April 14, 2014

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CMS Release of Medicare Data Attracts Lots of Attention; Provides Little of Value

The release last Wednesday of Medicare payment data for individual physicians drew much media attention in Maine and throughout the nation.  The data showed that nearly 5800 Maine physicians and other health care practitioners and providers were paid a total of $300 million for services provided to Medicare patients in 2012.  

The data set was released following several years of litigation with the AMA challenging the release contained information on how much money was received under Medicare's fee-for-service program which covers the vast majority of the twenty plus percent of Mainers who are Medicare recipients.  Nationally, the data release was huge, containing data on more than 880,000 providers who received $77 billion in Medicare payments.

Of the fourteen top individual physicians identified, eight were ophthalmologists, four were oncologists/hematologists, and two were rheumatologists.  In media interviews with the Portland Press Herald, the Lewiston Sun Journal and the Bangor Daily News, MMA representatives emphasized the following points:

  • The amounts paid as reimbursement were gross figures, not net figures and the highest amounts generally included amounts reimbursed for expensive medication (such as Lucentis injected for treatment of macular degeneration at $2,000 per injection per eye.
  • That physicians had no ability to challenge the accuracy of the data.  In at least one case brought to our attention, there were substantial errors in the data.
  • In some cases, payments to one physician may include reimbursements for other practitioners as well who bill under the physician's billing number (this could include residents, physician assistants and others).

The data allows some comparison between specialties, geographic location and individual physicians.

MMA emphasized that the physicians who appear to have received the most reimbursement should not be targeted for fraud investigations but rather should be congratulated for seeing Medicare patients and for accepting the Medicare payments as payment in full for the patients.  "Transparency is a good thing and the release of this data, in and of itself is not a bad thing.  But it is unfortunate that the public was not provided with much context to fully understand the data and the physicians given no opportunity to check the data for accuracy", noted Gordon Smith, Executive Vice President of MMA.

You can read the AMA's statement on the data release here and the AMA's media guide on the data release here.


POLITICAL PULSE: Governor's Veto of MaineCare Expansion Holds, Options Remain

As reported last week, the focus of legislative activity has largely moved to the floor of the House and Senate where unanimous bills will make their way through the process and divided reports will accumulate on the calendar as the 126th Maine Legislature aims towards an April 16th adjournment.

Veto of Medicaid Coverage Bill Sustained, Two More Bills Remain

The Senate voted 22 to 13 last Friday in an attempt to override the Governor's veto of LD 1487, Senator Katz's bill seeking to expand Medicaid coverage to an additional 70,000 uninsured Mainers through federal funds and implementing managed care - just two votes shy of the necessary two-thirds to override the veto. The Maine Medical Association is disappointed in the failure to override the veto of this compromise bill.  MMA believes it is critical to continue to pursue legislative options to accept federal funds to ensure nearly 70,000 Mainers have access to health care.  The MMA encourages legislators to keep working to pass MaineCare expansion this session via other legislative vehicles tabled in both the House and the Senate, and encourages MMA members to contact your legislators to voice support.   You can find your legislators here.

Appropriations Committee Closes Budget Gap for 2015
Early Wednesday morning, after working through the night, the Appropriations Committee closed its second supplemental budget, focused on the remaining FY 2015 issues.  There is approximately $29 million in new spending and $30 million in savings initiatives for FY 2015 in this budget.  The largest spending item was to increase Medicaid payments to providers by $17 million (state share). The largest savings initiative is an adjustment in the timing of Medicaid payments to some providers by requiring DHHS to look at its payment process and stretch the turnaround time for processing claims from the current 7-10 days to approximately 21 days.  There will be exemptions for some providers.  The budget also includes $3.5M (state share) in savings from more intensive Medicaid audit, includes a plan to reduce waitlists for people with developmental disabilities and provides more funding to nursing homes.

Legislature Overrides Veto of Price Transparency Bill, Will Become Law 

Last week, overwhelming majorities of the House and Senate voted to override the Governor's veto of LD 1642.  LD 1642 was Senator Woodbury's bill that attempted to improve upon the bill that passed last legislative session, LD 990, requiring that health care practitioners provide patients with price information.  The new law clarifies that the prices should be listed by CPT code and that the practice needs to notify patients of the list but does not need to provide the full list to every patient. The law also clarifies that a health care entity that does not routinely render services directly to patients in an office setting may satisfy the requirements by providing information on its publicly accessible website. The full text of the final law can be found here.  It will become effective 90 days after the legislature adjourns, or mid-July.  The Governor had vetoed the bill stating that it did not go far enough to provide price information to patients. The House voted 138-4 and the Senate voted 31-3 in favor of the override. 

House Passes Naloxone Bill Unanimously; Governor Threatens Veto

This morning, the House voted in favor of an amended version of L.D. 1686, the widely reported bill to expand access to the anti-overdose drug, naloxone, by a vote of 147-0.  The bill would permit a prescriber to issue a prescription for the drug to a family member of someone at risk and also would permit law enforcement and EMS personnel to carry the drug.  The Governor apparently opposes use by law enforcement personnel.  The measure has not yet been considered by the Senate, but it is likely to pass with sufficient votes to withstand a potential veto.



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Physician Identity Theft Through Fraudulent Tax Returns Surfaces in Maine

Following a trend identified earlier in Indiana, South Dakota, and Puerto Rico, last week the MMA learned that as many as a dozen Maine physicians have been the victims of identity theft through the fraudulent filing of tax returns using their names, addresses, and social security numbers to obtain a tax refund.  Physicians usually discover the problem when they try to electronically file their tax returns but are rejected because a return already has been filed using their social security number.  The MMA would like to understand the scope of the problem in Maine, so if you have been victimized in this way, please contact Gordon Smith, EVP, at gsmith@mainemed.com or 622-3374, ext. 212. 

Also, the MMA encourages all Maine physicians to be alert to this problem during this tax-filing season.  You’ll find more information about the Internal Revenue Service’s (IRS’) recommendations to address this threat here: http://www.irs.gov/uac/Taxpayer-Guide-to-Identity-Theft. [return to top]

Announcing Single Sign-On Access from HealthInfoNet (HIN) to the PMP

To promote use of the Maine PMP and HIN, effective Thursday, April 10th, the PMP is accessible directly from the HIN clinical portal through a single sign-on process. This will provide health care providers throughout Maine easier access to comprehensive patient data and assist them in providing effective patient treatment.
This single sign-on process will allow HIN users to bypass the whole PMP login process and launch directly from the HIN clinical portal to the PMP Practitioner/Pharmacist query portal patient look up site. All prescribers, dispensers and their delegates who are interested in using this feature must be registered to use both the PMP and HIN.

Important: If you want this service, you must request it.
You can sign up for single sign-on one of two ways.

  1. Request access through the HIN portal using the “Request PMP Access” link on the Links Menu.
  2. Contact HealthInfoNet at customercare@hinfonet.org or 207-541-9250. Please include your PMP user name, first name, last name and date of birth in your message.

Need to register with the PMP?
If you are not registered with the PMP, please submit a completed and signed registration request form to the Office of Substance Abuse and Mental Health Services (SAMHS), Prescription Monitoring Program. Registrations forms can be found on www.maine.gov/pmp. For any PMP technical issues, contact the Help Desk at mepmp-info@hidinc.com or 1-866-792-3149.
Need a HIN user account?

If you do not have a HealthInfoNet user account and your organization is connected, contact your organization’s IT Help Desk. If your organization is not connected to HealthInfoNet, please visit the website at www.hinfonet.org or call 207-541-9250 to learn more.

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New Laws Impacting Medical Practice the Subject of May 2 First Friday Presentation

 With the 126th Maine Legislature scheduled to adjourn its Second Regular Session this coming week, MMA will present an educational session on the laws passed by the 126th Legislature on Friday morning, May 2 from 9:00am to noon as part of the First Friday educational programming.

New laws from both sessions will be discussed by a distinguished group of faculty including:

Ann Robinson, J.D., of Preti-Flaherty

Dan Morin,  Government Relations staff at MaineHealth

Charles Soltan, Esq. of the Law Offices of Charles Soltan

MMA Attorneys Gordon Smith, Andrew MacLean and Jessa Barnard.

Among the subject matters discussed will be the new price disclosure laws, the truth in advertising laws enacted in 2013 and the laws enacted amending the Medical Practice Act.

Registration is available on the MMA's website at www.mainemed.com or by calling Ashley Bernier at MMA at 622-3374 ext. 213.   [return to top]

MMA Legislative Committee Weekly Conference Call, Tues., 4/15/14, 8 p.m.

The next MMA Legislative Committee weekly conference call will take place tomorrow night, Tuesday, April 15th at 8:00 p.m. 

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:  1-619-326-2772 

Passcode:  729-7185

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.  The MMA staff lists a suggested position for each bill and any medical specialty particularly affected by the bill.

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

There are no new bills for review this week, but the MMA staff will brief participants on the latest news from the State House. [return to top]

Save the Date: MMA's 23rd Annual Practice Education Seminar June 18 in Augusta

The Augusta Civic Center will once again be the site of the Association's 23rd Annual Practice Education Seminar which is intended to present physicians and practice managers with the information and trends in medical practice in Maine and across the country.  The program will be held on Wednesday, June 18 from 8:15am to 4:00pm.

The theme of this year's program is "Preparing Your Practice for the Rough Road Ahead."  The focus will be on payment reform and best practices.  Carol Vargo from the American Medical Association will present data from the Rand survey conducted for the AMA which asked physicians questions about their level of satisfaction with their work and also elicited opinion about practice sustainability.  Kevin Flanigan, M.D., Medical Director for MaineCare will present a keynote luncheon talk on the State Innovation Model grant and its role in reforming the payment and delivery system in the state.  Other speakers will be announced shortly and the complete program will be included with the April-May-June issue of Maine Medicine. Registration will also be available on the MMA website at www.mainemed.com after May 1.

This year's program is supported by the Payment Reform grant from the Maine Health Access Foundation (MeHAF). [return to top]

Maine Takes Part in National Drug Return Day April 26

Maine is participating in another national drug return day on Saturday, April 26.  In previous years, Maine has led the nation in the number of pills collected on a per capita basis  These twice a year events have made it possible for seniors and others to return unused medication to a central secure site in their community and thus ensure their proper disposal.  Many community police departments maintain secure drop sites throughout the year.

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Over 7 Million Enroll in Health Insurance Marketplace - Special Enrollment Still Available for Some

Health Insurance Marketplace Enrollment Information

Over 7 million people chose a Marketplace plan during the ACA's first open enrollment period which ended on March 31.  As of late February, Maine had surpassed goals for ACA enrollment with the highest number of people enrolled per capita for any federally-facilitated state.  The next open enrollment period to sign up for insurance coverage through the Healthcare Marketplace for 2015 is November 15, 2014 through February 15, 2015.


Coverage Options Outside Open Enrollment

The following information is from www.healthcare.gov:

In order to buy a Marketplace health insurance plan outside the open enrollment period, you must have a qualifying life event or a complicated situation related to using the Health Insurance Marketplace. 

  • If you have a qualifying life event, you get a special enrollment period.  Most special enrollment periods last 60 days from the date of the qualifying life event. 
  • Some examples of qualifying life events are getting married, permanently moving to a new area that offers different health plan options, and having, adopting or placement of a child.
  • Information about qualifying life events, complex situations and special enrollment periods is available at www.healthcare.gov/how-can-i-get-coverage-outside-of-open-enrollment/ (tabs for seven enrollment topic areas are in the left column).

Find out more about health insurance coverage through the Marketplace:

For providers and practice managers:

For additional information about the healthcare marketplace and enrollment, resources for patients or providers, or to schedule a presentation or meeting with staff:

contact Susan Kring, ACA Outreach Coordinator at 662-2364 skring@mainemed.com

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New Funding Opportunity: Improving Access to Quality Care for Uninsured Individuals

The Maine Health Access Foundation (MeHAF) announces the availability of grants under round two of the Improving Access to Quality Care for Uninsured Individuals (A2QC) program.  Grants under this program will support the advancement of a sustainable system of care that delivers comprehensive, high-quality health care services to improve the health of uninsured, low-income individuals, and reduces the time spent in poorly-coordinated, inefficient and costly care.

The A2QC program is an effort to support and work with health systems, health care and social services providers to minimize disruptions in established provider relationships as patients cycle on and off public or private coverage, and advance collaborative, community-based systems of care.

This second round of A2QC planning grants will provide an opportunity for communities in areas of the state where no round one A2QC award was made to apply. Eligible areas: Northern, Eastern, Western, and Central Public Health Districts, Piscataquis County and Northern Penobscot County. Each project's service area may vary from County-wide to individual communities.

Up to three one-year planning grants of up to $50,000 will be available. In 2015, A2QC planning grantees will be eligible to compete for three-year implementation grants.

Informational sessions will be held on 4/15 in Presque Isle, 4/16 in Ellsworth, and 4/17 in Farmington. An informational webinar will also be offered on 4/17.  For more information on the A2QC program, informational sessions and application schedule, go to the A2QC New Funding Opportunity page on the MeHAF website, or contact Program Officer Charles Dwyer.
Deadline for online applications is May 21, 2014 by 4:00 p.m. (EDT).

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President Nominates OMB Director to Replace Sebelius at DHHS

As reported widely in the press over the weekend, on Friday, April 11th, President Obama announced the resignation of DHHS Secretary Kathleen Sebelius and his plan to nominate Sylvia Mathews Burwell, the Director of the Office of Management & Budget (OMB) as her replacement.  Sebelius has been DHHS Secretary since early in the President's first term in 2009.  The President acknowledged Sebelius' hard work in implementing the ACA, but observed that there is more work to be done and that Burwell is an excellent choice to take the helm at DHHS.  The President called Burwell a proven manager who has demonstrated the ability to field great teams, forge strong relationships, and deliver excellent results at the highest levels in both the private and public sectors.  Burwell worked previously as chief operating officer and later president for global development at the Gates Foundation, where she worked on the world's most pressing health challenges.  President Obama also said that Burwell gained experience in how health insurance markets work as the head of the Walmart Foundation and a board member of MetLife. [return to top]

Upcoming Events

Ever Wanted to Take a Harvard Course?

Now you can! Beginning April 7, 2014, Harvard University will be launching a new, free online course about health policy in the United States. You'll have the opportunity to experience world class teaching from a world class faculty as you delve into the essentials of U.S. health care policy.

To learn more about the class visit www.getbettermaine.org


Maine's Health Workforce:  What Does the Data Tell Us?

Presented by the Maine Health Workforce Forum

April 15, 2014

8:30  – 10:30 am 

MaineGeneral Medical Center, Alfond Center for Health, Augusta,

Pre-registration not required

For more information, visit: www.mainehealthworkforceforum.org


2014 Hanley Center Honors for Leadership in Health Equity & Health Disparities

Wednesday, April 16, 2014

 Reception & Dinner

 Portland Marriott at Sable Oaks, South Portland

The keynote speaker at the recognition dinner will be Dr. Lori Alviso Alvord, the first Navajo Woman Surgeon and author of "The Scalpel and the Silver Bear." 

Please join us in an evening celebration to recognize the following Maine-based organizations and individuals for their outstanding achievements assuring equitable care for all Mainers. The honorees include: Marjorie Wither, Maine Migrant Health Program, United Somali Women of Maine & Waldo County Dental Care


MaineCare Provider Advisory Committee Meeting

April 17, 2014


Conference Room 103B

Cross State Office Building, 111 Sewall Street, Augusta, Maine or  via phone:  1-877-455-0244, with passcode 7989253087#

The MaineCare topics for this meeting will be Telemedicine and Physician Assistant prescribing rights. Any provider interested in MaineCare initiatives may attend the meeting.


Webinar - E-cigarettes: Challenges for Clinicians

April 23, 2014

1:00 - 2:30 pm 

This free webinar is hosted by the Smoking Cessation Leadership Center (SCLC) and the Association for the Treatment of Tobacco Use and Dependence (ATTUD).  The webinar will: describe the various types and components of electronic cigarettes (e-cigarettes); describe the current evidence for the clinical use of e-cigarettes among tobacco users; explain the potential clinical and health risks and benefits of e-cigarette use and respond to clinical inquiries regarding e-cigarettes from patients and colleagues. 

Click here to register.

Participants who join the live session on April 23, 2014 can claim CME/CEU credit for $35 per certificate


Prescription Assistance Information and Networking Meeting

April 25, 2014

9 a.m. - 12 p.m

Maine Medical Association, Manchester

To register contact MedHelp Maine medhelpmaine@gwi.net or (207) 793-4462

Meeting attendees from organizations with existing medication access programs will learn best practices from their medication access colleagues, and individuals from communities not yet offering such resources will learn how they might do so. 


The Maine Public Health Association (MPHA) Tobacco Webinar Series  

The Answers Are Out There: Best Practice Strategies to Reduce Tobacco Use

May 1, 2014, 2:00 pm 

Register here: https://www1.gotomeeting.com/register/198693440

Sex Sells: the Wild, Wild East—Emerging Tobacco Trends

May 15, 2014, 2:00 pm 

Register here: https://www1.gotomeeting.com/register/910761344

Consider the Source: The Intersection Between the Fund for a Healthy Maine and Tobacco Prevention and Control

June 3, 2014, 2:00 pm 

Register here: https://www1.gotomeeting.com/register/553284137

For more information, visit: http://www.mainepublichealth.org/events/event/


Maine Society of Eye Physicians and Surgeons Spring Educational Program and Business Meeting

Friday, May 2, 2014

12:00pm - 4:45pm

Harraseeket Inn, Freeport, ME

For more information, please contact Shirley Goggin at sgoggin@mainemed.com or 207-445-2260.


AAP Maine Chapter Annual Spring Education Conference

May 9-10, 2014

Harborside Hotel, Bar Harbor

This year we will focus on "The Main Things for Pediatric Practice in Maine," featuring a keynote address by Ross Greene, PhD, author of The Explosive Child. 

Please visit www.maineaap.org/conferences for more information and to register.  Please register and book your hotel room by April 28th. 


Nominations for 16th Annual Schwartz Center Compassionate Caregiver Award

Due May 9, 2014

This prestigious award recognizes healthcare providers in New England (CT, ME, MA, NH, RI, VT) who display extraordinary compassion in caring for patients. The recipient will receive $5,000, and four finalists will receive $1,000 each. Nominations are due May 9, 2014. The Schwartz Center will honor the award recipient and four finalists at its annual Kenneth B. Schwartz Center Compassionate Healthcare Dinner on November 20, 2014, at the Boston Convention Center. For more information, visit http://www.theschwartzcenter.org/supporting-caregivers/cca.aspx or call (617)724-4746.


Maine Harm Reduction Conference

Wednesday, May 14, 2014

9 am - 4:30 pm 

Kaplan University, Augusta, ME

Keynote Speaker, Jon Zibbell, Medical Anthropologist with the U.S. Centers for Disease Control will explore the intersection of culture, stigma, drug use behaviors and infectious diseases such as HI and hepatitis C. Jon's anthropologcial fieldwork immersed him in the subculture and lives of persons who inject drugs.

For more information, visit: http://www.downeastaidsnetwork.org/mehra-sec/


Inter Professional Collaborative Practice Summit 

May 28, 2014

University of New England Harold Alfond Forum, Biddeford, Maine

Funded by the Josiah Macy, Jr. Foundation and the Maine AHEC network, the summit will host national experts to address the relationship between health professions education, clinical practice, and national healthcare reform. 4.25 hours CME credit expected.

Click here for more information.


Maine Concussion Management Initiative Trainings 

June 13, 2014 in Waterville at Colby College (Date tentative)
October 21, 2014 in Portland in conjunction with the Maine Brain Injury Conference

All sessions 7:30 a.m. - 12:00 p.m. 

Includes An Introduction to Concussions and Concussion Management & Interpreting Neurocognitive Testing (including using ImPACT)

$100 for Health Care Professionals  (CEUs/CME available); $40 for school personnel and all other attendees

For more information or to register, contact Jan Salis, jsalis@aol.com, (207) 577-2018



The Maine Public Health Association’s (MPHA) 30th annual 2014 Fall Conference

October 7, 2014

Augusta Civic Center

MPHA Call for Abstracts for breakout sessions: Abstracts from all areas of public health are welcome.  We encourage abstracts focusing on the theme of building on 30 years of public health progress. All abstracts must be submitted via e-mail no later than Wednesday, May 21 at 5:00 p.m. to MPHAabstracts@gmail.com.

 The Call for Abstract form is available at: http://www.mainepublichealth.org/category/pressroom/


Free On Demand CME: Motivational Interviewing 

Basic Skills and Clinical Applications of Motivational Interviewing

This online activity consists of two-30 minute modules on using motivational interviewing techniques to help patients change health behaviors. Specifically, the program addresses four different problems that negatively affect health: non-adherence to treatment guidelines, poor eating habits, lack of exercise, and smoking. The activity also provides scenarios that demonstrate how MI is used in clinical settings.

Faculty: Michael Bierer, MD, MPH

Provided by Lunder Dineen Health Education Alliance of Maine - In Collaboration with Massachusetts General Hospital

Click here for more information or to take the course.

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Job Openings

Medical Director - Scarborough, ME

We are seeking an experienced Medical Director with interest in occupational medicine for our clinic in Scarborough, ME. The Medical Director will be able to practice medicine in a supportive environment while providing oversight to mid-level practitioners.

The successful candidate must be board certified or board eligible MDs or DOs in Maine. Previous experience in Occupational, Emergency, Internal or General Practice Medicine is preferred.

About U.S. HealthWorks:

U.S. HealthWorks Medical Group is a leading national provider of occupational medicine and urgent care services. Operating close to 200 medical centers in 19 states with nearly 2,000 employees, including approximately 350 affiliated physicians; U.S. HealthWorks serves thousands of patients each day. At U.S. HealthWorks Medical Group, we offer programs and services that can help prevent illness, maintain health and provide early intervention and rehabilitation whenever injuries or health problems occur.

In addition to competitive salaries we offer: 

Occupational Medicine Focus

Incentive plans

Opportunity to grow and learn with an industry-leading healthcare organization

Flexible hours and excellent work environment

Benefits including, health, dental, vision, 401(k)

Apply Today!

Email: providerrecruitment@ushworks.com - Online: www.ushealthworks.com - Call: 1.888.770.8749 ext. 2659



Department of Psychiatry Faculty Position

The Geisel School of Medicine at Dartmouth, Department of Psychiatry, in a productive collaboration with the State of Maine, is seeking psychiatrists to join our faculty for inpatient responsibilities at the Riverview Psychiatric Center.

Riverview Psychiatric Center is a 92-bed acute psychiatric facility located in Augusta, ME and is the flagship inpatient treatment center for Maine’s public mental health system.  Psychiatrists with expertise in general inpatient psychiatry or forensic psychiatry are encouraged to apply.

Academic duties can include teaching and supervision of medical students and residents. Research opportunities available and encouraged.

Candidates should be board certified or eligible in Psychiatry. This position will include a faculty appointment at The Geisel School of Medicine at Dartmouth at a rank and salary commensurate with experience. Curriculum vitae and three letters of reference, addressed to Dr. William Torrey, Search Chair, should be e-mailed to psychiatry.jobs@dartmouth.edu.  Please reference search number PS0314D.

Dartmouth College/Dartmouth Hitchcock Clinic/Geisel School of Medicine is an equal opportunity/ affirmative action employer with a strong commitment to diversity. In that spirit, we are particularly interested in receiving applications from a broad spectrum of people, including women, persons of color, persons with disabilities, veterans or any other legally protected group.


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