This lunch and learn featured Thomas Kincheloe, NCMS Director of Legislative Affairs, and Alan Skipper, NCMS VP of External Affairs, presenting an overview of the first few weeks of the 2023 legislative long session in NC and a summation of what is happening at the federal level thus far in 2023.

Additional Resources:

On Point: Room with a View - by James E. Hill, Jr., MEd, PA-C Emeritus, DFAAPA

I have been clinically retired as a practicing PA for several years now after a 42-year career as a PA, mostly in emergency medicine. During that time, a number of patient experiences have remained with me, mostly for the life lessons they taught me. There is one, though, which has haunted me for over 10 years, and I’ve finally decided to banish those demons by sharing the story.

In emergency medicine, the practice environment is a closed system. There are no windows and the doors lead to other areas of the ED or the hospital. In wintertime, while working a day shift, it was dark when I left for work and dark when I finished my shift to drive home. The florescent lights on the ceilings are our synthetic sunshine.

One winter’s shift I arrived to discover that the Spanish interpreter we usually used to help us with our Hispanic patients had called in sick, and there was not a backup interpreter available. My first patient was a 12-year-old Hispanic girl who was presenting with 2 weeks of nausea. She spoke English fluently, but her mother did not speak English. I had a dilemma since there were no staff in the ED who spoke Spanish that day.

I decided to speak to the 12 year old since she was intelligent and appeared mature for her age. I did ask her to share my questions with her mother, and her answers with her mother---English to Spanish to English. A history of present illness revealed no associated symptoms---just intermittent nausea throughout the day for 2 weeks. She also told me she had not started having menstrual periods yet and had no boyfriends.

Her physical examination was normal---no signs of dehydration, no icterus, no abdominal discomfort. The decision was then made to obtain some laboratory studies (blood and urine) as a screening assessment. Just before sending these to the lab for analysis, my “6th sense” told me to add a urine pregnancy test. All the labs came back normal except for one---a positive pregnancy test.

I returned to the room to speak to my patient about her lab results. She swore to me, quite adamantly, that the test had to be a mistake as she had no boyfriend and had never had sex. I was determined to uncover the truth, and we continued our discussion for over an hour---her denials and my persistent assertions that it was important to face the truth for her health. Ultimately, she started to cry, then told me that her stepfather had been sexually abusing her for several years, finally progressing to penetration in the past few months. She begged me not to tell her mother, saying that he was the only one who worked in the family and that she, her younger brother and her mother would have no place to live if he was arrested. I convinced her to tell her mother what she had told me. And, I told both of them I had to report this to the police and to the social worker as what the stepfather was doing was harmful to both of them, as well as a crime.

The mother had difficulty accepting the diagnosis and the facts behind the pregnancy. The police arrived as well as a social worker, and the stepfather was arrested in the waiting room. All I could think to say to the 12 year old girl that she would come to realize later this was the only way to heal and move toward a healthy life.

I then returned to seeing other patients after being tied up with one patient for over 2 hours. As is common in emergency medicine, her follow-up was lost to me. At the end of my shift, I drove home in darkness, thinking about this child and the terrible events bringing her to the emergency department, wondering what would happen to her and her pregnancy, wondering if she and her family would survive the betrayal of trust from her step-father and his path through the criminal justice system, wondering if she would grow wiser in the coming years. It was then I had an epiphany. The emergency department may have no windows, but it is truly a room with a view. It allows us to see people in their worst times, caused by events not of their choosing in most cases, and it allows us as PAs to be part of their lives for a sliver of time when dealing with the results of those events. I’m happy to settle for that.

Public Health Principal Policy Draft: Comment Period Open

On Point: CMS needs to include measures for social drivers of health

This op-ed was shared on April 29, 2022, on STAT

By Michael DarrouzetJennifer Hanscom and Chip Baggett

Every day, physicians encounter patients in their practices who show the toll of skipping meals to feed their children, or who cannot refrigerate their insulin because they have no electricity. They know that improving their patients’ health is achievable only by addressing these and other social drivers of health (SDOH), but are often limited in their ability to do that.The Centers for Medicare and Medicaid Services (CMS) could change that by enacting the first-ever measures in a federal quality or payment program that offers incentives to physician practices and hospitals to engage their patients around these issues.A recent survey of America’s physicians conducted by The Physicians Foundation found that 80% believe that “the country cannot improve health outcomes or reduce health care costs without addressing SDOH.”Patients — and the physicians who care for them — bear the economic and psychological risk associated with unaddressed social drivers of health. The inability to address these drivers can lead to physician burnout, as well as penalize physicians caring for affected patients via lower scores on federal quality programs, like CMS’s Merit-based Incentive Payment System, which, in turn, negatively affects physician reimbursement.Physicians themselves have identified the top three most important strategies to address these issues: asking patients about their social needs, like access to healthy food or safe housing; investing in the technological and human capacity to connect patients with the community resources they need; and investing to ensure there are adequate community resources to meet patients’ social needs. In particular, the majority of physicians surveyed (65%) cited the importance of public and private payers enacting quality measures that address social drivers of health to improve health outcomes and ensure high-quality, cost-efficient care.

Yet even with an ongoing pandemic that has painfully brought these issues to the fore, no measures of social drivers of health exist in any federal quality and payment programs, and these factors are still not accounted for in CMS’s “risk adjustment” calculations — how healthy (or sick) a patient is and, therefore, how much their physician should be paid to care for them.

The Physicians Foundation, whose directors are appointed by 21 state and county medical societies, responded to CMS’s annual invitation for new Medicare measures by putting forward the first two SDOH measures ever proposed. These focus on the percentage of patients who are asked about food insecurity, housing instability, inadequate transportation, interpersonal safety, and difficulties paying for electricity and other utilities; and the percentage of patients who are positive for each of these needs. Even though CMS has declared it a priority to “develop and implement measures that reflect social and economic determinants,” these two measures are the only ones related to social drivers of health and are the only patient-level equity measures in this review cycle.

To truly move the needle to improve health outcomes for vulnerable Americans and give physicians the quality measures they want and need, CMS must act now to incorporate these two measures. Last week, CMS took a crucial first step by proposing these measures for the Hospital Inpatient Quality Reporting Program, which sets rules for Medicare payments to hospitals. Next, it will consider the same measures for the Merit-based Incentive Payment System.

Many stakeholders have emphasized the particular importance of the percentage of patients who screen positive for social needs. The rate itself should not be rewarded or penalized, recognizing that it would be influenced by the community in which a practice exists and its patient population. Yet this measure is essential to make visible and address factors that contribute to health disparities and support improvement activities. In addition, this measure would enable CMS to account for patient-level social drivers of health in risk adjustment, providing a more complete picture of the impact of these factors on health care costs, outcomes and disparities.

Both measures are essential to fulfill CMS’s commitment to health equity — articulated in its recently released health equity strategy pillar and its vision for the Centers for Medicare and Medicaid Innovation and its associated health equity initiatives, all of which cite the importance of routinely and in standard ways “collecting self-reported demographic and social-needs data.”

Over time, these measures of social drivers of health can and will be improved with the benefit of the input of physicians and patients across the country and the data generated by these measures. Yet we also recognize that, given the profound challenges that Covid-19 has wreaked on patients, physicians, and the U.S. health care system at large — and the commitment to equity and the reduction in health disparities that CMS and health care institutions across the country have declared — that time is of the essence in enacting these historic measures of social drivers of health.

Michael Darrouzet is the chief executive officer of the Texas Medical Association. Jennifer Lawrence Hanscom is the chief executive officer of the Washington State Medical Association. Chip Baggett is the chief executive officer of the North Carolina Medical Society. All are board members of The Physicians Foundation, a nonprofit seeking to advance the work of practicing physicians and help them facilitate the delivery of high-quality health care to patients.

On Point: Address rising violence in the ER - by Michael Utecht, MD

This op-ed was shared in several publications including the Raleigh News & Observer and the Charlotte Observer on January 27, 2022

Picture this: You’re a physician, nurse or other hospital staff member working a Friday night shift in a busy emergency department — where tensions often run high. Local law enforcement officers usher in a violent patient. He is placed in a room, evaluated and kept under guard for several hours.

Before it can be determined that the patient can be released back into police custody, he violently assaults a staff member, as well as the police officer guarding him. He grabs the officer’s weapon and threatens everyone around him. Shots ring out. Hospital police use deadly force to subdue the once patient, now assailant, and staff and patients flee.

This very scenario played out Jan. 14 in the Emergency Department at Duke University Medical Center. Violence in emergency departments and other hospital settings is growing at an alarming rate. Not just in large, urban centers but across the spectrum of healthcare facilities. VA hospitals, small rural hospitals and local community hospitals are not immune from such violence.

According to surveys by the American College of Emergency Physicians and the Emergency Nurses Association, almost half of emergency physicians report being physically assaulted at work, while about 70% of emergency nurses report being hit and kicked while on the job. Nearly 7 in 10 emergency physicians say their hospital reported the violent incident, yet only 3% of the hospital administrators pressed charges. So it is no surprise that 80% of emergency physicians say violence in the emergency department impacts patient care. To compound the problem, the COVID-19 pandemic has increased emergency department use by patients with behavioral health and substance abuse issues, pushing already resource-strained departments to the brink. Unfortunately, state and federal legislators have thus far done little to introduce legislation to prevent such violence. Often focused on “punishment” in the aftermath, no current legislation empowers hospitals to take the necessary measures to prevent violence in the first place. Simple measures such as requiring metal detectors at hospital main and emergency department entrances have proven to be effective as a first line of defense.

Sadly, some hospital administrators feel this promotes a negative image to their “clients,” although multiple studies have proven the contrary. Certainly metal detectors do not seem to deter anyone from attending a sporting event! Fortunately, groups like the American College of Emergency Physicians and Emergency Nurses Association continue to advocate for meaningful legislation to address violent crime in hospitals. Only time will tell if their efforts will put an end to the violence. But, quite frankly, time is running out. The frequency of violent attacks on nurses, physicians and patients in our nation’s emergency departments is unconscionable and unacceptable. For medical professionals, being assaulted must no longer be tolerated as “part of the job.” As one of the Duke Emergency Medicine residents said to me shortly after witnessing the events of that recent Friday night: “I never thought I was entering a profession where I could be killed!”


Michael Utecht is an emergency medicine physician in Durham and current president of the N.C. Medical Society.


Joint Legislative Oversight Committee - Medicaid and NC Health Choice

The Joint Legislative Oversight Committee on Medicaid and NC Health Choice met on January 12, 2020.

View the metting agenda here. Watch the replay of the meeting here.

COVID-19 Vaccine Distribution 

NC DHHS Secretary, Dr. Mandy Cohen, MD, provided the Committee an overview of the COVID-19 vaccine distribution process.
















North Carolina Healthcare Association Vaccine Rollout

Leah Burns, Vice President of Government Relations for the NC Healthcare Association provided an update on the vaccine distribution process from the hospital's perspective. She explained the steps to the process of vaccinate the 1A population and the 75+ population. She shared that flexbility, the CVMS operability, and rural popuations are current challenges. She suggested that working with primary care providers and retail pharamcies could help with vaccinating more individuals more rapidly.



DHHS Medicaid Transformation

Dave Richard and Jay Ludlam from the Department of Health and Human Services shared a brief update about the NC Medicaid Transformation.

Day 1 Goal for Transformation: Patients get the care they need, and providers get paid.


Identified Medicaid Transformation Challenges:

  • COVID-19
  • Provider Contracting
  • Legislative Changes
  • State Budget

Transparent Communication & Engagement with Partners:

  • Beneficiaries
  • Providers
  • Counties
  • Health Plans

Proactive Comunication

  • DHHS remains committed to transparency and frequent updates to the legislature and the general public.

Contracting During COVID-19

  • Contracting during the pandemic has made it challenging for providers & health systems to focus on contracting.
  • Plans are currently focused on open enrollment and contracting with primary care physicians and health systems.
  • NC Medicaid is convening workgroups between prepaid health plans and certain provider groups to understand and resolve issues that may be standing in the way of contracting.




Coronavirus Relief Fund Update

ABC Science Collaborative





House Select Committee on Community Relations, Law Enforcement and Justice

The House Select Committee on Community Relations, Law Enforcement and Justice met on December 14, 2020.

Listen to the entire audio here.

The Committee approved a draft report to be presented to the NCGA.

  • Create additional statwide law enforcement training require and provide additional educational and training resources
  • Create requirements for law enforcement agencies to report disciplinary actions, resignations, and terminations
  • Create whistlblower protection for officers that report misconduct
  • Provide law enforcement with additional resources encountering mental health issues in the field
  • Provide law enforcement with additional resources to recieve mental health treatment
  • Increase availability of specialty courts
  • Ban the use of chokeholds
  • Require law enforcement to report use of force incidents
  • Mandate the duty to intervene and the duty to report miscondcut
  • Fund pilot program for student law enforcment career exploration
  • Establish a system to allow infividuals to recieve notification of court dates

NC Child Fatality Task Force Intentional Death Prevention Committee

The NC Child Fatality Task Force Intentional Death Prevention Committee met on December 14, 2020 from 1:30-3:30.


Agenda Items

  • Student Mental Health and Child Abuse Neglect Reporting
  • Infant Safe Surrender
  • Updates from NC Division of Social Services

View all of the sildes for this meeting here.

Joint Legislative Program Evaluation Oversight Committee

The Joint Legislative Program Evaluation Oversight Committee met on Decenber 14, 2020.

North Carolina Council for Health Care Coverage Second Meeting

The North Carolina Council for Health Care Coverage will meet on Friday, December 18th at 10:ooam.

NCMS CEO, Chip Baggett, JD, and NCMS Board Member, Dr. Merritt Seshul, MD, MBA, FACS are members of this Council.

The meeting will be live streamed on Youtube here.

View the agenda here. View the participant list here.

Future proposed meeting dates:

  • Friday, January 8
  • Friday, January 22