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Volume 12 Issue 4 / Autumn 2016

The North Carolina

Family Physician Quarterly News in North Carolina Family Medicine

Raeford’s Rockstar— Dr. Karen L. Smith Named 2017 AAFP National Family Physician of the Year

The New & Improved Academy A By-the-Numbers Look into the NCAFP’s CME & Meetings Feds Issue Final MACRA Rules


Winter Family Physicians Weekend Dec. 1-4, 2016

The Omni Grove Park Inn in Asheville, NC

LEARN MORE AND REGISTER TODAY AT

WWW.NCAFP.COM/WFPW


Inside Autumn 2016

16 Raeford’s Rockstar Dr. Karen L. Smith Named 2017 National Family Physician of the Year

For the second straight year, a North Carolina family physician has been awarded AAFP’s highest honor. Discover what makes Raeford’s Dr. Karen Smith one of the best family physicians in the nation.

PRESIDENT’S MESSAGE

MEETINGS & EDUCATION

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20 A By-the-Numbers Look Into the NCAFP’s

Not in My City!

HEALTH POLICY & ADVOCACY

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Your Academy in Action

NCAFP FOUNDATION

12 Dr. Maureen Murphy Honored at the 2016

Family Medicine Gala

24 The Three Mentors You Meet in Medicine PRACTICE MANAGEMENT

32 Feds Issue Final MACRA Rules DEPARTMENTS

PUBLISHED BY

t919.833.2110 •

Meetings & CME Department RESIDENTS & NEW PHYSICIANS

fax

919.833.1801 • ncafp.com

Managing Editor & Production Peter Graber, NCAFP Communications

President’s Message 4 Policy & Advocacy 6 Chapter Affairs 10 NCAFP Foundation 12 Membership 16 CME Meetings & Education 20

Residents & New FPs 24 Student Interest 30 Practice Management 32

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 NCAFP Members By Dr. Rhett L. Brown 2015–2016 NCAFP President

Not in My City! We can all work toward reducing social injustices and healthcare disparities

How could this happen in Charlotte? In my city? I have lived in Charlotte almost continuously since 1966. I started first grade the first year of busing in Charlotte back in 1970. Sure, it has not been a perfect city… but riots? Tear gas? The death of a protestor? This is my city, my hometown! Things like this should not be happening here. But it did. There will be a thorough investigation into the root causes of this tinder box but I suspect one will be systemic barriers leading to economic segregation that limits access to quality education and quality healthcare. Working to improve and reduce the disparities of health care in Charlotte is one thing I can do to prevent this from happening in my city again. Charlotte experienced unprecedented large-scale protests as the result of a police shooting in September. Individuals frustrated with a city and policies that are stacked against them reacted. How did we get here? Decisions and policies made over generations have led to a community that is very divided along economic lines that often serve as markers for racial segregation. The integrated schools I knew in my youth have vir-

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tually all faded. Now we have schools with a majority of students living in poverty that are separated from schools with wealthier students. We are a community of haves and have nots. A 2014 study by researchers at Harvard University and UC Berkeley ranked the Charlotte area 50th out of 50 cities for economic mobility. The probability that a child born into the bottom fifth of incomes will rise to the top fifth in her lifetime is just 4.4 percent. By contrast, the probability that a child born into the same circumstances in San Jose, California, will rise to the top is 12.9 percent. The problem is likely to get worse as poor and minority children with the least education become a larger share of the population – spelling trouble for the state’s future workforce. Projections show that more jobs will require more education at a time when a growing proportion of North Carolinians will be less prepared to meet these requirements. Economic segregation and lack of opportunities to improve play a significant role in the health of an individual and of the community as a whole. The World Health Organization defines the social determinants of health as the conditions in which people are born, grow, live, work and age. The circumstances are shaped by the distribution of money, power, and resources at global, national, and local levels. In essence, a person’s zip code may be more important to health than their genetic code. Charlotte is not immune to the effects policies and choices made by our leaders over the years have had on our current situation. A statement I often use in quality improvement is “a system is perfectly designed to achieve the results it gets.” And that seems to apply here. Like quality improvement work in our offices, if we want to make things better, we need to know where we are and develop a goal to aim toward.

The North Carolina Family Physician


2015-2016

NCAFP Board of Directors

The leadership of the Mecklenburg County Health Department and its Director, Dr. Marcus Plescia, a family physician, completed a study of health care disparities and the underlying social determinants in Charlotte. Maps of education and income levels for Mecklenburg County show a concentration of highest poverty in six zip codes near uptown Charlotte. These zip codes are associated with low education rates, higher rate of unemployment and high rates of preventable disease. The health department has targetLike quality improvement work ed these zip codes for in our offices, if we want to make improvements in key health behaviors. The things better, we need to know top four health issues where we are and develop a goal found by a Communito aim toward. ty Health Assessment conducted in 2013 were: 1) chronic disease prevention; 2) mental health; 3) access to care; and 4) violence prevention. The county knows where we are right now and has a goal to aim for. By working as part of the community, the healthcare providers (all of us) can begin to remove some of the injustice that can fuel the fire. As healers we must take our role in helping to heal our community. It will take all of us. By energizing all the components of healthcare we can start to reduce some of the fuel leading to our recent firestorm. And begin to heal our community.

Executive Officers President President-Elect Vice President Secretary/Treasurer Board Chair Past President (w/voting privileges) Executive Vice President

Rhett L. Brown, MD Charles W. Rhodes, MD Tamieka M.L. Howell, MD Alisa C. Nance, MD, RPh Thomas R. White, MD William A. Dennis, MD Gregory K. Griggs, MPA, CAE

District Directors District 1 - Mackenzie Smith, MD District 2 - Gilbert Palmer, MD District 3 - Eugenie M. Komives, MD District 4 - Shauna L. Guthrie, MD, MPH District 5 - Dimitrios “Taki� P. Hondros, MD District 6 - Cody A. Wingler, MD District 7 - Jennifer L. Mullendore, MD At-Large Jason T. Cook, MD At-Large David R. Rinehart, MD IMG Physicians Joseph P. Pye, MD Minority Physicians Benjamin F. Simmons, MD Osteopathic Family Physicians Slade A. Suchecki, DO New Physicians Jessica Triche, MD Medical School Representatives Chair Warren P. Newton, MD, MPH (UNC) Family Medicine Residency Directors Viviana Martinez-Bianchi, MD (Duke University FMR) Resident Director Margarette Shegog, MD, MPH (MAHEC-A) Resident Director-Elect Alyssa Shell, MD, PhD (MAHEC-A) Student Director Jeffrey Pennings (Campbell) Student Director-Elect Angie Maharaj (Campbell) Medical School Representatives & Alternates Chair (UNC) Warren P. Newton, MD, MPH Alternate (Campbell) Charlotte Paolini, DO Alternate (Duke) J. Lloyd Michener, MD Alternate (ECU) Chelley Kaye Alexander, MD Alternate (Wake) Richard W. Lord, Jr., MD, MA AAFP Delegates & Alternates AAFP Delegate Michelle F. Jones, MD AAFP Delegate Karen L. Smith, MD AAFP Alternate Richard W. Lord, Jr., MD, MA AAFP Alternate Robert L. Rich, Jr., MD The NCAFP Family Medicine Councils Advocacy Council Robert L. Rich, Jr., MD, Chair CME Council Membership & Workforce Practice Management Council Public Relations & Marketing

Autumn 2016

Alisa C. Nance, MD, RPh, Chair Jessica Triche, MD, Chair Benjamin Simmons, MD, Vice-Chair Joseph P. Pye, MD, Chair Thomas Wroth, MD, Vice-Chair William A. Dennis, MD, Chair

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

The Academy in Action NCAFP’s Work on Your Behalf

BCBS officials. At the same time, representatives of the NC Medical Society expressed concerns on behalf of their entire membership and also facilitated a meeting with BCBS officials. Ultimately, BCBS NC decided not to implement the policy, leaving knee and shoulder injections as a covered service for their plan members, and allowing physicians to keep these key tools in their arsenal of ways to provide relief and treatment to their patients. We appreciate the opportunity to discuss these issues with our state’s largest insurer and their willingness to listen to and act on comments and concerns of our state’s family physicians and others.

Providing Assistance to Members Regarding Medicaid While the Medicaid payment problems caused by the implementation of NCTracks over the last 18-months “The Academy in Action” is a new feature in our have subsided, sometimes members still experience magazine to let you know how the NCAFP leadership difficulty with Medicaid in other ways. In October, and staff are working to advocate for and on behalf of a member contacted the our members. Each quarter NCAFP concerned about we will just highlight a few Each quarter we will just highlight recoupment letters they were of the ways we have helped a few of the ways we have helped receiving from the state’s members in the past few members in the past few months Medicaid program. Most months, whether it’s been troubling was the fact that through an individual memthey had received several ber contact or a more broadwithout explanation from based effort. Please note a Medicaid on why the practice received the letters few of these efforts below. or why an overpayment may have occurred. The practice had not been able to get good answers from NCAFP and Others Oppose BCBS NC Policy Change Medicaid through their contacts. In August, Blue Cross and Blue Shield of NC announced plans to eliminate coverage for steroid inThrough the NCAFP’s ongoing relationship with the jections in knees and shoulders. Once aware of the State’s Medicaid Director and others, the NCAFP was plan, the NCAFP staff and leadership acted quickly, able to bring the issue to the attention of the top leaderalong with the NC Medical Society and other specialty groups. After this initial action, BCBS decided to ship in our state’s Division of Medical Assistance, who immediately agreed to look into the problem and try to hit the pause button and delay implementation of the find some answers. While at press time, the problem policy change. had not been completely rectified, and it’s possible the recoupment will still be sought, through the work of Subsequently, NCAFP staff expressed concern to BCBS your NCAFP staff, the practice was getting commumedical directors electronically and arranged for addinication from Medicaid with promises of an ultimate tional conversations with a leading family physician expert on joint injections, our own Dr. Jim McNabb resolution in the near future. of Mooresville. Dr. McNabb expressed concerns in writing and in an extensive phone conversation with

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The North Carolina Family Physician


Representing Family Physicians in Economic Development, Public Health and More When the NCAFP advocates for family physicians, it happens in numerous ways. One is the NCAFP’s attendance and participation at numerous events across the state. A few of the recent events NCAFP staff and leaders have attended are included below: NC Rural Assembly: In September, NCAFP staff attended and exhibited at the NC Rural Assembly, an annual conference held by the NC Rural Economic Development Center. This year’s conference focused on the intersection of healthcare and economic development and included wide ranging topics from healthcare workforce to the opioid crisis to Medicaid expansion. The NCAFP, along with the NC Pediatric Society, participated in a resource fair to highlight the importance of primary care on both population health and the local economy in North Carolina.

represented at this year’s M3Conference, a joint effort between the NC Medical Society and the NC Medical Group Managers Association. Past NCAFP President Michelle Jones, MD, and NCAFP Member Arthur E. Apolinario, MD, MPH, both serve on the Board of Directors of the NC Medical Society. NCAFP Board Member Shauna Guthrie, MD, also attended the meeting, along with NCAFP EVP Greg Griggs and numerous other family physicians from around the state. During the meeting, Dr. Paul Cunningham took over as President of the NC Medical Society. Dr. Cunningham is past Dean of the Brody School of Medicine at East Carolina University, having stepped down from the role of Dean earlier this fall International Influence While the NCAFP focuses on the needs of family physicians in North Carolina, more and more the influence of North Carolina’s family physicians can be felt throughout the world. NCAFP Board Member Dr. Viviana Martinez-Bianchi is seeking election to the WONCA Board of Directors during their annual conference in Brazil in November. WONCA is the World Organization of Family Physicians.

NC Institute of Medicine Annual Meeting: In mid-October, NCAFP staff and leaders participated in the NC Institute of Medicine’s Annual Meeting. Ironically, this year’s IOM Annual Meeting also focused on the intersection of economic development and healthcare. The IOM is led by NCAFP member Adam J. The South Korean FP delegation visited Duke and the NCAFP. Zolotor, MD, DrPH. NCAFP Government Affairs Consultant Christopher Hollis continues to represent family physicians across the state at numerous legislative hearings. Just recently, both the Joint Legislative Oversight Committee on Health and Human Resources and the Joint Legislative Oversight Committee on Medicaid and Health Choice held meetings to discuss possible legislation once the General Assembly returns to Raleigh in January. The Family Medicine Community was also well

She also recently served as host of a group of South Korean Family Physicians who visited Duke University. During the short time the group visited North Carolina, the NCAFP hosted them for lunch, where they heard about the Academy and the Patient-Centered Medical Home from NCAFP EVP Greg Griggs. Dr. Randall Williams, Deputy Secretary of the NC Department of Health and Human Services, also presented on key elements of healthcare in our state. The group then toured the practice of past NCAFP President Dr. Conrad Flick.


NATIONAL LEVEL

Happenings from the AAFP Congress of Delegates You belong on our team.

FAMILY MEDICINE

Physician Career Opportunities Carolinas HealthCare System, a national leader in the transformation of healthcare services, is actively seeking dynamic Family Medicine physicians to join our growing team throughout North and South Carolina. General details include:  Primarily outpatient only with a few locations offering inpatient  Positions are Monday–Friday, 8 a.m.–5 p.m.  Comprehensive Care Teams At Carolinas HealthCare System, you will work as a key member of a supportive team that is responsive to your opinions and respects your expertise. With more than 1,000 primary care physicians across our System, we are One team dedicated to transforming the delivery of healthcare while providing a superior patient experience. Our service area allows for an exceptional quality of life, giving you the option of living and working anywhere between the world-famous Carolina beaches and the breathtaking Blue Ridge mountain chain. We offer a comprehensive compensation and benefits program designed to be competitive and responsive to the varied needs of our diverse workforce. For more information about a career with Carolinas HealthCare System, please contact:

MICHELE ROCCO PHYSICIAN RECRUITER

As always, this year’s AAFP Congress of Delegates was packed full of policy discussions and much, much more. Your North Carolina chapter once again sent a full delegation to the Congress including:

Karen L. Smith, MD, Delegate Michelle F. Jones, MD, Delegate Robert L. (Chuck) Rich, MD, Alternate Delegate Rich Lord, MD, Alternate Delegate

In addition, Benjamin (Frankie) Simmons, MD, served as a delegate for the Member Constituencies for AAFP this year, and several other individuals attended from North Carolina, including current President Dr. Rhett Brown, President-Elect Dr. Charles Rhodes, past presidents Dr. Shannon Dowler (‘13) and Dr. Jim Jones (‘73). NCAFP Executive Vice President and CEO Greg Griggs and Vice President and COO Brent Hazelett also attended the activities. Some of the issues addressed at this year’s Congress of Delegates included the administrative burden of prior authorizations, telehealth, anti-discrimination policy, gun violence, pain as the fifth vital sign, the cost of medication, physician burnout and student debt relief. In some instances, the AAFP officially adopted new policies, while in other issues the Congress outlined specific action steps to address the issues. Finally, in some instances, the Board or appropriate

Michele.Rocco@CarolinasHealthCare.org (800) 847-5084

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EOE/AA

Active at the Congress: NCAFP’s Benjamin Simmons, MD, served as a delegate for the Member Constituencies for AAFP this year.

Continues on Back Cover

The North Carolina Family Physician


Get Free Posters for your Practice! ~ Email ~ thinkle@ncafp.com


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

The New and Improved Academy Changes Geared Towards Delivering Better Service to Members

You may be noticing some changes at the NCAFP. We hope you do and we hope you’ll find them for the better – the “new and improved” Academy so to speak. Well you may be asking what’s happening and why. And those are good questions. So let me try to update you on just a few of the changes and the background behind them. First and foremost, we are trying to become as effective and efficient as possible. We want to use your dues dollar as wisely as possible, and our changes are directed at just that – how can we most effectively represent the family physicians of North Carolina in the most efficient manner as possible. A New Location For nearly 20 years, the NCAFP has owned a building on Annapolis Drive. And our headquarters has served us well. However, as we move forward, the cost of maintaining a large building has increased, and the wear and tear on the building has taken its toll. The amount of space needed in today’s environment has also changed. Over the past few years, it has be-

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come increasingly more time consuming and more expensive to maintain an aging building. At the same time, we were fortunate to be in a “seller’s market” with a willing buyer (an existing neighbor), and this led to a very positive return on the original investment the Academy made in the building. Your Board considered the issue of selling the building over multiple meetings last year, finally deciding to move forward last December, with the new buyer closing on our property this summer and allowing us to lease back for a period of time. As of October 17, the NCAFP headquarters relocated to new leased space in Raleigh near Rex Hospital. Our new address is 2501 Blue Ridge Road, Suite 120, Raleigh, NC 27607. So what does the new space bring? The relocation brings a more effective and efficient workspace with updated technology for your NCAFP staff. Rather than focusing on maintaining a building, we can now put 100 percent of our efforts into assisting our members. The new space will also facilitate greater collaboration between our staff, consultants and others with 21st century workspace. We look forward to serving you from this new location for many years.

A New Look At the same time that we are updating our facility, we are also updating the look, feel and effectiveness of all of our communication vehicles, and adopting the AAFP “Torch” as part of our logo and brand. You’ll notice a new look and feel of our magazine, the North Carolina Family Physician, throughout this edition. And soon we will introduce an updated website. You’ll notice similarities in the look and feel of our print publications, our website and ultimately our e-newsletter.

The North Carolina Family Physician


All these changes are designed to make information easier for you to find and more meaningful to you as NCAFP members. Please let me know what you think as we move forward. Our ultimate goal is to get you information you need in a timely manner without overwhelming you with letters, e-mails and other communication. To that end, we are also rolling out a schedule for our electronic communications. You are now receiving our e-newsletter, NCAFPNotes, every other week on Thursday. On the opposite Thursday you will receive electronic updates on our meetings and other educational opportunities. Again, our goal is to give you the information you need in a timely manner without overwhelming you with e-mails. Finally, you’ll notice changes in those electronic e-mails in the coming weeks. We are working to reformat them to make them more meaningful and to help them stand out from the clutter that we all receive. And we hope you’ll let us know what you like and don’t like in these e-mail communications. The only way we can make sure you get the right information at the right time is through your feedback. The Ultimate Goal We know today’s practice environment is tougher and busier than ever. That’s why we are making our own changes to better meet your needs. We want to be as efficient and effective as possible so we can respond to your needs on a dime. As we move forward, let us know how we are doing as we try to focus NCAFP resources in the most efficient and effective ways possible.

Four Decades of NCAFP Presidents (L to R): Allen Dobson, Jr., MD (‘99); Robert Gwyther, MD (‘02); Jim Jones, MD (‘73); Maureen Murphy, MD (‘01); Douglas Henley, MD (‘89) and Michelle Jones, MD (‘07).

John T. Henley Sr., Endowment to Provide Training for Family Medicine Leaders On Sept. 30, the auditorium at UNC’s Department of Family Medicine was crowded with North Carolina’s primary care pioneers and notable leaders. Drs. Jim Jones, Ed Shahady, Warren Newton, Allen Dobson, Doug Henley and Al Daugird joined dozens of lifelong family medicine physicians including UNC and ECU faculty, alumni, residents, medical students and fellows to celebrate the launch of the John T. Henley, Sr. Endowment for Leadership in Family Medicine. “We are honored to carry on Senator Henley’s legacy, and share his passion with future physician leaders,” said Cristy Page, MD, MPH Interim Chair for UNC’s Department of Family Medicine. “We are grateful to all of the donors, and we thank the NCAFP for supporting this effort from its inception.” Established in 2011 to honor former Senator Henley’s advocacy for family medicine in North Carolina and across the country, the endowment has grown with the help of his family, friends and colleagues. Now, closing in on the $150,000 goal, the endowment will support activities not otherwise possible that support and develop leadership in family medicine. A focus will be on programs that impact medical students, residents and fellows. However, activities like lectures that impact the greater family medicine community with a focus on leadership and advocacy of Continues on Back Cover

Autumn 2016

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NCAFP FOUNDATION By Tracie Hazelett NCAFP Foundation Development Coordinator

Dr. Maureen Murphy Honored at 2016 Family Medicine Gala On a late Saturday in August, the NCAFP Foundation held its only fundraising event of 2016 in downtown Raleigh. The Family Medicine Gala brought together 200 Academy members, supporters and friends of family medicine for a fabulous, fun-filled evening of fundraising, accolades and laughs. The night was spent celebrating the remarkable career of Dr. Maureen Murphy of Concord, NC, mentor extraordinaire to students, residents and practicing physicians alike. In addition to acknowledging her lengthy contributions as a role model and teacher, Dr. Murphy was also recognized for being AAFP’s 2016 National Family Physician of the Year. The event netted nearly $50,000, all of which will be used to support future medical student interest programs. Master of Ceremonies for the evening was Tom Campbell, host and moderator of NC Spin. Mr. Campbell navigated the audience through a series of tributes -- and roasts -- of Dr. Murphy by an engaging and entertaining panel of speakers who highlighted Dr. Murphy’s path from medical school to where she stands today: a physician leader in her community and the state of North Carolina. Colleagues from as far as Kansas were on hand to pay tribute to Dr. Murphy. Kansas Chapter Executive Vice President, Carolyn Gaughan, who first met Dr. Murphy when she was a medical student and introduced her to

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the Academy of Family Physicians, joined attendees by video. Former anatomy lab partner Dr. Bob Moser flew all the way from Kansas to pay tribute to his long-time friend; followed by Murphy’s fellow resident at Duke, Dr. Viki Kaprielian and her attending, Dr. Joyce Copeland, who shared stories from their days of residency training. Dr. Gary Schenk was one of Dr. Murphy’s clinical colleagues from her days in Gaston County and he shared memories of a decade of unrivaled experiences together. Two mentees from days gone by, Dr. Takie Hondros and NCAFP Past President Dr. Shannon Dowler (‘13), talked of Murphy’s influence on their career choice and in their lives. They relayed funny stories of times spent with her as students and later as practicing physicians. Another NCAFP Past President, Dr. Allen Dobson (‘98), and current President-Elect Dr. Charles Rhodes talked about their numerous attempts to recruit her to Cabarrus Family Medicine. There has not been

The North Carolina Family Physician


a dull moment since she joined them! The evening of speakers concluded with laughs and heartfelt words from some of her most recent mentees, including Dr. Deanna Didiano, a new physician now practicing in Lincoln County and Cabarrus Family Medicine Residency Intern, Dr. Megan Campbell. Those who know Dr. Murphy know she was a sports reporter in her first career life. Her love of sports has never wavered and she is a die-hard Carolina Panthers fan today. A final surprise of the evening was when a letter was read to Dr. Murphy penned by Carolina Panthers head coach Ron Rivera. On behalf of the Carolina Panthers, Coach Rivera congratulated her on being named the AAFP’s 2016 Family Physician of the Year. Like so many who acknowledged Murphy, Coach Rivera summed it up when he acknowledged her service to the many communities in North Carolina and her lasting legacy impacting thousands of lives. Rivera also recognized the current challenge Dr. Murphy faces as she recently began her battle against lymphoma. Dr. Murphy, we are all grateful for your generosity, compassion, leadership and your commitment to the field – and the future – of family medicine. Thank you, “Keep Pounding!”

A Wonderful Gala: Dr. Maureen Murphy pictured on-stage with her husband, Scott Maxwell, and with Dr. Gary Schenk.

Autumn 2016

If you were unable to attend the Gala but wish to make a contribution to the Foundation to honor Dr. Murphy, or another mentor in your life, please visit www.ncafp.com/contribute.

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MEMBERSHIP & MEMBER SERVICES

Raeford’s Rockstar Dr. Karen Smith, FAAFP, Named 2017 AAFP National Family Physician of the Year By Peter Graber NCAFP Communications

Life has amazing ways of leading you on a journey. It often connects the dots in ways that some consider coincidence and others call fate. Whatever your view, the story of Dr. Karen L. Smith of Raeford, NC, AAFP’s 2017 National Family Physician of the Year, suggests it’s a little bit of both. Orlando, Florida plays a huge role. When Dr. Smith first visited Orlando as a young girl more than 40-years ago, she remembers being amazed by the sheer creativity and magic of Walt Disney World. The trip happened at a very challenging time for Smith’s family. Her mother insisted they make the trip even though she was battling sarcoidosis. For some reason, the trip was very important to the elder Smith. Her mother’s illness had a big impact on Dr. Smith. Apart from the frustration of watching her mom

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The North Carolina Family Physician


fight a disease few understood at the time, there was a silver lining. Her mother’s illness helped Smith discover the world of healthcare, medicine and doctors. It also allowed her to recognize its connections with compassion, creativity and helping others. Simply, the illness helped plant a seed. During the family trip to Disney, Dr. Smith began to realize it, too. Over the next 40-years, Karen Smith journeyed far beyond the gates of the Magic Kingdom, working tirelessly to become the physician she envisioned as a young girl. During her trek, she held fast to her belief in God, her calling to medicine and a conviction that creativity, drive and compassion can accomplish anything. Coming back to Orlando this September to accept AAFP’s highest honor as National Family Physician of the Year was both emotional and bittersweet. The award acknowledged Smith’s profound contributions to her patients, her community, and the specialty of family medicine, but also reminded her where her dream began to take root. Coincidence or fate, it marked a very special return.

The rest of Dr. Smith’s address struck an inspirational chord. She used stories to explain what makes family medicine so special, pounding home the simple message ‘Because We Care’ and asking all physicians to reflect on their own situations. “Please take a moment and reflect upon your own individual upbringing in the profession,” Smith urged. “Take a moment and recall that one mentor who clinched your enthusiasm leading toward the final decision of “I want to be a family physician.” One physician Smith has always credited for introducing her to medicine was Dr. Barrington B. Barnes, an internist-pulmonologist who cared for her mother. While she didn’t mention Barnes by name or any other physician who has influenced her, mentoring is a big part of what makes Dr. Smith a standout nationally. Alongside her busy independent practice in Raeford, Smith trains and encourages providers to work at the

Smith’s award was the second straight year that a North Carolina family physician was named for the honor, further demonstrating the strength of our state’s family medicine community. It also firmly established Smith as a mentor to all family physicians across our state and nation. Inspirational & Energized After accepting the award onstage from AAFP Executive Vice President Dr. Douglas Henley, Dr. Smith addressed thousands of family physicians in attendance, beginning with a lighthearted acknowledgment of AAFP’s 2016 honoree, NCAFP’s Dr. Maureen Murphy of Concord, NC. “What a ‘wow’ moment,” Smith began. “As my good friend Dr. Maureen Murphy would say, ‘This is why family physicians are so freakin’ awesome!”

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Hoke County Health Department, and regularly hosts students from area universities such as East Carolina, UNC-Greensboro and N.C. Central to encourage their interest in primary care. Her work is truly moving the needle. One of the more striking aspects of the remainder of Smith’s remarks was how she acknowledged the struggles of daily practice life and sought to inspire physicians in the audience. “We face many times in a day the gut wrenching frustration of, ‘What can I do to make a difference in this person’s life?’ It is this spirit of compassion which drives the mind toward creativity to make a difference in another’s life,” explained Smith. “How great the gift of the physician who is able to act with knowledge, skill, and integrity, as we embrace the communities we serve.” Messages like these point to the deep conviction that drives Smith as a physician and what makes her one of our country’s best family doctors. She strives every day to serve patients by following her simple practice motto: The Power of Touch: Physical, Emotional and Spiritual. Caring for patients goes far beyond the

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clinical to Smith. To her, it is about creativity, compassion, community and making a difference with each and every patient. Members interested in viewing a video of Smith’s remarks can do so at www.ncafp.com/smith-fpoy. A True Superstar Hoke County and North Carolina have an extraordinarily special family physician in Karen Smith. Her dedication, spirit and endless drive has touched thousands, improving their lives and making her community -- and by extension our state -- a better place to live. And our Sandhills superstar may only just be getting started. Smith’s new goal is to spread the word about the power of creativity to thousands of family physicians who change lives everyday. “It is truly a small world, smaller than we think,” stressed Smith. “Especially when we hold onto imagination, creativity, sprinkle it with lots of compassion and a whole lot of belief that the family physician is empowered with love to accomplish the goal of health care for all.”

The North Carolina Family Physician


MEMBERSHIP ANNOUNCEMENTS

Two Important Membership Deadlines are on the Horizon There are two important deadlines approaching for NCAFP members to be aware of. If you need help with either of these, NCAFP’s Tara Hinkle may be reached at thinkle@ncafp.com or via telephone at (919) 833-2110. 2017 Membership Dues: It’s that time of year again! 2017 dues invoices are available for download and online payments can be made at www.aafp.org/quickpay. Sign up on an installment plan, activate an auto renewal, or make payment arrangements between now and AAFP’s January 1st, 2017 deadline. Invoices were mailed last month to the primary address of each member. Although installment plans began to be debited last month, members may still sign up. Please note the expiration date on your card prior to enrollment to avoid an installment declines. For dues questions, please call 1-800-274-2237 or send email to aafp@aafp.org.

2016 CME Re-Election: All 2016 Re-Election candidates have until 12/31/16 to earn a minimum of 150 CME credits. These must include 75 AAFP Prescribed credits and 25 credits from live learning activities. If you have not yet fulfilled your requirements, please visit www.aafp.org/cme to browse CME by topic or format--more than 200 free Prescribed credits (posttests) are available. Also, AAFP’s free mobile app offers journal quizzes that provide additional options as well. Download the app on Google Play or the iTunes Store. Not sure of your re-election year or need to view, update, or print your transcript? Simply visit www.aafp. org/mycme or press the CME Reporting icon on AAFP’s mobile app. The AAFP will notify the ABFM when you have met its recertification requirements. Your username is your seven-digit AAFP ID#. For login issues, please contact AAFP at 1-800-274-2237. Additional CME Reporting and Re-election FAQs are available at www.aafp.org/cmerfaq or by calling 1-800274-2237 (9:00 a.m. - 6:30 p.m. EST).

MEMBER NOTES —

Family medicine is in your hands.

Prucha Awarded QI Fellowship at Duke

Now the AAFP is too. About AAFP

NCAFP member Dr. Ronald Prucha, Jr., from Cary, was recently awarded a 1-year Quality Improvement Fellow position by Duke Primary Care (DPC). This newly-created position at DPC entails performing a comprehensive overview of DPC’s chronic pain management strategies. Dr. Prucha will be working to refine and standardize DPC’s process in the context of newly-developed agency guidelines and facilitate the use of user-friendly tools within DPC’s EHR to help providers not only document chronic pain encounters more efficiently but also to help providers prescribe opioids safely and within the confines of new these new guidelines.

Autumn 2016

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EDUCATION & PROFESSIONAL DEVELOPMENT By Kathryn Atkinson NCAFP Meetings & Events Manager

In Review & Around the Corner

A By-the-Numbers Look Into the NCAFP’s Meetings & CME Department Did you know that as of December 2016, the NCAFP’s hardworking Meetings Department, CME team, and its many dedicated program chairs will have provided learners with over 72-hours of AAFP Prescribed credits? Did you also know that by the end of this year, over 900 family physicians and other primary care providers will have attended one or more of our three live educational opportunities? With numbers like that, chances are, you are one of those 900 attendees!

development of our mobile conference app and it has been a terrific addition to our events. Participants can quickly and easily view speakers, presentations and important links; complete surveys, connect with others, and even download their own personal Certificate of Attendance with the touch of a button. Over 93% of the 2016 Mid-Summer Family Medicine Digest attendees participated in this year’s conference via the mobile app! The app has allowed us to streamline important and useful third-party evaluations intended to measure outcomes and gather feedback for grant funded lectures while also drastically reducing our print costs and saving our attendees valuable time. And, for those participating in this year’s 2016 Winter Family Physicians Weekend, we are excited to introduce our fun and quirky badge game appropriately named, FamMedGo. Designed to engage attendees and to add a little “friendly competition” to the weekend, FamMedGo is also worth $300 to two lucky winners this year! In addition to keeping up with technology, we also

The NCAFP’s annual educational conferences offer more than just a large lecture hall and endless power points. With audience response technology, case-based study workshops, interactive-learning workshops, panel discussions and hands-on practice sessions, we offer creative and out-of-the-box learning opportunities at every event. Attend as much or as little as you would like with our half-day sessions, pre-conference workshops and afternoon seminars that offer flexibility and convenience for everyone. Our conference locations aren’t too shabby either. Whether you need a convenient regional location, sand between your toes or mountain views in the mornings, we have you covered. Our annual events continue to evolve with each program. We have put a great deal of effort into the 20

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sttrive to make certain that our curricula includes a variety of the most current, useful and relevant evidence-based topics. To determine lecture topics, we ask our attendees what they want to know and what they need to know for future events. This year’s conference agendas were comprised of over 50 different lecture topics. Attendees benefited from sessions on diabetes, chronic pain and opioid prescribing, women’s health, MACRA, hypertension, osteoporosis, cancer, obesity, physician wellness and more. And, we don’t just stop with the hot topics. If you have ever attended an NCAFP educational event, then you know we only invite the best of the best when it comes to our guest speakers. In 2016, over 70 knowledgeable and expert national and regional speakers participated in our annual events. Conference feedback continually tells us that our attendees like what they are seeing, hearing and experiencing: “There were clinical pearls in all lectures. I REALLY like the fact that the app was available with ability to preview

power point presentations.” “Found many of the workshops very useful. Lipids, asthma, allergic rhinitis and ACE inhibitor workshops were most pertinent to my current practice.” “Excellent national speakers. Good array of topics. Encourage more consistent audience participation. The app enhanced my experience a great deal.” “NCAFP continues to be a leading state chapter. Thank you for a great conference. It was very well done - I really enjoyed the conference and felt very comfortable physically and challenged mentally.” As you can tell, the NCAFP’s CME & Meetings Department is extremely proud of our educational opportunities. If you are a regular participant, Thank You for your participation, your support and your encouragement. If you have never attended an NCAFP educational conference, we invite you to join us in 2017. Mark your calendars now and prepare to experience first-hand what our educational conferences are all about. Planning for 2017 has already begun and we sincerely hope that you will join us at one or more of these fantastic events! 2017 Post-Graduate Symposium March 30 - April 1, 2017 Location to be announced. Charlotte, NC 2017 Mid-Summer Family Medicine Digest July 2 - July 6, 2017 Kingston Plantation | Embassy Suites Myrtle Beach, SC 2017 Winter Family Physicians Weekend November 30 - December 3, 2017 Omni Grove Park Inn Hotel & Spa Asheville, NC

If you have any questions or need more details about the information provided above, please contact Kathryn Atkinson, Manager of NCAFP Meetings & Events, via Katkinson@ncafp.com or 919-867-0087.

Autumn 2016

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PROFESSIONAL DEVELOPMENT

ABFM Overhauls Maintenance of Certification Process The American Board of Family Medicine (ABFM) launched its Maintenance of Certification for Family Physicians (MC-FP) Program nearly 15-years ago, but the work of fine-tuning the continuing certification process to best meet family physicians’ professional development and lifelong learning needs continues. For starters, the term “MC-FP” is going by the wayside; it’s the Family Medicine Certification process now. And although the four core elements that make up the certification process -- Professionalism, Self-Assessment & Lifelong Learning, Cognitive Expertise, and Performance Improvement -- remain with some modifications, other terms have changed, as well, to more accurately describe what they are. It’s all nicely laid out in the ABFM’s Summer 2016 Phoenix newsletter (www.theabfm.org), but here’s a quick cross-walk from the old to the new: Part II Modules -- also called Self-Assessment Modules (SAMs) -- are now known simply as Self-Assessment activities, Part IV Modules -- also known as Performance in Practice Modules (or Methods in Medicine Modules for FPs who do not provide continuing care for patients) -- are now called Performance Improvement activities, the MC-FP Examination is now referred to as the Family Medicine Certification Examination, MC-FP Stages are now Certification Stages, and MC-FP Points are now Certification Points. And it’s not just the terminology that’s changing. Perhaps the most substantive change to Family Medicine Certification was based on ABFM diplomates’ feedback regarding the SAMs. Namely, that the clinical simulation portion of these activities was not as useful as the knowledge assessment portion in helping to enhance clinical practice. Accordingly, the ABFM has now uncoupled the two elements. Whereas family physicians previously were required to complete a SAM that included both a 60-question knowledge assessment plus a clinical simulation, the Knowledge Self-Assessment (KSA) will now be the minimum required self-assessment activity. A completed KSA will provide 10 certification points

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and eight CME credits toward diplomates’ certification requirements. The Clinical Self-Assessment (CSA) is being evaluated and redesigned based on physician feedback, but will be available as an optional self-assessment activity that can be completed for five certification points and four CME credits toward certification requirements. Already completed a SAM during your current certification stage? Don’t worry, it still counts. A completed SAM will meet the minimum KSA requirement and provide 15 certification points along with 12 CME credits toward certification requirements. Overall, the introduction of KSA and CSA activities that results from splitting the SAM allows diplomates to more closely tailor how they complete their certification requirements, and the ABFM is reinforcing that flexibility by applying a points system to all physicians’ certification requirements regardless of when they last certified or which certification pathway they have chosen. All the details are outlined in the Phoenix, but here’s a key takeaway: The changeover to the point system does not require diplomates to complete any new activities. To complete a three-year Stage, a diplomate must simply complete one KSA and one Performance Improvement Activity. The majority of family physicians can get PI Activity credit through activities already being conducted in their offices (e.g., NCQA Medical Home). A diplomate needs to acquire 50 points every 3 years (by completing additional KSA, CSA, or Performance Improvement Activities.) Finally, the ABFM is simplifying how diplomates pay for certification, shifting from the current methodology -- which amortized the total cost of certification (including the cost of the next examination) based on whether the physician was following the 7- or 10-year certification cycle option -- to simply paying the same amount annually regardless of certification pathway. The annual payment will still include the cost of the next examination. Reprinted with permission from the American Board of Family Medicine

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RESIDENTS & NEW PHYSICIANS By Dr. Megan Campbell (PGY-1) Cabarrus Family Medicine Residency Program

The Three Mentors You Meet in Medicine My uncle once told me that when I got older there would come a time when I would sit down and be able to think of at least 3 people who helped me become the person I am. At the time, this just seemed like some advice from an old man (older than me anyway). These days, I am fortunate enough to not only have those 3, but a list of people who have helped me throughout life.

has known his/her own share of mentors.

All doctors have different points in their life when they realized they wanted to take on this career path. For me, I have really always wanted to be a doctor, even since before I started Kindergarten. When the day came for graduation from medical school, I could not help but think about all of the people who I was grateful to have had along the way to help me reach my lifelong dream. Unfortunately, that old man was right. I was thinking about all of those people who had believed in me, supported me, and taught me. I was thinking about all of my mentors.

It is hard to define a “mentor.” It is done best with examples. Throughout my short journey in medicine so far, mentors really are like lights on an airplane runway. They guide you through life, and as you move along, you need more of them. Fortunately, the ones who have helped you along the way, are still always behind you, lighting up the past into the present.

The reality is, every single person you meet impacts you in some way. From the people who clean the hospital, and always make sure your favorite snack is stocked in the lounge, to the attending physicians who teach and show you how to be a doctor. If you think about it, everyone has some influence on you, but then there are those who put a little… or a lot… of extra effort into you as an individual. These are the people who earn the title of “Mentor”, and often impact us more than they will ever know. Anyone on the path to becoming a physician, and even practicing physicians

It is easy to be attracted to things that are shiny and new, but it is not uncommon that I find myself on the phone with one of my third grade teachers, or my middle school Latin teacher. My first group of mentors are the ones from the past. Both of these teachers grew into mentors as they helped me build an educational foundation, challenged me to work hard, and encouraged me to learn as much as I could. They also serve as a reminder of where I have come from, and help me keep my humility, and remain humble. This group is often composed of your biggest cheerleaders.

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When I think about the concept of mentoring with regard to medical school, and now residency, there are essentially three groups of mentors, not just three people.

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THIS PLACE IS AMAZING So is the difference you can make.

FAMILY MEDICINE PHYSICIAN

Boiling Springs /Spartanburg, South Carolina Greenville Health System (GHS), the largest healthcare provider in South Carolina, seeks board-certified/board-eligible Family Medicine physicians to join a brand new state-of-the-art Outpatient Family Medicine Practice in the rapidly expanding, family-friendly city of Boiling Springs, SC. Accessible by I-26 and I-85, Boiling Springs is ideally located in the Spartanburg-Greenville-Asheville metroplex with the beach a short 3-hour drive away. Residents enjoy cultural events, great schools, bike trails, outdoor festivals and farmers markets, as well as recreational watersports and fishing at nearby Lake Bowen. GHS is a progressive, highly integrated academic health care delivery system committed to medical excellence through clinical care, education and research.

Next, as a medical student I quickly learned one of my most important groups of mentors was patients. To this day, they remain an invaluable resource. They give me the motivation to never stop learning, even when I can’t keep my eyes open. They make me cry some days and other days laugh until my belly hurts. Occasionally, they frustrate me, but that is when I learn the most. I learn medicine from them, but they also introduce me to so many of life’s challenges. This group represents the constant challenge that is needed to help you grow. The third group of mentors are the ones whom you aspire to be some day. This is where Dr. Maureen Murphy comes in for me. They are kind of like gardeners in a nursery, planting a seed and then nurturing it, with the hopes it will grow into a viable plant some day. Dr. Murphy grabbed me as a third year medical student and has been

Autumn 2016

GHS employs 15,000 people, including over 950+ physicians on staff. Our system includes excellent clinical facilities with 1,662 beds across 7 campuses. We host 15 residency and fellowship programs in various specialties including a 7-7-7 Family Medicine program, as well as Primary Care Sports Medicine, and one of the newest allopathic medical schools in the nation, the University of South Carolina School of Medicine Greenville, located on GHS’ Greenville Memorial Medical Campus. GHS is also a unique research and leading academic health center. *We are a Public Service Loan Forgiveness (PSLF) Program Qualified Employer.*

Please submit letter of interest and current CV to Senior In-house Physician Recruiter, Kendra Hall, kbhall@ghs.org, Ph: 800-772-6987. GHS is an equal opportunity employer which proudly values diversity. Candidates of all backgrounds are encouraged to apply.

helping me along ever since. These people are approachable, very accomplished, and have a passion for teaching. They don’t just lecture, they show you every day an example of what you want to Continues on next page

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be. Now that I have started residency, this group has expanded to include all of the residents and attending physicians at Cabarrus Family Medicine. The other residents show me how to keep calm when you are really scared to death; they are like your brothers and sisters offering advice and serving as a listening ear. They also provide you with a group of lifelong friends to just have a good time with from time to time. Then there is that attending who shows you how important it is to be a part of your community, and is a walking example of a humble, country doctor. Or the one who shows you that as doctors we have feelings too, and help you through the death of your first patient. As residency interview season commences again, I hope everyone takes a moment to reflect on the mentors in your life. Some of them, like Dr. Murphy, are your biggest cheerleaders, the challenge that helps you grow, and who you aspire to be all wrapped into one. Others will fit into one of these categories and will provide diversity in accomplishing the same goals. For those who are thinking about residency, think about the kind of mentors you hope to have. This group of people will be the ones shaping you into future physicians, helping you through sad cases, frustrating cases, and celebrating after a long month on a tough rotation. In the end, mentors come in all shapes and sizes. You just have to pay attention.

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

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Operation Cornelius: The Making of a Residency at Novant Health By Peter Graber, NCAFP Communications

Back as early as 2013 whispers were circulating about a new family medicine residency in the works at Novant Health. As a major health system in North Carolina, adding a primary care residency made perfect sense.  Not only was the state’s primary care need growing but Novant leaders were grappling with how best to address their aging primary care workforce.   With primary care becoming more and more important within Novant Health and across healthcare in general, a new program would be a win-win. The idea of building a residency had been germinating for years.  Family physician Dr. David Cook, Novant Health’s Senior Vice President of Value-Based Care and a healthcare futurist, had always wanted to tackle the project.   But timing combined with more

Autumn 2016

immediately pressing primary care development needs held the concept on the back burner. Cook led successful Novant Health efforts in expanding primary care capacity in other ways, such as developing and launching Lakeside Family Physicians in 1995, and later, the Lake Norman Community Clinic in 1998. Cook viewed Lakeside as the ideal outpatient training location and designed the practice with that in mind. “The thought was that state-of-the-art family physicians needed a state-of-the-art outpatient training environment. That’s what Lakeside is,” recalled Dr. Cook. When NCAFP Past President Dr. Christopher Snyder (‘08) joined Novant Health Lakeside Family Physicians in 2006, Cook immediately convinced

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him to help spearhead the effort. Snyder brought exactly the type of experience needed for such a complicated project: he had played an important role in the formation of the Cabarrus Family Medicine Residency in the early 1990s and had solid residency operations experience.   Snyder embraced the concept from the get-go.

Let’s Let’s make make NCAFP’s NCAFP’s voiceeven even voice inRaleigh Raleigh in

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Throughout the years that followed, Cook and Snyder worked methodically behind the scenes to make the program a reality. Countless meetings and presentations were needed to establish the key buy-in with Novant Health leaders and its key departments.   After getting everyone on-board, formal approval came in late February of 2014 when Novant Health President and CEO Carl Amato signed an official statement of commitment letter.  Things accelerated quickly from there.   Over the ensuing months, a growing team developed and submitted Novant Health’s Institutional Accreditation Application to the Accreditation Council for Graduate Medical Education (ACGME) that established the system’s graduate medical education platform.   Once the ACGME approved Novant Health’s plan, milestones related to the program’s ACGME residency program application and its residency review process fell like dominoes.   Novant Health had a clear goal to create a program that would support all potential applicants, so it pursued accreditation from both the ACGME and the American Osteopathic Association (AOA).  The only tricky part was working within the constraints of a byzantine ACGME approval calendar to meet the program’s 2016 launch target. Novant Health’s successfully threaded the needle. Great news came to program leaders in October, 2015, when it received citation-free approval from the ACGME’s Residency Review Committee. About a month later an added bonus arrived -- accreditation from the AOA. Novant Health had not only established its graduate medical education entity, but also had its first dually-accredited residency program. The Program at a Glance

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Ask anyone with experience in academic family medicine about building a great residency and having the right people will be at the top of their list. Building a strong program not only requires great people— but special kinds of great people.  Novant Health’s goal was to recruit faculty and administrators with deep experience in traditional family medicine who understood how the changing environment would push the program and its graduates in new ways.

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described as a comAccording to Snyder, munity-based, populuck that bordered on lation health-focused divine intervention program designed helped Novant Health to train adaptable, construct its core clinically proficient leadership team. The family physicians. process caught a huge The program’s misbreak when Dr. C.J. sion is to “...train the Atkinson, a practice next generation of partner of Snyder’s innovative physician at Novant Health leaders equipped to Lakeside Family Phyimprove the health sicians, learned that of communities’ one his former Residenperson at a time.”   cy Director would be transitioning from “It’s our ultimate the military.   Atkingoal to create famson had trained and ily physicians who taught under Dr. are trained to deliver Mark Higdon at The patient-centered care Fort Benning Family in any setting,” says Medicine Residency Scenes from the Dedication (L to R): NCAFP President Dr. Rhett Higdon. Program and thought Brown with Dr. Mark Higdon, Residency Program Director. he could be a tremenConsidering the tectonic shifts happening today in dous asset.   Program leaders immediately recognized primary care, Higdon recognizes the huge chalHigdon’s potential.  After a quick pursuit and interview lenge ahead, but knows it is work that will pay big process, Higdon came aboard. dividends.   “This is truly an opportunity to see how the practice of family medicine is changing to meet the “In meeting Drs. Cook and Snyder, their vision for the needs of the patient and the community.”    residency was inspiring. It was clear -- in rather short order -- that the opportunity was a calling,” recalls Higdon. Residents will train as part of an integrated team that includes other physicians and a full support team of As a retired Army Colonel who earned his medical nurses, pharmacists, social workers, dietitians, health degree from the West Virginia School of Osteopathcoaches, and referral coordinators. They will also ic Medicine, Higdon brought military-style precision partner with patients to encourage wellness and preand nearly two decades of academic experience to ventive care, and be expected to pursue scholarly the program.  He hit the ground running and played research to help drive continuous improvement. major roles in securing the program’s dual accreditation, structuring its curriculum and building its faculty From a clinical standpoint, Novant Health’s facilities and administration.   The program officially launched are similar to those found in larger academic cenwith a leadership team led by Higdon as Residency ters. The twist, however, is that residents will take Program Director and consisting of Drs. Christopher advantage of a close knit, community feel by Snyder, C.J. Atkinson, Kelley Lawrence and Christolearning in an unopposed environment at Novant pher Zagar. Health Huntersville Medical Center, a 75-bed Novant Health’s Family Medicine residency can best be Continues on p. 34

Autumn 2016

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STUDENT INTEREST & INITIATIVES By Peter Graber & Tracie Hazelett

ECU Brody Students Help Rally Support for Hurricane Matthew Flood Victims Medical students and faculty from ECU Brody made a huge contribution to community relief efforts during the aftermath of Hurricane Matthew, as flooding affected thousands of families throughout eastern North Carolina. While many outsiders might think a week of cancelled classes

would allow exhausted students to catch up on much needed rest, more than 120 medical students worked throughout the Greenville community and surrounding areas to make sure residents were safe and as comfortable as possible. Organized by second-year medical students Christopher Crotty and John Hurley (above, l-to-r), the duo worked closely with Brody’s Dr. Susan Schmidt, Associate Dean for Student Affairs, to execute a well-organized outreach that helped hundreds of families and community residents. Students and faculty worked throughout Greenville and the local region to help distribute supplies

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The North Carolina Family Physician


to American Red Cross shelters, gather food, evacuate residents, and provide the needed medical support to ECU volunteer physicians. Crotty was quoted in a story published on the ECU website as saying, “All the agencies we’ve worked with have been overwhelmed with the support they’ve received. With the blessing and administrative support of Brody, we’ve gotten a lot of students involved and collected a lot of supplies.” Components of Brody’s mission include increasing the supply of primary care physicians to the state and improving the health of the citizens in eastern North Carolina. Medical students admitted to Brody seem to radiate the values of service and community. With the full support of the Brody School of Medicine, every medical student involved rallied, served and truly made a difference for the community. Thank you.

2017 SUMMER PROGRAMS

Family Medicine Interest Programs Available for First-Year Medical Students The NCAFP Foundation offers a variety of programs and opportunities to medical students. A few of these are clinical experience opportunities only available to 1st year medical students. These opportunities take place during the summer between your first and second year of medical school. There are two programs available, that range from two- to four-weeks in length. To learn more about these programs and the exciting specialty of Family Medicine please visit ncafp.com/students. The application deadline is January 15, 2017.

Three Medical Students Awarded NCAFP Foundation Family Medicine Scholarships The NCAFP Foundation is pleased to announce that three medical students have been selected to receive a scholarship through the NCAFP Foundation for the academic year of 2016-2017. This year all recipients are fourth-year medical students who have already committed to family medicine and are currently applying to FM residency programs. Recipients of the Foundation’s Family Medicine Scholarships are: Kelly Stanley, Campbell Maria Andrews, Duke Kate Timberlake, Wake Forest The NCAFP congratulates and extends best wishes to these outstanding students as they continue their training in family medicine.

Autumn 2016

For questions or more information please contact Tracie Hazelett at 919-833-2110 ext. 12 or thazelett@ncafp.com.

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PRACTICE MANAGEMENT By Peter Graber NCAFP Communications

Feds Issue Final MACRA Rules Reporting flexibility aimed to help ease the transition for practices

options within MACRA’s Quality Payment Program, a name that collectively refers to the Merit-based Incentive Payment System (MIPS) and the Advanced Payment Model (APM). The four options are designed to ease the transition into Medicare’s new valued-based payment program by dovetailing with a practice’s existing level of reporting preparedness or its ability to accept financial risk. The MIPS pathway enables physicians to choose from three reporting options in 2017. The options differ by length of time and the amount of information required in three separate categories: care quality, clinical improvement and advancing care (an EHR-related measure) information. A fourth measure, cost and resource use, was eliminated for 2017 but is expected to be needed in subsequent years.

Physicians simply choose what MIPS option best fits CMS published its final MACRA regulations last them. Physicians can choose to report as little as one month and they include several recommendations measure for 90-days or go as far as reporting on all advanced by family medicine to ease the new program’s measures for the full year. In either case, there will be administrative burdens. The final regulations feature no negative payment adjustment for 2019. On the expanded reporting flexibility for 2017, a streamlined flip side, physicians who do amount of data physicians not supply any data and fail must report and broader CMS pivoted towards to participate will receive an exclusions for physicians in flexibility and heeded the advice automatic 4% payment cut. low volume practices. CMS of organizations like the AAFP in also reduced the amount of crafting a final regulation. For the APM pathway, financial risk physicians physicians who receive a must shoulder if they parsubstantial portion of ticipate in MACRA’s their Medicare reimadvanced payment modbursement from a qualified Advanced APM are els. All in all, CMS pivoted towards flexibility and exempt from MIPS and will receive a five percent heeded the advice of organizations like the AAFP in bonus in 2019. However, to be considered a qualicrafting a final regulation that recognizes the broad fied Advanced APM, a physician must bear more than differences of where practices sit on the value-based nominal financial risk, a definition MACRA defines as transformation spectrum. This should help practiceight percent of all Medicare reimbursements or three es of all sizes --particularly smaller ones-- successfully percent of the expected expenditures for which the phytransition into the new program. sician is responsible for under the APM. MACRA also Preparing for the Transition defines unique risk standards for various medical home models and creates a new classification for existing APMs Medicare’s payment transition officially begins in that do not meet its 2017 standards. These are known 2019 and will be based on performance data physias ‘MIPs APMs’ and will use MIPS-style reporting to cians will report next year. Coined the ‘transitional capture incentives. year’, 2017 will offer flexibility by allowing physicians to ‘pick their pace’ when selecting from four reporting Outside of the reporting and pathway adjustments,

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The North Carolina Family Physician


Save or Reduce Debt – What Should You Address First? By Whit Newton, CFP ®, a Northwestern Mutual Financial Advisor based in Raleigh, NC An admirable trait of physicians is their decisiveness and understanding of procedures. Physicians understand that there’s a right way and a wrong way to do something – depending on how you approach it. A common question I hear from physicians of all ages is, “Should I overpay my debt or save more.” No physician would ever recommend a procedure without diagnosing a patient. Likewise, the same is true for a good financial advisor. To answer the question, an advisor would need to know more information first. Perhaps the most important question would be what is the interest rate of the debt, and is it tax deductible? Secondly, what is the time frame for the money if you were to save/invest it, and what would be the expected return?

For example, recently a family physician client in their early 60s was looking towards a full life in retirement – a life that included a second home on the beach. He had sufficient cash and investments to buy the home with no debt – but he wondered if that was the right move. We ran the numbers and discovered that, with today’s low interest rates and tax deductibility of a mortgage, he would be better off leveraging a short duration mortgage so his investment dollars could continue to grow in the market. At the same time, you also have to consider how it makes you feel. I often tell clients, “I can mathematically prove to you it is better off to invest and not overpay the debt. However, if you wake up every day and are not going to be happy until the debt is gone, you should pay it off.”

Article prepared by Whit Newton with the cooperation of Northwestern Mutual. Whit Newton is a Financial Advisor with Northwestern Mutual based in Raleigh, NC. Newton is a licensed insurance agent of NM. Northwestern Mutual is the marketing name for The Northwestern Mutual Life Insurance Company (NM), Milwaukee, WI, and its subsidiaries. Northwestern Mutual Investment Services, LLC (NMIS), (securities) subsidiary of NM, broker-dealer, registered investment adviser, member FINRA and SIPC. Whit is a Representative of Northwestern Mutual Wealth Management Company®, Milwaukee, WI (fiduciary and fee-based financial planning services), a subsidiary of NM and federal savings bank. Please remember that all investments carry some level of risk including the potential loss of principal invested. They do not typically grow at an even rate of return and may experience negative growth. No investment strategy can guarantee a profit or protect against a loss. Certified Financial Planner Board of Standards Inc. owns the certification marks CFP®, CERTIFIED FINANCIAL PLANNER™ CFP® (with plaque design) and CFP® (with flame design) in the U.S., which it awards to individuals who successfully complete CFP Board’s initial and ongoing certification requirements.

MACRA’s final rule also redefined the program’s exclusion threshold. Physicians or practices serving less than 100 Medicare patients or billing under $30,000 per year are not required to participate in the MIPS or APM pathway. However, they still may participate in either pathway to capture additional incentives. Finally, CMS also confirmed that ‘virtual groups’ will be available to allow physicians in small practices to aggregate their data for reporting purposes. However, they will not be operational in 2017. Overall when compared to CMS’s original MACRA draft published last April, the agency clearly moved to make the new program easier to transition to for

Autumn 2016

more practices. This is especially true for small and rural practices, something that the AAFP was extremely vocal about throughout the summer. Looking Ahead The AAFP and NCAFP continue to analyze the 2,400page final regulation. NCAFP members should be on the lookout for additional insight on MACRA in the months ahead. The AAFP has committed substantial time and resources to educate members about the new program. An excellent resource they have developed is called ‘MACRA Ready’ at www.aafp.org/macraready. Members are encouraged to access it for the latest updates.

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community hospital. Higdon refers to the hospital as the ‘ideal acute location to train our future family physicians.’   It sits only five miles from the program’s outpatient clinic in Cornelius, NC.  Residents will also complete in-patient rotations at Novant Health Presbyterian Medical Center, a 622-bed regional hospital in downtown Charlotte and at the adjacent Novant Health Hemby Children’s Hospital.  

close-knit feel of the program and its leaders really impressed her. “The program administration instantly felt like family on interview day,” Talts wrote. She hasn’t looked back since.

Another member of the inaugural class is Dr. Allen Shepherd, a graduate of the Lake Erie College of Osteopathic Medicine. Shepherd said that while the Charlotte area and Novant Health’s facilities were The three environments offer a diverse clinical equally impressive and a good challenge and combine into a selling point, it was the progreat training ground. gram’s people that sealed the deal. Stethoscope Resting Full Steam Ahead BY DR. KELLEY LAWRENCE “The simple truth is that I conEartips in, All the preparation leaders put fidently chose this program diaphragm against chest, into structuring the program because of the character of the the family physician listens for murmurs, rubs, gallops, paid off in a huge way earlier program’s leadership team,” wheezes, crackles, rales. this year. The program took wrote Shepherd. “These leadEartips in, full advantage of its dual ers exude a caring, authentic bell tight on neck, accreditation by participating competence that inspired me the family physician listens for bruits or murmurs echoing upward. in the 2016 AOA Match from our first meeting.   After and the 2016 ACGME hearing about their vision for Eartips in, diaphragm pressing on abdomen, Match and its results were the program and experiencthe family physician listens exceptional.   The program’s ing the culture of their clinic for gurgling, tinkling, lack of noise. founding class consists of during my interview, I was Eartips out, five osteopathic physicians and sold.” tube draped behind neck, diaphragm at rest, one allopathic physician. the family physician listens: Novant Health formally dedto stories, to fears, Higdon explained that as the icated the program this past to hopes, program’s first residency class, July, bringing together system to dreams, to hearts that are broken. he first looked for exceptional leaders and family medicine interpersonal and communirepresentatives from around And stethoscope resting, the family physician mends, empowers, and cares. cation skills.   Each prospecCharlotte and across the tive resident was told that they state.  After brief comments by would be an ambassador for Novant Health Huntersville the program. Their initial interactions with Novant Medical Center Hospital President Mike Riley, resiHealth’s preceptors was crucial.   dency program leaders, and a new trainee, the health system’s new residents were officially presented with One resident who began training this summer is Dr. their stethoscopes.   Associate Program Director Dr. Ariel Talts, an osteopathic physician who earned her Kelley Lawrence recited a special poem she authored medical degree from the Virginia College of Osteoabout the work of a family physician.   pathic Medicine.   According to Talts, she viewed the Novant Health program as an opportunity to take Lawrence’s poem (inset) was the perfect ending to initiative in forming interdisciplinary relationships in a wonderful beginning for North Carolina’s newest otherwise unexplored fields within primary care.  The family medicine residency. 34

The North Carolina Family Physician


Introducing NCAFP FMCareers for Employers & Job Seekers

The NCAFP is proud to announce our new online career center -- NCAFP FMCareers! Access this targeted and qualified pool of opportunities and talent by looking for or advertising your jobs online. • Easily SEARCH and POST jobs • ACCESS highly-qualified, professional opportunities and candidates • TOOLS to deliver the best opportunities and candidates

Access now at jobs.ncafp.com If you are a job seeker, post your resume anonymously. Create job alerts. And do it all in less time than it takes to search through job postings on the mass job boards.

Autumn 2016

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AAFP Congress Commission will study an issue for final resolution.

The Congress elected Dr. Bob Raspa (Florida), Dr. Leonard Reeves (Georgia) and Dr. Ada Stewart (South Carolina) to the AAFP Board of Directors. In addition, current board member and past NCAFP President Dr. Mott Blair announced his candidacy for President-Elect with the election to be held at the 2017 Congress of Delegates in San Antonio. Look for more information on his campaign in upcoming editions of this magazine.

The Congress also elected three new Board members and new officers for the AAFP. The Congress elected Dr. Mike Munger (Kansas) as president-elect and re-elected Dr. Javette Orgain (Illinois) and Dr. Alan Schwartzstein (Wisconsin) as Speaker and Vice-Speaker, respectively. Dr. John Meigs (Alabama) was installed as President, and Dr. Wanda Filer

Henley Lecture continued from page 11

Sen. Henley is the father of Dr. Douglas Henley, the current AAFP Executive Vice President and former president of both the AAFP (‘96) and the NCAFP (‘89). For more information about contributing to the John T. Henley, Sr. Endowment for Family Medicine, contact Brad Wilson at Brad_Wilson@med.unc.edu.

Non-Profit Org. US Postage

In the late 1960s, while working as a pharmacist in Hope Mills, Sen. Henley realized his patients were struggling with access to primary care. At a time when many academic and community leaders were reluctant to support family medicine as a specialty, Henley used his influence in the NC legislature to create and initially fund the UNC Department of Family Medicine and lat-

“It’s because of his legacy that I’ve developed the clinical, leadership, research and teaching skills that have allowed me to lead this department that I love,” remarked Dr. Page. Others nodded in agreement that they owed their education, training and careers to Sen. Henley. She continued, “John Henley didn’t seek personal recognition or gain, he just did the right things for the right reasons, which I think is something we’re all trying to do here.”

PAID

“John Henley was a strategic optimist,” said Kellerman. “He was a leader who had a vision, communicated that vision and put the resources and people together to accomplish that vision.”

er the East Carolina University School of Medicine. Since their establishment, both institutions have played very significant roles in combatting the primary care physician shortage across the state. Alumni of the UNC and ECU programs attended the endowment’s launch.

Pontiac, Illinois Permit No. 592

family medicine principals are included. The inaugural John T. Henley, Sr. Lecture, the first endowment-supported event, was delivered by Rick Kellerman, MD, Chair, Department of Family and Community Medicine, at the University of Kansas School of Medicine and Past-President of the AAFP (‘07). Inspired by Sen. Henley, Kellerman spoke on what it means to be a leader in family medicine, and recalled his commitment to improving care in North Carolina.

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

(Pennsylvania) became Board Chair. www.ncafp.com

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