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THE NORTH CAROLINA

Volume 9 Issue 2 / Spring 2013

quarterly news in north carolina family medicine

Legislative Advocacy -

Contributing & Participating Helps Our Academy Help You!!

Spring 2013 • The NC Family Physician

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2012-2013 NCAFP Board of Directors Executive Officers President Shannon B. Dowler, MD President-Elect William A. Dennis, MD Vice President Thomas R. White, MD Secretary/Treasurer Rhett L. Brown, MD Board Chair Brian R. Forrest, MD Past President (w/voting privileges) Richard Lord, Jr., MD 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 - Janice E. Huff, MD District 6 - Alisa C. Nance, MD District 7 - David A. Rinehart, MD At-Large Holly Biola, MD At-Large Charles W. Rhodes, MD IMG Physicians Joseph P. Pye, MD Minority Physicians Benjamin F. Simmons, MD New Physicians Jennifer L. Mullendore, MD NC Family Medicine Departments Michael L. Coates, MD Family Medicine Residency Directors William A. Hensel, MD Resident Director Mo Shahsahebi, MD (Duke) Resident Director-Elect Aaron George, DO (Duke)

~Don’t Miss a Great Meeting ~

2013 Mid-Summer

Family Medicine Digest

See page 19

June 30th - July 6, 2013 Myrtle Beach, SC

Student Director Katy Kirk (ECU) Student Director-Elect Julie Barrett (ECU)

FM Department Chairs & Alternates 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

Robert L. Rich, Jr., MD, Chair William 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 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:

Legislative Advocacy -

Contributing & Participating Helps Our Academy Help You!! See Page 4

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

..,

PAC Contributions and Participation Helps Our Academy Help You............................ 4

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

An HMO-Managed Medicaid Program Would Bring Huge Changes.............................. 5 2012 NCAFP Annual Report........................................................................................ 12 Don’t Miss a Great Summer Meeting in Myrtle Beach.................................................. 19 Scholars Program Helping Medical Schools Attract Great Speakers .......................... 21

President’s Message............................................... 4 Residents & New FPs.............................................................. 9 Policy & Advocacy..................................................... 5 Executive’s Message................................................... 7

Meetings & Education......................................................... 19 Student Interest.................................................................... 19 In-Practice............................................................................ 23


PRESIDENT’S MESSAGE

Contributing and Participating Helps Our Academy Help You - Join Us Today! By Shannon B. Dowler, MD 2012-2013 NCAFP President

Since I am already almost halfway through my presidential year, I guess it’s safe for me to come clean and make a startling confession. I’m not proud of it, but it’s true. Even though I joined the Academy in the first year of medical school in (eegads, really?) 1995, I didn’t contribute to our PAC until the last few years. Yes, that’s right, well over a decade of membership before I figured out this was something I needed to do and then it was because I was joining the executive committee and the peer pressure and shame pushed me over the edge. There were always other things to spend money on, right? Diapers, wine, running shoes, tithing at church. Those are more important than politics, right? And political contributions aren’t even tax deductible! What took me over a decade to sort out was that even though sometimes it feels decidedly uncomfortable, the truth is, to have a seat at the table in this world of politics we simply have to make our PACs a priority. More than once every year, topics at the heart of Family Medicine are a feast on the table. What I have witnessed over and over again, is that by having a strong PAC we are

working for and helping not only our specialty in bill at times? Imagine if you were a contractor by medicine, but more importantly the many people trade, having to decide on scope-of-practice issues in North Carolina who depend on us to guard and or funding for mental health services. Truly, it would protect their health. And this is now more true than be like asking me to weigh in on whether brass ever with a threat of outside managed care HMO’s plumbing was safer than plastic (brass monkey, taking over our state’s Medicaid program. Such a chunky, that funky monkey…..sorry, I got move would be bad for patients, physicians and our distracted…the Beastie Boys are infinitely more state’s healthcare infrastructure in general. interesting to me than plumbing. See what I mean?) While it In our current is true that legislature, there is “Having the ear of your local politicians spend a neurosurgeon and an inordinate a physician assistant legislator is a good investment and amount of time and the rest of the may mean the difference of being at seeking funds to 168 Senators and the table, versus being servedup as support their Representatives future campaigns are decidedly not the main course. “ (and this gives medically trained. They propose, defend and vote on bills that often them a bad rep), it is also true that they carve out the entail multiple levels of medical complexity that time to meet with our colleagues when we present those of us in the trenches of Family Medicine ourselves to them. They listen, they question, have to read-up on before we take a stand. How they make genuine efforts to hear and understand in the world can those without the insight into the perspective of the family physician. Granted, the practice of medicine sort it out? How can they sometimes they vote with their party regardless of even hold their concentration to read the entire See ‘Help Us Help You’ on Back Cover

FAMPAC Empowering Family Medicine in North Carolina

Why Support Your PAC? FAMPAC contributions support legislators whose business, legal, and medical philosophy is consistent with those of the NCAFP and Family Medicine. Our specialty’s interests are more likely to receive greater attention among the many competing interests and proposals under consideration.

Contribute Today at www.ncafp.com/fampac

4 Spring 2013 • The NC Family Physician

www.ncafp.com/ncfp


ADVOCACY & POLICY

An HMO-Managed Medicaid Progam Would Bring Huge Changes to Practice and Payment Academy Voicing Major Concerns to State Legislators By Robert L. Rich, Jr, MD NCAFP Advocacy Council Chair Welcome to your spring 2013 Advocacy report. Normally I report the status of multiple issues which are important to our members and the efforts of your Academy to address those issues. This time, I have chosen to focus on one: the recently announced proposal by the Governor to privatize the North Carolina Medicaid program and its impact on Community Care of North Carolina (CCNC), our innovative program to better manage the care of our Medicaid patients which, quite frankly, is governed by you and me, the doctors of North Carolina. The Governor’s proposal would turn all aspects of the state’s Medicaid program over to three or four contracted managed care companies (“Comprehensive Care Entities”, CCE’s) that would be responsible for administering care for the Medicaid patient, including mental health care, long term care, provision of durable medical equipment, and home care services. I mention the latter four services as those are ones that CCNC has lobbied to manage in order to produce savings similar to those already being produced for outpatient services and hospital care. As proposed, in order to convert the current system and bring in those CCE’s, the state legislature would need to approve an application to the federal government for a waiver. The waiver would then be submitted to Washington for approval by the appropriate agencies and, once approved, a request for proposals (RFP) then would announced by the state. Managed care companies would then submit their respective RFP’s to the state to run the Medicaid program. As envisioned by the Governor, the entire process would be completed in time for the CCE’s to be up and running by July, 2015. At that point patients (through a yetto-be-defined process) would be assigned to one of these companies who would administer their entire care. All of the chosen CCE’s would reportedly be available in all 100 counties and each would not be allowed to “cherry pick” patients they would cover. The participation of CCNC in this process has yet to be determined, although the Governor’s Secretary of the Department of Health and Human Services (DHHS), Dr. Aldona Wos and the current Medicaid Director, Carol Steckel, have expressed a desire for

CCNC to become one of the CCE’s. For that to happen, CCNC would have to acquire significant capitalization that it currently does not have. With that background, what are our concerns and how do we envision it affecting you and your office? First, contracting with outside CCE’s (managed care companies) would remove the hallmark of CCNC, namely local supervision and management by North Carolina-based providers that are part of that region and have a unique understanding of the local resources and problems. They would be replaced by managers, both provider and nonproviders, who would reside in other states and not have a firsthand understanding of the practice concerns of North Carolina. Those same individuals

would be making the decisions regarding the care approved for your patients. Next would be the additional credentialing requirements to serve patients in three or four managed care networks, all of which you previously care for under the current Medicaid plan. You and your staff would now need to have knowledge of the various formulary/ diagnostic imaging requirements/ referral network limitations/procedural approval requirements unique to three or more CCE’s as compared to the ONE current Medicaid system. While the system is not perfect, most office staff will tell you that CCNC and the current Medicaid system is much more straightforward for navigating the above areas compared to many of the private See ‘Medicaid Privatization’ on Back Cover

Sign The ncaFP Petition!

ACT NOW Sign Our Petition Supporting Greater Physician Involvement in Medicaid Reform!!!

Spring 2013 • The NC Family Physician

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EXECUTIVE’S MESSAGE

65 Years of Progress in Family Medicine By Gregory K. Griggs, MPA, CAE Executive Vice President

Sixty-five years ago, a few “country doctors” came together to form the NC Chapter of the Academy of General Practice. Since that fateful day in April of 1948, your organization has continued to work to help you take care of your patients, the people of North Carolina. Much has changed since that time in the late 1940s, but some things have not. Most importantly, I believe our members continue to offer the best care possible to the people of our state forming our healthcare system’s foundation. I sometimes wonder what those few physicians who started the organization would think of the NC Academy of Family Physicians today. I certainly hope they would be proud. This organization stands on the shoulders of giants. Just the past presidents I know (both those who have put up with me while I have been your Chapter Executive and those who were President long before my arrival but still remain involved) are exceptional individuals. The accomplishments these men and women have made could fill volumes. But they never lost sight of why they became family physicians in the first place: to serve their patients. Just recently, I had the pleasure to talk to one of our past presidents who is now 82 years old. He happened to live in a district represented by a member of the General Assembly on a key healthcare committee. He was glad to hear from me and was thrilled to make a call to the representative in support of the Academy’s position. Even in retirement, he was still willing to serve his organization. Now that is where all of you, our members, come into the picture. The NCAFP is only as powerful as the collective voice of our members. Each of you must be willing to step up and serve, even if it’s only in a small way. You have an excellent staff at NCAFP headquarters, but what makes a difference is the commitment of our members. You don’t necessarily have to be on the Board, but you can be on a committee (Council) and serve in so many other ways. You may be asked to make a call, give a presentation or simply give us your opinion. Most importantly, I ask that you step up and act when we are dealing with important issues at the General

Assembly. Your voice is powerful. It’s amazing how much an elected official will listen to their local family doctor. We are facing extremely critical times and the majority of the members of the General Assembly have been in office only one or two terms. They don’t always know who to turn to, but they certainly respect the voice of the family physicians in their community. Whether the General Assembly is considering significant changes in Medicaid, changes in scope of

practice laws or state funding for tobacco cessation efforts, we need your help in making our collective voice heard. That voice can be extremely powerful, but only through the strength of our 3,300 combined members. So next time you get an e-mail from the Academy, make the call, write a letter or even go see your local elected official. We’ll help you with the messaging, but it’s up to you to make the contact. Keep the voice of family medicine strong, Take Action!

NCAFP Acts to Preserve Physician-Driven Medicaid Program In early April, Governor Pat McCrory and physicians, not out-of-state, profit-driven managed DHHS Secretary Aldonna Wos announced care companies. a plan to turn over Medicaid to three or four While we know that Medicaid is not perfect, we outside managed care want to make sure we preserve organization, what works, and that is the effectively taking physician-driven leadership of Medicaid out of the CCNC. hands of physicians We’ll continue to offer and other healthcare talking points for members providers and the awardon our own website (www. winning Community ncafp.com), but we also Care of North Carolina encourage you to visit www. program. ourNChealthcare.com and The Academy sign the petition asking for has spoken and NC solutions from NC spoken loudly. We’ve Physicians. Please have your Sign The Petition Today! encouraged our members patients and other community to call legislators and leaders go to the website and write letters to the editor. We’ve mobilized sign the petition as well. members to attend key meetings and to meet While the change is about Medicaid, we believe with administrators in the Department of outside managed care could greatly damage our Health and Human Services. And we’ve even overall healthcare system in NC, particularly the begun a targeted statewide media campaign, robust primary care infrastructure we’ve worked so including working with the state’s leading hard to build. We’ve simply can’t let this proposal public policy television show, NC Spin. tear down a system so integral to the care of your We’ve also created a new public “micro” patients. web-site addressing the issue at www. So make your voice heard and that of others in ourNChealthcare.com. We’re asking the state your community, visit www.ourNChealthcare.com to build on our solutions from our state’s and sign the petition today. Spring 2013 • The NC Family Physician

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RESIDENTS & NEW FPs

in powerful and actionable ways that have not been previously possible. Imagine these tools in the hands of our best and brightest young minds, learning to integrate them directly into practice from the outset of their careers. This all adds up to a more advanced training environment; one far more capable of developing the physician workforce North Carolina needs for tomorrow. Current proposals in our state legislature for Medicaid managed care threaten to weaken CCNC and, as a result, family medicine residency training. As several other states take steps to move toward a CCNC-like model, it is shocking that we are considering moving away from it. It is uncertain that managed care companies, particularly those from out of state, will continue to invest in PCMH, community development and data innovation in North Carolina. This may reduce our state’s ability to attract top medical students to our primary care residency programs - and worse, may result in our graduating residents looking to practice elsewhere. Recent discussions in health care echo profound calls for innovation at every level of the medical world. But how can we drive such innovation unless

~ R e s i d e n t Pe r s p e c t i v e ~

Community Care is an Innovative Partner in Residency Training By Mo Shahsahebi MD, MBA, NCAFP Resident Director Aaron George, DO, NCAFP Resident Director-Elect

While Community Care of North Carolina (CCNC) has been recognized on the state and national level for the benefits to patients and providers, its impact on family medicine residency education has been underreported. CCNC is an innovative partner in residency training in North Carolina and offers a unique opportunity for family medicine trainees to impact patient care with a next-generation approach. Traditionally, residents have been limited by lack of time, resources and networks to pursue forward-thinking avenues of care. Fortunately for residents in our state, CCNC provides unique opportunities to learn in a cuttingedge environment and care delivery model. With recent discussions on the privatization of Medicaid in North Carolina, we must be concerned for both the future of CCNC and the continuation of the competitive advantage it creates in family medicine education. CCNC has long served as an unrecognized driver for factors that have attracted top medical students to North Carolina residencies. Recent changes to core competencies, a renewed 100th anniversary to the Flexner report, as well as the various transformational teaching grants confirm that medical education is heading in new directions. The academic medical model is gradually evolving in step with our care systems, and medical students across the country are demanding new skills to meet the population-level demands in their communities. At a recent national Family Medicine Congressional Conference in Washington, DC, keynote speaker, Matt Burke, MD offered, “Medical students interested in family medicine should get to North Carolina, in any way possible. They are doing things the right way with CCNC and these training opportunities simply are not available anywhere else.” Today, all family medicine programs across our state train their residents in patient-centered medical homes (PCMH). Leveraging interdisciplinary, team-based care combined with robust complex care management programs, these PCMH-based residency programs train our future generation of family physicians. These function to provide

8 Spring 2013 • The NC Family Physician

outstanding patient care as well as serve for leaders and facilitators in a new age of medical care delivery. Imparting these skills at this crucial period of medical education is integral to the transformation of the family doctor from the sole provider of services to the team leader we need for tomorrow. This would not be possible without the strong leadership, unique blended payment model, practice enhancement tools and incentives CCNC provides. These are components of medical training that many residents in other states are simply missing. CCNC is an innovative partner in As we strive to learn and understand our local residency training in North Carolina and communities throughout offers a unique opportunity for family our training, many of us in medicine trainees to impact patient care residency do not have the opportunity to appreciate the with a next-generation approach. powerful role that each of our local CCNC networks play in cultivating and sustaining community-based resources. The decentralized we are purposefully training innovators? North structure of Community Care gives local providers Carolina offers a unique opportunity to prepare our the ability to mold the care provided to fit the trainees to respond to these challenges. CCNC is a needs and resources of each community in a unique pioneering driver of care delivery with a physician-led way. Though this all happens behind the scenes of model that is respected and promoted on a national daily resident life, it profoundly impacts the lives level. The mission and vision of CCNC aligns of the patients we serve and our ability to serve perfectly with the goals of primary care providers in them. Ultimately, it is fellow local physicians, not creating a well-coordinated, high quality care system bureaucrats or politicians that guide the practice for our patients. We simply cannot afford to let this patterns which will be instilled upon and carried invaluable asset to North Carolina be dismantled in forward by our family medicine trainees. favor of another attempt at managed care. The combination of all of these factors has made The time to act is NOW. The family physician North Carolina one of the most attractive primary has a long, rich tradition of serving in a leadership care practice and training environments in the role in our communities. There is tremendous country. Improved primary care access combined need to educate ourselves, our colleagues and our with enhanced care coordination and quality have patients about the risks to medical education the saved the state hundreds of millions of dollars. state is facing. We must reach out to legislators and New innovations such as the physician portal community leaders to highlight the valuable role (portal.n3cn.org) and new geomapping tool (www. CCNC plays in shaping the future primary care communitycarenc.org/nc-hip) now allow physicians workforce within our state. access to a wealth of expanded data and have the potential to transform our residency programs to teach new competencies, such as medical informatics,

www.ncafp.com/ncfp


Our Residencies: CMC-NorthEast / Cabarrus Family Medicine Residency

O

ne of the million dollar questions in residency education today is how best to train family physicians for the everincreasing variety of demands they will face in community practice. With family physicians serving more clinicallydemanding patients in environments as varied as solo practices to community health centers, it is a huge challenge. 

The Cabarrus Family Medicine Residency (CFMR) headquartered in Concord, NC, recognized these types of challenges more than 18 years ago. The residency is the ‘brainchild’ of Dr. Allen Dobson, who teamed up with Dr. Charles Rhodes, Dr. Mark Robinson, and Lynn Hawkins, to create a family medicine residency from scratch. The immediate driving force for creating the program was a local crisis in access for care. To best address this and future challenges, the team created a communitybased decentralized training program that can serve as a model for family medicine residencies far and wide. “We knew if we could get more family physicians into our local community, we knew health care access would improve. Training residents in the community was an ideal solution,” noted Dr. Charles Rhodes. From its beginnings in 1996, Cabarrus Family Medicine set out to approach outpatient training differently.  Program leaders envisioned improving the resident training experience by creating a model that better approximated the community practice environment its trainees would enter upon graduation.  The program launched using 4 outpatient clinics designed to operate as traditional community-based family medicine practices.  Each clinic delivered a common basket of services but also doubled as a community training site for Cabarrus Family Medicine residents.  This innovative ‘residency-within-a-practice’ model brought residents directly into the community. “Cabarrus is unique as a family medicine residency in that we’ve embedded our training program into four fully-operative community practices.  It’s a different approach that offers a lot of unique training opportunities,” noted Dr. Mark Robinson, the current Residency Program Director. Each of Cabarrus’ four outpatient sites consist of a team of 6 residents and 7 to 8 family physicians and advanced care practitioners (ACPs).  All clinics are fully-computerized PCMH Level III medical homes and provide a robust complement of diagnostic and lab support services.  Behavioralists, nutritionists and PharmDs at each location combine to create a whole-person oriented approach to patient care. “On Day 1 after graduation, our residents are uniquely prepared as community physicians because their training environment has mimicked what they’ll see and experience,” noted Dr. Robinson. Dr. Robinson went on to describe how Cabarrus’ ‘residency-in-apractice’ approach helps residents develop skills in a host of areas related to clinical care, including practice management, customer service and even practice finance as they come to grips with the financial expectations common today. The  four sites draw patients from a four-county catchment area Cabarrus, Mecklenburg, Stanly, and Rowan Counties - and generate over 130 thousand patient encounters annually.  Serving this varied patient population, Cabarrus’ family physician faculty work directly See ‘Cabarrus’ on p. 22 Spring 2013 • The NC Family Physician

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M EE T I N G S & E D U C A TI O N

30+

AAFP Prescribed Credits

Don’t Miss A Great Summer Meeting in Myrtle Beach!!! Sunday, June 30 – Saturday, July 6, 2013 at the Embassy Suites Hotel - Kingston Plantation in Myrtle Beach, SC Program Chair Thomas R. White, MD & David Rinehart, MD, Program Co-Chair

www.ncafp.com/msfmd GO’IN GREEN!! All Mid-Summer Meeting syallabus and educational materials will be provided as a download.

Make plans to join us at the Embassy Suites Hotel at Kingston Plantation in Myrtle Beach, South Carolina, for the NCAFP’s 2013 Mid-Summer Family Medicine Digest, Sunday, June 30 through Saturday, July 6th, 2013. Program Chair Thomas R. White, MD, and Co-Chair David Rinehart, MD, have a terrific program planned featuring a variety of timely and relevant topics. Attendees can capture 30+ AAFP Prescribed Credits and enjoy a great time at the beach. As an added benefit, the conference features convenient half-day sessions that leave your afternoons open for family, fun and recreation. The Mid-Summer meeting will present an excellent line-up of General Session lectures covering topics such as Type II Diabetes, Lipids, Osteoporosis, Hypertension, COPD, and many more. Conference attendees can also take advantage of a number of optional workshops and two SAMs study working groups. SAMs topics include ‘Mental Health in The Community (Friday, July 5th) and Heart Failure (Saturday, July 6th). Arrive early and take advantage of Pre-Conference CME workshops on Sunday, June 30th. Register now for “Coding ICD-10”, scheduled from 3pm to 5pm and “Going Forward: Tools & Tips You Didn’t Learn in Training: A GO! Diabetes Master Class Workshop” from 5pm to 8pm. See the registration for fees. Check

the NCAFP website (www.ncafp.com/msfmd) for the most up-to-date schedule of topics and speakers. General Sessions begin on Monday, July 1st, and conclude on Thursday, July 4th. On Friday and Saturday, attendees can attend two half-day seminars focused on sports medicine that are being presented as part of the NCAFP/NCMS Sports Medicine Committee’s 2013 Sports Medicine Symposium. Additional information on the 2013 Sports Medicine Symposium can be found at www. ncafp.com/symposium . Similar to its last few educational conferences, the NCAFP is ‘Going Green’ this year for the MidSummer meeting. This environmentally-friendly initiative saves on natural resources and makes learning materials convenient to access by your personal computer, tablet or cell phone. Please note, this means conference attendees will NOT receive a complimentary printed general session syllabus. Instead, each registered attendee will receive electronic access to all educational materials. Registered participants will 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. These online materials will be available for 90-days after the program. Printed paper copies of general session lectures and conference materials may be purchased in advance for $30, and handouts for the Sports Medicine Seminars (Friday and Saturday), the SAMs Study Working Groups and the Optional

CME Workshops will be provided at no charge. Please be sure to purchase and reserve your paper syllabus when you register. There will be limited copies available for purchase on site.

Hotel Accommodations 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, June 29 through Saturday July 6, 2013 are $235 per night plus tax. A variety of Condos and Villas are also available and range in price from $235 to $429 per night depending on size and location. 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. Complete 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, 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.

Spring 2013 • The NC Family Physician

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STUDENT INTEREST INITIATIVES Family Medicine Interest and Scholars Program

Class of 2016 Family Medicine Scholars Selected The NCAFP Foundation recently announced the selection of the Family Medicine Scholars from the class of 2016. These student scholars are the fourth and final group to participate in the Family Medicine Interest and Scholars Program as it is currently designed. This unique initiative jointly supported by the Blue Cross and Blue Shield of North Carolina Foundation and the NCAFP Foundation was first implemented in 2010 and since that time the interest in this program has continued to grow and the field of applicants become even more 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. Each student will begin their experience this summer with a 4-week externship with their Preceptor. Congratulations to the following selected Family Medicine Scholars: Brody School of Medicine at East Carolina:

Elizabeth Cherveny, Jered Cope Meyers, Shannon Hicks, Yoon Hie Kim and Nyira Muhirwa

Duke University School of Medicine: Jessica Friedman and Denise Pong

University of North Carolina School of Medicine: Robyn Levine and Liza Rathbun

Wake Forest University School of Medicine: Elizabeth Crowder, Christian Jasper and Virginia Kee

In related news, ten of the twelve original students selected as Family Medicine Scholars in 2010 participated in the MATCH in March. Five selected Family Medicine as their specialty of choice while three others are helping to fill primary care or other areas of need in NC: Psychiatry, Med-Peds and Obstetrics. In addition to the Scholars component of this program, the Interest component continues to impact students as well. Membership is at an alltime high with 569 total student members at this writing. Over 100 students attended the Annual Meeting in December and student interest in Advocacy and other Academy activities is on the rise as well.

2013 Family Medicine Day Saturday, May 18, 2013 Raleigh Hotel Brownstone - Raleigh, NC

Saturday, May 18th, 2013 Raleigh Brownstone Hotel

Scholars Program Helping Medical Schools Present Great Family Medicine Speakers Recently three North Carolina medical schools were able to take advantage of additional support provided by the Academy’s Family Medicine Interest & Scholars Program to bring national-level speakers to their campuses for banquets or other activities. AAFP President-Elect Dr. Reid Blackwelder visited Duke University in late March for their annual FMIG banquet. In writing about his visit, Dr. Blackwelder praised the school, its students and shared an important message, What we have been doing for many years is critical to the creation of a true health care system in this country. It has been, and continues to, be difficult at times. People don’t always understand what we do. However, for the first time, people in power are talking about primary care and the patient-centered medical home. Even if they don’t fully understand what those terms mean, it is a start. In late April Dr. David Buck visited UNC’s campus and over the course of two days his time was filled with small group opportunities and encounters with student leaders. He shared with them his path to becoming a family physician and how that path, his passion for public health, and his vision, led him to create Healthcare for the Homeless – Houston. During a lunch session that was attended by students, residents and faculty Dr. Buck spoke of the Triple Aim (Improving the patient experience of care; improving the health of populations; and reducing the per capita cost of healthcare) and Healthcare for the Homeless. Also in late April, NCAFP President, Dr. Shannon Dowler delivered the message to Brody School of Medicine students, residents, physician preceptors and faculty at their annual FMIG Graduation Banquet. Dr. Dowler spoke of the lessons she has learned along the way: ...at the end of the day, be Positive. Laugh. Take chances. Keep an open mind. Ask for help. Play the game. Continually improve. Be humble. Listen. Teach. In closing she also quoted her friend Aimee, who delivered her invocation in December: “We celebrate the complexity of what it means to be a “family physician” and your dedicated pursuit as detective, counselor, scientist, biographer, listener, judge, technician, advisor, educator, researcher and healer. May we all be blessed by our callings born from a God who provides the way, may we be blessed by what we give away and may the God who loves giving bless us today.”

Externship Program Gears up for Summer The NCAFP Foundation was able to offer numerous Externship experiences to students for the coming summer. In addition, through a partnership with MAHEC Hendersonville, one of North Carolina’s rural track residency programs, another 10 students will participate in the exciting Rural Health Experience program. This is the second year it has been offered to students and interest continues to grow. Students in all programs are in the process of being matched with a preceptor for their summer experience.

Workshops • Recruiting • Networking www.ncafpcom/fmd

Spring 2013 • The NC Family Physician

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CABBARUS continued from p. 9 alongside resident physicians in the office and at the hospital. “With our model of care, our faculty remain actively engaged in day-to-day patient care such that they’re closer to what the residents are experiencing and are better able to help them,” noted Dr. Erika Steinbacher.  Steinbacher went on to highlight how this helps in mentoring, team building and overall clinical care. The residents are treated as junior partners by faculty and staff in a true apprenticeship model. The Center of a Tight-Knit Medical Community Cabarrus Residency Director Mark Robinson, MD.

Cabarrus Family Medicine Residency is situated in the virtual center of a close-knit medical community in Cabarrus County. CMC-NorthEast, the program’s primary in-patient site and the county’s only hospital, serves as a referral hub for patients and area physicians.  Drawing from a large catchment area, CMC-NorthEast provides widely varied complex clinical experiences to trainees of many types of stages. Cabarrus Family Medicine residents operate unopposed at CMC-NorthEast and staff a busy in-patient family medicine service that accounts for more than 30% of all hospital admissions.  As the only residents at CMC-NE, Cabarrus residents have the opportunity to work side-by-side with attendings from a range of specialties and helps them to create connections within the medical community.  “There’s definitely not the common hierarchy of the attending and the resident here.  It’s more like ‘we are your colleagues,’ noted Mary Catherine Moree, MD, a third-year resident who will graduate next month.   She went on to describe how residents are routinely involved in complex cases and often asked for direct clinical input.  “It feels like an equal playing field and helps you learn and feel part of the community.” In addition to direct patient care, Cabarrus Family Medicine physicians and advanced care practitioners are often key leaders in important community health initiatives and participate in everything from the local Chamber, to the hospital’s executive committees and key medical staff leadership positions, including CMC-NE’s Chief of the Medical Staff.  Residents are encouraged to participate in these types efforts as time allows, including volunteering at the local free clinic, joining the practice’s annual mission trip to the Dominican Republic, or even assisting Cabarrus Family Medicine’s sports medicine physicians at the area’s local high schools. It’s all designed to instill residents with a strong sense of community and the importance of giving back.  Blessed with access to remarkable facilities, including the Copperfield Room, CFMR is hosting the two year I3 Population Collaborative. This event brings together 23 family medicine residency programs from the Carolinas and Virginia to discuss ways to improve quality of care, patient experience, and population health.  As part of the event, second-year Cabarrus residents presented their work they are doing regarding improving the overall patient clinical experience. Events like these demonstrate how Cabarrus works to engage its residents in its important health initiatives with the added benefit of showing them how it all comes together - from planning, research, to implementation.  Cabarrus residents are plugged-in, build key relationships in the medical community and carry both with them into community practice.

Committed to Building a Healthcare Foundation

In addition to its Concord clinic (pictured on p.9), the Cabarrus residency program operates three additional outpatient sites in Kannapolis (top), Harrisburg, and Mt. Pleasant. All in-patient training takes place at CMC NorthEast Medical Center, a 475-bed community hospital.

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Cabarrus’ goal is to build the foundation of its local region’s healthcare system, and, by extension, to impact every community where its graduates practice. So who is the Cabarrus Family Medicine Residency Program looking for when they recruit new residents? “We want conscientious residents who do the right thing even when no one’s looking,” Dr. Robinson shared. “We want to produce personal physicians who want to commit to high quality individualized care of patients and their families. My sound byte for Family Medicine is that it is ‘care for a lifetime’, Dr. Robinson added. Building a strong healthcare foundation requires a comprehensive approach and the commitment of a large team of talented people, including clinical and clerical staff, administration, advanced care practitioners, physicians, and more.  Cabarrus Family Medicine is making steady progress and it is primarily due to its key desire to serve the community. CFM residents and their relationship with the medical community help move this forward as well. “We are a vibrant community residency program in every way and so are our graduates,” noted Dr. Robinson.  He went on to describe how the program’s graduates practice in a wide range of roles today, from rural solo practice to community health centers, and even to academia. CFMR is building the foundation of a better health care system, one resident at a time. www.ncafp.com/ncfp


in - practice Academy is a Key Sponsor in New Statewide Health Education Initiative, ‘A Healthier NC’ The NCAFP is a leading sponsor of a new program that’s encouraging 1 million North Carolinians to be active for 15 million hours and to lose 10 million pounds. Officially unveiled at a press conference in mid-April, the ‘A Healthier NC’ campaign and challenge is an initiative that provides participants with free health journaling tools and access to a clearinghouse of North Carolina health resources and educational materials at its website, http://www.ahealthiernc.com. Initiated by Raleigh-based NC SPIN, the Academy is helping to sponsor the effort alongside other partners that include the N.C. Medical Society, N.C. DHHS Office of Rural Health and Community Care, the AARP’s Decide.Create.Share campaign, and Blue Cross and Blue Shield of N.C. The idea for the initiative arose out of concern for the state’s low rankings in reports that measure health on the national and state level. In addition to health resources, the program’s website is designed to facilitate group participation in the “A Healthier NC Challenge” that is promoting physical activity and weight loss. Academy members are being encouraged to participate in the program and to promote it within their practices. For complete information and to sign up for the challenge, visit http://www.ahealthiernc.com

Practices Must Complete Multiple Steps by July 1st for New State Medicaid Billing System Non-Complying Providers will Be Unable to Bill As part of the NC DMA’s upcoming roll-out and launch of its new Medicaid billing and patient information management system (NC Tracks), all current Medicaid providers must complete a series of steps to ensure successful migration to the new system. Providers not doing so will be unable to bill for Medicaid services after June 30th or be allowed to take advantage of the many patient coordination services the new system affords. Several training opportunities

are available that describe this process, review the new system, and outline what practices need to complete. Instructor-led Training (ILT) will be held in five locations across North Carolina through June 20, 2013. Detailed instructions for “How to Register for Training”, as well as an NC Tracks Training Tool Kit (including the ILT schedule) are available on the OMMISS Communication website at http:// ncmmis.ncdhhs.gov/communication.asp. Please don’t delay!

Attestation Required for Enhanced Medicaid Payment The Affordable Care Act (ACA) increased the Medicaid payment rate on certain primary care services for qualified providers to 100% of Medicare during calendar years 2013 and 2014. To take advantage of these enhanced payments, physicians and practices must attest that they qualify. Complete information on qualifying, as well as DMA’s online attestation system can be found at http://www.ncdhhs.gov/dma/provider/aca_home.html

Family Medicine Charlotte Metro Area

CAROMONT HELSTH CaroMont Health

Gaston Memorial Hospital | CaroMont Medical Group | CaroMont Specialty Surgery | CLiC | Gaston Hospice | Courtland

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. 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 Spring 2013 • The NC Family Physician

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HELP US HELP YOU continued from p. 4

what is right. Sometimes they intentionally choose the side we are not on. I suspect, sometimes, they have no idea what they voted on at all. Regardless, it is often our input that can be pivotal in the decisions they ultimately render. Having the ear of your local legislator is a good investment and may mean the difference of being at the table, versus being served up as the main course. The truth of the matter is, in the house of medicine, some of our specialty colleagues give incredibly generously to their PACs which in turn gives them a leg up on us in primary care as we advocate for our patients. For instance, compared with the $23,000 that family physicians gave to their PAC during the last two-year election cycle, the Anesthesiology PACs raised $412,000. Of course most specialists make more than family doctors and have a relatively larger pie to serve from, but the fact is, they prioritize their PAC and that translates into action and political capital. Let me give you a few more examples: Dentists gave $182,000 to their PAC in the last two-year election cycle. Chiropractors gave $89,000. Auto Dealers gave $150,000. And the NC Advocates for Justice (formerly the NC Academy of Trial Lawyers) gave $473,000. Supporting our PAC is one situation where you have to be willing to put your personal political beliefs and agendas on the back burner and put trust in your board and executive committee that the funds donated to the PAC will be guided intentionally to go to support legislators who have the best interests of the family doctors and the health of the public at heart. Being a control freak myself,

MEDICAID PRIVATIZATION continued from p. 5

carriers and managed care organizations. While it is anticipated in the future that all providers will be asked to assume some risk for the care of their Medicaid patients, it is widely anticipated, based upon managed care organization efforts in other states to date, that provider income will be significantly at risk and subject to a reduction if managed care is implemented in North Carolina. Provider PMPM’s as well as various hospital incentive payments (particularly for Critical Access hospitals), would all be expected to disappear. Replacing those payments would be a system where you presumably are paid based upon strict fee-forservice or upon your patients reaching clinical goals such as diabetes/asthma/ hypertension/measures, such things as decreased ER utilization, etc. While laudable, basing a provider’s reimbursement on only these measures would lead to reimbursement reductions for those providers with a high burden of difficult to treat patients, such as in rural areas. The net effect, a reduction in pay for those caring for

one of the reasons I avoided giving to the PAC in the past was the lack of control I had on where the dollars went. But the truth is, you can get behind the wheel. In the next few paragraphs I am going to explain how you can fix that little problem and get some control!

White Coat Wednesday

May 22nd 2013 At every Academy meeting we have council meetings: Advocacy, CME, Health of the Public and Practice Enhancement. And at almost every meeting, without fail, we have the same familiar (if not delightful) faces of the faithful to help guide the decisions that are brought to the board for action. These are not closed meetings. These are not particularly stressful meetings. These are certainly not secret meetings. Make an effort to attend our council meetings the next time you attend one of our meetings. Get your voice heard. Raise tough questions. Put your topics of interest on the agenda and take control of what items are brought to the board. Another terrific way to get involved in the workings of the Academy is to attend our White Coat

those patients and reduction in provider acceptance of those patients when a provider can chose to opt out. Just as an example, in Florida, which has a number of managed care HMO plans, the average pay for healthcare providers seeing a Medicaid patient is about 56 percent of the Medicare fee schedule. With these and other effects slated to occur under the current proposal, what can a family physician do to change this process and preserve CCNC? Advocate! Reach out to your local Representative or Senator. Utilize the local contacts that we all have to our elected officials as our legislators and their family members all must seek health care at one time or another in our offices. Lobbyists are constantly in contact with our elected leaders but the individuals that they prefer to hear from are the citizens from their own districts, with messages on how their decisions are affecting the people back home. If you are not comfortable doing this or do not know what to say, the Academy staff can help you with messaging and have prepared talking points for you to use (these talking points are available on the NCAFP website.) Express support for CCNC in

Wednesdays. In February of this year, we had a great group of 10-12 family doctors and students who attended hearings on mental health funding, met individually with legislators, and worked together to help spread the message of the importance of CCNC in our state. This was a powerful day of advocacy. I would love for our next White Coat Wednesday on May 22nd, 2013 to turn out four or five times that number of docs. Yes, it means blocking your schedule, driving, getting behind on EMR and email for a few hours. However, I would argue that the time is well spent and as you leave the day you feel a renewed sense of connection to your specialty society colleagues, but also to those men and women who have been charged with the responsibility of setting our policy and laws in NC. Taking the time out of your schedules is a very generous gesture that is clearly recognized in the legislature. I don’t think I am being naïve when I say many of our legislators look forward to our visits and our insights into matters that affect the health of our state. In case I haven’t been clear, the charge I am making today is this: make a new habit of making it a priority to contribute to our PAC every year with consistency, involve yourself and your voice in the councils of our Academy, and take a day to join your colleagues in the legislature on White Coat Wednesdays. Whether student, resident or crusty old family doctor, each of us has stories to tell and knowledge to share that our lawmakers rely on to make good decisions for our state. When you do these things, you are not only doing them for our specialty but for the good people of our state. Consider this your formal invitation to a great date--- can’t wait to see you on May 22nd!

your messaging and if you have an example from your practice where some aspect of CCNC, such as the efforts of the care managers, made a difference in the lives of your patients, tell it to your legislator. If you accept Medicaid in your practice, the proposed changes to Medicaid WILL affect your practice on multiple levels and even if you are an employed physician, it will ultimately affect the reimbursement you receive as well as the requirements for seeing these patients. If you have contacts with the Governor or one of his staff members, do not hesitate to also reach out to them with our message. The Governor was elected with the support of many members of the medical community. And while we applaud many of his goals, we disagree with the roadmap he is taking on Medicaid. As opposed to out-of-state managed care bureaucrats, we believe North Carolina’s physicians are best equipped to continue to improve the care of North Carolina’s patients. We’ve worked together to take CCNC this far, and it’s the envy of the nation. Now is not the time to throw out what is working right in our state.

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