October 13, 2014

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MMA Board of Directors to Meet on Wednesday, October 15th

The 26-member MMA Board of Directors will meet this coming Wednesday to consider a variety of issues, including the Resolution supported by the membership at the Annual Session encouraging further MMA action regarding treatment of pain and abuse and diversion of opioid medications.

The meeting will be held at 4:00 p.m. at the MMA offices in the Frank O. Stred Building in Manchester.  Other items on the agenda include:

  • Consideration of a request for MMA to support Question 2 on the November ballot proposing a bond issue to enhance the capabilities of the University of Maine animal and insect testing lab.

  • Consideration of a request by the MMA Public Health Committee to update the existing White Paper on Health System Reform, originally prepared in 2003 and updated in 2010.

  • Annual Review of the MMA and Maine Medical Education Foundation investments provided by investment advisors from RBC Wealth Management.

  • Potential renewal/extension of the two-year pilot program providing a variety of membership services to small Federally Qualified Health Centers.

  • Election of an at-large member of the Board to serve on the Executive Committee

The Board will welcome six new Board members elected at the Annual Session in September.  The Board will be chaired this coming year by Charles Pattavina, M.D. of Winterport.  Dr. Pattavina is an emergency medicine physician who serves as the Chief of the Emergency Department at St. Joseph Hospital in Bangor.

Anthem Covering Virtual PCP Visits

An article in the Portland Press Herald last week informed readers of the marketing by Anthem Blue Cross Blue Shield of Maine of an online service, LiveHealth Online, that Anthem customers in Maine may access for a "virtual" office visit with a primary care physician who is out of state but who has secured a Maine license.  The article features Mia Finkelston, M.D., who resides in Maryland but "sees" patients on-line from Maine and 18 other states.  To date, apparently no Maine physician has signed up with Anthem to provide such a service.  

LiveHealth Online uses a skype-like system in which a patient and a physician can see each other on a smart phone, tablet, or computer.  The LiveHealth Online website states that the typical "visit" is about 10 minutes.  For Anthem patients using the service, the visit is treated the same as an actual visit to the PCP with a typical co-payment of $5 to $10.  Patients who don't have Anthem and want to use LiveHealth pay $49 for a 10 to 15 minute consultation.  Anthem began offering these visits as a covered benefit this past summer and as many as 40 states are now seeing this activity.

In the Press Herald article, Rory Sheehan, an Anthem spokesman, states that insurance company accountants calculated that for Anthem policyholders, every LiveHealth visit saves an average of $71.00 to the entire healthcare system, primarily because patients can avoid visiting more costly urgent care centers and will be less likely to go to hospital emergency departments for non-emergency conditions.

Jeff Holmstrom, D.O., Anthem Medical Director in Maine said LiveHealth will not usurp primary care.  "This will not replace the PCP."  Dr. Holmstrom is quoted  in the article as stating, "This is an opportunity for enhanced access to doctors."   With the patient's permission, each LiveHealth visit is documented and sent to the patient's PCP.

A notable downside to the use of the service is that the physician providing the service does not normally have access to the patient's medical record, although patients can fill out a questionnaire with their medical history.  The "virtual" office visit also does not appear to be consistent with the recent guidelines on telemedicine issued by the Maine Board of Licensure in Medicine.  These guidelines require a face-to-face visit with the patient under some circumstances.




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PQRS Incentive Payments Now Available

Incentive payments for the Physician Quality Reporting System (PQRS) now are available for eligible professionals and group practices who successfully met the program's reporting criteria for Medicare Physician Fee Schedule Part B services furnished in 2013. 

Physicians can access their 2013 feedback reports in two ways:

  • National Provider Identifier (NPI)-level reports. These reports can be requested through the CMS communication support page by creating an NPI-level feedback report request.  The report will be sent electronically in two to four weeks to the email address provided in the request.
  • Taxpayer Identification Number (TIN)-level reports. These reports contain NPI-level detail and are available for download via CMS' quality reporting portal.  An "Individuals Authorized to Access CMS Computer Services" (IACS) account is required to access a TIN-level report through the portal. To request an IACS account, consult the IACS quick references guides

For more information about the PQRS incentive payments, review CMS' analysis and paymentWeb page.  For more information about interpreting the data in the report, view the 2013 PQRS feedback report user guide or the 2013 eRx incentive program feedback report user guide

Physicians can contact the QualityNet Help Desk for assistance 8 a.m.-8 p.m. Eastern time Monday through Friday at (866) 288-8912 or qnetsupport@hcqis.org.

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Newly Added November 7, First Friday Seminar: MaineCare Opiate Limits and Efficient Use and Application of Health Information Technology

November 7, 2014 at the Maine Medical Association - Please register on-line at www.mainemed.com!


To promote the use of Health Information Technology (i.e. PMP, HIE & SBIRT) to assist health care providers throughout Maine in achieving easier access to comprehensive patient data to assist them in providing integrated, effective & efficient patient treatment..  And to inform attendees of the experience in the MaineCare program of the Jan. 1, 2013 prior authorization requirements on opioid-based medication.


8:30 AM     Registration
9:00           MaineCare and Opioids Dr. Kevin Flanigan
10:00         Break
10:10         PMP/HIN Phil Profenno, PMP & Eriko Farnsworth
11:00          Panel session and Q&A
12:00         Adjourn


Philip Profenno, PMP, Director of Implementation and Client Services is Director of Implementation and Client Services at HealthInfoNet and responsible for connecting participants to the exchange, including data integration, clinical portal access, user training and education. He has been an IT Professional serving Maine healthcare organizations for over 20 years with extensive experience implementing practice management and electronic medical records systems. Phil holds a Bachelor of Arts in Mathematics from Bowdoin College and is certified as a Project Management Professional with the Project Management Institute.

Kevin Flanigan, MD is the medical director of MaineCare, the state’s Medicaid program for low-income and disabled adults and children. Among Dr. Flanigan’s goals are reducing the use of hospital emergency departments for nonemergency care and enhancing MaineCare’s statewide care management efforts. Dr. Flanigan is a graduate of the University of Richmond and the Medical College of Virginia in Richmond, Va. He completed an internship and residency at the University of Louisville Hospital in Kentucky, with concentrations in pediatrics and internal medicine. He continues to study at the University of Massachusetts at Amherst and serves in a leadership role with the Maine Medical Association. He first was licensed in Maine in 1997 and has worked in primary care, urgent care and hospital settings.

Eriko Farnsworth is managing the Prescription Monitoring Program’s integration and interoperability projects which include interstate PMP data exchange, integrating state’s health information exchange and other health networks with the PMP. She also oversees PMP data integrity and pharmacy compliance. She is currently involved with various in-state and nationwide committees and leadership groups helping to nationalize and standardize the PMP programs throughout the United States. Eriko’s background in law as well as in behavioral health gives her a unique perspective and insight into enhancing, promoting and increasing PMP utilization for efficient use of health information technology to improve patient care.

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Consider the Hanley Center's Advanced Leadership Course

Physicians are urged to enroll in the Hanley Center's Advanced Leadership Course.  Physicians who enroll this fall in the Hanley Center's 2015 Physician Executive Leadership Institute (Advanced Course) can lock in the 2014 tuition rate.  The Advanced Course has been designed for existing physicians leaders who want to deepen their leadership and management knowledge and skills—and build a trusted network of colleagues across Maine.  The course also is a good fit for physicians who are stepping up to roles of greater influence and authority.  During the past three years, 87 physician leaders from across Maine, Vermont, and New Hampshire have enrolled in the course.  Participating physicians are named "McAfee Fellows" in honor of Dr. Robert McAfee, the only Maine physician to have been elected president of the AMA.  The fourth class of McAfee Fellows will convene next April at the Samoset in Rockport for the first of six two-day sessions led by faculty from Brandeis University and Maine-based physician leaders and other subject matter experts.  The remaining five sessions will take place in Brunswick.  Developed in cooperation with the Maine Medical AssociationMaine Osteopathic Association, the Maine Hospital AssociationMaine Quality Counts, and other groups, the McAfee Fellows program is a major element of a five year plan to build physician leadership capacity throughout Maine.  Nearly 300 physician leaders have enrolled in the Advanced Program and year-long Foundational Programs that have been taken place at 11 sites across the state and New Hampshire over the past 34 months.  Two more Foundational programs are scheduled to begin soon at York Hospital and Central Maine Medical Center. 

To learn more about the Advanced Course, click here or visit www.hanleyleadership.org, to see program dates, an overview of the curriculum and information about the faculty and tuition.  Enrollments received by December 1, 2014 will lock in this year's tuition rate.  No obligation informational conference calls/webinars will begin on October 29th.  For more information, please contact the Hanley Center's Jim Harnar or Kathy Vezina.   [return to top]

Maine Prescription Monitoring Program Soon to Receive VA Data

The Maine office of Veterans Affairs (VA) has advised the Maine PMP that they are ready and have clearance to begin submitting schedule II-IV controlled substance prescription data.  They are communicating with the PMP vendor on logistics and the PMP hopes to start receiving their data very soon.  We will keep you posted on the progress through the Weekly Update. [return to top]

Report Shows Use of Value-Oriented Payments Increasing

According to a report released September 30th by the Catalyst for Payment Reform (CPR), nearly 40% of commercial health insurance carrier payments to physicians and hospitals now are value-oriented rather than simply fee-for-service.  The report, entitled, The National Scorecard of Payment Reform, says that this represents a 29% increase over 2013 when only 11% of payments were value-oriented.  The report is based on data submitted by commercial health insurance carriers covering 65% of commercially-insured lives in the United States.  The report concludes that 38% of payments to hospitals are value-oriented, compared with 24% of payments to primary care physicians and 10% of payments to specialists.  Forty-seven percent of the payments do not put health care providers at risk with much of the value-oriented payments being in "pay for performance" programs that provide potential financial rewards but no financial risk.  You can find the report online here. [return to top]

Mindfullness in Augusta and Waterville - January, February and March

Integrating Mindfulness-based Stress Reduction into Work, Family, Health, & Relationship with instructor Nancy Hathaway, who has studied and taught for 40 years will be offered this January, February, and March in an 8-Week session for 2 hours on Monday evenings in Augusta (5:30-7:30) and in Waterville on Wednesday evenings at School Street Yoga (6-8pm).

For more information please email Nancy at Hathaway.N@gmail.com

January, February, and March 2015 (no class Feb school vacation)
8 week training program
Integrating Mindfulness-based Stress Reduction into Work, Family, Health, & Relationship
with instructor Nancy Hathaway who has studied and taught for 40 years

(5:30-7:30) Monday evenings beginning January 5th

(6-8) Wednesday evenings  at School Street Yoga  beginning January 7th


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8 Top Challenges and Solutions for Making EHRs Usable

From the American Medical Association

It’s no secret that many physicians are unhappy with their electronic health record (EHR) systems, thanks in large part to cumbersome processes and limited features that get in the way of patient care.  Now a panel of experts has called for EHR overhaul, outlining the eight top challenges and solutions for improving EHR usability for physicians and their patients.

This new framework (log in) for EHR usability—developed by the AMA and an external advisory committee of practicing physicians and health IT experts, researchers and executives—focuses on leveraging the potential of EHRs to enhance patient care, improve productivity and reduce administrative costs.  Here are the eight solutions this group identified to address the biggest challenges:

1. Enhance physicians’ ability to provide high-quality patient care.  Poor EHR design gets in the way of face-to-face interaction with patients because physicians are forced to spend more time documenting required information of questionable value.  Features such as pop-up reminders, cumbersome menus and poor user interfaces can make EHRs far more time consuming than paper charts.

Instead, EHRs should be designed to enable physician-patient engagement. Technology should fit seamlessly into the practice and be based on work flow needs.

2. Support team-based care.  Current technology often requires physicians to enter data or perform tasks that other team members should be empowered to complete.  EHR systems instead should be designed to maximize each person’s productivity in accordance with state licensure laws and allow physicians to delegate tasks as appropriate.

3. Promote care coordination.  Transitioning patient care can be a challenge without full EHR interoperability and robust tracking.  EHR systems need to automatically track referrals, consultations, orders and labs so physicians easily can follow the patient’s progression throughout their care.

4. Offer product modularity and configurability. Few EHR systems are built to accommodate physicians’ practice patterns and work flows, which vary depending on size, specialty and setting. Making EHR systems more modular would allow physicians to configure their health IT environment to best suit their work flows and patient populations.  Allowing vendors to focus on specialized applications also would produce the tailored technology physicians need.

5. Reduce cognitive work load.  Although physicians spend significant time navigating their EHR systems, many physicians say that the quality of the clinical narrative in paper charts is more succinct and reflective of the pertinent clinical information.  A lack of context and overly structured data capture requirements, meanwhile, can make interpretation difficult.

EHRs need to support medical decision-making with concise, context-sensitive real-time data. To achieve this, IT developers may need to create sophisticated tools for reporting, analyzing data and supporting decisions. These tools should be customized for each practice environment.

6. Promote interoperability and data exchange.  Data “lock in” is a common problem. EHR systems should facilitate connected health care across care settings and enable both exporting data and properly incorporating data from other systems.  The end result should be a coherent longitudinal patient record that is built from various sources and can be accessed in real time.

7. Facilitate digital patient engagement.  Most EHR systems are not designed to support digital patient engagement.  But incorporating increased interoperability between EHR systems and patients’ mobile technologies and telehealth technologies would be an asset for promoting health and wellness and managing chronic illnesses.

8. Expedite user input into product design and post-implementation feedback.  The meaningful use program requires physicians to use certified EHR technology, but many of these products have performed poorly in real-world practice settings.  EHR systems should give users an automated option to provide context-sensitive feedback that is used to improve system performance and safety.

“Physicians believe it is a national imperative to reframe policy around the desired future capabilities of this technology and emphasize clinical care improvements as the primary focus,” AMA President-Elect Steven J. Stack, MD, said in a news release.

As part of its Professional Satisfaction and Practice Sustainability initiative, the AMA will use this framework to work with physicians, vendors, policymakers, health care systems and researchers to drive EHR improvements that can advance the delivery of high-quality, affordable care.

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Congress Urged to Adopt New Telemedicine Policy

In advance of the 114th Congress—which is expected to consider proposals to expand telemedicine services in Medicare, Medicaid, Veterans Affairs, and other federal health programs—the AMA's new policy on payment and coverage of telemedicine was promoted on Capitol Hill.

AMA Board of Trustees Member Jack Resneck, Jr., MD, presented the AMA's new telemedicine policy during two special congressional events. Dr. Resneck took part in a September 15th staff briefing of the U.S. House of Representatives hosted by the offices of Reps. Doris Matsui, D-California, and Bill Johnson, R-Ohio.  The following day, Dr. Resneck participated in a U.S. Senate Special Committee on Aging roundtable titled "Harnessing the power of telehealth: Promises and challenges?"

During these presentations, Dr. Resneck also discussed the AMA's support for the Federation of State Medical Boards' efforts to modernize and streamline the state-based licensure processes through an interstate physician licensure compact.

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Doctors Advocate for SGR Repeal During Lame Duck Session

Members of Congress received house calls from physician leaders the week of September 15th as members of the AMA Board of Trustees and leaders of four national specialty organizations, the AMA Council on Legislation and attendees of the annual AMPAC Federation meeting conducted more than 100 meetings on Capitol Hill, urging their U.S. senators and representatives to make repealing Medicare's sustainable growth rate (SGR) formula a priority for the lame duck session. 

Physicians asked Congress to pass H.R. 4015/S. 2000, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014, which garnered bipartisan, bicameral support earlier this year.  At the same time, the New Democrat Coalition held a briefing September 18th for its members and staff regarding the need for SGR repeal, during which the flaws of the formula and the negative impacts of perennial SGR patches were explained. 

All physicians should contact their U.S. senators and representatives while Congress is on recess over the next several weeks to encourage them to repeal the SGR formula during the lame duck session.  Visit the Fix Medicare Now website to access materials that can help these advocacy efforts. [return to top]

Upcoming Events


Maine Health Management Coalition 2014 Annual Symposium:

"Finding Value: How to Lower Cost & Improve Health"

Wednesday, October 15th, 8 am to 2:45 pm

at the Abromson Center on the University of Southern Maine campus 

MMA members are entitled to a special registration fee of $75 (instead of $100).

The Symposium is shaping up to be a truly enlivening event for all those engaged in the challenging work of improving health care delivery and controlling costs.  Highlights of the day will include:

  • Keynote speaker Ron Sims, Board Chair of Washington Healthplanfinder, Washington State’s insurance exchange.  A community health innovator, Sims is well-known for the award-winning employee wellness program he instituted to reduce rising healthcare costs.  Within the program’s first year, 75% of employees at moderate or high risk for developing a chronic disease eliminated at least one risk factor.
  • Other outstanding speakers include Neel Shah, MD, MPP, Founder and Executive Director of CostofCare.org, a national nonprofit that helps caregivers engage in controlling medical costs, and Richard Wexler, MD, Chief Integration Officer of Healthwise, which merged with the Informed Medical Decisions Foundation in April 2014 and now uses expertise in shared medical decision making to help people make better health decisions.

A full agenda with links to all of the Symposium details is available at http://www.mehmc.org/news-events/2014-symposium/agenda/. To register, go to https://webapp.usm.maine.edu/DCPEOnline/addRegCONFPage1.do?offeringId=100075926.


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

Family Physician - Potential income of $430,000.00 plus

We are recruiting for a full-time primary care physician with emergency/urgent care experience for a client in Nova Scotia, Canada.

The position is at a small community hospital near the town of Antigonish, Nova Scotia.  Antigonish is a vibrant, welcoming community and home to one of Canada’s top undergraduate schools, St. Francis Xavier University. 

The physician will be expected to maintain a primary care clinic at a community hospital and participate in after hours call for the level 1 ER at the facility.  The emergency room sees approximately 30-40 patients per day. 

This is an ideal position for a new physician with a sense of adventure, or an experienced physician looking for more work-life balance.  

Income is from an Alternative Payment Plan (APP) and fee-for-service.  Income of $236,000.00 for APP for daytime work, and $140/hour for out of hours emergency room coverage (expected 1400 hours of emergency room coverage, per physician, per year; 1 in 4 call.)

You will have access to a wide range of outdoor/indoor activities, including hiking, golf, boating, skating and, of course, hockey. (It’s Canada, after all.)  

Please Contact:

David Nurse

CanAm Physician Recruiting Inc.

Office: 1-902-719-7309

Fax: 1-902-640-3118



Industrial Physician - Salaried Job Opportunity

Job Description:

  • Provides routine and emergency medical services to BIW employees
  • Performs physical examinations to support regulatory driven medical surveillance programs such as asbestos, lead, cadmium, respirator and hearing conservation
  • Performs pre-placement and return-to-work examinations
  • Performs patient examinations to support the company's Probable Cause policy
  • Provides medical support for sea trials
  • Determines work capacity and assigns work restrictions for new or chronic injuries and illnesses
  • Interfaces with Workers' Compensation to assist case management
  • Participates in quality assurance audits
  • Provides consultation to management on ADA and job accommodations
  • Participates in updating clinic protocols and standards of practice

Required Education/Training:

  • Allopathic/osteopathic physician with Maine license
  • Board certified or board eligible in occupational medicine
  • ACLS certified

Experience (type and number of years):  Four years’ experience in ambulatory care preferred

Unique/Additional Requirements:  DOT/CDL examiner certification desirable

Thank you for your interest in Bath Iron Works.  For a link to this listing and other career opportunities, please visit our web site at: https://www.gdbiw.com/careers


Family Nurse Practitioner

Sacopee Valley Health Center is recruiting a Family Nurse Practitioner to provide walk-in care on Fridays, Saturdays and Sundays.  This 30 hour per week position involves no after-hours call with an excellent benefit package including health, disability and life insurance, 401k retirement plan, and a generous paid time off plan. Applicants must be a graduate of a Family Nurse Practitioner Program with current Maine licensure. Please submit resume to nbuck@svhc.org or mail to:  Human Resources Coordinator, Sacopee Valley Health Center, 70 Main Street, Porter, Maine 04068. Sacopee Valley Health Center is an Equal Opportunity Provider and Employer.


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, Ashland 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.

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.






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