State Health Plan to cut $300M in provider rates.
August 22, 2018 | view this message as a webpage
North Carolina Orthopaedic Association (NCOA)
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In this edition:

2018 Presidential Speaker
James D. Kang, MD
Orthopaedic Surgery Chairman at
Brigham and Women's Hospital,
Harvard Medical School

Program & Registration

NCOA Annual Meeting, Oct. 12-14 - Registration Now Open!

Please join us for the 2018 NCOA Annual Meeting, scheduled for October 12-14, at the Kiawah Island Golf Resort in Kiawah Island, SC, featuring our 2018 Presidential Speaker Dr. James Kang, Chairman of the Department of Orthopaedic Surgery at Brigham and Women's Hospital, Harvard Medical School. 

The meeting includes 6 hours of CME-accredited programs as well as several activities beyond the scientific sessions for your enjoyment, including a casual and family-friendly oyster roast and buffet dinner on Saturday evening at scenic Mingo Point featuring a live local bluegrass band providing musical entertainment.

The NCOA Annual Meeting is a great opportunity to renew old acquaintances and make new ones. We look forward to seeing you there!

  • Online Registration - Early-bird discounts end Sept. 20. 
  • Download the Registration Brochure
  • Accommodations: Kiawah Island is a ten-mile-long barrier island providing the ideal combination of climate, history, nature, golf, tennis, and beach. We have reserved one-, two- and three-bedroom villas, each with full kitchen and screened porch. Rates range from $230 to $295 plus resort fee and taxes, per night. For reservations, call the Kiawah Island Golf Resort at (800) 654-2924. The hotel deadline is Sept. 20. 
  • CME Credit Statement: The Southern Regional AHEC designates this live activity for a maximum of 6.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
  • Exhibiting Opportunities: Please share the Exhibitor Prospectus with the product and service representatives who call on your practice.
  • Questions? Contact Nancy Lowe at, or 919-833-3836 ext. 111.

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Lawsuit Filed Over Certificate of Need Restrictions

A Winston-Salem surgeon, Dr. Gajendra Singh, has filed a lawsuit against the State of North Carolina challenging the constitutionality of the state’s Certificate of Need (CON) laws, which are among the most restrictive in the country. North Carolina’s CON laws prohibit physicians from opening ambulatory surgery centers and from purchasing diagnostic equipment, thereby contributing to rising healthcare costs, adversely impacting surgical quality and limiting patient access to care.

There have been several attempts over the years at legislative solutions to deregulate the system, which the NCOA has supported, but those measures have yet to gain enough support to make it through the General Assembly. Most recently, Rep. Beverley Boswell (Dare Co.) in June offered an amendment from the House floor calling for a study of CON’s impact on healthcare access. The amendment failed 18-89, highlighting the low level of interest on this issue among House members.

The timeline for how and when this lawsuit will be adjudicated is uncertain.

Media Coverage and Additional Information:

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State Health Plan Takes Aim at Provider Rates

In a meeting on July 18, 2018 with State Treasurer Dale Folwell and key staff of the State Health Plan, NC Medical Society President-Elect Dr. Timothy Reeder (Greenville) encouraged the State to give physicians access to clinical and claims data to help drive down medical costs for the Plan. Citing quality improvements and cost reductions that have been achieved through value-based payment models, Dr. Reeder noted that physicians’ access into patient data is critical to eliminating waste in health care and improving health care quality.

The meeting was held by Treasurer Folwell to allow provider groups an opportunity to share their ideas on how best to reduce the Plan’s medical costs. On May 14, 2018, Treasurer Folwell and the Plan announced their intention to cut provider rates by at least 15 percent in contract negotiations this year with Blue Cross and Blue Shield of NC, the Plan’s third-party administrator. Meeting participants included NCOA Deputy Director Denna Suko, representatives from the NC Medical Society, state specialty societies, and hospitals. You can read the NCMS’s coverage of this meeting and a follow-up letter sent to Treasurer Folwell on the NCMS website.

For the most part, participants urged the Plan to consider value-based incentives that will lead to improvements in patient health, not just cost reductions. Robin Huffman, executive director of the NC Psychiatric Association, noted the importance of treating the whole patient and added that savings can be achieved through behavioral health integration. This sentiment was echoed by several stakeholders. Speaking on behalf of the NC Ob/Gyn Society, Rob Lamme noted the steps that ob/gyns have taken - such as reducing primary cesarean section, improving birth rates through increased access to progesterone therapy, eliminating elective deliveries before 39 weeks, and care coordination for at-risk mothers – which have led to improved health outcomes while also achieving reductions in health care costs. Cody Hand, on behalf of the NC Health Care Association, provided specific examples of patient-centered programs that have led to health improvements and cost reductions. NCMS’s Senior Vice President Chip Baggett reaffirmed the importance of access to clinical and claims data so that physicians can improve health care quality and he emphasized the valuable role that care coordination plays in achieving long-term health improvements.

In response, Treasurer Folwell and the Plan’s executive director Dee Jones indicated that the ideas presented by the provider groups did not produce the immediate savings the Plan needs to be sustainable.

In 2017, the plan spent $2.5 billion providing medical services. The 15 percent cut is expected to generate $300 million in savings per year, for a total savings of $1 billion over the next three years. The Plan provides health care coverage to more than 720,000 teachers, state employees, current and former lawmakers, state university and community college personnel and their dependents, including non-Medicare and Medicare retirees.

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Medicaid Transformation Update

As previously reported, the NC Department of Health and Human Services (DHHS) announced on August 9, 2018, that it has issued a Request for Proposal (RFP) for Medicaid Prepaid Health Plans (PHP) as part of the state’s transition from Medicaid fee-for-service to managed care. In a call with stakeholders, DHHS Secretary Dr. Mandy Cohen noted that this is the largest procurement in DHHS history and she expressed her appreciation for the stakeholders’ collaboration and feedback throughout the process. DHHS has published on its Medicaid Transformation webpage a helpful fact sheet summarizing the key content within the PHP RFP, including program goals and structure.

NC DHHS Medicaid Transformation Webpage

The RFP seeks proposals for standard plans by October 12, 2018. A PHP Evaluation Committee comprised of state employees will be tasked with the selection of four statewide plans and up to 12 regional plans. DHHS will announce the awardees in February 2019. Standard plans will launch in a phased-in approach with select regions going live on November 1, 2019. Full statewide implementation of standard plans is expected on February 1, 2020.

A separate procurement for tailored plans to provide services to beneficiaries with significant behavioral health and/or intellectual/development disability will be conducted at a later date.

This development follows the DHHS’s August 3 announcement that the state has awarded a contract for Medicaid managed care enrollment broker services to MAXIMUS, a government services provider based in Reston, VA, to provide choice counseling, enrollment assistance and education to beneficiaries as they select from a variety of health plans.

Approval of the new program design is required from the Centers for Medicare and Medicaid Services (CMS) before the state’s transition to managed care can be fully implemented. In September 2015, the NC General Assembly directed the transition of Medicaid from a fee-for-service structure to a managed care structure in North Carolina. The state submitted its managed care design plan to CMS in June 2016 in the form of an 1115 waiver. A revised 1115 waiver application was sent in November 2017 and is still under review by CMS. Dr. Cohen did not address the status of the 1115 waiver on the August 9 call with stakeholders.

Conor Brockett, the North Carolina Medical Society’s Vice President of Legal & Regulatory Affairs and Associate General Counsel, offers this quick overview of Medicaid transformation in North Carolina as of July 2018.

Make a Difference in a Colleague’s Life – Consider a PHP Board Position
Source: NC Medical Society

The North Carolina Medical Society (NCMS) appoints five physicians to the Board of Directors of the North Carolina Physicians Health Program (NCPHP). There currently is one vacancy on the NCPHP Board to be filled by an appointee of the NCMS. The NCMS is currently accepting applications from physicians interested in serving on the PHP Board of Directors.

The NCPHP offers an experienced team of experts to assist health care providers with substance use disorders, mental health issues, burnout, communication problems and other issues that may affect their ability to deliver optimal care and services to their patients. NCPHP’s expert evaluation, monitoring and treatment referral programs also provide the basis upon which they advocate for participants to their employers, partners, hospitals, insurance panels and licensing boards. To learn more about the important work of this organization, visit the NCPHP website.

Physicians interested in an NCPHP Board position should complete the application form and return it by August 31 to Evan Simmons, (preferred), or by US Mail to PHP Board Applications, North Carolina Medical Society, PO Box 27167, Raleigh, North Carolina, 27611.

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NC DHHS: Fewer Opioid Prescriptions, Improved Access to Care

The NC Department of Health and Human Services announced in May that the oversupply of prescription opioids in the state is being reduced and North Carolinians' access to treatment and recovery services has increased. This data comes from a new NC DHHS-created data dashboard.

According to an NC DHHS press release, there were 20 million fewer opioid pills dispensed statewide in the fourth quarter of 2017, compared to the same period the year before when 141 million were distributed. Data also indicate more people are receiving care through medication-assisted treatment, coupled with clinical treatment services, for substance use disorder.

"The opioid data dashboard is a powerful tool for health care providers, community coalitions and everyone involved in turning the tide of the opioid crisis in North Carolina," said DHHS Secretary Mandy Cohen, M.D. "While we are encouraged by these early metrics, our data show that we still have a lot of work to do."

More information, including instructions on how to use the dashboard, is available at the Opioid Action Plan Data Dashboard site. More details on the Opioid Action Plan and other steps being taken to turn the tide of opioid addiction in North Carolina are also available from the NC DHHS.

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NC HealthConnex: Are You Connected?

The June 1, 2018 deadline has passed for hospitals, physicians, physician assistants and nurse practitioners with an electronic health record (EHR) system to have initiated a connection to NC HealthConnex, North Carolina’s designated statewide health information exchange network. Providers with an EHR system who did not meet this deadline can request an extension for their connection.

To request an extension, providers must:

  1. Complete and sign an NC HIEA Participation Agreement;
  2. Have NC HIEA countersign the agreement; and
  3. Begin the onboarding process to connect to NC HealthConnex.

Hospitals, physicians, physician assistants and nurse practitioners who currently do not have an EHR system must connect by June 1, 2019. For complete details, visit the NC HIEA website.

NC HealthConnex is a secure electronic network that facilitates conversations between health care providers, allowing them to access and share health-related information across the state. Created by the North Carolina General Assembly (NCGS 90-414.7), NC HealthConnex is the state-designated health information exchange. It is managed by the North Carolina Health Information Exchange Authority (NC HIEA), housed within the NC Department of Information Technology.

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NCMS LEAD Health Care Conference: Registration Now Open!

The North Carolina Medical Society (NCMS) is pleased to announce its new and not-to-be-missed annual event – the LEAD Health Care Conference. Mark your calendar now for Oct. 18-19, 2018 to be part of this innovative conference focused on Leadership, Education, Advocacy and Discovery – LEAD. The Southern Regional AHEC designates this live activity for a maximum of 10.25 hours of AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This year’s excellent program will feature an update on the state’s Medicaid Transformation presented by NC DHHS Secretary Dr. Mandy Cohen; she is scheduled to speak on Friday morning, October 19, and we encourage you to attend if your schedule permits. For online registration and program details, visit the LEAD Conference website.

abstract submission deadline: Aug. 30

Due to the great success of the previous events, the North Carolina Medical Society (NCMS) is issuing a Call for Scientific Posters for its LEAD Health Care Conference, scheduled for October 18-19, 2018, at the Raleigh Marriott Crabtree Valley. The NCMS’s objective for the poster presentations is to offer medical students, residents and fellows an opportunity to share significant research and clinical work of interest with other fellow clinicians. We encourage all of our up-and-coming physicians to participate in this educational program by submission of a formal application for scientific presentation. The Poster Session will be divided into two categories: Clinical Research and Clinical Vignette.

Prizes will be awarded to the top three students, residents and fellows (first authors) in both categories.

  • 1st prize=$200 per student/resident/fellow author in both categories, for a total of six awards
  • 2nd prize=$100 per student/resident/fellow author in both categories, for a total of six awards
  • 3rd prize=$50 per student/resident/fellow author in both categories, for a total of six awards

Learn more and apply today (PDF).

Applications and abstracts due by August 30, 2018. Questions? Please contact Nancy Lowe, CMP, or (919) 833-3836 ext. 111.

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