Cracking the Codes: Coding and Billing for Influenza Virus Vaccine at Multiple Sites, is an online influenza coding seminar that will be offered:

Tuesday, Sept. 27         2:00pm ET

Thursday, Sept. 29       1:00pm ET

Monday, Oct. 3           12:00pm ET

Thursday, Oct. 6           3:00pm ET

Pre-register online at http://event.on24.com/clients/premiere/crackingthecodes2011. Participants will receive confirmation and reminder of event via e-mail.

Living Healthy – How to Implement An Evidence-Based Chronic Disease Self-Management Program, is a webinar that will be offered by Care Share Health Alliance on Wednesday, October 12, 2011, 10:00 am – 11:00 am. This program seeks to enable participants to build self-confidence and assume a major role in maintaining their health and managing their chronic conditions. Space is limited, so reserve your Webinar seat today at https://www1.gotomeeting.com/register/789094104.

North Carolina Health Insurance Institute, hosted by the NC Chapter Healthcare Financial Management Association, will be held October 13-14, 2011, at the Sheraton Hotel at Four Seasons in Greensboro. Registration materials are available at http://www.nchfma.org/.

A special track for Primary Care Physicians is being offered at the American Psychiatric Association’s Fall Institute for Psychiatric Services, October 27-30, 2011, in San Francisco. The special track will be on Friday, October 28 and devoted exclusively to psychiatry’s role with primary care, with more than 20 sessions that include workshops, symposia, lectures, discussion groups and courses. For more information, visit the APA website, http://www.psych.org/.

Lean Healthcare 200: Applying the Fundamentals is two full days of hands-on learning, equipping participants with practical tools and strategies to make significant and sustainable cultural changes within their organizations for the new healthcare environment. Next classes are scheduled for November 8-9, 2011, in Winston-Salem. No prior Lean training or experience is required. The course is limited to 30 attendees, so register today at www.NCQualityCenter.org/educationlean2011.lasso.  For questions and more information, please contact Dean Higgins at dhiggins@ncha.org or 919-677-4212. The NC Lean Healthcare Alliance is associated with the NC Quality Center and NC State University.

SMA Annual Excellence in Clinical Leadership, Cardiovascular Disease…Interdisciplinary Challenges will be offered at the Southern Medical Association Annual Meeting, November 3-5, 2011, in Williamsburg, VA. More information is available at http://www.sma.org/am2011.

The Centers for Medicare and Medicaid Services (CMS) have posted an online webinar held August 30, 2011, on clinical quality measures (CQMs) and how to report them during Stage 1 of meaningful use for the Medicare and Medicaid Electronic Health Record (EHR) Incentive programs.

The webinar presentation includes an overview of the CQMs, how to report CQMs during attestation, and why CQMs are included in the EHR Incentive Programs. You can view a PDF of the webinar presentation at: https://www.cms.gov/EHRIncentivePrograms/Downloads/CQM_Webinar_Slides.pdf.

A transcript of an hour-long question and answer session that followed the August 30 webinar will be made available online soon, along with a video of the webinar.

For more information about the EHR Incentive Programs, go to: https://www.cms.gov/ehrincentiveprograms/.

Events/meetings involving NCMS staff working on your behalf this week.

House Select Committee Looks at CON

A newly formed House Select Committee on Certificate of Need (CON) Process and Related Hospital Issues has been named. It will be chaired by Rep. Fred Steen (R-Rowan) and Rep. John Torbett (R-Gaston). You can find a complete list of the committee here. The committee is scheduled to meet on Wednesday, September 14, 2011 at 10:00 am in Room 544 of the Legislative Office Building in Raleigh.

The committee will take a look at the overall CON process. Additionally, the committee will look at two specifiic issues raised in bills during the 2011 long session:  HB 743 raised questions about the academic medical centers exemption, and HB 812 addressed the county line rule used in making need determinations. The NCMS Legislative Staff will provide updates and more information in the Bulletin and at http://www.ncmedsoc.org/. Questions may be directed to Chip Baggett at cbagget@ncmedsoc.org or call 919-833-3836.

Insurance Bills Included in 2011 Legislative Summary

Eight bills that fall under the Insurance category will be among the dozens of bills that will be reviewed in the soon-to-be released NCMS 2011 Legislative Summary. Insurance-related measures that will be in the summary include:

House Bill 496 – Insurance Co-pays for Chiropractic Services  (NCMS opposed)

Senate Bill 608 – Health Care Sharing Organizations (Passed)

House Bill 709 – Protect and Put NC Back to Work (Senate Bill 544) (Passed)

Senate Bill 517 – Freedom to Negotiate Health Care Rates (NCMS supports)

Senate Bill 774 – Update Electronic Prescription Rules (Not debated)

House Bill 138 – Amend Health Insurance Risk Pool Statutes (NCMS supports)

House Bill 298 – Insurance Amendments A-B (Passed)

Senate Bill 323 – State Health Plan/Appropriations and Transfer II (Passed)

Get Ready for 2012: Primary, Legislative Short Session and Election

Issues of importance to physicians and their patients will be part of the 2012 Election Year. The NCMS 2011 Legislative Summary will provide background to help you better understand many of these issues. Since 2012 is a Presidential Election Year, there will be increased voter interest in issues like health care reform, Medicare and Medicaid, jobs, and economic improvements. Your NCMS Legislative Staff will be working to provide timely information to help you understand these issues, and how you can engage with legislators at the state and national level. This information will be made available through the Bulletin, Member Alerts, Legislative Updates , and the NCMS website, http://www.ncmedsoc.org/. By being informed and involved, you can help us continue our efforts to provide access to quality health care for all North Carolinians.

As we have done with past severe weather-related events, the NCMS is prepared to implement its emergency/disaster plan in the event Hurricane Irene disrupts and damages physician practices or other health care delivery facilities in eastern North Carolina. We are partnering with the Old North State Medical Society (ONSMS) in order to enhance our communication wtih physicians across our state. We want to thank ONSMS President Edward Treadwell, MD, and Executive Director Thea Monet for making this possible.

On Thursday, Governor Perdue declared a state of emergency and President Obama approved federal aid to assist state and local responses to the storm. Forecasts at midday Friday indicated that the center of Irene was expected to make landfall in the vicinity of Cape Lookout around 9:00 am Saturday. Advisories showed Irene had weakened to a Category 2 hurricane, with maximum sustained winds of 105 miles per hour. Forecasters did not expect the storm to strengthen before making landfall. High wind warnings were issued for eastern North Carolina for Saturday, effective from 6:00 am to midnight. Heavy rains capable of producing flash floods were expected, beginning Friday afternoon and continuing through Saturday.

State emergency officials reported that storm shelters were opened in North Hampton, Wilson, Halifax, Nash, Wilson and Johnston Counties. Wake County was on stand-by to open an evacuation shelter, should the shelters in the eastern counties exceed 50 percent capacity. Mandatory evacuations were ordered in several coastal communities.

As many NCMS and ONSMS members will recall from Hurricane Floyd, high winds and floods can quickly displace physicians and their practices. Should you experience an extended storm-related disruption, or you become aware of a physician who has had such an experience, please contact Mike Edwards at the NCMS, medwards@ncmedsoc.org or 919-833-3836, ext. 112.

The NCMS emergency/disaster plan includes:

•  Serving as a key contact point to assist physicians affected by the storm
  • Call: 800-722-1350 or 919-833-3836
• Communication of important information to physicians in private practice and component medical societies in storm-affected areas
• Coordinating and communicating requests for volunteers, equipment, donations and other needs
• Serving as a liaison with the Division of Public Health, State Emergency Management and other agencies in communicating advisories, alerts, updates and other storm-related information important to physicians and component medical societies
• Creating online resources including phone numbers and other information to help physicians during the post-storm recovery

NCMS is prepared to utilize a variety of communication tools to reach physicians, including our Doctor to Doctor blog, NCMS Webpage, Twitter, Facebook, email, fax and phone calls. As past experience has demonstrated, power outages can affect locally available communication, so we will try to provide information using several sources and encourage physicians to periodically check the NCMS website, http://www.ncmedsoc.org/, for updates and other information.

Here are some helpful links for storm-related events:

CDC Hurricane Information for Health Care Professionals: www.bt.cdc.gov/disasters/hurricanes/hcp.asp

American Red Cross Information on Disaster and Emergency Preparedness:

Getting Assistance: http://www.redcross.org/portal/site/en/menuitem.d8aaecf214c576bf971e4cfe43181aa0/?vgnextoid=6cde1a53f1c37110VgnVCM1000003481a10aRCRD&vgnextfmt=default

Preparedness Information:  http://www.redcross.org/portal/site/en/menuitem.d8aaecf214c576bf971e4cfe43181aa0/?vgnextoid=46de1a53f1c37110VgnVCM1000003481a10aRCRD&vgnextfmt=default

NC Division of Emergency Management: http://www.nccrimecontrol.org/Index2.cfm?a=000003,000010

NC Department of Public Health (DHHS): http://publichealth.nc.gov/

NC State Government Hurricane Information: http://www.ncgov.com/NCHurricane.aspx

Hurricane and Health Safety (NC DHHS): http://www.ncdhhs.gov/hurricanes/

Please feel free to share this information with your physician colleagues and staff and know that we are here to help you. 

Robert Seligson, EVP, CEO, NCMS, rseligson@ncmedsoc.org.

Physicians can take for granted or underplay the importance of Medical Staff Bylaws in hospital operations. The experiences of two NCMS physician members demonstrates the value of good medical staff bylaws as more physicians are being employed by hospitals.

“Physicians may find it’s not much fun in dealing with medical staff bylaws, but they are your bill of rights to deal with hospital administration,” said Shannon Hunter, MD, an otolaryngologist who practices in Clyde, NC.

Dr. Hunter was chief of staff when physicians at Haywood Regional Medical Center (HRMC) learned the hospital had lost its Medicare certification in early 2008, causing the 190-bed facility to temporarily lose Medicare and Medicaid payments. While physicians had tried to address concerns with hospital administration for several months, they were not informed about the looming crisis that led to decertification. As the news quickly spread throughout the western North Carolina community, physicians scrambled to find alternatives to help their patients while the hospital evaluated its management and operations.

As the hospital worked to regain Medicare certification, Dr. Hunter and her colleagues began working on getting physicians more involved and having a greater voice in hospital affairs. During the recertification process, she recalls that many patches had to be made to an antiquated set of bylaws, “but it was clear that an overhaul of the entire document was necessary when we were out of our reactionary phase to regain certification.”

“We wanted honest guidance and to build trust,” Dr. Hunter said. “We wanted to make sure we had bylaws that were friendly for the medical staff—not just the administration.” She contacted the North Carolina Medical Society for assistance.

 “We looked to NCMS for guidance. NCMS made recommendations that helped us meet guidelines. This included hiring an outside attorney to review what we had developed. The process went very well and helped to build the level trust we wanted,” she said.

Today, HRMC is part of the Charlotte-based Carolinas Healthcare System. In reflecting on her experience, Dr. Hunter stressed the importance of reviewing medical staff bylaws to ensure that physicians have a strong voice in hospital management and operations.

“It’s important for medical staff to meet regularly. Some may not see the need for medical staff bylaws, but they must understand that bylaws protect doctors. With good bylaws in place, physicians can better respond to changes in rules and laws and make adjustments in the ever-changing medical environment,” Dr. Hunter said.

“Today, we have a comfortable relationship between the medical staff and hospital administration,” said Robin Matthews, MD, an obstetrician/gynecologist in Waynesville, NC, who continues to chair the committee that reviewed and revised the Medical Staff Bylaws as the hospital regained certification and underwent administrative changes.

“Dr. Matthews and the Bylaws Committee are to be commended for the completion of our revision,“ Dr. Hunter said. “They were constructed by the medical staff for the medical staff and reflect our commitment to stay involved in our own self-governance.”

Currently, the Bylaws Committee is working on rewriting the Rules and Regulations. Dr. Matthews describes medical staff relations as very healthy, with physicians asking questions, seeking accountability and avoiding complacency.

To keep the medical staff engaged, Dr. Matthews believes physicians need to:

• Meet regularly
• Stay involved
• Be aware of necessary changes and avoid resisting those changes
• Be assertive and engaged.

The NCMS encourages physicians to regularly review their medical staff bylaws and make changes to maintain a strong voice and ensure quality care for their patients. For assistance, please contact Melanie Phelps at mphelps@ncmedsoc.org or 919-833-3836.

Links to Helpful Resources:

Physician-Hospital Resource Area

Model Medical Staff Bylaws (Members Only)

Related stories:

Are Your Medical Staff Bylaws in Compliance? (Bulletin, 1-14-11)

Revised Model NCMS Medical Staff Bylaws Now Available (Bulletin, 1-7-11)

The Departments of Health and Human Services (HHS) and Treasury released three proposed rules on August 12, 2011 for Health Benefit Exchanges as related to the federal health system reform law. Over the next two months, the Administration will ask for public comment on the proposed rules at forums to be held in Atlanta, GA; Chicago, IL; Denver, CO; New York, NY; Portland, OR; and Sacramento, CA.

In announcing the proposed rules, HHS and Treasury awarded $185 million to 13 states, including North Carolina and the District of Columbia, to help build Exchanges. North Carolina will receive $12,396,019, which will be administered by the Department of Insurance.

The NCMS is actively involved in the debate over development of a Health Benefits Exchange in North Carolina. This includes tracking legislation needed to establish an Exchange. We will be providing more information and updates in the Bulletin and at http://www.ncmedsoc.org/.

For more information about the proposed rules, visit:

Overview: www.HealthCare.gov/news/factsheets/exchanges08122011a.html

Coverage for Consumers and Small Businesses: www.HealthCare.gov/news/factsheets/exchanges08122011b.html

Health Insurance Premium Tax Credit: www.treasury.gov/press-center/Documents/36BFactSheet.PDF

Medicaid Eligibility: www.HealthCare.gov/news/factsheets/exchanges08122011c.html

A copy of a letter sent to state officials by the Secretary of Health and Human Services is available here: www.HealthCare.gov/center/letters/exchanges08122011a.html.

Events/meetings involving NCMS staff working on your behalf this week.

Editor’s Note: The AMA requested that the following article by AMA President Peter W. Carmel, MD, be included in our weekly communication to NCMS members.

As the nation’s largest physician organization, the American Medical Association (AMA) is uniquely positioned to help physicians thrive in medical practice throughout all stages of their careers. The AMA is the only organization in the country that represents all physicians across all specialties in every state, and is the physicians’ voice as lawmakers work on issues critical to the future of medicine. In North Carolina, the AMA is proud to support and work alongside the North Carolina Medical Society (NCMS) on a variety of issues important to physicians, including medical liability reform. The AMA is pleased that we were able to contribute to a big win for North Carolina physicians this week as the Governor’s veto of medical liability reform legislation was successfully overridden.

America’s medical liability system is broken, failing both patients and physicians. The current system limits patient access to health care, leads to additional tests and treatments, increases health care costs and creates a communication barrier between patients and physicians. For physicians, the system leads to meritless lawsuits, increases liability premiums and causes physicians to practice defensive medicine.

While the AMA continues to pursue medical liability reform at the federal level, state liability reforms are essential to ensuring that physicians can do what they do best – care for patients. The AMA Advocacy Resource Center (ARC) works closely with state medical associations to support their state legislative efforts, and the AMA Litigation Center collaborates with state medical associations to assist them when the liability battle shifts to the courts. In North Carolina, the AMA contributed $100,000 to NCMS’ successful liability reform marketing efforts in 2011 to help fix the broken medical liability system for both patients and physicians.

The AMA is working with the NCMS on other issues in addition to medical liability reform. North Carolina has faced steep Medicare payment cuts every year since 2002 due to the failed Medicare physician payment formula, and each year the AMA has been able to secure congressional action to prevent these cuts. Most recently, at the urging of the AMA and the Federation, Congress passed legislation to provide stable Medicare payments for all of 2011. This legislation is worth an average of $29,000 to each North Carolina physician.

The AMA also offers North Carolina physicians the opportunity to participate in Webinars and seminars on topics that affect their daily practice of medicine, such as how physicians can succeed with new payment models like medical homes and accountable care organizations. Physicians can also take advantage of resources designed to help them adopt health information technology and qualify for federal incentives, like the free resource ”A Clinician’s Guide to E-Prescribing.” The AMA will continue to provide resources and support to help physicians in North Carolina help their patients.

Today the NC Senate took the first step in overriding the Governor’s veto of medical liability reform legislation, Senate Bill 33. To complete the process, the House will need to vote by 3/5 majority to override the veto. That vote is expected to occur during the last full week of this month. Today’s Senate vote was 35-12. The NCMS is working in a coalition of health and business interests to win the votes necessary in the House to complete the override.

“We are asking every physician in North Carolina to do their part to make medical liability reform a reality in our State,” said John R. Mangum, MD, president of the North Carolina Medical Society. Ask your State Representative to override the Governor’s veto by clicking here.

On Thursday, July 14, at 6 pm, the North Carolina Medical Society (NCMS) will conduct a brief live “Telephone Town Hall” meeting to update NCMS members on the strategy to override Governor Purdue’s veto of Senate Bill 33: Medical Liability Reforms. At promptly 6 pm, all phone numbers in our membership database will receive a call and an introductory message with instructions on joining the call. The “Telephone Town Hall” meeting will be very brief and is designed to update members who cannot attend one of the live Town Hall events taking place across the state.

As you may know from North Carolina Medical Society (NCMS) communications and media reports, Governor Perdue has vetoed Senate Bill 33 – Medical Liability Reforms. However, the Governor does not have the final word on this issue. The General Assembly is returning to Raleigh to consider overrides of Governor Perdue’s vetoes. Our task is to continue to make our case with members of the General Assembly and to encourage them to override the veto of SB 33. That is our goal. Learn more during tomorrow evening’s call.

To contact your legislator to encourage a veto override, click here.

To report a preferred phone number, click here.

NCMS Director of Legislative Relations Chip Baggett is educating western North Carolina physicians about efforts to encourage legislators to override the veto of SB 33-Medical Liability Reforms. Town Hall meetings are taking place Tuesday, July 12 in Asheville and Greenville.

Baggett encouraged physicians to take this critical effort to the finish line. “I’ve heard that physicians are frustrated by the override,” he said. “Now is NOT the time to get tired. Now is the time to carry this legislation to victory for physicians and their patients.”

The NC General Assembly is returning to Raleigh to consider business including potential overrides of Governor Beverly Perdues’ vetoes.  SB 33 – Medical Liability Reforms was vetoed on July 1. The NC Senate is expected to consider an override this week, with the House of Representives following during the last week of July. 

It is vitally important that NC legislators hear from the medical community about the importance of reform. Grassroots Physician Action is needed to engage contacts by physicians, hospitals, and business community leaders.  How?  Go to the NCMS website at www.ncmedsoc.org and click the CAPWIZ link at the top right- hand corner of the webpage to enter your home address and create an automatic email to your legislators.

Questions at the Town Hall Meeting were very specific about local legislators and their positions on SB 33. Physicians in attendance were very knowledgable about their local delegation.  NCMS Regional Director John Reynolds, MD, attended from Shelby and was impressed with the level of engagement. “In my opinion this is the  most important legislative issue in my 25 years of medical practice. I hope my colleagues statewide will respond with immediate, swift contact with the NC General Assembly,” he said.  “We need you,” said Baggett.  “Please take action, and spread the word among your colleagues.”

NCMS leaders and staff are calling on physicians across the state to contact their legislators asking that they vote to override Governor Perdue’s veto of Senate Bill 33 Medical Liability Reforms. Hundreds of physicians heard the message last night at Town Hall meetings in Greensboro and Wilmington—“the Governor does not have the final word on this issue.”

NCMS President John R. Mangum, MD, President-Elect Robert Monteiro, MD, and Speaker Michael Moulton, MD, spoke  to physicians  in Greensboro and Wilmington.

Physicians are urged to attend a Town Hall and learn what you can do to get the NC General Assembly to override the veto of this historically important legislation:

Tuesday, July 12:

Asheville, 6:00 pm, Thomas Bacon Auditorium-MAHEC

Greenville, 6:00 pm, Conference Room E, Staff Support Area, Pitt Memorial Hospital

Monday, July 18:

Charlotte, 5:30pm, City County Government Center, Conference Room 267

Tuesday, July 19:        

Hickory, 6:00pm, Catawba Valley Medical Center Hospital Class Room

Wednesday, July 20:  

Winston-Salem, 6:00pm, Forsyth Medical Center Conference Center

Thursday, July 21:

Fayetteville, 6:00pm, Cape Fear Valley Medical Center Board Room

New Bern, 6:00pm, CarolinaEast Medical Center Auditorium

NCMS will also conduct a Town Hall meeting by conference call on Thursday, July 14 at 6:00 pm. All NCMS members will automatically be called at 6:00 pm and invited to listen in to a brief update on the legislative effort. Members will receive an email with additional information about the call next week.

We need your help to override the Governor’s veto. For more information on what you can do, go to http://www.ncmedsoc.org/ and http://www.northcaroliniansforaffordablehealthcare.com/. 

Please act today as the NC House is expected to vote between July 25-29.