NC Family Physician - Fall 2023

Volume 19 Issue 4 • Autumn 2023

The North Carolina

Family Physician Quarterly News in North Carolina Family Medicine

75 Years of the Annual Meeting That Celebrates You PG. 8

Learn more at www.ncafp.com/cme Family Medicine Academic Summit

Friday, Feb. 16, 2024 and Saturday, Feb. 17, 2024 Sheraton Imperial Hotel Raleigh-Durham Program Chairs: Regina Bray Brown, MD & Molly Benedum, MD Approximately Eight CME Credits Available

Virtual DOT Medical Examiner Cer�ca�on/Re-cer�ca�on Training

Saturday, March 16, 2024 8 a.m. to 3:30 p.m.

Instructor: Thomas R. White, MD Approximately Six CME Credits Available

Virtual Complex Pain Project

Two OpportuniƟes to ParƟcipate!

Wednesday, May 15, 2024 6 to 8:15 p.m. or Saturday, May 18, 2024 9 to 11:15 a.m.

Instructor: Stephen Prakken, MD Approximately Two CME Credits Available

Virtual KSA Opportunity

Friday, June 21, 2024 5:30 to 8:45 p.m.

Instructor: Jonathon Firnhaber, MD Approximately Eight CME Credits Available

Virtual Summer Symposium

Saturday, June 22, 2024 8 a.m. to 3 p.m.

Program Chair: Lisa Cassidy-Vu, MD Program Vice Chair: Amir Barzin, MD Approximately Eight CME Credits Available

30-Minute Hot Topic Exchanges: A CME, Dinner, & Networking Opportunity Tuesday, Oct. 1, 2024 6 to 8:30 p.m.

Charlo�e, NC Approximately 1.75 CME Credits Available

2024 Winter Family Physicians Weekend

Thursday, Dec. 5, through Sunday, Dec. 8, 2024 Omni Grove Park Inn | Asheville, NC Program Chair: Thomas R. White, MD Program Vice Chair: Katherine Haga, MD Approximately 30+ CME Credits Available *Pre-Conference KSA | Wed., Dec. 4, 2024

Count on the NCAFP’s brand of high-quality, Ɵmely educaƟon you need and want, brought to you by Family Medicine experts every Ɵme!

Visit us at www.ncafp.com/cme for informa�on about these events, or contact Kathryn Atkinson, CMP, Director of CME & Events at Katkinson@ncafp.com for more details.

Inside Autumn 2023

Many of Your NC Family Medicine Colleagues Will Be Featured at This Year’s Annual Conference PG. 16

ADVOCACY

PROFESSIONAL DEVELOPMENT

4 Advocacy Victories to Reduce Administrative

16 Many of Your NC Family Medicine Colleagues

6 State Budget Brings Advocacy Wins for

MEMBERSHIP SERVICES

Burdens by Changing Prior Authorizations

Family Medicine

CHAPTER AFFAIRS

8 75 Years of the Annual Meeting That

Will Be Featured at This Year’s Annual Conference

20 That’s What Family Doctors Do: We Gain Knowledge

PRACTICE MANAGEMENT

Celebrates You

28 The Deadline to Apply for Making Care Primary

PUBLISHED BY

DEPARTMENTS

t 919.833.2110 • fax 919.833.1801 • ncafp.com Editor Kevin LaTorre, NCAFP Communications Managing Editor, Design & Production Peter T. Graber, NCAFP Communications

Pilot with Medicare is Nov. 30

Advocacy 4 Chapter Affairs 8 Health Landscape 14 Professional Development 16 Membership Services 20

Residents & New Physicians 22 Student Interest & Initiatives 24 NCAFP Foundation 27 Practice Management 28

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

ADVOCACY

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

Advocacy Victories to Reduce Administrative Burdens by Changing Prior Authorizations Thanks to the ongoing advocacy work of both the NCAFP and American Academy of Family Physicians (AAFP), UnitedHealthcare (UHC) took a significant step to reduce prior authorizations beginning on Sept. 1.

The first modifications (which began on Sept. 1) include codes for UHC’s commercial, Medical Advantage, and individual health care exchange plans. Those

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same plans will include more reductions on Nov. 1, along with the UnitedHealthcare Community Plan, which is the Medicaid Managed Care plan in North Carolina. Between the two planned reductions, UHC is eliminating nearly 20% of the overall volume of prior authorizations they previously required. The reductions involve hundreds of codes, including some of the most-ordered imaging in primary care. Please refer to each covered code removal list for specifics of each plan at https://www.uhcprovider.com/en/resource-library/ news/2023/medical-prior-auth-code-reduction-august. html.

In announcing the changes, UnitedHealthcare noted, “This is part of our comprehensive effort to simplify the health care experience for our members and network health care professionals. While prior authorization remains an important tool to address clinical quality and safety, as well as fraud, waste, and abuse, we also know that fewer prior authorizations can help streamline care delivery.”

UnitedHealthcare plans to take another significant step in 2024, when the payer will implement a national Gold

The North Carolina Family Physician

Card program for provider groups who meet certain eligibility requirements.

The groups that qualify will follow a simple administrative notification process for most procedure codes, rather than the prior authorization process.

UHC will release additional information on that program later this year.

FAMPAC

Empowering Family Medicine

But there’s still more good news! Carolina Complete Health, the provider-led plan for North Carolina’s Medicaid Program which is a joint venture of the NC Medical Society and Centene, is also taking steps to reduce prior authorizations.

In a recent meeting between NCAFP’s leadership and Carolina Complete Health’s leadership, the plan stated that they are in the process of reducing prior authorizations, and that we should also see reductions in Centene’s marketplace and Medicare Advantage plans as well. As with the UHC Gold Card program, more information on these changes will be forthcoming soon.

Both the NCAFP and AAFP continue to advocate for administrative simplification and reduction of prior authorization requirements. Any time that NCAFP representatives meet with a payer, we always stress the burden of prior authorizations on family physicians. Because of what we hear from our members, we will continue to advocate for removal of prior authorizations and other steps to reduce administrative burdens for the family physicians of our state.

JOIN THE FIGHT FOR FAMILY MEDICINE See 'Governor's Institute' on back cover Continues on next page

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

continues on Back Cover

Autumn 2023

STATE DEVELOPMENTS

State Budget Brings Advocacy Wins for Family Medicine The largest investment in primary care in decades includes $44 million for loan repayment and medical school forgivable loans.

The 2023-24 state budget includes a number of advocacy wins for Family Medicine and primary care. First and foremost, with passage of the budget, the state can finally move forward with implementing Medicaid expansion, which will provide coverage to hundreds of thousands of North Carolinians. In addition to this historic achievement, the budget includes several provisions that fund or address key advocacy priorities that the NCAFP has long championed.

Efforts to Expand Primary Care Workforce The budget advances the NCAFP’s priority of strengthening and expanding the primary care physician workforce in North Carolina through three key provisions.

First, the budget establishes a Forgivable Loan Program (up-front scholarships) for existing medical students interested in practicing primary care or psychiatry in rural areas of the state, which as written would include 80 of the state’s 100 counties. A student can receive up to $25,000 per year of medical school, which will be forgiven if they work in a rural area one year for every year they receive the scholarship. The budget allocates $16 million over the next two years to help fund the program. Students residing in an eligible county will receive priority for these scholarships.

Second, the budget provides $25 million per year for two years in new funding (above and beyond the exist-

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ing funding) for loan repayment programs for health care professionals. That includes $9 million extra per year for two years for the existing State Loan Repayment Program, for which family physicians qualify. In addition, a new Primary Care Loan Repayment Program is added at a level of $5 million a year for two years for practicing family physicians, general internists, general pediatricians, OB/GYNs, psychiatrists, and general surgeons practicing in a critical access hospital. This new program will be administered by the Office of Rural Health. Independent practices in rural or medically-underserved areas are deemed automatically eligible for this new program as long as at least The North Carolina Family Physician

• establish a standardized method to measure primary care spend • conduct an actuarial evaluation of the current health care spend on primary care services in Medicaid, commercial, and Medicare Advantage plans in North Carolina • study the primary care landscape in other states • identify data collection and measurement systems to inform creation of a primary care investment target • make recommendations back to the NC General Assembly on how to potentially increase investment in primary care

one clinician in the practice is accepting Medicaid patients.

In total, the budget includes $44 million in new scholarship or loan repayment funding for family physicians and others in key specialties of need.

Finally, the budget provides funding for the NC Area Health Education Centers Program (NC AHEC) to study the need for community preceptors for clinical rotations in outpatient primary care for medical students, physician assistant students, and nurse practitioner students. The study will look at the supply of community preceptors in NC, the demand, what it costs for a practice to serve as a precepting site, and then bring recommendations to the General Assembly on how to increase the supply of community preceptors. This portion of the budget also directs NC AHEC to select or develop five rural clinical teaching sites that will receive $150,000 per year (recurring) to offset teaching time in those clinics. Each site will be required to teach both medical students and either PA students or NP students.

The NCAFP has been working with Senate leaders to establish a task force like this one. Several other states that have undertaken such efforts have ultimately required an increase in primary care investment by insurance plans. The NCAFP looks forward to helping lead this work as part of our ongoing advocacy to reward family physicians for the value they bring to the health care system as a whole.

The General Assembly took final votes to approve the budget on Sept. 22, with Gov. Cooper announcing he would let the budget become law without his signature on that same day.

The NCAFP has advocated for all these workforce provisions and looks forward to working with the state to implement them.

Study of Primary Care Payment and Investment In addition to these provisions, the budget includes the creation of a Primary Care Payment Reform Task Force which will have representation from the NCAFP. The task force is designed to:

Autumn 2023

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CHAPTER AFFAIRS

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

75 Years of the Annual Meeting That Celebrates You As we near the penultimate event of NCAFP’s 75th Anniversary celebration, our 2023 Winter Family Physicians Weekend, it only seems appropriate to look back at the history of our annual meetings. So, this quarter, we will view the history of the NCAFP through the lens of our most important event of the year.

Founding leaders of what would become the NC chapter of the American Academy of General Practice (AAGP) pulled 42 North Carolina physicians together on Feb. 22, 1948, to pass a resolution approving the formation of our chapter. That meeting, only a few short years after World War II, started the long history of annual meetings for our chapter. In fact, Chapter VIII of the NCAFP’s Bylaws call for an Annual Meeting to be held “at a time and place to be determined by the Board of Directors.” Notice of such meeting must be given to all members by mail or electronic communications at least 60 days prior to such a meeting. The bylaws go on to outline that “board meetings, general business meetings, and scientific sessions shall be held at such time during the Annual Meeting.”

While the details on the first 15 years or so of our annual meetings are sketchy, we do still have some information. For example, in 1953-54, the NCAGP meeting was held aboard the MS Stockholm, cruising to Havana and Nassau, with the AAGP President in attendance. The MS Stockholm also served as home to the annual meeting in 1959, but a separate meeting was held at Sedgefield Manor in Greensboro for those physicians unable to go on the cruise.

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Our archives begin to reveal much more as we delve into the 1960s, especially in copies of the “Tar Heel Practitioner,” which served as the organization’s print newsletter. In the November 1966 edition, an article about the 18th Annual Meeting of NCAGP notes that over 160 members attended the event held at the Jack Tar Hotel in Durham for three days of education, fellowship, and rest. Jumping forward a few years, we see that the NCAFP’s 1971 budget included total annual meeting registration fees of $2,000 with an expected attendance of 130 members paying $15 each to attend the meeting. That Annual Meeting would be held in October at the Hilton Inn in Raleigh.

In November 1976, NCAFP President Dr. William W. Hedrick convened the Annual Meeting at the Royal Villa Hotel in Raleigh. At that time, the AAFP nationally had grown to 37,000 members. The 1979 Annual Meeting was held at the Sheraton Center in Charlotte, which would also represent the 31st Annual Business Meeting of the NCAFP. And while it now may seem like the Annual Meeting has been held at the Omni Grove Park Inn forever, the NCAFP first met there for the Annual Scientific Assembly Oct. 14-17, 1987. It would be a few more years before the Grove Park Inn became the NCAFP mainstay that it is today.

In the late 1980s, the meeting continued to bounce around from the Holiday Inn Four Seasons in Greensboro (1988) to the Adams Mark in Charlotte (1989) and back to Greensboro in 1990. This was also the period where the Annual Meeting and Scientific Assembly moved from the fall (1988) to the spring (1989).

The meeting would remain a spring-time event for a few years, but the NCAFP would still have additional education later in the year (now coined the Winter Family Physicians Weekend), which was held in Raleigh in 1989 and 1990 before the big move happened.

While the NCAFP Annual Meeting remained in the Triangle (at the Sheraton Imperial) in 1991, the NCAFP started what is now a 30-plus-year love affair with the Omni Grove Park Inn by holding a separate meeting, the 1991 Winter Family Physicians Weekend, there on Nov. 22-24, 1991. About 200 people The North Carolina Family Physician

attended, and since that time, we have made an annual trek to Asheville.

It would be a few more years before the “official” Annual Meeting landed at the Grove Park Inn, but the NCAFP still had its Winter Family Physicians Weekend there from 19921994, while the Annual Meeting and Scientific Assembly remained in the Spring in Greensboro in 1992, Charlotte in 1993, and back in Greensboro in 1994.

resident attendance, we super-charged those efforts with grant funding in 2010. As a result of those efforts and more family physicians from North Carolina and elsewhere wanting to attend, the Annual Meeting grew tremendously from 543 attendees in 2009 to over 800 by 2012. Attendance remained between the high 700s and low 800s until we faced a global pandemic, with peak attendance of 829 in 2017.

The chapter pivoted quickly in 2020, with staff changing a Spring Meeting to a virtual meeting in only three weeks and also hosting our first-ever As attendance at the chapter’s AnAnniversary Virtual Annual Meeting that Decemnual Meeting waned a bit in the early 1947-2023 ber.

Even virtually, we had 462 regis1990s, NCAFP leadership decided to trants and held our Executive Committee move the Annual Meeting and Scientific Meeting in person in a socially-distanced manAssembly back to late November or early Dener at the Grove Park Inn, ensuring that even during cember. Attendance then soared to 370 attendees with a global pandemic a few of us still made the trek to the marriage of the Annual Meeting and our Winter the mountains. We were able to return to an in-person Family Physicians Weekend in Asheville in 1995. meeting in 2021 but with a limited attendance of 586, but the meeting once again exceeded 700 attendees in So, if you get asked a trivia question about how long 2022. This year’s annual meeting is on pace to once the NCAFP has held its Annual Meeting in Asheville again reach the high 700s for attendees. at the Omni Grove Park Inn, listen very carefully to how the question is asked. Here are three answers: While I’ve only personally experienced the Annual Meeting's growth since 2005, it was great to take a • The NCAFP first held an Annual Meeting at the walk down memory lane through our archives all the Omni Grove Park Inn in 1987. way back to 1948. I smiled at so many pictures from • The Chapter has had meetings based there every year those meetings over the years, especially at photos of since 1991. past leaders of the NCAFP, many of whom I was able • However, the Annual Meeting has been held there to meet and get to know even long after their tenures continuously since 1995. as president.

Are you confused yet?

Each of our 4,200 plus members should be proud of the legacy of the NCAFP — whether it’s the history of The most important thing to remember is that the the Annual Meeting outlined here, our history of past NCAFP, the Grove Park Inn, the National Gingerleaders of AAFP, or our fights for you and your patients bread House competition, and the week after Thanksat the General Assembly. The NCAFP truly has a great giving have become almost synonymous over the last history that I hope and believe will still be strong in 30 years, growing from that record of 370 attendees in another 75 years. And then in 2098, someone else will 1995 to more than 700 by 2023. The meeting reached be digging through the electronic archives and read over 400 attendees in 2004, and over 500 attendees this article with a laugh or a smile. in 2007 (also the year I became your Executive Vice President after the long tenure of Sue Makey).

While the chapter has always focused on student and Autumn 2023

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FAMILY DOCS IN ACTION

By Shawn Parker, JD NCAFP General Counsel

These Physicians Serve Their Patients Through State-Based Leadership For a long time, physicians have held a special position in society. In addition to clinical responsibilities, many doctors frequently serve as leaders and advocates at the state and local level. Family physicians offer a unique position of insight given the breadth of their specialty and natural inclination for direct patient interaction, and they can provide useful perspectives outside their scope of medical practice. As respected members of their communities and key members of the health care ecosystem, family physicians have the opportunity to get involved and make a difference at any and all levels. The NCAFP is fortunate to see an abundance of its members serve in many venues of community, civic, and professional volunteer work. We would like to highlight a few members who have been recently appointed to a state board or commission by legislative act or executive order.

Robert “Chuck” Rich, Jr., MD North Carolina Medical Board Dr. Robert L. (Chuck) Rich, a NCAFP past president and current NCAFP Board member (American Academy of Family Phyisicians Delegate), was appointed by Gov. Roy Cooper to serve an initial three-year term on the North Carolina Medical Board (NCMB). Dr. Rich is a practicing family physician with Bladen Medical Associates in Elizabethtown. Dr. Rich is certified by the American Board of Family Medicine and is the AAFP representative to the National Academy of Medicine – Opioid Collaborative (Prescribing Guidelines Working Group), as well as a member of the NC Prescription Drug Abuse Advisory Committee.

The North Carolina Medical Board was created to regulate the practice of medicine and surgery for the benefit and protection of the people of North Carolina. Established on April 15, 1859, the Board is one of the oldest medical regulatory boards in the country. The Board consists of 13 members — 11 appointed by the governor and two appointed by the General Assembly upon the recommendations of the Speaker and the President Pro Tempore. In addition to Dr. Rich, NCAFP members Dr. Christine Khandelwal and Dr. Devdutta Sangvai currently serve on the NCMB and will ascend respectively to the offices of President and President-Elect on Nov. 1 of this year.

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Kerry Willis, MD Board of Trustees of the State Health Plan for Teachers and State Employees Dr. Kerry Willis is a practicing physician at Open Water Medical PA. He founded the practice over 30 years ago in Beaufort and has overseen its growth to multi-site locations in NC. Dr. Willis is actively involved with the NCAFP and is currently a member of the Advocacy Committee.

Dr. Willis was appointed to the Board of Trustees of the State Health Plan by the General Assembly upon the recommendation of the President Pro Tempore of the Senate. The State Health Plan is the medical and pharmacy benefit program that covers more than 720,000 teachers, state government employees, law enforcement officers, retirees, current and former lawmakers, and state university and community college personnel and their families. The State Health Plan is self-insured and funded by employee premiums and taxpayer monies and is overseen by the Treasurer’s office and a Board of Trustees who serve as fiduciaries. Its Board of Trustees consists of 10 members, who are experts in medicine, health administration, and education.

The North Carolina Family Physician

2022-2023

NCAFP Board of Directors

Garett R. Franklin, MD North Carolina Board of Athletic Trainer Examiners

Executive Officers President

Shauna Guthrie, MD, MPH

President-Elect

Dr. Garett R. Franklin, who serves NCAFP as President-Elect and will become President in December of this year, was appointed to the Board of Athletic Trainers by the General Assembly upon the recommendation of the Speaker of the House. He is currently practicing Family Medicine and sports medicine at Raleigh Medical Group/Cary Medical Group, while also working at NC State University as a team physician. In addition to this service, Dr. Franklin has chaired and been active on multiple NCAFP committees and many advocacy-related projects.

The North Carolina Board of Athletic Trainer Examiners was established to regulate the profession of athletic training in the interest of protecting public health, safety, and welfare. The Board enforces standards and criteria set forth in statute and adds specificity through the promulgation of regulations. The Board consists of seven members, including only one member who is a licensed family physician or pediatrician.

Garett R. Franklin, MD

Secretary/Treasurer

Mark McNeill, MD

Immediate Past President Executive Vice President

Dimitrios P. Hondros, MD Gregory K. Griggs, MPA, CAE

At-Large Directors Joshua Carpenter, MD Lisa Cassidy-Vu, MD Deanna Didiano, DO Nicole Johnson, MD, MPH Kelley Lawrence, MD, IBCLC, FABM Benjamin F. Simmons, MD Patrick Williams, MD Courtland Winborne, MD

Academic Position Margaret Helton, MD (UNC)

Resident Director Matthew Drake, MD (ECU)

Deanna M. Didiano, DO North Carolina Board of Dietetics and Nutrition

Resident Director-Elect Morgan Parker, DO (Novant Health) Student Director Morgan Beamon (ECU)

Dr. Didiano, a member of the NCAFP Board and Chair of the Advocacy Committee, was appointed by Gov. Cooper to serve on the Board of Dietetics and Nutrition. Dr. Didiano currently practices sports medicine for Atrium Health in the greater Charlotte area. She serves as team physician for Lincoln County high schools and team physician for Queens University in Charlotte. Prior to transitioning to full-time sports medicine, Dr. Didiano practiced Family Medicine and served as Medical Director of Atrium Health Primary Care Denver Family Medicine.

Student Director-Elect Akhila Boyina (Wake Forest)

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

The North Carolina Board of Dietetics and Nutrition was established to safeguard the public health, safety, and welfare and to protect the public from being harmed by unqualified persons by providing for the licensure and regulation of persons engaged in the practice of dietetics or nutrition. The Board is composed of seven members, one of whom must be a licensed physician.

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

Autumn 2023

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www.ncafp.com

Eugene Reynolds II, MD Justus-Warren Heart Disease and Stroke Prevention Task Force

ing of the conduct, promotion, and performances of live boxing, mixed martial arts, kick-boxing, and tough man contests in the state.

Dr. Eugene Reynolds II is a physician at Kintegra Health in Gastonia, where he has practiced Family Medicine for the past 24 years. Dr. Reynolds was appointed by the governor to serve on the Justus-Warren Heart Disease and Stroke Prevention Task Force in July. The Task Force is comprised of clinicians, members of the General Assembly, public health leaders, and many other partners committed to environmental and systems change that will improve cardiovascular health.

Gabriela Marie Plasencia, MD NC Minority Health Advisory Council

Corinna Lynn Myers, DO NC Human Trafficking Commission Dr. Corinna L. Myers practices in Concord and is affiliated with Atrium Health-Cabarrus Family Medicine, where she also received her residency training.

Dr. Myers has been involved with NCAFP committee work and recently completed a Policy and Advocacy Rotation with the Academy during her residency.

Dr. Myers was appointed by the Governor to serve on the North Carolina Human Trafficking Commission, which was established by the NC General Assembly to lead anti-human trafficking efforts in North Carolina.

Scott A. Playford, MD, MBA NC Boxing and Combat Sports Commission Dr. Scott Playford was appointed by the General Assembly to serve as one of two physician non-voting advisory members to the North Carolina Boxing and Combat Sports Commission. The Commission is charged with issuing participants licensing and developing rules for sanctioning and regulat-

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Dr. Gabriela Marie Plasencia was appointed by the Governor to serve on the N.C. Minority Health Advisory Council. Dr. Plasencia is currently a post-doctoral fellow with the National Clinician Scholars Program, a Health Equity Policy and Primary Care Fellow with the Duke-Margolis Center for Health Policy, and a Clinical Associate Faculty at the Duke University Department of Family Medicine and Community Health.

Vickie A. Fowler, MD and Lawrence Wu, MD NC Advisory Committee on Cancer Coordination and Control Dr. Vickie A. Fowler and Dr. Lawrence Wu both serve on the NC Advisory Committee on Cancer Coordination and Control, a legislatively-mandated committee of 34 members whose mission is to facilitate the reduction of cancer incidence and mortality for all North Carolinians, enhance statewide access to quality treatment, and maximize quality of life for cancer survivors, patients, and their loved ones. Dr. Fowler, who has been very active in the NCAFP and is currently on the Board of Trustees of the NCAFP Foundation, serves as the governor’s appointee of a Licensed Primary Care Physician. She practices with WakeMed in Raleigh and has been serving as co-chair of the Committee. She will become chair later this year.

Dr. Wu serves as a representative of the NC Association of Health Plans and is a long-term leader on the Com-

The North Carolina Family Physician

mittee. He is a Medical Director for Blue Cross and Blue Shield of North Carolina Shannon Brown Dowler, MD, FAAFP, CPE NC Interagency Council for Coordinating Homeless Programs Dr. Shannon B. Dowler, a past president of both the NCAFP and the NCAFP Foundation, currently serves as the Chief Medical Officer for North Carolina Medicaid. In this capacity she has been appointed to serve the Interagency Council, which was established by Executive Order to advise the Governor, his cabinet, and other state agencies on issues related to housing stabilization and services for persons that are homeless or at risk of homelessness.

In Conclusion Many physicians and professional leaders agree that community participation is an important role for physicians.

This service contributes significantly to their communities by offering valuable health expertise to the public, but it also provides opportunities for physicians to better understand the social, business, and governmental context of health policy. The NCAFP thanks these and other physician members for their service to the state and their communities. If you would like to become more involved, your NCAFP team is here to help anyway we can! Contact us at shawn@ncafp.com or ggriggs@ncafp.com.

In addition to the appointments mentioned above that were made in the last 12 months, we would like to highlight a few other NCAFP members who received appointments in recent years.

Rebecca T. Putnam, MD NC Council on Developmental Disabilities Dr. Rebecca T. Putnam, a family physician at MAHEC in Asheville, is a Gubernatorial Appointee to the NC Council on Developmental Disabilities as a parent or guardian of an individual with a mentally-impairing developmental disability. The North Carolina Council on Developmental Disabilities works to ensure that people with intellectual and developmental disabilities (IDD) and their families participate in the design of and have access to needed community services, individualized supports, and other forms of assistance that promote self-determination, independence, productivity, and inclusion in all areas of the community. Dr. Putnam will be presenting on IDD and Autism at our Annual Meeting in December.

Autumn 2023

The NCAFP Staff Visited the Country Doctor Museum in Bailey!

As a treat for the end of August, the NCAFP staff traveled out to Bailey, NC to visit the spectacular Country Doctor Museum! Not only was our visit a great time together as a team outside the office, but it also taught us plenty about how far medicine has come and how many people have been served by tireless physicians through the history of North Carolina. The exhibits at the Country Doctor Museum include medical tomes from past centuries, a garage full of the buggies and automobiles that enabled doctors to travel to their rural patients, blood-letting instruments (complete with leaches!), and a pristine replica of an in-home sick room. All these objects of medical history and more are nestled nicely into a quiet residential area of Bailey.

If you’re ever nearby or just interested in learning more about the history of American medicine, make sure you swing by!

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HEALTH LANDSCAPE

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

How Medical Education is Growing with New Campuses and Family Physician Leadership in North Carolina

Dr. Bell will begin his role by overseeing the accreditation process with the Liaison Commission on Medical Education and the Southern Association of Colleges and Schools Commission on Colleges, with plans to begin classes in July 2026. Most recently, Dr. Bell served as vice president for Medical Education Program Development at Cape Fear Valley Health.

Prior to joining Cape Fear, he served as professor, Vice President for Academic Affairs, and Dean for Developing Initiatives at Lake Erie College of Osteopathic Medicine (LECOM) in Erie, PA. He had also previously served as Dean of LECOM’s School of Pharmacy and earned his Master of Science in Medical Education there.

After completing his Doctor of Medicine in his hometown at the University of Toronto, Dr. Bell completed Family Medicine residency programs at both the University of Toronto and Duke University. He also graduated from Duke University’s National Family Medicine Faculty Development Program.

Earlier this year, Methodist University and Cape Fear Valley Medical Center announced a partnership to open a new medical school in Fayetteville. And earlier this summer, family physician Dr. Hershey Bell (a member Dr. Bell became of NCAFP) was Dr. Chuck Rich, Greg Griggs, Dr. Hershey Bell, and Methodist University Provost the third family named founding Suzanne Blum Malley, PhD. physician who is dean of that new medical school. currently leading a medical school in North Carolina, with Dr. Cristy Page serving as Executive Dean at The new medical school will be located on the campus the University of North Carolina School of Medicine of Cape Fear Valley Medical Center, combining the exand Dr. Brian Kessler serving as Dean of the Campbell pertise and resources of both the Medical Center and University School of Osteopathic Medicine.

Methodist University. In announcing Dr. Bell as the founding dean, Methodist University President StanIn accepting the position of founding dean, Dr. Bell ley T. Wearden stated, “Dr. Bell brings to the position stated, “My career has involved identifying novel ways a wealth of knowledge, experience, energy, and passion to educate future physicians, and this school will be for improving the quality of care through a more inteour laboratory for using innovative ideas to produce grated approach to medical education and treatment. I a different generation of physicians. This school will am confident that Dr. Bell is absolutely the right perhave a foundation of patient-centered care that will alson at the right time for the important job of founding low our students to understand the issues families face the medical school.”

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The North Carolina Family Physician

ADVISORY CAPITAL INSURANCE

in this region.” The new medical school will have the mission of “providing better medical care for rural and underserved populations and diversifying the physician workforce.”

In July, I had the pleasure to join NCAFP Past President and Delegate to the AAFP Dr. Robert L. (Chuck) Rich, Jr., who works with Bladen Medical Associates (an affiliate of Cape Fear Valley Health) in a meeting with Dr. Bell, Methodist University Provost Suzanne Blum Malley, PhD, and other leaders to discuss the new medical school.

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Our solutions are driven by a deep understanding of you. By actively listening and proactively creating tailored solutions, our advice is grounded in your priorities and elevated in your outcomes so you can do more and achieve more—in medicine,

As a gesture of our support, the NCAFP presented a $5,000 check to the school as an initial contribution to support their students who are interested in Family Medicine, particularly through the school’s Family Medicine Interest Group (FMIG). The NCAFP supports all our medical schools’ FMIGs for this same purpose.

The NCAFP is very excited to see medical education growing in our state, not only with the opening of this new medical school but also with the second four-year campus of the Wake Forest University School of Medicine coming to Charlotte in 2025. Even before that medical school opens, the NCAFP is already working to develop a multi-university FMIG in Charlotte since Wake Forest, UNC, and Campbell all have some existing medical students in the Greater Metrolina area. In addition, we are also very pleased that both of our state-supported medical schools, the University of North Carolina School of Medicine and the Brody School of Medicine at East Carolina University, have recently increased their overall enrollment.

The NCAFP will continue working with all our state’s medical schools to develop a physician workforce grounded in Family Medicine and primary care to meet the frontline health care needs of the people of North Carolina.

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ADVERTISE! Meet the whole office of Family Medicine professionals, all across North Carolina!

Autumn 2023

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

PROFESSIONAL DEVELOPMENT

By Kathryn Atkinson, CMP NCAFP Director of CME & Events

Many of Your NC Family Medicine Colleagues Will Be Featured at This Year’s Annual Conference *Warning: If you aren’t one of the more than 600 attendees already registered for the 2023 Winter Family Physicians Weekend, this article might leave you with a bit of FOMO!* Your NCAFP CME Team always strives to deliver top-tier CME opportunities by expert guest speakers. However, this time around, I think we may have truly outdone ourselves!

Combine the slate of timely, relevant, and requested topics presented by top-notch guest faculty with the fun and surprises we have planned for our 75th Anniversary Celebration, and we think this is the one annual Winter Family Physicians Weekend you will not want to miss.

Program Chair Dr. Tamieka Howell and Program Vice Chair Dr. Thomas White have developed a superb slate of topics that will keep you informed and engaged all weekend long. From head to toe (and the many body parts in between), this year’s meeting has the mainstage lectures and optional workshops guaranteed to leave you with countless pearls and new knowledge that you can begin using immediately. Better yet, the guest faculty line-up is a lengthy star-studded list of Family Medicine experts you know and love. On page 17 is a glimpse of what you’ll learn and who you’ll learn it

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from this December, courtesy of many of your favorite NC Family Medicine colleagues and friends. Catch the full rundown of all guest speakers and all planned lecture topics at www.ncafp.com/wfpw.

Don’t miss out on all this learning and fun! Begin making your plans soon to join us for this unforgettable Family Medicine reunion with approximately 30+ CME credits, meaningful learning, lasting camaraderie, and so much more! Reminder: this is an in-person event. Currently, there are no plans to offer a virtual option. Advance registration is mandatory for all attendees and guests. No walk-in registrations will be permitted under any circumstances. Registration closes at midnight on Sunday, Nov. 19, 2023. Learn more and register soon at www.ncafp.com/wfpw.

Please contact Kathryn Atkinson, CMP, Director of CME & Events, at Katkinson@ncafp.com with questions. We simply cannot wait to celebrate you and the essential work that you do! See you in Asheville!

*When this article was written in September, our attendee registration exceeded 600 participants. We anticipate over 700 family physicians and their health care partners will attend this year, and we sincerely hope to see you there, too!*

The North Carolina Family Physician

NC Family Medicine Experts Presenting at this Year’s Winter Weekend Include: Michael Baca‐Atlas, MD Margo Pray, MD & Kellner Prue�, MD Skin of Color Dermatology (Workshop) Angela Bacigalupo, MD, MPH & Elizabeth Baltaro, MD Improving Physician Wellness by Improving Admin Burden (Lunch Seminar) Marta Bringhurst, DO, MHPE Osteopathic Manipula�ons for the Non‐Osteopathic Physician (Workshop) Jewell Carr, MD & Robin Wallace, MD Intro to Long‐Ac�ng Reversible Contracep�on (Workshop)

Jonathon Firnhaber, MD KSA Study Working Group Diabetes (Workshop)

Rebecca Putnam, MD The Fatal Five in Au�sm and IDD: Medical Rule‐Out of Behavioral Change

Rebecca Hayes, MD Cancer Screening – An Evidence‐Based Approach

Sandy Robertson, PharmD Hormone Replacement for Women and Men – What’s the Proof?

Secretary Kody Kinsley A NC Department of Health and Human Services Update Thomas Koinis, MD Osteoporosis: Why, When, and How to Treat – An Update on Care Richard W. Lord, Jr., MD, MA Long‐Covid: How Can We Help Our Pa�ents?

Lisa Cassidy‐Vu, MD Because Machines Don’t Go to Medical School: A Review of EKGs Seen in Primary Care Prac�ces

S. Mark McNeill, MD Be Digitally Available Without Losing Your Mind: Best Prac�ces for Pa�ent‐Centric Portal/App Uses

Shannon Dowler, MD Managing Medicaid (Prac�ce Management Seminar)

J. Sloan Manning, MD Diagnosis and Management of Adults with Bipolar Disorder

Blake Fagan, MD Safe Opioid Prescribing, Chronic Pain Management, & Developing Buprenorphine Prescribing Skills (Workshop)

Jay Patel, MD Updates in the Management of Type II Diabetes – 2023

Karl “Bert” Fields, MD 10 Condi�ons of the Hand & Wrist that Family Physicians Should Know

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Nicholas Pennings, DO Shi�ing the Treatment Paradigm of Weight Management and T2D in Primary Care

Beat Steiner, MD Precep�ng: Improving Primary Care Workforce in Rural Communi�es (Workshop) Anthony Viera, MD, MPH Hypertension in the Older Pa�ent: Is Lower Be�er or Worse?

Thomas R. White, MD CVD Preven�on: Ge�ng Beyond LDL Eugene Wright, MD CKD Management in Primary Care Stephen Friedhoff, MD & Tom Wroth, MD How Value‐Based Care Can Posi�vely Impact your Prac�ce and Your Bo�om Line – A Panel Discussion Adam Zolotor, MD Collabora�ve Care Model and Behavioral Health Integra�on in Primary Care (Prac�ce Management Seminar)

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Enjoyment and Instruction at the AAFP 2023 National Conference

By Kevin LaTorre Communications and Membership Manager

At the end of July, two NCAFP staff members joined Family Medicine faculty, residents, and students at the American Academy of Family Physicians (AAFP) National Conference in Kansas City, MO. Executive Vice President and CEO Greg Griggs and Workforce Initiatives Manager Perry Price spent July 27-29 at what Greg called “one of the most energizing conferences that Family Medicine does each year.”

“National Conference is a great opportunity for medical students,” said Perry. “They can learn from leaders in our specialty, network with their peers from across the county, and spend time with our awesome Family Medicine Residency programs!”

Representing NC Family Medicine for the Next Generation Beginning the afternoon of July 27, the Family Medicine residency booths on display in the National Conference Expo Hall became one of the main attractions. Fourteen residencies from North Carolina set up their booths and showcased their opportunities to the medical students who attended the conference. Each booth brought several residents and faculty members, since they are the best family physicians to recruit future Family Medicine residents to North Carolina. “They were talking to medical students from all over the country about how great it is to train and practice here,” said Greg.

“It was great being able to speak to each of the residency programs to better understand the scope of Family Medicine that they practice, as well as how they serve their communities,” said Neil Cornwell, a medical student member from UNC. Over 1,440 medical students and over 1,300 residents attended the National Conference, according to the AAFP. These attendees not only visited the residency booths but also attended medical and professional workshops. “There’s a lot of learning going on,” Greg said. “They can walk around and learn about residency programs and procedures from all over the country.” He added that the North Car-

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olina residencies’ section of the Expo Hall received plenty of student traffic: “It really makes you feel good about the caliber of faculty and residents we have in North Carolina, seeing all the traffic they had.”

Several NCAFP student members said they learned both the big picture and small details of Family Medicine by attending the conference. UNC medical student Evans Lodge said he learned more about “the depth and breadth of family medicine practice across the country” because he attended.

“It was an amazing opportunity to learn more about how different people practice to best serve their communities,” he said.

Duke medical student Roshini Srinivasan added that she enjoyed learning about breastfeeding techniques at the conference. “Breastfeeding medicine is a burgeoning field,” she said, “led by Family Physicians who are uniquely at the forefront!”

Students and residents also experienced potential leadership opportunities through the conference.

The National Conference also offered leadership development opportunities for both students and residents. For example, student and resident delegates from each chapter participated in their respective “Congresses” writing and debating resolutions, as well as electing student and resident leaders for the next year.

The NCAFP was grateful to be represented by its own strong leaders in both the student and resident congresses. Colleen Yang, a Campbell medical student, served as our delegate in the student congress, and Dr. Dewonna Ferguson, a resident at Duke, served as the North Carolina delegate to the resident congress.

“There’s space for everyone to discover their own path,” said Perry. “There isn’t a comparable experience. Every medical student interested in Family Medicine should make an effort to go at least once.”

NCAFP member and UNC medical student Christina Frederick agreed: “I continue to be blown away by the reach family docs have!” she said.

The North Carolina Family Physician

MEMBERSHIP SERVICES

By Kevin LaTorre

NCAFP Communications & Membership Manager

“That’s What Family Doctors Do: We Gain Knowledge” DR. KAREN SMITH AFTER 31 YEARS OF AWARD-WINNING MEDICAL LEADERSHIP

On Aug. 9, NCAFP past president Dr. Karen L. Smith received the 2023 Larry Wooten Rural Leadership Award at a ceremony in the Executive Mansion in Raleigh. This award recognizes individuals who contribute their time, effort, and impact to rural communities in our state. “Dr. Karen L. Smith’s commitment to advancing rural health in North Carolina is truly commendable,” said Gov. Roy Cooper at the ceremony. “Her dedication to ensuring that all North Carolina residents have access to quality health care has made a significant impact on rural communities.” The agricultural advocate L.T. Ward also received the 2023 award for his service to rural communities through sustainable farming and development.

ment to those she serves: “We are here to serve our state, serve our friends, serve our neighbors. Whatever we can do, we are part of this team. We can do what we need to do in North Carolina to achieve healthy and happy communities.”

Serving “everyday people” first brought Dr. Smith to Family Medicine in North Carolina When she was attending medical school in Philadelphia, Dr. Smith found that her specialist-focused training lacked the comprehensive approach she wanted. “The emphasis was not on Family Medicine,” she said. “When I started searching for the field I wanted, it wasn’t an option. We were trained to take care of people in the university-based setting as part of the medical school. Those of us who wanted to take care of kids as well as adults were told we could do internal medicine or a pediatric combined subspecialty.”

However, Dr. Smith was lucky to hear about Family Medicine from Dr. Updegrove, the chair of the Department of Surgery where she was studying: “He said, ‘You care about more than the surgical needs of the patient, and that reminds me of my own father, who was a family physician. Have you ever thought of becoming a family physician?’” Dr. Smith recalled.

“He knew that even though my surgical skills were superb, my heart was that of a family doctor.”

Leaving an academic setting to treat “prevalent issues that face everyday people, every day” became very important to Dr. Smith. She went on to complete Gov. Roy Cooper with Dr. Karen Smith. her community-centric residency NC Dept. of Health and Human at the Fayetteville Area Health Services Secretary Kody Kinsley introduced Dr. Smith by Education Center (FAHEC) — now called the Southern saying, “Dr. Smith has been recognized in her career for the Regional Area Health Education Center (SRAHEC) — last 30 years for not only making a difference in her comand moved with her family to Raeford, the rural communimunity, but for showing, frankly, the rest of the country ty where she has worked and lived since 1992. “It was me, how it needs to be done. She’s leading the way not just for my husband, and my 18-month-old son,” Dr. Smith said, meeting the moment today but for the future.” “and I was pregnant at the time. We have been here for the duration of our children’s lives, and my whole professional In her acceptance speech, Dr. Smith reiterated her commitlife has been here too.”

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The North Carolina Family Physician

Once Dr. Smith arrived to care for Raeford patients, she wouldn’t move away. But she would travel widely and learn the core philosophy and the skills that have come to benefit her community.

National leadership improved Dr. Smith’s patient care, no matter how far from home she traveled The key to her work is respect. “Respecting every individual recognizes the unique value he or she possesses,” Dr. Smith said. “They add value to their community as part of their families, workplaces, and neighborhoods. As their doctors, we have to help them achieve that value. That starts with respect.”

And what goes in tandem with respect? Listening, the way a leader should. Dr. Smith learned from her involvement with the American Academy of Family Physicians (AAFP) to hear what other physicians have learned and tried: “There are lots of ideas for solving the same problems. You can rest assured people are going to express their thoughts, and your goal as a leader is to listen and hear what people are saying.

If you don’t listen, you’ll miss it.”

One stark instance of the need to listen came when Dr. Smith visited Jamaica for medical missions at the outbreak of COVID-19. “We were actually in Jamaica on March 13,

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2020,” she said. Even with the evidence of the pandemic, Dr. Smith still traveled to meet with physicians at the Jamaican Department of Family Medicine at the University of West Indies, Mona in Kingston. Then an exchange from the department chair and other leaders threw her for a loop: “The chair asked what we were doing in the U.S. to test for and isolate cases. When I said we were deciding which companies will be able to sell the kits, he laughed. He literally laughed!” The Jamaican team stressed how the virus was on its way, and that their own policy was to isolate and test first and foremost. “I thought, ‘Wow,’” Dr. Smith said. “I had just heard common sense from this institution that I was supposed to come over and teach!”

Her learning in Jamaica and her gladness for the lesson also demonstrate Dr. Smith’s concern for global health, which she said began during her residency in Fayetteville: “The patient population there is a military population, which brought me into global health. We were taking care of people from all over the world, not just people from North Carolina.” The variety of her patients challenged her as a resident, she said: “It’s hard to treat someone who speaks different languages and has been all over the world and then later that day to treat someone who has rarely been outside Hoke County.”

What she learned to give all those patients then is what she continues on pg. 23

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RESIDENTS & NEW PHYSICIANS

By Jan Rainey NCAFP Financial Manager

Dr. Nathaniel Bowen: A New Generation of Family Medicine After a long and successful career, Dr. Otis Bowen left a lasting impact in each area where he served: medicine, military, and politics. He completed medical school at Indiana University and served in the medical corps of the Army during World War II. He established a local practice and later went on to become a representative in the Indiana state legislature, the state’s governor in 1973, and eventually the Secretary of Health and Human Services during the Reagan administration.

He is remembered by many as one of the faces of the government’s response at the beginning of the HIV and AIDS studies.

His grandfather inspired Nathaniel to go into Family Medicine, but he said it was in medical school at Campbell University that he really “fell in love with full-scope primary care.” He feels that Family Medicine offers more flexibility and “gives the most opportunity to truly make a difference in our patients’ lives.” He told us he found a home at Cabarrus Family Medicine with a group of physicians and residents who were all striving to give the best patient care possible.

Dr. Nathaniel Bowen

First and foremost, Dr. Bowen was a family physician, and that meant helping people wherever he was, from his local practice to his government service. Dr. Otis Bowen joined the AAFP in 1949 and was a Life member. But why are we writing about him now? Because the impact he left as a physician inspired a new generation of family physicians to follow in his footsteps — including his grandson, Dr. Nathaniel Bowen. The younger Dr. Bowen is now an intern at the Cabarrus Family Medicine Residency in Concord.

The elder Dr. Bowen retired from medicine and politics before his grandson was old enough to learn about his practice, but Nathaniel will always remember the impact he had on the community. His grandfather built his practice in Bremen, IN and returned there from Washington after retiring from politics. Nathaniel would often visit Bremen while growing up and now remembers how everyone in the community always had a story to tell about his grandfather.

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They would talk about what an incredible person and physician Dr. Bowen had been. His family’s high regard for Family Medicine, along with his grandfather’s legacy, inspired Nathaniel to follow the same path. Nathaniel has other family members that trained as doctors, but there are no other family physicians.

Providing the best possible care today is quite different than his grandfather’s generation. DNA had not been discovered when Dr. Otis Bowen graduated from medical school. Nathaniel and physicians today have a whole new area of biologics and immunology that was not even heard of when his grandfather practiced. Nathaniel feels that this area would be the most surprising for physicians from his grandfather’s generation.

Dr. Bowen considers it a blessing to have Dr. Maureen Murphy (one of our past NCAFP presidents and current leaders) as a preceptor. He told us he gets to learn both the art and science of Family Medicine from her.

“From patient interactions to latest updates in the field, Dr. Murphy is a wealth of knowledge and a wonderful resource; her fresh baked goods are just a nice bonus!”

With the legacy of his grandfather and the knowledge gained from Dr. Murphy, Dr. Nathaniel Bowen will soon be making his own successful career in Family Medicine.

Despite being years apart, both Dr. Otis Bowen and Dr. Murphy have had a profound influence on Dr. Nathaniel Bowen’s career path, helping lead him into a new generation of Family Medicine.

The North Carolina Family Physician

THAT'S WHAT FAMILY DOCTORS DO – continued from pg. 21

shows her Raeford patients today: respect for everyone in her community. “There really is something about the familiarity of people living in a community,” Dr. Smith said, “especially when you hear what people are saying.”

She is glad to give all that she has learned back to her local community of patients: “Raeford is where I share those ideas that I’ve learned from traveling all over the world.

I’m going to hear the solutions that other physicians come up with and take those nuggets of knowledge back to our hometown community. Then, it’ll be time to share back with those other physicians too.”

Congratulations to Dr. Smith on her well-earned award!

And on behalf of the patients and family physicians you have helped by your decades of leadership, thank you!

MEMBERS IN THE NEWS

Dr. Wesley Roten Received UNC’s House Staff Service Award!

On Aug. 2, UNC Health announced the five winners of the 2023 Robert C. Cefalo House Officer Awards. One of the recipients was Dr. Wesley Roten, and along with the other award winners, he was recognized for “exemplary service to patients and families, professional performance and compassionate patient care.” As you might expect, the testimonies that others gave to nominate Dr. Roten were glowing: “Dr. Roten has the personal characteristics that make him an exemplary physician,” said one testimony. “He is bright, motivated, and has a wonderful sense of humor. He has natural leadership skills and will serve as our chief resident next year.”

Another testimony highlighted his continued care for patients in need: “In medical school at UNC, Dr. Roten was a Kenan Rural Scholar, with a commitment to serving a rural and underserved community post-training. Furthermore, in residency, he committed to our FQHC track and in our 2nd class of residents who completed their continuity clinic at the Siler City Community Health Center, a federally qualified health center about 40 minutes from Chapel Hill serving a large Spanish speaking population.”

Congratulations to Dr. Roten, who earned this award through his selfless service to his patients!

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Dr. Llewellyn Mensah Speaks with the AAFP About Building Patient Trust for Vaccination NCAFP member Dr. Llewellyn Mensah spoke with the American Academy of Family Physicians (AAFP) in late August about the progress he has already made as one of two Vaccine Science Fellows in 2023. “The enthusiasm for vaccination in my community has been anemic since the COVID-19 pandemic has waned,” Dr. Mensah says, “and I would like to be part of the effort to regain the trust of the public.” When we first mentioned that he had become a Vaccine Science Fellow in the summer issue of The North Carolina Family Physician, addressing vaccine hesitancy had already been one of his key motivations.

Throughout the interview, Dr. Mensah returns to the element of trust between patients and their physicians. “Most patients who have been hesitant, it’s a trust issue, and it’s always in patients who I might not have a very long relationship with,” he says. “What I’ve found in cases like that is just to be the best physician that you can be, and just let patients know that you are truly for them and someone they can trust. Sometimes it takes more than one visit because it takes time to build that relationship, but eventually, once they find out that you are a good doctor and are looking out for them, recommending vaccines becomes a very easy thing.”

If you’d like to hear more from Dr. Mensah, you can watch the entire interview at https://www.aafp.org/news/inside-aafp/vsf-2023-mensah.html

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STUDENT INTEREST & INITIATIVES

landscape to benefit our future patients.

By Lily Hale MS4 at the UNC School of Medicine

I entered the NCAFP Health Care Leadership and Policy elective hoping to gain a deeper understanding of the current payment model landscape and to learn ways to funnel more investment into primary care. With ExHANDS-ON EXPERIENCE IN HEALTH ecutive Vice President Greg Griggs, I had the privilege CARE LEADERSHIP AND POLICY: of attending meetings about Medicaid’s investment in Collaborative Care Management, Medicare’s new “Making Care Primary” model, and I even spoke with State Treasurer Dale Folwell to learn more about the State Health Plan. Through these meetings, I saw different strategies for investing in primary care, such as increasing reimbursement rates in the traditional feefor-service model and the innovative apAs medical students, we are asked to rapproaches utilized in the value-based care idly learn a huge amount of new informaspace. Witnessing these payment modtion in our preclinical years. At first, it feels els after learning about them in school like learning a new language, with words allowed me to better grasp the realistic like “rales” that have no real meaning bechallenges of each approach, as well as hind them (no matter how many YouTube the struggle to unify strategies across payvideos you watch trying to understand the ors. Health care leaders in North Carolisound). Often, it is only once we enter the na share an understanding that primary clinical setting and relate these concepts care holds value in reducing health care to patients that the terms truly come into costs and improving quality of life in our focus. Caring for a patient experiencing a state. The level of investment and inheart failure exacerbation helps to undernovation I’ve witnessed in primary care Lily Hale stand cardiovascular physiology, and by makes me especially excited to join the performing countless lung exams on patients we befield of Family Medicine. gin to pick out those lungs with crackles. The value of hands-on experience is why many medical schools boast Medical students should not overlook the importance of offering clinical exposure as early as possible. of becoming familiar with health care policy, as it will continue to shape how we care for our patients. Beyond Obtaining an understanding of health care policy has this elective, there are many other ways we can learn never been more important for medical students, eviabout policy, from attending a White Coat Wednesday denced by the increasing attempts to legislate the paevent to establishing a relationship with your local reptient-doctor relationship. However, policy is an intimresentative. If you have an area of interest, the NCAFP idating topic for many medical students, as it comes staff can connect you with someone in that space who with its own language that many of us don’t easily uncan help you learn its language. The NCAFP is filled derstand. While we are capable of learning this lanwith incredible, inspirational family physicians who guage just like we learn complex physiology, we are are leading the way toward better health care in North typically not afforded the hands-on experience needed Carolina, and you could be next! to make sense of these confusing concepts. However, the NCAFP Health Care Leadership and Policy elective offers students a valuable opportunity to see policy in action so that we can better navigate the health care

The NCAFP Medical Student Elective

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The North Carolina Family Physician

TRYING TO LEAVE MEDICINE BETTER THAN WE FOUND IT:

Integrating Well-Being in the Journey to Becoming a Physician Co-written By: Aryanna Thuraisingam MS3 at Campbell University School of Medicine Dana Shefet MS3 at ECU Brody School of Medicine

It’s no surprise that the health care industry is facing a critical epidemic of stress, burnout, depression, and suicide among our medical professionals. However, the American Academy of Family Physicians (AAFP) formed a new Family Medicine Interest Group Well-being Champion Program (FMIG WBC Program) that provides medical students an opportunity to intervene early in their well-being by building a sustainable and healthy culture at their schools. This program is a part of the Physician Health First: Building Resiliency Intersectionally During Graduate Education (BRIDGE) grant initiative, and it is supported by the Health Resources and Services Administration of the U.S. Department of Health and Human Services.

How the FMIG WBC Program Works The student well-being champions in this program receive training to produce and facilitate workshop sessions at their medical schools to help guide their fellow students to a healthier state of wellness that they can keep up. The champions meet virtually on a regular schedule and in person twice a year to develop their skills in curriculum development, instruction, training, and programming.

The sessions they receive cover six wellness topics that compose the “Bridge to Better” series: • Suicide prevention (in collaboration with the American Foundation for Suicide Prevention) • Resiliency • Burnout prevention • Substance-use prevention • Building trust and cultivating relationships • Indebtedness Dr. Catherine Florio Pipas, professor at Geisel School of Medicine at Dartmouth, spearheads this program. Dr. Pipas is co-chair of the AAFP Leading Physician Well-being Program and serves as chair of the AAFP Physician Health First initiative. She is author of “A Doctor’s Dozen: 12 Strategies for Personal Health and a Culture of Wellness.” continues on next page

The student-developed curricula has been delivered at prospective medical schools, at the 2023 AAFP Well-being Conference in Palm Springs, CA, and at the 2023 National Conference of Family Medicine Residents and Medical Students in Kansas City, MO.

Our Time As Well-Being Champions Aryanna: Prior to my participation in the AAFP FMIG WBC Program in my first year of medical school, I came across an article entitled, “Why doctors like me are leaving medicine.”

This article prompted many points of consternation for me as a first-year medical student at the time. It made me sad that in our current model of training, doctors are left feeling that they have lost a core sense of self throughout the tumultuous medical school and residency experience. It also left me unwilling to accept that this culture should continue.

Serving as a 2022-2023 Well-being Champion afforded me the opportunity to enrich my educational experience by advocating for a culture of well-being in my medical school environment at Campbell University School of Medicine.

As part of the first cohort of the program, I worked with four other medical students around the country as we were mentored by Dr. Pipas and AAFP staff. We brainstormed key issues facing current medical students and began to de-

sign and pilot curriculum that targeted the six domains of wellness in the “Bridge to Better” series. I took the lead in developing the programming for substance-use prevention in a workshop entitled “Keep Your Tank Full: Substance-Free Strategies for Stress Management” and also helped to facilitate a virtual book club that covered “A Doctor’s Dozen: Twelve Strategies for Personal Health and a Culture of Wellness.”

My experience with this program has truly been empowering — I’ve been able to connect with new friends across the country who are interested in changing the landscape of wellness for medical professionals, and I am now more hopeful for a future that values a culture of well-being in every level of medical training.

Dana: Throughout medical school, I have made it my purposeful mission to live through the phrase “we cannot care for our (future) patients if we do not care for ourselves.” I have continuously prioritized and emphasized holistic well-being for myself and my classmates, and this mindset perfectly aligns with the FMIG WBC Program. As a member of the second cohort, I work alongside seven medical students from across the country under the leadership of Dr. Pipas. My goals as a well-being champion include bringing her to speak directly to our medical students and residents on Family Medicine Grand Rounds at ECU Health. She will speak about her journey of well-being and lead a session on wellness and strategies to prevent burnout. Additionally, I will be collaborating with the Chief Well-being Officer’s department during ECU Health’s monthlong initiative of hospital events regarding suicide prevention awareness, so that I can lead a session for medical students and residents using curriculum from Say Something: Physician Suicide Awareness and Prevention. Eastern North Carolina has a diverse and medically-complex patient population, and I am excited to put my time and energy into sustaining the future generations of physicians who will serve them!

Applications for the 2024-25 cohort of Well-Being Champions will be released later this year.

Please check the AAFP Well-being Champion website listed below for updates and applica-

tion dates: https://www.aafp.org/students-residents/medical-students/fmig/well-being-champion-program.html 26

The North Carolina Family Physician

NCAFP FOUNDATION

By Perry Price NCAFP Workforce Initiatives Manager

reach medical students where they are. We carry some of their same feelings of anticipation and excitement when we walk into a lecture hall or classroom to meet students and serve as a part of their understanding of Family Medicine.

Why We Visit Medical Schools to Meet with Students

The campus visits take a variety of forms. Sometimes we lead or participate in sessions that share what Family Medicine is, bring in family physicians who are experts in their field of study to speak, support the events that the school’s Family Medicine departments are hosting, or serve on campus panels. Generally, we aim to be available to meet the needs of the students Much like the way a and faculty. These visits are family physician’s caa chance for us to showcase reer includes both beFamily Medicine to medical ginnings and endings students, while we share the at once, the back-toNCAFP opportunities that school season is also will further demonstrate marked by simultathe specialty to students neous beginnings and away from their campuses! endings. The season Our visits also grant stumarks the end of freedents a chance to ask quesdom and summer adtions and share their underventures while also standing of what choosing marking the begina career in Family Medicine ning of returning to means. These valuable interthe routine of a school actions provide insight into Perry Price during a campus visit. year and learning. It is the conversations students the beginning of a safety net for many students and are having, which give us an opportunity to shape their families who rely on the support, while also an end perception of what Family Medicine truly is and what the of comfort for the students who struggle in academic specialty can offer them. settings. Concurrently, the season also carries a diverse range of emotion for people: excitement, anticipation, Our campus visits are often a student’s first introducanxiety, fear, comfort…it seems like no matter how tion to the NCAFP, and thanks to this foot in the door, old we get, or how far removed we are from returning we can track considerable student engagement as a reto school ourselves, the feelings and traditions of this sult! The time spent on campus is also an energizing season stay with us. experience for us and for any member physician that joins us — much like the electric emotions of back-toAt the NCAFP, back to school means a return to camschool season, campus life has an underlying current pus visits, following the summer hiatus when we host of energy and determination that reinvigorates and resummer programs for rising MS2s and attend AAFP inforces the importance of our goals. While we know National Conference while the medical students start not every medical student is suited to become a family research, new rotations, clinical study and continue on physician, we hope that those who are will know from their paths to becoming physicians. Campus visits are the beginning that the NCAFP and the community of a crucial aspect in accomplishing our goals of growfamily physicians here will be there to support them at ing our specialty, since they serve as an opportunity to every step.

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PRACTICE MANAGEMENT

By Gregory K. Griggs, MPA, CAE Executive Vice President & CEO

The Deadline to Apply for Making Care Primary Pilot with Medicare is Nov. 30 As we noted in the summer issue of this magazine, North Carolina is one of eight states selected by the Centers for Medicare and Medicaid Services (CMS) to participate in an innovative pilot payment model for primary care practices who care for fee-for-service Medicare patients. The program is entitled “Making Care Primary” (or MCP for short). The Request for Application (RFA) for Making Care Primary came out in late August and the portal to apply for the program opened in early September. CMS will accept applications for the program until Nov. 30.

Given the potential benefit to family physicians practicing in North Carolina, we wanted to supplement the previous article with additional details based on the RFA. CMS outlined its primary goals for the model as follows: • To create a system of primary care that is integrated, coordinated, person-centered, and accountable • To provide a pathway for primary care clinicians to adopt prospective, population-based payments and to become more accountable for cost and quality • To invest in primary care and help control overall health care costs through broad incentives that are within the control of primary care.

What CMS Learned from Past Models CMS has piloted a few other models for primary care (CPC, CPC+, and Primary Care First) that were not offered in North Carolina. Making Care Primary builds on some of the lessons from these previous models. Here are key lessons CMS learned and is applying to this model: • First, practices need an on-ramp to value-based transformation. As a result, the new model includes a progressive payment architecture that moves toward prospective payment for core primary care services, along with quality bonuses of up to 60%.

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• Second, improved coordination and collaboration between primary care and specialists is essential to improving care and lowering costs for patients with multiple complex conditions. As a result, the model will specifically fund primary care collaboration with specialists and provide practices with data on high-quality, low-cost specialists.

• Third, improvements in quality and efficiency take time.

Thus, this pilot will last 10.5 years.

• And finally, any model needs to prioritize partnerships at the state level and leverage existing infrastructure. As a result, CMS is working with state Medicaid programs and other payers to try to bring broader alignment across payers. While the level of alignment by other payers outside of Medicare is not yet finalized, it could include alignment on quality measures, type and format of provided data, payment models, and learning priorities.

To participate in the model, practices must have at least 125 fee-for-service Medicare beneficiaries, which should make most Family Medicine practices in North Carolina eligible.

Rural Health Centers, direct primary care practices, concierge-type practices, and current ACO REACH participants are not eligible for the model. In addition, practices will not be able to concurrently participate in MSSP and MCP after the first six months of the model. While you must apply by Nov. 30, you do not have to commit to participation until spring of 2024. Practices will be selected in the winter of 2024 with onboarding taking place in the spring. As part of onboarding, CMS will provide practices detailed information on the beneficiaries that will be attributed to each practice, including past cost and services for those beneficiaries. A practice will have the chance to analyze this data and make a final determination on participating in the model. The bottom line: applying does not bind a practice to participate.

Three Tracks of Making Care Primary Practices can enter one of three tracks, with Track 1 being designed for practices with no experience in value-based care. Payment for primary care in Track 1 will remain primarily fee-for-service with small financial incentives for improving patient outcomes. In addition, practices in Track 1 can receive $72,500 per year for two years to help fund infrastructure development. Practices in this track will be required to begin risk stratifying patients, developing workflows for care management, and develop workflows for behavioral health integration.

Track 2 will require practices to implement choric care management for high-risk patients, implement episodic

The North Carolina Family Physician

care management and patient self-management programs, and systematically screen for depression and substance use orders. A practice can opt to start in Track 2 or will progress to Track 2 after a period of time in Track 1. Once a practice is in Track 2, practices will receive half the fee-for-service rate but will also receive an amount equivalent to half of their traditional fee-for-service payments prospectively through quarterly payments based on the per-member, per-month cost of care for core primary care services. In addition, Track 2 practices are eligible for an upside only 45% bonus based on performance on a limited number of quality metrics. Track 2 practices must also begin integrating care with specialists but can receive a fee for every e-consult they have with a specialist.

Finally, Track 3, to which most practices will progress over time (although a few may enter the model at that level) requires further optimization of care delivery and greater specialty care integration. It also requires individualized care plans for all high-risk patients, linkages to community-based supports, and greater behavioral health integration. At this point, 100% of typical fee-for-service payments for core primary care services will come in the form of a prospective payment. Bonus incentives also increase to as high as 60% based on quality performance.

The model incentivizes using high-performing specialists and asks practices to establish Collaborative Care Arrangements with at least one specialist, although you could have more. While the number or type of specialists is broad, CMS requires that at least one agreement be with either a cardiologist, an orthopedist, or a pulmonologist. These types of relationships are incentivized by introducing the new primary care e-consult code and a time-limited co-management code for the specialist. And maybe more importantly, CMS will adjust payments by both clinical indicators and social risk of the beneficiaries who are participating in order to incentivize care for potentially higher risk/higher acuity patients.

Beneficiary Attribution & Quality Measures For a patient to be attributed to your practice, one or more clinician in your practice must have furnished the plurality of a beneficiary’s primary care, and/or billed chronic care management services,

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Reminder to All Members: Re-Verify Your Status as a Medicaid Provider Many Medicaid providers still may need to re-verify their status after the hiatus on reverification was lifted with the end of the federal COVID-19 public health emergency (PHE) on May 11. All providers must be reverified (or re-credentialed) periodically to remain eligible to participate in NC Medicaid.

NC Medicaid reviewed all the provider reverifications which had been paused during COVID-19 and began contacting those providers to complete their mandatory reverification process starting on May 12. “Approximately one-third of participating providers will be impacted over the next six months,” reads the Medicaid announcement.

NC Medicaid has been sending reverification notifications to just over 1,000 providers each week since May. These notifications have included 50-day, 20-day, and five-day warnings to re-submit the Medicaid verification application. On July 21, the first group of non-responsive providers were suspended, and notifications have continued since then.

If you were suspended, you can still submit your application for the next 50 days without being terminated. But if you don’t receive notice from the Department by this date, you should review the NC Medicaid guide to reverification and due dates at https://medicaid.ncdhhs.gov/ providers/provider-enrollment/provider-enrollment-recredentialing. Make sure you find and review the “Active Provider Re-Verification Due - July 2023 - Dec 2023” document. At the same time, monitor your NCTracks inbox for your notifications from NC Medicaid and re-submit your application if you’ve received any.

But how? We’re glad you asked, because we have two more resources you can access online: • Clarify the process with the Reverification FAQs at https://www.nctracks.nc.gov/content/public/providers/ faq-main-page/faqs-for-re-credentialing0.html • Learn exactly where to reverify and how with the full list of user guides at https://www.nctracks.nc.gov/content/ public/providers/provider-user-guides-and-training/factsheets.html

and/or billed the most recent claim for an Annual Wellness Visit or a Welcome to Medicare Visit. As noted above, practices will receive a list of attributed beneficiaries prior to the start of the model and then quarterly thereafter.

While there are quality metrics, CMS has reduced the number to 10 and has balanced clinical, cost, and other measures. The measures the program will be using include the following: • Controlling high blood pressure • Diabetes Hemoglobin A1c Poor Control (>9%) • Colorectal Cancer Screening • Screening for Depression and a Follow Up Plan • Depression Remission at 12 Months • Person-Centered Primary Care Measure • Screening for Social Drivers • Total Per Capita Cost (Includes all Medicare FFS Parts A and B standardized allowable charges incurred by each beneficiary in the quarter) Emergency Department Utilization • And Continuous Improvement where you are benchmarked against how you did the previous year Practices will receive full credits for reaching the 70th percentile for quality measures in Tracks 1 and 2; and the 80th percentile in Track 3. Practices will receive half credit for each measure for ranking in at least the 50th percentile.

Payment Methodology There are a number of key payment structures for Making Care Primary that evolve as you progress from one track to the next. Here is a quick overview of the various payments.

• Upfront Infrastructure payments (UIP) – Up to $145,000 ($72,500 per year for two years) – Track 1 Only. These payments can be used for increased staffing (case management, support staff for screening, etc.), social determinants strategies, health care infrastructure, IT, etc.

• Enhanced Services Payment (ESP) – A Per Beneficiary Per Month Risk Adjusted (clinical and social risks) payment made quarterly (similar to a PMPM for care management).

This payment goes down as you progress through the Tracks.

It must be used to support the augmented services required in the model. These payments are risk adjusted based on Hierarchical Condition Category (HCC) scores and Area Deprivation Index (ADI) Social Risk scores. CMS estimates that the average ESP payment will be $15 PMPM in Track 1, $10 in Track 2, and $8 in Track 3.

• Prospective Primary Care Payment (PPCP) – 50% of FFS

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in Tier 2; 100% in Tier 3. These payments will be based on two years of historical claims data based on each individual beneficiary. There are more details on how these payments will be calculated on the Making Care Primary website.

• Performance Incentive Payment (PIP) – Up to 3% bonus in Track 1; 45% bonus in Track 2; 60% in Track 3. This will be paid in two payments to provide more upfront resources (first quarter of performance year and third quarter of following year). To receive the payment, practices in Tracks 2 and 3 must meet or exceed a “gateway threshold” of 30% for Total Per Capita Cost (nationally). For Track 2 and 3, 38% of the incentive is based on quality, 37% is based on utilization and cost, and 25% is based on continuous improvement.

• MCP e-Consult (MEC) – $40 per e-consult with a specialist for beneficiaries in the MCP model (Track 2 and 3 only).

• Ambulatory Co-Management – Time-limited PMPM for specialty care partner. Track 3 only. A specialist partner can bill this code for up to three months for their collaboration with primary care.

Conclusion You can find more details of this model on the CMMI website by simply Googling “CMMI & Making Care Primary.”

Please also continue to watch the NCAFP e-newsletter every Thursday and the NCAFP website for additional information and resources. Ultimately, each practice will need to evaluate their current situation to determine whether it will be beneficial for you to participate in this pilot. However, because you will not be making a binding commitment at the time of your application (deadline Nov. 30), if you are at all interested or even on the fence, we recommend you go ahead and apply. That will give you the chance to further evaluate and make your decision once CMS selects participating practices and provides more data on Medicare beneficiaries attributed to your practice. In addition, this will give us more time to gather information on how other payers may align with this new model.

The North Carolina Family Physician

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MEMBERS IN THE NEWS

Dr. Wesley Roten Received UNC’s House Staff Service Award!

Employers:

On Aug. 2, UNC Health announced the five winners of the • PLACE your job in front of our 2023 Robert C. Cefalohighly House Officer Awards. One of the qualified members recipients was Dr. Wesley Roten, and along with the other SEARCH our resume database of award winners, he was• recognized for “exemplary service to qualified candidates patients and families, professional performance and com• MANAGE andexpect, applicant passionate patient care.”

As you jobs might the testimoactivity right on our site nies that others gave to nominate Dr. Roten were glowing: • LIMIT applicants only to those who are qualified

“Dr. Roten has the personal characteristics that make him • FILL your jobs more quickly with an exemplary physician,” said one testimony.

“He is bright, great talent motivated, and has a wonderful sense of humor. He has natural leadership skills and will serve as our chief resident next year.”

Another testimony highlighted his continued care for patients in need: “In medical school at UNC, Dr. Roten was a Kenan Rural Scholar, with a commitment to serving a rural and underserved community post-training. Furthermore,

Family Physicians: • POST multiple resumes and cover letters or choose an anonymous career profile that leads employers to you • SEARCH and apply to hundreds of fresh jobs on the spot with robust filters • SET UP efficient job alerts to deliver the latest jobs right to your inbox • ASK the experts advice, get resume writing tips, utilize career assessment test services, and more

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