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Volume 18 Issue 1 • Winter 2022

The North Carolina

Family Physician Quarterly News in North Carolina Family Medicine

By Dr. Dimitrios 'Takie' Hondros

LEARNING, GROWING AND ADAPTING AS A FAMILY PHYSICIAN P. 4

2022 NCAFP Meetings & Events SAVE THESE DATES Celebrate your commitment of providing the best possible care to your patients with these fantastic learning opportunities in 2022!

Family Medicine Academic Summit Friday, April 1 – Saturday, April 2, 2022 Marriott Raleigh Crabtree Hotel, Raleigh, NC Program Co-Chairs: Victoria Boggiano, MD, MPH & Lisa Cassidy-Vu, MD Estimated 6 CME Credits Available

www.ncafp.com/summit

2022 Virtual Summer Symposium

Saturday, August 6, 2022 From the comfort of your favorite location! Program Chair: Thomas White, MD Estimated 6 CME Credits Available

www.ncafp.com/summercme

2022 Winter Family Physicians Weekend Thursday, December 1 – Sunday, December 4, 2022 Omni Grove Park Inn, Asheville, NC Program Chair: Deanna Didiano, DO Program Vice-Chair: Tamieka Howell, MD Estimated 25+ CME Credits Available

www.ncafp.com/wfpw

If you have never attended an NCAFP Conference, please consider joining us in 2022 and experience firsthand what all the buzz is about! Here’s what your colleagues had to say about their NCAFP conference experiences: “Excellent conference. Rivals AAFP FMX.” “Great way to stay informed and dedicated to my profession as a family physician.” “This was a great conference, and I am so glad I had the opportunity to attend. Everyone was extremely welcoming, and it was a great experience!” “Great conference and panel of presenters. I love this conference, and I will be back next year!”

Learn | Connect | Engage

www.ncafp.com/continuing-education

Please contact Kathryn Atkinson, CMP, Manager of NCAFP Meetings & Events with any questions you may have about these fantastic opportunities - Katkinson@ncafp.com.

Inside Winter 2022

A Review of Key Elements of NCMBs' Telehealth Position Statement P. 22

PRESIDENT’S MESSAGE

CHAPTER AFFAIRS

The 2021-22 President's Inaugural Address

Thank You to Mrs. Marietta (Ellis) Saunders for Her 20+ Years of Service to Family Medicine

ADVOCACY

STUDENT INTEREST & INITIATIVES

Remembering the Positives During a Time of Turmoil

Finding My Home in Family Medicine Began with My FMIG

MEETINGS & CONFERENCES

PRACTICE MANAGEMENT

2022 Promises Fantastic CME Opps that You’re Going to Love

A Review of Key Elements of NCMBs' Telehealth Position Statement with Post-Pandemic Considerations

DEPARTMENTS

PUBLISHED BY

President’s Message 4 Advocacy 8 Meetings & Conferences 12 t 919.833.2110 •

fax

Chapter Affairs 16 Student Interest 20 Practice Management 22

919.833.1801 • ncafp.com

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

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

PRESIDENT’S MESSAGE to Members By Dr. Dimitrios 'Takie' Hondros 2021–2022 NCAFP President

2021 INAUGURAL ADDRESS

Learning, Growing and Adapting as a Family Physician Thank you to all. As I look out in the crowd, I am humbled to be standing here. There are so many people to thank. First to my family. To my wife and kids. I am so blessed to have an awesome, caring, and loving wife. Her support of my love for the NCAFP over the last 20 plus years has been fully appreciated. My three children have kept me grounded and have helped me become a more compassionate and comprehensive family physician. To my parents, sisters, and their husbands, they have taught me the importance of hard work, dedication, and love for family. To my wife, kids, parents, and siblings, I love you with all my heart and appreciate you being here tonight. To my amazing medical office partners, colleagues, and staff: how blessed are we to work together? I am surrounded by the most hardworking, talented team in medicine. Their support of me and care of our patients goes above and beyond what most clinics will do. They truly are “our secret sauce.” To my new independent physician colleagues under Avance’s umbrella in Charlotte, Drs. Rhett Brown, Carson Rounds, Gen. Brauning, and Faison Knox, I am excited to call you my new ‘re-found’ friends on this new great journey for us. To Greg Griggs, a mentor, friend, and so thankful that we here at

The North Carolina Family Physician

2021-2022

NCAFP Board of Directors

Executive Officers President

Dimitrios “Takie” P. Hondros, MD

President-Elect

Shauna Guthrie, MD, MPH

Secretary/Treasurer

Garett R. Franklin, MD

Immediate Past President Executive Vice President

Jessica L. Triche, MD Gregory K. Griggs, MPA, CAE

At-Large Directors Joshua Carpenter, MD Jewell P. Carr, MD Deanna Didiano, DO Nicole Johnson, MD, MPH Mark McNeill, MD Benjamin F. Simmons, MD Ying Vang, MD Courtland Winborne, MD

Academic Position Margaret Helton, MD (UNC)

Resident Director Ryan Paulus, DO (UNC) Resident Director-Elect Matthew Drake, MD (ECU)

Student Director

TAKING THE OATH...

Morgan Carnes (Wake Forest) Student Director-Elect

Dr. Hondros is a graduate of UNC Chapel Hill and

Morgan Beamon (ECU)

Wake Forest University School of Medicine and completed his residency at Carolinas Medical Center where he also served as chief resident. He currently practices Family Medicine in Matthews, NC. Dr. Hondros is married and has three children. He has been involved with the Academy since the start of medical school. As FMIG president and while at WFUSOM, Dr. Hondros served on many state committees, even

AAFP Delegates & Alternates AAFP Delegate

Richard W. Lord, Jr., MD, MA

AAFP Delegate

Robert L. Rich, Jr., MD

AAFP Alternate

Tamieka Howell, MD

AAFP Alternate

Thomas R. White, MD

as a student representative. He later served on the NCAFP Foundation Board as a resident and later a physician member. He has been active within the Academy through medical student activities as well as being a master preceptor, a community preceptor, and a scholarship applicant review committee member.

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

Winter 2022

www.ncafp.com

the NCAFP can call him our EVP. And finally, to Fr. Vasileos: your spiritual guidance has kept me focused on why we are here – to help our fellow patients and ourselves improve spiritually, physically, and mentally. My love for Family Medicine started at the age of 11. My parents at the time moved us to a place with a family medical clinic right out of our neighborhood. Actually, it backed up to my grandparents’ house. Dr Marshall McMillan became our family physician. I remember during my middle and high school years, I would climb my grandparents’ fence and began to shadow him whenever I had free time. His love and care of all ages was inspiring. Family is important in my culture, so seeing a family physician who valued that just clicked. As I went off to college to major in the sciences, I knew that medical school and Family Medicine was where I wanted to end up. Every chance I got, I would come back to their office to shadow and learn. For that Dr McMillan, thank you. As I matriculated into medical school at the Wake Forest University School of Medicine, I remember the Dean on Day One meeting all of us individually and asking what aspiring medical career choices we were pondering. "Well of course Family Medicine,” I replied. His response, “you will change your mind.” In fact, I didn’t. I quickly met the family physicians there and stuck to them like glue from my first year of medical school. One in particular, Dr. Rich Lord, had just joined the Family Medicine faculty there where his love of teaching and Family Medicine was quickly self-evident. Because of him and others, I quickly joined the Family Medicine Interest Group and also the NCAFP. For that Dr Lord, thank you. I went on to attend my first winter conference here at the Grove Park Inn. Not many first-year students would come to this meeting back then. I remember less than 20 total students here. Someone special was also present at this meeting: Dr Maureen Murphy. She took us out to dinner the first night, told us how great Family Medicine was, and invited any of us who were interested to rotate with her in Sparta for Family Medicine rotations. Not only did 6

I eventually do four months of rotations with her in medical school and residency -- including sleeping in an AHEC ‘old’ mobile home in the middle of a cow farm -- but ultimately experiences like that solidified my love for Family Medicine. For that Dr Murphy, thank you. This is the NCAFP to me. A place where folks from all walks of life can come interact, meet, exchange ideas, and reaffirm why they currently are or will choose to be in Family Medicine. I wouldn’t be here if it wasn’t for my mentors. As l look out to see students, residents, fellows, and current family physicians, I am amazed of the collective power in this The North Carolina Family Physician

room. We need to be here for each other. As healthcare quickly changes, Family Medicine will continue to be at the forefront of how we deliver care to our patients. We can only do that if we support, teach, and cultivate the love of Family Medicine to future generations of medical students. My former NCAFP Student Scholars, Lucy and Brittany, both chose Family Medicine as their careers. Brittany Means, thank you for being here. My current medical student, Sophia, is also aspiring to go into Family Medicine. Sophia, thanks for being here as well. With my student scholars, I am 3 for 3! The more we teach, inspire them to love and appreciate what we do, the better we can succeed in ensuring they choose Family Medicine as their future career. This can’t happen without our NCAFP Foundation. As a past executive member on the NCAFP Foundation, I realized here is where we need to focus our energies for our student programs. It is through our Foundation that we can ensure the great teaching and mentoring of future generations. It is one of my personal goals next year to work closely with our Foundation to help finally grow our student endowment to a self-sustainable amount. It is only with enough funds that we can continue to innovate our student/resident programs for future generations. We should be proud of our profession, and teaching future generations the value of going into Family Medicine is utterly important. The first goal is to encourage more preceptors to volunteer. We can work with our local medical schools to encourage innovative ways to precept. We can encourage medical schools to innovate their rotation curriculum to help community preceptors. In Charlotte, for example, our medical students are with us over a 6-month period once a week. We can work with other Family Medicine clinics in our areas to share students. We can work to encourage our local health systems to incentivize precepting, such as more dedicated time during the week, no penalties if your RVU’s decrease slightly during that month, and perhaps a stewardship metric for teaching built into your non-productivity pay for example. It is importWinter 2022

ant that health systems know the importance of training future generations. We can continue to work at the state level within the legislature on creative ways to help with incentivizing precepting and mentoring. We will also dedicate our efforts next year to growing our foundation's student endowment. In 2022, we will begin a fundraising campaign in hopes that we can get the endowment large enough to become self-sustaining. We understand that for this to succeed monies are needed. I am honored to help with this effort along with my former mentor and past president of the NCAFP Dr Maureen Murphy!! Personally, I pledge $5,000 next year to the Foundation to help continue and grow our amazing student programs. With student activities, I also pledge to visit each medical school next year to meet with their local Family Medicine faculty, their Family Medicine Interest Group, and its leaders. It is here as well, that the sooner students are exposed to Family Medicine, the more likely they will choose it as a career. Our former student scholars program proved that. As we move into value-based healthcare in 2022, the NCAFP must continue to be at the forefront in helping to educate our members and advocate for them. In the last 12 months, I transitioned out of being a health system employee, to becoming an independent MD under a collaborative partnership with Avance. Having now worked both sides of the aisle, both in hospital-based and independent Family Medicine, I feel better prepared to represent our voices in the NCAFP. From a health systems perspective, the NCAFP must continue to engage them to make sure the majority of value-based care dollars make their way to family physicians. We are the ones doing most of the value based metric work anyway! We also need to continue to encourage collaborative care practices (like embedded counselors, dieticians, pharmacists, etc.) within our medical offices, both private and hospital-owned, to help drive down healthcare costs from costly referrals for common services. Insurers need to encourage patients to seek continues on Back Cover

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

~ Working for You ~

Remembering the Positives During a Time of Turmoil In tough times, it can be easy to forget the good that is occurring around us. After two full years of a global pandemic, our state’s family physicians are tired. But there continue to be small victories. As a result, I wanted to provide updates on a few of the positive things that are happening in healthcare, particularly for Family Medicine. So here is a little good news. MEDICARE SEQUESTRATION AVOIDED Recently, Congress passed, and the President signed, S. 610, the Protecting Medicare & American Farmers from Sequester Cuts Act into law, a true positive for Family Medicine. As part of implementing S. 610, the Centers for Medicare & Medicaid Services (CMS) released an updated 2022 Medicare physician fee schedule conversion factor (i.e., the amount Medicare pays per relative value unit). The updated conversion factor will be $34.6062. That is less than the 2021 conversion factor of $34.8931 but more than the conversion factor of $33.59 that CMS planned to implement before passage of S. 610. Using the new conversion factor and accounting for other changes in S. 610, the American Medical Association (AMA) estimates family physicians will see no change in their total Medicare allowed charges in the first quarter of 2022, a substantial improvement over the -8.7% change the AMA estimates

would have occurred in the absence of S. 610. The AMA estimates most other physician specialties will experience a decrease in their total Medicare allowed charges even with the changes made by S. 610. This represents a big victory for family physicians. And remember, in the previous year, family physicians received a substantial bump from Medicare with E&M codes receiving a higher RVU value. MEDICAID CHANGES While NCAFP still supports a broader coverage expansion to provide all North Carolinians access to affordable healthcare, the NC General Assembly did make some additions to Medicaid coverage last year. For example, post-partum mothers can now stay on Medicaid for a full 12 months. Previously, Medicaid coverage for mothers ended six weeks after delivery. Another change involved children of parents in the foster care system. Previously, parents of children in foster care automatically lost coverage. This meant if the reason the parent lost coverage was substance use, the parent also lost the opportunity to seek substance use treatment. Now, those parents will remain on Medicaid, so that they can get access to the appropriate treatment. Medicaid has also worked to incentivize getting recipients vaccinated for COVID-19. Medicaid recently increased the administrative fee you receive when providing a COVID-19 vaccine to $65 per immunization. That’s up from the $40 previously provided for COVID-vaccine administration. Even better, the administrative fee increase is retroactive to April 1,

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2021. As a result, you will automatically receive a payment for the $25 increase for every COVID-19 vaccine you have administered back to April 1st. NC Medicaid hopes this will help incentivize all family physicians to keep or continue to keep COVID-19 vaccine in your office for vaccine-hesitant patients. Speaking of vaccine hesitancy, NC Medicaid also pays you to counsel your patients about receiving the COVID vaccine using code 99401. As you continue to work to get your patients vaccinated, you can counsel the patient multiple times and add this code to your visit each time you counsel. This is one more way that Medicaid has been acknowledging the work you have been doing throughout the pandemic. MEDICAID TRANSFORMATION – MOVE TO MANAGED CARE While we know the move to Medicaid Managed Care in the middle of a global pandemic was certainly not ideal, there were some positives during the process. For example, last year Medicaid temporarily increased the per-member, per-month (PMPM) care management fees in several ways for various primary care practices to help them through the transition. First, practices could receive up to three months of “glide path” payments for working to exchange data with the pre-paid health plans before the go live date. In addition, practices with patients in certain zip codes that had greater poverty levels, received temporary PMPM increases for social determinants of health projects. We continue to work with Medicaid to let them know of issues that arise due to this transition. While it has not been perfect, compared to managed care roll outs in other states, North Carolina was well positioned. continues on next page

Winter 2022

CONTINUING EDUCATION The NCAFP has also become more innovative in the educational opportunities we provide with great success. For example, our virtual offerings in 2020 and 2021 were better attended than any live meeting outside of our Annual Meeting. As a result, we have decided to permanently offer virtual meetings where you can learn from anywhere. In 2022, we will have a virtual offering on Saturday, August 6, and will also offer a virtual KSA. See page 12 for more information.

Finally, we are at the table with statewide discussions on minimizing the number of quality metrics you must meet and how to better align those metrics across payers. Again, this will not be easy, but is a key focus for the NCAFP.

Workforce: We continue our efforts to increase the family physician workforce. One focus area is to make it easier for our members to serve as role models for medical students by incentivizing precepting. We will be working with our healthcare systems to discuss the value of teaching medical students and how they should incorporate that value into compensation your NCAFP Board packages. We also are working on policy levers to try to incenof Directors also community-based teachupdated our strategic tivize ing.

We were also extremely fortunate to bring you back together for the first time in two years in December, 2021. While we had to limit attendance and put many safety measures in place, the energy at the meeting was palpable. plan to truly focus It truly showed the “family” of FamProfessional Development: ily Medicine as colleagues and friends on your needs As stated above, we are focused came together for our annual reunion. moving forward. on delivering our members We were fortunate to host the meetthe best continuing education ing at the end of the “Delta curve” out there both in-person and but before we hit the beginning of the virtually. While we will still focus on clinical topics, “Omicron surge.” We learned how to come together we will mix in a few non-clinical issues that could safely, and we are already planning for this year’s Anhave a significant impact on your specialty, includnual Meeting in Asheville. ing value-based care.

“

”

LOOKING TO THE FUTURE Over the past year, your NCAFP Board of Directors also updated our strategic plan to truly focus on your needs moving forward. The work won’t be easy, but some of our key areas of focus include:

These are not all our activities but do represent a few of our key priorities. The bottom line, we want to continue to be the bright light for you, even during a global pandemic. While we hope the pandemic eases in the coming weeks and months, know the NCAFP is here for you every day.

Administrative Burden: NCAFP staff and leaders will be working to reduce the administrative burden of family physicians in a few key areas. First and foremost, we are meeting with insurance companies to address the burden of Prior Authorizations. But we will also provide greater education on how to use Electronic Health Records more efficiently. We will be holding a webinar (or two) with “Super Users” from various EHR platforms offering tips and tricks.

The North Carolina Family Physician

FAMPAC

Empowering Family Medicine

Blue Cross NC Reinstates Payment for After Hours Codes Thanks to the advocacy work of the NCAFP, the NC Pediatric Society, and Community Care of North Carolina, Blue Cross and Blue Shield of NC has reinstated payment for after-hours care. Following what we believe was ill-advised guidance from the Centers for Medicare and Medicaid Services (particularly during a Public Health Emergency), Blue Cross NC had stopped paying for B Codes 99050 (after hours services when office is normally closed) and 99051 (services provided in the office during regularly scheduled evening, weekend, or holiday hours). These are codes that increase the value of the regular office visit when provided after typical office hours. In responding to our concerns, Blue Cross NC noted that they are “committed to supporting providers, especially during the public health emergency, when access to care is critical,” and they have updated their policy and reinstituted coverage of these codes effective January 21, 2022. The updated Blue Cross NC policies can be found at ncafp.com/ bcbsah22. We appreciate Blue Cross NC responding to the concerns of primary care physicians across our state and reinstating these codes.

Winter 2022

JOIN THE FIGHT FOR FAMILY MEDICINE Participating is easy -• Get to know your elected officials and become their trusted healthcare advisor. • Contribute so we can support candidates that support Family Medicine. • Participate in NCAFP’s ongoing advocacy events and efforts.

To learn more about FAMPAC and donate, visit www.ncafp.com/fampac

MEETINGS & CONFERENCES By Kathryn Atkinson, CMP NCAFP Meetings & Events Manager

~ THE YEAR AHEAD ~

2022 Promises Fantastic CME Opps that You’re Going to Love Your NCAFP Meetings Department enjoyed a little rest and a little relaxation (and a quick dip in the Atlantic Ocean for good luck on New Year’s Day!) over the December holidays. But, when January 3rd rolled around, our focus quickly returned to designing and planning several terrific and empowering educational opportunities just for you. Grab your calendar and save the dates for these fantastic CME opportunities in 2022.

2022 Family Medicine Academic Summit The NCAFP’s first-ever 2-day Family Medicine Academic Summit, with a dedicated focus on guidelines, tips, and trends, is a “2022 Must-Do” for all NC Medical School Departments of Family Medicine and NC Family Medicine Residency Program faculty. Co-sponsored by the NC AHEC Program, this unique in-person conference, scheduled for Friday, April 1, and Saturday, April 2, 2022, at the Marriott Raleigh Crabtree Hotel, includes practical and actionable takeaways for everyone in your department or program. Program co-chairs, Dr. Victoria Boggiano and Dr. Lisa Cassidy-Vu have included a slate of topics by expert guest speakers to include ACGME Guidelines, New Family Medicine Residency Tracks in NC, MAT and OUD Updates, FMLA Guidelines and Updates, Junior Faculty

Career Tips and Resources, and Leadership Training in Academic Settings and Healthcare Organizations. The program will also include a panel discussion, keynote sessions, and fantastic networking opportunities that you will not want to miss. Registration to attend is $125 per person, and attendees can expect to earn approximately 6 CME credits by their participation. You can find full schedule details, the guest speaker lineup, online registration, hotel reservations, and more at www.ncafp.com/summit.

2022 Virtual Summer Symposium Last year’s Virtual Summer Symposium was such a terrific success and so well-received by so many of you that we’ve added it to our 2022 CME portfolio. Program Chair Dr. Thomas White has already begun developing this highly requested and convenient summertime learning opportunity that you are sure to enjoy. Mark your calendars for Saturday, August

The North Carolina Family Physician

6, 2022, and plan to advance your knowledge and understanding of common patient issues you see and treat every day via this fun and lively webcast. With approximately 6 CME credits up for grabs, this oneday interactive virtual opportunity will include timely requested topics brought to you by industry experts and family physician colleagues. Begin thinking about your favorite location to be in for this relaxed and favorable format for learning, and watch your email and the conference site at www.ncafp.com.summercme for more updates and complete details coming soon!

2022 Winter Family Physicians Weekend Affectionately known around the office as “The Big Meeting,” the 2022 Winter Family Physicians Weekend is always an end-of-year favorite for everyone. This annual winning combination of timely requested CME, camaraderie, networking, and just plain old good fun is scheduled for Thursday, December 1 – Sunday, December 4, 2022, at the Omni Grove Park Inn. Your program chair, Dr. Deanna Didiano, and your program vice-chair, Dr. Tamieka Howell, have already begun preparing a slate of topics that you will not want to miss. Begin making your plans to join

us for this long-standing tradition in the beautiful Blue Ridge Mountains of Asheville, NC, this December. Watch your email and the conference site, www.ncafp.com/wfpw, for more updates and complete schedule and registration details coming soon! Your NCAFP Meetings Department is committed to providing you with the best learning opportunities in 2022, and we look forward to seeing you at one or more of these fantastic events. If you have never attended an NCAFP conference, we warmly invite you to join us this year and experience firsthand what all the buzz is about. You’ll enjoy a CME program that is guaranteed to leave your family medicine heart refreshed and re-energized. On behalf of the NCAFP, thank you for ALL that you do for your patients and communities every day. We appreciate you, and we are so proud of you! Best wishes for a safe, happy, and rewarding 2022. Please contact Kathryn Atkinson, CMP, at Katkinson@ncafp.com for more information about the NCAFP’s Meetings & Events.

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The North Carolina Family Physician

Winter 2022

CHAPTER AFFAIRS By Kathryn Atkinson, CMP NCAFP Meetings & Events Manager

@ H E A D QUA RT E R S

Thank You to Mrs. Marietta (Ellis) Saunders for Her 20+ Years of Service to Family Medicine If you have ever attended an NCAFP CME meeting, there is no doubt that you have benefitted from Marietta Ellis Saunders’ work and dedication to Family Medicine. Marietta has worn many hats over the years at NCAFP, including two stints as an employee of the organization and serving as our CME Specialist contract consultant over the last few years.

exciting role in her life that is so well-deserved. These days you will find a “semi-retired” Marietta (she still does some consulting) enjoying beach-life-living in Oak Island, NC, with her husband and family physician, Dr. George Saunders. An avid traveler, Marietta plans to use some of her free time to visit Germany and Austria, along with a return visit to Hawaii, one of her favorite Marietta has been a vacation spots.

In her most recent role, Marietta tremendous asset to provided CME support through NCAFP over the years, educational grant submissions, helping make the and worked very closely with NCAFP’s educational many NCAFP program chairs to design and plan timely educational meetings and events opportunities for thousands of some of the most family doctors in North Carolina sought-after and highly and beyond. Marietta has been anticipated CME a tremendous asset to NCAFP conferences around. over the years, helping make the NCAFP’s educational meetings and events some of the most sought-after and highly anticipated CME conferences around. We sincerely appreciate her many talents and contributions to the NCAFP and Family Medicine.

It has been an honor and a privilege to have Marietta on our team all these years. Please join us in thanking her for her many contributions to the Academy and her remarkable dedication to its members. Happy Retirement, Marietta! Thank you again for your amazing service and dedication to Family Medicine.

As of December 31, 2021, Marietta began a new and

The North Carolina Family Physician

ADVISORY CAPITAL INSURANCE

Eight NCAFP Members Complete AAFP’s Physician Well-Being Program Eight NCAFP members recently completed a 10-month long certificate program from the American Academy of Family Physicians (AAFP) called, “Leading Physician Well-being” (LPW). They are:

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• Angela Bacigalupo, MD • Scott Gremillion, MD • Anjali Marble, DO • Berlondrika McNeal, MD, MS. ED • Melanie Sanders, MD • Amanda Steventon, MD • Meredith Taylor, MD • Brittany Watson, MD 120 physicians total were selected from a national pool to participate in the inaugural year of this program, which was created to provide leadership development, training in physician well-being advocacy, and performance improvement project skill-building. They developed a System Well-being Improvement Project (SWIP) and presented this to their peers in a final project showcase in October. AAFP LPW Scholars completing this certificate are well-positioned to fill leadership roles within health care systems where they can create value around physician well-being which honors the doctor-patient relationship. Congratulations to all for this outstanding accomplishment!

Winter 2022

CORPORATE SPONSOR OF THE NORTH CAROLINA ACADEMY OF FAMILY PHYSICIANS

ADVERTISE! Reach many types of Family Medicine professionals in North Carolina. Contact Peter Graber with the NCAFP at pgraber@ncafp.com 17

MEMBERSHIP & MEMBER SERVICES By: Tara Hinkle NCAFP Member Services Manager

Catherine Coe, MD, Named to AAMC Board of Directors UNC Health Family Medicine assistant professor Catherine Coe, MD, has been named to the Association of American Medical Colleges (AAMC) Board of Directors. Dr. Coe is the inaugural person to hold the junior faculty representative seat, chosen out of a pool of more than 60 nominees across the country. Dr. Coe has been heavily involved in medical student education during her time as faculty, and we have no doubt she will bring a wealth of knowledge and perspectives to this role. Congratulations!

Family Physician Joins Blue Cross NC as Senior VP, Health Care Services Family Physician Dr. Stephen Friedhoff has joined Blue Cross and Blue Shield of North Carolina (Blue Cross NC) in the newly-formed role of Senior Vice President, Health Care Services. Dr. Friedhoff brings extensive experience in outcomes-based care management, launching innovative health care strategies, integrating core clinical claims systems, and improving network performance and value-based contracting to the role. In his role, Dr. Friedhoff will be responsible for relationships with health care providers, medical policy, corporate pharmacy, appeals, care management, and overall leadership of the company’s health care division. He will

also lead implementation of Blue Cross NC medical cost and care initiatives such as value-based care and other innovative payment models, in addition to supporting programs for independent primary care practices. Dr. Friedhoff is a seasoned executive with more than 20 years of experience in clinical and administrative leadership roles. Most recently, he served as the Chief Clinical Officer for Help at Home. Dr. Friedhoff is a graduate of the Rutgers-New Jersey Medical School and completed his Family Medicine residency at Virtua Memorial Hospital in Mounty Holly, NJ, where he served as chief resident and was recipient of the New Jersey Academy’s Resident of the Year Award.

Connect with the NCAFP on Social... Please remember to follow the NCAFP on our social media channels! Our Twitter handle is @myncafp and on Facebook, you can find us at @ncafp.

The North Carolina Family Physician

MEMBERSHIP BEAT...

•

Thank you to our members who paid 2022 membership dues by the end-of-year deadline. As we begin a new membership year, we would like to share a few important details that may help in your planning:

Status Change: If your practice status has changed (fellowship, interrupted practice, retired), please contact the AAFP at 1-800-274-2237 x 0 to change your membership status.

•

Moved: If you have moved out of NC, please contact the AAFP at 1-800-274-2237 x 0 for a required state chapter relocation transfer to avoid cancellation. Alternatively, you may find a relocation application PDF form under the “Changes” section at www.ncafp.com/membership/member-tools-resources and submit to AAFP as instructed on the form.

•

New Life Members: Congratulations to our new Life members! Remember, this is your last invoice cycle. You will never have to pay dues after this year, and you still retain all member benefits. No CME is required, but you are always welcome to attend any of our meetings at a discounted Life member rate. We hope our paths will cross again in the future!

2022 Membership Dues for Active, Inactive, Supporting & the 2022 Class of Life Members - If you missed the January 1, 2022, payment deadline for 2022 membership dues, please enroll in the installment plan or pay your balance during the grace period to maintain your membership via one of the following options: •

Phone: Call the AAFP at 1-800-274-2237 x 0 (M-F 9:00 a.m. – 6:30 p.m.)

•

Online: www.aafp.org/quickpay (username is your email address on file with AAFP)

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AAFP Mobile App: Press More > Financial Transactions

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By Check: Make checks payable to AAFP and mail to: AAFP, 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2680

Please note: the grace period has been shortened, and the cancelation date has been moved from May to March. Please pay your dues balance or enroll in installments by March 2, 2022.

A Family Medicine Community Podcast

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December 2021 - Dr. 'Taki' Hondros

Feb. 1st - Dr. Mark Robinson

Newly-installed NCAFP President Dr. Dimitrios "Takie" Hondros discusses his leadership journey in Family Medicine and outlines a few of his goals for the next year, including mentoring the next generation of family physicians and harnessing the promise of value-based care.

Dr. Lee Beatty interviews Dr. Mark Robinson, family physician, scholar, and co-founder of the innovative Cabarrus Family Medicine Residency Program in Concord and surrounding communities.

November 2021 - NCAFP Year in Review Current NCAFP President Dr. Jessica Triche reviews the Academy's activities in 2021, including how the Academy helped our members throughout COVID, the NCAFP's new strategic initiatives, how NCAFP is helping members with administrative burden, her goals for the future and even a few humorous moments from her year as President.

Jan. 1st - Dr. Melvin Pinn Dr. Thomas White talks with the legendary Dr. Melvin Pinn. If you are not familiar with Dr Pinn and his career, you absolutely need to listen to this interview! You will hear about his growing up in segregated Lynchburg Virginia, his title of “the best marbles shooter ever”, and his career as a collegiate tennis star.

STUDENT INTEREST & INITIATIVES By: Morgan Carnes, NCAFP Student Director Wake Forest School of Medicine

STUDENT UPDATE

Finding My Home in Family Medicine Began with My FMIG When I arrived at Wake Forest School of Medicine, I had a vision for what my future practice as a physician would look like post-residency, but I was not sure what that specialty was called. I knew I wanted to have long-term relationships with my patients, to know their families and hobbies, and to be involved in their community. I wanted to incorporate my passion for education and prevention with all ages of patients, from new families with toddlers to seniors working through the challenges of aging. At my first Family Medicine Interest Group (FMIG) meeting, I learned that Family Medicine would allow me to do all of that and more. From that moment on, I became involved in every event and conference that related to Family Medicine within the state. I did not realize the community I was walking into would provide me with so many opportunities to learn about myself and to expand my vision for my future practice. My biggest takeaway from the first NCAFP Annual Meeting I attended in Asheville was the realization that I was surrounded by hundreds of physicians

who were just as passionate about all of the items I mentioned above – and that they actually wanted to be family physicians, and did not just select it as a ‘backup plan’ in case their first choice of specialty did not work out (a mentality which had unfortunately been expressed to me on more than one occasion after sharing my career aspirations). My experience at Family Medicine Day the following March showed me that there is an entire community of support through students, residents and physicians as part of Family Medicine in North Carolina. I have never felt more supported in my pursuit of becoming a primary care physician than I have with the network of North Carolina Family Medicine! My participation in the rural Summer Internship in Hendersonville even further confirmed my dedication to Family Medicine and piqued my interest in other rural settings of NC.

Ms. Carnes is a fourth-year medical student at the Wake Forest School of Medicine in Winston Salem. She grew up in Charlotte and earned Bachelor of Arts degrees in Kinesiology and Spanish at Occidental College in California. After working for a risk-based health system as an Associate of Population Health in Chicago, Ms. Carnes returned to NC for medical school. Her exposure to Family Medicine during her first interest group meeting on campus led to involvement in every Family Medicine experience possible.

My time as a Student Trustee of the NCAFP Foundation Board taught me more than the basics of budgeting and fundraising for a large organization. I have learned about true lifelong learning and leadership through connecting with family physicians who have influenced our community here in NC and around the world for decades. By engaging in conversations with these leaders – many of whom I admired since learning about their work at my first conference – for the first time I not only saw myself as a future member of North Carolina’s community of family physicians, but also as a leader. As I listened to Dr. Shannon Dowler at Family Medicine Day in 2020 speak about her journey through various phases of her career, I could envision myself standing on that stage in 20 years sharing my story of various roles I had served during my career as a family physician in NC. These experiences have confirmed that Family Medicine is the best fit for me and I look forward to learning about the various environments in which Family Medicine provides care for patients who need it most.

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Introducing the 2021-22 Student and Resident Leadership We are excited to welcome our new 2022 Student and Resident Leaders! Be on the lookout throughout the year as these leaders share their thoughts and observations as they begin their careers in medicine. STUDENTS NCAFP Student Director........................................................................................................... Morgan Carnes (Wake) NCAFP Student Director-Elect �� Morgan Beamon (Brody) NCAFP Foundation Student Trustee ��Collette O’Connor (Wake) NCAFP Foundation Student Trustee �� Keri Lanier (Campbell) Member Satisfaction & Practice Environment Committee ��Emmanuella Mensah (Brody) Payer & Systems Advocacy Committee �� Cy Fogelman (UNC) Workforce Pipeline Committee �� Kandis Fogelman (UNC)

RESIDENTS NCAFP Resident Director......................................................................................................Ryan Paulus, DO (UNC) NCAFP Resident Director-Elect ��Matthew Drake, MD (ECU) NCAFP Foundation Resident Trustee ��Caitlin Porter, DO (MAHEC-B) NCAFP Foundation Resident Trustee �� Carley Borrelli, MD (Novant) Member Satisfaction & Practice Environment Committee �� Brittany Lee, MD – (Atrium Charlotte) Payer & Systems Advocacy Committee �� Austin Witt, MD (Duke) Workforce Pipeline Committee �� Wesley Roten, MD (UNC)

Dr. Hannah Smith Offers Match Insight With a January 31st deadline to register for the National Resident Matching Program already in the rear view mirror, many students are working through the uncertainly that follows interview season. AAFP interviewed a faculty member, a fourth-year student and two Family Medicine interns (including NC's own Dr. Hannah Smith) who participated in last year's virtual Match to offer their insights on the process. See ncafp.com/match-insights-2022

Winter 2022

PRACTICE MANAGEMENT By Shawn P. Parker, JD, MPA NCAFP General Counsel & Chief of Staff

A Review of Key Elements of NCMBs' Telehealth Position Statement with Post-Pandemic Considerations Over the past decade, significant advancements in medical and communications technologies have contributed to the increased use of telemedicine as a component of the practice of medicine. Its use throughout the COVID-19 pandemic helped expand access-to-care, reduce disease exposure to medical professionals and patients, and allowed for screening and management of persons who needed clinical care but would not come in person in compliance with state-issued travel restrictions, individual reluctance out of fear of potential exposure to COVID or otherwise had difficulty accessing in-person care. In an effort to make telemedicine more widely available during the public health emergency, both state and federal authorities made substantive modifications to many laws, rules, policies, and other regulations that govern the delivery of health care through telemedicine technologies. The changes significantly contributed to the growth in its use. Prior to the pandemic, telemedicine visits accounted for a small percentage of total care visits, but within the first six months of the declared public health emergency, total telemedicine visits increased by more than 2,000 percent. Since that time, the number of total telemedicine visits may have waned since the early stages of the pandemic, however, the increased familiarity with telemedicine for patients and providers alike signal

significant continued use beyond the pandemic. North Carolina Medical Board Position Statement 5.4.1 Telemedicine serves as guidance to licensees and others on the appropriate use of telemedicine technologies for the delivery of medical care to patients located in the State of North Carolina. The Statement provides that the Board is cognizant that technological advances have made it possible for licensees to provide medical care to patients separated by a geographical distance if doing so is consistent with the applicable standard of care. And while standards of care continually shift based on the context in which medicine is practiced, the position statement clearly articulates those licensees providing care via telemedicine will be held to the same standard for care delivered through this modality as if the care was delivered in traditional in-person medical settings. The Board reviewed the Position Statement in March of 2021 made no substantive changes deeming the guidance to be sufficient in light of the growth in popularity and use during the COVID 19 public health emergency. Licensure- As provided in the Position Statement, [t]he Board deems the practice of medicine to occur in the state where the patient is located. Therefore, any licensee using telemedicine to regularly provide medical services to patients located in North Carolina should be licensed to practice medicine in North Carolina. Licensees need not reside in North Carolina if they have a valid, current North Carolina license. Care delivered via telemedicine is considered to be rendered at the physical location of the patient, and therefore, a provider to be appropriately licensed in state where the patient is located. Typically, there is an exception for episodic or follow-up care delivered to an established patient regardless of their location, as well as exceptions for consulting with physicians licensed in the patient’s location or special assessments prior to establishing the physician-patient relationship. A few states have adopted special telehealth licenses and during the pandemic many states have made specific excep-

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tions that allow an out-of-state provider to render services via telemedicine through a temporary license. North Carolina utilizes a time-limited emergency license for qualified providers during state-designated emergencies. There are two efforts worth noting which are working to address the use of telemedicine technologies across state lines. The first is the Interstate Medical Compact which provides uniform expedited licensure among the participating states. As of this writing, the compact is comprised of 34 states, the District of Columbia, and the territory of Guam. North Carolina is currently not a member but does have legislation (SB 380) introduced in the State Senate. The second is the Uniform Law Commission’s effort to establish state law to be adopted universally that creates a registration system for out-of-state practitioners. The effort proposes to allow the state board to decline to register a practitioner if it would also decline to license the practitioner. It further proposes to subject the registrant to disciplinary actions within the state of registration. Licensee-Patient Relationship- The physician-patient relationship is fundamental to the provision of medical care. It is the expectation that physicians recognize the obligations, responsibilities, and patient rights associated with establishing and maintaining a physician-patient relationship. The Position Statement stresses the importance of proper patient identification prior to any telemedicine encounter. The licensee using telemedicine should verify the identity and location of the patient. Furthermore, the licensee’s name, location, and professional credentials should be provided to the patient. Critical to establishing the physician-patient relationship is obtaining appropriate consents from requesting patients which needs to include disclosures regarding any limitations regarding the use of telemedicine technologies. Appropriate informed consent acknowledges the risks, limitations, alter-

UNC Family Medicine Center Inpatient Service Moves to the New UNC Hospital Hillsborough Campus On January 7, 2022, the UNC Family Medicine Center Inpatient Service moved into its new unit on the first floor of the new UNC Hospital Hillsborough Campus. Hillsborough Hospital is poised to continue growing, with more services locating there over the next five years. The Family Medicine inpatient service provides hospital care for Family Medicine patients as well as those from Piedmont Health Services, and services local primary care practices. It is a full-spectrum service for adult inpatient care and a rich training environment for its residents, medical students, pharmacy students, and other health professionals.

NC AHEC Practice Operational Assessments NC AHEC Practice Support provides 1:1 practice support coaching at no cost to independent family medicine practices, FQHCs, rural health centers and health departments with primary care services. This includes practice operational assessments that are available to help practices identify potential gaps or opportunities related to human resources, financial management, quality management, care access, and health information technology. Coaches will work 1:1 with your leadership and staff to perform this analysis and help you address or close these gaps. Practice support coaches have extensive experience in practice facilitation, practice management, quality improvement, health information technology, and clinical workflow redesign. If you are interested and accept Medicaid, please contact NC AHEC Practice Support at practicesupport@ncahec.net.

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Winter 2022

natives, and benefits of the telemedicine encounter and should be included. Evaluations and Examinations- Licensees using telemedicine technologies to provide care to patients located in North Carolina must provide, or rely upon, an appropriate evaluation prior to diagnosing and/or treating the patient. Evaluations via telemedicine require you to exercise clinical judgment as to your ability to facilitate aspects of the patient assessment needed to render care. “If it is possible to gather sufficient clinical information from the patient during a telemedicine consultation to provide care that meets at least the minimum accepted standards of care, then the Board considers it appropriate to use telemedicine.” The evaluation should include collection of relevant clinical history to identify underlying conditions or possible contraindications to the treatment recommended. Prescribing- According to the NCMB’s COVID-19 Telemedicine FAQs, “if it is possible to gather sufficient clinical information during a telemedicine encounter to provide care that meets at least the minimum accepted standards of care, NCMB considers it appropriate to prescribe [controlled substances] following that encounter.” The guidance further notes this exception may be linked to a shifting standard during the public health emergency. For the duration of the declared federal state-of-emergency related to the coronavirus pandemic, DEA has waived the requirement for an in-person medical evaluation for both established and non-established patients prior to prescribing controlled substances as long as certain conditions are met. One condition is the encounter must be conducted using an audio-visual, real-time, two-way interactive communication system. Prior to the Pandemic, the DEA was directed by Congress to create a special registration for telemedicine. Those regulations have not yet been enacted, possibly for the lack of necessity due to the public health emergency exception.

the history, review of systems, consultative notes, or any information used to make a medical decision about the patient must be documented along with a note that the service was provided through telemedicine. Of note, the Position Statement includes the following: "Licensees practicing via telemedicine will be held to the same standards of professionalism concerning the transfer of medical records and communications with the patient’s primary care provider and medical home as those licensees practicing via traditional means. These records should be readily accessible in a format for future patient use." Training of Staff- Staff involved in the telemedicine visit should be trained in the use of the technology being used to deliver care and competent in its operation. Physicians and their staff will need to have basic knowledge of technology needed for the delivery of high-quality telehealth services. This includes understanding when and why to use telehealth and how to assess patient readiness, patient safety, practice readiness, and end-user readiness. References Cortex C, Mansour O, Qato DM, Stafford R, Alexander C. Changes in Short-term, Long-term, and Preventative Care Delivery in US Office-Based and Telemedicine Visits During the COVID-19 Pandemic. Jama Health Forum. 2021;2(7):e211529. Doi:10.1001/jamahealthforum.2021.1529 Federation of State Medical Boards. Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine. April 2014. https://www.ncmedboard.org/resources-information/faqs/ covid-19-telemedicine-faqs North Carolina Medical Board. Position Statement 5.4.1: Telemedicine. May 2021. R. David Henderson, JD. NCMB Update and Telemedicine overview. Presentation to NCAFP Board of Directors. December 2, 2021.

Medical Records- Documentation requirements for a telemedicine service are the same as for a faceto-face encounter. The information about the visit,

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CAREPOINTS

The Need for New Solutions to the Mental Health Tsunami of the COVID Pandemic By: Samantha Meltzer-Brody, M.D. Assad Meymandi Distinguished Professor & Chair, UNC Department of Psychiatry; Director, UNC Center for Women’s Mood Disorders

Reprinted with slight edits with permission from the NC Psychiatric Association magazine and from Dr. Metzer-Brody.

The mental health impact of the COVID-19 pandemic is enormous and constitutes a public health crisis. Both national and international data demonstrate worsening mental health globally.1 Primary drivers of worsening mental health include worry and stress of contracting COVID-19, caring for sick family members, loss of a loved one to COVID-19, disrupted employment, economic hardship, social isolation, school closures, and loss of childcare. This crisis has led to a massive need for psychiatric and behavioral health care that our U.S. health care system is not prepared to absorb. The following sobering statistics paint the story of the magnitude of the need. Population data estimates from the Household Pulse Survey, a partnership of the National Center for Health Statistics (NCHS) with the Census Bureau, show 4 in 10 adults had clinically significant symptoms of anxiety and/or depression in January 2021, a marked increase compared to a similar time period in 2019 (pre-pandemic).2 Communities of color have been disproportionately impacted; 48% of non-Hispanic black adults report symptoms of anxiety and/or depressive disorders, compared to non-Hispanic white adults (41%).4, 5 Data from the March 2021 Kaiser Family Foundation (KFF) report demonstrates that younger people and women, including mothers, have been those who are hardest hit by the mental health impact of the pandemic.

The impact of the pandemic on our youth

If we look specifically at the impact on our children and teens, the pandemic has been particularly cruel. Between

March and October 2020, the percentage of emergency department visits for children with mental health emergencies rose by 24 percent for children 5 to 11 years old and by 31 percent for children and teens 12 to 17 years old (CDC).3 There has also been a devastating 50 percent surge in emergency department visits for suspected suicide attempts among girls 12 to 17 years old. Suspected suicide attempts climbed in boys by 3.7 percent.7 New data from the 2022 Mental Health in America Report confirms and expands the CDC data: more than 2.5 million youth (10.6%) have severe major depression, and 15.7% of youth experienced a major depressive episode in the past year. In North Carolina specifically, the chronic under-funding of child and adolescent mental health services has led to a dire situation across the state. North Carolina is near the very bottom of all 50 states in terms of funding for child and adolescent mental health services.6 This egregious situation has caused our emergency rooms to be filled with our youth requiring care, there is a horrendous lack of inpatient psychiatry beds for children and adolescents. Parents (and primary care physicians) are unable to find outpatient clinicians for mental health care of these children. It is simply unacceptable. The path forward Innovative approaches are needed to address the mental health crisis. This will require new resources, widespread collaboration, and a financial investment from all stakeholders, including federal, state, and local entities. It will also require a robust and coordinated effort to make meaningful change. I want to share an example of what UNC is doing to tackle the impact of the mental health crisis. UNC Health and the Department of Psychiatry are significantly expanding the scope of clinical services to address the ever-growing need across the state in all aspects: inpatient beds, outpatient services, scope of our training mission, and expanded research programs. We are building our capacity to expand the reach of telepsychiatry services across UNC Health entities in North Carolina, many in rural areas. At the university, in response to three tragic deaths of students from suicide over a one-month period, the Chancellor called for a November 15th Mental Health continues on next page

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Summit for the UNC Community. The goal of the Summit was to educate, engage, and foster discussion among faculty, staff, and students, and included opportunities to hear diverse voices and perspectives from students, faculty, and parents, learn from national leaders, and hear from campus working groups focused on prevention, crisis response, and campus culture. The discussions will help distill a set of recommended action items to augment new initiatives already in process and being deployed. The UNC Mental Health Summit is the beginning of a conversation about where we are now and where we need to go next. It is a great model of what needs to be happening in North Carolina, at all levels, to discuss the mental health landscape. Primary Care Collaborating with Psychiatry (Added for NCAFP with permission) - This is not just a concern for psychiatrists, but for primary care physicians as well. Psychiatry knows how critical family physicians and pediatricians are to caring for patients with mental illness. One of the potential benefits of moving to Medicaid Managed care is once again allowing primary care to provide services to individuals with mild to moderate behavioral health issues, thereby integrating mental health care back into primary care rather than carving it out to the state’s LME/MCOs. As the state moves to tailored plans at the end of this year, LME/MCOs will change their focus and will be concentrating on whole-person care for persons with severe and persistent behavioral health issues. These changes provide an opportunity for mental health and primary care professionals and organizations to work together more closely to provide whole-person care in the medical home. The Collaborative Care Model is one evidence-based way to do just that, using behavioral health care managers working with a primary care physician and a consulting psychiatrist. We are seeing how this is working in the UNC system and across the state. This is particularly timely, as behavioral health issues related to COVID are significantly stressing the current system. Together, our specialties—Family Medicine and Psychiatry—can and must do great work to build new solutions for mental health care. Editorial Note: The NC Psychiatric Association (NCPA) and the NC Academy of Family Physicians, along with others, are

already in discussions on how we can better collaborate to combat this growing crisis. The NCPA, NCAFP, NC Pediatric Society, NC AHEC Program and Community Care of NC, have a history of collaborating to try to address behavioral health issues going back at least 15 years. More recently, the organizations have been discussing how to work to better integrate behavioral health into primary care through the Collaborative Care Model and other efforts. In the coming months, it is expected that NCPA, NCAFP, NC Peds, NC AHEC, CCNC and others will introduce further education and assistance on this model. Both Medicaid and Medicare already pay for using collaborative care codes in primary care, and we hope our commercial insurers will do so in the near future as well. Look for additional information as it becomes available. REFERENCES: 1.

(LANCET, https://www.thelancet.com/infographics/covid-mental-health)

https://www.cdc.gov/nchs/covid19/pulse/mental-health.htm https://www.cdc.gov/mmwr/volumes/69/wr/mm6945a3. htm?s_cid=mm6945a3_w

3. Leeb RT, Bitsko RH, Radhakrishnan L, Martinez P, Njai R, Holland KM. Mental Health–Related Emergency Department Visits Among Children Aged <18 Years During the COVID-19 Pandemic — United States, January 1–October 17, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1675–1680. DOI: http://dx.doi. org/10.15585/mmwr.mm6945a3external icon 4.

Panchal N, Kamal R, Cox C, Garfield R. The Implications of COVID-19 for Mental Health and Substance Use. Feb 10, 2021. DOI: https://www.kff.org/coronavirus-covid-19/issue-brief/theimplications-of-covid-19-for-mental-health-and-substance-use/

Kearney A, Hamel L, Brodie M. Mental Health Impact of the COVID-19 Pandemic: An Update, April 14, 2021. DOI: https:// www.kff.org/coronavirus-covid-19/poll-finding/mental-healthimpact-of-the-covid-19-pandemic/

6. Reinert, M, Fritze, D. & Nguyen, T. (October 2021). “The State of Mental Health in America 2022” Mental Health America, Alexandria VA. 7. Yard E, Radhakrishnan L, Ballesteros MF, et al. Emergency Department Visits for Suspected Suicide Attempts Among Persons Aged 12–25 Years Before and During the COVID-19 Pandemic — United States, January 2019–May 2021. MMWR Morb Mortal Wkly Rep 2021;70:888–894. DOI: http://dx.doi. org/10.15585/mmwr.mm7024e1.

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'Inaugural Address,' continued from p7

Family physicians, along with being here for each other, are also here to be voices for their patients. Patient advocacy -- as healthcare may quickly change next year -- will be a key area for the NCAFP to continue in 2022. We must continue our hard work with insurance companies and the state legislature to ensure everyone can have access to affordable healthcare. Advocating coverage for collaborative ancillary services, like nutritional, behavioral, and wellness in the primary care setting, will help improve health care outcomes.

That is the NCAFP, a place where for me in the last 20 plus years, I have come to learn, grow, and adapt as a family physician. Learn from your leaders, learn from colleagues, learn from your patients, learn from your families, and most importantly, as master Yoda once said, ‘pass on what you have learned…” to the future physicians of our profession. Always keep your head up, always beg the question, and always be a voice with your colleagues. The members of this Academy are working every day in the trenches because we know how to best deliver cost-effective and phenomenal healthcare. Do not be afraid to speak up and never be afraid to challenge the status quo for the betterment of our patients and our profession. It is truly an honor to be standing here tonight, and I will do my best to uphold the oath I took tonight. Know, I am always here for you, never hesitate to reach out if you ever need anything, and above all, please take care of yourselves and each other!! Non-Profit Org. US Postage

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Pontiac, Illinois Permit No. 592

We also must continue our efforts to reduce the administrative burdens faced by family physicians across the state and, at the same time, work to ensure that Family Medicine is valued by payers so that we can put great teams around us to assist in our efforts with the increasing complexity of our patients.

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The NCAFP will continue our mission of inclusion. I have been blessed to work with current and past leaders from all walks of life. Family physicians like Drs. Tamieka Howell, Rhett Brown, Jessica Triche, David Rinehart, Charlie Rhodes, and Alisa Nance, have provided amazing guidance and leadership on this subject. We will continue to advocate from the state and national level down to help ensure family physicians from all backgrounds will continue to be included in various arenas of health care. We will also continue to be inclusive within our own leadership at the NCAFP. At the end of the day, we are here to learn, respect, and support each other, as a community that celebrates diversity.

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comprehensive care from the medical home and not charge a patient’s deductibles if services are delivered there. This is truly how we drive down health care costs.

Lastly, as we are hopefully coming out of this pandemic, let us not forget that what we practice is called the ‘art’ of medicine. Let’s be open minded when it comes to the ever-changing recommendations in medicine. Let’s respect one another if sometimes our medical opinions may differ. Let’s continue to engage each other, learn from our differences, learn from each other, and at the end of the day, agree that we are all here for one overall purpose: the betterment of our profession and the betterment of the health of our patients. Our patients aren’t a medical statistic or a number. Each patient has a different background, and that impacts how you strive to personalize their healthcare delivery.