Learning Opportunities
NCTracks Training Courses Available in May 2015. Unless otherwise noted, all courses will be offered at the CSC facility (2610 Wycliff Road, Suite 102, Raleigh, NC 27607-3073) and involves hands-on training. Enrollment will be limited to 45 participants. To register for these courses, 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 courses can be found in the sub-folders labeled ILTs: On-site and ILTs: Remote via WebEx, depending on the format of the course. Refer to the Provider Training page of the public Provider Portal for specific instructions on how to use SkillPort.
- Monday, May 18 - 9 a.m. to noon - Provider Web Portal Applications Webinar (WebEx) will guide providers through the process of submitting all types of provider applications found on the NCTracks Provider Portal. This course is taught via WebEx and can be attended remotely from any location with a telephone, computer and internet connection. The WebEx will be limited to 115 participants.
- Wednesday, May 27 - 9:30 a.m. to noon - Prior Approval - Medical (Professional) will cover submitting Prior Approval (PA) Requests to help ensure compliance with Medicaid clinical coverage policy and medical necessity. It will also cover Prior Approval inquiry to check on the status of the PA Request.
- Wednesday, May 27 – 1 to 4 p.m. - Submitting a Professional Claim will focus on how to submit a Professional Claim via the NCTracks Provider Portal.
The North Carolina Healthcare Information and Communications Alliance (NCHICA) offers the following session to learn more about how good data can help you care for your patients.
- Pain Management Updates for the Primary Care Provider on May 16, at the Friday Center in Chapel Hill. Register Here.
A workshop on The Role of Coordinated Team Care in Improving the Health of Children and Adults with Intellectual and Developmental Disabilities, will be held on May 20, and is an opportunity for medical and disability professionals to learn from one another and develop partnerships and plans promoting coordinated team care. Registration is $25, limited to 50 participants, and includes lunch, breaks and CMEs/CEUs. Contact Kelly Crosbie for more information.
June 2, 2015, Predictive Analytics Workshop, The Research Triangle Foundation, RTP, NC
This one-day workshop will demonstrate how Accountable Care Organizations and others are using predictive analytics to support their goals of improving quality and reducing costs. Speakers include Shantanu Nigam (Jvion), Angela Diaz (CCME) and J.C. Layton (InfraScience). The registration fee is $199 NCHICA member/$299 non-member. Click here for further details and to register.
Learn more about the 2014 Mid-Year Quality and Resource Use Reports (MYQRURs) on this Medicare Learning Network (MLN) National Provider Call on Wednesday, June 3; 1:30-3pm. The call will provide an overview of the 2014 MYQRUR and explain how to interpret and use the information in the report. Learn more about the reports on the MYQRUR web page. To Register: Visit MLN Connects® Upcoming Calls. Space may be limited, register early. The call will be more meaningful if you have your MYQRUR in front of you to follow along. Visit the How to Obtain a QRUR web page and access your report prior to the call.
Cleveland Clinic Florida’s 6th Annual Internal Medicine Review Board, May 30, 2015 – June 3, 2015 at the DoubleTree by Hilton in Sunrise, Florida, assists Internal Medicine physicians and residents who are preparing to take their boards. More info.
Save the date -- June 12, 2015, for Go SIMple, an opportunity to learn about the hottest trends in simulation education from experts. The training session will be held at Campbell University College of Osteopathic Medicine in Lillington, NC.
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.
NCMS Update: May 11, 2015
Watch what you call that disease:
In naming infectious diseases, the World Health Organization (WHO) would like to be more sensitive. Read their view on the issue.
North Carolina Wins Kudos from Sec. Burwell:
The US Health and Human Services Secretary praised the state for being one of the top enrollment states for the ACA. Read health care reporter Karen Garloch’s account of her visit to The Charlotte Observer.
Other Headlines:
Hepatitis C Infections Soaring Fueled By Prescription Painkiller Abuse, USA Today
After Nearly Claiming His Life, Ebola Lurked In A Doctor’s Eye, The New York Times
NCMS Update: May 7, 2015
The NCMS Legislative Cabinet met last night
The group discussed the latest developments at the legislature and welcomed NCMS PAC chair Sharon Foster, MD, who encouraged Cabinet members to host PAC events to support our legislative agenda.
Don’t miss today’s webinar – but if you do, no worries. It will be repeated next Tuesday
Stephen Nuckolls, CEO of Coastal Carolina Quality Care, will present a 45-minute webinar in which he shows how ConvergX™, an analytics visualization and modeling solution developed by Carolinas Center for Medical Excellence (CCME) in collaboration with Carolina Quality Care, applies predictive statistical modeling to proactively identify high-risk patients, providing care coordinators the ability to deploy targeted resources. This approach has been shown to address patient needs and prevent unnecessary utilization.
Today’s session is at 4 p.m. and will be repeated on Tuesday, May 12 at 10 a.m. Get the details and register.
Registration for next weekend’s ‘must attend’ event ends tomorrow
For those who live, practice or will be passing through the Triangle next Friday, May 15, be sure to register by tomorrow, May 8, for the Mix and Mingle social event at the DuBose House, Rizzo Center, Chapel Hill. Stop in anytime between 5:30 and 7:30 p.m. to share your thoughts regarding the practice of medicine with the NCMS Board of Directors and catch up with your friends and colleagues from throughout the area.
Cocktails and hors d'oeuvres will be served during this casual reception. The event is open to members and prospective members of the NCMS, and spouses are welcome. Register today at www.ncmedsoc.org/mixer.
In case you missed this news:
Rex Hospital Will Not Lose Federal Funding
Rex Hospital will not lose federal funding over an incident in which staff improperly kept a violent, mentally ill patient in restraints and subdued him with a Taser stun gun. Federal investigators decided not to penalize the hospital since it has changed its policies. This was the first time Rex has been placed on "Immediate Jeopardy" status and put at risk for losing hundreds of millions of dollars federal funding through the Medicaid and Medicare programs. Read the Raleigh News & Observer full report.
UNC’s School of Medicine May Open A Branch Campus
The University of North Carolina School of Medicine is considering a branch campus in Wilmington in collaboration with New Hanover Regional Medical Center. Find out more in the Wilmington Star-News article.
NCMS Update: May 6, 2015
NCMS UPDATE
May 6, 2015
Gun bill dropped for the moment
HB 562, Second Amendment Affirmation Act, was pulled from the calendar of the House Appropriations Committee where it was to be discussed Wednesday morning. The bill’s sponsor, Rep. Jacqueline Schaffer, R-Mecklenburg did not explain why she had it removed from the calendar, according to press accounts. The NCMS opposes the provision in the bill that would prohibit a doctors from inquiring about gun ownership in written form.
Here’s another opinion piece from the Fayetteville Observer addressing the issue and mentioning our position on it.
We’re the oldest!
It’s official. The North Carolina Secretary of State has confirmed that the North Carolina Medical Society is the oldest professional association in the state. Officially, we were incorporated in 1858. Informally, we date our founding to 1849. Either way, we’ve been around a long time.
Success by Association, the magazine of the Association Executives of North Carolina (AENC) ran a story about our history. Read all about it.
Mix and Mingle next Friday night
If you live or practice or are just going to be in Chapel Hill next Friday evening, May 15, come and mingle with your NCMS colleagues. Share your thoughts regarding the practice of medicine with the NCMS Board of Directors at this casual open house. Cocktails and hors d'oeuvres will be served. Catch up with old friends and make new ones.
Stop in anytime between 5:30 and 7:30 p.m. at the DuBose House, Rizzo Center, Chapel Hill. The event is open to members and prospective members of the NCMS. Spouses are welcome. Register today.
NCMS Update: May 5, 2015
NCMS UPDATE
May 5, 2015
Happy Cinco de Mayo!
NCMS Announces Settlement of Lawsuit with United Healthcare:
Read our press release on the settlement of this 11-year old lawsuit. Here’s a brief selection of media coverage of the settlement.
Triangle Business Journals
WFAE radio in Charlotte also ran a brief story quoting NCMS CEO Robert W. Seligson and the Raleigh News & Observer is working on a story for today.
Today is Cinco de Mayo AND World Asthma Day:
Read what the National Institutes of Health have to say about the estimated 300 million people worldwide who are living with asthma, right here. In North Carolina, 100 people died from asthma in 2013. Learn what the state is doing for Asthma Awareness Month, here.
One Columnist’s View Of The NCMS’ Stance On Proposed Gun Legislation:
Greensboro News Record
Headlines:
This Small, Wonky Obamacare Program Saved $384 Million Over 2 Years, Vox
Paying Medicaid Enrollees To Quit Smoking, Lose Weight; Will It Pay Off? MedPageToday
NCMS Update: May 4, 2015
Got Quality? See How You’re Doing According to CMS:
The Centers for Medicare & Medicaid Services (CMS) has released the 2014 Mid-Year Quality and Resource Use Reports (MYQRURs) to physician solo practitioners and groups of physicians nationwide. The 2014 MYQRURs were made available for informational purposes only and provide interim information about performance on the six cost and three quality outcomes measures that CMS calculates from Medicare claims and are used in the calculation of the Value Modifier. The value-based modifier will be used to adjust Medicare physician payments according to the physician fee schedule. More information, about the MYQRUR can be found on the 2014 MYQRUR webpage.
The 2014 MYQRUR can be accessed on the CMS Enterprise Portal using a valid Individuals Authorized Access to the CMS Computer Services (IACS) account. More information about obtaining a MYQRUR can be found on the How to Obtain a QRUR webpage. If they have not done so already, we strongly encourage authorized representatives to sign up for a new IACS account or modify an existing account at the CMS Applications Portal.
Need help understanding the drive to quality? Go to “Quality Time with the NCMS” on our website to get information and access our resources. You must register in order to see this page.
How to apply analytics for value-based success:
Join Stephen Nuckolls, CEO of Coastal Carolina Quality Care, as he identifies the metrics that matter most to manage population health for successful clinical and financial ACO outcomes, in an engaging 45-minute webinar this Thursday, May 7, at 4 p.m., OR Tuesday, May 12, at 10 a.m.
Mr. Nuckolls’s ACO has been ranked third in overall performance and second in care coordination among ACOs in the country.
To demonstrate these key performance indicators, Mr. Nuckolls will be using ConvergX™, an analytics visualization and modeling solution developed by the Carolinas Center for Medical Excellence (CCME) in collaboration with Coastal Carolina Quality Care. Registration is free and pre-registration is required. Register at: http://bit.ly/ConvergX.
Headlines:
Pollack Tapped To Lead AHA, ModernHealthCare, 5-4-15
Physician Burnout Heavily Influenced By Leadership Behaviors, MedPageToday, 5-3-15
Untapped US Energy Source – Excess Human Fat, Improbable Research, 4-30-35
NCMS Update: May 1, 2015
Crossover is over; Onward to the Budget: The NC General Assembly finished their business in the wee hours of this morning (2:26 a.m. to be exact). Overall, 1,655 bills were filed this session with 343 bills passing in the House and 164 passing in the Senate by the crossover deadline. Several policy bills of interest to NCMS made it through:
- HB158, the Jim Fulghrum Teen Skin Cancer Prevention Act (aka Ban the Tan) would prohibit those under 18 from using tanning equipment
- HB 306 would require insurers to cover cancer drugs taken orally.
- HB528, Chiropractor Co-Pay Parity, would prohibit insurers, other than the state's employee health plan, from charging larger co-pays than for physicians if a medically similar service is provided.
HB562, which would prohibit physicians from asking their patients about firearms is still alive thanks to a last minute change that attached a $20,000 price tag to the legislation. Bills with a budgetary impact are not subject to the crossover deadline. Most significantly for NCMS this means the debate over Medicaid reform is about to heat up.
Those bills of interest that didn’t make it through include:
- A House committee unanimously rejected a proposal to legalize medical marijuana.
- The House Rules Committee killed a repeal of the state's mandatory helmet law for motorcycle riders.
Name change for the IOM: The National Academy of Sciences voted to change the name of the Institute of Medicine to the National Academy of Medicine. The newly named National Academy of Medicine will continue to be an honorific society and will inherit the more than 1,900 current elected members and foreign associates of the IOM. The National Academy of Medicine will join the National Academy of Sciences and the National Academy of Engineering in advising the nation on matters of science, technology, and health.
On the road with Will: Yesterday our Director of Membership Will Barnett was meeting with the physicians at the Outer Banks Hospital. Today, he’s at the Campbell University Jerry M. Wallace School of Osteopathic Medicine getting the medical students ‘psyched’ about NCMS membership.
Headlines:
Medicare Data Show Contrast in Generic, Brand Prescribing, Associated Press
The Doctor Will Video Chat With You Now: Insurer Covers Virtual Visits, NPR
US Doctors Rush To Aid Nepal Relief Efforts, MedPageToday
NCMS UPDATE: April 30, 2015
Time stands still in Raleigh: Today is “crossover” at the General Assembly, meaning late nights for the NCMS Government Affairs lobbying staff as legislators try to push their bills through either the House or Senate. If a policy bill is not passed by either chamber by midnight tonight, it’s pretty much ‘dead’ this session. Bills with a budget impact, however, like Medicaid reform, are not subject to this deadline. In the past, legislators have been known to ‘stop the clock’ at midnight to give themselves a little extra off-the-record time to get a bill passed.
Don’t mention guns: One of the bills that generated a lot of discussion on Wednesday was HB562. This bill would prohibit physicians from asking their patients about firearms – a common safety screening question for pediatricians and family physicians. The NCMS issued the following statement on the bill in response to requests from the media for our position:
The North Carolina Medical Society (NCMS) opposes any legislation restricting physicians’ ability to communicate with a patient on important matters involving health and risks to their health, and especially the health of children. Doctors routinely speak with their patients about potential health threats, including dangerous chemicals, car seats, water safety, tobacco and guns. These discussions are helpful to patients and should not be discouraged or prohibited by the General Assembly.
Ultimately, a $20,000 price tag was attached to the bill, which means it is not subject to the crossover deadline and will be taken up again, perhaps next week.
Here’s what the media had to say on the issue:
Raleigh News & Observer
WRAL
NC Health News
NCMS calls on the Outer Banks Hospital: NCMS Director of Membership, Will Barnett, is visiting the Outer Banks Hospital today to speak with their physicians about what the NCMS can do for them.
Headlines:
More Medical Workers Can Monitor Executions in NC House Bill, Greensboro News-Record
Healthcare Spending Rises 5.5% While Rest of Economy Sputters, ModernHealthCare
The SGR Has Been Repealed. Now What?
With the long awaited and historic repeal of the sustainable growth rate (SGR) formula two weeks ago, national health policy analysts and North Carolina Medical Society (NCMS) staff have been digging through the legislation to uncover what it all means for you and your practice going forward.
First, add a new acronym to your vocabulary – MACRA, which stands for Medicare Access and CHIP Reauthorization Act, which is the legislation that repealed the SGR.
See a year-by-year summary of MACRA’s new payment structures through 2026 and beyond here.
Most immediately, some practices may have had claims processed at the decreased rate before the bill was signed into law. Palmetto GBA, the Medicare administrator for North Carolina, offers answers to the questions they’ve received about this here.
MACRA contains many provisions beyond repeal of the SGR, perhaps most significantly that Physician compensation will be adjusted based on performance under the new law’s Merit-Based Payment Incentive System (MIPS). This includes incentive/penalty programs like the Physician Quality Reporting System (PQRS), EHR/Meaningful Use Incentive Program, and Value-Based Payment Modifier (VBPM). Professionals who treat few Medicare patients, or those who receive a significant share of their revenue from eligible Alternative Payment Models (APMs) will be excluded from the MIPS.
Get a better understanding of these various programs and the deadlines that apply at the Quality Time with the NCMS webpage (you must register on the NCMS website in order to access the information on this page).
Other provisions include:
- Electronic Health Records (EHR) must be interoperable by 2018 and prohibits providers from deliberately blocking information sharing with other EHR vendor products. MACRA defines “Interoperability” as “the ability of two or more health information systems or components to exchange clinical and other information…to provide access to longitudinal information for health care providers in order to facilitate coordinated care and improved patient outcomes.”
- Extension of funding for Community Health Centers (CHC) and National Health Service Corps Fund (NHSC) and Teaching Health Centers. The fund for all three programs was set to expire in September 2015, but MACRA authorizes an additional two years of funding through fiscal year 2017.
- No delay in implementation of ICD-10.
Watch the NCMS Bulletin and website for ongoing updates on what the new law means for you.
ACO Toolkit for Gynecologists Now Available
For gynecologists interested in learning more about accountable care organizations and what their practice’s role may be in such a model of care, a new resource is now available online. The Accountable Care Guide for Gynecologists (PDF) has been released and may be downloaded for free on the Toward Accountable Care (TAC) Consortium and Initiative website. The Accountable Care Guide for Obstetricians was published last year and also is available on the website.
This is just the latest addition to the growing library of resources aimed at helping various specialties understand accountable care. The North Carolina Medical Society (NCMS), has spearheaded these toolkits through TAC, as well as facilitated the NC ACO Collaborative, which brings together both existing and developing ACOs throughout the state along with the organizations that support them to discuss their challenges and successes. For more information about any of these projects, please contact Melanie Phelps at the NCMS, 919-833-3836.
Applications Now Accepted for NCMS Leadership College 2016
Applications for Leadership College 2016 are now being accepted. 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 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, 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.
Palmetto GBA Will Continue As North Carolina’s Medicare Administrator
The Centers for Medicare & Medicaid Services (CMS) announced as of April 1, 2015, Palmetto GBA has been awarded another five year contract to administer Medicare services for the region that includes North Carolina. Palmetto GBA has been the Medicare Administrative Contractor for the jurisdiction that includes North Carolina, South Carolina, Virginia and West Virginia since 2010.
These contracts are awarded under a federal competitive bid process. Details about the process are available here.
The five-year contract will employ more than 600 administrative and professional employees within Palmetto GBA offices in Georgia, Ohio and South Carolina.
According to CMS, Jurisdiction M includes more than 3.2 million Medicare beneficiaries, more than 59,000 physicians and 327 hospitals that serve Medicare patients.
Dispelling ICD-10 Myths
The Centers for Medicare & Medicaid Services (CMS) wants to dispel some of the myths surrounding the impending implementation of the new ICD-10 codes. Here are the facts about ICD-10:
- No more delays -- the ICD-10 transition date is set for October 1, 2015.
The government, payers, and large providers alike have made a substantial investment in ICD-10. This cost will rise if the transition is delayed, and further ICD-10 delays will lead to an unnecessary rise in health care costs. Get ready now for ICD-10. - You don’t have to use 68,000 codes.
Your practice does not use all 13,000 diagnosis codes available in ICD-9. Nor will it be required to use the 68,000 codes that ICD-10 offers. As you do now, your practice will use a very small subset of the codes. - You will use a similar process to look up ICD-10 codes that you use with ICD-9.
Increasing the number of diagnosis codes does not necessarily make ICD-10 harder to use. As with ICD-9, an alphabetic index and electronic tools are available to help you with code selection. - Outpatient and office procedure codes aren’t changing.
The transition to ICD-10 for diagnosis coding and inpatient procedure coding does not affect the use of CPT for outpatient and office coding. Your practice will continue to use CPT. - All Medicare fee-for-service providers have the opportunity to conduct testing with CMS before the ICD-10 transition.
Your practice or clearinghouse can conduct acknowledgement testing at any time with your Medicare Administrative Contractor (MAC). Testing will ensure you can submit claims with ICD-10 codes. During a special “acknowledgement testing” week to be held in June 2015, you will have access to real-time help desk support. Contact your MAC for details about testing plans and opportunities.
Visit the CMS ICD-10 website for the latest news and resources to help you prepare, and sign up for CMS ICD-10 Industry Email Updates.
ICD-10 Help From NCTracks
NCTracks Medicaid claims system staff is gearing up for the transition to ICD-10, and offers this advice to providers: Find out what your ICD-10 codes will be by using the latest version of the NCTracks ICD-10 Crosswalk.
The ICD-10 codes in the Crosswalk are the ones that will be used in NCTracks when it is switched to ICD-10 codes on October 1. A few non-specific ICD-9 codes are not in Crosswalk -- not in the NCTracks Crosswalk nor the one created by CMS. If you enter a specific ICD-9 code and don't receive corresponding ICD-10 codes, email the NCTracks staff at [email protected]. Use this email address for all your questions regarding ICD-10 and NCTracks. NCTracks staff promises a personal answer.
BCBSNC ICD-10 Provider Readiness Survey
From Blue Cross and Blue Shield of North Carolina
This ICD-10 conversion readiness survey is being conducted to identify and evaluate opportunities to minimize possible disruptions in health care billing, reporting, and payment processes within North Carolina’s health-care industry.
The survey consists of just six questions related to your organizational readiness for ICD-10 compliance on October 1, 2015, for services and inpatient discharges occurring on and after that date. The responses from this survey will enable BCBSNC to collectively reach a state of readiness, as well as better prepare for risk mitigation where needed.
Response to the following questions will be used to help gain an understanding of ICD-10 preparedness with North Carolina, and to identify if there are any specialties of care that may be experiencing a slower transition due to code changes complexities. The purpose of this survey is to gain an understanding about statewide ICD-10 readiness and identify possible trends. Individual practice details are not being identified or recorded by this survey*. Thank you for your participation in this survey.
TAKE THIS QUICK SURVEY NOW
*Answers to the survey questions are anonymous but in order to be entered into the monthly drawing for a $25 gift card, please provide your contact information. Contact information will not be included in your survey response and will not be shared.
What Does A Patient Safety Organization Offer?
The US Department of Health and Human Services (HHS) enacted the Patient Safety & Quality Improvement Act, which creates a voluntary reporting program in which health care providers can share information relating to patient safety events with a patient safety organization (PSO) on a privileged and confidential basis. The goal is to bolster efforts to improve the quality and safety of health care. Belonging to a PSO can benefit your practice. The AMA has consistently endorsed the benefits of belonging to a PSO since the physician’s perspective is often missing when it comes to analyzing patient safety events. Sharing these events with a PSO allows others to learn as well.
Providers can report safety events to PSOs within a protected environment safe from legal discovery and publication. As a result, PSOs can be a source of confidential advice and data analysis for physicians seeking to understand and improve their health care delivery. Physicians are foremost leaders in deciding whether health care is good, safe, and efficient, but the work of improving performance is difficult and demanding. By developing and using their own patient safety evaluation systems to report to PSOs, physicians are better able to develop robust, actionable information in order to redesign processes and systems that improve care delivery, reduce the potential for patient harm and increase care efficiency.
For information on the NCQC Patient Safety Organization, please contact Nancy Schanz, Director, NCQC PSO
In the News
Huge Medicare Appeals Backlog Draws Senate Scrutiny, ModernHealthCare, 4-28-15
How Is the Doctor-Patient Relationship Changing? It's Going Electronic, The Washington Post, 4-27-15
Should Doctors Be Allowed to Ask Patients About Their Gun Habits?, The Los Angeles Times, 4-23-15
Five Years Old, Going On 10: The Future of the ACA, MedPageToday, 4-22-15
Few Consumers Are Using Quality, Price Information to Make Health Decisions, Kaiser Health News, 4-21-15
Jeb Bush Proposes Medicare End-of-Life Directives, The New York Times, 4-17-15
Half the States Look At Right-To-Die Legislation, USA Today, 4-15-15
Goodbye and Good Riddance to SGR, MedPage Today, 4-15-15
Party on SGR's Grave May End In Hangover, ModernHealthCare, 4-15-15
Health Care Data Points, ModernHealthCare, 4-11-15
Congress Votes to Repeal SGR
Last night history was made when the US Senate repealed the sustainable growth rate (SGR) formula with passage of H.R. 2, the “Medicare Access and CHIP Reauthorization Act,” or MACRA. The Senate passed bill was identical to the version that passed the House of Representatives by an overwhelming 392-37 margin on March 26. Now the legislation is with President Obama, who has indicated he will sign it into law.
The passage of this bill marks the conclusion of nearly two decades of frustration with the formula, which most everyone agreed was broken. For years, Congress would annually defer the scheduled reductions in Medicare payments because they could not agree on how to offset the cuts to pay for a permanent fix.
This historic passage would not have been possible without your efforts in reaching out to your Senators and Representatives to let them know how this broken system affected you and your practice. Please call or write to thank them for supporting you with their vote.
While the North Carolina Medical Society (NCMS) worked diligently over the years mobilizing our membership and making repeated visits to Washington, D.C. to lobby our Congressional representatives to repeal the SGR, the ultimate result would not have been possible without the extraordinary efforts of the AMA’s Senior Vice President for Advocacy Richard Deem and his lobbying team.
The NCMS staff is busy analyzing the law and its many new provisions and what they will mean to you. Watch your email and the Bulletin for more information in the weeks and months ahead.
Thank Your Legislator
NCMS Leads Medicaid Reform Efforts
The North Carolina Medical Society (NCMS) has been leading the charge toward meaningful Medicaid reform most recently by bringing together the groups most affected by changes to the state’s Medicaid program. The goal of this large group of concerned organizations is to present a detailed plan to legislators in the next few weeks. Ideally, the plan would serve the most vulnerable citizens of North Carolina, while providing a sustainable financial package to meet the budgetary issues legislators face.
On April 9, the NCMS hosted an historic meeting at its Center for Leadership in Medicine in Raleigh. More than 75 individuals from organizations that sometimes find themselves on opposing sides on policy issues attended the meeting. Groups representing doctors, hospitals, nurses, long-term care, skilled nursing, adult care, hospice, PhRMA, pharmacy, mental health, behavioral health, social workers and Medicare ACOs attended the meeting.
Absent a cohesive vision for how Medicaid should operate in the state, it is likely state legislators will turn the program in its entirety over to a managed care organization, as the recently filed Senate Bill 703 proposes. The provider groups have a small window to present an alternative plan for reform to legislators.
Medicaid reform is a key legislative priority for the NCMS this session. We have steadfastly supported a provider-led, value-based approach, and are opposed to turning the program over to a managed care organization.
General Assembly Considers Changes To NC Medical Board Law
House Bill 543, Amend Laws Pertaining to NC Medical Board, was reviewed today by the House Health Committee. This bill is similar to one introduced last year at the General Assembly and is the result of a year’s work to reach a broad agreement within organized medicine on the content of the proposed amendments.
Among the proposed changes:
- The bill would modernize the Physicians Health Program (PHP) enabling statute and increase due process by providing a summary of PHP’s assessments and basis for any recommendations to participants as recommended by the State Auditor.
- It would increase annual physician licensing and renewal fees from $175 to $250. The last fee increase was nine years ago. The increase is needed to ensure the Board’s continued effectiveness and to increase funding for the PHP as recommended by the State Auditor.
- The bill also would offer further transparency and protections for physicians in their contacts with the Medical Board. For instance, it would permit the Medical Board to share information with its licensees via email. Other provisions state that the Board could not refuse to renew a license held by a current licensee simply because the applicant is not board certified by a medical specialty certifying body.
Review all the provision of the bill here.
3 Percent Medicaid Retroactive Rate Reduction to Begin April 23
The NC Department of Health and Human Services issued a special Bulletin to Medicaid providers last night alerting everyone that they will begin reprocessing claims incorporating the retroactive 3 percent rate reduction passed by the General Assembly in 2014. The reduced rate will be assessed back to January 2014, when it was originally to begin.
Learn the details about what this may mean for you and your practice here.
This retroactive reduction is highly unfortunate, and increases the urgency with which the North Carolina Medical Society (NCMS) is working toward reform of the state’s Medicaid system.
CMS Proposal Seeks to Streamline EHR Incentive Programs
On Friday, April 10, the Centers for Medicare and Medicaid Services (CMS) issued a new proposed rule for the Medicare and Medicaid EHR Incentive Programs standardizing the 2015 meaningful use reporting period from one year to 90 days among other changes.
CMS’ goal is to allow providers to “focus more closely on the advanced use of certified EHR technology to support health information exchange and quality improvement.”
Together with the Stage 3 notice of proposed rulemaking (NPRM) issued on March 20, 2015, the rules align and merge the “stages” of meaningful use requirements.
The proposed rule changes the programs by:
- Streamlining reporting by removing redundant, duplicative, and topped-out measures
- Modifying patient action measures in Stage 2 objectives related to patient engagement
- Aligning the EHR reporting period for eligible hospitals and CAHs with the full calendar year
- Changing the EHR reporting period in 2015 to a 90-day period to accommodate modifications
The proposed changes are subject to a 60-day comment period. A final rule will be drafted after that and could be issued this summer.
The North Carolina Medical Society (NCMS) Director of Practice Improvement Terri Gonzalez regularly consults with practices to help them meet meaningful use and receive their incentive payments. Contact Gonzalez via email or by phone at 919-833-3836 x123.
The new proposed rule may be viewed online. A fact sheet about the NPRM is also available. More information on the comment period for this proposed rule will be available soon.
For more about meaningful use, visit the CMS EHR Incentive Programs website.
CMS Certifies NCTracks Paving Way for Higher Federal Payments to State
NCTracks, the claims payment system implemented by the North Carolina Department of Health and Human Services, has earned certification by the federal Centers for Medicare and Medicaid Services (CMS). The certification of this claims system, which fumbled at its launch on July 1, 2013, means the federal government will now bear more of the cost of its operation resulting in about $19 million additional federal funding for the state.
NCTracks meets the federal government's requirements for accurate and timely payment of claims for medical services submitted by health care providers, according to CMS, which will now cover 75 percent of NCTracks' annual operating costs, instead of the 50 percent it has covered since the system went live.
“We are thrilled with this news," said DHHS Secretary Aldona Wos, MD in a press release. "This accomplishment represents tremendous dedication and commitment on the part of our team. We are also grateful for the North Carolina providers and the provider associations who have partnered with us during this roll-out."
The department contracted with Computer Sciences Corporation (CSC) in 2008 to design and develop this claims payment system. When it launched on July 1, 2013, the system was plagued by problems, which meant many doctors were not being paid. The North Carolina Medical Society (NCMS) helped hundreds of our members resolve their claims issues with NCTracks, and continues to work to improve the system for members.
"This is certainly good news for the Medicaid budget and NCTracks," said NCMS CEO Robert W. Seligson. "We hope that the system has turned the corner and the worst is over for our members."
North Carolina Medicaid covers 1.9 million North Carolinians at an annual cost of $13 billion in combined state and federal funds.
NC Medical Care Advisory Committee Seeks Nominees
The Medical Care Advisory Committee (MCAC), which advises the Director of the NC Department of Medical Assistance (DMA) on how proposed initiatives and changes would impact the Medicaid Program, is seeking new members. Read more about the purpose of the MCAC here.
Committee members must represent all 13 congressional districts in the state and must include health care providers, consumers representing the general public and recipients or former recipients served by the Medicaid program. Each committee member is appointed by the Secretary of the North Carolina Department of Health and Human Services and is asked to serve a 3-year term.
The role of the health care providers on the committee is crucial due to their professional and scientific background. They have particular insight to offer on peer review and misutilization within a specific area of practice as well as the implementation of policies relating to medical care practices. The health care members on the committee can help solve many of the problems facing the health care system today including rising health care costs, disorganization, improper allocation of resources and inadequate emphasis on preventive care.
The committee meets quarterly for approximately two hours at DMA's office in Raleigh. Members are required to attend the meetings in person at the specified location, generally from 10 a.m. to noon. To make a nomination, please complete this biographical sketch form. Forms along with the nominee's resume are due April 26 to Pamela Beatty, NC DHHS-Division of Medical Assistance (Director’s Office), 2501 Mail Service Center, Raleigh, NC 27699-2501 or via email: [email protected]. Questions, please contact Beatty via email or at 919-855-4102.
NCMS President Schaaf Receives Order of the Long Leaf Pine
North Carolina Medical Society (NCMS) CEO Robert W. Seligson presented NCMS President Robert E. Schaaf, MD, FACR, with the Order of the Long Leaf Pine on behalf of Governor Pat McCrory on Monday evening, April 13, at the Wake Radiology employee dinner and brand launch. The Order of the Long Leaf Pine is North Carolina’s highest honor conferred by the Governor on those who have demonstrated long and distinguished service to the state.
“In his 11 years on the NCMS Board and now as our president, I’ve come to know how effective Dr. Schaaf is as a leader,” Seligson told the crowd of 300 Wake Radiology employees. “In addition to his tenure on our board, he also serves as Vice Chairman of the Board of Trustees for the Medical Mutual Insurance Company and was appointed by the Governor to the Medical Care Commission. He truly has made a commitment to your profession in this state.”
In addition to this honor, Schaaf was recognized by his colleagues at Wake Radiology for his 35 years with the group where he served as President and Managing Partner for 27 of those years, from 1986 to 2013.
“Dr. Robert Schaaf turned Wake Radiology into what it is today, and I am eternally grateful for his leadership and his friendship,” said Lyndon Jordan, MD, Wake Radiology’s current President, who is a longtime NCMS member and Leadership College alumnus, class of 2013. The gathering for Wake Radiology employees also marked the launch of the group’s new brand, which is reflected on its new website and marketing materials.
Congratulations, Dr. Schaaf!
Practice in Pennsylvania in the Last Six Years? You May Get a Refund Payment
If you practiced in Pennsylvania in 2009, 2010, 2011, 2012, or 2014, you may be eligible for a refund payment from the Mcare Fund, a state fund that provides excess medical liability coverage for physicians and certain other health care providers and is funded by assessments on the providers.
The refunds are required as a result of a settlement of litigation involving the Mcare Fund brought by the Pennsylvania Medical Society (PAMED) and other provider organizations. The settlement requires the Mcare Fund to refund $139 million for assessment overcharges in the listed years.
The Mcare Fund will be mailing notices to eligible health care providers about their refunds – likely in the fall of 2015. The first round of payments is tentatively scheduled for early 2016.
PAMED has created a dedicated website to help physicians and physician practices understand the refund process, including who is eligible for refunds and how to address potential rights to the refund by another person or entity who may have paid the assessment, such as an employer.
The PAMED website can be found at www.McareRefund.org.
If you believe that you are eligible for a refund, you should review the PAMED website and make sure that your mailing address is up-to-date with the Pennsylvania physician licensing boards. This is the address the Mcare Fund will be using for mailing refund notices and payments.
The PAMED website includes instructions on how to update your Pennsylvania license address. You can do this, even if your Pennsylvania license is no longer active.
The AMA State Litigation Center, in which the North Carolina Medical Society (NCMS) participates, provided a financial contribution to help cover PAMED’s litigation costs and also filed an amicus curiae brief in support of PAMED’s position.
Tomorrow Is Health Care Decisions Day
North Carolina Governor Pat McCrory has proclaimed tomorrow, Thursday, April 16, 2015 Health Care Decisions Day. The special recognition is designed to raise public awareness of the need to plan ahead for health care decisions related to end-of-life care and medical decision making whenever patients are unable to speak for themselves. The proclamation also encourages the specific use of advance directives to communicate these important health care decisions. Read the entire Proclamation here.
The North Carolina Medical Society (NCMS) has long been involved in encouraging such advanced planning through our advocacy efforts at the General Assembly and through our North Carolina Partnership for Compassionate Care program. The Partnership offers a wealth of information and resources for both patients and doctors. Visit the website here.
Also, keep in mind our Understanding MOST E-learn courses to get a better understanding of the MOST form and how it ties into advance care planning. To learn more, click here.
Register for “Understanding MOST: Part 1“ (Why MOST is an essential tool for knowing and honoring patient wishes at the end of life) – $10 registration fee
Register for “Understanding MOST: Part 2“ (Completing the MOST form) – $10 registration fee
Credible -- Newest NCMS Gold Level Partner
The North Carolina Medical Society (NCMS) is pleased to announce Credible has become a new Gold level partner as part of our Marketplace to benefit our members.
Credible offers NCMS members the ability to easily save on their student debt. With Credible, you can easily submit a single form and receive offers from multiple lenders. The average medical school graduate who refinances with Credible saves over $40,000.
This is just the latest partner addition to NCMS’ Marketplace for member services, which provides a comprehensive listing of vendors offering services in areas of most use to you and your practice. The website provides an easily navigated, tiered vendor system for easy comparison as well as the ability to search by specialty.
We hope you take advantage of this valuable member benefit.
Watch the Bulletin and visit the site often as new vendors will be added frequently.
Nominees Sought For Physician Community Service Award
The North Carolina Medical Society (NCMS) is accepting nominations for the E. Harvey Estes, Jr., MD, Physician Community Service Award. This award is designed to provide recognition for the many and varied services rendered by physicians to their communities apart from their practice of medicine. The recipient must be a physician licensed in North Carolina; must not have received the award previously; and must have compiled an outstanding record of community service, which, apart from his or her specific identification as a physician, reflects well on the medical profession.
Nominations must be received by 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 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 form here.
Anderson Award Open for Nominations
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.
Problem Solved: Are There Guidelines For Closing Or Departing a Medical Practice?
If you need an answer or a problem solved regarding your practice, as a North Carolina Medical Society (NCMS) member you have access to our Solution Center Coordinator, Belinda McKoy, who is standing by to help you solve the problem or answer your question. Call (919-833-3836 x142) or email Belinda the next time you need a problem solved.
Here is a common question Belinda receives:
Question: Are there guidelines for closing or departing a medical practice?
Answer: This issue is addressed by the North Carolina Medical Board in a position statement. For more details, please visit the North Carolina Medical Board's Guide: The Doctor Is Out: A Physician's Guide to Closing a Practice.
NCMS Plan Health Promotion Coordinator Named To Top 100
NCMS Plan Health Promotion Coordinator Jason Horay was named as one of the Top 100 Health Promotion Professionals by the Wellness Council of America (WELCOA) for promoting well-being among NCMS Plan members.
WELCOA’s Top 100 were selected based on peer voting and a judging panel that reviewed the applications. To qualify, the health professionals must coordinate ongoing health programs, implement innovative health solutions, have a vision for the future of the health industry, and serve as business and community leaders. WELCOA is the largest national organization for health professionals and sets the standard for workplace wellness programming.
“I’m grateful to receive this recognition from WELCOA. The NCMS Plan continues to enhance its products and services to drive wellness, support behavior change, and ultimately allow members to lead healthier lives,” Horay said. “Enhancing the well-being of the medical practice professionals we serve requires key leadership support, and I have found that support widespread across the state. My vision is to move beyond the traditional risk reduction model and focus on the vitality of our members. As health promotion professionals, we need to take a more holistic approach and offer solutions that fit with a person’s unique lifestyle.”
As a member of the Top 100, Jason will be featured on the welcoa.org website.
The North Carolina Medical Society Employee Benefit Plan (NCMS Plan) has been providing group benefit solutions to medical practices in North Carolina since 1998. Sponsored by the North Carolina Medical Society and managed by MMIC Agency, the NCMS Plan currently is the preferred choice for group benefits for over 700 medical practices in North Carolina. Learn more about the NCMS Plan here.
In the News
Prescription Drug Spending Jumps 13% To Record $374 billion in 2014, The Los Angeles Times, 4-14-15
Oncologists Weigh In On Ken Burns' Cancer Documentary, MedPage Today, 4-13-15
Survey: Nearly 9 in 10 Adults Now Have Health Insurance, The Associated Press, 4-13-15
The County Doc With A $10 Billion Budget, MedPage Today, 4-12-15
Health IT Interoperability Remains Elusive, ModernHealthCare, 4-11-15
Texas Doc Board Votes To Restrict Telemedicine Visits, ModernHealthCare, 4-11-15
Veterans Affairs Makes Little Headway To Shorten Wait Times for Care, The Associated Press, 4-9-15
Dr. Donald Lindberg: 30 Years At the Intersection of Computers, Medicine and Information Sharing, Kaiser Health News, 4-8-15
How Much Doctors Are Paid For Quality May Not Be As Important As Some Think, ModernHealthCare, 4-6-15
How Bill Awaiting Congressional OK Achieves Medicare Savings, The Associated Press, 4-6-15
Medicare is Stingy in First Year of Doctor Bonuses, Kaiser Health News, 4-6-15
Medicare at 50: Run to Value, MedPage Today, 4-1-15
FTC Commissioner Suggests Regulatory Board Changes Following Supreme Court Decision, ModernHealthCare, 4-1-15
Germanwings Crash Highlights Workplace Approaches To Mental Health, NPR, 4-1-15
Learning Opportunities
NCMS Legislative Update, TOMORROW, Thursday, April 16, noon- 1p.m. Join Jennifer Gasperini, NCMS Director of Health Policy, for this free webinar in which she will discuss the latest updates on Medicaid reform and other legislative issues being discussed by the North Carolina General Assembly in the 2015 long session. You must register here to attend.
How to Register for the PQRS Group Practice Reporting Option in 2015, TOMORROW, Thursday, April 16, 1:30-3 p.m. This Medicare Learning Network (MLN) National Provider Call provides a walkthrough of the Physician Value (PV) - Physician Quality Reporting System (PQRS) Registration System, an application serving the Value Modifier (VM) and PQRS programs. A question and answer session will follow the presentation. To register, visit MLN Connects® Upcoming Calls.
MAHEC's Spring CE offerings:
February 19th – May 28: “MAHEC Motivational Interviewing for Health Care”
April 30: “Finding Stability: Management to Live Better with Parkinson Disease or Essential Tremor”
May 6-8: “MAHEC Women’s Recovery Conference”
May 8: "Healthcare Express Track"
May 12: “You’re Looking at Me Like I Live Here and I Don’t – A Unique Documentary About Living with Alzheimer’s and Post-Film Panel Discussion”
Save-the-Dates: June 3-6: “Southeast Pain Symposium”
ICD-10 classes for small rural practices offered by CMS for those physicians and practice managers who need a “jump start” to prepare for the October 2015 implementation of ICD-10. The remaining in-person classes offered in North Carolina are both on Wednesday, April 22 in Fayetteville from either noon to 2p.m. or 5 to 7 p.m. Register for the afternoon class here; the evening class here. The classes are free.
Review of Systems: A Practice Workshop, April 25, 2015 at the McKimmon Center, Raleigh, NC is presented by the NC Psychiatric Association. This one-day workshop will focus on practice management issues and important policy updates that will improve your bottom line. 6.5 hours of AMA PRA Category 1 Credits™ More information and register here.
Cleveland Clinic Florida’s 6th Annual Internal Medicine Review Board
Cleveland Clinic Florida would like to assist Internal Medicine physicians and residents who are preparing to take their boards. They will be able take their boards with confidence by attending the 6th Annual Internal Medicine Board Review from May 30, 2015 – June 3, 2015 at the DoubleTree by Hilton in Sunrise, Florida. More info.
Save the date -- June 12, 2015, for Go SIMple, an opportunity to learn about the hottest trends in simulation education from experts. The training session will be held at Campbell University College of Osteopathic Medicine in Lillington, NC.
Thank your legislators for the repeal of the SGR
Please reach out to thank the Senators and Representatives who voted in favor of HB2 and repeal of the SGR. A sample message may read:
Thank you for your support of HB2. This is historic legislation that finally brings an end to an era of uncertainty for Medicare beneficiaries and their physicians and puts us on the road toward implementation of innovative care models that will improve care quality and lower costs. As a physician, I thank you and I’m sure the many Medicare beneficiaries I care for and who are your constituents thank you.
Not sure who represents you? Visit http://www.house.gov/representatives/find/.
Legislator |
|
Phone |
| US Senator Richard Burr | http://www.burr.senate.gov/contact/email | 202-224-3154 |
| US Senator Thom Tillis | http://www.tillis.senate.gov/content/contact-thom | 202-224-6342 |
| US Representative Renee Ellmers | https://reneeellmers.house.gov/contact/ | 202-225-4531 |
| US Representative Virginia Foxx | http://foxx.house.gov/contact/ | 202-225-2071 |
| US Representative Alma Adams | http://adamsforms.house.gov/contact/ | 202-225-1510 |
| US Representative G. K. Butterfield | http://butterfield.house.gov/contact/email-me | 202-225-3101 |
| US Representative Mark Walker | https://walker.house.gov/contact/email | 202-225-3065 |
| US Representative Patrick McHenry | http://mchenry.house.gov/contact/zipauth.htm | 202-225-2576 |
| US Representative David Price | https://price.house.gov/contact | 202-225-1784 |
| US Representative David Rouzer | https://rouzer.house.gov/contact/email | 202-225-2731 |
| US Representative Richard Hudson | https://hudson.house.gov/email-me | 202-225-3715 |
| US Representative Robert Pittenger | http://pittenger.house.gov/contact/email-me | 202-225-1976 |
| US Representative George Holding | http://holding.house.gov/contact/email-me | 202-225-3032 |
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.
Dr. Gloria Graham Named NC Doctor of the Year
By popular demand, Dr. Gloria Graham was named NC Doctor of the Year on March 30 in honor of Doctors’ Day. The 80-year-old Graham was presented with the award and a $5,000 check to be used toward her medical or professional mission at her office, Eastern Dermatology and Pathology in Morehead City.
“It’s been a great pleasure and I really think it was a great idea you all had [to start North Carolina Doctors’ Day,]” she said. Dr. Graham, a dermatologist, received the most online votes of the 10 NC Doctor of the Year finalists over the last two weeks of March leading up to Doctors’ Day.
For the first time this year, the North Carolina Medical Society (NCMS), launched a homegrown way to recognize and honor the state’s physicians. More than 140 patients and colleagues from throughout North Carolina nominated doctors during February. From this group, 10 finalists were selected. Since March 16, the public has cast their votes online at the www.ncdoctorsday.org website for the person they think should be named NC Doctor of the Year.
Dr. Graham, 80, considered a legend in dermatology by many, has practiced medicine for 54 years and still practices three days a week. She intends to use the award money to benefit the Broad Street Clinic, which was founded by one of her personal physicians; the Country Doctor Museum, which contains many articles that were part of her father’s practice and possibly the Department of Dermatology at Wake Forest University. She also announced at the award presentation she would like to give $1,000 of the award to the Merci Clinic, a free clinic in New Bern, and the workplace of Dr. Mark Heffington, the NC Doctor of the Year finalist she narrowly edged out to win the award.
“Congratulations to Dr. Graham!” said Robert W. Seligson, NCMS Executive Vice President and CEO. “Dr. Graham certainly exemplifies the caring and compassion that distinguishes so many doctors across North Carolina.
“Since most everyone has been or will be a patient at some point, I encourage you to show your gratitude to your doctor not only on Doctors’ Day, but all year long.”
NCMS Helps Dozens of Practices Improve Care and Increase Revenue
In her role as NCMS Foundation Director of Practice Improvement, Terri Gonzalez, has helped dozens of practices achieve National Committee for Quality Assurance (NCQA) recognition. Receiving this recognition means the practice or clinician values quality health care delivery and uses the latest clinical protocols to ensure patients receive the best care at the right time. This “seal of approval” can translate into higher reimbursements.
“Through these quality initiatives, we are working to improve the quality of health care for all patients and provide efficient and cost effective measures at the practices throughout the state,” said Gonzalez, who is a Patient Centered Medical Home (PCMH) Content Expert and is certified by NCQA to offer consulting services on PCMH as well as Patient Centered Specialty Practice (PCSP) recognition programs.”
The latest example of Gonzalez’ successful approach to helping practices achieve these often confusing and time-consuming recognitions, is with the United Physician Management Network. Recently, 18 Ob/Gyn practices stretching from Morehead City to Asheville received their NCQA recognition with Gonzalez’ help. This recognition will qualify them for higher reimbursements through the Blue Cross and Blue Shield of North Carolina’s Blue Quality Physician Program (BQPP). Started in 2009, BQPP recognizes and rewards practices that demonstrate a strong commitment to patient-centered care, improving health outcomes and reducing costs. The NCQA Patient Centered Medical Home recognition is the core mandatory element to be eligible for the BQPP.
“The outstanding recognition by NCQA of the Unified Women’s Health (UWH) of North Carolina corporate survey tool reflects the group's strong commitment to providing the highest level of women's health care services to Blue Cross and Blue Shield members in North Carolina,” said Barrett Gunter, MD, President, UWH of North Carolina. “One of the real strengths of this group is its ability to embrace technology to improve the cost, quality and access to health care by women. The group is dedicated to improving outcomes and enhancing the patient experience. As President of the group, I would also like to thank Terri Gonzalez and the North Carolina Medical Society, who along with UPM, our management partner, worked to make this project a success. "
If you would like more information about how Gonzalez can help your practice, contact her via email or call her at 919-833-3836 x123.
Where Do We Stand With the SGR?
Very 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.
CQU Class of 2016 Announced
Seven teams from across the state have been named to participate in the 2015-16 Clinical Quality track of the Kanof Institute for Physician Leadership – also known as CQU. Each team, which includes one physician, will undertake a project aimed at improving the quality of care provided to patients. The 12-month program consists of a mix of face-to-face learning at the North Carolina Medical Society (NCMS) Center for Leadership in Medicine in Raleigh, NC, as well as webinars and coaching. Watch the Bulletin for more information about each team’s project.
The CQU Class of 2016 is:
- American Anesthesiology, Charlotte: Team Leader, Janet Beck, CPHQ, CQA; Kelly Mumford, RN, BSN, MBA; Paul Rieker, MD
- Burlington Peds, Mebane: Team Leader, Yun Boylston, MD, FAAP; Karin Minter, MD, MPH, FAAP; Lisa Delphias, MHA
- Kidzcare Peds, Fayetteville: Team Leader, Ashok Jain, MD; Gauri Dalvi, MD; E. Nicole Trent, PA
- Lincoln, Durham: Team Leader: Quinnette Jones, MHS, PA-C, MSW, LCSW; Barbara Johnston, MD, FACP; Sandra Gomez, RN, BSN, MSN, MPA
- Mission, Asheville: Team Leader, Robert Fields, MD; Amanda Gerlach; Kelly Terry
- Novant, Cornelius: Team Leader, David Cook, MD; Amy Vance; Danica Patterson
- Wake Radiology, Raleigh: Team Leader, Catherine Lerner, MD; Jill Garrett, RT, CBDT; Angie Sutphin, RT, CBDT
New Resources from the Toward Accountable Care Consortium
Two new Toward Accountable Care Consortium and Initiative (TAC) guides are now available: Accountable Care Guide for Pediatric Care (PDF) and Accountable Care Guide for Child Psychiatry (PDF). These guides are located with the other 16 guides on the TAC website.
The NCMS Foundation Associate Executive Director and NCMS Deputy General Counsel and the person spearheading the TAC Initiative, Melanie Phelps, also would like to call your attention to another resource available through the US Department of Health and Human Services and the Centers for Medicare and Medicaid services. CMS is launching the Health Care Payment Learning and Action Network to help advance the work being done across sectors to increase the adoption of value-based payments and alternative payment models. More information and how to register is available here.
NC Doctors’ Day Tribute Cards Benefit the NCMS Foundation
Donors contributed hundreds of dollars to purchase tribute cards and e-cards to thank a special physician during the final two weeks of online voting for the NC Doctor of the Year Award. Proceeds from the cards will be used by the NCMS Foundation to grow our work to improve access to quality health care for North Carolina’s most vulnerable patients. In 2014, the Foundation’s Community Practitioner Program assisted 38 primary care providers located across NC. These physicians, PAs and NPs provided a whopping $350 million in care for the under- and uninsured in the past year alone!
Don’t forget the Foundation’s tribute program is year-round. For a contribution of $25 per card, the Foundation will send a greeting card in honor or in memory of someone special. Birthdays, work anniversaries, congratulations and retirement are all great reasons to send a tribute card. Visit our secure donation page and complete the “Tribute Information” section. Your tribute gifts will help the Foundation make sure that all North Carolinians have a doctor in their own hometown!
Send Your Tribute Today!
Have You Considered Joining a Patient Safety Organization?
The US Department of Health and Human Services (HHS) enacted the Patient Safety & Quality Improvement Act, which creates a voluntary reporting program in which health care providers can share information relating to patient safety events with a patient safety organization (PSO) on a privileged and confidential basis. The goal is to bolster efforts to improve the quality and safety of health care. Belonging to a PSO can benefit your practice. The AMA has consistently endorsed the benefits of belonging to a PSO since the physician’s perspective is often missing when it comes to analyzing patient safety events. Sharing these events with a PSO allows others to learn as well.
Providers can report safety events to PSOs within a protected environment safe from legal discovery and publication. As a result, PSOs can be a source of confidential advice and data analysis for physicians seeking to understand and improve their health care delivery. Physicians are foremost leaders in deciding whether health care is good, safe, and efficient, but the work of improving performance is difficult and demanding. By developing and using their own patient safety evaluation systems to report to PSOs, physicians are better able to develop robust, actionable information in order to redesign processes and systems that improve care delivery, reduce the potential for patient harm and increase care efficiency.
For information on the NCQC Patient Safety Organization please contact Nancy Schanz, Director, NCQC PSO
Need PQRS Reporting Help? This is Free!
You may have received a negative payment adjustment letter from the Centers for Medicare and Medicaid Services (CMS) regarding your 2013 Physician Quality Reporting System (PQRS) participation. If you received such a letter, Alliant Quality, the QIN-QIO (Quality Innovation Network-Quality Improvement Organization) for North Carolina can help you avoid future payment adjustments.
We are offering free support to assist eligible professionals in PQRS and Value Based Payment Modifier (VBPM) reporting. More information is available here.
What Would You Like to Learn At The NCMS Annual Meeting?
Please take our quick survey to let us know what CME you would like at the 2015 NCMS Annual Meeting.
Create your free online surveys with SurveyMonkey , the world's leading questionnaire tool.
Problem Solved: Are Category 2 CME Hours Required?
If you need an answer or a problem solved regarding your practice, as a North Carolina Medical Society (NCMS) member you have access to our Solution Center Coordinator, Belinda McKoy, who is standing by to help you solve the problem or answer your question. Call (919-833-3836 x142) or email Belinda the next time you need a problem solved.
Here is a common question Belinda receives:
Q: Are Category 2 CME hours required?
A: According to the North Carolina Medical Board:
Category 2 CME hours are no longer required and may not be counted to satisfy the CME requirements. The Board encourages licensees to continue to complete CME, whether Category 1 or 2 hours, above and beyond the minimum required, as their time permits. Many Category 2 CME activities may be useful to licensees.
For more information on CME requirements, visit the FAQ page on the Medical Board's website.
Online Courses Help You Gain a Better Understanding of the MOST Form
The North Carolina Medical Society (NCMS) Foundation in conjunction with the North Carolina Partnership for Compassionate Care are sponsoring a two-part E-learn course to help you get a better understanding of the MOST form and how it ties into advance care planning. To learn more about the Partnership and these courses, click here.
- Register for “Understanding MOST: Part 1“ (Why MOST is an essential tool for knowing and honoring patient wishes at the end of life) – $10 registration fee.
- Register for “Understanding MOST: Part 2“ (Completing the MOST form) – $10 registration fee.
Register Now for the Ob/Gyn 2015 Annual Meeting, April 17-19
It’s a rapidly changing health care world out there! To help you get the knowledge you need and provide the best care for your patients, this meeting includes 12 hours of CME! The North Carolina Ob/Gyn Society (NCOGS) and NC Section/ACOG proudly welcome special guests speakers Dr. John Jennings, Dr. Matthew Hanley, and Dr. Robin Cummings to the 2015 Annual Meeting program.
Matthew Hanley, MD, MBA, Chief Medical Officer at Carolinas Medical Center in Charlotte, will give the Presidential Address, “Quality and Safety in the Disruptive Landscape of Healthcare Reform – A Brave New World.” Dr. John Jennings, ACOG President, will give a presentation that is of particular interest to NC ob/gyn physicians. His presentation, “Work Force Issues and Future of Women’s Health Care Delivery” is particularly relevant as our health system seeks out new ways to improve care and control cost. Dr. Robin Gary Cummings, Medicaid Director, will provide a Medicaid Update, including progress with NCTracks, physician payment cuts and Medicaid reform efforts at the N.C. General Assembly.
The meeting will be held April 17-19 at Kiawah Island. More information. Register here.
Kudos to Two Leadership College Alumni
Two graduates of the North Carolina Medical Society Foundation’s Leadership College were recently honored.
Robin G. Cummings, MD, the North Carolina Department of Health and Human Services Deputy Secretary for Medicaid and Leadership College class of 2005, spoke at the 12th annual World Health Care Congress in Washington, D.C., March 22-25. He sat on a panel that shared different approaches to the changing Medicaid environment in the U.S. Cummings told global leaders in the health care industry about the approach being developed in North Carolina.
“In North Carolina, our efforts are focused on improving the health care delivery system by building on what works in our state,” he said. “Our doctors want more control over improving the health of their patients, and they should be rewarded for their efforts. Moving to an Accountable Care Organization, or ACO, model will give us patient-centered care that is led by health care professionals.”
Nancy S. Henley, MPH, MD, FACP, Chief Medical Officer for the Division of Medical Assistance and Leadership College class of 2013, recently received the Laureate Award from the North Carolina Chapter of the American College of Physicians. The Laureate Award honors fellows or masters of the college who have demonstrated a commitment to excellence in medical care, education or research, and to service for their community, chapter and the American College of Physicians.
Henley has more than 25 years of executive management experience with large public and private insurers. She previously served as medical director for the North Carolina State Health Plan and deputy director for clinical affairs with the Division of Medical Assistance in the Department of Health and Human Services.
Elected to Fellowship in the American College of Physicians in 1998, Henley has served on several North Carolina Medical Society committees and the Executive Council of the North Carolina Chapter of the American College of Physicians since 2009.
Tax Scam Is Back; Be Prepared
Unfortunately the North Carolina Medical Society (NCMS) has fielded five calls this tax season from doctors who have reported being victims of an Internal Revenue Service (IRS) tax scam. According to the reports, which are similar to those last year, someone is filing fraudulent federal income tax returns using physician names, addresses and Social Security numbers. The scam is not targeted at physicians, but many contacted the NCMS last year, prompting us to seek advice for our members from the authorities.
This particular scam is a popular identity theft scheme. The IRS issued a report on this type of identity theft affecting tax payers in a publication called the Dirty Dozen Tax Scams for 2015.
The majority of those affected first become aware of it when they receive an IRS 5071C letter advising them of possible fraud. Others are receiving a rejection notification when attempting to electronically file their tax return. It indicates it cannot be submitted because a return has already been filed under that Social Security number. At least one person learned of the fraud when he received a large tax refund check before filing a tax return.
Next steps; act quickly
- IRS – If you are a victim of this scam, you’ll note the IRS 5071C letter provides instructions about contacting the IRS through its identity theft website or by phone at (800) 830-5084 to let officials know you did not file the return referenced in their letter. If you are a victim, you may not be able to electronically file your return this year since a return with your Social Security number has already been filed. You’ll need to file a paper return and attach an IRS 14039 Identity Theft Affidavit to describe what happened. Attach copies of any notices you received from the IRS, like the 5071C letter. Be sure to let your tax preparer know if this happens to you. Verify with the IRS and your tax preparer where to mail your paper tax return, based on the type of return you are filing and your geographic area.
If you have not received a notification from the IRS but believe your personal information may have been used fraudulently or are concerned about whether you may have been victimized, call the IRS Identity Protection Specialized Unit at (800) 908-4490. Find more information from the IRS, including forms, at the IRS website. - Office of the North Carolina Attorney General - Physicians affected should contact the North Carolina Attorney General’s Office at 1-877-5-NO-SCAM toll free within North Carolina or file a consumer complaint online at http://www.ncdoj.gov/. Their website also lists steps for identity theft victims to take .
- Federal Trade Commission (FTC) - File a complaint with the FTC here. This not only helps the FTC identify patterns of abuse, but the printed version becomes your Identity Theft Affidavit. Along with a police report, that affidavit becomes your Identity Theft Report, which you will need. The FTC recommends other immediate steps and provides helpful information here.
- Police report - Consider filing a report with the local police where you reside. Bring all documentation available, including any state and federal complaints you filed. This will likely be necessary if there is financial account fraud as a result of the identity theft. However, if the only fraud is tax fraud, the police report will be necessary only if requested by the IRS.
- Social Security - Call the Social Security Administration’s fraud hotline at (800) 269-0271 to report fraudulent use of your Social Security number. In case your number is being used for fraudulent employment, you can also request your Personal Earnings and Benefit Estimates Statement here or call (800) 772-1213. Check it for accuracy.
- U.S. Department of Justice (DOJ) - Consult the DOJ website for additional information.
NCMS next steps
The NCMS continues to monitor this matter and will forward information to relevant agencies. Please notify us if you have been victimized by this tax scheme so we can convey the scope of the situation to the proper authorities. Contact the NCMS at 919-833-3836 or email Belinda McKoy at [email protected]. Watch your email and the NCMS eBulletin for any updates on this matter.