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THE NORTH CAROLINA

Volume 11 Issue 2 / Spring 2015

quarterly news in north carolina family medicine


The 2015 north carolina

Family Medicine Gala Sat., Aug. 29th, 2015 Raleigh Convention Center Raleigh, North Carolina

Supporting North carolina Medical Students

HELP THE NCAFP FOUNDATIoN MAKE AN EVEN LARGER IMPACT ON STUDENT INTEREST The Family Medicine Gala will be a fun and glamorous black tie (optional) event that will include food, spirits and an evening spent honoring and roasting a legend in the field of Family Medicine in North Carolina — Dr. Jim Jones.

Proceeds from this inaugural event will be used to support the NCAFP Foundation’s Family Medicine Interest Initiatives. These programs play a key role in helping to ensure the future of Family Medicine in our state by providing valuable experiences and opportunities to North Carolina medical students.

For more information or to reserve your seat at the Gala, please visit: www.ncafp.com/2015gala. To participate as a Gala Sponsor, please contact Tracie Hazelett at thazelett@ncafp.com or 919-833-2110.


Inside 11

2014 NCAFP Annual Report

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President’s message

The Future of Family Medicine: Let’s Connect the Dots!

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policy & advocacy

Legislative Session Marked by Wide Range of Health Proposals

Meetings & education

Sun, Sand & CME: The Perfect Combination

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Chapter affairs

North Carolina Family Medicine Takes Center Stage

Medical students

28 Students to Participate in NCAFP’s 2015 Summer Programs

Practice managment

Medicare Payment Changes on The Horizon

23 26 30

THE NORTH CAROLINA DEPARTMENTS

PUBLISHED BY THE NORTH CAROLINA ACADEMY OF FAMILY PHYSICIANS, INC. R aleig h , N o rt h C aro lin a 2 7 6 0 5

919.833.2110 • fax 919.833.1801 • www.ncafp.com MANAGING EDITOR, DESIGN and PRODUCTION

P eter T. Gr a be r, Dir e c tor of Communic a tions

President’s Message.......................... 4 Policy & Advocacy................................ 8 CME Meetings & Education................. 10

Chapter Affairs.................................... 23 Student Interest.................................. 26 Practice Management......................... 30

HAVE A NEWS ITEM WE MISSED? NCAFP members may send news items to the NCAFP Communications Department for publishing consideration. Please send via email to pgraber@ncafp.com.


PRESIDENT’S

By: Dr. Thomas R. White 2014-2015 NCAFP President

MESSAGE TO MEMBERS

The Future Of Family Medicine... The Fall of The Incas ... and Grasshoppers!

What IS the future of Family Medicine? I have asked myself that question many times recently. Will ours be the most admired and valued specialty among the public and payors? Will Family Medicine be the most coveted and desirable career choice of medical students? Will we one day occupy a suite in the House of Medicine? Or for that matter, will we have our OWN house, with others knocking at OUR door asking for our blessing and for permission to enter? Will we jump forward like grasshoppers and land upon the sweet spot we all envision? Recently I attended and participated in the Health is Primary event in Raleigh. This was an incredible opportunity to shine a light on the value of primary care and share some amazing stories. One fellow family physician told me later that he drove home from the event feeling so proud and more optimistic than ever for Family Medicine.

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clinical professionals, pharmacists, and other health professionals side-by-side, and how in practice they can all work together as a team to better serve the patient. We showed how creative, "out of the box", flexible approaches can benefit employers and employees. We highlighted the work of family physicians out in their communities giving of their time and expertise to enhance the health of the public. As a listener to these stories, I was in awe. As a participant who got to share his own community project (a project actually more modest and less impressive than the many other activities of my fellow family physicians in their own communities), I felt honored to represent them.

How could you not be?

Indeed, the future of Family Medicine seems bright. We have the intellect, the creativity, the commitment, the passion, and the willingness to meet the needs of our patients as we move into a new world of value-based care, and be THE specialty we all want and envision. We are all grasshoppers.

We told stories of practices being transformed to better deliver the Triple Aim of better care, improved outcomes, at a lower cost. We demonstrated the value of educating and training physicians, advanced

But what if we are wrong? What if Family Medicine fails to reach its potential? What if Family Medicine actually continues to muddle and struggle along our path - in the back room or the outhouse of the House of

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Medicine - or, shudder to think - what if Family Medicine ceases to exist? What if we DON'T jump forward? Crazy. No way. Surely not, you say. But I confess, I have had those dark thoughts. Here's why. This past November I had the opportunity to visit Peru, and do something I have always wanted to do: see Machu Picchu. Machu Picchu, as you know, is the "lost city" of the Incas. It was built by the Incas around 1450 in a very hard to reach location at an elevation of approximately 8000 feet high up in the Andes Mountains. Abandoned by the Incas when their civilization dissolved, it was rediscovered by an American historian and Yale professor, Dr Hiram Bingham, in 1911. I chose to reach Machu Picchu by joining a group of 7 other crazy tourists, 8 amazing porters, 1 much-appreciated cook, and an always upbeat, inspiring, knowledgeable guide of Inca descent. We hiked and camped the 26+ mile Classic Inca Trail over 4 days to Machu Picchu. It was one of the hardest and most rewarding things I have ever done. It crossed my mind then, and I continue to ponder the question: How did


2014-2015 NCAFP Board of Directors a culture like the Incas, with their incredible architectural, engineering, and scientific skills, become, for all practical purposes, an extinct civilization? How did Machu Picchu become an abandoned city, hidden under the overgrowth of the jungle for hundreds of years high up in the Andes, until shared with the world by Dr Bingham? Why did the Incas "fail"? The reasons are many, and much has been written on the subject. I will try to summarize the generally agreed upon contributing factors: Before Pizarro, the Spanish explorer, landed in Peru around 1532 and began to search for the rumored treasures hidden in the Andes, the Incas had created an empire stretching some 3000 miles along the western coast of South America. They believed themselves to be invincible. They were, to use a

sports analogy, ranked Number One and undefeated. Too big to fail, as they say. However, by 1572, the Spaniards were able to claim victory and what we know today as Peru was colonized.

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

Fortunately for Pizarro and the Spaniards, at the very time they invaded the Inca Empire, the Incas were in the midst of their own civil war. Two Inca half-brothers, sons of a powerful ruler, were pitted against each other for control of the empire. After a bitter fight for power, one prevailed. But the price paid was a divided and vulnerable nation.

District Directors District 1 - Jessica Triche, MD District 2 - Gilbert Palmer, MD District 3 - Eugenie M. Komives, MD District 4 - Shauna L. Guthrie, MD, MPH District 5 - Janice E. Huff, MD District 6 - Alisa C. Nance, MD District 7 - David A. Rinehart, MD At-Large Jason T. Cook, MD

Pizarro and his men were actually outnumbered. The Incas could have easily annihilated their visitors. But the Incas were intimidated by the Spaniards' horses, guns, and threats. Many of the Incas believed the Spaniards to be

At-Large Jennifer L. Mullendore, MD IMG Physicians Joseph P. Pye, MD Minority Physicians Benjamin F. Simmons, MD Osteopathic Family Physicians Mark Sakr, DO

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New Physicians Cody A. Wingler, MD NC Family Medicine Departments Brian A. Kessler, DO (Campbell) Family Medicine Residency Directors Geoffrey Jones, MD (MAHEC-Hendersonville) Resident Director Deanna M. Didiano, DO (Cabarrus) Resident Director-Elect Margarette Shegog, DO (MAHEC-A) Student Director Christian A. Jasper, MPH (WFU) Student Director-Elect Jeffrey Pennings (Campbell) Medical School Representatives & Alternates Chair (Campbell) Brian A. Kessler, DO Alternate (Duke) J. Lloyd Michener, MD Alternate (ECU) Chelley Kaye Alexander, MD Alternate (UNC) Warren P. Newton, MD, MPH Alternate (Wake) Richard W. Lord, Jr., MD, MA AAFP Delegates & Alternates AAFP Delegate Michelle F. Jones, MD AAFP Delegate Karen L. Smith, MD, FAAFP AAFP Alternate Richard W. Lord, Jr., MD, MA AAFP Alternate Robert L. ‘Chuck’ Rich, Jr., MD The NCAFP Family Medicine Councils Advocacy Council Robert L. Rich, Jr., MD, Chair Brian Kessler, DO, Vice-Chair CME Council

Alisa C. Nance, MD, Chair

Membership & Workforce Jessica Triche, MD, Chair Benjamin Simmons, MD, Vice-Chair Practice Management Council Joseph Pye, MD, Chair Thomas Wroth, MD, Vice-Chair Public Relations & Marketing THE NORTH CAROLINA FAMILY PHYSICIAN • Spring 2015

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William A. Dennis, MD, Chair Brian Blank, Vice-Chair


in our country, and nearly 3000 in North Carolina. The AAFP is strong and wellorganized and wellrun. Our state chapters are effective and strongly supported, especially ours here in NC. We have residency programs across the country. We have strong relationships with our patients. One out of every 4 office visits in the United States is made to a family physician. We are here. We are entrenched. We aren't going anywhere. We are grasshoppers, jumping forward, not backward. Aren't we?

"gods." They believed the Spaniard's promise of wealth, independence, and freedom. They chose to negotiate, were lured into a trap, and the Spaniards killed many of the Incas in a famous bloody surprise attack, thus gaining a powerful psychological advantage. Before the Spaniards, the Incas because of their geographic and social isolation - were naive to many of the infectious diseases common to the rest of the world. The Spaniards introduced smallpox, flu, typhoid, among other diseases, leading to the death of many Incas and further weakening the empire psychologically and physically. And lastly, once the Incas realized their once seemingly-invincible world had been torn apart and severely crippled, defeat seemed imminent in their minds, they lost their pride and their will. They surrendered and fled to the jungle. Those who remained succumbed to their conquerors. A lost city, a lost culture, and essentially a lost people. Is it possible we will follow the fate of the Incas, and one day be a footnote in the history of medicine? Likely not you say. We are here now. There are more than 90,000 Family Physicians

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Yes, I agree, but let's take a moment to pause and consider what we can learn from the Incas: As big as we are, and as organized as we are, we must remain wary and on-guard. We must never become complacent. There may well be "others" in our midst who believe we can be replaced. (After all, how hard can "primary care" really be? Can't we just replace those FPs with cheaper workers to check the boxes and keep the conveyor belt moving?) We must focus on making our specialty even more attractive to medical students and to the public. We must be more aggressive in our recruitment efforts. We are big, but not nearly big enough. We must be very intentional and strategic as we jump forward, in order to not merely survive, but to reach what we all believe is our deserved position in the health care system, an outcome which we all believe would be in the best interest of the public.

clinical practice vs academicians vs administrative roles vs all the other careers family physicians have chosen. Family Medicine is diverse. But there are ties that bind us, and at the end of the day, we must commit to come together and stay together for the sake of our specialty. We tend to underestimate ourselves. We must not obsequiously fall into the trap that we are going up against invincible "gods." We tend to forget that our greatest allies and advocates may not be (gasp) other physicians (who chose other specialities) but our patients, WHO HAVE CHOSEN US. (Sorry to be politically incorrect). Should we negotiate to achieve our goals? Absolutely! Should we be naive and forget our own strength? Never. There are many potentially "infectious" threats out there: greed, egos, jealousy, and pettiness. These can weaken and decimate us. We must put our personal issues and needs aside, and continue to focus on what is best for our patients. In the end, what is best for our patients, and not ourselves individually, will be best for Family Medicine. We absolutely must not back down, assume we have been defeated, turn and run. We are so close. We cannot be intimidated and "sell out." We must stay the course. We must speak the truth as we believe it, even if at times it angers others and invites their threats and their opposition. We have been threatened and we will be threatened again. We must be strong. Because we can be. So, is our future bright? Actually, I am confident that it is. We will maintain our values. We will do the right things. We will not lose our way. We will not be the Incas of health care. We will be united and strong. We will make Family Medicine the specialty of choice. Fellow grasshoppers, we will jump forward. Not sideways. Certainly not backward.

There are many real and potential conflicts within our own ranks. Employed vs Independent physicians. Traditional business models vs alternative models, such as Direct Primary Care. Single payer vs multipayer advocates. Those in

Forward. Strongly. Confidently. Deservedly. We must. Our future depends on it.


SECURITY BREACHES ON THE RISE – ARE YOU COVERED? The recent cyber-attacks on one of the largest health insurers, Anthem Inc., underscores the fact physicians and other health care entities are increasingly exposed to privacy related claims such as lost laptops, hacking, and virus attacks, which can result in an embarrassing and costly loss. Does your practice have adequate cyber-liability coverage in the event of a security breach? In the case of Anthem, hackers stole personal information relating to current and former customers after breaching an IT system containing data on approximately 80 million people, the company reported. Cyber-security has become a major concern both for U.S. firms facing a barrage of attacks, as well as insurers trying to figure out how much of that risk they can afford to underwrite. Medical identity theft is often not immediately identified by patients or their provider, giving criminals years to milk such credentials. That makes medical data more valuable than credit cards, which tend to be quickly canceled by banks once fraud is detected. “The [Anthem] information is a treasure trove for cybercriminals. It can easily be sold on underground markets within hours and used for a wide variety of identity fraud schemes,” said Stuart McClure, chief executive of cybersecurity firm Cylance Inc. (Insurance Journal, 2/5) Experts say that even in light of the Anthem and other recent breaches, it has been a challenge to convince health care organizations to step up their spending and reverse their chronic underinvestment in information technology security. Even before the Anthem data breach, there had been 1,172 breaches large enough to expose 500 or more individuals’ records, or 40.9 million individuals’ medical records in all, according to the breach list compiled by the Department of Health and Human Services’ Office for Civil Rights. Dr. James Madara, CEO of the American Medical Association, expressed hope that the recent breaches will lead to greater security spending. Data security hasn’t made many top-five problem lists among health care organizations, Madara said. The Anthem breach “will bring some light to that. If cyber-security isn’t something that’s at the top of your list as an insurer or an integrated system, it has to get there very quickly.” (Modern Healthcare, 2/7) In today’s data-driven world, where sensitive patient information is collected, stored, and communicated electronically, physician and surgeon practices of all sizes are especially vulnerable to costly and damaging liabilities from data security breaches. Cybercrime, including identity theft, is the fastest growing criminal activity. Whether your data is compromised by a hacker, virus, cyber thief, or simply because of lost or stolen computers, laptops, flash drives or smart phones, the breaches can have serious ramifications. The cost to recreate compromised patient data is staggering, and includes the expense of notifying customers—now legally mandated by 46 states—possible fines, and legal expenses. Your practice can also suffer immense damage to its reputation and from the interruption to business. Traditional liability insurance products only cover “tangible” assets. Electronic data is not considered “tangible” under the typical policy definition. Cyber-liability coverage fills that gap. There may be a small amount of coverage on a professional liability policy, but this amount can be quickly eroded. It is highly recommended that all health care offices purchase additional cyber liability coverage.

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HEALTH POLICY

By: Joanna Spruill, JD NCAFP Director of Government Relations & General Counsel

ADVOCACY & GOVERNMENTAL AFFAIRS

2015 Legislative Session Marked by Wide-Ranging Healt

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he 2015 legislative session is well under way in Raleigh, North Carolina. The snow days in February did not slow down lawmakers one bit, though they made the weeks leading up to crossover a bit more hectic. As of early May, lawmakers had filed more than 1,600 bills this session. The NCAFP governmental affairs team has been monitoring any and all health legislation that is filed and introduced. So far this session, there have been a variety of bills dealing with health policy including: reforming the state's Medicaid program, ending the Primary Care Case Management contract, prohibiting children under 18 from using commercial indoor tanning equipment, mandating chiropractor co-pay parity to primary care, requiring testing for Type 1 childhood Diabetes at certain age intervals, allowing independent practice for advanced practice registered nurses, changing the minor consent law, and reforming the state's certificate-of-need process. Out of the 1,600 bills filed, only some of them will actually become law. Once a bill is filed, it must not only receive a favorable vote in any of its assigned committees, but it must also pass the full chamber's approval on the floor, and then it is only half-way done. It must go through a similar journey in the other chamber, before it can be presented to the Governor, who then must sign it into law.

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White Coat Wednesday Push April 15, 2015 Almost two-dozen NCAFP members attended family medicine's first White Coat Wednesday for the legislative session, advocating on several key issues important to Family Medicine, including the need to continue to support Community Care of North Carolina, to build on what's currently working in Medicaid, and to support physicianled, patient-centered medical homes. Physicians, residents, and students all had productive meetings with legislators. The day began at NCAFP offices, where the NCAFP governmental affairs team briefed members on relevant issues, reviewed talking points, and discussed what to expect in a meeting. NCAFP's final White Coat Wednesday of 2015 is scheduled for June 10, 2015. Crossover -- April 30, 2015 While the North Carolina General Assembly has no limits on when it must end its session, crossover is a provision that at least attempts to limit the number of bills the legislature must juggle as the session progresses. It is the last day by which most bills not involving raising or spending money must pass either the House or Senate in order to be eligible for consideration the rest of the year and for the following short session. This year the legislature set the crossover deadline as April 30, 2015. The weeks leading up to crossover are busier than usual at General Assembly. The daily calendar is full of committee meetings and session often creeps into

Two dozen NCAFP members visited with legislators is planned for Wednesday, June 10, 2015. the late evening. This year was no exception. The House held a marathon session Wednesday, April 29th that went into early morning Thursday. They debated bills for ten hours and finally gaveled out around 2:30am on April 30th. In the other chamber, the Senate took a more methodical approach, holding session regularly each day. Medicaid Reform Recap Reform of the state's $14 billion Medicaid program continues to remain a priority this session for both the House and Senate. So far, six bills have been filed: Senate Bill 696 (House Bill 525): Medicaid Modernization; Senate Bill 701: Discontinue Medicaid Contract for PCCM; Senate Bill 703: Medicaid Transformation; Senate Bill 574 (House Bill 372): 2015 Medicaid Reform;


You belong on our team.

th Proposals

FAMILY MEDICINE

Physician Career Opportunities members. This conference committee negotiates the full budget. The very first step in the budget process is the Governor's Budget recommendations. In early March, Governor Pat McCrory presented his budget recommendations to the General Assembly. Highlights from his budget include: • $1.2 million each year to invest in the oversight and administration of accountable care organizations.

in mid-April. The Academy’s next advocacy push

and Senate Bill 568: NC Health Care Modernization. NCAFP's governmental affairs team continues to monitor these bills and advocate for a physician-led solution to reform - one that leverages the investments we have already made and shifts to a value-based healthcare delivery system. The State Budget The method for developing a $21 billion tax-and-spending plan is a lengthy process. This year the House is tasked to develop and adopt its budget proposal first. Once the House adopts their version, the Senate is then tasked to adopt its own version. Once both chambers have adopted versions of the budget, legislators will appoint a conference committee made up of a smaller number of House and Senate

• A Medicaid Rebase of $287 million in for the first year and $460 million in the second. The Medicaid Rebase includes forecasted changes in enrollment, utilization of services, federal matching funds, and changes in anticipated costs per recipient. • A Medicaid Risk Reserve fund totaling $175 million over two years. • $5.3 million over two years to improves services at the Office of the Chief Medical Examiner. • $8 million allocation of funds to the Brody School of Medicine at East Carolina University. Notably, no cuts to Medicaid reimbursement to physicians were included in the Governors budget or the budget proposed by the House. The NCAFP advocacy team will be closely monitoring the budget as it continues through the process.

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

MICHELE ROCCO PHYSICIAN RECRUITER

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

EOE/AA


EDUCATION

By: Kathryn Atkinson NCAFP Meetings & Events Manager

2015 NCAFP Mid-Summer Meeting

Sun, Sand & CME The Perfect Combination I like when things are combined into threes ... and to me, this is the perfect combination! Sun, Sand & CME! Throw in a few practical and popular workshops, general sessions that end by 1:15 pm each day and family fun that memories are made of, and the perfect combination gets even better! I'm talking about our Mid-Summer Family Medicine Digest scheduled for Sunday, June 28 through Friday, July 3, 2015 at the Kingston Plantation and Embassy Suites in Myrtle Beach, SC. This annual event features up to 30+ AAFP Prescribed Credits, a free interactive-mobile conference app and includes lectures addressing the medical issues you see most often on the practical topics that you have requested. Dr. Alisa Nance, Program Chair, has assembled an outstanding line-up of lecture topics to include: Obesity, Sleep Disorders, Onychomycosis,

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Problems During Pregnancy, Diabetes, Pediatrics, Sports Medicine, Lung Cancer, Varicose Veins, Adult Immunizations, and many more. She has also planned for some lively interactive team-based learning on Hypertension and Lipids, as well as helpful workshops such as Mastering Valuable Hands-On Procedures, Practice Management, and a SAMS Study Working Group on Early Childhood Illness. By the way, you won't need to shuck oysters to take home a pearl or two of your own from Myrtle Beach. When our knowledgeable and expert guest speakers take center stage, you are sure to come away with pertinent, useful information on various topics that you can begin using in your practice right away. Our faculty of carefully-chosen speakers includes Dr. B. Wayne Blount, Dr. Richard W. Lord, Jr., Dr. Rhett L. Brown, Dr. Thomas R. White, Ms. Emily Hill, Dr. Brian R.

Forrest, Dr. Carolyn Dunn, Dr. Paul M. Berman, Dr. Kevin Burroughs, Dr. James W. McNabb, Dr. David G. Weismiller, Dr. Americo Fraboni, and many more. If you have ever attended an NCAFP event before, then you know that we only invite the best! Did I mention this event is hosted each year in the perfect location? The Embassy Suites / Kingston Plantation is oceanfront and offers several sleeping room options. Whether you enjoy your week by the sea in the hotel, the villas or the condos, the beach is only steps away! The Embassy Suites / Kingston Plantation can be reached at 800-Embassy or by calling 800-876-0010. Hotel room rates range from $245 to $448 per night, depending on size and location. Be sure to mention the NCAFP for our group rates and make your hotel arrangements early, as the hotel is likely to sell out for this event. Finally, your week of CME includes plenty of time outside the lecture hall. A flexible conference schedule allows you time in the afternoons to make memories with friends and family. Enjoy splashing in the ocean, strolling along the beach, floating in the Lazy River pool and visiting the many area restaurants and entertainment attractions at your leisure. The NCAFP also has discount tickets to the Alabama Theater on Thursday night and we encourage everyone to participate in Wednesday morning's Fourth Annual 5K Beach Fun Run. Watch your email or visit our conference website at www.ncafp.com/ msfmd for additional announcements, updated schedule information, lecture topics, confirmed speakers and to register online. Contact Kathryn Atkinson in the Meetings Department at 919-833-2110 (or 800-872-9482 in NC only) at ext. 114 or at Katkinson@ncafp. com with any questions you may have. Mark your calendar, dust off your flip flops and start making plans soon for your own perfect combination of sun, sand and cme in Myrtle Beach. I look forward to seeing you soon! #ncafpcme


North Carolina Academy of Family Physicians

2014 Annual Report

THE NORTH CAROLINA FAMILY PHYSICIAN • Spring 2015


2014 State of the Academy What could best be described as a whirlwind year, 2014 was marked by big opportunities, shifting challenges, and a more publicly-visible North Carolina Academy. From the highs of speaking alongside Governor Pat McCrory at the Governor’s mansion to the continued uncertainty of state Medicaid Reform, the NCAFP’s leadership team had one of its most demanding, but also one of its most successful years in its 66-year history. Throughout the year, we grappled with change, pressed forward with our goals, and positioned the NCAFP for an even stronger future.

Dr. William A. Dennis NCAFP President 2013-2014

A Demanding Legislative Year Ask any NCAFP leader about the machinations at the North Carolina General Assembly in 2014, and one common theme you might discover is how demanding it was for a so-called ‘short’ session. Keeping NCAFP’s advocacy team busy at every turn was the ongoing Medicaid Reform debate, a dominating discussion that changed direction multiple times and had NCAFP leaders working both inside and outside of the legislature. All of this led to family physicians playing a leading role in advocating for physicians and patients and becoming an important voice in the legislative discussion. NCAFP leaders testified several times before the Medicaid Reform Advisory Group, a panel that sought to gather perspectives on how best to reform Medicaid. Family physicians also played visible roles in other ways, including providing one-on-one insight with key state leaders, executing a very public and proactive media campaign, and supporting our healthcare allies in several coordinated advocacy efforts. This work paid tremendous dividends for Family Medicine, the most notable of which was raising the profile of the specialty with state leaders and the media across North Carolina. The high point came with NCAFP’s involvement at a major news conference held by Governor McCrory which included myself speaking in front of a throng of media. Never before has a family physician been awarded such an honor and it speaks to the steady progress our chapter has made in the last few years in raising our profile. This event generated near hundreds of media mentions across the state and is an experience I shall never forget. Membership At the chapter level, we were just as busy and the Academy worked hard to refine and improve how we serve our members. The seeds of this effort were planted in 2013 when the chapter conducted a comprehensive member needs assessment. This generated feedback and insight that helped Academy

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NCAFP Membership Growth

3500 3000

2013 2014

2500 2000 1500

86% Market Share in NC

1000 500 0 12

Total

Actives

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Students

Residents

3rd highest in the nation at 86%


leaders better understand the changing needs of our membership. The most striking shift our assessment confirmed was the movement towards practicing in employed roles for many of our members. Responding to this trend and others we discovered, your Academy took a number of steps, including crafting an updated strategic plan and realigning our main councils. In each of these, embracing change was the common thread, and our Academy remains committed to providing you, the member, with the most value it can and doing whatever is necessary to help our members thrive today and tomorrow. Expanding Collaboration Another important investment area was your Academy’s work in enhancing our relationships

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% (AAFP 76.3%).

to strengthen primary care. We seated an osteopathic physician representative on the Academy’s board of directors and also continued to work closely with our osteopathic colleagues at the North Carolina Society of the American College of Osteopathic Family Physicians. Additionally, we collaborated with organizations across primary care, including the NC Pediatric Society and the NC Community Health Centers Association, to help improve the overall practice environment. Education & Development On the education front, your Academy continued to provide exceptional education and professional development. From our conferences that continue to be very well-

attended to the growing lineup of workshops, seminars and online programs your Academy provides, our excellent education continues to improve. We helped train more than 400 physicians to be DOT-certified medical examiners and also educated multiple hundreds at our annual conferences. Continue to look to the NCAFP for great CME! I will never forget my experience serving as your president, especially in acting as your voice and advocate during such a demanding and challenging time. What I’ve mentioned above is just a small snapshot of what occurred in 2014, and I haven’t even mentioned one of my proudest moments: hearing Dr. Mott Blair’s name called out as one of the new AAFP Board Members at the Congress of Delegates in Washington, DC.  More on that elsewhere in this Annual Report. But none of this would have been possible without our members or the hardworking and dedicated physician leaders I have been privileged to work alongside.  Thank you for the trust you placed in me and in a leadership experience I shall never forget.   

97.1% 95.1% 87.6%

Active Member Retention (2013-2014) First place, large chapter category with 97.1% Active member renewals (AAFP 94.4%)

New Physician Retention (2013-2014) First place, large chapter category at 95.1% (AAFP 89%).

Resident-to-Active Conversion (2013-2014) 4th highest large chapter at 87.6% (AAFP 76.8%).


Academy Year in Review

Greg Griggs, MPA, CAE, NCAFP Executive Vice President

Another Successful Year! It is an honor and privilege to continue to work for the NC Academy of Family Physicians. Few days go by when I don’t enter the office excited to go to battle for the family physicians of our state. Why because you – the family physicians of North Carolina – always put the needs of your patients and communities first. That simple fact sets your organization and your specialty apart – caring about the patients and communities of North Carolina. And that is what your Chapter leaders and staff always try to remember as well. And that is exactly what breeds success as an organization. Here are just a few of the successes from 2014.

Membership Your Chapter continues to grow, surpassing 3,700 members in 2014. That includes almost 2,400 practicing family physicians

across the state, nearly 800 students and nearly 300 residents. Some key facts:

certification exam to give physicians to truck drivers. Other key facts:

• Membership grew by a total of 189 individuals in 2014.

• Over 240 people attended our Mid-Summer Meeting, and 31 companies exhibited. At that meeting, we rolled out a new “app,” which 72% of the attendees used during the course of the week.

• We retained a higher percentage of members than any other large AAFP Chapter in the country. • We also retained new physician members (less than seven years out of residency) at a higher percentage than any other large Chapter.

Continuing Medical Education We continue to offer numerous valuable educational programs. In 2014, we added DOT Medical Examiners training to our basket of services, helping nearly 400 physicians across the state pass the

• Our Annual Meeting once again approached 800 attendees, with total registration of 778 plus 79 exhibits. Governor Pat McCrory attended our annual meeting, filming a special year-end edition of NC Spin with Tom Campbell. McCrory then took questions from the audience. • We launched another MOC Part IV Online Program in conjunction with CCNC and the NC Pediatric Society, this one on Caring for Foster Children.

2013-2014 NCAFP Board of Directors 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 Brian R. Forrest, MD Past President (w/voting privileges) Executive Vice President Gregory K. Griggs, MPA, CAE

IMG Physicians

Joseph P. Pye, MD

Minority Physicians

Benjamin F. Simmons, MD

Osteopathic Family Physicians

Robert Agnello, DO

New Physicians

Matthew G. Kanaan, DO

NC Family Medicine Departments Family Medicine Residency Directors

Brian A. Kessler, DO (Campbell) Geoffrey Jones, MD (MAHEC-Hendersonville)

Resident Director Resident Director-Elect Student Director

District Directors

14

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

THE NORTH CAROLINA FAMILY PHYSICIAN • Spring 2015

Student Director-Elect

Aaron George, DO (Duke) Deanna M. Didiano, DO (Cabarrus) Julie Barrett (ECU) Christian A. Jasper, MPH (WFU)

Medical School Representatives & Alternates Chair (Campbell) Brian A. Kessler, DO Alternate (Duke) J. Lloyd Michener, MD Alternate (ECU) Kenneth K. Steinweg, MD Alternate (UNC) Warren P. Newton, MD, MPH Alternate (Wake) Richard Lord, Jr., MD


Advocacy and Government Affairs While you probably have heard more about Medicaid Reform than any other government affairs topic that is just one of many of the issues we tackled in 2014. And while we did continue to advocate against corporate managed care and for provider led solutions, here are some of the other actions you’re your Government Affairs Team: • Finalized and submitted comments regarding the Hydraulic Fracturing Chemical Disclosure Rules that sought further clarification on how the rules could impact the physician-patient relationship. • Launched the NCAFP Capitol Report, a weekly update on legislation, policy, and politics initially sent to Advocacy Council and NCAFP Board members, to increase member engagement in our advocacy efforts. Now, anyone can sign up for this special report by just e-mailing Joanna Spruill, JD, at jspruill@ncafp.com.

we have now increased our Foundation’s endowment for medical student programs to almost $1.1 million.

• Coordinated and promoted a series of White Coat Wednesday Advocacy events, culminating with a press conference at the Governor's Mansion to support the House's provider-led Medicaid reform plan.

And that’s Not All In 2014, your communications team relaunched a new and improved NCAFP website at www.ncafp.com. In addition, we expanded our quarterly NC Family Physician magazine to 32-pages.

And at the national level, we were proud to report that Dr. Mott Blair won a three-year term on the AAFP Board of Directors in a hard fought campaign culminating at the 2014 Congress of Delegates in Washington, DC. At that same meeting, Dr. Robert L. (Chuck) Rich was named chair of the AAFP Commission on Health of the Public and Science, continuing a long line of AAFP Commission Chairs from NC that recently included Dr. Blair, Dr. Karen Smith, Dr. Tom Koinis, Dr. Conrad Flick and Dr. Viviana Martinez-Bianchi.

Our student programs continue to roll along with growing student interest in family medicine. Nationally, one in four medical students are now members of the AAFP. And

Here’s looking to continued success for the NCAFP, and most importantly for the family physicians of North Carolina and your patients.

• Increased media exposure and grassroots presence through letters to the editor, calls to action, and earned media focusing on Medicaid reform.

NCAFP Past Presidents (L to R from above): Drs. Tom Koinis (97); Tommy Newton (96); Shannon Dowler (13); Karen Smith (05); Chip Watkins (10); Mott Blair (03); Maureen Murphy (01); Bob Gwyther (02); Bill Dennis (14); Conrad Flick (04); Tom White (15); Rich Lord (11); Bill Hedrick (76); Brian Forrest (12); Chuck Rich (09); Christopher Snyder (08); Carson Rounds (06); Michelle Jones (07); Allen Dobson (99); and Jim Jones (73).

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

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

AAFP Foundation Board of Directors

Michelle F. Jones, MD

AAFP Commission on Continuing Professional Development Richard Lord, MD AAFP Commission on Governmental Advocacy

Karen L. Smith, MD, FAAFP

AAFP Commission on Health of the Public & Science Robert L. Rich, Jr., MD AAFP Commission on Membership & Member Services

The NCAFP Family Medicine Councils Advocacy Council Robert L. Rich, Jr., MD, Chair CME Council Alisa C. Nance, MD, Chair Health of the Public Council Charles W. Rhodes, MD, Chair Practice Enhancement Council Rhett L. Brown, MD, Chair

AAFP Commission on Quality & Practice AAFP Congress of Delegates - Student Delegate AAFP Commission on Education, Student Representative AAFP Resident Delegate to the AMA House of Delegates AAFP FMIG Regional Coordinator, Southeast AAFP Student Rep. to the Annals of FM Editorial Board

Gregory K. Griggs, MPA, CAE Brian R. Forrest, MD Brian Blank (UNC) Brian Blank (UNC) Aaron George, DO (Duke) Cleveland Piggott (UNC) Samantha Heuertz Moore (UNC)

THE NORTH CAROLINA FAMILY PHYSICIAN • Spring 2015

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CME Meetings & Conferences 2014 Midsummer Family Medicine Digest

2014 DOT Medical Examiner Certification Training Courses • 6 AAFP Prescribed Credits

• 36.50 AAFP Prescribed Credits

• Program Chair: Thomas R. White, MD

• Program Chair: Thomas R. White, MD

• Program Vice-Chairs: Michael Busman, MD and Nicolas Bird, MD

• Program Vice-Chair: Alisa C. Nance, MD • 243 Registrations; 31 Exhibitors

• 204 Registrations (142 Members / 62 Non Members) - Raleigh 2014 • 185 Registrations (107 Members / 78 Non Members) - Hickory 2014

2014 Winter Family Physicians Weekend

• 34 Registrations (24 Members / 10 Non Members) - Charlotte 2014

• 34 AAFP Prescribed Credits 2014 NCAFP Leadership Retreat - The Pinehurst Resort

• Program Chair: Charles W. Rhodes, MD

• Non-CME

• Program Vice-Chair: Jennifer L. Mullendore, MD

• Program Chair: William A. Dennis, MD

• 778 Registrations; 79 Exhibitors

• 45 Registrations

NCAFP’s Frontline CME Programs 2014 Mastering Valuable Hands-On Procedures – Part V. Conducted workshops at NCAFP Mid-Summer and Winter Meetings. Our Raleigh, NC workshop was filmed for an online program. New Insights in the Management of Fibromyalgia: Refining the Response of Patients to Individualized Treatment – Chapter Lecture Series – Part II.  The NCAFP in joint sponsorship with Consensus Medical Communications, conducted lectures at eight AAFP chapters during 2013 and 2014. Improving Adherence and Maintaining Remission in Major Depressive Disorder – Chapter Lecture Series – Part II.  The NCAFP, in joint sponsorship with Consensus Medical Communications, conducted lectures at eight AAFP chapters during 2013 and 2014. ID OC: Identifying & Addressing Opioid-Induced Constipation Opioid-Induced Constipation in Individuals – Chapter Lecture Series – Part I.   Conducted lectures at several regional AAFP chapter meetings aimed at recruiting four chapters.  NCAFP is continuing to work in joint sponsorship with Spire Learning to develop CME content. Maintenance of Certification Part IV Project - Creating A Medical Home For Children and Youth In Foster Care and  Promoting Dental Homes for Young Children Through Screenings, Varnishing, and Referrals. Two additional MOC Part IV projects of five where developed and launched. These projects were grant supported by Federal CHIPRA funding program through Community Care of North Carolina.

2014 Educational Supporters AAFP Chapter Lecture Series: ADHD in Females

Forest Laboratories, Inc.

Supported by an educational grant from Shire.

Fortis Spectrum Boehringer Ingelheim Pharmaceuticals, Inc.

Supported by an educational grant from Takeda Pharmaceuticals, Inc.

California Academy of Family Physicians Member of the collaborative on REMS Education (CO*RE)

Integrity Continuing Education

Supported by an independent educational grant from the ER/LA Opioid Analgesics REMS Program Companies (RPC.)

Legally Mine

Center for Independent Healthcare Education and Vemco MedEd

LipoScience

Supported by an educational grant from Astellas Scientific and Medical Affairs, Inc.

Lilly USA, Inc.

Creative Educational Concepts

National Kidney Foundation THE NORTH CAROLINA FAMILY PHYSICIAN • Spring 2015

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2014 Educational Supporters continued...

New Jersey Academy of Family Physicians This activity is supported by an educational grant from Takeda Pharmaceuticals, Inc. North Carolina Academy of Family Physicians and Spire Learning This activity is supported by an educational grant from Takeda Pharmaceuticals, Inc. North Carolina Academy of Family Physicians and Spire Learning This activity is supported by an educational grant from Genentech. OMEW- Outcomes Management Educational

North Carolina FAMPAC

Workshops Primary Care Consortium, Inc. Purdue Pharma L.P.

Contributions to FAMPAC, the Academy’s political action committee for Family Medicine, totaled $15,644.50 from a total of 54 NCAFP members in 2014. FAMPAC made contributions to 20 candidates in 2014 totaling $15,750.00. The ending balance in the committee’s account as of December 31, 2014  was $2,164.68.  The following members made contributions:

University of Nebraska Medical Center, Center for Continuing Education and the North Carolina Medical

Robert Agnello, DO

William S. Kelly, MD

Board and the France Foundation

Bailey Balentine, MD

Brian Kessler, DO

Daniel D Bellingham, MD

Mary F. Knox, MD

Janalynn F. Beste, MD

Eugenie Komives, MD

Holly Biola, MD

Richard Lord Jr., MD

2014 Educational Partnerships

Mott P. Blair, IV, MD

John Mangum, MD

MagMutual

Janet Bowen, MD

Tim McGrath

Medical Mutual Insurance

Rhett L. Brown, MD

James W. McNabb, MD

Lisa A. Cassidy-Vu, MD

Jennifer Mullendore, MD

William A. Dennis, MD

Maureen Murphy, MD

Shannon Dowler, MD

Alisa Nance, MD

J. Wesley Earley, MD

J. Thomas Newton, MD

Howard Eisenson, MD

Donald A. Nisbett, MD

Janice Huff Ezzo, MD

Michael Pass, MD

Garett Franklin, MD

D. Michael Payseur

Aaron E. George, DO

Joseph Pye, MD

Gregory K. Griggs, MPA, CAE

Bonzo Reddick, MD

Michael Gross, MD

Charles W. Rhodes, MD

Robert Gwyther, MD

Robert L. Rich Jr., MD

David Hall, MD

David A. Rinehart, MD

Douglas I. Hammer, MD

J. Carson Rounds, MD

Gala Henson, MD

Benjamin F. Simmons, MD

Dimitrios Hondros, MD

Christopher Snyder, III, MD

Tamieka Howell, MD

Beat Steiner, MD

Mary Ibarra, MD

R.W. Watkins, MD

James Jones, MD

Thomas R. White, MD

Michelle F. Jones, MD

Matthew Williams, MD

2014 Frontline Programs Gebauer’s Pain Ease

2014 Non-CME Satellite Programs Merck Exact Sciences Marley Drug Novo Nordisk Health Diagnostic Laboratory, Inc. Galderma

THE NORTH CAROLINA FAMILY PHYSICIAN • Spring 2015

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Awards & Honors 2014 NC Family Physician of the Year Maureen E. Murphy, Concord, NC A passionate advocate for patients while striving to educate and mentor the next generation of family physicians. These core traits have defined the remarkable medical career of Dr. Maureen Murphy of Concord, NC, a family physician, medical educator and mentor to countless medical students and residents. Dr. Murphy was recognized for effortlessly blending adept clinical skill with compassion and wisdom while embracing all of the key ideals of the specialty, including a lifelong commitment to delivering both comprehensive and coordinated care, helping to advance the specialty of Family Medicine, and tirelessly serving North Carolina’s communities. Dr. Murphy began her career in communications, working as a television reporter and public relations writer. This path led her to join the Society of Teachers of Family Medicine as their membership and public relations director in 1977. It was in this role where Dr. Murphy would discover her true life’s calling: family medicine. Murphy currently serves patients as a member of the teaching faculty at Cabarrus Family Medicine in Concord.

2014 Outstanding Family Medicine Residents

2014 Community Teaching Award Winners

Cabarrus Family Medicine Residency Program

The Brody School of Medicine at East Carolina University

Jacob A. Frady, MD

Ken T. Yang, MD

Carolinas Medical Center Family Medicine Residency Program at Charlotte

Duke University School of Medicine

Jessica L. Grass, MD

Patti Wheeler, MD

Carolinas Medical Center Family Medicine Residency at Union Regional

University of North Carolina School of Medicine

David E. Small, MD Cone Health Family Medicine Residency Program

Edward V. Williamson, MD

Bobby M. Levy, MD Wake Forest School of Medicine

Ted J. Nifong, MD

Duke University Family Medicine Residency Program

Jonathan P. Bonnet, MD East Carolina University Family Medicine Residency Program

Vontrelle Roundtree, MD MAHEC Family Medicine Residency Program at Asheville

Katharine C. Rasche, MD MAHEC Family Medicine Residency Program at Hendersonville

2014 Family Medicine Faculty Advisors The Brody School of Medicine at East Carolina University

R. Aaron Lambert, MD Susan K. Keen, MD Susan A. Schmidt, MD Vontrelle Roundtree , MD

Cristin M. O’Grady, MD, MPH New Hanover Family Medicine Residency Program

Duke University School of Medicine Nancy J. Weigle, MD

William C. McLeod, DO Jerry M. Wallace School of Osteopathic Medicine at Campbell University Southern Regional AHEC Family Medicine Residency Program

Alexander C. Gelou, MD UNC Chapel Hill Family Medicine Residency Program

Keyona C. Gullett, MD Wake Forest School of Medicine Family Medicine Residency Program

Elizabeth M. Nelson, MD

Charlotte Paolini, DO University of North Carolina School of Medicine

Kelly Bossenbroek Fedoriw, MD Thomas F. Koonce, MD, MPH Wake Forest School of Medicine

C. Randall Clinch, DO, MS

WOMACK Family Medicine Residency Program

Ashley A. Roselle, DO THE NORTH CAROLINA FAMILY PHYSICIAN • Spring 2015

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Financial Summary The following represents the 2014 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

Dec. 31, 2014

Dec. 31, 2013

Dec. 31, 2012

Current Assets: Cash and Cash Equivalents 587,000 887,015 883,019 Accounts Receivable, net of Allowance for Doubtful Accounts of $500 in 2014 and 2013 75,014 100,293 38,198 Prepaid Expenses 17,230 18,298 19,865 Certificates of Deposit 300,000 Investments 1,392,350 1,289,450 973,671 Total Current Assets 2,071.594 2,595,056 1,914,753 Property and Equipment: Land Building and Improvements Furniture and Equipment Less Accumulated Depreciation Net Property and Equipment

205,000 668,305 285,859

205,000 642,835 278,080

205,000 625,108 243,873

(526,682)

(504,191)

(471,538)

632,482

621,724

602,443

Other Assets Investment, Deferred Compensation 130,047 Certificates of Deposit Total Assets

Liabilities and Net Assets

125,045 120,235 300,000

2,834.123 3,341,825 2,937,431

Dec. 31, 2014

Current Liabilities: Accounts Payable 103,833 Deferred Revenue - Membership Dues 248,635 Deferred Revenue - Programs 52,139 Accrued Retirement Contributions Accrued Paid Time-Off 15,509    Total Current Liabilities 420,116

Dec. 31, 2013

Dec. 31, 2012

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

157,300 239,065 200,983 13,025

991,471 610,373

Long-Term Liabilities: Deferred Compensation

130,047

Total Liabilities

550,163 1,116,516 730,608

125,045

120,235

Net Assets Undesignated Board Designated

2,257,764 26,196

2,154,805 70,504

2,137,301 69,522

Total Net Assets

2,283,960

2,225,309

2,206,823

Total Liabilities and Net Assets

2,834,123 3,341,825 2,937,431


FOUNDATION 2014 NCAFP Foundation Board of Trustees Foundation Executive Officers President

J. Carson Rounds, MD

Vice President

Christopher Snyder, III, MD, FAAFP

Secretary/Treasurer

Robert L. Rich, Jr., MD, FAAFP

Executive Vice President

Gregory K. Griggs, MPA, CAE

Physician Trustees Mott P. Blair, IV, MD, FAAFP William A. Dennis, MD L. Allen Dobson, MD, FAAFP Dimitrios P. Hondros, MD Michelle F. Jones, MD, FAAFP Viviana Martinez-Bianchi, MD, FAAFP David E. Lee, MD Robert L. ‘Chuck’ Rich, Jr., MD, FAAFP J. Carson Rounds, MD Christopher Snyder, III, MD, FAAFP Thomas R. White, MD, FAAFP

Trustee Emeritus Maureen E. Murphy, MD, FAAFP

Corporate Trustees Marina Calabrese, Medical Mutual Insurance Company JJ Darby - Johnson & Johnson Services, Inc. Patti Forest, MD, MBA, FAAFP - Blue Cross & Blue Shield of NC

Foundation Financial Summary The Foundation ended 2014 with $2,268,972.00 in total assets. Grant revenue was $194,350.00 and total revenues for the year were $320,808.00.

Contributions Contributions from Member Dues $26,430.00 Individual Designated Contributions: Individual Contributions $10,818.00 (includes General Fund, Tar Wars, Interest & Scholars Fund and Silent Auction Cash Contributions) Medical Student Endowment $3,122.00 Corporate Member Contributions $4,500.00 Silent Auction Contributions $16,727.00 Including Corporate Sponsorship AAFP Foundation Grant for Student Externships $1,250.00 AAFP Foundation Grant for Student $7,000.00 Rural Health Programs Grant Funded Projects Blue Cross and Blue Shield of NC $177,100.00 Foundation-FM Interest & Scholars Program 2014 Corporate Membership Program The following organizations contributed at least $1,000 to the Foundation and were named corporate members for the year:

Medical Student Endowment Fund The endowment now totals $1,074,787.00 The Annual Foundation Silent Auction This event generated revenue of $16,727.00, with expenses of $10,511.00 for a net gain to the Foundation of $6,216.00.

Resident Trustees Farhad Modarai, DO (Duke) Holly L. Stegall, MD (Cabarrus)

Student Trustees Marlana R. Sheridan (ECU) Lauren A. Visser (UNC)

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THE NORTH CAROLINA FAMILY PHYSICIAN • Spring 2015

• Blue Cross and Blue Shield of North Carolina Foundation • GlaxoSmithKline • Medical Mutual Insurance Group • NC Academy of Family Physicians


Student Activities Family Medicine Interest Groups – The Foundation supported all North Carolina interest groups with funding and staff support. Financial support totaled over $32,400.00 directly to FMIGs and/or students and included the following: support to offset FMIG annual banquet costs, student attendance at the AAFP National Conference for Family Medicine 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 over $5,200.00 in support for elected NCAFP student leaders to attend Academy and Foundation board meetings. Student leaders include two Student Trustees on the NCAFP Foundation Board of Trustees, as well as the NCAFP Student Director and Student Director-Elect. Family Medicine Rural Health Externship Programs – Two, 2-week programs were offered in partnership with the Hendersonville Family Medicine Residency Program and the Brody School of Medicine at East Carolina Family Medicine Residency Program. The residency programs/medical school provided their leadership and the Foundation provided coordination and support in the amount of over $22,000.00. Twenty students participated, ten in each twoweek experience. Family Medicine Externship Program – A total of 8 students participated in the Foundation’s summer externship, for a total cost of $8,000.00. The Foundation was able to secure grants from the AAFP Philanthropic Consortium of $1,250.00 to offset some program expenses.

remained in the program. During the year, a total of $91,970 was paid directly to and/or for students and preceptors. This included stipends awarded to students and preceptors totaling $26,955.00. Additional support to student participants in this program included: $9,656.00 to attend the NCAFP annual meeting; $4,708.00 to attend the AAFP National Conference for FM Residents and Medical Students; $4,700.00 to participate in the NCAFP Leadership Elective; and, $10,033.00 for travel expenses to other national conferences. An additional $10,918.00 was paid for CME registration fees and for preceptor faculty development at our Annual Meeting. Finally, $25,000.00 was paid for initial scholarship payments for students in the second class of Family Medicine Scholars that matched into Family Medicine. From this second class of scholars, of the ten that entered the MATCH in 2014, four selected the specialty of Family Medicine. Four of the remaining six entered other specialties of need in North Carolina (psychiatry (2), med/peds and peds). Those entering Family Medicine residency programs include: Joshua T. Carpenter (ECU) - Cabarrus Family Medcine Residency - Concord, NC Katy A. Kirk (ECU) - Banner Good Samaritan Medical Center - Phoenix, AZ William C. Mclean (UNC) - MAHEC - Asheville, Asheville, NC Amy J. Nayo (UNC) - University of North Carolina Chapel Hill, NC NCAFP/Student Scholarship/Loan Program – A total of $11,000 was awarded to 4 students. Mr. Ian Lateef Cannon (UNC), now entering Family Medicine training in Asheville, NC; Jered Cope Meyers (ECU) current 3rd year student; Jessica Freidman (Duke), current 3rd year student; and Scott Gremillion (ECU) now entering Family Medicine training in Charlotte, NC.

Family Medicine Interest & Scholars Program – In 2014, the Scholars aspect of the program started with 38 students. Following graduation, 28 students

THE NORTH CAROLINA FAMILY PHYSICIAN • Spring 2015

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2014 NCAFP Foundation Contributors NCAFP members and supporters of the Academy are encouraged to make gifts of on-going significance or annual contributions to the NCAFP Foundation. The following individuals contributed to the Foundation in 2014:

22

Robert and Kerry Agnello, DO

Taylor Fie

Eugenie M. Komives, MD

Murali D. Pisharody, MD

D. Landon Allen

Kaylan Fisher

Hervy B. Kornegay, Sr., MD

Jesse C. Pittard, MD

Mark D. Andrews, MD

Janet Fontanella

Abby Lancaster

Lara J. Pons, MD

Ray Antonelli

Patti L. Forest, MD

David E. Lee, MD

Lincoln Pratson

Evan Ashkin, MD

Brian R. Forrest, MD

Robyn Levine

Elizabeth Ramsey

Sarah Asman

Daniel James Frayne, MD

Kyle Levitt

Camille Ratliff

Emily Bardolph

Sarah Frederick

Richard Lord, Jr., MD

Audra Reiter

Julie E. Barrett

Nancy R. Freeman, MD

Mark Lorenzi

Charles W. Rhodes, MD

John F. Baumrucker, MD

Jessica L. Friedman

Alexander Madeira

Robert L. Rich, Jr., MD

Timothy M. Beittel, MD

Endya L. Frye

Angie Maharaj

David A. Rinehart, MD

Christopher Benton

Aaron E. George, DO

Makda Majette

Mark D. Robinson, MD

Mark A. Bernat, MD

John Gerhing

John R. Mangum, MD

Michael Robinson

Yvonne E. Berstler, MD

Donald B. Goodman, Jr., MD

J. Paul Martin, MD

J. Carson Rounds , MD

Janalynn F. Beste, MD

Scott Gremillion

Alexa Martin

Corey Sadler

Holly Biola, MD

Gregory K. Griggs, MPA, CAE

Viviana Martinez-Bianchi, MD

Charles Semelka

Mott P. Blair, IV MD

Elias Gunnell

Alfred T. May, III, MD

Margaret Shaffe

Janet Bowen, MD

Robert E. Gwyther, MD

Michaela S. McCuddy

Marlana R. Sheridan

Charles O. Boyette, MD

Wayne A. Hale, MD

Geeta J. McGahey, MD, MPH

Kristina Simeonsson, MD

Tracey Brader

Mary N. Hall, MD

John Patrick McGee

Priyanka Sista

Dalia Brahmi, MD, MPH

Douglas I. Hammer, MD

William C. McLean, MD

Nadine Skinner, MD

Sarah Burroughs

Diana E. Hancock

David McMullen

Christopher Snyder, III, MD

William D. Byars, MD

Jonathan Hanson

Sean McRitchie

Kelly Stanley

Kenya Caldwell

Jillian Hartwell

Julia Mead

Holly L. Stegall, MD

Brittany Carr

Carl L. Haynes, Jr., MD

Sudha Meghan

Naima Stennett

Alexander Carrese

Tracie L. Hazelett

Kira Mengistu

Tarreyca Taylor

Jane T. Carswell, MD

Margot Hedlin

Shannon Mentock

Kathryn Taylor

Lisa Cassidy-Vu, MD

Jessica Herman

Lloyd Michener, MD

Kate Timberlake

Jimmy Chen

M. Mark Hester, MD

Asiyah Mikell

Robert T. Toborg, MD

Beth Cherveny

Shannon Hicks

Farhad Modarai, DO

Robert G. Townsend, MD

Sandra C. Clark, MD

Brittany Pierce Hipkins

Caroline Moffett

Jessica L. Triche, MD

Laura Cone

Jordan E.K. Hitchens

Daniel Moses

Lily Trout

Collin Conrad

Dimitrios P. Hondros, MD

Jennifer Mullendore

Blake Turvey

Sarah Conrad

James Hooper

Jered Cope Meyers

Talia Horwitz

Michael Murphey

Kari Usinarkaus, MD

Elizabeth Crowder

Tamieka Howell, MD

Maureen E. Murphy, MD

Katarina Velickovic

Alyssa D’Addezio

Janice E. Huff, MD

Jessica Deffler

Jessica L. Hulbert

Alisa C. Nance, MD

Scott and Melodye Visser, MD

Willam Dennis, MD

Elizabeth Isak

Dan-Thanh Nguyen

William Visser

Jinal Desai

Christian A. Jasper, MPH

Andrew Norris

Heather Wagner

Stephen Despins

Geoffrey L. Jones, MD

Nellie O’Connor

Garland E. Wampler, MD

Hallum Dickens

James G. Jones, MD

Christopher O’Keeffe

Edina Wang

Deanna M. Didiano, DO

Michelle F. Jones, MD

Samuel Olson

Alexa Waters

Rosemarie Dizon

Chase Jones

Patrick O’Shea

Demetria Watford

Claudia Douglas

Travis C. Kauffmann

Michael Ouzts

Suzanne Watson

Shannon B. Dowler, MD

Genni Kee

Jill Palchinsky

Jamie Weaver

Patrick Downs

William S. Kelly, MD

Oana R. Panea, MD, MSPH

Jessica Webb

J. Wesley Earley, MD

Brian A. Kessler, DO

J. Ashely Parker, MD

Robert Wergin, MD

Howard J. Eisenson, MD

Yoon Hie Kim

Anthony J. Parker

Thomas R. White, MD

Marietta Ellis

Robert S. Kline, MD

Robert W. Patterson, MD

Matthew M. Williams, MD

Carol A. Ervin

Kyle Knowlson

Jeffrey Pennings

Rachel Wilson

Elizabeth Ferruzzi

Kevin Kohler

Paul Pikman

Maryshell B. Zaffino, MD

THE NORTH CAROLINA FAMILY PHYSICIAN • Spring 2015

and Mr. Joshua Evans

and Mr. Scott Maxwell

Porshia G. Underwood

Lauren Visser


CHAPTER AFFAIRS, UPDATES & BRIEFS

North Carolina Family Medicine Takes Center Stage at Health is Primary’s City Tour in Raleigh

O

n a beautiful Thursday afternoon in Raleigh in late April, North Carolina’s family medicine community took center stage in Family Medicine’s largest and most ambitious communications effort ever undertaken. In a room packed with state health care representatives, Family Medicine professionals, and several members of the media, the national Health is Primary campaign showcased Family Medicine’s unique power to improve quality, lower health costs and keep patients healthier. The audience heard about several primary care innovations happening in North Carolina, the majority being driven by family physicians.

The event was part of an ongoing nationwide city tour developed by Health is Primary, the 3-year, $22M communications campaign that’s working to complement Family Medicine for America’s Health (FMAHealth) and promote the value of patient-centered family medicine and primary care. Health is Primary plans to visit multiple cities across the country this year to raise awareness of local care innovations and primary care’s ability to help advance the nation’s health system. North Carolina was selected as a tour site largely due to the high number of innovations taking place in the state. The centerpiece of the event was a panel discussion moderated by TR Reid, a wellknown national reporter, documentary film maker and NY Times Best Sellers

author. FMAHealth Board Chair and AAFP Past President Dr. Glen Stream, NCAFP President Dr. Thomas R. White, and several family physicians and health professionals sat on the panel as well. Cathie Pettit, Executive Director of DirectNet, LLC was also a panelist; DirectNet is a Hickory, NC-based preferred provider organization that serves four self-insured employers and helps them address rising healthcare costs through patient-centered approaches. In describing DirectNet, Petit outlined how the insurer has developed patient-centered medical homes at approximately twenty local primary care practices. DirectNet also operates eleven worksite clinics that continue to generate positive patient satisfaction, Continues on next page

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and have also been instrumental in helping acheive significant financial rewards for DirectNet’s member companies. One key example Pettit highlighted was Vanguard Furniture, a 500-employee, family owned manufacturer of furniture and case goods that had been struggling to contain its ever rising healthcare costs. In 2009, Vanguard was grappling with a significant rise in its healthcare costs. Working with DirectNet, Vanguard began to offer employees an attractive, easy-touse PCMH-based plan designed to lower primary care access barriers. DirectNet also continued to provide a worksite clinic at Vanguard’s manufacturing facility, which employees consider a key benefit, accoding to Pettit. “One of the most profound testimonies we have learned from this effort has come from a physician who told us this approach has changed the way they practice medicine,” noted Pettit. “He expressed he now understands what the population wants from a primary care physician.” Another North Carolina innovation discussed was Carolina Advanced Health (CAH), the unique collaboration between UNC Health Care and Blue Cross and Blue Shield of North Carolina. Aimed at managing adult patients with multiple chronic conditions, CAH has been aggressive in utilizing a full spectrum, technology-enabled and patient-centered approach to improve quality and lower costs. Dr. Thomas Warcup, CAH’s Medical Director, noted that CAH views the health of their population through more than 22 quality metrics, each reviewed on a monthly basis. Dr. Warcup explained that CAH has identified several significant trends, including reductions in ER and urgent care utilizations and hospitalizations. The panel also highlighted several other examples. Panelist Dr. Edward Bujold, a family physician from Granite Falls, described how his practice’s hospital admission rates dropped 80% in five years by utilizing the key tenets of the patient-centered medical home. Additionally, NCAFP Past President Dr. Karen Smith (05) of Raeford, noted how the use of health information technology has enabled her practice to improve quality.

NCAFP President Dr. Thomas White of Cherryville shares his experiences with a unique program

NCAFP President Dr. Thomas White of Cherryville, NC, described a unique project, stressing that system improvements (and savings) can also be realized upstream, by educating defined populations about their specific risk factors. Dr. White described a unique collaboration between himself and the Cherryville Fire Department that educates firefighters on their risks of cardiovascular disease. Acute cardiovascular disease is the leading cause of death among firefighters -- heart attacks being the leading line-of-duty killer -- accounting for approximately 45 percent of firefighter deaths every year. Dr. White went on to describe that much like firefighters who are trained to cover each others backs, family physicians too work in tandem alongside their patients. The panel generated a lot of great discussion and a number of key insights. Health is Primary expects to use some of the examples in a compilation project that will be introduced towards the end of the campaign.

Media Coverage and Videos The Health is Primary event generated a number of media interviews, including coverage on radio and television that aired across the state. FMAHealth’s Dr. Glen Stream was interviewed by four NC-based radio stations, and Time Warner Cable’s Capitol Tonight news magazine broadcaset a 6-minute interview with NCAFP Watch the full video of President Dr. Thomas White. Related followup coverage in the Charlotte Observer and News & Observer was also published, including a mid-May editorial viewpoint on primary care pipeline issues. Finally, the NCAFP produced and made available several video interviews recorded at the event, one of which

Photos with this story (including on the cover) by David Keith Photography

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THE NORTH CAROLINA FAMILY PHYSICIAN • Spring 2015


Executive’s Desk

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

The Physician-Patient Relationship Must Remain Sacred

that is educating firefighters on their risk factors.

the event at www.ncafp.com/hip includes TR Reid sharing his thoughts on the value of primary care. In addition to Mr. Reid’s perspectives, additional short videos featuring NCAFP members Dr. Warren Newton, as well as NCAFP Past President and current AAFP Board member Dr. Mott Blair are also available. To view these videos, visit NCAFP’s YouTube channel, see www.ncafp.com/yt

Each year it seems that the NCAFP is battling more and more legislative and bureaucratic issues. And as your elected leaders make decisions about how to handle these issues, there are some basic principles that rule the day. One such principle is the sanctity of the physician-patient relationship. Of late, we have seen more excursions into the exam room by both insurance company bureaucrats and our own elected legislators. While many of the issues that come up in this arena are controversial, we ultimately believe it should be between you and your patient to decide. Let’s examine just two of the issues that have developed during this legislative session. While very different, they both represent a potential intrusion of lawmakers into the exam room, a space that should be reserved for the physician and their patient. Type 1 Diabetes Screening A bill filed in the NC General Assembly this year would have mandated screening for Type 1 diabetes at birth, 12 months of age and 24 months of age, despite little to no evidence that such screening would benefit your young patients. While the legislator who introduced the bill was acting out of real concern (a young child in their District had died from Type 1 Diabetes), we believe these types of decisions should be left up to your scientific expertise and the prevailing evidence, not decided by a law. At this point, the bill now encourages physicians to educate parents about the warning signs of

Type 1 Diabetes at various intervals as opposed to mandating a screening or a certain test or conversation. Guns While we by no means oppose gun ownership, we do believe that it is appropriate for a physician to educate their patients (especially patients with young children) about how to avoid the safety risk from improperly stored firearms. We also believe in the use of evidence-based screening tools. This year, another bill before the General Assembly, would limit the use of evidence-based screening tools when they asked about gun ownership or gun storage. We’re certainly not demanding that you ask every patient about safe gun storage, but we also don’t want you to be prohibited from asking such a question or using such a screening tool, if you deem it appropriate for that patient. Homicide and suicide now rank as the second and third leading causes of death among 15-24 year olds in the United States. Asking about gun safety should be no different than asking if a patient uses seat belts or is involved in other risky behaviors that could result in negative health outcomes. While these are two very different laws, we believe they both represent potential intrusions into the exam room. The bottom line, we want you to decide what conversations are appropriate to have with your patient. An elected official or bureaucrat should not dictate whether a conversation should or should not occur, and your decisions about testing should remain evidencebased. After all, the physician-patient relationship is sacred, and we believe it should stay that way.

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STUDENTS

By: Tracie Hazelett NCAFP Student Interest & Initiatives Manager

INTEREST & INITIATIVES

28 Medical Students to Participate in NCAFP’s Summer Programs The NCAFP Foundation recently announced the selection of twentyeight rising 2nd-year students for experiences in summer programs that will take place May through August of this summer. Selected students will participate in paid opportunities in the four-week clinical Externship Program or one of the two-week Rural Health Experiences. Additional students have opted to participate in experiences without a stipend that will better meet their scheduling needs and availability. All students who applied for programs demonstrated the potential to excel in Family Medicine and offer very diverse academic, work and volunteer experiences. We have truly impressive medical students in North Carolina!

Summer Programs Congratulations to the following program participants: Brody School of Medicine at ECU Davita Brockington, Laddie Crisp, III, Alyssa D’Addezio, Elizabeth Ferruzzi, Stuart Hedgpeth, Amanda Morgan, Lauren Morris, Kody Pratson, Taylor Sears, and Rachel Williams

Jerry M. Wallace School of Osteopathic Medicine Sarah Burroughs, Benjamin Byerly, Stephanie Carbone, Emma Ciborowski, Joseph Hale, Natalie Kandinata, Anjuli Maharaj, Alexa Martin, Nicholas May, Alison Mitchell, Courtney Moore, Paul Pikman, Cara Puzzio, Timothy Rabe, and Claire Unruh UNC School of Medicine Kevin Courts and Brianna Sexton Wake Forest University School of Medicine: Katherine Murray

P romoting family medicine on campus

NCAFP Promotes Health is Primary, Helps FMIGs Attract National Speakers In addition to the clinical experiences offered to rising 2nd year students, the Academy has been involved in numerous events with the state’s five medical schools. The Health is Primary campaign went on the road to three schools this spring and will be visiting the remaining two in the fall. To date Greg Griggs, Executive Vice President of the NCAFP, has promoted the Health is Primary campaign to more than 150 medical students. FMIG Support All five medical schools also recently took advantage of support provided by the NCAFP Foundation to bring national-level Family Medicine speakers to their campuses for banquets or other activities. Dr. Lew Hofmann visited Wake Forest FMIG for their annual spring banquet and shared his version of “It’s a Wonderful Life” with stories about his truly unique worldwide journey through Family

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Medicine. Dr. Hofmann is a family physician who is a former White House physician to the Vice President and a former Flight Surgeon to Air Force One. Dr. Hofmann continues to practice in Maryland. Dr. Wanda Filer, AAFP President-Elect, completed a four-campus tour in late April and had the opportunity to address or personally meet with over 200 medical students, Family Medicine residents and other Family Medicine faculty. Dr. Filer shared personal experiences and many stories about her path to Family Medicine and beyond. Her passion was inspirational for many and as more than one student noted, “just what we needed to hear to renew our interest in Family Medicine after a tough exam!”


Find Your Kind in an AAFP Member Interest Group The AAFP is committed to giving all members a voice within our increasingly diverse organization. Member interest groups (MIGs) have been created as a way to define, recognize, and support AAFP members with shared professional interests. MIGs support members interested in professional and leadership development and provide connections to existing AAFP resources, opportunities to suggest AAFP policy, and networking events with like-minded peers. Current AAFP MIGs include: • Direct Primary Care • Emergency Medicine/Urgent Care • Global Health • Hospital Medicine • Independent Solo/Small Group Practice • Oral Health • Reproductive Health Care • Rural Health • Single Payer Health Care • Telehealth

Visit aafp.org/mig to learn more, join a MIG, or start your own.


AN OUNCE OF

PREVENTION

WHERE HEALTH IS PRIMARY. Patients with access to primary care are more likely to receive preventive services and timely care before their medical conditions become serious – and more costly to treat. Family doctors work with their patients to keep them healthy. We want to ensure that all patients have access to and use regular preventive care.

Let’s make health primary in America. Learn more at healthisprimary.org. #MakeHealthPrimary 28

THE NORTH CAROLINA FAMILY PHYSICIAN • Spring 2015


POINT OF VIEW

By: Margarette Shegog, MD, MPH NCAFP Resident Director-Elect

A Resident’s Perspective

Dr. Shegog is a 2nd-year resident at the MAHEC-Asheville Family Medicine Residency Program.

R esident V iewpoint

Support Patients and Show Ourselves as Allies With this hectic life, it is easy to lose sight of the “world around us and the events that will ultimately affect our practices. We are physicians, family, friends, and ultimately people. In this time of great change, it is important to remember the little things we can do to support our patients and show ourselves as allies. — Margarette Shegog, MD, MPH November 25th, 2014, I was in clinic standing at the nurse’s station with a nurse and one of the janitorial staff. We were all reeling from the same decision- Officer Darren Wilson would not have a trial. That was not the first time that Black Americans gathered to find solace, nor was it the last. Throughout this winter and spring much of the Black community has been dealing with the violence and injustice against our community. While this is not new, recently it has been brought more to light. While I was well aware of this problem, it made me think about the health disparities that we as black Americans face as well. According to CDC data, black Americans have the lowest life expectancy of any race in the United States at 74.6 years, more than 4 years less than white Americans. Black American infant mortality is more than twice that of any other race. Black Americans have higher preventable hospitalization rates than other races. JAMA noted in their April 14th article that black American men have the lowest life expectancy of any group and often only experience primary care through military or prison service. These data, in addition to the frequent reports of police brutality, make one feel powerless. One day I happened to see a colleague wearing a “Black Lives Matter” button. With that one gesture I knew I had an ally. “I was so upset I had to do something,” she responded when I thanked her. That acknowledgement of the current situation meant so much to me. I

could not imagine what it would mean for a patient. JAMA calls for action in the medical community through supporting community partnerships and programs that address environmental and social health. This can seem daunting and some may wonder where to start. As I reflected on my colleague’s pin I wondered, what simple and powerful ways can we be allies and advocate for our patients. Also along the lines of people affected by inequality, there has been much debate in the news media surrounding women’s health and rights. Women’s wages, maternity care, birth control and bodily rights have all come under fire in the last few years. With North Carolina’s failure to expand Medicaid, approximately 277,000 women are ineligible for health care (State of Women’s Health, 2013). And recently there was House Bill 847 which would have significantly decreased young people’s access to mental health care, STI, and pregnancy care without having notarized permission from a parent. Fortunately, these provisions of that bill were removed. We often support women individually on a daily basis in our offices. However, by using our voices over the phone or in person to our elected officials in Raleigh and Washington, we can begin to support women in a larger way. On April 15th NCAFP had a White Coat Wednesday and among the different topics discussed was H.B 465. H.B 465 would significantly limit family physicians

ability to provide care for women in North Carolina. Making it to Raleigh for White Coat Wednesday is wonderful, but it can be as simple as picking up the phone. Another common marginalized group is the GLBTQQ (Gay Lesbian, Bisexual, Transsexual, Queer and Questioning) community. AAFP has long accepted and supported all families. However, GLBTQQ teens are still twice as likely as their heterosexual peers to have attempted suicide. About 25% of Transgender youth have attempted suicide (CDC GLBT Youth). At MAHEC’s diversity discussion, one woman discussed how welcomed she felt when a physician wore a rainbow rod of Asclepius. I have had patients express to me how refreshing it was to have a physician who was sex positive and discuss how to have healthy consensual relationships with their chosen partners. Being a sex-positive physician can involve domestic violence screening in samesex relationships, answering questions about hormones for transitioning and gender queer patients, and discussing how to make dental dams out of condoms. Many GLBTQQs avoid going to the physician for fear of judgement. Creating a non-judgmental environment is a first step to creating a space where all patients feel comfortable seeking medical care. This can be as easy as making sure that a preferred name is seen in the EMR, using a preferred pronoun or wearing a pin. Daily events are occurring which affect our communities, our patients, our communities and ourselves. As physicians, we have busy lives of examining patients, completing notes, continuing our education and managing practices. With this hectic life, it is easy to lose sight of the world around us and the events that will ultimately affect our practices. We are physicians, family, friends, and ultimately people. In this time of great change, it is important to remember the little things we can do to support our patients and show ourselves as allies. We are allies not only in their health, but also of their overall wellbeing. Wear a pin or a button. Ask the question. Make a call.

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PRACTICE MANAGEMENT, NEWS & INSIGHTS

National and State Practice Management Briefs... Chronic Care Management Covered by Medicare Advantage Says CMS CMS recently clarified some ambiguity and confusion around the payment for Chronic Care Management (CCM) services for Medicare Advantage beneficiaries. Early this year, the CMS could not verify that Medicare Advantage (MA) plans were required to recognize the code and the AAFP communicated with CMS, calling for it to specify the requirement for all MA plans. In a conference call attended by the AAFP and several other groups earlier this spring, CMS clarified the requirement, noting that while physicians serving MA patients could bill for the code, it does require an appropriate contract provision between the provider and the plan. For patients that choose and out-of-network provider to provide CCM services, the MA plan must pay the CCM fee as a out-ofnetwork physician service as well.

New AAFP Breastfeeding Toolkit Excellent for Clinical, Coding and Education The AAFP has created a handy new resources toolkit on breastfeeding (http://www.aafp.org/patient-care/ public-health/breastfeeding/toolkit. html) aimed at assisting family physicians with the clinical, coding, and patient education challenges around the issue. The toolkit, which bolsters AAFP policy, also includes the breastfeeding position paper that the Academy released in November with updates informed by evidencebased research that occurred since

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the previous position paper’s 2008 release. The toolkit provides office- and community-based tools, advocacy resources, evidence-based knowledge and educational material.

SGR REPEALED

Medicare Payment Changes on Horizon Now that the flawed Sustainable Growth Rate formula (SGR) has been repealed by Congress, family physicians and practices will need to begin planning for the coming Medicare payment changes on the horizon. While MACRA (The Medicare Access and CHIP Reauthorization Act of 2015) does provide Medicare payment stability over the next ten years with annual payment increases of 0.5%, capturing bonus payments in 2019 and beyond (as well as annual payment updates beginning in 2026) will require providers to make an informed choice relative to their elected payment pathway. Physicians and practices will need to decide whether to opt for payments based on alternative payment models (such as PCMH) or for the more traditional fee-for-service model that’s now called the Merit-Based Incentive Payment System. The AAFP has already published online resources answering some common questions (see aafp.org) and is expected of offer additional information in the coming months. Look to the AAFP and NCAFP for notification on when these become available.

NC’s Controlled Substances Reporting System Gets Revamp Family physician users of North Carolina’s Controlled Substances Reporting System (CSRS) should have noticed a brand new look and feel to the tool. NCCSRS rolled out the redesign in mid-April, the aim of which is making the system more clinically-valuable tool for patient care and increasing its usage across the care continuum. The new interface is more intuitive and aprovides new features as well, including a more streamlined password reset function, an enhanced user profile updating process, and easier to read reports that contain new information.

NC Medicaid Reprocessing Claims as Part of 3% Rate Reduction The NC Medicaid program announced has begun re-processing of physician payment claims to take into account the NC General Assembly’s 2013 Session Law 360 which cut payment rates by 3%. This means that for physicians who attested for ACA-enhanced payments before June 30, 2014, claims between 1/1/2015 and 3/1/2015 will be reprocessed. Claims reprocessing is taking place over multiple checkwrites due to claim volume and began with the checkwrite of April 28th. According to estimates provided by NC Medicaid, the average repayment amount for an ACAattested physician is $240.27.


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