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Month: July 2016

Transition to MIPS

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Dr. Ame

Transition to MIPS

On this week’s MAG episode, I hosted Dr. Adrienne Mims, Vice President and Chief Medical Officer, Medicare Quality Improvement for Alliant Quality, to talk about the transition to the Merit-based Incentive Payment System (MIPS).

Adrienne Mims, M.D., MPH, is the vice president and chief medical officer for Alliant GMCF. Board certified in family medicine and geriatrics, she has more than 30 years of primary care, consultative and home care geriatric experience. Dr. Mims serves on a number of boards, including the American Health Quality Association (the trade association for Medicare Quality Improvement Organizations), the Georgia Academy of Family Physicians, and the PCPI (the national organization that develops quality measures for all specialties).

In addition, the MAG member serves on the NCQA Geriatric Measurement Advisory Panel and the NCQA Clinical Programs Committee.  Dr. Mims was the medical director of the Georgia Medicaid Management Program, and she was the director of prevention health promotion and research with The Southeast Permanente Medical Group in Atlanta.

Dr. Mims completed her undergraduate training at George Washington University, her medical school at Stanford University, her residency at the Martin Luther King Jr./Charles Drew Medical Center, and her geriatric fellowship at the West Los Angeles VA. She also has an MPH in epidemiology from UCLA. It is imperative for medical practices to make a successful transition to Medicare’s new Merit-based Incentive Payment System (MIPS).

Instead of the EHR (Electronic Health Record) or the PQRS (Physician Quality Reporting System) or the Value-based Payment Modifier programs, the government will employ a single payment platform
– which is the result of the Medicare Access and CHIP Reauthorization Act (MACRA) that was signed into law in 2015. The new payment model will be based on a 100-point MIPS Composite Performance Score. That CPS will determine your Medicare payment adjustment – either up or down.

This is scheduled to commence in 2019, and the Centers for Medicare and Medicaid Services will use the 2017 calendar year as the basis for the initial reimbursement – keeping mind this is not an optional process.

Special Guest:

Dr. Adrienne Mims, Vice President and Chief Medical Officer, Medicare Quality Improvement, Alliant Quality

 

Maternal Fetal Medicine via Telehealth

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maternal-fetal medicine

Dr. C. Anne Patterson

maternal-fetal medicine

Tanya Mack

Maternal Fetal Medicine via Telehealth

Women’s Telehealth’s Tanya Mack, interviews the company’s CEO and Medical Director, Dr. C. Anne Patterson, discussing maternal-fetal medicine as a specialty, and how they are now able to capitalize on telemedicine technology to deliver high-risk maternity care to a wider patient population.

Maternal fetal medicine is rare sub-specialty of obstetrics which delivers high risk obstetric care. These
specialists manage complex complications of pregnancy such as: multiple gestations, chronic medical
conditions during pregnancy, gestational diabetes and fetal abnormalities. The CDC and March of Dimes both estimate that in 2015 in the US, approximately 1:10 babies in the US are born prematurely.

GA ranks 50/50 for maternal death and 42/50 for infant mortality. Getting access to maternal fetal medicine services is often difficult as there are only about 1200 MFM physicians in the US and most are not located in rural areas.

Clearly, there is a need for many physicians of different specialties in rural areas and maternal-fetal medicine is one of them.  OB practices and hospitals in these areas can engage with Womens Telehealth to be able to help these patients avoid having to spend long travel times in cars to be seen by these needed specialists.  This allows them to stay closer to home and receive care in their local community.

But this solution has value for urban practices as well.  There are very few maternal-fetal specialists nationwide—only ~20 or so in Georgia.  By deploying the Womens Telehealth solution, these city-based groups and hospitals can also provide access to this specialty care for their patients, preventing potential loss of the patient to other facilities/groups in the community that do have maternal-fetal specialists on campus.

Special Guest:

Dr. C. Anne Patterson, CEO/Medical Director, Womens Telehealth

Talking Compliance

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compliance

Liz Schoen

Talking Compliance

On this week’s episode with Medical Association of Georgia, healthcare law expert, Liz Schoen stopped by to share information regarding compliance with current healthcare law and regulations on Top Docs Radio.

Liz Schoen has more than 25 years of experience in the health care field. She serves as a legal and business advisor for health care providers and businesses. Schoen began her legal career as an assistant regional counsel for the U.S. Department of Health, Human Services in Atlanta. Later, she served as the general counsel and chief compliance and privacy officer at the Harbin Clinic – a large multi-specialty, physician-owned medical practice in northwest Georgia.

While there, she was responsible for advising the executive team, board of managers, physicians, and staff on a variety of federal and state complex legal and regulatory matters related to health care and compliance. Schoen drafted, reviewed, and negotiated the majority of contracts for the organization as well as developing and enhancing its compliance and privacy programs and protocols.

She also worked as hospital counsel for the Shepherd Center in Atlanta, and she was the vice president of compliance and assistant general counsel for the Georgia Hospital Association. Schoen has a law degree from Emory University School of Law.

Complying with the staggering number of complex federal and state laws and regulations is a daunting task for physicians and their staff, regardless of the medical practice’s size. Distinguishing between marketing “hype” from outside consultants versus practical reality is another challenge faced when trying to allocate proper resources that don’t appear to directly impact patient care.

The first step for medical practices is understanding what compliance issues are and how they pose risk to their practice. The laws continuously change and the next step is understanding how and where to prioritize staff time and resources. Lastly, physicians and their staff need to understand what best practices are and compare such best practices to what is in their own shop and proactively develop solutions to fill-in any gaps.

Special Guest:

Liz Schoen, Attorney, E.S. Schoen & Affiliates

compliance

 

 

Legal Considerations in Telemedicine

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telemedicine

Bill Boling, Mason Reid

telemedicine

Tanya Mack

Legal Considerations in Telemedicine

This week, Tanya hosted healthcare and telemedicine legal experts, Bill Boling and Mason Reid, of Boling and Company, to talk about legal considerations in telemedicine.

Affordable, quality telemedicine is on almost everyone’s mind! Telemedicine is a tool that is being used more frequently to provide access when and where needed and to decrease costs. One analyst recently predicted that 2020, the telemedicine market would be worth $36B dollars.

Although technology improvements have enable a new generation of telemedicine services, policy makers have been slower to adopt telemedicine.  Recently, however, a number of telemedicine related bills have been introduced that could fuel escalated telemedicine adoption by patients, payers and providers.

Bill and Mason discussed such topics as parity law, telemedicine informed consent, provider licensure requirements, telepresenter regulations, provider-patient encounter requirements, security and telemedicine clinical standards of care.

Special Guests:

Bill Boling, Founder, Boling and Company

 

Mason Reid, Associate, Boling and Company