4 The Long Road: One Story of What to Do and What Not to Do in Attacking Medical Student Loans
ADVOCACY
6 NCAFP Advocating for Greater Investment in Primary Care: Task Force Presenting Report to General Assembly
NCAFP FOUNDATION
8 An Update on the NCAFP Foundation’s Telehealth/Medical Scribe Pilot Program
PROFESSIONAL DEVELOPMENT
14 From a Hammock Swing or Your Favorite Beach Chair — You’ll Enjoy this Summertime CME from Anywhere!
MEMBERSHIP SERVICES
18 Member Spotlight: Dr. Beth Hodges
STUDENT INTEREST & INITIATIVES
22 What Our Summer Programs Give to Students, Preceptors, and Family Medicine
DEPARTMENTS
Membership Services 18 Student Interest & Initiatives 22 Practice Management 24 PUBLISHED BY
t 919.833.2110 • fax 919.833.1801 • ncafp.com
Editor Kevin LaTorre, NCAFP Communications
Managing Editor, Design & Production
Peter T. Graber, NCAFP Communications
President's Message 4 Advocacy 6 NCAFP Foundation 8 Professional Development 14
Have a news item we missed? NCAFP members may send news items to the NCAFP Communications Department for publishing consideration. Please email items to kevin@ncafp.com.
PRESIDENT'S MESSAGE
By Garett Franklin, MD, FAAFP NCAFP 2023-2024 President
The Long Road: One Story of What to Do and What Not to Do in Attacking Medical Student Loans
Eight Years After Residency, I’m Free of Student Debt
In this spring season, I fondly remember putting the finishing touches on medical school by ending on fun rotations, waiting for the residency match results, and preparing for residency. While generally a great time to celebrate the monumental accomplishment of graduating medical school and looking forward to “learning how to be a doctor” in residency, I do recall one moment of panic: What about those student loans I had been living on the last four years?
During medical school, I really didn’t consider my loans very often. After the initial sticker-shock and the “what did I just get into” moment, I suppressed all knowledge and plowed forward into medical studies. It was easy to think of it as “Monopoly money” or just put it off until residency “when I make a paycheck.” However, when residency started, I had a rude awakening. The paychecks really didn’t match my desires to support a family and pay loans off, too. Therefore, like a lot of residents, I put off repaying loans until I would make “a real doctor’s wages.”
I eventually made it out of residency and got my first “real” job as a doctor (even if I might have stalled by sticking around for a fellowship year). I was happy to be making more money and finally able to find some breathing room financially. Quickly, I realized there were many things, in
addition to student loans, that I had been putting off in life. I began to realize that there were competing entities for this newfound paycheck. Bills, moving to a new city, credit card debt, and some poor luck with automobiles through the years had taken their toll.
I also found that I had not been planning for the financial future. I had failed to think about disability and life insurance, emergency funds, retirement savings, college funds for children, and many other considerations. If that was not enough, I felt the urge to let loose! We wanted to enjoy some of these new funds by spending more generously on “fun things” like restaurants, shopping, and maybe even a vacation since we had been living very meagerly over the last eight years of medical school, residency, and my fellowship.
I quickly found myself saying, “What do I do?” and “No one told us about this in med school!”
The years that followed were quite a long road. I feel compelled to share my experiences and try to provide wisdom for those who might be living through this road now or in the future. My greatest lesson was finally admitting that, frankly, I had no idea what I was doing, and then putting my pride aside and seeking help. Specifically, help looking at my physician employment contract to ensure that I was maximizing my worth to the company and community. I wanted to ensure that I was getting all the benefits I was due.
Second, I developed a relationship with a financial planning guru to balance the needs to budget, pay bills, pay off outstanding debt, plan for the future, but also attack the medical school loans. We were able to craft a plan that has evolved over time depending on my family’s needs and financial circumstances. Lastly, I changed my attitude and mentality. Knowing I had a plan and a team I could trust, my anxieties lessened, and I was more confident about reaching the goal of being student debt-free. And I am happy to report as of January 2024, we have paid off all our student loans. It took eight years and lots of sacrifices, but we made it. Mission accomplished! And we did it while adding to the family. We now have three children between a few months old and nine years old.
However, the goal of this article is not to gloat over my personal success but to reach out and provide hope to those who might be struggling with this issue. Your Academy is quite attuned to this issue. We are building resources and forging partnerships to help, whether it’s by reviewing an employment contract for residents or helping you find a financial planner.
Also, your Academy’s advocacy team has placed a focus on this issue with health care systems, payors, and legislators. Some of our early successes have been a new “Forgivable Educational Loans for Service” program specifically for medical students entering primary care or psychiatry, and additional loan repayment programs to help you pay off your student debt sooner. But this is a long battle. And we will keep fighting for a better future where students, residents, and early-career physicians are less burdened by this debt and able to more fully focus on their patients, families, and communities.
Lastly, if this message has resonated with you, I would implore you to continue on that long road. Stay focused and do not lose hope! Continue to be diligent and a good steward of your resources, but forget your pride and ask for help when needed. Your NCAFP leadership and staff are happy to help when appropriate, and there are lots of community resources available as well.
Keep working hard, and good things will happen!
2023-2024
NCAFP Board of Directors
Executive Officers
President Garett R. Franklin, MD, FAAFP
President-Elect S. Mark McNeill, MD, FAAFP
Secretary/Treasurer Benjamin F. Simmons, MD, FAAFP
Immediate Past President Shauna Guthrie, MD, MPH, FAAFP
Executive Vice President Gregory K. Griggs, MPA, CAE
At-Large Directors
Josh T. Carpenter, MD
Lisa A. Cassidy-Vu, MD, FAAFP
Deanna M. Didiano, DO
Nichole L. Johnson, MD, MPH, FAAFP
Kelley V. Lawrence, MD, IBCLC, FABM, FAAFP
Amanda R. Steventon, MD, FAAFP
Patrick S. Williams, MD
Courtland D. Winborne, MD
Academic Position R. Aaron Lambert, MD, FAAFP
Resident Director
Morgan Parker, DO
Resident Director-Elect
Stephanie P. Wilcher, MD, MPH
Student Director S. Evan Morgan
Student Director-Elect
Nicholas Wells
AAFP Delegates & Alternates
AAFP Delegate Richard W. Lord, Jr., MD, MA, FAAFP
AAFP Delegate Robert L. Rich, Jr., MD, FAAFP
AAFP Alternate Tamieka Howell, MD, FAAFP
AAFP Alternate Thomas R. White, MD, FAAFP
NCAFP Committee Chairs
Workforce Pipeline Chair Jay Patel, MD, MPH
Advocacy Committee Chair Deanna M. Didiano, DO
Member Satisfaction Nichole Johnson, MD, MPH, FAAFP and Practice Environment Committee Chair
Academic Departments Margaret Helton, MD, FAAFP Chair
NCAFP Foundation President Maureen Murphy, MD
2501 Blue Ridge Road, Suite 120,
27607
www.ncafp.com
By Gregory K. Griggs, MPA, CAE NCAFP Executive Vice President & CEO
FIGHTING FOR FAMILY MEDICINE ADVOCACY
NCAFP Advocating for Greater Investment in Primary Care: Task Force Presenting Report to General Assembly
The NC Academy of Family Physicians is continuing to advocate for greater investment in primary care after successfully convincing the legislature to study the issue as part of the 2023-24 budget.
During the last session of the legislature, the General Assembly approved a “Primary Care Payment Reform Task Force” chaired by Jay Ludlam, Deputy Secretary for Medicaid in the NC Department of Health and Human Services. Dr. Mark McNeill, NCAFP President-Elect, is representing Family Medicine on the Task Force.
not be addressed adequately without a meaningful increase in primary care investment. The efforts of the Primary Care Payment Reform Task Force are a great first step on what could be a transformative shift in reimbursement.”
Since Jan. 1, 2024, the Task Force has held five meetings to develop a report that it forwarded to the General Assembly in late March. As part of the effort, the Task Force made several recommendations, including:
• Developing a definition of primary care based on Barbara Starfield’s Four C’s: continuous, comprehensive, coordinated, and first contact. The definition includes a broad set of services but excludes inpatient settings, emergency room, urgent care, retail clinics, and other settings that do not provide continuous, longitudinal care.
• Setting a target for relative improvement of primary care spend by 1% per year. For example, one national study (which wasn’t based on the NC definition of primary care) estimates that our state spends 5.8% of the health care dollar on primary care. If that target proves accurate, then the relative yearover-year goal would be to increase primary care spending to 6.8% of total health care spend in 2025.
The General Assembly directed the Task Force to define primary care relevant to North Carolina’s Medicaid, State Health Plan, and commercial insurance market. The legislature asked the Task Force to analyze primary care spending and adequacy in North Carolina compared with other states, develop strategies for related data collection, and set an investment target. Additionally, Task Force members were asked to consider the need for an ongoing effort and evaluate other necessary steps for improving primary care delivery and ensuring an adequate workforce.
“As a family physician, I value being available to my patients and having enough time to spend with them,” Dr. McNeill said when asked about his participation in the Task Force. “Unfortunately, that level of service is unattainable for many patients in NC due to a Family Medicine workforce burdened by an inadequate pipeline, high burnout rates and increased administrative burden. These challenges can-
• Developing a data collection strategy that would include a template with a certain code set and certain provider set to collect information on primary care spending from both public and private payers in the state.
• Asking the General Assembly to continue the Task Force beyond the 2024 legislative session and provide the Task Force authority to collect ongoing data.
North Carolina would join approximately a dozen other states who are in the process of collecting data and developing investment targets. In each state, the definitions of primary care look at type of providers, place of service, and type of service through specific code sets. While they’re not perfect, the Task Force believed the definitions and code sets developed during this process would be a good benchmark for our state given the limited data available at this time. Other, non-claims payment data could be added in the future.
The group also agreed to use a relative spending target of 1%
year over year for all payer types and groups, as opposed to an absolute target. As data begin to be gathered over time, the Task Force could come back and set an absolute target (say 10-12% of total health care spend).
The current assessment for North Carolina comes from a national primary care report card that pegs North Carolina primary care spend at around 5.7% to 5.8%, which is slightly better than the national average, but far below benchmark states that have been working to increase primary care investment for some time. In those states furthest along in this process, such as Rhode Island and Colorado, they have seen improved outcomes and lower total cost of care by increasing primary care investment to 10% or more.
The group also examined the supply versus demand of primary care in our state, and what that trend will look like in coming years. The demand for primary care statewide is already higher than the supply, and that difference is expected to worsen over the next decade. However, if action is taken to improve the primary care landscape, the differential can be reduced.
Aside from Medicaid’s Jay Ludlam and Dr. McNeill, the Task Force includes a representative of Medicaid Managed Care plans, commercial insurance, the NC Nurses Association, the Office of the State Insurance Commissioner, the NC Community Health Center Association, the Administrator of the State Health Plan, the Director of the NC AHEC Program, and the Director of the NC Health Information Exchange.
Moving forward with increasing primary care investment in our state is one of the NCAFP’s top legislative priorities going into the short session of the General Assembly that will last from late April until early July. Look for additional information and Advocacy Alerts in our weekly e-newsletter, NCAFPNotes
•
JOIN THE FIGHT FOR FAMILY MEDICINE
By Shawn Parker, JD, MPA NCAFP General Counsel & Chief of Staff
INNOVATION ON DISPLAY
An Update on the NCAFP Foundation’s Telehealth/Medical Scribe Pilot Program
Early last fall, the NCAFP Foundation received a significant donation from UnitedHealthcare (UHC) to support small practices that are integrating telehealth and in-person visits. The Pilot Program intends to reduce up-front financial risks to practices by funding the cost of adding one or two new medical scribes or assistants per practice for one year, with the goal of bringing additional efficiencies to the practices and ultimately sustaining these new hires through the money saved. This investment allows the practices to re-engineer their workflow and test various ways to increase patient access, with the hope that other family practices in similar situations could replicate their efforts.
This pilot project was implemented at three NCAFP member practices located in underserved areas of the state: Clinton, Asheboro, and Wilmington. In February, I joined NCAFP Executive Vice President and CEO Greg Griggs, UHC CEO Anita Bachmann, and a small team of physician and program ambassadors from United HealthCare to visit each of the three practice sites for a Mid-term Pilot Project update.
What the Three Clinics Are Doing
The first practice site we visited was Hodges Family Practice in Asheboro. Hodges is currently building out their current telehealth program, which focuses on managing patients with chronic condition. The practice utilized grant funds to engage a company to supply blood pressure monitors and glucometers to their patients, to better monitor patients’ blood pressure and blood glucose remotely. They have begun scheduling patients with chronic diseases to be seen
twice a year by virtual visits, and they noted that the next step is to create virtual education which is easily accessible for diabetic and transportation-limited patients. Hodges is also focusing on increasing virtual visits for patients with acute issues (when appropriate). Telehealth from the new funding has created the opportunity to triage acute issues and has been beneficial for patients who work out of town or have difficulty leaving work, while also helping Hodges to keep patients that may be contagious from needing to visit in-person. The practice’s staff is committed to maximizing the true value of telehealth. A key to their effort, described by co-founder Dr. Fransico Hodges, is that “con-
stantly evaluating and perfecting” is the secret sauce of innovation at the clinic: “If we want to do something, we implement, and evaluate. Then we move to adopt, adapt, and modify.” Hodges Family Practice uses a team-based approach to patient care and sees virtual care as requiring the same organization.
The second site visited was Clinton Medical Practice, which utilized the funding to restructure a current patient-facing position to take on more quality support. This change, while
Can
valued advice at curi.com
initially impacting billable activities, allowed more attention and better coordination for care transitions, telehealth annual wellness visits, and pre-appointment preparation for visits, which improve the doctor-patient experience and help close care gaps (a key tenet of physician compensation in value-based system). Clinton also attempted to hire a medical scribe to reduce the administrative requirements of its physicians, though a limited employee pool made this hiring problematic for the time being. Because the practice remains optimistic about advances in artificial intelligence, its staff is also exploring opportunities to test its effectiveness in streamlining administrative activities.
MedNorth Health Center in Wilmington was the third and final clinic that we visited. Thanks to its pilot funding, MedNorth was able to onboard a new scribe/medical assistant late last year. In addition, the use of a remote tele-scribe service is being used for in-patient and telehealth services. MedNorth staff spoke about the advantages of using a dedicated scribe, who spends more time connecting with patients and truly helps with all aspects of the primary care medical home. The scribe keeps up with patient messaging, is involved in the clinic’s daily huddles, and allows the physicians to stay one step ahead in the patient visit. The practice also enjoys benefits from using remote scribes as well. Hiring virtual scribes means that there are more job candidates to consider, and MedNorth staff note that some patients prefer not to have additional individuals in the room. The physicians there said the assistance has improved their mental health, professional accuracy, and work-life balance. One said, “I can fully pay attention to the patient. I can focus on pathology, the
plan and next steps. It really makes you a better clinician.” MedNorth serves patients who speak other languages, and because translating and transcribing simultaneously takes more effort, hiring bilingual scribes could be even better for the clinic and the patients. So far, MedNorth has found that adding a scribe reduces clinician burnout from documentation requirements and increases the providers’ focus during their interactions with patients. Participation in the pilot is increasing satisfaction, efficiency, and productivity, allowing a more detailed and comprehensive documentation of notes that improves patient care.
It is evident that the seed funding provided by the UHC grant helps foster the creativity and ingenuity necessary for primary care practices to succeed. At the mid-point of the pilot program, we are seeing three clinics test three unique solutions to broader issues of administrative burden and operational inefficiencies present in modern health care delivery. The NCAFP applauds the efforts of these practices and hopes to share more on their experiences as the conclusion of the pilot program.
The Importance of Peer Support
By Kristi Wright, Senior Vice President, Claims, Curi Insurance
For physicians, the idea of facing a malpractice lawsuit is one of the most terrifying experiences imaginable. It’s understandable why medical providers wouldn’t want to ever discuss such a topic, even when the provider knows they have done nothing wrong. However, being named in a lawsuit is not nearly as uncommon as many might assume. In fact, according to Medical Economics, nearly one-third of U.S. physicians have been sued at some point in their career s1. So, if you ever find yourself in this position, know that you are not alone.
When named in a suit, a physician’s first call is often to their medical malpractice insurance carrier. At Curi, we recognize the emotional and mental toll this experience can take on our members and do our best to provide holistic support as their trusted partner. We take a three-pronged approach to supporting our members. First, we have dedicated, experienced claims consultants who are here for you to guide you through the process. They attend first -suit meetings, mediations, depositions, and are by your side at trial, answering questions you may have along the way. Second, we provide an experienced medical malpractice defense lawyer , who will vigorously defend your care and work towards the best possible resolution. And finally, what I would like to discuss more with you today, is our Cl inician Peer Support Program.
It's important that providers don’t internalize the negative emotions that may come up during a lawsuit. By speaking with peers who have faced similar circumstances, our members can feel better understood and more prepared to face difficult situations head -on.
I recently sat down with Curi member and Chief Medical Advisor, Dr. Carolyn Anctil, to discuss her perspective on the importance of peer support, and here is what she shared:
Physician egos are often deeply entwined with their profession . They attend medical school with the goal of helping others They take an oath promising to do no harm. So, when something goes wrong and a patient is harmed, physicians take the news to heart. Errors are inevitable, physicians are not superhumans; but they often feel personally responsible for patient outcomes. The pain and guilt of causing or being part of a medical error is significant. Being named as a defendant in a lawsuit causes additional shame, anxiety, and embarrassment for the most caring of physicians.
Research demonstrates that talking to a peer about a significantly stressful event speeds recovery. Fortunately, Curi has a dedicated team of experienced physicians who have been involved in harm events or litigation themselves to provide support for doctors facing an active suit. Being involved in an adverse medical event doesn’t mean you’re a bad doctor, and Curi Peer Support helps to make the burdensome load of a lawsuit feel a little lighter.
The power of connection cannot be understated in difficult situations, and I’m proud to be able to offer members the opportunity to connect with one another in meaningful ways when support is needed most.
For more ideas and observations from Curi’s in -house experts, visit blog.curi.com.
1“See you in court: 31% of physicians get sued during their careers ,” Medical Economics, May 2023
The opinions and views expressed in this post belong to and are solely those of the individual author, and do not necessarily reflect those of Curi Insurance or Curi Insurance’s parent or affiliated companies or their members, insureds, clients, customers, or partners The information and services provided in the Peer Support Program are intended for informational purposes only. They do not serve as a substitute for legal or medical advice or medical assessments or treatment. The program offerings do not constitute medical care, and no patient -provider relationship is established. If medical or legal services are needed, please se ek out a professional.
Sights & Scenes from the 2024 NC Family Medicine Academic Summit &Family Medicine Day
Attendees gather dinner together at the Academic Summit.
NCAFP Workforce Initiatives Manager Perry Price and Jamie Crews.
Dr. Audy Whitman assists Eelyah Sefat.
Dr. Robert Agnello with the Campbell University medical students who won the inaugural Murphy Cup.
Dr. David Brendle speaks with Dr. Connor Brunson.
Medical students enjoy the Residency Fair.
Dr. Michelle Keating administers the wound care workshop at Family Medicine Day.
Dr. Thomas Koinis and Dr. Hershey Bell.
Dr. Beatrice Zaki assists Stephiya Sabu in the suturing workshop.
Dr. Keli Jones comments Academic Summit.
Dr. Keli Jones and Dr. Janalynn Beste.
comments
Aliya Othman, Leah Hollander, and another student practice joint injections at Family Medicine Day.
Academic Summit.
Perry Price greets Brigid Kearns
at the Summit.
Drs. Marta Bringhurst, Regina Bray Brown, Meghan Hubbard, Jennifer Hill, and Varshaben Songara.
Medical students pose for a group picture at Family Medicine Day.
Dr. Mark Higdon and Dr. Lauren Penwell-Waines help a medical student in a mock interview.
Dr. Karen Wolf greets a friend at Family Medicine Day.
Vidhya Suresh and another student take a break at Family Medicine Day.
NCAFP President Dr. Garett Franklin, Foundation President Dr. Maureen Murphy, Andrew Gasperson, and Jennifer Lockhart.
Colleen Yang, Paul Scott, Evan Morgan, and other students practice in the LARC workshop.
PROFESSIONAL DEVELOPMENT
By Kathryn Atkinson, CMP NCAFP Director of CME & Events
From a Hammock Swing or Your Favorite Beach Chair — You’ll Enjoy this Summertime CME from Anywhere!
In June, family physicians will be able to enrich their expertise and enhance their patient care through the NCAFP’s 2024 Virtual Summer Symposium. Spearheaded by Program Chair Dr. Lisa Cassidy-Vu and Program Vice-Chair Dr. Amir Barzin, this year’s annual Summer Symposium, scheduled for Saturday, June 22, 2024, from 8 a.m. to 3:20 p.m., promises a dynamic platform for learning and networking.
Drs. Cassidy-Vu and Barzin have made sure to include the areas of interest you have requested. Count on a comprehensive array of clinical topics relevant to family physicians, brought to you by primary care experts. See the full rundown of this year’s lecture topics and esteemed guest faculty:
• Immunization Update: RSV and Pneumococcal Vaccines, by Sarah Cartwright, MD
• Adolescent SUD: Addiction is a Pediatric Disease, by Martha J. Wunsch, MD, FAAFP, FASAM
• Common MSK injuries in the Urgent Care, by Karl “Bert” Fields, MD, CAQSM, FAMSSM
• NC Family Navigation Guide: Helping Families of Children with Disabilities Identify Needed Services and Supports, by Elizabeth “Betsy” Crais, PhD; Kori Flower, MD, MS, MPH; & Rebecca Pretzel, PhD
• Chronic Heart Failure: Comprehensive Care by Family Physicians, by Kathleen Barnhouse, MD
• Case Studies in Continuous Glucose Monitoring, by Steven Brunton, MD
• Diabetic Ulcer Offloading Techniques and Venous Ulcer Compression Therapy, by Brian Rayala, MD
• Navigating the Diet Maze, by Carolyn Dunn, PhD, RDN, LDN
• Reproductive Aging: Menopause and Perimenopause, by Narges Farahi, MD
• G2211 Codes, by Enoch “Nick” Ulmer, MD, CPC
• A Pre-Conf KSA Study Working Group on Asthma, by Jonathon Firnhaber, MD
Whether you are a seasoned family physician or just beginning your career in Family Medicine, the Summer Symposium promises to revitalize your commitment to unparalleled care for your patients and community. With approximately 6.50 CME credits available, you will further your professional development while immersing yourself in cutting-edge medical knowledge. This day of virtual CME allows you to learn from and engage with leading experts, ensuring a rich and interactive learning experience you will not want to miss. The NCAFP’s newest virtual platform enables you to interact with guest faculty and peers, share insights, exchange experiences, and collaborate with
like-minded colleagues.
Here’s another excellent quality about this virtual summertime CME opportunity: the sheer convenience! This oneday interactive virtual opportunity is a CME program you will want to enjoy from anywhere. There’s no need to travel or disrupt your busy summertime schedule — simply log in from the comfort of your home, beach chair, or hammock swing this June!
Plan to spend your day with us on Saturday, June 22, 2024, as you expand your clinical knowledge and stay updated with practical and valuable information that you will begin using immediately. Registration fees are $175 for Active members, $75 for Resident members, $60 for Life members, $25 for Student members, and $225 for non-members. Review the complete schedule, session learning objectives, and guest speaker bios, and submit your online registration at www.ncafp.com/summercme.
Lastly, those interested in an Asthma KSA Working Group can join in on Friday, June 21, 2024, for a pre-conference KSA that evening from 5:30 p.m. to 8:30 p.m. Plan to fulfill your ABFM requirements and pick up an extra 8 CME credits by participating in the workshop! KSA registration fees are $200 for a KSA Workshop Registration Only and $150 to add it to a full Virtual Summer Symposium Conference Registration.
Please contact me with any questions at katkinson@ncafp. com. We look forward to learning with you in June!
NCAFP Members Collaborated at the 2024 NC Family Medicine Academic Summit and
Family Medicine Day
By Kevin LaTorre NCAFP Communications and Membership Manager
NCAFP members at all levels of training and experience came to the Sheraton Imperial Hotel in Durham to learn and train together on Feb. 16 and Feb. 17. On Friday evening and Saturday morning, guests attended the 2024 NC
Family Medicine Academic Summit, while Saturday brought medical students and representatives from NC Family Medicine residency programs for the 2024 Family Medicine Day. The attendees enjoyed themselves at both events: “Excellent meeting with a tremendous amount of information and resources!” said one attendee in a postevent survey. “I love interacting with this group in this collegial atmosphere.”
“It was a wonderful two days!” said Kathryn Atkinson, CMP, NCAFP Director of CME & Events.
During the Academic Summit, residency program and medical school leaders and faculty learned about Competency-Based Medical Education (CBME) under the direction of program co-chairs Dr. Aaron Lambert and Dr. Regina Bray Brown. During her opening session, Dr. Bray Brown explained that CBME has become a “hot topic” to medical residencies and that their leaders need “to find a way to develop physicians who can make a difference” using CBME standards. All the CME offerings at the Academic Summit centered on what these guidelines are, how they will change by 2025, and how medical training can better incorporate them to develop well-rounded, experienced family physicians.
During Family Medicine Day, 87 medical students attended workshops hosted by Family Medicine residency facul-
ty and residents to experience the entire scope of medicine that family physicians provide each day. The workshops included joint injections, suturing, triaging in the field, clinical de-escalation techniques, and many more hands-on skills to help interested medical students understand what they can do for their patients through Family Medicine. “It was definitely interesting to see all this,” said one student attendee. “I wouldn’t have learned that without coming to an event like this.”
NC Residencies and Students Brought Their Skills and Passion to Both NCAFP Events
Both events succeeded because their attendees brought the full extent of their knowledge to work alongside others. Speakers like Dr. Bray Brown, Dr. Lambert, and Dr. Grant Hoekzema spoke at length about CBME and its usefulness for Summit attendees. “This year’s Academic Summit was an insightful platform for learning about CBME, sharing knowledge, and fostering collaboration,” said Atkinson. “It was great to have so many of NC’s finest Family Medicine residency programs join us for the important discussions.”
“This was a good overview and good discussion,” said one attendee.
Meanwhile, the residents and faculty from 16 North Carolina residencies brought their daily experiences and clinical skills to the students during the four workshop tracks at Family Medicine Day. The students themselves brought their own passion for learning new care to those sessions and picked up the new procedures they wanted to learn.
“The students here are really good,” said Dr. Matthew Ammons, a resident at the Sampson Regional Family Medicine Residency Program. “They really got into our session.”
Attendees’ knowledge certainly increased thanks to the
events. For instance, some medical students at Family Medicine Day attended a workshop for mock residency interviews and the annual Residency Fair, which both exposed them to the strategies and people they will need to know for applying to Family Medicine residencies in North Carolina.
“I learned things that aren’t really in my curriculum,” said Zoe Greene, MS-3 at Eastern Carolina University’s Brody School of Medicine. “I attended the wound-healing session and learned a lot. They taught us how to apply wound care, including looking at the wound to see what it actually needs. It was very cool to have so much hands-on work.”
For the students preparing for residency applications, meeting directly with residents and faculty through the workshops and the Residency Fair came at the perfect time. “It’s my third year, so being here really matters,” said Aryanna Thuraisingham, OMS-3 at Campbell. “And I want to stay in North Carolina.”
Attendees Also Enjoyed Coming Together at the Events
The discussions that they had in their workshops and the Q&A sections of their lectures often went well beyond the initial teachings. During the discussion portion of Dr. Hoekzema’s keynote lecture on Feb. 16, Dr. Lambert said, “This is an amazing discussion, which is exactly why we’re all here in person.” The lecture that Dr. Bray Brown led earlier in the evening included an opportunity for smallgroup discussions of CBME and how residency faculty were
already implementing it.
“I love this event!” said one Summit attendee. “It has wonderful networking!”
And during Family Medicine Day, students gathered and chatted over coffee, cookies, and apples between their workshops, comparing notes and meeting fellow medical students from around North Carolina. “It’s so nice to see so many people who care so much about Family Medicine,” said one medical student after the event.
NCAFP staff see this camaraderie as one of the most important parts of Family Medicine Day (and all other events we put on throughout the year). “Talk about passion!” said Atkinson. “It’s too bad we can’t bottle the excitement and enthusiasm that Family Medicine Day brings us every year. I always enjoy catching up with the students at the end of the day to ask them about their favorite workshop, and they name all four of the sessions they attended because they can’t pick just one. But I really love the ones that say, ‘This was the best day! I love Family Medicine!’”
*A version of this article appeared online at ncafp.com in February 2024.
MEMBERSHIP SERVICES
By Kevin LaTorre NCAFP Communications & Membership Manager
Member Spotlight: Dr. Beth Hodges
Dr. Beth Hodges co-owns Hodges Family Practice in Asheboro with her husband, Dr. Francisco Hodges. In addition to caring for patients there, Dr. Beth Hodges serves as Chief Clinical Officer for Triad Healthcare Network (THN). But her path to both excellent patient care and committed physician advocacy began long before medical school.
Family Medicine Is All in the Family for Dr. Hodges
“My father was a family physician,” she said. Later considered “the father of Family Medicine” in Ohio, he had worked in private practice for over 20 years before he moved his family from Cincinnati to Dayton to help start a new medical school at Wright State University. “He was the director of the Family Medicine residency and also the chairman of the Family Medicine department for the medical school,” Dr. Hodges said. “My dad would take me with him to the hospital and to his house calls. So I always wanted to be a doctor. Always.”
But because the clinical climate in Virginia didn’t meet their needs, the Hodges had to look elsewhere. Dr. Hodges’s father recommended North Carolina: “He said, ‘North Carolina has their act together.’” After researching several towns in the state where they could open their practice, the Hodges chose Asheboro and set up Hodges Family Practice in 1999. “We love Asheboro,” Dr. Hodges said. “We’ve been here since we opened the practice.”
Dr. Hodges soon pursued advocacy for physicians in addition to patient care.
“We’ve always done some work on the side,” she said. “Fransisco has been a medical director for several nursing homes and works as a part-time medical director at a Medicare Advantage insurance company. I began with hospice care but in 2015 got involved with the Triad Healthcare Network, because it was about letting doctors get back to the work they love to do, which is keeping people healthy.” THN is an accountable care organization (ACO) focused on delivering value-based care.
Set on becoming a family physician, Dr. Hodges attended Boonshoft School of Medicine at Wright State. There she met Francisco, who was also training to become a family physician. After completing their couples match and getting married, they both attended a “very comprehensive” residency at the Medical College of Virginia. “We were well-trained when we finished and able to do whatever we wanted,” Dr. Hodges said. “And my husband and I wanted to open our own practice.”
By 2017, Dr. Hodges had served on several THN committees and wanted more formal work with the network. “They made me a part-time medical director for primary care, which I continue to do,” she said. “I became the chief clinical officer in April 2022.” These extra responsibilities are a lot of work, Dr. Hodges admits, but they’re enjoyable because of what she can do for her fellow family physicians. “With these ACO initiatives, I can make an impact in keeping patients healthier but also in helping practices financially,” she said. “Half of our network is independent physicians, and their practices struggle month by month to stay open. I can help them.”
For one thing, Dr. Hodges said, “The money practices can get from participating in value-based care can be a buffer to profit margins, which can help keep their doors open.” But sometimes the help she gives is more personal: “Some of our practices have problems dealing with an insurance compa-
ny, and I have contacts now at the insurance companies. I can advocate for them, and that’s been rewarding.”
Dr. Hodges explains that her father’s example helped her advocate for her fellow family physicians. “My dad was a big physician advocate,” she said, “and he drilled into me that you needed to advocate for your profession. So, taking a leadership position at THN just seemed like a natural thing to do.”
She continues seeing her patients three days a week in Hodges Family Practice. Since it opened, her patients have
Members in the News
By Kevin LaTorre NCAFP Communications & Membership Manager
Congratulations to Everyone Who Matched into Family Medicine!
On March 15, Family Medicine residencies and students around the U.S. celebrated Match Day, and according to the American Academy of Family Physicians (AAFP), Family Medicine enjoyed “a record-breaking Match Day”! Last week, American Family Medicine residencies filled 4,595 positions in the main match – 65 more positions than the record-breaking class of 2023. “We celebrate and welcome those who matched today,” said AAFP Vice President of Medical Education Karen Mitchell, M.D., FAAFP. “Our new family physicians of the future will deliver much-needed health care across the United States, serving in rural and underserved areas in a way that is unique to family medicine.”
aged as they’ve remained her patients. “My part of the patient pool has aged,” Dr. Hodges said. “The vast majority of my population is over 55, and I think my oldest patient is about 104 years old.”
We’d like to thank Dr. Hodges for her service to her patients in Asheboro and her help to physicians around the state.
*A previous version of this article appeared online at ncafp.com in March 2024.
Here in North Carolina, 81 medical students matched into Family Medicine residencies, which is a great increase from 2023. And of those students who matched, about 50% will remain in North Carolina to complete residency – a plus for the workforce outlook in our state. Congratulations to all our student members who matched last month!
Dr. Karen Smith Testified Before Congress on March 7
Past NCAFP president and current AAFP Board member Dr. Karen L. Smith appeared at the March 7 Medicaid Expansion hearing on Capitol Hill. North Carolina Rep. Don Davis (who represents the First Congressional District of North Carolina) invited Dr. Smith to speak about the benefits of the recent expansion and her own experience as a family physician in our state. She joined Rep. Hank Johnson (DGA), Rep. Steve Cohen (D-TN), and other national stakeholders to discuss the current state of Medicaid expansion, its impact on patients, hospitals, and communities, and how Congress can proactively ensure everyone has access to affordable health care. Dr. Smith shared the impact of expansion in North Carolina from her perspective as a family physician in Raeford, to chronicle her experience of expanded Medicaid and to encourage expansion in the eleven states that still haven’t.
“North Carolina’s strategy of collaborative leadership with persistence across government, advocacy, and stakeholder
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groups moved Medicaid expansion into reality,” Dr. Smith said. “The numbers demonstrate the impact of providing access to people who were going without health care. Medicaid is available for people and to refrain from expansion is denying access to life changing health care.”
Dr. Raman Nohria Named STFM New Scholar
NCAFP member Dr. Raman Nohria became a New Faculty Scholar of 2024 at the Society of Teachers of Family Medicine (STFM) in February. The STFM selected Dr. Nohria as one of only 14 scholars across the U.S. because of his outstanding leadership potential and his commitment to teaching Family Medicine. He’ll now receive coaching and networking to improve his leadership skills throughout the year. “I feel honored to be selected to the program,” Dr. Nohria said. “I am excited to expand my professional and mentorship network and gain an understanding of how I can merge my strengths and passion to fulfill my potential for a career in Family Medicine.”
Dr. Kathy Andolsek Appointed to Executive Committee of the Accreditation Council for Graduate Medical Education Board of Directors
NCAFP member Dr. Kathy M. Andolsek was appointed to the Executive Committee of the Accreditation Council for Graduate Medical Education (ACGME) Board of Directors. The ACGME sets and monitors voluntary professional educational standards in residency and fellowship education in the U.S., to improve health care and patients’ health by assessing and improving its quality. Dr. Andolsek also chairs the ACGME Policies and Procedures Committee and serves on several other committees, including the Council on Requirements, the Education Committee, the Policy Committee, and the DEI Advisory Group. She teaches as a professor in Family Medicine and Community Health at the Duke School of Medicine and is the assistant dean in Premedical Education there. Congratulations to Dr. Andolsek on her new position!
Past President Dr. Hervy Kornegay Has Passed Away
Former NCAFP president Dr. Hervy B. Kornegay passed away on Feb. 15 at the age of 90. He had served as the 1983-84 NCAFP president in the midst of a career where he also performed several key roles to care for his community: co-founder of Mount Olive Family Medicine Center until 2019, medical director of the Duplin County Health Department, medical examiner for Duplin and Wayne counties, medical director for several nursing homes in Mount Olive, and the volunteer team physician for North Duplin High School for over 40 years.
In lieu of flowers, the Kornegay family requests that memorials be made to any of the following organizations:
• Dr. and Mrs. Hervy B. Kornegay, Sr. Endowed Scholarship at ECU Health Foundation, PO Box 8489, Greenville, NC 27835
• The Kornegay-Clifton Endowment Fund, University of Mount Olive, PO Box 90, Mount Olive, NC 28365
• Calypso Presbyterian Church, PO Box 321, Calypso, NC 28325
Dr. Viviana Martinez-Bianchi
Attended the White House Hunger and Health Kick-Off Event
On Feb. 27, NCAFP member Dr. Viviana Martinez-Bianchi attended the Challenge to End Hunger and Build Healthy Communities event at the White House. She attended to support the administration’s program of the same name, which in 2023 called stakeholders across the U.S. to commit to equitably reducing diet-related diseases and ending hunger by 2030. As the new president-elect of the World Organization of Family Doctors, Dr. Martinez-Bianchi has certainly taken up the call to equitably advance nutritional and communal health. We are thrilled to see her take her place among national health leaders.
Financial Health, Personal Well-Being Go Hand-in-Hand for Family Physicians
By Paul Hain, MD, FAAP
Professional life for family physicians these days seems to be as much about spreadsheets, software and staffing models as taking care of patients. All physicians are keenly aware that the business of practicing medicine has become more complex. That’s one reason why more doctors are taking steps to recognize and manage the sources of financial stress they face - for the benefit of their patients, themselves and their families.
It’s old news by now that family physicians are facing burnout in record numbers. You’ve probably seen the data points:
Physician burnout rose to 50% in 2021, up from 44% in 2017, among those with 11 to 20 years experience, as reported in study published in the JAMA Open Network in October 2023.
The study found considerably higher burnout rates among female physicians and among primary care physicians
With more primary care physicians leaving or retiring, and an inadequate pipeline of new doctors, the Association of American Medical Colleges projects shortages of up to 48,000 primary care physicians by 2034
More often than not, surveys of physician job satisfaction point to the business challenges brought on by our complex and evolving ways of delivering and paying for care in the United States. These hurdles - financial, administrative, staffing, billing, coding, IT, EHRs - are the ones that physicians often cite as making their jobs more difficult. They’re present no matter what business model you’ve chosen, whether you’re an employed physician, an independent, or in partnership with other doctors.
It would be one thing if these challenges could be easily defined and managed. That’s just not the case. Every business and operational decision currently comes in an environment that’s not exactly hospitable to physician practices, as costs keep rising and reimbursement isn’t keeping pace.
Nearly nine in 10 medical groups saw their operating costs increase in 2023, with an average increase of 12.5%, according to a survey by the Medical Group Management Association.
And we all know about the recent 3.4% cut to the conversion factor in Medicare’s physician fee schedule.
Of course, business matters are just one set of challenges for family physicians. Another comes from the daily stress of delivering care, although for the vast majority, this takes a back seat to the satisfaction of serving patients and families, helping them get the best possible care when they need it. This is when family doctors are in their element. It’s why they went into medicine in the first place.
Fortunately, the family physicians here in North Carolina that I speak with understand the importance of seeking out and using a variety of resources to help them thrive - both professionally and personally - in the face of challenging circumstances.
Staying active in professional associations, for example, is one way physicians find support in ways that go beyond clinical and research
discussions. Much of what takes place at NCAFP gatherings offers continual learning on such things as business models and practice operations, not to mention sharing personal stories with each other. The NCAFP Member Satisfaction and Practice Environment Committee helps with practice effectiveness as well as physician health and wellness, among other duties in its charter.
Likewise, the AAFP offers a wealth of resources and educational opportunities on practice management. These include big-picture items such as choosing business models for your practice, and operational details like revenue cycle management and accurate billing and coding. As the AAFP notes, these resources are useful for all family physicians, even employed physicians who aren’t accountable for day-to-day operations.
In our work at Alo, we often have conversations with independent practice owners who want to position themselves for a better future but aren’t quite sure how to get there. Inevitably the topic of value-based care comes up.
We tend to advise physicians on proceeding with VBC on the basis of what’s right for them given where the practice currently sits on the continuum of risk. This might mean, for example, that we discuss the benefits of being in a clinically integrated network (CIN) and accountable care organization (ACO) at the same time. Or we might explain why just being in the CIN makes the most sense for now.
It’s true that family physicians have more business and financial choices than ever. It’s a long list that includes: outsourcing administrative functions, signing value-based care agreements, securing outside investment, merging with other practices, selling outright to - or breaking off fromhealthcare systems, closing the practice, and maintaining status quo. You might even opt for a combination of these models.
These topics are crucial. But they’re far from the only ones that come up. The business of medicine is highly personal, I think more so for family physicians than other specialties.
Experienced doctors want to know they’re building a legacy of outstanding patient care and maybe even doing so for several generations of families that they serve. Those who have recently started their careers are eager to make a difference in the profession, and it’s hard to do that if you’re constantly worrying about whether your practice can survive financially. I personally enjoy getting to know the history and motivations within our physician community across the state, which only helps as we’re trying to advise on business decisions.
We all want assurances that what we’re doing professionally matters. While different from the commitment to patient care, ensuring that your practice is financially healthy and that you as a family physician are personally healthy also require commitment. Physicians who take time to evaluate their options and make good choices on both of these fronts can look forward to a sustainable future focused on serving their patients and their communities.
Paul Hain, MD, FAAP, is Chief Clinical Officer at Alo. Headquartered in Durham, Alo provides strategic services and solutions to help North Carolina physicians manage the business of medicine.
STUDENT INTEREST & INITIATIVES
By Perry Price NCAFP Manager of Workforce Initiatives
What Our Summer Programs Give to Students, Preceptors, and Family
Medicine
Spring has arrived, which means summer is just around the corner! We are eagerly preparing to host students from medical schools across North Carolina for experiences that will transform their understanding of Family Medicine.
During our two-week immersion experiences, the students spend their first week at a residency program, participating in lectures and clinical workshops, visiting clinics in the community, and getting to interact with residents and faculty! They live with a resident or faculty member for the first week as well, getting to see what their daily lives and schedules look like. During the second week, the students are paired one to one with a practicing physician in the community, with whom they live and work. This total immersion in the life of a family physician is an incredibly powerful experience, as it affords the students a chance to see the impact a family physician can have on a community
The Foundation Endowment Campaign Has Raised the First $1 Million!
The NCAFP Foundation’s ongoing campaign to raise $6 million to grow our Medical Student Endowment has exciting news: we’ve just reached the $1 million milestone!
Increasing the Medical Student Endowment will provide a larger source of permanent funds enabling us to sustain and grow our programs that support medical student engagement with Family Medicine! Growing our scholarships, summer programs, conference stipends, mentorship opportunities, FMIG engagement, and the many other offerings we have for students is a crucial element to increasing the number of students choosing Family Medicine.
as well as the numerous roles many family physicians play.
Our four-week externship shows a bit of a different perspective. The student spends four weeks shadowing their preceptors in their clinic, while also participating in outsideof-work obligations that impact their practice or are due to their practice. This experience gives students a broader picture of the variety of patients and cases a family physician sees, but once again it allows them that opportunity to see the impact family physicians have on their communities!
We know that mentorship and relationships are important to sustaining a physician’s well-being, and these relationships built between the students and physicians who serve as preceptors or hosts in these programs often last far beyond the time spent together. They also have huge impacts on medical students deciding to pursue Family Medicine in residency! The NCAFP and the NCAFP Foundation work in concert to ensure that these opportunities exist for all students who seek them out, and that the opportunities are shared with medical students across the state! We count on our members to serve as preceptors and hosts for these students, and we trust them to be strong ambassadors for Family Medicine!
We will be sharing preceptor and student spotlights throughout the summer on our website and social media, so be sure to follow along! If you’re interested in learning more about precepting or you’d like to support the NCAFP Foundation’s efforts to support Family Medicine reach out to me at perry@ncafp.com.
We’re grateful for the support we’ve received so far, and we are excited to continue towards our final goal! If you have any questions about the Endowment Campaign or the work that the Foundation does to support medical students in their experience of Family Medicine, please reach out anytime. Our member support and engagement are crucial to our success!
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By Aram Alexanian, MD, FAAFP Novant Health Primary Care
10 Tips to Decrease Time in Your EHR
Family Physicians and APPs are spending more and more time in the EHR. This additional time has crept into many other aspects of a clinician’s life, which makes it very difficult to truly “escape” from their work and therefore harder to recharge their minds for what they love to do most — taking care of patients.
The Novant Health Wellness Informatics team has been able to see common practices which lead to inefficient use of the EHR. Below is a list of 10 observations that can help decrease your time in the EHR and improve quality of time you spend with your patients.
1. TAKE TIME TO PERSONALIZE THE EHR TO BEST FIT YOUR MEDICAL PRACTICE
EHRs have multiple ways you can personalize your workspace. Although some of these personalization settings are purely aesthetic, other options can significantly improve efficiency. We have found that clinicians who spend time optimizing the system have the greatest return on that investment.
For example:
• Ensure your screens are optimized, such that your eyes are drawn to the most pertinent and relevant information needed for patient care
• Streamline views to minimize clicking and scrolling
• Have a great preference list, so that you do not spend too much time searching for less commonly ordered items. Some ways to improve efficiency include creating order panels and using keyword searches for commonly placed orders
• Develop shortcuts to search your patients’ charts
2. TAKE ADVANTAGE OF SUPPORT TEAMS
The level of support available depends on your institution. However, it never hurts to ask what kind of EHR support systems are available to you. If there are none, you can always consider starting or requesting one (or see item 10 below).
The Novant Health Wellness Informatics team offers the following services which may serve as a framework should you want to create your own:
• One-to-one sessions — in-person or virtually
• Lunch-and-learns
• In-classroom advanced tips and tricks courses
• Email and Teams chat support
• In-person go-live support
• New clinician support and personalization sessions
• Close collaboration with other teams who shape the EHR, including educational, training, analytical, and physician-builder teams
3. TAKE PART IN SYSTEM OPTIMIZATION OPPORTUNITIES
This is also institution dependent. In our organization, we have processes in place to allow clinicians to provide feedback to analysts and builders, such as:
• GROSS (Getting Rid of Stupid Stuff)
• Teams within each specialty that vet any opportunities for EHR optimization. These teams are paired with analysts and physician builders. If the suggestion is deemed impactful, a change will be made.
If you do not have these options, reach out to your EHR vendor and see what processes they may have in place where feedback can be given.
4. USE ANY AND ALL DOCUMENTATION TOOLS TO THEIR MAXIMUM ADVANTAGE
Documentation burden is a huge contributor to burnout. Even if you have been using the same documentation tools for years, it does not hurt to hear of other options your EHR system may have.
Also, don’t forget about the documentation changes which went into effect in January 2021. Your E/M levels of service are now based on medical decision-making or time. Understanding these changes will help decrease note bloat.
Pre-charting can save a lot of time. What I have found in my personal experience is that pre-charting allows me to think through a case better and makes my time in the room with the patient much more efficient.
Team-based approaches can also be very beneficial. As an example, a medical assistant can help with documenting parts of your note.
Do not forget about voice recognition. Use of voice recognition can save up to three minutes per note. Although I am a very fast typist, voice recognition software has come a long way and is much more accurate and faster than I could ever be.
Finally, there are now many scribe opportunities — from in-person scribes to ambient AI. We have had great success with all forms of scribe services.
5. DO NOT IGNORE IMPORTANT POP-UP WARNINGS.
Alert fatigue is real, but pop-ups are designed with patient safety in mind. Although this is institution dependent, take heed to warnings, in particular for drug-drug interactions. Sadly, bad outcomes happen due to alert fatigue and ignoring serious warnings.
6. OPTIMIZE WORKFLOWS
Poor workflows can make or break your office efficiencies, regardless of how well you use the EHR. Look at everything from check-in to check-out and every process in-between to see how you can make things as efficient as possible. And keep patient experience at the center of this evaluation.
For instance, I want to maximize time with my patients and don’t want to search for a clinical assistant when I step out of a patient room. Therefore, we have systems in place where we communicate with each other in the EHR (either using chat or writing notes on the schedule). Our communication system can be seen by all clinical team members, which fosters a team approach should the primary assistant be occupied.
7. ALLOW YOUR CLINICAL TEAM MEMBERS TO WORK AT THE TOP OF THEIR LICENSE
We have had to do some research and confirmation as to what a clinical team member can and cannot do based on state guidelines. You may find that a medical assistant can assist you with tasks such as completing a diabetic foot exam. Our team has seen cases where clinicians are reluctant to give up on some tasks they have been doing for several years. But once they do, it frees them up to do other meaningful tasks.
8. MAINTAIN AN ACCURATE (AND CLEAN) PROBLEM LIST
Maintaining an accurate problem list can help in many ways, ranging from efficiency to improved coding and reimbursement. When updating your problem list, make sure you are using diagnoses that best and most accurately describe the condition you are treating. Keep hierarchical condition category (HCC) coding in mind as you update your diagnoses, as these codes could positively impact re-
imbursement in value-based payment models. For more information on HCC coding, the AAFP journal has a helpful article on the subject: https://www.aafp.org/family-physician/practice-and-career/getting-paid/coding/hierarchical-condition-category.html
9. ADDRESS IN-BASKET MESSAGES IN A TIMELY FASHION
One sign of burnout can be delayed responses to in basket messages or delayed closure of encounters. The aspirational goal should be to always get today’s work done today.
10. LEARN EHR TIPS AND TRICKS FROM YOUR COLLEAGUES
Sharing EHR tips and tricks with colleagues can not only improve our efficacy in using the system but also provide valuable opportunities for meaningful interaction and connection with your practice partners.
BONUS TIP: SEEK HELP WHEN YOU NEED IT!
We all hit bumps in the road. Practicing medicine is a wonderfully rewarding profession, but also very demanding and stressful. There have been many times when our Wellness Informatics team is working with a clinician to help with an EHR-specific task all for the encounter to become a counseling session. Our team is equipped to help and connect the clinician to the right resource and also to lend a supporting ear.
I hope you find this information helpful in your continued pursuit of taking the best care of your patients…and each other.
Aram Alexanian, MD, FAAFP is a family physician and clinical physician executive for Wellness Informatics. He is also currently serving as chair of family medicine for his local hospital.
There Are New Recommended Tests and Reimbursements for Diagnosing and Treating Syphilis
On Feb. 8, the Centers for Disease Control and Prevention published a report of new recommendations to support successful diagnosis of syphilis. “A syphilis epidemic is occurring in the United States, with sustained increases in primary and secondary syphilis from 5,979 cases reported in 2000 to 133,945 cases reported in 2020, a 2,140% increase,” the report states, adding that “approximately 176,000 cases in the United States” were reported to the CDC in 2021.
These comprehensive recommendations on laboratory testing for syphilis are quite long but worth reviewing as you continue to monitor congenital syphilis cases in your patients: https://www.cdc.gov/mmwr/volumes/73/rr/rr7301a1.htm
In addition, reimbursements for in-office syphilis treatments have increased. Medicaid reimbursement of Bicillin-LA administered in offices has been increased as part of the state’s effort to address rising rates of syphilis and congenital syphilis. Reimbursement per unit of Bicillin-LA has been increased from $3.88 per 100,000 units to $21.73 per 100,000 units. For a typical adult dose of 2.4 million units, that totals $521.52 per administration.
Betsey Tilson, Chief Medical Officer at NCDHHS, said, “Data show that in 2023, only 32% of women with symptomatic syphilis received same-day treatment and 34% of women were not treated until more than seven days after their syphilis diagnosis. This change in reimbursement of Billicin L-A for office-based treatment can improve that treatment gap.”
And as of March, NC Medicaid will now cover imported benzathine benzylpenicillin (Extencilline) for outpatient claims. This new coverage will help treat syphilis and congenital syphilis more widely as cases increase, since there is a national shortage of Bicillin L-A (the first-line treatment for those diseases). Review the billing guidance for Extencilline as you consider prescribing it: https://medicaid.ncdhhs. gov/blog/2024/02/29/nc-medicaid-cover-imported-benzathine-benzylpenicillin-extencilline-billing-guidelines
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