Maine Medicine Weekly Update - December 16, 2019
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Walmart Will Delay Electronic Prescribing Mandate

Walmart had previously announced that it would require electronic prescribing for controlled substances (EPCS) for all controlled substances as of January 1, 2020, with no exceptions. The AMA and multiple medical societies opposed the mandate, urging a delay due to the likelihood for patient harm and how the Walmart policy did not comport with state or federal law. Now it has announced it will delay that mandate.

[from the American Medical Association]

We are pleased to report that Walmart said it will delay its EPCS mandate.

"We recognize not all provider networks and prescribers will have the technology and systems in place to accommodate this requirement, so we will continue to take written prescriptions so patients are not unintentionally negatively affected by this process," Walmart spokeswoman Marilee McInnis said in a statement to USA TODAY.

AMA President Patrice A. Harris, MD, MA, provided the following statement to USA Today:

“The AMA welcomes Walmart’s decision to delay implementation of an electronic prescribing mandate that would have resulted in harm to millions of Americans, including many in rural areas who rely on Walmart as the only pharmacy in reasonable distance. The policy, which the AMA urged Walmart to delay, was not developed in consultation with the nation’s physicians, who support electronic prescribing of controlled substances, but want to see it implemented in a manner that supports—rather than disrupts—patient care.”

"The AMA will continue to work with physicians, pharmacists, and other partners in health care to improve medication adherence, including removing barriers that impede physicians from electronically prescribing controlled substances."

The AMA will continue to monitor this development, and it encourages the help of all physicians in sharing this information with state medical and pharmacy boards, as appropriate, to ensure all pharmacies and other stakeholders comply with state law governing the prescribing and dispensing of controlled substances. Maine law requires opioids to be prescribed electronically, unless the prescriber has received a waiver from the Maine Prescription Drug Monitoring Program or fits into one of the few exceptions to the requirement.

U.S. CDC: At Least 1,300 Deaths from Flu This Season...So Far

A preliminary estimate from the U.S. CDC states that at least 1,300 people around the country have died from the flu so far this season.

CNN (12/13, Bonifield, Gumbrecht) reported that “at least 1,300 people have died from the flu so far this season, according to a preliminary estimate” from the CDC. In addition, “there have been at least 2.6 million flu illnesses and 23,000 flu-related hospitalizations, according to the” CDC. The article also listed the 23 states where the CDC says there is widespread flu activity.

NBC News (12/13, Edwards) reported that Dr. William Schaffner, medical director of the National Foundation for Infectious Diseases, said that the early start of the flu season may indicate “we’ll have a prolonged influenza season.”

Schmidt Institute Opioid Program Expands Statewide

A successful opioid and benzodiazepine prevention program sponsored by the Maine Office of Substance Abuse and Mentail Health Services and the Schmidt Institute, a joint venture of St. Joseph's Hospital and Penobscot Community Health Center, is being expanded statewide.

[from the Maine Hospital Association's Friday Report]

A program that that has reduced patient dependence on opioids and benzodiazepines in the Bangor area is being expanded statewide through a partnership between the Maine Office of Substance Abuse and Mental Health Services (SAHMS) and the Schmidt Institute, a joint venture of St. Joseph Healthcare and Penobscot Community Health Care (PCHC).

Since 2013, the Institute’s Controlled Substance Stewardship (CSS) Program has been implemented at PCHC, a Federally Qualified Health Center that serves 65,000 patients. This effort has resulted in a 77 percent reduction in overall opioid and benzodiazepine prescribing at PCHC’s practice sites, a key effort given that opioids put patients at great risk for unintentional overdose and have not been proven effective as a long-term treatment for chronic pain.

CSS provides support and consultation to prescribing clinicians with a goal of promoting compassionate, coordinated care for patients whose prescriptions are being tapered. It also offers tools for clinicians and practice staff, such as informed consent and patient-provider agreements that provide clear descriptions of risks and expectations of treatment, and prompt referral and access to experts in alternative pain management and other relevant services (e.g., medication-assisted treatment for Opioid Use Disorder).

The program supports front-line providers who are caring for patients with chronic pain, substance use disorders, mental illness and other complex conditions. CSS disseminates to providers clear and practical policies around evidence-based prescribing and management of opioids, benzodiazepines, hypnotics and stimulants.

SAMHS, an office of the Maine Department of Health and Human Services, is sponsoring a statewide expansion of the model, with the goal of promoting safer, evidence-based treatment options for chronic pain, while supporting providers in alleviating opioid prescribing issues and concerns.

The partnership will include establishing statewide prescribing guidelines that providers and organizations can use to inform their opioid prescribing and tapering practices, and clinical case reviews by the Institute’s CSS Committee, an interdisciplinary team with expertise in pharmacy, pain management, family medicine, psychiatry and care management.

Case reviews will be offered at no cost to providers in Maine, thanks in part to financial support from the state of Maine through Overdose Data to Action, a federal Centers for Disease Control and Prevention grant recently awarded to the state.

For more information about the Schmidt Institute and their CSS work, contact: Larry Clifford, director, planning & development, Schmidt Institute, (207) 404-8032.

Opioid Related Webinars Offer CME Credit

MaineHealth has developed two learning modules for providers.

Difficult Conversations around Opioids

Naloxone Education and Toolkit

Visit the MaineHealth Opioid Education web page to access the modules. There is no cost to participate in either of the modules and they can be taken at any time. Upon completion, 0.50 CME hours are available (AMA PRA Category 1 CME credits).

This Week's Public Health Updates from the AMA

Click through for a brief update on recent public health issues, provided by the American Medical Association's electronic publication, Morning Rounds. [This article is updated weekly.]

Suicide rates for U.S. soldiers on active duty rose in America’s “endless” wars in Vietnam, Iraq, and Afghanistan, research indicates

The NBC News (12/13, Liautaud, Martin) website reported, “Suicide rates for U.S. soldiers on active duty rose in America’s ‘endless’ wars in Vietnam, Iraq and Afghanistan, reversing historical trends that go as far back as the Civil War,” researchers concluded in a study that “also suggested there is no clear link between combat operations and military suicide.” In arriving at these conclusions, investigators “analyzed military records as far back as the 1840s to develop what they say is the most extensive historical examinations of suicide among active-duty soldiers to date.” The findings were published online Dec. 13 in JAMA Network Open.

Hormone therapy combining estrogen and progestin for women entering menopause tied to higher breast cancer risk up to 19 years after treatment discontinuation, federal data indicate

The AP (12/13, Marchione) reported results from the Women’s Health Initiative, a large federal study, indicate “women who use certain types of hormones after menopause still have an increased risk of developing breast cancer nearly two decades after they stop taking the pills.” Moreover, physicians “say a new generation of women entering menopause now may not be aware of landmark findings from 2002 that tied higher breast cancer rates to” hormone replacement therapy (HRT) “combining estrogen and progestin.” The findings presented at the San Antonio Breast Cancer Symposium also showed “women on estrogen alone for seven years had a 23% lower risk of developing breast cancer up to 19 years later.”

Frail, older adults may struggle after even minor operations, study suggests

In “The New Old Age,” the New York Times (12/13, Span) reported research published online in JAMA Surgery “has found that frail, older adults are more likely than other patients to die after even supposedly minor procedures – and even when the surgery goes well, without complications.” The study authors recommended that physicians screen all older adult patients prior to any operation, as “our data indicate that there are no low-risk procedures among patients who are frail.”

Resistance exercise may preserve BMD while dieting in adults with obesity

Reuters (12/12, Rapaport) reports, “Obese adults who diet to lose weight may be able to protect against bone thinning with resistance exercise,” research indicated.

Endocrinology Advisor (12/12, Akirov) reports, “Resistance exercise alone or in combination with aerobic exercise was found to be better than aerobic exercise alone in reducing weight loss-induced decreases in hip bone mineral density (BMD) in adults with obesity,” researchers concluded after examining “data from 160 participants aged ≥65 years in the Lifestyle Intervention Trial.” The findings were published online in the Journal of Bone and Mineral Research.

Few childcare centers require children, childcare workers to get flu shot, research indicates

Reuters (12/12, Steenhuysen) reports research indicates “only a quarter of childcare centers in the United States require children in their care to get a flu shot, and even fewer require childcare workers to be vaccinated.” Investigators arrived at this conclusion “based...on a 2016 telephone survey of 518 childcare center directors in 48 states that were randomly chosen from a national database of licensed U.S. childcare centers.” The findings were published online in the Journal of the Pediatric Infectious Diseases Society.

Resources From The Alzheimer's Association

The Alzheimer's Association, Maine Chapter is a source of resources and Information on caring for people living with dementia, tools to assist with cognitive assessment, diagnosis and care planning.

Diagnostic and Management Tools for Health Systems and Clinicians The Alzheimer's Association has partnered with government and professional organizations to develop several physician guidelines and recommendations that can help you care for your patients with dementia. Resources include detection of cognitive impairment in primary care, recommendations for defining preclinical Alzheimer's disease, appropriate use criteria for amyloid PET imaging, and more. https://www.alz.org/professionals/health-systems-clinicians/guidelines_index_(1)

Tools to Assist with Cognitive Assessment during the Medicare Annual Wellness Visit The Alzheimer's Association convened a group of practicing expert clinicians to make consensus recommendations for an effective, practical and easy process for detecting cognitive impairment in the primary care setting.
https://www.alz.org/professionals/health-systems-clinicians/cognitive-assessment

Diagnosing Patients With Dementia The Alzheimer's Association and the National Institute on Aging (NIA) jointly issued four criteria and guidelines to diagnose Alzheimer's disease, including recommendations for clinical office settings. https://www.alz.org/professionals/health-systems-clinicians/dementia-diagnosis

How does one optimally manage a patient living with Dementia? Both nonpharmacologic and pharmacologic interventions are needed to optimally treat the cognitive, behavioral and psychological symptoms of Alzheimer's disease. Explore resources and tools to enhance and inform the treatment and management of patients living with dementia at https://www.alz.org/professionals/health-systems-clinicians/management.

Making a Plan of Care for Patients with Cognitive Decline and Dementia Cognitive decline, including Alzheimer's disease and other dementias, can be difficult and time consuming to discuss with patients. Although in-depth care planning is beneficial for all, this type of service has not been covered under Medicare - until recently. CPT® code 99483 provides reimbursement for a clinical visit that results in a comprehensive care plan, allowing you to deliver services that can contribute to a higher quality of life for your patients. Clinicians who can be reimbursed under the code include physicians, physician assistants, nurse practitioners, clinical nurse specialists and certified nurse midwives. Care planning for individuals with dementia is an ongoing process and a formal update to a care plan should occur at least once per year or when indicated by disease progression.
https://www.alz.org/professionals/health-systems-clinicians/care-planning

Diagnosis, Treatment and Management of Dementia https://www.alzmassnh.org/hospital/physician-cme-course/

For more information, contact:
Peter Baker, LCSW, Program Director
Alzheimer's Association, Maine Chapter
207-772-0115 x9691 1-800-272-3900
pbaker@alz.org

MMA Legislative Calls Will Begin Tuesday, January 14th

MMA Legislative Committee Chairs Jay Mullen, M.D. and Lindsey Tweed, M.D. welcome you to participate in the weekly conference calls of the MMA Legislative Committee. The first MMA Legislative Committee weekly conference call for the Second Regular Session of the 129th Maine Legislature will take place Tuesday, January 14th, at 8:00 p.m.

MMA Legislative Committee Chairs Jay Mullen, M.D. and Lindsey Tweed, M.D. welcome you to participate in the weekly conference calls of the MMA Legislative Committee.

The first MMA Legislative Committee weekly conference call for the Second Regular Session of the 129th Maine Legislature will take place Tuesday, January 14th, at 8:00 p.m.

Legislative Committee members and specialty society legislative liaisons are strongly encouraged to participate. Any physician, practice manager, or other staff member who is interested in the MMA's legislative advocacy also is welcome to participate. It is not necessary to RSVP for the calls. To date the Legislature has printed approximately 1700 bills, and as the deadline for committee consideration is approaching the number of bills printed each week is beginning to dwindle. While that makes the work of the legislative call shorter, it also allows for more in-depth discussion of significant matters.

Please use the following conference call number and passcode. These will remain the same for every weekly call during the session.

Conference call number: 1-603-766-5646

Participant ID - 699139#

The purpose of the weekly conference calls is to discuss the MMA's position on bills printed the previous week, to hear the views of specialty societies on the new bills or their concerns about any current health policy issues, and to discuss the highlights of legislative action of the week. The calls rarely last longer than an hour.

The following are bills of interest to the physician community printed last week. (For those not familiar with the term, a "concept draft" is a bill that contains only a title and a brief description of what it is intended to do. It does not contain the actual bill text.) We will discuss the priority bills marked with an asterisk (*) first.

Following are the bills of the week:

Maine Legislature's List of Bill Titles for 2020 Session: Initial Approval List

The Maine Legislature has published the list of bill requests for the 2020 session. Click through for lists, by subject and by sponsor, of those bills which have received initial approval. Appeal is still available for those not receiving initial approval.

The Maine Legislature has published the list of bill requests for the 2020 session. Click through for lists, by subject and by sponsor, of those bills which have received initial approval.

Appeal is still available for those not receiving initial approval, with the Legislative Council to meet on those items December 6 at 10:00 a.m. The list of titles being appealed is here.

Upcoming Specialty Society Meetings

Below you will find an on-going list of Upcoming Specialty Society Meetings. Any questions should be referred to the contact person listed for each specialty.

UPCOMING SPECIALTY SOCIETY MEETINGS

February 1-2, 2020
Maine Society of Anesthesiologists Annual Meeting
Sugarloaf Mountain Hotel & Conference Center – Carrabassett Valley, ME
Contact: Lisa Montagna at 207-620-4015 or mesahq@gmail.com

February 7-9, 2020
Maine Urological Association & Rhode Island Urological Society’s 2020 Winter Program
Sugarloaf Mountain Hotel & Conference Center – Carrabassett Valley, ME
Contact: Dianna Poulin at 207-480-4194 or dpoulin@mainemed.com

March 25, 2020
Richard Engel, MD, FACP 2^nd Annual Primary Care Symposium
Maine Chapter, American College of Physicians and MMC Department of Medicine
Maine Medical Center – Portland, ME – 8:00am – 12:00pm
Contact: Warene Eldridge at 207-215-7118 or mainechapteracp@gmail.com

April 1-4, 2020
28th Annual MAFP Family Medicine Update & Annual Meeting
DoubleTree by Hilton Portland, Portland, ME
Full brochure and registration available after January 15, 2020 at www.maineafp.org
Contact Deborah Halbach at 207-938-5005 or maineafp@tdstelme.net

April 16-17, 2020
Maine Association of Psychiatric Physicians, 14^th Annual Spring Program
Hilton Garden Inn, Freeport, ME
Contact Dianna Poulin at 207-480-4194 or dpoulin@mainemed.com

May 1, 2020
Maine Society of Eye Physicians and Surgeons Spring Meeting
Harraseeket Inn – Freeport, ME 11:30am - 5:00pm
Contact: Shirley Goggin 207-445-2260 or sgoggin@mainemed.com

May 1-3, 2020
American Academy of Pediatrics, Maine Chapter Annual Meeting and Spring Conference
Hilton Garden Inn and Conference Center – Freeport, ME
Contact: Dee Kerry 207-480-4185 or dakerry@aapnet

MMA partners with the Maine Suicide Prevention Program and the Maine CDC/Sweetser to offer training for clinicians.

MMA continues to partner with the Maine Suicide Prevention Program to offer training for clinicians.

The Maine Suicide Prevention Program, administered by NAMI-Maine, is excited to announce their Fall schedule. The following suicide prevention, assessment and management trainings are open for registration. MMA works closely with NAMI-Maine to provide educational opportunities for Maine physicians and other clinical providers. CMEs and contact hours for licensure are offered as appropriate.

Suicide Prevention Gatekeeper Training

Suicide Prevention Training of the Trainers

Suicide Assessment for Clinicians Training

Non-Suicidal Self Injury Training

Suicide Prevention Protocol Development Training

Suicide Prevention Curriculum Training

If you have needs not identified in the above list, please contact Nicole, Suicide Prevention Coordinator, to discuss the possibility of a customized training program.

The Maine CDC and Sweetser are offering free online Suicide Prevention Training Modules!

Enrolling is easy. There are 12+ courses available at no charge. Download the flyer with enrollment info here.

Sample modules:

· Columbia Suicide Severity Rating Scale (C-SSRS)

· Depressive Disorders in Children and Adolescents

· Counseling on Access to Lethal Means (CALM)

· Collaborative Assessment & Management of Suicidality (CAMS)

· Safety Planning Intervention for Suicide Prevention

· Suicide Risk Factors, Screening and Assessment

10th Annual Maine Patient Safety Academy - March 30, 2020

This all-day conference will focus on the interprofessional nature of patient safety, with the theme: Vision 2020 - Looking at the Future of Patient Safety

This all-day conference will focus on the interprofessional nature of patient safety, with the theme: Vision 2020—Looking at the Future of Patient Safety

What: 10th annual Maine Patient Safety Academy

When: Monday, March 30, 2020

Where: University of Southern Maine, Abromson Center

Cost: $60 general | $25 students and faculty

Website FMI and to register: http://mainepatientsafetyacademy.org/

Orthopedic Surgeon Opportunity in Beautiful New England

Our Northern Light Inland Hospital and Northern Light Sebasticook Valley Hospital Network seeks a BC/BE General or Hand Orthopedic Surgeon to join our Orthopedic Specialist team.

Our Northern Light Inland Hospital and Northern Light Sebasticook Valley Hospital Network seeks a BC/BE General or Hand Orthopedic Surgeon to join our Orthopedic Specialist team. This position will be split between the two hospitals and the scope of practice will primarily focus on hand and upper extremity surgery, while also including a component of general orthopedics. Extensive hand surgery experience is a must! The ideal candidate will have a desire for community outreach and promoting collaborative relationships with other physicians in the community. The preferred candidate will also have the interest to live within the hospital service area.

For confidential consideration, please contact:
Nick Huff, DASPR, CST
Provider Recruiter
Email: providerjobs@northernlight.org
Phone:207-973-5358
Or apply directly to: https://northernlighthealth.org/Careers/Position/60311/Orthopedic%20Surgeon

3/16/20

Northern Light Sebasticook Valley Hospital seeks a BC/BE General Surgeon

Bread and butter surgery, with high volume elective surgery and low volume emergency surgery. Upper and lower endoscopy ability required. Breast surgery preferred, but not required.

Northern Light Sebasticook Valley Hospital seeks a BC/BE General Surgeon. Bread and butter surgery, with high volume elective surgery and low volume emergency surgery. Upper and lower endoscopy ability required. Breast surgery preferred, but not required.

Northern Light Sebasticook Valley Hospital is a progressive, Joint Commission accredited, 25-bed Critical Access Hospital in Pittsfield, Maine that serves an area encompassing 40,000 people throughout the central region. Northern Light Sebasticook Valley Hospital is a member of Northern Light Health, an integrated statewide health delivery system that is raising the bar with no-nonsense solutions that are leading the way to a healthier future for our state.

Why Northern Light Health?

Robust compensation and benefits package

Student Loan Reimbursement Programs

Relocation Bonus

Sign on Bonus

Flexible schedules and exceptional work/life balance

Generous PTO benefits

For confidential consideration, please submit CV to: Providerjobs@northernlight.org

01/13/20

Family Medicine Physician

Northern Light Sebasticook Valley Hospital is seeking a full time Family Medicine physician to join Sebasticook Valley Family Care, a modern practice located just off I-95 in Pittsfield.

Northern Light Sebasticook Valley Hospital is seeking a full time Family Medicine physician to join Sebasticook Valley Family Care, a modern practice located just off I-95 in Pittsfield. This is an excellent opportunity to come join a team of well-established, quality-driven providers serving the greater Pittsfield community. Our team of advanced practitioners are committed to providing excellent medical care, exceptional service and a satisfying relationship between patient and provider. We do this by blending the latest technology with oldfashioned care and customer service. Our skilled office staff and providers work as integrated care teams to provide our patients with a full spectrum of family care. Work schedule is 4 days per week, with limited telephone call from home. This position comes with competitive compensation, fringe benefits, assistance with medical education debt, signing/relocation bonus negotiable.

Sebasticook Valley Hospital (SVH) is a 25-bed, regional Critical Access Hospital for the more than 30,000 residents living in our footprint. Our neighbors count on us as a resource for healthcare and health information. SVH is part of Northern Light Health, an integrated health system serving the great state of Maine. For confidential consideration, please contact: Sherry Tardy, physician recruiter: Northern Light Health-Provider Recruitment at PRoviderjobs@northernlight.org or 207.973.5358 (office).

12/16/19

Family Medicine Opportunity in Beautiful Western Maine

Western Maine Primary Care, a department of Stephens Memorial Hospital, is currently seeking a BC/BE family medicine physician to join our exceptional team of providers.

Western Maine Primary Care, a department of Stephens Memorial Hospital, is currently seeking a BC/BE family medicine physician to join our exceptional team of providers. Western Maine Primary Care is committed to providing high quality care. Now is a great time to join our team as we recently relocated our practice to our brand new, state-of-the-art medical office building.

Stephens Memorial Hospital, a 25-bed critical access hospital, is a part of the MaineHealth family, the premier healthcare system in Maine, and is nationally renowned for its innovative programs in rural healthcare. This position offers teaching opportunities of medical students, as Stephens Memorial Hospital is one of the teaching sites for the Maine Medical Center – Tufts University Medical School program. Come be a part of our dynamic team of providers and exceptional support staff and experience the warmth of a small town combined with a medical community working closely with colleagues throughout the MaineHealth system.

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

12/30/19

BC/BE Family Medicine or Internal Medicine Physician

Northern Light Eastern Maine Medical Center has an exciting leadership opportunity for a BC/BE Family Medicine or Internal Medicine Physician to lead our primary care network of five well-established, quality-driven, outpatient practices serving the greater Bangor community.

The Physician Director, Primary Care will collaborate with the Practice Director, Primary Care to form a dyad partnership in leading our primary care team, as well as provide peripheral oversight for our Walk In Care and university health center locations. The Physician Director of Primary Care will have clinical, operational, financial and strategic duties. This role is 80% administrative and 20% clinical practice.

Why Northern Light Health? We offer a robust compensation and benefits package, generous PTO benefits, loan repayment program, and an exceptional work/life balance.

For confidential consideration, please contact:
Amanda Klausing, FASPR, Physician Recruiter
ProviderJobs@NorthernLight.org
207.973.5358

1/6/19

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.

Volunteer Opportunity with Partners for World Health - Portland, ME

Partners for World Health has a great need for advice from certain medical professionals on how to sort and package the vast amount of supplies received, for shipping and use in destination countries.

Partners for World Health (PWH) is a non-profit 501(c)3 based in Portland, Maine committed to reducing medical waste, improving the quality of healthcare in underserved countries, and educating our local community about global healthcare issues.

Our mission is to collect unused/discarded medical supplies from local medical facilities and to distribute those medical supplies to international communities in need. This work limits the negative impact we have on the environment and provides much-needed resources to the developing world. To support our work in improving health conditions around the world, we send local medical personnel on medical missions to developing countries, and we educate our local Maine community about global health issues.

PWH has a great need for advice from certain medical professionals on how to sort and package the vast amount of supplies received, for shipping and use in destination countries, specifically, in the areas of:

Surgery: all aspects of OR medical supplies and equipment
Respiratory: any and all aspects
Anesthesia
Laparoscopic surgery: advice on the proper components of a “tower”
Cardiology

Please note: this request is not for ongoing time commitment but rather for a few hours of a professional’s time to help organize certain supplies appropriately.

While PWH receives tens of thousands of pounds of equipment/supplies from hospitals and clinics, there are certain critical items always in short supply.

For more information, contact volunteer Rita Zanichkowsky at rznct@maine.rr.com or 207-232-3264, or contact Partners directly at 774-5555. Thank you!

https://www.partnersforworldhealth.org/

Maine Medicine Weekly Update - December 16, 2019(Print All Articles)