July 18, 2016

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MMA & Quality Counts Join Forces to Assist Prescribers with Compliance with Chapter 488

Last Thursday, MMA and Quality Counts hosted an educational session to assist prescribers in compliance with the new Maine law limiting opioid scripts prescribed for pain.  More than 75 people attended and heard from a variety of experts on the law and the medicine.  The first part of the new law takes effect on July 29, 2016.  The educational program was part of the Caring for ME initiative sponsored by MMA and Quality Counts.

In addition to hearing from MMA attorneys on the technicalities of the new law, attendees also heard from medical experts on subjects ranging from compassionate tapering to conducting functional assessments.  Peter Leighton, M.D., an internist practicing in Bridgton, spoke of his personal experience in prescribing Suboxone and urged physicians to consider becoming Suboxone prescribers.   Stephen Hull, M.D. from Mercy Hospital spoke on the benefits of using a multi-disciplinary, team-based approach to pain management.  Other presenters included Noah Nesin, M.D., Lisa Letourneau, M.D., M.P.H., Christopher Pezzullo D.O., Heather Skolfield, Clare Desrosiers, Thomas E. Sullivan, M.D., Elizabeth Fowlie Mock, M.D., M.P.H., Eva Quirion, N.P., Jessica Bates, Pharm.D., Eric Haram, L.A.D.C., and Erika Pierce, MMSc., PA-C.  Most of the presentations have been recorded and will be placed on the Quality Counts website.  

The first part of the law limiting daily dosages of opioid medication to 100 morphine milligram equivalents (MME) will take effect on July 29.   This requirement is subject to several exceptions and can be overridden based on documented medical necessity until January 1, 2017.  The provision does not apply to cancer pain, medication dispensed and administered in a hospital, nursing facility or emergency room, hospice care, or palliative care.   A summary of all the provisions in the bill can be found on the MMA website where a new page has been dedicated to the law.

MMA lawyers are available to present a one hour CME program on the new law to a medical staff, specialty society or other prescribing groups.   If you are interested in such a presentation, contact MMA EVP Gordon Smith, Esq. at gsmith@mainemed.com or call 207-215-7461 (cell). 





Congress Enacts Comprehensive Addiction and Recovery Act (CARA)

At the end of last week, just before adjourning for the summer recess, the Senate passed the conference report of the Comprehensive Addiction & Recovery Act (CARA), sending the legislation addressing the nation's opioid problem to the President to be signed.  The White House has said President Obama will sign the bill, although there is no new funding to go along with the legislation.

Republicans and Democrats have not reached agreement about any additional funding for the law beyond what is proposed in each body's spending bills to fund the federal Department of Health and Human Services in the upcoming fiscal year.   While the Senate bill proposes a 93% increase over the current year's spending,  Democrats say that is still not enough to address the current crisis.

Items in the law of particular interest to Maine include the ability of Nurse Practitioners and Physician Assistants to prescribe Suboxone following appropriate education in those states where their scope of practice would permit the prescribing of controlled substances, which Maine law does permit.   It is hoped that passage of this bill will increase the supply of Suboxone prescribers in the state.



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Governors Sign Compact to Fight Opioid Addiction

Last week the governors of 46 states and territories signed “A Compact to Fight Opioid Addiction,” a series of commitment statements about the ongoing fight against opioid addiction.  The Compact contains several specific goals such as developing evidence-based opioid prescription guidelines, requiring ongoing prescriber education on pain management and addiction, reducing payment and administrative barriers to the use of opioid alternatives, and requiring the use of PMPs, prescription monitoring programs.  Many of these goals are included in Maine’s recent landmark opioid legislation, Public Law chapter 488.  The Compact also calls for pursuing overdose prevention and harm reduction strategies similar to those contained in Public Law chapter 508, which provides increased access to naloxone and contains “Good Samaritan” protections for providers.

Unfortunately, Maine’s Governor Paul LePage was not one of the governors signing the Compact.  Through a spokesperson, Governor LePage called the Compact a “feel-good measure” that fails to address the complete problem. He was particularly concerned that the Compact does not address law enforcement issues.

The governors also pledged to enhance communications strategies, particularly in schools and through social media, and to partner with professional associations “to improve understanding of the disease of addiction among health care providers and law enforcement.” In Maine, the Opiate Collaborative has been doing just that. Through its three task forces, Prevention/Harm Reduction, Treatment and Law Enforcement, the different prongs of the efforts to reduce opioid addiction have been communicating and working together to address the problem in a comprehensive manner. Maine has been a leader in that regard. LD 1646, the Governor’s bill which formed the basic structure and set the agenda for chapter 488, and the participation of the Maine Department of Public Safety in the work of the Collaborative in the area of law enforcement, are evidence of that leadership.

The governors who signed the compact have committed to review their work at the 2017 National Governors’ Association Winter Meeting and to build further on what they have accomplished by then.  At the same time, the Maine Medical Association looks forward to continuing its work in collaboration with Governor LePage’s administration and the Maine Legislature. We have already taken important steps together to deal with the problem of opioid addiction, and we can continue to do more by working together.

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Sign Up Today for MMA's 163rd Annual Session in Bar Harbor, September 9-11, 2016

Register today to join your colleagues at the MMA's 163rd Annual Session being held at the Harborside Hotel in Bar Harbor, Sept. 9-11, 2016.  The theme of this year's meeting is Renewing the Joy & Passion in Medicine.  Three and one-half hours of CME is available.

Highlighting the educational sessions are Jo Shapiro, M.D., of Brigham & Women's Hospital in Boston and George "Joe" Dreher, Jr., M.D. from Maine Medical Center who along with colleague Christine Hein, M.D., will discuss the successful development and operation of a resilience program.  The keynote talk on Saturday will be presented by popular WCSH weatherman Kevin Mannix and his wife Linda Rota.  They will discuss their popular book, entitled Weathering Shame.   On Sunday morning, Nancy Hathaway, M.Ed, will once again offer her mindfulness program.

Other activities include the opening evening reception, the Sunday morning road race, the business meeting on Saturday morning, and the annual banquet on Saturday evening where MMA President Brian Pierce will present the President's gavel to Charles Pattavina, M.D. of Winterport.   Saturday evening also will feature annual MMA awards including the Mary Cushman, M.D., award for humanitarian service.

Registration is available on the MMA website at www.mainemed.com.  Hotel reservations can be made by calling the Harborside at 1-800-328-5033.  Any questions about the meeting can be directed to Diane McMahon at MMA via e-mail to dmcmahon@mainemed.com or by calling 622-3374, ext. 216.   Room reservations must be made by August 9th if you wish to stay at the Harborside.  Other accommodations are available.

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2016 Mary Cushman Award Nominations Are Due By August 1

Nominations for the 2016 Mary F. Cushman Award for Exceptional Humanitarian Service as a Medical Volunteer are due by Monday, August 1st.  The award will be announced at the MMA's Annual Session in September.  The nomination form and brochure with additional information about the award is available at the Annual Session webpage.   [return to top]

MMA Receives Substantial Feedback from Physicians About Proposed MaineCare Rule on MAT

Last Monday morning, the Maine Department of Health & Human Services (DHHS) held a public hearing on proposed amendments to the MaineCare Benefits Manual (MCBM), Chapters II & III, Section 65, Behavioral Health Services specifically dealing with Medication-Assisted Treatment (MAT).  The proposed amendments define MAT and affect both methadone clinics and Suboxone or buprenorphine providers, but would seem to have a greater impact on Suboxone providers because the State has not previously sought to regulate this practice.  MMA is concerned about the additional administrative burdens the proposed amendments would impose upon physicians providing Suboxone treatment and, accordingly, would hinder access to such treatment at this critical time.  You can find the rulemaking documents here.  The comment deadline is Thursday, July 21st.

Many physicians responded to the article in last week's edition of Maine Medicine Weekly Update.  We very much appreciate your feedback and will reflect your concerns in our comments.  Reacting to the article in last week's newsletter, a representative of the Administration advised MMA that the proposed rule changes were intended to apply to methadone clinics only.  If you have further questions or comments about this proposed rulemaking, please contact Andrew MacLean, Deputy EVP & General Counsel (622-3374, ext. 214; amaclean@mainemed.com).   [return to top]

AMA Provides Comment on MACRA Proposed Rule; MACRA Resources Available

In a letter dated June 27, 2016, the AMA provided extensive comments on the proposed rule, Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive Under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models (CMS-5517-P).  

The AMA also has a page on its web site dedicated to helping physicians understand the Medicare Access & CHIP Reauthorization Act (MACRA).
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CMS Proposes 2017 Medicare Physician Fee Schedule

On July 7, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that updates payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2017.  The proposal includes a number of revised physician fee schedule policies that CMS says will improve Medicare payment for those services provided by primary care physicians for patients with multiple chronic conditions, mental and behavioral health issues, and cognitive impairment or mobility-related disabilities.  The goal is to reflect changes in medical practice and the relative value of services, as well as changes in the Medicare statute. 

Among the changes proposed for the Physician Fee Schedule are changes to the billing code set to more accurately recognize the work of primary care and other cognitive specialists to accommodate the changing needs of the Medicare patient population.  Some CPT codes will be revalued, new codes will facilitate separate payments for comprehensive assessment and care planning for patients with dementia and other cognitive impairments, and changes will be made in an attempt to reduce administrative burden associated with chronic care management.

In addition to the Physician Fee Schedule, changes are proposed to other Medicare Part B payments, the Medicare Shared Savings Program, and medical loss ratio reports submitted by Medicare Advantage and Part D plans.

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HHS Announces New Measures to Fight Opioid Epidemic

The U.S. Department of Health & Human Services announced last week several new actions the Department is taking to combat the nation's opioid epidemic.  

  • The rule finalized by the Substance Abuse & Mental Health Services Administration (SAMHSA) includes expanding access to buprenorphine; it allows clinicians who have had a waiver to prescribe buprenorphine for up to 100 patients for a year or more, to now obtain a waiver to treat up to 275 patients.  Clinicians are eligible to obtain the waiver if they have additional credentialing in addiction medicine or addiction psychiatry from a specialty medical board and/or professional society, or practice in a qualified setting as described in the rule.

  • The rule also includes a proposal to eliminate any potential financial incentive for physicians to prescribe opioids based on patient experience survey questions.  HHS states that this is an attempt to address physicians' and other health care providers' concerns that patient survey questions about pain management in the Hospital Value-Based Purchasing program unduly influence prescribing practices.

  • The rule will require Indian Health Service prescribers and pharmacists to check state PMP databases before prescribing or depending opioids for pain.

  • In addition, the department is launching more than a dozen new scientific studies on opioid misuse and pain treatment and soliciting feedback to improve and expand prescriber education and training programs.

The measures are intended to build on the HHS Opioid Initiative, which was launched in March 2015 and is focused on three key priorities:  1) improving opioid prescribing practices; 2) expanding access to medication-assisted treatment (MAT) for opioid use disorder; and 3) increasing the use of naloxone to reserve opioid overdoses.  They also build on the National Pain Strategy, the federal government's first coordinated plan to reduce the burden of chronic pain in the U.S.

It is hoped that these federal initiatives will support the several activities going on in Maine to also respond to the epidemic, including the recommendations of the Maine Opiate Collaborative and the work of the Caring for ME initiative developed by MMA and Quality Counts.

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Key Changes Recommended for the New Medicare Payment System

Physicians have submitted comments to the Centers for Medicare & Medicaid Services (CMS), detailing the changes that need to be made to the draft rule for the new Medicare physician payment system so it works for physicians and their patients.

The AMA is urging changes across the reformed program as well as revisions that are specific to the Merit-based Incentive Payment System (MIPS) and the alternative payment model (APM) option.

Three of the overarching program recommendations call on CMS to:

  • Create a transitional reporting period in the first year, beginning July 1, to allow sufficient time to prepare physicians and have a successful launch of the new payment system.
  • Provide more flexibility for solo physicians and small group practices, such as modifying the low volume threshold, lowering reporting burdens, comparing practices to their peers, and providing education, training and technical assistance to these practices.
  • Provide physicians with more timely and actionable feedback in a more usable and clear format.

Changes needed to improve MIPS
The comments outline several key recommendations regarding MIPS, which currently is comprised of four components.  The comments ask CMS to:

  • Align the different components so MIPS operates as a single program, rather than four separate parts.
  • Further simplify reporting burdens by creating more opportunities for partial credit and reducing the number of required measures.
  • Maintain the thresholds for reporting on quality measures at 50 percent.
  • Replace current cost-of-care measures that were developed for hospital-level measurement and refine new episode-of-care measures prior to widespread adoption.
  • Remove the pass-fail component of the Advancing Care Information score and restructure the electronic health record performance measures rather than folding the current Meaningful Use Stage 3 requirements into MIPS.
  • Improve risk adjustment and attribution methods before moving forward with the resource use category, and reduce the number of required Clinical Practice Improvement Activities.

Changes needed to improve the advanced APMs option
MIPS is a revised fee-for-service model that most physicians will participate in initially.  But the program allows for an alternative course through APMs that may work better for some practice types.

Physicians detailed several ways the APM option could be improved, including:

  • Simplify and lower financial risk standards for advanced APMs, and base the risk requirements on physicians' Medicare revenues instead of total Medicare expenditures.
  • Provide more opportunities for APM participation.

Physician organizations submit collective recommendations
More than 110 state medical associations and national medical specialty societies joined the AMA in a sign-on letter to CMS that called for simplification, an easier APM pathway, and accommodations for physicians in small and rural practices.

"The overall goal in MIPS should be to create a more unified reporting program with greater choice and fewer requirements," the letter said.  "While we see several positive changes in the proposed rule, our main concern is that CMS continues to view the four components as separate programs, each with distinct measures, scoring methodologies and requirements."

Physicians identified in the letter several of the positive MIPS proposals that should be finalized, including reporting quality information through a variety of methods, such as electronic health records (EHR), clinical registry, qualified clinical data registry (QCDR) and group practice reporting.

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Upcoming Events

163rd Annual Session

  September 9-11, 2016

Harborside Hotel - Bar Harbor, Maine

The theme of this year's program is "Renewing the Joy & Passion in Medicine."  For more information and to register click here


15th Annual Downeast Ophthalmology Symposium

September 23-26, 2016

Harborside Hotel - Bar Harbor, Maine

15 Hours Category 1 AMA PRA CME Credits Offered

Topics include Glaucoma, Cataract, and Uveitis.  Michael X. Repka, MD, MBA will deliver the Keynote address on Ophthalmology in an Era of Health Care Evolution.  There will also be time to enjoy the beautiful area!

For more information and to register visit: https://maineeyemds.com/symposium-home or contact Shirley Goggin at 207-445-2260 or sgoggin@mainemed.com.



MCMI Training Programs - Level 1 and Level 2

October 25, 2016

When and where held:  On October 25, 2016, the Maine Concussion Management Initiative will present Level 1 and Level 2 Training as the Youth Concussion Track at the Brain Injury Association of America-Maine Chapter's 7th Annual Conference on Defining Moments in Brain Injury in Portland at USM.

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: 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: Conference - 7:30pm to 4:30pm

MCMI Level 1: 9:30am to 1:00pm

MCMI Level 2: 1:30pm to 4:30pm                                                   


Fee: $100 for all participants for the entire day

How to register: online atwww.biausa.org then click on BIAA-Maine (in the menu on the left)

CMEs will be provided. Exact contact hours not determined at this time

For more information contact:

Jan Salis, PT, ATC, MCMI - Membership and Education Committee - Chair

jsalis@aol.com or (207) 577-2018




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Job Openings


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.


MEDICAL DIRECTOR SOUGHT for Mayo Regional Hospital Psychiatry and Counseling Clinic

Mayo Regional Hospital is seeking a part time Medical Director for its Psychiatry and Counseling clinic.  Mayo Psychiatry and Counseling provides mental health and substance abuse outpatient services, 5 days per week. The practice is staffed with a Director, Adult Psychiatrist, 2 PMHNP (child, adolescence and adult scope) and 7 clinicians.  The position would require 10-15 hours per week, with a combination on on-site and off-site work. Please contact, Lori Morrison, Vice President Physician Practices 207-564-4336 or lmorrison@mayohospital.com.



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.


INTERNAL MEDICINE PHYSICIAN - Maine Medical Partners Internal Medical Clinic

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) 661-7383 or nathaa@mainehealth.org.



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



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.


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