President’s Message

THE BULLETINTHE BULLETINTHE BULLETIN

BUNCOMBE COUNTY MEDICAL SOCIETY

Bill McCann, MD

Volume XX * Issue III

community is going to have to face these new realities, and just as every community is unique, the solutions to coping with these realities need to be unique as well. BCMS is one of the most active, engaged, and creative county (and now regional) medical societies in the state and, I would wager, across the country. BCMS and its physician members have a tremendous reputation for developing innovative solutions to difficult problems. BCMS’ Project Access has become a national model for providing care to the uninsured in the community. The success of Project Access lies in the spirit of leadership, compassion, and cooperation of our members. As we focus on the future, I would implore all of you to again come together and help design an innovative approach to ensure that the people of Western North Carolina continue to receive the world class care to which they are accustomed.

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When I took over as President of BCMS last January, I knew that the upcoming year would be full of change. As my tenure nears its close, I look back and realize the degree to which I underestimated how much transformation would occur in a few short months. On a local, regional, state, and national level, so much in the realm of healthcare has transpired. Undoubtedly, this is just the beginning. As the national healthcare reform debate draws to a climax, the down stream consequences will affect us all in the years to come. All of these rapid changes have brought us both positive and negative results. On the positive side, changes have brought about a renewed sense of vision, purpose, innovation, and leadership at BCMS that has propelled our society forward on many important fronts. For example, we are thoroughly educating ourselves about different models of physician-led partnerships to align ourselves for the future. With partner organizations, we’re exploring the ins and outs of health information technology. We are expanding our horizons and regionalizing to establish a WNC physician network. These are only a handful of examples of the strategic work of BCMS that will position us favorably for the future. On the flip side, local issues this past year have caused much angst and concern in our medical community. Unfortunately, they have also created tensions and divisions. As the new year approaches, it is my earnest hope that we can all move forward in a renewed spirit of collegiality, respect, and cooperation. Healthcare as we now know it will not exist in the near future. We are entering an age of integration, accountable care, and, yes, cost cutting. Every

In this issue… President’s Message............................................ 1

BCMS Staff Updates........................................... 2

Foundation Chair Report .................................... 3

Project Access Updates....................................... 3

What Has BCMS Done in 2009?...................... 4

2009 Legislative Session Brief.......................... 5

In Gratitude .......................................................... 6

News from WIN ................................................... 7

Retrovirus Linked to Chronic Fatigue................ 7 Public Health Corner .........................................10

Attention Physicians ...........................................10

Calendar of Events ............................................11

Managing Stress the Mindful Way................12

HeartStrings 2010.............................................12

Fall Conference Recap .....................................13

Welcome New Members..................................14

Bill McCann, MD

“Change is inevitable—except from a vending machine.”

~Robert C. Gallagher

BCMS is the physicians’ voice advocating for the health of the medical profession, the health of the patient, and the health of the community.

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Amidst all the talk of integration, bundled payments, and public options, I believe that true healthcare reform starts by refocusing on the most essential element of healthcare, the patient. I doubt any of us went to medical school to learn how to navigate insurance company bureaucracy or understand Medicare SGR formulas. We got into medicine to treat patients, so let’s start with them. How do we change the way we deliver care, from the office to the hospital to the lab or pharmacy to make the system more patient friendly? How do we build systems that ensure that patients have the right test at the right time and for the right reasons? How do we coordinate care and collaborate with each other better to ensure optimal outcomes for our patients? I do not pretend to know the answers to these questions and, honestly, I don’t think any one person has the answers. However, as a community of incredibly talented, caring doctors, we can, together, find the solutions that best fit our community. BCMS, YOUR medical society, is here to facilitate this dialogue and move forward. Please join us. Now more than ever is the time for us to work together for a better future. Join BCMS in advocating for the health of the medical profession, the health of our community and, most importantly, the health of our patients.

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A departure… It is with a mixture of sadness and happiness that BCMS announces the recent departure of one of our most beloved staff members, Althea Gonzalez. While we regret our loss, we are happy that she is entering an exciting new phase of her life that seems to be a great fit for her. Althea is now serving as the NC Manager with Hispanics in Philanthropy, working with funders and grass-roots Latino organizations across our state. In her four-year tenure with Buncombe County Medical Society, Althea Gonzalez transformed our organization with her vision, drive, and passion. Althea was instrumental in creating the WNC Interpreter Network and the Asheville Buncombe Institute for Parity Achievement. Althea also helped expand the Shrimp Picnic fundraiser, which raises funds for the BCMS & Alliance Endowment. Her profound understanding of the healthcare system and determination to make a difference with her work made her an enormous asset to BCMS and to Buncombe County as a whole. Althea will be greatly missed. Hispanics in Philanthropy is fortunate to have her on board.

A promotion…

BCMS is delighted to inform you that Jana Kellam has been promoted to Director of Foundation Programs, a role that will be critical to the Foundation’s future success, given Althea Gonzalez’s departure, the changing landscape of local healthcare systems, and the growing complexities of the Foundation’s various programs. Jana has been the Manager of Health Access Programs since October 2007. As Director of Foundation Programs, she will continue to be responsible for the operation of Project Access and its associated grants. In addition, Jana will direct the Western North Carolina Interpreter Network (WIN) and its expansion into Henderson County, and coordinate BCMS & Alliance Endowment activities. Jana and Miriam will be working to shape the future of the Minority Medical Mentoring Program, the Dr. Charles Blair Minority Scholarship Fund, and other fledgling programs. Miriam will continue to act as Director of the Foundation at large as there are additional financial, marketing/PR, and community-based responsibilities to running the Foundation. Please join us in congratulating Jana on this well-deserved promotion.

Buncombe County Medical Society Staff Updates

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It’s hard to believe a year has passed since I stepped into the role of Foundation Chair. Locally so much has happened in the areas we focus on in the Foundation. We received funds to support the expansion of Western North Carolina Interpreter Network (WIN) into Henderson County and that program has begun to garner state-wide attention for innovation! This year’s passing of Dr. Charles Blair, a champion for addressing health disparities, created an opportunity to establish a scholarship in his honor to encourage minorities seeking higher education to become physicians and mid-level providers. And who would have guessed at this time last year we would be witnessing the outsourcing of adult primary care from Buncombe’s health department to Buncombe’s Federally Qualified Community Health Center (called Western North Carolina Community Health Services, or WNCCHS)? While change is often accompanied by anxiety, WNCCHS promises to afford healthcare access to more uninsured and underinsured patients than did the health department and is also funded to contract directly with specialty care providers for the patients who need such care. BCMS is very glad to learn from WNCCHS that specialty care physicians will be paid under contract to see WNCCHS referrals, including the uninsured, as resources allow. WNCCHS has been careful to note that this arrangement helps but most certainly will NOT solve the problem of access to care for the uninsured. The BCMS Project Access network of care is still desperately needed by other safety net providers such as ABCCM, Three Streams, Sisters of Mercy, Emma Clinic, ABIPA, MAHEC, and the emergency department. BCMS physicians and PA staff are in the throes of brainstorming and strategic planning with these community partners to anticipate how Project Access will morph to meet future needs. We will keep you posted. Also of note, the NCMS House of Delegates recently adopted BCMS’ resolution to offer tax incentives to physicians who donate medical care to patients. As I transition into my new position as the medical director for Blue Ridge Community Health Services, a sister Federally Qualified Health Center (FQHC) in Henderson County, it has become clear that it is time to step down from my position as volunteer medical director for Project Access. In the course of this year we realized how integral the role of Foundation Chair is to the Medical Director of Project Access and, beginning in 2010, those roles will be merged and I will turn over the leadership to the infinitely able Dr. Susan Mims. As I step down from this role, I want to extend a very heartfelt thank you to the many doctors out there who give tirelessly of themselves providing care for the indigent. Your generosity of time and spirit made my role in Project Access a pleasure. Working now in Henderson County, a community without an organized physician-led system of charity care, I have a renewed appreciation for the power of this program to achieve greater health outcomes and reduce the burden of the uninsured. It is not only great, the work that you do, it is awesome. I thank all of you who have sat on the Foundation Board, the Development Council, and the Corporation Board for your volunteer hours to support the success of the physicians of Buncombe County. As we regionalize, I am honored to remain on the Foundation Board as a regional representative. Lastly, it is imperative to applaud the work of the dedicated staff of the Medical Society. They are cheerleaders and advocates for every physician they represent while working to improve access to quality healthcare for the people of Western North Carolina.

Foundation Chair Report Shannon Dowler, MD

Shannon Dowler, MD

Adjusting to a changing landscape As Dr. Shannon Dowler, our Project Access Volunteer Medical Director and Foundation Chair, mentioned in her message, we are working diligently to ensure that Project Access remains focused on helping physicians give back to our community. In an effort to address the changing face of healthcare in Buncombe County with the Health Center and WNCCHS transition, BCMS Project Access has assembled a Task Force of physicians and other community members to look at ways that our program can

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Project Access Updates Jana Kellam, Director of Foundation Programs

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continue to provide care for those who slip through the cracks. We value our partnerships with Buncombe County and the other safety net providers and will keep you informed of our progress with the planning. BCMS Project Access continues to be committed to working with the County to implement Medicaider as the primary eligibility screening and enrollment tool for our program and other County programs. Our goal is to be able to offer this screening for BCMS members above and beyond the screening that will be done for Project Access patients. This should allow us to find payer sources (Medicaid or Medicare) for qualifying patients, decreasing the amount of unpaid work you do in your office. Greater efficiency Project Access is working to become more efficient. One of our efforts is a new program called “Prompt Patient” which will be launched in early 2010. This tool will encourage increased compliance with patient appointments, patient notifications, and enrollment renewals. The Prompt Patient system will dial out to patients’ phones with prerecorded messages reminding them of appointments and renewals. This system will also be used to follow up with a patient following a known scheduled appointment to ask for their follow up visit information. We hope this low cost tool will enhance our ability to keep patients with ongoing medical needs properly enrolled and documented as well as assisting with patient notifications and tracking. Research & program funding BCMS is continuing its work with researchers from Wake Forest University Law and Public Policy Department who have received a Robert Wood Johnson grant to research safety net systems that will help inform national deliberations on the optimal structure and funding for the uninsured. We are encouraged by their vast knowledge of the healthcare system in general and specifically regarding Buncombe County. The study results are expected in 2010. BCMS Foundation was notified that our state HealthNet grant funding for our Life Skills Coach will continue for a third year. We have seen wonderful changes in the lives of Project Access patients our Life Skills Coach has helped, so we look forward to seeing even more growth and positive outcomes going forward. Stay in touch With the departure of Althea Gonzalez (former Manager of Parity Programs), my role has shifted to Director of Foundation Programs (read more on page 2). As always, if you ever have a question, comment, or concern about BCMS Project Access or any other Foundation program, feel free to contact me at 274-6989 ext 305 or jana@bcmsonline.org.

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Information/Education • Distributed e-newsletters and The Bulletin to keep physicians, practice managers, and community leaders updated on events,

news, articles of interest, resources, and job opportunities. • Held informative and timely educational sessions on physician-led private practice joint ventures, including multi-specialty

practice, federated umbrella model, and clinical integration. • Established a BCMS Facebook Page and Twitter feed for up-to-date information. See the right-side of our home page for

links. • Collaborated with the public health community to push out to private practices information and issues of population health

and emergencies. • Monitored health information technology updates and ensured BCMS representation at HIT (Health Information Technology)

forums. • Partnered with WNC Medical Managers Association to present a timely, informative Fall Conference focused on healthcare

reform, physician-led collaborations & joint ventures for private practices, health information technology, and more.

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What Has BCMS Done for You in 2009? Miriam Schwarz, CEO

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Professional Regulation S958 – Due Process/NC Medical Board Disciplinary Procedures (Nesbitt, D-Buncombe) • Requires the Board’s process to be transparent • Requires notice when an investigation is initiated • Requires an investigation lasting more than six months to be justified by the Board in writing • Requires the Board to communicate through licensee’s counsel • Bans Board members from initiating an investigation on their own • Bans Board members from serving as expert witnesses for the prosecution H703 – Disapprove NC Medical Board Profile Rule (Glazier, D-Cumberland) • Increases threshold for publishing a medical malpractice settlement from $25,000 to $75,000 • Effective date changed to May 2008 Scope of Practice Below are seven of the most significant scope bills filed during the 2009 Legislative Session:

H1195 – Definition of Surgery/Optometry (England, D-Rutherford) S1043 – Licensure of Naturopathic Doctors (Kinnaird, D-Orange) H1374 – Physical Therapy Modernization Act (Gibson, D-Anson) H333 – Licensure of Certified Professional Midwives (England, D-Rutherford) H1122 – Licensure of Colon Hydro Therapists (Insko, D-Orange) H842 – Consumer Health Freedom Act (Parmon, D-Forsythe) H746 – Licensed Professional Counselors Practice Act Update (Insko, D-Orange)

Insurance Regulation S877 – Health Plan Provider Contracts/Transparency (Clodfelter, D-Mecklenburg) • Bans unilateral changes to fee schedules during the term of a contract • Requires the use of a provider identified contact person to receive fee schedule amendments H1297 – Provider Credentials/Insurer Contracts (Stewart, D-Nash) • Requires the issuance of a temporary credential if the insurer fails to complete the credentialing process within six months

of application • Provides additional details about notice delivery when dealing with fee schedule amendments • Exempts hospital-owned physician offices from inspection by the Division of Health Service Regulation Medical Malpractice Reform NCMS continues to advocate for positive medical malpractice reform in North Carolina. Here are a few examples of our collaborative work with legislators in 2009: • 13 positive bills introduced this session by both Republicans & Democrats in both chambers • Data collection has vocal, bipartisan support in the Senate • Collateral source could be a part of a House bill pending in the Senate during the Short Session Budget: HHS Cuts • Medicaid provider rates cut by $76 million • New cost containment initiatives coming soon • Safety Net funding restored • Mental health funding reduced • Rural & mental health physician recruitment funding reduced or eliminated

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2009 NCMS Legislative Session Brief Chip Baggett

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Certificate of Need H436 – Fairness in CON Determination/Inflation Adjustment (Folwell, R-Forsythe) • Some CON exemptions are driven by spending thresholds that are not regularly adjusted • Some thresholds apply to institutions while more onerous thresholds apply to physician services • H436 would have originally expanded the threshold exemptions for institutions while not addressing any physician services

thresholds • NCMS opposed the original draft and helped to modify the bill so that it did not adversely affect physicians S804 – CON Changes (Rand, D-Cumberland) • Blocks the agency from issuing a new CON until the appeals process has been exhausted • Allows the non-appealing party to request a bond up to $300,000 (previously $50,000) Budget: New Taxes • Corporate taxes rate will increase by 3% • Income taxes will increase by 2 to 3% • Sales taxes will increase by 1% • Beer, wine & cigarette taxes will increase slightly Public Health H2 – Prohibit Smoking in Certain Public Places (Holliman, D-Davidson) • Bans smoking in restaurants and bars • Exempts private clubs H1296 – Establish Drug & Medical Device Repository (Stewart, D-Nash) • Allows for donations of unused products to the uninsured • Distribution through local Free Clinics

Chip Baggett is the Director of Legislative Relations for the North Carolina Medical Society.

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In gratitude for all you do for our community

We know that BCMS asks for your help and support many times during the year. We solicit your donations for fundraisers or charitable funds—the Phantom Ball and the Endowment Fund to name just two. We ask you to join in fundraisers—shooting hoops for Sawbones vs. Jawbones or sweating it out for HeartStrings. We call on you to volunteer your skills and resources—as members of committees and boards, and, of course, as providers for patients enrolled in Project Access. In these ways and so many more you repeatedly say “yes” to our requests, doing what you can to serve the healthcare needs of our community.

So, for at least once this year, we don’t want to ask you for anything. We simply want to offer each of you our heartfelt gratitude for who you are and the many, many things you do for BCMS and the community at large!

Thank You from the BCMS Staff! Miriam Donna Jana Christie Denise Elena

Laura Melinda Robert Sheri Shonnie

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The WNC Interpreter Network (WIN) has undergone many changes this year. As the beneficiary of a BlueCross BlueShield grant, WIN contracted with a consultant to help the network move beyond a dependency on grant funding to self-sufficiency. The consultant, who owns an interpretation and translation business, proposed changes to bring WIN more in line with other similar businesses around the country. Some revisions were minor and easy to make, others are more complex, and will take time to implement. The following are some of the changes that have already been made to the WIN system: • Billing cycle is now monthly, rather than bi-monthly. • Rates, which had not changed since 2005, have gone up $5.00 an hour. • BCMS members receive a discounted rate. • Rate categories have been added: off-hours (including before and after hours and weekends) and less-common-languages

(everything other than ASL, Spanish, and Russian). • Some minor changes were made to interpreter pay, which had not been changed since 2005.

In an effort to keep prices low for BCMS members, WIN is looking to expand into new markets and other WNC counties. WIN recently sent a mailing to Henderson County practices explaining WIN services and began recruiting Hendersonville interpreters. Blue Ridge Community Health Services in Hendersonville has been a huge help, providing advice and guidance as we expand. In 2010 and beyond, WIN hopes to implement more changes toward our goal of becoming a self-sustaining program, including: • 24/7 answering service • Expanded translation services • More internal operational changes to make work more efficient WIN helped The North Carolina Professional Interpreters Association administer the interpreter certification pilot test in Asheville. We hope that next year, Spanish interpreters will be able to become certified and that a CPT code will be assigned for this service. This would allow physicians to bill Medicaid, Medicare, and other insurance for the use of certified interpreters. Did you know? • You can save time and money by scheduling appointments over the internet directly on our interactive calendar. Call our

office for more information or a demonstration. • Project Access patients are provided with WIN interpreters at no charge to your practice. When the doctor donates his time,

so do WIN interpreters. • Combined appointments cost less. Back-to-back appointments in the same language are charged as one appointment. • WIN offers phone interpretation services. Sometimes a 3-way phone call is the best choice to give test results or other very

detailed information. They are done at a reduced rate and are billed in quarter hour increments. • WIN has interpreters in 14 languages: Albanian, American Sign Language, Chinese (Mandarin), Farsi, French, Greek, Hindi,

Korean, Moldovan, Portuguese (Brazilian), Russian, Spanish, Thai… and now in Japanese too. Thank you for your continued support of WIN. If you have any questions, or if you would like further information on our services, please don’t hesitate to contact us at 274-0950.

News from WIN Laura Cooper

Listen to the BCBS Foundation interview with WIN staff, interpreters and physicians entitled

The Strength of Our Communities: Stories of

Health and Hope in North Carolina

The first convincing association of an isolated retrovirus with CFS was recently published in Science (2009) out of the Whitemore-Peterson Institute in Reno, Nevada along with The Cleveland Clinic and the National Cancer Institute (NIH). The gammaretrovirus XMRV was only recently discovered in 2007 at the Cleveland Clinic and cultured out of prostate cancer tissue from prostate cancer victims who had a rare mutation in the anti-viral RNAse-L pathway. CFS patients also have unusual alterations in the same anti-viral pathway (1997) though different in its detail and far less rare. Read the complete article and more information on Dr. Cheney’s research.

Retrovirus Linked to Chronic Fatigue Paul R. Cheney, MD, PhD

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Transitions at the Health Center The Buncombe County Health Center (BCHC) is now in its final stages of preparations for the division of services that we currently provide. As of January 4, 2010, our primary care patients will be moved to two different locations. • Adult and acute services will be offered at WNCCHS at 257 Biltmore Avenue (just north of Matthews Ford). • Family medical care will take place at WNCCHS’ Ridgelawn facility (10 Ridgelawn Road, 28806). From the BCHC, Drs. Steve Swearingen, Stan Hamaker, Kathy Robinson, and Mary Scott Hayes will be serving our primary care patients in these new locations along with Paul Moore, FNP and Teresa Oursler, FNP. We wish our parting colleagues well. Back at the BCHC, we are planning to change our name back to the Buncombe County Health Department as we forge ahead. We are working hard to be reorganized to the point of being able to provide better core public health services than ever before. We are currently partnering with the MAHEC FP residency to begin offering a Centering Group for prenatal sessions with 6-12 patients being seen at a time, combining routine prenatal care in a group setting that includes prenatal/childbirth education and an opportunity for social networking in this patient population. We have also begun a Nurse Family Partnership program to improve both short- and long-term outcomes in pregnancies of first time moms. H1N1 Update The H1N1 virus activity remains widespread in Buncombe County, North Carolina, and around the world. Immunization remains the best preventive measure. At the BCHC we are currently offering vaccine to high-risk groups which include: • Pregnant women • Persons who live with or care for babies <6 months old • 6 month olds – 24 YO’s • HCW’s and EMT’s • People ages 25-64 with chronic medical conditions including asthma, DM, heart and lung disease Only one dose is required for persons 10 years of age and older. Children 9 and under require a second dose in 4 weeks. H1N1 Flu Mist is available for healthy 2-49 YO’s who are neither pregnant, nor immunocompromised. 2009 H1N1 influenza viruses are susceptible to the neuraminidase inhibitor antiviral medications, oseltamivir and zanamivir, but are resistant to the adamantane antiviral medications, amantadine and rimantadine. Antiviral Drugs. It is not too late to begin antiviral treatment after 48 hours of the onset of flu symptoms in hospitalized or high-risk groups. For more information: http://www.cdc.gov/h1n1flu/ or www.epi.state.nc/epi/gcdc/H1N1flu.html or call the BCHC flu hotline 250-6400.

Cynthia Yancey, MD is the Medical Director of the Buncombe County Health Department.

Public Health Corner Cynthia Yancey, MD

These statistics indicate that there is a strong likelihood that someone who works in your practice is now struggling or will struggle with some kind of substance abuse problem. Even more likely, is the possibility that one of your employees has a family member who is actively abusing substances. More than half of all workers have a family member who is addicted, and half of working family members of alcoholics report that their ability to function on the job is affected by their loved one’s addiction. A study conducted by Cicala (2003), found that 8% to 12% of physicians were estimated to develop a substance abuse problem. Emergency medicine and anesthesiology are usually the highest-risk specialties. Nurses are also at risk. Trinkoff and Storr conducted an investigation (1998) where substance use was studied among nurses. Thirty-two-percent of 4,439 respondents

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Attention Physicians! Did you know the following? 75% of adult illegal drug users are employed 79% of binge drinkers are employed

60% of adults classified with substance dependence are employed

EAN

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indicated some substance abuse (study asked about marijuana, alcohol, cocaine, prescription drugs, and nicotine use). ER nurses were 3.5 times as likely to use substances as general practice nurses or pediatric nurses. Oncology or administrative nurses were 2 times as likely to binge-drink. Psychiatric nurses were 2.5 times as likely as general practice nurses to smoke cigarettes. While addressing current and potential substance abuse problems in your medical practice is simply the right thing to do for the employee, co-workers and the practice in general, there are real dangers if you do not address problem behaviors early on. When someone is abusing substances, there are indications of a developing problem. Absenteeism problems are often one of the earliest signs, along with general disorganization, mistakes, and decreased work quality. There may also start to be more patient and co-worker complaints and the employee may often complain of feeling bad, or have medical issues. After awhile, attendance problems become worse, more frequent. An employee may be more undependable and inconsistent at work. There may be more evidence of mood swings, being more argumentative. The employee may start avoiding others, and job performance will deteriorate even more. There may even be more accidents on the job and more minor injuries or hospitalizations. While physicians and practice managers are frequently reluctant to get too involved with an employee’s personal business, when there are problems in performance at work it can be dangerous not to intervene. Having an Employee Assistance Program (EAP) can be so beneficial because it can keep you from having to figure out if your employee is abusing substances or having some other type of personal problem. You simply need to identify the performance problems (e.g., absenteeism, disorganization), address the problem with the employee, and refer them to the EAP. At Employee Assistance Network, we specialize in helping problem employees get back on track with their performance. We are skilled in helping an employee identify if substance abuse may be a part of the problem and help connect him/her to resources to put an end to the abuse if needed.

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BCMS offers an affordable Employee Assistance Program (EAP) to BCMS members and their staff through a partnership with Employee Assistance Network (EAN). Practices pay one annual fee based on their number of employees. For details or to enroll for EAP services, contact Donna Wiedrich at 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

January 16 ................................. 29th Annual Martin Luther King, Jr. Prayer Breakfast, 8:30am, Grove Park Inn January 30 .............................................BCMS Annual Meeting and Celebration, 6-10:30pm, Doubletree Hotel February 6 ...................................................................................HeartStrings 2010, 10am-7pm, Asheville Mall February 22 ..............................................................BCMS Corporation Board Meeting, 6pm, Doubletree Hotel February 24 ................................................................BCMS Foundation Board Meeting, 6pm, Doubletree Hotel March 22.................................. BCMS Corporation Board Executive Committee Meeting, 6pm, Doubletree Hotel March 30................................................. National "Doctors Day;" Buncombe County “Doctors Day” (March TBA) April 26 ....................................................................BCMS Corporation Board Meeting, 6pm, Doubletree Hotel May TBA................................................ Emeritus Chapter Quarterly Luncheon, 11am, Country Club of Asheville

May 26 .......................................................................BCMS Foundation Board Meeting, 6pm, Doubletree Hotel June 6.............................................................................................................Shrimp Picnic, time & location TBA

June 21.....................................................................BCMS Corporation Board Meeting, 6pm, Doubletree Hotel

NOTE: Watch for upcoming educational and legislative forums to be announced via BCMS e-newsletter.

Online calendar access at: https://www.bcmsonline.org/main/about/calendar.php 

Calendar of Events through June 2010

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On September 29, 2009, seventeen people gathered in a softly lit room to meet each other and practice meditation. This was the opening activity of the Inner Strength Retreat, a first-time event for participants in the Project Access (PA) Life Skills Coaching program. The half-day event was designed by BCMS coach, Shonnie Lavender, to give a group of her clients the opportunity to fully immerse themselves in learning about and practicing ways of dealing positively with the challenges of life— a topic that the PA participants themselves said was personally important. Many of these people have health issues that are exacerbated by stress. If they can learn to better manage or reduce their stress levels our hope is that they’ll have less need for non-routine physician office visits.

Of the coaching clients registered for the event, all showed up for the retreat which was held at WriteMind Institute which also donated facilitation of the event. Activities included meditation and creative expression, both led by WriteMind’s founder, Jonathon Flaum, and gentle yoga, led by Joyce Thornburg a local instructor. The participants also enjoyed a healthy, home-cooked meal and conversation at the conclusion of the evening. Several commented that the evening had been very meaningful and that they were glad to have come.

Such a retreat was a first-time experience for these coaching clients, most of whom had never personally experienced yoga or meditation. One participant said he “received more than I had imagined.” In an email Shonnie received the next day, a participant noted that, “Being in the situation last night surely built up my confidence and acceptance of myself. You have definitely led me on a path that I feel good about and want to continue. I am still digesting everything that I experienced and see there is much work ahead. It was a wonderful morning today, to start off with thoughts and techniques learned last night.”

Managing Stress the Mindful Way Shonnie Lavender, BCMS Life Coach

Retreat participants learn tension-releasing yoga poses

Participants got creative to “draw” persistent emotions and thoughts

We are excited to announce a new workout this year for our well-known HeartStrings fundraiser. CrossFit! “We’re thrilled to bring a new challenge to our participants this year,” says Miriam Schwarz, BCMS CEO, herself a regular CrossFit practitioner. Instead of riding stationary bikes we’ll all be skipping rope and doing burpees (see pictorial of the burpee below). “After a warm up and stretching, we will teach people how to do these exercises properly and safely,” says Shanna Duvall, co-owner of CrossFit Asheville, the organizer of athletic activities at HeartStrings 2010. These activities use minimal equipment and are adjustable so they’re accessible to any level of exerciser. In fact, the workout will even be scaled to beginner, intermediate, and advanced levels that participants choose. Join Us! Teams are asked to raise at least $200 per individual member with a total goal of $40,000 for the 2010 event. Prizes are awarded to the top three fundraisers as well as the fittest individuals in each participant category. Participants will also get a HeartStrings t-shirt, snacks, and other gifts. There are several ways to join: • Form a team at your practice or business, or even participate solo — Contact Shonnie Lavender for details (274-2267, #311) • Promote your practice/business as a HeartStrings 2010 sponsor — Contact Miriam Schwarz for info (274-2267, #312) • Give a monetary donation to a colleague or friend who is participating if you can’t make it BCMS would like to recognize our sponsors to date: Asheville Anesthesia Associates, Biltmore Farms, CarePartners, and Lynn and Bob Kieffer.

HeartStrings 2010 — The “Get Fit” Fundraiser

This is one burpee from start to finish.

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On November 19, Buncombe County Medical Society held its annual Fall Conference in partnership with the WNC Medical Managers Association (WNC MMA). Approximately 60 practice managers and physicians attended the day-long conference, which was held at the Biltmore Doubletree Hotel. The theme of this year’s conference was “Succeeding in the Era of Reform,” featuring keynote speaker David Coates, PhD from Wake Forest University. Professor Coates addressed “Strategic Choices in the Reform of Health Care” and compared the two broad liberal and conservative positions in the contemporary debate on healthcare. Attendees also enjoyed sessions on Practice Implications for ARRA HIT Stimulus (Gary Balser, Carolinas Center for Medical Excellence), NC Legislative Update (Chip Baggett, North Carolina Medical Society), Physician-led Collaborations & Joint Ventures between Private Practices (Glen Sumner, OrthoTennessee), and Keeping Your Eye on the Ball – Tricks and Trends for Better Revenue Cycle Management (Ibby Whitten, Medical Insights).

Attendees enjoyed the spacious surroundings and state-of-the-art facility provided by the new venue, as well as vendor displays and a delicious hot lunch buffet. Once again, we thank WNC MMA, the planning committee, and our sponsors for making this outstanding educational opportunity possible. BCMS would like to extend special thanks to our sponsors for their financial support.

2009 BCMS Fall Conference – A Success Once Again!

Champions for Access

Friends of Medicine

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Welcome New BCMS and WNC Members

Pamela Allen, MD (Orthopaedic Surgery) Dr. Allen received her Medical Degree from the University of North Carolina at Chapel Hill. Dr. Allen completed her internship and residency at Wake Forest University. Dr. Allen is associated with Blue Ridge Bone & Joint Clinic.

Werner Brooks, MD (Orthopaedic Surgery) Dr. Brooks received his Medical Degree from Duke University. Dr. Brooks completed his internship and residency at the Medical University of South Carolina. Dr. Brooks is associated with Blue Ridge Bone & Joint Clinic in Hendersonville.

Robert Conklin, MD (Radiology) Dr. Conklin received his Medical Degree from the Medical College of Virginia. Dr. Conklin completed his internship at Carilion Health Systems in Roanoke, VA. He completed his residency at the Medical College of Virginia. Dr. Conklin is associated with Asheville Radiology Associates.

Christopher Copenhaver, MD (Allergy/Asthma) Dr. Copenhaver received his Medical Degree from the University of North Carolina at Chapel Hill. Dr. Copenhaver completed his internship and residency in Pediatrics at the University of Rochester Children’s Hospital at Strong Memorial Hospital. Dr. Copenhaver is associated with Allergy Partners of WNC. Rebecca Daniell, MD (Internal Medicine) Dr. Daniell received her Medical Degree from University of Rochester. Dr. Daniell completed her residency at Mary Imogene Bassett Hospital. Dr. Daniell is associated with Junaluska Internal Medicine, PC.

Daniel Fertel, MD (Pulmonary Diseases) Dr. Fertel received his Medical Degree from Ohio State University of Medicine. Dr. Fertel completed his internship and residency at University of Maryland. Dr. Fertel is associated with Asheville Pulmonary & Critical Care. John Hicks, MD (Orthopaedic Surgery) Dr. Hicks received his Medical Degree from the University of South Carolina School of Medicine. Dr. Hicks completed his internship at University of Tennessee, Department of Surgery. He completed his residency in Orthopaedic Surgery at the Campbell Clinic in Memphis, TN. Dr. Hicks is associated with Blue Ridge Bone & Joint Clinic. David Hodges, MD (Radiology) Dr. Hodges received his Medical Degree from Wake Forest University School of Medicine. Dr. Hodges completed his residency at Wake Forest University. Dr. Hodges is associated with Asheville Radiology Associates.

Lauren Livingston, MD (Family Practice) Dr. Livingston received her Medical Degree from Duke University. Dr. Livingston completed the MAHEC Family Medicine Residency Program. Dr. Livingston is associated with Community Family Practice, P.A.

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Ann Mitchell, MD (Emergency Medicine) Dr. Mitchell received her Medical Degree from East Carolina University. Dr. Mitchell completed her residency at Ohio State University. Dr. Mitchell is associated with Carolina Mountain Emergency Medicine. Ruchi Moore, MD (Obstetrics Gynecology) Dr. Moore received her Medical Degree from Medical College of Georgia. Dr. Moore completed the MAHEC OB/GYN Residency Program. Dr. Moore is associated with Laurel OB/GYN, P.A.

John Morris, MD (Internal Medicine/Pulmonary Diseases) Dr. Morris received his Medical Degree from the University of Alabama. Dr. Morris completed his internship and residency at Wake Forest University. Dr. Morris is associated with Four Seasons Hospice.

Danna Park, MD (Internal Medicine/Pulmonary Diseases) Dr. Park received her Medical Degree from Tufts University School of Medicine. Dr. Park completed her residency at Baystate Medical Center. Dr. Park is associated with Mission Integrative Health Care.

Jan Pattanayak, MD (Internal Medicine) Dr. Pattanayak received his Medical Degree from University of Medicine and Dentistry of New Jersey. Dr. Pattanayak completed his internship and residency at Brigham and Women’s Hospital. Dr. Pattanayak is associated with Asheville Cardiology Associates. Ditte Phillips, MD (Internal Medicine) Dr. Phillips received her Medical Degree from University of Massachusetts Medical School. Dr. Phillips completed her internship at Mary Imogene Bassett Hospital in Cooperstown, NY. Dr. Phillips is associated with Mountain Medical Associates.

Aaron Pulver, MD (Internal Medicine) Dr. Pulver received his Medical Degree from Duke University Medical School. Dr. Pulver completed his internship and residency at the University of Utah - Primary Children’s. Dr. Pulver is associated with Asheville Cardiology Associates. Elise Rackoff, MD (Dermatology) Dr. Rackoff received her Medical Degree from the University of Virginia. Dr. Rackoff completed her internship and residency at the Medical University of South Carolina. Dr. Rackoff is associated with Advanced Dermatology & Skin Surgery.

Carlos Vargas, MD (Family Practice) Dr. Vargas received his Medical Degree from the University of North Carolina at Chapel Hill. Dr. Vargas completed his internship and residency at West Virginia University Hospital. Dr. Vargas is associated with CarePartners Hospice and Palliative Care.

Welcome New BCMS and WNC Members

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Kirsten Weiser, MD (Internal Medicine) Dr. Weiser received her Medical Degree from Dartmouth Medical School. Dr. Weiser completed her internship at Tufts-New England Medical Center. She completed her residency at Dartmouth Hitchcock Medical Center. Dr. Weiser is associated with Asheville Gastroenterology Associates.

Jesse West, MD (Orthopaedic Surgery) Dr. West received his Medical Degree from Duke University School of Medicine. Dr. West completed his internship at Duke University. He completed an Orthopaedic Residency at University of Wisconsin. Dr. West is associated with Carolina Hand Surgery Associates.

Welcome New BCMS and WNC Members

(Continued from page 4….What Has BCMS Done for You in 2009? by Miriam Schwarz)

Advocacy/representing “the physicians’ voice” • Represented the physicians’ voice in dozens of forums and organizations to shape the future of our region’s healthcare

system. Topics included access to healthcare for the uninsured, health disparities, the growing burden of chronic disease, payment systems, and insurance reimbursement reform, among many others.

• Tirelessly advocated for open, honest dialogue between the hospital and physicians regarding hospital integration by researching and sharing information on successfully integrated systems, encouraging exploration of options other than hospital employment, and meeting on a regular basis with hospital administration.

• Conducted a comprehensive online survey of county physicians regarding physician integration, then shared results with membership, hospital leaders, MMA Board, and other key stakeholders.

Legislative involvement • Submitted two resolutions, “Tax benefits for physicians providing charity care” and “Physician reimbursement for interpreter

services.” Both passed by the NC House for NCMS board action. • Held legislative forums to provide physicians and legislators opportunities to educate and dialogue with one another. • Supported medicine-friendly candidates through BCMS PAC. Addressing healthcare quality, access, and parity achievement • Provided interpreter services in 10 languages at over 1,500 appointments for more than 500 patients, helping to ensure that

physicians were able to communicate with their Limited English and Deaf/Hard of Hearing patients. • Established the Dr. Charles Blair Scholarship fund to encourage African-American students to go into medicine and return to

Buncombe County to practice. • Coordinated enrollment of over 3,500 Project Access (PA) patients helping physicians care for the low-income, uninsured

residents of Buncombe County. • Provided case management and life skills/wellness coaching services to Project Access patients with chronic diseases. Strengthening/promoting benefits of society membership • Began implementation of a WNC physician’s network, called WNC Medical Society, to bring regional physicians together on

legislative issues and other shared interests to strengthen the physicians’ voice across the region. Enhancing physician image in community • Highlighted through various media outlets the charitable work of physicians and the more than $14 million of uncompensated

care generously provided by our community. • Began a public relations plan as part of a larger strategic planning process to create public awareness about and improve the

image of the medical profession.