AMA Study Reveals Independent Practice is Still the Prevalent Model
The American Medical Association’s (AMA) Division of Economic and Health Policy Research recently released is latest study titled: “Updated Data on Physician Practice Arrangements: Inching Toward Hospital Ownership.” [If you are an AMA member you can login to download the study.]
The research shows physicians in small, independent practices are still in the majority, but the trend continues toward employment at larger practices and health systems.
"I wouldn't say the game is over for solo physicians, but it's the bottom of the ninth and you are behind. There is nothing going your way," says a recruiting executive.
Other findings include:
- Around 56.8 percent of physicians still practice in a wholly physician-owned setting. In 2012, the number was 60 percent.
- More than 60 percent of physicians work in practices with 10 physicians or fewer, and that practice size didn't change much between 2012 and 2014.
- Just over half of physicians are practice owners, a slight decrease from 53.2 percent in 2012.
- Slightly more than 17 percent of physicians are in solo practice, a decrease from 18.4 percent in 2012.
- The share of physicians in practices with at least some hospital ownership increased from 23.4 percent to 25.6 percent in 2014.
- Orthopedic and spine surgeons are among the most independent-minded specialties. There are around 35 percent of orthopedic surgeons working in the orthopedic group practice setting and an additional 15 percent in private practice, according to the American Academy of Orthopaedic Surgeons
One Week Left to Apply to Leadership College
The deadline to apply for Leadership College 2016 is a week from today -- July 22, 2015. Don't miss this opportunity to hone your leadership skills and reach the next level in your career. Apply today!
The NCMS Foundation Leadership College, part of the Kanof Institute for Physician Leadership, was developed for physicians from across the state who want to develop their leadership skills, and who are interested in attending a professional leadership development program. Since its inception in 2002, the Leadership College has graduated over 200 scholars, almost half of whom have advanced to leadership positions in their workplace and/or professional organization.
If you would like to learn more about this selective program, please contact Erin Grover, 919-833-3836, x134. You also can apply online. All applications will be reviewed by the Kanof Institute for Physician Leadership Advisory Committee and scholars will be notified the beginning of September.
BCBS Rate Increase Request Not Off-Set by ACA Reimbursements
A July 7 article in the Raleigh News & Observer reported that Blue Cross and Blue Shield of North Carolina is eligible for nearly $295 million in federal reimbursements under the Affordable Care Act and seemed to question why, in light of this money, the company is seeking another rate increase from the state.
BCBS responded with a letter to the editor and provided information on their blog explaining that the federal funds do not make up the gap in the cost of care.
“It boils down to the fact that ACA customers are sicker and use more health care than individual customers historically have — and more than anyone projected. We’re seeing costs go even higher as more people with more health problems seek more medical care. That’s why we had to request a significant rate increase for next year’s ACA business,” the blog post states.
Alan Skipper Inaugurated As AENC President
Our own North Carolina Medical Society (NCMS) Director of Specialty Society an
d Meeting Services, Alan Skipper was inaugurated Monday morning, July 13, as President of the Association Executives of North Carolina (AENC). The organization provides professional development and networking opportunities to those in the association management profession, including CEOs and the staff of associations across North Carolina. AENC celebrates its 60th anniversary this year.
Alan was honored as part of the AENC’s Awards Breakfast and Annual Business Session at the Durham Convention Center.
Congratulations, Alan!
NCMS Responsible for Popular World War II Medical Car Display
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.
Be 'On Call' For This Fun and Helpful Event
The North Carolina Medical Society (NCMS) is once again joining with our friends at the Pitt County Medical Society to answer WITN viewers’ medical questions at the “Doctors on Call” phone-in event. This annual event will be held this year on Wednesday, Sept. 30, from 5 p.m. to 7 p.m., at WITN’s new studios in Greenville. Please consider volunteering to staff the phone bank for one to two hours, as your schedule permits. This is a great effort to help the community! Sign up here. For more information, contact Kristen Shipherd at the NCMS, 919-833-3836 x115.
In the News
'Surgeon Scorecard' Measures Docs By Complications, USA Today, 7-14-15
Leaked Document: Nearly One Third of 847,000 Veterans in Backlog for VA Health Care Already Died, The Huffington Post, 7-13-15
Should Doctors and Drug Makers Keep Their Distance?, NPR, 7-12-15
Headed For Risk: Health Systems Sign Private Sector ACO Deals That May Lead to Capitation, ModernHealthCare, 7-11-15
How CVS Quit Smoking and Grew Into A Health Care Giant, The New York Times, 7-11-15
Medicare's End-of-Life Counseling Policy May Find Acceptance, The Associated Press, 7-9-15
Egg Shortage Hits Health Care Industry, ModernHealthCare, 7-8-15
What the CMS' ICD-10 Truce With Docs Means for the Oct. 1 Crunch, ModernHealthCare, 7-8-15
Want A Good Laugh? Head To The Hospital, Kaiser Health News, 7-8-15
Panel Calls W.H.O. Unfit To Handle A Crisis Like Ebola, The New York Times, 7-7-15
Industry Payments To Nurses Go Unreported In Federal Database, NPR, 7-6-15
More Competition Is Supposed To Help Consumers. That Might Not Be True With Health Insurance, The Washington Post, 7-6-15
Age: Is It All In the Mind?, MedPageToday, 7-6-15
With Merging of Insurers, Questions for Patients About Costs and Innovation, The New York Times, 7-5-15
Evidence Counters Myths About Medicare, Medicaid, MedPageToday, 7-1-15
Industry Payments to Doctors Are Ingrained, Federal Data Show, NPR/ProPublica, 7-1-15
ICD-10 Implementation Fight Drags On With Three Months Left, HealthIT Analytics, 7-1-15
Learning Opportunities
The NCTracks training being offered in July is for providers of services from the Division of Public Health (DPH). Registration is now open for several instructor-led training courses to be held in July for DPH providers. The duration varies depending on the course. See the course list and registration information.
ModernHealthCare free Webinar: The IT Behind Accountable Care, July 22, 11 a.m. EDT.
Having a fully developed IT infrastructure is key to delivering the high-quality, lower-cost care sought by the growing numbers of ACOs. But the investments required are significant. The webinar will feature three speakers involved in ACOs at various stages of IT investment. Learn more and register.
Palmetto GBA will host the next Part B Ask the Contractor Teleconference: ICD-10 -- Are You Ready? on Aug. 13, 2015, from 10 to 11 a.m. This call is intended for Part B providers and their billing staff billing for services rendered in North Carolina. This call will focus on helping providers prepare for the implementation of mandatory use of ICD-10 codes on Oct. 1 and will not teach providers how to code using ICD-10.
Medicare Learning Network (MLN) Connets will hold a National Provider Call: Countdown to ICD-10, Thursday, Aug. 27, from 2:30 to 4 p.m. to register, visit MLN Connects Event Registration. Space may be limited, register early. As of Aug. 27, it will be five weeks before ICD-10 implementation on Oct. 1, 2015. Sue Bowman from the American Health Information Management Association (AHIMA) and Nelly Leon-Chisen from the American Hospital Association (AHA) will offer coding guidance and tips, along with updates from CMS.
Move to Value Summit, the ultimate primer on value-based health care will be held at Biotech Place in Winston-Salem, Aug. 27-28. Hosted by CHESS Health Enablement Soutions and sponsored by Wake Forest Baptist Health and LabCorp, the Move to Value Summit is designed to provide you with a broad and deep understanding of what it takes to transform your fee-for-service-dependent organization to one rooted in pay-for-value. Learn more and register.
Registration is now open for NCHICA’s 21st Annual Conference & Exhibition on September 13-16, 2015 at Pinehurst Resort in Pinehurst, NC. This year’s theme is Transforming Healthcare from Volume to Value. The conference provides an excellent opportunity to learn about the latest developments and best practices in health IT and network with your peers. For further details, click here. The registration fee is $475 NCHICA members/$675 non-members. For further details, click here. Fees will increase after August 13, so please register early! NCHICA has a special group rate at the Pinehurst Resort of $205/night, which is good until August 13, 2015. For further details on how to register at the special rate, click here.
The North Carolina Coalition Against Domestic Violence is having a Screening Training for physicians and their medical teams/staff on Sept. 18, 2015 in the Raleigh/Durham area. Topics will include best practices for intimate partner violence screening in clinical settings. More information and to register.
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].
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.
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.
Application Deadline Extended for Review Panel of NC Medical Board
The North Carolina Review Panel for Nominating Members of the North Carolina Medical Board (NCMB) has extended its application deadline to July 15, 2015 for the two physician positions and one physician assistant or nurse practitioner position that will open in November 2015 on the NC Medical Board.
Applications and all supporting documentation must be submitted on or before 5 pm EDT on Wednesday, July 15, 2015 to be considered for the 2015 review. Learn more about the available positions. Complete and submit your application.
New Workers’ Comp Physician Fee Schedule Takes Effect
Today, July 1, the new workers' compensation medical fee schedule becomes effective, marking the culmination of years of effort by the North Carolina Medical Society (NCMS) working with the Industrial Commission and other stakeholders to update the fee schedule and fix flaws in the billing and claims process. The Industrial Commission has now posted the Fee Schedule Table and FAQs.
"This is another great example of how the NCMS can effect positive change for our members and their patients," said NCMS CEO Robert W. Seligson. "The old physician fee schedule -- which had not been maintained since its adoption in 1995 -- offered physicians some of the worst rates across the country. This had taken a toll on physician participation, making medical care more difficult for workers to find and more expensive for employers. Starting today we look forward to a more equitable and efficient system for injured workers."
The NCMS and its Workers' Comp Task Force along with payers, the business community and the state agencies that oversee the workers' comp program had worked for several years to establish a fee schedule that successfully ensures injured workers can receive the care they need; medical providers are compensated at reasonable rates; and medical costs remain adequately contained. The old fee schedule had grown stale since its adoption in the mid-1990s, and no longer struck the necessary balance. The new schedule successfully balances these interests.
In addition to new payment rates, NCMS pushed for -- and secured -- additional changes that will resolve administrative hassles for medical practices. For instance, the Industrial Commission has abandoned the rule that medical providers must substantiate their claims to the carriers for injectable drugs and durable medical equipment with paper invoices. Physicians can now bill for these services with a specific code without the paperwork and be paid according to the fee schedule allowable for that item or service. The Commission also clarified other practitioners like physician assistants and nurse practitioners also are to be paid at the full fee schedule amount, so long as the services they provide are within their respective scopes of practice.
For more information visit the NCMS Workers' Comp page on our website and watch the Bulletin for updates and analysis of what this may mean for your practice.
NCMS’ Statement On US Supreme Court’s Ruling on King v. Burwell
When the US Supreme Court's ruling on the King v. Burwell challenge to the subsidy provision in the Affordable Care Act was announced last Thursday morning, the North Carolina Medical Society (NCMS) provided the following statement to the media:
"Broader health insurance coverage for the citizens of North Carolina has been the stated policy and goal of the North Carolina Medical Society (NCMS) for the last 30 years. In the last five years, we have been pleased that more people have health insurance coverage protecting them in case of injury or illness, and hope this trend will continue unabated with the Supreme Court’s decision. As recent opinion polls show, the public agrees no working person should have to sacrifice food on the table for medical care.
"No legislation is perfect, especially one as far-reaching as the Affordable Care Act. We will strive to retain the positive aspects of the law and fix what is broken on behalf of our members and their patients. As the oldest and largest physician association in the state, today representing more than 12,500 physicians and physician assistants, we are committed to continuously improving our health care system’s quality, efficiency and patient service for the people of North Carolina."
The quote was picked up by the Associated Press and WNCN-TV. Read the AP article, which appeared in the Asheville Citizen-Times and the WNCN story.
As mentioned in the statement, the NCMS remains committed to fixing what is ‘broken’ in the Affordable Care Act, and keeping and improving those provisions that are working. Earlier this year Congress repealed Medicare’s Sustainable Growth Rate formula thanks in part to NCMS members’ diligent work over the years and pressure on their Congressional representatives at the ninth hour. The SGR repeal opens the door for positive and meaningful reform. Our staff continues to analyze what the new sweeping legislation – MACRA – means to you and your practice. Watch the Bulletin and the Quality Time with the NCMS webpage for updates.
We’re still working toward antitrust protections for physicians as well as a law to give physicians and senior citizens the ability to directly contract for any Medicare services. We’re also seeing some progress with the House passage last week of a bill to repeal the Independent Payment Advisory Board. We will continue to push to eliminate as many of the onerous regulations forcing physicians to spend time filling out forms instead of seeing patients.
Accountable Care Investment Model Announced By CMS
The Centers for Medicare & Medicaid Services (CMS) recently announced expansion of new Accountable Care Organization (ACO) model as part of the Medicare Shared Savings Program (MSSP). ACOs represent one part of a comprehensive series of initiatives in the Affordable Care Act designed to lower costs and improve care. When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, it shares in the savings it achieves for the Medicare program.
The ACO Investment Model (AIM) offers pre-paid shared savings to encourage new ACOs to form in rural and underserved areas and current MSSP ACOs to transition to arrangements with greater financial risk.
CMS had originally announced this opportunity in November 2014 for ACOs starting in the MSSP program in 2015. The North Carolina Medical Society (NCMS) began the NC Rural ACO Initiative to take advantage of this model and currently five ACOs in the state are applying for the 2016 MSSP and AIM.
By offering pre-payment of shared savings in both upfront and ongoing per beneficiary per month payments, CMS believes participation in areas of low ACO penetration may spur new markets to focus on improving care outcomes for Medicare beneficiaries.
AIM was developed to address concerns and research suggesting some providers lack adequate access to the necessary capital to invest in infrastructure to successfully implement population care management.
Learn more about this new ACO model, if your practice is eligible to participate and how to apply. NOTE: the application period for ACOs started in 2014 and 2015 -- or will start in 2016 – opens today, July 1st, 2015 and closes July 31, 2015.
Payment Data for 2014 Now Public
The Centers for Medicare & Medicaid Services (CMS) yesterday published 2014 Open Payments data enumerating payments, honoraria or research grants from drug and device manufacturers to health care providers. The data includes information about 11.4 million financial transactions attributed to over 600,000 physicians and more than 1,100 teaching hospitals, totaling $6.49 billion.
The program relies on voluntary participation by physicians and teaching hospitals to review the information submitted by various drug and medical device manufacturing companies. CMS will update the Open Payments data at least annually to include updates to data disputes and other data corrections made since the initial publication. The financial data available through Open Payments was submitted by applicable drug and device manufacturers and applicable group purchasing organizations (GPOs). The accuracy of all data included in Open Payments reporting is attested to by the submitting manufacturer or GPO.
For all 2014 and 2013 data, CMS was able to validate that 98.8 percent of all records submitted in the Open Payments system contained accurate identifying information about the associated covered recipient. Records that could not be verified to align to an individual covered recipient were rejected and were not processed by the system. CMS will continue to update the Open Payments website annually with data collected from the previous year.
Prior to publication of any Open Payments data, physicians and teaching hospitals are given the opportunity to register with the Open Payments system to review and dispute data submitted about them by applicable manufacturers and applicable GPOs. With this data release, both the 2014 and 2013 financial records are now available as part of the Open Payments dataset.
CMS will refresh and publish an update to the full calendar year of 2014 financial data in early 2016. Learn more about Open Payments.
ICD-10 is Coming. Are You Ready?
To help ensure that you are ready for the Oct. 1, 2015 implementation of the new ICD-10 codes, The Physicians Foundation is promoting a free resource designed to help your practice make the transition. ICD10Charts.com was developed by a medical student, Parth Desai, who saw the need for such a resource while working in his father's medical practice.
ICD-10 Charts is a collection of innovative ICD-10 training resources that can help streamline your entire ICD-10 implementation process and save your practice a considerable amount of time and money during this transition. Desai has refined the software even more recently, making ICD-10Charts a most valuable tool to help you prepare. Watch a short informational video detailing how the site works.
The Centers for Medicare & Medicaid Services (CMS) and NCTracks are providing a steady stream of information to help practices be prepared for ICD-10 as of the Oct. 1, 2015 implementation date. CMS is offering a Quick Start Guide to help practices who are scrambling to begin the process.
The following is a brief compilation of frequently asked questions (FAQs) these agencies have been fielding.
For providers with claims that will span the ICD-10 implementation date of October 1, 2015, CMS offers:
MLN Matters® Special Edition Article SE1408, “Medicare FFS Claims Processing Guidance for Implementing ICD-10 – A Re-Issue of MM7492”
Visit the ICD-10 Medicare Fee-For-Service Provider Resources web page for a complete list of Medicare Learning Network® educational materials.
Here are some ICD-10 FAQs on certificates of medical necessity, prescriptions, and orders:
Question: I have Certificates of Medical Necessity (CMNs) for patients that contain ICD-9 diagnosis codes. Do I need to submit new CMNs with ICD-10 codes for claims submitted after the transition to ICD-10?
Answer: CMS is not requiring suppliers to submit updated CMNs for claims submitted on or after the ICD-10 implementation date of October 1, 2015; however, these claims must contain a valid ICD-10 diagnosis code. CMNs created after the transition to ICD-10 must use ICD-10 codes. Suppliers should ensure that the diagnosis code(s) billed on the claim are supported by documentation in the medical record.
Question: After ICD-10 implementation, how should pharmacies handle prescriptions with ICD-9 codes written prior to the implementation date?
Answer: When filling prescriptions that were written prior to the ICD-10 implementation date of October 1, 2015, pharmacies have the option to use the reimbursement mappings posted on the 2015 ICD-10-CM and GEMs and 2015 ICD-10 PCS and GEMs web pages to translate ICD–9 codes into ICD–10. New prescriptions written after the transition to ICD-10 must use ICD-10 codes.
Question: If patients have recurring appointments for physical therapy, occupational therapy, or speech-language pathology services that will continue after ICD-10 implementation, will new orders with ICD-10 codes be required?
Answer: In cases where physician or qualified non-physician practitioner orders are applicable to rehabilitation services furnished under CMS programs, CMS is not requiring updated orders to continue rehabilitation services after ICD-10 implementation on October 1, 2015; however, these claims must contain a valid ICD-10 diagnosis code. Physicians will need to provide the appropriate ICD-10 code to the therapist for these claims. Orders created after the transition to ICD-10 must use ICD-10 codes.
Dr. Randall Williams Is New NC Deputy Health Secretary
Randall Williams, MD, an obstetrician/gynecologist from Raleigh Gynecology and Wellness, assumes his new post as Deputy Secretary of Health Services within the N.C. Department of Health and Human Services today. He will oversee the Division of Public Health and the Office of Rural Health and Community Care.
Williams has been engaged in both taking care of patients in North Carolina and in public health for the last 26 years. A native North Carolinian, he graduated from the University of North Carolina at Chapel Hill with honors with a double major in History and Zoology, and went on to the UNC School of Medicine where he was a Holderness Fellow and co-founded the Students Teaching Early Prevention initiative. He then served as Administrative Chief Resident in Obstetrics and Gynecology at North Carolina Memorial Hospital.
Since moving to Raleigh in 1989, Williams has served as president of the Wake County Medical Society and on the Wake County Board of Health. He subsequently was elected by the North Carolina Medical Society (NCMS) to serve on the North Carolina Commission for Public Health from 2004 until 2012. He is president-elect of the UNC School of Medicine Alumni Association.
For the last 11 years, Williams has served as a volunteer in U.S. State Department and World Health Organization sponsored endeavors, teaching physicians and helping with clinical governance overseas. Serving mostly in conflict zones, his work has taken him to Iraq on 11 deployments in addition to Afghanistan, Libya and Haiti. He has been recognized as the Red Cross Humanitarian of the Year, Raleigh News & Observer Tar Heel of the Week and Triangle Business Journal Health Care Hero of the Year.
An avid runner, Dr. Williams has run marathons in Boston, New York, Paris, Athens and Jerusalem.
Congratulations on your new postition, Dr. Williams!
NC Health Department Updates Screening Guidelines for International Travelers
According to the World Health Organization (WHO), no new Ebola cases have been identified in Liberia since March 20, 2015. On May 9, 2015, forty-two days after the last laboratory-confirmed case was buried, the WHO declared the Ebola outbreak over in Liberia. Despite recent reports of two new cases in Liberia, the new guidelines remain in effect, according to Zack Moore, MD, MPH, the North Carolina Department of Health and Human Services Medical Epidemiologist. Read the new guidelines for Liberia.
Unfortunately, the outbreak has not yet ended in Guinea or Sierra Leone. Public health monitoring of and clinical management recommendations for travelers returning from Guinea and Sierra Leone have not changed. Read the recommendations or contact the epidemiologist on call at 919-733-3419.
Health care providers should continue to screen patients for recent international travel. A thorough travel history is essential to identify potential exposures to diseases of concern globally and to direct appropriate laboratory and diagnostic testing. The importance of obtaining a travel history has been reaffirmed by recent and ongoing travel-associated outbreaks of Middle East Respiratory Syndrome (MERS), measles, avian influenza, and other emerging infections.
The North Carolina Division of Public Health encourages health care providers and facilities to post notices in waiting rooms and triage areas encouraging patients to report recent international travel. Examples in English, Spanish and French.
NCMS Offerings Abound This Summer
Asheville-area members take note: you're invited to our Membership Mixer!
Join the NCMS and Western Carolina Medical Society leadership at this casual family get-together at the Highland Brewing Company in Asheville. Get the details and register today at www.ncmedsoc.org/mixer2. July 10, 2015 from 5-7 pm.
Submit your photo to the 2015 NCMS Photo Contest!
Got a great vacation photo or a cool abstract image? Submit it to the contest and enter it to win. Thirteen photos will be chosen as finalists that will be featured in the upcoming 2016 NCMS Member Calendar. Check out the rules and prizes. Deadline for submission: July 30, 2015
Hone your leadership skills -- apply to be a part of the Leadership College Class of 2016.
Applications are currently being sought for the NCMS Leadership College, which provides both orientation and skill development to North Carolina’s future medical leaders. Learn more about the program at www.ncmsleadershipcollege.org. Applications are due July 22, 2015.
Greenville-Area Doctors: Be on WITN-TV's Doctors on Call Program, Sept. 30, 2015. Physician volunteers from all specialties are needed to answer WITN viewers' medical questions from 5-7 pm on Sept. 30. Learn more or register here. Deadline to register: Sept. 28.
Students and residents take note: the Scientific Poster Session will take place again this year during the NCMS Annual Meeting. Download details (PDF) for your chance to present your work and win cash prizes courtesy of MagMutual Insurance Company. Poster submission deadline: September 15, 2015
Save the date for the NCMS Annual Meeting, Oct. 23-24, 2015.
This year's meeting will take place at the Grandover Resort in Greensboro. For more information, visit www.ncmedsoc.org/annualmeeting.
NCMS Plan Dental with MetLife
Over 250 NCMS Plan practices are enrolled in the MetLife group dental program. With nine different plan designs, the option to offer two plans for your employees to choose from and competitive rates, now is the time to compare your current group dental coverage with our offering, especially if you are among the many NCMS Plan practices with health benefits renewing August 1st.
The MetLife plans give your employees the freedom to choose any licensed dentist, even if that dentist does not participate in MetLife's network of Preferred Dentists. MetLife's network of dental providers includes more than 5,000 locations in North Carolina.
Last year we introduced a new dental plan design with a $5,000 benefit, much higher than standard group dental plans. This plan with a current employee rate of only $48 per month has become very popular. All NCMS Plan dental products require no underwriting with rates as low as $29 per month.
Participation requires a minimum of 75 percent of eligible employee enrollment and an employer premium contribution of at least 25 percent. For more information about NCMS Plan dental, contact your NCMS Plan agent or the plan office at (800) 662-7917. You can also find a description of benefits and rates on the NCMS Plan website.
Weigh-in With Your Thoughts on Obesity As a Disease
Robert Carels, Ph.D., MBA, a professor and the Director of Clinical Training for the Clinical Health concentration of the Health Psychology doctoral program in the Psychology Department at East Carolina University, seeks the opinions of those medical professionals who treat obese patients on the American Medical Association’s recent decision to label obesity a disease. The survey will take approximately 5-10 minutes to complete and has been approved by ECU’s IRB. Your responses are completely anonymous.
Take the survey.
MDs Needed to Speak to High School Students About Medical Specialties
The National Youth Leadership Forum on Medicine is seeking doctors who are interested in speaking to a group of high school students from all over the country about their specialties in medicine. They also are looking for a doctor with experience in kidney transplants in which the students view (either live feed or pre-recorded video) surgeries. Doctors are invited to provide further information and answer any questions. The meetings are taking place this month at the University of North Carolina, Chapel Hill.
The panels take place on the following dates and times:
What’s Your Specialty
July 16, 2015 – 7:30 p.m. to 9:15 p.m.
July 29, 2015 – 7:30 p.m. to 9:15 p.m.
Surgery Panel
July 15, 2015 – 10:45 a.m. to 12:30 p.m. (Autopsy)
July 28, 2015 – 10:45 a.m. to 12:30 p.m. (Knee Replacement)
More information about these events and about the National Youth Leadership Forum on Medicine.
In the News
Open Payments Data Shows Docs Got Most (By Far) From Genentech, ModernHealthCare, 6-30-15
Who Controls The Data? US Supreme Court Agrees To Hear Health Care Case, ModernHealthCare, 6-29-15
California Legislature Passes Mandatory Vaccination Bill, The Los Angeles Times, 6-29-15
Transforming Health Care Scheduling and Access: Getting to Now, Institute of Medicine, 6-29-15
Obamacare's Next Five Hurdles to Clear, Kaiser Health News, 6-26-15
Providers Frustrated, Seek Accommodations As ICD-10 Draws Near, MedPageToday, 6-25-15
Best or Worst Place to Practice -- It's Not Just About the Money, MedPageToday, 6-25-15
Learning Opportunities
The NCTracks training being offered in July is for providers of services from the Division of Public Health (DPH). Registration is now open for several instructor-led training courses to be held in July for DPH providers. The duration varies depending on the course. See the course list and registration information.
Move to Value Summit, the ultimate primer on value-based health care will be held at Biotech Place in Winston-Salem Aug. 27-28. Hosted by CHESS Health Enablement Solutions and sponsored by Wake Forest Baptist Health and LabCorp, the Move to Value Summit is designed to provide you with a broad and deep understanding of what it takes to transform your fee-for-service-dependent organization to one rooted in pay-for-value. Learn more and register.
Registration is now open for NCHICA’s 21st Annual Conference & Exhibition on September 13-16, 2015 at Pinehurst Resort in Pinehurst, NC. This year’s theme is Transforming Healthcare from Volume to Value. The conference provides an excellent opportunity to learn about the latest developments and best practices in health IT and network with your peers. For further details, click here. The registration fee is $475 NCHICA members/$675 non-members. For further details, click here. Fees will increase after August 13, so please register early! NCHICA has a special group rate at the Pinehurst Resort of $205/night, which is good until August 13, 2015. For further details on how to register at the special rate, click here.
The North Carolina Coalition Against Domestic Violence is having a Screening Training for physicians and their medical teams/staff on Sept. 18, 2015 in the Raleigh/Durham area. Topics will include best practices for intimate partner violence screening in clinical settings. More information and to 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.
NCMS Statement on King v. Burwell Ruling
The North Carolina Medical Society (NCMS) issued the following statement from NCMS CEO Robert W. Seligson in response to the Supreme Court's ruling on King v. Burwell:
"Broader health insurance coverage for the citizens of North Carolina has been the stated policy and goal of the North Carolina Medical Society (NCMS) for the last 30 years. In the last five years, we have been pleased that more people have health insurance coverage protecting them in case of injury or illness, and hope this trend will continue unabated with the Supreme Court’s decision. As recent opinion polls show, the public agrees no working person should have to sacrifice food on the table for medical care.
"No legislation is perfect, especially one as far-reaching as the Affordable Care Act. We will strive to retain the positive aspects of the law and fix what is broken on behalf of our members and their patients. As the oldest and largest physician association in the state, today representing more than 12,500 physicians and physician assistants, we are committed to continuously improving our health care system’s quality, efficiency and patient service for the people of North Carolina."
Medicaid Reform Update
Now that both the North Carolina House and Senate have laid out their respective Medicaid reform proposals, the North Carolina Medical Society (NCMS) has a clearer outline for our advocacy efforts in the weeks and months ahead.
The NCMS has allocated the necessary resources to make Medicaid reform its top priority this session to protect our members’ interests in what is sure to be a contentious and lengthy debate. We plan to stay focused on the elements in both the House and Senate plans that uphold the basic principles our members support – patient-centered and provider-led are key tenets we will work to ensure.
Even before the House bill was introduced several weeks ago, the NCMS had engaged with the North Carolina Hospital Association, long-term care organizations and over 70 other individuals representing Medicaid beneficiaries to craft a unified reform plan to help shape the House proposal. Much of what this disparate group of stakeholders sought was indeed included in the House bill (HB372), which places Medicaid in the hands of ‘provider-led entities.’ The House approved this bill on Tuesday on a vote of 105-6, setting the stage for negotiations with the Senate.
The Senate’s Medicaid reform proposal is contained within their budget – a procedural strategy to help ensure reform is achieved this session. Highlights of the Senate budget. The Senate’s plan focuses heavily on corporate managed care organizations (MCOs) as a means to reform Medicaid, but their plan also includes physician-led entities and some quality assurance measures.
Both plans endorse a full capitation model. The difference between the House and Senate lies in what entity would assume the risk – MCOs or physician-led entities or a combination of the two. See a side-by-side comparison of the two plans.
As always, NCMS members guide our advocacy work, and our members say they are not knowledgeable enough, as doctors, to take on the full organizational and underwriting burden of Medicaid.
“Doctors are not insurance companies; they are first and foremost caregivers,” said NCMS President Robert E. Schaaf. “Our job going forward is to make sure our patients’ care comes first regardless of what ‘entity’ manages the state’s Medicaid program.”
To prepare for the likelihood that the underwriting risk would fall to an insurance company, the NCMS Government Affairs staff lobbied hard to have language included in both the House and Senate reform plans making the “Triple Aim” the standard for whatever group assumes the risk. The Triple Aim, the goal guiding most accountable care organizations, focuses on 1) improving the health of a population of patients, 2) enhancing patient experience and outcomes and 3) reducing the per capita cost of care for the particular population.
Retaining this crucial provision will be a focus going forward as a way to protect patients especially in light of other states’ negative experiences with managed care organizations. If included in the final legislation, North Carolina would be establishing new ground by incorporating the triple aim into its Medicaid statutes.
The federal government also recently introduced an update to its Medicaid managed care regulations --the first major change to Medicaid and CHIP managed care regulations in more than a decade. This proposed rule aims to “improve beneficiary communication and access, provide new program integrity tools, support state efforts to deliver higher quality care in a cost-effective way and better align Medicaid and CHIP managed care rules and practices with other sources of health insurance coverage,” according to the Centers for Medicare and Medicaid Services (CMS). Read the proposed rule. The comment period for this proposed rule closes on July 27.
The battle over Medicaid reform will be long and challenging. Legislators have indicated reform will get done this session, which may mean the General Assembly won’t adjourn until fall. Watch your NCMS Bulletin and email for updates and calls to action when necessary over the next few months.
NCMS To Help Reduce Overuse of Certain Tests and Treatments
The North Carolina Medical Society (NCMS) is among the groups working with the North Carolina Healthcare Quality Alliance (NCHQA) to reduce the use of medical tests and treatments that the Choosing Wisely campaign has identified as overused. The effort is thanks to a grant from the ABIM Foundation grant program and will enable NCHQA to build a multi-stakeholder alliance to reduce the use of antibiotics to treat viral infections in adults, DEXA scans to measure bone density in women younger than 65 and men younger than 70, carotid artery stenosis screening in asymptomatic patients, and annual Pap tests for women between the ages of 30 and 65.
Duke Medicine and Cornerstone Health Care will each implement three Choosing Wisely recommendations, reducing targeted tests and treatments by 20 percent over three years. In addition, the NCMS, Blue Cross Blue Shield of North Carolina and the State Health Plan for Teachers and State Employees will launch complementary efforts to educate clinicians and consumers in North Carolina about the problem of overuse and the Choosing Wisely campaign.
NCHQA was one of seven grantees that the ABIM Foundation selected to receive funding.
Launched in April 2012, Choosing Wisely encourages clinicians and patients to discuss which medical tests and procedures may be unnecessary for their condition, and in some instances, can cause harm.
“The new Choosing Wisely grantees are undertaking a systematic effort to make a measurable difference on some of the most pervasive examples of waste or overuse in our nation’s health care system,” said Richard Baron, MD, president and CEO of the ABIM Foundation. “The diverse regional health care coalitions selected for these grants all include active clinician participation and leadership, continuing the campaign’s emphasis on working with the health care community to put the Choosing Wisely recommendations into practice.”
Join Us In Asheville To Mix and Mingle
Physicians and PAs in the Asheville area are welcome to attend a “Mix and Mingle” event on July 10 from 5-7 p.m. at the Highland Brewing Company, 12 Old Charlotte Highway, Asheville, NC. This is a great opportunity to meet other North Carolina Medical Society (NCMS) and Western Carolina Medical Society members and the leadership of the two organizations. Come have a beer on us! Families are welcome to attend. For more information or to register, visit www.ncmedsoc.org/mixer2.
For questions, please contact Will Barnett, (919) 833-3836 x 130, [email protected]. Future mixers are planned in other areas of the state; stay tuned!
NCMS Joins In Calling for Grace Period for ICD-10 Compliance
The North Carolina Medical Society (NCMS) has signed on to a letter along with other state medical and specialty societies and the AMA urging Congressional leadership to mitigate the impact of the ICD-10 transition by implementing a transition period. During this ‘grace period’ physicians would not be penalized for coding errors and system malfunctions. As learned from previous and significantly less complex claim processing changes, unanticipated problems can occur. Implementing a transition period would simply allow physicians a learning period, whereby contractors could identify common errors, provide feedback, and resolve system problems without resorting to claim denials.
Physicians at the 2015 AMA Annual Meeting passed policy calling on the Centers for Medicare & Medicaid Services (CMS) not to withhold claim payments based on coding errors, mistakes or malfunctions in the system for two years directly following implementation. Read more about the AMA's policy.
Meanwhile, Rep. Gary Palmer, R-Ala., introduced the Protecting Patients and Physicians Against Coding Act, which aims to provide a two-year grace period during the transition.
As noted in the last Bulletin, you may contact your representatives to encourage them to adopt the grace period legislation through the AMA Physicians Grassroots Network.
In 98 Days ICD-10 Will Be a Reality – Get Ready!
The North Carolina Medical Society (NCMS) encourages you to get ready to make the transition to ICD-10 by the Oct. 1, 2015 deadline. The risk is that claims will be denied if providers don't make the switch.
All insurers, public and private, are affected.
In North Carolina, NCTracks currently is testing with providers and trading partners to make sure the system will be ready.
Providers who have delayed their preparations are urged to take advantage of available resources to learn about ICD-10, especially the Centers for Medicare & Medicaid Services (CMS). For links to this and other resources, consult their ICD-10 webpage. CMS also offers a Quick Start Guide highlighting the five steps necessary to be ready for Oct. 1: 1) Make a Plan, 2) Train Your Staff, 3) Update Your Processes, 4) Talk with Your Vendors and Health Plans, and 5) Test Your Systems and Processes.
NCTracks offers answers to recent questions they’ve received:
Q: For claims with dates of service prior to October 1 but submitted after, we use ICD-9 codes, right?
Yes, that is correct.
Q: What is NCTracks doing to prepare for the amount of claims that will be split come the October 1 switch to ICD-10 codes?
Most claims are submitted as electronic X12 transactions to NCTracks, which are processed in near real time, as resources are available. In other words, the higher claim volume anticipated over the October 1 transition date will be queued up and processed as they are received. It may take somewhat longer to adjudicate the higher volume of claims. However, the NCTracks system is designed to accommodate fluctuations in claim volume. A normal checkwrite may vary from 2 million to as much as 7 million claims in a given week.
Q: Have these new ICD-10 codes been added into NCTracks?
The ICD-10 codes are in the NCTracks system, but federal rules for ICD-10 implementation will not allow ICD-10 codes to be used prior to October 1. NCTracks is actively engaged in testing with providers and trading partners through July. After that we will take any lessons learned from testing and make any changes needed. The ICD-10 codes will be available for use in the NCTracks system on October 1.
Q: Has NC Tracks tested with any clearinghouses? If so, which?
Yes, clearinghouses are participating in testing. They include ClaimLogic, ClaimRemedi, CPSI, MedAssets, Emdeon, HealthFusion, HIS, PHYSICIAN'S COMPUTER COMPANY, Relay Health, SSI Group, and Trizetto Provider Solution.
Apply for Meaningful Use Hardship Exemptions by June 30
Physicians can apply for a meaningful use hardship exemption by midnight next Tuesday, June 30 to avoid a 2016 penalty. Some of the hardship exemptions require physicians to file accompanying documentation that may be hard to compile in a single day, so it is important not to wait until the last day to file.
Certain types of physicians designated by their Medicare Provider Enrollment, Chain and Ownership System (PECOS) code are not required to file for a hardship. Instead, Medicare will automatically grant a hardship exemption to the following specialties:
- Anesthesiology
- Diagnostic radiology
- Interventional radiology
- Nuclear Medicine
- Pathology
Get more information and instructions from the Centers for Medicare & Medicaid Services (CMS). Or contact Terri Gonzalez, Director of Practice Improvement for the North Carolina Medical Society (NCMS), 919-833-3836, x123.
Sunshine Act Payment Data To Be Released June 30
Physicians' 2014 financial data under the Physician Payments Sunshine Act, also known as the Open Payments program, will be released to the public June 30. There is still time to review and dispute errors that will be reflected in the next scheduled update of the database.
Doctors in Greenville Needed To Be 'On Call’
The North Carolina Medical Society (NCMS) is once again joining with our friends at the Pitt County Medical Society to answer WITN viewers’ medical questions at the “Doctors on Call” phone-in event. This annual event will be held this year on Wednesday, Sept. 30, from 5 p.m. to 7 p.m., at WITN’s new studios in Greenville. Please consider volunteering to staff the phone bank for one to two hours, as your schedule permits. This is a great effort to help the community! Sign up here. For more information, contact Kristen Shipherd at the NCMS, 919-833-3836 x115.
Give Us Your Best Shot: 2015 NCMS Photo Contest Now Underway
2015 NCMS Photo Contest Now Open
Deadline: July 31, 2015
Now in its seventh year, the NCMS Photo Contest is an annual tradition that has gained national recognition, and we want you to be a part of it! Submissions currently are being accepted for the 2015 contest. Think you have the perfect picture to send in? Check out the rules below (please note: some of the rules have changed from previous years!).
The rules:
- Contest participants are limited to current NCMS members (member physicians, PAs, residents and medical students) only; the NCMS member must be the photographer of the image submitted.
- Submit one image by Friday, July 31, 2015. If you need ideas on what appeals to the judges, review the work of last year's finalists.
- There will be three categories in the contest this year. Please submit images that fall into one of these three and be sure to tell us under which category you are submitting your image:
- Nature (animals, plants, landscapes)
- North Carolina (images should be of locations within the state)
- Travel (send in your best vacation shots)
- Shots should be of landscapes, animals, or abstracts, preferably horizontal in layout; images of people/portraits are generally discouraged, as photo permissions are hard to acquire;
- Please state the title of your photo, where the photo was taken, and any other information you would like to include about the image;
- Photos may be in color or black-and-white;
- Please limit photo manipulation (i.e. Photoshop). Acceptable photo manipulations include minimal dodging/burning or color correction as well as cropping of the original image. The contest is based on photographic skills and highly altered images are not currently accepted.
- NCMS staff members will pick the 13 finalists whose work will be on display in the 2016 Member Calendar.
- The grand-prize winner and category winners will be chosen by a panel of NCMS staff and affiliated jury members;
- The contest finalists will also have their images voted on by the public, with a "Viewer's Choice" award going to the winner of online voting.
Prizes:
- Grand prize winner: $200 gift card and placement on the cover of the 2016 NCMS Member Calendar
- Nature category winner: $100 gift card
- North Carolina category winner: $100 gift card
- Travel category winner: $100 gift card
- Other finalists: $25 giftcard and NCMS gift pack
- All contest participants will receive an NCMS gift pack
How to Enter:
Send your high-resolution images (jpg, tif, eps, or png at least 300 dpi) sized at least to 8" x 10" by any method below:
- Email your file to [email protected]
- Upload your digital file
- Mail a CD/flash drive with your images to NCMS, PO Box 27167, Raleigh, NC 27611 Attn: Kristen Shipherd.
The top 13 photographs will be decided by August 17, when voting opens to the public to determine the "Viewer's Choice" winner.
Menscer Chairs AMA Council on Medical Education
North Carolina Medical Society (NCMS) past president Darlyne Menscer, MD, of Charlotte recently was elected to chair the American Medical Association (AMA) Council on Medical Education. She is in her second term serving on the Council.
Founded to improve medical education in the US, the Council on Medical Education formulates policy on medical education by recommending educational policies to the AMA House of Delegates, through the AMA Board of Trustees. The Council also is responsible for recommending the appointments of representatives to medical education organizations, accrediting bodies and certification boards.
Congratulations on being named chair of this important body, Dr. Menscer!
NCMS Member Prepares for Space Flight
Michael Brennan, MD, a North Carolina Medical Society (NCMS) life member who has been heavily involved in the society and its foundation for many years, is preparing to become one of the first passengers on Virgin Galactic’s commercial suborbital spaceflight. A lifelong dream for Dr. Brennan, he doesn’t know exactly when the flight will happen – perhaps as early as next year – so he has to stay in shape and keep his schedule flexible as he anticipates this journey of a lifetime.
Dr. Brennan, an ophthalmologist who will be retiring at the end of this summer from the Alamance Eye Center, finally decided to apply to become one of Virgin Galactic’s 700 future astronauts last fall after the company’s VSS Enterprise crashed during a test flight in California’s Mojave Desert.
“I thought it would be a good time to apply because a lot of people will drop out,” he told his hometown newspaper The Burlington Times-News. “I could be higher on the list and get to go earlier.”
Virgin Galactic interviewed Brennan twice to make sure he was in good shape and knew what he was getting into. He paid the required upfront deposit and signed a contract shortly afterwards.
Read more about Dr. Brennan’s lifelong desire to be an astronaut. Learn about the Virgin Galactic Future Astronaut Program at their website.
NCMS Marketplace Welcomes New Bronze Level Partner Life Line Community Healthcare
The North Carolina Medical Society (NCMS) is pleased to announce Life Line Community Healthcare is a bronze level partner as part of our Marketplace of products and services to benefit our members.
Life Line Community Healthcare offers NCMS member health systems, ACOs, IPAs, and physician practices a suite of Provider Support Services. These services equip our partners with an added value to help fulfill the care management and reporting obligations, which would otherwise be too burdensome. These services include but are not limited to: annual wellness visits, Medicare Advantage HRA's, and chronic care management. Our Provider Support Services harness the annual wellness visit (AWV) and Medicare Advantage (MA) HRA as gateway opportunities to accelerate achievement of long-term goals and improved patient outcomes. Starting with AWV and MA HRA utilization and following up with a solid chronic care management program, you can decrease your spend on the back end, reduce hospital admissions, and long-term care costs.
Life Line Community Healthcare is just the latest addition to NCMS’ Marketplace, which provides a comprehensive listing of partners offering services in areas of most use to you and your practice. The website provides an easily navigated, tiered partner 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 Marketplace site often as new vendors are added frequently.
Harris Award Nominations Accepted Until June 30
The Carolinas Center for Medical Excellence (CCME) is accepting nominations for the 2015 Harris Memorial Award in honor of the life and memory of one of its founding members, T. Reginald Harris, MD until next Tuesday, June 30.
Presented each year at the Annual Meeting of the North Carolina Medical Society in October, the award honors a North Carolina physician for outstanding achievements in the areas of health care quality and service to the medical community.
“In memory of Dr. Harris, we continue to honor a deserving physician who has made a significant contribution to the practice of medicine and outstanding patient care,” said John B. Smith, MD, board chairman of CCME. “Dr. Harris devoted his career to improving the quality of health care for patients in North Carolina. He provided decades of service to the medical community through the North Carolina Medical Society, the American Medical Association, and many other professional, civic, and community activities.”
To nominate a physician, please complete and submit the nomination form for the physician leader you think is most deserving by Tuesday, June 30, 2015. Download the nomination form. For more information, contact Chris Pfitzer at 800-682-2650, ext. 5687, or [email protected].
Anderson Award Nominations Due July 1
The North Carolina Medical Society (NCMS) is accepting nominations for the John Huske Anderson Award, given annually to a layperson whose contributions have had a positive impact on the medical profession and public health. The award honors Mr. Anderson's service to medicine and the Society, having served as NCMS legal counsel from 1937 until his retirement in 1983. Nominations must be made by an NCMS member.
The deadline for submissions is July 1. You may send the completed nomination form by scanning it and emailing it to Abbey Ruggiero, faxing it to her attention at 919-833-2023 or mailing it to her attention at P.O. Box 27167, Raleigh, NC 27611. If you have questions, please contact Abbey via email or by calling 919-833-3836 x147. Download the nomination form here.
Apply Today To Become a Better Leader
Applications for the NCMS Foundation Leadership College 2016 are now being accepted. The deadline to apply is July 22, 2015.
The Leadership College, part of the Kanof Institute for Physician Leadership, was developed for physicians from across the state who want to develop their leadership skills, and who are interested in attending a professional leadership development program. Since its inception in 2002, the Leadership College has graduated 200 scholars, almost half of whom have advanced to leadership positions in their workplace and/or professional organization.
If you would like to learn more about this selective program, please contact Erin Grover, 919-833-3836, x134. You also can apply online. All applications will be reviewed by the Kanof Institute for Physician Leadership Advisory Committee and scholars will be notified the beginning of September.
In the News
"Death Panels" May Never Die, The Washington Post, 6-23-15
Your Pocket Guide To Obamacare Replacement Plans, The Washington Post, 6-23-15
Examining Race-Based Admissions Bans On Medical Schools, NPR, 6-23-15
Fewer Poor Uninsured Under Health Law, Study Finds, The New York Times, 6-23-15
Obese Now Outnumber Overweight Americans, ModernHealthCare, 6-22-15
Looming Decision Could Cripple Part of NC Health Insurance Market, WFAE, 6-22-15
Report: Wait List for Vets Even Longer Today Than Last Year, The Associated Press, 6-20-15
Blog: AMA, State Medical Societies Call On CMS To Mitigate ICD-10 'Disaster,' ModernHealthCare, 6-19-15
FDA's Trans Fat Ban: Is It a Life-Saver?, MedPageToday, 6-17-15
Drug Overdose Deaths On the Rise in the US, The Huffington Post, 6-17-15
Walgreens Offering Digital Doctor Visits in Five States, USA Today, 6-17-15
Health Insurance Mergers Don't Benefit Consumers, California Regulator Warns, The Los Angeles Times, 6-17-15
BCBSNC Announces New Narrow Network Plan, The Durham Herald-Sun, 6-15-15
Doctors Can Use Social Media in These 3 Ways, MedPageToday, 6-15-15
Think Your Practice is HIPAA Compliant? Think Again, MedPageToday, 6-8-15
Learning Opportunities
Move to Value Summit, the ultimate primer on value-based health care will be held at Biotech Place in Winston-Salem Aug. 27-28. Hosted by CHESS Health Enablement Solutions and sponsored by Wake Forest Baptist Health and LabCorp, the Move to Value Summit is designed to provide you with a broad and deep understanding of what it takes to transform your fee-for-service-dependent organization to one rooted in pay-for-value. Learn more and register.
Registration is now open for NCHICA’s 21st Annual Conference & Exhibition on September 13-16, 2015 at Pinehurst Resort in Pinehurst, NC. This year’s theme is Transforming Healthcare from Volume to Value. The conference provides an excellent opportunity to learn about the latest developments and best practices in health IT and network with your peers. For further details, click here. The registration fee is $475 NCHICA members/$675 non-members. For further details, click here. Fees will increase after August 13, so please register early! NCHICA has a special group rate at the Pinehurst Resort of $205/night, which is good until August 13, 2015. For further details on how to register at the special rate, click here.
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.
ACO Final Rule Released
On June 4, the Centers for Medicare & Medicaid Services (CMS) released a final rule detailing program changes for the Medicare Shared Savings Program (MSSP) in response to feedback and aimed at making the program more viable to current and potential participants. CMS made significant changes to the program requirements, including allowing for an additional 3-year contract term with no downside risk for current ACO participants, maintaining the 50 percent sharing rate for those who choose this option. There were a number of other notable changes made including:
- An additional downside risk option including a 75 percent shared savings rate, prospective assignment of patients to the ACO, and an opportunity to apply for waiver of the current 3-day Skilled Nursing Facility rule.
- A new benchmarking policy, resetting the benchmark in a second or subsequent agreement period by integrating previous financial performance and equally weighting benchmarks for subsequent agreement periods.
- Clarifications to the patient assignment process, including an updated list of CPT codes that will be considered primary care services to include Transitional Care Management codes and the Chronic Care Management code. This rule also finalizes a policy to use primary care services furnished by NPs, PAs and CNSs under step 1 of assignment (in addition to physicians).
- Expanding the types of patient data to be made available to ACOs in various reports provided by CMS to assist in care coordination activities.
- Simplifying the process for patients to decline claims data sharing to reduce the burden for current ACOs (effective Nov. 1, 2015).
The NCMS is pleased to see CMS make these much needed improvements to the MSSP program. CMS indicates that it will continue to make updates and improvements to the program in future rulemaking. If you are interested in learning more about the MSSP program, please visit our Toward Accountable Care (TAC) Consortium and Initiative website.
Watch the NCMS website and future Bulletins for a more thorough analysis of the rule.
CMS Releases Physician Medicare Payment Data
Last week, the Centers for Medicare & Medicaid Services (CMS) released its second annual physician Medicare payment data. This information is intended to offer the public more transparency to foster innovation in the health care system and better informed and more engaged health care consumers, according to CMS.
The data released consists of information on services and procedures provided to Medicare beneficiaries by physicians and other health care professionals. It also shows payment and submitted charges, or bills, for those services and procedures by provider. It allows for comparisons by physician, specialty, location, types of medical services and procedures delivered, Medicare payment and submitted charges. The new 2013 dataset has information for over 950,000 distinct health care providers who collectively received $90 billion in Medicare payments.
The North Carolina Medical Society (NCMS) encourages you to view your data – you can search by your last name here. CMS also has a fact sheet for your review. If you have any questions or notice some irregularities in your data, please contact Jennifer Gasperini, NCMS Director of Health Policy.
NCMS’ Osbahr Re-Elected to AMA Board of Trustees
The North Carolina Medical Society (NCMS) proudly announces Albert J. Osbahr, MD, has been reelected to a second term on the AMA Board of Trustees at the AMA’s Annual Meeting currently underway in Chicago.
Since 2004, Dr. Osbahr has been Medical Director of Occupational Health Services at Catawba Valley Medical Center. Before this, he served 14 years as Occupational Health Director at Haywood Regional Medical Center.
“We congratulate Dr. Osbahr and look forward to his continued leadership at the AMA,” said NCMS CEO Robert W. Seligson. “Dr. Osbahr is an accomplished physician and brings this knowledge and his great leadership expertise to his role on the Board of Trustees on behalf of all physicians.”
Dr. Osbahr’s background reflects a legacy of both local and national leadership roles beginning in 1981 as a student AMA delegate from North Carolina. The AMA appointed him to the Council on Medical Service (CMS) as a student, then elected him to the resident seat where he served for over eight years. Dr. Osbahr twice has been elected to the AMA Council on Science and Public Health, chairing the Council in 2010-11. The AMA appointed him to the national One Health Commission in 2009 where he served 4 years as chairman and International Pain Summit representative in 2010. He has been an NC AMA Delegate since 1998. He currently serves on the Joint Commission Board of Commissioners and on its accreditation committee.
Dr. Osbahr was NCMS president in 2008-2009, having been a region representative to the NCMS Board prior to his presidency. He has been a member of the NCMS Industrial Commission Liaison Committee since 1991. Beginning in 1981, he was appointed to the NC Governor’s Task Force on Public Health and served on the first NC Review Panel for the NC Medical Board. He provides medical review work for a variety of organizations. SEAK, Inc. has honored him as one of the 50 Most Influential People in Workers’ Compensation and Occupational Medicine nationally.
Dr. Osbahr received his BA and MD degrees from the University of North Carolina. He completed a Family Medicine residency at Marshall University School of Medicine in 1989 where he also received an MS in community medicine. He completed his occupational/preventive medicine residency at the University of Kentucky in 1990.
He is Board Certified by the American Board of Family Medicine, American Board of Preventive Medicine in Occupational and Preventive Medicine and Public Health, and the American Board of Independent Medical Examiners, and is certified as a reviewer through the American Association of Medical Review Officers.
Congratulations, Dr. Osbahr!
NCMS Works To Modernize Policy Development and Governance
In the months following the 2014 North Carolina Medical Society (NCMS) House of Delegates (HOD), the Bylaws Modernization Task Force appointed by NCMS President Robert Schaaf, MD has worked to revise the current bylaws to reflect a policymaking process within the NCMS that is more accessible and efficient. The revisions propose that component medical societies and NCMS members be able to bring issues to the Board of Directors for discussion and action on a timely basis, rather than waiting for the House of Delegates to meet annually. At the HOD’s direction, the Annual Meeting for the NCMS will be preserved, but policy decisions would be made by the Board, and the House would be dissolved.
“Concern has been raised about the current House of Delegates process being an optimal manner for developing NCMS policy,” said the report to the House by the Constitution and Bylaws Committee. “Although the House has served the profession well for over 150 years, for many years the majority of substantive decisions have been made by the Board of Directors. Using the Board in this manner is the model many businesses use where shareholders elect a smaller group to provide ongoing leadership, who are in turn accountable to the shareholders.”
Jeff Runge, MD, NCMS regional board member and former Vice Speaker of the HOD, chairs the Bylaws Modernization Task Force. At the NCMS Board of Directors and Past Presidents’ meeting held May 16 in Chapel Hill, Dr. Runge reviewed the draft changes to the bylaws. The proposed bylaws were received favorably. NCMS Past President David Bruton, MD, chimed in “I like what I hear. We must change our way of doing business to be relevant to a new generation of members. This is getting it right.”
Dr. Runge, who is joined on the Task Force by Vice Speaker John Meier, MD and Past President and former Speaker Darlyne Menscer, MD, presented the following schedule for finishing their work and presenting new bylaws to members prior to the 2015 Annual Meeting, scheduled for October 23-24, 2015 in Greensboro at the Grandover Resort and Conference Center. “Our goal is to gather as much member feedback as possible on the revisions so that we can make adjustments and produce a first-rate product, delivering meaningful bylaws to our membership.” The timeline includes:
- On May 16, 2015 the Board of Directors and Past Presidents reviewed the overall changes.
- By June 15, the Board of Directors, the Constitution and Bylaws Committee, and former HOD Speakers will provide any additional feedback to recommended changes.
- In July, the Task Force will incorporate changes or bring back any discussion items to the NCMS Board at their meeting on July 11.
- By July 15, the proposed bylaws document will be published on the NCMS website for member feedback.
- By September 1, the Constitution and Bylaws Committee and Task Force will send a summary of member feedback and the final version to Board of Directors for endorsement.
- In September, the final version will be sent to the HOD from the Constitution and Bylaws Committee.
- In early October, the proposed amendments to the NCMS Constitution and Bylaws will be posted online along with any other HOD business.
- Discussion on the report will take place online and at the Annual Meeting.
Watch the NCMS website and the Bulletin for further information.
ICD-10 – It's Going To Happen This Time So Get Ready
All indicators are there will NOT be further delays in implementation of ICD-10 coding set to take effect on Oct. 1, 2015. Both state and local agencies are working to educate medical practices about the change to be ready on Oct. 1.
NCTracks, the state’s Medicaid claims system, is offering regional seminars throughout the state in June to educate new billing staff and providers, and serve as a refresher for current and experienced staff. Regional seminars allow for greater participation by those who cannot travel to attend Instructor-Led Training sessions in Raleigh. And they offer attendees an opportunity to meet and become familiar with their Regional Provider Relations Representatives. It is a learning opportunity and a chance to network.
The seminars will give providers a high level overview of NCTracks, Claim Submission, Prior Approval, Provider Enrollment, Credentialing, Re-Verification, Provider Record Maintenance, Recipient Eligibility, Managed Care Referrals basics, and current system updates. Each of the seminars runs from 9 a.m. to 4 p.m. Register for the seminar most convenient for you.
- Greenville - June 12, 2015 - NC Cooperative Extension- Pitt County Agricultural Extension Auditorium
- Winston Salem- June 16, 2015 - NC Cooperative Extension- Forsyth County Center
- Raleigh - June 19, 2015 - CSC Facility, 2610 Wycliff Road
Registration is for the entire seminar, but participants can review the agenda and choose to attend all or as many topics as they wish. Printed materials will not be available, but providers can download and/or print their own Participant User Guides (PUGs) from the ILT Guides folder in SkillPort prior to the seminar.
Note that the seminar runs through lunchtime, so providers may want to bring their own lunch, so they can take full advantage of all of the seminar topics. (Lunch is not provided.)
Provider Help Centers will be offered at each location concurrent with the Seminars. NCTracks staff from Claims, Provider Enrollment, and Provider Relations will be available to assist registered NC providers with questions or concerns regarding NCTracks. (Prior Approval, EDI, and Finance staff will be available by phone, if there are questions in those areas.) Please bring specific examples of issues. Registration is required, separate from the seminar, for either the morning or afternoon Provider Help Center sessions and limited to 21 providers per seminar. After all registered Help Center participants have been assisted, and if time permits, the NCTracks staff will see other seminar participants on a first come, first served basis.
Providers can register for the NCTracks Regional Seminars and the Provider Help Centers in SkillPort, the NCTracks Learning Management System. Logon to the secure NCTracks Provider Portal and click Provider Training to access SkillPort. Open the folder labeled Provider Computer-Based Training (CBT) and Instructor Led Training (ILT). The sessions for the Seminar and the Provider Help Center can be found in the sub-folder labeled ILTs: On-site. Refer to the Provider Training page of the public Provider Portal for specific instructions on how to use SkillPort. The Provider Training page also includes a quick reference regarding Java, which is required for the use of SkillPort.
For resources and information on preparing for ICD-10 from the Centers for Medicare & Medicaid Services (CMS) visit their ICD-10 website and Sign up for CMS ICD-10 Industry Email Updates.
Finally, NCTracks staff want to clarify the difference between a CPT code and an ICD-9 soon to be ICD-10 code and what is changing this fall.
An ICD-9-CM code (which will become an ICD-10-CM code this year on October 1) is used to describe a symptom, condition, or disease that is being treated, also known as the diagnosis code.
A CPT code is used to describe the evaluation and management (E/M) code (meaning the physician time, intensity of service, and complexity of the examination performed on a patient at each visit, when applicable.) It can also be used to describe any treatment or diagnostic services (lab tests, radiology tests, immunizations, and so forth) provided to the patient, also known as the procedure code.
AMA Calls for Two-Year ICD-10 Grace Period
While being prepared for the transition to ICD-10 is encouraged, the American Medical Association (AMA) at its Annual Meeting this week in Chicago has called for a two-year grace period for implementation.
The AMA continues to have significant concerns with the readiness of many providers, payers and other participants in the billing chain to implement ICD-10 by the October 1, 2015 deadline. They are asking members to contact your Representatives and Senators to ask them to provide a grace period during implementation so that potential disruptions do not impact the delivery of care.
Read and send the Physicians’ Grassroots Network message to Congress here.
Potential Benefits In the SGR Repeal Law -- MACRA
When the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was signed into law in April, it didn't just repeal the Medicare sustainable growth rate (SGR) formula that had been plaguing physicians for nearly two decades. The bill contained other provisions that will impact how physicians deliver care now and in the future.
Here are several provisions that should be beneficial for physicians:
Medicare payment rates will be stable.
MACRA prevented an impending physician payment cut under the SGR and increased the Medicare conversion factor, part of the formula for calculating physician payments. As a result, Medicare physician pay this year will be 27 percent greater than under SGR. The bill also provides for positive payment updates of 0.5 percent, starting July 1 this year and then on January 1 annually through 2019. Over the next decade, MACRA is projected to increase Medicare funding for physician services by roughly $150 billion.
Quality reporting programs will be consolidated.
Medicare's current quality reporting programs will be simplified into one merit-based incentive payment system, referred to as "MIPS." This means the current web of penalties under the Physician Quality Reporting System (PQRS), meaningful use electronic health record (EHR) program and the value-based payment modifier will expire at the end of 2018 and will be replaced with the MIPS.
Beginning in 2019, physicians who score well in the MIPS could receive substantial bonuses. Performance under the MIPS will be based upon four categories—quality, resource use, meaningful use and clinical practice improvement activities. The MIPS also would build and improve upon current quality measures and concepts in existing programs. Physicians will be encouraged to report quality measures through certified EHR technology or qualified clinical data registries. Participation in a qualified clinical data registry would also count as a clinical practice improvement activity.
Alternative payment models will be rewarded.
Physicians who participate in qualified alternative payment models will receive a 5 percent bonus starting in 2019. These physicians also will be exempt from participating in MIPS. Technical support will be provided to help smaller practices participate in alternative payment models. The AMA is engaging with medical specialty societies and other organizations to help develop and get payers to support implementation of physician-designed alternative payment models.
Results from a recent AMA study conducted by the RAND Corporation found that doctors want to improve patient care delivery through new payment models but need help successfully managing the transition. That includes being able to resolve the diverse priorities and quality metrics of different payers and securing more timely and accurate clinical data to ensure long-term success. Through its Professional Satisfaction and Practice Sustainability initiative, the AMA is taking on this challenge. Visit the Web page on Medicare alternative payment models for more information.
Physicians will have liability protections.
The bill contains a provision similar to the Standard of Care Protection Act that will protect physicians by preventing quality program standards and measures (such as PQRS or MIPS) from being used as a standard or duty of care in medical liability cases.
Learn more about how MACRA will impact physicians on the AMA's new Web page on Medicare physician payment reform, including fact sheets on the impact of MACRA in each state.
Reminder: Register for PQRS Group Practice Reporting Option by June 30 Deadline
Groups have until June 30 to register to participate in the 2015 Physician Quality Reporting System (PQRS) Group Practice Reporting Option (GPRO) via the Physician Value - Physician Quality Reporting System (PV-PQRS) Registration System. PQRS GPRO is an option available to groups with two or more eligible professionals (EPs). Groups must meet the satisfactory reporting criteria through the PQRS GPRO in order to avoid the -2.0% CY 2017 PQRS payment adjustment. More information is available on the PQRS Payment Adjustment Information web page.
Physicians in groups of all sizes and physician solo practitioners are subject to the Value Modifier in 2017, based on performance in 2015. Under the Value Modifier, these physicians and groups must meet the criteria to avoid the downward payment adjustment under PQRS in order to avoid an additional automatic downward adjustment under the Value Modifier and qualify for adjustments based on their quality performance. Satisfactorily reporting via a PQRS GPRO is one of the ways groups can avoid automatic downward adjustments and qualify for performance-based payment incentives under the Value Modifier. See What Physicians Need to do in 2015 for the 2017 VM on the Value Modifier web page for more information.
Instructions for registering to participate in the 2015 PQRS GPRO are provided in the 2015 PQRS GPRO Registration Guide.
Learn about the move to quality reporting, keep up to date on the deadlines, access resources and learn what lies ahead for your practice at "Quality Time with the NCMS" on the North Carolina Medical Society (NCMS) website. Registration is necessary.
Free Support if You Report PQRS through Your EHR
Alliant Quality, the Quality Innovation Network – Quality Improvement Organization (QIN-QIO) for Georgia and North Carolina is providing free support to practices reporting to PQRS via the EHR or Data Submission Vendor (DSV). They would like to identify 35 practices in North Carolina to participate in this initiative. Ideal practices would need to report clinical quality measures (CQMs) for Controlling High Blood Pressure (NQF 0018) and Tobacco Cessation Counseling (NQF 0028) in addition to the seven CQMs needed to meet PQRS EHR reporting requirements. Any medical specialty is eligible for the support as long as they can report the two CQMs above. You must respond and sign up for this free support before July 5, 2015.
To enroll, your practice must meet certain criteria to receive the free support, including:
- Commit to report Controlling High Blood Pressure (NQF 0018) and Tobacco Cessation Counseling (NQF 0028) as a CQM for PQRS EHR based reporting.
- Ensure that you are on one of the following EHRs in the table below.
- Complete these two enrollment forms: Combined Participation Agreement and Practice and Practitioner Demographics
For more information or questions about this initiative please contact Tara McAdoo at 678-527-3673 or [email protected]
| Known EHRs that Support PQRS Reporting in 2015 | |
| Aprima | MPM |
| ASP.MD Medical Office System | Practice Fusion |
| Athena Health | Practice Studio |
| Azzly EHR | SuperEMR |
| Cerner | Springcharts |
| Cure MD | Success EHS |
| eMDs | Total Outcomes Management |
| Meditouch | Vitera Intergy |
| Medinformatix | |
| Medical and Practice Management | |