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Mid-Summer Family Medicine Digest

Myrtle Beach, SC

June 28th - July 4th, 2009 The North Carolina Family Physician

Vol. 5 - No. 2

See Details on Page 7

Second Quarter, 2009

The Patient-Centered Medical Home Holds Promise for Family Medicine

Also in This Edition Family Medicine Advocacy Requires a Chorus of Voices.....................................................5 Re-Designed Councils Focus on Chapter’s Future.............................................................6 2009 Mid-Summer Meeting to be One of Our Best Ever......................................................9 What to do When The Government Comes Knocking.........................................................10 2008 NCAFP Annual Report.................................................................................... 13

2009 Mid-Summer Family Medicine Digest


Mid-Summer Family Medicine Digest

Myrtle Beach, SC

June 28th - July 4, 2009

Embassy Suites Kingston Plantation Myrtle Beach, SC Information at www.ncafp.com/msfmd The upcoming AAFP Board elections present a tremendous opportunity for the NCAFP. Your proven support of our association gives me confidence that you’ll consider this important call to action. As you are aware, Dr. Thomas Koinis, our current NCAFP Foundation President, is a candidate for the AAFP Board of Directors. His candidacy offers the NCAFP an excellent opportunity to influence AAFP policy at the national level, and to help direct our specialty at a very critical time. Should he be elected, Dr. Koinis will be able to communicate our region’s views on topics like tort reform, medical malpractice insurance, the Future of Family Medicine Project, and our growing reimbursement crisis. If elected, he arolina cademy will be a powerful resource for our association as Drs. Jones and Henley have been.

The North C of


Although the benefits are clear, election campaigns are both time-consuming and costly. I am personally asking for your financial Family Physicians proudly announces the candidacy of support. Your contribution will help our chapter offset campaign expenses – estimated this year at over $15,000 – and allow us to wage a very competitive effort leading up to balloting on October 2nd. It will insure that Dr. Koinis’s message will be heard by all AAFP delegates. His election will help us secure a strong voice on the AAFP Board through 2006. Your contribution and involvement is vital.

Conrad L. Flick, MD

To make your contribution, simply fax or mail the completed form below to Academy headquarters. The fax number is (919) 833-1801 or use the enclosed business reply envelope. I always appreciate your continued commitment and look forward to success in October. Thanks!

2009 Board of Directors of American Academy of Family Physicians

for the the


Dr. Mott P. Blair, IV President

Yes, I want to help Conrad Get Elected!

North Carolina wants to continue to impact family medicine at the national level by helping to lead the AAFP. By contributing to Dr. Flick’s campaign, you help ensure that the NCAFP can conduct one of the best campaigns in the nation. To contribute, simply complete the form at right and return with your contribution to Academy offices.


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

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)

Volume 5

The North Carolina Family Physician

Number 2



The Patient-Centered Medical Home Holds Promise for Family Medicine.............. 4 Family Medicine Advocacy Requires a Chorus of Voices................................... 5 Re-Designed Councils Focus on Our Future.................................................. 6 2009 Mid-Summer Meeting to be One of Our Best Ever.................................... 9 2008 NCAFP Annual Report...................................................................13 What to do When The Government Comes Knocking....................................... 14 Sections

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

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

Chapter Affairs.........................................6

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 NCAFP Editorial Committee Advocacy Council Continuing Medical Education Council Health of the Public Council Practice Enhancement

William A. Dennis, MD Shannon B. Dowler, MD Elizabeth B. Gibbons, MD Richard W. Lord, Jr., MD Brian Forrest, MD R. W. Watkins, MD Richard Lord, Jr, MD James McNabb, MD Jennifer Mullendore, MD Thomas R. White, MD Willam A. Dennis, MD Tim J. McGrath, MD


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

The Revised NCAFP Strategic Plan Mission Statement: 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


NCAFP President’s Message

2 0 0 9



N O .


The Patient–Centered Medical Home Holds Promise for Family Medicine In reviewing my job as your President for this

does not preclude staff members such as the

year, one of the tasks that I had outlined in

nurses or physician extenders from taking

my inaugural address was the promotion of

ownership of a particular patient’s care , but

the patient-centered medical home (PCMH)

in my opinion, the physician is the leader of

concept to our membership. In order to perform

the group and the one ultimately responsible

that task, I found it necessary to review what

for the patient. As you may be aware, the AAFP recently

is actually outlined in the definition of the PCMH, as I have found in my conversation with

signed on a proposal between several

membership of our organization and our sister

physician and nursing organizations

professional organizations, significant variability

extending PCMH designation to practices

in understanding of the concept.

led by nurse practitioners in states where

As taken directly from the AAFP website,

NPs have independent practice privileges.

the PCMH model of care is envisioned as

While recognizing the contributions that

having the following features:

nurse practioners have brought to many


Patients have a relationship with a

personal physician. 2.

A practiced-based team takes collective

responsibility for the patient’s ongoing care. 3.

The care team is responsible for

of our practices, the leadership of your state Academy under my direction felt that this proposal would seriously undermine the stated role of principle 1 where each patient has their own personal physician.

providing and arranging all the patient’s health

Accordingly, your NCAFP leadership joined as

care needs.

a co-signer on a letter from the Pennsylvania


Patients can expect care that is

coordinated across care settings and disciplines. 5.

Quality is measured and improved as

part of a daily process. 6.

Patients experience enhanced access

and communications. 7.

Practices utilize EHRs, disease registries

and other clinical support systems.

chapter to the national AAFP leadership expressing our concern about the proposed addendum to the PCMH model. As of this article, AAFP has now withdrawn their support of this proposal and developed an alternative statement with more palatable language regarding NPs.with further discussion to occur later this year. Another area of question involves the

With the above principles as a basis for understanding, I will expand upon several areas

care of the patient outside of the direct

which you may have considered in reference

confines of the PCMH such as hospital care,

to your own practice and PCMH designation.

home health care, specialist care, nursing

I begin with a discussion of the physician role

home care, etc. In principles 3 and 4, the

in the PCMH practice. As noted in principle

PCMH is envisioned as being responsible

number 1, patients are identified as having a

for arranging and coordinating the patient’s

personal physician and, as originally outlined in

care across the many levels of care that our

the AAFP discussion of the PCMH, the physician

patients encounter today. While the PCMH

was envisioned as being the leader of the health

does not mandate active hospital or nursing

care team caring for the patient. This team could

home privileges to provide a continuum of

consist of multiple members, including but not

care for our patients, I do believe that it does

limited to physician extenders, nurses, social

require improved communication with these

workers etc., all being led by the physician who

facilities in order to facilitate the care of our

develops the plan of care for the patient with

patients into and out of the same. Certainly,

additional input from the staff members. This

our new forms of information technology

APRIL - JUNE 2009 | the North Carolina Family Physician

Robert L. Rich, Jr, MD NCAFP President can facilitate this transfer of information, but it is still our ultimate responsibility to see that this information is shared. I also agree that there can be a better sharing of this information back to the medical home but I believe that it will require a greater involvement of our members in the leadership of these institutions driving this emphasis on improved communication. As already noted, principle 7 describes the use of EHRs and other clinical systems in the PCMH. While this does not mandate the use of EHRs and other potentially expensive technologies, particularly for the small office setting, in today’s’ technology-driven environment, the absence of the same would make it practically impossible to facilitate the sharing of information and the attention to quality improvement noted in principle 5. The guiding principle for the obtainment of EHRs and other technologies is that they are obtained in order to facilitate those processes and are to be a tool used just like a thermometer or stethoscope. The Academy continues to monitor the developments in the EHR industry and continues to lobby for passage of funding bills in our state legislature and US Congress to facilitate practices obtaining these technologies. It should be noted that the American Resource and Recovery Act of 2009 actually provides

See PCMH on Back Cover WWW.NCAFP.COM

Family Medicine Councils N C A F f P

A d v o cac y

C o u nc i l

Family Medicine Advocacy Requires a Chorus of Voices By Dr. Brian Forrest, Advocacy Council Chair Somebody will make the rules; we will all

As the cornerstone of primary care, Family

that should not exist and there are still “smoke

be expected to follow them. When policy is

Physicians need to lead by example with

and mirrors” clauses and negotiations that need

made, it is our choice to either be participants

innovation and ideas that can improve and

to be standardized to avoid small and rural

or to be ignored. Either way, we will be

restore the institutions of healthcare. We

practices from being disadvantaged.

affected by the policy that is created. It is

should not be waiting for others to come

3. Emphasizing Family Medicine’s Value - There

the goal of the NCAFP Advocacy Council

up with answers. We ought to be creating

is a need for equitable payment in the healthcare

(formerly known as the Governmental Affairs

the solutions to these challenges. This

system. Let’s face it, many medical students

Advisory Council) to make it a certainty that

includes building on successful formulas

have in the past made their specialty decisions

Family Physicians are participants in the

like Community Care of North Carolina

based upon economic factors. I am certain that

shaping of the laws and regulations that will

and increasing awareness of its costs savings

if Family Physicians’ value is reflected in their

govern our practices.

to prevent it from being undermined by

payment that the primary care shortage will

third party offers for “quick fixes” that are

be corrected and that we will have the most


talented physicians continuing to enter our field.

Many things will be different this year. Our state faces a budget deficit of recordsetting proportions that reached as high as

We also have to stand up for quality care

It’s not about greed but about survival of the

$3 billion; the NC State Health Plan was in

and make sure that our patients’ care does not

independent practicing Family Physician, which

need of its own “bailout.” In the midst of all

become substandard and fragmented by retail

will be the key to improving the healthcare of

this, physicians are being pressed even harder

health clinics. We have to insist on standards

the people of NC.

by challenges in their offices. As chair of the

for any professional involved at the point-

NCAFP Advocacy Council it is my hope that

of-care to provide consistency, transparency,

achievements. Funding for a new Family

we can help Family Physicians through this

and proper mid-level supervision to keep our

Medicine Center at ECU was finally obtained.

tough time and even seize it as an opportunity

patients safe and well-cared for.

Our input was crucial in shaping the Medical

to make positive changes in legislation,

Other issues that are on our radar for this

Last year we had several major advocacy

Board’s policy on posting physician profiles

policy, and practice transformation so that

upcoming year that we will act on as they

online to prevent retroactive reporting of paid

members of our Academy can enjoy taking

become pertinent are

or settled cases that were up to seven years

quality care of their patients with dynamic

1. Medical School Expansion - There is

old. Medicaid funding was preserved at 95%

and economically successful practices in the

definitely going to be a severe shortage of

of Medicare. Misleading advertising for some


primary care physicians, general surgeons,

retail health clinics was pulled off the air

and psychiatrists in the near future. It is

after we pointed out our concerns. Our policy

the new umbrella of the Advocacy Council.

important that as we support the training

statement and guidelines for retail clinics are

Affecting positive legislation for our members

of more physicians, we also take policy

under consideration by the Medical Board and

by establishing and maintaining a presence at

measures to ensure that these physicians

the Board of the NC Medical Society, as well

our state legislature is essential. Our current

enter the specialties that are needed, like

as the AAFP. Payment at time-of-service using

President, Dr. Robert L. ‘Chuck’ Rich, has

Family Medicine. Several ideas have surfaced

technology such as bar codes or magnetic strips

committed to being a regular presence in

to help achieve this such as debt repayment

on insurance cards to allow instant eligibility

downtown Raleigh, as will myself and our

incentives, primary care tract medical school

and payment has been taken on as an issue for

legislative liaison, Peyton Maynard. However,

slots, and increasing the number of residency

the NCMS after they passed such a resolution

we need a chorus of voices to be heard, not

slots in the needed specialties. As resources

from our Academy. Getting physicians paid

just a quartet.

become available for this expansion, we have

for their services in a timely manner – and

to ensure that these actually result in more

lowering the costs to do so – is a top priority of

physicians in the needed areas.

the Advocacy Council as demonstrated by such

There are many areas that will fall under

Healthcare policy is also under the purview of the Advocacy Council. Whether working with the NC Medical Board to ensure

2. Fair Contracting - In some states (such

policies and innovations. Academy staff promote and support these

quality care for our patients or through

as Colorado), legislation has been passed

helping to shape policies of the NC Medical

to give equitable and transparent standards

activities through multiple channels including

Society and AAFP to ensure family physicians

to the insurance contracting process. Your

disseminating fact sheets on the value of Family

are the foundation of the patient-centered

Academy has had legal counsel review the

Physicians, attending meetings with healthcare

medical home and coordinated medical care,

general statutes in NC and we have found that

leaders and politicians, and through technology

we need the participation of all members to

many protections in these bills already exist.

outlets such as the website, not to mention the

make our efforts fruitful.

However, there are still inequities in payment

publication you are currently reading.


North Carolina ACADEMY OF Family PhysicianS, INC





Redesigned Councils Focus on Our Future As your Board of Directors developed a new strategic plan for the NCAFP throughout the last half of 2008, their complete focus was on positioning your Chapter for the future. As we have entered the first few months of2009, we have turned to implementing the vision developed last year. Part of this process has included a restructuring of the Academy’s Councils (committees). In order to provide “laser-like focus” for the future, the Academy’s primary Council structure has been reorganized to reflect the four goals of the new strategic plan. The majority of the same issues will still be addressed just in a more focused manner. Let me provide a quick overview of the new Council structure.

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 Director 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 KerrVance Academy on its Board of Directors.

Advocacy Council

regarding public health law and promote

What was formerly called the Government

tools and resources for health promotion/

Affairs Advisory Council is now the

disease prevention.

“Advocacy Council.” Under direction of chair Dr. Brian Forrest and vice chair Dr.

Practice Enhancement Council

Chip Watkins, this Council is tasked with

The newest focus area for the NCAFP is

helping family medicine become a valued

practice management. This Council is

cornerstone of our state’s healthcare system.

designed to concentrate on the business of

This year that focus is on preserving Medicaid,

medicine in order to help our members have

enhancing Community Care of North Carolina

vibrant, successful practices. The Council

and insuring you are paid for services provided

is co-chaired by Dr. Bill Dennis and Dr. Tim

under the State Employees Health Plan.

McGrath. The Council hopes to increase

Education (CME) Council

management tools, provide linkages to

The goals of this Council have remained

resources on becoming a Patient-Centered

fairly consistent: to provide high-quality,

Medical Home, and create a format for

innovative, sustainable Continuing Medical

sharing best practices. As a result of this

Education to improve the care provided by

focus area, the Chapter has already signed

Family Physicians. In 2009, this includes

an affiliate agreement with the national

three traditional meetings: Spring, Mid-

TransforMed project and partnered with the

Summer Family Medicine Digest and Winter

NC Pediatric Society to have family medicine

Family Physicians Weekend, as well as a one-

practice managers attend an existing Pediatric

day procedures workshop, an online program

Practice Management Conference.

regarding health disparities and much more. This Council is chaired by Dr. Richard Lord,

By focusing on four core areas, your

and Dr. Jim McNabb is serving as vice chair.

Academy leadership hopes to utilize limited

Health of the Public Council

resources to provide the most bang for your buck. It doesn’t mean that the Chapter

The NCAFP and our state’s Family Physicians

won’t be involved in other issues. It simply

have always focused on the needs of their

means our primary focus will be on those

patients. And this Council reflects that desire

key areas identified through our member

to concentrate on the health care needs of

needs assessment and strategic planning

the people of North Carolina. Co-chaired


by Dr. Jennifer Mullendore and Dr. Thomas

continue to serve on numerous other Boards

White, this Council hopes to increase public

and committees, from quality initiatives to

awareness of poor diet, lack of exercise, use

immunization coalitions. The NCAFP also

of tobacco, and abuse of alcohol and drugs.

remains highly involved in the successful

The Council will also support advocacy efforts

member awareness of existing practice

APRIL - JUNE 2009 | the North Carolina Family Physician

Representatives of the Academy

See Future on p. 24

C hapter

A cti v ities

Nine from NCAFP Attend Pediatric Society’s Practice Managers’ Retreat

for Electronic Medical Records included in the stimulus package to dealing with difficult employees. The North Carolina Pediatric Society

Seven administrators from member physician

(NCPS) currently has over 100 members

offices and two NCAFP staff members recently

involved in the Practice Manager’s Section,

attended the N.C. Pediatric Society Practice

of which nearly 40 attended the Spring

Manager’s Spring Retreat, held March 5-6, in

Retreat. NCAFP hopes to begin a similar

Concord. The meeting included a number

program and the N.C. Pediatric Society has

of presentations with topics ranging from a

been generous enough to allow NCAFP

legal review of HIPAA and medical records;

participation in these meetings while

a Human Resources review that included

momentum is being generated. Current

pointers on effective hiring, firing and the

plans include NCAFP possibly hosting its

use of background and reference checks; a

first Practice Manager’s Meeting at NCAFP

legislative update; a managed care update; an

headquarters later this year.

Immunization Branch immunization registry update; information on Medicaid Provider

If you are interested in becoming

Enrollment; a presentation on how to perform

part of this group or being added to the

and respond to chart audits and finally, a

distribution list for details about future

two-hour session on “Hot Topics.” Nearly

events for practice management, please

20 different topics were discussed during the

contact Brent Hazelett at bhazelett@ncafp.

roundtable format that touched upon funding

com or 919.833.2110.

Family Medicine Leaders Attend NC Health Summit in Greensboro Family Medicine was well represented at the White House Regional Forum on Health Care Reform hosted by Governor Bev Perdue, along with Nancy-Ann Deparle, Director of the White House Office on Health Care Reform. The 90-minute meeting consisted of three parts, one featuring personal stories of individual and family struggles with the current system, one on controlling health care costs, and one featuring innovations in health care. Community Care of North Carolina received accolades and prime placement during that portion of the program. The Academy sent a broad delegation to the meeting, including AAFP President Elect Dr. Lori Heim, NCAFP President Dr. Robert L. Rich, Jr.,; NCAFP Board Chair Dr. Christopher Snyder, III; Vice President Dr. Richard Lord; Past Presidents Dr. Allen Dobson, Dr. Conrad Flick and Dr. Carson Rounds; and NCAFP Member and current NC Medical Board President Dr. George Saunders, as well as Chapter EVP Greg Griggs. For additional information on the event or national reform efforts, visit http://www. healthreform.gov/ or visit http://healthforum. nc.gov.

See Family Physician of the Year on p. 13



3:55:29 PM












Mid-Summer Family Medicine Digest

Mid-Summer Family Medicine Digest June 28-July 4, 2009 - Kingston Plantation - Myrtle Beach, SC

Myrtle Beach, SC

2009 Mid-Summer Meeting To Be One of The Best Ever NCAFP Returns to the Kingston Plantation in Mrytle Beach for Full Week of Education and Relaxation The NCAFP is gearing up for one of our best summer meetings ever! Under the direction of program chair Karen L. Smith, MD, attendees will enjoy a series of convenient half-day learning sessions and have the opportunity to participate in two half-day workshops that will help build skills in two key areas: practice management and office procedures. Family Physicians will not want to miss this opportunity. The conference begins Monday, June 28th, 2009, and concludes Saturday, July 4th. Clinical Topics Lineup The Mid-Summer Family Medicine Digest will present daily general session plenary lectures from Monday, June 28th through Thursday, July 2nd. Sessions are scheduled from 7:30 am - 1:15 pm to give attendees plenty of time each day to enjoy what Myrtle Beach has to offer. Lectures will cover topics that include coding, adolescent immunization,

hypertension, asthma, osteoporosis, COPD, contraception and medication abuse. A complete listing of topics can be found online at www. ncafp.com/msfmd. Two Days of Great Workshops On Friday and Saturday, July 3rd and 4th, two half-day workshops are being offered, each focusing on an important practice theme. On Friday - Practice Enhancement Day - physicians will learn key lessons and techniquess in modernizing their practices. Questions such as ‘which EHR system should you buy’, or ‘what can you do to improve quality in your practice’ will be answered. This half-day seminar will delve into these and other important practice management issues like risk management, maximizing collections and the Patient-Centered Medical Home. Saturday’s theme - Practice Procedures Day - will present (3) three-hour learning sessions that will

enable the Family Physician to perform minor office procedures for patients. Too often patients are referred out of the practice to a subspecialist and there are many benefits to adding these types of simple and quick procedures. Segments include: Joint Injections for Family Physicians that will describe the indications/contraindications for joint and soft-tissue injections and aspirations, discuss the critically reviewed evidence-based literature and identify safe and effective techniques for the 16 most common procedures and Skin Biopsy Techniques that will address the common techniques used to perform skin biopsies. Participants will perform the different types of techniques including punch, shave, currette, incisonal and excisional biopsies using the fusiform excision technique.

NCAFP to Offer Web-Based CME Program on Health Disparities In late summer of 2009, the NCAFP expects to launch a new online CME program focusing on health disparities. The program will provide insights into the definition of health disparities, the causes and methods to address them. The speaker will define the Culturally and Linguistically Appropriate Services standards (CLAS) as outlined by the National Office of Minority Health. Also they will discuss how to use CLAS as a way to improve cultural competency and therefore reducing health disparities. More information will be available in the coming months.

Academy Leadership Retreat Scheduled for July 25th, 2009 in Raleigh The NCAFP will be holding its annual Leadership Retreat at the Sheraton Hotel Downtown in Raleigh on Saturday, July 25, 2009. This yearly events gathers NC family medicine leaders from across the state for indepth discussions on key issues facing the specialty and provides practical training for communicating. This year’s retreat is expected to provide media training techniques. Look for additional information on the Retreat in the coming weeks. WWW.NCAFP.COM

first topic: CHRONIC PAIN www.aafplearninglink.org

North Carolina ACADEMY OF Family PhysicianS, INC

family medicine in practice

What to do when the government comes


By Michael R. Gordon and Sean A. Timmons

Government investigations continue to focus on health care providers. Should the government contact you, here are some potential action steps to consider in consultation with your attorney. 1. Doctor and Management of Medical Practice’s Rights in Dealing with Government Agents • There is no obligation to voluntarily speak with government agents (hereinafter “agents”). • You have a 5th Amendment right to refuse to speak to agents. • If you are contacted by an agent, respectfully request that the agent contact your attorney. • If contacted by an agent, request the agent’s name, place of business, and phone number (as well as the name and phone number of the government attorney involved in the investigation). 2. Your Employees’ Rights • Employees are not obligated to speak with agents. However, do not encourage employees


APRIL - JUNE 2009 | the North Carolina Family Physician

not to speak to agents. This could be considered obstruction of justice, which, in and of itself, is illegal. You should simply inform your employees that it is their decision whether they want to speak to an agent. • Regardless of whether the employee decides to be interviewed by an agent, ask that the employee inform you when they are contacted by an agent. • If an employee informs you that they are going to speak to an agent, simply tell the employee to answer all questions truthfully. • Let your employees know that they have the right to be represented by counsel during an interview. • Inform the employee that if they agree to an interview, then your attorney would like to be present for the interview. 3. Should an Agent present a search warrant, do (or Instruct Your Employees to Do) the following: • Request a copy of the warrant and affidavit supporting execution of the warrant. (Please note that the affidavit is often not available, because it is often under seal.) • Accept the warrant and fax or e-mail a copy to an attorney experienced in this area of law. Politely, ask the agent if they can wait for your attorney to arrive before searching or if you can have some time to discuss the warrant with your attorney before the search begins. • Send your entire staff home so long as that will not compromise patient care. • No one is required to talk to an agent. Search warrants are for documents, not testimony.

• Do not interfere with the search as authorized, but do not consent to the search of other areas or other documents except those authorized by the warrant. • Ask the agent some questions. Try to learn the nature of the investigation and what crimes are suspected. • Listen to what agents are saying as they search and take notes accordingly. They might say something about the investigation that your attorney will find useful. • Read the warrant very carefully so that you can determine if the agent is searching the appropriate areas of your practice. Always check to see if the search is being conducted within 10 days of the date the warrant was issued (the law requires this). If the search is being executed before or after business hours, check the warrant to see if this is authorized. • During the search, identify and determine the agency of each agent present and the agent in charge. (There might be members of more than one agency present during the search.) Get business cards, if they have them. • Ask the agent if a designated member of the practice can accompany the agent to each searched area. • Make a detailed list of all of the areas searched and any items seized, along with specific information concerning the location in which the document came. • With respect to essential documents, ask the agents if they can take copies instead of the originals. • Ask the agents if you can make copies of any document seized. • Determine whether any of the documents covered by the warrant may be protected by the attorney/client-privilege (like letters or memoranda from attorneys to you or from you to attorneys). If there are such documents, then: o Identify the document and their location; o Inform the agents that the documents may be subject to the attorney/client-privilege and insist that the appropriate procedures be followed to protect that privilege; o Advise the agents that you object to their seizure of such documents, but you will agree to separate and preserve them until your attorney can speak with the government attorney; o If the agents insist on removing WWW.NCAFP.COM

the documents, ask them to keep the documents under seal in a separate file until the court resolves this issue; o Obtain a copy or list of the documents. • Refuse to sign any vague inventory of seized items presented by the agents. • If an agent asks you to sign an affidavit, do not comment as to the validity of its contents and explain that you are not authorized to sign any document prior to its review by your attorney. 4. Subpoenas from the Government • Get your attorney to review the Subpoena. • An experienced attorney can often limit the burdensome scope of the Subpoena. • An experienced attorney can get some details regarding the investigation and ascertain the legal status of the doctor or practice in connection with the investigation. Mike Gordon joined Smith Anderson in 1998 after serving for three years as an Assistant District Attorney in the Manhattan District Attorney’s Office under the Honorable Robert M. Morgenthau. He practices in the areas of investigations; white collar criminal defense; civil fraud defense; commercial litigation and medical malpractice defense. He represents doctors before the North Carolina Medical Board and nurses before the North Carolina Nursing Board. Sean Timmons practices in the area of health care and regulatory law. His experience includes Certificate of Need issues, joint ventures between physicians and institutional providers, Medicare and Medicaid fraud and abuse, North Carolina anti-referral laws, Medicare and Medicaid reimbursement, and acquisition and other transactions involving health care entities. Mr. Timmons has advised numerous health care clients on the formation of business entities and physician buy-ins and buy-outs.

*Information contained within this document is for general information only and should not be construed as legal advice. It is neither an offer to represent you, nor is it intended to create an attorney-client relationship. Please consult with an attorney for specific legal advice pertaining to your circumstances. WWW.NCAFP.COM

CCME Tapped by CMS to Maximize EHRs in Physician Offices By Anna Marquez Cook CCME Creative Services Coordinator Quality Improvement Organizations, like The Carolinas Center for Medical Excellence (CCME), are playing a crucial role in helping physician practices improve their preventive health services through the use of electronic health records. Electronic health records (EHRs) are here to stay. The American Recovery and Reinvestment Act of 2009, the stimulus package signed into law on February 17 by President Barack Obama, set aside $19 billion for the development and adoption of health information technology. A majority of this—about $17 billion—will be allocated as incentive payments through Medicare and Medicaid to encourage providers, hospitals, and other organizations to adopt EHR technology by 2011. As specified in the legislation, hospitals and eligible professionals will receive incentive payments for the first five years, from 2011 to 2015, for demonstrating “meaningful use of certified EHR technology.” If meaningful use of EHR technology is not demonstrated by 2015, incentive payments will not be received, and reimbursement payments under Medicare will be reduced, as specified in the legislation. In an effort to maximize EHR use in the physician office, the Centers for Medicare & Medicaid Services (CMS), has empowered QIOs to work closely with physician practices. Under their ninth contract cycle, or Statement of Work, with CMS, QIOs are tasked with improving the delivery of preventive health services and screenings for people with Medicare. It is a national initiative that focuses on increasing rates for mammography, colorectal cancer screening, and influenza and pneumococcal vaccinations. Key interventions include optimizing the EHR capabilities of physician practices by providing onsite education and consultations,

workflow redesign, and process improvement training. Recruitment in North Carolina has recently begun and will recruit 90 practices. Goals of the program include preparing each participating practice for upcoming public reporting initiatives using their EHRs and adopting quality improvement methodologies aimed at improving clinical outcome measures. For more information about CCME’s EHR Preventive Care Program please contact Jennifer Anderson at 800-682-2650, ext. 2004, or via email at janderson@thecarolinascenter.org.

North Carolina ACADEMY OF Family PhysicianS, INC


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n c a f p

a n n u a l

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The State of The Academy It gives me great pleasure to report that your Academy reached a number of important milestones in 2008. We worked hard along several fronts to promote and strengthen family medicine across North Carolina, influence the direction of our specialty at the national level and ensure that our state chapter is both capable and equipped to tackle any challenges that lie ahead. Our most significant contribution this year in advancing family medicine in North Carolina was our victory in securing the necessary funding to build a new family medicine center at East Carolina University. While this accomplishment was years in the making, our message finally resonated with members of the General Assembly. I am both humbled and honored to have had a small part in a success that will impact future generations of family physicians serving eastern North Carolina. This would not have been possible without the perseverance and teamwork of both past and present NCAFP leaders, the Brody faculty, our government affairs consultant, and the support of family physicians from across the state. Thank you. Another major accomplishment centered on efforts to promote our state’s family medicine residency training programs. For the second straight year, the Academy saw an increase in the number of students attending NC’s Family Medicine Day, our state’s residency recruitment conference. Recruiting the best and brightest new physicians into North Carolina continues to be more and more competitive, so events like Family Medicine Day help give our residencies a leg up on the competition. It also speaks to our commitment to ensuring that are state’s primary care workforce remains one of the best in the nation. Our work at the national level also met with great success. Our chapter worked tirelessly to elect Dr. Lori Heim of Vass, NC, as AAFP’s president-elect. This accomplishment has only been achieved three other times in North Carolina and really speaks to the importance our chapter places on having our voices heard clearly and convincingly at the national level. We anticipate Dr. Heim will lead the AAFP with the same level of passion and vision she was known for during her military career. In matters closer to home, the Academy also completed an exhaustive and rigorous redesign of our strategic plan. This ultimately resulted in a document that has re-focused your fellow leaders on our core mission, clarified our core values and created a framework to integrate the chapter’s many important initiatives. Once finalized and approved, we followed its tenets by revisiting our Council structure to better align them with the plan and our resources. In short, we embraced the concept of pursuing a ‘laser-like focus’ in all of our efforts. There were many more activities we pursued, all in the name of improving the specialty. This has only been a brief summary of our work this year. I encourage you to read the rest of this report for insight into your Chapter’s efforts with education and development, improving our health care delivery system, and promoting and strengthening family medicine. It has been an honor and privilege to serve you.

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.

Board of Directors..................................14 Executive’s Report..................................15 Membership Summary...........................15 Continuing Education.............................16 Advocacy Summary................................17 Chapter Honors & Awards......................18 NCAFP Financial Position........................19 NCAFP Foundation.................................19


NCAFP Board of Directors

The Executive Officers

President President-Elect Vice President Secretary/Treasurer Board Chair Executive Vice President Past President (w/voting privileges)



Christopher Snyder, III, MD Robert Lee Rich, Jr., MD R. W. ‘Chip’ Watkins, MD, MPH Richard W. Lord, Jr., MD Michelle F. Jones, MD Gregory K. Griggs, MPA, CAE J. Carson Rounds, MD

Robert Lee Rich, Jr., MD R.W. “Chip” Watkins, MD, MPH Richard W. Lord, Jr., MD Shannon B. Dowler, MD Christopher Snyder, III, MD Gregory K. Griggs, MPA, CAE Michelle F. Jones, MD

R. Kevin Talton, MD Christopher B. Isenhour, MD Victoria S. Kaprielian, MD William A. Dennis, MD Sara O. Beyer, MD Thomas J. Zuber, MD Shannon B. Dowler, MD Brian R. Forrest, MD Elizabeth B. Gibbons, MD Rafael G. Torres, MD Suzanne E. Eaton Jones, MD Jana C. Watts, MD Janalynn F. Beste, MD Tamieka Howell, MD (GAHEC) Alicia C. Walters, MD (WFUBMC) Carrie Hamby (UNC) Lillianne M. Lewis (Duke)

R. Kevin Talton, MD Connie Brooks-Fernandez, MD Victoria S. Kaprielian, MD Tim J. McGrath, MD Sara O. Beyer, MD James W. McNabb, MD Thomas R. White, MD Brian R. Forrest, MD William A. Dennis, MD Nalini S. Baijnath, MD Enrico G. Jones, MD Jana C. Watts, MD Janalynn F. Beste, MDD Alicia C. Walters, MD (WFUBMC Meshia Q. Todd, MD (Duke) Lillianne M. Lewis (Duke) Kathryn Norfleet (UNC)

Warren P. Newton, MD, MPH J. Lloyd Michener, MD Kenneth Steinweg, MD Michael L. Coates, MD

Warren P. Newton, MD, MPH J. Lloyd Michener, MD Kenneth Steinweg, MD Michael L. Coates, MD

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

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

The District Directors

District 1 District 2 District 3 District 4 District 5 District 6 District 7 At Large At Large IMG Physicians Constituency Minority Physicians Constituency New Physicians Constituency FM Residency Director Resident Director Resident Director-Elect Student Director Student Director-Elect FP Department Chairs and Alternates

Chair (UNC) Alternate (Duke) Alternate (ECU) Alternate (WFU) AAFP Delegates and Alternates

AAFP Delegate AAFP Delegate AAFP Alternate AAFP Alternate

Executive Actions Summary - The information below is a sampling of the key actions taken by your Executive Committee and Board throughout 2008: • • • • • • • • • • • •

Approved Academy’s involvement and leadership in the N.C. Immunization Coalition. Approved collaborative relationship with the N.C. Cancer Control Branch that led to an online CME program in addition to ongoing live CME programs related to cancer Approved the nomination of Dr. Conrad L. Flick, Dr. Warren P. Newton and Dr. L. Allen Dobson to the Board of the N.C. Healthcare Quality Alliance. Approved renovations to the Academy’s building including interior and exterior painting, as well as new carpet throughout. Approved collaborating with the NC Pediatric Society at their 2009 Practice Managers Conference. Responded to the N.C. Medical Board regarding proposed regulations governing public physician profiles. Approved seeking legal assistance to analyze NC contracting laws to determine specific action that would be needed to enact a bill similar to the Colorado or Ohio Uniform Contracting laws. Agreed to begin developing a list of potential law firms that could help members with contract negotiations and other legal issues. Approved the concept of three resolutions to the AAFP and three to the NCMS, covering the subjects of: Post Payment Audits; Payment at Time of Service; Retail Health Guidelines and Uniform Contracting. Endorsed the application of Dr. Darlyn Menscer for a position on the AMA Council on Medical Education. Approved utilizing $1,000 in Foundation funds designated for general prevention efforts to help with the cost of an update and reproduction of “Slip Slap Slop.” Approved Letters of Support for a number of grant applications by NCAFP partner organizations. 14

Executive’s Report 2008: Preparing for the Future As I reflect on my first full-year as your Chapter Executive, my focus turns to four primary accomplishments, all designed to better prepare family medicine in North Carolina for the future. They include: securing funding for the new Family Medicine Center at East Carolina University, continuing the tradition of excellent and well-attended Continuing Medical Education, electing the fourth AAFP President from North Carolina, and the development of a new strategic plan for our Chapter. •

Success for ECU: Late in the2008 Legislative session, the N.C. General Assembly approved issuing over $56 million in bonds for a new Family Medicine Center at the Brody School of Medicine. Anyone who had toured the facility knew it was overcrowded and out of date. That will now change as the state invests in the medical school that had the second highest percentage of students entering family medicine in the nation over the past three years.

Strong Professional Development: Through the Academy’s three key meetings, a total of 905 participants received Continuing Medical Education in 2008. Beyond these meetings, 55 medical students attended the Academy’s Residency Recruitment Fair (co-sponsored by NC-AHEC), a new online program on cancer was developed (in conjunction with the N.C. Division of Public Health), and the Chapter produced a monograph on lipids. All these programs are designed to provide the ongoing education members need to stay on the cutting edge for the future.

• AAFP President-Elect: In September, the AAFP Congress of Delegates elected North Carolina resident Dr. Lori Heim to the position of president-elect of your national Academy. Dr. Heim follows in the footsteps of Dr. Amos Johnson, Dr. Jim Jones and Dr. Doug Henley. We are truly pleased that Dr. Heim chose NC and this Chapter for her home after a distinguished career in the military. •

Strategic Focus: Finally, during the last six months of the year, your Academy leaders developed a new strategic plan to insure an ongoing laser-like focus. That focus includes Advocacy, Continuing Education, Practice Management, and probably most importantly, better care for the public, your patients. If you haven’t reviewed the new strategic plan, make sure you do by visiting the Academy’s website at www.ncafp.com.

Membership Summary NCAFP saw an increase in membership, with the most gains in the Active category. At the end of December 2008, the chapter ranked 11th in terms of highest membership totals among AAFP chapters.

Dec. 31, 2008

Dec. 31, 2007 Active:

Active: Supporting: Inactive: Life: Students: Residents:

2106 14 25 211 103 239

2064 15 24 202 112 236




Life: Supporting: D 31 2007 Dec.31,2007



Residents: Students: Total: 0







Resident Membership - For the fourth consecutive year the chapter 100% resident membership and was recognized for this accomplishment by the AAFP. Retention and Recruitment - In addition to contacting a) family physicians who live in NC but have not yet joined the chapter and b) members of the Uniformed Services living in NC who would like to join our chapter as “Adjunct Affiliates,” the NCAFP identified and invited into membership past members whose memberships had been dropped. As a result of that effort, approximately nine applications were received for active membership, which produced $2,790 in chapter dues.


Continuing Medical Education The chapter produced six educational and development programs in 2008. Fifty-five (55) of our prescribed credits conformed to AAFP criteria for EB continuing medical education.  Spring Family Physicians Weekend James McNabb, MD, Program Chair Credits: 41 (17 Evidence-Based) 137 Registrations Midsummer Family Medicine Digest Brian Forrest, MD, Program Chair Credits:  40, plus 1 elective credit (12 Evidence-Based) 228 Registrations

Concord, NC

Myrtle Beach, SC

NCAFP Leadership Retreat Christopher Snyder, MD, Program Chair Credit: 6.25 27 Registrations

Cary, NC

Winter Family Physicians Weekend Richard Lord, MD, Program Chair Credit: 55.5 (19.5 Evidence-Based) 540 Registrations

Asheville, NC

Looking Beyond LDL: Managing The High Risk Patient Christopher Snyder, MD & Thomas White, MD, Program Chairs Authors: Thomas R. White, MD Dean A. Bramlet, MD, FACC, FACP, FAHA Michael D. Ozner, MD, FACC, FAHA H. Robert Superko, MD, FACC, FAHA


Printed Monograph Credit: 1.5 What Every Family Physician Should Know About Cancer Web-Based Christopher Snyder, MD, Program Chair Authors: Marcus Plescia, MD, MPH Ann Denham, MD, MPH

Educational Supporters & Partnerships The NC Academy of Family Physicians gratefully acknowledges the commitment and support from the fol­lowing companies. The 2008 Meetings would not have been possible without their continued support. Educational Supporters Abbott Pharmaceutical Academic Alliances in Medical Education, Inc. Allergan American Academy of Family Physicians Astra Zeneca BioForm Medical, Inc. Boehringer Ingelheim Bristol-Myers Squibb Sanofi-Synthelabo Partnership California Academy of Family Physicians Candela Laser Corporation Daiichi Sankyo, Inc.   Dannemiller Memorial Educational Foundation / Customer Link Duke University /Customer Link Eli Lilly Merck & Co. Merck / Schering Plough Michigan Academy of Family Physicians NC Comprehensive Cancer Program NC Prevention Partners New Jersey Academy of Family Physicians Ortho-McNeil Janssen & Scientific Affairs Outcome Mgt. Educational Workshops, Inc. Proctor & Gamble Sanofi Aventis Sanofi Pasteur Southeast United Dairy Industry Association Takeda Pharmaceuticals North America, Inc.  TEVA – Neuroscience Wyeth Pharmaceuticals Educational Partnerships NC Health & Wellness Trust Fund Mag Mutual Insurance Company Medical Mutual Insurance Company ICARE Partnership

Frontline Programs Abbott Laboratories NC Comprehensive Cancer Program

Online CME Program Credit: 2 (1 Evidence-Based)


Advocacy Summary Once again in 2008, the Academy adopted a vibrant and active advocacy agenda. Beyond achieving funding for the new Family Medicine Center at the Brody School of Medicine at ECU, some of the issues addressed included: •

Medical School Expansion: The Academy sought to influence the discussion on increasing class size at UNC and ECU to insure focus on the needs of the state, particularly primary care.

Retail Health Clinics: The NCAFP adopted an updated position on retail health clinics taking a stronger stance to protect the medical home and insure adequate supervision.

Community Care of NC: The NCAFP worked to strengthen CCNC by encouraging greater participation as the program expands to include more Aged, Blind and Disabled (ABD) patients and the dually eligible (Medicare and Medicaid).

Increasing Payment and Value for Family Medicine: Several efforts were undertaken to increase the financial position of family physicians in North Carolina, including exploration of uniform contracting legislation and ongoing conversations with major payers regarding increased compensation for primary care and preventive services.

Medical Board Proposal on Physician Profiling: The Academy sought to shape new regulations of the Medical Board that will ultimately post public physician profiles, including recommendations to provide more time for physicians to notify the Board, opposing making information retroactive prior to the time the rules were approved, and increasing the threshold for reportable malpractice settlements.

Access to Care: The Academy continued to work with various organizations to increase access to care for the un- and under-insured without placing an increasing financial burden on private physicians.

AAFP Appointments & Leadership - The following members advocate for and serve the specialty at the national level through appointments by the AAFP or elections by the AAFP Congress.

Conrad L. Flick, MD – Chair, AAFP Commission on Governmental Advocacy. Lori J. Heim, MD - Member, AAFP Board of Directors; Board Liaison, Commission on Quality. Victoria S. Kaprielian, MD – Member, AAFP Commission on Continuing Professional Development. Thomas Koinis, MD – Member, AAFP Commission on Health of the Public & Science. Viviana Martinez-Bianchi, MD – Member, AAFP Commission on Membership and Member Services. Karen L. Smith, MD – Member, AAFP Commission on Practice Enhancement & Quality.

FAMPAC Contributions Summary - NCAFP’s political action committee raised a total of $8,269 from NCAFP member contributions as of Dec. 31, 2008. The Committee contributed a total of $12,500 to various candidates in 2008 and ended the year with a balance of $12,827.46. The following members made contributions to the committee: MARK D. ANDREWS TIMOTHY M. BEITTEL JANALYNN F. BESTE SARA O. BEYER MOTT P. BLAIR, IV CONNIE BROOKS-FERNANDEZ BENTLEY CRABTREE JR MARK A. CRISSMAN WILLIAM A. DENNIS L. ALLEN DOBSON JR SHANNON DOWLER JOHN K. EARL JAMES H EARLY BRIAN R FORREST JAMES M. GALLOWAY




Chapter Honors & Awards Family Physician of the Year - Dr. Donald Nelson Gardner, Mt. Airy, NC Vision, compassion and commitment. These are the hallmarks of Dr. Donald Nelson Gardner of Mt. Airy, the 2008 North Carolina Family Physician of the Year. 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 fully-integrated primary care and multi-use fitness and lifestyle center. 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 that operates alongside a fully-equipped fitness and exercise facility that includes an indoor track, lap pool, tumbling gym and aerobics studio. The facility spans approximately 45,000 square feet and provides space to deliver a variety of programs for seniors, adults, and even children. Numerous patients of Dr. Gardner’s expressed how the facility has impacted their lives. Distinguished Service & President’s Awards G. Peyton Maynard – For his tireless work on behalf of the ECU Family Medicine Center at the NC General Assembly. David Brody - For the critical support he provided for the family medicine center project with the ECU’s Board of Trustees. President’s Awards Dr. Brian Forrest, Access Healthcare Lakeside Family Physicians / Lakeside Primary Care Mrs. Joy Snyder and family 2008 Outstanding Family Medicine Residents - The Academy recognized 14 third-year family medicine residents as Outstanding Residents in their respective programs. Cabarrus FMR............................... Jessica Macrie, DO Moses Cone FMR.......................... Mark Rowand, MD Camp Lejeune FMR...................... Shari Buzolich, MD New Hanover FMR........................ Scott Kahn, MD CMC-Charlotte FMR...................... Renita Eason, MD Southern Regional AHEC FMR....... Avtar Chana, MD CME-Union FMR........................... Alexander Borun, MD UNC-Chapel Hill FMR ................... Antonio Rodriguez, Jr., MD Duke University FMR.................... Leal Hsiao, MD Wake Forest University FMR......... Alicia Walters, MD East Carolina University FMR....... Sujatha Sajeevan, MD WOMACK FMR.............................. Randolph Taylor, MD MAHEC-Asheville FMR.................. Allison Turk, MD MAHEC-Hendersonville FMR........ Kelli Konst-Skwiot, 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 UNC-Chapel Hill...................... Stanley R. Watson, MD East Carolina University.................. Cabarrus Family Medicine Wake Forest University.......... Frank R. Moyer, MD 2008 FMIG Faculty Advisors Recognitions - The chapter 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 UNC-Chapel Hill...................... Thomas Koonce, MD Duke University.............................. Almaz Smith, MD ............................................... & Dain Vines, MD Wake Forest University................... C. Randall Clinch, MD


Dec. 31, 2008

Dec. 31, 2007

Dec. 31, 2006




48,704 13,541 509,280 236,696

38,510 15,548

28,321 13,453






205,000 625,108 229,806 -

205,000 606,113 219,006 36,022







Net Property and Equipment




Other Assets: Investment, Deferred Compensation







Dec. 31, 2008

Dec. 31, 2007

Dec. 31, 2006

- 222,095

3,278 223,305

4,804 222,675




Long-term Liabilities: Deferred Compensation Accrued Leave

105,523 -

104,074 36,000

85,449 36,000







Net Assets: Undesignated Board Designated

2,028,718 61,812

1,930,307 71,528

1,839,976 59,203

Total Net Assets




Total Liabilities and Net Assets




Financial Position Summary

Assets Current Assets: Cash and Cash Equivalents Accounts Receivable, net of Allowance for Doubtful Accounts of $500 in 2006, 2005 Prepaid Expenses Certificates of Deposit Investments

The following represents the year-end financial summary for the NCAFP Academy.

Total Current Assets

This Consolidated Statement of Financial Position is only a part of the complete financial statements examined by Thomas, Judy & Tucker, P.A., Certified Public Accountants. The complete Financial Statements are available to any member of the North Carolina Academy of Family Physicians, Inc. upon request at the NCAFP headquarters.

Property and Equipment: Land Building and Improvements Furniture and Equipment Vehicles Less Accumulated Depreciation

Total Assets

Liabilities and Net Assets Current Liabilities: Accounts Payable Deferred Revenue

Total Current Liabilities

Total Long-term Liabilities

Total Liabilities

The NCAFP Foundation

205,000 606,113 181,904 36,022

2008 Foundation Officers

The Foundation ended 2008 with $1,453,619 in total assets, including a net operating surplus of $146,435 for the 2008 fiscal year. Grant revenue increased to $679,763 and total revenues for the year were $814,548.

President Vice President Secretary/Treasurer Executive Vice President

• Contributions

2008 Physician Trustees

Maureen E. Murphy, MD Mott P. Blair, IV, MD Shannon B. Dowler, MD Gregory K. Griggs, MPA, CAE

Total Member Contributions $41,650 Medical Student Endowment Fund $7,475 Silent Auction $19,415 Academy Contributions to Medical Student Endowment Fund $3,900 Corporate Contributions $9,000

Mott P. Blair, IV, MD Shannon B. Dowler, MD E. Bruce Elliston, MD Robert E. Gwyther, MD James G. Jones, MD Eugenie M. Komives, MD

• Grant Projects (Revenue) HWTF Health Disparities Initiative IPIP Project – Robert Wood Johnson Funding IPIP Project – NC Division of Public Health Funding ICARE Partnership AAFP Foundation Health Literacy Grant

2008 Corporate Trustees Rudy L. Snow, Southeastern Biomedical Assoc. 2008 Ad Hoc Members Andy Gilliland, MD Jason Perlman, MD Wake Forest FMRP Cabarrus FMRP Kyle Geissler Miles Harmon ECU FM Program UNC FM Program

$128,816.04 $202,500 $105,684.67 $194,947 $2,000

Ofelia N. Melley, MD Maureen E. Murphy, MD Jennifer L. Mulliendore, MD Robert L. Rich, Jr., MD Christopher Snyder, III, MD


Medical Student Endowment Fund – Our endowment grew to $622,939.47 in 2008, as the Foundation continues towards its goal of $1,000,000.

statewide poster contest winner. Logan received fourth place at the National Poster Contest that was held July 21-22, 2008 in Washington, DC.

The Annual Silent Auction – The format was adjusted in 2008, with great results. The event raised a total of $19,415, netting nearly $14,000 in proceeds for the Foundation.

Health Disparities Initiative - In July of 2006, the NCAFP Foundation received a three-year grant from the N.C. Health and Wellness Trust Fund Commission to help eliminate health disparities in North Carolina. Presentations regarding the initiative were made nationally at the STFM’s Conference on Families and Health and the NIH Summit: The Science of Eliminating Health Disparities in April, 2008. To date, over 1,500 family physicians, residents and medical students have participated in educational sessions through this project.

Resident & Student Activities

Family Medicine Interest Groups - The Foundation supported all interest groups with funding in 2008, and staff support. The Foundation was also able to support each FMIG with a total of $1,400.00 in funding. Family Medicine Externship - A total of ten students completed the program in 2008. The Foundation was also able to secure grants of $6,950 in 2007 to offset program expenses this year. NCAFP/F Student Scholarship/Loan Program - The following students received scholarships: Rhianna Kirkpatrick (UNC), JulieThibodeaux (UNC), and Kyle Geissler (ECU). Family Medicine Day Residency Recruitment Fair - The Foundation produced a residency recruiting conference that attracted fifty-five medical students. The event was made possible through funding by the NC AHEC program. Health Initiatives

North Carolina Tar Wars Program - NC Tar Wars was presented at 15 schools in 2008, reaching 1,600 fourth- and fifth-graders. Logan Ruppard of Glade Valley, NC, was selected as the 2008

The ICARE Partnership - ICARE promotes research, education, pilot studies and practice tool development for utilizing integrated care approaches in the primary care setting. The NCAFP Foundation continues to be responsible for providing training and technical assistance to primary care providers by embedding educational content into medical specialty and healthcare association meetings, as well as providing on-site support. The Partnership worked to improve the capacity to properly code / bill for the provision of mental health care in a primary care setting. Improving Performance in Practice (IPIP) - IPIP successfully completed its contractual obligations to the American Board of Medical Specialties and has grown from two quality improvement consultants serving 16 practices in two regions of the state to a total of twelve quality improvement consultants serving over 100 practices statewide. Participating practices have demonstrated improvements in process and outcomes measures in Diabetes and Asthma care which impacts the lives of tens of thousands of patients across North Carolina.

Foundation Contributors - Members and supporters are encouraged to consider making gifts of ongoing significance or yearly, individual donations to the Foundation. The following individuals have contributed to the NCAFP Foundation in 2008: Mark Andrews, MD Woody & Adria Appleby Johnny W. Bagwell, MD Nalini S. Baijnath, MD Rebecca Beal-Landis, MD Gary O. Bean, MD Timothy J. Beittel, MD Janalynn F. Beste, MD Mary-Emma Beres, MD Sara O. Beyer, MD Mott P. Blair, IV, MD J. Thomas Bowman, MD C. Christopher Bremer, MD Connie Brooks-Fernandez, MD Jack Cahn, MD Edward S. Campbell, MD| Jane T. Carswell, MD C. Franklin Church, MD Michael L. Coates, MD Carlos De La Garza, MD William A. Dennis, MD L. Allen Dobson, MD Shannon B. Dowler, MD

Charles H. Duckett, MD James H. Early, MD, FAAFP Suzanne Eaton-Jones, MD, MPH Kenneth P. Edel, MD Allen R. Edwards, MD E. Bruce Elliston, MD Conrad L. Flick, MD Brian R. Forrest, MD Kyle E. Geissler Deepak R. Gelot, MD Jack Gerard, MD Valerie Gilchrist, MD Margaret Gradison, MD Gregory K. Griggs, MPA, CAE Robert E. Gwyther, MD Wayne A. Hale, MD Mary N. Hall, MD Douglas I. Hammer, MD Charles M. Harmon Brent A. Hazelett, MPA Lori J. Heim, MD Mark Heitbrink, MD Melissa M. Hicks, MD

Tamieka M. L. Howell, MD Janice E. Huff, MD Nicola J. Jacobucci, MD Ronald W. Johnson, MD Robert S. Jones, Jr., MD James G. Jones, MD Michelle F. Jones, MD Victoria S. Kaprielian, MD Catherine M. Kelly, MD John Kelly, MD Robert S. Kline, MD Eugenie M. Komives, MD Hervy B. Kornegay,Sr., MD Frank W. Leak, Sr., MD Michael J. Lewis, MD Katie Lowry Marcus Lowry, MD Mary Elizabeth Lyon-Smith, MD Michael P. McGonigal, MD Mary T. MacKenzie, MD Scott Maxwell Marjorie F. Matthews, MD Alfred T. May, III, MD

Lloyd Michener, MD Paul F. Meyer, MD James G. McNabb, M Deborah S. McRoberts, MD David Moore Stephen I. Moore, III, MD Jennifer Mullendore, MD, MSPH Maureen Murphy, MD J. Thomas Newton, MD Warren P. Newton, MD Robert W. Patterson, MD Madhavi Reddy, MD Robert L. Rich, Jr., MD Mark D. Robinson, MD J. Carson Rounds, MD Margie Satinsky, MD George L. Saunders, III, MD Charles J. Sawyer, III, MD Karen Linear Smith, MD Jack Spies, DO Rudy L. Snow Christopher Snyder, III, MD Acquawon J. Stallworth, MD

Beat D. Steiner, MD David B. Tapper, MD RG Townsend, Jr., MD Rafael G. Torres, MD Robert G. Townsend, III, DO Raymond Vickers, MD Henry H. Wade, MD Portia Wade Alicia C. Walters, MD R. W. Watkins, MD, MPH Thomas R. White, MD Melinda D. Wonsick, MD Thomas J. Zuber, MD


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a d v e r t o r i a l

“Nutrient Rich Foods” for the Right Start in Life Many American children are overweight, but

cups a day of low-fat or fat-free milk or milk products and

just as troubling is the fact that many are

three cups a day once they turn 9. The American Academy

also undernourished. Because kids do not

of Pediatrics recommends four dairy servings a day for

eat enough of the right foods, they aren’t

adolescents.6 The first step to putting these guidelines into

getting enough of five key nutrients: calcium,

practice is to be aware of them – but 60 percent of parents

magnesium, potassium, vitamin E, and fiber,

don’t know how much calcium their kids are supposed to be

according to the 2005 Dietary Guidelines for


Americans (DGA).1

A Doctor’s Influence – In and Out of the Office

The guidelines identified four “Food Groups to Encourage” from the USDA’s MyPyramid: fruits,

Physicians can start by promoting healthy eating in the

vegetables, whole grain foods, and low-fat and

counseling room. Asking patients about their eating habits,

fat-free milk or milk products. Encouraging kids

educating them about the importance of balanced nutrition, and recommending a healthy diet

and families to eat adequate quantities of these

that includes low-fat dairy, fruits, vegetables and whole grains are positive steps a healthcare

nutrient-rich foods can help ensure that they

provider can take. A doctor can also help by referring a patient to a registered dietitian when

are getting balanced nutrition from their diets.


Dairy Foods: Rich in Nutrients, But Lacking in Some Diets

Outside the office, physicians can make a difference in community schools. A respected voice can

Arlene Murrell MS, RD, LD, CLE

encourage schools to promote nutrient-rich foods lacking in children’s diets and discourage the marketing and availability of foods and beverages low in critical vitamins and minerals.

The dairy group, one of the highlighted food groups, is often underestimated as a source of

Poor nutrition in American children isn’t only a behavior gap; it’s a knowledge gap. Because of

key nutrients. Known as a superior calcium

their expertise and the respect they command in their communities, health professionals have

source, dairy foods also deliver potassium and

an important role to play in closing that gap and steering families onto a healthier path through

magnesium – three of the five “nutrients of

education, guidance and active involvement.

concern for children.” A number of studies have shown that getting calcium is a key to building peak bone mass and preventing osteoporosis and fractures later in life. The American Academy of Pediatrics calls dairy foods “preferred” sources of calcium compared to supplements and other foods.2 Unfortunately, half of children ages 2 through 8 and three quarters of children ages 9 through 19 don’t get the recommended daily amount of milk or milk products.3 The 2003-2004 National Health and Nutrition Examination Survey found that African-American children have lower intakes of calcium, magnesium, and potassium than children of other races and ethnicities.4 This is consistent with a recent finding that adolescent African-Americans eat and drink less dairy than non-AfricanAmericans.5 All children 2 to 8 years should get at least two



1 U.S. Department of Health and Human Services and U.S. Department of Agriculture. Dietary Guidelines for Americans, 2005. 6th Edition, Washington, DC: U.S. Government Printing Office, January 2005., p. 7. 2 Frank R. Greer, M.D. and Nancy F. Krebs, M.D. “Optimizing Bone Health and Calcium Intakes of Infants, Children, and Adolescents.” Pediatrics (2006). 4 Sept. 2007 <http://pediatrics.aappublications.org/cgi/content/ full/117/2/578>. 3 National Dairy Council, unpublished data based on the National Health and Nutrition Survey, 1999-2002. 4 Fulgoni, Victor. “Dairy Consumption and Related Nutrient Intake in African-American Adults and Children in the United States: Continuing Survey of Food Intakes by Individuals 1994-1996, 1998, and the National Health and Nutrition Examination Survey 1999-2000.” J Am Diet Assoc. (2007). 4 Sept. 2007 <http://lib.bioinfo. pl/pmid:17258962>. 5 Fulgoni, Victor. “Dairy Consumption and Related Nutrient Intake in African-American Adults and Children in the United States: Continuing Survey of Food Intakes by Individuals 1994-1996, 1998, and the National Health and Nutrition Examination Survey 1999-2000.” J Am Diet Assoc. (2007). 4 Sept. 2007 <http://lib.bioinfo. pl/pmid:17258962>. 6 Frank R. Greer, M.D. and Nancy F. Krebs, M.D. “Optimizing Bone Health and Calcium Intakes of Infants, Children, and Adolescents.” Pediatrics (2006). 4 Sept. 2007 <http://pediatrics.aappublications.org/cgi/content/ full/117/2/578>. 7 Opinion Research Corporation for GTC Nutrition

january - march 2009 | the North Carolina Family Physician


Presorted Standard U.S. Postage

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


Raleigh, NC Permit No. 171


FUTURE, continued from p.7

for some funding for EHR.

of the PCMH such as improved access issues,

mental health-primary care integration project

the process of obtaining PCMH designation,

(the ICARE Partnership) and maintains an

(including those of CCNC here in North

the costs of the PCMH etc, but I refer you to the

Advisory Committee for our Health Disparities

Carolina which utilizes many of the concepts

AAFP website and our own website for further

Grant (which includes both Academy members

from the PCMH model) have demonstrated,

information. I am pleased to report that the

and representatives of outside organizations).

the PCMH produces improved quality-of-care

NCAFP will be presenting a presentation on

We also will have discussion groups on an

Why do all this? As studies of the PCMH

outcomes with substantial

PCMH at our upcoming

as-needed basis, including one for Child and

savings to the health care

Mid-Summer Family Medicine

Maternal Health issues.

system. Additionally,

Patient-Centered Medical Home Presentation

studies have demonstrated that when patients of various ethnic and racial backgrounds are linked to a medical home, many of

Digest in Myrtle Beach in July (See p. 9 for more details). I do believe that the patient-centered medical home is the best care model for our practices and I will

the disparities of care tend

Friday, July 3rd Myrtle Beach, SC

to disappear with improved medical outcomes. And

~See p. 9 for details~

finally, in the future, your

continue to advocate for its establishment. I welcome any comments you may have about the PCMH and I refer

compensation could be

you to the Academy blog

greatly increased through

where those comments can be

blended payment methods.

exchanged. Until the next issue.

The bottom line key to our success: your personal involvement. We hope you will be willing to serve on a Council. If you were already active on a Council, we have assigned you to the Council most reflective of your previous interest area. If you have not been involved in a Council but would like to do so, please e-mail me at ggriggs@ncafp.com. Hereâ&#x20AC;&#x2122;s to working together to insure much success for family medicine in North Carolina throughout the next decade.

This article does not address all the principles










Family Medicine - Taylorsville, NC

NC Family Care Center (FCC) is a unique practice opportunity in rural North Carolina. Local recreational activities include water sports, camping, golf and snow skiing. We are seeking a board eligible family medicine resident, preferably bilingual in Spanish and English, to help serve our growing Hispanic population. FCC has in-house laboratory services, X-ray, physical therapy and EMR. We offer a competitive salary and generous benefits package. Please send a resume to Trevor Craig, M.D., 260 Terrace Lawn, Taylorsville, NC 28681, or e-mail it to: tcraig777@gmail.com.

Board Certified Family Physician Wanted

Blue Ridge Medical Center, a well established federally qualified community health center in central Virginia needs a full-time board certified family physician to assume an established panel. Practice has electronic health records and a good physician/support ratio. Pharmacy, X-ray, mental health and physical therapy onsite. No hospital and 1:4 call. Benefits include malpractice coverage, health, dental and life insurance, retirement, generous leave and paid CME. The site has mountain views and Nelson County area boasts orchards, wineries and the Wintergreen Resort which offers golf and winter sports. Additional sporting and cultural activities are 30 minutes away in nearby Charlottesville and Lynchburg. E-mail CV to Peggy Whitehead peggyw@brmedical.com

Keep YOur member info Up-to-date Members â&#x20AC;&#x201C; 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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