~ Story on Page 10 ~
The North Carolina Family Physician
Vol. 6 - No. 3
Third Quarter, 2010
Blue Cross and Blue Shield of North Carolina Foundation Partners with NCAFP On
Innovative Program to Tackle Shortage in Primary Care
Immunization Challenges Continue Vaccines Buying Info Inside
~ Story on Page 14 ~
Family Medicine: Is The Worm Beginning to Turn? | Legislative Year Brought Challenges | My Own Home Visits | Immunization Challenges
Dec. 2-5, 2010 The Grove Park Inn Resort & Spa - Asheville, NC General Session Topics--Redefining the Hospice and Palliative Care Patient in Primary Care Healing and Preventing Diabetic Foot Ulcers: A Marriage of Team, Technology and Tenacity What Every Family Physician Should Know About Lung Cancer Health Disparities in Coronary Artery Disease Dyslipidemia Management –Five Issues to Consider Before You Treat Excellence in Diabetes Care: A Team Approach Tips for Preventing and Treating Childhood Obesity Using Reminder and Recall Systems to Improve Adolescent Immunization Rates
Optional Workshops--Meaningful Use Patient Centered Medical Home Health Disparities Valuable Hands on Procedures – Joint Injections & Skin Biopsies Cosmetics Procedures SAMS Working Group: Pain Management
ls i a t De e 10 ag P n FP o
AA dits 30+ ed Cre b scri Pre
Satellite Programs --The Challenges of Treating Depression in Older Adults Exploring the Evidence: The Neurobiology of Bipolar Disorder Pathophysiology of Pain: Mechanisms and Manifestations
Complete meeting information
Dr. Michelle F. Jones - Program Chair
is online at www.ncafp.com/wfpw
PUBLISHED BY
THE NORTH CAROLINA ACADEMY OF FAMILY PHYSICIANS, INC Raleigh, North Carolina 27605 919.833.2110 • fax 919.833.1801 http://www.ncafp.com
2009-2010 NCAFP Board of Directors NCAFP Executive Officers President R.W. ‘Chip’ Watkins, MD, MPH, FAAFP President-Elect Richard W. Lord, Jr., MD Vice President Brian R. Forrest, MD Secretary/Treasurer Shannon B. Dowler, MD Board Chair Robert Lee Rich, Jr., MD Executive Vice President Gregory K. Griggs, MPA, CAE Past President (w/voting privileges) Christopher Snyder, III, MD
Volume 6
The North Carolina Family Physician
Number 3
TA B L E O F C O N T E N T S Features
Family Medicine: Is The Worm Beginning to Turn?......................................... 4 Innovative Program to Tackle Shortage in Primary Care................................... 5 Legislative Year Brought Challenges.......................................................... 6
The District Directors District 1 R. Kevin Talton, MD District 2 Connie Brooks-Fernandez, MD District 3 Scott E. Konopka, MD District 4 Timothy J. McGrath, MD District 5 Rhett L. Brown, MD District 6 James W. McNabb, MD District 7 Thomas R. White, MD At-Large George L. Saunders, MD At-Large William A. Dennis, MD IMG Physicians Constituency Nalini S. Baijnath, MD Minority Physicians Constituency Enrico G. Jones, MD New Physicians Constituency Jana C. Watts, MD FM Department Constituency Kenneth K. Steinweg, MD FM Residency Directors Gary I. Levine, MD Resident Director Meshia Q. Todd, MD (Duke) Resident Director-Elect Nicole Shields, MD (SR-AHEC) Student Director Kathryn Norfleet (UNC) Student Director-Elect Sohale Vu (ECU) AAFP Delegates and Alternates AAFP Delegate AAFP Delegate AAFP Alternate AAFP Alternate
Mott P. Blair, IV, MD Karen L. Smith, MD, FAAFP L. Allen Dobson, MD Michelle F. Jones, MD
FP Department Chairs and Alternates Chair (ECU) Alternate (Duke) Alternate (UNC) Alternate (WFU)
Kenneth Steinweg, MD J. Lloyd Michener, MD Warren P. Newton, MD, MPH Michael L. Coates, MD
NCAFP Editorial Committee Chair NCAFP Council Chairs Advocacy Council Continuing Medical Education Council Health of the Public Council Practice Enhancement Council
William A. Dennis, MD Shannon B. Dowler, MD Richard W. Lord, Jr., MD Brian R. Forrest, MD Richard Lord, Jr, MD James McNabb, MD Jennifer Mullendore, MD Thomas R. White, MD William A. Dennis, MD Tim J. McGrath, MD
MANAGING EDITOR & PRODUCTION
Peter T. Graber, MMC,CAE, Director of Communications FOR ADVERTISING INFORMATION
Peter Graber, pgraber@ncafp.com 919.833.2110 • 800.872.9482 www.ncafp.com/academy/publications/advertising
My Own Home Visits............................................................................. 8 2010 Winter Family Physicians Weekend....................................................10 Sections
President’s Message............................4
Residents & Students..................................11
Chapter Affairs..................................... 9
Health Improvement & Initiatives....................... 12
Education & Development.................... 10
Family Medicine in Practice............................. 14
The NCAFP Strategic Plan Mission Statement: to advance the specialty of Family Medicine, in order to improve the health of patients, families, and communities in North Carolina. Vision Statement: Family physicians will be universally valued for their role in providing high quality care to the people of North Carolina. Core Beliefs: • We believe that Family Medicine is essential to the well-being of the health of North Carolina, and that Family Medicine is well-suited to improve the health of the residents of our state. • We believe in a healthcare system that is primary care driven. We believe there is an inherent value in a primary care medical home—providing quality, access and affordability. • We believe in a healthcare system that is fair, equitable and accessible. We believe in the elimination of health disparities and barriers to access to healthcare for North Carolina. • We believe in a comprehensive approach to patient care, and value the health and well being of patients, families and communities. • We value collaborative communication with all parties concerned with healthcare delivery, and advocate for a positive practice environment to nourish the specialty of family medicine. • We value the professional and personal well being of our members. Core Values: • Quality, evidence-based, timely education. • Professional excellence and integrity. • Fiscal responsibility, organization integrity and viability. • Creativity and flexibility. • Member-driven involvement in leadership and decision making. Additional details on the strategic plan are located at www.ncafp.com/home/academy/mission
Ed i t i o n 23
WWW.NCAFP.COM
North Carolina ACADEMY OF Family PhysicianS, INC
NCAFP President’s Message
~ 2010 PRESIDENTIAL MESSAGE NO. 3 ~
Family Medicine: Is the Worm Beginning to Turn? Recent Developments Point to Promise for Specialty The phrase “the worm turns” originates from William Shakespeare’s play Henry VI, Part 3. The original phrase was uttered by Clifford, killer of Rutland as, “The smallest worm will turn being trodden on, and doves will peck in safeguard of their brood.” The term is used to convey the message that even the smallest or most docile of creature will strike if pushed too far. Also, it is typically used when someone or a group of some ones previously downtrodden ultimately get their reward – that is, an unfavorable situation is reversed. Not that I would ever liken the family physician as a worm – far from it! However, suffice to say we as a group have felt downtrodden or overlooked by the House of Medicine, the insurance industry and government. But for the first time in my career, I am beginning to see and feel real hope for those who deliver primary care. Most of the excitement centers around the model of the PCMH or the “Patient-Centered Medical Home.” Those birthing new Health Care Reform believe that the medical home, with its physician-led team delivery of coordinated, holistic, primary care in both the exam room and online - through the increased use of electronic medical records and practice-based websites, is exactly what our country needs to improve quality of health care delivery while lowering costs. At the same time, the hope is to give primary care physicians the extra pay they deserve for operating such medical homes — most likely through blended payment systems with a mix of capitated per member per month payments, fee-for-service and pay-for-performance. It promises to deliver these clinicians from the fee-for-service medicine nightmare with its often piecemeal, punitive disincentives making us feel like we are always on a treadmill running faster and faster. Currently, much of what we do goes without payment – or worse yet is actually costing us by what we are giving away in time (money) through performing often menial, redundant, or unnecessary tasks mandated through the pro-bono work we do for third-party payers. In a recent article in the NEJM: “What’s Keeping
Us So Busy in Primary Care? A Snapshot from One Practice” by Richard J. Baron, M.D. we read, “Primary care practices typically measure productivity according to the number of visits, which also drives payment. Work that does not involve a visit from a patient is invisible to those who support and purchase primary care.” The physicians in the article cited 50-60 hours of scheduled patients/week with 23.7 phone calls per physician per day, 12.1 script refill requests every day, 16.8 email messages, 19.8 labs; 11.1 imaging reports, 13.9 consultations reports all each day. Each of those requires review and correlation with a chart and a patient – and NONE OF IT, excluding the office visit, is billable. So will the PCMH indeed be our salvation? Maybe…according to a set of 8 articles in a special supplement of the Annals of Family Medicine, released July 8th, 2010, which evaluated a 2-year medical-home demonstration project. The authors of the summary article in the collection felt that although it is certainly possible for practices to become medical homes, the transformation “requires tremendous effort and motivation,” and that most practices would need help from the outside, in addition to adequate compensation for practices to make the switch to PCMH. The authors of the summary article also recommended that third-party payers turn to arrangements such as monthly capitation payments to make the cost and effort of converting to PCMH worthwhile for physicians. “Expecting practices to front the cost of transformation with the hope of more appropriate reimbursement in the future is unlikely to succeed,” the article stated. We have seen this type of model work in NC within the CCNC network. In early July, Medicare invited states to apply for the first of three medical-home demonstration projects that will combine fee-for-service payments with a PCMH incentive - which could take the form of PMPM capitation payments, add-ons to usual fees, or other pay-for-performance incentives. Hopefully, Medicaid and even private payers
july - september, 2010 | the North Carolina Family Physician
R.W. Watkins, MD, MPH, FAAFP 2009-2010 NCAFP President will also participate in this project. In addition, there have been very creative and progressive models put forth by insurers like BCBS of NC in their “Blue Quality Physician Program” where higher fee-for-service is paid for those practices qualifying for one of three different levels of PCMH through the NCQA system. Is the worm turning? Perhaps. One thing is for certain: If we are to remain viable as a specialty, and see more medical students entering into family medicine and primary care, the pay differential between specialists and primary care must change. Here is some data from the Council on Graduate Medical Education. In the 1980s, primary care physician income levels were 75% of specialty incomes, and medical student choice of primary care careers was 35%. Both numbers fell, but with the rise of managed care in the early to mid 1990s, interest briefly inched up above 35%. When higher incomes did not materialize and the relative income actually plummeted, medical students moved away from primary care in droves, at 15-20% for the last 7 years, not nearly enough for an effective system – which is touted to be roughly 50% primary care and 50% specialists. For the last 30 years, the changes in interest in primary care can be virtually superimposed upon the changes in income relative to specialty income. Canada’s experience is informative. When Canadian family physician incomes increased to 83% of specialty incomes, from $160,000 in 2004 See PRESIDENT’S MESSAGE on back cover
WWW.NCAFP.COM
www.ncafp.com/residents_and_students
RESIDENTS & STUDENTS
Blue Cross and Blue Shield of North Carolina Foundation Board Chair Brad Wilson led the press conference in Raleigh.
Blue Cross and Blue Shield of North Carolina Foundation and NCAFP Announce Innovative Program to Tackle Shortage in Primary Care In June, the Blue Cross and Blue Shield of North Carolina (BCBSNC) Foundation announced a new partnership with the NC Academy of Family Physicians to establish an innovative mentoring and family medicine interest program to encourage more medical students to choose a career in family medicine and ultimately practice in North Carolina. The project is funded through a $1.18 million grant from the BCBSNC Foundation to the NCAFP Foundation, along with nearly $600,000 of matching funds from the Chapter. Through the grant, the NCAFP will increase medical students’ exposure to innovative family medicine practices and encourage more of the state’s medical students to pursue a career in family medicine, ultimately ensuring that more North Carolinians have access to high quality primary care. Brad Wilson, Chairman of the BCBSNC Foundation, made the announcement June 2 at the Raleigh office of NCAFP Past President and current AAFP Board Member Dr. Conrad Flick. “Too many North Carolinians struggle to find primary care in their community,” Wilson said. “Our cities and towns work hard to attract quality physicians, but the reality is there are not enough family doctors to address the need. While the number of family physicians WWW.NCAFP.COM
in North Carolina is growing, current rates of growth would only meet 75 percent of the projected need.” Wilson went on to describe the issues surrounding a career choice in family medicine today. “As many of you know, today’s medical
students have little incentive to become family physicians,” Wilson said. “A study conducted by the AAFP states students who reject family practice are concerned about low income, prestige, and breadth of knowledge required for this specialty. The Blue Cross and Blue Shield of North Carolina Foundation believes that by supporting this scholarship and mentoring program, we will encourage more students to consider and pursue a career in this critically important field.” The program aims to increase the percentage of medical students who commit to a residency in family medicine by approximately 30 percent and the percent of those who elect to stay in the state for their residency training from 56 percent in 2008 to at least two-thirds over the course of the six-year program. The program will provide North Carolina medical students with role models in family medicine, pairing up to 12 scholars each year with innovative family physicians in clinical practice settings. These physician mentors will work with students for three consecutive years to strengthen skills, offer guidance and help fast-track their health care leadership training. In addition, the program will target a broader audience of medical students to increase interest in family medicine by improving and increasing interaction between practicing family physicians and students --primarily through the Family Medicine Interest Groups at each of North Carolina’s four medical schools. In accepting the grant, NCAFP President See SCHOLARS PROGRAM on back cover
The first class of students and mentors participating in the program beginning this academic year include:
Students
Hometown
Medical School
Corrie Burke Hannah Fuhr Kelley Haven Samantha Heuertz Ashley Hink Kathryn Lawrence Holly Love William Martin Brian Moore Brian Sanders Daniel White Patrick Williams
Lithonia, GA Bad Kreuznach, Germany Greenville, NC Charlotte, NC Raleigh, NC High Point, NC Mount Pleasant, NC Winterville, NC Chapel Hill, NC Greensboro, NC Johnson City, TN Hickory, NC
UNC School of Medicine Brody School of Medicine at ECU Brody School of Medicine at ECU UNC School of Medicine Brody School of Medicine at ECU Wake Forest University School of Medicine Brody School of Medicine at ECU UNC School of Medicine UNC School of Medicine Wake Forest University School of Medicine UNC School of Medicine Brody School of Medicine at ECU
Physician Mentors Mark E. Beamer, MD Sara O. Beyer, MD Jonathan E. Fischer, MD Conrad L. Flick, MD Brian R. Forrest, MD Elizabeth P. Fry, MD Michelle F. Jones, MD David E. Lee, MD J. Thomas Newton, MD Charles W. Rhodes, MD J. Carson Rounds, MD
Location Belhaven, NC Charlotte, NC Carrboro, NC Raleigh, NC Apex, NC Greenville, NC Wilmington, NC Lewisville, NC Clinton, NC Mount Pleasant, NC Wake Forest, NC
Practice Pungo Family Medicine, PA Steele Creek Family Practice Piedmont Health Services Family Medical Associates of Raleigh Access Healthcare Physicians East Wilmington Health Associates Family Medical Associates Clinton Medical Clinic, Inc. Cabarrus Family Medicine Village Family Medicine
North Carolina ACADEMY OF Family PhysicianS, INC
POLICY AND ADVOCACY
~
NCAFP
LEGISLATIVE
ADVOCACY
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Legislative Year Brought Challenges The oxygen masks have not fallen from the ceiling, but the seatbelt sign is on By Dr. Brian Forrest, Chair, NCAFP Advocacy Council
Medicaid provider rates are expected to take another cut. This time it will be smaller than last year, and given the nearly $1 billion state budget shortfall, we have done well to emphasize the importance of family physicians and the survival of the Medicaid-accepting practice to preserve the rates where they are. The cuts could occur earlier than anticipated because Congress has failed to act on extending additional Federal Medicaid Assistance funds (FMAP) to the states. As the Legislative session wound to a close, members of the General Assembly drafted a list of contingency cuts to be taken if the anticipated $500 million in federal FMAP assistance did not occur. The fifth of a list of eight contingency measures was a cut of $26 million to Medicaid provider rates. In an attempt to soften the blow and minimize future cuts, it is likely that a 1% to 1.5% cut will go into effect in the near future in order to buffer the impact if the additional federal dollars are not approved by Congress, which seems more likely every day. Last year, the Academy was able to successfully lobby to preserve the rates for E&M codes which preferentially affect primary care physicians. It appears that these new cuts will be across the board and will not have any special carve outs for E&Ms. To make matters worse, Legislators are anticipating a record deficit in the state budget next year, which could be over twice the size of this year. If that comes to pass, the advocacy team at the NCAFP will do all it can to preserve rates for family physicians. Clearly, some cuts will happen soon, but it is also likely that Medicaid will experience additional cuts next year. It’s up to us to contact our local legislators and help them to understand how to prioritize those cuts. We certainly need education dollars, but if the population is not healthy, then education will not do much good. A solid primary care workforce as the foundation for our state’s health is crucial to having a productive
economy and that is what your local lawmakers need to hear. We have been asking for contributions to FAMPAC to help support legislative candidates supportive of family physicians and strong primary care. In the next eighteen months, physicians will reap what they have sown in terms of investing in the political process. I hope at the end of the day you will be able to say that you did all you could have, because this is your future. If you have not contributed to FAMPAC, do so now!
I have a friend that lives in Raleigh who will take their child to whatever pharmacy or retail clinic they happen to be closest to that day for things that Family Physicians and Pediatricians used to do. She has lost a sense of connectedness to a single source of care for her child. She senses that all health care is “generic” and that you get the same quality no
Vaccine Program Eliminated
In other legislative developments, North Carolina’s Universal Vaccine Program will no longer exist as it has in the past due to the state budget. An effort to have private insurers pay into that system to ensure a free vaccine supply was not successful. Had this proposal been enacted, insurance companies would have turned over the responsibility of providing vaccine for their insured population to the state program, which would have been the sole source for immunization in North Carolina. Under the revised system, vaccines for Medicaid recipients and uninsured children will still be available through the state. However, vaccines for your insured patients will have to be purchased through private channels. The important thing to remember in all of this is that Family Physicians need to continue to provide immunizations in their community even though they will have to order them privately. If you stop offering vaccines as part of your “basket of services,” you will allow other providers and pharmacists to fill that void and further fragment continuity-of-care. Not providing vaccinations further narrows the scope of what family physicians offer and makes the public wonder about the importance of a having a medical home at all.
july - september, 2010 | the North Carolina Family Physician
Legislative Advocacy is a Key Focus of the NCAFP The Academy continues to maintain a constant presence at the NC General Assembly in Raleigh and continually encourages family physicians to become engaged in the advocacy process. Pictured above is a recent lobbying segment hosted by the NCAFP that provided tips and techniques to physicians in advocating for the specialty with their elected state officials.
matter where you go or the relationship that you may or may not have. This is exactly the culture that threatens family medicine and See LEGISLATIVE yEAR on p. 15
WWW.NCAFP.COM
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Executive’s message
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NCAFP
STRATEGIC
DIRECTION
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My Own Home Visits Member practices and training facilities yield great insights During a recent visit to one of our state’s residency programs, one of the faculty commented that he always told his residents if they really wanted to figure out what was going on with a patient, to do a home visit. To some extent, I feel like I’ve been doing the same. Over the past 12 months, I’ve been making a concerted effort to visit some of our member practices and more recently some of our state’s residency programs. It has reminded me of an old quote, “when you’ve seen one (fill in the blank), you’ve seen JUST one.” And that’s really true of our state’s diverse family medicine practices. But there’s always been one common theme -- I come back re-energized, ready to do battle for you, the family physicians of North Carolina. I hope you will indulge me and let me describe just a few of the home visits (to our practices) I’ve made over the past year. I started my travels last year to some of the far southeastern reaches of our state visiting Bladen Medical Associates and New Hanover Community Health Center. I went to Wilmington to conduct a board orientation for a new Board Member, Dr. Nalini Baijnath. I left amazed at what her community health center does, serving a very needy population. From mental health services to dental and pharmacy, her Center truly offered an integrated medical home with all the services a patient could need under one roof. I travelled up the road a bit to visit with Dr. Robert L. (Chuck) Rich, who then served as our President and now serves as our Board Chair. I marveled as he gave me a tour of their 25-bed critical access hospital. He could hardly walk through the wards or the emergency department without staff and patients alike trying to get a quick word with their own Dr. Rich. Dr. Rich works in a more traditional family practice serving a rural underserved population with regular visits to the nursing home and daily visits to the hospital, even staffing their small intensive care unit. I left these two visits re-energized with a better understanding of the need that they faced
in both a more urban and a rural setting. Later in the year, I travelled to Clinton Medical Associates to visit with Dr. Tommy Newton, not for a traditional practice visit but to learn more about how he takes prevention into the community. You see, Dr. Newton has developed an innovative physical activity program and implemented it in Clinton’s elementary schools. His program, Fitness Renaissance, now has its own non-profit status and a governing board of directors with many community leaders and even representation from the NCAFP. Again, Dr. Newton showed what is great about family medicine with his care for the community at large whether they were his patients or not. As we moved into late 2009, I ventured to Greensboro for a transition meeting with current president Dr. R.W. (Chip) Watkins. When I walked into his practice, I saw a setting that I had never seen before. His office offered a tranquil feel unlike any practice I had visited and an integrative approach to medicine with acupuncture and even bio-feedback services available. But his emphasis still deployed the core values of family medicine: prevention and disease management. I also visited the practice of Dr. Jim McNabb in Mooresville, where he deploys his own “surgical day” once a week, performing many procedures from joint injections to numerous dermatological procedures. He talked about how his work with procedures allowed him to keep more of his patients’ healthcare right in their medical home and at the same time increased his practice’s revenue streams. And I’ve had the pleasure of visiting Access Healthcare in Apex and Dr. Brian Forrest, our Advocacy Council Chair, on numerous occasions to learn about his low-overhead model of practice. In more recent months, I’ve reached out to at least a few of our state’s residency programs. My travels have taken me to Greenville, where I
july - september, 2010 | the North Carolina Family Physician
Gregory K. Griggs, MPA, CAE
Executive Vice President saw their re-designed teaching service now being emulated by other departments at Brody and attended the topping off ceremony for their new Family Medicine Center. Due to their shear proximity, I have the ability to visit UNC and Duke on a regular basis but know I’ve only seen a microcosm of what they have to offer. And my short visit to Wake Forest included residents reporting on journal articles on the Patient-Centered Medical Home. I’ve also had the privilege of visiting a number of private practices closer to home here in the Triangle. From Village Family Medicine and NCAFP Foundation President Dr. Carson Rounds in Wake Forest to Family Medical Associates of Raleigh and AAFP Board Member Dr. Conrad Flick to NCAFP Vice President Dr. Brian Forrest and his low-overhead model, I’ve experienced three practices with similar values when it comes to patient care but very different models. And I also made it out to Cary Healthcare Associates and Henderson Family Medicine where I did brief presentations on the Academy and the concept of the Patient-Centered Medical Home respectively. More recently, I spent a day and a half visiting Cabarrus Family Medicine Residency Program and Carolinas Family Medicine Residency in Charlotte. At Cabarrus, Dr. Mark Robinson started me early with the 7:00 a.m. morning report by residents at Northeastern Medical Center. This was followed by a tour of the hospital and a visit to one of the patients the residents had reported about, as well as visits to all four of their primary care residency training
WWW.NCAFP.COM
www.ncafp.com/academy
sites in Mt. Pleasant, Kannapolis, Harrisburg and Concord. While in Mt. Pleasant, I visited briefly with NCAFP Family Physician of the Year Dr. Charlie Rhodes and one of the first-year medical students chosen as part of the first class of Family Medicine Scholars. And later, I learned about many of the quality improvement efforts their graduating residents had implemented during their third year of training. My trip ended with a visit to the Charlotte residency program the next day and a presentation on the activities of the NCAFP, focusing particularly on our advocacy efforts. It is true: when you’ve seen one practice or residency program, you’ve seen just one. However, there is a common thread that runs through everywhere I visited. It’s simple – our members, the family physicians of our state, care about the health and well being of their patients, the people of North Carolina, more than anyone can imagine, and certainly more than any other specialty. Getting out in the field to experience what you deal with on a daily basis makes me better prepared to serve you. As a non-clinician, I can never truly understand what you experience in your daily lives, but these visits have at least provided me a glimpse into the world you live in. And those brief looks make me proud to represent each and every one of you.
New N.C. Center of Excellence to be Located in Academy Offices The Governor recently announced the newly formed NC Center of Excellence for Integrated Care, a ground-breaking initiative that moves towards coordinated care using a model that combines the delivery of medical and mental health care services. The Center will be managed by the North Carolina Foundation for Advanced Health Programs and will build upon ICARE, (Integrated, Collaborative, Accessible, Respectful, and Evidence-based Care), a partnership created in 2006 designed to address the need to combine mental health treatment with medical care in primary care settings. Offices for the new Center will be located in a second floor suite at NCAFP headquarters in Raleigh. The Center of Excellence will continue to work with primary care offices and expand this effort of integrated care into other health care systems such as hospital emergency departments and mental health agencies. The Center will also ensure that consistent standards of care are adopted across different health care settings. WWW.NCAFP.COM
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CHAPTER
AFFAIRS
&
BRIEFS
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UNC SOM Announces Leadership Appointments, Distinguished Professorships Dr. Bill Roper, Dean and CEO, recently announced several key leadership appointments and title changes in the UNC School of Medicine. Two NCAFP family physicians have been appointed to key roles. Warren P. Newton, MD, MPH, (top right) was named Vice Dean for Education and will be the principal education leader for the School of Medicine. He will focus primarily on medical student education, but will also be charged with integrating all of UNCs medical school education activities, including allied health education, continuing medical education, and graduate education in the basic medical sciences. In addition to this appointment, Dr. Newton was also recently elected as Chairman of the American Board of Family Medicine (ABFM) at ABFM’s annual meeting in April. He will serve one year as chair-elect, one year as chair and one year as immediate past chair. Allen Daugird, MD, MBA, was named President of UNC Physicians and Associates. He will be the principal leader of the School of Medicine’s faculty practice plan. In addition to these leadership appointments, UNC also announced that B’eat Steiner, MD, MPH, (lower right) was named as an Alumni Distinguished Professor. These professorships are intended to honor mid-career faculty with a track record of substantial leadership in teaching medical students as well as educational innovation. Dr. Steiner is the first family physician to secure this honor. The goal is to help the professors serve as agents of change within the School of Medicine nationally and ambassadors for the School of Medicine, underscoring UNC’s commitment to national leadership and innovation in medical education.
ECU’S Dr. Gary Levine Recognized for Exemplary Teaching in Family Medicine NCAFP Residency Directors Board Representative, Dr. Gary I. Levine, Program Director at the ECU Family Medicine Residency Program and longtime family medicine educator, has been awarded AAFP’s Exemplary Teaching Award for full-time faculty. Dr. Levine has received tremendous accolades from medical students, family medicine residents, faculty, and professional peers during his three decades of service as a medical educator, all of which has been in resident training. Dr. Levine was a recipient of the “Chair’s Faculty Award” in the ECU Department of Family Medicine last summer for his leadership and success in family medicine resident training, and medical students have also recognized and appreciated his teaching excellence. He was one of the few ECU School of Medicine faculty each year during 2003, 2004, 2005, 2006, and 2008 to be honored by selection for PEARLS presentations to the medical student body.
NC Family Physicians, Residents and Medical Students Descend on NC General Assembly Forty family physicians, residents and medical students conducted a major advocacy push at the NC General Assembly on Wednesday, June 9, 2010. The visits were part of the Chapter’s annual Leadership Retreat and its ‘Advocacy101’ conference. Physicians, residents and students each met with their elected state Senators and/or House members to advocate for family physicians, primary care and for Community Care of North Carolina, the state’s Medicaid management program.
North Carolina ACADEMY OF Family PhysicianS, INC
EDUCATION & DEVELOPMENT
~ 2010 NCAFP Annual Winter Meeting ~
Winter Meeting in Asheville will Feature Refined Schedule Planning for this year’s Winter Family Physicians Weekend is in full swing and an outstanding series of lectures, workshops and social activities is expected to greet attendees at The Grove Park Inn & Spa in Asheville, NC, from December 2-5, 2010. NCAFP Past President and Program Chair Dr. Michelle Jones of Wilmington, NC, is designing a program that will feature a strong line-up of topics, along with a slightly modified schedule providing attendees some relaxation time to enjoy beautiful Asheville. Complete meeting information and registraiton is available at www.ncafp.com/wfpw. Engaging Contemporary Topics The 2010 Winter Meeting is expected to present 30+ AAFP Prescribed Credits (applications for CME credits are pending.) The final schedule of topics and speakers is still being finalized, but listed below are some key lectures, workshops and satellite programs that have already been confirmed. Redefining the Hospice and Palliative Care Patient in Primary Care – Thanks to modern medicine, people are living longer with many chronic and advanced illnesses. Palliative care was specifically designed to provide continuityof-care and a level of coordination that responds to the episodic and long-term nature of these illnesses. This session will identify the large and growing population of patients with serious and/or life threatening illnesses who would benefit from palliative care and/or hospice, yet who are predominantly managed in the primary care setting. Dyslipidemia Management: Five Issues to Consider Before You Treat – Dyslipidemia is an increasingly common medical problem seen in primary care patients both with or without coronary heart disease (CHD). This condition is more than just LDL-C, as it includes HDL-C and triglycerides. However, a recent survey by the NLA (National Lipid Association) concluded that only 51% of all physicians reported being “familiar” with total cholesterol recommendations and correctly identified the desirable levels for LDL-C, HDL-C, and TGs. 10
Treating COPD Appropriately in Family PracticeCOPD is a slowly progressing lung disease characterized by airflow obstruction that interferes with the normal breathing process. COPD is the 4th leading cause of death in the US, accounting for 1 in 20 of all deaths and is among the top ten reasons patients visit a family physician. This lecture will highlight the latest thought and techniques in successful management. A slight change to the meeting’s General Sessions schedule is being implemented this year. On Friday, Dec. 3rd, 2010, all General Session lectures will conclude at 3:00 pm to allow attendees time to enjoy The Grove Park Inn & Spa and to get acquainted with nearby Asheville. There will still be optional learning activities for those interested.
within ABFM’s Maintenance of Certification Program (MOCP). Please note that you do not need to register for the Annual Meeting in order to participate. After completing this session, AAFP staff report your answers to the ABFM. Your next step is to go to the ABFM Web site, pay the necessary fees, and complete the clinical simulation section. The clinical simulation section presents patient care scenarios corresponding to this topic. Valuable Hands On Procedures - Joint Injections & Skin Biopsies – Family physicians, nurse practitioners and physicians assistants often see patients with conditions that require the performance of minor office procedures. This workshop will present an introduction on techniques for integrating these types of procedures into your family medicine practice.
Excellent Optional Workshops
A Variety of Satellite Programs
Workshops are always an excellent way to increase your knowledge through in-depth teaching and discussion in small groups. As of press time, two workshops have been confirmed; please be on the lookout for additional announcements as they become available. SAMS Working Group: Pain Management – This workshop will present a 60-question group discussion and review of the pain management module
july - september, 2010 | the North Carolina Family Physician
What is a SAM Working Group?
Physicians who have entered the ABFM Maintenance of Certification cycle come together to complete the knowledge assessment section for the MC-FP SAM requirement (Part II). After completing the working group session, NCAFP staff report your answers to the ABFM. Your next step is to go to the ABFM Web site, pay the necessary fees, and complete the clinical simulation section. The clinical simulation section presents patient care scenarios corresponding to the topic module. Following these steps enables you to complete Part II of the MC-CP.
The Academy has been expanding the number of additional ‘satellite’ learning activities it presents at the Winter Meeting. These satellite programs are structured much like workshops in that they provide extensive and valuable information. However, satellites do not provide CME credit for participation. As of press time, three satellite events have been confirmed. As additional satellite programs are finalized, the Academy will be announcing their availability in NCAFPNotes and online at the Winter Meeting website. WWW.NCAFP.COM
www.ncafp.com/cme
Exploring the Evidence: The Neurobiology of Bipolar Disorder – Program Description – Bipolar disorder affects the mind, (mood, thought, and behavior) as well as the function and structure of the brain and the physical health of patients. The severity of this disorder and the risk of untreated symptomatology can have a debilitating effect on the patient’s life. This live interactive program will review the ultimate goal of bipolar disorder treatment: achieving full symptomatic and functional remission. The Challenges of Treating Depression in Older Adults – This presentation will focus on why symptoms of major depressive disorder (MDD) may be dismissed or overlooked by clinicians and patients. The speaker will introduce the challenge of diagnosing MDD in the long-term care facility as well as the risk factors associated with MDD in older adults, and will discuss the goals of treating late-life depression. Pathophysiology of Pain: Mechanisms and Manifestations – Pain transmission and processing occurs in the peripheral and central nervous system. Acute pain serves as a warning to prevent damage. Chronic pain is defined
as pain that persists beyond acute pain or beyond the expected time of normal healing. This presentation will review pain pathways in the peripheral and central nervous system and the mechanisms leading to the development of chronic pain. Fun & Lively Social Events The Winter Family Physicians Weekend is always a great time to spend time with friends, family and colleagues in family medicine, especially with the hotel’s festive atmosphere. This year’s meeting will allow for more free time to enjoy the mountains. In addition, this year’s combined Silent Auction & Presidential Gala event will be on Saturday, December 4th at The Grove Park Inn Resort & Spa. The entire family will enjoy this night complete with terrific items for bidding along with the fun and excitement of jugglers, stilt walkers and other surprise guests during the annual NCAFP Foundation’s Silent Auction. The evening will continue with the Presidential Gala hosted by Dr. & Mrs. Richard W. Lord, Jr., featuring a live band
The ECU Brody Family Medicine Interest Group(FMIG) has been recognized by the AAFP with a Program of Excellence Award (PoE), specifically in the category of professional development. Each year the AAFP Family Medicine Interest Group (FMIG) Network recognizes FMIGs that exhibit exemplary efforts in infrastructure, student involvement/retention, family medicine advocacy, and community outreach/patient advocacy, along with several categorical awards. This is the second consecutive PoE award that ECU has been honored with. The AAFP also awarded several North Carolina medical students and residents with important travel scholarships to the 2010 National Conference in Kansas City. Winners were Jonathan Wells - Tomorrow’s Leader Award; Ellen Perkins and Beth-Erin Springer- Student Scholarships; and Dr. Megan Adamson, Dr. Stephanie Foley and Dr. Megha Shah with Minority Scholarships for Residents.
WWW.NCAFP.COM
Complete and up-to-date information on the 2010 Winter Family Physicians Weekend is available online at
www.ncafp.com/wfpw
www.ncafp.com/residents_and_students
RESIDENTS & sTUDENTS
AAFP Honors ECU FMIG; Awards Several NC Students Scholarships to NatCon
and a terrific dinner menu specially prepared by the Grove Park Inn chefs. Admission to both events is free with CME Registration. Students, Residents and Registered spouses/guests children are also free. Additional tickets for this event may be purchased for $55 per person.
Attention New Physicians—
IRS Announces Attractive Tax Benefits for Working in Underserved Areas The Internal Revenue Service announced recently that under the Affordable Care Act, health care professionals who received student loan relief under state programs that reward those who work in underserved communities may qualify for refunds on their 2009 federal income tax returns as well as an annual tax cut going forward. The Affordable Care Act included a change in the law, effective in 2009, that expands a tax exclusion for amounts received by health professionals under loan repayment and forgiveness programs. More detailed information on this new benefit can be found on the IRS.gov website.
NCAFP Resident Director Elected as AAFP Resident Delegate Dr. Meshia Todd, a PGY-3 at Duke University Family Medicine Residency Program and current Resident Director on the NCAFP Board of Directors, was elected as Alternate Resident Delegate to the AAFP Congress of Delegates (COD) at the National Conference of Family Medicine Residents and Medical Students in late July. Dr. Todd will serve as an alternate delegate from the residents to this year’s Congress of Delegates and then be one of two official Resident Delegates to the COD in 2011. This is a tremendous honor for Dr. Todd. Congratulations.
North Carolina ACADEMY OF Family PhysicianS, INC
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HEALTH IMPROVEMENT & INITIATIVES
www.ncafp.com/initiatives
Health Literacy
~Tobacco Prevention~
Addressing Low Health Literacy in Your Practice Teaching improves patient compliance and outcomes
North Carolina Wins Third Place at National Poster Contest
By Jennifer Danai, MPH NCAFP Health Initiatives Manager
Health literacy is the degree to which individuals have the capacity to obtain and understand the basic health information and services needed to make appropriate health decisions. Health literacy is not simply the ability to read and write, but includes a patient’s ability to understand their health provider and treatment plan, read prescriptions and comprehend forms, and procedures related to health insurance. There are many reasons as to why patients have difficulty understanding health information including their age, language, culture, religion, emotion, pain level, stress, reading ability and disabilities. According to the 2003 National Assessment of Adult Literacy completed by the U.S. Department of Education, fourteen percent of the United States population have below basic health literacy skills. The assessment also found that only twenty-two percent have basic health literacy skills and health literacy deteriorates with age. In the population of sixty-five years old and older, only three percent have proficient health literacy skills. Overall, only twelve percent of the United States population has proficient health literacy skills. One way of addressing low health literacy is using the teach-back method. And while recent research has shown this method to possess a number of benefits, few providers have integrated this technique into their practices. Teach-back is more than simply asking if the patient understands. Most times a patient will not admit that they do not understand. With teach-back, patients
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play an active role in their healthcare. Some keys to teach-back include using plain language, defining new terms, avoiding medical jargon, being specific, and encouraging the patient to ask questions. Teach-back also limits information per visit and avoids asking questions with yes or no answers. Central to this method is the technique in which providers ask patients to state in their own words (i.e. teach back) key concepts, decisions, or instructions just discussed. Patients who cannot restate your instructions correctly may need further instructions, possibly utilizing simpler language. Most important is for the patient to reach a level of understanding that allow him/her to re-state the key message in their own words. Teaching your patients instead of telling them will not only improve the patient’s understanding but also their compliance and health outcomes. An important part of health literacy is the patient acting on information, not just hearing, reading and understanding it. Numerous studies show that about half of all patients do not correctly follow medical instructions. This number is likely to be even higher for disparate population groups who are diagnosed with multiple conditions. The teach-back technique is a proven way to assess and confirm understanding and help improve compliance. The NCAFP is addressing health literacy through its Health Disparities Initiative. If you would like more information about this program, please contact Jenni Danai at jdanai@ncafp.com or go to www.ncafp.com/initiatives/disparity.
july - september, 2010 | the North Carolina Family Physician
Students from 35 States Recognized for Achievements in National Tar Wars Poster Contest Students visit Capitol Hill to share their message of tobacco use prevention WASHINGTON — Krysti Maines, a fifth-grader from The Sparta School in Sparta, N.C., was awarded 3rd Place at the 2010 Tar Wars national poster contest. Winners were announced on Monday, July 26, at a ceremony during the Tar Wars National Conference in Washington, D.C. In addition to Krysti and the top finishers, 26 other state winners in attendance received a prize packet and a special gift. Following the awards announcements, the Tar Wars National Conference also allows students to voice their opinions about tobacco use and tobacco legislation to their congressional leaders during visits to Capitol Hill. Krysti took the opportunity to meet with Senators Burr and Hagan, as well as Representative Virginia Foxx. Congratulations on a job well-done!
WWW.NCAFP.COM
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Call MAG Mutual’s Frank Snyder toll-free at 1-888-834-5941 or visit us at www.magmutual.com. *Dividend effective June 1, 2010. Dividend payments are declared at the discretion of the MAG Mutual Insurance Company Board of Directors.
FAMILY MEDICINE IN PRACTICE
Immunization Challenges Continue Academy Working to Assist Practices with Transition By Brent Hazelett, MPA NCAFP Chief Operating Officer
Effective July 1, 2010, significant changes to the North Carolina Immunization Program (NCIP) took place when state funding for the program was eliminated. To assist in the transition, the state legislature approved $3 million in one-time funding to ensure all children will be appropriately vaccinated before the start of the 2010-2011 school year. The biggest impact on our members is that health care providers who typically contact the NC Immunization Branch to order vaccines for all the children they serve will only be able to order vaccines for the VFC (Federal Vaccines for Children)-eligible children. Providers will now need to privately purchase vaccines for the non-VFC-eligible patients, which also affects insured children, including those covered by NC Health Choice. The challenge to the provider is obvious – how to continue to serve an important population without negatively impacting the practice. With immunization payment rates often close to a break even proposition for practices, it may be tempting to consider eliminating these immunizations from your practice’s services. The NCAFP and the Immunization Branch urge physicians to continue to offer these immunizations to their patients. The primary risk of discontinuing immunizations is further fragmentation of the medical home and ultimately ceding scope to other providers. A primary example of this is NCAFP’s ongoing struggles with pharmacy organizations, who continue to seek expanded authority to provide immunizations in this state. This would-be expansion not only fragments the medical home, but runs counter to health care reform efforts that put the trust in primary care to lower costs. For example, an adolescent visiting your office to receive an immunization presents an excellent opportunity for a physician-to-patient conversation about risky behaviors. If immunizations are not given, many of these important and necessary conversations will not take place. Obviously, the challenge to continue 14
july - september, 2010 | the North Carolina Family Physician
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immunizations is financial. The NCAFP continues to work to provide real solutions to family physicians to ultimately address the financial aspects of this challenge. NCAFP has compiled a list of resources to aid practices on this front. Listed at the end of this article and also published at http://www.ncafp. com/resources/practice-management/vaccinespurchasing-info-providers, many of these resources include buying groups that may assist practices with acquiring needed vaccines at a discounted price (for example, Atlantic Health Partners, Main Street Vaccines, Physician’s Alliance, and others). For family physicians not interested
in joining buying groups, an additional national resource is Access Vaccines (www. accessvaccines.com). Access Vaccines specializes in helping providers with both the educational and financial aspects of vaccine procurement, while allowing physicians greater choice with respect to vaccines that are used. Finally, be sure your practice is optimally coding and billing for immunizations. Surveys have found many practices are incorrectly coding and billing for these services. For example, a practice codes for Tetanus, when in fact the immunization given is Tdap, which commands a higher
WWW.NCAFP.COM
www.ncafp.com/resources/tracks
rate. Or when applicable, a practice fails to code using a modifier which shows a separate and significant service given during the same patient encounter. Many pharmaceutical companies offer services that will help practices ensure they are billing and coding optimally, so please do not hesitate to contact them. Immunizations are just one way family physicians define and personify the patientcentered medical home principal. NCAFP will continue to monitor this situation and keep our members apprised of resources as they become available. For comments or questions about this issue, please contact Brent Hazelett at bhazelett@ncafp.com.
VACCINE BUYING GROUPS Sanofi Pasteur and Merck Vaccines:
For information on “Physician Purchasing Groups” for Sanofi Pasteur and Merck vaccines, please visit one of the following resources: • Atlantic Health Partners http://www.atlantichealthpartners.com • Main Street Vaccines http://www.mainstreetvacs.com
Practice
Tracks
CMS Releases Final EHR ‘Meaningful Use’ Requirements
CMS released its final ‘Meaningful Use Requirements’ on Tuesday, July 14, 2010. The rule outlines the requirements for participation in the EHR incentive program established by the American Recovery and Reinvestment Act (ARRA) of 2009. Starting in 2011, eligible health professionals can quality for up to $44,000 over five years under Medicare or $63,750 over six years under Medicaid. Eligible users who are not ‘meaningful users’ of EHRs will face reduced Medicare payments. The new rules are significantly scaled back from requirements proposed earlier by CMS. To help family physicians and others sort out what is meant by “meaningful use,” the AAFP is presenting a webinar on Aug. 19, 2010. Additional information is published at http://www.centerforhit.org/online/chit/home/project-ctr/meaningful_use.html.
NC AHEC REC Rolls Out Onsite Consulting for Primary Care Providers
NC AHEC is working with Primary Care Providers to help them achieve “meaningful use” of their new or existing Electronic Health Records (EHR). As a federally-designated Regional Extension Center (REC), NC AHEC will provide individualized, on-site EHR consulting tailored to qualified practice’s specific needs at no charge to the practice. Consultants from AHEC will help practices to: Prepare for an EHR by assessing and redesigning office systems; Evaluate and select a certified EHR that offers the best value for each practice; Identify and enhance workflows in the practice; Successfully implement a certified EHR; Achieve state and federal standards for “meaningful use” of EHR incentive payments to providers and more. NC AHEC has posted FAQs on the program online at http://www.med.unc.edu/ahec/pubs/newsletters/2010_Summer/rec.html.
Payment Error Rate Measurement Program Set to Target North Carolina
The Payment Error Rate Measurement (PERM) Program, implemented by CMS to measure improper payments in the Medicaid Program and the Children’s Health Insurance Program, will be targeting 17 states in 2010, including North Carolina. Practices being audited will begin being contacted this summer. When contacted, practices have 60 days to send the audited medical record. For additional information about the PERM Program, please visit http://www.cms.hhs.gov/PERM.
GSK Vaccines:
The following is a list of some “Physician Purchasing Groups” for GSK vaccines, which are actively working with customers in North Carolina: • Physician’s Alliance http://www.physall.com • Access Vaccines http://www.accessvaccines.com • National Physician Care http://www.nationalphysiciancare.com Additionally, Sam Lanier, GSK Senior Executive immunization Specialist and Contracting Specialist may be able to help with GSK vaccine procurement. His e-mail is sam.lanier@gsk.com and his phone is 919-619-1743. For customers that do not wish to belong to any purchasing group or organization, a direct purchasing agreement can be accessed through www.GSKvaccines.com or by contacting a local GSK representative.
WWW.NCAFP.COM
LEGISLATIVE yEAR, continued from page 6
primary care workforce issues. We continue to insist that increased positions in medical schools and residency be linked to improving the number of family physicians available in our communities. This is an ongoing effort. Promoting Physician-Led Practices
On the state and national level, your Academy has also been trying to make sure that primary care practices are physician-led, since this leads to the most cost effective and comprehensive care. One effort was to meet with officials from Minute Clinic and NC DHHS to consider their role as a Medicaid provider in NC. Several concerns were raised by your Academy leadership including fragmentation of care, improper triage and treatment delay of serious conditions. As for now, no CCNC network has agreed to use Minute Clinic as a Medicaid provider. One pilot did get proposed by Minute Clinic for Wake County, but after consideration, it was determined that the benefits would not outweigh the costs. At the national level, the NCAFP was also instrumental in helping to reshape AAFP policy on supporting retail health clinics that adhered to a standard set of agreed upon principles. We pointed out that in North Carolina one of the chains clearly was not abiding by the minimum set of standards and therefore, the cooperative relationship and joint principles that had been established by the AAFP have been dissolved. Stay tuned, and stay alert-this is a critical time for our specialty in this state and nationally. And remember, the anesthesiologists give so much money to legislatively support their specialty, that they have 14 PACs in our state. We only have one. Give until it hurts before it hurts so bad you can’t.
North Carolina ACADEMY OF Family PhysicianS, INC
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Scholars program, continued from page 5
president’s message, continued from page 4
Canadian medical students who chose primary care careers went from 24% in 2004 to 39% in 2009, a relative increase in student interest of 62%! In the US, the data from last year indicate that median primary care income is only 52% of specialty income. If specialty income were held constant, primary care incomes would need to increase from $180,000 to $299,000 to be at 83%. I would imagine that there would need to be more of a budget neutral change. So, if the median specialty income came down just over 10% to $330,000, then .83 of that is $273,000. The math is simple. The concept is simple. The solution to the health care crisis is simple. We need more family physicians taking care of more patients and getting adequate and appropriate pay for the work they do.
References: Richard J. Baron, M.D. “What’s Keeping Us So Busy in Primary Care? A Snapshot from One Practice”. NEJM. Volume 362:1632-1636. Number 17. April 29, 2010. Medscape Medical News. July 8th, 2010. Lack of Adequate Pay Reduces Effectiveness of Medical Home Author Robert Lowes
R.W. “Chip” Watkins, said, “This project makes a very loud statement. Primary care is important and family medicine is important. We need to ensure that our state’s medical students have every opportunity to learn about our specialty. Through this partnership, we can make a much greater impact and reach far more medical students than we have in the past.” The first year’s class of “Family Medicine Scholars” includes five students from the Brody School of Medicine at East Carolina University, five students from the University of North Carolina Medical School and two students from the Wake Forest University School of Medicine. First year students enrolled in any North Carolina medical school are eligible for the program and are selected for their interest in family medicine. In commenting on behalf of the first class of scholars during the press conference, UNC First-Year Medical Student Samantha Heurtz said, “In fact, we need our brightest medical students to go into family medicine because of the breadth of knowledge needed. Not only will this program provide me with extra mentorship and training, but it will also give me the opportunity to be a part of a group of medical students immersed in family medicine. As a result, I look forward to presenting the specialty to other medical students in a more meaningful and informed manner.” Responses from the state’s medical schools and the Master Preceptors chosen to mentor the first class of scholars have been overwhelmingly positive. “This grant from the BCBSNC Foundation is the most significant response to the growing
need for family physicians in North Carolina I have seen,” said Dr. Dean Patton, a longtime professor of family medicine and director of the medical student education division at ECU. In speaking on behalf of the first group of Master Preceptors Dr. Conrad Flick said, “This initiative will allow for more students to have those needed mentors and role models.“ “We know that a strong network of quality family medicine practices is crucial to the future of our healthcare system,” Flick continued. “Primary care reduces health care costs through ongoing health promotion and prevention, easy access when needed, streamlined health coordination, and personal communication between the patient and physician. I am very pleased that the Blue Cross and Blue Shield of North Carolina Foundation has given us this opportunity to foster and grow many of our state’s next generation of family physicians and has partnered with us to help make sure our communities are well cared for into the future.” “We are proud to support a program that will have a real impact on the state,” added Kathy Higgins, president of the BCBSNC Foundation. “Identifying students early who are interested in a career in family medicine and helping them reach that goal will in-turn benefit communities all across North Carolina.” In closing the press conference, BCBSNC Foundation Chair Wilson said: “Working together, we can make a difference and provide improved access to primary care to those in this state who need it most. And, again, for us there is no better investment.” On The Cover (L to R): Minnie Haven (18-months), Kelley Haven, Samantha Heuertz, Brian Moore, Dr. Chip Watkins, Brad Wilson, Dr. Conrad Flick, Corrie Burke, Daniel White, Ashley Hink, and Holly Love.
REACH FAMILY DOCS
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