April 17-20, 2008 Concord/Charlotte
The North Carolina Family Physician
Vol. 4 - No. 1
First Quarter, 2008
Dr. Christopher Snyder, III Installed as NCAFP President
In This Issue.. .
Dr. Lori Heim: A Family Physician Ready To Take The Lead Dr. Tommy Newton Named 2007 NC Family Physician of The Year Academyâ€™s Obesity Initiative Pays Off
The NCAFP and Dr. James McNabb Present
April 17-20, 2008 Embassy Suites Concord, NC
Four Reasons To Attend... 1) Centrally Located in Concord/Charlotte area at a Great Hotel 2) Fantastic Educational Lineup - 24+ Credits 3) Practical & Engaging Workshops 4) Plenty of Fun for the Family!
Complete Spring Family Physicians meeting information and registration is online at http://www.ncafp.com/sfpw
THE NORTH CAROLINA ACADEMY OF FAMILY PHYSICIANS, INC Raleigh, NC 27605 919.833.2110 • fax 919.833.1801
The North Carolina Family Physician
Volume 4 Number 1
2007-2008 NCAFP Board of Directors NCAFP Executive Officers President Christopher Snyder, III, MD President-Elect Robert Lee Rich, Jr., MD Vice President Roy W. ‘Chip’ Watkins, MD, MPH, FAAFP Secretary/Treasurer Richard W. Lord, Jr., MD Board Chair Michelle F. Jones, MD Executive Vice President Gregory K. Griggs, MPA, CAE J. Carson Rounds, MD Past President (w/voting privileges) The District Directors District 1 Kevin Talton, 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 Brian R. Forrest, MD At Large Elizabeth B. Gibbons, 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 Warren P. Newton, MD, MPH FM Residency Director Janalynn F. Beste, MD Resident Director Tamieka Howell, MD (GAHEC) Resident Director-Elect Alicia C. Walters, MD (WFUBMC) Student Director Carrie Hamby (UNC) Student Director-Elect Lillianne M. Lewis (Duke)
TABLE OF CONTENTS Features
Chapter Leadership, Advocacy and an Important Campaign ..............................................4 Continued Chapter Success Will Require Laser-Like Focus...........................................7 A Family Physician Ready to Take The Lead..............................................................................9 Clinton’s Tommy Newton Named NC Family Physician of The Year................................11 Academy’s Statewide Obesity Initiative Pays Off..................................................................12 The Data Are Within Your Reach..................................................................................................14 S e ction s President’s Message...................................................... 4
Meetings & Education.......................................................... 8
Chapter Briefs.............................................................. 10 Student Programs...............................................................11 Member Highlight..........................................................11
Family Medicine In Practice................................................14
AAFP Delegates and Alternates AAFP Delegate AAFP Delegate AAFP Alternate AAFP Alternate
L. Allen Dobson, MD Conrad L. Flick, MD Mott P. Blair, IV, MD Karen L. Smith, MD
FP Department Chairs and Alternates Chair (UNC) Alternate (Duke) Alternate (ECU) Alternate (WFU)
Warren P. Newton, MD, MPH J. Lloyd Michener, MD Kenneth Steinweg, MD Michael L. Coates, MD
NCAFP Council Chairs Janalynn F. Beste, MD Jennifer Mullendore, MD Governmental Affairs Robert Lee Rich, Jr., MD Brian R. Forrest, MD Health Promotion & Disease Prev. Jessica Shore-Saxe, MD Mental Health Michelle F. Jones, MD Al Mooney, III, MD Professional Services Brian R. Forrest, MD Christopher B. Isenhour, MD Health Disparities Viviana Martinez-Bianchi, MD Continuing Medical Education Richard W. Lord, Jr., MD
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.
Child & Maternal Health
NCAFP Editorial Committee Chair
William A. Dennis, MD Shannon B. Dowler, MD Elizabeth B. Gibbons, MD Richard W. Lord, Jr., MD David C. Luoma, MD
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.
MANAGING EDITOR & PRODUCTION
Peter T. Graber, MMC,CAE Director of Communications PUBLISHED BY
Virginia Robertson, President Publishing Concepts, Inc. 14109 Taylor Loop Road Little Rock, AR 72223 FOR ADVERTISING INFORMATION
Greg Jones firstname.lastname@example.org 501.221.9986 • 800.561.4686 Ed i t i o n 13
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.
Chapter Leadership, Agressive Advocacy and Winning an Important Campaign NCAFP President Dr. Christopher Snyder, III, Outlines His 2008 Presidential Goals The following speech was delivered by Dr. Christopher Snyder, III, during his inaugural address as President of the NCAFP. Christopher Snyder, III, MD 2007-08 NCAFP President
An ancient proverb states: “May you live in interesting times.” These are certainly interesting times for the North Carolina Academy of Family Physicians. They are challenging times, frustrating times, and even dangerous times as the future of our specialty seems to be determined by forces beyond our control. Many of our members express discontent and even despair over these threats to our professional lives. But I believe these are also exciting and optimistic times. In the next year I endeavor to work on three areas: a smooth transition to our new leadership, political action for payment reform and a winning campaign for the NCAFP and Uniform Services candidate for President-Elect of the AAFP. Two years ago, in preparation for the selection of our new Executive Vice President, your Academy performed a member survey; we wanted to know what you felt was needed for a strong future. We received about 34% return on the survey, which is a remarkable return rate and is evidence that you have faith in your Academy to represent you. For the first time, the survey found that continuing medical education is not at the top of the list, it came in second. At the top of the list is advocacy—specifically for help with those issues that threaten our ability to – literally – stay in business and to maintain our specialty. To fight these new battles, we needed an Executive Vice President who is enthusiastic, insightful and ready to jump into these challenging arenas. The selection task force reviewed over thirty applications and interviewed many candidates. Our ultimate choice was Greg Griggs. Early in the selection process, it became clear he was pulling away from the pack. I called him the 4
‘Secretariat’ of candidates, Secretariat being one of the greatest race horses of all times, finishing the Kentucky Derby thirty-two lengths ahead and posting a faster time in each quarter. Greg ran a similar race. Our Academy is indeed in good hands. He has a keen understanding of the political process and how to effect changes that will level the playing field. I am proud to be his first President and look forward to working with Greg. Earlier this year, as you all well
And then came House Bill 1590. Crafted by Sue Makey and Peyton Maynard, HB 1590 specifically addressed a health insurance company’s authority to unilaterally force changes upon physicians. It mandated that before any prior authorization requirements can be instituted, the company must demonstrate how much money would be saved, how it would improve patient care, reduce premiums, and impact a physician’s practice. This
“ In advocating for our members, our Academy
must continue to focus our energy and resources on the politics that invade the health care system.” - Dr. Christopher Snyder, III know, several health insurance plans unilaterally instituted a prior authorization plan for imaging studies and shoved it down our throats. They introduced it with the usual rhetoric, saying it will reduce costs, improve patient safety, and will really only affect those who are abusing the system. Our Academy performed a survey of our members and found it took at least the amount of time for two office-visits every day and added about $10,000.00 a year to your office overhead, not to mention the aggravation of having someone in Minnesota making decisions for our patients in North Carolina. Our Academy contested these handcuffs with our usual weapons: solid reason, hard facts, and common sense. Our efforts were to no avail. It seemed to be just another example of how big business has the contractual upper hand and another example of the fact that we were powerless to do anything other than complain and comply.
january - march 2008 | the North Carolina Family Physician
bill would also give physicians an opportunity to pass judgment or even to opt-out of the contract. As soon as this bill was introduced, it immediately received strong pushback from the health insurance lobbies. HB 1590 died in committee but the message is clear. Contracts are one thing, but even health insurance companies have to comply with the laws of North Carolina. In advocating for our members, our Academy must continue to focus our energy and resources on the politics that invade the Health Care system. This type of advocacy has also been successful in the state of Colorado. Three years ago, the Colorado Medical Society introduced the Uniform Contracting Bill that created a mandatory contract template for all insurance plans to utilize; a contract written in plain language that even a doctor can understand. It too required written notification for any substantial changes and allowed the physicians
to opt-out if they felt the proposed changes were unreasonable. The first year it passed the legislature, but was vetoed by the governor. The second year it brought all the insurance plans to the table, a level table I might add, and a new bill was crafted that addressed the doctors’ concerns. The third-year it passed the Colorado legislature and was signed by the governor. The legislation takes effect in 2008. We will track its effect and take the best components for our own political efforts in North Carolina. In Chicago at this year’s AAFP Congress of Delegates I learned that insurance companies net about $400,000.00 a year on every primary care doctor. Our own research on bonuses for CEOs of health insurance plans revealed an obscene amount of money that they should be ashamed to deposit in the bank. I dare say that most of that profit has been gained from the fact that when our patients show up at our medical homes, we take them in. Family Physicians are the best value, from acute care, chronic disease management, prevention, screening, continuity-of-care of an entire family, and cost containment. No one does it better or more efficiently. Many times we perform all these functions in the context of a single office visit! It is time for us to be paid accordingly. Earlier this year, the Commonwealth Fund released a report that stated the only two things in the health system that reduce ethnic and racial disparities are whether the patient has health insurance and whether the patient has a medical home. ‘Home’ has been defined as the place that when you go there, they have to take you in. The medical home, in my mind, is defined
as the place where - when our patients come - we want to take them in. The ongoing relationships with our patients is what makes us go to work every day. The insurance industry has taken advantage of this fact for decades and has rewarded us with confusing contracts and low rates. Thus far, we have been willing accomplices in this situation. But times are tough and if our medical homes are to thrive, not merely survive, we need payment reform. We must separate our business needs from our medical mission. Employers and insurance companies will not reward us more for what we are doing now. They must be convinced of the value of the Family Physician, and in so doing, realize that the medical home must accommodate all medical
challenges with modernization and some redesign. This of course takes a financial commitment on their part! A compass will still get you to The Grove Park Inn, but I dare say most of us used a GPS system to get here. This redesign requires having the financial resources to maintain a competent and caring staff, modern equipment and services for our patients, a functioning electronic health record that performs disease management and screening, and not just electrifying our paper charts. We must have expanded hours and open access that serve the patient’s schedule, not just the doctors’ or staff’s schedule. Group visits, case managers, electronic access to advice and information, are
a necessity, not a luxury. With these, financial parity is needed to ease the burden of having to cram two more patients per half-day into an already overloaded schedule. And if there is money left over, well, Family Physicians know what to do with that, too! Community Free Clinics, Fitness Renaissance, ICARE, the Adolescent Obesity and Inactivity Project, and Tar Wars to name a few. We reinvest in the health of our patients and in the betterment of our communities. I am not so naïve to think that anything we do politically to effect payment reform will pass on the first try. It took three years for the Colorado Medical Society to achieve success. And I don’t know where we will be in one or two years down this political road, but I do know where we will be if we don’t try this or something similar. I would rather try and fail than sit in my medical home and watch it be attacked by those who pretend to provide continuity-of-care, and do everything except take the patient in when they are most in need. Sue Makey’s legacy of the Student Activities Endowment is wonderful indeed, but I say equally important is her creation of HB 1590. HB 1590 will return to the legislature and when it passes, will help ensure that medical students - with family medicine in their hearts - will see happy, well-paid Family Physicians, excited to teach and mentor, with time to teach and mentor. They will see Family Physicians happily serving their patients and community in a physician-driven, patient-centered, modern and functional office. Those students won’t have to make a financial choice for their careers. As more medical students become Family Medicine residents, who stay in North Carolina, the healthcare manpower shortage will be solved. Our problems in North Carolina are also the nation’s problems. The AAFP is well aware of these issues facing all Family Physicians and is taking strong action on our behalf. North Carolina has
always had a tradition of sending excellent leaders to the national level and can boast of three AAFP Past Presidents. This is soon to be four! North Carolina is fortunate to have Dr. Lori Heim, a current member of the Board of Directors of the AAFP and a practicing Family Physician and citizen of North Carolina. She has decided to run for AAFP President-Elect this September. Her platform of advocacy for fair payment, workforce reform, and adequate health care for all will benefit every Family Physician and their patients across the nation. Our Academy is behind her 100% and we will support her campaign in the coming year. Our Academy has many of the resources needed to make these exciting changes happen. We have a new energetic Executive Vice President; at our Academy headquarters is an excellent staff who are able to translate our visions (we call them visions, they call them hallucinations) into reality with talent, hard work and patience; we have a skilled lobbyist, Peyton Maynard, an oasis of integrity among the shifting sands of politics; Peyton has more credibility in Raleigh than most of the elected officials; we have a dedicated Executive Committee and Board of Directors, council chairs and members striving for excellence. And we have members willing to make the sacrifice to lead at the national level. None of our initiatives will come to fruition without financial resources. Money is not a dirty word, it is not a four-letter word, and money is not the root of all evil. It only becomes evil in the context of greed. We are not
greedy, we are hungry for what is best for our specialty and for our patients. Politicians understand two things: votes and campaign donations. This Academy needs the resources to aggressively educate and support the elected officials who are sympathetic to our needs. Legislators must comprehend the magnitude of skill
that comprises the profile of a Family Physician. They must understand the economic impact each Family Physician has on his or her community. They must also understand that Family Medicine is the only specialty represented in all 100 counties in North Carolina. Knowledge is power only if we use it. Our Governmental Affairs Advisory Council has been very active in past years. As of late October, our state political action committee (FAMPAC) had collected $3,525 from 22 contributors. Last year we raised $8,305 from 57 contributors. Compare that to the $150,000.00 raised by the dental PAC, to the $32,000.00 raised by the chiropractors; in 2006 the trial lawyers raised $336,000.00. Our Academy has 2000 active members and we have formidable adversaries. We cannot afford to go to battle unarmed. On your table is a pledge card for the NCAFP Political Action Committee; I am asking you to check the dollar a day box; you can’t have a speech about money without asking for some! You knew it was coming! A dollar-a-day. Our Academy has approximately 2000 active members; do the math. Would you give one dollar every day to prevent another prior authorization from being shoved down your throat; to have a managed care contract you can understand and gives you some measure of power? Article Continues on Page 16
WWW.NCAFP.COM | North Carolina ACADEMY OF Family PhysicianS, INC
THE EVP’S CORNER
Continued Chapter Success Will Require A Laser-Like Focus for NCAFP Gregory K. Griggs, MPA, CAE Executive Vice President
During our Annual Meeting and the festivities surrounding Sue Makey’s retirement, the phrase “you have big shoes to fill” seemed to be in continuous use. And if you were among the 537 attendees in Asheville, you likely know that our Board Chair, Dr. Michelle Jones, presented me with a pair of size 13, high-heel pumps. Well, I can’t claim to be Sue Makey or even female for that matter, and I definitely don’t wear high heel pumps! However, this does seem like a good time to tell you a little bit about who I actually am and hopefully what I believe is a shared vision for the future of the N.C. Academy of Family Physicians. First, a little background about your new exec... As an equal opportunity sports fan, I have tried to receive education from all of the Triangle’s institutions of higher learning. After growing up in a small town about one hour west of Charlotte, I attended the University of North Carolina where I majored in journalism (public relations) and political science. I later continued my education at N.C. State University where I received a Masters degree in Public Administration, concentrating in association management. But my first formal education about family medicine, although I saw a family doctor early in life, came only a year into my professional career when I worked at Duke University for what was supposed to be a two-week temporary assignment after running a failed political campaign. More than four years later, I was still in Duke’s Department of Community and Family Medicine, having worked with the Family Medicine Interest Group, the required pre-doctoral rotation in family medicine, and for the most part, faculty development programs including a fellowship and a workshop series. In fact, my oldest son’s godfather is a fellowship graduate of both the Duke and UNC Departments of Family Medicine. Through my work with the faculty development workshop series, I had the opportunity to meet family medicine faculty from
residency programs and medical schools all over the country and even attend a few meetings of the Society of Teachers of Family Medicine. While at Duke, I went back to graduate school which led to the 15+ years I have spent in non-profit membership organizations. These years included time at a national association representing automotive parts manufacturers, serving as the president of a local chamber of commerce, and then leading the state society of association executives. Throughout this time, I continued to seek a role that would bring passion to my daily professional life. In mid2005, I found that opportunity when I joined the Academy as Director of Professional Services. Now a few words about my philosophy and my passion for the job which your Executive Committee and Board entrusted to me by hiring me as your new Executive Vice President. It’s clear that today’s healthcare system is upside down. It is a system led by specialists conducting expensive procedures – and getting well paid for it. Yet, for too long our country has ignored prevention, health promotion and disease management. Primary care in general – and family physicians specifically – must be at the center of any meaningful health care reform in the United States. We’ve already proven that in North Carolina through innovative programs such as Community Care of North Carolina. But what can we do as a state Academy? The answer is a great deal! First, we must constantly advocate for payment reform. Family physicians must be compensated for the cost savings you can bring through prevention, disease management and so much more. As family physicians, you deserve to be paid for the job you do and the savings you bring. And without payment reform, we’ll never be able to meet the growing workforce needs of our state. As North Carolina’s population grows and ages, we need more family physicians. A key way to attract students to the profession
is through payment reform and an appealing lifestyle for practicing family doctors. In short, North Carolina needs well paid, happy family physicians. We may not get there overnight, but this must be our goal. Step by step – by fighting burdensome pre-authorization residency training. Our state’s citizens requirements, advocating for mixed must understand the difference and payment systems such as per member the value of family medicine. per month fees, or making sure the Finally, we must continue to provide legislature understands the value our high quality educational programs to members bring to North Carolina– insure that our state’s family physicians we can slowly win the battle. have cutting edge knowledge for today But that’s not all we need to do. and tomorrow. And that knowledge We must also continue to advocate must include content on quality for the needs of your patients. Good improvement, appropriate coding public policy is good for medicine. and information about implementing Whether it’s through the Foundation’s many of the tenets of the Future of public health initiatives on issues Family Medicine. such as adolescent obesity, health As you can tell, the Academy’s plate disparities or the ICARE Partnership, is full. To accomplish these goals we the Academy is uniquely positioned to Article Continues on Page 16 have a profound impact on the health of the people of North Carolina and health policy in our state. Next, we must also market family medicine and its role and value to the citizens of our state. We must undertake a significant effort through free and possibly even paid media to help your patients – and those NC Neuro Psych who choose not to see a family physician – understand why your role is so important. This must include a clear delineation of family physicians from other specialists or mid-level providers. Your education is unique and extensive. You don’t have a twoyear master’s degree but are trained in a unique medical specialty with a four-year postgraduate degree and at least three years of WWW.NCAFP.COM | North Carolina ACADEMY OF Family PhysicianS, INC
Complete Spring Meeting information and registration is online at ww.ncafp.com/sfpw
MEETINGS & EDUCATION
2008 Spring Family Physicians Weekend Promises To Please April 17-20, 2008 in Concord, North Carolina The Academy’s Spring Family Physicians Weekend is heading to Concord/Charlotte, NC on April 1720, 2008. Dr. James McNabb has prepared an outstanding program full of engaging topics, pertinent skills workshops and entertainment that everyone will enjoy! The meeting officially begins on Thursday, April 17, 2008 at 4:00 pm. General session lectures start Friday morning and conclude Sunday just before noon. This format offers physicians the flexibility of a near complete workweek and the opportunity to obtain over 20-plus Category I credits - several of which may offer evidence-based credit. Attendees will also be able to take advantage of several workshops, including one on joint injections, substance abuse, coding, and even a presentation on adding cosmetic procedures as a value-added service.
Hotel Information The meeting will take place at the brand new Embassy Suites Hotel in Concord, NC. The hotel is conveniently located off I-85 at Speedway Boulevard, overlooks the Rocky River Golf Course, and is less than a half-mile from Lowe’s Motor Speedway and Concord Mills Mall. It’s also just minutes to the Concord Regional Airport and Concord’s Historic Downtown. Like all Embassy Suites, the facility is completely full-service and features an all-suite design: perfect for a weekend of education and relaxation! Great Workshops The meeting will present some excellent workshops. The first one takes place Thursday afternoon (4/17) and reviews Joint Injections (4:00 6:00 pm). Immediately following this will be a Regional ICARE workshop
covering Substance Use in Primary Care. This free workshop includes a full dinner and a two-hour lecture. Attendees will April 17-20, 2008 learn the importance Concord/Charlotte of screening and recognition, will get to know options for assessing and screening of patients, as well as understanding the basics of how The Embassy Suites Concord/Charlotte is a brand new full-service, to perform a brief all-suite hotel that’s a quick drive to just about everything in Concord. intervention. Last, Center close by, shopping and retail a Coding Workshop is also being presented. The workshop has offers plenty to do! been developed to help physicians recognize the proper techniques for correct coding. ~ Coming This Summer ~ Lots of Fun for Families There’s also plenty of entertainment options to enjoy in the Charlotte/ Concord metropolitan area. Tickets will be available for tours of Lowes Motor Speedway, Charlotte’s Discovery Place, and even to the Mint Museum of Craft & Design. And with the huge Concord Mills Shopping
Mid-Summer Meeting June 29-July 4, 2008 Kingston Plantation Myrtle Beach, SC Info and registration at
A Family Physician Ready To Take The Lead Dr. Lori Heim Campaigns for AAFP President-Elect AAFP Board Director and new North Carolina resident Dr. Lori Heim of Vass recently announced her candidacy for AAFP President-Elect. To provide members insight into her leadership philosophy and her perspectives on the specialty and what’s needed at the national level, The North Carolina Family Physician asked her to share her thoughts on a number of key questions. Answers to the first of these appears below, with the remainder to follow in the April issue.
Dr. Lori Heim AAFP Board Director
You recently relocated to Vass, NC from the state of Washington. How has the transition been on your family and your practice of medicine? What lessons can be applied? I left the miliary after 25 years of service. That alone taught me about the joy of serving when you have a clear mission. But I also didn’t face the problem of tiered health care benefits. My patients got what they needed and I didn’t have to worry that they wouldn’t take medications or get studies because of a lack of ability-to-pay. I fully appreciate now what a luxury that was. That makes me sad that the rest of the US population doesn’t have that because it shouldn’t be a luxury to have basic
at what prevents the patient from getting the treatment they need, what hinders the physician, nurse, etc., from being safe and effective. When looking at small practices, it is more difficult to get some of the efficiencies I enjoyed in a larger group, but it has the advantages of being more nimble. There is less bureaucracy and barriers to some change, but the profit margin drives many of the barriers. What are the biggest challenges you see facing the specialty in the next 24 months.
Medicare. The 10% cut was delayed, but Congress hasn’t risen to the imperative to fix the SGR. The SGR is the formula currently used to calculate payment for each procedure and visit and it is fatally flawed. It overvalues procedures and devalues the cognitive work that Family Physicians do. The public, business and politicians recognize the need for health care reform. Family medicine Dr. Heim has participated in several NCAFP leadership activities since her relocation into North Carolina, including the Academy’s annual Leadership must be guiding the Retreat in August of 2007. direction this reform takes. We know that family medicine is health care. I was trained to run clinics and foundational for a true health care system hospitals and to adapt to changing in this country that is coordinated and environments, both economic and the patient-focused. Certain forces want practice environment. Although I am to see more privatization, such as the not in austere conditions practicing Medicare Advantage programs. But out of a tent, or in a new hospital every these do not save money, nor are they few years, the adaptability principles are supportive of a primary care base and similar. My approach to running a clinic reform for Family Physicians. Businesses have begun to demand or hospital was to evaluate based on a systems approach. This means looking change. That’s great, as they may be the
tipping point to get the legislators and the insurance players to begin to remodel the current dysfunctional system. But I’m concerned that we won’t have enough Family Physicians (or all of primary care) ready to meet the challenge. Both the government and business leaders have been very clear that they are not willing to pay more for the same care they are getting for their beneficiaries. Yet we know that a solid primary care base, (which means Family Medicine as the core), is required and will result in lower costs and higher quality. Our own NC physician, Dr. Allen Dobson (and AAFP Public Health Physician of the year for 2007), took the leadership role and has proven the value of Family Medicine with the NC Community Care project. But are the primary care physicians across the nation ready? My fear is that we aren’t. The AAFP and TransforMed are working to help to provide tools for practices to assess their status and then provide the resources to help them move up. This is not just about meeting standards; it’s about providing better care and being adequately paid for what we provide. The AAFP recently embarked on an aggressive campaign to promote the value of family medicine. How can each AAFP member and chapter leader contribute to its success? Take the TransforMed assessment for your practice and then look to what you might do to improve. AAFP is committed to providing tools to assist members. There’s many other ways as well: Contribute to FamMedPac and NCAFP’s FAMPAC. Download the AAAFP sample letters for your patients
and legislators to push for a Medicare fix. We cannot afford to ignore this. Get involved with our local, state and national politicians; call, write and engage them in all venues. Tell them how medicine today affects your patients. Keep the message focused on the patient. Also, talk to your local paper, TV and radio station. The NC chapter can help you figure out how to do this and be successful. We need to get our faces and voices and more importantly – the voices of our patients – into the public square. Once the media knows they can count on you for a story, they will come back. Physicians can get, or stay involved with their state or local chapters. Respond to the calls to action by the state and national Academy. Your participation can mean the difference when we are trying to stop or promote a bill. It won’t happen without the grassroots support. The national office simply can’t muster the congressional votes without the legislators knowing that their state constituents feel the same way. Give the state and national Academy officers and staff constructive criticism what you need, what’s working and what improvements will make a difference for your practice and patients. Finally, get or stay involved with medical students and residents, and show them the value of our specialty. Don’t focus on what’s wrong - we all know that and are working to correct it, but let them see the joy in what we do in caring for our patients. Desiring to lead the AAFP represents a major commitment on your behalf. What’s driving you to seek the position and what do you want to accomplish should you get elected? I am the best candidate to move our national agenda forward. Not only will I try my best, because all of the candidates will do that, but I have the training and background to be the most effective. I am passionate about our Academy and know that Family Physicians are the ones who provide the highest quality and best value for our population. We must have a basic health care plan provided for all of the US population and in order to achieve a true health care system that improves the health of the US, we have to have a strong Family Medicine foundation. We don’t have that now and time is running out for us to fix this. I have the sense of urgency, the drive, the ability and the strategic planning background to move our agenda forward. Part II will Appear in April
WWW.NCAFP.COM | North Carolina ACADEMY OF Family PhysicianS, INC
2007 Annual Meeting Draws Record Attendees to Asheville Special Events Punctuate Historic Gathering as a New Leadership Phase Begins The 2007 Winter Family Physicians weekend turned out to be a historic event, complete with record attendance, record continuing education credits, productive meetings and events that drew dignitaries from as far away as California. Total attendance for the four-day event set a record at 537. Along with the Family Physician of The Year Award (next page), the chapter conferred the following honors:
The Academy also recognized Drs. Drew Bridges and Warren P. Newton, MD, MPH with Presidential Awards. Dr. Bridges is a practicing psychiatrist in Wake Forest who has played an integral role in developing and leading a growing statewide integration effort between primary care physicians and the mental health services community. Dr. Warren Newton, MD, MPH, was recognized for his efforts in helping to
lead an influential statewide physician quality improvement initiative. The Improving Performance in Practice program is training individual practices on techniques and measures to improve their overall care quality. 2007 Outstanding Residents
14 third-year family medicine residents were named Outstanding Residents by their programs.
Lifetime Service Award
After thirty-one years promoting family medicine across North Carolina, Sue L. Makey, CAE, was recognized with the chapter’s Lifetime Service Award upon her retirement. Sue is the first non-physician to be honored with the award since its creation by the association in 1999. The chapter celebrated her lifetime contributions with a retirement gala on Friday, Nov. 30.
Cabarrus Brent Messick, MD Camp Lejeune Rachel Thomas, MD CMC-Charlotte Matthew Sproul, MD CME-Union Jamie Wise, MD Duke University Mario Olmedo, MD East Carolina Elizabeth Fry, MD New Hanover Gandhari Loomis, DO MAHEC-Asheville Jennifer Hall, MD MAHEC-Hend. Mark Cornelius, MD Moses Cone Adlih Moreno-Coll, MD Southern Regional Quoc Tai Phan, MD UNC-Chapel Hill Kenyon Railey, MD Wake Forest Univ. John Hyden, Jr., MD WOMACK David Gordon, MD 2007 Community Teachiers
Each medical school recognizes doctors dedicated to teaching medical students about family medicine.
Numerous family medicine dignitaries were in Asheville for the 2007 Winter Family Physicians Weekend in early December, including twenty-six past presidents of the NCAFP.
Duke University East Carolina UNC-Chapel Hill Wake Forest Univ.
Sara O. Beyer, MD Ann Scott, MD Scott Visser, MD Chris Christakos, MD
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Call toll-free today at 1-888-249-7876 for more details. The annual net collection rate is the total amount paid to the practice, plus contractual adjustments, divided by the total gross charges billed for one year. A fee credit, if due, will be applied to your MMHSI billing invoice upon completion of 12 months of service. Please call for details. Guarantee effective for new billing service clients through 12/31/07, upon receipt and evaluation of the practice’s contracted fee schedules.
NCAFP MEMBER HIGHLIGHT
Tommy Newton of Clinton Named 2007 NC Family Physician of The Year
2008 Family Medicine Externship Program Seeking Applicants Deadline is March 17, 2008
Clinton’s Dr. J. Thomas “Tommy” Newton —
2007 Family Physician of The Year Dr. Tommy Newton of Clinton, NC did it! Part country doctor, community elder, and medical statesman, Newton’s dedication to his patients, community and profession were honored by the NCAFP in Asheville on November 30, 2007. His journey in family medicine has been remarkable. After graduating UNC-Chapel Hill medical school and completing residency in Roanoke, Virginia, Dr. Newton came to Clinton almost by chance. Seeking to practice anywhere east of Raleigh, he heard of an opportunity in Clinton through his brother. During his interviews, Newton grew fond of Clinton and appreciated the opportunity to practice the full-scope of medicine. “The group had an excellent standing in the community and provided the full-scope. Doing OB was important to me,” he recalls. He joined Clinton Medical Group in 1984 and became its fourth physician. Today, the practice consists of eight Family Physicians, three Pediatricians, and a full support staff. If moving to Clinton seemed by chance, then deciding to pursue family medicine was just the opposite. Even prior to entering medical school at UNC, Newton had made up his mind where he was headed. He was influenced by his own family physician, Dr. Charles Sawyer, who had cared for him in high school while growing up in Ahoskie, NC. “The reason I stuck with family medicine is that I enjoyed what a family physician does on a daily basis. I liked the daily interactions, and
the camaraderie I saw among the doctors,” he remembers vividly. Throughout his journey in medicine, Newton has had a number of mentors. He notes that former UNC Family Medicine Chair Dr. Ed Shahady, and especially Dr. John Nance - his ‘father figure’ in medicine – were significant. Also influential was Dr. Frank Leak for his encouragement of getting involved in the house of medicine, an activity Newton enjoys tremendously. “It’s always been an excellent way to interact with colleagues from across the state, “ he notes. In organized medicine, Newton’s reputation is likened to a staunch advocate. He’s been active with the NC Medical Society and several Sampson County groups since 1986, but has really devoted his most significant energies to the NC Academy. He served as chapter President in 1996. “After a lot of thought, I chose the Academy because of my kinship with family medicine,” he admits. Newton continues to be involved
Dr. Newton’s Fitness Renaissance Program holds a special place in the hearts of youngsters in Sampson County. Medals motivate kids to continually improve and strive every nine weeks.
with the chapter and shows no sign of letting up. If this weren’t enough, Newton has also served the Clinton community with distinction. He’s been a role model and volunteer leader at Clinton High School, held numerous positions on community organizations, and most recently, played a major role in helping the city win the national All American City Award (AACA). The centerpiece of AACA was Clinton’s Fitness Renaissance Program, a project Newton created with the help of his local school system. This program has become a nationally-recognized way to tackle childhood obesity. What makes the program unique is that it drives children to focus on short-term goals and is highly individualized. This incentivizes them to participate and strive to improve all year long. “Human nature tells us shortterm goals make you strive harder versus longer-term ones,” he said. To date, the program has impacted over 1,400 children in Sampson County. Newton takes special privilege in noting its effectiveness. “What’s beautiful about this program is that everybody has the same opportunity to get an award. And the looks on the kids’ faces when they do speaks for itself,” he said. Newton resides in Clinton with Annette, his wife of thirty years, and has three grown children.
The NCAFP is excited to announce that its 2008 Family Medicine Externship Program anticipates one of our best years ever! Medical students interested in applying to the program should contact Experience your school’s Family Medicine First Hand family medicine department as soon as possible. The Externship Program consists of four weeks of intensive shadowing of a practicing family physician. Students are immersed into the specialty and receive a stipend for program completion. For complete info,visit http://www.ncafp. com/externs with North Carolina’s Family Medicine Externship Program 4-Weeks in Summer 2008
Great Experience & Exposure Limited Number of Slots
For complete information about this program, including applications and directions on how to apply, please see your medical school’s Family Medicine Department.
Don’t Miss The NCAFP’s 2nd Annual Family Medicine Day For the second consecutive year, the NCAFP will be holding ‘Family Medicine Day’ - the best opportunity for rising 3rd- and 4th-year medical students to meet-and-greet North Carolina’s family medicine 2008 family residency programs. Family medicine day Learn and Medicine Day Discover will be held on Sat. May 17, 2008 Saturday, May Millennium Hotel 17, 2008 at the Millennium Hotel in Durham, North Carolina. Just like last year, students will be able to take advantage of four hours of skills workshops and free accomodations. A special overview of global health training within NC’s training programs will also be presented. For complete information on this year’s event and to register, simply visit www.ncafp.com/fmd. Durham, North Carolina
WWW.NCAFP.COM | North Carolina ACADEMY OF Family PhysicianS, INC
Mental Health & Primary Care Integration
The Adolescent Obesity & Inactivity Project
Academy’s Statewide Obesity Initiative Pays Off 3-Year Project Helps Achieve Multiple Successes in 15 NC Counties The ICARE Partnership, a collaborative effort to bring “mind and body together”, has completed its first year and is forging ahead into expanded training opportunities. The mission of ICARE is to develop systems of care that are Integrated, Collaborative, Accessible, Responsible and Evidence-based in order to improve access and outcomes for patients requiring mental health, developmental disability and substance abuse services (MH/DD/SAS). The latest effort involves offering training, technical assistance and support to physicians at the practice level based on their individual practice needs and desires. Some topics that may be addressed at the practice level include: • Use and incorporation of general screening tools, assessments or algorithms into practice, including tools for alcohol/drug screening & brief intervention, depression, ADHD, autism and anxiety. • Information presented to practices regarding: • An overview of different models available to integrate patient care; • How to begin the process of providing integrated care to patients; • How to maximize use of the ICARE website to locate resources for patients, as well as tools for personnel within the practice; and, • Sessions to address questions regarding billing and coding as it relates to behavioral / mental health codes. The NCAFP would like to encourage all physicians to consider their needs and inform the chapter if they are interested in receiving support in an area identified above or any other area. We anticipate adding more options and customizing additional trainings to meet individual practice needs. To provide suggestions, feedback or to request assistance, please contact Tracie Hazelett at 919833-2110 or email@example.com
The Academy’s statewide efforts to prevent adolescent obesity are paying off, according to the results of a study recently released by the NC Health and Wellness Trust Fund as part of their Fit Together Initiative. According to the evaluation conducted by a team from East Carolina University, 90% of the children and adolescents participating in the project’s cohort study stayed in their same weight category or improved categories over the three-years of the study. The NCAFP Foundation was one of 21 grantees participating in the project, with the NCAFP’s efforts enrolling 109 participants. The Adolescent Obesity and Inactivity Project was spearheaded by NCAFP President Dr. Mott P. Blair, IV, and his recognition of the two problems of adolescent obesity and inactivity in his own community. The project began to take shape when the NCAFP was awarded a threeyear grant from the N.C. Health and Wellness Trust Fund Commission in 2004 as a component of its Fit Together Initiative. The goal of NCAFP’s project was to connect family physicians with other local community organizations, with a particular emphasis on local Cooperative Extension agents. Carolyn Dunn, PhD, Associate Professor and Nutrition Specialist for the N.C. Cooperative Extension Service, served as the project’s primary partner and helped identify Family and Consumer Science Agents to collaborate with family physicians in 15 NC counties. In each county, family physicians and Extension Agents were given the task of collaborating. A curriculum called “Families Eating Smart Moving More” was developed and Extension Agents across the state were trained to present it in their counties. Family physicians were encouraged to refer their at-risk obese patients to the Extension Agent or to a specific Families Eating Smart Moving More program. Another resource developed as part of the project is an interactive CD-ROM called “Fast Food and Families” that lists fast food restaurant menus and nutritional information. Physicians
January - March 2008 | the North Carolina Family Physician
were encouraged to distribute these to their patients. These CDs are still available at the NCAFP office and also available online through the website www.fastfoodandfamilies.com. Other resources developed for the project include two kinds of prescription pads: a blank prescription pad for agent information or event specifics, and a generic prescription pad with tips for healthy eating and physical activity. These are available through the NCAFP office for a limited time and even available for download at http:// www.ncafp.com/aoi. Dr. Blair and Carolyn Dunn, PhD, developed a capstone presentation on the project and delivered it at the NCAFP Family Physicians Winter Meeting in early December, 2007. The presentation is now available online for 1.5 CME credits and can be accessed through the Academy’s website at http://www.ncafp.com/obesity. The Academy’s participation in Fit Together represented one of the only statewide efforts among the 21 grantees. Many other grantees developed concentrated and localized community initiatives. Through the Academy’s efforts, several success stories highlight the project’s impact. One follows. A Local Success Story In Nash County, the relationship between the physician and agent as part of AOI will prove long-lasting. Through the project, Dr. Nadine Skinner developed a collaborative team with the local Cooperative Extension Agent, local school nurses and individuals from the health department. Last summer they collectively planned a series of Families Eating Smart Moving More classes that took place last fall. All contributed to the planning process and participated in a kickoff for the series in August. Drawing upon this new network, the health education supervisor at the Nash County Health Department approached the group with an idea to apply for a diabetes prevention grant using the models they were already implementing. With letters of support, they received a $27K grant from The
WakeMed Pediatric Diabetes Program for their community-based intensive education and lifestyle change program. Dr. Skinner is thankful to have this collaboration to continue to tie her own obesity prevention to a larger community effort and to continue to draw upon the physician referral model. Results from Fit Together East Carolina University researchers reviewed the results of 19 childhood obesity grant projects funded by the NC Health and Wellness Trust Fund. ECU researchers looked at 1,346 children from 4 to 18 years-old who were grouped into one of four categories when the projects began: underweight, healthy weight, overweight and obese. Using approaches such as nutrition lessons that encourage less sweet beverage consumption, 90% of the children stayed in their previous weight category or improved over the three years of study. Among overweight and obese children in the study, 51 percent improved their weight category. For some, improving their weight category meant they actually lost weight. For others, it meant they grew taller while maintaining their weight. Some did both. NCAFP Member Physicians Participating in the Cohort Study The NCAFP would like to thank the following physicians for recruiting their patients to participate in the cohort study: Mary Digel, MD, Maureen Murphy, MD, Mott P. Blair, IV, MD, Al Hawks, MD, Colin Jones, MD, Karen L. Smith, MD, Susan Snider, MD, Bill Carr, MD, J. Thomas Newton, MD, William Dennis, MD and Elizabeth Gibbons, MD. All together they collected data on 109 patients! Other physicians who participated in the project by working with their local Extension Agent included: Suzanne Landis, MD, Shannon Dowler, MD, Christopher (Reb) Snyder, III, MD, Tamara Babb, MD, Peter Jacobi, MD, Woody Warburton, MD, and Belinda McPherson, MD.
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If you work in a health care setting . . .
Get a Flu Shot!
Or Nasal-Spray Vaccine*
You are likely to be exposed to ﬂu at work. If you donʼt get ﬂu vaccine, you can catch the ﬂu and become very sick. The ﬂu is a lot worse than a cold.
Protect Your Family
You can spread the ﬂu even before you feel sick. Your family and friends could become seriously ill, especially babies and older adults. Likewise, your family and friends could miss days of school or work.
Protect Your Patients
You can also spread the ﬂu to your patients. For some patients, ﬂu can be a life threatening disease. *
If you are under 50 and are not pregnant, you can get the nasal-spray vaccine instead of a shot. However, do not get the nasal-spray vaccine if you have a chronic disease like asthma or diabetes, or work in a hospital isolation unit.
Have questions? Visit www.immunizenc.com or call the Centers for Disease Control and Prevention Hotline: 1-800-CDC-INFO 1-800-232-4636.
State of North Carolina • Department of Health and Human Services • www.ncdhhs.gov • N.C. DHHS is an equal opportunity employer and provider. 08/07
FAMILY MEDICINE IN PRACTICE
The Data Are Within Your Reach
Ann Lefebvre MSW, CPHQ
We live in a time that data are used in all industries to gain an advantage, improve quality, increase efficiency and reduce waste. Healthcare is no different. As retailers collect phone numbers and zip codes from their customers at the checkout to gauge their radius of consumers and internet sites collect data on advertisement hits, insurance companies are using billing claims to review the use of the plans and services by their beneficiaries and the performance of providers. Today’s providers need to prepare for the day when they are asked to report their data to external sources. This may not be far off and some practices may already participate in programs such as the Physician Quality Reporting Initiative (PQRI) or Bridges to Excellence through accreditation 31/07 with 2:05 Page 1Committee for thePMNational Quality Assurance (NCQA). One could argue that any provider should be actively learning to pull data from whatever systems they currently use
to analyze their own performance and documentation so that they can ready themselves for any opportunities that may come with financial incentives for reporting this data later. Some thoughts to get you started: 1. Don’t wait. Start thinking about what tools you have in your practice today that can produce data for you. Most practices have some ability to generate electronic data that can be queried to provide information about the practice, the patient population and the services provided. 2. Learn your systems. Think of how you can use the systems you have to learn more about your practice. Most practices have a practice management system (PMS) that can provide an enormous amount of data regarding your patient population, scheduling habits, no show rates, etc. In addition, providers either have or contract with a billing system that can provide insight into the practice, including diagnosis codes, revenue generation, and payer mix.
Director of Improving Performance in Practice in North Carolina
3. Dare to ask. Push yourself to look deeply into your practice to discover how your practice uses the tools it has to function to its highest potential. If you have an electronic health record, how is it used? All electronic health records should be used as a database of information and much more than a documentation device. How can you generate point of care data from your electronic health record to indicate the quality of care that you provide? Important note: when using the electronic health record, the less information included in a text note and the more information included in data fields will greatly increase the amount of data one is able to produce from any electronic health record product. If you are on a paper-based record system, consider using an electronic registry to generate information on specific conditions treated in your practice. More information on disease registries can be located at http://www.aafp.org/fpm/20060400/
At the least, you could consider using a paper flowsheet in your chart to guide your care. At the end of each day, have a staff member enter the information from those flowsheets into an Excel spreadsheet to get an idea of the quality of care that you provide to those specified conditions. These flowsheets are available from a multitude of sources, including your Community Care of North Carolina Network. In closing, there is a wealth of information in any physician practice; you just need to be creative in where to look and how to get the data. As we approach an era of public reporting and pay for performance, take the time now to look at your own internal data and improve to your highest potential. The more effort that is put in now to know your practice and to measure and improve quality and efficiency, the more potential you will have for improved satisfaction and financial reward to come your way in the long run.
Family Medicine Physicians
You chose a career in medicine for the chance to help others. Now, choose a career path that can help you connect with a whole new level of opportunity, challenge and satisfaction - personally and professionally. Carolinas Physicians Network supports over 80 practices and 600 physicians. With continual growth and a variety of opportunities, you’re sure to find the practice and lifestyle you’re looking for. We are seeking BC/BE Family Medicine Physicians for our expanding network of existing and new Family Medicine practices and Urgent Care centers throughout the greater Charlotte, North Carolina area. Openings are employed positions with attractive compensation and benefits at the following locations: • Boiling Springs, NC • Charlotte, NC • Mint Hill, NC • Monroe, NC
• Wesley Chapel, NC • Fort Mill, SC • Lancaster, SC
We offer a great payor mix, low malpractice rates, a quality of life that blends with quality of practice and the stability of employed positions with the incentives of private practice. Join our extraordinary team today! Discover all the possibilities that await you here. Visit us online to learn more: www.carolinashealthcare.org/careers/physicians. To submit a CV for consideration, please contact Michele Rocco, Physician Recruiter: firstname.lastname@example.org or call: (800) 847-5084. EOE/AA
Carolinas HealthCare System CARING–COMMITMENT–INTEGRITY–TEAMWORK
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NC Academy of Family Physicians P.O. Box 10278 Raleigh, NC 27605
President’s Message - continued from p4
EVP’s Corner - continued from p7
Would you give a dollar a day for the chance to have a medical student in your office so they can make a career choice with their heart and not their wallet? Would you give one dollar a day to send Dr. Heim to the AAFP and bring honor to North Carolina and our Academy? 2008 is a leap year; I don’t want you to think we are taking advantage of you during a leap year; if you will give a dollar a day for 2008, I will cover Feb. 29th for each of you! Now is your chance to hurt me where it hurts the most. If you can’t give a daily dollar, please give what you can; we will do our best to see that it is returned to your pocket many times over. Not everything that can be faced can be changed, but nothing can be changed until it is faced. We will never change what we tolerate, and we have tolerated our situation too long. Obstacles are those frightening things you see when you take your eyes off your goals. Your Academy has the goal of payment reform through political action clearly in sight and has the tools to overcome all obstacles. Those of you who know me well know how fond I am of public speaking; I asked a friend and mentor of mine about what to say; he said that speeches were not about having all the answers, but about creating hope. I hope that I have reassured you that the NCAFP remains in dedicated and capable hands. I hope that I have convinced you that your Academy will work to achieve the relief, reform, and respect we deserve; to work for real solutions for the real world, solutions that will preserve our medical homes in North Carolina. I hope I have enlisted your help in your Academy’s goal to complete a winning campaign for Dr. Lori Heim in 2008 as President-Elect of the AAFP and to continue North Carolina’s legacy of sending excellent leadership to the AAFP. In 366 days I will stand before you at this podium and be judged by you. I hope I will have lived up to the responsibilities of this office and the trust you have placed in me. And, I hope you will agree with me that these are certainly “optimistic, exciting and interesting times.” Thank you for this wonderful opportunity. God bless each of you. Thank you.
must maintain laser-like focus. It won’t be easy, and it may not always be fast, but I believe together we can succeed. I hope you will join me in helping make these goals a reality. Become involved in one of our Councils, attend our educational programs, come to our Leadership Retreat later this year where we will work to refine our strategic plan, join us in advocacy days at the Legislature, give to our Political Action Committee, and don’t hesitate to simply call and share your thoughts and opinions with me or other members of your Academy staff. In closing, let me make one
Little Rock, AR Permit No. 2437
last extraordinarily important comment about who I am: a husband and a father. I have been privileged to be married to a wonderful woman for nearly 20 years. My wife, Melanie, serves as an Assistant Principal at an elementary school in Henderson, only a few minutes from where we live. No, you can’t take a small-town boy totally out of the small town, although Henderson looks almost metropolitan compared to where I grew up. We are also the proud parents of an 8-year-old son and a 12-year-old son, meaning much of our life is spent getting them from one sporting or school event to
another. So when you don’t find me fighting for family physicians and the goals of family medicine, you’ll find me working to be the best possible husband and father that I can be. I look forward to working with each of you for many years to come, and I hope you’ll join me in the fight to make family medicine the best paid and best appreciated specialty in healthcare today. With best regards, Greg Griggs