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The North Carolina Family Physician

Volume 3

Number 3

Early Intervention Resources for the Family Physician

Let’s Continue to Invest in NC Community Care

Family Medicine Day A Success FP helps Secure City AWARD Disparities Initiative: Year 1 | The Co-Pay Culture


NCAFP Presiden Presiden Vice Pres Secretary Board Ch Executive Past Pres

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PUBLISHED BY THE NORTH CAROLINA ACADEMY OF FAMILY PHYSICIANS, INC Raleigh, NC 27605 919.833.2110 • fax 919.833.1801 The North Carolina Family Physician


2007 NCAFP Board of Directors NCAFP Executive Officers President Michelle F. Jones, MD President-Elect Christopher S. Snyder, III, MD Vice President Robert Lee Rich, Jr., MD Secretary/Treasurer Elizabeth B. Gibbons, MD Board Chair J. Carson Rounds, MD Executive Vice President Sue L. Makey, CAE Past President (w/voting privileges) Karen L. Smith, MD, FAAFP The District Directors District 1 Donald Keith Clarke, MD District 2 Christopher B. Isenhour, MD District 3 Victoria S. Kaprielian, MD District 4 William A. Dennis, MD District 5 Sara O. Beyer, MD District 6 Thomas J. Zuber, MD District 7 Shannon B. Dowler, MD At Large R.W. Watkins, MD, MPH At Large Richard Lord, MD IMG Physicians Constituency Rafael G. Torres, MD Minority Physicians Constituency Suzanne E. Eaton Jones, MD New Physicians Constituency Jana C. Watts, MD FM Department Constituency Michael L. Coates, MD FM Residency Director Stephen Hulkower, MD Resident Director Parker McConville, MD, (GAHEC) Resident Director-Elect Tamieka Howell, MD, (GAHEC) Student Director Mindy Jean Deason, (UNC) Student Director-Elect Carrie Hamby, (UNC) AAFP Delegates and Alternates AAFP Delegate AAFP Delegate AAFP Alternate AAFP Alternate


Let’s Continue to Invest in a Medicaid Model Proven to Work: ....................................................... 3 The Community Care Program Busy Legislative Year for the NCAFP................................................................................................... 4 Family Medicine Day Leads to Great Recruiting for NC .................................................................... 5 Family Medicine Residencies Family Physician Plays Key Role in Helping Community .................................................................. 7 Achieve National Recognition Early Intervention: An Important Resource for The Family Physician...........................................13 Sections President’s Message...................................................... 3 Meetings & Education.......................................................... 9 Advocacy........................................................................ 4 NCAFP Foundation..............................................................10 Chapter Briefs................................................................ 5

Family Medicine In Practice................................................12

Residents & Students.................................................... 6

Physician Perspective........................................................14

L. Allen Dobson, MD Conrad L. Flick, MD Mott P. Blair, IV, MD Karen L. Smith, MD

the FP Department Chairs and Alternates Chair (WFU) Michael L. Coates, MD Alternate (Duke) J. Lloyd Michener, MD Alternate (ECU) Valerie J. Gilchrist, MD Alternate (UNC) Warren P. Newton, MD, MPH NCAFP Council Chairs Child & Maternal Health Governmental Affairs Health Promotion & Disease Prev. Mental Health Professional Services Health Disparities

Shannon B. Dowler, MD Robert Lee Rich, Jr., MD Mott P. Blair, IV, MD Michelle F. Jones, MD Brian Forrest, MD Karen L. Smith, MD

NCAFP Editorial Committee Chair

William A. Dennis, MD Shannon B. Dowler, MD Elizabeth B. Gibbons, MD Richard Lord, MD David C. Luoma, MD

LAYOUT & DESIGN Peter T. Graber, CAE Director of Communications CREATED BY: Virginia Robertson, President vrobertson@pcipublishing.com Publishing Concepts, Inc. 14109 Taylor Loop Road Little Rock, AR 72223 FOR ADVERTISING INFORMATION: Greg Jones gjones@pcipublishing.com 501.221.9986 • 800.561.4686 Ed i t i o n 11



The mission of the North Carolina Academy of Family Physicians is to improve the health of patients, families, and communities by serving the needs of family physicians with professionalism and creativity. Strategic Objectives 1. Health Promotion & Disease Prevention (Health of the Public): Assume a leadership role in improving the health of North Carolina’s citizens by becoming proactive in health promotion, disease prevention, chronic disease management and collaborating in other public health strategies. 2. Advocacy: Shape healthcare policy through interactions with government, the public, business, and the healthcare industry. 3. Workforce: Ensure a workforce of Family Physicians which is sufficient to meet the needs of patients and communities in NC. 4. Education: Assure high-quality, innovative education for family physicians, residents, and medical students that embodies the art, science, and socioeconomics of family medicine. 5. Technology & Practice Enhancement: Strengthen members’ abilities to manage their practices, maintain satisfying careers, and balance personal and professional responsibilities. 6. Research: Develop and promote new medical knowledge and innovative practice strategies through information technology, primary care research and assessment of the practice environment. 7. Communications: Promote the unique role and value of family medicine, family physicians and the NCAFP to the public, business, government, the healthcare industry and NCAFP members.


Let’s Continue to Invest in a Medicaid Model Proven to Work: the Community Care Program By Michelle F. Jones, MD NCAFP President

While you have been busy attending to more and more patients and adjusting to newly imposed quality measures while receiving meager payment which barely covers the overhead, some of our elected officials have been quietly considering a plan which undermines all that community physicians, nurses, hospitals, health departments, and social service agencies have created to ensure that our state’s poorest and most disadvantaged citizens receive access to quality healthcare. Unfortunately, this year members of the N.C. General Assembly considered a plan that would outsource Medicaid (or pilot-outsourcing Medicaid in various regions of the state) to an outof-state HMO to save money in the state budget. Yet, our state already boasts one of the most cost-effective Medicaid programs in the nation though Community Care of North Carolina (CCNC). Many of you have spent countless nonreimbursed hours in meetings to help organize networks, better known regionally as Access III or Community Care Plan of North Carolina. These networks allow local providers to ensure that their most needy patients get quality care in efficient settings. Every dollar spent by the state for a Medicaid patient stays in this state to help pay the physician, the case manager, the local administrator and others involved in the care of patients. Not only does this program maximize dollars-to-care for patients, but it is employing North Carolina’s own citizens. In turn, this aids the local economy. An out-of-state for profit HMO would not foster the local economy, but would siphon 2030 percent of funds paid for Medicaid services to administrative costs and corporate profits. This diminishes funding available to care for patients, and many local jobs are lost to out-of-state administrators who have no investment in our state and don’t understand the nuances of our local communities. You have established 15 networks of care in North Carolina which are governed by local health providers. Each network is able to address local needs — with local resources. A simple yet elegant plan. Several years ago the North Carolina Legislature wisely decided to invest in its own care management system (CCNC). As a result, this program has increased the access of patients to the care they need, improved the quality of care provided, and 

jUNE - August 2007 | the North Carolina Family Physician

has saved the state millions of dollars. This has been accomplished without limiting or decreasing enrollment during years when the state economy was in crisis. The introduction of an HMO would in effect undermine the Community Care concept. As a result, physicians would leave the system or become marginalized; access to care providers would be limited; emergency room visits would increase; and costs would ultimately escalate. Indeed, we need only look to other states who utilize these programs to find such examples. North Carolina’s Community Care management program is a model envied by other states looking to control spiraling Medicaid expenditures.

The introduction of an HMO would effectively undermine the Community Care concept. As a result, physicians would leave the system or become marginalized; access to care providers would be limited; emergency room visits would increase; and costs would ultimately escalate. Admittedly, an HMO proposal may appear attractive in a specific budget cycle by promising short-term savings. These savings can obviously be used by legislators to fund other budgetary items. However, a closer look reveals that the HMO will place priority on its own profit margin, leaving care for our most vulnerable patients at risk. This usually comes at the expense of restrictive medical policies, greater administrative burdens, and reduced reimbursement to physicians and other providers. More and more patients must be seen to generate a positive cash flow. In the end, many physicians would be forced to drop Medicaid patients from their panels in favor of plans which provide better payment. Physicians in rural areas of North Carolina

with large numbers of Medicaid patients cannot afford to drop this program. As a result, under an HMO, physicians would be forced to see many more patients and to accept payment below market rates. Juggling numbers, quality, and physician well-being is difficult and eventually access in the rural areas becomes critical as physicians leave for more favorable lifestyles. North Carolina legislators would do well to take a historical look at HMO’s attempts and failures to succeed in a rural environment. Our current system, Community Care of North Carolina, provides care to more than 700,000 persons in all 100 counties through more than 3,000 physicians. In addition to fee-for-service (which is 95% of Medicare), a management fee is paid to physicians on a per-member, per-month basis. All patients are assigned their choice of primary care provider. This relationship is the key to access and prevention – two factors in the success of the program and a large driver of cost savings. While it may be simple and intuitive to us as family physicians, it is a much more difficult concept for others (third party payors, academic institutions, and some government officials) to embrace. Case workers also play a significant role in the care of patients and success of disease management. The CCNC Program seeks to improve the quality of care of the patients it serves. Physicians have input into the quality initiatives, guidelines, measurement tools, and benchmarks used to assess quality and improve cost containment. Programs such as asthma and diabetes management have provided physicians with continuing medical education, practical and useful office tools, and devices such as spirometry. Chart audits provide feedback and measure the success of providers and practices, but also show areas in need of improvement. The clinical directors of each network meet on a regular basis to share information and best practices. These networks also provide a small scale for testing new ideas. An excellent working example of this is the iCARE Partnership. The iCARE Partnership is a grant-funded program which seeks to integrate mental health care and primary care. Four pilot projects are ongoing in four separate community care networks. From these pilots, we Continues as CCNC on page 15

Advocacy Update

Busy Legislative Year for the NCAFP By Robert ‘Chuck’ Rich, MD NCAFP Vice President

In the past 12 months, leaders of your Academy have descended on the General Assembly on no less than four occasions, supporting the mission of family medicine and the needs of our members. Most recently, NCAFP President Michelle F. Jones, MD; President-Elect Christopher (Reb) Snyder, III, MD; and Professional Services Council Chair Brian Forrest, MD; spent the day meeting with their Senators and House members advocating on behalf of you. Members of the group met with House Speaker Joe Hackney, Rep. Jeff Barnhart, Rep. Carolyn Justice, Rep. Marian McLawhorn, Sen. Bob Atwater, Sen. R.C. Soles, and Deputy State Health Director Steve Cline, DDS, among others.

Some of the key issues addressed that day and throughout this session of the General Assembly have included the following:

Peter Graber

Fiscal Impact of Health Insurance Policy Changes: Thanks to the efforts of the Academy, Rep. Bob England introduced legislation that would have required insurers to conduct a fiscal impact study on any policy changes affecting healthcare providers, including the additional administrative costs caused by pre-authorization programs. The bill would have required insurers to consider how cost savings could

NC Neuro Psych

be shared with both policy holders and physicians burdened with the additional administrative work. While the bill was not approved by the House prior to the crossover deadline, national representatives at AAFP hope to make the North Carolina bill model legislation that can be introduced throughout the country. While this year’s effort was not a complete success, the bill did generate much discussion regarding the increasing burden placed on healthcare professionals and a revised version will likely be reintroduced in the future.

Inflationary Increases in Medicaid Payments: The Academy has continued to advocate for inflationary increases in Medicaid payments. While the state House approved a significant amount of funding for such an increase, the Senate’s version of the budget had reduced that amount substantially. At press time, House and Senate conferees were negotiating differences in their versions of the budget. While some increase is likely, it is unclear whether the increase will have a significant impact on provider payments.

Mental Health Parity: Some form of mental health parity will likely pass during this year’s session of the General Assembly. The state House approved a bill that would require parity on plans with more than 25 members. However, the bill did not cover substance abuse services. At press time, the Senate was considering similar legislation but may limit coverage to certain mental health conditions.

Preservation of Community Care of North Carolina: Early in the session, the Academy learned of a proposal to institute a Medicaid HMO which would have the effect of phasing out at least a portion of the CCNC networks with their local/ state supervision and substituting management by an outside company. This company would reportedly save the state on Medicaid expenditures with the savings generated by limiting services to patients, payments to providers and other means as evidenced by the company’s experience in other states. Academy leadership, with support from other organizations, directly lobbied the Senate leadership that was considering this proposal, and as of press time, any efforts to introduce a Medicaid HMO proposal are on hold. Additionally, the Academy, through the efforts

Voluntary Arbitration: As a first-step toward medical liability reform, the state House approved a bill that would limit discovery and cap damages at $1 million when both parties agree to voluntary arbitration. It’s likely that this bill will be approved by both Chambers. Academy leaders attended the House Health Committee Meeting when this bill was approved. At this point, the bill has universal support from both the medical community and the N.C. Academy of Trial Lawyers.

Article Continues on page 15

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Family Medicine Day Leads to Great Recruiting for NC Family Medicine Residencies

Peter Graber

“The recruiting opportunities were just fantastic and the students were great,” commented Dr. Mark Robinson, Residency Director at the Cabarrus Family Medicine Residency Program in Concord. Dr. Robinson chaired the event and began work to develop the conference way back in 2005.

Peter Graber

The program consisted of a series of workshops nine in total - that all student registrants participated in. Each student attended four different workshops which covered a range of clinical skills topics including suturing, radiology reviews, splinting/casting, foot disorders and several others. The event concluded with a recruitment fair spotlighting all NC family

jUNE - August 2007 | the North Carolina Family Physician

Peter Graber

North Carolina’s first Family Medicine Day was a big success, drawing students from as far away as Miami, Florida to Cary, NC on Saturday, May 19th. Forty-five students participated in a full day of clinical skills workshops and a residency recruitment fair presented by North Carolina’s family medicine residency programs, the North Carolina Academy and NC’s AHEC Program.

7 Students Complete Externships

medicine residency training programs. Several outof-state programs from Virginia, Tennessee and South Carolina exhibited as well, bringing the combined total to sixteen residency programs. While the students participated in workshops, residency coordinators representing nine different programs participated in a half-day networking seminar. The goal was to increase the dialogue among residencies, while sharing operational insights and strategies. Funding for the event was made possible through sponsorship by the North Carolina AHEC program, with the NCAFP providing in-kind promotional, logistical and meeting planning management. Family Medicine Day was modeled after a very successful, long-running program in South Carolina. Residency-focused recruitment events like these are becoming increasingly popular, as several surrounding states are considering or have already implemented similar programs. Already, several have commented on the quality of NC’s event. At press time, NCAHEC has again committed to sponsoring funding for next year. The exact date and location are still being determined.

The NCAFP’s family medicine externship program introduced seven (7) rising second-year medical students to family medicine this year. The program provides four weeks of intensive in-clinic shadowing and is very effective in providing a real-world glimpse into the care process and the daily life of a family physician. A total of nine students entered the program, with students representing the Brody School of Medicine at East Carolina University and the Bowman Gray School of Medicine at Wake Forest University. Due to this year’s strong demand, the NCAFP Foundation approved additional funding in April. The program will continue to be offered in 2008. Students interested in next year’s program can obtain complete information online at www.ncafp.com/ externship

NCAFP/AAFP Financial Support for NC FMIGs Reaches $5,600!!! Each North Carolina family medicine interest group received more money this year than ever before! All FMIGs received a total of $1,400 in funding from the NCAFP/AFFP. The increase in monies was made possible in part by a new program introduced by the AAFP Foundation. The NCAFP’s Foundation’s Medical Student Endowment Fund continues to provide an increasing level of financial support to all programs; this can’t happen without contributions. Consider making a contribution to the NCAFP/F Medical Student Endowment Fund by contacting Marlene Rosol at (919) 833-2110 or via email at mrosol@ncafp.com.

Full NC Contingent Going To Kansas City for 2007 National Conference North Carolina will be very well represented this year at the National Conference of Family Medicine Residency and Medical Students, August 1-4, 2007 in Kansas City. As this issue goes to press, approximately 30 thirty students and 20 residents will be attending. North Carolina has been fortunate this year to receive several travel scholarships from the AAFP: (3) first-time travel awards and (1) Tomorrow’s Leader Award. The chapter has also assisted all NC residency programs in developing informational materials about the state, as well as exhibit signage to help them get noticed! Stay tuned for additional updates on developments at the conference.


State Government Radio Airs Segment on the NCAFP & Family Medicine in NC

NCAFP’s Jenni Fisher, MPH Named . New NCAFP/F Health Initiatives Manager

NCAFP’s Peter Graber Reaches 5-Year Service Milestone, Achieves CAE Designation

Dr. Christopher Snyder, III, NCAFP President Elect, was interviewed on State Government Radio on June 27, 2007. The five-minute segment aired on the morning of Thursday, June 28 and featured Dr. Snyder outlining the specialty’s focus on prevention, the overall economic impact of family medicine in the state, as well as briefly discussing important advocacy issues for FPs, including current House Bill 1590. State Government Radio has an audience comprised mostly of state employees within the various state branches, including the NC General Assembly. To listen to the segment, go to www.ncafp.com/home/node/311.

Jenni Fisher, MPH, has been named Health Initiatives Manager by the NCAFP. In her new expanded role, Ms. Fisher will help oversee the implementation and execution of several of the chapter’s grant-funded health initiatives, including the NC Tar Wars Project, the NC iCARE Project and the NC Health Disparities Project. Previously, Ms. Fisher managed the NCAFP/F’s Adolescent Obesity and Inactivity Project. She will also continue in that role. Jenni is a graduate of the University of Illinois and obtained her Master’s in Public Health from UNC-Greensboro.

Peter T. Graber, CAE, NCAFP’s Director of Communications, celebrated his 5-year employment anniversary with the Academy in June. He began work with the chapter shortly after relocating from upstate New York. He also recently attained the Certified Association Executive (CAE) designation from the American Society of Association Executives. The CAE designation is the highest professional credential in the association industry, with less than 5% of all association professionals having earned it. The NCAFP is fortunate to now have 3 CAEs on staff.

NCAFP Selected as Key Particpant in AAFP-Sponsored National Industry Partners Forum in Delaware NCAFP Director of Professional Services Greg Griggs, MPA, CAE, served as one of three panelists representing Academy Chapters around the country during AAFP’s Annual industry Executive Leadership Forum and Update on Family Medicine in Wilmington, Delaware, in early June. The Forum

is designed to update pharmaceutical companies and other industry partners on activities of AAFP. The two-day program included an update on AAFP’s Annual Clinical Focus, “A Day in the Life of a Family Physician” by AAFP President Rick D. Kellerman, MD, FAAFP, and a panel highlighting

Chapter activities and how the national organization and state Chapters collaborate. Other states selected to participate in the panel included Connecticut and Pennsylvania. During the presentation, Griggs highlighted NCAFP’s CME activities, as well as a number of the Chapter’s grant funded projects.

Mag Mutual

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Family Physician Plays Key Role in Helping Community Achieve National Recognition A small city in Sampson County recently garnered the coveted All American City Award, one of only nine other cities in the country to do so in 2007. That city – Clinton, NC – is home to several NCAFP family physicians, including one in particular who helped play a very special role in making it happen...

Dr. J. Thomas Newton (Pres.1995-96), helped his community stand out among over twenty finalists in Anaheim, CA during the National Civic League’s All American City awards competition in late May. Dr. Newton’s physical fitness program, Fitness Renaissance, was a key element of Clinton’s overall presentation and a big factor in their recognition. About The Award

guidance of the Clinton City Schools administration. The program has received both local and statewide attention, including being awarded grant funding from the Blue Cross/Blue Shield of NC Foundation. What makes the program unique is that it helps draw attention to students demonstrating physical fitness and exercise improvement through incentives and public recognition. Several civic organizations in Sampson County have embraced the program and it continues to grow in popularity. Along with Fitness Renaissance, Clinton’s delegation also highlighted two other key community efforts: its March-to-a-Million Campaign and its Technology Learning Center. The March-to-a-Million Campaign was a community-wide effort that sought to raise $1.4 million dollars in just 4 months. The funds were earmarked to cover a shortfall in funding needed for a series of amenities the community desired at its new public high school. To date, the campaign has raised over $2,4M. Clinton’s Technology Learning Center opened in late 2001 to provide the community with free access to technology, as well as offer students (K-12) with quality afterschool homework and technology assistance. The center has been so successful that a second facility opened in the fall of 2003.

The All American City Award is the oldest and most prestigious civic recognition competition in the US. Communities from all over the country participate annually in the competition that selects only ten cities as true examples of successful community teamwork and the American spirit in action. Each city steps through an extensive applications/screening process conducted by the Civic League. Then upon invitation, sends a small delegation of civic activists to present three examples of their community’s collaborative problem solving efforts. For Clinton’s effort, Dr. Newton was a key player in the entire process – culminating with his presentation on behalf of the city to Civic League judges in Anaheim. The city’s ten-minute presentation centered on the concept of a street reporter puppet, ‘Dan Rather-be-in-Clinton’, doing live, on-the-street interviews. The skit presented each key Clinton project through ‘interviews’ of key

community spokespeople. Dr. Newton described his highly successful Fitness Renaissance program and fielded questions from the judges.

Scouts Honor Family Physician with Distinguished Citizen Award

UNC’s Dr. Warren Newton Elected to 5-Year Term on The American Board of Family Medicine

The Torhunta and Neusiok districts of the NC Boy Scouts bestowed citizen honors this spring, with Johnston County family physician Dr. Stan Watson receiving a 2007 Distinguished Citizen Award. The award honors individuals who provide their communities leadership or philanthropic efforts that exemplify the qualities that Scouting instills in youth. Dr Watson, an Eagle Scout, is a physician with Horizon Family Medicine in Smithfield. He and his wife, Beth Parker Watson, are the parents of five children.

Dr. Warren P. Newton, MPH, has been elected to a 5-year term on the board of directors of the American Board of Family Medicine. Dr. Newton is the William B. Aycock Distinguished Professor and Chairman of the Department of Family Medicine at the University of North Carolina at Chapel Hill. He has held local, state and national leadership positions within family medicine and has been involved in the development of the North Carolina Governor’s Quality Initiative. As a member of the board, Newton will serve on the Information & Technology Committee, the Research & Development Committee, and the Communications/Publications Committee. Dr. Newton currently serves on the NCAFP Board of Directors as an alternate Family Medicine Departments Chair.

jUNE - August 2007 | the North Carolina Family Physician

The Fitness Renaissance

Fitness Renaissance was first introduced in Clinton in 2004 and is modeled after a successful reading program and the high school Presidential Physical Fitness Awards Program. Dr. Newton is credited for conceptualizing the program and helping to make it a reality with the aid and



NCAFP Helps Train FP Leaders on Media Skills, Health Policy Advocacy

AAFP’s Ask & Act Tobacco Cessation Program Coming To NCAFP Winter Meeting The NCAFP is proud to

NCAFP Set to Host Southeast Family Medicine Forum The chapter is hosting this invitation-only event at The Grove Park Inn on August 16-18, 2007. The Southeast Forum is an annual conclave that brings together chapter executives and physician leaders from twelve southeastern states to discuss contemporary issues within family medicine and chapter affairs. This last time the NCAFP hosted the event was in 1996.

The NCAFP’s Future of Family Medicine Leadership Retreat was held on July 27-29, 2007, at the Embassy Suites Hotel in Cary, NC. The retreat focused on communicating family medicine’s core messages and values to the media. Dr. Michelle F. Jones facilitated a day-long workshop on media training with NCAFP’s Dr. Kevin Soden of Charlotte, NC. Dr. Soden has extensive media and television experience. He provided an outline to techniques and analyzed mock video interviews recorded during the session. Physicians also participated in a segment on healthcare resolution writing. The Leadership Retreat followed the AAFP’s LIVE CME session that was held on Friday, July 27, 2007. After the media training and resolution writing segments, each of NCAFP’s family medicine councils assembled to discuss issues and draft prospective health policy resolutions. The Academy has seven councils in which physicians participate: Child and Maternal Health, CME, Health Promotion and Disease Prevention, Mental Health, Health Disparities, Governmental Affairs, and Professional Services. Council members are asked to review policies, positions and proposals under consideration by state agencies and/or related organizations, including the AAFP. Complete information on all NCAFP councils is available at www.ncafp.com/councils.

2008 Academy Spring Meeting Returning to North Carolina The NCAFP’s annual spring business and educational symposium will return to North Carolina in 2008. The event will be held at the Embassy Suites Hotel in Concord, NC on April 1720, 2008. Planning for the meeting is continuing, but look for additional details in upcoming editions

of NCAFPNotes, the NC Family Physician and online at www.ncafp.com/sfpw. The Concord area is a great place to visit and the hotel provides quick-and-easy access to amenities like the Concord Mills Shopping Center, Lowe’s Motor Speedway, and the Mint Museum of Craft and Design.

announce that the AAFP’s ‘Ask and Act’ Chapter road show is coming to Asheville in December! Because tobacco addiction causes over 440,000 deaths in the United States each year, it is considered the most preventable cause of death. Of the 46 million current U.S. smokers, 70 percent say they would like to quit. Family physicians are taking a frontline approach to helping these smokers meet their goal. NCAFP’s Jenni Fisher has been selected as the Ask and Act chapter liaison for North Carolina. She help deliver the program that’s designed to motivate family physicians to “Ask and Act,” about tobacco use with their patient population. A small library of materials is available to help AAFP members educate their patients

Help Raise Fund’s To Help Improve Family Medicine in North Carolina

on cessation options

Join your fellow Family Physicians and decorations, silk plants, gift baskets, guests at the auction tables during pottery, or a fashionable knitted the Winter Family Physicians Weekend. hat and scarf. All donated auction Being held at the Grove Park Inn Resort items are tax deductible, and the & Spa in the breathtaking mountains proceeds go towards the various Nov. 30 - Dec. 1, 2007 of Asheville, November 29 – December NCAFP Foundation programs and 2, this is an event you won’t want to miss! If you’re interested projects. If you want to donate an item (or two!), contact Marlene Rosol, in donating an item, suggested items are electronics (DVD players, Development Coordinator, at (919) 833-2110, (800) 872-9482 [NC only], or palm pilots, iPods), children’s toys, hand-crafted jewelry, Christmas mrosol@ncafp.com.


and techniques. Look for additional information about this program in upcoming issues of NCAFPNotes.

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Foundation Awards Four Scholarships for 2007 We offer our heartfelt congratulations to our 2007 Foundation Student Scholarship winners! This year’s proud recipients are Cherrie Mae Crowder of East Carolina University, and Rhianna Jean Kirkpatrick, Oritsetsemaye Otubu, and Lorene Temming of the University of North Carolina. The awards remain scholarships under the condition that the students successfully complete their residency training in the specialty of Family Medicine. If, however, residency training is not completed in this specialty, the scholarship converts into a loan and payment requirements commence. We encourage all students registered at the four NC medical schools to apply for scholarships. For more information on student scholarships, or how you can make a donation to the Scholarship Program, please contact Marlene Rosol, Development Coordinator, at (800) 872-9482 [NC only], (919) 833-2110, or mrosol@ncafp.com.

Student Endowment Fund Now Stands Over $500K The NCAFP Foundation is happy to announce that the Medical Student Endowment Fund has reached its goal of $500,000! At the 2005 Winter Family Physicians Weekend, Sue Makey issued a challenge to reach $500,000 for the Endowment Fund prior her retirement on December 31, 2007. In addition to a major gift from the Academy on December 31, 2005, the Endowment now stands at $509,447.07. Interest earned on future contributions received for the Endowment will be earmarked to support student activities. We’re proud to announce that Sue’s challenge has been realized!


jUNE - August 2007 | the North Carolina Family Physician

NCAFP/F Health Disparities Initiative Completes First Year The Health Disparities Initiative (HDI), funded by the NC Health and Wellness Trust Fund, has now completed its first year. During the first year the project focused on physician education about risk factors for disparate population groups, cultural differences and how to provide culturally appropriate care. This was done through online CME training through the Carolinas Center for Medical Excellence and traditional education through lectures at the Academy’s Winter and Spring meetings. The other form of education for this project is in the form of practice based initiatives. Pilot practices were selected in May. These practices will be working for

High Marks from The Trust Fund!!


ded by as now ear the ut risk cultural opriate raining ellence at the

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2007 NcAFP/F Corporate

the next two years to increase their clinics’ compliance with the Culturally and Linguistically Appropriate Services (CLAS) standards guidelines and to develop relationships with other local organizations representing minority populations. The five pilot practices include:

Grand Patrons

NC Academy Of Family Physicians, Raleigh, NC*

• Dr. Karen Smith, private practice in Raeford


• Dr. John Torontow, Siler City Community Health Center • Dr. David Gibvson, Chatham Primary Care • Dr. Tim McGrath, Kernodle Clinic in Mebane • Dr. Ann Chelminski, Scott Clinic in Burlington

S up p ort ers

ECR Pharmaceuticals, Richmond, VA**

Kevin Sitko and Joshua Evans, second-year medical students at the UNC School of Medicine, are both working in two of these practices for six weeks during the summer. They will be evaluating how well the clinics meet the CLAS standards and then developing a plan for each clinic tto fill in any gaps where standards are not being met. In June 2009, two new medical students will return to these four clinics and reassess the clinics’ compliance and document their progress. In the second year, the project will continue its educational efforts both online and at the Winter Family Physicians Weekend and the Academy’s Spring Meeting. Pilot practices will work to implement strategies developed to fill the gaps where the CLAS standards are not being met. If you have any questions or would like information about the Health Disparities Initiative, please contact Jenni Fisher, MPH at 919-8332110 or jfisher@ncafp.com.

The disparities initiative received high marks from the N.C. Health and Wellness Trust Fund during an annual site visit in late May. Representatives of the Trust Fund and their Technical Assistance Team from N.C. Central University encouraged the Academy to continue to expand outreach efforts to supplement the excellent work that is already going on as a result of the initiative.

MAG Mutual Insurance Company, Atlanta, GA* Med Cost, LLC, Winston-Salem, NC* Medical Mutual, Raleigh, NC* Misys Healthcare Systems, Raleigh, NC* Rudy L. Snow, Stanfield Mini-Mart, Stanfield, NC*

Thank you to our 2007 NCAFP Foundation Corporate Members! Their participation and support are crucial to what we do, and we are proud to include them as part of our Foundation family. *Corporate Members – Unrestricted / **Corporate Members – Restricted

NCAFP’s Annual Meeting Will Be Full of Festivities The NCAFP will be mixing great education with a round-up of business meetings and special events in Asheville on Nov.29th through Dec. 2, 2007 during the annual Winter Family Physicians Weekend. Please join us as we return to the beautiful Grove Park Inn and Spa. For the second year in a row, Dr. Kevin E. Burrough’s is serving as CME Program Chair. He has put together another great educational agenda, combining timely updates with new information on emerging topics. A current list of topics to be presented is available online at www.ncafp.com/wfpw. The meeting will also present a full slate of business meetings and social events. One event you don’t want to miss is a special banquet highlighting the career of Sue Makey, CAE, NCAFP’s long-serving Executive Vice President. Sue will be retiring at the close of

2007 and the Academy will honor her 31 years of service on Friday, November 30. Additional information on this event can be found online. The Academy will be mailing the official meeting brochure in the coming weeks. For physicians interested in beating the rush and registering immediately, online registration is

The NCAFP will honor Sue Makey’s thirty-one years of service on Friday, Nov. 30, 2007.

available now at www.ncafp.com/wfpw.

WWW.NCAFP.COM | North Carolina ACADEMY OF Family PhysicianS, INC



NCQA, ABFM Align Physician Measurement Standards Physicians Can Use NCQA Recognition For Credit Towards Maintenance of Certification; more than 70,000 Diplomates Stand to Benefit The American Board of Family Medicine (ABFM) and the National Committee for Quality Assurance (NCQA) recently announced an agreement under which ABFM Diplomates recognized for quality care through NCQA’s popular Physician Recognition Programs will also receive credit towards their Maintenance of Certification for Family Physicians (MC-FP). Maintenance of Certification for Family Physicians is the means by which the ABFM continually assesses its more than 70,000 Diplomates to ensure that they meet the highest standards of accountability and clinical excellence. Under the agreement, ABFM Diplomates who successfully complete NCQA’s Diabetes Physician Recognition Program or its Heart/ Stroke Recognition Program are eligible to receive credit for the completion of a MC-FP Part IV Performance in Practice Module. Diplomates are required to complete one such module during each stage of the Maintenance of Certification process. NCQA’s Physician Recognition programs identify clinicians who demonstrate consistent delivery of high-quality care for key conditions. Physicians qualify for NCQA recognition by meeting rigorous standards and reviewing the medical records of a sample of patients to ensure

that they receive care consistent with evidencebased guidelines. Program standards are set by NCQA and its partners, the American Diabetes Association and the American Heart Association/ American Stroke Association. More than 5,000 physicians have earned NCQA Recognition to date. “NCQA Recognition, like Certification from the ABFM, is a mark of excellent care,” said NCQA President Margaret E. O’Kane. “We’re pleased to work with the ABFM to bring our program standards in alignment – it’s a great way to add value to both programs.” “NCQA’s Recognition programs and the ABFM’s Performance in Practice modules both employ widely accepted guidelines for care based firmly in medical evidence,” said ABFM President and Chief Executive Officer James C. Puffer, MD. “Allowing our Diplomates to pursue Recognition and Maintenance of Certification simultaneously reduces measurement burden so our physicians can spend more time doing what they do best— delivering the best possible care to their patients.” For details regarding MC-FP and PPM requirements, Diplomates may visit the ABFM Website, www. theabfm.org, or call the ABFM Support Center at (877) 223-7437. For more information about NCQA’s Physician Recognition programs, log on to NCQA’s Web site at www.ncqa.org.

Family physicians and public health agencies are natural allies in supporting the health and well-being of children and youth in North Carolina. The Women’s and Children’s Health Section is launching Public Health Connections to help inform

~ Attention All Providers ~

Medicaid’s ValueOptions Fax Numbers Have Changed ValueOptions relocated its office and its fax numbers changed back in February 2007. Many providers, however, still may be relying on their old fax number. Beginning February 24, 2007, the following fax numbers became operational. Please reset your fax machines accordingly.

[Medicaid MH/SA 919.461.0599], [Medicaid Developmental Disabilities 919.461.0669] and [Health Choice 919.379.9035]. Providers are reminded to reset your fax machines. Faxes sent to the incorrect fax number will NOT be honored.

Make a Special Gift

You can honor or memorialize a colleague, friend or family member with a gift to the NCAFP Foundation. With this special designation, the Foundation will send a card to the family of the deceased, individual or organization being honored. The card will show your name as the donor, but not the amount of the contribution. To make your special, tax-deductible gift, contact Marlene Rosol, Development Coordinator, NCAFP Foundation, (919) 833-2110, (800) 872-9482 [NC only], or mrosol@ncafp.com 12

jUNE - August 2007 | the North Carolina Family Physician

primary care providers about how N.C. Division of Public Health initiatives can assist physicians in their efforts to optimally serve their patients. Each issue of Public Health Connections will feature an article about an issue or a public health program we feel will be useful to you in your practice. We will aim to raise awareness and promote collaboration between family physicians and the Division of Public Health as a means of achieving our shared goal of supporting children and families across the state. We also invite you to send feedback to Dr. Gerri Mattson, Pediatric Medical Consultant for the Children and Youth Branch, N.C. Division of Public Health at gerri.mattson@ncmail.net.

Early Intervention

An Important Resource f o r t h e Fa m i l y P h y s i c ia n

Suppose you see an infant in your office and identify developmental concerns through the ASQ during the visit. What would you do? The Infant Toddler Early Intervention (EI) Program can help.

The EI program is an important resource for been referred to or is receiving Early Intervention EI, it is important that the medical home monitor infants from birth to three years of age. Mediated services, since child care providers and others can the infant or child closely. Those children should be through a network of Children’s Developmental and do make referrals to EI. Knowing referral referred to the Child Service Coordination (CSC) Service Agencies (CDSAs), the program is open status will help with the communication process, program. The CSC program partners with families in all 100 counties, and anyone — primary care since information from the CDSA will only go to identify strengths and needs and access services provider, child care provider, family, etc. — can back to the initial referral source unless the family to meet identified needs. The CSC program is for refer a child. If you suspect a developmental delay requests information be sent to others with whom eligible children birth to five years who are at risk or other special needs, you can refer the child and the family works. A physician can ask the parent(s) for or diagnosed with developmental delay, socialhis or her family to your county’s CDSA. Staff at to sign a consent for release of information to the emotional disorder or chronic illness. The CSC and the CDSA will contact the family, find out what medical home to allow the CDSA to share the EI programs both work to get parental consent at the time a child is referred to a program so that the child’s needs are, and do an evaluation to see if information with the medical home. information can be shared between the child is eligible for the EI program. programs and with providers. You can use the www.ncei.org website to If you suspect a developmental delay or other The primary care provider should feel get CDSA contact information for your special needs, you can refer the child and his or free to refer the infant or child back to county. Up-to-date eligibility criteria for her family to your county’s CDSA. the CDSA at any time if developmental EI and a list of frequently asked questions concerns remain. EI program staff are can also be found at www.ncei.org. A referral to EI should include the following If a child has received an evaluation for speech, interested in working with the child’s primary information: the name and address of the primary occupational, and/or physical therapy because care provider to assess other options for services caretaker; whether the caretaker was informed concerns were previously identified in one or more in the community that an infant or child might about the referral to Early Intervention; the developmental areas, this information can be used need. There are also community opportunities preferred language of the family; and the name and in the CDSA evaluation process. The EI program for primary care providers to discuss and address location of the child’s medical home. The detailed will try to get parental consent for information early intervention issues through participation results of any standardized developmental screening from other providers at the time a child is referred in meetings with the county Local Interagency tools or other assessments and consultations on a to the program, so that information can be shared Council, the local Cooperative Extension agent, child should also be provided to the CDSA. The between programs and with providers. It is Smart Start, Regional Interagency Council and/or additional information will help with the CDSA important to make sure there is permission from the CDSA. Many Local Interagency Councils or parents for communication among parents, CSC, other agencies such as Smart Start are interested process for eligibility determination. EI program staff are working to improve the medical home, other providers, agencies, and EI in developing resource books for primary care communication with medical homes about the staff. There is a need for ongoing communication, providers that map out community resources and infants and children they are evaluating and and the medical home can help coordinate care and services for young children to assist with referrals to address social/emotional and other early serving. It is important for family physicians and facilitate the communication process. primary care providers to ask families if a child has If an infant or child is not found to be eligible for intervention needs. WWW.NCAFP.COM | North Carolina ACADEMY OF Family PhysicianS, INC






Dental Varnish Procedure Time Interval Changes Effective June 2007 In an effort to increase opportunities for young Medicaid children to have the six maximum dental varnish procedures, Medicaid has changed the time interval requirements. Children are now eligible for the procedure until they are 3 ½ years old (through 41 months) and the time interval between procedures is reduced from 90 to 60 days. This promotes flexibility for providing the procedure at well child visits scheduled at 90-day time intervals as well as at the 3-year well child visit. Effectiveness data show that children receiving 4, 5 or 6 oral screening and fluoride varnish procedures have approximately 40% fewer dental treatment needs. At the present time most children receive the procedure only twice before their 3rd birthday. Thank you for your feedback on these barriers and to Medicaid for working to increase access to oral preventive care for enrolled children. ALL ‘Into the Mouths of Babes’ toolkit contents and the ‘Babes Brief’ newsletter are now on the web! Be sure to visit www.oralhealthncdhhs.gov to access materials or their links. From this page select Oral Health Education and you will see the ‘Into the Mouths of Babes’ link under Professional Education. We hope to have a direct link from the main page very soon! If you are interested in becoming an IMB provider or would like more information about the program, check out the above web site or call Kelly Haupt, Project Coordinator, at 919-707-5485 or email Kelly.Haupt@ncmail.net

A Physician’s Perspective

The Co-Pay Culture and Rebuilding the Value of the Medical Home By Brian Forrest, MD Chair, NCAFP Professional Services Council In a time where many people are used to having their car tuned up for $200+, it is surprising that the same culture makes patients complain about a $15 co-pay to get a complete physical of their most important asset: themselves. The “Co-pay Culture”, as I like to refer to it, is one of the things that is devaluing the cognitive work that is done by family physicians. Non-medical people forget that there is much more cost associated with their visit that just the trivial amount that they pay at time of service. However, when they pay at the mechanic for the tune-up, they may be thrilled to pay any bill under $250. This schism in attitudes about costs of healthcare is the part of the reason that insurers and the employers that support them have placed a decreasing value on primary care services. The co-pay culture has allowed people to take healthcare out of their family budgets because the insured feel that any costs will be trivial. These same families expect to pay for car repairs and generally do without too The co-pay culture has allowed much complaining. Let me expand this analogy: people to take healthcare out of their Car insurance does not pay for oil changes, tune-ups, or new tires, but people expect their family budgets because the insured health insurance to cover flu shots, office visits feel that any costs will be trivial. for colds, and other relatively minor medical expenses. Insurance, in principal, is intended to spread catastrophic risks over a large pool of insured people so that no single occurrence or expense is financially devastating. But the co-pay culture has eroded any sense of financial responsibility for one’s own healthcare and a co-pay is expected for things that are not financially burdensome, such as flu shots. This is the reason that premiums have become so inflated. The premiums do not represent insurance in the truest sense of the word, but rather an administrative middleman pass-thru. In other words, you or your employer pays $3 per month in extra premiums to cover the $25 annual flu shot. That means instead of it costing $25 if you had paid for it yourself, it actually ends up costing you or your company $36. This inefficiency and loss of middleman administrative costs is driving the healthcare system to higher costs without any increase in payment for physicians. This Co-pay Culture has also led to some erosion of the physician-patient relationship and subsequently loss of a medical home for many patients. Some patients’ relationships with their physicians are dependent on their physician’s participation in their PPO or HMO. Patients at times are showing more loyalty to their network than to their physician. Let us look at the car/mechanic analogy again. Many people take their cars to specific dealerships or service centers to maintain or repair their cars. The price differences can be as much as $50-100 difference between mechanics. Many people will tell you that they do not mind paying this difference for their preferred mechanic. But those same people would be appalled to pay $25 more for an out-of-network co-pay, even if they preferred the out-of-network physician. So in fact, the medical home for our cars may in some cases be more consistent than our medical home for our own health. Patients need a medical home much more than their cars need a favorite service center. We can start to reshape attitudes in our culture about the value of the services that family physicians provide by building stronger physician-patient relationships. Just as customers of the Quickey-Lube type oil change centers have put convenience at a higher priority than the relationships and trust of their favorite mechanic, so have some patients opted for Retail Health Clinics. The change in our culture must start with family physicians. So, where do you get your oil changed?

Have a perspective you would like to share with other physicians? Want to provide your insight into a particular area of focus? All NCAFP members are encouraged to contribute articles for consideration. Please send your perspectives to pgraber@ncafp.com. 14

jUNE - August 2007 | the North Carolina Family Physician

Advocacy - Continued from page 4

CCNC - Continued from page 3

of your Governmental Affairs Advisory Council continues to monitor the status of and advocates on your behalf the following areas:

hope to create models for the state to help improve access to mental health services. These projects have been quite successful in the early stages of development, and the programs have been well received by the physician community. Their structure and function can easily be replicated in practices across the state. As future pilot projects arise and as programs are successful, they can be shared with the other networks to the benefit of the entire state. At this time Community Care of North Carolina provides care for only the Medicaid insured. However, one could envision savings in all categories of those insured by the state, including the state employees and the dually eligible. Imagine if the state paid Community Care to manage the health of all teachers and support staff, retirees, and other state workers. You and I would be determining the medical policies and ensuring quality care, not the private insurers such as Blue Cross and Blue Shield. Imagine also the hundreds of millions of dollars which could be saved and spent on other programs. If our elected officials need to look for money for other budget items, they should look at moving more of the state paid insured into the Community Care Program, not taking action that could torpedo

The state of the medical school at ECU, and in particular, the status of the planned new Family Medicine Center: The NCAFP continues to work with leaders both in the medical school and outside the school via various government entities to ensure the continued importance of Family Medicine to the charter of the medical school, and we continue to push for the complete funding and subsequent start of construction of the new Family Medicine center. The reinstitution of the Family Medicine Residency at Duke Medical Center and the subsequent training of family medicine physicians: Your chapter President, Dr. Michelle Jones, has been closely involved in these discussions with Duke and has been quoted by the news media in reference to this process. The continued growth of retail health clinics: The Academy, through GAAC, continues to closely monitor this trend and at press time, GAAC leadership was preparing several proposed guidelines to be forwarded to various governmental entities for action to ensure proper supervision and management of these clinics. Our emphasis for these proposals is to ensure proper patient safety when seen in these clinics and to ensure the subsequent return of the patient’s care afterwards to their medical home. These are just a few examples of the issues addressed at the state level by members of the Academy, under the direction of your Government Affairs Advisory Council, chaired by Robert L. (Chuck) Rich, Jr., MD. The Council is advised by the Academy’s Government Affair Consultant, G. Peyton Maynard. In addition, the Academy’s efforts are not limited to state advocacy. In May, three North Carolina members joined their colleagues from across the country during AAFP’s Annual Advocacy Conference in Washington, DC. Dr. Conrad Flick, Dr. Mary Hall and Dr. Warren Newton met with a number of the members of North Carolina’s congressional delegation including: Rep. David Price, Rep. Brad Miller, and Rep. Sue Myrick, as well as staffers from the office of Sen. Richard Burr and Sen. Elizabeth Dole. For information on the efforts of the Academy’s GAAC, contact Greg Griggs, MPA, CAE, Director of Professional Services, at 919833-2110 or by e-mail at ggriggs@ncafp.com.

this successful program. If you are not involved in Community Care of North Carolina, I urge you to go to the website www.communitycarenc.com and find your network. You can also help ensure a brighter future for our members and their patients by urging your legislator to support Community Care not outof-state companies looking to profit through a Medicaid HMO.

Keep YOur member info Up-to-date Members – please be sure to keep all of your contact info up to date. This includes your home and business address, phone, fax, and email address. To update, contact Marlene Rosol, NCAFP Membership Coordinator, at mrosol@ncafp.com, 919-833-2110, or 800-872-9482.

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