July 7, 2014

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U.S. CDC Highlights Mainers' Use of Long-term Opiates

According to a new study by the U.S. Centers for Disease Control and Prevention, in 2012, Maine had the nation's highest rate of prescriptions for long-term, extended release opiate medications.  But there are some indications that opiate use in the state, via legal prescriptions, has decreased since 2012.

The study shows that physicians and other prescribers in Maine wrote 21.8 such prescriptions per 100 residents which is more than twice the national average of 10.3.  The authors of the study noted that long-term, extended release opiates, including such drugs as Oxycontin and fentanyl, are more likely to be abused and more likely to be associated with overdose deaths than other prescription drugs. Based on the 2012 data, Maine also ranked 11th nationally in the prescription rate for high dose pain medication that is opiate based.

The study, which was widely publicized in Maine and around the nation last week, was based on data that preceded the 2013 MaineCare rules which limited, subject to prior authorization, the maximum dosages of opiates that MaineCare will cover for both acute and chronic conditions.  The limits, which were mandated by legislative action, took effect on January 1, 2013 and led to a 17 percent reduction in opiate medications from 2012 to 2013.  Data so far in 2014 is consistent with this decrease.  Kevin Flanigan, M.D., MaineCare Medical Director was quoted in some of the articles in the media last week and he noted that the CDC data gives credence to the work that was done in 2012 and prior to that time.  The Portland Press Herald in its July 3rd story quotes Dr. Flanigan as stating, "We've taken some very definitive actions and the providers and the patients have responded very positively to it."

In a related development, last Monday (just before the publication of the CDC reports), Attorney General Janet Mills convened a group of interested parties in her office to discuss prescription drug abuse in the state, the growing number of overdose deaths and efforts by law enforcement to apprehend and punish those individuals trafficking in illegal drugs.  MMA representatives were invited and attended, as did representatives of various state and federal law enforcement offices, the Office of Substance Abuse and Adult Mental Health Services, and representatives of pharmacists, nurse practitioners, and hospitals.  Attendees reported on efforts their organizations were engaged in regarding prescription drug abuse, diversion, and addiction.  A lot of focus was on the Prescription Monitoring Program and the many enhancements that have been made with more in progress.


New Resources Available on MMA Payment Reform Webpage

Please visit the MMA's payment reform webpage where you will find several new additions including the latest report from the AMA Innovators Committee “Where Do I Fit In? Dividing the Pie in New Payment Models.”  This resource provides guidance to practicing physicians about how payments might flow to individual providers under new models, as well as the organizational and governing structures and the negotiating strategies that are likely to ensure payments are disbursed fairly among model participants.  Under the webpage’s “Webinars and Presentations” section, you will also find an archived collection of eight webinars on payment and delivery reform offered by the AMA between November 2012 and April 2014.  Please visit the payment reform webpage to view these and many other resources for physicians.

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Senior Section Luncheon on August 20th to Feature Discussion on Single Payer

MMA's Senior Section, which meets several times a year over lunch to allow our retired physicians to network and stay connected to what is happening in health care in Maine will convene again on Wednesday, August 20th at 11:30 a.m. at the Frank O. Stred Building in Manchester.  The topic for the session will be Single Payer Healthcare with presentations by Philip Caper, M.D., from Maine Allcare, State Senator Geoffrey Gratwick, M.D. (D-Penobscot) and State Representative Charles Priest, Esq. (D-Brunswick).  There will be ample time reserved for questions and discussion.

Any MMA member is welcome to attend the luncheon, whether retired or not, but please let us know for planning purposes by either calling Lisa Martin at 622-3374, ext. 221 or e-mailing her at lmartin@mainemed.com.  The Senior Section is chaired by Buell Miller, M.D.

There is no charge for this MMA event.

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Maine Quality Counts Launches Patient Provider Partnership (P3) Pilot Initiative

 Maine Quality Counts is launching the Patient Provider Partnership (P3) Pilot Initiative, a program in ten primary care and behavioral health practices with the goal to improve health care quality and reduce avoidable costs by engaging patients more actively in decisions about their health care. 


The P3 Pilot Initiative will address three priority areas of high strategic importance to the state.  The first set of pilots will use the American Board of Internal Medicine (ABIM) Foundation’s “Choosing Wisely®” initiative as the basis for promoting more productive patient-provider conversations and engaging patients in shared decision making about their care.  The second set will focus on shared decision making for low back pain treatment.  The third will focus on medication decisions in behavioral health.


Each of the P3 Pilots will be designed to engage physician practices or provider organizations as a means of testing how such patient-provider partnerships can subsequently be implemented more widely in provider organizations and communities. 


“We need to fully engage patients in their care and patient engagement starts with giving patients the tools they need to work with their health care provider and ask questions.  Patients without the skills to manage their health care incur costs up to 21 percent higher than patients who are highly engaged in their care,” 1 says Dr. Lisa Ryan, P3 Pilot Physician Consultant.


Dr. Neil Korsen, P3 Pilot Shared Decision Making Physician Consultant, says “the time is now to transform the patient-provider experience through the use of shared decision aids that help bring the patient’s views and preferences into the clinical decision making discussion.”


The ten participating practices will attend learning sessions, develop plans to incorporate shared decision making tools and patient aids into their practice workflow and engage and empower patients in the visit.  The pilot program will run through March 2015, culminating with each practice reporting the best practices they discovered for engaging patients in their care.


The P3 Pilot sites are:

Choosing Wisely Pilots:

·         Gardiner Family Medicine

·         Lisbon Family Practice

·         Sebasticook Family Doctors

·         St. Mary’s Regional Medical Center – Poland Family Practice


Low Back Pain Pilots:

·         Intermed

·         New England Sport and Spine

·         University of New England College of Osteopathic Medicine and Southern Maine Healthcare


Medication Decision in Behavioral Health Pilots:

·         EMMC Family Medicine – Husson Avenue

·         Maine Medical Center Psychiatry OP

·         Tri-County Mental Health Services [return to top]

Ethical Issues in Contemporary Medicine is next First Friday Program on August 1

MMA's popular First Friday educational series continues on Friday morning, August 1st with a program entitled, "Ethical Issues in Contemporary Medicine."   The program will be held from 9:00 am to noon at the offices of the Association in Manchester, Maine although it can also be accessed through webex.  The program will explore many of the ethical issues that arise in a medical practice and hospital today and ethics committee members may find the program particularly valuable.  The faculty will include Frank Chessa, Ph.D., Director, Clinical Ethics at Maine Medical Center and Assistant Professor at the Tufts University School of Medicine, Steve Johnson, Esq. with Kozak & Gayer, P.A., and MMA attorneys Gordon Smith and Andrew MacLean.  You may register at any time at www.mainemed.com.  The registration fee is $70 per person. [return to top]

MMA Needs Your Imput on MaineCare and ACA Primary Care Fee Increase

The Affordable Care Act made available to all states 100% funding for calender years 2013 and 2014 to increase Medicaid fees to Medicare rates for most primary care codes.  Physicians eligible needed to complete an attestation statement and forward it to the Office of MaineCare Services attesting to the fact that they were practicing in family medicine, internal medicine or pediatrics.  Physicians employed by an entity receiving provider-based reimbursement or salaried by a federally qualified health center were not eligible as their reimbursement methodologies were already enhanced by facility fees.  

Based on information provided by MaineCare, it appears that nearly seven million dollars annually is being received through this increase.  As MaineCare reviews whether to seek state funds to continue the increase, it has asked MMA to inquire of the practices what the impact of the additional reimbursement has been.  Have any practices re-opened to MaineCare patients if they were previously closed?  What was the financial impact of the increase to your practice? Have practices that were still open to MaineCare patients accepted more because of the increase?  Our ability to furnish this type of information will be essential in our advocacy to retain the increase.

While President Obama included an additional year of the increase in his proposed federal budget for FY 2016, this proposed budget is unlikely to be accepted by the Republican controlled House of Representatives.

Any information that you can provide that would be helpful on this issue should be sent to MMA EVP Gordon Smith, Esq., at gsmith@mainemed.com.  Or give Gordon a call at 622-3374 ext. 212. [return to top]

MMA Nominations Committee Seeking A Few Good Men and Women
The MMA Committee on Nominations, Chaired by Kenneth Christian, M.D. of Holden, will be meeting in July to fill committee and board of director positions within the Association.  If you are an MMA member and would like to step up to the plate and provide some volunteer leadership in your professional association, please communicate with EVP Gordon Smith, Esq. at gsmith@mainemed.com.  There are Board of Director positions available, as well as positions on the following committees:

Payment Reform
Physician Quality Committee (oversees all MMA activities in the area of quality improvement, including the external peer review committee and the office-based quality improvement committee)
Loan and Trust
Committee on Legislation
CME and Accreditation
Public Health 
Annual Session
All the nominations made will be presented to the membership at the Annual Membership meeting on Saturday, Sept. 6 in Bar Harbor, held in conjunction with the MMA 161st Annual Session.


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Register Now: MMA's 11th Annual Golf Tournament on Monday, July 21st, Honoring John B. Makin, Jr., M.D.

The MMA's 11th Annual Golf Tournament is scheduled for Monday, July 21st at the beautiful Augusta Country Club in Manchester, Maine.  This year's tournament will honor Past President and avid golfer John B. Makin, Jr., M.D. who died unexpectedly late last year.  The two beneficiaries of the tournament this year are the Maine Medical Education Trust Scholarship Fund and the Memphis Area Golden Retriever Rescue, Dr. Makin's favorite charity.  We welcome players and sponsors both and you will find registration details and online registration on the MMA web site here.  

For more information about the event, you also may contact Lisa Martin at lmartin@mainemed.com or 622-3374, ext. 221. [return to top]

Rescheduling TRAMADOL as Schedule IV drug as of August 18, 2014

DEA Publishes Final Rules Rescheduling Tramadol to Schedule IV

Effective August 18, 2014

The US Drug Enforcement Administration today published its Final Rule in the Federal Register placing tramadol into Schedule IV effective August 18, 2014.

A number of states in the country including Arkansas, Mississippi and New York have already placed tramadol as a controlled substance.

Acknowledging that changes such as these take time to implement, the DEA extended the usual effective date for this type of change from 30 to 45 days to provide what it considers to be "reasonable time for registrants to comply with handling requirements for a schedule IV" drug, such as moving tramadol products into a warehouse cage or adjusting suspicious monitoring systems to include tramadol orders.

Effective August 18, 2014 all manufacturers will be required to print the designation "C-IV" on every bottle and it is unlawful for commercial containers of tramadol to be distributed without that designation.  In addition, all DEA registrants will be required to take an inventory of all tramadol stock in compliance with 21 C.F.R. §  1304.11(d).

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White House Report on ACA Medicaid Expansion Describes What Some States are Missing

On July 2nd, the White House released a report entitled, Missed Opportunities:  The Consequences of State Decisions Not to Expand Medicaid addressing the losses for the 24 states that chose not to accept the federal funds available under the ACA for Medicaid expansion.  These states would have received $88 billion in additional federal funds through 2016 and this money could have created 379,000 jobs through 2017.  More than 4.3 million people will get health insurance coverage by 2016 in the 26 states that have expanded their Medicaid eligibility while an estimated 5.7 million people will go without insurance in the states that have not pursued Medicaid expansion.  You can read more about the recent report here. [return to top]

Upcoming Events

5th Annual Patient Safety Academy

Friday, September 5, 2014

 9 am – 4 pm

University of Southern Maine, Portland campus, Abromson Center

Cost: $50, with a discounted rate of $25 for students

Registration is now open. To register, click here or visit the Patient Safety Academy webpage at usm.maine.edu/muskie/psa

The Maine Public Health Association’s (MPHA) 

30th Annual Fall Conference

October 7, 2014

Augusta Civic Center

Keynote speakers include: Erik N. Steele, D.O., FAAFP, Senior Vice President, Chief Medical Officer, Summa Health System and Paul Kuehnert, DNP, RN Team Director for the Bridging Health and Health Care Portfolio, Robert Wood Johnson Foundation

For more information or to register, click here.


Maine Concussion Management Initiative Training

October 21, 2014 in Portland in conjunction with the Maine Brain Injury Conference

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

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Job Openings

Join the Health Team or Professional Space Available

We are a dynamic Bone Health Team in South Portland Maine, looking for providers to join us to help promote and manage overall health, bone strength, nutrition, fitness and related lifestyle enhancement.  We offer high quality DXA testing and comprehensive osteoporosis management skills.  We created and continue to run the Southern Maine Osteoporosis Support and Education Group - since 1996.  If you really want to help patients to improve their health and their lives - this is the place.   Ann Babbitt MD and Staff

We also offer the opportunity for Office Sharing or Rental:   1) ~ 1500- 4800 sq. ft.  -several offices and exam rooms 9 +, open space for meetings/activities, full kitchen and storage area, 3 bathrooms, lots of parking; all is on ground level. The spaces and possibilities are flexible and options are available.  

Call 207-233-4266 or email ababbitt@maine.rr.com.


Full time Emergency Department Position Available

A full time Emergency Department position is available at Sebasticook Valley Hospital (SVH). Join a hospital employed team of 5 physicians providing 24-hour coverage. ED volume is 13,000 annually. Schedule options include 12 and 24 hr. shifts. SVH is part of the Eastern Maine Healthcare System. Ground transportation and Lifeflight services are available at SVH. The position comes with generous pay rate, vacation, malpractice, relocation expenses, and assistance with medical education debt. Qualifications: Board Certified in Emergency Medicine, or Family Practice with ED/urgent care experience. Contact: Sherry Tardy, 207-487-4085.

Sebasticook Valley Health (SVH) is a progressive 25-bed Critical Access Hospital in Pittsfield, Maine. We are an integral member of the communities it serves. SVH takes a proactive approach in helping people in the Sebasticook Valley region improve the quality of their lives. The hospital works with local businesses, schools, area organizations, and private individuals to make the Valley a healthy place to live. SVH serves an area of approximately 16,500 people and has a wide range of outpatient services, including many specialty services. An expansion and total renovation of the inpatient unit was completed in 2013, offering attractive spacious private patient rooms, state of the art communication’s system.


ED Provider Jobs

Challenging, Lucrative, ED Provider jobs in central Maine - honoring and serving Veterans.  ED Physicians are needed in Augusta. Must-have an unrestricted medical license (from any U.S. state), and current ACLS certification. This is your opportunity to use and develop your skills of diagnosing, treating, and managing patients according to standard, usual, and acceptable methods and techniques.

B/C or B/E specializing in EM, IM, or FP by the appropriate accrediting agencies (EM preferred).

This is the opportunity for you to receive a competitive salary, a generous leave package, excellent health & life insurance benefits, and retirement benefits. You'd be eligible to participate in a pension program as well as a matching Thrift Savings Plan which is similar to a 401K. If you are a veteran, you may be able to combine accrued military retirement credit with VA pension benefits.

Your salary will be determined by local Physician/Dentist Compensation Panel (commensurate with education, experience and qualifications). By law, U.S. Citizens will be given 1st preference but non-citizens will be considered in the absence of qualified citizens. A signing bonus may be available.  Equal Opportunity Employer. Disabled persons and/or veterans are encouraged to apply.

FMI, call John Poulin at (877) 421-8263 x6913, or email him at john.poulin@va.gov

To apply, go to https://www.usajobs.gov/GetJob/ViewDetails/328066200


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