Whooping Cough Cases Spike in NC
The highly contagious illness is increasing nationwide too. Whooping cough tends to peak during the fall and winter, so cases are expected to keep rising
(NC HealthNews, Jennifer Fernandez) -- Whooping cough cases in North Carolina have risen sharply in 2024. There have been close to 600 reported cases — 6.4 times more than last year at this time.
Nationally, cases are 4.8 times higher, federal data shows.
The highly contagious respiratory illness tends to rise and fall in cycles as vaccines wear off and new children are born without immunity, experts said. In recent years, efforts to prevent the spread of COVID-19 played a role in lowering the number of whooping cough cases. People were isolating, and fewer children were congregating in schools.
The return to regular habits of socialization post-pandemic could account for much of the uptick, but vaccine hesitancy may be driving part of this latest spike, some experts warned.
“It is honestly a problem we deal with every day,” Suresh Nagappan, medical director of the Children’s Unit at Moses Cone Hospital in Greensboro, said about people debating whether to get vaccinated. “I think a lot of it is people have lost trust in authority.”
Fewer and fewer people are taking the word of public health experts or even the advice of their family doctors. To combat that loss of authority, doctors need to personalize the information they give to patients, such as sharing what they have read in recent studies or how vaccines have helped their other patients, Nagappan said.
Peak in cases still ahead
As of the week ending Nov. 23, North Carolina had recorded 576 cases of whooping cough, up from 90 cases during the same time last year, according to data from the Centers for Disease Control and Prevention. Cases are expected to keep rising as whooping cough tends to peak during the fall and winter.
Whooping cough, also known as pertussis, is caused by a bacterial infection that can be life-threatening, especially for infants. The name “whooping cough” comes from the “whooping” sound made when people catch their breath after a prolonged fit of coughing.
That coughing, and the swelling in the airways associated with pertussis, is especially hard on infants, with their tiny airways.
During a 2012 outbreak in Winston-Salem, a 2-month-old died.
“They just can’t handle it in the same way” as an adult, Nagappan said.
Early symptoms can mimic a cold. Typically, it takes five to 10 days for symptoms to appear, although it can take as long as three weeks. The cough associated with pertussis can last for weeks, even months and can lead to pneumonia in children and adults. For some, the coughing is so severe that they can fracture ribs or faint.
About a third of babies younger than 12 months old who get whooping cough will end up in a hospital, the CDC said. One in five babies with whooping cough get pneumonia. About 1 percent, or one in 100, will die.
North Carolina requires that all children get immunized against several illnesses, such as measles, polio and whooping cough.
Nagappan said while the number of cases is trending in the wrong direction, the net number of cases “is not huge compared to what it was in recent memory.”
The country is trending toward a total of about 30,000 cases this year, if weekly counts remain steady. That’s well below the 48,277 cases in 2012, which was the highest in more than six decades.
Nagappan attributed the increase to the advent of a new version of the pertussis vaccine introduced in the early 1990s. It came with fewer side effects, which health care providers — and parents — welcomed, but this “acellular” vaccine is only about 85 percent effective and doesn’t provide protection for as long as the previous version.
Helene’s impact
From late 2018 through August 2023, North Carolina had 16 whooping cough outbreaks, according to the North Carolina Department of Health and Human Services. Before the remnants of Hurricane Helene hit western North Carolina, the area was experiencing another increase in cases of the illness, mainly in children, following an earlier outbreak in the spring, according to media reports.
In Buncombe County, cases have doubled since September, according to media reports and data from Buncombe County Health and Human Services.
In one of its advisories, NCDHHS warned that respiratory illnesses would be an issue after the storm. The agency encouraged vaccination not only for seasonal respiratory viruses, but also for whooping cough among those who have not been vaccinated, and “especially for individuals living in crowded living situations or shelters,” where respiratory infections can spread easily.
Under state law, children typically have to show proof of vaccination to attend school or child care. Students have 30 days from when they first start school or child care to provide proof of vaccination or show they are exempt. Students who miss that deadline can be suspended.
In response to Helene, state officials gave students affected by the storm more time to meet vaccination requirements. That could have allowed for spread too.
Return to pre-pandemic patterns
At one time, whooping cough was one of the most common childhood diseases and a major cause of death in children. Once a vaccine was developed in the 1940s, U.S. cases began to drop from 200,000 annually to fewer than 19,000 in 2019.
Cases plummeted during the COVID-19 pandemic to a low of 2,116 nationally in 2021, CDC data shows. Health officials said the decrease likely came from people isolating, masking and washing hands more during the pandemic. Preventing the spread of COVID also tamped down other respiratory illnesses, like whooping cough.
Those same practices can help prevent whooping cough from spreading now, health officials said.
The country is starting to return to pre-pandemic patterns of whooping cough, where more than 10,000 cases are typically reported each year, the CDC said — although experts believe much of the disease goes unrecognized and unreported.
The agency expects whooping cough cases to increase in vaccinated and unvaccinated populations this year.
Vaccinations down, exemptions up
Overall vaccination coverage for kindergarteners has been dropping nationally and in North Carolina over the past decade.
In North Carolina, 93.5 percent of incoming kindergartners had received all required vaccinations last year, according to the most recent CDC data. That’s down two percentage points from the 2011-12 school year.
Nationally, coverage last school year ranged from 92.3 percent for the diphtheria, tetanus and acellular pertussis vaccine — more commonly known as DTaP — to 92.7 percent for the combined measles, mumps and rubella vaccine, according to the most recent CDC data available.
Meanwhile, the percentage of students claiming an exemption from getting vaccinated remains small, but continues to rise, driven mostly by non-medical reasons, data shows. Last school year, 2.9 percent of North Carolina kindergarteners received an exemption, below the 3.3 percent of kindergarten students exempted nationwide.
In North Carolina, the percentage of kindergartners exempted for any reason has more than tripled over the past 12 years. Nationally, that number doubled.
While there has been pushback on COVID-19 and measles vaccines, Nagappan said, he’s seen a lot of interest from parents in the new antibody treatment released last year for respiratory syncytial virus, or RSV. RSV, which is caused by a common virus, can be very dangerous for very young infants and for babies and young children who have certain health problems.
There have been enough bad seasons of RSV that many people know someone whose child ended up hospitalized, he said. And with several outbreaks of the illness, parents were inundated with warnings from day care centers about the dangers of RSV, so that “primed people that RSV was dangerous,” he said.
That response to a new treatment gives Nagappan hope.
“I think it’s not a wholesale rejection of vaccines,” he said. “I think it is people want specific recommendations and (are) basing it on their own experiences.”
Holiday Parties Could Mean Fewer Cocktails for Those on Obesity Drugs
Dizzy after one drink? Social drinkers on obesity drugs lose the taste for alcohol
(NPR - Allison Aubrey ) -- Many social drinkers who take obesity medications, such as Wegovy or Mounjaro, say they don't enjoy alcohol as much.
A new study of Weight Watchers members who take obesity drugs — and were in the habit of drinking — finds about half of them cut back after they started the medication.
"I feel amazing," says Tamara Hall, 45, a mother of three. She began taking the GLP-1 drug Mounjaro in 2023 as part of a Weight Watchers program.
The medicine is covered by her insurance. At the time she had elevated blood sugar and her weight put her in the category of having obesity. She's now lost more than 100 pounds, and though she was never a daily drinker, she consumes much less.
"This is the best I have felt in my entire adult life," Hall says. Her A1C (which is a blood test that measures blood sugar over a three-month period) is now in the healthy range. "It's life changing," she says.
Hall was a moderate drinker who enjoyed wine or a cocktail at social gatherings. "A margarita or mixed drink, that was my go to," she says. But once she started the medication, her appetite for alcohol changed.
She noticed feeling full and dizzy after one drink, whereas before she felt she tolerated alcohol much better. "The impact of the alcohol was more intense," she says, and so cutting back was easy. "I didn't know it would have the impact of me not wanting the alcohol — so I think it's a huge benefit." She says the medication seems to cancel out the cravings.
Hall's experience fits with the results of the new study published in the journal JAMA Network Open. The study included survey data from about 14,000 Weight Watchers members, mostly women, all of whom were taking medication including Wegovy and Mounjaro. Some were taking older medications such as metformin.
"The main finding is that approximately 50% of patients who consumed alcohol at baseline reported decreased alcohol use after initiating their anti-obesity medication, says study author Lisa Matero, a health psychologist and researcher at Henry Ford Health.
Those who had the highest levels of drinking were about 19 times more likely to cut back compared to those who were categorized as light drinkers. "Those who lost more weight were also more likely to decrease their drinking," Matero says.
The reductions in alcohol use held up among people taking the new generation obesity medications and older drugs, including metformin, which is typically prescribed for diabetes. "I think what surprised me was that there was a reduction of alcohol use across all different types of anti-obesity medications," Matero says.
"Maybe being enrolled in a weight management program encourages healthy behavior change," she says. This could be part of the explanation of the study findings.
A growing body of evidence on GLP-1 drugs points to significant effects on behaviors.
During some of the landmark clinical trials of GLP-1 drugs that demonstrated reductions in body weight, researchers heard anecdotal reports from participants about changes in habits.
"They would tell us that they would drink less or even shop less," says Dr. Robert Kushner of Northwestern University, a GLP-1 researcher who is also a consultant to drug makers. People also reported less 'food noise' he says. Their "thinking of food diminished and the reward of food was diminished," Kushner says.
GLP-1 – which stands for glucagon-like peptide 1 – drugs increase the amount of insulin that the pancreas produces and boost the ability of the pancreas to release insulin. But the drugs also influence the brain's reward system. "The drugs circulate throughout the body, including the brain, to reduce appetite," Kushner says.
So, Kushner says he's not surprised by the results of this study pointing to less alcohol consumption. " I think this is an extension of this reward based biology that we see that these drugs are affecting," he says.
There's a lot more to learn about these drugs, says Dr. Lorenzo Leggio, clinical director at the National Institute on Drug Abuse. "We are very excited about the possibility that these drugs may be effective for alcohol addiction and other addictions," Leggio says. But he says the evidence is preliminary, so it's too soon to draw any conclusions.
There are randomized controlled trials underway - which are considered the gold standard in medical research. While the research is ongoing, Leggio points to medications such as naltrexone, that the FDA has already approved to treat alcohol use disorder.
The new study comes at a time of increased focus on wellness and prevention, and there's a growing cultural awareness that limiting alcohol can help achieve that goal.
"Most people that we talked to get on these medications because they're overall trying to get healthier, and reducing alcohol consumption can also be part of that journey," says Michelle Cardel, the chief nutrition officer at Weight Watchers.
This new study helps to better disentangle how obesity medications can help influence that journey.
New Study: People Three Times More Likely to Colon Cancer Screen at Home
(UPI HealthDay News) -- People are three times more likely to undergo at-home colon cancer screening if they're provided a free test, a new study says.
About 30% of patients mailed a free stool test kit completed their screening within six months, compared with about 10% of those who weren't sent a kit, researchers reported Monday in JAMA Network Open.
The kit, a fecal immunochemical test (FIT), uses antibodies to detect blood in stool. This blood is an early warning sign of colon cancer, and those who test positive are urged to undergo a colonoscopy.
"Mailed FIT is an excellent complement to usual care screening services," researcher Alison Brenner, an associate professor at the University of North Carolina School of Medicine, said in a news release. "It reaches a lot of patients who, for whatever reason, aren't getting screened in usual care and significantly increases screening rates."
Colon cancer can be prevented, by early detection and removal of pre-cancerous polyps inside the GI tract.
Guidelines recommend that adults 45 to 75 undergo regular screening. Thanks to screening, colon cancer rates among seniors 65 and older have declined, but rates among those under 50 have been rising during the past three decades.
Colonoscopy is considered the gold standard of colon cancer screening, because doctors can examine the entire colon and remove polyps during the procedure. Screening is done once every 10 years.
But a colonoscopy involves the use of powerful laxatives to prepare for the procedure, which is performed under sedation. The prospect causes some to skip the screening.
Due to these qualms, doctors also offer stool tests to screen for colon cancer. These tests, taken once a year, can help keep tabs on a person's cancer risk.
For this study, researchers recruited more than 4,000 people 50 to 75 receiving medical care at low-income health centers in North Carolina.
Half were mailed free FIT kits, and also received support for a follow-up colonoscopy if the test was positive. The other half received usual care, which included a recommendation to undergo colon cancer screening.
After a year, about 35% of those mailed a free kit had taken the FIT test, compared with about 17% of those receiving usual care, researchers said.
The free kit group also had a higher follow-up rate among those with a positive test - 69%, compared with 44% in the control group.
"Reaching a largely unscreened, predominantly low-income population using centralized mailed screening kits and patient navigation for those with abnormal tests can substantially increase guideline-recommended colorectal cancer screening," researcher Dr. Daniel Reuland, co-director of the UNC Lineberger Carolina Cancer Screening Initiative, said in a news release.
Based on these findings, researchers are looking into ways to expand the program.
"FIT testing is inexpensive, so we anticipate that this kind of outreach will be a very cost-effective way to improve population screening," Reuland said. "In tandem with this, we're working to find ways to scale and sustain this kind of intervention to have greater impact."
Capitol Chronicle: The NCMS Keeps Pounding – “Fix Medicare Payment!”
The NCMS Keeps Pounding – “Fix Medicare Payment!”If you’ve been to a Carolina Panthers football game, you are familiar with the slogan – KEEP POUNDING! That’s exactly what the North Carolina Medical Society is doing in the ongoing effort to avert the 2.8% Medicare physician payment cut. The NCMS, along with many partner organizations, has made Medicare payment reform a priority this past year and is turning up the intensity as year-end approaches. The payment cut is scheduled to take effect on January 1, 2025. Recently, the NCMS joined national and state medical societies in a joint message to congressional leadership imploring them to take action. You can do the same. The AMA and many of the national specialty academies have set up online links to connect with our offices on Capitol Hill and to advance the push for support of H.R. 10073. This legislation was recently introduced in the US House by Rep. Greg Murphy, MD (NC-3), a practicing urologist in Greenville, NC, and would avert the payment cut as well as add a positive payment adjustment to help offset the increased practice costs projected for 2025. Contacting your US House office to encourage support of H.R. 10073 is as simple as clicking HERE. Also, your patients are an untapped resource in convincing Congress to take action. Enlist your patients’ support by posting this notice and sharing it with a request to take the simple steps to reach out to those who represent us in Washington. It includes a QR code to help make that connection. Please encourage your colleagues to engage in this effort as well and if you hear back from your member of Congress, please forward their reply to help our ability to follow up and continue our work toward a payment fix.
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Thank you. Your engagement matters.
Do you know your state and federal legislators? More importantly, do your legislators know you?
The NCMS can help you connect with policy makers as a constituent and advocate!
Gov. Roy Cooper Appoints Dr. Nadyah Janine John to NC Recreational Therapy Board
RALEIGH -- On Wednesday, Governor Roy Cooper announced several key Board and Commission appointments. Among them is Dr. Nadyah Janine John to the North Carolina Recreational Therapy Licensure Board. Dr. John is a physician licensed per Article 1 of Chapter 90. She is a Staff Psychiatrist at Walter B. Jones Alcohol and Drug Abuse Treatment Center. Dr. John is also an Affiliate Faculty Member for the Department of Psychiatry and Behavioral Medicine for the Brody School of Medicine at East Carolina University.
NCDHHS Low Income Energy Assistance Program is Taking Applications. What Your Patients Need to Know as Temps Drop
Last Year More Than 130,000 Households in NC Received Help to Pay for Heating Bills
The North Carolina Department of Health and Human Services’ Low Income Energy Assistance Program will begin accepting applictions from older adults 60 and older or people with disabilities receiving services through the NCDHHS Division of Aging on Dec. 2, 2024.
The federally funded program helps low-income households with a one-time payment sent directly to their heating vendor to offset the high cost of warming their homes during the cold weather months.
Low Income Energy Assistance Program payments will be distributed automatically to heating vendors beginning in December 2024 if a member of the household meets the following three requirements:
- Is age 60 or older or a person with a disability receiving services through the NCDHHS Division of Aging,
- Currently receives Food and Nutrition Services and
- Received a LIEAP payment during the 2023-2024 season.
Households meeting the requirements for the automatic payment are being notified of their eligibility through November 2024 and do not need to re-apply for LIEAP. Any household with a person 60 or older or with a disability and is receiving services through the Division of Aging who did not receive notice of an automated payment, can apply online at epass.nc.gov. Applicants can also call their county department of social services to apply by phone, in person or print a paper application from epass.nc.gov to mail, fax or drop off at their county department of social services.
To be eligible for the LIEAP program, a household must
- Have at least one U.S. citizen or non-citizen who meets the eligibility requirements,
- Have income equal to or less than 130% of the federal poverty limit, and
- Be responsible for their heating cost.
Beginning Jan. 2, 2025, all other eligible households who meet the eligibility requirements may begin applying. Applications will be accepted from Jan. 2, 2025, to March 31, 2025, or until funds are exhausted.
Last year, the LIEAP program provided approximately $48 million to help more than 134,000 households pay their heating bills from December 2023 through March 2024. For more information on the program and eligibility, visit the NCDHHS website.
Western NC Community Care Stations Closing December 2
When will Community Care Stations close?
At the end of the day on Dec. 2, all water distribution sites and Community Care Stations in Asheville and Buncombe County will close, with the exception of four stations in the most impacted communities:
- Fairview Ingles at 225 Charlotte Highway by Reynolds High
- Morgan Hill Baptist Church, 594 Barnardsville Highway
- Bethel United Methodist, 1050 Riceville Road
- Owen Pool, 117 Stone Drive, Swannanoa
Today is Cyber Monday. Some Warnings for Physicians.
Today is Cyber Monday. It is commonly known as the day Americans hit their computers, rather than stores. Economists have been predicting the eventual collapse of the brick-and-mortar commerce for more than a decade.
In an article in Forbes, Dr. Robert Pearl noted that the coronavirus pandemic came on like a retail wrecking ball in 2020, sending shopping-mall icons like Brooks Brothers, J. Crew and Neiman Marcus into bankruptcy.
1. Doctors must integrate technology with in-person care
It used to be that Black Friday was the end-all-be-all of shopping events. In fact, just eight years ago, a Walmart spokesperson said, “We think about Black Friday as if it were our Super Bowl.”
Cyber Monday, by contrast, always sat at the kiddy table—a holiday afterthought for most retailers. That’s no longer the case. In 2019, Cyber Monday sales hit $9.4 billion, besting Black Friday’s $7.4 billion. This year, amid a pandemic that’s pushing nearly all retail sales online, many traditional sellers are now combining their Black Friday sales with Cyber Monday, hoping to capitalize on the eCommerce opportunities they overlooked for so long.
The healthcare takeaway: Technology-based care belongs at the adult table, alongside office-based care. It’s a lesson many doctors still disregard.
Since the pandemic video visits have been declining. That’s a major error. Most patients want to keep using virtual care after the pandemic. So, instead of rolling back digital offerings, doctors should take a lesson from retailers this Cyber Monday and look for ways to combine digital tools with in-person services.
Of course, doctors can’t deliver all forms of care virtually. But they also can’t continue to overlook the evolving needs of patients either.
Just as online shopping alternatives shifted the balance of power between sellers and consumers, it is realigning the power dynamics in healthcare, too. Patients in need of medical advice, a prescription or specialty expertise once had no choice but to make in-person appointments at the convenience of a local doctor. Technology has changed all that. If physicians continue to resist (rather than embrace) modern IT solutions, patients will vote with their feet.
2. Doctors must combine technologies to maximize value, quality
A survey conducted in 1998 found that only 2% of U.S. healthcare providers had implemented a fully operational computer system in their offices. That same year, two-thirds of American families had a computer in their homes.
Like traditional retailers, most doctors are not “early adopters” of technology. And because many physicians struggle to integrate basic tech into their practices—including video visits, online scheduling and secure emailing—they are missing a much larger opportunity. Not only do these tools add convenience and value to the lives of patients, they can also greatly improve the quality of care provided.
One physician who has seized on this opportunity is Dr. Devi Shetty. The world-renowned heart surgeon currently maintains hospitals in his home country of India and in the Grand Cayman Islands. These facilities are separated by a dozen time zones and yet the two locations operate seamlessly as one. When the cardiology teams in India go home at night, their patients are monitored by physicians on the other side of the globe. And 12 hours later, flow reverses.
Consider how this approach would benefit at-risk patients in the United States, where hospital staffing slows down significantly on nights and weekends. Currently, when a patient experiences a dangerous drop in blood pressure or oxygenation overnight, it can take U.S. doctors an hour or more to notice and respond.
But with video monitoring and a shared medical-record system, doctors located anywhere in the country (or even in other parts of the world) could observe these patients and address their medical needs at the first sign of a problem, making sure no one falls through the cracks.
The future will reward physicians who embrace technology to provide high-quality medical care around the clock. Those who cling to the past will be left behind.
3. Doctors must be the disruptors, not the disrupted
Most of the time, the origins of disruptive innovation can be traced back decades, to an unfulfilled consumer need that a successful incumbent never saw—or recognized but chose not to address.
Nowhere is this truer than in American medicine. Independent research has long confirmed that the U.S. healthcare system is the most expensive and least effective in the developed world. Medical costs have bankrupted millions of patients and sent millions of others deep into debt. Among the world’s wealthiest nations, the United States has the lowest life expectancy, highest infant and maternal mortality rates, and the most preventable deaths per capita.
If ever there was a system primed for disruption, it is American healthcare. As the coronavirus pandemic continues to rage, most doctors are anxiously awaiting a return to “normal.” They will be sorely disappointed. Whether the disruptive innovations are led by big business, global competitors or entrepreneurial doctors and hospitals, the fact remains: Change is coming. The days of healthcare providers surviving by simply raising prices are gone.
People who prefer shopping online during Cyber Monday (rather standing in lines for Black Friday) ought to ask themselves: “What if getting medical care were this easy?” Once patients realize it could be, medicine will never again return to the old normal.
World's First Fully Robotic Double Lung Transplant Performed in US
(NYU Langone Health) -- A surgical team at NYU Langone Health has performed the first fully robotic double lung transplant in the world. The procedure marks a breakthrough in the potential of robotic surgery and minimally invasive patient care, making NYU Langone the new leader in robotic transplant surgery around the globe.
Stephanie H. Chang, MD, associate professor in the Department of Cardiothoracic Surgery at NYU Grossman School of Medicine and surgical director of the Lung Transplant Program for the NYU Langone Transplant Institute, led the minimally invasive procedure. Her team transplanted both lungs into a 57-year-old woman with chronic obstructive pulmonary disease (COPD) using the Da Vinci Xi robotic system at each stage. Small incisions were made between the ribs, and then the robotic system was used to remove the lung, prepare the surgical site for implantation, and implant the new lung. Both lungs were transplanted using these robotic techniques.
The transplant was performed on October 22, 2024, just four days after patient Cheryl Mehrkar was placed on the lung transplant list following several months of evaluation by Jake G. Natalini, MD, assistant professor in the Department of Medicine and a member of its Division of Pulmonary, Critical Care, and Sleep Medicine, and Luis F. Angel, MD, medical director of lung transplantation for the NYU Langone Transplant Institute. Dr. Chang was assisted by Travis C. Geraci, MD, assistant professor in the Department of Cardiothoracic Surgery, and Eugene A. Grossi, MD, the Stephen B. Colvin, MD, Professor of Cardiothoracic Surgery.
“I’m so grateful to the donor and their family for giving me another chance at life,” said Mehrkar. “For a long time, I was told I wasn’t sick enough for a transplant. The team at NYU Langone Health centered my quality of life as a priority, and I’m so grateful to the doctors and nurses here for giving me hope.”
Mehrkar, who inherited a genetic predisposition to lung disease, was diagnosed with COPD in 2010 at 43 years old. Her condition worsened after a bout with COVID-19 in 2022. Throughout her life, she has been an active thrill-seeker, traveling the world as a scuba divemaster, becoming an avid motorcyclist, and earning her karate black belt with her husband, Shahin. The couple owned a dojo, and she had a passion for teaching before her health sidelined her. After retiring from karate, she became a volunteer emergency medical technician with a local fire department in Dutchess County, New York. She remains active in the department to give back to her community.
“It is one of the greatest privileges to be able to help patients return to a healthy quality of life,” said Dr. Chang. “By using these robotic systems, we aim to reduce the impact this major surgery has on patients, limit their postoperative pain, and give them the best possible outcome. It couldn’t happen here without a talented group of surgeons and an institution dedicated to moving transplantation forward.”
Just a month earlier, NYU Langone announced Dr. Chang performed the first fully robotic single lung transplant in the nation. Now her team is the global leader in lung transplantation surgery.
A Breakthrough Innovation in Transplant Surgery
“This latest breakthrough in robotic surgery speaks to the culture of innovation we’ve built by bringing the most talented people in their fields together,” said Robert Montgomery, MD, DPhil, the H. Leon Pachter, MD, Professor of Surgery, chair of the Department of Surgery, and director of the NYU Langone Transplant Institute. “Our Transplant Institute team pushes the field forward to better serve our patients and deliver the lifesaving care they need with the best patient experience.”
The NYU Langone Transplant Institute performed 76 lung transplants in 2023 and was rated best in the nation for lung survival after transplant and for getting patients off the waitlist the fastest by the Scientific Registry of Transplant Recipients, a national quality tracker overseen by the U.S. Department of Health and Human Services.
“We are grateful to have some of the most talented surgeons in the world who break barriers and push the boundaries of what is possible for our patients,” said Ralph S. Mosca, MD, the Henry H. Arnhold Chair of Cardiothoracic Surgery, professor in the Departments of Cardiothoracic Surgery and Pediatrics at NYU Grossman School of Medicine, and director of the Pediatric Congenital Heart Program at Hassenfeld Children’s Hospital at NYU Langone. “This latest innovation is a watershed moment in lung transplantation surgery worldwide and just the beginning of a new era in patient care.”
Surgeons at NYU Langone are international leaders in using robotic technology to manage a wide range of medical conditions, performing more than 2,000 robot-assisted surgeries each year. NYU Langone experts have pioneered the development and innovation of many robotic surgery techniques and continue to invest in new and evolving technology. As leaders in robotic surgical techniques, we train surgeons from hospitals across the nation and from around the world in how to perform the latest robot-assisted cardiac, bariatric, thoracic, gynecologic, colorectal, urologic, and gastrointestinal procedures.
NYU Langone Health is a world-class, patient-centered, integrated academic medical center, with a culture rooted in excellence in patient care, education, and research. Vizient Inc. has ranked NYU Langone the No. 1 comprehensive academic medical center in the country for three years in a row, and U.S. News & World Report recently placed nine of its clinical specialties among the top five in the nation. NYU Langone offers a comprehensive range of medical services across 6 inpatient locations, its Perlmutter Cancer Center, and more than 300 outpatient locations across the New York area and Florida. With $14 billion in revenue this year, the system also includes two medical schools, in Manhattan and on Long Island, and a vast research enterprise.
Biden Administration Proposes Expanding Obesity Drug Coverage Under Medicare/Medicaid
The Biden administration unveiled the first 10 prescription drugs that will be subject to price negotiations with Medicare.
(ABC News - Jon Haworth) -- The Biden administration has proposed a new rule to “significantly” expand coverage of anti-obesity medications for Americans with Medicare and Medicaid, according to the White House.
“Over the past few years, there have been major scientific advancements in the treatment of obesity, with the introduction of new life-saving drugs,” the White House said in a statement released on Tuesday. “These anti-obesity medications can help prevent the development of Type 2 diabetes. Furthermore, these drugs reduce deaths and sickness from heart attack and other cardiovascular outcomes by up to 20%. But for too many Americans, these critical treatments are too expensive and therefore out of reach. Without insurance coverage, these drugs can cost someone as much as $1,000 a month.”
Millions of Americans struggle with obesity -- an estimated 42%, according to the White House -- and it is now widely recognized as a chronic disease with increased risk of all-cause mortality and multiple related comorbidities such as diabetes, cardiovascular disease, stroke and some cancers.
Medicare and Medicaid currently cover the use of anti-obesity medication for certain conditions, like diabetes. But the new proposal on Tuesday would “expand access to these innovative medications for obesity, which is widely recognized as a disease and help an estimated 3.4 million Americans with Medicare,” the White House said.
“Medicare coverage would reduce out-of-pocket costs for these prescription drugs by as much as 95 percent for some enrollees. Approximately 4 million adult Medicaid enrollees would also gain new access to these medications,” the White House continued.
The proposal would “allow Americans and their doctors to determine the best path forward so they can lead healthier lives, without worrying about their ability to cover these drugs out-of-pocket, and ultimately reduce health care costs to our nation,” White House officials said.
The proposed rule would be implemented at the same time as a comprehensive agenda to lower the costs of drugs, including the drug price negotiation program and increased market competition.
“Thanks to the President’s efforts, seniors are already seeing lower prescription drug costs with insulin capped at $35, free vaccines, and out-of-pocket costs for prescription drugs capped at $2,000 starting in 2025,” the Biden administration said. “Already this year, nearly 1.5 million people with Medicare Part D saved nearly $1 billion in out-of-pocket prescription drugs costs in the first half of 2024 because of the Biden-Harris Administration’s Inflation Reduction Act. Furthermore, HHS has reached agreement with drug manufacturers for the first ten negotiated drugs, with new prices that are reduced between 38 to 79 percent starting in 2026.”
NCMS VP of Solutions Franklin Walker Featured in Article About Project VBOT
The North Carolina Medical Society Project VBOT took center stage at a meeting of the Manteo Health Care Task Force on November 12. VP Franklin Walker talked to stakeholders from the Dare County community, including health care addiction treatment providers, social services, government , and nonprofit sectors.
Project VBOT (Virtual Based Opioid Treatment) expands access to treatment for people suffering from opioid use disorder who live in underserved areas.
“They’ve got so much need down there for behavioral health and addiction treatment services, but they don’t have anybody to do it,” Walker explained, “and so they’ve got people that are going to drive three hours to see patients all day and then return to go back to Greenville or wherever they came down from.”
Read the full article here.
Read more on Project VBOT here.
NCMS Responds to Payment Issues with BCBSNC
A message from NCMS Manager of Payer and Practice Engagement, Jenni Hines:
The NCMS is fully committed to understanding and addressing the needs of practices facing urgent payment issues with BCBSNC. We are currently working on items related to unilateral denials of labs and procedures with Avalon, claim denials specifically related to modifier -25 and unexplained provider removal from the SHP network. We understand the impact these delayed payment tactics have on your practices, and have been actively gathering feedback, collaborating with relevant stakeholders, and making progress towards meaningful improvements.
We are advocating for your concerns and doing everything possible to make a meaningful difference. Your issues are important to us, and we are committed to taking the necessary steps to address them.
41 Senators Sign Letter Urging US Senate to Address Medicare Cuts Before Year End
As physicians face another year of cuts stemming from the Medicare Physician Fee Schedule, 41 Senators cosign a letter urging the Senate to address cuts before end of year.
The letter to Majority Leader Chuck Schumer and Minority Leader Mitch McConnell is an urgent request to address the 2.8 percent cut to Medicare payments that is due to go into effect on January 1, 2025. I outlines persistent instability in the health care sector due, in part, to consistent payment cuts. It also stresses the cuts impact on the ability of independent clinical practices, especially in rural and underserved areas.
North Carolina Senator Thom Tillis is one of the 41 senators who signed the letter.
To read the letter in full click here.
Atlas of Cells Offers Milestone Leap in Understanding of Human Body
Could discovery lead to new treatments?
(CNN, Katie Hunt) -- Each human is a finely tuned orchestra of more than 37 trillion cells. Mapping this little-known world is one of biology’s greatest challenges — and one in which scientists say they just made a significant dent.
More than 3,600 researchers from over 100 countries have analyzed more than 100 million cells from over 10,000 people, according to the latest update from an ambitious project launched in 2016 to produce an atlas of every single kind of cell in the human body.
New research based on the findings, published in several papers in Nature and its sister journals, represents a “leap in understanding of the human body,” according to the Human Cell Atlas consortium. The endeavor is similar in scale and scope to the Human Genome Project, which took two decades to complete.
“Cells are the basic unit of life, and when things go wrong, they go wrong with our cells first and foremost,” said Aviv Regev, founding cochair of the Human Cell Atlas and executive vice president for research and early development at Genentech, a biotechnology company based in South San Francisco, California.
“The challenge we’ve had is that we didn’t know the cells well enough to understand how variants and mutations in our genes are really affecting disease. Once we have this map, we’re able to better find the causes of disease,” she said at a news briefing November 20, 2024.
Update to a ’15th century map’
Regev compared scientific knowledge of cell biology before the Human Cell Atlas initiative with a “15th century map.”
“Now, years later, the resolution of the map is a lot higher,” she said. “It’s more like Google Maps, where you have a very high-resolution view of the real topography, and then on top of that, you have the street view that really explains to you what is going on there. And on top of that, you can even see the driving patterns, like the dynamic changes that happen during the day,” she added.
“That is the leap that we have done … but we still have work to do.”
A challenge is that different types of cells can look morphologically indistinguishable under a microscope but can vary dramatically at the molecular level. What’s more, cells change as humans age and in relation to the external environment.
Advances in single-cell sequencing technology allow scientists to understand how genes in an individual cell are switched on and off by analyzing RNA, which reads the DNA contained in each cell. This technology, combined with powerful computing and artificial intelligence methods, allows researchers to create an ID card for each cell type.
It was once thought there were only 200 or so different types of cells. Scientists now know there are thousands.
The consortium is building maps of 18 biological networks, the most complex of which is the brain, and the first complete draft of the Human Cell Atlas will be published in 2026, Regev said. The cell atlas aims to fill in a missing link between genes, diseases and treatment therapies.
“This is just an incredibly exciting journey, in terms of our voyage through the human body and discovery of fundamental new insights into our cells,” said Sarah Teichmann, founding cochair of the Human Cell Atlas and a professor at the Cambridge Stem Cell Institute at the UK’s University of Cambridge.
Milestones could unlock new treatments
The milestones made public Wednesday include mapping all the cells of the gut; producing a blueprint of how human skeletons form in utero; understanding the basic structure of the thymus, an organ that plays a key role in how the immune system functions; mapping the molecular architecture of the placenta; and building an atlas of human vascular cells.
The gastrointestinal tract atlas, which includes the tissues of the mouth through to the esophagus, stomach, intestines and colon, was created with data from 1.6 million cells and revealed a cell type that might play a role in chronic conditions such as inflammatory bowel disease.
The early skeleton map found certain genes activated in early bone cells that might be linked to an increased risk of developing hip arthritis as an adult. “Having a clearer picture of what is happening as our skeleton forms, and how this impacts conditions such as osteoarthritis, could help unlock new treatments in the future,” said Ken To, a researcher at the Wellcome Sanger Institute in England who coauthored that research, in a statement.
English scientist Robert Hooke discovered cells in 1665, looking at cork under a microscope. He introduced the word cell because the patterns made by the cellulose walls of dead cork reminded him of blocks of cells used by monks. However, it was 200 years later when scientists finally understood that cells were the fundamental unit of the human body.
Unlike the original draft human genome, which was predominantly based on a single individual, the cell atlas aims to be globally representative and involves researchers and human tissue samples from around the world.
The project has already led to some significant breakthroughs, including the discovery of a previously unknown cell type in the respiratory tract called an ionocyte. Study of this rare cell type could lead to new ways to treat cystic fibrosis, a genetic condition caused by a gene that affects the movement of salt and water in and out of cells.
During the Covid-19 pandemic, the Human Cell Atlas community used the available data to reveal that the nose, eyes and mouth were most vulnerable to infection.
“It was only clear through the Human Cell Atlas data that those cells were … entry points before the virus continued into the internal organs. That really illustrates quite simply how important a healthy reference map of the human body is, and a deep molecular understanding of ourselves,” Teichmann said.
Jeremy Farrar, chief scientist at World Health Organization, who was not involved in the research, agreed that insights emerging from the atlas are “already reshaping our understanding of health and disease.”
“This landmark collection of papers from the international Human Cell Atlas community underscores the tremendous progress toward mapping every single kind of human cell and how they change as we grow up and age,” Farrar said in a statement.
Truist Bank Announces Hundreds of Millions in Loans for Residents and Businesses Affected by Hurricane Helene in NC
Charlotte-based bank announces more than $650 million in loans
(WUNC, by Associated Press) -- Truist Financial Corporation has announced that it is making hundreds of millions of dollars in loans available to residents, businesses and local governments affected by Hurricane Helene in North Carolina.
The Charlotte-based bank said in a news release Wednesday that it will lend more than $650 million and offer more in grants and investments over three years.
Meanwhile, state legislators have approved hundreds of millions of dollars in aid for Helene relief and recovery, while the governor's office says more is needed. Disaster recovery can take years, as evidenced by ongoing needs from hurricanes that affected the eastern part of the state years ago.
The Truist initiative includes $340 million in lending for small businesses, home mortgages and commercial real estate. It will offer another $310 million in low-cost, tax-exempt loans to municipalities for infrastructure.
Meanwhile, another $50 million in loans or investments will come from its Truist Community Capital subsidiary and $25 million in charitable grants will come from the Truist Foundation.
The resources will be made available starting in December.
"Through this new initiative, Truist will address areas of critical need in Western North Carolina, including a focus on small businesses as well as housing and infrastructure projects," Truist Chairman and CEO Bill Rogers said in a news release.
Helene brought widespread devastation to western North Carolina, damaging roads and water systems and temporarily knocking our electricity and cellular service to a wide swath of counties. It also disrupted transportation networks across the region by damaging at least 6,000 miles (9,650 kilometers) of roads and more than 1,000 bridges and culverts, the state budget office has said. More than 100 people were killed in North Carolina.
Register Now: NC Medicaid Community Partners Webinar
Community Partners Webinar – An Update on Medicaid: December 5, 2024
The Community Partners webinar series is designed to provide updates on NC Medicaid and key Medicaid initiatives.
Join us Thursday, Dec. 5 from 3-4 p.m. for the next session in our ongoing webinar series. The webinar will provide an informational overview on Medicaid.
To register for the webinar, simply click on the registration link below. Feel free to share the webinar invitation and registration link with other community partners you think would be interested in attending.
Community Partners Webinar – An Update on Medicaid
Thursday, December 5 from 3-4 p.m.
Click here to register
For more information or questions contact us at [email protected]
*Close captioning is available in English and Spanish. If additional accessibility and communication accommodations are needed, please email [email protected] with the details of your request.
Renewal Season is underway, and NCMS has made it easier than ever!
For your convenience, we have consolidated your memberships into one simple invoice!
This year you we have made it EASIER FOR YOU to renew with all of your memberships on one form. Renew everything at once!
You can renew:
- Your NCMS membership
- Your County Society
- Your Specialty Society
Your emailed and mailed paper invoice offer all of your available options. You can also renew anytime online and select all of the memberships you wish to renew by adding each to your cart.
Check your inbox today and look for your renewal invoice! Need an invoice sent to you again? Please contact [email protected] and request one be sent to you.
You can also ROUND UP WHEN YOU RENEW and help your colleagues in Western North Carolina rebuild after the devastating impact of Hurricane Helene.
RENEW TODAY!
Did you see this? Renewal Season is underway and you don't want to miss it!
Did you see this on Wednesday? It is your NCMS Renewal form!
Check your spam file today! It is time to Renew your NCMS membership!
This year you we have made it EASIER FOR YOU to renew with all three NCMS membership categories in one form. Renew everything at once! Organized medicine is simplified by the NCMS because we know we are better together. You can renew:
- Your NCMS membership
- Your County Society
- Your Specialty Society
You can also ROUND UP WHEN YOU RENEW and help your colleagues in Western North Carolina rebuild after the devastating impact of Hurricane Helene.
The NCMS is working harder than ever to make your life easier!
Amazing Turnout for NCMS Social in Cary!
The final NCMS Social of 2024 draws big crowd despite bad weather!
CARY -- The final NCMS Social or Regional Meeting is in the books and it was fantastic! This time it was fun for members and guest, but also families! A big thank you to Dr. Alan Rosenbaum for bringing his child (who was the star of the event)!
The NCMS Director of Membership and Engagement, Toni Hill, says "Despite the nasty weather, we had an amazing turnout of members and non members. It was a great night of connecting our community, across specialties! It was also nice to have some kids involved because we love seeing our members' families too!"
Look for our first Regional Meeting in the Fayetteville area in January and our first NCMS Social in Raleigh in February. Details coming soon!
NC Radiological Society Virtual Breast Imaging Review Course (Jan. 17-19, 2025)
Date/Time
Date(s) - January 17, 2025 - January 19, 2025
Time TBA
Save the date for the NC Radiological Society Virtual Breast Imaging Review Course!
January 17-19, 2025 - Virtual
Manteo Healthcare Task Force Talks Project VBOT, Applauds NCMS Work in Outer Banks
Town of Manteo considers using the NCMS Foundation Project VBOT
The Manteo Healthcare Task Force met with NCMS's Franklin Walker to talk about the Virtual Based Opioid Treatment (VBOT) Program. At the meeting, the Mayor of Manteo thanked the NCMS Foundation and Walker for helping set up the Outer Banks Medical Group, the NCMS Preceptor Hub formed in partnership with Manteo Community Health in Manteo, Engelhard, and Ocracoke.
The conversation, however, focused on how to bring virtual care to area residents. The program would allow law enforcement or recovery programs to connect patients with virtual counselling, mail-in drug screenings, and help eliminate long commutes to treatment facilities.
The mission of Project VBOT is to facilitate patient access to treatment, contain treatment costs, empower clinicians, deliver advanced methodology, and connect with communities.
Walker said after the meeting that "It is three or four hours for a behavioral health provider to drive down here. With our model that won't happen. A person in treatment in our model can be at home or be in their car and we can see them over telehealth."
Manteo and the Task Force are in early discussions with the NCMS about joining the program.
For more on Project VBOT click below.
NC Receives National Award for Medicaid Expansion
NC Medicaid is the recipient of the National Association of Medicaid Directors’ 2024 Spotlight Award.
RALEIGH -- NC Medicaid is the recipient of the National Association of Medicaid Directors’ 2024 Spotlight Award. This recognition for the North Carolina Department of Health and Human Services comes as more than 570,000 people have enrolled in Medicaid expansion in the 11 months since its Dec. 1, 2023, launch. The record enrollment in year one is almost the total 600,000 that were estimated to enroll in Medicaid expansion over two years.
"We never gave up on making sure more North Carolinians got health insurance through Medicaid Expansion," said Governor Roy Cooper. "Now, more of our neighbors, friends and loved ones can see a doctor, get preventative care, manage chronic conditions and get life-saving prescriptions without the burden of high premiums or co-pays."
The award from NAMD attributes the record enrollment in part to NCDHHS’ extensive outreach efforts that included a collaboration with community partners. More than 215 partners across all 100 counties in the state including local organizations, health care providers, business leaders, community advocates and elected officials are all participating in sharing information about Medicaid expansion with their communities ensuring more North Carolinians can get health care coverage through Medicaid.
Since launch, these community-centered approaches led to more than 270,000 people being enrolled the first day of Medicaid expansion and more than 570,000 enrolled as of Nov. 14, 2024. New Medicaid enrollees have filled more than 3.4 million prescriptions for heart health, diabetes, seizures and other illnesses. Medicaid has also covered more than $53 million in claims for dental services since Medicaid expansion began.
"We got Medicaid expansion done — and we got it done well — with the help of our state and community partners who worked tirelessly to make it easier and more accessible for people to apply," said NC Health and Human Services Secretary Kody H. Kinsley. "Nearly 600,0000 people are already seeing the positive impact and life-saving care made possible by Medicaid expansion."
North Carolina’s outreach efforts include a dedicated website and Community Engagement Toolkit that enabled organizations to tailor Medicaid messaging for their specific communities. Partners can customize materials in multiple languages including Arabic, Spanish and Swahili, all while maintaining crucial information about enrollment processes through ePass or county departments of social services.
Additionally, the Medicaid Ambassador initiative empowered North Carolinians to help their neighbors navigate the Medicaid system. This volunteer program provides comprehensive training and resources, allowing community members to confidently guide others through the application process.
"North Carolina's approach demonstrates how centering community voices can transform program implementation," said NAMD Executive Director Kate McEvoy, "their innovative partnership model breaks new ground."
To learn more about or apply for NC Medicaid, visit Medicaid.nc.gov and read the Medicaid expansion FAQs.
Don't Miss this Leadership Opportunity! Deadline for Applications is November 30, 2024.
Don’t Miss the Opportunity to Become a Healthcare Leader!
Register for a Leadership Program Today
Deadline to apply is November 30, 2024
The NCMS Kanof Institute for Physician Leaders presents the Academy for Advanced Healthcare Leaders and the Academy for Executive Healthcare Leaders. We are excited to announce that both programs are currently accepting applications for 2025.
Each program provides a unique leadership journey that is tailored to meet the needs of healthcare professionals at various stages in their careers. Ideally, we encourage newer/mid-career leaders and residents to enroll in the NCMS Academy for Advanced Healthcare Leaders (AHL) and more senior-level healthcare clinicians and administrators to enroll in the NCMS Academy for Executive Healthcare Leaders (EHL). Both programs offer a distinctive curriculum that can support the leadership needs of healthcare professionals.
Note: Both programs are CME eligible.
Why you and your colleagues should enroll in the 2025 NCMS Academy
Research shows that the long-term benefits of leadership development programs are immeasurable. Here are a few benefits of applying to an NCMS Academy for Healthcare Leadership program:
- Individual Leadership Project: Apply your newfound knowledge and skills to a real-world project of interest that drives positive change within your organization/community.
- Networking Opportunities: Connect with a community of like-minded healthcare leaders and build valuable relationships.
- Build Psychological Safety: Participate in learning sessions designed to improve self-awareness and engagement with others.
- 360-Degree Leadership Assessment: Gain a deeper understanding of your strengths, weaknesses, and blind spots through a comprehensive 360-degree assessment.
- Personalized 1:1 Executive Coaching: Work closely with a seasoned executive coach to develop a personalized leadership development plan to address specific challenges.
- Experiential Change Initiative Project: Develop and implement a change initiative project that can improve outcomes for patients, organizations, and healthcare systems.
Apply Today!
Interested applicants can apply by visiting the following links, respectively:
NCMS Academy for Advanced Healthcare Leaders Application
NCMS Academy for Executive Healthcare Leaders Application
Deadline to apply for each program is November 30, 2024.
Contact Erica Neal at [email protected] for more information.
CDC: Black Infant Mortality Rate More Than Double Rate Among White Infants
Black infants died at a rate of 10.9 deaths per 1,000 live births, the CDC said.
(ABC News, Mary Kekatos and Dr. Harika Rayala) -- Infant mortality rates remained relatively unchanged from 2022 to 2023, but racial and ethnic disparities still persist, new provisional federal data released early Thursday finds.
The U.S. provisional infant mortality rate in 2023 was 5.61 infant deaths per 1,000 live births, unchanged from the 2022 rate, according to a report from the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS).
The report also found that infants born to Black mothers still died at much higher rates than those born to white and Asian mothers -- more than double the rate of white infant mortality, according to the CDC.
Additionally, changes in the neonatal mortality rate from 3.59 deaths per 1,000 live births in 2022 to 3.65 deaths per 1,000 live births in 2023, and the postneonatal mortality rate from 2.02 deaths per 1,000 live births to 1.96 deaths per 1,000 live births from 2022 to 2023 were not seen as statistically significant, the report's authors said.
Neonatal refers to the first four weeks of an infant's life and postneonatal refers to the period between 28 days and 364 days after birth.
Dr. Danielle Ely, co-author of the report and a health statistician at the NCHS, said 2022 was the first year there was a significant increase in the infant mortality rate in about 20 years. That the rate did not increase in 2023 shows the rise in 2022 was likely not a fluke, she said.
"So what we're seeing is that what we were hoping would be just a one-year blip is now a two-year higher rate," she told ABC News. "It is unfortunate that it did not go down again to where it was in 2021 at least or at least down from 2022. It just quite literally stayed the same, the infant mortality did."
Black infants died at a rate of 10.9 infant deaths per 1,000 live births, more than double the rate of 4.5 deaths per 1,000 live births for white women and 3.4 deaths per 1,000 live births for Asian women, per the CDC data.
Infants born to American Indian and Alaska Native women also had higher rates than white and Asian women at 9.2 deaths per 1,000 live births, according to the report.
Data also showed infants born to Hawaiian or Pacific Islander women died at a rate of 8.2 deaths per 1,000 live births, and those born to Hispanic women died at a rate of 5.0 deaths per 1,000 live births.
Why racial disparities continue to persist is "the $100 million question," Dr. Kirsten Bechtel, a pediatric emergency medicine physician at Yale New Haven Children's Hospital and an expert in infant mortality, told ABC News.
"One of things that's great about this data is that it helps us work backward. It's like the canary in the gold mine," Bechtel, who was not involved in the report, said. "Death is an outcome that everyone agrees on is a problem, but why that problem happens is oftentimes subject to vigorous discussion."
She said one reason behind the disparities could be that Black mothers have a higher rate of pre-term birth, and pre-term birth is associated with higher infant mortality.
"That has a lot to do with access to timely prenatal care," Bechtel said. "Trying to get folks access to timely care during pregnancy and timely care that is evidence-based. We also know there is some elements of structural racism that is built into some of the care these women receive."
Bechtel said the findings show that pregnant people need to be supported financially with access to medical care and by the community helping take care of a child.
"Raising a child can be very daunting, especially if you have socioeconomic challenges or you have to go to work and you can't take time off after your baby's birth," she said. "So we really need to look at policies that support pregnant people."
Harika Rayala, M.D., MSJ, is a neurology resident physician at the University of Virginia and a member of the ABC News Medical Unit.
UNC Hospitals See Spike in Walking Pneumonia Cases in Children. What You Should be Worried About.
A national spike in walking pneumonia cases is being reflected in the Triangle.
(WUNC, Abigail Celoria) -- UNC Hospitals reported 40 walking pneumonia cases in the last week of October, which includes patients tested in clinics, emergency departments, and other locations. That's compared to almost none in the same week last year.
This follows the Centers for Disease Control and Prevention's warning about the rise of mycoplasma pneumoniae infections, a bacteria that can cause walking pneumonia. These cases surfaced again in 2023 after a low following the pandemic.
Dr. Zach Willis, a pediatric infectious disease specialist at UNC Children's, says the outbreak is particularly affecting kids.
"It's much more common in children who are teenage years or, you know, down to about age 10," he said. "But, typically children under five, usually not. It's usually very rare in children who are not yet school age."
Typical symptoms of walking pneumonia include cough, fever, sore throat, difficulty breathing, and fatigue, with other symptoms appearing in children. What's unusual about the outbreak this year is its bacterial cause.
"If a three-year-old had walking pneumonia (before), I would say they probably have a viral infection," said Willis. "But more recently, if a three-year-old had walking pneumonia, I would say there's a good chance that they have mycoplasma (pneumoniae)."
Despite the spike, Willis stressed that parents don't have to worry.
"We all know that this time of year, especially if you have kids in school or in daycare, respiratory infections are common," he said. "And, this is just a different thing that has occurred this year. But, it is helpful for people to be aware, because if a child does have fever, sore throat, or cough that's persistent, then that can be made better."
According to Willis, it's also helpful for clinicians to be aware, since mycoplasma pneumoniae responds to a different antibiotic than what's usually used to treat pneumonia.
"So for mycoplasma (pneumoniae), specifically, hand washing and cough hygiene are very important," he said. "It's spread by coughing. And so those are ways to prevent getting infected. But, if it does happen, it is something that can be managed if the patient gets the right treatment."
FEMA Disaster Recovery Center Announces Closure
CHARLOTTE, N.C. (WBTV)—The Federal Emergency Management Agency (FEMA) Disaster Recovery Center (DRC) in Mecklenburg County announced on Wednesday, Nov. 13, that it will permanently close at 7 p.m. on Friday, Nov. 15.
Officials gave no reason as to why the center is closing; however, they did emphasize North Carolinians will still have many options for in-person help at the other 24 open DRC locations in the state.
“It is not necessary to go to a center to apply for FEMA assistance,” a spokesperson wrote. “The fastest way to apply is online at DisasterAssistance.gov or via the FEMA App.”
For additional DRC locations in the state, click here.
Will Hurricane Helene Impact Drop in NC Drug Overdose Deaths?
As drug experts parse the data trying to understand the factors that could contribute to a sudden drop in overdose deaths, harm reductionists in western N.C. work to stave off a possible spike in overdoses after the destruction brought by Hurricane Helene.
(NC Health News, Taylor Knopf) -- Just as substance use experts celebrated a somewhat mysterious drop in drug overdose deaths across North Carolina, Hurricane Helene blew through the western part of the state, causing death and widespread property damage. In the storm’s aftermath, many residents found themselves without homes and businesses and facing an uncertain future.
For harm reductionists like Hill Brown, the southern director of Faith in Harm Reduction, Helene’s impact raised serious concerns. Brown knew that the disruption to the local drug supply, coupled with the stress of losing housing, could lead to an uptick in overdoses in the coming months.
Over the past month, Brown, who lives in western North Carolina, has been pushing to get the overdose reversal drug, naloxone, into the hands of more people. Brown said she was surprised to find that some rural areas that had previously resisted harm reduction efforts, including naloxone distribution, have begun to embrace these life-saving tools in the wake of Helene.
“Once the [drug] supply comes back online, and people haven’t had good access to their dealers or to whatever supply they were using, there is going to be an uptick in overdoses, because we just don’t know what the supply is going to look like,” Brown said.
“If we’re talking about a crisis where lots of people are losing their housing, or their housing is becoming unlivable because of flooding, then people are going to be stressed out, and they’re going to do things that they know how to do to cope.”
This threat comes when the overdose crisis in North Carolina has shown signs of improvement — at least on paper. The latest data reported by the Centers for Disease Control and Prevention predicts about a 30 percent decrease in overdose deaths in North Carolina from May 2023 to May 2024, a statistic that will be confirmed once death certificates are finalized.
Nationally, the CDC estimates roughly a 13 percent decrease in overdose deaths for the same time period, based on provisional death data.
These numbers will likely shift because the data is incomplete right now, and North Carolina has been particularly slow in reporting its overdose death data to the federal agency, according to a note that initially topped the latest CDC report. Spokesperson Summer Tonizzo, with the N.C. Department of Health and Human Services, told NC Health News that this is an indication that North Carolina has a high number of “pending” deaths.
Provisional data from the North Carolina Office of the Chief Medical Examiner’s Office shows suspected overdose deaths in the state dropping so far in 2024. Credit: North Carolina Office of the Chief Medical Examiner
“These are cases being investigated by NC’s Medical Examiner System which continues to struggle with rising caseloads and staff vacancies — both of which have negatively impacted the system’s ability to timely close pending death records,” Tonizzo wrote in an email.
Even so, North Carolina epidemiologists say, all indicators point to a significant decrease in overdose deaths. But as they dig into the data, a more complex picture emerges — one marked by uneven progress and disparities affecting marginalized communities.
Cautiously optimistic
Those ongoing pressures in the medical examiner system means it takes a long time to certify death reports that go through the state’s medical examiner’s office. North Carolina’s last complete year of finalized overdose death data is 2022.
“We’re almost at the end of 2024. It’s not fast enough,” Mary Beth Cox, an epidemiologist who tracks substance use at the North Carolina Division of Public Health told a NC Opioid and Prescription Drug Abuse Advisory Committee meeting in September.
Because there will always be some lag in the data, researchers like Cox look to some early indicators, such as emergency department visits, to track the state’s progress in addressing the overdose crisis. Since 2018, her department has been putting out monthly reports on overdose trends seen in emergency departments across the state. The latest report shows emergency department visits are down consistently in 2024 over the same period of time last year. For example, 1,055 overdose visits were reported in August 2024 while 1,518 were reported in August 2023.
Another early indicator researchers look at is 911 calls seeking help for an overdose. Nationally, first responders report that those calls are down 16 percent in October 2024 from October 2023.
But these systems don’t paint a clear enough picture, Cox said.
“If we’re seeing a decrease in [emergency department] data, does that actually mean a decrease in overdoses? We don’t know. It just means people aren’t going to the [emergency department],” she explained. “If we see an increase in [emergency department] visits, you might say, at face value, that’s a bad thing. But it could mean more people are getting connected to care.”
“Without the death data to supplement, it’s really hard to know what’s going on,” Cox said.
Her team has worked with the chief medical examiner’s office to put out an additional report every month on suspected overdose deaths. Their most recent report shows a 27 percent decrease in suspected overdose deaths in September 2024 from September 2023.
North Carolina Attorney General (now governor-elect) Josh Stein attended the meeting and applauded the group for their tireless work to address the opioid crisis. His office played a key role leading the multi-state legal challenges that resulted in $1.5 billion in opioid settlement money for North Carolina.
“We are starting to see some hopeful developments on the horizon,” Stein said in September. “Obviously, we are not naive. We know the work is not done. There is so much more to do. But it’s appropriate to see and appreciate that something is better today than it was yesterday because folks have been working really hard for that to happen.”
Cox cautioned that these decreases don’t appear to be uniform across all demographics. “This is still very provisional data, very subject to change. But we’re seeing it across multiple indicators that historically marginalized populations, particularly our Black communities, are still experiencing a slight increase.”
A recent analysis of national data by KFF (formerly the Kaiser Family Foundation) found that white people have experienced the greatest drop in rate of overdose deaths, and Black and Indigenous communities are still battling disproportionately higher rates of overdose deaths.
While the overall trend offers glimmers of hope, Cox acknowledged the sobering reality behind the numbers — nine people are dying by overdose every day in North Carolina.
“That’s a lot of people still,” Cox said. “Certainly we’re headed in the right direction, but it’s a whole lot of death.
“Every one of those deaths is preventable.”
Not the full picture
Those who work in harm reduction, like Michelle Mathis, executive director of Olive Branch Ministry, say the state’s surveillance data fails to capture the reality they see on the ground. Mathis’ ministry serves people who use drugs in the foothills/Western Piedmont area of North Carolina. Olive Branch offers multiple fixed syringe exchange sites and mobile programs.
“The trends that we see — and when I talk to other agencies as well — they’re not seeing this big downward reporting in overdoses,” she said.
She said that harm reduction workers always ask participants: Are you aware of any overdoses or have you personally experienced an overdose since the last time we saw you? Their answers are consistently recorded, but Mathis said the state health department only takes up that data once a year to include in an annual report.
“I have argued for this for as long as syringe services have been legal in the state. … We have to have some kind of monthly reporting mechanism,” she said.
Mathis said the majority of people that participate in Olive Branch’s exchange do not call 911 or go to the hospital when someone overdoses.
“Perhaps overdoses are not necessarily down, but people have access to more Narcan — because of harm reduction agencies — and so they are not as prone to being involved with EMS and the hospitals,” she said.
She added that a big reason her participants say they hesitate to call 911 during an overdose is fear of the state’s “death by distribution” law, which has been strengthened by the state legislature since it was enacted in 2019. The law allows prosecutors to charge someone with second degree murder if they sell drugs to someone who then dies of an overdose. Advocates say that the line between drug dealer and drug user is blurry, as people often buy and sell drugs from their friends and people they use with, who might not be what most would consider a “dealer,” per se.
Advocates say this law deters people from seeking help.
Brown, who has worked on advancing harm reduction efforts in Mitchell, Yancey and Buncombe counties, also said it’s hard to make sense of a reported drop in overdoses after witnessing the ever-changing illegal drug supply and people’s fear of potential death by distribution charges.
Why are overdose deaths declining?
These huge drops in overdose deaths being reported in North Carolina and around the country are puzzling to many. Substance use experts at the Street Drug Analysis Lab at the University of North Carolina say that a 15 percent to 20 percent decrease in drug overdoses would be “unprecedented.”
“To our knowledge, no public health intervention in the United States has ever achieved this benchmark,” members of the lab wrote in a recent blog post. “Something has changed. And that this is happening without central coordination is a big deal. It has major implications for the way we think about overdose prevention interventions.”
Adams Sibley, social behavioral scientist with UNC lab, co-authored the lengthy blog post, which digs into the many leading hypotheses for the mysterious drop — from increased naloxone distribution to law enforcement operations at the border to removal of barriers to addiction treatment.
Sibley also presented to the NC Opioid and Prescription Drug Abuse Advisory Committee in September and said the decrease is likely a combination of many things, including the presence of xylazine in the street drug supply and a shift from injecting substances to snorting or smoking.
Xylazine, a veterinary tranquilizer, is an additive that has been increasingly found in the illegal drug supply added to fentanyl or heroin. It can cause nasty wounds and potentially deadly skin infections at the site of injection.
“There’s a hypothesis that xylazine is one contributor to the drop in overdose deaths in a positive way,” Sibley explained. “Xylazine gives fentanyl legs, which means people may be using fentanyl less throughout the day because it’s prolonging the perceived effect of fentanyl. Xylazine also causes these skin injuries, and so it might be encouraging people to switch to smoking.”
Switching mode of drug consumption from injecting to smoking or snorting is a harm reduction measure because people use smaller amounts of drugs at a time. And smoking has surpassed injecting as the most common way people use drugs, according to the CDC. There are several reasons someone might switch to smoking, Sibley said.
Mathis said she has witnessed a shift toward smoking in participants of Olive Branch Ministry’s syringe exchange programs. She noted that the law that legalized syringe services programs does not allow for the distribution of smoking and snorting supplies.
“So we see — and we want to acknowledge — that change in mode of consumption is contributing greatly to this massive positive trend,” she said. “Yet state statute does not allow us to distribute the supplies which could really help boost this trend if we could legally do it.”
Sibley reminded the audience gathered in September that it’s important to stay humble, examine the data closely and listen to people who use drugs.
“We are not always in control of the numbers and the trends,” he said. “We know treatments are working. We know naloxone is working. But there may be reasons that overdose deaths are dropping that are out of our control.”
Two NC HBCUs Partner with Duke to Increase Black Student Representation in Medicine
(WUNC, Brianna Atkinson) -- Two of the state's private Historically Black Colleges and Universities (HBCUs) are partnering with Duke University to increase representation in the medical field. Students from Bennett College, a women's-only institution in Greensboro, and Saint Augustine's University in Raleigh will participate in a 15-month intensive program to study otolaryngology (ear, nose, and throat) and communication sciences.
According to the American Medical Association, otolaryngology has especially low numbers of women and Black people compared to other medical specialties. Women make up about 2.5% of the field and Black people just 1.1%.
Dr. Dennis Frank-Ito is leading the program at Duke University. He said in his experience, many Black students aren't aware of otolaryngology and communication sciences until they are already deep into their undergraduate studies.
"Which might be too late for them to start taking the right classes in preparation for this," Frank-Ito said. "There's a critical need (because) we know that for Black and African American patients, if there is a concordance between the patient and the provider that often leads to better health outcomes."
According to a 2023 study from the National Institutes of Health (NIH), there are "significant healthcare disparities in care and treatment outcomes" for underrepresented groups in otolaryngology. The study found that Black patients have higher instances of HPV and oropharyngeal cancer, as well as a lower survival rate compared to white patients.
Frank-Ito hopes the program at Duke, which will run for at least five years, will help more Black students gain interest in the field.
"We are hoping that in the next 10 years we can see that through this program we have more Black professionals in our field," Frank-Ito said. "And when we look at health outcomes for Black and other minority populations – especially in the Triangle area – there's an improvement in how patients feel when they see specialists in our field. That's the legacy we plan to leave behind."
In each cycle, there will be three rising juniors from Bennett College and Saint Augustine's University. At least one student will come from each university.
The cohort will stay on Duke University's campus for the summer, where they will participate in clinical trainings and professional development. This can range from classes about how COVID-19 affects the sense of smell to how to gather data from online libraries. The program is being funded through an R25 grant from the NIH.
After the summer sessions, students will work with Duke faculty remotely for the remainder of the 15-month cycle. Frank-Ito said all students that apply to the program will have access to these virtual trainings and materials.
"So even though they were not selected, they still have enough information from this training program to have the right exposure, whether or not to pursue a career in our field," Frank-Ito said. "Our lasting impact is to increase representation in our field. We want to ensure that through this program, we are going to be able to pave the way for more Black professionals in otolaryngology and communication sciences."
‘Not Medically Necessary’: Inside the Company Helping America’s Biggest Health Insurers Deny Coverage for Care
Who is Really Making the Decisions?
This story was originally published by ProPublica. It co-published with The Capitol Forum.
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Every day, patients across America crack open envelopes with bad news. Yet another health insurer has decided not to pay for a treatment that their doctor has recommended. Sometimes it’s a no for an MRI for a high school wrestler with a strained back. Sometimes for a cancer procedure that will help a grandmother with a throat tumor. Sometimes for a heart scan for a truck driver feeling short of breath.
But the insurance companies don’t always make these decisions. Instead, they often outsource medical reviews to a largely hidden industry that makes money by turning down doctors’ requests for payments, known as prior authorizations. Call it the denials for dollars business.
The biggest player is a company called EviCore by Evernorth, which is hired by major American insurance companies and provides coverage to 100 million consumers — about 1 in 3 insured people. It is owned by the insurance giant Cigna.
A ProPublica and Capitol Forum investigation found that EviCore uses an algorithm backed by artificial intelligence, which some insiders call “the dial,” that it can adjust to lead to higher denials. Some contracts ensure the company makes more money the more it cuts health spending. And it issues medical guidelines that doctors have said delay and deny care for patients.
EviCore and companies like it approve prior authorizations “based on the decision that is more profitable for them,” said Barbara McAneny, a former president of the American Medical Association and a practicing oncologist. “They love to deny things.”
EviCore says it scrutinizes requests to make sure that procedures recommended by doctors are safe, necessary and cost-effective. “We are improving the quality of health care, the safety of health care and, by very happy coincidence, we’re also decreasing a significant amount of unnecessary cost,” an EviCore medical officer explains in a video produced by the company.
But EviCore’s cost-cutting is far from coincidental, according to the investigation.
EviCore markets itself to insurance companies by promising a 3-to-1 return on investment — that is, for every $1 spent on EviCore, the insurer would pay out $3 less on medical care and other costs. EviCore salespeople have boasted of a 15% increase in denials, according to the investigation, which is based on internal documents, corporate data and dozens of interviews with former employees, doctors, industry experts, health care regulators and insurance executives. Almost everybody interviewed spoke on condition of anonymity because they continue to work in the industry.
An analysis of the company’s own data shows that, since 2021, EviCore turned down prior authorization requests, in full or in part, almost 20% of the time in Arkansas, which requires the publication of denial rates. By comparison, the equivalent figure for federal Medicare Advantage plans was about 7% in 2022.
EviCore has several ways to cut costs for insurers. Chief among them is the dial, the proprietary algorithm that’s the first stop in evaluating a prior authorization. Based on data entered by a doctor’s office, it can automatically approve a request.
The algorithm cannot say no, however. If it finds problems, it sends the request for review to a team of in-house nurses and doctors who consult company medical guidelines. Only doctors can issue a final denial.
This is where tweaking the dial comes in. EviCore can adjust the algorithm to increase the number of requests sent for review, according to five former employees. The more reviews, the higher the chance of denials.
Here’s how it works, the former employees said: The algorithm reviews a request and gives it a score. For example, it may judge one request to have a 75% chance of approval, while another to have a 95% chance. If EviCore wants more denials, it can send on for review anything that scores lower than a 95%. If it wants fewer, it can set the threshold for reviews at scores lower than 75%.
“We could control that,” said one former EviCore executive involved in technology issues. “That’s the game we would play.”
Over the years, medical groups have repeatedly complained that EviCore’s guidelines were outdated and rigid, resulting in inappropriate denials or delays in care. Frustration with the rules has led some doctors to refer to the company as EvilCore. There is even a parody account on X.
The guidelines are also used as a tool to cut costs, the investigation found. Company executives “would say, ‘Keep a closer eye on the guidelines for reviews for a particular company because we’re not showing savings,’” said a former EviCore employee involved in the radiation oncology program.
EviCore says that it develops its guidelines with the input of peer-reviewed medical studies and professional societies, and that they are routinely updated to stay current with the latest evidence-backed practices. It said its decisions are based solely on the guidelines and are not interpreted differently for different clients.
EviCore is not alone in engaging in the denials-for-dollars business. The second-biggest player is Carelon Medical Benefits Management, a subsidiary of Elevance Health, the health insurer formerly known as Anthem. It has been accused in court of wrongfully denying legitimate requests for coverage. The company has denied all charges. Several smaller companies do the same kind of work.
There is no question that prior authorizations play an important role in modern medicine. They serve to guard against doctors who recommend unnecessary and even potentially harmful treatments. They also protect insurers from fraudulent physicians who overbill for services.
In a response to questions, a Cigna spokesperson provided a statement on behalf of EviCore. “Simply put, EviCore uses the latest evidence-based medicine to ensure that patients receive the care they need and avoid the services they do not,” it said.
The statement acknowledged that EviCore used algorithms for some clinical programs, but “ONLY to accelerate approval of appropriate care and reduce the administrative burden on providers.”
The statement noted that doctors have the ability to appeal prior authorization denials, and that the company routinely monitors the outcomes “as part of our continuous quality improvement to ensure accurate and timely medical necessity decision-making.”
Prior authorization reviews provided by EviCore save money for the entire health insurance system, the statement said. “The natural product of improved care quality and reduced waste is savings for our clients, lower out-of-pocket costs for patients, and fewer health care premium increases for Americans.”
Turning the dial
In the fall of 2021, when the air grew crisp and the leaves reddened in central Ohio, Little John Cupp began feeling short of breath. He gasped while pushing a shopping cart. His feet and ankles swelled. He could only sleep while sitting up.
An echocardiogram revealed that his heart was having trouble pumping blood. Cupp’s doctor suggested more testing, including the insertion of a catheter to examine whether his arteries were blocked.
A few days after the doctor made the request, Cupp received a letter from his insurance company, UnitedHealthcare. The procedure, it said, was “not medically necessary.”
One sentence in 8-point type revealed that the insurer had outsourced the decision to EviCore.
Cupp’s doctor put him on medications to reduce swelling and high blood pressure and tried a second time to win approval for a left heart catheter examination. EviCore turned it down again. He revealed his disappointment in shorthand in Cupp’s medical records: “ideally he needs LHC (denied twice by insurance).”
Cupp was 5-foot-7 and 282 pounds, with a wedding ring the size of a quarter. He had a white beard, his face wide and warm. He wore blue jean overalls and scuffed leather work boots. He had spent most of his life as a welder, working at metal fabrication shops in and around his hometown of Circleville, Ohio, population 14,063. He was 61, nearly the same age as his father when he died from a massive heart attack. Cupp was a stoic, his daughter Chris said, but the denial worried him.
“Well, I have to call the doctor and see what we’re going to do,” he told her after the second rejection.
The doctor decided to give up on getting an approval for the catheter exam. In challenging EviCore, he was fighting not just a company but an industry.
EviCore is the product of a massive, decadeslong push by insurance companies to control health care costs. They point to studies that show 20% to 45% of some medical treatments are wasteful or ineffective. To decrease such spending, insurers began requiring doctors to seek permission for medical care before agreeing to pay for it — a process known as “utilization review.” As treatments became more complex, the reviews proved costly in themselves.
Created from a 2014 merger of two smaller companies, EviCore offered a solution: It allowed insurers to outsource prior authorization decisions for the most specialized and expensive procedures. EviCore today issues recommendations for imaging, oncology, cardiology, gastroenterology, sleep problems and many other fields.
It works with more than 100 insurers across the country, including industry titans such as UnitedHealthcare, Aetna and Blue Cross Blue Shield and some Medicare and Medicaid contractors. Cigna took over the company in 2018, but EviCore maintains its independence by blocking insurers from prying into one another’s proprietary data.
In responses to inquiries, the large insurance companies said they hired EviCore as a way to make sure that customers received safe and necessary medical treatments, while holding down costs for inappropriate care.
EviCore built its business by relying on different types of contracts. In one, a health insurance company pays EviCore a flat rate to review coverage requests.
Another type is more lucrative, providing an incentive for EviCore to cut costs, former employees said. Known as risk contracts, EviCore takes on the responsibility for paying claims. As an example, say an insurer spends $10 million a year on MRIs. If EviCore keeps costs below that figure, it pockets the difference. In some cases, it splits the savings with the insurance company.
“Where you really made your money was on a risk model,” a former EviCore executive said. “Their margins were exponentially higher.”
EviCore teams involved in developing the algorithms and contracting with clients “operate separately” from reviewers “to prevent any potential conflicts of interest,” according to the statement from Cigna’s spokesperson.
Insurers do not make explicit demands for more denials, a former EviCore sales executive said, Instead, they asked about “controlling the spend” — the amount of money paid out on certain procedures, he said. Nor would EviCore always use the word “denials” — they employed circumlocutions like “inappropriate determinations.”
Aetna and Cigna are two of the companies that have requested “high touch” plans — those that would send more cases to clinical review and thus generate more denials, according to the former employee involved in data issues.
Aetna did not directly respond to whether it used “high touch” plans. “Although we never automate medical necessity denials, we automate and provide real-time approval of some services to ease administrative burden and allow providers to focus on patient care,” the insurer said in a statement. Cigna did not respond to questions about its use of such plans.
“When you have human eyes on something, you can pick up where there might be a gray area where the algorithm might not pick up,” a former EviCore account executive said. “That is how you would increase the denial rate.”
EviCore can also adjust the algorithm to achieve its internal goals, without the knowledge of clients, former employees said. This happened when EviCore was not generating enough savings to demonstrate its value to insurers, several former employees told ProPublica.
“The pressure from our business leaders was to make sure that we were able to provide evidence of a strong enough impact to justify the contracts with clients,” said the former employee involved with technology.
The system also runs in reverse. When doctors or employer health plans complain about high rejection rates, insurance companies can ask EviCore to back off. The company simply adjusts its algorithm to approve more prior authorization requests.
Dave Jones, a former California insurance commissioner and now director of the climate risk initiative at the University of California, Berkeley School of Law, said arbitrarily increasing or decreasing manual reviews didn’t appear to violate any standards. Still, he questioned whether a payment structure or contract for EviCore based on reducing claims payments or authorizations would result in objective and thorough evaluations of prior authorization requests, as required by law.
“That to me is troubling,” Jones said. “It suggests that the claim settlement procedure is not objective, right?” He added, “It calls into question everything that’s occurring.”
Other industry experts found the manipulation of denial rates upsetting.
“The fact that these big companies focused on profits and can play all these games is quite disturbing to me,” said Martin Lustick, a former insurance executive and the author of a book on industry practices. “They know the more reviews they do, the more denials they get.”
Disputed guidelines
On March 2, 2022, Cupp and his daughter entered the Adena Regional Medical Center, a gray and glass building surrounded by central Ohio’s low rolling hills.
It had been almost three months since EviCore first turned down coverage for the catheterization. Changing tack, Cupp’s doctor ordered a new exam, which EviCore approved, called a nuclear stress test. It shows how well blood flows through your heart.
A heart catheterization generally costs around $3,500 when done in network, according to Fair Health, a nonprofit that tracks health care prices. A nuclear stress test runs about $315.
Afterward, Cupp greeted Chris in the waiting room. He told her he felt fine. They went for lunch at a favorite hamburger spot. At the time, they did not know the results of the stress test, which showed that his heart was pumping even less blood than indicated by his echocardiogram.
At each step of the way, EviCore had steered Cupp’s medical treatment by denying or approving his doctor’s coverage requests based on its own internal guidelines.
Those guidelines have long been the subject of complaints from doctors. Over the past five years, organizations ranging from the American College of Cardiology to the Society for Vascular Surgery to ASTRO, the American Society for Radiation Oncology, have written to EviCore or regulators that the guidelines are flawed and can interfere with delivering the right care for patients. Benjamin Durkee, a doctor who chairs ASTRO’s payor relations committee, said EviCore had generally made “a good faith” effort to respond to the society’s concerns. But, he noted, the company continues to consistently deny a radiation treatment called proton beam therapy for some pelvic tumors that is more costly but supported by ASTRO’s recommendations.
A 2023 academic study examined the criteria EviCore used to approve payment for imaging of the lower spine in cases of extreme pain. It found the guidelines deficient. Two of five medical experts who reviewed the guidelines even recommended not using them.
A 2018 audit by the Centers for Medicare and Medicaid Services, obtained through the Freedom of Information Act, found that Health Care Service Corporation, a Blue Cross Blue Shield insurer, had hired EviCore to review prior authorizations. EviCore, the audit found, played a role in making “inappropriate denials” for 30 patients because it failed to keep its cancer guidelines up to date. As a result, EviCore retrained its staff. HCSC did not respond for comment.
Former employees have also questioned how the guidelines were put to use.
A maternal-fetal medicine physician in Colorado, Gail Miller, took a job as a doctor at EviCore in 2018. The idea of ensuring safe medical practices appealed to her. But she soon grew convinced that EviCore was more interested in saving money.
EviCore rejected her suggestions for improving its maternal fetal health guidelines. Her supervisor required her to decide at least 15 cases an hour — or one every four minutes. She often reviewed requests by physicians outside her specialty.
Nine months after starting at EviCore, Miller quit, disappointed by the attitudes of some of her colleagues. “Most of the physicians who work at these places just don’t care,” she said. “Any empathy they had is gone.”
EviCore noted its clinical staff had “high engagement, satisfaction and retention rates.” It said the most common reason for denying a prior authorization is because doctors neglect to include necessary information.
Results
EviCore meets regularly with insurers and state Medicaid programs. It is a critical part of the business. The company has to demonstrate savings or clients will have little reason to continue their contracts.
Typical was a 2019 meeting with Vermont’s Medicaid program, which for years had used EviCore to review coverage requests for advanced radiology and cardiology scans. A slide show demonstrated how the company had helped lower costs for cardiac imaging through denials. Rates had zigzagged, from a high of almost 15% of requests in one three-month period to a low of 6.1% in another.
But the presentation, obtained through Vermont’s Public Records Act, revealed another way that EviCore saved money for insurers. Prior authorization requests for radiology imaging services had dropped to 3,629, a decline of 16%. Cardiology requests had plummeted even more — down 38% in a little more than a year. Doctors had simply stopped asking for procedures for their patients.
An EviCore executive called this the “sentinel effect” at a legislative hearing in Kansas. It is like the sheriff coming to town. Once doctors know EviCore is watching, they make fewer inappropriate prior authorization requests, he said.
Doctors, however, say that such decreases reflect how difficult it is to fight EviCore and similar companies. Their entrance into the market frustrates doctors from making otherwise legitimate requests.
In its statement, Cigna described the sentinel effect differently. The company said that it helps doctors stay up to date on best practices. “Sentinel effect refers to the reduction in frequency with which physicians order inappropriate services because they are now aware of the latest clinical evidence,” the statement read.
A spokesperson for Vermont’s Medicaid program said the state does not believe that EviCore made unfair or unsound coverage recommendations. Instead, EviCore helped Vermont make “sound decisions from both a fiscal and patient care perspective.”
“It is never a goal for the state of Vermont or our third-party contractors to deny service,” said Alex McCracken, spokesperson of Department of Vermont Health Access. “We are committed to delivery of service for our customers.”
Vermont eventually ended its contract with EviCore because it decided to no longer require prior authorization for advanced imaging scans in its Medicaid program.
‘Too much say’
The day after his stress test, Cupp drove to his granddaughter’s high school to drop off her archery bow — it had been left behind in the morning rush. He and his wife went shopping at the grocery store. That evening, he watched as his grandkids showed off some baby frogs they had purchased at a pet store.
He went to bed at 8:30 p.m. in order to wake at 2:30 a.m. for the hourlong drive to his job as a maintenance worker at a medical supplies warehouse just south of Columbus.
At about 10:30 p.m., Cupp’s wife, Vivian, shook Chris awake. “Your dad’s breathing funny,” she told her. Chris ran into their bedroom. Her father was gasping for air. Suddenly, he stopped. Chris began CPR. She told her mom to call 911.
By the time the ambulance arrived at Adena Regional Medical Center, where he had received his nuclear stress test 36 hours earlier, his body was mottled and cool. He had suffered cardiac arrest. The time of death was 11:39 p.m.
ProPublica asked four cardiology experts to review Cupp’s medical situation. One cardiologist said she would not have recommended a heart catheterization. Given his symptoms, which did not include complaints about chest pain, the best diagnostic tool would have been the stress test, she said.
Three others said the heart catheterization was appropriate. One cardiologist noted that Cupp was diabetic, overweight and showed signs of having suffered a prior heart attack. “It’s very reasonable to say we’ll just go straight to a heart catheterization,” the cardiologist said.
If Cupp had received the procedure when first ordered, his life may have been saved, one expert said. “The doctor was absolutely right to order the catheterization. It was certainly necessary,” said Jonni Cooper, president of American Board of Cardiovascular Medicine and a board certified cardiovascular nurse practitioner.
State and federal regulators rarely impose onerous penalties on companies like EviCore.
Connecticut’s Insurance Department recently reviewed EviCore and Carelon. It found no problems with Carelon. EviCore was fined $16,000 this year for more than 77 violations found in a review of 196 files. EviCore is also accredited by two trade associations, which review companies periodically for compliance with industry standards.
Holding the companies legally responsible for their decisions is also difficult. In 2022, Carelon settled a lawsuit for $13 million that alleged the company, then called AIM, had used a variety of techniques to avoid approving coverage requests. Among them: The company set its fax machines to receive only 5 to 10 pages. When doctors faxed prior authorization requests longer than the limit, company representatives would deny them for failing to have enough documentation. Carelon denied the allegations in court and admitted no fault. A spokesperson declined to comment on the lawsuit.
Elevance, Carelon’s parent company, said its subsidiary “is focused on improving health outcomes while also lowering the cost of care.”
This year, Chris, representing Cupp’s estate, sued United Healthcare, EviCore, the Adena Regional Medical Center and Cupp’s doctor, accusing them of malpractice, among other allegations. Cupp’s attorney, John Markus, later decided to drop United and EviCore. Lawsuits against employer-funded health plans, like the one Cupp had with United, must be tried in federal court, where case law favors insurance companies. For instance, insurers found at fault do not pay punitive damages, only the cost of treatment. The medical center and the doctor declined to comment, citing the ongoing litigation. In court, both denied any wrongdoing. United and EviCore declined to discuss Cupp’s case, despite an offer from Chris to sign a waiver of medical privacy rights.
Her father’s death wracked Chris. He had been her best friend. He helped raise her three kids. He provided for the family. Two years before his death, he purchased a new double-wide trailer to replace a rusting single-wide the family had lived in for years. It had four bedrooms, enough for everyone. It stood on the side of a hill, surrounded by oak and maple, a leafy retreat with a view of the valley below.
Cupp was buried at a cemetery across from a cornfield on March 9. A gray granite headstone marks his date of death.
Chris Cupp drives a school bus to make ends meet. For extra pay, she picks up a lot of the trips for night games. She says she hopes that no one else has to go through what she did.
“Insurance has too much say over something that can save your life,” she said. “When it comes to your heart, something that’s going to kill you, they have too much say in that. That’s my thought about it.”
Agnel Philip contributed reporting.
Congratulations to the NCMS Member Candidates!
Four NCMS Members Claim Victory in 2024 Election
Congratulations are in order for four members of the North Carolina Medical Society who emerged victorious in their respective races on Tuesday! Their success marks a significant achievement, highlighting the importance of healthcare professionals in state leadership.
North Carolina’s election results revealed a split decision in some of the state's most high-profile races. Voters selected Republican Donald Trump for President, while electing Democrat Josh Stein as Governor. This dynamic points to North Carolinians' nuanced perspectives on governance at both the state and federal levels.
In the state legislature, Republicans maintained control of the Senate with a supermajority, underscoring their stronghold and potential sway in legislative decision-making. However, the House saw a notable shift, as Republicans lost their veto-proof majority, meaning that bipartisan cooperation may now play a greater role in passing state legislation. These results set the stage for a dynamic political landscape in North Carolina, with opportunities for collaboration as well as new challenges ahead.
Congratulations to:
- Dr. Greg Murphy, US House of Representatives District 3
- Dr. Grant Campbell, NC House of Representatives District 83
- Dr. Timothy Reeder, NC House of Representatives District 9
- Mark Hollo, PA, NC Senate District 44
We also extend our deepest gratitude to all of our dedicated member candidates who put their time, energy, and passion into advancing healthcare priorities across North Carolina. Your hard work and commitment to the wellbeing of our communities have not gone unnoticed.
Thank you for your dedication to improving healthcare for all North Carolinians and for your willingness to serve. Your voices, whether in office or out, continue to move us forward in creating a healthier, more equitable future for our communities.
The NCMS talked with all our member candidates prior to the election. To see more of those interviews click here.
How Communities Impacted by Hurricanes Helene and Milton Are Celebrating Halloween
Helene and Milton Can't Keep the Halloween Spirit from Happening!
(Time, Chantelle Lee) -- Krista Gamble and her family love Halloween. But this year, as her community in Asheville, North Carolina, was still dealing with the aftermath of Hurricane Helene—a category 4 storm that ravaged the city last month—she wanted to make sure that families in the area would be able to enjoy the holiday.
“It’s traumatizing a lot of the things some of these kids have seen or learned,” Gamble says about Helene. “It’s important to let these kids still be kids; they’ve had a tough month.”
Helene reached Florida on Sept. 26 and tore through the Southeast. The storm devastated western North Carolina—almost half of deaths due to Helene were in North Carolina, and 42 were in Buncombe County where Asheville is located, according to The Associated Press. Less than two weeks later, Hurricane Milton made landfall in Florida as a Category 3 hurricane, wreaking havoc on communities that had just begun to recover from Helene. Officials are still calculating the damage from the two storms, but it’s estimated to cost tens of billions of dollars.
Gamble says she and her family were fortunate that they only had minimal flooding in their basement, but they were left without power and running water for a couple weeks after Helene hit. Gamble says much of Asheville is still under a boil water notice as of Tuesday. But as the community has embarked on rebuilding and cleanup efforts, people like Gamble have also been coming together to help each other find moments of levity—like by celebrating Halloween.
North Carolina celebrates Halloween despite Helene
After Helene, Gamble started collecting donations of Halloween costumes and ended up bringing about 150 of them to a local community space in Asheville, which held a free fall festival on Oct. 27 that included face painting, candy, and a costume drive. Gamble was one of several people who organized costume donations or Halloween events for kids and families.
Nearby, the Monte Vista Hotel and a local restaurant, Goldfinch, hosted its first-ever fall festival on Oct. 26, which included a Trunk or Treat, hayride, and even therapy horses, among other activities. There were also about 400 costume donations for people to choose from. Everything offered at the event was donated from in and out-of-state. The hotel, located in Black Mountain, had been providing free meals to people in the days after Helene hit, and has been housing people whose properties were damaged in the storm and qualify as survivors with the Federal Emergency Management Agency (FEMA). FEMA has been providing assistance and coordinating relief efforts to states—like North Carolina—that were impacted by Helene.
But still, hotel staff wanted to do more.
“None of us, I think, thought this was going to last as long as it has in our little town,” says Chloe Greene, the hotel’s assistant general manager. Black Mountain, like Asheville, was one of many communities devastated by Helene—the storm brought severe flooding and damaged numerous properties in the area. Black Mountain is also still under a boil water notice as of Tuesday, according to Greene.
“We just wanted to provide relief for parents that were worrying about so much,” says Ken Floyd, the hotel’s general manager. He says nearly 1,500 people attended the event.
“We gave out about 200 plus pounds of candy. And to see the kids’ faces light up when they got to pick out their costume…” Floyd adds. “People got to sit down, relax, eat some food, and watch their kids just have a great time and that’s really … what it was all about.”
Read More: How You Can Help Hurricane Helene Victims
Morgen Stanzler, like Gamble, wanted to collect costume donations to help out the Black Mountain community, where she and her family own a second home. After Helene, she started collecting decoration kits for the Monte Vista Hotel’s Trunk or Treat and costumes for the festival’s costume drive.
“I love this place so much,” Stanzler says. “In the wake of a tragedy like this, I can’t rebuild roads, there’s not too much I can do. … [But I wanted to help] the community to just find a little bit of joy in the middle of something that’s really devastating.”
After back-to-back storms, Floridians come together
Soon after Helene ripped through Florida, residents had to start preparing for another storm: Hurricane Milton. Officials issued evacuation orders for millions of people in the Tampa area. While not as severe as meteorologists had expected it to be, Milton brought more destruction to the state—tornadoes hit parts of the state, and the storm flooded neighborhoods and downed trees.
In the aftermath of Milton, Karen Aucoin—who owns an event and wedding venue in Largo, Florida in the Tampa Bay area—decided to move forward with her business’ annual Halloween event. Studio 131, has hosted it the past few years, and this year’s event featured a Trunk or Treat, vendor market, and a haunted manor at its event venue space on Oct. 13. Most of the event was free; the haunted manor had a $5 fee, but Aucoin says they waived it for people who didn’t have it. Between 100-200 people came to the event, Aucoin estimates. Studio 131 has also been working with local organizations to collect donations for people who were affected by the hurricanes.
“I just knew, no matter what, we have to do something really good for the community—give everybody a sense of normalcy,” Aucoin says.
New Shingles Treatment May Reduce Eye Pain and Vision Loss
Long-Term, Low-Dose Antiviral Treatment Benefits Patients with Eye Disease & Pain from Shingles
Anyone who has had chickenpox can get shingles, and it can lead to debilitating and long-lasting vision loss for the 8% of sufferers whose virus affects a particular nerve that supplies the eyes. Now for what you came here for — the good news: Such symptoms may soon be alleviated thanks to a new treatment plan dubbed a “possible breakthrough” by CBS News.
In a multiyear study, a long-term, low-dose antiviral treatment was found to help reduce the risk of damaging and often painful periods of inflammation and infection around the eye. Study participants who took antivirals for a full year saw a 26% reduction in their risk of new or worsening eye disease at 18 months, and they were less likely to have multiple disease flare-ups compared to those who received a placebo.
The current treatment is typically a 7-10 day course of an antiviral. “We explored longer-term treatment because, while the standard approach has been shown to reduce the chances for chronic eye disease, it still leaves many suffering from it,” said lead study author Elisabeth J. Cohen, who herself has damaged vision as a result of the shingles virus.
Read full report here.
NC House and Senate Pass Second Round of Hurricane Relief Funding
SB 743 Transfers $604 million from Rainy Day Fund to assist part of state in long-term recovery efforts
The North Carolina General Assembly returned on Thursday to quickly pass another round of funding needed for Western North Carolina as the region continues to recover from the devastating hurricane that hit last month. SB 743: The Disaster Recovery Act of 2024—Part II transfers $604 million from the state’s Rainy Day Fund to assist that part of the state in their long-term recovery efforts.
“This will be a long recovery, and the legislature will not lose sight of rebuilding the region and fixing the damage,” said Senate President Pro Tem Phil Berger (R-Rockingham). “Our second relief package puts the General Assembly’s total commitment so far at almost $900 million, and that will only grow as we continue to evaluate and repair the damage.”
Highlights from the legislation include the following:
Economic Development
- Allots $5 million to the Economic Development Partnership of North Carolina to advertise and encourage tourism in Western North Carolina;
- Exempts the local-match requirement temporarily for Job Development Investment Grants (JDIG) in impacted areas.
Education
- Appropriates a total of $101.7 million for education, which includes funding for K-12 schools, the UNC System and the state’s community college system;
- Allocates $50 million in K-12 school repairs and $5 million in increased mental health support for K-12 schools;
- Provides $16.5 million for emergency scholarship grants for students at impacted community colleges, UNC System schools and private colleges, along with $5.5 million to cover spring tuition for UNC-Asheville students and $5 million to cover spring tuition for community college students in the area.
Environment
- Provides $139 million to the Department of Environmental Quality (DEQ), including $100 million to be distributed to local governments through bridge loans for water and wastewater repair.
Residents’ Assistance
- Secures $9 million for utility assistance to individuals impacted by the hurricane;
- Allocates $10 million to provide weatherization services to impacted homeowners.
Small Businesses
- Allots $50 million for bridge loans to businesses impacted by the hurricane, with applicants able to qualify for up to $100,000.
Transportation
- Requires the Division of Motor Vehicles (DMV) to extend emission inspection licenses in disaster areas.
On Thursday afternoon, both chambers adopted the conference report to SB 743 by unanimous vote, with a 108-0 vote in the House and 46-0 in the Senate. A copy of the bill text for SB 743 can be found here, and a copy of the committee report can be found here.
Speaker of the House Tim Moore (R-Cleveland) stated that the General Assembly is expected to take up another hurricane relief bill during the November session and that there could be additional legislation proposed in December’s session. “Everything right now is so preliminary. For example, we don’t know what percentage of the damages are going to be covered by insurance. We don’t know exactly how the federal match is going to work,” said Speaker Moore. “If the state goes ahead and just front loads a bunch of money, and were to drain the account, you could actually forfeit the ability to get some federal match.”
During the one-day session, the House and Senate also passed SB 132: Early Voting Sites/Helene Counties, which authorizes additional in-person early voting sites for 13 counties impacted by Hurricane Helene.
Governor Cooper’s Hurricane Relief Budget Recommendation
One day prior to the General Assembly releasing its hurricane relief funding bill, Governor Roy Cooper and State Budget Director Kristin Walker unveiled their recommended hurricane relief and recovery funding package. The Cooper Administration’s recommendation proposed $3.9 billion in state funding to rebuild critical infrastructure, homes, businesses, farms, schools and universities damaged by the hurricane.
The Governor called his package a “down payment on Western North Carolina’s future.” He further remarked, “This proposal, built on the assessment of damages sustained and lessons learned from past storms, would give Western North Carolina a jump start on recovery.”
Governor Cooper and his team estimated the total cost from the hurricane’s damage as being $53.6 billion. His budget director asserted that the federal government would cover about $13.6 billion in estimated damages and insurance or other private sector funding would total approximately $6.3 billion, which would leave $33.8 billion left unfunded.
Key provisions from the Governor’s package include:
- $650 million for the region’s economy, with $475 allocated for a Helene Business Recovery Grant Program;
- $650 million for housing, with $325 to start rebuilding homes though a Homeowner Recovery Program;
- $578 million for utilities and natural resources, with half of this funding going towards a federal dollar match;
- $282 million for education, with $100 million for capital needs and $50 million for student support needs.
- $422 million for agriculture, with $250 million for grants to farmers for losses to crops, livestock and infrastructure;
- $252 million for Health and Human Services, including $43 million for increased mental health services.
A copy of the Governor Cooper and the Office of State Budget and Management’s full budget recommendation can be found here.
This week Governor Roy Cooper also released a memo laying out the state’s response and recovery efforts, in conjunction with federal, local and non-profit partners, to the deadliest tropical storm in North Carolina’s history. It includes the Governor’s actions, progress from state government agencies and utilities, volunteer efforts and National Guard response, FEMA assistance and other updates. A copy of the memo from the Governor’s Office can be found here.
NCMS in Action: Rep. Greg Murphy Gives US Capitol Building Flag to Eagle Scout Son of NCMS Board Member
Eagle Scout Britton Ferrell Receives Flag from Rep. Greg Murphy
RALEIGH -- On Thursday, Congressman Dr. Greg Murphy presented a flag to Britton Ferrell, son of NCMS Board member Dr. Bill Ferrell. Britton recently attained the level of Eagle Scout, the highest rank in the Boy Scouts of America's Scouts BSA program.
The flag flew over the United States Capital Building on October 13, 2024.
The Eagle Scout rank is a life-long achievement that's highly sought after by leaders in business, college, military, and community service. Only about 6 percent of all Scouts BSA members earn Eagle. Britton earned his after recently completing his community service project.
Britton is from Troop 325 in Raleigh and completed his Eagle Scout board of review in June. His Eagle Scout Project was constructing and installing a little library at Hayes Barton Methodist Church in Raleigh.
His 13 Point of the Scout Law: A Scout is COMMITTED. Britton is the 49th Eagle Scout of North Star District for 2024.
NCMS Practice Impact Survey Results 10/25/24
The North Carolina Medical Society is working closely with the North Carolina Office of Emergency Services to assess the condition of medical practices in Western North Carolina. The data we receive from our members and others in the healthcare community will help direct vital resources where they are needed most.
NCMS will update you daily on our initial findings. Here is the report for 10/25/24:
NCMS in Action! Board Member Dr. Karen Smith Addresses State Health Plan Trustees on Prior Auth
"Reforming prior authorization practices of insurers is a top priority for the North Carolina Medical Society." - Dr. Karen Smith
RALEIGH -- The State Health Plan Board of Trustees met Thursday in Raleigh. At the meeting, North Carolina Medical Society Board of Directors member Dr. Karen Smith presented on behalf of NCMS on prior authorization reform.
"Two decades ago, we fought against these abusive practices, and unfortunately," Smith said, "they have resurfaced in a new form."
Smith thanked the Board for requesting an analysis of prior authorization, which she says can deprive both employers and employees of coverage they have already paid for.
She encouraged the Board to act on behalf of the nearly 9,000 members of the NCMS to take swift, decisive steps to adopt comprehensive reforms, akin to those outlined in House Bill 649: Ensure Timely/Clinically Sound Utilization Review. This bill passed the North Carolina House of Representatives with unanimous support and is based on proven, effective models used by the American Medical Association and states that have successfully tackled these issues.
Here are the common-sense reforms recommended to the Board:
- Requiring insurers to make utilization review requirements and restrictions transparent, easily understood, accessible to the public, and updated annually based upon clinical standards.
- Mandating that insurers communicate with the treating physician and patients prior to denying any recommended care.
- Requiring that the physician reviewing denied care be licensed in North Carolina, have the same or similar credentials as the treating physician, and have experience treating patients similar to the one filing the appeal.
- Ensuring timely decisions based on the urgency of the required care.
- Addressing continuity of care and retrospective denials, concerns highlighted in your presentation, which we commend Segal for recommending.
Smith added that "physicians across the state have shared alarming stories about how prior authorization has negatively impacted their patients’ health. The current process used by insurers often causes unnecessary delays in treatment, leading some patients to abandon life-saving care."
Smith also pointed to statistics from the American Medical Association that say physicians and their clinical teams spend an average of 13 hours per week -- nearly two business days -- on prior authorizations, time that could be spent on actual patient care.
Also speaking on behalf of prior authorization reform was Greg Griggs, EVP of the NC Academy of Family Physicians. He added to the voice of physicians and PAs saying "the time for reform is now."
See a portion of her comments at the meeting below.
https://www.youtube.com/watch?v=7-dw6a1hVs4
The 2024 NCMS Golden Stethoscope Award Winners Are...
Meet the Winners at the NCMS Golden Stethoscope Awards Dinner November 2
Region 1 - Charin L. Hanlon, MD, FACP,
Dr. Charin Hanlon was nominated by Ryan Barclay, the Director of Graduate Medical Education Novant/New Hanover Regional Medical Center in Wilmington.
Here is Dr. Hanlon's nomination essay:
Dr. Charin Hanlon has dedicated her life to the pursuit of excellence in medicine. She is dual certified in Psychiatry and Internal Medicine and is a driver of innovation in medical education at our institution and within the community. She thrives on interprofessional collaboration to better support our patient population. Dr. Hanlon has held many roles including being the former president of the New Hanover County Medical Society, Director of Internal Medicine Residency Program and has most recently been promoted to the Designated Institutional Official for Graduate Medical Education in the coastal region. She has organized and led many initiatives including physician wellness committees, exploration of a new cardiac fellowship, and brought one of the only sickle cell clinics in the area to her practice. She is always striving to raise the bar for our medical education team. Her leadership has led to better access to medical care for patients and improved training opportunities for the next generation of practicing physicians.
Dr. Hanlon is the Designated Institutional Official for Graduate Medical Education at Novant/NHRMC
Region 2 - Christine Khandelwal, DO
Dr. Christine Khandelwal was nominated by Nanette Lavoie-Vaughan, DNP, APN, CGCP
Here is Dr. Khandelwal's nomination essay:
It is with great honor I would like to nominate my colleague, Dr. Christine Khandelwal, to be recognized for the North Carolina Medical Society Golden Stethoscope Award. Whether it is in her teaching, clinical work, or leadership skills, Dr. Khandelwal is an inspirational leader who develops innovative ways to care for patients in our communities while also training the future workforce in geriatrics and palliative medicine.
I have known and worked with Dr. Khandelwal for the past two years in our community-based geriatric and palliative care practice, Transitions LifeCare, before she took a faculty position at Campbell University College of Osteopathic Medicine (CUSOM) the past year. As I retire, it would be remiss of me not to have Dr. Khandelwal recognized by her peers as the inspirational physician leader she is within our community.
Dr. Khandelwal’s ability to navigate complex healthcare systems and advocate for systemic changes has been a testament to her exceptional leadership skills and unwavering commitment to excellence. Dr. Khandelwal has been a pivotal figure within the Wake Med Hospital Systems and surrounding communities, where her contributions have significantly advanced her mission to provide exemplary care for older adults and those with serious illnesses. Dr. Khandelwal was able to develop a palliative care program in the Wake Med Hospitals for the past ten years. The success of this team is attributed to Dr. Khandelwal’s inspiring leadership to elevate her team’s abilities and vision of success in caring for patients they serve. Due to this successful practice model, Dr. Khandelwal is currently developing a new palliative care service in the rural, undeserved region of Harnett County.
Dr. Khandelwal has also been a driving force in the community, spearheading numerous initiatives aimed at improving the health and well-being of our aging population. Her leadership in community health through the development of novel care models has bridged gaps in care and enhanced the quality of life for countless individuals. For example, Dr. Khandelwal developed a new model of care with a regional nephrology practice to improve care for patients with advanced kidney disease. This community-based, nephrology and palliative care partnership is the first of its kind in our state.
Additionally, Dr. Khandelwal developed an outpatient Comprehensive Geriatric Clinic with Wake Med. She has consistently demonstrated extraordinary leadership by creating collaborations with interprofessional teams, including a partnership with community-based neurology service to ensure timely patient care. As a testament to the quality care Dr. Khandelwal provides for her patients and their families, a grateful family recently contributed to the Wake Med Foundation's Geriatrics Program to support other patients and families. This generous contribution highlights the profound impact of Dr. Khandelwal's dedication and the trust she inspires in those she serves.
As a Professor of Family Medicine at CUSOM, Dr. Khandelwal provides her expertise in training students in managing patients with serious illnesses and at the end of life. Dr. Khandelwal has developed an Interprofessional, End-of-Life Care Simulation experience, emphasizing a trauma-informed pedagogical approach. Recognizing the potential risk of secondary traumatization and retraumatization with death and dying, Dr. Khandelwal has prioritized student safety in all her educational programs. The success of this program has led to invitations for Dr. Khandelwal to present her trauma-informed curricula at regional, state, and national conferences.
Dr. Khandelwal is an exemplary physician whose contributions to geriatric and palliative medicine have been both profound and far-reaching. Her unwavering dedication to all our patients, learners, and community makes Dr. Khandelwal a truly deserving candidate for the NCMS Golden Stethoscope Award. Thank you for considering my nomination of Dr. Christine Khandelwal for this prestigious award.
Dr. Khandelwal is currently building the geriatric and palliative care program at Campbell University.
Region 3 - Dr. Jennifer Stoddard, MD
Dr. Jennifer Stoddard was nominated by Dr. Karen Smith, MD
Here is Dr. Stoddard's nomination essay:
Dr. Jennifer Stoddard is a champion for physician initiatives. I have the honor of working with her for many years on projects which not only improve quality and access of care for our communities but also insure Physician workforce stability. She is very much aware of the business of medicine and the impact on independent practice but also realizes the importance of working in collaboration with systems mutual benefit of Physicians, Physician assistants, practices but most of all patients we care for in our office settings.
She is admired for recognizing the work of the North Carolina Medical Society and the role Moore County plays in the strength of the Sandhills region of our state. Her organizational efforts insure the voice of the region is at the table as healthcare decisions are made which impact the Physician and practice of medicine.
Her awareness of the need to emphasize Physician Well-being as so many new models and initiatives are introduced further requiring more tasks to be completed in the exam room and raising the risk for burn-out and how to optimize wellness strategies is timely.
Her compassionate professionalism is appreciated across all specialties as her focus is on you the physician or the provider beyond that of your specialty organization.
I enjoy the downtime with Jennifer because it usually means good time, great conversation, realistic, and leaving the venue empowered to return to the daily practice of medicine.
It is a honor to recognize her efforts as an example of a doctor who truly represents the profession of medicine.
Dr. Stoddard is a nephrologist in Pinehurst.
Region 4 - Dr. Mohan Thakuri, MD
Dr. Mohan Thakuri was nominated by Dr. Martin Palmeri, MD, DO
Here is Dr. Thakuri's nomination essay:
Dr. Mohan Thakuri has been the foundation of malignant hematology care in Western North Carolina. Over the last 15 years, he has helped to grow and develop a complex malignant hematology program at Mission Hospital. Dr. Thakuri was a lead physician at Cancer Care of Western North Carolina. At the peak of the program, Mission hospital was performing over 40 induction therapies for acute leukemia patients as well as a robust population of patients getting high dose Methotrexate for CNS lymphoma. In 2019 when HCA took over Mission Hospital, there were serious concerns about the future of complex malignant hematology care in Western North Carolina. Dr. Thakuri was a vocal champion for oncology patients as well as the inpatient oncology nurses. During this transition, Cancer Care of Western North Carolina disbanded. Dr. Thakuri was a key leader in forming Messino Cancer Centers which allowed for sustained and uninterrupted oncology care in Western North Carolina.
During this HCA transition, many highly qualified oncology nurses quit and they were replaced with enthusiastic but inexperienced nursing graduates. Dr. Thakuri never refused an opportunity to provided teaching and education to these new nurses to help get them up to speed. As time passed and ongoing failures on the part of HCA led to further deterioration of inpatient oncology services (despite significant investment on the part of the doctors of Messino Cancer Centers to bolster Mission's program), Dr. Thakuri had the wherewithal to recognize the fact that we should not be providing complex hematology care at Mission hospital. For any doctor who is passionate about their craft, this is an exceeding hard decision. He has subsequently helped to coordinate having these patients transferred to our regional academic centers and continues to support these patients when their care can be resumed locally.
Dr. Thakuri has also been a dedicated rural oncologist. He has been a staple in Franklin for over 10 years. His leadership and care has helped to grow regional rural oncology care.
Over the years, I have seen many of Dr. Thakuri's patients both in the community setting as well as when I cover for him in the hospital. His patients have a deep appreciation for his care. Dr. Thakuri has announced his retirement at the end of the year and there has been a wave of patients sharing their gratitude and thanks for the care he has provided. He will be deeply missed by his patients.
If I had to summarize Dr. Thakuri, he is tender and thoughtful when it comes to his patients. He is a tough and tenacious advocate for oncology care in Western North Carolina. He does not accept or ever settle for mediocrity.
Dr. Thakuri is recently retired and is currently spending a month hiking Kathmandu.
Gov. Roy Cooper Proposes $3.9 Billion to Spur Hurricane Helene Relief and Recovery
Initial Damage Assessments from Hurricane Helene Total $53 Billion, More Than Three Times Greater Than Hurricane Florence
RALEIGH -- Less than a month after Hurricane Helene hit Western North Carolina, Governor Roy Cooper today shared a state budget recommendation to help rebuild stronger to withstand future storms. Governor Cooper recommends an initial $3.9 billion package to begin rebuilding critical infrastructure, homes, businesses, schools, and farms damaged during the storm.
“Helene is the deadliest and most damaging storm ever to hit North Carolina,“ said Governor Cooper. “This storm left a trail of destruction in our beautiful mountains that we will not soon forget, but I know the people of Western North Carolina are determined to build back better than ever. These initial funds are a good start, but the staggering amount of damage shows we are very much on the front end of this recovery effort.”
Initial damage estimates are $53 billion, roughly three times Hurricane Florence estimates in 2018 and the largest in state history. A strong recovery will require significant investments by private insurers as well as the federal, state and local governments. Large scale disasters fueled by climate change in recent years have shown the challenges and enormous costs of recovery as well as the need to ensure structures are hardened are they are rebuilt to withstand future storms. Successful recoveries require significant early investments to ensure communities have the tools to fully rebuild.
Economy
The economic devastation from Hurricane Helene is unparalleled. Thousands of businesses in the region suffered damages leaving business owners and workers suffering. The Governor’s funding package includes $650 million to address economic losses and physical damage for non-agricultural businesses and non-profit organizations. This would include a revival of the pandemic-era Business Recovery Grant Program, which helped North Carolina’s economy recover faster than the national average. Governor Cooper has already increased unemployment insurance benefits through an executive order with a bipartisan and unanimous vote of the Council of State.
Housing
The Governor’s budget recommendation includes $650 million to address physical damage to residential structures and cost of housing assistance. These investments would jumpstart permanent housing construction in advance of potential federal funds, which can take months or years to be approved.
Utilities and Natural Resources
Critical and high-risk infrastructure was damaged across the region, including water and sewer systems in multiple communities and power generation facilities. Much of this infrastructure is in geographically isolated locations and challenging to reach, slowing restoration of services to communities. The Governor’s funding package includes $578 million to address the physical damage and cleanup of energy, water, waste clean-up, telecommunications, dams and other infrastructure.
Transportation
Hurricane Helene severely impacted approximately 5,000 miles of state-maintained roads across the affected area in Western North Carolina, including several major national interstates and critical transportation corridors. The proposed funding package includes $55 million to address physical damage and state revenue implications of the transportation infrastructure damage.
Agriculture
The funding package includes $422 million to address physical damage and business disruption for agricultural enterprises. This storm caused significant damage to hundreds of thousands of acres of agricultural land and hundreds of structures.
Recovering From Additional Recent Disasters
As North Carolina is still recovering from other recent natural disasters, Governor Cooper’s proposed budget includes $420 million for needs related to PTC-8, Tropical Storm Debby, and funds to complete homeowner assistance for Hurricanes Florence and Matthew.
The full Budget Recommendation can be found here.
Feeling Anxious About the Election? Here's How to Cope
Election Day is almost here. If you're feeling stressed, here is some help.
(KatieCouricMedia, Tess Bonn) -- Election Day is just around the corner — and the race to the finish line has been anything but predictable. Unfortunately for our blood pressure, it’s looking like it’ll be a nail-biter till the bitter end. Polls show that former President Trump and Vice President Kamala Harris are locked in a dead heat. And while Republicans and Democrats are as divided as ever, many of us all share a common emotional reality: election anxiety.
Some people are so worried about the impending outcome that they’ve put their lives on hold — even delaying weddings and avoiding buying a house. Others are losing sleep: Nearly half (46 percent) of respondents to a new American Academy of Sleep Medicine survey reported not getting enough rest due to anxiety surrounding the 2024 election.
“When you feel like something is out of your control, that can make you feel more stressed, anxious, and worried,” says therapist Colleen Marshall, a chief clinical officer at the mental health organization Two Chairs. “This is especially true when it comes to elections.”
It’s important not to conflate feeling anxious (a natural and normal emotion) with a mental health issue. “Anxiety can be defined as a reaction to stress that’s more temporary, whereas an anxiety disorder results in anxiety that persists or recurs, interfering with day-to-day life,” explains psychologist Scott Lyons. “It’s important to recognize that feeling anxious about elections is a common experience, but if you find that it is drastically affecting your daily life, it might be worth seeking professional help.”
If you’re experiencing periodic bouts of apprehension about possible election outcomes, here are some practical tips for managing those emotions as we head into November.
Set limits around news consumption
While staying informed about what’s happening in the world is healthy, reading too much about the election can harm your overall well-being. In fact, research has shown that more political news consumption — especially via polarizing platforms like Twitter and TikTok — is correlated with higher levels of anxiety. So if you’re prone to panic, setting limits for yourself is essential.
“Anxiety often happens when we feel out of control, so setting boundaries around media consumption is one way to regain control and avoid becoming overwhelmed,” Lyons tells us.
So what does this look like in practice? For some, this may mean watching the news for only an hour each day, while others prefer setting aside 30 minutes in the mornings or evenings to scroll the headlines to stay on top of the issues they care about most. There’s no right or wrong way to go about it — the limits will depend on your day-to-day habits. “Set a boundary that feels right to you,” Marshall says.
But Marshall acknowledges that setting boundaries can be tricky at times, especially if someone doesn’t have the same ones as you, so communication is vital. “In my house, if someone is watching the news all the time, I might go outside for a walk instead,” she says. “Or I might talk to that family member about only keeping the news on during certain hours of the day.”
Focus on sparking positive interactions
During this stressful time, navigating relationships with those who might not share your views can be even more challenging than usual.
Lyons recommends focusing on “constructive conversations and activities that foster understanding rather than deepening divisions.” In other words, you don’t have to get to the bottom of every disagreement — consider staying on the surface or finding common ground where possible.
Avoiding political talk altogether, even with family and friends, might be a good idea. But Marshall advises communicating that expectation to your loved ones, especially before spending time together.
“We have lots of beliefs around setting boundaries that are just not helpful, when really, what we all need in our lives is just to be clear about what we need to be and to feel safe in relationships,” she says.
Don’t forget about self-care
The constant barrage of news and heated discussions can make us forget our basic needs. Simple things like sleep, exercise, and a healthy diet can help a lot more than you’d think.
“If you sleep, eat, and exercise well, you physically feel better — and mental health is similar,” explains Marshall.
Even small acts of self-care can have a major impact. The National Institute of Mental Health says incorporating a daily 30-minute walk can boost your mood and overall health. But don’t be discouraged if you can’t get it all at once — because even limited amounts of self-care add up.
There are plenty of other relaxing activities you can do. If a long bath or a good book helps calm your nerves, lean into that. Just try to stick to low-stress hobbies — maybe table that scarf you’ve been struggling to knit for a post-election project.
An opportunity for personal growth?
Election anxiety can also be an opportunity to grow and become more resilient. Our experts agree that the healthier habits we build now can sustain us no matter the outcome in November.
“If we approach it mindfully, election anxiety can indeed be an opportunity for personal growth. It can help us develop better stress management techniques, improve our ability to think critically, and engage in constructive dialogue when faced with different viewpoints,” says Lyons. “In a larger sense, whenever we can calm ourselves in the face of anxiety, we experience growth and teach our nervous systems that we are safe. The more we flex this muscle, the more we build our resilience in the face of uncertainty.”
Buncombe County Revises Death Total From Hurricane Helene
Sheriff's office data reduces death toll
(Associated Press) -- The North Carolina county that is home to Asheville overcounted deaths caused by Hurricane Helene by as many as 30, according to a statement Tuesday from its sheriff's office and data from the state, significantly reducing the death toll from the historic storm. Buncombe County officials, who previously reported 72 deaths, are now deferring to a state tally of 42 deaths for the county. Meanwhile, some areas in Florida have seen a recent increase in confirmed cases of flesh-eating bacteria following the devastating hurricanes Helene and Milton, according to state health department data. Health officials issued a statement urging residents to remain vigilant and avoid floodwaters where the Vibrio vulnificus bacteria can multiply rapidly.
On Tuesday, the Buncombe County Sheriff’s office acknowledged in a statement that the number of deaths in the county was lower than the number it provided. The statement, attributed to Public Information Officer Christina Esmay, cited factors ranging from updated causes of death to communication challenges after the storm knocked out cell service and electricity in multiple mountain counties.
“In the early aftermath of Hurricane Helene all deaths were being classified as storm related and from Buncombe County. However, as the days progressed BCSO was able to identify who had passed away due to the hurricane, who was in fact from Buncombe County, and who passed away from other causes,” the statement said. “Compounded with the lack of consistent communication, due to widespread outages, the Buncombe County fatality number that was initially provided to Sheriff Miller has decreased.”
The sheriff’s office did not provide additional information on how they arrived at their tally, and spokesman Matt Marshall said any other questions about how deaths have been investigated and counted should be sent to state officials. In response to a request to interview the sheriff, Marshall said he would look into his availability.
Another county, Henderson, had previously reported two more local deaths than the state, but said on Tuesday that it agrees with the state’s number.
The Office of the Chief Medical Examiner in Raleigh typically reviews weather deaths and makes a ruling on cause before reporting numbers through state officials, a process it has used in past storms for years. But in the chaos following Helene, a number of counties reported fatality numbers independently of the state. The state’s tally has gradually increased through Tuesday, but the climb has slowed as bodies have been examined.
State Department of Health and Human Services spokesperson Kelly Haight Connor said in an email Tuesday that all examinations are complete for storm-related deaths, but she wouldn’t rule out additions if other cases emerge. The state reported 96 deaths from Helene statewide on Tuesday.
The AP had tallied at least 246 total deaths across multiple states due to Helene through Monday, including 128 in North Carolina, based on data from the state and counties, including Henderson and Buncombe. With the disclosure from Buncombe County that its number was inflated, the AP has adopted the state’s total of 96, so the news organization’s multistate tally now stands at 214.
Imported IV Fluid Hits US as Shortage Continues
The first IV fluids imported from Baxter facilities in other countries reached the U.S. on Saturday
(Axios, Maya Goldman) -- IV fluids from as far away as China are being imported to the U.S. to alleviate nationwide shortages stemming from hurricane damage to a key manufacturing plant in North Carolina.
Why it matters: Hospitals now have 50% more IV fluid available to them than immediately after Hurricane Helene swamped Baxter International's North Cove manufacturing site in Marion, North Carolina, per the Health and Human Services Department. But health providers expect shortages to last weeks longer.
State of play: The first IV fluids imported from Baxter facilities in other countries reached the U.S. on Saturday, HHS said.
- The Food and Drug Administration has authorized temporary importation from Baxter plants in Canada, China, Ireland and the U.K., the company said. Baxter is working with the FDA to authorize imports from its other international sites.
- Baxter, in partnership with HHS's Administration for Strategic Preparedness and Response, expects to deliver nearly 18,000 tons of products from Europe and Asia by the end of the year.
- The FDA has also added more IV solutions to the drug shortage list, which allows for the distribution of compounded substances
Meanwhile, pre-hurricane staffing levels will resume at Baxter's North Carolina plant this week, the company said on Monday.
- The more than 2,500 employees will work alongside more than 1,000 contractors who are helping bring the facility back up to speed. But the company does not yet have a timeline for when pre-hurricane production levels will be restored.
- Progress on restoring the physical facilities "has exceeded our expectations in many respects," the company wrote in its Monday memo.
Yes, but: Hospitals are preparing to weather IV fluid shortages for a while longer.
- The Indiana Hospital Association said it could take weeks for hospitals to get their allocated IV fluids, despite importations and Baxter's North Carolina facility ramp-up.
- Oregon Health & Science University interim CEO Joe Ness told his board of directors last week that the the acute shortage could last as long as six more weeks, Oregon Public Broadcasting reported.
- "We're managing through it, but it is very tough. It does remind us of COVID days," Ness told the board.
Early Voting in NC Starts Today
Early voting starts Thursday, General Election is Tuesday, November 5
During the early voting period, voters may cast a ballot at any early voting site in their county. This is different than Election Day, when registered voters must vote at their assigned polling place. During the early voting period, eligible individuals may also register to vote and vote at the same time (see Same-Day Registration below).
For an overview of North Carolina’s current elections, visit Upcoming Election.
Early Voting Dates and Sites
- The in-person early voting period for the 2024 general election:
- Begins Thursday, Oct. 17, 2024.
- Ends 3 p.m. Saturday, Nov. 2, 2024.
- The general election is on Tuesday, Nov. 5, 2024.
- Find early voting sites and schedules in your county: Early Voting Site Search.
- Locations and voting hours are also available here: Early Voting Sites for the Nov. 5, 2024 General Election (PDF).
Unsure if You Are Registered?
Find out if you are registered to vote by entering your information into the Voter Search.
Don’t Forget Your Photo ID
North Carolina voters will be asked to show photo ID when they check in to vote. Learn more: Voter ID.
Same-Day Registration
When you check in to vote at an early voting site, you may update your name or address within the same county if necessary. Individuals who are not registered to vote in a county may register and immediately vote at that same site. This process is called “same-day registration.” Find more information at Register in Person During Early Voting. Although same-day registration is available for voters during early voting, same-day registration is not available for most voters on Election Day.
Your Sample Ballot
To view sample ballots, registered voters must enter their information into the Voter Search and navigate to “Your Sample Ballot.” Voters can practice making selections with the accessible sample ballot: “Option 4” at the NC Absentee Ballot Portal.
Note: Sample ballots for each election are only available once finalized.
By-Mail Absentee Ballot Drop-Off
Voters who receive an absentee ballot by mail may deliver their ballot to their county board of elections office or to an election official at an early voting site during any time that site is open for voting. Ballots will be kept securely and delivered to the county board of elections for processing.
Voting Equipment
Curious which equipment will be at your voting site? Check the interactive map and table: Early Voting Equipment by County.
Voter Assistance and Curbside Voting
Any voter who qualifies for assistance may ask for help at their polling place under Assistance to voters (N.C.G.S. § 163-166.8). To find more information, visit Help for Voters with Disabilities. Curbside voting is available for eligible individuals. For more information, see Curbside Voting.
After You Vote
You can find out whether your vote counted in the “Your Absentee Ballot” section of the Voter Search database. Under North Carolina law, all early votes — by-mail or in-person — are considered absentee votes. Your ballot status also will show up in the “Voter History” section as soon as your county completes the post-election process of assigning voter history to your record. This may take up to a few weeks after Election Day.
Learn more about NCMS member candidates here.
As You Head to the Polls, Learn More About the NCMS Member Candidates
Early Voting Available Until November 2
The North Carolina Medical Society has interviewed several member candidates on issue important to members. Click here to find out what they have to say.
Unsure if You Are Registered?
Find out if you are registered to vote by entering your information into the Voter Search.
Don’t Forget Your Photo ID
North Carolina voters will be asked to show photo ID when they check in to vote. Learn more: Voter ID.
Same-Day Registration
When you check in to vote at an early voting site, you may update your name or address within the same county if necessary. Individuals who are not registered to vote in a county may register and immediately vote at that same site. This process is called “same-day registration.” Find more information at Register in Person During Early Voting. Although same-day registration is available for voters during early voting, same-day registration is not available for most voters on Election Day.
Note: Same-day registration at early voting sites is not available during second primaries. However, individuals who become eligible to vote between the primary and second primary and who are otherwise eligible to vote in the second primary may register and vote on the day of the second primary.
Your Sample Ballot
To view sample ballots, registered voters must enter their information into the Voter Search and navigate to “Your Sample Ballot.” Voters can practice making selections with the accessible sample ballot: “Option 4” at the N.C. Absentee Ballot Portal.
Note: Sample ballots for each election are only available once finalized.
By-Mail Absentee Ballot Drop-Off
Voters who receive an absentee ballot by mail may deliver their ballot to their county board of elections office or to an election official at an early voting site during any time that site is open for voting. Ballots will be kept securely and delivered to the county board of elections for processing.
Voting Equipment
Curious which equipment will be at your voting site? Check the interactive map and table: Early Voting Equipment by County.
Voter Assistance and Curbside Voting
Any voter who qualifies for assistance may ask for help at their polling place under Assistance to voters. N.C.G.S. § 163-166.8. To find more information, visit Help for Voters with Disabilities. Curbside voting is available for eligible individuals. For more information, see Curbside Voting.
After You Vote
You can find out whether your vote counted in the “Your Absentee Ballot” section of the Voter Search database. Under North Carolina law, all early votes — by-mail or in-person — are considered absentee votes. Your ballot status also will show up in the “Voter History” section as soon as your county completes the post-election process of assigning voter history to your record. This may take up to a few weeks after Election Day.
Western Carolina Medical Society Executive Director Talks Aftermath of Hurricane Helene
Karen Wallace-Meigs Describes First Frightful Days Following Hurricane Helene
“Worst thing I have ever seen. I am absolutely fine, but there is a lot of survivor's guilt. “
Karen Wallace-Meigs was only on the job as the Executive Director of the Western North Carolina Medical Society for five months when the remnants of Hurricane Helene tore across the Southeast and destroyed much North Carolina's beloved western counties. The impact was both tragic and heartfelt.
With the number of people still missing in North Carolina near 100, Wallace-Meigs' days are not getting any easier.
She describes the first few days as harrowing and filled with uncertainty.
“I’ve never had less communications in my life. You really didn’t know what was happening because of a lack of news. No water, power, internet, cell service.” She also shares that traveling was out of the question because road conditions were unknown, and she was unsure of the full extent of the damage.
After a few days, however, WCMS began to regain its footing. The first thing was to get in touch with her staff, some of whom were as far away as Canada. Her newsletter editor is in South Carolina and estimates it will be a year or more before she can return home.
"We are still getting it out!"
Wallace-Meigs says they are definitely back in working mode and the newsletter will return. WCMS also has the largest interpreter network in Western North Carolina and the need for interpreters is greater than ever. "The interpreter network is ready to go" she says and WCMS will be working as hard as possible to put the right interpreters in place for the foreseeable future.
One of the first things Wallace-Meigs worked on was finding places for people to go when they were discharged from hospitals. "People just didn't have a home to go to anymore!" WCMS has been putting retired physicians together with any area churches that have electricity and water to take in people when they leave the hospital. "They have to have a place to recover," she says, "or else they will never get well. What happens next is still to be determined."
"It is about to get cold, and I am not sure what that will mean."
The need for water is well known from reports throughout the region, but Wallace-Meigs says that there will soon be a desperate need for warm clothing, bedding, and shelter. "It will soon be too cold here to stay in a home with no electricity." She says people also forget that losing your home means you lose things like your eyeglasses and your canes. "Durable equipment is going to be something we will need soon as well," she says.
"Don't forget us."
When asked what she wants the people of North Carolina to know, Wallace-Meigs says “Don’t forget us. We’re here, and we’ll be here struggling for a long time. We are resilient, but we need you beside us.”
To help the people of Western North Carolina with a financial donation to the NCMS Disaster Relief Fund click here.
NC Legislative Update 10-11-24
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NCMGMA Salary & Benefits Survey Now Open
| 2024 NCMGMA Salary & Benefits Survey is Open 75% Completion Grants Complimentary Data Access |
| Complete your survey by November 21st |
| This comprehensive study is designed to bring our members the information they need to see trends specific to the healthcare industry, and provide comparative information your organization can use to assist in making crucial business decisions.
REMEMBER! If you participated last year, you can copy last year's data into this year's survey, effectively reducing the time it takes to complete the survey. |
| Data collection is now open through Thursday, November 21st. |
| Access to the Site |
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| Survey Information |
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| Questions |
| If you have any questions about the 2024 Salary & Benefits Survey, please contact the NCMGMA offices at [email protected]. |
Gov. Roy Cooper's Latest on Helene as Others Finally Get Access to Hardest Hit Areas of WNC
Gov. Roy Cooper vowed Wednesday that the state government will continue to provide the resources Western North Carolina communities need to recover from Tropical Storm Helene. “This is a true all-hands-on-deck moment,” Cooper said. In a wide-ranging briefing, officials touched on a number of topics related to the Helene response. Notably, Cooper called out the effects of wide-reaching disinformation that has been spreading in Helene’s wake; FEMA Administrator Deanne Criswell vowed to keep significant assets in North Carolina even as the agency responds to Hurricane Milton’s impending landfall in Florida; and Cooper called for direct assistance for small businesses impacted by the storm.
Other State Leaders Flocking to WNC to Assess Damage, Response
Where once were surging floodwaters, now elected representatives from both the federal and state level are pouring into Western North Carolina and Haywood County, touring damaged areas, talking to local officials about needs and thanking first responders for their service to their communities.
North Carolina Gov. Roy Cooper, with FEMA Administrator Deanna Criswell in tow, continued his multi-day western swing on Oct. 4, making stops in Haywood and Jackson Counties. On Oct. 8, Sen. Thom Tillis visited the same complex Cooper had a few days before, saying he was pleased with the overall response by FEMA. Mark Pless, Haywood County’s Republican representative in the General Assembly, said that House Speaker Tim Moore, R-Cleveland, met with leaders in Canton on Oct. 4, delivering supplies and moving onto Clyde, Waynesville and the Crabtree Fire Department before joining the mayors of Hot Springs and Marshall in Madison County, which Pless also represents. Rep. Destin Hall, R-Caldwell, and Rep. Karl Gillespie, R-Macon, accompanied Pless to Marshall and Hot Springs again on Oct. 6.
NC Lawmakers Pass $273M Helene Relief Bill with Voting Changes to More Counties
Describe it as a down payment on aid and a way to help hard-hit counties
RALEIGH, N.C. (AP, Gary Robertson) — North Carolina legislators completed an initial $273 million relief package Wednesday to help spur recovery from Hurricane Helene, describing it as a down payment on aid and a way to help hard-hit counties gain more flexibility in holding elections already underway.
The legislation, which was approved unanimously in the House and Senate, comes less than two weeks after the catastrophic flooding from the storm’s historic rainfall in the North Carolina mountains.
Over half of the 238 confirmed Helene-related deaths in Southeastern states in Helene’s path occurred in North Carolina, a presidential battleground state where absentee voting has already begun.
Tens of thousands of electricity customers in the region remain without power and some people, including residents of Asheville, still lack running water. The voice of legislators from the ravaged region cracked with emotion when talking about the heavy blows dealt by Helene.
“I want to thank you for putting your first seeds into the ground,” said Sen. Ralph Hise, a Republican from Mitchell County, where he said the local water system is “unsalvageable” and otherwise would take years to replace. “We’ve never seen devastation like this before.”
Republican legislative leaders who helped craft the measure with input from Democratic Gov. Roy Cooper’s administration and election officials emphasized repeatedly that more legislation and funds would come soon. Lawmakers have also agreed to return Oct. 24 for more action, rather than wait until mid-November for an already scheduled session. They acknowledged the effort would take months and years to complete.
“The recovery that is going to have to be done is going to be something that is a Herculean task, but it is something that we will get done,” House Speaker Tim Moore said.
Nearly all the money in the bill — $250 million — is earmarked for state agencies to meet the federal government’s match for state and local disaster assistance programs. State government currently has $4.75 billion set aside in a “rainy-day” fund and $733 million in a disaster response reserve. Other pots of money could be tapped if needed.
The governor was expected to sign the legislation. “I appreciate the efforts of the legislature today to pass a bill to aid these communities,” Cooper said at a Helene recovery briefing at the state Emergency Operations Center in Raleigh.
The bill also includes specifics to ensure teachers and cafeteria workers in public schools closed in Helene’s aftermath get paid. Fees for people to replace lost driver’s licenses and identification cards are getting waived, as are some highway repair and open storm debris burn permitting requirements.
The bill also largely follows rule alterations for conducting elections and turning in ballots that were approved unanimously earlier this week by the State Board of Elections. But lawmakers decided to expand the alterations from 13 of the state’s 100 counties approved by the board to 25 counties — in keeping with the scope of the federal disaster declaration, Senate leader Phil Berger said.
The storm’s flooding has severely damaged some voting sites, making replacements necessary. Early in-person voting is held Oct. 17 through Nov. 2.
The legislation allows voters registered in the 25 counties, for example, to request an absentee ballot in person up until the day before Election Day. These voters also would have more ways to drop off those absentee ballots, including any open early voting site or county election office in any of the 100 counties, as well as at the State Board of Elections office in Raleigh. That goes beyond the additional options approved by the state board. Such ballots still must be turned in by 7:30 p.m. on Election Day to be counted.
Republican presidential candidate Donald Trump’s campaign sent out a news release late Tuesday suggesting 10 changes so displaced voters “don’t lose their right to participate in this important election.” Most of the ideas are contained in the legislation, although one appears absent.
Overall, the region affected by the election changes has historically favored Republican candidates, although Asheville and surrounding Buncombe County is considered a Democratic stronghold.
Sen. Paul Newton, a Cabarrus County Republican and Senate elections committee co-chairman, emphasized the changes in the bill were nearly all based on the board’s bipartisan order earlier in the week, and that many entities provided input to staff.
“We just saw the level of devastation and knew we had to make changes for anybody to have a chance of voting in these elections,” Newton said. “That would be true no matter whether it’s red or blue.”
In floor debate, Democratic and Republican mountain legislators described the destruction they’ve witnessed in their districts. They spoke gratefully about acts of heroism and assistance from outside the region, including convoys of supplies.
GOP Rep. Jennifer Balkcom, who with others helped open a Henderson County aid distribution warehouse, said mountain people are strong and resilient.
“But people are still needing help even though they don’t ask for it,” Balkcom said, adding the legislation is “a start to help get people what they need.”
Hurricane Helene Frequently Asked Questions
After Helene: Answers to Some of Your Questions
Updated 10/16/24, 3:40 pm
The North Carolina Medical Society is continuing to update information for our members and people across North Carolina with the latest on Hurricane Helene disaster recovery continues. Here is a list of Frequently Asked Questions.
- I need to let state agencies know the status of my practice.
- Click here for the NCMS Impact Survey and the NCMB Practice Status Form. Both MUST BE SUBMITTED AS SOON AS POSSIBLE.
- If you know someone without internet access you can fill out the form for them or have them call the NCMS at 919-833-3836.
- I need financial support. What are my options?
- roviders in need of financial supports should work directly with the health plans to learn what supports each plan is offering and their associated process(es).
Contact Information
- Alliance Health alliancehealthplan.org/provider-updates/hardship-payment-requests-2
Provider support: 855-759-9700 - AmeriHealth Caritas North Carolina amerihealthcaritasnc.com
Provider support: 888-738-0004 - Carolina Complete Health carolinacompletehealth.com
Provider support: 833-552-3876 - Healthy Blue healthybluenc.com/north-carolina/home.html
Provider support: 844-594-5072 - Partners partnersbhm.org/tailoredplan/providers/providerconnect
Provider support: 877-398-4145 - Trillium ncinno.org
Provider support: 855-250-1539 - United Healthcare Community Plans of North Carolina uhccommunityplan.com/nc/medicaid/medicaid-uhc-community-plan
Provider support 800-638-3302 - Vaya Health https://providers.vayahealth.com/helene-recovery/
Provider Support Line: 866-990-9712 - WellCare of North Carolina wellcare.com/nc
Provider support 866-799-5318 - NC Medicaid Direct To request a hardship advance, contact the Medicaid Provider Ombudsman [email protected] or 866-304-7062
Information on the flexibilities in place for Hurricane Helene can be found on the NC Medicaid Bulletins webpage.
Visit the NC Medicaid Hurricane Helene Virtual Bulletin Board for information and resources for NC Medicaid beneficiaries and families impacted by Hurricane Helene.
- Alliance Health alliancehealthplan.org/provider-updates/hardship-payment-requests-2
- roviders in need of financial supports should work directly with the health plans to learn what supports each plan is offering and their associated process(es).
- I have an emergency or need rescue. What can I do?
- Call 911 for any emergencies. While some 911 centers are down in western NC, their calls are being routed to other counties in central and eastern NC.
- I have undocumented patients. Can they stay in shelters?
- If a person needs to stay in a shelter, get emergency supplies or needs other types of disaster relief, legal action will NOT be taken. If someone tries to enforce immigration law, report it: DHS.gov/file-civil-rights-complaint.
- My bilingual staff can't work right now. How can I help my Spanish-speaking patients?
- They can reach out to Línea de Salud NC, a free, Spanish-language Health Hotline, at 1-844-438-6827.
- Mental health resources are also available. Call the Disaster Distress Helpline at 1-800-985-5990. Press 2 to get help in Spanish.
- I have questions about food, shelter, roadways, or need other general non-emergency information. Who can I call?
- You may call 211 for any non-emergency related questions.
- I cannot stay at home and need shelter. Where can I find out what to do?
- Visit ReadyNC.Gov for sheltering information and follow your local government’s social media and website for more information.
- My business or home is damaged. Who can I email?
- Residents with questions about the recovery process or Individual Assistance may email [email protected].
- Who do I contact in my county for the latest information?
- NCDPS list of county resources is available by clicking here.
- My practice is open, but we can't access medical records.
- NCHealthConnex can help find information for displaced patients.
- My patients need medicine. Where are open pharmacies?
- The NC Board of Pharmacy is updating it's list of operating pharmacies in Western NC. Click here for the most up to date list.
- Who do I contact at Division of Emergency Management?
- The NC Division of Emergency Management has divided the state into three branches. Click here of contact names and information.
- I have Blue Cross NC and need clarification on how it is handling Prior Authorization, telehealth, and appeals
- Blue Cross NC is deferring Prior Auth for all acute inpatient admissions and emergency services. Read full statement here.
- Blue Cross NC telehealth audio only reimbursable at 100 percent. Details here.
- Blue Cross NC extends timeframe for post-service provider appeals. Read full statement here.
- I use the State Health Plan, but don't know how to get information.
- The State Health Plan has released a list of resources for those impacted by Helene. Click here for full list.
- When will I know what recovery programs are available?
- This will be announced following the damage assessment process with local governments. Determinations are not a rapid process as the disaster assessments take time to ensure accuracy, which can benefit North Carolinians by activating further resources.
- I need help with clean-up!
- Yes, you can contact Crisis Clean Up at 910-218-1569 and they can potentially assist with connecting you with volunteer organizations in your area that can be a resource.
- What roads are open and closed right now?
- Visit DriveNC.Gov for the most up-to-date information on roadway conditions from the North Carolina Department of Transportation. You can also follow your local government’s social media pages or websites for updated information on roadway conditions.
- The election is days away and I'm afraid I won't be able to vote.
- A bipartisan state board has approved measures to help WNC voters. Your vote is your voice.
- I need to transfer a patient from Western NC hospitals impacted by Helene.
- Enter the patient here: https://nc.readyop.com/fs/4dDL/830f or contact 919-937-7112.
- How do I access shelters that manage individuals requiring non-acute medical care by physicians, nurses, etc..
- I have Medicare. Who do I contact for lost or damaged durable medical equipment, prosthetics, orthotics, and supplies?
- Contact 1-800-MEDICARE (1-800-633-4227) for assistance.
- How do I help my patients obtain and maintain access to critical life-saving services such as dialysis?
- CMS activated the Kidney Community Emergency Response (KCER) program and working with End-Stage Renal Disease (ESRD) Network 6 (Georgia, North Carolina) and Network 7 (Florida), which is responsible under a contract with CMS for assessing the status of dialysis facilities in potentially impacted areas of the impacted states. Visit the Kidney Community Emergency Response (KCER) program website: kcercoalition.com/ Contact: The ESRD Network 6 (Georgia, North Carolina) toll-free hotline is 1-800- 524-7139 and ESRD Network 7 (Florida) toll-free hotline is 1-800-826-3773.
- I'm a NC physician/PA. How do I get information about Limited Emergency License in North Carolina?
- NCMEDBOARD.ORG
- I'm an out-of-state physician/PA and do not currently have a license in North Carolina. How do I obtain a temporary licensure under the emergency policy?
- Visit: www.ncmedboard.org/disaster
- I'm a physician/PA with a full North Carolina license. Am I able to volunteer without obtaining a volunteer license?
- Physicians and physician assistants with a full North Carolina license are able to volunteer without obtaining a volunteer license. Note that PAs who provide volunteer medical services DO need a supervising physician per NC law.
- I have patients who need help buying food. Who should they contact.
- Visit this page here.
- What should I know about Well and Septic Safety following Hurricane Helene?
- Visit the page here.
The NCMS will continue to update this page as more information becomes available.
Critical Update from SBA on Helene Recovery Resources. Webinar 10/10/24
Webinar: SBA Resources for All Businesses Impacted by Helene
A critical update with the U.S. Small Business Administration on Resources for Helene Recovery
Around 25% of businesses fail after a disaster. To ensure North Carolina businesses get the timely answers they need, the NC Chamber is hosting a complimentary webinar on Thursday, Oct. 10: “SBA Resources for All Businesses Impacted by Helene.”
Every business (any size) within the declared areas, private nonprofit organization, or resident affected by Helene can apply online or at the opened Business Recovery Centers (BRCs) managed by SBA or Disaster Recovery Centers (DRCs) managed by FEMA. A full list of counties in the declared areas is at the bottom of this email.
It’s helpful to start this process immediately. You do not have to wait for insurance coverage determinations or claims denials to apply for SBA programs. The application filing deadline for physical damage is Wednesday, Nov. 27 and economic injury is Monday, June 30.
This programming is offered on a complimentary basis to all. Please share it with anyone in your network who might benefit from SBA resources.
Counties Eligible for Relief
The disaster declaration covers Alexander, Alleghany, Ashe, Avery, Buncombe, Burke, Caldwell, Catawba, Clay, Cleveland, Gaston, Haywood, Henderson, Jackson, Lincoln, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Transylvania, Watauga, Wilkes, and Yancey counties and The Eastern Band of the Cherokee Indians in North Carolina which are eligible for both Physical and Economic Injury Disaster Loans from the SBA.
Small businesses and most private nonprofit organizations in the following adjacent counties are eligible to apply only for SBA Economic Injury Disaster Loans (EIDLs): Cherokee, Graham, Iredell, Mecklenburg, Surry, Swain and Yadkin in North Carolina; Rabun, Towns and Union in Georgia; Cherokee, Greenville, Oconee, Pickens, Spartanburg, and York in South Carolina; Carter, Cocke, Greene, Johnson, Sevier, and Unicoi in Tennessee; and Grayson in Virginia.
Agenda
Thursday, October 10
| 11:00 am | Welcome and Introductions |
| 11:05 am | Presentation: Overview and Update |
| 11:40 am | Q&A |