Yesterday the NCMS and the Physicians Advocacy Institute, Inc., (PAI) released a documentary detailing the two-year ordeal that Eastern Carolina Internal Medicine (ECIM) experienced during a Medicare audit. The documentary, entitled “Guilty Until Proven Innocent: When Medicare Audits Cause Casualties,” reveals the Medicare audit process as unfair, devoid of common sense and negatively impacting doctors as they work to provide quality patient care. View the video below.

 

“This documentary offers an example of the real-life consequences of a federal government audit program that is out of control,” said Robert W. Seligson, executive vice president and CEO of the NCMS. “Federal audit contractors are paid to find problems, extrapolate the findings and increase the fines to exorbitant amounts, which can lead to medical practices closing their doors, especially in rural communities already facing critical primary care physician shortages.”

The documentary describes a series of events, beginning with a medical records request, that resulted in the Centers for Medicare and Medicaid Services (CMS) imposing a fine on ECIM of more than $1 million. The Medicare Program Safeguard Contractor (PSC) took minor errors alleged in the medical charts and extrapolated $40,000 to reach the overpayment amount of $1 million. After two years, thousands of dollars in legal and administrative expenses and a severe impact on access to patient care, ECIM proved that it had provided the appropriate services to its patients and had documented claims correctly. The original fine was reduced to less than $4,000 only after ECIM physicians and staff spent three days with an administrative law judge reviewing each claim in question. It even took US Senator Richard Burr (R-NC) contacting CMS directly in order for ECIM to receive the money owed back to them.

The NCMS and PAI hope to urge the federal government to take steps in addressing the flawed audit system and help physician practices understand the importance of appealing adverse audit findings. For a copy of the video, contact the NCMS at 919-833-3836 or 800-722-1350. Members can also refer to the NCMS Health Care Audit Resource Center for more information on how to prepare for and address medical audits. PAI will be hosting the webinar “Medical Audits: What Physicians Need to Know” on Tuesday, May 15, 2012, 2:00 pm, which will provide information about different types of audits faced by physician practices. Principal author of PAI’s recently published white paper, “Medical Audits: What Physicians Need to Know,” Frank Cohen, MPA, MBB, will present the webinar. Click here to register. Look for more medical audit learning opportunities in future issues of the Bulletin.

The primary election is scheduled for next Tuesday, May 8.  Early voting continues through this Saturday. The NCMS encourages you to uphold your civic duty by making sure that you vote. Consider this is your first act of advocacy on behalf of your profession and your patients. 

Many of the races on Tuesday will be the determining race, since they have no further challenge in the fall. Others are merely a stepping stone to the next challenge as the parties choose their candidates. Either way, your vote counts and your vote is needed.

The NCMS has highlighted a number of races over the last few weeks. We would like to again recognize three NCMS members in primary races that have a strong chance of winning, but continue to need your help in these final days leading up to next Tuesday.

Eric Mansfield, MD (Democrat Candidate for Lt. Governor)

Dr. Mansfield is an ENT physician from Fayetteville. He is currently serving his first term in the North Carolina Senate. He was a strong supporter and key vote during the medical malpractice reform debate during the 2011 session. Dr. Mansfield has proven himself to be a strong advocate for bipartisan consensus during his short time in the North Carolina Senate. This is his first attempt at statewide office. He is running in a close Democratic primary against former Rep. Linda Coleman. You can find more information about Dr. Mansfield by clicking here to go to his website.

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Jim Fulghum, MD (Republican Candidate – NC House District 49 – Wake County)

Dr. Fulghum is a neuro surgeon in Raleigh. He is running in his first bid for elected office against former Rep. Russell Capps in the Republican primary. This new district was added during the remapping process this year. It is a leaning Republican district though Dr. Fulghum would still face a Democrat challenger in the general election. Dr. Fulghum has made healthcare and the economy his leading campaign issues. His voice as a practicing physician will be important with the loss or retirements of all three of our physicians in the North Carolina Senate this year. You can find out more about Dr. Fulghum by clicking here to go to his website.

 

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Mark Hollo, PA (Republican Incumbent – NC House District 73 – Alexander County)

Rep. Hollo is serving in his second term in the North Carolina House. He is a physician assistant in Taylorsville. He currently serves as one of the House Health Committee Chairs and was another strong voice for tort reform this past session. He has also been instrumental in writing the Medicaid portion of the state budget. Rep. Hollo is currently double bunked with Rep. McCormack (R) who filed for office but has subsequently withdrawn from the race. Even so, Rep. Hollo will still have to collect the majority of votes next Tuesday since Rep. McCormack’s name could not be removed from the ballot after filing. Rep. Hollo will then move on to take on a Democrat challenger in the leaning Republican district during the fall election. Click here to learn more about Rep. Mark Hollo.

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Other NCMS members on the ballot include Bruce Blackmon, MD (Democrat Candidate for Governor) and Eric Troyer, MD (Republican Candidate – NC House District 76 – Rowan County). Please make sure that your voice is counted next Tuesday, if not before. You can click here to go to the NC Board of Elections website to find your sample ballot, early voting locations and your precinct voting site for next Tuesday. Go Vote!

Ann Miller Wilson, MD, recently spent time with the NCMS Government Affairs Department completing a one-month elective to learn more about how to help protect physician interests in the state legislature. During this time, Dr. Wilson created several whitepapers pertaining to scope of practice issues currently being discussed at the North Carolina General Assembly. The whitepapers will be available shortly.

Dr. Wilson became interested in physician advocacy when Chip Baggett, NCMS Director of Government Affairs, visited Carolinas Medical Center in an effort to rally support around the monumental tort reform bill. Dr. Wilson is completing her residency in physical medicine and rehabilitation at Carolinas Medical Center.

Dr. Wilson is a Virginia native who grew up in Richmond, VA. After graduating from high school in 2000, she attended the University of Virginia where she earned a BA in Psychology. Immediately following graduation in 2004, Dr. Wilson worked in the National Preparedness and Response Corps (NPRC) at the American Red Cross and aided in disaster relief efforts nationwide. She also worked in event planning for the Red Cross and created a Girl Scout badge program focusing on disaster preparedness. After her year of work with the NPRC, Dr. Wilson pursued her medical degree from the Medical College of Virginia. There she became a member of the Alpha Omega Alpha honor society. After graduation, she accepted an intern position with the University of Virginia’s Department of General Surgery. Thank you Dr. Wilson for all of your hard work!

Last week Doctors Making Housecalls, LLC, announced that it has been selected as a demonstration site for CMS’ Independence at Home (IAH) demonstration program, which was developed to provide homebound and elderly Medicare patients with medical care in their homes. This program, which will begin on June 1, 2012, will provide care to 10,000 home-limited Medicare beneficiaries in the hopes to increase quality of life, reduced cost of care and the number of hospital and emergency room visits.

Doctors Making Housecalls has made more than 250,000 medical home visits to patients, who are typical medically fragile and elderly, since 2002. The practice also provides comprehensive and urgent care to younger adults and older children. Such demonstration sites will help determine whether a home medical care model can contain escalating health care costs. The program is funded entirely from self-savings.

To learn more about IAH and Doctors Making Housecalls, contact Alan Kronhaus, MD, NCMS member and co-founder and CEO, at 919-246-9455 or akronhaus@doctorsmakinghousecalls.com.

As a Physician Lending Specialist with SunTrust Mortgage, Paul Godbold helps physicians achieve their homeownership goals with the Doctor Loan Program, a unique program offering up to 100 percent financing and no mortgage insurance requirements. NCMS members may be eligible for relationship discounts and competitive pricing via this new member benefit program.

As a full-service lender, SunTrust Mortgage provides financing solutions for every stage of homeownership. Whether you are considering building or renovating a home, purchasing a second home or investment property, or refinancing your existing mortgage, Paul will work with you to understand your needs and help you identify the best mortgage to meet your individual goals.

Click here for more information about the SunTrust Mortgage Doctor Loan Program or contact Paul Godbold, Physician Lending Specialist, at 704.362.5461 or paul.godbold@suntrust.com.

NCMS and Pitt County Medical Society members who participated in the 22^nd Doctors on Call on Wednesday, April 25, 2012, assisted nearly 400 patients in eastern North Carolina while taking phone calls at the WITN-TV studio in Greenville, NC. Members from various specialties spent three hours answering patient questions and concerns. The NCMS, Pitt County Medical Society and WITN-TV would like to thank the following volunteers for their time and hard work:

Daniel Acosta, MD; Robert Bauer, MD; Raymond Baule, MD; Ramesh Daggubati, MD; Alex Dalzell, MD; Tracy Eskra, MD; Robert Frere, MD; Andre Hnatov, MD; Kurt Jackson, MD; Folashade Jose, MD; Geeta Katwa, MD; Eric Lindbeck, MD; Mark Manwaring, MD; Robert Monteiro, MD; Frank Parker, MD; John Pender, MD; Noel Peterson, MD; Charles Phillips, MD; Timothy Reeder, MD, MPH; David Ryan, MD; Jessica Scott, MD, JD; Jonathan Taylor, MD; Ricky Watson, MD and Charles Willson, MD.

Participating physicians received phone calls from male and female patients ranging in age from 19 to over age 75 and answered questions pertaining to dermatology, orthopaedics, family medicine, geriatrics, urology, neurology, dental, oncology, arthritis, cardiology, endocrinology, obstetrics/gynecology, ENT, infectious diseases, rheumatology, gastroenterology, ophthalmology, mental health, nutrition and wellness and more.

The NCMS facilitates Doctors on Call in conjunction with county medical societies and news stations across the state. Stay tuned to upcoming Bulletin publications for information about the next Doctors on Call event.

The North Carolina Obstetrical and Gynecological Society and the North Carolina Section of the American College of Obstetricians and Gynecologists held its 2012 Annual Meeting April 20-22, 2012 at the Embassy Suites Charlotte-Concord. Approximately 100 attendees and 40 vendors participated. Attendees discussed topics including, but not limited to, new ovarian cancer testing, interventional radiology, osteoporosis, medical malpractice, and legislative updates. To emphasize the importance of being involved in healthcare advocacy, medical liability reform, pregnancy medical home, North Carolina’s Medicaid budget and the “Women’s Right to Know” law were addressed.

Robert Bashford, MD,  who is a professor of psychiatry, obstetrics and gynecology, and Associate Dean of Student Affairs at the UNC School of Medicine was the featured speaker at the meeting. NCMS member Margaret Harper, MD, received the 2012 Distinguished Service Award for her efforts in investigating pregnancy-associated mortality, perinatal interventions, and the prevention of preterm birth. Since 1992 Dr. Harper has served as Chair of the North Carolina Pregnancy-Related Mortality Review Committee. In 2010 she received the Award of Research Excellence from the Society for Maternal-Fetal Medicine. Neil P. Johnson, MD, from UNC School of Medicine, is this year’s recipient of the resident paper competition. Residents from five of the state’s training programs competed.

The following officers and leaders were selected at the meeting:

President: Haywood Brown, MD / Durham
President-Elect: Lindsay Stevenson, MD / Elizabeth City
Secretary-Treasurer: James Al-Hussaini, MD / Mooresville
Secretary-Treasurer-Elect: Keith Nelson, MD / Greenville
Immediate Past President: William Meyer, MD / Raleigh
Past President: Mary Lane, MD / Lumberton
Annual Meeting Chair: John Thorp, Jr., MD / Chapel Hill
Member at Large: Cecilia Grasinger, MD / Blowing Rock
Member at Large: C. Richard Kirsch, MD / Thomasville
ACOG Section Chair: Brenda Peacock, MD / Washington
ACOG Legislative Liaison: Harold Pollard, III, MD / Winston-Salem

Yesterday, April 26, 2012, NCMS member and North Carolina Physicians Health Program (NCPHP) Medical Director and CEO Warren J. Pendergast, MD, assumed the position as president of the Federation of State Physician Health Programs (FSPHP). Dr. Pendergast is the first PHP medical director from North Carolina to undertake this role. He will serve a two-year term and will continue his role as medical director and CEO of NCPHP. Congratulations Dr. Pendergast!

Dr. Pendergast was appointed NCPHP medical director and CEO in 2004, after serving as associate medical director since 1999. NCPHP was established by the NCMS in 1988 and strives to improve the quality of health care for North Carolinians by assuring medical professionals are physically and mentally healthy. Since its establishment and through Dr. Pendergast’s involvement, NCPHP has evolved into a not-for-profit independent corporation, supported and endorsed not only by the NCMS but by the North Carolina Medical Board (NCMB), which has reached a 90 percent success rate of effectively helping improve the health of impaired physicians and physician assistants by providing the appropriate course of treatment. As president of FSPHP, Dr. Pendergast will strive to provide the same support to physicians and physician assistants across the United States.

Dr. Pendergast previously served on the FSPHP Board of Directors and the Executive Committee and also served as president-elect of FSPHP in 2010 and 2011. In addition to his participation in NCPHP and FSPHP, Dr. Pendergast serves on the NCMS Mental Health Task Force, the NCMS Opioid Death Reduction Task Force, the North Carolina Society of Addiction Medicine, and is a Distinguished Fellow of the American Psychiatric Association. He is also an adjunct assistant professor in the psychiatry department at the University of North Carolina at Chapel Hill (UNC) School of Medicine. Dr. Pendergast graduated from medical school at the University of Minnesota in 1986 and completed his psychiatry residency at the UNC School of Medicine in 1990.

To learn more about NCPHP, refer to this week’s Frequently-Asked-Question (FAQ).

Earlier this year, a delegation from the North Carolina Neurological Society (NCNS) participated in the American Academy of Neurology’s “Neurology on the Hill” event.  Alan Finkel, MD, of Chapel Hill; Michael Kushner, MD, of Rocky Mount; Robert Yapundich, MD, of Hickory; and Alan Skipper, NCNS Executive Director, met with North Carolina representatives and their staff and addressed issues that included Medicare reimbursement and National Institutes of Health (NIH) research funding.

To learn more about North Carolina specialty societies managed by the NCMS, click here.

The NCMS Foundation’s Community Practitioner Program (CPP) provides medical school loan repayment to primary care physicians, physician assistants, and nurse practitioners serving in rural and underserved areas of North Carolina.  By offering some relief for often tremendous educational debts, the program encourages talented and caring health care professionals to serve in areas of North Carolina that need them most.  Click here for more information on CPP.

The NCMS will showcase a CPP participant each month in order to honor their hard work and dedication to the patients of North Carolina. To learn more about Eva Shaw, MD, MPH, and her practice, click here.

The NCMS would like to congratulate members Michelle Chiu, MD, of Charlotte and Daniel Khera-McRackan, MD, of Raleigh, for receiving the American Medical Association (AMA) Physician’s Recognition (PRA) Award. This award recognizes physicians who demonstrate a commitment to staying current with medical advancements by participating in certified continuing medical education (CME) activities.

Download a brochure (PDF) to learn more about the AMA PRA Program.

Duke doctor on RDU-bound jet flies into action to save baby, 4-4-12, WRAL
NCMS member and WRAL Health Team physician Allen Mask, MD, reports that David Brizel, MD, who is also a member of the Society, saved an infant’s life on board a jet flying from London to Raleigh.

Dr. Redding Recently Recognized by Strathmore’s Who’s Who Publication, 4-2-12, pr.com
Victoria Brandon released that NCMS member and Past President Marshall S. Redding, MD, was recognized by Strathmore’s Who’s Who Registry for his outstanding contributions and achievements in ophthalmology.

Building a Network: State begins linking medical records, 3-30-12, Triangle Business Journal
Reporter Jason deBruyn writes that Community Care of North Carolina (CCNC) is the first qualified partner with the North Carolina Health Information Exchange (NC HIE).

Carolinas HealthPlan Analysis, Winter 2012, HealthLeaders InterStudy
Terri Gonzalez, NCMS Foundation Practice Technical Assistance Coordinator, contributes to the HealthPlan Analysis by showcasing the benefits of e-prescribing.

Legislators, DHHS plan ahead of Medicaid cutoff deadline, 4-4-12, WRAL
Reporter Mark Binker writes that North Carolina stands to lose $414 million in federal funding due to conflicts between how state and federal rules say personal care service dollars should be spent.

Answers to questions about possible changes to Medicare, 4-4-12, The News and Observer/ Kaiser Health News
Writer Marilyn Werber Serafini publishes questions and answers regarding overhauling Medicare and reducing spending, and proposals under consideration.

Many Medical Tests and Procedures Aren’t Needed–Doctor’s Groups, 4-4-12, Wall Street Journal
Blogger Anna Wilde Mathews writes that physician groups are starting the “Choose Wisely” campaign to limit number of medical tests and procedures performed when they aren’t needed.

Pneumonia Death Rate Drop May Not Be Real, 4-4-12, Medpage Today
Editor John Gever reports that an apparent decline in pneumonia mortality rates may actually reflect changes in diagnostic coding.

Last patients to leave Dorothea Dix in August, 4-4-12, The News and Observer
Writer Rob Christensen reports that the Council of State voted to close Dorothea Dix Hospital in August ending an era of treating the mentally ill since 1856.

Study of NC counties links health, affluence, 4-4-12, Winston-Salem Journal
Writer Monte Mitchell reports how North Carolina counties rank in regards to health.

North Carolina Health Information Exchange (NC HIE), a nonprofit organization incorporated in April 2010 as a State Designated Entity (SDE), conducted their first external testing this week for the Health Information Exchange Portal, a web-based program that gives physicians access to a central location where health information regarding mutual patients can be shared.

Audrey Moore, NC HIE Interface and Testing Engineer, facilitated the testing between the following volunteers: Karen Smith, MD, FAAFP, PA, NCMS member and former Community Practitioner Program (CPP) participant; Terri Gonzalez, NCMS Foundation Practice Technical Assistance Coordinator; Mitch Goldman, of Community Care of North Carolina (CCNC); and Jessica Reed and Wayne Lewis of Regional Extension South East Area Health Education Center (SEAHEC).

“Based on the success of the testing, it is clear that the portal will allow physicians to understand and utilize health information that flows from individual physician records to NC HIE and eventually to other physicians who are taking care of the same patient,” said Gonzalez.

As the first NC HIE Qualified Organization (QO), CCNC will begin initiating practice participation to the portal in coming weeks.

Participants of the North Carolina Program to Advance Technology for Health (NC PATH) will be among the first entities to utilize the portal. NC PATH, a Blue Cross Blue Shield of North Carolina (BCBSNC) initiative, partnered with NC HIE, as well as Allscripts MyWay™ to provide electronic health record (EHR) software and support to connect health care professionals across the state.

“Getting the HIE portal up and running is a process that has required many hours of planning, not just the technology of it, but also the operational side of implementing the appropriate business structures and privacy and security policies. Our goal is to bring a valuable information sharing tool to the market that benefits health care providers and consumers,” said Keith Scott, Chief Technology Officer of NC HIE.

Using HIE technology, like the portal, can improve care, save time and cut down on costs. “Like any new technology, participants and their staff will need to take the time to learn how to use the HIE portal,” said Scott. “Taking the time now will dramatically improve the care and time spent with patients in the future.”

NC HIE will be providing online tools and tutorials to assist participants with the HIE portal. A large volume of participants will increase the flow of the information, and overall, the benefit of utilizing the portal.

More information about NC HIE educational resources will be featured in upcoming issues of the Bulletin.

Regulations at the tanning bed could soon be up for debate among lawmakers, 3-26-12, News 14 Carolina
Reporter Linnie Supall interviews NCMS and NCDA member Craig Burkhart, MD, and David Ollila, MD, about the controversy behind indoor tanning regulations.

Warren P. Newton, MD and Brad Wilson: Legislator was a force for better care, 3-29-12, The News and Observer
NCMS member Warren P. Newton, MD, and Brad Wilson, Blue Cross Blue Shield of North Carolina (BCBSNC) CEO, remember former state Sen. John T. Henley Sr., for his impact throughout the state and beyond.

Justices take up heart of health care overhaul law, 3-27-12, WRAL.com/ Associated Press
Reporter Mark Sherman writes that the Supreme Court is addressing the main concerns with President Obama’s health care overhaul.

High court has options on health care law, 3-29-12, The News and Observer/ Associated Press
Reporters Mark Sherman and Ricardo Alonso-Zaldivar provide possible outcomes of what the Supreme Court will do with President Obama’s health care overhaul.

CNN Poll: Should health care law be overturned?, 3-27-12, CNN Politics
CNN reports that most Americans don’t want the Supreme Court to completely overturn the federal health care reform law.

Teen Health Clinic’s Affordable Care Act Grant Nets Visit from DHHS, 3-29-12, Examiner
Writer Crystal Roberts reports that Wilmington Health Access for Teens (WHAT) hosted a visit from the Department of Health and Human Services Regional Director, Anton Gunn, to share its plan for using the grant awarded through the Affordable Care Act.

Prices paid for physician services decreases for second month running, 3-26-12, amednews
American Medical News reports that the amount of money paid for physician services by patients and insurers decreased by 0.5 percent.

More doctors work part time, flexible schedules, 3-26-12, amednews
Writer Victoria Stagg Elliott reports that two of the fastest-growing demographics of physicians are driving the demand for options beyond full time.

FirstHealth Moore Regional Hospital Earns High Rankings, 3-27-12, The Pilot
Writer Ted M. Natt, Jr., reports the findings of Business North Carolina that FirstHealth Moore Regional Hospital is one of the best in North Carolina and is at the forefront of “a revolution” in how patients and their employers pay for care.

Obesity-linked cancers increase, 3-29-12, Fox News/The Wall Street Journal
Fox News reported that several cancers linked to obesity and a sedentary lifestyle have risen each year from 1999 through 2008, as improved screening and a sharp decline in the number of smokers have decreased the rate of new cancer diagnosis.

Two years after the Patient Protection and Affordable Care Act (PPACA), known as the “Affordable Care Act,” took effect, the U.S. Department of Health and Human Services (HHS) released a report summarizing some of the achievements of the health reform law. The political circumstances that accompanied passage of the ACA, together with its failure to address several issues of critical importance to doctors, have caused significant reluctance within the physician community to take advantage of the law’s beneficial provisions. NCMS has been working to ensure physicians can seize the opportunities created by the ACA, identify issues related to implementation, and correct the defects that have been identified.

To read more about the results of the law and implementation dates for 2012 and beyond, visit: http://www.healthcare.gov/law/resources/reports/patients-bill-of-rights09232011a.pdf

The NCMS continues to guide medical practices during this transformative time in healthcare. The NCMS is launching an initiative called “Toward Accountable Care,” to provide tools for physicians and other health care providers to successfully navigate and thrive in collaborative systems.

• In addition to the Health System Reform Resource Center, members can review the frequently-asked-question (FAQ) section of the NCMS website for questions and answers concerning the Centers for Medicare and Medicaid Service’s (CMS) Medicare Shared Savings Program.
• The NCMS has been active in discussions at the state level about a health benefits exchange.
• The NCMS Employee Benefit Plan has worked to ensure it complies with the new law and has served as a resource to practices about insurance issues.

Visit the Toward Accountable Care area of the NCMS website for a collection of resources on the NCMS’ activity in helping practices comply with the Affordable Care Act. We will continue to report on developments of the law’s implementation in future issues of the Bulletin.