Maine Medicine Weekly Update - May 21, 2018
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Maine Chapter, American College of Surgeons Conclude Successful Meeting in Kennebunkport

The Maine Chapter of the American College of Surgeons met this past weekend in Kennebunkport and heard CME presentations on subjects ranging from post-surgery prescribing of opioid medication to the difficulty of maintaining general surgeons in rural Maine.

 

Dr. Jamie Loggins, outgoing President, & Dr. Amy Tan, incoming President

 

Speakers included John Weigelt, M.D., DVM, MMA, FACS, recently retired as Professor of Trauma Surgery at the Medical College of Wisconsin; Richard J. Barth, Jr., M.D., FACS, Professor of Surgery, Geisel School of Medicine at Dartmouth and Chief, Section of General Surgery, Dartmouth-Hitchcock Medical Center; Kristin L. Long, Assistant Professor of Surgery at the University of Wisconsin School of Medicine and Public Health, Sam Pakraftar, MB, Bch, BAO from MaineGeneral Medical Center; Jens Rueter, M.D., Medical Director, Maine Center Genomics Initiative, Jackson Lab, and George C. Velmahos, M.D., PhD, FACS, Chief of Trauma, Emergency Surgery & Surgical Care, Massachusetts General Hospital.

 
On Friday afternoon, Brad M. Cushing, M.D., FACS, Chief of Surgery at Maine Medical Center moderated a panel on Solutions for Rural Surgery that included James L. Clarke, M.D., FACS, from Eastern Maine Medical Center, Rodney Lahren of Northern Maine Medical Center, Samer Sbayi,M.D., MBA, FACS of Long Island, NY but formerly of Penobscot Valley Hospital in Lincoln and Dr. Weigelt.
 
During the Chapter business meeting on Sunday morning, President Jamie Loggins, M.D., FACS presented the President's gavel to Amy Tan, M.D., FACS who will lead the Chapter for the next two years.   Damien Carter, M.D., FACS was elected President-Elect.  Dr. Tan practices surgery at Blue Hill Memorial Hospital and Dr. Carter is Chief of the Burn program at Maine Medical Center.
 
Over 50 surgeons attending the meeting which was managed for the second year by the Maine Medical Association.

Trump Administration Releases Drug Pricing Blueprint

The AMA and other medical organizations are analyzing the Trump Administration's proposals in the complex federal regulatory framework in the United States.


On May 11, The Trump Administration Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs (Blueprint) was issued along with a request for information. The President framed the Blueprint as advancing four goals:

  • Reducing list prices.
  • Improving government's ability to negotiate better prices.
  • Encouraging competition through rapid entry to market of generics and biosimilars.
  • Lowering patient out-of-pocket expenses.

The Blueprint proposes a broad number of changes to prescription drug programs in several federal health care programs (Medicare, Medicaid, and other safety net programs) as well as Food and Drug Administration (FDA) policies that should impact commercial and federal health care program access to affordable prescription drugs.

While some of these proposals can be undertaken through immediate regulatory or subregulatory actions, others are still on the drawing boards at the U.S. Department of Health and Human Services and some will require congressional action to implement. Although the Blueprint proposes a select number of programmatic and design changes, there are a large number of questions for which the Administration is seeking feedback.

Based on a preliminary review, it appears that overall there will be increased access to lower-cost alternative generics. However, careful consideration by the AMA and Federation members will be needed on a number of proposed changes to the Medicare Part D prescription Drug Benefit program as well as the Part B drug reimbursement methodology.

One concern is that the proposed changes may limit patient access to medically necessary alternative brand or specialty treatments and result in additional administrative burdens on physicians and patients. Also of concern is the proposal to eliminate the requirement that Part D plans include a minimum of two drugs proven to be effective in each therapeutic category or pharmacologic class, if available.

The AMA will be preparing comments to the various proposals, but does applaud overall efforts to increase competition through a number of FDA proposals as well as proposed bans on gag clauses and ensuring a substantial portion of rebates are received by Medicare beneficiaries at the point-of-sale. 

 

Maine's is Named One of the Best Medical Examiner Offices in the Country

The National Association of Medical Examiners granted Maine's Office of Chief Medical Examiner (OCME) full accreditation, citing it as "one of the best Medical Examiner Offices in the country."

 

"The accreditation and accolades by the national association is an extraordinary acknowledgment and validation of the good work and team effort put in by Dr. Flomenbaum and the OCME staff," said Janet T. Mills, Attorney General. "Their hard work providing closure to families ensures that we get it right when investigating and understanding unexplained deaths. This is not easy work-and I commend their commitment and dedication."

During its accreditation report, the office was specifically cited for having a "a staff that is enthusiastic and committed to high professional standards and completing high quality reports furnished with exemplary speed and accuracy". The Medical Examiner Office received full accreditation for the maximum of five years.

The twelve person office is led by Mark Flomenbaum, M.D., PhD, who was appointed by Governor Paul LePage in August 2014 after serving as Deputy Chief under the direction of Dr. Margaret Greenwald.

"I am so proud to work alongside a team of such dedicated, talented, and focused individuals," said Dr. Flomenbaum. "Each step of the way, our staff meet opportunities and challenges with enthusiasm and vigor to raise and exceed our work standards. They are consummate professionals who deliver the highest quality of service with the sensitivity and dignity that all Mainers deserve. I am so glad that we have been acknowledged for this on a national level."

Under Dr. Flomenbaum's leadership, the OCME has: Reduced the backlog of cases from multiple hundreds to zero. Reduced turnaround time for case completion from 4-5 months to less than 3-4 weeks. Upgraded and improved mortuary equipment to increase efficiency and protect health of staff. Created new position to manage and track data for demographic, statistical, and other forensic purposes. Received acclaim from federal agencies that Maine was number one in speed and thoroughness out of 34 national medical examiner jurisdictions participating in research collecting data on drug abuse and violent deaths.

The Office of Chief Medical Examiner is a statewide system that is charged with the investigation of sudden, unexpected and violent deaths. OCME investigations determine cause and manner of death and when necessary, perform autopsies to assist in that determination. Over 3,000 deaths are reported to the OCME each year.

Dr. Flomenbaum added, "This is a team effort-not just with the central office staff in Augusta, but also with the dozens of physicians around our state who volunteer their time and expertise and are a crucial part of the success of our mission."

Urge Patients to Confirm Mailing Address for New Medicare Card

CMS is in the process of sending new Medicare cards to beneficiaries in phases by geographic region.

 

The Centers for Medicare & Medicaid Services (CMS) is in the process of mailing new Medicare cards to beneficiaries. The cards are being sent in phases by geographic location, but some mailings may be slightly delayed so that CMS can ensure all cards are sent to the correct address.

Practices should continue to remind their patients about the new Medicare card and encourage them to ensure that their address is up to date with Medicare by contacting the Social Security Administration. These tear-off sheets, available in English and Spanish, can be used to remind them to check their addresses. More information is available on the AMA's New Medicare Card page and the CMS New Medicare Card website

Pain Specialists Report Significant Barriers to Care

See a summary of a survey conducted recently by the American Board of Pain Medicine (ABPM).

 

A new survey of pain medicine specialists found that policies enacted by states, health insurers, pharmacy benefit managers and worker compensation programs are causing patients to go into withdrawal, experience anxiety, depression and increased pain.

The survey was conducted by the American Board of Pain Medicine (ABPM) to help identify how the nation's opioid epidemic is affecting patients with pain and the pain medicine specialists who treat them.
The survey found:

  • 83 percent of pain medicine specialists said that they—or their patients—have been required to reduce the quantity or dose of medication they have prescribed;
  • 93 percent of pain medicine specialists said that they have been required to submit a prior authorization for non-opioid pain care—with the physicians and their staff spending hours per day on such requests.
  • 68 percent of pain medicine specialists said that they have had to hire additional staff to handle the prior authorization requirements.

"Prior authorization in some cases may be understandable to help ensure coverage benefits or coordinate complex care, but when it is used almost universally like this, it seems that the real purpose is to discourage physicians and patients from seeking non-opioid pain care," said ABPM President Mitchell J. Cohen, MD.

Respondents to the survey listed a wide range of non-opioid therapies that have been subject to prior authorization, including:

  • Physical therapy limits, psychiatric services, occupational therapy.
  • Pain creams and patches (e.g., lidocaine, Lidoderm, Voltaren, topical NSAIDs).
  • Non-opioid prescription medications (e.g., Cymbalta, Lyrica, Celebrex).
  • Non-opioid pain treatments (e.g., TENS, facet blocks, spinal cord stimulators, epidural injections).

For more information about the survey, contact Mike Slawny, executive director of ABPM at mike.slawny@abpm.org.

 

Medicaid Waivers: Work Requirement OK'd in N.H.; Lifetime Limits Denied in Kansas

Maine has an application for a similar waiver pending before CMS.

 

On May 7, New Hampshire became the fourth state approved to implement a work requirement for certain Medicaid beneficiaries. The AMA opposes work requirements as a condition of Medicaid eligibility. As of Jan. 1, 2019, New Hampshire will require adult, non-elderly, non-disabled Medicaid beneficiaries to participate in 100 hours per month of "community engagement activities" such as employment, education, job skills training or community service.

Certain individuals, such as those who are pregnant, medically frail, or caring for a young child, are exempt. The work requirement was a key condition for state legislators who reauthorized the state's Medicaid expansion program this year.

Kansas also requested federal approval to impose a work requirement on certain Medicaid beneficiaries and additionally proposed to limit lifetime coverage eligibility to 36 months even if those work requirements were met.

On May 7, CMS notified the state that it would deny the state's request to impose a 36 month lifetime limit on Medicaid benefits. CMS did not render a decision on work requirements without a lifetime limit. Kansas has not expanded Medicaid under the ACA, and, to date, CMS has only approved work requirements in Medicaid expansion states (Arkansas, Kentucky, Indiana and New Hampshire). 

Nominations Sought for Mary Cushman, MD Award

The Mary F. Cushman, MD Award is presented by the MMA each year to recognize the humanitarian service of Maine medical volunteers.

 

The Maine Medical Association presents the Mary F. Cushman, MD Award each year to recognize the humanitarian service of Maine medical volunteers who serve many hours - in Maine, throughout the United States, or abroad - to help the less fortunate of humanity.  The award is announced at the Association’s Annual Session in September.

Priority consideration is given to:

  • the nomination of a Maine physician who is a member of the Maine Medical Association.
  • nominations submitted by members of the Maine Medical Association.
  • nominations that, for international volunteering, include training people in other countries to provide care in their own communities.

Nominations for the 2018 award are due by August 1, 2018 and should describe the volunteer’s activities and contributions to the profession.  The nomination form is available at http://www.mainemed.com/annual-session.

 

Int’l Mediterranean Diet Month: Making the Case for a Healthy Diet as a Tool for Diabetes Prevention

Your patients have been made well aware through such things as social media, family, friends and marketing that a healthy diet can contribute to significant improvements in health. Several studies have also revealed that healthy diets can not only prevent type 2 diabetes, but can also improve cholesterol levels, reduce hypertension and decrease heart disease. 

 

Your patients have been made well aware through such things as social media, family, friends and marketing that a healthy diet can contribute to significant improvements in health. Several studies have also revealed that healthy diets can not only prevent type 2 diabetes, but can also improve cholesterol levels, reduce hypertension and decrease heart disease.  

Yet the statistics indicate there’s still a disconnect for patients. More than 84 million U.S. people have prediabetes—that’s 1 in 3 adults—and 9 out of 10 people don’t know they have the condition, according to the Centers for Disease Control and Prevention (CDC).

This May, International Mediterranean Diet Month, presents an opportunity to educate patients on the benefits of a healthy diet and how it can help reduce their risk for type 2 diabetes and other chronic disease.

Benefits of a Mediterranean Diet

The Mediterranean diet is a healthy approach to eating that people from countries around the Mediterranean practice. Key elements of the Mediterranean diet highlight eating mostly plant-based foods which include:

  • Fruits
  • Veggies
  • Nuts
  • Legumes
  • Whole grains

The diet does not limit fat consumption but instead encourages making better decisions when choosing what types of fats to eat. It does emphasize monounsaturated and polyunsaturated fats. Healthy fats such as olive oil, for example are substituted for butter. Herbs and spices, which can promote health, replace salt as seasoning. The Mediterranean diet also encourages limiting red meat consumption to a few times a month, while eating fish and poultry twice weekly, drinking red wine in moderation and incorporating regular exercise.

Following a Mediterranean diet has been found to reduce heart attacks, strokes, and certain types of cancers. It can also lower LDL cholesterol, and may help in the prevention of other chronic diseases such as type 2 diabetes.

Even if patients don’t practice the Mediterranean diet, a diet that incorporates more plant-based foods can prove beneficial.

Offering tips for nutrition

To help patients understand the positive impact that lifestyle changes such as eating more fruits and vegetables can have on their health, especially in the prevention of type 2 diabetes, it’s important that they be aware of their risk for prediabetes.

Screening your patients with the online prediabetes risk test allows you to perform additional blood tests and then refer your patients to a National Diabetes Prevention (DPP) lifestyle change program in their community or online. DPPs have been proven to empower patients to make lifestyle changes that become habits, including dietary improvements and increased physical activity in support of their health.

You can also start the conversation around healthy eating with the help of an online CME nutrition course offered by the American Medical Association in partnership with the Gaples Institute for Integrative Cardiology. The course will arm you with the information you need to talk with your patients about their nutrition needs.

 

Update Will Change Buprenorphine MME Display in Most State PMPs

The AMA and American Society of Addiction Medicine (ASAM) worked with Appriss Health, the developer of more than 40 state PDMP platforms, to ensure that buprenorphine for the treatment of opioid-use disorder has been removed from all displayed morphine milligram equivalent (MME) calculations throughout its system.  

 

Appriss Health reported that it deployed a full system update on April 11, 2018, that clearly separates buprenorphine from opioids that are used for the treatment of chronic pain. The company also strengthened guidance to exclude medications used for medication-assisted treatment from Centers for for Disease Control and Prevent-recommended MME limits (i.e. 90 MME per day).  

New Interactive Online Course Ups Physicians’ Nutrition Knowledge, Supports Patients in Diabetes Prevention

An important part of preventing type 2 diabetes is lifestyle changes. Research conducted by the Centers for Disease Control and Prevention (CDC) revealed that people with prediabetes can reduce their risk of developing type 2 diabetes by nearly 60 percent when they participate in a structured lifestyle change program.

 

An important part of preventing type 2 diabetes is lifestyle changes. Research conducted by the Centers for Disease Control and Prevention (CDC) revealed that people with prediabetes can reduce their risk of developing type 2 diabetes by nearly 60 percent when they participate in a structured lifestyle change program.

"Early risk detection and educational interventions for diabetes have tremendous potential for engaging people more meaningfully in their own wellness and for reducing the risk of developing diabetes and all of its complications and costs," said Noah Nesin, MD, Vice President of Medical Affairs at Penobscot Community Health Care, and Physician Champion for MMA's diabetes prevention efforts.

Part of lifestyle changes include learning how to eat properly to maintain a healthy weight, which is often a contributing factor for type 2 diabetes. In fact, the CDC study found that people could lose between 5 percent and 7 percent of body weight through healthier eating. However, learning how to eat properly isn’t always intuitive and requires education about nutrition.

Most patients usually look to their physicians for help as a starting point. Unfortunately, many physicians may simply not be armed with enough education and training on nutrition to provide sufficient education. In turn, this makes trying to help patients challenging.

Although patients can work with health coaches and be referred out to a CDC-recognized diabetes prevention program (DPP) to help improve eating habits, physicians now have access to nutrition tools as well. A new self-paced online course on nutrition helps physicians begin the conversation with patients at risk for chronic disease such as type 2 diabetes and hypertension.

Nutrition training through modules

Research reveals that medical schools provide less than 20 hours of nutrition training, and very little continuing medical education (CME) that’s relevant is offered. To fill in the gap, the American Medical Association partnered with the Gaples Institute for Integrative Cardiology to develop a three-hour interactive course called Nutrition Science for Health and Longevity: What Every Physician Needs to Know.

The course provides evidence-based information, encourages a team approach and offers tools necessary to make referrals to nutrition professionals. Broken up into four modules of 45 minutes each, the course addresses the following topics:

  • Module 1: Why does nutrition matter to your patients?
  • Module 2: Dietary fats and patient health
  • Module 3: Helping your patients understand carbohydrates and protein
  • Module 4: Making nutrition counseling work in a busy practice

The first three modules address core nutrition concepts while the fourth module offers practical tools for implementation and then uses realistic patient scenarios to test your knowledge and provide customized feedback. Links to the original studies are also provided, which allows you to dig deeper in the materials, and all the modules offer a printable summary sheet of each module to help you put the education into practice.

Upon completion of the course, physicians earn three hours of AMA PRA Category 1 credit.

Additional tools to support patients

Screening tools can help you identify your patients who have prediabetes. Once you’ve identified these patients, you can begin the conversation on nutrition with them and help refer them to a DPP to get the necessary support they need to make lifestyle changes.

Some tools physicians may find useful include:

Most chronic diseases can in part be prevented by eating a healthy diet. In fact, the No. 1 contributing factor to premature death and disability in the United States is poor nutrition. Equip yourself with the knowledge and tools you need to meet this challenge head on and partner with patients on chronic disease prevention.


 

Legislative Report: Primary Elections June 12th

Primary elections in Maine will be held June 12, 2018. On the 13th we should know who will be the major party candidates for various political offices. Click through to find out which health-related vetoes were overridden and which sustained.

 

 

There were no new developments on the Legislative front this week. 

Vetoes Overridden (Requires 101 votes in House and 23 votes in Senate):

LD 166: An Act to Increase Reimbursement for Child Care Services (31-3, 119-29)

LD 1187: An Act to Amend the Child Protective Services Statutes (34-0, 144-3)

LD 1388: An Act to Prohibit the Falsification of Medical Records (34-0, 148-0)

LD 1719: An Act to Implement a Regulatory Structure for Adult Use Marijuana (28-6, 109-39)

LD 1740: An Act Regarding Criminal Forced Labor, Aggravated Criminal Forced Labor, Sex Trafficking and Human Trafficking (34-0, 136-12)

LD 1771: An Act to Stabilize Vulnerable Families (34-0, 148-0)

LD 1874: Resolve, to Ensure the Continued Provision of Services to Maine Children and Families (34-0, 141-7)

LD 1892: An Act to Clarify the Prescribing and Dispensing of Naloxone Hydrochloride by Pharmacists (34-0, 132-16)

Vetoes Sustained:

LD 1063: Resolve, to Reduce the Number of Substance-exposed Infants (80-68)

LD 1587: Resolve, to Study the Feasibility of the Establishment of Paid Family Leave in the State (80-68)

LD 1866: An Act to Increase Youth Mental Health Awareness in Schools (82-66)

 

    Monday, May 21 in Brewer: Next Steps in Addressing Maine's Opioid Crisis

     3-hour presentation from 5-8:30 pm at Jeff's Catering in Brewer.

     

    Register Now   This 3-hour education session will feature an update on Maine opioid prescribing laws and rules as well as clinical content with a compassionate, patient-centered perspective.  The topics covered at this session will be:

    • Opioid Use Disorder and Medication Assisted Recovery: Caring for Our Communities
    • Alternative Treatments for Chronic Pain
    • Recent Legal Changes Affecting Opioid Prescribing in Maine
    This MICIS presentation activity qualifies for a maximum of 3 CME credits of the 3 CME credit requirement for opioid medication education found in P.L.2015, Chapter 488, Maine's recent legislation to address the opioid drug crisis.
     
    Presenters: Elisabeth Fowlie Mock, MD, MPH and Peter Michaud, JD, RN
     
    Monday, May 21, 2018 from 5:00 - 8:30 pm
    Jeff's Catering, 15 Littlefield Road, Brewer
     
    Check in begins at 4:30pm
    FREE - advanced registration is required
    Light snacks will be provided
    For More Information and To Register
     
    The Maine Independent Clinical Information Service (MICIS) is a program of the Maine Medical Association.
     
    The Maine Medical Education Trust designates this live activity for a maximum of 3 AMA PRA Category 1 Credit(s).TM  Physicians should only claim credit commensurate with the extent of their participation in the activity.  
     
    This activity has been planned and implemented in accordance with the Essentials and Standards of the Maine Medical Association Committee on Continuing Medical Education and Accreditation through the partnership of Maine Medical Education Trust and the Maine Independent Clinical Information Service (MICIS).  The Maine Medical Education Trust is accredited by the Maine Medical Association's Commitee on Continuing Medical Education to provide CME activities for physicians.
     
     

    Inspiring Hope: How to Support Recovery Ready Communities - May 24 Conference

    8am-3pm at the Hilton Garden Inn, Bangor.

     

    Young People In Recovery - Brewer is grateful to be presenting their first ever YPR-Maine Statewide Conference, aimed at embracing change, inspiring hope and removing stigma.

    Registration and Event Information

    Thursday, May 24, 2018   8:00 am-3:00 pm

    Hilton Garden Inn, 250 Haskell Road, Bangor ME

    This event is sponsored in part by the Maine Health Access Foundation, Bangor Area Recovery Network, the United Way of Eastern Maine, and Penobscot Community Health Center.

    One River, One Ocean: June 2-14, 2018

    River Awareness fundraiser on the Androscoggin River.

     

     

    One River, One Ocean: June 2-14, 2018

    Androscoggin River Awareness Journey and Fundraiser

    A River Awareness Journey down the Androscoggin, from Errol, NH to Topsham, ME

    One River~One Ocean

    When:  Saturday, June 2, 8am – Thursday, June 14, 6pm

    Where: Androscoggin River

    One woman’s river awareness journey down the Androscoggin~~~

    I am a Registered Maine Guide, retreat leader  and founder of Nurture Through Nature Retreat Center,  in Denmark, Maine, interested in bringing a voice to the Androscoggin River, its history, heritage and evolution in our culture. My intention is increase awareness about water quality and raise money for an environmental non-profit organization that includes in its mission and vision water and natural resource protection. I grew up on this river and have a deep appreciation for it. I am grateful to be in collaboration with MaineRIvers.Org whose mission is to protect, restore and enhance the ecological health of Maine’s river systems.

    I will be paddling its length and sharing what is discovered along the way.

    Please join me for the culminating celebration, where this majestic river meets the sea,  at the Sea Dog Brewing Company, 1 Bowdoin Mill Island #100, Topsham, ME on June 14, 4-6pm. Special thanks to Sea Dog Brewing for donating the space for this event.

    HPV Summit in Brewer June 7th

    Join the Maine Primary Care Association in collaboration with the American Cancer Society and the Area Health Education Centers during this year’s summit to support an HPV Cancer-Free Maine.

     

    During this event, participants will hear from Dr. Katherine Hsu, MD, a pediatric infectious disease specialist involved in STD prevention and treatment with adolescents. Dr. Hsu will start the day by discussing HPV prevention and the hesitancy around vaccinating. Participants will also hear directly from Anne Graham, MSN, RN, CPNP, from ACS, with direct service advice, followed by a panel of cancer survivors.

    We hope you will join us to network with your colleagues and to better understand the latest vaccination guidelines and strategies for communicating the importance of vaccination for prevention. 

    Note: Registration fee is $20; CMEs are being offered  

    Target Audience: Clinical leaders and providers, Quality improvement professionals, healthcare organization administration

     For more information, please contact Greta Doe: gdoe@mepca.org or 621-0677 x201

    Wednesday, June 13 in Augusta: Next Steps in Addressing Maine's Opioid Crisis

    3-hour presentation from 5-8:30 pm at the Augusta Civic Center.

     

    Register Here This 3-hour education session will feature an update on Maine opioid prescribing laws and rules as well as clinical content with a compassionate, patient-centered perspective.  The topics covered at this session will be:

    • Opioid Use Disorder and Medication Assisted Recovery: Caring for Our Communities
    • Alternative Treatments for Chronic Pain
    • Recent Legal Changes Affecting Opioid Prescribing in Maine
    This MICIS presentation activity qualifies for a maximum of 3 CME credits of the 3 CME credit requirement for opioid medication education found in P.L.2015, Chapter 488, and the similar requirement in the recent amendments to Chapter 1 of the Rules of the Board of Licensure in Medicine.
     
    Presenters: Elisabeth Fowlie Mock, MD, MPH and Gordon Smith, Esq.
     
    Monday, May 21, 2018 from 5:00 - 8:30 pm
    Augusta Civic Center, Augusta
     
    Check in begins at 4:30pm
    FREE - advanced registration is required
    Light snacks will be provided
    For More Information and To Register
     
    The Maine Independent Clinical Information Service (MICIS) is a program of the Maine Medical Association.
     
    The Maine Medical Education Trust designates this live activity for a maximum of 3 AMA PRA Category 1 Credit(s).TM  Physicians should only claim credit commensurate with the extent of their participation in the activity.  
     
    This activity has been planned and implemented in accordance with the Essentials and Standards of the Maine Medical Association Committee on Continuing Medical Education and Accreditation through the partnership of Maine Medical Education Trust and the Maine Independent Clinical Information Service (MICIS).  The Maine Medical Education Trust is accredited by the Maine Medical Association's Commitee on Continuing Medical Education to provide CME activities for physicians.
     

    X Waiver Course in Waterville June 16th

    AAAP’s “Half and Half” course with Dr. Richard Fein is a free American Academy of Addiction Psychiatry program that combines 4.25 hours of face-to-face/in-class instruction and 3.75 hours of online training.

     

    Office-Based Treatment of Opioid Dependence Course
     
    FOR: All physicians, NPs, PAs, MAs, other medical office staff
    DATE: Saturday, June 16, 2018
    LOCATION: MaineGeneral Thayer Center for Health, Dean Auditorium 149 North Street, Waterville, ME 
     
    Those wishing to qualify for a waiver to prescribe buprenorphine (Suboxone, Subutex) must complete both components of this program.
     
    Training will focus on clinical vignettes to help participants think through “real life” experiences in opioid dependence treatment. The online modules provide a background on the treatment of opioid dependence and substance use disorders. This program has been approved for a maximum of 8 AMA PRA Category 1 CMEs. Note that NPs/PAs can take this 8 hour waiver training and it will count towards their waiver application.
     
    To register or for more information email shane.gallagher@mainegeneral.org Body text here.

    MCMI Training Programs - Level 1 and Level 2 - June 22

    The Maine Concussion Management Initiative (MCMI) will to holding a training program on June 22 in Waterville at Colby College. It is appropriate for athletic administrators/directors, school nurses, coaches, athletic trainers, physicians, nurse practitioners, and physician assistants.

    The Maine Concussion Management Initiative (MCMI) will to holding a training program on June 22 in Waterville at Colby College. It is appropriate for athletic administrators/directors, school nurses, coaches, athletic trainers, physicians, nurse practitioners, and physician assistants.

    MCMI Training Programs – Level 1 and Level 2

    When and where held:

    June 22, 2018 in Waterville at Colby College (Level 1 in the morning and Level 2 in the afternoon)

                                  Class size limited to 40.

    October 16, 2018 in Portland at the Double Tree by Hilton Hotel in conjunction with the Brain                       Injury Association of America-Maine Annual Conference

                                  Class size limited to 30

                                  (Level 1 in the morning and Level 2 in the afternoon)

                                  (Registration and fees will be through the BIAA-Maine for October 2017)

    Training Programs:

                   Level 1 – An Introduction to Concussions and Concussion Management

                                  Speaker: Deb Nichols, CPNP and/or Peter Sedgwick, MD and/or Jaclyn Tourtelotte, ATC

                                  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 Berlin 2016

                                                   Concussion Assessment Tools  

                                                   Using ImPACT Testing in Concussion Management

                                                   Interpreting ImPACT Test Results

                                                   Concussion Case Reviews

    Schedule:

                   June 22 – Level 1:

                                                 7:45am – 8:00am             Registration

                                                 8:00am – noon                 Training Program

                                    Level 2:

                                                 12:45pm – 4:00pm          Training Program

                                                                              

    CME:   Level 1 – 3.5 hours            Level 2 – 3.0 hours

                  

    CEU:    Level 1 – 3.5 hours            Level 2 – 3.0 hours

    Registration Fee for June 22:     

                   $100 for Health Care Professionals taking Level 1 or Level 2

                                  (MD, DO, NP, PA, Neuropsychologist, RN, PT, OT, SLP)

                   $175 for Health Care Professionals taking Level 1 and Level 2

                   $40 for school personnel and all other attendees taking Level 1 or Level 2                                        (Athletic trainer, school nurses, coaches, athletic directors and administrators, parents)

                   $70 for school personnel taking Level 1 and Level 2

                   $20 for students currently enrolled in a college program taking Level 1

                   $35 for students taking Level 1 and Level 2

    Registration Confirmation will be sent by email.

    Refund / Cancellation Policy: If you need to cancel contact Jan Salis, PT, ATC. You can choose to apply your registration fee to another training program or have a 100% return no matter when you cancel – before, day of or after.

    For more information contact:

                   Jan Salis, PT, ATC

                   MCMI - Membership and Education Committee - Chair

                   jsalis@aol.com

                   (207) 577-2018

    NATA CEU Statement of Credit – June 22, 2018 – Level 1 and Level 2

    MATA is recognized by the Board of Certification, Inc. to offer continuing education for Certified Athletic Trainers.  This program offers 6.5 CEUs. The MATA BOC Approved Provider Number: P325 

    AMA Designation Statement – June 22, 2018 – Level 1 and Level 2

    MaineGeneral Medical Center is accredited by the Maine Medical Association’s Committee on Continuing Medical Education to provide continuing medical education (CME) to physicians.  MaineGeneral Medical Center designates this live activity for a maximum of 6.5 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity. 

    Joint Providership – June 22, 2018

    This activity has been planned and implemented in accordance with the Essentials and Standards of the Maine Medical Association Committee on Continuing Medical Education and Accreditation through the joint providership of MaineGeneral Medical Center and the Maine Concussion Management Initiative. Maine General Medical Center is accredited by the Maine Medical Association’s Committee on Continuing Medical Education to provide continuing medical education (CME) to physicians. 

    REGISTRATION:

    Registration can be done online at: https://mcmi-colby.org  Payment still needs to be mailed.

    Checks can be made out to “Colby College-MCMI”. Note on check for “MCMI Conference Registration”

    Send check and completed registration form to:

                   Jan Salis, PT, ATC

                   MCMI

                   4 Cassie Lane

                   Poland, ME 04274

    If you need more information: contact Jan Salis, PT, ATC, at jsalis@aol.com or 207-577-2018

     

    New Free CME on Alzheimer's Risk, Detection, and Management

    Discussing memory concerns with your patients can be difficult. Alzheimer's and other dementias are complex, and patients often have many questions and concerns.

     

    To help you prepare for these visits, the Alzheimer's Association® presents Challenging Conversations About Dementia. In this free course, you'll receive information to confidently approach the detection, diagnostic and care-planning process for your patients with cognitive impairment and dementia.

    For more information and to complete this course, go to www.alz.org/FreeCME. Other tools on the website include the Cognitive Impairment Toolkit.

    Peer Navigation Program from Facing Our Risk of Cancer Empowered (FORCE)

    Free program for those affected by hereditary breast and ovarian cancers.

    The mission of Facing Our Risk of Cancer Empowered (FORCE) is to improve the lives of individuals and families affected by hereditary breast, ovarian, and related cancers.

    The FORCE Peer Navigation Program helps match people facing hereditary cancer with support and resources.  This free program connects cancer survivors, people at high risk and their caregivers to support and resources personalized for them.

    For more information visit the FORCE website at http://www.facingourrisk.org

    Online Learning Opportunities Offering CME Credits - from the Northern New England Practice Transformation Network

    Take Advantage of Online Learning Opportunities Offering CME Credits - Available 24/7 now from the Northern New England Practice Transformation Network (NNE-PTN).

     

    Take Advantage of Online Learning Opportunities Offering CME Credits - Available 24/7 now from the Northern New England Practice Transformation Network (NNE-PTN)

    The Northern New England Practice Transformation Network, led by Maine Quality Counts in collaboration with the Citizens Health Initiative at the University of New Hampshire's Institute for Health Policy and Practice, and Vermont Program for Quality in Healthcare, Inc., is funded through the Centers for Medicare and Medicaid Services' Transforming Clinical Practice Initiative to provide technical assistance to support you, your practice, and your consumers in the transition to value-based payment. The QC Learning Lab has been designed to support health care practitioners and professionals, and practice teams with a wide range of continuing education offers including online courses, webinars, and learning sessions.

    Topics include:

    • Improving Patient Outcomes with Cost of Care Conversation in the Clinical Practice
    • How to Transform Practice Finances for Success with Advanced Payment Models
    • Seamless Care
    • Get a Grip on Change
    Click here to register for these no cost online learning opportunities, available 24/7 at your convenience.
     
    This project is supported by FONCMS-1L1-15-003 from the U.S. Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the author and do not necessarily represent the official views of HHS or any of its agencies or the Maine Medical Association.

    Northern New England Society of Addiction Medicine 2018 Annual Conference & Meeting - Nov 2-3

    Save the date for the NNESAM 2018 Annual Conference taking place at the Trapp Family Lodge in Stowe Vermont November 2 & 3, 2018.

    SAVE THE DATE

    Northern New England Society

    of Addiction Medicine

    2018

    Annual Conference & Meeting

    November 2 & 3, 2018

    (Friday evening, all day Saturday)

    Conference registration forms will be available later

    Trapp Family Lodge

    Stowe, Vermont

    www.trappfamily.com – please contact the Lodge for reservations

    Conference rate:  $187, rate available for 11/4 and 11/5

    Please request conference rate for NNESAM

     

    Behavioral Health Consultant

    Sacopee Valley Health Center is seeking a full time LCSW/LCPC to join our Medical Team as a Behavioral Health Consultant.

    Sacopee Valley Health Center is seeking a full time LCSW/LCPC to join our Medical Team as a Behavioral Health Consultant. This position involves working with patients in a busy integrated primary care setting to more effectively manage the behavioral aspects of their physical/mental illnesses and/or chronic medical conditions. The individual holding this position needs to possess a high degree of flexibility and consultative/collaborative skills, while providing short, solution-focused assessments & intervention to a general patient population. 

    Applicant must possess a valid State of Maine licensed or be license eligible. Experience in a health care setting is preferred.

    Send resume to lwatson@svhc.org or mail to:

    Director of operations, Sacopee Valley Health Center, 70 Main Street, Porter, ME 04068

    Sacopee Valley Health Center is an equal opportunity provider and employer organization.

    6/18/18

    Internal Medicine Outpatient Physician Opportunity

    Western Maine Primary Care is seeking a BC/BE Internist for their well-established outpatient practice located in the Norway, Maine. 

    Western Maine Primary Care is seeking a BC/BE Internist for their well-established outpatient practice located in the Norway, Maine.  Experience the warmth of a small town combined with a medical community working closely with colleagues throughout the MaineHealth system to ensure the healthcare needs of patients are delivered with the highest level of quality.

    Come be a part of our dynamic team of providers, which includes seven internal medicine physicians and five nurse practitioners, working with exceptional support staff.

    Stephens Memorial Hospital is a 25-bed critical access hospital. The position involves teaching and mentoring residents and medical students from the Maine Medical Center-Tufts University School of Medicine Medical School Program.

    Norway is a scenic affordable community in the heart of a four-season recreational area. Surrounded by more than ten lakes and ponds, Norway is a haven for boating, swimming, and fishing. The nearby mountains provide hiking with vista views of Mount Washington and the Presidential Range.

    Competitive salary and benefits, including student loan repayment. FMI contact Abbie Graiver, Director of Physician Recruitment (207) 744-6049 or graiverab@wmhcc.org.

    6/4/18

    Ob/Gyn Physician Opportunity

    Western Maine OB/GYN is currently seeking a BC/BE OB/GYN physician to join our exceptional team of providers.

    Western Maine OB/GYN is currently seeking a BC/BE OB/GYN physician to join our exceptional team of providers. Come be a part of our dynamic team, which includes board-certified physicians and a nurse practitioner, working with exceptional support staff. Now is a great time to join our team as we are currently relocating our practice to our brand new, state-of-the-art suite in the fall of 2018.

    Stephens Memorial Hospital is a 25-bed critical access hospital. The position involves teaching medical students from the Maine Medical Center-Tufts University School of Medicine Medical School Program.

    Norway is a scenic affordable community in the heart of a four-season recreational area. Surrounded by more than ten lakes and ponds, Norway is a haven for boating, swimming, and fishing. The nearby mountains provide hiking with vista views of Mount Washington and the Presidential Range.

    This position is a four day a week position, weekday call 1:3 and weekend call 1:4. Competitive salary and benefits, including student loan repayment. FMI contact Abbie Graiver, Director of Physician Recruitment (207) 744-6049 or graiverab@wmhcc.org.

    6/4/18

    Outpatient Internal Medicine Physician – Bangor, Maine

    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.

    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. We also offer a relocation bonus and sign-on bonus in addition to our generous educational loan repayment program.

    Candidates in need of J-1 visa waivers welcome to apply.

    For confidential consideration, please contact:

    Amanda Klausing, AASPR, Physician Recruiter

    Eastern Maine Medical Center

    Phone: 207-973-5358

    ProviderJobs@emhs.org

     7/2/18


    Family Practice Physician - Bucksport Regional Health Center

    Bucksport Regional Health Center, a Federally Qualified Health Center (FQHC) has a unique opportunity in our small independent, community-based primary care facility offering great quality indicators, team atmosphere and excellent working conditions. 

    Bucksport Regional Health Center, a Federally Qualified Health Center (FQHC) has a unique opportunity in our small independent, community-based primary care facility offering great quality indicators, team atmosphere and excellent working conditions.  Located along the Penobscot River, we are centrally located along the beautiful coast of Maine, close to Acadia National Park and Bangor.

    This is a full scope of outpatient primary care services commensurate with his/her field of training and State of ME licensure.  Offers care to a diverse age population.  Optional 4/5 days/week schedule. 

    Candidates must have graduated from an accredited medical school & completed Family Practice or Med/Peds residencySheila, have a current State of Maine Medical License and D.E.A. Certificate and at least 5 years of experience in the practice of family or internal medicine.  Submit resume and cover letter to: Danel Adams, Human Resources, 110 Broadway, Bucksport, ME  04416,  email dadams@brhcme.org

    5/14/18

    Relocate to Beautiful Southwestern Maine - Medical Director/Family Practice Physician

    Sacopee Valley Health Center has a position available for a Medical Director/Family Practice Physician for our multi-service, progressive, rural federally qualified community health center located in a medically underserved area.

    Sacopee Valley Health Center has a position available for a Medical Director/Family Practice Physician for our multi-service, progressive, rural federally qualified community health center located in a medically underserved area. This position allows for the medical director to apply leadership skills while partnering with health center staff and colleagues to provide optimal health care for our patients on a daily basis. Services on site include integrated primary care, dental services, family planning, mental health counseling, psychiatry, nutritionist, optometry, podiatry, social services support, sliding fee coverage, care management, radiology and lab services. NextGen EMR. Practice is outpatient only with no OB. On-call rotation is 4-5 times per month. NCQA Level III PCMH. Competitive salary and benefits package; physicians are eligible to apply for NHSC loan repayment. We are located in Porter, ME, between Portland and the White Mountains. Area is known for terrific four season recreational activities. Just two and one-half hours from Boston. Submit CV to: Linda Watson, Director of Operations or, (lwatson@svhc.org), Sacopee Valley Health Center, 70 Main Street, Porter, ME 04068. EOE. www.svhc.org Sacopee Valley Health Center is an equal opportunity provider and employer.

    7/2/18

    Psychiatry Faculty, Division of Child & Adolescent Psychiatry

    Maine Medical Center (MMC) is seeking a BC/BE part/full-time Child & Adolescent Psychiatrist clinician-educator or clinician-scientist to join the Department of Psychiatry.

    Maine Medical Center (MMC) is seeking a BC/BE part/full-time Child & Adolescent Psychiatrist clinician-educator or clinician-scientist to join the Department of Psychiatry.

    The position involves outpatient care in the child and adolescent psychiatry clinic. It also includes a role as the clinician leader of the Child & Adolescent Psychiatry Division’s Portland Identification and Early Referral (PIER) program team.

    Maine Medical Center has 637 licensed beds and is the state’s leading tertiary hospital and Level One Trauma Center, and  the position involves teaching and mentoring Psychiatry residents, Child & Adolescent Psychiatry fellows, and medical students from the Maine Medical Center-Tufts University School of Medicine Program. 

    Just two hours north of Boston, this is an exceptionally diverse and vibrant community. 

    For more information please contact Alison C. Nathanson, Director, MaineHealth Physician Recruitment Center at (207) 661-7383 or nathaa@mainehealth.org.

    5/28/18

    Psychiatric Medical Director

    Tri-County Mental Health Services has multiple current and developing programs including Integrated Primary Care and Behavioral Health Homes.

    Change can make a world of difference. We offer hope.

    Tri-County Mental Health Services has multiple current and developing programs including Integrated Primary Care and Behavioral Health Homes. This is a true leadership position, where understanding of healthcare systems is important and involvement in the agency’s mission, clinical programs, and growth into new areas is key.

    As the Psychiatric Medical Director you will:

    • Oversee integrated behavioral healthcare initiatives and programs across multiple settings.
    • Build partnerships within healthcare systems.
    • Develop and implement integrated and consultative models of care that enhance access to quality whole health services.

    State of Maine licensure, certificate in psychiatry and DEA certificate required.

    Located in Lewiston, Maine.

    Contact Jessica Lachance at 207-344-1839 or jlachance@tcmhs.org for more information.

    6/4/18

    Maine's Largest FQHC in need of Physician for Geriatric Program

    PCHC in Bangor, Maine is seeking Board-Eligible Internal Medicine or Family Med Physician to join our team of doctors and advanced practice providers in our Community Care and Geriatrics department!

    PCHC in Bangor, Maine is seeking Board-Eligible Internal Medicine or Family Med Physician to join our team of doctors and advanced practice providers in our Community Care and Geriatrics department!

    • Provide care to seniors in post-acute care settings and in area long-term care facilities and serve as Medical Director in those facilities.
    • No call, no holidays, no nights or weekends.
    • Opportunity to mentor PA, NP, and DO students through partnerships with multiple university programs.
    Penobscot Community Health Care is a nationally recognized FQHC that focuses on patient-centered care, innovation and collaboration. For you, for your family, for our community. For more information, please contact Vanessa Sanderson, Recruitment Coordinator at (207)404-8015 or vsanderson@pchc.com.

    6/4/18

    Multiple Family Med Opportunities in Beloved Community Health Centers

    PCHC is recruiting Family Medicine Physicians for locations in Belfast, Old Town, and Bangor. This is your chance to work for a nationally recognized FQHC that is a leader in integrated primary care!

    PCHC is recruiting Family Medicine Physicians for locations in Belfast, Old Town, and Bangor. This is your chance to work for a nationally recognized FQHC that is a leader in integrated primary care!

    • Come and join our team at Seaport Community Health Center and become a part of a vibrant and active coastal community!
    • Work and play minutes away from the flagship university of the University of Maine System by working at our Helen Hunt Health Center!
    • Become a part of the health center where it all began, Penobscot Community Health Center located in the heart of Bangor, Maine!

    We are the largest and most comprehensive FQHC in Maine and the 2nd largest in New England. PCHC offers family medicine, psychiatry, mental health, pediatrics, specialty services, physical therapy, pharmacy, social work, lab, x-ray, and a large public health dental center -- all within our organization. If your passion is in community health, there is no place else to be. Questions? Contact Vanessa Sanderson, Recruitment Coordinator at (207)404-8015 or vsanderson@pchc.com.

    6/4/18

    Outpatient Only - Internal Medicine with Loan Repayment & Sign-on Bonus

    The Central Maine Medical Group seeks BE/BC Internal Medicine physician to join cohesive, well-established, hospital-employed practice in Lewiston, Maine. 

    The Central Maine Medical Group seeks BE/BC Internal Medicine physician to join cohesive, well-established, hospital-employed practice in Lewiston, Maine.  We offer:
    • Up to $200K in medical student loan repayment
    • $50K sign on bonus
    • Up to $12K moving allowance
    • 4 day work week/generous outpatient call
    • Healthy work/life balance
    Central Maine affords easy access to the coast and mountains where you can enjoy four seasons of outdoor activities.  We have a growing arts and restaurant scene in a very safe affordable area to live and raise a family.  To join our growing team, contact Donna Lafean, Central Maine Medical Center, 300 Main Street, Lewiston, ME  04240.  Email:  Lafeando@cmhc.org; Fax: 207/344-0658; Call:  800/445-7431; or visit our website:  http://recruitment.cmmc.org/.

    7/2/18

    Internal Medicine Outpatient Physician

    Maine Medical Partners Internal Medicine Westbrook is seeking a BC/BE Internal Medicine physician for their well-established outpatient practice located in the greater Portland, Maine area. 

    Maine Medical Partners Internal Medicine Westbrook is seeking a BC/BE Internal Medicine physician for their well-established outpatient practice located in the greater Portland, Maine area.  The selected candidate will join 4 internal medicine physicians, 4 family medicine physicians and a geriatrician.

    Maine Medical Center has 637 licensed beds and is the state’s leading tertiary care hospital and Level I Trauma Center, with a full complement of residencies and fellowships and an integral part of Tufts University Medical School.  The position involves teaching and mentoring residents and medical students from the Maine Medical Center-Tufts University School of Medicine Medical School Program.

    Situated on the Maine coast, Portland offers the best of urban sophistication combined with small-town friendliness.  Just two hours north of Boston, this is an exceptionally diverse and vibrant community. 

    For more information please contact Alison C. Nathanson, Director, MaineHealth Physician Recruitment Center at (207) 661-7383 or nathaa@mainehealth.org.

    5/7/18

    Clinical Cardiology Opportunity

    Maine Medical Partners MaineHealth Cardiology is seeking an invasive clinical cardiologist (non-interventional) for their practice located in their Augusta and Waterville, Maine locations

    Maine Medical Partners MaineHealth Cardiology is seeking an invasive clinical cardiologist (non-interventional) for their practice located in their Augusta and Waterville, Maine locations.  Selected candidates will join a growing team of over 50 cardiologists who provide inpatient, outpatient and consultative services. 

    Maine Medical Partners MaineHealth Cardiology is a growing practice, with office locations in Augusta, Waterville, Lewiston, Rockport, and Scarborough, and is affiliated with the nationally recognized cardiac services at Maine Medical Center and its parent organization MaineHealth. 

    This integrated practice includes Maine General Health, Maine’s third largest health care system.  The Alfond Center for Health, MaineGeneral Medical Center’s state-of-the art, 192-bed regional hospital, has a cardiac catheterization lab and full on site imaging, including echocardiography and nuclear testing.  The Augusta/Waterville practice consists of 9 cardiologists and 2 advanced practice providers.

    For more information please contact Alison C. Nathanson, Director, MaineHealth Physician Recruitment Center at (207) 661-7383 or nathaa@mainehealth.org.

    5/21/18

    Opportunities at the VA for Volunteer Physicians

    Take advantage of this opportunity with the Veterans' Administration to thank our veterans in a concrete way for their service and their sacrifices.

    The Physician Ambassador Program was created by the Department of Veterans Affairs as a best practice recruitment and placement initiative seeking fully licensed physicians and clinicians to enhance health care services for Veterans.

    The Physician Ambassador Program is a without compensation program that provides civilian physicians and clinicians an opportunity to give back to the Veteran community by serving in a volunteer role to deliver health care services to Veterans. 

    If you are interested in participating in this program at VA Maine Healthcare System, please contact Jonathan Barczyk at (207) 621-4886.