NCMS Responsible for Popular World War II Medical Car Display

Dr. Ward recounts how NCMS donated the hospital car at his home in Lumberton.
Dr. Ward recounts how NCMS donated the hospital car at his home in Lumberton.

In the late 1970s, few people would have guessed the significance of the railroad car sitting in disrepair on a downtown Raleigh street corner. But a few decades earlier, hundreds of wounded World War II soldiers returning stateside certainly would have been happy to see Hospital Unit Car No. 89480.
In its prime, the car traveled between New York City and Charlotte, welcoming home soldiers when they arrived off the boats and providing care, including basic surgeries, while transporting them to permanent hospital facilities. It also was shipped overseas to serve troops during the Korean War in the early 1950s.
After the war, the car spent a brief stint as an exhibit in Promontory, Utah. In 1977, it was acquired by Raleigh’s Mutual Distributing Company, which planned to turn it into a lounge—until then-North Carolina Medical Society (NCMS) President Dr. D.E. Ward helped the train car take a different track.
In 1979, Ward received a call from Allan Paul, of the North Carolina Department of Cultural Resources, who had stumbled across the car when looking for state railroad history artifacts to add to the collection of the North Carolina Transportation Museum in Spencer.
“It was an untold story and North Carolina had quite a connection to the World War II hospital trains that operated across the United States,” Paul said, explaining that the car had been staffed by North Carolina medical personnel. “It was an interesting, modern approach to dealing with the wounded.”
Paul reached out to Ward and the NCMS for the $5,000 needed to buy the car. Ward’s immediate reaction was to get it however he could.
The car held a special significance for Ward, a history buff and World War II veteran who served two years in the United States Navy as the same time as his brother, who was killed on the last day of the war.
After the NCMS executive committee clarified that membership money couldn’t be used for the car’s purchase, Ward decided to reach out directly to the members by putting a notice in the NCMS bulletin asking for donations.
“I put a picture of the car in there and said, the medical society needs to buy it, send your money to the medical society and let’s buy it,” Ward said. “I thought it would be natural for the doctors in the medical society to buy the car and give it to the museum.”
Thanks to lots of small donations, the $5,000 was raised in just one month.
“They really came through,” Ward said. “They thought it was a good project, and it’s turned out great.”
The car is still on display in the transportation museum and, according to Paul, is the only car of its type that has been fully restored.
“It wouldn’t have been possible without the wonderful financial support and encouragement of the North Carolina Medical Society,” Paul said.
Since the restoration was completed in 2007, the car has become one of the museum’s most popular exhibits and one of the few cars visitors can walk through and tour. The car features a fresh olive green paint job with red crosses on the sides, 15 hospital beds and video of medical staff who worked on the car, including two retired nurses who reside in Charlotte.
“If you ever get close to Spencer, you go up and see that car,” Ward said. “It’s well worth it.”
Longtime NCMS member and former NCMS President Elizabeth Kanof, MD, recently made the trip to Spencer.
"Seeing the medical car at the Transportation Museum was an unexpected and moving experience," she said. "I felt a sense of pride that DE Ward and colleagues had made this important contribution to NC history. With demands so great and resources needing to be spent so judiciously I am glad we made this contribution when we could."
Ward, now 94, retired from practicing general surgery in Lumberton four years ago, but continues to work as a medical examiner for Robeson County, as he has since 1976.

NC House Health Committee To Vote on Medicaid Reform Bill

Today the North Carolina House Committee on Health will likely vote on HB 372, 2015 Medicaid Modernization. HB 372 includes many of the provisions the North Carolina Medical Society (NCMS) has been advocating for alongside other key stakeholders. Since the start of the Medicaid reform debate two years ago, we have been building support for a provider-led Medicaid reform solution, and this bill advances that objective. HB 372 recognizes the value of physician leadership in the delivery of health care and demonstrates the commitment of House leaders to have a system that controls costs while also maintaining high-quality health care. The bill calls for provider-led entities (PLEs) to transition over a six-year period of time to a capitated payment for Medicaid services, with an emphasis on quality measurement and performance-based payments. This legislation also requires that a majority of the PLE’s governing board be comprised of physicians treating Medicaid patients. The bill also includes a provision that would require that PLEs control the state’s cost growth at least two percentage points below national Medicaid spending growth as projected in the annual report prepared for CMS for non-expansion states.
While the bill will need further revision, it represents the beginning of an ongoing discussion on Medicaid reform. The Medical Society will continue to work to address issues in HB 372 and other reform plans to support the medical community’s goals of keeping clinical decision making at the forefront of any Medicaid cost savings and reform initiatives, while building on successful programs already in place in our state. We anticipate that the Senate budget will include a Medicaid reform proposal of their own, and it is expected that this plan will place a greater emphasis on corporate managed care. The Medical Society will continue to provide members with updates on the progress of HB 372 and the larger Medicaid reform negotiations at the General Assembly through our Bulletin announcements.

Multiple Medicaid Reform Bills, Nursing Bills Gain Traction at the NC General Assembly

Four separate Medicaid reform bills have been filed at the General Assembly, three of which would rely on corporate Managed Care entities as the vehicle for transforming the current Medicaid system. At the same time, a number of other bills addressing important issues like physician supervision of nurses and other non-physician practitioners were introduced following the Senate bill filing deadline last week. These bills demonstrate the Senate’s desire to address important health care related issues this session. Though it is early in the session, the multitude of bills indicate there is likely to be a large focus on issues affecting the practice of medicine.
Below is a brief summary of some of the key bills the Medical Society is following. Stay tuned for more information on these bills and others, and how you can help the NCMS in our advocacy efforts relating to these important topics.

Medicaid Reform

SB 568: North Carolina Health Care Modernization (Tarte)
Senate Bill 568 would authorize licensed commercial health insurers to offer Medicaid plans based on a primary care centric purchasing strategy. These entities would work in collaboration with LME/MCOs to serve Medicaid patients based on a capitated payment. This bill also would create a Joint Legislative Oversight Committee on Primary Care and Medical Benefits to examine budgeting, financing, administrative and operational issues related to Medicaid reform, taking these functions away from the NC Department of Health and Human Services.
SB 574: 2015 Medicaid Reform (Jackson, Pate, Tucker)
Senate Bill 574 would transform the state’s current Medicaid program to a program that “provides budget predictability for the taxpayers of this state while ensuring quality care to those in need.” The bill is light on details, but instructs that the following elements are included in the reform plan: ensuring budget predictability through shared risk and accountability; creating “balanced” quality and patient satisfaction as well as financial measures; the use of efficient administrative systems; and using a sustainable delivery system.
SB 696: Medicaid Modernization (Hise)
Senate Bill 696 would transform the Medicaid program from fee-for-service to full risk capitated health plans for all Medicaid recipients, covering all Medicaid health care items and services. The bill contemplates competition between multiple provider-led and non-provider-led health plans, all of which would be full risk plans within two years. The bill also would create a new Health Benefits Authority to be managed by a board of experts in health administration, health insurance, health actuarial science, health economics and health law and policy appointed by the Governor and General Assembly to manage and oversee the Medicaid and NC Health Choice programs. The legislation also would create a Medicaid Reserve Account in the General Fund for the purpose of providing for unexpected budgetary shortfalls with the Medicaid and NC Health Choice programs.
SB 703: Medicaid Transformation (Berger)
Senate Bill 703 would direct the NC Department of Health and Human Services (DHHS), Division of Medical Assistance to create and implement a Medicaid reform plan. This plan would be required to transform the current fee-for-service system into a capitated, risk-based managed care Medicaid program. The bill requires at least three statewide Medicaid managed care organizations to assume the full risk for Medicaid benefits. This legislation directs the NC DHHS to implement this plan no later than Jan. 1, 2017.

Scope of Practice

SB 695: Modernize Nursing Practice Act (Hise, Pate)
Senate Bill 695 would make changes to the North Carolina Board of Nursing, including adding advanced practice registered nurse (APRN) licensure for nurse practitioner, certified nurse midwife and clinical nurse specialist providers. In addition, the legislation would include the following in the APRN scope of practice, beyond the current RN scope of practice:

  • Conducting an advanced assessment
  • Delegating and assigning therapeutic measures to assistive personnel
  • Performing other acts that require education and training consistent with professional standards and commensurate with the APRN’s education, certification, demonstrated competencies and experience

The bill also permits the following areas of focus for APRN practice:

  • The family or individual across the life span
  • Adult gerontology
  • Neonatal
  • Pediatrics
  • Women’s health
  • Psychiatric or mental health

SB 240: Define Scope of Practice of CRNAs (Davis)
Senate Bill 240 would eliminate the requirement of physician supervision of nurse anesthetists (CRNAs). Specifically, the legislation would include the following components as the practice of nursing by a certified registered nurse anesthetist:

  • Perform nurse anesthesia activities in collaboration with a physician, dentist, podiatrist or other lawfully qualified health care provider with each provider contributing his or her respective area of expertise consistent with the lawful scope of practice and according to established policies, procedures, practices and channels of communication that lend support to nurse anesthesia activities
  • Lend support to nurse anesthesia activities
  • Define the roles and responsibilities of the certified registered nurse anesthetist within the practice setting
  • Maintaining individual accountability for the outcome of individual actions

SB 542: Decriminalize Direct Entry Midwifery (Rabin, Sanderson, Krawiec)
Senate Bill 542 would allow any person certified as a Certified Professional Midwife by the North American Registry of Midwives to provide prenatal, intrapartum, postpartum and newborn care.
SB 543: Home Birth Freedom Act (Rabin, Sanderson, Krawiec)
Senate Bill 543 would license Certified Professional Midwives, creates licensing requirements for this certification, and mandates that a patient may not be required to be served by a physician instead of a Certified Professional Midwife. This legislation also would allow for third-party reimbursement and coverage for maternity and obstetrical care by a Certified Professional Midwife.

Health Care Regulation

SB 702: Repeal CON and COPA Laws (Apodaca)
Senate Bill 702 would repeal two laws that are generally viewed as reducing competition in health care. The measure repeals the state’s certificate of need (CON) law, which places limits on who is permitted to own certain medical facilities and technologies, and where they may be located. Also repealed are the certificate of public advantage (COPA) laws, which allow competing health entities (e.g., hospitals) to engage in activities that undermine competition, despite antitrust concerns. If enacted, the law would become effective January 1, 2017. Senator Tom Apodaca (R, Henderson) is the primary sponsor of S702.

Where Do We Stand With the SGR?

SGR-updateVery early on the morning of March 27, after completing a lengthy round of votes on the budget resolution, a handful of Senators blocked efforts to reach agreement on the rules for debate on H.R. 2, the “Medicare Access and CHIP Reauthorization Act,” which passed the House on March 26 by an overwhelming margin of 392-37.
Congress is now adjourned for its April recess.  In statements made on the floor, Senate leaders said they will bring the bill up promptly when Congress returns from its recess on April 13.   According to remarks made by Majority Leader Mitch McConnell (R-KY) shortly after 3 am, “It’s encouraging this passed the House with such a large bipartisan majority, and I want to assure we’ll move to it very quickly when we get back…..I think there is every reason to believe it’s going to pass the Senate by a very large majority.”
While some Senators expressed reservations or opposition to the bill, we agree there were more than enough supporters to pass the bill.  It appears that an unfortunate combination of timing, budget amendment fatigue, and procedural obstacles having nothing to do with the policies set forth in H.R. 2 were working against us.
Of course, the current payment patch expires today, April 1, long before Congress reconvenes. As a result, all physician services provided on or after April 1 will be subject to a cut of 21 percent.  The Centers for Medicare & Medicaid Services (CMS) is instructing its carriers to “hold” for 10 business days any claims for services provided on April 1 and beyond, until legislation can be passed and signed into law that reverses the 21 percent cut. The 10-business-day hold means that April claims will be held through Tuesday, April 14.  Since no claims by law can be paid sooner than 14 calendar days from their receipt, this hold should have little practical impact on Medicare remittance in the short-term, although billing for copayments and claims reconciliation will be more complicated.
In the meantime, some practices are asking what they should charge.  By law, Medicare is required to pay physicians the lesser of the submitted charge or the Medicare approved amount. For this reason, the AMA is advising against submitting claims with reduced amounts reflecting the 21 percent cut.  Instead, we recommend physicians either continue charging the current 2015 rates for April dates of service or defer submitting claims until after final action on the legislation. In the unexpected event that Congress allows the 21 percent cut to take effect, Medicare would pay physicians at the reduced amount no matter what the physician billed and no further action would be necessary. However, non-participating physicians who have collected balance billing amounts for unassigned claims based on the currently-allowed amount could be required to make refunds to their patients based on new, lower balance billing limits.
Watch the NCMS website and Bulletin where we will update you as information about the claims hold and further Senate action become available.

National Call to Action: Repeal the SGR








If you want the Medicare Sustainable Growth rate (SGR) to end, today is the day to make your voice heard.

The AMA has organized a National Call to Action Day today, Tuesday, March 24. Please join your colleagues in North Carolina and across the country by calling your US Representatives and Senators and urge them to eliminate the flawed SGR formula.
Last week, lawmakers in both the U.S. House of Representatives and U.S. Senate introduced bills, H.R. 1470 and S. 810, consistent with the policies established in last year's bipartisan, bicameral Medicare payment reform bill. Congressional leaders are working together to finalize the legislation. Both the House and Senate must vote on the proposal this week, before the March 31 expiration date of the current patch, or physicians will be facing a 21 percent Medicare payment cut.
Do your part: Participate in National Call to Action Day
Contact your senators and representatives and urge them to support H.R. 1470 and S. 810 in any of the following ways:

  • Call your lawmakers using the AMA's toll-free Physicians Grassroots Hotline at 1-800-833-6354.
  • Send an urgent email to your lawmakers reinforcing the need for SGR repeal now.
  • Contact legislators directly through their own social media channels, and share your message with your own Facebook friends and Twitter followers.

To bolster your message use these talking points. Visit the Fix Medicare Now website for additional information on effort to repeal SGR and improve Medicare for our nation's seniors.
Read about the provisions of the bipartisan bill at AMA Wire.

NCMS Hosts Successful NC Medical Group Managers Advocacy Conference

NCMGMA White Coat Wednesday attendees
NCMGMA White Coat Wednesday attendees

For its 2015 Advocacy Days Conference, the North Carolina Medical Group Managers Association convened this week at the NCMS Center for Leadership in Medicine.  The conference was attended by a strong contingent of advocacy-oriented medical practice leaders from across North Carolina. Cam Cox of MSOC Health and NCMGMA’s Advocacy Liaison moderated the event.
Tuesday’s packed agenda opened with a presentation by Chip Baggett, NCMS Director of Legislative Relations, in which Chip highlighted the need for effective messaging on the looming 3% retro-cut in Medicaid. The afternoon also featured appearances by former state senator Eric Mansfield, MD; Becki Gray of the John Locke Foundation; Adam Linker of the NC Health Access Coalition; and Dr. Robin Cummings, Director of North Carolina Medicaid.
Discussions covered a host of different hot topics in health care, including Medicaid reform, Medicaid expansion, the state’s certificate of need program, and scope of practice.
The managers returned Wednesday morning for a briefing by NCMS staff on the day’s legislative calendar, and they then ventured to the General Assembly to meet with legislators and attend committee meetings.  This was the first year the event was held entirely at the NCMS facility, and we hope to host again in years to come!

Don’t Miss Meaningful Use Attestation

March 20 is the last day to attest to meaningful use for the Medicare EHR Incentive Program’s 2014 reporting year. This extended deadline does not affect deadlines for the Medicaid EHR Incentive program. Attesting by the deadline will ensure you earn an incentive payment, if applicable, and avoid the Meaningful Use penalty which will be applied in 2016 (based on 2014 performance).
Understanding the criteria for participating in the various Medicare quality programs is of critical importance, as penalties will be applied to those who do meet the prescribed requirements. Visit our new members-only webpage dedicated to quality issues—“Quality Time with the NCMS” at—to learn more about the criteria, and how to avoid these penalties, which could cost you up to 11% in total of your Medicare reimbursements in future years.

Wanted: Nominations for NCMS & AMA Leadership Positions

The Nominating and Leadership Development Committee is seeking nominations from physician members for NCMS leadership positions that will become vacant in 2015. The deadline for receiving all nominations is July 1. If you are interested in serving in the following positions, please submit your nomination form to Devdutta G. Sangvai, MD, Chair of the Nominating and Leadership Development Committee, NCMS, PO Box 27167, Raleigh, NC 27611-7167.


  • Officers
    • President-Elect (1-year term)
  • Region and At-Large Members (3-year term)
    • Region 1 Representative (1) (incumbent eligible for re-election)
    • At-Large Member (1) (incumbent eligible for re-election)


  • AMA Delegates (3) (2-year term) (incumbents eligible for re-election)
  • AMA Alternate Delegate (1) (2-year term) (incumbent eligible for re-election)

The NCMS Board of Directors is seeking nominations for the following positions.  If you are interested in serving in these positions, please submit your nomination form and resume to Robert E. Schaaf, MD, President, NCMS, PO Box 27167, Raleigh, NC 27611-7167.

  • North Carolina Medical Care Commission (1) (4-year term) (incumbent eligible for re-election)
  • North Carolina Commission for Public Health (2) (4-year term) (incumbents eligible for re-election)

The Committee strives to identify, attract, and develop the most competent physician leadership in the Society.

  • Region 1 (1) (incumbent not eligible for re-election)
  • Region 2 (1)
  • Region 3 (2) 
  • Region 4 (2) (One incumbent not eligible for re-election)

Region 1 includes:
Beaufort, Bertie, Brunswick, Camden, Carteret, Chowan, Columbus, Craven, Currituck, Dare, Duplin, Edgecombe, Gates, Greene, Halifax, Hertford, Hyde, Jones, Lenoir, Martin, Nash, New Hanover, Northampton, Onslow, Pamlico, Pasquotank, Pender, Perquimans, Pitt, Tyrrell, Washington, Wayne, Wilson
Region 2 includes:
Alamance, Caswell, Chatham, Davidson, Davie, Durham, Forsyth, Franklin, Granville, Guilford, Johnston, Lee, Montgomery, Orange, Person, Randolph, Rockingham, Stokes, Vance, Wake, Warren
Region 3 includes:
Anson, Bladen, Cabarrus, Cleveland, Cumberland, Gaston, Harnett, Hoke, Lincoln, Mecklenburg, Moore, Richmond, Robeson, Sampson Scotland, Stanly, Union 
Region 4 includes:
Alleghany, Alexander, Ashe, Avery, Burke, Buncombe, Caldwell, Catawba, Cherokee, Clay, Graham, Haywood, Henderson, Iredell, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rowan, Rutherford, Surry, Swain, Transylvania, Watauga, Wilkes, Yadkin, Yancey
To obtain a nomination form for any of the above positions, please contact Abbey Ruggiero at (800) 722-1350 or by email at [email protected]

Take Action

 In 2013, the NC General Assembly included a 3% “withhold” for all Medicaid services with the intention of using that money as the foundation of a shared-savings program.  After difficulty developing the program, the “withhold” was redrafted as a cut the following year with an effective date of January 1, 2014.  That cut has not been implemented due to delays in NCTracks. 
Doctors treating Medicaid patients now face a requirement to pay back 3% of everything they have been paid by Medicaid for the last 14 months.  Every day that passes increases this financial and administrative burden. We know this money has already been spent on staff salaries, office overhead, and other basic requirements of serving the Medicaid population. 
Call or email your representative/senator and tell them how much you will have to send back to Medicaid, and what it will mean to you and your practice. Tell your legislator that you cannot afford a massive recoupment at the same time as you are being asked to transform the entire way we deliver health care to the Medicaid population. 

Take Action Now >>

NOTE:  Primary care physicians who received enhanced Medicaid payment rates in accordance with the ACA will not be subject to the 3% reduction in 2014. However, those same PCPs will be subject to the reduced rates and a recoupment of payments made for January and February 2015 dates of service.

NCMS Reports From the Legislature

NCMS’ Medicaid Reform Guiding Principles
Medicaid reform is our top priority this session, and dialogue continues at the General Assembly on what would constitute the most sensible approach to reform. The NCMS steadfastly supports accountable care organizations (ACOs) as the foundation of any change. Some legislators still insist that importing managed care corporations is the best option for the state and show a strong reluctance to maintaining “risk” of budget over-runs in the Medicaid program, favoring capitation instead of any shared savings approach. As the debate continues, the NCMS has outlined several guiding principles to help shape meaningful and sustainable change around the ACO approach. For instance:

  • While cost reduction is an important goal, the primary goal must be improved quality of care for each Medicaid patient.
  • ACOs are modeled on integrated care delivery. They empower physicians to work in teams with other providers to care for individual patients. This allows doctors, and all members of the team, to function at their fullest capacity for the good of their patients. ACOs incentivize everyone to work together.
  • Since doctors have the clinical expertise to know what makes sense for their patients, physicians need to be included in the operational governance structure as well as the clinical governance structure. Legislators, government administrators and corporate bureaucrats do not know what makes sense clinically. We want to ensure physicians have a prominent place in improving Medicaid since they know what’s reasonable and how to achieve it clinically.
  • Much discussion has revolved around whether—and how—to segment the state into regions to better track and administer a Medicaid program. Our position is that carving out exclusive regions in which certain providers would care for certain Medicaid recipients is counter to the idea of homegrown competition. We say, allow Medicaid ACOs to emerge in the same way Medicare has promoted ACOs nationwide.
  • Finally, the linchpin to this whole scenario is data. To be successful, claims data and clinical data need to be side-by-side to make meaningful comparisons. Luckily, the tool to do this already exists in the NC Health Information Exchange (NC HIE). The legislature needs to continue to support the NC HIE.

We ask for your support to keep you, the physician, in the driver’s seat of care delivery in Medicaid by supporting shared savings and ACO reform models as an alternative. We also ask for your feedback. Please send your thoughts to NCMS Solution Center Specialist Belinda McKoy.
Projected State Budget Shortfall This Fiscal Year: $271m
Top state economists told lawmakers on Feb. 12 that they expect North Carolina will face a $271 million budget shortfall this fiscal year, which ends June 30.  That represents a modest 1.3 percent deficit that state reserves and/or spending cuts can handle fairly readily.  But its cause—lagging personal income tax payments (5.8 percent below budget projections) resulting from sluggish wage growth across North Carolina—is a signal that the state’s economic recovery is not yet as robust as anticipated, the economists told legislators.
However, with the state’s unemployment rate dropping now steadily, wages should start climbing during the next fiscal year, said the economists from the legislature’s Fiscal Research Division and Gov. McCrory’s Office of State Budget and Management.  The state’s fiscal situation will be clearer by early May, after April’s final surge of state income tax payments have been recorded, they noted.  For now, the disappointing state revenue receipts could make legislators less likely to consider much additional program funding, further significant tax cuts, or new or expanded economic-development tax incentives as they begin their discussions on adjusting the state’s $21 billion budget.
Meanwhile, the state’s revenue trends are positive, predicted to finish at a modest 2.9 percent growth rate for the current fiscal year—just not the 4 percent legislators expected when they adopted the budget last summer.  And the budget picture includes some bright spots:

  • Sales tax receipts are 2.3 percent ahead of expectations.
  • Business taxes, including corporate income and franchise taxes, are up 5.7 percent.

Review the state economists’ revenue and budget presentation.
Governor’s State of the State Address
Governor Pat McCrory delivered his State of the State Speech to the General Assembly on February 4. The Governor did speak about a “partnership with doctors” and making North Carolina “an excellent place for doctors to practice medicine.” Watch the 4-minute segment of his address, which focuses on health care.