V4n3

2008 The North Carolina Family Physician

Vol. 4 - No. 3

Inn Park rove lle, NC G e i Th shev A

8 , 200 7 4 .

Dec

See Details on Page 6

Third Quarter, 2008

ADVOCACY SPELLS VICTORY

ECU FAMILY MEDICINE CENTER NOW FUNDED Details on page 9

In This Edition The Value of Family Medicine....................................................................................3 Small Actions Can Lead to Big Results..........................................................................4 Foundation’s Health Disparities Initiative Enters Final Year............................................... 10 ICARE Continues to Educate, Train and Engage Physicians on Mental Health............................10 New Immunization Requirements for the 2008-2009 School Year........................................ 13

PUBLISHED BY

THE NORTH CAROLINA ACADEMY OF FAMILY PHYSICIANS, INC Raleigh, North Carolina 27605 919.833.2110 • fax 919.833.1801

Volume 4

The North Carolina Family Physician

http://www.ncafp.com

2007-2008 NCAFP Board of Directors NCAFP Executive Officers President Christopher Snyder, III, MD President-Elect Robert Lee Rich, Jr., MD Vice President R.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 Past President (w/voting privileges) J. Carson Rounds, MD 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)

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TA B L E O F C O N T E N T S Features

The Value of Family Medicine........................................................................................................3 Small Actions Can Lead to Big Results........................................................................................4 Family Medicine Center at ECU Finally Funded...........................................................................9 Foundation’s Health Disparities Initiative Enters Final Year....................................................10 ICARE Continues to Educate, Train and Engage Physicians on Mental Health.......................10 New Immunization Requirements for the 2008-2009 School Year............................................13 Sections

President’s Message................................3

Health Initiatives............................................... 10

Chapter Affairs.........................................5

In Practice......................................................... 13

AAFP Delegates and Alternates AAFP Delegate AAFP Delegate AAFP Alternate AAFP Alternate

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

the

ncafp

mission

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

NCAFP Council Chairs Child & Maternal Health

Janalynn F. Beste, MD Jennifer Mullendore, MD Governmental Affairs Robert Lee Rich, Jr., MD Brian R. Forrest, MD Health Promotion & Disease Prev.

Jessica Schorr-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 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

MANAGING EDITOR & PRODUCTION

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.

Peter T. Graber, MMC,CAE, Director of Communications PUBLISHED BY

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

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.

Ed i t i o n 14

WWW.NCAFP.COM

President’s Message

The Value of Family Medicine Signs exist that family medicine care is being appreciated once again Over and over we hear the cry “the healthcare • Only 27% of patients with hypertension are delivery system is broken.” The system is not controlled, only 14% of patients with CHD broken, it is just rapidly becoming antiquated. have LDL levels in the targeted range.

The best part of the system – family medicine • 60% of medical care rendered to the Medicare population comes from Family Physicians.

– is still present! There has been and always will be competent, caring and compassionate If the current (old) system is no longer viable, Family Physicians who continue to work in what then will take its place and who will pay for almost any system or situation. The needs of it? The new aspects of delivering medical care in our patients are evolving ever faster. We can the future are not really medical in nature, they offer more to our patients than ever before, are infrastructure: Concepts such as open access but we are locked into an infrastructure that scheduling, disease registries, true coordinationworked well 20 years ago. Our incentives are of-care, electronic health records that perform still aligned with this antiquated infrastructure. prevention and disease management, and on-line The despair and apathy many Family patient-centered access to information and advice.

Physicians feel stems from knowing there is a A system that can accomplish these tasks will better way to offer much more to our patients require a payment system that values time and but we are literally handcuffed to an ancient effort on a patient’s behalf apart from face-to-face system, a system that is insurance-centric, not encounters. Any Family Physician can easily fit patient-centered. We are brick layers being paid for each patient we see in a system which is built around payment “The needs of our patients are evolving ever faster. We can for acute, episodic care, offer more to our patients than ever before, but we are locked not continuity-of-care, into an infrastructure that worked well 20 years ago. Our coordination-of-care incentives are still aligned with this antiquated infrastructure.” or chronic disease management. That system

- Christopher Snyder, III, MD worked well for decades, but no longer. The rising cost of medical care is into this new model and would feel empowered forcing change. Employers are tired of paying large sums for a system centered on episodic care. and essential to his or her patient’s health. This is how we will change those statistics above.

Here are a few statistics gathered from the No one wants to foot the bill for an untried AAFP Annual Leadership forum in May: new system. Many Family Physicians and • 70% of health care spending comes primary care physicians are facing financial from 5 chronic diseases: Diabetes, CAD, pressures just to remain open. The insurance CHF, Asthma, and Depression. industry will not pay more for what is currently • 10% of our population account for the status quo of medical care. Many employers 70% of health care spending. are unable to compete because of rising costs.

• 40% of Americans do not have Two important efforts, fortunately, are leading a primary care provider. the way through this change. First, the AAFP’s • 54% of diabetics have a Hgb. A1c >7.0 TransforMED Project outlines the basic changes • The US health care system is ranked that move a traditional medical practice to a true 37th by the World Health Organization Patient Centered Medical Home (PCMH). I and we spend the most per capita. invite you to visit and logon to TransforMED • The US has the worst record of the 19 [http://www.transformed.com] and see how developed economies in adding yearsyour practice measures up to the standards of of-life with medical intervention. a PCMH. You will see where you will need to • It is estimated that patient-centered make changes. Becoming a certified National primary care would save $29 Billion.

Committee for Quality Assurance (NCQA) • 15% of children in America have PCMH (whether level one, two or three) will never seen a doctor other than an Emergency Room Physician.

WWW.NCAFP.COM

Christopher Snyder, III, MD 2007-08 NCAFP President

Dr. Snyder attended HampdenSydney College in Virginia for his undergraduate work and attended medical school at the Medical College of Virginia in Richmond. His internship and residency were completed at Fairfax Family Practice Center in Falls Church, Virginia. Dr. Snyder practiced Family Medicine in Leesburg, Virginia for 12 years before joining Mt. Pleasant Family Physicians in 1991. In 1998, Dr. Snyder became an Associate Director for Cabarrus Family Medicine Residency Program. He joined Lakeside Family Physicians, Novant/ Presbyterian Medical Group in 2006. His interests include medical education, prevention and professional well-being.

Continues on page 16

North Carolina ACADEMY OF Family PhysicianS, INC

THE EVP’S CORNER

Small Actions Can Lead to Big Results A movie I recently watched with my children, “Evan Almighty,” highlighted the importance of Acts of Random Kindness (ARK, as the movie pointed out in their not-so-veiled reference to Noah). As I watched the movie, it made me think of two “probably-not-sosmall” steps that our members have taken that may ultimately lead to big dividends for the profession of family medicine. So as I write to you in this edition of the North Carolina Family Physician, I urge each of you to look for those small steps you can take to ultimately help your profession. So rather than my normal column, I am going to relate the stories of two not-so-random acts recently made by your fellow family physicians.

Fighting for Your Rights

In the Fall of 2005, Dr. Karen L. Smith (Raeford, NC) began an odyssey that would ultimately lead to Capitol Hill. That month, representatives of Cigna/ Medicare subcontractor AdvanceMed arrived at her office to request charts. Almost three years – and a major fight later – Dr. Smith found herself before the U.S House Committee on Small Business, Subcommittee on Regulations, Healthcare and Trade.

Smith chronicled her years-long battle with CMS and their subcontractors. The subcontractor reviewed CMS payments to the practice of a grand total of just over $1550. However, when the company extrapolated its calculations based on a sampling size of 2,935 patients (more than twice the number of Medicare patients listed in Smith’s practice management system), the Agency demanded payment of over $48,000. Smith’s ensuing appeals ultimately led to her testimony to Congress.

“The escalating cost of healthcare cannot be subsidized from monies taken out of the businesses of small physician practices,” commented Smith as she described her experiences while testifying. Smith highlighted the audit to show how many primary care medical offices are struggling with increased regulations and decreasing payments.

After months of appeals, significant legal fees and much work by Dr. Smith and her entire

practice, the CMS review proved predominantly favorable. While the Agency never rectified the different sampling size compared to actual data from the practice’s electronic records, Dr. Smith halted further appeals due to the emotional and financial drain on her practice and employees and made a payment a fraction of the size of the original demand. While Smith would have likely prevailed further, the cost of continuing the odyssey became a barrier to further appeals.

In her testimony before Congress, Dr. Smith noted: “It defies common business sense to run a high-quality practice that utilizes electronic health records in a financial environment where Medicare does not recognize the true total costs for caring for individual patients with many medical problems.”

One physician. One fight. But now the message is clear on Capitol Hill. In response to her testimony and that of three others on the panel in mid-May, Rep. Charlie Gonzalez (a Texas House Member who chairs the Subcommittee) made the following statement: “When federal agencies make rules, the law requires them to consider their effect on entrepreneurs, and examine less burdensome alternatives. Communities across the country depend on small medical practices for their care.

If CMS disregards the needs of these providers, it undermines their ability to serve patients.”

Rep. Gonzalez noted that patients deserve a system that provides quality care and is cost effective.

“The small medical provider market can help make that a reality,” Gonzalez said. “It’s one of our most valuable assets. CMS should keep that in mind, because ignoring that fact is more than just short-sighted – it threatens to leave millions of Americans without access to the high quality care they need and deserve.”

One family physician standing up for her rights and those of her fellow doctors. One Act of Random Kindness for her profession. Now the attention of our Congressional leaders.

From Duplin County to Denver, Colorado: Campaigning to be a National Convention Delegate

Dr. Mott Blair (Wallace, NC) set the bar high, and he won. In mid-May, Blair was elected as a delegate

July - September 2008 | the North Carolina Family Physician

Gregory K. Griggs, MPA, CAE Executive Vice President

to the Democratic National Convention. It is highly unusual to win such a prestigious position the first time out, but Dr. Blair is no stranger to political circles in eastern North Carolina, and certainly not afraid to seize an opportunity.

As a delegate to the AAFP Congress of Delegates, Blair is normally with a group of North Carolina Family Physicians at the Annual Leadership Forum in Kansas City each year. Instead, this year he rubbed elbows with Sen. Hillary Clinton and Sen. Barrack Obama in Raleigh on his road to serving as a delegate in Denver.

As part of his efforts to win his election, Blair and his wife attended this year’s Jefferson Jackson Dinner, always the most high-profile event on the state’s Democratic calendar but elevated to new levels this year due to the appearance of both major Democratic candidates. The event was a virtual who’s who of North Carolina Democratic politics with Dr. Blair right in the middle of it all.

After criss-crossing his Congressional district throughout the spring, Dr. Blair ultimately was elected as one of Sen. Clinton’s delegates from North Carolina.

But what’s probably even more important is how Dr. Blair took advantage of opportunities he encountered while travelling to Democratic events throughout the eastern part of our state. In Kinston, Blair and his daughter ended up quoted in a front page article of the local newspaper.

“I see so many patients who can’t get the health care that they need and that they deserve,“ Blair noted in the article.

But he didn’t stop with the local media. Before a Clinton campaign rally in Wilmington, he approached an unknown reporter and simply struck up a conversation. Before he Continues on page 16

WWW.NCAFP.COM

CHAPTER AFFAIRS

•

M E M B E R S H I P

Building Renovations Completed at Headquarters

•

Give The Gift of Membership Did you know that a one-time $25 investment can result in a future family physician? How does that happen?

With the total cost of a student membership in the AAFP/NCAFP only $25, your gift of a dues payment covers national and state membership throughout a student’s entire four-year medical school career. If you precept students in your practice or know a medical student, ask them if they are members of the Academy. If not, consider giving them the gift of membership .

•

M E M B E R S H I P

•

The Academy’s Board of Directors authorized a number of renovations to the Chapter’s headquarters earlier this year, including painting and new carpet and upgrades to the association’s phone system. The renovations began in earnest on Thursday, May 8 and were complete in early June. In addition to cosmetic improvements, the Chapter also updated its phone and data services. The renovations included new paint and new carpet throughout the interior of the building. The exterior of the building will be repainted later this summer.

Academy’s Carol Ervin Reaches 5-Years of Service The Academy’s Administrative Support specialist, Carol Ervin, celebrated her five-year employment anniversary with the Chapter on May 12th. Carol assists in a variety of headquarters operational functions including tasks such as accounts payable/receivables, various reception duties and check preparations. She and her husband Don live in Raleigh. Congratulations!

Chapter Well-Represented at AAFP’s Annual Leadership Forum Members and staff of the NCAFP traveled to Kansas City in early May for AAFP’s Annual Leadership Forum and National Conference on Special Constituencies. The Chapter’s

delegation included NCAFP President Christopher Snyder, III, MD; Board Chair Michelle F. Jones, MD; President-Elect Robert L. Rich, Jr., MD; At-Large Executive Committee Member Brian R. Forrest, MD; Past President and AAFP Delegate Conrad L. Flick, MD; Past President and AAFP Alternate Delegate Karen L. Smith, MD; AAFP Board Member Lori Heim, MD; Jennifer L. Mullendore, MD; Rafael G. Torres, MD; and Chapter staff members Executive Vice President Greg Griggs, MPA, CAE, Director of CME Marietta Ellis and Director of Finance and Administration Brent Hazelett, MPA.

100% Resident Membership for NCAFP in 2007!

The NCAFP was recognized by the AAFP for 100% Resident membership for the fourth straight year. This award would not have been possible without the continued commitment of North Carolina’s family medicine residency programs and their encouragement and support of Academy membership. The Chapter received the recognition during the AAFP’s Annual Leadership Forum in early May.

NCAFP Past President Appointed to NC Institute of Medicine Dr. J. Carson Rounds, NCAFP Past President, was recently appointed to a 5-year term on the NC Institute of Medicine

by Gov. Mike Easley. Dr. Rounds is in private practice in Wake Forest.

MAG MUTUAL

CONTINUING MEDICAL EDUCATION

STUDENT ACTIVITIES

Students Give High Marks to NCAFP’s Family Medicine Day

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i n e i n N o r t h C a r o l i n a fo r

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Annual Meeting in Asheville will Celebrate Chapter’s 60th Anniversary at The Grove Park Inn - Dec. 4-7, 2008 It will be an Annual Winter Meeting like no other. This year, amid the spectacular mountaintop views, crisp autumn air and festive holiday spirit, the NCAFP will celebrate its 60th anniversary in Asheville from December 4-7, 2008! Dr. Richard Lord, Program Chair, has planned an extravaganza that will present over thirty AAFP prescribed credits, a complete list of Chapter business meetings, several workshops, and an array of social activities. Please don’t miss this wonderful mountain celebration.

The scientific program for the meeting continues to be refined, but will tentatively include talks on New Methods in Smoking Cessation, Poly Ovary Syndrome, Osteoarthristis, Acute Coronary Syndrome and a number of others.

See the meeting website (http://www.ncafp. com/wfpw) for an updated listing of topics.

The meeting’s social events are always lively, fun and entertaining, and this year is expected to be no different. To recognize the NCAFP’s 60th anniversary, a special party will be held on Friday, December 5th that will combine the NCAFP Foundation Silent Auction with what’s being headlined as a physician talent show for the whole family. Got an interesting talent that people don’t know about? Come to the anniversary party and strut your stuff. There will be plenty of other activities as well, including holiday tours

UPCOMING MEETINGS & EVENTS

Dec. 2008

april 2009

2008 NCAFP Annual Meeting

2009 NCAFP Spring Meeting

Dec. 4-7, 2008

April 2-5, 2009

Asheville, NC

Charleston, SC

ncafp.com/winter

ncafp.com/spring

July - September 2008

of the Biltmore Estate, golf, Biltmore Spa packages and the President’s Gala on Saturday night.

The official brochure will be mailed in the coming weeks. For complete information, please visit the Chapter’s website at http://www.ncafp.com/wfpw.

The site contains the most up-to-date information and even allows you to register. If you have specific questions, please contact Kathryn Atkinson with the NCAFP Meetings Department at (919) 8332110 x 114 or via email at katkinson@ncafp.com.

More than fifty medical students from across the southeast converged in Durham on Saturday May 17th to attend the NCAFP’s second annual Family Medicine Day. Family Medicine Day is a residency recruiting conference sponsored by the NC Area Health Education Centers and coordinated and produced by the NCAFP. This year’s event attracted more students and more family medicine residency programs than in 2007. And as an added benefit, there was a major increase in the number of out-of-state students who attended, with one traveling from Miami, Florida just to visit North Carolina’s training options. Students were able to meet and greet nineteen residency training programs, including twelve programs from North Carolina and seven from neighboring states.

The theme for this year’s event was global and international health. The event began with a luncheon and opening presentation on the variety of global health training opportunities available to NC family medicine residents.

Continues next column

Westcare Health

Students then proceeded to a series of four clinical skills workshops presented and taught by physicians from each NC residency program. Techniques presented included suturing, splinting and casting, shoulder and knee exams and injections, perineal lacerations and radiology reviews. Family Medicine Day

concluded with a two-hour recruiting fair that gave each student the opportunity to meet with each of the programs, make quality contacts and interact with other medical students.

Teaching faculty and Residency Coordinators from all NC private and university-based residencies attended. Residency Coordinators took the opportunity to meet and share ideas on recruiting and program operations.

NCAFP President Dr. Christopher Snyder, III was also in attendance, as was NCAFP Past President J. Carson Rounds, MD and NCAFP Foundation Corporate Trustee Rudy Snow.

Students and faculty each gave the event high marks. The Academy will once again be hosting the event in 2009. Look for additional information in the coming months.

For the third consecutive year, the NCAFP’s Family Medicine Externship Program has grown substantially. The program placed a total of eleven (11) students in family medicine practices across North Carolina this summer. Each participating student completes a four-week experience to help them gain insight into the specialty. Funding support for the program is being provided this year by the NCAFP Foundation and through grant funding from the AAFP Foundation and the AAFP Foundation’s Family Medicine Philanthropic Consortium.

AAFP Recognizes Three NC Schools for Membership Recruiting Efforts

ECU Brody Earns Prestigious Achievement Award by AAFP The Brody School of Medicine at East Carolina was recognized in May with the prestigious Achievement Award from the AAFP. The award recognized ECU’s efforts to foster student interest in family medicine and to produce graduates who enter the specialty of family medicine. Based on a three-year average, for the period ending October 2007, 19.1 percent of

11 Students Participating in Family Medicine Externships This Summer

Brody graduates entered an ACGME-accredited family medicine residency program! ECU was second among all medical schools in the nation for producing Family Physicians during the period.

This is a remarkable achievement. Representatives from the school were formally recognized during the Society of Teachers of Family Medicine annual meeting in Baltimore in early May.

The AAFP awarded stipends to three North Carolina Family Medicine Interest Groups for their membership recruitment efforts during the past year. Interest Groups at Wake Forest University, East Carolina University and Duke University each received $100 for increasing student membership on their respective campuses by 20% or more. The award was part of a membership drive sponsored by the AAFP in mid-2007. Great work!

Carolinas healthcare

ADVOCACY FOR FAMILY MEDICINE

ADVOCACY UPDATE

“Politics drives the process which determines policy” The above quote was the opening statement of the session on advocacy during this year’s AAFP Annual Leadership Forum in Kansas City. It is a fitting description of the process by which many of the events and policies that affect the everyday practice of each member of our Academy are formulated and subsequently implemented. In this article we will outline some of the concerns that this Academy faces during this year and how your Chapter - with your help - will try to influence the outcome of the decisions regarding those concerns.

As of the deadline for this article, the following issues were the main areas of concern for the Academy and the subject of our government affairs agenda: (1) Obtaining legislative funding for a new Family Medicine Center at ECU. At the start of this session, funding for the Center was listed as the second capital request for East Carolina University, following the proposed dental school which the UNC Board of Governors ranked first. This funding request was listed as $36.8 million (in addition to the $10 million from other sources), for a total budgeted cost of $46.8 million. As of early July, the Legislature included funding for this project in the new budget through issuance of government bonds.

Construction is expected to start this calendar year. The NCAFP has taken the position that funding and completion of the new Center symbolizes our state’s commitment to Family Medicine and primary care in general. A tremendous amount of effort went into securing funding for this project, including a targeted Advocacy Day in the Legislature in early June with 26 members participating, including several faculty and students from ECU. (2) The proposed medical school expansion program with new programs to be sited at hospitals in Charlotte and Asheville through an expansion at UNC-Chapel Hill, as well as an additional expansion at ECU. The Academy has taken the position of cautiously supporting this effort as long as emphasis is placed on the production of primary care physicians as a key component of this expansion.

(3) Preservation of the CCNC Medicaid payment system and primary care network.

As last year’s legislative session demonstrated,

there are pressures each year to modify or eliminate the Community Care of North Carolina (CCNC) model of care, and replace it with an HMO or other system all in the name of cost-reduction. Our concern is that any changes to the CCNC model would result in restricted access for our Medicaid patients, as well as decreased payment to our providers.

(4) Retail health clinics and medical supervision.

The Academy has completed our policy statement regarding retail health clinics and is in the process of forwarding this policy to the AAFP, NCMS, the NC Medical Board and others for comment and/or implementation. The core issues of our policy focus upon preservation of the medical home/continuity-of-care/safety/and public health. We continue to monitor the development of new retail health clinics in our state and their impact on the medical home.

(5) Medical Board proposed rules on physician profiles. As you probably know, the NCAFP asked our membership to send comments to the NC Medical Board about the public availability of physician profile information, including the listing of malpractice awards for the preceding 7 years. The NCAFP adopted a similar position to the NC Medical Society in that only those awards in which the NC Medical Board took disciplinary action against the physician should be posted. The NCAFP submitted extensive comments about the proposed regulations, and Past President Dr. Carson Rounds testified on behalf of the Academy at the public hearing.

(6) Payment and the value of Family Medicine.

This includes payments by Medicaid, Medicare, as well as from our private insurers and any costs imposed on the individual practice by regulations or policies developed by these entities.

We continue to work with our legislators and public officials to develop policies to protect physician payment and to highlight the cost of insurer policies on the physician office.

These are a few of the issues that your Academy is monitoring this year. In addition to these issues, please be aware that the Academy is actively working with our Government Affairs Consultant to help lobby for and develop legislation to address these particular areas of concern. The Academy has had the good fortune of employing one of the

July - September 2008 | the North Carolina Family Physician

Robert L. Rich, Jr, MD NCAFP President-Elect

most well-respected legislative liaisons in Raleigh (G. Peyton Maynard), and his wisdom and guidance have proven valuable to the Academy on multiple occasions. He maintains a full-time presence at the General Assembly, as well as at other government facilities, where he monitors proceedings and reports to the Academy about areas of interest and potential problems.

Staff at the Chapter’s office have prepared and continue to update fact sheets for distribution to our governmental officials about the value of Family Medicine to the state, its counties and communities, as well as the impact of proposed policies on our membership. The Academy is able to share these fact sheets with the membership via downloads from our web site, in fax transmissions and through email. Personnel in the office continue to explore new methods of disseminating information about our value, including the use of Academy-sponsored blogs and other new media technologies. The leadership recently saw how other chapters were utilizing video clips produced in-house for education/ lobbying purposes and will evaluate how similar methods could possibly be utilized here.

What do we ask you to do? Become involved in the process! In conversations with our legislators, the telephone call, letter, or visit from a concerned physician in that legislator’s home district was frequently cited as one of the most influential things affecting that legislator’s decision about an issue. Our legislators receive multiple sources of information in the course of the year about a particular issue (including fact sheets from our own Academy); the information that they seem to remember the most is from the members of their own community, particularly their physician friends and acquaintances. If you know a legislator personally, please contact the Academy and we will enlist your help in contacting that legislator at the appropriate time regarding an issue of interest. If needed, Continues on page 9

WWW.NCAFP.COM

ADVOCACY TRACKS

NCAFP Meets with Congressional Delegation in Washington, D.C.

Family Medicine Center at ECU Finally Funded After several years of efforts, funding for a new Family Medicine Center at ECU’s Brody School of Medicine is now secure. In early July, the N.C. Legislature authorized the issuance of $36.8 million in certificates of participation (government bonds) to fund the Center. While the total cost is just over $46 million, most of the remaining funds have already been secured from a bequest for the Geriatric Center, grant funds and planning moneys already expended by the University. Construction for the Center is likely to begin later this year.

Several Academy leaders have been holding ongoing discussions with ECU leaders and elected officials from eastern North Carolina over the last several years. In addition, the Academy’s Government Affairs Consultant, G. Peyton Maynard, has expended tremendous energy to insure the project’s ultimate funding.

The Academy’s efforts culminated in early June with a blitz in the Legislature including 26 family physicians and ECU medical students, as well as most of the Academy staff and AAFP Executive Vice President Doug Henley, MD. During the day, members of the group met with approximately 50 of the 170 members ADVOCACY UPDATE

the Academy can provide fact sheets about an issue, educate you on “talking points”, and even help set up a meeting with your elected official.

We just need your willingness to be involved.

What else can you do? Contribute to FAMPAC, the NCAFP’s political action committee. Historically our organization has lagged behind the fundraising efforts of even smaller organizations, with those organizations raising totals averaging 2-3 times more per member than what we have raised during the same time period. Your contributions allow the Academy to gain access to and attention from our legislators; the larger the funds we have available, the greater our ability to contact and WWW.NCAFP.COM

of the General Assembly, including Senate Pro Tempore Marc Basnight and Speaker of the House Joe Hackney. Leading up to the meeting, Maynard and the Academy’s staff distributed background information about the project to all the members of the General Assembly through both electronic and written communication, as well as numerous phone conversations.

Information ultimately distributed, included: • A background briefing sheet about the need for the center and the importance of family medicine in North Carolina.

• A letter from the Department Chairs from all three of the state’s other medical schools supporting the proposed building.

• A letter from the student leadership at the Brody School of Medicine at ECU. • Numerous phone calls and e-mails from Academy leaders, as well as Academy members with connections ECU. Thanks to all our members for your efforts to make this new building possible and keep family medicine and primary care in general strong at the Brody School of Medicine.

educate those legislators who are critical to the passage of legislation favorable to our positions.

The NCAFP Governmental Affairs Advisory Committee has set a goal for fundraising for 2008 of $25,000 which would be $15,000 more than we have raised in years past. Without those funds our message would be lost to our legislators, masked by the efforts of competing political action committees, such as those of the trial lawyers and other groups. Please contribute today!

For further information about FAMPAC or what you can do to become involved in the political process, please contact Executive Vice President Greg Griggs, MPA, CAE at the Academy office at 919-833-2110 or ggriggs@ncafp.com.

Seven family physicians and chapter Executive Vice President Greg Griggs, MPA, CAE, attended the AAFP’s National Congressional Conference in Washington, D.C. on May 1920. Physician attendees included AAFP Board Member Lori Heim, MD; AAFP Commission on Government Affairs Chair Conrad L. Flick, MD; Association of Family Medicine Residency Directors President Mark Robinson, MD; Michael Gross, MD; Mary Hall, MD; Al Meyer, MD; and James Wetter, MD. After a briefing on issues impacting family medicine, NC’s contingency visited Capitol Hill and met with a majority of the state’s Congressional delegation, including US Senator Elizabeth Dole and a number of members of the House delegation and their key health care policy advisors.

NCAFP Conducts Major Advocacy Outreach at the NC General Assembly Twenty-six family physicians met with nearly fifty different state legislators at the NC General Assembly during a major advocacy push by the NCAFP in late May. Physicians who attended conducted face-to-face meetings with legislators or their key personnel and had the opportunity to hear testimony at several legislative committees.

Two themes were central in the discussions and meetings: the importance of appropriating funds for a new family medicine center at East Carolina University and communicating the impact of family medicine and primary care across the state, especially as it relates to our Medicaid populations. The chapter was honored to have N.C. native and AAFP Executive Vice President Dr. Doug Henley in attendance.

Sights and scenes from the event are available at the NCAFP website at [http://www.ncafp. com/home/gallery/].

Dr. Karen Smith Testifies to House Small Business Subcommittee Dr. Karen Smith of Raeford, testified before the House Small Business Committee, Subcommittee on Regulation, Health and Trade on May 14th about uncontrolled costs and decreasing payments to small medical practices.

Smith shared her perspectives on the impacts that current regulations are creating for primary care practices across the state and country.

Other witnesses on Dr. Smith’s panel included AMA’s Dr. William Dolan, Texas pharmacist Dennis Weisner, and Dr. Michal Schweitz, a Florida rheumatologist speaking on behalf of the Alliance for Medical Specialties. Smith’s testimony can be found on the NCAFP website at [http://www.ncafp.com/smithcms].

Health Initiatives UPdate

Foundation’s Health Disparities Initiative Enters Final Year The NCAFP Foundation’s Health Disparities following family medicine residencies: Moses Initiative recently completed year two of Cone, MAHEC-Asheville, UNC-Chapel Hill, its three-year project. Year two focused on Duke University, and most recently, at the New NC Tar Wars Wraps Up educating physicians through continuing Hanover Regional Medical Center in Wilmington. education at the NCAFP’s meetings and The Health Disparities Initiative was made Another Great Year conducting intensive interventions at the possible through a grant by the NC Health and 2007-08 is down into the history books for Initiative’s five (5) pilot Wellness Trust Fund Commission. the NC Tar Wars Program. Logan Ruppard, a practice sites. Over the The Initiative is currently fifth grade student at Sparta Elementary, won course of Year Two, the investigating new and additional first place in this year’s state Tar Wars Poster Initiative consistently funding opportunities as a means to Contest. His poster, titled “We Have a Dream,” continuing its important work. Stay followed-up with its X[ij ^[Wbj^ YWh[ \eh Wbb won him a trip to the National Tar Wars Poster practices to assist them with tuned for future developments.

Contest and Conference in Washington, instituting the necessary DC, held July 21-22. This year marked the changes needed for increased compliance If you would like more information, please 20th anniversary of the Program so there were with the Culturally and Linguistically contact Jenni Fisher, NCAFP’s Health Initiatives several special celebrations, including a keyAppropriate Services (CLAS) Standards.

Manager, at 919-833-2110 or jfisher@ncafp.com. note address by Jeffrey J. Cain, MD, Tar Wars’ Year Two provided several exciting and co-founder. Along with participating in the unexpected opportunities. These opportunities Conference’s activities, Logan and his parents included a presentation by UNC second-year Be sure to visit the NCAFP website met with their local Congressional Delegation. medical students Kevin Sitko and Joshua to learn more about the Health Disparities Initiative at www.ncafp.com/disparity NC Tar Wars had another strong year. The Evans at the Society of Teachers of Family Program was presented in Yancey, Orange, Medicine’s (STFM) 28th Annual Conference Continues on page 12 on Families and Health in New Orleans.

Titled ‘Redesigning Medical Offices into Healing Environments: Using CLAS as the Model,’ Sitko and Evans described how a CLAS assessment can be carried out in the context of an office setting and presented their findings from the CLAS assessments each conducted at the Initiative’s pilot practices. This As the financial needs of the NCAFP Foundation continue to grow, keeping pace financially presentation helped showcase the work of the is essential to continuing its many fine programs, such as the scholarships/loans it provides Initiative and offered an excellent glimpse of to medical students interested in family medicine, supporting our Family Medicine Interest the efforts being made in North Carolina.

Groups and delivering preventive health care programs like NC Tar Wars. These programs Year Two also saw the Initiative work are why charitable giving to the Foundation in the form of planned giving is so important. closely with its key partners. In early May, Planned giving enables you to make a donation in a way that is tax-preferred to your individual NCAFP’s Jenni Fisher, MPH, Health Initiatives needs and to those of your estate. By planning today and utilizing common forms of planned Manager, and Raleigh’s Dr. Rafael Torres, gifts (including charitable bequests, charitable remainder trusts and gifts of life insurance), you were invited as guest lecturers to the Wake can make a future contribution to a very worthy cause. Oftentimes gifts in these forms may County Medical Society’s (WCMS) CME benefit you and your estate by reducing your current and future income taxes, and in some event. Fisher and Torres presented a lecture instances, may also help reduce your final tax burden. Please be sure to visit your tax advisor on the CLAS Standards and introduced or estate planner during your next annual review to learn more about your options. Once participants to a number of Latino cultural determined, you may then direct your gift to be used in any number of ways by the NCAFP/F. and social issues that can impact patient By making a provision or gift through your estate, your charitable gift will help care and outcomes. Their lecture also the NCAFP Foundation continue its mission of providing valuable programs and discussed Title VI of the Civil Acts Right. projects that serve the needs of our patients and our specialty. These gifts also ensure The Initiative began its third and final year that future generations will have access to the same compassionate care Family in early July. It hopes to educate more Family Physicians deliver and that the specialty continues to thrive in North Carolina.

Physicians and family medicine residents about the CLAS standards and to continue supporting its pilot practices. There are also plans on working with the Carolina’s Center for Medical Please contact Kathryn Atkinson, Foundation Development Coordinator, for more information Excellence (CCME) to reach the balance of regarding charitable giving or other donations to the NCAFP Foundation. She can be reached by the state’s family medicine residency programs. phone at (919) 833-2110 or 800-872-9482 (NC Only) or via email at katkinson@ncafp.com.

To date, presentations have been made at the

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Charitable Giving … Helping the Future of Family Medicine

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July - September 2008 | the North Carolina Family Physician

WWW.NCAFP.COM

M E N T A L

H E A L T H

I N T E G R A T I O N

ICARE Continues to Educate, Train and Engage Physicians on Mental Health The ICARE Partnership continues to provide educational opportunities to physicians across North Carolina. Seminars presented over the last few months have each been designed to assist Family Physicians and primary care providers in treating and managing key mental health issues while encouraging them to pursue integrative approaches with their mental health provider community.

During this spring and summer, ICARE delivered two web conferences, one conducted

by Dr. Richard D’Alli on Pediatric Bipolar Disorder and another, Adult Depression, presented by Dr. Bradley Gaynes. Each conference was delivered over the Internet and enabled participants to utilize a convenient format – their personal computer – to learn about two important topics. Supporting these trainings were four ‘live’ regional programs on Substance Use and Abuse. At each of the live or virtual trainings, attendees strengthened their

clinical skills and familiarized themselves with new approaches in treating mental illnesses.

The Partnership is continually refining and adapting its curriculum based in-part on feedback generated from these programs. It is currently in the early stages of developing several new learning modules targeted towards further educating physicians and providers on screening topics, referrals, follow-up care, as well as utilizing local resources.

Partnership Director Sally Smith and team members Jennifer Borton, Regina Dickens, Karen French and Tracie Hazelett, NCAFP’s ICARE Provider Training Specialist, also continued to collaborate and conduct trainings.

In early April, they teamed up to present From Fragmentation to Integration: Promoting Primary Care and Mental Health Collaboration at Piedmont Behavioral Healthcare of Charlotte’s “Cultural Competence Conference.” This session provided participants with an overview

of ICARE, helped define what integrated care is, and reviewed why it is so important to treat the mind and body together. Smith, Borton and Hazelett also presented the closing plenary at the Annual Two Worlds Unite Symposium in Asheville during the same weekend.

As a complement to its trainings, ICARE continues to provide collaborative support and speakers for Academy meetings. This assistance helped the Chapter present key mental health sessions at its 2008 Spring Meeting in Concord and at this month’s Mid-Summer Family Medicine Digest in Myrtle Beach. ICAREsponsored speakers have also presented at other specialty society meetings, including the NC Pediatric Society, the NC Academy of Physician Assistants and the NC Nurses Association.

ICARE continues to be engaged at the practice level as well. The Partnership’s practice-based training component recently collaborated with the Helping Hands Clinic of Lenoir to deliver mental health trainings to a number of its participating physicians. Helping Hands is a free medical clinic and pharmacy serving lowincome and uninsured residents of Caldwell Continues on page 16

TAR WARS WRAPS UP

Mecklenburg, Onslow, Guilford, Sampson, Alleghany, Henderson, Union, and Durham Counties and reached approximately 1,600 fourth- and fifthgraders. The Program Tar Wars’ celebrated its 20th also continued to Anniversary in Washington, be popular with DC in late July. medical students. Evan Corey and Joseph Hoyle, both medical students at UNC-Chapel Hill, delivered a presentation on the Program during UNC School of Medicine’s Community Service Day. Numerous first- and second-year UNCCH medical students volunteer each year to present the Program in the Chapel Hill and Carrboro-area elementary schools. This year the students were able to reach over 450 fifth grade students with the anti-tobacco message.

Tar Wars is an important pro-health, tobaccofree educational program and poster contest.

The forty-five minute interactive curriculum focuses on the short-term, image-based consequences of tobacco use and how children can think critically about tobacco advertising.

It also helps engage physicians, residents and medical students into their local communities.

The Program is continually seeking presenters to help reach additional children and provides materials to conduct a presentation.

For additional information on how to participate in the Program, contact Jenni Fisher, MPH, NCAFP Health Initiatives Manager, at jfisher@ncafp.com or 919-833-2110.

AAFP Re-Election

Reminder!

If you were last re-elected in 2005, you have until the end of 2008 to report 150 hours of CME to maintain your AAFP/NCAFP membership.

Requirements include at least 75 AAFP prescribed credits, a minimum of 25 credits from group learning activities, and no more than 25 credits from enrichment activities. Hours reported should be obtained between January 1, 2006 through December 31, 2008.

For further details, please visit the NCAFP website at [http://www.ncafp.com/cme/reelection], the AAFP website at [http://www.aafp.org], or call Tara Hinkle, NCAFP Membership Coordinator at 919-833-2110 or 800-872-9482.

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Family Physicians Continue to Make Difference in Fight Against Obesity The grant funding period of the Adolescent Obesity Initiative (AOI) officially ended last December. But a number of great tools are still available at the Academy’s office to promote healthy lifestyles in teens and young adults, including tear-off pads with healthy messages for waiting rooms, Fast Food and Families CDs, the AOI Physician Guide and other useful collateral. All materials are provided at no cost to NCAFP members.

Two family physicians are continuing Fitness Renaissance Program. Dr. to promote exercise and good health to Newton, a family physician from children and adolescents – and having Clinton, conceptualized and designed great success. Both serve as excellent this program that develops daily examples of physicians making a physical activity habits in children. difference in their communities At its core, Fitness Renaissance is an and continuing AOI’s core spirit. activity and awards program that Dr. Mark Hawkins, a family is split into four nine-week periods AOI materials are still available physician in Catawba County, and delivered through the Clinton at NCAFP offfices. developed a very unique program that’s Public School System. Children in its third year and continues to be successful. concentrate on a different physical activity (e.g.

Hawkins’ Kid’s Marathons have children run 25 shuttle run) during each period and are assessed miles over a 4-8 week time period. Then, on on their individual performances and given a the last day or ‘marathon day’, they run the last personal goal to achieve. If the student achieves 1.2 miles. Children who participate usually run their goal during that period, he or she receives 1-2 miles daily with the help of their parents. an award during an assembly that completes the This gets a majority of their miles done before period. At the end of the year, students achieving the “final mile” day. Dr Hawkins feels it is a their goals more than once during the year receive great way to get kids motivated to exercise, lose special recognitions during a grand finale ceremony. weight, and to raise their self-esteem. It also The program has been fantastically successful in develops school spirit and helps raise money to Clinton schools and is credited with helping drive improve the schools. If you are interested in a double-digit reduction in obesity levels. For getting more information about Kids Marathons, more information about Fitness Renaissance, please please contact Dr. Mark Hawkins at mhawkins@ contact Dr. Tommy Newton at 910-592-6011. charterinternet.com or 828-459-4448.

These two programs are great examples of key Another great program is Dr. Tommy Newton’s AOI concepts continuing to make a difference.

ICARE Partnership Bridging The Gap for Quadrant IV Patients Nearly three-quarters of people with severe mental illness also have at least one chronic physical health condition, and experts say provider collaboration is vital for individual with concurrent, persistent physical and mental health conditions – known as Quadrant IV patients.

“Neither physical nor mental health can improve until all of a patient’s concerns are addressed by primary care professionals and mental health specialists working in concert,” said Dr. Dan Gerber, a psychologist and consultant with the Western Highlands Network local management entity (LME).

Propelled by that principle, The ICARE Partnership [http://www.icarenc.org] has established a program in Buncombe and Henderson counties aiming to integrate Quadrant IV patients into primary care practices. Through

July - September 2008 | the North Carolina Family Physician

sponsorship from ICARE, the pilot targets Medicaid, Medicare and uninsured patients.

Communication is the key

ICARE pilot leaders say the key to integration is seamless communication between primary care providers (PCP) and behavioral health professionals – accomplished, in part, through coordinated case management like that provided

by ICARE case manager April Conner. Working with Access II Care of Western North Carolina, Mountain Area Health Education Center and Western Highlands, Conner serves as an advocate for both patients and providers, helping clients obtain referrals and comply with treatment plans while liaising with Continues on page 14

WWW.NCAFP.COM

Family medicine in practice

Physician Reminder -

New Immunization Requirements for the 2008-2009 School Year

By Amanda Dayton, NC Immunization Branch

Over the summer months, please remember to immunize the children, adolescents, and adults in your practice who will be affected by the new immunization requirements for school and college entry. Children who will be entering kindergarten, adolescents who will be entering 6th grade (or turning 12), or adults who will be entering college for the first time this fall need to be in compliance with the new requirements. If you see any of these individuals in your practice, please make sure they have received the vaccines required for school entry this fall.

One booster dose of Tdap (tetanus/ diphtheria/pertussis) vaccine is now required for the following age groups: • All individuals attending public school who are entering the 6th grade on or after August 1, 2008, if five years or more have passed since the last dose of tetanus/diphtheria toxoid.

schools) who are 12 years of age on or after August 1, 2008, if five years or more have passed since the last dose of tetanus/diphtheria toxoid.

• Individuals enrolling in college or university for the first time on or after July 1, 2008, if a tetanus/diphtheria toxoid or tetanus/ diphtheria/pertussis vaccine has not been administered within the past 10 years.

This rule change also impacts mumps vaccination. Individuals will now be required to receive a second dose of mumps vaccine before enrolling in school, college or university for the first time on or after July 1, 2008.

Don’t miss this opportunity to vaccinate the adolescents and college-bound students with the additional vaccines recommended for their age group. When patients come in your office to receive the Tdap or mumps vaccine, it’s also a good time to speak with them about the additional vaccines recommended for adolescents, such as

meningococcal conjugate vaccine (MCV4) and human papillomavirus vaccine (HPV).

For more information about the immunization rule change, the NCAFP has published a downloadable flyer (courtesy of the NC Immunization Branch) at [http://www. ncafp.com/home/node/387]. Additional documentation on these new requirements can also be found at the NC Immunization Branch’s website at [http://www.immunizenc. com/Rule%20Change.htm]. Educational materials such as reminder/recall postcards are available to be ordered free of charge.

Physicians who have questions regarding these changes should contact the NC Immunization Branch Central Office at 919-707-5550.

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The NC Immunization Branch has published a number of resources online at www.immunizenc.com

• All individuals not attending public schools (i.e., private, home-school, non-traditional

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NCAFP Practice Manager’s Group Planned for 2009 A New Look for NCAFPNotes The Chapter recently completed a re-design of its weekly e-mail newsletter, NCAFPNotes. ‘Notes’ now sports a brand new look and features quick links to each edition’s news items for fast and easy scanning.

NCAFPNotes provides week-by-week coverage of the latest news relavant to family medicine in North Carolina, highlights the Chapter’s work within its health initiatves and keeps members informed of NCAFP events and activities.

Members who do not receive Notes but wish to do so, should confirm the accuracy of their primary email address on file with the AAFP and check any custom settings or filters on their personal in-boxes or corporate networks.

WWW.NCAFP.COM

The NCAFP Professional Services Council recently agreed to form a Practice Managers’ Group to address key issues impacting practices across the state. During the Council’s meeting this past April, the Council accepted an invitation from the NC Pediatric Society to participate in its existing Practice Managers’ Group through their Spring Meeting, scheduled for March 5-6, 2009 at the Embassy Suites Concord.

Greg Griggs, NCAFP Executive Vice President, attended the Pediatric Society’s Practice Managers Group’s most recent meeting this past March and commented: “The two groups share very common issues with regard to efficient and effective practice management. I believe this opportunity to learn from peers will be a great benefit to our members.” At the Pediatric Society Meeting, the Group discussed workers compensation, coding, general human resources issues, and also conducted a very informative segment titled “Hot Topics.” Hot Topics is a

NCAFP’s Professional Services Council is forming a Practice Manager’s Group and will participate in the NC Pediatric Society’s existing group next spring, 2009.

roundtable discussion where attendees discuss the latest issues facing practice management.

At the direction of the Academy’s Professional Services Council, the Chapter is continuing to develop additional resources for practice managers. One tool being pursued is an email ‘listserv’ for members to utilize to host discussions and to share best practices. For additional information about the ongoing development of an NCAFP Practice Manager’s Group, please contact Brent Hazelett, NCAFP Director of Finance and Administration at bhazelett@ncafp.com or via telephone at (919) 833-2110 ext. 103.

North Carolina ACADEMY OF Family PhysicianS, INC

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ICARE - Quadrant IV

providers and making psychiatric consultation available to PCPs in a timely fashion.

According to Conner, pilot results thus far have been very encouraging. When the program launched in July 2006, fewer than two percent of Conner’s clients received integrated care. As of December 2007, nearly half of Conner’s clients benefit from provider collaboration.

Individual stories help highlight ICARE’s success, said Conner. After six months of coordinated case management, a bipolar client with a history of crack cocaine use is now clean and sober, medically stable and linked with primary care, mental health and substance abuse services. Conner was able to help another client stop overusing emergency room services after she was alerted to the situation by the client’s community support worker.

“Two years ago, there would have been no contact and this problem would have gone unaddressed,” said Conner.

screen and refer for physical illness.

With input from participating practices and partners – including Western Highlands, Access II Care, MAHEC and four local medical practices – the pilot is developing a bipolar tool kit: guidelines that will help physicians assess a patient’s presenting problems and diagnosis and prescribe medications when appropriate.

The kit will also indicate when psychiatric consultation or referral should be considered.

The pilot committee is also developing similar notes and additional provider training for metabolic syndrome – a combination of four medial conditions that increase the likelihood of stroke, heart disease and diabetes.

Quadrant IV patients may be susceptible to these conditions because of genetics, lifestyle issues and the use of prescribed atypical antipsychotic medications, which often cause weight gain and decrease insulin sensitivity.

‘Not just a demonstration’

The right tools for the job

In addition to providing case management, the ICARE pilot enables primary care providers to offer behavioral health services and helps behavioral health providers

Pilot members say their ultimate goal is to shape a health system that functions collaboratively even after the pilot ends.

“We’re working to create communication protocols and tools that are simple and intuitive to

use so that collaboration will happen naturally,” said Conner. “We want to see integrated care thrive here – even without outside support.”

To help build a self-sufficient integrated system, pilot participants are calling for a new mental health funding structure – one that would reimburse care coordination and case management activities that link primary care providers and community support agencies. The model set forth by ICARE is working and could easily be adopted by all LMEs, said Dr. Louis Stein, medical director at Western Highlands.

Currently, the pilot is funded through The Duke Endowment, the Kate B. Reynolds Charitable Trust, AstraZeneca, North Carolina Area Health Education Centers, the North Carolina Department of Health and Human Services and the North Carolina Foundation for Advanced Health Programs. Pilot participants are thankful for the generous support but hope to find a permanent source of funding in the future.

“We need to continue the pilot’s work beyond sheer grant funding if we are to maintain our credibility with primary care providers,” Stein said, noting that ICARE has applied for additional charitable funding to maintain the pilot through 2009. Pilot participants hope that by that time, a state-backed plan for sustainable funding will be in place.

PENDING

TransforMED Offers Free Medical Home Assessment Tool Family medicine practices working to become qualified medical homes can now measure their progress with a free assessment tool made available by TransforMED at [http:// www.transformed.com/MHIQ/welcome. cfm]. TransforMED is a practice redesign initiative affiliated with the AAFP. To measure overall progress, the ‘Medical Home Implementation Quotient (MHIQ)’ guides practices through a series of eight modules, each containing between 13-30 questions.

Practices are quizzed about practice procedures, protocols, and enhancements in health information technology, practice management, quality and safety, patient-

centered care, and other areas.

The tool then provides reports on each practice’s progress within each module and the overall process. Practices that come in the top two tiers of the four levels possible are considered on their way to becoming a patient-centered medical home.

NPI Numbers Now Required on All Submitted Crossover Claims to Medicare

- Stay Informed Online visit www.ncafp.com

As of May 23, 2008, all claims, including Medicare crossover claims, must contain an National Provider Identification (NPI) number and taxonomy code or the claim will be denied. Additionally, all claims need to include the Zip+4 for the billing address and service facility location, if applicable. It is highly recommended that you also continue to submit your Medicaid Provider Number (MPN) on all claims until you receive the NPI Ready letter.

The NCAFP Annual Meeting

NC DMA Directs Medicare Cross-Over Claims to be Filed Directly to Medicaid The NC Medicaid Program is aware that some claims are not directly crossing over from Medicare with the taxonomy code.

NC Medicaid is currently researching this issue with Medicare. In the meantime, NC Medicaid is working to develop a solution to prevent the provider from having to submit a secondary claim directly to Medicaid for this reason. Until the solution is implemented, providers must file these claims directly to Medicaid and include the taxonomy code.

Professional crossovers can be filed electronically via the 837 transaction or the NCECSWeb, or on paper. Inpatient hospital and nursing home crossovers must be filed on paper.

Remember to Code for After-Hours Differential Compensation to DMA Physicians who provide services ‘at times other than regularly scheduled office hours or on days when the office is normally closed’, can receive additional payment from Medicaid by billing CPT Code 99050.” For services provided during regularly scheduled evening, weekend or holiday hours, in addition to the basic service, CPT code 99051 to Medicaid is billable. In addition to these codes, there are others that address specific situations, but all enable providers to capture differential ‘after-hours’ payment for services rendered in emergent and urgent medical care situations.

The Chapter has posted a copy of DMA’s General Clinical Policy that outlines specifics at [http://www.ncafp.com/home/afterhours].

Dec. 4th - 7th, 2008

Grove Park Inn - Asheville, NC www.ncafp.com/wfpw

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 Tara Hinkle, NCAFP Membership Coordinator, at thinkle@ncafp.com, 919-833-2110, or 800-872-9482.

WWW.NCAFP.COM

North Carolina ACADEMY OF Family PhysicianS, INC

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NC Academy of Family Physicians P.O. Box 10278 Raleigh, NC 27605

Presorted Standard U.S. Postage

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Little Rock, AR Permit No. 2437

THE VALUE OF FAMILY MEDICINE

SMALL ACTIONS CAN LEAD TO BIG RESULTS

position your practice to eventually reap the rewards of the second issue - payment.

Recently, the Relative Value Update Committee (RUC), the AMA committee that recommends to Congress what they feel payments should be for services and procedures rendered, recommended a per member/per month fee for practices that are a NCQA-certified PCMHs. This is in addition to traditional fee-for-service payments. There are several pilot projects underway that I believe will show healthcare dollar cost savings, improved outcomes and higher patient satisfaction from a PCMH (not to mention increased physician satisfaction and the ability to recruit medical students into Family Medicine).

The value of Family Medicine/primary care is being appreciated once again. Family Physicians are uniquely equipped to deliver all of the essentials of a PCMH and will be rewarded accordingly. This will take some time to achieve. It also takes time to become a true NCQA certified PCMH, but if you strive toward becoming a PCMH now, your practice will be in a position to qualify for the benefits immediately, instead of playing catch up after the fact. We must shift our focus from that of bricklayers working for a daily wage to that of brick masons, building Patient Centered Medical Homes that will protect our patients, our specialty and our nation.

knew it, he was quoted in the New York Times, this time encouraging John Edwards to endorse one candidate or another, but planting seeds of health care in another reporter’s mind.

Blair’s activism helped get him elected as a delegate to the convention. And now, when each of us watches the Democratic convention later this summer – no matter what our affiliation – we can be proud that a local Family Physician will be representing North Carolina in Denver.

One physician. Starting with a few simple acts. Making a difference in national publications and now national policy. An Act of Random Kindness for his profession.

What Can You Do

Now you may not aspire to testify before Congress or serve as a delegate on the national stage. But there is so much more that you can do to make a difference – one small act at a time. For example, ask yourself just a few simple questions: • Have I developed a relationship or even personally contacted my House and Senate member at the N.C. General Assembly?

• Have I spoken to a local civic group about the importance of health promotion and disease prevention and therefore the importance of a primary care medical home?

• Have I written a health care article for my local newspaper or sent in a letter to the editor about the key health care issues of today?

• Do I take the opportunity to talk with any of my local reporters about the tenets of family medicine and primary care?

• Have I donated to a political candidate or my own profession’s Political Action Committee (FAMPAC)?

• Have I called my Congressional office in D.C. to ask my elected officials to support Medicare payment reform?

It does not necessarily take a lot, but those Acts of Random Kindness (ARKs) toward your profession may have much more of an impact than you think. I urge you to do just one of the six suggested acts listed above. If all 2,600 of our members took just one small action, it may surprise us all what kind of impact can be made.

And you never know, you just might end up being the next family physician to testify on Capitol Hill or the next doctor quoted in the New York Times.

Make a difference - Act Today!

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Contribute to FAMPAC online at www.ncafp.com/fampac

ICARE Continues to Educate, Train and Engage Physicians on Mental Health

County. Since opening in 1998, the Clinic has provided more than $11 million worth of care to 6,000+ individuals. The Clinic relies on community physicians to deliver care and has partnered with approximately 96% of all family and primary care physicians in Caldwell County. Each physician provides care to approximately 20 uninsured patients with the goal of leveraging the physician/patient relationship to improve

outcomes in several chronic diseases. To help the Clinic implement a mental health training component for providers, ICARE presented its Prescription Medication Abuse and Adult Depression training. Both ICARE and the Clinic considered the trainings a win-win success.

Physicians and practices interested in learning more about ICARE are encouraged to visit the Partnership’s website at [http://www. icarenc.org]. If you would like to provide

suggestions or feedback on ICARE’s practicebased training or need assistance, Academy members may contact Tracie Hazelett, ICARE Provider Training Specialist, at 919-8332110 or via email thazelett@ncafp.com.

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Learn more about the ICARE Partnership at www.ncafp.com/icare