September 2016
Carolina Partners in Mental HealthCare, PLLC Providing Quality and Compassionate Mental Health Care
T H E M A G A Z I N E F O R H E A LT H C A R E P R O F E S S I O N A L S
Carolina Partners offers
Over 90 Mental Health
Care Professionals in 23 locations around North Carolina
Also in This Issue Contact Dermatitis Patient Compliance
From the Editor
Enlightened and on Target T H E M A G A Z I N E F O R H E A LT H C A R E P R O F E S S I O N A L S
Integrated, personalized mental health care distinguishes Carolina Partners in Mental Health’s “enlightened” treatment approach. This month’s cover story describes a practice that goes beyond conventional psychiatric care. Targeted treatment plans address individual patient needs using advanced tools for definitive diagnosis and evidence-based treatment. Carolina Partners’ Ivonne Draughon, who has a doctorate in nursing practice degree, complements the cover story with her column on strategies for improved patient compliance. Also in this issue of The Triangle Physician, physician assistant Tracey Cloninger explains allergy misconceptions and why accurate testing and avoidance – not new lotions – is best treatment for contact dermatitis. Physician advocate Marni
Editor Heidi Ketler, APR heidi@trianglephysician.com Contributing Editors Marni Jameson Carey Tracey S. Cloninger, P.A.-C. Ivonne Draughon, D.N.P., N.P.-C. Margie Satinsky, M.B.A. Creative Director Joseph Dally jdally@newdallydesign.com
Advertising Sales info@trianglephysiciancom News and Columns Please send to info@trianglephysician.com
Jameson Carey outlines a power-packed lineup of national speakers at the first annual meeting of the Association of Independent Doctors in Orlando Nov. 5. Practice management consultant Margie Satinsky answers frequently asked questions about leadership coaching, including benefits and the best approach for selecting a coach.
The Triangle Physician is published by: New Dally Design Subscription Rates: $48.00 per year $6.95 per issue Advertising rates on request Bulk rate postage paid Greensboro, NC 27401
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Every precaution is taken to insure the accuracy of the articles published. The Triangle Physician can not be held responsible for the opinions expressed or facts supplied by its authors. Opinions expressed or facts supplied by its authors are not the responsibility of The Triangle Physician. The Triangle Physician makes no warrant to the accuracy or reliability of this information.
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september 2016
3
Table of Contents
6
COVER STORY
Carolina Partners in Mental Health P.L.L.C. Specialized Treatment Is Integrated for Prompt Relief, Long-Term Health september 2016
Vol. 7, Issue 8
FEATURES
9
DEPARTMENTS 10 Practice Management
Dermatology
Leadership Coaching Part 2: Strengthening Skills in a “Safe” Space
Contact Dermatitis: Accurate Testing, Allergen Avoidance Best Treatment Nurse practitioner Tracey Cloninger highlights a common
12 Physician Advocacy Independence in Action Is “Meeting of Year” for Independent Doctors
misunderstanding surrounding allergies.
14
15 Duke Research News New Understanding of Immune System Informs HIV
Avoid Perfectionism: Emphasize Sensitive, Integrated Care Dr. Ivonne Draughon suggests simple provider strategies that may produce more effective patient outcomes.
4
Vaccine Development
Patient Care
The Triangle Physician
16 News
Welcome to the Area
The Magazine for Health Care Professionals
The Triangle Physician
Did You Know? We mail to over 9,000 MDs, PAs, administrators, and Hospital staff in 17 counties in the Trinagle – Not to each practice but to each MD or PA personally
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september 2016
5
Cover Story
Carolina Partners
Specialized Treatment Is Integrated for Prompt Relief, Long-Term Health Partners in Mental Health P.L.L.C. provides
health and wellness, so that anyone seek-
Rather than simply discussing the patient’s
conventional psychiatric and therapeutic
ing help can have a treatment plan tailored
experience and/or prescribing a trial-and-
care, acknowledging that health care is a
to their precise needs.
error regimen of medications, which may or may not address the root cause, the
diversified field with no single approach being 100% effective for everyone. In or-
There are three main specialty areas cur-
clinician first asks the questions, “Where
der to help as many people as possible,
rently housed by Carolina Partners: The
do these symptoms actually come from? Is
Carolina Partners directs a considerable
Neuropsychiatric Clinic, Wellness Servic-
there a physical, neurological cause that
amount of energy and resources to spe-
es, and Transcranial Magnetic Stimulation
may have been overlooked?” (A “neuro-
cialized treatment methods, which fall
(TMS) therapy.
logical cause” could include ADHD, brain injury, memory problems, and issues as
outside of the limited scope of traditional The Neuropsychiatric Clinic’s purpose is
a result of aging, to name a few.) The pa-
to integrate neurology, the study of the
tient undergoes thorough testing by way
Said treatment methods range from the
physical brain, into convention al psychiat-
of a four to six hour evaluation period to
tried-and-true to the more experimental,
ric treatment, allowing for a more in-depth
ensure a complete picture of the problem.
allowing Carolina Partners to explore a
examination of a patient’s symptoms.
mental health care.
more holistic, individualized approach to
The clinic then addresses the issue from a neurological perspective, treating the physical problem, while still turning to conventional psychiatric and therapeutic measures to help treat the symptoms in the meantime. That way, the neurological damage is treated, and the patient is still mentally stable; neither the neurological nor the psychological side of the process is compromised for the other. Specific services of The Neuropsychiatric Clinic include: • Advanced ADHD testing: allowing for a definitive diagnosis and comprehensive treatment plan. • The Cogmed Working Memory Training program: A five-week program designed by neuroscientists aimed at improving memory, concentration, and cognitive abilities. • The COGNISION™ System: an electroencephalogram device, approved by the FDA, used to objectively assess cognitive function. It is a great help
6
The Triangle Physician
in determining the root cause of
luted enough to remain non-toxic to the
cognitive problems, be it a neurologi-
body’s system. Carolina Partners believes
cal disorder, the effects of aging, or
in treating “like with like”, the theory that
Alzheimer’s.
a supplement that may cause symptoms in
• Evaluation and treatment: for
large doses also has the power to cure a
dementia, developmental disabilities,
person of those same ailments in low dos-
mood disorders (including bi-polar),
es. However, homeopathy emphasizes a
and borderline personality disorder.
natural healing process, which is why the medicines are much more diluted than in
Carolina Partners believes that integra-
conventional medicine.
tive, neuropsychological solutions represent the future of psychiatry. That’s a bold
Life coaching is also available. Highly
statement, but it’s also intuitive. Especially
trained specialists focus on effective life
since long-term health and immediate re-
planning and in-depth, non-judgmental
lief are both important, why should one
nutritional counseling. They follow the
take precedence over the other when both
Carolina Partners anthem of individually
are within reach?
tailoring a health plan to the unique needs of the patient, while also working to over-
Transcranial Magnetic Stimulation is one
come psychological blocks that may be
of the most promising and exciting ad-
preventing them from a healthy lifestyle.
vances in the mental health field today. An FDA-approved alternative treatment for de-
Carolina Partners has received many testi-
pression, TMS was designed specifically to
monials from patients who have described
aid the many patients who don’t respond
amazement at the interconnectedness
to antidepressants. At Carolina Partners,
of their physical and mental health. How
the TMS remission rate is 52.4 percent,
could a simple dietary change improve
compared to a 6.9 percent for similar pa-
anxiety and arthritis? Or how could exer-
tients on medication.
cise be the cure for insomnia?
Wellness Services encompasses another
These questions are at the crux of what
specialty area. Carolina Partners is the
Carolina Partners is striving for. It’s time
proud partner of Goldenseal Wellness, a
we stop looking at “health and wellness”
supplement and wellness store dedicated
as a series of disconnected, isolated symp-
to health and wellness in the community.
toms that must be examined and treated
Goldenseal sells holistic supplements,
individually.
vitamins, medication guides, self-help books, even heliotherapy Sun Lamps.
The psychological cannot be separated from the neurological. The physical can-
For patients who want to take a less clini-
not be separated from the mental.
cal approach to their health or for whom a clinical approach has been ineffective,
One’s age, experiences, diet, sleep pat-
Carolina Partners also houses a variety of
terns, activity level, medications, life sta-
homeopathic health options. Homeopa-
bility, emotional wellbeing, and treatment
thy is the theory that a body’s natural heal-
needed are all part of the complicated,
ing systems are the most effective form of
interconnected nexus of what it means to
healing.
be human. Any attempt at health care that does not take this nexus into account is in-
Specialists meet with a patient and pre-
complete and lags behind the enlightened
scribe a series of heavily diluted sub-
movement towards integrative care.
stances, which are aimed at triggering those natural responses while being di
Carolina Partners Providers RALEIGH, NC Carolina Partners of Raleigh 1055 Dresser Court
•
Raleigh, NC 27609 Phone: 919-876-3130 Fax: 919-876-3134
James A. Smith III, MD, Managing Partner Elizabeth Bruce, PMHNP-BC Robin Cassidy, MSN, NP Liz Corbett, MSN, RN, PMHNS/NP-BC Kelly Crenshaw, NP-C Morrow Dowdle, PA-C J. Gray McAllister, MD Jenny Smith, MD Margaret Tyma, PA-C
• Carolina Partners Raleigh Annex
1005 Dresser Court Raleigh, NC 27609 Fax: 919-239-8271
Matt Wolf, LCSW, LCAS, Managing Partner Christy Ellis, LCSW Leah Graham, MSW, LCSW, LCAS Randy Marsh, PhD, LCAS Allison Simpson, LCSW
• Carolina Partners Counseling Center North Raleigh
3723 Benson Drive Raleigh, NC 27609 Phone: 919-792-3947 Fax: 919-803-6771
Christy Ellis, LCSW Twonya Griffin, MSW, LCSW Dorothy Muccio, LCSW Michael Rosen, LCSW
• Carolina Partners Wellness Center
1033 Dresser Ct. Raleigh, NC 27609 Phone: 919-792-3960 Fax: 919-977-8359 John Cassidy, PhD, PA-C Sharon Crenshaw, PA-C Ben Jeffrey, MSN, FNP
CONCORD, NC Carolina Partners of Concord
•
236 LePhillip Ct, Suite J Concord, NC 28025 Phone: 704-792-4312 Fax: 704-262-3579
Barry Bertolette, MSN, FNP-BC
DURHAM, NC Carolina Partners Counseling Center Durham
•
1415 W. Hwy 54, Suite 215 Durham, NC 27707 Phone: 919-401-2933 Fax: 984-888-0955
Tara Escalante, LCSW Maureen Gomeringer, MSW, LCSW Nina Hightower, MSW, LCSW Kelly Hotchkiss, MSW, LCSW Lenora Lemke, MA, MEd Sherri Pietropaolo, MSW, LCSW september 2016
7
• Carolina Partners of Durham
CARY, NC Carolina Partners of Cary
3604 Shannon Rd. Suite 200 Durham, NC 27707 Phone: 919-403-2122 Fax: 919-401-4993
Yvonne L. Monroe, MD, Managing Partner Claudia Campbell, DNP, FNP-BC, APRN Mary Hartsell, DNP, FNP, PMHNP-F Gregory Helton, MD Patricia McKissic, MSN, PMHNP-BC Jeffrey S. Miller, M.Ed, MSW, LCSW Louis Sawyer, PhD
• Carolina Partners of New Hope Court
1502 W. Highway 54, Suite 103 Durham, NC 27707 Phone: 919-967-9567 Fax: 919-403-4363
Louise Newton, MSW, LCSW, SEP, Managing Partner Deborah Payne, MD Spencer Simon, PA-C An’Drea Taylor, MD ASHEVILLE, NC Carolina Partners of South Asheville 1200 Ridgefield Blvd., Suite 250
•
Asheville, NC 28806 Phone: 828-633-6070 Fax: 828-633-6073
L. Ralph Jones, MD, Managing Partner Harriett Buerckholtz, LPC Julia Cavender, PMHNP-BC
• Carolina Partners of Central Asheville
4 Doctors Park, Suite H Asheville, NC 28801 Phone: 828-285-9911 Fax: 828-285-9970
Paul Fleischer, PsyD, Managing Partner Wendy Leogrande, DNP, ARNP-BC Amparo Penny, MA, LPC
•
Lawrence Greenberg, MD, Managing Partner Bonnie Angelelli, RN, MSNed, FNP-BC Theresa Keiser, MSN, FNP-BC Cara Lutzow, MSN, FNP-BC, PMHNP-BC Denise Nelson, PA-C Varsha Vora, MD
• Carolina Partners Counseling Center - Cary
•
Chapel Hill, NC 27514 Phone: 919-929-8791 Fax: 919-929-0711
Karla de Beck, MD Heather Fayhee, MSN, FNP Anne Ruminjo, MD Hazel Shepherd, MSN, CPNP Paula Sumner, MSN, FNP-BC, CS
8
The Triangle Physician
140 Iowa Lane, Suite 204 Cary, NC 27511 Phone: 919-354-0855 Fax: 919-234-1285
Michael Goulding, MSW, LCSW, CWC, Managing Partner Amelia Peebles, PhD, LPC, ACS, NCC, NBCT Melanie Reynolds, MSW, LCSW Jennifer Schiappa, LCSW Victoria Shawl, MA, LPC, NCC WAKE FOREST, NC Carolina Partners of Wake Forest 120 Capcom Ave, Suite 101
•
Wake Forest, NC 27587 Phone: 919-488-1444 Fax: 919-488-1445
Jenny Smith, MD, Managing Partner Cameron Collins, PhD Dee Etheridge, MSW, LCSW Ashley Finch, MSW, LCSW David Fulford, PA-C Dennis Harris, PA-C Dolan Williams, MSW, LCSW THE NEUROPSYCHIATRIC CLINIC 1011 Dresser Ct.
Raleigh, NC 27609 Phone: 919-792-3940 Fax: 919-792-3949
Sandeep Vaishnavi, PhD, MD, Director Ann Forsthoefel, FNP-C Lawrence Greenberg, MD Maria Karandikar, MSN, GNP/ANP-C, APRN Crystal Tillman, DNP, PMHNP, CPNP CPMH AFFILIATES 1140 Kildaire Farm Road , Suite 200, Room 3
•
Cary, NC 27511 Phone: 919- 589-3650
Jenny Tart, MA, LPC
• 1829 East Franklin Street, Bldg 1100, Suite B
Mitchell Odom, PNP-BC, Managing Partner Ivonne Draughon, DNP, NP-C Paula M. Leif, MSN, PMHNP-BC Jeffrey S. Miller, M.Ed, MSW, LCSW Audrey Rice, ANP-C Jennifer Tangeman, FNP-C
Chapel Hill, NC 27514 Phone: (919) 717-1383
Dana Bennison, MA, LPC
• Carolina Partners Counseling Center –
Chapel Hill, NC 27514 Phone: (919) 548-2452
Mary Linker, LCSW
Wake Forest
CHAPEL HILL, NC Carolina Partners of Chapel Hill 401 Providence Rd. Suite 100
790 S. E. Cary Pkwy, Suite 201 Cary, NC 27511 Phone: 919-443-4100 Fax: 919-443-4080
1780 Heritage Center Drive, Suite 203 Wake Forest, NC 27587 Fax: 919-761-5026
Caroline Barndt, MSW, LCSW Huguette Curah, MSW, LCSW Meredith Hailey, MSW, LCSW Michael Marcinowski, LPC WILSON, NC Wilson Psychiatric Associates: A Carolina Partners Practice 2261 Nash St NW
•
Wilson, NC 27896 Phone: 252-237-8403 Fax: 252-237-7443
• 1829 E. Franklin St, Building 100C
• 100 Central Ave
Asheville, NC 28801 Phone: (828) 778-1315
Anne Henschel, MEd, MS, LPC
• 1219 E. Chatham Street, Suite 205
Cary, NC 27511 Phone: 919-460-3020 Fax: 919-460-8285
Donna Parrish, MSW, LCSW
New patients call 919-929-9610 or toll free 877-876-3783. We accept most insurance plans, including Medicare and file claims for our clients. For more information, visit www.carolinapartners.com.
Dermatology
Contact Dermatitis Accurate Testing, Allergen Avoidance Best Treatment By Tracey S. Cloninger, P.A.-C.
In North Carolina when spring comes
involves someone who typically suffers
around, a lot of our immune systems
from the “atopic triad” of asthma,
mistake pollen for a dangerous and invasive substance. The body (as we’ve all
rhinitis (hay fever) and skin eczema. •T he third ideal patient would be
seen many times) literally gets sick over it.
someone whose current rash never
And so people buy Benadryl, Claritin or
seems to improve.
Zyrtec just to keep life manageable. Too often physicians keep trying new lotions Perhaps this yearly ritual is why people
rather than referring patients to get a simple
think of allergens as pollen, dust mites,
patch test performed. At Southern Derma-
mold, pet dandruff, etc. But contact aller-
tology, we use the North American Series.
gens begin through physical contact rather
This series tests 70 of the most common al-
than inhalation. These allergies can be trig-
lergens by carefully taping patches on the
gered by substances found in a variety of
back of the patient. These patches contain
household goods like lotions, shampoos,
an organized matrix of allergens.
cosmetics, formaldehyde, formaldehyde releasing preservatives and even topical
The patches are worn for a few days.
therapies used to treat patients.
During the test, patients are not allowed to
Physician assistant Tracey Cloninger of Southern Dermatology earned her bachelor’s degree in physical education from the University of North Carolina Wilmington, her physician assistant degree from East Carolina University and her master of education degree in exercise physiology from the University of Georgia. She is a member of the American Academy of Physician Assistants, North Carolina Academy of Physician Assistants and Society of Dermatology Physician Assistants.
shower, because they must keep the patch This kind of allergy often manifests itself
area dry. Patients can experience itching
Successful results can drastically improve
as a rash that typically itches. But unlike
or minor discomfort, but generally the
a patient’s quality of life. For many people,
inhaled allergens, contact dermatitis is
procedure is simple and painless.
rashes cause the double discomfort of physical irritation and social anxiety,
often avoidable. If people know which substances cause the allergic reaction,
By the end of the test, the patches are
because many rashes are unattractive and
they can normally avoid physical contact
removed and by identifying which areas
appear in hard-to-hide areas, like the face,
with those substances and improve their
are inflamed, providers are able to identify
neck and legs.
quality of life.
the specific substances that are causing the allergic reactions. Once identified,
The good news: Many of the most common
The best way to determine this type of
dermatology providers also can provide
allergens are easily avoided. You just need
disruptive allergen is through a patch test.
information and strategies to help patients
to know what to avoid.
Three kinds of patients are ideal candi-
avoid contact with the harmful substances.
dates for a patch test. • The first ideal candidate is a patient who shows a reaction to a known contact dermatitis allergen – for example, someone with a rash on their abdomen right where the belt buckle would hit or on their ears where earrings are likely to touch. • The second type of patient that should be referred for patch testing is someone with known atopic dermatitis. That
september 2016
9
Practice Management
Leadership Coaching: Part 2 Strengthening Skills in a “Safe” Space By Margie Satinsky, M.B.A.
This article is the second in a two-part series on leadership coaching for health care providers. Last month we focused on common leadership problems. This month we focus on ways coaching can enhance leadership skills. Orit Ramler Szulik, a professional leadership coach based in Durham, N.C., collaborated
- Gaining focus, direction and commitment
with us in answering commonly asked
- Planning, thinking and strategizing
questions about leadership coaching.
- Learning to work and lead with vision rather than by dealing only with day-to-
What’s the purpose of a leadership coach in a medical practice setting?
day issues - Acquiring best practices for time
A coach helps a physician leader set clear
management and life balance
goals, develop strategies and take action in
- Improving performance toward
order to become successful, more efficient and gain a personal and professional sense of fulfillment.
measurable goals - Addressing and resolving challenges and problems •H oning communication skills by:
Who can benefit from leadership coaching?
- Improving interpersonal communication
Contrary to what some people think,
- Developing comfort and ability to
leadership coaching is not directed toward
engage in “difficult” conversations
those who are on the verge of failure. It
- Mastering the art of asking
also is not an opportunity to pass the buck
- Learning how to say “no” and “yes”
for responsibility to someone else. Rather,
- Learning to negotiate respectfully and
it is directed toward those who choose to succeed and want to excel in their leadership roles. Both experienced and newer physicians can benefit.
effectively - Enhancing team performance, collaboration and spirit •G rowing your vision by: - Thinking “outside the box”
What benefits can leadership coaching bring to a physician? Coaching offers a “safe” space for developing important professional strengths. • Development of a personal managerial and leadership style and skills by: - Venting and reinventing - Recognizing and transforming blind spots and ineffective habits
10
The Triangle Physician
Margie Satinsky is president of Satinsky Consulting L.L.C., a Durham consulting firm that specializes in medical practice management. She has helped many physicians start new practices, assess the wisdom of affiliating with a larger health care system and improve their current practices. Ms. Satinsky is the author of numerous books and articles, including Medical Practice Management in the 21st Century. For more information, visit www. satinskyconsulting.com.
- Identifying and promoting your unique abilities and services offered - Obtaining greater visibility and increasing impact - Taking a new approach to solving an old problem •E nergizing people within and outside your practice by: - Managing relationships and change
- I mproving decision-making -C reating frameworks for managing burnout, stress, emotions and expectations -F acilitating an enjoyable and more productive work environment -P erforming at your best in the middle of the storm How can I find a leadership coach who is right for me? We have four suggestions for finding a leadership coach: 1. Start with your own needs, identifying the ways in which you and/or your organization would like to improve both performance and satisfaction. Then decide what approach and which coach are best for you?
Practice Management How do leadership coaches package
tion is to participate in the leadership de-
willing to devote to coaching. You can
and price their services?
velopment programs of such organizations
certainly find a coach who will help you
Services may be offered as a set package at
as the North Carolina Medical Society or
remotely. But nothing beats on-site, one-
a fixed price. For example, the Center for
the American Association of Physician
on-one personal attention.
Creative Leadership (CCL) in Greensboro,
Leadership (formerly the American Col-
N.C., (www.ccl.org/leadership/coaching/
lege of Physician Executives).
2. Determine the time and effort you are
3. Ask colleagues and professional societies whom they recommend.
individual.aspx?pageid=202) offers three
4. Use the Internet to explore the different
individual coaching opportunities that can
Where can I learn more about
options. Some coaches specialize in
be used alone or integrated with another
leadership coaching and how it might
helping physicians only. Others work
program.
help me?
with professionals in many
If you are interested in formal leadership
fields, including, but not
coaching, check out the following
limited to medicine.
resources: • S atinsky Consulting L.L.C. (www.satinskyconsulting.com)
How does a leadership coach
•M ake It a Good One
work with clients?
(makeitagoodone.com),
Coaching adapts to individual
(http://www.makeitagoodone.com)
needs, so there’s no set formula
•A merican Association of Physician
for the methodology. It’s meant
Leadership (www.physicianleaders.org)
to make the client’s plate lighter,
•N orth Carolina Medical Society
not fuller. Other leadership coaches customize a
Leadership College Program
The frequency of the coaching varies
package of services to individual physician
(www.ncmedsoc.org)
according to need. At the start, the coach
need (e.g., content, length of time, price)
meets with the client every week or every
and charge an hourly fee. Still another op-
other week. Generally there are more coaching sessions at the beginning and fewer as the process unfolds. Some clients choose to work long term with a coach in order to preserve that safe space for thinking and planning. Each meeting or conversation has a
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clear goal. During each session, coaches may coach, consult, mentor, train and/ or facilitate as needed At the end of each session, the client and coach agree on a step or assignment (e.g., something to do, read and/or accomplish) for professional growth. The client’s progress in-between the coaching conversations is as important and sometimes more relevant than what happens during the session. Between
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meetings, the coach is usually available for short consultations in order to provide support or discuss issues that arise. Some coaches shadow their clients or plan retreats with them and their teams.
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DER131_AD_Triangle Physican WANT Conc.indd 3
september 20162:49 PM 11 3/15/16
Physician Advocacy
Independence in Action is “Meeting of Year” for Independent Doctors Attendees Earn Six CME Credits By Marni Jameson Carey
Forbes and Wall Street Journal contributor
self-regulation and regain a culture of pro-
Scott Gottlieb, M.D., a practicing physi-
fessional authority that is better for patient
cian and resident fellow at the American
care and public health.
Enterprise Institute, is the most recent addition to an all-star lineup of nationally
Those attending Independence in Action/2016
renowned presenters set to speak at the
also will hear the following speakers:
first meeting of the Association of Independent Doctors this November.
Follow the Money
Marni Jameson Carey is the executive director of the Association of Independent Doctors. You may reach her at (407) 571-9316 or marni@aid-us.org. Visit www.aid-us.org for more information.
– Gerard Anderson, Ph.D. The meeting is already being hailed as the
A leading authority on health care pay-
The Virtues of Independence
nation’s most significant meeting of the
ment reform, Dr. Anderson will discuss
– Richard B. Gunderman, M.D., Ph.D.
year for independent doctors.
how pricing decisions made by physicians
In our era of increasing oversight, con-
and hospitals influence profits, revenue
solidation and physician employment,
As if hearing terrific speakers and net-
and quality of care. His talk will examine
independent doctors appear to be go-
working with other independent doc-
the characteristics that allow doctors and
ing the way of the dinosaurs. What are
tors weren’t enough, those attending the
hospitals to have the greatest bargaining
the virtues of independence and what
one-day conference Saturday, Nov. 5, at
power and reveal who are most likely to
steps can physicians and practices take
the Walt Disney World Swan & Dolphin
use that power to their advantage. Dr. An-
to promote independence for the benefit
Resort, in Orlando, may receive six con-
derson is professor of health policy and
of patients and communities? A philoso-
tinuing medical education credits. AID
management, Bloomberg School of Pub-
pher and physician, Dr. Gunderman will
recently received approval to offer the
lic Health, Johns Hopkins University and
make the case for doctor independence
credits (6.0 AMA PRA Category 1) from
director of the Center for Hospital Finance
with his trademark grace, humanity, au-
the American Board of Quality Assurance
and Management.
thority and reason. A professor of radi-
and Utilization Review Physicians Inc., which is accredited to provide CME for
JUST THE FACTS:
physicians.
Independence In Action 2016
In a talk titled “Uncle Sam, MD: The Federal Regulation of Medicine,” Dr. Gottlieb, who previously served as U.S. Food and Drug Administration deputy commissioner for medical and scientific affairs, will discuss the events and trends that have led to the dramatic cultural change in the relationship between the government and the practice of medicine. He will shed light on why federal authorities believe they not only have a legal right to regulate medical practices but also, somehow, an obligation. Finally, he will explore how doctors can reclaim a tradition of
12
The Triangle Physician
Saturday, Nov. 5, 2016, Walt Disney World’s Swan & Dolphin Resort, Orlando Disney Theme Park Discounts: Conference attendees can save 10% on multi-day park passes, and 25% on after-3 pm tickets to Disney theme parks.
Members $175 Non-Members $225 Join AID today and save Receive 6 CME credits* www.aid-us.org/conference *This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of the American Board of Quality Assurance and Utilization Review Physicians Inc. (ABQAURP) and the Association for Independent Doctors (AID). ABQAURP is accredited by the ACCME to provide continuing medical education for physicians. The American Board of Quality Assurance and Utilization Review Physicians Inc. designates this live activity for a maximum of 6.0 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity
Physician Advocacy ology, pediatrics, medical education,
During lunch, George M. White, M.D., an
future of the practice of medicine or the
philosophy, liberal arts and philanthropy,
Orlando orthopedic surgeon and founder
administrator of an independent medical
Dr. Gunderman also serves as vice chair
of Integrated Independent Physicians
practice, you will want to be a part of this
of the radiology department at Indiana
Network L.L.C., will discuss “The Role of
landmark conference.
University and is a contributing writer to
the IPN in Maintaining Independence.” TRegister for the conference at:
The Atlantic. If you are a doctor concerned with the
www.aid-us.org/conference.
Two Person Panel The Fight Against Fraud – Elin Baklin-Kunz, MBA The force behind one of the largest and most closely watched hospital fraud and Stark Law cases in U.S. History, Ms. Kunz will share her five-year journey as she battled Halifax Hospital, her employer of 20
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years, and won. The case U.S. vs. Halifax Hospital Medical Center culminated in an $86 million settlement in 2014. In her talk, Ms. Kunz will discuss what lay behind the fight, including the detrimental dynamic created by hospital-physician employee contracts, the ways hospitals overpay physicians and disguise it, the salient points
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of Federal Stark Law and the anti-kickback law, as well as how to mount a challenge when violations occur. A national speaker and published author on topics related to medical practice compliance, coding, reimbursement, chart audits and fed-
DBT Group for Adolescents with Meredith Hailey, MSW, LCSW, CH
eral regulations, Ms. Kunz is certified in Healthcare Compliance, and is a Certified Professional Coder, Certified Professional Medical Auditor, and Certified Coding Specialist .
Some of the issues our clients experience are:
– Marlan B. Wilbanks, Esq. Nationally
recognized
attorney
DBT is noted to be very successful for clients with difficulty managing their emotions. Ms. Hailey was trained by Marsha Linnehan's (the creator of DBT) original students and trained and has supervised other therapists in DBT since 1995.
for
work on Stark Law violations and false claims, Mr. Wilbanks has championed
Mood Swings | Depression | Substance Abuse | Poor Impulse Control Borderline Personality Disorder | Eating Disorders | Anxiety/OCD Self-Injurious Behavior | Suicidal Thoughts | Anger Problems
cases that have resulted in more than $2 billion in settlements being returned to the U.S. Treasury. Sharing lessons learned from fighting fraudulent claims on behalf of the American taxpayer, Mr.
26 week program (4 modules) 6:00pm - 7:30pm | Every Thursday Ages 15-18
Wilbanks will discuss recent settlements he’s won, how these cases impact providers and the scope and potential impact of current cases. He also will discuss current cases and the vital and perilous role of the whistleblower.
Call Meredith Hailey at 919-761-5023 to find out more about the group, or to schedule a consultation to determine if this group is a good fit.
september 2016
13
Patient Care
Avoid Perfectionism
Emphasize Sensitive, Integrated Care By Ivonne Draughon, D.N.P., N.P.-C.
“Perfectionism” – a word that has haunted
deploy in their pursuit of providing effective
us since we were children. It transformed
and cost-efficient health care. One major,
the innocent and carefree into self-
positive trend is the industry’s general
conscious,
Most
move toward integrated care, which
health care providers strive for constant
emphasizes deep communication between
self-improvement, enjoying activities like
providers and patients, as opposed to
exercise and travel.
the “silo mentality,” which minimizes
goal-driven
adults.
patient input. Under this integrated model, While perfectionism can have some obvi-
treatment decisions can be made based on
ous workplace benefits, this quality also
a patient’s individual needs, expectations
can present some unexpected challenges
and capacities.
when treating patients: Health care provid-
Dr. Ivonne Draughon earned her doctor of nursing practice degree from East Carolina University and has been practicing for more than 10 years. She currently treats all ages at Carolina Partners of Wake Forest and specializes in psychiatric medication management and general primary care services. For more information visit www.carolinapartners.com.
ers might find themselves wondering how
Another way providers can remove the
they can gently encourage their patients
“silo mentality” and shift toward integrative
to take their health care seriously should
to make difficult medical or behavioral
care is by cultivating positive self-images
always be friendly, open and engaged.
changes without demanding the strictures
among patients. For example, overweight
Eye contact and other nonverbal cues
of perfectionism in treatment plans.
patients often feel unwelcome or embar-
indicating that you are paying attention are important. Doctors should strive to radiate positive energy and good humor, heeding Hippocrates’s maxim from more than two millennia ago: “Where there is love of humanity, there will be love of the profession.” Sensitive treatment of patients requires that providers attend to their personal needs for comfort, safety and positive reinforcement in primary care. This is particularly crucial for patients suffering from obesity. We must remember that the person, not the condition, should be the focus of treatment.
Health care professionals can better
rassed in medical settings and even face
Any chronic health condition demands a
improve their patients’ health and self-
discrimination or, otherwise, negative at-
productive, ongoing relationship between
image by being supportive and nurturing
titudes. By making patients feel more wel-
the patient and provider. By seeking input
rather than depending solely on the
come – something that can be done simply
from patients on what works for them and
strategy of perfectionism (even if that
by smiling, engaging and being interested
what may be challenging for them in a
strategy is successful for the providers
in them as people – doctors can go a long
treatment plan, doctors can at once make
themselves).
way toward improving their patients’ health
their patients feel valued as human beings
care experiences and outcomes alike.
and establish a treatment approach that works more effectively for the individual
Fortunately, there are many methods that physicians and nurse practitioners can
14
The Triangle Physician
Doctors interested in encouraging patients
patient.
Duke Research News
New Understanding of Immune System Informs HIV Vaccine Development One of the main mysteries confounding
author Anthony Moody, M.D., chief medical officer of the Duke
development of an HIV vaccine is why some
Human Vaccine Institute.
people infected with the virus make the desired
Barton F. Haynes, M.D
antibodies after several years, but a vaccine can’t
“These findings suggest that for a broadly neutralizing antibody-
seem to induce the same response.
inducing HIV vaccine to be successful, we will need to mimic with vaccination the immune perturbations that occur in the setting of
A research team led by scientists at the Duke
HIV infection,” Dr. Haynes said.
Human Vaccine Institute has been unraveling that mystery, detailing new insights in a study published July 29 in the journal Science
“The important point here is that the first step to finding a way
Immunology.
around a roadblock is to be able to understand the biology behind the problem,” Dr. Haynes said. “We now know what we need to do.
Studying 100 HIV-infected people – half whose immune systems
The next step is to figure out how to safely mimic what happens in
eventually made HIV-neutralizing antibodies and half whose
infection when the right antibodies are induced.”
immune systems did not – the researchers found several key immune differences that should help in the development of a how-
In addition to Dr. Haynes, study authors include M. Anthony Moody;
to manual for an effective vaccine.
Isabela Pedroza-Pacheco; Nathan A. Vandergrift; Cecilia Chui; Krissey E. Lloyd; Robert Parks; Kelly A. Soderberg; Ane T. Ogbe;
“This work gives us the beginning of an understanding of the
Myron S. Cohen; Hua-Xin Liao; Feng Gao; Andrew J. McMichael;
immune mechanisms that control development of broadly
David C. Montefiori; Laurent Verkoczy; Garnett Kelsoe; Jinghe
neutralizing antibodies, which is a major goal of a successful HIV
Huang; Patrick R. Shea; Mark Connors; and Persephone Borrow.
vaccine,” said Barton F. Haynes, M.D., director of the Duke Human Vaccine Institute and senior author of the study. “This moves forward
The study received support from the National Institute of Allergy
important concepts for vaccine design to overcome a roadblock
and Infectious Diseases directly (AI100696) and through the Duke
that has been present since we began this work 30 years ago.”
Center for HIV/AIDS Vaccine Immunology-Immunogen Discovery (AI100645 and AI067854), and from an MRC Programme grant (MR/
In earlier work, Dr. Haynes and colleagues studied a person
NEWSOURCE-JUN10:Heidi
K012037).
8/5/10
12:57 PM
Page 1
with both HIV and a form of lupus erythematosus, which is an autoimmune disease. The person’s immune system both controlled the virus and developed broadly neutralizing antibodies.
Do They Like What They See?
According to a Duke press advisory, the researchers have hypothesized that the same immune disruptions that caused the
Make sure you connect with your key audiences using strategic, cost-effective advertising, marketing and public relations.
person to develop lupus were somehow enabling the broadly neutralizing antibodies to fulfill their potential and fight the virus.
Our services range from consultation, to design, to creation and implementation of strategic plans.
Now, by directly studying large numbers of HIV-infected people whose immune systems made broadly neutralizing antibodies, the researchers found that they have similar immune alterations, or perturbations, as found in individuals with autoimmune disease. “In essence, HIV cloaks its vulnerable sites that the immune system
newsource & Associates
wants to see by making them resemble our own tissues, thereby creating an environment in which the virus is protected and the beneficial antibodies are treated as a threat to the body,” said lead
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september 2016
15
News Welcome to the Area
Physicians
Catherine Callaghan Coombs, MD
Tyler Bridgeland Jones, MD
Neonatal-Perinatal Medicine; Pediatrics
Hematology and Oncology, Internal Medicine
University of North Carolina Hospitals Chapel Hill
Emergency Medicine
David Franklin Kappa, MD
Irina Perjar, MD
Keyaria Denise Gray, DO Duke University Medical Center Durham
Jeremy Thomas Jubach, DO Cardiovascular Surgery
Duke University Medical Center Cardiovascular and Thoracic Surgery Durham
Katie Kwaschyn, DO Geriatrics; Internal Medicine
UNC Hospitals Chapel Hill
Dominick Paul Trapani, DO Family Practice
Falls Pointe Medical Group Raleigh
Jordan Price Allem, MD Cardiology; Internal Medicine
Wakemed Raleigh Campus-Heart Center Raleigh
Kathleen Elizabeth Batley, MD Hospitalist; Internal Medicine
Duke University Hospital Medicine Durham
Adam Rod Bensimhon, MD Pediatrics
University of North Carolina Hospitals Chapel Hill
UNC Lineberger Comprehensive Cancer Ctr Chapel Hill
Brittany Marie Dixon, MD Hospitalist; Internal Medicine
Duke University Hospitals Durham
Matthew Evan Ehrlich, MD Neurology; Vascular Neurology
Katherine Pandelidis Kaufman, MD Internal Medicine; Pediatrics
University of North Carolina Hospitals Chapel Hill
Patrick Shane Ellsworth, MD Internal Medicine; Pediatrics
UNC Hospitals Chapel Hill
Bradley David Figler, MD Urology
Pulmonary Disease and Critical Care, Internal Medicine
Duke University Hospitals Durham
Adnan Imdad Khan, MD Neurology
Duke University Hospitals Durham
Brenda Jean Lanan, MD Emergency Medicine
UNC-Chapel Hill Urology Chapel Hill
Duke Emergency Department Durham
Cory Shamar Henderson, MD
Tracey Harrop Liljestrom, MD
Cardiology; Cardiovascular Disease, Internal Medicine; Hospitalist
UNC Hospitals Chapel Hill
Mark Edward Henry, MD Anesthesiology - Critical Care Medicine
Pediatrics
WakeMed Physician Practices Raleigh
Internal Medicine; Pediatrics
Duke University Hospitals Durham
Joshua Gray Long, MD Emergency Medicine
UNC Hospitals Chapel Hill
Zak Loring, MD Cardiology; Internal Medicine
Andrew Julian Mincey, MD
Daniel Lee Cavanaugh, MD Orthopedic Surgery; Orthopedic Surgery of the Spine
University of North Carolina Hospitals Chapel Hill
Austin Wei-Hong Chan, MD Infectious Diseases, Internal Medicine
UNC Hospitals Chapel Hill
Peace Nnenna Ibekwe, MD Pooja Dipak Jani, MD Preventive Medicine/Occupational; Public Health
UNC-Chapel Hill Chapel Hill
Jolene Rose Jewell, MD Dermatology
Duke University Hospitals Durham
Triangle Dermatology Durham
Peter Leonard Charvat, MD
David Yutaka Johnson, MD
Emergency Medicine
Johnston Health Smithfield
16
The Triangle Physician
Radiology
Duke University Hospitals Durham
Geriatrics; Internal Medicine
Duke Clinic 1J Durham
Michael Charles Raisch, MD Dermatology
Duke Dermatology Durham
Daniel Hampton Reed, MD Emergency Medicine; Urgent Care
Aberdeen
Nicholas Thomas Rudnick, MD Radiology
Duke University Medical Center Durham
Steven Michael Salisbury II, MD Emergency Medicine
Carolyn Mariko Sawyer, MD
Jordan Alexander Holmes, MD
2777 Brentwood Rd Raleigh
Laura Ann Previll, MD
David Manly, MD
Paul Richard Carney, MD
Radiation Oncology
UNC Endocrinology Chapel Hill
WEPPA Cary
Duke University Hospitals Durham
Family Medicine; Family Practice
Karla Michelle Pou, MD
Duke University Hospitals Durham
University of North Carolina Hospitals Chapel Hill
Family Medicine
Surgery
Diabetes; Endocrinology, Internal Medicine
Anesthesiology
Rachel Elizabeth Hines, MD
Tracy Cassagnol, MD
Jennifer Kay Plichta, MD
Edward Robert Kessler, MD
Raleigh
University of North Carolina Chapel Hill
UNC Hospitals Chapel Hill
Amine El-Amraoui, MD
Samareh Ghorbani Hill, MD
Child Neurology
Anatomic and Clinical Pathology; Pathology
Duke Surgery Durham
Obstetrics; Gynecology Endocrinology/Infertility
Family Medicine
Duke University Hospitals Durham
Duke University Medical Center Durham
Duke Medical Durham
UNC Hospitals Chapel Hill
Margaret Kelly Burkhead, MD
Obstetrics and Gynecology
Erica Sopah Peethumnongsin, MD
University of North Carolina Hospitals Chapel Hill
Meaghan Rolland Bowling, MD Raleigh
Emergency Medicine
Cardiology; Cardiovascular Disease, Internal Medicine
Pediatrics
Duke University Hospitals Durham
William David Scheidler, MD Psychiatry
Ophthalmology
Carolina Eye Associates Pinehurst
Jill Caroline Moore, MD Gastroenterology, Internal Medicine
Duke Gastroenterology Durham
Berjees Mukhtar, MD Psychiatry
Cary
Antoinette Truc Nguyen, MD Obstetrics and Gynecology
UNC Family Planning Chapel Hill
Adam Carl Ottley, MD Pediatrics
Morrisille
UNC Hospitals Chapel Hill
Benjamin Houghton Schmidt, MD General Surgery; Surgical Oncology
UNC Division of Surgical Oncology Chapel Hill
Shreyansh Dineshbhai Shah, MD Neurology; Vascular Neurology
Duke University Medical Center Durham
Stephen Patrick Shaheen, MD Emergency Medicine; Sports Medicine
Duke Family Medicine Residency Program Durham
News Welcome to the Area Neema Kapadia Sharda, MD
Kajal Gordhan Zalavadia, MD
Jordan L Hausladen, PA
Trina Darlene Powell, PA
Internal Medicine, Geriatric
Internal Medicine
Duke University Hospitals Durham
Bariatric Specialists of North Carolina Cary
Cardiology; Critical Care-Internal Medicine; Emergency Medicine
Psychiatry
Lauren Elizabeth Siewny, MD
Duke University Medical Center Durham
Emergency Medicine
Sharon Bain Henderson, PA
Duke University Medical Center Durham
Family Practice (and OMT); Student Health
Jeremy Matthew Silver, MD Emergency Medicine
Durham
Diana Marie Spahlinger, MD
RADAR: BAY15001 WakeMed Physician Practices Ad: Version 1 Obstetrics & Gynecology Date: 6/15 Morrisville Gynecology; Obstetrics; Gynecologic Surgery
Tara Breanne Spector, MD
Physician Assistants
Afua Boatemaa, PA Family Medicine; Gynecology - Reproductive; Obstetrics and Gynecology; Pediatrics
Raleigh
Allison Brooke Brantley, PA
Raleigh
Catherine Marie Landgraf, PA Emergency Medicine; Hospitalist; Neurology
FirstHealth Moore Regional Hospital Pinehurst
Neurology/Psychiatry
Michelle Marcella McMoon, PA
NC Neuropsychiatry Chapel Hill
Critical Care-Internal Medicine
Duke Regional Hospital Durham
Hospitalist; Internal Medicine
Caroline Elizabeth Cordell, PA
Duke University Hospital Durham
Pinehurst
Steven David Owens, PA
Autumn Kari Konz Fingerson, PA
FirstHealth Pinehurst
Gita Suneja, MD Radiation Oncology
Duke University Medical Center Durham
Internal Medicine; Neurology
Duke Neurological Disorders Clinic Durham
Hung-Jui Tan, MD
Emergency Medicine; General Practice
Triangle Neuropsychiatry Durham
Linda Chang Schelle, PA Critical Care Surgery
828 Aaron Circle Durham
Kristina Marielle Stanson, PA Hey Clinic Raleigh
W
Vanessa Marie Taylor, PA Abdominal Surgery; Internal Medicine
Duke University Hospital Durham
Mary Kathryn Tucker, PA Family Medicine; General Surgery; Geriatrics; Internal Medicine
Raleigh
Hillary Hays Weissinger, PA Rheumatology, Urgent Care
Cary
LaQuetta Monet Planter, PA Internal Medicine
Select Specialty Hospital-Durham Durham
Urological Surgery; Urology
UNC Hospitals Chapel Hill
William Arthur Teeter, MD Emergency Medicine
UNC Hospitals Chapel Hill
Raymond Joseph Toher Jr., MD Internal Medicine
Samaritan Health Center Durham
Carolina Veronese, MD Emergency Medicine
UNC Hospitals Chapel Hill
Joseph Sam Wehby Jr, MD Family Medicine; Family Practice
University of North Carolina Hospitals Chapel Hill
Blair Nicole Wendlandt, MD Pulmonary Disease and Critical Care, Internal Medicine
UNC Hospitals Chapel Hill
Julie Ann Wesp, MD
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