Workers’ Comp Study Reveals Positive Trend for Physician Fees

A new study verifies that the interim changes to North Carolina’s physician fee schedule for workers’ compensation claims in 2013 have had a positive impact on payment. With the more comprehensive updates to the fee schedule that took effect last July, it’s likely the payment trends for treating injured workers will continue to be positive.
The Workers Compensation Research Institute’s study, CompScope™ Medical Benchmarks for North Carolina, 16th Edition, examines medical payments, prices and utilization in North Carolina from 2008 through 2014, and compares them with 16 other states. The information is aimed at helping policymakers and other stakeholders involved in the North Carolina workers’ compensation system identify current cost drivers and emerging trends in payments, prices and utilization of medical services among nonhospital and hospital providers. Read the study, which will only be available free of charge until next Thursday, Oct. 29, 2015.
The data revealed that the interim fee change for evaluation and management (office visits) and physical medicine, which took effect in 2013, had a dramatic impact on reimbursement for treating workers’ comp patients.
In July of this year, a more comprehensive change to the North Carolina physician fee schedule took effect as the result of lengthy and intense negotiations with multiple medical specialties as well as the business community and other stakeholders. The North Carolina Medical Society (NCMS) through its Workers’ Comp Task Force and the efforts of NCMS Associate General Counsel Conor Brockett were instrumental in bringing about these positive changes. Watch a video about this process.
Until this change, North Carolina’s workers’ comp physician fee schedule had not been updated in 20 years, placing us near the bottom nationally among states with such fee schedules. This study confirms that North Carolina is moving up the ranks when it comes to physician reimbursement for treating workers’ comp patients.
“The report is useful for identifying where medical costs and care patterns may be changing,” said Ramona Tanabe, executive vice president and counsel for WCRI. “It also helps identify where medical payments per claim or utilization may differ from other states. In addition, where there may be concerns about restrictions on access to care, the study can help identify potential underutilization of medical services.”


Time is Running Out for Informal Review of 2016 Value Modifier

If you are in a practice with 10 or more eligible providers subject to the 2016 Value Modifier, which will apply to the Medicare Physician Fee Schedule for 2016, you may want to request an informal review of your value modifier determination before Nov. 9.  If you think there is an error in the calculation, this is your opportunity to request a correction.
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.
Groups and solo practitioners are identified in the QRURs by their Taxpayer Identification Number (TIN).  The QRURs are also  available for groups and solo practitioners that participated in the Medicare Shared Savings Program, the Pioneer Accountable Care Organization (ACO) Model, or the Comprehensive Primary Care initiative in 2014, and to those TINs consisting only of non-physician eligible professional (EPs).
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).
Also, next Wednesday, Oct. 28, from 2 – 3 p.m., The Centers for Medicare & Medicaid Services (CMS) will hold the second session of a three-part Virtual Office Hours series titled “2015 PQRS Reporting Measures Series (Session 2 of 3): Measures Overview.” Topics to be discussed in this session include an overview of the measures, and live walkthroughs of the 2015 PQRS Measures List and the 2015 PQRS Individual Claims/Registry Measure Specification Supporting Documents.
This PQRS Virtual Office Hours session will allow stakeholders an opportunity to ask a CMS representative questions about how to get started with quality measures for 2015 PQRS reporting. To participate in this session, please register here.
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.


No News Is Good News on ICD-10

Nearly three weeks after the transition to ICD-10, no major glitches have been identified.
At the end of last week, NCTracks was reporting that a third or more of the claims submitted have been ICD-10 and most have adjudicated successfully. No major system issues have been found, although a few issues affecting limited groups of providers or services have been identified and have either been resolved or the resolution is underway. For details, see the Issues List posted under Quick Links on the Provider Portal home page and the Announcements posted on the same page.
For issues involving Medicare claims, the Centers for Medicare and Medicaid Services (CMS) offers these steps:

  • Step 1: Find resources on our CMS ICD-10 website and Road to 10 online tool.
  • Step 2: Contact your MAC for Medicare claims questions. Your MAC is your first line for Medicare claims help. MACs cannot respond to questions about Medicaid or commercial health plans. If you have a Medicaid claim question contact your state Medicaid agency. If you have a commercial or private health plan claim question, please contact your health plan directly. The new ICD-10 Resource Guide and Contact List gives MAC and Medicaid contact info organized by state.
  • Step 3: Contact the ICD-10 Ombudsman for questions. The ICD-10 Ombudsman is an impartial advocate with a dedicated team of experts to answer your questions. Responses will typically be sent within 3 business days of receipt.

CMS maintains that help is available if you have problems with ICD-10.


Issues Remain with the Latest Meaningful Use Rule

From AMA Reports
As outlined in the last North Carolina Medical Society (NCMS) Bulletin, on Oct. 6, 2015, the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) released a series of final rules on the Meaningful Use (MU) program. These rules outline the program requirements for a Modified Stage 2, Stage 3 and a new edition of certified technology.
The AMA advocated for many of the changes adopted in the Modifications rule (modified MU Stage 2, program years 2015-2017) but opposed finalizing Stage 3 due to a need to first assess the changes made to Stage 2 and a lack of alignment with the new Merit-Based Incentive Payment System (MIPS).
The AMA believes CMS made several immediate improvements in the Modifications rule, including:

  • A shortened 2015 reporting period (from a full calendar year to any 90 consecutive days in 2015);
  • Overall reduced number of measures;
  • Reduced measure threshold for the View, Download or Transmit requirement (from 5 percent to just one patient in 2015 and 2016); and
  • Reduced measure threshold for Secure Messaging (from 5 percent to simply having the capability in 2015 and one patient in 2016).

Given the lateness of the modifications rule, it is very difficult to educate physicians on the changes. In addition, the Administration increased the requirements for the Public Health and Clinical Data Registry Reporting Objective. A new requirement at this point in 2015 makes it extremely difficult for physicians to be successful. The AMA raised concerns with this objective to senior Administration officials, and they have indicated they will address the issue, though at this point it is unclear how that would occur.
While CMS did issue a final Stage 3 regulation, the agency is allowing for a 60-day comment period to hear feedback on how Stage 3 can better align with MIPS and alternative payment models. The agency made relatively few changes in the final Stage 3 regulation from the proposed regulation. Overall, publishing of the Stage 3 final rule signals to vendors that these are the requirements for the program, and they may begin developing their systems to meet these standards.
With respect to Stage 3, these requirements will be optional in 2017 and required for all participants beginning in 2018. CMS finalized increased threshold requirements for many of the measures that are well-beyond the previous Stage 2 levels. The rule also adds new requirements related to patient-generated data and the use of “app” technology, which may be overly ambitious given the state of current technology. Despite the 60-day comment period, the AMA has tremendous concerns with the final MU Stage 3. We will intensify our efforts to engage lawmakers and stakeholders to reset the direction of the Meaningful Use program.
The Administration also finalized the 2015 certification regulation. As a result of the release of this rule new or upgraded EHRs will be required for Stage 3 participation. ONC did make improvements in the final Certification regulation, including: price transparency and in-field testing. Yet, the AMA remains concerned additional requirements in the Certification regulation may divert attention away from solving usability and interoperability challenges.
If you’d like to learn more from CMS about the final rule, they have posted the presentation and recording from the Oct. 8 webinar titled , ”EHR Incentive Programs Final Rule Overview and What You Need to Know for 2015,” to the 2015 Program Requirements and eHealth events webpages.
More information and resources about new requirements for participation in the EHR Incentive Programs is available on the 2015 Program Requirements webpage of the CMS EHR Website.
Also, Terri Gonzalez, the North Carolina Medical Society Foundation's Director of Practice Improvement will be leading a webinar on the final rule and the 2015 Meaningful Use Attestation Requirements on Nov. 12 from noon to 1 p.m. 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.


Dr. Terrell Appointed to High-Level Payment Advisory Committee

Grace-Terrell-thumb-227x250Grace Terrell, MD, MMM, has been selected as a member of the Physician-Focused Payment Model Technical Advisory Committee, a high level committee created by the SGR repeal legislation to advise the US Department of Health and Human Services on alternative payments models.
Dr. Terrell is a long-time North Carolina Medical Society (NCMS) member, an internist and President and CEO of Cornerstone Health Care in High Point, a multi-specialty group of more than 375 physicians and advanced practice providers providing care in central North Carolina. She also serves as President and CEO of CHESS, a population health management company that focuses on helping health systems transition to value-based medicine. She has been highly involved with helping the NCMS provide guidance and resources to our members on alternative payment models and the move to a value-based health care system.
The US Comptroller General appointed the 11 members of the Physician-Focused Payment Model Technical Advisory Committee, which will provide comments and recommendations to the Secretary of Health and Human Services on physician payment models.
“This committee will be a critical source of information and advice for the Secretary of Health and Human Services as the department considers new payment approaches for Medicare physician services,” said Gene L. Dodaro, US Comptroller General and head of the US General Accountability Office (GAO). “We were extremely impressed by the caliber of the nominations received for the new committee, and it is with great pleasure that I announce today’s appointees.”
The terms of the committee members are intended to be staggered, with the first set of appointments for terms of 1, 2, or 3 years. Committee members may be appointed for subsequent 3-year terms.
Congratulations Dr. Terrell!


Build a Culture of Quality in Your Practice / Apply by Feb. 17

Enroll your team today to be part of an innovative 12-month program from the North Carolina Medical Society (NCMS) Foundation designed to help you build a culture of quality in your practice. Applications are due by February 17, 2016. Learn more here.
Are you prepared to be paid based on the ‘quality’ of services you provide your patients? Do you even know what that means? If you’re unsure, and perhaps perplexed, anxious, frustrated or even a little angry about the changes taking place in our health care system, you’re not alone. That is why the NCMS Foundation, in conjunction with the North Carolina Quality Center, has developed CQU (short for Clinical Quality University). CQU will help you understand exactly what this ‘move to quality’ means, and give you the necessary tools to lead and succeed in this new environment.


New Benefits Available at the NCMS Marketplace

f69c92cd9a28fa3ae89bb533d3f67658The North Carolina Medical Society (NCMS) is pleased to announce Ponce D. Moody Funding has become a new gold level partner in our member benefit Marketplace.
Ponce D. Moody Funding offers NCMS members Commercial Real Estate Financing and Medical Accounts Receivable Funding.
Reese Consulting Group, a Raleigh-based consulting and risk management firm established to provide innovative and comprehensive insurance solutions for the health care industry, is the latest bronze level partner to join our member benefits Marketplace.
Reese Consulting Group offers NCMS members a complementary premium and terms analysis of all commercial property and casualty lines of insurance.  They specialize in Medical Malpractice premium rate reduction and optimal policy terms.
These companies are just the latest addition to NCMS’ Marketplace, which provides a comprehensive listing of vendor partners offering services in areas of most use to you and your practice. Our Marketplace website provides an easily navigated, tiered vendor system for easy comparison as well as the ability to search by specialty.
We hope you take advantage of this valuable member benefit and watch the Bulletin and visit the site often as new partners will be added frequently.


NCMS Plan Offers Employee Wellness Resources and Information

The NCMS Plan continues to successfully infuse healthful habits into the culture of NCMS Plan practices through a variety of resources. This helpful article, “Often Ignored: Healthcare Employees' Well-Being,”  highlights the special opportunities and challenges that come with empowering those involved in the health care system to move more, eat mindfully and maintain a high quality of life.
A few noteworthy highlights:

  • Health care workers are notorious for neglecting their own care and not taking time for their own well-being.
  • Health care workers must be able to lead patients by example.
  • Staff well-being drives significant organizational outcomes.
  • Helping employees thrive in all elements of well-being is key.
  • A "care for the health care worker" approach is essential within health care organizations to give workers the energy, focus and adaptability they need to come to work ready to be their best every day.
  • Health care workers with high well-being are more likely to be resilient and recover quickly from stress, important qualities to possess when overseeing the lives and welfare of others.
  • Medical professionals who are thriving in three or more elements are also two times less likely to look for a new job than their counterparts with lower well-being. Both of these findings are significant, because attendance and retention are crucial components of proper patient care, patient satisfaction, correct staffing coverage and reduced expenses.

To learn more about how to encourage a healthy lifestyle, be sure to attend “Mastering the Art of Behavior Change” at the NCMS Annual Meeting on Friday, Oct. 23, 2015 at 1 p.m. The NCMS Plan and Medical Mutual are sponsoring the session, which features Laura Putnam, the author of “Workplace Wellness That Works” and CEO of Motion Infusion, a well-being training and consulting firm that provides creative solutions in the areas of engagement, behavior change, human performance, and building healthier, happier and more innovative organizations.


Learning Opportunities

TODAY -- The North Carolina Medical Board will host a roundtable titled “Switching Gears: Longevity in Practice” on Wednesday, Oct. 21 from 4 to 6 p.m. at the Board’s offices, 1203 Front St., Raleigh. As medical practitioners age, they may want, or need, to make changes to the way they practice medicine. The longevity roundtable will bring together stakeholders to explore ways to support licensees in fulfilling their goals for career longevity and, perhaps, to explore ways to assist licensees in making an appropriate determination of their career longevity goals. Keynote Speaker: Thomas M. Hess, Ph.D., North Carolina State University Distinguished Professor of Psychology. From 3:30 to 4 p.m. there will be a light reception.


Palmetto GBA is offering two free Medicare Part B Traveling 10 Workshops Oct. 26 and 27, at the Palmetto GBA Government Programs Complex (GPC) located in Columbia, South Carolina from 10 a.m. to 3 p.m. These workshops will offer insight on reducing overall claim error rate and provide strategies for ensuring claims are processed correctly the first time. These workshops will feature a presentation from one of Palmetto GBA's Medical Directors concerning ICD-10, detailed information on the top errors and how to prevent and resolve them and clinical information focused on how to reduce your medical review denials. Additional details and register for event.


The Centers for Medicare & Medicaid Services (CMS) will hold the second session of a three-part Virtual Office Hours series titled “2015 PQRS Reporting Measures Series (Session 2 of 3): Measures Overview”, on Wednesday, Oct. 28, 2015 from 2 – 3 p.m. Topics to be discussed in this session include an overview of the measures, and live walkthroughs of the 2015 PQRS Measures List and the 2015 PQRS Individual Claims/Registry Measure Specification Supporting Documents.
This PQRS Virtual Office Hours session will allow stakeholders an opportunity to ask a CMS representative questions about how to get started with quality measures for 2015 PQRS reporting. To participate in this session, please register here.


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


Legislative Session Ends With a Last Minute Flurry of Activity

The seemingly endless North Carolina Legislative Session finally came to a close last Wednesday – the longest session since 2001. Watch this video to hear what North Carolina Medical Society (NCMS) CEO Robert W. Seligson and NCMS Director of Legislative Relations Chip Baggett had to say at the conclusion of the session.
Over the last nine plus months, legislators established the framework for Medicaid reform; deferred  various scope of practice bills and CON legislation to next session; enacted the Jim Fulghum Teen Skin Cancer Prevention Act and, in the final hours, passed a bill (SB119) containing a wide variety of provisions -- some of which are good news for you and your practice.
For instance, for years we have been trying to change the requirement to pay a $100 credentialing fee to see Medicaid patients every three years.  While we were not able to eliminate the fee, we were able to move the re-credentialing timeline to re-credential every five years instead of the current requirement of every three years.  This puts Medicaid re-credentialing in-line with Medicare and should prove to be some relief and more predictable. This change can be found on page 39, Section 87.5, of the legislation.
Additionally, the bill clarifies the transfer of the Health Information Exchange (HIE) to the successor exchange (pages 37-39 in Section 86.5(a) of the bill).  The change requires the state Chief Information Officer (CIO) to “negotiate and enter into or amend a contract for services with an effective date of no later than 30 days from receipt of the transferred funds.”  This should help overcome any resistance or delay tactics we may encounter in the transition.
Finally, Graduate Medical Education (GME) money was preserved. The provision (Section 88 on page 39 of the bill) extends the practice of reimbursing GME as an allowable Medicaid expense. A proposal to end this practice without any alternative solution for funding primary care and specialty residency slots prompted extensive debate this year. This final provision ensures the continuation of those opportunities for the next budget cycle with some limitations.
We currently are making a more comprehensive assessment of all the bills in play this year, and despite the quick turnaround due to the lengthy session, we plan to have our Legislative Summary ready in time for our Annual Meeting on Oct. 23-24. Hope to see you then!


ICD-10’s Debut Is Quiet, But Stay Tuned

After years of anxiety and delays, ICD-10 officially became the diagnostic code set of the land on Thursday, Oct. 1. The debut brought little disruption to business as usual last week, but as claims are filed and reviewed, the coming weeks may see an uptick in delays or denials.
The North Carolina Medical Society (NCMS) has compiled a list of resources on our website to help members troubleshoot any problems they may encounter. Our Solution Center also is standing by to help. You can contact Belinda McKoy, our Solution Center coordinator, at 919-833-3836 x142 or email her at [email protected] if you have an ICD-10 issue.


CMS Releases Updated Meaningful Use Rule

The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) yesterday released final rules that simplify requirements providers must meet in order to qualify for Medicare and Medicaid electronic health record (EHR) incentive payments and avoid downward payment adjustments under the Medicare EHR Incentive Program.
The new rule changes the Medicare and Medicaid EHR Incentive Programs reporting period in 2015 to any consecutive 90-day period in the calendar year. Other changes of note include lower thresholds for patients to view, download or transmit their health information, and for secure messaging in order for a practice to achieve meaningful use.
The North Carolina Medical Society (NCMS) staff experts currently are reviewing the 752-page rule. Watch the Bulletin and our website for updates.
A 60-day public comment period on the rule will allow CMS to gather additional feedback on the EHR Incentive Programs going forward, in particular with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which established the Merit-based Incentive Payment System (MIPS). Achieving meaningful use will be a component of the new MIPS program.
The ONC rule finalizes a new edition of certification criteria and modifies the ONC Health IT Certification Program to make it open and accessible to more types of health IT and health IT that supports various care and practice settings.
Also, CMS is holding a webinar titled, “EHR Incentive Programs Final Rule Overview & What You Need to Know for 2015,” to learn more about the recently released Medicare and Medicaid EHR Incentive Programs Final Rule, tomorrow, Thursday, Oct. 8, from noon to 1 p.m. Space is limited. Register now to secure your spot for this webinar. If you are unable to join, a copy of the presentation will be posted on the CMS Events page of the eHealth website following the event.
Read the CMS rule.
Read the ONC rule.
Read the CMS Fact sheet.
 
 


Thank your PA!

10568826_10154495836310078_7050077312771407637_nThis is national Physician Assistant Week, Oct. 6-12, a time to recognize physician assistants (PAs) and the important role they play on the health care team. To all our North Carolina Medical Society (NCMS) PA members – thank you! We appreciate you this week and throughout the year.
Be sure to thank your PA!


Fair Medical Audits Act Gaining Momentum

US Representatives David Rouzer, (R-NC), and Mark Meadows, (R-NC) have signed on as co-sponsors to HR2568, The Fair Medical Audits Act of 2015. This legislation originally was filed in June by Rep. George Holding (R-NC) and seeks to reform the RAC audit process – something the North Carolina Medical Society (NCMS) along with the Physicians Advocacy Institute (PAI) has long been advocating for in Washington, D.C. Currently, we are working to get the entire North Carolina Congressional Delegation to become co-sponsors. As of today, there are 17 co-sponsors of the bill including the three representatives from North Carolina. Please encourage your representative to sign on.
“We are grateful to Rep. Rouzer and Rep. Meadows for their support of this important bill,” said NCMS CEO Robert W. Seligson. “We have been working for years to improve the flawed and unfair process that plagues the current Medicare audit program. This legislation will address the concerns of physicians in North Carolina and nationwide.”
The NCMS has been integrally involved in pushing for this legislation over the years, and looks forward to supporting its passage. To highlight the issue of fairness and transparency in the RAC audit process, the NCMS profiled one practice in New Bern that was devastated by the current system in a documentary titled “Guilty Until Proven Innocent: When Medicare Audits Cause Casualties.” Watch it now.
Currently, Medicare pays recovery audit contractors or “RACs” on a contingency basis to find overpayments to health care providers, providing these contractors with undue monetary incentives to audit doctors. This legislation would establish incentives for RACs to make more accurate audit findings and increase educational efforts to help physicians avoid common mistakes.
Watch future Bulletins for updates on the progress of this important legislation as well as a similar effort in the US Senate led by Sen. Richard Burr (R-NC).


NCMS Closely Monitoring Proposed Health Insurance Mergers

The proposed mergers between health insurance giants Aetna and Humana and Anthem and Cigna have been much in the news lately as company representatives have appeared before the House Judiciary Committee and were sharply questioned by committee members on what the impact of the mergers would mean to doctors and patients.
The North Carolina Medical Society (NCMS) along with our national partners, The Physicians Foundation, PAI and the American Medical Association (AMA) are investigating a variety of avenues to address our members’ concerns over this merger and the resulting concentration of market share in the health insurance industry.  Watch the Bulletin and our website for updates on this matter.
The mergers are under review by the Justice Department’s anti-trust division. While Congress has no role in the decision over whether to allow the mergers, lawmakers can try to influence Justice Department officials and rally public opinion.
The AMA recently released a study of the issues surrounding the merger. In written testimony to the committee, AMA President-elect Andrew Gurman said “the AMA's analysis shows there has been a near total collapse of competition among health insurers. Health insurance markets are already mostly highly concentrated, meaning that typically there are few sellers and they possess significant market shares. Thus, most health insurance markets are no longer competitive, while the national market in which large employers purchase coverage is also shrinking.”
A recent blog post in Forbes by The Physicians Foundation President Walker Ray, MD, and the Foundation’s first president and former Connecticut State Medical Society Executive Director Tim Norbeck outlines the concerns physicians and consumers have with the mergers. Read the post.


AMA Resources Help to Understand New Payment Model in Commercial Payer Contracts

Commercial payers are increasingly pursuing contracts with physicians based on new payment models, such as pay-for-performance and bundled or episode-based payment. These alternative payment models can rely on both cost and quality metrics to determine payment rates for physicians. Navigating the assortment of new payer contracts can be made easier by gaining an understanding of payer agreements and the portions of those agreements that should be prioritized and can be negotiated.
The American Medical Association (AMA), in continuing its work to help physicians adapt to and succeed in the new world of alternative payment models, has developed two new resources that explain key issues physicians should consider when evaluating bundled or episode-based and pay-for-performance agreements.
Each of these documents outlines important considerations, including:

  • Summary of payment model
  • Contractual issues, including model language
  • Guidelines for evaluating risk and success

These documents are part of a continuum of resources the AMA is developing to ensure physicians are well equipped to succeed in our evolving health care environment. AMA membership is required in order to access these resources.


Remember to Have Some “Quality Time with the NCMS”

Our “Quality Time with the NCMS” webpage is frequently updated by our experts with items like the latest information and analysis of the newly updated Meaningful Use rule and the Physician Compare website, which continues to add publicly displayed information about physicians who participate in the Medicare program. Keep up with this rapidly evolving and complex new frontier in health care by logging on to “Quality Time with the NCMS” today. You simply need to register on our website.


NCMS Part of the Race to Quit

NC Quits_Press Conference Images_Dr Davis_Quote 2 (002)The North Carolina Medical Society (NCMS) is a partner in this week’s Race to Quit NC, a new campaign centered on awareness events being held all week across the state connecting tobacco users with the tools and resources they need to quit. The North Carolina Alliance for Health, QuitLineNC, and more than 50 other statewide patient and physician groups, health care systems, local health leaders and nonprofits launched “Race to Quit, NC.”
As part of the campaign kick-off, an editorial appeared yesterday in the Raleigh News & Observer, outlining the importance of helping smokers quit and the role Race to Quit can play.
Get involved by tweeting your thoughts on why quitting smoking is important to your patients or share your personal story of quitting at #WhyNCQuits or #RaceToQuitNC.
The Affordable Care Act requires all preventive services recommended by the U.S. Preventive Services Task Force to be covered at no cost through most health insurance plans. That task force last month recommended that Americans have access to a comprehensive quit-smoking benefit – all seven FDA-approved medications and all three forms of counseling.
To help your patients, here is a list of Race to Quit, NC partners and their quit-smoking resources.


Docs on Call Help 205 Callers

IMG_0014Thank you to the doctors who volunteered to field calls from WITN viewers in the Greenville area the evening of Sept. 30 for the annual Doctors On Call event. The two-hour phone bank staffed with volunteer physicians from a variety of specialties is sponsored by the North Carolina Medical Society and the Pitt County Medical Society. This year, the volunteers answered 205 calls from viewers with a wide array of health questions and symptoms. The majority of callers were over age 50.
Watch an interview with Paul Cunningham, MD, Dean of the Brody School of Medicine, NCMS Board Member and a 2015 Doctors On Call volunteer.
Watch an interview with Timothy Reeder, MD, of Greenville, an emergency medicine physician, an NCMS Board member and a 2015 Doctors on Call volunteer.
Watch an interview with Cindy Ballenger, MD, a radiation oncologist in Greenville, and a 2015 Doctors On Call volunteer.
Watch an interview with Anjali Malik, MD, a radiologist from Greenville and a 2015 Doctors on Call volunteer.


Help Your Patients Save On Prescriptions This Flu Season

The North Carolina Drug Card, a benefit provided through the North Medical Society (NCMS) is free and offers significant discounts on prescription medication. Cards are available to distribute to your patients or they can be accessed online. Learn more.


Coastal Carolina Receives Top National Ranking for Cancer Screening

For the second year, Coastal Carolina Health Care (CCHC), P.A.’s Accountable Care Organization has received the nation’s top ranking for cancer screening, quality and cost savings for patients. The group received the honor in August when the Centers for Medicare and Medicaid Services (CMS) publically released quality and cost results for 333 Accountable Care Organizations around the country.
“I think it was because of our dedicated and motivated team of doctors and staff and everybody working together to make sure much needed screening is being done on our patients,” Stephen W. Nuckolls, CEO of CCHC, told the local media. Approximately 6,500 Medicare patients were screened last year for breast cancer and about 6,500 patients for colorectal cancer through CCHC.
Congratulations Coastal Carolina! Read more in the New Bern Sun Journal.


Maureen Murphy, MD, Is Nation’s Family Physician of the Year

profile-maureen-murphyLongtime North Carolina Medical Society (NCMS) member Maureen Murphy, MD, of Concord was awarded the American Academy of Family Physicians’ highest honor – Family Physician of the Year – at their annual meeting last week in Denver. The award honors one outstanding family physician nationwide who provides patients with compassionate, comprehensive care, and serves as a role model in his or her community and to other health professionals.
In March, Dr. Murphy was one of 10 North Carolina Doctor of the Year finalists as part of the NC Doctors’ Day celebration. She also is active in the North Carolina Academy of Family Physicians recently serving a term as their president.
Murphy's lasting legacy to family medicine centers on her gift as a talented teacher and mentor to medical students and the next generation of family physicians. Following her residency at the Duke University Family Medicine Residency Program she became a clinical instructor at the East Carolina School of Medicine Family Practice Center in Greenville. Murphy was in private practice from 1990 to 2011. She founded an independent, family medicine practice in Gastonia and became a leading advocate for both patients and physicians at Gaston Memorial Hospital, where she established a family medicine department and delivered hundreds of babies.
Murphy's success in Gastonia led her to the small mountain community of Sparta where she pursued her dream of caring for the medically underserved.  In 2011, Murphy's passion for teaching brought her to Cabarrus Family Medicine in Concord, where she continues mentoring the next generation of family physicians and providing care to patients of all ages. She remains very involved as a preceptor for medical schools both in and outside of North Carolina.
Congratulations, Dr. Murphy!


Wake Internal Medicine Named NCMGMA’s 2015 NC Practice of the Year

header-logoWake Internal Medicine Consultants was named the 2015 Practice of the Year at the North Carolina Medical Group Management Association’s (NCMGMA) Leadership Summit, held September 16-18 at the Pinehurst Resort in Pinehurst, NC. The Practice of the Year Award recognizes a medical group practice that makes significant contributions to its community, patients and staff through volunteer work, fundraisers, staff wellness programs, community clean ups and community screenings and education.
“Wake Internal Medicine Consultants genuinely characterizes all that this award stands for -- their commitment to their community and patients, which includes an outstanding Chronic Care Management initiative which serves to aid their sickest and neediest patients,” said Laura Sanborn, NCMGMA’s 2011-12 President and current Governance Committee Chair, on presenting the award. “Additionally, this practice’s desire to educate the community via their blog and outreach initiatives stood out in their submission.”
The Practice of the Year Award, sponsored by First Citizens Bank, provides a $3,000 check to a charity chosen by the award recipient. This year’s funds will be given to the Fill Your Bucket List Foundation which grants the wishes of adults battling cancer in order to make lifelong dreams come true.
Congratulations to Wake Internal Medicine Consultants!


DRB Student Loan Is Gold Level Marketplace Partner

The North Carolina Medical Society (NCMS) is pleased to announce DRB Student Loan has become a new Gold level partner in our Marketplace of services to our members.
DRB Student Loan offers NCMS members low rate student loan refinancing (starting at 1.9 percent variable, 3.5 percent fixed). The easy online application takes only 20 minutes (with no obligation to accept), and the entire process is totally free to the borrower. Better yet, NCMS members receive a $300 bonus when you close a loan with DRB. Refinancing allows you to combine all of your federal and private loans into one low monthly payment, at a much lower interest rate.
DRB is the only lender in the country with a dedicated refinancing program for medical and dental residents/fellows. House officers are able to secure these very low rates, and pay only $100/month all through training. The average medical graduate owing $220,000 stands to save $50,000 or more by refinancing.
To receive your $300 Bonus, you must apply through this link: Click Here to Apply Now
This is just the latest addition to NCMS’ Marketplace, which provides a comprehensive listing of vendors offering services in areas of most use to you and your practice.


TetraSoft Joins NCMS Marketplace

The North Carolina Medical Society (NCMS) is pleased to announce TetraSoft Inc. has become a new bronze level vendor in the NCMS Marketplace of services to benefit our members.
TetraSoft Inc offers NCMS members IT Consulting, Outsourcing, Testing, Product Development and Maintenance services.  These services include unique patented ICD-10 Tool capabilities, which are leveraged in our billing and “Revenue Neutral” tools.  The objectives of our ICD-10 tools are to monitor and report that providers are paid in a “Revenue Neutral” amount for the same services they performed, whether billed in ICD-9 format or the new ICD-10 format.  These services and tools are uniquely developed and affordable for providers of all sizes.  For more information on TertraSoft’s ICD-10 Tools and applications please contact Sunita Eyunni at [email protected].
This is just the latest addition to NCMS’ Marketplace, which provides a comprehensive listing of vendors offering services in areas of most use to you and your practice. The website provides an easily navigated, tiered vendor system for easy comparison as well as the ability to search by specialty.
We hope you take advantage of this valuable member benefit.
Watch the Bulletin and visit the site often as new vendors will be added frequently.
 


Learning Opportunities

The Centers for Medicare and Medicaid Services (CMS) is holding a webinar titled, “EHR Incentive Programs Final Rule Overview & What You Need to Know for 2015,” to learn more about the recently released Medicare and Medicaid EHR Incentive Programs Final Rule, tomorrow, Thursday, Oct. 8, from noon to 1 p.m. Space is limited. Register now to secure your spot for this webinar. If you are unable to join, a copy of the presentation will be posted on the CMS Events page of the eHealth website following the event.


The North Carolina Industrial Commission will hold its 20th Annual North Carolina Workers' Compensation Educational Conference on October 14-16, 2015 at the Raleigh Convention Center. The conference provides a valuable opportunity for professionals to share information on current issues impacting the workers' compensation arena. View the conference brochure, which includes the conference agenda and registration information. For more information, please contact Jeanne Bush or Eric Oxfeld at the International Workers' Compensation Foundation office by telephone at (386) 677-0041, fax at (386) 677-0155, or e-mail at [email protected].


The Centers for Medicare & Medicaid Services (CMS) is offering a Virtual Office Hours series on the 2015 Physician Quality Reporting System (PQRS) quality measures. The series will include three separate sessions that will cover topics related to PQRS measures, such as explaining what a quality measure is, measures-related resources and next steps for participation in 2015 PQRS.
The first session, titled “2015 PQRS Reporting: Introduction to Quality Measure Reporting,” will be Wednesday, Oct. 14, from 2 – 3 p.m. Dates and times for other sessions will be announced soon.
This PQRS Virtual Office Hours session will allow stakeholders an opportunity to ask a CMS representative questions about how to get started with quality measures for 2015 PQRS reporting. To participate in this session, please register here.


“ICD-10: Denials and How to Work the Mounting Backlog,” a webinar sponsored by the North Carolina Medical Society Foundation in cooperation with the North Carolina Medical Group Managers, on Oct. 21, noon to 1 p.m. Featuring Amy Poplin Dunatov, MPH, FACMPE, CCS-P, ICDCM-CT. On the day of this webinar, ICD-10 will have been live for 20 days. How is your practice doing? Join us for this session to learn alternative strategies for denials management and how to be proactive in overall denials reduction to decrease expenses and speed up cash flow. Register here.


The North Carolina Medical Board will host a roundtable titled “Switching Gears: Longevity in Practice” on Wednesday, Oct. 21 from 4 to 6 p.m. at the Board’s offices, 1203 Front St., Raleigh. As medical practitioners age, they may want, or need, to make changes to the way they practice medicine. The longevity roundtable will bring together stakeholders to explore ways to support licensees in fulfilling their goals for career longevity and, perhaps, to explore ways to assist licensees in making an appropriate determination of their career longevity goals. Keynote Speaker: Thomas M. Hess, Ph.D., North Carolina State University Distinguished Professor of Psychology. From 3:30 to 4 p.m. there will be a light reception.


Palmetto GBA is offering two free Medicare Part B Traveling 10 Workshops Oct. 26 and 27, at the Palmetto GBA Government Programs Complex (GPC) located in Columbia, South Carolina from 10 a.m. to 3 p.m. These workshops will offer insight on reducing overall claim error rate and provide strategies for ensuring claims are processed correctly the first time. These workshops will feature a presentation from one of Palmetto GBA's Medical Directors concerning ICD-10, detailed information on the top errors and how to prevent and resolve them and clinical information focused on how to reduce your medical review denials. Additional details and register for event.


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.


NCTracks Training Opportunities in October: Registration is now open for several instructor-led training courses in addition to the ICD-10 courses previously announced.
Friday, Oct. 9 - 9 a.m. to noon (WebEx) - ES User Role_Abbreviated MCR_Upload Documents. This course will guide providers through the enhancements to the provider enrollment application processes.   This course is taught via WebEx and can be attended remotely from any location with a telephone, computer and internet connection.
Wednesday, Oct. 14 - 9 to 11 a.m. (WebEx) - New Office Administrator. This course shows authorized users the process for changing the current Office Administrator (OA) to a new Office Administrator for an Individual Provider or Organization with a National Provider Identification (NPI) number or Atypical Provider Number. This course is taught via WebEx and can be attended remotely from any location with a telephone, computer and internet connection.
Wednesday, Oct. 14 - 1 to 4 p.m. (WebEx) - Provider Web Portal Applications Webinar. This course will guide providers through the process of submitting all types of provider applications found on the NCTracks Provider Portal.  This course is taught via WebEx and can be attended remotely from any location with a telephone, computer and internet connection.
Monday, Oct. 19 - 9:30 a.m. to noon - Prior Approval - Medical (Professional). This course 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.
Monday, Oct. 19 - 1 to 4 p.m.  - Submitting a Professional Claim. This course 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.
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


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.
 


What the State's New Budget Means to Health Care in North Carolina

On September 18, Governor McCrory signed the state’s $21.7 billion budget bill, HB 97, into law. There were many provisions related to health care included in the final draft. The North Carolina Medical Society (NCMS) has summarized key health care issues in the budget. Take a look at our summary (PDF), including the budget provisions on Medicaid reform.


What the State's Compromise Medicaid Reform Bill May Mean to Your Practice

On September 17, the legislature released their compromise version of Medicaid reform legislation. The conference report for HB 372, Medicaid Transformation and Reorganization, takes a hybrid approach to reforming the state’s current fee-for-service Medicaid program by allowing both commercial plans and Provider-Led Entities (PLE) to compete for Medicaid business in the state under a fully capitated system. Both the House and Senate have now passed this compromise legislation into law and the medical community now must look forward to the long road of implementation that lies ahead.
The North Carolina Medical Society (NCMS) has advocated since the beginning of the state’s Medicaid reform debate nearly three years ago for physicians to lead reform efforts, rather than relying on the standard corporate managed care solution so many other states have used to address budgeting issues within the program. With the introduction of managed care into the state, we must now focus our efforts on using this transition time to implement value-based, patient-centered care models for Medicaid patients.
“Medicaid reform is challenging, and we understand the difficulty of the decisions legislators faced,” Robert W. Seligson, CEO of the NCMS told the press. “We oppose the General Assembly’s decision to involve corporate managed care in our Medicaid program. Including some of the patient protections we requested such as performance standards based on quality, cost and patient experience is an improvement.
“This is not the end of the Medicaid reform debate,” he said. “We will continue to work with our partners and the state’s leaders on the many decisions that lie ahead to enable the delivery of high value medical care to our state’s most vulnerable citizens.”
Read a detailed summary (PDF) of what this legislation means to our Medicaid program and your practice.


Find Out Now If Your Practice Will Be Penalized in 2016

Have you looked at your Quality and Resource Use Report (QRUR)? If not, now is the time to do so. The QRUR is a free tool provided by the Centers for Medicare & Medicaid Services (CMS) to help physicians and practices better understand their quality and cost information for the year, as well as how their performance compares to that of their peers. This year, the report will also preview whether or not you or your practice can expect a penalty starting in 2016 for not sufficiently providing quality information (PQRS) or poor performance in the Value-Based Payment Modifier (VBPM) in 2014. Access your report.
Review your report now to be sure the information listed for your practice is accurate. If you find issues with the information included in your report, you have until November 9 to submit a request for reconsideration and ask questions about what is listed. Learn more about the review and dispute process here. Don’t miss the November 9th deadline to file your review request! If you request a review, you 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.
Please see CMS’ 2014 Physician Quality Reporting System (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.
To keep up with the growing number of quality initiatives and to better understand what they mean to you and your practice, log on to Quality Time with the NCMS, where the North Carolina Medical Society’s Director of Health Policy Jennifer Gasperini and Director of Practice Improvement Terri Gonzalez post updates and offer resources. Follow the simple directions to register in order to access the valuable information on this blog.
 


CDC Issues New Draft Guidelines for Opioid Prescribing

The Center for Disease Control and Prevention (CDC) released new draft guidelines for opioid prescribing last week. The guidelines aim to provide recommendations for the prescribing of opioid analgesics for adults in primary care settings. Clinical practices addressed in the guidelines include determining when to start or continue opioids for chronic pain outside of end-of-life care; opioid selection, dosage, duration, follow-up, and discontinuation; and assessing the risk and harms of opioid use. Review the guidelines.
Also of note: tomorrow, Thursday, Sept. 24, from 2 to 3 p.m., the CDC is sponsoring a free CME webinar titled, “The Role of Clinicians in Addressing the Opioid Overdose Epidemic.” During this webinar, participants will learn about the drivers of the increases in opioid-related morbidity and mortality and steps clinicians can take to help reverse concerning trends. This webinar is hosted by the CDC Emergency Communication System’s Clinical Outreach and Communication Activity (COCA) Call. Registration is not needed. Call in at 888-469-1370. The passcode is 3791890. Join by Webinar. If you have questions or trouble accessing this COCA Call, please e-mail [email protected]. Call materials (slides, audio, and transcript) will be posted to the webpage a few days after the live call.


It's Here -- ICD-10 Starts Next Week

After many delays and countless admonitions to doctors and practice administrators to prepare, the coding system in this country will transition from ICD-9 to ICD-10 next Thursday, Oct. 1. If your practice is not ready for the change, the North Carolina Medical Society (NCMS) will be hosting the Centers for Medicare & Medicaid Services (CMS) at our Center for Leadership in Medicine tomorrow (Thursday, Sept. 24) for a two hour session to help you and your staff prepare for the changeover. Register here.
CMS has provided an infographic to help you understand where your practice should be at this point and to provide resources for any last minute preparations.
In North Carolina, Medicaid providers have ICD-10 resources available through NCTracks. Access that information.


NCMS Hosts National Expert on Health Care Payment Reform

Harold Miller
Harold Miller

Last week the North Carolina Medical Society (NCMS) welcomed nationally respected health care payment reform expert Harold Miller to the Center for Leadership in Medicine for two full days of events and one-on-one meetings with members, NCMS leadership and staff. Miller is the President and CEO of the Center for Healthcare Quality and Payment Reform, based in Pittsburgh.
On Wednesday, Miller, along with Karen Cannon, MD, the Chief Medical Operations Officer for CHESS, a physician-managed health care services company based in High Point, NC, led a session titled “How to thrive in a value-driven health care system.”  Miller spoke about the larger systemic changes necessary in moving toward value driven health care, while Dr. Cannon addressed the more specific hands-on ways to make the change happen while delivering care to patients.
Download Harold Miller's Presentation "How to Thrive..." (PDF - members only; log in or register as a new user to view).
Throughout the day, Miller had individual meetings with members and staff and in the evening met with the NCMS Board over dinner.
Thursday was another full day in which those involved in health care transformation in North Carolina had an opportunity to learn from Miller’s valuable insights and expertise. He participated in the NC ACO Collaborative meeting that afternoon, and made a presentation at the 2015 Health Care Media Summit. This summit, co-sponsored by the NC Press Association and the NC Association of Broadcasters along with the NCMS, gave media from across the state a chance to learn more about the complexities of health care reform to help inform their reporting.
In a follow up email, Miller commented that he was “impressed by all the good work” the NCMS is doing.


Alliant Offers Mental Health Screening Help for Primary Care Practices

Alliant Quality, the Quality Innovation Network – Quality Improvement Organization (QIN-QIO) for North Carolina is recruiting primary care practitioners to improve identification of depression and alcohol use disorder in Medicare beneficiaries.
Seniors often have multiple medical problems and take many medications. Yet, symptoms of depression can masquerade as somatic complaints. This new assistance program can make patients safer by finding masked depression. Through these efforts, Alliant hopes to increase the annual screening rate for the identification of depression and alcohol use disorders. Learn more about the program and join.


October is Breast Cancer Awareness Month

The North Carolina Drug Card offers discounted prices on many of the drugs used to treat breast cancer. Help your patients access this free benefit by alerting them to this prescription discount program. Download the flyer with more information for your patients here.


Drug Take Back Day is Saturday, Sept. 26

The Drug Enforcement Administration (DEA) nationwide drug take back day will be held this Saturday, Sept. 26. Cities and towns throughout North Carolina are participating in this event, which encourages people to dispose of unneeded, unwanted or expired medications safely. The DEA offers a nationwide collection site finder to locate the disposal site nearest you.


Get a Head Start and Renew Your NCMS Membership Now

Believe it or not, the New Year will be here before you know it. Why not get a head start on those end-of-year activities and renew your North Carolina Medical Society (NCMS) membership now? Renewal notices should be arriving in your mailbox soon, so watch for that mailing. OR, cross NCMS membership renewal off your to-do list right away by renewing online now.


Brown Named Chief Physician Executive at New Hanover Regional

Philip Brown, MD
Philip Brown, MD

Longtime North Carolina Medical Society (NCMS) member, Philip Brown, MD, New Hanover Regional Medical Center’s current Chief of Medical Staff has accepted the position of Chief Physician Executive effective January 1.
In his new role, he will oversee care quality, care transformation and physician leadership within the organization. Brown is former president of the New Hanover-Pender Medical Society and will continue as co-director of the NCMS Foundation’s Kanof Institute for Physician Leadership.
Congratulations Dr. Brown!


First Medical Solutions Joins the NCMS Marketplace

The North Carolina Medical Society (NCMS) is pleased to announce First Medical Solutions is a bronze level vendor in our Marketplace of member benefits.
First Medical Solutions is an award-winning and leading provider of Cloud (EMR/EHR) electronic medical records and practice management software.  First Medical Solutions is pleased to offer NCMS members a 5 percent on-going discount on Electronic Health Records Suite software, their monthly EHR software, online training and many other included perks.
First Medical Cloud Suite is a complete cloud medical software package, which includes:
Scheduling:

  • Multi-site/Multi-Physician Scheduling
  • Automatic health insurance eligibility verification
  • Auto Patient Reminder (Text Message, Email, Automated phone call)

Integrated Electronic Health Records:

  • Integrated Clinical Electronic Laboratory results integration

Integrated Billing Claims:

  • Automatic Billing Claim generation (will generated from the EMR chart)
  • Claims Scrubbing
  • Automatic Claim tracking

Integrated Patient Portal
Practice Business Intelligence Reports
First Medical Solutions has been in the medical software business for over 20 years, and is just the latest addition to NCMS’ Marketplace, which provides a comprehensive listing of vendors offering services in areas of most use to you and your practice. The website provides an easily navigated, tiered vendor system for easy comparison as well as the ability to search by specialty.
We hope you take advantage of this valuable member benefit, and watch the Bulletin and visit the site often as new vendors will be added frequently.


Legislature Unveils Compromise Medicaid Reform Bill

On September 17, the legislature released their compromise version of Medicaid reform legislation. The conference report for HB 372, Medicaid Transformation and Reorganization, takes a hybrid approach to reforming the state’s current fee-for-service Medicaid program by allowing both commercial plans and Provider-Led Entities (PLE) to compete for Medicaid business in the state under a fully capitated system. Review some of the key details of the compromise legislation here and stay tuned for a more thorough analysis in our Bulletin publication on Wednesday. Read our media statement on the bill.
Read the key details of the bill.


Governor McCrory Signs State Budget Into Law

On September 18, the Governor signed the state’s $21.7 billion budget bill, HB 97, into law. Many provisions related to health care are included in the final draft. Take a look at our brief summary of key issues identified by the North Carolina Medical Society (NCMS), and stay tuned for a more detailed synopsis in our Bulletin publication on Wednesday.
Read our Summary.


Medicaid Reform Progress -- Don’t Give Up Now

legislative-buildingAs legislators reach consensus on a state budget, the debate over Medicaid reform has progressed to a point where several big questions appear to have been decided – the state will no longer assume the financial risk for Medicaid and will transfer that risk to a mix of managed care and provider-led entities. This does not mark the end of the battle for a Medicaid system that puts patients at the center and the providers in key leadership roles, but the beginning of another phase in reform.
The North Carolina Medical Society (NCMS) has redoubled its efforts at the legislature, clearly outlining the fundamental provisions needed under the proposed ‘hybrid’ system to preserve the heart of our original, 3-year-old proposal – physician-led, patient-centered care – whether it is through a managed care organization or a physician-led entity. You can read what we, in partnership with other stakeholder organizations, have determined to be the essentials of any Medicaid reform legislation here.
In listening to you, we understand that few physician practices are ready to assume the financial risk of the state’s Medicaid program. But some provider-led entities are ready, and they should be allowed to prove themselves as a viable alternative to managed care. Likewise, the safeguards we want to see in any final legislation will help ensure the managed care organizations abide by the principles of patient-centered care, quality metrics, patient satisfaction and that practicing physicians will have key, decision-making roles in any patient care policies.
The battle underway now is to convince legislators to take other states’ bad experiences with managed care as cautionary tales and use that knowledge to enact legislation to truly protect our most needy and vulnerable patients.
Now is not the time to turn away from this issue, thinking the war on behalf of your Medicaid patients is over. This is an important battle in what likely will be a long series of debates as North Carolina’s mammoth Medicaid system is transformed. Now is the time to take action to make sure legislators understand what is at stake for you and your patients. Send your legislator a message now.
The view from the frontlines – watch NCMS Director of Legislative Relations Chip Baggett explain the status of Medicaid reform.


Health Care Payment and Delivery Reform Expert Visits NCMS

Harold D. Miller
Harold D. Miller

Nationally recognized expert on health care payment and delivery reform, Harold D. Miller, President and CEO of the Center for Healthcare Quality and Payment Reform, will be visiting the North Carolina Medical Society (NCMS) for two days next week to share his expertise and insights. There are several opportunities for you to meet and discuss the issues with Mr. Miller.
On Wednesday, Sept. 16, from 11:30 a.m. until 2 p.m. Mr. Miller will join with Karen Cannon, MD, Chief Medical Operations Officer for CHESS, a physician-managed health care services company based in High Point, NC, to answer the question "How to Thrive in a Value-Driven Health Care System."  Mr. Miller and Dr. Cannon will provide a vision for health care transformation now and into the future and how to thrive in a value-driven environment. The $25 fee for this session includes lunch. Register for this event. The session will be recorded and available for viewing after Sept. 16 if you are unable to make it on Wednesday.
Mr. Miller also is available for individual meetings by appointment. Please contact Belinda McKoy  (919-833-3836 x142) to arrange a time to meet with Mr. Miller on Wednesday, Sept. 16, or Thursday, Sept. 17. He also will be available to speak with you by telephone, if that is more convenient.
Mr. Miller serves as Adjunct Professor of Public Policy and Management at Carnegie Mellon University and has given invited testimony to Congress on how to reform health care payment systems. He has worked with physicians, hospitals, employers and health plans in over 30 states and regions to help them implement win-win-win approaches to improving health care. In previous positions, he served as CEO of the Network for Regional Healthcare Improvement and the Director of the Pennsylvania Governor’s Office of Policy Development.
Don't let this unique opportunity to engage in meaningful dialogue with an expert like Mr. Miller slip away. Register for Wednesday's event or arrange a special meeting today.


We Want Your Input on the NCMS By-Laws Changes

Thank you to all who have posted comments on the proposed by-laws changes unveiled several weeks ago on our website. Your input is crucial to this process, and we welcome your remarks. Please keep them coming.
The overarching goal in eliminating the House of Delegates is to increase direct member participation in the Society by modernizing the process. The proposed by-laws changes accomplish this by:

  • Offering members the opportunity to bring policy or other issues of importance directly to the Board of Directors at any of their meetings. To facilitate participation by members throughout the state, the meetings will be held at least quarterly in areas best suited to enhance member access and involvement.
  • An open forum will be held at the Annual Meeting as another venue for members to bring issues directly to the Board of Directors without the cumbersome delegate credentialing process and formality of the House of Delegates.
  • The Nominating and Leadership Development Committee membership will be augmented to reflect the diversity of the overall membership and to ensure a Board composition representative of the membership-at-large and the component specialty societies.
  • Opening the election of Board members to the entire membership – not just the House of Delegates -- through a secure, electronic voting system.
  • Instituting a referendum process to allow any member, component organization or specialty society to place a question on the election ballot for consideration and vote by the entire membership.

Please review the details for each of these changes in the revised bylaws. Again, the intention is to streamline, modernize and make the process more inclusive of and responsive to the entire NCMS community. Please give us your feedback so we can work to get it right. Truly representative governance of our Society depends on each member taking on the responsibility of being involved and speaking out. Now is your chance to make a difference.
Comment below or review previous comments from members and add your thoughts.>>


NCMS to Host CMS ICD-10 Training

The North Carolina Medical Society (NCMS) will host a free ICD-10 training at the NCMS Center for Leadership in Medicine on Thursday, September 24, from 10a.m. to noon. This is the second such training session the medical society has hosted on behalf of the Centers for Medicare and Medicaid Services (CMS), which will be doing the training. Learn more about the session and register.
And remember, the transition to ICD-10 will occur on Oct. 1 – just 23 days from today.
More information on ICD-10 implementation from NCTracks.
More information on ICD-10 implementation from CMS.


AMA Study: Health Insurance Mergers Would Diminish Competition in Many States

From AMA reports
The combined impact of proposed mergers among four of the nation’s largest health insurance companies would exceed federal antitrust guidelines designed to preserve competition in as many as 97 metropolitan areas within 17 states, according to new special analyses of commercial health insurance markets by the American Medical Association (AMA).
For these locations, the mergers would enhance market power. According to the U.S. Department of Justice, “a merger enhances market power if it is likely to encourage one or more firms to raise price, reduce output, diminish innovation, or otherwise harm customers as a result of diminished competitive constraints or incentives.”
The mergers would also raise significant competitive concerns in additional markets. All told, the two mergers would diminish competition in up to 154 metropolitan areas within 23 states.
“A lack of competition in health insurer markets is not in the best interests of patients or physicians,” said AMA President Steven J. Stack, M.D. “If a health insurer merger is likely to erode competition, employers and patients may be charged higher than competitive premiums, and physicians may be pressured to accept unfair terms that undermine their role as patient advocates and their ability to provide high-quality care. Given these factors, AMA is urging federal and state regulators to carefully review the proposed mergers and use enforcement tools to preserve competition.”
These findings are based on an in-depth analysis of data used to create the newly released 2015 edition of AMA’s Competition in Health Insurance: A Comprehensive Study of U.S. Markets, which offers the largest and most complete picture of competition in health insurance markets for 388 metropolitan areas, as well as all 50 states and the District of Columbia. The study is based on 2013 data captured from commercial enrollment in fully and self-insured plans, and includes participation in consumer-driven health plans.
Read The New York Times’ take on the AMA study.


Physician Consortium for Performance Improvement Evolves To Enhance Effectiveness

From AMA Reports
The American Medical Association (AMA) recently announced the Physician Consortium for Performance Improvement® (PCPI®) has evolved into a new PCPI® Foundation as an independent, not-for-profit foundation.
The AMA convened the original PCPI 15 years ago with a goal of enhancing quality and patient safety and fostering accountability with a membership made up of state and specialty medical societies and health care professional organizations. The North Carolina Medical Society (NCMS) has been and continues to be involved with PCPI. Now, PCPI will continue pursuing its goals with a larger, more diverse membership to include consumers, employers, government agencies, group practices, health information technology organizations, health plans, health systems, hospitals, licensing, accrediting and credentialing organizations, outpatient clinics, patients, pharmacies and quality improvement organizations.
The PCPI has created more than 340 performance measures, many of which have been adopted by federal and other quality reporting programs, and hopes to expand its leadership role in measurement science and performance measure development. Key strategic activities related to measurement science, quality improvement and registries will continue, including the work of the National Quality Registry Network (NQRN®). A multi-stakeholder coalition of organizations and individuals committed to increasing the use of clinical registries, the NQRN is just one example of the type of anchor programs now helping to propel the new PCPI forward.


NC Health Department Issues Guidance on Avian Flu

While no cases of highly pathogenic avian influenza (HPAI) have been detected in domestic or wild birds in North Carolina, the N.C. Department of Health and Human Services, Communicable Disease Branch is disseminating guidance in the event HPAI-infected birds might be identified in the state, or that providers in North Carolina are asked to provide care for people who are exposed to HPAI-infected birds in other states.
The Division of Public Health is continuing to work with the North Carolina Department of Agriculture and Consumer Services to prepare for the possible introduction of HPAI into the state. Recommendations are likely to change as new information becomes available. Updated information and guidance are available from the CDC at http://www.cdc.gov/flu/avianflu/h5 and from the North Carolina Department of Agriculture and Consumer Services at http://www.ncagr.gov/avianflu.