Wake County Physican Magazine April 2014 by Tina Frost

contents

betsy tilson receives 2014 health care hero award

doing something differentâ&#x20AC;&#x201D;wcms alliance update

6 7 8

welcome new wcms members improving medication compliance navigating the new health insurance marketplace

why join wcms

the madness of lady macbeth: the other tragedy

ncms spearheads initiative to educate health community on accountable care

wcms thanks project access practices and physicians for the donated care provided in 2013!

WAKE COUNTY PHYSICIAN | 1

contributors

WCPM

April 2014

Publisher Wake County Medical Society Editor Paul Harrison Wake County Medical Society Officers and Executive Council

Council Terry Brenneman, MD Members Maggie Burkhead, MD Warner L. Hall, MD Ken Holt, MD M. Dixon McKay, MD Assad Meymandi, MD, PhD, DLFAPA Robert Munt, MD Patricia Pearce, MD Derek Schroder, MD Michael Thomas, MD Brad Wasserman, MD Andrew Wu, MD

WCMS Deb Meehan Alliance Louise Wilson Co-Presidents

Wake County Medical Society 2500 Blue Ridge Road, Suite 330 Raleigh, NC 27607 Phone: 919.792.3644 Fax: 919.510.9162 dearp@wakedocs.org www.wakedocs.org

“The Wake County Physician Magazine is an instrument of the Wake County Medical Society; however, the views expressed are not necessarily the opinion of the Editorial Board or the Society.” 2 | APRIL 2014

L. Jarrett Barnhill, MD

is a professor of Psychiatry at the UNC School of Medicine and the director of the Developmental Neuropharmacology Clinic within the Department of Psychiatry. He is a Distinguished Fellow in the American Psychiatric Association and Fellow in the American Academy of Child and Adolescent Psychiatry.

Deborah Owens

is a Federally Facilitated Marketplace (FFM) Navigator working in Wake and Johnston Counties.

Melanie Phelps

is Associate Executive Director, NCMS Foundation, Deputy General Counsel (NCMS).

Ben MacDonald

is a care management nurse with Community Care of Wake and Johnston Counties. He also holds a degree in English Literature from UNC-Asheville.

Angela McGee, PharmD

is a clinical pharmacist that started working for Community Care of Wake and Johnston Counties in July 2013. She received her Bachelor of Science degree in Biology from North Carolina State University in 2005 and her Doctorate of Pharmacy degree from the University of North Carolina-Chapel Hill in 2009. Angela’s primary role with Community Care of Wake and Johnston Counties is to perform medication reconciliation in collaboration with care managers and to communicate and follow-up with primary care physicians on drug therapy problems identified for patients.

Deborah Harrell Meehan

As a physician’s spouse, Deborah responded to a personal invitation to join the Wake County Medical Society Alliance in 2006, a non-profit organization dedicated to bringing together the families of the medical community. After years of service in various roles, Deborah is currently the co-president of the Wake County Medical Society Alliance and serves on the Board of Directors for the North Carolina State Medical Alliance. She continues to serve the community as an advocate for the empowerment of women and the health and safety of women and children everywhere. Deborah and her husband, Dr. David V. Meehan, are parents to eight wonderful children and three granddaughters.

Additional contributors include:

Paul Harrison | Executive Director, WCMS Pam Carpenter | Project Access Deborah Earp | Membership Manager, WCMS

Dear WCMS Executive Council Members, Please note the following Executive Council meeting dates for 2014. Dates: May 13, 2014 Sept. 9, 2014 Nov. 11, 2014 Time:

All meetings will take place at 6pm

Where: 2500 Blue Ridge Rd. #330 | Raleigh NC 27607 A light dinner will be served at each meeting. On behalf of Susan Davis, Executive Director of Community Health Foundation and myself, we look forward to working with you throughout 2014. Thank you, Paul Harrison Executive Director Wake County Medical Society

Wake County Physician Magazine (WCPM) is a publication for and by the members of the Wake County Medical Society. WCPM is a quarterly publication and is digitately published January, July, April, and October. All submissions including ads, bio’s, photo’s and camera ready art work for the WCPM should be directed to: Tina Frost Graphic Editor WCPM tina@tinafrost.com 919.671.3963 Photographs or illustrations: Submit as high resolution 5” x 7” or 8” x 10” glossy prints or a digital JPEG or TIF file at 300 DPI no larger than 2” x 3” unless the artwork is for the cover. Please include names of individuals or subject matter for each image submitted. Contributing author bio’s and photo requirements: Submit a recent 3” x 5” or 5” x 7” black and white or color photo (snapshots are suitable) along with your submission for publication or a digital JPEG or TIF file at 300 DPI no larger than 2” x 3”. All photos will be returned to the author. Include a brief bio along with your practice name, specialty, special honors or any positions on boards, etc. Please limit the length of your bio to 3 or 4 lines. Ad Rates and Specifications: Full Page $800 1/2 Page $400 1/4 Page $200

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This year’s Health Care Heroes Award goes to... Betsy Tilson By Ben MacDonald

n Thursday, March 20th, Triangle Business Journal hosted the 2014 Health Care Heroes Awards at the Marriot City Center in Raleigh. According to Bryan Hamilton, publisher of Triangle Business Journal, “these awards were created to recognize the many people who have put innovation and compassion to work to improve the human condition. The winners exemplify what it means to be heroes. Whether serving those in need or striving for innovation, these heroes do whatever it takes to offer critical services to change people’s lives.” In consideration of this spirit of innovation and service, Elizabeth Cuervo Tilson, MD, MPH, was selected as a winner in the 2014 Health Care Heroes Award in the “physician” category. Dr. Tilson is Board Certified in Preventive Medicine and Pediatrics, and serves patients in our community on two levels: as a practicing pediatrician in a safety net clinic in Wake County, and as a leader in population health with Community Care of Wake and Johnston Counties (CCWJC), a regional network of Community Care of North Carolina (CCNC). In her direct patient care role, Dr. Tilson provides pediatric primary care in the Wake County Human Services (WCHS) Child Health 4 | APRIL 2014

Clinic. Dr. Tilson’s work at WCHS is closely tied to quality improvement initiatives that have led to improved patient outcomes. Asthma is a major practice focus and the clinic is a leader in this area, having met 100% of the key quality metrics for asthma care for the past 3 years. There has also been a dramatic decrease in the rate of asthma related ED visits and hospitalizations for the patient population. In addition to her role at WCHS, Dr. Tilson’s training in prevention and public health allows her to significantly impact the health of her local community, and to demonstrate “best practice” for other health care professions through her role as the Medical Director of Community Care of Wake and Johnston Counties (CCWJC). CCWJC is one of the regional networks of the statewide CCNC program. The CCNC networks provide population health, quality improvement, and care management services for Medicaid and other populations. The CCWJC network is administered through the Wake County Medical Society Community Health Foundation and encompasses approximately 155 primary care practices and 120,000 Medicaid patients and other populations. In her role as Medical Director, Dr. Tilson directs clinical initiatives, leads an internal team of physicians, fosters strategic [continued on page 20]

wcms alliance update

Doing Something Different

eaching into the same bag of tricks inevitably leads to repeating the same ol’ same ol’…especially if you have a small bag and a limited number of tricks! Telling the same great joke eventually gets boring…How many times can you laugh at the same punch line? If you haven’t already heard, this year’s WCMSA has broken out of the normal and somewhat expected routine. I can honestly say that with the active and passionate leadership of our Board of Directors, we have infused energy and enthusiasm into our mission, setting sparks… if not FIRES… of creativity, thus breathing new life into the organization! And…WE LOVE IT! On Sunday, March 2, the evening of the Academy Awards, we threw our FIRST EVER

Oscar Pre-Party Event from 5 – 7pm. Hosted by Dan and Karen Albright, their home was transformed into a Hollywood mansion, complete with a Red Carpet photo shoot, mini statues, catered delicacies and endless bubbly! We used this opportunity as a fundraising event for our target organization, F.I.G.S., selling raffle tickets to vote for our choice of Oscar Nominees in six categories...AND…there were great prizes! Not only did we raise significant dollars for our charitable organization, but we also recruited 3 new members for the Alliance and had a total blast doing it! It’s simply amazing what a few fresh ideas, combined with that spark of creativity can do to take your organization to the next level! Watch out…There’s more to come! Cheers! Deborah Harrell Meehan Co-President, Wake County Medical Society Alliance, 2013-2014

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Kevin M. Bowman, MD Practice: Raleigh Ophthalmology Speciality: Ophthalmology Medical School: Wake Forest University School of Medicine Graduation: 2008 Hobbies: Hiking, camping, kayaking Matthew Kanaan, DO, MS, CAQSM Spouse: Amanda Kanaan Practice: Wake Sports Medicine Speciality: Primary Care Sports Medicine / Nonsurgical Orthopedics Medical School: Lake Erie College of Osteopathic Medicine Graduation: 2009 Hobbies: golf, tennis Marshall A. Kuremsky, MD Spouse: Cara Kuremsky Practice: Triangle Orthopaedic Associates Speciality: Orthopaedic Surgery Medical School: Columbia University, College of Physicians & Surgeons Class of: 2003 Michael (Mike) F. Soboeiro, MD Spouse: Elizabeth Soboeiro Practice: WakeMed Garner Primary Care Speciality: Internal Medicine Medical School: UNC Graduation: 1991 Hobbies: Golf, church, yoga, social justice 6 | APRIL 2014

Peter H. Adler, MD | Emergency Medicine William T. Bradford, MD | American Anesthesiology of NC-Wake Practice Center Edwin R. Cadet, MD | Raleigh Orthopaedic Clinic William T. Cushing, MD, MBA, JD | William T. Cushing, MD, JD Robin L. Elledge, PA-C | Bariatric Specialists of North Carolina Maxlyn L. V. Ellison, MD | Ellison & Associates of Raleigh J. Todd Harris, MD | Raleigh Children & Adolescent Medicine Kimberly D. Jones, PA-C | Triangle Orthopaedic Associates Andreas W. Linke, PA | Fast Med Urgent Care Kimberly Livingston, MD | WakeMed Faculty Physicians Jennifer L. R. Long, MD | Raleigh Children & Adolescent Medicine Nisha T. Manickam, DO | Raleigh Infectious Diseases Associates Lori A. McLamb, PA-C | Raleigh Orthopaedic Clinic Ishtiaque H. Mohiuddin, MD | Premier Cardiovascular Lanning R. Newell, MD | Triangle Gastroenterology Jessica Oâ&#x20AC;&#x2122;Neill, PA-C | Wake Nephrology Associates Alison S. Powell, MD | American Anesthesiology of NC-Wake Practice Center Carl L. Smith, DO | Triangle Orthopaedic Associates Sarah Stout, PA-C | Bariatric Specialists of North Carolina Christopher M. Terry, MD | American Anesthesiology of NC-Wake Practice Center Donna A. Theodore, PA | Wake Nephrology Associates Anne T. Tuveson, MD | Wake Dermatology Associates Frank J. Wessels, MD | Saleeby & Wessels, MD Sung-Eun Yoo, MD | Cary Endocrine & Diabetes Center

3.8 billion

prescriptions are written

every year in the United States, yet more than

50% of them are taken incorrectly or not taken at all. Non-compliance continues to be an epidemic that is contributing to poor outcomes for patients with chronic diseases and increased costs to the health care system, as it accounts for 33-69% of medication-related adverse events resulting in hospital admissions. Compliance remains poor even after life-threatening events such as an MI. Research has shown that within 2 years of starting therapy post-hospitalization for an acute MI, only half of patients were still taking prescribed statins, beta-blockers, ACE inhibitors, or ARBâ&#x20AC;&#x2122;s. The question still remains: How can we get patients to be more compliant and what steps are we taking locally in our community to improve these staggering statistics? Compliance is such a challenge due to its complexity and unfortunately there is no universal solution. Multiple factors can play a role in patient non-compliance and reasons why patients may go off-regimen vary from person to person, but may include forgetfulness, perceived side effects, denial, lack of knowledge, financial barriers, psychological barriers, health literacy, complexity of regimen, and provider-patient relationship. From a provider standpoint, it is becoming more difficult for them to engage patients in conversations and explore how patients view their chronic diseases and medications due to time constraints. Strengthening the provider-patient relationship is one stepping stone that may have a positive influence on patient behaviors and they may therefore be more likely to comply with the recommendations and advice provided to them. Community Care of Wake and Johnston Countiesâ&#x20AC;&#x2122; multi-disciplinary team of nurses, social workers, pharmacists, patient coordinators and provider services specialists act as extensions to a patientâ&#x20AC;&#x2122;s primary medical home to assist with and facilitate coordination of care in an effort to improve patient outcomes. When a patient is discharged from the hospital, a patient coordinator follows up with them within 72 hours and attempts to make arrangements for a care manager to complete a home visit with the patient to assess for potential care deficits. Data including discharge information and medication lists from multiple sources are gathered prior to a home visit. Medications are assessed during the

Improving Medication Compliance: A Collaborative Approach By Angela McGee

home visit and compliance is evaluated with the use of open-ended questions and motivational interviewing techniques to determine if there are specific barriers patients may have to taking certain medications as directed. CCWJC pharmacists work collaboratively with care managers to look for any additional drug therapy problems and provide reporting to physicians for any concerns, including compliance issues, requiring notification or follow-up. CCWJC also partners with local pharmacies in our community that participate and engage in programs to address some of the socioeconomic, patient-related, and therapyrelated concerns that lead to compliance issues. Some of the services currently offered include synchronizing and blister packaging medications, filling pill boxes, delivering medications, and coordinating payment plans in cases where there are financial barriers to taking medications, which CCWJC finds is a major burden for many of our patients. For a list of local pharmacies involved in some of these specialty services in the Wake and Johnston County area please email your CCWJC network pharmacy representative at Pharmacy@wakedocs.org. The concept of improving compliance seems [continued on page 15]

WAKE COUNTY PHYSICIAN | 7

y father was a physician in a small town in eastern North Carolina. His hero was Margaret Thatcher and so our discussions on health care delivery touched on the evolution of the American and British systems and lots of free-wheeling discussions of the efficacies, judgments, economics and political considerations inherent in the practice of American medicine. He was a great diagnostician, opined that the only two good things to ever come out of

and insurance plans are more comprehensive. One of the biggest impacts is the access to affordable insurance for people who were uninsured, underinsured, or unable to afford comprehensive health plans. People can now go online, call or mail in applications for coverage, receive assistance by phone or in-person, and easily compare plans whose benefits are clearly and simply spelled out. The CapitalCare Collaborative (CCC) has long had a focus on increasing access to health care

Navigating the New Health Insurance Marketplace By Deborah Owens Boston were anesthesia and the New England Journal of Medicine, and like his hero Maggie, considered himself an old school Conservative. His voice is one of the many things that run through my head each day as I meet with clients as a Navigator for the Health Insurance Marketplace (HIM). The Affordable Care Act (ACA) has brought about some significant changes for many people. Young adults can remain on their parentsâ&#x20AC;&#x2122; insurance, pre-existing conditions donâ&#x20AC;&#x2122;t affect eligibility for coverage, lifetime and yearly coverage limits have been eliminated, 8 | APRIL 2014

for the uninsured, so when the opportunity arose to join a consortium in order to apply for funds to bring on HIM Navigators, it was an easy decision. This initiative fit well with our mission, and because of our partnerships and collaborations we were confident that we could play a big role in getting people in Wake and Johnston Counties connected with affordable coverage. Open Enrollment began October 1, 2013 and runs through March 31, 2014, but the first couple of months were problematic with the www.healthcare.gov system. Much of the time Navigators spent with consumers was spent on [continued on page 18]

WHERE IN RALEIGH?

Rotunda, North Carolina State Capitol, Raleigh, North Carolina Ranked #27 of 135 attractions in Raleigh Created Date:1833 to 1840 Architectural Note: The structure is one of North Carolinaâ&#x20AC;&#x2122;s finest and best preserved Greek Revival public buildings. A sequence of architects were involved in the project. Nichols functioned only in the capacity of architect on this project In 1970, a marble replica of the Canova Washington was added. The building was restored to its original paint colors and granitizing in the 1990s. Historical Note: The building is listed on the National Register of Historic Places, both as a North Carolina Historic Site and as a National Historic Landmark. Photo by John Elk

WAKE COUNTY PHYSICIAN | 9

American Anesthesiology of NC Ajinder Chhabra, MD Al Melvin, MD Amanda Crow, MD Amanda Froment, MD Andrew Lutz, MD Asra Ali, MD Benjamin Antonio, MD Bruce Janson, MD Brendon Howes, MD Bryan Max, MD Carrie Gill-Murdoch, MD Charles Nicholson, MD Christa Gray, MD Clarence Huggins, MD Daniel Amitie, MD Deborah Pellegrini (Quint), MD Deitra Williams-Toone, MD Donald Edmondson, MD Earl Crumpler, Jr. 10 | APRIL 2014

Edgar Garrabrant, III, MD Edward Bratzke, MD Elee Stewart, MD Erhan Atasoy, MD Eric Mason, MD Francis “Fran” Abdou, MD Francis “Greg” Brusino, MD Gerald Maccioli, MD Hsiupei Chen, MD Jack Lam, MD Jafar Shick, MD James Collawn, MD James Cummings, II, MD Jeremy Reading, MD John McDowell, MD Jonathan Blank, MD Justin Hauser, MD Karen Meyers, MD Kassell Sykes, Jr., MD Keith Kittelberger, MD

Kimberly Greenwald, MD Manu Gupta, MD Matthew Atkins, MD Melanie Lutz, MD Michael Hauser, MD Michael Lish, MD Michael Neville, MD Nathan Christie, MD Nevin Shrimanker, MD Nicole Scouras, MD Paul Woodard, MD Ralph Ramos, MD Randy Efrid, MD Reed VanMatre, MD Robert Alphin, MD Robert Marshall, III, MD Robert “Paul” Rieker, Jr., MD Robert Seymour, III, MD Robert Treadway, Jr., MD Ronald Gore, MD

Russell Ford, MD Scott Garrison, MD Scott Tyrey, MD Shawn Kruse, MD Shehzad Choudry, MD Sherman Lee, MD Stephen Rogers, MD Steven Sherman, MD Susan Steele, MD Thomas Buchheit, MD Thomas Monaco, MD Timothy Gruebel, MD Vincent Hoellerich, MD Walter Daniel, MD Wendell Zee, MD Whitney Scott, MD William Bolding, MD William Corkey, MD William Crocker, MD Andrus & Associates Dermatology, PA Rebekah M. Oyler, MD Associated Urologists of North Carolina Mark Jalkut, MD Timothy P. Bukowski, MD Steven Shaban, MD Brian Bennett, MD Scott Baker, MD Marc Benevides, MD Daniel Khera McRackan, MD Joseph Neighbors, MD AUNC Cary Urology PA Kevin Khoudary, MD Kevin Perry, MD Frank Tortora, MD William Kizer, MD Bariatric Specialists of NC Michael A. Tyner, MD Cancer Centers of North Carolina Alan Kritz, MD Charles F. Eisenbeis, MD PhD Elizabeth Campbell, MD John Reilly, MD Margaret Deutsch, MD Mark Yoffe, MD Neeraj Agrawal, MD P.J. Singh, MD

Roy Cromartie, MD Scott Sailer, MD Stephen Tremont, MD Virgil Rose, MD William Berry, MD John F. Reilly, MD Scott D. Meredith, MD Monica B. Jones, MD Capital Area Ob-Gyn Associates, PA Christin N. Richardson, MD George M. Tosky, MD Katherine E. Barrett, MD Michael F. Buckley, MD Paige L. Gausmann, MD Capital Nephrology Associates, PA Daniel W. Koenig, MD Frederick S. Jones, MD James E. Godwin, MD Jeffrey G. Hoggard, MD Kevin M. Lee, MD Michael I. Oliverio, MD Prabhakar N. Vaidya, MD Capital Neurology & Headache Center David H. Cook, MD Capitol Ear Nose & Throat, PA David A. Clark, MD H. Craig Price, MD Jeevan Ramakrishnan, MD Mark S. Brown, MD R. Glen Medders, MD Stanley Wilkins, MD Steven H. Dennis, MD Capitol Raleigh ENT H. Clifton Patterson, MD Kevin M. Doyle, MD Laura Devereux Brown, MD Mark W. Clarkson, MD Matthew J. Gerber, MD Stephen E. Boyce, MD Steven J. McMahon, MD William F. Durland, Jr., MD Caroling Cardiology - WMFP William Parsons, MD James Nutt, MD

Carolina Endocrine, P.A. Michael J. Thomas, MD, PhD Khushbu Chandarana, MD Courtney Koppenal, PA-C Ellie Andres, PA-C Cary Dermatology Catherine Hren, MD Heidi Mangelsdorf, MD Cary Ob-Gyn Michael Anthony, MD Sharon Stephenson, MD Centre Ob-Gyn Ann Collins, MD Erika Clark, MD Jerome Gardner, MD Randolph Scott, MD Robert Littleton, MD Tanneisha Barlow, MD Creedmoor Centre Endocrinology Julia Warren-Ulanch, MD Dermatology Skin Cancer Center Eric D. Challgren, MD Gregory J. Wilmoth, MD Laura D. Briley, MD Margaret B. Boyse, MD W. Stacy Miller, MD Tracey S. Cloninger, PA-C Digestive Healthcare Murtaza K. Parekh, MD Colm Oâ&#x20AC;&#x2122;Loughlin, MD Karen Saville, FNP Kenneth R. Kohagen, MD M. Dixon McKay, MD Ruth Mokeba, MD Naveen V. Narahari, MD Rig S. Patel, MD Duke Cardiology of Raleigh Lawrence Liao, MD Radha Kachhy, MD James Peterson, MD Mark Leithe, MD Stephen Robinson, MD Duke Cancer Center of Raleigh Michael Spiritos, MD Sharon Taylor, MD Yuri Fesko, MD

[continued on page 12]

WAKE COUNTY PHYSICIAN | 11

Duke Eye Center of Raleigh Christopher Boehlke, MD Eric Postel, MD Grace Prakalapakorn, MD Jason Liss, MD Leon Herndon, MD Paul Hahn, MD Duke Gastroenterology of Raleigh Aaron Woofter, MD Jane Onken, MD Jesse Liu, MD Michael Feiler, MD Rebecca Burbridge, MD Duke Neurology of Raleigh Paul Peterson, MD Duke Otolaryngology of Raleigh Seth Cohen, MD Duke Radiology of Raleigh Alan Rosen, MD Marc Finkel, MD Morgan Camp, MD Robert Vogler, MD Tedric Boyse, MD Vernon W. Pugh, III, MD Duke Thoracic Surgery David White, MD Katie Gillis, PA-C ENT & Audiology Associates Douglas K. Holmes, MD Eye Specialists of Carolina Demetrius Dornic, MD Friendship Medical Center Annette Troy, MD Fuquay Chiropractic & Wellness Cente, PLLC Jill M. Miehe Currin, DC Joyner Ophthalmology Walton Joyner, MD Kamm, McKenzie, Harden, Smith, Bass Ashley N. Rush, MD Brian Bass, MD 12 | APRIL 2014

Crystal Privette, MD Cynthia Saacks, MD Joel M. Berstien, MD Lauren M. Wheeler, MD Michael D. Smith, MD Paul B. Harden, Jr., MD Sheppard McKenzie, III, MD Mann ENT Charles H. Mann, MD Jared E. Spector, MD Richard M. Jones, MD Mid Carolina Obstetrics & Gynecology, PC Amy O. Groff, MD Eloise Watson, MD Leon F. Woodruff, MD Myra Lynn Teasley, MD Ruth Wind, MD Sarah Maddison, MD Orthopaedic Foot & Ankle Sarah E. Dewitt, MD Piedmont Foot & Ankle Clinic, PA Jason E Nolan, DPM Richard J. Hauser, DPM Robert J. Lenfestey, DPM Raleigh Endocrine Associates Elizabeth M. Holt, MD Raleigh Endoscopy Center Raleigh Infectious Diseases Christopher Ingram, MD Edwin Brown, MD Henry Radziewicz, MD Henry T. Radziewicz, MD John Engemann, MD Nisha Manickam, MD Paul Becherer, MD Ravi Padmanabhan, MD Debra Kosko, FNP Diane Tilley, FNP Drew Bullington, ANP Laurie Hogan, ANP Raleigh Neurology Associates, PA A. Thomas Perkins, MD David Konanc, MD Eric Kirch, PA-C

Gregory Bertics, MD Karen Riley, NP Katharine Kovacs, PA-C Keith Hull, MD Kelly Pate, NP Kenneth Carnes, MD Michael Bowman, MD Patricia Naslund, MD Pavan Yerramsetty, MD Rhonda Gabr, MD S. Mitchell Freedman, MD Scott Binford, PA-C Susan Glenn, MD Theresa Behil, NP Wanda Cecil, NP William Ferrell, MD Raleigh Neurosurgical Clinic Robin Koeleveld, MD Raleigh Ophthalmology & Surgical Eye Associates Timothy Jordan, MD Raleigh Orthopaedic Clinic Bradley K. Vaughn, MD Cara B. Siegel, MD Carroll D. Kratzer, MD Daniel J. Albright, MD David W. Boone, MD Dwayne E. Patterson, MD G. Hadley Callaway, MD Harrison Gray Tuttle, MD Jeffrey K. Kobs, MD John B. Chiavetta, MD Joseph U. Barker, MD Keith P. Mankin, MD Kevin Logel, MD Leonard D. Nelson, Jr., MD Lyman S.W. Smith, MD Mark R. Mikles, MD Matthew T. Boes, MD Neil C. Vining, MD Robert T. Wyker, MD Scott M. Wein, MD Wallace F. Andrew, MD William M. Isbell, MD Raleigh Pathology Labs Raleigh Plastic Surgery Glenn Lyle, MD Rhett High, MD Raleigh Radiology Andrew B. Weber, MD

Andrew G. Moran, MD Cynthia S. Payne, MD Donald G. Detweiler, MD Gintaras E. Degesys, MD Gregory A. Bortoff, MD Gregory C. Hinn, MD Jason R. Harris, MD Jeffrey Browne, MD Jennifer S. Van Vickle, MD Jerry L. Watson, MD John G. Alley, Jr., MD Joshua B. Mitchell, MD Juilia K. Taber, MD Kirk D. Peterson, MD Laura O. Thomas, MD Mark H. Knelson, MD Michael C. Hollingshead, MD Neil A. Ramquist, MD Satish Mathan, MD Steven R. Carter, MD Svati Singla Long, MD Todd J. Roth, MD Tracey E. Oâ&#x20AC;&#x2122;Connell, MD W. Kent Davis, MD Rex Heart & Vascular George Adams, MD James G. Jollis, MD, FACC Sameh K. Mobarek, M.D., F.A.C.C. Deepak Pasi, M.D., F.R.C.P., F.A.C.C., F.S.C.A.I., F.A.A.C. Mohit Pasi, M.D., F.A.C.C., F.S.C.A.I. Bruce Usher Jr., M.D., F.A.C.C. Ben Walker, M.D. James Zidar, M.D. F.A.C.C, F.S.C.A.I. Rex Hematology Oncology Associates Marie Carr, PA Ashley Bragg, PA Clare Bremer, PA Denise Pescaro, NP Jeremiah Boles, MD Nirav Dhruva, MD Maha Elkordy, MD Erin Adcock, PA Jeffrey Crane, MD JoEllen Speca, MD Lola Olajide, MD Susan Moore, MD Beverly Neely, NP Robert Wehbie, MD

Rex Pathology Associates F. Catrina Reading, MD John D. Benson, MD John P. Sorge, MD Keith V. Nance, MD Preeti P. Parekh, MD Keith Volmar, MD Timothy R. Carter, MD Vincent C. Smith, MD Rex Surgical Specialists Dustin M. Bermudez, M.D. Tricia A. Burns, P.A.-C. Woodward Cannon, M.D., F.A.C.S. Richard A. Chiulli, M.D., F.A.C.S. Joel B. Dragelin, M.D., F.A.C.S. David B. Eddleman, M.D., F.A.C.S. Kirk B. Faust, M.D., F.A.C.S. Rachel Goble, D.O. Thomas W. Maddox, M.D., F.A.C.S. Peter M. Milano, M.D., F.A.C.S. Peter C. Ng, M.D., F.A.C.S. Paul B. Park, M.D. Yale D. Podnos, M.D., F.A.C.S. David C. Powell, M.D., F.A.C.S., R.P.V.I. Lindsey S. Sharp, M.D. David, A. Smith, M.D. Jerry A. Stirman, M.D., F.A.C.S. Matthew J. Strouch M.D.

Daniel R. Vig, M.D., F.A.C.S. Seth M. Weinreb, M.D., F.A.C.S. Rex/UNC Radiation Oncology Catherine Lee, MD Charles W. Scarantino Justin Wu, MD Lawrence Marks, MD Leroy Hoffman, MD Robert Ornitz, MD Roger F. Anderson, MD Richard D. Adelman, MD Richard D. Adelman, MD Donna Griffith Kathleen Janus, FNP Southern Eye Associates Jerome Magolan, MD Philip Martin, MD TaylorRetinal Center Jeffrey Taylor, MD J. Carey Pate, MD Nitin Gupta, MD The Raleigh Eye Center Alice Lin, MD Holly P. Johnson, MD James W. Kiley, MD R. Jeffrey Board, MD

[continued on page 14]

WAKE COUNTY PHYSICIAN | 13

Triangle Radiation Oncology Triangle Orthopaedic Associates, PA Brett J. Gilbert, MD David B. Musante, MD Elliot Kopp, MD (rheum) Eugenia F. Zimmerman, MD Joseph B. Wilson, MD Kurt J. Ehlert, MD Mark A. Burt, MD Paul J. Kemer, MD Perico N. Arcedo, DO Shepherd F. Rosenblum, MD Tony Ning, MD (rheum) William D. Hage, MD William P. Silver, MD Wake Endoscopy Center Chris Schwarz, MD Michael Battaglino, MD Monica Manzi, PA-C Neeraj Sachdeva, MD Ronald Schwarz, MD Subhash Gumber, MD Tracy Jones, PA-C Wake Gastroenterology Bulent Ender, MD Wake Nephrology Associates, PA Karn Gupta, MD Mark Rothman, MD Michael Casey, MD Michael Monahan, MD Phillip Timmons, MD Sammy Moghazi, MD Samsher Sonawane, MD Sejan Patel, MD

William Fan, MD Wake Opthalmology Associates Robert Stone, Jr., MD Christopher Rusinek, MD Wake Radiology Consultants, PA Wake Radiology Diagnostic Imaging, Inc. Wake Radiology Oncology Services Alan B. Fein, MD Andrew C. Wu, MD Andrew S. Kennedy, MD Brent Townsend, MD Bryan M. Peters, MD Carmello Gullotto, MD Carroll C. Overton, MD Catherine Lerner, MD Charles V. Pope, MD Claire M. Poyet, MD Danielle L. Wellman, MD David Ling, MD David Schulz, MD Dennis M. Oâ&#x20AC;&#x2122;Donnell, MD Duncan Rougier-Chapman, MD Eithne T. Burke, MD Elizabeth A. Rush, MD G. Glenn Coates MS, MD Holly J. Burge, MD Imre Gaal, Jr., MD J. Mark Spargo, MD Jared B. Bowns, MD John Matzko, MD John Sierra, MD Joseph B. Cornett, MD

Joseph W. Melamed, MD Karen A. Coates, MD Kerry E. Chandler, MD Laura Meyer, MD Louis F. Poscillico, MD Lyndon K. Jordan, III, MD Margaret R. Douglas, MD Mark Marchand, MD Martin Rans Douglas, MD Melissa C. Lipton, MD Michael D. Kwong, MD Michael L. Ross, MD Nikunj P. Wasudev, MD Paul A. Haugan, MD Peter L. Leuchtmann, MD Phillip C. Pretter, MD Phillip R. Saba, MD R. David Mintz, MD Randy D. Secrist, MD Richard E. Bird, MD Richard J. Max, MD Robert A. Cerwin, MD Robert E. Schaaf, MD Russell C. Wilson, MD Scott R. Sailer, MD Sendhil K. Cheran, MD Steven R. Mills, MD Susan L. Kennedy, MD Susan M. Weeks, MD Thomas L. Presson, Jr., MD William G. Way, Jr., MD William James Vanarthos, MD William T. Djang, MD Williams, Benavides, Marston & Kaminski, MD, PA Randall Williams, MD Mental Health Providers Cynthia Dowdy, PhD E. Janice Morgan, LCSW Gayle Gonzalez-Johnson, LCSW John O Donoghue LMFT Lou Murray, Substance Abuse Counseling Margaret J. Dorfman, MD North Raleigh Psychiatry Jeffrey Snow, MD John Olarte, MD Brady Lamm

14 | APRIL 2014

National Doctor’s Day is commonly celebrated in healthcare organizations as a day to recognize the contributions of doctors to individual lives and communities. [Improving Medication continued from page 12] simple. There are essentially 4 steps involved: receiving the correct prescription, filling the prescription, remaining on the medication for at least 6 months when rates of non-compliance are highest, and continuing the medication as directed for an indefinite period. Since there is no “magic bullet” suitable for addressing medication noncompliance for all patients, health care providers are often charged with determining the breakdown in these steps in a world where time constraints prohibit in-depth patient interactions. Providers working as part of an integrated team that may include nurses, social workers, pharmacists, and local resources such as pharmacies that target noncompliance may be our best defense in confronting this health care epidemic. §

REFERENCES: 1. Cutler DM, Everett W. Thinking outside the pillbox – medication adherence as a priority for health care reform. N Engl J Med. 2010,362:1553-1555. 2. Why Are So Many Patients Noncompliant? Medscape. Available from www.medscape.com/viewarticle/818850. Jan 16, 2014. 3. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353:487-489. 4. Akincigil A, Bowblis JR, Levin C, et al. Long-term adherence to evidence based secondary prevention therapies after acute myocardial infarction. J Gen Intern Med. 2008;23:115-121. 5. World Health Organization. Adherence to LongTerm Therapies: Evidence for Action. Publication WHO/ MNC/03.01. Geneva, Switzerland: WHO; 2003.

WAKE COUNTY PHYSICIAN | 15

[Medical Hero continued from page 4] community partnerships, and provides guidance, resources and education to providers in the network. Over the last six years, Dr. Tilson helped forge and lead a collaborative multi-disciplinary team from CCWJC, WCHS, and Wake County Environmental Services to address environmental triggers for pediatric asthma patients. The program, entitled “Environmental Asthma Trigger Home assessment Program” has been shown to improve the lives of children by improving their asthma control and making their home a safer place to live. This collaboration has also resulted in decreased asthma-related ED use, hospitalizations, and health care costs, and has led to a national health award for Wake County from the National Association of Counties. Dr. Tilson’s effective leadership as the medical Director of CCWJC was summarized in a recent CCNC site review, where descriptions of network performance included: “Outstanding leadership team with a balance of clinical and operational leadership;” “The Network has created a quality based, mission driven culture that has improved population health outcomes;” and “Leadership has been forward thinking and has worked to engage strategic partners in population management initiatives.” Dr. Tilson’s peers echo this praise. As one of her peer physicians in the network stated, Dr. Tilson “has a wealth of knowledge regarding the resources that are available in the county for Medicaid clients and the initiatives being brought 16 | APRIL 2014

forth at the state and local level. This sharing of information is a huge benefit to all of our staff.” Another physician offered, “…with the guidance of the leaders in Community Care, we physicians are shown better, more cost effective ways of managing our most complicated patients. This is good for everyone.” Yet another peer exclaimed, “Joining CCWJC is the best thing we ever did for our practice.” Dr. Tilson reflects on her work saying, “I recognize and value the enormous privilege and responsibility I have been given to care for people. As such, I am motivated by a sincere desire to improve the health and health care system for the patients and populations I serve, especially the most vulnerable in our community. I greatly value the respect I have been shown from my colleagues and peers as a trusted source of guidance, information, support, and leadership and I continually strive to be worthy of and build upon that trust. Finally, I am honored to receive some of the credit for the successes of the whole CCWJC staff and network providers, including our network receiving the highest level of assessment by the CCNC central office.” Given the scope and impact of her innovations and leadership in our community, Dr. Tilson is clearly deserving of this year’s Health Care Heroes Award. §

From left to right: Dr. Allen Dobson, Hugh Tilson, husband; Dr. Elizabeth County Medical Society Community

President of Community Care of North Carolina; h Tilson; Susan Davis, Executive Director of Wake Health Foundation.

WAKE COUNTY PHYSICIAN | 17

[Navigating the New HIM continued from page 8] educating them on the ACA and estimating the subsidies they would likely be eligible for. Before the website fix towards the end of November, it was unusual to be able to sign someone up, but now it’s unusual not to be able to do so. Despite the slow start, the payoff has been great. We are seeing the reduced stress of a consumer base that was making high cost COBRA payments that were draining their savings accounts or that were in high risk insurance pools that could cost half of their monthly income. Now there is excitement from the large volume of uninsured for whom January 1st (the first effective date of coverage) couldn’t come fast enough. And while I’ve still got a few errant insurance card e-mails in my inbox, people often write and tell me things like they’ve gotten flu and shingles vaccinations, treatment for ACL tears, and much needed medications – or even that they have begun discussions with a provider about a bone marrow transplant. Through these consumers, I hear the nascent work-a-day delivery of health care to folks who had either been left out or priced out – often for many years. While meeting with these good folks over these fast few months, I’ve been struck by so many things. I have been reminded that employment is still extremely scarce, and that the very nature of it has been altered beyond many people’s recognition, including the delinking of health care to employment in many cases. The doldrums of the economy has certainly been a factor. The stories are vast and varied. There is the diabetic who desperately needed health coverage but who had been denied coverage for being “too sick”. There was the couple digging into their retirement savings well before retirement age to pay for COBRA and health costs after a cancer diagnosis that followed a lay off. I’ve met with 18 | APRIL 2014

middle class folks who never in a million years would have thought they would have found themselves with not savings and uninsured, but there they are. In short, I’ve seen a sea of need out there. For some people, it’s the first time ever, or in a long time, that they’ve had coverage. I have seen people pulling out their “readers” and getting out sharp pencils as they look at their out-of-pocket expenses when comparing plans. The ACA has made insurance policies more transparent, with long listings of Summary of Benefits that I have spent hours mulling over with clients. While some previously insured are dealing with higher premiums (and richer plans), our lower and lower middle income consumers are facing deductibles and co-insurance - that “skin in the game” - along with the multitude of calculations that go on when prescription drugs are thrown into the mix. Lately we’ve begun seeing those “young invincibles” drift in to balance out the risk pool, perhaps encouraged by their parents or because they got information at an outreach or enrollment event. These young folks probably don’t spend much time lying awake worrying about a catastrophic illness or accident wiping out a family’s resources, but there is a big push to educate them and encourage their participation to help balance out the pool - to offset the costs that will be incurred by those who are older and less healthy. Deborah Owens is a Federally Facilitated Marketplace (FFM) Navigator working in Wake and Johnston Counties. The CapitalCare Collaborative, one of the service programs for the Wake County Medical Society Community Health Foundation received funding to provide this service within our community. Other CCC staff received training to assist any of the uninsured patients they worked with as certified application

counselors. Navigators meet with people, one-on-one, in clinics, libraries, churches, and community centers. People are scheduled either by a centralized call center or by host site clinics â&#x20AC;&#x201C; whose goals include getting as many eligible patients signed up as possible in order to open up slots for those with fewer resources. Navigators attend community events, health fairs, telethons, information sessions and enrollment fairs. They educate people on the ACA via news programs and through media interviews. They inform their friends who are selfemployed or who are hairdressers, artists, baristas, and restaurant workers. They spread the word

through social media and at churches and schools. They are committed, passionate, and tireless in their efforts. Such efforts are paying off in NC. Through the end of January, about 1,000 people have been assisted by the CCC Navigation team. Recent data shows that NC had the third highest enrollment (107,778 through December) of FFM states - only falling behind much larger Florida and Texas. In addition, 9 out of 10 people that enrolled in NC received financial assistance (8 out 10 nationally). County specific data will be coming soon to provide more detailed information on enrollment at the local level. Â§

WAKE COUNTY PHYSICIAN | 19

THE MADNESS OF LADY

the other tragedy By L. Jarrett Barnhill, MD

n Act 1 of Shakespeare’s Macbeth, Lady Macbeth appears as an ambitious, driven, and strong-willed woman. By Act 5 she is a tormented, traumatized sleep walker re-enacting the murder she her husband towards. She ends up murdering a dissociated self, allowing death to free her from the psychological consequences of Duncan’s murder. Did Lady Macbeth’s increasing self-alienation, represent guilt-laden madness, did it arise from the recognition of the monster she unleashed? In this sense Shakespeare created a parallel tragedy within his tragedy- the fall of Lady Macbeth Macbeth is a play driven by dark, supernatural catalysts. Both Macbeth and Banquo were men of action who meet three bearded, otherworldly hags after a bloody victory. The heroes hear favorable prophecies but question their veracity. Yet Macbeth steps aside to reveal his darker place. Banquo has 20 | APRIL 2014

no soliloquy. Perhaps his unimaginative nature gives him immunity to the witch’s seduction. But Macbeth wears different robes. He contacts Lady Macbeth and sets her aflame with volcanic ambition and verbal ruthlessness. Whatever her pre-prophecy character she tries to metamorphose into a savage woman who fears her husband’s vacillation. Once at home he does falter, and confirms her suspicions.

Macbeth who bloodies herself while planting the incriminating evidence. Macbeth will sleep no more as he becomes a darker, bloodier minister who is so deep in blood that he dare not return.

Shakespeare’s tells us nothing about Lady Macbeth before her descent into murky hell. Her fall is as mysterious as the witches’ magic. Just as they mix potions, she arms her tongue for action, summons Macbeth’s imagination dark ministers to unsex her, nearly shuts the doorway to change her milk to gall, murder. His stunning soliloquy and close every portal to paints the grim, cosmic conscience. In a moment of consequences of murdering verbal savagery, she unsexes a kinsman, his king and his Macbeth by viciously guest. At this stage of the attacking his masculinity. play Shakespeare depicts She proclaims that he is Macbeth as a fierce warrior “too filled with the milk of but an uncertain murderer. In human kindness” to act his anguish he hallucinates, decisively, a dissonant image a dagger pointing toward of a man who just defeated his damnable crime. After two armies. Enraged by the murder he returns to his continuing vacillation, Lady Macbeth, frozen in she joins the witches of horror, transiently catatonic. Shakespeare’s time as she He cannot return the blood verbally dashes the brains stained murder weapons to out of a suckling infant at her frame the guards. It is Lady breast. But do Lady Macbeth

or the witches inflame Macbeth to murder, or does his reign of terror arise from within. Lady Macbeth seems unaware that her husband ordered the murders of his friend Banquo and Fleance to remove the one who begat kings. Likewise she seems unaware of Macbeth’s murder of Macduff’s family to remove to any threats to his power. Lady Macbeth proclaims that by murdering Duncan he be not only king, but also a man. Her “prophecies” are as full of ambiguity as those offered by the weird sisters. Interestingly their last appearance together is at a dinner when Banquo’s ghost appears. Like Hamlet’s mother, Lady Macbeth cannot see the ghost. Likewise she is not fully aware that Macbeth is metamorphosing into one of the demons she desired to possess her. Yet in spite of all her fury she remains in the role as a helpmate. In modern terms, we could say that behind every Macbeth is a Lady Macbeth. But unsexed or not, she stops short of murder. She casually dismisses the stain of regicide by cleansing with a little water; repressing the horror of the deed and eventually covering for Macbeth during his unexplainable collapse at the banquet. She knows nothing of Banquo’s murder and cannot see his ghost.

But after this scene she retreats into the shadows, reappearing only as a sleepwalker. She wanders about haunted by her conscience as she follows her candle to “dusty death”. But there are dissonant foreshadowings. In spite of her ruthless façade, she cannot kill Duncan. He looks too much like her father. We can only speculate when she begins to realize that Macbeth has exceeded her heinous expectations. She evaporates as the hags from the stage. But does she also fear that Macbeth might ignore the sisters and murder her to find another who can produce male heirs? Does she realize that she now belongs to Mephastophilis and that no amount of water or perfume can unbind her from her bloody contract? Perhaps the horror of Macbeth’s savagery unseams her. Young Siward’s death is collateral damage but her suicide is the last murder in Macbeth’s reign of terror. Her death ends her role as a “poor player that struts and frets ‘her’ hour upon the stage and then is heard no more.” Lady Macbeth’s death is filled with “sound and fury, signifying nothing”.

discovers that Macduff ‘is not of woman borne”, he finds meaning in a fight to the death. He is a soldier again, defending his kingdom and castle. Lady Macbeth is hardly Malcolm’s “fiendish queen” as she tortures herself, then suicides. The play closes with only male warriors and no visible hope for offspring. The world that made Macbeth, Lady Macbeth and Malcolm king will fall to Fleance and eventually his descendent James I. Their great speeches are barren soliloquys spoken by poor actors in a tale told by idiots. Only Fleance signifies the future. Oddly, Lady Macbeth like Medea cracks the veneer of a society filled with Macbeths. She unsexed herself to become a warrior, only to go mad in the process. She disappears into the sterile earth along with Hecate and the weird sisters. Perhaps this descent is the fulfillment of another unstated prophecythat she would die as a queen in her sleep. §

By today’s standards, Lady Macbeth descends into catastrophic depression and commits self-murder. Macbeth responds by soliloquizing on meaninglessness. Once he WAKE COUNTY PHYSICIAN | 21

NCMS Spearheads Initiative to Educate Health Care Community on Accountable Care By Melanie Phelps

he health care landscape in North Carolina has changed dramatically in the past five years and will continue to do so for the foreseeable future as the approach to health care delivery undergoes significant transformation. In that short time period, the number of independent hospitals in NC fell from 142 to 24, and that trend is likely to continue. Employment of physicians by hospitals and health systems has increased, and this trend will likely continue. More physician practices are looking into forming accountable care organizations (ACOs) or aligning themselves with ACOs or with other physician groups in order to remain viable as accountable, or valuedriven, care gains momentum. And just last month, the NC Department of Health and Human Services announced their proposal to reform the state’s Medicaid system, which places ACOs as the backbone to the overhaul. The legislature will consider the proposal during their upcoming May session, and the North Carolina Medical Society (NCMS) and other health care organizations are working closely with the department and legislators to ensure the reforms promote the best outcomes for patients and their doctors. The State Health Plan also has expressed interest in exploring the possibilities offered by the ACO model. The proliferation of ACOs, whether hospital or physician-owned is quite notable. Medicare alone has approved over 400 ACOs, and there are numerous non-Medicare ACOs under development with the support of the private sector. North Carolina currently has 22 ACOs 22 | APRIL 2014

that cover the vast majority of the state (see map). For this new model of care to work, however, physician leadership is imperative to ensure that changes are clinically-driven and in the best interests of the patients. To assist physicians in this epic journey, the Wake County Medical Society, the NCMS and 37 other state, local and specialty medical societies and organizations have joined together to create and deploy the Toward Accountable Care (TAC) Consortium and Initiative. TAC is designed to provide the medical community with the knowledge and tools needed to understand, participate in, navigate, lead and succeed in a value-driven health care system. TAC Consortium member organizations are the vehicles for disseminating resources created for the Initiative (see below for list of TAC Consortium members). Since its inception almost two years ago, TAC has produced numerous articles, webinars, presentations and the following toolkits/ guides:

• • • • •

• The Physician’s Accountable Care Toolkit • Accountable Care Legal Guide Distribution Based on Contribution: A Meritbased Shared Savings Distribution Model Accountable Care Guide for Neurologists Accountable Care Guide for Urologists Accountable Care Guide for Psychiatrists Accountable Care Guide for Radiologists

The above mentioned guides are posted on the TAC website, which was launched last year and is a dedicated site for the TAC Initiative— www.tac-consortium.org. Accountable Care

Guides for emergency medicine physicians, cardiologists, oncologists and hospice & palliative care are undergoing final approval and will be posted on the website soon. A guide dedicated to bundled payment arrangements also is under development. In addition, TAC currently is convening small groups of pediatricians, OB/GYNs and child psychiatrists, to begin the development of accountable care guides for those specialties. A guide for community supports also will be developed in the next quarter. Once these guides are complete, 11 more are slated to be developed. The TAC Consortium and Initiative, which is spearheaded by the NCMS, also sponsors the NC ACO Collaborative. The Collaborative is comprised of representatives of existing NC ACOs and aspiring ACOs or ACO participants. The group’s quarterly meetings provide an opportunity for emerging and developing ACOs to share experiences and ideas about transitioning to accountable, value-driven, health care delivery systems and to identify and discuss possible solutions for facilitating that transition. Meeting locations are rotated among the membership. Interest in this learning collaborative continues to increase. The TAC Consortium and Initiative is guided by a Physician Advisory Committee comprised of national and state leaders in innovative health care delivery: Nancy Henley, MD; Perrin Jones, MD; John Meier, MD; Devdutta Sangvai, MD; and Grace Terrell, MD. Staff includes Julian “Bo” Bobbitt from Smith Anderson law firm in Raleigh; and Melanie Phelps and Steve Keene from the NCMS , which has committed significant staff resources to ensure that this Initiative remains viable and that other Consortium members remain engaged. For more information about the TAC Consortium and Initiative or the NC ACO Collaborative, please contact Melanie Phelps at mphelps@ncmedsoc.org. §

Specialty Societies

Carolinas Chapter, American Association of Clinical Endocrinology North Carolina Academy of Family Physicians North Carolina Chapter of the American College of Physicians North Carolina College of Emergency Physicians North Carolina Council on Child and Adolescent Psychiatry North Carolina Dermatology Association North Carolina Neurological Society North Carolina Obstetrical and Gynecological Society North Carolina Orthopaedic Association North Carolina Pediatric Society North Carolina Psychiatric Association North Carolina Radiologic Society North Carolina Society of Anesthesiologists North Carolina Soc. of Asthma, Allergy & Clinical Immunology North Carolina Society of Eye Physicians and Surgeons North Carolina Society of Gastroenterology North Carolina Society of Otolaryngology – Head and Neck Surgery North Carolina Oncology Association North Carolina Society of Pathologists North Carolina Society of Plastic Surgeons North Carolina Spine Society North Carolina Urological Association

State Society / Organizations

Community Care of North Carolina Carolinas Center for Hospice and End of Life Care North Carolina Academy of Physician Assistants North Carolina Community Health Center Association North Carolina Foundation for Advanced Health Programs North Carolina Medical Group Managers North Carolina Medical Society

TAC Consortium Members

Cleveland County Medical Society Craven-Pamlico-Jones County Medical Society Durham-Orange County Medical Society Mecklenburg County Medical Society Forsyth-Stokes-Davie County Medical Society New Hanover-Pender County Medical Society Pitt County Medical Society Rutherford County Medical Society Western Carolina Medical Society Wake County Medical Society WAKE COUNTY PHYSICIAN | 23

The Wake County Medical Society (WCMS) is a 501 (c) 6 nonprofit organization that serves the licensed physicians and physician assistants of Wake County. Chartered in 1903 by the North Carolina Medical Society.

CURRENT PROGRAMS Project Access - A physician-led volunteer medical specialty service program for the poor, uninsured men, women, and children of Wake County. Community Care of Wake and Johnston Counties CCWJC has created private and public partnerships to improve performance with disease management initiatives such as asthma and diabetes for ACCESS Medicaid recipients. CapitalCare Collaborative - The CCC program is a membership of safety net providers working corroboratively to develop initiatives to improve the health of the regionâ&#x20AC;&#x2122;s medically underserved such as asthma and diabetes for Medicaid and Medicare recipients.

HOW TO JOIN To become a member of the Wake County Medical Society contact Deborah Earp, Membership Manager at dearp@wakedocs.org or by phone at 919.792.3644 A portion of your dues supports the volunteer and service programs of WCMS. Membership is also available for PAâ&#x20AC;&#x2122;s. There is even an opportunity for your spouse to get involved by joining the Wake County Medical Society Alliance.

JOIN T

Become a Member of Wake County Medical Society and help support the indigent care and community service programs associated with the Society.

BENEFITS OF MEMBERSHIP WHY JOIN Membership in the Wake County Medical Society is one of the most important and effective ways for physicians, collectively, to be part of the solution to our many health care challenges. A strong, vibrant Society will always have the ear of legislators because they respect the fact that doctors are uniquely qualified to help form health policies that work as intended. Itâ&#x20AC;&#x2122;s heartening to know so many of Wake County physicians, more than 700 to date, have chosen to become members of the Wake County Medical Society.

WCMS MISSION To serve and represent the interests of our physicians; to promote the health of all people in Wake County.

TODAY!

Service Programs - The spirit of volunteerism is strong in Wake County. Hundreds of local physicians volunteer to help our indigent. The Society coordinates several programs that allow low income individuals access to volunteer doctors and to special case management services for children with diabetes, sickle cell anemia or asthma. Publications Members receive the peer-reviewed The Wake County Physician Magazine four times a year, and we keep you informed regularly via pertinent emails. The magazine focuses on local health care issues in Wake County. Socializing with your physician colleagues - Many physicians feel too busy to do anything except work long hours caring for patients. But, the WCMS provides an opportunity for physicians to nourish relationships through social interaction with one another at our dinner meetings featuring prominent speakers and at other events. Finally, joining the WCMS is plain and simple the right thing to do - Physicians and the community benefit from our membership and our leadership in local affairs.

Are you interested in becoming a Wake County Medical Society member? Simply visit our website at www.wakedocs.org and complete the online application or contact us by phone at 919.792.3644.

A portion of your dues joining the Wake County contributes to the volunteer Medical Society Alliance. and service programs of WCMS. Membership is also available for PAâ&#x20AC;&#x2122;s. There is even an opportunity for your spouse to get involved by

JOIN TODAY!