12pm ET Each Tuesday
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Genteel LLC manufactures and sells a lancing device for those with
diabetes who either avoid, or limit, their blood glucose checks because of the anxiety and pain of the
dreaded finger stick! Developed by Dr. Christopher Jacobs, biomedical engineer, Genteel is the only
stand-alone lancing device, 510K cleared by the FDA for both fingers and alternate site testing.
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Kevin Rainwater
MAG member practices can reduce their fiduciary liability, lower plan expenses, and retain
their employees by participating in the MAG-sponsored 401(k) retirement plan that’s available
through ACG Wealth. The MAG 401(k) Plan is treated like one large plan from a government
Form 5500 reporting standpoint. In short, the MAG 401(k) Plan offers the advantages and
flexibility of a stand-alone plan while avoiding the expenses and administrative headaches
associated with sponsoring a stand-alone plan.
Member benefits include…
By participating in the MAG 401(k) Plan, virtually all of the administrative tasks can be offloaded from the practice to ACG Wealth and MAG.
Kevin Rainwater is a managing partner with Atlanta Capital Group. He specializes in retirement planning. Kevin began his career in the financial services industry more than 16 years ago. He has a passion for helping employees, executives and business owners reach their retirement goals. Kevin provides investment and plan advisory services to companies and individuals throughout the nation.
He relies on his extensive knowledge of qualified plan design and investment offerings to provide business owners and participants with the most competitive retirement plan option available.
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Paula Eichenbrenner
I sat down with Executive Director of the AMCP Foundation, Paula Eichenbrenner, to talk about some of the emerging research trends likely to have an impact on managed care pharmacy over the next few months and years.
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Susan Cantrell and CW Hall
I sat down with AMCP CEO Susan Cantrell at the spring conference in Denver. She shared an update on a few of the issues leaders and pharmacy clinicians are dealing with this year. Some top areas of focus include contracting with pharmaceutical companies. Value-based reimbursement is emerging as a new trend that will likely gain traction over the coming year.
Jim Kenney, Manager of Specialty and Pharmacy Contracts at Harvard Pilgrim, lead a session titled “Approaches to Managed Care Contracting with Pharmaceutical Manufacturers.” This session discussed innovations in managed care pharmacy contracting, including indication-based contracts and price protection arrangements.
The Boston Globe recently reported on two Harvard Pilgrim pay-for-performance programs focused on rheumatoid arthritis and osteoporosis aligned with adherence and effectiveness measures. The strategy is designed to curb spending while giving patients access to costly treatments.
Healthcare Risk Management Review described the launch of an Enhanced Medication Therapy Management (MTM) program by Tabula Rasa HealthCare. This pilot program of the Part D Enhanced MTM Model involves seven states: Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming. The article shared requirements of the Centers for Medicare and Medicaid Innovation (CMMI), which oversees the model.
And of course, the AMCP conference featured speakers discussing the possibility of repeal/replacement of the ACA and the impacts such a change would have on the pharmacy landscape.
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Cat Rye
Sleep Awareness Week is coming up soon, April 23-29, and the slogan is “Sleep Better. Feel Better.” A great night’s sleep not only makes us feel better, but it also improves our health. We are here today to promote improved understanding of a rarely diagnosed, often misunderstood, serious neurological sleep disorder, known as idiopathic hypersomnia (IH). The hallmark symptom of IH is excessive daytime sleepiness, even with a full night’s slumber. This central disorder of hypersomnolence (CDH) negatively impacts patients’ lives, as they are often unable to function at work, at school, with machinery (e.g., driving), and in relationships. Join Catherine Page-Rye (Cat Rye), co-founder and a Board of Director of the Hypersomnia Foundation, as she educates us, raises awareness, and spreads hope across America and on a global scale about IH. Let’s get #BeyondSleepy!
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Dr. Ronnie Smith
Dr. Ronnie Smith is an internist with Vidalia Medical Associates. He has practiced medicine for
nearly 40 years. He has a medical degree from the Medical College of Georgia. Dr. Smith
graduated from the Executive Medical Management Program at the Wharton School at the
University of Pennsylvania. He is an expert in outpatient and inpatient risk adjustment documentation and coding and reimbursement, and he is passionate about educating his fellow
physicians and their practice staff on how to master risk adjustment and simplify the transition to
the new value-based care model.
Dr. Smith has developed innovative, point-of- care reference tools to assist physicians and medical practices that streamline the workflow process.
Risk-Adjusted Reimbursement
Physicians in the United States find themselves in a seismic paradigm shift from volume-based
reimbursement to value-based reimbursement. This is being driven by escalating health care
costs and an increasingly-sicker population. Pay-for- performance is consequently based on
patient risk scoring, and quality measures are being used at every level of our health care system.
These changes are meant to stimulate quality improvement and cost-efficiency within the health
care system.
Physician reimbursement that is tied to patient risk scoring is here to stay, so it is imperative for
physicians to understand how patient risk scoring works because it will affect their income in
significant ways. Risk adjustment uses a patient’s health status in a base year to predict or estimate what utilization costs should be the following year. If a physician fails to recognize risk-adjusting diagnoses and under code them, they will likely fail under today’s value-based reimbursement system. The clinical management of the utilization-based spending that will be required to qualify for any shared savings incentives will be challenging.
If a physician can accurately and thoroughly document how sick their patients are, they stand a far
better chance of achieving their budget objectives. This, then, gives them the best opportunity to
receive the shared savings incentives and to minimize their risk for shared losses. Dr. Smith’s key steps to succeed under the new value-based, pay-for- performance reimbursement models include…
Dr. Ronnie Smith is an internist with Vidalia Medical Associates. He has practiced medicine for
nearly 40 years. He has a medical degree from the Medical College of Georgia. Dr. Smith
graduated from the Executive Medical Management Program at the Wharton School at the
University of Pennsylvania. He is an expert in outpatient and inpatient risk adjustment documentation and coding and reimbursement, and he is passionate about educating his fellow
physicians and their practice staff on how to master risk adjustment and simplify the transition to
the new value-based care model.
Dr. Smith has developed innovative, point-of- care reference tools to assist physicians and medical practices that streamline the workflow process.
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Dr. Ellen Shaver is the chair of CopernicusMD. After 25 years as a board-certified neurosurgeon,
Dr. Shaver knew there had to be a better way to manage practice cash flow, patient billing
notifications, carrier approvals, and collections. Her desire to enhance practice operations as well
as the patient experience led her to form CopernicusMD.
Don O’Neill is the executive managing director of CopernicusMD. Don is responsible for the
execution, launch and roll-out of the CopernicusMD platform in the private practice and facility
and public and government services sectors. He has a wealth of experience in both consumer-
facing technology solutions and project management. Don previously served as the general
manager of CreditMiner LLC, where he successfully launched a cutting-edge platform for
consumer credit in loan transactions and enabled the company to obtain full reseller status with
the three major credit bureaus.
Guest Information
CopernicusMD
The cost of medical procedures and insurance-related expenses continues to rise. Patients are
increasingly expected to pay a larger sum of money at the time procedures are performed. More
than 60 percent of employed Americans are unprepared for an out-of- pocket expense of $5,000
or more. The market for financing in medical procedures continues to evolve with new lenders
entering the space each year. Each lender has a very specific credit profile which they seek from
potential patients/clients. Managing these options is time consuming and frustrating for both the
provider and the patient.
CopernicusMD queries a patient’s ICD-10 codes against their insurance to determine how much
they will be responsible to pay out-of- pocket. It offers qualifying patients the option of financing
their medical expenses. CopernicusMD (instead of practice staff) takes on the responsibility of
managing the billing and collection of those payments. CopernicusMD pre-qualifies patients for a
loan if they need one. It also matches patients with lenders. CopernicusMD is not a collection
agency; it is a finance solution.
Go to www.copernicusmd.com or call 877.356.4712 or send an email to
info@copernicusmd.com for details.
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Womens Telehealth CEO, Tanya Mack sits down with Dr. Gregg Raduka, Director of Prevention/Intervention Programming and Services at The Council on Alcohol and Drugs to learn about the scope of population dealing with not just consumption, but abuse and in many cases, addiction. This month is Alcohol Awareness Month and we had this conversation to draw a picture of how many lives are affected, what options are available for those dealing with abuse or addiction, and research going on around the issue.
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Distracted driving is a serious problem in Georgia. Distracted driving occurs when people aren’t
paying 100 percent of their attention to driving their vehicle. People are killed and disfigured for
life every day as a result distracted driving. And not only does distracted driving endanger the
driver, it also endangers their passengers and innocent bystanders.
According to the Triple-A Foundation for Traffic Safety, distracted driving contributes to about 16
percent of all fatal crashes in the U.S. – which represents about 5,000 deaths every year.
Distracted driving is any activity that could divert a person’s attention away from the primary task
of driving. These types of distractions include texting, using a cell phone or smartphone, eating
and drinking, talking to passengers, grooming, reading, looking at maps, using a navigation
system, watching a video, and adjusting the radio.
During this year’s legislative session, MAG supported a bill by Rep. Betty Price that would have
prohibited drivers in the state from holding a cell phone to text or talk while driving a motor
vehicle. H.B. 163 did not pass in 2017, but MAG will take an active role in a legislative committee
that will study distracted driving this summer.
Dr. Wilmer says that, “Distracted driving is spreading like a deadly cancer throughout Georgia. It
threatens all of us, including our spouses and our children and our friends. A fellow physician I
knew was killed by a distracted driver while he was riding his bike. In that instant, a family lost a
father, a husband, and their economic peace of mind. His 3,000 patients also lost a great doctor.”
