Updated Mumps and Zika Virus Guidelines for NC Clinicians
The North Carolina Division of Public Health recently issued several updated memos on communicable diseases involving a mumps outbreak in the Charlotte area and the Zika virus, which has been much in the news lately.
The Division of Public Health is working with local health departments to investigate and control an outbreak of mumps in the Charlotte region. The memo is intended to summarize information regarding mumps diagnosis, management and prevention and to encourage clinicians to promptly report suspected mumps cases.
As of March 7, 15 cases had been identified among persons in the Charlotte region with parotitis onset dates ranging from January 10–February 29, 2016. Mumps cases were first reported among employees at a large home improvement corporate office in Iredell County. More recent cases have been identified among persons with no known link to this office or to previously reported cases, including two students at a university in Mecklenburg County. Mumps outbreaks have also been recently reported among students at colleges and universities in several other states, including cases among vaccinated students.
Read the memo on mumps here.
The Division of Public Health also issued an updated memo to provide information to NC clinicians and laboratories regarding diagnosis, management and reporting of Zika virus infection. This memo was updated to include revised information and guidance about sexual transmission of Zika virus from male travelers to female non-travelers. Read the memo on the Zika virus here.
Medical Student Summit a Huge Success
More than 50 medical students representing all of the state’s five medical schools gathered at the North Carolina Medical Society (NCMS) Center for Leadership in Medicine in Raleigh last Saturday for an afternoon of learning, networking and develop the necessary skills to survive medical school and beyond.
Devdutta Sangvai, MD, MBA, an NCMS Past President, shared why it’s especially important now for medical students to get involved in organized medicine. Guest speaker, Niket Sonpal, MD, a Gastroenterology and Hepatology Fellow at Lenox Hill Hospital in New York City spoke on the "History of Accidental Discovery in Medicine," and a physician panel imparted their wisdom on how to be ready for residency. There were breakout sessions on leadership development, board review and STEP study strategies, how to stay physically and mentally well and strong throughout medical school and residency and tips on how to keep personal finances healthy.
“The first annual NCMS student summit was a wonderful opportunity to learn from the current leaders in medicine and meet medical students all over North Carolina,” said Audrey Lan, a medical student at the University of North Carolina-Chapel Hill. “I first heard Dr. Niket Sonpal speak at the AMA conference in Chicago last summer, and I was very excited to hear his insights on accidental discoveries in medicine and STEP study strategies.”
Based on the interest in and success of this inaugural Student Summit, watch for future events like this.
CMS Extends Deadline for EHR Incentive Program Hardship Exception Process
The Centers for Medicare and Medicaid Services (CMS) extended the application deadline for the Medicare EHR Incentive Program hardship exception process until July 1, 2016. In January. CMS is extending the deadline so providers have sufficient time to submit their applications to avoid adjustments to their Medicare payments in 2017.
In January, CMS posted new, streamlined hardship exception application forms to help reduce the burden on clinicians. The new applications and instructions for providers seeking a hardship exception are available here.
Are You Going to the M3 Conference? Your Colleagues Will Be There
This year the North Carolina Medical Society (NCMS) and the NC Medical Group Management Association (NCMGMA) are joining forces to bring you an exciting array of educational and networking opportunities at the M3 – Merging Medicine and Management – Conference on Sept. 15-18 at the Grandover Resort and Hotel in Greensboro. Sessions on leadership development, wellness, opioid prescribing, MACRA and Medicaid reform in our state as well as legislative updates will be just part of this new conference.
Mark your calendar and plan on being in Greensboro for the M3 – where physicians and practice managers will meet!
NC Doctors’ Day Tribute Cards Benefit the NCMS Foundation
Donors contributed hundreds of dollars to purchase tribute cards and e-cards to thank a special physician during the final two weeks of online voting for the NC Doctor of the Year Award last year. NC Doctors’ Day 2016 is in full swing – our finalists for the NC Doctor of the Year Award will be posted on the website on March 18. Become part of the celebration by saying ‘thank you’ in a meaningful way to your doctor or colleague.
Proceeds from the cards will be used by the NCMS Foundation to grow our work to improve access to quality health care for North Carolina’s most vulnerable patients. In 2014, the Foundation’s Community Practitioner Program assisted 38 primary care providers located across NC. These physicians, PAs and NPs provided a whopping $350 million in care for the under- and uninsured in the past year alone!
Don’t forget the Foundation’s tribute program is year-round. For a contribution of $25 per card, the Foundation will send a greeting card in honor or in memory of someone special. Birthdays, work anniversaries, congratulations and retirement are all great reasons to send a tribute card. Visit our secure donation page and complete the “Tribute Information” section. Your tribute gifts will help the Foundation make sure that all North Carolinians have a doctor in their own hometown!
Send Your Tribute Today!
New Partner Joins NCMS Marketplace
The North Carolina Medical Society (NCMS) is pleased to announce Liberty Mutual Insurance is a bronze level partner in our Marketplace of benefits for our members.
Liberty Mutual offers NCMS members exclusive discounts for home and auto insurance. As a proven insurance leader since 1912, Liberty Mutual can offer more than just insurance.
- Expert advice from your local agent, Amanda Cole.
- Guaranteed rates for 12 months.
- 24-Hour Claims Assistance, Contractor Network Referral, and optional 24-Hour Road Side Assistance.
- Lifetime Repair Guarantees for auto and home claims
This is just the latest addition to NCMS’ Marketplace, which provides a comprehensive listing of partners offering services of most use to you and your practice. The Marketplace website provides an easily navigated, tiered system for easy comparison as well as the ability to search by specialty.
We hope you take advantage of this valuable member benefit.
Watch the Bulletin and visit the site often as new partners will be added frequently.
United Health Foundation Releases 2016 America’s Health Rankings Spotlight: Prevention
United Health Foundation released its in-depth look at prevention measures across all 50 states recently. 2016 America’s Health Rankings Spotlight: Prevention looks at health care access, immunizations and chronic-disease prevention.
Among key findings, the report shows that use of important clinical preventive services is uneven and varies by income, education and geography, with Hispanics accessing preventive services less than non-Hispanic white and non-Hispanic black adults. It also finds that New England states perform best in prevention measures, and that there is significant variation among states when it comes to immunizations. You can access North Carolina’s Spotlight: Prevention profile here. Read the full report here.
In the News
Group Representing Anesthesiologists Overhauls Certification Process Affecting 1,000+ NC Doctors, Triangle Business Journal, 3-2-16
R2D2's Next Assignment: Hospital Orderly, Kaiser Health News, 3-1-16
Battle Rages Over Florida Law Limiting Doctor's Gun Speech, The New York Times, 2-27-16
Treating Addiction As A Chronic Disease, NPR, 2-26-16
UNC Medical School Opening Wilmington Campus, Greater Wilmington Business Journal, 2-26-16
The Racial Divide in the Opioid Crisis, Modern Healthcare, 2-25-16
Slavitt Shares Four Lessons from ICD-10 Transition, Healthcare Dive, 2-25-16
Are Hospitals Fueling Cancer Drug Spending As They Buy Up Oncology Practices?, Modern Healthcare, 2-25-16
Learning Opportunities
NCTracks will offer the following training courses in March. Register for these courses in SkillPort, the NCTracks Learning Management System. Refer to the Provider Training page of the public Provider Portal for specific instructions on how to use SkillPort.
Wednesday, March 2 - 9:30 to 10:30 a.m. - Using the Provider Message Center Inbox (WebEx) will guide authorized users on how to use the Provider Inbox within the Provider Message Center of NCTracks. This course is taught via WebEx and can be attended remotely from any location with a telephone, computer and internet connection. The WebEx will be limited to 115 participants.
Friday, March 4 - 9 to 11 a.m. - New Office Administrator (WebEx) shows authorized users the process for changing the current Office Administrator (OA) to a new Office Administrator for an Individual Provider or Organization with a National Provider Identification (NPI) number or Atypical Provider Number. This course is taught via WebEx and can be attended remotely from any location with a telephone, computer and internet connection. The WebEx will be limited to 115 participants.
Tuesday, March 8 – 1 to 2:30 p.m. and Thursday, March 24 - 1. to 2:30 p.m. Provider Re-Credentialing/Re-Verification Refresher (WebEx) will serve as a refresher for the steps to be taken by the provider to complete the Re-Verification process through NCTracks. It also covers the steps to enter information and submit a Manage Change Request (MCR) in the event the user is prompted to complete an MCR during Re-Verification/Re-Credentialing. This course is taught via WebEx and can be attended remotely from any location with a telephone, computer and internet connection. The WebEx will be limited to 115 participants. (The same course is being offered on multiple dates.)
Wednesday, March 16 – 1 to 2:30 p.m. - Managed Care Referrals and Overrides shows authorized users how to submit Managed Care Referrals and inquire about Managed Care Referrals and Overrides. This course will be offered at the CSC facility in Raleigh. It involves hands-on training and will be limited to 45 participants.
Thursday, March 17 - 1:00 p.m. to 3:00 p.m. - Create and Submit a PA for DME and Home Health Supply using Electronic Physician Signature (WebEx) will guide users through the new process that allows the requesting provider to enter a prior approval (PA) request on the Provider portal and then route it through NCTracks to the prescribing provider for review and approval using an electronic signature (PIN).
Tuesday, March 22 – 1 to 4:00 p.m. - ES User Role_Abbreviated MCR_Upload Documents (WebEx) will guide providers through the enhancements to the provider enrollment application processes.
Coastal Carolinas Health Alliance, working with their Health Information Exchange will hold their Annual Meeting on March, 11 at Country Club of Landfall (800 Sun Runner Place Wilmington, NC 28405). They will be offering 2 CMEs opportunities. Dr. Randall Williams of the NC Department of Health and Human Services, and Dr. Charles Kennedy of Healthagen, will speak on Regional Interoperability and Value Based Care. Email Bobby Deignan to register.
Learn about the growing popularity of Narrow Networks and their potential impact on organizations and consumers at a Lunch and Learn webinar sponsored by North Carolina Medical Society Foundation, in cooperation with the North Carolina Medical Group Managers on March 15, from noon to 1 p.m. The featured speaker will be Barry Herrin, FAHIMA, FACHE, ESQ., Smith Moore Leatherwood LLP. Register here.
NCHICA will offer a workshop on Navigating the Transition to Value, March 16, 8 a.m. to 5 p.m. at the Research Triangle Foundation in Research Triangle Park. The purpose of this workshop is help health care providers (delivery systems, hospitals, physicians, etc.) explore strategic considerations—technical, financial, and operational—of moving to a value-based system. As providers move away from a fee-for-service system to an outcomes-based system, what changes are necessary in technology, analytics, etc.? What strategies are needed for incremental change? Where does one start on the path to transition? Learn more and register.
The Carolinas Center and the Virginia Association for Hospices and Palliative Care are offering the 2016 Palliative Care Symposium, Support for a Lifetime: Palliative Care Across the Continuum, April 7 at the William and Ida Friday Center, University of North Carolina-Chapel Hill. More information here. The early registration deadline is March 17.
The Medical Society of Virginia Foundation (MSVF) in collaboration with the American Society of Addiction Medicine (ASAM) and Johnston Memorial Hospital in Abingdon, VA, is offering two opioid pain management educational programs in Abingdon, Virginia on Friday, March 18, 2016. Read more about them and register.
The Western Carolina Medical Society is offering the “Heart of the Healer” Retreat to equip physicians with practical and field-tested tools to reduce and prevent burnout on Saturday, April 16th 2016 at Montreat Conference Center in Montreat, NC. Earn up to 4.5 hours of CME; spouses/significant others invited; childcare available (ages 3+). Event details and registration is available at www.mywcms.org/burnout2016 or call us at 828-274-2267 ext. 1313. Space is limited, so please register by March 20th.
USF Health and i3 Health are hosting the 2nd Annual Hematologic Malignancies Symposium in Asheville on April 16 at the Asheville Renaissance Hotel. This live 1-day CME/CE-certified meeting is targeted towards medical oncologists, hematologists, oncology advanced practitioners, oncology nurses and other health care professionals involved in the treatment of gastrointestinal malignancies. Participants will receive expert insights from leading investigators in treatment selection and supportive care best practices for patients with hematologic malignancies. More information and register here.
USF Health and i3 health are hosting the 1st Annual Gastrointestinal Malignancies Symposium in Asheville on April 16 at the Asheville Renaissance Hotel. This live 1-day CME/CE-certified meeting is targeted toward medical oncologists, surgical oncologists, radiation oncologists, oncology advanced practitioners, oncology nurses and other health care professionals involved in the treatment of patients with gastrointestinal malignancies. More information and register here.
2016 Addiction Medicine Conference, April 22-23 in Asheville, will once again provide up-to-date substance abuse related education, applicable across general medical as well as addiction specialty practices. New this year is a Pre-Conference day on April 21 including two longer, skill-based workshops: Motivational Interviewing: A Foundation for Helping Patients with Substance Use Problems and The ABCs of Pain Management: Skills for the Specialist and Non-specialist Alike. Register Today! For more information contact Shaquita Basemore at 919-256-7416.
The Pain Society of the Carolinas (PSOC) urges you to save the dates for several other courses on pain management.
DUKE Pain Meeting, on April 29-May 1, covering cancer pain, palliative care and end-of-life. To be held in Chapel Hill. Registration CLICK HERE to Register. Register early for discounted rates!
Save the date for the PSOC Annual Meeting, Sept. 25, at The Omni Grove Park Inn, Asheville NC
Greensboro AHEC is offering a day long course titled “What Do I Say? A Course in Talking About Death and Dying on April 22 OR Nov. 4, at The John A. Lusk, III, MD Caregiving Education Center – the Lusk Center 2501 Summit Avenue, Greensboro, NC. More information and register here.
The NC MGMA will hold its Annual Conference, May 11-13, in Charleston, SC. This year’s conference, “Making Connections,” will tie together the various aspects of what health care administrators are challenges with every day featuring content on finance, customer service, legal, social media and human resources. The Practice of the Year Award also will be presented at this gathering (see article in this edition of the Bulletin). Learn more and register.
NC DHHS Unveils Medicaid Reform Draft Plan
Today the North Carolina Department of Health and Human Services unveiled its multi-year draft plan to reform the state’s Medicaid program to the Joint Legislative Oversight Committee on Medicaid and NC Health Choice.
As Dee Jones, Chief Operating Officer for DHHS’ new Division of Health Benefits, described it this plan is simply the “end of the beginning” of the reform process.
Read the 69-page draft waiver application to the Centers for Medicare and Medicaid Services (CMS), which outlines how the state will implement Medicaid reform as envisioned in the legislation passed by the General Assembly last fall. Review the PowerPoint slides DHHS Secretary Rick Brajer and his staff used to present the plan to the committee here, and the full report here.
North Carolina Medical Society (NCMS) staff is thoroughly reviewing the documents and will provide analysis in Friday’s Bowtie Briefing and next week’s Bulletin, so watch your email and our website for more.
HIE Connection NOT Required At This Time to See Medicaid Patients
Even if your practice is not yet connected to the new state-run North Carolina Health Information Exchange (HIE) you may continue to see Medicaid patients. As the new NC HIE launched today, March 1, some practices have erroneously concluded if they are not part of the HIE, they are no longer eligible to see Medicaid patients.
Only “legacy” practices – those who were already part of the HIE – were required to submit a new participation agreement several weeks ago in anticipation of the launch of the new HIE.
Eventually, all practices seeing Medicaid patients will need to be part of the NC HIE, however, that is not mandated by the Medicaid reform legislation passed last fall until 2018. Today’s launch is just the next step in the lengthy process of transferring the HIE to the state authority.
Please send any questions to [email protected].
DMA Finally Publishes Guidance on Medicaid Recoupment
Two months after NC Medicaid hit physicians with a surprise year-end recoupment, the Division of Medical Assistance (DMA) has finally published guidance for affected medical practices thanks to the persistence of the North Carolina Medical Society (NCMS). The information now is available on the NCTracks website FAQ page.
In a letter to NCMS dated January 27, DMA apologized for its handling of the December recoupment and promised to promptly post FAQs with additional information that NCMS requested on behalf of our members. After our repeated requests over the last two months, the information was published today.
Details Shared with NCMS
DMA also shared with NCMS an unpublished draft Frequently Asked Questions (FAQ) . Much of the information in the FAQ document, which addresses the December recoupment and related challenges, is good news. In particular, the FAQ explains that thousands of claims completely denied in the December recoupment because Medicaid later discovered other insurance coverage (known as “third party liability” or “TPL”) was available for many Medicaid patients. In FAQ number three, DMA states that it has decided to reprocess ALL of the claims that denied for TPL in last December‘s recoupment. As long as the claim is otherwise “clean” it should reprocess and pay at 97 percent of the original payment amount you received. DMA does not have a target date for the reprocessing, however.
In the meantime, NCMS suggests not pursuing reimbursement from the primary payer since you could receive payment from DMA through their reprocessing effort.
Please continue watching the Bulletin for updates as we continue working on this. If you have further questions, please contact NCMS Solution Center Coordinator, Belinda McKoy.
NCMS Addresses Major Issues on Capitol Hill
For two days this week North Carolina Medical Society (NCMS) representatives met with key US House and Senate members and staff to discuss major issues facing NCMS members such as the implementation of MACRA, reform of Medicare’s EHR/Meaningful Use program, Medicare RAC audit reform and stemming the opioid abuse epidemic. NCMS CEO Robert W. Seligson, former NCMS President Albert Osbahr, MD, and long-time NCMS member David Tayloe, MD, were part of the NCMS contingent.
The visit to Washington, D.C. was in conjunction with the Coalition of State Medical Societies, which represents 10 state societies including the NCMS. Coalition members met with U.S. Representative Michael Burgess, MD, (R-Texas), who serves on the House Energy and Commerce Committee and chairs its Subcommittee on Commerce, Manufacturing and Trade. He also sits on the subcommittee on Health. A practicing physician for 30 years, Congressman Burgess was a strong advocate for repealing the SGR, which was accomplished last year. Coalition representatives also met with the Chair of the House Ways and Means Committee, U.S. Representative Kevin Brady (R-Texas); democratic and republican members of the Senate Finance Committee; and with House Energy and Commerce Committee staff in addition to members of the North Carolina congressional delegation.
The Coalition told lawmakers that the medical community continues to carefully monitor implementation of MACRA to prevent unnecessary regulations that discourage physician participation. They called on representatives to adopt immediate reforms to the Meaningful Use program including expanding hardship exemptions; requiring interoperability to ensure information exchange between physicians, hospitals and health plans; and providing proportional credit for quality measures and electronic standards physicians do meet rather than taking an all-or-nothing approach.
Coalition representatives urged lawmakers to support RAC audit reform legislation to prohibit RACs from recouping physician payments until the appeals process is final; to impose penalties for inaccurate findings and to provide incentives for RACs to educate physicians on any incorrect billing practices to avoid future billing errors. North Carolina Representative George Holding and Senator Richard Burr have been strong supporters of such reforms.
Other issues addressed over the two days on Capitol Hill included increased funding for prescription drug abuse monitoring systems to help stem the opioid abuse epidemic and to expand coverage of telehealth services in order to approve access to care, while ensuring physicians are licensed in the state where the patient is receiving the treatment.
“These efforts to educate lawmakers on how policies affect physicians back home is crucial to protecting the interests and livelihood of our NCMS members,” said NCMS CEO Seligson, who attended all the meetings. “We had good, meaningful discussions on these issues and others and I hope they will bear fruit in the days and months to come.”
Meaningful Use Updates – What You Need to Know Now
- Register By Monday to Remain Eligible for Incentive Payments
CMS issued the following updated FAQs on Thursday, Feb. 25:
FAQ #14393 (New): Can a provider register their intent after the first 60 days of the reporting period in order to meet the measures if a registry becomes available after that date?
FAQ #14397 (New): What should a provider do in 2016 if they did not previously intend to report to a public health reporting measure that was previously a menu measure in Stage 2 and they do not have the necessary software in CEHRT or the interface the registry requires available in their health IT systems? What if the software is potentially available but there is a significant cost to connect to the interface?
FAQ #14401 (New): For 2016, what alternate exclusions are available for the public health reporting objective? Is there an alternate exclusion available to accommodate the changes to how the measures are counted?
FAQ #13657 (Updated): What steps does a provider have to take to determine if there is a specialized registry available for them, or if they should instead claim an exclusion?
FAQ #14117 (Updated): What steps do eligible hospitals and Critical Access Hospitals need to take to meet the specialized registry objective? Is it different from EPs?
FAQ #13653 (Updated): What can count as a specialized registry?
Last week, North Carolina Medical Society (NCMS) Foundation’s Director of Practice Improvement Terri Gonzalez sent an email strongly urging practices to register intent to submit data on the North Carolina Immunization Registry and the North Carolina Centralized Cancer Registry before the end of February to help ensure you remain eligible for meaningful use (MU)incentive payments, the. There are still a few days remaining the month to do so. Register intent to submit via the NC DPH Meaningful Use Site for Registration of Intent.
To meet Stage 2 MU public health reporting requirements, providers must declare their intent to submit information electronically to two public health registries in the first 60 days of the year. That means practices would need to complete the process by Monday, Feb. 29.
The only specialized registry offered by NC DPH is the NC Centralized Cancer Registry, which accepts cancer reports from eligible professionals who diagnose or treat cancer.
Information about other specialized registries can be found here.
“The important thing is to show you tried or had the intent to register,” Gonzalez said. “Then you’ll have the paperwork to back you up and shouldn’t miss this requirement to receive incentive payments.”
For more information on why this is required, please read this CMS FAQ carefully. please contact the N.C. DPH Meaningful Use Help Desk by email ([email protected]), or for questions related specifically to immunization reporting contact [email protected].
- CMS Clarifies What MU Hardship Exception Means
CMS has clarified that applying for a hardship exception from the 2017 meaningful use payment penalty will not preclude physicians from receiving the incentive if they successfully attest to meaningful use in 2015. CMS’ clarification may be found in the answer to FAQ #14357.
The AMA is encouraging all physicians to apply for a hardship exception as a result of the delay of the 2015 meaningful use modification rule. To file for the exception, read the instructions and download the application form. The deadline to file the application is March 15, 2016.
- Meaningful use attestation deadline extended
Physicians now have an additional two weeks to attest to meaningful use for the 2015 program year. CMS extended the original Feb. 29 attestation deadline to midnight March 11.
Physicians must attest to meaningful use every year to receive an incentive payment and avoid a penalty. Note that CMS is only extending the attestation period, not the reporting period, so physicians must have concluded their reporting by Dec. 31, 2015.
To attest, physicians should submit their data through the CMS registration and attestation system. Physicians may select an EHR reporting period of any continuous 90 days from Jan. 1, 2015, (the start of the 2015 calendar year) through Dec. 31, 2015.
To speed the attestation process, the AMA recommends that physicians attest during off-peak hours, such as evenings and weekends, and take time now to ensure that their information is up-to-date before beginning to enter 2015 data.
NC HIEA Participation Agreement Update
As the March 1 transition to a state-run Health Information Exchange (HIE) rapidly approaches, the North Carolina Medical Society (NCMS) has been working closely with the HIE Authority (HIEA), the new state entity that will oversee the HIE, to help pave the way for a smooth transfer for participants.
An issue with the insurance provisions in the participation agreement was resolved last week as the deadline for submitting the agreements arrived on Friday. Learn more about the significance of the HIEA and how to amend your participation agreement if you need to do so by watching the Bowtie Briefing video or clicking here for the necessary amendment to the agreement.
NCMS President Seeks Feedback; Shares Thoughts on the Importance of Professional Organizations
North Carolina Medical Society (NCMS) President Docia Hickey, MD, spent an evening in Durham recently listening to the concerns of Durham-Orange County Medical Society (DOCMS) members. Earlier in the day, she shared her thoughts on the importance of professional organizations with residents in the University of North Carolina-Chapel Hill anesthesiology program. Dr. Hickey’s visits were a result of the NCMS’ new governance model, which creates a direct line of communication between the physicians of the state and the NCMS Board of Directors.
Kunal Mitra, MD, the DOCMS President welcomed Dr. Hickey to the forum where she began by briefly outlining the NCMS’s 2016 priorities. NCMS Board Member John Meier, MD, also was present and spoke about the new governance structure and the various mechanisms for communicating directly with the Board of Directors on policy matters. A robust discussion followed with DOCMS members speaking out on policy issues of concern to them including Certificate of Need (CON) laws, opioid prescribing, health insurance company consolidations and expanding Medicaid in North Carolina. Dr. Hickey invited DOCMS representatives to the NCMS Board of Directors meeting to further discuss Medicaid expansion.
State Senator Mike Woodard, (D-Caswell, Person, Durham) attended the meeting as well and expressed the need for physician activism to ‘move the ball’ on Medicaid expansion. He complimented NCMS legislative efforts on this issue.
Earlier in the day, at the invitation of former Durham-Orange County Medical Society (DOCMS) President and NCMS member David Hardman, MD, Dr. Hickey participated in an informal panel discussion on the importance of professional organizations with resident and attending physicians from the UNC Anesthesiology program. She shared her path to leadership and spoke of the beneficial experiences and connections she has made through her professional organization membership. The other panelists were DOCMS Immediate Past President Will Silver, MD, NC Society of Anesthesiologists (NCSOA) President Tim Gundlach, MD, Director Paul Rieker, MD. The common theme running through each panelists’ comments was that experiences in these associations and the people they met along the way were instrumental to their career development and professional fulfillment.
PAI Report Outlines Payment Differentials Across Outpatient Settings
Last week, the Physicians Advocacy Institute (PAI) released a study prepared by Avalere Health entitled “Medicare Payment Differentials Across Outpatient Settings of Care,” that provides a comprehensive examination of Medicare payment rate differentials across service settings.
The report assesses the Medicare payment differential for three common services routinely performed in hospital outpatient department (HOPD) and physician office settings: echocardiograms, colonoscopies and evaluation and management services. The report confirms that for all three types of services, Medicare spends more when patients receive services in a HOPD instead of a physician office. For instance, the study found that cardiac imaging payments are more than triple when patients receive care at a hospital outpatient department instead of a physician’s office – roughly $2,100 vs. $655, respectively. Read the full report here.
Release of the report has garnered media coverage including this article published today in Health Leaders Media.
PAI is a not-for-profit advocacy organization whose mission is to advance fair and transparent payment policies and contractual practices by payers and others in order to sustain the profession of medicine for the benefit of patients. PAI’s Board of Directors includes CEOs and former CEOs from nine state medical associations, including California, Connecticut, Georgia, Nebraska, New York, North Carolina, South Carolina, Tennessee and Texas, as well as a Kentucky physician.
Trouble Getting Through to BCBS? Reminder of Numbers to Call
Members continue to report trouble getting through to Blue Cross and Blue Shield of North Carolina (BCBSNC) to receive pre-certification or pre-authorization of services for their patients. Below are the numbers BCBS previously provided us to help our members speed the process with minimal time on the phone.
For Utilization Management/PreCert/Authorizations – please use this number 800-672-7897.
For emergent eligibility verification issues:
- If the patient is in the office and you are unable to verify eligibility for an immediate, urgent/emergent service or appointment via Blue eSM or the toll-free provider line (800-214-4844), before turning the patient away, you may call 919-765-4035 for assistance. If voicemail picks up on this line, please leave a contact name and a contact number for the office. Please Note: this will not include detailed benefit information only to verify ELIGIBLITY
- If you are verifying eligibility for future appointments, please attempt to utilize Blue eSM or the 800 eligibility line.
CMS Announces Core Quality Measures As Part of Simplification Effort
The Centers for Medicare and Medicaid Services (CMS) last week released seven sets of “core quality measures” developed in conjunction with the Core Quality Measures Collaborative. The goal of the Collaborative is to achieve multi-payer alignment of quality measure sets to reduce the administrative onus on physicians doing the reporting.
To help ensure our members have input, the North Carolina Medical Society (NCMS) has established the Performance Measurement Task Force, which will help inform advocacy work with stakeholders to ensure fair and appropriate use of quality and performance measures that are as minimally burdensome to physicians as possible.
The national Collaborative included CMS, America’s Health Insurance Plans (AHIP), the American Medical Association (AMA), National Quality Forum (NQF), national specialty societies and others. The core measures are comprised of the following seven categories:
- Accountable Care Organizations (ACOs), Patient Centered Medical homes (PCMH) and Primary Care
- Cardiology
- Gastroenterology
- HIV and Hepatitis C
- Medical Oncology
- Obstetrics and Gynecology
- Orthopedics
In the announcement, CMS states “the guiding principles used by the Collaborative in developing the core measure sets are that they be meaningful to patients, consumers and physicians, while reducing variability in measure selection, collection burden and cost. The goal is to establish broadly agreed upon core measure sets that could be harmonized across both commercial and government payers.”
Commercial payers plan to implement the core measure sets as contracts come up for renewal, and The Collaborative plans to continue to meet to monitor and adjust the measure sets as needed.
CMS will use this work to inform their implementation process for the Medicare Access and Chip Reauthorization Act (MACRA) through its rulemaking process, expected to begin this spring. See the full CMS announcement and review the measure lists here. A copy of AHIP’s corresponding news release is available here.
Get the Facts on MACRA
If you are still uncertain what MACRA is all about, get the facts by downloading the recording of last week’s webinar on MACRA hosted by North Carolina Medical Society (NCMS) Director of Health Policy Jennifer Gasperini and sponsored by the NCMS Foundation and the NC Medical Group Managers Association (NCMGMA).
“I thought the material and how it was presented was well thought out. I am very appreciative of the NCMS efforts in providing relevant and timely information to the physician community.”
-- Becky, a practice manager in Durham.
There Is an App for That Drug Card
As if the North Carolina Drug Card is not easy enough to use, now there is a smartphone app that will give patients another way to access this valuable benefit. The North Carolina Medical Society (NCMS) in partnership with the North Carolina Drug Card encourages physicians to give out the free card – or recommend the app – that allows patients who aren’t insured or who take prescription drugs that aren’t covered by their health insurance plans, to obtain discounts of up to 75 percent off the retail price for FDA-approved medications.
Learn more and download the app.
Or visit the NCMS Marketplace or the NC Drug Card website to request the cards to distribute to your patients.
Reflection: “Thank you, Doctor”
We’d like to introduce a new feature in our Bulletin highlighting reflections on the ‘heart and soul’ of practicing medicine -- the relationship with patients. We invite you to share anecdotes, stories, poems or any other creative form expressing how you have helped people deal with some of life’s most difficult challenges and the courage and resilience often necessary as doctor and patient. By sharing these reflections we hope to remind you of the importance and the universal human context of what you do every day.
Today’s feature recounts one instance of the gratitude patients often have for your efforts. It was written by O’Neill D’Cruz, MD, a neurologist in Chapel Hill. His story, “Thank You, Doctor” is from All Shall Be Well, a collection of his essays. His goal in writing and compiling these stories, several of which have been published previously in national journals, was to help residents and students counsel patients as well as aid patients and their loved ones find a way forward in the face of illness.
“I found patients find these stories more helpful than facts and figures because they are universal to us as human beings and let us find our own way,” Dr. D’Cruz explains. “Also, sharing these stories helps us heal our own wounds.”
Dr. D’Cruz is a Kanof Institute for Physician Leadership (KIPL) Leadership College alumnus and now serves as a KIPL faculty member.
“Thank You, Doctor” is an especially fitting story as we’re currently seeking nominations for the NC Doctor of the Year Award as part of the NC Doctors’ Day celebration on March 30. Patients, staff and colleagues already have nominated well over 200 physicians throughout the state who they think worthy of being named the 2016 NC Doctor of the Year. Visit the NC Doctors’ Day website to learn more about this way to express gratitude for what doctors do every day.
Enjoy Dr. D’Cruz’s story, and please email Elaine Ellis, North Carolina Medical Society (NCMS) Director of Communications and Marketing with any reflections you’d like to share. If you have questions, please call her at 919-833-3836 x112.
NCMS Leadership College Scholar Already Putting Skills to Good Use
Christen MacKorell, a physician assistant student at Gardner-Webb University in Boiling Springs, NC and a 2016 North Carolina Medical Society (NCMS) Foundation Leadership College scholar, is already putting her newly acquired leadership skills to use.
“After enjoying and benefitting from attending our own NCMS meetings, I wanted my classmates [at Gardner-Webb’s PA program] to have similar opportunities to develop their individual leadership potential,” MacKorell said. “To that end, I applied for the Lanny Parker Memorial Endowment through the NCAPA [NC Association of Physician Assistants] and was awarded funding to take three of my classmates with me to the [American Academy of Physician Assistants Leadership and Advocacy Summit in Washington, DC].”
The summit includes time for attendees to lobby their representatives on Capitol Hill and MacKorell and her classmates met with House Majority Chief Deputy Whip Representative Patrick McHenry (R-NC). They asked the Congressman to support legislation to include PAs as prescribers of buprenorphine (Suboxone) at the federal level. They also advocated for the expansion of Medicaid to reimburse all physicians and PAs for rendering behavioral health services.
MacKorell also offered “a shout out” to NCMS Director of Legislative Relations Chip Baggett praising his Leadership College presentation, which “perfectly prepared me to navigate my classmates through the policy discussion!”
Long-time NCMS Member Appointed to NC Medical Board
Governor Pat McCrory recently appointed Venkata Jonnalagadda, MD, a Greenville psychiatrist and long-time NCMS member, to serve on the North Carolina Medical Board.
Dr. Jonnalagadda is medical director at Eastpointe Human Services, which offers mental health, disability and substance abuse services in Robeson, Bladen, Columbus, Duplin, Edgecombe, Greene, Lenoir, Nash, Sampson, Scotland, Wayne and Wilson counties. She also is a partner in private practice with Greenville Psychiatric Association P.A., serves on the adjunct teaching faculty in the Department of Pediatrics at East Carolina University’s Brody School of Medicine, and works as a clinical psychiatrist with the federal Veterans Administration. She is the president of the Pitt County Medical Society and a member of the NCMS’ Ethical and Judicial Affairs Task Force. In 2015, McCrory appointed her to a three-year term with the North Carolina Commission of Public Health.
The 13-member North Carolina Medical Board is responsible for licensing, monitoring, disciplining and guiding physicians, physician assistants and the other health care professionals.
AMA Calls On Physicians To Turn the Tide of the Opioid Epidemic
Last week, the nation’s physicians received a direct appeal from AMA President Steven J. Stack, MD, urging them to take swift action to end the opioid epidemic that has claimed more than 250,000 lives over the past 15 years.
“We have a defining moment before us—the kind of moment that we will look back on in years to come as one in which we as a profession rose to the challenge to save our patients, our families and our communities during a time of crisis,” Dr. Stack wrote.
He likened this epidemic to the HIV/AIDS epidemic, in which policymakers, public health leaders and physicians came together to implement solutions that changed the course of history for people with an HIV/AIDS diagnosis and their loved ones. He called on physicians to “mount a similar response” to the opioid epidemic.
“The loss of lives we are seeing around us and in the news every day is unacceptable—and we don’t have to accept it,” he wrote. “Each and every one of us must band together to take specific actions that will turn the tide.”
He pointed to the five essential actions and resources for physicians that have been identified by the AMA Task Force to Reduce Prescription Opioid Abuse:
Register for and use their state’s prescription drug monitoring program (PDMP)
Enhance their education and training about safe prescribing
Co-prescribe naloxone to patients at risk of overdose
Get training to provide medication-assisted treatment (MAT) for and help reduce stigma around substance use disorders
Speak out against stigma around patients in pain and the physicians who treat them
See more recent news on actions to stem the opioid abuse epidemic in this Bulletin’s ‘In the News’ section.
NCMGMA Practice of the Year Award Nominations Open
The North Carolina Medical Group Management Association (NCMGMA) and its partner, First Citizens Bank, have announced that nominations are open for the 4th Annual Practice of the Year Award, to be presented on the evening of Thursday, May 12th during the NCMGMA Annual Conference in Charleston.
This award recognizes a medical group practice that has made a significant contribution to their community, patients and/or staff through volunteer work, indigent clinics, fundraisers, staff wellness programs, community clean ups, community screenings and education (internal and external), etc.
To submit your practice for Practice of the Year, please fill out this nomination form and submit back to the NCMGMA offices. All nominations for this award are due by 5pm on March 21st.
In the News
Shortage of Addiction Counselors Further Strained By Opioid Epidemic, NPR, 2-24-16
Obama Says Nation's Doctors Are Key to Fixing Opioid Abuse Epidemic, Modern Healthcare, 2-22-16
Governors Devise Bipartisan Effort to Reduce Opioid Abuse, The New York Times, 2-21-16
Expanded Scope: Nurse Practitioners Making Inroads, Modern Healthcare, 2-20-16
Population Health's Ripple Effect, MedPage Today, 2-18-16
The Hard Work Ahead On Adopting Uniform Quality Measures, Modern Healthcare, 2-18-16
A Novel Plan for Health Care: Cutting Costs Not Raising Them, The New York Times, 2-17-16
To Treat or Not? Question Looms for Elderly and Sick, USA Today, 2-17-16
Let's Change the Conversation Around Mental Health, The Huffington Post, 2-17-16
Justice Scalia's Death Leaves Health Care Cases, Makeup of Supreme Court In Limbo, Modern Healthcare, 2-13-16
Disparity in the Life Spans of the Rich and the Poor Is Growing, The New York Times, 2-12-16
McCrory Appoints Bill Daughtridge to NC Industrial Commission, Triangle Business Journal, 2-12-16
Top NC Educator Joins Team Shaping NC's Medicaid Reform, North Carolina News Network, 2-10-16
Learning Opportunities
NCTracks will offer the following training courses in February. Register for these courses in SkillPort, the NCTracks Learning Management System. Refer to the Provider Training page of the public Provider Portal for specific instructions on how to use SkillPort.
Friday, Feb. 26 - 1 to 3 p.m. - Recipient Eligibility Verification will cover how to use the Eligibility Verification System (EVS), which provides information regarding a recipient's eligibility for services in real time. This course will be taught at the CSC facility in Raleigh. The course includes hands-on training and will be limited to 45 participants.
Coastal Carolinas Health Alliance, working with their Health Information Exchange will hold their Annual Meeting on March, 11 at Country Club of Landfall (800 Sun Runner Place Wilmington, NC 28405). They will be offering 2 CMEs opportunities. Dr. Randall Williams of the NC Department of Health and Human Services, and Dr. Charles Kennedy of Healthagen, will speak on Regional Interoperability and Value Based Care. Email Bobby Deignan to register.
NCHICA will offer a workshop on Navigating the Transition to Value, March 16, 8 a.m. to 5 p.m. at the Research Triangle Foundation in Research Triangle Park. The purpose of this workshop is help health care providers (delivery systems, hospitals, physicians, etc.) explore strategic considerations—technical, financial, and operational—of moving to a value-based system. As providers move away from a fee-for-service system to an outcomes-based system, what changes are necessary in technology, analytics, etc.? What strategies are needed for incremental change? Where does one start on the path to transition? Learn more and register.
The Carolinas Center and the Virginia Association for Hospices and Palliative Care are offering the 2016 Palliative Care Symposium, Support for a Lifetime: Palliative Care Across the Continuum, April 7 at the William and Ida Friday Center, University of North Carolina-Chapel Hill. More information here. The early registration deadline is March 17.
The Medical Society of Virginia Foundation (MSVF) in collaboration with the American Society of Addiction Medicine (ASAM) and Johnston Memorial Hospital in Abingdon, VA, is offering two opioid pain management educational programs in Abingdon, Virginia on Friday, March 18, 2016. Read more about them and register.
The Western Carolina Medical Society is offering the “Heart of the Healer” Retreat to equip physicians with practical and field-tested tools to reduce and prevent burnout on Saturday, April 16th 2016 at Montreat Conference Center in Montreat, NC. Earn up to 4.5 hours of CME; spouses/significant others invited; childcare available (ages 3+). Event details and registration is available at www.mywcms.org/burnout2016 or call us at 828-274-2267 ext. 1313. Space is limited, so please register by March 20th.
USF Health and i3 Health are hosting the 2nd Annual Hematologic Malignancies Symposium in Asheville on April 16 at the Asheville Renaissance Hotel. This live 1-day CME/CE-certified meeting is targeted towards medical oncologists, hematologists, oncology advanced practitioners, oncology nurses and other health care professionals involved in the treatment of gastrointestinal malignancies. Participants will receive expert insights from leading investigators in treatment selection and supportive care best practices for patients with hematologic malignancies. More information and register here. Early bird discount available until March 1.
USF Health and i3 health are hosting the 1st Annual Gastrointestinal Malignancies Symposium in Asheville on April 16 at the Asheville Renaissance Hotel. This live 1-day CME/CE-certified meeting is targeted toward medical oncologists, surgical oncologists, radiation oncologists, oncology advanced practitioners, oncology nurses and other health care professionals involved in the treatment of patients with gastrointestinal malignancies. More information and register here.
The Pain Society of the Carolinas (PSOC) urges you to save the dates for several other courses on pain management.
DUKE Pain Meeting, on April 29-May 1, covering cancer pain, palliative care and end-of-life. To be held in Chapel Hill. Registration CLICK HERE to Register. Register early for discounted rates!
Save the date for the PSOC Annual Meeting, Sept. 25, at The Omni Grove Park Inn, Asheville NC
Greensboro AHEC is offering a day long course titled “What Do I Say? A Course in Talking About Death and Dying on April 22 OR Nov. 4, at The John A. Lusk, III, MD Caregiving Education Center – the Lusk Center 2501 Summit Avenue, Greensboro, NC. More information and register here.
The NC MGMA will hold its Annual Conference, May 11-13, in Charleston, SC. This year’s conference, “Making Connections,” will tie together the various aspects of what health care administrators are challenges with every day featuring content on finance, customer service, legal, social media and human resources. The Practice of the Year Award also will be presented at this gathering (see article in this edition of the Bulletin). Learn more and register.
NCGA Committee Considers Relaxing Supervision Requirements in NC
On Tuesday, members of the North Carolina General Assembly’s Joint Legislative Oversight Committee on Health and Human Services (JLOC-HHS) heard testimony from Christopher Conover, PhD recommending the relaxation of supervision requirements for all Advanced Practice Registered Nurses (APRNs) in NC. This recommendation was based on a meta-analysis study paid for by the North Carolina Nurses Association (NCNA). The study, which was premised on the expectation of a physician shortage, speculated that APRNs are the solution to the impending physician shortage. The conclusion asserted that relaxing supervision would have a three-fold benefit of (1) improving access, (2) improving quality and (3) lowering cost.
Many of the committee members questioned the assumptions inherent in Conover’s presentation, citing the absence of any physicians on the steering committee charged with studying a physician shortage; no grasp of the cost components embedded in the studies that were used in the meta-analysis; and the lack of comparative quality data in light of the broad spectrum of practitioners considered APRNs. Both House and Senate committee members suggested that the essence of the problem facing our state is the growing concentration of health care providers in the 14 most populous counties and therefore dwindling access to providers in North Carolina’s rural communities. The committee recommended further discussion at the next meeting in March.
North Carolina Medical Society (NCMS) staff will continue to follow this issue closely and provide you with opportunities to communicate with your legislators about the resources needed to provide care to North Carolina’s rural citizens. A copy of the slides used during the presentation can be found here.
NC Medicaid on Budget Target For Third Consecutive Year
Leaders from the NC Department of Health and Human Services (DHHS) presented a number of reports and updates to the North Carolina General Assembly’s (NCGA) Joint Legislative Oversight Committee on Medicaid (JLOC-Medicaid) this week. One important report showed that NC Medicaid is currently $181 million below budget forecasts. Legislators pointed out that, if this trend continues, it will be the third consecutive year that NC Medicaid has hit the budget target set by the NCGA. This is welcome news after the tumultuous budgets of 2011, 2012 and 2013, which saw significant decreases in reimbursement rates for physicians and other providers in order to get Medicaid within budget.
The North Carolina Medical Society (NCMS) continues to work closely with DHHS and law-makers on the current Medicaid program as well as Medicaid reform. A report on the waiver outlining ideas for how to reform Medicaid will be presented at the March meeting of the JLOC-Medicaid committee.
New Participation Agreement for HIE Required by Feb. 19 for Current Users
The North Carolina Medical Society (NCMS) has been monitoring and working closely with the state as the new state entity, the North Carolina Health Information Exchange Authority, takes over operation of the Health Information Exchange (HIE) from Community Care of North Carolina (CCNC).
The first step in this transition process is for all current users to sign a new Participation Agreement and return it to the NC HIEA by Friday, Feb. 19. To get a copy of the agreement, contact the HIEA at (919) 754-6912 or [email protected].
Submitting the new Participation Agreement means that your data will come straight to the State infrastructure at no cost to your organization starting March 1. If you do not complete and submit the new agreement by Feb. 19, your connection to the HIE Network may not occur by March 1.
The other step in this transfer process involves changes to your current connectivity configuration. To facilitate the transition the State and its contractor, SAS Institute, will have technical resources available to you upon receipt of a fully executed Participation Agreement with the NC HIEA. The conversion to the new model will also be free of charge.
You should have received this information via email and in a letter dated Feb. 5 from the newly appointed NC HIEA Director Kelly Fuller. Read the letter here. Visit the HIEA website for more information on the transition, FAQs and updates. If you have any questions, please contact the HIEA at (919) 754-6912 or [email protected].
BCBS Quality Report Corrections Due March 18
Blue Cross and Blue Shield of North Carolina (BCBSNC) is reminding physicians of the deadline to report corrections to their Provider Quality Reports, which were published at the end of January 2016. Any data corrections must be reported no later than close of business on March 18. Any corrections must be accompanied with the appropriate supporting documents and medical records.
BCBSNC Corrections will begin a practice-level star rating system in June based on the reported quality measures data. This information will be shared as part of BCBSNC’s Physician Quality Measurement program, which publishes quality data for its members on its local and national websites. To learn more about this initiative, visit the BCBS website.
NCMS Participates in Old North State Medical Society Leadership Summit
The Old North State Medical Society (ONCMS) held its 2016 Leadership Summit in Chapel Hill on Jan. 30, 2016. The meeting took place in the Sonja Haynes Stone Center for Black History and Culture on the campus of the University of North Carolina. Stephen Keene, the North Carolina Medical Society (NCMS) Deputy Executive Vice President of Government Affairs and Health Policy, presented on issues related to Medicaid expansion and Medicaid reform.
Based on legislation enacted by the General Assembly and signed by the Governor last summer, North Carolina is negotiating a waiver with the federal government that will allow it to implement some innovations in Medicaid aimed at improving the program’s efficiency. Whether these changes will be accompanied by an expansion in Medicaid eligibility is unknown. Expansion of the program has been a topic of serious debate since the federal government offered to substantially increase its financial support for new Medicaid enrollees beginning in 2014, provided they are very low income (at or below 138 percent of the federal poverty level).
Approximately 50 physicians and medical student members of ONSMS discussed many of the important issues these changes raise for the medical community and their patients. Among the topics discussed were the Health Information Exchange, the use and selection of quality measures, how to improve patient engagement, the role of health plans in a reformed Medicaid program and the influence Medicaid has on the broader health system.
“It was a pleasure to meet with ONSMS and have such a robust dialogue on these matters,” Keene said. “We look forward to working together to advocate on these important issues on behalf of all North Carolina physicians.”
NC Medicaid Incentive Payment System Now Ready to Accept MU Attestation
The North Carolina Medicaid Incentive Payment System (NC-MIPS) modifications to comply with the new Final Rule are complete, so NC-MIPS is now accepting Program Year 2015 Modified Meaningful Use (MU) attestations. NC-MIPS attestation assistance can be found in the eligible provider (EP) Modified MU Attestation Guide for Program Year 2015 located on the right hand side of NC-MIPS.
Please note, all EPs will be attesting to the Center for Medicare and Medicaid Services’ (CMS) Modified Stage 2 MU requirements. More information regarding Modified Stage 2 MU can be found on the NC Division of Medical Assistance website or on CMS’ website.
NC-MIPS will not be accepting Program Year 2016 attestations (AIU or MU) until May 1, 2016. Please note, Program Year 2016 is the last year an EP may begin participating in the NC Medicaid EHR Incentive Program. Program Year 2016 is also the last year an EP may attest to, and receive payment for, AIU.
If EPs have questions, they should contact the NC Medicaid EHR Incentive Program Help Desk at [email protected] for assistance.
Other questions on the MU program, please contact NCMS Director of Practice Improvement Terri Gonzalez or call her at 919-833-3836 x123.
EHR Incentive Program Hardship Exception Program Instructions
If you did not successfully meet Meaningful Use (MU) for an EHR incentive program reporting period in 2015 – or even if you did -- the North Carolina Medical Society (NCMS) Director of Practice Improvement Terri Gonzalez would like to draw your attention to the instructions and forms necessary to file for an EHR Incentive Program Hardship Exception. Read the instructions. Download the application form. The deadline to file the application is March 15, 2016.
The AMA is recommending that everyone should apply for an exception. Those who don’t apply could face up to a 3 percent cut in their Medicare payments in 2017 since the meaningful use program operates on a two-year look-back period. New this year, individuals can apply on behalf of a group of physicians.
Even physicians who believe they met the requirements of the meaningful use program in 2015 can apply. Submitting an application for a hardship exception will not prevent those who qualify from receiving an incentive payment, according to the AMA. The AMA offers this fact sheet to help you avoid a penalty.
The Centers for Medicare & Medicaid Services (CMS) has stated it will broadly grant hardship exceptions as a result of the delayed publication of the Stage 2 meaningful use modifications rule, which left physicians with insufficient time to report under the modified program requirements issued in late 2015.
Medical Board Seeks Input on New Opioid Prescribing CME Requirement
The North Carolina Medical Board (NCMB) is seeking preliminary public comment on draft rules for implementing a new state requirement that all who prescribe controlled substances obtain mandatory continuing medical education (CME) in prescribing these medications. The Board will accept public comment on the proposed rule changes until Feb. 29. Email comments and any supporting materials to [email protected]. These initial comments will be considered by the Board at their March meeting before possibly filing the rule with the Rules Review Commission. Once filed with the commission, the formal rule making process will begin with an official public comment period. Watch the North Carolina Medical Society (NCMS) Bulletin and the NCMB website for updates on that process.
Under the proposed rules, physician licensees would be required to earn three hours of Category 1 CME in controlled substances prescribing during each three-year CME cycle, and physician assistants would be required to earn two hours of controlled substances prescribing CME during their two-year cycle. CME earned may count towards the licensee's total number of required hours for the cycle. Physicians are required to complete 60 hours of Category 1 CME earned over three years, while PAs must earn 50 hours over two years.
The rule changes do not provide detailed guidance on the content of courses to be completed. The only requirement is that course content be related to controlled substances prescribing practices, recognizing signs of abuse or misuse of controlled substances and/or controlled substances prescribing in the context of chronic pain management.
Read the proposed changes to the physician CME rule
Read the proposed changes to the PA CME rule
What Impact Would the Proposed Insurance Company Mergers Have on You and Your Practice?
In light of the proposed merger of Anthem and CIGNA and between Aetna and Humana, the AMA has developed a survey to assess the potential impact this may have on physicians’ practice and patient care. Responses will be used by the North Carolina Medical Society (NCMS) solely for the purpose of petitioning the state and federal government concerning the antitrust issues raised by Aetna’s proposed acquisition of Humana and Anthem’s proposed acquisition of CIGNA. Please take a few minutes to complete this survey and share your thoughts. Thank you!
Take the survey.
NCMS Financial Education Seminars Prove Popular
The North Carolina Medical Society recently began offering a financial education program to benefit our resident members and potential members. Two sessions have been held so far with 30 people attending the one held in Fayetteville and a dozen more taking part at the session in Durham.
Research has shown that personal finance is a key area of interest for young physicians as they enter practice since they often have considerable debt, but also a substantial income. Proper planning is vital to ensuring a strong financial start. The NCMS has joined with two seasoned financial planners, Andrew Bernstein, JD, CFP and Smith Andrews, who have extensive experience working with residents and physicians.
If you would like to learn more about organizing an hour-long Financial Education Seminar for your group, please contact Will Barnett, NCMS Director of Membership, or call him at 919-833-3836 x130.
Student Summit Cultivates Next Generation of NCMS Members
Medical students from the five North Carolina medical schools are invited to the Inaugural North Carolina Medical Society (NCMS) Student Summit on Saturday, March 5, at the NCMS Center for Leadership in Medicine in Raleigh. The Summit, which runs from 11 a.m. until 4 p.m. and includes lunch, will acquaint students with what the NCMS offers physicians at each stage of their career path.
Former NCMS President Dev Sangvai, MD, will address why it is important to get involved in your professional society and why it is especially important now. Guest speaker Niket Sonpal, MD, will speak on the ‘History of Accidental Discovery in Medicine. There will be a panel discussion on residency readiness and breakout sessions on wellness, financial planning and preparing for board exams.
Get more information or contact Will Barnett or 919-833-3836 x130.
March Madness Mixer with the NCMS Board
Get to know your North Carolina Medical Society (NCMS) Board members in a relaxed and fun environment watching basketball. Join the Board and your colleagues at the March Madness Mixer, Friday, March 18, at the Riverview Terrace, Hilton Wilmington Riverside in Wilmington. Here is your opportunity to discuss what is on your mind with Board members -- whether it's an important health care policy or who is favored to go to the Final Four. Food and beverages will be provided and spouses are welcome to attend.
Learn more and register now!
The NCMS Board is holding meetings like this one in Wilmington throughout the state this year and inviting those in the area to mix and mingle. Upcoming meetings include:
- May 13-15 - Cary, NC
- July 15-16 - Charlotte, NC
- September 15-18 - Greensboro, NC
Hope to see you in Wilmington or a meeting in your area soon!
NC Public Health Division Updates Zika Guidelines and Issues Flu Advisory
The North Carolina Division of Public Health recently updated its guidelines for Zika virus diagnosis, management and reporting. Read the memo. This document and other information on the virus also is available at the department’s Zika virus webpage.
The Division also recently put out an advisory regarding severe respiratory illnesses reported to CDC among young to middle-aged adults with influenza A/H1N1 infections. The advisory reminds clinicians to treat suspected influenza in high-risk outpatients, those with progressive disease, and all hospitalized patients with antiviral medications as soon as possible, regardless of negative rapid influenza diagnostic test (RIDT) results and without waiting for RT-PCR testing results. Early antiviral treatment works best, but treatment may offer benefit even when started more than 48 hours after symptom onset in hospitalized patients. Read the advisory.
No increase in severe influenza infections has been noted so far in North Carolina; influenza activity in the state remains low overall. Influenza surveillance data for North Carolina are updated weekly at flu.nc.gov.
As a reminder, physicians in North Carolina are required to report all influenza-associated deaths (adult and pediatric) to their Local Health Department. An influenza-associated death is defined for surveillance purposes as a death resulting from a clinically compatible illness that was confirmed to be influenza (any strain) by an appropriate laboratory or rapid diagnostic test.
Pam Highsmith Shares Her Wellness Journey
Pam Highsmith
North Carolina Medical Society (NCMS) Director of Development Pam Highsmith recently shared her ‘wellness journey’ in the NCMS Employee Benefit Plan Connections newsletter. In the YouTube video, Pam shares how the support and wellness resources she has through the NCMS and the NCMS Employee Benefit Plan have helped her establish and maintain a healthy lifestyle.
The NCMS Employee Benefit Plan is available to all NCMS member organizations. An important benefit of the Plan is helping you and your employees be mindful of balance and wellness in their lives.
If your practice is not already taking advantage of the NCMS Employee Benefit Plan and all it offers, please contact NCMS Deputy EVP for Operations and Administration Shawn Scott, or call her at 919-833-3836 x117, to learn more.
Former NCMS Longtime Employee, LaRue King, Passes Away
LaRue Alford King, 96, passed away Sunday, Feb. 6, at her home in Bunn. Mrs. King was a longtime North Carolina Medical Society (NCMS) employee, serving the Society for over 30 years, including as Assistant to the Executive Director.
Memorial contributions can be made to Bunn United Methodist Church, where Mrs. King was the oldest member and where her father was a founding member and instrumental in constructing the church. The address is PO Box 142, Bunn, NC 27508.
Read the complete obituary from the Raleigh News & Observer.
In the News
After Super Bowl Sunday, Physicians In Denver and Charlotte Expect a Flu Surge, Beckers Infection Control and Clinical Quality, 2-5-16
Zika News: Microcephaly Potentially Over-Reported, 1st Known Transmission Via Blood Transfusion, NEJM Journal Watch, 2-5-16
FDA Renews Efforts to Stem Epidemic of Prescription Opioid Abuse, NEJM Journal Watch, 2-5-16
Wake Forest Baptist to Buy Cornerstone Health Care, Winston-Salem Journal, 2-3-16
Study Finds No Harm in Allowing Surgeons-In-Training to Work Longer Shifts, Kaiser Health News, 2-2-16
Obamacare Sign-ups Strong in NC Despite High Rate Hikes, WFAE, 1-29-16
Small Number of Docs Account for Large Share of Malpractice Claims, Modern Healthcare, 1-27-16
Learning Opportunities
The Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Georgia and North Carolina is collaborating with partners in your area to recruit primary care practitioners (PCP) to improve identification of Depression and Alcohol use. On Friday, Feb. 12, from 12:30-1 p.m. they will host a webinar titled 'Engaging Primary Care Providers in Older Adult Mental Health.' Learn more about this initiative and join the webinar from your computer, tablet or smartphone by logging on at https://global.gotomeeting.com/join/848449957. You can also dial in using your phone. United States: +1 (646) 749-3122 Access Code: 848-449-957
MACRA Update Webinar featuring Jennifer Gasperini, North Carolina Medical Society (NCMS) Director of Health Policy, Tuesday, Feb. 16, from noon to 1 p.m. The NCMS Foundation, in cooperation with the North Carolina Medical Group Managers, invites you to join a discussion of the latest updates on the Medicare Access and Chip Reauthorization Act (MACRA). The webinar will review key elements of MACRA, including how the current Medicare quality reporting programs will be affected. Attendees will learn more about CMS' plans for Medicare reform and key timelines to consider in the implementation process. This webinar is free, but you must be registered to attend. Space is limited so register early! Register here.
The Philadelphia Regional Office of the Centers for Medicare & Medicaid Services (CMS) will be hosting a webinar entitled “The Medicare Quality Reporting Programs: What Eligible Providers Need to Know in 2016” on Wednesday, Feb. 17, from 11:30 a.m. – 1 p.m. The webinar will be delivered via WebEx, and instructions on how to join the calls will be given upon registration. Register here.
NCTracks will offer the following training courses in February. Register for these courses in SkillPort, the NCTracks Learning Management System. Refer to the Provider Training page of the public Provider Portal for specific instructions on how to use SkillPort.
- Wednesday, Feb. 17 - 1 to 4 p.m. (WebEx) - Provider Web Portal Applications Webinar will guide providers through the process of submitting all types of provider applications found on the NCTracks Provider Portal. This course is taught via WebEx and can be attended remotely from any location with a telephone, computer and internet connection. The WebEx will be limited to 115 participants.
- Tuesday, Feb. 23 - 9:30 a.m. to noon - Prior Approval - Medical (Professional) will cover submitting Prior Approval (PA) Requests to help ensure compliance with Medicaid clinical coverage policy and medical necessity. It will also cover Prior Approval inquiry to check on the status of the PA Request. The course is being offered in-person at the CSC facility in Raleigh. It includes hands-on training and will be limited to 45 participants.
- Tuesday, Feb. 23 – 1 to 4 p.m. - Submitting a Professional Claim will focus on how to submit a Professional Claim via the NCTracks Provider Portal. The course is being offered in-person at the CSC facility in Raleigh. It includes hands-on training and will be limited to 45 participants.
- Friday, Feb. 26 - 1 to 3 p.m. - Recipient Eligibility Verification will cover how to use the Eligibility Verification System (EVS), which provides information regarding a recipient's eligibility for services in real time. This course will be taught at the CSC facility in Raleigh. The course includes hands-on training and will be limited to 45 participants.
Mark your calendar now for the Centers for Medicare and Medicaid Services (CMS) hosted series of one-hour webinars to discuss recent updates and the future of Physician Compare, including a publicly reported benchmark. The webinar will be conducted via WebEx at the following times. (All sessions will present the same information.):
- Tuesday, Feb. 23, 2016 at noon ET
- Wednesday, Feb. 24, 2016 at 4 pm ET
- Thursday, Feb. 25, 2016 at 11 am ET
Registration details will be posted at a later date.
Coastal Carolinas Health Alliance, working with their Health Information Exchange will hold their Annual Meeting on March, 11 at Country Club of Landfall (800 Sun Runner Place Wilmington, NC 28405). They will be offering 2 CMEs opportunities. Dr. Randall Williams of the NC Department of Health and Human Services, and Dr. Charles Kennedy of Healthagen, will speak on Regional Interoperability and Value Based Care. Email Bobby Deignan to register.
NCHICA offers workshop on Navigating the Transition to Value, March 16, 8 a.m. to 5 p.m. at the Research Triangle Foundation in Research Triangle Park. The purpose of this workshop is help health care providers (delivery systems, hospitals, physicians, etc.) explore strategic considerations—technical, financial, and operational—of moving to a value-based system. As providers move away from a fee-for-service system to an outcomes-based system, what changes are necessary in technology, analytics, etc.? What strategies are needed for incremental change? Where does one start on the path to transition? Learn more and register.
The Carolinas Center and the Virginia Association for Hospices and Palliative Care are offering the 2016 Palliative Care Symposium, Support for a Lifetime: Palliative Care Across the Continuum, April 7 at the William and Ida Friday Center, University of North Carolina-Chapel Hill. More information here. The early registration deadline is March 17.
The Medical Society of Virginia Foundation (MSVF) in collaboration with the American Society of Addiction Medicine (ASAM) and Johnston Memorial Hospital in Abingdon, VA, is offering two opioid pain management educational programs in Abingdon, Virginia on Friday, March 18, 2016. Read more about them and register.
USF Health and i3 Health are hosting the 2nd Annual Hematologic Malignancies Symposium in Asheville on April 16 at the Asheville Renaissance Hotel. This live 1-day CME/CE-certified meeting is targeted towards medical oncologists, hematologists, oncology advanced practitioners, oncology nurses and other health care professionals involved in the treatment of gastrointestinal malignancies. Participants will receive expert insights from leading investigators in treatment selection and supportive care best practices for patients with hematologic malignancies. More information and register here. Early bird discount available until March 1.
USF Health and i3 health are hosting the 1st Annual Gastrointestinal Malignancies Symposium in Asheville on April 16 at the Asheville Renaissance Hotel. This live 1-day CME/CE-certified meeting is targeted toward medical oncologists, surgical oncologists, radiation oncologists, oncology advanced practitioners, oncology nurses and other health care professionals involved in the treatment of patients with gastrointestinal malignancies. More information and register here.
The Pain Society of the Carolinas (PSOC) urges you to save the dates for several other courses on pain management.
- DUKE Pain Meeting, on April 29-May 1, covering cancer pain, palliative care and end-of-life. To be held in Chapel Hill. Registration CLICK HERE to Register. Register early for discounted rates!
- Save the date for the PSOC Annual Meeting, Sept. 25, at The Omni Grove Park Inn, Asheville NC
NCMS Urges Guidance from Medicaid on December Recoupment
Anticipates Good Result on Denied TPL Claims
As 2015 was winding down, physicians were hit with an unpleasant surprise by North Carolina Medicaid – an unannounced reprocessing effort involving approximately 292,000 claims. The official reason for the reprocessing was to apply a 3 percent rate reduction that should have been in effect when the claims were originally processed, but was not.
To make matters worse, many practices reported that some reprocessed claims were denied outright for other reasons such as “third party liability or TPL” and for violating NCCI edits. The recoupment amount on those was 100 percent, not just 3 percent.
Upon learning these details, North Carolina Medical Society (NCMS) staff met immediately with senior Medicaid officials for an explanation as to why the 3 percent recoupment was so late, why so many claims completely denied, and what options remained for pursuing reimbursement on these already-rendered services.
In short, Medicaid acknowledged the lack of adequate communication and pledged to send a more complete explanation. After several weeks, NCMS expects Medicaid will release a Frequently Asked Questions document regarding the December recoupment in the next couple days. Please watch for this important communication if you were affected by the December recoupment.
We further anticipate the FAQ will include some good news: Medicaid plans to automatically reprocess all claims that denied for “third party liability or TPL” and repay at the corrected rate (assuming the claim is otherwise “clean”). Approximately 47,000 claims fall into this category.
BCBSNC Creates Escalation Process for Physicians to Verify Patient Eligibility
Blue Cross and Blue Shield of North Carolina (BCBSNC) continues to cope with huge customer service demands from individuals who are trying to straighten out their coverage and from physicians seeking to confirm coverage and provide services. Upon learning that physicians and other providers have been unable to access information from BCBSNC to verify eligibility, BCBSNC has coordinated with NCMS and NCMGMA to create a temporary, streamlined process to ensure patients with BCBSNC coverage receive timely care. Here is a description of the steps BCBSNC has created:
Normal Process
If a BCBSNC member is seeking services but has not yet received his/her ID card, please check Blue-e to confirm the member's benefits and eligibility. If you are unable to confirm via Blue-e, please try again as BCBSNC is continually processing enrollment applications.
Most BCBSNC members already have ID cards; however, some members are still waiting for their ID cards and may instead present a Certificate of Coverage issued by BCBSNC. Please accept a Certificate of Coverage as proof of enrollment.
Escalated Process
If a BCBSNC member is in the office for an immediate appointment or to receive an urgent/emergent service, and you have been unable to verify eligibility via Blue-e or BCBSNC’s Provider Service Line (800-214-4844), please call (919) 765-4035 for assistance. If voicemail picks up on this line, please leave a contact name and a contact number for the office.
Again, if you are attempting to verify eligibility for future appointments, please attempt to use Blue-e or the Provider Service Line first. If a patient needs clinical services authorized for a future appointment, please try our dedicated Authorization Line (800-672-7897).
BCBSNC emphasized to NCMS that their escalated process is not a permanent solution, and encouraged medical practices to use this process as appropriate until recent problems with Blue-e are corrected and call volumes reduce.
What’s Ahead for Meaningful Use Program?
For a brief moment this month, it seemed that the Centers for Medicare and Medicaid Services (CMS) had abandoned its Meaningful Use incentive program, based on social media’s interpretation of remarks made by the agency’s Acting Administrator Andy Slavitt.
Here is what Slavitt stated at the JP Morgan Annual Health Care Conference on Jan. 11: “Now that we effectively have technology in virtually every place care is provided, we are now in the process of ending Meaningful Use and moving to a new regime culminating with the MACRA implementation. The Meaningful Use program as it has existed, will now be effectively over and replaced with something better.”
After Twitter lit up with tweets like ‘CMS Administrator Announces End of Meaningful Use,’ Slavitt and Karen DeSalvo, MD, the National Coordinator for Health Information Technology, took to the CMS Blog to clarify what’s ahead for the average practice grappling with EHR Meaningful Use and its incentive programs.
Currently, CMS is in a transition between the Meaningful Use program and the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) adopted by Congress last year. MACRA considers quality, cost and clinical practice improvement activities as well as meaningful use of certified EHR technology in calculating how Medicare physician payments are determined. CMS hopes to make improvements to the requirements surrounding use of EHR technology to better serve physicians and their patients. Slavitt and Desalvo outlined the principles guiding them toward this new and improved system:
- Rewarding providers for the outcomes they achieve for their patients through
- Allowing providers the flexibility to customizehealth IT to their individual practice needs. Technology must be user-centered and support physicians.
- Leveling the technology playing field to promote innovation by unlocking electronic health information through open APIs – technology tools that underpin many consumer applications. This way, new apps, analytic tools and plug-ins can be easily connected to so that data can be securely accessed and directed where and when it is needed in order to support patient care.
- Prioritizing interoperability by implementing federally recognized, national interoperability standards and focusing on real-world uses of technology, like ensuring continuity of care during referrals or finding ways for patients to engage in their own care. CMS will not tolerate business models that prevent or inhibit the data from flowing around the needs of the patient.
The proposed regulations around this use of technology will be unveiled this spring and open for comments. In the meantime, CMS has streamlined the process for granting Meaningful Use hardship exceptions. [See the following story in this issue of the NCMS Bulletin for more on this.]
North Carolina Medical Society Director of Practice Improvement Terri Gonzalez, who has helped dozens of North Carolina practices achieve Meaningful Use incentives since the program began, was initially concerned that if the incentive program were to go away abruptly, some practices might be tempted to stop collecting data that can ultimately benefit patients.
“Really, if you went into the program for the incentives – that was the wrong reason. If you went into it for the right reasons, you’ll continue doing what you’re doing with or without the incentives,” she said.
CMS Announces Streamlined Hardship Application Process for Meaningful Use
The Centers for Medicare and Medicaid Services (CMS) recently announced a new, streamlined hardship application process for physicians looking to avoid Meaningful Use penalties. In its announcement, CMS states that the new process will reduce the amount of information physicians will need to provide to apply for a hardship exception. These changes are being implemented as a result of the Patient Access and Medicare Protection Act (PAMA), which allows CMS to consider hardship exceptions for “categories” of providers identified by CMS rather than reviewing all individual applications on a case-by-case basis. To use the new, streamlined process providers must apply for a hardship exception no later than March 15, 2016 to avoid the 2017 Meaningful Use penalty. The new applications and instructions are available on the CMS website.
PAMA also allows CMS to consider groups of providers, who may now apply for a hardship exception on a single application. According to CMS, providers will have the option to submit an electronic file (in excel or csv formats) with all National Provider Identifiers (NPIs) for the providers within the group or use a multiple NPI form to submit their application. Instructions on filling out the application form are available here.
North Carolina Boasts Many of Nation’s PCSPs
The National Committee for Quality Assurance (NCQA), which offers quality designations for practices achieving Patient Centered Medical Home (PCMH) and Patient Centered Specialty Practice (PCSP) recognition, has said that the number of PCSP recognized practices nationwide have grown to 118. North Carolina is home to two-thirds of those.
Being recognized as a PCSP means the practice demonstrates patient-centered care and clinical quality through: streamlined referral processes and care coordination with referring clinicians, timely patient and caregiver-focused care management and continuous clinical quality improvement. North Carolina Medical Society (NCMS) Director of Practice Improvement Terri Gonzalez works with practices throughout the state to help them achieve PCMH and PCSP recognition, which can mean higher reimbursement rates through programs like Blue Cross and Blue Shield of North Carolina’s Blue Quality Physician Program.
Over the past year, Gonzalez has worked with a large network of ob-gyn practices to help them achieve this valuable designation.
"Without the direct assistance of Terri Gonzalez, NCMS and the Corporate Tool made available for our benefit, we would have found this goal insurmountable. Terri's weekly workshops were helpful, but her one-on-one communication and in-office assistance proved most beneficial. She was very instrumental in helping us achieve Level 3 recognition with NCQA and we are very appreciative and grateful," said Eva Ballance, office manager at Wayne’s Women Clinic in Goldsboro.
If you would like more information on how your practice can become PCMH or PCSP recognized, contact Gonzalez or call her at 919-833-3836 x123.