Watch Dr. Bruch's testimony to the Senate Health Care Committee.
July 26, 2016 | view this message as a webpage
North Carolina Orthopaedic Association (NCOA)
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2016 NCOA Annual Meeting
October 7-9
Pinehurst Resort

Legislative Wrap Up: CON, CSRS, Opioid Epidemic and More!

The 2016 “short session” of the NC General Assembly concluded on July 1, 2016. The final weeks of the session saw a flurry of legislative committee meetings and action on a number of health-related items of interest to orthopaedic surgeons and other physicians.

Certificate of Need – NCOA member Dr. Richard Bruch (Durham) urged the legislature to repeal the state’s Certificate of Need (CON) program at a June 14 hearing on the issue. The Senate Health Care Committee heard testimony regarding potential legislation to repeal the state's CON program, but did not vote on the bill. Representatives from the North Carolina Society of Otolaryngology-Head and Neck Surgery, John Locke Foundation and Americans for Prosperity also testified that CON contributes to rising health care costs and decreases patient access to care. You can watch video coverage of the debate online (begins at 28:15).

Dr. Bruch spoke about the inadequate supply of operating rooms in North Carolina. He also relayed the comments of Dr. Timothy Jordan (Raleigh), an ophthalmologist, who struggles to get morning operating times for his pediatric patients. Dr. Bruch told legislators, “There is no ‘need’ in our certificate of need mechanism for ambulatory surgery centers. We have stifled operating rooms in this state.”

Dr. Charles Ford, an ENT physician in Boone, also testified on June 14. “CON limits patient access and choice, allowing the most costly models to flourish.” He told legislators that patients are increasingly seeking out alternative sites of care, and that they are traveling from Boone to have procedures done at ambulatory surgery centers in the region. He reported the cost of ear tube procedures at the hospital in Boone at $5,200 compared to the ASC cost of $1,700.

Dr. Richard Bruch and ENT Dr. Patrick "Tate" Maddox (Boone) encouraged law-makers to end CON during meetings at the legislature on May 25. Pictured (L-R): Denna Suko, Dr. Maddox, Dr. Bruch and Alan Skipper.

Dr. Charles Ford testified that CON drives up health care costs and limits access to care in North Carolina.

Controlled Substances Reporting – Legislators, faced with an opioid abuse epidemic, also have concerns that usage of the state's Controlled Substances Reporting System (CSRS) among physicians remains low. In response, the 2016 Appropriations Act enacted two notable provisions with regard to the CSRS.  First, the budget appropriated $600,000 to facilitate connectivity between our CSRS and the reporting systems in surrounding states as well as integration with NC’s Health Information Exchange (HIE). The budget also allocates and more than $650,000 to develop and implement software for the performance of advanced analytics within the CSRS. The legislation further requires physicians to register with the CSRS once the upgrades are complete.

Step Therapy – On June 22, the House Insurance Committee debated House Bill 1048, Reduce Barriers to Improve NC Health & Safety, but did not vote on the measure. The bill would set standards for the development of step therapy (or "fail first") pharmaceutical coverage protocols and requires transparency in the exceptions determination process. The bill also includes provisions for health benefit plans’ coverage of abuse-deterrent opioids. Though several patient and physician organizations have aligned in support of the bill, the hearing on June 22 was dominated by opponents of the bill who emphasized the increased cost that would result if step therapy protocols were restricted in any way.

Opioid Abuse Epidemic – According to Project Lazarus, a statewide public health non-profit that is partnered with Community Care of North Carolina, our state has higher than average overdose death rates. Nearly all of these deaths involve prescription opioid pain relievers (like methadone, oxycodone, fentanyl, morphine, tramadol, or hydromorphone). The state is taking steps to combat the harmful and rippling effects of prescription drug abuse. Several bills took aim at the opioid abuse epidemic during the final weeks of the short session.

The 2016 Appropriations Act established a medication-assisted opioid use disorder treatment pilot program with a goal of studying the effectiveness of combining behavioral therapy with the utilization of a nonnarcotic, non-addictive, extended-release, injectable formulation of opioid antagonist approved by the United States Food and Drug Administration for the prevention of relapse to opioid dependence.

Also significant, Governor Pat McCrory signed into law on June 20, 2016 an act authorizing the State Health Director to prescribe opioid antagonists by means of a statewide standing order, with immunity from civil and criminal liability for such action.

A provision in the 2015 Appropriations Act established a requirement - effective January 1, 2017 - that all NC Medical Board licensees complete at least one hour of continuing education annually regarding controlled substance prescribing. To help meet your needs, the NCOA has incorporated opioid prescribing CME into is Annual Meeting program.  Additionally, a free two-hour CME session on opioid prescribing will be offered on Saturday Sept. 17, in conjunctions with the NC Medical Society's M3 Conference

Medicaid Reform – North Carolina submitted its Medicaid waiver application to CMS on June 1. Federal review of the state’s plan to capitate payment for services provided to NC’s Medicaid population through a network of statewide and regional Medicaid carriers could take up to two years. DHHS Secretary Richard Brajer presented an overview of the final application to the House Health Committee moments before the application was signed by Governor Pat McCrory and sent to CMS. Brajer told legislators his department had worked with over 50 stakeholder organizations, held 12 public hearings across the state and received comments from over 750 organizations and individuals in developing this final waiver application.

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NC Medicaid Announces Direct Enrollment of Mid-Level Providers
Take action now to ensure that your claims are not suspended or denied.

In accordance with new Federal regulations, claims for services will no longer be filed as "incident to" in NCTracks. All attending, rendering, ordering, prescribing or referring providers in NC Medicaid or NC Health Choice, including Physician Assistants (PAs), Nurse Practitioners (NPs), Certified Registered Nurse Anesthetists (CRNAs), and Certified Nurse Midwives (CNMs), are encouraged to begin submitting enrollment applications now to NCTracks. This will ensure that your claims are not suspended on November 1, 2016 – the effective date of this new rule. Visit the Provider Enrollment page.

For all claims submitted beginning November 1, the provider’s National Provider Identifier (NPI) will be required as a data element on the claim for programs listed in this May 2016 Special Bulletin. Any NPI entered on a claim will be validated, even if it is not required for that service/claim type. Limited exceptions to this new regulation include any Resident or Intern in a Graduate Dental and Medical Education program.

For reference:

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Register Today for NCMS Foundation's Leadership Development Programs

The North Carolina Medical Society Foundation and the Kanof Institute of Physicians Leadership (KIPL) invite you to register for one of two programs beginning this fall; Leadership College and the new Health Care Leadership & Management Program (HCLM). Applications are due August 1 for Leadership College and September 1 for HCLM.

The Leadership College Program focuses on leadership fundamentals to enhance physicians’ and PA-Cs’ core aptitudes to excel as leaders within organized medicine, hospitals, health care systems, medical staffs, group practices, as well as in the public policy arena. The curriculum of the Health Care Leadership & Management Program is designed with greater emphasis on deeper leadership development and skills that include strategic planning, negotiation and financial literacy and application.

To learn more about the programs, please visit the NCMS Foundation website.

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13.75 CMEs @ the M3 Conference, Sept. 15-18

The NC Medical Society (NCMS) and the NC Medical Group Management Association (NCMGMA) have joined forces on THE educational conference of the year, focusing on current and evolving practice improvement, leadership in health care and personal development. Don't miss the M3 Conference – Merging Medicine and Management – September 15-18 at the Grandover Resort in Greensboro. Visit the M3 Conference website for complete program details and online registration.

Presented by leading experts and industry professionals, the educational sessions will help you understand and implement new payment and practice models, sharpen your leadership and management skills, adapt to changing technology and keep your practice ahead of the curve in the ever-changing world of health care. The Southern Regional AHEC designates this live activity for a maximum of 13.75 AMA PRA Category 1 Credit(s)TM.


  • Three consecutive days of relevant, cutting-edge educational sessions;
  • Social events and networking opportunities;
  • Engaging speakers and informative sessions on the most timely heath care issues;
  • Poster competition for medical students and residents;
  • Exhibit Hall with health care vendor products and services.

M3 is the place to be

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CMS Resuming Regular Medicare Revalidation Cycles

The Centers for Medicare and Medicaid Services (CMS) has completed its initial round of revalidations and will be resuming regular revalidation cycles. In an effort to streamline the revalidation process and reduce provider/supplier burden, CMS implemented several new revalidation processing improvements. CMS is making multiple attempts to notify enrolled providers of their revalidation due date. You must complete revalidation by your assigned due date to avoid a possible hold on your Medicare payment and deactivation of your Medicare billing privileges. For complete information, including FAQs, visit the CMS website.

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MACRA Resources and Information from AAOS

On April 27, 2016, the Centers of Medicare & Medicaid Services (CMS) released a proposed rule detailing for the first time the physician reimbursement framework required by the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. AAOS submitted formal written comments with state and specialty societies that can be found online here.

Find more MACRA news and resources at and email AAOS with any questions or concerns at

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e-Notification of New NCMJ Issues

As a North Carolina health care provider, you might find the North Carolina Medical Journal (NCMJ) to be of interest. A journal of health policy analysis and debate, the NCMJ covers a range of medical and public health topics. For example, 2015 topics included rural health, traumatic brain injury, patient and family engagement, evidence-based practice, and military health.

If you would like to be notified when new issues are available online, sign up at Your email address will only be used for new issue alerts.

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Registration opening soon!
2016 NCOA Annual Meeting
October 7-9 | Pinehurst

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