THE NORTH CAROLINA
Volume 8 Issue 2 / Spring 2012
quarterly news in north carolina family medicine
Transforming Our Practices is Key to FM’s Prosperity See page 4
Inside
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Spring 2012 • The NC Family Physician 1 | Moving 2011 NCAFP Annual Report | MATCH Results Promising | 2015 FM Scholars Announced PCMH Forward
2011-2012 NCAFP Board of Directors Executive Officers
2012 Mid-Summer Family Medicine Digest
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 District 7 - David A. Rinehart, MD At-Large Holly Biola, MD
July 1-6, 2012 Embassy Suites Hotel at Kingston Plantation Myrtle Beach, SC
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) Student Director John Trimberger (WFU)
Fantastic Schedule for CME Lectures Engaging Optional Seminars!
Student Director-Elect Katy Kirk (ECU)
FM Department Chairs & Alternates
See page 10
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/msfmd
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 NCAFP Strategic Plan
Transforming Our Practices is Key to FM’s Prosperity See page 4
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
THE NORTH CAROLINA
Inside
..,
Transforming Our Practices is Essential for Longterm Prosperity................................... 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
NC Spin Healthcare Forum Highlights the Need for More Primary Care......................... 6 Legislative Turnover Creating Need for Proactive Advocacy......................................... 8 The 2011 NCAFP Annual Report.................................................................................. 11 AAFP Releases ‘Top 5’ Overused Tests & Procedures................................................. 23
President’s Message............................................... 4 Meetings & Education......................................................... 10 . Chapter Affairs........................................................... 6 Executive’s Message............................................................. 19 . Advocacy & Policy..................................................... 8
Residents & New FPs.......................................................20 Student Interest & Initiatives.............................................22 Practice Management............................................................ 23
PRESIDENT’S MESSAGE
Transforming Our Practices is Key to Family Medicine’s Prosperity By Brian R. Forrest, MD NCAFP President
To Be or Not to Be? That really is the question. Will your practice be bought by a large hospital system? Will you continue the old model of practice on the treadmill and try to bill every type of code and modifier and stay independent? Will you add services like botox, cosmetics, or a weight loss program to help your bottom line? Will you become a Patient Centered Medical Home in order to receive incentives from payers to demonstrate that they value your services? Will you take steps to ensure that you are not vulnerable to a RAC audit by Medicare or Medicaid for your billing? Will you join a large IPA or physician network? Will you become an employee of a hospital or a multispecialty group? Will you join an Accountable Care Organization with the hope that shared savings will trickle down to you? Or will you decide that taking care of patients is about exactly that- not taking care of their insurance company, or the local hospital, or billing bureaucracy and regulations. There is a choice to make, and the deadline for becoming a fossil or a thriving practice is approaching. Doing nothing, waiting on the sidelines, continuing in the status quo will soon be unsustainable. So the time to answer the question is soon. The options may at times seem too numerous to count. However, family physicians must update their practices, modernize, and be willing to embrace new models that help optimize care for patients. There is no single right answer to the questions above for any physician. The key is that the status quo will become ‘status no’ in the next few years. Flowers are either growing or wilting, but they are never in the - Brian Forrest, MD same stage of bloom for long. Having been through some of these transitions in my own practice, such as implementing our first EHR four years ago, I know how disruptive and painful that change can sometimes be. Our first EHR was hardly user-friendly, and, after having some of our providers fully use it and others only partially use it (myself included), I was extremely frustrated with the implementation of a new documentation system different than the paper SOAP notes I had used for the previous 10-years. However, we were trying, knowing that ultimately most medical records would be electronic. We had to start somewhere. Now four years later, we have a new EHR that we
Transforming ourselves to be the change we want to see in health care will not only serve our patients, but also lead to thriving practices.
4 Spring 2012 • The NC Family Physician
have been using for about 8-months. It has actually improved practice workflow, documentation, and efficiency. I truly enjoy it and prefer it over the old paper system we used to have. The transition was painful though. I give this as a personal example of just one of hundreds of changes that many practices are making now. In some practices, this may be the only significant change they make. In others, they may become part of a hospital system or a large IPA network. None of these answers are right or wrong, but the need to transform from the old model by affecting some significant change is mandatory for survival. All transformations may not be practice-based. Some may be much more personal. Have you sat on the sidelines and watched your colleagues represent you at the legislature, at town hall meetings about health care, and with their contributions to the Academy’s political action committee (FAMPAC)? Have you personally benefitted from not having rate cuts, by being part of a CCNC network, or by having new physicians join you at your practice that were excited about practicing family medicine in NC? Maybe it’s time for you to participate in your specialty outside of your practice walls. Being a local activist for family medicine in your community, with phone calls and emails to your state legislator, with your personal contributions to FAMPAC, and with your commitment to improve the health care system for your patients is what our state truly needs. Every family physician can and does make a difference in their communities on a daily basis. What we need now is for family physicians to build medical homes that will mean real health care reform on the local level, that will improve access, and decrease fragmentation of care. Transforming ourselves to be the change we want to see in health care will not only serve our patients but also lead to thriving practices. As Calvin Coolidge once said, “No enterprise can exist for itself alone. It ministers to some great need, it performs some great service, not for itself, but for others...or failing therein, it ceases to be profitable and ceases to exist.” Becoming more politically active, transforming your practice, and personal contributions to improve our specialty do take time, effort, and yes, money. But all of these are investments that will pay huge dividends for family medicine in NC for our patients, and our profession. The future for family medicine in NC is bright, but you have to move forward to be part of that future.
Dr. Forrest completed medical school at UNC Chapel Hill and his residency in Family and Community Medicine at Wake Forest University in Winston-Salem. He is the Founder and President of Access Healthcare and the Access Hypertension Clinic in Apex, NC. His special interests include hypertension, new models of practice and prevention of cardiovascular disease. He is an amateur magician and teaches martial arts as a Black Belt in the discipline of Hap Ki Do.
www.ncafp.com/ncfp
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NC Spin Forum Highlights the Need for More Primary Care NCAFP Helps Co-Sponsor Program that Gathers State Business and Healthcare Leaders largely primary careNC Spin, the state’s leading non-partisan political talk show, driven and managed, with hosted, “What the Health: Can We Survive Our Current over 85% of the state’s System” in late March at GlaxoSmithKline in Research primary care physicians Triangle Park. The NCAFP was one of several co-sponsors enrolled. of the daylong event that brought together approximately Alongside the panel 200 business, healthcare and healthcare policy leaders from discussions, NC Spin across the state. The forum featured a keynote address by also released the results Dr. Victor Dzau of Duke University Health Systems and of a public opinion poll three panel discussions on healthcare. Several primary care that surveyed North leaders participated, including Dr. John Morrow, Pitt County Carolina residents about Health Director, Dr. Olsen Huff, a pediatrician and childcare health care. The survey advocate, as well as NCAFP Past President (‘99) and current Several NCAFP leaders attended the forum, including (l to r) Past Presidents Carson revealed that over 80% Rounds, MD (2006); Chip Watkins, MD (2010), Christopher Snyder, III, MD (2008); Community Care of NC, Inc., President and CEO Dr. Allen EVP Greg Griggs; President Brian Forrest, MD; and Viviana Martinez-Bianchi, MD. of respondents receive Dobson, Jr. their primary care by a Several key themes emerged throughout the daylong primary care physician event. The event’s three panel discussions and speakers noted that stronger and more integrated primary care will be increasingly with whom they have a personal relationship. Primary care and Community Care of NC were both repeatedly mentioned as a critical pieces to healthcare in important as health reforms continue to progress. One panel discussion designed to showcase the health care innovations taking place in North North Carolina. The NCAFP produced a short video summary of the event that can be viewed online at www.ncafp.com/video. Carolina highlighted CCNC. The program was recognized for its overall effectiveness in improving health quality while saving money. CCNC is
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ADVOCACY & POLICY
Legislative Turnover Creating Need for Proactive Advocacy NCAFP Prepared to Advocate on Several Issues During 2012 ‘Short Session’ By Robert L. Rich, Jr, MD NCAFP Advocacy Council Chair Short Session Begins May 16th
In the last few months, numerous state politicians have announced their retirement from the General Assembly. Foremost of these was Governor Perdue’s decision not to seek a second term. Because Perdue’s announcement occurred somewhat late in the filing process for political offices, this caught most politicians off guard and left the Democratic field scrambling to field viable candidates. This has clearly had the effect of introducing significant uncertainty into the election process and in determining where the gubernatorial candidates stand on Medicaid, CCNC, and other key healthcare issues. In addition to the Governor’s announcement, numerous other Representatives and Senators from both parties have announced that they are not running. Some current estimates suggest that there will be 40+ new Representatives and 15+ new Senators – at a minimum – after this November’s elections. Complicating this unprecedented turnover, there is also a strong likelihood that there will be little or no physician presence in either the House or Senate come January, 2013. Your governmental affairs team has been closely monitoring these changes and is working with various campaigns in order to educate our new potential leaders on the value of primary care, the importance of CCNC, and stable Medicaid provider rates. In order to achieve these goals, we will need your PAC contribution more than ever and we urge you now to sign up for the Academy’s serial contribution program. We are asking all current and past leaders to
8 Spring 2012 • The NC Family Physician
participate in the “Family Medicine Forerunners” program, with a goal of having at least a hundred individuals contributing just over a dollar a day or at least $400 dollars per year. Our staff can set up quarterly payments of $100 each to anyone wishing to participate. Please consider becoming a Family Medicine Forerunner.
The start of the legislative ‘Short Session’ is upon us. As in previous years, we continue to focus upon preservation of CCNC, its primary care physician focused network, and its emphasis on quality care and subsequent cost savings for the Medicaid program. CCNC has been tasked by the legislature with producing significant cost savings for the current budget year and we support that effort by continuing to reinforce the importance of patientcentered medical homes for our practices. The goal is to keep patients out of the emergency room. By doing so, we hope to preserve the Medicaid payments paid to our practices and preserve the high levels of participation in the CCNC network by family physicians. We will continue to lobby our legislators to ensure that any and all savings to Medicaid produced by these efforts remain in the Medicaid program and are not utilized to fund other state programs. And remember, CCNC is now much more than Medicaid, with many See ‘Advocacy’ on back cover
NC FAMPAC FORERUNNER Now more than ever, NC’s family medicine community must support and educate legislators on both sides of the aisle. FAMPAC Family Medicine Forerunners help make this happen. As a Family Medicine Forerunner, your contribution of $100 each quarter (just over a dollar a day) to NCAFP’s Political Action Committee (FAMPAC) helps family medicine keep its voice heard and our issues recognized in the NC legislature. Signing up is easy. Do it today and help keep family medicine running strong in North Carolina.
www.ncafp.com/forerunner www.ncafp.com/ncfp
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MEETINGS & EDUCATION
Don’t Miss the 2012 Mid-Summer Family Medicine Digest Sunday, July 1 – Friday, July 6, 2012
THE NCAFP is GO’IN GREEN!! All Mid-Summer Meeting syallabus and educational materials will be provided as a download.
D TEN EX OUR Y EK WE
Mark your calendars now and make plans to join us at the Embassy Suites Hotel at Kingston Plantation in Myrtle Beach, South Carolina, for the NCAFP’s 2012 MidSummer Family Medicine Digest, Sunday, July 1st through Friday, July 6th, 2012. Program Chair Thomas R. White, MD, has planned a terrific program on a variety of issues and topics faced by most primary care physicians today. Attendees will receive up to 30+ AAFP Prescribed Credits and the entire family will enjoy their time at the beach. The conference features convenient half-day sessions that leave your afternoons open for family, fun and recreation. Plus, physicians can also take advantage of two extra days of learning at the 2012 Sport Symposium that takes place on Saturday to Sunday, July 7th & 8th that immediately follows the Mid-Summer conference. The General Sessions lineup tentatively includes: Mental Health Issues Facing Family Physicians, Motivational Interviewing, Geriatric Falls, Coding Updates, Rheumatoid Arthritis, Hypertension,
10 Spring 2012 • The NC Family Physician
Embassy Suites Hotel at Kingston Plantation in beautiful Myrtle Beach, South Carolina
2012 Sports Medicine Symposium Saturday, July 7 & Sunday, July 8, 2012 • Sponsored by the NCAFP and the NCMS Sports Medicine Committee
Diabetes, Pediatrics in Pictures, A Cholesterol Update, Obesity, Pediatrics & Adolescent Vaccine Compliance, MRSA, Adult Skin Lesions, Pain Management, Kidney Stones, Celiac Disease, Prostate Cancer and much more. Be sure to check the website (www.ncafp.com/msfmd) for the most up-to-date information and topics line-up. Two half-day seminars focused on Practice Management and Mastering Procedures will be offered on Thursday, July 5th and Friday, July 6th. Thursday’s Practice Management lecture topics will include Payment Reform, Importance of Quality Outcome Measures, New Practice Models, Harnessing the Power of the Web to Grow your Practice, and Transition to ICD-10. Friday’s Mastering Procedures Seminar will include lectures and demonstrations on the topics of Joint Injections and Aspirations, Ortho Emergencies and Cosmetic Procedures. In addition, those participating in the ABFM Maintenance of Certification Cycle will have two opportunities to participate in a SAMs Study Working Group during these days. SAMs topics include Depression and Cerebrovascular Disease. Extend Your Stay for More CME Extend your stay at the beach and earn additional
CME credits by attending the 2012 Sports Medicine Symposium on Saturday, July 7th and Sunday, July 8th, 2012. Program Chairs Drs. Bert Fields and Walton Curl have a fantastic line up of topics for this program. The purpose of the Symposium is to provide continuing education for physicians, Physician Assistants, Physical Therapists and Athletic Trainers in the field of sports medicine. Upon completion of the Symposium, attendees will be well-versed in the diagnosis and treatment of multiple sports-related issues including, a focus on tendinopathy, heat and critical issues management, complicated concussions, diagnosis and management of metatarsal fractures, rotator cuff management and pediatric anterior knee pain. Emphasis will be placed on newer diagnostic techniques and new treatment options for the symposium topics, including concussion evaluation and return to play form, musculoskeletal of common tendons and mastering examination skills for shoulders, hips, knees and ankles. See ww.ncafp.com/symposium to learn more about this terrific opportunity. The Symposium is being sponsored by the NCAFP and the NC Medical Society Sports Medicine Committee. See ‘Mid-Summer’ on back cover www.ncafp.com/ncfp
mittee
The State of the Academy Members are the backbone of our specialty and I would like to begin by thanking our Chapter’s more than 3,000 members. It is through your continued commitment to our specialty, your patients and the communities you serve that helped our Academy make continued progress in 2011. Serving as president of our Chapter has been a monumental experience for me, both personally and professionally. I could never have dreamed of this opportunity as I was beginning in my first practice out of residency. This experience has also helped me develop a finer appreciation for the important work of our Academy and for the contributions that our members make in achieving its goals. The Academy began the year with a vision of expanding its collaborative relationships. Our Chapter’s leaders have Richard W. Lord, Jr., MD long recognized that as primary care continues to embrace 2011 President more team-oriented approaches, it is critical that our allied health colleagues recognize the value that teamwork brings to patient care, particularly as it relates to the Patient-Centered Medical Home (PCMH). To that end, we were successful in building a richer dialogue with the NC Nurses Association through two face-to-face meetings with its leaders. While these represent only preliminary steps, we envision a future in which we build a dialogue with numerous other allied health organizations to identify and support policies that enhance PCMH and improve the quality of care delivered to our patients. The Academy also worked closely with the North Carolina Medical Society, the North Carolina Hospital Association, and the North Carolina Pediatric Society in helping to achieve several key legislative victories. Our victories included passage of significant medical malpractice reform, maintaining Medicaid payment rates for primary care, and protecting physician-delivered primary care from further fragmentation. In these victories, your Academy was guided by a simple principle: Work for what is best for our patients and what will enhance family medicine’s ability to provide high quality care. Complementing our legislative advocacy work, the NCAFP also continued to broaden family medicine’s presence on many important healthcare policy groups, task forces and committees. These groups often wield considerable influence in crafting the health policies that affect our dayto-day practice. Of particular interest to the Academy is the work of the North Carolina Institute of Medicine (IOM). The Academy’s leadership committed to being ‘at the table’ within the IOM, and I am proud to report that family medicine has active representation on IOM’s Board of Directors, and several task forces related to implementation of health care reform including sub-committees on Professional Workforce, the Health Benefits Exchange, Medicaid, and Models-of-Care. Family physicians are also active within North Carolina’s House of Medicine -- and our presence is growing. During 2011, the presidents of the NC Medical Board, the NC Medical Society, and the NC Medical Society Foundation were all family physicians. Plus, the Academy can count no less than forty groups where family physicians are active voices in discussions.
North Carolina Academy of Family Physicians 2011 Annual Report Outside of the health policy arena, your Academy also continued the important work in developing our state’s future family medicine workforce. Our nationally-acclaimed Family Medicine Interest & Scholars Program entered its second year and continues to generate momentum for the specialty across the state. The program has created a groundswell of awareness and excitement about family medicine in our medical schools and helped us expand North Carolina’s network of high quality family medicine preceptors. We continue to be thankful for the tremendous support of the Blue Cross and Blue Shield of North Carolina Foundation for helping to make this program a reality. Your Academy also made a number of other advances. On the pages that follow, you will see that our educational conferences expanded, membership grew, and our finances remained strong. We also delivered new tools and information to equip all members, and even raised our public health outreach efforts. All of these activities are designed to help serve you better and make your practice of family medicine more rewarding and enjoyable. My year as president has been an experience that I will always treasure. I appreciate the trust you placed in me in helping lead this Academy and represent you. As our journey as family physicians continues to evolve, some changes will come easily, while others will push us to be more resilient. But rest assured, the NCAFP will continue to be your most vocal advocate and support you along the way.
Executive’s Report Gregory K. Griggs, MPA, CAE
2011 - A Record Year for the NCAFP
2011 in Review I believe we have one of the best Academy Chapters in the country and our benchmarks for 2011 back that up. But it doesn’t happen without the support of you, our members. We are only as good as our member leaders and our member volunteers. And you made 2011 a record year. Let me provide a brief review.
Education Our Annual Meeting in December capped a banner year for continuing medical education within our Chapter. Nearly 750 learners registered for CME at the Winter Family Physicians Weekend, making our Chapter’s Annual Meeting the largest state gathering of family physicians in the country. Our programming continues to attract record crowds due to our diverse educational offerings, strong clinical content, excellent physician guidance, and an energy that can’t be matched in any other state. Yet, it wasn’t just the Annual Meeting. Attendance rose for every Academy Meeting with our Spring Family Physicians Weekend growing by nearly 10 percent to 161 attendees, and our Mid-Summer Digest growing slightly to over 250 attendees. We also held multiple SAMs study groups, several procedures workshops in North Carolina and in other states, and continue to develop new and innovative programming, including a Maintenance of Certification Part IV quality improvement project which will be rolled out in 2012.
Membership For the second year in a row, the NCAFP will have the highest retention rate of all state Chapters. We also had a tremendous increase in student membership. At the end of October – our annual benchmark date, the NCAFP had a total of just under 3,200 members, with nearly 2,300 of them in the Active category of currently practicing family physicians. This represents active membership growth of nearly 4% and overall membership growth of 11.4% spurred by 240 new student members bringing our student membership totals to 410. This mirrors increased interest in family medicine and primary care in our state’s residency programs and medical schools.
Legislative Session
2
The 2012 Session of the NC General Assembly proved extremely successful for the House of Medicine. Despite a significant state budget deficit, we were able to avoid Medicaid provider rate cuts and preserved most Medicaid services for your patients. We also protected our state’s award winning program, Community Care of North Carolina, from the threat of outside Medicaid HMOs. One of the most important legislative victories came in the form of significant Medical Malpractice reform. Led by the NC Medical Society and supported by a coalition of other healthcare organizations, including the Academy, the reform passed the General Assembly against strong opposition by the trial lawyers, with the General
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Attendance grew at all three major NCAFP meetings in 2011. NCAFP’s annual Winter Family Physicians Weekend was the largest state gathering of family physicians in the country, with nearly 750 learners.
NCAFP’s guide to Accountable Care Organizations is being used by the AAFP as a resource for family physicians across the country.
Assembly ultimately overriding the Governor’s veto. We also battled efforts to further fragment care. North Carolina’s pharmacists sought authority to provide any and every immunization. Your leadership strongly believed this would erode the medical home and pose a public health risk by more immunizations taking place in retail settings. While the bill remains alive for the 2012 Short Session, we convinced numerous legislators of the advantages of keeping immunizations as part of the medical home. These are just a few examples of the daily work your government affairs team undertakes in the General Assembly. And much work also occurs outside of the halls of the Legislature with NCAFP physician participation in numerous task forces and study groups well in advance of legislative proposals.
Involvement in Public Health The NCAFP continues to undertake numerous efforts to protect the health of the public in North Carolina. Whether it’s been the numerous projects of your Foundation – dental varnish, adolescent obesity, health disparities – or leader involvement in key statewide committees and commissions, the NCAFP has been and continues to be at the forefront of public health initiatives in the state. Here are examples of just a few of the approximately 40 national and state task forces and committees that NCAFP members serve on representing your profession: The United Nations Summit on Non-Communicable Diseases, the AAFP Commission on Health of the Public and Science, the Justus-Warren Heart Disease and Stroke Prevention Task Force, the NC IOM Early Childhood Obesity Task Force, Eat Smart Move More NC and the NC Cancer Control Advisory Committee, among many, many others. Your Health of the Public Council also began an initiative in 2011 to reach out to local newspapers to provide key articles on healthcare, prevention and primary care. While this initiative is still at an early
T re th N b
2010-11 NCAFP NCAFP Membership Growth & Retention
3000 2500
EXECUTIVE OFFICERS
2000
de
able ing urce the
Board of Directors
3500
1500 1000
2010 2011
500 0
Active
LIfe
Resident
Student
Total
The NCAFP grew by over 300 members in 2011. The Chapter led the nation in membership retention with 98.1% of all Active members renewing their membership; NCAFP also had the highest large Chapter (1,000+ members) rates of New Physician retention at 95.7%, and NCAFP’s Resident-to-Active conversion was also the highest in the nation at 86.5% — 13% better than the national average!
stage, we hope to provide media outlets across the state with a key source on healthcare issues impacting their readers. If you happen to know someone at your local paper, let us know so we can make sure they are receiving these periodic articles.
Practice Enhancement And last but not least, we still are very involved in the business and process of medicine. We continue to work with our partners to develop resources on the Patient Centered Medical Home. Much of this work in the last year has occurred in the context of Community Care of North Carolina. CCNC now has numerous resources on PCMH available on their website, and your NCAFP staff and physician leaders have been crucial in developing these materials. We also continue to work with payers to insure that they value the medical home. This has included involvement in the Blue Quality Physician Program, an initiative developed by BCBS NC that enhances payment for independent practices that become recognized Patient-Centered Medical Homes by the National Commission on Quality Assurance (NCQA). And it’s not surprising that our state is once again leading the nation, now having the 3rd most recognized PCMHs of any state, with over 8 percent of the nationally recognized medical homes housed in North Carolina. To date, almost 2,000 primary care physicians in the state have achieved some level of PCMH recognition. And last but not least, in 2011, we developed numerous educational materials on Accountable Care Organizations, including a one-day conference and a white paper. You can download “The ACO Guide: How to Identify and Implement the Key Elements for Accountable Care Organization Success” on our website at www.ncafp.com. The guide is a good overview of the key elements of successful ACOs and by reading it you can receive CME credit. After being developed for NC family physicians, AAFP adopted this same guide for national use. To come full circle, your Chapter truly helps lead the country. From member retention to the number of recognized medical homes to key resources for family physicians, the NCAFP is near the top. But it’s you – our members – who make it all possible. Thank you.
President President-Elect Vice President Secretary/Treasurer Board Chair Past President Executive Vice President
Richard W. Lord, Jr., MD Brian R. Forrest, MD Shannon B. Dowler, MD William A. Dennis, MD R.W. ‘Chip’ Watkins, MD, MPH Robert L. ‘Chuck’ Rich, Jr., MD Gregory K. Griggs, MPA, CAE
BOARD DIRECTORS District 1 District 2 District 3 District 4 District 5 District 6 District 7 At-Large At-Large IMG Physicians Minority Physicians New Physicians FM Residency Directors Resident Director Resident Director-Elect Student Director Student Director-Elect
R. Kevin Talton, MD Matthew M. Williams, MD Scott Edward Konopka, MD Tamieka Howell, MD Rhett L. Brown, MD James W. McNabb, MD Thomas R. White, MD Charles W. Rhodes, MD Holly Biola, MD Nalini S. Baijnath, MD Enrico G. Jones, MD Nadine B. Skinner, MD Gary I. Levine, MD Nicole Shields, MD (SR-AHEC) Matthew Kanaan, DO (DUKE) Amy Marietta (UNC) John Trimberger (WFU)
FAMILY MEDICINE CHAIRS Chair Alternate Alternate Alternate
Kenneth K. Steinweg, MD (ECU) Warren P. Newton, MD (UNC) Lloyd Michener, MD (DUKE) Michael L. Coates, MD (WFU)
AAFP DELEGATES Mott P. Blair, IV, MD
Karen L. Smith, MD, FAAFP
AAFP ALTERNATE DELEGATES L. Allen Dobson, Jr., MD Michelle F. Jones, MD
3
Awards & Honors 2011 N.C. Family Physician of the Year Donald A. Ribeiro, MD, FAAFP Ayden, North Carolina
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 in the 9th grade when he recognized his love of science and people. A moment’s conversation with his chemistry teacher and her suggestion of becoming a physician started a journey he’s still completing. 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 and in 2005, he 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. In addition to serving patients and managing his three clinics, Ribeiro also continues to serve a calling he recognized during high school. Dr. Ribeiro is the senior 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 22,000 square-foot facility that serves the ministry and the local community. Dr. Ribeiro and his wife Karen reside in Ayden and are the parents of three children, Jessica, Sarah and Josh.
2011 Outstanding Family Medicine Residents Cabarrus Family Medicine Residency Camp Lejeune Family Medicine Residency Carolinas Family Medicine Residency at Charlotte Carolinas Family Medicine Residency at Union Duke University Family Medicine Residency East Carolina University Family Medicine Residency MAHEC Family Medicine Residency at Asheville MAHEC Family Medicine Residency at Hendersonville Moses Cone Family Medicine Residency New Hanover Family Medicine Residency Southern Regional Family Medicine Residency UNC Chapel Hill Family Medicine Residency Wake Forest University Family Medicine Residency WOMACK Family Medicine Residency
Casey J. Henritz, DO Stephen T. Rachael, MD Cordula Davis, MD Nicole Brooks, MD Stephanie J. Foley, MD Rajen Patel, MD William E. Dameron, MD Aaron J. Beck, MD Khary S. Carew, MD Karen M. Isaacs, MD Robert Alcott, DO Kimberly B. Burrows, MD Neil L. Sparks, DO Evan T. Trivette, DO
2011 Community Teaching Awardees East Carolina University Duke University University of North Carolina at Chapel Hill Wake Forest University
Joseph R. Overby, Jr., MD Mark E. Beamer, MD John C. Lalonde, MD David E. Lee, MD
2011 Family Medicine Interest Group Faculty Advisors East Carolina University Duke University University of North Carolina at Chapel Hill Wake Forest University
Susan Schmidt, MD and Jason A. Foltz, DO Nancy Weigle, MD Thomas Koonce, MD and Kelly Bossenbroek-Fedoriw, MD C. Randall Clinch, DO
AAFP Chapter Recognitions 100% Resident Membership – Chapter’s seventh consecutive year achieving this. Active Member Retention, Large Chapters – The NCAFP led the nation with 98.1% of active members renewing their membership for 2011. Highest Percentage Increase in Student Members, Large Chapters – The NCAFP led all large AAFP Chapters in student member growth, adding 240 new students. Highest Member Retention Percentage of New Physicians, Large Chapters – The NCAFP retained 95.7% of all new physicians.
4
Financial Summary The following represents the 2011 year-end financial summary for the NCAFP Academy. This Summary is only a part of the complete financial statements examined by Thomas, Judy & Tucker, P.A., Certified Public Accountants. The complete Financial Statements are available to any member of the North Carolina Academy of Family Physicians, Inc. upon request at the NCAFP headquarters.
Dec. 31, 2011
Dec. 31, 2010
Dec. 31, 2009
583,649
486,946
1,126,015
48,455 20,036 550,000 888,653
57,891 21,923 500,000 871,490
64,300 15,590 698,241
2,090,793
1,938,250
1,904,146
205,000 625,108 243,873
205,000 625,108 243,873
205,000 625,108 243,873
(445,282)
(416,281)
(383,886)
628,699
657,700
690,095
115,611
111,164
106,889
2,835,103
2,707,114
2,701,130
Dec. 31, 2011
Dec. 31, 2010
Dec. 31, 2009
Current Liabilities: Accounts Payable Deferred Revenue - Membership Dues Deferred Revenue - Programs Accrued Paid Time-Off
245,314 250,645 36,739 13,025
166,769 230,660 43,547 10,293
156,557 227,830 92,836 9,237
Total Current Liabilities
545,723
451,269
486,460
Long-term Liabilities: Deferred Compensation
115,611
111,164
106,889
Total Liabilities
661,334
562,433
593,349
Net Assets Undesignated Board Designated
2,099,537 74,232
2,078,291 66,390
2,048,821 58,960
Total Net Assets
2,173,769
2,144,681
2,107,781
2,835,103
2,707,114
2,701,130
Assets Current Assets: Cash and Cash Equivalents Accounts Receivable, net of Allowance for Doubtful Accounts of $500 in 2011 and 2010 Prepaid Expenses Certificates of Deposit Investments Total Current Assets Property and Equipment: Land Building and Improvements Furniture and Equipment Less Accumulated Depreciation Net Property and Equipment Other Assets Investment, Deferred Compensation Total Assets
Liabilities and Net Assets
Total Liabilities and Net Assets
AAFP Service & Appointments Lori Heim, MD - Vass, N.C. AAFP Board Chair and Chair, AAFP Primary Care Valuation Task Force
Meshia Q. Todd, MD - Durham, N.C. Resident Delegate, AAFP Congress of Delegates
Conrad L. Flick, MD - Raleigh, N.C. Member, AAFP Board of Directors
Robert L. Rich, Jr., MD - Elizabethtown, N.C. Member, AAFP Commission on Health of the Public & Science
Michelle F. Jones, MD - Hampstead, N.C. Member, AAFP Foundation Board of Directors
Viviana Martinez-Bianchi, MD - Durham, N.C. Chair, AAFP Commission on Membership & Member Services Nailah Adams - Durham, N.C. Southeast Regional Coordinator, AAFP Family Medicine Interest Groups
5
Meetings & Professional Development The Chapter produced six educational programs in 2011, totaling 82.5 Prescribed Credits. The following summarizes all continuing education and professional development produced by the Chapter in 2011. 2011 Spring Family Physicians Weekend – Winston Salem, NC Alicia C. Walters, Program Chair Credits: 20 Registration: 161 Attendees / 38 Exhibitors
2011 NCAFP Leadership Retreat – Chapel Hill, NC Richard Lord, MD, Program Chair Credits: 5.75 Registration: 52 Attendees
2011 Midsummer Family Medicine Digest – Myrtle Beach, SC Thomas R. White, MD, Program Chair Credits: 31 Registration: 253 Attendees / 30 Exhibitors
2011 Winter Family Physicians Weekend – Asheville, NC James W. McNabb, MD, Program Chair Credits: 25.5 Registration: 747 Attendees / 82 Exhibitors
NCAFP Educational Funding Partners & Sponsors 2011 Educational Sponsors
American Academy of Family Physicians Annenberg Center for Health Sciences at Eisenhower Access TLC/North Carolina Lung Cancer Partnership Endo Pharmaceuticals France Foundation Georgia Academy of Family Physicians Integrity Continuing Education Lilly USA, LLC LipoScience Merck NC Governor’s Institute on Substance Abuse National Association of Chronic Disease Directors National Foundation for Infectious Diseases, VEMCO MdEd, Merck and Supported by a Grant from Merck & Co., Inc. New Jersey Academy of Family Physicians Outcomes Management Educational Workshops, Inc. Ortho-McNeil Janssen Scientific Affairs, LLC Pfizer Primary Care Education Consortium llinois Academy of Family Physicians Purdue Pharma, LP Sanofi Aventis Total Body Contouring University of PA School of Medicine, AXDEV Group, Spectrum Medical Education, Vemco MedEd
2011 Educational Partners:
Mag Mutual Insurance Company Medical Mutual Insurance Company
2011 Frontline Supporters
Gebauer Company Physicians’ Institute
NCAFP Frontline CME Programs COPD – Practice Improvement Initiative Brian Forrest, MD, Program Chair • Six (6) practices participated in this quality improvement initiative. • CME meetings educational sessions at Spring 2011 and Winter 2011– COPD lecture and spirometry workshop conducted. Mastering Valuable Hands on Procedures AFP Chapter Series – Part II James W. McNabb, MD and Richard Lord, MD, Program Chairs • Recruiting and Training of Faculty – James McNabb, MD; Richard Lord, Jr., MD; Kevin Burroughs, MD; Amrish Patel, MD; and Mark Beamer, MD. • Completed Final 2 of 6 in Chapters Series – Pennsylvania AFP – Saturday, July 16th, 2011. Drs. Lord and Burroughs. Virgina AFP - Friday, July 22nd and Saturday, July 23rd – Drs. McNabb & Patel. • Completed NC workshop on September 24th, 2011 – Sheraton Greensboro Hotel at Four Seasons, Greensboro, NC with Drs. James McNabb and Mark Beamer. Credits: 6 Registration: 45 per chapter
6
FAMPAC Contributions FAMPAC, the Academy’s political action committee for Family Medicine, raised $7,998.66 from contributions by 54 members in 2011. FAMPAC made contributions to 6 candidates totaling $4,000.00. The ending balance in the committee’s account as of December 31, 2011 was $7,675.91. The following members made contributions: Nalini Baijnath, MD Angela H. Bailey, MD Andrea D. Barkley, MD Steven Bauer, MD Yvonne Berstler, MD Holly Biola, MD Samual D. Blackwell, MD Mott P. Blair, IV, MD Denise Bryant, MD John Steven Corder, MD William A. Dennis, MD
Allen Dobson, MD Shannon Dowler, MD Janice Huff Ezzo, MD Conrad L. Flick, MD Brian R. Forrest, MD James Galloway, MD Gregory K. Griggs, MPA, CAE Michael Gross, MD Robert Gwyther, MD Mary Hall, MD Douglas I. Hammer, MD
James Hawkins, Jr., MD Mark Hester, MD Tamieka Howell, MD Thomas Jeffries, MD Enrico G. Jones, MD Michelle F. Jones, MD Victoria Kaprielian, MD Thomas Koinis, MD Scott E. Konopka, MD Richard Lord, Jr., MD Kathryn Lynch, MD
Timothy Madigan, MD John Mangum, MD James W. McNabb, MD Susan Murphey, MD John D. Nelson, MD John Thomas Newton, MD Dean Patton, MD Charles W. Rhodes, MD Robert L. Rich, Jr., MD David A. Rinehart, MD John Carson Rounds, MD
George Saunders, MD Mohammad Shahsahebi, MD Nicole Paulsen Shields, MD Kenneth K. Steinweg, MD Jessica Triche-Staton, MD Jason J. Troiano, MD R.W. “Chip” Watkins, MD Thomas R. White, MD Aretha Wiggs-Grimes, MD Matt Williams, MD
2011 NCAFP Foundation Summary
wer hip
s MCO
2011 Board of Trustees
NCAFP Foundation Financial Report & Operations
Executive Officers
The Foundation ended 2011 with $1,936,622 in total assets, including a net operating surplus of $46,157. Grant revenue was $227,302 and total revenues for the year were $423,257.
President
J. Carson Rounds, MD
Vice President
Jennifer L. Mullendore, MD
Secretary/Treasurer
Christopher Snyder, III, MD
Executive Vice President
Gregory K. Griggs, MPA, CAE
Physician Trustees Inc.
up,
Shannon B. Dowler, MD E. Bruce Elliston, MD Brian Forrest, MD Dimitrios P. Hondros, MD
Eugenie M. Komives, MD Richard Lord, Jr., MD Viviana Martinez-Bianchi, MD Robert L. ‘Chuck’ Rich, Jr., MD
Michelle F. Jones, MD Trustee Emeritus
Maureen E. Murphy, MD
Corporate Trustees Jim Kay, Medical Mutual Insurance Company Judy Mann Rudy Snow - The Rudy L. Snow Company Resident Physician Trustees
Medical Student Trustees
Contributions from Member Dues ............................................... $25,635 Individual Designated Contributions:
General Fund ................................................................................ $10,024 Tar Wars Program .............................................................................. $140 Student Scholarship Fund ................................................................. $100 Medical Student Endowment Fund ............................................... $3,175 Family Medicine Interest & Scholars Program .............................. $6,400 Corporate Member Contributions ................................................. $7,050 Silent Auction Contributions (Including Corporate Sponsorship)........... $23,670 NCAFP Contribution to the Family Medicine Interest & Scholars Program ............................ $87,265 AAFP Foundation Grant for Student Externships ....................... $1,250 Grant Funded Projects: HWTFC - Health Disparities Initiative...................................................$70,911 Blue Cross and Blue Shield of NC Foundation Family Medicine Interest & Scholars Program...................................... $149,700
Mo Shahsahebi, MD (Duke) Amy Shipley (ECU) Jedlyn Pierrilus, MD (SR-AHEC) Benjamin Kirkley (UNC)
7
2011 Corporate Membership Program – The following organizations contributed at least $1000 to the Foundation and were named corporate members for the year:
Blue Cross and Blue Shield of North Carolina Johnson & Johnson Services, Inc. Mag Mutual Insurance Company Medical Mutual Insurance Group N.C. Academy of Family Physicians, Inc. The Rudy Snow Company Medical Student Endowment Fund and Family Medicine Interest and Scholars Fund – The endowment now totals $722,935. The Academy did not contribute to this fund in 2011, but did contribute $87,265 to the Foundation’s Family Medicine Interest & Scholars Program. The Annual Foundation Silent Auction – This event generated revenue of $23,670, with expenses of $4,797, for a net gain to the Foundation of $18,873.
Student Activities Family Medicine Interest Groups – The Foundation supported all interest groups with funding and staff support. Financial support included $3,200 to help off-set FMIG annual banquet costs. An additional $4,000 was awarded to help support student attendance at the AAFP National Conference for FM Residents and Medical Students. Over $5,100 was used to bring National-level speakers to FMIGs and an additional $14,400 was provided to support student attendance at the NCAFP Annual meeting in Asheville. Family Medicine Externship Program – A total of 7 students participated in a summer experience of one to four weeks for a total cost of $6,250. The Foundation was able to secure a grant from the AAFP Philanthropic Consortium of $1,250 to offset program expenses.
Family Medicine Interest & Scholars Program – In 2011, the Scholars aspect of the program expanded to 24 students. Stipends awarded to students and preceptors totaled $65,000. Additional support to participants in this program included: $13,800 for student participants to attend the NCAFP annual meeting; $6,715 in CME registration fees paid for preceptors; and, $6,600 for travel to the 2011 AAFP National Conference for Family Medicine Residents and Medical Students. Medical students selected from the Class of 2014 to participate in the Family Medicine Scholars Program were as follows: Joshua T. Carpenter (ECU) Laura S. Cone (UNC) Emily A. Dell (ECU) C. McLean Ellis (UNC) Vanessa C. Gallegos (WFU) Katy A. Kirk (ECU)
William C. McLean (UNC) M. Adele Moser (ECU) Amy J. Nayo (UNC) Cleveland A. Piggott, Jr. (UNC) Emily L. Ross (ECU) Lindsey M. Wright (WFU)
NCAFP/Student Scholarship/Loan Program – The following four students were each awarded scholarships in the amount of $2,000. Nailah S. Adams (Duke) Amy Shipley (ECU) Amy E. Marietta (UNC) Katherine S. Wiegert (Duke)
2011 NCAFP Foundation Contributions NCAFP members and supporters of the Chapter and specialty are encouraged to make gifts of on-going significance or annual contributions to the NCAFP Foundation. The following individuals contributed in 2011:
8
Mark S. Abel, MD
Shannon B. Dowler, MD
Kevin E. Johnson, MD
Judy Mann
Lara J. Pons, MD
Ronald G. Accas, PA-C
John K. Earl, MD
Johnson & Johnson Services, Inc.
Viviana Martinez-Bianchi, MD
Charles W. Rhodes, MD
Nailah S. Adams
David P. Fieseler, MD
Champ M. Jones, Jr., MD
A. Thomas May, III, MD
Carlos M. Rish, MD, FAAFP
Johnny W. Bagwell, MD
Brian Forrest, MD
James G. Jones, MD
William L. McDaniel, Jr.,MD
Mark D. Robinson, MD
Vijaya Bapat, MD
Donald B. Goodman, Jr., MD
Suzanne E. Jones, MD
Deborah S. McRoberts, MD
J. Carson Rounds, MD
Janalynn F. Beste, MD
Gregory K. Griggs, MPA, CAE
Colin D. Jones, MD
Medical Mutual Insurance Co.
George L. Saunders, III, MD
Holly R. Biola, MD
Robert E. Gwyther, MD
Victoria Kaprielian, MD & Jon Luis
Paul F. Meyer, MD
Charles J. Sawyer, III, MD
Stephen G. Bissette, MD
Wayne A. Hale, MD
William S. Kelly, MD
Don W. Moore, MD
Jessica Schorr Saxe, MD
Mott P. Blair, IV, MD
Douglas I. Hammer, MD
Ben G. Kirkley
Jennifer Mullendore, MD
Karen L. Smith, MD
Blue Cross & Blue Shield of NC
James H. Hawkins, Jr., MD
Eugenie Komives, MD
Susan Murphey, MD
Rudy Snow Company
Betty B. Bradley, MD
Lori J. Heim, MD
Scott E. Konopka, MD
Maureen E. Murphy, MD
Christopher Snyder, III, MD
Rhett L. Brown, MD
Dimitrios P. Hondros, MD
Frank W. Leak, Sr., MD
Shahla Namak, MD
Beat D. Steiner, MD
William D. Byars, MD
Laura K. House, MD
Richard V. Liles, Jr., MD
J. Thomas Newton, MD
David B. Tapper, MD
Lisa A. Cassidy-Vu, MD
Tamieka M. Howell, MD
Richard Lord, Jr., MD
Warren P. Newton, MD
Robert G. Townsend, III, MD
Michael Coates, MD, MS
Janice E. Huff, MD
Kathryn J. Lynch, MD
Denzil Dean Patton, MD
Thomas R. White, MD
Amy R. Csorba
Ronald C. Huffman, MD
Mag Mutual Insurance Company
Jedlyn Pierrilus, MD
Matthew M. Williams, MD
William A. Dennis, MD
Thomas L. Jeffries, MD
John R. Mangum, MD
Jesse C. Pittard, MD
Glenn A. Withrow, MD
EXECUTIVE’S MESSAGE
Moving the Medical Home Forward North Carolina Helping to Lead the Way Nationally By Gregory K. Griggs, MPA, CAE Executive Vice President
North Carolina continues to grow in the number of recognized medical homes Blue Cross and Blue Shield of North Carolina. Through their and is close to the top of the pack nationally. Our state has the third highest Blue Quality Physician Program (BQPP), they are offering higher number of nationally-recognized Patient-Centered Medical Homes in the reimbursement of E&M codes for independent family practices obtaining country, only behind Pennsylvania and New York, and our numbers are growing PCMH recognition and the other BQPP standards. This once again gave the every day. financial rewards for practices doing the right things to improve the quality of I recently had the chance to work with Ashley Wofford, a fourth year care. medical student from UNC, during her policy and leadership rotation with the Now as anyone who has been through the process can attest, obtaining NCAFP. She focused on the costs and benefits of PCMH recognition, and I PCMH recognition is not easy. It takes time and effort. But it’s the right was pleasantly surprised to learn that our state had more than 8% of the NCQA thing to do and over 2,000 primary care physicians in the state have already (National Commission on Quality Assurance) recognized medical homes in completed the process -- over 1,900 under the original 2008 standards and the country. That’s a testament to the hard work of so many of you out in the almost 100 more under the new 2011 standards. So it can be done and it trenches of primary care! should be done. I give the efforts of Community Care of North Carolina a lot of credit for It is the right thing to do for patient care, and most physicians who have our success in the medical home arena. Many of our CCNC practices were well gone through the process are glad they did. They have better data about along the curve to recognition because of the data-driven quality improvement their patient population. They improve the processes for patient care in work that had been going on within CCNC for so long. The concept of a their office. They have better information back from testing and specialty per-member per-month payment referrals. And generally, both the physicians for care management and wrap and their staff are happier in the end. around services helped move Plus, in a large majority of cases, there are practices forward with actual financial incentives that make it worth Medical Homes & North Carolina financial incentives. your while. But I also give our own Academy • North Carolina currently ranks credit for helping move the ball Keep NC Near The Top 3rd in the nation for the number forward. Even before my tenure of NCQA-recognized PCMH clinicians with NCAFP began nearly seven Help keep North Carolina at or near the years ago, the Academy had been top. If you haven’t done so already, join • 1,962 NCQA Recognized clinicians offering a series of educational your colleagues on the road to recognition, (PCMH 2008 standards) programs helping practices learn and let’s work to ensure that every North about and ultimately implement Carolinian has a medical home meeting electronic medical records. Past • 96 NCQA Recognized Clinicians the quality standards outlined under the President Dr. Karen Smith was NCQA Patient-Centered Medical Home (PCMH 2011 standards) one of the leading advocates for recognition process. We can’t undertake the • North Carolina’s CCNC program EHRs and showed that it could process for you, but we certainly can point widely considered the most be done even in rural Hoke you in the direction of a lot of resources that successful large scale medical County. The percentage of family can help you along the way. Don’t home network nationwide physicians who adopted electronic hesitate to ask. records at an early stage was much • Multiple PCMH pilot higher in North Carolina than programs happening many other states. While you right now. can obtain NCQA recognition without an EHR, it is certainly extremely helpful in meeting the criteria and better managing your patient population. I also credit the recent work of Spring 2012 • The NC Family Physician
19
RESIDENTS & NEW FPs 2012 North Carolina MATCH Results bybyProgram 2012 Match Results Program
2012 Family Medicine MATCH Sees Slight Increase 45 North Carolina Medical Students Enter the Specialty North Carolina’s family medicine residency programs had another strong MATCH this year. Cumulatively, the state’s programs filled 98.8% of its 88 total positions, with only one position filled in the revised ‘scramble’ process. Nationally, final figures point to a very slight uptick in the fill rate for family medicine as compared to 2011. Family medicine offered 32 more positions this year and achieved a fill rate of 94.6% (0.01% increase from 2011). Within North Carolina, a total of 45 medical students selected family medicine. Of this group, approximately 52% will be staying in-state for their residency training. In related news, family medicine was also the largest MATCHed specialty by Osteopathic medical students in its 2012 Osteopathic MATCH. Family
# Offered via Match
# Filled via Match
# Filled via SOAP
# Total Slots Filled
Carolinas Medical Center – Cabarrus
8
8
0
8 of 8
Carolinas Medical Center – Charlotte
8
8
0
8 of 8
Carolinas Medical Center – Monroe
3
2
1
3 of 3
Duke
4
4
0
4 of 4
Southern Regional AHEC
7
7
0
7 of 7
MAHEC – Asheville
9
9
0
9 of 9
MAHEC – Hendersonville
3
3
0
3 of 3
10
10
0
10 of 10
8
8
0
8 of 8
12
12
0
12 of 12
6
6
0
6 of 6
10
10
0
10 of 10
Program
Medicine saw a 16% increase in the number of positions filled at 433. According to a 2011 report by the American Osteopathic Association (AOA), roughly half of all DOs practice in primary care, particularly in the nation’s rural and underserved areas. North Carolina’s Campbell University will open its new DO school in in the Fall of 2013. Listed at right are the 2012 MATCH figures from North Carolina’s programs
UNC-Chapel Hill Moses Cone East Carolina University New Hanover* Wake Forest
* Filled 3 DOs via the 2012 DO MATCH, Filled 3 MDs via the allopathic MATCH.
Family Medicine Charlotte Metro Area Outstanding outpatient family medicine opportunities available in communities located minutes from Charlotte, one of the fastest growing cities in the country. These are employed opportunities and will offer competitive compensation packages including two year salary guarantee, productivity bonus potential, generous benefits and relocation expenses. CaroMont Medical Group operates under the guidance of a physician-led Governance Committee allowing for an active partnership with the Medical Staff. Over 300 active medical staff representing all major medical specialties at Gaston Memorial Hospital, a modern and progressive 435-bed hospital which provides comprehensive care to patient base of over 300,000.
CAROMONT HELSTH CaroMont Health
These lovely communities have easy access to the beautiful North Carolina Mountains and some of the most popular beaches on the East coast. Just minutes from an international airport and two large lakes, communities offer unlimited cultural and recreational amenities. A superb quality of life exists here with many charming neighborhoods and stellar public and private schools. If interested in being considered for this opportunity, please send CV to: Celia G. Billings Manager, Physician Recruitment CaroMont Health 2240 Remount Road Gastonia, NC, 28054 T: 704-834-2153 | F: 704-834-4615 Email: billingc@caromonthealth.org
Gaston Memorial Hospital | CaroMont Medical Group | CaroMont Specialty Surgery | CLiC | Gaston Hospice | Courtland
20 Spring 2012 • The NC Family Physician
www.ncafp.com/ncfp
Our Residencies: MAHEC Hendersonville
The MAHEC Hendersonville Family Medicine Residency -
Rural Family Medicine Training with a Personal Touch The age-old image of Marcus Welby, MD, serving his small community as a trusted physician, neighbor and confidant is still alive and well in Western North Carolina. With full-scope family medicine held dear for the legions of rural and small town family physicians, it is exactly the type of physician that the Mountain Area Health Education Center (MAHEC) Family Medicine Residency program at Hendersonville aims to produce. “The reason why we started this program was to increase the supply of family physicians to small towns like Hendersonville,” commented Dr. Steve Crane, Assistant Division Director of MAHEC and one of the program’s founders, as he related a story on the creation of the program in the early 1990s. Dr. Crane described an era with a limited number of physicians taking Medicaid/Medicare patients or caring for the uninsured. Attracting new physicians to Henderson County was also very difficult. “The thought was that if we were closer to the end of the pipeline, we’d be more successful in keeping the end product in the community.” Hendersonville FMR was formally established in 1994 and has since produced a total of 33 family physicians. Sponsored by Pardee Hospital, the program is one of only 24 rural track family medicine residencies in the country. It accepts three residents per year, and according to Dr. Crane, over half of the program’s graduates have started their practices in Henderson County. “Even more impressive, though, is that we recently looked at where all of our residents are now. We found that 82% are practicing in either a HPSA (health professional shortage areas ) or HMSA (Health Manpower Shortage Area),” he noted. The program’s main outpatient facility is located at the Pardee Hendersonville Family Health Center, Henderson County’s largest family practice group. Residents and faculty manage care for about 10K patients and conduct approximately 20K patient visits per year. For inpatient training, residents split time between Pardee Hospital where they are unopposed, and also at Mission Hospital in Asheville, the region’s largest tertiary care center. Community-Centric at its Core
Hendersonville’s primary goal is to produce well-trained, personal family physicians that are community-oriented. To complement its full-scope
The Hendersonville Family Medicine Residency is located at the Pardee Hendersonville Family Health Center and is the largest family practice group in Henderson county. Dr. Steve Crane (pictured), one of the program’s key founders, described the origins of the residency and its commitment to producing personal physicians who are engaged in their communities.
curriculum and its unique approach to rural continuity training, the program also works to develop residents’ skills in community and population health management. Several community and regional health initiatives are based at the program and two faculty members hold leadership positions in key initiatives. This differentiates Hendersonville from other rural track residencies, creates unique learning opportunities, and helps introduce why community health leadership is important for rural providers. It also helps create stronger physcians. “Our program’s embrace of innovation and community collaboration has led to the successful recruitment of outstanding residents, who are highly sought after upon graduating for their clinical and leadership skills, as well as their ability to create the patient-centered medical home in their new practices,” noted Residency Program Director Geoffrey Jones, MD. Program faculty Dr. Richard Hudspeth serves as the full-time Medical Director of the Community Care of Western North Carolina (CCWNC), and Dr. Diane Curan is full-time Medical Director of the Henderson County Health Department. “Our residents benefit from our faculty’s knowledge and involvement in community health, but they also get to some unique educational experiences, too,” added Dr. Crane. “We not only want to produce highly competent family physicians, but also to produce well-trained personal physicians. We try to take the physician-patient relationship to a whole different level.” Enhanced Rural Continuity Through P4
In 2007, Hendersonville was selected to participate in TransforMed’s P4 initiative (Preparing the Personal Physician for Practice). P4 is a 6-year project that grew out of the needs identified by the Future of Family Medicine Project (FOFM). The program is designed to test and compare different approaches in adapting the content, structure, and length of family medicine residency education. FOFM highlighted the desire of patients to have a personal physician who could cross the spectrum of care and be an integral partner in their health. See ‘Hendersonville’ on back cover Spring 2012 • The NC Family Physician
21
STUDENT INTEREST
~ Family Medicine Interest and Scholars Program ~
2015 Class of Family Medicine Scholars Announced Applicants Possess Diverse Academic, Professional and Volunteer Experiences By Tracie Hazelett Manager, Family Medicine Interest Initiatives The NCAFP Foundation recently announced the selection of the Family Medicine Scholars from the Class of 2015. These student scholars are the third group to participate in the Family Medicine Interest and Scholars Program, a unique initiative jointly supported by the Blue Cross and Blue Shield of North Carolina Foundation and the NCAFP Foundation. Interest in this program continues to grow and the field of applicants has become very competitive. All students who applied demonstrated the potential to excel in family medicine. Collectively, this group of students offers very diverse academic, work and volunteer experiences. A few of the volunteer experiences range from local community outreach -- time in free clinics, churches, Boys & Girls Clubs and rescue organizations -- to international outreach to the poor and underserved in dozens of countries. Some of the work experience held by this impressive group includes a Veteran of the Iraq war, a Mom/Strategic Advisor & Business Consultant, a former producer on two major television news networks, and a teacher through Teach for America. Each student will begin their experience this summer with a 4-week externship with their Master Preceptor. Congratulations to the following selected scholars: Brody School of Medicine at East Carolina
Daniel Allen, Julie Barrett, Kenya Caldwell, Kaylan Fisher, Scott Gremillion, and Marlana Sheridan
Duke University School of Medicine
Brittany Pierce
University of North Carolina School of Medicine
Brian Blank, (Ian) Lateef Cannon, Kerry O’Connor, and Lauren Visser
Wake Forest University School of Medicine
Nicolas Johnson and Julia Wofford
In related news, Family Medicine Scholars from the previous two groups attended the NCAFP Winter meeting last December and had the opportunity
Banner Year for Medical Student Externships The NCAFP Foundation was able to offer a large number of Externship experiences to students for this coming summer. In addition, through a partnership with North Carolina’s two rural track residency programs (MAHEC Hendersonville and Union Regional in Monroe) another 10 students have the opportunity to participate in an exciting new Rural Health experience. Students in all programs are in the process of being matched with a preceptor for their summer experience.
22 Spring 2012 • The NC Family Physician
to touch base with their preceptor at that time. Next up for both groups is Family Medicine Day. Currently, students in the Class of 2013 are planning their final year of medical school, mapping out electives based on anticipated specialty selection, including a Healthcare Policy / Leadership rotation through the NCAFP. The Class of 2014 is completing their 2nd year of medical school and is focused on preparation for the USMLE Step 1 exam before looking ahead to National Conference in Kansas City. Following those events, they will be back in the clinical setting where they begin their 3rd year rotations and will spend their family medicine rotation with their Master Preceptor again. Good luck to each scholar as they continue their journey through medical school!
UNC and Duke FMIGs Host AAFP Past Presidents Jim Jones and Rich Roberts The UNC-Chapel Hill FMIG and the Duke University FMIG each hosted a former AAFP President as part of their ongoing family medicine speaker series. Both presentations were made possible by the NCAFP’s Family Medicine Interest & Scholars Program and its committment to bringing national-level family medicine speakers to North Carolina’s medical Jim Jones, MD schools. The presentations are designed to share engaging and thought-provoking perspectives on the specialty with medical students. On March 28th, Past AAFP and NCAFP President Dr. Jim Jones of Hampstead, NC, addressed close to fifty UNC medical students. Dr. Jones touched on a range of issues in healthcare today, from framing the larger health policy debate, to encouraging Rich Roberts, MD students to take responsiblity for their personal well-being, honor their personal calling to medicine and to remain steadfast in pursuing their careers. Also in April, current World Organization of Family Doctors (WONCA) President Dr. Richard Roberts visited Duke University. During his visit, Roberts toured several of Duke’s community clinics, met with medical students, residents, and several family medicine leaders and also presented an engaging lecture on evidence-based medicine. Dr. Roberts described the state of evidence within the national and global care environment. During his lecture, he cited numerous international examples regarding the interplay of evidence, outcomes, guidelines, and research. www.ncafp.com/ncfp
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FAMILY MEDICINE Sat., May 19, 2012 DAY in Durham, NC • Skills Training • Recruiting • Networking
Information at www.ncafp.com/fmd
AAFP Releases ‘Top 5’ List of Overused Tests and Procedures The AAFP has begun to encourage family physicians and their patients to carefully consider five items before proceeding with a treatment plan. The announcement came as part of the new Choosing Wisely� Campaign, a national initiative of the ABIM Foundation that is encouraging doctors and patients to carefully consider and openly-discuss certain tests, treatments and procedures before they take any action. The five recommendations include: 1) Imaging for low back pain.� Do not do imaging for low back pain within the first six weeks, unless red flags are present; 2) Routine antibiotic prescriptions.� Do not routinely prescribe antibiotics for acute mild-to-moderate sinusitis unless symptoms last for seven or more days or symptoms worsen after initial clinical improvement; 3) Dual-energy x-ray
absorptiometry (DEXA) screening for osteoporosis. Do not use DEXA in women younger than age 65 or men younger than 70 with no risk factors; 4) Annual electrocardiograms (EKGs) or any other cardiac screening. Do not order EKGs or other cardiac screening for low-risk patients without symptoms; and 5) Pap smears. � Do not perform Pap smears on women younger than 21 or who have had a hysterectomy for non-cancer disease. The AAFP’s �Top 5�list is an endorsement of the five recommendations for family medicine previously proposed by the National Physicians Alliance and published in 2011 in the Archives of Internal Medicine, as part of its Less is More series. The goal was to identify items common in primary care practice, strongly supported by the evidence and literature, that would lead to significant health benefits, reduce risks and harm, and reduce costs. TM
Visit choosingwisely.org for complete program information and resources for clinicians.
The Core Content Review of Family Medicine Why Choose Core Content Review? • • • •
CD and Online Versions available for under $200! Cost Effective CME For Family Physicians by Family Physicians Print Subscription also available North America’s most widely-recognized program for Family Medicine CME and ABFM Board Preparation.
• Visit www.CoreContent.com • Call 888-343-CORE (2673) • Email mail@CoreContent.com PO Box 30, Bloomfield, CT 06002
Advocacy counties covered under the 646 waiver caring for Medicare patients within CCNC medical homes, and seven counties covering private pay BCBS patients and the State Employees Health Plan as well. Your advocacy team continues to monitor and prepare for some expected scope-of-practice issues. We anticipate a continued push in this year’s session for expanding the immunizing authority of pharmacists, but remain prepared to meet that challenge by emphasizing our concerns about fragmented care, vaccine safety, etc. Similarly, we also continue to monitor a possible effort for the independent licensure for nurse practitioners using the argument of improved healthcare access for underserved areas. Your advocacy team is also monitoring several other issues, including consolidation of the Offices of Rural Health and Community Care, possible changes to local Health Departments under Sen. Bill 433, the status of the state-based Health Insurance/Benefits Exchange, preserving Master Settlement Funds to support the QuitLine and other tobacco prevention efforts, and several other issues. Last session, the Offices of Rural Health and Community Care were consolidated under the intent of budgetary savings. Unfortunately, the effect of this consolidation may be that the approval process for provider loan repayment
contracts may now become significantly delayed. The NCAFP understands the difficulty of recruiting providers for underserved areas and worries that any additional burdens on this process coulde result in the loss of viable candidates for these areas. Senate Bill 433 as currently worded would allow increased County Commissioner control over local health departments, including having local health directors not be required to have any public health or medical experience. The proposal would also allow consolidation of local health departments into a single county entity with other agencies, such social services, mental health LMEs (local management entities). During this year’s short session, we anticipate that legislation will move quickly, with most bills debated and acted upon over a period of just several weeks. Your legislative team has prepared for this and asks that the membership be prepared to contact their respective Senator/ Representative if called upon. We will try to give you as much advance notice as possible, but please remember that the pace of the short session may require quick action in order to influence the given piece of legislation. Be prepared to participate in the legislative process and we ask you to contribute NOW to our political action committee — FAMPAC.
Mid-Summer The NCAFP is ‘Going Green’ this year for the Mid-Summer meeting. This environmentally-friendly initiative will save on natural resources and a significant amount in printing costs. By GOING GREEN this Summer, attendees will NOT receive a complimentary printed general session syllabus. Instead, each registered attendee will receive a CD Rom of the program syllabus & conference materials. A printed paper copy of general session lectures and conference materials may be purchased in advance for $10. There will be a limited number of paper syllabi on site for purchase. In addition, Registered participants will also receive an email with a web link approximately one week prior to the conference. The email will include a username and a password that will enable you to download, save and/or print your preferred program materials and course handouts. Attendees are encouraged to bring laptops, tablets or other mobile devices to the lecture hall and seminars. There will be limited power stations available and wireless internet access may be purchased directly from the Embassy Suites. We appreciate your support as we Go Green. Please note that the NCAFP will provide complimentary printed workbooks for the SAMs Study Working Groups and the Optional Seminars on Thursday and Friday.
Hotel Accommodations
Make plans now and spend the Fourth of July with us in Myrtle Beach. Begin making your hotel reservations by contacting the Embassy Suites Hotel at Kingston Plantation and mention the North Carolina Academy of Family Physicians in order to receive the discounted room rate. Room rates in the Embassy Suites Hotel for Saturday, July 1 through Saturday July 7, 2012 are $235 per night plus tax. There are also a variety of Condos and Villas available. Please call 800-Embassy or 800-876-0010 for more details and to make your reservations. The Kingston Plantation and Embassy Suites Resort is located at 9800 Queensway Boulevard, Myrtle Beach, SC 29572. Conference and Symposium information, along with online registration, is available at www.ncafp.com/msfmd. Registration rates offer great flexibility and package savings. If you have any questions or would like to request a conference brochure, please contact Marietta Ellis, Director of CME or Kathryn Atkinson, Manager, Meetings & Events, at 919-833-2110 or (800) 872-9482 (NC Only) via e-mail at mellis@ncafp.com or katkinson@ncafp.com. We look forward to seeing you in Myrtle Beach.
Hendersonville However, it became apparent that a training gap existed within the specialty’s residencies. It was critical that future family physicians be trained to develop and utilize these approaches. Hendersonville wanted to enhance its residents’ continuity experiences and have them train in environments that would better resemble real-world rural practice. For its P4 project, the program utilized its existing practice affiliates to establish three rural training sites in several small communities in Henderson County – towns that contained either one or no stop lights. Each site embraces progressive patient-centered care and provides a unique rural experience. Hendersonville is currently in the last year of P4. The project has significantly impacted the program and has led it to try some rather dramatic practice flow changes, including changing its approach to the front desk and waiting room, forming care teams, and essentially adapting several portions of the patient experience. In 2010, the program created a new P4 training site in Flatrock, NC. In doing so, it took all of the best practices it had learned about practice redesign to create an extremely low-overhead environment. Flatrock has no
waiting room or front desk, operates with only one medical assistant and one provider, yet also offers most of the conveniences of a modern suburban practice. Flatrock patients schedule their own appointments online, complete their profiles electronically and have access to such things as e-visits, group visits and even telemedicine. This site is a great example of a small rural location providing Hendersonville residents with full-scope training. And similar to Hendersonville’s main outpatient clinic, Flatrock also houses to some unique community health programs. A Bright Future
The future looks bright for Hendersonville. The program is currently looking to expand it collaborative relationships, enhance its training curriculum, and continue to impact Henderson County and the region with its community health leadership. The program also recently attained Level 3 PCMH recognition by NCQA and has even begun exploring some unique working relationships with Blue Ridge Community Health Center.