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HealtheParadigm

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health information exchanges

Susan Moore and Laura McCrary

HealtheParadigm

I hosted a special edition of Top Docs Radio with MAG this week, to talk about healthcare information exchanges with MAG’s Susan Moore, and Laura McCrary, SVP of KaMMCO Health Solutions (KHS) and the executive director of the Kansas Health Information Network, Inc. (KHIN).

KHIN is a non-profit organization that provides health information exchange technology services to over 1,350 health care organizations throughout Kansas. KHS incorporates the KHIN formula for success with the valuable lessons learned and provides health exchange information and analytics services to physician-led organizations across the nation.  Laura has been instrumental in developing the new HealtheParadigm health information network that is available in Georgia.

Susan Moore is the Medical Association of Georgia’s Director of Third Party Payer and Health Policy. She will serve as MAG’s primary contact for HealtheParadigm.

MAG and KaMMCO Health Solutions (KHS) have established a partnership that is called HealtheParadigm that is transforming the state’s health care system with a health IT solution that enables physicians to generate sophisticated patient data reports that they can use to improve outcomes and fulfill the new quality-based payer metrics.

It features a private, statewide health information network that participating physicians can use to share key patient data. HealtheParadigm will appeal to a lot of physicians and other health care providers who have remained on the sidelines because they haven’t found the right ‘fit’ given the options that are currently available in Georgia.

With the new alternative payment models that have been developed by CMS as a result of federal law – including the Merit-based Incentive Payment System (MIPS) and a number of Advanced Alternative Payment Models (APMs) – it is imperative for physicians to be able to secure and submit the data they need to demonstrate they are delivering quality care.

Physicians who participate in the HealtheParadigm network will have access to actionable, real time data and meaningful reports which can help identify high-risk patients and chronic disease populations and improve patient outcomes through enhanced care coordination.  Physicians have indicated they want a proven technology for connectivity that also delivers actionable intelligence while also providing patients with access to their own health data.

This new suite of health information tools not only provides physicians with seamless, real-time access to their patient’s full longitudinal medical record at the point of care but also prepares them for the transition to the MACRA/MIPS alternative payment models.  MAG has established a HealtheParadigm advisory committee that consists of physicians and MAG’s executive director, Donald J. Palmisano Jr.

Physicians can contact Susan Moore with MAG at smoore@mag.org or 678-303- 9275 for details on how to begin using HealtheParadigm.

Special Guests:

Susan Moore, Director of Third Party Payer and Health Policy, Medical Association of Georgia

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Laura McCrary, EVP, KaMMCO Health Solutions  linkedin_small1
Executive Director, Kansas Health Information Network

 

Author Dr. Jay Faber and Enduring Hearts

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Ankur Chatterjee

Ankur Chatterjee

Author Dr. Jay Faber and Enduring Hearts

Founded as a nonprofit organization in 2013, the mission of Enduring Hearts is to fund research that both increases the longevity of pediatric heart transplants and improves the quality of life for transplant recipients. The results of funded research projects contribute to the clinical and scientific knowledge about many important aspects of organ transplantation, e.g. the mechanisms of long-term organ deterioration, the consequences of tissue injury, and opportunities to intervene, postpone, and eliminate these rejection processes.

Executive Director for Enduring Hearts, Ankur Chatterjee joined me to talk about how the organization got its start and what it hopes to achieve by supporting research that will help extend the life

Dr. Faber is a veteran children’s and adult psychiatrist on staff at the Amen Clinic in Atlanta and in Costa Mesa, California.  He has written a book entitled “Escape: Rehab Your Brain to Stay out of the Legal System,” so he’ll be talking about this publication and how he believes this will be a game-changer for those who find themselves constantly getting into trouble with the law, often to the point of incarceration.

I was surprised to hear that as many as 85% of incarcerated Americans suffer from some form of substance abuse/addiction and many also face mental illness.  Dr. Faber’s book shares a road map for people who are dealing with substance abuse/addiction to be able to have a greater chance of recovery.

Practice Transformation Networks Explained

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Practice Transformation Networks Explained

This week, on MAG’s ongoing Top Docs Radio series, I hosted two experts in practice transformation networks (PTN’s).

The Transforming Clinical Practice Initiative (TCPI) is designed to help more than 150,000 U.S clinicians improve quality and reduce costs – keeping in mind that the Medicare is changing from a volume-based payment system to a quality-based payment system in the next several years. The four-year, $800 million TCPI initiative is being funded by the Center for Medicare & Medicaid Innovation.

It is aligned with the Affordable Care Act (ACA) and the Medicare Access and Reauthorization Act of 2015 (MACRA). The TCPI includes a network of 29 “practice transformation networks” (PTNs) that are designed to 1) improve health outcomes and 2) improve care coordination and 3) better engage patients and families and 4) improve patient, clinician and staff satisfaction and 5) reduce the overall cost of care. There is no cost for clinicians or practices to join a PTN. There are four PTNs that support clinicians in Georgia.

QualityImpact PTN

The QualityImpact PTN provides medical practices with meaningful support and resources to help them thrive in a value-based delivery environment. The QualityImpact PTN is a conduit and agent of CMS to work locally with physician groups and practices to assist them in preparation and readiness for alternative payment models. It provides services across the southeastern U.S. and beyond. It has already surpassed its enrollment target of 3,400 clinicians. Practices that enroll in the QualityImpact PTN receive a “comprehensive, transformation ‘package’ that includes: MDinsight – A sophisticated, EHR-integrated, population health management platform; Care Delivery Consulting – Process improvement facilitation enabling improved efficiency, quality, and proactive patient management; Clinical Quality Improvement – Expert-led guidance tailored to care gaps/opportunities.”

National Rural Accountable Care Consortium

NRACC has recruited more than 7,000 providers nationwide and is leading more than 876 practices through transformation from volume-based to value-based care payment models. TCPI will equip practices and clinics with the education and resources to establish the necessary population health framework and infrastructure at no cost to participating physicians while improving revenue through new billable wellness and prevention services. The following TCPI services are delivered to each practice location free for four years: Health Data Analytics Software offering a Quality Improvement Program, Risk Stratification, Annual Wellness Visit Tracking and Care Planning Program; Training & Development for Care Coordinators, Practice Managers, Billers and Coders; Implementation of a Billable Chronic Care Management program; 24/7 Nurse Advice Hotline; Patient Satisfaction Program with computer tablets for each practice; and PCMH readiness assessments every six months and training in Quarterly workshops.

Debra Simmons is the project director for the Consortium for Southeastern Hypertension Control’s (COSEHC)QualityImpact PTN. She also serves as COSEHC’s executive director. COSEHC is a non-profit professional health care organization that is based at the Wake Forest University School of Medicine in North Carolina. Debra has a long history in health care – serving in such roles as clinical nurse, department director, chief nursing officer, and quality improvement program director in both pediatric and adult hospital settings.

Kathy Whitmire is the regional vice president of the National Rural Accountable Care Consortium. Her responsibilities include physician recruitment and oversight of continuous quality improvement for the Transforming Clinical Practices Initiative (TCPI) in the Southeast. Kathy’s experience is in health care reimbursement and education. She served as the managing director of a rural hospital network of 65 hospitals and their affiliated clinics and practices in the Southeast for 15 years. She holds a degree in business administration and is a member of the American College of Healthcare Executives and the Georgia Chapter of the Healthcare Financial Management Association.

Minimally-invasive Gynecologic Surgery

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minimally-invasive

Tanya Mack and Dr. Hugo Ribot of Cartersville OB-GYN

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Minimally-invasive Gynecologic Surgery

The field of women’s health has had some remarkable advancements in recent years – well even recent
months! Although there have been many advancements in women’s health, today’s show will focus on
three areas we have additional resources for here in Georgia: Laparoscopic Surgery, Maternal Fetal
Telemedicine in the OB office and Zika virus recommendations for pregnant women.

In this US, 1:9 women are expected to have a hysterectomy in their lifetime, mostly for benign disease. Technology advancements have now made it possible for MFM specialists to bring high risk care directly into the OB office vs. the patient traveling to a tertiary care center and well – the Zika virus has come to our communities in the US. Dr. Hugo Ribot has been a premier Georgia OB/GYN for over 20 years and has continued to be a top GYN surgeon and forward thinking obstetrician outside of the metro Atlanta area.

Time to get informed on what’s new in women’s health!

Special Guest:

Dr. Hugo Ribot, MD, Cartersville OB/GYN Associates  linkedin_small1

minimally-invasive

Dr. Hugo Ribot

Reducing Chronic Diseases In Georgia

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chronic diseases

Jean O’Connor talks chronic diseases

Reducing Chronic Diseases In Georgia

This week I sat down with Dr. Jean O’Connor of the Georgia Department of Public Health to talk about efforts to reduce occurrence of numerous chronic diseases in Georgia.  Chronic diseases – such as asthma, cancer, diabetes and heart disease – cost Georgia approximately $40 billion dollars each year, contribute to increased absenteeism among students and employees, increase health care costs for Georgia employers, and result in more than 200,000 thousands of years of life lost. Chronic diseases in Georgia are preventable and controllable.

Through better nutrition, increased physical activity, eliminating tobacco use and providing access to high quality health care delivery practices, Georgia can improve population health, support better educational outcomes and economic development, and improve the quality of life for the state’s families and communities.  Physicians and other health care providers can use a common risk factor approach to control chronic disease in Georgia by encouraging behavior change, providing guidelines-based care and creating healthier communities.

Specifically, physicians can implement three overarching strategies into their patient care protocols to identify, control and prevent chronic diseases:

1. Use the 5As to address tobacco use with patients – ask, advise, assess, assist, arrange
2. Recommend physical activity and healthy eating using the new U.S. Dietary Guidelines
3. Utilize electronic health records (EHR) technology to quickly identify potential cases of undiagnosed
hypertension and diabetes to rescreen and monitor those patients regularly

The Georgia Department of Public Health provides resources and tools to support providers interested in engaging in these best practices.

Jean O’Connor, JD, MPH, DrPH, is the Chronic Disease Prevention Director at the Georgia Department of Public Health (DPH).  Since joining the agency in 2013, Dr. O’Connor has held responsibility for developing and managing statewide public health programs related to cancer screening and treatment, heart disease, diabetes, tobacco use prevention, adolescent health, nutrition, physical activity and asthma.

She also serves as the principal investigator on chronic disease-related federal cooperative agreements that provide funding, technical assistance and evaluation to Georgia health systems, local health departments and other partner organizations.  In subsequent years, Dr. O’Connor served as a state deputy health director; a health scientist at the Centers for Disease Control and Prevention (CDC); and a health policy advisor.

For the past 12 years, she has also taught public health law and policy as an affiliate professor at Emory University’s Rollins School of Public Health.  Dr. O’Connor earned her Juris Doctor and Master of Public Health degrees from Emory University, and a Doctor of Public Health degree from the University of North Carolina at Chapel Hill. She is a member of the State Bar of Georgia and serves on the Board of Directors for the National Association of Chronic Disease Directors (NACDD).

Special Guest:

Dr. Jean O’Connor, JD, Chronic Disease Prevention Director, Georgia Department of Public Health (DPH)

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

 

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

 

Manners Matter

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Manners Matter

Dr. Silverman is a cardiologist with Northside Hospital. He also teaches at the cardiac clinic at Grady Memorial Hospital – where he has been a volunteer since 1973. Dr. Silverman received his medical degree from Ohio State University. He completed his internship and residency at Vanderbilt University, while he received his cardiology training at Johns Hopkins Hospital in Baltimore.

He was an officer with the U.S. Public Health Service at the CDC. Dr. Silverman started the cardiology teaching program at Emory for Northside Hospital. He also developed Northside’s cardiology program. He served as the editor of Atlanta Medicine magazine for 15 years, and he is a long-time member of the MAG Journal editorial board.
After retiring as the founder of the pediatric ICU of the Scottish Rite Campus of Children’s Healthcare of Atlanta and founding and directing Atlanta’s busiest special care nursery, Dr. Saul Adler completed a Master of Arts degree in Professional Writing from Kennesaw State University. He currently writes short stories and novels and screenplays.

Dr. Barry Silverman and Dr. Saul Adler wrote the book ‘Your Doctor’s Manners Matter: Better Health Through Civility in the Doctor’s Office and in the Hospital.’ The book helps patients understand what qualities they should look for in their doctors. Good manners are about respect, communication, being dutiful, caring, benevolence, and understanding.

These are all critical values in an accomplished doctor. The book describes what common courtesies and manners patients should expect from their health care providers – and how failing to meet these expectations can result in lower quality and more costly care.

Their book addresses a number of important issues, including the origins of poor behavior in the medical office; why manners matter; how doctors communicate; how rude and uncivil behavior can lead to bad outcomes; what a patient should expect in terms of civility and good manners; how ordering a lots of tests does not necessarily
translate into quality care; what a patient should expect in the doctor’s office; how to navigate a hospital setting (emergency room, admitting office, surgical suite, and hospital ward); how to interact with multiple physicians at the same time; understanding who is in charge; and how to interact with the nurses, PAs, and consulting and attending physicians.

The book is available on Amazon.com.