NC Family Physician - Fall, 2021 by NCAFP

Volume 17 Issue 4 • Autumn 2021

The North Carolina

Family Physician Quarterly News in North Carolina Family Medicine

I Trained at a

FULL-SCOPE FAMILY MEDICINE RESIDENCY, Now What? P. 20

Save these Dates for Terrific NCAFP CME in 2022 Celebrate your commitment of providing the best possible care to your patients with these fantastic learning opportunities in 2022.

Friday, April 1 - Saturday, April 2, 2022 Academic Family Medicine Meeting

Crabtree Raleigh Marriott - Raleigh, NC

Saturday, August 6, 2022

Virtual Summer Symposium

From the comfort of your favorite location!

Thursday, December 1 - Sunday, December 4, 2022

Winter Family Physicians Weekend

The Omni Grove Park Inn - Asheville, NC

NCAFP Meetings & Events

Learn | Connect | Engage Learn more at www.ncafp.com/continuing-education

Contact Kathryn Atkinson, CMP, Manager of Meetings & Events at Katkinson@ncafp.com

Inside Autumn 2021

COVID Perspectives And Some Positives We've Learned from the Pandemic

P. 4

PRESIDENT’S MESSAGE

COVID Perspectives

ADVOCACY

Legislative Session Proves Mostly Positive

MEMBERS & MEMBERSHIP SERVICES

Dr. Karen Smith Elected to the AAFP Board of Directors

RESIDENTS & NEW PHYSICIANS

I Trained at a Full-Scope Family Medicine Residency, Now What?

CHAPTER AFFAIRS

Shawn Parker Joins the NCAFP Executive Team

PRACTICE MANAGEMENT

Managing Your Career and Your Practice: AAFP Resources at Your Fingertips

DEPARTMENTS

PUBLISHED BY

President’s Message 4 Advocacy 8 Chapter Affairs 14 t 919.833.2110 •

fax

Members & Membership 16 Residents & New Physicians 20 Practice Management 24

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

COVID Perspectives And Some Positives We've Learned from the Pandemic By the time you read this we will be close to two years into a pandemic. As a state, we have lost over 18,000 patients/friends/family members to COVID. Our country has lost over 740,000 lives. We are all tired. We are tired of spending 15 minutes of a 15-minute visit explaining to patients the importance of the vaccine and debunking online myths. We are tired of losing unvaccinated patients, some healthy and young, to COVID. We are tired of being short staffed because we have lost staff due to burnout, or, more unfortunately, refusing to be vaccinated. I have to try really hard not to be snarky about patients who ask for ivermectin or other TikTok-approved COVID treatments. I know I am not alone. I have attempted to look at anything positive that has come from COVID. I have managed to find a few.

TELEHEALTH! Cheers to the medical world for

recognizing telehealth as a valuable tool. Medicaid, Medicare, and private insurances recognized the value of telehealth. Thanks to family physician leaders, such as Dr. Shannon Dowler, Medicaid continues to value telehealth the same as in person visits. We have had the opportunity to see into our patients’ lives and connect. Our patients who “no showed” because of transportation issues now eagerly await our video visits. Patients who never bring in their medicines can now show us what they are actually taking. Viewing our patients’ homes and their lives help us figure out a care plan.

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 CoChief 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.

I learned a patient couldn’t read and had a stutter after a virtual visit. Now I know what he is taking and why he doesn’t say much during his visits. He was much more comfortable speaking to me in his home environment. Telehealth has helped us provide care to patients who work. I am sure I am not the only physician who virtually saw a patient during their lunch break. Did anyone else have to tell their patient to pull over and park in order to complete the virtual visit she was attempting to have while on her mail delivery route? Telehealth also allows us to see multiple family members at the same time. This is really helpful in learning how some of our younger patients deal with caring for their elderly family members. Telehealth is here to stay and, hopefully, will continue to be valued as an important and useful tool.

VIRTUAL MEETINGS! C’mon ya’ll...does any-

one REALLY dress up for a virtual meeting anymore?? The “Zoom mullet” is a thing and I fully endorse it! continues on next page 6

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, MD (ECU)

Student Director-Elect Morgan Carnes (Wake Forest)

AAFP Delegates & Alternates 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

Autumn 2021

www.ncafp.com

Although the stores will not be fully stocked for quite Collared or dress shirt...and pj pants! Joking aside, a while, and the substitutions made can be hilarious I think we have all learned that virtual meetings can (dry beans for canned, sliced deli ham instead of a be productive. Definitely easier and less expensive for whole ham), the concept of ordering online groceries organizations. I have noticed that some folks who never is here to stay. spoke up during in person meetings, have found their voice virtually. I find myself paying attention more to virtual meetings than in person. In a real meeting I DENTAL & ACNE COVER UPS! I have would just text my friends about how boring the meethad several patients tell me how they love wearing a ing was. But virtually, I felt I had to listen-probably mask because it hides their dental issues. For a few, because there was always that it was poor dentition. For chance your face would be in others it was lack of dentition. As the year comes to an end, Many patients struggle to get the first Zoom box that everyI do think it’s worthwhile to one sees! The chat box is a useful dentures due to cost. They tool that allows us to ask quesreflect on the positive things enjoy hiding behind the mask. tions without interrupting the In fact, sitting at a kids soccer that we have learned or speaker. I know we all value in game, I had a granddaughter gained from the COVID person meetings where we really of a patient show me a picture pandemic. form friendships and bond with of her grandma. She was so exeach other. However, moving cited to get her dentures back forward, virtual meetings can be useful for obtaining after losing them in a house fire. She showed me her CME without leaving your family. In fact, the AAFP photo, no mask, and I laughed. I had NO idea she was just announced that live CME is no longer a requiremissing her dentures when I saw her in clinic! Her ment for membership, although we still hope you will granddaughter told me she loved wearing a mask for value the personal interaction you get at both AAFP this very reason! and NCAFP in-person events. Although masks are irritating and can cause “maskne” TAKEOUT INNOVATIONS! Don’t we all love (mask acne), they are also useful for covering up acne. the new food offerings?? Three years ago we would I clearly remember seeing a young patient for the chief have never thought about picking up the local 5 star complaint of “acne”. When I walked into the room, I restaurant meal to go. Fast food or Panera-type restauwas surprised as I saw an acne-free masked face. But, rants were the only options. Well, now it’s a thing. lo and behold, when he removed the mask I saw a terRestaurants have upped their game and take out is at rible case of pustular acne. During the visit he told me a new level. I mean some places come to your car winthat the mask helps his social life as nobody can see his dow! Take out at fancy restaurants is here to stay. It acne at school or work. As a child of an almost teenallows us to get a decent and healthy meal, safely, any ager, I can see how the mask can be useful for hiding night of the week. Please remember to tip well!! stubborn zits.

“

”

GROCERY ORDERS! Who would have thought

that our 80-year-old patients could have figured out online grocery shopping! The geriatric population became tech savvy in order to protect themselves. Many of my patients tell me they will only shop this way from now on as they don’t have to lift heavy groceries or worry about not being able to reach things on the top shelf. For patients with disabilities, grocery ordering has made a trip to the store an easier experience.

As the year comes to an end, I do think it’s worthwhile to reflect on the positive things that we have learned or gained from the COVID pandemic. I am sure there are more examples than those listed. We all need to continue and try to stay positive as we push through the COVID pandemic. We have done a great job so far. Stay strong and stay safe!

The North Carolina Family Physician

~ A DV E RTO R I A L ~

Mitigating Second-Order Impacts of the COVID-19 Pandemic The devastating consequences of the COVID-19 pandemic have no doubt left a lasting impact on the world as COVID-related deaths continue to climb. While COVID-19-related deaths and hospitalizations are the most notable immediate effects of the pandemic, second-order impacts (i.e., situational health consequences resulting from pandemic-era restrictions) are also plaguing individuals around the world, both worsening many health conditions and creating new ones. Recognizing and understanding many of the most common second-order impacts will help physicians and practices better care for current and future patients. Below we explore six common health-related consequences of pandemic restrictions and provide actionable advice to address them. 1.

Delayed screenings Medical professionals know that delayed diagnosis can lead to adverse outcomes—that fact is nothing new. Unfortunately, with pandemic restrictions, screenings for many common medical issues were put on hold, directly affecting physicians’ ability to detect diseases for early intervention. 2. Delayed “elective” surgeries and procedures While many surgeries and procedures may have been considered non-urgent in the early stages of the pandemic, leaving these issues unaddressed can lead to worsening conditions. The burden of disease can continue to accumulate while patients await surgery, sometimes leading to advanced issues and even death. 3. New and worsening mental health disorders According to a U.S. Census Bureau Household Pulse Survey, more than 40% of adults have reported symptoms of anxiety or depressive disorder during the pandemic, up from 11% in 2019. A KFF Health Tracking Poll from July 2020 also revealed an uptick in specific negative mental health and wellbeing impacts due to worry and stress over the pandemic. 4. Delayed childhood vaccination According to a study conducted by the National Center for Biotechnology Information (NCBI), nearly one-quarter of parents surveyed reported a delay of more than one month in the immunization of their child, with 60% citing fear of COVID-19 infection as the most common reason. This delay in childhood vaccination leaves children vulnerable to many vaccine-preventable diseases. 5. Increased instances of downstream health impacts associated with food insecurity During the pandemic, many Americans have suffered from financial hardship and/or an inability to access nutritional food. According to Feeding America, the low overall food insecurity rates seen in 2019 were upended by the pandemic, and recent projections predict a continued trend of elevated levels of food insecurity across the nation. 6. Care interruption for patients with chronic diseases As a result of pandemic-related restrictions, most practices saw a reduction of chronic care activities, and this care disruption left many patients vulnerable to new and worsening issues associated with their chronic conditions. Resources in practices and hospitals shifted toward an effort to contain the pandemic and minimize direct consequences, translating to reduced access to necessary chronic disease management. HOW DOCTORS AND MEDICAL PRACTICES CAN ADDRESS SECOND-ORDER IMPACTS To effectively address many of the above concerns, it’s critical for practices to reengage their patients and follow up with missed and cancelled appointments. EHR and EMR patient management systems can help track cancellations and no-shows while monitoring patient conditions. Telemedicine also remains an effective tool for physicians to meet with patients. However, it’s important for practices and providers to keep in mind that licensure requirements, waivers, and payment parity may be affected in weeks to come. With necessary follow-up and greater accessibility, it’s possible for physicians and practices to address second-order impacts and ensure patients remain healthy in the post-pandemic era. If you have questions on this topic, call 800-662-7917 to speak with one of our experts right away. © Copyright 2021 Curi

800-662-7917 | curi.com

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

STATE

Legislative Session Proves Mostly Positive 2021 has certainly been a unique year, and that is no different when it comes to the North Carolina General Assembly. Fortunately, due to great collaboration within the House of Medicine, it has been generally a positive year on Jones Street in Raleigh. However, the General Assembly continues to meet to finalize budget provisions and redistricting, among other items. During the 2019 long session, the General Assembly and the Governor could not come to agreement on a complete state budget, so a series of mini budgets were enacted, leaving many areas utilizing “continuation budgets” at levels that were approved back in 2017. At the time of this writing, there is still hope that a complete budget will be enacted in 2021. However, we are already in the second quarter of the fiscal year. Earlier this year the House and Senate had each approved their own version of the budget. In September and early October, House and Senate leaders negotiated their differences behind closed doors before presenting a confidential proposal to the Governor. Since that time, the Governor and General Assembly leaders have been negotiating several provisions, including tax cuts, education spending, and possibly expanding Medicaid. On the positive side, there appears to be some

The North Carolina Family Physician

consensus on increasing spending in a few healthcare areas, such as loan repayment, but this will not be confirmed until a final budget is enacted. The NCAFP and other groups within healthcare continue to advocate for increased funding, as well as mechanisms to close the health insurance coverage gap. Stay tuned, we may know more even before this article hits your office via the mail. In other policy areas, early in the legislative session it appeared that medicine was under attack from every angle, including physician mandates, government interference with the physician-patient relationship, and various bills that seemed to confer medical degrees to others who have not undergone as rigorous training. Thanks to great collaboration within the House of Medicine including the NCAFP, the NC Medical Society, the NC Pediatric Society, the NC Psychiatric Association, and many others, most of these issues have been resolved. But let’s look at a few of them in more depth. Mandates and Interference with the Physician Patient Relationship Several bills were proposed that would have mandated how you care for your patients, what you prescribe and even what continuing education you receive. Others would have severely interfered with the physician-patient relationship. Fortunately, as of this writing, each of these remain bottled up in committee, have been changed significantly to address concerns, or have failed outright. A number of these bills have required very careful tactics. As a result, while you may not always hear the NCAFP shouting about what we are working on, our Government Affairs team is nonetheless hard at work. In many instances, quiet, behind-the-scenes negotiations are much more effective than making loud public statements, and that has been the case this year. Our strategy is based on being effective versus issuing loud proclamations. And believe us, it truly worked this year with several controversial bills. article continues on next page

Autumn 2021

Pharmacists Early in the session, it appeared that some legislators believed that pharmacists were the answer to all healthcare access issues. While we value our pharmacist colleagues, there is certainly significant differences in training and the specifics of each role. Proposals this year would have allowed pharmacists to “prescribe and dispense” a whole host of medications including all tobacco cessation medications (including those that have behavioral health side effects), epinephrine, short-acting bronchodilators, all contraceptives, Prep and PEP for HIV treatment, opioid antagonists, and any travel medication. The proposal also would have allowed pharmacists to “test and screen for any minor, non-chronic health condition,” with no further definition on what a minor, non-chronic health condition is. Fortunately, through a coalition led by the NCAFP, NC Medical Society and NC Pediatric Society, the final bill was much more narrow. The bill allows pharmacists to “dispense and deliver” Nicotine Replacement Therapy (no other tobacco cessation medications), prenatal vitamins, post-exposure prophylaxis for prevention of HIV, Glucagon, and self-administered oral or transdermal contraceptives after the patient completes an assessment consistent with the CDC Medical Eligibility Criteria. This was probably the most contentious provision, with some physicians concerned about safety and missing other care at contraceptive visits, while other physicians touting the public health merits of easier distribution of contraception. When a pharmacist dispenses any of these medications, they must notify the individual’s primary care physician within 72 hours if they have a medical home. If the patient does not have a medical home, the pharmacist must give the patient information about the importance of having one. Finally, the bill did allow pharmacists to administer many injectable medications but only pursuant to a specific prescription order, leaving physicians still in control of medical decision making. If a physician does prescribe an injectable, the pharmacist must report administering the injectable to the prescriber

within 72 hours unless it is a psychotropic medicine, then they must notify the prescriber within 48 hours. In addition, the final bill did not allow pharmacists to test for or treat minor non-chronic conditions. While not a completely ideal piece of legislation, overall, the House of Medicine felt like the outcome balanced access and public health with patient safety and the important role of the medical home. Regulating PBMs and Reducing Out of Pocket Expenses A wide-ranging bill containing several important health care provisions (Senate Bill 257) passed both chambers of the General Assembly and was signed into law by the Governor. The first section of the bill requires Pharmacy Benefit Managers to be licensed and regulated by the NC Insurance Commissioner, including numerous provisions regulating how a PBM can interact with a pharmacy in North Carolina. The bill also requires that both pharmacy co-pays paid directly by the individual patient and other payments paid on behalf of that individual (for example, discounts covered by manufacturer programs) contribute to the patient’s deductible, reducing the out-of-pocket burden a patient may have. As you know, many patients with chronic conditions requiring expensive medications rely on co-pay assistance programs to help cover the cost of pharmaceuticals. Before this law was passed, some insurance companies refused to count outside co-pay assistance toward an individual’s deductible or out-of-pocket maximum, leaving patients with higher medical costs. Numerous patient advocacy groups, the NCAFP, and others in the House of Medicine all supported this bill. APRNs and PAs The legislature continues to consider a bill that would allow all Advanced Practice Registered Nurses -- regardless of what point in their career they are or whether they attended an online APRN program -- to practice without any collaboration from a physician regardless of the setting. The House of Medicine and

The North Carolina Family Physician

the NCAFP continue to oppose the bill, expressing particular concern around APRN schools that provide all didactic training online and require students to find their own rotations and preceptors, without providing preceptors with curricula or evaluation tools.

FAMPAC

Empowering Family Medicine

In a separate bill that the House of Medicine supports, the specific supervising relationship between a physician and a physician assistant could change in very specific circumstances. Once a PA has been out of school for a certain defined period where he or she has worked closely under an individual physician’s supervision, and only if the PA practices in a teambased setting (a setting with physician involvement and ongoing quality improvement for all clinicians), then individual reporting paperwork for the Physician Assistant could be eliminated. The team-based practice would still have to maintain certain materials on site indicating ongoing quality improvement activities and the scope of practice for the PA (the Medical Board could ask for this information at any time), but this would not have to be regularly reported to the Medical Board. The NC Academy of Physician Assistants has worked closely with the House of Medicine to develop the specifics of the legislation. While it has passed one chamber of the General Assembly, all parties are asking to wait to the 2022 legislative session before moving forward. Specifically, the NC Medical Board is working on some potential clarifying language, as well as a framework for potential rules that would be used to implement the bill. This specific bill aligns well with a set of principles on scope of practice of other clinicians previously adopted by the NCAFP Board. The NCAFP Board policy places patient safety first, acknowledges the significant differences in training between primary care physicians and other clinicians, but also places a high value on other clinical colleagues and the important role they play in healthcare.

JOIN THE FIGHT FOR FAMILY MEDICINE 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

All in all, it has been a very busy legislative session, with the session ongoing as of this writing.

Autumn 2021

STATEL ine

Medicaid Managed Care Implementation Now in Its Second Quarter Plan CMOs to Attend NCAFP Annual Meeting to Answer Your Questions July 1st ushered in a new era of Medicaid in North Carolina with the implementation of Medicaid Managed Care, including five “Prepaid Health Plans (PHPs)” and Medicaid Direct for those patients who are not in managed care. The state has now moved beyond the initial implementation period and we are now well into the second quarter of managed care. While there have certainly been bumps in the road, due to the tireless work of NC Medicaid and ongoing advocacy with health plans by NCAFP and others, the pain of this transition has generally been less than anticipated. The NCAFP, the NC Pediatric Society, the NC Medical Society, and others continue to work with Medicaid and the PHPs to reduce administrative burdens, address any payment issues, and monitor implementation. Recently, NC Medicaid enacted several measures around transparency and accountability. For example, Medicaid has rolled out several dashboards to shed light on Medicaid enrollment (by county, region, and health plan), quality metrics, financial metrics, and even the percent of claims being paid and denied by each of the Prepaid Health Plans. You can find all of this information and more at medicaid.ncdhhs.gov/reports/dashboards.

We realize there are still issues as our members navigate the complexities brought about by moving from one government payer to multiple payers. If you are having an issue, the first step is to contact your plan representative. If that does not work and you have not gotten the issue resolved satisfactorily, you should contact the Medicaid Provider Ombudsman at Medicaid.ProviderOmbudsman@dhhs. nc.gov or call 866-304-7062. You can also let the NCAFP know about significant issues by e-mailing EVP Greg Griggs at ggriggs@ncafp.com. The NCAFP is working with the NC Medical Society and other specialty societies to help identify problematic trends that may become systemic. However, always contact the plan first and give them the first opportunity to resolve the issue.

The North Carolina Family Physician

At our upcoming Annual Meeting in Asheville this December, Deputy Secretary and Medicaid Director Dave Richard and Chief Medical Officer for Medicaid Dr. Shannon Dowler will update attendees on the managed care roll out. This session will take place Saturday morning, December 4 at 8:30 am. We are fortunate to have a great family physician in the CMO role at Medicaid. Each of the individual health plan Chief Medical Officers, along with Dr. Dowler and Mr. Richard, will be available to answer any questions from 10:00 am to 12:00 noon that same Saturday morning in the Eisenhower Room at the Grove Park Inn. Please drop by to meet the CMOs of each of the plans. Fortunately, NC plans have strong primary care physicians in these roles who are very willing to listen and try to address concerns from our family medicine community. Please take this opportunity to get to know each of them a bit better and ask any questions you have. The Chief Medical Officers for each plan include:

MEDICAID MANAGED CARE

Dashboards Aim to Equip Physicians and Practices with Latest Medicaid Enrollment, Quality and Expenditure Data North Carolina Medicaid has introduced a new enrollment dashboard. The dashboard (below), shows Medicaid enrollment by Managed Care Plan and by category of enrollment. You can also look at enrollment by county, as well as historical funding and expenditures for our state’s Medicaid program. Finally, the data shows how Medicaid is doing in several key quality metrics, including HEDIS measures. To view, visit medicaid.ncdhhs.gov/reports/dashboards.

Michelle Bucknor, MD, MBA, a Pediatrician – UnitedHealthcare NC Medicaid Plan. George Cheely, MD, MBA, a General Internist – AmeriHealth Caritas NC. Genie Komives, MD, a Family Physician – WellCare of North Carolina. William Lawrence, MD, a Pediatrician – Carolina Complete Health. Michael Ogden, MD, MMM, a Pediatrician – Healthy Blue NC. We look forward to having each of them join us in Asheville.

Autumn 2021

CHAPTER AFFAIRS

@ H E A D QUA RT E R S

Shawn Parker Joins the NCAFP Executive Team as General Counsel and Chief of Staff Shawn P. Parker, JD, MPA joined the NCAFP staff October 1st as part of the executive leadership team as General Counsel and Chief of Staff. In this combined role, Shawn will manage a wide range of responsibilities to support the legal, financial, and administrative operations of both the NCAFP and NCAFP Foundation, as well as provide governance, legal, and strategic guidance to the Executive Vice President/CEO and Governing Boards. Shawn will represent the NCAFP externally on legal, contractual, regulatory, and business development issues. Shawn joins the NCAFP with senior level experience in many positions across the health care spectrum,

most recently as a health care attorney at Smith Anderson where he advised physicians, and health care entities and related nonprofit organizations on legal, policy, legislative advocacy, executive strategy, regulatory, and practical guidParker ance concerning the business and politics of organized medicine. Prior to that, Shawn served as General Counsel and Senior Vice President at Community Care of North Carolina (CCNC). Additionally, he was employed as a Senior Legislative analyst and Staff Attorney with the North Carolina General Assembly serving as nonpartisan staff to standing and interim study health care committees. Shawn is in his sixth year as a public member of the North Carolina Medical Board and has been twice elected to serve nationally on the Board of the Federation of State Medical Boards Shawn brings extensive practical experience in healthcare law, policy development and analysis and is well known and respected by our many partners in the house of medicine. In his free time, he enjoys spending time with his wife Stephanie and two children, Abby and Roman. Shawn is an avid Carolina Panthers fan and loves most if not all sports. He also purports to be a bit of a foodie and enjoys cooking. Please join us in welcoming Shawn to the NCAFP family.

Hazelett Leaves NCAFP to Run Dermatological Foundation After serving the members of the NC Academy of Family Physicians for the last 14 years, Brent Hazelett, MPA, CAE, will be departing the Academy at the end of December to serve as Executive Director of the HS (Hidradenitis Suppurativa) Foundation.

“We are sorry to see Brent go but know he will do great things at the HS Foundation,” said Greg Griggs, Executive Vice President and CEO of the NCAFP. “We have been lucky to have someone of Brent’s caliber and character for the last 14 years. It has truly been an honor to have him as part of the NCAFP team.”

During his tenure as Vice President and COO, Hazelett has led the financial, operational, and educational components of the NCAFP.

Hazelett has numerous accomplishments during his tenure at the Academy, including:

The North Carolina Family Physician

ADVISORY CAPITAL

• Selling the previous NCAFP building at a significant profit to add to the organization’s reserves and overseeing the transition to state-of-the-art leased space. • Upgrading the NCAFP’s technology. • Streamlining operational and financial procedures. • Reorganizing our CME offerings, including leading us into the virtual education realm. • Improving the member experience at NCAFP meetings.

INSURANCE

How could I make this work?

Give us a challenge and we’ll find you an opportunity. As a fullservice advisory firm that works harder to understand how to make your life easier, our advice is grounded in your priorities and elevated in your outcomes—in medicine, business, and life. Find valued advice at curi.com

• And strengthening the organization’s financial portfolio with an eye toward improving return on investment at minimal risk. “I am eternally grateful for the opportunity given to me by Greg and the NCAFP. Working on behalf of family physicians is something I will always cherish, and the relationships I have developed are ones I know I will carry forward. Family Physicians are truly some of the most compassionate, kind, and welcoming people I have ever met, and I know having a Family Medicine perspective will serve me well as I move into a more specialized role. Thank you for the opportunity to serve you for these past fourteen years.” CORPORATE SPONSOR OF THE NORTH CAROLINA ACADEMY OF FAMILY PHYSICIANS

ADVERTISE! Autumn 2021

Reach many types of Family Medicine professionals in North Carolina. Contact Peter Graber with the NCAFP at pgraber@ncafp.com 15

MEMBERSHIP & MEMBER SERVICES By: Tara Hinkle NCAFP Member Services Manager

N AT I O N A L

Karen Smith Elected to AAFP Board of Directors Congratulations to NCAFP’s Dr. Karen Smith of Raeford, NC, on her recent AAFP campaign victory! Dr. Smith won a three-year term on AAFP’s Board of Directors at the 2021 AAFP Congress of Delegates Special Session. Serving alongside Dr. Smith for threeyear terms are Gail Guerrero-Tucker, MD (AZ), and Sarah Nosal, MD (NY). Teresa Lovins, MD (IN), will serve a one-year term. The Vice-Speaker win went to

ELECT

MITH S . L N E R A K , FAAFP MD

for

AAFP BOARD OF DIRECTORS

Daron Gersch, MD (MN), and Russell Kohl, MD (KS), will serve as Speaker. Tochi Iroku-Malize, MD (NY), is the new President-Elect, and Sterling Ransone, Jr., MD (VA), will serve as President. Best wishes to all! We are so excited for Dr. Smith, and we know she will do great things for Family Medicine, patients, and communities in NC and beyond.

2022 AAFP/NCAFP Dues Invoices Available for Payment/Deadline January 1st Membership dues invoices for the 2022 calendar year are available for payment online at www.aafp.org/ checkmydues. These invoices apply to Active, Inactive, first-year Life, Supporting, and Transitional members. (If you are a Resident, please check with your residency coordinator to ensure your July – June dues are paid from your allocation). The payment deadline is January 1, 2022, and an installment plan is available. Remember your username is your email address on file with the AAFP. If you need assistance logging in, please call the AAFP at 1-800-274-2237. If you have retired, interrupted practice, or moved out of NC, please contact the AAFP immediately for a status transfer or chapter relocation. Membership is unified, so your membership must be current with both the AAFP and the state chapter in which you live or work.

If you have any questions or would like to pay by phone, please call the AAFP at 1-800-274-2237 M-F 9:00 a.m. – 6:30 p.m. Mailed invoices have been sent to primary addresses on file with the AAFP, but they may be downloaded anytime online at www.aafp. org/checkmydues. Important note: The AAFP has allowed a grace period in the past up until May. Due to member feedback and analysis, the cancelation for dues non-payment will be moved up to early March instead of May 2022. Please keep this in mind during your planning. Thank you for your continued membership. We appreciate all you do for Family Medicine, your patients, and your communities!

The North Carolina Family Physician

M E M B E R

P E R S P E C T I V E S

This editorial was published in the Charlotte Observer on September 30, 2021. Reprinted with author's permission.

When Your Doctor Leaves a Practice, You Shouldn’t Have to Play Hide and Seek By Dr. Jessica Schorr Saxe A few friends recently received letters informing them that their doctors were leaving their practices. The letters were perfunctory, acknowledging the doctor’s service and telling the patients that they could see other providers in the office. In no case did the letters discuss the departing doctors’ plans — notably that they will still be practicing in Charlotte — nor tell the patients how they could continue care with their primary physicians.

MEMBERS IN THE NEWS

David Baker, MD, featured in the August issue of Medical Professionals Charlotte Check out the August issue of Medical Professionals Charlotte featuring Dr. David Baker of Novant Health Michael Jordan Family Medical Clinic, North End. Medical Professionals Charlotte is a peer-to-peer platform for the physicians, nurses, and healthcare professionals in Mecklenburg County to share information about their specialties, collaborate, and hopefully encourage some new referral relationships. The article features some great family photos and covers wide-ranging topics from personal to professional. Dr. Baker has been an involved member of the NCAFP since his medical school days at ECU. Congratulations!

Autumn 2021

I am both shocked and not surprised. This is one more example of the encroachment of business decisions on the practice of medicine, of the primacy of institutional profit over the doctor-patient relationship. As a physician, I took the Hippocratic oath to work “only for the good of my patients keeping myself far from all intentional ill-doing” and to “safeguard the rights of my patients,” keeping their secrets and never revealing them. When I was in practice, I noted that the longer I knew patients, the more they trusted me, See 'Hide & Seek' on back cover

2021 CME Re-Election Deadline is December 31st Members with a CME Re-election cycle ending 12/31/21 have until the end of this year to earn the 150 required credits for the three-year re-election cycle. (Remember, if you were a 2020 re-election candidate, your reporting deadline was extended until the end of this year—your hours must have been earned by 12/31/20). The cancelation date for any unreported CME credits will be early March, so make plans now to report your hours before the holiday rush. Reporting by the 12/31/21 deadline will also remove you from any reminder notifications. You may report your credits any of the following ways: • Visit www.aafp.org/cme (your username is your email address on file with AAFP) • Call 1-800-274-2237 M-F 9:00 a.m. – 6:30 p.m. • Fax to 913-906-6075 • Scan letters of participation on AAFP’s free mobile app • Mail submissions to: AAFP Member Service Center, 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672 If you have retired, interrupted practice, or moved out of NC, please contact the AAFP immediately for a status transfer or chapter relocation. If you are a 2021 re-election candidate, remember that you may count teaching/precepting, Board certification exam, and medical staff/society meetings. And a bonus, the AAFP will inform the American Board of Family Medicine (ABFM) once you have met its CME requirement! If you have any questions, please email aafp@aafp.org, call 1-800-274-2237, or visit CME FAQs at aafp.org/cme. The AAFP would also be happy to “walk through” your transcript with you to ensure all the credits you’ve earned are included. 17

MEMBERS IN THE NEWS

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.

Drs. Thomas White and Aregai Girmay Recognized as “Boundary Breakers” by the AAFP Due to the COVID-19 pandemic, AAFP chose not to award a national Family Physician of the Year honor in 2020 or 2021. Last year, the AAFP named all family physicians as their Family Physician of the Year. This year, they are highlighting “boundary breakGirmay White ers” from each state. The NCAFP nominated our two most recent Family Physicians of the Year who were not able to be considered for the national honor: Drs. Thomas White and Aregai Girmay. Please see aafp.org/events/fmx/2021-highlights. html, as well as AAFP’s social media posts honoring Dr. White and Dr. Girmay. Dr. Cody Wingler Interviewed on Healthcare in Rural NC by WFAE NCAFP member Dr. Cody Wingler of Taylorsville, NC, was recently interviewed by WFAE Public Radio in Charlotte on healthcare issues in rural NC. The interview is part 3 of an 11-part series exploring healthcare costs in the U.S. called, “The Price We Pay.” In this interview titled, “In Places

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Like Rural NC, 'Deaths of Despair and Education Level Lead to Decline in Life Expectancy,” Dr. Wingler discusses his experience as a family physician serving an economically depressed Taylorsville, the town in which he was born and raised. NCAFP Past President Dr. Shannon Dowler Appointed to CHAC The Centers for Disease Control and Prevention (CDC)/Health Resources and Services Administration (HRSA) Advisory Committee on HIV, Viral Hepatitis and Sexually Transmitted Diseases Prevention and Treatment (CHAC), has appointed Dr. Shannon Dowler as one of its four new members and South Carolina's Dr. Ada Stewart as the new Presidential Advisory Council on HIV/AIDS (PACHA) liaison to CHAC. Dr. Dowler currently serves as the Chief Medical Officer at North Carolina Medicaid and is a passionate educator and advocate for sexual health. Dr. Stewart is a Lead Provider and HIV Specialist, Eau Claire Cooperative Health Centers (Now Cooperative Health) in Columbia, SC. She is currently chair of the board of the American Acade-

my of Family Physicians (AAFP). We look forward to their many important contributions to come. Duke's Dr. Viviana Martinez-Bianchi Testifies Before Congress NCAFP member Dr. Viviana Martinez-Bianchi, Director of Health Equity and Associate Professor in the Department of Family Medicine and Community Health at Duke University School of Medicine, testified at a virtual hearing in September Martinez-Bianchi before two subcommittees of the US House of Representatives Committee on Education and Labor. The testimony was part of a joint hearing titled, “How to Save a Life: Successful Models for Protecting Communities from COVID-19.” The purpose of the hearing was to discuss best practices for increasing COVID-19 vaccinations through the lens of health equity. Dr. Martinez-Bianchi’s five-minute testimony can be seen at the 32:30 mark of the recording here: https://youtu.be/Bz-2r8DVQ9Y.

October 2021 - Physician Employment Contracts In the latest episode of NCFM Today, we talk to Shawn Parker, JD, MPA, General Counsel and Chief of Staff for the NC Academy of Family Physicians about physician employment contracts. Shawn discusses different elements in an employment contract, what physicians should look for, and where to find more help. This is definitely an episode you don’t want to miss.

September 2021 - Physician Career Transitions

A Family Medicine Community Podcast

www.ncafp.com/podcasts

Als

: s s i M t o Don

This episode of NCFM Today talks to five different family physicians who have all made transitions in their careers. They share pearls about how they made these decisions, what personal and professional influences led them to these decisions, and what other family physicians should consider as they think about transitioning jobs. They also discuss the unique ability of family physicians to practice in different settings and wear different hats from telehealth to Direct Primary Care to system-based practice to independent practice to the VA. You don't want to miss this informative episode as we hear from Dr. Vickie Fowler, Dr. Talia Aron, Dr. Thomas White, Dr. Takie Hondros and Dr. Liz Baltaro.

“The Family Doctor: Lessons Learned… Wisdom Shared” -- Dr. Thomas White talks to Dr Jim Jones, former President of the NCAFP and the AAFP, and former Chair of the Department of Family Medicine at the Brody School of Medicine at East Carolina University. Affectionately known as the “Godfather of Family Medicine in North Carolina”, Dr. Jones discusses the impact of his faith, the challenges he overcame and barriers he broke as a Native American, stories from his years in practice in Jacksonville NC (including a case you will not forget), and his efforts to further Family Medicine.

RESIDENTS & NEW PHYSICIANS By: Ryan Paulus, DO PGY3 and Molly Duffy, MD PGY3 UNC Family Medicine Residency Program

CAREER DEVELOPMENT

I Trained at a Full-Scope Family Medicine Residency, Now What? So, you’ve graduated from a full scope Family Medicine Residency. You spent three years providing holistic care to people of all ages and backgrounds. You worked throughout the hospital, on the wards, the ICU, labor and delivery, and the Emergency department. You explored your interests in the outpatient setting, learning ways to best serve your continuity panel by becoming proficient in point-of-care ultrasound, addiction medicine, end-of-life care, hepatitis C treatment, and prenatal care. You worked in federally-qualified health centers, community hospitals, public health departments, large tertiary care centers, and academic clinics. Now that these three years are coming to a close, you finally have to address the one question that hasn’t been answered, what’s next? If you are like us, the answer to that question seems obvious. We want to continue to use our full spectrum training to provide comprehensive care to people in our communities. When reflecting on our time in residency, a few patient encounters stand out. Just recently a patient came in to establish care at one of the clinics in our Rural Health Track. She was a 38-year-old woman presenting after she was found to have high blood pressure at a work physical and was told she needs to start a medication to lower her blood pressure. Throughout the visit, she gradually shared

the rest of her story. She has a history of opiate and alcohol use disorder. She takes methadone but has been struggling to get to her methadone clinic because it is over 45 minutes away from her home. She shares that she has also been dealing with lifelong depression and anxiety, and in addition, needs a referral to an OB-GYN because her IUD is expired. In a 30-minute visit, we were able to start treatment for her hypertension, connect her to our on-site behavioral health counselor to discuss her mood disorder, get her scheduled for IUD replacement, and

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discuss possible transition to suboxone to make it easier for her to remain in remission from opiates. At the end of the visit, the patient shared that she couldn’t believe she could come to one clinic to have all of her needs addressed, especially one that was only 10 minutes from her home.

Resident Interest vs Practicing Physician 70% 60%

50% 40%

Resident Interest vs Practicing Physician

30%

70%

20%

60%

10%

50%

This is the type of medicine we trained to practice. However, in our graduating class of 12 residents, we have seen multiple people turned away from jobs in North Carolina because they desired “too large” of a scope of practice or were told “we don’t do that here” when asking about opportunities to treat hepatitis C or use medication-assisted therapy. Nationally, the trend has been similar. Despite the perception of improved training in Family Medicine programs, the scope of practice of current physicians continues to narrow1. Additionally, there continues to be significant differences between the intended scope of practice amongst graduates when compared to the reported scopeof-practice amongst practicing family physicians2. Looking specifically at North Carolina, the NCAFP has conducted resident and practicing physician surveys to evaluate this trend. In 2017, 53% of residents had an interest in practicing inpatient medicine, 36% were interested in obstetric deliveries, and 64% had an interest in

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40%

Inpatient Medicine

Obstetric Delivery

Sports Medicine

30% 20%

Resident 2017

Resident 2021

Practicing Physician 2017

Practicing Physician 2021

10% Figure 1: Percentage of current family medicine residents interested in inpatient medicine, obstetrics, and sports medicine

compared to the actual reported percentage of practicing physicians doing inpatient medicine, obstetrics, and sports medicine.

0% 1: Percentage of current Family Medicine residents interested in Figure Inpatient Medicine Obstetric Delivery Sports Medicine inpatient medicine, obstetrics, and sports medicine compared to the actual Outpatient Interest Among Residents reported percentage of practicing physicians doing inpatient medicine, Resident 2017 Resident 2021 Practicing Physician 2017 Practicing Physician 2021 LARC medicine. Placement (IUD/Nexplanon) obstetrics, and sports

90%

Home Visits 24% Figure 1: Percentage of current family medicine residents interested in inpatient medicine, obstetrics, and sports medicine

compared to the actual reported percentage of practicing physicians doing inpatient medicine, obstetrics, and sports medicine. Transgender Care (Hormone Replacement Therapy) 49%

Nuring Home Care

12%

Outpatient Interest Hospice and Palliative Care Among

Residents 27%

Obesity Medicine

75%

LARC Placement (IUD/Nexplanon)

Medication Assisted Therapy Home Visits

63%

24%

Hepatitis C Treatment

Transgender Care (Hormone Replacement Therapy)

Colposcopy Nuring Home Care

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63%

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Dermatologic Procedures Figure 2: Percentage of current family medicine residents interested in listed opportunities. Joint Injections Office-Based POC Ultrasound

90% 95% 75%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Figure 2: Percentage of current family medicine residents interested in listed opportunities.

Figure 2: Percentage of current Family Medicine residents interested in listed opportunities.

providing prenatal care. Most residents also planned on providing pediatric care (88%). In 2021, almost 40% of residents still wanted to practice inpatient medicine, 27% wanted to perform obstetric deliveries, and the number wanting to do prenatal care and pediatric care remained similar (63% and 86%, respectively) (Figure 1). article continues on next page

As outpatient opportunities for family doctors continue to expand, residents were asked about the outpatient scope. In the 2021 survey, 95% of the residents are interested in joint injections, 90% want to continue to do dermatologic procedures and LARC placement, and 75% plan on using point-of-care ultrasound in their practice (Figure 2). Residents also expressed interest in working in the urgent care and emergency room settings (40% and 12%, respectively). Similar surveys were sent to practicing physicians in 2017 and 2021. The results support the claim that residents’ desires are larger than the scope practiced. Only 18% of practicing physicians did inpatient work (both in 2017 and 2021), 52% did child/maternal health in 2017 that reduced to 50% in 2021, and obstetric care saw an increase from 11% to 12% (Figure 1). When asking the residents if they would leave North Carolina if the desired career opportunities didn’t exist here, 74% said yes or maybe in 2017 with the number increasing to 83% in 2021. Similar to national trends, there continues to be a difference between the intended scope-of-practice for residents versus the current scope of practicing physicians. This is despite the fact that research has shown that family physicians who perform a greater variety of procedures or work in more clinical areas are significantly less likely to report feeling burned out. This finding was particularly notable amongst physicians practicing inpatient medicine or obstetrics.3 While further investigation is required, we are concerned about the downward trend in resident interest in practicing inpatient medicine and obstetrics from 2017 to 2021. We question whether residents are choosing to limit their scope because they feel they will be unable to find jobs that allow them to continue to utilize all aspects of their training. In response to the question, “If your practice plans have changed over time, please indicate why,” one 2021 survey respondent wrote, “I am having trouble finding a job that will allow me to practice prenatal and OB deliveries, so I may have to move out of the state or take a job that doesn’t allow me to do those things.” Finally, despite more than half of residents indicating

that they plan to continue MAT, hepatitis C treatment, pediatric and prenatal care, and office-based point-ofcare ultrasound, anecdotally residents report that finding full spectrum outpatient jobs in North Carolina has been difficult. These findings highlight a need to advocate for further employer support for new graduates interested in maintaining a full-scope outpatient practice, in order to retain residents in the state and continue to provide high quality, holistic Family Medicine. The NCAFP is committed to helping you find your ideal job here in the state of North Carolina. The NCAFP does have a career search engine on the website (jobs.ncafp.com). We have also found 3RNET (www.3rnet.org), a resource for rural and underserved jobs, helpful in finding jobs that may not have the resources to broadcast their openings across the state. In addition, the Family Practice Management journal recently released an article that provides guidance and tips on finding the career path that is right for you4. Please reach out to the NCAFP if you are struggling to find the job you are looking for. If there are ways you think the NCAFP can help advocate for you and your career desires, please reach out to Ryan Paulus, a resident member of the NCAFP Board at ryan_paulus@ med.unc.edu. REFERENCES

1 Weidner AKH, Chen FM. Changes in preparation and practice patterns among new family physicians. Ann Fam Med. 2019;17(1):46–48. 2 Coutinho AJ, Cochrane A, Stelter K, Phillips RL Jr, Peterson LE. Comparison of Intended Scope of Practice for Family Medicine Residents With Reported Scope of Practice Among Practicing Family Physicians. JAMA. 2015 Dec 8;314(22) 3 Weidner AKH, Phillips RL Jr, Fang B, Peterson LE. Burnout and scope of practice in new family physicians. Ann Fam Med. 2018;16(3):200–205. 4 Thomas H, Jensena C, and Andrea M. Life After Residency: Exploring Practice Options in Family Medicine. Fam Pract Manag. 2021 Sep-Oct;28(5):30-35.

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PRACTICE MANAGEMENT By Brent Hazelett, MPA, CAE NCAFP Chief Operating Officer

Managing Your Career and Your Practice: AAFP Resources at Your Fingertips As a Family Physician, you are responsible for a great deal: caring for your patients, yourself, and your practice. When you have questions or need assistance in any of these areas, remember the AAFP has a tremendous number of resources for all three at aafp.org and familydoctor.org. While the latter focuses on providing the best care for your patients, bountiful resources exist at aafp.org for taking care of yourself and your practice. This includes everything from employment contracting to maximizing payment for claims, to alternative payment models and everything in between. Here are just a few areas you may find useful: NEGOTIATE YOUR EMPLOYMENT AGREEMENT WITH CONFIDENCE Whether you are a resident facing the daunting task of reviewing your first contract, or a seasoned veteran reviewing your fourth contract, it is wise to consult others when navigating this process. AAFP has a wealth of resources that may help you: Family Practice Management Journal – AAFP’s indexed, peer-reviewed, practice improvement journal offers practical ideas for improving your practice environment. In the Fall 2021 career issue, the journal includes a guide to navigating employment contracts, as well as a wealth of other resources related to managing and optimizing your career in Family Medicine. Download the PDF here: https://www.aafp.org/ fpm/2021/0900/p17.html

Family Medicine Practice Hacks – view the AAFP’s latest practice hack video, a five-minute overview of the four steps you can take to ensure you are informed throughout the contracting process. The video can be viewed by searching “practice hack videos” from the aafp.org home page. A Family Physician Guide to Employment Contracts – AAFP has developed an extensive guide to better understand the provisions and elements of contracts and specifically the employment contract process. This includes potential pitfalls and red flags to watch out

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for, as well as key questions to ask during the negotiating process. The full guide can be downloaded here: aafp.org/family-physician/practice-and-career/managing-your-career/employment-contracting.html PRACTICE MANAGEMENT RESOURCES The business of medicine has never been more complex than it is today. It is nearly impossible to keep up with the best patient care and manage an effective and efficient practice. Don’t forget that the AAFP provides a wealth of resources that may help you navigate some of the complexity around running a practice. Ease the strain of administrative burdens such as prior authorizations by learning how to streamline your prior authorization process – AAFP provides a workbook to best manage the prior authorization process, as well as another practice hack video, which gives tips that help reduce the burdens of prior authorizations. Starting, Closing, or Selling a Practice – AAFP has developed a tool to assist family physicians with the process of deciding whether to, and how to set up a new practice. In addition, for those physicians looking to close or sell their practice in the near or distant future, the AAFP can be a very helpful resource. The “managing your practice” section of their website has multiple resources, including an easy-to-use checklist of tasks needed to wind down your practice. While you will ultimately want to use financial and legal advisors to navigate the complexity of closing a practice, this resource is helpful for those just beginning the process. Medical Billing and Coding – AAFP has a wealth of resources on their website to assist with the everchanging complexity of proper billing and coding. Examples of deep dives include: • Coding Basics • Coding for E&M Services • Medicare Wellness and Care Coordination

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• Hierarchical Condition Category Coding • Coding for Group Visits • Newborn Care Services • Vaccine Administration • Chronic Care Management • Getting Paid

Great patient care and an efficient practice won’t matter if you aren’t able to keep the doors open. Ensuring you get paid fairly and completely for the excellent care you provide is paramount. Many of the resources offered by the AAFP are targeted to maximizing your income. Advanced Alternative Payment Models – whether it’s MACRA or MIPS or a litany of other acronyms in this arena, it’s important to know what existing payment models might apply to your practice and payer mix. It can be exceptionally confusing to navigate these options and AAFP’s website has many resources that can assist. Under the “Family Physician” tab on the AAFP website, select “getting paid” to find out more. Value-Based Delivery and Payment Models – when it comes to being paid based on the value of care you provide, there are an increasing number of choices out there. On AAFP’s website, you can compare different care models, including accountable care organizations, direct primary care, and many more. Private Payer Issues – both the NCAFP and the AAFP are advocating on your behalf with the major state and national payers. At the state level, the NCAFP is working with payers to reduce administrative burden and reward family medicine for its vital role in providing low cost/high quality care, ultimately making it easier to take care of your patients and find a work/life balance that is rewarding and healthy. Make it a point to regularly visit ncafp.com and aafp.org to learn more about the issues facing you and your practice, and more importantly, find resources to help you make the most of your career, provide the best care for your patients, and ensure your practice is healthy and strong for years to come.

PRACTICE BRIEFS

Curi Launches New Advisory Business to Support Physicians & Medical Practices Raleigh-based Curi, a firm that advises physicians and medical practices, recently announced the launch of Curi Advisory, a new business unit dedicated to helping independent physician practice leaders protect, optimize, and grow their businesses via a business intelligence platform and related data-driven consulting. The unit’s core offerings at launch include the Arrowlytics technology platform and a host of practice operations, risk solutions, and health policy consulting services. In a press release announcing the launch, the new unit represents a natural evolution for Curi, stemming from its mission to continually develop solutions that help physicians in medicine, business, and life. “We have been focused on growing and diversifying our advisory offerings for many years now, always with an eye toward how we can best support physicians and their practices,” said Curi CEO Jason Sandner.

“The launch of Curi Advisory represents an important milestone in our long-term strategy of being a trusted partner for the member-owners and customers we serve and the physician community at large.” Curi Advisory will offer the Arrowlytics Platform, software designed to help practices drive new patient volume, increase per-patient margins, and optimize overall practice performance. Arrowlytics pulls critical data from disparate sources, including various practice management systems and social media, into a single platform—giving practice leaders total business insight. Complementing Arrowlytics, Curi Advisory will also deliver practice and risk management consulting services through a team with deep expertise. Broadly, these offerings are expected to help practice leaders protect, optimize, and grow their businesses with confidence. To learn more, visit curi.com/advisory.

PAYMENT

COVID-19 Vaccination Outreach Code Reimbursement NC Medicaid-enrolled providers can now bill code 99401 with HM modifier for telephone outreach to unvaccinated Medicaid beneficiaries, effective Oct. 22, 2021. The goal of the outreach is to educate the beneficiaries on the COVID-19 vaccine and assist them in scheduling an appointment, ideally in the office where the outreach originated. Billing Specifications: • CPT 99401 HM has a limit of one call per beneficiary per day. The code can only be billed for successfully connecting with the beneficiary. 26

• Medicaid-enrolled providers must bill CPT 99401 HM with a CR modifier to indicate a PHE code. • There is no requirement for a specific diagnosis code associated with the code. Providers are encouraged to counsel Medicaid beneficiaries following CDC guidance for qualifying for vaccination. Parents or guardians of Medicaid children can be counseled on the benefit of receiving the COVID-19 vaccination even if the parent or guardian is not enrolled in NC Medicaid. The counseling session (99401) for the parent or guardian can be billed to the child’s Medicaid ID, but only one code can be billed per day per ID.

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CAREPOINTS

Controlled Substance Reporting System Now Covering Integration Fees for BiDirectional EHR Connections Great news for practices! The Controlled Substance Reporting System (CSRS) is now able to provide financial support to practices by fully covering the initial integration fees for a bidirectional EHR connection to the CSRS. The North Carolina Department of Health and Human Services will cover the licensing fees associated with the integration service for approved prescribers and pharmacists in North Carolina to connect their EHR to PMPGateway and NarxCare. Additional fees, in which the practice is responsible for, may be assessed by their EHR/PM vendor. The practice will need to consult with your vendor representative if you have questions. Please take a moment to take a look at the inset flyer for specifics on the advantages of the integration. The benefits of the bidirectional connection are that the provider/user has access to the CSRS from within the EHR and does not have to log into another system. The bidirectional connection also decreases the search time by making the information more accessible in the EHR and within the established workflow. Results have shown that processing time is reduced from several minutes to several seconds per transaction. Stephanie Johnson at CSRS has graciously provided her email address if physicians and/or practices have initial questions:

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stephanie.johnson@dhhs.nc.gov on the program. Practices wishing to move forward, should contact the CSRS via CSRSUtilization@dhhs.nc.gov. Practices may also contact NC AHEC Practice Support at practicesupport@ ncahec.net for more information.

Know the Factsof EHR /CSRS Integration The North Carolina Department of Health and Human Services will cover the licensing fees associated with the integration service for approved prescribers and pharmacists in North Carolina to connect their EHR to PMP Gateway and NarxCare. Additional fees, in which you are responsible for, may be assessed by your EHR/PM vendor. Please consult with your vendor representative if you have questions.

Eliminate the need for delegate searches and increase the speed of search times. Integration also eliminates the need to log into other tabs and leaving your EHR.

Let us know your needs and request technical assistance and/or education on using the system as a clinical tool by emailing: CSRSUtilization@dhhs.nc.gov

Start the integration process today: Integration is on a first come, first serve basis. Please allow processing time and verification of all documents for completion and accuracy.

HAVE A SINGLE POC (LIKE BUSINESS ADMIN MANAGER) WHO HAS SIGNING PRIVILEGES FOR THE ENTITY TO COMPLETE THESE STEPS: 1. Create an Account in Customer Connect then verify the email address by following the instructions in the email sent to you. https://connect.hc.appriss.com/ 2. Complete the License Questionnaire and sign the Terms & Conditions 3. Prescriber List- Template located here, have prescribers full name, DEA and NPI numbers and NC Professional License Number ready for the practice- https://files.nc.gov/ncdhhs/documents/files/NC_presciber_list_template.xlsx

'Hide & Seek,' continued from p17

As far as I know, healthcare systems have not sworn to put your interests first, nor been educated to respond to your innermost fears. Their decisions, as well as those of insurance companies and drug and device companies, often prioritize market share over patient care. Trust is a fundamental, if underrated, ingredient in the success of medical care. We have seen this only too painfully in vaccine resistance during the pandemic. Trusted primary care physicians can play a crucial role in vaccine acceptance. And during this pandemic, patients need trusted physicians to help them with illness, fear and loss. When doctors are treated as interchangeable parts in someone else’s machine, we are not in positions to establish that trust. Patients suffer, and doctors suffer as forces distance us from the sanctity of the relationships with patients that called many of us into medicine. None of us should give in to this. Patients: Be vigilant and watch out for financial decisions taking precedence over your care. If your healthcare system claims to be patient-centered yet is willing to sever the doctor-patient relationship, let them know that violates your trust.

Medicine has changed. Our forebears would be fascinated with the worlds opened by MRIs and genetic testing. I would hope they would recognize the benefits of the gender and ethnic diversity they would see in the faces on hospital rounds. But they would undoubtedly be appalled by the idea of the business of medicine. In fact, Osler, the father of modern medicine, said so explicitly:” The practice of medicine is an art, not a trade; a calling, not a business.” Nearly 30 years ago, I wrote in the Charlotte Observer about “Musical Doctors,” when, as though they were children playing musical chairs, patients were abruptly forced to change doctors because of changes in insurance. I decried the interference in the doctor-patient relationship. I quoted Hippocrates, who said “. . .some patients, though conscious that their condition is perilous, recover their health simply through their contentment with the goodness of the physician.” Instead of nurturing the relationship between doctors and patients, we have moved in the opposite direction. If we want to recapture the benefits to all of us, we need to let our institutions know how important those relationships are to us.

Non-Profit Org. US Postage

Read also at: https://www.charlotteobserver.com/ opinion/article254567987.html

PAID

Dr. Jessica Schorr Saxe is a retired family physician in Charlotte. She is chair of Health Care Justice North Carolina.

Pontiac, Illinois Permit No. 592

Fellow physicians: Don’t stand for it. We took oaths, we belong to a venerable profession, we walk— or should be walking — in the footsteps of giants: Hippocrates,

Medical practices: Have respect for the doctor-patient relationship and let patients know if their doctor can be seen elsewhere. Forego a short-term business advantage for the long-term welfare of patients.

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

Patients told me their hopes, their fears, and their concerns about and dreams for their children, who were often also my patients. Sometimes, only after years, did they reveal histories of abuse that they had told no one. And, once I knew, I could help.

Rebecca Crumpler, Sir William Osler, Arnold Relman, to name a few.

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and the more they confided in me.