NC Family Physician - Summer 2023 by NCAFP

Volume 19 Issue 3 • Summer 2023

The North Carolina

Family Physician Quarterly News in North Carolina Family Medicine

NC Selected to Test New Medicare Alternative Payment Model PG. 12

Celebrating Family Medicine & You! mainstage sessions Include:

Cme Camaraderie Celebrations

Adolescent Mental Health Alzheimer's Disease Atrial Fibrillation Autism Bipolar in Adults Cancer Screening CKD Management Optional Workshops Coding & Seminars Include: Continuous Glucose Monitoring CVD Prevention Improving Physician Wellness Diabetes KSA Study Working Group | Diabetes Hepatitis B Long-Acting Reversible Contraception Hormone Replacement Therapy Opioids & Pain Management Lung Cancer Osteopathic Manipulations Narcolepsy Persons of Color Dermatology Workshop Osteoporosis Practice Management Pediatric Atopic Dermatitis Preceptor Development Physician Health & Well-being Sports Medicine Value-Based Care Expect to enjoy a wide range of sessions on Weight Management new treatment options, patient care, And many more!

& Lots of Fun!

physician well-being, and technology brought to you by the best and brightest experts in primary care. With several fun surprises to commemorate our diamond jubilee, we promise this is the one annual conference you do not want to miss!

www.ncafp.com/wfpw Contact Kathryn Atkinson, CMP | Director of NCAFP CME & Events with Questions | Katkinson@ncafp.com

Inside Summer 2023

Five Ways Chickens May Relate to Patient Care PG. 4

PRESIDENT’S MESSAGE

HEALTH LANDSCAPE

4 Five Ways Chickens May Relate to Patient Care

12 North Carolina Selected to Test New Alternative

ADVOCACY

6 Shining a Light on the AAFP 2023 Family Medicine Advocacy Summit

CHAPTER AFFAIRS

10 Remembering the Godfather as We Celebrate

Medicare Payment Model

PROFESSIONAL DEVELOPMENT

14 Celebrating Family Medicine Milestones…and You! PRACTICE MANAGEMENT

Our 75th Anniversary

30 Continuing to Move Collaborative Care

PUBLISHED BY

DEPARTMENTS

t 919.833.2110 • fax 919.833.1801 • ncafp.com Managing Editor, Design & Production Peter T. Graber, NCAFP Communications Editor Kevin LaTorre, NCAFP Communications

Forward in North Carolina

President’s Message 4 Advocacy 6 Chapter Affairs 10 Health Landscape 12 Professional Development 14

Membership Services 20 NCAFP Foundation 24 Residents & New Physicians 26 Student Interest & Initiatives 28 Practice Management 30

Have a news item we missed? NCAFP members may send news items to the NCAFP Communications Department for publishing consideration. Please email items to kevin@ncafp.com.

PRESIDENT’S MESSAGE to NCAFP Members By Dr. Shauna Guthrie 2022–2023 NCAFP President

Five Ways Chickens May Relate to Patient Care NCAFP President Dr. Shauna Guthrie

I have raised chickens for about the past eight years. I’m no expert, but to anyone even mildly interested I enthusiastically recommend getting a few chickens and getting started IMMEDIATELY, not just for quality-of-life reasons but for diagnostic skills as well. I’m usually asked the same questions, so to save you the time, here are some answers and even a look into how raising chickens teaches medical care: Are chickens hard to care for? No. They are ridiculously easy. Mine are a little less easy, especially since it turns out I’m incredibly allergic to chickens so I avoid touching them if at all possible. Let me explain… Traditionally, chickens put themselves to bed. When the sun starts to go down, they get the hint and go bed down for the night in their coop. If they have been outside all day, you simply close the door and they’re in there safe and sound for the night (many assumptions made here regarding coop safety, so see my below comments). Mine used to bed down this way, as expected, but one day they suddenly stopped. Instead of putting themselves to bed inside the coop, they instead chose to be on top of it. The symptom would soon invite a closer look and eventually a diagnosis. I thought this behavioral change odd, but after a couple nights things went back to normal. Then it started back up and became more consistent which meant I had to regularly grasp each chicken and place them in the coop. Every night. All five of them. This is neither hard work nor inhumane. They are quite docile when the sun goes

down. It is annoying and slightly time consuming, especially when I factor in the all-important washing the allergens off my hands IMMEDIATELY before touching anything. When this became the standard rather than the exception, I realized something had changed, and, of course, I started with the history, as any concered doctor should. Though my chickens are VERY chatty, my interpreter was a no-show that day and so I had to rely on caregiver history. Lately an egg had occasionally been found out on the ground in the attached run instead of inside the coop. That was odd, but I had chalked that up to the egg simply being accidentally knocked out (thanks to the ground settling, things are slightly on a slope these days). A couple times, their food in the coop had been knocked over come morning (Y04.0XXA — assault unarmed brawl or fight — “chicken fight club” was my #1 differential diagnosis at the time. They are some rough-and-tumble gals!). Now, on my physical exam, there was a five-inch HOLE in the ground on the back side of their run. Something was getting in and participating in chicken-fight-club! Trigger warning — I don’t want to give anything away but don’t read this if you’re eating something or afraid of rodents. My next step was getting more specificity into… whatever my diagnosis is (taking suggestions). The Internet was not very helpful but did provide some other exam ideas and diagnostic tests. (I just wished there had been an “UpToDate” for chicken fight club.) I

The North Carolina Family Physician

2022-2023

NCAFP Board of Directors

Executive Officers President

Shauna Guthrie, MD, MPH

President-Elect

Garett R. Franklin, MD

Secretary/Treasurer

Mark McNeill, MD

Immediate Past President Executive Vice President

Dimitrios P. Hondros, MD Gregory K. Griggs, MPA, CAE

At-Large Directors Joshua Carpenter, MD Lisa Cassidy-Vu, MD Deanna Didiano, DO Nicole Johnson, MD, MPH Kelley Lawrence, MD, IBCLC, FABM Benjamin F. Simmons, MD Patrick Williams, MD Courtland Winborne, MD

Academic Position Margaret Helton, MD (UNC)

Resident Director Matthew Drake, MD (ECU) Resident Director-Elect Morgan Parker, DO (Novant Health) Student Director

learned to check my chickens’ toes because sometimes rats bite them off (what??). All toes present and accounted for. Coop negative for non-chicken feces. Coop negative for mites (not the big problem at hand but that could’ve been part of the story). The hole was small but not THAT small — so probably not mice. Different diagnoses? Less likely: Unknown tiny beast, non-beast, prank from a friend, canine interference (Wendell the Beagle once took it upon himself to discreetly eat all their eggs for a week — I thought they had stopped laying for some reason, but no, he just figured out when the door was open, lunch was served!).

Morgan Beamon (ECU) Student Director-Elect Akhila Boyina (Wake Forest)

AAFP Delegates & Alternates AAFP Delegate

Richard W. Lord, Jr., MD, MA

AAFP Delegate

Robert L. Rich, Jr., MD

AAFP Alternate

Tamieka Howell, MD

AAFP Alternate

Thomas R. White, MD

Possible common concern: fox — there was a known group of them near a friend’s house a couple miles away. My yard is fenced but not impenetrable. But something was scaring my chickens, not eating them, which is not the MO of a fox. Most likely cause: possum or raccoon. Both had been spotted in or around the coop in the past. They might eat the chickens, but also Continues as 'Chickens' on pg. 31

Summer 2023

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

ADVOCACY By Karen L. Smith, MD, FAAFP AAFP Board Member and Past President of NCAFP

Shining a Light on the AAFP 2023 Family Medicine Advocacy Summit This year’s Family Medicine Advocacy Summit, otherwise known as the “Capitol Hill Fly-in,” brought over 300 Family Physicians (including 10 North Carolinians) to D.C. to connect with lawmakers about financial stability for family physicians, protecting Medicare beneficiaries, reducing administrative burden, and investing in the primary care workforce. The heavyweight talking points, or Family Medicine Asks, were discussed with conference attendees beginning on Sunday at the welcome reception, which introduced our advocacy as the opportunity to change the policies which impact our everyday work. North Carolina’s breadth of representatives included teachers of Family Medicine, system-employed physicians, independent practice owners, large multi-specialty groups, direct primary care, and association leadership. For the first time, the 2023 Summit gave Family Medicine residents and interested medical students a fireside chat with a special emphasis on effective advocacy. The AAFP Commission on Federal and State Policy organized awe-inspiring mainstage presentations from Assistant Secretary for Health Admiral Rachel Levine, Rep. Yadira Caraveo, and CMS Deputy Administrator Jon Blum, as well as an expert panel of Commission members who shared current challenges, new programs, and envisioned outcomes. Over meals around our nation’s capital, our delegation was also able to share new and diverse perspectives with members from other state delegations.

During our meetings on Capitol Hill, passionate stories revealed the administrative burdens impacting family physicians, patients, and practices. Lawmakers and their staff heard about the joys of educating young physicians and also the need to permanently support funding for teaching health centers as a key bulwark for graduate medical education. One Family Medicine educator discussed her residents’ difficulty in selecting programs which may not have the funding to exist by

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she advised for her patients from telephone reviewers or even AI systems that lack basic health care knowledge! The artificial up-front savings by insurance companies resulted in escalation of fiscal and human costs on the back end, especially when health services were denied by those authorization reviews. A newly-established direct primary care physician exuberantly shared her newfound joy of caring for people while also eliminating several system barriers she had once faced. But she still expressed the need to optimize health care delivery for all populations. Seasoned physicians spoke of strategies to prevent burnout while others told heartfelt stories of patients’ loss of access to caring doctors due to myriad factors, including policies that undervalue the need for increasing the number of primary care physicians. The powerful relationships established with the North Carolina congressional delegation, along with legislators from other states, open the lines of communication and trust with a bridge to exchange even more information. Our discussions were perfectly timed for AAFP Executive Vice President and CEO Shawn Martin to deliver testimony on “Consolidation and Corporate Ownership in Health Care: Trends and Impacts on Access, Quality, and Costs” during a Senate Finance Committee hearing less than a month later. What a prelude: more than 300 Family Physicians speaking face-to-face with lawmakers about the issues that matter.

the time they finished their training, due to teaching centers’ widespread lack of permanent funding. We also advocated for increased investment in primary care, including regular cost-of-living updates for physicians within the Medicare program and reduced burden for physicians. A community-based family physician spoke about her frustration with obtaining authorizations for the medications, tests, and services

Summer 2023

We look forward to bringing more ideas on our return visit next year as Family Medicine continues to be the most trusted specialty, according to Capitol Hill surveys. The close of the Summit was merely a recess, as now is the time for us to utilize the advocacy tools in each of our “doctor bags,” like virtual communication around the topics which impact your practice of medicine. The AAFP Family Medicine Advocacy Summit is an outside-the-exam-room experience that encourages family physicians — from medical students to retirees — to share your real-life wisdom and advocate for the growth of our specialty.

ADVOCACY EVENTS

NCAFP Members Advocated for Their Profession and Patients at the General Assembly By Kevin LaTorre Communications and Membership Manager

On April 19, NCAFP members and staff met with their state representatives to explain the value of primary care in North Carolina, stress the state’s need for increased investment in primary care and reduced administrative burden for family physicians, and advocate for incentives that would bolster the workforce of future doctors. The 22 NCAFP members who attended also built relationships with their representatives and with one another. Relationships that will support informed health care policy for North Carolina were the point of White Coat Wednesday, according to NCAFP leadership. “We’re building long-term relationships,” NCAFP Executive Vice President Greg Griggs told members before their meetings. “Think of building relationships with your lawmakers like building continuity of care with your patients. It’s not a one-off meeting.” LEARNING THE LEGISLATURE White Coat Wednesday began with an early morning advocacy orientation and planning meeting. Each participant was scheduled for two to three meetings in both the Legislative Building and the Legislative Office Building at the General Assembly. Dr. Lisa Cassidy-Vu met with Sen. Paul Lowe, a Democrat from Forsyth County. Afterward, she said, “He gave me his card for following up. It was so eye-opening.” Campbell University medical student Mark Bushhouse went with Dr. Corinna Myers to meet with Sen. Val Applewhite for their first meeting of the day and later said it was a success. “It’s educational but more laidback than I’d anticipated,” he said. “I would definitely recommend it.” By the end of the event, NCAFP members had attended over 30 meetings. Members with time between meet8

ings congregated in the 1300 court of the Legislative Building, recapping their visits and sharing insights. But usually they were on the move, either participating in smaller meetings with representatives or observing meetings like the Senate Health Committee meeting. For first-time attendees like Dr. Adeem Tahira, experiencing the legislature first-hand was instructive. “I’m encouraged by the other groups wearing coordinated t-shirts for organized trips here,” Dr. Tahira said. “It’s nice to see people getting involved for their communities.” ATTENDEES ALSO LEARNED TO EDUCATE They often found that meeting with legislators included clarifying what Family Medicine is, how family physicians are trained, and the benefits that strong primary care gives to patients in our state. Dr. Tahira said she spent time explaining the full scope of the specialty in her meetings with lawmakers who were previously unaware of how family physicians treat patients from cradle to grave. Clarifying and supporting the versatile care that family physicians provide has been a long-time goal of the NCAFP, and so sharing it with policymakers directly through our members is crucial. It meant that advocates like Dr. Tahira were teaching their representatives at the same time that they were also learning to better advocate for the specialty. In particular, the NCAFP’s group meeting with Rep. Kristin Baker, MD (R) and Rep. Tim Reeder, MD (R), highlighted the singular role that family physicians play in giving accurate medical input to lawmakers. The two representatives are the only physicians in the legislature — Rep. Baker is a psychiatrist, while Rep. Reeder is an emergency doctor. Addressing members at the meeting, Rep. Baker said, “You all know what’s going on in your communities. The more you can come into our discussions, the more we will trust you with our questions.” The North Carolina Family Physician

“You’re coming to advocacy from a good place,” said Rep. Reeder, “since you have the patient-physician relationship. You know more about health care than most of the people here.”

FAMPAC

Empowering Family Medicine

Long after the 2023 legislative session, the NCAFP will benefit from relationships where family physicians can speak with policy makers who trust their expertise. These types of relationships and open channels of information for health policy can take time to cultivate. Firsttime advocates from April 19 may well become trusted physicians at the forefront of state-level health policy, like NCAFP President-Elect Dr. Garett Franklin working with other stakeholders to create the NC Office of Violence Prevention, or Secretary-Treasurer Dr. S. Mark McNeill advocating better digital-workflow quality measures for both state and national policy. Both Dr. Franklin and Dr. McNeill attended White Coat Wednesday and accompanied firsttime participants to meetings, in addition to attending their own meetings with representatives. The NCAFP specifically designed this system to encourage support and relationships between members. Informally, this same work happened at the end-of-day lunch in the legislative cafeteria. There, members reconnected and recapped their day over a shared meal. “You all had great conversations with your elected officials,” Griggs told the group after the event ended, “and I think you made a significant impact. This was one of the most successful White Coat Wednesdays we’ve ever had, and that’s all because of you.” Thank you to every member who joined us, and thank you to every lawmaker who met with our members! See images from this event from our full tableau on pages 18 and 19. Summer 2023

JOIN THE FIGHT FOR FAMILY MEDICINE See 'Governor's Institute' on back cover Continues on next page

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

continues on Back Cover

Carolina, feel about Jim Jones. Second, my sincere condolences to Michelle, Jim Jr., Robert, and all the family.

CHAPTER AFFAIRS By Gregory K. Griggs, MPA, CAE

But how do you summarize the life or your feelings about this man in under five minutes? There are so many things you can say about Jim:

NCAFP Executive Vice President

Remembering the Godfather as We Celebrate Our 75th Anniversary

You can talk about his rise from poverty in Robeson County to become the first native American student as an undergraduate AND a medical student at Wake Forest. You can talk about his contribution to Family Medicine at the state and national level as president of the NC Academy of Family Physicians (1972) and the American Academy of Family Physicians (1988).

As we celebrate the NCAFP’s 75th Anniversary, we lost a key figure in the history of Family Medicine in North Carolina in May: James G. (Jim) Jones, MD. I had the honor and privilege to speak at his funeral services in Hampstead, along with Dr. Robin Cummings (Chancellor of UNC-Pembroke), Dr. Paul Cunningham (former Dean of the Brody School of Medicine at ECU), Dr. Allen Dobson (past president of NCAFP and past president of Community Care of North Carolina), Dr. Doug Henley (past Executive Vice President and CEO of AAFP and a former president of both the NCAFP and AAFP), Ms. Lydia Newman (Executive Vice President and Chief Administrative Officer of CCNC), and Dr. Tommy Newton (another past president of NCAFP). I was humbled to speak in such an esteemed group.

You can mention his role in bringing health care to so many in eastern NC through the establishment of the Brody School of Medicine at ECU and through his position as first chair of the Department of Family Medicine (he was instrumental in getting the medical school established at ECU). And you can mention him serving as chair of Jim Hunt’s Health Care Commission. For mere mortals, any of these would be a lifetime achievement, but this was the godfather, Jim Jones.

Former NCAFP President Dr. James (Jim) Jones

But it’s the personal connections that Jim made that are so, so meaningful. He took so many of us under his wing — med students, residents, or just folks like me. It was the personal time together that had the most lasting impact.

My goal was to represent you, the family physicians of North Carolina, and discuss the impact Dr. Jones had on Family Medicine. He truly is a part of our history. And so, I thought it was fitting to publish my remarks in our magazine:

The personal stories he shared — whether it was his adventures at AAFP elections or patients getting bit by a dead snake — were the stories that brought us so much joy.

“First, I am humbled to be asked to talk about such a great man, and hope I will do an adequate job to summarize how so many people, especially the family physicians of North

Just a couple years ago, my wife and I had the opportunity to be at Jim and Michelle’s house when he recorded a podcast with Dr. Tom White: "The Family Doctor, Lessons Learned. Wisdom Shared." I was providing tech support in

And he was always there for advice. I don’t know how many applicants to med school he helped along the way, including my own son….

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Hampstead with Dr. White on the other end of recording a Zoom session.

joined his classmate Tom Kitchen, MD, and started the JonesKitchen Clinic in Jacksonville.

The podcast ended up being 50 minutes of Jim’s wisdom and stories. But after the formal recording ended, we were on the Zoom with Dr. White for well over another hour. I so wished we had recorded all of that too, because it was more of Jim’s humor, stories, and wisdom.

"Dr. Jones was active in the North Carolina Academy of Family Physicians, serving as its president in 1972. It was at this time he learned of the lack of generalist physicians to provide care to North Carolina’s most vulnerable citizens. He became a passionate advocate lobbying the legislature for the establishment of a new medical school with the express mission to train more family physicians and primary care physicians to serve rural parts of the state. He was instrumental in the development of the Family Medicine program at East Carolina University’s new school of medicine and went on to serve as the founding chair of the Department of Family Medicine and Associate Dean for Rural Health for two decades.

But truly, that’s how I felt every time I talked to him. What a privilege to have time with Jim. We all feel that way. And we all thank God for Jim’s life, his impact on so many, his impact on the state, and his impact on the specialty. To close, I want to say that Jim was truly like another father to me — the GODFATHER — especially for my time working in Family Medicine. And, boy, all I can say is I am much better of a person because of the impact of Jim Jones.”

"In 1994, he was appointed by Governor James B Hunt Jr as the first Executive Director of the North Carolina Health Planning Commission. Dr. Jones was elected President of the American Academy of Family Physicians, a national organization, in 1988 and continued his advocacy by establishing a Student Scholarship program to further s you look back at the history of Family Medicine in the interest of medical students in Family Medicine. North Carolina, Jim Jones’s name has to be at More locally, he also helped found the North or near the top of the impact any individCarolina Albert Schweitzer Fellows Program, ual family physician has had in our state. Here which funds students to develop programs are just a few other facts about his life and cato serve underserved communities. He reer from his obituary: served on the board of trustees of Coastal Carolina Community College and the "Dr. Jones was raised with his four sibUniversity of North Carolina at Pembroke lings by his paternal grandparents, Arserving the later as Board Chair. thur C. and Dovie L. Jones, on a rural farm Anniversary in Pembroke, NC. He helped support the 1947-2023 "Amongst his awards are the Order of the Long family by delivering newspapers to the local Leaf Pine given in 1988 by Gov. James G Martin community. It was here his faith in God and adand honorary doctorate degrees from the University of miration of Dr. Albert Schweitzer informed his desire to North Carolina at Pembroke and Mars Hill University. In become a medical missionary. This faith guided his vision January of this year, he was honored through funds raised and his actions. Upon graduation from Pembroke High by friends and family with a Distinguished Professorship School in 1951, Dr. Jones earned a two-year degree from in Family Medicine at the Brody School of Medicine. He Mars Hill College. He continued his education at Wake was described by other doctors as a 'Giant in medicine in Forest University and then attended Bowman Gray School North Carolina' and was known for his famous saying, 'The of Medicine. He was not only the first Native Ameriquality of your health care should NOT be determined by can but also the first minority to integrate both schools. your ZIP Code.' Indeed, he concluded his medical career as a simple ‘country doctor’ in Maple Hill, NC. He never "It was during his tenure at Bowman Gray he came home retired from sharing his faith and continued to teach Sunto support the Lumbee tribe at the historic Battle of Hayes day School and participate in a Clinton Men’s Bible Study Pond. After a rotating internship at Grady Memorial until his death.” Hospital in Atlanta, he served his country in the United States Navy as a medical officer at Camp Lejeune Marine Corp Base. Following an honorable discharge in 1962, he

Summer 2023

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

North Carolina Selected to Test New Medicare Alternative Payment Model In early June, the Center for Medicare and Medicaid Innovation (CMMI), the innovation arm of the Centers for Medicare and Medicaid Services (CMS), announced a new primary care payment model – the Making Care Primary (MCP) Model – that will be tested in eight states, including North Carolina. In announcing the new model, CMMI noted, “Access to high-quality primary care is associated with better health outcomes and equity for people and communities.” The announcement went on to add that “MCP is an important step in strengthening the primary care infrastructure in the country, especially for safety net and smaller or independent primary care organizations. The model seeks to improve care for patients by expanding and enhancing care management and care coordination, equipping primary care clinicians with tools to form partnerships with health care specialists, and leveraging community-based connections to address patients’ health needs as well as their health-related social needs.” The new model reflects many of the recommendations for value-based primary care that the American Academy of Family Physicians (AAFP) has been sharing with CMMI for several years, including enhanced investment, reduced administrative burden, and increased alignment across payers. While we are excited for the launch of this program, the AAFP and NCAFP are undertaking a full review of the technical specifications of the model as more details continue to become available. In addition to North Carolina, CMS will test the model in Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, and Washington. CMMI plans to partner with state Medicaid Agencies in these eight states to engage in full care transformation across payers. NC Medicaid is exploring how they can potentially

participate in the model, and the NCAFP is encouraging both Medicaid and commercial payers in the state to examine how their value-based payment efforts could align with Medicare’s plans. Below are the basic details of the model, with greater discussion to come: Model Logistics • Making Care Primary is a 10-year model test beginning in July 2024 • CMMI will define participating units by Tax Identification Numbers (TINS) instead of brick-and-mortar practices, as previous primary care models have done • Practices must have a minimum of 125 fee-for-service Medicare beneficiaries Payment Methodology • Practices to gradually move from predominantly fee-forservice payment to higher levels of capitation • Includes no downside risk. • Pays an incentive for performance on each quality measure instead of creating a quality gate. • Incorporates a new primary care focused patient-reported outcome measure – the Person-Centered Primary Care Measure for which the AAFP has been an avid champion • Includes payments which will be risk adjusted to reflect a patient’s clinical and social needs in alignment with the AAFP’s Guiding Principles for Value-based Payment Model Overlap Previous CMMI primary care models have allowed some degree of overlap with other payment models/approaches, but MCP will not. For example, practices currently enrolled in the Medicare Shared Savings Program (MSSP) that wish to join MCP must disenroll from MSSP before Jan. 1, 2025, to participate in the model “The Making Care Primary Model represents an unprecedented investment in our nation’s primary care network and brings us closer to our goal of reaching 100% of traditional Medicare beneficiaries and the vast majority of Medicaid beneficiaries in accountable care arrangements, including advanced primary care, by 2030,” CMMI Director Liz Fowler said in the news release. The MCP Model will provide participants with additional

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revenue to build infrastructure, make primary care services more accessible, and better coordinate care with specialists. CMMI expects this work to lead to downstream savings over time by improving preventive care and reducing potentially avoidable costs, such as repeat hospitalizations.

format of quality measures. As an example, the MCP model only includes 10 quality measures to reduce administrative burdens. CMMI will also encourage other payers to move away from fee-for-service into an aligned prospective payment model.

The model includes a progressive three-track approach based on participants’ experience level with value-based care and alternative payment models. Participants in all three tracks will receive enhanced payments, with participants in Track One focusing on building infrastructure to support care transformation. In Tracks Two and Three, the model will include certain advance payments and will offer more opportunities for bonus payments based on participant performance. This approach will support clinicians across the readiness continuum in their transition to value-based care.

Payment Model Changes

Background on Each Track If a practice enters in Track 1, they start by remaining in a fee-for-service payment model. However, CMS will provide additional financial support through infrastructure development payments. The payments can be as much as $72,500 at the beginning of the first year and a second payment of $72,500 at the beginning of the second year. In Track 2, participating practices are asked to partner with social service providers and specialists, implement care management services, and systematically screen for behavioral health conditions. Payment will shift partially to prospective, population-based payments. Participants are eligible to earn increased financial rewards for improving patient health outcomes and achieving savings. These bonuses can equal up to 45% of the amount achieved through a combination of the fee for service and prospective payments. Finally, in Track 3, practices will use quality improvement frameworks to optimize and improve workflows, address silos to improve care integration, and deepen connections to community resources. Payment for core primary care services will shift fully to prospective, population-based payment while CMS will provide financial rewards of up to 60% of total Medicare payments for improving health outcomes and achieving savings.

CMMI has also offered a few more specifics on payment changes. Over time, a Prospective Primary Care Payment (PPCP) replaces fee for service revenue for beneficiaries attributed to this model. The payment will reflect participants’ historical primary care billing. CMS will use a methodology that bases a portion of the PPCP on regional spending trends for Track 3 participants. CMMI will also provide Enhanced Services Payments (ESP). These will be risk-adjusted per beneficiary-per month payments to participants in all three tracks in addition to payment for typical primary care services. However, these payments decrease as participants build capacity. In addition, CMS will provide upside only bonus payments (Performance Incentive Payments) based on quality, utilization, and cost. The percentage of bonus potential increases with each track reaching as much as 60% in Track 3. Finally, practices participating in this model will be eligible for additional payments to support specialty care integration. Participants in Tracks 2 and 3 can receive a $40-per-service payment (subject to geographic adjustment) when they send an eligible e-consult to any specialist, to encourage coordination between primary care and specialty care. Second, when a practice is in Track 3, a specialist can bill an Ambulatory Co-Management (ACM) Code for time-limited co-management activities designed to encourage specialist involvement with primary care practices. As more information on the model is released and specifics about applying to participate become available, we will cover them in our e-newsletter, NCAFPNotes, and also store this MCP information on our website at www.ncafp.com. In the meantime, you can find the Making Care Primary website at https://innovation.cms.gov/innovation-models/ making-care-primary.

CMMI plans to work with other payers in the selected MCP states to encourage close alignment in areas that directly reduce burden on clinicians, such as the type and

Summer 2023

PROFESSIONAL DEVELOPMENT By Kathryn Atkinson, CMP NCAFP Director of CME & Events

2023 WINTER FAMILY PHYSICIANS WEEKEND

Celebrating Family Medicine Milestones… and You!

During your online registration, select Saturday’s optional CME lunch, where you will also discover ways to enhance clinical workflow efficiency through technology and a teambased approach — all while promoting physician well-being. A dedicated Sunday session also aims to keep you mentally fit and physically strong so that you can continue to provide the best care for your patients. As any great December meeting should, this conference just keeps on giving! The main schedule is filled from start to finish with can’t-miss learning opportunities brought to you by Family Medicine experts. When the afternoons

Bring on the celebrations! This year’s Winter Family Physicians Weekend, scheduled for Nov. 30–Dec. 3, 2023, will mark the NCAFP’s 75th Anniversary, and we can hardly wait to celebrate this fantastic milestone with you! Your program chair, Dr. Tamieka Howell, and your program vicechair, Dr. Thomas White, have a fantastic weekend planned. By their leadership, this year’s premier learning opportunity at the Omni Grove Park Inn promises over 30 CME credits, endless networking opportunities, and lots of fun. With several fun surprises to commemorate our diamond jubilee, we promise this is the one annual conference you do not want to miss! Expect to enjoy a wide range of sessions on new treatment options, patient care, physician well-being, and technology brought to you by the best and brightest experts in primary care. Mainstage sessions will address continuous glucose monitoring, pediatric atopic dermatitis, Hepatitis B, hormone replacement therapy, weight management, autism, diabetes, sports medicine, bipolar disorder in adults, adolescent mental health, atrial fibrillation, narcolepsy, Alzheimer’s Disease, chronic kidney disease, NASH fatty liver, CVD prevention, osteoporosis, lung cancer, cancer screening, and many other subjects. Your NCAFP CME Team is also excited to include a variety of CME sessions focused on prioritizing physician health and well-being. While the GPI will not let us host these physician wellness sessions in their world-class spa (even despite my best efforts!), we have carefully integrated them into the schedule so you can take full advantage of them. Thursday afternoon’s general sessions include presentations on ways to remain sane while managing your overflowing email and cool coding tips to save you time and money.

roll around, the optional workshops and social activities are just as fantastic. In other words, you’ll have some hard decisions to make when it comes to how to spend your afternoons in Asheville. If you arrive on Wednesday, Nov. 29, you can participate in the optional KSA on Diabetes or the optional Long-Acting Reversible Contraception workshop. The group-study KSA offers 10 ABFM activity points and eight prescribed CME credits. The two-hour pre-conference LARC CME workshop combines interactive didactic sessions with practical training using medical models. Additionally, take advantage of the osteopathic manipulations workshop on Thursday afternoon, where you’ll learn hands-on manual techniques to address musculoskeletal issues, reduce pain, and improve mobility in your patients. There is also an important preceptor workshop that afternoon for active preceptors (or those seeking to learn more about precepting!). This workshop underscores the need, value, and importance of precepting and spotlights ways to share your Family Medicine enthusiasm and expertise with medical students.

The North Carolina Family Physician

On Friday afternoon, you can pick up 1.5 credit hours towards NC’s controlled substance training requirement with a 90-minute optional opioid and pain management workshop. Or, choose to attend our first-ever persons of color dermatology workshop. This applied learning session will teach ways to deliver safe, effective, and culturally-competent skincare procedures to a diverse patient population. As a reminder, Friday morning’s annual Practice Management Seminar, co-hosted with the NC Medical Society, is always a terrific opportunity for physicians and office staff to improve their practice management skills and knowl-

facials, relaxing massages, and more. Guests staying at the Grove Park Inn should book their spa appointments soon. It’s important to recognize this annual weekend of CME and camaraderie would not be possible without our many terrific sponsors and vendors. Believe it or not, the exhibit hall offers more than just coffee and yummy snacks. Be sure to take advantage of this bustling hub filled with over 70 vendors committed to Family Medicine. We kindly invite you to show your appreciation for their support and explore the exhibit hall daily to connect, network, and discover their many resources and valuable offerings. Even better, many sponsors offer door-prize drawings and other spectacular giveaways! Last but certainly not least, Saturday evening’s Presidential Gala is always the pinnacle of the weekend’s festivities. Join us as we pay tribute to the remarkable legacy of Family Medicine and acknowledge the many contributions of our esteemed leaders throughout the years. We will formally introduce your newest NCAFP Board Members and inaugurate Dr. Garett Franklin as your 2024 NCAFP President. The commemorative evening will include a gourmet meal prepared by the GPI chef, a brief live auction to support the NCAFP Foundation, and live music by the NCAFP’s unofficial Winter Weekend band, Too Much Sylvia. Dress in your favorite holiday attire, wear your dancing shoes, and prepare for a night of fun memories and Family Medicine celebrations.

edge. Discussions during this year’s optional seminar will include collaborative care and behavioral health integration, minimizing malpractice and regulatory risks, and highlighted innovations in practice. Conference attendees can add this concurrent session to their conference registration for an additional $45. Those interested in attending only the Practice Management Seminar can register and attend the course for $55. If you still want more after a full day of learning, here are a few more suggestions to enhance your conference experience. Enjoy a self-guided candlelight tour of the Biltmore House with family and friends on Thursday evening. Delight in the merriment and breathtaking holiday decorations as you stroll through the magnificent estate. Be sure to add your tickets to your online registration and pick them up when you check into the conference. (Transportation will be your own.) Take your conference experience to another level with a visit to the Grove Park Inn’s renowned spa. Choose from revitalizing body treatments, soothing

Summer 2023

Your NCAFP is proud to continue this tradition of topnotch CME led by Family Medicine experts in a beautiful, relaxed setting. Plan to join us for another unforgettable weekend filled with meaningful learning, camaraderie, and fun surprises to commemorate our 75th Anniversary. We cannot wait to celebrate you and the essential work that you do. We sincerely hope to see you there! Registration is open, and full conference details are available at www.ncafp.com/wfpw. Please contact Kathryn Atkinson, CMP, Director of CME & Events, at Katkinson@ncafp. com with any questions.

Approx. 1.75 Credits Available! Victoria Boggiano, MD, MPH Program Co-Chair

Ryan Paulus, DO Program Co-Chair

Experience a convenient and enjoyable learning opportunity this September! Join us for a lively public health-centered CME & Dinner Program where you will gain new knowledge to make positive impacts on your patients and communities. This after-office hours educational program offers the perfect blend of camaraderie and CME sessions. We think you'll enjoy the 30 minute session topics, and you'll love the chance to fellowship with colleagues and friends.

Topics Include: Geriatric Care in NC Health Impacts of Climate Change in NC Hepatitis C, HIV, & Hep B in NC

Registration Fees $25 Member Physicians $15 Member Residents $35 Non-Members

A casual light dinner will be provided by Med Deli!

Get full details and register at www.ncafp.com/unccme 16

Contact Kathryn Atkinson, CMP - Director of NCAFP CME & Events with Questions

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Virtual CME at Its Best: A Recap of the 2023 Virtual Summer Symposium By Kathryn Atkinson, CMP NCAFP Director of CME & Events

Your NCAFP CME Team hosted our third annual Virtual Summer Symposium on June 24. The convenient program provided a super-fun and lively web-based learning opportunity for over 150 family physicians and their health care partners. We are so grateful to everyone who participated. We know you have many choices when it comes to receiving your CME, and we were delighted to have you with us that day. Thank you for being a part of the learning and fun! For those unable to join us at the Symposium this year, I’d like to share more about the virtual format and its learning opportunities (so that you can be sure to join us next year!). With various 60-minute, 45-minute, and 30-minute learning sessions, the day provided six AAFP Prescribed Credits and a T2P Opportunity for an additional two credits. The Saturday sessions themselves included clinical updates on common MSK injuries, asthma, obesity, opioid use disorder, cardiovascular health, dementia, physician self-care, hospice care, and autism. Over 60 attendees also took advantage of a pre-conference KSA on behavioral health for an additional eight CME credits. Many attendees earned up to 16 prescribed credits over the weekend — all from the convenience of their favorite locations. For enhanced production value and to mitigate technical difficulties, expert guest faculty pre-recorded their lectures to suit the virtual format. Then, as the recorded sessions played during the webinars, presenters actively engaged with attendees by typing replies to their questions in the Q/A box of the platform. In the final five minutes of each session, faculty appeared live via video feed, allowing further interaction with the audience. During this live segment, presenters answered additional questions posed by the program chairs. If attendees wanted to discuss a topic further or ask additional questions, they met with the presenters

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in the “Meet the Expert” Zoom room. This practical approach to delivering virtual CME allowed members access to high-quality content while also providing opportunities for active participation and direct interaction with the presenters. According to their feedback, attendees greatly appreciated the virtual learning opportunity and all that it offered. Here are a few of our favorite comments from the overall conference survey: “This was very well done, with lots of great information! Thank you!” “I think your platform for this conference is excellent. I’ve been doing a lot of virtual CME in the past three years — Harvard, Mayo, Cleveland, AAFP, AMA — and this is the best platform to be able to submit questions and do the speaker evals that I have seen.” “Very good virtual event. Great CME. Great technology!” “This was great!!! It was easy to log in, interactive, and gave ample time to get another cup of coffee without missing a thing.” “Great topics today. This format worked very well. Thank you!” The NCAFP Meetings Department would also like to extend a big heartfelt thank-you to program chair, Dr. Jessica Triche, program vice-chair, Dr. Dawn Caviness, and the many terrific guest faculty who shared their expertise and knowledge with our attendees. The dedication and hard work of members like you are vital to making the our terrific CME opportunities possible. Thank you again to everyone who joined us, and we hope you will join us again next year! Please contact Kathryn Atkinson, CMP, Director of CME & Events with more information on the NCAFP’s many terrific learning opportunities at Katkinson@ncafp.com.

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Sights & Scenes from Chapter Events

Summer 2023

MEMBERSHIP SERVICES By Kevin LaTorre

NCAFP Communications & Membership Manager

Two Executive Board Members Appeared in a Triangle Business Journal Cover Story As the business models and workplaces of North Carolina health care change, physician input only gets more crucial. That’s why we’re thrilled that the Triangle Business Journal spoke with NCAFP President Dr. Shauna Guthrie and President-Elect Dr. Garett Franklin about making medicine work for their patients and practices.

But Ezzone writes that the arrival of Medicaid Managed Care in North Carolina has complicated the choices and parties that physicians have to work with. “There’s no model of primary care that’s perfect,” Guthrie said. “If there was, we’d all be doing that.” As the Triangle Busines Journal article shows, the business of primary care has many answers and even more challenges. We continue to advocate for the best methods to serve your patients and pay you for your good work. Seeing Dr. Franklin and Dr. Guthrie publicly describe their experience only reiterates the valuable insight that family physicians have in this so many areas of healthcare, including the business side.

NCAFP President Dr. Shauna Guthrie

Reporter Zachary Ezzone covered the financial outlook of health care in our state, including the realities for physicians and their workplaces. That’s why Dr. Franklin was able to comment on working at Raleigh Medical Group, a large independent practice based in Raleigh. “I joined NCAFP President-Elect this practice because of the flexDr. Garett Franklin ibility,” Dr. Franklin said. “You have a say in the day to day, and I could craft how many patients I see. Also on the business side, I can get involved with contract negotiations.” That said, he also mentioned the trouble of recruiting new physicians and the tenuous place that primary care still faces: “Primary care lives on the margins.” Dr. Guthrie spoke about her experience leading Sun20

flower Direct Primary care, which operates on a “membership-based model” in which patients pay monthly fees and Guthrie sees them when needed. She explained that this model means Sunflower Direct Primary Care doesn’t have to bill insurance nor face the full brunt of administrative burden that requires. “The benefit for the physicians,” she said, “other than the immediate cash flow...is [physicians] want to focus on people, not filling out spreadsheets and forms.”

Former NCAFP President Dr. William Hedrick Has Retired This month, Family Medicine icon and former NCAFP president Dr. William Hedrick announced his retirement after 61 years of treating patients in the Raleigh area. At the time of his retirement, Dr. Hedrick was one of our state’s longest-tenured physicians. He first began Former NCAFP President Dr. William Hedrick practicing in 1962, and a quick anecdote from the WRAL interview celebrating his retirement illustrates exactly how long his career felt for his patients. “There was a patient came to me the other day,” Dr. Hedrick recalled. “He said, ‘You know doc, you did my high school physical.’ And now, he’s 70.” Dr. Hedrick delivered, healed, and cared for over 2,500 patients at the time of his retirement. For all of them,

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Dr. Hedrick says he pursued one goal in his treatment: “Making people feel better and making them live longer lives,” he said.

munity has been anemic as the COVID-19 pandemic has waned, and I would like to be part of the effort to regain the trust of the public.”

Of course, Dr. Hedrick has also improved the health and longevity of Family Medicine in our state. After joining the NCAFP in 1966, he soon rose to leadership and served as the Academy’s president in 1975. But he wouldn’t claim that leadership role as the pinnacle of his medical practice in North Carolina — Dr. Hedrick has long shown that devotion to his patients is his primary concern, first at WakeMed but then in the decades since through his independent practice. Congratulations, Dr. Hedrick!

Dr. Anthony Viera Received the Leonard J. & Margaret Goldwater Distinguished Professorship

Dr. Llewellyn Mensah Became a 2023 AAFP Vaccine Science Fellow Earlier this summer, the American Academy of Family Physicians (AAFP) announced its 2023 Vaccine Science Fellows. This year, the two fellows include NCAFP member Dr. Llewellyn Mensah! Dr. Llewelynn Mensah We’re thrilled that Dr. Mensah was named as one of only two Vaccine Fellows. The fellowship helps develop family physicians’ skills and knowledge surrounding vaccination, to connect public health with Family Medicine in practice. Dr. Mensah and the other fellow will receive guidance from AAFP physician mentors as they gain practical hands-on experience in vaccine science and policy by meeting with experts in immunization, public health, policy groups and vaccine manufacturers. They will also develop a self-study project to be disseminated to AAFP membership, public health officials, and other stakeholders.

“I believe having a strong background in vaccine science will be a valuable asset for any public health professional looking for a leadership role,” said Dr. Mensah. “Another reason I want to become a vaccine science fellow is to be able to better address vaccine hesitancy. The enthusiasm for vaccination in my com-

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Recently, Duke Family Medicine and Community Health announced that Dr. Anthony Viera received the Leonard J. & Margaret Goldwater Distinguished Professorship from Duke Dr. Anthony Viera University. “He is the first member in the department’s history to earn this recognition,” the announcement read. Dr. Viera received the honor from Duke President Vincent Price and Interim Provost Jennifer Francis during a ceremony with other recipients on May 4, for his “commitment to scholarly excellence and mentoring the next generation.” Dr. Viera has served as chair of the Family Medicine and Community Health Department since 2017. His research interests include cardiovascular disease prevention through improving detection and control of hypertension, ambulatory blood pressure monitoring, and obesity prevention. “It is an honor to be named the Leonard J. & Margaret Goldwater Distinguished Professor. I am especially humbled that this simple country doctor is among such an amazing community of researchers and scholars,” he said. Congratulations, Dr. Viera!

Dr. Ryan Paulus Received Funding for New POCUS Training Dr. Ryan Paulus has received funding for a new point-of-care ultrasound (POCUS) program from the Society of Teachers of Dr. Ryan Paulus Family Medicine (STFM). Dr. Paulus is first-year faculty at UNC, and he has long recognized the need for a certificate program for POCUS in Family Medicine (as you might remember 21

from his presentation at the 2023 Academic Summit in February). He proposed the idea of a POCUS certificate program to the STFM in order to provide more opportunities for Family Medicine residency faculty to get trained in POCUS. “They have been amazing to work with and have been very excited about the project,” Dr. Paulus said. The STFM board approved the project at the Annual Conference in April and gave Paulus the approval and funding to move forward with the development of the program. It will focus on teaching POCUS with a particular emphasis on spreading this technique through a “train the trainer” model. It will include hands-on workshop learning, longitudinal components, and mentorship. “This wouldn’t have happened without the support and mentorship from [UNC POCUS Curriculum Director] John Doughton,” says Paulus, “I consider him my POCUS mentor, and he was instrumental in helping me design this project.” At that same Annual STFM Conference, Dr. Paulus also received approval to develop a POCUS Collaborative. He will serve as the Collaborative’s chair and intends for it to connect like-minded providers and their POCUS ideas within Family Medicine.

Dr. Adam Goldstein Received a UNC Award and Visited the White House In June, Dr. Adam Goldstein was named the Elizabeth and Oscar Goodwin Distinguished Professor of Family Medicine at the University of North Carolina. He was one of only six professors in the School of Medicine to receive this honor, since an appointment to a distinDr. Adam Goldstein guished professorship is one of the highest faculty honors UNC can bestow. These awards give research funds along with the honorary title. Dr. Goldstein also serves as the Director of Tobacco Intervention Programs in the School of Medicine, and his research measures the impact of health policies in tobacco regulatory science, patient-centered tobacco cessation, and disparities in tobacco use. His medical leadership has included mentoring and teaching countless medical personnel both in our state and around the world and even culminated in his place at the first-ever Cancer Moonshot Smoking Cessation Forum at the White House on June 1. The Forum joined leaders from across federal, medical, and community organizations to discuss strategies to reduce smoking nationwide. “My visit to the White House was a phenomenal opportunity and experience,” said Dr. Goldstein. Congratulations to Dr. Goldstein on this prestigious honor!

~ Member Spotlight ~

Dr. Melissa Ratliff Dr. Melissa Ratliff took the scenic route to Family Medicine. But she reached the destination that even she couldn’t anticipate when she founded and opened Ratliff Integrative Family Medicine in Waxhaw, NC in May 2023. “I went to medical school at age 35 with a threeyear-old and an eight-year-old,” says Dr. Ratliff. She explains that she had become “stir-crazy” as a stay-at-home mother and so told her husband she wanted to attend medical school. Dr. Ratliff had already graduated from Dr. Melissa Ratliff Davidson College near Charlotte with a degree in chemistry and worked as a chemist for a time. But she wanted to return to school for the medical career she’d originally planned at Davidson: “I craved that intellectual stimulation,” Dr. Ratliff says. During her time in medical school, she found herself drawn to Family Medicine by her own family doctor, Dr. Sinclair McCracken. “She was a great mentor to me as my family doctor,” says Dr. Ratliff. “She’s the one who encouraged me to pursue the specialty.” Once she’d graduated from Eastern Virginia Medical School, Dr. Ratliff returned to North Carolina to attend the Carolinas Medical Center Atrium Family Medicine Residency. After residency, Dr. Ratliff would spend nine years at Novant Health, including five years as the lead physician in her practice. But during her time there, she began thinking about what she wanted

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from the future: “As things played out in life, I thought maybe there were some other options,” she says. “Maybe I needed something a little less stressful, because the work was really tough.” To explore other options, Dr. Ratliff left Novant Health to take up concierge medicine alongside an integrative medicine fellowship. By then, she began planning her next step: “I’d always had in the back of my mind the idea that I’d like to have my own practice someday.” After her time to plan and learn, Dr. Ratliff opened that practice on May 1. She says that she has just enough room for her existing patient population. “My previous practice is about 10 minutes away,” Dr. Ratliff says, “and so I have a large patient base already down here.” She is currently renting a room from a clinic to see those patients in person. “I just have an 11-by-11 room as my office, with my desk, my exam table, and all my equipment.” This size and lack of formality suits what Dr. Ratliff wants for her patients, she says. “It’s a quaint little room,” she says, “just a good place to talk. It feels like home.” The direct primary care model at Ratliff Integrative Family Medicine will also have the personal touch that first motivated Dr. Ratliff to become a doctor. “The frustration with practicing in the traditional fee for service world is not having control over your schedule or which patients you can see,” she says. “I really wanted to be free to have autonomy and practice medicine the way I dreamed it would be: having time to connect with my patients.” Her time in concierge medicine showed her the benefit of longer visits with her patients, Dr. Ratliff says. “My patient visits were for an hour, even an hour and a half,” she says. “I really enjoyed having that experience with my patients instead of the traditional 15-minute appointment.” That’s the experience she’s now building for her patients in Waxhaw, and she’s glad to do it: “I figured out what I needed to do.” We’d like to thank Dr. Ratliff on behalf of her current and future patients in Waxhaw!

NCAFP FOUNDATION By Shawn Parker, Esq. NCAFP General Counsel

NCAFP Foundation Selects Three Practices to Participate in a Pilot Program that Funds the Use of Additional Scribes/MAs

“rooming” and managing both virtual and in-person visits add to the strain on practices. This is most difficult in our rural and underserved areas where the health care system is already stretched thin. Prior research has indicated that adding scribes (or additional scribes and/or medical assistants) increases productivity and enhances physicians’ practice experience.1 By adding an additional scribe or medical assistant, physicians can be more efficient, spend more time with patients, reduce charting time, and improve work-life balance, reducing the risk of burnout. However, there has been little research on using the model with a combination of virtual and in-person visits in a post-COVID world.

As reported earlier this year, the NCAFP Foundation received a significant donation from UnitedHealthcare to support small practices that are integrating telehealth and in-person visits. The project was designed to help fund new employees at three small practices for a year to better integrate in-person and virtual visits into those practices’ workflows. The idea is to improve practice efficiency in order to increase access to care in our state’s rural and underserved areas and reduce administrative burdens borne by physicians using telehealth. A committee of the NCAFP Foundation selected the following three practices to participate in the year-long project.

The Pilot reduces up-front financial risks to practices by funding the cost of adding one or two new scribes or medical assistants per practice for one year, with the goal that this investment will ultimately bring additional efficiencies and potentially be self-sustaining. The Pilot funding should allow the practice to re-engineer their workflow and test various ways to increase patient access and efficiency with the hope that the efforts are replicable across similarly situated practices.

“We are thrilled to be partnering with UnitedHealthcare on this innovative pilot project to evaluate the benefits of additional support in increasing access in small practices,” says Greg Griggs, NCAFP Executive Vice President and CEO. “It is this type of innovation that can lead to greater access to healthcare for the most vulnerable North Carolinians.”

New Hanover Community Health Center, Inc. d/b/a Med North Health Center Wilmington, NC (Eastern Region)

GENESIS OF THE PILOT: BACKGROUND AND GOALS

During COVID-19, telehealth utilization accelerated greatly. However, as practices returned to more normal schedules, the difficulty of maintaining both telehealth and in-person visits has led to some primary care practices drastically reducing or eliminating the telehealth component of their practice. COVID-19 also exacerbated the problems of burnout among primary care physicians. The complexity of

PRACTICES AWARDED GRANTS TO PARTICIPATE IN THE PILOT

MedNorth Health Center is a federally-qualified health center (FQHC) that provides a full spectrum of primary and preventative health care services (including essential ancillary and enabling services) to medically-underserved populations in New Hanover and surrounding counties in Southeastern North Carolina. Patients receive services regardless of their ability to pay. Their services are designed to cover prenatal, pediatric, adolescent, adult, and geriatric life cycles. In 1993, MedNorth (formerly New Hanover Community Health Center) was incorporated as a non-profit organization and also received a 501(c) (3) Internal Revenue Service Classification. New Hanover Community Health Center saw its first patient in the spring of 1994 and has been in continuous service since that year.

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Clinton Medical Clinic Clinton, NC (Central/Eastern Region) Clinton Medical Clinic (CMC) was founded in 1969 and has provided comprehensive primary medical care to the residents of Sampson and surrounding counties for over 54 years. CMC offers primary care for both adult and pediatric populations. In addition, CMC offers bone density screening, CT Scans, echocardiograms, immunizations, laboratory testing, minor procedures, nuclear stress testing, physical exams, preventative care, psychological testing/counseling, pulmonary function testing, vascular studies, X-ray and diagnostic ultrasound, and telehealth services. CMC strives to ensure care is accessible by accepting patients by appointment and walk-in visits daily. Weekend call is available on both Saturday and Sunday. CMC is located in the heart of rural Sampson County and services a large Medicaid population base. Hodges Family Practice, Inc. Asheboro, NC (Central/Western Region) Hodges Family Practice serves patients in the age range of 1 day to 103 years of age. The practice provides traditional Family Medicine with a new emphasis on lifestyle medicine and wellness, as well as chronic disease manage-

ment. The practice has a robust Chronic Care Management and Remote Patient Monitoring program to assist in disease management. Hodges Family Practice has a very dedicated, welcoming, and focused team consisting of doctors, physician assistants, nurses, health coaches, lifestyle coaches, and nurse educators. They provide 24/7 access to health advice for their patients, and providers are available by phone and via the patient portal with direct messaging. Hodges Family Practice works closely with the area's urgent care clinics to provide after-hour care and on the weekends with a goal to prevent unnecessary hospital ER visits. Hodges Family Practice works directly with all medical and surgical specialties to provide co-management of medical issues, including mental health care. Thanks again to UnitedHealthcare for making this pilot possible. We also appreciate our selection committee, who reviewed the many diverse applications we received. We only wish we could have funded more than three practices. Finally, we look forward to working with our three pilot practices to implement this program and evaluate their results. We wish them the best as they kick off their pilot programs. 1. “Can Scribes Boost FP Efficiency and Job Satisfaction?” Journal of Family Practice, Vol 66, Issue 4, April 2017

RESIDENTS & NEW PHYSICIANS By Dr. Patrick Williams

NATIONAL ADVOCACY

Experiences at NCCL Meeting for A First Time Attendee I recently had the honor and privilege to represent the NCAFP as the New Physician Delegate to the National Conference of Constituency Leaders (NCCL). This was a new experience for me and my first experience becoming more directly involved in national policy.

The challenges we experience are the same challenges that they experience, and the camaraderie created by our common goals helps to put things in perspective. A primary standout at the NCCL meeting is the passion for progress, particularly in advocacy and equity. Anyone who has been involved with any governing body knows that the wheels of change can turn a bit slower than we would like. There are reasons for that, with safeguards protecting large entities from sudden upheavals and threats to the foundation of their philosophies. That being said, the NCCL is in many ways a direct challenge to the natural obstinacy of large organizations. There is certainly no shortage of urgency at the NCCL to move forward with many changes that are needed in practice and policy. Without going into details regarding the procedures for bringing about new resolutions, it’s clear that the process is designed to garner a wide variety of ideas for progress and present those to small groups for meaningful discussion. New ideas are numerous. Multiple resolutions are brought forward. Discussions regarding these potential resolutions are often passionate, but the professionalism of our colleagues even during times of conflict is inspiring. Then again, would we expect any less from family physicians?

For those of you who may not be familiar with this conference, the NCCL meets yearly to discuss issues affecting family physicians nationwide and to make resolutions to present to the AAFP. There were also votes for national representation to the AAFP Congress of Delegates, as well as to the AAFP Board of Directors. The NCCL consists of representatives from five constitDr. Patrick Williams uencies including women, minorities, new physicians, international medical graduates, New resolutions were quite varied, ranging and LGBTQ+ physicians. The conference is an opfrom equality to education to advocacy at the national portunity for underrepresented physicians to voice level. It was clear that the unique perspectives brought their perspectives and initiate change. I was excited to to the conference by the different constituencies conbe able to represent the new physician constituency. tributed quite significantly. Conversation and debate about resolution topics were especially rewarding. This One of the best things about all conferences is the opwould range from conceptualizing broad ideas into acportunity to connect with colleagues from around the tionable policy as well as debates on specific wording. country. The NCCL was no different in this regard. I had the chance to meet quite a few physicians from For instance, the resolution that I was personally invarious backgrounds who practice in all areas of Famvolved in regarded national perceptions of Family ily Medicine. Sometimes during the day-to-day work Medicine. The resolution was a call for the AAFP to of a family doctor, it’s common to feel a bit isolatcollect and provide data on stakeholder opinions and ed. We often forget that there are thousands of other assessments related to the value of care provided by physicians just like us putting in hard work towards family physicians. This resolution has the ultimate goal bettering the health of our patients and communities. of improving the national understanding of our spe-

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ADVISORY CAPITAL INSURANCE

cialty’s merit, particularly by insurance companies and large medical systems. One of the toughest challenges that I found at the conference was how to transform philosophical ideas into specific policies and position statements. Many times, it seems like certain ideas are universal, especially in Family Medicine. We have a passion for fairness and equality at all levels. We want a strong health care system that serves all of our patients and supports us as physicians. However, evolving these philosophical ideas into concrete actions that can be reasonably acted on with the resources at hand can be quite tricky. That was the goal, and the representatives were up to the challenge. A summary of actions can be found at https://www.aafp. org/events/aclf-nccl/nccl/business.html. The conference was great, and I got to brush up on leadership skills, parliamentary procedure, and hopefully help make some positive change.

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Lastly, I would be remiss if I didn’t mention how great it was to get to spend a little time outside of the conference with the other fine representatives of the NCAFP. We are blessed to have amazing doctors and wonderful people that represented your Academy well at both the leadership conference, as well as the NCCL. And just in case there was any question; yes, I did enjoy some Kansas City BBQ. I'd also like to thank my fellow NCAFP attendees, who were both instructive to me and effective in their advocacy for their respective constituencies: Dr. Tamieka Howell - Minority Dr. Tambetta Ojong - IMG Dr. Katherine Haga - Women Dr. Nicole Johnson - LGBT

CORPORATE SPONSOR OF THE NORTH CAROLINA ACADEMY OF FAMILY PHYSICIANS

ADVERTISE! Meet the whole office of Family Medicine professionals, all across North Carolina!

Summer 2023

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

STUDENT INTEREST & INITIATIVES By Perry Price Workforce Initiatives Manager

Growing Tomorrow’s Family Physicians Through Summer Precepting One of the highlights of the summer is the opportunity to interact with the medical students who participate in one of our summer programs! The students, fresh from their first year of medical school, have all chosen to spend time during their summer break to learn more about Family Medicine in various new settings. This summer, we were able to offer three different options for students — a rural health immersion experience in partnership with MAHEC Hendersonville, a suburban and rural immersion experience in partnership with Cabarrus Family Medicine, and a fourweek externship that could be anywhere in the state. While some of the students participating are already somewhat familiar with Family Medicine, others will enjoy their first exposure to the benefits, challenges, and endless pathways of the specialty in this program! This summer, 12 students from four different NC medical schools are participating in one of the three programs the NCAFP is offering. For this program to be successful, we rely on our member physicians to be willing to serve as preceptors and hosts for these students and to be strong ambassadors for family medicine! During their immersion experiences, the students spend the first week at the residency program, doing some clinical workshops, participating in lectures, visiting clinics in the community, and getting to interact with residents and faculty. They live with a resident or faculty member for that week, getting to see what daily life and schedules look like. During the

second week, the students are paired one-to-one with a practicing physician in the community, and they live and work with them. This total immersion in the life of a family physician is an incredibly impactful experience, as it affords the students a chance to see the impact family physicians have on their communities, alongside the numerous roles family physicians play any given week. Our four-week externship shows a different perspective: the students don’t live with their preceptor but instead spend four weeks shadowing them in their clinic, as well as participating in outside-of-work obligations that impact or are related to their practice. This experience gives students a broader picture of the variety of patients and cases a physician sees but also (once again!) allows them the chance to see family physicians’ impact up close! The relationships built between the students and their physician preceptors or hosts in these programs often last beyond the time they spend together, and they can have a huge effect on whether medical students decide to pursue Family Medicine in residency. That’s why the NCAFP and the NCAFP Foundation work in concert to ensure that these opportunities exist for all students who seek them out, and that the opportunities reach medical students across our state. We are truly grateful for our partners at MAHEC Hendersonville, Cabarrus Family Medicine, and the many preceptors and hosts that make this program possible! Landon Allen, MD Taineisha Bolden, MD Rhett Brown, MD Austin Bush, MD Josh Carpenter, MD Kim Causey, MD Stephen Causey, MD Deanna Didiano, DO Elizabeth Ferruzzi, MD Jeffrey Ham, DO Maggie Hayes, MD Bryan Hodge, DO

Aaron Lambert, MD Macy Latter, DO Maureen Murphy, MD Macy Osborn, MD Sarah Asman Peiffer, MD Caitlin Porter, DO Carson Rounds, MD Erika Steinbacher, MD Jenna Thomas, MD Julie Todd, MD Dwight Willet, MD Daniel Yoder, MD

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NORTH CAROLINA’S

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Resident & Student Research Poster Presentation David Lehrburger with Dr. Rhett Brown and Dr. Carson Rounds

Ryan Taylor (right) with Dr. Josh Carpenter

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

Students receive in-clinic training in Hendersonville.

Resident and Student members interested in participating must submit their application and all corresponding materials (including final PDF of poster) by October 1st, 2023.

PRACTICE MANAGEMENT By Gregory K. Griggs, MPA, CAE Executive Vice President & CEO

Continuing to Move Collaborative Care Forward in North Carolina The NCAFP continues to take part in the NC Collaborative Care Consortium, a group of associations, payors, and state officials working to encourage adoption of the Collaborative Care Model (CoCM) in North Carolina. Specifically, North Carolina’s Medicaid program hopes to move integration of behavioral health and primary care forward through the CoCM by supporting team-best care, alignment across payors, technical assistance to practices, and providing a state-ofthe-art registry for Medicaid enrolled practices. First, as a reminder, what is collaborative care? The CoCM is an evidence-based integration model designed to better utilize our scarce psychiatric resources where primary care physicians, psychiatric consultants, and behavioral health care managers work together to provide care and monitor a patient’s progress. It uses a population-based measurement approach to treat behavioral health issues (primarily depression, anxiety and ADHD) to target. The original evidence for the model comes from the IMPACT Study from 19982003, but there continues to be greater and greater evidence for a broader use of the model. To quote one local psychiatric consultant, Duke University’s Nathan Copeland, MD, MPH (chair of the legislative affairs committee of the NC Psychiatric Association), “In collaborative care, you see a lot of people getting better who might not have ever connected to a behavioral health specialist. It’s a really satisfying and meaningful experience to spend a couple of hours a week and help 80 to 100 people at a time.” Collaborative care uses a team approach, with primary

care physicians providing clinical care to the patient, a behavioral health care manager helping manage the patient to target, and the use of a psychiatric consultant to provide guidance to the primary care team. There are a few key components of the CoCM model: care management by someone trained in behavioral health, a designated consulting psychiatrist, outcome measurement, and stepped care. For example, if the team targeted a population of depressed patients, together the CoCM team would: • Identify and track depressed patients by using a screening and referral tool such as the PHQ-9 and have ongoing follow up and tracking • Enhance patient self-management through education and brief therapy • Provide additional supports for treatment, including medication and possibly specialty mental health care • Utilize psychiatric consultation for difficult cases Contact with a patient is made after a positive screen to conduct an initial assessment. Then treatment begins, which could include medication or therapy. Progress is tracked in an EMR or registry, and cases are reviewed on an ongoing basis with the primary care physician champion, the psychiatrist, and the behavioral health care manager. During active treatment, there are at least two contacts per month (a mix of in-person visits or phone follow-up) until there is a significant decrease on the screening tool, followed by a monitoring period where contact is less frequent. Thanks to the work of the collaborative, practice coaching is available through the NC AHEC Program. Certain small and independent practices that accept Medicaid can receive a state-funded registry through June of 2025 and then discounted rates after that point. In addition, Medicaid has increased funding for CoCM codes, which are filed “Incident To” the primary care physician and billed by the minute similar to Medicare’s Chronic Care Management (CCM) codes. Psychotherapy can be billed separately when needed. CoCM can now be billed to Medicare, Medicaid, and almost all commercial plans in North Carolina. And NC Medicaid increased their payment to 120% of Medicare as of last December.

The North Carolina Family Physician

So, what’s the value of CoCM? • It increases early intervention, hopefully catching behavioral issues when they are mild to moderate as opposed to when they are worse and may require higher levels of treatment • It increases the number of patients receiving care by better utilizing scarce resources • There is a proven increase in quality outcomes both for practices and the populations they serve • CoCM doubles the likelihood of patient improvement

CHICKENS: Continued from page 5

might be satisfied with only their food instead? I had a run-in with a raccoon about a year prior, so this culprit option seemed to make a lot of sense. Before I went ahead to fully raccoon-proof my chicken coop (keep in mind, these little guys have HANDS and can open doors and what not), I wanted to be sure. I opted for imaging to confirm my diagnosis (no prior authorization was needed, for once): I put a webcam in the coop and diligently checked it every morning until…GOTCHA! I was both glad and regretted having caught it on video. In a picture, I might have thought it was a possum by the way this not-so-little beast was tipping himself easily in and out of the top of the feeder around dawn. But I had VIDEO! And the movements told me this was no possum — I had a rat!! The “RatKing,” as he is (still) affectionately called by my clinic team. Mystery solved. I caught it early enough, right? RIGHT?? I had the diagnosis (W53.19XS other contact with rat, sequelae, among others) and now needed treatment. After thinking about treatment options I considered just throwing chicken food into the woods so the rats would go there instead of inside my coop but decided that the risk was too great of becoming the Rat Queen myself. The gold-standard treatment would be to pull up my coop, bury new mesh wire a foot deep around all its sides (the footprint of my coop and run is about 120 square ft), and bask in greatness knowing my chickens had received the best, most-expensive Summer 2023

If you are looking for additional information, please refer to the AHEC Technical Assistance Support website for collaborative care at https://www.ncahec.net/ practice-support/collaborative-care/. NC Medicaid partners with NC AHEC to provide educational and practice-based support to interested primary care practices, including coaching on workflows, billing and coding, registry implementation, and continuing education programs. To contact AHEC practice support, you can email practicesupport@ncahec.net.

care (but my chickens had a high-deductible plan, so the most expensive care was not an option). After a consultation with a chicken specialist (read: a nurse I work with who also has chickens), I opted to balance risk and benefit (and labor and cost) and fill the holes, check the perimeter daily, and place large objects like rocks and buckets of water over any holes that develop. I also monitor closely for recurrence by leaving my camera in the coop, and so far so good! It has been over 365 days since the last rat-related chicken incident. Was this effective? Yes! Would I do it this way again? Yes! But we all know that prevention is better than treatment. I now include in my chicken counseling to put in some extra work up front and install their coops with better in-ground protection. Epilogue: My chickens occasionally put themselves to bed but their aberrant behavior remains (F40.248 other situational phobia?), leading me to believe that I did not catch this early enough and palliation is the care goal. Can anyone refer me to a good chicken therapist? I checked Psychology Today and I don’t see any in Vance County. Oh, and chickens: 2. are hilarious 3. eat bugs 4. make DELICIOUS eggs 5. supply good stories that can even relate to medicine

Comprehensive care for eating disorders in North Carolina

Multidisciplinary treatment for children, adolescents, and adults of all genders All levels of care: inpatient, residential, PHP/IOP, and outpatient Individual, group, and family therapy Medical and psychiatric services Telehealth and in-person options available

For more information or to make a referral, call 855-875-5812 or visit veritascollaborative.com