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Fighting for Stability in Medicaid The North Carolina Family Physician

Vol. 6 - No. 4

See page 5

Fourth Quarter, 2010

Winter Meeting Will be a Great Educational Experience Dec. 2-5, 2010 - Asheville

Integrative Medicine | 2010 AAFP Congress of Delegates was Productive for NCAFP | Fellowship Project Leads to Key Insights

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 Samantha Brown Brown••samantha.brown@novanthealth.org samantha.brown@novanthealth.org Mimi Davis • mjdavis@novanthealth.org Mimi Davis •mjdavis@novanthealth.org Anne Propst • abpropst@novanthealth.org Anne Propst • abpropst@novanthealth.org Kirsten Quinlan • kjquinlan@novanthealth.org Kirsten Quinlan • kjquinlan@novanthealth.org Emily Slagle • ecslagle@novanthealth.org www.novanthealth.org • www.novantmedicalgroup.org

www.novanthealth.org • www.novantmedicalgroup.org


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 Christopher Snyder, III, MD Past President (w/voting privileges)

Volume 6

The North Carolina Family Physician

Number 4

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

Integrative Medicine: The Globalization of Our Current Paradigm........................ 4 Academy Very Proactive in Fighting for Stability in Medicaid ............................ 5 2010 AAFP Congress of Delegates was Productive for NCAFP............................ 8

The District Directors District 1 R. Kevin Talton, MD District 2 Connie Brooks-Fernandez, MD District 3 Scott E. Konopka, MD District 4 Timothy 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 I. 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 Vacant 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


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

Winter Meeting in Asheville Set to Be Great Educational Experience...................10 Fellowship Project Leads to Key Insights on Health Disparities.........................14 Sections

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

Residents & Students..................................11

Chapter Affairs..................................... 8

Health Improvement & Initiatives....................... 14

Education & Development.................... 10

Family Medicine in Practice............................. 16

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 24


North Carolina ACADEMY OF Family PhysicianS, INC

NCAFP President’s Message


Integrative Medicine: The Globalization of Our Current Paradigm

What do you think of when you hear the term How did we forget about the things that really “Integrative Medicine”? How does one define it? make us well - things that make us whole? When Perhaps one of the problems of understanding did we forget that the mind and the body are the nature of integrative medicine is rooted in connected? When did we forget that medicine the wide swath of therapies it can encompass. is at least on some level, a spiritual calling? I Sometimes we talk about “alternative medicine,” blame penicillin. We had patients on death’s but that may conjure up something that is just door ready to succumb to pneumonia. A couple a little (or a lot) off center. We hear the term of shots of Pen G in the rear and the next day “traditional medicine” and we may think about they are up and eating and talking. Amazing! We old timey therapies that we in our sophisticated began to believe that we could do anything with place in history have let go of because we think science, technology, and drugs. I remember that we have outgrown them. Then there is the term by the end of my third year of medical school, “complimentary medicine.” What of that? I thought I knew everything there was to know Some days, I think to myself that if I hear about the human body. It did not take long, the phrase, “I was watching Dr. Oz on TV, and however, dealing with patients and their families he said…”one more time, I am going to set my to discover that there is more to healing than just hair on fire and run naked out the front door of knowing the anatomy and the “right” therapy. my clinic! But when I think about integrative The vast majority of our training made little medicine, I like what Dr. account for the spiritual Mehmet Oz told Krista aspects of our patient’s Tippett in a recent interview lives. “I remember that by the end on her radio show “Speaking I believe much of our of Faith.” In the interview, humanness (that is, our of my third year of medical he stated he saw integrative ability to connect with school, I thought I knew eve medicine as “a mutually the intangibles) may enriching encounter of the have been wrung out of rything there was to know best practices of Western us as medical students about the human body. It did when we worked into and Eastern cultures.” With this definition, we do not long hours of the not take long, however, deal- the belittle the remarkable night – taking little time advances that have been for rest or even physical ing with patients and their made in our technologically nourishment – much families to discover that there less attending to our and pharmaceutically-based system of treatment, but we own spiritual needs. In is more to healing than just realize and acknowledge the fact, it has only been fact that there are limitations knowing the anatomy and in the last few years to our current empirical and that I have begun to the ‘right’ therapy.” drug-based paradigm. And put more emphasis on it is precisely at the edge of this part of my nature those limitations that we can following dissolution allow the “something else” – the intangible, the of a marriage, a move, job changes, and some immeasurable - to work with us in healing our serious health concerns of my own. patients. Here, we are not simply working to rid The model I now use in my practice involves patients of disease, but rather are working to bring looking at the whole person in the areas of diet, about true healing – to help the patient become exercise, and hormone optimization to bring well. about balance in my patients. But the journey

October - December, 2010 | the North Carolina Family Physician

R.W. Watkins, MD, MPH, FAAFP 2009-2010 NCAFP President rarely ends with what we put in our mouths in the form of medications, foods, or even nutritional supplements. Many patients move forward in their lives with those things as supports, but their real work comes in learning to relax, meditate, or just remembering how to breathe - becoming aware of the breath and spirit within them. Thus, in my practice we use biofeedback, breathing techniques, yoga, acupuncture, meditation, and healing touch to bring about some of the deeper awareness that can lead to personal growth and sustained levels of health and wellness. Obviously, none of these methods are meant to supplant or substitute for personal prayer, reflection, and worship, but rather can be used to enhance the very natural relationships we as physicians know exist between the mind, body, and spirit. It is when we have used the latest technologies, or the newest medicine – or in many cases the newest combination of medicines - and the patient STILL does not feel well, to what do we look then? I think it is there and then that we need to push ourselves out of our comfort zones and possibly be open to integrative therapies and areas of spirituality that might help us and our patients bridge the gap between our current culture of medicine and more ancient treatments – cultures of healing outside modern day medicine’s borders. This is what has been called by Mehmet Oz and others as the “globalization of medicine”. We have global media – this article could be shot to Tokyo in the blink of an eye. We have See PRESIDENT’S MESSAGE on back cover








Academy Very Proactive in Fighting for Stability in Medicaid

2011 is Expected to Bring Additional Challenges Over the past few months, the NCAFP has been very active in working to communicate with state elected officials the importance of long-term stability in Medicaid provider payment and overall program management. The Chapter expects that in the coming months continued proactive efforts will be needed to educate key legislative leaders and to encourage fair, marketbased reimbursement levels. Here is a brief recap of the work the Chapter has conducted since early Summer, 2010. September Medicaid Provider Rate Cut Averted

This past August, the Academy was a key player in expressing concerns with the state’s proposal to implement an additional Medicaid rate cut as of September 1st. The reduction was one of several money-saving contingency options approved by the NC General Assembly to be carried out if Congress failed to appropriate additional federal funds to North Carolina. Congress eventually approved additional funding and the state actually received an amount larger than originally

anticipated. However, NCDHHS, at the direction of the Governor, decided to move forward with the contingency rate cut. The NCAFP, along with the entire medical community, strongly opposed the move. In response to the proposed cut, the Chapter communicated its concerns directly to Governor Perdue, key leaders in the legislature, as well as to the Secretary of the Department of Health & Human Services. Academy President Dr. R.W. (Chip) Watkins and several others from the Board and the membership at large wrote

Support CCNC Information Portal The Academy has put together a growing collection of information on Community Care of North Carolina (CCNC) that’s designed to educate and inform decision makers about the impact of the program. Refer to it for useful information on the program’s cost savings, quality, and workforce impacts. Visit www.ncafp.com/support-ccnc today

to Governor Perdue indicating the impact additional reimbursment cuts could have on family physicians across the state. They also highlighted the impact on the ability of Medicaid recipients to maintain access-to-care. NCAFP Government Affairs Consultant Peyton Maynard and EVP Greg Griggs also communicated directly with members of the administration and the legislature, sharing concerns about unfunded cost burdens by family physicians. The pressure worked. In early September, NCDHHS announced a roll-back of the rate reduction, in large part from due to the outcry from the entire house of medicine. In response to the announcement, the NCAFP sent a letter to Governor Perdue and several key legislative leaders expressing appreciation for her intervention. But while the roll-back did provide temporary relief, the issue is not over. With a $3.5 billion deficit for the state looming in 2011-12, the administration is already asking state agencies to compile contingency plans for next year at anywhere from a 5 percent to a 15 percent reduction in their departmental budgets. Senate and House Candidate Outreach

This fall’s elections provided an another opportunity to engage incumbents (and challengers) on the issue. Early last month, the Academy wrote to all NCAFP members encouraging you to contact your local NC Senate and House candidates to educate them on the importance of Medicaid and the state’s Continues on next page, first column


North Carolina ACADEMY OF Family PhysicianS, INC

Medicaid management program - Community Care of North Carolina. Members were given candidate names and telephone numbers (where feasible) and directed to contact each candidate by telephone. It is all part of an effort designed to educate and inform elected officials on the importance of the program, as well as to communicate why market-based payment for services is critical. Plus, with so few elected officials having formalized training in medicine, educating legislators on the impact of both programs is even more important. Many do not entirely appreciate the impact the program has on health care in their districts– especially in rural areas – of our state.








The Best Medicine for North Carolina are Physician-Led Medical Homes By Dr. Brian Forrest, Chair, NCAFP Advocacy Council

Patients deserve to know that the medical professional taking care of them has had the training and experience needed to provide the best possible medical care. With the recent IOM report, some have advocated a system of medical care that allows non physicians to be the primary care provider of the public. While pharmacists, nurse practitioners, physician assistants, dieticians, and nurses all play important roles in the health care system, it is imperative that physicians lead the medical home.

Launched Online Information on CCNC

When the NC General Assembly returns to Raleigh this January, it begins the start of another legislative session and one with very pressing budget issues. The state budget deficit for 2011-12 is expected to be in the neighborhood of $3-4 Billion. Elected officials will be looking to save big money the easiest ways possible. One concept that may be considered is the ‘privatization’ of the Medicaid program, or worse, significant cuts to funding to Community Care of North Carolina (CCNC), the state’s Medicaid Management program. CCNC serves approximately COMMUNITY CARE 990K of the state’s OF NORTH CAROLINA 1.4M Medicaid Improving Care, Saving Money recipients through an integrated and personalized approach that is managed by the program’s 14 locally-directed and physicianrun health networks. Cuts to this program could devastate it and the services it provides to its recipients and to physicians. Cuts would impact every legislative district. To help educate leaders (both current and newly-elected), the Academy has published a series of web pages, titled ‘Support CCNC,’ that can be found online at www.ncafp. com/support-ccnc. The page lists the money saving, quality enhancing, and workforcebuilding nature of the program. Please visit these pages and review them. If you speak with your elected officials, direct them to this website.


Physicians have had significantly more clinical training that is focused on diagnosis and management of disease. In the instance of a board certified family physician versus a nurse practitioner, the difference in clinical training hours is vastly significant, by some estimates as much as 15,000 more clinical hours for a family physician as compared to a nurse practitioner. With limited resources and healthcare manpower to provide the primary care needs of our population, the pressure to use nonphysician trained care providers is increasing. While all of these health care professionals have an important role and extend the capacity of physicians to provide health care, ultimately, it is the physician that has the responsibility, training, and experience to handle the broad spectrum of care including chronic disease management. If pharmacists become the primary immunization providers, we will have fragmentation of care for children and adolescents. Many times these patients only come in for screening and preventive visits when they are getting their vaccines. If physicians are not immunizing and this part of care becomes a multi-facility patchwork of care, what will be missed? What preventable illness, developmental delay or disease will go untreated or undiagnosed? Make sure you continue to provide immunizations to your patients and help your community understand the value of having these provided within your office, the patient’s medical home. Family physicians are the pinnacle of welltrained primary caregivers for a population. They can manage over 90 percent of presenting illnesses and conditions and provide continuity from birth to end of life. They can treat the family in context, many times seeing multiple generations within the same community. They

October - December, 2010 | the North Carolina Family Physician

can coordinate care from multiple “sous chefs” to create an optimum delivery of preventive care and chronic disease management. As policy makers consider expanding roles of non-physicians, we have to be vigilant and vocal to make sure that primary care is still being led by physicians. Stringent medical school admissions qualifications, internship, residency, and board certification in a specialty like Family Medicine do make a difference to patient care. To protect patients and to provide the best medicine, we need to ensure that physicians are not excluded from the healthcare of patients. Advocacy is the key to make sure that those regulating medicine and healthcare policy have heard from family physicians about what is best for their patients. You are welcome at NCAFP Advocacy meetings, and you can contribute to FAMPAC. Even if you do not participate in those, make sure your local legislator knows how you feel about what is best for the health of the citizens of North Carolina.


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Chapter affairs







2010 AAFP Congress Productive for Chapter Leadership The NCAFP had a very productive AAFP Congress of Delegates in Denver on Sept. 27-29th. The Chapter’s three resolutions each generated thoughtful debate. In addition, NCAFP member Dr. Lori Heim completed her term as AAFP President, culminating in the installation of Dr. Roland Goertz (Texas) as the 2010-11 President of AAFP. Dr. Heim will now serve as Chair of the AAFP’s Board of Directors for the next 12 months. Members from North Carolina attending the Congress of Delegates included Dr. Heim; AAFP Board Member Dr. Conrad Flick; AAFP Delegates Drs. Allen Dobson and Karen Smith; AAFP Alternate Delegates Dr. Chuck Rich (current NCAFP Board Chair) and Dr. Michelle Jones; current Chapter President Dr. Chip Watkins; NCAFP Past President Dr. Jim Jones; NCAFP Resident Director Dr. Meshia Todd, who served as an Alternate Resident Delegate to the Congress of Delegates; and NCAFP Resident Director-Elect Dr. Nicole Shields. NCAFP staff members EVP Greg Griggs, MPA, CAE and COO Brent Hazelett, MPA, also attended. Outcomes of Chapter Resolutions

The NCAFP submitted three resolutions for consideration by the Congress. A copy of the each resolution and its outcome can be found online at the NCAFP website. Here is a recap of the Chapter’s three resolutions.

AAFP President Dr. Lori Heim of Vass, NC, led the question-and-answer segment that featured the candidates for AAFP President-Elect.

First, ‘Keeping Immunizations in the Medical Home,’ passed as a substitute resolution with very minor changes. The final resolution read RESOLVED, that the American Academy of Family Physicians (AAFP) encourage public and private plans to pay family physicians at a rate that encourages immunization administration in the medical home. Next, ‘Ban on Tobacco and Alcohol in Healthcare Facilities,’ - passed with slight modifications based on testimony that alcohol, in limited quantities, is not always detrimental to health. The final resolution read: RESOLVED, that the American Academy of Family Physicians (AAFP) support state or national efforts to prohibit the sale of tobacco in the same location where healthcare or health counseling is provided.

Finally, ‘Opposition to Automatic Refill Programs,’ - was referred to the AAFP Board of Directors for additional review and consideration by the Reference Committee due to the complexity of the issue. The Reference Committee did not want the Board to completely oppose the use of automatic refill programs, and in some instance, felt like the programs could be appropriate if utilized property. The NCAFP will monitor the progress of this and report updates as they become available. Finally, EVP Greg Griggs interviewed several members of the NC delegation while in Denver. The Chapter has posted a video snapshot of those interviews online at ncafp.com/videos, titled 2010 AAFP Congress of Delegates Productive for North Carolina Delegation.

New N.C. Center of Excellence Located in Academy Offices The Governor announced the newly formed NC Center of Excellence for Integrated Care in early July, a ground-breaking initiative that moves towards coordinated care using a model that combines the delivery of medical and mental health care services. The Center of Excellence is being managed by the North Carolina Foundation for Advanced Health Programs and will build upon ICARE, (Integrated, Collaborative, Accessible, Respectful, and Evidence-based Care), a partnership created in 2006 designed to address the need to combine mental health treatment with medical care in primary care settings. Offices for the new Center are now located in a second floor suite at NCAFP headquarters in Raleigh. The Center of Excellence will continue to work with primary care offices and expand this effort of integrated care into other health care systems such as hospital emergency departments and mental health agencies. The Center will also ensure that consistent standards of care are adopted across different health care settings.

October - December, 2010 | the North Carolina Family Physician







Martinez-Bianchi Named Chair of AAFP Member and Member Services Commission During the AAFP’s recent Congress of Delegates in Denver, Dr. Viviana Martinez-Bianchi was named Chair of the AAFP Commission on Membership and Member Services. The Commission’s scope of work includes recruitment and retention, member services, member needs, special constituencies and the Annual Leadership Forum. North Carolina has had four Commission Chairs over the last three years. Last year, Dr. Karen Smith Chaired the Commission on Quality and Practice, and Dr. Tom Koinis chaired the Commission on health of the Public and Science. Dr. Conrad Flick, a current AAFP board member, previously chaired the Commission on Governmental Advocacy. Congratulations to Dr. Martinez-Bianchi on her appointment!

NC Boxing Advisory Commission Appoints Jacksonville-Based FP

Dr. Scott Playford, a family physician at Eastern Orthopedic Clinic in Jacksonville, NC, has been appointed to the NC Boxing Advisory Commission. A native of South Carolina, Dr. Playford completed a Primary Care Sports Medicine fellowship through the Uniformed Services University of Health Sciences in Bethesda, MD, and has a strong interest in event and sideline medical coverage.

NCAFP Board Chair Featured in Prominent AMA News Story on CCNC

Current NCAFP Board Chair Dr. Robert L. Rich of Elizabethtown, NC, and NCAFP Past President Dr. Allen Dobson, Jr., (1998) were both featured in a key news story published by the American Medical Association News (AMA News). You can find a copy of the article at http://www.ama-assn. org/amednews/2010/08/02/gvsa0802.htm. The story provides an excellent overview of Community Care of North Carolina, its origins and its financial impact on the state’s Medicaid program. The piece also points to the strong national influence the program has had with other states as they seek to implement similar systems.

Social Networking and Short Videos Added to Chapter Website The NCAFP continues to add new features and tools to its web site to keep members informed and connected. The Chapter has begun to encourage members enrolled in the popular social networking website ‘Facebook’ to become a fan of the Chapter. This enables members to receive ongoing updates via Facebook. Search ‘North Carolina Academy’ on Facebook. Additionally, the NCAFP has also begun to produce short video segments that accompany select stories in NCAFPNotes. Each are available online. Members can view these videos by visiting www.ncafp.com/video.

If you work in a health care setting . . .

Get a Flu Vaccine!

Protect Yourself

You are likely to be exposed to the flu at work. If you don’t get a flu vaccine, you are more likely to catch the flu and miss several days of work.

Protect Your Family

Have questions? Visit www.immunizenc.com or call the Centers for Disease Control and Prevention Hotline: 1-800-CDC-INFO 1-800-232-4636

You can spread the flu even before you feel sick. Your family and friends could become seriously ill. The flu is especially hard on babies and older adults.

Protect Your Patients

You also can spread the flu to your patients. For some patients, flu can be a life threatening disease. All health care workers should get vaccinated.

State of North Carolina Department of Health and Human Services www.ncdhhs.gov N.C. DHHS is an equal opportunity employer and provider. 10/10


~ 2010 NCAFP Annual Winter Meeting is Only Weeks Away - Register Today at www.ncafp.com/wfpw~

Winter Meeting Set to Be A Great Educational Experience

Over 49 AAFP Prescribed Cat. 1 Credits Available December’s Winter Family Physicians Weekend is set to present an excellent array of lectures, workshops and social activities. The conference takes place at The Grove Park Inn Resort & Spa in Asheville, NC, from December 2-5, 2010. NCAFP Past President and Program Chair Dr. Michelle Jones of Wilmington, NC, has put together an educational program that will feature a slightly modified schedule to offer attendees more free time, but will provide an excellent line-up of educational topics. Complete meeting information and registration is available at www.ncafp.com/wfpw. The 2010 Winter Meeting will present 49.5 AAFP Prescribed Category I credits. The final schedule of topics and speakers can be found online at www.ncafp.com/wfpw. A slight change to the meeting’s General Sessions schedule is being implemented this year. On Friday, Dec. 3rd, 2010, all General Session lectures will conclude at 3:00 p.m. to allow attendees time to enjoy The Grove Park Inn and to get acquainted with nearby Asheville. There will still be optional learning

2010 Foundation Silent Auction - Get In On Fun! The Winter Family Physicians Weekend is always a great time for everyone and this year makes no exception. The Academy is extremely excited about this year’s combined Silent Auction & Presidential Gala event that will be held on Saturday, December 4th at The Grove Park Inn Resort & Spa. The entire family will enjoy this Saturday Night, complete with terrific items for bidding, along with the fun and excitement of jugglers, stilt walkers and other surprise guests. Bring your checkbook and help further the NCAFP Foundation’s mission of providing quality healthcare to the people of North Carolina. This event is free to all registered attendees and their guests. Contributing is Easy for Everyone

Please consider contributing this year to one or more of the following opportunities: the Foundation’s General Fund, the Medical Student Endowment Fund, the Tar Wars Fund


Dec. 2-5, 2010 -- Asheville, nc activities for those interested, including a series of workshops and satellite learning events. Workshops and satellite learning events are great ways to increase your knowledge in the convenience of a small group format. A total of thirteen optional learning activities will be presented, including eight optional workshops (w/CME credits available) and five satellite programs (non-CME). Complete descriptions of each workshop/satellite can be found online at www.ncafp.com/wfpw (See ‘Workshops’ section). The Winter Family Physicians Weekend is also

or this year’s Silent Auction. Additionally, a new opportunity to support is the Family Medicine Interest & Scholars Initiative. This new program was announced earlier this year and is jointlysupported by the Blue Cross and Blue Shield of NC Foundation and the NCAFP Foundation.  Our commitment involves raising a minimum of $300,000 over the next six years.   Members who cannot attend the Auction, may contribute directly to either of these programs/projects by regular US Mail or online at the Foundation’s website. Please take a moment to consider the opportunities and make a tax-deductible gift to the program of your choice.  Contributions will enable the Foundation to continue its mission of serving our members, our communities and the specialty of Family Medicine. Donations to the Silent Auction or the NCAFP Foundation are eligible as a tax- deductible charitable contribution. A Donation Form for tax purposes will be sent to you upon receipt of your donated item. Please contact Tracie Hazelett, NCAFP Foundation Development Coordinator with any questions you may have or to contribute to the event at thazelett@ncafp.com or 919-833-2110 / 800-872-9482 (NC Only).

October - December, 2010 | the North Carolina Family Physician

a great opportunity to spend time with friends, family and colleagues in family medicine. This year’s meeting will allow for more free time to enjoy the mountains and will also feature a fun line-up of social events, culminating with the combined Silent Auction & Presidential Gala on Saturday, December 4th. The entire family will enjoy this night complete with terrific items for bidding during the annual NCAFP Foundation’s Silent Auction. The evening will continue with the Presidential Gala hosted by Dr. & Mrs. Richard W. Lord, Jr., featuring a live band and a terrific dinner menu specially prepared by the Grove Park Inn chefs. Admission to both events is free with CME Registration. Students, Residents and Registered spouses/guests children are also free. Additional tickets for this event may be purchased for $55 per person. Complete meeting information is posted online at www.ncafp.com/wfpw. If you plan to attend, please register immediately. Questions can be directed to the NCAFP Meetings Dept. at (919) 833-2110. ext. 114. See you in Asheville!

2011 Spring Meeting April 14 -16, 2011 Embassy Suites Winston Salem NEW PROGRAM FORMAT • OPTIONAL SAMS Working Group Thursday, April 14, 7:00 - 9:00 pm • General Session Lectures Begin on Friday, April 15, 9:00 am. • General Session Lectures End on Saturday, April 16, at 3:15 pm Watch for Details Soon!



Academy to Educate Providers on COPD with New Performance Improvement CME Process The Physicians’ Institute recently awarded the NCAFP a $15,000 grant to deliver a unique performance improvement CME program (PICME) focused on the diagnosis and management of COPD. The grant is part of a multi-state collaborative spearheaded by The Physician’s Institute and made possible by support from Pfizer, Inc. and GlaxoSmithKline. The primary goal of this program is to improve provider adherence to evidence-based COPD treatment guidelines by focusing on barrier problems identified through a series of chart audits. The program will utilize a new educational methodology in which actual physician deficiencies will guide the development of the educational component. The program will be targeted to family physicians and other primary care providers, including nurse practitioners, nurses, and physician assistants.

In the coming months, the NCAFP will be selecting 10-12 providers, each of which will be required to pull a number of patient charts for auditing. Each patient chart will be entered into a data collection tool designed by the collaborative. Once entered, the data will serve as the basis for identifying specific topics and focus areas of the program’s educational activity; the activity is expected to be a plenary lecture. After attending the educational activity, selected physicians will then pull a new set of patient charts for additional auditing and self-assessment. Overall, the program will promote performance improvement on behalf of each physician and allow them to compare their care to established evidence-based guidelines and performance measures. All practices selected for chart auditing will be provided with a stipend for their participation. Physicians or providers interested

The number of family medicine residency slots in NC just increased! The New Hanover Family Medicine Residency Program in Wilmington, NC, was recently awarded one of the Federal government’s Primary Care Residency Expansion Grants, enabling it to offer two additional residency slots for the next five years. “We are very excited to be expanding our residency program. There is still a vast need for family physicians in southeastern North Carolina and this will allow us to continue to fill that need,” commented Dr. Janalynn Beste, Program Director. The funding will allow New Hanover to increase its numbers by two positions, creating a 6-6-6 program through 2016. With the recruiting season in full swing now, New Hanover is now recruiting for 6 interns to start on July 1, 2011. Congratulations! WWW.NCAFP.COM

in being considered as volunteers are directed to contact Marietta Ellis, NCAFP Director of CME, at (919) 833-2110. This activity is supported through an independent educational grant from Pfizer to the Physicians’ Institute for Excellence in Medicine as part of the ACES Collaborative for the improvement and management of COPD. The Physicians’ Institute retains full control over the distribution of individual grants under this program.



New Hanover Residency Program Awarded Federal Expansion Grant


Important 2011 Deadlines for Student Programs Attention students -- two key application deadlines are set for this upcoming January, 2011. Applications for the 2011 Family Medicine Scholars, as well as the NCAFP Foundation Externship Program, are due by Monday, January 17, 2011. See the information on each program below. For questions or more information please contact Tracie L. Hazelett, Manager Family Medicine Interest Initiatives at the NCAFP, at 919-833-2110 or thazelett@ncafp.com. NCAFP Family Medicine Scholars Program Deadline to apply: Monday January 17, 2011

2011 NCAFP Family Medicine Externship Deadline to apply: Monday January 17, 2011

Selected student scholars will be rising secondyear medical students. This program pairs students with innovative family physicians in clinical practice settings for 3-years. Up to 12 students will be selected to participate and each will be enrolled in an exciting three-year curriculum designed to enhance their individual clinical skills, develop their health care leadership abilities, and offer the option of accessing a scholarship should they enter a family medicine residency training program. A complete program timeline is available online that offers additional program information. For more details please visit: http://www.ncafp.com/scholars-program/ or inquire with your school’s Department of Family Medicine.

The NCAFP Family Medicine Externship Program is a 4-week summer learning experience that exposes rising second-year medical students to the daily activities of family physicians. The program gives the student a better understanding of the role that the family doctor plays in his or her community. Students are given the opportunity to work beside a physician with their patients on a day-to-day basis, visiting hospitals, nursing homes, attending continuing medical education seminars, leadership meetings, etc. For more details, please visit: http://www. ncafp.com/externs or inquire with your school’s Department of Family Medicine.

North Carolina ACADEMY OF Family PhysicianS, INC




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Fellowship Project Leads to Key Insights on Health Disparities


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By Jenni Danai, MPH

In January 2009, Jenni Danai, MPH, NCAFP’s Health Initiatives Manager, began a journey through a new two-year North Carolina Health Disparities Fellowship Program. The program is sponsored by the North Carolina Health and Wellness Trust Fund Commission and was created to engage public health and social work professionals in ongoing efforts to decrease health disparities in the state. The program functions through the Duke Global Health Institute and North Carolina Central University and combines in-class learning with ongoing field work in the form of customized student projects. During the first year of the fellowship, each fellow was immersed in four educational modules. In year two, all fellows are required to implement a custom health disparities project that can be incorporated into their daily professional work. Ms. Denai has crafted a unique project titled, “Adapting Culturally and Linguistically Appropriate Service (CLAS) Recommendations in Healthcare for Hispanic Populations in North Carolina,” that consists of a series of focus groups conducted with Latino/Hispanic patients from Wake and Alamance counties. During the sessions, Ms. Denai asks questions related to several core themes of the CLAS standards, including language access, perceived cultural competency of the caregiver, and organization supports recognized by the patient. A bi-lingual co-facilitator and interpreter were present during the sessions. Ms. Denai has managed the NCAFP Foundation’s Health Disparities Initiative since it began in 2006. She has utilized the ‘Culturally and Linguistically Appropriate Services Standards (CLAS)’ to educate physicians on health disparities and to build the capacity of clinics to better care for patients of all cultures, backgrounds and beliefs. Her focus group experience is proving to be as enlightening for her professionally as the actual participant answers have been for the overall project. Several main themes have emerged from the focus groups conducted thus far. Primarily, most patients communicated that they merely sought a good physician, regardless if the physician spoke Spanish or not. Ironically, they do favor a physician who tries to speak Spanish, even if just a few words, because it shows that the physician was trying to get to know them and to build a relationship. Conversely, they also showed some distrust for interpreters. This tends to support the belief that there is a significant need for a comprehensive training program for interpreters, as well as a universal proficiency testing to include patient communication skills. Another common issue among participants was that most of the participants did not see a physician unless they had a 14

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known health issue. Cost and time seem to be key drivers of this, since most of the participants did not have health insurance. However, many have returned to Mexico for health care when needed. Preventive visits to see a physician are a luxury. During one of the focus group sessions, Jenni inadvertently broke one of the major rules of using an interpreter; she spoke directly to the interpreter instead of looking and talking to the participant. Immediately, she recognized what she had done and was embarrassed for breaking a rule that she so often educated others about. The lesson learned from this is that doing this is such a common mistake and providers should not get

October - December, 2010 | the North Carolina Family Physician

discouraged if they make a mistake like this but recognize it and correct it immediately with the patient. The lessons learned from the project add to the body of knowledge about Hispanics and Latinos in North Carolina. Future efforts will include building awareness in these communities of the importance of prevention and a medical home. Clinics with night and weekend hours should be compiled and promoted to these populations. Overall, healthcare providers should not be afraid to make a communication mistake with their Latino patients, it’s better for the provider to try than to not make an effort at all. WWW.NCAFP.COM

OCT 1st, 2013 Prepare Now for the ICD-10 Transition The change to ICD-10 codes takes effect on October 1, 2013. What do you need to get ready? Providers will need to use ICD-10 diagnosis and inpatient procedure codes starting on October 1, 2013. And in preparation for ICD-10, starting January 1, 2012, all practice management and other applicable software programs should feature the updated Version 5010 HIPAA transaction standards. Make sure your claims continue to get paid. Talk with your software vendor, clearinghouse, or billing service NOW, and work together to make sure you’ll have what you need to be ready. A successful transition to ICD-10 will be vital to transforming our nation’s health care system. Visit www.cms.gov/ICD10 to find out how CMS can help prepare you for a smooth transition to Version 5010 and ICD-10.

Official CMS Industry Resources for the ICD-10 Transition


family medicine in practice

president’s message, continued from page 4

global banking – when I’m in Stockholm, my VISA allows me to stick in the card and kroner magically appear. When I’m in London, pounds sterling pop out. We have global networks, global finance, and global entertainment. But medicine has remained very provincial in its culture. We do what we were taught to do. Training is essentially localized. Thus, the therapies we use now are the ones we learned in medical school to a great extent. Often, we tend to ignore, negate, or even vilify therapies that do not make sense to us or that not been “proven.” Nevertheless, what is happening in the rest of the world may be beginning to happen in medicine. Integrative medicine, to me, is really an illustration of the re-aligning of medicine with other areas of globalization – from finance to popular culture. We see incorporation of efficacious therapies from around the world as doctors and patients look for ways to heal and to live well. Of course our creed, “do no harm” is still in force and these therapies will need to meet the rigors of scientific testing – whenever possible, but we must also realize that in the realm of the spirit and in the field of energy medicine, we may have not yet invented the right tools to assess the parameters and outcomes we need to measure to prove their efficacy.

Flu Season 2010-2011: Take the Opportunity to Prevent Pneumococcal By Amy Caruso, NC Immunization Branch

As patients come to your practice for their annual flu vaccination this season, take the opportunity to get them vaccinated against pneumococcal disease. The major clinical syndromes of pneumococcal disease are pneumonia, bacteremia, and meningitis. Each of these syndromes causes thousands of hospitalizations a year. Pneumococcal pneumonia is the most common, causing an estimated 175,000 hospitalizations a year. There are currently two types of pneumococcal vaccines: pneumococcal polysaccharide vaccine (PPSV or Pneumovax) and pneumococcal conjugate vaccine (PCV7 and PCV13 or Prevnar). PCV13 is replacing PCV7. Pneumococcal Polysaccharide Vaccine (Pneumovax) Recommendations include: adults 65 years of age or older or persons 2 years of age or older with chronic illness, anatomic or

functional asplenia, immunocompromised (disease, chemotherapy, steroids), HIV infection, environments or setting with increased risk or Cochlear implants; and adults 19 through 64 years of age who smoke cigarettes or who have asthma. Pneumococcal Conjugate Vaccine (Prevnar) Recommendations are for children less than 2 years of age or children 2 through 5 years of age with a high risk medical condition. The new pneumococcal conjugate vaccine, PCV13, was licensed for use in the U.S. this year. It replaces PCV7 and includes six additional serotypes, protecting against more disease than PCV7. In particular, PCV13 vaccine protects against serotype 19A, which has become the most common pneumococcal serotype and is often resistant to antibiotics.

Info on Medicare/Medicaid EHR Incentive Programs Available Now Through CMS CMS has published additional information on helping family medicine and primary care practices know about the available EHR incentive programs available. As the US healthcare system transforms to improve access, quality and efficiency of care, as well as upgrade to ICD-10, the HI-TECH Act has established programs under Medicare and Medicaid to provide incentive payments for the ‘meaningful use’ of certified EHR technology. The website is located at www.cms.gov/EHRIncentivePrograms.


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

To place an advertisement, contact Peter Graber at (919) 833-2110 ext. 115 or via email at pgraber@ncafp.com

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