Volume 63 Issue 19 – May 11, 2012
	Featured Stories NCMS and NCAPA Petition Medicaid’s PA Enrollment Requirements On May 8, the North Carolina Medical Society and the North Carolina Academy of Physician Assistants submitted a rulemaking petition to the Department of Health and Human Services regarding mandatory Medicaid enrollment for physician assistants and nurse practitioners. Continue reading » NCMS Legislative Cabinet Recommends 2012 Priorities The NCMS Legislative Cabinet recently met to discuss the current political landscape and issues facing physicians and physician assistants during the legislative session set to begin next week. Continue reading » NCMS PAC — Primary Election Success! We are pleased to announce that, through the generous support of members like you, your NCMS PAC was able to invest in 72 candidates for office this year. Continue reading » In This Issue Governor’s 2012 Budget Adjustments Announced Grab Your White Coats and Head to the General Assembly CMS Proposed Rule Updates and More Three North Carolina Health Organizations Receive Innovation Grants NCMS FAQ of the Week: Disposing of Controlled Substances Durham-Orange County Medical Society Invites Physicians to Retirement Planning Seminar NCMS Welcomes New Member Services Director NCMS Medicare Audit Video Reaches Thousands on Twitter Early Bird Registration for 2012 Sports Medicine Symposium Now Available Play athenahealth’s Daily Win Game to Learn More Practice Management System Options NC Surgical Safety Checklist Webinar May 17 Nominations Open for NCMS John Huske Anderson Award In the News This Week… Learning Opportunities Center

	Meetings & Events 05/11/2012 ICD-10-CM Training & Implementation Issues for the Provider Office – Boone, NC more info » 05/16/2012 ICD-10-CM Training & Implementation Issues for the Provider Office – Rocky Mount, NC more info » 06/01/2012 ICD-10-CM Training & Implementation Issues for the Provider Office – Fayetteville, NC more info » Contact Info Address: PO Box 27167 Raleigh, NC 27611 Phone: 1.919.833.3836 1.800.722.1350 (NC only) Fax: 1.919.833.2023 FAX

© North Carolina Medical Society. All rights reserved.

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

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

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

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.

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

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

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

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

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

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

Medicare Conditions of Participation (CoPs) Revised Proposed Rule

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

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

CMS Releases Proposed Rule regarding Medicaid Payments for Primary Care Services

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

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

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

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

More information about this initiative can be found here.

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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The deadline for submissions is July 1. For a nomination packet, contact Linda Carter at 919-833-3836, 800-722-1350 or by e-mail at lcarter@ncmedsoc.org.

A Letter to the Editor: An act of love, 5-5-12, Times News
A letter to the editor mentions the NC Medical Society’s support in the advance medical directive law.

Doctors who take Medicare scarce, 5-10-12, WTVD-TV
Reporter Steve Daniels writes that it can be difficult for Triangle transplants and people aging up into Medicare eligibility to find doctors.

Highlights of Perdue’s budget proposal for 2012-13, 5-10-12, The Examiner/Associated Press
The Examiner highlights findings published by the Associated Press of adjustments in the $20.9 billion spending play for the 2012-13 fiscal year, which include health care funding.

How providers impede their chances for smooth-running EHR systems, 5-9-12, EHR Intelligence
Writer Jill Halloran blogs about issues and solutions physicians are having with electronic health records.

Raleigh hospitals hold health screenings, 5-9-12, WRAL
Reporter Michelle Marsh writes that health care professionals from local hospitals were on hand at the North Carolina State Fairgrounds Exposition Center in Raleigh to give free medical screenings and health advice as part of Community Health Screening Day.

HanesBrands and Wake Forest Baptist Medical Center Deliver Healthcare Services to Children in Dominican Republic, 5-10-12, Enhanced Online News
HanesBrands announced an ongoing partnership with Wake Forest Baptist Medical Center to provide critical ear, nose and throat surgeries to hundreds of children each year in the Dominican Republic through volunteer medical missions.

Obesity could affect nearly half of American by 2030, 5-8-12, USA Today
USA Today reports that health experts fear there will be dramatic jump in health care costs if nothing is done to bring the obesity crisis under control.

Diabetes treatment guidelines stress individualized care, 5-9-12, amednews
Writer Alicia Gallegos reports that the American Diabetes Association recommends that physicians take a less prescriptive but more patient-centered approach to managing hyperglycemia patients with type 2 diabetes.

Nurse practitioner tackling more ‘doctor’ tasks, 5-11-12, The News and Observer/Sun Sentinel
Reporter Scott Travis writes that many of patient health care needs may soon be handled by a nurse due to higher standards of nursing school accreditation that could go into effect as soon as 2015.

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.

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.

NCDA 2012 Summer Meeting, which is also 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, Virginia. 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.

Volume 63 Issue 18 – May 4, 2012
	Featured Stories NCMS and PAI Release Documentary Warning Practices About Consequences of Medicare Audits 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. Continue reading » They Just Aren’t Getting It: Medicaid Again Announces Enrollment Deadline for PAs & NPs In its May 2012 Bulletin, the Division of Medical Assistance (DMA) has again announced that it will require direct enrollment of all physician assistants and nurse practitioners who treat Medicaid patients. Continue reading » NCMS Recommends Clarification by NC Medical Board on e-Prescribing The NCMS met recently with representatives of the NC Medical Board to discuss elements of the Board’s position statement entitled ‘Writing of Prescriptions’ that appear to discourage or prohibit licensees from e-prescribing controlled substances. Continue reading » In This Issue CIGNA Announces 90-Day Claim Submission Requirement Vote for NCMS Members on Tuesday, May 8 NC House Sets Budget Schedule for 2012 Session More Trouble Ahead for Mental Health Upcoming Deadlines to Comment on CMS ICD-10 Delay, Stage 2 Meaningful Use NPIs Must Be Included in Medicare and Medicaid Claims as of June 2012 NCMS Partners with NC Bar Association for End-of-Life Video Volunteers Needed for Skin Screening at the NC Legislature Update: Photo ID Now Required for Certain Controlled Substances NCMS Member Completes Elective with Society To Learn More about Physician Advocacy New Physicians and PAs Enjoy Reception at NCMS NC Practice Announces Selection as CMS Program Demonstration Site Member Benefit: SunTrust Mortgage, Inc. Offers Specialty Mortgage Financing through its Doctor Loan Program Nominations Sought for NCMS Leadership Positions In the News This Week… Learning Opportunities Center

	Meetings & Events 05/11/2012 ICD-10-CM Training & Implementation Issues for the Provider Office – Boone, NC more info » 05/16/2012 ICD-10-CM Training & Implementation Issues for the Provider Office – Rocky Mount, NC more info » 06/01/2012 ICD-10-CM Training & Implementation Issues for the Provider Office – Fayetteville, NC more info » Contact Info Address: PO Box 27167 Raleigh, NC 27611 Phone: 1.919.833.3836 1.800.722.1350 (NC only) Fax: 1.919.833.2023 FAX

© North Carolina Medical Society. All rights reserved.

“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.