Current Bulletin

  • Learning Opportunities

    Throughout the fall, NC DHHS is offering training to help you understand the state’s Advanced Medical Home model as the primary vehicle for delivering local care management at the transition to Medicaid managed care takes place. Learn more about the upcoming statewide webinars as well as the regional training forums and register.

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    First annual Raab Multidisciplinary Cancer Symposium: Melanoma – Surgery, Immunotherapy and Beyond, on Oct. 26, at the Eastern Area Health Education Center, 2600 W. Arlington Blvd., Greenville, NC. The purpose of this symposium is to provide comprehensive and state of the art evidence-based data from each discipline involved in the care of a specific disease site. Featuring the insight of nationally recognized leaders from all disciplines combined with regional experts in the field, the focus of this year’s conference is malignant melanoma. Learn more and register.

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    The Centers for Medicare & Medicaid Services (CMS) will host a MLN Connects® National Provider Call about Physician Compare on Oct. 30, from 1:30 – 3:00 p.m. Learn more about Physician Compare and the public reporting of 2017 Quality Payment Program performance information. The Physician Compare preview period allows clinicians and groups to review their performance information before it is publicly reported on the Physician Compare website. This webinar will describe: (1) what to expect during the upcoming 30-day preview period and (2) how to navigate previewing your performance information. __________________________________________________________________________________

    Registration is open for The Southeast Institute for Innovation in Palliative and Supportive Care at the University of Alabama will hold the Forging the Future of Palliative Care Summit 2018 on Nov. 1-2, in Birmingham, AL. Learn more and register.

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    ASPIRE to Knockout Pneumonia Readmissions on Nov. 2 from 8:30 a.m. to 3 p.m. at the Novant Health Conference Center in Winston-Salem. Dr. Amy Boutwell will use the ASPIRE tool guide to help participants design a data informed pneumonia readmission reduction strategy and action plan. Learn more and register.

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    Join current and future academic medicine leaders in Austin, TX Nov. 2-6, for the Association of American Medical Colleges Learn Serve Lead 2018. The conference brings together diverse stakeholders—medical school deans, hospital CEOs, university and hospital administrators, faculty physicians, scientists, researchers, physician residents and students—to advance new ideas by working and learning together. Learn more and register.

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    The ASAM Treatment of Opioid Use Disorder Course will be held Nov. 6 at the University of North Carolina School of Medicine in Chapel Hill from 8 a.m. to 12:30 p.m. The course covers all evidence-based practices and medications for treating patients with opioid use disorder. Physicians will be eligible to apply for the DEA DATA 2000 waiver after completion of this course. Learn more and register.

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    The Carolinas Center and the North Carolina Partnership for Compassionate Care will present a one day conference on Nov. 14 from 9 a.m. to 3:15 p.m. at Novant Health Forsyth Medical Center Conference Center in Winston-Salem on ‘Navigating the Future By Planning for the Unexpected.’ Learn more and register.

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    The NC ACO Council will meet on Thursday, Nov. 15, from 10:30 a.m. to 2:30 p.m. at the Piedmont Triad Regional Council, 1398 Carrollton Crossing Dr., Kernersville, NC. Watch the Bulletin for registration details. Questions please contact Danielle Snyder at dsnyder@ncmedsoc.org.

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    The Governor’s Institute inaugural fall conference Addiction Medicine Essentials will be held Nov. 16-17 at the Archie K. Davis Conference Center in RTP/Durham. The conference will cover a wide range of essential addiction medicine topics including AM 101, Pharmacotherapy, Pain & SUDs, Medical and Psychiatric Co-Morbidities and more! Up to 11.25 hours of CME pending. Learn more and register.

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    The 45th Annual Williamsburg Conference on Heart Disease will be held Dec. 2-4 at Williamsburg Lodge in Williamsburg, VA. Learn more and register.

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    ‘Providers’ Clinical Support System: Buprenorphine Office-Based Treatment for Opioid Use Disorders, the ‘Half and Half’ Course’ and ‘Recovery Within Reach: Building Team Expertise in Office-Based Opioid Treatment,’ will be offered at locations throughout the state beginning Dec. 4 and continuing through February. Learn more and register.

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    NCTracks has Computer-Based Training (CBT) courses on a variety of topics available to providers 24 hours a day, 7 days a week, every day of the year. Anyone who is a registered user with NCID access to the NCTracks secure Provider Portal can access and take a self-paced course. A list of courses available can be found here and under Quick Links on the NCTracks Provider Training page of the public Provider Portal.

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    MAHEC, working with the North Carolina Academy of Family Physicians, The Governor’s Institute on Substance Abuse and Project Lazarus: A Project of CCNC, is offering A Guide to Rational Opioid Prescribing for Chronic Pain, an online education course. The course is designed for all prescribing health care practitioners who are interested in an overview of the rational prescribing approaches for persons with chronic pain disorders. It will fulfill the North Carolina Medical Board’s requirement of at least one hour of continuing education designed specifically to address prescribing practices for chronic pain management. The course cost is $15 for the first 6 months. Offers 3 hours of AAFP, AMA/AAFP Equivalency, and CDE; www.mahec.net/opioid.

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    Save-the-Date for the Governor’s Institute’s 10th annual spring conference Addiction Medicine 2019 to be held in Asheville, NC on March 21-23 when we will take a deeper dive into all things addiction medicine!

     

     

     
  • After the Storm: The Story of Two Medical Practices in Eastern NC

    G & G Healthcare, Cerro Gordo

    Running a medical practice in poor, rural eastern North Carolina is not easy, but for one physician it is the culmination of his dream. Family physician Melvin Gerald, MD, grew up near Whiteville in Columbus County, and returned in 1998 to open G & G Healthcare. For the last 20 years, it has been a constant struggle – to find fellow health care professionals willing to live and practice in the area; to make ends meet when 80 percent of his patients are on Medicaid; and to survive when devastating hurricanes destroy his offices. But Dr. Gerald is not giving up.

    “I’m staying. That office in Cerro Gordo is my dream,” he says. Since he was a teenager, he knew he wanted to do something for his community. As a child, he remembers his mother seeking medical care and being “treated like dirt.”

    “When we’d get there, we’d be in the back room where they kept the cleaning supplies and stuff like that. I decided well before I finished high school, that one day I was going to go to college and go to medical school and then I was coming back home to help people who deserved health care most. That was always in my mind,” Dr. Gerald recalls.

    He made good on his promise, graduating from Morehouse College in Atlanta, receiving his medical degree and completing his residency at Howard University in Washington, D.C., and then earning his master’s degree in public health at Johns Hopkins University. When he returned to North Carolina as a family physician to establish G & G Healthcare in Cerro Gordo, Fair Bluff and Whiteville, Columbus County ranked last out of the 100 counties in the state in health indices, he said, noting that the needle has moved slightly in a positive direction since then.

    But then Hurricane Matthew washed out his office in Fair Bluff in 2016; and just last month Hurricane Florence flooded out his practice in downtown Whiteville. With no flood insurance, Dr. Gerald estimates rebuilding will cost between $50,000 and $75,000. Money he doesn’t have. But more troubling to him is the many patients he saw in Whiteville who won’t be able to make the 15-mile trip to Cerro Gordo to be treated.

    “Many practices in this area really don’t welcome Medicaid patients, unfortunately,” he said. “They will find it very difficult to be seen by any other providers. So, we’ve got more morbidity and more mortality. That’s what you’ll have.”

    Once the water in the Whiteville office receded, Dr. Gerald and his two brothers, who serve as COO and CIO for the practice, got together to rip out the soaked flooring. They’re awaiting word from the insurance company on what they might recover. But they are not optimistic.

    “I’m not sure we can afford to reopen that office. It’s been a drain. The whole endeavor,” Dr. Gerald said. “It never made a whole lot of money, but we provided services and I think we’ve impacted the health care of the county significantly. I don’t know how long we can continue to do this and especially with disaster after disaster, things we can’t control.”

    Video link: Dr. Gerald surveys the damage at his Whiteville practice on Thursday, Oct. 4.

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    Jessica Faircloth and Betty Van Swaim welcome patients at the makeshift reception desk outside Carolina Skin Vein.

    Carolina Skin & Vein Center, Wilmington 

    Four days before Hurricane Florence lashed Wilmington, Lois Beard Martin, DO, a dermatologist and owner of Carolina Skin & Vein Center, was seeing patients, completing skin cancer surgeries, taking biopsies — and hurricane-proofing her practice as much as possible before evacuating.

    Two weeks passed before the water receded and the roads into Wilmington were passable again, allowing Dr. Martin to return to assess the damage to her office. It had been flooded out. The watermark running along the bottom of the walls shows that the floodwaters reached above the baseboards in spots. The flooring has already been ripped out; the sheet rock walls will need to be replaced. For now, dehumidifiers run constantly, the pans needing to be changed every few hours in an attempt to keep the mildew at bay, but already the cloying, moldy smell sticks in the nostrils.

    But Dr. Martin, a solo practitioner, needed to continue seeing patients – for the sake of her business and the welfare of her patients. Racking her brain for alternatives, she had an epiphany. She phoned a family member in Ohio, who promptly made the 12-hour drive to Wilmington in their RV.

    The 25-foot Palomino Puma now sits in the parking lot outside her office. A makeshift waiting area with two chairs, an end table and magazines is set up alongside. Jessica Faircloth answers the office phone — its cord snaking inside to the phone jack — sitting at a card table reception desk on the sidewalk outside the front door.

    “Patients were lining up, saying ‘we’ve got to be seen,’” said nurse, Betty Van Swaim. While they can’t do surgery in the RV, “we can write a prescription, freeze a wart, do follow-up to surgeries,” she said.

    The makeshift office space opened three weeks after Hurricane Florence and a steady stream of patients have been coming; patiently sitting in the breezy and humid outdoor ‘waiting room’ for the doctor to see them. Others have been calling insisting they need to be seen. Surgeries need to be performed.

    Despite a waiver issued by US Department of Health and Human Services Secretary Alex Azar before Florence hit, Dr. Martin is still waiting on approval from Medicare (70 percent of her patients are on Medicare) to change location and be paid for seeing patients.

    Dr. Martin and her staff have been touched by the outpouring of support from her patients. However, her staff is becoming discouraged because its been three weeks of continued delay. “I need an answer from CMS,” Dr. Martin said.

    She has reached out to her US Representative David Rouzer’s office where his assistant Pam Neville is trying to expedite the process. Now, to add to her stress, Hurricane Michael is bearing down on the state.

    “I’m not giving up,” Dr. Martin said. “It’s hard enough as a small business owner after a natural disaster such as this, but the added bureaucracy and red tape makes it worse.”

    Dr. Martin describes the impact of Florence on her practice.

     

    The North Carolina Medical Society Foundation has established a Disaster Relief Program to help practices like Dr. Gerald’s and Dr. Martin’s. Learn more and please consider a donation.

    Donate today.

     
  • Exercise Your Power – Vote for 2019 NCMS Leadership

    All active North Carolina Medical Society (NCMS) members received an email last Thursday, Oct. 4, with a unique link to cast their ballot for NCMS leadership. Unfortunately, voter turnout has gradually tapered off since that day. If you have not yet voted, please look for the email from election@intelliscaninc.net, the third party vendor conducting the secure and confidential election, and VOTE! Those without email addresses received a postcard with the link and login instructions.

    To review who is running for the open positions on the NCMS Board of Directors, AMA Delegation and Nominating and Leadership Development Committee, visit our NCMS Election Headquarters site to review the candidate profiles.

    The final results will be announced at the NCMS Annual Business Meeting to be held at the LEAD Health Care Conference on Friday, Oct. 19 at noon. Register for the conference.

     
  • Final Countdown Begins: LEAD Health Care Conference Is Next Week!

    Only a few days remain to register for the LEAD Health Care Conference, which will convene next Thursday in Raleigh. Don’t miss this educational opportunity (over 10 hours of CME is available); the chance to connect and reconnect with your colleagues from throughout the state and a time to have fun and explore our capital city (watch a light-hearted look at what fun is available during the conference).

    A few highlights of the conference include:

    • More than 30 speakers presenting on topics ranging from physician burnout to the current political scene to unconscious bias in health care and more. See who all will be speaking.
    • A chance to hear what’s on the mind of our future health care leaders as the 2018 Leadership College scholars each give at 10-minute MedTalk revealing findings from their year-long projects. Learn more about MedTalks.
    • Enjoy dinner at the landmark Angus Barn Pavilion – a time to relax with colleagues over delicious food.
    • Kick up your heels and celebrate health care leaders at our LEADership Dinner. The culmination of the conference and a chance to dance the night away to the swinging sounds of the Russ Wilson & His Famous Orchestra.

    Register now before it’s too late!

    A special shout out to our sponsors: Carolina Complete Health and Medical Mutual Insurance Company, our premier sponsors; Smith Anderson, gold sponsor and Emtiro Health, silver sponsor.

     

     

     

    Note: If you have already registered, please bring donations for the Inter-Faith Food Shuttle, which will have a truck parked at the conference hotel to collect food and other supplies for those affected by the recent hurricane as well as others who need help. Here is a list of suggested items to donate.

     
  • NCMB Seeks Input On Statement Regarding Signing Death Certificates

    The North Carolina Medical Board (NCMB) would like to hear from physicians and PAs about its proposed position statement on clinicians’ obligation to sign death certificates. Feedback is due no later than end of business on Monday, Oct. 15.

    The NCMB believes that licensees should complete death certificates if requested, although it also has stated that it has no interest in pursuing disciplinary action against any physician or PA who inaccurately states a cause of death on a death certificate, provided the death was certified in good faith and to the best of the licensee’s abilities. Review the Board’s proposed position statement that reflects this belief.

    Enter your comments on the NCMB’s policy discussions page.

     

     
  • Appalachian Regional Begins NCMS Leadership Training Program

    The Advancing Leaders Program, a customized course designed specifically for Appalachian Regional Healthcare System (ARHS), launched last week with 21 scholars seeking to hone their leadership skills. The curriculum, specially created through the North Carolina Medical Society (NCMS) Foundation’s Kanof Institute for Physician Leadership, will guide the participants as they develop and practice individual leadership skills to meet challenges and issues related to management and leadership in their health care system and the larger community.

    Over the course of the year-long course, the scholars will explore three key topics: leadership and leadership styles, change and change immunity, and emotional intelligence and communication.

    ARHS President and CEO Chuck Mantooth and Chief Physician Executive Danielle Mahaffey, MD, recently made all physicians in the system NCMS members and worked with Kristina Natt och Dag, NCMS vice president for Leadership Development, to customize this leadership development program to serve their needs.

    “The ultimate goal is to give participants the tools they need to effectively apply what they learn in working with their staff and the whole health care team,” Natt och Dag said. “This is where positive organizational change begins – with the individual.”

    If you or your practice is interested in exploring leadership development opportunities through KIPL, please visit the institute’s website.

     
  • Checks Finally Coming Through for Vaccine Underpayments

    The $10-$12 million in underpayments for vaccine administration in 2013 and 2014 are beginning to arrive in mailboxes of pediatric practices. The underpayment affected approximately 2.5 million vaccinations administered to Medicaid patients under the Vaccines for Children (VFC) program during those years.

    Last year, the North Carolina Pediatric Society and the North Carolina Academy of Family Physicians (NCAFP) along with eight member practices were victorious in their lawsuit to correct underpayment of the vaccination administration fees. In November, the NC Division of Medical Assistance (DMA/Medicaid) decided not to appeal the Superior Court’s decision that they must rectify the underpayment of Medicaid vaccine administration payments made in 2013 and 2014. Superior Court Judge Beecher R. Gray allowed DMA until November 2018 to reprocess the claims.

    The NC Department of Health and Human Services (NCDHHS) identified all codes that were underpaid and will remit the difference directly to each affected practice. Practices will be reimbursed $6.74 per qualifying vaccine.

    The North Carolina Medical Society (NCMS) once again congratulates the NC Pediatric Society and the NCAFP for this important legal victory on an issue that the NCMS and the other organizations have long advocated to correct.

     
  • Planning Ahead for the 2019 Legislative Session

    Dr. Richard M. Wardrop, III, and six UNC School of Medicine students attended the first White Coat Wednesday of 2018’s legislative short session.

    While January 2019 may seem far away, the start of the North Carolina General Assembly’s long legislative session will be here before you know it. Now is the time to plan how you want to be involved this coming year.

    • Sign up now for a White Coat Wednesday. This popular day at the State Capitol allows you to meet with your legislators to discuss the health care policy issues that concern you and your patients. Our legislative affairs staff will offer pointers on how to effectively communicate with legislators and build a good working relationship. Learn more and sign-up now.
    • Serving as Doctor of the Day at the General Assembly is a distinct personal honor and an honor for the profession of medicine. Volunteering to serve allows you a seat on the floor where legislators conduct the state’s important business. Contact the Speaker of the House Tim Moore’s office (919-733-3451) or his legislative assistant, Brittany Eller, eller@ncleg.net to inquire about becoming Doctor of the Day during the upcoming session.
    • If you’re not already registered to receive our Action Alerts, be sure to do now. When physicians and PAs most need to make their voices heard with legislators, you’ll receive an email alert from us. Sign up now.
    • Finally, be sure to vote in the upcoming elections on Nov. 6. Look up the candidates who will appear on your ballot and educate yourself on the amendments here.
     
  • Help Your Patients Choose Wisely

    Choosing Wisely® in North Carolina, which aims to reduce health care waste by helping patients make smart and effective health care choices, now offers a new tool to help achieve this goal. The new Choosing Wisely toolkit offers resources and suggestions on how to effectively communicate with and educate patients to make wise choices. This information is particularly important now as the flu season begins and patients may be requesting unnecessary antibiotics to treat the flu, for instance.

    The North Carolina Medical Society (NCMS) along with four partners received a Choosing Wisely grant in 2016 administered through the North Carolina Healthcare Quality Alliance (NCHQA) to reduce by 20 percent the unnecessary use of antibiotics to treat viral bronchitis in adults, DEXA scans to measure bone density in women younger than 65 and men younger than 70, and annual Pap tests for women between the ages of 30 and 65. These are all examples of care that is not recommended under current medical guidelines.

    Partners Duke Health and Cornerstone Health Care implemented programs to reduce unnecessary tests and procedures and surpassed the goals set out in the grant. The NCMS, Blue Cross Blue Shield of North Carolina and the State Health Plan for Teachers and State Employees all conducted complementary efforts to educate clinicians and consumers in N.C. about the problem of test and antibiotic overuse.

    Keep the momentum going by accessing the new Choosing Wisely toolkit. You can learn more about Choosing Wisely at the NCMS LEAD Health Care Conference on Thursday, Oct. 18, when those involved with the recent Choosing Wisely grant hold a panel discussion on “The Choosing Wisely Program: How NC Health Systems and Practices Are Reducing Costs.” Learn more and register.

     
  • Congress Agrees On Legislation To Address Opioid Epidemic

    Last week, the United State House passed H.R. 6, the “SUPPORT for Patients and Communities Act,” by a vote of 393 to 8, and the Senate followed suit, passing H.R. 6 by a vote of 98 to 1. President Donald Trump is expected to sign the bill into law.

    The legislation touches on almost every aspect of the opioid epidemic, including access to substance-use disorder (SUD) prevention and treatment programs. The AMA lobbied in favor of provisions that would:

    • Expand existing programs and create new programs to prevent SUDs and overdoses, including reauthorization of the Office of National Drug Control Policy.
    • Expand programs to treat SUDs, including medication-assisted treatment (MAT); partially lift (for five years) a current restriction that blocks states from spending federal Medicaid dollars on residential addiction treatment centers with more than 16 beds by allowing payments for residential substance-use disorder services for up to 30 days; and allow Medicare to cover MAT, including methadone, in certain settings, to treat SUDs.
    • Increase funding for residential treatment programs for pregnant and postpartum women; and require the Centers for Disease Control and Prevention (CDC) to develop educational materials for clinicians to use with pregnant women for shared decision making regarding pain management during pregnancy.
    • Authorize an alternative payment model demonstration project developed by the American Society of Addiction Medicine, with support from the AMA, to increase access to comprehensive, evidence-based outpatient treatment for Medicare beneficiaries with opioid-use disorders.
    • Authorize CDC grants for states and localities to improve their Prescription Drug Monitoring Programs (PDMP), collect public health data, implement other evidence-based prevention strategies, encourage data sharing between states, and support other prevention and research activities related to controlled substances, including education and awareness efforts.
    • Expand the use of telehealth services for Medicaid and Medicare SUD treatment.
    • Provide loan repayment for SUD-treatment professionals, including physicians, who agree to work in mental health professional shortage areas (HPSAs) or counties that have been hardest hit by drug overdoses, and clarify that mental and behavioral health providers participating in the National Health Service Corps can provide care at a school or other community-based setting located in a HPSA as part of their obligated service requirements.
    • Help stop the flow of illicit opioids into the country by mail, especially synthetic fentanyl and its analogs.
    • Provide funding to encourage research and development of new non-addictive painkillers and non-opioid drugs and treatments.
    • Require the U.S. Department of Health and Human Services (HHS) to study and report to Congress on the impact of federal and state laws and regulations that limit the length, quantity, or dosage of opioid prescriptions.

    The final bill also retained some provisions with which the AMA raised concerns, primarily related to mandates on physicians and duplicative requirements in state and federal programs. Read the AMA’s full report.