As reported in the past, the North Carolina Department of Health and Human Services (DHHS) has been working to manage cash flow within their approved budget while juggling a number of fines, penalties and lawsuits. This external pressure along with increased enrollment led to the announcement yesterday, April 4, 2012, at the North Carolina General Assembly (NCGA) that DHHS, and more specifically the Division of Medical Assistance (DMA), will likely run out of money at the end of this month to pay for services for Medicaid patients.

Governor Beverly Perdue’s Budget Director, Andy Willis, testified before the Joint Legislative Oversight Committee on Government Operations during a meeting dedicated to the Medicaid budget. Mr. Willis reported that money would run short at the end of this month but that DHHS had found $45 million within their state appropriation to continue to reimburse for services until the NCGA reconvenes on May 16. 

Senator Pete Brunstetter (R-Forsyth), one of the Appropriations Chairs for the North Carolina Senate said, “This is something that we are going to have to address quickly, in the first few days when we return in May.” 

The problem that he refers to is a limitation in the DHHS Budget that says the department must balance within its’ own budget. That provision essentially means that no money can be shifted from any other general funds (i.e., Transportation, the Rainy Day Fund) to balance Medicaid. The provision was included by budget writers in part because of a history of problems like this where overspending required the State Office of Budget Management to redirect additional general fund dollars to cover Medicaid overages.

Even with the various overages experienced this year, Medicaid is within three percent of the budgeted target for the roughly $12 billion program, of which the state funds about $3.4 billion. Many legislators agree that is a significant improvement over previous years. Lawmakers continue to look for ways to better predict these health care expenditures, which is difficult because of varying enrollment, fluctuating utilization and additional burdens steadily flowing down from the Federal Government due in part to the health reform law.

Your NCMS continues to work with legislators and other health care partners to identify savings opportunities without jeopardizing access to care for your Medicaid patients or payment reductions. While lawmakers still view rate cuts as a possible solution, Wednesday’s conversation revealed that this initial budget problem would be handled with money from other sources in the state budget. At the same time, we will be facing budget corrections for the remaining biennium budget year.

Watch the Bulletin and other action alerts for opportunities to communicate with your legislators about this issue in the coming month.

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.

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.

The NC Cervical Cancer Resource Directory is a cervical cancer prevention resource launched by Cervical Cancer-Free NC. This web-based directory includes educational resources concerning cervical cancer, county-specific information on screening services for uninsured and underinsured women, and information regarding the HPV vaccine. The directory is available in both English and Spanish. Click here for a flyer that can be distributed to patients informing them about the directory.

The NCMS recently assisted Pediatric Partners of Raleigh in becoming a level three Patient Centered Medical Home (PCMH), the highest recognition standard for 2011 released by the National Committee for Quality Assurance (NCQA). As a PCMH, Pediatric Partners utilizes health information technology (HIT) for systematic patient-centered and coordinated care management processes to ensure that their patients get the evidence-based care that they need. While Pediatric Partners is one of only three private practices to achieve 2011 Recognition, North Carolina ranks third highest in all PCMH/PPC medical homes nationwide.

“Critically evaluating your practice against PCMH 2011 standards involves various challenges related to information technology, innovation and implementation of practice changes, measuring outcomes, achieving each standard goal, and then finally preparing documentation for NCQA submission,” says Georgette (Gigi) Gura, DNP, CPNP, CRRN, who championed the PCMH initiative and prepared the 2011 NCQA submission at Pediatric Partners.

Pediatric Partners was founded by NCMS member Terry Brenneman, MD, in 2006. As part of attaining level three PCMH distinction, Pediatric Partners implemented additional technology including a patient portal and evaluated provider performance and patient experience survey results. Working toward this distinction also required the practice to work together in order to adjust to the changes associated with PCMH. “Seeing each other regularly and being able to work well together allowed for a smooth transition to PCMH,” said Melanie Walker, MD. Pediatric Partners is now able to incorporate modern medical knowledge and technology to provide interactive and quality care to their patients.   

Ms. Gura also praised the assistance of the NCMS Foundation. “As an early adopter, I found it valuable to have Terri Gonzalez, NCMS Foundation Practice Technical Assistance Coordinator, to collaborate with while preparing PCMH 2011 NCQA submission for recognition.  She is very knowledgeable and easily accessible.”

The NCMS Foundation offers consulting services and technical assistance to NCMS members in order to help practices become PCMH recognized. Members can contact Terri at 919-833-3836 or tgonzalez@ncmedsoc.org for information regarding PCMH consultations and recognition.

North Carolina Medicaid’s Adult Safety with Antipsychotic Prescribing (ASAP) Initiative begins Tuesday, March 20, 2012, with a prior authorization policy called “Off Label Antipsychotic Safety Monitoring” for recipients 18 and older.  The first phase of the program will include Medicaid eligible adults receiving atypical (second generation) antipsychotic agents prescribed for an indication that is not approved by the federal Food and Drug Administration (FDA).  Here is the process for obtaining prior authorization:

1. Off label uses such as insomnia, anxiety, and primary treatment of depression will require a fax (866-246-8507) or phone-based (866-246-8505) prior authorization request to be submitted to ACS, a Xerox company who administers medication-related prior authorizations for NC Medicaid.
2. The presence of psychiatric diagnoses such as schizophrenia, bipolar disorder, Tourette’s syndrome, and adjunctive treatment of depression warrant exemption from prior authorization. To authorize an exemption for these specific indications, the prescriber must write in his or her own handwriting “meets PA criteria” on the face of each new or renewal antipsychotic prescription or in the comment block on e-prescriptions. 

For complete information, please refer to the Medicaid website at http://www.ncmedicaidpbm.com/  and the Resources page of http://www.documentforsafety.com/. These sites will be live by the program start date.

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: What is the statute of limitations for medical malpractice actions in NC?

A: The statute of limitations for medical malpractice claims generally is three years, beginning on the date of the last act of the physician giving rise to the claim. However, if the injury is not readily apparent, then the patient gets up to one additional year (up to seven additional years for non-therapeutic foreign objects left in the body) to file the claim.

The statute of limitations for claims brought on behalf of children is the longer of three years after the last act of the defendant giving rise to the claim, or when the patient reaches the full age of ten years. Additional time is provided if the child is in the custody of a state agency or if a judge rules that a child is neglected or abused. The statute limiting claims brought on behalf of minors was a major provision of medical liability reform in 2011. The previous statute allowed minors to wait until age 19 to file their claims.

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

If you are a provider who needs to file for hardship exemption for the 2013 Electronic Prescribing (eRx) payment adjustment, your opportunity to do so has been extended. The Centers for Medicare and Medicaid Services (CMS) has reopened the Quality Reporting Communication Support Page until Saturday, June 30, 2012.

Guidance on requesting a hardship exemption is available at the Quality Support Page User Manual.

The NCMS Health Information Technology (HIT) Resource Center may also be helpful. Questions can be directed to Terri Gonzalez, NCMS Foundation Practice Technical Assistance Coordinator, at 919-833-3836 or tgonzalez@ncmedsoc.org.

NC SPIN, North Carolina’s only independent statewide talk show, will host the “Can We Survive Our Healthcare System?” forum on Tuesday, March 20, 2012, beginning at 8:30 am at GlaxoSmithKline R&D Auditorium, 5 Moore Dr., Research Triangle Park. The keynote address will be given by NCMS member Victor Dzau, MD, MPH, chancellor for health affairs at Duke University and president and CEO of Duke University Health System. Other panelists include Jack Bailey of GlaxoSmithKline; Alan Verhey of Duke Divinity School; Lanier Cansler, former Secretary of Health and Human Services; and NCMS member L. Allen Dobson, Jr., MD of Community Care of North Carolina (CCNC).

The forum will address problems surrounding the healthcare system and providing innovations toward improving the system. There will be Q&A sessions throughout the day. The forum costs $45 per person, $35 for students and groups of five or more. Lunch will be provided. Click here to register.

Are you interested in becoming more familiar with Patient Centered Medical Home (PCMH)? The National Committee for Quality Assurance (NCQA) will be having a series of webinars and training sessions pertaining to PCMH. Click here to view the schedule. The last page of the schedule provides instructions on how to register for each event.

Did you know that the NCMS offers consultation services for PCMH2011 to its members? Contact Terri Gonzalez, NCMS Foundation Practice Technical Assistance Coordinator, at 800-722-1350 or tgonzalez@ncmedsoc.org for more information.

This week was National Patient Safety Awareness Week (March 4-10). Some tools and resources are available from the Agency for Healthcare Research and Quality (AHRQ) that medical practices can utilize to continuously promote patient safety:

• A brief waiting room video emphasizing the importance of communication and question-asking between physicians and their patients.
• A brochure that provides guidelines for patients to be more involved in their health care, which includes suggestions for patients to follow during, before, and after their visits.
• A notepad to help patients prioritize their top three questions for physicians and a question builder tool to allow patients to create lists of questions based on their health condition.

Free copies of the DVD, brochure and notepad are available by emailing AHRQpubs@ahrq.hhs.gov.

The Physicians Foundation will distribute a survey in the next couple of months to physicians across the nation asking for their perspective on today’s health care environment. The survey will ask physicians about the state of their practice, their morale, career plans and whether they can continue to provide services while managing current regulatory and financial burdens. For those members who are interested, survey results will be shared with political leaders, policy makers and media outlets nationwide.

The NCMS will also distribute the survey to its members in mid-April.

The NCMS would like to inform its members of the following events being held by the Centers for Medicare and Medicaid Services (CMS):

Version 5010 Webinar

CMS will be holding the “Version 5010 – Where Are We Now?” webinar on Tuesday, March 6, 2012, 10:00 am – 11:00 am. This webinar is helpful for those members who are interested in learning more about the transition to Version 5010. The webinar will address the following:

• Current conversion statistics
• Top 10 concerns impacting the 5010 transition
• Status of current Version 5010 Standard System Maintainer fixes
• Top 10 Version 5010 edits
• Medicaid updates

Click here to register. The NCMS also offers additional Version 5010 information and resources on our website.

Stage 2 Requirements for EHR Incentive Programs

CMS will be holding a national provider call on Monday, March 12, 2012, 12:30 pm – 2:00 pm, to discuss the changes and requirements in CMS’ proposed rule for Stage 2 for the Medicare and Medicaid Electronic Health Record (EHR) incentive programs. This provider call will help NCMS members understand what is needed to receive EHR incentive payments.

Registration for the call should be available shortly.

Questions regarding Version 5010 transition and EHR incentive programs can be directed to Franklin Walker (fwalker@ncmedsoc.org), NCMS Foundation Director of Programs and Practice Management, or Terri Gonzalez (tgonzalez@ncmedsoc.org), NCMS Foundation Practice Technical Assistance Coordinator, at 800-722-1350.

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

Q: I am looking to update my practice guidelines and patient forms. Does the Society offer any resources that can help with this process?

A: Yes, the Society publishes a policy and procedure manual every couple of years to provide its members with tools and resources to update their practice regulations and forms. The 2010 Medical Practice Policy and Procedure Manual can be utilized specifically for your practice. It provides guidelines on patient relations, communication, privacy and security, patient safety, financial management, employment policies and several patient forms necessary to run a practice. Using this customized manual will decrease the amount of time spent updating this information and allow more time for patient care. The manual, which is in CD format, is available online at our bookstore and can be purchased by NCMS members at a discounted rate.

Click here to order and view the manual’s table of contents to see what other tools are available. Questions regarding practice management can be directed to Franklin Walker, NCMS Foundation Director of Programs and Practice Management, at 919-833-3836 or fwalker@ncmedsoc.org.

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

The North Carolina Medical Society Foundation, in conjunction with Abbott, will be holding a webinar regarding transformations in healthcare on Tuesday, March 6, 2012, 12:00 pm – 1:00 pm. The webinar will feature Marjie Grazi Harbrecht, MD, Chief Executive Officer of HealthTeamWorks (formerly Colorado Clinical Guidelines Collaborative (CCGC)).

Dr. Harbrecht assists practices transform healthcare delivery through two initiatives: Improving Performance in Practice (IPIP) and the Colorado Multi-Player Patient Centered Medical Home (PCMH) Pilot. This webinar may be of interest to practices looking to improve quality of care and to learn more about PCMH.

Click here to register. Questions can be directed to Terri Gonzalez, NCMS Foundation Practice Technical Assistance Coordinator, at 919-833-3836 or tgonzalez@ncmedsoc.org.