Current Bulletin

  • Report from July NCMS Board Meeting

    Your North Carolina Medical Society (NCMS) Board of Directors met at NCMS headquarters in Raleigh on Saturday, July 14. Here is a summary of some of what was discussed at that meeting.

    PAI and The Physicians Foundation as Valuable Resources

    The Board welcomed Kelly Kenney, Executive Vice President and CEO of the Physicians Advocacy Institute (PAI). PAI was established in 2006 as a result of class action settlements against major national for-profit health insurers. The PAI’s primary mission is two-fold: to guarantee compliance with the settlements by these health insurers; and to develop projects and tools for the future that guarantee the viability of physicians’ medical practices and the ability of physicians to deliver quality patient care.  NCMS CEO Robert W. Seligson is the president of PAI.

    Kenney outlined the three areas of PAI’s work: advocacy, research and education. Some highlights include the comprehensive educational resources available to practices on the Centers for Medicare and Medicaid Services (CMS) Quality Payment Program (access these resources on the NCMS website) and research into the trends around physician employment, which was heavily quoted in the national media. Learn more about what PAI does for physicians at its website.

    Seligson also reviewed the work of The Physicians Foundation, a 501(c)3 organization that also was formed as a result of the class action settlements. The Foundation offers education, research on trends affecting physicians and makes grants. Seligson, who serves on The Physicians Foundation board, estimated that the NCMS has received $5 million in hard dollars as well as access to valuable resources. Learn more about The Physicians Foundation. Also, consider subscribing to The Foundation’s newsletter. Here is the latest edition.

    Discussion of Statement on Parent/Child Separation

    The NCMS Ethics and Judicial Affairs Committee at their last meeting had asked the Board of Directors to consider a statement on the health impact of separating children from their parents as the result of a government policy. The AMA and several national medical specialty societies had issued media statements in response to recent actions at the southern US border. Read the AMA statement.

    The Board discussed the committee’s recommendation first on a conference call shortly after the implementation of the recent government policy on immigration and decided to more fully discuss it in person at the July Board meeting. Board members referred the matter to a subcommittee to craft an appropriate statement.

    Other reports to the Board:

    • At-large Board member, Palmer Edwards, MD, DFAPA, as a representative to the Physicians Health Program (PHP) board, reported statistics on use of the program as well as that PHP’s Medical Director Clark Gaither, MD, has been instrumental in PHP offering free burnout consultations to help determine if a practice’s culture fosters burnout.

    [Listen to an NCMS Bedside Manners podcast featuring Dr. Gaither discussing the causes, symptoms and solutions to physician burnout.]

    If you are interested in serving on the PHP Board, learn more about the current vacancy in this issue of the Bulletin.

    • Staff updated the Board on the planning for October’s LEAD Health Care Conference in Raleigh [see article in this issue of your Bulletin]. Board members discussed session topics as well as social and entertainment offerings that might draw record-setting attendance at this year’s conference.

    Just prior to the beginning of the LEAD conference an invitation only Summit on Physician Wellness will convene with thought-leaders and health care decision makers from across North Carolina coming together to address issues around wellness and burnout.

    • Region two Board representative Jeffrey Runge, MD, FACEP, who serves as CEO and President of Carolina Complete Health Network (CCHN), the NCMS’ joint effort with the North Carolina Community Health Center Association and Centene Corporation to provide health care to the state’s Medicaid recipients. Learn more about CCHN.

    [To learn more about the state’s Medicaid transformation and where we are in the process, see the overview written by the NCMS’ Vice President for Legal and Regulatory Affairs and Associate General Counsel Conor Brockett, in this issue of the Bulletin.]

     
  • Overview of the NC Medicaid Transformation Process Thus Far

    Conor Brockett, the North Carolina Medical Society’s Vice President of Legal & Regulatory Affairs and Associate General Counsel, offers this quick overview of Medicaid transformation in North Carolina thus far.

    In 2015, the North Carolina General Assembly enacted House Bill 372, marking the start of the state’s transition away from its classic fee-for-service Medicaid and Health Choice programs to Medicaid managed care. Under HB 372, North Carolina Medicaid will rely on multiple statewide and regional prepaid health plans (“PHPs”) to manage the insurance risk of the program and fully embrace the principles of value-based care delivery.

    In the current session, the General Assembly enacted House Bills 156 and 403, which provide additional clarity on how the Medicaid transformation will proceed. Given these new laws, the North Carolina Medical Society has partnered with Medical Mutual to review the status of the transition and what it means for medical practices across the state.

    Most medical practices probably haven’t noticed significant changes yet. However, many have started receiving communications from companies that hope to become one of the state-selected PHPs. These companies seek to form early relationships with providers (typically by contract or a non-binding letter of intent) to demonstrate their viability as a PHP and to improve their chances in the bidding process.

    Here’s a quick overview of the history of Medicaid transformation and what’s next.

    The History of Medicaid Transformation

    Since 2015, the NC Department of Health & Human Services (DHHS) has been gradually designing the new program. This effort involves shifting its own culture and role from operating the Medicaid program to administering multiple large contracts for the delivery of health services. Here are some key events that have occurred since the enactment of House Bill 372:

    • June 2016: DHHS submits North Carolina’s 1115 Waiver Application to the federal Centers for Medicare & Medicaid Services (CMS), which must review and approve major changes to Medicaid. CMS usually takes many months to review large-scale programmatic changes.
    • August 2017: DHHS issues Proposed Program Design for Medicaid Managed Care and seeks public comment. This detailed blueprint articulates DHHS’s priorities for Medicaid reform under Secretary Mandy Cohen’s leadership, which began in January 2017.
    • November 2017: DHHS submits to CMS an amended version of the 1115 Waiver Application. This is the most current version of NC’s Waiver Application and is still under review by CMS.
    • November 2017: DHHS begins publishing a series of short concept papers on key topics in transformation. These papers reveal how DHHS may answer important policy questions it faces in transformation.
    • March 2018: NC’s Medical Care Advisory Committee convenes stakeholder subcommittees to study and issue recommendations on key reform topics. Subcommittees on network adequacy, provider credentialing, beneficiary engagement, and managed care quality (among others) are asked to make recommendations to the MCAC and DHHS.
    • June 2018: The General Assembly enacts additional legislation (HB 156 and HB 403) that will accelerate Medicaid transformation. Highlights of the legislation include:
      • Requires PHPs to adhere to patient and provider protections that apply in the commercial insurance market. Provider groups have consistently advocated for these “Chapter 58 protections,” which include prompt payment, direct access to certain specialists, fair contracting, and more.
      • Requires each PHP to maintain a medical loss ratio of 88%.
      • Sets a 60-day deadline for DHHS to release its request for proposal (RFP) and open the competitive bidding process for PHPs.
      • Increases the number of statewide PHP contracts to be awarded from three to four.
      • Creates a pathway for new “tailored plans” to finance the care for certain patients with serious, persistent mental illnesses.

    What’s Next?

    The next major step in Medicaid transformation is DHHS’s release of the RFP and the competitive bidding process for PHPs. This milestone—originally scheduled to occur in spring 2018—is expected to take place this summer. The document will reveal in more definitive detail what the transformed Medicaid program will look like under the management of PHPs. Once the RFP is released, bidders will have 60 days to submit their responses.

    Once submitted, DHHS will review the bids and award contracts in the fall. The entities selected will then proceed with a more intensive ramp-up process. They will continue recruiting providers to their networks, determine coverage policies and claims processing rules, prepare materials for their beneficiaries, and prepare for implementation.

    DHHS is still currently sticking to the original proposed go-live date of July 1, 2019. This is when PHPs begin receiving capitated payments from the state and when Medicaid beneficiaries will start receiving services from medical practices as network providers. However, there is considerable speculation that go-live may be pushed to 2020, given the delay in the state’s release of the RFP and CMS’s continued review of the Waiver Application.

    Conclusion

    The second half of 2018 will be the busiest period yet in the transformation of North Carolina Medicaid. Physicians and medical practices should begin following the developments closely and analyzing their options for future involvement with the selected PHPs.

    To follow the latest news, watch for updates on the North Carolina Medical Society’s website (secure.ncmedsoc.org)and DHHS’s dedicated website at www.ncdhhs.gov/medicaid-transformation. Medical Mutual members can also reach out to the company’s Senior Vice President of Health Policy, Sam Cohen, for additional guidance (sam.cohen@mmicnc.com and 919.878.7602).

     
  • CMS’ Proposed Physician Fee Schedule Rule for 2019

    Last week, the Centers for Medicare and Medicaid Services (CMS) published its proposed Physician Fee Schedule Rule for 2019 and provisions for the Quality Payment Program (QPP).  North Carolina Medical Society (NCMS) as well as AMA staff is reviewing the 1,473-page proposed rule and will provide a summary and analysis as well as comments in the near future. Comments are due to CMS on September 10, 2018.

    Here is a brief summary of the key Medicare Fee Schedule proposals:

    • With the budget neutrality adjustment to account for relative value changes, as required by law, the proposed 2019 Physician Fee Schedule (PFS) conversion factor is $36.05, a slight increase above the 2018 PFS conversion factor of $35.99.
    • CMS has proposed to collapse payment for office and outpatient visits.  New patient office visit (99202-99205) payments would be blended to be $135. Established office visits (99212-99215) would be blended to be paid at $93. New codes would be created to provide add-on payments to office visits for specific specialties ($9) and primary care physicians ($5).
    • To replace existing documentation guidelines, CMS proposes to allow use of (1) 1995 or 1997 documentation guidelines; (2) medical decision-making or (3) time. Documentation for history and exam will focus on interval history since last visit. Physicians will be allowed to review and verify certain information in the medical record entered by ancillary staff or the beneficiary, rather than re-entering the information.
    • When physicians report an E/M service and a procedure on the same date, CMS proposes to implement a 50 percent multiple procedure reduction to the lower paid of the two services.
    • CMS will implement new CPT codes and payment for remote monitoring and interprofessional consultations.
    • CMS updated supplies and equipment pricing. The re-pricing of antigens has a significant impact on allergy and immunology payments, with an estimated 6 percent reduction for the specialty.

    Here are some of the highlights of the Merit-based Incentive Payment System (MIPS) proposals:

    • Retain the low-volume threshold but add a third criteria of providing fewer than 200 covered professional services to Part B patients.
    • Retaining bonus points for:
      • Care of complex patients
      • End-to-end reporting
      • Small practices
    • Allowing eligible clinicians to opt-in if they meet one or two, but not all, of the low volume threshold criteria.
    • Consolidating the low-volume threshold determination periods with the determination period for identifying a small practice.
    • Eliminate the base and performance categories and reduced the number of measures in the Promoting Interoperability category.
    • Require Eligible clinicians to move to 2015 CEHRT.
    • Providing the option to use facility-based scoring for facility-based clinicians.
    • For 2019 performance year the weights are:
      • Quality  – 45 percent
      • Cost- 15 percent
      • Promoting Interoperability – 25 percent
      • Improvement Activities- 15 percent

    Thanks to AMA advocacy, the Bipartisan Budget Act of 2018 provided additional flexibility for CMS on several MIPS issues including:

    • Excluding Medicare Part B drug costs from MIPS payment adjustments and from the low-volume threshold determination;
    • Allowing CMS to reweight the cost performance category to not less than 10 percent and not more than 30 percent for 2019-2021 performance years; and
    • Allowing CMS flexibility in setting the performance threshold for performance years 2019-2021 to provide a gradual and incremental transition for physicians.

    CMS has provided Fact Sheets on the major components of the rule which are available at the following links:

     
  • Position Available for NC PHP Board of Directors

    The North Carolina Medical Society (NCMS) appoints five physicians to the Board of Directors of the North Carolina Physicians Health Program (PHP). There currently is one vacancy on the PHP Board to be filled by an appointee of the NCMS. The NCMS is currently accepting applications from physicians interested in serving on the PHP Board of Directors.

    To learn more about the important work of this organization, visit the PHP website.

    Interested physicians should complete the application form and return it to Evan Simmons, esimmons@ncmedsoc.org (preferred), or by US Mail to PHP Board Applications, North Carolina Medical Society, Post Office Box 27167, Raleigh, North Carolina, 27611 by August 31st.

     
  • Don’t Forget to Mark Your Calendar for Oct. 18-19

    Planning is underway to bring you compelling speakers, CME and plenty of fun at this year’s LEAD Health Care Conference to be held Oct. 18-19 in Raleigh. A few highlights:

    • Our opening keynote speaker, Julie Ann Freischlag, MD, CEO of Wake Forest Baptist Medical Center and Dean of Wake Forest School of Medicine, will share her insights as a strong leader, educator and patient advocate.
    • This year’s class of Kanof Institute for Physician Leadership scholars will offer the results of their yearlong Leadership College projects during their MedTalks reports. Throughout the two days of the conference these TEDTalk-style presentations will give you a brief overview of a wide array of important and timely issues affecting your practice and your patients.
    • A fun – and delicious — evening at the Angus Barn’s beautiful lakeside pavilion is planned for Thursday. The conference culminates with a gala dinner and inspiring recognition of distinguished colleagues.
    • Plenty is happening in Raleigh that weekend – the North Carolina State Fair will be in full swing; grab a stein of beer at Triangle Octoberfest; take in a Hurricanes game or an exhibit at one of the many triangle area galleries or museums. Bring the family and make a fall weekend of it!

    Watch the LEAD Conference website and this Bulletin for more details and the opening of registration.

     
  • Nominate An Outstanding Physician for the 2018 Harris Award – Deadline This Friday!

    The Carolinas Center for Medical Excellence (CCME) currently is accepting nominations for the 2018 Harris Memorial Award in honor of the life and memory of one of its founding members, T. Reginald Harris, MD.

    Presented annually in conjunction with the North Carolina Medical Society’s (NCMS) LEAD Conference, a plaque is given to a North Carolina physician for outstanding achievements in the areas of health care quality and service to the medical community.

    “In memory of Dr. Harris, we continue to honor a deserving physician who has made a significant contribution to the practice of medicine and outstanding patient care,” said John B. Smith, MD, board chairman of CCME. “Dr. Harris devoted his career to improving the quality of health care for patients in North Carolina. He provided decades of service to the medical community through the North Carolina Medical Society, the American Medical Association, and many other professional, civic, and community activities.”

    Download the Harris Award nomination form. Submission deadline is Friday, July 20, 2018. For more information, contact Celeste A. Gore at mcgore@thecarolinascenter.org or
    800-682-2650, ext. 5684.

     
  • Increase in Legionnaire’s Disease Prompts Call for Vigilance

    The incidence of Legionnaires’ disease in the United States increased more than 4‐fold between 2000 and 2016. The reported incidence in North Carolina is similar to the national incidence and has followed a similar trend during this period, increasing from 0.65 to 2.36 cases per 100,000 population.  The North Carolina Division of Public Health asks that clinicians help address increases in Legionnaires’ disease by sharing prevention measures with patients and by ensuring the early detection of cases, allowing for a rapid response to prevent additional cases.

    Read the NC Department of Public Health’s memo to clinicians.

     
  • Got an Opinion? Share It With Your Colleagues!

    Do you have strong feelings about a health care issue that affects your practice; your patients; your life as a physician or PA? If you would like to share your thoughts with your fellow North Carolina Medical Society (NCMS) members, we welcome your viewpoint pieces for publication in this Bulletin.

    Here are our broad guidelines:

    • Only NCMS member submissions will be accepted.
    • The content and tone of the piece must be respectful.
    • All statistics, statements made as fact and quotes will be verified.
    • Topics must pertain to health care, physicians and PAs and/or the practice of medicine.
    • Recommended word count is 500-800 words. The NCMS reserves the right to edit for length.

    Please email your submission to Elaine Ellis, eellis@ncmedsoc.org. If you have questions, please contact Elaine via email or at 919-833-3836 x112.

     
  • Tomorrow: Webinar on How to Master ACO Benchmarking for Financial Success

    The ACO Council, which brings together Accountable Care Organizations throughout the state that are part of the Medicare Shared Savings Program (MSSP) to share valuable information is offering a free webinar tomorrow, Thursday, July 19 from noon to 1 p.m. on “How to Master Your ACO’s Benchmark for Financial Success.” Register here.

    Stephen Nuckolls, CEO of Coastal Carolina Health Care, PA, and its ACO, Coastal Carolina Quality Care, Inc., will offer his insights into the topic and share his experiences on:

    • The importance of benchmarks compared to quality;
    • The MSSP benchmarking process (costs, risk adjustment, regional adjustment, trend);
    • Strategies to improve your benchmark (HCC codes, cost initiatives, impact on trend); and
    • How to compute quarterly performance estimates.

    Nuckolls is responsible for the direct management of the 60-provider multi-specialty physician-owned Coastal Carolina Health Care medical practice and its ACO, which is currently in a two-sided risk model.  Prior to helping form Coastal Carolina Quality Care in 1997, he helped guide physicians and integrated hospital organizations in the formation of larger systems.

    Nuckolls earned his BA in Economics from Davidson College and his MAC from UNC’s Kenan-Flagler Business School. He is a founding member of the National Association of ACOs and served as its board chair from 2016-2017; he currently serves as Treasurer. He also has served on several advisory boards and committees for the North Carolina Medical Society and is a frequent speaker on ACOs and related topics at medical conferences including presentations for the Medical Group Management Association, the American College of Physicians, and the National Association of ACOs.

    Register for the webinar.

     
  • Learn About Office Based Opioid Treatment (OBOT) At These Upcoming Training Sessions

    Opioid addiction is a chronic, relapsing brain disease that affects millions of Americans and produces a tremendous burden on the health care system. In 2002, U.S. physicians gained the opportunity to treat opioid-addicted patients with buprenorphine in primary care settings, commonly referred to as office-based opioid treatment (OBOT). OBOT has been shown to be effective in primary care settings and impacts public health through the reduction of opioid use, opioid overdose mortality, and transmission of infectious diseases. However, it remains underutilized.

    One consistently cited barrier preventing OBOT expansion is lack of adequate clinical support given the additional needs for patient monitoring. Successful medication-assisted treatment (MAT) requires a team-based approach just like treatment for other chronic diseases. In addition, treatment is more effective when providers can use a trauma-informed and gender-responsive treatment plan.

    Learn about the North Carolina Medical Society (NCMS) Foundation’s Project OBOT initiative.

    Several upcoming trainings are designed to increase health care teams’ comfort with OBOT as well as provide waiver training.

    • Recovery Within Reach: Building Team Expertise in Office Based Opioid Treatment, Sept. 5, from 8:30 a.m. to 12:45 p.m. at the NCMS headquarters in Raleigh. Get the details and register.
    • Providers Clinical Support System: Buprenorphine Office-Based Treatment for Opioid Use Disorders (the “Half and Half” Course), Sept. 5, from 4:30-9 p.m. at the NCMS headquarters in Raleigh. Get the details and register.