On May 8, the North Carolina Medical Society (NCMS) and the North Carolina Academy of Physician Assistants (NCAPA) submitted a rulemaking petition to the Department of Health and Human Services (DHHS) regarding mandatory Medicaid enrollment for physician assistants (PAs) and nurse practitioners (NPs) who provide care to Medicaid and North Carolina Health Insurance Program for Children (CHIP) patients. View the petition here. It is the position of both the NCMS and NCAPA that DHHS may not require enrollment of PAs and NPs until a rule is adopted pursuant to the state Administrative Procedure Act, NC General Statute 150B-1. DHHS has 30 days to respond to the petition.

In the petition, the NCMS and NCAPA offer the following reasons why the proposed rule should be adopted:

• To comply with federal regulations published by the Center for Medicare and Medicaid Services (CMS) that mandate, “the State Medicaid agency must require all ordering physicians or other professionals providing services under the state plan or under a waiver of the plan to be enrolled as participating providers.” In October 2011, DHHS requested that CMS approve the addition of PAs to the State Plan. That request is still pending, but is expected to be approved.
• DHHS cannot unilaterally require PAs, NPs or other healthcare professionals to enroll as participating providers because the rulemaking exemption available to DHHS for developing medical coverage policies does not apply “in adopting new or amending existing medical coverage policies pursuant to GS 108A-54.2”
• DHHS Division of Medical Assistance (DMA) has made multiple, conflicting announcements over the last nine months. These monthly changes have created confusion about what the DHHS/DMA expect from the provider community.
• DHHS officials have already agreed with the NCMS and NCAPA that rules are required to mandate direct enrollment. Even though DMA has made promises to have stakeholder meetings and has given verbal assurances since September that draft rules were being developed and would be available shortly, no rules have materialized and planned meetings called by DMA were cancelled. DMA continues to signal that it will proceed with requiring direct enrollment before completing the rulemaking process, despite repeated objections from both the NCMS and NCAPA.

The NCMS and NCAPA will continue to press the DHHS and DMA about abiding by existing protocol in amending the State Plan. Updates will continue to be provided in future Bulletin issues.

Last night, the NCMS Legislative Cabinet met to discuss the current political landscape and issues facing physicians and physician assistants during the legislative session set to begin next week. The Legislative Cabinet consists of 15 NCMS members from diverse specialty backgrounds with proven experience in the advocacy arena. They meet regularly in order to develop legislative strategy, analyze proposals in light of current NCMS policy and advise the NCMS Board on all matters related to political advocacy.

The Legislative Cabinet approved three key objectives as recommendations for the Society’s 2012 legislative priorities. The following recommendations will go to the NCMS Board for review:

1. Ensure continued access to high-quality care for Medicaid patients by defending against further rate reductions, cuts to essential medical services and further erosions to the mental health care system.
2. Defend the significant improvements to the medical liability reform system achieved in 2011.
3. Continue to protect our patients by opposing proposals by practitioners to be licensed, relax current regulatory safeguards, or expand licensure beyond their training and abilities.

As the NC General Assembly convenes, look for upcoming articles and action alerts to provide resources for you to connect with your legislators about these and other important medical issues being debated.

Your NCMS PAC has been hard at work raising money since the 2010 general elections to be ready to assist those legislators that would face primary challenges in 2012. We are pleased to announce that, through the generous support of members like you, your NCMS PAC was able to invest in 72 candidates for office this year. All but four of those candidates have now won their election or moved on to face a challenger in the general election this November. 

Even with this success, there is still more to do. The campaign season never ends and we have to gear up for an even bigger battle this fall. Your NCMS PAC was able to contribute more than $180,000 this spring and we will need to do that and more again in just a few short months. Please consider becoming a sustaining donor to the PAC by committing to $20 per month or making a one-time gift of $250. 

Your ongoing support enables the NCMS to continue to have strong advocacy programs on behalf of you and your patients. While the focus of many of our reports over the past year have been centered on tort reform, we have also had outstanding success with protecting Medicaid physician services rates, defending against lesser trained practitioners seeking the endorsement of the state through licensure, progress on workers compensation laws and improvements to the insurance regulations that cost your practice time, money and resources.

This success is only possible through your contributions to the NCMS PAC, your personal relationships with local legislators and ongoing communication about our goals and positions on bills of interest to you. NCMS staff will be organizing communication throughout the legislative session that begins next week and we will be doing elections briefings in early September to help you prepare for November.  We hope that you will choose to be part of this winning team and consider a contribution today.

Governor Bev Perdue released her budget adjustments yesterday for consideration by the NC General Assembly. The $20.9 billion budget includes a three quarters cent sales tax increase, restoration of education funds cut during the last year, salary increases for some state employees and a continuation of the many smaller cuts in Medicaid. There do not appear to be any additional across-the-board rate cuts proposed in the Governor’s budget. While the health and human services portion of the budget seems to be relatively untouched, your NCMS legislative team is working to analyze each line item to ensure no further erosions to rates and essential medical services. Further detail and a comparison to the House budget expected to be released next week will be posted online.

Are you looking to learn more about physician and patient advocacy? Do you have an issue that you would like to address with your legislators? Sign up today for White Coat Wednesdays, an NCMS program that gives its members the opportunity to advocate for their profession by speaking directly with legislators about current medical practice concerns. NCMS staff will prep participating members and provide tips on how to convey messages regarding pressing medical and patient issues. The next legislative session is set to begin next week.

This program is a great way for medical organizations across North Carolina to present a united front while advocating on behalf of their fellow physicians. The NCMS Leadership College, Academy of Family Physicians, North Carolina Orthopaedic Association, and the North Carolina Pediatric Society are just a few organizations that will be participating this session. On White Coat Wednesdays, members will visit and see the General Assembly in action, meet one-on-one with North Carolina legislators while also taking part in committee meetings. These interactions build relationships that will benefit the health care profession today and in the future. 

Grab your white coats and come to Raleigh and see what advocacy–on behalf of you and your patients– is all about. There are currently several openings on Wednesdays, May 23 and June 13, 2012. The NCMS can accommodate multiple groups at once so contact the Society for an updated schedule. For an agenda and to schedule a White Coat Wednesdays visit, contact Chip Baggett (cbaggett@ncmedsoc.org), NCMS Director of Legislative Relations, or Will Barnett (wbarnett@ncmedsoc.org), NCMS Assistant Director of Legislative and Political Action, at 800-722-1350.

Stage 2 Meaningful Use Proposed Rule Comment Letter

In last week’s Bulletin, the NCMS announced that, along with other professional medical associations, the Society will be submitting a comment letter pertaining to the State 2 Meaningful Use proposed rule. The proposed rule outlines the requirements for the next stage of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program administered by CMS. Click here to view the comment letter, which was submitted May 7.

Medicare Conditions of Participation (CoPs) Revised Proposed Rule

In October 2011, CMS published a proposed rule to revise the Medicare Conditions of Participation (CoPs) for hospitals that the American Medical Association (AMA), along with several state and national specialty societies, including the NCMS, submitted formal comments to CMS that voiced strong opposition to several of the proposals in the rule. On May 10, 2012, CMS published the final rule on CoPs and included the following improvements:

• The proposed concept of a single medical staff for a multi-hospital has been removed
• The proposed concept of the privileging of physicians without appointment to the medical staff has been removed
• A hospital’s governing body must now include at least one medical staff member
• The proposed concept of credentialing for medical staff membership in accordance with “hospital policies and procedures” has been removed
• The mandatory inclusion of non-physician practitioners on medical staffs strongly proposed by several other groups was not adopted.

CMS Releases Proposed Rule regarding Medicaid Payments for Primary Care Services

According to a proposed rule recently released by CMS, the number of specialties receiving Medicaid payment under Medicare Rates for primary care services will expand to include subspecialties. Family medicine, general internal medicine and pediatric medicine specialties were originally identified in the Patient Protection and Affordable Care Act (PPACA) to receive Medicare Rates in both the 2013 and 2014 calendar year. View the proposed rule here. The subspecialties included in the expanded list are recognized in accordance with the American Board of Medical Specialties.

Duke University, Mountain Area Health Education Center (AHEC) and the Lincoln Community Health Center in conjunction with the National Health Care for the Homeless Council recently received the DHHS “Innovation Challenge Grant,” which will provide innovative health care to patients in underserved areas. According to DHHS, 26 projects granted throughout the United States will save $254 million over the next three years.

Local home care teams affiliated with Duke University will provide patient centered coordinated care to improve outcomes for patients with Type 2 diabetes. This initiative will lower costs by reducing the number of hospital and emergency room visits in these patients.

Mountain AHEC will provide primary care with the help of nurse practitioners and physician assistants to coordinate care, such as counseling, medication management, for approximately 2,000 patients. These efforts will lead to improved pain control, health and reduce the amount of outpatient visits.

Lincoln Community Health Center, along with other Community Health Centers across the country, will serve about 1,700 patients by conducting outreach and case coordination to direct homeless to receive care in health centers rather than at emergency departments.

More information about this initiative can be found here.

Due to a high volume of questions coming in through the Member Resource Center, the NCMS features a Frequently-Asked-Question (FAQ) for its members each week to share information about current medical and health care issues that their colleagues are having.

Q: Is it appropriate for physicians to recommend that their patients return his/her unused controlled substance prescription to a pharmacy?

A: No. A patient may not return his or her unused controlled substance medication to a pharmacy. Click here for more information on proper disposal. Unused controlled substance medication may only be returned to a pharmacy in the event of the medication being recalled or a dispensing error has occurred. Both health care professionals and patients should be aware of the proper ways to dispose of controlled substances as well as non-narcotic prescription medication. View those standards here.

Have a question? Contact the NCMS Member Resource Center at (919) 833-3836 or kfreeman@ncmedsoc.org.

Physicians practicing in the Triangle area are invited to attend a presentation sponsored by the NCMS and Durham-Orange County Medical Society (DOCMS) regarding North Carolina Physicians’ Retirement Strategy (NCPRS) on Wednesday, June 6, 2012, 6:00 pm – 7:30 pm at University Club, 3100 Tower Blvd., Durham. Free retirement analysis and case design are available at the meeting to determine if physicians are on track to meet their retirement income goals.

This event is free for NCMS and DOCMS members. Registration ends Monday, June 4, 2012, 12:00 pm. To sign up for this event contact Diane Lindsey of NCPRS, at dlindsey@exfinancial.com or 336-297-9194. Registration can also be faxed to 336-297-4945. Include your name, practice name, office phone and fax as well as your email when registering for this event.

This week, NCMS Executive Vice President, CEO Robert Seligson announced that Emily Deese has joined the NCMS as Director of Member Services. Emily’s career has previously focused on pharmaceutical sales with more than 19 years of experience at Sanofi-Aventis, where she expanded sales and marketing of prescription urology, psychiatry, and cardiovascular drugs. During her tenure at Sanofi-Aventis, she served as a senior territory manager and won several regional and national sales awards. Emily graduated from North Carolina State University with a Bachelor of Arts in Business Management and Spanish Language/Literature.

As Emily begins her role at the Society, she hopes to use her physician marketing experience to build NCMS membership. Congratulations Emily and welcome to the Medical Society!

Last week the NCMS and the Physicians Advocacy Institute, Inc. (PAI), released a documentary that details the inaccuracies of a medical audit conducted by CMS. Both the NCMS and PAI distributed the documentary to various publics through several different channels, including social media. According to TweetReach, the documentary has reached thousands of tweeters. Here are a few mentions and re-tweets that the NCMS received upon releasing the video:

tnmed: RT @NCMedSoc: new documentary warns med. practices about consequences of #medicare audits; reveals a system that is out of control bit.ly/KteDRf

nashvillemed: RT @NCMedSoc: new documentary warns med. practices about consequences of #medicare audits; reveals a system that is out of control bit.ly/KteDRf

RT: @IP4PI: The Real Life Repercussions of #Medicare #RAC #Audits http://goo.gl/fb/IaiCh

@JediPD: The Pernicious nature of Audits http://goo.gl/fb/IaiCh @aapsonline @drcraigwax @jorient

@doctorwes: The Real Life Repercussions of Medicare Audits http://goo.gl/fb/IaiCh

@Matt_R_Fisher: RT @doctorwes: The Real Life Repercussions of #Medicare Audits http://goo.gl/fb/IaiCh – video about an audit

The documentary was also featured by a physician blogger. Follow the NCMS on Twitter @ncmedsoc for health care updates and breaking news.

Early registration for the 2012 Sports Medicine Symposium, an event sponsored by the NCMS Sports Medicine Committee and the North Carolina Academy of Family Physicians (NCAFP), is now available through June 1. The symposium will be held Saturday-Sunday, July 7-8, 2012 at the Kingston Plantation Embassy Suites Hotel, Myrtle Beach, SC. Attendees can receive up to eight AMA PRA Category 1 Credits™.

The symposium is for physicians with an interest in sports medicine and emphasizes new diagnostic techniques and treatment options for:

• Complicated concussion;
• Heat/critical issues in management;
• Patellar Tendon; Achilles Tendinopathy;
• Ultrasound use in diagnosing/monitoring metatarsal fractures;
• Rotator cuff partial and complete tears;
• Pediatric anterior knee pain;
• And includes workshops designed to master examination skills.

Click here for more information and to register. Questions can be directed to Nancy Lowe, NCMS Associate Director Specialty Society and Meeting Services, at 800-722-1350 or nlowe@ncmedsoc.org.

NCMS members can win daily prizes by exploring the many ways athenahealth, a NCMS partner, can help physicians and physician assistants get more money and more control of their medical practice through the athenahealth Daily Win Game. There are five easy ways to gain Sweepstakes entries, which enters participants to win great prizes like a free annual Medical Group Managers Association (MGMA) membership, a copy of CPT Changes 2012 – An Insider’s View Book, the Muscle System Pro III iPad application, an American Express gift card and much more. The promotion ends Wednesday, May 16, 2012, so play today!

athenahealth was recently named to Forbes‘ annual list of America’s 25 Fastest-Growing Tech Companies. Click here for more information about athenahealth products and services.

The North Carolina Center for Hospital Quality and Patient Safety (NC Quality Center), an affiliate of the North Carolina Hospital Association (NCHA), will be holding the “NC Surgical Safety Checklist Campaign Orientation” webinar on Thursday, May 17, 2012, 9:00 am – 10:30 am, to discuss the World Health Organizations (WHO) Surgical Safety Checklist.

Participants will learn about tools and strategies needed in implementing the checklist. William R. Berry, MD, MPH, FACS, Safe Surgery 2015 Project Director at Harvard School of Public Health and Laura Maynard, M.Div, Director of Collaborative Learning at NC Quality Center will provide insight into the processes of using the list. Click here to register.