Medicare’s Merit-based Incentive Payment System (MIPS)

Posted on May 27, 2016May 27, 2016

Elizabeth Woodcock

Medicare’s Merit-based Incentive Payment System (MIPS)

On this week’s episode we continue our series with Medical Association of Georgia, talking about the changing reimbursement picture for physician practices by the Centers for Medicare and Medicaid Services. Medicare’s new Merit-based Incentive Payment System (MIPS) will change, yet again, physician reimbursement over the next couple of years and it is important for practice managers and physicians to make sure they understand all new requirements.

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.

Elizabeth Woodcock is one of the leading third party payer and medical practice management consultants in Georgia. She is a professional speaker, trainer and author. Woodcock has focused on medical practice operations for more than 20 years. She has delivered presentations at regional and national conferences to more than 200,000 physicians and managers.

In addition to her popular email newsletters, she has authored 15 best-selling practice management books and published dozens of articles in national health
care management journals. Woodcock is a fellow in the American College of Medical Practice Executives and a certified professional coder. In addition to a degree from Duke University, she has an MBA in health care management from The Wharton School of Business of the University of Pennsylvania.

Special Guest:

Elizabeth Woodcock, Principal, Woodcock & Associates

Pre-pregnancy and Prenatal Genetic Testing

Posted on May 20, 2016May 25, 2016

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Tanya Mack of Women’s Telehealth

Pre-pregnancy and Prenatal Genetic Testing

We continue our twice-monthly series with Women’s Telehealth’s Tanya Mack. She caught up with Certified Genetic Counselor, Rachel Klein, of GenPath Diagnostics. The topic of discussion was focused on pre-pregnancy and prenatal genetic testing, when it makes sense, the difference between screening and diagnostic tests, how to deal with results, and more.

Women are routinely offered a variety of genetic tests during the first three months of pregnancy in the US. Every woman wants to believe their baby is normal and uncomplicated. However, the CDC reports that 1:33 babies born in the US will have a birth defect. Genetic tests, both screening and diagnostic, show the likelihood that a developing baby has a genetic condition that may cause problems with growth, development and bodily functions.

Information from genetic testing plus the mother’s age, the couple’s ethnic background and a family history of a genetic disorder can help calculate the odds that the fetus might have a defect such as Cystic Fibrosis, Tay-Sach’s Disease, Sickle Cell Anemia, Down’s Syndrome or neural tube defects. Joining us for this segment of Top Docs is Rachel Klein, a Certified Genetic Counselor from one of the nation’s leading prenatal genetic testing labs, GenPath.

Special Guest:

Rachel Klein, Genetic Counseling Program Manager, GenPath Diagnostics

Transforming Clinical Practice Initiative (TCPI)

Posted on May 17, 2016May 25, 2016

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Dr. Doug Patten

Transforming Clinical Practice Initiative (TCPI)

Dr. Doug Patten is the chief medical officer of the Georgia Hospital Association, which is the leading advocate for Georgia’s hospitals and health systems. GHA supports the efforts of its members as they strive to improve access to health services, improving the health of all Georgians. Dr. Patten was a general surgeon in southern Georgia before he became the chief medical officer of the Phoebe Health System in Albany.

He has been GHA’s chief medical officer for nearly two years. He is focused on improving quality and safety, engaging patients and their families, and physician leadership. He is a member of the Medical Association of Georgia and the American College of Surgeons.

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, including the Compass PTN – which has been endorsed by the Medical Association of Georgia given MAG’s “multi-year collaboration with GHA on matters related to quality, safety and community health.”

The Compass PTN will serve more than 7,000 primary and specialty care clinicians in six states. The Compass PTN is led by six non-profit partners, including the Georgia Hospital Association. In Georgia, the Compass PTN hopes to serve 1,000 clinicians, including 150 specialists.

Special Guest:

Dr. Doug Patten, CMO, Georgia Hospital Association

Zika Virus

Posted on May 12, 2016May 17, 2016

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Dr. Cherie Drenzek

Dr. Patrick O’Neal

Zika Virus

The Zika virus has been making news over the past year as we approach the coming Olympics in Brazil, a known location heavily populated by the species of mosquito known to carry the virus. I sat down with Dr. Patrick O’Neal of the Georgia’s Department of Public Health, and Dr. Cherie Drenzek, Epidemiologist for the State of Georgia to talk about what we need to be thinking about here in Georgia.

Dr. Cherie Drenzek grew up in Detroit and received her bachelor’s degree in Biological Sciences and her Master’s degree in Food Microbiology from Wayne State University. She attended Michigan State University College of Veterinary Medicine and received her DVM in 1995. She then entered the Epidemic Intelligence Service program at CDC and was stationed in the Rabies Section. Following EIS, Dr. Drenzek was employed as an Assistant Professor of Epidemiology at the University of Georgia College of Veterinary Medicine.

Dr. Drenzek has been employed at the Georgia Department of Public Health since 1999 and has served in a variety of roles, including infectious disease medical epidemiologist and State Public Health Veterinarian. She served as Director of the Acute Disease Epidemiology Section and Deputy State Epidemiologist since October 2005 and was named State Epidemiologist and Director of the Epidemiology Program in 2011.

Dr. Patrick O’Neal is the Director of Health Protection for the Georgia Department of Public Health (DPH), where he has oversight responsibility for Emergency Medical Services (EMS), Trauma, Emergency Preparedness, Epidemiology, Infectious Disease, Immunizations, and Environmental Health. For 29 years prior, he practiced
emergency medicine at DeKalb Medical Center in Decatur. He received his medical education at the Tulane University School of Medicine in New Orleans.

Zika virus (pronunciation: zee-kah) is a viral disease that is primarily transmitted to people by infected Aedes species mosquitoes. The most common symptoms of Zika are fever, rash, joint pain, and conjunctivitis. The illness is usually mild with symptoms lasting for several days to a week after being bitten by an infected mosquito.

However, there can be more severe clinical outcomes, and Zika virus infection during pregnancy can cause a serious birth defect called microcephaly, as well as other severe fetal brain defects. Prior to 2015, outbreaks have occurred in Africa, Southeast Asia, and islands in the Pacific Ocean. In May 2015, Zika virus transmission was confirmed in Brazil and outbreaks are currently occurring in many countries in the Americas and worldwide.

No local mosquito-borne Zika virus disease cases have been reported in the continental U.S., but there have been travel-associated cases, as well as cases associated with sexual transmission from travelers to affected areas. These imported cases could result in local spread of the virus in areas of the United States where the Aedes mosquito vectors are found. A list of countries where Zika virus is currently being spread can be found at the CDC website http://www.cdc.gov/zika/geo/index.html. Zika is an unprecedented public health emergency that poses significant risks to pregnant women.

This is the first time in more than 50 years that a virus has been linked to serious birth defects and poor pregnancy outcomes (and the first-ever mosquito-borne cause!). Georgia has not documented any local transmission of Zika virus, but as of the end of April 2016, has confirmed more than a dozen travel-associated Zika infections.

For general information about Zika virus and surveillance for mosquito‐borne diseases in Georgia, call your District or County Health Department or the Georgia Department of Public Health at 404‐657‐2588. You may also visit the Georgia Department of Public Health website at dph.georgia.gov. Also go to the CDC website at cdc.gov/zika/index.html.

Special Guests:

Dr. Cherie Drenzek, Epidemiologist, Georgia Department of Public Health

Dr. Patrick O’Neal, MD, Director of Health Protection, Georgia Department of Public Health

Azalea Health

Posted on May 6, 2016May 11, 2016

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Baha Zeidan

Azalea Health

This week we started our twice-monthly series with Tanya Mack, CEO of Women’s Telehealth. Her first guest was CEO and Co-founder of Azalea Health, Baha Zeidan. Azalea Health is an EMR company that launched in 2008 in Valdosta, GA. Since then the company has enjoyed steady growth and has been recognized as one of Inc. 500 Nation’s fastest growing private companies, Georgia Top 40 Innovator, and 2014 Emerging Company of the Year Phoenix Award Winner.

Healthcare IT is at the forefront of revolutionizing trends that will change the way healthcare is delivered and patients’ health and wellness outcomes. Healthcare providers and patients who are resistant to technology may be left behind. Today- EMR’s, patient portals, mobile health apps and wearables, cloud computing, and interoperability are not fringe applications but active advances that allow the patients to become more a part of the healthcare team.

Technology makes that possible. Currently, the global EMR market is $11 Billion and the US remains dominant in EMR adoption. As we move to electronic medical records, EMR’s hold a lifetime of health data and can be used to predict our individual health future through modeling.

Today’s guest, Baha Zeidan, CEO of Azalea Health will be discussing his company’s
EMR and Practice management platform and how it is evolving to incorporate these new technology advances.

Special Guests:

Baha Zeidan, CEO of Azalea Health

Tanya Mack, President, Women’s Telehealth

Value-based Payments

Posted on April 29, 2016

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Dr. Kimberly Rask

Value-based Payments

Kimberly J. Rask, M.D., PhD is the chief data officer at Alliant Health Solutions, which is a nonprofit companythat supports quality improvement in public sector health care programs under Medicare, Medicaid and End-Stage Renal Disease (ESRD) Networks across the Southeastern U.S. Dr. Rask is a primary care physician andhealth economist.

She also holds joint appointments in health policy and management and medicine at EmoryUniversity. Dr. Rask has published book chapters and peer-reviewed articles on primary care practice, quality improvement, and outcomes measurement. With more than 20 years of experience in quality research and practice, she also serves on national expert panels on value-based purchasing programs and quality measurement.

The Value-based Payment Modifier (VM) is a relatively new pay-for- performance program that is being used by CMS to pay physicians in part based on how their quality and cost compare to other physicians. It is similar to other pay-for- performance initiatives for hospitals, nursing homes, and home health agencies – and it is part of a larger effort by public and private payers to control health care costs.

Although the VM started as part of the Affordable Care Act (ACA), more recent federal legislation has expanded its reach. Medicare uses the VM program to adjust physician pay based on quality and cost measures, which vary by specialty. The reimbursement rates for 2016 are based on 2014 Physician Quality Reporting System (PQRS) data.

There are more than 250 quality metrics. Eligible providers are required to select a number of metrics –typically nine – to report. Failure to report PQRS measures can result in a penalty that is applied to all Medicare payments for the entire year. The program is revenue-neutral, so physicians who score well receive higher payments while physicians who have relatively lower scores receive lower payments.

In 2016, only medical groups with 10 or more eligible professionals will be subject to the program. In 2016, all eligible groups could receive a bonus – but only groups with 100 or more eligible professionals face a penalty in 2016. By 2017, the program is scheduled to apply to all Medicare physicians. Of the nearly 14,000 physician groups that will subject to the VM program in 2016, less than one percent – only 128 groups that include about 4,300 physicians – will receive Medicare bonuses of either 16 or 32 percent; the higher increase will go to the practices with the most high-risk patients.

Meanwhile, more than 5,400 groups that include more than 130,000 physicians will see a two percent pay cut for failing to submit their data. And nearly 60 groups that include more than 10,000 physicians will see a pay cut of one percent or two percent because their quality measures were too low. Under the MACRA legislation that passed in 2015 that permanently replaced the Medicare sustainable growth rate (SGR) formula, the VM will become one component of a new consolidated performance score. There will be two payment options for physicians.

Physicians who participate in Alternative Payment Models (e.g., some types of ACOs) will be eligible for an automatic five percent incentive payment every year. Physicians who are not participating in an APM will receive incentives or be subjected to penalties of up to nine percent based on how they perform relative to other physicians on PQRS measures, their use of EHR, quality improvement efforts, and the cost of care for their patients. Since this “new” payment program is similar to the existing VM program, preparing physician practices for success with today’s VM will position practices for success in the future.

There are several programs that available to assist physician practices with accurate quality reporting and quality improvement, which includes Alliant Quality (www.alliantquality.org) in Georgia.

Special Guest:

Dr. Kimberly Rask, MD, Alliant Health Solutions

Telemedicine

Posted on April 3, 2016April 5, 2016

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Telemedicine

Today’s technology, particularly internet, communications, and mobile platforms, is empowering disruption in the traditional healthcare delivery model. Telemedicine is an emerging trend that shows no sign of slowing and my guests on this episode focus on this platform for delivering high quality care.

In some ways, mobile technology is bringing us full circle. The “House Call” is back and being seen by a physician and/or other health professional in our home or other location outside of a doctor’s office, urgent care, or ER will likely be as common as it was decades ago, if not even more so.

Telemedicine is taking advantage of these technology capabilities to put patients together with healthcare professionals virtually and in some cases, through a combination of someone sitting with the patient facilitating an exam while another provider is connected to the interaction via video/telephony.

TeleHealth Solutions is a consultancy that works with healthcare organizations and practices seeking to add telemedicine to their delivery model. The company is able to evaluate the client’s goals and determine (hopefully prior to any expenditures on equipment/platforms) the best platform for achieving those objectives.

In some cases they may even advise the client to hold off on adding such a platform, depending on what they were expecting it to do, avoiding large costs for something that will ultimately not be used. Turner Smith explained how there are often unseen pitfalls around launching such a delivery model, so working with experts such as himself and his team can insure desired patient outcomes are achieved while making financial investments in the right technology/service.

Glenn Pearson spent nearly 20 years leading the Georgia Hospital Association. As such, he’s well-versed in the in’s and out’s of how hospitals do business, make decisions regarding technologies they will deploy (or NOT deploy), and factors that can make what seems to be a great idea for a solution that will ultimately fail to be adopted.

He’s leveraging that experience at Pearson Health Tech Insights, providing consulting services for tech companies who are developing (or plan to develop) technology solutions that will serve the hospital/health system space. He and his team can help the tech developer potentially pivot their solution if needed, or in some cases do some redesign before going to market. In this way, just as Turner’s firm helps tech buyers purchase wisely, Glenn’s company helps the developer have greater probability of success in getting their technology adopted.

I met Tanya Mack a couple of years ago on her show Doctors Roundtable here on Business Radio X. She is now leading a company called, Women’s Telehealth, a virtual physician practice comprised of maternal-fetal specialists and high-risk pregnancy OB’s.

These healthcare experts are able to link up with a hospital or group’s existing telehealth technology to provide the medical expertise needed by moms in high-risk pregnancies. With value to both urban and rural areas, Women’s Telehealth is allowing organizations that do not have high-risk OB specialists on staff, to be able to handle many of these patient needs, allowing the organization to simultaneously meet a patient need, while keeping them in their delivery system rather than losing them to a competing hospital.

Special Guests:

Tanya Mack, President, Women’s Telehealth

Turner Smith, VP of Business Development, TeleHealth Solutions

Glenn Pearson, Principal, Pearson Health Tech Insights

Dr. Mark Beaty and Dr. Manny Rodriguez

Posted on March 21, 2016June 21, 2017

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Dr. Mark Beaty

Dr. Manny Rodriguez

Dr. Mark Beaty and Dr. Manny Rodriguez

I was joined in studio by facial plastic surgeon, Dr. Mark Beaty, and I spoke with infectious disease physician, Dr. Manny Rodriguez about the Zika virus.

Dr. Mark Beaty specializes in elective aesthetic facial procedures to improve or reconstruct facial blemishes and flaws. Today we know there is more than simple vanity as reasons to consider improving the look of one’s face, particularly when you are a business professional.

Dr. Beaty shared information about recent studies that looked at individuals who underwent aesthetic procedures to address issues such as symmetry with regard to their earning over time. The study showed that business professionals in sales/leadership positions earned significantly more over time than counterparts who did not correct such issues.

We talked about some of the various ways Dr. Beaty is able to improve facial beauty, including some of the basic surgical procedures he performs, such as lifts and tucks, reconstruction of the nose, etc. He draws upon years of experience and refinement of his technique to offer what he calls, ProLIFT, allowing optimal aesthetic result with less recovery time.

He also discussed a number of innovative non-surgical procedures he is able to offer that hasten return to work with short recovery, minimal bruising or external thermal wounds. His CoolSculpting program creates the best value for non-surgical fat reduction through the use of a special device that is able to kill adipose cells, while protecting other tissues in the trouble spot.

He also explained the new Profound skin tightening procedure for non-surgical improvement of loose, saggy skin. Dr. Beaty is pleased to now have an office located in Midtown Atlanta to increase convenience for his in-town patients.

We’ve heard much about the Zika virus in the news lately, as several persons in the US have been found to be carrying the disease upon returning to the US (typically from Brazil). The virus has caused alarm due to the fact that it has recently been attributed as the cause for microcephaly in infants delivered to mothers who were infected during pregnancy.

Infectious disease physician, Dr. Manny Rodriguez took time to sit down and share some information about the virus for our listeners. In many ways, the zika viral infection is relatively benign, according to Dr. Rodriguez, with only a small number of persons exhibiting symptoms that alert them to the fact that they were exposed to the virus.

We talked about the symptoms that are most commonly seen when symptoms manifest, how the infection is diagnosed, what to expect should one become infected, along with some useful information on how to avoid the infection to begin with.

As we approach the Olympic games that will be held in Brazil, I’m sure we will continue to focus on this issue. I’m pleased to share some information straight from the expert for our listeners!

Special Guests:

Dr. Mark Beaty of Beaty Facial Plastic Surgery

Doctorate in Medicine, University of Kentucky College of Medicine
Residency, University of Iowa Department of Otolaryngology
Fellowship, Facial Plastic Surgery, Emory-Affiliated Buckhead Facial Plastic Surgery
Board Certified in Facial Plastic Surgery and Otolaryngology
Recipient, Sir Harold Delf Gilles award for research evaluating effects of rhinoplasty techniques on nasal architecture

Dr. Manny Rodriguez, DO, Infectious Disease Services of Georgia

Doctor of Osteopathy, Nova Southeastern University
Master of Public Health, Nova Southeastern University
Residency, University of South Alabama
Fellowship in Infectious Diseases, The George Washington University
Board Certified in Infectious Disease and Internal Medicine

Project DAN and Georgia’s 911 Medical Amnesty Law

Posted on March 10, 2016March 16, 2016

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Dr. Shonali Saha, CW Hall, Dallas Gay

Project DAN and Georgia’s 911 Medical Amnesty Law

We continued our series with Medical Association of Georgia this week, talking about Project DAN and Georgia’s 911 Medical Amnesty Law. Dallas Gay and Dr. Shonali Saha were my guests.

MAG Foundation ‘Think About It’ campaign Community Chair Dallas Gay and Shonali Saha, M.D. – an adolescent medicine and addiction medicine physician with the Georgia Behavioral Health Professionals practice in Smyrna – discussed naloxone and the state’s ‘9-1-1 Medical Amnesty Law’ on the ‘Top Docs Radio’ program on the Business Radio-X Network at 12:00 p.m., Tuesday, March 8.

Naloxone is an effective, non-addictive prescription medication that reverses the effects of opioid drug overdoses. Under Georgia’s 9-1-1 Medical Amnesty Law, naloxone can be delivered on an intranasal or intramuscular basis. Physicians in Georgia can prescribe naloxone via a standing order to a person who is at risk of experiencing an opioid overdose. And at their discretion, physicians can prescribe naloxone to pain management clinics, first responders, harm reduction organizations, or family members or friends or other people who are in a position to assist a patient who is at risk of experiencing an opioid overdose.

The 9-1-1 Medical Amnesty Law provides limited immunity for individuals who possess certain drugs and drug paraphernalia when they experience a drug overdose and are in need of medical care, for people who seek medical care for a person who is experiencing a drug overdose, and for certain underage drinking offenses for minors who seek medical care during an alcohol overdose.

Special Guests:

Dallas Gay, Co-Chair, “Think About It” Campaign

Board Member, Northeast Georgia Medical Center
MBA, Georgia State University
Member, Drug Free Coalition of Hall County
Former President, Protein Products, Inc
Former President, American Proteins, Inc.

Dr. Shonali Saha, MD, Georgia Behavioral Health Professionals

Doctor of Medicine, Mount Sinai School of Medicine New York University
Residency, Cambridge Health Alliance
Fellowship, Adolescent and Addiction Medicine, Johns Hopkins School of Medicine
Attending Physician, Ridgeview Institute

Health Care Fraud and False Claims

Posted on February 29, 2016February 29, 2016

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Scott Grubman, CW Hall, and James Marcus talk healthcare fraud.

Health Care Fraud and False Claims

I hosted 2 False Claims Act legal experts on this week’s MAG edition of Top Docs Radio. You’re going to want to check out what they have to say, as it could mean the difference between practicing medicine or not, in the end.

Scott Grubman is a partner with the law firm of Chilivis Cochran Larkins & Bever in Atlanta. He represents health care providers of all types and sizes with government investigations and audits, False Claims Act, and other complex litigation and various regulatory and compliance matters. Prior to joining private practice, Scott served as a trial attorney with the U.S. Department of Justice in Washington, D.C., and as an assistant U.S. attorney in Savannah – where he served on a district health care fraud taskforce. Scott also serves as an adjunct professor at Georgia State University’s College of Law, where he teaches a course in health care fraud and abuse.

Jason Marcus is among a select group of lawyers who devote their practice to qui tam and related retaliation claims under federal and state False Claims Acts. He has practiced FCA law exclusively since 2008, and he formed the firm of Bracker & Marcus in January of 2015 with partner Julie Bracker, who is dedicated to representing whistleblowers nationwide. Jason is a 2006 graduate of the University of Georgia School of Law, a former clerk to the honorable Magistrate Judge G.R. Smith of the Southern District of Georgia, and a member of Taxpayers Against Fraud Education Fund and the Georgia affiliate of the National Employment Lawyers Association.

Health care is one of the fastest growing and most heavily-regulated industries in the United States. Given that government payers (Medicare, Medicaid, etc.) finance a significant portion of the system, regulators and law enforcement have dedicated tremendous resources to rooting out and punishing fraud and abuse in health care. In fiscal year 2015 alone, the federal government recovered nearly $2 billion in settlements and judgments from health care providers under the federal False Claims Act, which does not include recoveries through audits and other administrative avenues.

Moreover, not only are the actions of healthcare providers constantly scrutinized by federal and state auditors

and law enforcement, but also by competitors, commercial insurance companies, private whistle blowers, and the public. Big hospitals and health care entities with “deep pockets” have historically carried the bulk of the liability in government enforcement actions. But beginning in 2015, the federal government announced a new policy which focuses on holding individuals – particularly individual health care providers – responsible and liable for unlawful conduct. A lot of the laws governing health care fraud and abuse do not require a specific intent to defraud or even actual knowledge of the unlawful nature of the conduct. In fact, one of the major laws governing health care fraud and abuse (the physician self-referral law or “Stark law”) requires no culpable mindset whatsoever. Accordingly, it is crucial for health care professionals of all types to be aware of the various statutory and regulatory schemes that govern health care billing and to act accordingly.

MORE INFO SOON!

Special Guests:

Scott Grubman

Jason Marcus

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Medicare’s Merit-based Incentive Payment System (MIPS)

Medicare’s Merit-based Incentive Payment System (MIPS)

Pre-pregnancy and Prenatal Genetic Testing

Pre-pregnancy and Prenatal Genetic Testing

Transforming Clinical Practice Initiative (TCPI)

Transforming Clinical Practice Initiative (TCPI)