American Medical Association Annual Meeting Opens in Chicago

The AMA Annual Meeting is currently under way in Chicago and AMA delegates from Maine, Richard Evans, M.D. and Maroulla Gleaton, M.D. are in attendance along with MMA President Brian Pierce, M.D. and Deputy Executive Vice President Andrew MacLean, J.D.

The AMA Annual Meeting is underway at the Hyatt Regency Hotel in Chicago.  The meeting schedule today includes educational sessions on Scope of Practice sponsored by the AMA’s Advocacy Resource Center (ARC), by the Litigation Center of the AMA and the State Medical Societies, and Maintenance of Certification (MOC) sponsored by the Pennsylvania Medical Society.  This morning’s Scope of Practice session included presentations on APRN legislative debates in Ohio, California, and Arizona, as well as the VA APRN proposed rule having significant implications for anesthesiologists.

The Medicare Access & CHIP Reauthorization Act (MACRA) and the AMA’s efforts to influence CMS’ implementation of it and to prepare physicians for it are key policy issues before the AMA House of Delegates.  You can find the AMA’s MACRA resources on the web here:  http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-physician-payment-reform.page.  Recognizing a physician shortage in the country, another topic of debate at the meeting is increasing available residency slots.  Some of the other current issues on the agenda at this meeting are professional burnout among physicians, health information technology interoperability, and response to the national opioid abuse epidemic, including improvements to state Prescription Monitoring Programs (PMPs). 

The 2016 Annual Meeting began on Saturday, June 11^th and will conclude on Wednesday, June 15^th.  The inauguration of President-Elect Andrew W. Gurman, M.D. will take place on the evening of Tuesday, June 14^th.  You can find the meeting schedule and materials on the web here:  http://www.ama-assn.org/sub/meeting/index.html.

Quality Counts Webinar on Compassionate Tapering of Opioids: Why and How

A major provision of Maine’s new opioid prescribing law will soon require providers to limit the daily opioid dosages of chronic pain patients. But how can providers meet this legal requirement while also limiting their patients’ distress? This webinar offers answers by exploring the effectiveness of high dose opioids, looking at pain control alternatives, delving into Morphine Milligram Equivalents and sharing techniques for effectively and compassionately tapering opioid dosages to below legal limits and, ultimately, to zero.

Time:  June 14, 2016 at 12:00 PM

Caring for ME: Offering Tools for Responding to the Opioid Crisis

Providers across Maine are asking what they can do to help alleviate the opioid and heroin crisis. Responding to their call for tools and information, we and Maine Quality Counts have created Caring for ME, an initiative to help improve the management of chronic pain, the safety of opioid prescribing, the identification of addiction, and referral for substance abuse treatment services. The current home of Caring for ME is a web page on the QC website that contains links to resources and information addressing many of the challenges providers face in effectively responding to the crisis. We urge you to visit the Caring for ME page and also attend our monthly Caring for ME webinars. The next webinar, Tuesday, June 14th at Noon, will offer advice on measuring and tapering opioid dosages.

Register Now for Annual MMA Benefit Golf Tournament, July 18, 2016
Registration is now available for the Annual MMA Benefit Golf Tournament being held on Monday, July 18 at the Augusta Country Club in Manchester.  The event begins with lunch on the patio at 11:00am with a shotgun start at noon.  The format is a traditional four-person scramble.  Prizes will be given to the top three gross and net winners and for longest drives on the first hole.  Prizes will also be awarded for closest to the pin on all four par-3 holes.  The cost for an individual golfer is $125 and $500 for a team.  Hole sponsorships are also available. Donations for raffle prizes are also being sought.  Registration is available on the MMA website at www.mainemed.com or by calling Lisa Martin at 622-3374 ext. 221.

How New Medicare Payment System Intends to Help Small Practices

Draft regulations released last month outline sweeping changes to the Medicare payment system, and one of those eagerly anticipated changes is the Centers for Medicare & Medicaid Services' (CMS) stated intent to ease physicians' administrative burdens—including for those in small or rural practices.  A new fact sheet outlines flexibilities the agency is proposing for physicians in the new payment system.

Responding to physician feedback
The proposed rule for implementing key provisions of the Medicare Access and CHIP Reauthorization Act (MACRA) has drawn concerns regarding its regulatory impact analysis, which projected that the quality and resource use components of the new Merit-based Incentive Payment System (MIPS) would have a negative impact on most solo physicians and small practices.

CMS has clarified in its new small practices fact sheet that the projections made in the analysis were "based on 2014 data when many small and solo practice physicians did not report their performance.  It also does not reflect the accommodations in the proposed rule that are intended to provide additional flexibility to small practices."

In particular, the impact analysis table in the proposed rule only offers a partial picture of physicians' potential success in MIPS because it fails to include participation in the categories of "clinical practice improvement" and "advancing care information"—formerly the electronic health record meaningful use program.

Another flaw in the analysis was that it did not provide the magnitude of how physicians would be affected.  For example, physicians who opted not to participate in quality reporting and meaningful use would be subject to an 11 percent payment cut in 2019 under previous law. Under MACRA, the maximum payment cut would be 4 percent. Unlike MACRA, previous law did not provide any partial credit for efforts that were not 100 percent successful.

The analysis looked at successful participation of "eligible clinicians" in the Physician Quality Reporting System (PQRS) and under the value-based modifier.  CMS' definition of "eligible clinicians" includes nonphysician health professionals such as chiropractors.  Many of these eligible clinicians could not participate in PQRS or the value-based modifier. Consequently, the subset of the physicians actually reflected in the analysis is relatively small.

Andy Slavitt, acting administrator of CMS, recently testified before a congressional committee, emphasizing that the agency is focused on providing the flexibility required for physicians in smaller practices to be as successful under MIPS as those in larger groups.

Here are some of the flexibilities that CMS says were included in the proposed rule to accommodate the unique needs and challenges faced by physicians in small practices:

• Physicians with a low Medicare volume won't be subject to the MIPS payment adjustment.  To avoid unnecessary reporting burdens, clinicians or groups who have less than or equal to $10,000 in Medicare charges and less than or equal to 100 Medicare patients are excluded from the MIPS payment adjustment.
  
  
• Physicians should not be held accountable to inapplicable categories.  If a MIPS performance category does not have enough measures or activities that are applicable for the practice, then the category would not be included in the practice's MIPS score.
  
  
• Physicians will have fewer measures on which to report.  The agency is proposing to remove unneeded measures and reduce administrative requirements.  For example, CMS proposes to reduce the number of required measures in the quality and advancing care information categories.
  
  
• Physicians can use a single reporting mechanism.  Three of the four categories will require reporting—all of which can be done through the same mechanism, instead of the distinct reporting options required under the current payment system.  Physicians also have greater choice regarding which reporting mechanism to use.

Easing the burden within performance categories
CMS has proposed additional flexibilities within MIPS performance categories to account for the unique circumstances of individual clinicians, small groups, and practices in rural or professional shortage areas:

• Quality.  The total possible points would be 80 for a group of nine or fewer, while a group of 10 or more would be 90 points.  Also in an effort to reduce physicians' reporting burden, the quality category would require practices of all sizes to report only on six measures, rather than the nine current measures. In addition, physicians would receive partial credit for measures.
  
  
• Clinical practice improvement activities.  Under this category, physicians and other clinicians would be rewarded for clinical practice improvement activities, such as those focused on care coordination, beneficiary engagement and patient safety.  A list of more than 90 options will be available for physicians to select activities that match their practice's individual goals.  For physicians in small practices located in rural or professional shortage areas, this category allows them to submit one activity of any weight to receive partial credit or two activities of any weight to receive full credit. Larger practices would be required to submit three to six activities.
  
  
• Cost.  A cost score would not be calculated for physicians who don't have a high enough patient volume for the cost measures (generally defined as a minimum of 20 cases pertaining to a particular measure).  CMS would reweight the cost category to zero and adjust other MIPS performance category scores to make up the difference.

While these proposals are important changes for physicians, the agency will need to make additional improvements during the rulemaking process to best address things that have been getting in the way of physicians focusing on providing high-quality care to their patients.  The proposed rule is open for comment through June 27, and CMS has said it welcomes feedback from patients, physicians, caregivers, health care professionals and members of Congress, among others.

The AMA is developing recommendations to further ease the burdens on physicians in small or solo practices to enable their success under this new payment system.

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Search Under Way for New Quality Counts Executive Director

As Dr. Lisa Letourneau prepares to wrap up her decade-long tenure as Executive Director of Maine Quality Counts in December, the QC Board of Directors has begun the search for the organization's next leader.  In partnership with the Board, the executive search firm Nonprofit Professionals Advisory Group has developed a detailed new job description for the position that includes instructions for interested candidates.  Know of a dynamic individual with the vision and energy to move QC forward?  Please urge them to apply!  [return to top]

Disability Rights Maine's Survey on Maine's Mental Health System

Disability Rights Maine has announced the launch of its statewide survey, "SNAPSHOT: Maine's Mental Health System!"

Anyone who currently receives mental health services is invited to take part in this survey - this is a chance to let DRM know what's working or not working.

If you are a provider, we hope you will share this survey with your clients and encourage them to participate.

The feedback will be used to advocate for systemic changes to Maine's mental system.

You can access this survey by:

1. Visiting http://drme.org/news/2016/memhcs and completing it directly on the DRM website;
    
2. Clicking on the SurveyMonkey link, https://www.surveymonkey.com/r/MEMHCS; or
    
3. If you/your clients wish to participate, but do not have internet access, please call the DRM office (1.800.452.1948).  They will mail a paper copy to you, along with a self-addressed, stamped return envelope.

Additionally, DRM staff will be conducting outreach to vocational clubhouses, peer-run social clubs, residential treatment facilities, and inpatient settings.

If you have questions about this survey or DRM's outreach plans, please contact Kevin Voyvodich at 1.800.452.1948.

New Asthma Action Plan Available for EMR

The Maine CDC Chronic Disease Prevention and Control Program has two new Asthma Action Plans available on its website – a pediatric and an adult plan. These Plans were developed as a collaborative effort by clinical staff (primary and specialty care) at MaineHealth, and incorporates feedback from the Maine Asthma Coalition, the Maine Chapter of the American Academy of Pediatrics, and the Maine Association of School Nurses. The versions available on the Maine CDC Chronic Disease Prevention and Control Program’s website are unbranded.

Link to the new Asthma Action Plans

The Plans comply with Meaningful Use reporting requirements and Maine’s statute “An Act To Authorize Certain School Children To Carry Emergency Medication On Their Persons.” School nurses in Maine utilize Asthma Action Plans as an important tool to help their students with asthma.  A uniform Asthma Action Plan will improve ease of use for providers, parents and school nurses.  

The Plan is available as a .pdf document on the Maine CDC Chronic Disease Prevention and Control Program website, and can be downloaded and scanned or imported into the EMR, or printed for use by practices not using an EMR.

The National Heart Lung and Blood Institute recommends a written Asthma Action Plan as one of the most effective methods to help patients manage their disease. Utilizing one form across practices and hospitals in Maine to treat people with asthma will improve coordination and quality of care.

The Maine CDC Chronic Disease Prevention and Control Program continues to provide NCR (carbonless copy) paper copies of the Maine Asthma Coalition’s pediatric Asthma Action Plan. Contact Desi-Rae Severson at 287-3041, or via e-mail at Desirae.Severson@maine.gov to order copies. Click here for all Maine CDC Asthma Prevention and Control Program’s Asthma Action Plans.

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Volunteers Sought for MMA Board and Committees

The MMA Nominations Committee, chaired by Kenneth Christian, M.D. of Holden, is seeking volunteers for the MMA Board of Directors and all committees.  A list and description of each committee may be found on the MMA website at www.mainemed.com.  Among the more active committees are the Legislative Committee, the Public Health Committee, and the Committee on Loan & Trust Administration.

Maine's ACA Enrollment Up 12.37% Over 2015

The federal government reports that enrollment in Maine's Affordable Care Act Marketplace during the 2016 open-enrollment period was 84,059, a 12.37% increase over 2015's 74,801 enrollment.  See the following article in MaineBiz.

http://www.mainebiz.biz/article/20160606/NEWS01/160609973/1092?utm_source=enews&utm_medium=Daily%2BReport&utm_campaign=Monday

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Freedom of Patient-Physician Conversations Hinges on Court Case

A federal court will be hearing a case about the constitutionality of a state law that represses free discussion between physicians and patients regarding health and safety issues.

In a friend-of-the-court brief filed April 26th, the AMA and eight other medical societies urged the Court of Appeals for the 11th Circuit to overturn a Florida law that restricts physicians from discussing firearm safety with patients and their families.

The brief argues that the Firearm Owners' Privacy Act is unconstitutional and intrudes on the practice of medicine. The law will inevitably affect other aspects of patient care, the brief says.

In 2012, the district court had found the 2011 law unconstitutional.  In 2014 a court of appeals panel of three judges issued a split decision. While one judge sided strongly with physicians opposing the law, the other two ruled in favor of the state. Physician groups and others sought a rehearing.

In a rare decision, the full court of appeals agreed to rehear the case.  The rehearing will be held before the court en banc—all 11 active judges are to hear the case. Oral arguments are scheduled for June 21 in Atlanta.

In its April 26th briefing, the AMA and other organizations call the law an example of politics overriding medicine. It has already led Florida physicians to self-censor when talking with patients, the brief says.

"It is censorship, imposed for purely political motives," it says.

The law directly clashes with a consensus on care that dates to at least 1989.  That year, the AMA enacted a policy that encourages members to inquire into the presence of firearms in households and to promote the use of safety locks on guns in an effort to reduce injuries to children.

"Effective medical care requires unfettered communications between physicians and their patients," the brief tells the court.  [return to top]

Upcoming Events
 

MCMI Training Programs – Level 1 and Level 2

General Information for 2016

When and where held:

                June 10, 2016 in Waterville at Colby College

              October 25, 2016 in Portland in conjunction with the Maine Brain Injury Conference

                                (Registration and fees will be through the Maine Brain Injury Conference for October 25)

               June and October programs will be Level 1 in the morning and Level 2 in the afternoon.

Training Programs:             

              Level 1 – An Introduction to Concussions and Concussion Management

                            Speaker: Deb Nichols, CPNP or Peter Sedgwick, MD or Bill Heinz, MD

                           Level of Difficulty: beginner

                           Content: The Diagnostic and Return to Play Dilemma

                                           How Concussion Occurs and Pathophysiology            

                                           Concussion Signs and Symptoms

                                           Concussion Evaluation Tools

                                           Concussion Treatment

                                           Recovery Epidemiology

                                           Return to Function – Academics and Play

                                           Risk Factors and Protective Equipment

                                           Short and Long Term Sequelae

                                           Neurocognitive Testing

                                           Concussion Sideline Assessment

                                           Key Points

              Level 2 – Advanced Concussion Management (Level 1 is a prerequisite for taking Level 2)

                           Speaker: Mike Rizzo, FNP-C, CIC or Paul Berkner, DO

                           Level of Difficulty: intermediate

                           Content: Updates from Zurich 2012       

                                           Using ImPACT Testing in Concussion Management

                                           Interpreting ImPACT Test Results

                                           Concussion Case Reviews

Schedule:

              June – Level 1:

                           7:45am – 8:00am           Registration

                           8:00am – noon               Training Program

                           Level 2:

                           12:15pm-12:30pm          Registration

                           12:30pm – 4:30pm         Training Program

Registration Fee:           

              For morning only training programs: March 11 and April 8

              $100 for Health Care Professionals (MD, DO, NP, PA, Neuropsychologist, AT, RN, PT, OT, SLP)

              $40 for school personnel and all other attendees

                           (School nurses, coaches, school athletic directors, administrators, parents, etc.)

              $20 for students – currently enrolled in a college program

              For morning and afternoon training program: June 10

              $100 for Health Care Professionals (MD, DO, NP, PA, Neuropsychologist, AT, RN, PT, OT, SLP)

              $175 for Health Care Professionals taking Level 1 and Level 2 - Only June 10

              $40 for school personnel and all other attendees                                                                                                              (School nurses, coaches, athletic directors and administrators, etc.)

              $70 for school personnel taking Level 1 and Level 2 - Only June 10

              $20 for students currently enrolled in a college program            

              $35 for students taking Level 1 and Level 2- Only June 10

CME/CEU contact hours: 3.50

Registration Confirmation will be sent by email.

Refund / Cancellation Policy: If you need to cancel contact Jan Salis, PT, ATC. You can choose to apply your registration fee to another training program or have your check returned.

For more information contact:

              Jan Salis, PT, ATC

              MCMI - Membership and Education Committee - Chair

              jsalis@aol.com

              (207) 577-2018

  ***

2nd Annual Maine LGBTQ+ Health Conference
Exploring the Intersections

The Green Ladle
156 East Ave.
Lewiston, ME 04240

Monday, June 27th 2016 2015 - 8:00 am - 5:00 pm

**CMEs and CEUs available**

TO REGISTER OR FOR MORE INFORMATION CLICK HERE

__________________________________

This day-long LGBTQ+ Health Conference has been organized by the Health Equity Alliance and the QCHA, an LGBTQ+ Community Health Initiative. The 2016 LGBTQ+ Conference highlights lived experiences of community members to explore how multiple, complex identities impact health outcomes.

This conference will explore questions like:

How can a harm reduction approach improve queer health?
What are the unique health needs of elders who are LGBT?
Why are STIs and HIV still on the rise for gay and bisexual men?
How can providers make transition-related care more accessible?

This year's keynote address, "Not Because Our Bodies Are Different: LGBT Cancer Health Disparities" will be delivered by Liz Margolies:

Liz Margolies, LCSW, is the founder and executive director of the National LGBT Cancer Network, the first and only national program addressing the needs of LGBT people with cancer and those at risk. Based in NYC, the Network focuses on education, training, advocacy and support. Liz is also a psychotherapist in private practice, specializing in trauma, loss, health disparities and sexuality. In addition, she is a regular blogger for the Huffington Post. In 2014 Liz was chosen as one of the OUT100 for her work in the LGBT community.

Special thanks to our sponsors: AARP Maine, SAGE Maine, and the New England AIDS Education and Training Center

__________________________________

Who Should Come

Health Care Providers: Physicians, Family Nurse Practitioners, Nurse Practitioners, Registered Nurses

Social Workers and Public Health Professionals: Social Workers, Prevention Providers, Outreach Workers, Epidemiologists, Youth Workers, Counselors, Clinicians

LGBTQ+ Community Members Welcome

TO REGISTER OR FOR MORE INFORMATION CLICK HERE

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Job Openings

Maine Medical Partners is seeking a PT BC/BE internal medicine physician for their Internal Medicine Outpatient Clinic at Maine Medical Center in Portland, Maine. 

The Clinic is the primary outpatient teaching site for Maine Medical Center’s Internal Medicine Residency Program and is the medical home for a culturally diverse population.  The ideal candidate will have an interest in residency education and international/immigrant patient care.  The clinical portion of the position involves a mix of direct patient care and the precepting of Internal Medicine Residents. 

Maine Medical Center has 637 licensed beds and is the state’s leading tertiary care hospital, with a full complement of residencies and fellowships and an integral part of Tufts University Medical School. 

For more information please contact Alison C. Nathanson, Director, MaineHealth Physician Recruitment Center at (207) 396-8683 or nathaa@mainehealth.org.

7/4/16

PHYSICIAN/MEDICAL DIRECTOR - Nasson Health Care 

Nasson Health Care is seeking a qualified clinical leader to work collaboratively with a team of health and administrative professionals to provide comprehensive primary care to patients while utilizing the Patient-Centered Medical Home model of care delivery.  

The Physician/Medical Director: 

• Provides advice and counsel regarding a broad range of clinical, clinical policy, programmatic and strategic issues required to achieve the short and long-term strategies and objectives of Nasson Health Care; 
• Provides direct clinical services and oversees physicians and advanced practice nurses; works in partnership with members of the practice team to manage the care of patients, assuring a high standard of medical care; 

  Qualifications include:

• A minimum of three years’ experience as a Medical Director of a primary care medical practice;  A degree from an accredited medical school in the U.S.,
• Board certification in Family or Internal Medicine;  An unrestricted Maine license to practice medicine, as well as a U.S. Drug Enforcement Agency license;
• Working knowledge of the core concepts of evidence-based practice, social and behavioral determinants of health, population-based care, integration of medical, behavioral health and dental care, and Meaningful Use of health information technology.

Visit http://www.nassonhealthcare.org for an application. Completed cover letter, resume, and employment application will be accepted until position is filled.

6/27/16

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

7/18/16

FAMILY MEDICINE/OUTPATIENT INTERNAL MEDICINE PHYSICIAN  

The Maine Highlands offers great outdoor adventures, historic and cultural experiences, many culinary delights and unexpected entertainment opportunities.  KVHC’s newest clinic, Brownville, is located in the Maine Highlands and Katahdin Region.  As a result of this 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 the Brownville/Millinocket Maine regions.   KVHC’s clinics are outpatient only 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.

8/29/16

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