Page 1

THE NORTH CAROLINA

Volume 8 Issue 1 / Winter 2012

quarterly news in north carolina family medicine

The 2012 PRESIDENTIAL ADDRESS

Family Physicians:

The Keys to a Better Health Care System

Inside

..,

Winter 2012 •| The NC Family Physician 1 2011 Family Physician of The Year | Residents: FMs Future Leaders | ACO Game Plan for FPs The PCMH Revisited


2011-2012 NCAFP Board of Directors Executive Officers President Brian R. Forrest, MD President-Elect Shannon B. Dowler, MD Vice President William A. Dennis, MD Secretary/Treasurer Thomas R. White, MD Board Chair Richard Lord, Jr., MD Past President (w/voting privileges) R.W. Watkins, MD, MPH Executive Vice President Gregory K. Griggs, MPA, CAE District Directors District 1 - Jessica Triche, 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 - David A. Rinehart, 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 Michael L. Coates, MD Family Medicine Residency Directors William A. Hensel, MD Resident Director Matthew Kanaan, DO (Duke) Resident Director-Elect Mo Shahsahebi, MD (Duke)

April 12-15, 2012 Charleston, SC

Student Director John Trimberger (WFU) Student Director-Elect Katy Kirk (ECU)

FM Department Chairs & Alternates

Great educational lineup Optional SAMs Study Groups on Thursday & Saturday

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

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

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 Advocacy Council

Additional meeting information

is online at www.ncafp.com/sfpw

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

CME Council Health of the Public Council Practice Enhancement Council

Thomas R. White, MD, Chair Charles W. Rhodes, MD, Chair Rhett L. Brown, MD, Chair www.ncafp.com/ncfp


The 2012 PRESIDENTIAL ADDRESS

Family Physicians:

The Keys to a Better Health Care System

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, organizational 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/academy/mission On the Cover: Dr. Brian Forrest on Dec. 3, 2011.

THE NORTH CAROLINA

Inside

..,

Family Physicians: The Keys to a Better Healthcare System........................................... 4

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

Dr. Donald A. Ribeiro of Ayden - 2011 North Carolina Family Physician of the Year...... 6 NCAFP Advocacy Team Gearing Up for a Busy Session................................................ 8 Queen City Treasure: CMC Charlotte’s Family Medicine Residency............................. 15 A Game Plan for Small Town Family Physician Success with ACOs............................. 18

President’s Message............................................... 4 Meetings & Education......................................................... 10 . Chapter Affairs........................................................... 6 Student Interest.................................................................... 11 . Advocacy & Policy..................................................... 8

Executive’s Message.........................................................12. Residents & New FPs.......................................................14 Practice Management............................................................ 18


PRESIDENT’S MESSAGE The 2012 PRESIDENTIAL ADDRESS

Family Physicians: The Keys to A Better Health Care System By Brian R. Forrest, MD NCAFP President

Dr. Brian Forrest of Apex, NC, was installed as the 63rd President of the NCAFP on December 3rd, 2011, in Asheville. Below are remarks he shared with members during his inaugural address. I would like to start by thanking you, my colleagues, for giving me the honor to serve as your 63rd president. I would also like to thank several people who have helped me along this path. I have been blessed to have a supportive family, an extraordinary group of peers and colleagues, and a line of wise and caring mentors. To my mentors, Dr. Jim Jones, Dr. Bob Gwyther, Dr. Robert McConville in Sanford, Dr. Warren Newton, and more recently, Dr. Chuck Rich, and many more who I do not have time to name - you have modeled outstanding patient care, advocacy, leadership, and vision that I have learned greatly from. To my colleagues at Access Healthcare, I would like to say thanks in advance for all of the scheduling changes and covering that you will do at the practice this year and for all that you have done in the past. And finally, to my wife Shelley, who is an MPA. Greg Griggs and her would tell you that those initials stand for ‘Master of Public Administration’ since they both hold that degree. However, as I have told her, to me it stands for ‘Most Precious Asset’. And she is. She is the embodiment of compassion and has taught me a lot about that value. She also is the detail person and possesses multi-tasking skills that I will never achieve. What a blessing God sent into my life at the DMV that day in 1990. So, where do we go from here? As president of your Academy, I want to take you to a better place, a place where family physicians lead the medical home, providing continuous coordinated care for their patients that is focused on prevention of disease rather than last ditch efforts to stave off its consequences. I want to take family physicians to a place where their skills are the most highly valued, where medical students do not have to make a choice between taking care of their loans or taking care of their communities. I envision a healthcare system where family physicians are the MVP quarterbacks of their Superbowl healthcare teams, with the vision to see the entire healthcare field. Some of you may be thinking that the place I want to take you sounds like a fairytale. But the place I want to take you is your future - a future where the brightest medical students are eager to become family physicians and use their skills to keep patients healthy. There are some obstacles on the path to our destination. The practice overhead/reimbursement ratio has been steadily growing. This is driving small practices to become employed by hospitals, to look for alternative revenue streams, and, unfortunately in some cases, to close altogether. Practice managers would say the solution to an overhead/reimbursement problem is higher volume. Physicians have responded to the “make more widgets” ethos by cutting average patient contact time down to 10-minutes per visit. This impairs the ability of physicians to take the time with their patients they need to establish therapeutic relationships, which drives the culture and patient belief that doctors are an independent commodity service like gas stations. You go to the closest one you

4

Winter 2012 • The NC Family Physician

can find that you have a discount creditcard for. You have no allegiance or relationship with any one gas station, you just go to the one that is open the longest and is the most convenient -- assuming that all gas is roughly the same and that convenience is all that matters -- sounds awfully close to picking a doctor solely based on their insurance network doesn’t it? Well, with physicians relationships DO matter. Knowing your patient, their family, their values, their tribulations. It affects the care we deliver as family physicians and we are not interchangeable like gas stations. To change the culture and to show our value requires better outcomes. We must show through the use of registries, quality improvement initiatives, and data collection that quality primary care makes a difference. Showing insurers, legislators and the public what a quality family physician can do for the health of a community will force them to realize that the Starfield data is accurate and, that to truly reform the health care system, it will take family physicians! Anything worth doing is worth doing yourself, so we all need to participate in reforming healthcare and making primary care the foundation on which the House of Medicine is built. Advocacy is important but legislation alone is not enough to cure what ails our current healthcare system. It will take dedicated, skilled and innovative people. It will take family physicians. To improve the health of our country, our citizens, and our communities. We must be a beacon, illuminating a path to better health care. Bringing down costs of care, while at the same time improving the quality of care will take family physicians. Bringing transparency, health care value, and integrity to the health care system will not take a bunch of bureaucrats, bean counters, or analysts. It will take family physicians. Changing our co-pay culture from a system that focuses on sickness instead of wellness, on parts rather than the whole human being, on creating demand for care rather than providing it - will take family physicians. There are communities where the only payer is the government, where poverty creates limited opportunity, where patients truly have difficulty affording any care. And for family physicians working in those rural or underserved areas, we have to stand up as advocates for our patients, support legislation that makes providing care for people in those settings tenable, and support the Community Care Network that makes being a family physician viable there. Impoverished patients will not have PAC money to support candidates that understand the value we bring to communities. There is only one voice that is strong enough and needs to be loud enough to be heard by our elected officials - it is the voice of family physicians. It will take family physicians. www.ncafp.com/ncfp


As many of you know, I took a bold step - and some would say foolish step - 10-years ago to try to reform the system as one family doc. I did not fully understand at the time what was wrong with healthcare and I still don’t. But I knew that being forced to see 30-40 patients per day, having to charge the uninsured more than the insured, and not having enough time with my patients to truly develop a healing relationship was not the medicine I wanted to practice. I spent 18-months reading everything I could get my hands on about practice management, innovative ideas for practice, cutting overhead, and decreasing costs for patients. I said a lot of prayers and felt encouraged to flip the current model of medicine on its head and practice in a way where every dollar spent by a patient went directly to their care, rather than on the bureaucracy of getting paid to provide their care. There is a huge difference. To be exact, I found that billing insurance, expert coding, appealing claims, and claims processing costs practices nearly $250,000 per year - per physician. I had the crazy idea that if I just did not spend that nearly quarter-million dollars on payor-driven overhead, I could actually reduce the amount I had to charge patients, creating a way for those without insurance to actually be able to afford primary care. I also had the idea that decreasing overhead that much might actually mean I did not have to run from exam room to exam room and see 20 patients per day just to pay my overhead. Foolish ideas; crazy that you could charge patients less and spend more time with them and actually survive. Nobody thought it would work. That’s the reason I opened the practice on April Fools Day back in 2002. I know another company that did that as well. Nobody thought there would ever be a computer in every household. That company’s name was Apple. This solution certainly is not for everyone, but I tell you this short version of a longer story for a reason. It is that one family physician can make a difference, that reforms can happen without legislation, and that the only one that has the voice to stand up for our patients and our profession and take bold action is us. To accomplish this, it will take family physicians. To truly reform healthcare, to create access for patients that have fallen through the cracks and have no safety net, to make medicine about wellness rather than sickness, to make North Carolinians and our country as healthy as any nation in the world - it will not be partialists looking after individual body parts, it will not be insurance companies, it will not be only hospitals and technology. It will take family physicians. Not just a solo performance but a choir singing together to put art and caring back into medicine. Let me tell you an example of what makes me love going work every day. A patient came into my office about 7-years ago and one of the first things he said was “my wife made me come.” That’s certainly not the first time I heard that: thank heaven for wives!

A Record-Setter

Chapter’s Annual Meeting Draws 750 to Asheville The NCAFP set a new attendance record in Asheville last December during its 2011 Winter Family Physicians Weekend. Over 750 attendees participated in the conference, making it 2011’s largest state family medicine event in the US. Alongside the meeting’s registered attendees, over twenty prominent North Carolina healthcare and state legislative leaders were on hand, including NC DHHS Secretary Lanier Cansler, Representative Mark Hollo, PA, CoChair of the NC House Health & Human Services Committee; and Representative Nelson Dollar, NC House Appropriations Chair and House Health & Human Services Co-Chair. Program Chair James W. McNabb, MD, presented a scieintifc program that consisted of 25+ AAFP Prescribed credits and a large number of workshops, SAMs study groups, and non-CME satellite programs. Eleven different workshop options were available, including a Diabetes seminar that featured special guest speaker Dominique Wilkins, the 9-time NBA Allstar. Honors, Awards and Recognitions A number of year-end awards were bestowed by the Chapter, including the 2011 Family Physician of the Year award to Dr. Donald Ribeiro of Ayden (see story on p. 6). The Academy also formally honored Representatives Mark Hollo, PA, (88th district) of Taylorsville, and Rep. Nelson Dollar (36th district) of Cary, with President’s Awards. Both legislators were honored for championing a number of healthcare measures beneficial to primary care and Community Care of North Carolina (CCNC). In addition to Academy honors, the Chapter also officially inducted Drs. Kevin Johnson and Brian Ingalls, as AAFP Degrees of Fellow. Dr. Johnson is part of the teaching faculty at the New Hanover Family Medicine Residency Program in Wilmington. Dr. Ingalls is a family physician who practices in Tennessee. Wrapping up the meeting, the NCAFP Foundation held its annual Silent Auction. The auction generated approximately $13K for the Foundation and featured a number of competitive bidding wars. A commemorative guitar signed by the likes of Eric Clapton and B.B. King attracted the most interest, drawing a winning bid of $3,000. From Top: NC DHHS Secretary Lanier Cansler; Dr. Richard Lord with Representative Mark Hollo, PA; Dr. Donald Ribeiro and Dr. Richard Lord; Representative Nelson Dollar; Dr. James McNabb with Dominque Wilkins; The Silent Auction’s commemorative guitar.

Continues on Back Cover Winter 2012 • The NC Family Physician

5


Chapter Affairs

Dr. Donald A. Ribeiro of Ayden 2011 North Carolina Family Physician of the Year Dr. Donald Ribeiro of Ayden, NC, is not your average country doctor. What makes him so unique is that in addition to operating three family medicine clinics in eastern North Carolina, (Pitt and Greene Counties), Dr. Ribeiro is also the full-time pastor of the 200-member Ormondsville Original Free Will Baptist Church! Dr. Ribeiro’s journey in medicine started simply enough. In the 9th grade he figured out that he loved science and he loved people. A moment’s conversation with his chemistry teacher and her suggestion of becoming a physician started a journey he’s still completing. The people and families of eastern North Carolina continue to reap the rewards. Dr. Ribeiro completed his undergraduate, medical degree and residency training at East Carolina University. In 1989, he started in practice with Pitt Family Physicians in Ayden. He later went on to purchase the Greenville Healthcare Center in 2002. In 2005, Dr. Ribeiro decided to open up a new practice in Hookerton, a rural community about 35 minutes southwest of Greenville in Greene County. Hookerton was attractive to Dr. Ribeiro because he had been pastoring in Ormondsville and felt called to serve its local community. “I decided I wanted to get back to a very rural setting where the community could be impacted by a strong family practice.,” Dr. Ribeiro shared. Dr. Ribeiro worked closely with the Town of Hookerton to establish his practice in a townowned facility and by committing to serve a predominantly indigent population. Hookerton Family Practice has steadily grown since and will be doubling in size in the coming months thanks to a grant secured by the town that will expand the facility. The expansion will not only double Ribeiro’s clinic space, but will also provide space for additional services like pharmacy, eyecare, and even dental services “Our practice has been the beginning point. If you have a physician’s practice with a solid foundation, you can build off it,” Ribeiro noted as he explained how the town plans to integrate these other healthcare services. Each practice will be independently owned and private, and Ribeiro believes that this is the key to long-term sustainability for the town and for the county. Practicing Family Medicine is only half of the Dr. Ribeiro’s work. The other half is serving a calling that he recognized during high school. Dr. Ribeiro is the full-time pastor at the Ormondsville Original Free Will Baptist Church, a position he’s held since 1998. Under his leadership, Ribeiro has shepherded significant growth in the ministry, including expanding its community outreach and worldwide missions, and even expanding its facilities. The church recently completed construction of a new 22K square foot facility that serves the ministry and event the local community as one of the area’s largest gathering places. So how does he do it? “Only God can do it. He’s opened up all the doors to make this possible,” Ribeiro noted, with his eyes lighting up. He went on to explain that it was his ministry in Ormondsville that led him to establishing his practice in Hookerton. “God got me in the right places in the right time. In looking back thirty years ago, why was I called to be physician at age 13 and a minister at age 17?,’ Ribeiro asked. ‘Because God knew that thirty years later, that would be the combination that would get me into this community.” Dr. Ribeiro and his wife Karen reside in Ayden and are the parents of three children, Jessica, Sarah and Josh.

6 Winter 2012 • The NC Family Physician

A Family Physician Called to Serve

Ribeiro operates three clinics in Pitt and Greene Counties, yet also finds the time to serve as the full-time pastor of the Ormondsville Original Free Will Baptist Church. The ministry he leads recently completed its move to a new state-of-the art facility that serves Greene County’s as a community gathering location for various events.

www.ncafp.com/ncfp


$12.5 Million Dividend Declared in 2010!*

Stronger than ever. Physician Ownership and Leadership • Financial Stability

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


ADVOCACY & POLICY

NCAFP Advocacy Team Gearing Up for a Busy Session By Robert L. Rich, Jr, MD NCAFP Advocacy Council Chair

8 Winter 2012 • The NC Family Physician

its innovative programs, such as the Multi-Payor constructed. NCAFP will continue to support Project, Pregnancy Medical Homes, Patientthe concept of CCNC as the possible appropriate Centered Medical Homes, and expanding its structure upon which to build a primary care models of care to Medicare, State Employee Health physician-based ACO, and communicate the need Plan and select BCBS patients. for adequate reimbursement for primary care. Similar in importance to CCNC, will be Our final area of emphasis for 2012 will be the the expanding scope-of-practice battles that we expansion of the primary care physician workforce. anticipate. Defeated in their initial attempts With the pending retirement of many of our to expand their immunization authority, the members within the next decade, along with the pharmacist lobby can be expected to try again to continued growth of our state’s population, expand those immunization powers to include the NCAFP will continue to lobby for more medical all adult and school and adolescent residency As we go into this legislative year, we will vaccines, as well focus on need your support, both financially and as as an increasing primary number of pediatric care. We will legislative contacts, more than ever. vaccines. The nurse continue to practitioner lobby promote the is also expected to lobby for more independent Family Medicine Scholars Initiative to the students practice status, bolstered by articles from the at the various medical schools to broaden their Institute of Medicine and other entities, which exposure to primary care. In conjunction with appear to support the safety and efficacy of that, with the announcement of the new Campbell independent NP practices as part of the solution University DO medical school, we will continue to care in medically underserved areas. Through to work with that school to assist their leaders in the outstanding work of our two current building their school and developing postgraduate residents leaders over the past year, we are training opportunities. now able to objectively demonstrate that nonOther possible areas of interest include the status physician providers are no more inclined to of federal health care reform, and related issues practice in underserved areas than their physician such as the state-based health benefits exchange. counterparts; we will work this session to get that We also plan to monitor the expansion of retail message to our legislators and hopefully be able to health clinics, public health issues such as obesity educate them as to what independent practice for prevention efforts, and smoking cessation, etc. non-physician providers will or will not actually Please remember that NCAFP will continue accomplish. to need your volunteer efforts to contact local NCAFP will also continue to monitor the final legislators throughout the year regarding upcoming development of Accountable Care Organization legislation and we will continue to ask you to (ACO) regulations and the subsequent contribute to FAMPAC, early and often. Your development of ACOs in the state. We continue voices were heard during this past legislative cycle to emphasize the Patient-Centered Medical Home and those voices will need to be heard again to pass (PCMH) with its emphasis on primary care as the legislation that’s fair to you - the practicing doctor. appropriate entities upon which ACOs should be

{

{

Welcome to the first edition of the 2012 Advocacy Report. In looking back at our accomplishments from the 2011 legislative session (meaningful tort reform, preservation of CCNC and primary care Medicaid reimbursement, scope of practice issues, etc.), I must laud the efforts of the members of our organization who, when requested, personally called and lobbied their legislators for our positions. It is clear from the feedback we received from several legislators - particularly those on the various subcommittees - that they DID hear those messages from their physician constituents and that they were able to make more informed choices from the information that you, the family physician, gave them. As we go into this legislative year, we will need your support more than ever, both financially and as legislative contacts. I also want to acknowledge, that during this past session, the “House of Medicine” demonstrated an exceptional willingness to work together as never before. The NCAFP, the NC Medical Society, the NC Pediatric Society, and the various subspecialty organizations worked together to achieve our shared legislative goals. With the opening of the 2012 legislative session in May just around the corner, below outlines our major areas of interest. Although it is technically a ‘short session’, we anticipate another busy year. Our first and greatest concern will focus upon the continued preservation of Community Care of North Carolina and its primary care provider background. Increasingly recognized by the federal government and other states as an example of how a primary care-based system can work in terms of quality, cost effectiveness, and innovation, CCNC nevertheless faces a potential assault from outside HMO companies. These companies will promise the State millions in savings if the legislature and executive branch would just turn over Medicaid to them. The NCAFP, in conjunction with NCMS, the NC Pediatric Society and others, will continue to work to preserve CCNC and promote

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


MEETINGS & EDUCATION

Enjoy Springtime in Charleston

20+P

AF A d Credits Prescribe

2012 Spring Family Physicians Weekend - April 12-15, 2012

The Academy is excited to return to quaint Charleston, SC, for our 2012 Spring Family Physicians Weekend from April 12th-15th, 2012, at the Embassy Suites Convention Center, North Charleston. The conference begins on Thursday afternoon, April 12th, with an optional SAMs Study Working Group on Diabetes. General Session lectures start on Friday morning, April 13th, and wrap-up on Sunday just before Noon. The Spring Meeting is Going Green!

This year’s most significant change relates to the conference’s printed educational materials and syllabi. The NCAFP has received numerous requests to ‘go green’ and we are excited to be making this happen. This environmentally-friendly initiative will save on natural resources, and help the NCAFP save a significant amount on printing costs for the meeting. Going green means we will NOT be providing a printed general session syllabus or workshop syllabi for the 2012 Spring Family Physicians Weekend. The program syllabus, workshop syllabi and all conference learning materials will be available for download online to attendees. Registered participants will receive an email with a web link approximately 1-week prior to the conference. The email will contain a username and password that will enable you to download and print your preferred program materials and all course handouts. These online materials will be available for 90-days after the program. Additionally, our General Sessions meeting room will offer wireless Internet service to all conference attendees. Attendees are encouraged

GO’IN GREEN!! All Spring Meeting syallabus and educational materials will be provided as a download.

10 Winter 2012 • The NC Family Physician

to bring laptops, tablets or other mobile devices to the lecture hall and workshops. There will also be a number of power stations, as well as a dedicated printing station. The scientific program - led by Program Chair William A. Dennis, MD, - includes a diverse General Sessions schedule, along with a line-up of optional workshops, and two SAMs Study Working Groups. General Session will feature talks on contraception, pain management, hypertension, physician wellness, prostate cancer, and numerous others. Please visit www.ncafp.com/sfpw for the latest schedule. Complementing General Session will be six optional workshops and a non-CME satellite program. These activities are great ways to supplement your knowledge in specialized areas. The Spring Meeting is taking place at the Embassy Suites Hotel directly adjacent to the Charleston Area Convention Center, the North Charleston Coliseum, and the North Charleston Performing Arts Center. The discounted room rate is $149.00 plus tax. You may call the hotel directly at 843-747-1882 or 1-800-Embassy and indicate that you are attending the NCAFP Spring Family Physicians Weekend. The cut-off date for this room block is Monday, March 12, 2012. Please note, this does NOT GUARANTEE that rooms will be available up until this date. The

hotel sells out quickly for this event. Please make your reservations early. The hotel is located at 5055 International Boulevard, North Charleston, SC, 29418. Any trip to Charleston wouldn’t be complete without savoring the city’s fine southern cuisine. Yet along with the city’s bevy of fine restaurants, there’s also a number of atrractions, including the South Carolina Aquarium. Registered attendees can take advantage of discounted tickets to the Aquarium. The Aquarium merges fun, wonder and education for the whole family in one amazing experience. The NCAFP is also holding a Conference Welcome Reception on Thursday night. It’s a great opportunity to mix and mingle with your colleagues in Family Medicine. For complete meeting information and online registration, visit www.ncafp.com/sfpw.

www.ncafp.com/ncfp


STUDENT INTEREST

NCAFP Students Elect New Leaders The NCAFP’s Student Section held elections last December at the Academy’s Winter Family Physician Weekend. Congratulations go out to the following individuals for their election and their commitment to representing all students in North Carolina’s medical schools. The Academy thanks you in advance for your willingness to serve and your passion to impact Family Medicine. NCAFP Student Director: John Trimberger, WFU NCAFP Student Director-Elect: Katy Kirk, ECU Foundation Student Trustee: Christopher Danford, Duke Foundation Student Trustee: Samantha Heuertz, UNC In other student leadership news, the Academy would like to congratulate Nikki Henry, a 3rd-year medical student at Duke University School of Medicine for her recent appointment by the AAFP to serve as an FMIG Regional Coordinator. Her term is January 1, 2012 – December 31, 2012. For more information on this and all Leadership positions with the AAFP visit: http://www.aafp.org/online/en/home/residents/ membership/getinvolved.html

John Trimberger

Katy Kirk

BCBSNC Foundation’s ‘Inspired’ Advertising Campaign Features NCAFP Mentors and Scholars The Academy is among a select group featured in Blue Cross and Blue Shield of North Carolina Foundation’s new ‘Inspired’ campaign. Inspired (www.inspirednc.org) is a webbased storytelling effort that spotlights the philanthropic works of nonprofit organizations and leaders throughout North Carolina who are changing their communities for the better. “These are people and organizations committed to a bigger solution and they are working tirelessly to succeed,” said Kathy Higgins, BCBSNC Foundation president. “We are uplifted by their work on a daily basis and we wanted to create a venue to share their stories with others, to draw much needed attention to the impact they are having.” The website features first-person Videos distributed as part of the Inspired campaign showcase the Academy’s FM Interest and Scholars accounts from those committed to finding program. ECU’s Patrick Williams is interviewed with his solutions to some of today’s most pressing mentor, Dr. Charles W. Rhodes of Mt. Pleasant, NC healthcare issues, including access to dental care, childhood obesity and the uninsured, among others. NCAFP Family Medicine Scholar Patrick Williams (ECU) and his physician mentor, Dr. Charles Rhodes of Mt. Pleasant, are featured in a video discussing the Family Medicine Scholars and Interest Initiative. Also featured is Past President Dr. Richard Lord, Jr., in his role as Medical Director of the Southside Clinic in an underserved area of Winston-Salem. Please visit these online and share them with your colleagues. Every time someone shares, “Likes” or “tweets” about one of the videos, the BCBSNC Foundation will donate $1 into a pool of funds that will be shared by the featured programs, including the NCAFP Foundation. So help raise money for your Foundation by sharing these inspiring stories.

P L HEANTED W Seeking Community Physician Preceptors & Mentors Last year, the NCAFP was able to offer clinical experiences to 19 rising second-year North Carolina medical students. We couldn’t have done that without your help, and we need your help again. Historically the NCAFP has offered 4 to 5 students the opportunity to complete a 4-week externship during the summer. That number continued to grow with the addition of the FM Interest and Scholars Program in 2010. For the coming summer we have partnered with North Carolina’s Rural Residency Programs (Hendersonville and Union Regional) to help give students a chance to experience rural medicine. We anticipate 20-25 students will be given the opportunity to participate in some type of clinical experience this summer. We are seeking experienced, enthusiastic, physician-teachers to mentor students who are excited to expand their understanding about life as a family physician. If you are willing to share your passion for FM with a student in your practice this summer please contact Tracie Hazelett at the NCAFP, 919-833-2110 or thazelett@ncafp.com for more details by February 17, 2012.

*** Students & Residents ***

NATCON

POSTER PRESENTATION Submission Deadline April 11, 2012

Outstanding poster presentations will be recognized during National Conference with ribbons, July 26–28, 2012 in Kansas City, MO. No monetary awards are offered however, one resident and one student will win a trip to the 2012 AAFP Scientific Assembly in Philadelphia, PA to present their posters. www.aafp.org/online/en/home/cme/aafpcourses/conferences/ nc/posters.html

Winter 2012 • The NC Family Physician

11


EXECUTIVE’S MESSAGE

2011 Review and 2012 Resolutions By Gregory K. Griggs, MPA, CAE, Executive Vice President

As we leave the holiday season and an old year behind, I, like many of you, have health positions. As of December, NCAFP had representatives on approximately taken the opportunity to reflect on the past and also increase my “resolve” for 40 boards, commissions, task forces or committees at the state and national the future, both personally and professionally. It’s nice that the Academy’s fiscal levels, with that number continuing to increase. year also reflects that of a calendar year, so I truly am turning those personal and And finally, for the second year in a row, NC will rank at the top in terms professional pages at the same time. of member retention by Chapters, with over 98.5% of our members renewing First, I want to briefly reflect on 2011, although you will also receive an their commitment to Family Medicine and the Academy during 2011. overview of all of our activities in our 2011 Annual Report as part of the Spring So where does that leave us as we move into the meat of 2012 and beyond. Issue of the North Carolina Family Be assured, your physician leadership Physician. and your staff will not rest on our laurels. As your NCAFP year ended, we On a personal note, I, like many held our largest Annual Meeting ever others, have resolved to undertake with a final count of 747 registered a healthier lifestyle – meaning more 2012 Resolutions educational attendees. That number exercise, better nutrition and hopefully By The Staff at the NCAFP does not include special guests, the loss of a few pounds. exhibitors, spouses, or others. We But more importantly, on a • We resolve to continue to provide believe our Annual Meeting represents professional note, here are some of our exemplary member service, answering the largest state-meeting of family resolutions from the NCAFP staff: your inquiries with professionalism and physicians in the country. We resolve to continue to provide as quickly as possible. During the educational sessions, exemplary member service, answering • We resolve to work with our physician special events, and committee meetings your inquiries with professionalism and leaders to provide top quality continuing in Asheville, we heard from a number as quickly as possible. medical education for our members. of distinguished guests, including We resolve to work with our the Secretary of the NC Department physician leaders to provide top quality • We resolve to actively and passionately of Health and Human Services, two continuing medical education for our advocate on your behalf at the NC members of the General Assembly, members. General Assembly and with various payers in the state. the Chief Medical Officer for North We resolve to actively and passionately Carolina’s Medicaid Program, and the advocate on your behalf at the General • We resolve to do all we can to make Dean and Vice Dean of Campbell Assembly and with various payers in the North Carolina the best environment in University’s new Osteopathic Medical state. the nation for family physicians to be School. As a result, the level of policy We resolve to do all we can to make well-respected and well-paid in order discussion was as high as the quality of North Carolina the best environment in to provide top quality healthcare to the citizens of North Carolina. our educational programs. the nation for family physicians to be In 2011, our Chapter led the way well-respected and well-paid in order nationally in resources on Accountable to provide top quality healthcare to the Care Organizations, developing the citizens of North Carolina. ACO Blueprint for Success, which is It’s our mission. It’s our mantra. It’s a must read for anyone considering our passion. To advance the specialty establishing an ACO or being asked to of Family Medicine, in order to improve the health of patients, families, and participate in one. It’s still available as a link from the front page of our website communities in North Carolina! at www.ncafp.com, and offers continuing education credit. We look forward to continuing to work with you, our members, to make Last year, advocacy efforts in the General Assembly by the House of Medicine 2012 the best year possible for family medicine in our state. Thank you for resulted in meaningful malpractice reform, no cuts in Medicaid, and at least your continued support and involvement. temporarily prevented further fragmentation that would have resulted if the NC Pharmacy Association had succeeded in legislative changes which would have allowed pharmacists to provide any immunization to patients over seven. Help, questions, feedback and perspectives to: ggriggs@ncafp.com We have continued to increase our involvement in key policy and public

12 Winter 2012 • The NC Family Physician

www.ncafp.com/ncfp

T


Primary Care, Simplified. Primary Care, Simplified. Quality Quality

Studies have shown Studies have shown that encounter length that encounter length is directly responsible is directly responsible for quality of for quality of outcomes. outcomes.

Cost Cost

The Direct Pay Health The Direct Pay Health model is simple: model is simple: remove unnecessary remove unnecessary overhead that does overhead that does not contribute to not contribute to patient care. patient care.

Access Access

Anyone who wants Anyone who wants good quality, low cost good quality, low cost Primary Care will be Primary Care will be right at home in a right at home in a Direct Pay Health Direct Pay Heath office. office.

Transparency Transparency When patients visit When patients visit your Direct Pay Health your Direct Pay Health practice, they’ll know practice, they’ll know the total charge and the total charge and how much to pay at how much to pay at checkout. checkout.

The Medical Medical Practice PracticeYou’ve You’veAlways AlwaysWanted Wanted

Is Available AvailableNow. Now. Is

Visit .com Visitus uson onthe theweb: web:DirectPayHealth DirectPayHealth .com


RESIDENTS & NEW FPs

Fostering The Next Generation of Leaders in Family Medicine By Matthew Kanaan, D.O. NCAFP Resident Director Across the nation there are great physician leaders who are being underutilized. Not out of a lack of motivation, talent or knowledge, but purely due to a lack of opportunity. I am referring to the thousands of residents in training programs throughout the U.S. While some might assume that residents are too busy to become involved in leadership projects or to hold positions, I have found the opposite to be true. After spending four years in undergraduate training and another four years in medical school, residents are hungry for opportunities to make a difference both locally and nationally. Unfortunately of those resident leadership positions that do exist, many are no more than a title and lack the depth needed to create or aid in any significant change. Why Residents Need to Be at the Table

system and ultimately how to better problem-solve in the future. I am certain that there are an unlimited number of these opportunities around our state that might just need an extra set of eyes, a fresh opinion, or maybe just a little research. How The NCAFP Has Supported This Concept

I attended my first NCAFP meeting as an intern, and was overwhelmed by the number of residents in attendance. Amazing as it was, there were only four residents in leadership positions and our involvement in the NCAFP as an organization didn’t seem to have much of an impact. I wanted more. I believe all the residents did. It was then that the residents set out to change the entire structure, and function of the resident section. We essentially added 16 new leadership positions for residents, and asked for a webpage devoted solely

We all know healthcare is changing. Both physicians and patients have suffered the costs of a broken system for far too long. Those of us who are passionate about Family Medicine understand the significance of ensuring primary care is at the center of this new healthcare system. Our current Family Medicine leaders are working hard to ensure that this happens, however our supply of visionaries is not an infinite source. This is why it is so important to include young physicians and residents in the larger discussions of the future of healthcare and our role in directing change. Our current residents will be taking over this system in the future, and one could argue that they have the greatest stake in what healthcare will look like in 20 years. We are fortunate in the state of North Carolina to have some great residency programs, and subsequently many bright and motivated residents ready for an opportunity to lead, and to be contributing members of our Academy. Creating Opportunities

How do we accomplish the task of better utilizing residents in leadership opportunities? The greatest impact starts in part with direct mentorship. Many medical societies and professional organizations have a resident position or a resident section. My experience has generally been that these positions are limited in terms of the scope of opportunities that are presented. While residents will always feel honored to sit on a committee or be present at a board meeting, what they truly seek is some means by which they can contribute. It may not always be feasible to completely turn over a large scale project to a resident, but it is always possible to give a portion to a resident and then mentor them along the way. This isn’t just limited to medical societies. Physicians in private practice can also mentor residents by providing them with opportunities to work on projects that bring value to their leadership training, and might actually benefit that physician. Exposing a resident to the inner workings of private practice and asking them to solve issues that impact quality improvement, for example, will directly expand their comprehension of the

14

Winter 2012 • The NC Family Physician

2012 NCAFP Resident Leadership: (L to R) Dawn Caviness, MD, Advocacy Council Rep.; Sarah Moyer, MD, Foundation Resident Trustee; Sonya Williams, MD, Health of the Public Council Rep.; Jewell Carr, MD, CME Council Rep.; Resident Director-Elect Mo Shahsahebi, MD; Resident Director Matt Kanaan, DO; Zachary Smith, MD, Foundation Resident Trustee and Richard Smits, MD, Practice Enhancement Council Rep.

to communicating with our resident colleagues. Our goal was to mirror the positions of the NCAFP Board, knowing that once you achieve structure only then can you have meaningful function. We also asked the NCAFP to include our resident leaders in more of the important discussions and projects that will ultimately lead to the change we all desire in medicine. This has been an exciting few years for myself, and for the other resident leaders within the NCAFP as we work side by side with our mentors towards a common goal. My hope is that the NCAFP’s example will inspire more opportunities for the next generation of family medicine leaders to continue the work of our current mentors, and become active participants in an ever-changing healthcare system. www.ncafp.com/ncfp


rah Rep.; rector

Our Residencies: Carolinas Medical Center Charlotte

Queen City Treasure With a new facility, experienced faculty and diverse training locations, Carolinas Medical Center’s Charlotte Family Medicine Residency Program offers the best of both worlds.

The CMC Charlotte Family Medicine Residency program moved into a new facility in late 2009 that brought it closer to Carolina’s Medical Center, the program’s primary teaching hospital. The move allowed the program to expand its main outpatient family medicine clinic, Elizabeth Family Medicine, and make its inpatient training experience stronger than ever. “The move has been a wonderful enhancement,” noted Residency Program Director Dr. Vanessa McPherson. “Particularly because of our beautiful state of the art facility, as well as the unique patient-centered experience and training our residents get here at Mercy.” The program now sits directly adjacent to CMC’s Mercy Hospital, a 185-bed adult acute care facility and the first Planetreedesignated hospital in North Carolina. Planetree is a system of care that recognizes excellence in patient-centered and personfocused care across the continuum

and shares many common themes with PCMH. The model centers on the simple premise that care should be organized first and foremost around the needs of patients. Healthcare organizations like CMC Mercy that adopt the model will often adapt their cultures and care processes around this philosophy. For the residency program, Planetree has already led to some very positive changes. “With Planetree, the team rounds with the nursing staff to promote a team-based care approach. The patients see the physician and nurse communicating together and making the plans for the day. This keeps everyone on the same page and is a great learning experience for our residents. The patients really appreciate it, too,’ McPherson explained. CMC Mercy serves as the primary inpatient hospital for the program’s adult inpatient service, which serves both Elizabeth Family Medicine, as well as Biddle Point Family Medicine, the clinic site for their urban/underserved training program. Second- and third-year residents spend most of their time in the “unopposed” setting at CMCMercy, while interns still complete most of their inpatient services at Carolinas Medical Center, a large tertiary care center about a mile away, where they train alongside residents from many other specialties. With the drastic differences in these two inpatient settings, McPherson believes the program is producing stronger clinicians that are Winter 2012 • The NC Family Physician

15


2012

FAMILY MEDICINE Sat., May 19, 2012 DAY in Durham, NC • Skills Training • Recruiting • Networking

Information at www.ncafp.com/fmd

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

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. • Provide all supplies and materials related to the service line.

• Focus efforts on patient safety, patient compliance and patient outcomes • Allow you to treat allergy patients rather than cover their symptoms with medications.

Visit our booth at the Winter Family Physicians Weekend

Interested in becoming a UAL Allergy Center? Visit www.UnitedAllergyLabs.com or call 888.50.ALLERGY.

16 Winter 2012 • The NC Family Physician

more adaptable. It has also made the program’s full scope curriculum even stronger as well. “We want to prepare our residents to practice in any environment they choose, so our program’s full scope is really attractive to students.” Full scope at CMC plays out primarily through the program’s strong Dr. Vanessa McPherson academic curriculum, but also through its unique combination of training environments. At CMC, McPherson’s residents are one of many different specialties, but at Mercy, they operate unopposed as the only residents in the hospital. McPherson went on to explain she will “...often describe our program as ‘the best of both worlds’ to students. Training here lets them experience the full scope of Family Medicine in an academic, tertiary care environment, but with our so-called “unopposed” status at CMC-Mercy, you get a lot of unique clinical experiences here too.” CMC Charlotte accepts eight (8) residents per year into its program: six residents for its main track, and two for its underserved ‘urban’ track, that focuses on the needs of the urban disadvantaged. Residents selected for this track (which has become extremely competitive over the past few years) complete an identical training curriculum as their counterparts, but conduct all of their continuity training Residents train in a modern outpatient clinic with their patients at CMC Biddle Point. Biddle Point is a community health center opened by Carolinas Healthcare in 1997 that serves a predominately African-American population from western and central Charlotte. Urban track residents become knowledeable in a community-oriented approach to serving the disadvantaged and get the opportunity to work alongside full-time practicing family physicians during their continuity experiences. Another unique training feature of CMC Charlotte is its new Integrative Medicine in Residency (IMR) curriculum. The program was one of only eight residencies in the nation who piloted the competencybased online integrative medical training into their curriculum. IMR is a 200-hour training program that is completed through a combination of web-based activities, programspecific experiential exercises and group process-oriented activities. Residents are taught about integrative approaches, prevention and wellness, and tools of Integrative medicine. Alongside its main curriculum, CMC Mercy has been CMC Charlotte also offers a wide completely renovated. range of electives - from geriatrics to international health, maintains an active research department, and even offers a Sports Medicine Fellowship to residency graduates. For complete information on the program, see http://www.charlottefmresidency.org

www.ncafp.com/ncfp


MM_NewsAd_.pdf

3/21/07

3:55:29 PM

T

At Medical Mutual, we are

dedicated to serving you

with a comprehensive array of insurance products.

Professional Liability

Employee Benefits

Commercial

A.M. Best has awarded Medical Mutual’s professional liability coverage the highest rating of “A” (Excellent) for four consecutive years.

Find out more by calling 800.662.7917 or visiting www.medicalmutualgroup.com Diamond Level Sponsor of the North Carolina Medical Group Managers

Exclusive endorsement of the Winter 2012 • The NC Family Physician

17


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

A Game Plan for Small Town Family Physician Success in ACOs By Julian ‘Bo’ Bobbitt, JD Smith Anderson, LLP You know that Accountable Care Organizations, or ACOs, are hot topics these days. You have heard that there is great opportunity for the primary care physician You have also learned that they are going to require complex and expensivesounding systems, health information technology, metrics, contracts, and legal structures. But you are a typical hardworking family physician in rural North Carolina, meaning you have no extra cash and even less spare mental bandwidth. How in the world are you going to get in on the ACO movement? Is your only option hoping that the hospital will employ you? No. There is actually a straightforward way for a North Carolina family physician to have lasting success in an ACO and without spending a dime. This article explains the four-part strategy: Get Up to Speed Through NCAFP. The NCAFP has extensive resources to arm you for success in the accountable care era, including this article series. From among those resources, The Family Physician’s ACO Blueprint for Success covers in detail the following:

ACO

GAMEPLAN

• Why unsustainable health care costs are making ACOs, or some version of collaborative care, inevitable; • How virtually all successful ACOs will have a patient-centered medical home (“PCMH”) core driving care improvement and savings—with corresponding incentive payments; • How to recognize and shape the 8 Essential Elements of every successful ACO; • Top ACO strategies for family physicians; and • A step-by-step guide on how to participate in or form an ACO. The NCAFP is offering numerous PCMH and ACO resources, including webinars and programs. In short, in a surprisingly short period of time (hours, not weeks) you can be the most prepared person in the room the next time there is an ACO meeting. FREE ACO GUIDE for FPs

The ACO Guide

How to Identify and Implement the Essential Elements for Accountable Care Organization Success

Download it at www.ncafp.com ©2011 Smith, Anderson, Blount, Dorsett, Mitchell & Jernigan, L.L.P.

18 Winter 2012 • The NC Family Physician

Conduct an ACO Readiness Assessment - Perhaps the first item would be to prepare to be a medical home. Of the 8 Essential Elements of a successful ACO, a culture of teamwork is by far the hardest. Cultivate relationships with specialists, and get outside your “silo.” Assess your HIT, data capture, and patient selfsupport tools.

Create or Join a PCMH Network ACO - This is the most important strategy for the small town family physician. If possible, join one that has, or will have, the 8 Essential Elements for ACO success. This is a rare opportunity, not available to specialist physicians, to not only have such a rich “target field” of high-impact ACO initiatives to choose from, but also to have friendly pre-existing vehicles becoming available. North Carolina is a national leader in PCMH network ACO development. No Buy-In - Medicaid and other payors in many states are interested in this model. These payors often do not require a buy-in or require the physician to accept financial risk. Instead, on top of fee-for-service payments, there is often a per member/per month fee and occasionally shared savings bonus payments. Be a Champion - You can not only be able to be savvy about which ACO options will make it and in which you will be able to participate with no financial investment, but family physicians also have an historic opportunity to lead. With these NCAFP tools, you can influence the very success of your ACO and your role in it. A “how to” on ACO leadership for the family physician will be a topic of an upcoming article in our series.

It is not hopeless. In fact, because you happen to be in one of the best specialties to thrive in the accountable care era, opportunity knocks for the small town North Carolina family physician. For more on ACOs, contact Brent Hazelett, MPA, at the NCAFP or go to www.ncafp.com/aco-guide.

www.ncafp.com/ncfp


N

H E A L T H

C A R E

D E L I V E R Y

Care Delivery and Outcomes Transformed for Low-Income Moms Each year in North Carolina, approximately 21,000 women on Medicaid give birth to their first child. Often young, without adequate resources, these mothers face escalating risk factors – resulting in poor health outcomes and continued poverty. In NC, one evidence-based program – the Nurse-Family Partnership (NFP) – helps first-time, low-income mothers overcome these challenges. One of the oldest, most rigorously evaluated homevisiting programs in the nation, NFP pairs mothers with registered nurses from pregnancy until the child’s second birthday. Outcomes from randomized trials in other states include: • 79% reduction in preterm delivery for smoking mothers • 32% fewer subsequent pregnancies and reductions in high-risk pregnancies from greater intervals between first and subsequent births. • 48% reduction in child abuse and neglect • 50% reduction in child language delays at age 21 months

T

• 83% increase in labor force participation by the mother In 2008, The Duke Endowment, Kate B. Reynolds Charitable Trust, North Carolina Department of Health and Human Services Division of Public Health (DPH), Blue Cross and Blue Shield of North Carolina Foundation, the North Carolina Partnership for Children, Inc. and Prevent Child Abuse North Carolina, agreed NFP was the program North Carolina needed. Ten NC counties are currently implementing NFP with

funding from this public-private partnership. To date, North Carolina NFP programs have served more than 1,350 families. Initial outcomes include 90 percent of babies born full-term, 92 percent born at a healthy weight (≤ 5.5 lbs.) and 71 percent of mothers without subsequent pregnancies within 24 months. NFP has also helped mothers quit smoking, keep up child immunizations, and continue education or find work. NFP’s initial success positioned North Carolina to receive $3.2 million in federal grants for implementing evidence-based home-visiting programs. The funding will allow NFP to expand in Buncombe and Robeson, and add six new counties – Columbus, Gaston, Edgecombe, Halifax, Hertford and Northampton. Learn more about the NurseFamily Partnership at www.nursefamilypartnership. org/Locations/North-Carolina.

NC Nurse-Family Partnership Sites

wo years ago, Blue Cross Blue Shield of North Carolina (BCBSNC) announced a new payment policy for certain primary care practices in North Carolina who attained Patient Centered Medical Home (PCMH) status according to a set of criteria they developed within their organization. BCBS of NC is one of a growing number of insurance entities who now reward primary care physicians financially for attaining PCMH status. I had been thinking of becoming a PCMH for several years but couldn’t see the point of doing this just for the exercise. There didn’t appear to be any carrot held out to make it a worthwhile endeavor or the employees in my organization and it was a huge amount of work to receive the certification. BCBS of NC changed all of that. Before I describe how we re-engineered our practice I need to give you as readers a snap shot of my practice. If you decide to undertake what we did it is hard to make realistic decisions unless you know the environment I work. I am a solo practitioner with two mid-level providers (a nurse practitioner and a physician assistant). I see between 25-40 patients on full days and my midlevel practitioners see between 15-25 patients on their full days. We have eleven full time employees and two part time employees. I provide health insurance paid in full for my employees (I am told by my accountant it is rare that a small business does this anymore), we have a dental plan, retirement plan and a disability plan in place for our employees. I mention all of this because I believe it is one of the reasons we have very little employee turnover in our practice. Some of my employees have worked for me for twenty five years. It probably takes three years for someone to really grasp and learn the nuances of their job in our office whether that be front office personnel, nurses and even clinicians. This is a crucial detail as I describe what we have accomplished in regards to delivering quality care in an office based setting. It is very difficult to provide quality in health care without a stable, competent work force. I also maintain

a busy hospital practice and share call with another family physician and 2 internists during the week. I don’t do obstetrics but otherwise practice a full range of family practice. I practice in a small town outside of Hickory, NC. I incorporated an electronic health record (EHR) into our practice in 2000. At the time I was Patient-Centered Medical Homes fifty years old and felt if By Ed Bujold, MD - Granite Falls I didn’t take on this arduous task at the time, I would be too old to make it pay off. We suffered through the growing pains of the information technology industry as many early adaptors did but learned a lot of valuable lessons along the way. In 2010 our IT provider merged and we were told the IT platform we were on would not support the Meaningful Use criteria for EHRs as defined by the Affordable Care Act. We were forced to move to a new and much improved electronic health record which was completely certified for Meaningful Use. This was a difficult transition but much easier than our 2000 transition. Ironically, the cost to move to this new EHR was almost the same amount as the bonus we would receive if we met the Meaningful Use criteria for Medicare. You don’t get many deals from IT companies when it comes to EHR costs but this really was a deal and I just didn’t think we could pass this up. In 2009, we decided to become certified by NCQA as a level III PCMH and recertify as a NCQA diabetes center and get a NCQA certification for stroke/ coronary artery disease (the criteria were not all that different for what we did

Revisited

See PCMH Revisted on Back Cover

Winter 2012 • The NC Family Physician

19


Inaugural Address, continued from p.5 When I asked him why he was there, he said he was having to sit up at night in a chair in order to breathe. During his exam I found a protuberant abdomen full of ascites. I was concerned about cancer but he had more pressing concerns since his Bp was 232/143. I counseled him that the safest place for him was the ER and (of course) documented that in the chart. But he told me that the last time be went to the ER that he ran up a huge bill and still had not paid it off. He said he had not seen a primary care physician in 14 years since he was a used car salesman and had no insurance. He made too much to qualify for Medicaid and had assumed he could not afford care until he found our practice. Since he refused the ER I went about the business of getting to work on his blood pressure and before he left the office. It came down to a much safer level. To shorten the story, this patient who it turned out had 8 liters of ascites due to his diastolic pressure exuding subcutaneous fluid, and was told by cardiology that he would need a heart transplant has never been hospitalized. 1 year later his Bp was 118/72, he had lost 40 pounds, and was discharged by the cardiologist to just do biannual followup. That patient now brings us birthday cake on his birthday because he says every one of them now is thanks to us. He gave me permission to share this story. He later got health insurance, but remains one of our favorite patients that we see. Guys that’s what we went into medicine for- not to do prior auths and to file insurance forms. I look forward to leading our Academy into a new era for family physicians - into an era where there is more opportunity for our profession than ever before, an era where we can improve the quality of care, remove disparities and obstacles to access, and put the patient back in the center of our mission. We are all here for a purpose, and as family physicians we are important tools in the hands of a master carpenter. We must have unabashed courage and confidence

so that where others follow the crowd, we will be willing to trod unexplored paths. Sir William Osler said “without faith a man can do nothing, and with faith anything is possible.” Therefore, our faith must not be shaken, but must become more steadfast during this time of transition. As your president I will respect tradition but never fear innovation and trail blazing. The unexplored road is sometimes the best one. Some would call it the narrow path— where others see a wall we will look for a door. Where some see a chasm we will create a bridge. Family physicians will be the light that guides patients and others through the convoluted system so that wellness and coordinated care can triumph over fragmented piecemeal treatment. As Family Physicians, you are the beacon of light that navigates patients through the healthcare system and have as your superhero powers compassion, creativity, understanding of your community, and diverse training that allows you to identify and treat over 90% of diagnoses. You have a unique physician patient relationship that comes from years of trust, a detailed knowledge of other family members, and an understanding of how prevention is the most important aspect of wellness. Thank you family physicians, for being the foundation for our healthcare system since the days of Doc Baker on Little House on the Prairie to 2011 where we are transforming into the conductor of a complex symphony of health care. Your Academy is working hard to advocate for family physicians. As I officially start as your president, your academy has achieved some outstanding successes. For two years in a row we will have had the highest member retention rate of any state in the country according to the AAFP. By working together with the entire House of Medicine, we have achieved in NC some level of tort reform with economic caps on non medical damages after years of being pushed back by trial lawyers. This

is due in large part to Herculean efforts made by the staff and leadership at the NCMS. We now have a state of the art family medicine center, probably the finest in the country that has been constructed and opened at ECU. This is due in large part to our Academy working with a consortium of allies including the legislature and the leadership of our states departments of family medicine. We now have the BCBS Family Medicine Interest & Scholars program- unique nationally and getting ready to start our third class of scholars thanks to 1.8 million dollars from the BCBSNC Foundation and NCAFP Foundation. This program is leading the way in recruiting talent into primary care. We have a more robust influence and presence in the state legislature than ever before in our history-In a time of national and state historic budget shortfalls we have stood with our colleagues at the Medical Society and the NC Pediatric Society and defended Medicaid rates and CCNC. Our state has become known nationally for innovation, leadership, and vision in healthcare models. Together we will all be a beacon to better healthcare. This year we will use our laser like focus: we will cut through red tape, we will explode barriers to quality healthcare-disparities, access problems due to payment, and fragmented care and the result will be a brighter future for family medicine. Thank you for being beacons to better healthcare and illuminating a path to a brighter future for family medicine. Thank you for giving me the privilege and entrusting me with the honor to serve you as the President of the NC Academy of Family Physicians. I look forward to working shoulder to shoulder with you to move forward our profession and to improve the quality of healthcare for the citizens of NC in the upcoming year. God Bless and thank you.

coronary artery disease and we have reached all the targets set for Meaningful Use and should receive our initial stimulus money before the end of the year. Was this worthwhile? Now I can say yes. While we were in the midst of it, in some of my more pessimistic hours, you probably didn’t want to ask. Now, what are the rewards? For starters, BCBS of NC fees for most E&M management codes rose substantially, making it very much worth my while. In addition, because of our quality certifications, informed businesses in our area are now starting to come to us. They want value for their work force and they are beginning to understand clinics like ours are going to offer them value for their health care dollars. Is it a good time to be a family physician? I would say yes. Many health care entities starting with Medicare and the federal government are starting to value what we do and third party insurance carriers usually follow right behind. From 2011-2015, the

Affordable Care Act has added a 10% bonus to all of the Medicare dollars we earn. If you did $200,000 of Medicare business last year that amounts to a $20,000 raise. They are also paying incentives for e-prescribing and PQRI quality initiatives. These are not hard bonuses to earn. I have medical students rotate through my office and primary care is still a difficult sell, at least in this state. The universities in which they are educated still don’t promote primary care as much as I believe they should. I was curious why BCBS of NC offered 10 bonus points in their 200 point process for mentoring three medical students. Now I believe this was a wise decision. The more students we can mentor in our new PCMH model homes, I believe, the more students we can influence to choose primary care as a career. I am sixty years old and maybe, just maybe, our specialty is finally getting the respect and rewards we have been waiting almost a generation.

PCMH Revisited, continued from p.19

for diabetes and we were doing the work anyway). If your practices are anything like mine, no one in our office has time to work on all of these projects. We elected to hire a person on a part time basis to help us with both the certifications and the EHR transition. This was an extremely wise investment of time and money on our part. Granted you must look for the right person with some IT experience and preferably some health care expertise but they are out there. At the end of 2011, I am extremely proud to say we have reached all of the goals we set back in 2009. I would have to give the people working for me all of the credit. I supplied the vision but they did all of the work. Was it difficult? I would say yes. Back in March of this year, we all suffered from practice fatigue/ burnout. As you all know, you still have a practice to run and patients to see. We are now certified by NCQA and BCBS of NC as a level III PCMH; we are also certified by NCQA for diabetes and stroke/

Profile for NCAFP

V8n1  

V8n1  

Profile for ncafp1