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THE NORTH CAROLINA

Volume 10 Issue 2 / Spring 2014

quarterly news in north carolina family medicine

Preparing FOR Accountable Care


30

+

2013-2014 NCAFP Board of Directors Executive Officers President William A. Dennis, MD President-Elect Thomas R. White, MD Vice President Rhett L. Brown, MD Secretary/Treasurer Charles W. Rhodes, MD Board Chair Shannon B. Dowler, MD Past President (w/voting privileges) Brian R. Forrest, MD Executive Vice President Gregory K. Griggs, MPA, CAE

AAFP PRESCRIBED

CREDITS

District Directors District 1 - Jessica Triche, MD District 2 - Matthew M. Williams, MD District 3 - Eugenie M. Komives, MD District 4 - Tamieka Howell, MD District 5 - Janice E. Huff, MD District 6 - Alisa C. Nance, MD District 7 - David A. Rinehart, MD At-Large Holly Biola, MD At-Large Jennifer L. Mullendore, MD IMG Physicians Joseph P. Pye, MD Minority Physicians Benjamin F. Simmons, MD New Physicians Matthew G. Kanaan, DO

2014 NCAFP

NC Family Medicine Departments Brian A. Kessler, DO (Campbell) Family Medicine Residency Directors Geoffrey Jones, MD (MAHEC-Hendersonville) Resident Director Aaron George, DO (Duke) Resident Director-Elect Deanna M. Didiano, DO (Cabarrus) Student Director Julie Barrett (ECU) Student Director-Elect Christian A. Jasper, MPH (WFU)

Sports Medicine Symposium & Mid-Summer Family Medicine Digest

June 29 - July 4, 2014 Myrtle Beach, SC See Page 12 for details

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

Brian A. Kessler, DO J. Lloyd Michener, MD Kenneth K. Steinweg, MD Warren P. Newton, MD, MPH Richard Lord, Jr., MD

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

Mott P. Blair, IV, MD Karen L. Smith, MD, FAAFP Michelle F. Jones, MD Robert L. ‘Chuck’ Rich, Jr., MD

The NCAFP Family Medicine Councils Advocacy Council

Robert L. Rich, Jr., MD, Chair

CME Council

Thomas R. White, MD, Chair

Health of the Public Council Practice Enhancement Council

Charles W. Rhodes, MD, Chair Rhett L. Brown, MD, Chair


The NCAFP Strategic Plan Mission Statement: To advance the specialty of Family Medicine in order to improve the health of patients, families, and communities in North Carolina. Vision Statement: Family physicians will be universally valued for their role in providing high quality care to the people of North Carolina. Core Beliefs:

North Carolina Academy of Family Physicians

2013 Annual Report

We believe that Family Medicine is essential to the well-being of the health of North Carolina, and that Family Medicine is well-suited to improve the health of the residents of our state.

We believe in a healthcare system that is primary care-driven. We believe there is an inherent value in a primary care medical home - providing quality, access and affordability.

We believe in a healthcare system that is fair, equitable, and accessible.

We believe in the elimination of health disparities and barriers to access to healthcare for North Carolina.

We believe in a comprehensive approach to patient care and value the health and well-being of patients, families, and communities.

We value collaborative communication with all parties concerned with healthcare delivery, and advocate for a positive practice environment to nourish the specialty of Family Medicine.

We value the professional and personal well-being of our members.

See Page 13

See Page 13

Core Values: • • • • •

Quality, evidence-based, timely education. Professional excellence and integrity. Fiscal responsibility, organizational integrity and viability. Creativity and flexibility. Member-driven involvement in leadership and decision making.

Additional details on the NCAFP strategic plan are located at www.ncafp.com/academy/mission

Inside

THE NORTH CAROLINA

..,

Never Forget Why You Went Into Family Medicine....................................................... 4

PUBLISHED BY THE NORTH CAROLINA ACADEMY OF FAMILY PHYSICIANS, INC. R ale igh, Nor th Ca r olina 27605 919 .833.2110 • fa x 919.833.1801 http://www.nc a fp.c om M ANAGING EDITOR & PRODUCTION Peter T. Gr a be r, Dir e c tor of Communic a tions

President’s Message .............................................. 4 Policy & Advocacy .................................................... 6

Preparing for Accountable Care Organizations............................................................ 6 The 2013 NCAFP Annual Report................................................................................. 13 Kindling New Innovations in Family Medicine Residnecy Curricula ............................ 22 Triad HealthCare Network ACO Shows Promise ........................................................ 24

Student Interest ..................................................................... 8 Chapter Affairs..................................................................... 10 CME Meetings & Education ................................................. 12

Residents & New Physicians ................................................ 22 Practice Enhancement .......................................................... 24


President’s Message

Dr. William A. Dennis 2013-2014 NCAFP President

Never Forget Why You Went Into Family Medicine You CAN go home again. I did it just the other day. When AAFP President-Elect Bob Wergin came to town in March, I volunteered to tag along - hey, it beats work! - and we spent the day traveling the flat roads of Eastern North Carolina. During the morning we made a visit to the East Carolina School of Medicine. (Just can’t get used to calling it “Brody” … and we won’t even TALK about “Vidant.”) It was my first trip back to the medical school since I graduated from there 15 years ago. A few weeks later I was honored to return to speak at the ECU FMIG banquet, and meet the unbelievably impressive class of graduating 4th years, along with old friends and some new faculty - all of whom were pretty impressive as well. Following is a recycling of that speech, mixed in with some new thoughts:

Wouldn’t it be great to go back to those first days of medical school (OK, if we could do it without the studying part) and recapture that joy and excitement about medicine? My wife says my sons and I have a bad habit of communicating with each other in movie and TV lines. She thinks it’s annoying. We regard it as cutting-edge creative. My favorite movie of all time is Field

4

THE NORTH CAROLINA FAMILY PHYSICIAN • Spring 2014

of Dreams, and toward the end, Ray Kinsella’s daughter tells him not to plow up his baseball field and sell the bankrupt farm, because “people will come.” James Earl Jones’ character then takes up the cause (it’s better if you imagine it in his voice): “…People will come Ray. They'll come to Iowa for reasons they can't even fathom. They'll turn up your driveway not knowing for sure why they're doing it. They'll arrive at your door as innocent as children, longing for the past. … And they'll walk out to the bleachers; sit in shirtsleeves on a perfect afternoon. They'll find they have reserved seats somewhere along one of the baselines, where they sat when they were children and cheered their heroes. And they'll watch the game and it'll be as if they dipped themselves in magic waters. The memories will be so thick they'll have to brush them away from their faces …” Going back to the old Brody building the other day was kind of like that for me. It took me a long time to get through that door the FIRST time - 20-years after graduating from college. Not that I applied to med school every one of those years, just a couple. I had aimed to go to medical school when I first entered college, but took a long and scenic detour through the newspaper business. The med school dream kept gnawing away at my insides though, and I finally decided to give it a shot in my late 30s - it was then or never. The wait for word from the admissions office was agonizing, but when Dean Hayek called to offer me a position in the Class of ’99, I felt that my whole life had been validated. And the rest, as they say, is history. My personal history. Ever since, I’ve been living the dream. Not to say the whole

dream has been good - sometimes you wake up screaming - but overall, it has been a great ride. So to paraphrase Ray Kinsella’s dad, who got to come back from the afterlife to play baseball (which by the way is another of my goals): I would ask, ‘Is this Heaven?’ “No, it’s Iowa,” Ray replies. “IS there a heaven?” “Oh yeah,” replies his father. “It’s the place where dreams come true.” Ray looks around, seeing his wife playing with their daughter on the porch swing in the beautiful summer twilight. “Maybe this IS heaven,” he says. Well, anyone who has lived through one or two Julys in Greenville knows the place is WAY too hot to be heaven. But getting the chance to go back a few weeks ago, I was again reminded that it is the place my dreams came true. As soon as I approached the building, the memories came rushing back … “so thick I had to brush them away” from my face. The sights, the smells, the hallways, the stairs, the classrooms. I still remember my seat. Some of my Juicy Fruit is probably still stuck on the bottom of it. I remember my professors, the standardized patients, the cafeteria bagels. And my brain - the one I kept in the tupperware bucket on the 7th floor in neuroanatomy. The posters on the bulletin boards - some of them are the same ones I think. I still broke out in a cold sweat when I walked past the admissions office. Must be a learned reflex. Most of all I remember my classmates. My Band of Brothers (and Sisters). We went through so much together, truly blood, sweat, beers and tears. I remember how the school, from Day One of orientation, emphasized teamwork, getting along, helping each other up and having each other’s back. It worked. There is a lot that approach could teach


ATTENTION RISING 2ND & 3RD YEAR MEDICAL STUDENTS our hospitals and practices these days. As someone who tiptoes on the tightrope between busy-ness and burnout, I needed the reminders. And I suspect many of you are in that same boat. Wouldn’t it be great to go back to those first days of medical school (OK, if we could do it without the studying part) and recapture that joy and excitement about medicine? It’s still exciting most of the time, but as I’ve said before, we all too often get diverted from our patients by the process of punching data into computers, begging insurance company permission for tests and medications, answering e-mails, choosing the right codes, meeting “meaningful use,” ensuring that Press Ganey thinks at least 97.352% of our patients are “satisfied,” and staking part of our compensation on patients who won’t take their medicine, never exercise, and pay for their dinner by the pound at the Golden Corral buffet. This is the part of “Living the Dream” where you wake up, run to the window, and yell to anyone who will listen: “I’m mad as hell, and I’m not going to take it anymore!” Well, your Academy is not being content just to “take it.” The NCAFP and AAFP are working on many of these issues. We think we are the key to improving healthcare in this country, to controlling costs, to helping our patients stay healthy. We think if we take care of the doctors who, as Paul Grundy says, focus on protecting the fish who are still in the lake, we won’t have to spend so much rescuing the ones who wash over the dam. I’m happy to report we are making progress, but there is much more to do and we need all the help we can get. Many of you already are active in the Academy, but if you aren’t, we have a place for you. Get involved! I could go on, but I’m afraid I’ve already exceeded my word limit. So, of course I have to close with a movie reference, this one from Captain Phillips. Electronic medical records and computers are here to stay, which mostly is a good thing, but in my clinic, and perhaps most clinics, they often get between the doctor and the patient. Sometimes the patient is actually BEHIND me on the exam table while I’m tasked with clicking boxes and linking orders. I fully expect that, one day soon, a patient is going to get frustrated, grab my arm, spin me around and say, “Look at me …. LOOK at me … I am the captain now!!” Remember that. Remember who the “captain” is, why we went into this profession, and where we need to steer this ship. If we can do that, maybe we can keep those “pirates” from hijacking our joy and excitement!

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Help Raise The Voice of Family Medicine in Raleigh NORTH CAROLINA

FAMPAC

Empowering Family Medicine in North Carolina

CONTRIBUTE TODAY! Contributing to North Carolina’s political action committee for Family Medicine offers an easy, low-risk way for you to be part of the political process. Help raise the voice of Family Medicine in Raleigh. Contribute today at:

>> www.ncafp.com/fampac

Health Policy & Advocacy ncafp.com/advocacy

Joanna Spruill, JD NCAFP Director of Government Affairs & General Counsel

Advocacy Through Action:

Preparing for Accountable Care Organizations A little over a year ago, Governor Pat McCrory proposed transitioning the state's Medicaid program to private managed care organizations (MCOs) as a way to ensure budget predictability. Those MCOs would have contracted with the state, on a per capita basis, to provide care to Medicaid beneficiaries. In a little over a year and after continued talks with the administration and the Department of Health and Human Services, the proposal to reform Medicaid now does not include MCOs—instead the "m" has been replaced with an "a." The shift to ACOs is a step in the right direction and will change how healthcare is delivered to Medicaid beneficiaries, but what does it mean for family physicians?

based medicine, report internally on quality and cost metrics, coordinate care for beneficiaries, emphasize patientcenteredness through individualized care plans and transitions of care, and aim for whole-person care.

ACOs will play an important role not only in Medicaid reform, but also in value-based payment reform. As the NCAFP advocates for reform at the General Assembly, it is imperative that family physicians position themselves strategically for change, even if ACOs are not ultimately enacted for Medicaid. There are several concrete strategies family physicians can employ to prepare for this new accountable model of healthcare.

What is an ACO?

Get to know your data

ACOs stand for accountable care organizations. An ACO consists of healthcare providers, like family physicians, pediatricians, and others, who agree to coordinate care for a set of patients with the goal of limiting unnecessary spending and improving quality outcomes. Payment is tied to both quality of care and reductions in cost of care. ACOs already exist in North Carolina through the Medicare Shared Savings Program and with private payers. Under the reform proposal sent to the General Assembly on March 17, 2014, physicians and other providers are encouraged to form ACOs that would be responsible for the cost of the Medicaid population attributed to them. These ACOs would be required to promote evidence-

Data is perhaps the most important tool within an ACO. Measurement leads to a better understanding of patient populations. A better understanding allows for management of that population, and eventually can lead to improvements in that population. The two main priorities of an ACO, savings and quality outcomes, lie in the data that is collected, synthesized, and acted upon by physicians. By using data, family physicians can identify patients that cost more, that have not received important preventive services, and whose quality outcomes may be lagging. Family physicians should improve their data collection, data analytics, and quality metrics, but most importantly, get comfortable using the data, working with it, and manipulating it. Identifying those areas where costs are above and below average will lead practices into

How can Family Physicians prepare?


cost-effective strategies. Becoming familiar with the data is an excellent, if not the best, strategy for preparing for accountable care. Continue Patient-Centered Medical Home Development

Avenues for Advocacy

At the heart of every ACO, there should be a strong foundation of primary care because many important mechanisms for controlling costs are addressed by a family physician. Patientcentered medical homes (PCMHs) offer great tools, such as electronic health records, disease management, and responsive scheduling, that could improve quality of care and reduce total costs. An easy way to prepare for ACOs is to continue working with PCMHs, improve care coordination, and start identifying those tools within the medical home that are in fact lowering

The fight for Medicaid Reform is far from over. The Medicaid Reform Proposal in front of the General Assembly is a major step in the right direction and the Academy remains committed to moving forward with it while working out the details. While we need family physicians to work with us in our advocacy efforts at the legislature, there are also many things family physicians can start working on in their practices that ease the transition to accountable care and advocate for reform at the same time. One of the Academy's most important advocacy strategies is to show leaders

GET TO KNOW ACOs

The ACO Guide

How to Identify and Implement the Essential Elements for Accountable Care Organization Success

The Family Physicians ACO Blueprint for Success - www.ncafp.com/aco-guide The Physician’s ACO Toolkit - www.tac-consortium.org Elements to Achieve Accountable Care - www.pcpcc.org/guide/better-best ©2011 Smith, Anderson, Blount, Dorsett, Mitchell & Jernigan, L.L.P.

AAFP’s ACO Center - www.aafp.org/practice-management/payment/acos.html AAFP’s ACO FAQs - www.aafp.org/practice-management/payment/acos/faq.html Accountable Care Center at CMS - http://innovation.cms.gov/initiatives/aco/

costs and improving outcomes. Knowing of potential obstacles and sharing effective strategies to decrease costs will make family physicians leaders within the development and growth of ACOs. Population Health Management Agreeing to be responsible for quality of care and total costs associated with a patient population requires a different mindset than just day-to-day care delivery. Family physicians should begin to monitor compliance with clinical guidelines and analyze data on high-use resources within their practices. Begin thinking about broad-based strategies that affect groups of patients and identify what type of data and resources a family

Charles L. Rich, Jr., MD Chair, Advocacy Council NCAFP Past President

physician would need to be successful. By the time it is time to join an ACO, family physicians will already have transitioned their skillsets and resources to work in this new delivery environment.

through the action of our members. By working on the things mentioned in this article family physicians can position themselves to be invaluable to any ACO and demonstrate to legislative leaders that they are ready for the transition. While it may seem like family physicians must align or create an ACO immediately, you don't have to act right away. Working on data collection, care coordination, and population health management will ensure your best position for the future. Familiarize yourself with the tools needed and perfect your methods before you embark on building this new model. And when it's time to build—you will be ready.

ADVOCACY REPORT

Effective Advocacy is All About Member Participation As I write this article, I would like to say that all is well and that our members have nothing to be concerned about with the coming legislative session. Unfortunately, that is not the case as you will see from reviewing other articles in this magazine, particularly the article by Joanna Spruill, our legislative affairs consultant, who details the major elements of the Medicaid Reform Proposal as presented to the legislature. As envisioned by the Reform proposal, the Medicaid plan will evolve into one which will rely heavily on Accountable Care Organizations (ACOs) to be the entities which will arrange specialty care, submit claims to, and receive payment from for your management of the Medicaid patient. Currently, the majority of our members are not affiliated with an ACO and the majority of our Medicaid patients are not part of any ACO. With the legislature’s action the last session calling for changes in how physicians are compensated (in order to introduce some element of performance- based compensation), the potential exists for changes to your bottom line. Scope of Practice In addition to changes to the Medicaid plan, the legislature may consider such issues as scope of practice concerns from various non-MD groups such as the Nurse Practitioners, the ongoing concerns regarding NC Tracks/NC Fast and other issues. These issues could also affect your bottom line, the willingness of providers to accept new Medicaid patients, as well as the future availability of providers to serve our medically-underserved areas. To deal with these and other threats to the viability of our livelihood and practices, I am asking you to consider becoming involved in the advocacy process of the See ‘Advocacy’ on Back Cover


Student Interest & Initiatives ncafp.com/students

By Katy Kirk (MS-4) Brody School of Medicine East Carolina University

Full-Scope Family Medicine: Is ‘Doing It All’ A Dying Art? Significant scope-of-practice shifts taking place within the specialty As I exuberantly near the end of my fourth year in medical school, freshly matched into a Family Medicine residency, I have become increasingly aware of shifts in the so-called ‘scope of practice’ of family physicians (FPs), both in North Carolina and nationally, which I fear may endanger the future of my newly chosen field. My decision to enter Family Medicine had a great deal to do with the wide variety of patients, services, procedures, and the multitude of settings and practice formats that it offered—a perfect fit for someone with a million interests, a short attention span, and a “do-it-all” mentality. I wanted then, and now, to practice ‘full-scope’ Family Medicine, including obstetrics, women’s health, pediatrics and adolescent medicine, geriatrics, procedures, in-patient care, acute and chronic care, etc. However, I was warned that practicing with such a wide scope would be a feat, or might very well be impossible in modern medicine. The glorification of classical, broad-spectrum Family Medicine is still alive in academic programs, but the fullscope family physician now seems to be a rapidly diminishing species outside of academia and the most rural of settings - a fact I find to be both sad and deeply worrisome for the future of Family Medicine and healthcare in America. During a recent leadership elective, the NCAFP graciously offered me the opportunity to explore the topic further and to ground my observations in some hard data. I analyzed a set of pertinent self-reported data, gathered by way of an AAFP member survey and transmitted to the state chapter, on NC physicians’ practice settings, formats,

8

THE NORTH CAROLINA FAMILY PHYSICIAN • Spring 2014

and the services and procedures offered in their clinics with the aim of defining the current scope of practice of FPs in NC. Responses to the voluntary survey were collected over the time frame of 7/2/2012 to 1/4/2014, with a resultant sample size of 1,318 North Carolina participants, including 1,243 MDs, 74 DOs, and 1 student respondent. Analysis of answers to questions concerning scope-of-practice revealed some dramatic trends in the types of services and procedures offered by

alarming that over 25% respondents reported they do NOT care for infants/children and that only 25.2% reported care for newborns. Ironically, geriatric medicine and chronic care management—which are commonly thought to be swallowing up primary care as of late with the birth of the Patient-Centered Medical Home and the onslaught of the baby boomers—are apparently provided by only 78.7% and 82.4% of respondents, respectively. Thus, about one fifth of respondents

Changing Scope-of-Practice Among Family Physicians Number of Respondents Offering Various Types of Services Adolescent Medicine

1063 / 1318 - 80.7%

Care of Infants & Children

963 / 1318 - 73.1%

Chronic Care Management

1086 / 1318 - 82.4%

Emergency Care

523 / 1318 - 39.7%

Geriatric Medicine

1037 / 1318 - 78.7%

Hospice / Palliative Care

466 / 1318 - 35.4%

In-Patient Care

348 / 1318 - 26.4%

Intensive Care

203 / 1318 - 15.4%

Obstetrics

106 / 1318 - 8.0%

Occupational Medicine

402 / 1318 - 30.5%

Sleep Medicine

84 / 1318 - 6.37%

Sports Medicine

518 / 1318 - 39.3%

Urgent Care

760 / 1318 - 57.7%

family physicians in our state. The responses given by participants, when asked to report which types of clinical services they personally provided, are summarized in the table above. Given Family Medicine’s mission of caring for all types of patients throughout their lifespan, I found it

have managed to escape that fate entirely. This is still a concerning finding, though, because it does not support the field’s aim to provide consistent, continuous care throughout the lifespan. Also, barely more than half (57.7%) reported providing urgent care, which See ‘Scope of Practice’ on p. 27


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HIGHLIGHTS & BRIEFS

Chapter News & Affairs

NC’s Allopathic Family Medicine Residencies Have Another Strong MATCH Year

ncafp.com/academy

North Carolina’s twelve allopathic family medicine residency programs had another strong year in the national allopathic resident MATCH. North Carolina’s allopathic community- and university-based programs filled all 91 of its available residency slots, with nearly 99% doing so on the first round. Compared to the state’s results in 2013, NC’s allopathic programs MATCHed at a higher percentage (98.9% vs 91%) and filled more total positions (91 vs 88).

# Filled in MATCH

Total Slots Filled

Cone Health

8

8 of 8

CMC Cabarrus

8

8 of 8

CMC Charlotte

9

9 of 9

CMC Monroe

1

2 of 2

Program

NCAFP Vice President Dr. Rhett Brown of Charlotte was one of over 40 Academy leaders to attend the strategic planning session in Pinehurst.

NCAFP Leaders Complete Key Strategic Planning and Visioning Session

Duke University

4

4 of 4

East Carolina Univerrsity

13

13 of 13

MAHEC-Asheville

9

9 of 9

MAHEC-Hendersonville

4

4 of 4

Over forty NCAFP leaders gathered in Pinehurst in early March for an important strategic planning session. The session was facilitated by Cecilia Sepp, an executive with Association Laboratory, a national consultancy that specializes in the development of business strategy for associations and non-profits. Sepp began the planning by reviewing a number of key NCAFP member needs as identified by the 2013 NCAFP Member Needs Assessment. With these in mind, NCAFP leaders then participated in a series of round-table discussions to generate a list of strategic and tactical goals. In the coming months, NCAFP officers will utilize these goals in drafting a new strategic plan for the Chapter. It is expected that the draft of the new plan will be presented to the NCAFP Board of Directors this summer.

New Hanover Regional1

6

6 of 6

Southern Regional AHEC1

8

8 of 8

UNC Chapel Hill

10

10 of 10

Wake Forest

10

10 of 10

Footnotes

1) Filled (3) positions through 2014 Osteopathic Match.

R U R A L P R I M A R Y C A R E I N N O VA T I O N

Past President Dr. Chip Watkins Helps Lead Team that Receives $25,000 Rural Health Award NCAFP Past President R. W. ‘Chip’ Watkins (2010) and a collaborative PCMH ‘swat team’ he helps lead were awarded the 2014 Innovations in Rural Health Award by the Kate B. Reynolds Charitable Trust (KBR). As winner of the national award, the program received a $25,000 award and a commitment by KBR to helping scale the program across the state. Known as the Primary Care Improvement Collaborative, Watkins’ effort has brought together undergraduate students from Appalachian State University’s College of Health Sciences with professionals working with AccessCare of the Blue Ridge, a CCNC-affiliated network. The Collaborative helps rural practices in western North Carolina achieve

10 THE NORTH CAROLINA FAMILY PHYSICIAN • Spring 2014

the Patient-Centered Medical Home (PCMH) designation from the National Committee on Quality Assurance. The program is unique in that it is a collaboration between AccessCare of the Blueridge and Appalachian State University (ASU) College of Health Science’s Health Care Management Program. Using junior and senior undergraduate students from ASU, students provide individualized, practice-to-practice outreach and consulting. To date, the program has helped 18 primary care practices representing more than 26,000 patients achieve See ‘Rural Health Award’ on Back Cover


Past President Dr. Robert Gwyther Receives 2014 Glaser Award by Governor’s Institute

NCAFP Delegation Completes a Busy Two-Days of Advocacy on Capitol Hill Fourteen representatives from the NCAFP went to Washington, DC, in early Apil as part of AAFP’s annual Family Medicine Congressional Conference. After briefings on key national issues facing the specialty and some issues training, NCAFP’s delegation met with twelve members of North Carolina’s congressional delegation. Visits were held with Senator Richard Burr and Representatives Mark Meadows, Patrick McHenry, George Holding, David Price, Richard Hudson, Mike McIntrye, and Walter Jones. The group also met with staff representatives from several additional offices. In each of the meetings, the delegation discussed several key issues, including the need for increased payments for primary care, asking for the support for extending the Medicaid-to-Medicare parity payments and Teaching Health Centers programs, and funding for Title VII and AHRQ. In a related development while in Washington, NCAFP Past President Dr. Allen Dobson (1998), President & CEO of Community Care of North Carolina, testified before the US Senate’s Health, Education, Labor and Pensions Committee’s Subcommittee on Primary Health Care and Aging. In a meeting entitled, ‘Addressing Primary Care Access and Workforce Challenges: Voices from the Field,’ Dr. Dobson testified about the need for increased primary care pipeline investment, including accelerating payment reforms, supporting and building capacity in rural areas, and expanded multi-payer efforts.

NCAFP Past President Dr. Robert E. Gwyther, MBA (2002), was the recipient of this year’s Frederick B Glaser Award, an award honoring Dr. Glaser, one of the pioneers of addiction medicine in NC and the country. Glaser had a distinguished career in the field of substance abuse, including the study of opiates and alcohol. Dr. Gwyther was noted as a pioneer and leader in the field of addiction medicine, including his work in making significant contributions through education, clinical work and in the community. In addition to his Academy service, Dr. Gwyther has been an active member of the NC Society of Addiction Medicine, and the NC Physicians Health Program. He also served on the NC IOM’s Substance Abuse Task Force that made recommendations to the NC General Assembly in 2009.

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Sand, Sun, Fun

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& GREAT in Myrtle Beach CME Make plans to splash in the ocean, soak up the sun and satisfy your CME requirements during the week of July 4th. Our annual Sports Medicine Symposium and Mid-Summer Family Medicine Digest promises a great line up of lecture topics and workshops all week long. Scheduled for Sunday, June 29 through Friday, July 4, 2014 at the Embassy Suites & Kingston Plantation in Myrtle Beach, this annual conference is a great time for CME, relaxation, camaraderie and fun for everyone. Sports Medicine Symposium The week will kick off on Sunday, June 29th with an eight-hour Sports Medicine Symposium beginning at 1:00pm. Program Chair Bert Fields, MD, has planned an exciting symposium focused on important and useful sports medicine re-

Sports Medicine Symposium & Mid-Summer Family Medicine Digest • June 29th - July 4, 2014

lated topics, including Hand Problems in Athletes, Sports After Joint Replacement, Clearing the Patient with Concussion, How Exercise Affects Cancer, and much more. The symposium will also include two rotating hands-on workshops that will place emphasis on upper and lower extremity examinations and diagnoses. Physicians, Physician Assistants, Physical Therapists and Athletic Trainers are encouraged to attend this informative and fun symposium. Mid-Summer FM Digest The Mid-Summer Family Medicine Digest will begin bright and early Monday morning with a continental break-

NEW MOC-IV ONLINE COURSE

Online Course Promoting Dental Homes for Young Children Available Now The NCAFP recently launched a new Maintenance of Certification Part IV program that is free-of-charge to all North Carolina family physicians. Titled ‘Promoting Dental Homes for Young Children Through Screenings, Varnishing, and Referrals,’ the program is entirely web-based and features 4 video-based learning sessions. The aim of the course is to promote the importance of a dental home for young children (6-months to 42 months) who are in the care of pediatric and/or family practices. The course will assess practices and protocols for child oral health and is

12 THE NORTH CAROLINA FAMILY PHYSICIAN • Spring 2014

fast in the exhibit hall. General Sessions are scheduled each day from 7:30 am to 1:15 pm leaving your afternoons free for fun and family while at the beach. Dr. Thomas R. White, Program Chair, and Dr. Alisa C. Nance, Program Vice-Chair, have compiled a great line-up of various medical topics faced by most primary care physicians today. Lecture topics include Pre-Diabetes & Emerging Therapies, New Lipid Guidelines, New Hypertension Guidelines, Pediatrics, Major Depressive Disorder, ER/LA Opioid REMS, Contemporary Perspectives on COPD, New Insights on the Management of Fibromyalgia, What's New in Urology See ‘Mid-Summer’ on Back Cover

approved for 20 AAFP Prescribed credits. Participants who enroll now through June, 2014, can participate in an interactive series of webinars being held each month (they began March 26th) that will review the learning session and enable learners to collaborate on how to improve child oral health in your primary care practice. For additional information and questions on the course and its collaborative learning sessions, please contact Cameron Graham, Activity Director, at cameron@camerongrahamconsulting.com. The course is a partnership between the NCAFP, the NC Pediatric Society, the NC DHHS Office of Rural Health, Community Care of North Carolina, and the NC Foundation for Advanced Health Programs. To access the course, simply visit http://oralhealth.ncafp.com.


North Carolina Academy of Family Physicians

2013 Annual Report

Dr. Shannon B. Dowler

2012-2013 NCAFP President

State of the Academy As chapter president in 2013, the progress the NCAFP made in advancing Family Medicine can best be summarized in two words: embracing change. There are several strategic areas where your physician leaders and our Academy staff was able to adapt to a changing environment and bring about positive outcomes. What follows is a description of our key successes.

our presence in the halls of the General Assembly and wherever healthcare policy decisions are being made. All of these efforts helped us reach a key strategic goal: an effective and respected voice within important legislative, executive, and health policy arenas.  

Challenging Political Times

Another key area of focus in 2013 has been building new partnerships. Because NCAFP members serve different kinds of patients in many different ways, the NCAFP's links across the health spectrum are critical. These links help family physicians maintain an active role in improving care delivery, but also enable our Academy to spread the message that the specialty of Family Medicine is at the forefront of transformative change.

Perhaps like no other time in recent memory, our healthcare system is undergoing dramatic transformation. From the Affordable Care Act's launch to the ways our state's elected leaders are approaching healthcare spending, to the ways physicians document and see patients, change seems to be everywhere. Our Academy has been quick to adapt and refine our approaches by using new tools and relationships to communicate our message effectively. 2013's state legislative session was incredibly fast paced from Day 1. Several scope-ofpractice proposals and the impacting implications of Medicaid reform kept our governmental affairs team busy at every turn. Even with these demands, our Academy carried out one of the most proactive and effective advocacy programs in recent memory. In the pages that follow you'll read about several of our key legislative victories, but the real takeaway has been our success in combining both old and new approaches to deliver the message of Family Medicine powerfully. By doing so, we were effective and innovative! For example, our Academy utilized the power of television for the first time and in a way few other state health care organizations have considered. We used the Internet and social media to create new issues-oriented websites, email campaigns, and petitions for use as advocacy tools. Family physicians testified more, attended and led more meetings, and grew

Investing in Partnerships

To that end, our Academy continued to actively represent the specialty on over thirty existing state healthcare policy groups and improvement initiatives. We also invested time in establishing the specialty as an active leader in new groups and efforts. For example, our Academy was a key participant on an emerging oral health collaborative working to establish a statewide network of dental homes for children. We also actively positioned Family Medicine within the payment reform discussion, especially with groups like the Towards Accountable Care Consortium. We worked closely with the NC Medical Board as they updated their policies on prescribing controlled substances, and also had a lead sponsorship role in AHealthierNC, an innovative healthy lifestyle and improvement effort.

Modern Professional Development Continuing medical education and professional development is also a changing field, and like other areas, our Academy continued to adapt

to best meet the needs of our members. The NCAFP delivered a great deal of member education designed to provide the right learning at the right time. Our Academy developed and launched two online Maintenance of Certification Part IV programs while we continued to present an excellent series of annual conferences that are the envy of many state AAFP chapters. We began to offer new tools to make mobile learning easier and laid the groundwork for our DOT certification workshops that have been extremely well-received by members this spring. Finally, we put helpful employment resources into the hands of our residents. Simply put, assisting our members with professional development is changing and requires more than the didactic lectures of the past: it's interactive, informational and on-demand.

Preparing for Tomorrow The final effort I'll describe is probably the most important for our members. Last year, our Academy conducted our first member needs assessment in almost a decade. More than 370 NCAFP members responded and the results were eye opening. While we found that advocacy for the profession and our patients remains the most critical role we play for our specialty, changes in the practice environment are creating new demands. The practice arrangements of our members today are vastly different than they were when we conducted our last needs assesment, and this is impacting the information, support and types of education NCAFP members need and desire. The Academy is continuing to use this data as we work to update our strategic plan in 2014 to best reflect the needs of our family physicians across the state. My experience serving as your President can best be described as a 'whirlwind tour' and one I will never forget. It was an honor to represent you, speak for you, and fight for you as my fellow family physicians.


Year in Review

2012-2013 NCAFP Board of Directors Executive Officers President

Shannon B. Dowler, MD

President-Elect

William A. Dennis, MD

Vice President

Thomas R. White, MD

Secretary/Treasurer

Rhett L. Brown, MD

Board Chair

Brian R. Forrest, MD

Past President (w/voting privileges) Executive Vice President

Richard Lord, Jr., MD Gregory K. Griggs, MPA, CAE

District Directors District 1

Jessica Triche, MD

District 2

Matthew M. Williams, MD

District 3

Scott E. Konopka, MD

District 4

Tamieka Howell, MD

District 5

Janice E. Huff, MD

District 6 District 7

Alisa C. Nance, MD David A. Rinehart, MD

At-Large

Holly Biola, MD

At-Large

Charles W. Rhodes, MD

IMG Physicians

Joseph P. Pye, MD

Minority Physicians

Benjamin F. Simmons, MD

New Physicians

Jennifer L. Mullendore, MD

NC Family Medicine Depts.

Michael L. Coates, MD

FM Residency Directors

William A. Hensel, MD

Resident Director

Mo Shahsahebi, MD

Resident Director-Elect

Aaron George, DO

Student Director

Katy Kirk

Student Director-Elect

Julie Barrett

FM Department Chairs & Alternates Chair (WFU)

Michael L. Coates, MD

Alternate (Duke)

J. Lloyd Michener, MD

Alternate (ECU)

Kenneth K. Steinweg, MD

Alternate (UNC)

Warren P. Newton, MD, MPH

AAFP Delegates & Alternates AAFP Delegate

Mott P. Blair, IV, MD

AAFP Delegate

Karen L. Smith, MD, FAAFP

AAFP Alternate

L. Allen Dobson, Jr., MD

AAFP Alternate

Michelle F. Jones, MD

NCAFP Family Medicine Councils Advocacy Council

Robert L. Rich, Jr., MD, Chair William A. Dennis, MD, Vice Chair

CME Council Health of the Public Council

Thomas R. White, MD, Chair Charles W. Rhodes, MD, Chair

Practice Enhancement Council

Rhett L. Brown, MD, Chair

AAFP Service & Appointments Conrad L. Flick, MD - Raleigh, N.C. Member, AAFP Board of Directors

Michelle F. Jones, MD - Hampstead, N.C. Member, AAFP Foundation Board of Directors

Richard Lord, MD - Winston-Salem, N.C. Member, AAFP Commission on Continuing Professional Development

Robert L. Rich, Jr., MD - Elizabethtown, N.C. Member, AAFP Commission on Health of the Public & Science

Gregory K. Griggs, MPA, CAE Executive Vice President

Fighting for You and Your Patients 2013 ushered in some of the most intense advocacy efforts ever undertaken by the NC Academy of Family Physicians, with the ultimate goal of improving care for your patients and ensuring that the practice environment for family physicians in our state is a positive one. It’s not been an easy undertaking, but working together we’ve accomplished much in the last year. The game changed greatly with a new administration and a proposal for a major overhaul of North Carolina’s Medicaid program, with the threat of outside managed care companies taking center stage. Your Academy reacted and reacted strongly. We undertook a major campaign to ensure that North Carolina physicians continued to make decisions about North Carolina healthcare. Entitled “Our NC Healthcare” the effort included a new web presence, social media activities, a series of press releases and editorials, and most importantly a significant presence on North Carolina’s leading public policy talk show, NC Spin. The efforts also included numerous meetings with Governor McCrory and his healthcare policy team, the Department of Health and Human Services Secretary Aldona Wos, MD, and her leadership team, as well as the outside consultants the department hired. Our activities, combined with those of other medical and healthcare organizations, made a significant difference in the ongoing debate throughout 2013 and into 2014. Our Advocacy efforts didn’t end with the fight for a patient-centered, physician-driven Medicaid program. Your Academy’s leadership has also stepped up efforts in numerous areas, including advocating for the value of primary care and the importance of the continuous and comprehensive care provided by family physicians. These efforts have occurred with both public sector and private sector payers, culminating with an hour and a half live presentation of NC Spin at our Annual Meeting in December. This live presentation was edited for television and ultimately aired twice on their public policy television show in early 2014. Another key issue in 2013 focused on an effort to preserve patient safety and prevent fragmentation of care, while at the same time increasing patient access to needed immunizations. The ultimate outcome allowed pharmacists to provide five immunizations to adults under a written physiciansupervised protocol, as long as the pharmacists check the state immunization registry, include any given immunizations in the registry, follow a specific agreed upon screening questionnaire, and report back to an individual’s primary care physician if the person has one. If the patient does not have a primary care physician, the pharmacist is required to provide information about the importance of a medical home. Flu vaccines remained more flexible as they previously had been, and other adult immunizations can be provided by a pharmacist but only with a specific written prescription from a physician. As we move into the future, we know these enhanced advocacy efforts will be needed even more. As a result, your Board of Directors voted to put the resources into place by using a limited portion of our financial reserves in 2013-14 and increasing our financial contributions toward advocacy in 2014 and beyond. This led to the hiring of an in-house Director of Government Affairs, Joanna Spruill, JD, in October of 2013, while maintaining the services of our long-time government affairs consultant, Peyton Maynard. The bottom line: in 2013, the NCAFP continued to put your needs and the needs of your patients in the forefront of our activities. Whether it is advocacy or continuing medical education, the NCAFP will continue to be there to help you traverse the pitfalls of a global transformation of healthcare at the local, state and national level. Stay tuned.


Membership

FAMPAC

Category

Dec. 31, 2013

Dec. 31, 2012

• 105 total contributions from 71 different people totaling $11,990.

Active:

2,346

2,304

• Six campaign contributions to five different candidates totaling $6,000.

Inactive:

31

23

Life:

236

220

• 21 Forerunner members at the end of 2013, each contributing a minimum of $100 per quarter.

Resident:

272

272

Student:

640

508

Supporting:

9

12

Total:

3,534

3,339

Forerunners

Chapter Membership Recognitions

Janalynn F. Beste, MD Holly Biola, MD Janet Bowen, MD Rhett L. Brown, MD William A. Dennis, MD Shannon Dowler, MD Gregory K. Griggs, MPA, CAE Douglas I. Hammer, MD

Large Chapter Active Member Retention: NC tied for 2nd place nationally at 96.7%.

Other Contributors

Chapter Market Share: NC placed 3rd nationally at 85.6%. New Physician Retention: Nearly 93% retained their membership. Resident-to-Active Conversion: Chapter acheived 85.1% conversion rate. Resident Membership: Achieved 100% Resident membership for the ninth consecutive year.

Yvonne Berstler, MD James S. Blair, MD Mott P. Blair, MD David Brendle, MD Lisa A. Cassidy-Vu, MD Michael Coates, MD John Steven Corder, MD Nancy Brous Distefano, MD L. Allen Dobson, MD Kawanta F. Durham, MD Janice Huff Ezzo, MD Godfrey S. Fondinka, MD Brian R. Forrest, MD James Galloway, MD Aaron E. George, DO Donald Goodman, MD Michael Gross, MD

Mary Ibarra, MD Eugenie Komives, MD Richard Lord Jr., MD James W. McNabb, MD Jennifer Mullendore, MD John Thomas Newton, MD Joseph Pye, MD Bonzo Reddick, MD

Charles W. Rhodes, MD Robert L. Rich Jr., MD John Carson Rounds, MD Roy Wayne Watkins, MD Thomas R. White, MD Matt Williams, MD

Robert Gwyther, MD Wayne A. Hale, MD David Hall, MD Mary Hall, MD Tamieka Howell, MD Thomas Jeffries, MD James Jones, MD Michelle F. Jones, MD Victoria Kaprielian, MD William Sherwood Kelly, MD Thomas Koinis, MD Timothy Madigan, MD John Mangum, MD James Sloan Manning, MD Paul F. Meyer, MD Maureen Murphy, MD John D. Nelson, MD

Jelaun Newsome, MD Bret Powell, DO Marjorie R. Rachide, MD David A Rinehart, MD Lindsay S. Robbins, MD Jane Satter, MD George Saunders, MD Mohammad Shahsahebi, DO Barbara L. Sheline, MD Christopher Snyder, III, MD Beat Steiner, MD Margaret Stetson, MD Jessica Triche-Staton, MD Alicia C. Walters, MD Cynthia Witt, MD


CME Meetings & Conferences Live Programs

Frontline Programs

The Chapter produced five educational programs in 2013 that presented a total of 87.5 AAFP Prescribed Credits.

Diagnosing & Managing Alpha-1 Antitrypsin Deficiency in Primary Care – Chapter Lecture Series - Part I: Lectures at all chapter meetings and at the Georgia Academy summer annual meeting.

Spring Family Physicians Weekend – Greensboro, NC James W. McNabb, MD & Nadine B. Skinner, MD Program Co-Chairs Credits: 20.5 Registration: 166 Registrations / 22 Exhibitors

Mastering Valuable Hands-On Procedures – Part IV: Conducted workshops at NCAFP 2013 Midsummer/Sports Medicine Symposium and Winter Meetings, and Georgia Academy’s Winter meeting.

NCAFP Media Training – Greensboro, NC Shannon Dowler, MD, Program Chair Registration: 92 Registrations 2013 Family Medicine Day – Raleigh, NC William Hensel, MD, Program Chair Registration: 67 Registrations / 16 Exhibitors Midsummer Family Medicine Digest & Sports Medicine Symposium – Myrtle Beach, SC Thomas R. White, MD, Program Chair, & David Rinehart, MD, Program Vice-Chair, Mid-Summer Family Medcine Digest; Bert Fields, MD, Program Chair, Sports Medicine Symposium Credits: 34 Registration: 266 Registrations / 42 Exhibitors Winter Family Physicians Weekend – Asheville, NC Richard W. Lord, Jr., MD, Program Chair & J. Carson Rounds, MD, Program Vice-Chair Credits: 33 Registration: 773 Registrations/ 94 Exhibitors

Team A: The Evolution of the Anticoagulation Management – Performance Improvement Collaboratory: This is a grant project developed by the California Academy of Family Physicians who requested that the NCAFP recruit physicians and practices participate in the program. Members participating in 2013 were Karen L. Smith, MD, and Shannon Dowler, MD. Participating practices assessed their readiness to change, employed a series of “small tests of change,” and made measurement improvement in at least one mandatory clinical measurement. The NCAFP provided administrative support, including reporting and participated in monthly calls, reporting on progress of team members as well as benchmark and evaluation measures. Contemporary Perspectives in COPD: A Family Physician’s Practical Guide to COPD Chapter Lecture Series – Part I: Conducted lectures at several regional AFP chapter meetings aimed at recruiting five chapters. The chapter is also working in joint sponsorship with Consensus Medical Communications (CMC) in developing educational content relevant and valuable to family physicians. New Insights in the Management of Fibromyalgia: Refining the Response of Patients to Individualized Treatment – Chapter Lecture Series – Part I: Conducted lectures at several regional AFP chapter meetings aimed at recruiting eight chapters. NCAFP is working in joint sponsorship with Consensus Medical Communications (CMC) to develop CME content. Improving Adherence and Maintaining Remission in Major Depressive Disorder – Chapter Lecture Series – Part I: Conducted lectures at several regional AFP chapter meetings aimed at recruiting eight chapters. NCAFP is working in joint sponsorship with Consensus Medical Communications (CMC) to develop CME content. Maintenance of Certification Part IV Project – Comprehensive Screening for Maternal Depression and Infant Toxic Stress: Second of five MOC Part IV projects under a grant supported by Federal CHIPRA funding through Community Care of North Carolina.


Awards & Honors Educational Supporters & Partnerships AAFP Chapter Lecture Series: Treating Obesity in Adult Patients * This activity is supported by an educational grant from Eisai Inc., Takeda Pharmaceuticals Intl., Inc., US Region and VIVUS, Inc. AAFP Chapter Lecture Series: Human Papillomavirus (HPV) *The CME activity is funded by an educational grant to the AAFP from Merck. AAFP Chapter Lecture Series: Type 2 Diabetes *The CME activity is funded by an educational grant to the AAFP from Novo Nordisk, Inc. Boehringer Ingelheim Pharmaceuticals, Inc. Bristol-Meyers Squibb California Academy of Family Physicians Cine-Med, Inc. Creative Educational Concepts Endo Gastric Solutions Fortis Spectrum Genentech Georgia Academy of Family Physicians Grifols Interstate Postgraduate Medical Association Lilly USA, Inc. Lung Cancer Initiative of North Carolina Merck New Jersey Academy of Family Physicians North Carolina Foot and Ankle Society Pfizer Inc. Primary Care Education Consortium Primary Care Network Purdue Pharma L.P. Research (ASBMR) & The France Foundation ResMed Corporation Southeastern United Dairy Industry Association, Inc. The American Society for Bone and Mineral The Annenberg Center for Health Sciences at Eisenhower The Pain Society of the Carolinas Educational Partnerships MAG Mutual Insurance Company Medical Mutual Insurance Company Frontline Programs Gebauer

2013 North Carolina Family Physician of the Year Robert Earl Lane, MD, FAAFP - Hertford, NC Inspired at a young age by his own family doctor to pursue a career in medicine, family physician Dr. Robert Earl Lane of Hertford, NC, was recognized for his remarkable 40+ year medical career. He has been Perquimans County’s only family physician for more than 37 years. Dr. Lane obtained his undergraduate degree from Mississippi State University, finished medical school at Tulane Medical School, and completed his residency training in 1972 in General Practice. He went on to found Coastal Carolina Family Practice in Hertford in 1987, growing it into the largest family medicine group within 100 miles Hertford. Dr. Lane resides in Windfall, NC, with his wife of 30-years, Chris. The Lanes are the proud parents of five children and grandparents to nine.

2013 Outstanding Family Medicine Residents Cabarrus Family Medicine Residency Program - Jenna S. Thomas, MD Camp Lejeune Family Medicine Residency Program - Michelle M. Lynch, MD Carolinas Medical Center Family Medicine Residency Program at Charlotte - Anna L. Claugus, MD Carolinas Medical Center Family Medicine Residency Program at Monroe - Brittany L. Baird, DO Duke University Family Medicine Residency Program - Elizabeth H. Chisholm, DO East Carolina University Family Medicine Residency Program - Nirmala N. Maharaj, MD MAHEC Family Medicine Residency Program at Asheville - Janice Esker, MD MAHEC Family Medicine Residency Program at Hendersonville - Brent Meadows, DO Moses Cone Family Medicine Residency Program - Jill N. Konkol, MD New Hanover Family Medicine Residency Program - Richie A. Smits, MD Southern Regional Family Medicine Residency Program - Rishita R. Patel, MD UNC Chapel Hill Family Medicine Residency Program - Joseph L. Wilson, MD Wake Forest University Family Medicine Residency Program - Keli L. Beck, MD WOMACK Family Medicine Residency Program- Blake R. Busey, DO 2013 Community Teaching Awardees

NON-CME Satellite Programs Chapter Direct Everything Esthetic Health Diagnostic Laboratory, Inc. Marley Drug Practice Fusion

Brody School of Medicine at East Carolina University - Mackenzie M. Smith, MD Duke University School of Medicine - James Gregg Sigmon, MD Wake Forest School of Medicine - Ted J. Nifong, MD University of North Carolina School of Medicine - Charles E. Baker, MD 2013 Family Medicine Interest Group Faculty Advisors Brody School of Medicine at East Carolina University - Susan A. Schmidt, MD Jerry M. Wallace School of Osteopathic Medicine at Campbell University - Charlotte Paolini, DO Duke University School of Medicine - Nancy J. Weigle, MD University of North Carolina School of Medicine - Kelly Bossenbroek Fedoriw, MD University of North Carolina School of Medicine - Thomas F. Koonce, MD Wake Forest School of Medicine - C. Randall Clinch, DO, MS


Financial Summary The following represents the 2013 year-end financial summary for the NCAFP Academy. This Summary is only a part of the complete financial statements examined by Thomas, Judy & Tucker, P.A., Certified Public Accountants. The complete Financial Statements are available to any member of the North Carolina Academy of Family Physicians, Inc. upon request at the NCAFP headquarters.

Assets Current Assets: Cash and Cash Equivalents Accounts Receivable, net of Allowance for Doubtful Accounts of $500 in 2013 and 2012 Prepaid Expenses Certificates of Deposit Investments Total Current Assets Property and Equipment: Land Building and Improvements Furniture and Equipment Less Accumulated Depreciation Net Property and Equipment

Dec. 31, 2013

Dec. 31, 2012

887,015

883,019

100,293 38,198 18,298 19,865 300,000 1,298,450 973,671

Liabilities and Net Assets

583,649 48,455 20,036 550,000 888,653

2,595,056 1,914,753 2,090,793

205,000 642,835 278,080

205,000 625,108 243,873

205,000 625,108 243,873

(504,191)

(471,538)

(445,282)

621,724

602,443

628,699

Other Assets Investment, Deferred Compensation 125,045 Certificates of Deposit Total Assets

Dec. 31, 2011

120,235 115,611 300,000

3,341,825 2,937,431 2,835,103

Dec. 31, 2013

Dec. 31, 2012

Dec. 31, 2011

343,108 253,777 347,715 31,500 15,371

157,300 239,065 200,983

245,314 250,645 36,739

13,025

13,025

Current Liabilities: Accounts Payable Deferred Revenue - Membership Dues Deferred Revenue - Programs Accrued Retirement Contributions Accrued Paid Time-Off    Total Current Liabilities

991,471 610,373 545,723

Long-Term Liabilities: Deferred Compensation

125,045

120,235

115,611

Total Liabilities

1,116,516 730,608 661,334

Net Assets Undesignated Board Designated

2,154,805 70,504

2,137,301 69,522

2,099,537 74,232

Total Net Assets

2,225,309

2,206,823

2,173,769

Total Liabilities and Net Assets

3,341,825 2,937,431 2,835,103


Funding & Support FOUNDATION

2013 Operational Summary 2013 NCAFP Foundation Board of Trustees Foundation Executive Officers President Vice President Secretary/Treasurer Executive Vice President

J. Carson Rounds, MD Jennifer L. Mullendore, MD Christopher Snyder, III, MD Gregory K. Griggs, MPA, CAE

Physician Trustees

Mott P. Blair, IV, MD Shannon B. Dowler, MD William A. Dennis, MD L. Allen Dobson, MD Dimitrios P. Hondros, MD Michelle F. Jones, MD Viviana Martinez-Bianchi, MD Jennifer L. Mullendore, MD Robert L. Chuck Rich, Jr., MD J. Carson Rounds, MD Christopher Snyder, III, MD

Trustee Emeritus

The Foundation ended 2013 with $2,281,230 in total assets, including a net operating surplus of $113,786. Grant revenue was $297,550 and total revenues for the year were $480,349. Contributions from Member Dues

$25,850

Individual Designated Contributions: General Fund (includes Silent Auction Cash Contributions) Medical Student Endowment Family Medicine Interest & Scholars Program

$9,687 $2,850 $200

Corporate Member Contributions: Corporate Member Contributions Silent Auction Contributions (including Corporate Sponsorship) NCAFP Contribution to FM Interest & Scholars Program NCAFP Contribution to Tar Wars Program AAFP Foundation Grant for Student Externships

$7,000 $15,378 $8,485 $10,000 $3,750

Grant Funded Projects: Blue Cross and Blue Shield of NC Foundation FM Interest & Scholars Program

$274,800

2013 Corporate Membership Program – The following organizations contributed at least $1,000 to the Foundation and were named corporate members for the year: • Blue Cross and Blue Shield of North Carolina Foundation • Johnson & Johnson Services, Inc. • Mag Mutual Insurance Company • Medical Mutual Insurance Group • NC Academy of Family Physicians Medical Student Endowment Fund - The endowment now totals $1,030,646. The Academy contributed $8,485 to this fund in 2013 in addition to the $10,000 contributed to the Foundation’s Tar Wars Program. The Annual Foundation Silent Auction – This event generated revenue of $15,378, with expenses of $6505 for a net gain to the Foundation of $8,872. An increased profit of 30% over the 2012 Silent Auction.

Maureen E. Murphy, MD

Corporate Trustees

Jim Kay - Medical Mutual Insurance Company JJ Darby - Johnson & Johnson Services, Inc. Patti Forest, MD - Blue Cross & Blue Shield of North Carolina

Resident Trustees

Teah Bayless, DO (Duke) A. Mansa Semenya, DO (UNC)

Student Trustees

Brian M. Blank (UNC) Cleveland A. Piggott (UNC)

Student Activities Family Medicine Interest Groups - The Foundation supported all Family Medicine interest groups with funding and staff support. Financial support totaled over $22,000.00 directly to FMIGs and/or students and included the following: support to off-set FMIG annual banquet costs, student attendance at the AAFP National Conference for FM Residents and Medical Students, the ability to bring National-level speakers to FMIGs and support to help students attend the NCAFP Annual meeting in Asheville. Family Medicine Student Leaders - The Foundation provided $6,780 in support for elected Student Leaders to attend Board Meetings. Leaders include the Foundation Board Student Trustees (2) and the Student Director and Director-Elect. Family Medicine Rural Health Externship Program - A two-week program offered in partnership with Hendersonville Family Medicine Residency Program. The residency program provided leadership of the experience, as well as funding in the amount of $13,500. The Foundation provided an additional $3,000.00. Ten students participated in this two-week summer experience.


Family Medicine Externship Program - A total of 6 students participated in a summer experience of two to four weeks for a total cost of $4,750.00. The Foundation was able to secure grants from the AAFP Philanthropic Consortium of $3,750.00 to offset some program expenses. Family Medicine Interest & Scholars Program - In 2013, the Scholars aspect of the program remained at 36 students. During this year a total of $124,265.00 was paid directly to and/or for students and preceptors. This included stipends awarded to students and preceptors totaling $59,125.00. Additional support to student participants in this program included: $11,239.00 to attend the NCAFP annual meeting; $13,416.00 for AAFP National Conference for FM Residents & Medical Students; $2540.00 for the Leadership Elective; and, $3,355.00 for travel to other national conferences. An additional $12,090.00 was paid for CME registration fees paid for preceptors at our Annual Meeting. Last, $22,500.00 was paid out for initial scholarship payments for students from the inaugural class of Family Medicine Scholars that matched into Family Medicine. From that inaugural class, of the ten that entered the MATCH in 2013, five selected the specialty of Family Medicine. Four of the remaining five entered other specialties of need in NC (psychiatry, med/peds, ob/gyn and general surgery). Those entering Family Medicine residency programs include: Kathryn V. Lawrence (WFSOM) - Wake Forest Baptist Medical Center - Winston-Salem, NC William Martin (UNC) - Greater Lawrence Family Health Center - Lawrence, MA (4-year program) Brian P. Sanders (WFSOM) - Oregon Health and Science University - Portland, OR (4-year program) Daniel J. White (UNC) - Univ. of Colorado SOM - Denver Health Track - Denver, CO Patrick S. Williams (ECU) - CMC-Northeast Medical Center / Cabarrus - Concord, NC NCAFP Student Scholarship/Loan Program - Ms. Sophia Malik (UNC), now entering Family Medicine training in Seattle, WA, was awarded a scholarship in the amount of $2,000.00. North Carolina Tar Wars Program - The mission of Tar Wars is to educate students about being tobacco free, provide them with the tools to make positive decisions regarding their health, and to promote personal responsibility for their well-being. This program continues to be presented to NC fourth- and fifth-graders by student members of the state’s Family Medicine Interest Groups, as well as other healthcare professionals around the state. Rylie LaRue, of Sparta, NC was selected as the 2013 State Tar Wars Poster Contest winner. Rylie and her family went to Washington D.C., to participate in the Tar Wars National Conference.

Contributors NCAFP members and supporters of the Chapter are encouraged to make gifts of on-going significance or annual contributions to the NCAFP Foundation. The following individuals contributed to the Foundation in 2013: Ronald G. Accas, PA-C Kerry E. Agnello, DO Robert N. Agnello, DO Marshal E. Agner, MD Mark A. Bernat, MD Yvonne E. Berstler, MD Janalynn F. Beste, MD Sara B. Beyer, MD Holly Biola, MD Reid Blackwelder, MD Mott P. Blair, MD Don Bradley, MD Jane Carswell, MD Lisa Cassidy-Vu, MD Gary S. Crawford, MD William Dennis, MD L. Allen Dobson, MD Shannon B. Dowler, MD Anthony J. Esterwood, MD Michele E. Fass, MD Conrad Flick, MD Ashleigh J. Freeman, MD Mr. & Mrs. John Gehrig Margaret Gradison, MD Gregory K. Griggs, MPA, CAE Robert G. Gwyther, MD Wayne A. Hale, MD David H. Hall, MD Douglas I Hammer, MD Mrs. Tracie Hazelett Lori Heim, MD Melissa Hicks, MD Dimitrios P. Hondros, MD Tameika M. Howell, MD Janice E. Huff, MD Bruce Hughes, MD Thomas L. Jeffries, MD Enrico G. Jones, MD Michelle F. Jones, MD Victoria S. Kaprielian, MD, and Mr. Jon Luis William S. Kelly, MD Thomas F. Koinis, MD

Eugenie M. Komives, MD Hervy B. Kornegay Sr., MD Richard Lord Jr., MD Shelly S. Lowery, MD Sabine M. Maas, MD John R. Mangum, MD Viviana S. Martinez-Bianchi, MD A. Thomas May, MD Mr. William C. McLean Paul F. Meyer, MD John S. Mitchell, MD Jennifer L. Mullendore, MD Maureen Murphy, MD, & Mr. Scott Maxwell Alisa C. Nance, MD J. Tommy Newton, MD Warren P. Newton, MD Oana R. Panea, MD, MSPH Mr. Cleveland A. Piggott Jesse Pittard, MD Lara J. Pons, MD Joseph P. Pye, MD Charles W. Rhodes, MD Robert Rich, Jr., MD David A. Rinehart, MD J. Carson Rounds, MD & Mrs. Amy Rounds Nadine B. Skinner, MD Christopher Snyder, MD Beat D. Steiner, MD Wayland C. Stephens, MD David B. Tapper, MD Robert T. Toborg, MD Robert G. Townsend, MD Jessica Triche, MD Amanze Ugoji, MD Garland E. Wampler, MD R.W. ‘Chip’ Watkins, MD, MPH Thomas R. White, MD Gustav C. Wilde, MD Matthew Williams, MD Ms. Kym Wood Thomas H. Woollen Jr., MD Rupal L. Yu, MD


P A I D

A D V E R T I S E M E N T

Top of Mind: ICD-10 TOP OF MIND: ICD-10 We recognize that we are not ICD-10 experts; The U.S. Department of Health and Human however, we thought it would be helpful tothe Health The U.S. Department of Health and Human (HHS) has designated ICD-10 as a code set under Services (HHS) has designated ICD-10 asServices a Insurance Portability and Accountability Act (HIPAA). Physicians other health care providers willcare be required to use compileand resources available to health code set under the Health Insurance Portability effective October 1, 2015.Physicians and providers on this daunting issue. While we may andICD-10 Accountability Act (HIPAA). not be in a position to address all of your ICDother health care providers will be required to As you are undoubtedly aware, in comparison to previous HIPAA mandates, the transition to ICD-10 is expected to be 10 questions and concerns, please have peace use ICD-10 effective October 1, 2015. most disruptive for physicians, as they are required to adjust documentation and other processes. Previous HIPAA of mind knowing that we are working with the mandates have allowed physicians to rely on billing services, vendors, and other partners; however, ICD-10 will involve a As you are undoubtedly aware, in comparison North Carolina Medical Society (NCMS) and much higher level of direct physician involvement. to previous HIPAA mandates, the transition to other organizations to identify and develop ICD-10 is expected to be most disruptive for Medical Mutual has heard from a number of our insured practices thattothey are seeking training in order for to prepare for the resources support a smooth transition physicians, they aretorequired to adjust transition as from ICD-9 ICD-10. Some havedocuhired outsideour consultants have expertise training for various insured that medical practiceswith andICD-10 physician medical and specialties, while others have attended educational seminarsThe offered by thewebsite American Academy of Professional mentation other processes. Previous HIPAA members. NCMS currently Coders (AAPC), the American Academy of Ophthalmic Executive (AAOE), and the Medical Group Management mandates have allowed physicians to rely on features a comprehensive list of ICD-10 Association (MGMA). Based the cost and complexity to implement ICD-10, training is imperative in order to prepare for billing services, vendors, andon other partners; learning opportunities. the changeover to code sets for new diseases and procedures. This conversion means that health care providers and however, ICD-10 will involve a much higher insurers will have to replace the approximately 14,000 existing codes with roughly 68,000tonew Medical Mutual is sensitive thecodes. impact that level of direct physician involvement. the ICD-10 delay has had on medical pracWe recognize that we are not ICD-10 experts; however, we thought it would be helpful to compile resources available to Medical Mutual has heard from a number of our tices is undoubtedly health care providers on this daunting issue. While we may not and be inphysicians. a position to This address all of your ICD-10 questions insured practices that they are seeking training a cumbersome process. Please and concerns, please have peace of mind knowing that we are working withand the costly North Carolina Medical Society (NCMS) in order to prepare for thetotransition ICD-9 the MedNotes blog to view periodic and other organizations identify andfrom develop resourcesvisit to support a smooth transition for our insured medical practices to ICD-10. Somemembers. have hired consul-currently features updates on this issue.list of ICD-10 learning opportunities. and physician Theoutside NCMS website a comprehensive tants that have expertise with ICD-10 training is sensitive to the impact that the ICD-10 delay has had oninformation, medical practices andatphysicians. This is For additional visit us www. for Medical various Mutual medical specialties, while others undoubtedly a cumbersome and costly process. Please visit the MedNotes blog to view periodic updates on this issue. medicalmutualgroup.com or call us at: have attended educational seminars offered by 800.662.7917 the American Academy of Professional Coders For additional information, visit us at www.medicalmutualgroup.com or call us at: 800.662.7917 (AAPC), the American Academy of Ophthalmic Executive (AAOE), and the Medical Group Management Association (MGMA). Based on the cost and complexity to implement ICD-10, training is imperative in order to prepare for the changeover to code sets for new diseases and procedures. This conversion means that health care providers and insurers will have to replace the approximately 14,000 existing codes with roughly 68,000 new codes.

TOP OF MIND: ICD-10


Residents & Chapter Affairs New Physicians ncafp.com/residents-newfps

By Dr. Deanna Didiano NCAFP Resident Director-Elect

Kindling New Innovations in Family Medicine Residency Curricula “Education is the kindling of a flame, not the filling of a vessel” ---Socrates As Family Medicine residents, we are in a unique position within the educational process. We have finished our ‘basic training’ in medical school, and are starting as family physicians. We are just beginning our dedication to life-long learning and caring for our patients. Our flame has only recently been kindled and we are just starting to add logs on the fire. There are many core requirements for Family Medicine residencies, with standards and guidelines well outlined by national organizations such as the ACGME (American College of Graduate Medical Education) and the AOA (American Osteopathic Association). Our North Carolina residency programs have much in common, including required rotations in the basics, electives, standardized testing and other traditional components. However, we are also fortunate to have great diversity in the way our programs add fuel to the growing fire. There are ways that each residency program strives to be unique, and this leads to new pathways of learning. When creative faculty members and ambitious young resident physicians look outside the box to create a new experience, the possibilities are energizing. A progressive vision in residency education can be seen across North Carolina within the fifteen Family Medicine residencies, from Wilmington on the coast, to Hendersonville bordering on the Great Smoky Mountains. This diversity is as unique as the people and the landscape of the program. Each residency offers experiences and an environment that shapes the physicians of the future – effectively kindling the flame of learning. To explore some of these innovations in residency education, I asked residents

22 THE NORTH CAROLINA FAMILY PHYSICIAN • Spring 2014

from several of our state programs to share unique features of their residency curriculum, and how it has affected and influenced them. Residents are by nature a busy bunch; and the stories below offer only a glimpse into the breath of diversity across our state. Starting in the coastal haven of southeastern NC, I recently spoke with Dr. Richie Smits, one of the chief residents at the program in Wilmington. Dr. Smits was greatly

enthusiastic about the revamping of a didactic curriculum that has taken place in the last few years. Under the direction of education faculty Dr. Bonzo Reddick, there is a structured block curriculum, in which residents, faculty, and specialists in the area present didactic lectures. These have been centered on a general theme such as cardiology or obstetrics. One special feature that Dr. Smits highlighted as particularly rewarding is the incorporation of a focused board review, consisting of questions and evidence-based reference material. As a 3rd year resident, Dr. Smits has led some of the reviews, and says he found himself able to dissect the test material and understand the evidence behind the questions; this has helped him feel more prepared and confident leading into his certification exam. Dr. Smits is looking forward to continu-

ing his educational focus after graduation, when he starts as a faculty member at Cabarrus Family Medicine in Concord. He hopes to help build on this topic-focused and board review curriculum. On the opposite side of the state, nestled in the mountains, 2nd year resident Dr. Ryan Eichhorn of Hendersonville Family Medicine Program—Rural Track, has been exploring a long-standing passion for wilderness medicine. Dr. Eichhorn has been an avid outdoorsman and kayaker for years, and was eager to pursue a focused experience in wilderness medicine to broaden his medical knowledge and skills. Through a physicianled curriculum directed by the Wilderness Medical Society, Dr. Eichhorn completed field training, lectures and workshops in the Great Smoky Mountains National Park in Tennessee. He described realistic mock emergency medical scenarios involving search and rescue efforts in very difficult terrain, including nighttime scenarios. His residency program has encouraged this pursuit in additional wilderness medicine training hoping to create a wilderness medicine curriculum for future residents. Dr. Eichhorn is excited about the opportunity to bring back his knowledge and skills to fellow residents through lectures, skill workshops and field training exercises in the Hendersonville area. He also plans to complete a fellowship in Wilderness Medicine in the future. I have been fortunate to be involved in a quality improvement project at my residency program, Cabarrus Family Medicine. I have been interested in incorporating QI further into the curriculum, and have had the opportunity to work through the North Carolina Medical Society and the

C


Kanof Institute for Physician Leadership Advisory Board. These groups are collaborating to lead a pilot program to provide physician members with more QI training. I partnered with Anita Schambach, director of Community Care Partners of Greater Mecklenburg and Dr. Janice Huff, faculty member at the CMC Family Medicine Residency in Charlotte. The emphasis of the program is on patient self-management support with their medical problems, and incorporating these goals into the primary care office visit. This is accomplished through a team-based approach, utilizing motivational interviewing skills and community resources; hoping to improve person-centered care. Ultimately, I would like to help design a longitudinal curriculum in QI in the residency program, incorporating additional didactic training and QI projects to improve patient care.

These are just a few of resident education experiences going on in our state; hopefully we can hear about more in other programs in the coming months. North Carolina is a great state for Family Medicine training; the future is bright and full of innovation. We are fanning the flame of education to produce the doctors that are needed to take care of our patients and our communities.

May 27th & 28th in Raleigh

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Outstanding outpatient family medicine opportunities available in communities located minutes from Charlotte, one of the fastest growing cities in the country. These are employed opportunities and will offer competitive compensation packages including two year salary guarantee, productivity bonus potential, generous beneďŹ ts and relocation expenses. CaroMont Medical Group operates under the guidance of a physician-led Governance Committee allowing for an active partnership with the Medical Staff. Over 300 active medical staff representing all major medical specialties at Gaston Memorial Hospital, a modern and progressive 435-bed hospital which provides comprehensive care to patient base of over 300,000. These lovely communities have easy access to the beautiful North Carolina Mountains and some of the most popular beaches on the East coast. Just minutes from an international airport and two large lakes, communities offer unlimited cultural and recreational amenities. A superb quality of life exists here with many charming neighborhoods and stellar public and private schools. If interested in being considered for this opportunity, please send CV to: Celia G. Billings Manager, Physician Recruitment CaroMont Health 2240 Remount Road Gastonia, NC, 28054 T: 704-834-2153 | F: 704-834-4615 Email: billingc@caromonthealth.org


Guide The ACO

Practice Enhancement ncafp.com/practice-mgt

LEARN MORE ABOUT ACOs

ment ify and Imple How to Ident Elements for ss the Essential ization Succe le Care Organ Accountab

Download the NCAFP’s ACO Blueprint for Success at http://www.ncafp.com/aco-guide

Reprinted with Permission by

The TAC Consortium

©2011 Smith,

Anderson,

Blount, Dorsett,

Mitchell &

Jernigan,

L.L.P.

Triad HealthCare Network ACO Shows Promise Family Medicine and Primary Care Occupy Key Leadership Roles As the saying goes – ‘if you’ve seen one accountable care organization (ACO), you’ve seen one accountable care organization.’ But while every ACO in our state is “homegrown” in its particular population and faces its own challenges as well as advantages, some transcendent lessons can be gleaned from each unique situation. Triad HealthCare Network (THN), based in Greensboro, for example, may be considered distinctive because of its relationship with the local hospital and employed physician network at Cone Health. “Cone was masterful in their approach,” said Steve Neorr, vice president and executive director of THN. “Cone fully let physicians lead and drive this.” The relationship between doctors and the hospital network, however, wasn’t always so trusting. Starting back in 2010, the real work began to create this successful partnership, which has proved itself through successful care management initiatives and shared savings through the Medicare Shared Savings Plan. THN was, in fact, the only ACO in North Carolina to exceed the threshold to achieve shared savings for the latest financial report from the Center for Medicare and Medicaid Services (CMS) in February 2014. At first, though, it was just a group of three doctors who realized that health care as they currently were delivering it was not sustainable as to cost, access and quality. They believed that developing a local network based in the PiedmontTriad area to serve patients and promote cost-efficient, high-quality health care across the broad provider community was key to the future of health care.

24 THE NORTH CAROLINA FAMILY PHYSICIAN • Spring 2014

“Physicians have always been about quality and doing the right thing for their patients. That was an easy sell. The hard sell was we were telling them that now we were going to measure it,” said Thomas C. Wall, MD, the executive medical director at THN and one of the three doctors with the original vision for their community. “There also was a lack of trust between the hospital and doctors. It

required a lot of relationship building.” Wall and his colleagues set to work and initially chose 20 doctors, respected clinicians and leaders in the community who were willing to cross the old boundaries and open a dialogue with the hospital and other doctors. Three administrators from Cone also sat on the committee born out of dissatisfaction with the health care system status quo. Everyone agreed to check their egos at the door and have respectful, honest discussion, Wall said. Over hours of intense conversation, THN was born. “It’s really a team effort,” Neorr said. “Having a hospital partner like Cone really made a difference for us. They have led the way in launching initiatives to keep people healthy and out of the hospital which is rather progressive for hos-

pital systems. We believe strongly that Cone’s efforts combined with the efforts of THN Care Management to remove barriers to care and coordinate social services will equate to cost savings.” Keeping people out of the emergency department and out of hospital beds runs counter to the assumed financial logic of hospitals, but THN has experienced willingness on the part of Cone Health to embrace this change as the right way to deliver care for the community. Wall envisions one day using the hospital for ambulatory health training centers for patients – perhaps a “Center of Excellence” for high-risk heart patients to learn about and practice preventive care for their disease. “We need to get used to a different way of delivering health care,” Wall said. THN currently includes 844 doctors with about 494 of those in independent practice and the remainder employed by Cone Health throughout the four counties the network spans. The model is physician-led with all physicians agreeing to set aside the specific interests of their own organizations and specialties and to work together to provide coordinated, patient-centered care. In addition, the network has partnered with THN Care Management (formerly MedLink) to provide results-oriented care management. “We can provide someone to really listen; to build a relationship in the home, if necessary,” said Rhonda Rumple, RN, director of THN Care Management. THN Care Management receives 95-97 percent patient satisfaction ratings, and there are numerous stories of improved patient outcomes and cost efficiencies. For instance, the patient who vis-

W h e

F in T c o

*

NCF


ited the ED 130 times in a year really just needed a way to get to doctor appointments for regular care. Working with the person’s landlord, the care management team was able to get a ramp to make the patient’s home accessible and to arrange transportation to and from the doctor’s office. The needless, high-cost ED visits ended. Rumple’s team of pharmacists, licensed clinical social workers, and registered nurses use predictive software to analyze patient data and pinpoint their care management efforts to maximize their limited resources. “Referrals [to THN Care Management] from providers have ballooned,” Rumple said, and Wall noted that it is considered a great asset to a practice. “Connecting patients to this community of care has so much value for these patients and our physician practices.” The many hours of initial discussion have begun to pay off, although THN, like all ACOs, are still fledglings, and this model of care is still evolving. Every time information is shared between emerging ACOs new insights are gained and lessons learned. “A lot of good work is going on around the country,” said Neorr, who joined THN in 2011. “It’s important to identify the right partners whose philosophy aligns with ours. Medicine is local.”

PRACTICE BRIEFS New 90-Day Rule Extends Time Services are Deemed Covered When Premium Payment Lapses Occur Family physicians and their practices should be aware of new regulations within the Affordable Care Act (ACA) that extend the time services are deemed covered when there is a lapse in payment of the insurance premium. This new rule only affects those patients who receive tax subsidies to purchase insurance plans through the health insurance marketplace. Known as the 90-Day Rule, the provision extends the grace period for patients to zero-out any past insurance premiums owed prior to coverage being terminated. Family Medicine practices should review their current policies and procedures regarding eligibility as a result of this new rule. The AAFP has published an excellent FAQ located at http://www.aafp.org/dam/AAFP/documents/practice_management/payment/90DayFAQ. pdf. Additional background information can be found at http://www.aafp.org/news/ government-medicine/20140326cmsgraceperiod.html.

NCQA Releases New Version of PCMH Recognition Standards The National Committee for Quality Assurance (NCQA) released its latest generation of NCQA medical home standards, PCMH 2014. The new standards are the third iteration of the NCQA medical home program since 2008. Currently, over 10 percent of U.S. primary care practices are PCMH-recognized by NCQA. According to NCQA, PCMH 2014 retains the strengths of earlier NCQA standards, including alignment with contemporary federal requirements for “meaningful use” of health information technology-now Meaningful Use Stage 2. PCMH also promotes further integration of behavioral health, includes more care management focus on high-need populations, enhances emphasis on team-based care, and works to align improvement efforts with the triple aim. A copy of the new standards can be downloaded at http://www.ncqa.org.

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THE NCFP CLASSIFIEDS

AAFP’s New PCMH Planner Offers Medical Home Roadmap The AAFP has created the PCMH Planner, an interactive online tool, to help family physician practices successfully transition to a patient-centered medical home model. Tracey Allen-Ehrhart, manager of the AAFP’s center for quality, said the planner concept came about after 2012 data showed only about 24% of family medicine practices had achieved official PCMH status. The planner was created to help physicians and staff members sharpen their PCMH focus and then take the right steps, at the right time, to achieve medical home practice transformation. The cost of the planner depends on the number of users in a practice, as well as whether or not a physician within your practice is an AAFP member. Pricing is based on a two-year subscription. For instance, an AAFP member practice with one user pays $99.95, a practice with two to five users pays $149, and a practice with six to 10 users pays $249. Those considering whether to invest in the PCMH Planner should note that it is compatible with mobile devices; however, creators agree that content is best viewed on larger screens. See http://www.aafp.org/news/practice-professionalissues/20140319pcmhplanner.html for additional information.

Curious About Electronic Cigarettes? -- NC DHHS Information Provides Some Key Facts With the popularity of e-cigarettes seemingly growing by the day, physicians and health providers need to get up to speed on how they can impact the health of their patients, especially those looking to quit. NC DHHS distributed a short fact sheet earlier this year providing some excellent information that can answer some common questions. Members can download this information from the NCAFP website at www.ncafp.com/e-cigs. In January, the AAFP also released its official policy position on e-cigarettes and called for rigorous research in the form of randomized controlled trials of e-cigarettes to assess their safety, quality, and efficacy as a potential cessation device. It also recommended that the marketing and advertising of e-cigarettes, especially to children and youth, should cease immediately until e-cigarette’s safety, toxicity, and efficacy are established. AAFP’s policy can be read at http://www.aafp.org/about/policies/all/e-cigarettes.html.

PHYSICIANS NEEDED FOR OUTPATIENT EXAMS Tri-State Occupational Medicine, Inc. (TSOM) is looking for physicians to join their group to perform disability evaluations in their NC offices. Part-time opportunities. No treatment is recommended or performed. No insurance forms. No follow up. No call, no weekends and no emergencies. Physicians working for us have various backgrounds and training. Training and all administrative needs including scheduling, transcription, assisting, and billing are provided. Must have a current NC medical license. TSOM has an excellent reputation for providing Consultative Evaluations for numerous state disability offices. Contact: Susan Gladys 866-9298766 / 866-712-5202 (fax) / susang@tsom.com.

Save The Date

Sat., August 2nd, 2014 Registration is now

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available online or via our fill-able PDF registration form at www.ncafp.com/dot Seating is limited and advance registration is required

26 THE NORTH CAROLINA FAMILY PHYSICIAN • Spring 2014

www.ncafp.com/dot


Scope of Practice continued from p. 8 may or may not correlate with ‘acute care’; and, only 26.5% of respondents offer inpatient care. What does this say about the continuity or quality of transitional care across settings that we seek to provide? I chose to take a closer look at the data concerning obstetrics out of both personal interest and the recognition of a national decline in family physicians offering these services. The data here would seem to uphold this observation, with only 106/1318 (8%) respondents reportedly offering these services. This particular survey captured only one point in time and thus there is no prior data in the sample with which to compare, but demographic data from the American Board of Family Medicine shows a decline in the number of FPs providing maternity care from around 23% to less than 10% nationally over the span of 2000 to 2010, with the lowest proportions found in the southern and eastern US. The same data also indicates a similar decline for this time period in the proportion of FPs treating children, from roughly 78% to 68%. This parallel is at least logical considering that one of the best ways to accrue pediatric patients is to be the one who delivers them, though many other factors are certainly involved. Given the relative density of obstetricians combined with the high cost of liability insurance for deliveries in NC, it is thought to be more financially feasible to practice obstetrics if one is rurally located at an academic center, or working with a Federally Qualified Health Center (FQHC). Of the 106 respondents providing obstetrical services 50 reported their primary patient care location as “office or clinic other (including non-profit or public hospital-owned offices & clinics);” 30 reported “office or clinic: privately owned medical practice (including private hospital-owned offices & clinics);” 16 reported primary practice setting as an FQHC, 5 reported “Hospital (not Emergency Department);” 3 reported “Hospital Emergency Department;” 1 reported “Institutional residential facility (student health, prisons, nursing homes);” and 2 responded “Other.” Of the 90 OB providers who did not report an FQHC as their primary practice setting, 12 reported that they see patients in an FQHC in addition to their primary practice location—so this may be how some of those physicians are able to feasibly continue practicing obstetrics even if they do not offer these services within their primary clinical locations. The geographic distribution of the respondents providing OB care—when AAFP member addresses were cross-referenced with the data—was limited to 37/99 NC counties, spread mostly across central and western NC, with the top 5 counties being: 1) Orange; 2) Pitt; 3/4) Mecklenburg/Buncombe; and 5) Cabarrus County. The respondents in these counties may represent the academic programs at UNC, ECU, MAHEC, Cabarrus, and/ or CMC, where you would expect the scope-of-practice to be broader, given residency program requirements, and more likely to include maternity care. As healthcare shifts to emphasize more cost-effective, higher quality care, it is the wide scope of FPs and our ability to meet most of our patients’ needs in-house that make us more valuable than physicians in other specialties. In fact, per recruitment data

compiled by Merritt, Hawkins & Associates, FPs have remained the most recruited physicians of any specialty by hospitals, medical practice groups, or other health care organizations for almost the past decade. This is because regular primary care has been shown to improve health outcomes at lower costs and, more importantly, a FP who can manage a diverse patient population, navigate a variety of settings, and offer the majority of necessary care without referral or consultation can reduce the fragmentation of health care—all with a personal touch that our patients value. A narrowing scope-of-practice is not only bad for healthcare, but also bad for physician well-being. This is because a variety of patients, cases, services, and settings (i.e. clinic to hospital, nursing home, ED, etc.) can serve as relief from the monotony of complex, chronic disease management and can prevent disinterest or physician burnout. Unfortunately, the scopeof-practice of FPs is eroding away before our very eyes due to the convergence of many different factors, including healthcare reform, team-based care models with increased utilization of mid-level providers, the current fee-for-service reimbursement scheme, increasing patient load, and an aging population amongst many others. If we are to preserve the field of Family Medicine, we must investigate this topic further and find a way to balance between accommodation of a dramatically increasing patient load through delegation of responsibilities in a teambased/PCMH model and the personal and economic value of a meaningful, intimate, and consistent relationship between a full-scope FP and his/her patients, forged through continuity of care for those patients across various settings, circumstances, or particular service needs. Sources: http://www.aafp.org/medical-school-residency/choosing-fm/value-scope.html http://www.hrsa.gov/advisorycommittees/bhpradvisory/cogme/Reports/ twentiethreport.pdf Warren P. Newton, MD, MPH, Chair, ABFM. “Family Physicians and Scope of Practice: What We Know, Why It Matters…” February 25, 2012 Fraher, Erin, PhD MPP. "Trends in the Supply and Distribution of Obstetric Delivery Providers in North Carolina." Program on Health Workforce Research & Policy, Cecil G. Sheps Center for Health Services Research, UNC-CH. Joint Legislative Oversight Committee on Health and Human Services, Subcommittee on Midwives. Raleigh, NC. 26 Feb 2014. ABFM Website: http://www.certificationmatters.org/abms-member-boards/familymedicine.aspx AAFP Member Blog “Having Your Say on the Future of Family Medicine: AAFP Calls for Member Input.” http://www.aafp.org/news/opinion/20130910ffm2.html TCS Healthcare Technologies. 2012 Health IT Survey. “Trend Report #7: Caseloads.” http://www.tcshealthcare.com/index.php?q=Trend-Report-7 “Estimating a Reasonable Patient Panel Size for Primary Care Physicians With TeamBased Task Delegation.” Altschuler, MD, Margolius, MD, Bodenheimer, MD, and Grumbach, MD. Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California, San Francisco. San Francisco, CA. Ann Fam Med 2012;10:396-400. doi:10.1370/afm.1400.


Advocacy continued from p. 5 Academy. Legislators do listen to their local constituents and one of the most respected individuals from their district is the legislator’s own personal hometown physician. I am asking those readers that personally know a Representative/Senator to contact that individual over the next several weeks on behalf of the Academy to advocate for CCNC, the Medicaid program, and the other pertinent issues. The Academy can supply you with informational packets outlining the issues, as well as suggested responses. If the Academy office is given advanced notice of your visit to the legislature to meet with your local legislators, arrangements can be made for Academy staff to meet you and provide you with the materials you need for your visits, as well as suggested tips for the advocacy process.

Mid-Summer continued from p. 12 Treatments, Male Hormone Replacement Therapies and much more. The week at the beach is packed with additional CME opportunities and family fun. Attendees can also sign up for optional workshops including Advanced Hands-On Procedures featuring Joint Injections & Aspirations; a Nexplanon Training workshop; and a satellite lunch on Understanding Legal Tools: The Key to Lawsuit Prevention & Tax Reduction. Get the family going early Tuesday morning with a One Mile Fun Run on the beach and enjoy a night out on Wednesday with discount group tickets to the Carolina Opry's Good Vibrations, a live must-see high energy music show, perfect for all ages.

Rural Health Award continued from p. 10 PCMH recognition. Practices are experiencing improved clinical outcomes, higher operational efficiency and saving precious healthcare dollars in the process. The Collaborative grew out of the need to help practices participating in CCNC’s Multi-payer Advanced Primary Care Project (MAPCP) with the recognition process. For many of the practices in the region, committing the staff time to tackle the PCMH was a

In addition to individual advocacy efforts, I would like you to consider participation in several group advocacy efforts. Currently we have the following events scheduled: Hypertension Day– May 21st, Resident White Coat Day– May 28th, and White Coat Wednesday– June 4th. We typically will meet the Tuesday night prior to the legislative day’s events to be briefed about the issues being debated the next day and review the informational materials which you may be asked to distribute to legislators. You will be asked to wear a clean lab jacket on white coat Wednesdays to help identify you as a medical provider and, on the Hypertension day, you will be asked to help staff a booth in strategic areas of the legislative buildings where legislators, staffers, and visitors, etc can stop to get their BP checked. As part of all those days, arrangements will often be made so that you can sit in on important committee meetings and ar-

rangements will also be made for individual meetings with your local legislators. Finally, I must ask you to seriously consider contributing to our political action committee— FAMPAC. I have detailed on several occasions how our contributions to FAMPAC have significantly lagged behind other organizations such as the Chiropractors, Trial lawyers or other MD groups such as the Anesthesiologists. FAMPAC funds, while not directly influencing legislators, do help you to access legislators and get their attention so that you can detail our issues. I ask you to donate at least $100, preferably a dollar a day amount for a ($365) or even more. With the legislative elections this fall, those PAC funds are needed NOW as part of our advocacy efforts. Please contact Academy staff to arrange your contribution. Or contribute online by visiting www.ncafp.com/fampac.

Golf discounts at various courses including Arcadian Shores, Waterway Hills and Shaftesbury Glenn are also available. Our conference wraps up on Friday, July 4th with a Practice Management Seminar highlighting hot topics such as Coding & Transition to ICD-10, Value Based Payments, Population Management and Office Workflow and Alternative Payment Models. A SAMs Study Working Group opportunity on the topic of Well Child Care is also available on Friday for those who need to fulfill their ABFM Maintenance of Certification requirements. Schedule information, confirmed lecture topics, guest speakers, hotel accommodation information and basic conference details can be found at www.ncafp.com/msfmd. Registra-

tion is available online and via a fill-able PDF form that can be emailed, faxed or mailed with payment. Registration options vary and offer flexibility and savings. The Midsummer Family Medicine Digest will include a free interactive and fun Mobile App (paper syllabus is available by purchase), while those attending the one-day Sports Medicine Symposium will receive a complimentary paper syllabus and a web address for online materials. CME credit has been filed with the AAFP and determination of credit is pending. The NCAFP is also recognized by the Board of Certification, Inc. to offer CE for Certified Athletic Trainers. Please contact the NCAFP Meetings Department at 919-833-2110 or by email at meetings@ncafp.com for more details. We look forward to seeing you there!

major barrier. NCQA estimates that it takes between 100-200 hours to document and upload the required documentation. Dr. Watkins and other CCNC leadership in the region worked with ASU to develop an elective course entitled, ‘Practicum in Primary Care.’ The course brings students into a primary care practice where they work to orient the practice on PCMH, and help them complete the documentation tasks necessary to achieve recognition. Dozens of students have gained invaluable experience and

the region now has a stronger network of primary care practices. The Collaborative was chosen from more than 70 submissions from around the U.S and was judged on five criteria: the ability to address long-standing issues of prevention or treatment, 2) transferability to rural and economically distressed regions of North Carolina, 3) consistent with high-impact work in other rural places, 4) potential for impact within three to five years, and 5) signs of success.

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