December 26, 2016

 
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Updated Information on Chapter 488 Requirements Taking Effect on Jan. 1

Prescribers of opioid medication prescribed for pain and of benzodiazepines or their delegates must check the PMP prior to writing such scripts, effective January 1, 2017 and every 90 days thereafter.  In addition, the ability to override Chapter 488 by using the medical necessity exception expires January 1st and the 7-day and 30-day limits on scripts for acute pain and chronic pain respectively take effect on the same day.  Because the PMP changed vendors on December 20th and further because of an emergency rule providing for some exceptions taking effect on January 2nd, HHS officials announced last week that state enforcement of the law will be delayed until March 1st.

As a reminder, the maximum daily dose provision (100 MME) took effect on July 29, 2016, but patients who were on 100 or more MME of opioid medication on that day can receive up to 300 MME until July 1, 2017.  If a patient exceeds 100 MME and does not qualify for the 300 MME exception (until July 1, 2017), the only exceptions available are:

  • Cancer pain
  • Hospice care
  • End of Life care
  • Palliative Care

However, DHHS is preparing an emergency rule, as called for in the law, which will likely authorize some additional exceptions, including exceeding the limit to allow for post-op care in cases where the patient may already be receiving pain medication for one or more chronic conditions and for patients who are undergoing an active taper.  At the final Stakeholders' meeting held on December 7th,  DHHS staff stated that the emergency rule will be e-mailed to PMP registrants on January 2nd, the effective date of the rule.  Under the state Administrative Procedures Act, an emergency rule can take effect immediately and then the public comment period begins.  While MMA staff and several physicians, pharmacists, and other health professionals have provided information to DHHS and commented on draft exceptions language, we have not had an opportunity to see the final rule and have been told it will not be public until its effective date on January 2nd. As it will take some time to educate prescribers regarding the emergency rule, MMA has asked DHHS to provide for a grace period of 30 to 60 days prior to enforcing the new rule. (See separate article in this issue with the text of DHHS' grace period announcement.)

Stephen Hull, M.D., Director of Medical Pain Management at Mercy Hospital, attended the Stakeholders' meeting on December 7th,  along with MMA Associate General Counsel Peter Michaud, J.D., R.N., and prepared a summary of the discussion.  We very much appreciate the effort that Dr. Hull and several other physicians have made to provide clinical input into the emergency rule.

MMA is pleased to share Dr. Hull's comments below:

Policy Update

As it stands, the statutory exceptions of inpatient, residential treatment (i.e. nursing home), cancer pain, end of life, palliative care, and medically assisted treatment (methadone and Suboxone for substance use disorder) will all remain.  In addition, I am expecting an exception for postponing active taper during pregnancy, a total dosage "pursuing active taper" exception that will likely be limited to no more than 6 months (though it will apply to current patients, it is not proposed specifically for those providers who have been delaying implementation of a taper in hopes of an exception that would apply for their patient(s), but instead is intended for that patient moving into the state and coming under our care on large doses after implementation of the new rules).  Though there was not any discussion in relationship to the many particulars, we also expect an exception for patients who have failed an active taper, likely requiring some documentation of substantive decline in function that was subsequently recovered on reengagement of doses >100 MME.  This last exception has tons of complicating issues:  how long was the patient at a dose below 100 MME, what measure and documentation of function will be required, etc.

The DHHS staff at the meeting, while not committing to any position about this, did seem to understand that they should allow some grace period to allow education of prescribers
, since the new rules will not be published before we are expected to be accountable for them.  I am expecting more about this and some, though not extensive, leniency on enforcement during the first weeks to a month.

Dr. John Pier has reminded me of an additional anticipated important exemption, the acute on chronic pain circumstance.  This could be any acute on chronic pain, particularly post surgical pain.  I am anticipating that the rules will include the capacity for a prescriber presented with a patient who has an acute on chronic pain to be allowed an exemption to exceed the 100 MME aggregate limit with renewable 7-day prescriptions for acute on chronic pain. The rulemaking discussions did not address at what point it is appropriate to convert an acute patient to chronic and at that time it would be likely that a "pursuing active taper" exception would apply as the patient was again returned to a dose less than 100 MME.

PMP Update

The Department has selected a vendor to replace the current PMP vendor, Appriss (see below) to provide the upgrade of the PMP.  They currently have a portfolio of 28 state PMPs they host/serve and provided a demo.  The "go live" for the upgrade was December 20th.  Appriss sent a guidebook on how to use this upgrade to the Maine PMP to registrants via email or snail mail on December 19th.  Those registrants (but not their delegates) who have provided email addresses (are currently receiving emails from the PMP) are being migrated over from the current vendor to the Appriss product.  All delegates and those current registrants who do not have an email address registered with the current vendor will need to re-register with the Appriss product.  This appeared from the demo to be an easy process that will be hastened somewhat by entering their NPI, which will be in the system with a limited amount of data that will populate the registration page.  When a delegate first registers they will identify prescribers under whom they are requesting delegate status, and an invitation will be sent to the prescriber to accept the delegate.

The necessity for all delegates to re-register, which will require action by the prescriber as well, was only announced recently.  As there could be no registrations by delegates or prescribers until the conversion took place on Tuesday, December 20th, these circumstances also call for a grace period in enforcement to allow for all the delegates to get re-registered which will be an enormous challenge prior to  January 1, 2016, the effective date of the PMP mandate. 

Appriss PMP Demo. 
Most registrants are likely to be pleased with the upgrade.  It seems more user friendly than the present system.  I won't provide a detailed description of the product but instead this PDF: http://www.appriss.com/static/sitedocs/PMPAWARE_ProductSheet.pdf.  I believe the most useful feature will be the ability for delegates to batch search the database on behalf of a provider.  In our clinic I would anticipate our delegates to upload the day's schedule in a PDF or CSV format to the PMP and then be able to rapidly produce a report for the prescribers patients for the day.  Additionally, I was told that there would be a way for us to all save some trees by uploading these reports to our EHRs, though they did not demonstrate this function.  My recommendation to medical directors would be that they alert their IT department to the implementation on December 20th and, though clearly short notice, have them provide instructions to the prescribers, or more correctly, their clinic managers, on how to create a PDF or CSV formatted report of a day's scheduled patients.  The data points that will be required will be Last Name, First Name and Date of Birth.  Including Zip Code will allow the program to use some fuzzy logic to search for aliases that may be in the system, i.e. misspellings of the patient's name of incorrect dates of birth, allowing the delegates to accept or reject close matches as their patient.

Again, MMA wishes to express gratitude to Dr. Hull both for his dedicated participation in the stakeholder process and for his excellent summary of the PMP and rule status. 

Happy New Year and Predictions for 2017

The Maine Medical Association staff, board, and President Charles Pattavina, M.D. wish all our members and Weekly Update readers all the best for 2017.  We appreciate your interest and support and look forward to preparing another 52 issues of Maine Medicine Weekly Update (and quarterly issues of Maine Medicine) during the coming year.  If you have any new associates or staff members whom you would like to receive these publications, please contact Lisa Martin at MMA (lmartin@mainemed.com).

Before providing our predictions for 2017, here is a recap of our predictions from one year ago.  Except for failing miserably in predicting the results of three of the five voter initiated ballot questions, we did reasonably well.

1.  National elections.  While we joined most of the professional pollsters in predicting the election of a Democratic president following a "campaign distinguished by its nastiness," we did correctly predict the re-election of Republican majorities in the House and Senate in Washington.  We correctly predicted the re-elections of Maine's two congressional representatives, Chellie Pingree and Bruce Poliquin and the re-election of a House led by Democrats and a Senate led by Republicans at the State House.

2.  State elections.  We correctly predicted that Republicans would retain control of the Maine Senate and that Democrats would retain control of the Maine House in the 128th Maine Legislature.

3.  Health plan mergers.   We predicted that the Department of Justice would ultimately approve the mergers subject to conditions that would result in one of the mergers not going forward.  At this point, the litigation brought by the Justice Department against the mergers has not yet been completed.

4.  MaineCare expansion.   Regrettably, we correctly predicted that Maine would remain the only New England State that did not expand Medicaid coverage under the provisions of the Affordable Care Act.

5.  Hospital market consolidation.  We predicted that hospital mergers in Maine would continue and that one major system would merge into another.  That has not happened, although discussions continue between hospitals of potential affiliations which could lead to further consolidation.  And, MaineHealth did announce in the Fall its intention to move to a system governed by one Board of Trustees, potentially eliminating local hospital boards in the hospitals which are part of the MaineHealth system.  Eastern Maine Healthcare System has taken steps to integrate the various employed physician groups in its hospitals organizing the groups around five different regions.

6.  Further attention to opioid prescribing.  We correctly predicted the continuing focus on decreasing prescribing of opioid medication for chronic pain.  There has been a continuing decrease in the number of opioid pills prescribed in both 2015 and 2016, based upon both IMS data and PMP data.

7.  Ballot questions.   One year ago, we predicted that anticipated ballot questions on ranked choice voting and recreational use of marijuana would fail.  They both passed.  And, we predicted that the ballot question on background checks on gun sales would pass.  It failed.  So 0 for 3 on these.

8.  CMS payment reform.   We predicted that CMS alternative payment systems to traditional fee-for-service would struggle and be delayed.  Late this year, CMS administrators did significantly alter the programs and lightened the reporting obligations required to avoid the penalties.  The ability to "determine your own pace" with respect to these payment reforms was welcomed by the AMA and other national medical organizations.

9.  Riverview Psychiatric Facility.  We predicted that Governor LePage and legislative leaders would eventually agree on the need for a step-down forensic unit to reduce pressure on Riverview.  Just recently, the Governor announced that the unit would be built in Bangor on the grounds of the Dorothea Dix Psychiatric Facility. 

10.  2018 Gubernatorial election.  We predicted a year ago that candidates would start lining up for the 2018 Governor's race but that many would be reluctant to announce until Senator Susan Collins determined whether she would return to Maine to run.  That prediction still stands.

While some of the results do not qualify for a clean win, we think we averaged about 70 to 80% success.   Here we go for 2017!

1.  Legislative Session.  Despite mostly good intentions, the 1st Regular Session of the 128th Legislature becomes an extremely contentious session with the LePage Administration and the Republicans supporting budget priorities sharply differing from Democratic priorities.  How to deal with the voter passed ballot questions involving the income tax increase (Question 2), the minimum wage (Question 4), and recreational use of marijuana (Question 1) take up a great deal of time and also become contentious.  It will take all of the diplomacy available in Augusta to avoid a shut down of state government on July 1st.

2.  Health plan mergers.   The Department of Justice prevails in the federal litigation challenging the Anthem-Cigna merger and the two health plans announce plans to terminate the agreement to merge.  The Aetna-Humana merger, however, goes forward.

3.  ACA Repeal.   The Trump Administration and Republicans in Congress vote shortly after the inauguration to repeal the Affordable Care Act but to delay most of its implementation for two years in order to allow those individuals covered through the ACA to maintain coverage until the Republicans have an opportunity to enact their own version of healthcare reform.  The Republican plan will come to be seen as reform-light with elimination of any mandate to purchase health insurance (both individual and employer mandates) while relying on tax incentives and more private coverage rather than expanded public coverage through Medicaid.  Medicare will remain largely intact.

4.  DHHS Secretary.   President Trump's HHS nominee Thomas Price, M.D., is confirmed by the Senate following contentious confirmation hearings.  His appointment continues to divide physician professional organizations.

5.  Hospital finances and consolidation.  In the absence of MaineCare expansion, Maine's hospitals continue to take on more bad debt and charity care and more than half continue to operate in the red.  As a result, more hospitals move into larger systems.

6.  U.S. Senate race 2018.   Senator Angus S. King formally announces his campaign for re-election to the United States Senate.  Governor LePage continues to make statements about his interest in running against Senator King with an announcement due in January of 2018.

7.  Riverview Psychiatric Center.   Governor LePage is successful in locating a step-down forensic unit consisting of 28 beds on the grounds of the Dorothea Dix Psychiatric facility in Bangor.  He is also successful in having the facility operated by a private company contracting with DHHS.

8.  Maine's Opioid Abuse Crisis.   Maine and the nation continue to experience a high rate of overdose deaths, despite more treatment options becoming available through state and federal financial support.  The work of the Maine Opiate Collaborative continues with emphasis on prevention and treatment.

We have only 8 predictions for 2017.   Feel free to add your own and we will publish in the update next week.  Send them to EVP Gordon Smith at gsmith@mainemend.com.  And, have a very Happy New Year!

 

 


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Legislative Leaders Announce Committee Assignments

Just before the holiday weekend, the legislative leadership announced their appointments to the various committees which will begin their work in early January as the 128th Maine Legislature gets down to business. The following are the appointments that will be of most interest to physicians and other health care interests.

Westbrook Democrat Drew Gattine will serve as House Chair of the Joint Standing Committee on Appropriations & Financial Affairs.  The Committee will have jurisdiction of the state budget for the two-year period beginning July 1, 2017.  Governor LePage will present his proposed budget in January.  Because of statements the Governor has made publicly, the Governor's proposed budget is expected to include significant income tax reductions and deep cuts in state spending.  These items will undoubtedly set up a very contentious debate between the two political parties over state priorities during the last two years of the LePage Adminstration.

Replacing Rep. Gattine as House Chair of the Joint Standing Committee on Health & Human Services will be York Democrat and physician Patty Hymanson.  Rep. Hymanson was re-elected to serve a second term in November and is a reitred neurologist.  Her medical knowledge and health care background will be invaluable as this committee considers hundreds of bills during the coming two years.  The Senate Chair of the Committee will continue to be Senator Eric Brakey of Auburn, a Republican who also chaired the Committee during the 127th Legislature.  There are several new faces on the Committee including Augusta Republican Senator Roger Katz who will be serving his 4th and final term in the Senate.  Senator Katz will also be the second Republican Senator on the Appropriations Committee and will chair the Governmental Oversight Committee.  He is seen as one of the Senators most likely to work with the opposing party on significant legislative issues and in the past has sponsored legislation to expand MaineCare under the provisions of the ACA.

Returning as Chair of the Joint Standing Committee on Labor, Commerce, Research & Economic Development is Scarborough Republican Senator Amy Volk.  The House Chair will be Biddeford Democrat Ryan Fecteau.  The second Republican Senator on the Committee will be Ellsworth Republican Brian Langley who will also serve as the Chair of the Joint Standing Committee on Education & Cultural Affairs.

A full list of the committee appointments can be found here.

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From the AMA: How Physician Advocacy Shaped Health Care in 2016

The evolving health care system benefits from a strong physician voice. Here are a few ways that voice impacted health policy this year.

Making MACRA more flexible
The Medicare Access and CHIP Reauthorization Act (MACRA) repealed the flawed sustainable growth rate formula in 2015. In 2016, regulations were issued to create the new Quality Payment Program (QPP). As a result of efforts by the AMA and other organized medicine groups, physicians have a much greater opportunity for success under Medicare's physician payment system, the QPP.

In the first year of the program, physicians will not receive penalties if they simply report on one measure for one patient thanks to the addition of "Pick Your Pace." Those who choose to report more data for the year may be eligible for significant bonus payments. Physicians spoke up and the AMA pressed CMS to create a transition year that allows physicians to ease into the new program. Andy Slavitt, acting administrator of CMS, listened and, in addition to Pick Your Pace, changed much of the program in the final rule.

Reporting burdens were significantly reduced, with fewer measures required and a 90-day period rather than full-year reporting. CMS removed some challenging EHR measures, such as computerized provider order entry and clinical decision support, from the QPP. The twenty-nine percent of physicians who have a low volume of Medicare patients—fewer than 100 patients or less than $30,000 in Medicare revenue—will be exempt from penalties and reporting requirements. Small practices received specific accommodations in the final rule and will benefit from lower reporting burdens and technical assistance. And, due to AMA advocacy, the final QPP policies provide a more welcoming environment for physicians interested in APMs.

The AMA has developed a collection of tools and resources to help practices prepare for Medicare changes.

Blocking insurer mergers
Mergers between major health insurers Aetna Inc. and Humana Inc., and Anthem Inc. and Cigna Corp. were announced in July 2015. Since then, the AMA led a successful effort to convince the U.S. Justice Department and several state attorneys general to block the mergers–as well as insurance commissioners of both Missouri and California.

The foundation of this effort was the 15th edition of Competition in Insurance: A Comprehensive Study of U.S. Markets, published in September by the AMA. The study supported the argument that the two mega-mergers would exceed federal antitrust guidelines designed to preserve competition, which would also negatively affect patient access to affordable coverage and care. The study, combined with an AMA-generated physician survey and collaboration with medical associations and patient coalitions, ensured that the physician voice was heard by federal and state regulators.

Efforts to end an epidemic
Through the work of the nation's medical societies and the AMA's Task Force to Reduce Prescription Opioid Abuse, notable progress was made toward reversing the nation's opioid overdose epidemic. A Nationwide physician awareness campaign helped lead to a 10.6 percent decrease in opioid prescriptions, greater use of prescription drug monitoring programs (PDMP), increased physician education and expanded access to naloxone.

Patients will have greater access to medication assisted treatment for opioid use disorder, and hospital payments will no longer depend on patient satisfaction survey questions that promote opioid prescribing.

AMA Wire® spoke with several physicians this year on how to work with patients to prevent overdose, reduce stigma, use PDMPs and manage chronic pain.

Clearing the view on drug prices
In response to nationwide concerns about the rising cost of prescription drugs, the AMA launched a grassroots campaign, TruthinRx.org, calling on pharmaceutical companies, pharmacy benefit managers and health insurers to provide more transparency regarding costs, pricing and financial practices. The campaign is also collecting and sharing patients' stories of how rising drug costs have affected their lives and access to health care.

Covering diabetes prevention
With the release of the Medicare Physician Fee Schedule final rule, the Centers for Medicare and Medicaid Service (CMS) made a landmark decision to provide coverage for diabetes prevention programs (DPP), marking the first time that the CMS Actuary concluded that prevention services generate cost savings. With coverage, the AMA's work with physicians and health systems across the nation to prevent diabetes will see an expansion in 2018.

The AMA also established a partnership with Omada Health and Intermountain Healthcare to develop an online DPP to overcome challenges of geography and feature a social experience similar to that of an in-person program.

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ALERT: Official Communication from DHHS re: Opioid Prescribing/PMP Rules

Following is the verbatim text of a letter sent December 19th by State Health Officer Christopher Pezzullo, DO:

December 19, 2016

Dear Prescribers, Dispensers, Professional Boards and other interested parties:

Thank you for your commitment to the health of the people of Maine. As you are aware, Public Law Chapter 488, an Act to Prevent Opioid Abuse by Strengthening the Controlled Substances Prescription Monitoring Program (PMP), has been in effect since July 29, 2016.

For the past six months, the Department of Health and Human Services (Department) has been collaborating with our medical community to improve functionality of the Maine PMP and promulgate rules. The Department anticipates emergency rules being effective January 2, 2017. As part of the APA process, the new rules will receive a thorough public vetting, including a public hearing which will take place near the end of January. We encourage stakeholders to provide meaningful comments at that time so the Department may finalize a rule that is as inclusive as possible.

Additionally, the Department has been informed by multiple stakeholders of a concern regarding the short period of notice for their respective healthcare communities to fully comprehend and implement systems around the new rules. As a result of these concerns, and our desire to support Maine’s medical community in the implementation of this rule, the Department plans to allow a brief grace period regarding the enforcement penalties articulated in the law. To be clear, Chapter 488 Law is still fully in effect, however:

1. Professional boards will not be notified by the Department for non-compliance with the requirements of the Law and rules until March 1, 2017.

2. Civil penalties as outlined in Chapter 488 Law will not be enforced until October 1, 2017.

Electronic Prescribing:

Additionally, there have been questions and concerns regarding the waiver process for electronic prescribing; the Department anticipates initiating the waiver application process by April 1, 2017.

Opioid Continuing Education opportunity- please save the date:

On March 6, 2017, the Department will host an all-day conference at the Augusta Civic Center about the opioid epidemic facing Maine. The event will feature speakers from the National Safety Council and local speakers who are leaders in opioid medication practices. Attendees will be able to learn and discuss alternatives to pain management along with successful tapering options for patients already prescribed opiates. We will provide more details soon on the conference and how to register.

Please do not hesitate to contact the Department so we may collectively work together to combat the opioid challenges in Maine through enhancing the PMP and implementing PL 488 rules.

Sincerely,

Christopher J Pezzullo, DO

State Health Officer

 

“Overall, 1 of every 550 patients started on opioid therapy died of opioid-related causes a median of 2.6 years after the first opioid prescription; the proportion was as high as 1 in 32 among patients receiving doses of 200 MME or higher. We know of no other medication routinely used for a nonfatal condition that kills patients so frequently.” (The New England Journal of Medicine)  [return to top]

Board of Licensure in Medicine Moves CME Opioid Educational Requirement Back to April 19th

At its monthly meeting last week on December 13th, the Board of Licensure in Medicine, at the request of MMA, moved the effective date of the three hour CME requirement back to April 19, thus allowing licensees who took accredited education on Chapter 488 or related issues after that date to count it toward the three hour CME requirement which must be met by December 31, 2017.  At its November meeting, the Board had set the effective date as July 29th, which was the effective date of the law. April 19th is the date the Governor signed the law.  

At the Board meeting, MMA EVP Gordon Smith requested that the Board move the date back to April 19th to accommodate those physicians who had taken accredited courses between April 19th and July 29th, in order to benefit these physicians who had tried to get out in front of the law as soon as possible.  After discussion, the Board voted to do just that.

 
 
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Significant Change to DEA Registration Renewal Process 1/1/17

Through a notice on its website, the Drug Enforcement Administration (DEA) recently announced significant changes to its registration renewal process.  Effective January 1, 2017, the DEA is eliminating the informal grace period which the agency has previously allowed for registrants to renew their registrations.  Only one renewal notice will be sent to each registrant’s “mail to” address approximately 65 days prior to the expiration date; no other reminders to renew the DEA registration will be provided.  The notice also advises that online capability to renew a DEA registration after the expiration date will no longer be available, and that failure to file a renewal application by midnight EST of the expiration date will result in the “retirement” of the registrant’s DEA number.  The original DEA registration will not be reinstated.  In addition, paper renewal applications will not be accepted the day after the expiration date.  If DEA has not received the paper renewal application by the day of the expiration date, mailed in renewal applications will be returned and the registrant will have to apply for a new DEA registration.

The AMA has strongly expressed its concerns to DEA about this change in policy and the problems it could create for both patients and their physicians.  In letters sent Friday, December 9 to DEA Acting Administrator Charles Rosenberg and Louis Milione (Assistant Administrator for Diversion Control), the AMA urged DEA to reverse the change to the renewal process. 

Maine physicians should take note of this significant change  in process and act accordingly.

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PQRS and Value-based Modifier Reprieve Due to October 1st ICD-10 Update

The AMA several months ago learned that the yearly ICD-10 coding update could potentially affect successful 2016 Physician Quality Reporting System (PQRS) results and Value-based Modifier calculations.  Due to a several-year freeze of ICD-10 codes, there was a larger than normal update of new codes on October 1, 2016—three-quarters of the way through the 2016 PQRS reporting period.

The AMA has been working with the Centers for Medicare and Medicaid Services (CMS) to reach a fair resolution that would ensure physicians would not be adversely penalized in 2018 due to the 2016 PQRS measure specifications failing to incorporate the updated information.  Due to AMA advocacy, CMS will not apply the 2018 PQRS payment adjustments to any eligible professional (EP) or group practice that failed to satisfactorily report from October 1-December 31, 2016, due to the ICD-10 update.  The Value-based Modifier program will also consider EPs as successful if they met PQRS reporting requirements.

CMS also addressed EPs who were part of a Shared Savings Program ACO participant TIN in 2015 and are now reporting outside of their ACO for the secondary reporting period because their ACO failed to report on their behalf for the 2015 PQRS reporting period.  CMS will apply the same policy and EPs or group practices will not receive a penalty if their fourth quarter 2016 PQRS measure specifications were affected by the ICD-10 update.

For the 2017 quality measure specifications that are affected by the ICD-10 update, CMS will publish an addendum containing the relevant ICD-10 codes.  The addendum should be published very soon and the AMA will provide an update once the information is released by CMS.

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VA Finalizes Rule Allowing Most APRNs to Practice Independently

The Department of Veterans Affairs (VA) December 13th published a final rule that permits full practice authority for three categories Advanced Practice Registered Nurses (APRNs): Certified Nurse Practitioner (CNP), Clinical Nurse Specialist (CNS) and Certified Nurse-Midwife (CNM). The Final Rule defines "full practice authority" to mean that an APRN working within the scope of VA employment would be authorized to provide services without the clinical supervision or mandatory collaboration of a physician, regardless of state or local law restrictions on that authority.

Certified Registered Nurse Anesthetists (CRNA) were carved out of the final rule— that is, CRNAs will be excluded from full practice authority— but the VA has requested further comment on this issue. The rule also clarifies that radiology studies should not be performed and read by APRNs who are not credentialed in radiology.

The AMA discussed its concerns with giving APRNs full practice authority in meetings with VA officials and in its comment letter. The AMA emphasized that providing physician-led, coordinated, patient-centered, team-based care is the best approach to improving quality care for our nation's veterans. The AMA will monitor the implementation of this policy and will engage the VA if issues arise.

The deadline to submit comments on the CRNA exclusion is January 13, 2017.

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PMP Changeover 12/20/16--Delegates Must Re-register

Following is the verbatim text of a letter from the Maine PMP announcing the changeover to a new platform and the need for delegates to re-register:

Dear Account Holder:

As a reminder, tomorrow, December 20, 2016, the Maine Prescription Monitoring Program (PMP) will be upgrading software systems. Today, December 19, is the last day you will be able to use the existing system (https://mepdm-ph.hidinc.com/melogappl/bdmepdmqlog/pmqhome.html).

You will receive an email notification tomorrow, December 20, if your current PMP account successfully transfers to the new system. This notification will include your login information.

If you do not receive an email notification tomorrow, December 20, you will need to register in the new PMP system starting tomorrow.This will include delegates and users whose accounts are not able to be transferred to the new system. Please note that delegates will not be able to register themselves in the new system until their supervisor’s account (i.e., the account they wish to be a delegate for) has been approved by the state PMP administrator.

For more information about Maine’s new PMP system, including how to register, please see the Maine PMP AWARxE User Support Manual. For a quick guide to requesting patient reports, you may consult the Quick Reference Guide. These guides will also be posted on the Maine PMP website (http://maine.gov/pmp).Again, the new system will not be available until tomorrow, December 20.

Please note that there will be a delay in viewing prescription history from the two weeks prior to the transition in software systems. This history will be loaded in the new system within two weeks of the transition. Thank you for your patience during this time.

Starting tomorrow, December 20, you may call support directly at 1-844-4ME-4PMP (1-844-463-4767). Technical assistance is available 24 hours a day, 7 days a week, 365 days a year. Should you have any policy questions in the meantime, you may contact the Maine PMP at (207) 287-2595 or by email at SAMHS.PMP@maine.gov.

Best Regards,

Sheldon Wheeler

Director, Office of Substance Abuse and Mental Health Services

CC:

Evelyn Sharkey, PMP Coordinator

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Job Openings

Physician – Monmouth

DFD Russell Medical Centers (DFDRMC) operates three community health centers in central Maine.  We are seeking a full time Physician, for our Monmouth location.

Our three health centers serve a multicultural, rural population of about 10,000 patients and have a family practice focus serving pediatrics to geriatrics. We have excellent clinical support staff.

This position requires a high degree of flexibility, good clinical skills and commitment to team work and open lines of communication. It is a full-time at 4 days per week.

This position combines making a difference in patients' lives with a family-friendly work life, please e-mail your resume to Laurie Kane-Lewis, CEO. (Laurie.Kane-Lewis@DFDRussell.org) EEO

Requirements:  Current Maine license. Proficiency with electronic medical records.

Benefits:  Excellent benefit package: medical, dental, life, 401(k), flexible spending accounts and a generous paid time-off plan. Salary is commensurate with experience; there is also an incentive plan and a CME reimbursement.

1/16/17

FNP/NP – Monmouth

DFD Russell Medical Centers (DFDRMC) operates three community health centers in central Maine.  We are seeking a full time FNP/NP, for our Monmouth location.

Our three health centers serve a multicultural, rural population of about 10,000 patients and have a family practice focus serving pediatrics to geriatrics. We have excellent clinical support staff.

This position requires a high degree of flexibility, good clinical skills and commitment to team work and open lines of communication. It is a full-time at 4 days per week.

This position combines making a difference in patients' lives with a family-friendly work life, please fax or e-mail your resume to Laurie Kane-Lewis, CEO. (Laurie.Kane-Lewis@DFDRussell.org) EOE

Requirements:  Current Maine license. Proficiency with electronic medical records.

Benefits:  Excellent benefit package medical, dental, life, 401(k) , flexible spending accounts and a generous paid time-off plan. Salary is commensurate with experience; there is also an incentive plan and a CME reimbursement.

1/16/17

OUTPATIENT ONLY - BC/BE INTERNIST - Central Maine Medical Center

Central Maine Medical Center offers an exciting practice opportunity to a BC/BE Internist for its employed practice.  Join colleagues committed to excellence.  This office based position offers a 4 or 4 ½ day work week, outpatient only call (weekend call approximately 1:10 ) , and full EMR.    An attractive compensation and benefits package, including loan repayment and a generous sign on bonus, are enhanced by the scenic beauty and abundant outdoor adventure Maine lifestyle affords.  Combine your talent and skills with our established excellent reputation of the best physician care. Interested candidates, send CV or call: Gina Mallozzi, Central Maine Medical Center, 300 Main Street, Lewiston, Maine 04240.  Fax: 207-344-0696, E-mail: MallozGi@cmhc.org, or call: 800/445-7431.  Not a J1 opportunity.

3/13/17

NP or PA - Jackman Community Health Center

JCHC is a part of Penobscot Community Health Center which is a nationally recognized health care facility that focuses on patient-centered care, innovation and collaboration. Signing, retention, and relocation bonuses are up for grabs with this position! This site is also loan repayment eligible.

Give yourself the opportunity you deserve, by working for a healthcare facility that always puts the patient first…for you, for your family, for our community.

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

If you want to enjoy Maine, the way it should be, come and experience the simple pleasures of small town medicine while being surrounded by over 250,000 acres of woodlands. Each season offers something for everyone except a traffic light. Jackman Community Health Center is in need of a full-time NP or PA to work in their highly unique primary care and urgent care facility.

1/2/17

CMHVI IN-PATIENT CARDIOLOGY, NP or PA, Baylor Staffing Plan, Nights, Lewiston, Maine

CMHVI Cardiology, in Lewiston, Maine is seeking an experienced Nurse Practitioner or Physician Assistant, full-time Baylor Staffing Plan, 11pm – 7am, Friday, Saturday and Sunday, to work 24 hours and get paid for 36 hours! This person will perform dedicated in-patient care under the supervision of a CMHVI cardiologist.  Candidate must have (2) or more years as a hospital-based Physician Assistant/Nurse Practitioner experience and at least (1) year cardiovascular experience preferred.

CMMC is proud to offer you a competitive salary and benefit package that includes:  Substantial hiring bonus; all-inclusive relocation packages; generous loan repayment; short term and long term disability insurance; significant time off to complete CME & allowance for paid program; excellent 403B retirement/savings plan; state of the art Fitness Center and Wellness Program.

Contact Donna Lafean, lafeando@cmhc.org; FMI: http://recruitment.cmmc.org/

12/26/16

GENERAL SURGEON - Brunswick, ME

Mid Coast Medical Group is seeking a full time General Surgeon. This is a community hospital oriented job with needed skills in all core aspects of general surgery.  The surgeon will be part of a long standing 4-5 provider general surgery group. The office is conveniently located adjacent to Mid Coast Hospital. New graduates and experienced candidates are encouraged to apply.

Part of the Mid Coast–Parkview health family of services, Mid Coast Hospital offers competitive benefits and compensation package, along with an excellent work environment. Please send CV to Melanie Crowe, Physician Recruiter, at mcrowe@midcoasthealth.com or call (207) 406-7872, for more information.

1/2/17

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.

1/16/17

 

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