At their regular bi-monthly meeting held Saturday, March 18 in Greenville, the North Carolina Medical Society (NCMS) Board of Directors discussed pending legislation before the General Assembly including the STOP (Strengthen Opioid Misuse Prevention) Act, HB243/S175, aimed at curbing the state’s opioid poisoning epidemic.
Rep. Greg Murphy, MD, (R-Pitt) a sponsor of the STOP Act, co-chair of the House Health Committee and the only physician in the General Assembly met with NCMS Board members over dinner on Friday night before the Board meeting. Watch Dr. Murphy discuss why it is important for physicians to support this legislation.
The Board expressed concern about provisions in the bill including the mandate that physicians or their delegate check the state’s Controlled Substance Reporting System (CSRS) before prescribing a controlled substance; the drugs covered by the mandate; the daily limit for first prescriptions related to acute, post-operative pain and the requirement to use e-prescribing.
NCMS Senior Vice President for Advocacy, Chip Baggett, explained that the STOP Act is the result of broad, bipartisan work by legislators and the State Attorney General’s Office. The multi-faceted effort to curb the opioid abuse epidemic includes holding physicians accountable as prescribers. It is highly likely to be passed by the legislature this session. The NCMS is supporting the STOP ACT and working with legislators to make changes to achieve the bill’s intent while ensuring that its implementation is realistic in practice and not overly burdensome to physicians.
“We are working to make sure that when these new mandates become operational they do not have a huge negative impact on your practice,” he said. “But they will affect your practice.”
Based on feedback from members on how these new policies might play out, the NCMS is working to:
- Clarify what specific drugs and drug schedule(s) would be covered by the mandate. Currently, it appears controlled substances like Adderall and Ritalin are included in the bill language. The NCMS is asking that drugs not currently identified as contributing to the opioid poisoning crisis be excluded from the mandate to query the CSRS before prescribing and certain other bill provisions.
- Refine the language around e-prescribing since small practices may not currently have the necessary e-prescribing technology nor the financial resources to acquire it.
- Ensure the CSRS is functioning properly and is interoperable with other states’ prescription drug monitoring systems before the mandate would take effect.
- Time the mandate to coincide with the connection of the CSRS with the NC Health Information Exchange (HIE). This will enable prescribers to access the most current information in their electronic medical record and the CSRS simultaneously.
The bill has been discussed in the House Health Committee, and will likely be brought up again as the changes are negotiated over the next few weeks.
The NCMS Board will meet next in May in Chapel Hill. If you have a policy matter you’d like them to address, you may submit a Board contact form.
Fifty physicians turned out for the opioid prescribing CME in Greenville last Saturday, March 18, offered for free by the North Carolina Medical Society (NCMS) and the Pitt County Medical Society. It seems word is getting out that as of July 1, the North Carolina Medical Board’s new opioid prescribing CME requirement will take effect.
Under the new requirement, a physician or physician assistant prescriber whose CME cycle renews on or after July 1, 2017, will be expected to have met the new requirement. Physicians who prescribe controlled substances (including non-opioids) must complete three hours of eligible CME during each cycle and PAs must complete two hours. These hours are part of the licensee’s total CME requirement for the cycle, not in addition to it.
To help our members fulfill this new requirement, the NCMS has been offering free opioid prescribing CME in conjunction with its Board of Directors’ meetings held throughout the state. The Medical Board also is directing physicians and PAs to resources like the U.S. Centers for Disease Control and Prevention’s seven free prerecorded modules on safe opioid prescribing. CME credit can be obtained after viewing or listening to any CDC module by completing an online evaluation and post-test. Courses are certified for credit through December 2017. Access the CDC opioid modules. Additional CME courses and information about the new controlled substances requirement can be found at www.ncmedboard.org/prescribingCME
The NC Medical Board also has partnered with Wake AHEC to create free CME that will cover the required topics through a webinar and four live panel sessions. The webinar is available now and covers the CDC guidelines and utilization of the Controlled Substances Reporting System (CSRS). It is free to watch and will provide an hour of Category 1 CME and meets the requirements of the controlled substances CME. Link to the webinar.
Registration for the four panel sessions is open now as well. These panels are live, 2-hour events being held in central North Carolina (see dates and locations below) and are free to NC licensed medical professionals. Attendees at the live event are highly encouraged to watch the webinar in advance of the panel session. Combined, the webinar and panel sessions will fulfill the controlled substances CME requirement going into effect July 1.
Register for the panel convenient for you:
It has been a busy few weeks on scope of practice issues. In brief, here is the latest:
The North Carolina Society of Eye Physicians and Surgeons (NCSEPS) held a press conference yesterday, Tuesday, March 21, to release the results of a survey they conducted to assess how voters feel about HB36, which would authorize optometrists to perform eye surgery with lasers and scalpels. The statewide poll revealed that nine out of 10 North Carolina voters oppose HB36. Read the press release and survey results.
One interesting bit of data revealed that when told that the North Carolina Medical Society (NCMS) opposes HB 36, public opposition to the legislation rose to 89 percent overall, and 91 percent among Republicans illustrating once again the influence of the NCMS not only among legislators at the General Assembly, but also with the voting public.
Last week, on Wednesday, March 15, the Chair of the NCMS Legislative Cabinet, William G. Ferrell, MD, a neurologist with Raleigh Neurology Associates, family physician, Conrad Flick, MD, and Director of the NC Society of Anesthesiologists R. Paul Rieker, Jr., MD, testified before the House Health Committee in opposition to HB88. Watch the hearing to see these physicians testify as well as hear the nurses’ representatives. The entire hearing runs about an hour, but we’ve broken it into two installments.
The bill seeks to eliminate physician supervision for nurse practitioners, certified nurse midwives, clinical nurse specialists and certified registered nurse anesthetists. This effort is nothing new, but putting these various practitioners into one bill has not been done previously.
The NCMS opposes this bill because it undermines the team approach to care delivery. Under current statute, advanced practice RNs are allowed to practice to the top of their individual training and abilities. By eliminating physician supervision and reducing their scope of practice to specifically what is outlined in a statute, NC nurses will be left with a shared definition that is the lowest common denominator skillset. Learn more about this bill.
NC Ob-Gyn Society Changes Its Stance on Supervision
The North Carolina Obstetrics and Gynecology Society (NCOGS) recently announced a change in its policy on physician supervision of certified nurse midwives. The new stance calls for a licensure process that acknowledges certified nurse midwives as independent health care professionals and requires a physician collaboration agreement. Currently, the state requires certified nurse midwives to be supervised by a physician.
This new arrangement brings the organization closer to the American College of Obstetricians and Gynecologists policy, which supports complete independent licensure. The new NCOGS policy more closely aligns with the current collaboration between North Carolina physicians and their nurse midwife colleagues.
“The Ob/Gyn Society’s decision to change its position on this issue came after more than a year of review by a diverse committee of Ob/Gyns from across North Carolina,” wrote NCOGS President Cecilia F. Grasinger, MD. “The committee reviewed current law, other states’ rules, as well as the policies of the American College of Obstetricians and Gynecologists. After the committee recommended a change in our policy, the NC Ob/Gyn Society’s Executive Committee unanimously accepted the committee’s recommendation.”
The policy change will not have an immediate impact on licensure, but will influence policy discussions at the General Assembly.
The NCMS remains opposed to HB88, which includes allowing certified nurse midwives and other advanced practice nurses to practice without physician supervision as described above.
A group of physicians from western North Carolina made the trek to Raleigh today, Wednesday, March 22, to participate in the North Carolina Medical Society’s (NCMS) White Coat Wednesday at the General Assembly. Their visits to educate legislators about the issues affecting the practice of medicine in the state are invaluable.
Thank you to these dedicated and involved physicians! If you’d like to take part in a White Coat Wednesday, contact NCMS Assistant Director of Advocacy Sue Ann Forrest.
As of press time, the fate of the US House GOP’s American Health Care Act (AHCA) that seeks to repeal and replace the Affordable Care Act (ACA) is still uncertain. Early in the week, GOP leadership made changes in the original bill to appeal to the more conservative wing of his party. Changes included providing more generous tax credits for older Americans, adding a work requirement for the Medicaid beneficiaries and federal block grants to states for Medicaid.
President Trump also sought to win over conservative Republicans to vote in favor of the bill. Without these votes, the bill may not pass the House. The House is expected to vote on Thursday.
The North Carolina Department of Health and Human Services and the General Assembly Fiscal Research Division analyzed the GOP’s bill to try to determine its impact on the state. Review the analyses.
The AMA has come out in opposition to the AHCA and today sent this letter to Speaker of the House Rep. Paul Ryan and Democratic leader Nancy Pelosi.
The AHCA wasn’t the only health care bill under consideration. Here is a list of other health care bills filed last week in Congress.
The North Carolina Medical Society is in close contact with the key players on Capitol Hill monitoring the various proposals and their impact here in North Carolina. Watch the NCMS legislative blog for updates.
The North Carolina Medical Society (NCMS) along with other state medical and specialty societies and the AMA this week sent a letter to Seema Verma, the administrator for the Centers for Medicare and Medicaid Services (CMS) urging her to work to reduce regulatory burdens and penalties for physicians participating in Medicare value-based programs like meaningful use (MU), the physician quality reporting system (PQRS) and the value-based modifier program, which pre-date MACRA and its Quality Payment Program.
The letter requests an “Administrative Burden” category of hardship exemption those providers participating in the 2016 performance year for MU and PQRS. Read the letter and the proposal to reduce the regulatory burdens and penalties.
Online voting for who will be named the 2017 NC Doctor of the Year on March 30, National Doctors’ Day, opened on Monday. On the NC Doctors’ Day website you can read profiles about each of the 10 finalists and then cast your vote for your favorite. The winner will receive a $5,000 award to be used to further a professional or community project of importance to them.
The finalists were selected by a committee of their peers, who reviewed the many physician nominations statewide submitted by colleagues, patients, family and friends. This year’s finalists are:
- Lydia Wright, MD, Maternal Fetal Medicine, Wilmington
- Alan Forshey, MD, Family Medicine, Newton
- Jennifer Orr, MD, Gynecology, Morehead City
- Karin Minter, MD, Pediatrics, Burlington
- Katie Lowry, MD, Pediatrics, Lumberton
- Nicole Swiner, MD, Family Medicine, Durham
- Christopher Duggins, MD, Anesthesiology, Charlotte
- Velm Taormina, MD, Public Health, Gastonia
- Christine Petzing, MD, Internist/Hospitalist, Nags Head
- Graham Cosper, MD, Pediatric surgery, Charlotte
You may vote once from each device. Vote today!
Hundreds of doctors are deserve to be honored for what they do for their patients every day. Show a colleague just how much you appreciate them with by sending an NC Doctors’ Day tribute card. For donations of $10 and $15, the NCMS Foundation will send an e-card or traditional mailed greeting card to a physician you think is “AHHSOME”! The cards can be ordered online through our simple, secure process here.
Proceeds from the tribute cards benefit the NCMS Foundation and its work to improve access to quality health care for North Carolina’s most vulnerable patients.
With the purchase of a tribute card you will not only make a physician’s day a little brighter, but you will also play a key role in making sure all North Carolinians have a doctor in their own hometown! Purchase a card today!
Over 150 practice administrators and physicians attended the Multi-Payer Expo yesterday, Tuesday, March 21, at the McKimmon Center in Raleigh. The Expo has been taking place periodically throughout the state for the last three years. The event allows practice representatives to meet with various insurance payers in one place at one time to gather information and get answers to questions. The North Carolina Medical Society (NCMS) Project Manager, Solution Center Belinda Battle-McKoy and Director of Membership Joe Cupolo also were on hand to meet face-to-face with many of the practice managers and physicians who call the Solution Center looking for answers to their payer and other practice quandaries.
In addition to the booths for Blue Cross Blue Shield of North Carolina, United Healthcare, Medcost and LabCorp, there were two educational sessions for attendees: the ‘Top Issues in Health Care’ with Cameron Cox, III, and ‘Knowing the Quality of Your Code Assignment,’ with Lee Ford.
Future Multi-Payer Expos are scheduled in:
- Winston-Salem on May 23, 8 am to 1 pm
- Asheville on July 18, 8 am to 1 pm
- Wilmington on Sept. 19, 8 am to 1 pm
Details on exact locations are still being finalized. Watch the NCMS Bulletin for updates.
The North Carolina Medical Society Foundation offers acclaimed leadership development programs through its Kanof Institute for Physician Leadership (KIPL). Offerings include three distinct leadership development tracks – Leadership College, Health Care Leadership and Management and Clinical Quality University. Applications are now being accepted for the next class of Leadership College and Health Care Leadership and Management scholars. Explore each of these tracks and apply. If you have questions please contact Erin Grover, KIPL project manager.
KIPL also will design a customized program like the award-winning curriculum developed specifically for UNC Physicians Network. If your organization is interested in exploring a customized program to meet your specific leadership development needs, please contact Kristina Natt Och Dag.