North Carolina Section Fall 2019

The North Carolina Section will be transitioning to new leadership.  John Allbert will be rolling off as section chair as he starts his new role on the Society of Maternal Fetal Medicine board of directors.  Robin Matthews from Waynesville will be the new Section Chair and Katie Borders from Shelby will bring her great enthusiasm and passion to the role of SectionVice Chair.

This November, the North Carolina Medicaid program will transition from fee for service to managed care.  Providers will no longer be paid by the state directly but instead by Prepaid Health Plans, (PHP).  The initial program will be a standard plan, and in later years, tailored plans for high need populations will be developed.  The original and successful North Carolina Pregnancy Medical Home program will transition into the Pregnancy Management Program.  The global fee for providers will remain along with financial incentives to perform universal risk assessment at the first prenatal visit and depression screening at the postpartum visit.  Participants will not be required to have prior authorization for ultrasounds.  After risk stratification, those patients in the highest risk group will be provided a care manager through the health department. 

North Carolina has been an AIM state since 2016, and the North Carolina perinatal quality collaborative, (PQCNC), continues to bring new initiatives along with AIM into action under the guidance of Dr.  Arthur Ollendorf.  The program first started with implementing the Hypertension Bundle statewide in 2015 and followed this up with the Pregnancy Hemorrhage Bundle in 2018.  62 of the 83 hospitals in North Carolina that provide obstetrical services are participating by implementing hemorrhage reducing measures, quantifying blood loss and developing their own protocols for managing postpartum hemorrhage.  In 2019, the Cesarean Section Reduction bundle is being initiated with a focus on properly diagnosing labor arrest disorders.  Regional classes led by physician leaders and midwives across the state will be conducted on best practices for labor support that will hopefully help reduce operative deliveries for dystocia.  The goal for the cesarean section rate for the state is 20%.   In 2021 PQCNC will begin work on the maternal and neonatal opioid reduction program.

Legislative priorities for North Carolina are like many states involve maintaining access to reproductive services for our patients and scope of practice issues.  Recently a bill was passed that would limit the choice of women in our state.  The governor vetoed the bill and thanks to the 2018 election, and ACOG lobbying, his veto was not able to be overturned. 

There is now a bill that was recently introduced that would allow certified midwives who currently can only work under the supervision of a physician to move into a collaborative practice model. We are committed to help with legislation that will allow certified midwives to practice independently as long as they can confirm that they have an established relationship with a local physician and hospital so that quick and safe referrals can be accomplished should patients develop complications during their pregnancy or during delivery.  Up until now, this condition has not been acceptable to the midwife leadership team.

North Carolina has yet to expand Medicaid, and there are currently 500,000 citizens without healthcare coverage in our state.  There are a few bills being debated in the legislature that are a compromise and hopefully will provide funds for many uninsured families that currently do not qualify for Medicaid.  However, the likelihood of such legislation in a republican dominated legislature is unlikely.

We all know that one of the concerns of good mental health screening is that we will identifying more patients than we feel we can adequately help.  Untreated patients are at a higher risk of substance abuse disorders, attachment problems and suicide.   An exciting now project is starting this year called North Carolina Maternal Mental Health Matters.   A $650,000 federal grant per year for the next five years will improve access to mental health services including evaluation and treatment for the 10-20% of our obstetric patients with perinatal mood and anxiety disorders.  The program led by Dr. Mary Kimmel, will provide support for local providers through training on screening and treatment.  This will be augmented with support through a consultation line with a perinatal psychiatrist, and improved referral pathways for patients via in person consultation as well as telepsychiatry assessment and a telepsychiatry clinic for patient living in areas with limited access to mental health providers. 

Finally, the annual combined meeting of the ACOG Section and the North Carolina Obstetrical and Gynecology Society will on April 3-5, 2020 at the new conference center at the beautiful Kiawah Island Resort.  Dr. Ollendorf and Dr. Amy Bryant are the program directors, so the meeting quality is guaranteed to be the highest quality.  All district IV members are welcomed to attend.  It is a great time of year to be on the South Carolina coast.

Respectfully submitted,

John R. Allbert, MD, FACOG
Chair, North Carolina Section