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Spring FAMILY PHYSICIANS

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Weekend The North Carolina Family Physician

Vol. 6 - No. 1

First Quarter, 2010

2010 Presidential Address

Health Reform Needs to Recognize Primary Care

Your Academy: Helping NC’s Citizens | Dr. Charles Rhodes Named Physician of The Year | Disparities Initiative Building Partnerships


Patient Focused. Physician Driven.

FAMILY PRACTICE OPPORTUNITIES IN THE BEAUTIFUL CAROLINAS … Novant Medical Group is a physician-led organization located throughout the Carolinas and Virginia. It is comprised of physician partners that are supported by highly-skilled professionals to provide assistance and support at every level. We are led by doctors with years of private practice experience who know and understand the details of practice management. We are leaders in bringing advanced medicine to patients. Our physicians and patients have access to the latest in imaging and diagnostic technology, national drug trials and new surgical techniques. Affiliation with some of the nation’s leading research institutions allows us to share and participate in new discoveries and therapies.

Novant Medical Group physicians are employees of the Novant Health system, which includes 13 hospitals. Novant Medical Group has over 1,000 physicians in over 345 practice locations. All of our physicians receive a competitive salary with an opportunity to earn an incentive payment. We offer a flexible benefits program, retirement and many other benefits ranging from malpractice insurance to CME reimbursement and relocation.

To learn more about current Family Practice opportunities contact any of our physician recruiters below: Samantha Brown • samantha.brown@novanthealth.org Mimi Davis • mjdavis@novanthealth.org Anne Propst • abpropst@novanthealth.org Kirsten Quinlan • kjquinlan@novanthealth.org www.novanthealth.org • www.novantmedicalgroup.org


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

2009-2010 NCAFP Board of Directors NCAFP Executive Officers President R.W. ‘Chip’ Watkins, MD, MPH, FAAFP President-Elect Richard W. Lord, Jr., MD Vice President Brian R. Forrest, MD Secretary/Treasurer Shannon B. Dowler, MD Board Chair Robert Lee Rich, Jr., MD Executive Vice President Gregory K. Griggs, MPA, CAE Past President (w/voting privileges) Christopher Snyder, III, MD The District Directors District 1 R. Kevin Talton, MD District 2 Connie Brooks-Fernandez, MD District 3 Scott E. Konopka, MD District 4 Tim J. McGrath, MD District 5 Rhett L. Brown, MD District 6 James W. McNabb, MD District 7 Thomas R. White, MD At-Large George L. Saunders, MD At-Large William A. Dennis, MD IMG Physicians Constituency Nalini S. Baijnath, MD Minority Physicians Constituency Enrico G. Jones, MD New Physicians Constituency Jana C. Watts, MD FM Department Constituency Kenneth K. Steinweg, MD FM Residency Directors Gary E. Levine, MD Resident Director Meshia Q. Todd, MD (Duke) Resident Director-Elect Nicole Shields, MD (SR-AHEC) Student Director Kathryn Norfleet (UNC) Student Director-Elect Sohale Vu (ECU) AAFP Delegates and Alternates AAFP Delegate AAFP Delegate AAFP Alternate AAFP Alternate

Mott P. Blair, IV, MD Karen L. Smith, MD, FAAFP L. Allen Dobson, MD Michelle F. Jones, MD

FP Department Chairs and Alternates Chair (ECU) Alternate (Duke) Alternate (UNC) Alternate (WFU)

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

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

William A. Dennis, MD Shannon B. Dowler, MD Richard W. Lord, Jr., MD Brian R. Forrest, MD Richard Lord, Jr, MD James McNabb, MD Jennifer Mullendore, MD Thomas R. White, MD William A. Dennis, MD Tim J. McGrath, 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 www.ncafp.com/academy/publications/advertising

Volume 6

The North Carolina Family Physician

Number 1

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

Health System Reform Needs to Recognize Primary Care................................. 4 Your Academy: Striving to Help the People of North Carolina............................. 6 2010 Spring Meeting will Offer 20+ Credits.................................................. 8 Disparities Initiative Collaborating with Asheville Community Organzations..........11 BCBSNC’s Move Towards the Patient-Centered Medical Home...................... 13 Sections

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

Residents & Students................................... 9

Chapter Affairs..................................... 7

Health Initiatives.......................................... 11

Education & Development......................8

Family Medicine in Practice............................. 13

The 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

Ed i t i o n 21

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North Carolina ACADEMY OF Family PhysicianS, INC




NCAFP President’s Message

2 0 0 9

P R E S I D E N T I A L

M E S S A G E

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1

Health Care System Reform Needs to Recognize Primary Care President’s Inaugural Address Outlines Thoughts on Health Reform

Dr. R.W. ‘Chip’ Watkins, MPH, FAAFP, of Greensboro, NC, was installed as NCAFP President on Saturday, December 5, 2009, in Asheville. Below is the first segment of his inaugural address to members. The final portion of Dr. Watkins’ speech will be published in the spring edition of this magazine. Ladies and gentlemen, honored guests, colleagues, board members, my dear friends and my family. As I thought about what I was going to share with you, I wondered how I could take over 20 years of experience in solo practice, group practice, corporate medicine, and teaching and distill that into 240 slides during a 90 minute presentation! Just kidding, I am not going to do that to you this afternoon. Wow. These are rapidly changing times, but I cannot imagine a more exciting time to take on this job. Health care reform is really upon us. Now I think we can all agree that we need to reform America’s ailing health care system. But instead of dealing straightforwardly with its deeply flawed and fundamental problems, we have seen the debate, once again, deteriorate because of the rival factions struggling to stand with or against the President’s agenda. To cite Dr. Jeffrey Flier, Dean of the Harvard School of Medicine in a Nov 18th issue of the WSJ1, “The rhetoric on both sides is exaggerated and often deceptive. Those of us for whom the central issue is health – not politics – have been left in the lurch.” So what this legislation will look like fully fleshed out remains to be seen. I fear that because of the above mentioned factions it may remain pretty much “business as usual” and the “elephant in the living room” - that is, the real problems of cost, access, and quality, will not be addressed. That is why at this point, we need to be even more vigilant in making sure that the “new” health system really meets the needs of the American people and that it values primary care as its foundation. Without that, any health care delivery system is destined to fail. Our current system simply cannot sustain itself precisely



because of the fact that primary care medicine has not been valued Health care reform has been up for debate about 5 times since the World War II. In the 1960’s, the U.S. chose public coverage for the elderly and the very poor. Many other countries at that time chose ‘Health Care for All’ programs – as did our neighbors to the north in Canada. Now we have 47 million Americans without health insurance, millions more are underinsured, and health care bills bankrupt more than 1-million Americans every year. Just as an example, Canada spends 10% of its national economy on health care; the U.S. spends 16%. The extra 6% of GDP amounts to more than 800 billion dollars a year. Yet, Canadians live on average about 3 years longer than Americans and have infant mortality rates that are lower than ours by 20%. I am not standing here advocating for a duplication of the Canadian or any other national health system. But our philosophy here at the state level and on a national level has been, “Something is going to happen so let’s be involved in the process. Let’s be at the table for this go-round.” We do not want health care reform to happen to family physicians as it has in the past. Now through the efforts of our family medicine leadership at both the state and national level, health care policy is being shaped by family physicians. So we have to keep talking and we all have to become involved. If we walk away from the discussion of these health care bills – whatever side of Congress they come from – we remove ourselves from any opportunity to affect those bills. We must continue to be at the political table. What compels me to make these statements with passion and conviction? It’s because I love my job! I love what I do every day and I am proud to call myself a Family Physician. Please allow me to share with you a little about myself and my work as a family doc. I did my undergraduate work at Chapel

January-March, 2010 | the North Carolina Family Physician

R.W. Watkins, MD, MPH, FAAFP

2009-2010 NCAFP President

Dr. Watkins graduated from the Brody School of Medicine at East Carolina in 1986, and completed his internship and residency in Family Medicine at Florida Hospital, Orlando in 1989. Dr. Watkins received his Masters in Public Health in Health Promotion and Nutrition from Loma Linda University School of Public Health in Loma Linda, California in 1990. He has over 20 years experience in private practice, teaching, and corporate medicine. His interests include integrative medicine, nutrition, neuro-endocrinology, and predictive genomics. He has lectured on a wide variety of topics at the local, national and international levels. In addition, he has authored a number of journal articles and textbook chapters.

WWW.NCAFP.COM


Hill and then did my medical school training at East Carolina University School of Medicine – which, by the way, is slated to have the most state-of-the-art Family Medicine facility in the country – in small part, at least, due to the efforts of the leadership of this Academy. I did my residency in Orlando at Florida Hospital. During my time there, I worked toward a Master’s in Public Health in Health Promotion and Nutrition from Loma Linda University in Loma Linda, California. I finished my MPH shortly after graduating from residency. Since that time, I have always had a love for talking to patients about their health, lifestyle, and nutrition. Upon reflection, I see that every new path I have taken has really been patient-driven. About ten years ago, it seemed just about every patient who would walk through the door had a question, an article, or an Internet reference about an alternative treatment. They would ask, “Doc, can I take this CoQ10 with my BP medicine?” Or, “Doc, have you ever heard of this? I found it on the Internet.” I would invariably say, “No, I haven’t. Or, no, I don’t know”. And you know what? I got tired of telling people “I don’t know.” So I started learning and going to integrative medicine CME conferences. I found there was a whole world out there that I had not been exposed to in medical school. I have always had an open, but skeptical and critical mind. I believe that has kept me honest scientifically and academically. So I started researching and writing in peer-reviewed journals on the subject of Herbal Medicine. After that, I started lecturing all over country on Herbal Medicine - including our AAFP Scientific Assemblies for about 5 years in a row. It was a blast, and I learned a ton – and did, what I thought, was a tremendous service to my patients. From then on, I became known as “the doctor who knew something about herbs.” About eight years ago, my experiences led me to eventually leave my practice to take on a role as Medical Director for an integrative lab here in Asheville. What the heck is an integrative lab? Well, we did conventional testing such as lipid panels, but we were some of the first to add tests such as homocysteine, hs-CRP, WWW.NCAFP.COM

fibrinogen, and lipid fractionation. We helped develop and bring to market diagnostic markers for measuring inflammation of the bowel and did heavy metal testing and hormonal analysis and all kinds of fascinating and cutting-edge testing - all designed to help physicians find the underlying triggers and antecedents of their patients problems. It was some fun stuff! And that work kept me here in Asheville for about 4 years. But I was moved to return to primary care. I really missed taking care of patients. So I moved back to Greensboro in 2005 to open a new practice where I developed an integrative model that looks at the body’s communication system – its hormones, neurohormones, and neuropeptides. This to me was where the action was – and is. Currently, I am mostly helping patients with neuro-endocrine problems in what I like to call “an age-management” model. So I see a lot of things like diabetes and metabolic syndrome, menopause and andropause, PMS and PCOS, and lots of anxiety, depression, and sleep problems, as well as all the routine issues patients deal with just like most of you. But if I bring anything to the table, it is an understanding of the inter-relationships between the different hormonal and neurohormonal systems and that is what I have really built my current practice on. That communication system is like a web – pull here, and all this moves – pull here and all this moves. It is all intricately and beautifully linked together. And, true to my long-standing convictions about health, I spend a lot of time talking to people about their diet, exercise, and lifestyle choices. In addition, I try and integrate some mind-body medicine, such as biofeedback, acupuncture, deep breathing, and meditation along the way. I share this with you, because I want you to know my heart, the heart of a family doctor, and that I know that family medicine needs to be the bedrock of our health care system. Simply said, We are the solution to the health care reform situation. To have doctors that look at the whole person. Our specialty of family medicine is clearly the best way to care for people – and certainly the most efficient from a business perspective.

There has been a tremendous amount of research that continues to confirm that primary care physicians deliver more comprehensive and less expensive health care. From one of Barbara Starfield’s works2 we find six mechanisms, alone and in combination, may account for the beneficial impact of primary care on population health. They are (1) greater access to needed services, (2) better quality of care, (3) a greater focus on prevention, (4) early management of health problems, (5) the cumulative effect of the main primary care delivery characteristics, and (6) the role of primary care in reducing unnecessary and potentially harmful specialist care. So if all of the research surrounding the effectiveness and efficiency of a model where primary or family medicine is foundational, one would think it would become self-evident that this is the path we need to take as a nation. What stands in the way? What is blocking the path? Well, just like with any other political battle, the battle lines are drawn to protect those with the money and the power. Our kinfolk, the specialists or partialists as they have begun to be called, continue to drive health care costs up through the use of expensive procedures and because our system is procedurallyoriented in terms of pay (i.e. the more you do, the more you get paid) they continue to increase the income gap between primary care and specialty care. From 2000 to 2005, the number of office visits per Medicare beneficiary for established patients to the primary care office increased only 12 percent, while specialty services increased at far higher rates: colonoscopies, 40 percent; cardiovascular stress tests, 45 percent; and magnetic resonance imaging (MRI) scans, 94 percent. Indeed, technology growth, abetted by specialist-oriented workforce and financing policy, has become the leading cause of high U.S. health spending.3 Higher fees, higher volumes, and an increasing procedure-orientation explain the widening income gap between primary care and most specialties. In 1973 the average surgeon earned 136 percent of the average family physician’s income; by 1983 this gap was 211 percent. By 2004 the income of radiologists was 260 percent that of family physicians; invasive cardiologists, 253 percent; and gastroenterologists, See INAUGURAL ADDRESS on page 15

North Carolina ACADEMY OF Family PhysicianS, INC




CHAPTER AFFAIRS

N C A F P

S T R A T E G I C

D I R E C T I O N

Your Academy: Striving to Help the People of North Carolina Our Mission clearly states it: The Academy is here to advance the specialty of family medicine in order to “improve the health of patients, families and communities in North Carolina.” The health of our state’s people (health of the public) is clearly one of the four cornerstones of our strategic plan.

Gregory K. Griggs, MPA, CAE Executive Vice President

~ Strategic Plan Snapshot ~ Health of the Public Goal: The health of all people in North Carolina will improve. Objectives: 1. Increase public awareness of problems of poor dietary habits, lack of exercise, tobacco/alcohol abuse, drug abuse, health disparities, etc. 2. Expand implementation of the Medical Home model. 3. Support advocacy regarding public health laws.

4. Improve/expand education/ tools for physicians regarding Health Promotion /Disease Prevention. 5. Promote integration of healthcare services for Mind and Body.



But how do we do that? Let me outline a few of the ways. First, we’re here to insure that the environment is a positive one (as much as we can) for today’s and tomorrow’s Family Physicians. We need to help insure that the Family Physician workforce is there to care for the people of North Carolina. We all know that other specialists (partialists) are more expensive, order more tests, and quite frankly do less for the overall care of our people and our communities than family doctors do. But that’s not all. The Academy also undertakes numerous public health initiatives to help improve the welfare of our state’s citizens. Let me just outline a few. We remain committed to the reduction of tobacco use in North Carolina. As an organization, we supported House Bill 2 in last year’s legislative session that successfully made all bars and restaurants in North Carolina smoke free as of January 1st. We also continue the innovative Tar Wars Program, aimed at educating 4th and 5th graders about the dangers of tobacco use. Members in over 15 counties around the state present to elementary school students on an annual basis, providing this important message. Your staff continues to be at the center of anti-obesity efforts in the state as well. Both Jenni Fisher, our Health Initiatives manager, and I remain active in Eat Smart Move More North Carolina. This group helped develop a statewide plan to encourage increased opportunities for healthy eating and physical activity wherever people live, learn, earn, play, and pray. I have the privilege of serving as Immediate Past Chair of the organization’s Executive Committee, and the group is now chaired by Carolyn Dunn, PhD, a nutrition specialist with the NC Cooperative Extension Service at NC State University. You may remember Dr. Dunn’s work with our own Dr. Mott Blair (Pres. 2003) to partner Cooperative Extension Agents in numerous counties around the state. To learn more about Eat Smart Move more, visit www.eatsmartmovemorenc.com.

January-March, 2010 | the North Carolina Family Physician

Our most visible current public health initiative centers on preventing health disparities. As you may know, we have held numerous educational programs at our meetings on disparities involving specific diseases, as well as programs on improving care to specific population groups in North Carolina. We also have an online program on the subject that can be found at http://healthcaredisparities.ncafp. com. For more information on this important project, please contact Jenni Fisher, MPH, the Academy’s Health Initiatives Manager, at jfisher@ncafp.com. In addition to eliminating health disparities, the Academy has been extremely involved in working to improve services for the behavioral health needs of our state’s citizens. From mental health to substance abuse to development disabilities, Family Physicians are on the frontline of providing behavioral health care. We all know that patients never come in with just one issue. It’s the diabetic patient who is depressed and also has congestive heart failure that proves most difficult. Through involvement in projects such as the ICARE Partnership, the Academy has worked to bring mind and body together to better care for patients as complete individuals. These are just a few of the public health initiatives where the Academy truly looks out for our state’s population as a whole. And I haven’t even mentioned our involvement in groups like the Justus-Warren Heart Disease and Stroke Prevention Task Force, the N.C. Immunization Coalition, Fitness Renaissance or the NC Early Childhood Oral Health Collaborative, just to name a few. Your staff and member representatives serve in advisory capacities to many more public health organizations. Let me close by including the components of our strategic plan dealing with the Health of the Public. (Far left column) This is the basis of our commitment. This is our hope for the people of North Carolina.

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P h y sician

of

T h e

Year

~ Chapter News Briefs ~

h onoree

NC’s Conrad L. Flick, MD, Elected to AAFP Board of Directors

Charles W. Rhodes, MD, Named 2009 Family Physician of the Year Compassionate, knowledgeable, engaged in the community and a leader in the profession. These are the hallmarks that have come to define Dr. Charles W. Rhodes, the 2009 North Carolina Family Physician of the Year. The Academy honored Dr. Rhodes with the award during a brief ceremony in Asheville in early December. Dr. Rhodes was recognized for embracing all of the key ideals of the specialty, including his lifelong commitment to delivering both comprehensive and coordinated care to his patients, helping to advance the specialty of family medicine and his tireless efforts in serving his local community. Dr. Rhodes has been providing the full scope of family medicine to the citizens of Cabarrus County since 1987 when he became the second physician to join Mount Pleasant Family Physicians. The clinic would grow into the 19th largest employer in Cabarrus County, with fifty physicians and thirteen individual facilities. Through it all, Rhodes’ deep commitment to his patients has stayed largely the same, focused mainly on continuity, strong relationships with his patients and their families, and adept clinical skill. His current practice includes out-patient and in-patient care, as well as weekly home visits to his elderly patients. One patient described how Dr. Rhodes has partnered with their entire family for over ten years, specifically mentioning the house calls Rhodes still provides. In addition to patient care, Dr. Rhodes juggles several executive duties and has helped lead a number of efforts to strengthen the health care system in and around Cabarrus County. One the most significant was Rhodes’ instrumental work in helping to establish the Cabarrus Family Medicine Residency Program, a program that has been directly responsible for the training of eighty family physicians since its inception. Dr. Rhodes played a significant part in the leadership of the former Cabarrus Memorial Hospital (now CMCNortheast) and helped form the Department of

Dr. Rhodes was recognized during the 2009 Winter Family Physicians Weekend in Asheville.

Family Medicine there in 1992. He also has been active in the Cabarrus County Medical Society, taught residents and physicians on innumerable topics, and has been active with several health care organizations. Beyond his professional pursuits, Dr. Rhodes is very active within the community, donating his time to several community service organizations. He has served with distinction at the Cabarrus County Home Health, the Board of Health, his local library and his church, Glorieta Baptist Church in Concord. He’s been noted as the driving force in establishing a global health program serving the Dominican Republic and teaching other churches in the area on how to establish these types of mission programs elsewhere. This breadth of service is a testament that Dr. Rhodes’ spirit of service goes far beyond the clinic and hospital. Dr. Rhodes obtained his undergraduate degree from UNC-Chapel Hill in 1976, went on to attend medical school at the Bowman Gray School of Medicine at Wake Forest University, and completed his residency training at ECU. He is a Fellow of the American Academy of Family Physicians. Prior to entering private practice, Dr. Rhodes served the US Air Force, rising to the rank of Major. He continues to practice in Mt Pleasant where he began in 1987 and currently serves as the Executive Vice President and Medical Director of Cabarrus Family Medicine.

REACH FAMILY DOCS

& PRIMARY CARE PROFESSIONALS Advertise with the NCAFP! Magazine - Email Newsletter - Website - Meetings Visit www.ncafp.com/advertising for complete information

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NCAFP Past President Conrad L. Flick, MD (2004) of Cary, NC, was elected to serve a 3-year term on the AAFP Board of Directors in mid-October, 2009. This victory was a culmination of over a year of planning by the Chapter, a number of past Chapter leaders and Dr. Flick’s election committee. Dr. Flick’s campaign centered on his commitment to impacting three key areas: advocacy for the profession; the practice environment; and direct patient care. His campaign outlined his substantial policy/advocacy experience, highlighted his independent family practice, and showcased his work and passion for his patients. The Chapter staff and numerous past and present physician leaders participated in election activites while in Boston, and Dr. Flick delivered an exceptional campaign speech and performed strongly in a candidate’s Q&A session. Dr. Flick joins a long list of NC Family Physicians who have ascended to leadership positions at the AAFP. Congratulations!

Drs. Bob England and Eugenie Komives Recognized for Service to Specialty NCAFP President Dr. Robert Rich presented NC House member Bob England, MD, (D-112), with a presidential award for his legislative work at the NC General Assembly, as well as his efforts in saving the life of another state legislator. Rep. England is a physician representing Cleveland and Rutherford Counties. Dr. Rich also presented Blue Cross Blue Shield of NC’s Eugenie Komives, MD, with a recognition for working to improve and enhance BCBSNC’s work relative to primary care and family medicine in North Carolina. In addition to her recognition by the Academy, Dr. Komives was also selected to serve a second term on the NCAFP Foundation Board of Trustees as a Physician Trustee.

North Carolina ACADEMY OF Family PhysicianS, INC




EDUCATION & DEVELOPMENT

~ EDUCATION SNAPSHOTS ~

Spring FAMILY PHYSICIANS

NC Medical Board Rolls Out New CME Audit Program

March 26-28, 2010

Kingsmill Resort & Spa Williamsburg, VA Be Academy’s Annual Spring Meeting will

Weekend

in Williamsburg, VA in Late March

2010 Spring Meeting will Offer 20+ Credits Quality education, superb venue and lots of family activities to be offered For the first time in ages, the NCAFP will be holding its annual Spring Weekend in our neighboring state to the north -- Virginia! The 2010 Spring Family Physicians Weekend is scheduled for March 25-28, 2010, at the Kingsmill Resort & Spa in beautiful Williamsburg, VA. Conference Program Chair Dr. Sara O. Beyer has assembled an outstanding weekend of educational topics, skills workshops and activities emphasizing key subjects and clinical practice areas. Mark your calendars and register now so you don’t miss out on this fantastic learning and networking opportunity. Great Workshops Offered Over the past several meetings, the Academy has been expanding the number of optional workshops at each of its annual conferences. Continuing this trend, we’re excited to be offering 3 great workshops in Williamsburg. These optional workshops enable you to fine tune your skills and/or knowledge in specific areas, help you learn completely new techniques that improve your practice, and provide focused, personalized learning in a small group format. Take advantage of them. Three workshops will be presented in Williamsburg: A Coding Update; An Intro to Cosmetic Botulimun Toxin Type A; and an EHR Adoption workshop. The Academy has posted specifics on each of these workshops at www.ncafp.com/sfpw/workshops. Please review what each seminar will provide, and register 

for them if interested. Keep in mind that seating is limited in each workshop, so don’t delay in signing-up. Flexible Learning Schedule The Spring Weekend will officially begin on Thursday, March 25 with our optional Coding workshop and be followed by a fantastic reception kick-off in our Exhibit Hall from 7:00 to 9:00 pm that evening. General Session lectures will begin Friday morning, run for a half day on Saturday, and conclude on Sunday, March 28, at 12:15 pm. This flexible format -- featuring 20+ Category I credits -- will allow you to enjoy a full day of CME before heading out for family fun and entertainment in Williamsburg.

The NC Medical Board has begun implementing a new CME audit program to verify that physician licensees in the state are accurately reporting CME credits. Physicians must earn 150 hours of CME over three years, with at least 50 of those hours being Category 1 hours. The Board has begun to randomly select percentages of physicians renewing each month to be audited. Selected licensees will be asked to complete a new CME Audit form and provide documentation of CME hours reported during the renewal process. Documentation of Category I CME can be as simple as keeping a date record of your attendance at, or participation in, accredited CME programs. Licensees should also keep a file of receipts or certificates verifying the information recorded. This new audit program is aimed at encouraging licensees to fully and accurately report CME activity to the Board. During the renewal process, licensees can refer to the Board’s online tracking system that shows each licensee how many hours have been earned during the current three-year cycle. The NCAFP plans to provide members who are experiencing an audit with documentation support (receipts) of meeting attendance for Academy-sponsored conferences held after December, 2005. To do so, physicians must contact the NCAFP Meetings Department directly at (919) 833-2110. For more information on the NC Medical Board’s CME requirement, visit http://www. ncmedboard.org/faqs/list/category/continuing_ medical_education_cme/

Lots of Fun in Williamsburg A big draw to Williamsburg, VA is the sheer number of activities the region offers - all within relative close proximity to the conference venue, the Kingsmill Resort & Spa. Fun for the whole family awaits you at Busch Gardens amusement park. You can learn about early colonial America at Historic Williamsburg or even take a tour of the Williamsburg Winery. Plus, there’s always a casual round of golf at the Resort’s beautiful golf course for the sporting types and, of course, a great spa to pamper yourself. Conference registration entitles families to special pricing for some of these activities. See the NCAFP website for complete information and details at www.ncafp.com/sfpw.

January-March, 2010 | the North Carolina Family Physician

New Interactive Course on Cosmetic Procedures to Launch This May The NCAFP Meetings Department is excited to announce that a new online CME learning module will be available in early May, 2010. ‘Mastering Valuable Hands-On Procedures’ will offer physicians the opportunity to learn about profit-enhancing, office-based cosmetic procedures. The program will be similar to the Chapter’s existing online educational offerings, and will be free to members. Stay tuned for more information.

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~

I N T E G R A T E D

L E A R N I N G

C U R R I C U L U M

~

NCAFP Introduces Integrated Educational Program on GERD The NCAFP introduced a major F our W ays to L earn A bout G E R D educational program on GERD in late 2009 to help Family Physicians HOME STUDY CONFERENCES CASE STUDY TELECONFERENCE and primary care providers with improving patient-communication u A webcast by expert u Interactive case study u Interactive case-based u Traditional plenary faculty, who will address that delves into the teleconference series lectures at NCAFP and understanding the latest crucial obstacles to special challenges on the continuing cycle meetings/conferences. therapeutic options for managing effective GERD treatment. of older patients. of GERD management. acute and chronic stage GERD. The Chapter has partnered with the TCL Institute of Cary, NC, to From a clinical standpoint, the program is communication by utilizing patient education deliver an integrated program that combines emphasizing the critical therapeutic objectives materials; asking key questions regarding traditional learning with a series of unique and primary care clinicians need to meet, including symptoms and concomitant medications, as convenient interactive learning modules. recommendations for dietary and lifestyle changes, well as addressing the impact GERD symptoms The most unique aspect of this new program appropriate medication choice, and timing of are having on a patient’s quality of life. The is the number of ways that Family Physicians pharmacotherapy for acute and chronic stage program also explores the impact and limitations and health providers can access the learning patients. Because significant questions exist about of non-pharmacological and pharmacological content and its key lessons. Information on the safety of currently available acid suppression interventions and present suggestions for GERD is being presented within traditional therapy, it is important that PCCs be educated implementing and maintaining patient meeting lectures, through an online case study about these issues. compliance. series, by teleconference and even in a unique Complementing this clinical information, All providers interested in this program should home-study format. By integrating learning the program is also working to improve patientbe on the lookout for additional information from across each of these formats, physicians have clinician communication. Research indicates the Chapter. As each learning tool or lecture is a multitude of ways to achieve greater clinical that this area is often lacking and can hinder introduced, the Academy will announce how to performance and enhanced skills in addressing treatment. Family Physicians will improve overall take advantage of these programs. the problems of GERD.

RESIDENTS & sTUDENTS

FMIGS Complete Statewide Service Project Representatives of each of NC Family Medicine Interest Group (FMIG) report that their fall campus blood drives were a success! The drives were part of a coordinated statewide student service project developed by FMIG leaders last summer to help promote family medicine, each campus FMIG and raise awareness of the importance of giving blood. Student leaders are expected to discuss opportunities for other coordinated projects this spring when they meet in Durham.

Family Medicine Day 4 is Saturday, May 22nd

4

2010 Family Medicine Externship

Friday, March 12, 2010 www.ncafp.com/externs The Externship Program is a 4-week summer learning experience that exposing medical students to the activities of Family Physicians.

ATTENTION RISING 3Rd ANd 4Th YEAR MEdIcAl STudENTS

N.C. Family Medicine Day

Get ready 2nd- and 3rd-year medical students -- the NCAFP’s fourth annual Family Medicine Day is expected to be another great event that you don’t want to miss. The event is returning to the same location (Milliennium Hotel in Durham) as last year, but will feature a few new workshop options, and a great lecture on the patient-centered medical home. All NC family medicine residency training programs will be in attendance. Pick up new skills, meet and greet with other medical students, and get a jump on having a great family medicine MATCH in 2011. Student members of the AAFP will be receiving information in the mail in the coming month. Visit www.ncafp.com/fmd for additional information.

2010 Family Medicine Loan/Scholarship

Sat., May 22, 2010 • Durham, NC

brought to you by the North caroliNa academy of family physiciaNs aNd the North caroliNa area health educatioN ceNters program

The North Carolina Academy of Family Physicians (NCAFP) and the North Carolina AHEC Program are presenting a family medicine residency recruitment conference introducing rising M3 & M4 medical students to the state’s family medicine residency training programs. Don’t miss this great event!

• Meet and greet opportunities with NC’s family medicine residency training programs

• Free for all rising M3 & M4 medical students

• 4 Hours of clinical skills workshops

• Free overnight hotel reservations

• Great networking opportunities

• Students from Across southeast

$20.00 Refundable Registration Fee Required

The Following Skills Workshops Will Be Offered

• Basic Suturing & Common

• IUD Insertion/Endometrial Biopsy

• Dermatology Procedures • Splinting/Bracing & Casting

• EKG Reading Session

• Outpatient Radiology Film Review

• Shoulder Exams & Injections

• Knee Examinations & Injections

• Common Foot Disorders

• OB Perineal Laceration Repair

For complete information and online registration please visit http://www.ncafp.com/fammed2010

For additional information, please contact Peter Graber at the North Carolina Academy of Family Physicians at (919) 833-2110 or via email at pgraber@ncafp.com.

WWW.NCAFP.COM

UPCOMING STUDENT DEADLINES

Monday, May 3, 2010 www.ncafp.com/scholars Provides loan/scholarships of up to $2,000 to North Carolina medical students seeking careers as family physicians.

North Carolina ACADEMY OF Family PhysicianS, INC




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HEALTH INITIATIVES

~ Tobacco Cessation ~

Disparities Initiative Collaborating with Asheville Community Organzations Year 1 of the second phase of the Health Disparities Initiative is focusing on promoting successful models of physician collaboration with disparate population groups being utilized by health care practices in Buncombe County. The goal is to increase the effectiveness of collaboration and outreach to all targeted population groups and enhance information sharing and best practice adoption. The Initiative is currently working with two other Health Disparities Initiative grantees in Buncombe County. These groups are: Asheville Buncombe Institute of Parity Achievement (ABIPA) - ABIPA’s mission is to promote economic, social, and health parity achievement for African Americans and other people of color in Buncombe County through advocacy, education, and community partnerships. They conduct many activities during after-hours and on weekends in community churches, community centers and public units. ABIPA focuses on eliminating disparities in health care and related socioeconomic factors for African Americans in Buncombe County. They are primarily focused on diseases that greatly impact this population such as diabetes, heart disease, breast cancer and prostate cancer. ABIPA is the only agency in Western North Carolina whose mission is to achieve parity for the African American community.

In May 2009, ABIPA sponsored the Hope Gala which was a new event that benefits the Minority Medical Mentoring Program (MMMP). MMMP provides internships and scholarships for high school seniors of color who plan to enter the medical profession. To learn more, visit www.abipa.org or call (828) 251-8364. The YWCA of Asheville’s Diabetes Wellness Program - The goal of the YWCA’s Diabetes Wellness Program is to empower those with diabetes to develop the habit of exercise to better manage their illness. The program begins with participants committing to exercising a minimum of two times a week. All participants receive membership to the YWCA Health and Fitness Center, peer mentorship, one on one fitness counseling, monthly educational sessions and weekly support groups. With full memberships to Club W, participants are encouraged to use the pool, fitness center and classes. Through regular exercise, participants notice better blood sugar levels, more energy, weight loss, greater flexibility and greater self confidence. Working out together, participants support one another, creating an environment of inclusion, acceptance and friendship. Our mandatory fitness counseling insures participants are continuing to progress. Trainers tailor fitness plans to meet the needs of each individual. Visit http://www.ywcaofasheville.org/.

-- Attention Providers Administering Dental Varnish --

Duraphat® No Longer Manufactured; Alternative Product Recommended

Colgate, the distributor of Duraphat Fluoride Varnish recently reported that the manufacturer has stopped production. Many physicians who administer the fluoride varnish procedure have had difficulty ordering it in the past and physicians in organizations that undergo the JCAHO accreditation process are required to use unit dosing. The ‘Into the Mouths of Babes’ (IMB) Advisory Committee is recommending an alternative fluoride varnish product: Duraflor. This product has similar ingredients, the most important being the resin-based adhesive that keeps the varnish on the teeth for an extended period of time. Duraflor comes in tube or unit dosing. However, the IMB Advisory Committee does NOT RECOMMEND the transparent or ‘white’ varnish products due to lack of long-term clinical trial data demonstrating effectiveness in preventing cavities or safety in young children. You may continue to order these products from Henry Schein (1-800-772-4346 or www.henryschein.com ) or the company of your choice.

WWW.NCAFP.COM

www.tobaccopreventionandcontrol.ncdhhs.gov

Tobacco Branch Website Offers Excellent Cessation Resources for Providers When the state smoking ban in bars and restaurants went into effect January 1st, it created a great opportunity for Family Physicians to focus on prevention, wellness and smoking cessation with their patients. As a physician, you see first-hand the negative impacts that smoking has on health. What you might not know is that an estimated 70 percent of smokers say they want to quit, and each year 30-50% of smokers attempt to quit. Without assistance, only 3-5% of smokers are successful, but their personal physician can help make all the difference. To help physicians be aware of the latest clinical guidelines on tobacco cessation and counseling, one particular resource that can be very helpful is provided by the Tobacco Prevention and Control Branch of the NC Division of Public Health (See web address above). Published on their website are a number of resources dedicated to educating and equipping health professionals. Many of the downloadable resources published within the site’s ‘Smoking Cessation Resources for Healthcare Professionals’ section are geared for enhancing a provider’s clinical cessation skills. Resources include links to clinical practice guidelines, QuitLine information, and even an online Smoking Cessation course. There’s links to patient materials that providers can distribute as well. NCAFP encourages all Family Physicians to use the state’s new smoking ban as a conversation starter to proactively counsel your patients on tobacco cessation. North Carolina ACADEMY OF Family PhysicianS, INC

11


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FAMILY MEDICINE IN PRACTICE

P HY S I C I A N

P E R S P E C T I V E

BCBSNC’s Move Towards the Patient-Centered Medical Home is Helping My Small Family Practice By Ed Bujold, MD, Granite Falls, NC In November, I had just returned from Kansas City where I presented a paper with several PharmD’s who work with our Community Care of North Carolina’s (CCNC) Medicaid program. The conference was the Annual Practice Improvement Conference sponsored by the Society of Teachers of Family Medicine, the National Research Network and the American Academy of Family Physicians. The entire conference was devoted to the Patient-Centered Medical Home (PCMH). While there, I attended a breakout session on how practices of any size could become a National Committee for Quality Assurance (NCQA) Patient-Centered Medical Home. Over the last 10 years I have worked diligently to develop a PCMH, but I have never applied for recognition because there was no financial incentive to go through this very arduous process, and I voiced this opinion during the session. I was told by one of the other attendants that there were several initiatives all around the country thinking about reimbursing practices for the PCMH concept. How many times have we heard payers value our services as we see more practices going bankrupt, closing their doors or moving into hospital organizations unable to meet their financial obligations? In most circles I travel, if your services are truly valued you are rewarded financially for those services, particularly if you are saving organizations millions of dollars in the process, year in and year out. But now in North Carolina, at least one insurer has made steps to recognize practices moving toward quality improvement and the PatientCentered Medical Home. Blue Cross and Blue Shield of North Carolina (BCBSNC) has changed the manner in which private practices will now be reimbursed, at least if you are on their base primary care contracts. Late last year, BCBSNC rolled out their new contracts and I was pleasantly surprised, almost shocked, when I sat down with our BCBSNC representative upon returning from that conference in November. This represents a sea change in my previous interactions with insurers. I am 58 years-old in a solo practice with two mid-level providers, and

WWW.NCAFP.COM

PCMH I honestly never thought I would see this day come before I retired. As primary care physicians, we now stand to make significantly more money if we become a NCQA-certificed PCMH. It is clear patients will receive better care in a PCMH. Emphasizing preventive health maintenance, chronic disease management and practicing evidenced-based medicine will save millions of health care dollars, as Community Care of North Carolina has demonstrated with our state’s Medicaid program. Although I disagree with some parts of my contract, the basic concepts are solid. I have invested over $150,000 in the last 15 years implementing a sophisticated computerized practice management system, an electronic health record in 2000, an online patient portal in 2007, e-prescribing in 2009 and, most recently, a data registry and disease management software feature designed by CINA, a Medicare-registered company, for PQRI reporting. BCBSNC has set up a point system to reach their Level III payment tier. A practice must score 160 points on a 200 point system to qualify for the Level III payment tier. In a small practice, and I suspect this is true for most small practices, no one has the time to devote to certifying their practice as a PCMH. We have solved this problem by outsourcing this task to a project manager who works for us part-time until the task is complete. We have utilized this for all of our software

implementations and it has worked well for us. One of the crown jewels in our health care system is Community Care of North Carolina (CCNC). Through the collaborative wisdom of several guiding lights, CCNC providers have been developing and nurturing the PCMH concept for years. A CCNC practice, with a bit of tweaking, can qualify for a BCBSNC Level II payment tier without too much difficulty. So what does the future hold? BCBSNC has made a good decision to invest in those practices that are investing in 21st century health care delivery systems. Let us hope this is the first step of many to come. Per Member/Per Month (PMPM) payments would help us mature and develop the PCMH much like CCNC does now. I have been involved in a pilot program with CCNC involving a PharmD who works in my office one day a week. She initially helped our practice manage Medicaid patients who filled more than six prescriptions per month, had frequent visits to the Emergency Department, my office or frequent hospital admissions, and, most recently, reconcile medications as people leave the hospital. Every month we add to her job description. Medicaid spends $3 per $100 on physician services. For a few cents more, highly trained personnel like my PharmD benefit the patients with higher quality medical care, save the payers and the health care system in general thousands of dollars per medical practice. This addition to my medical team, along with the CCNC nurse case manager, has been a tremendous asset to our PCMH. Upwards of 50% of our patients have mental health issues. A competent mental health provider and dietician could add great value. These highly valued team players could be assigned to several practices in a given area and rotate through offices one day per-week to help us with our patient needs. As physicians, we are probably over trained for much of what we now do. The current payment system doesn’t reward us for working at the top of our professional capability. With a capable team surrounding us, think of the quality of care we could be providing and the cost savings. BCBSNC has made a very good first step but let us not be satisfied when we could be so much more.

North Carolina ACADEMY OF Family PhysicianS, INC

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Call MAG Mutual’s Andy York toll-free at 1-888-892-5218 or Mike Tekely toll-free at 1-888-834-5940 today. www.magmutual.com Dividend payments are declared at the discretion of the MAG Mutual Insurance Company Board of Directors.


N C A F P

P R A C T I C E

T R A C K S

Local Health Departments have H1N1 Vaccine If you are not already administering H1N1 vaccine in your office, but would like to offer it to your patients, you may acquire vaccine directly from your local health department. The N.C. Division of Public Health reports that more than 800,000 doses of H1N1 vaccine are currently available to be shipped to local communities. Private providers have been key players in the immunization effort, with more than 1.33 million doses shipped directly to 1,579 physicians’ offices and clinics statewide. While current demand for vaccinations is low, State Health Director Jeffrey Engel, M.D., has asked that local providers continue to encourage their patients to get vaccinated in anticipation of a resurgence of H1N1 in February and March, during typical peak flu season. If you or your patients have questions about H1N1 or immunizations, you are encouraged to visit flu.nc.gov.

c l a s s ified s BC/BE Family Physicians Across NC - Multiple Opportunities Carolinas Healthcare System

Carolinas HealthCare System seeks BC/BE Family Medicine physicians for our expanding network of existing and new traditional and out-patient only Family Medicine practices and Urgent Care facilities throughout the Carolinas. Contact Thomas Baysinger (704)355-0282, thomas.baysinger@carolinashealthcare.org. Contact: Thomas Baysinger Tel: (704) 355-0282 / Fax: (704) 355-5033 Website: www.carolinashealthcare.org

BC/BE Family Physician - Mount Pleasant Carolinas Healthcare System

Cabarrus Family Medicine, part of the Carolinas Healthcare System, is looking for a full time BC/BE Family Physician for its Mount Pleasant, NC office. Full scope of practice, including inpatient and obstetrics at CMC Northeast in Concord. Call is approximately two times per month, plus OB call shared with 12 other providers. This is a residency clinic for the CFM Residency Program, affiliated with UNC. Teaching experience a plus. Contact Thomas Baysinger (704)-355-0282 phone or Thomas.baysinger@carolinashealthcare.org. Contact: Thomas Baysinger Tel: (704)-355-0282 / Fax: (704) 355-5033 Website: www.carolinashealthcare.org

INAUGURAL ADDRESS FROM PAGE 4

218 percent.4 In contrast, PCPs experienced a 10.2 percent reduction in inflation adjusted income from 1995 to 2003.4 Today, there are more visits to specialists in the U.S. than there are to primary care physicians. Currently, 30% of the U.S. Healthcare workforce are primary care docs and 70% are specialists. That situation does not look like it is getting any better with 90% of medical school graduates choosing specialty fields over primary care. This must change if we are to have a viable health care system in this country. We need to move toward a 50/50 mix of specialists and primary care and equity in our payment structures so that more graduates will be attracted to primary care and family medicine programs. As we well know, at times, the insurance industry has been a barrier to reforming our health care system in favor of primary care and balancing the disparities of access to care and physician payment. You know, I learned from Dr. Snyder a couple of years ago when he stood where I am today, that insurance companies net about $400,000.00 a year on every primary care doctor. This type of situation can translate into a $1.6 billion dollar compensation package for the CEO of United Health Care in 2006 – folks, that is equivalent to 4 million dollars a day, every day, for just remembering to breathe out. Yet, my UHC patients are continually frustrated by how little their coverage pays for. Citing the WSJ article again: Dr. Flier points out that the “currently proposed federal legislation would undermine any potential for real innovation in insurance and the provision of care. It would do so by over-regulating the health care system in the service of special interests such as insurance companies, hospitals, professional organizations and pharmaceutical companies, rather than the patients who should be our primary concern.” In our current system, tax policy drives employment-based insurance; this leads to over-insurance and drives costs higher, at the same time creating and increasing inequities for the unemployed and self-employed. The amount of regulatory red tape stifles innovation and creativity and crushes small business in the process. I was talking with a business owner recently about how much his insurance coverage for the business was costing him. He said if the premiums continued to increase, he would have to forgo providing insurance for his employees or go out of business. We discussed the fact that the purpose of insurance is to prevent the business from suffering loss due to a catastrophic occurrence. It seems in our current environment that the cost of insurance has become the catastrophe! You see, the current bills do indeed address the problem of patient access by expanding Medicaid and mandating insurance coverage – but this will be at substansial cost! The problem is, I have seen precious little discussion about controlling growth of these costs or initiatives to raise the quality of care. So once again, the politicians will be able to pat themselves on the back for addressing the social issues surrounding access, but will have done nothing to address the deeper issues – and we may end up bankrupting the nation in the process. This is again where we, as Family Physicians, have the answers. The conclusion of Dr. Watkins’ comments will appear in the Spring edition.

Part-Time Family Medicine Opportunity - Raleigh, NC Blue Ridge Family Physicians

Established Family Medicine practice in Raleigh, NC seeks BC/FM physician for part-time position. Hours flexible, EMR, no call. Contact Douglas I. Hammer, MD, (919)232-5455, dhammer@blueridgefp.com. Contact: Douglas Hammer, MD Tel: (919) 232-5455 / Fax: (919) 232-0006 Website: www.blueridgefamiilyphysicans.Com Website: www.carolinashealthcare.org

WWW.NCAFP.COM

1. 2. 3. 4.

Flier, Jeffrey S. Health “Debate” Deserves a Failing Grade. Wall Street Journal. 18 November 2009. Contribution of primary care to health systems and health. Starfield B, Shi L, Macinko J. Milbank Q. 2005;83(3):457-502. P.B. Ginsburg, “High and Rising Health Care Costs: Demystifying U.S. Health Care Spending,” October 2008, http://www.rwjf.org/pr/product.jsp?id=35368. T. Bodenheimer, R.A. Berenson, and P. Rudolf,“The Primary Care–Specialty Income Gap: Why It Matters,” Annals of Internal Medicine 146, no. 4(2007): 301–306.

North Carolina ACADEMY OF Family PhysicianS, INC

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Hello, I m Dr. Benson. I ll be performing your appendectomy today.

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