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BULLETINBULLETIN

BUNCOMBE COUNTY MEDICAL SOCIETY

President’s Message Bill McCann, MD

Volume XX * Issue I

While the work of BCMS may not grab headlines, I would like to assure you that the BCMS is actively engaged. The increased energy to support BCMS’ work is evident by the large number of physicians joining BCMS in the last four months: 27 in all! Over the past year, the leadership of the Society has been formulating a strategic plan that emphasizes its role as the physician’s voice. As your advocate, the Society strives to ensure that elected and community leaders clearly understand the concerns and opinions of physicians. To that end, BCMS leadership has been meeting with our local elected officials and has had frank and open discussions regarding the potential impact of changes in Medicaid and medical liability reform. We are exploring alternative, cost saving options to assist the state Medicaid program and continue to press for medical liability relief for physicians. BCMS remains in very close contact with our colleagues at the North Carolina Medical Society on these and other important legislative efforts.

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If you are like me, you are finding it harder and harder to keep up with all the news. Sometimes you just want to tune it all out and pretend it doesn’t exist. And yet, we can’t simply ignore all that is going on around us. The current economic crisis may very well prove to be the most dire since the Great Depression and our government’s response may rival that of FDR’s. At home, people are hurting. We are all seeing more and more patients who have lost their jobs or health insurance and are struggling to pay their bills. Unfortunately, some may choose not to buy necessary medications or delay receiving needed medical care. In the midst of all this, talk of health care reform is in the air. While the state struggles to balance its budget, Medicaid funding cuts may be in the offing. At the national level, President Obama’s budget includes a health care reserve fund for future changes to the health care system. The most recent stimulus package includes incentives and penalties to encourage physicians to adopt electronic health records. Locally, hospital-physician integration dominates many discussions. It’s enough to give you vertigo. During this challenging period, many are certainly asking, “What are my professional societies doing about this? What is the Medical Society doing about this?”

“We’re at a place called Vertigo” ~ U2 In this issue…

President’s Message.............................................1 MOST Form............................................................2 Alternatives to Layoffs ........................................3 Member Pursues Research & Teaching ............4 Where is Moldova?..............................................5 Emeritus Corner.....................................................5 HeartStrings Success ............................................6 Foundation Chair Report.....................................6 Health Care Reform.............................................7 Calendar of Events...............................................7 Asheville Cardiology & Health Parity..............8 BCMS Annual Meeting Review ..........................8 Staying Connected to Your Family ...................9 Dr. Charles Blair Parity Fund ..........................10 Dr. Brian Ling Memorial Scholarship..............10 American Recovery & Reinvestment Act .......11 Public Health Corner.........................................13 United We Stand ..............................................13 Welcome New Member Physicians................14

Bill McCann, MD

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On a more local level, BCMS leadership and members have formed a Physician-Hospital Relations Task Force. This Task Force has been meeting with medical staff leadership to improve communication and share member concerns. We remain in dialogue with the Hospital Administration regarding integration and other pressing topics. In addition, BCMS is working with other community groups and resources to ensure that patients in need can access health care. While the physicians of Buncombe County have always been extremely generous, the sheer volume of those in need may far exceed our philanthropic capacity. Innovative, collaborative solutions will need to be formulated and enacted post haste. Amidst all of this, BCMS will continue to provide our members educational offerings to help you stay updated and informed. Some of these will be traditional meetings while others may be video conferences or perhaps as downloads to your iPod. Whatever the medium, BCMS will keep you up to date. Hopefully, you won’t get vertigo.

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MOST Form Ellen Kaczmarek, MD, Extended Care Physicians

The MOST Form (Medical Orders for Scope of Treatment) has been in use in North Carolina since January 2008. I’m writing as a physician who has enthusiastically used the MOST document to understand the focus of the end-of-life care that my patients wish for themselves. It also provides an opportunity for a very specific discussion between patients and their families regarding choices in their on-going medical care. The North Carolina MOST form began as a collaborative research project in Western North Carolina in 2004 to explore how best to define and deliver desired end-of-life care. The project evolved into a medical-legal document adopted first by the NC Medical Society and then by the NC State legislature in October 2008. Unlike a patient’s Living Will/Advanced Directive statements, the MOST form is a medical order set that does not require further interpretation by the clinician who is currently treating the patient. It facilitates appropriate treatment across the spectrum of health care settings. The MOST form can be changed at any time upon the request of the patient/family and it must be re-viewed at least annually (and preferably any time there is a significant change of medical conditions). Who should have a MOST form? My strong feeling is that every patient who resides permanently in a long-term care facility needs a MOST document. This provides the medical/nursing staff a clear “road-map” of how to treat the patient, based on what the patient/family desires for care. Countless patients and families have expressed the belief that “my living will covers all of this.” Perhaps it does, but not in a forthright or accessible set of medical orders that can be easily followed. Another group of patients who should have a MOST form are those for whom you can say that you would not be surprised if they died within the next year. Consider those patients with progressive renal failure, congestive heart failure, end-stage COPD, and advancing dementias in this grouping. A caveat for using the MOST form with community-dwelling patients: certain aspects of the form (i.e., comfort measures only) often can’t be actualized without specific resources (like Hospice Care) in place. It may require an ER visit or hospitalization to be able to achieve the ultimate care that is desired. In my own practice as Medical Director at Highland Farms Retirement Community, 100% of the patients in the long-term care facility now have a MOST form. On admission, an informational packet explaining the MOST is presented to the patient/family. The social worker, trained to discuss the MOST form, follows up within the first few days of admission to explore the decisions made. When I have reviewed the desired care, I ensure that this is truly in concert with the desires that I have heard

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expressed by the patient. I then write the orders in the chart. When there is a disconnect between the diagnoses and the desired care, a conversation between the clinician and the patient/family needs to occur. The MOST form is posted on the chart and should any transfers be made to the ER/hospital, the MOST form accompanies the patient to ensure seamless care. In this way, patients have been allowed to choose full resuscitative efforts with transfer to the hospital for intensive care. Others have chosen “comfort measures” in the facility and have been allowed to stay in familiar surrounds to die peacefully when their time has come. With my outpatients at Highland Farms, I use the MOST form at their request, as a “template” for end-of-life care. I make a white copy of the hot-pink official MOST form and keep a copy on their charts. This allows them to speak to me frankly about their desired care when the “time comes” and they can also share specifics with their families. I specifically request that they share the information with their Durable Health Care Power of Attorney. “When my time comes, I want the system to have it right.” (Sen. Martha Walker, Chair, WV Senate Health Committee). As physicians, we can help our system have it right by utilizing the MOST form and helping our patients get the type of end-of-life care that they truly desire.

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Alternatives to Lay-Offs in a “Down” Economy It’s painful for any practice to consider laying off workers, and perhaps even more so for small practices where employees tend to become not only valued workers, but also friends. In an economic downturn, practices of all sizes search for ways to cut costs and reducing labor costs is often one of the first tactics considered. In a poll conducted by the Society for Human Resource Management last October, nearly half of the over 600 respondents reported employee layoffs in the prior year. Sixty percent indicated that layoffs were likely or somewhat likely to occur over the next 12 months. Other than layoffs, the two major tactics used to cut labor costs were attrition (72%) and hiring freeze (48%).1 You may be able to avoid layoffs altogether by implementing proven cost-reduction methods. First, look throughout your organization to identify cost cutting strategies that won’t harm your practice. If you must reduce your labor costs, there are alternatives to layoffs that you may want to consider first. Here are a few suggestions: 1. Be transparent. Uncertainty about job security nearly always affects productivity and morale. Clearly communicate to all

staff the purpose of any cost reduction strategies and engage everyone in the process. Employees often have good ideas and know where cuts can be made.

2. Freeze hiring. Existing staff may have a little more work, but knowing the alternative makes them willing to share the load. Use a staffing agency or outsource selected services so you are paying for this work only when needed, rather than through a recurring payroll expense.

3. Take a good look at job descriptions. Changing a job to revise or shift duties might prevent letting a valued employee go.

4. Reduce salaries, eliminate overtime, and consider variable pay options. This works best if done early, usually in the first few months of a downturn. A salary reduction may negatively affect morale, but employees prefer this to job loss. Some larger organizations reduce management pay first and at a greater percentage than that of non-management staff. Dedication may suffer after a pay cut, but it helps to know that everyone is pitching in. Another option is to reduce base salaries by a percentage and distribute any bonus or other annual payments over 12 months, adding that amount to employees’ monthly pay. This may provide staff with close to the same monthly income.

5. Shorten the workweek. A reduction in pay is more acceptable if the time at work is less. A 35- or 32-hour workweek reduces

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Carolyn Worthington, PhD, Consultant

1 www.shrm.org; SHRM Poll; Layoffs in light of 2008 challenges to the economy; 10/30/08; pp. 3, 10, 12.

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payroll in the short term, and a compressed workweek offers employees more time off. Despite less pay, most workers prefer this practice to job loss and productivity is not usually decreased.

6. Establish a leave policy and offer voluntary sabbaticals or business-condition furloughs. The cost of replacing an employee is far greater than the cost of a sabbatical. Most employees understand that a leave for a set period with reduced or no pay is better than being laid off. Benefits are still provided and the leave can be paid, partially paid, or unpaid. The duration of leave is solely at the employer’s discretion. A pay schedule for a leave might be a three-month leave at 50% pay; six months at 40%; nine months at 30%; or 12 months at 20%. A more cost-effective schedule might be three to nine month leaves at 30% pay. Staff could be allowed to take other jobs while on leave or encouraged to advance their education. Leaves do not have to be paid other than for exempt employees who have done any work for the employer during the week or are absent for partial days. An employer can decide if benefits are paid during leave and can have the employee contribute to the cost of continued coverage. Paid time off accruals can stop during the leave. Review any related plan documents, summary plan descriptions, written policies and procedures, and laws or regulations to ensure an integrated and compliant approach to providing leaves. Talk with an attorney or a human resource professional if help is needed.

7. Implement mandatory vacation. Having employees take some of their accrued vacation days at a designated time can cut labor costs in the short term. Some may not like this, but most will see it as some assurance of job security. Asking employees to take a set number of vacation days over several months gives them some flexibility to choose. Alternatively, they could take a set number of Fridays over several weeks as unpaid vacation.

8. Make all necessary job cuts at one time. If this can be done, it keeps staff from wondering, “Am I next?” Regardless of the methods you use to reduce labor costs, assure your employees that the channels of communication will remain open throughout the process. And, be sure to follow applicable regulations to keep your practice out of trouble.

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Dr. Worthington is a Senior Consultant at Strategic Workplace Solutions, LLC; www.strategic-workplace-solutions.com.

Asheville orthopaedic surgeon Gordon I. Groh was a full-time faculty member and director of shoulder and elbow surgery at the University of Colorado School of Medicine in Denver before joining Blue Ridge Bone & Joint in 1995. Today, in addition to his busy practice, Dr. Groh continues to actively pursue research and teaching opportunities. He has presented in every major city in the US, as well as in Mexico, Canada and in Japan at the 2008 annual meeting of the Japanese Society for Fracture Repair. Most recently Dr. Groh served as a member of the faculty for a three-hour surgical skills instructional course on reverse shoulder arthroplasty at the annual meeting of the American Academy of Orthopaedic Surgeons held in February. About 10,000 orthopaedic surgeons from around the world attended the conference, where Dr. Groh presented two scientific pa-pers: “The Treatment of Posterior Traumatic Sternoclavicular

Joint Injuries” and “Results of Treatment of Snapping Scapula with a Periscapular Muscle Strengthening Program.” Earlier this year, he served as faculty at the Tucson (AZ) Orthopaedic Institute Surgical Training Center for a course on shoulder arthroplasty as part of the Glenoid Exposure Mastery Series. The surgical training program included hands-on instruction with Dr. Groh in the facility’s state-of-the-art cadaveric learning center. Dr. Groh is a board-certified specialist in shoulder, elbow, and hand surgery and is one of only four orthopaedic surgeons in the US to hold memberships in both the American Shoulder and Elbow Surgeons and the American Society for Surgery of the Hand. For more information: www.drgordongroh.com.

BCMS Member Pursues Research and Teaching Opportunities in Addition to Busy Orthopaedic Practice

Gordon Groh, MD

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Where in the world is Moldova? WNC Interpreter Network

Buncombe County physicians periodically see patients who are Moldovan immigrants. Moldova has the largest number of citizens living abroad of any European nation. Many Moldovan immigrants to the US are religious refugees. Approximately 20,000 Moldovans have immigrated to the US since 1998 and several hundred live in our community. The following is a brief introduction to this population. Background Moldova, a country slightly larger than Maryland, is located on the southwestern border of the former Soviet Union, sandwiched between the Ukraine and Romania. It is a densely populated but mainly rural republic. Its long and troubled history has been shaped by successive conquerors, beginning with the Romans, followed by the Mongolians, Austro-Hungarians, Ottomans, Czarist Russians, and most recently the USSR. Moldova declared independence in 1991. Moldova and North Carolina Moldova became North Carolina’s Sister State in 1999 as part of the Partnerships for Peace between US states and the newly independent Soviet republics. The objective is to develop democratic values and economic, political, and military ties. Exchanges between medical professionals of both countries have also been active. In 2006, the twelve North Carolina medical libraries began a partnership with the Scientific Medical Library of Moldova. Over 7,000 current medical books and journals were shipped from North Carolina medical libraries to the Scientific Medical Library of Moldova. Language issues The population is approximately 4 million people. Ethnic Moldovans which account for 78% of the population are Romanian-speakers and share the Romanian culture. Sixteen-percent of the population use Russian as their first language. It is not uncom-mon within the same family to find grandparents who speak Romanian, parents who speak Russian, and adolescents who speak Romanian. It all depends on whether they learned the language before, during, or after the Soviet occupation. The Declaration of Independence states that the official language is Romanian whereas the Constitution names Moldovan as the official language. When requesting an interpreter for a Moldovan patient, this can be confusing…should you have a Moldovan or a Russian inter-preter? To best serve your Moldovan patients, let WIN help you figure this out. Call 828-274-0950 or email win@bcmsonline.org.

MOLDOVA

Emeritus Corner Robert A. Abernathy, MD, Internist (Ret.), Emeritus Member

When I started in solo practice as a young man I enjoyed the thrill of the practice of medicine. In those days I made house calls, which though very time consuming, were quite rewarding in satisfaction. My greatest coup was discovering the first case of psittacosis in the city of Richmond—occasioned by the observation that a couple of parakeets that had been in the house on a previous visit had died. Then there was the older gentleman with some heart trouble who quite unexpectedly became quite ill with cardiac insufficiency. I was really puzzled because he had been cautioned against salt. After he was rescued I sat there trying to determine the cause of his problem when he offered me a can of salted peanuts that he had been snacking on. As time progressed and I became affiliated with a hospital in Southwest Virginia the practice of medicine became also the practice of confrontation—with insurance companies, with Medicare, with the financial needs of the hospital, with the families of patients who declared that their particular family member was still too ill to be discharged despite what all the financial entities insisted. I started losing enthusiasm and finally threw in the towel and retired. Then came Free Clinics—currently ABCCM Medical Ministry. The joy of medicine returned. No more of the disagreeable stuff—just the pleasure of interviewing and treating sick people—and watching them improve. The staff there is tremendous, very caring, helpful and competent. The other doctors who also volunteer are real humanitarians. Mission Hospital and Project Access doctors, bless them all, are very helpful. Since we do not write for controlled substances, there is no more struggle with patients wanting narcotics and tranquilizers. It is a glorious experience! For me, it is much better than playing golf!

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I’ve sat a couple years now on the Foundation Board

And now follow in the footsteps of two great men who chaired before.

From Johnson to Hathaway the bar has been raised high

But if I can outdo them, you know I gotta try. Your Foundation Board slate looks great, full of big hitters. From Mims, as my second, to Landis, our big knitter. Jenkins and McCann are nothing to sneeze about And Wallenius keeps it cool, weighing all the options out. Our new doc is Steve Buie, we hope he’ll keep us on task. Susan Schriefer from the Alliance always has our back. Many thanks to Carroll Hughes, architect and treasurer And you gotta love Eller, pretty cool… for a lawyer. Bob Roberts holds the line, a fundraising machine David Blackmon makes sure that we always keep it clean. Good ole Doc Chambers, our dentist with heart Works with the team glad to do his part. With Miriam at the helm, our feisty-savvy leader combo And Jana the commander on the S.S. Project Access-O Althea, Queen Latina, keeping language lines clear With her posse of interpreters, always in high gear. From Project Access to WIN our reputation has been set And your team on the board will work with blood, tears

and sweat. For all you great docs out there who meet the needs of

Buncombe County Thanks for your dedication and sharing of your bounty. With the economy woes and unemployment yet to peak A lot of good people may find themselves up a creek. So when called upon for help, friends, do not groan, do not

whine Because probably more than ever, people will need us in ‘09. If you’d like to help us out, offer tips or your opinion The Project Access Task Force may by in your dominion. I look forward to the challenge and with that I will

adjourn Better watch out, next year may be your turn!

2009 Foundation Chair Report: A Lighthearted Prognosis

Shannon Dowler, MD

HeartStrings 2009: The Most Successful Year Yet!

Buncombe County Medical Society Foundation’s annual HeartStrings fund-raiser was a huge success, thanks to our volunteers, riders and sponsors. Partici-pants raise money for Buncombe County Medical Society’s Project Access, an initiative that provides free healthcare donated by area physicians and Mission Hospital to low-income, unin-sured patients in Buncombe County. Last year, Project Access physician volunteers and Mission Hospitals donated more than $14 million in free care. Since its inception, Project Access has helped over 15,000 patients find a medical home, and receive care they need—even life-saving specialty care—for free. This year, over 200 participants rode in teams of 10–20 riders. Teams included Asheville Anesthesia Associates, Asheville Cardiology Associates, Mission Hospital, Mission Medication Assistance, Extended Care Physicians, and the Buncombe County Health Center, as well as many business groups such Wachovia, Kimmel & Associates, CVS, Van Winkle Law Firm, and the Asheville Police Academy. Each rider was asked to raise at least $200 and ride with their team on stationary bikes for an hour during the 10-hour event. The goal was to raise $50,000 to purchase prescriptions for Project Access patients...but we actually raised over $56,000!

Thank You 2009 Sponsors

Partner in Health Asheville Anesthesia Associates

Champions for Access Asheville Cardiology Associates, CarePartners Health

Services, CVS Pharmacy, Deerfield Episcopal Retirement Community, WNC Magazine

Friends of Medicine Insurance Services of Asheville, Lynn & Bob Kieffer

Shannon Dowler, MD

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A New Era in Health Care Reform? Olson Huff, MD, FAAP

It should go without saying that all members of the medical profession are well aware that Health Care Reform is at the top of the agenda for the new federal government administration and indeed at the top of the list for most Americans. One small piece of that reform was evident on February 4, 2009 when President Obama signed into law the new State Health Insurance Plan. Formerly know as S-CHIP, the new designation is CHIRPA—Children’s Health Insurance Program Reauthorization Act of 2009. In many ways the new law extends what S-CHIP provided but those medical practices that deal with children would be well advised to study carefully this portion of health care reform as there are some substantial differences. Following are some specifics to note: • Significant new funding is provided that will carry the program through fiscal year 2013. Every two years there will be

“re-basing” that allows states who are using their funds well to receive the most funding.

• New initiatives to enroll the lowest income children are put in place. Many children already eligible for current Medicaid or, in the case of North Carolina, Health Choice, are not enrolled. Proposals such as “Express Lane” eligibility are designed to

increase the enrollment of those eligible children.

• Of significance is that the five year waiting period for legal immigrant children and pregnant women has been eliminated.

• New language in the law allows for more explicit coverage of pregnant women.

• Flexibility for states to expand their coverage is given. Reduction of matching rates from the federal government is however

reduced if states go above 300 % of the federal poverty level.

• Adult coverage is eliminated.

These are some of the very important changes to this critical safety net for children’s insurance coverage. It is anticipated that at least 4 million more children nationwide will now have coverage that they previously did not have. This is especially important for families who are financially stressed during these difficult economic times.

It is worth mentioning that most all medical societies and academies have advocated for just reimbursement for physicians, hospitals and allied professionals. It is critical to all to understand that increased opportunity to have insurance coverage does not fully equate to increased access to care. Only if providers are available and fairly reimbursed will full access be available. That is one part of reform that must be at the top of everyone’s agenda.

April 27 ............................................... BCMS Corporation Board Meeting, 6pm, Doubletree Hotel Biltmore

May 9 .............................................................................................. Asheville Prom, 8pm, The Orange Peel

May 12 ........................................... Emeritus Chapter Quarterly Luncheon, 11am, Country Club of Asheville

May 28 .................................................. BCMS Foundation Board Meeting, 6pm, Doubletree Hotel Biltmore

June 22................................................ BCMS Corporation Board Meeting, 6pm, Doubletree Hotel Biltmore

August 24...............................BCMS Delegation Meeting (delegates only), 5pm, Doubletree Hotel Biltmore

August 24............................................ BCMS Corporation Board Meeting, 6pm, Doubletree Hotel Biltmore

August 27.............................................. BCMS Foundation Board Meeting, 6pm, Doubletree Hotel Biltmore

September 27.....................................................................................Newcomers Picnic, 2pm, Taylor Ranch

September 28.......BCMS Corporation Board Executive Committee Meeting, 6pm, Doubletree Hotel Biltmore

October 29.............BCMS Foundation Board Executive Committee Meeting, 6pm, Doubletree Hotel Biltmore

November 16....................................... BCMS Corporation Board Meeting, 6pm, Doubletree Hotel Biltmore

November 19......................................... BCMS Foundation Board Meeting, 6pm, Doubletree Hotel Biltmore

November TBA ......................................................................BCMS Fall Conference, time and location TBA

Calendar of Events

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According to the US Dept of Health and Human Services, African-American women are 35% more likely than non-Hispanic white women to die from heart disease. Diabetes, high blood pressure, high cholesterol, lack of exercise, and smoking all put women at risk for heart disease. Studies have shown that African Americans don’t get the same care for heart disease as whites because they don’t get the same tests and treatments. (http://www.womenshealth.gov/minority/africanamerican/hd.cfm) This was part of the message that Dr. Lim of Asheville Cardiology Associates (ACA) brought to a group of African-American women at Nazareth First Baptist Church in March. As part of ACA’s ongoing community outreach efforts, they formed a part-nership with ABIPA (Asheville Buncombe Institute for Parity Achievement) to inform African-Americans about heart disease. ACA’s Education Coordinator, Leslie Council noticed that heart disease is not discussed frequently in the African-American community where hot topics are breast cancer, diabetes, or blood pressure. That’s unfortunate considering the statistics. To create awareness about this important topic, Dr. Lim donated his time to meet with this group of 15 senior citizens. Since every woman present was diabetic, he focused on how diabetes relates to heart disease. He suggested that they talk with their primary care physician about their risk for heart disease and ways they could diminish those risks. The women acknowledged that they didn’t know what questions to ask and were sometimes hesitant to do so. Dr. Lim offered some key questions and sug-gested that they write down their questions prior to going to a doctor’s visit. Dr. Lim also answered some personal medical ques-tions from the participants. The women were honored and impressed to have extensive one-on-one interaction with a physician. In further collaboration with ABIPA, Angela Moser (an ACA nurse) attended ABIPA’s PACE Diabetes Support group at Bethel 7th Day Adventist Church in March to discuss how diabetes relates to heart disease. By educating the community and increasing awareness of this important health issue, Asheville Cardiology Associates continues to close the gap of health disparities. For information on the work of ABIPA to address health disparities or to assist with their educational programs, visit: www.abipa.org. To learn more about Asheville Cardiology Associate’s outreach efforts, contact Leslie Council at 828-274-6000.

Asheville Cardiology Associates Working Toward Health Parity

BCMS’ 124th Annual Meeting & Celebration

The BCMS Annual Celebration was held January 24 at On Broadway. Over 130 physicians, spouses, and community leaders gathered to celebrate the 124th year of BCMS. Special guests included NCMS’s Bob Seligson and Steve Keene, Joe Damore (Mission Hospitals), and Keith Challenger (Crescent PPO). Thanks to our event sponsors: At the Champion for Access Level ($2,500): Crescent PPO, Mission Hospitals; at the Friend of Medicine Level ($1,000): HomeTrust Bank, Advantage Printing, and Carolina First Bank. Our very special event was made possible by these outstanding sponsors and supporters. Bill Hathaway (outgoing Foundation Board Chair), Shannon Dowler (incoming Foundation Board Chair), Alex Diez (Alliance Outgoing Co-Chair), Monica DeMatos and Heather Jarrett (Alliance Incoming Co-Chairs), Lorena Wade (outgoing Corporation President) and Bill McCann (incoming Corporation President), filled us in on BCMS’ outstanding accomplishments during 2008 as well as plans for 2009. Read Dr. McCann and Alex Diez’s speeches at http://www.bcmsonline.org/main/announcements/2009_annualmtg.php. We also paid tribute to Dr. Charles Blair with the formal unveiling of the Dr. Charles Blair Health Parity Fund, a collaborative effort between BCMS Foundation, Sisters of Mercy Services Corporation, Asheville Buncombe Institute of Parity Achievement, and Three Streams Family Health Center. For details, click http://www.bcmsonline.org/main/announcements/Blair_fund.php. We also approved the new slate of officers for the Corporation (http://www.bcmsonline.org/main/about/board_corp.php) and the Foundation (http://www.bcmsonline.org/main/about/board_found.php). There were some great giveaways during the raffle including massages, weekend packages at the Doubletree Executive Tower and The Forest, dinner and wine, even a yoga class. Dr. Sharon Hathaway won a weekend at the Doubletree. We hope she and Bill will really enjoy it. They deserve some R&R after Bill’s chairmanship of the Foundation in 2008!

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Following the meeting, BCMS members, staff, and their guests enjoyed a festive atmosphere and casual conversation as the mood shifted from business to pleasure. Party goers made multiple trips to buffet tables loaded with delectable food, wines and beer from around the world provided by Celine & Company and Mutual Distributing. Then to top off the evening, many guests sashayed onto the dance floor to shake, slide, shimmy and sway to tunes of all eras provided by DJs of Asheville. All who stayed for the social scene truly enjoyed themselves and finished the night with smiling faces. If you weren’t there, you missed a great party…but we’ll do it again next year! Thanks to all of you who came out to On Broadway and celebrated with us.

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Most people agree that their relationships with their spouses and children are what make life satisfying and meaningful. But it’s easy to let the demands of a job interfere with these important connections. How can you nurture your connections to your family when you’re up to your elbows in reports and household chores? Here are some simple guidelines for strengthening the bonds between you and your family members. Spend Time with Your Spouse or Partner In a two-parent family, your relationship with your spouse is the framework for the family structure. Intimacy is what makes this framework strong. Spend at least an hour of private time with your spouse every day, no matter how busy you are with work and parenting responsibilities. Even if you don’t have time for romance, this is a good time to talk about feelings and share news of the day. If you have something difficult to talk about, approach your mate when you’re both relaxed. Avoid bringing up challenging situations right when you or your spouse walk in the door after a hard day at work. Respect your spouse’s need for personal time, as well as togetherness. Learn to Nurture Your Children Children derive their sense of self-esteem from their relationship with their parents. They depend on their parents to set limits for their behavior and to provide good role models for expressing their feelings and behaving in a responsible manner. Healthy communication builds self-esteem. A child who can depend on the consistent, loving attention of a parent feels cared for, important and safe. One of the great joys of parenting is discovering and nurturing your child’s personality and passions. Plan time together to find out what makes your child happy. This will also give your child an opportunity to know you better. When you’re together, make simple listening and talking a priority. Try to forget about goals—the point of togetherness is to discover and appreciate each other, not necessarily to create the perfect craft project or to skate around the block. Do Things Together as a Family Make the most of family time. Schedule regular family meetings to assign chores and discuss family goals and problems. This is an excellent way to involve children in problem-solving, such as deciding how to spend a summer vacation, figuring out how to keep the living room neater or choosing a weekly dinner menu. Family fun and leisure activities also keep you connected. Take advantage of leisure time to get to know your children outside the normal time pressures of school and work schedules. Plan family vacations, weekend outings and other recreational activities that everyone can enjoy together. The fun of having a good time together or the thrill of a shared adventure will create family memories you can all enjoy for many years to come.

If you or your family is experiencing emotional or other problems, please call EAN to make an appointment with one of our licensed professionals. All interviews are kept strictly confidential.

800-454-1477 828-252-5725 www.eannc.com

Staying Connected to Your Family Employee Assistance Network

This article is brought to you by BCMS and the Employee Assistance Network (EAN). BCMS offers an affordable Employee Assistance Program (EAP) to BCMS members and their staff through a partnership with EAN. Practices pay one annual fee based on their number of employees. For details or to enroll for EAP services, contact Donna Wiedrich at 828-274-2267, ext. 313, email donna@bcmsonline.org.

BCMS/EAN Annual Enrollment Fees

1 - 5 employees $500 6 - 10 employees $750 11 - 15 employees $1,000 16 - 50 employees $1,500 51 - 75 employees $2,000 Over 75 employees Purchase directly from EAN

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Dr. Brian Ling Memorial Scholarship Fund The Buncombe County Medical Society Alliance has been honored to help Isabel achieve her dream as recipient of the 2008 scholarship. A graduate of Asheville High School, she is currently pursuing a degree in nursing at AB-Tech. Please help us continue this wonderful tradition in Dr. Brian Ling’s name by supporting our scholarship fund. Donations can be mailed to the BCMS office at 304 Summit Street, Asheville, North Carolina, 28803. Put “Dr. Ling Fund” in the memo line. Dr. Ling, a respected and devoted physician, served his patients with compassion, humor and interest in their lives. The BCMSA seeks to honor his spirit and dedication through the annual scholarship they award each May to a graduating senior from Buncombe County who is interested in pursuing higher education in the field of healthcare. Presently the scholarship committee is reviewing the many applications received from seniors throughout the county. Their goal is to give one $750 scholarship to the candidate they think best demonstrates the characteristics Dr. Ling embodied, including responsibility, respect, compassion for others, dedication, and honor.

“Since I was little I have dreamt of becoming a nurse, but my economic situation could prevent this dream of mine from becoming true.” “No one in my family

has attended college, and most of my relatives did not even finish high school. My parents and I would be very proud if I could attend college.”

Isabel Perez 2008 Dr. Brian Ling

Scholarship Recipient

Excerpts from Isabel Perez’s letter to the Brian Ling Memorial Scholarship Committee.

Dr. Charles Blair Health Parity Fund

The Froehlichs were a wonderful couple from Scarsdale, New York who had only one child. When she became a teenager, she developed a brain tumor. They established the Karen Froehlich Foundation to keep her memory alive. I did not have the opportunity to meet Karen. However, the Froehlichs selected me as the first recipient to receive the scholarship. Karen Froehlich’s memory lives on through me as others. I hope The Dr. Charles Blair Health Parity Fund can serve such a purpose.

A story from Dr. Blair—My first health career scholarship

Dr. Charles Blair, a talented doctor, compassionate healer, and visionary thinker in our community for many years, passed away on April 3 after his courageous battle with cancer. Since coming to Asheville in 1990, Dr. Blair was a staff physician at the Buncombe County Health Center and Sisters of Mercy Urgent Care. For many years, he served on the North Carolina Minority Health Advisory Council. The founder and medical director of the New Hope Community Health Center, Dr. Blair also served as medical director of the Three Streams Family Health Center. A pioneer working to bring quality healthcare to all, his persistent and passionate community service includes founding the Asheville Buncombe Institute of Parity Achievement (ABIPA). Dr. Blair treated people with compassion and worked tirelessly to achieve health parity in our community even when few others were committed to the cause. Late in 2008, the BCMS Foundation Board of Directors established the Dr. Charles Blair Health Parity Fund to honor his spirit and pass on his dedication to health parity. The Dr. Charles Blair Health Parity Fund will provide scholarships for African-American youth pursuing health careers. BCMS has partnered with the Sisters of Mercy Services, the Asheville Buncombe Institute of Parity Achievement (ABIPA), Three Streams Family Health Center, the Blairs, and others to raise at least $250,000 in funds and establish scholarship guidelines. Contribute to the Dr. Charles Blair Health Parity Fund We encourage you to make a gift honoring Dr. Blair’s leadership in working for health parity in Buncombe County. To contribute, send a check to Buncombe County Medical Society with “Dr. Blair Fund” in the memo line or go online to http://www.bcmsonline.org/main/announcements/Blair_fund.php.

Charles Blair, MD 1955-2009

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A financial plan is dynamic, something that is always changing and therefore needs to be routinely updated. Tax rules change so often that it is important to stay informed in order to take advantage of, and ensure that you are abiding by, the myriad tax regulations. There is no doubt you’ve heard much about the American Recovery and Reinvestment Act of 2009 (ARRA). Below is a summary of a few items in this act that may pertain to you or a family member. First Time Homebuyers Tax Credit The maximum amount of this credit is increased from $7,500 to $8,000, and the requirement to repay the credit is com-pletely removed if held for 36 months as a primary residence. It is a maximum of $8,000 for both individual and married couples, calculated as 10% of the purchase price. The credit is subject to a phase-out based on adjusted gross income (AGI). Individuals $75,000-$95,000; Married $150,000 to $170,000. American Opportunity Education Tax Credit For 2009 and 2010, the credit is $2,500 of the cost of tuition and related expenses paid during the taxable year. The credit will be subject to phase out for individual taxpay-ers with adjusted gross income (AGI) in excess of $80,000 and married taxpayers with AGI in excess of $160,000. If the credit results in a negative tax liability, up to 40% of the credit will be refundable. A refund of the credit will not occur if is for a child that will be subject to the “kiddie tax.” Families with 529 plans and Coverdell Savings Accounts they should plan to cover a portion of annual child expenses from their taxable accounts to be eligible to declare the credit. AMT Tax Relief Under the new rules, for 2009 only, the AMT exemption is increased to $46,700 for individuals and $70,950 for joint returns. Thanks to this one year exemption these various ARRA credits are allowed for both regular and AMT in 2009. Sales Tax Deduction for Vehicle Purchases Under the new rules for ARRA, taxpayers will be able to deduct the state and local sales taxes paid on the first $49,500 of new vehicle purchases. This applies to vehicle purchases occurring after February 17, 2009.

This deduction is phased out for single taxpayers with AGI in excess of $125,000-$135,000; married taxpayers with AGI of $250,000-$260,000. Making Work Pay Credit The credit provides a refundable credit of up to $400 for qualified working individuals and $800 for married families and is applicable for 2009 and 2010. Administered as an adjustment to IRS withholding tables allowing eligible tax-payers a slightly increased paycheck. ARRA also provides a $250 stimulus check that will generally go to seniors. If a joint return and both spouses are eligible, each will be receive $250. Eligibility is determined if receiving Social Security, RR retirement, Veterans Compensation or State and Federal pension. Please consult your financial advisor or tax advisor for details of these new regulations and how they may affect you. For more information:

Rick Manske, CFP® Managing Partner 888-877-1012 rmanske@parsecfinancial.com

Parsec Financial was founded in 1980 and as of 1/31/09 we managed over $699,900,000 in client assets. We currently serve clients in 36 states from our offices in Asheville and Charlotte, North Carolina. Our firm has been included in Bloomberg’s annual list of top wealth managers for the past seven years, and Bart Boyer has been listed several times by Medical Economics magazine as one of the top 150 financial advisors for doctors. In addition, he appeared on the cover of Worth Magazine in 2002.

Disclaimer: This article is submitted by our sponsor and is intended for educational purposes only. BCMS takes no

responsibility for advertisers' claims or offerings.

A Summary of the American Recovery and Reinvestment Act of 2009

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United We Stand

The BCMS Corporation, Foundation, and Alliance had drifted apart until 2008 when BCMS leadership from these three entities came together to unify the organization, driving home the single message that BCMS is the physicians’ voice for the health of the community. We are proud to share with you some of the elements of our unified identity!

• Mission: The Buncombe County Medical Society is the physicians’ voice advocating for the health of the medical profession, the health of the patient, and the health of the

community.

• Vision: To be a dynamic physician community dedicated

to a healthy, vibrant Western North Carolina.

• Values: Integrity. Quality. Compassion. Diversity.

Innovation.

Disease reporting Recently a local provider saw a young unvaccinated student with a rash and fever and made a clinical diagnosis of Rubella. However, the provider did not notify BCHC about the child and the child returned to school. When we discovered this informa-tion we immediately got involved and excluded the child from school and had a blood test done for Rubella IgM antibodies. We also had to exclude other unvaccinated children at the school pending the lab results. Luckily the test was negative. This situation highlights several important disease reporting issues. We need providers to report to us as soon as the diagnosis

is suspected in diseases that require immediate or within 24 hours reporting. At that time we can help you with making the diagnosis and start our investigation to protect others who might be at risk. Proper reporting is so important for us to be able to do our job to protect the public. Remember that social distancing is a valuable tool to prevent spread of infectious disease. Our disease control nurses are experts in this situation and are available 24/7 at 828-250-6565. During regular working hours call 828-250-5109. Here are links to information about disease reporting (http://www.epi.state.nc.us/epi/gcdc.html) and an electronic version of the Clinician Guide to Disease Reporting (http://www.bcmsonline.org/main/files/09_clinician_guide.pdf). Changes in Primary Care Buncombe County is moving forward with a plan to provide primary care services for our uninsured and underinsured adults and children in Buncombe County through a partnership with Western North Carolina Community Health Services (WNCCHS). The decision to do this comes after a careful and thorough financial analysis of the best way to use county dollars to deliver health care services. As many of you know, the federal model we are working under encourages communities to use the Federally Qualified Health Center (FQHC) structure to deliver services. With this change the BCHC will be strengthening the Health Department core services. For more information, see the following links:

• http://www.bcmsonline.org/main/files/2009_mandy_stone_ltr.pdf

• http://www.bcmsonline.org/main/files/09_restructure_concept_summary.pdf

• http://www.bcmsonline.org/main/files/09_10essential_services.pdf

We are still in the early planning stages of this change. We will be doing everything we can to make this a positive transition so that the current Primary Care patients at BCHC will not have a disruption in services. With the additional funding available for WNCCHS, our goal is to expand access to care for the un- and underinsured residents of Buncombe County. The County will continue its financial commitment to serving the health care needs of the public by investing county dollars currently used to provide services at the health center into this new partnership. http://www.buncombecounty.org/governing/commissioners/ArchivedAgenda/20090303/web_PDF/adultprimarycardppt.pdf

10 Essential Services of Public Health

Public Health Corner Steve Swearingen, MD, BCHC Medical Director

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14

Welcome New BCMS Members

Richard R. Burris, MD (Family Practice) Dr. Burris received his Bachelor’s Degree from Appalachian State University. He received his Medical Degree from East Carolina University School of Medicine. Dr. Burris went on to complete his internship and residency at the MAHEC Family Practice Residency Program. Dr. Burris is associated with Arden Family Health Center. Gregory H. Campbell, MD (Internal Medicine) Dr. Campbell received his Bachelor’s Degree from McGill University. He received his Medical Degree from the Medical College of Georgia. Dr. Campbell went on to complete his internship, residency and fellowship at Tufts New England Medical Center. Dr. Campbell is associated with Asheville Pulmonary & Critical Care. Colby G. Colasacco, MD (Critical Care Pediatrics) Dr. Colasacco received her Bachelor’s Degree from the University of North Carolina at Chapel Hill. She received her Medical Degree from UNC at Chapel Hill School of Medicine. Dr. Colasacco completed her internship and residency at the University of California at San Diego. She has also completed Fellowships in Pediatric Critical Care at the University of Virginia and University of California at San Diego. Dr. Colasacco is associated with Mission Children’s Clinic. Randall K. Cope, DO (Internal Medicine) Dr. Cope received his Bachelor’s Degree from Thomas Jefferson University. He received his Doctor of Osteopathic Medicine Degree from Des Moines University. Dr. Cope then completed his internship and residency in Internal Medicine at the University of Iowa at Des Moines and Iowa Methodist Medical Center. Dr. Cope is associated with Asheville Hospitalist Group. Rory R. Dalton, MD (Pathology) Dr. Dalton received his Medical Degree from the University of Alabama School Of Medicine in Birmingham. Dr. Dalton went on to complete his residency at the Medical College of Georgia. He has also completed a fellowship at Fox Chase Cancer Center. Dr. Dalton is associated with Mountain Area Pathology, PA.

Robert H. Dowdeswell, MD (Pathology) Dr. Dowdeswell received his Medical Degree from the Medical University of South Carolina College of Medicine. Dr. Dowdeswell then completed his internship and residency at the Medical University of South Carolina. Dr. Dowdeswell is associated with Mountain Area Pathology, PA.

Laura E. Dressel, MD (Family Practice) Dr. Dressel received her Bachelor’s Degree from the University of Georgia. She received her Medical Degree from the Medical College of Georgia. Dr. Dressel then completed her internship and residency at the MAHEC Family Practice Residency Program. Dr. Dressel is associated with Asheville Family Health Center.

Jennifer D. Dukowicz, MD (Internal Medicine) Dr. Dukowicz received her Bachelor’s Degree from Georgetown University. She received her Medical Degree from Tufts University School of Medicine. Dr. Dukowicz went on to complete her internship and residency at Beth Israel Deaconess Medical Center. Dr. Dukowicz is associated with Asheville Internal Medicine. Elizabeth S. Garbarino, MD (Obstetrics/Gynecology) Dr. Garbarino received her Bachelor’s Degree from the University of Richmond. She received her Medical Degree from the University of Tennessee College of Medicine. Dr. Garbarino completed her internship and residency at The Ohio State University. Dr. Garbarino is associated with Biltmore OB-GYN, PA.

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Welcome New BCMS Members

Jennifer J. Hall, MD (Family Practice) Dr. Hall received her Bachelor’s Degree from the University of North Carolina at Chapel Hill. She received her Medical Degree from the Medical College of Georgia. Dr. Hall completed her internship and residency at the MAHEC Family Practice Residency Program. Dr. Hall is associated with North Buncombe Family Medicine. Margaret A. Harper, MD (Maternal & Fetal Medicine) Dr. Harper received her Bachelor’s Degree from the University of North Carolina at Chapel Hill where she also received her Medical Degree. Dr. Harper went on to complete her internship at the University of Rochester. She has completed residencies at Highland Hospital of Rochester, NY and Wake Forest University School of Medicine, where she also completed a Fellowship. Dr. Harper is associated with MAHEC Regional OB/GYN Specialists. Shaw C. Henderson, MD (Pulmonary Disease & Critical Care/Internal Medicine) Dr. Henderson received his Bachelor’s Degree from Williams College. He received his Medical Degree from the University of Vermont College of Medicine. Dr. Henderson completed his internship and residency at the University of Utah. Dr. Henderson is associated with Asheville Pulmonary and Critical Care.

Paul E. Iacono, MD (Pediatrics) Dr. Iacono received his Bachelor’s Degree from Clemson University. He received his Medical Degree from the University of South Carolina School of Medicine. Dr. Iacono went on to complete his internship and residency at Richland Memorial Hospital in Columbia, SC. Dr. Iacono is associated with Children’s Developmental Services Agencies. Cameron J. Kurowski, MD (Family Practice) Dr. Kurowski received his Bachelor’s Degree from the University of Virginia. He received his Medical Degree from Wright State University in Dayton, OH. Dr. Kurowski went on to complete his internship and residency at MAHEC Family Practice Residency Program. Dr. Kurowski is associated with Hominy Valley Family Health Center.

Craig H. Linger, MD (Internal Medicine) Dr. Linger received his Bachelor’s Degree from the University of Colorado. He received his Medical Degree from Vanderbilt University. Dr. Linger then completed his internship and residency at the University of Alabama at Birmingham. Dr. Linger is associated with Mountain Medical Associates.

Mark T. Mason, MD (Psychiatry) Dr. Mason received his Bachelor’s Degree from the Georgia Institute of Technology. He received his Medical Degree from the University of Tennessee at Memphis. Dr. Mason went on to complete his internship at West Suburban Hospital in Oak Park, IL. He completed his residency at the University of Tennessee at Memphis. Dr. Mason is associated with the Julian F. Keith Alcohol & Drug Abuse Treatment Center. Daniel P. Meigs, MD (Emergency Medicine) Dr. Meigs received his Bachelor’s Degree from the University of North Carolina at Chapel Hill. He received his Medical Degree from Wake Forest University School of Medicine. Dr. Meigs completed his internship and residency at George Washington University’s Department of Emergency Medicine. Dr. Meigs is associated with Carolina Mountain Emergency Medicine, PA. Christopher G. Meyer, MD (Rheumatology/Internal Medicine) Dr. Meyer received his Bachelor’s Degree from Northern Arizona University. He received his Medical Degree from the University of Arizona College of Medicine. Dr. Meyer went on to complete his internship, residency and fellow-ship at Duke University Medical Center. Dr. Meyer is associated with Asheville Arthritis & Osteoporosis Center.

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Holly C. Musgrove, MD (Family Practice) Dr. Musgrove received her Bachelor’s Degree from Auburn University. She received her Medical Degree from Wright State University in Dayton, OH. Dr. Musgrove went on to complete her internship and residency at MAHEC Family Practice Residency Program. Dr. Musgrove is associated with Hominy Valley Family Health Center.

C. Britt Peterson, MD (Psychiatry) Dr. Peterson received his Bachelor’s Degree from North Carolina State University. He received his Medical Degree from the University of North Carolina at Chapel Hill School of Medicine. Dr. Peterson went on to complete his internship and residency at University of New Mexico Hospitals. Dr. Peterson is associated with Mission Psychiatric Services. Teresa T. Pham, MD (Pathology) Dr. Pham received her Medical Degree from Louisiana State University School of Medicine. Dr. Pham then completed both a residency and fellowship at Duke University Medical Center. Dr. Pham is associated with Mountain Area Pathology.

Harold C. Poston, Jr., MD (Pathology) Dr. Poston received his Medical Degree from the Medical University of South Carolina. Dr. Poston went on to complete his residency at the Naval Hospital and University of California at San Francisco. Dr. Poston is associated with Mountain Area Pathology.

Vicky L. Rholl, MD (Pathology) Dr. Rholl received her Medical Degree from University of Minnesota School of Medicine. Dr. Rholl went on to complete her residency at Tripler Army Medical Center in Honolulu, HI. She also completed a fellowship at the National Naval Medical Center in Bethesda, MD. Dr. Rholl is associated with Mountain Area Pathology.

Melita A. Ritter, MD (Anesthesiology) Dr. Ritter received her Bachelor’s Degree from Wright State University. She received her Medical Degree from Medical College of Ohio at Toledo. Dr. Ritter then completed her internship and residency at the Medical College of Ohio. Dr. Ritter is associated with Asheville Anesthesia Associates, PA.

Mark A. Rorie, MD (Cardiovascular Disease/Internal Medicine) Dr. Rorie received his Bachelor’s Degree from the University of Mississippi. He received his Medical Degree from the University of Mississippi Medical Center. Dr. Rorie went on to complete his internship and residency at Wake Forest School of Medicine. He has also completed a fellowship at the University of Kentucky Chandler Medical Center. Dr. Rorie is associated with Asheville Cardiology Associates, PA. Melissa A. Thingvoll, MD (Pediatrics) Dr. Thingvoll received her Bachelor’s Degree from the University of Rochester. She also received her Medical Degree from the University of Rochester. Dr. Thingvoll completed her internship, residency and fellowship at the University of Rochester. Dr. Thingvoll is associated with Olson Huff Center for Child Development.

Joseph E. West, MD (Pulmonary Disease & Critical Care/Internal Medicine) Dr. West received his Bachelor’s Degree from Emory University. He received his Medical Degree from the Medical College of Georgia. Dr. West went on to complete his internship and residency at Greenville Memorial Hospital. He also completed a fellowship at Wake Forest University Baptist Medical Center. Dr. West is associated with Asheville Pulmonary and Critical Care.

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Welcome New BCMS Members

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