NCMS, Author at North Carolina Medical Society - Page 25 of 38

NC Harm Reduction Coalition Reports Over 4000 Overdose Reversals Since 2013

As of Aug. 31, 2016, the North Carolina Harm Reduction Coalition (NCHRC), a statewide nonprofit dedicated to reducing drug overdose deaths has reported that since Aug. 1, 2013 when they began distributing overdose prevention kits containing the opioid antagonist naloxone, the total number of overdose reversals they know of stands at 4170. For a list of reversals by city click here.
The NCHRC began offering naloxone along with overdose prevention training to community members after the passage of the 911 Good Samaritan law in North Carolina. The 911 Good Samaritan law encourages people to seek medical help for an overdose by offering limited immunity for some drug, alcohol, and probation/parole violation offenses. It also grants civil and criminal immunity to anyone who administers naloxone in good faith and allows community-based organizations to distribute naloxone through a special prescription (a standing order) from a medical provider.
In June 2016, North Carolina Medical Society (NCMS) Board member Jeffrey Runge, MD, and NCMS member Joshua Landau, MD, both stood behind Governor McCrory as he signed a bill into law authorizing state health director Randall Williams, MD, to sign a statewide standing order for naloxone. Dr. Williams lauded the NCMS’ support of the bill and efforts to curb prescription drug abuse.
NC Department of Health and Human Services (DHHS) Secretary Richard Brajer noted at the bill signing ceremony that last year almost 1,000 people in the state died from drug overdoses. These deaths, he said, could have been “reversible” had naloxone been readily accessible.
Now, with the statewide standing order, any licensed pharmacist can dispense the drug to someone who is at risk or knows someone at risk for opioid overdose. Pharmacists can choose to dispense the intranasal or intramuscular form of naloxone. The intramuscular form is cheaper, but the branded intranasal form called Narcan, is easy to administer. Medicaid will cover all the options listed in the standing order, but otherwise prices will vary depending on the insurance plan. Without insurance, cost estimates for Narcan range from $150 to $180.
For more information, visit the state’s site at www.naloxonesaves.org. The NCHRC also has information on overdose training and how to receive a naloxone kit at their website here.

Study Shows Nearly 40 percent of U.S. Physicians Now Employed By Hospitals or Health Systems

A new study prepared by Avalere Health finds the number of physician practices owned by hospitals/health systems rose 86 percent between 2012-15, with the percentage of physicians employed by hospitals or health systems increasing in every region of the country during this time. Released by the Physicians Advocacy Institute (PAI), the analysis also finds that by mid-2015, 38 percent of U.S. physicians were employed by hospitals and health systems. This reflects roughly a 50 percent increase between 2012 and 2015, growing from 95,000 employed physicians in 2012 to more than 140,000 employed physicians in 2015.
In its analysis of hospital acquisitions of physician practices, the study shows that as of mid-2015, one in four medical practices was hospital-owned. From 2012 to 2015, hospitals acquired 31,000 physician practices. These acquisitions typically involve the acquisition of the services of multiple physicians through employment contracts, as well as the practice’s physical building and equipment. PAI studied these trends in order to better understand how these changes affect the practice of medicine for physicians and also implications for patients and the wider health care system.
Another PAI analysis developed by Avalere earlier this year found Medicare payments for three common services are up to three times higher when performed in a hospital outpatient department instead of a physician-owned office.
“Medicare spends less when patients receive treatment in a physician’s office, yet the number of physician-owned medical practices is rapidly shrinking,” said Kelly Kenney, PAI executive vice president. “The shift toward more physicians employed by hospitals could mean higher costs for the entire health care system. For patients, it impacts both where they receive and how much they pay for care.”
North Carolina Medical Society (NCMS) CEO Robert Seligson, in his capacity as PAI President noted that: “Regardless of where they live, physicians who want to remain in private practice are under tremendous pressure. Payment policies from governmental agencies and health insurance companies heavily favor large health systems and make it challenging for independent physician practices, especially smaller practices, to survive. Just like what’s happened with local book stores and corner grocers, it is increasingly hard for local physicians to own their practice. The incentives are stacked against them.”
Learn more about the study in the Q and A here and this PowerPoint presentation. Read the media release here.

What the National and Local Elections Might Mean for Physicians and PAs

While you may feel inundated with information about November’s national and local elections, be sure to subscribe to North Carolina Medical Society (NCMS) Director of Legislative Relations Chip Baggett’s popular Bowtie Briefing. These weekly videos focus on the timely legislative and advocacy issues of particular interest to you as physicians and physician assistants. Stay informed during this important election season by sending your name and email to [email protected] and saying ‘sign me up for the Bowtie Briefing.’
See what a Bowtie Briefing is all about by watching last week’s briefing here.

NCMS Seeks Applications for PHP Board

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. Through December 31, 2016, the NCMS will be 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. View the PHP Director Responsibilities (PDF).
Interested physicians should complete the application form and return it to Evan Simmons, [email protected] (preferred), or by US Mail to PHP Board Applications, North Carolina Medical Society, Post Office Box 27167, Raleigh, North Carolina, 27611 by December 31, 2016.

Concussion Brochure Helps You Communicate With Parents

The North Carolina Brain Injury Advisory Council and the Brain Injury Association of North Carolina are offering physicians and physician assistants a new tool to help them communicate with parents whose children have suffered a concussion.
The brochure “Returning to School After a Concussion” assists parents in understanding the school’s role in supporting appropriate recovery of students who sustain concussions. It is intended to enhance communication from medical providers to parents, and parents to schools, in order to ensure that all students who sustain concussions are being appropriately monitored and supported as they transition back into their respective educational environments. Download the brochure for distribution to your patients here.
In 2011 the North Carolina General Assembly passed the Gfeller Waller Concussion Awareness Act (GWCA), which addresses concussion management for injuries experienced in the context of participation in public school sports. This law provided clear guidelines and procedures for managing the concussion symptoms of middle and high school students, including return-to-play guidelines, but did not address:

non-sports related injuries,
injuries that occurred outside the school setting,
injuries to younger children, or,
needs of students as they returned to the educational environment.

The current education policy provides “return-to-learn” guidelines that should assist all NC public school systems in addressing the learning, emotional, and behavioral needs of all students, including those under the GWCA, following a concussion.
In support of the Return to Learn policy, an Implementation Guide has been developed. This guide is intended to:

Provide guidelines for the identification of students who have sustained a concussion;
Guide staff in the evaluation of a student with a concussion and provide guidelines for parent notification;
Provide parents and staff with concussion education;
Provide guidance for staff as they develop educational and health-related accommodations for students who have sustained a concussion;
Provide guidance to staff as they provide educational supports for students with prolonged symptoms related to concussion. (Persisting problems following concussion in children are more common in those with previous head injury, as well as those who have experienced preexisting learning difficulties, neurological, or psychiatric difficulties.)

The “Return to Learn” brochure was developed to establish a uniform system of communication regarding the school’s role in concussion management that can be provided to the parent by the medical provider at the point of diagnosis.

Three NC ACOs Make '100 ACOs To Know' List

Cornerstone Health Enablement Strategic Solutions in High Point, Triad HealthCare Network in Greensboro, and WakeMed Key Community Care in Raleigh were identified by Becker’s Hospital Review as among the ‘100 ACOs to Know’ nationwide. This is the fifth year for the listing, which is based on quality and cost performance, participation in the Centers for Medicare and Medicaid Services (CMS) Next Generation Model, the Pioneer Model or advanced tracks of the Medicare Shared Savings Program as well as if the organization has recently established new commercial agreements.
According to January 2016 data from Leavitt Partners, ACOs cover approximately 28.3 million lives in this country and continue to experience rapid growth.
The North Carolina Medical Society (NCMS), through its work spearheading the Toward Accountable Care Consortium and Initiative, offers valuable resources for those practices exploring alternative payment models like ACOs. Learn more here.
Read what Becker’s has to say about Cornerstone here; Triad HealthCare here and WakeMed Key here. See the full list of ‘100 ACOs to Know’ here.

New Book Documents Link between Poverty and High Health Care Costs

The Physicians Foundation recently announced the release of Poverty and the Myths of Health Care Reform, which was commissioned by the Foundation and documents the impact of social determinants on health care costs. Authored by the late Richard (Buz) Cooper, M.D., a prominent physician and academic, the book draws on decades of health research and economic data to demonstrate the pervasive, debilitating effects of poverty on health care costs, resource utilization and overall patient outcomes.
"The essential truths uncovered in Buz's work are very clear from my own medical practice," said Joseph Valenti, M.D., FACOG, and Physicians Foundation Board Member. "Poverty has become one of the most challenging issues we face here in the U.S., particularly with the financial burden it places on our healthcare system in comparison to other developed nations. Insights from this book should help all healthcare stakeholders, including legislators, acknowledge the tangible impact of poverty on costs, outcomes and society as a whole."
To hear more insights from Dr. Valenti as well as other colleagues, friends and family about Dr. Cooper's findings and life, view their video commentary here.
For more information, please visit www.physiciansfoundation.org.

Clinical Laboratory and Consultation Service Joins NCMS Marketplace

Radeas, a clinical laboratory and consultation service, has joined the North Carolina Medical Society (NCMS) Marketplace as a gold level partner.
Radeas provides a comprehensive solution of laboratory services to health care providers. By delivering toxicology and hormone testing, wellness panels as well as consulting services, they aim to produce a full scope of medical laboratory services both accurately and efficiently.
They invest in Sciex 6500 Series Mass Spectrometers, the finest state of the art equipment available today. These are the gold standard in laboratory equipment, providing substance detection levels down to n0.2 ng/mL. Their team of scientists holds multiple patents in the industry. Radeas’ methods drive better medical decisions by providing the most accurate data available today. Their medical directors from Duke ensure their methodologies deliver world class data.
Their motto is that they deliver objective truth and constantly reinvest in the newest and best equipment available, continually evaluating the market and investing in the best science has to offer.
Learn more at the NCMS Marketplace or the Radeas website. Contact Radeas directly at 919-263-1150 or [email protected].

Dr. Fagg Honored With Order of the Long Leaf Pine

dr. fagg receives award — Dr. Fagg accepts his award from Sec. Brajer.

Long time North Carolina Medical Society (NCMS) member and former NCMS President John A. Fagg, M.D., of Winston-Salem, received the Order of the Long Leaf Pine recently for his service to North Carolina, particularly in the advancement of the practice of medicine.
A native North Carolinian, Dr. Fagg has served on the North Carolina Medical Care Commission for 13 years, the last two as its chairman. He was joined by his wife Nancy, son John and daughter Caroline for the presentation Aug. 12 by Department of Health and Human Services Secretary Rick Brajer. The award was presented during a quarterly meeting of the Medical Care Commission.
The Order of the Long Leaf Pine is one of the most prestigious awards presented by the Governor of North Carolina. It is presented to individuals with a record of extraordinary service to our state. Gov. McCrory asked Secretary Brajer to present the award.
During Dr. Fagg’s tenure the commission has approved 203 bond issuances representing $17.6 billion, which improve access to health care facilities at lower costs to North Carolinians. He has provided medical leadership in his local community, in our state, and nationally, having served in numerous leadership positions at Novant/Forsyth Memorial Hospital, the North Carolina Medical Society, and the American Medical Association.
Congratulations Dr. Fagg!

Pieces of the Whole -- A Wellness Series, Part 3

Well-being is more than simply the absence of disease. It is the full integration of social, emotional, spiritual, environmental, occupational, intellectual and physical wellness. These seven dimensions act, and interact, in a way that contributes to the overall quality of life.
Over the next few issues of the NCMS Bulletin, Jason Horay, MS, ATC, CHES, the NCMS Plan Health Promotion Coordinator, will take you on a journey through each aspect of well-being, offering personal reflections and examples of ways to enhance each dimension within your workplace, community, and at home.
We encourage you to share this content with colleagues using social media and to share your ideas and personal experiences for enhancing your well-being by posting comments to the blog.
The next installment focuses on spiritual well-being.
Spiritual Well-being
Spiritual well-being is the ability to balance your inner needs with the needs of the world surrounding you to create a state of harmony. It is understanding the morals and values that guide and shape you, and the sense that your life has meaning and purpose.
Whether we realize it readily or not, we each have a code of ethics, values and morals that play a part in guiding us throughout life. During the search for spiritual well-being, a person may notice feeling a balance of both peace and frustration. It is important to realize the importance of negative emotions, such as frustration, doubt and fear, as well as the positive emotions, such as happiness and gratification. You will begin to experience harmony and spiritual wellness when your actions are driven by your beliefs.
I would encourage everyone to create your own Mission Statement based on your personal philosophy. A Mission Statement is about one to three sentences in length and dictates how you will navigate through all of life’s decisions based on your own set of beliefs. It is personal and does not have to be shared with anyone else. You may choose to display it somewhere you can see it every day.

In the News

Ribbon Cut At New Cherry Hospital; Will Serve More in Southeast NC, The Robesonian, 9-6-16
Half Of Physician Time Spent on EHRs and Paperwork, NEJM Journal Watch, 9-6-16
CEO Power Panel: Are Your Physicians Ready for Reform?, Modern Healthcare, 9-3-16
How To Tell A Mother Her Child Is Dead, The New York Times, 9-3-16
NC To Receive About $950,000 For Opioid Treatment, Greensboro News-Record, 8-31-16
The Roadmap to Physician Payment Reform: What Will It Take for All Clinicians To Succeed Under MACRA, Health Affairs, 8-30-16
State Opens Long-Delayed New Psychiatric Hospital for Eastern NC, Triangle Business Journal, 8-30-16
Report Shows 90 NC Counties May Have Only One Exchange Health Insurer, Winston Salem Journal, 8-30-16
FDA OKs Concussion Screening App, MedPage Today, 8-29-16
Pediatricians Urge States To Get Tough On Parents Who Don't Vaccinate Their Kids, The Los Angeles Times, 8-29-16
Top MSSP ACOs In Quality, Shared Savings for 2015, Becker's Hospital Review, 8-26-16
Purdue Pharma Rejects Request from New Hampshire Attorney General For Information on Suspected Diversion of OxyContin, The Los Angeles Times, 8-26-16

Learning Opportunities

The North Carolina Chapter of the Healthcare Financial Management Association (HFMA) will hold its 2016 Health Insurance Institute on Sept. 22-23, at the Sheraton Hotel, Four Seasons in Greensboro. Learn more and register here.

28^th Annual Fall Foliage Cancer Conference, “Update on Melanoma and Gastrointestinal Cancers,” will be held Oct. 21-22 at the Grove Park Inn in Asheville. More information and registration available here.

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

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.

The Medical University of South Carolina (MUSC) Department of Healthcare Leadership and Management is offering the 19th Annual Healthcare Leadership Conference on Friday, October 21^st, 2016 at Charleston Area Convention Center in North Charleston. Panels will focus on composition and development of our health care workforce. The three sessions focus on: 1) Talent Management for Bench Strength Development; 2) Diversity and Inclusion and 3) Developing an Environment of Civility and Respect In Healthcare Organizations: Resources to Empower Healthcare Leaders to Identify, Intervene, and Prevent Workplace Bullying, Incivility and Disrespect. Learn more and register here.

An Election In Which You’ll Enjoy Voting For the Candidates

Yes, the November elections are just around the corner, but before you cast your ballot for POTUS, the polls will open for North Carolina Medical Society (NCMS) officers and representatives in just over a week. You will receive your ballot by email (please contact us at [email protected] if you need a paper ballot), so be sure to add Survey and Ballot Systems to your email contacts list. This is the third-party vendor that will be conducting the election. Around Sept. 1, begin watching your email and spam filters for a message from “North Carolina Medical Society Election Coordinator mailto:[email protected]”. This will be your formal ballot.
All NCMS members are eligible to vote for your society’s leaders. Voting will close on Thursday, Sept. 15 at midnight, and election results will be announced at the Annual Business meeting on Saturday, Sept. 17, between 2:45 to 5 p.m. at the Grandover Hotel in Greensboro. Register for the Annual Business meeting as well as the M3 conference educational sessions here.
Here is your slate of officers as they will appear on your ballot:
President-Elect - John L. Reynolds, MD
Board of Directors, Region 2 -Jeffrey W. Runge MD
Board of Directors, At-Large - Brian S. Kuszyk, MD
AMA Delegates

John R. Mangum, MD - CHAIR
William E. Bowman, MD
Darlyne Menscer, MD

AMA Alternate Delegates

G. Hadley Callaway, MD
Liana Puscas, MD

Send Us Your Agenda Items for the Annual Business Meeting

If you have an issue that needs to be considered by the North Carolina Medical Society (NCMS) leadership, please submit it as soon as possible to NCMS President Docia Hickey, MD, at Docia Hickey [email protected] or NCMS CEO Robert W. Seligson at [email protected] or consideration for the agenda at our Annual Business Meeting on Saturday, Sept. 17, from 2:45 to 5 p.m. at the Grandover Hotel in Greensboro. Register here for the business meeting, and be sure to check out the educational conference being held that weekend worth 13.75 hours of CME.
With the dissolution of the House of Delegates last year, the NCMS membership has opted for a more direct form of policy making by bringing issues directly to the Board of Directors. This is your chance to have a voice on an issue of importance to you, your practice and your patients.
Submit your agenda item to Dr. Hickey.
Submit your agenda item to Robert Seligson.

Not-So-Early Bird Still Can Get Worm

Early bird pricing for the M3 – Merging Medicine and Management – Conference, Sept. 15-18, at the Grandover Hotel in Greensboro, has been extended until this Friday, Aug. 26.
REGISTER HERE
This important gathering features a wide array of educational sessions important to the success of your practice and that will inspire you with tips and techniques on how to reduce your stress and be happier during these tense times. How can you even put a price tag on your happiness? Get the specifics on the speakers, the 13.75 hours of CME available and register today. By signing up now, you still have access to our group rate for hotel accommodations at the Grandover.
Helpful links:
M3 Conference Registration Brochure for NCMS members (PDF)
M3 Conference Registration Brochure for NCMGMA members (PDF)
Accommodation Information

New Opioid Prescribing CME Rules Approved

The NC Rules Review Commission has granted final approval to North Carolina Medical Board rule changes that establish a new requirement for physicians and physician assistants (PAs) to earn continuing education hours in controlled substances prescribing.
The requirement applies to physicians and PAs who prescribed controlled substances during their most recent continuing medical education (CME) cycles. Physicians must earn three hours of CME in controlled substances prescribing during each three year CME cycle. PAs must earn two hours of CME in controlled substances prescribing during each two year cycle. Licensees who prescribed no controlled substances during their most recent CME cycles are not subject to the requirement.
To count towards the requirement, CME hours must include instruction on controlled substance prescribing practices, recognizing signs of the abuse or misuse of controlled substances, and controlled substance prescribing for chronic pain management. It is not necessary for each class completed to cover all three education topics; However, all three topics must be covered within the cumulative total hours completed.
The new CME requirement will be in effect as of July 1, 2017. Licensees whose CME cycles end on or after July 1, 2017, will be expected to complete CME hours that fulfill the new requirement.
For more information on the new CME requirement, including an extensive FAQs list, visit NCMB’s resource page at www.ncmedboard.org/prescribingCME
Be sure to take advantage of the FREE Opioid Prescribing CME offered at the upcoming M3 conference in Greensboro on Sept. 15-18. The opioid prescribing CME session, "Opioid Prescribing: Safe Practice, Changing Lives," will be offered on Saturday afternoon. Register for this session and browse the M3 site to learn about the nearly 14 total hours of CME available at this valuable event. Learn more and register here.

BCBSNC Extends Date for Mid-Level Provider Credentialing

Blue Cross and Blue Shield of North Carolina (BCBSNC) has extended the deadline for mid-level provider credentialing until March 1, 2017. In the last Bulletin we reported that nurse practitioners (NPs), physician assistants (PAs), and certified nurse midwives (CNMs) working with in-network groups and providing services for commercially-insured BCBSNC members, would be required to complete credentialing with BCBSNC, on or before January 1, 2017. BCBSNC extended the deadline until March, due to the high response of credentialing applications already received, they said.
“We appreciate the quick response from NPs, PAs, and CNMs initiating credentialing with BCBSNC,” the insurer said on its website. “We're actively working to complete the applications we've received. If you have not yet submitted a credentialing application to BCBSNC, please wait to send in your applications until October 1, 2016, or later. If you have already completed your application and obtained the time-sensitive supporting documents, we will not reject your application if it is received before October 1.”
Only NPs, PAs, and CNMs who are not already credentialed by BCBSNC are required to complete credentialing by March 1, 2017. Often, NPs, PAs, and CNMs work at more than one location, and may already be credentialed for the services they provide at another site. In these cases, if the credentialing was completed directly with BCBSNC, rather than a "delegated" health care system, additional credentialing may not be required.
NPs, PAs, and CNMs are only required to complete initial credentialing once with BCBSNC, as long as their credentialed status remains effective. Additionally, a provider's credentialed status can be applied to more than one in-network location, if the provider has been enrolled with BCBSNC by an additional location for their work at the location.
Please read more about the credentialing requirements here. You may also contact a BBSNC Provider Network representative (formerly Network Management) with any questions about this new credentialing requirement. If you need assistance initiating the credentialing process, or you're unsure about your credentialed status with BCBSNC, please contact us at 1-800-777-1643.

Beware of 'Phishing' Scam

The American Medical Association (AMA) IT Security has been alerted to an attempt to trick AMA members into divulging their personal information via email, commonly called ‘Phishing’. The email, claiming to be from “American Medical Association,” actually redirects to a googlemail.com sender, and shunts users to a malware site to harvest information. PLEASE be aware of any email sent to you from unknown sources asking you to click on links, or directing you to unknown sites, especially sites that do not seem to match the intended purpose. The AMA will never ask you for your digital identities.

Attorney General’s Conference Brings Together Thought Leaders on Opioid Epidemic

NC Attorney General Roy Cooper speaking at opioid prescribing conference in Raleigh.

The National Attorneys General Training & Research Institute (NAGTRI) brought together leaders from the medical, legal, law enforcement and community action groups for a day-long symposium to better define the problem of opioid abuse in our state and consider solutions.
Over 300 people from various disciplines convened at the McKimmon Center on the NC State University campus in Raleigh on Aug. 11 to hear from national and local experts on curbing prescription drug and opioid abuse. Attorney General Roy Cooper kicked off the meeting urging participants to leave at the end of the day with a ‘to-do list’ of actions to alleviate the opioid abuse epidemic. He quoted startling statistics including that an estimated 1.9 million Americans today are addicted to opioids and 4 out of 5 heroin users started by using prescription opioids.
“In general, prescription drugs are good. We assume they’re safe,” Cooper said. “But they can be more dangerous than street drugs. Unfortunately, there is easy access to prescription drugs for many reasons including overprescribing, diversion, doctor shopping, kids getting into the family medicine cabinet.”
He outlined several recent positive actions to stem the opioid epidemic including stepped up educational efforts for parents and children, take back programs to safely dispose of leftover drugs, increased use of the Controlled Substance Reporting System (CSRS) to discourage doctor shopping, new abuse deterrent formulations by pharmaceutical companies and the statewide standing order for the opioid antagonist naloxone, which was recently signed into law by Gov. Pat McCrory. He also encouraged attendees to work with the state legislature to expand Medicaid as a method of curbing opioid abuse by extending needed services for those who seeking help for their addiction.
“This is a public safety and public health issue,” he said.
The North Carolina Medical Society (NCMS) has been heavily involved with this issue at the legislature and through the media and in opinion pieces. During the most recent legislative session the NCMS listened when physicians told us the CSRS needed improvements to be truly useful. Thanks in part to our efforts, the General Assembly allocated nearly $1.5 million to make the CSRS easier to check, connect it to the state’s Health Information Exchange and to the controlled substance reporting systems in surrounding states. The original legislation broadly mandated that every time a controlled substance was prescribed the CSRS needed to be consulted – including prior to administering anesthesia before surgery. The NCMS successfully fought to more narrowly focus the law and improve the efficiency of the system.
We continue to stay abreast of the various proposals and programs around opioid prescribing and abuse including by attending sessions like the one put on by NAGTRI this month. Please share your insights and ideas on this important issue by commenting on this blog or by emailing us at [email protected].

Feds Offer Free Buprenorphine Trainings for Physicians

This month, the federal government, through the Office of National Drug Control Policy, reached out to all 50 Governors about the urgent need for more doctors to be trained and certified to treat people with prescription opioid and heroin use disorders. The Obama Administration is offering free buprenorphine trainings, a type of medication-assisted treatment (MAT), which includes the use of FDA-approved medications like buprenorphine. MAT has proven more effective at helping people with opioid use disorders enter into long-term recovery. Other FDA approved medications to treat individuals with opioid use disorders are naltrexone and methadone.
As of February 2016, however, 1,489 counties did not have at least one physician with a buprenorphine waiver or someone to dispense buprenorphine from a doctor’s office. The vast majority of need for these treatments is in rural areas.
To help address the need for treatment providers, the Administration offers free buprenorphine trainings for physicians through the Providers Clinical Support System for MAT. These trainings, called DATA 2000 waiver trainings, provide information to physicians on treating individuals with opioid use disorders. After being trained, physicians can be certified by the Drug Enforcement Administration (DEA) to properly and safely administer buprenorphine to individuals with opioid use disorders.
Federal and State agencies have used their authorities to take every available action to address the opioid epidemic. In July of this year, for example, the Department of Health and Human Services issued a final rule that increases from 100 to 275 the number of patients qualified physicians who prescribe buprenorphine for opioid use disorders can treat.
More information on the process for prescribing or dispensing buprenorphine and the training is available here.

ICD-10 ‘Flexibilities’ to End October 1

The Centers for Medicare and Medicaid Services (CMS) now expects that practices are “coding to the highest level of specificity” available under ICD-10, which adopted nearly one year ago. If your practice is not, CMS will no longer grant any ‘flexibility’ come Oct. 1, 2016.
Thanks to lobbying efforts by the American Medical Association and other groups before the new ICD-10 codes were implemented last year, CMS agreed to be flexible for one year giving practices some leeway and not denying claims “based solely on the specificity of the ICD-10 diagnosis code” as long as the provider used a valid code “from the right family.” The one year period of flexibility ends this October 1, and CMS has updated its FAQs to answer any concerns about whether your coding will be adequate. Review the full list of questions here.
Several of the key questions include:

Question 25: (new as of 8/18/2016) Is Medicare going to phase in the requirement to code to the highest level of specificity?

Answer: No, providers should already be coding to the highest level of specificity. ICD-10 flexibilities were solely for the purpose of contractors performing medical review so that they would not deny claims solely for the specificity of the ICD-10 code as long as there is no evidence of fraud. These ICD-10 medical review flexibilities will end on October 1, 2016. As of October 1, 2016, providers will be required to code to accurately reflect the clinical documentation in as much specificity as possible, as per the required coding guidelines. Many major insurers did not choose to offer coding flexibility, so many providers are already using specific codes.

Question 26: (new 08/18/2016) How do I get ready for the end of flexibilities?

Answer: Avoid unspecified ICD-10 codes whenever documentation supports a more detailed code. Check the coding on each claim to make sure that it aligns with the clinical documentation.
The CMS also has a state-by-state list (PDF) of ICD-10 resources and contact information, including phone numbers of Medicare administrative contractors and state Medicaid offices.

Adventure Awaits -- NCMS Travel Discount Program

The North Carolina Medical Society (NCMS) is pleased to offer an exclusive worldwide travel discount service to our members. Savings may exceed 50 percent, and average 10-20 percent below-market on all hotels and car rental suppliers around the world.
Save time and money. Let the Discount Program negotiate the best deals and comparison price for you. Any hotel, any car, anywhere, anytime.
Click here to save on your next trip.

Constant Care Joins Your NCMS Marketplace

Constant Care provides a unified platform for integration and delivery of preventative services such as annual wellness visits, chronic care management, advance care planning and preventative screenings.
Their turnkey delivery model provides patients with the full spectrum of preventative services to enhance overall care delivery without disrupting day-to-day operations of the practice. Constant Care focuses on maximizing value to both providers and patients. They do this with expert coordination of preventative care options available today while strategically shaping these services to meet performance requirements expected of providers in the future. At no financial risk to Constant Care physicians, they provide the staff, software and technology to perform the following services:

Preventative Care Coordination
Patient Outreach and Scheduling
Annual Wellness Visit
Chronic Care Management with 24/7 call center support
Advance Care Planning
Medication Adherence and Medication Therapy Management
Screenings (mental health, falls, etc.)
Certified EHR
Integrated Patient and Physician Portals
Telehealth

For more information about this newest bronze member of the North Carolina Medical Society (NCMS) Marketplace, visit the Constant Care website or contact them directly at 910-795-0440 or [email protected].
Remember to visit the NCMS Marketplace whenever you or your practice has a need for a good or service. Many of our partners offer discounts for NCMS membership. Visit the NCMS Marketplace.

Communicating Effectively With Your Patients on Key Issues

The Choosing Wisely program has a wealth of resources for physicians to more effectively communicate important information with their patients on key topics being addressed by the program. Here are links to easily understood brochures on the eight most common topics. Spanish language versions are in the works.
Get Pap Tests -- but only when you need them
Do you have lower back pain?
Can antibiotics help you feel better?
Get a vitamin D test -- but only if you need it
Get a bone density test -- but only if you need it
Get medical tests before eye surgery -- but only if you need them
Get a heart stress test before surgery -- but only if you need it
Sleeping pills can have risks for older adults
And don’t miss the Choosing Wisely presentation at the M3 Conference, Sept. 17, with Devdutta Sangvai, MD, titled, “Avoidable Care and Choosing Wisely.” Learn more about this particular session and the nearly 14 hours of CME available at the M3 Conference, Sept. 15-18 at the Grandover Hotel in Greensboro here.

Congratulations on 50 Years of Caring for Children in the Sandhills

Sandhills Pediatrics, founded by longtime North Carolina Medical Society (NCMS) member and leader David Bruton, MD, is celebrating its 50-year anniversary this year. The practice Dr. Bruton helped create serves more than 20,000 children in the Sandhills area today. Read a feature article about Dr. Bruton and Sandhills Pediatrics here.

Kudos To KidzCare Pediatrics

ashok-jain — Ashok Jain, MD

KidzCare Pediatrics, based in Fayetteville, was named the North Carolina Small Business & Technical Development Center’s (SBTDC) Business of the Year for 2015-16. Founding physician, Ashok Jain, MD, is a Kanof Institute for Physician Leadership alumnus in both the Leadership College (class of 2013) and in the Clinical Quality University (CQU), class of 2015. Read about how Dr. Jain is building KidzCare Pediatrics into a statewide entity with 17 offices in 64 counties across North Carolina serving an estimated 100,000 children in the SBTDC’s Annual Report here. The SBTDC seeks to stimulate business growth and economic development.

Pieces of the Whole – A Wellness Series, Part 2

Well-being is more than simply the absence of disease. It is the full integration of social, emotional, spiritual, environmental, occupational, intellectual and physical wellness. These seven dimensions act, and interact, in a way that contributes to the overall quality of life.
Over the next few issues of the NCMS Bulletin, Jason Horay, MS, ATC, CHES, the NCMS Plan Health Promotion Coordinator, will take you on a journey through each aspect of well-being, offering personal reflections and examples of ways to enhance each dimension within your workplace, community, and at home.
We encourage you to share this content with colleagues using social media and to share your ideas and personal experiences for enhancing your well-being by posting comments to the blog.
The next installment focuses on emotional well-being.
Emotional Well-Being, by Jason Horay, MS, ATC, CHES
Emotional well-being is the ability to understand ourselves and cope with the challenges life can bring. The ability to acknowledge and share feelings of anger, fear, sadness, or stress/hope, love, joy, or happiness in a productive manner contributes to our emotional well-being.
Being emotionally well is more than just handling stress. It also involves being attentive to your thoughts, feelings, and behaviors, whether positive or negative. My wife gave me an incredible gift this Christmas that has allowed me to become more aligned with my feelings and cope with personal challenges. The Start Where You Are: A Journal for Self-Exploration has helped me navigate the confusion and chaos of daily life by reminding me that by knowing ourselves and our dreams, we can appreciate the world around us and take the appropriate steps to achieve our dreams. Continuing to work on my own emotional well-being has helped me become more aware and accepting of my own feelings, rather than denying them. It has also allowed me to take a more optimistic approach to life, and enjoy life despite its occasional disappointments and frustrations.
Below are some additional examples of how to enhance your emotional well-being throughout the day:
At Work

Participate in mindful meditation and deep breathing
Seek out your employer’s Employee Assistance Program (EAP)
Invite a co-worker to lunch
Enroll in a stress management course

In the Community

Connect with nature
Download a stress management/resilience app to your mobile device
Participate in a yoga or fitness class

With your Family

Use journaling as a method of reflection
Enroll in relationship counseling
Sing or practice music therapy
Read
Light candles contributing to a peaceful environment

Publication Focuses on the Whole Physician Family

Physician Family, a publication of the AMA Alliance, focuses on medical families and the special joys and challenges they may face. The publication is free online here.
Beginning with the Summer 2016 magazine now available, each issue will detail a different stage on the journey of medicine - from medical school to residency to active practice to retirement. The current issue features six articles that focus on the first stage of the journey, medical school, in addition to several other pieces for physician families at ALL stages of the journey.
Other articles focus on:

relationships
health and wellness
work/life balance
financial and legal issues
making a difference
food, travel, humor

In the News

This Brain Eating Amoeba Kills 97 Percent of the People It Infects. Not Sebastian DeLeon, The Washington Post, 8-24-16
Could Medicare's New Doctor Payment System Endanger Small and Rural Practices?, Kaiser Health News, 8-23-16
Blue Cross Blue Shield of NC Gets A Closer Look From Insurance Regulator, Triangle Business Journal, 8-22-16
Whose Lives Should Be Saved? To Help Shape Policy Researchers in Maryland Ask the Public, The New York Times, 8-21-16
Tanning Industry Blames 10,000 Salon Closings on 'Obamacare', The Associated Press, 8-20-16
7 Things to Know About Aetna's ACA Exchange Exit, Becker's Hospital Review, 8-18-16
Exchanges Do Work for Some Health Plans; Ask Kaiser, Modern Healthcare, 8-17-16
Medical Providers Try Uber, Lyft for Patients With Few Transportation Options, Kaiser Health News, 8-17-16
A Doctor Bikes Across the Country to Ask Americans About Obamacare. This Is How He Ended Up Feeling Hopeful, The Los Angeles Times, 8-16-16
UNC's Dr. Taft Helps Olympians Heal, WRAL, 8-16-16
Doctor Who Started Practice in 1946 Reflects on 'Amazing' Changes, Winston-Salem Journal, 8-15-16
What's Behind Growing Push to Punish Dealers in Fatal ODs?, The Washington Post, 8-13-16

Learning Opportunities

TOMORROW, Thursday, Aug. 25, the Centers for Medicare and Medicaid Services (CMS) will offer a 2016 EHR Incentive Programs Requirements for Eligible Professionals webinar from 1 to 2 p.m., highlighting how eligible professionals can participate successfully in the EHR Incentive Programs in 2016 based on the criteria outlined in the October 2015 final rule. To participate, please register here. To learn more, please see the What You Need to Know in 2016 Tip Sheets for Eligible Professionals and other resources on the 2016 Program Requirements page of the CMS EHR Incentive Programs website.

The North Carolina Healthcare Information and Communications Alliance (NCHICA) 22nd Annual Conference & Exhibition, “The New Healthcare Ecosystem,” is scheduled for Aug. 29-31 at the Omni Grove Park Resort in Asheville. The conference provides an opportunity to learn about the latest developments and best practices in health care IT, and network with your peers. To learn more and register, click here.

28^th Annual Fall Foliage Cancer Conference, “Update on Melanoma and Gastrointestinal Cancers,” will be held Oct. 21-22 at the Grove Park Inn in Asheville. More information and registration available here.

The North Carolina Chapter of the Healthcare Financial Management Association (HFMA) will hold its 2016 Health Insurance Institute on Sept. 22-23, at the Sheraton Hotel, Four Seasons in Greensboro. Learn more and register here.

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

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.

The Medical University of South Carolina (MUSC) Department of Healthcare Leadership and Management is offering the 19th Annual Healthcare Leadership Conference on Friday, October 21^st, 2016 at Charleston Area Convention Center in North Charleston. Panels will focus on composition and development of our health care workforce. The three sessions focus on: 1) Talent Management for Bench Strength Development; 2) Diversity and Inclusion and 3) Developing an Environment of Civility and Respect In Healthcare Organizations: Resources to Empower Healthcare Leaders to Identify, Intervene, and Prevent Workplace Bullying, Incivility and Disrespect. Learn more and register here.

Do You Want to Influence the Future of Medicine in NC?

You may not feel like you have a voice or the power, but you do! The North Carolina Medical Society (NCMS) is your professional organization and we’re listening. If you have a health policy issue or concern, contact the organization that has the expertise and history of success in advocating for you. Send your health policy idea, concern, suggestion to NCMS President Docia Hickey, MD, [[email protected]] and copy it to NCMS CEO Robert Seligson [[email protected]] and NCMS staff [[email protected]]. The ideas submitted will form the basis for topics to be discussed at the 2016 NCMS Annual Business Meeting on Sept. 17.
Here are several other simple ways you can take action to positively influence how you are able to practice medicine – several don’t even require you to leave your desk:

Attend the 2016 NCMS Annual Business Meeting on Saturday, Sept. 17 from 2:45 to 5 p.m. at the Grandover Resort in Greensboro. The NCMS Board of Directors will be at this important gathering as well as other health care leaders and your NCMS colleagues to discuss topics of importance to you and conduct the society’s annual business of installing new officers. This meeting is free of charge, so register today here.
Cast your vote for the NCMS leadership. Soon the final slate of candidates to lead the NCMS will be announced and an online ballot mailed to you by a third party vendor. (If you need a paper ballot contact us at [email protected]). This is your opportunity to decide who will lead your professional society, and another opportunity to have a voice.
Attend the M3 conference taking place the same weekend as the NCMS Annual Business Meeting at the Grandover, Sept. 15-18. Early bird pricing ends Monday, so register today! This conference offers you 13.75 hours of CME to educate yourself on what the future holds for health care as well as how to be an effective leader and a happy and well-balanced person in the face of the many stresses you, no doubt face. Sessions include:
- Understanding what MACRA may mean for you and your practice
- Leaders from several innovative NC ACOs will reveal their challenges – and successes
- The director of the NCMS Foundation’s acclaimed leadership development programs will help you hone your leadership skills
- Experts on keeping or regaining your resilience will inspire you to take steps to feel better, more fulfilled and happy in your life both at work and outside of work.

Learn more about what the M3 Conference can offer to help you feel more knowledgeable and in-control of your future here. Register today!

Read your NCMS Bulletin so you don’t miss important news about your profession and the membership benefits you are entitled to receive to make your life as a physician or physician assistant better now and in the future. The Bulletin is published every other Wednesday and archived on the NCMS website. Each story is part of a blog, so it’s easy to comment on any article to make your voice heard. Just look for the comment box at the end of each article.

Take action to influence the future for your profession and yourself – it’s simple -- email, register, read.

Apply Now to Gain a Better Understanding of the ‘Business’ of Medicine

Don’t miss the opportunity to gain insight into the business and financial aspects of the practice of medicine – and hone your leadership skills -- through the Kanof Institute for Physician Leadership’s (KIPL) Health Care Leadership and Management course. The application deadline is Sept. 1. This program spans four weekends over the course of a year with sessions held throughout the state.
The project-based curriculum emphasizes deeper leadership development and skills, including strategic planning, negotiation and financial literacy and application. This program provides a critical framework for physicians based on economics, finance and leadership development that will provide graduates with the necessary vocabulary for the business realm, equipping them to take on greater leadership positions in their career. The program also involves on-site visits to health care organizations.
Learn more and apply here.

NC HIEA News and Update

The North Carolina Health Information Exchange Authority (HIEA) recently sent an update on its progress in connecting clinicians through the HIE. The update also included a reference to a column in the North State Journal by North Carolina Medical Society (NCMS) CEO Robert Seligson, which reiterated the NCMS’ stance on the importance of the HIE: “Much work needs to be done to ensure that doctors, hospitals and health systems are financially and technologically able to tap into the HIE in order to submit and retrieve information on behalf of their patients,” Seligson wrote. “Success will mean a healthier bottom line for the Medicaid program and, most importantly, a healthier population.”
Read the full update from the HIEA. Some highlights include:

Progress is also being made to provide much-needed training materials to the NC HIE users. The NC HIEA User Guide is in its final stages.
Longtime NCMS member William G. Way, MD, an imaging radiologist with Wake Radiology, was among those appointed by the NC General Assembly to the NC HIEA Advisory Board.
NCHIE enhancements coming this summer include the NC HIE portal will be able to deliver notifications to users when a patient’s record is updated by another participant (i.e. lab results, medication change, ER admittance)
This fall a directory will be available so providers will be able to look up and communicate safely and securely through web messaging.

If you have questions, call the HIEA business office at 919-754-6912 or send an email to [email protected].

Another Workshop To Help Your Practice Make the Transition to Value

Is your practice ready for the transition to value-driven health care? If not, the North Carolina Medical Society (NCMS) Foundation is partnering with the National Rural Accountable Care Consortium (NRACC) to help small, rural practices throughout the state make the transition to value-based health care delivery and payment. For those in western North Carolina, don’t miss the opportunity to attend a free workshop to help with this transition in Asheville on Wednesday, Aug. 24, from 1 to 4 p.m. at MAHEC’s Biltmore location in the education building.
Kathy Whitmire, Regional Vice President, Southeast with NRACC, will present how practices can succeed under the new guidelines for the Physician's Quality Report System (PQRS) and the Value-Based Modifiers (VBM).
NRACC is a Provider Transformation Network (PTN), which is a CMS-funded program that is part of the Transforming Clinical Practice Initiative (TCPI) to help physician practices and clinics prepare for Value-Based payment models and the Merit-based Incentive Payment System (MIPS). For a basic introduction to NRACC and the TCPI program, please view the webinar presentation, “Surviving Value-Based Payment Reform Including an Update on the New MACRA Proposed Rule” here.
The support, training and resources at the workshop are provided at no cost and will allow North Carolina practices and clinics to establish the necessary framework and infrastructure for implementing value-based payment models, improve population health and lower overall costs, while improving their financial sustainability. In addition, all program components are currently developed and available for immediate program start-up by participating practices.
For additional information about the NRACC PTN and the training offered click here.

Four Years Later TAC Boasts 40+ Members and Dozens of Toolkits

Over four years ago a group of far-sighted individuals launched the Toward Accountable Care Consortium and Initiative (TAC). The Consortium now includes over 40 health care association and organization members, who joined for the purpose of preparing the medical community for the transition to value. The Consortium was successful in securing two grants from The Physicians Foundation to develop resources with national applicability. The resulting TAC toolkits, covering the range of specialties and topics related to legal and financial issues are available free of charge. All may be downloaded from the TAC website.
The Texas Medical Association was so impressed with the toolkits, they sought and received permission to offer CME credit for reading and absorbing the information in the seminal guide, “The Physicians Accountable Care Toolkit.” North Carolina Medical Society (NCMS) members can access this CME at a discount by simply clicking here to download the guide and entering ‘NCMS’ in the coupon code space to receive the NCMS member discount.
Another positive result of the Consortium’s work is the NC ACO Collaborative, which has grown to over 100 participants and meets twice a year (first and third quarters). A smaller group of Medicare Shared Savings Program (MSSP) and Next Gen ACOs meets separately twice a year (second and fourth quarters), and the membership in that group also continues to expand.
If you are interested in being part of the Collaborative, please contact Melanie Phelps at [email protected].

NC Health Department Issues Memo on Measles Case

Wake County Human Services and the North Carolina Communicable Disease Branch are alerting clinicians in Wake County of a case of measles diagnosed on Aug. 1. The infected person had multiple contacts during the infectious period including at RDU International Airport. A memo has been issued summarizing the case and outlining recommendations. Read the memo here.

BCBSNC Requires Mid-level Clinicians to Be Credentialed By January 2017

Blue Cross and Blue Shield of North Carolina (BCBSNC) has notified its practices that, come January 2017, nurse practitioners (NPs), physician assistants (PAs), and certified nurse midwives (CNMs) at in- network practices will be required to be credentialed by BCBSNC just as physicians currently are.
Through its credentialing process BCBSNC requires individual practitioners to meet a minimum set of credentialing criteria, based on their care specialties before they are eligible to perform in-network services for BCBSNC members. The practitioners must be re-credentialed every three years.
BCBSNC is requesting NPs, PAs, and CNMs (or their organizational credentialing departments) to initiate the credentialing process as soon as possible. Instructions on how to begin are available on bcbsnc.com on the “Providers” home page by opening the link located within the blue box, labeled “Become a BCBSNC Provider.”
The credentialing process can take up to 60 days from the date a credentialing application is received by BCBSNC to complete. BCBSNC follows the credentialing guidelines established by the National Committee for Quality Assurance (NCQA) and the North Carolina Department of Insurance (NCDOI). Following a NP’s, PA’s, or CNM’s completion of credentialing, the credentialed provider’s name and group affiliation will become eligible for display in BCBSNC’s online provider directory, “Find a Doctor.”
Failure to complete credentialing by January 1, 2017, may result in a mid-level provider’s inability to provide in-network services for BCBSNC’s commercial membership, according to the announcement. BCBSNC intends to conduct claims audits, and therefore, services determined to have been provided by a non-credentialed NP, PA, or CNM, after January 1, 2017, may be denied or adjusted, if the services were performed while working as part of, or under the supervision of a provider within an in-network health care organization.
Please contact a representative of BCBSNC’s provider networks (formerly named Network Management) if you have questions about this new requirement for mid-level providers. BCBSNC representatives also can help you initiate the credentialing process, and are available by phone at 1-800-777-1643.

Meaningful Use Incentive Program Reporting Opportunity

The CDC’s National Center for Health Statistics conducts the National Health Care Surveys, which include the National Hospital Care Survey (NHCS), National Hospital Ambulatory Medical Care Survey (NHAMCS), and the National Ambulatory Medical Care Survey (NAMCS). These nationally representative surveys provide data and information used by Congress, health care services researchers and others to shape health care policy and the future of health care in the United States.
The National Center for Health Statistics is accepting registration from eligible professionals (EPs), eligible hospitals (EHs) or Critical Access Hospitals (CAHs) of their intent to submit data to the National Health Care Surveys as part of the Medicare and Medicaid EHR Incentive Programs (Meaningful Use). You may attest to either Objective 10 – Public Health and Clinical Data Registry Reporting, Measure 3 for MU Stage 2 or Objective 8 - Public Health and Clinical Data Registry Reporting, Measure 4 for MU Stage 3.
Please see the updated National Health Care Surveys Declaration of Readiness here and consider registering for the National Health Care Surveys. EPs, EHs and CAHs can register their intent to submit data by emailing [email protected].
For more information, please visit the CDC Meaningful Use website or send your questions to [email protected].

Get the Latest on Employment Law Changes Facing Medical Practices

The North Carolina Medical Society (NCMS) Foundation in cooperation with the North Carolina Medical Group Management Association, invites you to join a webinar to review the significant changes in employment law facing medical practices today. The review includes the new overtime regulations, ADA and FMLA compliance challenges, expanding protections for LGBT workers, and independent contractor misclassification risks. The webinar will be held Tuesday, Aug. 16, from noon to 1 pm and features Patti Bartis, Partner, Parker Poe Adams & Bernstein. The webinar is free but you must register here to attend.

UNCPN Physicians Now Part of NCMS

A warm welcome goes out to the UNC Physicians Network (UNCPN) physicians who recently joined the North Carolina Medical Society (NCMS) en masse. We look forward to getting to know you better and introducing you to the many benefits of membership. And, thank you to the UNCPN leadership for recognizing the value NCMS membership brings to your doctors.
“We welcome the UNCPN to the North Carolina Medical Society and look forward to sharing the many benefits of membership with you,” said NCMS CEO Robert W. Seligson. “For 167 years the medical society has been the advocate for physicians and their patients in North Carolina. Today, in the midst of the many changes in our health care system, having an organization dedicated exclusively to representing physician interests is crucial. We encourage you to maximize your NCMS membership – call us, join us for our events, access our leadership development and other valuable programs. We’re here for you.”
Enjoy reading the NCMS Bulletin, which is published every other Wednesday. If you have a question about membership or about your practice, contact Belinda B. McKoy or 919-833-3836 x142 in our Solution Center and she will get you an answer.

Two More ACO Partnerships Formed in NC

Recently, Aetna and UnitedHealthcare formed accountable care partnerships with several major medical groups in the state. Accountable Care Organizations (ACO) are focused on enhancing care coordination between doctors and others involved in patient care; improving patient experience and health outcomes for everyone in the plan; and lowering overall costs for care.
Last week, Aetna established an accountable care organization with Duke Health in Durham, and WakeMed Health & Hospitals in Raleigh. Aetna Whole Health-Duke Health & WakeMed will offer employers and individuals in 12 central North Carolina counties health care services “designed to improve quality, efficiency and the patient experience, and to control costs,” according to the press release announcing the agreement.
The ACO will foster collaboration between physicians at Duke Health and WakeMed hospitals and outpatient facilities. Duke Health includes Duke University Health System and Duke University Schools of Medicine and Nursing. WakeMed is a three-hospital system with nearly 8,500 employees. Aetna provides health plans to 550,000 people in North Carolina. The partnership also will include WakeMed Key Community Care, the system's ACO that includes 370 primary-care providers and 750 specialty-care providers.
Earlier in the summer, UnitedHealthcare and Mission Health Partners (MHP), an ACO covering the western portion of the state, established a new network relationship giving people enrolled in UnitedHealthcare Medicare plans access to all MHP facilities and physicians. In 2017, the two organizations plan to launch an accountable care program dedicated to improving care coordination for patients by using shared technology, timely data and information about emergency room visits and hospital admissions.
UnitedHealthcare serves more than 180,000 Medicare Advantage members and nearly 1.3 million people in North Carolina in total, with a network of 140 hospitals and more than 28,000 physicians and other care providers statewide.
MHP is one of the largest ACOs in the country, covering 47,000 Medicare beneficiaries. MHP also covers 18,000 lives through the Mission Health employee benefits plan and some 8,200 patients attributed through Medicare Advantage plans. The plan currently is accountable for the cost and quality of care for roughly nine percent of western North Carolina.
“Mission Health Partners is an important provider of health care services, and this new relationship helps provide the foundation for collaboration which will help those in North Carolina receive quality, affordable care,” said Charles Russo, CEO of UnitedHealthcare Medicare & Retirement in North Carolina in a statement announcing the new partnership.

Four NC Independent Orthopaedic Practices Join To Form EmergeOrtho

Four independent orthopaedic physician groups from across North Carolina have joined together to form a new practice called EmergeOrtho. With 49 office locations in 21 counties statewide, EmergeOrtho is one of the largest physician-owned orthopaedic practices in the country. Additional practices are poised to join during a second phase of expansion projected for early 2017. The combined practices include 126 physicians and 237 physician assistants, nurse practitioners and therapists.
With the projected 2017 expansion, there will be approximately 170 physicians in the practice. The practices that combined to create EmergeOrtho are: Blue Ridge Bone and Joint of Asheville, Hendersonville and Arden; Carolina Orthopaedic Specialists with offices in Alexander, Burke, Caldwell and Catawba counties; OrthoWilmington with offices in New Hanover, Brunswick and Onslow counties; and Triangle Orthopaedic Associates of the greater Raleigh-Durham area. The four practices began operating under the EmergeOrtho name on Aug. 1.
“We are very fortunate to be creating an alliance of four well-established physician practices with excellent reputations,” said longtime North Carolina Medical Society member Thomas Dimmig, MD, President of Triangle Orthopaedic Associates, who is also serving as president of the new group as quoted in the announcement. “We united in order to preserve the private practice model, a standard of care that puts the patient first. The integrated group will allow these physicians to remain independent and provide their own higher quality, lower cost care.”

Leadership College Alumnus Is A Much-Quoted Expert

Plescia_150 — Marcus Plescia, MD, MPH

Marcus Plescia, MD, MPH, Kanof Institute for Physician Leadership (KIPL) 2005 alumnus, has been quoted widely recently in his role as Mecklenburg County Health Department Director. Plescia has been working to help ensure the water at the US National Whitewater Center in Charlotte is safe after a teenager died earlier this summer after an infection caused by a brain eating amoeba she inhaled while rafting at the whitewater center. Read one of the stories in which Dr. Plescia is quoted here.
If you’re interested in becoming part of this esteemed group of leaders who have completed the leadership development training through KIPL, the Health Care Leadership and Management (HCLM) course is now accepting applications through Sept. 1. Learn more about this highly regarded program here.

Pieces of the Whole – A Wellness Series

Well-being is more than simply the absence of disease. It is the full integration of social, emotional, spiritual, environmental, occupational, intellectual and physical wellness. These seven dimensions act, and interact, in a way that contributes to the overall quality of life.
Over the next few issues of the NCMS Bulletin, Jason Horay, MS, ATC, CHES, the NCMS Plan Health Promotion Coordinator, will take you on a journey through each aspect of well-being, offering personal reflections and examples of ways to enhance each dimension within your workplace, community, and at home.
We encourage you to share this content with colleagues using social media and to share your ideas and personal experiences for enhancing your well-being by posting comments to the blog.
The series begins with the following article by Horay on Occupational Well-being
Occupational well-being is the ability to get personal fulfillment from your job while maintaining balance in your life. The desire to contribute in our careers, and to make a positive impact on the organizations we work in, and to society as a whole, leads to occupational well-being.
It is important for your overall well-being to do what you love and to love what you do. When you are doing what you are meant to do, you deepen you sense of meaning and purpose.
Choice of profession, job satisfaction, career ambitions, and personal performance are all important components of your path's terrain. I chose a career in health promotion because I recognized the personal satisfaction and enrichment felt when working with clients on individual behavior change and creating an overall culture of health at client medical practices.
While traveling on the path toward occupational well-being, I’ve been able to contribute my unique gifts, skills, and talents to my work that are both personally meaningful and rewarding.
I encourage you to ask yourself the following questions:

Do I enjoy going to work most days?
Do I have a manageable workload at work?
Do I feel that I can talk to my boss and co-workers when problems arise?

If you answered "no" to any of these questions, it may indicate an area where you need to improve the state of your occupational well-being. Below are some additional examples of how to enhance your occupational well-being throughout the day:
At Work

Attend conferences to refine your skills
Expand your task set
Enhance your work/life balance
Seek out career counseling/coaching
Connect your purpose with your career
Create connections with your co-workers
Participate in continuing education online

In the Community

Attend classes at a community college
Volunteer
Attend professional networking groups

With Your Family

Seek work/life balance and boundaries
Create a separate, dedicated space to work at home
Turn off all notifications and devices when at home

In the News

High Death Rates In Cancer 'Hotspots' Across NC, North Carolina Health News, 8-9-16
Syncing Up Drug Refills: A Way to Get Patients to Take Their Medicine, Kaiser Health News, 8-8-16
Campbell University, Harnett Health Welcome First Residency Program Physicians, The Fayetteville Observer, 8-5-16
Xtreme Eating 2016, Center for Science in the Public Interest, 8-5-16
Vexing Question on Patient Surveys: Did We Ease Your Pain?, The New York Times, 8-4-16
Aetna Is Notifying Some Doctors About Their Drug-Dispensing Habits, The Washington Post, 8-3-16
New Map Shows North Carolina Could Be Zika Hot Zone, ABC-11, 8-3-16
Dope Sick, Stat, 8-2-16
New Insurance Policy: Abandon ACA Exchanges to Avoid Losses, The Associated Press, 8-2-16
Price of Drug That Reverses Opioid Overdose Is On the Rise, Modern Healthcare, 8-2-16
Many Well-Known Hospitals Fail to Score 5 Stars In Medicare's New Ratings, Kaiser Health News, 7-27-16
Amid Opioid Epidemic, Rules for Drug Companies Are Loosened, The Los Angeles Times, 7-27-16
When Writing a Prescription Should You Also Write Why?, NEJM Journal Watch, 7-28-16

Learning Opportunities

The North Carolina Harm Reduction Coalition along with the NC Urban Survivors Union are hosting a conference on Integrating Harm Reduction into Existing Service Provisions on Aug. 11, from 9 a.m. to 4 p.m. with an evening social event from 6:30-11 p.m. at Castle McCulloch, 3925 Kivett Dr, Jamestown, NC. Sign up here. For more information contact Louise Vincent, [email protected].

The North Carolina Department of Justice is bringing together law enforcement, public health, medical, legal and public policy professionals to discuss how to curb prescription drug and opioid abuse in North Carolina at a conference to be held on August 11 at the McKimmon Center on the North Carolina State University Campus in Raleigh. Register here. For more information contact Natalie Wood, [email protected] or 919-716-6073.

The North Carolina Medical Society (NCMS) Foundation in cooperation with the North Carolina Medical Group Management Association, invites you to join an Employment Law Update webinar to review the significant changes in employment law facing medical practices today. The review includes the new overtime regulations, ADA and FMLA compliance challenges, expanding protections for LGBT workers, and independent contractor misclassification risks. The webinar will be held Tuesday, Aug. 16, from noon to 1 pm and features Patti Bartis, Partner, Parker Poe Adams & Bernstein. The webinar is free but you must register here to attend.

“Opioid Safety in the Hospital and After Discharge,” a webinar on how a patient can manage their own persistent pain through the use of non-drug alternatives and possibly refrain from the use of opioids will be offered Wednesday, Aug. 17, from 1 - 2 pm. More information and to register.

“Innovations in Patient Safety: A Deeper Dive into Medication Effectiveness and Safety with Comprehensive Medication Management,” a Centers for Medicare and Medicaid Services (CMS) Learning Network webinar will be offered Wednesday, Aug. 17, from 1 to 2 p.m. Register here.

The Centers for Medicare and Medicaid Services (CMS) will hold the first session of a three-part Virtual Office Hours series regarding 2016 Physician Quality Reporting System (PQRS) quality measures. The first session, titled “2016 PQRS Reporting: Introduction to Quality Measures Reporting (session 1 of 3)”, will take place on Tuesday, August 16, 2016 from 1 to 2 p.m. Topics to be discussed in this session include How to Get Started with PQRS and what are claims/qualified registry clinical quality measures. This PQRS Virtual Office Hours session will allow stakeholders an opportunity to ask a CMS representative questions about how to get started with quality measures for 2016 PQRS reporting. You must register to participate in this session. Click here to access the registration page. Complete information about PQRS is available on the CMS PQRS web site.

Take a deep dive into value-based health care at the second annual Move-to-Value Summit in Winston-Salem on Aug. 21-23. Learn more and register here.

Get Help in Making the Transition from Fee-for-Service to Value-based Payment Models on Wednesday, Aug. 24, from 1 to 4 p.m., at MAHEC in Asheville. This workshop presented by the National Rural Accountable Care Consortium (NRACC) to help practices succeed under the new guidelines for the Physician's Quality Reporting System (PQRS) and the Value-Based Modifiers (VBM). For a basic introduction to NRACC and the Transforming Clinical Practice Initiative (TCPI) please view the webinar presentation, “Surviving Value-Based Payment Reform Including an Update on the New MACRA Proposed Rule” here. And read the story in this Bulletin for more information.

The North Carolina Healthcare Information and Communications Alliance (NCHICA) 22nd Annual Conference & Exhibition, “The New Healthcare Ecosystem,” is scheduled for Aug. 29-31 at the Omni Grove Park Resort in Asheville. The conference provides an excellent opportunity to learn about the latest developments and best practices in healthcare IT, and network with your peers.

28^th Annual Fall Foliage Cancer Conference, “Update on Melanoma and Gastrointestinal Cancers,” will be held Oct. 21-22 at the Grove Park Inn in Asheville. More information and registration available here.

The North Carolina Chapter of the Healthcare Financial Management Association (HFMA) will hold its 2016 Health Insurance Institute on Sept. 22-23, at the Sheraton Hotel, Four Seasons in Greensboro. Learn more and register here.

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

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.

NCMS Board of Directors Discuss Issues of Note

NCMS Board members and Mecklenburg County Medical Society Board members come together to discuss the issues.

The North Carolina Medical Society (NCMS) Board of Directors gathered in Charlotte on July 15-16 to meet with the Mecklenburg County Medical Society Board and later to hear informally from Charlotte area physicians and physician assistants at a reception Friday evening.
Members of both Boards reinforced the need for ongoing dialogue between the NCMS board and county and specialty society members to bring policy matters of importance to the NCMS Board for consideration. The local meetings are one forum for discussion of key issues as well as submitting policy proposals through the online Board Feedback Form, or contacting the NCMS office or NCMS President Docia Hickey, MD, directly.
“If it is a controversial issue you can be assured that there will be a task force or committee to thoroughly debate the policy,” NCMS CEO Robert Seligson told those assembled for the joint meeting. “We will work to establish good policy.”
NCMS President-Elect Paul Cunningham, MD, also noted that physicians and physician assistants on the ‘front lines’ need to speak up about issues of importance to them if the new governance structure is to be successful.
“The House of Medicine can’t be virtual,” he said. “Participation is key.”
New NCMS Election Process and the M3 Conference

Charlotte area physicians and PAs socialize with their colleagues and the NCMS Board of Directors at the NCMS July Mixer.

The Board reviewed the new procedures for electing board officers and members now that the House of Delegates has been eliminated. They also received the initial slate of candidates submitted by the Nominating and Leadership Development Committee. Review the slate here.
As reported previously, under the new rules, any NCMS member had the opportunity to nominate another member for an open Board seat by last Wednesday, July 20. The final slate of candidates will be officially published by Aug. 28 and voting will open on Sept. 4, and will be conducted online. Paper ballots will be available for those who need them. Watch the Bulletin, your snail mail and email boxes for more information on this new voting process.
Installation of the newly elected officers and board members will be conducted at the NCMS’ annual business meeting on Saturday afternoon, Sept. 17, during the M3 Conference. Please go online to register for this meeting as well as the celebratory awards dinner on Saturday night and the nearly 14 hours of CME offered throughout this weekend conference. NCMS members may attend the annual business meeting free of charge.

Please Comment! Hospital Medical Staff Rules Up for Review
The North Carolina Medical Care Commission (MCC) is charged with regulating health care facilities in our state. Recently, the MCC initiated a comprehensive review of 245 current regulations pertaining to hospital licensure. The rules have not been updated in at least 10 years, and several pertain to how hospital medical staffs are organized and function.
The NCMS Board unanimously agreed that medical staff issues remain an area of great interest and concern for physician members, as issues still commonly arise involving hospital medical staff governance and core functions. It is time that these rules be updated and strengthened by the MCC.
Therefore, the Board decided that the NCMS will submit comments to the MCC on four specific medical staff rules, and encourages individual physicians to also review the regulations and submit comment. The deadline to submit comments is Monday, Aug. 8.
Instructions for Commenting
The goal at this stage is to persuade the MCC that the following rules need to be revised:

10A NCAC 13B .3503 – Functions [of the Hospital/Governing Body]
10A NCAC 13B .3701 – General Provisions [Requiring Medical Staff]
10A NCAC 13B .3702 – Establishment [of Medical Staff]
10A NCAC 13B .3706 – Organization and Responsibilities of the Medical Staff

Please consider commenting briefly on each of these rules. You may submit your comments to the MCC here. NCMS staff will post our comments shortly. Watch for them on the NCMS website.
Non-Compete Clauses
Board members also discussed the value of non-compete clauses in physician contracts. NCMS General Counsel Stephen Keene outlined both the benefits and drawbacks of such provisions for the Board. On the one hand they protect a practice that has made a substantial investment in hiring a physician from competitors seeking to recruit local physicians and avoid the up-front investment. On the other hand, such clauses can frustrate healthy competition and perhaps unduly constrain physicians’ employment options.
Such clauses are sometimes enforceable, Keene said, provided they are reasonable with respect to time and geography, and are supported by consideration. While this is not a new issue, Keene asked the Board whether it’s time to consider an official NCMS policy on non-competes. The Board agreed and asked staff to research the issue more fully and come back to them with a report and recommendation. Watch the Bulletin for future updates on this.

What Is the M3 Conference? Why Should I Go?

The M3 Conference is a unique and historic gathering bringing together those on the frontlines of health care – physicians, physician assistants and practice managers -- for three days of learning, sharing ideas and insights, networking and socializing. The conference takes place Sept. 15-18 at the Grandover Hotel in Greensboro.
For North Carolina Medical Society (NCMS) members this conference also includes our Annual Business meeting. With the dissolution of the House of Delegates last year, this important meeting will serve as a forum to bring health policy issues to the NCMS Board of Directors. The new NCMS officers and board members will be installed during this meeting as well.
A few reasons to attend:

You can earn 13.75 hours of CME.
Voice your opinion on health policy issues of importance to you by bringing them to the NCMS Board of Directors at the NCMS Annual Business Meeting on Saturday afternoon. There is no cost to attend this meeting.
Fulfill your opioid prescribing CME requirement. This free session is titled “Opioid Prescribing: Safe Practice, Changing Lives” and is presented by the popular, Christopher Grubb, MD.
Begin to celebrate what's good in your work, your relationships, your family and yourself. Dr. Wayne Sotile, back by popular demand, is a national speaker on resilience, and will help you understand the important connection between your career and what you carry home after the work day.
Learn how to avoid common patient communication pitfalls.
Better understand the move to value-based payment from innovative North Carolina health care leaders who have made the move.
Find out more about what North Carolina health officials are doing to fight the Zika virus.

Review the full agenda and register for this must-attend event here.

Rural Practices Begin to Learn How to Survive Payment Reform

rural aco consortium workshop — Kathy Whitmire, regional vice president for the National Rural Accountable Care Consortium, presents to workshop participants at the NCMS Center for Leadership in Medicine. on July 15.

Two dozen health care practitioners including physicians, physician assistants, care coordinators and practice managers gathered at the North Carolina Medical Society (NCMS) Center for Physician Leadership on July 15 to learn how to survive the value-based payment reform and gain a better understanding of the rules proposed as part of the massive MACRA legislation.
The free, day-long workshop was presented by the National Rural Accountable Care Consortium (NRACC), a Practice Transformation Network. The workshop is part of the NCMS Foundation’s commitment to helping physicians and physician assistants prepare for the new quality payment program under MACRA.
The workshop was divided into two tracks for the day. One was an introduction aimed at care coordinators while the other, more physician-focused course, covered well-visits and providing value-based appointments.
The next workshop will be in Raleigh on Oct. 18. Learn more about how your practice can adapt to the health care reforms and become part of the Practice Transformation Network here.
This initiative is part of the Centers for Medicare & Medicaid Services’ (CMS) Transforming Clinical Practice Initiative (TCPI). CMS has dedicated millions of dollars to support more than 140,000 clinician practices over the next four years in sharing, adapting and further developing their comprehensive quality improvement strategies through TCPI. It is one of the largest federal investments offering nationwide, collaborative and peer-based learning networks to facilitate practice transformation. The NCMS Foundation is partnering with the NRACC a Provider Transformation Network (PTN) to provide free training for practices in North Carolina as part of the TCPI.

New Toward Accountable Care Specialty Guides Available For Rheumatologists and Rural Health

Rheumatologists and those health care professionals serving rural areas have a new resource to consider as our health care system makes the move to value. The Toward Accountable Care (TAC) Consortium and Initiative have published toolkits aimed at these two specialties and their unique role to play in the world of accountable care organizations. Browse all the TAC guides and download those of general interest or for your specialty.
Don’t forget you can earn CME for reading and absorbing the information in the original Physicians’ Accountable Care Guide, thanks to the Texas Medical Association. This is the seminal toolkit, which provides the basis for all the specialty specific guides that followed. Simply click here to download the guide and learn how to earn the CME. Be sure to enter ‘NCMS’ in the coupon code space to receive the NCMS member discount.