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.

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.

During the 2011 session, the NCMS reported to you on another round of mental health reforms outlined in HB 916. The bill sought to transition Local Management Entities (LMEs) into Managed Care Organizations (MCOs) over the course of one year. The concept was based on a pilot project that has been underway for nearly seven years at Piedmont Behavioral Health (PBH). While PBH has been working under a capitated system of care delivery for some time, other LMEs have had trouble making the transition from managing provider contracts to adjudicating and paying claims in a very short window of time. So far, just three LMEs have made the transition. Two more are scheduled to come online by the end of July with the remaining six not scheduled to go live until closer to January 2013.

Physicians and other mental health care providers have faced a myriad of problems in the areas that have made the transition. For those that have not transitioned, questions abound about the process and what to expect. A few of the problems that we have heard from NCMS members include:

• Blanket denials of service/non-payment for services previously reimbursed.
• Cumbersome re-credentialing requirements with 11 different LME/MCOs versus the previous single process with Medicaid.
• Over-flowing emergency departments because of a lack of local outpatient services.
• Back logs of patients at state mental health facilities.

NCMS is working with a coalition of partners to ensure that this transition has more predictability, more standardization across the different LME/MCOs, and less interruption of services to patients. We are working with legislators to identify additional oversight and assistance that can be provided to the LME/MCOs in order to support this policy change that the North Carolina General Assembly has determined will go forward.

It is important that we continue to hear from you through this transition to ensure that we are being proactive, not only at the North Carolina General Assembly, but also at the DMA. Please continue to reach out to our Government Affairs team with your concerns so that we can ensure that you are not only compensated for the vital work that you provide but that your services continue to be available to this fragile patient population. Please contact Amy Whited, Director of Health Policy at awhited@ncmedsoc.org or Conor Brockett, Associate General Counsel at cbrockett@ncmedsoc.org for assistance.

This week, the NCMS partnered with the North Carolina Bar Association (NCBA) to produce a short video informing patients about the importance of speaking with family members about what a patient would want in a life threatening situation if he/she could no longer speak for him/herself. The video explores several scenarios of how patients and families should address talking about those wishes and preparing end-of-life documents such as advance directives.

The video will be distributed upon completion and will be available on both the NCMS and NCBA website. In the interim, physicians can direct patients to the end-of-life resources available on the NCMS website.

Attention Dermatologists! The North Carolina Dermatology Association (NCDA) will host a Skin Screening at the North Carolina Legislature on Wednesday, June 13, 2012, 9:00 am – 3:00 pm in Room 1124 of the Legislative Building in Raleigh. Volunteers are needed to assist with this unique public service/advocacy event which will provide skin screening for legislators, their staff members and vistors to the Legislative Building.

Free screenings will include full-body examinations, providing skin cancer warning handouts with information on how to find a dermatologist, and teaching skin self-examinations. This event offers an excellent opportunity to reinforce the NCDA’s message about proposed legislation regarding the dangers of indoor tanning. Individual meetings with legislators will also be scheduled.

The NCDA seeks dermatologists to help make this skin screening event a success. Volunteers are asked to serve two-hour shifts. To sign up, contact Nancy Lowe, NCMS Associate Director, Specialty Society and Meeting Services, at nlowe@ncmedsoc.org or 919-833-3836.

NC HIE Roadshows, held by the North Carolina Health Information Exchange (NC HIE), will provide numerous sessions across North Carolina during the month of May to teach health care professionals about how NC HIE strives to implement the access, exchange and analysis of health information to improve the quality of care to patients. Click here to view the schedule and to register.

Upcoming ICD-10 Training Sessions for Practice Administrators: Area Health Education Centers (AHEC) across the state will be holding ICD-10 training and implementation sessions for medical practices. The sessions will assist practice administrators, managers, coders, billers and clinical staff understand ICD-10-CM diagnosis codes and identify documentation and implementation issues that may impact a practice. The program costs $135 for early registration and $150 up to ten days before the event. Click here for training session schedules, session agendas and to learn more about awarded continuing education credits.

North Carolina Health Information Exchange (NC HIE) Participation Agreement webinar, hosted by the North Carolina Society of Health Care Attorneys (NCSHCA) will be held on Tuesday, May 8, 2012, 11:00 am – 12:30 pm, to discuss the efforts of NC HIE in providing secure and private exchange of health information across care settings. Health care professionals participating in NC HIE must sign this agreement so it is imperative that it is easily understood. The webinar fee is $35.00 for NCSHCA members $45.00 for non-NCSHCA members. Click here for more information and to register.

First Spine Care Conference, offered by the Medical University of South Carolina (MUSC) Multidisciplinary Spine Center, will be held from Friday-Saturday, May 11-12, 2012 at Kiawah Island, South Carolina. The conference will focus on diagnostic and therapeutic strategies, both operative and non-operative, for patients suffering from spinal disorders. Click here to register. Questions can be directed to Pamela Benjamin, MUSC CME Program Coordinator, at 843-876-1925 or benjamin@musc.edu.

NC Hospice Free Pain Assessment Workshop, hosted by the Association for Home and Hospice of North Carolina and the Hospice and Home Care Foundation of North Carolina, will be on Wednesday, June 13, 2012, 12:30 pm – 3:30 pm at the Hospice of Wake County, Raleigh, NC. The workshop will focus on pain management and assessment in patients with dementia. Click here to register.

“What’s Up, Doc, with the Future of Healthcare Law?”, a CME program hosted by the North Carolina Bar Association (NCBA), the North Carolina Society of Healthcare Attorneys, and Duke University, will be held on Friday, June 15, 2012, 8:00 am – 5:00 pm, at the Duke University – North Pavilion. The program allows physicians and lawyers to discuss healthcare reform, malpractice reform and other current healthcare issues. Participants can receive up to 7.25 AMA PRA Category 1 Credit(s)™. Click here to register.

2012 Sports Medicine Symposium, an event sponsored by the North Carolina Academy of Family Physicians, the Southern Regional Area Health Education Center (SR-AHEC) and the NCMS Sports Medicine Committee, will be held Saturday-Sunday, July 7-8, 2012, at Kingston Plantation Embassy Suites Hotel, Myrtle Beach, SC. Attendees can receive up to eight AMA PRA Category 1 Credit(s)™. Click here for more information and to register.

North Carolina Dermatology Association (NCDA) 2012 Summer Meeting, sponsored by the Wake Area Health Education Center (Wake AHEC), will be held Friday-Sunday, July 13-14, 2012 at the Homestead Resort, Hot Springs, VA. Attendees can receive up to 10.75 AMA PRA Category 1 Credit(s)™. Click here for discussion topics; meeting schedule and fees; accommodations information and to register. Contact Nancy Lowe, NCMS Associate Director, Specialty Society and Meeting Services, at 800-722-1350 or nlowe@ncmedsoc.org for more information.

‘Alcohol Misuse and Abuse Affects Us All’ Patient Resources: ACTnowNC has launched an initiative to build awareness and communication about alcohol issues. Visit http://www.actnownc.org/ or contact Tayna Roberts, MSW, ICPS, NC ABC Commission Contractor, at 252-665-3424 or taynaroberts@gmail.com for these alcohol education resources.

The North Carolina Institute of Medicine (NCIOM) recently released a data snapshot pertaining to uninsured individuals in North Carolina by age, residence and other characteristics to assist health care professionals, insurers and state and local policymakers better understand the current condition of the healthcare system. The data findings are from 2009 and 2010. Click here for the estimated rates and risk-levels of children and adults in North Carolina’s 100 counties who are uninsured. Click here for data findings conveying the common characteristics of uninsured North Carolinians.

The North Carolina Division of Public Health (DPH) has released its yearly updated memos about vector borne diseases that were originally sent to physicians and other providers in 2009. Read the latest information about Diagnosis and Surveillance for Tick Borne Rickettsial dieases (TBRD), Arboviral diseases and Lyme disease. Questions regarding these udpates can be directed to State Public Health Veterinarian Carl Williams, DVM, DACVPM, at carl.williams@dhhs.nc.gov.

Volunteers are needed for “Doctors on Call,” an event hosted by the NCMS and the Pitt County Medical Society, at WITN-TV in Greenville on Wednesday, April 25, 2012, 4:00 pm – 7:00 pm. This event gives local area viewers the opportunity to speak directly with physicians about their health concerns. 

Local physicians in all medical specialties are asked to reach out to Eastern North Carolina citizens by volunteering for one-or two-hour shifts between 4:00 pm – 7:00 pm.  Spanish-speaking volunteers are also needed. The success of “Doctors on Call” relies on sufficient volunteers to cover the phone bank during this primetime, early evening broadcast. 

To volunteer, register online now or contact Kristin Freeman, NCMS Member Resource Center Coordinator, at 919-833-3836 or kfreeman@ncmedsoc.org or click here to download a response form.

William Pully, President of the North Carolina Hospital Association (NCHA), was honored as the 2012 recipient of the Ronald Levine Legacy Award in recognition of his contributions to public health in North Carolina. The award was presented at the annual 2012 State Health Director’s Conference on January 27, 2012. It is named in honor of the former State Health Director and long-time NCMS leader, Ron Levine, MD, who presented the award along with outgoing State Health Director Jeffrey Engel, MD.

“Bill is well deserving of this prestigious recognition for his leadership in helping create a statewide disease event tracking system and the Public Health and Hospital Collaborative,” NCMS EVP, CEO Robert W. Seligson said. “These advancements contribute greatly to the quality of care given our citizens and to the public health of our great state.” 

The Collaborative is a public-private partnership between the Division of Public Health, NCHA, the NC Institute for Public Health and the NC Center for Health Quality that has developed standards for community health assessments as required for non-profit hospitals by the federal health care reform law and the Public Health Exchange.

Pully, a Rocky Mount native began his career with NCHA as director of government relations. He became president of the association in 1999.

On Monday, January 23, a committee of the Child Fatality Task Force took up the issue of indoor tanning and legislation proposed by the North Carolina Dermatology Association (NCDA) to ban teens and children under 18 years of age from using indoor tanning beds. The NCDA offered testimony to the committee stressing the science which confirms the danger of indoor tanning devices and citing recent studies validating the need for stronger laws to protect our state’s youth.

Speaking for the NCDA were David Ollila, MD, Professor of Surgery at UNC-Chapel Hill and Co-Director of the UNC Melanoma Program; and Craig Burkhart, MD, Assistant Professor of Pediatric Dermatology at UNC-Chapel Hill. Also providing supporting statements were Amy Whited on behalf of the NC Medical Society and Christine Weason for the American Cancer Society.

Some of the key points in the NCDA’s testimony included:

• The science is clear: there are no health benefits from tanning beds that cannot be obtained more safely and without the risk of skin cancer.
• There are safe alternatives to tanning beds that many tanning bed operators are already offering.
• UV radiation in tanning booths can be up to 15 times greater than the sun.
• Every visit to a tanning bed increases the odds of developing melanoma.
• Melanoma incidence is rising at alarming rates.
• Melanoma ranks second among all cancers in years of productive life lost.
• Melanoma is the most common form of cancer for young adults 25-29 years old and the second most common form of cancer for adolescents and young adults 15-29 years old.
• Melanoma is increasing faster in females 15-29 years old than males in the same age group.
• Even minimal exposure to UV radiation from tanning beds before the age of 35 can increase the risk of developing melanoma by 75 percent.
  [IARC. International Journal of Cancer: 2006 March 1;120:1116-1122.]
• A person who has used tanning devices for more than 50 hours, 100 sessions, or 10 or more years is 2.5 to 3 times more likely to develop melanoma than a person who has never tanned indoors.
  [Lazovich D, Vogel RI, Berwick M, Weinstock MA, Anderson KE, Warshaw EM.  Indoor tanning and risk of melanoma: a case-control study in a highly exposed population. Cancer Epidemiol Prev 2010;19:1557-68.]
• North Carolina laws currently protect children’s health by restricting their access to: 
        -Tobacco         -Alcohol         -OTC medications
• The estimated total direct cost associated with the treatment of melanoma in 2010 was $2.36 billion
• Protecting children from tanning beds will save lives and millions of dollars in avoidable health care costs

The indoor tanning industry was represented by a paid consultant, Mr. Lee Feldman, who asserted that the research on indoor tanning was of poor quality and that the science is inconclusive. 

Following deliberation, the committee voted to send a recommendation to the full Child Fatality Task Force that it should support an increase on the age limit for indoor tanning from 14 to 18 years of age. The Task Force is scheduled to take up this issue at the April 16 meeting.

Questions about the indoor tanning issue may be directed to Alan Skipper, Director of Speciality Society and Meeting Services, at askipper@ncmedsoc.org.

On Wednesday, February 1, 2012, CBS News reported that a new congressional report accused tanning salons of lying to customers just to get their business. Click here to view Probe: Tanning Salons Lure Teens with Lies, by Correspondent Nancy Cordes.

State public health officials have issued advice on steps everyone can take to avoid a common and unpleasant gastrointestinal illness known as norovirus The Division of Public Health (DPH) says norovirus infections have been reported by several local health departments across North Carolina.

“The most important message we have right now is that people who are ill with vomiting or diarrhea should not work, go to school or attend daycare while they are having symptoms,” said State Epidemiologist Megan Davies, MD. “Everyone needs to wash their hands frequently and thoroughly with soap and water. This is the most effective way to protect yourself and others against norovirus since hand sanitizers alone are not as effective against this hardy virus.”

People with norovirus are contagious from the moment they begin feeling sick until at least three days after they recover. Dr. Davies says some people may be contagious for an even longer period. Dehydration can occur rapidly and may require medical treatment or hospitalization.

Noroviruses are easily transmitted by touching a contaminated surface as well as by direct contact or by eating food or drinking liquids that have been contaminated with the virus, according to a news release issued by the NC Department of Health and Human Services. Noroviruses are notoriously difficult to kill with normal cleaning and disinfecting procedures. Symptoms include nausea, vomiting, diarrhea and stomach cramping. Some people may have fever, chills, headache, muscle aches and a general sense of tiredness.

For more information on norovirus and precautions to minimize its spread, go to http://www.ncpublichealth.com/.

In addition to announcing that she would not seek reelection this week, Governor Beverly Perdue announced that Laura Gerald, MD, former Executive Director of the Health and Wellness Trust Fund, would become State Health Director, effective February 1, 2012, and will lead the newly combined Division of Prevention, Access and Public Health Services. Outgoing State Health Director Jeffrey Engel, MD, will move to a broader policy-making role and become a special advisor on health policy to the Secretary of the Department of Health and Human Services (DHHS). Both Dr. Gerald and Dr. Engel are active members of the NCMS.

The leadership moves coincide with the Governor’s executive order encouraging agencies to consolidate and realign state government, to improve service and efficiency, according a DHHS news release.

“As we move to enact the Governor’s executive order, the focus shifts to a more integrated approach to improving the health of all North Carolinians,” outgoing DHHS Secretary Lanier Cansler said. He will be working in consultation with incoming Acting Secretary Al Delia to begin the formation of the new division.

Related articles:

State health official stepping down, 1-24-12, Winston-Salem Journal, by Richard Carver

Governor Names Delia Acting DHHS Secretary, Bulletin, 1-20-12

Special Report: DHHS Secretary Cansler Resigns, Doctor to Doctor Blog, 1-14-12

State public health officials report a decrease in influenza activity for the week ending January 7, 2012. However, the latest NC Division of Public Health (NCDPH) Flu Report cautions that the usual peak of influenza activity is during January or February, noting that we can expect to see consistent increases during the next few weeks. No flu-associated deaths have been reported in the state since the end of the 2010-2011 flu season. 

The World Health Organization (WHO) reports flu activity in the temperate regions of the northern hemisphere remains below seasonal thresholds, though notable increases in activity have been reported in some areas of Canada, Europe, northern Africa and the Middle East. The viruses detected throughout the northern hemisphere temperate zone have been predominately of the A(H3N2) type. Only very small numbers of A(H1N1) have been reported in recent weeks.

More information is available at www.flu.nc.gov and at http://www.cdc.gov/flu.

The North Carolina Division of Public Health (NCDPH) Tobacco and Control Branch launched the QuitlineNC Nicotine Reduction Theraphy (NRT) Program on January 1, 2012. Adult patients who use tobacco products can receive free NRT (patches, gum, and lozenges) until supplies run out. Physicians can download two flyers, one that explains the program, and the another that can be given to patients who want to quit using tobacco products.

Click here to download the Help Your Patients flyer.

Click here to download the Quitline NRT Program flyer, which can also be used as a poster in your waiting room or examining room.