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THE NORTH CAROLINA

Volume 7 Issue 4 / Autumn 2011

quarterly news in north carolina family medicine

ECU Begins New Era in Family Medicine

Inside

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The NC Family Physician 1 Physician Burnout | 2011 Winter Meeting Preview | Newton Chairs the ABFM Board | A NewAutumn Day2011 for•Family Medicine

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

2012

Spring Family Physicians Weekend

District 7 - Thomas R. White, MD At-Large Holly Biola, MD At-Large Charles W. Rhodes, MD IMG Physicians Nalini S. Baijnath, MD Minority Physicians Enrico G. Jones, MD 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)

April 12-15, 2012 Charleston, SC

Student Director Amy Marietta (UNC) Student Director-Elect John Trimberger (WFU)

FM Department Chairs & Alternates

Great educational lineup Optional SAMs Study Groups on Thurs., Fri. & Sat.

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

Chair (ECU) Alternate (Duke) Alternate (UNC) Alternate (WFU)

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

Advocacy Council

Additional meeting information

is online at www.ncafp.com/sfpw

James W. McNabb, MD, Chair

CME Council

Thomas R. White, MD, Chair

Health of the Public Council Practice Enhancement Council

Rhett L. Brown, MD, Chair

www.ncafp.com/ncfp

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:

ECU Begins New Era in Family Medicine ~ See Page 6 ~

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•

•

•

•

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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

THE NORTH CAROLINA

Inside

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Physician Burnout is an Issue All Physicians Must Be Vigilant With..................................4

PUBLISHED BY THE NORTH CAROLINA ACADEMY OF FAMILY PHYSICIANS, INC. Ra le igh, Nor th Ca r olina 27605 919.833.2110 • fa x 919.833.1801 http://www.nc a fp.c om MANAGING EDITOR & PRODUCTION P eter T. G ra be r, MMC, CAE, Dir e c tor of Communic a tions

First in Health Initiative Pushing the Primary Care Payment Envelope...............................8 Winter Meeting Set to Offer Full Educational Lineup....................................................12 A New Day for Family Medicine...................................................................................15 Information Technology and Your Practice...................................................................18

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

Executive’s Message.............................................................15.

Chapter Affairs...........................................................................16 Practice Management.................................................................18

PRESIDENT’S MESSAGE

Physician Burnout is an Issue All Physicians Must Be Vigilant With

By Richard Lord, Jr., MD, NCAFP President

As I am writing this article, I am looking forward to a week at the Outer Banks with my family. The reason I put this out there is that the focus of this message is on physician burnout. My first message reflected on engaging patients in the Patient-Centered Medical Home, once again asking us as family physicians to add another concern to our overflowing plates. Recently at meetings of the Academy leadership, discussions about the needs of our members led to concerns being voiced about physician burnout and our need as an Academy to help the membership stay healthy.

Burnout is a syndrome that occurs when individuals are under constant pressure.

Family physicians at the current time are under pressure from our patients who are more complex, with multiple diseases than ever before. We are under pressure from payors to provide a medical home for patients often without increased resources at the start, and we are under pressure from the health system to help control costs of care. These just mention a few. Many of us may also have pressures at home caring for our spouses and children or even our aging parents. The symptoms of burnout include emotional exhaustion, cynicism, and perceived clinical ineffectiveness, and a sense of depersonalization in relationships with co-workers, patients, or both.1 Having burnout can lead to poor decision making with patients and poor decision making in our personal lives as we try to deal with the pressure. Many of us may experience some of these feelings from time to time and when they are present, we need to take a break and assess our health as physicians and take steps to prevent burnout.

Many different factors may put us at risk for burning out during our careers. Studies have identified that personal characteristics such a being more compulsive, work-related stressors such as loss of control over work load and family stressors put us more at risk for burnout.1,2,3 While many of these factors are modifiable, we all know that as physicians we put off taking care of ourselves and delay getting the care we need. Unfortunately, it appears this delay is now leading many physicians to consider leaving the profession at a point in time when they have acquired a wealth of experiential knowledge.

The early retirement of physicians will only exacerbate the predicted shortage of primary care physicians in N.C. and across the country. Patients across North Carolina continue to need and count on their family physicians to provide high quality effective care and the only way to assure this is for all of us to look for ways to keep ourselves healthy.

Spickard et al1 state that the best prevention for burnout is to promote personal and professional well-being on all levels: physical, emotional, psychological, and spiritual. They further state that this focus on well-being

needs to begin during medical school and continue through our careers, all the way to retirement. Spending time on keeping ourselves healthy and balanced in these areas can lead to a more fulfilling career and satisfying personal life. Several different strategies have been suggested for us to use in the prevention of burnout. Many of these will seem very familiar to us, influence happiness through personal choices, spending time with family and friends, participating in religious or spiritual activity, having a healthy diet and regular exercise, and having a supportive partner. Another important area for us to focus on in the current environment is our workplace.

Across the state our workplaces have seen significant changes. The institution of electronic health records (EHR) in many practices, becoming an NCQA-recognized PCMH, becoming employed by a health system, or selling a practice to a larger system. Studies have suggested that the loss of positive factors in the workplace such as loss of autonomy, recognition of one’s work and utilization of skills, put physicians at greater risk for burnout than having negative factors, such as high work demands, or negative patient encounters.2 As we move forward with health system change and reform, we all need to look at the workplaces we enter and ask ourselves how is physician well-being promoted in the practice and by the institution. One important strategy in the work place is to find a mentor who can help you stay balanced and provide support when needed.

The leadership of the NCAFP recognizes physician burnout as an important issue for all our members. Be assured that your Academy is working to develop CME to help our members, and is looking at ways to advocate for physician wellness across the state. So as the hectic holidays and sickness season begins, I encourage all of us to take a moment to reflect on our personal and professional lives and take an honest assessment of our needs. If you find that you are in need of help there are many resources across the state to help physicians and I encourage you to ask for the help you need. Let’s keep ourselves healthy so that we can continue to serve the population of North Carolina.

Having burnout can lead to poor decision making with patients and poor decision making in our personal lives as we try to deal with the pressure.

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Autumn 2011 • The NC Family Physician

References: 1. Spickard A, Gabbe S, Christensen, J. Mid-Career Burnout in Generalist and Specialist Physicians JAMA. 2002;288(12):1447-1450.

2. Kushnir, T. Cohen A. Positive and negative work characteristics associated with burnout among primary care pediatricians Pediatrics International (2008) 50, 546–551.

3. Wallace J, Lemaire J, Ghali W. Physician wellness: a missing quality indicator. Lancet 2009; 374: 1714–21.

www.ncafp.com/ncfp

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R E S I D E N T S & N E W F Ps

ECU Begins New Era in Family Medicine State-of-The Art Teaching and Residency Training Center Now a Reality!!!

You could feel the energy almost immediately when walking through the main entrance. Finally, after decades of effort and thousands of hours of work, a bold vision had become a sparkling new reality. East Carolina University’s new Family Medicine Center & Frances J. and Robert T. Monk Geriatric Center was open for business!

ECU formally dedicated the new center in late September with a ceremony that brought together leading dignitaries from the University, ECU’s Family Medicine Department, friends, supporters, and several elected officials from Pitt County. Excitement filled the room as dedication speakers shared their thoughts and expressed what the center will mean to the university and to health care for eastern North Carolina. A common theme emerged: the influence that teamwork and partnerships had on making the new $38 million center a reality.

“Great things happen with great partners,” commented ECU’s Chancellor Dr. Steve Ballard. Dr. Ballard made key mention of the NCAFP’s legislative advocacy work as instrumental in helping ECU to secure the necessary support in the General Assembly. “And what great partners we had in the North Carolina Academy of Family Physicians.”

For many physicians and faculty on hand, the dedication was a culmination of decades of work and planning. None more so than founding ECU Family Medicine Department Chair and NCAFP Past President Dr. Jim Jones (1972). Dr. Jones is largely credited for setting the initial vision for a new center during his tenure as department chair.

“In my fondest dreams and imaginations, I could not have dreamed about today. I’m eternally grateful,” commented Dr. Jones.

The new center is completely state-of-the-art and befits the university’s medical school as a leading producer of students who enter Family Medicine residencies. Current Family Medicine Department Chair Dr. Ken Steinweg highlighted during his remarks the Brody School of Medicine’s status as the nation’s leader in the percentage of graduates entering Family Medicine residencies over the last decade. And with this major accomplishment, Steinweg believes that the center represents a long term commitment and ‘continuity’ to providing the very best Family Medicine training and patient care possible.

Prior to the center’s opening, ECU’s Family Medicine department was extremely spread out, using four separate buildings. Space was at such a premium that residents, staff and faculty were routinely forced to work

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Autumn 2011 • The NC Family Physician

A number of present and past NCAFP leaders attended the dedication. Pictured from left, Drs: Michelle Jones, William Dennis, Conrad Flick, Jim Jones, Dean Patton, Brian Forrest, Robert Rich, Jr., Ken Steinweg, Chip Watkins and EVP Greg Griggs.

wherever they could find space. It was not uncommon to find residents working in hallways, or even an open exam room. Plus, faculty and residents located in different buildings made collaboration difficult.

“Since the department was in four separate buildings, our learners and faculty had to move all around the separate locations,” Steinweg said. “We are now all in one place, which has allowed us to organize our practice to meet the needs of the patient-centered medical home. It is just wonderful.”

At more than 110K square feet, the new facility contains more than 60 exam rooms. It also brings together the key components of integrative out-patient Family Medicine, including sports medicine, geriatrics, physical therapy and pharmacy. The center also houses an urgent care center, facilities for medical procedures and minor surgeries, radiology, and even expanded teaching classrooms for medical students. With everything in one location, www.ncafp.com/ncfp

Greenville. Prospective residents have been very impressed with the facility’s features, especially those that are expected to impact their training. For example, the residency has enhanced its ability to video record resident-patient encounters within its core teaching modules. This allows training faculty to review patient interactions with individual residents or even showcase select encounters within the program’s didactic sessions. It’s expected that this teaching tool that will further enhance the quality of the learning experience, and clearly illustrates the value that a modern facility can have on training future physicians.

“There is a lot more support here for residents as learners. The new facility is equipped to maximize their educational experience,” noted Dr. Levine. This will translate into better recruitment, and eventually and most importantly, better family physicians for North Carolina.”

Exam room video is just one of many new teaching tools at the program’s disposal. Expanded conference and precepting facilities, a stable of new diagnostic equipment, and resident offices directly adjacent to their faculty leaders are others.

Always A Physician, But Not Only a Physician.

faculty and residents are interacting more - often spontaneously - offering immeasurable training value.

Big Boost for Residency Program

ECU’s new center has been a fantastic addition to the University’s medical complex and has boosted morale. Possibly the biggest winner has been ECU’s Family Medicine Residency Program, a 12-12-12 program that has produced 320 family physicians since its inception.

“People are excited. With excitement comes fresh new ideas, better ways of doing things, and a willingness to explore outside of the box,” commented Dr. Gary Levine, Residency Director. “It’s a wonderful beginning toward what we feel will be even greater things to come.”

The new center has already been a fantastic change for the program’s 36 residents and is turning out to be even better for recruiting. Levine pointed out that ECU medical students continue to show great interest in our specialty, and many envision themselves training and practicing in

ECU seeks Family Medicine residents who are academically accomplished, people-oriented, team players and have passions outside of medicine. This special mix is central to the program’s core philosophy that stresses that its physicians will not only be expert clinicians, but will also be individuals who contribute beyond the clinic, to the community as a whole. Even with its new facility and tools, the program is still guided by its simple home grown principle. Known as APNOP, ‘Always a Physician, But Not Only a Physician’.

“We feel very confident in our ability to produce excellent clinicians through high quality in-patient and outpatient clinical experiences, and structured didactic sessions. But we want more from our residents, too,” Levine explained.

“We want them to be leaders in their community, humanitarians, and engaged in pursuing interests outside of medicine. They will be better physicians and better people because of it. That’s what APNOP is all about.”

APNOP has also been the foundation for the program’s ‘Resident Bill of Rights’ and a ‘Residents Bill of Responsibilities’ as well. Each outlines clear expectations on the part of residents and faculty, and provides a ‘constitutional framework’ for its training.

As in other residency programs, ECU’s residents complete a very involved training curriculum and are likewise encouraged to pursue scholarly projects.

The program offers a number of electives, including pharmacotherapy, endocrinology, gastroenterology, infectious disease and others. Didactic sessions happen three times a week and cover evidence-based topics, the spectrum of knowledge within the discipline of family medicine, and challenging cases related to in-patient care. One to three residents per year go on to fellowships. The department currently offers fellowships in Women’s Health, Geriatrics, and Sports Medicine.

With a new world class facility, a strong foundation of expert faculty, and a recently expanded residency class, this already nationally-recognized residency program is justifiably excited about the present and well positioned for the future.

Autumn 2011 • The NC Family Physician

7

ADVOCACY & POLICY

CCNC’s First in Health Initiative Pushing Payment Envelope A number of large North Carolina employers will collaborate with Community Care of North Carolina (CCNC) to provide medical homes for their employees in a new initiative announced at the NC Institute of Medicine Annual Meeting in late August.

“First in Health” is a public-private partnership that will enable private sector employees to tap into the medical home infrastructure previously created for Medicaid recipients by CCNC over the past decade.

Partners in the initiative include GlaxoSmithKline (GSK), the State Health Plan of North Carolina (SHP), local pharmacy chain Kerr Drug, business analytics company SAS, and Blue Cross and Blue Shield of North Carolina. The companies are joining forces to promote medical homes, change the way care is delivered and demonstrate that increasing the focus on managing chronic diseases can improve outcomes and hold down costs.

CCNC is already known for providing the state’s Medicaid program with “on the ground” care management, HIT infrastructure and population-based health initiatives that have resulted in Medicaid savings of nearly $1.5 billion over just three years. Now, private sector companies are joining the effort in hopes of realizing similar quality and cost-savings benefits for their covered lives.

First in Health builds on several federal medical home demonstration projects already underway in North Carolina, including the Beacon Communities program, the Medicare 646 waiver and the Multi-Payer Advanced Primary Care Initiative.

In January, GSK will begin offering its NC employees the option of

joining a CCNC medical home. Employees deciding to enter the program will have their copayments for primary care waived, and participating doctors will receive a “per member, per month” fee for each GSK employee assigned to their practice. These resources will fund an enhanced level of care coordination including improved HIT and “high touch” assistance from local care managers.

The State began offering employees access to CCNC medical homes in targeted counties this Fall, and the State Health Plan hopes to offer the option to 400,000 enrollees in all counties within two years through a cooperative agreement with Active Health management. Kerr Drug is working through its benefits process with an eye toward offering employees access to medical homes in the company’s 2013 benefit year. SAS will provide sophisticated analytical tools and experienced health data consultants to the program.

First in Health is one more example of how more and more people are realizing the value of primary care delivered through a Patient-Centered Medical Home. A video summary on the initiative can be found on the NCAFP website at www.ncafp.com/firstinhealth. Look for more information on this initiative in future editions of the North Carolina Family Physician.

New Program will Get EHRs into NC’s Free Clinics, Independent Practices In late September, Blue Cross and Blue Shield of North Carolina announced a collaboration with Allscripts to make Electronic Health Records available to more than 750 North Carolina physicians. The new initiative, called the North Carolina Program to Advance Technology for Health (NC PATH), will cover 100 percent of the cost for 39 eligible free clinics to implement electronic health records (EHR) over the next five years. It will cover 80 percent of the software and setup costs for 600 physicians in eligible independent practices.

BCBSNC is investing $15 million in order to help these physicians adopt health information technology tools and implement electronic medical records. In addition, Allscripts is investing approximately $8 million in the initiative.

“The alliance with Allscripts puts our state on a path to better health outcomes driven by high standards,” said Brad Wilson, BCBSNC president and CEO. As part of the program, participating practices receive support for their efforts toward earning Patient-Centered Medical Home Recognition, which has shown results in enhancing health care quality and managing costs. BCBSNC is also working with the NC Area Health Education

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Autumn 2011 • The NC Family Physician

Centers Regional Extension Center programs to assist practices in identifying quality improvement opportunities within their practice, and the NC Health Information Exchange to create a program that will enable participating providers to ultimately connect to HIE. Patients of PCMH-recognized practices commonly experience increased quality of care, including over 50 percent fewer visits to specialists and 70 percent fewer emergency room visits, lower radiology costs and lower average lengths of stays in hospitals. Independent practices that reach PCMH recognition may also be eligible for increased reimbursements from BCBSNC. The program eliminates the largest barrier to EHR adoption for eligible independent practices by covering such a large portion of the initial implementation cost. It also helps physicians meet key provisions of the HITECH Act, including reaching meaningful use which makes physicians eligible for up to $44,000 in EHR incentive payments from Medicare in addition to the BCBSNC subsidy.

Practices that implement “meaningful use” certified EHR technology consistently show improvements in the quality of care provided, reductions in medical areas and reductions in redundant or unnecessary procedures.

www.ncafp.com/ncfp

The Centers for Medicare & Medicaid Services (CMS) is giving incentive payments to eligible professionals, hospitals, and critical access hospitals that demonstrate meaningful use of certified electronic health record (EHR) technology.

Incentive payments will include: • Up to $44,000 for eligible professionals in the Medicare EHR Incentive Program • Up to $63,750 for eligible professionals in the Medicaid EHR Incentive Program • A base payment of $2 million for eligible hospitals and critical access hospitals, depending on certain factors Get started early! To maximize your Medicare EHR incentive payment you need to begin participating in 2011 or 2012; Medicaid EHR incentive payments are also highest in the first year of participation.

Registration for the EHR Incentive Programs is open now, so register TODAY to receive your maximum incentive.

For more information and to register, visit:

www.cms.gov/EHRIncentivePrograms/ For additional resources and support in adopting certified EHR technology, visit the Office of the National Coordinator for Health Information Technology (ONC):

www.HealthIT.gov

SAVE THE DATES

STUDENT INTEREST

~ S T U D E N T I N T E R E S T & I N V O LV E M E N T ~

NCAFP Student Leadership Positions Applications Due by 11/14/11 - Elections on 12/3/11 NCAFP Externship Program Application Deadline: Tues., Jan. 17, 2012 NCAFP Interest & Scholars Program Application Deadline: Tues., Jan. 17, 2012 NCAFP Foundation Scholarship Application Deadline: Mon., May 7, 2012

Now you can provide a complete allergy testing and immunotherapy service line.

North Carolina Student Elected as National AAFP FMIG Coordinator Nailah Adams, a fourth-year student at Duke University School of Medicine, was elected National AAFP FMIG Coordinator during this summer’s National Conference. As National Coordinator, Adams will serve as leader and consultant for the National FMIG Network and FMIG Regional Coordinators. Ms. Adams will be serving a 1-year term.

The AAFP established the National FMIG Network to strengthen the on-campus organizations that focus on promoting Family Medicine as a career. Composed of campus faculty and student FMIG leaders, appointed regional coordinators, the network fosters communication among FMIGs across the country.

Adams said her love for science, health topics, teaching and people first drew her to medicine. The ability to combine those interests with the full range of medical practice attracted her to Family Medicine.

Prior to medical school, Ms. Adams taught elementary school in Trinidad, West Indies, and middle school in Oxon Hill, Md. She was also a steelpan and music theory teacher at the Cultural Academy for Excellence in Hyattsville, Md., for six years during her undergraduate and graduate studies. She’s passionate about generating interest in family medicine among students in elementary, middle and high school, as well as among undergraduate college students.

In addition to her AAFP involvement, Ms. Adams currently serves as the co-president of both the Student National Medical Association and the Family Medicine Interest Group at Duke, and is a member of the Primary Care Leadership Track Advisory Group.

Duke’s FMIG Co-Presidents Receive University Awards

Your patients no longer have to suffer from seasonal allergies and you don’t have to risk losing them by referring out to specialists. By offering this service line, physicians are able to provide a higher level of care to a large portion of their patient base, while generating a new revenue stream.

About United Allergy Labs and our service: • We hire and train a Certified Clinical Allergy Lab Specialist to test, educate and custom build immunotherapy under the supervision of the on-site physician.

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Visit our booth at the Winter Family Physicians Weekend

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Kate Wiegert is the Michael R. Nathan Memorial Fund award winner at Duke. She was selected for her project: “Reducing Maternal Mortality in Rural Haiti-Effect of Traditional Birth Attendant Education”. This award is given to one 3rd or 4th year medical student who undertakes a project in community health, occupational health, or international health. Ms. Wiegert can use a portion of the award to offset tuition expenses and the rest is used for travel and project expenses.

Nikki Henry is the Eva J. Salber Award winner for her project: “Addressing Generative Desires and Mitigating Depression in the African American Elderly through Intergenerational Interactions and Autobiographical Narratives”. This award is given to one or more Duke 2nd or 3rd year medical students to enable them to acquire a community perspective in medicine. Ms. Henry can use a portion of the award to assist with her tuition expenses and the rest is for expenses incurred while carrying out the project designed to investigate and improve the health of a disadvantaged population group.

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MEETINGS & EDUCATION NCAFP’S 2011 Winter Family Physicians Weekend

Winter Meeting Set to Offer Full Educational Lineup Thursday, Dec. 1st – Sunday, Dec. 4th, 2011 at The Grove Park Inn – Asheville, North Carolina

Soak up the autumn air and the assessment and management of kick-start your holiday season. Join patients and cardiovascular risk. This Program Chair, James W. McNabb, dinner lecture will review current MD, in Asheville this December guidelines ( which focus on LDL 1st-4th as he presents a conference cholesterol as the primary treatment full of topics valuable to family target), explore emerging data, physicians in all types of practices. and summarize recently-released There will be high quality lectures guideline recommendations, on issues like asthma, palliative care, including ATP 4 (if available).

EN V prescription drug abuse, ADHD, Should physicians measure beyond E L D E AN gout, and many others. There will LDL, and if so, what should be S U THO also be a great line-up of optional measured, on what patients, and T WO CME seminars, SAMs Study to what goals? Using case studies Working Groups and non-CME as illustration and for discussion, Satellite programs throughout practical strategies for the busy the weekend. The NCAFP clinician will be emphasized. There 2011 Winter Family Physicians is no fee to attend. You must be a Weekend will present over 25 AAFP registered conference attendee to Prescribed credits. Some select attend the dinner lecture. Dinner Asheville, N.C. lectures will offer additional credit will be provided. through Transition to Practice (t2p), a new credit category being piloted These are just two of 11 different workshop and satellite learning by the AAFP. A full list of General Session topics, workshops, and activities. Other workshop topics include New Payment Models, satellite programs can be found online at http://www.ncafp.com/wfpw.

Spirometry, Cosmetic Procedures, T2DM, Community Precepting, Headlining the conference’s optional workshop lineup is the “Living Practice Management 101, and more. These are in addition to a full with Diabetes” (Thurs., Dec. 1st, 12:30-1:30 pm) seminar that will agenda of General Sessions topics. Please see the website for a complete feature keynote speaker Dominique Wilkins, former professional NBA listing with descriptions. basketball player and nine-time NBA All Star. Diabetes, unlike many The conference will also offer plenty of relaxation and entertainment. other chronic illnesses, is a disease that if properly managed can let Make plans to attend the annual NCAFP Foundation Silent Auction those it impacts live healthy and fulfilling lives. Wilkins was diagnosed and Gala hosted by Dr. & Mrs. Brian Forrest on Saturday evening. with Type II Diabetes 10 years ago and will share his story. He will This is always a terrific event at The Grove Park Inn (GPI). The night stress the importance of healthy and pragmatic lifestyle choices such starts off with bidding wars and terrific holiday shopping at the annual Silent Auction. The Auction benefits the programs that the NCAFP Foundation conducts on behalf of Family Medicine in North Carolina.

Complete 2011 Winter Meeting Information Following a terrific gourmet dinner prepared by the GPI, kick up your heels with a live dance band -- Bueller -- honoring all the great hits from is available at www.ncafp.com/wfpw the 1980’s. It’s the perfect commencement to Dr. Brian Forrest’s term as President of the NCAFP! Be sure to visit our website and review our registration brochure as diet, exercise and proper medication. By sharing his personal battle for more information on additional learning and entertainment with the disease and how he has dealt with his illness over the years, opportunities that will be offered over the weekend.

Dominique will relay his message that diabetes is not a curse but a long Registering is easy and can be done either online or by mail or fax. term commitment. Following a short break, Dr. Wendy Lane will share For a hard copy registration, simply mail or fax (919-833-1801) your a presentation titled ‘Getting to Goal: The GLP 1 Story.’ Dr. Lane will registration form with your credit card number or check made payable to provide a clinical review on Type II Diabetes Treatment - Victoza (GLPthe North Carolina Academy of Family Physicians. Registrations can also 1). Sponsored by Novo Nordisk, this program is open to all Registered be completed by visiting www.ncafp.com/wfpw.

Conference Attendees. There is no fee to attend. Pre-registration is Please contact the NCAFP Meetings Department for more required. Lunch will be provided. information or to request a brochure and registration form by calling Another great workshop will be the CME dinner and lecture, ‘Beyond (919)833-2110 or (800)872-9482 (Toll Free in NC only) or via email at LDL Cholesterol – How and How Far’ (Thurs., Dec. 1st, 6:45 - 7:45 meetings@ncafp.com. pm).

There is growing interest in the use of “advanced lipid testing” in www.ncafp.com/ncfp Spring 2011 • The NC Family Physician

s Weekend n a i c i s y h Winter Family P Dec. 1-4, 2011 Grove Park Inn & Spa

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N C A F P

F O U N D A T I O N

I N I T I A T I V E S

Green Mountain 6th Grader Selected as State Tar Wars Poster Contest Winner Brenea Waldrup, a rising 6th grader from Green Mountain, North Carolina was selected as this year’s state winner in the 2011 Tar Wars poster contest. As the winner she recently traveled to Washington, D.C. to participate in the national poster contest and awards ceremony. The Tar Wars awards ceremony was held July 12 and 13 in Washington D.C., where the original artwork was on display. Her poster was inspired by her love of the movie Dirty Dancing (filmed at North Carolina’s very own Lake Lure), the slogan she created was “Kick up your Heels, Tobacco Free is the Way to Be!” As part of the Tar Wars program, Brenea, accompanied by her parents

Pinehurst’s Dr. Clare Reinhardt Attends National Tobacco Advocacy Meeting In late September, NCAFP’s Dr. Clare Reinhardt was privileged to attend “Protecting Families from Tobacco: Leadership Advocacy Training.” The conference was a collaborative effort between the AAFP, AAP, AMA, and ACOG. Attendees apply and are selected to particpate in the conference by the AAFP. During the conference, participants were presented with educational materials and a state specific tobacco resource packet.

Unfortunately, even as North Carolina has made great strides with recent smoking bans in several specific types of public places, we still have a long way to go in the campaign to protect families from the harmful effects of tobacco.

The conference’s training curriculum focused on methods to increase advocacy efforts for tobacco cessation in individual practice settings as well as ways to advocate for decreased tobacco exposure on the sate, federal, and even global levels. Lectures and panel discussions focused on working with state and local agencies, increasing access to pharmacotherapy coverage, incorporating secondhand smoke and thirdhand smoke (the residual tobacco contaminants that remains after a cigarette has been extinguished) messages into cessation, and developing an advocacy plan. Faculty lectures from the training can now be viewed at http://www.aap.org/richmondcenter/Policy_Advocacy.html.

The training also included breakout sessions with a wide range of topics pertaining to tobacco cessation advocacy. Topics covered included identifying a starting point for advocacy work, creating an office practice infrastructure, setting clinical and community goals, researching and writing testimony, increasing coverage for pharmacotherapy coverage, and media communication in tobacco control advocacy. Participants were then grouped by geographic location to discuss developing a personal advocacy plan.

William and Tammy, as well as her Grandmother, were able to see sights in the Washington D.C., area. They were able to visit with Senator Burr to thank him and to have a photograph taken with him. They were also able to participate in a tour of the Capitol with his staff. The family briefly met with Senator Hagan’s staff as well.

The AAFP has overseen Tar Wars since 1997, and the program has grown to reach thousands of fourth and fifth grade students in all 50 states, several territories and internationally each year. Since its founding, Tar Wars has reached more than 8 million children. For more information on Tar Wars and how you can get involved in this important educational initiative, please contact Tracie Hazelett at the NCAFP offices, thazelett@ncafp.com.

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www.tangible.com Autumn 2011800.393.9886 • The NC Family Physician 13

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EXECUTIVE’S MESSAGE

A New Day for Family Medicine

By Gregory K. Griggs, MPA, CAE, Executive Vice President

“But now at length I have the happiness to know that it is a rising and not a setting sun.”

- Ben Franklin, September 1787

Ben Franklin, one of our founding fathers, made this statement as our country’s leaders signed the United States Constitution. Franklin had contemplated the painting on the back of the presiding officer’s chair, noting that it was many times difficult to determine whether an artist had the intent of capturing a rising or a setting sun. But after fighting a long battle with Great Britain and debating how government would ultimately operate in this new land, Franklin was convinced that a new Democratic nation was rising from the ashes of the Revolutionary War. Some 225 years later, we are in a similar position relevant to our country’s healthcare system, and particularly primary care. Is the sun setting on what we have known as primary care? Or is our specialty rising from the ashes like a Phoenix to take its rightful place in the healthcare landscape.

I choose to believe the latter, and the overwhelming course of evidence today supports that belief. The sun is truly rising on a new day where Family Medicine can and will be the foundation of our healthcare system.

While I realize it is still easy for one to see the glass as half empty particularly in today’s changing climate of alphabet soup (ACOs, PCMH, NCQA, etc., etc.). But let me outline just a few of the things that are happening at both the state and national level that I believe will ensure Family Medicine’s place at the forefront of healthcare.

First and foremost, the Centers for Medicare and Medicaid Services (CMS) is taking action to improve the value of primary care services. For example, in late September CMS announced the Comprehensive Primary Care Initiative (CPCI). This pilot effort is designed to help primary care practices deliver higher quality, better coordinated, and more patient-centered care. Under this initiative, Medicare, commercial and state insurance plans will offer bonus payments to primary care doctors who better coordinate care of their patients by combining fee-for-service with a per-patient, per-month coordination fee ranging from $8 to $40 per month. While this will only be offered in a few regions to a limited number of practices, it is one more effort by CMS to better value primary care.

At the same time, the Medicare Payment Advisory Commission (MedPAC) is proposing draft recommendations that call for eliminating the sustainable

growth rate (SGR) formula, accompanied by a positive payment differential to the Medicare conversion factor for primary care. MedPAC is calling for the Department of Health and Human Services to establish more accurate work and practice expense values, which likely would result in shifting payments from overvalued procedural services to evaluation and management services commonly used in primary care.

But it’s not just these federal initiatives that are recognizing the value of primary care and Family Medicine. Many things are also happening right here close to home.

Community Care of North Carolina (CCNC) is currently involved in at least three initiatives that could have a significant impact on how family physicians are valued in our state.

First, the Medicare Quality Demonstration (646 Waiver) project added Medicare recipients to the traditional Medicaid care management model in more than 200 practices across 26 counties in the state. And this is expected to grow. Using Medicare claims data, CCNC is identifying patients who would benefit from specific disease management interventions. And in this instance, the local CCNC networks and participating practices can share any savings generated from the better management of these high cost patients.

Second, in seven rural counties, CCNC practices are taking part in the Multi-Payer Advanced Primary Care Practice Project. Practices in Ashe, Watauga, Avery, Transylvania, Granville, Bladen and Columbus counties are all working to qualify for the NCQA Patient Centered Medical Home designation. Doing so will qualify these practices for a per-member permonth payment (like they currently have for Medicaid patients) or other enhanced payment for patients who are insured through Medicaid, Medicare, Blue Cross and Blue Shield of North Carolina and the State Employees Health Plan. The local CCNC network will continue to employ additional care managers to help the practice manage the population, and both the network and the practice will benefit financially for the extra effort they make to better manage these patients, resulting in a substantial increase in income for these practices.

Third, CCNC also recently announced the “First in Health” Initiative involving major employers in the Triangle region, which adds additional private sector support for primary care. In this instance, practices in the Triangle will receive additional financial incentives for serving as a medical home to GSK employees, among others (see more details on page 8).

Beyond CCNC, Blue Cross and Blue Shield of North Carolina has two initiatives designed to help independent smaller primary care practices.

See ‘New Day’ on Back Cover Autumn 2011 • The NC Family Physician

15

C HAP T ER A F F A I R S

~MEMBER LEADERSHIP SPOTLIGHT ~

UNC’s Warren Newton Serving as 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, Vice Dean of 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 numerous state and national leadership positions within Family Medicine, and has served on the NCAFP Board for a number of years.

The North Carolina Family Physician had the opportunity to conduct an email-based interview with Dr. Newton that appears below. In addition, Dr. Newton formally addressed the AAFP Congress of Delegates in early September. The NCAFP has provided a complete video of his comments, as well as a brief interview he conducted with Chapter staff. Both are available at www.ncafp.com/newton-abfm.

Describe your history of involvement with the ABFM. When did you get involved? How were you nominated/elected as Board Chair?

begins to narrow in ways that are important, our social contract is at risk.

Now obviously, many family physicians morph into what their communities need. But, in many settings, the broader scope of care is important. I think many family physicians acknowledge that they are no longer doing WN: I was elected to the American Board of Family Medicine in 2007. The deliveries - that’s not unexpected. What is unexpected is other narrowing of board currently has a total of 15 members - 3 per year and one of those 3 is care, including children, the care of mentally ill a representative from other boards. I was elected as and other elements. Our current data, which are Chair-Elect for two years by my peers. incomplete, suggest that there are significant shifts going on, at least across the US. We are beginning Describe the key issues the Board is addressing to try to collect better information both across the and their potential impacts on the specialty.

The American Board of Family Medicine US and state by state as in NC. WN: The American Board of Family Medicine is engaged along a broad array of issues, and it Family Medicine is in a state of transformational change. With this, what is clearly a leader among the various boards. Probably the key element is do you see as ABFM’s most important role right now.

Maintenance of Certification. This came out of concerns in the 90s that the profession was not being responsive to public concerns about quality, safety WN: I believe medicine as a whole is in a state of not just usual change and ongoing competence. Hence, the American Board of Medical Specialties but transformative change. In this fundamental restructuring, it is critical required all of the boards to introduce Maintenance of Certification that Family Medicine as a discipline take the lead. I think we’ve seen that ongoing certification. We are the first board to have completely enrolled in the Patient Centered Medical Home movement. ABFM’s contribution all of our diplomates in that - about 82,000. Maintenance of Certification is a relentless emphasis on improving quality of care, rediscovering the includes many components. There is, of course, the SAMs (self assessment professionalism that is at the root of our commitment to our patients and modules) which include an open book test, a simulation and the Part IV communities and reinventing our educational model. of quality improvement component. The board is also making a great deal of effort to make Maintenance of Certification as useful as possible to What is ABFM pursuing in order to encourage more FPs to board certify? diplomates - including giving direct CME, facilitating PQRI reimbursement, negotiating with insurance companies to get on preferred provider lists WN: As noted, we’ve tried to make the process significantly easier - more and to support quality improvement efforts. I believe there will also be flexibility, more locations and a 10 year cycle. We are also trying to add opportunities to have Maintenance of Certification stand in for the quality value to maintenance of certification - through giving CME that is free review necessary for hospital credentialing. for physicians, by supporting quality improvement, by enabling PQRI reimbursement and ongoing direct communication with national insurers In your address to the AAFP Congress of Delegates, you expressed that the to help identification and preferred provider lists. We will shortly be ABFM is concerned about the decrease in FPs taking care of children and offering opportunities to help with meaningful use and also we hope to what it suggests about changes in scope-of-practice. Why is this so critical? allow maintenance of certification to stand in for maintenance of licensure requirements that are coming. Finally, as NCAFP has done, we think that WN: In my address to the AAFP Congress of Delegates, I expressed our SAMs and other structures provide opportunities for family physicians to concern about the narrowing scope of practice. Family Medicine came work together to improve care - much like the information conversations that out of the social ferment of the 60’s - out of a need for personal doctoring, used to take place in doctors’ lounges in hospitals. continuity and comprehensiveness of care. That is our value. If our care

ABFM

16 Autumn 2011 • The NC Family Physician

www.ncafp.com/ncfp

~ N AT I O N A L & I N T E R N AT I O N A L ~

NCAFP Past President Conrad Flick Announces Candidacy for AAFP President-Elect NCAFP Past President Dr. Conrad L. Flick (2004) of Cary, NC, recently announced his candidacy for AAFP President-Elect in 2012. Dr. Flick has served on the AAFP Board of Directors since 2009.

Dr. Flick has been active in national AAFP affairs since the mid-1990’s. His service began within AAFP’s Special Constituencies Section in 1998; he went on to serve as its Chair in 2001.

Dr. Flick was also active in the AAFP Commission on Governmental Advocacy and chaired that Commission in 2008.

Dr. Flick is in private, independent practice at Family Medical Associates of Raleigh. Family Medical Associates is comprised of five physicians, three mid-level providers and a registered dietician.

The North Carolina Family Physician will be publishing an interview with Dr. Flick regarding his perspectives on Family Medicine and his thoughts on leadership in an upcoming edition.

2011 NCAFP Foundation

SILENT AUCTION

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 / 800-8729482 (NC Only). We appreciate your contributions & participation and we look forward to seeing you in December!

NCAFP’s Martinez-Bianchi Leads Argentineans at UN High-Level Meeting on Non-Communicable Diseases Duke Department of Community of Family Medicine’s Dr. Viviana Martinez-Bianchi participated in the United Nations high-level meeting on non-communicable disease prevention and control Sep 19-20th.

Proclaiming the spread of non-communicable diseases a socio-economic and development challenge of “epidemic proportions,” governments at the UN summit on Non-Communicable Diseases (NCDs) pledged to work with the United Nations to adopt targets to combat heart disease, cancers, diabetes and lung disease, and to devise voluntary policies that cut smoking and slash the high salt, sugar and fat content in foods that cause them.1 NCDs such as coronary artery disease, diabetes, chronic respiratory conditions and cancer account for over 63% of deaths in the world, killing 9 million people under 60 years of age every year.

World leaders, Health and Development ministers with civic society representation met at the United Nations in New York City to set a global agenda and adopt a Political Declaration on the prevention and control of NCDs. This was considered to be a historic moment, since the General Assembly had met only once before to discuss a health issue when it outlined a strategy for AIDS. Dr. Martinez-Bianchi attended the meeting as a representative member for civic society in the Argentinian delegation (her country of origin) and carried with her the support and interests of WONCA (The International organization that represents family doctors worldwide).

“It was an exciting time to be at the General Assembly,” Martinez-Bianchi said. “I felt privileged to be able to hear world leaders, including General Assembly President Nassir Abdulaziz Al-Nasser, Dr. Margaret Chan, DirectorGeneral of WHO, Secretary-General Ban Ki-moon, presidents, prime ministers and ministers of health, as well as members of civic society share their opinions on such an important topic.” Princess Dina Mired (Union for International Cancer Control), NYC Mayor Michael Bloomberg and Lance Armstrong (LIVESTRONG) all shared their perspectives. MartinezBianchi also had the opportunity to engage in meaningful conversations with colleagues and experts from her own country of origin. Argentina has led the G77 group in the discussions towards this meeting and in drafting the declaration.

“As a family physician interested in population health issues, one of my worries was that the agenda set by the Assembly would be too narrow– addressing only cancer, heart disease chronic pulmonary conditions and diabetes in a silo – but the resolutions showed strong support for universal health care, prevention and primary care including mental health services.

World leaders recognize the need to engage with each other, and with their communities, civil society, private sector leaders and industry in a serious approach to the issue.”

Endnotes 1 WHO website; http://www.un.org/News/Press/docs/2011/ga11138.doc.htm.

Autumn 2011 • The NC Family Physician

17

P RAC T I C E M A N A G E M E N T

Information Technology & Your Practice A Key Building Block to PCMH A core tenet of the Patient-Centered Medical Home (PCMH) is the concept of managing patient health information and leveraging it to identify patients and their diseases, enhancing care coordination, and empowering the entire health care team, including patients. Health Information Technology (HIT) is also critical for providing the practice with ongoing management information on their care quality and performance.

Practices that have installed electronic health record (EHR) systems or practice management technology should be familiar with most of these topics.

But practices that are just stepping through integrating new technology for the first time may not fully grasp these issues, let alone those of ‘meaningful use’, e-prescribing, disease registries and self-service portals. Linking these concepts and others with PCMH can be daunting.

Applying HIT within a PCMH is what enables efficient access to patient data. With the right toolset, practices can leverage their HIT investments to manage patient populations more efficiently, improve quality, and enhance care coordination and communication. Health technology also helps to kick-start practice performance improvement by providing critical quantitative data.

Many of the patient/population identification and communication concepts endorsed by PCMH can be achieved through the use of an electronic health record (EHR). Disease registries, e-prescribing, lab results systems, and even web-based self-care portals are all examples. Although specific features and functions continue to evolve, the key is to recognize how each of these components integrate with PCMH. Both the Federal Government and the entire health care industry have realized the financial challenges practices face in implementing Electronic Health Records.

But many of these financial hurdles are beginning to be addressed.

Federal Programs Designed to Help Two key Federal programs designed to computerize practices are well underway. As part of the 2009 American Recovery and Reinvestment Act, stimulus dollars began to be earmarked for critical investments into the nation’s HIT infrastructure. Some funding was aimed at directly incentivizing physicians and practices to make technology investments. The legislation approved an approximate $19 billion dollar down payment ($17 billion for physicians / $2 billion for development of key national infrastructure) to make this happen.

The two Federal programs - one for Medicare physicians and one for Medicaid providers - both began to roll-out as of this past January. Each program provides eligible physicians/ providers with direct incentive payments for the ‘meaningful use’ of certified EHR technology.

Physicians/providers must choose which of these incentive programs they wish to participate in when they register, but this must be done before

18 Autumn 2011

2015. However, they may switch programs once after the first incentive payment is initiated. According to CMS, most eligible professionals can maximize their incentive payments by participating in the Medicaid EHR Incentive Program. Unfortunately the threshold for patient mix is quite high, so for most family physicians, the Medicare incentive program is the likely course. Providers need to be aware that the Medicare incentive program limits their ability to participate in Medicare’s Electronic Prescribing (eRx) Incentive Program. Additionally, providers who qualify for either the Medicare or Medicaid programs but do not choose to participate, will see Medicare payment adjustments starting in 2015.

Under the Medicare program, eligible physicians can receive up to $44,000 over five years, with additional incentives (plus 10%) for eligible professionals who provide services in a Health Professional Shortage Area (HSPA). To get the maximum incentive payment, Medicare eligible professionals must begin participation by 2012. Providers/physicians who have been slow to adopt an EHR can capture successively decreasing payments through 2015. For 2015 and later, physicians who have not adopted an EHR will begin to be penalized a percentage of their Medicare payments (capped at 5%).

In terms of the Medicaid program, North Carolina’s Medicaid EHR Incentive Program opened for registration in January, 2011 (http:// www.ncdhhs.gov/dma/provider/ehr.htm). Under this program, eligible providers will be able to apply for the incentive payments in any 6-year consecutive period until 2021 and can receive up to $63,750 over the six years that they choose. NC Medicaid is directing practices See ‘HIT’ on Back Cover

Official CMS Industry Resources for the ICD-10 Transition

www.cms.gov/ICD10

HIT - continued from p. 18 to first review ‘The Provider Insider’ (http://www.ncdhhs.gov/dma/ehr/ EHRNews012011.pdf), prior to registering. If your practice sees a significant number of Medicaid patients, this is an appropriate first step to take.

The eligibility requirements for each of these programs vary, but tools for determining provider eligibility can be found online. CMS provides an in-depth overview of both programs at https://www.cms.gov/ ehrincentiveprograms, including participation criteria, incentive payment schedules, listings of Certified EHR Technology and more. CMS also has made available a handy online eligibility tool. The process of actually registering for each incentive program is completed online, starting at https:// ehrincentives.cms.gov/hitech.

As with any major Medicare and Medicaid effort - and especially one that centers on technology - practices will likely have many more questions than answers as they begin to participate. Family Medicine and primary care practices often lack the technical expertise to fully evaluate technology, let alone the experience with the rigors of understanding very fluid government guidelines and how to apply them. With significant investment and incentive dollars involved, mistakes can be extremely costly.

To assist primary care practices, the North Carolina AHEC program, under its Regional Extension Center grant from the Office of the National Coordinator, has staffed all nine AHEC regions with personnel who are experts in EHR implementation, clinical practice and process improvement, and know what’s needed to successfully participate in CMS’s main EHR incentive programs. The best part about the program is that it’s free! AHEC will serve individual practices free of charge and help a practice evaluate, select and integrate certified EHR technologies. They also offer assistance with practice workflow issues and insight into how a practice’s health IT integrates with PCMH. Physicians and practices can sign up by applying at https:// www.ncahecrec.net.

It’s All About Meaningful Use Both Federal EHR incentive programs revolved around the concept of ‘meaningful use’ of certified technology. Although a complete discussion on meaningful use is beyond the scope of this article, it consists of a physician, practice or eligible provider demonstrating the use of certified EHR in a meaningful manner, exchanging health information in ways that improve quality, and submitting clinical quality measurements. According to CMS, ‘meaningful use’ means providers need to show they’re using certified EHR technology in ways that can be measured significantly in quality and in quantity.’ The criteria that physicians will use for demonstrating meaningful

use will be staged in three steps over the course of the next five years. Stage I sets the baseline for electronic data capture and information sharing and currently consists of 25 meaningful use objectives, 20 of which must be met by the physician/provider. Stages 2 and 3 will continue to expand on this baseline and be developed through future rulemaking. Additionally, reporting of clinical quality measures will be required.

Linkages to PCMH & PCMH Recognition Whichever incentive program a physician or practice chooses and regardless of HIT vendor or product, meaningful implementations of HIT (within a PCMH) provide a number of new capabilities and several patient-centered advances. According to a report by the Patient-Centered Primary Care Collaborative, five key themes are emerging that link meaningful HIT with high quality patient-centered care. These are: 1) Ability to exchange relevant personal health data and information; 2) Enabling all members of a person’s health care team to communicate; 3) Enabling collection, measurement and reporting on the processes and outcomes of individual and population performance and quality of care; 4) Enhancement of evidence-based, real-time decision support tools; and 5) Capability of consumers and patients to be informed and increasingly literate about their health and their medical conditions. With these, the concept of a ‘connected medical home’ is created.

The connected medical home supports team-oriented medicine, reduces costs, improves convenience, and closes collaborative gaps that exist between doctors and their patients.

The National Committee for Quality Assurance (NCQA) PCMH recognition program also recognizes and measures a practice’s support for HIT and EHR. The NCQA PCMH standards were revised in 2011 and a significant difference from 2008 is the reliance on an EHR to help meet the tenets of the PCMH. Several factors are embedded within the 2011 NCQA PCMH program, including the CMS Meaningful Use requirements. This, combined with the fact the NCQA’s revised program enhances the importance of clinical performance measures and promotes electronic communication with patients/families, demonstrates the increasing importance of HIT and EMR in the healthcare delivery system.

The quest to meet meaningful use and PCMH may seem like daunting and expensive journeys. However, with federal dollars at stake, free state resources at your disposal, and for those that qualify, increased payment, it is worth taking the next step. To get started, visit https://www.cms.gov/ ehrincentiveprograms and for additional information, please contact Brent Hazelett at bhazelett@ncafp.com.

NEW DAY - continued from p. 15 First, the Blue Quality Physician Program allows practices on the company’s standard fee schedule for primary care to receive substantial increases in their E&M codes when achieving the NCQA PCMH Designation and meeting a few other key criteria (i.e., e-prescribing, filing claims electronically, etc.).

Second, BCBS NC and Allscripts recently announced a program to provide no-cost Electronic Health Systems to the state’s 39 Free Clinics and to pay for 85% of the initial start up cost for EHRs in up to 100 smaller independent primary care practices (see page 8 for more details).

And if I’ve not convinced you yet, look at what is happening in our state’s medical schools. East Carolina University’s new Family Medicine Center is just one example of the value these schools are placing on YOUR specialty.

At more than 110,000 square feet, the Center is the newest and most state of

the art Family Medicine training facility in the country.

With its new Osteopathic Medical School (planned to open in 2013), Campbell University hopes to concentrate on family medicine and other primary care specialties. And Wake Forest, UNC and Duke all continue to innovate to attract more students into primary care specialties. For example, Duke now has a primary care leadership track where medical students will be accepted into Duke with the intent of entering primary care specialties.

There is certainly still work to be done, and we all must pull together to promote the specialty of Family Medicine. But I truly believe the sun is rising on a new day for your specialty in North Carolina and around the country. Get involved in your Academy and help the new Phoenix of Family Medicine take flight.