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2008 The North Carolina Family Physician

Vol. 4 - No. 4

Fourth Quarter, 2008

Inn Park ove e, NC r G The shevill A

See Details on Page 7

8 , 200 7 4 Dec.

North Carolina’s Dr. Lori Heim Elected AAFP President-Elect

In This Edition Sweet Victory................................................................................................. 3 What A Fantastic Year....................................................................................... 4 December’s Annual Meeting Will Celebrate Chapter’s 60th Anniversary..................................7 Health Disparities Education and Training Fostering Practice Changes............................10 2008-09 Flu Season: Reminders for The Family Physician..................................................12


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

Number 4


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 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)



Sweet Victory...................................................................................... 3 What A Fantastic Year............................................................................ 4 December’s Annual Meeting Will Celebrate Chapter’s 60th Anniversary................ 7 Physician Advocacy Took Many Forms in 2008.............................................. 8 Health Disparities Education and Training Fostering Practice Changes............10 2008-09 Flu Season: Reminders for The Family Physician................................ 12 Sections

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

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

Chapter Affairs.........................................5 In Practice......................................................... 12

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

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


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

Contribute to FAMPAC Today In 2008, the NCAFP has continued to establish significant inroads with the NC Legislature. Through the tireless efforts of volunteer leadership, staff and our government affairs experts, the NCAFP played a pivotal role in passage of funding for the new Family Medicine Center at ECU. In addition to this hard work, FAMPAC has contributed over $12,000 to campaign funds that will support candidates that helped make this successful year a reality. Because of our visibility this past year, momentum is on our side. In order to maintain this position, NCAFP needs to be as active in 2009 and years forward as we have been this year. FAMPAC is a tremendous resource for NCAFP and if you are not regularly contributing to this important cause, please consider giving in 2008. As we head into the elections, NCAFP needs to assist our legislative representatives that have proven to be allies of medicine. If every physician member gave just a small amount each year, FAMPAC would raise substantial resources that could make an even greater impact on family medicine issues in NC. Contributions can be made on the NCAFP website at http://www.ncafp.com/fampac or personal checks (corporate contributions are not allowed by law) can be sent directly to the NCAFP headquarters.

Ed i t i o n 16


President’s Message

Sweet Victory!!! NC’s Lori Heim to lead AAFP as momentum builds for family medicine Having just returned from the Patient-Centered Medical AAFP Congress of Delegates Home. This will require in San Diego, I am pleased to change, but we must let announce that our candidate for go of what may be familiar President-Elect, Dr. Lori Heim, and comfortable to reap was elected on the first ballot! the rewards of the future. She will be the 63rd President of Family Medicine’s recogthe AAFP, the fourth President nition at the national and to hail from North Carolina (L to R): Drs. Robert Rich, Lori Heim and state level has not occurred Christopher Snyder, III, in San Diego after and the second woman family by accident. It is the result the AAFP election victory. physician to be President of the of political advocacy by AAFP. Dr. Heim is from Vass, officers and members NC and is in private practice. She is one of us. and from political action committee funding. We She is acutely aware of the day-to-day pressures were victorious in the forestalled Medicare cut in and realities of family medicine in NC and part by the concerted actions of family physicians the nation. She is also acutely aware of how to who called or contacted their legislators. The remedy the concerns of family medicine, namely AAFP estimated that over 4,000 calls occurred access-to-care for all Americans, payment reform in the few weeks around the voting deadline. I and demonstrating the quality of care we deliver. hope you were one of those who participated. The main topic of discussion of the AAFP At the state level, the NCAFP focused its energy Congress of Delegates this year centered on the and resources on a legislative goal of funding the remedy for the nation’s health care crisis. Our ECU Family Medicine and Geriatric Center buildcurrent health care system no longer functions ing. After many face-to-face visits with legislators in this day and age. It was designed for acute care, fostered fragmentation of “The Patient-Centered Medical Home (PCMH) is the vehicle care and rapidly escalated that will take our specialty into the future. Taking respectful care of the cost of care to a point our patients is how we have always practiced family medicine. ” that is not sustainable. As a nation, we have the highest - Christopher Snyder, III, MD per capita cost for care, but rank 20th in the industrialized nations for outcomes Now business, legislators, consumers and and through the efforts of our legislative consuleven the insurance industry are beginning tants and the NCAFP’s staff, the NC legislature to see that family medicine can provide the approved funds to complete the new building. access, quality and cost effectiveness required This success is the culmination of over five years of for the medical care system redesign. As effort by many individuals and institutions. This is the value of family medicine is appreciated, not only a victory for ECU, but also for the citizens payment will be allocated for non face-toof eastern North Carolina. The Center’s groundface services, coordination-of-care, chronic breaking ceremony occurred on September 26th. disease management and disease registries. Political action works. Our Academy has The Patient-Centered Medical Home the expertise and resources to advocate on (PCMH) is the vehicle that will take our your behalf, both nationally and locally. specialty into the future. Taking respectful care Family Medicine is the specialty that best deals of our patients is how we have always practiced with uncertainty and while we have seen uncertain family medicine. The PCMH will redesign times, we are now entering a phase where we are how we deliver that care into the electronic and valued for our breadth of knowledge and services, global arena. I invite each of you to look at our cost effectiveness and the continuity-of-care the AAFP web site and its TransforMed Project we give to our patients. In short, there has never (www.transformed.com). Early next year, the been a better time to be a family physician. AAFP web site will unveil its toolkit that will help each of our practices to transition into a


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.

North Carolina ACADEMY OF Family PhysicianS, INC



What A Fantastic Year! Chapter makes key strides to advance Family Medicine There are still three months left in 2008, but this year is already one for the records. And it should be — it’s your Chapter’s 60th Anniversary! And what an Anniversary it is with several key accomplishments, including: our state’s fourth AAFP President; funding for the new Family Medicine Center at ECU; renovations of the Academy’s headquarters building, and much more. Let me take a few minutes to outline what has made the 60th Anniversary of your Chapter so special. National AAFP Leadership

Dr. Amos Johnson. Dr. Jim Jones. Dr. Doug Henley. A great legacy of national leaders from North Carolina. And now Dr. Lori Heim. These are the four AAFP presidents who have called North Carolina home. While Dr. Heim may not be a native – having travelled the country in the U.S. Air Force, she has had several North Carolina connections during her career, and ultimately chose our state and our Chapter as her home. She began her private practice in Moore County about 18 months ago and now joins the legacy of national leaders elected from North Carolina. Dr. Heim previously completed a faculty development fellowship at UNC and served as medical Operations Squadron Commander at Pope Air Force Base for several years. A more complete article about her campaign and victory is included elsewhere in this magazine (see p. 5). But please join me in congratulating Dr. Heim on her victory. New Center at ECU Finally Funded

In a victory for our entire state, funding for a new Family Medicine Center at the Brody School of Medicine at ECU was finally secured during this summer’s short session of the Legislature. Having fought for the funding for at least five years, the Academy implemented a full-court press by working with key legislators and having nearly 30 members visit the General Assembly. Thanks to the laser-like focus and the trusted guidance of Government Affairs Consultant Peyton Maynard, the efforts succeeded with the Legislature approving the issuance of $36.8 million in bonds for the project. On September 26th, several of the Academy’s leaders attended the groundbreaking ceremony for the new Center, including NCAFP President Dr. Christopher Snyder, President-Elect Dr. Chuck Rich, Board Chair Dr. Michelle Jones, 4

Past Presidents Dr. Jim Jones, Dr. Mott Blair, Dr. Conrad Flick, and Dr. Carson Rounds, and current Board Members Dr. Brian Forrest and Dr. Kevin Talton. The work of these key individuals and others led to this important success. Medical Policy Changes Proposed at the State and National Level

Your Academy continues to push for new directions in health care policy through both the AAFP Congress of Delegates and the N.C. Medical Society’s House of Delegates. For example, during AAFP’s national policy discussions in San Diego in September, your Chapter sponsored resolutions addressing stricter guidelines for retail health clinics (successfully referred to the AAFP Board for further consideration), supporting relief from post payment audit reviews by CMS independent contractors (a portion of the resolution reaffirmed as AAFP policy and a portion also referred to the AAFP Board), encouraging point-of-service payment systems (a slightly revised resolution ultimately supported by the Congress), and supporting modifiers for ADA-related services (not approved, but current policy supporting direct payment of interpreters reiterated). At press time for this article, several of these same issues were also on the Academy’s agenda for the N.C. Medical Society House of Delegates in October, including retail health clinics, point of payment systems and a resolution encouraging standardized contracting with insurance companies. Look for more information on all of these resolutions in future issues of this magazine, as well as on the Academy’s website. Building Renovations

About 10 years ago, the Academy purchased its current headquarters at 1303 Annapolis Drive in the Cameron Village area of Raleigh. Over the first few months of 2008, the Academy’s staff and leaders evaluated whether this was the most appropriate location to continue to effectively and efficiently serve your needs and came up with a resounding “yes”. As a result, the Academy began to put substantial resources into renovating the building for ongoing use, including new paint (inside and out), new carpet, new technology (including a new phone system) and several other improvements. While the effort caused some staff disruption over a two-month period, the changes were certainly worth it. Some

October - December 2008 | the North Carolina Family Physician

Gregory K. Griggs, MPA, CAE Executive Vice President

additional renovations are in the works for the future to insure that your headquarters meet your needs for many years to come. Successful Meetings

This year’s Spring and Summer CME Meetings also proved successful. First, the Spring Meeting brought our programming to a different region of the state – Concord. Almost 140 members attended. As a result, the Spring Meeting will begin a rotating schedule with the 2009 Spring Meeting headed back to Charleston, SC, and the 2010 Meeting travelling to Williamsburg, VA. The 2011 Meeting will likely head to our own coast or once again to a more central region of the state. While funding for meetings is becoming more and more difficult, the NC Chapter is one of the most successful in the country for both attendance and financial stability. Our Summer Meeting in Myrtle Beach continued that trend with nearly 230 attendees in the second year of an innovative split-week schedule, the most attendees in at least five years. We expect our 60th Anniversary Meeting in Asheville in December to be just as successful, although it will be hard to top the incredible attendance that came to wish Sue Makey well in her retirement last year. We truly hope you will join us in Asheville as we celebrate the end to what has been a momentous 60th Anniversary. But be assured, we will not rest on our laurels in 2009. Some things you can expect to hear about: • Another national campaign, with PastPresident Dr. Conrad L. Flick seeking a position on the AAFP Board of Directors • Ongoing work on health care policy • Updated strategic initiatives for the Academy See Fantastic - page 16




Dr. Lori Heim Elected AAFP President-Elect North Carolina’s own Dr. Lori Heim, a Family Physician from Vass, has been elected President-Elect of the American Academy of Family Physicians (AAFP). Dr. Heim was elected by a vote of delegates at the AAFP’s Congress of Delegates on Wednesday, Sept. 18, 2008 and will begin her presidential term in October, 2009. “We are at a pivotal point in healthcare and in our efforts to improve access, increase the number of family doctors, and provide health care to all of our people,” noted Heim in her address to delegates. “It is time for bold action - we no longer have the luxury of time!” During her campaign, Heim stressed the need to significantly transform the U.S. healthcare system through policy changes supportive of primary care, prevention and patient-centered care. “Policy makers and the public

must understand that primary care is foundational and that we must increase our numbers to allow all patients to access a family doctor,” Heim noted. Prior to her election, Heim had served on the AAFP’s Board of Directors since 2006. In this role, she was involved in

Leaders Work to Shape Chapter’s Future Direction and Strategy Jean Frankel of Chicago-based Tecker Consultants led 25plus Chapter leaders and staff through a number of strategic planning exercises during the Chapter’s Annual Leadership Retreat in Cary, NC, in late August. Ideas and input gathered from these discussions and exercises will be used to finalize and re-formulate key NCAFP strategy statements and help guide Chapter projects and initiatives in 2009. It is expected that final working statements will be published on the Chapter website after official Board consideration, approval and authorization in early December.

NC Student Receives Fourth Place at National Tar Wars Poster Contest

numerous AAFP policy and leadership activities, including participating on several of AAFP’s commissions and a number of its advocacy initiatives. Most recently, she served on the board of managers for TransforMED, AAFP’s practice redesign

Congratulations to Logan Ruppard, a 5th grade student at Sparta Elementary! Logan received Fourth Place in the Tar Wars National Poster Contest held July 21st in Washington, DC. NCAFP’s Health Initiatives Manager Jenni Fisher, MPH, accompanied Logan and his family and represented North Carolina.

See Election - page 16

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Call MAG Mutual’s Andy York toll-free at 1-888-892-5218 or Mike Tekely toll-free at 1-888-834-5940 today. www.magmutual.com *Effective September 1, 2008, policies renewing on that date and beyond will automatically receive the reduction. **Beginning June 1, 2008, $15 million will be distributed to all eligible MAG Mutual Physicians and Surgeons Professional Liability policyholders of record as of the close of business April 1, 2008. Dividend payments are declared at the discretion of the MAG Mutual Insurance Company Board of Directors.


NCAFP’s Policy Proposal on Retail Health Clinics Will Be Studied by AAFP Board Chapter Submits Four Policy Proposals to AAFP Congress The NCAFP sponsored four policy resolutions to the AAFP Congress of Delegates for consideration and debate during this year’s meeting in San Diego. These resolutions were presented at two different AAFP reference committees, with Chapter representatives officially presenting them for debate and offering perspectives. A copy of each of these resolutions can be found at the NCAFP website at [http:// www.ncafp. com/2008cod]. Of the proposals submitted by the Chapter, its resolution on retail health clinics fostered the most activity when debated within AAFP’s Reference ComNCAFP President-Elect Dr. mittee on OrRobert Rich spoke on behalf ganization and of family physicians in NC. Finance. After lengthy discussions that drew both support and opposition to the measure, the resolution was ultimately referred to the AAFP Board of Directors for further study. NCAFP’s PresidentElect Dr. Robert Rich (Bladenboro) and Past President Dr. Conrad Flick presented on behalf North Carolina. While select committee testimony agreed in concept with the Chapter’s proposal, the Committee recommended further examination of the measure and especially its relation to AAFP’s existing policy on the clinics (Desired Attributes of Retail Health Clinics). Dr. Rich was quoted on the issue in a special AAFP publication distributed to attendees of the Scientific Assembly. The article can be found online at [http://www.aafp.org/online/ en/home/publications/news/news-now/annualassembly/20080917codretailhealth.html].



Three FPs Selected as NC Medical Society Leadership Scholars The North Carolina Medical Society (NCMS) Foundation recently announced the physician scholars who have been selected for its Leadership College Class of 2009. Three NCAFP Family Physicians have been selected to participate in the upcoming class. They are Robert W. Fields, MD (Asheville); Michelle F. Jones, MD (Hampstead); and John R. Smith, Jr., MD (Raleigh). Additionally, Drs. Shannon B. Dowler, MD (Asheville, NCAFP District 7); Gowri D. Sathiraju, MD (Rutherford College); and Lawrence R. Wu, MD (Cary) are all expected to graduate from the College this October.

Dr. Mott Blair, IV, Participates in Democratic National Convention NC family medicine was well-represented during the Democratic National Convention in August. NCAFP Past President Mott Blair, IV, MD, (Wallace) not only was a delegate, but was a media star! He was one of a select group interviewed by CNN.com regarding his overall experiences as a delegate. Dr. Blair capitalized on this unique media opportunity to mention key problems facing the US health care system and specifically those he sees on Main Street in Wallace. Blair’s video interview can be seen it its entirety at http://www.ncafp.com/blaircnn and is a great example of simple and effective grass roots media advocacy.

Dr. Jim Jones Discusses Community Care on State Government Radio Past President Dr. Jim Jones discussed the benefits of Community Care of North Carolina during a segment on State Government Radio. Periodically, NCAFP leaders - past and present - are interviewed about health care issues on the online radio station that is listened to by many state legislators. Jones discussed the state’s innovative Medicaid medical home model. To hear Dr. Jones’ remarks, visit http://www.ncafp.com/media.

Chapter Presents 2009 Board of Directors Slate Pursuant to the NCAFP Bylaws, the Board of Directors recently approved the 2009 Board Slate. This slate was subsequently submitted to NCAFP members for ratification via US mail in early September. Members were given until September 22, 2008 to vote and/or to submit floor nominations. Based upon the results of the “Vote by Mail” ballot, we are pleased to present the following new board members and officers for 2009. The individuals below will be installed during the Winter Family Physicians Weekend at The Grove Park Inn, Asheville, NC, on Saturday, December 6, 2008. President.........................................................................................Robert L. “Chuck” Rich, Jr., MD Board Chair.......................................................................................... Christopher Snyder, III, MD President-Elect................................................................. R.W. “Chip” Watkins, MD, MPH, FAAFP Vice President............................................................................................ Richard W. Lord, Jr., MD Sec./Treasurer............................................................................................. Shannon B. Dowler, MD District 2 Director............................................................................ Connie Brooks-Fernandez, MD District 4 Director...........................................................................................Tim S. McGrath, MD District 6 Director........................................................................................James W. McNabb, MD District 7 Director....................................................Thomas R. White, MD (filling unexpired term) At Large . .................................................................................................... William A. Dennis, MD IMG Physician Constituency............................................................................Rafael G. Torres, MD Minority Physician Constituency...................................................................... Enrico G. Jones, MD New Physician Constituency................................................................................ Jana C. Watts, MD AAFP Delegate.................................................................................................Conrad L. Flick, MD AAFP Delegate Alternate...................................................................................Karen L. Smith, MD

In addition to these physicians, the Student Director-Elect, the Resident Director-Elect, the Family Medicine Department Chair Director and the Family Medicine Residency Director are elected by their respective peers during t he Annual Meeting. Each serves a one-year term.

October - December 2008 | the North Carolina Family Physician

10 Great Workshops


Preventive Healthcare Systems Workshop -

Many chronic diseases and early deaths are caused by tobacco use, unhealthy diet, and inadequate physical activity. Learn about preventive healthcare systems and how they improve care quality.


Wed., Dec. 3rd, 2008, 3:30 - 7:00 pm / Free

n ark In rove P NC G e h T ille, Ashev

B ui l d i ng Fa mi ly M e d i c

Latinos in NC – Where are they and what are their healthcare needs? - Facilitate the doctor-patient interaction through a culturally-competent approach in the medical environment and take away practice pearls that will help you treat the NC Latino patient. Includes dinner and lecture.

7, 2008 4 . c e D

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

S i x t y Ye a r s

Wed., Dec. 3rd, 2008, 7:15 - 9:00 pm / Free

December’s Annual Meeting 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! All festivities will take place at The Grove Park Inn & Spa from December 4-7, 2008. Dr. Richard Lord, Jr., Program Chair, has planned an extravaganza that will present over thirty AAFP prescribed credits, a full array of Chapter business meetings, a huge list of workshops, and a number of fun social activities for the entire family. Please don’t miss this wonderful learning activity. Extensive Educational Program

The scientific program for the Winter Meeting will present one of the broadest arrays of topics ever presented by the Chapter. In addition to the 30+ credits that will be presented during General Session, a total of ten different workshops will also be delivered. Workshop offerings include topics like preventive healthcare systems, latinos in North Carolina, and risk management. These are conveniently scheduled throughout the weekend to accommodate any schedule. (See listings at right; complete descriptions of the objectives of each workshop can be found online at www.ncafp.com/wfpw) The General Session portion of the meeting will present over 30+ prescribed credits, with some topics pending evidence-based approval. Topics currently include presentations on New Methods in Smoking Cessation, Poly Ovary

Syndrome, Osteoarthritis, Acute Coronary Syndrome and a number of others. The most up-to-date list of topics is published online. Festive & Fun Social Events

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 celebration will be held on Friday, December 5th. This event will combine the NCAFP Foundation’s annual Silent Auction with what’s being headlined as a Physician Talent Show. Geared for the whole family, this party will be your chance to see unique and entertaining live ‘talent’ and allow you to participate in an important fundraiser for the Foundation. Got an interesting talent that people don’t know about? Come to the Anniversary party and strut your stuff. The weekend will offer plenty of other activities as well, including holiday tours of the Biltmore Estate, autumn golf, Biltmore Spa packages and even the President’s Gala on Saturday night. Please be sure to reserve your tickets for each of these events and check the website for specifics. For complete information on the Winter Annual Meeting, please visit the Chapter’s website at http://www.ncafp.com/wfpw. The site contains the most up-to-date information and allows you to register in a few short clicks. If you have specific questions, please contact Kathryn Atkinson with the NCAFP Meetings Department at (919) 833-2110 x 114 or via email at katkinson@ncafp.com.

Thurs., Dec. 4th, 1:00 – 2:30 pm / Free

Cosmetic Procedures Workshop & Demo Introduction to laser surgery, techniques for laser hair removal, vascular and pigmented lesions, wrinkle reduction, skin tightening and tattoo removal. Lecture and demonstration. Thurs., Dec. 4th, 4:30 & Fri., Dec. 5th, 7:00 am. / Free

Risk Management Workshop - A veteran NC defense attorney will address some “hairy cases” in primary care, with a professional risk manager offering loss prevention pointers for each. Thurs., Dec. 4th, 4:30 - 6:30 pm. / Free

Introduction to Botulinum Toxin Type A - A dinner and demonstration on incorporating these aesthetic procedures into a new or existing practice. Thurs., Dec. 4th, 6:30 – 9:00 pm. / Fee $25

½ Day Botulinum Lecture & Training - Four hours of training that will describe the mechanism of action of botulinum toxin injections and discuss the injection technique with individualized hands on instruction. Registration is limited. Fri., Dec. 5th, 1:30 -5:30 pm. / Fee $295

Mastering Joint Injections for Physicians, FNPs, & PAs - Indications and contraindications for joint and soft-tissue injections and aspirations, review of evidence, and review of safe and effective techniques for the 10 most common procedures. Fri., Dec. 5th, 5:00 - 6:30 pm. / Fee: $50

Spirometry Workshop - This workshop will address the barriers that currently exist in the family physician’s office with respect to the use of spirometry when diagnosing patients with COPD. Limited seating. Fri., Dec. 5th, 5:00 - 6:30 pm. / Fee $25

Complete information & regsitration is online at http://www.ncafp.com/wfpw WWW.NCAFP.COM

Regional ICARE Workshop & Lunch - An overview of the diagnosis and treatment of children with bipolar disorder, including distinguishing BPD from other disorders. Full dinner and lecture.

Successful Innovations & Practice Models A panel discussion on innovation and flexibility in practice design.

North OF pm. Family PhysicianS, INC Sat.,Carolina Dec. 6th,ACADEMY 2:30 -4:30 / Free



Physician Advocacy Took Many Forms in 2008 As we enter the fourth quarter of 2008, I would like to outline the accomplishments of our advocacy efforts for 2008. Throughout the year we have worked to better focus our efforts on those areas that you -- the membership -- have identified as most important to your practice and professional well-being. We feel that our efforts have addressed many of your concerns and I present them for your review. We agree that there are areas that are unfinished and the later portions of this article will outline our advocacy efforts for the coming year. We are pleased to share our accomplishments for 2008. (1) Funding for the New Family Medicine Center at ECU. As already outlined in Dr. Snyder’s President’s Message, our multi-year efforts to obtain funding for the new Center have finally succeeded. Please note that the funding was obtained as a result of the persistent efforts of the Raleigh staff, particularly our Legislative Liaison, with the support of the physician leadership of the Academy. (2) Medical School Expansion. Extensive discussions have been held at the Academy regarding the proposed medical school expansion plans. The Academy has held discussions with key legislators during this year, outlining our concerns that any expansion should emphasize the production of primary care physicians. One of the best avenues would be through the expansion of primary care residency slots, particularly Family Medicine. Planning money was appropriated to study the proposed expansion, with full funding to come during subsequent sessions. (3) Retail Health Clinics. Our policy regarding retail health clinics has been completed and accepted by the NCAFP Board of Directors. The policy was prepared in resolution format and presented to the AAFP Congress of Delegates in September. It is also being introduced to the NC Medical Society during its upcoming annual meeting in October. (4) NC Medical Board Proposed Rules Regarding Physician Profiles. As many of you are aware, the NC Medical Board recently posted its proposed policy outlining public listings of malpractice actions against physicians in North Carolina. As initially proposed, all malpractice actions involving physicians for the past 7 years were to be made publically available, similar to what is being done in other states. The Academy was invited to comment regarding the proposed policy and after developing a position statement about the proposal, Academy leadership and other interested parties participated in a 8

public hearing at the Medical Board on June 30th. The Medical Board received public comments, made some minor modifications, and forwarded the proposal to the N.C. Rules Review Commission. The Commission ultimately approved the proposal, but due to the number of physician objection letters it received regarding the new rule, the effective date of the rules has been delayed until after the General Assembly convenes in 2009. The General Assembly must either disapprove the rules through legislation or revise the statute that enables the rules before they can become effective. (5) Educating Public Officials. Efforts have focused upon producing fact sheets about the value and importance of Family Medicine in controlling rising health care costs and also to outline the specialty’s contribution to the patient-centered medical home concept. We have prepared information sheets that members can use to educate their local officials about the specialty’s importance and are preparing additional press materials which can made available to the media to further educate our officials and the public. (6) Medicare Cuts. Significant work was devoted to educate and mobilize the membership about the proposed Medicare cuts in June/ July in conjunction with the AAFP. Our membership was utilized to contact the North Carolina congressional delegation. Fortunately, the cuts have been delayed for at least 18 months. (7) Additional Items of Interest. NCAFP positions were developed regarding other

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

legislative items of interest including discussions about various Smoke-Free legislation, the Race and Ethnicity Data bill (see related article), Obesity Reduction bills, NCMS scope-of-practice efforts, work on bills similar to the Colorado Uniform Contracting Bill, and the Fiscal Impact bill. We invite you to join efforts with our Government Affairs Advisory Council (GAAC) as we prepare to begin the long legislative session of 2009. In addition, please consider a contribution to our political action committee, FAMPAC, before the year ends. This is a crucial election year and our PAC has made more contributions to candidates than ever before. Finally, consider becoming a key contact. If you have a relationship with one of y our state or federal elected officials, please let us know. For additional information, please contact NCAFP Executive Vice President Greg Griggs at the Academy office today.

New Law will Improve Reporting of Race and Ethnicity Data By Marcus Plescia, M.D.,Chief Chronic Disease and Injury Prevention Section, Division of Public Health Elizabeth Fancher Zurick, CDC Assignee Chronic Disease and Injury Prevention Section, Division of Public Health During the past legislative session, Senate Bill 4, An Act to Improve the Collection and Reporting of Race and Ethnicity Data to Public Health Officials, received legislative approval. The bill aligned with the Academy’s efforts to make meaningful policy changes to affect health disparities in the state, and for the most part mirrored an NCAFP resolution to the N.C. Medical Society in 2007. Trends in racial and ethnic health disparities in North Carolina have been identified through national surveillance systems; however, reliable

October - December 2008 | the North Carolina Family Physician

race and ethnicity health data are not available for the state at the community level. Health disparities are of ever increasing importance to the medical community in the state, especially given that North Carolina has the fastest growing Hispanic population in the country and North Carolina’s Asian population doubled between 1990 and 2000. Senate Bill 4 requires all medical care providers to provide patient, self-reported race and See Ethnicity - page 15



What does it mean to you to provide a personal medical home for your patients? By Leal Hsiao, MD The following essay was submitted to the AAFP and selected for a Minority Travel Scholarship to the 2008 National Conference of Family Medicine Residents & Medical Students. Dr. Hsiao, a third-year resident at the Duke University Family Medicine Residency Program, helped represent his program and participated in activities and events at the Conference.

Just after New Year’s, I saw a patient for her 28-week routine OB visit. She is a 19 year-old primigravida with a history of moderate persistent asthma. My first few visits with her had focused on getting her asthma under control, but by this visit we were both impressed by how responsible she had become with her medication regimen. I congratulated her when she told me how she had not wheezed in over two weeks! During this particular visit, she asked which OB doctor would be delivering her baby. When I asked her if she would like me to do the honor, she looked at me with a mixture of surprise and elation. “Wow, my friends are going to be jealous that my doctor will be delivering my baby,” she exclaimed through her smile. “But I thought you were a family doctor?” I chuckled when she asked this, but before I could explain that I was not laughing at her, she told me of how her closest friends saw a different physician each time they went in for their prenatal visits at the county OB clinic. She was glad she only has to remember one doctor’s name to call when she delivers, although she joked that she still didn’t quite know how to pronounce my last name. Because of patients like her, I am very grateful to be in the profession of family medicine, a profession that I believe inherently creates a medical home for its patients. What this means for me and this 19-year-old is simply that she is my patient and I am her doctor. After I deliver her baby – who I can care for in my clinic as well – I can continue to manage her chronic asthma while addressing any acute needs that arise. If she is seen in clinic by my colleagues, they can quickly review my dictated and typed


Be sure to visit the NCAFP website to learn more about Resident & Student Programs at http://www.ncafp.com


notes online, and I can access their notes just as easily. Should she ever run into financial trouble, we have a social worker who can help her find resources to keep her afloat. These are the benefits and perks that family physicians in team-based practice settings have been enjoying for years and so it is wonderful to see that these core aspects of a medical home have been found to be cost effective and to result in better health outcomes. Of course, I realize that there is still constant discussion of what the concept of a medical home should include. Incorporating new technology and striving for improvement in quality and delivery-of-care are important, but it is paramount not to lose sight of what its original goals are, both for the patient and for the provider. While it is exciting to be of the generation of family physicians who will help shape this new concept of care, right now I am simply looking forward to being on the labor floor when that certain patient of mine is ready for her first delivery.

Loan/Scholarship Winners Announced by Foundation The NCAFP Foundation would like to extend hearty congratulations to Julie Thibodeaux (UNC), Kyle Geissler (ECU) and Rhianna Kirkpatrick Ritter (UNC) for being selected as recipients of the Foundation’s Loan/Scholarship for 2008. The Foundation encourages students registered at the four NC medical schools to apply. Additional notices of next year’s opportunity will be released in the coming months. For more information on this program, please contact Peter Graber, MMC, CAE, Director of Communications, at pgraber@ncafp.com or via telephone at (919) 833-2110. Details are also available at www.ncafp.com/scholars.


Be sure to visit the NCAFP website to learn more about the Foundation’s Student Loan/Scholarship Program at http://www.ncafp.com/scholars

Health Initiatives UPdate

Health Disparities Education and Training Fostering Practice Changes The NCAFP Foundation’s Health Disparities Initiative, funded by the N.C. Health and Wellness Trust Fund Commission, began its third year this past July. The first two years of the grant proved to be successful in reaching out to over 1,200 family physicians, medical students and residents in North Carolina and educating them on health disparities. The Culturally and Linguistically Appropriate Services (CLAS) Standards are now better-recognized and implemented in clinics across the state. An emphasis on the project was an intensive training and follow-up in 5 pilot practice sites. Each of these sites were selected in Year 1 of the grant and committed to improving their practices and the quality of care their patients receive, regardless of race, culture or language. Three of the clinics were private practices and two were community health centers. Their patient populations ranged from almost 100 percent Hispanic, to mostly African American, to mostly Caucasian, though each clinic is situated in a very diverse community. The community health centers felt that they were effectively meeting the needs of their community population, but the private practices were not reaching out as efficiently to the community and its members’ needs.


Each pilot practice was assessed on the Culturally and Linguistically Appropriate Services (CLAS) Standards which were developed by the Office of Minority Health in 2001 to provide a common definition and understanding of culturally-appropriate health care and to decrease the impact of health disparities. The results of the assessments showed that none of the clinics were meeting all of the CLAS Standards and each had a specific area that needed improvement, if not several. While the community health centers served a more diverse population than the private practices, the community health centers still had gaps where standards were not being met. The practices were not discouraged by the results on the assessment but instead have worked diligently in the past year to improve their outcomes. Each of the five clinics has improved in at least one of the CLAS Standards and most

have progressed in several areas. Overall, the physicians’ feel that not only do they see health disparities as a problem, but their staffs also recognize the importance of improving outreach efforts to minority populations. The pilot practices have proven that implementing the CLAS Standards - though a daunting task at first - can be accomplished if the whole clinic is determined to make the changes and works together to make it happen. The practices have found that when they focus on the overall goal of improving care to all patient populations in their community and making it a whole systems change that they see more positive results. Some examples of improvements in the clinics include: bilingual signage throughout the clinic, hiring bilingual staff to fill vacant positions, including race, language preferred and country of origin on all patient forms, cultural luncheons for all staff and educating all staff on the CLAS standards and health disparities. To find out more about the NCAFP’s Health Disparities Initiative, please visit http://www.ncafp.com/home/programs/disparity or contact Jenni Fisher, MPH, Health Initiatives Manager, at jfisher@ncafp.com.

2008 Silent Auction to Coincide with Anniversary Party 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 919-8332110 or 800-872-9482.


Friday, December 5th, 2008 at The Grove Park Inn Resort & Spa in Asheville, NC This is your special invitation to get in on the fun! This year marks the 60th Anniversary of the NCAFP and this important milestone will be celebrated during the NCAFP Foundation’s Silent Auction & Family Fun Night on Friday, December 5th at The Grove Park Inn and Spa. Free to registered attendees and their families, our celebration will include a fantastic Silent Auction complete with …. an auctioneer and Emcee, fabulous items for bidding (resort getaways to the Kingsmill Resort, The Grove Park Inn, The Holiday Inn Sunspree, one-of-a-kind handmade gifts, merchandise and dinner gift cards and much, much more), food for everyone in the family, great music and dancing, a terrific deejay and more.   Another main attraction at the Celebration will be our Showcase of Hidden Talents of the Family Physicians. We have some very talented members in the organization. Join us and see… Who has magic up their sleeves ...Who is a natural rapper ...Who is a talented musician ...Who is a black belt in karate ...and much, much more! Do you have

October - December 2008 | the North Carolina Family Physician

a hidden talent? Let’s see it! Be a part of the excitement and help a truly worthy cause by participating in this extremely fun-filled evening! You do not have to be physician to participate.   As the philanthropic arm of the Academy, the NCAFP Foundation’s activities include providing scholarships to medical students considering the specialty, supporting student and resident efforts, and delivering a number of special projects aimed at improving the health of the public. If you would like to participate in the Talent Showcase or donate an item to the Foundation’s 2008 Silent Auction, please contact Kathryn Atkinson at 919-833-2110 / 800-8729482 or katkinson@ncafp.com and a contribution / participation form will be emailed to you. We appreciate your contributions and look forward to seeing you in December! Register online now at https://www.ncafp.com/wfpw


q u a l i t y

i m p r o v e m e n t

Improving Performance in Practice and the North Carolina Healthcare Quality Alliance In 2005, key stakeholders in primary care in North Under the direction of their clinical directors, Carolina came together to build the infrastructure for Community Care of North Carolina had worked a new national quality improvement initiative from in these two disease categories for many years and the American Board of Medical Specialties called Imhad previously established evidence-based best proving Performance in Practice practice standards for Diabetes and (IPIP). This national initiative, Asthma care. Additionally, CCNC funded by the Robert Wood had been working with practices Johnson Foundation, was looking to introduce and develop quality for two states to pilot its new improvement and medical home Improving delivery model for a statewide strategies through their regional Performance quality improvement program. networks. This foundation develIn Practice Benefiting from the tremenoped by CCNC, combined with the dous strengths of both the NC additional practice support offered Area Health Education Center (AHEC) program and by the QICs as part of IPIP, led to the early sucthe Community Care of North Carolina (CCNC) cesses of the practices participating in the project. program, as well as the engagement of NC Academy During this same time frame, the of Family Physicians, NC Pediatric Society, NC NC Governor’s Office began working with Medical Society, the NC Chapter of the American physicians, medical experts and health insurers College of Physicians and the NC DHHS, Division across the state to develop a statewide plan to of Public Health, North Carolina was quickly chosen fundamentally restructure the delivery of healthas one of two pilot states for the national initiative. care in NC. This restructure would be delivered In 2006, an eastern region and western region of in a three-pronged approach: 1. align quality the state were selected to pilot the delivery model and measures across payers, 2. provide feedback on the AHECs, CCNC Networks and other regional performance measures to practices, and 3. support partners in those areas began to deploy the Proquality improvement work in the primary care gram. Each region hired a Quality Improvement practices by using nationally recognized models. Consultant (QIC) and enrolled 8-10 primary care For more than a year, the health insurance practices to test the tools and theories of qualproviders, physicians and healthcare leaders met ity improvement in Diabetes and Asthma care. See IPIP - page 15





ICARE Now Providing Billing and Coding Assistance to Practices As ICARE enters its third year, the Partnership is pleased to announce that technical assistance in the areas of billing and coding relative to behavioral health services in the primary care setting is now available. ICARE recently partnered with Hill & Associates of Wilmington, NC, to develop practice tools and informational materials on billing and coding. Once completed, the tools are slated to include coding sheets for Medicaid and Medicare. Additional coding sheets are expected by the end of the calendar year on Blue Cross Blue Shield Health Choice, Blue Cross Blue Shield and United Healthcare. It is expected that these tools will include inserts that will provide explanations and guidelines for using codes, including the scope of reimbursement under appropriate entities. There will also be directional notes on maximizing reimbursement


in integrated care settings to correspond with each coding sheet. In addition to the creation of these useful billing tools, Emily Hill of Hill and Associates is available to provide technical assistance by phone, e-mail or round-table discussions at your practice site. If you would like to utilize this free resource or have any questions about the services available please contact Tracie Hazelett at 919-833-2110 or thazelett@ncafp.com Once completed, these tools will be available on the ICARE website www.icarenc.org Explore the website for these See ICARE - page 15

Why the IMB Advisory Committee Recommends Duraphat® Fluoride Varnish By Kelly Close, MPH IMB Project Coordinator

Perhaps one of the most frequent questions the IMB Program receives is why we recommend Duraphat® Fluoride Varnish. This is an excellent question - and a recommendation that is based on science. Duraphat® brand fluoride varnish has been used in Europe, Scandinavia, and Canada since the 1960s and there are approximately 200 studies documented in the literature. Over 40 of these are clinical trials and no other brand of fluoride varnish has as many published clinical trials showing effectiveness. We now have two US-based studies showing effectiveness in the infant- to 3-year-old age group. Our own IMB program data show that children receiving at least four applications of the oral preventive procedure with dental varnish have approximately 40% fewer dental treatment needs. A two-year randomized, dental-examiner-masked clinical trial from the University of California San Francisco showed very similar results and published these in Efficacy of Fluoride Varnish in Preventing Early Childhood Caries (Journal of Dental Research, June 2006). If you would like more information about fluoride varnish or the ‘Into the Mouths of Babes’ Program, please contact Kelly Close (formerly Haupt) at Kelly.Close@ncmail.net or 919-707-5485.

Rate Increase for Physician Fluoride Varnish Services Effective with date of service September 1, 2008, the reimbursement rate for the application of topical fluoride varnish (procedure code D1206) was increased to $16.80.  No adjustments will be accepted from providers for this rate change.  Providers are reminded to bill their usual and customary charges rather than the Medicaid rate. For coverage criteria and additional billing guidelines, please refer to Clinical Coverage Policy 1A-23, Physician Fluoride Varnish Services. For additional information, contact Kelly Haupt at Dental Program DMA at 919-8554280. Source: NC DHHS Medicaid Bulletin (Sept, 2008).

North Carolina ACADEMY OF Family PhysicianS, INC


Family medicine in practice

2008-2009 Flu Season: Reminders for The Family Physician By Amanda Dayton, NC Immunization Branch The upcoming flu season is almost upon us and it’s always constructive to keep abreast of the latest recommendations and insights. The CDC’s Advisory Committee on Immunization Practices (ACIP) has several recommendations (complete ACIP recommendations are published at www. cdc.gov/flu/ or www.immunizenc.com) for use of the influenza vaccine. Family physicians are encouraged to keep the following recommendations in mind this upcoming season: • Annual vaccination of all children aged 6 months to 18 years, • Children aged 6 months to 8 years should receive two doses of influenza vaccine if they have not been vaccinated previously at any time, p r a c t i c e

• Persons at high-risk of influenza complications because of underlying medical conditions, children aged 6 months to 23 months and persons aged greater than 49 years should receive TIV (trivalent inactivated influenza vaccine) and, • Either TIV or LAIV (live attenuated influenza vaccine) should be used when vaccinating persons aged 2 through 49 years who do not have medical conditions that put them at higher risk for influenza complications. Vaccinating High Risk Patients

Data presented at the 2008 Flu Summit in Atlanta reveal flu vaccination drops after Thanksgiving, but picks up again as flu season peaks around

t r a c k s

Medical Board’s Physician Profiling Rules Going to NC General Assembly The N.C. Medical Board (NCMB) made several modifications to the rules that will ultimately govern public profiles on physicians. This has been reported extensively by the Chapter, with particular emphasis on three key modifications. First, under the updated rules, physicians will now have 60 days rather than 30 to report malpractice settlements. Second, only malpractice settlements or payments over $25,000 will be included as part of the public physician profile, although all payments will still need to be reported to the Board under other regulations. And finally - and most importantly - only malpractice payments or settlements made after October 1, 2007 (the effective date of the legislation prompting the rules) will be reported. At the Board’s June public hearing on the issue, NCAFP Past President J. Carson Rounds, MD (Wake Forest), testified on behalf of family physicians. His comments can be seen on video at www.ncafp.com/rounds_ncmb. After this hearing, the Board’s final proposal and rules were approved by the NC Rules Review Commission (RRC) in late July. However, due to the number of physician objection letters it received regarding the new rule, the effective date of the rules has been delayed until after the General Assembly convenes in 2009. The General Assembly must either disapprove the rules through legislation or revise the statute that enables the rules before they can become effective. The NCAFP will continue to watch this process closely and keep members updated as changes occur. Look for additional updates and more information in future issues of NCAFPNotes and the NC Family Physician.

Blue Cross Blue Shield of NC Makes e-Prescribing Available Statewide In early August, Blue Cross Blue Shield of North Carolina (BCBSNC) announced the launch and availability of its new e-prescribing website (www.bcbsnc.com/providers/eprescribe). The mini-site serves as a one-stop shop for physicians seeking to begin utilizing e-prescribing and presents a listing of complete software and hardware solutions that can make it happen. As an added bonus, the company also announced a one-time $1,000 incentive to its network providers who meet certain e-prescribing criteria and adhere to specified program requirements. Please visit the e-Prescribe website for details. 12

October - December 2008 | the North Carolina Family Physician

February. The gap between late November and early February presents an opportunity to vaccinate more patients, especially those at high risk for complications from the flu. Some points to consider: • • • •

Opportunities exist to immunize more patients; Physician recommendations can drive increased immunizations; Vaccination is effective well beyond December, even into spring; and Current immunization rates are below Healthy People 2010 goals This Season’s Flu Vaccine

The 2007-2008 Flu Season impacted many North Carolinians because the virus strains in the vaccine weren’t a good match to the strains of circulating flu virus. Even if strains in this year’s vaccine don’t match the most commonly circulating strains, the flu vaccine can be beneficial because: • Antibodies made in response to vaccination with one strain of influenza virus can provide protection against different, but related strains, and • A less than ideal match still can provide enough protection to prevent or lessen illness severity and prevent flu-related complications.


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

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.


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 in the following areas: • Traditional Family Medicine • Outpatient Only • FT, PT and Job Share

• Urgent Care • Faculty Geriatrician • Sports Medicine

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: http://physicians.carolinashealthcare.org. To submit a CV for consideration, please contact Sarah Foster, Physician Recruiter: sarah.foster@carolinashealthcare.org or call (800) 847-5084. EOE/AA


North Carolina ACADEMY OF Family PhysicianS, INC


Family medicine in practice

Get to Know NC’s Controlled Substances Reporting System The North Carolina Controlled Substances Reporting System was established to improve the state’s ability to identify people who abuse and misuse prescription drugs that are classified as Schedule II-V controlled substances as defined by the Department of Justice. The Reporting System also helps to assist clinicians in identifying and referring patients who are misusing controlled substances. The NC Commission for, and the Division of, Mental Health, Developmental Disabilities and Substance Abuse Services contribute to policy development, information and manage the program. Physicians and practice are urged to familiarize themselves with this valuable tool, bookmark it and utilize its valuable resources. For complete information, visit http://www.ncdhhs. gov/mhddsas/controlledsubstance/index.htm

CMS Clarifies E-Prescribing Rule Regarding Tamper Resistant Paper CMS clarified its electronic prescribing rules as they relate to tamper-resistant prescription paper. Family Physicians who send patient prescriptions electronically - or those planning to utilize this type of technology in the future - will not need to utilize tamper-resistant paper when Phase II of the program goes into effect this October. CMS has stated that while special copy-resistant paper may be used, it is NOT necessary.

ABFM’s Performance-in-Practice Registry Now PQRI-Qualified The Centers of Medicare and Medicaid Services (CMS) announced in late August that ABFM’s Performance in Practice Registry is now a qualified to submit Physicians Quality Reporting Initiative (PQRI) data on behalf of diplomats. Beginning September 4th, Family Physicians can now utilize ABFM’s Diabetes Module to collect and submit data to the Registry on a set of either 30 or 15 consecutive patients with either Type 1 or Type 2 Diabetes. Physicians who meet the quality measures submissions criteria for 2008 will earn an incentive payment of 1.5 percent of their total allowed charges for Physician Fee Schedule (PFS) covered professional services furnished for 2008. Complete information about the Module and the Registry can be found at http://www.theabfm.org. 14


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More Practice Tools to Prevent Pediatric Obesity North Carolina has a new set of tools to help clinicians prevent, assess, and treat pediatric overweight and obesity. The tools, available for download on the Eat Smart, Move More North Carolina web site (http://www.eatsmartmovemorenc.com/programs_tools/PediatricObesityTools.html), include the following: • Pediatric Obesity Assessment, Prevention and Treatment Guide for Clinicians (called Clinician Reference Guide) • Color-coded BMI charts • Blood pressure tables • Prescription pads to promote “5-3-2-1-Almost None” prevention messages The NCAFP Foundation’s Adolescent Obesity and Inactivity Project would like to send a special ‘thank you’ to Dr. J. Thomas Newton of Clinton for providing input and assisting in development of these resources. The NCAFP has participated in the NC Eat Smart Move More Leadership Team since 2005 and currently Greg Griggs, MPA, CAE, serves as the Leadership Team Chair, with Jenni Fisher, MPH, NCAFP Health Initiatives Manager, serving on the implementation committee. Many tools from the NCAFP Foundation’s Adolescent Obesity Initiative (AOI) are still available at the Academy office. This initiative was a three-year effort that originated in 2004 through the efforts of Dr. Mott P. Blair, IV. Resources include tear off pads with healthy messages for waiting rooms, Fast Food and Families CD-ROMs, the AOI Physician Guide and others. All materials are provided to NCAFP members at no cost. Please contact Jenni Fisher, MPH, NCAFP Health Initiatives Manager, at jfisher@ncafp.com or 919-833-2110 for more information.

Community Care of North Carolina Featured in Annals of Family Medicine Community Care of North Carolina is highlighted in the July/ August 2008 edition of Annals of Family Medicine with both an excellent descriptive article on the program and a very positive editorial. First, six NCAFP Members (Dr. Beat Steiner, Dr. Amy Denham, Dr. Evan Ashkin, Dr. Warren Newton, Dr. Thomas Wroth and Dr. Allen Dobson) authored an article, titled Community Care of North Carolina: Improving Care Through Community Health Networks. Additionally, Dr. Thomas Bodenheimer, Department of Family and Community Medicine, Uwniversity of San Francisco, wrote a highly favorable editorial, titled North Carolina Medicaid: A Fruitful Payer-Practice Collaboration. Both articles can be found by going to the Annals of Family Medicine Website at http://www.annfammed.org/content/vol6/issue4/. Community Care began ten years ago and is currently saving the NC Medicaid program an estimated $160 million per year. Through a unique partnership between practicing community doctors, hospitals, health departments, social services departments, and the NC Medicaid Program, a network of fourteen locally-run health networks continue to increase health care quality and reduce costs. Annals’ Special Report gives an excellent overview of the program, its key goals, what’s been learned so far and where it could improve. All physicians are encouraged to read the article and participate.

October - December 2008 | the North Carolina Family Physician


Learn more about Community Care at www.communitycarenc.com


IPIP from page 11

ICARE from page 11

under the governor’s leadership to endorse a single set of indicators to more effectively measure the quality of care for five of the most widespread and costly chronic medical conditions (Diabetes, Asthma, Hypertension, Congestive Heart Failure and Post Myocardial Infarction) The third prong of this plan included the work that was being piloted in the IPIP program in Eastern and Western NC. By building the structure of the IPIP program into the governor’s initiative, medical professionals in primary care will be able to work with an on-site consultant provided to help their practice to redesign their delivery systems, update their electronic systems to view population data, and implement tools to support their patients in managing healthy lifestyle changes. Dr. Mark Beamer, of Pungo Family Medicine in Belhaven, North Carolina, had this to say of his participation in the IPIP Program, “We have found this program most interesting and beneficial to our practice. We have been afforded learning opportunities and collegial relationships with a number of people and agencies that without this program may not have been possible. We look forward to continued success with the program and are most appreciative of the IPIP program’s efforts.” Governor Easley announced his plan in April, 2008 and a non-profit organization, called the North Carolina Healthcare Quality Alliance (NCHQA), was created to manage the program. The IPIP program grew from a pilot in two regions of the state into a state-wide program included in the work of the NCHQA. with Quality Improvement Consultants available in every AHEC region working with every Network in the Community Care of North Carolina program to reach all primary care practices in the state who are interested in participating in the program. If you are interested in learning more about this initiative please visit www.ncquality.org or contact Ann Lefebvre at the NCAFP Office or via email at alefebvre@ncafp.com.

and many more valuable tools and resources, please come back often as there are continually changes and additions to enhance this resource. ICARE Partnership continues to create new educational content and CME. ICARE’s newly-developed curriculum includes: The New AAP Autism Screening Guidelines: Integrating Screening Guidelines in Primary Care Practice and a module on Adult Anxiety Disorder. Both curricula are designed to help primary care physicians in their practice with screening and referral, follow-up care and identification of appropriate local resources. Three new enduring credit programs have also been added to our website for CME and are provided courtesy of ICARE and AHEC Connect. These include Office-Based Approach to Adolescent Substance Abuse, Illicit Drugs of Abuse, A Clinician’s Guide and Prescription Medication Abuse: Skills for Prevention and Intervention. The ICARE Partnership has continued to provide CME opportunities in a variety of formats. Throughout the summer, web conferences were provided on Adult Bipolar Disorder and PTSD: What Primary Care Providers Need to Know About Mental Health Issues Facing Returning Service Members and Their Families. There was also a regional program held in Fayetteville on Screening, Diagnosing, and Treating Adult Depression in Primary Care Settings.

Ethnicity from page 8

ethnicity data to the Division of Public Health when submitting information on reportable diseases and conditions required by state law. For example, when required to report information on sexually transmitted diseases or communicable diseases, the new law requires reporting race and ethnicity. In fact, this information was al-


ready included on many reporting forms and many family physicians were already reporting such data. Physicians and other providers are not expected to submit race and ethnicity data on all patients in their care, only when submitting reportable diseases and conditions information already required by state law. The collection and reporting of specific race and ethnicity indicators will allow the state to identify and address community specific health disparities and open dialogue about healthcare disparities between policymakers and the public. North Carolina’s Office of Minority Health and Health Disparities and the North Carolina State Center for Health Statistics acknowledged the significance of racial and ethnic health disparities when they published the Racial and Ethnic Health Disparities Report Card in 2003, 2005 and 2007. However, data included in the report are limited to health outcome information obtained from death certificates. Information collected through this bill’s requirements will upgrade the report card to include more meaningful data on morbidity and quality improvement and track illnesses by age, gender, race and ethnicity.

Integrated Care Training Goes National

ICARE Project Director, Sally Smith, presented at the Hogg Foundation in Austin, Texas in September, providing an overview of the ICARE Partnership and what is currently happening in integrated care in North Carolina. During her time in Texas she was able to hear what the Hogg Foundation and other states are doing to promote integrated care in their communities. During the last few months ICARE has provided speakers for various specialty society meetings. In August ICARE sponsored a session at the N.C. Pediatric Society annual meeting: Adolescent Mood and Anxiety Disorders: Pediatric Care and Collaboration with Mental Health Providers provided by Dr. Kaye McGinty. The N.C. Academy of Physician Assistants selected to have Dr. James Finch provide information on Prescription Medication Abuse: Skills for Prevention and Intervention at their Summer Conference. The N.C Psychiatric Association provided information at their annual meeting to their members on Bipolar Depression and Antidepressant Use: Old Myths, New Facts and Evidence-Based Treatment. For a complete list of educational opportunities, including new downloadable podcasts, please visit the website (www.icarenc. org). To provide suggestions for training or to request assistance, please contact Tracie Hazelett at 919-833-2110 or thazelett@ncafp.com

The Health Research and Educational Trust (HRET) publishes a free, web-based Disparities Toolkit (www.hretdisparities.org) which provides hospitals, health systems, clinics, and health plans information and resources for systematically collecting race, ethnicity, and primary language data from patients. The Toolkit is useful for educating and informing medical providers about the importance of data collection, how to implement a framework to collect race, ethnicity, and primary language data, and how to use these data to improve quality of care for all populations. Race and ethnicity data collected through Senate Bill 4 will prepare North Carolina to participate in federal quality improvement initiatives that address disparities and will improve patient satisfaction and compliance for better health outcomes. Access to this data will help eliminate health disparities in North Carolina and ensure the highest quality of services and safety for all patients, regardless of their racial or ethnic background.

North Carolina ACADEMY OF Family PhysicianS, INC


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


Little Rock, AR Permit No. 2437

Fantastic from page 4

Election from page 5

• And continued Laser-Like Focus (LLF, expect to hear it more) in the Legislature, as we try to build on this year’s success and influence the medical school expansion debate to insure an emphasis on primary care. Unfortunately, our focus may become more about protection due to the economic crisis facing our country and budget shortfalls already identified by the state (loss of federal fundHere’s to ing for our another Mental Health Hospitals 60 years of an and major innovative and shortfalls successful N.C. in the State Academy Employees Health Plan). of Family Our 2009 Physicians! legislative mission may ultimately focus on protecting Medicaid payment rates in a time of budget pressure and protecting the nationally-acclaimed Community Care Program, as well as insuring timely payment of State Employee Health Plan claims as the plan comes under increased pressure. But don’t worry. Your Academy team will be leading the fight. And I personally look forward to working with each of you to make sure the profession of family medicine and your individual practices will be prosperous for many years to come. Here’s to another 60 years of an innovative and successful N.C. Academy of Family Physicians!

effort. Previous to these efforts, Heim was active with the Uniformed Services Academy of Family Physicians since 1992, holding all of its executive leadership positions. Heim joined the North Carolina Academy of Family Physicians in 2007 after 21 years of service in the U.S. Air Force. At that time, Heim entered private practice in Moore County. The NCAFP ran Heim’s campaign for national office, with NCAFP Past President Dr. Conrad L. Flick serving as Dr. Heim’s campaign manager. The election and victory was a culmination of months of planning, input and resources by Dr. Heim, the Chapter’s executive leadership, Chapter staff and colleagues from the Uniformed Services Academy of Family Physicians. Heim’s victory represents the fourth time a family physician from North Carolina has been elected to lead the AAFP. Other North Carolinians to serve as AAFP’s President include Dr. Amos Johnson (1964), Dr. James G. Jones (1987) and Dr. Douglas Henley (1995). Henley serves as Executive Vice President of the AAFP, a position he has held since 1998. The election consisted of three other physician candidates in addition to Dr. Heim. Delegates at the Congress were given the opportunity to meet and learn about each of them through a series of meet-and-greet receptions and from two key events held on the floor of the Congress: the candidate speeches and the live ‘question-and-answer’ period. In each of these activities, Dr. Heim met with family physicians from across the US and shared her insight on key issues facing the specialty and the association. This was a major victory by the Chapter and the state.

Above - NC Chapter leaders (foreground) listen to Dr. Heim’s victory speech. Bottom - Dr. Lori Heim and AAFP Past President Dr. Mary Frank of California.

Coming in Spring 2009

Spring 2009

Family Physicians


2009 Spring Family Physicians Weekend April 1-5, 2009

Embassy Suites - North Charleston, SC Information at www.ncafp.com/sfpw

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