NCAFP Representing FM in Multiple Ways at Multiple Meetings

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

~ ACADEMY IN ACTION ~

NCAFP Representing You in Multiple Ways at Multiple Meetings

• State Child and Maternal Health Summit sponsored by the NC Medical Society and co-sponsored by the NCAFP: Alisa Nance, MD, RPh, NCAFP President; Janalynn Beste, MD, Residency Director, New Hanover Regional Family Medicine Residency program and member, NCAFP Workforce Pipeline Committee; and Griggs.

• NC Medical Society Opioid Task Force: Brent Hazelett.

• 14th Annual Jim Bernstein Health Leadership Dinner: NCAFP President-Elect Dave Rinehart, MD; Board Member Slade Suchecki, DO; as well as three medical students, a resident, Griggs and Hazelett.

Rather than write a traditional column for this quarter’s magazine, I thought it would be good to provide our members with a list of just a few of the events where the NCAFP leadership and staff have represented the profession of Family Medicine in the last two months. As part of our efforts to advocate on behalf of you and your patients, we attend as many meetings that impact Family Medicine and primary care as possible. Here’s just a sampling of some of these events and at least a few of the individuals representing Family Medicine during each of these activities:

OCTOBER

• NC Medical Society LEAD Conference: David Rinehart, MD, NCAFP President-Elect; Shauna Guthrie, MD, and Garett Franklin, MD, NCAFP Board Members; and Greg Griggs, MPA, CAE, NCAFP EVP.

• NCMS Foundation Community Practitioner Program 30th Anniversary Luncheon and Advisory Committee Meeting: Brent Hazelett, MPA, CAE, NCAFP Vice President and COO.

REPRESENTATION

• NC DHHS Meeting with the Secretary on Advanced Medical Homes: Dr. Rinehart, Griggs and several other NCAFP members.

• North Carolina Institute on Political Leadership Hometown Debates broadcast by Spectrum News: Both Griggs and NCAFP Board Member and Family Medicine Chair at the Brody School of Medicine, Chelley Alexander, MD, served as panelists on two of the four debates.

• Presentation to Wake Forest University Family Medicine Interest Group and Health Policy Interest Group: Griggs and Tracie Hazelett, NCAFP Manager of Student and Resident Initiatives.

• Meeting with Residents at Cabarrus Family Medicine Residency Program: Tracie Hazelett, along with Clint Cresawn of the NC Office of Rural Health Placement Services Program.

SEPTEMBER

• AAFP Congress of Delegates: The

official delegation from NC included Dr. Nance and Dr. Rinehart; our two delegates, Dr. Michelle Jones and Dr. Karen Smith; and our two alternate delegates, Dr. Rich Lord and Dr. Chuck Rich; although a number of other individuals from the state chapter attended, including Immediate Past President Dr. Tamieka Howell, and Secretary-Treasurer Dr. Jessica Triche.

• Closing the Coverage Gap Meetings: Griggs.

• Monthly Meeting with NC DHHS Deputy Secretary in charge of Medicaid, Dave Richard: Griggs.

• Presentation by Dr. Karen Issacs to community members in Wilmington at the New Hanover Regional Medical Center on Navigating the Social Determinants of Health: Dr. Nance and Griggs.

• Practice visits to Wilmington Health Associates: Dr. Nance and Griggs.

• NCCare360 Advisory Council Meeting: Griggs.

• NC Opioid and Prescription Drug Abuse Advisory Committee: Griggs.

• NC Institute of Medicine Annual Meeting: Dr. Rinehart, Dr. Nance and Griggs.

• Advanced Medical Home Subcommittee of the Medical Care Advisory Committee: Dr. Rinehart.

• The NC Institute of Medicine Task Force on Health Services for Individuals Who are Deaf and Hard of Hearing: Griggs.

These are just a sampling of the meetings where NCAFP has an official attendee to make sure that family medicine’s voice is heard. Remember, the old saying, if you don’t have a seat at the table, you are probably on the menu. Every month we strive to make sure that family medicine is at the table and not on the menu. But we couldn’t do it without you, our members.

NCAFP Hosts Southeast Family Medicine Forum with AAFP Chapter Leaders

Leaders and chapter executives from twelve AAFP chapters across the southeast converged in Asheville in mid-August for two days of policy, advocacy and issues conversations. More than 75 attendees heard presentations on topics such as private equity in Family Medicine, addressing the social determinants, the move to value-based care, as well as health policy and programming updates from the ABFM and the AAFP. This rotating two-day conference brings together chapter and physician leaders from all southeast chapters and is always a privilege for the hosting chapter. For additional sights and scenes from the event, see the NCAFP’s Facebook page at www.facebook.com/ncafp.

NY Times Discusses North Carolina’s Move to Value-Based Care

Ardmore Family Practice in Winston Salem provided the backdrop for recent coverage in the New York Times about North Carolina’s move towards value-based care. Times reporter Steve Lohr visited the state in early summer to gather background and interview several people quoted in the article. Ardmore Family Practice physicians Drs. Robert Rosen and Amy Sapp provided an in-practice interview with Lohr; he also interviewed DHHS Secretary Dr. Mandy Cohen, and Dr. Mark McClellan of Duke University. Read the article at nytimes.com/2019/08/26/business/north-carolina-health-care-outcomes.html.

NCAFP Past President Dr. Shannon Dowler Named Medicaid’s New Chief Medical Officer

Academy Past President Shannon Dowler, MD, (’13) is the new Chief Medical Officer for the North Carolina Division of Health Benefits/North Carolina Medicaid. Dr. Dowler has a long history of service in leadership roles in North Carolina. Professionally, she most recently served as the Chief of Community Medicine and Ambulatory Population Health for Mission Health Medical Associates in Asheville where she helped lead primary care, including quality, safety and ambulatory population health strategy for Mission’s primary care practices across an 18-county region. In her volunteer pursuits, Dr. Dowler previously served as chair of the North Carolina Physicians Advisory Group and as a member of the AAFP’s Commission on Health of the Public and Science. She currently serves as President of the NCAFP Foundation. Dr. Dowler received her medical degree from East Carolina University and completed her residency training at MAHEC in Asheville.

NCAFP’s Dr. Rhett Brown Receives 2019 Equity of Care Award by Charlotte

Healthcare Executives

Past President Dr. Rhett Brown (‘17) was recently awarded the 2019 Equity of Care Award by the Greater Charlotte Healthcare Executives Group. The award recognizes physician leaders who are pioneering equity-of-care within their healthcare practice and whose actions, example, and efforts contribute to the advancement and promotion of diversity and inclusion. Dr. Brown is a leading healthcare advocate for the LGBTQ community in greater Charlotte who currently practices at Novant Health Midtown Family Medicine. Congratulations!

MEMBERSHIP By Tara Hinkle NCAFP Manager, Member Services

The NCAFP would like to thank all of our members for an outstanding 2019. We appreciate your participation, your voice, and your commitment to Family Medicine. Most of all, we appreciate your membership. If you have any questions, please use the contact information in each section or reach out to Tara Hinkle, NCAFP Manager, Member Services, at thinkle@ncafp.com or 919-980-5381.

2019 CME Re-Election Candidates If you are a candidate for 2019 CME Re-Election, you have until 12/31/19 to earn your 150 credits. Please note that the AAFP does not offer extensions on the earning deadline. Please visit www.aafp.org/cme to determine your re-election cycle (every three years), report CME, and view CME options if you are short of your required hours. You may also report and find quizzes on AAFP’s free mobile app. If you are attending our annual meeting in December, we will report your credits earned to the AAFP and they will add them to your transcript after processing.

2020 Membership Dues The deadline for 2020 dues payment is January 1st, 2020, for all Active, Inactive, Supporting, Transitional and first time Life members. Membership is on a January – December calendar year. Hard copy invoices were mailed to primary addresses last month. You may access your invoice anytime online at www. aafp.org/quickpay or www.aafp.org/checkmydues. You may also click on the “My Account” button on AAFP’s free mobile app. Installments are available. To pay dues by phone, please call the AAFP between 9:00 a.m. – 6:30 p.m. EST at 1-800-274-2237 x 0. If you have interrupted practice, retired, or moved out of NC, please call the AAFP as soon as possible to transfer your membership type or relocate your state chapter membership.

Handling Immunization Refusal in the Anti-Vaccination Era By Anita Linton, Senior Risk Manager, Curi

A growing number of parents are refusing to have their children vaccinated against preventable diseases, making it more important than ever for practices to clearly outline policies and procedures related to immunization. Physicians, particularly pediatricians, must tread carefully when faced with vaccine refusal, using a combination of education and documentation to both encourage healthy immunization practices and protect themselves against abandonment claims. Setting Policies All practices, regardless of specialization, should develop a clear policy statement regarding patient immunization. Whether this policy permits or refuses to treat unvaccinated individuals, the availability of such a statement will help patients understand the current environment and will provide clear expectations for ongoing care. Practice staff must then be educated on the details regarding this policy so that they can effectively communicate information to patients and their families. This policy should be clearly displayed for incoming patients on practice websites and also be available in the form of a handout. Education is Best It’s physicians’ responsibility to not only provide healthcare for patients, but to help them make educated decisions about their health and their children’s health. When faced with vaccine hesitancy, physicians have a number of resources available to help educate concerned parents on the importance, safety, and efficacy of vaccines. The Center for Disease Control provides comprehensive conversation materials to help physicians during encounters with parents exhibiting immunization hesitancy. Physicians should document this interaction for future reference, noting specific handouts and education materials discussed. Informed Refusal Education is often not enough to convince parents that vaccines are the healthiest choice for their child. Some practices may then choose to terminate the physician-patient relationship. This is an individual decision that should be evenly enforced as stated in the practice’s patient immunization policy. If a practice chooses to continue to treat children whose parents have refused immunizations, we strongly recommend that parents are asked to complete an informed refusal document. Documentation in this case should indicate that the parent was told why the vaccine is recommended, informed of the risks and benefits, and informed of the possible consequences of immunization refusal, as well as the specific education materials provided. The American Academy of Pediatrics (AAP) has created a sample informed refusal document that providers can implement in their practice. Additionally, the AAP created a document discussing how to minimize liability with vaccine hesitant parents. Curi members can reach out to our Risk Management team at for further guidance on this issue by calling 800-662-7917. Dealing with Disruptive Patients and Building a Positive Practice Environment By Donna Nicholson, Vice President, Risk Management, Curi If you’ve noticed a rising number of patient complaints and disruptive incidents in your practice in recent years, you’re not alone. Understanding how to handle disruptive patients and family members while addressing complaints and concerns is necessary to create a positive environment where providers are able to deliver high-quality healthcare. De-escalation Techniques When presented with a threatening patient encounter, the most important thing that a provider can do is to try to de-escalate the situation. When physicians and staff recognize sudden tension or feel physically threatened, we recommend the following: • Speak in a calm, soft voice when responding to angry or threatening assertions • Apologize when appropriate, acknowledging specific grievances (e.g., extensive wait times) • Avoid blaming others • Call a “time out” to provide the time and space they need to gather their thoughts Why So Many Complaints? According to a study by the Stanford University Department of Psychiatry, physicians with high burnout scores had a strong association with the number of patient complaints. When physicians feel overwhelmed or dissatisfied with their work, they are more prone to make errors or their interpersonal relationship skills may suffer. Furthermore, in an era characterized by high-deductible healthcare plans, patients have grown to expect more from their physicians and from practice staff. By taking a proactive approach to managing care quality and patient expectations as well as providing physicians with the optimal environment for practicing medicine, it’s possible to decrease the likelihood of disruptive incidents. What Patients Want According to an interactive poll from the Wall Street Journal, the top five things that patients want from healthcare team members are the following: 1. To be treated with dignity and respect 2. To have their healthcare concerns heard and questions answered 3. To work with providers that are easy to talk to 4. To have their concerns taken seriously 5. To work with providers who are willing to spend time with them Interestingly enough, none of these top concerns actually addresses the medical services themselves, but rather the behaviors of physicians and other providers. Understanding that these are the core factors that can drive patient complaints, we recommend that physicians and practice leaders encourage the following behavior among staff: • Be self-aware of behavior when interacting with patients and family members • Take accountability and express concern when patients are frustrated • Recognize professionalism in action and encourage continued • Be willing to give and receive constructive collegial feedback

Curi members can reach out to our Risk Management team at 800-662-7917 for further guidance on this issue.

NCAFP Sights & Scenes

2019 Foundation’s Raffle Raises Funds for Key Student Family Medicine Programs

The NCAFP Foundation supports hundreds of medical students each year. All proceeds from the 2019 Raffle Fundraiser will be used to provide clinical experiences, Family Medicine scholarships and travel awards directly to students, and on-going support to FMIGs on campus. Sales will continue until Noon on Sat., December 7th, with the drawing for the winner taking place at the Presidential Gala that evening in Asheville at the annual Winter Family Physicians Weekend. You do not need to be present to win, but we hope you join us that weekend for some great CME and good times with your colleagues!

And if games of chance aren’t for you, feel free to donate generously to the Foundation or Endowment at

~TRUSTEE PERSPECTIVE~ DR. MAUREEN MURPHY

HEY DOCS!!! Remember when you were a med student? Hundreds of years ago for me, not so much for the rest of you. Remember how many times you were told you were “too smart” for this field? Remember how great it was when you were able to find your “peeps”, the FM folks, and how it made such a difference when you got validation from them?

Medical students today still need validation and the NCAFP Foundation has programs to help with this. The Foundation provides scholarships, clinical experiences, financial support to send students to FM conferences - like our Asheville meeting and the national one in Kansas City - and funds FMIGs on each school’s campus.

We need YOU to step up and support the Foundation to help keep the pipeline going and there is an easy way for you to help and have a chance for a prize. The NCAFP Foundation’s raffle fundraiser helps support all student programs. For $50/chance you not only have a chance to win a FABULOUS adventure (see details at right), but also give much needed financial support and encouragement to medical students that might be ‘lost’ in the tertiary centers.

Do this NOW on the NCAFP site: www.ncafp.com/raffle and you will be honoring all those who helped lead you to Family Medicine. Get out those credit cards and PAY IT FORWARD to support our medical students.

~STUDENT PERSPECTIVE~ HANNAH SMITH

I sought opportunities to learn more about Family Medicine prior to medical school and have had some wonderful mentors in my life, but the opportunities available to students through the NCAFP Foundation have been instrumental in keeping me energized and excited about my training. As a first year

- THE 2019 NCAFP FOUNDATION RAFFLE - Win One of Fabulous Vacations in the US! 5

Become a Sonoma Valley Winemaker: Intimate Blending Seminar, Winery Tours & Tastings, Fairmont Sonoma Mission Inn & Spa 3-Night Stay with Airfare for two.

Classic Wrigley Field Rooftop Experience: Rooftop Bleachers & Dining Package at Regular Season Chicago Cubs Game, 3-Night Stay at Hyatt, Hilton, Marriott or comparable hotel with Airfare for two.

Tennessee Whiskey Adventure: Jack Daniels and George Dickel Distillery Tours and Tastings, Lunch, Transportation, 3-Night Stay at Renaissance Nashville with Airfare for two.

New York Long Weekend: Choice of Broadway Show, Dinner, 3-Night Weekend Stay at Hyatt, Hilton, Marriott or comparable hotel with Airfare for two.

America’s Cup Yacht Sailing in San Diego: Sailing Experience on America’s Cup Yacht, 3-Night Stay in San Diego at Estancia La Jolla Hotel & Spa with Airfare for two.

The NCAFP Foundation supports hundreds of medical students each year. All proceeds from the 2019 Raffle Fundraiser will be used to provide clinical experiences, Family Medicine scholarships and travel awards directly to students, and on-going support to FMIGs on campus. Sales will continue until Noon on Sat., December 7th, with the drawing for the winner taking place at the Presidential Gala that evening in Asheville at the annual Winter Family Physicians Weekend. You do not need to be present to win, but we hope you join us that weekend for some great CME and good times with your colleagues!

And if games of chance aren’t for you, feel free to donate generously to the Foundation or Endowment at www.ncafp.com/contribute.

at Brody, I had the chance to attend the annual Winter Family Physicians Weekend in Asheville, followed by the Western Rural Health Program during that first summer. By the end of the two-week summer immersion program, I had formed many new friendships with students from other schools and

a network of family physicians in Hendersonville and Asheville, each practicing in their own unique ways; and, endless relationships with patients who continue to shape my future every day.

Like me, so many students are impacted each year in North Carolina by the programming and involvement of the NCAFP in our medical schools.

~2017 RAFFLE WINNER~ DR. LISA CASSIDY-VU

First, I can’t thank the NCAFP enough for putting together such a great fundraiser! From the planning, to our return flights home, the entire process was seamless. My husband and I experienced Sonoma as an adult-only vacation, a rare treat in the Vu household!

THE NCAFP FOUNDATION’S EFFORTS TO SUPPORT STUDENT INTEREST INITIATIVES CONTINUES. NCAFP MEMBERS CAN SUPPORT THIS IMPORTANT WORK AND HAVE A CHANCE TO WIN YOUR CHOICE OF ONE OF FIVE FANTASTIC TRIPS!

Partipcating couldn’t be easier...

1) Simply visit www.ncafp.com/raffle.

per entry $50

2) Make your purchase by Noon on Saturday, December 7th, 2019, and your name is automatically entered in the drawing. Each entry is $50.00.

3) Winner will be drawn that evening at the Presidential Gala in Asheville. Winners do not need to be present to win, so spread the word and support the cause!

Winners will be fully informed of options prior to making their selection. Full details about available trips can be found at www.ncafp.com/raffle.

Questions? Contact Tracie Hazelett at thazelett@ncafp.com or 919-980-5357.

We stayed at the Fairmont Sonoma Mission Inn which is a gorgeous hotel in the middle of Sonoma. The breakfasts were delicious and there was a wine tasting every evening. Everything was very accessible — we were able to walk to the historic area of Sonoma and had very short drives (we had a rental car) to the vineyards.

We enjoyed three, completely carefree, relaxing days. It was phenomenal!

I have already bought more tickets for this year’s raffle to try to win another trip AND support the critical student interest initiatives the Foundation implements. It is worth every dollar I put toward a chance to win a trip while supporting crucial pipeline programs.