December 21, 2015

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Congress Passes Year-end Spending Bill and Tax Package to Close out 2015

This past week the Congress passed a bi-partisan year-end $1.15 trillion spending bill and a $680 billion tax package before recessing for the holidays.  Several provisions in the package are of interest to physicians.

Among the several provisions of interest to physicians and other health professionals:

  • A two-year delay in the "cadillac tax" and the medical device tax and a one-year delay in the health insurers tax, all three of which were established in the Affordable Care Act.

  • The National Institutes of Health will receive a $2 billion spending increase in 2016, $264 million of which is earmarked for the National Cancer Institute.

  • The ACA "risk corridor" program will be budget neutral for the second straight year.

  • First Responders on 9/11 will have their medical expenses associated with 9/11 paid for by the federal government for their lifetime.

The ACA 40% excise tax on high premium employer-sponsored health benefits was originally slated to go into effect in 2013. It was then pushed back to 2018 during the 2009 healthcare debate. Under last week's language, it won't go into effect until 2020. A bill pending in the Congress calling for outright repeal of the unpopular tax currently has 184 cosponsors, including 154 Democrats.  

Despite the provisions described above, President Obama has indicated his intent to sign the bill. All four members of Maine's congressional delegation voted for the legislation.

Maine Opiate Collaborative Announces Community Forums

The Executive Panel of the Maine Opiate Collaborative held a press conference at MMA offices last week to announce that ten or more community forums will be held around the state to hear from Maine citizens on the impact of the opioid/heroin crisis in the state. All three members of the Panel, U.S. Attorney Thomas Delahanty, State Attorney General Janet Mills and Commissioner of Public Safety John Morris all spoke at the event which attracted all the major TV stations and nearly a dozen print journalists.  

Also speaking at the press conference were three co-chairs of the Task Forces organized earlier in the Fall. Pat Kimball spoke for the Treatment Task Force, William Paterson for the Prevention/Harm Reduction Task Force and Portland Police Chief Michael Sauschuck for the Law Enforcement Task Force. Each Task Force has met four or five times and will continue to meet until a comprehensive set of recommendations has been made.  

Completing the press conference were Wendy Wolf, M.D., MPH, President of the Maine Health Access Foundation and Steven Rowe, President and CEO of the Maine Community Foundation who announced financial support of the two foundations for the community forums. The forums will be held in January and February throughout the state, with at least one forum being held in each of the nine public health districts in the state. If you would like to be involved in a forum in your area, please contact Carol Kelly at Carol has been retained by MMA to organize and facilitate the community discussions as MMA is the grantee of the foundation funds noted above.

More information will be available on the U.S. Attorney's website and the MMA website at

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FDA Proposes Ban on Indoor Tanning for Minors

On Friday, Dec. 18, the Food and Drug Administration announced a federal regulatory proposal prohibiting minors from using indoor tanning equipment. The FDA also will require tanning bed users to sign consent forms acknowledging the risks of the tanning salons. Salon operators would have to collect the forms from customers before their first tanning session and every six months thereafter.

Leadership of the American Academy of Dermatology welcomed the announcement following years of advocating for the action. Because of the alarming increase in the number of new cases of melanoma, the deadliest form of skin cancer, twenty three states already ban minors from using indoor tanning equipment.

"Despite available information about its adverse effects, many high schoolers continue to use indoor tanning devices", the FDA's Dr. Vasum Peiris told reporters.  "Now we're taking further steps."  Dr. Peiris is a chief medical officers in the FDA's device center. The FDA would be able to seize machines and fine tanning businesses that don't follow the rules, once finalized.

The Maine Medical Association has strongly supported such a ban in Maine. The Maine legislature has enacted such a prohibition on two occasions, only to have Governor Paul LePage veto the legislation and having the veto sustained. The MMA continues to support this and other initiatives to combat cancer.

Nearly 74,000 new cases of melanoma are expected to be diagnosed this year, and the disease is expected to cause nearly 10,000 deaths, according to the American Cancer Society.


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CDC Releases Data on 2014 Overdose Deaths

Friday's CDC MMWR contained an article on drug overdose deaths based on 2014 data. The article can be found at  A hearty thanks to Dora Mills, M.D., MPH for preparing the summary from the text of the article.

As expected, overdoes deaths have increased exponentially since 2000, including a 200% increase in the rate of overdose deaths involving opioids (including prescription pain relievers and heroin). Since 2000, the age-adjusted drug overdose death rate has more than doubled, from 6.2 per 100,000 persons in 2000 to 14.7 per 100,000 in 2014. Maine's rate in 2014 was 16.8 per 100,000.

States with statistically significant increases in the rate of drug overdose deaths from 2013 to 2014 included Alabama, Georgia, Illinois, Indiana, Maine, Maryland, Massachusetts, Michigan, New Hampshire, New Mexico, North Dakota, Ohio, Pennsylvania and Virginia. Maine saw a 27% increase in drug overdose deaths from 2013-2014; the U.S. overall saw a 6.5% increase.

In 2014, there were approximately one and a half times more drug overdose deaths in the U.S. than deaths from motor vehicle crashes. Opioids, primarily prescription pain relievers and heroin, are the major drugs associated with overdose deaths.

The 2014 data demonstrate that the United States' opioid overdose epidemic includes two distinct but interrelated trends; a 15-year increase in overdose deaths involving prescription opioid pain relievers and a recent surge in illicit opioid overdose deaths, driven largely by heroin.

Past misuse of prescription opioids is the strongest risk factor for heroin initiation and use, specifically among persons who report past-year dependence or abuse. The increased availability of heroin, combined with its relative low price and high purity appear to be the major drivers of the upward trend in heroin use and overdose.

To reverse the epidemic of opioid drug overdose deaths and prevent opioid-related morbidity, efforts to improve safer prescribing of prescription opioids must be intensified. Opioid pain reliever prescribing has quadrupled since 1999 and has increased in parallel with overdoses involving the most commonly used opioid pain relievers.  CDC has developed a draft guideline for the prescribing of opioids for chronic pain to address this need.  

In addition, efforts are needed to protect persons already dependent on opioids from overdose and other harms. This includes expanding access to and use of naloxone and increasing access to medication-assisted treatment, in combination with behavioral therapies. Efforts to ensure access to integrated prevention services including access to syringe service programs when available, is also an important consideration to prevent the spread of hepatitis C virus and human immunodeficiency virus infections from injection drug use.

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MMA Presents Opioid Prescribing and PMP Education on Jan. 20 in S. Portland

The Maine Medical Association will present a three hour CME course on opioid prescribing and the prescription monitoring program on Wednesday, Jan. 20 from 5:00 to 8:30pm at the Double Tree hotel in So. Portland.  The faculty includes Karen Simone, Pharm D., toxicologist for the Northern New England Poison Control Center, Stephanie Nichol, Pharm D., Husson College School of Pharmacy, John Lipovsky, MA, of the Prescription Monitoring Program and Gordon Smith, Esq., EVP of MMA.

As prescribing rates of pain medication in the state remain high in comparison to other states, it is essential that prescribers bring themselves up to date on the many guidelines now available for prescribing for pain while assessing for appropriate risk.  This program will include several tools to assist prescribers including a discussion of the new proposed guidelines proposed by the CDC.  Faculty will also discuss the current activities of the three Task Forces in the state addressing the problems of opioid/heroin abuse.

Registration is available by calling 622-3374 and on-line at   A $25 fee is charged to cover the cost of dinner and materials.

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Enrollments in Insurance Marketplace Surge Nationally

Through last week, nearly 6 million people have selected health plans for 2016 through that serves 38 states, including Maine.  "The more who sign up, the stronger the system becomes," President Obama announced to reporters at the White House.  "That is good news for every American who no longer has to worry about being just one illness or accident away from financial hardship."

In addition, hundreds of thousands of additional consumers have selected plans through marketplaces operated by those states operating their own enrollment systems, including California, New York, Connecticut and Maryland, and also the District of Columbia.

MMA provides information on enrollment opportunities for medical practices to distribute to eligible patients.  If you would like to partner with MMA in sharing these materials, please contact Susan Kring at  or call her at 662-2364.  Open enrollment closes on Jan. 31, 2016.

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A No-Cost Resource for Supporting Maine Physician Practices: Introducing the Northern New England Practice Transformation Network

Maine Quality Counts and regional partners have created the Northern New England Practice Transformation Network (NNE-PTN), a federally-funded set of resources and learning available to practices at no cost.  The NNE-PTN is a collaborative effort of trusted organizations that is offering support to primary care, specialist, and behavioral health clinicians to improve the health of patients, improve the health and vitality of clinicians and practice teams, and strengthen the financial health of practices. 

Interested practices can register for participation in the NNE-PTN online at

For more information, visit the Maine Quality Counts website at, or contact Lesley Myska at tel. 207.620.8526, ext. 1007 or  

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US Gun Deaths Now as Common as Motor Vehicle Deaths

According to new federal data for 2014 cited by Reuters, Americans are now just as likely to die by gunshot as in a motor vehicle accident. Each accounts for approximately 34,000 deaths per year. While gun homicide rates have fallen in recent years, that decline has been offset by a rise in suicide by firearm. Two out of every three gun deaths in the U.S. are attributable to suicide.

In New England, gun deaths outnumber traffic accident deaths in Vermont and New Hampshire, while vehicular deaths still prevail in the other four states. Nationwide, gun deaths outnumber vehicle deaths in 21 states and D.C.

The article points out that motor vehicle deaths can be attributed to increased regulation, improved technology, and better hospital care. Since the 1960s, we have seen mandatory seat belt use, anti-lock brakes, and electronic stability systems, along with better highway engineering. At the same time penalties have increased for drunk or distracted driving. Both government and the auto industry have invested significant amount so money in auto safety research.

In contrast to the changes relating to motor vehicles, technological changes toward improved safety have faced significant political opposition from the National Rifle Association and others, as have attempts at increased regulation such as universal background checks. There is also a longstanding ban on federal gun research.

The Maine Medical Association is on record as supporting current efforts to require and enforce universal and thorough background checks when firearms are purchased and acquired in the State of Maine. [return to top]

PQRS Errors at CMS Yield Unreliable Data

The AMA Wire reports that the Centers for Medicare and Medicaid Services has moved ahead with releasing new performance scores on its Physician Compare website in spite of calculation errors in the quality data (PQRS). Those errors give an unreliable and potentially misleading picture of physicians’ quality performance to patients, which in turn may affect their health care choices.

Information was posted for only about 40,000 physicians. Thousands were excluded due to data submission and CMS calculation errors leading which yielded inaccurate performance assessments.

“The data inaccuracies and difficulties with CMS's processes grew over the last couple of months and, while CMS has acknowledged these problems, it has failed to address the underlying issues,” said AMA President Steven J. Stack, MD. “The AMA is a strong supporter of transparency, but today's action goes in the opposite direction—offering the public information that will lead consumers to draw faulty inferences about the quality of care that an individual physician or group provides.”

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Community Health Options Stops Enrollment in Individual Market

The state's newest entry into the health insurance field announced has announced that it will stop accepting applications from new members for individual coverage after Dec. 26, more than a month in advance of the ACA open enrollment period for plans sold on the marketplace exchange. The announcement does not impact enrollments in the small group market.

The decision was made in response to higher than expected expenses in 2015. Community Health Options (CHO), the state's only co-op formed under the provisions of the ACA, lost $17 million in the first three quarters of the year. In media interviews, CEO Kevin Lewis said the co-op's reserves can cover all current and new members but the company had to respond to the higher than anticipated claims and its rapid growth. CHI currently insures over 60,000 Mainers, representing 80% of the marketplace enrollment for individual plans. Lewis also noted that the higher than expected claims costs were caused primarily by the increase in specialty drug costs.

MMA senior staff  has talked with Insurance Superintendent Eric Cioppa about the situation and came away from the conversation believing that the difficulty of setting premiums well in advance of the year led to the establishment of premiums that were insufficient to cover the cost of enrollee's care.  

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Job Openings

E.M. BC/BP Physicians

St. Joseph Hospital is recruiting E.M. BC/BP physicians for its dedicated group.  Collegial, nurturing workplace with latest technology and just-completed expansion.  Members support each other and know patient satisfaction is achieved through staff satisfaction.  Leadership development and participation in policies and direction available. 

Equitable scheduling based on 1440-1472 clinical hours per year; more flexible arrangements available. 

Staffing: 51 hours per day, mostly physicians, for 27,000 visits.  We have great E.D. nurses.   

Area offers many cultural attractions, including the University of Maine, natural and organic food producers, pleasant pace, low crime, friendly people, great public schools and affordable housing.  Acadia National Park, Baxter, scenic towns and harbors, Sugarloaf,  I-95 and Bangor International Airport are right here or close.

Highly competitive package includes relocation, signing bonus, loan repayment, retirement and protected vacation and CME time with allowance.

Contact: Charles F. Pattavina, MD, F.A.C.E.P., Chief, Emergency Medicine at 207.907.3350  or


Family Medicine Physician

Growing Direct Primary Care practice in Rockport, Maine is looking for the right family medicine physician to join our practice. 

Includes pediatric and adult outpatient care without OB, but skills that add value for patients are highly desired, such as: Office orthopedics, procedures, occupational medicine, DOT & USCG exams, ultrasound and buprenorphine waiver, etc.

Emergency room or hospitalist credentials may be helpful during the start up phase. 

For more information, please email Practice Manager, Jennifer Overlock, at answers@megunticookfamilymedicine, or call 207-390-8570.


Full Circle Family Medicine Seeks Family Practitioner

An opportunity awaits you in the heart of Mid-Coast Maine - you are able to live, play and work in one of Maine’s beautiful coastal villages.  Our medical practice is in Damariscotta, just an hour northeast of Portland, Maine’s largest city, and three hours from Boston.

Full Circle Family Medicine, is in search of a Family Practitioner wanting to join our NCQA recognized Patient Centered Medical Home practice.  We are proud to be a physician owned, independent practice which includes three MDs and three PA’s.

Job Details and Requirements:

  • Flexible work schedule
  • Provide a full range of care including: newborn and pediatric care, adult medicine, gynecology, geriatric and nursing home care
  • Telephone Call Coverage
  • Electronic Medical Records

Benefits of practicing at Full Circle Family Medicine include:

  • Competitive salary
  • Generous earned time program
  • Health Benefits
  • CME allowance
  • Retirement plan with employer match
  • Malpractice Coverage

For more information contact Wendy Williams, Practice Manager at or (207) 563-6623 option 7. 


Family Medicine/ Outpatient Internal Medicine Physician

As a result of our continuous growth, Katahdin Valley Health Center is recruiting a Family Medicine/ Outpatient Internal Medicine Physician that is committed to providing quality health care services to the people in Brownville/Millinocket Maine.   Join our practice in a newly renovated facility.  KVHC is a fully electronic medical record site and offers a four day work week with a competitive salary and benefit package which includes: a 10% of first year salary sign on bonus, generous amounts of paid time off and $2500 annually toward CME. 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 or visit our website at  KVHC is an equal opportunity employer.


Maine Judicial Branch Seeks Civil Involuntary Commitment and Treatment Examination Services

A copy of the RFP can be obtained from the MJB’s RFP Coordinator: Laura O’Hanlon, Esq., Chief of Court Management at:, or mailing address:  Administrative Office of the Courts, P.O. Box 4820, Portland, ME 04112-4820. All communication about the RFP must be in writing.  The MJB encourages all interested vendors to obtain a copy of the RFP and submit a competitive proposal.

Proposals must be submitted to the State of Maine Division of Purchases, located at the Burton M. Cross Office Building, 111 Sewall Street, 4th Floor, 9 State House Station, Augusta, Maine, 04333-0009 by 2:00 pm, local time, on December 28, 2015.

The State of Maine Judicial Branch (MJB) seeks Examiners for mental health services statewide to provide examinations of individuals subject to involuntary commitment and involuntary treatment proceedings under Title 34-B of the Maine Revised Statutes.  In accordance with State procurement practices, the MJB has announced the publication of Request for Proposals (RFP) # 201510191 for the purchase of those services.


Family Practice Physician – Bucksport Regional Health Center                                                                

The Bucksport Regional Health Center, a Federally Qualified Health Center, has a unique opportunity for an experienced Family Practice Physician to work at a small, independent, community-based primary care facility that offers great quality indicators, a team atmosphere, and excellent working conditions.  Responsibilities will include the diagnosis, treatment, coordination of care, preventive care and provision of health maintenance services to patients of all life cycles. 

Candidates must have graduated from an accredited medical school and completed a residency in Family Practice or Med/Peds, have a current State of Maine Medical License and D.E.A Certificate, and at least five years of experience in the practice of family or internal medicine. The successful candidate will be offered a generous compensation package, including a competitive salary and excellent benefits. 

The Bucksport Regional Health Center has been offering easy access to quality, affordable care for persons of all ages since 1974.  Interested applicants should apply with a resume and cover letter to Carol Carew, Executive Director, 110 Broadway, Bucksport, ME 04416 or via email at (or call 207-469-7371).



Inland Hospital Family Practice is seeking a full time Family Medicine Physician without OB to join the employed practice in Oakland.

The practice has been serving the greater Waterville/Oakland area for many years. The practice provides care for infants, pediatrics through geriatric care. A competitive salary with incentives, plus full benefits is offered along with assistance with medical education debt, paid time off, paid CME, and relocation allowance. Qualifications: Board Certified/Eligible in Family Practice. This site is not eligible to sponsor a J-1 waiver.

Inland Hospital is a dynamic healthcare organization that believes in putting the patient first in every way. We are a 48-bed community hospital in Waterville; Lakewood, a 105-bed continuing care center on the hospital campus; 18 primary and specialty care physician offices in Waterville and five surrounding communities. Inland has been a proud member of EMHS since 1998. Inland patients have seamless access to a higher level of care when needed.

For further information, please contact:

Sherry Tardy, Director Business Development/Provider Recruitment, Inland Hospital by email at: or by phone at: 207-487-4085.



As a General Surgeon in the Air Guard, you’ll adapt the skills and knowledge you’ve gained in your civilian career to the military environment.  You’ll provide urgent treatment to Air Guard personnel sick or wounded during duty, and regular healthcare to personnel training in your unit.


The Air Guard gives you the opportunity to serve your community and country with pride, and help people in a whole new way. If you still have student loans, you may be eligible for the Student Loan Repayment Program, or you can potentially get money for college that transfers to your dependents through the Montgomery G.I. Bill.

Besides a monthly paycheck, as a member of the Air Guard you’ll receive low-cost life insurance, a military retirement plan, and eligibility for VA home loans. With more than 140 Air Guard bases in the United States, Puerto Rico, Guam, and the U.S. Virgin Islands you’ll be able to serve where you live, without interrupting your civilian medical practice. And as an Air Guard member you’ll have access to Base Exchange and Commissary shopping as well as free available air travel.

Learn More Today

Go to or call 1-800-To-Go-ANG to find out how you can become an important member of America’s homeland defense in the Air Guard.


Orthopedic Surgeon

The Air Guard Orthopedic Surgeon examines, diagnoses, and treats diseases and injuries of musculoskeletal system by surgical and conservative means. In this role, you’ll manage orthopedic surgery services as well as oversee the administration of anesthetics and provide diet recommendations in addition to performing surgical procedures.


The Air Guard gives you the opportunity to serve your community and country with pride, and help people in a whole new way. If you still have student loans, you may be eligible for the Student Loan Repayment Program, or you can potentially get money for college that transfers to your dependents through the Montgomery G.I. Bill.

 Besides a monthly paycheck, as a member of the Air Guard you’ll receive low-cost life insurance, a military retirement plan, and eligibility for VA home loans. With more than 140 Air Guard bases in the United States, Puerto Rico, Guam, and the U.S. Virgin Islands you’ll be able to serve where you live, without interrupting your civilian medical practice. And as an Air Guard member you’ll have access to Base Exchange and Commissary shopping as well as free available air travel.

Learn More Today

Go to or call 1-800-To-Go-ANG to find out how you can become an important member of America’s homeland defense in the Air Guard.




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