Volume 13 Issue 3 / Summer 2017
The North Carolina
Family Physician Quarterly News in North Carolina Family Medicine
MOTT BLAIR RUNS FOR AAFP PRESIDENT-ELECT
See p. 14
Learn something new while you take in the view! Make plans now to join us for the Winter Meeting.
2017 Winter Family Physicians Weekend ANNUAL CONFERENCE & EXHIBITION 25+ AAFP Prescribed Credits Program Chair: Dimitrios “Taki” Hondros, MD • Program Vice-Chair: Lisa Cassidy-Vu, MD
Early Bird Discount Registration for Members Ends on Mon, Oct 9. Tentative lecture topics include: Cancer Influenza Depression Fibromyalgia Hypertension Chronic Urticaria
Allergy Immunotherapy Sleep Quality Chronic Pain Hepatitis C Heart Failure
IUDs Lipids Scoliosis Tendonitis & Bursitis Integrative Medicine And much, much more!
Optional CME opportunities: Practice Management 201 • Healthcare Policy Issues Update 2017 Medicare Payments for Integrated Health Services Seminar Pre-Conference CME opportunities: KSA Study Working Group on Asthma • Hands-On: Radiosurgery & Cryosurgery Lab
THURS, NOV 30 – SUN, DEC 3, 2017 Omni Grove Park Inn • Asheville, NC
CME | Camaraderie | Networking | Fun www.ncafp.com/wfpw
Inside Summer 2017
~ NORTH CAROLINA’S ~
STOP ACT What You Need to Know P. 20
PRESIDENT’S MESSAGE
EXECUTIVE’S MESSAGE
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16 Legacies of Past NCAFP Leaders Offer Inspiration
Keeping Me Humble
HEALTH POLICY & ADVOCACY
RESIDENTS & NEW FPS
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24 A Call to Advocacy in North Carolina
Your Academy in Action
MEETINGS & CONFERENCES
PRACTICE MANAGEMENT
10 The 2017 Winter Meeting: Way More Than
30 NC HealthConnex: Helping You Prioritize Patient
Lecture Halls & CME …It’s Also a Lot of Fun!
Health and a Successful Business
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Managing Editor & Production Peter Graber, NCAFP Communications
Residents & New FPs 24 Student Interest 26 NCAFP Foundation 29 Practice Management 30
Have a news item we missed? NCAFP members may send news items to the NCAFP Communications Department for publishing consideration. Please email items to pgraber@ncafp.com
PRESIDENT’S MESSAGE to Members By Dr. Charles Rhodes 2016–2017 NCAFP President
to slow down and take the time to listen. As we age, time becomes our most valuable possession, and they are thrilled to be able to share a little piece of their lives with you. And they have done some remarkable things.
One of my residents asked me to go with him to see - MUSINGS FROM THE MOUNT Ms. Mamie Smith. She was 105 at the time and still driving to church every Sunday. She lived with her son, who was in his 70’s, in a blue double-wide trailer at the end of a winding dirt road way back in the woods. She had just renewed her driver’s license online and was excited to show it to me. Sure enough, 105 years old. To be honest I was more impressed that she was able to use a computer than I was with the fact that she was still driving. Ms. Mamie was very healthy. This month marks the 30-year anniversary of my The only medication she took was an aspirin, which medical practice in Mount Pleasant. she had started a couple of years ago, Major milestones such as this tend as she felt she should be taking someto make us look back at what we’ve thing. She asked if she should stop. done, and to think about what lies No, Ms. Mamie, keep doing what ahead. What sticks with me, and you are doing, nothing here for me what has meant the most over time to improve upon. I asked her what are the patients whom I have known her earliest memory was: Armistice and cared for over the years. Day, November 11th, 1918. She remembered everyone coming out of Two groups stand out in my memory. their houses, banging on their pots The first are the babies. I did obstetand pans, and then the trickle of rics for over twenty years. Age finalsoldiers coming back from France. ly caught up with me and I couldn’t Ms. Mamie needed paperwork to enstay up all night and still function the ter the nursing home. Not that she next day, but I still remember many Charles W. Rhodes, MD needed the help. It was just that her of those deliveries. Both the easy ones 2016-2017 NCAFP President friends were all in the home, and she and the ones I prayed and sweated was lonely. She lived to be 106 and out. It is not unusual for me to get on an elevator, or passed away last fall. go to a local restaurant, or to be standing in line to buy something, and have a young person whom I have not I think of Mr. Virgil Jones, who was in his 80’s and seen since they were a baby introduce themselves and the picture of a southern gentleman. He looked like remind me that I delivered them. One of them even Colonel Sanders, seersucker suit, white goatee and all. works as a nurse in my office. Small town practice is He was a renowned local historian, and loved to share magical in that way, which is part of the secret sauce his knowledge of the area. Mr. Jones had an ingrown that makes Family Medicine special. toenail, so he took his vice-grips out and pulled his toe-
Keeping Me Humble
The other group I have enjoyed the most are the elderly. Older folks have experienced things we never will, and love to tell you about their lives. You just have
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nail off. He then cauterized the toe in turpentine, and it got infected, so he came to see me. Didn’t that hurt? “Sure did”. End of discussion. Farmers are tough. Virgil passed away some time later, and I went to the
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2016-2017
NCAFP Board of Directors Executive Officers President President-Elect Vice President Secretary/Treasurer Board Chair Past President (w/voting privileges) Executive Vice President
Charles W. Rhodes, MD Tamieka M.L. Howell, MD Alisa C. Nance, MD, RPh David R. Rinehart, MD Rhett L. Brown, MD Thomas R. White, MD Gregory K. Griggs, MPA, CAE
District Directors District 1 - Mackenzie Smith, MD District 2 - Gilbert Palmer, MD District 3 - Eugenie M. Komives, MD District 4 - Shauna L. Guthrie, MD, MPH District 5 - Dimitrios “Taki” P. Hondros, MD District 6 - Cody A. Wingler, MD District 7 - Jennifer L. Mullendore, MD At-Large Jason T. Cook, MD At-Large Benjamin F. Simmons, MD IMG Physicians Brian McCullough, MD
funeral home to pay my respects. The family asked if they could take my picture with Mr. Jones. I sheepishly agreed. Several days later I received a photo album at the office with a picture of me standing next to the coffin with Mr. Jones, and the title “Virgil and his doctor”. It really was a good picture, and I still have it at home, but not one I would share with my other patients. Farmers tend to be independent and won’t come to the office unless something is hanging off and needs to be sewn back on. Mr. Rinehardt came in one day with a very large abscess in his gluteus maximus. What happened to you? He had a sore throat and decided he needed antibiotics. So he went to the local feed mill and bought horse penicillin, which comes with a very long needle. And after several injections in the buttocks, he of course became infected and wound up in our office. The characters in life are what makes it memorable. The town cemetery is across the street from my office. Many of my friends and patients are buried there, more every year. And I think about them as I drive by on the way to work every morning. They remind me who really is in control (it’s not me), and they keep me humble, which I think is the perfect state for a physician to be in. To me, a good day is one in which I learned something. I had a good day today. 30 years down, 30 more to go.
Minority Physicians Jewell P. Carr, MD Osteopathic Family Physicians Slade A. Suchecki, DO New Physicians Jessica Triche, MD Family Medicine Residency Directors Viviana Martinez-Bianchi, MD (Duke University FMR) Resident Director Alyssa M. Shell, MD, PhD (MAHEC-A) Resident Director-Elect Courtland Winborne, MD, MPH (Cabarrus) Student Director Angie Maharaj (Campbell) Student Director-Elect Allyson Mentock (BSOM) Medical School Representatives & Alternates Chair (UNC) Warren P. Newton, MD, MPH Alternate (Campbell) Nicholas Pennings, DO Alternate (Duke) J. Lloyd Michener, MD Alternate (ECU) Chelley Kaye Alexander, MD Alternate (Wake) Richard W. Lord, Jr., MD, MA AAFP Delegates & Alternates AAFP Delegate Michelle F. Jones, MD AAFP Delegate Karen L. Smith, MD AAFP Alternate Richard W. Lord, Jr., MD, MA AAFP Alternate Robert L. Rich, Jr., MD The NCAFP Family Medicine Councils Advocacy Council Thomas R. White, MD, Chair Garett Franklin, MD, Vice-Chair CME Council Membership & Workforce
Alisa C. Nance, MD, RPh, Chair Jewell P. Carr, MD, Vice-Chair Benjamin Simmons, MD, Chair Shauna Guthrie, MD, MPH, Vice-Chair
Practice Management Council Public Relations & Marketing
Summer 2017
Thomas Wroth, MD, Chair Slade Suchecki, DO, Vice-Chair William A. Dennis, MD, Chair
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HEALTH POLICY & ADVOCACY By Gregory K. Griggs, MPA, CAE NCAFP Executive Vice President
Long Session Ends Quickly, But More to Come... NCAFP’s Work on Your Behalf
This year’s long session of the General Assembly proved to be one of the shortest in years, with the legislature adjourning prior to the end of the fiscal year on June 30th. And in general, for the healthcare community, the session proved to be a positive one. But there’s more to come. While the legislature adjourned, they scheduled three more sessions between now and the end of the year: one for August 3rd (when this magazine will be at press), one in September, and one in November. As a result, it is more important than ever that we continue to be vigilant to protect the interests of family physicians and your patients. Let’s first review some of the key wins of the 2017 “Long Session”. RATES: For the first-time in recent memory, the House of Medicine avoided the prospect of Medicaid rate cuts. Fortunately, no version of the budget (from the Governor, the House, or the Senate) suggested cutting rates as a way to reduce Medicaid costs. We believe this resulted from ongoing advocacy throughout healthcare. So, this alone was a major victory in 2017! OPIOIDS: The Academy and other healthcare associations worked very closely with the Attorney General, the Department of Health and Human Services and members of the legislature, especially, Rep. Greg
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Murphy, a physician from Greenville, to develop an effective but reasonable bill to combat the state’s opioid epidemic. While much work has already occurred to educate our members on appropriate pain management practices and the appropriate use of opioids, the General Assembly remains extraordinarily concerned about the number of deaths caused by misuse of both prescription and illegal opiates. The bottom line: the legislation that passed proved to be reasonable and actionable, particularly compared to what was approved this year in other states. For more on the specifics of this bill, please see the article on page 20. MOTORCYCLE HELMETS: Once again this year, both chambers introduced legislation to eliminate the requirement for adults to wear motorcycle helmets. Fortunately, the bill did not move forward. CONCUSSION BILL: Legislation to require public schools to provide training and protocols for athletes around heat-related illness also contained a provision that would have allowed parents to OK return-to-play for athletes that had experienced a head injury. The advocacy effort of the NCAFP and others convinced bill sponsors to remove that provision, leaving returnto-play decisions up to healthcare professionals. The remainder of that bill failed to move forward. YOUTH TOBACCO PREVENTION FUNDING: For the first time since 2012, the budget includes funding for teen tobacco use prevention. $500,000 was appropriated to “develop strategies to prevent the use of new and emerging tobacco products, including electronic cigarettes, by youth and people of childbearing age.” TOBACCO CESSATION FUNDING: The budget also includes $500,000 in additional funding for tobacco cessation services. These funds are to be divided between the QuitLine and You Quit, Two Quit. This funding will not provide full services to all callers but will increase the number of tobacco users that QuitLineNC can aid in quitting. HEALTHY CORNER STORE INITIATIVE: The budget includes $250,000 in continued funding for
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the Healthy Corner Stores initiative. The funding is designed to provide grants to corner stores to purchase refrigeration equipment to facilitate the sale of healthy fruits and vegetables in areas that would otherwise be considered food deserts. RESTORATION OF GME FUNDING: The Medicaid budget also restored funding for Graduate Medical Education that had been scheduled to be cut based on legislative action two years ago. The provision also established a joint subcommittee to examine how the state is spending money on medical and residency education, a positive for primary care. More to Come Several key legislative provisions remain under discussion. These are outlined below: NEGATIVE CHANGES TO MEDICAID MANAGED CARE: The Senate substituted language in a House Bill adding provisions that would be detrimental to physicians as the state moves to Medicaid Managed Care. First, the Senate version of the bill would eliminate certain protections that physicians have under Chapter 58 of the state’s insurance regulations. This is an area that we have fought to maintain to ensure due process and prompt payment for physicians. In addition, the bill would have required physicians to see patients on any Medicaid managed care plan whether the physician is in network or not – and at a pay of 90% of the prevailing Medicaid Fee for Service rates at that time. The Senate version of the bill containing these provisions has gone back to the House for consideration. The House leadership has indicated opposition to these provisions. However, this bill could still be considered in August or September. The House of Medicine stands united in our opposition to these provisions. SCOPE OF PRACTICE: Several bills impacting scope of practice saw action in 2017. The House approved a study bill that would consider expanding the scope of Optometrists. The original legislation would have allowed significant broad changes in Optometrist scope which was opposed by the House of Medicine. The Senate never took up the revised study bill, but it could be considered later this year. More significant to family medicine, Nurse Practitioners sought to eliminate physician supervision completely. While the legislation did receive a hearing in a House Committee, a vote was never taken. The NCAFP spent significant time and effort on this legislation in 2017. While we do not think this will gain legs in the scheduled sessions for later this year, it still could be considered in 2018. Continues on next page
Summer 2017
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HYPERTENSION AWARENESS DAY: The NCAFP supported efforts to declare the third Wednesday in May as Hypertension Awareness Day and participated in this year’s High Blood Pressure Awareness Day at the General Assembly, providing pressure checks in two different locations in the legislature. The House approved the bill, with it remaining alive for Senate consideration either later this year or in 2018. Advocacy Outside of the Legislature The NCAFP continues to advocate for our members in numerous ways, with a significant number of ongoing efforts occurring outside the halls of the legislature and sometimes even in the Halls of Justice. A few of these efforts are outlined below: MEDICAID LISTENING SESSIONS: The NCAFP had attendees at almost all of a series of listening sessions that the new Secretary of Health and Human Services, Dr. Mandy Cohen, held on Medicaid reform. The Academy continued to advocate for proper payment for primary care, reduction of administrative burdens, and better integration of behavioral health care into primary care, among other things. In addition, NCAFP staff continues to meet with the state Medicaid Director on a monthly basis. MEDICAID LAWSUIT: The NC Academy of Family Physicians, the NC Pediatric Society, and several primary care practices have sued the state Division of Medical Assistance seeking retroactive payment for immunization administrative fees. Under the Affordable Care Act, Medicaid rates for primary care matched Medicare rates for two years. As part of that rate increase, administrative fees for immunizations provided under Medicaid should have also increased. However, these fees were not increased during that time. After more than a year of negotiating with Medicaid, the organizations came to an impasse, primarily over technical language. As a result, the two organizations, along with a few pediatric practices, took legal action which is scheduled to be heard in Superior Court in Wayne County (the site of one of the pediatric practices) on August 28th. The two associations are seeking standing on behalf of all our members in this effort. We should
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know more after the initial court date in late August. AMICUS BRIEF: The NCAFP is also participating in a “friend of the court” (Amicus) brief in a lawsuit that five practices (including one family medicine practice) filed against the state and NCTracks due to harm caused by late payments during NCTracks implementation. The suit has been heard in Superior Court, the Appeals Court, and now is before the state Supreme Court. The NCAFP, the NC Medical Society and the NC Hospital Association are all involved in the brief. The state contends that Medicaid and its contractors have sovereign immunity, basically meaning that no one can sue over breach-of-contract over the state’s Medicaid agreement. All the associations adamantly disagree. This is the first time a case has gone before the state Supreme Court where the state has claimed sovereign immunity. INCREASED RELATIONSHIPS WITH INSURANCE COMPANIES: The staff of the NCAFP has been working to develop additional relationships with insurers operating in North Carolina to better advocate on behalf of our members. During the first six months of this year, our leadership and staff have met with several insurance companies, particularly with United Healthcare and the collaboration between Centene and the NC Medical Society for Medicaid (Carolina Complete Health), among others. The relationship with United has already paid dividends for a few members, with NCAFP staff helping connect members with Untied staff to work out concerns. We also remain involved with numerous companies that may apply for contracts to provide Medicaid Managed Care in North Carolina. Our goal is to make this legislatively-mandated change as smooth as possible for our members and your patients. With both the managed care companies and state regulators, we are stressing the foundational importance of primary care, the need to minimize administrative burdens, and the need to preserve the care management infrastructure that supports primary care practices around our state. As part of this process, many managed care
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Community Care Physicians Network Announces New Partnership with Aetna In mid-June, Community Care Physicians Network (CCPN), CCNC’s clinically-integrated network, and Aetna announced a collaborative agreement aimed at developing innovative ways to transform healthcare delivery in NC. The agreement is initially slated for five counties and represents the first contract the Network has established with an insurer. CCPN leadership noted, “This is an opportunity to demonstrate the effectiveness of a high-performing primary care network with Aetna’s Medicare Advantage membership. We believe this experience will also prepare independent primary care physicians for the eventual move to Medicaid managed-care in the future.” Laurie Brubaker, president and CEO of Aetna Medicaid, is quoted in a press release stating: “This agreement aligns with the changes taking place in health care right now both in the state and nationwide, and we look forward to working with CCPN and CCNC to develop a health care delivery system that will drive sustainable improvements for Aetna’s members in 2018 and in the future.”
companies are already seeking to form provider networks. We urge our members to review any offers very carefully and take your time making any ultimate decision. Remember, any insurer that ultimately bids on managed care contracts in North Carolina needs a robust primary care infrastructure (due to network adequacy standards), leaving you in a strong negotiating position.
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EDUCATION & PROFESSIONAL DEVELOPMENT By Kathryn Atkinson Manager, Meetings & Events
2017 Winter Family Physicians Weekend
It’s Way More Than Lecture Halls & CME… It’s Also a Lot of Fun! Nov. 30th - Dec. 3rd, 2017 • Asheville, NC
We’ve all heard that saying, “Time flies when you are having fun!” And, since it is already the eighth month of 2017, I really believe that the saying is true! While I am writing this, it is 95 degrees outside with a heat index of 106. It seems like just yesterday, I was bundled up in my heavy coat and very grateful to whomever invented my car’s seat-warmers. How can it be that it is already the middle of summer, that school starts back in a few weeks, and that the NCAFP’s Annual Winter Family Physicians Weekend is now less than four months away? I think it can only mean one thing: the NCAFP’s Meetings Department has been having a lot of fun this year! Speaking of CME meetings and fun times, last year’s Winter Family Physicians Weekend included over 800 family physicians and primary care providers and over 75 vendors. From comments and survey feedback, participants and their guests thoroughly enjoyed the NCAFP’s unique combination of camaraderie, networking opportunities, and timely CME that makes this annual event so enjoyable for everyone. I hope that you will begin making your plans soon to be a part of the excitement during this year’s
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Winter Family Physicians Weekend scheduled for November 30 – December 3 at the Omni Grove Park Inn in Asheville, NC. Program Chair, Dr. Dimitrios “Taki” Hondros, and Program Vice-Chair, Dr. Lisa Cassidy-Vu, have been hard at work assembling a superb line-up of timely topics with expert speakers, along with several other fantastic optional workshops and satellite opportunities. Highlighted general session lecture topics include Depression, Hep C, IUDs, Cancer, Sleep Quality, Lipids, Fibromyalgia, Scoliosis, Chronic Pain, Heart Failure, Influenza, Hypertension, and much more. Optional CME Workshops include Practice Management 201, a Healthcare Policy Issues
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Update, and a seminar about Medicare payments for integrated care services. With over 25+ AAFP CME Credits up for grabs between general sessions and optional CME workshops, we are confident this year’s annual event in the Blue Ridge Mountains will include something for everyone. And, for those who just can’t wait to get the conference started, Continues on Back Cover
Summer 2017
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MEMBERSHIP By Tara Hinkle Manager, Member Services
- MEMBER SUPPORT-
Visit AAFP’s New Welcome Center The AAFP has launched a new feature on their website available to all members. The Member Welcome Center (http://www.aafp. org/membership/welcome-center.html) is an exciting new addition intended to be a one-stop portal for all your membership needs. At the Center, you can update your contact information; access and update your CME transcript; explore ways to become more engaged; view and register for AAFP events or online CME; and read AAFP publications. It is accessible by directly visiting www.aafp.org/welcomecenter or through the Membership section of AAFP’s website.
Keep in mind, former web addresses you have used are still accessible, but this page provides access to more features in one location. If you have questions about the site, please contact the AAFP at aafp@aafp.org or via phone at 1-800-274-2237. 12
2018 Member Dues Believe it or not, invoices for 2018 dues will be available for payment online at www.aafp.org/ quickpay at the end of September for Active, Inactive, Supporting, and first-time Life members. AAFP will mail invoices to primary addresses in October. Whether your fiscal year began July 1st or begins January 1, please begin making necessary payment arrangements in advance. The payment deadline for 2018 dues is January 1, 2018. You may also enroll in the installment plan to extend payments monthly October 2017-August 2018. The earlier you enroll, the more monthly installments you will have to help spread out the balance.
Please make sure AAFP/ NCAFP has the most upto-date contact information in your membership record before invoices are mailed. Visit the new Member Welcome Center, featured above, at www.aafp.org/welcomecenter to view and/or update your information.
Remember that if you are moving out of NC or if you have interrupted practice for a retirement or other extenuating circumstances, you will need to contact the AAFP at 1-800-274-2237 to either relocate your membership to the appropriate state chapter (AAFP and state chapter membership is unified) or transfer your membership to another category to avoid membership interruption. Please notify the AAFP as soon as possible prior to 2018 dues invoice creation and mailing. Thank you for your continued membership and support. We appreciate all you do!
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CHAPTER AFFAIRS
- NATIONAL LEADERSHIP-
Dr. Mott Blair Runs for AAFP President-Elect NCAFP Past President Dr. Mott P. Blair, IV, (2003) of Wallace, NC, is a candidate for AAFP President-Elect. The election will take place next month at the AAFP Congress of Delegates in San Antonio. To provide members insight into Dr. Blair’s candidacy, the NC Family Physician asked him to share his insights on several questions. His responses follow.
NCAFP: Briefly describe your background as a family medicine leader and how your experiences have helped you prepare for such as important national role. MB: I practice in my hometown of Wallace, NC, where my father was a family physician. After residency, I joined him in practice. I later practiced on my own after he passed away. Ten years ago my practice was acquired by a hospital group as the business model and regulatory burden made it impossible to continue on my own. Like over 60 percent of our members, I am now an employed physician, but I still remember how hard it is to have a private practice. I serve as a Regional Medical Director in my health system and on the board of a regional ACO. In the Academy, I have had many leadership positions, including service to our state chapter as president in 2002. On a national level, I have served as a longtime delegate to the Congress of Delegates and have served on the Committee on Rural Health, as well as the Commission of Health of the Public (chairing this commission). Over the last three years, I have served on the AAFP Board of Directors and have been a liaison to
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the Commission on Membership and Membership Services, Commission on Quality and Practice, Commission on Governmental Advocacy and on the Board’s Executive Committee. The Academy represents a very broad and diverse group of physicians. My experience as a small-town physician running a small business, as an employed physician fighting for our specialty in the corporate suite, and on a national level advocating for our patients and specialty, have prepared me well for this role. NCAFP: What do you consider to be your key strengths as a physician leader and how can you apply them as AAFP President-Elect? MB: It has been a great honor to represent my specialty through the years on the local, state, and national levels. I have extensive experience serving my community, and I have always been a good listener and consensus builder. One area that I have a lot of experience in is governmental service and politics. I have been battle-tested in some hard political contests, particularly in 2010 when I ran for the state house as the only physician in a state race. Although I was not elected, I learned that it is important to step forward when you need to lead and to stand ground on those principles that should not be compromised. If elected, my promise to our members is to do exactly that, both as President-elect and President of the AAFP at this most critical time for our patients and members. NCAFP: Change is everywhere in family medicine today. What role do you see the AAFP playing in helping members and their practices manage it effectively and thrive? MB: There is a great deal of change happening in healthcare in our country today. Much of it is driven by the spiraling cost of medical care and the poor outcomes we have when compared to other developed countries. However, Family Medicine
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offers a solution to some of the problems that our country faces. We know that when healthcare spending for primary care goes up, that the overall cost-of-care declines. So I think that we are in a unique position at this time in history, because we offer the solution to the problems facing healthcare. No other group or specialty does what we do. We have to continue to embrace the core attributes of Family Medicine, including first contact, comprehensive, continuous, coordinated, patient-centered care, and embrace the models of care that support these attributes. We also have to work to help our members succeed, whether it is adapting to the Quality Payment Program (MACRA), starting a Direct Primary Care practice, or thriving in the accountable care environment as just a few examples. And we must fight for the foundational role that our specialty should rightfully play in our healthcare system and ensure our members are rewarded properly. NCAFP: What do you consider to be the most significant day-to-day issue affecting family physicians in the practice of family medicine? How can the AAFP help address it? MB: Administrative complexity is the most pressing
Summer 2017
issue impacting Family Physicians today. Whether it is the complexity of the new Quality Payment Program (MACRA) or the ever ending regulatory burden placed on family physicians from a myriad of governmental oversight programs (HIPAA, CLIA, RAC audits, quality reporting etc.), virtually no family physician is unaffected. Add in the demands that insurers place on prior authorizations for our patients’ prescriptions or diagnostic procedures and this sets up an environment that takes the joy out of caring for our patients and, in my opinion, negatively impacts our patients’ health. The Academy must be the voice of common sense and push for reforms of excessive administrative burdens both with govermental payers and private insurers. We have to make the unContinues on next page
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reasonable demands of excessive prior authorizations go away. We need to streamline reporting measures. It is about returning family physicians to what they love and do so well-- caring for our patients. NCAFP: Personal wellness of the primary care workforce is increasingly important. What role can the AAFP play in this? MB: The Academy has a central role in working towards maintaining a healthy primary care workforce. In this time of rapid change, some of the biggest drivers of burnout have been the administrative burden under which our members suffer daily. EHR’s have not delivered on the promise of efficiency. They have increased our workload and are driving dissatisfaction. Family physicians have a very real role on a national level to advocate for a solution to these problems. On a more personal basis, we can reach out to members and help them self-identify symptoms of burnout. We can work with our members and provide resources to help them cope, whether through online resources, wellness seminars, or by simply building awareness. Family Physicians care for our patients but also for each other, and through our organization we can support and lift up our colleagues.
Executive’s Message
Life Legacies of Former NCAFP Leaders Provide Inspiration By Gregory K. Griggs, MPA, CAE NCAFP Executive Vice President
To improve the health of patients, families and communities in North Carolina. That simple phrase is a key part of the mission statement of the NC Academy of Family Physicians. The entire mission statement of the Academy reads as follows: “to advance the specialty of family medicine in order to improve the health of patients, families and communities in North Carolina.” Recently, I was vividly reminded how family physicians do that each and every day – working to improve not only the health of their patients, but their entire communities and beyond. I believe it is what makes family physicians unique – what makes your specialty unique. And it’s what makes me so glad to work for family physicians in our state. Unfortunately, what reminded me so vividly of the passion family physicians show was attending one of our past leader’s funeral in June. In the last year and a half, we have lost three of our past presidents, family physicians who worked humbly but truly were bigger than life. I was fortunate enough to attend two of the funerals to hear the impact they had directly. And I know enough about the third to understand the impact he had as well. Charles O. Boyette, MD Dr. Boyette passed away in March of 2016, fighting to the bitter end to preserve access to healthcare for his patients and his community. Everyone who ever met Dr. Boyette knew how passionate he was about taking care of the people of the small town of Belhaven. In 1964, he established the Boyette Medical Clinic where he served until his death, having practiced
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medicine in his adopted hometown for 51 years. For 30 of those years, he also served his community as Mayor. He became president of our chapter in 1986, and was later named the NC Family Physician of the Year. During Dr. Boyette’s year as NCAFP President, Governor Jim Martin included $7.3 million in the state budget to build the family medicine building at UNC, a project the Academy had long envisioned. He served as a member of the NC Institute of Medicine, the Governor’s Commission on Infant Mortality and the NC Medical Directors Association, among other things. He also worked as chief of staff at his community hospital for 19 years and was one of the leading advocates for maintaining inpatient beds in his community. A man who truly improved the health of patients, families and communities. George T. Wolff, MD Dr. George Wolff died late last October, having served as NCAFP President in 1966-67. Dr. Wolff was best known for the indelible mark he placed on so many residents who trained at the Family Medicine Residency at Moses Cone Hospital in Greensboro. When Dr. Wolff served as president of the Academy, our organization was still called the American Academy of General Practice. He was most passionate about his work with medical students and residents guiding them toward a rewarding career in family medicine. His ongoing passion for students even continued after his death, as he asked that people remember him with contributions to the NCAFP Foundation’s student programs. While Dr. Wolff’s presidential year was 50-years before he ultimately passed away, his connection to the Academy remained strong. He went on to serve as Vice President and Treasurer of the American Academy of Family Physicians and was honored by his state chapter as the NC Family Physician of the Year in 1985. A decade later, the UNC School of Medicine honored him with their Distinguished Alumni Service Award as he continued to mentor and guide medical students.
There were so many individuals at his funeral who talked about the impact Dr. Wolff had been on their career and their life in general. A multi-generational group of family physicians had been guided by his steady hands and he had worked to heal so many in the Greensboro community, still coming into the residency program on occasion just a few years before his death. Once again, a family physician working to improve the health of patients, families and communities. Edward S. Campbell, MD In June of this year, Dr. Ed Campbell died after a brief illness. He had served as president of the NCAFP in 1999-2000 and was the leading advocate for the Chapter’s long-time participation in the Tar Wars initiative. After a stint in the Navy, Dr. Campbell practiced medicine in Mooresville at Lake Norman Family Medicine for almost 30 years (1988-2017). I knew Dr. Campbell personally better than the past presidents mentioned above, mainly because he had more recently been in leadership, particularly with our Foundation. But I found that I didn’t really know him until I attended his funeral. Speaker after speaker – from family members to colleagues to patients – talked about what Dr. Campbell had meant to them and their community. He had undertaken mission work, both locally and overseas. One speaker told of a trip Campbell took with Samaritan’s Feet, and how he ultimately was the busiest person on the trip, caring for the feet of the children in a remote village while others fitted the children with shoes. Another speaker (one of our current leaders) spoke about how Dr. Campbell began mentoring her while she was in medical school and how she ultimately joined his practice before opening an independent practice of her own. There were very few dry eyes among the hundreds of mourners who attended his memorial service, but there was a lot of laughter as well. Mainly because many of the speakers said Dr. Ed would have wanted it that way. It was so clear to see the impact he had: on his patients, their families, his communities and communities hundreds of miles away on far flung continents. Continues on next page
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One speaker challenged attendees to try to be just a little bit more like Dr. Ed when they left the service – to be a little more caring, to do one extra thing for someone else, to help carry the legacy that Dr. Campbell lived for his patients and community every day. So What Does it All Mean I really can’t do justice to any of these three individuals in just a few words. Nor can I do justice to any of the work that NCAFP members do day after day in communities all across our great state. But it does make me proud to work for a group of individuals who put their
patients, their families, and their communities first. I do ask that you take the challenge given at Dr. Campbell’s funeral seriously. I believe we have a legacy to uphold – to follow the beliefs of all the great family physicians who came before us. We truly stand on the shoulders of giants. I can only guarantee you one thing: every day I come to work for the NC Academy of Family Physicians, I will do what I can to help make it just a little bit easier for you to care for your patients, their families and your community. It’s not always easy, but that’s exactly what your staff is here to do. Thanks for that opportunity!
Sights and Scenes from NCAFP Events
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The North Carolina Family Physician
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PATIENT CARE
- OPIOID PRESCRIBING-
What Does the STOP Act Mean to You? In recent months, you’ve probably heard a lot about the STOP (Strengthening Opioid Misuse and Prevention) Act, which finally was adopted by the General Assembly in late June. The questions you are probably now asking are what does it mean for my practice and when do I have to comply. The answers are not always straight forward, and different sections of the Act become effective at different times. However, we’ll do our best to give a simplified outline of the impact on how you practice medicine and prescribe opioids.
Definition of Targeted Controlled Substances First, for your prescribing purposes, this Act only applies to certain Schedule 2 and Schedule 3 Controlled substances that are defined as “Targeted Controlled Substances.” In other words, it does NOT apply to all controlled substances as we once had feared. These targeted controlled substances are specifically outlined in Chapter 90-90 (1) or (2) and Chapter 90-91 (d) of the NC General Statutes. While we have provided a list of all these “targeted controlled substances” later in this article; in general, these are highly addictive pain medications such as hydrocodone, oxycodone, fentanyl, codeine, morphine, etc. The list is outlined in detail below. Limitations on Prescribing for Acute Pain or Post-Surgery The Act limits an initial prescription for acute pain to a five-day supply for these targeted controlled substances. For post-operative care, this is raised to a seven-day supply. However, these strict limits are only in place for initial con-
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sultation on acute pain or post-operative pain. This does not apply to chronic pain. Acute pain is defined in the statute as pain expected to last for less than three months, while chronic pain is pain that typically lasts longer than three months. This portion of the Act becomes effective January 1, 2018, but we would encourage you to begin complying with this provision immediately when writing a prescription for an initial diagnosis of acute pain or for post-operative pain. Education of Families of Hospice or Palliative Care Patients The statute also instructs hospice or palliative care providers who prescribe a “targeted control substance” for use by a patient at home to provide verbal and written information to the patient and their family regarding proper disposal of those medications. This provision is now in effect, becoming effective July 1st, just a few days after passage of the bill. Mandatory Controlled Substances Reporting The new law mandates that prior to initiating an individual on a targeted controlled substance, the prescriber (a family physician in the case of our members) must review data from the state’s Controlled Substance Reporting System covering the last 12-months. This does not apply if the controlled substance is administered to a patient in a hospital or nursing home, if the prescription is for the treatment of cancer or another condition associated with cancer or it is prescribed to a patient in hospice care or palliative care. The prescriber must also check the CSRS at least quarterly, if the patient is receiving the “targeted controlled substance.” Originally, the NCAFP had been concerned that this may apply to all controlled substances and require checking the database monthly. This provision does not go into effect immediately, although we recommend routinely beginning this process now. The new law indicates that this provision will go into effect 30-days after the state has confirmed that the Controlled Substances Reporting System has been updated. The General Assembly did appropriate funds to improve the system this year. At this point, it is unclear when this provision will take effect, but we recommend complying immediately. Once it does go into effect, the Department of Health and Human Services can conduct periodic audits of the use of the system and report violations to the appropriate licensing board which could lead to action by the NC Medical Board. E-Prescribing Effective January 1, 2020, all “targeted controlled substances” must be prescribed electronically (no paper prescriptions permitted after this date) with the exception of a “practitioner who is dispensing directly to the ultimate user, a practitioner
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states, we believe this legislation is a much more positive and reasoned approach to helping combat opioid abuse and misuse. The NCAFP is committed to working with our partners to overcome this public health issue. We hope you will join us in working to ensure that those who need pain medications have it readily available but at the same time preventing abuse or misuse of controlled substances. The following chart outlines the controlled substances that are considered “Targeted Controlled Substances” as outlined in the STOP ACT. This includes a portion but not all of Schedule 2 and Schedule 3 Controlled Substances.
NORTH CAROLINA’S
STOPACT
Targeted Controlled Substances As outlined in NC General Statutes 90-90 (1): Any of the following substances whether produced directly or indirectly by extraction from substances of vegetable origin, or independently by means of chemical synthesis, or by a combination of extraction and chemical synthesis, unless specifically excepted or unless listed in another schedule: a. Opium and opiate, and any salt, compound, derivative, or preparation of opium and opiate, excluding apomorphine, nalbuphine, dextrorphan, naloxone, naltrexone and nalmefene, and their respective salts, but including the following:
ordering a controlled substances in a hospital, nursing home, hospice facility or outpatient dialysis facility, a practitioner who experiences temporary technological or electrical failure but this must be documented, or a practitioner who writes a prescription to be dispensed by a pharmacy located on federal property.” The bottom line: Beginning in 2020, pretty much all targeted controlled substances will have to be prescribed electronically. If your EHR does not have the capability of doing so now, you should determine any needed upgrades. In some EHRs, the function is there but it is not permitted by the software, so it could be just a simple programming change. At any rate, begin taking the necessary steps now. The implementation of this part of the legislation was pushed back to allow two and a half years for prescribers to prepare for this provision. Overview While there are many additional provisions of the bills that apply to pharmacists, such as standing orders for naloxone, etc., these are the provisions that will impact you the most. We worked very closely with the office of the state Attorney General, representatives of the General Assembly and the Department of Health and Human Services to make this legislation as effective as possible while minimizing the burden on primary care physicians. In comparison to bills in other
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1. Raw opium. 2. Opium extracts. 3. Opium fluid extracts. 4. Powdered opium. 5. Granulated opium. 6. Tincture of opium. 7. Codeine. 8. Ethylmorphine. 9. Etorphine hydrochloride. 10. Hydrocodone. 11. Hydromorphone. 12. Metopon. 13. Morphine. 14. Oxycodone. 15. Oxymorphone. 16. Thebaine. 17. Dihydroetorphine. b. Any salt, compound, derivative, or preparation thereof which is chemically equivalent or identical with any of the substances referred to in paragraph 1 of this subdivision, except that these substances shall not include the isoquinoline alkaloids of opium. Continues on next page
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c.
Opium poppy and poppy straw.
d. Cocaine and any salt, isomer, salts of isomers, compound, derivative, or preparation thereof, or coca leaves and any salt, isomer, salts of isomers, compound, derivative, or preparation of coca leaves, or any salt, isomer, salts of isomers, compound, derivative, or preparation thereof which is chemically equivalent or identical with any of these substances, except that the substances shall not include decocanized coca leaves or extraction of coca leaves, which extractions do not contain cocaine or ecgonine. e. Concentrate of poppy straw (the crude extract of poppy straw in either liquid, solid or powder form which contains the phenanthrine alkaloids of the opium poppy). As outlined in NC General Statutes 90-90 (2): Any of the following opiates, including their isomers, esters, ethers, salts, and salts of isomers, whenever the existence of such isomers, esters, ethers, and salts is possible within the specific chemical designation unless specifically exempted or listed in other schedules: a. Alfentanil. b. Alphaprodine. c. Anileridine. d. Bezitramide. e. Carfentanil. f. Dihydrocodeine. g. Diphenoxylate. h. Fentanyl. i. Isomethadone. j. Levo-alphacetylmethadol. Some trade or other names: levo-alpha-acetylmethadol, levomethadyl acetate, or LAAM. k. Levomethorphan. l. Levorphanol. m. Metazocine. n. Methadone. o. Methadone - Intermediate, 4-cyano-2-dime- thylamino-4, 4/y- diphenyl butane. p. Moramide - Intermediate, 2-methyl-3-mor- pholino-1, 1-diphenyl-propane-carboxylic acid. q. Pethidine. r. Pethidine - Intermediate - A, 4-cyano-1-meth- yl-4/y-phenylpiperidine. s. Pethidine - Intermediate - B, ethyl-4-phenylpiperi- dine-4-carboxylate. t. Pethidine - Intermediate - C, 1-methyl-4-phen- ylpiperidine-4-carboxylic acid.
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u. Phenazocine. v. Piminodine. w. Racemethorphan. x. Racemorphan. y. Remifentanil. z. Sufentanil. aa. Tapentadol. As defined in NC General Statutes 90-91 (d) Any material, compound, mixture, or preparation containing limited quantities of any of the following narcotic drugs, or any salts thereof unless specifically exempted or listed in another schedule: 1. Not more than 1.80 grams of codeine per 100 milliliters or not more than 90 milligrams per dosage unit with an equal or greater quantity of an isoquinoline alkaloid of opium. 2. Not more than 1.80 grams of codeine per 100 milliliters or not more than 90 milligrams per dosage unit, with one or more active, nonnarcotic ingredients in recognized therapeutic amounts. 3. Not more than 300 milligrams of dihydrocodeinone per 100 milliliters or not more than 15 milligrams per dosage unit with a four-fold or greater quantity of an isoquinoline alkaloid of opium. 4. Not more than 300 milligrams of dihydrocodeinone per 100 milliliters or not more than 15 milligrams per dosage unit, with one or more active, nonnarcotic ingredients in recognized therapeutic amounts. 5. Not more than 1.80 grams of dihydrocodeine per 100 milliliters or not more than 90 milligrams per dosage unit, with one or more active, nonnarcotic ingredients in recognized therapeutic amounts. 6. Not more than 300 milligrams of ethylmorphine per 100 milliliters or not more than 15 milligrams per dosage unit, with one or more active, nonnarcotic ingredients in recognized therapeutic amounts. 7. Not more than 500 milligrams of opium per 100 milliliters or per 100 grams, or not more than 25 milligrams per dosage unit, with one or more active, nonnarcotic ingredients in recognized therapeutic amounts. 8. Not more than 50 milligrams of morphine per 100 milliliters or per 100 grams with one or more active,
nonnarcotic ingredients in recognized therapeutic amounts.
The North Carolina Family Physician
~ ADVERTORIAL ~
$17.6 MILLION VERDICT IN MISSOURI DRIVES HOME MEDICAL LIABILITY IMPLICATIONS OF OPIOID EPIDEMIC By Jason Newton, Senior Vice President, Claims and Risk Management, and Associate General Counsel A Missouri jury last month awarded $17.6 million to a man who claimed his physician overprescribed opioids for him, confirming what we at Medical Mutual have been telling our members for more than a year: that in addition to its human toll, the opioid epidemic carries significant implications for physicians’ medical liability. In the case, a 45-year-old man alleged that he became addicted to three different opioids his primary care physician (unaffiliated with Medical Mutual) prescribed to him for back pain—a total of 40,000 pills over four years, according to the plaintiff. The plaintiff alleged that the volume of painkillers prescribed by his physician led him to become addicted to them, requiring him to enter a drug rehabilitation program and damaging personal relationships, including his marriage. The jury found the physician liable, awarding $1.4 million in compensatory damages to the man and $1.2 million to his wife, as well as $15 million in punitive damages. Until this opioid epidemic ebbs, doctors will need to stay mindful of its potential impact on their liability. The verdict drives home for physicians and practices the vital importance of ensuring that opioid prescribing practices are consistent with CDC and state medical board guidelines. That’s not just good patient care—it’s also prudent risk management. Medical Mutual members can visit www.medicalmutualgroup.com to view CME-eligible webinars, three of which can help doctors meet North Carolina pain management CME requirements.
About the Author Jason graduated from UNC Chapel Hill and obtained his law degree from Wake Forest. After a 14year career in private law practice defending doctors, APPs, and hospitals, in 2013, Jason came on board with Medical Mutual—a longstanding client—in an in-house capacity. At Medical Mutual, Jason oversees the Risk Management, Healthcare Compliance, and Claims departments.
RESIDENTS & NEW FPS By Landon Allen, MD, MPH, MBA MAHEC Hendersonville Family Medicine Residency Program
A Call to Advocacy in North Carolina When I graduated from medical school in May of 2016, I was mostly excited, but also a little terrified. There is always a sense of novelty and danger that accompany major transitions in life, and moving from student to physician is definitely a major transition. I was fortunately matched to a program in Hendersonville, NC filled with supportive clinicians eager to help shape me into an autonomous provider balancing evidence-based medicine with the resource limitations facing the patients at our federally-qualified health center. Over the course of the last year, I have certainly had the experiences one would expect a new family physician to have: witnessing death, diagnosing fatal conditions, attending deliveries; it is not about these that I am writing today, but rather the sense of duty I feel to care and advocate for the population I serve and the people of North Carolina. I was born to a blue-collar family and was the first to go to college. I was a product of North Carolina’s public schools and university system and my
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time in undergraduate, graduate, and then medical school was all paid for through scholarships awarded to me by the state. All 23-years of my education, from my first day of kindergarten to my medical school graduation, was given to me by North Carolinians and I feel a sense of indebtedness to the citizens of this beautiful corner of the country to be the type of physician they need. The privilege to practice medicine with those individuals as my patients is something that I value greatly. My sense of servitude to our state and experiences thus far in life have led me to the goals of serving my patients compassionately, working toward eliminating health disparities, and helping lead others in the fight for better access, decreased costs, and improved quality of care. All of these goals require some degree of advocacy.
D. Landon Allen, MD, MPH, MBA
Dr. Allen is a second-year family medicine resident at the Mountain Area Health Education Center Rural Family Medicine Residency Program in Hendersonville, NC. His undergraduate, graduate, and medical degrees were obtained from East Carolina University. He has a primary interest in health disparities and his public health work has focused on migrant farmworker populations across the state of North Carolina. He currently serves as a resident member of the NCAFP Foundation Board of Trustees.
For me, my passion for medicine comes from a deep-seated desire to serve the disenfranchised and a sense of duty to do so in a state that gave me the opportunity to accomplish my own aspirations in life. While not all family physicians have the same interests or specific passions as I do, I believe we all have something that we’re passionate about. Perhaps you’re interested in transgender issues or human trafficking or rural healthcare access or local public health policy or vaccination rates or ED utilization or Medicaid reform or the opioid epidemic or medical education or any number of things… Whatever it may be, I would challenge each of us to think about our practices and what it is exactly that interests or concerns us, and what motivates us to work hard for our patients every day. Then recognize that the station we hold in our communities automatically places us in a position to advocate for those issues and populations. Our
education,
experiences,
and
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rapport with patients and the community at-large makes us an invaluable asset when it comes to advocacy issues and I would argue that in many cases, the advocacy that family physicians undertake can be as influential on the health of a community as caring for our patients. So then if we are so well-equipped to advocate for our patients and communities, why do we as a specialty not do so more effectively than we do? I believe the answer lies in having an awareness of what we can do to advocate; it isn’t as difficult as one might think. Advocating for a particular population or issue can initially feel like an insurmountable task, but the secret is that small things count and there is no wrong approach. You don’t have to start with a multi-faceted project to drive huge changes; begin with small actions. Start by finding out who else in your community is working on the same issues and then combine efforts. You can put up posters in your clinic, write letters to your local paper, give interviews to local reporters on new policy
changes, call your state representatives and ask to meet when they’re back home and out of session, speak at local civic groups, attend conferences on the issue, get involved with the NCAFP advocacy efforts, speak at town board meetings, or even become a part of local government. Check out the advocacy resources on the NCAFP website for more ideas. The key to advocacy is to just start somewhere; advocacy efforts have a way of attracting others with similar interests and I think you’ll be surprised at the collaboration that results. So think about what it is that interests you; dig deep and identify an issue that you feel needs someone to speak out about and then make a plan to help. Start with something small and consider combining efforts with others already advocating in that arena. It doesn’t have to take up all of your time, after all, if a first year resident can find the time to engage in advocacy efforts, anyone can. If we all pick something that we’re passionate about and engage in modest advocacy efforts, think of all the good the 4,000 members of the NCAFP could do for our state.
Resident & Student Leadership Opportunities Elections for new Resident and Student leaders will take place during their respective Section meetings on Saturday, December 2nd at the 2017 NCAFP Winter Family Physicians Weekend in Asheville, NC. NCAFP Resident and Student members will each elect a Director-Elect to the NCAFP Board of Directors and two members to serve as Trustees on the NCAFP Foundation Board of Trustees. Resident members will also elect four residents to sit on the Academy’s Councils (Membership and Workforce, Practice Management, Public Relations and Marketing, and Continuing Medical Education). Deadline to submit materials for these elected positions is November 15, 2017.
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If you have questions, please contact Tracie Hazelett at 919-980-5357 or thazelett@ncafp.com.
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STUDENT INTEREST & INITIATIVES By Tracie Hazelett Manager, Medical Student & Residency Relations
Over 20 Medical Students Participate in NCAFP’s Summer Family Medicine Experiences Students from the Brody School of Medicine at East Carolina University and The Jerry M. Wallace School of Osteopathic Medicine at Campbell University participated in summer experiences designed to immerse medical students in family medicine. Twenty rising 2nd-year medical students participated in two-week family medicine experiences that emphasized primary care in rural settings. Another three students participated in four-week clinical externship experiences with family physicians. Students who applied for these summer programs demonstrated a sincere interest in learning more about career opportunities in the specialty and brought very diverse academic, professional, and volunteer experiences. The NCAFP’s two rural health programs provide opportunities for ten students in each program held in western North Carolina and eastern North Carolina. During the two-week experience, students reside with family medicine residents, faculty of our partner residency programs, or with practicing family physicians, for a complete immersion in family medicine. These invaluable experiences give students a look at family medicine outside of the academic center, some-
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thing difficult to come by in the early years of medical school. Students observe how physicians balance clinic, family and community life. The first week of each rural health program consists of group didactics, hands-on opportunities and field experiences. Some of the offerings during the first week include discussions on the scope of family medicine, the rural healthcare landscape of North Carolina, hands-on procedures workshops, interaction with patients, and panel discussions with residents and practicing family physicians. There are also ample opportunities to network with family medicine residents, faculty and area family physicians throughout the week for a glimpse into the future. During the 2nd week of the program, each student is assigned to work with a community-based, family medicine preceptor. Students experience life as a family physician in the clinic, as well as after hours in homes
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and the community. Students witness first-hand the physician-patient relationship, learn more about the business of family medicine, and observe collaborative partnerships in action with other health professionals and community organizations. These are all essential components to delivering high quality healthcare to the citizens of our communities. The Family Medicine Externship The NCAFP Externship Program provided to three medical students this summer differs from the rural health programs. The Externship provides a longer experience in the clinical setting that allows for more exposure over a period of time, versus a more intense, complete immersion in family medicine like the two-week rural health programs. The NCAFP recognizes experiences like these are critical for students early in their education to help dispel myths surrounding rural family medicine, to help them better understand the scope of family medicine, as well as the tremendous need to improve access to care in North Carolina’s rural communities. Evidence has shown that this type of early exposure increases the likelihood students will consider primary care specialties and ultimately increase the consideration given to practicing in rural areas if they have had early positive encounters. These vital family medicine learning experiences would not be possible without the support of the Foundation’s donors and the partnership of enthusiastic family physicians, supportive and involved medical schools, and the family medicine faculty from the MAHEC Hendersonville and the East Carolina family medicine residency programs. Our partners not only give their time and energy to implement these programs but many also open their homes and lives to these medical students as they positively impact them early in their education. Thank you!
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Family Medicine Leads Taps Four from NC for Leadership Development Congratulations to the AAFP Foundation Family Medicine Leads Emerging Leader Institute winners from North Carolina: Erin Clark, OMS-III at Campbell, along with Megan Campbell, MD, PGY2 at Cabarrus; (William) Miller Johnstone, III, MD, PGY-2 at East Carolina; and Jessica Lapinski, DO, PGY-2 at Duke. These individuals have received scholarships from the AAFP to participate with students and residents from around the country in this year-long leadership development program. The Family Medicine Leads Emerging Leader Institute focuses on ensuring the future of the Family Medicine specialty by increasing the number of future Family Medicine leaders and provides training for this important role. Those selected began their year-long leadership development with in-depth leadership workshops at the AAFP National Conference of Family Medicine Residents and Medical Students in July. Throughout the coming year participants will work to complete a project relevant to one of three tracks: Policy & Public Health Leadership, Personal & Practice Leadership or Philanthropic & Mission-Driven Leadership; and, have the chance to win additional scholarship money to present their project at future conferences. The NCAFP also extends congratulations to AAFP Foundation Family Medicine Leads Scholarship winners who received awards to attend the recently held AAFP National Conference of Family Medicine Residents and Medical Students. Eleven students were selected to receive travel awards from the AAFP, they included: Ray Antonelli (UNC); Natalie Broadway-Robertson (ECU); Caroline Fryar (UNC); Elizabeth Ferruzzi, (ECU); Lauren Groskaufmanis (Duke); Camille Guzel (Duke); Franklin Niblock (UNC); Enioluwafe Ojo (UNC); Erin Saner (Wake Forest); Greeshma Somashekar (UNC); and Mona Xiao (UNC). In addition to the above AAFP award recipients, the NCAFP Foundation provided travel awards to 16 more North Carolina medical students to help offset their travel expenses to attend this conference, congratulations to all!
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NCAFP FOUNDATION By Tracie Hazelett
Support the Foundation in its 2017 Raffle
Win One of
5
Fabulous
Become a Sonoma Valley Winemaker:
Package includes an Intimate Blending Seminar, Winery Tours & Tastings, 3-Night stay at the Fairmont Sonoma Mission Inn, with airfare for two.
Classic Wrigley Field Rooftop Experience:
Join the Academy as our NCAFP Foundation raises funds for student interest initiatives. This year’s annual effort is currently underway and we are selling raffle chances to members – and beyond – to raise money to continue our efforts to provide high quality family medicine experiences to North Carolina medical students. Each raffle ticket, or chance, is $50.00 and will earn purchasers an entry into a drawing for a fabulous vacation to one of five magnificent destinations within the US.
Rooftop Bleachers & Dining Package at a regular season Chicago Cubs Game, 3-Night Stay at Hyatt, Hilton, Marriott or comparable hotel, with airfare for two.
New Orleans Jazz & Dining:
Preservation Hall of Jazz, Commander’s Palace Jazz Brunch or Dinner with Wine Pairing, 3-Night Stay at Hyatt, Hilton, Marriott or comparable hotel with airfare for two.
The drawing will take place on Saturday evening, December 2nd, during the Presidential Gala at the NCAFP annual meeting in Asheville. Winners do not need to be present to win and will be notified following the drawing to determine their trip of choice.
New York Long Weekend:
All available trips are for 2 people, include airfare, 3 nights of accommodations and an experience(s) relevant to the locale of choice. All packages have a retail value of $5,400.00 or more. Winners can choose to add extra people or additional nights to further customize their trip when working out the details with the Concierge/Booking service for Winspire*, however any trip additions will be at the expense of the winner. Vacation experiences available include:
America’s Cup Yacht Sailing in San Diego:
Choice of Broadway Show, Dinner, 3-Night Weekend Stay at Hyatt, Hilton, Marriott or comparable hotel with airfare for two.
Sailing Experience on America’s Cup Yacht, 3-Night Stay in San Diego at Estancia La Jolla Hotel & Spa with airfare for two.
For questions or to buy a chance to win, please contact Tracie Hazelett at thazelett@ncafp.com or 919-980-5357 or visit www.ncafp.com.
*Winspire focuses on providing unique experiences for use in charity auctions and fundraisers. Their focus is specifically to help nonprofits maximize fundraising. Information about Winspire can be found at www.winspireme.com.
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The North Carolina Family Physician
NORTH CAROLINA’S
Vacations in the US!!!
Resident & Student Research Poster Presentation The NCAFP Foundation’s twenty-fourth annual Research Poster Presentation will be held at the Academy’s Winter Family Physicians Weekend (Nov. 30 – Dec. 3, 2017) this December. The Foundation is interested in practice-based research, but poster presentations may address any topic relevant to Family Medicine. Work-in-progress may also be submitted. Submissions must be of original work not yet published. Projects previously presented at medical schools or student “Research Days” are acceptable and concurrent submissions to other conferences such as NAPCRG and STFM are also appropriate.
Posters will be judged for awards with winners announced at the Annual Meeting in December.
$50 per entry
Resident and Student members interested in participating must submit their application and all corresponding materials (including final PDF of poster) by October 1st, 2017. Please direct questions to Tracie Hazelett at thazelett@ncafp.com or 919-980-5357.
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PRACTICE MANAGEMENT
HEALTH INFORMATION EXCHANGE
NC HealthConnex: Helping You Prioritize Patient Health and a Successful Business By Christie S. Burris Health Information Exchange Authority
You’re working diligently every day—reacting quickly, diagnosing, treating—prioritizing patient health and striving to provide whole-person care. You’re also trying to sustain a successful business. In today’s health care landscape, it can be difficult to do both. From unnecessary testing to navigating multiple technologies to learn a patient’s history, there are hassles that cost extra dollars and take away the time you could be spending with patients. Electronic health records have helped combat some of those inefficiencies in recent years, but there are still gaps in the system. Having knowledge of a patient’s complete medical record at your fingertips can not only help you, it can improve diagnoses and save time and money. North Carolina’s state-designated health information exchange (HIE), NC HealthConnex, helps bridge this gap. With 3.7 million unique patient records and growing, NC HealthConnex links disparate systems and existing HIE networks together to deliver a holistic view of a patient’s record. It will allow you to access your patients’ comprehensive records across multiple providers, as well as review consolidated lists of labs, diagnoses, allergies, medications and more. Think about what decreased redundancy; more efficient, accurate diagnoses, recommendations and treatment; and improved coordination across all levels of care would mean for your practice and your patients. In addition, the platform helps you and your staff do your jobs better and faster. Through near real-time access to a patient’s medical history, you can see a more complete picture of your patient’s health and make quicker, more educated treatment decisions.
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NC HealthConnex makes it easy to pull down data, only requiring the patient’s name in order to access medical history. While the current connections are North Carolina focused, a connection is also underway to the nationwide eHealth Exchange. Once completed, the foundation will be laid for NC HealthConnex to build connections to out-of-state HIEs and federal agencies, enabling participants to access federally available data on their patients (e.g., military/veteran health records). The first eHealth Exchange connection to the Georgia HIE is scheduled to be completed in July. So, how do you connect? The first step is to sign a Participation Agreement with the North Carolina Health Information Exchange Authority (NC HIEA), a state agency that manages NC HealthConnex. There is no cost from the NC HIEA to sign up or connect and use NC HealthConnex. The Participation Agreement requests that EHRs are minimally capable of sending HL7 messages, version 2.0 and higher to enable the technical connection and data submission to NC HealthConnex. There are then two ways to access patient records: via the Clinical Portal (a web portal), or through your EHR directly (if the EHR is capable of bidirectional integration). All North Carolina providers are eligible to connect and reap the benefits of NC HealthConnex. And, if you receive state funding for the provision of health care services, you must connect by certain dates in 2018 and 2019 per state law. [See sidebar below with updated legislative requirements from the 2017 Legislative Long Session.] “NC HealthConnex is a game changer for North Carolina and NCAFP is proud to support our statewide HIE,” says Greg Griggs, executive vice president of NCAFP. “We urge members to begin the connection process and join us as we strive to improve health care quality and outcomes for all North Carolinians.” The NC HIEA works directly with its technical partner, SAS Institute, to continually audit, strengthen and optimize the HIE. This helps to ensure the highest levels of patient security, data security and participant satisfaction. Additional benefits of NC HealthConnex include: • • • • • • • • •
Efficient access to comprehensive patient records at the point of care Elimination of duplicative tests Improved coordination across levels of care Improved diagnoses and treatment plans Access to secure, encrypted email through Direct Secure Messaging Access to public health registries (immunization registry currently available) Access to a directory of over 10,000 provider addresses HIPAA-compliant, automated sharing with other providers Use of configurable clinical notifications to receive ED alerts, follow in-patient care, etc.
The North Carolina Family Physician
Over the next two years alone, the NC HIEA expects to connect a majority of the state’s health care providers to NC HealthConnex. With access to this breadth of patient data in a consolidated, usable format, imagine the effect these benefits will have on your practice and daily patient care. The NC HIEA is committed to its vision of linking all North Carolina health care providers, enabling participants to access information to support improved health care quality and outcomes. Let’s work together as we all strive to continue to improve health care in our state. For more information, visit NCHealthConnex.gov.
About the North Carolina Health Information Exchange Authority (NC HIEA) and NC HealthConnex: In 2015, the North Carolina General Assembly established a state-managed Health Information Exchange Authority (NC HIEA) to oversee and administer the NC Health Information Exchange Network (NCGS 90-414.7). Housed within the NC Department of Information Technology’s (DIT) Government Data Analytics Center (GDAC), the NC HIEA operates North Carolina’s state-designated health information exchange--now called NC HealthConnex. NC HealthConnex is a secure, standardized electronic system in which providers can share important patient health information. The use of this system promotes the access, exchange, and analysis of health information to help improve care coordination, quality of care, and enable better health outcomes.
2017 Appropriations Act Addresses HIE Legislation The North Carolina Senate and House of Representatives worked together to provide adjustments to the HIE Act in the 2017 Appropriations Act, North Carolina’s State Budget, based on input from the NC HIEA, NC DHHS, stakeholder trade associations and providers impacted by the law. Changes to the HIE Act are outlined below.
Connection Timeline Revisions: Hospitals as defined by G.S. 131E-176(3), physicians licensed to practice under Article 1 of Chapter 90 of the General Statutes, physician assistants as defined in 21 NCAC 32S .0201, and nurse practitioners as defined in 21 NCAC 36 .0801 who provide Medicaid services and who have an electronic health record system shall connect by June 1, 2018. All other providers of Medicaid and state-funded services shall connect by June 1, 2019. Prepaid Health Plans (PHPs), as defined in S.L. 2015-245, will be required to connect to the HIE per their contracts with the NC Division of Health Benefits (DHB). Clarifies that PHPs are required to submit encounter and claims data by the commencement of the contract with NC DHB. Clarifies that Local Management Entities/Managed Care Organizations (LMEs/MCOs) are required to submit encounter and claims data by June 1, 2020. Other Changes: Allows NC DIT to establish an extension process in consultation with NC DHHS to grant limited extensions of time for providers to establish connectivity to the HIE network if such providers can “demonstrate ongoing good faith effort to take necessary steps to establish such connectivity.” More information on this process will be available fall 2018. Clarifies that 42 C.F.R. Part 2 programs (i.e., federally assisted
Summer 2017
substance use disorder treatment facilities) are exempt from sending data pertaining to substance use disorder treatment services, pursuant to federal law. Providers who participate in these programs will still be required to send clinical data that is not subject to these restrictions. Repeals the emergency opt out provision (G.S. 90-414.10(e)). When a patient opts out of the HIE, his/her data is sent to the HIE, but it is blocked from being shared with any of the HIE’s authorized users (those accessing the HIE for treatment, payment, or other HIPAA-covered purposes). The former law allowed for a treating provider to access the record of a patient who had opted out in the case of a medical emergency. The NC HIEA requested the repeal of this provision because the current HIE technology only allows for a privacy officer at the NC HIEA or SAS to open a patient record that had been blocked due to an opt out request. For example, an ER physician would not be aware that a patient record exists in the HIE for a patient who has opted out. The NC HIEA expects the impact of this change to be minor, as the current opt-out rate is >0.1% of patients with records in the HIE. Requires a joint study to be conducted by NC DHHS, NC DIT, and the State Health Plan to better understand which data elements providers other than hospitals, doctors, and mid-level practitioners collect electronically, and whether those data elements have clinical meaning for HIE users. This is a priority for the NC HIEA and our partner agencies to provide clarity to these provider types impacted by the mandate. Final findings and recommendations will be submitted to the Joint Legislative Oversight Committee on Health and Human Service and the Joint Legislative Oversight Committee on Information Technology by April 1, 2018.
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WINTER MEETING, from pg. 11
On Saturday night, come dressed in your holiday-best for a fabulous night with family, friends, and colleagues during the Presidential Gala. It will certainly be a night to remember when we install your new board members and Dr. Tamieka Howell as the 2017-2018 President. And, when one of our favorite bands, Too Much Sylvia hits the stage, be ready to dance the night away to your favorite top hits from today as well as some classic 80’s & 90’s that will take you back to your younger years.
A full schedule of events, workshop descriptions, online registration rates, hotel accommodation information, and more is available at www.ncafp.com/wfpw. Keep in mind, the Early Bird Rate for Members ends on Monday, October 9th so register early and save $35 before the Early Bird cut-off. I look forward to seeing you in Asheville, and I bet November 30th will be here before you know it! See you soon! Contact Kathryn Atkinson, Manager of NCAFP Meetings & Events at katkinson@ncafp.com or via direct-dial at 919214-9058.
Non-Profit Org. US Postage
PAID
Pontiac, Illinois Permit No. 592
In closing, I did a little research on the web to try and understand just why it is that time seems to fly when we are having fun. Google quickly rewarded me with
2501 Blue Ridge Road, Suite 120, Raleigh, North Carolina 27607
This annual event offers much more than just lecture halls and CME sessions, so be sure to include your friends and family as you make your plans to attend. Relax your mind, body, and soul with a customized treatment in the luxury Spa at the Grove Park Inn, brush up on your history with a candlelight tour of the breathtakingly beautiful Biltmore House, or learn more than you ever imagined possible about hops and grains during an Asheville-area brewery and tasting tour. Or, simply take it easy and relax with an afternoon sunset, a refreshing beverage and some fabulous mountain views from the comfort of your very own rocking chair in the GPI’s Great Hall.
www.ncafp.com
two fantastic pre-conference CME workshop opportunities on Wednesday, November 29th. Plan to arrive early and jump in on the optional KSA Study Working Group on Asthma (with 8 AAFP Prescribed credits and perfect for those who need to fulfill MC-FP requirements!) or this year’s optional Valuable Hands-On Workshop Opportunity featuring a Radiosurgery & Cryosurgery Lab.
over 1.8 million links and included research articles, theories and speculations, and even song lyrics on the topic. Apparently, it does involve a lot of science with things like a suprachiasmatic nucleus, visual attention and time interval reproduction, circadian rhythms, and even a lateral intraparietal cortex. (For the record, I just might have read a little further if any of those links mentioned flux capacitors or jigowatts – but that’s another story.) Regardless of how or why it happens, if you are like me and time just seems to be flying by this year; I hope that it also means that you too have enjoyed many fun-filled days at work and home. I also hope that you are already making your plans to join us in Asheville for another fabulous and fun Winter Family Physicians Weekend.