Maine Medicine Weekly Update : March 25, 2020

Join Maine DHHS leadership and Northeast Telehealth Resource Center (NETRC) staff for an overview of the recent significant expansions to telehealth policy at the state and federal level that will allow Maine providers and patients to better leverage technology and promote continuity of care for their patients during the COVID-19 pandemic. NETRC staff will also share key telehealth resources and information that are being made available to help clinicians implement telehealth services, including a new, weekly “Telehealth Virtual Office Hours” that will begin the week of March 30th to provide ongoing and timely technical assistance to clinicians and their staff.

Governor Mills Acts to Promote Access to Health Care During COVID-19

The Administration of Governor Janet Mills has taken two actions to promote Maine people’s access to health care in response to COVID-19, which bolster the health care work force and facilitate the expansion of telehealth.

“I am committed to ensuring that Maine people have access to quality, affordable health care as we respond to COVID-19,” said Governor Mills. “As a result of these actions, I am hopeful that more Maine people will be able to get counseling, prescriptions, and treatment from their trusted health care providers from the safety of their homes whenever possible and without sacrificing other basic necessities.”

“These changes advance Maine’s role as a national leader in supporting telehealth and make it possible for more of our patients and health care providers to connect online and over the phone rather than in person,” said Department of Health and Human Services Commissioner Jeanne Lambrew. “We stand ready to work with providers to ensure patients can get the health care they need, especially with so many Maine people staying home to help prevent the spread of COVID-19.”

First, Governor Mills has signed an Executive Order (PDF) allowing licensed physicians, physician assistants, and nurses greater flexibility to contribute to Maine’s response during the civil state of emergency. Those who are licensed and in good standing in other states can now:

Additionally, all physicians, physician assistants and nurses licensed in Maine and those authorized under the order may provide services through all methods of telehealth, including video, audio and other electronic technologies to treat Maine people for all medical needs. The order expands acceptable technologies beyond only those that are compliant with patient privacy laws, to align Maine with major changes made by the federal government that provide broad coverage for telehealth services for Medicare members.

In addition to this Executive Order, the Administration’s second action also aligns Maine with federal guidance and improves the affordability of needed health care services delivered through telehealth. To implement the Governor’s initiative, Superintendent of Insurance Eric Cioppa on Friday signed an order that requires insurance companies to provide coverage for clinically-appropriate services delivered by telephone, as well as via more commonly used apps, such as FaceTime, WhatsApp and Skype, as long as they are private. This provides flexibility to patients who may not have access to web-based applications traditionally used for telehealth.

“The telehealth order allows health care providers greater options in delivering care to Mainers,” said Cioppa. “The change will allow people to have virtual house calls, providing them with the health care they need, while at the same time maintaining social distancing.”

The Superintendent’s order also requires insurance carriers to pay providers for telehealth services at the same rate they would pay for an in-person visit for the same service. This supports health care providers who are following national and state recommendations to postpone in-person appointments for non-urgent care and makes it more likely that patients will be able to get the care they need through telehealth visits.

MaineCare, or Medicaid, already pays the same rate for most covered services whether delivered in person or through telehealth. Last week, the Maine Department of Health and Human Services (DHHS) announced an expansion of this already robust policy through an emergency rule change that allows for prescribing through telehealth. Maine DHHS has long supported the promotion of telehealth services, as described in a new fact sheet.

The Insurance Superintendent’s authority extends only to fully-insured health plans -- not to Medicare Advantage or self-insured plans. The Governor urges all self-insured large employers in Maine to adopt the same policies to ensure their employees continue to get the care they need.

DHHS Commissioner Jeanne Lambrew and the Northeast Telehealth Resource Center will host a statewide virtual statewide Telehealth Town Hall meeting on Thursday, March 26 for health providers to explain these changes and announce a range of resources (PDF) available to support them in using telehealth services.

Additionally, DHHS reconstituted a statewide Telehealth Advisory Committee in 2019 to promote consistent practices across health care payers, use of tele-psychiatry in emergency departments, and use of telehealth for new workforce models.

Important Information from Maine CDC

Maine now meets U.S. CDC’s criteria for a Moderate level of community transmission. At present, a limited national supply of laboratory materials inhibits Maine’s testing capacity. Therefore, consistent with U.S. CDC guidelines, Maine is now creating a prioritization system to test individuals in high-risk categories.

To preserve Maine’s specimen collection and testing supplies for patients who may develop severe COVID-19 illness over the coming months, effective immediately, Maine Health and Environmental Testing Laboratory (HETL) will prioritize testing to high-risk individuals and will only accept specimens for testing from symptomatic individuals who have fever or respiratory symptoms and who fall into one of the following high-risk categories:

AMA Releases Special Coding Advice Related to COVID-19

New guidance from the AMA provides special coding advice during the COVID-19 public health emergency.

New guidance from the AMA provides special coding advice during the COVID-19 public health emergency. One resource outlines coding scenarios designed to help health care professionals apply best coding practices. The scenarios include telehealth services for all patients. Examples specifically related to COVID-19 testing include coding for when a patient: comes to the office for E/M visit, and is tested for COVID-19 during the visit; receives a telehealth visit re: COVID-19 and is directed to come to physician office or physician’s group practice site for testing; receives a virtual check-in/online visit re: COVID-19 (not related to E/M visit), and is directed to come to physician office for testing; and more. There is also a quick-reference flowchart that outlines CPT reporting for COVID-19 testing. A new web page on the AMA site also outlines CMS payment policies and regulatory flexibilities related to COVID-19. Check the AMA COVID-19 resource center to stay up to date and for additional resources.

A Message from Maine Responds

We appreciate all of the offers coming in to assist in Maine CDC's COVID-19 response. By registering with Maine Responds, you will join our listing of volunteers against which we search for any emergent volunteer workforce needs. Read on for the details of joining both Maine Responds, and our more involved volunteer opportunities through Maine Medical Reserve Corps - members of both start with the same first step: register at maineresponds.org.

We appreciate all of the offers coming in to assist in Maine CDC's COVID-19 response. By registering with Maine Responds at maineresponds.org, you will join our listing of volunteers against which we search for any emergent volunteer workforce needs. Read on for the details of joining both Maine Responds, and our more involved volunteer opportunities through Maine Medical Reserve Corps - members of both start with the same first step: register at maineresponds.org.

The Maine Responds Emergency Health Volunteer System is the online registration system for public health, healthcare and emergency response volunteers for the State of Maine.

Maine Responds is a partnership that integrates local, regional, and statewide volunteer resources to assist our public health and healthcare systems. It is part of a national initiative to train, coordinate, and mobilize volunteers during an emergency. Maine Responds coordinates verified, pre-credentialed public health, healthcare and emergency response volunteers into a single database that can coordinate the need for volunteers across county, regional and state lines if needed.

Maine Medical Reserve Corps (MRC) volunteer programs reinforce our state's public health infrastructure and support low stress/no-fault exercise environments that test critical response capabilities. Members of both Maine Responds and MRC start with the same first step: register at maineresponds.org.You will be able to select your local MRC unit in the drop-down menu under the "Organizations" section of the registration - refer to this link to determine your Public Health District(s). Maine Responds ESAR-VHP is our volunteer communication and activation system.

Public Health Emergency Preparedness
Department of Health and Human Services
Maine Center for Disease Control and Prevention

Millions Of Older Americans Live In Counties With No ICU Beds As Pandemic Intensifies

More than half the counties in America have no intensive care beds, posing a particular danger for more than 7 million people who are age 60 and up ― older patients who face the highest risk of serious illness or death from the rapid spread of COVID-19, a Kaiser Health News data analysis shows.

Millions Of Older Americans Live In Counties With No ICU Beds As Pandemic Intensifies

Intensive care units have sophisticated equipment, such as bedside machines to monitor a patient’s heart rate and ventilators to help them breathe. Even in communities with ICU beds, the numbers vary wildly ― with some having just one bed available for thousands of senior residents, according to the analysis based on a review of data hospitals report each year to the federal government.

Consider the homes of two midsize cities: The Louisville area of Jefferson County, Kentucky, for instance, has one ICU bed for every 442 people age 60 or older, while in Santa Cruz, California, that number stands at one bed for every 2,601 residents.

Differences are vast within each state as well: San Francisco, with one bed for every 532 older residents, and Los Angeles, with 847 residents per bed, both have greater bed availability than does Santa Cruz.

Even counties that rank in the top 10% for ICU bed count still have as many as 450 older people potentially competing for each bed.

“This is just another example of geography determining access to health care,” Arthur Caplan, a bioethics professor at NYU Langone Medical Center, said when told of KHN’s findings.

Overall, 18 million people live in counties that have hospitals but no ICU, about a quarter of them 60 or older, the analysis shows. Nearly 11 million more Americans reside in counties with no hospital, some 2.7 million of them seniors.

Dr. Karen Joynt Maddox, a professor at Washington University School of Medicine in St. Louis, said that hospitals with larger numbers of ICU beds tend to cluster in higher-income areas where many patients have private health insurance.

“Hospital beds and ICU beds have cropped up where the economics can support them,” she said. “We lack capacity everywhere, but there are pretty big differences in terms of per capita resources.”

Doctors in rural counties are bracing for the possibility they may run out of critical care beds. Northern Light Sebasticook Valley Hospital, in central Maine, has one ventilator and 25 beds. Two of those are “special care” beds that don’t meet full requirements for intensive care but are reserved for the sickest people. Such patients are often transferred elsewhere, perhaps to the city of Bangor, by ambulance or helicopter.

But that may not be possible if COVID-19 surges across the state “because they’re going to be hit just as hard if not harder than we will be,” said Dr. Robert Schlager, chief medical officer at the hospital in rural Pittsfield. “Just like the nation, we probably don’t have enough, but we’re doing the best we can.”

Hospitals also say they can quickly devise plans to transfer cases they can’t handle to other facilities, though some patients may be too ill to risk the move.

Certainly, being in a county with few or no ICU beds may not be as dire as it seems if that county abuts another county with a more robust supply of such beds.

In Michigan, health planners have determined that rural counties with few ICU beds, such as Livingston and Ionia, in the central part of the state, would be served by major facilities in nearby Lansing or Detroit in a major crisis.

Dr. Peter Graham, executive medical director for Physicians Health Plan in Michigan, is affiliated with Sparrow Health System in Lansing. He is making no assumptions. It’s possible central Michigan could take overflow COVID-19 patients from Detroit if that’s where the disease clusters, he said. Or patients might have to be transferred hundreds of miles away.

“It’s just obvious people are going to need to move” if local facilities are overwhelmed, he said. “If we’re able to find a ventilator bed in Indianapolis, in Chicago or Minneapolis or wherever, it is go, get them there!”

Yet experts warn that even areas comparatively rich in ICU beds could be overwhelmed with patients struggling to breathe, a common symptom of seriously ill COVID-19 patients.

“No matter how you look at it, the numbers [of ICU beds] are too small,” said Dr. Atul Grover, executive vice president of the Association of American Medical Colleges. “It’s scary.”

Lenard Kaye, director of the University of Maine Center on Aging, a state with a large older population and relatively few ICU beds, agreed. “The implications are tremendous and very troubling,” he said. “Individuals are going to reach out for help in an emergency, and those beds may well not be available.”

Health workers might need to resort to “triaging and tough decisions,” Kaye said, “on who beds are allocated to.”

That concern isn’t lost on Linnea Olsen, 60, who has lung cancer and knows she is especially vulnerable to any respiratory virus.

Olsen worries about a potential shortage of ventilators and ICU beds, which could lead doctors to ration critical care. Given her fragile health, she fears she wouldn’t make the cut.

“I’m worried that cancer patients will be a low priority,” said Olsen, a mother of three adult children, who lives in Amesbury, Massachusetts.

Olsen, who was diagnosed with lung cancer almost 15 years ago, has survived far longer than most people with the disease. She is now being treated with an experimental medication — which has never been tested before in humans ― in an early-stage clinical trial. It’s her fourth early clinical trial.

“I’m no longer young, but I still would argue that my life is worthwhile, and my three kids certainly want to keep me around,” she said.

She said she has “fought like hell to stay alive” and worries she won’t be given a fighting chance to survive COVID-19.

“Those of us with lung cancer are among the most vulnerable,” Olsen said, “but instead of being viewed as someone to be protected, we will be viewed as expendable. A lost cause.”

The total number of ICU beds nationally varies, depending on which source is consulted and which beds are counted. Hospitals reported 75,000 ICU beds in their most recent annual financial reports to the government, but that excludes Veterans Affairs’ facilities.

The United States has about three times as many ICU beds per capita as Italy and 10 times as many as China, two countries ravaged by COVID-19, according to a new report from the Society of Critical Care Medicine. The supply of ventilators also exceeds other developed countries, another study found. But as with ICU beds, “there is wide variation [in ventilators available] across states,” the study found.

Many experts predict that demand may soon exceed the supply. Over a period of months, the country may need 1.9 million ICU beds — 20 times the current supply ― to treat COVID-19 patients, according to the American Hospital Association.

Dr. Tia Powell, who co-chaired a 2007 New York State Department of Health group that set guidelines for rationing scarce ventilators, said preventing wildfire-like spread of disease is critical to keeping sick patients from overcrowding hospitals.

“If it spreads slowly, you’re much less likely to run short of critical supplies,” she said. “If you need all of your ventilators right now, this week, that’s what makes trouble.”

Even slowing the pandemic does not guarantee hospitals can cope. While some hospitals are planning to treat patients with less serious illness in tents, it’s far more difficult to create intensive care units or even expand existing ones, said Dr. Greg Martin, president-elect of the Society of Critical Care Medicine, which represents intensive care doctors.

Martin said ventilators need to be hooked up to oxygen and gas lines to supply the appropriate mix of air patients need. To convert a standard hospital unit to an ICU, “you would literally need to tear down the wall and run the piping in,” he said.

Few areas — such as operating rooms, emergency department and units used for post-anesthesia care ― have the hookups needed, according to Martin.

Intensive care units also require specially trained doctors, nurses and respiratory therapists. While nurses in other areas of the hospital may care for six patients, ICU nurses typically focus on one or two, Martin said.

“Mechanical ventilation of a fragile patient is rather dangerous if provided by someone other than these trained ICU professionals, which is why mechanical ventilation is not typically done outside of the ICU,” the group said.

Bob Atlas, president and CEO of the Maryland Hospital Association, noted that hospitals and government officials have been discussing ways to boost staffing levels, such as calling on doctors with expired medical licenses, or those licensed to practice in other states, to treat patients in viral hot spots.

Also up for discussion: loosening rules for “scope of practice,” regulations that spell out the duties medical professionals are permitted based on their training.

Atlas and others said they hope steps hospitals have taken to free up beds, such as deferring nonessential surgery, will keep the system from collapsing.

“It’s not as if every Medicare beneficiary will need an ICU bed,” he said. He also said hospitals could wind up treating only the sickest patients.

Greg Burel, the former director of the Strategic National Stockpile, said he hoped that hospitals lacking ICU beds could quickly iron out transfer agreements to move critically ill patients.

“Let’s hope we don’t get there,” he said.

Novant Health Brunswick Medical Center, on North Carolina’s coast, ordered additional ventilators two months ago in case COVID-19 went global. It has six and expects four more, said Shelbourn Stevens, its president. But it has only five intensive care beds among its 74-bed total.

Drawing on decades of experience with emergency care after hurricanes, the hospital’s staff is decreasing elective-surgery cases and preparing to rapidly increase screening for the new coronavirus.

“I’m very comfortable with our plans right now,” Stevens said. “Disaster planning is in our bones, so to speak. Our team knows how to react.”

But the hospital’s critical-care capacity is limited. North Carolina’s Brunswick County, where it is located, has one bed for every 2,436 residents 60 and older. Such a population could overwhelm the facility in a COVID-19 surge.

If necessary, patients could be transferred to the larger New Hanover Regional Medical Center, a short helicopter ride away, in Wilmington, North Carolina, Stevens said. But with 57 intensive care beds, New Hanover County, which includes Wilmington, still ranks in the lower two-thirds of counties for ICU beds per senior residents.

If the pandemic becomes severe, no amount of critical-care beds will be enough, experts say.

“I liken it to sitting on a Gulf shore when a hurricane is offshore,” said Dr. Graham, from Michigan. “It’s a question of how soon and how hard.”

Maintaining Childhood Immunizations During COVID-19 Pandemic

If a practice can provide only limited well child visits, healthcare providers are encouraged to prioritize newborn care and vaccination of infants and young children (through 24 months of age) when possible.

The COVID-19 pandemic is changing rapidly and continues to affect communities across the United States differently. Some of the strategies used to slow the spread of disease in communities include postponing or cancelling non-urgent elective procedures and using telemedicine instead of face-to-face encounters for routine medical visits.

Ensuring the delivery of newborn and well-child care, including childhood immunization, requires different strategies. Healthcare providers in communities affected by COVID-19 are using strategies to separate well visits from sick visits. Examples include:

• Separating patients spatially, such as by placing patients with sick visits in different areas of the clinic or another location from patients with well visits.

• Collaborating with providers in the community to identify separate locations for holding well visits for children.

Because of personal, practice, or community circumstances related to COVID-19, some providers may not be able to provide well child visits, including provision of immunizations, for all patients in their practice. If a practice can provide only limited well child visits, healthcare providers are encouraged to prioritize newborn care and vaccination of infants and young children (through 24 months of age) when possible.

The U.S. CDC and Maine CDC are monitoring the situation and will continue to provide guidance as it becomes available. Should you have additional questions, please feel free to call the Maine Immunization Program at 207-287-3746.

Thank you for all that you do for the Maine Immunization Program and the children of Maine.

Governor Mills Orders Further Steps to Protect Public Health

Under the authority granted to her during a State of Civil Emergency, Governor Janet Mills issued an Executive Order mandating that all non-essential businesses and operations in Maine close their physical locations that are public facing, meaning those that allow customer, vendor or other in-person contact.

Augusta, MAINE – Under the authority granted to her during a State of Civil Emergency, Governor Janet Mills today issued an Executive Order mandating that all non-essential businesses and operations in Maine close their physical locations that are public facing, meaning those that allow customer, vendor or other in-person contact. The Order also closes non-essential business sites that require more than ten workers to convene in a space where physical distancing is not possible. Non-essential businesses and operations may continue activities that do not involve these types of in-person contact and convenings, and should facilitate the maximum number of employees working remotely.

The Order is effective tomorrow, March 25, 2020 at 12:01 a.m. and extends for a period of 14 days through April 8, 2020 at 12:00 a.m.

It solidifies as a mandate her previous recommendation to close non-essential business sites.

Governor Mills also strongly urged all large, essential, public-facing businesses to immediately employ strategies to reduce congestion in their stores, including limiting the number of customers in the store at any one time and enhancing curbside pick-up and delivery services. These measures, aimed specifically at high-traffic retail stores in Maine that provide essential goods and services, seek to better protect both customers and employees from the threat of COVID-19.

“Today, I am taking further action to mitigate the spread of the virus, to protect the health of our loved ones and fellow citizens, and to safeguard the capacity of our health care system,” said Governor Mills. “I recognize these decisions will create significant difficulties for people and businesses across our state, but we are confronting an unprecedented challenge that is threatening the health and safety of our people.”

“Maine people should live their lives as if COVID-19 is in their community,” said Nirav D. Shah, Director of the Maine Center for Disease Control and Prevention. “Physical distancing in every part of Maine is crucial to limit potential spread of the virus. You can be there for loved ones without being in the same place.”

Governor Mills continues to strongly urge all Maine people to practice physical distancing. She particularly urged Maine residents who are considered at higher risk from COVID-19, such as older Mainers and those with underlying health conditions, to limit physical interactions with other people as much as possible.

Non-essential businesses and operations subject to the Governor’s Executive Order include, but are not limited to, shopping malls, fitness and exercise gyms, spas, barber shops, hair salons, tattoo and piercing parlors, massage facilities, nail technicians, cosmetologists and estheticians, electrolysis services, laser hair removal services, and similar personal care and treatment facilities and services.

The Executive Order excludes businesses that provide essential services including, but not limited to: food processing, agriculture, industrial manufacturing, construction, trash collection, grocery and household goods (including convenience stores), home repair and hardware and auto repair, pharmacy and other medical facilities, biomedical, behavioral health and health care providers, child care, post offices and shipping outlets, insurance, banks, gas stations, laundromats, veterinary clinics and animal feed and supply stores, shipping stores, public transportation, and hotel and commercial lodging.

State government remains open, but offices have significantly moved to telework and dispatch from home, limited client engagement, and have required physical distancing within office buildings. The Department of Administrative and Financial Services estimates that 70 percent of state government employees are working remotely. The Governor urges Maine people to avail themselves of the state’s online services and resources.

For those essential businesses that remain open, Governor Mills strongly urged them to implement physical distancing measures. She specifically urged high-traffic retail stores in Maine that provide essential goods and services to immediately employ strategies to reduce congestion in their stores, including:

These measures come as Governor Mills seeks to strengthen physical distancing measures in Maine to better protect both customers and employees from the threat of COVID-19. Physical distancing is considered one of the most effective methods to help mitigate the spread of COVID-19.

If the function of your business is not listed, but you believe that it is essential, you may request designation as an essential business at https://www.maine.gov/essentialservice

To align with today’s Executive Order, Governor Mills today also renewed her previous Executive Order prohibiting gatherings of more than ten people and the closure of dine-in service at restaurants and bars in Maine to extend its timeframe to April 8, 2020 at 12:00 a.m. Today’s Executive Order does not modify the previous Executive Order in any other manner.

Governor Mills is taking into consideration all COVID-19 response options, including a stay-at-home restriction. She is consulting with the Maine CDC, other clinicians and health system leaders, other states that have invoked this option, and other members of her Coronavirus Response Team. Those discussions are ongoing, and include, but are not limited to the public health efficacy of such orders compared to existing measures, Maine-specific factors, and their potential secondary health and economic implications. The Governor will make recommendations based upon their advice and what she deems is in the best interest of the health and safety of Maine people.

The Governor has taken steps to protect Maine workers and small businesses impacted by COVID-19. Upon Governor Mills’ request, the Small Business Administration (SBA) declared that Maine businesses are now eligible to apply for economic support loans to help them overcome any temporary loss of revenue due to COVID-19. Additionally, the emergency omnibus package she signed temporarily revises eligibility for unemployment insurance to extend it to individuals whose employment has been impacted by COVID-19. It also temporarily waives the one week waiting period for benefits so that workers may obtain benefits faster and ensures that claims for UI will not affect an employer’s experience rating. It also establishes a consumer loan guarantee program through FAME, in partnership with financial institutions, to provide low- or no- interest loans for eligible people in Maine.

These new steps from the Governor build on the work done by the Mills Administration to respond to COVID-19, including:

The best thing that Maine people can do to protect their health is to practice physical distancing and take the same preventive measures that avoid catching a cold: Wash your hands often for 20 seconds. Cover coughs and sneezes. Stay home if you are sick. Symptoms of COVID-19 include fever, shortness of breath, and lower respiratory distress. Call ahead to a health care professional if you develop a fever and symptoms of respiratory illness. Health care providers will make the initial determination on whether COVID-19 testing is necessary.

For more information on Maine’s response to COVID-19 and updated testing results, visit the Maine CDC website.

AMA, AHA, ANA Issue Open Letter Urging Public to #StayHome to Confront COVID-19

The AMA, AHA and ANA issued an open letter today calling on the American people to stay home to help reduce the spread of the novel coronavirus and limit its long-term health effect on our country. Staying at home in this urgent moment is our best defense to turn the tide against COVID-19.

The leading U.S. medical and health organizations today called on the American people to stay home to help reduce the spread of the novel coronavirus (COVID-19) and limit its long-term health effect on our country.

The open letter from the American Medical Association, American Hospital Association, and American Nurses Association is available here.

Physicians, nurses and our entire medical community are urging all people to stay at home. We are honored to serve and put our lives on the front line to protect and save as many lives as possible. But we need your help.

Physical distancing and staying at home are the key to slowing the spread of 2019 novel coronavirus (COVID-19) to give physicians, nurses and everyone on the front lines a fighting chance at having the equipment, time and resources necessary to take on this immense challenge. Those contracting COVID-19 are your family, friends, and loved ones.

That’s why we’re urging the public to #StayHome as we reach the critical stages of our national response to COVID-19. Of course, those with urgent medical needs, including pregnant women, should seek care as needed. Everyone else should #StayHome.

Millions of you are already leading this effort – and we thank you. You’re still connecting with friends and loved ones through video chats, social media or just over the telephone - proving that meaningful social connections can happen at a safe distance. Millions more must join this effort, which is why we’re calling for all-hands-on-deck to confront this public health battle against COVID-19.

Staying at home in this urgent moment is our best defense to turn the tide against COVID-19. Physicians, nurses and health care workers are staying at work for you. Please stay at home for us.

2020 Census Operational Updates March 18, 2020

2020 Census field operations will be suspended for two weeks until April 1, 2020. The public is encouraged to respond to the 2020 Census online at www.my2020census.gov, over the phone or by paper form, if they receive one.

2020 Census field operations will be suspended for two weeks until April 1, 2020. The Census Bureau is taking this step to help protect the health and safety of the American public, Census Bureau employees, and everyone going through the hiring process for temporary census taker positions.
U.S. Census Bureau Director Steven Dillingham on Operational Updates

The public is encouraged to respond to the 2020 Census online at www.my2020census.gov, over the phone or by paper form, if they receive one.

The census is a count of every person who lives in the US and its territories, and it happens every 10 years. In 2020 every household in America will receive a notice to complete the census to count everyone who lives in your home as of April 1, 2020.

Invitations to respond to the 2020 Census will be delivered between March 12-20. Once you receive the invitation, you can respond online, by phone or by mail.

Health care providers have a unique opportunity to remind their patients about the importance of the census. All responses will inform where funding is distributed each year to communities nationwide for clinics, schools, roads and more. In 2016 $4.1 billion of federal funding was allocated to Maine based on census data. Each person not counted is a loss of $15,000-$20,000 of federal funds lost to Maine over the course of 10 years. Children under the age of 5 are the group most commonly undercounted.

Responses to the 2020 Census are safe, secure, protected by federal law, and answers can only be used to produce statistics. For more information, visit 2020CENSUS.GOV.

Nominations for the MMA 2020 Mary Cushman Award for Humanitarian Service

Presented each year by the Maine Medical Association to recognize the humanitarian service of medical volunteers who serve in Maine, the US or abroad.

The Maine Medical Association presents the Mary F. Cushman, MD Award for Exceptional Humanitarian Service as a Medical Volunteer each year. The award was established in 2003 in recognition of the MMA's 150th anniversary.

Nominations for the 2020 Mary Cushman Award are due by July 31, 2020. The award is announced at the MMA's Annual Session in September and includes a $1,000 donation to the institution or organization of the recipient's choice.

MMA Legislative Calls are POSTPONED

The Tuesday evening Legislative Calls hosted by MMA will be postponed until further notice.

In response to the rapidly changing health crisis the Presiding Officers of the Maine Legislature late last week cancelled all committee meetings, including public hearings, work sessions and confirmation hearings for the rest of the session. The one exception was the Appropriations Committee, for various budgetary matters and work related to the Governor’s Supplemental Budget. It was also announced the Legislature would meet one more day to consider bills “directly related to coronavirus response and other critical services, then adjourn.” The Capitol was then closed to the public, with only legislators, staff and media members allowed in the building while lawmakers worked. All bills still not acted upon or under consideration will remain active until the Legislature reconvenes.

Governor Janet Mills issued a proclamation of civil emergency Sunday to help the state cope with the growing outbreak of COVID-19 just days after the Legislature’s announcement.

State House Highlights of the Week

Governor issues executive order closing nonessential businesses; Congress working on a $2 Trillion coronavirus response bill.

Governor Mills Tuesday issued another Executive Order. The latest order did not call for Mainers to shelter at home, however directed all nonessential businesses and operations in Maine close their physical locations to the public. The order takes effect at 12:01 a.m. Wednesday and lasts for two weeks.

It is critical to note, the Executive Order specifically outlines the following health care services as essential:

Biomedical, life science, behavioral health, health care, dental care, long-term care services.

The order also mandates the closure of nonessential business sites that require more than 10 workers to convene in a space where physical distancing is not possible. Nonessential businesses and operations that do not involve in-person contact or allow employees to work remotely can remain open.

The Governor’s press release specifically urged high-traffic retail stores in Maine that provide essential goods and services to immediately employ strategies to reduce congestion in their stores, including:

For stores with a physical retail space of more than 5,000 feet, limiting customers to no more than 100 at any one time,

Marking six-foot measurements by the cashier stations and reminding customers to remain six feet apart while in store,

The order does NOT prevent people from leaving their homes. In fact, the Governor strongly recommended people to continue outside exercise activities such as dog walking while emphasizing proactive social distancing to limit the spread of the virus by urging people to stay away from municipal playgrounds, beaches and avoid all gatherings of people.

The cities of Portland, Bangor and Brunswick also approved more stringent ‘shelter-in-place’ measures this week preventing residents from traveling or leaving their homes except to go to work, buy essential items and groceries, go to the doctor or exercise. Violations of the Portland order are punishable by a fine of up to $500 per person or business for each infraction.

The Republican led United States Senate was finally set to vote Wednesday on $2 trillion coronavirus spending bill. Senate leaders announced in the early hours of the day that a compromise was reached on a bipartisan piece of legislation that was in the works since midweek last week, to help workers, businesses and people nationwide. However, the deal seemingly collapsed midday Wednesday. Regardless, the Democratically led House of Representatives would need to review the final Senate bill after a vote to determine a course of action. House members are scattered around the country and the timetable for votes in that chamber are unclear. There is discussion among House Democratic and Republican leaders to achieve enough members for a voting quorum present and possibly pass the bill for the President signature by a simple voice vote without having to call all representatives back to Washington.

Highlights of the massive 500+ pages piece of legislation would send $1,200 checks to many Americans, create a $367 billion loan program for small businesses, and establish a $500 billion lending fund for industries, cities and states. Other provisions include $150 billion for state and local stimulus funds and $130 billion for hospitals. It would also offer greater unemployment insurance benefits, expanded eligibility and offer workers an additional $600 a week for four months, on top of what states pay. The MMA is still working with the MMA to uncover any direct physician practice provisions.

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.

August 29 - September 1, 2020 (Rescheduled from April 1-4, 2020)
Maine Academy of Family Physicians 28th Annual Family Medicine Update
DoubleTree by Hilton Portland, South Portland, ME
Updated schedule and online registration available at http://www.maineafp.org/cme/mafp-cme-meeting
Contact Deborah Halbach at 207-938-5005 or maineafp@tdstelme.net

October 2, 2020
Maine Society of Eye Physicians and Surgeons Fall Business Meeting
Harborside Hotel & Marina – Bar Harbor, ME
Contact: Shirley Goggin 207-445-2260 or sgoggin@mainemed.com

October 2-4, 2020
19th Annual Downeast Ophthalmology Symposium
(Presented by the Maine Society of Eye Physicians and Surgeons)
Harborside Hotel & Marina – Bar Harbor, ME
Contact: Shirley Goggin 207-445-2260 or sgoggin@mainemed.com

October 8-9, 2020 (Rescheduled from April 16-17, 2020)
Maine Association of Psychiatric Physicians, 14^th Annual Spring Program
Sexual Health in Psychiatric and Medical Practice
Hilton Garden Inn, Freeport, ME
Contact Dianna Poulin at 207-480-4194 or dpoulin@mainemed.com

Next Senior Section Meeting CANCELLED

The next Senior Section meeting at MMA which was to be held Wednesday, April 22nd, is now cancelled.

10th Annual Maine Patient Safety Academy POSTPONED

A tough decision as made to postpone the 10^th Annual Maine Patient Safety Academy which was scheduled to take place on March 30, 2020 at the University of Southern Maine, Abromson Center.

While the current COVID-19 situation in Maine does not call for cancellation of public events, we are taking action out of respect for the many healthcare and public health conference attendees who are fully dedicated to the priorities of preparation and planning for COVID-19.

A number of our presenters are now unable to participate due to their responsibilities to their respective organizations.

At this time, our plan is to put the Academy on hold and reassess the situation later in the spring. With your kind permission, we will leave registrations active instead of immediately instituting a refund process. Once the Academy is rescheduled, registrants will be notified and offered the opportunity to opt out and request a refund if desired.

We remain confident that we will reschedule our amazing plenary speakers and workshop presenters and gather the community of patient safety advocates, healthcare and public health professionals, students and faculty for the 10^th Annual Maine Patient Safety Academy in 2020!

Building Hope Across Populations-Beyond the Basics in Suicide Prevention POSTPONED

The Building Hope Across Populations 2020 - Beyond the Basics in Suicide Prevention conference at the Augusta Civic Center scheduled for April 10th has been postponed to Thursday, October 1, 2020.

Since its inception in 2003, Maine's annual Beyond the Basics in Suicide Prevention Conference has provided Maine health professionals, educators, clinicians, first responders, and community members with best practice information, guidance and resources in suicide prevention and management efforts. The conference is designed for an adult audience that has attained basic training and knowledge in suicide and suicide prevention, and wishes to deepen their understanding of prevention and expand their skills set.

Our theme for the 2020 conference is Building Hope Across Populations, and will include a range of informative breakout sessions centered on how to serve Maine's at-risk, diverse, and growing populations.

This year's conference features national experts on inclusive suicide prevention strategies, as well as local community members, professionals, and clinicians who will address suicide prevention, intervention, and post-vention issues. The program will offer messages of hope and recognize caring citizens who have made a difference in the lives of at-risk Mainers. Featuring keynote speaker Anneliese Singh.

Maine Suicide Prevention Program 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, offers the following suicide prevention, assessment and management trainings. MMA works closely with NAMI-Maine to provide educational opportunities for Maine physicians and other clinical providers.

If you have needs not identified in the above list, please contact Gretchen, NAMI Maine Suicide Prevention Coordinator, to discuss a customized training program.

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

· Depressive Disorders in Children and Adolescents

· Counseling on Access to Lethal Means (CALM)

Webinar on April 16th 6-7pm: Managing Student Debt

Plan to attend this informative financial education session, presented by Baystate Financial.

It's important to take control of your student loan debt - your future well-being likely depends on it.
This session will help you:

Hosted by Christopher Perry, Robert Larochelle and Larry Perry
Baystate Financial
75 Leighton Road, Building 3
Falmouth, ME 04105

Successful Opiate Recovery Strategies - June 3 at 2pm, Augusta Civic Center

Successful Opiate Recovery Strategies
with Dr. Stephen Loyd
A doctor's personal story of substance use and recovery

Postponed until Wednesday, June 3rd at 2pm
Augusta Civic Center
75 Community Drive, Augusta ME

Join us for an afternoon with Dr. Stephen Loyd, a medical practitioner who brings his own personal experiences with addiction to opioids and benzodiazepines to the conversation on substance use and recovery. This event is free and open to the public and is presented in partnership with the City of Augusta.

While there is no charge to attend, please register to reserve your seat. Register Here

BC/BE Family Medicine Physician - Lovejoy Health Center

Lovejoy Health Center, Albion, Maine seeks a BC/BE Family Medicine Physician to provide primary care to patients of all ages.

Lovejoy Health Center, Albion, Maine seeks a BC/BE Family Medicine Physician to provide primary care to patients of all ages. One of 11 practices of HealthReach Community Health Centers, Lovejoy serves 4,000 area residents and travelers each year. The clinician will provide outpatient medical care with integrated behavioral health services to individuals and families in our NCQA certified PCMH outpatient practice.

The selected candidate will receive competitive salary and benefits, malpractice coverage, pension plan with employer match, relocation, and loan repayment opportunities. EOE.

About Lovejoy: Located in Central Maine, Lovejoy Health Center resides in Albion, east of Waterville and west of Belfast, a coastal town. Locals and travelers alike value our farming community, which is home to some of Maine’s largest dairy herds. The community is known for its scenic rolling hills and wide-open fields. A short commute provides residents with job opportunities, shopping centers, four-season outdoor recreational adventures and cultural activities.

Family Medicine Outpatient Physician

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

Maine Medical Partners Westbrook Primary Care is seeking a BC/BE Family Medicine physician for their well-established outpatient practice located in the greater Portland, Maine area. The selected candidate will join 3 family medicine physicians, 4 internal medicine physicians, 4 pediatricians, 4 advanced practice professionals, a pharmacist, behavioral health provider and a geriatrician.

Maine Medical Partners is a division of Maine Medical Center and is Maine's largest multi-specialty medical group serving the healthcare needs of patients locally and throughout northern New England. This high quality team of nearly 600 physicians and 300 advanced practice professionals provides a wide range of hospital based, primary, specialty, and sub-specialty adult and pediatric care delivered throughout a network of 30 locations across the State and acts as a regional referral network.

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 is an integral part of Tufts University Medical School.

For more information please contact Gina Mallozzi, Physician Recruiter at (207) 661-2092 or gmallozzi@mainehealth.org.

Medical Director, Primary Care Physician

Northern Light Sebasticook Valley Health has an exciting physician leadership opportunity for a Board Certified/Board Eligible MD/DO Family Medicine or Internal Medicine Physician to lead our primary care network of three family medicine practices. This is an excellent opportunity to lead a group of well-established, quality driven, outpatient practices serving the greater Pittsfield community. Our team of physicians and NP/MHNP providers 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 old-fashioned 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. This role will be 20% administrative and 80% clinical practice.

The Physician Director of Primary Care will collaborate with the Practice Director for Primary Care to form a dyad partnership in leading our primary care team, as well as provider peripheral oversight for our Walk-In Care and university health center locations.

Northern Light Sebasticook Valley Health 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.

For confidential consideration, please contact:
Sherry Tardy, Physician recruiter
Northern Light Health -Provider Recruitment
PRoviderjobs@NorthernLight.org 207-973-5358 (Office)

Physician - Nasson Health Care

Nasson Health Care is seeking a qualified clinical leader to work collaboratively with a team of health and administrative professionals to provide comprehensive primary care to patients while utilizing the Patient-Centered Medical Home model of care delivery. The Physician provides direct clinical services and works in partnership with members of the practice team to manage the care of patients, assuring a high standard of medical care.

Applicants must have a degree from an accredited medical school in the U.S., Board certification in Family or Internal Medicine, an unrestricted Maine license to practice medicine, as well as a U.S. Drug Enforcement Agency license. Qualifications include:

Springvale is an iconic New England village located in western York County, Maine, less than an hour’s drive from Portland, Maine and Portsmouth, New Hampshire

Visitwww.nassonhealthcare.org for an application. Completed cover letter, resume, and YCCAC employment application will be accepted until March 27, 2020.

York County Community Action Corp.
6 Spruce Street, P.O. Box 72
Sanford, ME 04073
(207)324-5762 or 1-800-965-5762
Fax (207)459-2811
apply@yccac.org
EOE

Nurse Practitioner - Nasson Health Care

Nasson Health Care is seeking a qualified Nurse Practitioner to work collaboratively with a team of health and administrative professionals to provide comprehensive primary care to patients while utilizing the Patient-Centered Medical Home model of care delivery.

Applicants must have a Master’s degree in nursing, an unrestricted Maine license to practice as an adult, family or pediatric nurse practitioner, as well as a U.S. Drug Enforcement Agency license. Qualifications include:

Visit www.yccac.org for an application. Completed cover letter, resume, and YCCAC employment application will be accepted until March 27, 2020.

York County Community Action Corp.
6 Spruce Street, P.O. Box 72
Sanford, ME 04073
(207)324-5762 or 1-800-965-5762
Fax (207)459-2811
apply@yccac.org
EOE

Psychiatric Nurse Practitioner - Nasson Health Care

Visit www.yccac.org for an application. Completed cover letter, resume, and YCCAC employment application will be accepted until March 27, 2020.

York County Community Action Corp.
6 Spruce Street, P.O. Box 72
Sanford, ME 04073
(207)324-5762 or 1-800-965-5762
Fax (207)459-2811
apply@yccac.org
EOE

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.

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.

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:

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!

Maine Medicine Weekly Update - March 25, 2020
(Print All Articles)

Telehealth Town Hall for Maine Healthcare Providers Thursday, March 26th, 2020

Governor Mills Acts to Promote Access to Health Care During COVID-19

Important Information from Maine CDC

AMA Releases Special Coding Advice Related to COVID-19

A Message from Maine Responds

Millions Of Older Americans Live In Counties With No ICU Beds As Pandemic Intensifies

Millions Of Older Americans Live In Counties With No ICU Beds As Pandemic Intensifies

Maintaining Childhood Immunizations During COVID-19 Pandemic

Governor Mills Orders Further Steps to Protect Public Health

AMA, AHA, ANA Issue Open Letter Urging Public to #StayHome to Confront COVID-19

2020 Census Operational Updates March 18, 2020

Nominations for the MMA 2020 Mary Cushman Award for Humanitarian Service

MMA Legislative Calls are POSTPONED

State House Highlights of the Week

Upcoming Specialty Society Meetings

Next Senior Section Meeting CANCELLED

10th Annual Maine Patient Safety Academy POSTPONED

Building Hope Across Populations-Beyond the Basics in Suicide Prevention POSTPONED

Maine Suicide Prevention Program Training for Clinicians

Webinar on April 16th 6-7pm: Managing Student Debt

Successful Opiate Recovery Strategies - June 3 at 2pm, Augusta Civic Center

BC/BE Family Medicine Physician - Lovejoy Health Center

Family Medicine Outpatient Physician

Medical Director, Primary Care Physician

Physician - Nasson Health Care

Nurse Practitioner - Nasson Health Care

Psychiatric Nurse Practitioner - Nasson Health Care

Family Medicine Opportunity in Beautiful Western Maine

Orthopedic Surgeon Opportunity in Beautiful New England

Opportunities at the VA for Volunteer Physicians

Volunteer Opportunity with Partners for World Health - Portland, ME

Maine Medicine Weekly Update - March 25, 2020(Print All Articles)

Telehealth Town Hall for Maine Healthcare Providers Thursday, March 26th, 2020

Governor Mills Acts to Promote Access to Health Care During COVID-19

Important Information from Maine CDC

AMA Releases Special Coding Advice Related to COVID-19

A Message from Maine Responds

Millions Of Older Americans Live In Counties With No ICU Beds As Pandemic Intensifies

Millions Of Older Americans Live In Counties With No ICU Beds As Pandemic Intensifies

Maintaining Childhood Immunizations During COVID-19 Pandemic

Governor Mills Orders Further Steps to Protect Public Health

AMA, AHA, ANA Issue Open Letter Urging Public to #StayHome to Confront COVID-19

2020 Census Operational Updates March 18, 2020

Nominations for the MMA 2020 Mary Cushman Award for Humanitarian Service

MMA Legislative Calls are POSTPONED

State House Highlights of the Week

Upcoming Specialty Society Meetings

Next Senior Section Meeting CANCELLED

10th Annual Maine Patient Safety Academy POSTPONED

Building Hope Across Populations-Beyond the Basics in Suicide Prevention POSTPONED

Maine Suicide Prevention Program Training for Clinicians

Webinar on April 16th 6-7pm: Managing Student Debt

Successful Opiate Recovery Strategies - June 3 at 2pm, Augusta Civic Center

BC/BE Family Medicine Physician - Lovejoy Health Center

Family Medicine Outpatient Physician

Medical Director, Primary Care Physician

Physician - Nasson Health Care

Nurse Practitioner - Nasson Health Care

Psychiatric Nurse Practitioner - Nasson Health Care

Family Medicine Opportunity in Beautiful Western Maine

Orthopedic Surgeon Opportunity in Beautiful New England

Opportunities at the VA for Volunteer Physicians

Volunteer Opportunity with Partners for World Health - Portland, ME

Maine Medicine Weekly Update - March 25, 2020
(Print All Articles)