V5n1

April 2-5, 2009 See Details on Page 9 The North Carolina Family Physician

Vol. 5 - No. 1

First Quarter, 2009

Challenges & Opportunity:

Rich Outlines Key Goals for Family Medicine 2009

Also in This Edition Laser Like Focus: A Strategic Mantra for the Academy’s Future............................................6 Dr. Donald N. Gardner Named 2008 Family Physician of the Year.........................................7 Charleston Promises to Please...................................................................................9 Simple Steps Can Help Clinics Reduce Health Disparities............................................. 11 Cystic Fibrosis Screen Added to Newborn Panel..............................................................14

Spring 2009

Family Physicians

W E E K E N D

2009 Spring Family Physicians Weekend April 2-5, 2009 Embassy Suites - North Charleston, SC Information at www.ncafp.com/sfpw

PUBLISHED BY

THE NORTH CAROLINA ACADEMY OF FAMILY PHYSICIANS, INC Raleigh, North Carolina 27605 919.833.2110 • fax 919.833.1801 http://www.ncafp.com

Volume 5

The North Carolina Family Physician

Number 1

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

Features

2008-2009 NCAFP Board of Directors NCAFP Executive Officers President Robert Lee Rich, Jr., MD President-Elect R.W. ‘Chip’ Watkins, MD, MPH, FAAFP Vice President Richard W. Lord, Jr., MD Secretary/Treasurer Shannon B. Dowler, MD Board Chair Christopher Snyder, III, MD Executive Vice President Gregory K. Griggs, MPA, CAE Past President (w/voting privileges) Michelle F. Jones, MD The District Directors District 1 R. Kevin Talton, MD District 2 Connie Brooks-Fernandez, MD District 3 Victoria S. Kaprielian, MD District 4 Tim J. McGrath, MD District 5 Sara O. Beyer, MD District 6 James W. McNabb, MD District 7 Thomas R. White, MD At Large Brian R. Forrest, MD At Large William A. Dennis, MD Minority Physicians Constituency Enrico G. 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 Alicia C. Walters, MD (WFUBMC) Resident Director-Elect Meshia Todd, MD (Duke) Student Director Lillianne M. Lewis (Duke) Student Director-Elect Kathryn Norfleet (UNC) 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 Editorial Committee Chair

William A. Dennis, MD Shannon B. Dowler, MD Elizabeth B. Gibbons, MD Richard W. Lord, Jr., MD

MANAGING EDITOR & PRODUCTION

Peter T. Graber, MMC,CAE, Director of Communications FOR ADVERTISING INFORMATION

Peter Graber, pgraber@ncafp.com 919.833.2110 • 800.872.9482 Ed i t i o n 17

Family Medicine Facing Multiple Challenges in 2009...................................... 4 Laser Like Focus: A Strategic Mantra for the Academy’s Future.......................... 6 Dr. Donald N. Gardner Named 2008 Family Physician of the Year....................... 7 Charleston Promises to Please!................................................................ 9 Simple Steps Can Help Clinics Reduce Health Disparities............................11 Cystic Fibrosis Screen Added to Newborn Panel............................................ 14 Sections

President’s Message................................4

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

Chapter Affairs.........................................6 In Practice......................................................... 14

Contribute to FAMPAC Today Last year, the NCAFP 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 this year. 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.

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NCAFP President’s Message

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I N A U G U R A L

A D D R E S S

Family Medicine Facing Multiple Challenges in 2009

N

CAFP officers, colleagues, honored guests, family, friends, I stand before you as your new NCAFP President.

I thank you for this honor and as I outline my plan for the coming year, I ask you for your support, guidance, prayers and understanding.

Robert L. Rich, Jr, MD NCAFP President Dr. Rich graduated in 1979 from the University of North Carolina in Chapel Hill. He completed his medical education at Bowman Gray School of Medicine in 1984, and went on to East Carolina University School of Medicine, where he was the Co-Chief Resident in Family Medicine from 1986-1987. Dr. Rich practiced medicine at the Indian Health Service, Eastern Band of Choctaw Indians from 1987-1990, and received a commendation by IHS for meritorious service. He was in private practice from 1991-1995 in Elizabethtown, NC, and is currently the Medical Director in a group practice at Bladen Medical Associates, also in Elizabethtown. Dr. Rich also participates with the Family Medicine teaching program at NHRMC. Dr. Rich’s interests include rural medicine, medical management, and business management.

I mention my hometown, Garland, for a reason, which helped to shape my career choice of being a Family Physician. Through the sixty-year history of our state Academy, North Carolina has served as the home of now four AAFP presidents, the first of these being my hometown physician, Dr. Amos Johnson. I had known for many years that Dr. Johnson was a physician of importance as he was frequently away from his practice to attend meetings in Raleigh, Washington, DC., and other cities.

My questions were answered when I visited the boardroom in our Raleigh headquarters for the first time and saw Dr. Johnson’s picture on the wall where the pictures of all our previous NCAFP’s presidents are displayed. That day, Mrs. Sue Makey, our previous EVP, reviewed with me Dr. Johnson’s contributions to NCAFP and AAFP. As a young person, I had always admired Dr. Johnson’s stature and importance in our community and was amazed as Mrs. Makey outlined all that Dr. Johnson had done.

As a medical student, I had the opportunity to rotate with the doctors of Clinton Medical Clinic who had assumed my care as an older child and teenager upon Dr. Johnson’s retirement. Working daily with Drs. John Nance, Latham Peak, Frank Leak and John Smith, I noted how these physicians performed high quality, personalized healthcare upon the citizens of my home county. My experiences there confirmed a decision I had made by this time to pursue a career as a Family Physician. I had always been impressed by these physician leaders in my previous interactions with them and my admiration only grew when I learned of their previous Academy roles as NCAFP Presidents and NCAFP Family Physicians of

january - march 2009 | the North Carolina Family Physician

the Year. My admiration of Clinton Medical Clinic continues to this day, noting the present efforts of recent NCAFP President and Family Physician of the Year, Dr. Tommy Newton.

I would like next to highlight the influence on my professional life by one of the nation’s best family medicine training programs, the East Carolina University Family Medicine Program. During my time there from 1984 to 1987, I trained under the tutelage of previous NCAFP presidents such as Drs. Charles Duckett and Christopher Bremer.

It was there that I was also able to work and train under the most influential NC physician leader of the past 25 years, Dr. Jim Jones. As I have told several of you previously, I had the opportunity during a conference one day to overhear a conversation between several visitors who were listening to a presentation by another one of Dr. Jones’s protégés and previous NCAFP president, Dr. Allen Dobson.

During that conversation, they described, somewhat derisively Dr. Dobson as one of “Jim’s boys”. I relate that this day, as I consider myself as another of “Jim’s boys” and hope that my service as a physician and leader will honor your influence on all of us.

Finally, I would like to recognize the contributions and support that my coworkers and staff at Bladen Medical Associates and Bladen County Hospital have given to my efforts. Without their support, I could not be here today to assume this office and would not be able to serve my term during the coming year. Hard-working, dedicated and caring, they serve the citizens of Bladen County daily, using the resources available to them, emphasizing above all, and quality personalized healthcare to all.

At this point, I would like to take the time to describe the problems I see facing our Academy, profession and state in the coming year, as well as my plans to address those problems, and hopefully take advantage of the opportunities that those problems may also present.

North Carolina has the distinction of having

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one of the most generous Medicaid physician reimbursement schedules of any state in the southeastern United States. Currently, NC physicians are being reimbursed at a Medicaid rate at 95% of Medicare, compared to nearby states where the reimbursement rate is 75% of Medicare or less. When combined with the payment of per-member-per-month management fees, North Carolina physicians have indeed been reimbursed by Medicaid at rates physicians in other states would welcome.

Even though studies have demonstrated that our management fees and other Medicaid reimbursements have readily been accounted for by CCNC Medicaid program savings, it is my concern that 2009 will be a year that a Medicaid payment reduction may be proposed. With the current NC budget projections for 2009, clearly there will be concerns that the Medicaid program would become a prime target for spending reductions.

In conjunction with concerns about Medicaid funding reductions, we will need to be concerned about the status of CCNC as a whole. As has occurred in the past, the concept of a Medicaid HMO may be proposed with an outside company brought in, possibly from a state where a Medicaid HMO was already in effect to pilot a program in North Carolina.

This could undermine the successful patientcentered, physician-driven model of CCNC in our state and occur at the same time that other states are looking at the North Carolina model in order to develop a CCNC network of their own in order to provide quality care and Medicaid savings in their own states.

My next area of concern centers on medical education. For years, we have observed a continuing drop in the number of students choosing primary care residencies upon completion of medical school and the subsequent reluctance of those individuals to choose to practice in underserved regions such as rural and inner city regions. Various entities such as the National Health Service Corps., N.C. Office of Rural Health and North Carolina Medical Society Community Practitioner Program have been trying to entice these individuals to practice in these areas for years, with often low retention rates after program recipients complete their requirements. As a result, alternative solutions have been proposed, including a greater use of non-physician providers. While capable of providing basic uncomplicated health care, these providers are not “mini docs” and as I have witnessed through my years of working with and training these non-physician

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providers, they may fail to grasp the complexities the NC Medical Board in response to public of our multi-problem patients that we are seeing pressure to increase disclosure of physician more commonly in underserved regions. malpractice activities. At this time, the legislative The Academy and other groups have lobbied environment is not favorable towards the the Legislature and other entities for solutions development of a broad-scoped malpractice to the problems of inadequate staffing of rural revision bill but it probably is conducive to and underserved regions with suggestions such incremental actions in the coming year. as improved pay, expansion of management fees, Another area of concern focuses upon the increased scholarship funds to students from these changing status of our members in terms of how regions, and increased rural residency slots. In they are employed. A generation ago, membership response to the staffing crisis, the Legislature, after surveys revealed that the majority of our members reviewing recommendations from the Institute were employed in the tradional model of solo of Medicine and other groups, has begun to practitioner/ small group practice with a typical consider the possibility of state medical school expansion as the solution to the problem. The Academy, as well as other primary care specialty societies, is working to guide this discussion, emphasizing those strategies which have the best likelihood of producing the most primary care physicians for the state. Since this process will involve potentially hundreds of millions of dollars, the debate about this issue could potentially spread over several years in the Legislature, secondary to the state’s budgetary position. This could potentially work in our favor as expansion of existing primary care residency slots - which the Academy has favored - could produce more primary care physicians in a shorter period of time and at less expense than the proposed expansion of medical schools.

We remain concerned over the continued health of the State Employee Health Plan. In light of the recent Health Plan funding shortfall, it has been proposed that provider reimbursement be reviewed for reduction as a way of correcting part of that shortfall. We remain opposed to any reduction in provider pay and stand ready to assist the Legislature in Pinning of the President: Faye Rich finding options for preserving the State attaches the NCAFP Presidential lapel pin to her husband, Dr. Robert L. Rich, Jr. Employee Health Plan, including use of other entities, such as CCNC. Any discussion of issues important to the out-patient/ in-patient patient population.

NCAFP membership must also include a Current surveys reveal that a sizable portion of discussion of liability concerns. When our our members are still working in the traditional membership surveys are reviewed, medical model with a rapidly growing portion working liability ranks a close second to reimbursement in nontraditional roles, including out-patient and education concerns. In addition to concerns only, hospital/ large corporation employed, etc. about the cost of liability insurance, our members During a recent session on rural health care at practice under a cloud where every patient the N.C. Medical Society meeting, the speakers action that is taken must be viewed with an eye in attendance acknowledged that all of the towards how it will be perceived if ‘I am sued.’ models of care being presented to solve rural health care status utilized some form of corporate These concerns recently were heightened with the physician profiling proposal developed by See Inaugural Address on Back Cover

North Carolina ACADEMY OF Family PhysicianS, INC

CHAPTER AFFAIRS

S T R A T E G I C

P L A N N I N G

U P D A T E

Laser Like Focus: A Strategic Mantra for the Academy’s Future

By Gregory K. Griggs, MPA, CAE

At Academy Board and Committee meetings throughout the last year, the phrase “Laser-Like Focus” has become a common theme.

As several members of your Executive Committee have explained, if you steadily hold the laser in one spot long enough, you ultimately burn a hole in the problem – whether it’s medical or otherwise.

Gregory K. Griggs, MPA, CAE Executive Vice President Mr. Griggs has been on staff with the NCAFP since 2005 and is a member of the American Society of Association Executives (ASAE).

He completed his undergraduate studies at UNC-Chapel Hill and his graduate training in association and non-profit management at North Carolina State University.

He formerly served as CEO of the Henderson-Vance County Chamber of Commerce and as Executive Vice President of the Association Executives of North Carolina and the Filter Manufacturers Council.

Married with two children, Greg is Past President of the Henderson Lions Club, a current active member of First United Methodist Church in Henderson, and serves the Kerr-Vance Academy on its Board of Directors.

With that theme in mind, your Board undertook a six-month strategic planning process beginning in the Summer of 2008 and culminating at the Winter Family Physicians Weekend in Asheville. With economic pressures growing even before the worst of our nation’s current crisis became apparent, the goal became simple: to utilize limited Academy resources as efficiently and effectively as possible – in other words, to have laser-like focus.

The planning process included the use of expert outside facilitators, as well as two comprehensive surveys of your leadership. The efforts built upon the Membership Needs Assessment conducted approximately 18-months ago. The work resulted in updates to the Academy’s core mission statement, vision, core beliefs and values, and goals and objectives. But most importantly, the process will help align the Academy’s efforts and resources to best serve the needs of the state’s family physicians. For a copy of the new Strategic Plan, see www.ncafp.com/ home/strategicplan.

The realigned efforts center around four key focus areas: Advocacy, Education, Practice Enhancement and the Health of the Public. Let me briefly outline each of these areas.

Advocacy: Family Medicine will be a highly valued cornerstone of the health care system for the state of North Carolina.

The Academy’s key advocacy objective is to build a health care system in North Carolina based on primary care, with well-paid Family Physicians focused on prevention, disease management and continuity-of-care. These efforts will build upon the success of Community Care of North Carolina, and will work to increase payment for primary care services, increase the understanding of the importance of family medicine, and, ultimately, increase the family medicine workforce in our state.

january - march 2009 | the North Carolina Family Physician

Education: The NCAFP will provide high-quality innovative, sustainable Continuing Medical Education to improve the care provided by Family Physicians.

These efforts will continue the successful educational programs the Academy currently offers but develop new and innovative partnerships to expand delivery methods in areas such as team-based learning, online offerings and much more. The NCAFP wants to meet your CME needs at home by sustaining high-quality, cost-effective programs on an ongoing basis.

Practice Enhancement: Members will have vibrant, successful, dynamic practices.

First and foremost, the Academy wants to help member practices to survive, and more importantly, thrive. New efforts include a partnership with the NC Pediatric Society to provide a forum for your practice managers to learn from each other (see article on Page 9).

We also hope to make members more aware of existing practice management tools and strategies to become a Patient-Centered Medical Home.

Health of the Public: The health of all people in North Carolina will improve.

We know our state still lags in many healthcare outcomes, and much must be done. Efforts will center on encouraging every North Carolinian to have a medical home, support for improved public health laws, and additional tools to educate patients about health promotion and disease prevention.

Here’s hoping for a prosperous 2009 as we seek to focus our core resources on these areas that will ultimately benefit you – the member – the most.

WWW.NCAFP.COM

The Revised NCAFP Strategic Plan Mission Statement: The core purpose and mission of the North Carolina Academy of Family Physicians is to advance the specialty of Family Medicine, in order to improve the health of patients, families, and communities in North Carolina.

Vision Statement: Family physicians will be universally valued for their role in providing high quality care to the people of North Carolina.

Core Beliefs: • We believe that Family Medicine is essential to the well-being of the health of North Carolina, and that Family Medicine is well-suited to improve the health of the residents of our state.

• We believe in a healthcare system that is primary care driven. We believe there is an inherent value in a primary care medical home—providing quality, access and affordability.

• We believe in a healthcare system that is fair, equitable and accessible. We believe in the elimination of health disparities and barriers to access to healthcare for North Carolina.

• We believe in a comprehensive approach to patient care, and value the health and well being of patients, families and communities.

• We value collaborative communication with all parties concerned with healthcare delivery, and advocate for a positive practice environment to nourish the specialty of family medicine.

• We value the professional and personal well being of our members.

Core Values: • Quality, evidence-based, timely education.

• Professional excellence and integrity.

• Fiscal responsibility, organization integrity and viability.

• Creativity and flexibility.

• Member-driven involvement in leadership and decision making. >

Additional details on the strategic plan are located at www.ncafp.com/home/academy/mission

ANNUAL

MEETING

RECOGNITIONS

Academy Recognizes Brody, Maynard for Distinguished Service to Family Medicine During December’s Annual Meeting in Asheville (Dec. 3-7), the Academy bestowed two Distinguished Service Awards. East Carolina’s David Brody and G. Peyton Maynard, the NCAFP’s Government Affairs Consultant, were recognized for their instrumental efforts in helping to secure funding for the new family medicine center at East Carolina University. Brody, a member of ECU’s Board of Trustees, provided critical support for the project at ECU, while Maynard worked tirelessly at the NC General Assembly to help secure funding.

President Christopher Snyder also recognized Dr. Brian Forrest, Lakeside Family Physicians and Lakeside Primary Care, and Mrs. Joy Snyder and family with President’s Awards.

In addition to these awards, the Chapter also conferred recognitions for the state’s outstanding family medicine residents, its comunity teaching awards, as well as the state’s FMIG advisors. the 2008 Outstanding Residents

The Academy also recognized 14 third-year family medicine residents as Outstanding Residents in their respective programs.

Cabarrus..............................Jessica Macrie, DO Camp Lejeune................... Shari Buzolich, MD CMC-Charlotte.................. Renita Eason, MD CME-Union..................Alexander Borun, MD Duke University......................Leal Hsiao, MD

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MAHEC-Asheville......................Allison Turk, MD MAHEC-Hend................ Kelli Konst-Skwiot, MD Moses Cone..............................Mark Rowand, MD Southern Regional.......................Avtar Chana, MD See Awards on p. 13

Dr. Donald N. Gardner Named 2008 Family Physician of the Year

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ision, compassion and commitment.

These are the hallmarks of Dr. Donald Nelson Gardner of Mt. Airy (above left), the 2008 North Carolina Family Physician of the Year. The NCAFP honored Dr. Gardner with the award during a brief ceremony in Asheville on Dec. 5, 2008.

Gardner is a 1983 graduate of the Brody School of Medicine at East Carolina University and owns the innovative Pro Health Center and Northwest Medical Partners in Mt. Airy, NC. Gardner’s facility is best described as a fullyintegrated primary care and multi-use fitness and lifestyle center. Numerous patients of Dr. Gardner’s expressed how the facility has impacted their lives.

“Pro Health is the best thing that ever happened in Mt. Airy,” commented Opal Parker, a member of Pro Health’s Diabetic Program.

And D.C. Carter, an 87-year old Pro Health member for four years, remarked “I want to tell the world about Pro Health. I cannot praise these folks enough. They’ve given me back my life.”

The vision and inspiration for the center began to take shape shortly following Dr. Gardner’s arrival in Mount Airy in 1986. After taking over the practice of Dr. J. Dale Simmons, Gardner began to work towards developing a facility where patients and individuals could become partners with the medical staff to maintain their good health. After several years of planning, Gardner’s perseverance and vision paid off and the Center became a reality in 2001.

Today, Pro Health Center and Northwest Medical Partners is a state-of-the-art family medicine clinic operating alongside a fullyequipped fitness and exercise facility that includes an indoor track, lap pool, tumbling gym and aerobics studio. The facility spans See Family Physician of the Year on p. 13 North Carolina ACADEMY OF Family PhysicianS, INC

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CONTINUING MEDICAL EDUCATION ~ ONLINE EDUCATION ~ 2009

SPRING

FAMILY

PHYSICIANS

WEEKEND

NCAFP Publishes ‘Lipids’ Monograph

Charleston Promises to Please!

NCAFP Spring Meeting Returns to Low Country - April 2-5, 2009 The 2009 NCAFP Spring Meeting returns to Charleston, SC this year and begins on Thursday evening, April 2, 2009, with optional workshops. All general session lectures start on Friday and wrap-up on Sunday morning.

Hotel Information

The conference will take place at the Embassy Suites Hotel, directly adjacent to the Charleston Area Convention Center, the North Charleston Coliseum and the North Charleston Performing Arts Center. The hotel offers a complimentary airport shuttle. The NCAFP Room Rate is **$169.00 Single/Double (be sure to request the NCAFP room block.) Additional adults will be charged at $10.00 per person per night if more than two are staying in the sleeping room. Reservations must be made by Monday, March 2, 2009 to receive our Group Rate. The Academy has also reserved a block of rooms at the Residence Inn Marriott. The NCAFP Room Rate is **$164.00 single/Double.

Educational Workshops Several educational workshops will be

delivered during the Spring Meeting. Workshops are always a great way to supplement your knowledge in specialized areas. Workshops on Radiofrequency Surgery, Prescription Medication Abuse, Coding and Understanding the Impact of Gender on the Diagnosis of Depression will be offered. Complete descriptions on these workshops, as well as the topics that will be presented, can be found online at www.ncafp.com/sfpw.

Social Activities

No trip to Charleston would be complete without savoring the city’s fine southern cuisine.

To introduce Charleston’s culinary gems, the ‘Charleston Dine-Around’ will be a great way to experience tastes. Great for any budget.

On Saturday (4/4), we’re off to the Southend Brewery & Smokehouse, a casual relaxed atmosphere complete with great signature beverages and a spectacular view overlooking the Charleston Harbor. There’s no better place in Charleston to take in the NCAA Final Four!

For complete meeting information - and to register - visit www.ncafp.com/sfpw.

The Academy is excited to announce its latest continuing medical education monograph: ‘Looking Beyond LDL: Managing the High Risk Patient.’ This CME monograph is a complete transcript of a panel presentation delivered during the 2007 NCAFP Winter Family Physicians Weekend. Drs. Thomas White, Dean Bramlet, Michael Ozner and Robert Superko discuss how family physicians should assess the cardiovascular (CV) risks of individual patients, how to ascertain residual CV event risks after initiation of statin therapy, and several issues specific to combination therapy, LDL-C, HDL-C and TG. This activity provides 1.5 prescribed Category I credits. The monograph has been mailed to NCAFP members and is available for download on the NCAFP website. This activity was made possible by an educational grant from Abbott Laboratories. Go to www.ncafp.com/lipids.

NCAFP Expands Online CME Programs with New Course on Cancer The NCAFP is excited to announce the availability of a new online CME program: What Every Family Physician Should Know about Cancer. The program was made possible by a grant from the North Carolina Comprehensive Cancer Program of the North Carolina Division of Public Health. The program has been reviewed and is acceptable for up to 2 Prescribed credit(s) by the American Academy of Family Physicians. To take advantage of this convenient learning opportunity, visit www.ncafp.com/ cancer. The program is free to all members!

NCAFP to Partner with Pediatric Society to Host Joint Practice Manager’s Meeting, March 5-6, 2009 Maintaining efficient and effective management of a practice is extremely important to Family Physicians in today’s climate. For the past two years, the NCAFP’s Professional Services Council has discussed a need for a practice management group where its members can share best practices, discuss issues and concerns, as well as network with their industry peers. To that end, the NCAFP is proud to partner with the NC Pediatric Society (NCPS) at their upcoming Practice Manager’s Spring Meeting that will be held March 5-6, 2009 at the Embassy Suites Hotel and Conference Center in Concord, NC. The NCAFP is partnering with the Pediatric

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Society to provide our members with an opportunity to send their practice management personnel for two days of learning and information sharing on issues such as medical records and HIPAA, effective human resources management (hiring and firing), the legislative outlook for 2009, chart audits and a popular session called “Hot Topics” where a roundtable format allows open discussion on the biggest administrative issues facing practices today. The Pediatric Society has successfully hosted this meeting for several years and invited our own practice managers to participate in 2009 due to the similarity of practice management issues facing both specialties.

NCAFP’s Professional Services Council discusses practice management issues.

The registration fee charged by the NC Pediatric Society is $125, and will be remitted directly to NCPS. For more details about the meeting, please contact Brent Hazelett at bhazelett@ncafp.com or call him at 919.833.2110.

North Carolina ACADEMY OF Family PhysicianS, INC

Health Initiatives UPdate MENTAL

G et them to q uit ! !

More Resources Available for Tobacco Cessation

HEALTH

Cumberland County Providers Launch Integrated Care Workshop Series

By Sarah Maness As a family physician in North Carolina, have you talked with 100% of your patients about tobacco cessation? The AAFP ASK and ACT tobacco cessation program encourages physicians to ask about each individual patient’s tobacco use at every visit and to actively help tobacco users through the quitting process. In addition, SHP, BCBS-NC, Medicare and Medicaid will now pay physicians for tobacco counseling sessions (CPT code 99406 smoke/tobacco counseling 3-10 minutes or 99407 smoke/ tobacco counseling greater than 10 minutes).

Tools for the Family Physician involve using the five A’s of tobacco cessation: ASK, ADVISE, ASSESS, ASSIST, and ARRANGE follow-up.

Implement a system in your office that records patient tobacco use status at every visit. During office visits with tobacco users, provide advice to quit and discuss the health benefits. Upon each visit, assess the patient’s willingness to quit at that time. Encourage the patient to set a quit date within two weeks and gather the support of friends and family. If appropriate, suggest quitting medication, whether an over-the-counter nicotine patch, gum, or a prescription for varenicline, bupoprion SR, nicotine inhaler, or nasal spray.

Arrange a follow up within the first week of tobacco cessation and again within the first month when the process is often most difficult. Review circumstances that have caused relapse and use them as a learning experience.

Above all, remind your patient that quitting tobacco is one of the most important things they can do and congratulate their success.

Using counseling and medications to quit smoking doubles a patient’s likelihood of permanently quitting tobacco. For additional support, North Carolina offers QuitlineNC. Refer the patient to toll free 1-800-QUIT NOW using the referral form found at www.quitlinenc. com. QuitlineNC can provide three follow-up calls to check on a patient’s progress, with cessation coaches available from 8:00 A.M. to Midnight, seven days-a-week. Even brief treatment for tobacco use is effective and should be offered to every patient who is a tobacco user. Make sure your patients are receiving the tools necessary to quit their habit.

10

INTEGRATION

The right tools make all the difference.

Especially when it comes to integrated care. That’s why the ICARE Partnership has put the important tools you need all in one place. Algorithms. Screening tools.

Billing and coding resources. On- demand training. An interactive resource database. All at www.icarenc.org.

You want to provide integrated care – the ICARE Partnership can help. We’re a provider-led effort working across our state to build a more collaborative, accessible healthcare system. Visit www.icarenc.org to learn more about what we’re doing – and how we can help you.

It all starts here.

w w w. i c a r e n c . o r g

W

hen the ICARE Partnership hosted one of its integrated care training sessions in Cumberland County last year, the event confirmed what many area health professionals had been thinking: This is exactly what Cumberland County needs.

Providers at Cumberland County Mental Health Center (CCMHC) had been planning for some time to host an educational series on integrated care – care in which medical and mental health providers treat patients collaboratively.

In the course of designing the series, they were connected with ICARE (www.icarenc.org), a North Carolina partnership that brings together health professionals from a variety of disciplines to promote research, education, pilot studies and practice tool development in integrated care.

“When we learned about ICARE and discovered how its mission mirrored what we were trying to do, it made sense to join forces,” said Sharon Yates, public relations director for CCMHC. To kick off the effort last October, ICARE hosted “Managing Crisis Patients in a Primary Care Setting,” an event that addressed several key integrated care issues. Cooperating with three local health organizations – Cape Fear Valley Medical Center, Carolina Collaborative for Community Care and Southern Regional AHEC – ICARE then worked with CCMHC to map out future sessions.

Now a few months into the year-long series, local providers say the workshops are immensely valuable. “Primary care and mental health care providers want to integrate, but to do that, we need practical resources and guidance,” said Dr. John Lesica, a former military pediatrician and a psychiatrist with CCMHC. “For many of us,

january - march 2009 | the North Carolina Family Physician

integrated care is new territory, but these workshops are preparing and equipping us to treat patients collaboratively and improve outcomes.”

Open to providers in all disciplines, each monthly meeting will focus on a different facet of the integrated care model, conducted by an expert speaker. A portion of each meeting will be devoted to case studies, giving professionals a chance to solicit advice, suggest solutions and share best practices.

“For providers interested in integrated care, the training model being used in Cumberland County is ideal,” said Jennifer Borton, former Educational Program Specialist for Southern Regional AHEC. “Because these meetings are provider-led and local, they tackle the issues that are most pertinent to the professionals in the community. And because the sessions are practice-based, they will spur practical, on-the-ground changes that will benefit patients and providers immediately.”

Interest in the early workshops has been high, organizers report. The initial meeting, which addressed treatment for children with depression, drew approximately 35 attendees, and the response to the second event was overwhelming: The prescription drug abuse workshop had to be limited to 60 attendees due to space constraints. “Doctors are driving significant distances, on their own time, to be here, and that speaks volumes about how important these topics are,” said Lesica.

Workshop planners say the events have also helped foster a collaborative spirit among local health organizations. “Working together, we’re providing more than just education and training,” said Yates. “We’re setting an important precedent for future collaboration and teamwork in our county.”

ICARE Executive Director Sally Smith said ICARE is proud to be part of this grassroots team effort. “Integrated care is crucial for North Carolina residents, but ICARE alone isn’t the solution,” she said. “Local initiatives like the one in Cumberland County are the programs that will make a difference. We’re thrilled to see what Dr. Lesica and his fellow providers are accomplishing together, and we’re ready to help support similar efforts around the state in any way we can.”

For additional information on ICARE, contact Tracie Hazelett, ICARE Provider Training Specialist, at the NCAFP at (919) 833-2110 or via email at thazelett@ncafp.com.

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Simple Steps Can Help Clinics Reduce Health Disparities

By Sarah Maness, Health Disparities Intern

W

ith a growing Spanish speaking population in North Carolina, the need for physicians’ offices to accommodate diverse patient populations is of increasing importance. The NCAFP Health Disparities Project has implemented a Culturally and Linguistically Appropriate Services model (CLAS) at five pilot practices throughout the state to increase physician knowledge of health disparities and develop successful models of CLAS delivery. Sponsored by the Office of Minority Health, the complete CLAS standards and CME program can be found at www.thinkculturalhealth.org.

To begin to implement CLAS standards in a clinic, a few simple steps can be taken.

Encourage all staff to become involved, using a cultural awareness staff lunch or offering incentives for taking the online cultural health CME. Add “language preferred”, “race” and “ethnicity” to patient forms and update electronic records with this information.

This information can be used to maintain a current demographic cultural profile of the community served, which is especially helpful in developing needs assessments. Make sure that signs throughout the clinic are in both English and Spanish. These signs should include indications that interpreter services are available. Availability of interpreter services can also be stated on the clinic’s website and in its promotional services. When interpreter services are used, ensure that there is a clear procedure. Family and friends of the patient should not be used to provide interpretation unless requested by the patient. One resource

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.

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for translation is a multimedia medical Spanish translator found at http://dukeahec.mc.duke.edu/index.html.

The need for interpreter services can be addressed by promoting the hiring of a bilingual staff. The CLAS standards call for health care offices to recruit, retain and promote at all levels of organization a diverse staff and leadership representative of the demographic characteristics of the service area. Make clinic diversity a clear, widely recognized goal and communicate the desire for a bilingual staff to potential employees. Give incentives like salary bonuses or differentials to bilingual staff and utilize community and national ethnic health organizations to assist in recruitment. Hiring a bilingual staff will decrease the need to rely on translation phone services or inappropriately using patient family members for interpretation.

The lack of culturally-competent care in a clinic

will lead to the loss of minority patients and a decrease in community health. The CLAS standards improve the service of a clinic and increase patient satisfaction with health care. This leads to a higher quality of life and patient care in the commuity.

The NCAFP Health Disparities Initiative has received grant funding from the NC Health and Wellness Trust Fund Commission. If you would like more information about the Initiative, please visit www.ncafp.com/home/programs/disparity.

Snapshot of Office of Minority Health’s Recommended National Standards for Culturally and Linguistically Appropriate Services in Health Care Culturally Competent Care ~ 1. Care that is provided in a manner compatible with cultural health beliefs and practices and preferred language.

2. Cultural diversity in staff and leadership.

3. Ongoing education and training in CLAS delivery.

Language Access Services ~ 4.

5.

6.

7.

No cost billingual assistance services, including staff and interpreter services.

Bilingual verbal and written notices informing patients of their right to receive language assistance.

Competent and effective interpreters and bilingual staff.

Easily understood bilingual patient-related materials and signage in service areas.

Organizational Supports ~ 8. Strategic planning that outlines clear goals, policies, operational plans, and management accountability/ oversight mechanisms to provide CLAS. 9. Initial and ongoing organizational self-assessments of CLAS-related activities.

10. Data collection on the individual patient’s/consumer’s race, ethnicity, and spoken and written language.

11. Maintain demographic, cultural, and epidemiological profile of the community to accurately address cultural and linguistic characteristics of the service area.

12. Development of participatory, collaborative partnerships with communities in designing and implementing CLAS-related activities.

13. Provide culturally and linguistically sensitive conflict and grievance resolution processes to resolve cross- cultural conflicts or complaints by patients/consumers.

14. Regular progress updates to the public and successful innovations in implementing the CLAS standards.

North Carolina ACADEMY OF Family PhysicianS, INC

11

the NCAFP FOUNDATION FUNDRAISING

STUDENTPROGRAMS

Briefs

During the recent 2008 Winter Family Physicians Weekend, the NCAFP Foundation hosted its Annual Silent Auction with a new style and format.

This year’s auction was co-sponsored by Medical Mutual Insurance and included a DJ, music, dancing,

Deadline is March 13, 2009 The NCAFP is excited to announce that its Experience 2009 Family Medicine Family Medicine First Hand Externship Program anticipates one of our best years ever!

Medical students interested in applying to the program should contact your school’s family medicine department as soon as possible. The Externship Program consists of four weeks of intensive shadowing of a practicing family physician. Students are immersed into the specialty and receive a stipend for program completion. For complete info,visit http://www.ncafp.com/externs.

Apply To North Carolina’s 2009 Family Medicine Externship Program

4-Weeks This Summer 2009

Great Experience & Exposure Limited Number of Slots

www.ncafp.com/externs (Application Deadline is March 13, 2009)

For complete information about this program, including applications and directions on how to apply, please see the Family Medicine Department.

a wine raffle, food for everyone and lots of fun.

A fantastic talent show was the highlight of the evening with performances that included magic tricks, karate demonstrations, guitar, piano and trombone performances, and live song performances by several family physician members.

The Foundation raised over $13,000 during this event with the support and participation of our friends and members. On behalf of the Foundation, thank you to our sponsors, donors and participants who helped make this a great success!

Made Possible By The NCAFP Foundation & The NCAFP

Don’t Miss The NCAFP’s 3rd Annual Family Medicine Day The NCAFP will be holding ‘Family Family Medicine Medicine Day III’ Day - the best opportunity for rising 3rd- and 4th-year Building Tomorrow’s Medical Homes medical students Saturday, May 16, 2009 to meet-and-greet North Carolina’s family medicine residency programs.

Family Medicine Day will be held on Saturday, May 16, 2009 at the Millennium Hotel in Durham, North Carolina. Just like last year, students will be able to take advantage of four hours of skills workshops and free accomodations. A special overview on the patient-centered medical home will be presented

by AAFP President-Elect Dr. Lori Heim. For complete information on this year’s event and to register, simply visit www.ncafp.com/fmd.

2009

Millennium Hotel - Durham, NC

12

DEVELOPMENT

2008 Foundation Silent Auction & Family Fun Night Raises $13K

2009 Family Medicine Externship Program Seeking Applicants

Information & Applications at:

&

Dr. Shannon Dowler of Asheville, a.k.a. ‘Rap Docta D,’ performed her entertaining ‘I’m a Family Doc’ rap number during the physician talent show portion of the Silent Auction.

NCAFP’S Jenni Fisher Named to Health Disparities Fellowship Ms. Jenni Fisher, MPH, the NCAFP’s Health Initiatives Manager, has been named to the inaugural class of the new NC Health Disparity Fellowship Program sponsored by the NC Health and Wellness Trust Fund Commission and the Duke Global Health Institute.

The effort is designed to engage public health and social work professionals in ongoing efforts to decrease health disparities in North Carolina, to increase their knowledge about health disparities in the state, to develop the problem-solving skills required to design and implement community-based interventions and/or to conduct related evaluations that address health disparities in their community.

The two-year fellowship began in January and will include 20-days of required classroom course modules and online-postings and discussions. Twelve of those days will require fellows to be away from their workplaces. In the second year, each fellow will complete a project with a measurable outcome that can be incorporated into their daily work.

In December, Fisher represented the NCAFP and the Health Disparities Initiative at the NIH Health Disparities Summit in Washington. She presented a research poster titled “Redesigning Medical Offices Into Healing Environments: Using CLAS as a Model,” that detailed efforts in the pilot practice sites as part of the Health Disparities Initiative.

january - march 2009 | the North Carolina Family Physician

HEALTH PROGRAMS

NCAFP Foundation Secures Phase II Funding for Health Disparities Initiative The NCAFP and NCAFP Foundation are excited to announce that they have secured grant funding to continue their efforts towards eliminating health disparities for an additional three years! This funding has been made available by the NC Health and Wellness Trust Fund Commission are part of phase II of their Health Disparities Initiative. The NCAFP was awarded Phase I funding in July 2006.

The NCAFP efforts have focused on educating physicians and healthcare providers in NC on delivered culturally-competent care. In Phase II of the effort, the NCAFP will extend their scope beyond family medicine and primary care and will partner with other medical specialty associations in NC, including the Mecklenburg County Medical Society, the Buncombe County Medical Society, the North Carolina Pediatric Society, the Old North State Medical Society and the North Carolina Academy of Physician Assistants.

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FAMILY PHYSICIAN OF THE YEAR, continued from p.7 approximately 45,000 square feet and provides space to deliver a variety of programs for seniors, adults, and even children.

The NC Family Physician conducted an email-based interview with Dr. Gardner to gain insight into his practice of medicine.

What brought you into the field of medicine?

Describe how you came to be a doctor?

I was reading some papers I had written in the 1st and 2nd grades a few years ago and I noted that I spoke about becoming a physician very early on in my education. I think my father suggested the career to me at the time, but there were no physicians in my family. Growing up on a farm, I loved caring for animals, but decided that I was more interested in trying to help people with their health problems. I really enjoyed biology and chemistry and obtained a double major at UNC-CH. By then, I was very focused on becoming a physician. Dean Hayek at ECU interviewed me during my senior year, and they offered me a position in the 1979 class and I was so impressed with the people developing the school in Greenville and Pitt County Memorial Hospital that I immediately accepted. It was one of my best decisions.

Prevention is a huge part of your philosophy as a physician. Describe your thoughts on what greater personal health responsibility means to a patient.

How can family physicians encourage them?

Family Practice has always stressed prevention as the key to delivering Health Care. At Brody, it was central to our education from the first day of classes. I listened intently and learned. By practicing Primary Care for over 22 years in rural NW North Carolina, I developed a passion for prevention and health maintenance. I have relied heavily on the pioneering work of Dr. Kenneth Cooper in the fields of preventative care. I have attempted to develop a community based model based in our experience with prevention and health maintenance that could and should be available to any community. It is my belief that the future of primary care will evolve around these community based clinics charging the provider and the patient with a partnership to help each and every patient achieve their own personal state of best health. Health, wellness and fitness should be the domain of primary care medicine, and we should not expect non professionals to provide these critical services moving forward. We can demand hemoglobin A1Cs of less than 6.5 in our diabetics, but it will require a comprehensive approach stressing

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education, professional monitoring, state of the art diagnostics and management along with the required lifestyle therapies that are proven more effective than pharmaceutical and surgical intervention time and time again. These centers and services align everyone associated with delivering health care with mutually beneficial incentives to prevent illness, intervene earlier and more effectively in disease states, improve health, decrease the need for aggressive interventional medicine. While doing this the patient obtains a better state of health, and the bill to the 3rd party payer goes down. We have to do these things or our system will bankrupt our children.

program and I did. From that I have developed cardiac and pulmonary rehabilitation, physical therapy and programs for disease modification including obesity, diabetes and hypertension.

A lot of these have grown out of the cardiac rehabilitation model, but obviously most are not 3rd party funded. Thus, I have depended on the support of my patients to utilize the facility and services and finance the programs. It is quite remarkable that an economically challenged town in rural NC could support this center and the services we are trying to offer, but to date they have done just that for us. I must mention Humana and now Blue Cross of NC here, as they have pioneered 3rd party reimbursement of wellness and fitness services in their Medicare products, and this has been central to our being able to continue to provide our services.

What types of challenges have you had to overcome to make your dream a reality?

I started developing my plans at an educational meeting of the NCAFP in Myrtle Beach in 1999. While listening to a series of lectures on exercise and lifestyle modification, I decided to move ahead with a community based clinic, ProHealth Center. I left my previous position in a group practice I had helped start with a regional health care system and borrowed money and began building the clinic and the whole center. My first and ongoing challenges were financial, as the center cost over 3 million dollars to develop. The Harold family of Mount Airy and a local bank were very important to my early success. I started out with a family practice clinic, a PA and another MD and combined a fitness facility with standard membership programs. The local hospital, NHSC, asked me to consider taking over their cardiac rehabilitation

What would you say to other physicians who have similar dreams about expanding their practice’s services?

I do believe that the future of health care will be dominated by partnerships between providers, patients and payers that focus on the prevention and modification of the vast number of chronic disease states that are lifestyle dependant. Patients really do not want to become ill, and the system is going to have to promote best health along with disease management. We cannot reach our goals without accessible facilities, both economically and geographically, that can provide the services required to reach the goals of best health. I think this will not be only a dream for many providers, it is absolutely necessary for our future.

AWARDS, continued from p.7 UNC-Chapel Hill.....Antonio Rodriguez, Jr., MD East Carolina..................... Sujatha Sajeevan, MD Wake Forest Univ....................Alicia Walters, MD New Hanover.............................Scott Kahn, MD WOMACK........................ Randolph Taylor, MD 2008 Community Teaching Awards Each medical school recognizes doctors and practices dedicated to teaching medical students about family medicine. The 2008 awardees were: Duke University.................Marc F. Guerra, MD East Carolina Univ.......... Cabarrus Family Med. UNC-Chapel Hill.........Stanley R. Watson, MD Wake Forest University.....Frank R. Moyer, MD 2008 FMIG Faculty Advisors Recognitions

The Chapter also recognized physician faculty members working to promote the specialty of Family Medicine at each NC

medical school. The advisors recognized were: East Carolina University........ Susan Schmidt, MD Duke University........................ Almaz Smith, MD UNC-Chapel Hill................Thomas Koonce, MD and Dain Vines, MD Wake Forest University..... C. Randall Clinch, MD

Meeting Summary

The Annual Meeting was attended by over 545 family medicine professionals. The conference presented 55.5 AAFP Prescribed credits and included numerous chapter business meetings and social events. Dr. Robert L. “Chuck” Rich, Jr., of Bladenboro, was installed as the 60th President of the Chapter on Saturday (12/6) by AAFP PresidentElect Dr. Lori Heim. The Chapter’s Board of Directors, as well as thte NCAFP Foundation Board of Trustees both conducted official business meetings.

North Carolina ACADEMY OF Family PhysicianS, INC

13

Family medicine in practice

CHILD

&

MATERNAL

Practice Briefs

HEALTH

Cystic Fibrosis Screen Added to Newborn Panel

As of late December 2008, prior approval through the Carolinas Center for Medical Excellence (CCME) is no longer required for outpatient specialized therapy treatment services. Do not send requests to CCME after this date. Visit limits for children will remain at 52 visits per 6 months, per discipline, with prior approval requests required for visits over 52. For complete information, contact Nora Poisella, Clinical Policy and Programs DMA, 919-855-4310.

North Carolina is adding laboratory testing for cystic fibrosis (CF) to the newborn screening (NBS) panel in early 2009.

Research shows that early CF diagnosis and treatment can improve growth and lung function and potentially increase life span. The screening test for CF will include a two-tier strategy involving IRT (immunoreactive trypsinogen) and DNA testing. DNA testing will be conducted on the initial NBS sample in the State Laboratory of Public Health only if the IRT value is abnormal, as determined by exceeding the daily 95th percentile.

Abnormal results will be reported by phone to primary care providers by the Cystic Fibrosis Follow-Up Coordinator in the North Carolina Division of Public Health, Children and Youth Branch. The CF Coordinator will fax follow-up recommendations and provide guidance and assistance to primary care providers in locating the infant and with scheduling the sweat chloride testing. The state lab will also send a hard-copy report and request for follow-up. Genetic counseling will be strongly recommended for the families of those newborns who have CF or are carriers of CF. Newborns with abnormal CF screens should be referred to one of the five accredited Cystic

Do you have a child un

Fibrosis Care Centers in North Carolina: Brenner Children’s Hospital at Wake Forest University Baptist Medical Center in Winston-Salem; Duke Children’s Hospital in Durham; North Carolina Children’s Hospital at the University of North Carolina in Chapel Hill; Asthma and Allergy Specialists in Charlotte; and Mission Children’s Clinic at Mission Hospital in Asheville. In order to provide optimal care for these newborns and their families, primary care providers should refer only to these five CF Care Centers for sweat chloride testing and follow-up.

More information will be coming from the North Carolina State Laboratory of Public Health and the Children and Youth Branch.

If you have questions at this time, you can contact Lara Percenti at 1-919-707-5634 or email her at lara.percenti@ncmail.net.

Are you pregnant or breastf

The North Carolina WIC Program is making an important change to the WIC food package. Effective January 6, 2009, all women and children two years and older will receive lower fat milk which includes; reduced-fat (2%), low-fat (1%) and fat-free (skim) milks.

This policy change is consistent with the American Academy of Pediatrics (AAP) recommendation of using lower fat dairy products for all children older than two years. As a physician, you have the opportunity to influence the type of milk your patients and their families consume. The change to lower fat milk is the first of the changes to the WIC Food Package in North Carolina.

In October 2009, WIC will be making additional changes, including addition of a voucher for fruits and vegetables, reduced amounts of milk, eggs and juice, addition of whole grain bread and cereals and increased foods for exclusively breastfeeding women and their infants.

The North Carolina WIC Program will share additional information regarding these changes in the summer of 2009. If you have any questions or concerns please contact your local WIC Director or Alice Lenihan (alice.lenihan@ncmail.net or 919-707-5740).

january - march 2009 | the North Carolina Family Physician

NC Medicaid Plans Full NPI Implementation on May 1st, 2009

North Carolina Medicaid will fully implement the National Provider Identifier (NPI) on May 1, 2009. Upon full implementation, the current Medicaid Provider Number (MPN) will no longer be allowed on paper or electronic claims.

Claims submitted with the Medicaid Provider Number (MPN) will deny unless the provider is atypical. See http://www.cms. hhs.gov/NationalProvIdentStand/downloads/ npi_fs_geninfo_010906.pdf for more info.

WIC provides:

• healthy food • health referrals • breastfeeding support • nutrition information CMS Postpones Ban on Fax

Prescriptions untilin 2012North Caro Applicants must live Family physicians who participateand in meet income guidelines, hav Medicare will be pleased to know that has extended its deadline for the risk f an identified CMS nutrition/medical

North Carolina WIC Moves to Lower Fat Milk in 2009

14

Changes to Outpatient Specialized Therapies Approval Process

banning of faxed prescriptions. The new deadline for implementation is now Jan. 1, 2012. CMS cited patient safety concerns, along with its efforts to promote e-prescribing as key drivers in its reversal. The revision is included in the 2009 Medicare Physician Fee Schedule.

For more information abo Visit the WIC web site at

www.nutritionnc.co Or call,HIBtoll free in NC, Vaccine Shortage Unchanged HIB supplies currently remain in short1-800-FOR-BABY age and availability is largely based on CDC allotments. CDC issued guidance (1-800-367-2229) in late November for substituting Pen-

tacel for other products. This guidance can be found by visiting http://www.cdc. gov/mmwr/preview/mmwrhtml/mm5739a4.

This institution is an equal opportunity provider htm?s_cid=mm5739a4_e. Providers requiring additional information or assistance should contact their Regional Immunization Nurse Consultant or the Customer Service Staff at 1-877-873-6247.

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

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INAUGURAL ADDRESS, continued from p.5 care as the basis for placing physicians in these regions. While these arrangements include many benefits preferred by our members, these arrangements have had the effect of isolating Family Physicians from influencing the direction of care in the hospital environment and leave the employed physician subject to changes in the corporate environment which could prove deleterious to how those physicians are valued.

My final concern focuses on the financial health of our Academy. Through the guidance of our executive staff and leadership, the Academy is currently in the best financial shape of its sixty years of existence. Unfortunately, with the current economic environment that includes the anticipated reduction of pharmaceutical support and possibly grant funding in the future, the Academy will need even tighter stewardship of resources, as well as investigation into possible new funding sources.

With these and other areas of concerns not listed in mind, I will now outline my plans for the coming year. Foremost of these will involve a sustained and heightened emphasis on advocacy in the legislative arena. We have the example of this year’s completed advocacy efforts with the obtainment of funds for the new ECU Family Medicine Center. To accomplish that goal, the Academy enlisted the services of current Academy leadership, previous Academy leaders, former ECU graduates, and sympathetic local legislators, all under the expertise and guidance of the Academy’s legislative liaison. Preservation of CCNC, preservation of Medicaid funding (including management fees), as well as any expansion of CCNC into any additional areas in the coming year will require the same level of advocacy involvement, as well as, a renewed emphasis on involvement from the general membership.

While the Legislature is in session next year, I have pledged a day each week to be available in Raleigh as an advocate for the Academy. I ask for your assistance in that advocacy effort and if you have already identified yourself as a Legislative Key Contact, I will be calling you for your assistance. Fact sheets will be formulated for your use when contacting your legislators

and I, along with members of the Academy staff, would be happy to counsel any member on how to contact and educate your local legislator.

In recognition of the growing number of employed members, I have begun an effort to identify legal counsel that could be recommended to our members to aide in contact negotiations.

These individuals and firms would be identified as having expertise in professional contract negotiation and would be asked to represent our membership free of any conflict-of-interest and knowledgeable of the contract needs of our membership. My desire for this service is based upon an understanding of how physician contracts are often constructed in an employerfriendly manner which would not always be favorable to the employed physician. At this time, I cannot promise any reduction in legal rates for this service but this may become possible if enough interest develops in this service.

I will also seek to explore and publicize during my term, new employment options for our members, such as Dr. Forrest’s low overhead practice and other options. As already outlined, many of our new and even sustaining members are looking beyond the traditional solo/ partnership models for employment. I will ask the Academy to closely monitor these trends and publicize these new and developing employment options for our members as they are developed.

In conjunction with the Academy executive staff, I will seek every opportunity to streamline Academy functions and expenditures. We have wonderful people working in our Raleigh office and I welcome any input that they could give to make this Academy better serve the membership, including the use of new technologies and funding options.

Finally, I seek to publicize, at every possible opportunity, the medical home concept and how we, as Family Physicians, are best suited to implement all facets of the medical home. We have recognized that the medical home is the most cost effective and patient-friendly model of care that is available to our patients. I will push, in conjunction with our specialty friends, the medical home concept to our patients, insurers and hospitals as I attempt to install its

tenets in my unique practice environment.

I wish to conclude this speech by emphasizing the pride that I have in my hometown rural roots, my pride in my North Carolina-based medical education and my pride in our North Carolina Academy of Family Physicians during this sixtieth anniversary. I pledge to you that I will devote my time, energy and ability to my role as your president for 2009. It is my desire that when we reconvene in December 2009 for the instillation of your next president, that the legacies of my presidential year will reflect the results of my dedication and devotion to our Academy. I ask you now for your prayers and support as I begin this endeavor.

Thank you.

2009

Mid-Summer Family Medicine Digest

Myrtle Beach, SC

Get Ready for the Perfect Way to Combine Education with Family Fun Kingston Plantation Myrtle Beach, SC Look for additional details at www.ncafp.com/msfmd