December 28, 2015

 
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The Maine Medical Association Wishes You all the Best for 2016

With 2015 approaching an end, the Maine Medical Association thanks all our Weekly Update readers for your interest and support throughout the year.  We promise you another 52 issues in 2016 providing the information that medical practices in Maine need to provide excellent care to their patients.  And read the story below to see our predictions for 2016 and to see how we did with our predictions one year ago!

Maine Medicine Weekly Update is the primary means MMA has to share timely information with its members and their staffs. The printed publication, Maine Medicine, is mailed quarterly.  In addition, updates are posted on the MMA website at www.mainemed.com.

If you would like to add additional e-mail addresses for the benefit of other office staff or for new physicians in your practice, please send those addresses to Lisa Martin at MMA who maintains the database for the Weekly Update. She can be reached at lmartin@mainemed.com.

 
 

Top Ten Predictions for Health Care in Maine in 2016: And a Retrospective Look at our Predictions for 2015

How did we do last year? Of the ten predictions MMA executive staff made one year ago, we were accurate on four predictions, partially accurate on another three and completely wrong on three.  

What we got right: Successful implementation of ICD 10 without further delays. Failure of the Congress to repeal the Affordable Care Act despite many attempts. Supreme Court decision in King vs. Burwell upholding the subsidy provisions in the law.

We what got partially right: Continuing consolidation of hospitals in the state (MidCoast Medical Center absorbing Parkview Adventist Hospital following its bankruptcy; PenBay Medical Center and Waldo County General Hospital come under one board). Ebola continuing in West Africa but not becoming an issue in the U.S. or elsewhere. Opioid prescribing in Maine. We predicted a decline, and we believe there has been a modest decline by physicians but are awaiting the data confirming this.

What we failed miserably at predicting: We predicted that Maine would pass a modest MaineCare expansion.   This was apparently simply wishful thinking on our part. The last two failures we were pleased to have been wrong. We predicted that Congress would again delay implementation of SGR reimbursement cuts. We were pleasantly surprised when a complete repeal of the SGR formula was proposed and enacted. And in our final prediction, we predicted that Maine's immunization rate would continue to decline. We were delighted to see the recent CDC statistics that showed a significant improvement in immunization rates, particularly for toddlers. Congratulations to all the dedicated pediatricians and family physicians who have worked hard to accomplish this.

PREDICTIONS FOR 2016

1.  In a Presidential election that is distinguished by its nastiness, the nation elects a Democrat as President but Republicans continue their majorities in the House and Senate, although narrowed from the margins that currently exist.

2.  In Maine, Congressional representation does not change as Representatives Pingree and Poliquin are re-elected. At the State House, Democrats retain their majority in the House and Republicans continue their majority in the Senate.

3.  Late in the year, the United States Department of Justice approves the mergers of Anthem-Cigna and Aetna-Humana but subject to conditions in five or more states that the companies do not approve of. As a result, one of the two mergers does not go forward.

4.  Maine continues to be the only state in New England not to expand medicaid, thus losing out on the 100% federal participation which ends on Dec. 31, 2016. Maine also continues to be one of a select group of states that fails to decrease its rate of uninsured persons in the state, including, regrettably, children.

5. There continues to be further consolidation of the hospital industry in the state with one of the major systems merging into another. More hospitals struggle financially because of the failure to expand MaineCare and the increasing number of uninsured.

6.  The pendulum continues to swing in favor of limiting opioid medication except for acute pain, cancer pain and end of life care. Both the numbers of prescriptions and the dosages continue to decline, driven by voluntary efforts of prescribers, prior authorization requirements put in place by insurers, and regulatory and legislative initiatives aimed at limiting the availability of long-acting opioids. The number of deaths attributable to accidental overdose flatten out but do not decrease; however, there is a decrease in the number of babies born with neonatal abstinence syndrome.

7.  Several public initiatives qualify for the 2016 ballot but some of the high profile questions fail at the ballot box, including ranked-choice voting and legalization of recreational use of marijuana. Initiatives passing include an initiative to close the current loophole allowing private sales and gun show sales of firearms to escape background checks on purchasers.

8.  The alternative payment reform vehicles under development by CMS to replace fee for service continue to struggle and engender strong opposition from a broad range of stakeholders. The current time lines for implementation are pushed back, awaiting the results of several pilot projects.

9.  The LePage administration and the Legislature continue to struggle generally but do come together to authorize construction of a forensic facility to house and treat forensic patients currently at Riverview Psychiatric Facility. Mental health advocates split on the desirability of such a facility, although the treatment community favors the availability of more beds for those patients in need of inpatient treatment.

10.  By the end of 2016, with the Presidential election concluded, speculation centers on the 2018 gubernatorial election in the state.  But while several leaders in both parties are interested in testing the waters for a run, continuing interest in U.S. Senator Susan Collins closing out her career in the Blaine House causes all other candidates to exercise caution until Maine's senior senator makes her final decision.

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Maine Opiate Collaborative Task Force Meetings: Jan 7, Jan 21 and Feb. 4, 2016

Upcoming meetings of the Task Forces organized by the Maine Opiate Collaborative are as follows:

Prevention/Harm Reduction Task Force

Thursdays, Jan. 7, 21, and Feb. 4, 1:00 to 3:00 pm, at offices of the Maine Medical Association, 30 Association Dr., Manchester, Maine

Treatment Task Force

Thursdays, Jan. 7 and 21, 9:00 to 11:00am, at office of the Maine Medical Association, 30 Association Drive, Manchester, Maine

 

All meetings of these two task forces are open to members of the public.  Minutes of the meetings are posted on the public portion of the website of the U.S. Attorney's office.

In other Task Force news, Eric Haram has been named as the co-chair of the Treatment Task Force replacing Mark Publicker, M.D.  Eric will join Patricia Kimball who is the other co-chair for the Treatment Task Force.  Eric was serving as the co-chair of the Prevention/Harm Reduction Task Force with Bill Paterson.  A new co-chair for the Prevention/Harm Reduction Task Force will be named soon by the Executive Panel.

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

Among the several provisions of interest to physicians and other health professionals in the year end spending package passed by the Congress before adjourning for the holiday recess are the following:

  • 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 the language in the spending bill, 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.

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CDC Releases Data on 2014 Overdose Deaths

The Dec. 18, 2015 CDC MMWR contained an article on drug overdose deaths based on 2014 data. The article can be found at http:www.cdc.gov/mmwr/preview/mmwrhtml/mm64e1218a1.htm?s_cid=mm64e1218a1_e.  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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Maine Joins Interstate Opioid Monitoring Compact

Department of Health and Human Services Commissioner Mary Mayhew has executed an agreement to join the National Association of Boards of Pharmacy PMP Interconnect interstate data sharing solution (PMPi). The agreement paves the way to allow Maine providers a review of patient prescription history reports for patients under their care that fill prescriptions in other participating states. In all, over 30 states are using PMPi, including Rhode Island, Connecticut, New Jersey and New York. 

No implementation date has been set, and the DHHS promises more information as it becomes available. 

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New Polio-like Illness Appears

HealthDay News reports that a new illness, labeled “acute flaccid myelitis”, has stricken at least 120 children in 34 states since August 2014. The disease, of unknown cause, is similar to polio and is marked by a sudden onset of paralysis or limb weakness.

In California, cases spiked significantly during a national outbreak of enterovirus D68, which is in the same family as the polio virus. Children there developed acute flaccid myelitis almost six times for frequently during the D68 outbreak than before or after it. Still, the research is inconclusive as to cause. The research team did not find any traces of the enterovirus in the spinal fluid of children with acute flaccid myelitis. That fact neither rules out nor confirms a causal link between the two illnesses.

Since these viruses spread by physical contact, parents should be encouraged once again to teach their children to wash their hands often and to avoid contact with other children who are sick. Researches also note that this is a rare occurrence, with an incidence of 0.16 per 100,000 person-years.

More information can be obtained from the U.S Centers for Disease Control.

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MDEA 50% Ahead of Numbers of Heroin Investigations in 2015

The Maine Drug Enforcement Agency (MDEA) announced last week that it had conducted 50% more heroin investigations in the first 11 months of 2015 that it did during all of 2014. The agency has investigated 369 heroin cases as of the end of November compared to 243 investigations in 2014. These figures do not include the arrest of 15 people in Oxford County this past week, representing the largest investigation and arrest in the history of that part of the state.

Maine continues to experience an explosion of heroin activity in the state, as does the neighboring state of New Hampshire. New Hampshire is expected to experience over 400 overdose deaths linked to heroin and fentanyl, more than double the deaths in 2013 in that state.  

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Maine Opiate Collaborative Announces Community Forums

The Executive Panel of the Maine Opiate Collaborative held a press conference at MMA offices on Dec. 17th  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 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 carolkelly12@msn.com. 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 www.mainemed.com.

 
 
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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 mainemed.com.   A $25 fee is charged to cover the cost of dinner and materials.

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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 cpattavina@sjhhealth.com

1/18/16

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.

1/4/16

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 wwilliams@fullcirclefamilymedicine.com or (207) 563-6623 option 7. 

1/18/16

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 mlefay@kvhc.org or visit our website at www.kvhc.org.  KVHC is an equal opportunity employer.

2/22/16

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: DRMJB@courts.maine.gov, 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.

12/28/15

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 ccarew@brhc.info (or call 207-469-7371).

1/4/16

FAMILY PRACTICE PHYSICIAN Sought In Oakland Maine!

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: stardy@emh.org or by phone at: 207-487-4085.

1/25/16

Surgeon

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.

Benefits

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 GoANG.com/HP 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.

1/18/16

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.

Benefits

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 GoANG.com/HP 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.

1/18/16

 

 

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