In Memory of Bertram Williams, Jr., MD

Williams-Lifetime Achievement Winner-2015-CpdBertram Williams Jr., MD, a general surgeon and leading figure in the New Hanover County medical community for many decades, died on Nov. 16, 2015. He was 95.
“One of the things he was most proud of in his life was to feel like he had a big part in promoting quality delivery of health care in the greater Wilmington community,” Williams’ son Bert Williams III said in the local newspaper’s obituary on Dr. Williams.
Dr. Williams had been a North Carolina Medical Society member since 1951 and had been slated to receive a Lifetime Achievement Award as part of the Greater Wilmington Business Journal's Health Care Heroes Awards. A memorial honor was given instead the weekend after his death.
The son of a downtown Wilmington merchant, Williams earned his medical degree at Vanderbilt University before being assigned to the Second Marine Division during World War II, according to the Wilmington Star News obituary. Williams returned to Wilmington in 1951 to open his surgical practice and was active until his retirement in 1991.  As the medical community grew and diversified, Williams co-founded Wilmington Surgical Associates and was chief of staff at New Hanover Regional, in addition to serving terms on the medical center board of trustees and chairing the board. He played a leading role in creating the NHRMC Foundation, which helps fund the hospital’s mission independent of tax dollars.
Bonnie Jeffreys Brown, Executive Director of the New Hanover-Pender County Medical Society, told the newspaper that in addition to being a physician, Dr. Williams was an "astute business man, farmer, loyal friend, philanthropist and true Southern gentleman. His knowledge of area history was encyclopedic - and he gave fascinating talks without notes.  At 95, he continued to do it all until the very end!  His was a life well-lived, the quality of which most of us can only aspire to achieve. He was a treasure."


NCMS Doctors Are Award-Winning

Two North Carolina Medical Society physicians recently were honored by their specialty societies for their distinguished work.

Dr. Michael Brennan
Dr. Michael Brennan

At the American Academy of Ophthalmologists meeting in November, Michael Brennan, MD, was recognized as a role model for young ophthalmologists with the 2015 EnergEYES award, given to a senior ophthalmologist who "mentors young ophthalmologists, serves as a strong role model, and displays high energy that motivates them to get involved." This is the first time that a North Carolinian has received the EnergEYES award.
dr bruch
Dr. Richard Bruch

At the annual meeting of the North Carolina Orthopedic Association in October, Richard Bruch, MD, received the Honored Surgeon award, which recognizes orthopedic surgeons who promote high standards of orthopedic care and have a dedication to quality patient care and the medical profession.
Congratulations Drs. Brennan and Bruch!


Duke's Physician Assistant Program Turns 50

Dr. Harvey Estes
Dr. Harvey Estes

The media covered the 50th anniversary of Duke University’s physician assistant training program – the oldest in the country in November. In doing so, they recognized Harvey Estes, MD, who was instrumental in the founding of the program. Estes, a retired Professor and Chair of the Department of Community and Family Medicine at Duke University and a longtime North Carolina Medical Society (NCMS) member who also helped found the NCMS Foundation’s Community Practitioner Program. Listen to WUNC’s report.


The Top 10 Issues Discussed at the AMA Interim Meeting

The 2015 AMA Interim Meeting took place the week of Nov. 16. Here are links to articles on the top 10 issues discussed at the meeting. Read these highlights from the meeting, and see AMA Wire's® full coverage of the event to learn more.


Learning Opportunities

NCTracks is offering the following courses in December. Providers can register for these courses in SkillPort, the NCTracks Learning Management System. Logon to the secure NCTracks Provider Portal and click Provider Training to access SkillPort.
Friday, Dec. 4 - 9 to 11 a.m. (WebEx) - New Office Administrator 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. The WebEx will be limited to 115 participants.
Friday, Dec. 4 - 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.  The WebEx will be limited to 115 participants.
Monday, Dec. 7 - 10 to 11:30 a.m. (WebEx) - Provider Re-Credentialing/Re-Verification Refresher serves as a refresher for the steps to be taken by the provider to complete the Re-Verification process through NCTracks. The WebEx will be limited to 115 participants.
Tuesday, Dec. 15 - 1 to 2:30 p.m. (WebEx) - Provider Re-Credentialing/Re-Verification Refresher serves as a refresher for the steps to be taken by the provider to complete the Re-Verification process through NCTracks. The WebEx will be limited to 115 participants.
Friday, Dec. 18 – 9 to 11:00 a.m. - Recipient Eligibility Verification learn 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.
Friday, Dec. 18 - 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.


The Centers for Medicare and Medicaid Services (CMS) will address how the 2016 Medicare Physician Fee Schedule final rule impacts Medicare Quality Reporting Programs in a national provider call on Tuesday, Dec. 8 from 1:30-3pm. To Register: Visit MLN Connects Event Registration. Space may be limited, register early. The program will cover program changes to the Physician Quality Reporting System (PQRS), Electronic Health Record Incentive Program, Comprehensive Primary Care initiative, Value-Based Payment Modifier (Value Modifier), Medicare Shared Savings Program (Shared Savings Program) and Physician Compare among other topics. A question and answer session will follow the presentation.
This MLN Connects Call is being evaluated by CMS for CME and CEU continuing education credit (CE). Refer to the call detail webpage for more information


The 42nd Annual “The Williamsburg Conference on Heart Disease” – Dec. 6-8, 2015, Williamsburg Conference Center, Williamsburg, VA. Learn more and register.


What Do I Need To Know About Big Data To Improve My Patient’s Health? Dec. 15, 2015, 9 am - 12:15 pm at the Charlotte AHEC, Center for Learning & Development OR via Webinar will investigate innovative approaches to using data to make more informed decisions today and how to best leverage data in the future. Learn more and register.


The Mountain Area Health Education Center (MAHEC) fall course schedule is out. Find out what is being offered July through December 2015 and register today.


A video recording of the "PQRS/Value-Based Provider Modifier: What Medicare Professionals Need to Know in 2015" presentation has been posted to the CMS MLN Connects® page on YouTube. This presentation is the same as the webinars that were delivered on March 31, 2015 and April 7, 2015 by the Philadelphia Regional Office. View the video.


The 2nd Annual Bundled Payment Implementation Forum: How to Make Your Bundled Payment Program Work will be held Jan. 25-26, 2016 at the Wyndham Orlando Resort in Orlando, FL. Learn more about the program and register here. For questions, call 866-676-7689.
 


NCMS Formally Comments on Implementation of MACRA

The North Carolina Medical Society (NCMS) formally submitted comments yesterday, Nov. 17, in response to the Centers for Medicare & Medicaid Services (CMS) Request for Information regarding implementation of the Medicare Access and Chip Reauthorization Act (MACRA). MACRA was enacted in April 2015 to repeal the Sustainable Growth Rate (SGR) formula and replace it with incentives for physicians to participate in Alternative Payment Models (APMs). Under MACRA, starting in 2019, those who voluntarily participate in APMs will see a 5 percent bonus added to their Medicare payments. Those who continue to participate in fee-for-service will be subject to the Merit-Based Incentive Payment System (MIPS), which also will  begin in 2019. Under the MIPS, provider payments will be adjusted based on their performance in four categories: quality, resource use, participation in clinical practice improvement activities and use of an EHR.
In the comments to CMS, the NCMS stressed the importance of removing administrative burdens associated with the various quality reporting programs currently in place, and using MACRA as an opportunity to remove current payment system limitations to allow physicians to be truly innovative when looking to move beyond fee-for-service payment models. The NCMS also called on CMS to ensure a fully transparent process in implementing the new MIPS program, and certifying eligible APMs. The NCMS recommended taking a gradual approach to implementation while also leveraging existing practice transformation efforts currently underway.
Read our comments in their entirety. The NCMS also joined more than 100 state and national specialty societies in signing-on to an AMA letter outlining organized medicine’s priorities and principles for MACRA implementation. Read the AMA's letter.  The NCMS will continue to keep members informed and updated as we move toward implementation of the MIPS and APM structures under MACRA. Register and visit our Quality Time with the NCMS webpage to stay up-to-date on all the details.


NCMS Begins Implementation of New Governance System

The newly updated North Carolina Medical Society (NCMS) constitution and bylaws, reflecting the House of Delegates recent decisions to make the NCMS Board of Directors directly accountable to the Society’s membership, has been posted on our website for easy reference. Access the updated Constitution and Bylaws.
Implementation of the new structure is underway. Stay informed of the progress through the Bulletin and on the NCMS website.  As NCMS Board Member and Chair of the Bylaws Modernization Task Force Jeff Runge, MD, stated at the House of Delegates: “The Bylaws changes allow us to begin fine-tuning our processes.”
Some of the steps to achieve the standards in the new bylaws include:
Rotating Board of Directors meetings
The NCMS Board of Directors’ meetings will be held on the dates and in the locations listed below:

  • Jan. 8-9, 2016 in Raleigh                             
  • March 18-19, 2016 in Wilmington
  • May 13-14, 2016 in Cary                             
  • July 15-16, 2016 in Charlotte
  • Sept. 15-18, 2016, NCMS Annual Meeting/M3 Conference in Greensboro
  • Dec. 3, 2016 in Raleigh

The on-site schedule for the meetings will be available in the Bulletin as details are finalized. Meetings will include both business sessions and membership events. NCMS President Docia Hickey, MD, will preside over the meetings and invites members to submit items for discussion.
“I look forward to hearing from our members about the issues on their minds while caring for patients in their communities,” she said. “We already have feedback from some large county medical societies, which is a great start to our new workflow.”
To submit an issue for consideration on the Board’s meeting agenda, complete our secure, online form.
NCMS Annual Meeting
The NCMS Annual Meeting will evolve substantially to meet members’ needs. Several ideas were discussed at the Open Forum held following the 2015 House of Delegates. In response to members’ needs, the meeting will be expanded to include educational sessions, CME offerings and discussion of timely issues affecting medical practice.  The “Annual Meeting” as described in the bylaws will take place to consider all business issues on Saturday, Sept. 16, 2016, as part of the “M3 Conference: Merging Medicine and Management.” The new “M3 Conference” is an educational collaboration between the NCMS and the NC Medical Group Managers Association (NCMGMA).  Watch upcoming issues of the Bulletin for news about the conference and how to register.
Elections
In Spring 2016, the Nominating & Leadership Development Committee will publish its work schedule to allow ample time to receive and consider nominations for officer elections. The work schedule will include 2017 vacancies and requirements. The actual elections will take place electronically, using a third-party vendor to manage the process fairly and accurately.
House of Delegates Status Report
The actions of the 2015 House of Delegates will be documented and reported to members as in previous years through the House of Delegates Status Report. Moving forward, Board actions will be recorded and reported in a similar format, to ensure business items, including NCMS policy review, stay on track.
“The action taken by the House of Delegates last month empowers the NCMS to meet the needs of a much larger universe of members,” Dr. Hickey said. “The immediate nature of electronic communication and the critical issues before the NC General Assembly and regulatory agencies changes the way we do business and has created an urgent need for the Society to move more quickly than ever before. Open channels of communication and dialogue, along with a renewed focus on education,  will only serve to meet our members’ current needs and make the Society a more valuable and effective resource.”


Medicaid Physician Drug Program Reimbursement -- Is It An Issue for Your Practice?

Due to a rate freeze in Medicaid’s Physician Drug Program that occurred in 2010, a growing number of physician-administered drugs and devices are reimbursed at rates below cost. NCMS staff recently met with officials from the state’s Division of Medical Assistance to discuss this issue and examine ways to bring reimbursements in line with our members’ cost for pharmaceuticals used in treating their Medicaid patients.
DMA officials confirmed what we’ve heard from our members thus far. Many oncology and rheumatology drugs, vaccines, and long-term reversible contraceptives (to name a few) are cited as costing physicians significantly more than they are being reimbursed by the program. And as more time passes, more drugs move into this “underwater” status. DMA acknowledged this can become an access to care issue, and expressed willingness to work to reduce the gap in reimbursement.
As the NCMS continues to address this matter, it would be helpful to get a fuller understanding of if – and how dramatically – your practice is affected by these below cost drug reimbursements. Please post your comments at the end of this article, and watch the Bulletin for updates as our work on this issue continues.


Medicaid Re-Credentialing Efforts Resume on Large Scale

Re-credentialing necessary for continued participation in Medicaid/CHIP
Thousands of Medicaid providers received re-credentialing notices from NCTracks yesterday, which invite recipients to submit completed applications within 45 days. The notices were sent by CSC via regular mail and electronically to each provider’s Message Center Inbox on the NCTracks Provider Portal.
Please look for this notice today, and if you receive one, act promptly to begin the process. Providers that do not submit completed applications by the deadline will see Medicaid claims and payments suspended, and could also eventually have their participation terminated.
Since 2013 the automated function of notifying providers that it was time to complete re-credentialing has been disabled in NCTracks. This was due to technical glitches, inaccurate Medicaid provider records, legislative changes, and other reasons. Yesterday’s batch of notices is the first since the functionality was restored and activated, and NCTracks will continue to notify providers in this manner as they approach the end of their five-year cycles.
Federal Medicaid regulations and state law require providers to undergo re-credentialing periodically.  Thanks to lobbying efforts by the North Carolina Medical Society earlier this year, the provider re-credentialing cycle was extended from every three years to every five years. This positive change will reduce your costs and the administrative burdens associated with Medicaid participation.
The Division of Medical Assistance and CSC have published several articles with additional details, including the following:
DMA Provider Bulletin, page 2 – NCTracks Re-credentialing Notices, Oct 2015
NCTracks Announcement – Reminder of NCTracks Re-Credentialing Process, 10/28/2015
NCTracks – General Information and FAQ on Re-credentialing
NCTracks Job Aid – How to Determine Re-credentialing Due Date


Monday is Deadline to Submit PQRS Review Request

Monday, Nov. 23, is the deadline for eligible providers, comprehensive primary care practice sites and groups participating in the Physician Quality Reporting System (PQRS) that believe they have been incorrectly assessed the 2016 PQRS negative payment adjustment to submit an informal review request. The Centers for Medicare and Medicaid Services (CMS) will investigate incentive eligibility and/or make a payment adjustment determination. All informal review requestors will be contacted via email of a final decision by CMS within 90 days of the original request for an informal review. All decisions will be final and there will be no further review.
In 2016, CMS will apply a negative payment adjustment to those individual providers and groups that did not satisfactorily report PQRS in 2014. Individuals and groups that receive the 2016 negative payment adjustment will not receive a 2014 PQRS incentive payment.
All informal review requests must be submitted electronically via the Quality Reporting Communication Support Page (CSP) by midnight on Monday. Please see 2014 PQRS: Incentive Eligibility & 2016 Negative Payment Adjustment - Informal Review Made Simple (available on the Analysis and Payment section of the PQRS website) for more information.
For additional questions regarding the informal review process, contact the QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) or [email protected] Monday-Friday from 7:00 a.m. to 7:00 p.m. Central Time. To avoid security violations, do not include personal identifying information, such as Social Security Number or Taxpayer Identification Number (TIN), in e-mail inquiries to the QualityNet Help Desk.


In Memory of Charles L. Garrett, Jr., MD

1998 GarrettLong-time North Carolina Medical Society (NCMS) member, and past president (1997-98) Charles L. Garrett Jr., MD passed away Tuesday, Nov. 10. Dr. Garrett is remembered for his leadership and dedication to the NCMS as well as the professionalism and compassion he brought to his position as Onslow County Medical Examiner.
An NCMS member since 1976, Dr. Garrett served on the Legislative Cabinet and the MEDPAC Board as well as serving as NCMS President. He also was active in the NCMS Foundation, serving as a trustee.
According to his younger brother, Brown Garrett, Dr. Garrett had a lifelong love of medicine. He attended the Medical University of South Carolina, worked for the Dade County Medical Examiner’s Office in Florida and the Richland Memorial Hospital in Columbia, S.C. before moving to Onslow County in 1975 to take the medical county examiner position, which he held for more than 30 years. He also served as the state’s southeastern regional medical examiner and helped build the practice of the pathology group that contracts with Onslow Memorial Hospital to provide pathology services and conducts autopsies for a 9-county region.
In an obituary in his hometown paper, the Jacksonville Daily News, Dr. Garrett’s daughter, Edie Garrett Platt said her father “touched so many lives and helped give so many lives closure. He was a gentle, kind, loving man and that’s how he should be remembered.”
We extend our sympathies to Dr. Garrett’s family.


NCMS Foundation's Rural ACO Initiative Pioneering New Territory

The ambitious initiative that recently received a nearly $500,000 grant from the Kate B. Reynolds Charitable Trust is pioneering new territory in rural North Carolina. The project seeks to help rural practices make the transition to an Accountable Care Organization (ACO) model. ACOs are built on the ‘triple aim’ of improving the health of a patient population, improving patient experience and lowering cost.
North Carolina is fertile ground for the formation of ACOs and many are already well-established like Cornerstone Health Care in High Point, Coastal Carolina Health Care in New Bern and Wilmington Health in Wilmington. All ACOs face challenges in successfully coordinating patient care among a variety of doctors and support services, collecting data through electronic health records and analyzing that information to make improvements in patient care and realize cost efficiencies. Practices in rural communities, have particular challenges when it comes to resources and expertise.
The North Carolina Medical Society Foundation’s (NCMSF) Rural ACO Initiative, with the help of the recent grant from the Trust, seeks to help practices in rural areas meet those challenges. NCMSF has partnered with CHESS, a management services organization based in High Point, which will provide education and training to prepare practices for participation in the MSSP and other value-based models.  The NCMSF will offer practice management consulting services and leadership development training. Also, the NCMSF’s Community Practitioner Program is an integral part of this initiative. Learn more about the NCMSF consulting services, leadership development programs and its Community Practitioner Program.
In recent meetings with the initial practices participating in the project, NCMSF Director of Rural Health Initiatives Franklin Walker said the first hurdle will be in meeting the 5,000 patients that need to be attributed to the ACO in order to qualify for the Medicare Shared Savings Program (MSSP) funding.
“Getting to the minimum number of assigned lives is a huge task,” he said, noting the attrition rate for an urban practice is usually around 20-25 percent, but in a rural area the rate sky-rockets to 50-75 percent. Attrition refers to the number of Medicare fee for service beneficiaries that did not receive a plurality of primary care services from the ACO practices and therefore were not counted as assigned beneficiaries for that ACO.
Meetings are ongoing to determine how best to position rural practices to succeed.
 
 


Take Action To Reduce Opioid Abuse

Attention is being focused at both the national and state level on the epidemic of opioid abuse. At the state level, the General Assembly recently adopted budget provisions that:

  • Directs health care provider occupational licensing boards, including the NC Medical Board, to require continuing education on the abuse of controlled substances as a condition of license renewal for health care providers who prescribe controlled substances. This has been proposed repeatedly in recent years. The NCMS generally opposes these types of mandates. However, with prescription drug abuse growing in North Carolina and the use of the Controlled Substances Reporting System (CSRS) remaining low, we expect this new requirement to be implemented in the near future. The NCMS will work with the NC Medical Board to ensure a fair and transparent application of this new requirement.
  • Call for improvements to the CSRS system, including enabling a state-wide connection capability, which will greatly improve the functionality and utility of the information stored in this database.
  • Establishes a new Prescription Drug Abuse Advisory Committee in the NC Department of Health and Human Services (NCDHHS) to create and implement a new statewide strategic plan to combat prescription drug abuse.

These initiatives mirror what is happening at the national level. Patrice A. Harris, MD, who is the AMA Chair-elect and Chair of the AMA Task Force to Reduce Opioid Abuse shared her thoughts and a call to action on the need for measurable reductions in opioid-related harm while preserving access to safe and effective pain care in this recent blog post from the AMA.


Update: Health Insurance Mergers

The North Carolina Medical Society (NCMS) along with our national partners, The Physicians Foundation, PAI and the American Medical Association (AMA) are closely monitoring and speaking out on the proposed mergers between health insurance giants Aetna and Humana and Anthem and Cigna. The mergers currently are under review by the US Department of Justice’s anti-trust division.
In light of a variety of studies, including a comprehensive review of the issues surrounding the merger by the AMA [read the AMA’s study], organized medicine has serious concerns over these mergers and the resulting concentration of market share in the health insurance industry.
Recent comments by the DOJ’s top anti-trust enforcer, Assistant Attorney General Bill Baer shed some light on the concerns the DOJ has with the proposed mergers as well. Baer was speaking at a Yale Law School Conference on competition in the health care industry and was quoted as saying: “Consumers do not benefit when sellers – or buyers – merge simply to gain bargaining leverage. Consumers benefit when there is entry, expansion, innovation and competition.”
He also expressed concern about the possible impact on Affordable Care Act health insurance exchanges.
“Consumers who use exchanges with more competition enjoy lower premiums then those who have fewer choices,” he said.
The AMA recently sent a 17-page letter to Baer with an analyses of the proposed health insurance mergers and the impact they would have on consumers in terms of health care access, quality, and affordability. Read the letter.
The AMA urged DOJ to block the mergers, concluding the mergers will likely result in higher premiums for patients, a reduction in the quality of health insurance (e.g., less availability of providers, lower consumer service), and lower payment rates for physicians that lead to lower quality or quantity of the services that physicians are able to offer patients (e.g., less investment in newer technology).
Read more about the AMA’s work on this issue.
Watch the NCMS Bulletin for updates.


How to Improve EHRs and the 'Summary of Care' Documentation

As part of its efforts to improve EHRs and interoperability of EHRs, the American Medical Association (AMA) would like your thoughts on how to improve the summary of care document that is produced to meet the Transfer of Care objective in Stage 2 of Meaningful Use.  The AMA is assisting the Office of the National Coordinator (ONC) in gathering information through this 5-10 minute survey to help the ONC create a new standard that will reduce the number of pages in the summary of care, thus making it easier to find relevant information. The survey will close on Monday, Nov. 30, so place take a few minutes now to share your thoughts.
Take the survey.


Duke Connected Care: A Learning Opportunity While Serving the Community

This article is the latest in an ongoing series featuring Accountable Care Organizations throughout the state. Read previous feature stories at the Toward Accountable Care Consortium and Initiative website.
Back in 2009-2010, as the Affordable Care Act was being debated and then passed, Duke Health Systems decided they could not sit on the sidelines and watch as the whole landscape of health care was changing and new models of care were emerging. They needed to take part, but slowly and methodically, they decided, and in a way in which they could learn how to implement a value-based system of care while they were doing it. Thus, Duke Connected Care, a community-based, physician-led network of practices including the Duke University Health System was born in 2014. This is Duke’s Accountable Care Organization (ACO).
“Duke made a conscious decision to explore new opportunities, new models of care and payment,” said Dev Sangvai, MD, MBA, the executive director for Duke Connected Care, associate chief medical officer (ACMO) for Duke University Health System and medical director for DukeWELL (a physician-run population health program for Duke employees and dependents). “We dipped our toe in the water [with Duke Connected Care] with the questions, ‘what are we going to learn from it? What is going to make us a credible citizen in the new health care economy?’”
Not all ACOs have the backing of a major health system as they get off the ground – a definite advantage for Duke Connected Care in both know-how and start-up time.
“Duke had several ongoing care management programs - DukeWELL for the employee population and a few other commercial arrangements, and NPCC [Northern Piedmont Community Care] for Medicaid,” said Eugenie ‘Genie’ Komives, MD, Senior Medical Director for Duke Connected Care. “We also have a robust inpatient care management center for the typical hospital functions like discharge planning and transitions of care. When we moved into the Medicare patient population, we saw the need to enhance the skills and focus of our existing programs (particularly DukeWELL and NPCC) to help serve our Medicare (aging, geriatric, frail) populations.”
Duke Connected Care participates in the Centers for Medicare and Medicaid Services (CMS) Medicare Shared Savings Program (MSSP). Early this year Duke Connected Care contracted with Cigna to become one of the insurance company’s 10 collaborative care initiatives in the Carolinas. The partnership with Cigna benefits over 16,000 individuals covered by a Cigna health plan and receiving care through Duke Connected Care network physicians.
So far, Duke Connected Care encompasses nine practices including small physician groups, a solo practitioner, Duke University Affiliated Physicians and Lincoln Community Health Center, a Federally Qualified Health Center (FQHC) right down the street from Duke University Health System. Together this represents more than 1,200 Duke and select community physicians. Ten to 15 percent of the patients seen through Duke Connected Care are not attributable to the Duke system, Sangvai said.
“We are unique in being a ‘quaternary’ medical center,” Komives said. “Our ACO includes our primary care network, our entire network of Duke specialists (oncology, transplant, nephrology, etc) as well as Lincoln Community Health Center. Much of our attribution comes from patients who are referred in for care from those specialists. We may also have a higher proportion of dual eligible patients than many ACO's. Both of these aspects create different challenges in terms of patient risk (medical and socioeconomic) than other ACO's. Understanding how to address patients who become attributed through high cost specialty care as well as those with complex social needs are both challenges for us.”
By the same token, Duke Connected Care benefits from the full spectrum of closely aligned specialists and facilities like post-acute care services.
“If we were able to take full opportunity of [the spectrum of services], it may allow us to develop improved care pathways and processes that may be more of a challenge for a primary-care only ACO,” Komives said. “One example of this is the work we are doing with chronic kidney disease - developing analytic models to predict patients at high risk of rapid progression and using care managers and nephrology virtual consultations to reduce that risk.”
Like other ACO start-ups, physician engagement is key as well as a robust data sharing system. Both take time and resources. Duke Connected Care started with a bit of an advantage with data analytics.
“We had robust analytic shops to manage Medicaid and employed/commercial populations mostly focused on closing gaps in care for chronic illnesses like diabetes, and wellness quality metrics like mammograms,” Komives said, adding that there is an on-going commitment to improve in this area. “We have been working to enhance [the data analytics] to better predict patients who need individual high-touch care management to prevent hospitalizations, re-admissions, ED visits, progression to end-stage renal disease, etc. We have also been working to expand our analysis of variations in care from the inpatient space (where it has been very well developed) into outpatient episodes of care.”
Sangvai notes that while Duke could have “artificially created a set-up for success” with Duke Connected Care, instead the organization is being allowed to develop as organically and independently as possible in the community it serves.
Duke Connected Care was not among those North Carolina ACOs to receive shared savings last year, their first year in the MSSP, but did well in the quality metrics reporting.
“It’s hard work,” Sangvai said. From the broad perspective, Duke Connected Care’s progress has been an affirmation of the ACO approach, he said. On the granular level, however, there will always be numerous issues to address each day.
“We’re part of an academic medical center and it’s a credit to Duke -- they could have hung their hat on a lung transplant program, but they’re committed to the community and compelling us to do this work,” Sangvai said.
“The number of [practices that are part of the] MSSP program and the number of ACOs in the state is great for North Carolina,” Sangvai said. “It shows the willingness from many to think differently and think of what’s right for North Carolina. Sure, there are challenges, but overall, it’s a good time for health care in North Carolina.”


Leadership Development News

Rapidly Expanding Leadership Opportunities for NCMS Members
The North Carolina Medical Society Foundation (NCMSF) leadership development programs are growing rapidly, a testament to the desire of individuals in the health care community to develop their leadership skills in order to help drive the changes taking place in the medical profession.
The Kanof Institute for Physician Leadership (KIPL) now encompasses three tracks – the seminal Leadership College, which boasts an alumni network of over 250, Clinical Quality or CQ’U,’ which is in its second year and now the pilot program of the Health Care Leadership and Management track or HLCM is underway. In addition, customized programs are available. Currently, the University of North Carolina Physicians Network has a specially tailored leadership program through KIPL for 27 of their physicians.
The KIPL Advisory Committee, co-chaired by Philip M. Brown, Jr., MD, and Genie M. Komives, MD, oversees the total Leadership Development Program. The Leadership College track is co-chaired by Gerri Mattson, MD, and Robert Fields, MD; Holly Biola, MD, chairs CQ’U’ and the HLCM program is chaired by Dev Sangvai, MD.
The 2016 Leadership College scholars were just inducted at the NCMS Annual Meeting in October and have begun their year-long training. The HLCM program has held its second session to rave reviews from the inaugural class of participants. CQ’U’ is winding up its 2015 program. Applications for the 2016 CQ’U’ class are being accepted until February for the 2016 session, which begins in the spring.
Visit the KIPL website to learn more about each of these programs and which would be right for you.
Leadership College Alumni Newsletter Debuts
The alumni roster for the NCMSF Leadership College continues to grow with more than 250 health care leaders across North Carolina who can add ‘NCMSF Leadership College graduate’ to their resume. To help keep this alumni network strong, the first issue of the KIPL Chronicle appeared in mailboxes last month. The biannual publication contains alumni profiles alumni, a listing of the incoming class of scholars as well as the most recent graduates and other news and events.
LinkedIn -- Especially for Health Care Professionals
If you are a KIPL alumnus or are currently enrolled in one of the KIPL tracks, a special online tutorial on the LinkedIn professional networking site is available to you at no charge.
LinkedIn is the top platform for business professionals to engage and share knowledge. As health care professionals, connecting via LinkedIn is an effective way to establish thought leadership, build your professional reputation or engage with allied professionals. This online course “LinkedIn for Health Care Professionals” walks you through the major elements of a LinkedIn profile and how to optimize your profile for success. The course, taught by Janet M. Kennedy, the host of the “Get Social Health” podcast, is divided into eight modules with short videos and downloadable content.
Refer to your KIPL Chronicle if you’re an alumnus or contact Erin Grover to find out how to access this informative and valuable course.


Don’t Miss the NCMS Bulletin -- Renew your NCMS Membership Today

As 2015 is coming to a close in just a few weeks, be sure to renew your North Carolina Medical Society (NCMS) membership now so your Bulletin delivery will be uninterrupted in 2016. The Bulletin is the only publication that covers the crucial information about health care issues in North Carolina that affect your practice as well as news about your colleagues throughout the state. Don’t miss out on this valuable benefit of NCMS membership.
If you renew online you automatically will receive the beautiful 2016 NCMS Calendar featuring the stunning photography of your fellow NCMS members. Renew online now before you forget in the end-of-year, holiday rush.


Send NCMS Foundation Seasons Greetings Cards

wreaths-across-americaAs the holiday season is upon us, the North Carolina Medical Society Foundation (NCMSF) again offers you a way to give the meaningful gift of health and access to a primary care provider to people across the state through purchase of our Season’s Greetings cards. For a tax-deductible contribution of $35 per card, the Foundation will send each person on your holiday list a personalized greeting card informing them of your gift in their honor.
Website-card-optionsThis year, Season’s Greetings has teamed with the NCMS Service Team to support Wreaths Across AmericaTM, so $15 of every card will be used to purchase wreaths that will be laid at the gravesites of our fallen veterans at national cemeteries in Fort Bragg, New Bern, Salisbury, Raleigh and in Historic Oakwood Cemetery Field of Honor. Every fallen hero deserves a wreath.
Your gift will help ensure that thousands of underserved North Carolinians have access to the health care they need, and will show our veterans and their families that we will never forget!
Order your Season's Greetings cards at www.ncmedsoc.org/greetings.
Deadline to participate in the program is December 18, 2015.
We also invite you to join the NCMS staff on Saturday, Dec. 12 at 10 am at Raleigh National Cemetery to place the donated wreaths. For more information contact Belinda McKoy at [email protected].
More information about Wreaths Across America. If you choose to give directly on this site, please choose “support a local fundraising group” and search for the North Carolina Medical Society!
For more information on the Season's Greetings program, please contact Pam Highsmith or 800-722-1350.


"Med School of the Future" Grant Goes to UNC

The American Medical Association (AMA) awarded the University of North Carolina-Chapel Hill School of Medicine a $75,000 grant over three years to implement innovative curricula to help shape the medical school of the future. UNC was one of 20 schools nationwide to receive the award as part of the AMA’s grant program for changing medical education, bringing the total number of schools in the consortium to 31. The Brody School of Medicine at East Carolina University is already part of the consortium.
"We've asked for and are starting to receive a medical education system that keeps pace with the state of change" said AMA CEO and executive vice president James Madara, MD in announcing the grant. "Students must be ready to recognize and respond to health inequity, respond to population health, and be ready on Day One to put best practices ... to work. The work of the consortium will give physicians these skills and more.”
Some of the innovative grant projects underway include models for competency-based student progression, programs that allow medical students to be totally immersed within the health care system from the first day of medical school and increased use of technology to teach electronic health record and patient outcomes skills.


Did You Practice in Pennsylvania Between 2009 and 2014?

If you practiced in Pennsylvania between 2009 and 2014, you may want to know about a settlement of litigation involving the Pennsylvania Mcare Fund, a medical liability coverage fund that is operated by the Commonwealth of Pennsylvania and is funded by assessments on physicians and other health care providers.
The Pennsylvania Medical Society (PAMED) was a party to that settlement and has been working with Mcare and other parties to implement the refund component of the settlement.  Mcare is required to refund a portion of the assessments paid for 2009, 2010, 2011, 2012, and 2014 – $139 million in total.
On Nov. 16, Mcare mailed notice letters to physicians and other eligible health care providers with information about the refunds for their coverage.  You may be eligible for a refund and have been sent a notice letter if you practiced in Pennsylvania in a covered year.
PAMED has created a dedicated website – www.McareRefund.org – with extensive information on the settlement.  It was recently updated to include a suite of information to assist physicians understand the steps they need to take to assure proper payment of their refunds.
If you have any questions, please feel free to contact me at Michael Fraser, PAMED Executive Vice President, [email protected] or PAMED’s general counsel Elizabeth Metz at [email protected].


Learning Opportunities

The Centers for Medicare and Medicaid Services (CMS) will address how the 2016 Medicare Physician Fee Schedule final rule impacts Medicare Quality Reporting Programs in a national provider call on Tuesday, Dec. 8 from 1:30-3pm. To Register: Visit MLN Connects Event Registration. Space may be limited, register early. The program will cover program changes to the Physician Quality Reporting System (PQRS), Electronic Health Record Incentive Program, Comprehensive Primary Care initiative, Value-Based Payment Modifier (Value Modifier), Medicare Shared Savings Program (Shared Savings Program) and Physician Compare among other topics. A question and answer session will follow the presentation.
This MLN Connects Call is being evaluated by CMS for CME and CEU continuing education credit (CE). Refer to the call detail webpage for more information


The University of Michigan Injury Center Opioid Overdose Summit, a national webcast on Tuesday, Dec. 1, from 8:45 a.m. to 4:45 p.m., will feature national speakers leading a science-based exploration of an emerging public health issue: overdose injury and death related to opioids (prescription pain medications).  Please see the attached flyer or visit the website for more information and a link to the registration site.There is no cost to attend this event.  Questions?  Email [email protected].


The 42nd Annual “The Williamsburg Conference on Heart Disease” – Dec. 6-8, 2015, Williamsburg Conference Center, Williamsburg, VALearn more and register.


The Mountain Area Health Education Center (MAHEC) fall course schedule is out. Find out what is being offered July through December 2015 and register today.


A video recording of the "PQRS/Value-Based Provider Modifier: What Medicare Professionals Need to Know in 2015" presentation has been posted to the CMS MLN Connects® page on YouTube. This presentation is the same as the webinars that were delivered on March 31, 2015 and April 7, 2015 by the Philadelphia Regional Office. View the video.


The 2nd Annual Bundled Payment Implementation Forum: How to Make Your Bundled Payment Program Work will be held Jan. 25-26, 2016 at the Wyndham Orlando Resort in Orlando, FL. Learn more about the program and register here. For questions, call 866-676-7689.

 
 
 


NCMSF Receives Grant to Improve Access to Health Care for Those in Rural North Carolina

The North Carolina Medical Society Foundation (NCMSF) is pleased to announce the Kate B. Reynolds Charitable Trust has awarded a $440,500 grant to the Foundation’s Rural ACO Initiative to improve access to health care for people living in rural and underserved areas of the state.
The grant will span three years beginning in 2016 and enable medical practices to move to value-based models of care like Accountable Care Organizations (ACOs). Broadly, an ACO involves more coordination of patient care, meeting specific quality of care benchmarks for a population of patients served and through preventive care and greater efficiencies realizing cost savings. The change in how care is delivered, received and paid for in an ACO requires a large investment of resources and expertise to be successful. The Trust grant will help support this transformation in up to 15 rural practices over the next three years.
“We are sincerely grateful for the Kate B. Reynolds Charitable Trust’s support. We see this as an important opportunity to demonstrate that ACOs are a promising health care delivery model, and, most importantly will increase patient satisfaction and health outcomes,” said Jim Hill, PA-C, President of the NCMS Foundation Board of Trustees. “Health care providers who serve the financially needy are often hard pressed for the time and resources needed to adopt innovative improvements like better patient care coordination and identifying areas for cost efficiency. This initiative will help prepare practices to thrive in the emerging value-based health care payment and delivery system.”
The initiative will use the NCMSF’s 26-year-old Community Practitioner Program as the firm foundation from which to recruit rural practices to take part. Also eligible will be federally qualified health centers (FQHC), rural health clinics, critical access hospitals and small hospitals with under 100 beds, all of which serve financially needy patients.
The NCMSF has partnered with CHESS, a management services organization based in High Point, to provide the needed front-lines expertise to each participating practice. CHESS’ management services will include health information technology support, care coordination training, patient engagement skills, how best to integrate community health and faith community resources in each locale and to generally facilitate the major culture shift as a practice moves to a value-based model of care.
According to James Hoekstra, MD, Chief Business Development Officer for CHESS and Vice President for Network Clinical Affairs at Wake Forest Baptist Medical Center, “This is a great opportunity for us to continue our efforts to support the development of clinician-led, value-based medicine in the rural communities of North Carolina. The clinical and business expertise, technology, physician education services and patient engagement programs CHESS offers are perfectly aligned with the objectives of this grant. We are pleased and proud to be able to serve patients who live in the rural and underserved areas of North Carolina in this way.”
Through this initiative, CHESS will work with the NCMS Foundation to prepare aspiring rural ACOs for participation in the Centers for Medicare and Medicaid Services (CMS) Medicare Shared Savings Program, the CMS ACO Investment Model and other ACO arrangements.
While the Rural ACO Initiative will benefit all patients, it’s estimated that 60 percent of the patients in each participating practice will be financially disadvantaged.
“The Trust is committed to improving health throughout rural North Carolina, and supporting rural doctors and medical practices as they evolve and grow in the changing health care landscape is critical to that commitment,” said Allen Smart, interim president of the Kate B. Reynolds Charitable Trust. “Rural residents want and need access to quality care, and we believe providing technical and financial assistance to practices transitioning to ACOs is one way to ensure more coordinated, affordable care for patients.”
Success of the initiative will be measured in the expected increase in patient satisfaction with their care and lower costs. Thanks to the Trust’s help with funding and CHESS’ experience in managing the transition to an ACO, many more of the state’s most vulnerable citizens will have improved access to care.


A New and Improved NC HIE Is in the Works

The NC General Assembly passed legislation this year to implement a proper-functioning Health Information Exchange (HIE), a crucial step toward putting data into doctors’ hands, which will help our state’s health care system reach the quality and cost goals that are a priority.
You may recall that thanks to legislative action several years ago, North Carolina does, in fact, have an HIE. But opposition from within the health industry led to low levels of participation. Today, there is a broader understanding of the role an HIE would play in health system transformation and payers are beginning to appreciate that data and the medical expertise necessary to properly interpret it will help conserve health resources while improving quality.
As the power to control patient care decisions increasingly migrates back to doctors as part of the move to value-based systems of care, the HIE offers physicians many benefits, such as:

  1. giving physicians real-time access to their patients’ clinical data from throughout the health care system;
  2.  enabling those being held accountable for the Triple Aim (cost, population health, and experience of care) to better formulate strategies to succeed; and
  3. allowing those who authorize health program funding (e.g., legislators and government agency officials) to see where good value is being obtained and avoid taking actions that will harm patient health.

Under the law passed this year, all Medicaid providers will soon need to be connected to the HIE. Many important issues will need to be revisited as part of any effort to revitalize or reform the NC HIE. The NCMS is working to ensure:

  1. the governance structure for the HIE has appropriate physician representation;
  2. the substantial costs incurred by providers to implement necessary EHR technology in their practices is recognized by everyone as a contribution to achieving the HIE and health system improvement goals; and finally,
  3. the HIE is operated as a public utility, free of proprietary influence from EMR vendors or health care organizations.

The NCMS will continue working to ensure these priorities are reflected in the NC HIE. We’d like to have your input on this issue. Please post a comment on this blog, or contact us directly at [email protected] or 800-722-1350.


New NCMS Governance System Makes Board Accountable to YOU

The newly updated North Carolina Medical Society (NCMS) constitution and bylaws, reflecting the House of Delegates recent decisions to make the NCMS Board of Directors directly accountable to the Society’s membership, has been posted on our website for easy reference.
In keeping with this change in governance, following is the schedule of upcoming Board meetings, which will now be held throughout the state to make NCMS leadership meetings more accessible to the membership wherever they practice. Watch the NCMS Bulletin for details on each meeting as the date approaches.
Jan. 8-9, 2016 in Raleigh
March 18-19, 2016 in Wilmington
May 13-14, 2016 in Cary
July 15-16, 2016 in Charlotte
Sept. 15-18, 2016, NCMS Annual Meeting/M3 Conference in Greensboro
Dec. 3, 2016 in Raleigh (tentative)
If you have an issue you’d like to bring to a Board member’s attention in the meantime, please go to our website to contact the NCMS Board.


CMS Releases Interactive Tool to Map Opioid Prescription Claims

The Centers for Medicare & Medicaid Services (CMS) released an interactive online mapping tool, which shows geographic comparisons at the state, county and ZIP code levels of de-identified Medicare Part D opioid prescription claims – prescriptions written and then submitted to be filled – within the United States. This new mapping tool allows the user to see both the number and percentage of opioid claims at the local level and better understand how this critical issue impacts communities nationwide.
“The opioid epidemic impacts every state, county and municipality. To address this epidemic, while ensuring that individuals with pain receive effective treatment, we need accurate, timely information about where the problems are and to what extent they exist,” said CMS Acting Administrator Andy Slavitt. “This new mapping tool gives providers, local health officials, and others the data to become knowledgeable about their community’s Medicare opioid prescription rate.”
Data from the North Carolina Division of Public Health reveal more than 1,000 people in our state die of prescription drug abuse annually. Nationally, in 2013, overdose from prescription opioid pain relievers claimed more than 16,000 lives, with more than 145,000 people dying from these overdoses in the last decade. The resulting health, social, and economic consequences for communities across the country are enormous.
“The opioid abuse and overdose epidemic continues to devastate American families,” said CDC Director Tom Frieden, M.D., M.P.H. “This mapping tool will help doctors, nurses, and other health care providers assess opioid-prescribing habits while continuing to ensure patients have access to the most effective pain treatment. Informing prescribers can help reduce opioid use disorder among patients.”
The data set, which is privacy-protected, contains information from over one million distinct providers who collectively prescribed approximately $103 billion in prescription drugs and supplies paid under the Part D program.
CMS and the U.S. Department of Health and Human Services (HHS) believe that this level of transparency will inform community awareness among providers and local public health officials.
As part of this initiative, HHS is working through the Centers for Disease Control and Prevention (CDC) to develop opioid prescribing guidelines and supporting training and tools for providers to make informed prescribing decisions. For more information on CMS’ efforts to address the growing problem of abuse of opioids in the Part D program, read the Part D Overutilization Monitoring System Summary.
 


Enrollment is Open – Helping Patients Get Insurance on the Health Care Exchange

Open enrollment for individual insurance policies under the Affordable Care Act (ACA) began Sunday, Nov. 1 for people who want to continue or start health coverage on Jan. 1, 2016. These individual policies are sold on the federal exchange and come with financial subsidies for people in middle-to-lower income brackets. In North Carolina, three insurers are offering policies on the federal exchange – Blue Cross Blue Shield of North Carolina, UnitedHealthCare and Coventry Health Care of the Carolinas, which is owned by Aetna. Humana is joining the marketplace, although initially their plans will only be available in four counties in the Charlotte and Winston-Salem area.
Patients can go directly to the exchange site, Healthcare.gov to begin the enrollment process.  Access local resources here. This downloadable flyer also provides basic information for your patients about how to get started.
US Secretary of Health and Human Services Sylvia Burwell spoke to North Carolina journalists earlier this week on a conference call, noting that more than 90 percent of the 460,000 enrolled in North Carolina last year received federal subsidies, according to the Raleigh News & Observer.
Rates for the plans significantly increased this year. Blue Cross Blue Shield, the state’s largest insurer, was approved for a 32.5 percent average increase. It’s estimated that BCBS’s increases for individual plans on the exchange will range from 5 to 42 percent. UnitedHealthcare rate plans will increase between 2.5 and 50.3 percent and Coventry plans will increase on average 23.6 percent over last year.
Burwell said that the average rate increase from 2015 to 2016 in ACA plans is 7.6 percent. Nationwide, she said, 70 percent of people on the marketplace are finding plans that cost $75 a month or less, with federal subsidies.


CMS Extends Deadline for Physician Quality Reporting System (PQRS) Informal Review Process

The Centers for Medicare and Medicaid Services (CMS) is extending the 2014 Informal Review period until Nov. 23, 2015 for those individuals and practices requesting a review of their value modifier determination. This determination will apply to the Medicare Physician Fee Schedule for 2016. If you think there is an error in the calculation, you now can request a review until Monday, Nov. 23, an extension from the previous deadline of Nov. 9, 2015.
All informal review requests must be submitted electronically via the Quality Reporting Communication Support Page (CSP).  Please see 2014 Physician Quality Reporting System (PQRS): Incentive Eligibility & 2016 Negative Payment Adjustment - Informal Review Made Simple for more information.
The value modifier is based on the 2014 Annual Quality and Resource Use Reports (QRURs), which are now available for every group practice and solo practitioner nationwide. These reports show how groups and solo practitioners performed in 2014 on the quality and cost measures used to calculate the 2016 Value Modifier. For practices with fewer than 10 eligible providers and solo practitioners, the QRUR is for informational purposes only and will not affect their payments under the Medicare Physician Fee Schedule in 2016.
Authorized representatives of group and solo practitioners can access the 2014 Annual QRURs on the CMS Enterprise Portal using an Enterprise Identify Data Management (EIDM) account with the correct role.  For more information on how to access the 2014 Annual QRURs, visit How to Obtain a QRUR.
Additional information about the 2014 QRURs and how to request an informal review is available on the 2014 QRUR website and through the QRUR Help Desk at [email protected] or 888-734-6433 (select option 3).
For additional questions regarding the informal review process, contact the QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) or [email protected] Monday-Friday from 7:00 a.m. to 7:00 p.m. Central Time. To avoid security violations, do not include personal identifying information, such as Social Security Number or Taxpayer Identification Number (TIN), in e-mail inquiries to the QualityNet Help Desk.
Don't forget to keep up with important deadlines and information like this on our Quality Time with the NCMS webpage. Simply log on and have access to valuable resources to ensure you are fully informed.


CMS Finalizes 2016 Medicare Physician Fee Schedule

On October 30, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a final rule updating payment policies, payment rates and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2016. CMS finalized a number of new policies, including several that are a result of recently enacted legislation. The rule also finalizes changes to several of the quality reporting initiatives associated with PFS payments, including the Physician Quality Reporting System (PQRS), the Physician Value-Based Payment Modifier (Value Modifier), and the Medicare Electronic Health Record (EHR) Incentive Program, as well as changes to the Physician Compare website on Medicare.gov.
This is the first PFS final rule since the repeal of the Sustainable Growth Rate (SGR) formula by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
Read more about the fee schedule.


All Still Quiet on the ICD-10 Front

It has been just over a month since the transition to ICD-10 and so far there have been no major glitches.
The Medicaid claims system, NCTracks, reports that roughly two-thirds of the claims being received are ICD-10 and that the current rate of successful claim adjudication mirrors that for claims submitted prior to October 1, reflecting that most providers have adapted well to the new code set.
The Centers for Medicare and Medicaid Services (CMS) has been carefully monitoring the switch to ICD-10 and says that claims are processing normally, although due to the lag in payment (Medicare must – by law – wait two weeks before issuing a payment) CMS will have more information about the transition in November.
In the meantime, they have issued the following metrics from Oct. 1-27:

 Metrics October 1-27 Historical Baseline*
Total Claims Submitted 4.6 million per day 4.6 Million per day
Total Claims Rejected due to  incomplete or invalid information 2.0% of total claims submitted 2.0% of total claims submitted
Total Claims Rejected due to invalid ICD-10 codes 0.09% of total claims submitted 0.17% of total claims submitted (estimated based on end-to-end testing)
Total  Claims Rejected due to invalid ICD-9 codes 0.11% of total claims submitted 0.17% of total claims submitted (estimated based on end-to-end testing)
Total Claims Denied 10.1% of total claims processed 10% of total claims processed

If you do experience issues with ICD-10, the North Carolina Medical Society (NCMS) has listed resources on our website as well as live help from our Solution Center Coordinator, Belinda McKoy, 919-833-3836 x142.
CMS offers the following resources:
For general ICD-10 information: CMS’ Road to 10 website and www.cms.gov/icd10.
Your first line for help for Medicare claims questions is your Medicare Administrative Contractor. They’ll offer their regular customer service support and respond quickly.
You can contact the ICD-10 Coordination Center.
The ICD-10 Ombudsman, Dr. Bill Rogers, can be your impartial advocate.
 


NCMSF Community Practitioner Program Participants Focus on Quality and Value-Based Care

Participants in the North Carolina Medical Society Foundation’s (NCMSF) Community Practitioner Program (CPP) came together at their Annual Meeting on Oct. 23 at the Grandover Resort in Greensboro to hear from several guest speakers on timely issues facing clinicians.
The theme running throughout the meeting was the transition to a value-based model of care, and the challenges and opportunities that come with such a change. Accountable Care Organizations (ACOs) are built on a quality and value-based framework and Franklin Walker, NCMSF Director of Rural Health Initiatives was pleased to tell the 29 CPP’ers in attendance that the Kate B. Reynolds Charitable Trust had awarded the NCMSF a $440,500 grant to help fund the NCMSF’s Rural ACO Initiative. CPP practices are the foundation for this initiative, which will provide resources to small, rural practices seeking to make the oftentimes costly and labor intensive transition to an ACO model. [Read more about the grant in this edition of the Bulletin.]
Karen Cannon MD, CPE, Chief Medical Operations Officer, CHESS, spoke on the transition to ICD-10, which thus far has been smooth and will provide a greater depth of data necessary as practices make the move to value based models of care.  Genie Komives, MD, Senior Medical Director, Duke Connected Care addressed issues around payment reforms, specifically bundled payments and Lisa Shock, PA-C, Director of Care Transformation, CHESS spoke about population health, one of the three goals that make up the Triple Aim in value-based health care. The other two parts of the Triple Aim are cost efficiency and patient experience.
North Carolina Medical Society (NCMS) Director of Health Policy Jennifer Gasperini provided an overview of provisions in the federal Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) affecting their practices. MACRA is the legislation adopted when Congress ended the Sustainable Growth Rate (SGR) formula for Medicaid.
The CPP was founded 26 years ago with the aim of helping medically underserved communities across North Carolina attract and retain needed medical practitioners. The program helps practitioners pay off their medical education loans while they serve their community. Learn more.

The American Medical Group Association (AMGA) offers this list of ACO principles:

  • Multispecialty Medical Groups and Other Organized Care Systems Make the Strongest Foundation
  • ACOs Must Be Physician-Led
  • ACOs Must Be Held Accountable for Clinical Results & Cost Efficiencies in the Community
  • ACO Incentives Must Be Aligned to Foster Voluntary Participation
  • ACOs Must Have a Primary Care Core
  • ACOs Should Be "Learning Organizations" That Use Data to Improve Efficiency and Safety of Care

Read more.

 


New NC DMA Website Launches

A new North Carolina Division of Medical Assistance (DMA) website launched on Oct. 27, organized and designed for easier access to information to serve Medicaid beneficiaries. New features include:

  • Document Library. The new document library will contain documents such as clinical coverage policies, fee schedules and manuals.
  • Get Started. Beneficiaries will simply follow five straightforward steps to help them determine if Medicaid is right for them. A “Fast Start: Apply Now” button on each page takes an applicant directly to ePass.
  • Get Involved. This is a one-stop place to view public notices, comment on proposed policy changes or report fraud. It also includes contact information for committees and work groups. Future additions could include a public event calendar.
  • Find a Doctor. The dental, primary care physician and specialist provider lists now include an interactive map as an option. These lists will be updated on a regular basis.
  • ADA Compliant. The site design is more supportive of accessibility and the Americans with Disabilities Act, and also reflects new North Carolina state government branding.
  • RSS feeds. You can elect to be automatically notified when a file is posted to the document library.
  • Accessible. The website is more easily viewed on mobile devices and tablets.

Please note that the new website does not replace NCTracks, which will continue to be your source to file claims.
The DMA website is part of the N.C. Digital Commons Project, a multi-year effort to redesign all state department websites to be easier for citizens to navigate and provide a consistent look.


Reminder of NCTracks Re-credentialing Process

Please note the North Carolina Medical Society (NCMS) successfully advocated on your behalf to extend the re-credentialing period from every three years to every five years during this latest Legislative Session. This new provision will reduce costs and administrative hassles for practices and align with the federal (Medicare) requirement.
From the NC Division of Medical Assistance
The Centers for Medicare and Medicaid Services (CMS) requires that all Medicaid providers are re-credentialed. The N.C. Division of Medical Assistance (DMA) is reviewing the status of enrolled providers to ensure compliance. This is a reminder and update to the announcement posted on August 24, 2015.
Providers will receive a re-credentialing notice posted to their Message Center Inbox on the secure NCTracks Provider Portal when re-credentialing is due. Due dates for re-credentialing are specific to each provider. All providers will not receive re-credentialing notices at the same time. Providers have 45 days after notification to complete the re-credentialing process. As a reminder, North Carolina session law 2011-145 Section 10.31(f)(3)requires that providers pay a $100 fee for Medicaid re-credentialing.
It is crucial that all providers who receive a notice promptly respond and begin the online re-credentialing process. All Medicaid providers that receive a re-credentialing notice are required to re-credential as part of the NCDHHS Provider Administrative Participation Agreement. Re-credentialing is not optional.
Providers who do not complete the re-credentialing process on time will receive a letter notifying them that they are suspended from participation in the Medicaid program. Providers have 30 days following notification of suspension to complete re-credentialing. Providers who do not complete the re-credentialing process within that time frame will be subject to termination from the Medicaid program.
To assist providers with the re-credentialing process, a new webpage is available on the NCTracks provider portal. Providers are encouraged to consult the new webpage for information regarding the online re-credentialing process in NCTracks, as well as links to Provider Announcements, User Guides, and Frequently Asked Questions.


Revered Wilmington Doctor Honored With Lifetime Achievement Award

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R. Bertram Williamsn Jr., MD

Retired physician R. Bertram Williams, Jr. of Wilmington will be honored Nov. 21 with a Lifetime Achievement award at the Health Care Heroes awards event sponsored by the Greater Wilmington Business Journal. Dr. Williams joined the North Carolina Medical Society (NCMS) in 1951 and is an active life member today. He has touched many lives over his 39-year career and is revered by colleagues, patients and friends.
Dr. Williams is a general and thoracic surgeon and co-founder of Wilmington Surgical Associates. He served as chief of staff, a trustee and board chairman at New Hanover Regional Medical Center.
The son of a merchant, Dr. Williams earned his medical degree at Vanderbilt University before joining the Second Marine Division during World War II, tending to injured soldiers in the Pacific. After serving in Korea, Williams returned to Wilmington in 1951 to open his downtown surgical practice.
With his partners, Horace Moore Jr. and Ellis Tinsley Sr., the practice ate the costs of uninsured patients, which lead to home-grown vegetables and fresh seafood sometimes piling up on their doorsteps.
“He did not turn anyone away that needed his help,” his grandson, Tram Williams told the Greater Wilmington Business Journal. “It seems that his medical career was so much more than a job.”
NCMS Board member Philip Brown, MD, a vascular surgeon and current chief of the medical staff at New Hanover Regional Medical Center said Dr. Williams is “a model for what doctors should be.”
Former NCMS President Michael Moulton, MD, an Emergency Department Physician and President of Medac in Wilmington wrote of Dr. Williams in his nomination for the Lifetime Achievement Award: “I have known Dr. Williams for more than twenty years and consider him a dear friend. He has dedicated his life to his patients, this community and truly is a health care hero. At 95 years old, in addition to his active involvement with our local Medical Society, he continues to lead the Retired Physicians’ Section of the New Hanover County[-Pender] Medical Society with great vigor and success. He continues to mentor physicians and serves as an inspiration to all physicians who know him.”
 


Learning Opportunities

EHR 2.0 is sponsoring a webinar on Final Rule on 2015 Meaningful Use Attestation Requirements, Nov. 12, noon- 1 p.m. featuring Terri Gonzalez of NC Medical Society Foundation will share with us the final rule on 2015 Meaningful Use (MU) attestation. In order to ensure eligible professionals are using the right technology and meeting the program attestation objectives by the Feb. 29, 2016 deadline, the webinar will focus on the latest updates on Meaningful Use EHR incentive attestation requirements for Stage 2 and Stage 3. Get more information and register.


Carolinas Trauma Related Issues and Critical Knowledge Symposium (TRICKS) of Fracture Management, November 14, 2015, 8 am – 2 pm, Hilton Charlotte Center City Hotel, 222 E. 3rd St., Charlotte, NC 28202. For more information, call 704.512.6534 or visit the website for further information.


The North Carolina Medical Society Foundation in cooperation with the North Carolina Medical Group Managers is offering a webinar titled “Managing Social Media in a Busy Health Care Practice” featuring Janet M. Kennedy on Nov. 18, 2015, noon to 1 p.m. Kennedy is the host of the "Get Social Health" podcast, sharing best practice stories and interviews about social media in health care and will share practical tips and suggestions for developing, scheduling, tracking and managing your social media sites. Register here. This webinar is free, but you must be registered to attend. Space is limited so register early! After you register, you will receive an emailed confirmation with webinar and phone-in instructions.


The Centers for Medicare & Medicaid Services (CMS) is offering the third session of a three-part Virtual Office Hours series on 2015 Physician Quality Reporting System (PQRS) quality measures titled “2015 PQRS Reporting: Measure-Applicability Validation.” The session will take place on Wednesday, Nov. 18, 2015 from 2 – 3 p.m. Topics to be discussed in this session include the Measure-Applicability Validation (MAV) process, as well as an overview of How to Get Started with PQRS. To participate in this session, please register hereOnly a limited number of participants will be allowed to register.


NCTracks Learning Opportunities for November include:
Thursday, Nov. 5 - 10 a.m. to noon - 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).
Monday, Nov. 9 - 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.
Friday, Nov. 13 - 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.
Friday, November 13 - 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.
Tuesday, Nov. 17 – 9 a.m. to noon - ES User Role_Abbreviated MCR_Upload Documents (WebEx) will guide providers through the enhancements to the provider enrollment application processes.
Providers can register for these courses in SkillPort, the NCTracks Learning Management System. Logon to the secure NCTracks Provider Portal and click Provider Training to access SkillPort. Refer to the Provider Training page of the public Provider Portal for specific instructions on how to use SkillPort.


The University of Michigan Injury Center Opioid Overdose Summit, a national webcast on Tuesday, Dec. 1, from 8:45 a.m. to 4:45 p.m., will feature national speakers leading a science-based exploration of an emerging public health issue: overdose injury and death related to opioids (prescription pain medications).  Please see the attached flyer or visit the website for more information and a link to the registration site.There is no cost to attend this event.  Questions?  Email [email protected].


The 42nd Annual “The Williamsburg Conference on Heart Disease” – Dec. 6-8, 2015, Williamsburg Conference Center, Williamsburg, VALearn more and register.
The Mountain Area Health Education Center (MAHEC) fall course schedule is out. Find out what is being offered July through December 2015 and register today.


A video recording of the "PQRS/Value-Based Provider Modifier: What Medicare Professionals Need to Know in 2015" presentation has been posted to the CMS MLN Connects® page on YouTube. This presentation is the same as the webinars that were delivered on March 31, 2015 and April 7, 2015 by the Philadelphia Regional Office. View the video.


The 2nd Annual Bundled Payment Implementation Forum: How to Make Your Bundled Payment Program Work will be held Jan. 25-26, 2016 at the Wyndham Orlando Resort in Orlando, FL. Learn more about the program and register here. For questions, call 866-676-7689.



NCMS Bulletin 'Special Edition'

The following is a special edition of the North Carolina Medical Society (NCMS) Bulletin focused on our 2015 Annual Meeting, which was held last weekend (Oct. 23-24) at the Grandover Resort in Greensboro. As is our Society’s longstanding tradition – this was our 161st Annual Meeting -- the gathering brought together hundreds of NCMS members from across the state to reconnect, network, learn and share their common experiences. This year’s theme was “Resilience in Challenging Times.” Two CME sessions brought to light the problem of burnout and ways doctors and physician assistants can better cope with the challenges they face in order to be more fulfilled professionally and in their personal lives. Beyond the CME and the convening of the House of Delegates, smaller gatherings included meetings of the Community Practitioner Program participants, the Leadership College and the Women in Medicine section and much more. We hope you were able to be part of this ongoing tradition, but, if not, you can read all about it here.


Delegates Vote To Change NCMS Governance Structure

20151023_165527Delegates to the North Carolina Medical Society (NCMS) House of Delegates voted overwhelmingly in favor of changing the Society’s constitution and bylaws to move the governance and policymaking functions of the organization from the House of Delegates to the Board of Directors at its Annual Meeting on Oct. 23-24 at the Grandover Resort in Greensboro. After lengthy discussion and debate over the two days of the meeting, 78 delegates ultimately voted in favor of the change to the organization’s constitution with seven opposed.
After adopting the change to the constitution, a separate vote to amend the bylaws to support the constitutional change in governance structure also carried with 81 votes in favor and none opposed.
“Delegates have one last duty -- to go home and tell their constituents they can vote,” Art Apolinario, MD, a family physician in Clinton, NC, and Region 3 Representative to the NCMS Board of Directors told the delegates after the vote. “All NCMS members are now voting members.”
The vote to change the constitution and bylaws came after a two-year process of analysis, review, input and debate over how well the House of Delegates was serving the rank-and-file NCMS membership. For a brief overview of that process, watch this video in which NCMS President and CEO Robert W. Seligson reviews the timeline leading up to last weekend’s decision.
Going forward under the new constitution and bylaws, each NCMS member will now have the opportunity to bring important issues directly to the Board of Directors throughout the year. To facilitate this, Board meetings will be held across the state so members will not have to travel long distances to meet face-to-face with their representatives. Watch the Bulletin for notices about upcoming meetings in your area, or contact your area Board representative at any time. Board members are listed on the NCMS website under About NCMS. This new process is designed to make the Board more directly accountable to members.
To help ensure that no one group will co-opt the process, a referendum provision allows a petition by 5 percent of NCMS voting members to bring any matter to a referendum for a decision by the majority of the voting membership. The new process also allows more timely changes to the bylaws, if necessary, rather than waiting a full year for the Annual Meeting of the House of Delegates.
“This is the proper process, with the proper people, in the proper timeframe,” Robert “Charles” Monteiro told the delegates.
While the House of Delegates will no longer meet, the Annual Meeting and traditions like the inauguration of the incoming NCMS president will remain intact. The NCMS’ next Annual Meeting will be held at the Grandover Resort in Greensboro, Sept. 15-18, 2016. This meeting will be held jointly with the North Carolina Medical Group Managers Association with the theme of “M3 – Merging Medicine and Management.” This conference will offer robust CME programming tracks as well as the popular traditions you associate with past NCMS Annual Meetings. Mark your calendars now!
 


Docia Hickey, MD, Inaugurated As NCMS’ 162nd President

hickey-docia-2012On Friday evening, Oct. 23, Docia E. Hickey, MD, from Belmont, NC, was sworn in as the North Carolina Medical Society’s (NCMS) 162nd president at the Society’s Annual Meeting at the Grandover Resort in Greensboro, NC.
Dr. Hickey is a neonatologist, recently retired from Carolinas HealthCare System where she spent the bulk of her career. She has been a member of the NCMS since 1980, and has been in leadership roles on a variety of NCMS committees and task forces over the years. As a member of the Society’s Board of Directors since 2005, her positions included vice speaker and speaker, and, most recently president-elect. She also has served as president of the Mecklenburg County Medical Society, the North Carolina Perinatal Association, as a member of the North Carolina Child Fatality Task Force and on the boards of a variety of non-profit organizations including the Holy Angels Foundation, which serves the needs of intellectually and developmentally disabled children and adults.
“Next year we will still have a fight before us on Medicaid,” Dr. Hickey said in her inauguration remarks. “Reform has been enacted by our legislature, but the details and regulations still need to be defined.  We must be vigilant and continue to fight for protections for our patients and ourselves as providers.”
Dr. Hickey earned her undergraduate degree form Emory University after which she returned to her native North Carolina to earn her MD at the Bowman Gray School of Medicine at Wake Forest University. Outside of her two years as a fellow in neonatology at Vanderbilt University, Dr. Hickey was an intern and resident and spent her career at Charlotte Memorial Hospital, now Carolinas Health Center. She also has been a professor in the Department of Pediatrics at the University of North Carolina-Chapel Hill.
Outgoing NCMS President Robert E. Schaaf, MD, FACR, swore in Dr. Hickey and noted in his remarks: “With her years of leadership experience in organized medicine, her deep knowledge of the North Carolina Medical Society and her calm, yet firm presence, Dr. Hickey will be a strong advocate for our profession during her tenure as NCMS president.”
Congratulations Dr. Hickey!


NCMS Elects New Board Member and Officers

At the North Carolina Medical Society Annual Meeting on Oct. 23-24 at the Grandover Resort in Greensboro, Philip M. Brown, Jr., MD, a vascular surgeon from Wilmington, was elected to a three-year term on the NCMS Board of Directors as a representative of Region 1, which covers eastern North Carolina.
Paul R. G. Cunningham, MD, a general surgeon and Dean and Senior Associate Vice Chancellor for Medical Affairs at the Brody School of Medicine at East Carolina University in Greenville, has been an NCMS Board member since 2009, and now is NCMS President-Elect.
As a result of changes to the NCMS Constitution and Bylaws that were voted in at the meeting, which changed the governance structure from a House of Delegates model (see following Bulletin article) to one in which the Board of Directors are the policymaking entity, the speaker and vice speaker positions are no longer necessary. The Board members who held those positions, Palmer Edwards, MD, DFAPA, a psychiatrist in Winston-Salem, and John J. Meier, IV, MD, MBA, an internist and pediatrician in Raleigh, respectively, will now serve as Board Members-at-Large.
Congratulations to everyone in their new positions!
 
 


Dr. Carl Ravin Receives E. Harvey Estes Award

210_RavinCarl10-158x197The North Carolina Medical Society (NCMS) awarded renowned radiologist Carl Ravin, MD, the E. Harvey Estes, MD, Physician Community Service Award at its 2015 Annual Meeting at the Grandover Resort in Greensboro on Friday, Oct. 23, 2015.
The E. Harvey Estes, MD, Physician Community Service Award recognizes a physician who not only cares for individual patients, but also serves the larger community. Dr. Ravin is known as an outstanding clinician, a respected teacher-scholar and a pioneer in the area of thoracic radiology.
Early in his career, Dr. Ravin was one of the driving forces in the Department of Radiology at the Duke University Medical Center where he helped forge a nationally recognized department. Many of those Dr. Ravin brought to Duke have gone on to become part of the vanguard of the profession. As one nominator wrote: “Many of the leading radiologists in North Carolina are graduates of his training programs.”
Dr. Ravin’s contributions in research are honored through the Ravin Advanced Imaging (RAI) Laboratories at Duke University. Established in 1991, RAI prides itself on its quality research, which has high clinical relevance.
As President and Chairman of the Private Diagnostic Clinic at Duke, Dr. Ravin grew the clinic by several hundred doctors to become one of the largest physician groups in the state.
“Throughout his distinguished career as an innovator, scholar, teacher and clinician, Dr. Ravin has always stressed the importance of ‘patient first,’” said NCMS President Robert E. Schaaf, MD, FACR, on presenting Dr. Ravin with the award. “For his genuine impact on the profession and his community, it is my honor to present Carl E. Ravin the 2015 E. Harvey Estes Physician Community Service Award.”
Congratulations, Dr. Ravin!


Medical Mutual's Jenkins and Sousa Receive John Huske Anderson Award

In a fitting tribute on the day marking Medical Mutual Insurance Company’s (MMIC) 4oth anniversary, two of its longtime leaders received the North Carolina Medical Society’s John Huske Anderson Award honoring laypeople who have a positive impact on the medical profession.

Dale Jenkins3
A. Dale Jenkins

NCMS President Robert E. Schaaf, MD, FACR, awarded A. Dale Jenkins and David Sousa of MMIC with the coveted prize.
“Over its 40-year history, MMIC has matured into a highly successful, physician-owned mutual insurance company serving states throughout the country. It is recognized and respected nationally as one of the best and most innovative PIAA’s in the country,” Dr. Schaaf said. “Dale and David are the strong leaders who have guided MMIC through this continued growth and success.”
David Sousa
David Sousa

David Sousa, Chief Operating Officer and General Counsel, has been with MMIC since 1996. He has testified before the General Assembly numerous times on a behalf of the NCMS, and played a critical role in the Society’s 2011 tort reform victory. Currently, he serves on the NCMS Foundation Board of Trustees.
“David can always be counted upon for thoughtful, wise counsel on any issue that touches our membership,” Dr. Schaaf said.
A. Dale Jenkins has been MMIC’s CEO since 1995 and COO for the year prior to that. In his two decades with the company, he has provided vision and strength to both MMIC and the NCMS.
“Dale’s personal commitment to helping physicians succeed in their practices has had a tremendous positive impact on health care access and delivery,” Dr. Schaaf said.
Congratulations Dale and David!


Dr. James Bryan II Receives 2015 T. Reginald Harris Memorial Award

Dr. BryanJames Bryan II, MD, MPH, retired medical internist and former UNC School of Medicine professor, is the recipient of the distinguished 2015 T. Reginald Harris Memorial Award. This year marks the 17th anniversary that the award has been given by The Carolinas Center for Medical Excellence (CCME) in honor of the life and memory of founding board member, T. Reginald Harris, MD.
The award was presented during the North Carolina Medical Society’s fall meeting on October 23 and accepted by Dr. Bryan’s brother, Dr. Edwin Bryan.
Immediate past chairman of CCME’s board of directors and former NCMS President, John Mangum, MD, presented the award.
“We are very pleased to present this award to Dr. Bryan in recognition of his outstanding achievement in the improvement of quality health care and service to the medical community,” said Dr. Mangum. “He exemplifies the values that Dr. Harris brought to health care and to CCME.”
Described as teacher, physician, role model, leader, pioneer and mentor, Dr. Bryan’s 60-year career included practices in hematology/oncology and primary care geriatrics. He also was  a recognized instructor and research fellow. Dr. Bryan held a dual professorship in the UNC-CH Departments of Medicine and Social and Community Medicine and was an active mentor and adviser to his students.
Dr. Bryan holds a bachelor’s degree from Davidson College, a medical degree from the Perelman School of Medicine at the University of Pennsylvania and a master’s in public health from the University of North Carolina at Chapel Hill.
Although retired from medicine, Dr. Bryan remains actively involved in his community by volunteering at the free Samaritan Health Center in Durham, the Chapel Hill homeless shelter, the First Presbyterian Church in Chapel Hill, and the Hospice at UNC.
For more information about the Harris Memorial Award and past recipients, please visit CCME's Harris Award page at www.thecarolinascenter.org/HarrisAward.


2015 NCMS Leadership College Scholars Graduate; Class of 2016 Inducted

The 2015 Class of NCMS Foundation Leadership Scholars Graduated last weekend at the North Carolina Medical Society Annual meeting, thus joining the ranks of the nearly 300 Leadership College alumni throughout the state.
The following are those who successfully completed the year-long program designed to enhance their leadership skills and position them for key leadership positions in their practice and the larger health care community:
Ami Shah, MD, Cary, Plastic Surgery
Angela Alistar, MD, Winston Salem, Internal Medicine
Annette Grefe, MD, Winston Salem, Neurology
Charlene Morris, PA-C, Stonewall, Family Medicine
David Willis, MD, Grimesland, Family/Sports Medicine
Gauri Dalvi, MD, Fayetteville, Pediatrics
Jessica Triche, MD, Bath, Family Medicine

  1. Brooke Chalk, MD, Wilmington, Ob-Gyn

Karen Cannon, MD, High Point, Pediatrics/Clinical Documentation Improvement Officer
Kathleen Boncimino, MD, Concord, Internal Medicine
Kathryn Colacchio, MD, Wilmington, Pediatrics/Neonatology
Keith MCoy, MD, Durham, Psychiatry
Kelly Pearson, MD, Chapel Hill, Dermatology
Obi Ikwechegh, MD, Winston Salem, Psychiatry
Congratulations to the Leadership College Class of 2015!
And welcome to the Leadership College Class of 2016:
Daniel Barzana, DO, Wilmington, General Surgery
Yun Boylston, MD, Burlington, Pediatrics
Pedgrag Gligorovic, MD, Wake Forest, Psychiatry
Folashade Jose, MD, Greenville, Pediatrics
Scott Lisson, MD, Cary, Urology
Christen MacKorell, Boiling Springs, PA student
Christopher McCraken, MD, Boone, Psychiatry
Angela Meredith, PA-C, Fayetteville, Student
Christopher Norman, PA-C, Greenville, Hospitalist
Bhavik Patel, MD, Durham, Radiology
Zoe Stallings, MD, Durham, Primary Care
Rupashree Varadarajan, MD, High Point, Internal Medicine
Kim Vuong, Chapel Hill, Student
Elyse Watkins, PA-C, High Point, Professor
If you are interested in participating in the Leadership College or any of the Kanof Institute for Physician Leadership courses, visit the website for more information or contact the program director, Tina Natt Och Dag or Erin Grover at 919-833-3836.


Kudos to NCMS’ Poster Contest Winners

The North Carolina Medical Society’s (NCMS) Third Annual Poster Competition, sponsored by Mag Mutual Insurance Company, brought a competitive field of medical students, residents and fellows from all the state’s medical schools to the Grandover Resort in Greensboro last weekend to share their research findings and vignettes. Special thanks goes to the chair of this year’s competition, Dawn Brezina, MD, an internist at Duke Regional Hospital, as well as the poster contest judges.
The 2015 winners in each category are:
Fellows
1st place: Amber Kuk, MD for Telema Nga, MD (ECU) – Diastrophic Dysplasia: A Rare Disorder and a Rare Association
2nd place: Inga Aikman, MD, MPH (ECU) – Quality Improvement: Using Laptop Computers to Reduce Time to Note Completion in a Pediatric Resident Continuity Clinic
3rd place: Khaldoon Al-Moosavi, MD, MPH (UNC) – Turner Syndrome and Sleep Disordered Breathing
Residents
1st place, Vignette: Siena Ona, MD (ECU) – Rehabilitation Course of a Long Term Survivor of Glioblastoma Multiforme after a Poliovirus Trial, A Case Report
2nd place, Vignette: Hortensia Beng, MD (ECU) – Lipoprotein Glomerulopathy
3rd place, Vignette: Ankit Patel, MD (ECU) – Spontaneous Galactorrhea Status Post Spinal Cord Injury: A Case Report
1st place, Research: Santoshi Billakota, MD (Duke) – Continuous EEG Monitoring in Non-ICU Hospitalized Patients
Students
1st place, Research: Kelley Boyd, BS (ECU) – Relationship between Diabetes-Related Distress and Glycemic Control in Patients with Type 2 Diabetes
2nd place, Research: Sophie Austin (ECU) – Oral Hygiene Status of a Sample of Residents from Nursing Homes in North Carolina
3rd place, Research: Audrey Lan (UNC) – Assessing the Feasibility of Creating a Healthcare System Tetraology of Fallot Patient Registry
1st place, Vignette: James Crisp for Hannah Briet (Wake Forest) – Case Report: Copper Deficiency Myelopathy from Excessive Zinc Ingestion
2nd place, Vignette: Nielsen Fullmer, for Chaseton M. Nielsen (Campbell) – A Pathologist’s Approach to a Lung Tumor
Congratulations to the winners, and thank you to all the talented medical students, residents and fellows who participated.


Legislative Summit Seeks to Bring Together ‘House of Medicine’

Summit panel
(l-r) Dr. Phil Brown, Dr. Genie Komives, Lisa Shock, PA-C

The final program of the 2015 North Carolina Medical Society (NCMS) Annual Meeting brought together representatives of the state’s specialty societies to gather information and discuss issues of importance to their members. The goal of the meeting was informational as well as to consider how to present a unified front on key issues to better advocate for the entire ‘house of medicine’ in the coming year.
A panel discussion featuring leaders of three accountable care organizations (ACO) in the state addressed ways to advocate more effectively for the ‘Triple Aim’ or improving the patient experience, improving the health of populations and reducing the per capita cost of health care. The NCMS and the specialty societies have been advocating for this approach as the foundation for Medicaid reform.
The panelists, “pioneers on the road to value,” were Philip M. Brown, Jr., MD, President of Wilmington Health, Genie Komives, MD, Senior Medical Director at Duke Connected Care and Lisa Shock, PA-C, Network Development Officer, CHESS Health Enablement Solutions. They explained where each of their organizations are on the spectrum of ACO development and the challenges they have and continue to face. They agreed data analytics – providing doctors and care givers with actionable data -- remains a big, if not the biggest, challenge.
“We’re killing them one click at a time,” Dr. Brown said about the frustrations surrounding data collection and how data can be used to actually improve quality of care.
When asked what their legislative ‘wish list’ included, Dr. Komives mentioned being watchful as the Medicaid reform process unfolds over the next several years, especially around how patients are attributed to a particular group. Shock noted that the recently adopted Medicaid reform included provisions for a Health Information Exchange, which is positive. Brown stressed the importance of doctors and other health care providers taking leadership roles.
“Many of the solutions have to come from inside,” he said. “We need to increase the depth of physician leadership; bring them into the c-suite.”
NCMS Director of Legislative Relations Chip Baggett also summarized the immediate steps underway to implement the new Medicaid reform legislation, including formation of the new Division of Health Benefits within the NC Department of Health and Human Services. Baggett said he expects it will be four years before the new Medicaid system is fully implemented.
The specialty societies also heard an update on various scope of practice bills from Amy Whited of the NC Coalition to Protect Patients. Several physicians from the orthopedic, urology and ophthalmology specialty societies spoke about the need to take a firm position on certificate of need reforms. Baggett encouraged all specialties to come together to address this issue.


NCMSF Receives Grant to Improve Access to Health Care for Those in Rural North Carolina

The North Carolina Medical Society Foundation (NCMSF) is pleased to announce the Kate B. Reynolds Charitable Trust has awarded a $440,500 grant to the Foundation’s Rural ACO Initiative to improve access to health care for people living in rural and underserved areas of the state.
The grant will span three years beginning in 2016 and enable medical practices to move to value-based models of care like Accountable Care Organizations (ACOs), which are seen as the future of health care in this country. Broadly, an ACO involves more coordination of patient care, meeting specific quality of care benchmarks for a population of patients served and through preventive care and greater efficiencies realizing cost savings. The change in how care is delivered, received and paid for in an ACO requires a large investment of resources and expertise to be successful. The Trust grant will help support this transformation in up to 15 rural practices over the next three years.
“We are sincerely grateful for the Kate B. Reynolds Charitable Trust’s support. We see this as an important opportunity to demonstrate that ACOs are a promising health care delivery model, and, most importantly will increase patient satisfaction and health outcomes,” said Jim Hill, PA-C, President of the NCMS Foundation Board of Trustees. “Health care providers who serve the financially needy are often hard pressed for the time and resources needed to adopt innovative improvements like better patient care coordination and identifying areas for cost efficiency. This initiative will help prepare practices to thrive in the emerging value-based health care payment and delivery system.”
The initiative will use the NCMSF’s 26-year-old Community Practitioner Program as the firm foundation from which to recruit rural practices to take part. Also eligible will be federally qualified health centers (FQHC), rural health clinics, critical access hospitals and small hospitals with under 100 beds, all of which serve financially needy patients.
The NCMSF has partnered with CHESS, a management services organization based in High Point, to provide the needed front-lines expertise to each participating practice. CHESS’ management services will include health information technology support, care coordination training, patient engagement skills, how best to integrate community health and faith community resources in each locale and to generally facilitate the major culture shift as a practice moves to a value-based model of care.
According to James Hoekstra, M.D., Chief Business Development Officer for CHESS and Vice President for Network Clinical Affairs at Wake Forest Baptist Medical Center, “This is a great opportunity for us to continue our efforts to support the development of clinician-led, value-based medicine in the rural communities of North Carolina. The clinical and business expertise, technology, physician education services and patient engagement programs CHESS offers are perfectly aligned with the objectives of this grant. We are pleased and proud to be able to serve patients who live in the rural and underserved areas of North Carolina in this way.”
Through this initiative, CHESS will work with the NCMS Foundation to prepare aspiring rural ACOs for participation in the Centers for Medicare and Medicaid Services (CMS) Medicare Shared Savings Program, the CMS ACO Investment Model and other ACO arrangements.
While the Rural ACO Initiative will benefit all patients, it’s estimated that 60 percent of the patients in each participating practice will be financially disadvantaged.
“The Trust is committed to improving health throughout rural North Carolina, and supporting rural doctors and medical practices as they evolve and grow in the changing health care landscape is critical to that commitment,” said Allen Smart, interim president of the Kate B. Reynolds Charitable Trust. “Rural residents want and need access to quality care, and we believe providing technical and financial assistance to practices transitioning to ACOs is one way to ensure more coordinated, affordable care for patients.”
Success of the initiative will be measured in the expected increase in patient satisfaction with their care and lower costs. Thanks to the Trust’s help with funding and CHESS’ experience in managing the transition to an ACO, many more of the state’s most vulnerable citizens will have improved access to care.
About the North Carolina Medical Society Foundation
The North Carolina Medical Society Foundation (NCMSF) is the philanthropic arm of the North Carolina Medical Society. Its mission is to improve access to quality health care for all North Carolinians. To accomplish this, NCMSF focuses on recruitment and retention of health care practitioners to provide needed health care services to underserved populations, and physician leadership development. Through our programs, NCMSF supports efforts that: (1) improve the health of specific populations; (2) enhance the patient experience of care; and (3) reduce health care costs. For more information, visit www.ncmsfoundation.org
 About the Kate B. Reynolds Charitable Trust
The Kate B. Reynolds Charitable Trust was established in 1947 and is now one of the largest private trusts in North Carolina. Its mission is to improve the quality of life and quality of health for the financially needy of North Carolina. The Health Care Division promotes wellness state-wide by investing in prevention and treatment. The Poor and Needy Division of the Trust responds to basic life needs and invests in solutions that improve the quality of life and health for financially needy residents of Forsythe County. Wells Fargo Bank, N.A., serves as sole trustee.
 About CHESS
CHESS is a physician-managed healthcare services company that empowers physicians and health systems to make the transition to value-based medicine, a model where they are financially rewarded for improving the quality of care and reducing the cost of care they deliver to patients. Using advanced analytics to build and measure the success of targeted care models, along with payer contracts that enable physicians to share in cost savings, CHESS creates a healthcare environment that is both patient-centered and clinician-friendly.
CHESS is owned by Cornerstone Health Care, Wake Forest Baptist Medical Center and LabCorp. Led by a team of medical, technology and business experts who have a deep understanding of what it takes to transition clients to a new value-based care model, CHESS offers a single solution that incorporates all elements required to successfully make the move to value. For more information about CHESS, visit www.chessmso.com.


NCMS Annual Meeting Begins Friday

2015annmtg-emailheaderThe 161st North Carolina Medical Society (NCMS) Annual Meeting will be held this Friday and Saturday, Oct. 23-24 at the Grandover Resort in Greensboro. Please join your colleagues for this inspiring and fun event.
Reference committee reports will be available tomorrow. We will notify delegates when they're ready.
This year’s theme is resilience.  With the practice of medicine becoming more complex, physicians and PAs have to be as competent in dealing with the business of medicine as they are in caring for their patients. This double duty often leads to a work-life imbalance — a feeling of burnout that can affect patient care and relationships with colleagues and family. This year’s meeting is dedicated to addressing these imbalances and teaching attendees ways in which they can modify their behavior to become more resilient in challenging times.
We will also inaugurate our new NCMS President and our House of Delegates will consider some important changes. This includes bylaws changes that would suspend the House of Delegates in favor of a more direct policymaking process through the Board of Directors.
Review the detailed schedule. We hope to see you there!