NC Family Physician - Summer, 2021

Volume 17 Issue 3 • Summer 2021

The North Carolina

Family Physician Quarterly News in North Carolina Family Medicine

The

Insightful Voices of Medical Students

p. 4

The Mountains are Calling, And We Must Go Make your plans now to join us for this year’s in-person Winter Family Physicians Weekend

2021 Winter Family Physicians Weekend Program Chair: Jay Patel, MD / Program Vice-Chair: Deanna Didiano, DO

www.ncafp.com/wfpw

Approximately 25+ Credits Up for Grabs

Timely Topics Centered on the Issues You See & Treat Most Often

Diabetes

COPD Dementia

Overactive Bladder

HPV

Influenza Lung Cancer Hyperlipidemia Shingles STDs

Kidney Disease & Many More...

Including: an ABFM Update & The Importance of Precepting

Optional Workshops Include

KSA: Health Counseling & Preventive Care ∙ Preceptor Development Lung Cancer Screening ∙ Practice Management Seminar

Connect | Learn | Engage

Re-energize your passion for Family Medicine while reconnecting with colleagues & friends.

Fulfill your year-end CME requirements in a fun & relaxing atmosphere.

Celebrate your commitment to providing the best possible care to your patients.

Registration & full conference details available at www.ncafp.com/wfpw It is important to note; there are currently no plans to offer a virtual registration option for this event.

Contact Kathryn Atkinson, CMP, Manager of Meetings & Events, at 919.214.9058 or katkinson@ncafp.com with any questions.

Inside Summer 2021

Karen Smith Seeks Position on AAFP Board of Directors P. 16

PRESIDENT’S MESSAGE

MEETINGS & CONFERENCES

4

20

Student Voices

The Mountains are Calling and We must Go!

ADVOCACY

RESIDENTS & NEW PHYSICIANS

8

22

NCAFP Administrative Burden Survey Results Summary

CHAPTER AFFAIRS

12

Setting Sun or Rising Sun?

Small Efforts Yield Big Opportunities

PRACTICE MANAGEMENT

26

BCBS Announces Enhanced Resources for Independent Family Physicians

MEMBERS & MEMBERSHIP SERVICES

18

New Podcast on Family Medicine Set to Begin in Early September.

DEPARTMENTS

PUBLISHED BY

President’s Message 4 Advocacy 8 Chapter Affairs 12 Members & Membership 18 t 919.833.2110 •

fax

Meetings & Conferences 20 Residents & New Physicians 22 Student Interest 24 Practice Management 26

919.833.1801 • ncafp.com

Managing Editor, Design & Production Peter T. Graber, NCAFP Communications

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. Jessica Triche 2020–2021 NCAFP President

The Insightful Voices of Medical Students I think everyone knows how passionate I am about mentoring students. Yes, having students does change my workflow. I decrease my patient load. I bring more open charts home with me.

But ask my husband about how much fun I have with students!

There is laughter, sarcasm, music, occasional dancing, and lots of frank discussions. I have learned things about different music genres and how to use Venmo. I think a few students learned about work-life balance.

One student even came to my kids awards ceremony during our lunch break!

I reached out to former students to hear what they have to say about mentoring. Students are the future of Family Medicine. How can you not commit to having a student after reading about their experiences?

What do you look for in a mentor?

Dr. Matthew Drake (PGY2): “I look for someone who, when I see what they’re doing as a physician, as a community member and as someone with a family, I say ‘I want to be like them when I grow up’. I want to engage with someone who is inspiring within medicine, and ideally, would have a path similar to what you would hope to pursue in the future. Accessibility is

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Dr. Triche attended UNC-Chapel Hill for undergraduate studies and attended medical school at the Brody School of Medicine at East Carolina University. She completed her residency training at Moses Cone Family Medicine in Greensboro, NC, where she served as Co-Chief Resident.

Dr. Triche is married and has two sons and enjoys life on the water in Bath, NC. She is currently working at Vidant Family Medicine-Chocowinity located in Chocowinity, NC. She enjoys seeing a variety of patients, as well as teaching medical students. She is a graduate of both Vidant's Physician Leadership Institute as well as the North Carolina Medical Society Foundation's Leadership College. Dr. Triche also completed their Health Care Leadership and Management (HCLM) Program in 2018. She is currently involved in several leadership roles within the Vidant system. She also serves on the Beaufort County Board of Health.

also key. A good mentor should be easy to reach out to, and help you reach decisions regarding a practice, a residency program, or another life or career choice.”

Stephanie Wilcher (M4): “I look for characteristics that I see in myself and characteristics that I wish to have. Mainly, humor, authenticity, empathy, love, and kindness. Also, selflessness and self-determination. All of the mentors I’ve really connected with have been incredibly kind, strong, and hilarious women.”

Tulsi Patel (M4): “I look for someone knowledgeable in their field and passionate about using their own experience to advise and support others more junior than them. Mentors that have pushed me outside of my comfort zone have been the most influential towards my personal development. I look for someone I can connect with professionally, but also casually in a more relaxed manner.”

The North Carolina Family Physician

2020-2021

NCAFP Board of Directors

Executive Officers President

Jessica L. Triche, MD

President-Elect

Dimitrios “Takie” P. Hondros, MD

Secretary/Treasurer

Shauna Guthrie, MD, MPH

Immediate Past President Executive Vice President

David A. Rinehart, MD Gregory K. Griggs, MPA, CAE

At-Large Directors Talia M. Aron, MD Elizabeth B. Baltaro, MD Jewell P. Carr, MD Garett R. Franklin, MD Nicole Johnson, MD, MPH Brian McCollough, MD Mark McNeill, MD Ying Vang, MD

Academic Position Mark L. Higdon, DO (Novant FMR)

Resident Director Clayton Cooper, MD, MBA (Duke)

Resident Director-Elect Ryan Paulus, DO (UNC)

Student Director Hannah Smith (ECU)

Student Director-Elect Morgan Carnes (Wake Forest)

AAFP Delegates & Alternates

Please tell me about your experiences with mentors.

Stephanie: “The one mentor relationship that has made the biggest impact on my life was in high school. I was in the health sciences academy which was led by a teacher (also an RN) who set-up shadowing opportunities for students. I told her I couldn’t shadow because I didn’t have a ride to and from the clinic after school. She couldn’t let me miss the opportunity, so she took time out of when she would be with her family or working to take me to the clinic and pick me up and take me home evcontinues on next page

AAFP Delegate

Karen L. Smith, MD

AAFP Delegate

Robert L. Rich, Jr., MD

AAFP Alternate

Richard W. Lord, Jr., MD, MA

AAFP Alternate

Tamieka Howell, MD

2501 Blue Ridge Road, Suite 120, Raleigh, North Carolina 27607 www.ncafp.com

ery time there was an opportunity to shadow. She didn’t have to do that for me, but she did because she knew how important it was to me and she cared about her students. I didn’t know back then how much I needed an adult who cared about me and would move mountains to see me succeed. When I think back on all the mentors I’ve had, they all played a part in setting a path for my success.”

Dr Drake: “My primary experience has been with Dr. Triche. She comes to mind because I was able to work with her in my 2nd-, 3rd- and 4th-year rotations. I think every time I rotated with her, I felt that I would be happy doing this for the rest of my life. This experience is what helped me decide to go into Family Medicine.

She was always participating in advocacy projects and maintaining leadership positions within the community and NCAFP. Having her as a mentor allowed me to see Family Medicine as a specialty that would not only allow me to maintain current passions in the community, but explore new ones outside of it.”

Tulsi: “My mentors have come in the forms of professors, program directors, bosses and more. Their advice and support have been influential towards pivotal life and career decisions. I feel lucky to have had their overarching commitment to my happiness and success over my educational journey. One of my mentors, Mr. Wayne Godwin, used to answer my questions and concerns with – “well, are you happy?” While a simple question, it is something that has stuck with me since that time.”

What barriers have you experienced in looking for a mentor?

Tulsi: “Sometimes it is difficult to assess who is willing to establish long-term mentorship versus advice in the moment. It can feel unnatural to repeatedly reach out to one person and is easy to worry about being an annoyance. Across all the mentors I’ve had, I think few have actually used the word ‘mentor’. I think more use of that word would be reassuring as these relationships develop.”

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Have you had or do you plan on working with students in your future?

Stephanie: “While in Medical School, I was the Vice-President for the SNMA, which is an organization that aims to support African American pre-med and medical students. In this role, I organized a pre-med conference and hosted minority physician and medical student mixers in an effort to increase the admission and retention of African Americans in medicine. I would like to continue this work beyond medical school to help minority students enter the medical field as well.

Diversity in medicine is really important to me, so as a black female I want to do my part to see diversity in medicine continue to grow.”

Tulsi: “Yes! As a medical student interacting with various senior physicians daily, that is something I think about often. There are particular residents and attendings from each of my rotations that expressed commitment to my learning and have actively worked to improve my experience. Knowing how much of a difference it made for me, I can only hope to provide the same attention toward medical students down the line.”

Any ideas on how the NCAFP (or physicians in general) can promote mentorship and teaching?

Stephanie: “The NCAFP could possibly host mixers for physicians to meet medical students. Physicians in general could invite students to work with them or share a meal with them if they have time to allow a mentorship to form if the student is interested.

Basically, leaving the door open for the possibility of mentorship.”

What would you say to fellow physicians about mentoring?

Dr Drake: “I think it’s one of the best ways to encourage medical students to go into the field. I would encourage it because as someone who was a medical student a short time ago, it’s helpful to have access to teachers that expose you to different practice settings.”

The North Carolina Family Physician

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ADVOCACY

By Gregory K. Griggs, MPA, CAE NCAFP Executive Vice President

NCAFP Administrative Burden Survey Outcomes and Next Steps

Introduction Many NCAFP members recently completed a survey on administrative burdens family physicians face in practice. Everyone knows that administrative burdens have increased in healthcare, but the questions centered around the biggest pain points and key actions the NCAFP can take on a state level.

We asked and you answered. Here are some of the survey’s findings and the actions the NCAFP Advocacy Committee is recommending to the NCAFP Board as we move forward to address these results. (NOTE: At the time of this writing, the board had yet to meet and fully address the survey results and recommendations, but we wanted to share a preliminary update with our members as soon as possible. This article was in press at the time of the next scheduled Board Meeting on August 7th.)

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The North Carolina Family Physician

Key Findings Here are some of the key findings of the NCAFP member survey on Administrative Burden:

What is the top area of frustration in your practice as it relates to administrative burden?

1) Electronic Medical Records

(Ranked first by 38% of members)

2) Prior Authorizations

(Ranked first by 27% of members)

• Family physicians in rural areas were more likely to list Prior Authorizations as their top area of frustration compared to their urban colleagues.

• Family physicians in private practice were more than twice as likely to list Prior Authorizations as their top frustration compared to those family physicians working in hospital/health systems.

• Conversely, family physicians in urban areas or with hospital/health systems were much more likely to list EMRs as their top area of frustration.

What takes the most time away from patient care?

1) Electronic Medical Records (Ranked first by 61% of respondents.)

2) Prior Authorizations (Ranked first by 16% of respondents) • EMRs were universally ranked as the area taking time away from seeing patients.

• While prior authorizations ranked second across all practice settings, rural physicians and private practice physicians were more likely to rank prior auths higher in terms of taking time away from patient care.

continues on next page

Summer 2021

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What one area can the NCAFP focus on to help with administrative burden?

This question offered some more nuanced responses from our members, but there are still clear takeaways: 1) Elimination of prior authorizations based on a performance threshold. (31.5%)

• Several of the comments are heart wrenching, such as “I would love my job 10 times more and could see twice as many patients if it weren’t for the excessive administrative burden that pecks away at my soul.”

• And a few respondents asked questions about the evidence base around whether all the documentation truly improves care.

2) Interoperability of medical records and data exchange. (23%) 3) Move away from fee-for-service toward a bundled payment for core primary care services (per member, per month payment). (21%) • Reduce and align quality metrics among payers. (17%) • Eliminating prior authorizations based on a performance threshold was the top area for NCAFP to focus on regardless of practice setting.

• Overall, interoperability of EMRs and moving away from fee-for-service were ranked very closely in the second and third area of focus for most settings. However, private practices were not as likely to focus on moving away from fee-forservice to value-based care; they were more likely to ask for more focus on aligning quality metrics.

Define Administrative Burden in One Sentence

While respondents were not required to answer this question, over 95 percent did, resulting in some of the most heartfelt information we obtained from the survey.

• Numerous comments focused on administrative burden as what takes family physicians away from providing true direct patient care, with one respondent describing it as “paperwork that gets in between me and my patient.”

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Next Steps – Moving Forward As always, it is one thing to gather information, and something totally different to try to utilize that information to impact change. While the NCAFP Board will ultimately decide on next steps (as noted above), here are a few of the recommendations from the committee that reviewed the survey results in detail: 1) Develop education on how to more effectively and efficiently use EMRs, such as a workshop featuring super users teaching how to customize and optimize Electronic Medical Records.

2) Continue NCAFP’s involvement in groups to better align quality metrics across payers. NCAFP Immediate Past President Dr. David Rinehart, NCAFP Secretary-Treasurer Dr. Shauna Guthrie

The North Carolina Family Physician

and NCAFP EVP & CEO Greg Griggs are all participating in a work group convened by the Duke-Margolis Health Policy Center examining ways to align quality metrics in our state.

All of the state’s major payers are involved in this working group.

FAMPAC

Empowering Family Medicine

3) Present the survey results to key health insurance companies in North Carolina.

4) Discuss a set of possible options to mitigate the administrative burden of Prior Authorizations with our state’s insurance companies, including: • Paying primary care a small fee for the time it takes to complete a prior auth; •

Developing “gold card” policies for primary care practices that have a certain percentage of prior-auths approved or who are entering into value-based contracts;

• Developing a prior authorization sunset program to eliminate certain prior auths if auto-approval exceeds a certain threshold; • Requiring that a peer-to-peer be with a physician (versus other clinician) when there is an appeal; and •

Sharing data with NCAFP on the approval rate for the top-10 medications that require a prior authorization and are prescribed routinely by primary care, as well as the top imaging studies requested by primary care.

These are just a few of the initial ideas as the NCAFP moves forward on the quest to try to simplify the lives of our state’s family physicians. If you have other ideas or thoughts, please do not hesitate to reach out to NCAFP EVP & CEO Greg Griggs at ggriggs@ncafp.com.

Summer 2021

JOIN THE FIGHT FOR FAMILY MEDICINE IN RALEIGH Participating is easy -•

Get to know your elected officials and become their trusted healthcare advisor.

•

Contribute so we can support candidates that support Family Medicine.

•

Participate in NCAFP’s ongoing advocacy events and efforts.

To learn more about FAMPAC and donate, visit www.ncafp.com/fampac

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CHAPTER AFFAIRS By: Gregory K. Griggs, MPA, CAE NCAFP Executive Vice President & CEO

Setting Sun or Rising Sun

During our country’s Continental Convention, George Washington presided in a chair that later became immortalized by Benjamin Franklin.

Franklin’s comments at the end of the Constitutional Convention: “I have often looked at that picture behind the president without being able to tell whether it was rising or setting. But now at length I have the happiness to know that it is a rising and not a setting sun."

More than 230 years after that Constitutional Convention in 1787, we can safely say Benjamin Franklin was correct – our country was like a rising sun. Since that time, we have faced adversity, but our country and our democracy still stand.

And no, I am not moving into a political column. But I do think that figure on the chair of a rising or setting sun can parallel the state of Family Medicine and primary care in the United States today. Is this the rising or the setting of the Family Medicine sun? Now, most people who know me will say I am an optimist, but I truly believe the sun is still rising. But let’s take a quick look back at the history of Family Medicine.

To begin with, all physicians were really family physicians. They had to take care of everything and everybody. At some point in time, some began to specialize

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into specific organ systems or body parts. But what would be coined the General Practitioner/General Physician was still the frontline medical professional for most individuals in our country. To emphasize the role of the generalist physician, the American Academy of General Practice was formed in 1948, as was the NC Chapter.

Moving forward, as specialties began to be more formally recognized, the first Family Medicine residency programs began in 1968, with the American Board of Family Medicine being formed in 1969. In October of 1971, the American Academy of General Practice transitioned to the American Academy of Family Physicians.

The North Carolina Family Physician

H E A D QUA RT E R S U P D AT E

Perry Price Joins NCAFP Staff as Manager of Workforce Initiatives Perry W. Price joined the NCAFP staff in late July as Manager of Workforce Initiatives. In that role, Perry will be responsible for NCAFP’s medical student and residency initiatives, as well as working with the NCAFP Workforce Pipeline Committee. She will also work with various other related projects including helping with the NCAFP Foundation.

At times, it seems that Family Medicine specifically -- and primary care in general -- remain under attack; whether consistently being undervalued by payers OR outside forces telling you how to practice medicine OR someone trying to limit your scope.

We even recently conducted an administrative burden survey to learn more about what drains you and gets in the way of you doing what you love – taking care of patients. You can see the results of that survey on page 8 of this magazine. And it certainly brings up some significant challenges.

Yet, I still see Family Medicine as the rising sun of

Perry joins the NCAFP with significant non-profit experience, having spent the last three and a half years as Director of Education and Government Relations at the Cary Chamber of Commerce. In that role, she developed and strengthened relationships with the schools in the area; partnered on workforce initiatives with local schools; advocated for the Cary Chamber’s legislative priorities; and served as an active member of the Regional Transportation Alliance.

Before joining the Chamber of Commerce, Perry spent three years as a legislative assistant at the NC General Assembly. She is a Cum Laude graduate of NC State University with a major in communications and public relations, and a minor in arts entrepreneurship. Perry is married and lives in Cary. Please join us in welcoming Perry to the NCAFP team.

continues on next page

Summer 2021

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healthcare. Why am I so positive? Let me point out several issues.

Dr. Margaret Chan, who served as Director-General of the World Health Organization from 2006-2017 says it best: “Primary care is our best hope for the future. Family doctors are our rising stars for the future.”

• We know that adding family physicians to a community adds value to the healthcare system, but when you add more sub-specialists, costs go up and quality does not improve.

Quite frankly, we know that family physicians are the solution.

"I believe we can navigate those minefields and that process. It won’t be easy."

There are some key truths that I believe we know that will be acknowledged sooner or later.

• We cannot continue to increase our country’s spending on healthcare, particularly when our outcomes are worst among industrialized countries.

• We know that increased investment in primary care improves quality and lowers cost.

That still doesn’t mean it’s going to be easy. It won’t be. But I believe we have the facts on our side. As Churchill once said, “Americans will always do the right thing – after exhausting all the alternatives.”

We are probably the only country in the world that has so many different healthcare systems. We are like national healthcare in England, at least in the VA Health system. We are like the Canadians, at least in Medicare. And we are like Germany, at least in the

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The North Carolina Family Physician

employer-based healthcare system.

But in many ways, those systems were created out of necessity. For example, England developed a nationalized healthcare system after World War II when most of the hospitals were destroyed by the war. The government was the only thing left to lead the rebuilding efforts, and that included the entire healthcare system.

It is taking time, but I think our country has almost exhausted the alternatives and we are on the verge of building a healthcare system where primary care and Family Medicine are foundational. I see small signs of it as I talk to government agencies, insurance companies, and large employers.

They know we cannot keep funding a sick care system. They know they need to pay for value not widgets. But the process of getting from Point A to Point B is not necessarily linear, and it does contain political minefields.

But I believe we can navigate those minefields and that process. It won’t be easy. It won’t always be comfortable. We’ve got to keep proving the value of Family Medicine, even though it has been proven time and time again. But I think we are almost at the tipping point – a tipping point for a rising sun of Family Medicine.

So, I hope each of our members will join us in this process. Help us by responding to our e-mails, giving us feedback in our surveys, reaching out to elected officials when we ask, and staying involved. I look forward to continuing the journey with each one of you.

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Contact Peter Graber with the NCAFP at pgraber@ncafp.com Summer 2021

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Na t i o n a l L e a d e r s h i p —

Dr. Karen Smith Seeks Position on AAFP Board of Directors NCAFP Past President Dr. Karen L. Smith (2005) of Raeford, NC, is a seeking a seat on the AAFP Board of Directors. The election will be held in Kansas City during the AAFP’s Congress of Delegates in late September. We asked Dr. Smith a few questions about the campaign and her goals.

critical if we intend to deliver exceptional healthcare.

Content and happy doctors impact the health of their patients, families and communities more than those who are overburdened and frustrated.

What do you want to accomplish as an AAFP board member?

My dream is for our nation to embrace primary care as the foundation for a sustainable healthcare delivery system. Preventive care must replace ‘sick-care’ for our nation to tackle the growing burdens of chronic disease within our aging population while at the same time bending our nation’s healthcare cost curve. Family Medicine must be the center of healthcare going forward.

As a practicing family physician and small business owner, I think it is imperative that we reduce administrative burdens, achieve payment equity for our vital work, and realign primary care for the betterment of both patients and physicians. Physician well-being is

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What do you think the long-term goal should be for Family Medicine?

The North Carolina Family Physician

What motivates you to seek a national position?

Whether it’s been at the local, state, or national level, advocacy for our patients and our profession continue to be huge motivators for me. Whether it’s helping a local food pantry or testifying before Congress, I try to put patients first. I have served exhaustively on numerous boards and committees trying to make a difference, whether it’s been my County Board of Health, the NC Hospital Association’s Rural Health Advisory Board, chairing two AAFP commissions, or serving as a CMS Quality Physician Payment Program Champion. I am a true advocate for our patients and for our profession.

What makes you uniquely qualified for this role.

I have served on the frontlines of healthcare in one of our state’s most impoverished counties for my entire career. I first served patients at a small rural health center, then shifted to a system-based practice, before finally opening my own private independent practice in 2003. I have always believed that no matter what my patient’s circumstances, they deserved the best possible care. That has meant trying to be on the cutting edge of healthcare, such as implementing an electronic medical record as soon as I opened my private practice, constantly trying to close care gaps and improve the care the people of Hoke County receive. I believe in taking the practice of medicine outside the walls of the office deep into the community.

That’s why during the pandemic, I’ve taken vaccines into stores, into large employers and even into homes. I also host a regular radio program talking about healthcare, trying to encourage not just my patients, but entire communities to lead healthier lives through exercise and better nutrition.

ELECT

MITH S .

L N E R A K , FAAFP MD

for

AAFP BOARD OF DIRECTORS The NCAFP wants to continue to impact Family Medicine at the national level by helping lead the AAFP. Contributions to Dr. Smith’s campaign will help ensure that the NCAFP conducts one of the best campaigns in the nation. To contribute, simply complete the form below and return with your contribution to Academy offices.

PYes,

I Want to Help Get Karen Elected!!!

PAYMENT INFORMATION

Amount:

q I have enclosed a check, made payable to:

North Carolina Academy of Family Physicians

q Please charge my credit card Name on Card Billing Address: City

State Zip

Card Number Expiry Date CCR Code

~ Mail or fax this form to NCAFP headquarters at (919) 833-1801 or 2501 Blue Ridge Road, Suite 120, Raleigh, NC 27607 • THANK YOU!

~ LEARN MORE AT WWW.SMITHFORBOARD.COM ~

Summer 2021

MEMBERSHIP & MEMBER SERVICES

New Podcast on Family Medicine Set to Begin in Early September Two State Family Physicians of the Year will host innovative show

The NC Academy of Family Physicians is pleased to announce the start of a new podcast entitled “The Family Physician: Lessons Learned…Wisdom Shared.” The NCAFP is partnering with two past state Family Physicians of the Year to develop the podcast.

NCAFP Past President and 2020 NC Family Physician of the Year Dr. Thomas R. White will interview well known family physicians in North Carolina and beyond, asking them to share their pearls of wisdom and lessons learned throughout their career. The podcast will be produced by another past NC Family Physician of the Year, Dr. Lee Beatty ('16), who is now retired and living in Durham. The podcast will offer both a historical look at Family Medicine in our state and beyond, but also offer pearls of wisdom to current and future family physicians.

In the inaugural episode of the podcast, Dr. White will interview Dr. Beatty about his decades-long career in Mt. Holly. Future interviews already confirmed include Dr. James G. Jones, the founding Department Chair of Family Medicine at the Brody School of Medicine at East Carolina University, with

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more to be announced soon.

The podcast adds a second offering sponsored by the NCAFP. Greg Griggs, Executive Vice President and CEO, will continue to host the monthly podcast NCFM (North Carolina Family Medicine) Today discussing issues of importance to the NCAFP and outlining efforts the Academy is undertaking to assist our state’s family physicians. NCFM Today will continue to be published around the 15th of each month.

Dr. Thomas White

“The Family Physician: Dr. Lee Beatty Lessons Learned…Wisdom Shared” will also be produced monthly and will be published at the beginning of each month. Each will be available on the NCAFP’s website, via Buzzsprout, and on the Google Store and Apple Store. Look for the first episode of “The Family Physician: Lessons Learned...Wisdom Shared” around September 1st.

Retired, Interrupted Practice or Moved out of NC? If your status has changed and you have either retired or interrupted practice, please notify the AAFP as soon as possible so your 2022 invoice will reflect your proper status.

If you have moved out of NC, a relocation to the state in which you live or work is required to maintain AAFP membership.

Please contact the AAFP at 1-800-274-2237 between 9:00 a.m. – 6:30 p.m. M-F.

The North Carolina Family Physician

~ A DV E RTO R I A L ~

COVID-19 Public Health Emergency is Now Ending: What Does This Mean for Telehealth?

By Sam Cohen, Senior Vice President of Health Policy, Curi Whether practices will be able (or willing) to continue telehealth services at pandemic levels in a postCOVID-19 world is still up in the air. While there is a growing demand for the continued availability of telehealth offerings, concerns regarding new provider licensure requirements and payment parity will significantly affect the decision to continue or abandon providing these services following the pandemic. As your practice grapples with this decision, leaders will need to keep a close eye on upcoming legislation to ensure services comply with changing requirements and decide if your business model can sustain potential changes to reimbursement rates.

Patient Demand After polling more than 2,000 Americans, a recent survey from Sykes revealed that less than 20% of respondents had used telehealth prior to March 2020, increasing to over 61% just one year later. As for the demand for the continuance of telehealth services, more than 88% of those respondents report that they would like to continue non-urgent consultations via teleconference with their physician.

Unfortunately, potential legislative moves may make the continued use of telehealth services difficult for providers as state-wide emergency waivers lift. Depending on the practice’s state, physicians and other medical providers will need to achieve a certain set of requirements to continue providing telehealth services, and many may even require additional licensure applications.

Furthermore, changes in payment parity may become a significant obstacle as billing requirements change or revert to pre-COVID-19 models. While telehealth visits were reimbursed at the same payment rate as in-person visits during the pandemic, new legislation (or the ending of temporary executive orders and regulatory waivers) may result in lower reimbursement, making it difficult or even impossible for many practices to continue offering these services.

Physician response According to an MGMA Stat poll conducted in February regarding telehealth usage in 2021, providers appear to be evenly split in their expectations, with 31% expecting increased usage, 35% expecting decreased usage, and 34% expecting no change. Those who planned to increase usage cited patient demand and convenience. However, those expecting a decrease in usage cited coverage and reimbursement concerns that may make it more difficult for their practices to continue telehealth services.

What Lies Ahead At the federal level, the benefits of virtual care have caught the attention of congressional lawmakers, and we are seeing bipartisan efforts underway to permanently repeal some of the statutory restrictions that served as roadblocks to telehealth usage pre-COVID-19. Currently, there is no new information regarding upcoming laws, yet there may be new federal legislation to take effect later this year.

At the state level, it’s critical that practices turn to their state’s medical boards to stay abreast of new developments. Many organizations, including medical societies, practice administrator organizations, and licensing bodies may also serve as important resources for critical information. In addition, practices can learn more about telehealth policy changes by following the Center for Connected Health Policy. At Curi, we advise that all practices use these resources to closely monitor any announcements.

Check curi.com/news for updates on new legislation and reach out to one of our risk management experts at 800-662-7917 if you have any questions.

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MEETINGS & EVENTS By: Kathryn Atkinson, CMP NCAFP Meetings & Events Manager

The Mountains are Calling, And We Must Go. 2021 Winter Family Physicians Weekend will be held in-person this December

We are thrilled to welcome you back to the Omni Grove Park Inn Thursday, December 2 – Sunday, December 5, 2021, for our return to an in-person Winter Family Physicians Weekend. This long-awaited annual weekend of CME and camaraderie is an excellent opportunity to reconnect with colleagues, mentors, and friends while fulfilling your year-end CME requirements in a fun and relaxing atmosphere.

The annual four-day celebration of family medicine, complete with our winning combination of high-quality CME and fantastic networking opportunities, is a weekend you will not want to miss. Program Chair Jay Patel, MD, and Program Vice-Chair, Deanna Didiano, DO, have prepared a fantastic slate of over 20 diverse and timely topics centered on the issues you see and treat most often. Plan to strengthen your commitment to family medicine while soaking up essential and inspiring CME with general session updates on diabetes, dementia, STDs, overactive bladder, influenza, HPV, hyperlipidemia, kidney disease, shingles, COPD, lung cancer, and many more.

These mainstage lectures, along with several optional CME workshops and innovative seminars,

mean approximately 25+ AAFP Prescribed Credits are up for grabs this December. Those with ABFM requirements are encouraged to arrive a day early to attend a pre-conference Health Counseling and Preventive Care KSA workshop (with an additional eight prescribed credits) on Wednesday, December 1, from 3 pm to 7 pm. Everyone’s favorite weekend will also include a bustling exhibit hall with over 50 vendors eager to meet with you and discuss their valuable products and services.

While suggested conference attire is business casual, be sure to include your dancing shoes on your packing list because we can hardly wait for Saturday night’s return to laughter and fun during the Presidential Gala. Come dressed in your holiday best that evening for a night to remember with family and friends. Enjoy a delicious gourmet dinner specially prepared by the GPI chef, celebrate your newly installed NCAFP Board of Directors, and raise your glass for a toast to Dr. Takie Hondros as he is sworn in as the 2021-2022 NCAFP President.

Then, get ready to hit the dance floor when Too Much Sylvia takes the stage for their entertaining brand of live music that will have you dancing the night away.

If you have not yet registered for this year’s Winter Weekend, begin making your plans soon because, new this year, you must be a registered conference attendee to reserve a sleeping room within the NCAFP’s room block at the Omni Grove Park Inn. After registering for the conference, be sure to check your Registration Confirmation Memo (sent via email immediately after your registration is received) for a housing link to the NCAFP’s block of rooms at the GPI and our overflow hotel, the Asheville Renaissance.

The Blue Ridge Mountains are calling, and we warmly invite you to join us there this December.

Consider taking this opportunity to re-energize your passion for family medicine while reconnecting with colleagues and friends. Access the latest schedule of events and complete your online registration today by visiting the conference site at www.ncafp.com/wfpw. Online registration ends on Sunday, November 28, at 11:59 pm. Only onsite registrations will be accepted after this cut-off, and rates will increase by $50 for all registration types.

Lastly, the NCAFP is committed to providing you

Photo by Sara Parlier on Unsplash

with the best meeting experience possible, and we are simply delighted to host the 2021 Winter Weekend in person this year (Note: There are currently no plans to offer a virtual registration option for this year’s program). However, as a healthcare organization, we want to take all precautions and bring us back together carefully and appropriately.

As you register for the meeting, you will be asked to attest that you (and your registered guests) will follow important safety protocols we are putting in place to bring our members back together in-person safely. Thank you in advance for your cooperation with these new protocols.

If you have questions or need more details, please contact Kathryn Atkinson, CMP, Manager of NCAFP Meetings & Events, via Katkinson@ncafp. com or 919-214-9058. We look forward to finally seeing you again in Asheville and celebrating with gratitude all that you do for your patients and your communities. See you soon!

Note: While there are currently no plans to offer a virtual registration option for this year’s program, we are keeping a watchful eye on official guidelines and mandates. We will keep you well informed of any changes to the plans for this event.

RESIDENTS & NEW PHYSICIANS

By Katherine Haga, DO Novant Health, Cornelius, NC

ADVOCACY

Small Efforts Yield Big Opportunities

If you would have told me that I would have an opportunity to sit with the United States Secretary of Health and Human Services Xavier Becerra and North Carolina Congresswoman Alma Adams to discuss the Affordable Care Act (ACA) and its impact on access to health care, I wouldn’t have believed you. Instead, I would have told you that I felt there were many more qualified people than me. Yet on July 7, 2021, I participated in a round table discussion with 10 others, including the Secretary, Congresswoman, and some amazing local access coordinators, legal advocates, and leaders. During that hour and a half, we discussed the ACA and health access, the impact Medicaid expansion would have in North Carolina, Covid-19 vaccination rates, the growing mental health crisis, and the importance of telehealth.

As the only physician in the room, I had an opportunity to clarify issues from a clinical view. It was a humbling task to provide that important perspective in a non-clinical world when the topic involved health care policies and systems. Healthcare is an inherently different sector than any other. A true business, accounting for nearly 20% of our nation’s GDP, its essence deals with human lives, and those who administer care are those who do the work in our clinics and hospitals. Physicians, then, are leaders who are critically needed to unwind the tangled webs our of system and point the focus to where the system should be focused – on our patients.

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Dr. Katherine Haga pictured with United States Secretary of Health and Human Services Xavier Becerra.

So how did this happen? The short answer might be, right place, right time. Still, I believe it is more than that, and that it’s more a story of how small efforts can make a bigger impact. Recently, I participated in the AAFP Family Medicine Advocacy Summit (FMAS) on May 19, 2021. During this year’s virtual summit, we

The North Carolina Family Physician

NORTH CAROLINA’S met with the offices of our Senators and House of Representatives. At the District 12 meeting, we spoke with Representative Adams’ District Director and Legislative Assistant, and I was invited to meet with the Secretary and Congresswoman after that meeting. But my passion for transforming healthcare was sparked long before this event.

I am the only child of a single mom, the hardest worker I know. Due to being self-employed and having pre-existing health conditions, she was unable to obtain health insurance. This was the reality of health insurance prior to the ACA. Because of this, she paid out of pocket for health care, making too much for Medicaid, and often facing the choice between being able to see a doctor or being able to pay for other life essentials. This story is not unique, even today.

It is our personal stories and patients’ stories that need to be told to influence policy and create systemic change. Perhaps I was not the most qualified or the most knowledgeable physician that could have been in that room with the Secretary and Congresswoman, but I am passionate and well informed and will gladly sit at tables to share the stories that should be told, while offering the knowledge that I do have.

And that is the how and the why – simply showing up, remaining informed, and being passionate in pursuit of advocating for our patients and our field. I encourage all of you to do the same in your spheres of influence – participate, discuss, respectfully disagree. It’s amazing how little time and effort is needed to help influence change, and you’ll never know what meetings will make an impact. You’re not alone in this process – I relied heavily on the NCAFP to prepare for this meeting – they are an incredible resource for facts and data. Get involved, even if it’s only for a few hours one day once per year. Join us for next year’s AAFP FMAS. Your voice matters for the sake of our patients and the health of our system.

Summer 2021

2021

Resident & Student Research Poster Presentation The NCAFP Foundation’s twenty-seventh annual Research Poster Presentation will be held at the Academy’s Winter Family Physicians Weekend

The Foundation is interested in showcasing practice-based research, but poster presentations may address any topic relevant to Family Medicine.

Works-in-progress may also be submitted, but submissions must be of original work not yet published. Projects previously presented at medical schools’ or student “Research Days” are acceptable, as are concurrent submissions to other conferences such as NAPCRG and STFM.

Posters will be judged for awards with winners announced at the Annual Meeting.

For complete details and link to submission form, please visit www.ncafp.com Please direct questions to Perry Price at perry@ncafp.com Resident and Student members interested in participating must submit their application and all corresponding materials (including final PDF of poster) by October 1st, 2021.

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STUDENT INTEREST & INITIATIVES

Two NCAFP Members Selected for AAFP Foundation FML Emerging Leader Institute Project Award

We are pleased to share that Benjamin Kaplan (MS4), UNC School of Medicine, and Karen Scherr, MD, PhD (PGY3), Duke Family Medicine Residency Program, have been awarded one of nine Family Medicine Leads (FML) Emerging Leader Institute Leadership Project Awards from the 2020 cohort.

They each received a $1,000 project award to return to the AAFP National Conference of Family Medicine and Students and engage with the 2021 FML

Emerging Leader Institute Scholars. Both recipients prepared a poster of their work for display during National Conference. In addition, Mr. Kaplan’s project, “I Know Me: Developing an Interactive Photovoice Gallery to Mitigate Bias against Complex Care Patients,” was selected as the overall best project from his leadership track (Policy & Public Health) and will receive a $3,000 award to attend a special Family Medicine opportunity. Kaplan was also be a presenter showcasing project work at a session during National Conference.

Benjamin Kaplan (MS4)

Karen Scherr, MD, PhD

(PGY3)

Dr. Sanjay Batish Awarded AAFP Foundation Family Medicine Discovers Scholar Award Dr. Sanjay Batish, founder of Batish Family Medicine in Leland, N.C., was recently awarded an AAFP Foundation $40,000 Family Medicine Discovers Rapid Cycle Scientific Discovery and Innovation (FMD RapSDI) award for his project, “An evaluation of the SaFETy score as a predictor of gun violence in adolescent-young adults patients in a primary care setting.” Scholars are selected from a two-tiered application process and must be AAFP members. Finalists then complete an in-depth research project application with assistance from a mentorship team comprised of AAFP NRN leadership and external content or methods experts.

Dr. Batish’s project began June 15, 2021 and will end June 14, 2022. His project explores the potential for primary care practices to use an established survey tool to predict incidents of gun violence among adolescents and young adults in a non-urban setting. “I have experienced the epidemic of gun violence personally and professionally, and want to have some impact in a positive way,” says Dr.

Batish. “In my small practice, I see someone with a direct connection to gun violence once a month and someone with an indirect connection every day, or every few days.

If the research reveals helpful data, my hope is that someone can take it to the next level.”

FMD RapSDI, a collaboration between the AAFP Foundation and the AAFP National Research Network, provides the infrastructure and support needed for physicians to explore small projects that can yield results in a 12-month timeframe. “Our goal for this program is to help practicing family physicians thoughtfully try to solve issues they see in their office,” says Dr. Rebecca Jaffe, president of the AAFP Foundation Board of Trustees. “FMD RapSDI allows doctors who don’t typically do research to explore and scale great ideas, quickly.”

To learn more about FMD RapSDI, please visit aafpfoundation.org > Our Programs > Scientific Initiative. Congratulations to Dr. Batish on this amazing accomplishment!

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Employers:

Family Physicians:

• PLACE your job in front of our highly qualified members • SEARCH our resume database of qualified candidates • MANAGE jobs and applicant activity right on our site • LIMIT applicants only to those who are qualified • FILL your jobs more quickly with great talent

• POST multiple resumes and cover letters or choose an anonymous career profile that leads employers to you • SEARCH and apply to hundreds of fresh jobs on the spot with robust filters • SET UP efficient job alerts to deliver the latest jobs right to your inbox • ASK the experts advice, get resume writing tips, utilize career assessment test services, and more

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PRACTICE MANAGEMENT

By Brent Hazelett, MPA, CAE NCAFP Chief Operating Officer

BCBS Announces Enhanced Resources for Independent Family Physicians Managing a practice in North Carolina got significantly more challenging on July 1st with the long-delayed transition to Medicaid Managed Care.

Nowhere is this more evident than for those practicing independently. Fortunately, over the past few years several new organizations and initiatives have been developed specifically for small practices (Community Care Physicians Network, Aledade, and others to name a few).

Recently, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) announced a new investment that will support independent physicians and help them strengthen their practices. Established as a joint venture, the new entity will provide services to enable physicians to focus more on high-quality, cost-effective patient care while also offering practices the ability to grow more sustainably as value-based care expands. It is no secret that Blue Cross NC is evolving quickly towards value-based payment models and this latest announcement underscores this commitment.

According to Blue Cross NC, the new organization has been developed in collaboration with Deerfield Management Company, a health care investment firm with deep experience strengthening physician practices. The joint venture is the next phase of Blue Cross NC’s ongoing collaboration with providers to make health care better, simpler, and more affordable.

The venture will leverage Deerfield’s research and operational capabilities, and its extensive experience investing across all sectors of health care at every stage of development – including key investments and relationships in North Carolina.

“Independent physicians in North Carolina have an especially difficult burden when it comes to managing their practices without the resources and scale that come with being part of a larger organization,” said Dr. Tunde Sotunde, Blue Cross NC president and CEO. “We want to empower independent physicians – especially primary care – by offering a new level of support to help them lead their practices in a time of great change in health care. This new organization will fill a void for practices that are independently owned and will help them thrive.”

The new venture has been created with the goal to: • Provide infrastructure and support services to reduce administrative burdens and alleviate physician burnout; • Equip physicians with integrated technology solutions to monitor, manage and coordinate patient care effectively; • Share data and insights alongside value-added serSee 'BCBSNC' on Back Cover

Confirm Contact Info for 2022 Dues Invoices It might seem early to be thinking about dues for 2022, but invoices are being prepped now for online payment to begin in late September. Mailed invoices will be sent to primary addresses in October. Payment deadline is January 1, 2022. As a result, it is imperative that your contact information is up to date. We encourage all members to take

a moment to verify all contact information contained in your member record. To do so, please visit aafp.org/ welcomecenter and log into your account. Remember, your username is your email address associated with your member record. You may also call the AAFP at 1-800-274-2237 between 9:00 a.m. – 6:30 p.m. M-F.

ADOLESCENT IMMUNIZATION

Family Physicians Have a Critical Role to Play in Closing the Gap on Routine Vaccination By: Leonard Friedland, MD, Vice President, Scientific Affairs and Public Health, GSK Vaccines, North America

A new claims analysis commissioned by GSK and conducted by Avalere Health, a healthcare research firm, showed a sustained drop in immunization rates for recommended vaccines among adolescents (aged 7-18) and adults (19+) throughout the pandemic in 2020.

The study examined claims for CDC-recommended vaccines across commercial, managed Medicaid, Medicare Advantage and Medicare fee-for-service Part B from January through November 2020 compared to the same time period in 2019.

During the COVID-19 pandemic, adolescent and adult immunizations sharply declined, increasing the risk for preventable diseases, and further straining an overworked health care system. The study found: Adolescents and adults potentially missed over 26 million doses of recommended vaccines in 2020. This includes 8.8 million missed adolescent vaccine doses and 17.2 million missed adult vaccine doses.

Vaccine claims remain well below 2019 levels. Total non-influenza vaccine claims submissions were between 13-35% (adolescents) and 1740% (adults) lower than the same period in 2019.

Despite warnings of a potential “twindemic,” influenza immunization rates were lower in 2020 than in 2019.

Early gains in influenza vaccination claims lagged as the season progressed. Influenza vaccination claims from August-September of the 2020-21 season initially exceeded the same months of the 2019-20 season, suggesting early heightened awareness of respiratory disease in 2020; however, those surges levelled off by October and then fell in November.

A GROWING VACCINE GAP Even before the COVID-19 pandemic, immunizations were under-utilized for adults and adolescents and in underserved populations;i the pandemic has compounded this problem. Herd immunity is important to control spread of an infectious disease within a population, and even small drops in immunization rates can lead to a resurgence of disease as was demonstrated by the 2019 measles outbreaks in the US. History shows us what happens when individuals go unprotected against infectious and debilitating disease. For example, despite the availability of a vaccine since 1995, from 2016 through May 2021, 31 states had declared hepatitis A outbreaks, reporting 39,488 cases to the CDC.ii In 2014-15, 15 years after the World Health Organization declared measles eliminated from the US, a measles outbreak linked to exposures at the Disney theme parks in California sickened 147 people, most of them unvaccinated. In 2019, the CDC tallied 1,282 measles cases in 31 states.iii iv From 2011 through March 2019, meningitis B vaccination (recommended for teens and young adults aged 16-23) caused all US college meningococcal outbreaks, which involved 13 campuses, 50 cases, and 2 deaths among an at-risk population of approximately 253,000 students. Even though MenB vaccination has been available since 2014, recent See 'Immunization' on Back Cover

Summer 2021

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'BCBSNC,' continued from p26

2501 Blue Ridge Road, Suite 120, Raleigh, North Carolina 27607

• Offer flexible options to help physicians structure the management and ownership of their practices.

“Offering new resources to independent physician practices is the ideal next step in our collaborations with health care providers to improve quality and reduce costs for our members and for all North Carolinians,” said Dr. Von Nguyen, senior vice president and chief medical officer at Blue Cross NC. “Independent physicians typically have hundreds, if not thousands, of patients to care for, and they have a business to run. If we provide additional support to help them meet these demands, we can have a positive impact on health outcomes while doing more to address rising health care costs.”

www.ncafp.com

vices to identify and address opportunities to improve care;

Greg Griggs, NCAFP Executive Vice President commented, “The Academy is committed to working with payers to find creative solutions to reduce administrative burdens and increase payment to our members. For years Blue Cross NC has been willing to have meaningful conversations with the Academy about how they can better serve our members in an increasingly challenging climate for primary care. We are pleased this latest initiative is particularly focused on providing resources to the most challenged family physicians in North Carolina and look forward to providing input into the final details of this effort.”

Stay tuned for more details about this new program and how it might help you and your practice.

'IMMUNIZATIONS,' continued from p27 CDC data show that still, only about 1 in 5 17-year-olds in the US received at least one dose of MenB vaccination.

Learn more about the Avalere study and methodology at: https://avalere.com/insights/updated-analysis-finds-sustaineddrop-in-routine-vaccines-through-2020

CATCHING-UP ON ROUTINE VACCINES The CDC recently issued guidance that COVID-19 vaccines and other vaccines can be administered to people on the same day, making “catch-up” easier for adolescent and adult patients who may have missed vaccines.

i https://www.hhs.gov/sites/default/files/ HHS-Vaccines-Report.pdf ii https://www.cdc.gov/hepatitis/outbreaks/2017March-HepatitisA.htm iii https://blogs.cdc.gov/publichealthmatters/2015/12/year-in-review-measles-linked-to-disneyland/ Non-Profit Org. US Postage

PAID

iv https://www.cdc.gov/measles/cases-outbreaks.html

Pontiac, Illinois Permit No. 592

Family Medicine has a critical role to play in closing the gap on routine vaccination in the United States, especially among teens and adults. Ensuring that your patients are up-todate on CDC-recommended vaccines is one of the most important things you can do to keep individuals and communities healthy in the months to come.

SOURCES