Current Bulletin

  • Take Part in the 2017 NCMS Photo Contest!

    nc-chiang-karl-pier-into-the-night-Frisco Pier

    Last year’s contest winning photo “Pier Into the Night” by Karl S. Chiang, MD

    Calling all North Carolina Medical Society (NCMS) members: it’s Photo Contest time again!

    Deadline for submission is June 30, 2017. Learn more about the rules and the prizes.  (Please note: contest open to NCMS current members only; no public submissions.)

     
  • Updated Medicaid Reimbursement for Vaccines and Contraceptives May Come This Summer

    Primary care physicians and obstetricians-gynecologists received some promising news recently. The NC Department of Health and Human Services (NCDHHS) has begun the process to increase reimbursement for physician-administered vaccines and contraceptives in Medicaid’s Physician Drug Program. We applaud NCDHHS for taking action on this long-standing issue and congratulate the specialties affected by this proposed change. The North Carolina Medical Society (NCMS) will continue to advocate for fee updates in the Physician Drug Program,  including for drugs ordered regularly by oncologists and rheumatologists.

    In a posted State Plan Amendment last week, NCDHHS is proposing to revise the reimbursement rate for physician-administered vaccines to wholesale acquisition cost (WAC) plus 3 percent, and the rate for physician-administered contraceptives to WAC plus 6 percent. The posting on May 10 triggers the 10-day notice and comment period required before submitting the amendment request to the Centers for Medicare and Medicaid Services (CMS). If the process goes smoothly and CMS approves the change, the new payment formula will take effect July 1, 2017.

    As some drug and device costs have increased, physicians providing those services to Medicaid patients have been requesting an update to the fee formula in order to cover their costs for purchase of the vaccines and contraceptives.

     

     
  • NCMS Statement on BCBSNC’s Announcement

    Today Blue Cross and Blue Shield of North Carolina (Blue Cross NC) and Amerigroup (part of insurance giant Anthem) announced an agreement to jointly pursue participation in the forthcoming Medicaid managed care program. Here is a statement from the North Carolina Medical Society (NCMS) on this announcement:

    In January the North Carolina Medical Society (NCMS) working in conjunction with the North Carolina Community Health Center Association (NCCHCA), announced we had signed a definitive agreement with Centene Corporation (NYSE: CNC) to collaborate on a patient-focused approach to Medicaid under the reform plan enacted in the State of North Carolina. The NCMS hopes that all entities seeking to care for North Carolina’s Medicaid beneficiaries under the state’s reform initiative will put patients first, will be value-driven and will look to physicians as the key decision makers in how best to care for patients. We believe the State of North Carolina should focus on managed care organizations driven by those primary principles as it evaluates the future of our Medicaid program.

     

     
  • NC Legislative Update: Staying Vigilant as Budget Process Moves Ahead

    The NC Senate unveiled their spending plan for the biennium last week, and the North Carolina Medical Society (NCMS) was encouraged by the fact that there were no Medicaid rate cuts proposed. There are still several provisions of concern. Read a brief summary of the key health care provisions in the 362-page bill on our 2017 Legislative Session blog.

    Concerns include a provision that would completely remove your ability to negotiate with any health insurance company about the fees for your professional services. Some of SB629 regarding out-of-network notification and fees made its way into the Senate budget. SB629, Health Care Services Billing Transparency, would place a statutory cap on reimbursement at Medicare rates for any out-of-network services. This would tilt the balance in favor of the insurance companies.

    We’re also have concerns with language around re-certification fees for Medicaid providers and barring state funding to any physician who performs an abortion.

    The NC House now is developing its budget, and we’re watching the process carefully. We also are preparing for a possible hearing and vote on HB88 – Modernize Nurse Practice Act, which seeks to eliminate physician supervision for advanced practice nurses, next Wednesday, May 24, before the NC House Health Committee. Stay tuned for more information and action you can take to voice your opinion if this bill does come up in committee.

     
  • NC DHHS Hearings on Medicaid Reform Plan Wrap Up In Raleigh

    NCMS President Dr. Cunningham at the NCDHHS public input session in Raleigh on May 16.

    NCMS President Dr. Cunningham at the NCDHHS public input session in Raleigh on May 16.

    The fourth and final North Carolina Department of Health and Human Services’ (NC DHHS) ‘listening session’ seeking input on reforming the state’s Medicaid program was held Tuesday evening, May 16, at the McKimmon Center in Raleigh. As at the other three hearings held throughout the state beginning May 1 in Greensboro, approximately 150 people attended the two-hour session. NC DHHS will use the information they gather at these public hearings as it considers whether modifications are needed to the Section 1115 waiver application that was submitted a year ago to the Centers for Medicare and Medicaid Services (CMS) outlining how the state plans to move its Medicaid program to managed care.

    NC DHHS Secretary Mandy Cohen, MD opened the meeting asking for input on seven areas including how to care for the whole person to improve physical and mental health and how to address the social determinants of health. NC DHHS will accept written comments through May 25. Get the details on submitting written remarks. Sec. Cohen encouraged commenters to be as specific as possible in their remarks.

    Forty-two concerned citizens made brief, 2-minute remarks at the Raleigh hearing including North Carolina Medical Society (NCMS) President Paul R.G. Cunningham, MD. Watch a video of Dr. Cunningham’s comments below.

    Physicians representing the NC Academy of Family Physicians and the NC Pediatric Society also spoke as well as physicians from a variety of other specialties. Other speakers included concerned parents of disabled children or those with mental health issues; representatives of the NC Justice Center, the League of Women Voters, the American Heart Association, the LGBTQ community, local health departments and people living with HIV.

    The overwhelming message from just about everyone who commented was to expand Medicaid to provide health care coverage to those who currently must delay or forego care for financial reasons leading to more serious health care problems that tax the system. Other common threads included better integration of physical and mental health and reducing the red tape and bureaucracy that health care providers must endure to serve Medicaid patients.

     
  • What To Know About the ‘WannaCry’ Ransomware as a Health Care Professional

    As you probably heard, the United States Computer Emergency Readiness Team (US-CERT) received multiple reports of ‘WannaCry’ (also known as ‘WannaCrypt’) ransomware infections in several countries around the world and in the United States.  Some of these infections are impacting patient access to care.  Ransomware is a type of malicious software that infects a computer and restricts users’ access to it until a ransom is paid to unlock it.  Individuals and organizations are discouraged from paying the ransom, as this does not guarantee access will be restored.

    The AMA is offering resources to help physicians conduct a checkup of their systems, and to secure their networks and office computers.

    Ransomware can infect computers and medical devices. The WannaCry infection affects systems running Windows and spreads easily when it encounters unpatched or outdated software. Physicians should ensure that their computer’s operating systems and anti-virus software are updated and patched:

    • Run Windows Update immediately.  Download and install any available updates (‘patches’).  Run a scan on your anti-virus software and follow its prompts.  Microsoft has released a customized patch for older platforms that do not receive mainstream updates, including Windows XP, Windows 8, and Windows Server 2003. At this time, Windows 10 has not been targeted by the attack.
    • Check your computer’s settings to ensure that the system will automatically download and install new versions of the operating system and Microsoft Office software.  Do the same for your anti-virus software.
    • Note when the computer will install these new updates and make sure the computer is on at that time.

    In addition, physicians should contact their medical device vendors and manufacturers to ensure that they have patched their device software.  Medical device manufacturers can always update a medical device for cybersecurity; the FDA does not typically need to review changes made to medical devices solely to strengthen cybersecurity.

    Ransomware can be delivered via email by attachments or links within the email.  Attachments in emails can include documents, zip files and executable applications.  Malicious links in emails can link directly to a malicious website the attacker uses to place malware on a system.  To help protect yourself, be aware of the following:

    • Only open emails from people you know and that you are expecting.  The attacker can impersonate the sender, or the computer belonging to someone you know may be infected without his or her knowledge.
    • Do not open email attachments from an unknown, suspicious or untrustworthy source.  If you’re not familiar with the sender, do not open, download or execute any files or email attachments.
    • Do not open an email attachment unless you know what it is, even if it appears to come from a friend or someone you know.  Some viruses replicate themselves and spread via email.  Stay on the safe side and confirm that the attachment was sent from a trusted source before you open it.
    • Do not open any email attachments if the subject line is questionable.  If you think that the attachment may be important to you, always save the file to your hard drive before you open it.
    • Vigilance is the best defense against phishing scams.  “Phishing” describes email scams that attempt to acquire confidential information such as credit card numbers, personal identity data, and passwords.  Often these emails look like they come from real companies or trusted individuals.  If you want to find out whether the email is legitimate, contact the company via their published customer service contacts.  Do not reply to the email or click on any links.
    • Exercise caution when downloading files from the internet.  Make sure that the website is legitimate and reputable.  If you have any doubts, don’t download the file.
    • Do not open messages or click on links from unknown users in your instant messaging program.  Instant messaging can be a vehicle for transmitting viruses and other malicious code, and it’s another means of initiating phishing scams.

    If your organization is the victim of a ransomware attack, contact law enforcement immediately.

    1. Contact your FBI Field Office Cyber Task Force immediately to report a ransomware event and request assistance. These professionals work with state and local law enforcement and other federal and international partners to pursue cyber criminals globally and to assist victims of cyber-crime.
    2. Report cyber incidents to the US-CERT and FBI’s Internet Crime Complaint Center.
    3. For further analysis and health care-specific indicator sharing, please also share these indicators with HHS’ Healthcare Cybersecurity and Communications Integration Center (HCCIC) at HCCIC_RM@hhs.gov.

    Other resources include:

     
  • Federal Health Care News Round-Up

    capitol-buildingNorth Carolina Medical Society (NCMS) CEO Robert W. Seligson has been monitoring the health care legislative and regulatory scene at the federal level. Here are a few recent highlights.

    • The NCMS issued a statement when the US House of Representatives passed a revised version of the American Health Care Act (AHCA) on May 4. Read the NCMS statement as well as what other prominent health care figures had to say.
    • On Monday, the AMA sent a letter to the US Senate Majority and Minority leaders re-affirming its principles and objectives for health system reform. Read the letter.
    • The NCMS has joined with dozens of other state and specialty societies to sign onto a letter to Seema Verma, Administrator for the Centers for Medicare and Medicaid Services (CMS) expressing concern over CMS’ planned enactment of the Social Security Number Removal Initiative (SSNRI). The letter outlines how this initiative has the potential to significantly disrupt patient care and physician payment. Read the letter.
    • President Donald Trump appointed North Carolina Gov. Roy Cooper to the Commission on Combating Drug Addiction and the Opioid Crisis. Also appointed to the commission are: Gov. Chris Christie of New Jersey as chair; Gov. Charlie Baker of Massachusetts; Former U.S. Representative Patrick J. Kennedy of Rhode Island and Bertha K. Madras of Massachusetts. Among the charges of the commission is to study the scope and effectiveness of the Federal response to drug addiction and the opioid crisis and to identify and report on best practices for addiction prevention, including health care provider education and evaluation of prescription practices, and the use and effectiveness of State prescription drug monitoring programs.

     

     
  • Understanding Carolina Complete Health Network

    CCHN-logo_RGB headerCarolina Complete Health Network (CCHN) was formed by the North Carolina Medical Society (NCMS) for the purpose of establishing, building and maintaining a physician-led network of providers to serve Medicaid beneficiaries in North Carolina.

    On January 10, 2017, NCMS, working in conjunction with the North Carolina Community Health Center Association (NCCHCA), announced CCHN had signed a definitive agreement with Centene Corporation (NYSE: CNC) to collaborate on a patient-focused approach to Medicaid under the reform plan enacted in the State of North Carolina. Under the agreement, a joint venture, Carolina Complete Health, will be created to establish, organize and operate a physician-led health plan to provide Medicaid managed care services in North Carolina.  CCHN will furnish provider network services to Carolina Complete Health, to serve Medicaid beneficiaries with value-based models-of-care.

    As NCMS CEO Robert W. Seligson stated at the time of the announcement: “With the changes taking place in our health care system at the state level with Medicaid reform and new programs at the national level, the NCMS remains committed to ensuring that physicians are the ones making the clinical decisions in the best interest of their patients. Our leadership views this partnership as a unique opportunity to help lead the reform process and to put patients’ needs first.”

    To arrange an informational meeting with CCHN’s leadership team, please contact CCHN at networkrelations@cch-network.com.  Also, for current CCHN news, please visit CCHN’s website.

    Also in this issue of the NCMS Bulletin read about public hearings on the state’s Medicaid reform plans held this month by the North Carolina Department of Health and Human Services.

    NCMS and CCHN are “testing the waters” under Regulation A under the Securities Act of 1933, as amended, to gauge market demand from potential investors for an offering of CCHN’s securities. No money or other consideration is being solicited, and if sent in response, will not be accepted. No offer to buy the securities can be accepted and no part of the purchase price can be received until an offering statement is filed with, and qualified by, the Securities and Exchange Commission. Any such offer may be withdrawn or revoked, without obligation or commitment of any kind, at any time before notice of its acceptance given after the qualification date. A person’s indication of interest involves no obligation or commitment of any kind.

    This communication contains forward-looking statements. In some cases, you can identify these statements by forward-looking words such as “believe,” “may,” “will,” “estimate,” “continue,” “anticipate,” “intend,” “could,” “would,” “project,” “plan,” “expect” or the negative or plural of these words or similar expressions. These forward-looking statements include, but are not limited to, statements concerning the joint venture, the proposed health plan and our projections. You should not rely upon forward-looking statements as predictions of future events. These forward-looking statements are subject to a number of risks, uncertainties and assumptions, including, among other things, satisfaction of the conditions to closing of the joint venture transaction. In light of these risks, uncertainties and assumptions, the forward-looking events and circumstances discussed in this communication may not occur and actual results could differ materially and adversely from those anticipated or implied in the forward-looking statements. Except as required by law, neither NCMS, CCHN nor any other person assumes responsibility for the accuracy and completeness of the forward-looking statements. NCMS and CCHN undertake no obligation to update publicly any forward-looking statements for any reason after the date of this communication to conform these statements to actual results or to changes in our expectations.

     
  • NCMS Foundation Helps Rural Practices Transition to Value-based Payment

    Shann and Kelly Davis and family.

    Shann and Kelly Davis and family.

    The North Carolina Medical Society (NCMS) Foundation has joined with the Mountain Area Health Education Center (MAHEC) to help rural primary care practices in western North Carolina make the transition to value-based reimbursement.

    Thanks to a grant from the Kate B. Reynolds Charitable Trust, the NCMS Foundation is able to fund this year-long pilot project, which offers select small practices free consulting through the Health Innovation Partners (HIP) team at MAHEC to help these practices thrive in the emerging value-based reimbursement models.

    “This is the perfect thing for us,” says Shann Davis, PA-C, whose Country Clinic in Etowah is one of the first two practices selected to participate in the pilot program. “We need all the help we can get to stay afloat in the current health care environment.”

    Davis’ wife, Kelly, the practice administrator adds: “We’re not a big hospital; we can’t pay for consulting services [to help us make the transition to value-based reimbursement]. We feel blessed we were picked for this.”

    The MAHEC HIP team already has provided operational, quality and analytics support for over 100 practices in western North Carolina, including the Country Clinic, and the HIP consultants are well equipped to help practices navigate through the Medicare Access and CHIP Reauthorization Act (MACRA) and its Merit-Based Incentive Payment System (MIPS) as part of this pilot project.

    The MAHEC team will assess each practice in areas including EHR optimization and access to and focused use of data; patient engagement; care coordination and population health; and financial sustainability including how to maximize current fee-for-service opportunities and the new payment models under MACRA. After assessing the practice, the team will come up with a strategic plan and help a practice team implement the strategic goals.

    “Terri Roberts, who has been my representative consultant from MAHEC since 2010, contacted me about the project through NCMS,” said Sandra McCormack, MD, a solo practitioner in Tryon, and the second practice to sign on with the pilot project. [Terri] “has been my champion and is confident that I will be successful with the transformation to MIPS/MACRA.  The assistance with the NCMS project will be invaluable in achieving my goal.”

    Both the Country Clinic and Dr. McCormack’s practice serve a mix of primarily Medicare with some Medicaid and self-pay patients. Kelly Davis said they have a fair number of patients who will pay the penalty for not having health insurance and pay cash for any service provided.

    “Small independent practices take care of patients very well. Patients are not a number here,” Kelly Davis says. “They’re willing to pay cash because Shann really cares and they know that.”

    Dr. McCormack agrees that a small independent practice can be good for patients as well as the medical professionals who work there.

    “I opened my office Sept. 1, 1982 as a sole practitioner and have remained in this role since that time,” she says. “In the first four years I delivered babies and have watched them grow and even have their own children.  The rewards and benefits of rural living and becoming a ‘Tryon local’ have enriched my life.”

    The advent of electronic medical records and the drive to new models of reimbursement through MACRA, pushed both of these practices early on to consult with MAHEC to keep up with the changes.

    “My goal is to remain an independent practice as long as I can financially survive,” Dr. McCormack says. “That’s the hardest part about being solo, the challenges and pure economics of the current medical environment — operating a business, maintaining and documenting quality, ‘jumping through all the hoops’ and seeing one’s income decrease during the process.”

    NCMS Foundation Vice President for Rural Health Initiatives Franklin Walker says the Foundation is committed to helping practices like Dr. McCormack’s throughout the state.

    “We are very pleased to have these practices as part of our initial phase of this project,” Walker says. “We will begin recruiting practices for the piedmont and eastern areas of the state within the next month.”

    Both Dr. McCormack and the Davis family hope the pilot project will help them successfully navigate these changes and serve as a model for other small practices.

    As Shann Davis says: “In the long run it’s going to be better for patients and if we can benefit other small practices we’re happy to do it.”

    If you would like more information about this project, please contact Franklin Walker at fwalker@ncmedsoc.org or call 919-833-3836.

     
  • NC HealthConnex Offers “How to Connect” Webinar

    NC HealthConnexThe NC Health Information Exchange Authority (NCHIEA) or NC HealthConnex is hosting a “How to Connect” call next Monday, May 22 at noon. The hour-long webinar will explain what Health Connex is, the legislative mandate for practices to connect, an explanation of what is required of you during the connection process and an opportunity to ask questions. Learn more and register.