August 8, 2016

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Some Confusion Remains on New Opioid Prescribing Limits

Despite many opportunities for educational presentations and resources offered on the MMA and Quality Counts websites, reports were received last week of patients not being able to get necessary prescriptions filled. We have communicated with the Maine Pharmacy Association, and if a prescriber is utilizing the "medical necessity" exception (available until Jan 1, 2017), the prescriber should write that on the script so that the pharmacist is aware of the prescriber's opinion that the script is medically necessary.

The Governor and the Legislature were well aware that not all 16,000 patients currently receiving opioid medication in access of 100 morphine milligram equivalent (MME) would be able to be tapered immediately. Therefore, a medical necessity exception was added (to expire on Jan. 1, 2017) in addition to the provision for patients who are currently at 100 MME to be prescribed up to 300 MME until July 1, 2017. For those patients over 300 MME on Jan. 1, 2017, other exceptions may be established through state rule-making or the exception for palliative care may be considered.

Other exclusions in the law include prescribing opioid medication to a patient for:

  1. Pain associated with active and aftercare cancer treatment;
  2. Palliative care, as defined in Title 22, section 1726, subsection 1, paragraph A, in conjunction with a serious illness, as defined in Title 22, section 1726, subsection 1, paragraph B;
  3. End-of-life and hospice care;
  4. Medication-assisted treatment for substance use disorder; or
  5. Other circumstances determined in rule by the Department of Health and Human Services pursuant to Title 22, section 7254, subsection 2; and
  6. When directly ordering or administering a benzodiazepine or opioid medication to a person in an emergency room setting, an inpatient hospital setting, a long-term care facility or a residential care facility.
  7. Until Jan. 1, 2017, a prescriber can utilize an exception for medically necessity. In order to inform the pharmacy that it is within the law to fill a particular script over 100 MME, the prescriber should write "Medically Necessary" on the script.

Although the requirement to check the Prescription Monitoring Program (PMP) for a new script does not take effect until January 1, 2017, it would not be possible to know what opioid medication the patient may be receiving from other prescribers without checking the PMP. So, in effect, the PMP mandate should be observed beginning July 29th if a prescriber is not already routinely checking the PMP for new scripts for an opiate based medication. On January 1, 2017, the PMP mandate will include a first script written for a benzodiazepine in addition to an opioid.

Other information on the new law can be found on the MMA website at MMA attorneys are available to present CME programs on the new law. If you are interested in a presentation at your practice or facility contact MMA's CME Coordinator Gail Begin at or EVP Gordon Smith at or by calling Gordon at 215-7461.  Presentations are scheduled over the next month in Harrington, Fort Kent, Patton, Damariscotta, Skowhegan, Calais and Ellsworth.





MMA Website Features New Q&A on Opioid Law

The Maine Medical Association Website now features a new Questions-and-Answers document about PL 2015, chapter 488--the new Maine opioid law. It addresses questions that have been raised most frequently to MMA staff by our members and others since the bill was signed into law in April.

You can find it by going to the MMA website at and clicking on Question and Answer Document under the "Spotlight" section of the page. Or, to make it easier, you can just click here. [return to top]

Watch for Summer Issue of Maine Medicine in your Mail this Week.

MMA members, practice managers and Corporate Affiliates should watch their mail this week for the summer issue of Maine Medicine which is being mailed today or tomorrow from Augusta. This July-August-September issue contains articles on MMA's ongoing work on the new opioid prescribing law (Chapter 488), the upcoming 163rd Annual Session in Bar Harbor Sept. 9-11, and the usual reports from MMA President Brian Pierce, M.D., EVP Gordon Smith, J.D., and Deputy EVP and General Counsel Andrew MacLean, J.D.  

Maine Medicine is published four times per year and sent by U.S. mail to all MMA members, their practice managers and to MMA corporate affiliates and other strategic partners and friends. MMA welcomes feedback regarding the content and usefulness of Maine Medicine and of all MMA publications, including this Weekly Update. Comments can be sent to EVP Gordon Smith at

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MMA Board Votes to Send Resolution Opposing Question One to Membership Meeting, Sept. 10

At its summer board meeting last on Friday (August 5), the MMA Board of Directors voted to send to the Annual Meeting a Resolution opposing the effort to legalize the recreational use by adults of marijuana in the state. The Resolution, which will be posted in its entirety on the Association's website (, will be considered during the MMA General Membership Meeting on Saturday morning, Sept. 10.  The business meeting begins at the Bar Harbor Club at 7:30am and is expected to conclude by 10:00am in order to accommodate the CME program. Any MMA member is welcome to attend the meeting (there is no charge for attending just the membership meeting).

In other business at the meeting, Board members considered Question 2 on the November ballot which would have the state meet its statutory commitment of funding 55% of local K-12 education through the imposition of a 3% tax on income of over $200,000. The Board voted not to get involved in that Question 2 campaign but to educate members as to the ballot question and the proposed law underlying it.

Board members also heard a progress report from the Ad Hoc Committee reviewing and revising the Association's existing White Paper on Health System Reform. The existing document was drafted over ten years ago and is in need of an update. The Committee is chaired by Board member and Portland internist Hani Jarawan, M.D.

The Board meeting was held at the home of President Brian Pierce, M.D. and his wife Andrea in Camden.  The next Board meeting will be held in Bar Harbor during the Annual Meeting (Friday, Sept. 9, at 3:00pm before the opening night reception).

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MMA Room Block for Annual Meeting Expires August 9! Make Your Reservations NOW.

Maine Medical Association 

163rd Annual Session

September 9-11, 2016

Harborside Hotel, Bar Harbor, ME 


Renewing the Joy & Passion in Medicine

4.5 AMA PRA Category 1 CME Credits TM

Dear Colleagues & Friends:

Recognizing the signs of professional exhaustion is the first step to reintroducing joy and purpose to your career.   Please join your colleagues at this year's Annual Session where you will learn new tools that will help you develop resiliency and renewal in your personal and professional life. 

Click Here to view the full schedule and register for this event.  Bring your family so they can enjoy Mt. Desert Island and Acadia National Park.  

Saturday, Sept. 10, 10:00 a.m.

Tuning Up Your Resilience Program features five physicians who have extensive experience in physician resilience and burn-out prevention. Dr. Jo Shapiro serves as Chief, Div of Otolaryngology, Dept of Surgery, at Brigham and Women's Hospital and is an Associate Professor at Harvard Medical School. She was one of the first woman division chiefs and was recently named as a finalist for the Schwartz Center Compassionate Caregiver Award. Dr. George Dreher, knowing what a habit of mindfulness brought to his life and career at Maine Medical Center, started offering a Mindful Practice of Medicine course and helped create a medical staff subcommittee on practitioner health and resilience. Dr. Christine Hein, who is the Medical Director of the Emergency Medicine Workgroup, knows first-hand the pressure practitioners face in their daily work and how important self-resiliency strategies can be in maintaining ideal standards of care for patients. Ben Tipton, PAC, has been working to improve resiliency at the Mid Coast Hospital and has built a Mindfulness-based Stress reduction program which is providing training for an increasing number of staff. Dr. David Strassler is the chair of the Martin's Point Provider Resiliency Team and has recently undertaken a drive to reduce burdensome paperwork.

Saturday, Sept 10, 12:00 p.m.

Speakers Kevin Mannix and Linda Rota, LSW, will deliver the Saturday noon keynote.  Kevin and Linda have co-authored the book, Weathering Shame, an autobiography on their personal experience growing up with the stigma and shame of 

alcoholism and mental illness. Kevin is a veteran weatherman at WCSH6, Portland and WLBZ 2, Bangor.   His spouse, Linda Rota, LSW, has been a social worker for more than thirty years. She is a 1982 magna cum laud graduate of USM with a B.A. in social welfare and criminal justice. Linda served in the Peace Corps in Sierra Leone, West Africa and trained volunteers on cross-cultural issues. Their book will be available for purchase and book signing.

Sunday, Sept. 11, 9:00 a.m.

Simple Mindfulness Applications to Cultivate Joy & Passion in Work & Life.  Countless demands and rushing about are the norm these days. We live in stressful, chaotic times. The speed of life around us is going faster and faster. This way of living affects our health, our relationships, our families, and the quality of our lives. We do have the ability, the strength, and the stability within us to meet these challenges in a way that brings more happiness into our everyday lives. Mindfulness is a way to access these inner resources.

Nancy Hathaway, M.Ed., LpastC, has been studying and teaching mindfulness for 40 years. She has interned and worked with Jon Kabat-Zinn, Ph.D. in the Mindfulness Stress Clinic at the University of Massachusetts Medical Center and the State of Massachusetts, Department of Corrections. She teaches Mindfulness nationally including Harvard University's Work and Family Center, MIT, hospitals, universities, high schools, colleges, parent groups, and couples courses.  She is an Adjunct Professor in numerous colleges in Maine teaching Mindfulness courses.  She has studied internationally with teachers in the Zen, Vipassana, and Tibetan traditions and holds a Masters in Education degree with a Counseling Psychology track.


7th Annual Silent Auction

Request for Donations

The auction proceeds will benefit the Maine Medical Education Trust (MMET) Scholarship Fund which directly benefits Maine students and relies on this auction as a primary revenue source.


Donation Examples:

Gift Certificates to a Maine restaurant, hotel or resort

Gift Baskets

Weekend or week-long stay at a Condo, Camp or Vacation Home

Concert, Theater or Sporting event tickets

Painting, sculptures, drawing or other artwork

Wine and Spirits

Personal Services (such as spa treatments, car detailing, etc)


Handmade Items

For more information  on donations 

click here.

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Maine Medical Association

30 Association Drive

PO Box 190
Manchester, ME 04351


Copyright © 2016. All Rights Reserved.

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Maine Left Out of CPC+ Program

Fourteen states have been chosen to participate in Comprehensive Primary Care Plus (CPC+), a national advanced primary care medical home model from the Centers for Medicare and Medicaid Services (CMS) that aims to strengthen primary care through a regionally-based multi-payer payment reform and care delivery transformation.

Maine is not one of those states.

CMS estimates that up to 5,000 primary care practices serving 3.5 million beneficiaries could participate in the model. The five-year program, beginning in 2017, is designed to give practices greater financial resources and flexibility to make appropriate investments to improve the quality and efficiency of care and reduce unnecessary health care utilization. According to CMS, it is a medical home model that will enable primary care practices to care for their patients the way they think will deliver the best outcomes and to pay them for achieving results and improving care.

Building on the Comprehensive Primary Care initiative that launched in late 2012, CPC+ will benefit patients by helping primary care practices:

  • Support patients with serious or chronic diseases achieve their health goals
  • Give patients 24-hour access to care and health information
  • Deliver preventive care
  • Engage patients and their families in their own care
  • Work together with hospitals and other clinicians, including specialists, to provide better-coordinated care

Three health insurers, Anthem, Harvard Pilgrim and Community Health Options, applied to participate in the program through primary care practices in Maine. In response to CMS's invitation to participate in the program, Maine DHHS Commissioner Mary Mayhew wrote to CMS, "[W]e are somewhat perplexed by a request for a state Medicaid program to apply to Medicare for participation in a value-based payment model for Medicare physicians." She cited Maine's establishment of primary care and behavioral health homes and the MaineCare Accountable Community initiative as the major reasons for apparently declining to participate in the new initiative. Commissioner Mayhew went on to say, "We believe, however, that flexibility is a critical element to retain so that our initiatives are responsive to Maine's healthcare goals and our delivery system reforms. ...I am hopeful that Medicare's alignment with Maine's direction can be achieved quickly to accelerate delivery system transformation."

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8th Annual McKusick Lecture & Incoming Class Reception at TUSM - MMC Program

The 8th Annual McKusick Lecture & Incoming Class Reception took place on Thursday, July 28th at the Dana Center on the Maine Medical Center campus.  Richard W. Petersen, President & CEO of the Maine Medical Center welcomed the TUSM - MMC Program incoming class of 2020, parents, faculty, benefactors, and friends of the Program.  Peter W. Bates, M.D., Senior Vice President of Academic Affairs and Chief Academic Officer at the Medical Center and Harris A. Berman, M.D., Dean of the Tufts University School of Medicine spoke about the history of the Program and paid tribute to the McKusick family.  

Dr. Bates then introduced the McKusick lecturer, Farzad Mostashari, M.D., M.Sc., CEO of Aledade, Inc. and formerly a senior HIT staffer in the Obama Administration.  Dr. Mostashari offered a very engaging talk entitled, From Volume to Value, From Process to Outcomes:  The Future of Medical Care.

Following Dr. Mostashari's lecture, Robert G. Bing-You, M.D., Vice President, Medical Education, Maine Medical Center, and Jo E. Linder, M.D., Director of Student Affairs, Medical Education, Maine Medical Center joined Dr. Bates and Dr. Berman to introduce members of the incoming class and present them with their white coats.  The event closed with a reception.

The members of the Class of 2020 are:

  1. Kaitlyn Bergeron, Shapleigh, Northeastern University
  2. Mark Broadwin, Concord, MA, Colby College
  3. Corinne Carland, Shapleigh, MIT
  4. Elena Cravens, Winterport, Wellesley College
  5. Michael Delucia, Norwich, VT, MIddlebury College
  6. Eli Dibner-Dunlap, Cleveland, OH, Skidmore College
  7. Gabrielle Donahue, Cape Elizabeth, Colby College
  8. Jessica Evans, Van Buren, Bowdoin College
  9. James Finney, Kingston, NH, Dartmouth College
  10. Sydney Ford, Brunswick, University of St. Andrews, Scotland
  11. Jodi Forward, Sherborn, MA, Colgate University
  12. Eliot Gagne, Gorham, University of Maine
  13. Laura Getchell, Raymond, Wesleyan University
  14. Alexandra Grzywna, Framingham, MA, Wellesley College
  15. Ben Guido, Montville, Colby College
  16. William Hirschfeld, Hopkinton, NH, Dartmouth College
  17. Samuel Lloyd, Yarmouth, Boston College
  18. William Long, Littleton, CO, Regis University
  19. Micah Ludwig, Waldoboro, Bowdoin College
  20. Owen Maguire, Amherst, MA, Northeastern University
  21. Anna Martens, Scarborough, Muhlenberg College
  22. Hannah Martin, Yarmouth, Swarthmore College
  23. Lauren McAllister, Bethel, Bates College
  24. Parker Merrill, Brunswick, University of Virginia
  25. Robert Michaud, Limington, Saint Joseph's College of Maine
  26. Antigone Mitchell, Candia, NH, Bowdoin College
  27. Grace Mueller, Edwardsville, IL, University of Southern Maine
  28. Kelsey-An O'Neil, Cumberland, University of Southern Maine
  29. Jacqueline Ordemann, Groton, MA, Bates College
  30. Brianna Philbrick, Brewer, Boston University
  31. James Poulin, Lewiston, University of Maine
  32. Samuel Poulin, Readfield, Colby College
  33. Zachary Radford, Tuftonboro, NH, Bates College
  34. Sheila Rajan, Orrington, Colby College
  35. John Royal, II, Ellsworth, University of Maine
  36. Nabil Saleem, Alpharetta, GA, Bates College
  37. Jennifer Scontras, Saco, Brandeis University

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Largest HIPAA Settlement Ever: $5.55 Million

Advocate Health Care has agreed with US Department of Health & Human Services, Office of Civil Rights, to a settlement that constitutes the largest penalty in history for a HIPAA violation: $5.55 million. Advocate, based in Downers Grove, IL, includes 12 acute-care hospitals and more than 250 treatment locations. According to HHS it is the largest fully integrated healthcare system in Illinois.

Advocate said in a statement that it will cooperate fully with OCR to improve data security throughout its organization: “As all industries deal with the ever-evolving digital landscape and the impact it has on security, we've enhanced our data encryption measures to prevent this type of incident from reoccurring."

The settlement involved three separate breaches. The first, in 2013, resulted from the theft of four unencrypted laptop computers, which put at risk 4 million patients records. The other two breaches were to the network of a business associate and Advocate's ePHI system, each involving approximately 2000 patients. Advocate said, "[T]here continues to be no indication that the information was misused."

OCR based the size of the settlement on the extent and duration of Advocate's failure to comply with data security laws and the number of patients affected. It found that Advocate had neither accurately assessed potential risks to its systems nor ensured that it and its business associates had protected their systems adequately.

OCR Director Jocelyn Samuels said, "We hope this settlement sends a strong message to covered entities that they must engage in a comprehensive risk analysis and risk management to ensure that individuals' ePHI is secure. This includes implementing physical, technical, and administrative security measures sufficient to reduce the risks to ePHI in all physical locations and on all portable devices to a reasonable and appropriate level.”

This settlement once again underscores the importance of encrypting health care information and taking all steps necessary to protect laptops, flash drives and other equipment from loss or theft. The Maine Medical Association will be happy to provide a one-hour presentation by one of our three staff attorneys on the issue of HIPAA to any practice requesting it. Health care providers and organizations owe it to themselves and their patients to protect all medical information from loss or misappropriation. [return to top]

Department of Justice Challenges Proposed Health Plan Mergers

In late July, the United States Department of Justice announced that it would file litigation seeking to block the proposed mega-mergers of Anthem and CIGNA and Aetna and Humana. MMA, the AMA, and several other medical societies had asked the Justice Department to block the mergers based upon standard anti-trust principles. While this action by the Justice Department will not, in and of itself, halt the mergers, observers believe that Anthem and CIGNA may not have the desire to go forward in the face of federal opposition. It is possible that Aetna and Humana may continue with their plans, but if successful, the merger of these companies would not have as big an impact in Maine as an Anthem-CIGNA merger.

"Following substantial input from our members, the MMA Board voted to oppose the mergers and we were pleased to be able to talk with Justice Department investigators last January and convey to them the belief of our members that the mergers would not be in the best interest of patients or health professionals of all types," said Gordon Smith, MMA EVP following the announcement. "We are very appreciative of the work of the AMA and several other state medical societies which joined in the opposition to these mega-mergers and we are very gratified that the Justice Department, following its investigation, ultimately agreed with our position."

The annual research by the AMA on the consolidation of insurance markets by the national plans also was a very important element in the Justice Department investigation. The health insurance market in Maine was one of the markets that showed significant consolidation and concentration of the health insurance market if the Anthem-CIGNA merger were approved.

You can read the AMA's press statement on the recent DOJ action here.

MMA thanks those members and practice managers who provided input to both the Attorney General's office and the Justice Department.

An AMA Viewpoints post by AMA President Andrew W. Gurman, MD

Prospects for major health insurance consolidation took a major hit when the U.S. Department of Justice (DOJ) and a number of states filed antitrust lawsuits Thursday to block both the Aetna, Inc.-Humana, Inc. and Anthem, Inc.-Cigna Corp. mergers. The DOJ asserted that the mergers would substantially lessen competition.

When something comes up that could negatively affect our patients and the quality and affordability of the care they receive, physicians take the lead and engage policymakers. With the same drive that put us through late nights in med school, carried us through the intensity of our residencies and continues to push us every day to go the extra mile for our patients and their families, we took these mergers on—and our voices were heard.

Creating even larger goliaths would be unacceptable—and I said so in a public statement today. Federal and state officials have a strong obligation to enforce antitrust laws to protect patients by ensuring a competitive marketplace that operates in patients' best interests.

The DOJ's action is a significant step toward the kind of marketplace that doesn't put the insurers first but rather puts patients first. And that's what we as physicians care about most.

Physicians fight to protect patients
Both mergers were announced in July of last year. My colleague, Immediate-past President, Steven J. Stack, MD, responded swiftly with a statement detailing how the mergers would increase health insurance market concentration and reduce competition in both the market for the sale of health insurance and in the market in which health insurers purchase physician services, ultimately resulting in further patient injury due to a decrease in the quality and quantity of available physician services. Neither development is something we as physicians can allow.

At the outset of the DOJ and state investigation of these mergers, the AMA was armed by our annual market studies on competition in health insurance and by an AMA study published in a leading academic journal establishing that a previous merger—United Health Group Inc.'s 2008 merger with Sierra health services—resulted in higher premiums.

Over the course of the next year, we physicians took it upon ourselves to stand up against the mergers of these powerful insurers by submitting testimony in congressional and state proceedings and preparing memoranda to state and federal officials investigating the mergers. In this effort, the AMA joined with state medical societies and gained the assistance of influential lawyers and economists to gather the evidence and present the arguments against the mergers to the DOJ, state attorneys general and state insurance departments.

I testified at a congressional hearing examining the proposed mergers and the impact they would have on competition in September, urging them to closely scrutinize the mergers and utilize enforcement tools at their disposal to protect patients and preserve competition.

Two weeks before, my colleague, Barbara L. McAneny, MD, who is a member of the AMA board of trustees, testified before Congress with a similar message. Together, we carried that message into the 2015 AMA Interim Meeting, where the AMA House of Delegates passed new policy that emphasized the need for active opposition to consolidation in the health insurance industry that could result in anticompetitive markets.

In December, the AMA identified the "big 17"—states where the mergers would have the greatest impact—and formed a coalition to block the mergers. A survey was developed relating to the monopsony issues raised by the proposed mergers and sent out to physicians in those states. Physician feedback was included as the big 17 coalition drafted letters sent to the DOJ.

What's important is that the medical community came together under this coalition, not with the intention of fighting the goliath companies that would be formed by the mergers, but rather to prevent them from happening. The physician voice is stronger when we can all come together under the same leadership.

As the letters were drafted and sent, we continued to lay on the pressure and the argument of the coalition became stronger and harder to refute.

Last month, the California Department of Insurance issued a letter urging the DOJ to block the Anthem-Cigna merger. The insurance commissioner based this conclusion on a March 29 public hearing that included testimony and written comments from the public, patient advocates, experts on health insurance mergers, and both the AMA and the California Medical Association (CMA).

Jointly with the CMA, we filed a comprehensive, evidence-based analysis (log in) explaining why the merger should be blocked. At the hearing, our top antitrust attorney, testified that the consequences of the proposed merger would have long-term consequences for health care access, quality and affordability.

Similarly, Missouri, with our input, took a hard stand against Aetna's acquisition of Humana in May when the Missouri Department of Insurance issued a cease-and-desist order preventing the companies from doing any post-merger business in Missouri's Medicare Advantage markets and some commercial insurance markets.

All of these efforts raised awareness and ultimately led to this moment today—on the cusp of a win for our patients.

Today's news is especially gratifying. The DOJ /State suit against Anthem-CIGNA incorporates the AMA's concerns that the merger would result in a health insurer buyer "monopsony" power over the physician marketplace. The suit against Aetna adopts the AMA's long-held and strenuously argued view that Medicare Advantage is a separate market that would suffer antitrust injury by the proposed Aetna-Humana merger. Finally, the AMA is thankful the state Attorneys General, like Florida, who listened to the physicians' concerns and joined the lawsuits.

The fight isn't over yet
A merger of this magnitude would compromise physicians' ability to advocate for their patients—something we consider an integral part of our place in society. In practice, market power allows insurers to exert control over clinical decisions, which undermines our relationships with patients and eliminates crucial safeguards of patient care.

On the other hand, competition can lower health insurance premiums, enrich customer service and spur inventive ways to improve quality and lower costs. Patients benefit when they can choose from many different insurers that are competing for their business by offering coverage that patients want and at competitive prices.

The suit filed by the DOJ is not the end—yet. Both companies have stated that they plan to fight the battle in court and challenge the DOJ lawsuit. The AMA will remain engaged in this process and relentless in our quest to preserve competition in the health insurance marketplace.  

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Maine Gets an A for Hospital Price Transparency

Every year (since 2013) the Health Care Incentives Improvement Institute, a non-profit healthcare reform think tank, releases a “report card” on all the states, reporting on each state’s price transparency laws.  This year 43 of the 50 states received an “F”.  Oregon received a “B”, while Vermont and Virginia achieved “C” and Arkansas got a “D”.

Only three states received an “A” rating: Colorado, New Hampshire, and…Maine!

Maine moved up from a “B” last year to this year’s “A” rating due to improvements in how the data are presented, in addition to how they are collected.  The CompareMaine website was noted among Maine’s practices that other states should emulate: “Collects data in an APCD, including full scope of providers, and paid amounts. Has an excellent website for consumers.”

The 18-page report describes in considerable detail the process that was used in assessing the states during the grading process. It includes the legislation scoring rubric and the legislated website rubric.

While analyses of quality in comparison to price are open to critique on such issues as patient population, severity of conditions treated and other factors, and while we all still have improvements to make in developing accurate and reliable measures of quality and cost, price transparency is a step toward empowering patients in their attempts to make their own health care decisions based on data rather than anecdote.

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New Physician Non-discrimination Rules Now in Effect

On July 18, 2016 new regulations under Section 1557 of the Affordable Care Act went into effect that prohibit physicians and other health care providers from discriminating against individuals on the basis of various factors and require notice of those rights. The regulation went into effect after nearly 25,000 comments were received and reviewed. (Physicians employed by health care entities covered by the regulations don’t have to provide the notices and policies described below, since the employer has that obligation.)

The requirements apply to all health programs and activities that:

  • ·         Receive Federal financial assistance from DHHS;
  • ·         Are administered by Health Insurance Marketplace entities; and
  • ·         Are administered by DHHS (such as Medicare and Medicaid).

These new regulations codify requirements that already exist in more general terms, but they impose a new requirement that physicians provide a written notice of nondiscrimination to individuals. The notice must state that the physician’s practice:

  • Does not discriminate on the basis of race, color, national origin, sex [including gender identity], age [except for pediatric or gerontological specialists], or disability;
  • Provides free aids and services to people with disabilities to communicate effectively, such as sign language interpreters, written information in other formats; and
  • Provides language services to persons with limited English proficiency.

In addition, the notice must advise how those services may be obtained, contact information for the person responsible for grievance procedures (in offices of 15 or more employees), how to file a grievance, and how to file a discrimination complaint with the US DHHS Office for Civil Rights (OCR).

Covered entities may not rely on the person’s minor child to provide language services except in the case of a life-threatening emergency, nor may they rely on unqualified bilingual or multilingual staff or “low quality” video remote interpreting services.

This regulation by its terms does not apply to employment discrimination, which is covered elsewhere in state and federal law. Also, if the application of this regulation would violate federal laws protecting religious freedom and conscience, it need not be applied.

Finally, practices with 15 or more employees are required to designate a compliance coordinator who will investigate any grievances and adopt grievance procedures to address complaints.

The US DHHS Trainer’s Guide and PowerPoint slide deck on the new rules may be found on the DHHS website by clicking the links above. The website also has a notice form which is an appendix to the rule itself.

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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: or contact Shirley Goggin at 207-445-2260 or



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 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 or (207) 577-2018



Join MPCA HPV Summit: Improving Rates to Reduce Cancer in Maine

We hope you will join us for a half day summit to discuss promising practices in completing the HPV series through collaboration between state agencies, schools, medical providers and community partners. We are excited to showcase the work in Rhode Island for their Vaccinate Before you Graduate program, in addition to sharing the most up to date evidence around the HPV vaccine and its effectiveness in preventing cancers in both men and women.  

Date: Wednesday, August 24, 2016

Time: 10:00 AM - 2:00 PM

Location: Dirigo Conference Room, Bangor Savings Bank, Senator Way, Augusta 


Fee: $25


10:00-10:30:        Welcome, CDC “You Are the Key Presentation”

-          Jessica Reed, GNP-C, American Cancer Society

10:30-11:00:        What to know about HPV Related Cancers

11:00-12:00:        Perspectives from the Field: Practice-based strategies for improving HPV rates

-          Theresa Knowles, FNP-C, Penobscot Community Health Care

-          Jessica Reed, GNP-C, American Cancer Society 

12:00-12:45:        Lunch (provided)

12:45- 2:00:         Innovative Programs in New England: Vaccinate Before You Graduate – Rhode Island

-          Randall Linn, CEO, The Wellness Company

-          Lesa Volpe, Vaccinate Before You Graduate, The Wellness Company

2:00 PM                Thank You and Evaluations

This Summit is being offered through a partnership of the American Cancer Society and the Maine Primary Care Association, with support from the Maine AHEC Network.

The University of New England College of Osteopathic Medicine (UNECOM) is accredited by the American Osteopathic Association (AOA) and the Maine Medical Association’s Council on Continuing Medical Education and Accreditation (MMA CCMEA) to provide continuing medical education for physicians. UNECOM has requested that the AOA Council on Continuing Medical Education approve this program for 3.25 hours of AOA Category 1B CME credits.  Approval is currently pending. 




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Job Openings

PRIMARY CARE PHYSICIAN - Eastern Maine Medical Center

Eastern Maine Medical Center seeks a primary care physician, board-certified/board-eligible in internal medicine, to join our well-established, quality-driven, outpatient practice. Husson Internal Medicine is one of seven primary care practices operated by Eastern Maine Medical Center. Our practice was the second in the nation to achieve “Patient-Centered Medical Home” status with NCQA. All physicians are NCQA-certified in diabetes and cardiac care. Our primary care network, largest in our area, has adopted a new practice model to include teams of one physician, one nurse practitioner, two registered nurses, and two medical assistants.   

Eastern Maine Medical Center is a 411-bed, regional, tertiary care and level II trauma center serving the more than 500,000 residents living in central, eastern, and northern Maine We offer a collegial atmosphere, cutting-edge EMR, generous vacation and CME benefit, flexible work schedule, and reasonable call schedule. No hospital call required. Candidates in need of J-1 visa waivers welcome to apply.  

For confidential consideration, please contact: Amanda Klausing Eastern Maine Medical Center Phone: 207-973-5358   


PHYSICIAN - Penobscot Community Health Care

Penobscot Community Health Care is seeking a Physician who is interested in working on a team dedicated to patient-centered care, innovation and collaboration for their Belfast location, Seaport Community Health Center. If this sounds like an opportunity you would be interested in, consider this:

You will be working on a team that has served its community for nearly 30 years!

You will be providing comprehensive, integrated primary health care services for an organization that exemplifies their Mission in everything they do.

You will be working on a team that recently achieved the highest level of recognition as a Patient-Centered Medical Home (PCMH) by the National Committee for Quality Assurance (NCQA).

You will be given the chance to make a difference in the lives of not only your patients, but the community you serve…every day.  

For more information, please contact Vanessa Sanderson, Recruitment Coordinator, Penobscot Community Health Center at (207) 404-8015 or



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 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


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



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 or visit our website at  KVHC is an equal opportunity employer.


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