ABORTION

Teenage Pregnancy - Physician/Patient Privilege

Abortion

ADVERTISING

Radio and Television Advertising of Alcoholic Beverages

Response to Advertisements Negatively Portraying the Practice of Medicine

Opposition to Deceptive Advertising

AIDS

Support for the State HIV Medications Program and for Expanded HIV Prevention, Education, and Outreach Efforts, Including Needle Exchange Programs

Support Funding for HIV Medications Program and for Comprehensive HIV Education and Prevention Programs

Needle Exchange Programs

Needle Exchange to Reduce HIV

Funding for HIV Medication Programs

HIV Testing of Pregnant Women

North Carolina Medical Society AIDS Policies

ALCOHOLISM

Impaired Drivers

ALL-TERRAIN VEHICLES (ATVS)

All-Terrain Vehicles

Physician Promotion of Safety in Operating All-Terrain Vehicles

• Physicians who care for children should counsel parents regarding the inherent hazard of motor vehicle use by children. The use of motorized cycles by children less than 16 years of age should be discouraged. Outdoor recreation that is developmentally more appropriate for a child's size and skills should be encouraged.
• Physicians who care for children should provide safety guidelines for parents who (despite our discouragement) allow their children to ride these vehicles: (1) Vehicles should be sturdy and stable; quality construction is essential; (2) Riders should receive instruction from a mature experienced cyclist; (3) Riding should be supervised and allowed only after the rider has demonstrated competence in handling the machine on familiar terrain; (4) Riders should wear approved helmets and protective clothing (trousers, boots, gloves, etc.); (5) Roadway and nighttime riding should not be allowed.
• Physicians who care for children should promote the development and adoption of state and federal safety regulations to govern the manufacture and sale of these vehicles.
• Riders should be required to hold licenses based on demonstrated competence.

ALLIED HEALTH PERSONNEL

Public Posting of Health Professionals' Education

Co-Management

Criminal Record Check

Regulation of Medical Acts by Nurses

AMA (AMERICAN MEDICAL ASSOCIATION)

Endorsement of AMA Statement of Collaborative Intent

• achieve a unified voice for organized medicine;
  
• work for the common good of all patients and physicians;
  
• promote trust and cooperation among members of the Federation;
  
• advance the image of the medical profession; and
  
• increase overall efficiency of organized medicine for the benefit of our member physicians.

1. Organizations in the Federation will collaborate in the development of joint programs and services that benefit patients and member physicians.
2. Organizations in the Federation will be supportive of membership at all levels of the Federation.
3. Organizations in the Federation will seek ways to enhance communications among physicians, between physicians and medical associations, and among organizations in the Federation.
4. Each organization in the Federation of Medicine will actively participate in the policy development process of the AMA House of Delegates.
5. Organizations in the Federation have a right to express their policy positions.
6. Organizations in the Federation will support, whenever possible, the policies, advocacy positions, and strategies established by the Federation of Medicine.
7. Organizations in the Federation will support an environment of mutual trust and respect.
8. Organizations in the Federation will inform other organizations in the Federation in a timely manner whenever their major policies, positions, strategies, or public statements may be in conflict.
9. Organizations in the Federation will support the development and use of a mechanism to resolve disputes among member organizations.
10. Organizations in the Federation will actively work toward identification of ways in which participation in the Federation could benefit them.

ANTITRUST

Antitrust Protection for Physicians

BIOMEDICAL RESEARCH AND EDUCATION

Animals in Biomedical Research

Medical Research Involving Animals

BOXING

Boxing

CANCER

Comprehensive Cancer Programs in North Carolina Hospitals

Breast Reconstruction Availability

North Carolina Comprehensive Cancer Program

CERTIFICATE OF NEED

Certificate of Need

1. the availability of health care services to all patients;
2. timely access to needed health care services and treatments;
3. the harm caused to patients when health care treatments are unduly delayed; and,
4. the additional expense incurred by patients when access to services is restricted.

Certificate of Need Program

CHILD HEALTH

Expanded School Health Curriculum

Custody and Visitation Programs

Ban on Mobile Infant Walkers

Amendment to North Carolina Law to Require Health Assessments for Children Upon Entry to Preschool Pre-Kindergarten Health Assessment

Report of NC Child Fatality Task Force

Anti-Bullying In Schools

Obesity in Children and Adolescents

Task Force on Healthy Weight in Children

Medical Evaluation of Preschool Children Prior to Placement for Special Education Services

Accidental Poisoning in Day Care Settings

Adequate School Breaks and Lunch Times

Prevention of Firearm Injuries in Children

Immigrant Children's Health Improvement

Referral of Children for Dental Care

Support Funding for Statewide Infant Mortality Reviews

Child Health Incentive Reform Plan

Reimbursement for Health Services Rendered to Children in School Health Centers

Underage Drinking

Mandatory Pre-School Assessment

Child Abuse

Home Visitation/Head Start

Statewide Coordinator for SADD

Elimination of the Sale of Tobacco Products through Vending Machines

Learning Disabled and Speech-Language Impaired Children

Volunteer Vision and Hearing Screeners in Schools

CHILDREN'S SPECIAL HEALTH SERVICES PROGRAMS

Childrens Special Health Services Program

1. Provider Participation
1. Encourage physicians to be both Medicaid and CSHS providers of care for children with special health care needs.
2. Encourage physicians to be primary care providers for children with special needs, and participate in EPSDT so that children identified with complex medical problems can be referred to appropriate evaluation and treatment services.
3. Encourage CSHS to strengthen its relationship with primary care physicians.
4. Seek competitive rates of reimbursement for providers.
5. Seek to streamline the reimbursement process.
2. Standards of Care and Quality Assurance
1. Support the establishment of an agreement between the Division of Medical Assistance and CSHS to make CSHS a Medicaid provider of medical services. The agreement would allow CSHS to channel Medicaid children with chronic health care problems to qualified CSHS providers in order to assure competent services. However, families of Medicaid-eligible children would still have the right to choose other providers.
2. Utilize CSHS quality-of-care guidelines to ensure that those children whose care is covered by Medicaid will receive at least the same level of care as currently available through CSHS.
3. Fiscal Stability of Services for Children with Special Needs
1. Seek funding to enable CSHS to continue to provide inpatient and outpatient medical services up to the federal poverty level as a net income until the twenty-first birthday for children with special needs who do not qualify for Medicaid.
2. Seek new funds to enhance the CSHS service delivery system, including expanded clinic services, medical case management, and service coordination.
3. Seek expansion of Medicaid eligibility to 100% of the poverty level for all children with special needs up to age 21.
4. Seek to maintain or expand current state appropriations until CSHS program requirements are satisfied.
5. Seek legislative authority for CSHS to carry forward funds to honor prior year obligations for a period of at least six months after the end of a fiscal year.
4. Expanded Role for CSHS in the Implementation of the Education of the Handicapped Act (PL 94-142 and PL 99-457)

Services for Victims of Child Maltreatment

Coding and Reimbursement for Children with Special Health Care Needs

Children with Special Health Care Needs

CIVIL JUSTICE

Physician and Patient Advocacy Protection Fund

COGNITIVE SERVICES

Cognitive Services Reimbursement

COMMUNICABLE DISEASES

Tuberculosis

CONFLICT OF INTEREST

Licensing Board Conflicts of Interest

CONTRACEPTIVES

Contraception Services for Minors

Funding for Contraceptive Technologies for All Women and Men

CONVERSION OF NON-PROFIT ENTITIES

Conversion of Hospital or Medical Service Corporation

COPYRIGHT LAWS

Relief from Certain Restrictions Imposed by the Prevailing Copyright Laws

CORPORAL PUNISHMENT

Corporal Punishment in Public Schools

COST CONTAINMENT

Cost Containment

Cost Containment Activities

CREDENTIALING

Privacy in Credentialing Applications

CRIMINAL LAW

Child Abuse

Criminalization of Medical Acts

DEA -- DRUG ENFORCEMENT ADMINISTRATION

Disclosure of Drug Enforcement Administration Information

DEATH and DYING

Long-Term Feeding Tubes

No Code or Do Not Resuscitate Orders

1. General guidelines applicable to all no code or DNR orders
1. Orders shall be issued only by the patient's physician.
2. The orders shall be in writing and placed in the physician's order section of the medical record.
3. The physician shall state in a progress note of the chart the basis for the execution of the DNR order, including the patient's medical status and prognosis and that such an action is in keeping with the patient's rights, wishes and best interest.
4. Relevant conversations with family members or patient representatives should be noted in the medical record by physicians and other allied health personnel along with the presence or absence of an advance directive. Any advance directive should be contained in the patient record.
5. Details of the acceptability of telephone or verbal DNR orders shall be established in individual health care institutions or agencies through a joint effort of the medical staff and the administration.
6. Orders to limit, withhold or discontinue life-sustaining treatment, including a DNR order, shall be routinely renewed in writing in a timely manner under policies established by the medical staff and the administration of the institution or agency.
7. Such orders shall also be reviewed whenever there is: (a) a change in the patient's condition, including mental status; (b) a change in the patient's, family's or surrogate's wishes; (c) a change in the patient's physician; (d) a transfer to another care setting.
8. New orders to limit, withhold or discontinue extraordinary means or artificial nutrition or hydration, including the execution of a DNR order, shall be written, if appropriate, in accordance with these procedures after such reassessment.
2. Specific procedures for writing no code or DNR orders
3. 1. The common law procedure
      Orders to limit, withhold or discontinue extraordinary means or artificial nutrition or hydration (or DNR orders) when the primary physician chooses not to apply the provisions of the Right to a Natural Death Act and there is no Health Care Power of Attorney.
      
      While it may be appropriate to use the procedures contained in the Natural Death Act outlined in 2 (which follows) in order to have the civil and criminal immunity protections it offers, there are circumstances in which the physician may elect not to do so. In those circumstances the physician should follow the general guidelines above. The order should be written, reviewed and renewed or changed as described in the general guidelines.
   
   
   
   2. The procedure applying the provisions of the Right to a Natural Death Act
      Orders to limit, withhold or discontinue extraordinary means or artificial nutrition or hydration (or DNR orders) when the primary physician chooses to apply the provisions of the Right to a Natural Death Act.
   3. 
      
      1. Where There Is a Living Will
         A patient may declare, through a living will executed in accordance with G.S. 90-321(d), a desire that his life not be prolonged by life-sustaining treatment. If such a living will has not been revoked, then life-sustaining treatment may be limited, withheld or discontinued upon the direction and under the supervision of the physician, in which case the physician should:
   
   
   4. 1. Place a copy of the patient's declaration (living will) in the medical record.
      2. Document in the physician's orders section of the medical record all DNR orders or orders to limit, withhold or discontinue life-sustaining treatment.
      3. State in a progress note of the chart the basis for the execution of the DNR order.
      4. Document in the medical record that one or more vital functions may be restored or sustained only by extraordinary means or artificial nutrition or hydration.
      5. Document that the patient's present condition is terminal and incurable or that the patient is in a persistent vegetative state.
      6. Have a consulting physician record a statement in the medical record concurring with the physician's assessment of the patient's present condition.
   5. 1. Where There Is No Living Will
         Where there is no living will, the following are the requirements for issuing a DNR order:
   
   
   6. 1. The order shall be written as described in the general guidelines.
      2. Proper documentation of a DNR order is accomplished by recording the following in the patient's medical record:
      3. • A statement by the patient's physician that the patient has not made a living will.
         • A statement by the physician that the patient is comatose with no reasonable possibility of returning to a cognitive sapient state or is mentally incapacitated; and that the patient's present condition is terminal and incurable or the patient is diagnosed as being in a persistent vegetative state; and that one or more vital functions can be restored or sustained only by life-sustaining treatment.
         • A statement by a consulting physician who concurs with the physician's assessment of the patient's present condition.
         • A statement by the physician that the limiting, withholding or discontinuance of life-sustaining treatment was upon the direction and under the supervision of the physician with the concurrence of the patient's health care agent, guardian, spouse, or majority of relatives of the first degree, in that order, if any are available.
         • If the patient's agent, guardian, spouse, or majority of relatives of the first degree are not available, a statement by the physician that such was the case and that the limiting, withholding or discontinuance of life-sustaining treatment was at the physician's discretion, upon his direction and under his supervision.
   3. The procedure to follow if the patient has a Health Care Power of Attorney
      In addition to the general guidelines, the following procedures should be observed:


4. 1. The medical record should contain a copy of the signed, written determination by the person designated in the document to make this determination that the patient lacks sufficient understanding or capacity to make or communicate decisions relating to the patient's health care.
   2. Signed instructions of the health care agent to withhold or withdraw life-sustaining procedures should be in the medical record.

Layman's Guide to Death With Dignity

Durable Power of Attorney for Medical Decision Making in North Carolina

Living Wills

North Carolina Right to Natural Death Statutes

Policy Statement on Death and Dying and Care of the Terminally Ill

Universal Do Not Resuscitate Order Form

End of Life Issues

DIABETES

Diabetes Self-Care Education

DIAGNOSIS-RELATED GROUPS (DRG)

Medicare Payment Methodology

Hospital Diagnostic Related Group (DRG) Rates

Diagnostic Related Group (DRG) Certification Statement

DOCTOR -- MD/DO

American Osteopathic Association (AOA) Approved Education Programs,Postgraduate Training Programs, and Board Certification

DO/MD Designation and Advertising

Use of the Designation "MD or DO," Where Appropriate, Instead of the More General Term of "Dr."

Opposition to Inappropriate Use of the Term Provider

Definition of "Physician"

DOMESTIC VIOLENCE

Domestic Violence Reporting

1. Suspicion of abuse or neglect of a juvenile.
2. Every case of bullet wound, gunshot wound, powder burn, or any other injury arising from or caused by, or appearing to arise from or be caused by, the discharge of a gun or firearm.
3. Every case of illness caused by poisoning if it appears to the physician that a criminal act was involved.
4. Every case of a wound, injury caused or apparently caused by a knife or sharp or pointed instrument if it appears to the physician that a criminal act was involved.
5. Every case of a wound or injury or illness in which there is grave bodily harm or grave illness if it appears to the physician that it resulted from a criminal act of violence.

Domestic Violence

DRUG ABUSE AND TREATMENT

Drug Abuse During Pregnancy

Abuse of Anabolic Steroids

Physician Drug Prescribing Patterns

Drug Abuse and Drug Dependency

Drug Treatment Courts

EDUCATION LOANS

Personal Income Tax Deduction of Interest on Education Loans

ELDERLY CARE

Medical Care of the Elderly

Training of Personal Aides

ELECTROMYOGRAPHIC CONSULTATIONS

Electromyographic Consultations

EMERGENCY MEDICAL SERVICES

Statewide Trauma System

Support Efforts of North Carolina Office Of Emergency Management in Developing Disaster Response

Limitation of Professional Liability for Physicians Who Serve as Medical Directors for Emergency Medical Service (EMS) Agencies Without Compensation Immunity for EMS Medical Directors

Enhanced 911 Service in North Carolina

Hospital Funding for the North Carolina Trauma Registry

Emergency Medical Services

Funding for North Carolina Office of Emergency Medical Services

Direction of Prehospital Care at the Scene of Medical Emergencies

1. been properly identified
2. agreed to assume responsibility and
3. agreed to document the intervention in a manner acceptable to the local emergency medical services system (EMSS).

ENVIRONMENTAL HEALTH

Air Quality in North Carolina

Support Funding to Expand Recreational Water Quality Monitoring Efforts by the North Carolina Division of Environmental Health

Vibrio Vulnificus (Non-Cholera)

Environmental Health

Nutrient Runoff and Water Quality

State Department of Health

ETHICS

Sexual Exploitation by Psychotherapists

Endorsement of American Medical Association Self-Referral Policy

Sexual Misconduct in the Practice of Medicine

Physician-Assisted Suicide

Sale of Health-Related Products from Physicians' Offices

1. Physicians who do sell health-related products from their offices should not sell any health-related good whose claims of benefit lack scientific validity. Physicians should rely on peer-reviewed literature and other unbiased scientific sources that review evidence in a sound, systematic fashion when judging the efficacy of the product.
2. Physicians who sell health-related products from their offices should follow these guidelines to limit their conflicts of interest, minimize the risk of brand endorsement, and ensure a focus on benefits to patients.
1. Physicians may distribute health-related products to their patients free of charge or at cost, in order to make useful products readily available to their patients. When health-related products are offered free or at cost, it removes the elements of personal gain and financial conflicts of interest that may interfere, or appear to interfere, with the physician's independent medical judgement.
2. Except under certain circumstances, such as those described in AMA Opinion 8.032, 'Conflict of Interest: Physician Ownership of Medical Facilities,' physicians should not sell a health-related good when patients can obtain a product that offers the same medical benefit at a local pharmacy or health-products store.
3. Physicians must disclose fully the nature of their financial arrangement with a manufacturer or supplier to sell health-related products. Disclosure includes informing patients of financial interest as well as about the availability of the product or other equivalent products elsewhere. Disclosure can be accomplished through face-to-face communication or by posting an easily understood written notification in a prominent location that is accessible by all patients in the office. In addition, physicians should, upon request, provide patients with understandable literature that relies on scientific standards in addressing the validity of the health-related good.
3. Physicians should not participate in exclusive distributorships of health-related products, in which the products are available only through physicians' offices and for which product there is no comparable alternative available at a local pharmacy or health products store. Physicians should encourage manufacturers to make their products more widely accessible to patients.

Professional Services for Immediate Family Members

Position on Gifts to Physicians from Industry

1. Any gifts accepted by physicians individually should primarily entail a benefit to patients and should not be of substantial value. Accordingly, textbooks, modest meals, and other gifts are appropriate if they serve a genuine educational function. Cash payments should not be accepted. The use of drug samples for personal or family use is permissible as long as these practices do not interfere with patient access to drug samples. It would not be acceptable for non-retired physicians to request free pharmaceuticals for personal use or use by family members.
2. Individual gifts of minimal value are permissible as long as the gifts are related to the physician's work (e.g., pens and notepads).
3. The Council on Ethical and Judicial Affairs defines a legitimate "conference" or "meeting" as any activity, held at an appropriate location, where (a) the gathering is primarily dedicated, in both time and effort, to promoting objective scientific and educational activities and discourse (one or more educational presentation(s) should be the highlight of the gathering), and (b) the main incentive for bringing attendees together is to further their knowledge on the topic(s) being presented. An appropriate disclosure of financial support or conflict of interest should be made.
4. Subsidies to underwrite the costs of continuing medical education conferences or professional meetings can contribute to the improvement of patient care and therefore are permissible. Since the giving of a subsidy directly to a physician by a company's representative may create a relationship that could influence the use of the company's products, any subsidy should be accepted by the conference's sponsor who in turn can use the money to reduce the conference’s registration fee. Payments to defray the costs of a conference should not be accepted directly from the company by the physicians attending the conference.
5. Subsidies from industry should not be accepted directly or indirectly to pay for the costs of travel, lodging, or other personal expenses of physicians attending conferences or meetings, nor should subsidies be accepted to compensate for the physicians' time. Subsidies for hospitality should not be accepted outside of modest meals or social events held as a part of a conference or meeting. It is appropriate for faculty at conferences or meetings to accept reasonable honoraria and to accept reimbursement for reasonable travel, lodging, and meal expenses. It is also appropriate for consultants who provide genuine services to receive reasonable compensation and to accept reimbursement for reasonable travel, lodging, and meal expenses. Token consulting or advisory arrangements cannot be used to justify the compensation of physicians for their time or their travel, lodging, and other out-of-pocket expenses.
6. Scholarship or other special funds to permit medical students, residents, and fellows to attend carefully selected educational conferences may be permissible as long as the selection of students, residents, or fellows who will receive the funds is made by the academic or training institution. Carefully selected educational conferences are generally defined as the major educational, scientific or policy-making meetings of national, regional or specialty medical associations.
7. No gifts should be accepted if there are strings attached. For example, physicians should not accept gifts if they are given in relation to the physician’s prescribing practices. In addition, when companies underwrite medical conferences or lectures other than their own, responsibility for and control over the selection of content, faculty, educational methods, and materials should belong to the organizers of the conferences or lectures.

EXECUTION-LETHAL INJECTION

Executions

1. An individual's opinion on capital punishment is the personal moral decision of the individual. A physician, as a member of a profession dedicated to preserving life when there is hope of doing so, should not be a participant in a state execution. "Physician participation in execution" is defined generally as actions which would fall into one or more of the following categories: (a) an action which would directly cause the death of the condemned; (b) an action which would assist, supervise, or contribute to the ability of another individual to directly cause the death of the condemned; (c) an action which could automatically cause an execution to be carried out on a condemned prisoner.
2. Physician participation in an execution includes but is not limited to the following actions: prescribing or administering tranquilizers and other psychotropic agents and medications which are part of the execution procedure; monitoring vital signs on site or remotely (including monitoring electrocardiograms); attending or observing an execution as a physician; and rendering of technical advice regarding execution.
3. In the case where the method of execution is lethal injection, the following actions by the physician would also constitute physician participation in execution: selecting injection sites; starting intravenous lines as a port for a lethal injection device; prescribing, preparing, administering, or supervising injection drugs or their dose or types; inspecting, testing or maintaining lethal injection devices; consulting with or supervising lethal injection personnel.
4. The following actions do not constitute physician participation in execution: (a) testifying as to competence to stand trial, testifying as to relevant medical evidence during trail, or testifying as to medical aspects of aggravating or mitigating circumstances during the penalty phase of a capital case; (b) certifying death provided that the condemned has been declared dead by another person; (c) witnessing an execution in a totally non-professional capacity; (d) witnessing an execution at the specific voluntary request of the condemned person, providing that the physician observes the execution in a non-physician capacity and takes no action which would constitute physician participation in an execution; and (e) relieving the acute suffering of a condemned person while awaiting execution, including providing tranquilizers at the specific voluntary request of the condemned person to help relieve pain or anxiety in anticipation of the execution.

FAMILY MEDICAL LEAVE ACT (FMLA)

Family Medical Leave Act (FMLA)

FLUORIDATION OF PUBLIC WATER SUPPLIES

Fluoridation of Public Water Supplies

FREE-STANDING MEDICAL CARE CENTERS

Free-Standing Medical Care Centers

HEALTH AND WELLNESS TRUST FUNDS

Health and Wellness Trust Funds

HEALTH CARE ACCESS

Access to Health Care for all North Carolinians

• Universal Access
• Affordable Health Care Financing
• Defined Uniform Basic Comprehensive Benefits
• Community Rated Premiums and Fair Distribution of Costs
• Portability and Continuity
• Maximum Patient Freedom of Choice with Appropriate Care Decisions
• Integrity of the Doctor-Patient Relationship
• Support of a Professionally Ethical Environment
• Responsible Balancing of Medical Needs and Overall Healthcare Expenditures
• Intrinsic Incentives to Balance Costs and Benefits
• Individual Liability and Responsibility
• Available Accurate, Useful Information
• Intrinsic Self-Correcting Mechanisms
• Simplicity and Administrative Efficiency
• Unified Functional Health System
• Support of Preventive Primary Care Services and Coordination of Care with emphasis on patient education and responsibility for health wellness and lifestyle modification.
• Quality Improvement and Technological Advance: Any reform plan should incorporate methods for insuring quality of service and for evaluating treatment outcomes. Criteria and evaluation of treatment and outcomes should be developed and reviewed by practicing physicians.
• Public and Private Responsibilities and Balance: The public and private sectors should share equitably in the burden of caring for the uninsured and should work together to fashion innovative, successful approaches to financing this care.

• The expansion of successful voluntary care models, such as Project Access, through technical assistance and consultation as well as by support for public and private funding for administrative infrastructure and pharmaceuticals.
• The expansion of North Carolina's Child Health Insurance Program to cover more uninsured children as well as the parents of the poorest children.
• The expansion of North Carolina's Medicaid Program to cover low-income uninsured people who do not now qualify for assistance.
• A clear statement by North Carolina's General Assembly, in a Joint Resolution, of the principle and goal of access to health care for all North Carolinians.
• The establishment within state government of an office devoted to (1) gathering, interpreting and reporting statistics on access to health care in North Carolina; and (2) providing a focal point for the study and promulgation of proposals for advancing the state toward the goal of access to health care for all North Carolinians; and be it further

RESOLVED, That the North Carolina Medical Society supports joint efforts with other interested organizations to publicize: (a) the adverse outcomes associated with failure to provide access to health care for all North Carolinians; (b) the steps that it and its allies are taking to remedy the situation; and (c) the advantages that would accrue to the state and its people from improving access to health care.

North Carolina Community Care Coordination Project

Voluntary Care (An Interim Local Strategy to Improve Access Pending State or Federal Solutions)

Rural Health Center Staffing

Facilitating Medical Services for North Carolina's Migrant and Immigrant Populations

HEALTH EDUCATION

Adolescent Pregnancy Prevention

Support for Comprehensive School Health Education Programs in North Carolina

Encourage High Quality Physical Education in North Carolina Public Schools

Oral Health

Teenage Health Education

Sexually Transmitted Disease Treatment

Health Education in Public Schools

School Health Education

Alcohol Education

HEALTH INSURANCE

Small Employer Purchasing Groups

Disability Insurance Policies

Medical Insurance Coverage for Surgery and Medical Treatment of Any Disease of Teeth and Gums

Third-Party Reimbursement of Phase III Clinical Trials

Health Insurance

Discriminatory Reimbursement Practices

Payment of Asthma Educators for Services Rendered

Private Sector Involvement in Health Insurance Coverage

Continuation of Health Insurance Coverage for Students

Consumer Protection in ERISA Plans

Health Insurance Coverage for Certain Clinical Trials

Adequate Coverage by State Employees Health Program for Adolescent Chemical Dependency Treatment

Restricted Access to Health Plans

Payment for Medical Services to Juveniles Suspected of Being Abused, Neglected, or Maltreated

Inclusion of Coverage for Well Baby and Routine Child Care in Corporate Health Care Plans

Assignment of Benefits

Health Insurance High Risk Pool

Reimbursement for Specific Services or Benefits

1. The service or procedure is required in a life-threatening emergency, or
2. The service or procedure is required to prevent chronic disease, or
3. The service or procedure is cost-effective, i.e., will prevent or reduce future health care expenditures, or
4. The service or procedure would be considered by prudent laypersons to be a standard provision in a health insurance benefit package, or
5. The service or procedure is based on generally accepted standards of medical practice, based on credible scientific evidence published in peer-reviewed medical literature and generally recognized by the relevant medical community.

Health Plan Profits

HOME HEALTH PROGRAMS

Home Health Infusion Therapy Reimbursement

Home Health Programs and Services

Home Nursing and Support Services

HOSPITAL MEDICAL STAFFS

Admitting Officer and Hospitalist Programs

1. managed care plan enrollees and prospective enrollees should receive prior notification regarding the implementation and use of "admitting officer" or "hospitalist" programs, and
2. participating in "admitting officer" or "hospitalist programs" developed and implemented by managed care or other health care organizations should be at the voluntary discretion of the patient and the patient's physician, and
   
3. hospitalist systems when initiated by a hospital or managed care organization should be developed consistent with AMA policy on medical staff bylaws and implemented with approval of the organized medical staff to assure that the principles and structure of the autonomous and self-governing medical staff are retained, and
4. hospitals and other health care organizations should not compel physicians by contractual obligation to assign their patients to "hospitalists" and no punitive measure should be imposed on physicians or patients who decline participation in "hospitalist programs," and be it further

Full Medical Staff Membership

Economic Credentialing and Exclusive Contracting

External Peer Review

Economic Credentialing

Exclusive Contracts

IMMUNIZATION

State-Purchased Vaccines

Childhood Immunization

Insurance Coverage for Immunizations

Expansion of Vaccine Distribution Program to Include Rotavirus

Improving Child Health

Immunization of Senior Citizens

Expansion of Vaccine Distribution Program

Immunization Registry

Student Immunization Requirements

Routine Immunization of Children

IMPAIRED DRIVERS

Driving While Impaired with Minor Passengers

Driving While Impaired Under Age 21

Encouraging Further Research Into How to Distinguish the Impaired Driver

Immunity for Physicians Who Assist in Law Enforcement Investigations

Immunity for Reporting to N.C. Division of Motor Vehicles

Medical Evaluation Program

Impaired Driving Law

IMPAIRED PHYSICIANS

Physicians Health Program

INDIGENT CARE

Assistance for Indigent Care from Pharmaceutical Manufacturers

Medical Care for the Homeless

Position on Indigent Care

1. Establish indigent care pools funded by general revenues (generated from disproportionate share funds) to be distributed to physicians and providers in proportion to the amount of uncompensated care rendered. Incentives should be included in the reimbursement formula to assure reimbursement at the appropriate level of care, i.e., community health care centers, personal physicians, specialty care, hospitals, etc.
2. Establish adequate third-party payment to all physicians and providers.
3. Work to decrease the excessive administrative burden associated with Medicaid to encourage physician participation in the program.
4. Support the work of the Health Insurance Trust Commission to encourage small employers to offer adequate insurance to their employees.
5. Encourage all employers to offer adequate insurance to all part-time and full-time employees.
6. Establish risk insurance pools to enable people with preexisting medical conditions to buy health care coverage.
7. Encourage legislative study commissions to study the feasibility of providing tax-supported subsidies to small and low wage employers to assist them in purchasing adequate health insurance coverage which they could otherwise not afford for their employees.
8. Support the North Carolina network of rural health centers, community health centers, public health clinics and other public institutions supporting the indigent to improve the coordination of care at the local level and the scope and quantity of care.
9. Support legislation that will increase accessibility to obstetrical care for all citizens of North Carolina.
10. Encourage or foster volunteer community programs, such as the Open Door Clinic in Wake County.
11. Continue to emphasize health promotion programs to keep people healthy and prevent disease.
12. Encourage North Carolina Medical Society members to accept Medicare assignment for patients whose annual income is at or below 200% of the federal poverty level.
13. Request that the North Carolina Department of Health and Human Services set up local screening programs with periodic evaluation to identify Medicare recipients whose annual income is at or below 200% of the federal poverty level.
14. Seek state budget appropriations for increases in Medicaid reimbursement on a periodic basis.
15. Develop model plans for a physician referral program for medically indigent patients for statewide implementation.
16. Develop an educational program delineating the problems of the medically indigent population for the component medical societies to encourage participation in programs to address the problems of the medically indigent in their respective counties.
17. Endorse continued support for family planning clinics, and encourage programs in preconceptional counseling and prevention of low birth weight babies for public and private patients.
18. Expand legislation that subsidizes malpractice insurance premiums for physicians who provide obstetrical care in medically underserved areas to the extent that they serve Medicaid and medically indigent women.
19. Develop educational programs to encourage more physicians to follow through on referring their maternity patients to existing supplemental programs, such as the Women, Infants and Children Program (WIC) and the Early, Periodic Screening, Diagnostic and Testing Program (EPSDT), that have an impact on good pregnancy outcomes.
20. Support the care coordinator system for medically indigent and Medicaid patients that arranges for support services which facilitate access to medical care, such as transportation, assuring eligibility, keeping medical appointments and complying with treatments.
21. Support and seek implementation of public and private programs that provide or otherwise improve availability of prescription drugs for indigent patients, support a Medicare outpatient prescription drug benefit, and communicate support for the latter to North Carolina's Congressional delegation.
22. Support the development of public sector delivery systems which provide continuity of care in areas where there are deficiencies.
23. Support equalization of rural-urban differences in reimbursement for hospital care and physician services.
24. Report the status of implementation of these resolves to the House of Delegates, as needed or upon request.

Free Pharmaceuticals Request Forms

Indigent Care Financing

INFORMED CONSENT

Minors' Consent for Certain Medical Health Services

Informed Consent

INJURY PREVENTION

Weapons and Handguns

Statewide Injury Prevention and Control Program

Injury Prevention and Control

North Carolina Trauma Care System

1. regionalized trauma care system in North Carolina,
2. study of the rational development of Level III trauma centers,
3. continued evolution of the North Carolina Statewide Trauma Registry,
4. injury control by recommending the inclusion of E codes in all hospital and emergency department discharge data, and
5. the categorization of hospitals by the level of trauma care they can provide.

Inclusion of E Codes (External Cause of Injury) as Supplemental to ICD Codes

Firearm Safety

JCAHO

Joint Commission on Accreditation of Healthcare Organizations Standards

JCAHO Reports

JURY DUTY

Jury Duty by Physicians in North Carolina

LABORATORY SERVICES

Referrals for Laboratory Services

LEAD POISONING

Lead Poisoning Prevention

Standards for Screening Children at Risk of Lead Poisoning

Support for Continuation of Free Lead Testing by the State Laboratory

Certification of Lead Abatement Contractors and Inspectors

Lead Abatement

Lead Poisoning Prevention

LICENSING BOARDS

Establishing New Health Care Licensing Boards

Cost Accounting Requirement

LITERACY

Support of Literacy Programs

LONG-TERM CARE

Inappropriate Placement and/or Care of Patients in Rest Homes in North Carolina

Enhance Availability of Nursing Home Beds

Medical Directors in Long-Term Care Facility

Long-Term Care

MANAGED CARE ORGANIZATIONS

Managed Care Organizations' Medical Necessity Criteria for Approval of Benefits

Physician Office Inspection Tools

Opposition to HMO/MCO Bans on Dual Affiliation

All Products Clauses

Full Disclosure of Medical Policy in Managed Care Contracts

Silent PPOs

Managed Care Guidelines for Employers, Patients, Managed Care Organizations and Physicians

North Carolina Medical Society Managed Care Organization Report Card

Physician Advocacy with Managed Care Organizations

Physician Decision-Making in Health Plans

• Selection of diagnostic tests that are appropriate;
• When and to whom in-plan physician referral is indicated;
• When and to whom out-of-plan physician referral is indicated;
• When and with whom consultation is indicated;
• When non-emergency hospitalization is indicated;
• When hospitalization from the Emergency Department is indicated;
• Choice of in-plan service sites for specific services (office, out-patient department, home care, etc.);
• Hospital length of stay;
• Frequency and length of hospital out-patient visits or care;
• Use of out-of-formulary medications;
• When and what surgery is indicated;
• When termination of extraordinary heroic care is indicated;
• Recommendations to patients for other treatment options, including non-covered care;
• Scheduling of on-call coverage;
• Terminating a physician/patient relationship;
• Whether to work with and what responsibility should be delegated to mid level practitioners; and
• Determination of the most appropriate treatment methodology.

Managed Care Trauma Patients

Pluralistic System of Health Care

Ethics in Managed Care

Physician Credentialing by Managed Care Companies

Payment for Medical Services to Special Populations of Children

Health Plan Financial Incentives

1. Economic and other incentives given to providers to limit plan expenses.
2. Specific and detailed disclosure of restrictions in choice of physicians and limitations of services available.

Patients' Withdrawal from Managed Care Plans

Fairness Measures in Managed Care

• certification of managed care plans based on compliance with standards regarding access of enrollees to providers, disclosure of plan limitations, solvency, physician input into medical decision making, opportunity for physicians to apply to managed care panels, and assurance of patient confidentiality;
• due process for physicians who are terminated from panels;
• appropriateness of utilization review standards, including clinical relevance of screening criteria, and qualifications of physicians involved in utilization review;
• opportunity for patients to select plans with a reasonable point of service option;
• allowing any willing physician provider access to practice within any plan or plans of the provider's choice; if the provider meets the criteria for all others in the provider's scope of practice, and if the provider agrees to accept the terms of contract offered by the managed care organization; and
• requiring annual public disclosure of the complete financial statement of the managed care organization to include annual revenues, expenditures by line items, salaries, bonuses and fringe benefits paid to officers, directors and stockholders of such organizations and public disclosure of the names of officers, directors and stockholders.

Managed Care

MANDATES

Oppose Scope of Limited English Proficiency Guidance

MATERNAL HEALTH

Neonatal Bed Locator/Physician Access Line System for Placement of High Risk Infants

Prenatal and Delivery Care for Indigent Pregnant Women

Folic Acid Endorsement

Endorsement to Promote Use of Folic Acid

Checkbox for Pregnancy Related Deaths on North Carolina Death Certificates

Family Physicians/Obstetricians

Maternal Mortality

Pain Relief During Labor

Alcohol and Drug Use During Pregnancy

Pregnancy Prevention and Sexually Transmitted Diseases Education

Maternal Prenatal Testing

MEDICAID

Medicare—Medicaid Crossover Claims

County Share of Medicaid Costs

Carolina Access Program

Adequate Medicaid Reimbursement Rates

Criteria for Requests for Proposal in Contracting with a Carrier for the Medicaid Program

Prevention and Health Promotion Efforts by Local Health Departments

Care of Indigent Patients

Medicaid Coverage for Uninsured Workers

Dispense As Written

Mental Health Benefits in Medicaid Programs

Cochlear Implants

Poverty Level

Medicaid Reimbursement for Children's Dental Services

Access to Medical Care by Medicaid Patients

Extension of Medicaid Coverage for Family Planning Services

MEDICAL BOARD, NORTH CAROLINA

Procedures of the North Carolina Medical Board

Clinical Competence of Practicing Physicians

Licensure Standards

MEDICAL EDUCATION

Physicians as Preceptors in Ambulatory Care Education of Medical Students

Area Health Education Centers Ambulatory-Based Medical Education Efforts

Clinical Skills Assessment Exam

Support of Medical Students and Residents in Community-Based Ambulatory Settings

Continuing Medical Education Requirements

Support of Electronic Continuing Medical Education Reporting

Continuing Medical Education for Limited Scope Practitioners

Initial Residency Period and Limitations on Residency Slots

Participation in Organized Medicine Conferences for Postgraduate Medical Education Residents in North Carolina

Diversity in Medical Education

Role of North Carolina Medical Society in Accrediting Programs for Continuing Medical Education

1. Accept the report of a continuing medical education accreditation survey team.
2. Determine whether an accreditation applicant fulfills the criteria for accreditation as a provider of CME.
3. Transmit this decision, over the signature of the Chair of the Medical Education Committee, to the Accreditation Council for Continuing Medical Education.
4. Inform the applicant organization, over the same signature, of the action of the Medical Education Committee as approved by the Board of Directors on behalf of the North Carolina Medical Society.
5. Provide those accredited with an appropriate certificate, signed by the President of the North Carolina Medical Society and the Chair of the Medical Education Committee, attesting to the applicant's accreditation status.

Medical Student Financial Assistance

Community Practice Physicians on Admitting Committees or Boards of Medical Schools

Innovative Prevention and Health Promotion Continuing Medical Education (CME) Programs

Support for Community-Based Medical Education

MEDICAL EXAMINER

North Carolina Medical Examiner System

Medical Examiner Investigation and Autopsies

MEDICAL IRAS

Tax-Free Individual Medical Accounts

Health Savings Accounts

MEDICAL RECORDS

Access to Shared Medical Information for Victims of Child Abuse and Juveniles in Protective Custody

1. In the case of a juvenile under protective custody of the Department of Social Services, the juvenile's primary care and treating physician shall have the right to examine medical and psychiatric records maintained by the Department of Social Services relative to that juvenile.
2. In the case of a juvenile victim, the juvenile's primary care and treating physician shall have the right to examine medical and psychiatric records, which are necessary for the medical care of the child.

Charges for Patient Record Information

Achieving a Paperless, Protected, Patient-Centered Medical Record by 2010

Electronic Medical Information

MEDICAL TESTIMONY

Expert Witness

1. The physician expert witnesses must have a currently valid and unrestricted license to practice medicine in the state in which they practice.
2. The physician expert witnesses must show evidence of competence in the specialty or area of medical care of the defendant physician. Acceptable evidence of competence would include such accomplishments as Board Certification by a specialty recognized by the American Board of Medical Specialties and/or demonstrated experience in the area of medical care from which the complaint arose.
3. The physician expert witnesses must document that he or she dedicated the majority of his or her professional time, during the year immediately preceding the date of the occurrence that is the basis for the action, to either one or more of the following: (1) the active clinical practice of the same health profession in which the party against whom or on whose behalf the testimony is offered, (2) if the party is a specialist, the active clinical practice of the same specialty or a similar specialty which includes within its specialty the performance of the procedure that is the subject of the complaint and have prior experience treating similar patients; or (3) the instruction of students in an accredited health professional school or accredited residency or clinical research program in the same health profession as the party against whom or on whose behalf the testimony is offered; and be it further

MEDICARE

Assignment of Medicare Benefits

Equitable Physician Payment

Lack of Medicare Coverage for Diabetes and Lipid Screening

Medicare and Medicaid User Fees

MEDICO-LEGAL GUIDELINES

North Carolina Medico-Legal Guidelines

MENTAL HEALTH

Mental Health Programs in Communities

Mental Health System Reform

1. Every individual with psychiatric symptoms has the right to a comprehensive evaluation and an accurate diagnosis, which leads to an appropriate, individualized plan of treatment.
2. Mental health care should be patient and family centered, community based, culturally sensitive, and easily accessible without discriminatory administrative or financial barriers or obstacles.
3. Mental health care should be readily available for patients of all ages, with particular attention to the specialized needs of children, adolescents, and the elderly. Unmet needs of ethnic and racial minorities require urgent action.
4. Access to mental health care should be provided across numerous settings, including the workplace, schools, and correctional facilities. An emphasis should also be placed on the early recognition and treatment of mental illness.
5. Patients deserve to be treated with dignity and respect and are entitled to choose their physician or community-based agency and to make decisions regarding their care. When they are incapable to do so, they should receive the treatment they need and when able, they should choose future care.
6. Patients deserve to receive care in the least restrictive setting possible that encourages maximum independence with access to a continuum of clinical services, including emergency/crisis, acute inpatient, outpatient, intermediate level, and long-term residential programs.
7. Since mental illness and substance abuse occur together so frequently, mental health care should be fully integrated with the treatment of substance abuse disorders and with primary care and other general medical services.
8. Support must expand research into the etiology and prevention of mental illness and into the ongoing development of safe and effective treatment interventions.
9. Efforts must be intensified to combat and overcome the stigma historically associated with mental illness through enhanced public understanding and awareness.
10. Health benefits, access to effective services, and utilization management must be the same for people with mental illness as for other medical illnesses, preferably funded by integrated financing systems.
11. Funding for care should be commensurate with the level of disability caused by a psychiatric illness.
12. More resources should be devoted to treatment and to training an adequate supply of psychiatrists, especially child psychiatrists, to meet the current and future needs of the population.

Postpartum Depression

Child and Adolescent Psychiatric Inpatient Beds

Teen and Young Adult Suicide Prevention

Mental Health Carve-Outs

Specialty Society Support for Mental Health Parity

Psychiatric Hospitalization of Minors

Insurance Coverage - Psychiatric Services

Funding of Services Provided at Community Mental Health Centers

Mental Health Coverage for Youth

Psychiatric Evaluation and Treatment

Early Psychiatric Discharge

MIDWIFERY

Opposing Unskilled Non-Professional Midwifery and Home Deliveries

NATIONAL PRACTITIONER DATA BANK

National Practitioner Data Bank

NEWBORNS

Newborn Screenings

Criteria for Early Discharge of Newborns and Their Mothers

1. Early discharge is requested by the mother; and
2. Post-delivery care of the mother-infant unit can be provided within 48 hours of discharge; and
3. The minimum criteria for discharge of healthy term newborn infants published by the American Academy of Pediatrics are met, and be it further

NURSES

Physician Relationship with Mid-Level Practitioners

1. Each professional is responsible for meeting practice standards of her/his professional group and regulatory board.
2. Each professional is responsible for maintaining a working environment in which there is mutual trust and respect, and open, active communication, promoting the optimum contribution of skills and knowledge to the services offered to patients.
3. A clear understanding of the circumstances which would lead to cross consultation is negotiated and documented among these professionals.
4. Geographic separation is not a barrier when consultation can be accomplished in a reasonable time frame by telephone or other means of communication.
5. Professional credentials of each are communicated by signage, name tags, etc.
6. Practice arrangements include a negotiated method for addressing ongoing quality assurance.
7. Each professional is aware of limitations of knowledge or skills, and willing to refer for appropriate consultation and care as necessary; and be it further

Physician Supervision of Nurse Anesthetists

School Health Nurses

1. Sufficient funding to ultimately assure a school nurse: student ratio of at least 1:750.
2. Rules to require that health care services in schools be provided by or supervised by a health professional that is licensed, certified or otherwise authorized to provide the services in question.
3. The Division of Maternal and Child Health as the agency responsible for providing expert nursing consultation to school health nurses.

OCCUPATIONAL HEALTH

Capsaicin "Pepper" Spray

OPTOMETRY

Optometry Practice

ORGAN DONOR PROGRAMS

Organ Donation Awareness

Donation of Human Tissue

1. The study of transplantation and research, the diffusion of knowledge and an expanded program of public education as to the need, and the legal and medical methodology of making anatomical gifts to medical science.
2. Efforts to achieve maximal organ procurement and transportation service potential.
3. Availability of the necessary donation forms and informative literature in physician's offices and hospitals so that the public will be aware of the need for organs and aware of their physician's and hospital's approval of such donations.
4. The North Carolina Commission on Anatomy and organ procurement agencies in attaining their objectives to secure more donors, retrieve more needed human tissues, organs and bodies to be used by the transplanting surgeons, hospitals and medical schools of the State.
5. Physician participation in the retrieval of donated organs and tissues and leadership in the development of community resources through hospitals, civic and professional organizations, and committees.

North Carolina Eye Bank

OSTEOPOROSIS

Osteoporosis Education, Prevention and Treatment

PAIN MANAGEMENT

Chronic Pain Management

PATIENT EDUCATION

Breastfeeding

Patient Education

PEER REVIEW

Hospital Fair Credentialing and Peer Review

1. The process of choosing "indicators" or "monitors" of physician performance should be carried out by a quality committee at the medical staff level, rather than at the department or specialty level. The composition of this committee should represent the diversity of the medical staff, including "economic diversity." This diversity requirement should be clearly explained in the medical staff's policies. Oversight of this process should lie with the Medical Executive Committee, which should approve the variance criteria (indicators/monitors) chosen.
2. Physicians whose cases are chosen for peer review should be notified of this occurrence. They should have an opportunity to provide written input which can be considered by any peer review committee and which becomes part of the peer review file. The physician under review should also be informed of any decisions that may lead to recommendations for individual remedial action or corrective action, and the physician should have an opportunity to respond, in person or in writing, to the underlying quality concerns before the recommendations are implemented.
3. When data is tracked for trends, threshold criteria should be established for defining where a trend exists that needs further evaluation. This responsibility should lie with a medical staff quality committee. Although the Task Force expressed a preference to conduct peer review based on actual patient outcomes, it recognized that monitoring and evaluating trends was an effective approach to spotting concerns before they lead to poor patient outcomes.
4. The Task Force recommends that medical staffs use care in labeling certain aspects of their peer review activities. The term "investigation" should be reserved for a formal review of data that is anticipated to lead to corrective action, since this term has implications for reporting to the NPDB (National Practitioner Data Bank). Initial reviews of data should be labeled using other terminology, e.g. "quality review," "focused study," "peer review evaluation," etc. The purpose is to avoid unnecessary or inappropriate reporting to the NPDB, which may harm physicians who have no reportable quality concerns.
5. The Task Force recognized the important value of External Peer Review (EPR). Where EPR occurs, the Task Force recommends that selection of external peer reviewers occur from among a diverse group of physicians and individuals with no economic relationships to the doctor to be reviewed. The Task Force suggested that potential names of external reviewers be submitted in advance to the physician under review, and he or she have an opportunity to object to any particular individual. Such objections should not rise to the level of veto power, which could obstruct the process. In general, EPR should be reserved for circumstances in which internal review has raised the possibility of a restriction or reduction of privileges or where objectivity of internal peer review may have the appearance of being compromised because of medical staff demographics. A physician under review always has the option to request external peer review prior to a final decision implementing corrective action.
6. Medical staffs should adopt a mechanism that affords protection to physicians who, acting in good faith and the best interest of quality of care concerns, report concerns to the peer review committee, under the protection of a medical staff policy.
7. Fair Hearing panels should be selected with good faith effort where practical to include representation similar to that of the physician under review (i.e. with regard to race, gender, ethnicity, training, etc.) Physicians under review should have an opportunity to voice good faith objections to inclusion of any members of a Fair Hearing panel. Such objections should not rise to the level of veto power, which would obstruct the process.
8. Medical staffs should be informed about the uses of mediation and arbitration in resolving disputes around credentials and privileges.
9. The North Carolina Medical Society and North Carolina Hospital Association should facilitate educational programs to help assure that members of hospital boards, Medical Executive Committee, Credentials Committees, and quality committees are knowledgeable about proper practices regarding peer review, performance improvement and appropriate credentialing and privileging. To maximize availability, a variety of tools may be used to promote this education (e.g. video tapes, Internet tools, retreats, grand rounds, computer education tools, continuing medical education, etc.) The Task Force recommends consideration of orientation programs for new physician leaders.
10. Approaches should be developed to promote the sharing of successful practices that exist in member hospitals and medical staffs with regard to peer review/performance improvement activities.

Preventing Conflict of Interest in Medical Society Peer Review Committees

• Personal involvement in the case


• Close personal or professional association with the involved physicians(s)
• Past or present professional service to the involved patient(s) or other involved party
• Close personal acquaintance with the involved patient(s) or other involved party
• Direct professional competition in the community with the involved physician(s)
• Lack of impartiality;

PERINATAL REIMBURSEMENT PROGRAM

Perinatal Care Support

PHYSICAL EXAMINATIONS

Support of Periodic Physical Examinations

Physical Examinations Required of Teachers and School Personnel

PHYSICIAN HEALTH

Physician Health and Wellness

Educating Medical Students about the North Carolina Physicians Health Program

PHYSICIAN REIMBURSEMENT

Harnessing Market Forces in Medical Pricing

1. A Resource Based Relative Value Scale that is regularly updated and rigorously validated should form the basis for all physician fee schedules.
2. Government programs and private insurers may establish fee schedules based upon a dollar conversion factor but physicians should not be required to accept this as payment in full unless they have freely entered into a contract to do so.
3. Physicians should be free to set their own fees based upon a conversion factor determined solely by the physicians’ assessment of their overhead costs and the value of their services in the marketplace.
4. The conversion factors of payors and physicians should be widely published and distributed so that consumers can choose physicians based upon economic factors and the perceived quality of a physician’s services.

Reimbursement Policy for Visits and Procedures on Same Day

Primary Attending Physicians and Consultants

1. The primary attending physician admits, attends, and discharges the patient. The primary attending physician remains the primary physician until or unless care is transferred to another physician and this transfer is documented by a written order on the chart.
2. All physicians providing and documenting necessary and reasonable medical services should be appropriately compensated.
3. Complex or unusual problems within the scope of such medical services may entitle the consultant to additional and/or unusual payment.

Reimbursement for Cardiac Physical Rehabilitation

Fee-for-Service Payment

Administrative and Professional Services

1. There are no third party payor or other applicable contractual prohibitions on billing the individual patient for such services;
2. The practice has a clear policy outlining what services will be billed to the patient and how much;
3. The patient is notified in writing of the practice's policy, either at the initial visit or at the first visit after the policy is adopted by the practice; updated versions of the policy are provided as necessary; and
4. The amount charged is reasonable under the circumstances and is limited to costs incurred by the practice in performing the service.

PHYSICIAN-PATIENT RELATIONSHIP

Physicians' Roles as Patient Advocates

North Carolina Medical Board Statement on Physician-Patient Relationship

Physician-Patient Relationship and Cost Containment Efforts

PHYSICIANS, JOINT NEGOTIATIONS

Physicians and Joint Negotiations

POLITICAL ACTION

Political Action by Physicians

POSTOPERATIVE CARE

Postoperative Patient Care by Persons Not Licensed to Practice Medicine in North Carolina

Postoperative Care by Physicians

PRACTICE PATTERN VARIATION

Data Collection and Dissemination

PREADMISSION

Elimination of Preadmission Screening and Annual Resident Review (PASARR) for NC Nursing Facilities

PREMARITAL EXAMS

Mandatory Premarital Examinations

PRESCRIPTION DRUGS

Antibiotic Availability Over-the-Counter

Prescription Privileges

Competitive Products in the Same Medication Packaging

Prior Authorizations for Medications

Overly Restrictive Prescription Plans

• the inclusion of any drug formularies and the process of selecting drugs to be used on such formularies,
• the inclusion of any "tiered" formulary programs requiring higher copayments for certain drugs and the process for selection drugs to be used in such tiers,
• the inclusion of any "step" programs requiring use of one drug prior to the use of another subsequent drug and the process for selection of drugs in the step program, and
• an explicit list of drugs requiring preauthorization and the process for enrollees to use to obtain such preauthorization; and be it further

1. Compliance with current North Carolina General Statutes regarding pharmacy formularies and their effectiveness. This should include statutes permitting payors to develop closed prescription drug formularies, which are structured by pharmacy therapeutics committees.
2. The current structure and operation of North Carolina pharmacy formularies.
3. The impact of pharmacy formularies on the overall cost of medical care in North Carolina.
4. The impact of pharmacy formularies on off-label use of drugs and the possibility of prohibiting such use.
5. The administrative impact of formularies on physician’s practice and technological solutions to reducing that administrative burden.
6. Other patient care issues.

Prescribing of Drugs by Non-Qualified Healthcare Providers

Pharmaceuticals Over the Internet and Telephone Sites Prescribing and Dispensing

Stop Illegal Diversion of Prescription Drugs

Drug Substitution

Online Prescribing

Dispensing of Drugs from Physician's Office

Therapeutic Drug Substitution

Mandatory Restrictive Drug Formularies

Prescription Opioids

Privacy of Physician Prescribing Data

PRIMARY CARE

Primary Care Manpower

1. Support the need for and the role of the primary care physician in improving access to preventive and primary care, by supporting adequate compensation, adequate education and reduction of administrative burden.
2. Continue the partnership with the deans of the four medical schools and the state Area Health Education Centers director in support of a medical educational system that will help insure an adequate future supply of primary care physicians (generalists). This would include proposals to address admissions policies; financial incentives; expansion of training programs in primary care; focused activities that expose students to primary care specialties early in their medical school careers; and the development of a positive environment for primary care training.
3. Support North Carolina Area Health Education Centers programs aimed at the education of medical students and residents in community-based practice sites. Provide attractive education models of primary care practice in underserved areas.
4. Support and enhance the existing physician incentive programs [loan repayment etc.], administered by the NC Office of Research, Demonstrations, and Rural Health Development and the North Carolina Medical Society Foundation Community Practitioner Program, to increase the placement of primary care physicians in underserved areas of North Carolina.
5. To safeguard the availability of practice sites in underserved areas, support increased funding for operational and capital grants available to rural health centers through the Office of Research, Demonstrations, and Rural Health Development.
6. Re-institute the resident stipend program for those residents pursuing a rural residency track.
7. Support Small Rural Hospital initiatives as developed by the North Carolina Hospital Association and the Office of Research, Demonstrations, and Rural Health Development to the extent the initiatives are compatible with North Carolina Medical Society policies and goals.
8. Support stiffer repayment penalties and state enforcement of loan repayment contracts. A recipient who enters a subspecialty practice in violation of his/her contract should have his/her loan terminated and be assessed interest on the unpaid balance at substantial rates.
9. Stimulate interest in primary care and support a premedical sciences preparation program at the high school level aimed primarily at minority students.
10. Support the movement for payment reforms at the federal level which will increase payment to primary care physicians to levels necessary to assure that financial concerns do not dissuade students from careers in primary care.

PRISONERS MEDICAL CARE

Proper Care of Psychiatric Patients

1. Provide proper medical and psychiatric care to prisoners suffering from a psychiatric illness while incarcerated.
2. Arrange for proper follow-up care of former prisoners upon their release from prison, and
3. Provide follow-up care for mentally ill offenders upon return to the community.

Medical Care of Prisoners

PROFESSIONAL COURTESY

Professional Courtesy

PROFESSIONAL LIABILITY

Medical Liability Reform

Professional Liability Task Force Report

1. That the North Carolina Medical Society seek legislation to assure patients are fully compensated for real damages and to cap non-economic damages in medical malpractice actions.
2. That the North Carolina Medical Society seek legislation to require that plaintiffs accept periodic payments of judgments in medical malpractice cases so that resources will be available throughout the injured patient's lifetime.
3. That the North Carolina Medical Society seek legislation to limit attorney contingency fees in medical malpractice cases in order to ensure that injured parties receive adequate compensation and to eliminate excessive fees that serve as an incentive for the filing of frivolous cases.
4. That the North Carolina Medical Society continue the work of the Professional Liability Task Force in a manner determined by the Board of Directors.

Equitable Risk Classification in Medical Liability Premiums

Limited Immunity for Indigent Care

Mediation of Medical Malpractice Claims

Medical Liability Reform

Good Samaritan Law Immunity

Access to Liability Insurance Coverage

PROFESSIONAL REVIEW ORGANIZATIONS

Certified Notification by Professional Review Organizations

PROTECTIVE EQUIPMENT

Horseback Riding Safety

Bicycle Safety

Skateboards and In-Line Skates

PUBLIC HEALTH

Qualifications for State Health Directors and Director, NC Division of Mental Health, Developmental Disabilities and Substance Abuse

Formation of Liaison Committee Between Local Medical Societies and Local Health Departments

1. Urge federal, state and local governments to study public health and preventive services, and urge the allocation of necessary resources to maintain these services at a high level of quality.
2. Encourage local medical societies to establish liaison committees through which physicians in private practice and officials in local health departments can explore issues and mutual concerns involving public health activities and private practice.
3. Seek increased dialogue, interchange, and cooperation among state organizations representing public health professionals and those representing physicians in private practice or academic medicine.
4. Support increased attention to public health issues in its programs in medical science and education.
5. Encourage state and local public health agencies to focus on assessment of health problems, to develop policies to address those problems and to assure that conditions are present in communities to maximize the health status of its citizens.
6. Support the recommendation of the American Medical Association that the State Health Director be a qualified public health trained Doctor of Medicine or Doctor of Osteopathy (MD/DO).

Response to Biological, Chemical and Radiation Attack

Local Medical Society/Local Health Department Relationships

Healthy People 2010

Hearing Screening Programs

"Bone and Joint Decade" Endorsement

Support Expansion of Data Gathering Activities by the North Carolina Behavioral Risk Factor Surveillance System

1. Increasing the number of interviews conducted by the program’s staff;
2. Increasing the number of North Carolina-specific issues addressed in the program questionnaire; and
3. Obtaining the additional information needed to permit the program staff to compare North Carolina data by region or county.

Program to Help Physicians Incorporate Prevention Into Their Daily Patient Encounters

Health and Fitness Programs

Sentinel Event Notification System for Occupational Risks Program (SENSOR)

Behavioral Risk Factor Surveillance System (BRFSS)

Health Promotion and Disease Prevention

1. Extend health promotion/disease prevention programs to all, especially older adults and vulnerable populations, to improve overall well-being, prevent health problems, reduce health care costs, and help people cope with chronic conditions;
2. Shift the emphasis of our health system from illness care toward health management and prevention for people of all ages, particularly older adults, high-risk individuals, and underserved populations;
3. Make available and affordable preventive health measures, early detection methods, and screenings; and
4. Promote health, nutrition, physical activity, and cessation of tobacco use.

Support of Local Boards of Health

Local Health Directors

Public Health Authority

QUALITY IMPROVEMENT

Quality of Care and Performance Improvement

QUALITY IMPROVEMENT ORGANIZATIONS

Quality Improvement Organizations

REGULATORY BODIES

Playground Safety

Physician Representation on Government Entities

REHABILITATION SERVICES

Quality Assessment of Facilities Offering Comprehensive Rehabilitation Services

RELATIVE VALUE SCALE

Government and Private Insurance Payors to Adopt Equitable Physician Payment

SEXUAL ABUSE

Investigation of Suspected Sexual Abuse of or Assaults on Children

SEXUALLY TRANSMITTED DISEASES

Sexually Transmitted Diseases Awareness

SMART START

Smart Start

SMOKE DETECTORS

Smoke Detectors

SMOKING

Local Community Regulations Limiting Smoking in Public Places

No Smoking in North Carolina Medical Society Sponsored Events

Restricting Smoking in Public Places in North Carolina

Public Education Regarding Smoking During Pregnancy

Smoking

Smoke-Free Environment at All State Medical Society and Component Medical Society Meetings and Facilities

Health Care Facilities and Smoking

Smoking in Public Places

SPORTS MEDICINE

Resuscitation Standars for Health and Fitness Establishments

SUICIDE PREVENTION

Suicide Prevention Programs

SURGERY

Laser Surgery

Preoperative Care

Laser as Surgery

Second Opinion Surgery

SWIMMING POOL SAFETY

Support an American Academy of Pediatrics Position on Swimming Pool Safety

TANNING FACILITIES

Appropriate Warning of Health Risks with Ultraviolet Exposure

Tanning Facilities

TAXES

Healthcare Provider Taxes

TELEMEDICINE

Telemedicine

THIRD-PARTY PAYORS

Precertification

Payment For Tests and Procedures

Unfair Third-Party Payment Policies

Downcoding

Availability of Publicly Funded Health Plan Medical Necessity Criteria

Unfair Health Plan Payment Policies

• Demands for Refunds of "Overpayments,"
• Payor Responsibility for Payment following Eligibility Verification,
• Suspended Payments Pending Receipt of Coordination of Benefits (COB) Information from Patients,
• Balance Billing for Services Later Not Deemed Medically Necessary or for Ineligible Patients,
• Bundling and Automatic Downcoding,
• Absence of Provision of Fee Schedule Information and Fee Schedule Updates,
• Payor Refusals to Honor Assignments of Benefits,
• Provision of Mandatory Clinical Guidelines to Physicians,
• Absence of Opportunity for Provider Initiation of Grievances and Appeals,
• Health Plan or Payor Communications which Give Providers a Negative Image,
• Excessive Requests for Medical Records and Lack of Adherence to Principles or Patient Confidentiality,
• Refusal to Permit Specialist Physicians to Act as a Direct Point of Entry for Patients with Diseases within their Area of Specialization; and be it further

Support of Adequate Medicare and Medicaid Reimbursement Rates

Physician Credentialing

Payment Problem Surveillance

Reimbursement for Upper Airway Resistance Syndrome

Mandatory Participation in Medicare and Medicaid

On-Site Lab Work

Exclusivity of Hospital Emergency Use

Reporting of Claims Payment Data

Support Legislation Requiring Parity for the Treatment of Chemical Dependency

Support Standardized Communication Technology by MCOs and Insurers

Transplantation Services

Timely Payments of "Clean Claims"

Dietary Instruction for Chronic Disease Patients

Direct Access to Physiatrists

Prompt Claims Payment

Diagnostic and/or Laboratory Tests Codes

Hospital Authorizations

Tricare Payment

Obesity Surgery Coverage

TOBACCO

Tobacco Industry Support

Worker Exposure to Environmental Tobacco Smoke

Tobacco Excise Tax

Protect Youth from Tobacco

Support Allocation of Federal Tobacco Settlement Funds for Public Health Purposes

Tobacco Settlement Funds Used to Support Tobacco Cessation Programs

100% Tobacco-Free Policy In Schools

Rejoining the Smokeless States Coalition

North Carolina Medical Society Endorsement of the Vision 2010 Document

Tobacco Education

Tobacco Product Sales

Tobacco Product Regulation

Tobacco Products

TRAFFIC SAFETY

Medically Impaired Drivers

"Click It Or Ticket" Program

Drivers' Licenses

Motorcycle Helmets

Support an American Academy of Pediatrics Position on Pickup Truck Passenger Safety

Support Increased Helmet Use by All Segments of Bicycling Population

Support Linkage of Databases Related to Highway Injuries for Research Purposes

Mandatory Seat Belt Laws

Opposition to Increase in Truck Size and Weight on Highways

Seat Belts and Shoulder Harnesses

Passenger Protective Systems -- School Buses

Mopeds and Motorized Bicycle Helmets

Bicycling Access

Passenger Restraints -- Automobile

1. Require appropriate restraints for all occupants of vehicles;
2. Require child safety seat use to the age supported by current objective research; and
3. Impose a fine for any violation of these mandates and include the authority to assign license and insurance points for violations.

Bicycle Helmets

Graduated Drivers Licensing

UNLICENSED PRACTICE OF MEDICINE

Unlicensed Practice of Medicine

Prosecution of Persons Practicing Medicine without a License

UTILIZATION REVIEW

Regulation of Utilization Review Organizations and Third-Party Administrators

1. That the State of North Carolina continue to monitor operational standards of time and performance criteria for utilization review organizations third party payors and employer-sponsored plans; and
2. That utilization review organizations, third party payors and employer-sponsored plans be held liable in instances of patient harm due to improper denial of care; and
3. That physicians and nurses who review in North Carolina be licensed in the state of North Carolina.

Utilization Review Decisions

VALUES IN MEDICINE

Values in Medicine Task Force

VIOLENCE PREVENTION

Violence Prevention

WASTE MANAGEMENT

Underground Hazardous Waste Storage

Recycling in the Medical Community

Hazardous and Low Level Radioactive Waste Management and Disposal

1. Supporting continuation and periodic review by the State of comprehensive hazardous and low level radioactive waste management plans and urging that the permitting by the State of any hazardous or low level radioactive hazardous waste disposal facility be consistent with any such plans;


2. Supporting (a) monitoring the environmental and public health impact of all hazardous waste and low level radioactive waste treatment or storage facilities in North Carolina and (b) communicating with the public about the results of such monitoring;


3. Assisting appropriate regulatory authorities in the State�s health and environmental protection agencies in seeking strong regulation and strict supervision of hazardous and low level radioactive waste facilities;


4. Strongly supporting source reduction, recycling, and the pursuit of safer treatment alternatives which maximize environmental and human health; and


5. Educating physicians on worker and community health implications of hazardous and low level radioactive waste management.

Site of Low Level Radiation Waste Disposal