Mecklenburg Medicine January 2013

january 2013 • Vol. 43, No. 1

Mecklenburg Medicine A Publication of the Mecklenburg County Medical Society I www.meckmed.org

No matter where the future of health care takes us … together we have a stronger voice and ability to effect change for the health of our patients.

Mecklenburg County Medical Society • Mecklenburg Medical Alliance and Endowment Founders of: Bioethics Resource Group, Ltd., Hospitality House of Charlotte, Teen Health Connection, N.C. MedAssist, Physicians Reach Out

Cancer called.

It wants to put your patient’s life on hold.

Call Presbyterian instead.

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Call day or night to get connected. Because some questions are just too important to wait.

704-384-5373 presbyterian.org/cancernavigator

January 2013 • Mecklenburg Medicine

Contents January 2013 Vol. 43 No. 1

Features 6 Zfive: A Community of Support for the Social and Emotional Health of Young Children

8 G PS … Guiding Parents (and Physicians) to Services

OFFICERS

Janice E. Huff, MD President James B. Hall, MD President-Elect Simon V. Ward III, MD Secretary Stephen J. Ezzo, MD Treasurer Maeve E. O’Connor, MD Immediate Past President

B O A R D M embers

In This Issue 5 P resident’s Letter: Happy New Year!

MCMS 110th Anniversary 9 MedLink Highlight: Coordination of Care: A Case Study 11 Physicians Reach Out: The Affordable Care Act and the Funny Pages

11 Member News/New Members 12 Upcoming Meetings & Events 12 National Health Observances for January 13 At the Hospitals 15 Advertising Acknowledgement

Lloyd L. Bridges, MD Raymond E. Brown, PA Scott L. Furney, MD Harold R. Howe, Jr., MD Scott L. Lindblom, MD John P. McBryde, MD Paras H. Mehta, MD Cheryl L. Walker-McGill, MD A. Miller Wilson Maxwell, MD Thomas N. Zweng, MD

E x - O fficio B O A R D M embers Tammy Bridges President, Mecklenburg Medical Alliance & Endowment Keia V. R. Hewitt, MD President, Charlotte Medical Society Docia E. Hickey, MD NCMS Speaker of the House Stephen R. Keener, MD, MPH Medical Director, Mecklenburg County Health Department Darlyne Menscer, MD NCMS Delegate to the AMA

E x ec u t i v e S t aff

1112 Harding Place, #200 Charlotte, NC 28204 704-376-3688 • FAX 704-376-3173 meckmed@meckmed.org Copyright 2013 Mecklenburg County Medical Society Mecklenburg Medicine is published 10 times per year by the Mecklenburg County Medical Society, 1112 Harding Place, Suite 200, Charlotte, NC 28204. Opinions expressed by authors are their own, and not necessarily those of Mecklenburg Medicine or the Mecklenburg County Medical Society.

Mecklenburg Medicine reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted. Mecklenburg Medicine is not responsible for unsolicited manuscripts.

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Sandi D. Buchanan Executive Director Trisha G. Herndon Director, Meetings & Special Events Stephanie D. Smith Executive Assistant

Mecklenburg Medicine Staff Editor Mark E. Romanoff, MD Managing Editor Sandi D. Buchanan Copy Editor Lee McCracken Advertising Mark Ethridge 704-344-1980 Editorial Board N. Neil Howell, MD Janice E. Huff, MD Jessica Schorr Saxe, MD Graphic Design — Lydia Sumcad

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President’s Letter

Happy New Year!

MCMS 110th Anniversary

By Janice E. Huff, MD, President

I

would like to start 2013 by thanking all of you for the privilege of serving as your president. Maeve O’Connor will be a hard act to follow, and I thank her for her service and commitment as president in 2012. I look forward to working with her and your Board of Directors this year. Hopefully, everyone read her last article, in which she enumerated the events and benefits of the Mecklenburg County Medical Society.

As she mentioned, we are in the process of improving the Medical Society for another 110 years. We are holding focus groups to help us determine what the future should look like for the Medical Society, physicians, physician assistants and patients in Mecklenburg County.

If you have any ideas or concerns this year, please don’t hesitate to contact me.

We can accomplish many great things together in 2013.

Years ago, when I was a resident at Charlotte Memorial Hospital, one of my mentors told me I “shouldn’t mess with doctors’ time or money.” As with many pieces of advice, this mentor was spot on. However, I am going to disregard that sage advice and do precisely what he warned against.

One of the main things physicians and physician assistants value from their local, state and national medical societies is political advocacy. The Mecklenburg County Medical Society has a Legislative Committee that is composed of physicians, group managers and others, who are very active politically on your behalf. Meck PAC is a county-directed political action committee that determines support, or opposition, for targeted local, state and federal legislation and promotes greater involvement of the local medical community in the political process.

Both groups collaborate with the North Carolina Medical Society and its political action committee (NCMS PAC) to help elect legislators who are “friends” of medicine and to pass legislation that helps all healthcare providers and their patients, either directly or indirectly. In the past

few years we all have benefitted from their efforts on behalf of reimbursement rates, payor disputes, workman’s compensation issues and many others.

I am certain all of you know about Senate Bill 33 — the historic legislation that finally made medical malpractice tort reform the law in North Carolina in October 2011. Passed by the legislature, the bill was vetoed by Gov. Bev Perdue, only to have that veto overridden by politicians who understood everyone — patients, physicians and the public — would benefit from this law. Since then, plaintiffs’ attorneys have filed significantly fewer claims. This means decreased medical liability premiums, saving you and your practice money, and offering reassurance that you don’t have to practice defensive medicine.

Unfortunately, there are some who disagree with this law, and it is certain challenges will come in 2013 in an attempt to overturn SB 33.

Thus, I am making a plea for you to give to MCMS both your time and money — time to serve on a committee or attend an event, and money by way of your membership dues (and contribution to Meck PAC). For it is time, money and members that enable MCMS to not only remain viable, but to give physicians and physician assistants a meaningful voice in our future. And make no mistake, there are entities whose agendas run counter to ours, and they do not lack for funding and volunteers. Although many physicians keep politics out of their daily interactions with patients, your membership dues and your time allow us to successfully advocate for you and your patients in Mecklenburg County and Raleigh.

In order to successfully advocate for you and your patients, we need the support of all of you. There are 2,924 licensed active physicians and 471 licensed active physician assistants in Mecklenburg County. In 2012, MCMS had 624 active dues-paying members, 260 emeritus members and 231 resident members. More than 125 members

volunteered to be on committees. Some of our committees were very active and successful last year, and we would like to improve on those activities this year.

By now, you should have received your dues statement and the request to serve on a committee. If there is something you would like us to accomplish this year and don’t see a committee for it, let us know, and we will work with you to make it happen.

Many medical groups still pay dues for their doctors/PAs and we appreciate that.

If your group (or employer) currently doesn’t pay your dues as a business expense, consider asking them to change that policy and help support the Medical Society. If that doesn’t work, remember we cost less than $1 per day. Sounds like a bargain to me!

In future issues, I will talk about our past, present and future. We have had an amazing 110 years, and I know we can have another amazing, productive and fulfilling 110 years.

It is an honor to serve as your president in 2013. I will work hard to help you and your patients. I know you are dedicated to providing quality, compassionate care to your patients, and improving health care and our profession in Mecklenburg County. MCMS is ready and willing to help you do that. Feel free to call me at 704-641-3157 or any of the Medical Society staff if we can help you and your patients in any way.

Mecklenburg Medicine • January 2013

Feature

Zfive: A Community of Support for the Social and Emotional Health of Young Children

By John L. Ellis, PhD, Director, Mecklenburg County Children’s Developmental Services

T

here is increasing awareness in both the professional and lay community about the important role early development plays in health and wellness, not just during the period of childhood, but also throughout a person’s lifespan. New scientific evidence from multiple fields, including neuroscience, biology, genetics and the behavioral and social sciences, confirms brain development occurs at an explosive rate during the first three years of life.

What do we mean by mental health in young children, and what does it look like? Mental health in young children is about healthy social-emotional development — the ability to experience, regulate and express emotions, form close interpersonal relationships, and explore the environment and learn.

While this development occurs as a matter of course in most instances with little attention given to the nuances of how it happens, the evidence also is clear that disruptions during the prenatal period and the formative years can have a life-long effect on health, adaptive functioning and the very architecture of the developing brain.

So, who is looking out for the infants, toddlers and preschoolers who are experiencing significant adversity, including trauma, abuse, living with a parent with a substance abuse or mental health disorder or being raised in persistent poverty? In 2010, the N.C. General Assembly asked this very question, and in turn, directed the N.C. Institute of Medicine to convene a task force of statewide experts to study the adequacy of the current system of services. The Task Force of 43 members met 15 times between March 2011 and June 2012. Last July, the report, “Growing Up Well: Supporting Young Children’s Social-Emotional Development and Mental Health in North Carolina” was issued. The report details a set of

recommendations with both short- and long-term strategies for systemic change that fall into four broad categories: • Creating a more coordinated, integrated system to meet the socialemotional and mental health needs of young children and their families; • Promoting awareness and understanding of young children’s socialemotional and mental health; • Improving treatment to meet the social-emotional and mental health needs of young children and their families; and, • Ensuring a well-prepared workforce.

The full copy and briefs of this report can be found on the N.C. Institute of Medicine website (www.nciom.org).

Zfive: A community of support So what is happening in Mecklenburg County to keep pace with these recommendations? For the past five years, Zfive has existed as a local community collaborative, serving as a resource to physicians and their patients. Zfive is a team of clinicians, researchers, program managers and parents in Mecklenburg County who are dedicated to improving the lives of children, ages birth-5, with mental health issues, and their families. Since 2007, Zfive has been working to raise awareness, build resources and enhance the quality of developmental services provided to young children. Represented by more than 25 organizations, Zfive meets monthly to share information, build and implement new initiatives, evaluate progress and support each other on issues of shared concern.

Subgroups work between meetings to move initiatives forward. Recent activities include the identification and development of trauma screening and attachment-focused assessment protocols and instruments.

January 2013 • Mecklenburg Medicine

Increasing public awareness Zfive has produced three reports to frame the issues and identify community needs in the field of infant and young child mental health. These reports are available at www.Zfive.org: • An Assessment of Infant Mental Health Needs in Mecklenburg County: A Report to Smart Start of Mecklenburg County on Behalf of The Infant Mental Health Working Group, April 15, 2008 • Risk, Responsibility and Opportunity: Facing the Facts About the Social-Emotional Health Needs of Mecklenburg County's Most Vulnerable Young Children, prepared by Natalie Conner, PhD, for the Infant Mental Health Working Group, July 21, 2009 • Zfive Recommendations: Addressing the Social-Emotional Needs of Children 0-5 With a Substantiated Finding of Abuse or Neglect or in Need of Services in Mecklenburg County, 2010 Zfive’s website connects families and professionals with information including: 1) A locally produced video (in English and Spanish) for parents with concerns about their young child’s development; 2) Local news and events particularly regarding professional development opportunities; 3) Recommended reading and helpful websites on topics related to healthy social and emotional development of young children; 4) Overview of Zfive programs and reports; and 5) An “I Need Help” button that connects parents to definitions of the different types of providers in the community, questions to ask providers while shopping for the right match for their child, links to resources on how to choose a provider, family support resources in the state and a list of state-licensed providers in Mecklenburg County — agencies and

individuals — caring for the social and emotional development needs of young children ages 0-5. This list includes a description of the services provided, insurance accepted, locations where services are provided, languages spoken and much more.

Building resources and enhancing quality • Mentoring Program. Zfive offers licensed clinicians the opportunity to participate in a six-month mentoring experience led by a highly-trained and experienced young child mental health therapist. Established in 2008, the program increases the number of licensed clinicians who are competent in evaluating and treating the mental health needs of children ages birth-5 via evidenced-based assessments and practices. Clinicians gain knowledge about the skills needed to work with these children and their families, as well as become acquainted with evidence-based evaluations and therapeutic interventions for this population. Additionally, the person being mentored practices his/her new skills with children and families, with guidance from the mentor via weekly mentoring sessions and monthly group mentoring meetings.

• Peer Consultation. Last February, Zfive launched a peer consultation initiative to expand understanding, appreciation, knowledge and awareness of the clinical issues involved in infant mental health and to support the community in enriching the quality of treatment services for infants, toddlers, young children and their families. Monthly meetings, geared for a broad base of professionals, are led by core clinicians.

• YFS Collaboration. In 2010, Zfive completed a pilot program, in which a single infant mental health specialist was embedded in the Department of Social Services’ Geo-District One to serve as a consultant, coach and trainer for YFS social workers and supervisors. In 2012, YFS and Mecklenburg Children’s Developmental Services partnered to co-locate a licensed mental health clinician and a case coordinator in each Geo-District. With the support of a supervisor, they collaborate with the YFS social workers to meet the needs

of young children. Targeting all children under age 5 with a YFS case designated as (1) substantiated abuse or neglect or, (2) in need of services, the goal is improvement in child and family access to developmentally appropriate services that support children’s educational, social and emotional well-being.

• Young Child Mental Health Training Series. Zfive, in conjunction with the Charlotte Area Health Education Center (AHEC), has developed an ongoing training series covering a broad array of issues regarding social and emotional development in children ages birth-5. The training series offers topical presentations by nationally recognized experts in the field of early childhood mental health.

Many of these workshops are paired with community impact events to bring further attention to the information, and to deepen awareness and capacity in our community.

• What additional information do you wish you had about Zfive, or about infant mental health?

• Who else should Zfive speak with as part of “taking stock?”

• What will you do to ensure a bright future for all of our children?

Zfive meets on the third Thursday of each month at the Dr. Carlton G. Watkins Center, 3500 Ellington St., 9-10:30 a.m.

Attendance is open. For more information, e-mail John Ellis at john.ellis@mecklenburgcountync.gov or go to www.Zfive.org.

Extending our reach Zfive marked its fifth anniversary in 2012 and would like to pause long enough to take stock of where it has been and where it is going. Zfive continuously looks for opportunities to grow awareness about the field of infant and young child mental health outside of Mecklenburg County — as well as to learn from others across the state. Zfive members: 1) Connect each other to opportunities for participation in best-practice learning collaboratives; 2) Have presented Zfive highlights at the national Smart Start Conference, as well as local conferences and gatherings; 3) Have participated in an advisory capacity in the development of the Institute of Medicine’s Infant Mental Health Study; and 4) Have supported the development of the new N.C. Infant and Young Child Mental Health Association (www.ncimha.org).

What do you think?

We would like to hear from you.

• Where should Zfive pay particular attention over the next couple of years?

• What talent or resources could you contribute to strengthen Zfive?

• How could Zfive and its members help you or your organization?

MMAE Community Health Awards Applications Available Jan. 1, 2013 The Mecklenburg Medical Alliance and Endowment began the process of receiving applications on January 1, for the Community Health Awards to nonprofits in Mecklenburg County.

Since 1982, when MMAE established its 501(c)(3), it has granted more than $1 million to projects that improve the health and quality of the life of the people in the community.

Only applications that promote health-related charitable, scientific and educational needs in Mecklenburg County will be considered. Check the website at www.mmaeonline.com for further information about the application procedures, guidelines and deadline for applying. You also may contact Debbie Taylor, MMAE vice president of Grants and Disbursements, at debbietaylor130@ gmail.com or 704-896-3581.

Mecklenburg Medicine • January 2013

Feature

GPS … Guiding Parents (and Physicians) to Services

By Dianne Alexander, PhD, Coordinator, Guiding Parents to Services

A

utism Spectrum Disorders offer little that is straightforward or easy. Even its “Chinese menu” approach to diagnosis is challenging.

The Diagnostic and Statistical Manual of Mental Disorders, IV, requires a total of six (or more) behavioral characteristics from (A) qualitative impairment in social interaction, (B) qualitative impairment in communication, and (C) restricted, repetitive and stereotyped patterns of behavior, with at least two from (A) and one each from (B) and (C).

ASD is a disorder of degrees and nuances, subjective decisions, disagreement and passionate conviction; a disorder that taxes doctors, families and systems.

Physicians know the challenge of identifying and naming ASD; families know the resulting confusion, frustration and stress of dealing with ASD. In 2010, Smart Start of Mecklenburg County implemented a survey to identify the state of autism services for families of young children. Community response indicated the need for a family support assistance center, focused on providing parents with information about services in Mecklenburg County, as well as education and information about the entire identification, assessment and intervention process. To meet that need, Guiding Parents to Services (GPS) opened in October 2012 and is receiving families of children ages 05 at risk for autism. Since GPS is funded by Smart Start, there are no fees. It is the first stop when a child has failed the M-CHAT, or when the doctor has concerns that the 12-month-old isn’t babbling or has no “warm joyfuls” or the 18-month-old, who used to be social, now isn’t. GPS is the answer a doctor can give parents when they ask, “Now what do I do?”

Referrals may be made to GPS by medical staff, other professionals or by families. A call to 704-806-5123 or e-mail to dalexander@smartstartofmeck.org will start the process. The GPS Coordinator will meet with the family and help them make sense of their child’s differences and potential diagnosis. The family will be

guided through a critical and stressful time, when the impact of learning that their child may have autism coincides with pressure to act. The need to find appropriate service providers, navigate the world of referrals and paperwork, choose therapies and programs and become educated about this uniquely challenging disorder can seem overwhelming. There are no road maps, no one-size-fits-all responses and no flow charts that work as well or as easily as they appear. What there is … is the pressing responsibility to get started and to get it right. GPS helps families get started by explaining the local options for service and guiding them to find the best fit for their family. It offers ongoing support through the provision of educational workshops, support groups for the newly diagnosed and resource materials.

As a resource for medical practices, GPS bridges the gap between the doctor’s identification of ASD and the implementation of intervention and services.

Doctors’ referrals to GPS ensure families will be supported and guided to intervention services. This is critical, because identifying children with autism and initiating intensive, early intervention during the preschool years has been found to result in improved outcomes for most young children with autism (National Research Council, 2001).

Research suggests that, for very young children, the starting place for intervention is at home with families being focused on the child’s developmental needs and being able to offer sensitive and responsive parent-child interaction styles (Wallace and Rogers, 2010). Families need guidance and support to fulfill the long-term role of parenting a child with autism and to deal with associated high levels of stress and range of emotions — grief, guilt, confusion, isolation and anger — as they try to understand what Autism Spectrum Disorder (ASD) is and what to do about it.

It is likely their pediatrician or family doctor experiences similar stress. The physician often is the messenger the family wants to shoot and the mentor they desperately need. Families are told to

January 2013 • Mecklenburg Medicine

“ask their doctor” for answers, direction and advice. Parents expect the doctor to monitor their child’s development and identify delays or differences accurately and immediately. Since 2000, when the Quality Standards Committee of the Academy of Neurology and the Child Neurology Society identified surveillance and screening practices to detect children at risk for autism, the emphasis on early identification leading to early intervention has intensified.

At the same time, autism awareness has grown and the prevalence of ASD has increased dramatically to the recent all-time high in North Carolina of 1 in 70.

As the need for informed, responsive medical practitioners increases, doctors must unravel information, noteworthy for both its abundance and frequent inconsistency. Once the process of identifying children at risk for ASD has been completed, doctors then are expected to counsel and direct families to services and to stability. Entry into the world of service delivery begins a process replete with acronyms, procedures and criteria — a process usually confusing and often overwhelming. Doctors now can rely on Guiding Parents to Services to share some of these responsibilities and supplement their efforts to assist families.

For families receiving news of their child’s possible autism, GPS should be just what the doctor ordered.

American Psychiatric Association.

(2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.).

Washington, D.C. Author.

National Research Council. (2001).

Educating children with autism. Committee on Educational Interventions for Children with Autism. C. Lord and J.P. McGee, eds.

Division of Behavioral and Social Sciences and Education. Washington, D.C. National Academy Press.

Wallace, K. S., & Rogers, S. J. (2010).

Intervening in infancy: Implications for autism spectrum disorders. Journal of Child Psychology and Psychiatry, 51(12), 1300-1320.

MedLink Highlight

Coordination of Care: A Case Study

By Katharine Modisett, MD

F

or Carol Wall, a nagging feeling that she had something stuck in the bottom of her shoe turned into a devastating health problem. Wall is a Charlotte native who was a cashier at a fast-food restaurant and shared a nearby apartment with her niece. She enjoyed working daily and coming home to family.

But she began to notice a feeling like a bump on the bottom of her right foot.

“I just thought it was a callus, from not wearing the right shoes while I was working on my feet all day,” said Wall. Like many lower-paying jobs, Wall’s did not offer health insurance; and therefore, she sought treatment at local emergency rooms.

Unfortunately, the ER’s were unable to offer more than pain medication and a referral to a podiatrist for diagnosis. Wall wasn’t able to afford a visit to the podiatrist, and her primary care physician was at a loss at what to do. Meanwhile, the lump grew until it impaired walking and working. To make matters worse, while Wall’s condition became increasingly debilitating, her niece lost the apartment they were sharing.

Wall lost her job around the same time they lost the apartment, and her last safety net before the streets was the Salvation Army Center of Hope shelter. She moved there with a few belongings in late April 2012. Shortly after moving to the shelter she was assigned a caseworker to help her identify resources and start the journey back to independent living. One of those resources was the adjacent Shelter Health Services, where residents are able to seek medical care at no cost. Wall literally hobbled into the clinic, as she was no longer able to bear any weight on her right foot. As Wall described it, “That set the ball in motion.”

Lisa Bishop, RN, the clinical coordinator at Shelter Health Services, was shocked when she first examined Wall.

“It was amazing. This growth had reached such a size that Carol couldn’t even walk.

It’s not something you expect to see in the United States in 2012. You could see how this was making it so Carol wasn’t able to get around or do anything for her life.”

Other providers similarly were moved, including Katie Sprinkel, MD, a native of Ashland, Va., who is chief resident at

P ictured from left to right: Jucola Williams (medical assistant student); Michael Sowyak (executive director of Shelter Health Services); La’Porscha Smith (volunteer medical assistant); Michelle Carr, RN; and Carol Wall.

Carolinas Medical Center’s Department of Emergency Medicine. She volunteers monthly at Shelter Health Services because, in her words, “I really enjoy it.

I love working on a team with the clinic staff and really cherish getting to know our patients. They are some of the bravest, funniest and incredibly inspiring women I have ever met, and I feel lucky to have a chance to support them.”

Dr. Sprinkel felt the same sense of urgency as other clinic staff when she met Wall one afternoon last spring. “She had been dealing with the lesion on her foot for a long time, as far as I could tell, without an ounce of self-pity, and she had moved to crutches some time before I first met her, because she was unable to bear weight on that side. It had gotten to the point that it was preventing her from functioning in the

shelter, and she had developed pain in her arms and wrists from the crutches, as well as her other hip from trying to compensate.”

Dr. Sprinkel knew Wall needed a specialist. Through the clinic’s coordination of referral, transportation and scheduling, Wall was able to see Libby Edwards, MD, a Charlotte dermatologist. Edwards is triple board-certified in internal medicine, pediatrics and dermatology, and is the chief of dermatology at Carolinas Medical Center.

She has her own practice at Mid-Charlotte Dermatology, has served as investigator for more than 55 clinical trials and has written several textbooks.

Dr. Edwards holds a low-income clinic each Thursday, where she sees patients from local Charlotte practices and clinics like Shelter Health Services. During these clinic hours, she sees patients who require

Mecklenburg Medicine • January 2013

MedLink Highlight her expertise, but otherwise would not be able to afford it. She also collaborates with several local pathologists who read biopsy samples for her without charge.

When Dr. Edwards first met Wall, she was as struck, as others had been, by her condition. “Wall’s cyst was amazing — I had never seen one on the bottom of a foot before.” The cyst had reached such a size that Dr. Edwards referred Wall to Hazem El-Gawal, MD, a fellowship-trained dermatologic surgeon. Dr. El-Gawal was able to excise the cyst that had tormented Wall for so long. The total cost of this lifechanging procedure was $20, which was covered by Shelter Health Services.

After her procedure, Wall continued to visit Shelter Health Services for after care.

The wound was so large she had to change the dressing every day and use crutches for several weeks. She became a familiar face at the clinic as the nurses and medical assistants taught her how to change the dressings and watch for signs of infection.

Carrie Fales, MD, a Michigan native and third-year resident in emergency medicine at CMC, is a monthly volunteer at Shelter Health Services, and she took

care of Wall during her post-operative period. She was impressed by how well the clinic was able to care for Wall’s extensive wound and teach her to care for herself. Dr. Fales noted, “The patients at Shelter Health Services are a very special and vulnerable population. Without volunteers, they often have limited or no health care and frequent emergency department visits. By volunteering just once a month, I’m able to help care for patients, like Ms. Wall, who need care but don’t need to be seen in a high-acuity setting like the Emergency Department.”

When Wall was asked how she feels about all this, a smile spread across her face.

“This is a place where they can make things happen. You just have to be present, and they provide excellent, excellent care.” Wall said that with her newfound mobility, she hopes to go back to work and move out of the shelter into a place of her own. But she’s hoping for a change from standing behind a fast-food counter. “I’d really like to teach little kids. I used to do that for work, and I liked it a lot. Now that I can stand longer and run around after them, I think that’s something I’d be good at.”

University Area -

Wall’s story is inspirational, because it demonstrates extraordinary coordination of care among healthcare volunteers. In a disjointed system, where patients like Wall are often lost in a shuffle of co-pays, specialists, office hours and lack of transportation, this story is a ray of hope.

While Wall’s cyst became a clearly visible health issue, many patients at Shelter Health Services present equally debilitating, but less visible barriers — uncontrolled diabetes, hypertension, mental health issues and substance abuse disorders. Confronting these challenges, Shelter Health Services focuses daily on advocating for their patients and getting them back on their feet — sometimes literally.

Dr. Katharine Modisett is a second-year Emergency Medicine Resident at CMC and volunteer at Shelter Health Services. She can be reached at Katharine.modisett@gmail.com.

If you are interested in volunteering at the Shelter Health Services, or would like to make a donation, find more information at www.shelterhealthservices.com.

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Physicians Reach Out

Member News

The Affordable Care Act and the Funny Pages

New Members

By Donald K. Jonas, PhD, Executive Director, Care Ring

T

he Affordable Care Act is one of the most complex beasts our leaders in Washington ever birthed. It also is one of the most important and far-reaching pieces of legislation ever.

A recent article in the New York Times on the “ABC’s of the Health Care Law and Its Future” summed up this new law nicely: “It’s a series of policies and regulations and subsidies and mandates. That’s the reason it’s so complex. It builds on an incoherent medical system with all kinds of public and private insurance and tries to patch the holes.

And it affects different groups of Americans in different ways at different times.”

We all know what it has been like to work in an “incoherent” healthcare system. For decades, we have lived in a “system” of health care in America where some folks have private insurance, others public assistance and others nothing at all. Different folks for different reasons receive different levels of care.

And on top of this incoherence, the ACA has added policies, regulations, subsidies and mandates to fill the gaps.

It is so simple, right?

Of course not, and, as most physicians and their practice managers, not to mention consumers at all income levels, will attest, there is tremendous uncertainty as to how and in what ways the ACA will bear down on our medical practices and impact our ability to provide care to those in need.

Thankfully, there is a new handy guide on this law that I highly recommend to anyone looking for a clear-headed — and fun! — way to understand the ACA and its impacts.

If, like me, you grew up on comic books and still fancy the funny pages, you will find this new book on the ACA an indispensable source for understanding the new law.

For a simple, and yet comprehensive, understanding of the ACA — what it is and how it works — the best source I have found is actually a comic book for grownups.

Jonathan Gruber’s “Health Care Reform” is a graphic novel that uses humor to tell the story of the ACA in an entertaining way.

Gruber is not just any health care analyst. A professor of economics at MIT

and director of the Health Care Program at the National Bureau of Economic Research, he was a central architect of Gov. Mitt Romney’s health care overhaul in Massachusetts. Gruber was then a primary advisor to the Obama administration and congressional leaders in designing the ACA. Gruber’s “Health Care Reform” starts by introducing you to four “typical” Americans. Anthony has a good private insurance policy through his employer; Betty is retired and on Medicare; Carlos goes out into the nongroup individual private insurance market for a policy as his employer doesn’t offer health care insurance; and Dinah is uninsured.

Each hypothetical character then experiences a heart attack at the same time. And through the magic of illustrator Nathan Schreiber’s pen, we see how each person is treated in different ways — due to their health care insurance status — for the same condition.

Rather than recite sub-paragraph XYZ of section ABC of the Affordable Care Act, Gruber then uses the power of pictures and stories to describe each of the major components of the ACA. While the author clearly is biased in favor of the ACA — he was a major designer of the legislation — the descriptions of the ACA and its likely impacts on businesses and healthcare providers is one of the few sources of information on the ACA that does not require an advanced understanding of accounting or the U.S. insurance industry to proceed.

Regardless of your political views, or whether you believe the ACA was a brilliant piece of progressive legislation or one of the most reckless partisan acts in decades, the reality is that the ACA is here and is being implemented.

And, for those bewildered by the crazy quilt system of health insurance currently operating in the United States and those frozen with anxiety over what the ACA is about to do, Gruber’s book is a great place to start to begin to understand how this law dramatically will change health care in this country.

Kevin S. Cahill, MD, PhD, MPH Neurosurgery Carolina Neurosurgery & Spine Associates 225 Baldwin Ave. Charlotte, NC 28204 704-376-1605 University of Florida College of Medicine 2005 John D. Hall, MD *Psychiatry; *Addiction Psychiatry; *Psychiatric Medicine John D. Hall, MD 6809 Fairview Road Charlotte, NC 28210 704-364-0374 Medical College of Georgia 1997 Scott D. Wait, MD Neurosurgery Carolina Neurosurgery & Spine Associates 225 Baldwin Ave. Charlotte, NC 28204 704-376-1605 East Carolina University Brody School of Medicine 2004

Mark Your Calendars MedLink of Mecklenburg Forum Tuesday, Feb. 26, 2013 Harris Conference Center Featuring Dr. Pam Silberman, president and CEO N.C. Institute of Medicine

Mecklenburg Medicine • January 2013 11

Member News Upcoming Meetings & Events Meetings are at the MCMS office unless otherwise noted.

JANUARY

•T uesday, Jan. 8 MedLink meeting. 8:30 a.m.

• Tuesday, Jan. 8 Charlotte Pediatric Society meeting.

Speaker: Dr. Wesley Burkes, Currin Distinguished Professor and chairman of Pediatrics, UNC-Chapel Hill.

Topic: “Food Allergy for the General Pediatrician.” The Duke Mansion. 6 p.m.

• Tuesday, Jan. 8 Charlotte Dental Society Membership meeting. Myers Park Country Club. 6 p.m.

• Thursday, Jan. 10 Legislative Committee meeting. 4 p.m.

• Thursday, Jan. 10 Charlotte Medical Dental and Pharmaceutical Society Membership meeting. Location TBD. 6 p.m.

• Wednesday, Jan. 16 MMAE Board meeting. 10 a.m.

• Thursday, Jan. 17 CAMGM meeting. Myers Park Baptist Church Cornwell Center. Noon.

• Friday, Jan. 18 Child Health Committee meeting. 7:30 a.m.

• Tuesday, Jan. 22 MCMS Executive Committee meeting.

5:30 p.m.

• Tuesday, Jan. 22 March magazine deadline.

• Monday, Jan. 28 MCMS Board meeting. 5:30 p.m.

FEBRUARY

NO MCMS BOARD MEETING • Tuesday, Feb. 5 Charlotte Dental Society Board meeting. 6 p.m.

• Monday, Feb. 12 MedLink meeting. 8:30 a.m.

• Thursday, Feb. 14 Legislative Committee meeting. 4 p.m.

• Thursday, Feb. 14 Charlotte Medical Dental and

Pharmaceutical Society Membership meeting. Location TBD. 6 p.m.

• Monday, Feb. 18 MCMS Executive Committee meeting.

5:30 p.m.

• Wednesday, Feb. 20 MMAE Board meeting. 10 a.m.

• Thursday, Feb. 21 CAMGM meeting. Myers Park Baptist Church Cornwell Center. Noon.

• Friday, Feb. 22 April magazine deadline.

• Friday, Feb. 22 Charlotte Dental Society annual meeting.

7:30 a.m.-5 p.m. Harris Conference Center.

• Tuesday, Feb. 26 MedLink of Mecklenburg Forum.

Speaker: Dr. Pam Silberman, N.C. Institute of Medicine. Harris Conference Center.

News & Notes Pediatrician Karen Breach Elected to Leadership Role with the American Academy of Pediatrics Karen E. Breach, MD, FAAP, has been elected to the South Appalachian District (Virginia, North Carolina, South Carolina, Tennessee and Kentucky) National Nominating Karen E. Committee (NNC) of Breach, MD the American Academy of Pediatrics (AAP). Dr. Breach was elected for a three-year term and will represent the district at deliberations of the NNC, which is responsible for nominating two candidates for the office of President-elect.

Dr. Breach is a pediatrician at University Pediatrics in Charlotte. She is a past president of the AAP North Carolina Chapter (2010-2012), a past member of the MCMS Board of Directors and a long-time member of the MCMS Child Health Committee. Her pediatric career has included patient care, advocacy and education. She works to reduce health disparities by promoting diversity inclusion, health literacy and education. Recent efforts have targeted improving school behavior of at-risk students, promoting fitness in schools and reducing childhood obesity.

12 January 2013 • Mecklenburg Medicine

North Carolina Medical Society Honors Dr. James Parke, Jr. Dr. James Parke, Jr., a retired pediatrician, was awarded the Dr. Harvey Estes Physician Community Service Award at the North Carolina Medical Society James annual meeting in Parke, Jr., MD October. This award recognizes physicians whose service to their community is exemplary and reflects most positively on the medical profession.

Save the Date!

MCMS Annual Meeting Wednesday, Feb. 6 6-9 p.m.

Myers Park Country Club Guest Speaker: Pam Silberman, N.C. Institute of Medicine

NATIONAL HEALTH OBSERVANCES

January Cervical Health Awareness Month Birth Defects Prevention Month Blood Donor Month Glaucoma Awareness Month Jan. 6-12 Folic Acid Awareness Week Jan. 13-19 Healthy Weight Week Jan. 20-26 National Certified Nurse Anesthetists Week

At the Hospitals

CMC Receives $8 Million NIH Grant to Conduct First-Ever Study A research team in the Department of Oral Medicine at Carolinas Medical Center (CMC) has been awarded an $8 million National Institutes of Health (NIH) grant to study dental and oral medicine outcomes of patients who have received high-dose radiation to the head and neck region. This is the largest research grant ever awarded to CHS. Each year, 40,000 Americans develop head and neck cancer, and many have to receive high-dose radiation therapy, often in combination with surgery and/or chemotherapy. An unavoidable side effect of radiation therapy is damage to the oral and maxillofacial tissues, some of which persist for the lifetime of the patient.

“Currently, dental management of these patients is largely based on expert opinion and there are no evidencebased guidelines available to inform the healthcare team that manages patients before or after radiation therapy,” said Michael Brennan, DDS, MHS, principal investigator of the study. “The data we collect will lead to a better understanding of the oral and dental sequelae experienced by these patients after radiation therapy, which will lead to protocols for patients with head and neck cancer that are based on data from this five year study.”

Dr. Brennan is the Associate Chairman at CMC’s Department of Oral Medicine and has a major interest and expertise in the management of oral complications of cancer therapy.

CMC Transplant Programs Receive National Recognition Three transplant programs at CMC have been recognized for quality outcomes by the Health Resources and Services Administrations, part of the U.S. Department of Health and Human Services. CMC-Main is the only hospital in North Carolina to receive recognition in three programs: heart, liver and kidneypancreas. The individual transplant programs received the bronze award based on performance on post-transplant survival

rates, transplant rates and mortality rates after patients are placed on waiting lists.

At CMC, surgeons have performed some 2,400 adult kidney transplants, 89 pediatric kidney transplants, 600 living donor kidney transplants, 44 living pediatric donor kidney transplants, 135 kidney-pancreas transplants and 500 heart transplants.

The heart transplantation program at CHS’s Sanger Heart & Vascular Institute has seen a one-year survival rate of 96 percent in adults and 100 percent in pediatric patients. The 30-day readmission rate for heart transplantation is 5.88 percent, with the expected readmission rate of 35.13 percent. The average length of stay (LOS) for patents has been 11.11 days, with the expected LOS of 18.76 days. The one-year survival rate for kidney-pancreas transplants is at 90 percent and 86.4 percent for the liver transplant program. These numbers rank the program in the top quartile of all programs in the country.

Corporate Health and Wellness Creates “Fit-For-Duty” Test for Local Companies A unique Fit-For-Duty test has been developed for a local construction company to gauge physical capabilities for potential employees before the employee is hired.

The fitness exam, developed by Carolinas HealthCare System (CHS), incorporates a comprehensive range of services and can be tailored to a company’s specific needs to help reduce worker’s compensation claims.

Wayne Brothers, Inc., a Kannapolis construction company, became interested in pre-employment testing last year when several employees were found physically unable to lift the required amount of materials and supplies after they started work. The company approached CHS about creating a more extensive test to indicate which potential employees could complete the necessary level of work and also to improve overall safety. Of more than 200 potential Wayne Brother’s employees who have been screened since last October, there has been an 80-82 percent pass rate.

The Fit-For-Duty exam incorporates an extensive range of CHS services that can include occupational medicine, rehabilitation and urgent care locations.

Once the results of the Fit-For-Duty exam have been collected, the employer is contacted by email. Based on the results of

the exam, the employer can make a decision about proceeding with the hiring process.

Carolinas Rehabilitation Earns Three-Year Accreditation Renewal from The Joint Commission Carolinas Rehabilitation has earned a three-year accreditation renewal from The Joint Commission. TJC had no Direct Impact Requirements for Improvement.

This accreditation is for all hospitalbased locations, including Carolinas Rehabilitation (inpatient and outpatient), Carolinas Rehabilitation-Mount Holly (inpatient and outpatient), Carolinas Rehabilitation-Mercy (inpatient), Carolinas Rehabilitation-University (outpatient), Carolinas Rehabilitation-Pineville (outpatient), Morehead Medical Plaza (outpatient pelvic rehab services) and Mercy Medical Plaza (outpatient pelvic rehab services). Carolinas Rehabilitation also maintains a rehabilitation specific accreditation with CARF (Commission on Accreditation of Rehabilitation Facilities).

Former NFL Players Receive Health Screenings at CMC Jamar Nesbit, an offensive lineman who previously played for the Carolina Panthers, Jacksonville Jaguars and New Orleans Saints, received a coronary CT scan during a health screening on Nov. 10, 2012, for former NFL players held at Morehead Medical Plaza on the campus of Carolinas Medical Center. Nesbit was one of 33 Charlotte-area players screened as part of a national NFL Cardiovascular and Prostate Health Research Awareness Program sponsored by the NFL Player Care Foundation. The screenings were supervised by the Living Heart Foundation and The American Urological Association Foundation, with staff, equipment and facilities provided by CHS.

Mecklenburg Medicine • January 2013 13

At the Hospitals

Presbyterian Hospital First in Southeast to Implant Subcutaneous Heart Defibrillator On Oct. 9, 2012, Presbyterian Hospital became first in the Southeast to implant a Subcutaneous Implantable Cardioverter Defibrillator (S-ICD) following the Food and Drug Administration’s post-clinical trial approval of the device on Sept.

28, 2012. The procedure was the third nationwide following FDA approval.

The S-ICD is the first heart defibrillator that can be implanted just under the skin (subcutaneously) instead of being connected directly into the heart. Other implantable defibrillators require physicians to insert one or more electrical leads through the vein and into the heart, which can increase the chance of complications.

Mark Kremers, MD, FACC, a cardiologist at Mid Carolina Cardiology, was one of the lead investigators in clinical trials of the S-ICD and performed Mark Kremers, MD the first S-ICD implantation in the Southeast following FDA approval.

Harry L. Smith, Jr., Named President of Presbyterian Healthcare and Novant Health’s Greater Charlotte Market Harry L. Smith, Jr., joined Novant Health as president of Presbyterian Healthcare and Novant’s greater Charlotte market on Nov. 12, 2012.

Smith was selected following an extensive Harry Smith, Jr. national search. He has more than 25 years of experience in health care. Most recently, Smith served as president and CEO of Deaconess Hospital — part of Deaconess Health System headquartered in Evansville, Ind. For more than six years, Smith was responsible for three acute-care hospitals totaling 541

beds, with an average daily census of 370 and $646.7 million net operating revenue.

Smith has a strong track record of establishing positive working relationships with physicians in community hospital and academic settings. He is an evidence/factbased decision-maker and places a high priority on being a visible, collaborative leader. These strengths made him the right choice for Novant Health.

Smith also served as president and senior administrative officer at Sisters of Charity Hospital in Buffalo, N.Y., and executive vice president and chief operating officer at Northtowns Hospitals in Buffalo, Kenmore and Cheektowaga. In addition, he has held leadership positions at Geisinger Health System in Pennsylvania and Barnes Healthcare System in Missouri.

Smith has a bachelor of science degree in biology and a master’s in hospital and healthcare administration from the University of Minnesota.

Transapical Approach to Transcatheter Aortic Valve Replacement (TAVR) Now Available for Patients With Severe Aortic Stenosis Presbyterian Hospital is first in Charlotte to perform TAVR by the transapical approach, which was recently approved by the FDA. TAVR is a catheter-based approach for valve replacement. Many patients with severe aortic stenosis are considered either inoperable or having above-average risk for traditional surgical approach of open-heart surgery due to age or coexisting health reasons.

The transapical approach involves a left-sided mini thoracotomy. The replacement valve is then inserted directly into the heart using a catheter/ guide-wire system placed through the left ventricular apex and deployed at the aortic annulus, functionally replacing the diseased aortic valve.

Prior to this method, physicians were limited to a transfemoral approach, wherein a replacement valve is delivered via a small incision in the groin.

Patients who previously have been denied TAVR, because of limited access to the aortic valve from the femoral artery, now have an option for valve replacement.

To schedule a patient for evaluation, contact the Presbyterian Valve Clinic at

14 January 2013 • Mecklenburg Medicine

704-316-TAVR (8287) or valveclinic@novanthealth.org.

Presbyterian Healthcare Awarded Advanced Certification for Primary Stroke Centers Presbyterian Hospital, Presbyterian Hospital Huntersville and Presbyterian Hospital Matthews have retained Advanced Certification for Primary Stroke Centers. Presbyterian Hospital in Charlotte was first in the region to receive this designation, and Presbyterian Hospital Huntersville and Presbyterian Hospital Matthews were awarded primary stroke center designations in 2006.

The Joint Commission, in conjunction with The American Heart Association/ American Stroke Association, approved all three facilities to retain the designation for two more years.

Primary Stroke Center Certification is available only to stroke programs in Joint Commission-accredited acute care hospitals; the achievement signifies an organization’s dedication to fostering better outcomes for patients. Primary Stroke Center Certification demonstrates critical elements of performance needed to achieve long-term success in improving outcomes for patients.

“Presbyterian Healthcare is strongly committed to providing exceptional stroke care centered on the highest practice standards,” said Jodi Dodds, MD, medical director of the Presbyterian Neuroscience Institute. “The Joint Commission guidelines for the care of stroke patients are stringent, and retaining this certification is indicative of the excellent care we continue to offer at our hospitals.”

Presbyterian Breast Center Introduces Same-Day Screening Mammograms Presbyterian Breast Center is proud to introduce same-day mammograms for patients. Same-day and walk-in appointments are available at all nine convenient locations, including the new mobile breast center. Extended and weekend hours make it even easier for patients, and no physician referral is needed. This service is covered by most insurance plans.

Call 704-384-SCAN (7226) or visit presbyterian.org/pink to schedule a mammogram for a patient today or tell her to go to any of Presbyterian Breast Center’s nine convenient locations.

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CEENTA_MecklenburgMedicalSociety_January.indd 1

Mecklenburg County Medical Society

PRSRT STD U.S. POSTAGE PAID CHARLOTTE, N.C. PERMIT NO. 1494

1112 Harding Place, #200 Charlotte, NC 28204 CHANGE SERVICE REQUESTED

MCMS Mission: To unite, serve and represent our members as advocates for our patients, for the health of the community and for the profession of medicine.

Patient Service Centers

...for all your laboratory testing needs Ballantyne Billingsley** Carmel** Cabarrus East Broad St. Gastonia Stat Lab Huntersville Huntersville** Lake Norman Matthews** Matthews Northridge* Pineville Randolph** Rock Hill Salisbury Shelby Statesville** Statesville University**

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10410 Park Road, Suite 450 1928 Randolph Road, Suite 109 2460 India Hook Road, Suite 101 601 Mocksville Avenue, Suite B 809 N. Lafayette Street 1710-A Davie Avenue 1503 East Broad Street, #102 10320 Mallard Creek Road

* Drug Screens Only ** Blood Draws Only

16 January 2013 • Mecklenburg Medicine

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