NC Family Physician - Summer 2019

Volume 15 Issue 3 • Summer 2019

The North Carolina

Family Physician Quarterly News in North Carolina Family Medicine

DR. KAREN SMITH FOR AAFP BOARD OF DIRECTORS

REACH NEW HEIGHTS. Make plans now to join us at the Winter Meeting 2019 Winter Family Physicians Weekend ANNUAL CONFERENCE & EXHIBITION 25+ Credits Anticipated Program Chair: Nichole L. Johnson, MD • Program Vice-Chair: Victoria S. Kaprielian, MD

Early Bird Discount Registration for Members Ends on Sunday, October 6, 2019

Tentative Lecture Topics Include: Alzheimer’s Disease Hemophilia Awareness Eczema Management Hypertension Insulin Therapy

Pain Management & Opioids Physician Health Obesity Management Cancer Survivorship Mental Health

Managing Up— Influencing the Hierarchy Pelvic Pain in Women Women’s Sexual Health Osteoporosis

Diabetes & Nutrition Sexually Transmitted Diseases And many more

Optional Workshops & Seminars Pain Management & Opioids • Preceptor Development • Insulin Therapy • Physician Health • Osteopathic Manipulations for MDs Practice Models Summit • Obesity Management • Healthcare Leadership in a Value-Based World (practice management)

Optional Pre-Conference Opportunities on Wednesday, December 4 KSA Study Working Group—Heart Failure • Hands-on Procedures • Nexplanon Training

Optional Activities Satellite Learning Opportunities • Resident Recruiting & Job Fair • Research Poster Contest • Special Presentations • Exhibition Hall Presidential Gala • Biltmore House Candlelight Tours & More

THURSDAY, DECEMBER 5 – SUNDAY, DECEMBER 8, 2019 Omni Grove Park Inn • Asheville, NC

CME | Camaraderie | Networking | Fun www.ncafp.com/wfpw

All medical education topics offered by the NCAFP are reviewed by a family physician, and when possible and appropriate, are presented by a family physician. While the NCAFP may receive pharmaceutical funding to help provide education at our events, they are allowed no influence on the content provided. The integrity of the information provided is always the NCAFP’s primary concern.

Inside Summer 2019

NCAFP Helps Win Medicaid Fee Increase for Primary Care p.8

PRESIDENT’S MESSAGE

MEMBERSHIP & MEMBER SERVICES

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14 Dr. Karen Smith Runs for AAFP Board of Directors

Ramping-Up Payer and System Advocacy

HEALTH POLICY & ADVOCACY

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NCAFP Helps Win Medicaid Fee Increase for Primary Care

CHAPTER AFFAIRS

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PROFESSIONAL DEVELOPMENT

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Changes to NCAFP’s CME Programming Proving to Be a Welcome Change by Many

PRACTICE MANAGEMENT

2019: A Super Blue Moon Year

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Innovations Support NC Family Physicians in

Caring for the Intellectually and Developmentally Disabled

DEPARTMENTS

PUBLISHED BY

President’s Message 4 Health Policy & Advocacy 8 Chapter Affairs 10 Membership 14 t 919.833.2110 •

fax

Professional Development 20 Residents & New Physicians 24 Practice Management 28

919.833.1801 • ncafp.com

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

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

PRESIDENT’S MESSAGE to Members

By Dr. Alisa Nance, RPh 2018–2019 NCAFP President

~ THE NCAFP COMMITTEES ~

Ramping-Up Payer and System Advocacy Summer has come! What a great time of year. School’s been out and soon to restart. I hope your warm weather months have been full of fun and family—and hopefully sports and well physicals!

For this edition of the magazine, I would like to highlight the NCAFP Payer & System Advocacy Committee.

With its mission of strengthening the influence of Family Medicine with health systems and payers, this committee’s goals are as follows: • Decrease the administrative burden faced by family physicians in their day-to-day practice lives.

• Improve access to ancillary staffing for family physicians such as, scribes, MAs, behavioral health professionals, and other team members.

• Advocate for a broad scope of practice for family physicians.

• Increase the number and influence of practicing family physicians in administrative roles within health systems and payers.

• Empower family physicians to be voices for themselves and their patients.

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2018-2019

Payer & System Advocacy

NCAFP Board of Directors Executive Officers President President-Elect Secretary/Treasurer Immediate Past President Executive Vice President

Alisa C. Nance, MD, RPh David R. Rinehart, MD Jessica Triche, MD Tamieka M.L. Howell, MD Gregory K. Griggs, MPA, CAE

At-Large Directors Talia M. Aron, MD Jewell P. Carr, MD Garett R. Franklin, MD Shauna L. Guthrie, MD, MPH Dimitrios “Taki” P. Hondros, MD Jennifer Mullendore, MD Mackenzie Smith, MD Ying Vang, MD Slade A. Suchecki, DO Brian McCollough, MD Elizabeth B. Baltaro, MD Family Medicine Residency Directors Mark L. Higdon, DO (Novant FMR) Resident Director David S. Baker, MD (MAHEC-A) Resident Director-Elect Elizabeth Ferruzzi, MD (Novant) Student Director Cameron G. Smith (Campbell) Student Director-Elect Katelyn Turlington (WFSOM)

Medical School Representatives & Alternates Chair (ECU) Alternate (Campbell) Alternate (Duke) Alternate (UNC) Alternate (Wake)

Chelley K. Alexander, MD Nicholas Pennings, DO Anthony J. Viera, MD, MPH Cristen P. Page, MD Richard W. Lord, Jr., MD, MA

AAFP Delegates & Alternates AAFP Delegate AAFP Delegate AAFP Alternate AAFP Alternate

Michelle F. Jones, MD Karen L. Smith, MD Richard W. Lord, Jr., MD, MA Robert L. Rich, Jr., MD

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

• Build opportunities for regional networking among physicians employed by various systems, as well as independent practicing physicians.

2) Develop a one-page template to assist family physicians in meeting with health system leaders to facilitate such conversations.

The committee’s members include: Dr. Garett Franklin, Chair and NCAFP Board Liaison; Dr. Adrian Mancheno, New Physician; Dr. Alexa Mieses, Resident Physician; Dr. Tommy Newton, Past President; Matthew Leary, Student; Dr. David Rinehart, NCAFP Executive Board Liaison; and Drs. Andrea DeSantis, Deanna DiDiano, Eugenie Komives, Ronald Laney, Frankie Simmons, and Tom Wroth as Members-at-Large.

3) Plug-in system leaders with key Academy publications such as the magazine when we are highlighting individuals or activities from their system.

The committee is actively working with the following strategic initiatives: 1) Identify Family Medicine leaders within major health systems and catalog them (both established leaders and up and coming leaders).

4) Promote key Family Medicine accomplishments to both internal and external audiences.

5) Examine additional ways to communicate with members, including the possibility of a podcast.

6) Provide periodic updates in the e-newsletter and the magazine from the committees, as well as an update at the meeting next year. Utilize regional educational events to provide updates as well.

~ Commit tee Member Highlight ~

Dr. Andrea DeSantis Atrium Health CMC- NorthPark Family Medicine Andrea M. Desantis, DO, is our Payer and System Advocacy Committee member spotlight. She graduated from Philadelphia College of Osteopathic Medicine in 1995 and completed her Residency training at Carolinas Medical Center Family Medicine Residency Program - Urban Tract, in 1999.

After graduation, Dr. DeSantis joined an Atrium Hospital-based practice located in the ethnically diverse Northeast area of Charlotte. North Park Clinic, along with Biddle Point Family Medicine, Elizabeth Family Medicine, and CMC-Myers Park, provide comprehensive medical services to patients regardless of the type of insurance, lack of insurance, or ability to speak English. They see patients with Medicaid, Medicare, ACA, and employer-based private plans, and a sliding scale charity program for those without insurance. Onsite, North Park has X-ray, lab and

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a pharmacy. They also have an embedded Social Worker, a Clinical Doctor of Pharmacy, and care coordinators with both Community Care Partners of Greater Mecklenburg (a part of CCNC), and the Health Department’s CC4C early intervention program for children ages 0 to 5.

Dr. DeSantis says, “I just fell in love with [this clinic] and have been working there since graduating from residency 20 years ago. I initially told myself, ‘I’m only going to work here for a few years,’ but then found it to be so rewarding. Many patients had followed me here from my residency training and now they’re like family!”

Dr. DeSantis also states she “feels lucky to work in such a dynamic and diverse clinic.” Patients come from “all walks of life and from all over the world to get care at North Park clinic.” Though Spanish is the most common language, over 30 different languages are spoken including French, Vietnamese,

The North Carolina Family Physician

7) Continue efforts to develop payer relationships.

NCAFP staff, with committee input, has already developed a one-pager on the value of Family Medicine and primary care to be used during meetings with health system leaders, and a one-pager outlining the breadth that a family physician’s scope of practice can have.

From the start of the year, this committee has been very active in health issues affecting Family Medicine.

At our annual meeting last December, the NCAFP hosted a three-member panel of health system leaders: Terry Akin (CEO Cone Health), Carl S. Armato (CEO Novant Health), and Ronald A. Paulus (now past CEO of Mission Health)—three others were invited but were unable to attend. The panel answered targeted questions about how they see the role family physicians play in their systems and in the healthcare landscape. They also were asked about the changing

Arabic, and Burmese, to name a few. They have five on-site interpreters and also rely on laptops for virtual interpreters when needed. Dr. DeSantis is proud of the high standards of care the clinic provides for their medically and socially complex patients.

Dr. DeSantis is a member of the Care Redesign Committee, where she provides perspective from the hospital-based clinics to Atrium Health’s primary care leadership. Much of the work of the committee is to identify ways to maximize the efficiencies of the clinical care team so that physicians, advanced practice providers, nurses, pharmacists, and care coordinators, all provide enhanced access and comprehensive individualized care for patients.

Dr. DeSantis also enjoys teaching third year medical students in the UNC- Chapel Hill Longitudinal program. “They keep me honest, and I have learned a great deal from them as well. It thrills me when a student shows interest in Family Medicine as well as caring for the underserved.”

In her spare time, Dr. DeSantis advocates for health care finance reform. She has seen first-hand the inefficiencies and health disparities of our current multi-payer system and feels the Single Payer, Medicare for All, model would work best. “Patients do not always stay on the same insurance plan and will often lack insurance altogether when they lose or change jobs.

Increasingly, we are seeing the rising cost of deductibles

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climate from fee-for-service payment to value-based care in the future. As a result of the panel, several follow-up meetings came to fruition. Several NCAFP leaders and members have engaged in follow-up meetings with Novant and Cone Health Systems. Future meetings with these leaders and other systems are being planned moving forward.

Looking forward to our next annual meeting in December 2019, the NCAFP will have a course on “managing up,” giving pointers on interviewing and promoting the family physician’s goals and needs to their administrative leaders and chief executive officers. Make sure you register soon to take advantage of this opportunity. Registration is available now at www.ncafp.com/wfpw.

Other advocacy goals have been to work toward decreasing the coverage gap in NC, otherSee “Payers & Systems” on Back Cover

and co-payments causing patients to skip follow up appointments or stop refilling medications.” She also sees patients with very poorly managed conditions like diabetes, hypertension and depression, who wait until age 65 to finally manage their health more consistently and effectively.

Dr. DeSantis believes most of the issues around healthcare costs are related to lack of access to primary care along with unnecessary administrative waste and associated billing costs. Though the solution to this inefficiency could be simple, the next steps for our country will be the challenge and “the devil will be in the details.” A consistent source of reimbursement coupled with payment models that reward patient-centered care, has the potential to expand the primary care work force, reduce costs and save lives. According to DeSantis, legislators should take their cue from experts in medical economics, physicians, nurses, hospital administrators and patients. “Universal finance models have worked well in other countries,” she said, “and we can be reassured that something similar can work in the US as well.”

Even if we could start with reducing administrative waste and avoid delays in care, our “costs” would be less, DeSantis noted. Thanks Dr. DeSantis for your commitment and drive!

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POLICY & ADVOCACY

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

~ ADVOCACY IN ACTION ~

NCAFP Helps Win Medicaid Fee Increase for Primary Care By the time you are reading my column this month, you should already be receiving an increased Medicaid fee schedule for your Evaluation & Management codes, a 25-30 percent increase compared to what Medicaid had been paying for primary care.

As we have indicated previously, this increase is due to the hard work of the NCAFP and the NC Pediatric Society advocating on behalf of our state’s primary care physicians that provide care to Medicaid beneficiaries.

This increase comes while the state is moving to a Medicaid Managed Care system, and this new rate (at or near Medicare rates) will become the floor for the managed care plans.

Beyond the increase you should be receiving in your Medicaid rates right now, the state will begin reprocessing claims all the way back to January 1, 2019, to provide the increased rate to claims they have

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already paid during this calendar year.

We would like to personally thank Dr. Mandy Cohen, Secretary of the North Carolina Department of Health and Human Services and Dave Richard, Deputy Secretary for North Carolina Medicaid for their support of primary care through this rate increase. We would also like to thank Elizabeth Hudgins, Executive Director of the NC Pediatric Society, for her partnership in advocating for this rate increase.

The increase will be paid to primary care physicians, nurse practitioners and physician assistants as defined in Section 1202 of the Affordable Care Act (ACA), as well as obstetricians and gynecologists.

Reimbursement rates for E&M procedure codes ranging from 99201-99499 will be increased with an effective date of Jan. 1, 2019. NCTracks implementation of the rate increase should have begun in July (week of July 7).

Claims previously processed with dates of service from Jan. 1, 2019 through the implementation date of the rate increase will be scheduled for systematic reprocessing. Providers are reminded to bill their usual and customary charges rather than the Medicaid rate.

Providers will be notified through future Medicaid Bulletins and/or NCTracks provider communications regarding the claims reprocessing schedule.

For current pricing on all physician services codes, refer to the NC Medicaid website at https://medicaid.ncdhhs.gov/fee-schedule-index year.

This rate increase is just one of many examples of how the NCAFP is advocating on behalf of our members.

The North Carolina Family Physician

~ ADVERTISEMENT ~

Handling Immunization Refusal in the Anti-Vaccination Era

By Anita Linton, Senior Risk Manager, Curi Handling Immunization Refusal in the Anti-Vaccination Era A growing number of parents are refusing to have their children vaccinated against

By Anita Linton, Senior Risk Manager, Curi preventable diseases, making it more important than ever for practices to clearly outline policies and procedures related to immunization. Physicians, particularly pediatricians, must A growing number of parents are refusing to have their children vaccinated against tread carefully when faced with refusal, than usingever a combination ofto education and preventable diseases, making it vaccine more important for practices clearly outline documentation to both encourage healthy immunization practices and protect themselves policies and procedures related to immunization. Physicians, particularly pediatricians, must against abandonment tread carefully when claims. faced with vaccine refusal, using a combination of education and

documentation to both encourage healthy immunization practices and protect themselves Setting againstPolicies abandonment claims.

All practices, regardless of specialization, should develop a clear policy statement regarding patient Whether this policy permits or refuses to treat unvaccinated Settingimmunization.

Policies individuals, the availability such a statement will help patients understand the current All practices, regardless ofofspecialization, should develop a clear policy statement regarding environment and will provide clear expectations for ongoing care. patient immunization. Whether this policy permits or refuses to treat unvaccinated individuals, the availability of such a statement will help patients understand the current Practice staff must then be educated on the details regarding this policy so that they can environment and will provide clear expectations for ongoing care. effectively communicate information to patients and their families. This policy should be clearly displayed for then incoming patientson onthe practice be so available in the Practice staff must be educated detailswebsites regardingand thisalso policy that they canform ofeffectively a handout. 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 Education is Best of a handout.

It’s physicians’ responsibility to not only provide healthcare for patients, but to help them Education is Best make educated decisions about their health and their children’s health. When faced with It’s physicians’ responsibility to nota only provide healthcareavailable for patients, buteducate to help them vaccine hesitancy, physicians have number of resources to help make educated decisions about their health children’s health. When faced with concerned parents on the importance, safety,and andtheir efficacy of vaccines. vaccine hesitancy, physicians have a number of resources available to help educate concerned parents on the importance, and efficacy of vaccines.materials to help The Center for Disease Control providessafety, comprehensive conversation physicians during encounters with parents exhibiting immunization hesitancy. Physicians The Center for Disease Control provides comprehensive conversation help should document this interaction for future reference, noting specificmaterials handoutstoand physiciansmaterials during encounters education discussed.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 Informed their child. Refusal Some practices may then choose to terminate the physician-patient relationship.

Education is often not enough to should convince that vaccines are the choice for This is an individual decision that beparents evenly enforced as stated inhealthiest the practice’s their child.

Some practices may then choose to terminate the physician-patient relationship. patient immunization policy.

This is an individual decision that should be evenly enforced as stated in the practice’s immunization Ifpatient a practice chooses topolicy. continue to treat children whose parents have refused

immunizations, we strongly recommend that parents are asked to complete an informed If a practice chooses to continue to children whose parents have refusal document.

Documentation in treat this case should indicate that the refused parent was told why immunizations, we strongly recommend that parents are asked to complete an informed the vaccine is recommended, informed of the risks and benefits, and informed of the possible refusal document. Documentation in this case should indicate that the parent was told why consequences of immunization refusal, as well as the specific education materials provided. the vaccine is recommended, informed of the risks and benefits, and informed of the possible The American Academy of Pediatrics (AAP) has created a sample informed refusal document consequences of immunization refusal, as well as the specific education materials provided. that providers can implement in their practice. Additionally, the AAP created a document The American Academy of Pediatrics (AAP) has created a sample informed refusal document discussing how to minimize liability with vaccine hesitant parents. 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 calling can 800-662-7917.

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

Summer 2019

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

Alternate Delegates to AAFP go instead. This year, with North Carolina hosting, Brent Hazelett, our Vice President and COO, and Kathryn Atkinson, our Meetings and Events Manager, will also attend.

~ ACADEMY IN ACTION ~

The best way to describe the Forum is to give you a taste of what is on the agenda. But the bottom line is we try to share ideas and learn from each other.

CHAPTER AFFAIRS

2019: A Super Blue Moon Year 2019 is a bit of a unique year for the NCAFP, kind of like a Super Blue Moon year. Why is that the case you may ask? It’s simple – we have two unique opportunities in the same year.

First, about the time this magazine comes out, the NCAFP will be hosting the Southeast Family Medicine Forum (SEFMF). The Forum is designed to bring the 12 southeastern chapters together to discuss issues of concern, primarily around policy, advocacy and best practices. Four physician leaders and the Chapter Executive from each of the states attend. And once every 12 years, your Chapter plans, organizes and hosts the meeting. We will be doing just that in Asheville at the Renaissance Downtown, August 15-17.

Well who is representing your chapter?

We typically send our President (Dr. Alisa Nance), our President-Elect (Dr. Dave Rinehart) and our two AAFP Delegates (Dr. Karen Smith and Dr. Michelle Jones) to this meeting, along with me as your Chapter Executive. That’s who is attending this year. In a year where one of those individuals can’t attend, our

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This year’s agenda includes the following presentations: What Venture Capital Means to the Future of Primary Care; Addressing Social Determinants of Health in Primary Care; What to Expect in Value-Based Care from the Perspective of an Insurer; Family Physician Perceptions of Patient Assistance Programs and Prior Authorizations; updates from both the ABFM and AAFP; and an advocacy presentation entitled, ‘All We Have to Do is Explain it to Them, Right?’

The Forum will include two clinically-focused presentations on nutrition and immunizations, as well as a series of panels with representatives from each state discussing key advocacy issues, including workforce pipeline, efforts to simplify administrative tasks in primary care, and changes in opioid regulations and pain management.

As you can see, it’s quite an undertaking the year a Chapter hosts the meeting, but it’s very beneficial to join other chapter leaders to learn and share ideas each year. The discussions during the breaks and social activities many times prove as beneficial as the formal presentations.

Our second unique effort this year, although not as unique as hosting the Forum, is running a candidate for the AAFP Board of Directors. You can read more on page 14 about Dr. Karen Smith’s campaign for the AAFP Board.

The North Carolina Family Physician

Having an AAFP Board member puts North Carolina leaders at the forefront of national policy discussions. We’ve been lucky enough to have a few AAFP Board members in the 14 years I have been with this Academy, including Dr. Mott Blair, Dr. Conrad Flick and Dr. Lori Heim. Serving on the Board of the AAFP often leads to seats at other tables. For example, Dr. Mott Blair was just appointed to the board of the American Board of Family Medicine.

Running a candidate for the AAFP Board does require extra effort and extra costs, but we think it’s worth it. We ask that you consider making a small donation to Dr. Smith’s campaign to show your support and offset a bit of the cost of running a candidate. You can learn how to donate by going to page 18 or going to the campaign website at www.smithforboard.com/donate. Please also let your colleagues in other states know what an exceptional leader Dr. Smith is and encourage them to have their Chapter support her candidacy. The election will occur in Philadelphia at the AAFP Congress of Delegates, September 22-25.

Even in a Super Blue Moon year like 2019, the NCAFP continues to focus on all our issues at home, fighting for North Carolina’s family physicians at every turn. We’ve been successful in securing a Medicaid payment increase for primary care E&M codes (see page 8), and continue to fight for health insurance coverage expansion, administrative simplification and more.

Remember, we are here for you. We can best address the issues you are facing when we understand them. And we understand them the best when you are willing to outline those items that are keeping you up at night. So don’t hesitate to let me know the issues you are facing by calling the NCAFP or emailing me directly at ggriggs@ ncafp.com.

Here’s to a great remainder of 2019 – A Super Blue Moon Year.

Summer 2019

C H A P T E R

B R I E F S

Dr. Thomas White is Now President of Southeast Chapter of National Lipid Association NCAFP Past President Dr. Thomas White (’15) recently assumed the office of President of the Southeast Lipid Association (SELA), the oldest and largest chapter of the National Lipid Association. Dr. White will be serving a one-year term. In other related news, NCAFP President Dr. Alisa Nance, RPh, was seated as a SELA regional representative. An article co-authored by Drs. White and Nance appears in the May 2019 edition of Lipid Spin, the official magazine of the National Lipid Association. In addition, Dr. White shares guest comments as President of SELA.

NC Delegation Barnstorms Capitol Hill to Advocate for Family Medicine Nine representatives from the NCAFP joined hundreds of others from across the nation as part of AAFP’s annual Family Medicine Advocacy Summit in Washington, D.C., in late May. NCAFP representatives heard presentations on several national Family Medicine issues, including the general importance of primary care/family medicine, payment reform, pipeline reform in Graduate Medical Education, and others. NCAFP’s group also met with members of the North Carolina Congressional delegation for face-toface discussions. The Chapter was represented by President Dr. Alisa Nance, past presidents Drs. Karen Smith and Mott Blair, and members Drs. Clayton Cooper, Andrea DeSantis, Karen Isaacs, and Frankie Simmons. NCAFP EVP Greg Griggs and COO Brent Hazelett also attended.

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The North Carolina Family Physician

NCAFP

Sights & Scenes

Summer 2019

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Vision, Passion, & Experience for Family Medicine

~ NATIONAL LEADERSHIP ~

Dr. Karen Smith Runs for AAFP Board of Directors

By NCAFP STAFF

NCAFP Past President Dr. Karen Smith, (2005) of Raeford, NC, is a candidate for AAFP Board of Directors. The election will take place this September at the AAFP Congress of Delegates in Philadelphia. To provide Academy members with insight into Dr. Smith’s candidacy, the NC Family Physician asked her to share her perspectives on several questions.

To learn more about Dr. Smith and her campaign, please visit www.smithforboard.com

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NCFP: What is the primary reason you are running for the AAFP Board? As a family physician who began practice in a rural health clinic, who then moved to a corporate-based facility and is now in independent solo practice, I have observed our healthcare delivery system from many different angles. Since the beginning, my patients have presented and consistently needed either acute, chronic, or preventative services. They have also come to me with a longing to access simple, high-quality and efficient care. This has allowed me to become intimately familiar with the huge umbrella we call the social determinants of health and to recognize the profound

The North Carolina Family Physician

physician with the necessary resources and burden reductions to sustain them. Family physician businesses cannot be compromised as the transformation process is underway. The task of change management cannot be so great that the doctor becomes overwhelmed by the process of implementation.

The time is now to recognize the root causes of physician burnout and address unnecessary administrative burdens that stand between us and our patients. At the same time, we must prepare the next generation of family physicians for a future that may look very different from today.

NCFP: As a Family Medicine leader, what do you consider to be your key strengths? What unique abilities and experiences will help make you an effective representative for the specialty?

effects that personal (and regional) variations play on a patient’s ability to receive quality care.

As social determinants have become more broadly recognized, family physicians have moved forward with improving our practices. We have implemented and attested to using expensive electronic health records. We have changed our workflows, exam rooms, staffing, and even introduced team-based care in an effort to gain recognitions as patient centered medical homes. But while we have demonstrated improved quality-of-care and helped to decrease service utilization outside of the practice, there are still vast disconnects with the payment system. And these many years of healthcare transitions have also led to the burnout of legions of very capable physicians.

Simply, I am running for both my patients and my Family Medicine colleagues to play any part I can to improve our specialty and our healthcare system.

While the need for payment reform is long overdue, I believe it is also important to align the work of the

Summer 2019

Time and lots of hard work have helped me develop the leadership skills I believe are necessary to effectively participate on the AAFP Board of Directors.

While leadership skills come naturally for some, I have experienced the wonderous joys of leadership development. I believe my best leadership attribute is the ability to think outside of the box. This comes from recognizing what currently exists, what has been tried in the past, and what can be workable, scalable solutions for the future. I have developed this ability from constant trial and error and almost three decades of work.

I also feel I am humble and recognize the importance of humility to leadership and how it affects personal and professional growth. Staying humble as a leader helps me recognize the knowledge and skills within others while working alongside them. I know I make better decisions as a result.

Experience is another huge factor. My work experience and collaborations with local, state, and national thought leaders in medicine and health policy have molded and shaped me beyond measure. It has helped me develop a style of analytical thinking that

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has improved my decision making, but also has helped me to build stronger relationships with my patients and my colleagues.

NCFP: Advocacy continues to be hugely important for AAFP members and the specialty. How have your prior experiences influenced your perspectives on advocacy and the best ways in achieving meaningful progress?

In my view, representing Family Medicine as a major player in healthcare requires the ability to respond with the right words at the right time in the right places. We must share our patient stories and our daily ‘adventures’ to communicate Family Medicine’s unique ability to deliver efficient, high quality, and cost-effective care. It is clear to me that Family Medicine’s influence is growing and that leaders are increasingly recognizing the power of primary care.

As I have participated in formal leadership development with the NCAFP, my state medical society, and the AAFP, I have learned the importance of being knowledgeable, seeking answers to questions, and having a firm ability to communicate our message in all types of settings. I have also come to appreciate the nuances of collaboration and preparation.

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When collaborating and advocating, we must continually remind ourselves that every single role is important. For example, one of my patients is a retired military leader who will routinely share stories ranging from ground troop exercises to high-level Pentagon meetings. These simple interactions have helped me realize how important everyone’s effort is, regardless if one is protecting the flank, applying power with fortification, pulling and tugging in the middle, or leading through paths unpaved.

Preparation can often lead to unexpected rewards, too.

There’s a lot of truth to the saying that luck is where preparation meets opportunity. Just recently, while visiting our state representative in Washington, D.C. during the AAFP Family Medicine Congressional

The North Carolina Family Physician

Conference, the topic of the opioid epidemic became a point of attention. As I described my work within a local coalition formed to help tackle the problem, our discussions ultimately led to a personal visit to my county by the Senior Advisor for Rural Affairs within the White House Office of National Drug Control Policy. As a result, our local effort is now pursuing previously unknown federal funding opportunities designed for underserved and rural communities.

Family Medicine has been front-and-center throughout this whole process. This is a perfect example of an unexpected outcome that can be just as important as larger, more orchestrated strategic efforts.

Now is the time to prepare and equip all AAFP members to help amplify our advocacy. Together, we must

Summer 2019

make sure the value and worth of family doctors is not only communicated, but payment is commensurate.

NCFP: Change seems to be happening everywhere in healthcare, especially in frontline Family Medicine and primary care. How can the AAFP continue to help members, trainees, and chapters navigate these changes and prepare for what tomorrow may hold?

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The good news is that the changing times of today are helping people more clearly recognize the many challenges in healthcare. For example, addressing disparities in care, promoting health equity, and creating a sustainable primary care physician workforce are now on the radar screen of many organizations and represents issues where the AAFP is definitely making progress.

These are all major issues, and leadership strategy is necessary to continue the forward movement.

Constant education on physician burnout is another crucial area. For instance, I have the opportunity to present at the AAFP Performance Navigator course twice each year. I’ve often considered deleting my slides on burnout, and each time at least one physician, student, or resident shares comments which note the reality of the problem. This suggests the importance of AAFP to continue to combat this issue. The life of a physician is precious, and the impact of losing any doctor is simply unacceptable. The AAFP must continue its multifaceted approach, including incorporating education regarding identification of

burnout and solutions aimed at stamping out the problem.

Most recently, I had an opportunity to reflect on the physician pipeline while attending a historically black university college graduation ceremony. While there, I wondered how many of the students desired to become physicians and did they have the same opportunity as those graduating from my alma mater on the following day? Similar to health disparities, educational disparities are real, too.

NCFP: What does success look like to you if elected as an AAFP Board Member?

The key to success is knowing who we answer to in our daily activities. As family physicians, we answer to our patients. As a member of the AAFP Board, I will answer to our members, the family physicians of this great country. Our job is to help sustain the profession of Family Medicine and demonstrate how our members are leading the transformation of the healthcare industry, making a difference in the lives of patients every day.

Dr. Karen Smith, FAAFP for AAFP Board in 2019

Yes, I Want to Help Get Karen Elected!!!

PAYMENT INFORMATION

Amount:

q I have enclosed a check, made payable to: North Carolina Academy of Family Physicians q Please charge my credit card Name on Card

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

Dr. Karen Smith

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Associated Billing Address City Card Number

State Zip Expiry Date

CCR Code

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

for AAFP Board

The Vision to Lead. A Passion to Serve. ~ LEARN MORE AT WWW.SMITHFORBOARD.COM ~

The North Carolina Family Physician

LESS COMPROMISING. MORE COMPASSION. As a Doctor in the U.S. Air Force, you’ll not only be serving your country and caring for its Airmen and their families—you’ll also be an officer with benefits and advantages that allow you to advance your career and take your ongoing medical education as far as you’d like it to go. And since you won’t have to worry about managing a practice or meeting insurance companies halfway, you can focus more on doing what you love: helping others.

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VACATION WITH PAY YEARLY

WORK WITH CUTTING-EDGE TECHNOLOGY

©2018 Paid for by the U.S. Air Force. All rights reserved.

DAYS

WORLDWIDE HUMANITARIAN MISSIONS

AIM HIGH Health Professions Recruiter Joseph R. Eitzenhefer Technical Sergeant, USAF

919-799-0791 joseph.eitzenhefer.1@us.af.mil

PROFESSIONAL DEVELOPMENT

By Kathryn Atkinson, CMP NCAFP Meetings & Events Manager

~ MEETINGS & CONFERENCES ~

Changes to NCAFP’s CME Programming Proving to Be a Welcome Change by Many The NCAFP CME & Meetings Department continues to explore new ways of bringing you the best possible educational and networking opportunities. With our promise of always providing top-notch CME on timely requested topics presented by first-rate speakers, to an advanced yet user-friendly mobile app and time-saving registration kiosks; we pride ourselves on providing members with a fantastic and rewarding experience at every event.

Discovery and feedback gathered in the 2018 Membership Survey inspired NCAFP leadership and staff to do a little brainstorming on ways to further enhance 2019 CME events. Armed with a fresh perspective of what members need and want, we began refocusing energy and resources towards providing elevated education and networking experiences to more members throughout the state. The first step was pressing pause on the week-long summer CME conference in Myrtle Beach. A regular annual program for over 25 years, the program’s most recent three years experienced significant attendee (and vendor) drop-off.

Cost of travel, extended time away from the office, and limited CME budgets were critical attributes to the overall decline in attendance. In response, convenient regional programs with more affordable, schedule-friendly, and time-saving formats were

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designed to replace the five-day July conference.

And, the changes are paying off.

The Spring Symposium, a Saturday CME event spearheaded by Program Chair Dr. Nichole Johnson with 8.00 AAFP Prescribed Credits ready for the taking, was attended by over 100 Charlotte-area members in April.

Clinical sessions included diabetes, lupus, IBS, depression, migraines, and more. An overall conference survey indicated that the regional location and the convenient Saturday schedule (i.e., no lost office time) were the most significant influences on member participation.

In June, we added a fun twist to the CME calendar with a unique after-office hours dinner program tackling the topic of opioids. Hosted at the historic Kimpton Cardinal Hotel in Winston-Salem, over 50 local members enjoyed camaraderie and fun along with a timely presentation, “2019 Street Drugs: Do’s, Don’ts and Dupes,” by Dr. Paul Martin, a family physician and widely recognized expert speaker on the topic of addiction medicine. It was a packed house filled with colleagues and friends, all of whom enjoyed the one-of-a-kind atmosphere complete with foosball tables, a bowling alley, a delicious gourmet dinner, and 1.5 AAFP Prescribed Credits. Participants also earned credit towards the state’s controlled substance CME requirement for physicians by their participation. Survey results indicated the program’s timing, affordability, and location as driving factors in members’ decisions to attend.

In September and October, we will continue our trend of regionally available and schedule-friendly Carolina CME opportunities with events in Wilmington and Raleigh. While it may be hard to consider your plans for the fall now that summer is here and temperatures are in the triple digits, you’ll still want to grab your calendar and make a note of these unmatched NCAFP CME and networking happenings.

Those in and around the Wilmington area are invited to join us for a brand-new CME format,”30 Minute Exchanges - Exploring Hot Topics.” This premiere CME dinner program is planned for Thursday, September 12th from 6 pm to 8:30 pm at The Hops

The North Carolina Family Physician

Supply Company, a favorite local gastropub known for culinary delights and a laid-back setting. The convenient after-office-hours educational lineup includes three 30-minute sessions designed to examine the timely topics of Addressing Diversity in Immigrant Care, Basics on

Human Trafficking for Primary Care Providers, and Opioid Use Disorder & Hep C Concurrence. Registration fees are $25 per person and include a light reception, a casual dinner, and an estimated 1.5 CME credits. Online registration information and additional details are available now at www.ncafp.com/wilmingtoncme.

30 Minute Exchanges – Exploring Hot Topics A convenient, regional, after-office hours dinner and CME opportunity in a relaxed setting THURSDAY, SEPTEMBER 12, 2019 • 6:00 PM – 8:30 PM Hops Supply Company, Wilmington, NC Three 30-minute lectures: Appreciating Diversity in Immigrant Health Basics on Human Trafficking for Primary Care Providers Opioid Use Disorder and Hep C Concurrence Presenters: Karen Isaacs, MD, MPH; Kristin Kirkland, MD, MPH; and Mayra A. Overstreet-Galeano, MD

$25 registration fee includes light reception and dinner Estimated 1.5 credits Complete schedule information and online registration available at www.ncafp.com/wilmingtoncme

All medical education topics offered by the NCAFP have been reviewed by a family physician, and when possible and appropriate, are presented by a family physician. While the NCAFP may receive pharmaceutical funding to help provide education at our events, they are allowed no influence on the content provided. The integrity of the information provided is always the NCAFP’s primary concern.

Members nearer the Raleigh area are encouraged to register for, “The Essentials of Managing Common Chronic Diseases in Family Medicine,” Saturday, October 12th at the Hampton Inn at Brier Creek from 7:30 am to 12:30 pm. Led by program chair Dr. Nicholas Pennings, presentations and case studies will include effective treatments for obesity, hypertension, diabetes, and hyperlipidemia. Registration fees for the halfday Saturday CME & networking opportunity are $80 per person and include a continental breakfast, light refreshments, and an estimated 4.00 CME credits. Online registration, speaker information, and additional details for this program are available now at www.ncafp.com/raleighcme. com.

Lastly, I’d be remiss if I did not give a quick shout out to the upcoming 2019 Winter Family Physicians Weekend with Program Chair Nichole Johnson, MD, and Program Vice-Chair Victoria Kaprielian, MD leading the way. Enjoyed by hundreds every year, we warmly invite you to join in on the fun and to register soon for this famous annual weekend in the Blue Ridge Mountains. Scheduled for December 5 – December 8, 2019, at the Omni Grove Park Inn in Asheville, NC, and with an estimated 25+ credits on the schedule, this conference is truly like no other

Summer 2019

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you’ve ever attended. Complete with optional pre-conference workshops, four days of top-notch general session lectures, multiple innovative seminars, and complimentary satellite programs, this is an excellent opportunity to fulfill your year-end CME requirements and reignite your passion for family medicine - all in a fun and relaxed setting with family and friends. Register early and save as Early Bird Registration for members ends on Sunday, Oct. 6th.

Access the latest schedule of events and complete your online registration today by visiting the conference site at www.ncafp.com/wfpw.

The NCAFP CME & Meetings Department is delighted to provide new and engaging (along with traditional and always dynamic) education and networking opportunities to our members. We are thrilled that so many of you benefit from our commitment to provide convenient, affordable, and timely opportunities to learn and fellowship with colleagues and friends. Accessible and engaging CME programs are proving to be exciting new avenues for terrific face-to-face interactions and meaningful conversations. And, even better, member names that were usually only listed in a database are now appearing on name badges. These opportunities have also led to newly expressed interests in the Academy’s advocacy efforts, the Foundation’s student and resident initiatives, and important 22

Essential Elements of Managing Common Chronic Diseases in Family Medicine Raleigh ½ Day Saturday CME & Networking Opportunity

SATURDAY, OCTOBER 12, 2019 • 7:30 AM – 12:30 PM The Hampton Inn Brier Creek, Raleigh NC First-Rate Faculty: Nicholas Pennings, DO – Program Chair Alisa C. Nance, MD, RPh • Jay Patel, MD, MPH • Thomas R. White, MD Non-communicable diseases remain the predominate cause of morbidity and mortality in the US. Primary care providers remain at the forefront of early detection and treatment. Presentations and case studies in this session will focus on the effective treatment of the core components of a primary care practice: obesity, hypertension, diabetes, and hyperlipidemia.

Registration Fees: $80 AAFP/NCAFP Members • $125 Non-Members Estimated 4.00 Credits Register now at www.ncafp.com/raleighcme

All medical education topics offered by the NCAFP have been reviewed by a family physician, and when possible and appropriate, are presented by a family physician. While the NCAFP may receive pharmaceutical funding to help provide education at our events, they are allowed no influence on the content provided. The integrity of the information provided is always the NCAFP’s primary concern.

leadership opportunities within the association. Consider joining us soon to experience once again, or perhaps for the first time ever, a CME program designed with you in mind. Please contact

Kathryn Atkinson, CMP, Manager of NCAFP Meetings & Events, at katkinson@ncafp.com or via direct dial at 919-214-9058 with any questions.

The North Carolina Family Physician

jobs.ncafp.com

Employers:

Family Physicians:

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

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RESIDENTS & NEW PHYSICIANS

By Tracie Hazelett NCAFP Medical Student & Residency Relations Manager

Two NCAFP Residents Selected as Emerging Leaders by AAFP Foundation The AAFP Foundation’s competitive leadership development program has selected two residents from North Carolina to participate in the Family Medicine Leads’ Emerging Leader Institute.

Rana Alkhaldi, MD, was born and raised in North Carolina.

She obtained her undergraduate degrees in Biology and Arabic at UNC-Chapel Hill before moving to Connecticut, where she was in the second class of medical students at a new program with a focus on primary care: The Frank H. Netter School of Medicine at Quinnipac University. “In medical school, I discovered a passion for patient education and advocacy, preventative medicine, and fostering long-lasting relationships with patients. After also discovering that I loved every single rotation in my third year (and believing I was going to be an internist and then a surgeon and then a pediatrician and then…), I realized that full-scope Family Medicine was my true calling.”

Upon graduation, Dr. Alkhaldi returned to North Carolina and is once again in Chapel Hill while she completes her residency training at UNC, where she is now a second-year resident. Dr. Alkhaldi’s

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interests in medicine include obstetrics and women’s health, academic medicine, and refugee health. Outside of medicine, “I enjoy spending time with friends and family, eating food because there is SO much delicious food to eat around here, getting hooked on TV shows, yoga, and hiking.”

A. Brad Thompson, MD, MS, also hails from North Carolina and has been educated in three of the state’s universities along the way. He completed his undergraduate degree at NC State, his master’s degree at Wake Forest and completed his medical education at the University of North Carolina School of Medicine. Dr. Thompson chose Family Medicine because “it will allow me to develop long-lasting relationships with patients of all ages, while training me to provide excellent care in a variety of in-patient and out-patient settings. Family Medicine is very procedural, and I will get hands-on experience with the most basic to the most complex of procedures and techniques. I like that this field is continually evolving and changing to meet increasing demands for primary care and that it caters to a very diverse population. Now is a very exciting time to be in Family Medicine as it is currently on the forefront of healthcare change and innovation.”

Dr. Thompson is completing his Family Medicine residency training at Cone Health, where he is now a second-year resident. In his spare time, Dr. Thompson “enjoys reading biographies, hiking with his wife and daughter (and a brand-new baby), and cooking the best chicken (and also French toast) that you’ve ever had!”

Drs. Alkhaldi and Thompson are among the 30 scholars selected nationwide to participate in the program’s fifth cohort. Scholars attended National Conference July 25–27 in Kansas City,

The North Carolina Family Physician

MO, followed by workshops at the AAFP national headquarters on Sunday, July 28. Post conference, the scholars will develop a project based on one of three tracks: Policy & Public Health Leadership, Personal & Practice Leadership or Philanthropic & Mission-Driven Leadership; with Project Award recipients returning to present at the 2020 National Conference. A complete list of the 2019 FML Emerging Leader Institute Scholars is available (www. aafpfoundation.org). Congratulations Dr. Alkhaldi and Dr. Thompson!

Scholarship Winners The NCAFP also extends congratulations to AAFP Foundation Family Medicine Leads Scholarship winners who received awards to attend the recently held AAFP National Conference of Family Medicine Residents and Medical Students. Nine students were selected to receive travel awards from the AAFP. They included: Brooke Evans (Duke); Emmanuella Mensah (Brody); Sarah Nullmeyer (Duke); Margo Faulk (UNC); Kathryn Garner (UNC); Katie Myrick (UNC); JackĂŠe Okoli (Duke); Robert Wallace (Campbell); Robert Ward (Campbell); and, Ryan Zoldowski (Wake Forest).

An additional 14 students were awarded travel scholarships from the NCAFP Foundation to help offset travel expenses to attend the conference.

Congratulations to all!

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Contact Peter Graber with the NCAFP at pgraber@ncafp.com 25

NORTH CAROLINA’S

2019

Resident & Student Research Poster Presentation The AMA Awards UNC School of Medicine $1.8 Million to Support its FIRST Program The American Medical Association (AMA) announced in May that it will award the UNC School of Medicine $1.8M to support a significant expansion of the Fully Integrated Readiness for Service (FIRST) Program to new geographic areas of North Carolina and to additional high needs specialties, including Family Medicine, General Surgery, Pediatrics, and Psychiatry. The FIRST Program was founded in 2015 by Cristy Page, MD, MPH, former chair of the Department of Family Medicine and now Executive Dean of the UNC SOM, to link the Family Medicine workforce pipeline from medical school to residency and to service in rural/underserved North Carolina. FIRST participants have the opportunity to complete their medical degree in three years followed by the opportunity for placement with a Family Medicine residency program of North Carolina, after which FIRST scholars will take part in three years of service in an underserved area of North Carolina. They receive ongoing support from UNC Family Medicine in partnership with the NC Office of Rural Health and Community Care, AHEC, Piedmont Health Services, and the North Carolina Academy of Family Physicians.

The NCAFP Foundation’s twenty-sixth annual Research Poster Presentation will be held at the Academy’s Winter Family Physicians Weekend this December 5-8, 2019.

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 in December.

Resident and Student members interested in participating must submit their application and all corresponding materials (including final PDF of poster) by October 1st, 2019.

Complete info at www.ncafp.com/rpp Please direct questions to Tracie Hazelett at thazelett@ncafp.com or 919-980-5357.

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The North Carolina Family Physician

- T H E 2 0 1 9 N C A F P F O U N DAT I O N R A F F L E -

Win One of

5

Fabulous Vacations in the US!

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’S EFFORTS TO SUPPORT STUDENT INTEREST INITIATIVES CONTINUES. YOU CAN SUPPORT THIS IMPORTANT WORK AND HAVE A CHANCE TO WIN YOUR CHOICE OF ONE OF FIVE FANTASTIC TRIPS! Information about the Foundation’s raffle can be found at www.ncafp.com/raffle. Make your purchase by Noon on Saturday, December 7th, 2019, and your name is automatically entered in the drawing. Each entry is $50.00.

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.

$50

per entry

PRACTICE MANAGEMENT

- SPECIAL POPULATIONS -

Innovations Support NC Family Physicians in Caring for the Intellectually and Developmentally Disabled

By Karen Luken Disability and Health Consultant Project Director, I/DD Medical Health Home Initiative

North Carolina is in the midst of major health system transformation that requires innovation, collaboration and workforce development. This article briefly describes four North Carolina projects that support the critical role of family physicians and residents in meeting the health needs of children and adults with intellectual and other developmental disabilities.

PROACTIVE CARE FOR THE PHYSICAL AND MENTAL HEALTH NEEDS OF CHILDREN WITH I/DD AND THEIR FAMILIES The NC Pediatric Access Line (NC PAL) is a partnership between Duke Integrated Pediatric Mental Health, Duke Hospital and Health Center, the Carolina Institute for Developmental Disabilities at UNC-CH, UNC Complex Care Pediatric Service, and NC START Central.

It has implemented a telephone consultation service modeled after the Massachusetts Child Psychiatry Access Program (MCPAP) that enables a physician to contact a pediatrician or psychiatrist for immediate case consultation about diagnosis, medications, co-morbid medical conditions and referral

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The North Carolina Family Physician

resources. A resource coordinator or family partner can also assist the provider, patient, or family with follow-up and systems navigation.

To ensure that NC PAL is not only called upon when an individual patient is in crisis or distress, they have invested in proactive outreach to primary care practices and providers. A review of billing claims and EHR can identify patients with I/DD who are struggling with social determinants of health, in need of additional behavioral health supports, or assistance with transition planning.

Opportunities for growth of the NC PAL model include new Medicaid Behavioral Health Consultant Codes and 2 HRSA grants implementing the MCPAP telephone/ telehealth consultation model focused on pediatric mental health and maternal depression.

For more information, contact Dr. Gary Maslow, MD, MPH, Co-Chief in the Division of Child and Family Mental Health & Developmental Neuroscience and Medical Director of Integrated Pediatric Mental Health Clinical Practice Unit at Duke Health, at gary.maslow@ duke.edu.

BUILDING CAPACITY IN EASTERN NC FOR INTEGRATED HEALTHCARE SERVICES FOR PERSONS WITH AUTISM SPECTRUM Children with intellectual and other developmental disabilities living in rural environments are more likely to receive their care from family physicians rather than pediatricians or specialty providers. There is an urgent need to support rural primary care physicians in their ability to provide consistent, high quality care to individuals with Autism Spectrum Disorder (ASD) across the life course.

TEACCH UNC-CH is implementing Project ECHO Autism to improve the quality of care received by children and adults with ASD by increasing ASD-specific knowledge and treatment self-efficacy of rural primary care physicians and increasing diagnostic screening and treatment of common medical and behavioral health comorbidities.

The ECHO (Extension for Community Healthcare Outcomes) model uses tele-mentoring to create access to high quality specialty care in local communities, supports the patient’s medical home, and promotes

Summer 2019

knowledge sharing networks among specialists and community physicians.

An ECHO cohort meets bi-monthly for six months, with a brief didactic presentation by subject matter experts and then a case presentation by an ECHO participant. The TEACCH ECHO lecture topics and curricula include ASD screening, structured teaching strategies, differential diagnosis, medication management, family support, and community resources.

Evaluation has documented that participants have increased their knowledge of ASD and report increased self-efficacy in addressing medical and medication issues. Another significant finding is that ASD screening rates at 18 and 24 months have increased from 56 % to 90%.

Here is an example of participant feedback: “I have gained a wealth of knowledge regarding interventions. This training is truly insightful, practical, and empowering. Hands down, this training is an effective use of time and is yielding fruitful results.”

There is a growing state and national interest in the ECHO model as a way to increase workforce capacity and address health care disparities. The AMA has recently adopted a policy to encourage use of telemedicine, specifically highlighting the use of the ECHO model.

For more information, contact Dr. Laura Grofer Klinger, PhD, Director, TEACCH Autism Program, Associate Professor, Psychiatry, University of North Carolina at laura_klinger@med.unc.edu.

IMPROVING RURAL PRIMARY CARE FOR CHILDREN WITH COMPLEX NEEDS IN WESTERN NC DD Plus is being implemented by Mission Children’s Hospital, in partnership with McDowell Pediatrics, Hendersonville Pediatrics, MAHEC Family Medicine, and Vaya Health LME/MCO. The goal is to provide integrated, family-centered, community-based care for children with intellectual and other developmental disabilities who are experiencing behavioral health and other complex care needs. Strengthening relationships among regional providers and those with I/DD expertise supports access to quality care in the patient’s medical home and acknowledges that Continued on next page

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collaboration is necessary to manage significant challenges, remove barriers to care and provide family support.

DD Plus has developed an array of core activities: • Monthly Collaborative Office Rounds that offer a brief didactic lecture followed by a case presentation from a team member. Lectures have included diagnostic challenges, sleep habits, medication management, and understanding “problem” behavior in children with Autism Spectrum.

The robust discussion and exchange of ideas from multiple disciplines and perspectives expands the potential solutions and resources available to the family and medical home.

• Family Navigators with experience parenting a child with I/DD has been embedded in a primary care pediatric office to assist families with accessing needed services and supports and “connecting the dots” across multiple complex systems.

• Monthly I/DD educational sessions for behavioral health consultants in the pediatric practices. Educational topics have included Autism Spectrum, sensory rooted behaviors and parenting models (PCIT, Triple P, and Conscious Discipline).

INVESTING IN WORKFORCE DEVELOPMENT AND COMMUNITY CAPACITY Preparing Family Medicine Residents to Care for Individuals with I/DD The MAHEC I/DD clinic is dedicated to ensuring every physician graduating from its Family Medicine Residency is skilled and comfortable in the care of patients with I/DD and considers care of this population part of their responsibility in serving the community. The clinic is based in the MAHEC Family Health Center in Asheville and is a partnership between MAHEC Family Medicine and Vaya Health LME/MCO. The clinic offers comprehensive, individualized evaluation and consultation for children and adults with I/DD and is designed to support and coordinate care with the patient’s medical home within or outside MAHEC. Clinic services include: • Support for transitioning from pediatric to adult services • Referrals, (e.g. home health, PT/OT, medical specialists, behavioral health)

• Tele-consults between the developmental behavioral pediatrician and primary care team are available outside of COR meetings.

• Onsite consultation and/or services for wellness, nutrition, dietary education, dental care, psychiatry, medication review with a clinical pharmacist

For more information, contact Dr. Adrian Sandler, Medical Director of the Olson Huff Center, Mission Children’s Specialists, at Adrian.Sandler@hcahealthcare. com.

• Communication with and referrals to care navigators, care coordinators and specialists

Individuals with I/DD and their families want to receive healthcare from competent, caring, and accessible providers in their community. Each of these programs is designed to improve the education, mentoring and support given to family physicians so they can provide exceptional care to people with I/DD and their families. These four North Carolina projects acknowledge the critical role that family physicians play in advancing integrated health care and person-centered care.

In addition to patient appointments, the clinical team and partners meet regularly to discuss workflow, community outreach, best practices, evaluation, and feedback from residents, patients and families. The MAHEC I/DD clinic team demonstrates that collaboration is an essential ingredient in the development of integrated health systems and delivery of high quality care.

• Family and caregiver support

For more information, contact Dr. Rebecca Thomson, MD, MAHEC Family Health and NCAFP member, at Rebecca.

Thomson@mahec.net.

End Note: The I/DD Medical Health Home Initiative (MHHI) is a partnership among The Arc of NC, Easter Seals UCP NC, and the Autism Society of NC that is advancing innovation and access to quality healthcare for people with I/DD and their families. For additional information, contact Karen Luken at karenluken@gmail.com.

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The North Carolina Family Physician

INITIATIVES

Improving Health on the Frontlines The NCMS Foundation currently has two major initiatives underway aimed at improving health throughout the state. Project OBOT addresses the opioid abuse epidemic, and Our Community Health Initiative (OCHI) helps physicians connect patients to community resources.

Project OBOT Offers More Shauna Guthrie, MD, MPH, already was using Medication Assisted Treatment (MAT) to treat patients with opioid use disorder (OUD) at the Granville Vance District Health Department when Franklin Walker, NCMS’ VP for Rural Health Systems Innovation, approached her about the NCMS Foundation’s Project OBOT or Office Based Opioid Treatment.

Many of Guthrie’s OUD patients have trouble finding transportation to her appointments, let alone to visit a drug treatment counselor, making their recovery process more difficult.

“Having access to drug counselors for these patients through telemedicine is so awesome for them,” Dr. Guthrie said. She points to a Project OBOT laptop her OUD patients can take to a quiet space to connect via a telemedicine portal with their counselor while at her office. No need for a separate trip.

Project OBOT also offers an online dashboard where everyone involved in a patient’s treatment shares notes -- drug counselors, mental health professionals, even drug court personnel – and lab test results. The initiative provides patients deep discounts on costly MAT drugs, eliminating yet another barrier to recovery. Physicians have access to MAT training and help in integrating it into their practice workflow.

Learn more at http://projectobot.com.

Summer 2019

By: Elaine Ellis, MSJ Vice President, Communications & Marketing NC Medical Society

OCHI Connects the Community Our Community Health Initiative (OCHI) eases the interaction between physicians, PAs and community resources ultimately benefiting patients.

The first use of this innovative platform is underway in the Triangle, with physicians seamlessly referring patients with pre-diabetes to a YMCA of the Triangle Diabetes Prevention Program close to the patient’s home. Trainers at the Y have been equipped with tablets to record real time data charting the patient’s progress, which the physician then accesses through their EHR. Grant funding covers a patient’s Y medical membership, which includes care coordination and participation in an evidence-based program like the Diabetes Prevention Program.

Throughout North Carolina and the nation, YMCAs already have evidence-based health improvement courses in place like the Healthy Hero family health initiative and the Livestrong adult cancer survivor program. OCHI eventually will expand to include other projects with the YMCA and other community organizations.

“We have the goal of creating healthier individuals and communities,” said Susan Pettengill, vice president of Healthy Living for the YMCA of the Triangle.

By easily sharing the patient’s data back to the physician, the OCHI platform also can enhance the practice’s quality improvement scores.

“Education is so much of this,” said the NCMS’ Walker, the developer of OCHI. “We need to help change physician perception. The Y is a community health provider; [its programs] are changing behavior and improving health.”

Learn more at http://ourcommunityhealthinitiative.org.

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Perhaps the most exciting and greatest “win” for Family Medicine in our state Medicaid program is its payment parity with Medicare. Along with the North Carolina Pediatric Society, the NCAFP worked with Secretary Mandy Cohen and DHHS to bring Medicaid payments for family physicians and other primary care providers to parity with 2018 Medicare rates moving forward. Previously, primary care physicians were well below Medicare rates (about 74 to 75% of Medicare) for their evaluation and management codes, and hopefully this achievement will help those practices struggling to accept Medicaid patients. Another “win” in the Academy’s efforts with DHHS has been to limit the administrative burden of moving from one payer to four or five through a single application process and a uniform medication formulary across all plans.

The NCAFP has also been having ongoing conversations with Blue Cross NC. As Blue Cross NC is partnering with new health entities like CareMore Health, CityBlock, Iora Health, and Landmark Health, leaders within the NCAFP will meet with Blue Cross NC and other payers to help ensure there is little-to-no interference with the physician-patient relationship by a third-party.

Members of the committee also provided feedback on a Humana value-based healthcare video script, and staff has helped a member with relationships with United HealthCare.

Non-Profit Org. US Postage

PAID

As you can see, the Payer and Systems Advocacy Committee is actively involved to help you with your day to day practice needs. The NCAFP is actively engaged with payers and health systems of our state, to advocate for YOU!

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Also, on the horizon are the changes with the State Health Plan. With the NC Treasurer leading the directive of saving the state $300 million with his plan, those who have signed on to accept the plan moving forward, will see changes in reimbursement. Some physicians will benefit, and some will

Primary Care Investment is another area of interest for the NCAFP. Our goal has been to increase the percentage of health care dollars spent on primary care. In states where economic improvement in total cost of care has been realized, the primary care investment has been greater than that of North Carolina. Currently, the average primary care investment in NC is around 5-7% depending on the payer, and the goal would be to move to 12 to 15%. Blue Cross and Blue Shield of NC (Blue Cross NC) has already pledged to increase investment in primary care to at least 10 percent of the premium dollar. Our efforts continue as we strive to maintain patient access and to increase the family physician workforce.

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

wise known as Medicaid Expansion, and addressing Medicaid Reform.

While Medicaid Expansion is tied up in the state budget debate, Medicaid Transformation is well underway. As the full implementation of Medicaid managed care approaches, it is the NCAFP’s goal to help with provider engagement and education on the changes to come. Currently there are four statewide plans and one regional plan with which the Department of Health and Human Services (DHHS) has contracted. Regular updates on transformation are made at www.ncdhhs.gov/assistance/medicaid-transformation.

not. The reimbursement is supposed to level the playing field to a fixed percent of Medicare payment to providers (160 percent for professional services). Hospitals, especially small, rural ones, may see the greatest impact.

www.ncafp.com

PAYERS & SYSTEMS