Current Bulletin

  • NCMS Board Addresses Timely Issues

    At its November meeting last weekend, the North Carolina Medical Society (NCMS) Board of Directors took up many timely issues including discussion of how to address the state treasurer’s cost containment proposal for the State Employee Health Plan; legislative priorities for the upcoming long session and progress on our strategic plan.

    State Employee Health Plan

    NCMS Senior VP for Advocacy and Advancement Chip Baggett, JD, offered the Board one cause for celebration on this issue – the state treasurer dropped his original plan to pursue a straight 15 percent cut on provider reimbursement. The treasurer’s new approach to cost cutting is to go to a reference based reimbursement model, pegging the fee schedule to 160 percent of Medicare rates. The Board discussed the various ramifications of this and agreed that tinkering with reimbursement rates ignores the systemic faults with our current reimbursement system. The treasurer’s plan is not a lasting and effective way to bring down health care costs. They strategized on how best to address the plan on behalf of NCMS members going forward.

    Here is the NCMS’ official public statement issued Oct. 24, on Treasurer Dale Folwell’s proposal:

    Physicians and hospitals are united in their opposition to the state treasurer’s proposal to implement radical cost-cutting measures that could negatively impact access to health care for state employees. We are seeking an opportunity to work with leaders of the plan to develop a sustainable approach that will save money and not compromise the health care services available to state employees.

    “Over the past 40 years unilateral rate cuts to physicians and health systems have not worked to achieve long-term savings. Rather, rate cuts often result in reduced access to care for patients, particularly in rural areas, and jeopardize the financial stability of smaller physician practices and health systems,” said Robert W. Seligson, CEO of the NC Medical Society (NCMS). 

    The NCMS and NC Healthcare Association (NCHA) are proposing various strategies to strengthen the State Health Plan. Since 2012, leading physician groups and health systems in North Carolina have been developing and implementing value-driven models of care that save money and improve the health of the populations enrolled in them. These strategies are being implemented by private payers, Medicare, and soon will be adopted by Medicaid.

    We ask the state treasurer to work with physicians and health systems rather than to implement this tried and failed approach to reducing State Health Plan costs. 

    Physicians and health systems support positive change in the State Health Plan to improve health and control spending.  NCMS and NCHA are offering their expertise to the State Health Plan to address these challenges.

    Legislative Priorities

    The Board accepted the Legislative Cabinet’s recommendations that the NCMS should take the lead in the following are areas when the General Assembly convenes for its long legislative session in January. As always, the NCMS tracks hundreds of bills as they are introduced during any session, but our top priorities is any legislative that would:

    • Fight for transparency and open access for patients to choose their doctor (e.g. updated network adequacy rule, balance billing defense, step therapy)
    • Increase access in rural NC with more investment in GME and rural residencies.
    • Defend against erosions to our medical malpractice reforms.
    • Protect patient safety by ensuring practitioners have proper training requirements (e.g. defend against scope of practice challenges; address naturopath licensure).
    • Confirm the process for a smooth transition to managed care for Medicaid beneficiaries and push for inclusion in funding for social determinants of health programs.

    Strategic Plan Update

    NCMS staff reported to the Board on progress in several areas of the strategic plan.

    • Physician wellness – October’s Summit on Physician Wellness was extremely successful, bringing together more than 60 health care leaders to discuss the issues surrounding and strategizing on how to ensure a workplace culture that promotes wellness. Plans also are being developed to acquire baseline data on the prevalence of burnout in our physician community.
    • Community and Patient Engagement – many initiatives are underway to engage community partners outside of the clinical setting to support patients and promote health outcomes. Highlights include NCMS programs like Project OBOT, which involves many stakeholders in addressing treatment for substance use disorder and the Health Initiative, which includes community organizations like the YMCA in getting patients the support they need to be healthy. The NCMS also is partnering with the NC Institute of Medicine in their Accountable Communities Task Force and has been a strong supporter of incorporating provisions to address social determinants of health into the state’s Medicaid managed care contracts.

    The Board also agreed to have the Membership Committee research and make a recommendation on having a student and or physician assistant seat on the Board of Directors as was suggested at the Open Forum held at the NCMS’ Annual Business meeting in October.

     
  • Updated Training Schedule for Primary Care Practices Seeking AMH Designation In New Medicaid Program

    The NC Department of Health and Human Services (NCDHHS) has updated its listing of training sessions for those primary care practices that want to become an Advanced Medical Home (AMH) when the state moves to managed care for its Medicaid program. Access the updated listing.

    Already more than 680 people attended regional trainings at six locations across the state from August to October.

     
  • NCMS Board Hears Ideas On Improving Community Benefit Reporting

    Dr. Merrit Seshul

    Merritt Seshul, MD, FACS, FAAOA, of Hickory, a long-time member of the North Carolina Medical Society (NCMS) and NC Society of Otolaryngology and Head & Neck Surgery, spoke to the NCMS Board of Directors last weekend about Community Benefit Reporting (CBR) requirements, which currently apply to non-profit hospitals. These requirements form part of the basis for the hospitals’ tax-exempt status. Dr. Seshul had several proposals on how to improve the process to benefit patients, increase access to care and create opportunities to include and reward physician contributions to the community.

    Dr. Seshul, a 2009 NCMS Foundation Leadership College alumnus, has been researching the CBR system since completing his Leadership College research project, titled, “How Physicians Are Helping Indigent Patients.”

    He told Board members, the current requirements for hospitals to report on providing care for indigent patients as well as other benefits to the community are somewhat ambiguous in North Carolina. Nonprofit hospitals are not required to conduct community health needs assessments or submit community benefit plans or implementation strategies. The current system represents a lost opportunity for physician practices that play a role in solving North Carolina’s health care access issues.

    He suggests bringing North Carolina’s CBR requirements into line with federal standards and finding ways for physicians and physician practices to also report community benefit. He urged lobbying for some tax benefits for physicians who meet community benefit criteria. Other ideas he presented include taking steps to ensure CBR reports include a) details regarding social determinants of health and affirmative steps taken to meet the needs of underserved populations and b) a community benefit effectiveness measure – the ratio of benefit created/tax benefit received.

     
  • CMS Releases Final Rule for the 2019 Quality Payment Program

    The Centers for Medicare and Medicaid Services (CMS) recently issued its policies for Year 3 (2019) of the Quality Payment Program via the Medicare Physician Fee Schedule (PFS) Final Rule.

    A few highlights:

    • Expanding the definition of a Merit-based Incentive Payment System (MIPS)-eligible clinician to include physical therapists, occupational therapists, speech-language pathologists, audiologists, clinical psychologists and registered dietitians or nutrition professionals.
    • Modifying the MIPS Promoting Interoperability (formerly Advancing Care Information) performance category to support greater electronic health record (EHR) interoperability and patient access.
    • Moving clinicians to a smaller set of objectives and measures with scoring based on performance for the Promoting Interoperability performance category.
    • Allowing small practices to submit quality data for covered professional services through the Medicare Part B claims submission type for the Quality performance category.
    • Streamlining the definition of a MIPS comparable measure in both the Advanced Alternative Payment Models (APMs) criteria and Other Payer Advanced APM criteria to reduce confusion and burden amongst payers and eligible clinicians submitting payment arrangement information to CMS.
    • Updating the MIPS APM measure sets that apply for purposes of the APM scoring standard.
    • Extending the 8 percent revenue-based nominal amount standard for Advanced APMs and Other Payer Advanced APMs through performance year 2024.

    Learn more about the PFS Final Rule and the Year 3 Quality Payment Program policies, by reviewing the Press release, the Executive Summary and this Fact Sheet.

    CMS also encourages you to register for the Quality Payment Program Year 3 Final Rule Webinar on November 15 at noon.

     
  • PAI Offers News and Analysis Around Quality Payment Program

    The Physicians Advocacy Institute (PAI) offers tools and resources for practices that are grappling with the Centers for Medicare and Medicaid Services (CMS) Quality Payment Program. Access these through the North Carolina Medical Society (NCMS) website’s MACRA page. PAI, led by NCMS CEO Robert W. Seligson, also offers a periodic round-up of news and analysis available here.
     
  • BEWARE of Extortion Scam Targeting DEA Registrants

    The U.S. Drug Enforcement Agency (DEA) is aware that some registrants are receiving telephone calls and emails from criminals identifying themselves as DEA employees or other law enforcement personnel. The criminals have masked their telephone number on caller id by showing the DEA Registration Support 800 number. Please be aware that a DEA employee would not contact a registrant and demand money or threaten to suspend a registrant’s DEA registration.

    If you are contacted by a person purporting to work for DEA and seeking money or threatening to suspend your DEA registration, submit the information through “Extortion Scam Online Reporting” posted on the DEA Diversion Control Division’s website, www.DEADiversion.usdoj.gov.

    For more information locate the DEA Field Office for your area at this website or by calling the Registration Service Center at 1-800-882-9539 or via email at DEA.Registration.Help@usdoj.gov

     
  • Holding Asks CMS for Reconsideration on Step Therapy

    US Representative George Holding recently sent a letter to the Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma asking for reconsideration of the recent notification that Medicare Advantage plans will no longer be prohibited from using step therapy for Part B drugs.

    “Given the potential impact on patient access and care, I believe CMS should pause on moving forward with this policy in 2019,” Holding wrote.

    Read the letter.

     
  • Prescribers Must Check CSRS for Workers’ Comp Cases

    As of Nov. 1, 2018, health care providers are required to review the Controlled Substances Reporting System (CSRS) when prescribing a targeted controlled substance to an injured worker with a workers’ compensation claim. Health care providers must document in the injured worker’s medical record the review and any potential contraindications to prescribing a targeted controlled substance found in the CSRS.

    For more information on the North Carolina Industrial Commission Rules for the Utilization of Opioids, Related Prescriptions, and Pain Management in Workers’ Compensation Claims and the Companion Guide, please click here. For more information on the CSRS and how to register, click here.

     

     
  • Participate in Opioid Prescribing Study

    The Health Innovation Lab at the University of Texas at Austin’s Dell Medical School is recruiting clinicians with prescribing privileges to participate in a brief and confidential online survey to increase our understanding of clinical decision-making processes regarding opioid prescriptions.

    The IRB-approved survey will take less than 30 minutes. Participation is voluntary and no compensation will be provided. PLEASE CLICK HERE or go to http://j.mp/2CzVGmU to see if you are eligible to participate. Please contact projectoppp@austin.utexas.edu with any questions.

     
  • Partnership to Train Med Students On Opioid Prescribing

    Thanks to a new federal grant from the Substance Abuse Mental Health Services Administration, the Governor’s Institute and four North Carolina medical schools are teaming up to improve the way doctors understand and treat opioid addiction. The University of North Carolina School of Medicine, Campbell University School of Osteopathic Medicine, Eastern Carolina University Brody School of Medicine and Wake Forest University School of Medicine have all committed to integrating opioid use disorder (OUD) into their standard curricula. Medical students will also be given the opportunity to shadow physicians providing these services in clinical settings.

    Goals of this three-year project include:

    –Training hundreds of future North Carolina doctors on opioid use disorder;
    –Increasing the number of physicians eligible to prescribe buprenorphine;
    –Providing resources to train and support a workforce equipped to prevent and treat opioid addiction.