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Volume 7 Issue 3 / Summer 2011

quarterly news in north carolina familiy medicine

The Road to PCMH Recognition & Why it Pays for Family Physicians



Summer Advocacy Report


2011 Winter Meeting Preview


Residency Spotlight: Moses Cone


Summer 2011 • Theto NCAMA Family Physician Osbahr Elected Board


2010-2011 NCAFP Board of Directors Executive Officers President Richard 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. Watkins, MD, MPH Past President (w/voting privileges) Robert Lee Rich, Jr., MD Executive Vice President Gregory K. Griggs, MPA, CAE District Directors District 1 - R. Kevin Talton, MD



District 2 - Matthew M. Williams, MD

s Weekend n a i c i s y h P y l i m a F r Winte T WO




District 3 - Scott E. Konopka, MD District 4 - Tamieka Howell, MD District 5 - Rhett L. Brown, MD District 6 - James W. McNabb, MD District 7 - Thomas R. White, MD

Dec. 1-4, 2011 Grove Park Inn & Spa Asheville, N.C.

At-Large Holly Biola, MD At-Large Charles W. Rhodes, MD

ails Det ge 8 a on P5+ AAFP dits

IMG Physicians Nalini S. Baijnath, MD Minority Physicians Enrico G. Jones, MD

e 2 d Cr ribe s e r P

~ Topics Tentatively Include ~ ADHD: It’s More Than Being Hyperactive Update on Gout Management Vaccine Compliance: Efficiency and Cost Effective Office Routines Optimizing Asthma Care: Application of Guidelines for Diagnosis and Management Patient Centered Medical Home Physician Wellness Palliative Care Diabetes SAMs Study Working Groups Satellite Lectures & CME Workshops

New Physicians Nadine B. Skinner, MD NC Family Medicine Departments Kenneth K. Steinweg, MD FM Residency Directors Gary I. Levine, MD Resident Director Nicole Shields, MD (SR-AHEC) Resident Director-Elect Matthew Kanaan, DO (Duke) Student Director Amy Marietta (UNC) Student Director-Elect John Trimberger (WFU)

FM Department Chairs & Alternates Chair (ECU) Alternate (Duke) Alternate (UNC) Alternate (WFU)

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

AAFP Delegates & Alternates AAFP Delegate AAFP Delegate AAFP Alternate AAFP Alternate

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

The NCAFP Family Medicine Councils

Complete meeting information

is online at www.ncafp.com/wfpw

Advocacy Council

Robert L. Rich, Jr., MD, Chair Wiliam A. Dennis, MD, Vice-Chair

CME Council

James W. McNabb, MD, Chair

Health of the Public Council

Thomas R. White, MD, Chair

Practice Enhancement Council

Rhett L. Brown, MD, Chair


The Road to PCMH Recognition & Why It Pays for Family Physicians

~ See Page 18 ~

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 NCAFP strategic plan are located at www.ncafp.com/home/academy/mission




Healthcare Stands Together: Victory on Medical Malpractice Reform............................4 Legislative Session Marked by State Budget and Scope-of-Practice Issues....................6

PUBLISHED BY THE NORTH CAROLINA ACADEMY OF FAMILY PHYSICIANS, INC. R al ei gh, Nor th Ca r olina 27605 919.833.2110 • fa x 919.833.1801 http://www.nc a fp.c om

Winter Meeting in Asheville will be Festive and Educational..........................................8 Residency Spotlight: The Moses Cone Family Medicine Residency Program.................10 Family Medicine Interest and Scholars Program Marks First Anniversary........................13 Family Medicine Can Benefit from Business Concepts Surrounding Customer Service.......15

M AN AG IN G EDITOR & PRODUCTION P eter T. G raber, MMC , CAE, Dir e c tor of Communic a tions

President’s Message............................................... 4 Residents & New FPs....................................................... 10 Executive’s Message. Advocacy & Policy..................................................... 6 Student Interest Initiatives..................................................... 12 Meetings & Education.............................................. 8

Executive’s Message ......................................................... 15. Chapter Affairs.......................................................................16 Practice Management.............................................................18


Healthcare Stands Together: Victory on Medical Malpractice Reform! By Richard Lord, Jr., MD, NCAFP President

To say the least, this has been a contentious session of the NC General Assembly. But in many aspects, it has been a very positive year for the House of Medicine and healthcare in general, culminating with the passage of key medical malpractice reform legislation in late July. It was not an easy task, but through strong partnerships, healthcare prevailed. The N.C. Medical Society and the N.C. Hospital Association both put tremendous resources into the effort, complemented by the work of multiple specialty societies including the Academy’s government affairs team. While the Governor vetoed the legislation that had passed the General Assembly, both the state Senate and the House garnered the votes and political will to override the Governor’s veto. So what exactly does Senate Bill 33 do? Here is a simple summary of the key provisions. The bill:

These two bills will make a significant improvement to the practice environment in North Carolina, while at the same time preserving key patient protection provisions. Without your support – your calls and e-mails to members of the Legislature – this bill would have never been approved, and the Governor’s veto would have definitely not been overridden. I would like to personally thank you for your efforts. This once again shows that when the healthcare community comes together, we can make a difference in our state’s legislative process. This legislative session we were also able to preserve physician rates for Medicaid, preserve our strong physician-led Community Care of North Carolina network, and stand firm that key healthcare (such as immunizations) should be provided in the medical home. I invite you to read more about these significant accomplishments in an article by Advocacy Chair Dr. Chuck Rich on page 6 of this magazine. But as our Government Affairs Consultant Peyton Maynard always says, there are never permanent wins or losses in the General Assembly, only battles, because the next issue is always staring at us around the corner. Given that, I ask for your continued help. Now more than ever, we need to fill the coffers of our Political Action Committee (FAMPAC). I ask that you take a moment and contribute just $100 to our PAC, so that we can continue to stand together for Family Medicine. This year’s session showed us what is possible, but without ongoing financial support for contributions to candidates who have supported our issues, we may not be as lucky when the next battle comes along.

Malpractice Reform

• Places a $500,000 cap on non-economic damages adjusted to inflation with some exceptions for disfigurement, loss of use of part of the body, permanent injury or death when gross negligence occurs. • Establishes new provisions for appeal bonds. • Provides for special rules for claims arising from emergency medical conditions in hospitals requiring that negligence is proven by “clear and convincing” evidence. This provision should be helpful in making it easier to find specialty physicians to take unassigned call in the Emergency Room. • Moves to bifurcation of trials with Phase 1 looking at negligence and Phase 2 looking at how severe the injury was and what damages should be awarded. • Strengthens expert review provisions. • Places time limits on malpractice claims for minors under 10 years of age. These provisions had allowed for filing of a suit up until a minor turned 18, even if the claimed damages occurred at birth. Now, the age limit is 10 unless it is covered by another statute of limitation. A separate tort reform bill (House Bill 542), requires that information on medical claims be based on expenses actually paid. In the past, a jury was only allowed to hear about billed charges, even though the amount actually paid may have been significantly less.


Summer 2011 • The NC Family Physician

Rich Lord, MD President, NC Academy of Family Physicians

~ See More Legislative Coverage on Page 6 ~


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Summer 2011 • The NC Family Physician



Legislative Session Marked by State Budget and Scope-of-Practice Issues By Robert L. ‘Chuck’ Rich, Jr., MD, NCAFP Advocacy Council Chair

Welcome to the summer 2011 Advocacy Council Report. As of this writing, the Republican-led legislature has completed its primary work for this session and the approved bills have gone to the Governor. While many of those bills were signed, a record number were vetoed and the legislature returned to Raleigh in mid-July to consider an override of those vetoes, among other actions. Briefly, I will review the pertinent legislation which passed and highlight NCAFP’s efforts during this session. The primary focus of this legislative session was the state budget and its impact on our members. The legislature ultimately approved a budget that leaves physician Medicaid provide rates - and the core of the Medicaid program - intact, even after the usual yearly discussions of possibly bringing in an out-of-state Medicaid HMO. Community Care of North Carolina was called upon to produce additional cost savings for the coming year as part of the budget deal. Under the leadership of NCAFP Past President Dr. Allen Dobson, it is anticipated that those savings will be obtained. Since Medicaid is an important revenue source for many of our offices, preservation of physician payment rates was a key area of emphasis for our legislative team, especially as initial budget discussions included talk of potential provider cuts of 10% or more. Thanks to the combined lobbying efforts of the NCAFP, the NC Pediatric Society, the North Carolina Medical Society, and the NC Hospital Association, physician rates were left intact, although hospitals did agree to absorb a small reimbursement cut. The next major area of focus during this session was the passage of a significant medical malpractice bill - Senate Bill 33. As passed by the legislature, this bill contained several major changes favorable to physicians, including expert review of all cases prior to proceeding to trial, caps on non-economic damages at $500,000, clear protections for providers in emergency situations in hospitals, and changes in the statutes of limitation for birth injuries (down to age 10). Led by efforts from the NC Medical Society, the NCAFP assisted in the advocacy work to achieve passage of this bill, although the legislation was subsequently vetoed by Governor Perdue. Disagreeing with the governor’s reasons to veto the bill, the Academy worked closely with the Medical Society to persuade the legislature to override the governor’s veto. After much lobbying in July, both the Senate and the House voted to override the Governor’s veto, making the bill law. The legislature also considered various scope-of-practice bills which would have impacted physician practices across the state. Foremost of these was the proposal to expand the immunizing authority of pharmacists.


Summer 2011 • The NC Family Physician

As initially proposed, this bill would have given pharmacists authority to all vaccines down to the age 8 with minimal physician involvement, and to all vaccines to anyone over 18 with no physician involvement. Due to concerns about fragmentation of the medical home, care of patients with immunization reactions, missed counseling opportunities, etc., the NCAFP vigorously fought to modify the bill. As finally passed, pharmacists were given authority to only give flu vaccines down to the age of 14 -- which was essentially what they had been temporarily given by the State Health Director during the most recent flu outbreak. A second competing bill that passed the Senate with much modification is still alive, but the House seemed less likely to expand pharmacists’ authority further. However, we expect that we will face further attempts next year to expand pharmacists’ authority to not only give vaccines, but also possibly to diagnose and treat common medical conditions. At the same time, we will also have to face further attempts by FNPs, Naturopaths, etc., to expand their scope of authority. Other topics that the NCAFP team was involved with during the session included proposals to restrict indoor tanning by adolescents, licensing of “professional” (non-nurse) midwives for home deliveries, PA/ FNP signature authority for death certificates, implementation of various aspects of federal health reform legislation such as Health Benefits Exchanges and Health Information Exchange, proposals to require photo ID for pick-up of Schedule 2 drugs, etc. All of these efforts occurred during a shorter than average legislative ‘long’ session. This placed even more demands on NCAFP Government Affairs Consultants Peyton and Joel Maynard, as well as the NCAFP staff and member physicians. Through the debate about expanding immunizing authority of pharmacists, the Academy saw how vital grassroots advocacy is. Several legislators commented about the calls and e-mails from our members just prior to a proposed vote on the bill and how those calls led to a postponement of that vote until the legislation could be further modified. To conclude, I ask you to consider two things to assist the Academy’s efforts now and in the future. FAMPAC, our political action committee, is low on funds and we need your contributions. Please consider contributing $100.00 (in either a lump sum or through periodic payments) during this calendar year. Additionally, I also ask that when you receive a notice to contact your local legislator about an issue, that YOU contact that person by phone or e-mail and let that person know how a proposed bill will affect the people in their district. This is grassroots advocacy and you can help. Please, CONTRIBUTE and CALL - it really works! www.ncafp.com/ncfp


New AAFP Task Force will Evaluate, Appraise Worth of Primary Care Services N.C.’s Lori Heim, MD, Serving as Chair

Cary’s Dr. Conrad Flick Discusses CCNC at Capitol Hill Briefing on State of Medicaid The Partnership for Medicaid, a non-partisan coalition of doctors, hospitals, health centers, health plans, and health care professionals, held a lunch briefing in Washington, D.C., in mid-June to examine the current state of Medicaid. NCAFP Past President and current AAFP Board Member Dr. Conrad Flick of Cary, NC, was one of four main speakers at the event. Dr. Flick shared his ‘on-the-ground’ perspectives on Medicaid and talked about the impact that Community Care of North Carolina (CCNC) has had on his practice. “We cut costs primarily by providing greater quality and improving efficiency,” he said. “By that, I mean we provide the same services that we always have. We don’t decrease the access, and we don’t decrease the number of needed services. We just find the efficiencies in the services themselves.” Flick practices in Raleigh and pointed to the CCNC program as an example of how Medicaid could be reformed. CCNC has improved quality and saved billions in health care costs by relying on patientcentered medical homes and care coordination to deliver care to most of the state’s Medicaid population.

FAMPAC Empowering Family Medicine in North Carolina

Support Your State Political Action Committee!

The AAFP has formed a new Primary Care Valuation Task Force to review the methods for valuing health care services and make recommendations about more accurately valuing and paying for primary care physician services. An inaugural meeting is set for August 22nd in Washington, D.C. The task force will begin a six- to nine-month process to identify ways to appropriately appraise evaluation and management services (E&M) provided to patients. The task force consists of 22 thought leaders with extensive health care system and policy expertise. Chairing the group is North Carolina’s Dr. Lori Heim, AAFP Board Chair. “Increasingly, research suggests that the complexity of primary care physicians’ evaluation and management services are different and more intense than the E&M services provided by other specialties,” said Dr. Heim. “As a matter of fact, CMS recognized in their 2012 proposed Medicare Physician Fee Schedule the need to review primary care codes and asked the RUC to prioritize the review of these E&M codes.” The typical patient encounter varies across specialties and likely underestimates the intensity of the primary care physician’s work. The new task force will focus its attention on alternative payment methods that could work within the current fee-for-service model. The task force will present its findings to the AAFP Board during the first quarter of 2012. The AAFP Board will then present the recommendations directly to the Centers for Medicare and Medicaid Services for its consideration in assessing the appropriate work relative value units that measure the worth of a service and determine Medicare fee-for-service payment to primary care physicians. Formation of the task force comes on the heels of another AAFP announcement about primary care physician payment. Last month, the AAFP strongly requested that the RUC make specific changes in its structure, process and procedures so that primary care services are more fairly assessed and valued.

Donate Today at www.ncafp.com/fampac

Source: AAFP News Now

Summer 2011 • The NC Family Physician



NCAFP’S 2011 Winter Family Physicians Weekend

Winter Meeting in Asheville will Be Festive and Educational Thursday, Dec. 1st – Sunday, Dec. 4th, 2011 The Grove Park Inn – Asheville, North Carolina

It may be a little early to think about the holidays, but the Academy’s annual Winter Family Physicians Weekend is always a perfect time to spend in the mountains. It’s the perfect time to soak up the autumn air, and a great way to kick-start the holiday season. Please consider joining us this December 1st-4th, 2011 in Asheville as Program Chair, James W. McNabb, MD, presents an outstanding program of topics and issues faced by most primary care physicians in practice today. Evidence-based CME lectures on issues such as asthma, palliative care, physician wellness, prescription drug abuse, ADHD, and gout are just a few of the topics on the agenda. Participants will also get to enjoy many more quality lecture topics, optional CME seminars, SAMs Study Working Groups and non-CME Satellite programs throughout the weekend. The meeting’s educational line-up is jam-packed with high quality and engaging topics. Over 25 AAFP Prescribed credits will be presented. Plus, some select lectures offer additional credit through Transition to Practice (t2p), a new credit category being piloted. A full list of General Session topics can be found online. In addition to the General Sessions, several workshops and satellite learning events will take place. Headlining these is the “Living with Diabetes” seminar that will feature guest keynote speaker Dominique Wilkins, former professional NBA basketball player and nine-time NBA All Star player. Tentatively scheduled are two SAMs Study Working Groups - one on CAD and another on Preventive Care - and

Complete 2011 Winter Meeting Information is available at www.ncafp.com/wfpw workshops on Hands-On Procedures and Cosmetic Procedures. Make plans to join us Saturday evening for our annual Foundation Silent Auction and Gala hosted by Dr. & Mrs. Brian Forrest. This is always a terrific evening at The Grove Park Inn (GPI). Enjoy an evening kicked-off by bidding wars and terrific holiday shopping at the annual Silent Auction. The Silent Auction benefits the programs that the NCAFP Foundation conducts on behalf of Family Medicine in North Carolina. The evening will continue with a terrific gourmet dinner prepared by the GPI. Finally, get ready to kick up your heels with a live dance band -- Bueller -- honoring all the great hits from the


Summer 2011 • The NC Family Physician

1980’s as Dr. Forrest commences his term as President of the NCAFP. The Winter Meeting is a great time to visit Asheville and spend quality time in the mountains. To book your hotel reservations at The Grove Park Inn Resort & Spa, please call (800) 438-5800 or (828) 252-2711. Be sure to mention the NCAFP in order to receive the discounted room rate of $198. The cut-off date for hotel reservations is October 27, 2011. A second block of rooms has been reserved at the Renaissance Asheville Hotel, which is located approximately 4-miles from The Grove Park Inn. The Renaissance offers free shuttle service to and from the GPI at various scheduled times throughout the weekend. Make your reservations there by calling 800-468-3571 or 828-252-8211. Be sure to mention the NCAFP to receive the discounted room rate. Be sure to visit our website and review our registration brochure for more information on additonal learning and entertainment opportunities that will be offered over the weekend. We expect the brochure to arrive in your mailboxes later in August. Registering is easy and can be done either online or by mail or fax. For hard copy registration, simply mail or fax (919-833-1801) your registration form with your credit card number or check made payable to the North Carolina Academy of Family Physicians. Registrations can also be completed by visiting www.ncafp.com/wfpw. And don’t forget that members of the NCAFP or the AAFP can receive our Early Bird Registration Rate by completing the registration process by October 17, 2011. Please contact the NCAFP Meetings Department for more information or to request a brochure and registration form by calling (919)833-2110 or (800)872-9482 (Toll Free in NC only) or via email at meetings@ncafp.com. www.ncafp.com/ncfp

AAFP Piloting New CME Credit Category T2P Complements AAFP Prescribed Credit There’s a new CME credit category being piloted by the AAFP and it offers AAFP members the chance to capture two (2) additional Prescribed credits by applying their learning to their care practices. Known as Transition to Practice (t2p), the new credit began to be offered last year with AAFP Live, and was even available on some designated 2010 AAFP Annual Scientific Assembly topics. Several chapters have begun to pilot the credit and the NCAFP will be offering t2p at its upcoming 2011 Winter Family Physicians Weekend. AAFP’s goal with t2p is to encourage physicians to improve their care by implementing real practice change based on their education. During this pilot, certain designated Prescribed activities will offer t2p. If ultimately approved, t2p could be expanded to all Prescribed CME activities. Right now, each t2p course and its specific change activity is individually designated, and require no additional fees by the learner. The Chapter or CME provider outlines what the course’s change

activity entails and physicians are free to begin their practice change immediately. Participating physicians are required to complete a ‘Commitment to Change’ statement and must report back to the Chapter/ provider within 120 days of commencing their activity. And because t2p is not a self-reporting credit category, all practice change reporting must be submitted to the Chapter or CME provider. The AAFP is still evaluating the overall program as of this writing and has yet to officially approve t2p as a permanent credit category. It is anticipated that if the pilot is successful, t2p credits would be available for all Prescribed CME credits.

Transition to Practice

2011 NCAFP Foundation

SILENT AUCTION Office Procedures Workshop is Sept. 24th! Minor in-office procedures like skin biopsies and joint injections can be excellent -- and profitable -- value-added services for family physicians and primary care practices. Instead of being referred out of practice, patients appreciate when their personal physician can provide these services. The procedures become a win-win situation for everyone! To get more physicians up to speed, the Academy is offering its popular ‘Office Procedures Workshop’ in a convenient format. The seminar will take place on Saturday, September 24, 2011, at the Sheraton Greensboro Hotel at Four Seasons/Koury Convention Center. The workshop consists of two main segments. First, Mastering Joint Injections for Physicians, FNPs & PAs, will describe the indications and contraindications for joint and soft-tissue injections and aspirations, discuss the critically reviewed evidence-based literature, and identify safe and effective techniques for the 16 most common procedures. Participants will practice injection/aspiration techniques in various locations, including the shoulder, elbow, wrist, hand, hip, knee, and foot. A light lunch and question-and-answer session will follow. The final segment, Mastering Skin Biopsy Techniques for Physicians, FNPs & PAs, will review common techniques used to perform skin biopsies. Indications and contraindications for performing biopsies will also be discussed, as will the preferred approaches to specific lesions. Participants will perform the different types of techniques including punch, shave, currette, incisional, and excisional biopsies using the fusiform excision technique. Registration is only $125 and includes a continental breakfast and a light lunch. Visit http://www.ncafp.com/procedures for complete information and registration on the workshop.

Items Needed for the Silent Auction Christmas in August? No, not really, but it isn’t too soon to start thinking about trinkets, treasures and great gift ideas for the NCAFP Foundation’s Silent Auction! This year’s event will once again be held immediately prior to the Presidential Gala, dinner and dance on Saturday evening, December 3rd, 2011, at The Grove Park Inn. The entire family will enjoy this Saturday night complete with terrific items for bidding, along with live entertainment and fun. This is a call to all members to consider making a contribution to this important annual fund raiser. Make it easy on yourself and send a monetary donation. We are happy to do the shopping for you. Or consider obtaining donations from your local community such as restaurant gift certificates, children’s items, weekend getaways, sports memorabilia, or tickets to events. Donations of wine, artwork, jewelry, gift baskets and your handiwork are also encouraged. Donations to the Silent Auction are eligible as tax-deductible charitable contributions. An official Donation Form for tax reporting purposes will be sent to each donor. 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). We appreciate your contributions & participation and we look forward to seeing you in December!

Summer 2011 • The NC Family Physician


Moses Cone Residency Program Director Dr. William Hensel shared insights.

R E S I D E N T S & N E W F Ps The Moses Cone Residency Program —

Team-Oriented Training Building on Tradition Walk into the Family Medicine residency program at Moses Cone in Greensboro and immediately you feel the sense of tradition. Founded in 1969, Moses Cone was established as one of the first Family Medicine training programs in the nation. The program has since produced 271 family physicians, many of whom have went on to serve North Carolinians in all parts of the state. “We have a great sense of tradition and continuity here, and excellent continuity of faculty,” noted Dr. William Hensel, Program Director. “This helps to continue our great tradition.”

Based at Cone Health’s flagship 536-bed hospital, Moses H. Cone Memorial in Greensboro, the program offers residents a robust clinical training ground that serves a medically diverse patient base. The residency’s main practice center is a 13,000 square-foot facility designed specifically for teaching ambulatory care and equipped with all of the expected conveniences: an on-site lab, 16 exam rooms, conference suites and a procedures room. It serves a patient population comprised of approximately 35% Medicaid, 25% Medicare, 31% Managed Care, and 9% self-pay. Cone’s core mission is to train resident family physicians to serve their communities in a context that promotes the traditional principles of Family Medicine. The program relies on its 42-years of training experience to build each physician’s clinical acumen, yet also embraces modern team-oriented, evidence-based approaches. This helps physicians not only to train well, but to live well while in training.

10 Summer 2011 • The NC Family Physician

“We work hard to recruit team-oriented physicians. We also work hard to have balance between personal and professional life, yet maintain high standards,” noted Hensel. “This is appealing to a lot of folks.” Balancing the heavy clinical demands with its residents’ personal needs is never easy. The program holds a number of social activities each year with residents and faculty that complement its team-building efforts in the clinic and help residents to establish personal connections. “The future is teamwork - professional relationships that work together for the good of the community. If we can form those relationships and model that teamwork now, we can help our graduates thrive,” noted Dr. Hensel. Teamwork is only part of the Cone’s training recipe. The program has also embraced health information technology and patient-centered, evidence-based care to prepare its residents for practice life. Residents utilize a fully-implemented electronic health record and also have access to stipends for hand-held computing devices. And with PCMH Level III recognition, new patient-centered approaches are being integrated into all facets of its teaching spectrum. Moses Cone’s teamwork, technology and patient-centered curriculum help produce family physicians that are prepared to practice in any type of setting. Dr. Hensel believes Cone’s current training program and its practice management curriculum help its graduates transition well, in either employed or independent practice roles. “Much of our practice management curriculum is geared towards not the long distant future, but the immediate future for our residents,” commented Hensel. “We want our residents to be paid and valued for all they can do, but we also want them to be valuable to their organizations.” Dr. Hensel did note that challenges exist in preparing residents for clinical efficiency while health care moves toward bundled or new reimbursement frameworks. But he described Cone’s graduating residents as savvy and beginning to consider practice attributes like overall quality focus, community service initiatives, and overall practice makeup as important factors. “More of our graduates are joining larger practices than seeking independent employment. Moving forward, as more partnerships with health systems and physicians form, the differences between these two arrangements will be less important than in the past, and our physicians will be ready,’ noted Hensel. Cone experienced another strong MATCH this year, securing new interns from Wake Forest, Virginia College of Osteopathic Medicine, University of Virginia and Howard University. In addition to their traditional training curriculum, each resident can also take advantage of several enhanced curricular options. These include Sports Medicine, Obstetrics, International Health and Academic/Teaching and offer the opportunity to augment their learning.




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Residents Work to Increase Chapter Involvement with New Positions


Leaders of the NCAFP Resident Section have been busy over the last several months. Their efforts have focused on formalizing two new participation roles designed to enhance communications between and among resident members of the Academy. The efforts originated through discussions by the Section at the 2010 Winter Meeting and work began in January. The NCAFP Board of Directors approved the expansions at its board meeting in mid-April. Resident leaders have created two new participation roles, each designed to improve communication and coordination among residents. The positions include the addition of one (1) resident from each of the state’s (twelve university- and community-based) training programs to serve as a liaison between the Section and each residency program. The Section will also name one (1) resident to serve in a representative role on each NCAFP council: Advocacy, CME, Practice Enhancement, and Health of the Public. Both expansions are expected to improve resident dialogue with the Academy leadership, among fellow residents and their individual programs, and encourage Chapter involvement. The Section will be naming resident physicians to these roles at its annual Resident Section Meeting scheduled for Saturday, December 3, 2011, in Asheville. If you would like additional information on either of these roles, please contact Peter Graber at the NCAFP at (919) 833-2110, ext. 115.

NC Residents Enhance Peer Networking with Social Media The NCAFP Resident Section launched a presence on Facebook, the popular social networking site. All NCAFP resident members are being encouraged to join the Section’s group page. To locate it, search ‘NC Family Medicine Residents’ while logged-in on Facebook. Moving forward, the page will provide an additional way for residents to keep abreast of Chapter and Section activities, interact and share information.


With the


Dr. Richard Roberts, President of WONCA, the World Organization of Family Doctors, visited UNC-Chapel Hill on May 1-2, 2011. Dr. Roberts’ visit was organized by UNC Family Medicine Interest Group student leaders and was made possible by the NCAFP’s Family Medicine Interest and Scholars program. During his visit, Dr. Roberts met with a number of UNC students, UNC Family Medicine residents and program faculty. He also delivered a presentation to over 50 students and faculty during an FMIG luncheon. Dr. Roberts is currently serving a 3-year term as WONCA president. He is Past President of AAFP (2001), and the Wisconsin Medical Society. For a video recap of his visit - including a short interview - see www.ncafp.com/roberts2011.


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Log-in & Search: North Carolina Academy of Family Physicians Spring 2011 • The NC Family Physician

WONCA President Dr. Rich Roberts Visits UNC FMIG

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Family Medicine Interest and Scholars Program Marks First Anniversary • North Carolina will need 4,700 family physicians by 2020 • U.S. will need 39,000 more family physicians by 2020 • Current rates of growth would only meet 75% of state’s projected need

Family Medicine Scholar Patrick Williams with his mentor, Dr. Charles Rhodes. Williams will return to Cabarrus Family Medicine this fall for a clinical rotation.

residency training from 56 percent in 2008 to at least two-thirds over the The second group of students was recently welcomed into the Family length of the six-year program. Medicine Interest and Scholars Program; these students will participate “It is so heartening to see these students who are interested in a career in the program for their final three years of medical school. They will receive exposure to family medicine through clinical experiences as well in family medicine learning from primary care physicians who already are making a difference in communities all across North Carolina,” said as state and national level conference and leadership opportunities. Kathy Higgins, BCBSNC Foundation The students will receive president. “With the urgent need for more scholarship funding upon Students Hometown Medical School primary care physicians, we are proud to medical school graduation Joshua T. Carpenter Ellenboro, NC Brody School of Medicine at ECU support a program that will have a real if they ultimately enter a Laura S. Cone Jacksonville, NC UNC School of Medicine impact on the health and well-being of the Family Medicine residency Emily A. Dell Pittsburgh, PA Brody School of Medicine at ECU people of this state.” program. C. McLean Ellis Greenville, NC UNC School of Medicine Participating students also receive “My greatest joy in Vanessa C. Gallegos Miami, FL Wake Forest University School of Medicine additional exposure to family medicine participating in this Katy A. Kirk Raleigh, NC Brody School of Medicine at ECU throughout their schooling, including program is the chance for William C. McLean Asheville, NC UNC School of Medicine additional clinical experiences. Students me to pass my love and M. Adele Moser Cary, NC Brody School of Medicine at ECU in the first class of selected scholars now enthusiasm for family Amy J. Nayo Chicago, IL UNC School of Medicine in their third year of medical school, have medicine on to the next Cleveland A. Piggott Suwanee, GA UNC School of Medicine already started to create bonds with their generation. I have long felt Emily L. Ross Raleigh, NC Brody School of Medicine at ECU Master Preceptors and will continue to that family medicine is a Lindsey M. Wright Raleigh, NC Wake Forest University School of Medicine build those relationships through their calling,” said Dr. Charles clinical rotations. Rhodes of Cabarrus Family Medicine in Mount Pleasant, N.C., who “Spending time with Dr. Rhodes taught me more about the art of serves as a physician mentor in the program. “The spark that made medicine and the life of those who practice it than anything I learned in me want to be a family doctor was given to me by much beloved and the basic science years respected mentor physicians. I am thankful for of medical school,” the opportunity to pass that spark on to a new Physician Mentor Location Practice stated Patrick Williams, generation of doctors.” Mott P. Blair, IV, MD Wallace, NC Wallace Family Medicine a student at the Brody Entering its second year, the Family Medicine Marianna T. Daly, MD Marshall, NC Hot Springs Health Program School of Medicine at Interest and Scholars Program is a program Jonathan E. Fischer, MD Carrboro, NC Carrboro Community Health Center East Carolina University of the North Carolina Academy of Family Travis W. Howell, MD Winston Salem, NC Salem Family Practice and member of the Physicians (NCAFP) Foundation and is made Thomas L. Jeffries, MD Raleigh, NC North Raleigh Family Medicine inaugural class. “It was possible by a $1.18 million grant from the Thomas F. Koinis, MD Oxford, NC Oxford Family Physicians and is very refreshing Blue Cross and Blue Shield of North Carolina Zane I. Lapinskes, MD Benson, NC Benson Area Medical Center to be reminded that the Foundation. The program pairs North Carolina Jesse C. Pittard, MD Smithfield, NC Horizon Family Medicine practice of medicine is medical students with physician mentors who Karen L. Smith, MD Raeford, NC Karen L. Smith, MD, PA about people, not diseases work with students for three consecutive years Jessica L. Triche, MD Washington, NC Washington Family Medicine Center and symptoms, and my to strengthen skills, offer guidance and help fastMatthew M. Williams, MD Wilmington, NC Wilmington Health Associates time with Dr. Rhodes track their primary care training and experience. Benjamin L. Wilson, MD Lexington, NC Lexington Family Physicians epitomized that truth.” This innovative program aims to increase the The NCAFP percentage of medical students who commit to Foundation recently selected the second class of students and mentors (see a residency in family medicine by approximately 30 percent and to insets) to participate in the program that will run from 2011 to 2014. increase the percentage of those who elect to stay in the state for their Summer 2011 • The NC Family Physician


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Family Medicine Can Benefit from Business Concepts Surrounding Customer Service By Gregory K. Griggs, MPA, CAE, Executive Vice President I have recently been putting a lot of thought into the impression our members receive when you call, write or otherwise have a request for the Academy. In the association world, we refer to it as member service, but it really is the same as customer service. I want our members to receive the best customer service possible in any interaction with our organization. It’s not always easy, but I know every interaction makes an impression. And you, our members, will remember that impression when you make a decision about renewing your membership or attending one of our meetings. We’re certainly not perfect, but we do try to instill the value of member service in everything we do. Those same simple concepts can also be applied to working with your patients on a day-to-day basis. Regardless of whether we agree with it or not, I believe market forces and “consumerism” are now a day-to-day part of healthcare. Patients are making choices based on whether a clinic has convenient hours or how quickly they can make an appointment. I believe this has – in some ways – led to the rise of retail health clinics, a concept that can give many of us some heartburn. I believe one of the goals of Family Medicine should be to provide the highest quality, physician-led health care possible, but in a more consumer-friendly (i.e., patient-friendly) manner. This is actually one of the key tenets of the patient-centered medical home – providing the right care at the right time, without forcing patients into more expensive care settings such as emergency rooms. PCMH calls for open access scheduling, extended hours, and protocols on how quickly an office responds to various patient requests. Let me give you two examples – one from a retail business and one from health care – that I believe will illustrate my point on the importance of customer service. In the 1990s and early 2000s, I knew of a very good local furniture store that provided a high quality product. One problem – they closed during the week at 5:30 p.m. and only stayed open from 8:30 a.m. to Noon on Saturday. Many of their customers found it more and more difficult to get to this store during their limited hours of operation. Sadly, that furniture store is no longer in business. They simply did not meet the changing needs of their customers.

Now, I know many of you are saying that health care is very different. And you are right. But both health care consumers and their employers (who provide the insurance policy that pays the health care bills) are demanding a different kind of primary care and holding physicians accountable to quality metrics and cost savings. I recently heard of a patient experience that made the individual question where they are now receiving care. The individual walked into their primary care physician’s office around Noon with what they felt was a reaction to an insect bite. They didn’t have an appointment and were informed that no appointments were available that day. They ended up having to seek care at a much more expensive alternative: a nearby emergency room. The physicians in the office were ultimately very upset over what had happened. They never knew the patient had even been there. And they are working to change their staff training to make sure a similar event doesn’t happen again. Fortunately, the clinical outcome was fine, but it did make the patient question where they receive their primary care. Have we truly instilled a patient-service culture in the offices of Family Medicine practices? Are we making patients feel like this really is their medical HOME? If a patient doesn’t feel like they can even get a timely appointment, should we really expect them to do better on their own to adhere to the clinical recommendations their family physician makes when they do arrive? Again, none of this is easy. It’s not easy in our offices at a membership-based association, and there are nowhere near the complications here that you face each day as a family physician. Yet, I believe all of us can learn from the basic business tenets of customer service. Whether we like it or not, retail clinics have popped up to fill a void – somewhat due to convenient hours, but it also appealed to a group of consumers who weren’t getting health care in other locations. I want family physicians to be the first choice for health care today and tomorrow. I want you to be highly valued, well-compensated, keys to the future of health care in this state and country. We can all take the first steps by making sure that excellent customer service (patient- and member-service) is part of our daily lives.

Summer 2011 • The NC Family Physician



Hickory’s Dr. Albert Osbahr Elected to the AMA Board of Trustees Dr. Albert Osbahr, III, a family physician from Hickory, NC, was elected to the AMA Board of Trustees in late June during its House of Delegates meeting in Chicago. Dr. Osbahr is currently the Medical Director of Occupational Health at Catawba Valley Medical Center in Hickory and also serves as the Corporate Medical Director for Evergreen Packaging. He also finds time to serve as a Physician Reviewer for the Carolinas Center for Medical Excellence, as well as the Haywood County Health Department as a Medical Consultant. Dr. Osbahr received his B.A. and M.D. from UNC-Chapel Hill, and completed his residency training in Family Medicine, as well as an M.S. in Community Medicine, at Marshall University School of Medicine. He went on to complete an Occupational/Preventive Medicine residency at the University of Kentucky. Dr. Osbahr is Board-certified in Family, Occupational and Preventive Medicine. Dr. Osbahr has been active in organized medicine since medical school, with his membership in the AMA and the North Carolina Medical Society reaching back to 1981. His participation in the AMA began as a member of the AMA Medical Student Section Governing Council in 1982 and he also served on the AMA Council on Medical Service as both a student and a resident. Dr. Osbahr began service as a member of North Carolina’s AMA delegation in 1998. He has been elected twice to the AMA Council on Science and Public Health; first in 2004 and then 2008, reaching chairman status in 2010-2011. He also is a Past President of the North Carolina Medical Society (20082009). The NCAFP forwarded a few questions to Dr. Osbahr regarding his service at the AMA and his perspectives on leadership in medicine.

Q: Health care and health care delivery continue to change, and as reforms continue to roll-out over the next few years, more change is on the horizon. What do you see as AMA’s key challenges in the next few years in navigating what’s ahead. AO: The AMA’s key challenge is insuring that the legislation which exists now helps and not hurts our patients. Certainly if we work to help our patients and make changes to the health care legislation, we will make it better for all. Q: In speaking with your colleagues from across the nation, what are some of the things you share about North Carolina and its health care system? AO: We have a very unique situation in North Carolina which can be looked to and possibly exported: the Community Care of North Carolina (CCNC) program.  Taking a page from North Carolina can help our fellow states in their endeavors to tackle the problems of Medicaid utilization and help bend the cost curve.  Even commercial and private insurance programs are looking to N.C. on this issue.  

Q: Serving on the AMA Board is a tremendous honor. Describe your motivation for contributing and your goals in representing family physicians, occupational physicians, and all physicians from our region. AO: This is a tremendous responsibility to serve physicians across the country. Certainly helping to provide a perspective about medicine in North Carolina is an important aspect of my new role.  Q: You have been actively involved in organized medicine since medical school. For younger physicians who desire to get involved, describe what steps they should take in becoming organized medicine leaders like you have. AO: You, too, can get involved in organized medicine from medical school onward in so many different ways and experiences.  Young physicians should know that it does matter if they are involved and lead.  Do not sit on the sidelines watching others do the work --  get involved. 

16 Summer 2011 • The NC Family Physician

UNC’s Dr. Warren Newton Elected Chair of the American Board of Family Medicine The American Board of Family Medicine (ABFM) announced the election of four new officers and three new board members in mid-July. UNC-Chapel Hill’s Dr. Warren Newton, Executive Associate Dean for Medical Education and the William B. Aycock Distinguished Professor and Chair of the Department of Family Medicine, was elected chair of ABFM. Dr. Newton has held local, state and national leadership positions within Family Medicine, served on the NCAFP Board for a number of years, and has been involved in the development of the North Carolina Governor’s Quality Initiative. The Academy would like to congratulate Dr. Newton on his election and will be publishing additional information on his role in an upcoming edition. www.ncafp.com/ncfp

Academy Loses Robert L. Townsend, Jr., MD, Past President and Lifetime Service Award Honoree Dr. Robert Townsend of Raeford, NC, long active in NCAFP affairs, passed away in June. Dr. Townsend joined the NCAFP in 1965 and served as President of the Chapter in 1982. He later received the NCAFP Family Physician of the Year award in 1988, and was recognized with the NCAFP Lifetime Service Award in 2003. Townsend was one of the first Board-certified family physicians in North Carolina in 1970 and built a reputation for his forward-thinking ideas. In an address to Academy members in 1982, Townsend advocated that doctors ‘stand up and be counted’ and ‘… not wait for politicians to force upon us concepts of government benevolence.’ He emphasized to fellow members to provide quality care, yet also be

committed to proactive advocacy efforts. These concepts still apply today. In addition to the above honors, Dr. Townsend was also named Citizen of the Year by the Raeford Kiwanis in 1988. Dr. Townsend cared for an estimated 4,000 families in and around Hoke County. At the request of the family, contributions can be made to either the Raeford United Methodist Church (308 N Main St., Raeford, NC 28376), or to the Dr. Bob Townsend Scholarship Endowment at the North Carolina Community Foundation (4601 Six Forks Road, Ste. 524, Raleigh, NC 27609).

NCAFP Recognized for Member Retention and Growth at Annual Leadership Forum The North Carolina Academy took home top honors for membership retention during this year’s Annual Leadership Forum (ALF) in Kansas City. The NCAFP was recognized for retaining 97.2% of its members in 2010, making it tops in the large Chapter category (over 1,000 active members) and only second to Guam (only 22 active members) among all AAFP Chapters. North Carolina also ranked first with the highest percent increase in active members among large chapters, second in the highest percent retention of new physician members (out of residency less than seven years), second in the highest percent increase in student membership, and once again had 100% resident membership. No other Chapter ranked first or second in each of the five categories measured by AAFP! While at ALF, the NCAFP’s delegation had the opportunity to develop leadership skills, write resolutions

to the AAFP Board or Congress of Delegates, and hear from some outstanding speakers, including former Surgeon General Dr. David Satcher. Dr. Viviana Martinez-Bianchi of Duke University had a significant role at ALF, and the National Conference for Special Constituencies (NCSC) that is held at the same time. As Chair of the AAFP Commission on Membership and Member Services that oversees the event, Martinez-Bianchi provided introductory remarks before most plenary sessions, including the opening comments for the two conferences. A video summary of the conference and perspectives by Dr. MartinezBianchi is posted at the NCAFP website at http://www.ncafp.com/alf2011.

NCAFP’s Dr. Viviana Martinez-Bianchi, Chair of AAFP’s Commission on Membership & Member Services, played a significant role.


& 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


The Road to PCMH Recognition

& Why It Pays for veryone has heard plenty about the Patient-Centered Medical Family Physicians Home (PCMH). Many of you are probably tired of hearing


about it. It is a fancy and sometimes overused term for a very simple concept: comprehensive care coordination. But at the end of the day, what has been shown about the PCMH model in this country is that if increased payment for care coordination is going to occur for primary care, the PCMH model is the most proven method for accomplishing it. Over 1,000 of your colleagues in this state have received National Committee for Quality Assurance (NCQA – the most widely recognized accrediting institution) recognition as a Level I, II or III PCMH. Is it time for you to follow in their footsteps?

A key step in the patient-centered transformation journey is becoming recognized as a PCMH. Today’s most widely known PCMH recognition is NCQA’s Patient-Centered Medical Home (PCMH) designation. NCQA’s recognition is targeted at outpatient primary care practices and was designed with significant input from the American Academy of Family Physicians (AAFP) and the nation’s other key primary care associations. PCMH rigorously assesses ‘medical homeness’ by evaluating a practice on six core standards that measure both systematic and documented care processes. North Carolina currently has over 1,000 providers recognized by the program, a number that is near the top for the entire country and growing rapidly. Family Medicine practices that investigate the PCMH recognition program quickly realize that the process is challenging, especially given a practice’s degree of documentation that is required. Plus, the realization that significant time investment will be needed along with organizational and workflow changes make it reasonable for a practice to feel overwhelmed. The good news is that there is compelling evidence that PCMH recognition makes solid business sense, both for the practice and for physicians. Much of this centers on new performance incentive programs being introduced by both public and private payers. Practice leaders can now justify the time and expense needed for recognition and realize real financial benefits in doing so. PCMH recognition can also be framed as a strategic longer term investment that will position a practice to take advantage of the changing health care marketplace, especially as health care reforms role out and major health care purchasers migrate to PCMH standards. In North Carolina, this has already begun to play out.

18 Summer 2011 • The NC Family Physician

An excellent example of a private insurer leveraging PCMH concepts right now is Blue Cross and Blue Shield of North Carolina’s unique Blue Quality Physician Program (BQPP). BQPP provides enhanced payments to family medicine and primary care practices on a range of Examination-and-Management (E/M) codes. To qualify for participation a practice must meet the following four requirements: NCQA recognition as a PPC or a PPC-PCMH, electronic prescribing, electronic claims submission, and individual physicians in the practice must have completed cultural competency training. For additional information on qualifying for the BQPP Program, please contact your BCBS of NC representative. This program represents potentially significant payment increases, particularly for those that need it most: the small practices in rural areas across the state. North Carolina is also home to a new public-private partnership that officially launches later this year, but where work is already being done. Funded by CMS and known as the ‘Multi-Payer Advanced Primary Care Practice’ (MAPCP) Demonstration, this initiative is another great example of PCMH recognition in action and how important its principles are becoming for rural health care providers. This Demonstration will expand the existing benefits of Community Care of North Carolina’s health networks (also built on PCMH) to additional citizens in seven rural NC counties (Ashe, Avery, Bladen, Columbus, Granville, Transylvania and Watauga). Patients in these counties whose health coverage is through Medicaid, Medicare, BCBS of NC, or the State Health Plan will qualify. Participating practices that serve as these patients’ primary care medical homes will receive Per Member Per Month (PM/PM) payments to assist them with their efforts in improving health outcomes and lowering costs. Again, the key element for participation by each participating practice is that they become recognized as medical homes. The NCAFP and its leadership feel the success of this project is so substantial that it has committed Academy resources to this project. Brent Hazelett, NCAFP Chief Operating Officer, is spending part of his time working with CCNC staff dedicated to this project, including NCAFP Past President Chip Watkins, MD, MPH, who is also working at CCNC part time on the Demonstration Project. See ‘PCMH’ on Back Cover www.ncafp.com/ncfp

Becoming Your Own “Undercover Boss”

Mystery Shopping

By Amanda Kanaan If you haven’t seen the hit TV series “Undercover Boss”, the Emmynominated show follows CEOs and top executives as they go undercover to work alongside their employees and examine the inner workings of their companies. Their experience reveals the good, the bad and downright ugly about their organizations but in the end always makes them better for it. While it would be near impossible for you to go undercover in your own medical practice (unless you are one serious master of disguise) you can still think like an “Undercover Boss”. For instance, what do you think a patient’s experience is like when they call your office? Better yet, what about when they visit your office? You may think you have an idea based on the interactions you’ve personally witnessed, but what if the staff didn’t know it were you standing within ear’s reach? I have seen practices spend hundreds of thousands of dollars on marketing their practice and others spend very little yet one theme remains the same: you may be able to initially get patients to your door, but you and your staff must be the ones to not only get them through the door, but convince them to continue knocking time and

again. You could spend your entire budget recruiting patients but those efforts will be futile if your customer service is lacking. Yes, I said it - customer service. It may sound like a term used when describing your favorite restaurant or a local bank but it’s just as applicable to your practice. So how do you gain a glimpse into what your patients are really experiencing if going undercover isn’t an option? In the business world it’s called “mystery shopping”; however hiring an outside professional to provide honest insight about a business’ performance is just as effective in the health care world as well. The findings may pleasantly surprise you or they may even shock you. Either way, the information will give you invaluable feedback into what your practice is doing well, and what you can do to improve the patient experience in your practice. Too often, when medical practices come to realize the importance of See ‘Undercover’ on Back Cover

Stability. Success. Satisfaction. What does success mean to you? Is it long, unpredictable hours, or a schedule that allows you to have a healthy work/life balance? Perhaps it’s stability -- affiliating yourself with an industry leader with more than 310 medical centers across 40 states. Even better, success could mean the satisfaction of knowing that the burden of managing a private practice could be eased in an environment where your various insurance coverages and CME credits are paid for. At Concentra, we give you the opportunity to define what success means to you. This can mean as much or as little exposure to the management and administration of our centers as you want. Concentra helps put you on track toward that success, providing continuous opportunities for you to enhance your clinical and professional skills. Concentra is seeking Board Certified/Board Eligible physicians in North Carolina, preferably with urgent care and/or occupational medicine experience, who exemplify the welcoming, respectful, and skillful behaviors that drive our mission of improving America’s health, one patient at a time. Concentra is an equal opportunity employer. To learn more about Concentra, or to apply online, please visit our website. You can also call Amanda Quire, Senior Physician Recruiter, directly at 972-725-6942.

See ‘ACOs Take Center Stage’ on Page 10

Concentra.com/Careers Summer 2011 • The NC Family Physician ©2011 Concentra Operating Corporation. All rights reserved.


‘PCMH,’ continued from p. 18 In short, the project requires that the more than 70 primary care practices designated in these seven counties attain at least PCMH Level I recognition from NCQA to receive the increased payments. The team assigned to this project (including Hazelett, Watkins and others) is tasked with assisting these practices with the NCQA application process. The widely held belief is that if this project succeeds, it will pave the way for PCMH and increased payment models throughout the entire state, and likely the country. So where does a practice begin with PCMH recognition? NCQA advises practices to first request a free copy of its ‘PCMH 2011 Standards and Guidelines’ to determine the overall scope of the program, its specifics and how it works. This document is free and can be requested online by simply visiting www.ncqa.org. Doing so only takes a few minutes and all documents are delivered to your in-box as a series of four PDF files. The information reviews the entire program, its eligibility criteria, pricing, and explains how the program’s survey instrument works. There is also specific information on each of the six domain standards that make up the program’s foundation, including detailed descriptions of each element these domains contain, the factors within them, and how they are scored. Before proceeding in earnest, a practice should assemble all key stakeholders and identify a project lead to spearhead the effort. Additional project team members should also be selected. Some practices have elected to hire third-party consultants to manage/ execute this process, but many practices do this internally. Regardless of approach, the PCMH team will be extremely important, especially for practices that have little formalized processes or documentation in place. Team members should represent a cross-section of operational and clinical care areas. Once the project lead and the PCMH team are in place, the practice should determine its overall PCMH-readiness. There are a number of tools available to help with this. TransforMED’s Medical Home Implementation Quotient (MHIQ) is a free self-assessment tool designed to help gauge where a practice falls within the PCMH continuum (as defined by TransforMED) and compares its measure

against the NCQA’s PCMH program standards. TransforMED also offers the ‘TMED Medical Home Vitals Assessment,’ a web-based instant assessment tool, as well as a number of practice-specific consulting services that are fee-based. Regardless of how readiness is determined, pre-assessments will identify key gaps to be addressed and will help the PCMH team construct a reasonable timeline and action plan for the rest of their work. At this stage the real work begins. This process is one that can span from weeks to months. Generally, the time needed is directly related to the level of documentation already in place, the size and scope of a practice, the target level of NCQA recognition, and the amount of resources a practice dedicates. And like the pre-assessment phase described above, numerous resources exist to help practices reach different mileposts on their journey. The PCMH team’s final work product is ultimately the supplied documentation (i.e. documents, screenshots, reports and scans ) that is submitted to NCQA via the program’s web-based survey instrument. This provides evidence of the practice’s established policies, procedures, and care processes. Final applications can consist of hundreds of pages, but quantity does not always translate into quality. There are plenty of examples of lengthy applications being denied, as well as relatively short applications that pass. Emphasis should be placed on a high-quality, succinct yet thorough application. The NCQA PCMH recognition process can be a heavy lift, but it’s extremely worthwhile. To help equip and educate practices on PCMH, the NCAFP’s Practice Enhancement Council and its CME Council are both working to gather the latest information on this process. A number of PCMH-centric learning sessions have already been conducted at NCAFP educational conferences. These have included workshops, lecture sessions and panel discussions. Many of these have centered on nuts-and-bolts implementation techniques that practices are putting to use. Additionally, a growing body of information on PCMH is also available to members at the Chapter’s website. All members are encouraged to take advantage of these. Invest in PCMH. It pays.

‘Undercover,’ continued from p. 19 marketing, they end up spending the wrong proportion of their resources on mediums like print advertising. While advertising can be a useful tool in certain situations, it is a waste of money in others. Whether you are brand new to marketing your practice or have been investing in it for years, it’s never too late to devise a campaign that centers around cost-effective techniques to market smarter not harder – and that begins with good customer service. Start internally by using services such as mystery shopping to identify areas of improvement. After upgrading the patient experience, next strategize a plan for marketing your services to your current patient panel. I realize that may sound strange, but when a patient comes to see you it’s usually for a very specific reason. Because of this, patients may have no idea what ancillary services you offer, such as sports medicine services, minor office surgeries, exercise stress testing or even Saturday hours.

It’s still just as important to bring new patients into the practice, but marketing from the inside out ensures you have the infrastructure in place to not only attract new patients, but to keep them long-term. At the end of the day, marketing doesn’t have to cost a small fortune to make an impact. However make no mistake about it, running a medical practice is a business, and at the heart of most successful business models is exceptional customer service. This philosophy, combined with the power of marketing, can result in increased patient satisfaction, increased patient volume, and increased profits for your practice. Amanda Kanaan is a medical marketing consultant and owner of AK Medical Marketing based in Raleigh, NC. Her services include cost-effective marketing techniques for small to mid-sized private practices, including mystery shopping, collateral creation, website design and strategic marketing plans. www.AKmedicalmarketing.com.

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