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The North Carolina Family Physician

Vol. 7 - No. 1

First Quarter, 2011

2010-11 Presidential Address

Family Medicine: Embrace The Journey See page 4

Pittard Named Family Physician of The Year | Residents & Students Elect New Leaders | Disparities Initiative Improving Care in Guilford

www.ncafp.com/sfpw

April 14-16, 2011 at The Embassy Suites Winston-Salem in the Twin City Quarter - Winston-Salem, NC

NEW FORMAT Thursday through Saturday Program Format • OPTIONAL SAMs Study Workshop on the Care of the Vulnerable Elderly on Thursday, April 14, 2:00 pm to 8:00 pm • CME Lectures begin Friday, April 15, at 8:30 am • OPTIONAL Workshops on Friday, April 15 from 6:30 pm to 8:00 pm • CME Lectures continue Saturday, April 16, 8:00 am to 3:45 pm

GREAT TOPICS • SAMs Study Group of Elderly Patients • CME Lectures on Key Topics • Optional Workshops on COPD Diagnosis and PCMH • Full slate of Academy Business Meetings

DOWNTOWN WINSTON SALEM • Shop - Dine - Play in the heart of Winston-Salem!

On The Cover: Dr. Lord’s inaugural address. Photo by John Lord of John Lord Photography, Concord, NC.

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

2010-2011 NCAFP Board of Directors NCAFP Executive Officers President Richard W. Lord, Jr., MD President-Elect Brian R. Forrest, MD Vice President Shannon B. Dowler, MD Secretary/Treasurer William A. Dennis, MD Board Chair R.W. ‘Chip’ Watkins, MD, MPH, FAAFP Executive Vice President Gregory K. Griggs, MPA, CAE Robert Lee Rich, Jr., MD Past President (w/voting privileges)

Volume 7

The North Carolina Family Physician

Number 1

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

Family Medicine: Embrace The Journey..................................................... 4 The State Budget and Medicaid are Top Legislative Priorities for Academy ........... 6 Today’s Era of Change Offers Great Opportunity for Family Medicine.................... 9

The District Directors District 1 R. Kevin Talton, MD District 2 Matthew M. Williams, MD District 3 Scott E. Konopka, MD District 4 Pending Appointment District 5 Rhett L. Brown, MD District 6 James W. McNabb, MD District 7 Thomas R. White, MD At-Large Pending Appointment At-Large Holly Biola, MD IMG Physicians Constituency Nalini S. Baijnath, MD Minority Physicians Constituency Enrico G. Jones, MD New Physicians Constituency Nadine B. Skinner, MD FM Department Constituency Kenneth K. Steinweg, MD FM Residency Directors Gary I. Levine, MD Resident Director Nicole Shields, MD (SR-AHEC) Resident Director-Elect Matthew Kanaan, MD (Duke) Student Director Amy Marietta (UNC) Student Director-Elect John Trimberger (WFU) 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

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

NCAFP Council Chairs Advocacy Council

Robert L. Rich, Jr., MD, Chair Wiliam A. Dennis, Vice-Chair Continuing Medical Education Council James McNabb, MD, Chair Health of the Public Council Thomas R. White, MD, Chair Practice Enhancement Council Rhett L. Brown, MD, Chair

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

2011 NCAFP Spring Meeting will Feature Convenient Schedule.........................10 Jesse C. Pittard, MD, Named 2010 NC Family Physician of the Year...................11 Advanced Primary Care Demonstration Will Build Upon CCNC’s Success..............15 Sections

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

Residents & Students..................................12

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

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

Chapter Affairs................................. 11.

Family Medicine in Practice............................. 15

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.

www.ncafp.com/academy/publications/advertising Ed i t i o n 25

WWW.NCAFP.COM

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

North Carolina ACADEMY OF Family PhysicianS, INC

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NCAFP President’s Message

~ 2011 PRESIDENTIAL MESSAGE NO. 1 ~

Family Medicine: Embrace The Journey On December 4, 2010, Dr. Richard Lord, Jr., was installed as President of the NCAFP. his inaugural address appears below. A video summary of his speech can be viewed online at www.ncafp.com/video

Richard Lord, Jr., MD 2010-2011 NCAFP President

Dr. Lord is a graduate of the Bowman Gray School of Medicine in Winston-Salem. He completed his residency at Rush/ Christ Family Practice Residency in Chicago, IL. Dr. Lord was an assistant professor of family medicine at Bowman Gray and Rush/Christ Family Practice Residency. He was in private practice for three years in Virginia before returning to North Carolina. Dr. Lord has been active in the NC Academy for a number of years, serving in various leadership roles, including most recently as Chair of the CME Committee. He is presently on the faculty at the Wake Forest School of Medicine in Winston-Salem.

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First, I want to thank all of you for allowing me to have the privilege to be a voice for the 2,749 family physicians and our patients all across the great state. Let’s look at some of what is going on. We have a state legislature that is now in Republican hands for the first time in 140 years.

We have a budget deficit in the state that may reach $3.5 billion dollars. We have increased numbers of individuals who have difficulty accessing care due to their finances. We have the Accountable Care Act, with its different requirements, the Meaningful Use criteria for EHR, we have PCMH, ACO, proposed new methods of payment, scope-of-practice issues, potentially a 23% cut in Medicare payments.

Let me say -- it’s a great time to be a family physician!

Before you think I have gone crazy and you need to find a replacement for me, let me explain myself.

As I thought about what I wanted to share with you today, I did not want to stand up here and tell you how this is a period of unprecedented change. I believe we are better served to focus on our careers as Family Physicians as a journey.

I say this because of what I have experienced in my now 20-years in practice.

When I matched into Family Medicine in 1988, that Wednesday was called ‘Black Wednesday’ for Family Medicine. However, as managed care brought change to our system by 1997, we had 17.8% of medical students choosing family medicine. We had to change the way we operated in our offices in order to handle the managed care contracts and billing. Many physician practices were bought by health systems, only later to be jettisoned, and now they are being bought once again.

I believe that we as physicians can lose our

January-march, 2011 | the North Carolina Family Physician

joy of practice if we expect that just one more period of change to make it through, and then, the way I practice will not have to change for the rest of my career. You see, if we lose our perspective and enjoyment of the practice of medicine, we lose, our patients lose, our families lose, and our communities lose. We can all think of individuals we have worked with who have been able to make this journey and maintain their love of medicine, and others that were completely downtrodden at the end of their careers.

My goal for the NCAFP over the next year is to lay a foundation that will provide the environment to help all of us not just survive through the coming changes, but to thrive because I believe that having a vibrant, thriving group of family physicians all across our state is the best way to insure improved health to the population at a cost which everyone can afford.

Any journey takes planning and effort to make sure that we end up where we want to go.

First, we need to know where we are right now and then where we want to end up. Only then can we make the necessary plans to get there. Any journey can have unexpected problems that crop up. Let’s look at where we are right now as a group.

As family physicians we provide frontline access to health care regardless of age, sex, or health problems. We are able to deal with the uncertainties that come with trying to diagnose an illness early in its course. We are there over the long-term and develop a relationship with a patient that is unique to primary care. This was impressed upon me recently as I sat in my office talking to a patient that I have cared for over the past 8-years and who recently had been diagnosed with metastatic pancreatic cancer. I also care for his wife who would have ended up in a

WWW.NCAFP.COM

nursing home many years ago except for the herculean effort he has made. You see, not only did he want to discuss with me his prognosis, but with tears in his eyes, wanted to discuss how he could make sure his wife would be cared for after his eventual death.

I could not change his diagnosis nor cure his medical problem, but I could be there as part clinician, part friend, to an 88 year-old individual. That’s who we are as Family Physicians. Our training has provided us the ability to practice high tech medicine always mixed with high touch medicine. No matter what happens over the next several years with health system reform, one thing that will not change is the value of the doctor-patient relationship in an individual’s life.

In a recent survey when individuals were asked about important relationships in their lives, having a doctor was ranked right after family and right before pastors. Sorry, Pastor Kelly. Our patients want us there and we will never be able to fully measure the impact we may have on their lives.

Graham Center data shows that without Family Physicians providing primary care in North Carolina there would be approximately 80 counties that would meet the requirements as a Primary Care Physician Shortage Area.

Our specialty colleagues, when asked by the AAFP, view us as masters at dealing with uncertainty. This ability is what many of us would call watchful waiting or a therapeutic trial. There is a lot for us to celebrate as family physicians.

What is the end destination? Right now it is the Patient-Centered Medical Home.

Ultimately, I believe our destination has to be providing the best care we can to the individuals and communities we serve.

The future may hold different models and organizations of care, but if we keep this destination in mind, we can base our decisions on whether this helps us reach this destination or not.

As we move forward with this journey we need to recognize that we will need one WWW.NCAFP.COM

another’s help. There are some in this room who have received NCQA recognition as a Patient-Centered Medical Home and others who are just trying to keep the doors of the practice open. There are many of you who own your practice, while many of our new graduates are becoming employed physicians. Some of you are Hospitalists, some of you are just hoping to graduate medical school and start making a little money. We all need to learn from one another and recognize that while we may all be heading to a similar destination, we may all get there in a little different way.

Many of the leaders in our specialty have said, ‘when you’ve seen one medical home, you have only seen one medical home.’ I want to encourage you to use the relationships you have here and back home to help you along this journey. Any trip can have pitfalls. Right now there are several issues that we will face over this next year that could potentially derail us from reaching our destination. This is where the Academy will put its efforts over the next year to help us along the way.

The Budget Deficit. First and foremost is the state budget deficit. Right now predicted to be $3.5 billion, it is hard to see how we will not see a cut in Medicaid payments this year. A major concern is protecting Community Care of North Carolina (CCNC), a nationally recognized model that supports the medical home model while improving care and saving money. There was a survey recently sent out to all NCAFP members that will help us provide information to the legislators about the impact cuts would have on the health of the population.

Protecting CCNC will not be something the leadership of the Academy can do alone. We need all of you to contact your legislators and encourage them to not dismantle this nationally recognized model-of-care.

Representing Family Physicians. The Academy’s leaders will work tirelessly on your

behalf to evaluate and develop positions on legislation that are in keeping with our core values and will be seeking your input and action to help us maintain an environment where we can provide the best care possible to our patients. As part of our efforts to represent you at in the legislature, we will be exploring new ways to use social networking technologies to keep you engaged and provide you with useful up to date information.

Collaboration. During the coming year we will be reaching out to other associations in the state in order to develop collaborations with other medical specialties and allied health professions. While we will not agree on all policies, as financial pressures on the health system become greater in the next several years, we will not serve our patients needs if we are fighting between one another instead of collaborating to support policies that enhance the medical home model across the state.

Continuing Education. On the education front we will continue to provide the membership with CME that will allow us to offer the latest in diagnosis and treatment of illness. We will continue to develop educational topics that will help you in determining the best way for you to begin or continue your journey towards the medical home.

Leadership Development.

The Academy will continue to work with residents and students to develop our future leaders.

My hope is that 2011 will be the year that the Academy provides a foundation that will grow in the coming years to help us all not just survive, but to thrive, as we continue on our journey.

I want to assure you that I will represent the Academy membership and our patients with integrity and a steadfast commitment to furthering our mission as an Academy.

Thank you once again for this wonderful opportunity you have entrusted to me.

North Carolina ACADEMY OF Family PhysicianS, INC

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advocacy

Campbell University Names Founding Dean of Proposed Osteopathic Medical School School Leaders Vow to Focus on Primary Care Needs of the State

The halls of the NC General Assembly will be busy and challenging for health care in 2011.

The State Budget and Medicaid are Top Legislative Priorities for Academy State lawmakers are facing an approximate $3.8 billion budget deficit and it appears that this year’s legislative session will be a very trying time for the House of Medicine -- particularly for Medicaid and Community Care of North Carolina (CCNC). Physician payment rates and optional Medicaid services will be two areas that lawmakers will likely target as they look to cut spending. North Carolina’s state budget deficit mirrors the difficulties facing many other states, and although not a bad as some, the percentage of the total budget this deficit represents is very significant.

Across the nation several states have already proposed either significant provider rate reductions or complete overhauls of their Medicaid systems to help them address huge budget deficits. While North Carolina’s Medicaid program is well-managed and serves as a model for other states in many ways -particularly due to CCNC and its effectiveness at containing costs and improving quality -- the Legislature is near certain to consider provider rate and service reductions to save money. Even a complete privatization of the program may be proposed. There are a lot of uncertainties.

NCAFP’s government relations team has been very busy discussing this issue with the new legislative leadership teams in both chambers, including those in place on the committees dealing with healthcare and healthcare appropriations. Throughout these discussions the Academy is presenting practical, nuts-and-bolts information to explain the many possible impacts cuts would have on family physicians and primary care practices.

For instance, legislative leaders are being told how provider rate reductions will increase 6

the financial burdens of practices, may reduce overall access by forcing physicians to limit their Medicaid populations, and may even require physicians to cut visit times and/or see more patients daily. Apart from these patient-level impacts, the very real possibility of wide scale administrative staffing reductions could also add to the level of unemployment across many communities, particularly small rural ones.

The Chapter is also advocating in a number of other ways in spreading the message. Several NCAFP officers and staff attended opening day at the NC General Assembly on Jan. 26th and participated in the opening night Legislative Reception sponsored by the Association Executives of North Carolina. Representatives are also attending various committee meetings, have agreed to share testimony if called upon, and are working closely with other groups in the House of Medicine to present the concerns of physicians. NCAFP leaders have also attended several fundraisers and made contributions from FAMPAC, the Academy’s Political Action Committee.

But member participation is also critical!

To deliver our message, every member needs to raise their voices. The Academy calls upon members frequently to help us communicate and advocate for family medicine. As this legislative session continues to unfold, please consider joining in. Many members -- over 300 -- participated in the Chapter’s 2010 Medicaid Survey that provided excellent information we’ve been communicating. But it’s expected more engagement will be needed. Please look for additional calls-to-action and respond.

These often require only a few short minutes, but can be extremely effective.

January-march, 2011 | the North Carolina Family Physician

Campbell University has named John M. Kaufman, Jr., DO, as the founding Dean of the proposed College of Osteopathic Medicine.

Dr. Kaufman previously served as Vice Dean of the Virginia College of Osteopathic Medicine. Campbell is finalizing a feasibility study for the program and asked the NCAFP to write a note supporting the need for more primary care physicians in North Carolina.

Recently, NCAFP Executive Vice President Greg Griggs, MPA, CAE, had an extensive meeting with Dr. Kaufman, as well as Ronald W. Maddox, Pharm.D., Campbell’s Vice President of Health Programs, and Thomas P. Colletti, MPAS, PA-C, Program Director for Campbell’s Physician Assistant Program.

During the meeting, the leadership of the proposed program reiterated their desire to focus on the primary care needs of the state. The school’s leadership also indicated a strong willingness to work with the Academy, as well as the state’s existing medical schools and residency programs.

In a letter to the school, NCAFP leaders stressed the importance of building the state’s primary care workforce and noted that Campbell’s new College provides an excellent opportunity to train more family physicians for NC. Signed by NCAFP President Rich Lord, Jr., MD, the letter noted that osteopathic medical schools have a long track record of producing primary care physicians and Campbell’s real potential to increase the number of students remaining in-state for their residency training and ultimately to practice in North Carolina.

It is estimated that by 2020 North Carolina will need an additional 2,000 family physicians to serve the needs of the state.

According to Campbell, more than eight hundred osteopathic physicians currently practice medicine in North Carolina, and 80 NC residents are currently enrolled in various osteopathic medical schools located throughout the country.

Campbell will seek accreditation by the Commission on Colleges of Osteopathic Accreditation, with an anticipated opening date of August, 2013. Architectural planning is already underway for a proposed 85,000 square foot facility that will house the school.

WWW.NCAFP.COM

~

P O L I T I C A L

A C T I O N

C O M M I T T E E

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F A M P A C

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Is This The Best We Can Do -- Just $13,500 for our PAC?

By Dr. Holly Biola, MD

As physicians, we get so bogged down in our it. Money buys ads, hires lobbyists and generally day-to-day, patient-to-patient, busy lives that helps get the word out about the interests of sometimes it is hard to see the forest for the Family Physicians. trees. In this case, that forest is the world I would have thought with the number and in which we caliber of Family Physicians practice. We are “Family Physicians should be in NC that we would have a fortunate to live in a powerful people. Our patients trust strong, well-funded Political country that allows for Action Committee. Sure, us. Our communities respect the general citizenry we don’t get paid as well to participate in the us...but we do not have much as the specialists, but we political process that aren’t poor, and goodness political power because we do decides who governs knows we are smart. The not invest in politics.” us. However, it is Anesthesiologists in our possible to have more state have at least a dozen influence than just the one vote we cast at the ballot box.

Political Action Committee Contributions Family Physicians should be powerful people. Our patients trust us. Our Trial Lawyers $ 534,000 communities respect us...but we do not Anesthesiologists $ 400,000* have much political power because we do not invest in politics.

Chiropractors $ 236,000 We all know that money is not Nurse Anesthetists $ 93,000 supposed to buy influence in our Family Physicians $ 13,500 government...but we should not be so naive as to think that our noble Source: North Carolina State Board of Elections. * Cumulative total estimate. ideals will be promoted loudly without

FAMPAC

2011 Chronic Disease Day

Empowering Family Medicine in North Carolina

at the Legislature

Support Your State Political Action Committee!

Donate Today at www.ncafp.com/fampac

WWW.NCAFP.COM

different PACs, which in the 2010 election cycle had combined contributions of just under $400,000. The Chiropractors have two PACs that raised over $200,000 and the Advocates for Justice PAC (a.k.a. Trial Lawyers)? They raised just over half a million dollars!

Where does our PAC fit into that mix? With now over 2,900 members spread across this state representing the largest medical specialty in North Carolina, we managed to raise only $13,500 in that same two-year period.

When I heard that our PAC had raised less than $5 per member, I was shocked.

Is this really the best we can do?

We probably have all given at one point to a cause or a candidate we believed in...but don’t we believe in Family Physicians?

Please support the future of Family Medicine in North Carolina.

Give to FAMPAC and make it a habit to do so. Your dollars contributed to the PAC are second only to your dues dollars in providing funds to help the NCAFP support you and your practice. To make a contribution or learn more, please take the time to visit www.ncafp.com/fampac.

Heart disease, stroke and chronic disease reduction efforts continue to be a key focus area for the Academy.

Chapter leaders and staff will be representing family physicians during the 2011 Chronic Disease Day at the Legislature in late March, 2011.

Stay Tuned for Info

North Carolina ACADEMY OF Family PhysicianS, INC

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$12.5 Million Dividend Declared in 2010!*

Stronger than ever.

Physician Ownership and Leadership • Financial Stability

Call MAG Mutual’s David Haliburton toll-free at 1-888-892-5218 or visit us at www.magmutual.com. *Dividend effective June 1, 2010. Dividend payments are declared at the discretion of the MAG Mutual Insurance Company Board of Directors.

C H A P T E R

E X E C U T I V E ’ S

M E S S A G E

Today’s Era of Change Offers Great Opportunities for Family Medicine Family Physicians are needed now more than ever! the state continues to face an unprecedented As a noun, change is described as a transition need for primary care physicians and other from one phase to another or the replacing primary care providers. And a number of our of one thing for another. As a verb, it’s educational institutions have reacted to try to fill described as: to cause to be different or to that need, most recently with the announcement alter. of a new D.O. school at Campbell University.

One thing is for certain, in our current So where does all this leave you, the state’s environment, change is inevitable. The family physician? question is simple: will change be something I believe it leaves you with great opportunity. we let happen to us or something we You are needed now more than ever. You influence. As your professional association of are the key to the director of the Center for now over 2,900 members in NC, and more Medicare and Medicaid Services’ triple aim: than 97,000 nationally, I hope we can shape improving the experience of care, improving change to benefit you and your patients. the health of populations, and As we enter a new year, reducing per capita costs of change is all around us. It “Change is tough. health care. seems like there are new But I challenge you The experience of care is acronyms every day: from best when every patient has a ACOs (Accountable Care to help us make sure personal relationship with a Organizations) to the family physician. Our state’s PCMH (Patient-Centered that family physicians own innovative program, Medical Home), Healthcare influence change and Community Care of North Reform continues to bring Carolina, is showing how to a new set of terms and are not victims of it.” improve the care of entire variables. And some would populations. And primary care say it’s like going “back to the future” with a return to some of the tenets is the answer to lower costs. We don’t need more procedures and more technology. We of managed care. need more prevention and more primary care!

Both our state and nation have also Change is tough. But I challenge you to help faced unprecedented financial hardships us make sure that family physicians influence through what is now referred to as the change and are not victims of it. Get involved.

“Great Recession.” Most of us have never When we ask you to call your legislator, make experienced an economic downturn like we the call, not once but twice or even more. have seen in the past few years. And it has Give to your Political Action Committee left both national and state governments (FAMPAC). Educate yourself. Learn about facing very tough decisions about major ACOs. Become an NCQA Recognized Patient budget cuts. While for better or worse the Center Medical Home. And use the tools that federal government can print new money the Academy offers you such as our website’s and raise debt ceilings, there are no such PCMH resources or the White Paper on solutions at the state level. And over the Physician Hospital Affiliation options that we next six months, the state Legislature will commissioned and had the prestigious law firm likely cut the better part of $3.7 billion from Smith Anderson complete on our behalf. a state budget of about $18 billion (about 20 I can guarantee you one thing: the NCAFP percent). will be here to help you navigate the change.

At the same time, health care systems are Change will happen. But help us make family merging across North Carolina and once physicians influence change instead of falling again buying private practices is a reaction victim to it. The opportunity is yours: take to some of this change. Fewer community advantage of it. hospitals stand independently and systems seem to only get larger every day. In addition,

WWW.NCAFP.COM

Gregory K. Griggs, MPA, CAE Executive Vice President

Representing You! Below is a sampling of the ways the NCAFP works to represent family medicine in North Carolina.

NC Health Reform Advisory Committee, chaired by DHHS Secretary Lanier Cansler and NC Insurance Commissioner Wayne Goodwin.

State Health Workforce Planning Grant, Workforce Intermediary Committee Justus-Warren Heart Disease & Stroke Prevention Task Force Eat Smart Move More North Carolina Center of Excellence in Integrated Care Partners Meetings NC Immunization Coalition NC Medical Society Quality and Health Care Financing Committee NC Medical Society Mental Health Committee State Health Directors Annual Meeting Emerging Issues Forum on Health Care State Health Plan Wellness Summit

North Carolina ACADEMY OF Family PhysicianS, INC

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EDUCATION & DEVELOPMENT www.ncafp.com/sfpw

~ M E E T I N G S

&

E V E N T S ~

2011 NCAFP Spring Meeting will Feature Convenient Schedule Thursday thru Saturday format makes attending easy!

The Academy is excited to be holding its annual Spring Family Physicians Weekend in Winston-Salem, NC, on April 14-16, 2011.

The conference takes place at The Embassy Suites Hotel in the heart of Winston-Salem’s vibrant downtown ‘Twin City Quarter’ entertainment district. Program Chair Dr. Alicia C. Walters has assembled an outstanding educational program that will feature an excellent line-up of learning activities packaged in a convenient new schedule. The conference officially begins on Thursday, April 14, 2011, with an optional SAMS Study Group course on Care of the Vulnerable Elderly at 2:00 pm.

General Session CME lectures officially begin Friday morning at 9:00 A.M. and run until 6:45 P.M; sessions continue on Saturday until 3:45 P.M.

The Spring Meeting is happening in the heart of downtown Winston-Salem’s Twin City Quarter.

PLAY - Tons of activities within walking distance -- art, music, movies and history galore

SHOP - Huge amount of shops, galleries and studios.

DINE - Pubs to fine cuisine, casual to formal. All within a short stroll downtown!

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April 14-16, 2011

at The Embassy Suites Winston-Salem in the Twin City Quarter - Winston-Salem, NC

Fantastic CME in a Shorter Format

This year’s meeting will present another engaging array of topics but will use a shorter format. The educational portion of the meeting is scheduled to wrap on Saturday afternoon at 3:45 p.m. instead of on Sunday morning. This adapted and more condensed format aims to make attending the meeting as convenient as possible for all types of busy schedules. Some General Session topics slated to be presented include Update in Asthma Management; Contraception; Optimizing Fracture Prevention; and Heart Health. More topics still need to be finalized; please visit www.ncafp. com/sfpw for an up-to-date topics listing.

Centered Model of Care, and a workshop discussing Chronic Obstructive Pulmonary Disorder and the use of spirometry to diagnose this condition effectively. Please refer to the meeting website at www.ncafp. com/sfpw for complete information on each of these.

Activities in Winston-Salem

The Spring Meeting’s venue is located right in the heart of Winston-Salem’s vibrant ‘Twin City Quarter’ entertainment district.

The Quarter is alive with trendy restaurants, Optional Learning Activities stylish shops, arts and entertainment. It’s only a short distance to a number of other The Academy is continuing to expand the attractions in the Winston-Salem area, such variety of learning activities we pack into our as Wake Forest University, Winston-Salem meetings based upon the feedback we receive State University, and historic Old Salem. On from attendees. Each meeting’s optional Friday night, be sure to take advantage of the workshops and satellite modules provide Downtown ‘Dine-Around’ where you’ll enjoy focused learning in small group formats. The the abundance and full flavor of Winston2011 Spring Salem’s best downtown restaurants.

Meeting will The “Winston-Salem Guru” will offer a number be on-site Friday morning to What is a SAMs Study Group? of options. assist anyone in making dinner Beginning on Physicians who have entered the ABFM reservations and to answer Thursday, April Maintenance of Certification cycle come questions about the downtown 14th at 2:00 together to complete the knowledge scene. On Saturday, attendees pm, another assessment section for the MC-FP SAM who are staying overnight can popular SAMs requirement (Part II). After completing take advantage of exploring Old Study Group the working group session, NCAFP staff Salem and soaking up the early will be presented, report your answers to the ABFM. Your American history in a self-guided titled ‘Care of next step is to go to the ABFM Web site, tour. Old Salem portrays daily life the Vulnerable pay the necessary fees, and complete the in the 18th & 19th centuries in a Elderly.’ The cost clinical simulation section. The clinical park-like setting. And for new to attend is $125 simulation section presents patient care physicians, residents and students, scenarios corresponding to the topic for registered a Friday night mixer should module. Following these steps enables attendees/$175 offer plenty of meet-and-greet you to complete Part II of the MC-CP. for all others. opportunities for all!

Additional Please don’t miss this great optional learning opportunity in the heart workshops to of the Triad.

Complete and up-to-date be presented include a faculty development information on the 2011 Spring Family workshop for existing and prospective family Physicians Weekend is available online at medicine preceptors (See p. 14 for info), a www.ncafp.com/sfpw.

TransforMED workshop on the Patient-

January-march, 2011 | the North Carolina Family Physician

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Web-Based CME Program on Cancer Care Gets Updated The Academy recently launched an updated version of its online continuing medical education course on cancer care, titled ‘What Every Family Physician Should Know About Cancer-2010 Update.’ This course was originally made available in early 2009 and has been updated to reflect a number of current advancements. As family physicians continue to occupy a central role in caring for patients at all points along the continuum of cancer care, course presenter Dr. Amy Denham, MPH, uses both audio and video to describe the epidemiology of common cancers, review current recommendations for prevention and early detection of common cancers, explain some recent developments

in cancer prevention and control, and present resources that are available in NC to assist patients with cancer prevention and early detection. All NCAFP members can access this program free-of-charge at the Chapter’s website at www.ncafp.com/cancer. Completion of the program is acceptable for up to 1.5 Prescribed credit(s) by the American Academy of Family Physicians. This course has been made possible by a grant from the North Carolina Comprehensive Cancer Program of the North Carolina Division of Public Health.

2011 Mid-Summer Meeting July 3-9, 2011 in Myrtle Beach, SC ~Watch for Additional Info~

Log-on and learn at www.ncafp.com/cancer

chapter affairS

Jesse C. Pittard, MD, Named 2010 NC Family Physician of The Year Smithfield Family Physician honored for lifetime of care, practice development and medical leadership Personalized health care that’s based on serving families and built upon long-lasting, personal relationships. This is the core philosophy of Dr. Jesse C. Pittard, a family physician from Smithfield, NC, and the recipient of the 2010 North Carolina Family Physician of the Year Award. The Academy honored Dr. Pittard with the award during a brief ceremony in Asheville in early December during the 2010 Winter Family Physicians Weekend.

“The continuity of patient care, the multi-generational care, the broad spectrum of care we offer hasn’t changed a lot since day one,” commented Dr. Pittard when asked about how he’s seen his practice adapt over the years.

Dr. Pittard founded Horizon Family Medicine in 1980 (formerly Smithfield Family Medicine) and has grown his practice to include 12 physicians, 50 staff members, and clinic sites in Smithfield, Clayton, Four Oaks and Princeton, NC. Horizon offers a full-scope of patient and family healthcare services in an easy-to-access format for patients.

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Throughout his medical career, Pittard has been a leading advocate for patient-focused, high quality care that’s highly personalized. This philosophy has been central to Dr. Pittard’s approach in developing his practice.

In addition to serving patients, Dr. Pittard has been active in the leadership with the Johnston County Medical Society, as well as Johnston Medical Center throughout his career.

“A gratifying part of my career has been my involvement with my local hospital and in the various offices I’ve held,” Pittard commented. Beyond his service to the hospital, Dr. Pittard has served his local community as a founding member and pianist of ‘The Vintage Accents,’ a multi-piece ensemble that has performed at numerous community events.

While Dr. Pittard has kept an extremely demanding schedule as a rural family physician

and small business leader, he’s never compromised his patient’s needs, their location or anything else. This belief is evident in the scope and breadth of his practice’s services, their locations and how they’re run.

Dr. Pittard obtained his undergraduate degree from Duke University in 1973, attended medical school at UNC-Chapel Hill, and completed his residency training at Wake Forest University in 1980. He is a Fellow of the American Academy of Family Physicians, serves as a family medicine preceptor to medical students from all state-based medical schools, and is a member of the Coalition for the Advancement of Cardiovascular Health.

Dr. Pittard currently resides in Smithfield with his wife of 36-years, Cynthia, and has two grown children, Jonathan and Bradley.

North Carolina ACADEMY OF Family PhysicianS, INC

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~ M E M B E R S H I P ~

NCAFP Leads Large AAFP Chapters in Member Retention AAFP Membership at All-Time High Great news -- North Carolina led the nation in membership retention among large AAFP chapters with 97.2% of all members renewing this membership cycle (2010-11). The only other statistically higher retention rate achieved across the entire AAFP federation was by the Guam Chapter with its 22 members; the NCAFP has over 2,900 members. Coinciding with this achievement was AAFP’s success in overall membership growth. The AAFP captured increases in all major membership categories compared with 2009 levels. AAFP’s total membership now stands at over 97,600 members and represents an all-time high.

M ember N e w s & B rief S

Sanford FP John Magnum is 2010-11 NCMS President Dr. John Magnum, a family physician from Sanford, NC, was installed as the 2010-11 President of the North Carolina Medical Society (NCMS) in late October. A brief video summary of a portion of Dr. Magnum’s remarks are available at www.ncafp.com/video. In other news related to the NCMS Board, NCAFP Past President Michelle F. Jones, MD, (2007) was elected as an At-Large Member.

Dr. Jones will be serving a two-year term.

Dr. Jim Jones Receives CCME’s Reginald Harris Award NCAFP Past President Jim Jones, MD, (1973) was awarded the T. Reginald Harris, MD, Memorial Award by the Carolinas Center for Medical Excellence (CCME). CCME created the award to honor the life and work of Dr. Harris and is bestowed to an NC physician to recognize outstanding achievements in the areas of health care quality and service to the medical community.

Dr. Jones’ acceptance remarks can be seen at www.ncafp.com/video. Congraulations!

RESIDENTS & sTUDENTS

Resident & Student Sections Elect New Leaders The NCAFP Resident and Student Sections elected new leaders during the NCAFP’s Winter Family Physician Weekend in Asheville last December. In each of the section’s respective meetings, record numbers of residents and students were in attendance.

Congratulations go out to the following individuals on their election and their commitment to representing their respective constituencies. The NCAFP wishes to thank all of these leaders for their willingness to serve and their passion to impact family medicine.

www.ncafp.com/residents_and_students

~ Upcoming Events ~

2011 Family Medicine Day will Focus on the Residency Recruiting Process Set for Saturday, May 21st, 2011 The NCAFP’s 5th-Annual N.C. Family Medicine Family Medicine Day this Day May 21st is expected to be another great event for medical students. The event is returning to the same location (Millennium Hotel in Durham) as last year and will feature similar skills workshop options, along with a great lecture on the residency recruiting process. All NC family medicine residency 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 2012. Student members of the AAFP will be receiving information in the mail soon. Visit: www.ncafp.com/fmd2011 for additional information.

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ATTENTION RISING 3RD AND 4TH YEAR MEDICAL STUDENTS

Sat., May 21, 2011 • 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 - graduating in 2012 or 2013

•

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

• Lumbar Puncture

• Knee Examinations & Injections

• Ultrasound in OB & Sports Medicine

• OB Perineal Laceration Repair

For complete information and online registration please visit http://www.ncafp.com/fmd2011

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.

NCAFP Resident Director................................................................. Nicole Shields, MD (SR-AHEC) NCAFP Resident Director-Elect ����������������������������������������������������������Matthew Kanaan, MD (Duke) Foundation Resident Physician Trustees ������������������������������������������Jedlyn Pierrilus, MD (SR-AHEC)

Mo Shahsahebi, MD (Duke) NCAFP Board Student Director ������������������������������������������������������������������������Amy Marietta (UNC) NCAFP Board Student Director-Elect ��������������������������������������������������������� John Trimberger (WFU) Foundation Board Student Trustees ����������������������������������������������������������������������� Ben Kirkley (UNC)

Amy Shipley (ECU)

New Physicians, Residents & Student Mixer - April 15th at Spring Meeting - See meeting details on Pg. 10.

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January-march, 2011 | the North Carolina Family Physician

WWW.NCAFP.COM

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~ Student Highlights ~

HEALTH IMPROVEMENT

Duke’s Nailah Adams Named AAFP Regional FMIG Coordinator Congratulations to Nailah Adams (Y3) of Duke University on her recent appointment by the AAFP to serve as the Region 5 FMIG Regional Coordinator. Ms. Adams’ term runs from Jan. 1-Dec. 31, 2011. Along with her AAFP involvement, Ms. Adams is a current Albert Schweitzer Fellow and also co-leads the school’s Student National Medical Association. FMIG Regional Coordinators serve as important communications contacts among state FMIG groups. For more information on this and all leadership positions with the AAFP, visit: http://fmignet.aafp.org and click ‘Get Involved.’ ~ Preceptor Development ~

Spring Meeting to Present Faculty Development Workshop for Preceptors A faculty development workshop for Active and Prospective Medical Student Preceptors will be held at the Spring Family Physicians Weekend in Winston-Salem on Saturday, April 16, 2011 from 3:30 pm to 5:30 pm.

This workshop is a great opportunity to meet with other practicing physicians who have a passion for teaching and molding the next generation of Family Physicians. If you are thinking about precepting students but have questions, this workshop is for you.

Attendance is free and you DO NOT have to be a registered conference attendee to participate. Advanced registration is required.

Please visit our website for more details at www.ncafp.com/sfpw.

Call for Master Preceptors!

The selection process for 12 scholars from current 1st year medical students is underway. If you are interested in applying to participate as a Master Preceptor, now is the time! Information about the program and an application can be found here at www.ncafp.com/ scholars-program. Deadline to submit application to participate with this year’s class is 2/14/11. Notification of selection to participate will be in April. Please direct inquiries to Tracie Hazelett at the NCAFP, 919-833-2110 or thazelett@ncafp.com.

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~

H E A L T H

D I S P A R I T Y

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Disparities Initiative Utilizing Practice-Based Assessments to Improve Care in Guilford County Well into its second year, the NCAFP/F’s Health Disparities Initiative is collaborating with several community organizations and medical practices in Guilford County.

Through a partnership with the Greater Greensboro Society of Medicine and the High Point Medical Society, three practices have been recruited to participate in an intensive practice-based initiative which includes an assessment of compliance with the Culturally and Linguistically Appropriate Service (CLAS) standards, staff trainings and guidance in implementation with CLAS and other quality improvement strategies.

The NCAFP would like to thank the following practices for their participation in the Health Disparities Initiative: Bland Clinic, PA; Family Practice Center and Sports Medicine Center of Moses Cone Health System; and Henry H. Dorn, MD, Obstetrics Gynecology.

These practices have made the commitment to improve policies and practices in their offices to contribute to the efforts to improve the quality-of-care for disparate population groups in Guilford County. They will also collaborate with other local organizations representing

minority populations in order to decrease health disparities at the community level.

A fellow Health Disparities Initiative grantee in the Greensboro area, the Piedmont Health Services and Sickle Cell Agency, is targeting African American and Hispanic adult men and women to educate and screen males for prostate cancer; and females for breast cancer and cervical cancer.

This project, titled “Cancer Prevention for Minority Populations through Education and Screening,” provides free screenings at the Wellness Clinic. Patients are then referred to their primary care provider.

Piedmont Health Services and Sickle Cell Agency’s mission is “to provide outreach, education, screening and case management for people with high-risk health problems.”

They currently serve the following counties: Guilford, Forsyth, Alamance, Rockingham, Randolph and Caswell.

For more information related to the Health Disparities Initiative, please contact Jennifer Danai at jdanai@ncafp.com, or 919-833-2110.

NCAFP Presents Potential Collaboration Areas to NC Stroke Task Force Heart disease and stroke continue to be major killers in North Carolina, ranking as the second and third leading causes of death in the state. The NC General Assembly recognized this threat and created The Justus-Warren Heart Disease and Stroke Prevention Task Force in 1995 and tasked it with developing an action plan for reducing heart disease and identifying and disseminating information about the location of primary stroke centers. In January, the Task Force invited the NCAFP to deliver a brief presentation describing Family Medicine in the state and its work building primary care in North Carolina. Chapter representatives took the opportunity to stress several key areas of potential collaboration with the Task Force and describe how many of the strategic goals of the Academy closely correlate to the NC Stroke System of Care Plan.

January-march, 2011 | the North Carolina Family Physician

Academy Executive Vice President Greg Griggs, MPA, CAE, described how the Chapter’s core advocacy themes -- controlling healthcare costs by promoting prevention, improving chronic disease coordination, and reducing the number of uninsured’s -- provide a strong complement to the Task Force’s overall efforts in reducing stroke and heart disease. He also reviewed the strategic mission of the Academy’s Health of the Public Council, explaining that its goals of raising awareness of healthy lifestyle choices, integrated patient-centered care, and its work in equipping physicians with health promotion information/tools, demonstrate family medicine’s strong commitment in reducing chronic disease. Griggs went on to suggest several possible collaboration areas, such as additional educational sessions at the Chapter’s yearly meetings and enhanced dialogues with members and member practices.

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family medicine in practice

P A T I E N T - C E N T E R E D

M E D I C A L

H O M E S

Advanced Primary Care Demonstration Will Build Upon CCNC’s Success Family Medicine Forms Critical Foundation for Innovative Program Last November, the State announced that it had been selected by the Centers for Medicare and Medicaid Services (CMS) as one of eight states to participate in a unique Multi-Payer Advanced Primary Care Practice Demonstration Project.

This innovative public-private partnership program will extend the benefits of the Community Care of North Carolina networks to citizens in seven rural counties whose health coverage is through Medicaid, Medicare, Blue Cross and Blue Shield of North Carolina or the State Health Plan.

work to address the fundamental issues of fragmented, duplicative and uncoordinated care. These issues hinder the successful treatment of patients with multiple chronic diseases. Leveraging CCNC’s existing framework and methodology, this project will extend patient-centered care to both privately insured (BCBS and the SHP) and Medicare patients. Ultimately, the demonstration is seeking to evaluate whether advanced primary care practices -- or patient-centered medical homes -- will reduce unjustified utilization and expenditures, improve the safety, and efficiency

Selected practices will serve as primary care medical homes and will receive Per Patient Per Month payments to assist them with their efforts in improving health outcomes and lowering costs. The project is expected to include nearly 362,000 patients in Ashe, Avery, Bladen, Columbus, Granville, Transylvania and Watauga counties. Any citizen residing in these counties and currently insured by Medicare, Blue Cross or the State Health Plan can enroll in their local Community Care Network as part of the initiative.

of health care, and increase the availability and delivery of care in underserved areas and for large populations. CCNC has been already achieved all of these goals with its primary Medicaid population -- some 990K-- and its healthcare performance bests 90% of all commercial Medicaid managed care organizations on quality measures related to several chronic diseases.

Participating practices in each of the selected counties will have to meet certain requirements to become a medical home.

Patients who participate must be covered under the traditional Medicare, BCBSNC or State Health Plan fee-for-service program(s) and receive their primary care at the participating practice. Individual patients will not be restricted in any way from seeing other providers or from receiving all of the regular Medicare or plan benefits for which they are eligible. Each participating practice will receive a per patient/per month

Leveraging Community Care Community Care of North Carolina (CCNC) has received a number of national recognitions for its work in saving the NC Medicaid program an estimated $1 billion since 2003. It has done this by establishing a network of fourteen locally-managed and physician-run health networks that WWW.NCAFP.COM

stipend for each patient enrolled in this program. CCNC currently works similarly for Medicaid patients and their individual provider practices. These payments assist the practices in embracing key practice design, workflow and quality effort designed to improve and streamline care.

Family Medicine is Central

Family Medicine and family physicians will form the critical foundation for this project.

In a presentation about this initiative given to the NC Institute of Medicine’s Health Reform Quality Workgroup last year, Alan Hirsch, Acting Executive Director of the NC Healthcare Quality Alliance, anticipated that family medicine practices would be the most heavily represented among specialties, comprising over half of the participating provider practices.

The project is targeting overall savings of approximately $37M over the 3-year demonstration period. This will be achieved through reduced inpatient re-admission rates, reduced inpatient re-admission rates from preventable diseases, reduced unnecessary ED utilization, and implementation of EHRs.

North Carolina ACADEMY OF Family PhysicianS, INC

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family medicine in practice

Practice Tracks 2011 Kindergarten Health Assessment Form Available for Download

NC DHHS has updated the NC Kindergarten Health Assessment Form for 2011. The new form is available for download at the NC website at www.ncafp.com/kha2011. Both English and Spanish versions are available. In order to comply with North Carolina GS 130A-440 each child entering Kindergarten must have a health assessment. The Kindergarten Health Assessment (KHA) must not be done more than 12 calendar months prior to school entry and before the 30th calendar day after school entry. It must also be completed on the state KHA form. The goal of the health assessment is to identify health and developmental problems which may interfere with the child’s performance in school.

BCBS of NC Rolls Out Vaccine Administrative/Coding Changes

BCBSNC has updated its pricing and administrative policies for vaccine administration for 2011.

Effective January 1, 2011, new CPT codes for immunization administration, 90460 and 90461, have replaced CPT codes 90465 and 90468. Codes 90471 through 90474 have not changed.

BCBS has confirmed that every vaccine administered is entitled to ONE unit of 90460, PLUS as many additional units of 90461 as there are additional components in that particular vaccine.

BCBSNC has also confirmed that it will recognize the same number of components for each of the vaccines, as well as the corresponding CPT code listed for each in the Vaccine Component and Coding Table. Additionally, V20.2, V70.0, and Vo6.8 ICD-9-CM codes will also be honored when billed in conjunction with the new codes. For additional questions regarding vaccine administration coding and/or fee schedule changes, providers are encouraged to contact their network management representative.

NCTracks to Become NC Medicaid’s Web-Based Management Information System A new web site for providers sponsored by NC’s Office of Medicaid Management Information Systems & Services (OMMISS) has been launched that provides information about the Replacement MMIS called NCTracks. Providers and their practices should review the status of the NCTracks development project, and familiarize themselves with information on preparing their operations for NCTracks when it goes live pending approval by CMS and the State.

Providers can expect periodic releases of useful information, topics of interest for the provider community related to the Replacement MMIS, and answers to frequently asked questions (FAQs). Providers can also submit questions through the OMMISS website about the new system and receive timely responses from appropriate DHHS personnel.

AAFP CMS Still Undervaluing Primary Care Services in Fee Schedule, Says AAFP Dr. Lori Heim of Vass, NC, current Board Chair of the AAFP, sent a letter recently to CMS regarding the undervaluing of certain primary care codes in their updated 2011 CMS Fee Schedule. CPT codes for immunization administration, hospital observation care and maternity care were specifically addressed in her letter. She criticized the agency for disregarding the recommendations of the AMA/ Specialty Society Relative Value Scale Update Committee (RUC) by adopting relative value units (RVUs) that were less than what the RUC recommended. Of particular concern was the cross-walking of values from the old predecessor immunization codes to new codes given the underlying structural differences.

Vaccination coding is being adapted to enable the reporting of counseling per vaccine component rather than per administration. Additionally, CMS reduced the RVUs in the maternity care family of codes in spite of a recommendation to increase their values.

REACH FAMILY DOCS

& 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