physicians who work in underserved areas for five years (three of which could be through the Conrad 30 program) would be eligible for a green card through the physician NIW program and exempt from the worldwide cap on employment-based green cards.
  • Physicians who serve in Conrad 30 "flex" spots would be eligible for the NIW green card program. (Each state currently can use 10 of its 30 waivers for physicians who serve patients from underserved areas in facilities that are not located within underserved areas.)
  • Physicians could enter the country on a J visa to receive graduate medical education or training with the intent to immigrate permanently.
  • Spouses and children of physicians on J visas would be exempt from the two-year home country return requirement.

These provisions were taken largely from legislation that AMA staff helped to shape, S. 616, the “Conrad State 30 and Physician Access Act,” introduced by Senators Amy Klobuchar (D-MN) and Jerry Moran (R-KS) on March 19.  

During Judiciary Committee consideration, the AMA also convinced legislators to scrap proposed burdensome recruitment and hiring regulations that would have conflicted with the current operations of the medical residency match process and would have dissuaded employers from hiring international medical graduates (IMG) with H-1B visas.

Given the physician workforce shortage confronting the nation, the AMA strongly supports these provisions that will allow IMGs to continue providing much-needed health care to patients across the country.

The U.S. House of Representatives also is expected to advance separate immigration-related legislation this year.  Rep. Darrell Issa, R-Calif., along with House Judiciary Chairman Bob Goodlatte, R-Va., introduced H.R. 2131, the Skills Visa Act, on May 23. As a result of AMA advocacy efforts, this legislation includes many of the same physician-related immigration provisions as the Senate-passed bill.  H.R. 2131 was passed out of the House Judiciary Committee on June 27.

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Dorothea Dix Psychiatric Center is now Tobacco-Free

Beginning last week, Dorothea Dix Psychiatric Center (DDPC) is now a tobacco-free campus.

Superintendent Sharron Sprague said that since establishing this policy aligns with the hospital’s mission and while it may be challenging for some, it is the right thing to do.

“Tobacco use is the leading cause of preventable death and disease in this country,” she said. “We are a healthcare institution and our job is to save lives and prevent disease, so becoming 100 percent tobacco-free not only makes sense, but it is key to our mission and our vision as part of the Bangor community.”

Beginning last Tuesday, no smoking or tobacco use will be allowed in any DDPC space and staff will be expected to leave hospital grounds to use tobacco products. Patients will not be allowed to leave the hospital to smoke or use tobacco at any time.

“As our first priority, patients will be given resources, information and treatment to make them as comfortable as possible before, during and after their time at Dorothea Dix” said Sprague. “No one, including employees, patients or visitors, will be asked to quit using tobacco, but everyone will be expected to follow the policy.”

The state psychiatric hospital has sent a letter to providers asking that they inform patients of the change.  

All patients and family members will be informed of the tobacco-free campus policy in person verbally, with printed materials, signage and again as part of the patient assessment process, the letter said.  Tobacco products and lighters/matches will be removed and either taken home by family members or stored until discharge.  After admission, tobacco products and lighters/matches found in a patient's possession will be removed and destroyed as contraband. 

The clinical treatment team will develop a tobacco education and treatment plan including counseling, health coaching, medication and care management.  A "quit plan" with various components will be offered on an individual basis.  Specific education for patients will include expected nicotine withdrawal and anxiety symptoms, NRT/medication management, coping skill strategies and relaxation techniques, the letter said.

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CMS Offers Insurance Marketplace Trainings In Maine, July 16 & 25

Maine practices interested in learning more about the health insurance marketplace to be launched in October can attend one of several trainings being offered around the state.  The next two HHS training are being offered in Brewer and Lewiston: 

Date:  Tuesday, July 16

Time:  1pm - 4pm

Location: Brewer Medical Center, 735 Wilson St., Brewer, ME 

Register at http://cmshimtrainingme2.eventbrite.com 

 

Date:  Thursday, July 25

Time:  1pm – 3:30pm

Location: Community Concepts, 240 Bates Street, Lewiston, ME 04240

Register at http://cmshimtrainingme3.eventbrite.com

Ray Hurd, Regional Administrator, of the Centers for Medicare & Medicaid Services (CMS) invites community agencies, health care organizations and other stakeholders to participate in a training forum about the Health Insurance Marketplace in Maine.  This training event is part of our ongoing commitment to encourage public participation by engaging in conversations about the Marketplace in Maine.

If these dates do not work for you, please contact Jessa Barnard at the MMA, jbarnard@mainemed.com, if you are interested in scheduling a training at your practice location.  

CMS has also announced a new phone number and website that patients and practices can contact to learn more about the marketplace:  www.healthcare.gov or  1-800-318-2596. [return to top]

2 Dates/2Locations - Attend Commercial Driver Medical Examiner Training

The Maine Academy of Family Physicians is pleased to announce two more opportunities to complete the newly Federally required “Commercial Driver Medical Examiner (ME)” training here in Maine.

Beginning in 2014, the newly passed Federal regulations will require that anyone performing Commercial Driver physicals (including for school bus drivers), will have to:

a) Complete a certified training course every 5 years and

b) Pass a Federal certification exam every 10 years and

c)  Register for an individual ME provider number (required on all physical forms)

There are many Internists, PAs and NPs here in Maine that are doing these exams.  There are only a few training courses being offered nationally, and we are fortunate to be able to partner with the New England College of Occupational & Environmental Health to bring this training twice more here to Maine – Sept. 7th in Portland, and Oct. 26th in Bangor. 

This day-long program will be eligible for AMA Cat I CME credits (as well as AAFP Prescribed credits)

All of the information (complete brochure and registration form) is located on the AAFP website at: http://www.maineafp.org/nrcme-training.

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Job Openings

Emergency Department PA

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

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

7/8/13

Seeking two (2) full time psychiatrists, psychiatric nurse practitioners and/or physician assistants 

Assistance Plus is seeking two (2) full time psychiatrists, psychiatric nurse practitioners and/or physician assistants for the Medication Management Program in Benton and Wilton. The professional team is overseen by Robert Gordon, medical director. Our primary focus is to assist those with behavioral health disorders.

Applicant must be a graduate of an accredited degree program and licensed to practice in the State-of-Maine. A minimum of three years experience required.

We offer a generous benefit package of full coverage for health, dental, and 401K along with a sign on bonus of $5,000.  This position is Monday through Friday and no on call coverage is required.

Please submit resume and cover letter to Jillian Jolicoeur 453-4708 ext 408 or email jjolicoeur@assistanceplus.com

7/8/13

Family Practice Physicians

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 Houlton locations.  KVHC is a fully electronic medical record site and offers a competitive salary ($170,000 to $190,000 annual) and benefit package which includes: a 10% of first year salary sign on bonus, generous amounts of paid time off, $2500 annually toward CME as well as a completely outpatient site.  The call schedule is 1 in 8 with additional coverage from the Open Access Clinic.  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 10 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 www.kvhc.org.  KVHC is an equal opportunity employer.

8/19/13           

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Upcoming Events

What Health Care Providers Can Do to Address the Needs of Returning Veterans and Their Families 

July 16th, 2013

8:00 am—12:00 pm

Hannaford Lecture Hall, College of Pharmacy. University of New England

Register Online

This training, part of a national educational campaign aimed at civilian healthcare professionals, will enable these community providers to use their current clinical skills to provide culturally appropriate treatment to service members and their families.

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Breath Easy Coalition Annual Meeting 

August 15, 2013

10 am - 2:30 pm 

Augusta, Maine 

Click here to register 

Join us for for this FREE event! Featuring presentations and discussions around how smoke-free policies are impacted by medical marijuana and electronic cigarettes, celebration of 10 years of addressing smoke-free housing, networking, and roundtable peer-to-peer discussions around addressing tobacco-use and secondhand smoke exposure in Maine.

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Maine Public Health Association 29th Annual Meeting 

October 22, 2013 

8:30 am - 4 pm 

Augusta Civic Center 

For more information, click here

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2013 Division of Infectious Disease Annual Conference

November 13, 2013 

Augusta Civic Center

 Sponsored by the Maine Center for Disease Control & Prevention

Since 1983, the Maine Center for Disease Control and Prevention, Division of Infectious Disease, Department of Health and Human Services has organized an annual infectious disease conference targeting public health issues of emerging concern to medical practitioners throughout the State. Presentation topics will focus on a range of infectious diseases and immunizations. This year’s conference includes aspects from the Division of Infectious Disease’s Epidemiology, Immunization, HIV, STD and Viral Hepatitis Programs. 

For more information or to register, click here

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

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

100 Campus Drive, Conference Room, Scarborough, Maine

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

at 207-396-7634 or chasee@mccm.org

FREE CME Credit Available

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

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

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

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

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

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

December 18, 2013:  Palliative Care Review  Dr. Keating

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

February 26, 2014:  Clinical Research Overview  Dr. Thomas

March 26, 2014:  Hematologic, Treatment Update  Dr. Ryan

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