V9n4

THE NORTH CAROLINA

Volume 9 Issue 4 / Autumn 2013

quarterly news in north carolina family medicine

Overdose Prevention Ramps Up

North Carolina’s Project Lazarus —

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

2013

District 2 - Matthew M. Williams, MD District 3 - Scott E. Konopka, MD District 4 - Tamieka Howell, MD

WINTER

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

FAMILY PHYSICIANS WEEKEND

Dec. 5th-8th

IMG Physicians Joseph P. Pye, MD

Asheville, NC

Minority Physicians Benjamin F. Simmons, MD New Physicians Jennifer L. Mullendore, MD

NC’s Largest Family Medicine & Primary ~Don’t Miss a Great Meeting ~ Care Conference

2013 Mid-Summer

Family Medicine Digest See Details on page 11

See page 19

June 30th - July 6, 2013 Myrtle Beach, SC THE NORTH CAROLINA FAMILY PHYSICIAN • Autumn 2013

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) 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

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:

North Carolina’s Project Lazarus —

Overdose Prevention Ramps Up See page 16

THE NORTH CAROLINA

•

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

Inside

..,

Small Wins Help Offset Potentially Larger Losses in Changing Political Environment..... 4

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

Family Medicine Training in The Best of Both Worlds.................................................... 6 Unique Times Call for Bold Actions.............................................................................. 8 NC’s Capital Region a Hotbed of ACO Activity.......................................................... 14 CCNC’s Overdose Prevention Program is Saving Lives & Engaging Communities......... 16

President’s Message............................................... 4 Chapter Affairs....................................................................... 8 Residents & New FPs................................................. 6 Meetings & Eduation............................................................ 11 Executive’s Message................................................... 8

Practice Management............................................................ 14 Policy & Advocacy................................................................ 16 Student Interest.................................................................... 18

President’s Message

Dr. Shannon B. Dowler - President

Small Wins Helped to Offset Potentially Larger Losses in a Changing Political Environment This last installment of my Presidential Year is written at 30,000 feet from the flight that will deliver me to San Diego for the AAFP Congress of Delegates.

This is one of my last (planned) trips in what has been a phenomenally busy and enlightening year. By the time we meet again at the Winter Meeting, I will have travelled no less than 65 days for the Academy this year. I will have travelled to 7 different states, put 5,000 miles on my car, and well over 10,000

What I have come to realize as this year begins to wind down is how very small I am -- how small each of us is -- individually, yet how large and impacting we become when we stand together shoulder to shoulder. This has been an unprecedented year in health care in this country and it has certainly been an unprecedented year in politics in this state.

4

THE NORTH CAROLINA FAMILY PHYSICIAN • Autumn 2013

miles in the air. I will have attended board meetings, society and coalition meetings, graduations, hearings and summits. I will have spoken to state and national leaders, state senators and representatives, congressmen and women.

What I have come to realize as this year begins to wind down is how very small I am -- how small each of us is -individually, yet how large and impacting we become when we stand together shoulder to shoulder. This has been an unprecedented year in health care in this country and it has certainly been an unprecedented year in politics in this state. I wish I could say that things fell to our favor consistently, but there were many times when we realized we had to accept small victories to offset the larger losses in this rapidly changing, politically charged, healthcare environment.

In my address in December, I will touch on our wins and losses and deliver the State of the Academy address to all of you in attendance. For today, I want to remind each of you that while your individual strength in your practice and community is incredibly important, it is our impact as a physician community that drives the change. One of the most valuable lessons we learned this year was how important having an intentional presence at our state capitol is. Because of this, we have decided to expand our advocacy and lobbying staff in order to make sure family doctors and those we care for are given a chance to be represented as thoroughly as possible. Each of you also help the Academy represent your best interests with your individual advocacy

efforts. What we need at this time is to build our PAC. Even if 1 in 5 of us became regular “Fore Runners” (this is a $100 donation quarterly) we would be in a much better position to make a scratch in the surface of political equity!

I am honored to have been given the opportunity to represent you this year.

As I turn the crown and scepter over to my good friend and colleague, Dr. Bill Dennis, in December, I am grateful to have the opportunity to be surrounded by such excellent colleagues in medicine!

Dr. Dowler graduated from The Brody School of Medicine at East Carolina University in 1999 and completed her residency training in family medicine at the MAHEC Family Medicine Residency Program in Asheville. She is a Fellow of the American Academy of Family Physicians and has served on the NCAFP Board of Directors since 2003. She currently serves as Chief Medical Officer for Blue Ridge Community Health Services in Hendersonville. In addition to her clinical service, Dr. Dowler serves as a trustee on the Western North Carolina Medical Society Foundation, and is a member of the Physician Advisory Group, a clinical advisory board for North Carolina’s Medicaid program.

Most recently, Dr. Dowler also joined the Care Share Health Alliance’s Board of Directors.

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Residents & Chapter Affairs New Physicians ncafp.com/residents-newfps

CMC-Union Family Medicine

Residency Program Location:

Monroe, NC

Accreditation: ACGME

The CMC-Union Family Medicine Residency -

Family Medicine Training in The Best of Both Worlds

Approach:

Community-based 1+2 program using apprenticeship model.

Closely affiliated with CMC-Charlotte residency.

Positions:

(2) Annually

Inpatient:

CMC - Union Regional CMC - Charlotte

Outpatient:

Union Family Practice Union County HD

Web: http://www.carolinashealthcare.org/ cmc-union-family-medicine-education

MONROE, NC — If you drive southeast past Charlotte for about forty-five minutes, through Matthews and Indian Trail, you'll arrive in Monroe, North Carolina. As the fastest growing community in Union County, today's Monroe looks remarkably different than it did fifteen years ago.

Back in the year 2000, just three years after the family medicine residency program in Monroe was getting off the ground, the area maintained strong hints of its rural roots everywhere. At the time, the Union residency program located there was modeled to serve exactly the type of community that surrounded it.

Today, as Monroe has grown and changed, so has the Union Family Medicine Residency Program. It's aggressively adjusting to the continued growth of the area, the changing healthcare needs of its local region, and the changing face of what now resembles modern suburban/ small town outpatient primary care.

A Unique Suburban 1+2 Track

The Union Family Medicine Residency is known as a "1+2" track in training parlance. Closely affiliated with Carolinas Medical Center's downtown Charlotte (CMC) program, Union recruits two residents annually. Each Union resident completes their intern year in downtown Charlotte, then their second- and thirdyears in Monroe. Although both CMC and Union share much of the same training curriculum during the first year, they

6

THE NORTH CAROLINA FAMILY PHYSICIAN • Autumn 2013

Union Family Medicine Residency Program Director Dr. Vanessa McPherson, along with Associate Program Director Dr. Jennifer Fernandez.

diverge from there. In years two and three, Union trains its residents with a special focus on suburban and community medicine, while also incorporating some unique rural and underserved components as well. This combination of urban-suburban-rural training helps introduce Union residents to a wide spectrum of practice situations and prepares them for practice in growing suburban communities like Monroe, or even much larger areas like as Charlotte.

For residents in training, it's the best of both worlds!

Union's outpatient training approach is anchored in the apprenticeship model and uses a live community practice -Union Family Practice in Monroe -- as

its main outpatient clinic. Union Family Practice was founded in 1980 by two CMC Charlotte graduates, Drs. John Vick and James Trotter. The practice has steadily grown and is now comprised of six physicians, each who serve demanding dual roles as both full-time community physicians and as faculty to the program's trainees.

"Our apprenticeship model helps our residents learn a tremendous amount about real-world practice. From practice management to the diverse patient population they see, it's an excellent environment," noted Dr. Vanessa McPherson, Residency Program Director.

Union Family Practice is as equipped as See ‘Union Residency’ on back cover

TRACKS, TRENDS & UPDATES Dr. Aaron George Appointed as AAFP’s Resident Delegate to the AMA House

By Dr. Mo Shahsahebi, Resident Director &

Dr. Aaron George, Resident Director-Elect

North Carolina’s 2013 Residency Graduates Transition to Next Step 73.9% of Respondents Begin Their Medical Practice in North Carolina North Carolina continues to maintain a strong tradition of training and developing young family physicians. A survey of 69 of the state's most recent residency graduates indicates that our pipeline of family doctors remains strong and poised to help meet local primary care needs.

In 2013, the majority of North Carolina’s family medicine graduates chose to remain in the state. Meanwhile, many of those leaving the state did so to pursue fellowship opportunities.

Many of the goals and intentions of North Carolina's newest family doctors appear consistent with recent national trends. However, these recent graduates do demonstrate a greater likelihood to pursue larger scope and private practice settings, than do their national counterparts. Of those North Carolina graduates not pursuing fellowships, nearly a quarter will be starting their careers 8% with a hospital affiliated group (with OB) practice.

This compares with suggestions by the AAFP that upwards of 80% of young family doctors are employed physicians nationally1.

Though obstetrical practice is declining among family physicians nationally, one out of five of North Carolina’s family medicine graduates anticipate routinely delivering children and providing maternity care. One-quarter have chosen

to enhance their family medicine training through academic fellowship. Importantly, the overwhelming majority of graduates plan to continue their involvement with organized medicine through 26.1% AAFP, a testament to the value and benefits they perceive in the academy.

The fundamental goal of residency training is to both develop skilled clinicians and to meet the changing needs of our patient populations.

Based on the results of this data, it is evident that family medicine training in North Carolina (no OB) is working. We are retaining the majority of our graduates and they are likewise providing care to a spectrum of environments across the state. The NCAFP commitment to the state’s residents is certainly proving fruitful.

Family medicine training in North Carolina remains competitive and as interview season approaches, our residencies continues to attract quality applicants from across the nation.

NCAFP Resident Director-Elect Dr. Aaron George of the Duke University Family Medicine Residency Program has recently been appointed to serve as the AAFP’s Resident Delegate to the American Medical Association’s House of Delegates. In this role, Dr. George with represent the AAFP resident interests at the AMA-Resident & Fellow Section meetings and attend the Education Reference Committee of the AMA House of Delegates. He will also provide written and oral reports to the AAFP Commission on Education (COE). Congratulations to Dr. George on this honor!

Out of State

t 9% italis Hosp

Academic FM

21%

are C t en Urg

Full Scope 21%

In-State 73.9%

Full Scope 43%

1. Spogen, Dan. Shrinking Scope of Practice Raises Questions About Future of Family Medicine Training, published to the aafp Leader Voices blog on march 22, 2012. Can be accessed at http:// blogs.aafp.org/cfr/leadervoices/entry/shrinking_scope_of_practice_raises

Employment Survey:

FPs Top of Recruitment List for Seventh Straight Year For the seventh straight year, the demand for family physicians outpaced the demand for other specialists, according to the annual Merritt Hawkins survey (www.merritthawkins.com). The survey was based on more than 3,000 recruiting assignments conducted by the health care search and consulting firm between April 1, 2012, and March 31, 2013. The survey looked at medical specialties based on candidate population size and found that family medicine still is the “most requested and difficult search out there in terms of the sheer number of requests,” said Travis Singleton, senior vice president for Merritt Hawkins.

Resident Dues Now Due Please Don’t Delay Residents, your membership calendar is July – June, and dues are now due.

Please remember to check with your residency program coordinator to make sure your AAFP/NCAFP Resident dues have been paid. They may request another invoice from the AAFP by calling 1-800-274-2237 or sending an email to contactcenter@aafp.org.

~ NATIONAL ~

Chapter News & Affairs Executive’s Desk

ncafp.com/academy

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

Past President Mott Blair Announces Candidacy for AAFP Board Election will be held in 2014 in Washington, D.C.

Unique Times Call for Bold Actions NCAFP committing more resources to governmental affairs No one can deny that these are unprecedented times for healthcare – in our country and in our state. From implemtentation of the Affordable Care Act to the Governor’s proposal to reform Medicaid to scope of practice issues, family physicians in North Carolina and your Academy are faced with a growing array of public policy issues. But at the same time, it appears that the general public simply does not understand what makes a family physician special: from your training to the comprehensive, relationship-based care you provide to the continuity and coordination a family medicine office offers.

But unique times also bring great opportunities, and the NCAFP Board hopes to take full advantage of these opportunities. In early September, your Board voted to take bold action to make sure that you are truly represented in these unique circumstances, not left standing on the sidelines. The Board voted to use funds from the Academy’s healthy reserves to increase our Advocacy, branding and government affairs presence over the next 12 to 18 months. Through this move, the NCAFP will be putting more resources toward confronting these key issues than ever before.

In late October, Joanna Spruill, JD, will be joining the NCAFP as Director of

Government Affairs and General Counsel.

At the same time, we will retain the services of our long-time government affairs consultant, Peyton Maynard. Joanna completed her undergraduate studies in public policy at Duke University and completed her law degree at the University of North Carolina at Chapel Hill. Most recently, she has been clerking for a judge on the NC Court of Appeals.

Unique times truly do call for bold action. Just highlighting a few of the key issues the NCAFP has dealt Spruill with this year makes it abundantly clear that our members need us to advocate for them more than ever, particularly around payment reform and prompt payment. Here are just a few of the issues we have worked to address this year:

The NCAFP is proud to report that Past President Dr. Mott P. Blair, IV, (2003) of Wallace, NC, announced his candidacy for the AAFP Board of Directors. Chapter delegates made the announcement during AAFP’s Congress of Delegates in late September.

Dr. Blair has served the NCAFP as its senior delegate to the AAFP Congress for the past several years while maintaing an active role on the AAFP’s Commission on Health of the Public and Science. He served as a reference committee chair during this year’s AAFP Congress while in San Diego (pictured).

Dr. Blair is currently in practice with Vidant Family Medicine in Wallace.

Look for additional updates on Dr. Blair’s campaign in the coming months.

Medicaid Reform, including trying to place a primary care physician on the NC Medicaid Reform Advisory Group.

NCTracks, working to ensure that problems with Medicaid payments for family physicians get resolved in a timely manner.

See ‘Bold Actions’ on page 10

Family Medicine - Kings Mountain ***Large Multi-Year Retention Bonus***

CaroMont Health

There is an outstanding outpatient family medicine opportunity available in the small North Carolina community of Kings Mountain. This is an employed opportunity within CaroMont Medical Group and will offer a competitive compensation package including; two year salary guarantee, multi-year retention bonus, productivity bonus potential, engaged provider 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 450 active medical staff representing all major medical specialties at CaroMont Regional Medical Center, a modern and progressive 435-bed hospital which provides comprehensive care to patient base of over 300,000. This lovely community has 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, this community and the surrounding 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 click on the link below: http://www.caromonthealth. org/careersphysicianprovider/

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To find out more or schedule a demo of our Simplicity™ software: PhysiciancareDirect.com or call 855-PcD-2300

BOLD ACTIONS: Continued from p.8

Public Health Leadership Spotlight Series Profiles of leaders and members working in important public health roles

Proper implementation of Medicaid Pay Parity where primary care should be paid 100% of Medicare rates for Medicaid as required by the Affordable Care Act. Enrollment in the federal Health Marketplace/Health Insurance Exchange, see details about this process on page 12.

Changes in the State Employees Health Plan, particularly positive changes providing members of the plan an incentive for naming and going to a primary care physician.

Changes to the Blue Quality Physician Program implemented by BCBS NC to reward independent physicians who are working to improve quality through PCMH recognition.

Accountable Care Organizations and other value-based payment methodologies.

Addressing significant cuts to public health funding, including elimination of 15 positions in the state’s Oral Health Section. The NCAFP has been asked to provide input into how best to implement changes in order to make the section as effective and efficient as possible.

Changes in leadership in many key state government positions, including the Director of the Office of Rural Health and Community Care and the State Health Director.

Robert Rich: Working to Advance Care in Eastern NC ELIZABETHTOWN - Some family physiIn his work, Rich serves as a combination adcians just never slow down. Case in point: vocate, educator, facilitator, and consultant.

Elizabethtown’s Dr. Robert L. “Chuck” His expertise in opioid abuse as a member of Rich, Jr. As an Academy AAFP’s Opioid Abuse & Pain Past President (2009), Rich Management Workgroup has now turned his sights has led him to transfer some on improving care delivery key leanings from that group in eastern North Carolina. directly into his region as Dr. Rich currently serves Project Lazarus is establishas Clinical Director for ing itself. (See related story Community Care of the on p.16) Lower Cape Fear, a 98,000 “My work with the AAFP Medicaid patient network has allowed me share covering six counties in key insights, especially Robert L. “Chuck” Rich, Jr., MD eastern NC. The network is in working to get Lazarus Hometown: Elizabethtown, NC comprised of 154 primary established here. But I also Activities: Clinical Director,

Community Care of the care practices and is knee draw on my experience as

Lower Cape Fear; member, deep in what could be the clinician in working with

AAFP Commission on

Health of the Public & state’s most forward thinkour CCNC care managers.

Science ing medical home/physiCCNC continues to move the cian payment experiment: needle,’ noted Dr. Rich. the CMS Multi-payor Advanced Primary Several eastern counties where Rich has Care Demonstration. This demonstration helped spearhead the Lazarus efforts are well serves select Medicare, Blue Cross, and on their way to establishing great programs.

State Employee Health Plan patients in And what does Rich attribute all the success Bladen and Columbus Counties by layerto? “Get involved! The Academy is an exing CCNC’s member payments and netcellent vehicle - the contacts you make are work resources to strengthen the medical invaluable and it opens up opportunities you homes there. It was announced just recan’t anticipate.” cently that all practices in Demonstration are now NCQA PCMH-recognized.

Aggressively advocating regarding a plethora of scope of practice bills filed in the General Assembly this year dealing with everything from professional midwifes to naturopaths to pharmacists.

At the same time that we have worked to deal with all these issues, there is more focus on the value that primary care brings than ever before. Family physicians are uniquely positioned to help lower cost and improve quality within the healthcare system. But you too must be positioned to take advantage of these opportunities.

Our members, the state’s family physicians, must be prepared for population management, use of quality metrics, a movement to increase access for patients, and more. The healthcare system is changing, and we – together – must be prepared to meet the changes head on.

Rest assured, the NCAFP intends to make the investment to help you show your value in the trying times ahead.

10 THE NORTH CAROLINA FAMILY PHYSICIAN • Autumn 2013

Membership News & Reminders 2014 Dues Reminder: Pay Them Online Today - Active, Inactive, Life & Supporting members are now able to pay 2014 dues online. This includes recent residency graduates who have been upgraded to Active status—remember to take advantage of your first year discount!

Payment deadline for all membership categories is Jan. 1, 2014. To pay your 2014 dues online or to print an invoice, please visit www.aafp.org/checkmydues. Your username is your seven-digit membership ID number, and your password is typically your last name unless changed. If you are not able to pay the entire dues amount, you may set up an installment plan (installments taken out through August 2014) by calling AAFP at 1-800-274-2237. A paper invoice will be mailed to primary addresses mid-October. Should you have any questions about dues or would like to sign up for the installment or auto renewal plans, please contact AAFP at 1-800-274-2237. Please verify that we have updated contact information while online or on the phone with AAFP staff.

2013 CME Re-Election - CME Re-election is around the corner for 2013 candidates! To determine your reelection cycle or to view/update your transcript, please visit www.aafp.org/mycme. Remember – only CME hours earned during your three-year cycle are applicable and consists of earning at least 150 credits with a minimum of 75 Prescribed credits and 25 credits from live learning activities. Please keep in mind that all hours must be earned prior to the 12/31/13 deadline to maintain your membership. AAFP no longer offers earning extensions, so all online quizzes and CME hours must be completed prior to 12/31/13. If you think you will be short of the required 150 hours by the 12/31/13 deadline, please contact the AAFP immediately at 1-800-274-2237. Did you know that more than 200 free Prescribed credits may be earned by completing multiple posttests at www.aafp.org/cme!

CME Meetings & Education ncafp.com/education

NCAFP’s New Mobile App will Launch During This December’s Winter Family Physicians Weekend The Academy’s continued efforts to ‘go green’ have led it in a new, exciting direction.

The NCAFP Meetings Department is very excited to announce the launch of a new mobile conference app during this year’s Winter Family Physicians Weekend. The Winter meeting is scheduled for December 5-8, 2013 at The Omni Grove Park Inn in Asheville.

The new user-friendly mobile app will feature all general session presentations, each speaker’s biography and PowerPoint slide presentation, lecture information, and contact information. Additionally, mobile app users will enjoy the app’s fantastic notetaking capabilities that will allow notes to be written directly on each slide!

There’s also a new simplified online speaker evaluation module that make completing evaluations a snap.

App users will be able to personalize their conference schedules with their own “must see” general session topics and “must do” workshops, seminars and social activities.

Finding old friends and colleagues is another new addition that will be exciting and fun as well. The app’s social media capabilities will help connect attendees via Facebook and Twitter feeds. Additional app features include a handy list of participating sponsors and exhibitors and their valuable contact information. Also, session information, updates and conference announcements

will also be sent periodically throughout the weekend via notifications generated within the app.

The app will be made available to all registered attendees at no charge and can be downloaded from Apple’s AppStore and at Google Play. For those who still prefer a printed paper syllabus, attendees may purchase one in advance for $35.

Conference attendees can expect to earn up to 30+ AAFP Prescribed Credits for their participation in the event.

Program Chair Richard W. Lord, Jr., MD, and Program Vice-Chair, J. Carson Rounds, MD, have put together a terrific conference for family physicians by family physicians and we hope to see you there in Asheville this December!

Academy to Offer Training on New DOT Medical Examiner Certification New Requirements Go Into Effect on May 21, 2014 Effective May 21, 2014, all health care professionals who perform physical examinations and issue medical certificates for interstate commercial motor vehicle (CMV) drivers will be required to complete an accredited certification training course and pass an examination. Medical examiners who complete the training and successfully pass the test are included in an online directory on the National Registry website.

Mark your calendars now and make plans to participate in the NCAFP’s

training courses that will be held beginning in late January, 2014. Each training will last from 8:00 am to 3:00 pm and will provide 6-hours of instruction. The first of these sessions is scheduled to be held in Raleigh on January 25th (See right). Later in March, a similar event is planned for Hickory, NC. Online registration is currently available for the January event by visiting www.ncafp.com/dottraining. Look for additional info in the weeks ahead...

Save The Date

DOT Medical Examiner

Training

Sat., Jan. 25, 2014 Doubletree Hilton Brownstone University Raleigh, NC www.ncafp.com/dot-training

Autumn 2013 • THE NORTH CAROLINA FAMILY PHYSICIAN

11

Healthcare Reform

North Carolina Gets Cover

Marketplac

Roll-Ou

What Family Physicians Need to K

T

he much anticipated launch of the Patient Protection and Affordable Care Act’s (ACA) health benefits marketplace has arrived and patient enrollment is now in full swing. For the first time in history, uninsured patients across North Carolina who may have struggled to obtain health insurance coverage either due to preexisting conditions, prior claims history or affordability now have a range of options to consider.

Regardless of your personal view of the ACA or its main tenets, patients with questions may look to their family physicians and primary care providers for information and guidance, whether for themselves, a close family member, or someone they know.

With this, family physicians should be familiar with the basics of the law, know what’s involved with enrolling, and have a good understanding of what’s covered.

This article aims to provide information

12

that physicians can use in fielding questions and presents resources where additional information can be located.

Inquiring Patients Want to Know The cornerstone of the ACA is the ‘individual mandate’ that requires all citizens to obtain qualified health insurance by 2014 or pay a fine. Beginning in 2014, patients who do not qualify for an exemption and fail to obtain coverage will pay a penalty of $95 per adult, $47.50 per child, or 1% of their income (whichever is higher). These penalties will increase every year.

To obtain coverage, uninsured North Carolinians will use the state’s health insurance marketplace or ‘exchange’ that formally launched on October 1st at www.healthcare.gov. This exchange is run by the federal government and enables citizens to research, compare and enroll - either with or without a computer.

THE NORTH CAROLINA FAMILY PHYSICIAN • Autumn 2013

All health plans offered on North Carolina’s exchange provide a common set of benefits known as ‘essential health benefits.’ These benefits include outpatient ambulatory and emergency services, preventive care, maternity care, pediatric care, mental health and substance abuse, lab work, hospitalization, prescription drug coverage, and rehabilitative/habilitative services.

Consumers select plans from one of four distinct categories: bronze, silver, gold, and platinum. A fifth ‘catastrophic’ plan category is also available but it is age-restricted and reserved only for extreme hardships. Plans are priced according to the percentage each pays of the average overall costs of the benefits they provide, and each lists the amounts the patient is required to pay out-of-pocket for hospital visits or prescription medications.

In North Carolina, patients have access to 51 different plans offered by two insurers: Blue Cross and Blue Shield of North Carolina (BCBSNC) and Coventry Health

Covered —

ace

Out

d to Know

Care of the Carolinas.

BCBSNC’s 26 plans are available to patients in all 100 counties and range from as little as $145 per month for a 25-year-old subscriber on a catastrophic plan, up to as much as $594 per month for a 60-yearold. Coventry Health Care is offering 25 plans, but in a limited geographic footprint.

Coventry’s coverage targets only 39 NC counties which include a number of rural ones, as well as Raleigh, Charlotte, Greensboro, Asheville and Fayetteville.

Neither BCBSNC or Coventry can deny patients coverage or charge patients differently due to preexisting health conditions or medical claims history. They also cannot charge women and men differently based on their gender and they cannot limit each plan’s annual benefit spending amount.

Patients who enroll prior to December 15, 2013, will have coverage beginning January 1st, 2014.

of their existing arrangement. Patients need to determine this on a case-by-case basis.

Applying & Enrolling for Coverage To actually enroll in a plan, patients have a range of ways to do so: online, in-person, by telephone, and even by regular mail.

Help and in-person guidance programs aimed to assist citizens are available in many areas; North Carolina currently has over 80 organizations providing localized help. A full list of these can be found at https://localhelp.healthcare.gov.

To complete the application process, patients will need to know their household income and their social security number.

Most importantly, they will also need to firmly grasp how health insurance works, what its key features mean, and understand the financial implications of their decision.

The AAFP’s www.familydoctor.org provides a number of resources that help explain the basics, and the entire Healthcare.gov website provides comprehensive information on virtually anything related to the program. See additional resources listed at right.

For patients using healthcare.gov, enrollment is a multi-step process that includes account registration, identity verification, subsidy eligibility determination, and plan selection. While initial roll-out of the exchange has made completing this a challenging process, improvements continue daily.

ACA RESOURCES & INFORMATION Family physicians can utilize these resources in serving patients who have general questions on the ACA, the marketplaces, enrollment or subsidies.

Key Websites The Health Care Exchanges CMS’s Healthcare.gov - http://www.healthcare.gov CMS’s Health Insurance Marketplace http://marketplace.cms.gov USDHHS’s Healthcare Reform Center http://www.hhs.gov/healthcare Kaiser Family Foundation’s Health Reform Center http://kff.org/health-reform

Consumer Information Kaiser Foundation’s Subsidy Calculator http://kff.org/interactive/subsidy-calculator AAFP’s FamilyDoctor.org - All Things Health Reform http://sitesearch.familydoctor.org/?q=health+reform 10 Things to Tell Your Patients About the Exchanges http://www.aafp.org/fpm/2010/0500/p14.html

Resources & Help Galore About Patient Subsidies

Dovetailing with the ACA’s ‘individual mandate’ are federal tax subsidies that citizens can capture to help offset their costs. Estimates conclude that roughly half of NC’s 1.5 million uninsured citizens will be eligible for some level of subsidies, the amount of which can be determined during the enrollment process. For example, individuals making less than approximately $46,000 a year and families of four earning less than $94,000 a year would both qualify for some level of tax credits. However, approximately 430-500,000 of North Carolina’s poorest citizens with incomes below the poverty line of $11,490 for individuals (or 45,960 for a family of four), will not eligible for any subsidies.

Patients with existing coverage through their employers, in private plans, or even on programs like Medicaid/Medicare, COBRA, TRICARE, etc., are considered covered and may keep their existing policies. While some may in fact opt to pursue exchange-based plans, they would lose any financial benefit

With the wide NC Health Coverage Subsidies by Federal Poverty Level Percentage scope of this Family Size 100% 250% 400% type of launch, 1Person $11,490 $45,960 $28,725 information and resources 2 People $15,510 $38,775 $62,040 explaining how 3 People $48,825 $78,120 $19,530 the exchanges work and how the 4 People $23,550 $58,875 $94,200 law is designed are everywhere.

Less than 100% No subsidized coverage, unless already Medicaid-eligible As part of the More than 400% Exchange, no federal subsidies ACA’s legislation, several types of ground-based support programs were For Physicians & Practices established and are now operating across the state. For example, these mechanisms include AAFP’s ACA Information Center the ACA’s ‘navigator’ program, In-Person http://www.aafp.org/advocacy/act/aca.html Assisters program, and Certified Application Counselors.

In North Carolina, the NCAFP’s Health Reform Page navigator program is being delivered through four organizations, the largest of which is http://www.ncafp.com/health-reform Community Care of North Carolina’s and its consortia of over 100 different organizations NC Department of Insurance Reform Center and groups. A range of other groups have http://www.ncdoi.com/HealthCareReform/ begun to provide some level of front-line assistance as well; be sure to be on the lookout in your area or visit localhelp.healthcare.gov.

Autumn 2013 • THE NORTH CAROLINA FAMILY PHYSICIAN

13

Practice Management ncafp.com/practice-mgt

NC’s Capital Region is a Hotbed of ACO Activity Raleigh-based Key Physicians Embraces Accountable Care to Raise Quality and Lower Costs While the number of Accountable Care Organizations in NC continues to grow, more and more physicians may be asking how they can take advantage of this model of care. This is why the Towards Accountable Care (TAC) Consortium was formed, to educate physicians across the state of North Carolina about the opportunities associated with ACOs. The NCAFP is a founding member of the TAC, which now includes nearly 40 medical societies and organizations. The Consortium has developed numerous resources for physicians, the latest of which is a guide to ACO merit-based savings distribution. This guide can be found by visiting http://www.ncafp. com/files/Shared-Savings-Guide.pdf.

Recently, the TAC highlighted Key Physicians, one of the most recent ACOs to be recognized in NC. The business model at Key Physicians, an organization of more than 220 independent physicians in Wake, Durham, Orange and Johnston Counties, has been evolving over the last four years from a traditional Independent Physician Association (IPA) to an accountable care organization (ACO) model. The constant throughout the process has been improving the quality of care for patients while maintaining physician independence. The moral of the Key Physicians story is that a group does not have to be “owned” by a large entity to be part of an accountable care model – you just need smart affiliations that focus on value and what is best for the patient.

“I worry that what’s best for patients isn’t usually in the equation in health care so far in our society,” said John Rubino, MD, President of Key Physicians. “As independent physicians

14

– and we’re trying hard to maintain that [independence] -- we can choose the best place for a particular patient for their particular problem. I hope that independent physicians remain as strong advocates for their patients in choosing the right thing for them.”

The journey for Rubino and his group began about four years ago when Key Physicians’ doctors decided to pursue patient-centered-medical-home designation. A few physicians left, but everyone else made the necessary changes to become identified as a PCMH. This accomplishment showed at least one insurance company, Cigna, that Key Physicians could get things done as an IPA. So about a year ago, Cigna and Key Physicians entered into an accountable care arrangement. Basically, they agree if certain goals for preventive care are met, and money is saved, Key is able to keep some of that savings. A similar agreement was struck with Blue Cross and Blue Shield of North Carolina this year, and recently WakeMed and Key announced their intent to form a Medicare ACO, focused on reducing health care costs and improving quality in both the traditional Medicare program and in private insurance programs.

“By forming an ACO of Key Physicians’ extensive primary care network and WakeMed’s inpatient and outpatient services, clinical resources and physicians, we will help facilitate patient access to a coordinated health care team focused on delivering efficient, quality care at a reasonable cost,” Rubino said in the statement announcing the partnership. “While patients will retain access to all of the region’s hospitals, they will benefit from an overall strategy to provide a more seamless experience regardless of where the care is delivered.”

These arrangements “are bringing into

THE NORTH CAROLINA FAMILY PHYSICIAN • Autumn 2013

the health care system something that it grossly lacks – competitiveness based on quality and price,” Rubino said. “Some of the insurance companies now are telling you the prices of procedures at different places, but [patients] don’t have a sense of the quality, so they go, ‘if it costs more it must be better.’ But that is not necessarily true.”

Doctors have the expertise to evaluate the quality of the outcomes, which may not correspond to the price. Rubino said Key Physicians have identified as much as

Founded: 1994 Membership: 220+ independent primary care physicians and

80 physician extenders throughout Wake, Durham,

Orange and Johnston Counties Specialties: Family Medicine, Pediatrics, Internal Medicine

and Urgent Care PCMH: All 61 practice locations recognized as NCQA

patient-centered medical homes More at:

www.keymedicalhome.com

a 30 percent cost difference for the same quality procedure, leading to significant savings and equal patient outcomes.

“There are a lot of opportunities out there to do things that make a lot of sense,” he said. “We are proactively searching for those opportunities. It’s better for the health care system and our community.”

Independence is important to competition because Key Physicians – and patients -- are not restricted to particular specialists or hospitals for their care. These providers need to earn Key’s “business.”

C

PRACTICE BRIEFS “All too much right now in our health care system locally and across the country, everybody is choosing [exclusive affiliations]. The problem is no one asks the patients about that. I can tell you, no one system is the best of everything,” Rubino said. “Whereas, more and more, the choice is made based on where you are to start with. So, if your primary care doctor [has a certain affiliation], for example, it’s very likely you’re going to refer to a doctor [with the same affiliation] whether or not that’s the best choice for that particular patient.”

Rubino is pleased with the progress Key Physicians has made toward the accountable care model and the ability to provide high quality care at lower costs.

Moving toward the accountable care has “provided a mechanism for a number of very independently minded doctors to get together, do some good things for their patients and their community, and get a greater voice in local health care,” he said.

To learn more about the Towards Accountable Care Consortium and to see all of their resources, please visit them at: http://www.ncmedsoc.org/ac/

Physicians Risk 1.5% Medicare Payment Penalty in 2015 for Not Participating in PQRS Now If you fail to sign-up for CMS’s Physician Quality Reporting System (PQRS) and do not begin reporting this year, physicians will suffer a payment penalty of 1.5% of all Medicare billings in 2015. PQRS is a CMS reporting program that uses a combination of incentive payments and payment adjustments to promote reporting of quality information. Several tools and resources can help you get started immediately. The AAFP has published a snapshot of the program that includes links to how to enroll (http://www.aafp.org/practice-management/regulatory/ pqrs.html), as well as to a listing of qualified reporting registries. CMS’s ‘How to Get Started’ with PQRS is excellent, too. Finally, the ABFM offers a no-cost qualified reporting registry that diplomates can access through their secure physician portfolio. In addition, ABFM’s PQRS Diabetes registry and its MOC module on Diabetes can be utilized to qualify for an extra 1% incentive payment based on successful diabetes reporting. See the ABFM website at http://www.theabfm.org/moc/pqrs.aspx for more details.

Great Resources are Available for Having Vaccination Conversations with Parents

VACCINATION

There are a number of new resources available to physicians who often find themselves having important conversations with parents about vaccinations. The CDC, AAP, and AAFP created these materials to help physicians assess parents’ needs, identify the role they want to play in making decisions for their child’s health, and then communicate in ways that meet their needs. These resources are collectively called Provider Resources for Vaccine Conversations with Parents.

Titles include Talking to parents about vaccines, Understanding vaccines and vaccine safety, Immunization schedules and others. To access and download for use in your practice, visit http://www.cdc.gov/vaccines/hcp/patient-ed/conversations/index.html.

Family Medicine Charlotte Metro Area

CAROMONT HELSTH CaroMont Health

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

REGULATORY UPDATES

Pharmacists’ Immunizing Authority Expanded on Oct. 1st Changes to the Immunizing Pharmacists law went into effect on October 1st, 2013, as a result of legislation passed by the General Assembly last summer. In the past, pharmacists could only administer influenza vaccines under a protocol and pneumococcal and zoster vaccines with a minimum of a verbal order from a physician. The new law allows pharmacists to provide pneumococcal, zoster, Hepatitis B, meningococcal and TDAP vaccines to anyone over 18 under a written protocol from a physician practicing and licensed in NC. In addition, the pharmacist must check the NC Immunization Registry before providing these vaccines, input the vaccination into the NCIR within 72 hours, notify the individual’s primary care provider if one is identified, and provide information on the importance of having a medical home if the person does not identify a primary care provider. In the process, pharmacists must follow a screening questionnaire that was developed with input from the NCAFP, the NC Medical Society and the NC Pediatric Society. Not all pharmacists will be operating under the new law initially, as training and implementation of work on the NCIR is rolled out across the state.

However, pharmacists can continue to give zoster and pneumococcal vaccines under the old law’s regulations through June 30 of next year, meaning they would still need a minimum of a verbal order from a physician’s office until such time that they can utilize the NCIR. The law did not change how pharmacists handle influenza vaccine, and that vaccine can be given to someone as young as 14 without a physician’s order. For a copy of the sample minimum screening questionnaire and the materials that are available for a pharmacists to provide a patient about the importance of having a medical home, please visit www.ncafp.com/ immunizing-pharmacists. If you have any questions, please contact NCAFP EVP Greg Griggs at ggriggs@ncafp.com.

Student Interest & Initiatives ncafp.com/students

Changes to State Health Plan in 2014 Could Impact Family Medicine Practices The State Health Plan for Teachers and State Employees is making several significant plan changes for 2014 that could impact Review the changes at family www.ncafp.com/shp-2014-changes medicine practices for both their active members and retirees on Medicare, including efforts to encourage Plan members to name a primary care provider. These new options, along with moving the plan benefit year to a calendar year, were approved by the Plan’s Board of Trustees in February 2013. The current open enrollment period is underway and will end October 31 for benefits effective Jan. 1, 2014-Dec. 31, 2014.

Family Medicine Interest Programs Available for First-Year Medical Students Application deadline is January 15, 2014 The NCAFP Foundation offers a variety of programs and opportunities to medical students. A few of these are clinical experience opportunities only available to 1st year medical students.

These opportunities take place during the summer between your first and second year of medical school. There are two programs available. You do not have to be convinced that the specialty of Family Medicine is your career path; you must merely have an interest in learning more about this exciting specialty. For more information please visit: http://www.ncafp.com/students. For questions or more information please contact Tracie Hazelett at 919-833-2110, ext. 120 or thazelett@ncafp.com.

32nd Annual AAFP National Retrospective Ranks ECU #1 The Brody School of Medicine at ECU is again the top school in the nation based on the last 3-years average percentage of graduates who were family medicine residents. Brody achieved a 20.9% rate to capture the top spot. Other schools in the top five included University of Kansas, University of North Dakota, Oregon Health & Sciences University, and Marshall University.

An analysis of US Medical School graduates into Family Medicine Residencies, 2012-2013 appears in the October 2013 edition of the journal Family Medicine.

Student Leadership Opportunities are Available Elections for new Student Leaders will take place during the Student Section meeting on Saturday December 7th at the NCAFP Winter Family Physicians Weekend in Asheville, NC. NCAFP student members will elect a Student Director-Elect for the Academy Board and two students to serve as Student Trustees on the NCAFP Foundation Board of Trustees. Deadline to submit materials for these elected positions is November 22, 2013. For more details please visit: www.ncafp.com/students/leaders. If you have questions please contact Tracie Hazelett at 919-833-2110, ext. 120 or thazelett@ncafp.com.

Community Preceptors Needed for NCAFP Summer Programs The NCAFP has multiple programs for medical students that call for physicians that are passionate about their work and willing to take time to teach and mentor. Programs vary in length from one to four weeks and occur between May 26th and August 1st 2014. We are seeking physicians that will show students what life is like inside the clinic as well as outside those walls. Ways you are engaged locally with your community or simply that it is possible to have work-life balance. Although not a requirement for all programs, we have significant need for those of you practicing in rural or underserved areas. Student selection for the programs will be complete in March with placements determined by May. Preceptor selection is based on geographical need, practice type and other mutual interests of students selected to participate. Please consider mentoring a student! Contact Tracie Hazelett at 919-833-2110, ext. 120 or thazelett@ncafp.com.

16 THE NORTH CAROLINA FAMILY PHYSICIAN • Autumn 2013

ges

Shopping Blues?

Trouble finding the perfect gift for friends and family members who have everything? A gift to the NCAFP Foundation is the gift that keeps on giving!

The NCAFP Foundation Medical Student Endowment now stands at approximately $987K. Help us reach $1,000,000 this year!

To donate, complete the form below or donate online at www.ncafp.com/contribute

Yes,I want to support and strengthen Family Medicine in North Carolina!

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Send acknowledgement to: Annual Fund Recognition Levels

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Mail to NCAFP Foundation, P.O. Box 10278, Raleigh, NC 27605. Fax your credit card contribution to (919) 833-1801. Questions? Please contact Tracie Hazelett, Development Coordinator at (919) 833-2110 or email at thazelett@ncafp.com. Financial information about this organization and a copy of its license are available from the state Solicitation and Licensing Section at (888) 830-4989. The license is not an endorsement by the state.

Health Policy & Advocacy ncafp.com/advocacy

By: Robert L. “Chuck” Rich, Jr., MD NCAFP Advocacy Council Chair

Overdose Prevention Ramps Up

CCNC’s Overdose Prevention Program is Saving Lives and Engaging Communities In the previous report, I highlighted some of the proposed mechanisms that practices can begin to implement in an effort to improve quality of care and help produce savings for the Medicaid program.

Community Care of North Carolina (CCNC) has sponsored various initiatives over the past few years, either statewide or at the network level, to accomplish those goals. For this article, I will review one of the projects sponsored statewide

year, closely matching the same number of deaths by motor vehicle accidents.

In response to the problem, a group of concerned community leaders from Wilkes County put together a coalition of law enforcement, public health, education, faith-based organizations and medicine to combat the problem.

Through their efforts, which became known as Project Lazarus, they were able to lower the death rate from unintentional overdoses in Wilkes County by 69% from

Project Lazarus at a Glance What is it:

Statewide community-based overdose prevention and opioid safety program founded in 2008 in Wilkes County.

Community Care of NC has adopted the program as a major statewide initiative.

Impact:

Wilkes County decreased its prescription drug overdose death rate by 69% between 2009 and 2011. Goal is to replicate this impact in other communities across the state.

Training: Physician education on opioid pain management is critical and a key program

component. Trainings being conducted now across the state.

See www.eventbrite.com/org/3624699521 for the next event.

More Info:

At CCNC:

www.projectlazarus.org www.communitycarenc.org/population-management/chronic-pain-project

by CCNC, its chronic pain initiative or the Project Lazarus Initiative as it is now known.

As everyone is aware, abuse of prescription opioid pain relievers and subsequent overdose deaths have risen sharply in North Carolina over that past decade. From the latest statistics available (2011), 1,140 such deaths occurred that

18

2009-2011. CCNC has now adopted Project Lazarus as one of its initiatives and with a grant from the Kate B Reynolds Trust and matching funds from the Office of Rural Health, CCNC is now taking the initiative statewide.

Project Lazarus consists of three interrelated initiatives: the organization of community-based coalitions; provider

THE NORTH CAROLINA FAMILY PHYSICIAN • Autumn 2013

education around the clinical process; and the establishment of and satisfaction of program outcome goals. All three aspects of the initiative are considered vital to the success of the program.

The establishment of a communitybased coalition is typically the first part of the initiative and is often launched with a stakeholder meeting of invited leaders from the various community groups, similar to those which made up the Wilkes County coalition. These stakeholder meetings typically will have a keynote speaker, such as Fred Brason II, the CEO of Project Lazarus, with the goal of educating community leaders about the extent of the problem and developing community interest in prevention and early intervention. From that, regional goals are developed and agreements developed to sustain the community coalition and implement the tenets of Project Lazarus in that community.

At the same time that the community initiative is developed, the clinical process is started. This step focuses on the proper medical assessment and treatment of patients with chronic pain issues in that community. The clinical process highlights the use of assessment tools for coexisting substance abuse and behavioral health disorders, use of prescribing and monitoring tools, use of CCNC’s Provider Portal/the NC Controlled Substance Reporting System (CSRS) as informational tools, etc. CCNC is now conducting CME and non-CME training events across the state as part of the clinical process, with targeted audiences including primary care providers, ER providers, dentists, pain management providers as well behavioral health providers. Topics covered in these meetings include the areas mentioned above, as well as discussion of the role of See ‘Project Lazarus’ on back cover

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PROJECT LAZARUS: Continued from p.16 pharmacists and behavioral health providers in the treatment process.

A series of three toolkits have been produced for primary care providers, ER providers and care managers as reference materials which are subsequently distributed to attendees for the training sessions. These toolkits include the substance abuse/ behavioral health screening tools, sample treatment agreements, consent forms, prescriber and patient education materials, treatment algorithms, medication flow sheets, care plans, local community resources, as well as applications for the CSRS program. Supplementing these events include such efforts as practice “Lunch & Learns’ and other practice based education conducted by local network medical directors.

The third part of the initiative focuses upon the assessment of outcome goals. As many of you are aware, CCNC has a very robust data repository and analytic capability

UNION RESIDENCY: Continued from p.6 any modern family practice office you'll find.

The practice sits in a newly-developed medical park only about a half-mile from Carolinas Medical Center-Union where residents complete their in-patient training. The practice features a full laboratory, a radiology suite, procedural suite, an embedded PharmD, and a host of other features. These help make Union an excellent community practice and a capable training environment, strengthening each resident’s training experience.

In discussing the program and its goals with Dr. McPherson, she described a number of unique training advantages offered to Union residents. In addition to the day-to-day practice operations and practice management experiences residents receive, Union's patient population is also widely diverse. In comparison to many university-based programs, Union residents serve a patient panel that is socioeconomically diverse across the board, featuring a mix of privately-insured, indigent and even self-pay patients.

The program also provides a broad spectrum of in-patient training locations that also have become a key training advantage. Union residents train in CMC's large 800+ bed tertiary care center in downtown Charlotte that features every imaginable service and amenity.

On the flip side, residents also get to experience a wholly different community hospital at Carolinas Medical Center-Union Regional.

At 247-beds, Carolinas Medical Center-Union exposes residents to different demands, with the added bonus of its "unopposed" status.

"Many of Monroe's specialists are very eager to work with our program's residents. There

which is readily accessible by care managers, CCNC staff and providers. Providers, both at the practice and the Emergency Room level can access patient data through the CCNC Provider Portal and can view the narcotic fill activity, ER utilization and other information pertinent to those patients with chronic pain issues. Based on data analysis, CCNC has been able to identify those chronic pain patients that need more intense care supervision, and subsequently targeted care manager services and provider feedback for those patients.

In my own network, we have been able to identify a cohort of high risk chronic pain patients and their prescribing practices in order to focus our efforts on education and intense care manager services. Through those efforts, to date, we are demonstrating significant reductions in such areas as ER utilization, narcotic fills, total Medicaid drug cost, and inpatient mental health admissions with more data analysis to come.

The Academy asks you to be aware of the

work of the Project Lazarus initiatives in your community and reminds you to practice safe opioid prescribing as outlined in the initative, further details of which are available on the CCNC website. As family physicians, we are the primary source of chronic pain care for the majority of our patients and we must practice responsible pain management or those who question our ability to prescribe opioid pain relievers will succeed in limiting those privileges. If that was to occur, many of our patients would be left without access to these medications as there not enough pain management specialists to treat everyone, particularly in our rural and underserved areas.

are no other residents who rotate at CMCUnion and as a result, our residents get tremendous opportunities and a lot of individual attention here," commented Dr. McPherson.

Outside of the hospital and the clinic, Union residents draw on opportunities to work with an underserved multicultural population through the local Union County Health Department (UCHD). Union residents get immersed in women's health, including maternity care, and the care of children at UCHD's modern and spacious facility that's just a short distance away. And because UCHD also caters to the general health needs of the underserved in Union County, residents also experience different facets of safety net care, including the opportunity to work with a large Spanish-speaking population.

to McPherson, the work is already having an impact. For instance, the program knocked its 2013 residency survey 'out of the park' with feedback ranking at or above national averages on everything.

A significant part of Union's realigned strategy is building on its existing ties with CMC Charlotte. Union residents already get to take advantage of weekly teaching conferences with their Charlotte colleagues. In the future, Dr. McPherson only expects ties like these to increase, including a more closely-integrated longitudinal curriculum in the 3rd year. Also in the works is a new Rural Family Medicine rotation for all PGY3 residents in neighboring Anson County, where Carolinas HealthCare System is developing an innovative medical home model that is embedded in the local emergency department.

In addition to the operational changes, Union is also making improvements to its facilities. A new state of the art practice module that will co-locate both the residents’ clinic space and program administration within Union Family Practice is currently under construction. Day to day, it's expected that this will provide more easy access to program leadership, directors and faculty.

Dr. McPherson is excited for what the future will bring to the program. "The sky is the limit here in Monroe. As a resident, it truly is the best of both worlds. As a residency within a great community practice, exceptional faculty, in a growing area, Union is a fabulous place to train."

Re-Aligned for Today & Tomorrow

Along with all of Union's unique advantages, the program has had to juggle some challenges inherit in its training model. For example, as Union Family Practice has grown over the last several years and gotten much busier, program administrators have had to re-align certain parts of the program's approach. To do so, program administrators sought input from Union Family Practice faculty as it analyzed every aspect of the program with one goal in mind: to make itself a model program.

"As a residency we want to be a model program and add as much value as possible to our residents and to our practice," explained Dr. McPherson.

As Dr McPherson and her team developed the plan, the program received an outpouring of support from CMC leadership. According