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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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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

 

AMA Talks Opioid Abuse and MACRA

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Opiod

AMA Talks Opioid Abuse and MACRA

Patrice A. Harris, M.D., M.A., is a psychiatrist from Atlanta. She is the chair of the American Medical Association’s Board of Trustees (BOT), and she is the chair of AMA’s Task Force to Reduce Opioid Abuse. Dr. Harris has been the president of the Georgia Psychiatric Physicians Association, and she has served on the Medical Association of Georgia’s Council on Legislation.

In 2001, Dr. Harris was honored as the Georgia Psychiatric Physicians Association’s
Psychiatrist of the Year. After she earned her medical degree at West Virginia University, she did her residency in psychiatry and fellowships in child psychiatry and forensics at Emory.

She was also a Barton senior policy fellow at the Emory University School of Law. Dr. Harris was the director of Health Services for Fulton County, and she served as the medical director for the Fulton County Department of Behavioral Health and Developmental Disabilities.

Opioid abuse is a crisis in America. More than 40 people in the U.S. die from an opioid overdose every day, while many more are becoming addicted. The American Medical Association (AMA) Task Force to Reduce Opioid Abuse – which is comprised of 27 physician organizations and the American Dental Association – has announced several recommendations to address this epidemic.

It is urging physicians to register for and use state-based prescription drug monitoring programs (PDMPs) as part of the decision-making process when they consider treatment options.  When fully-funded and available at the point of care, PDMPs are an effective tool for physicians to identify patients who may be misusing opioids and can be used to implement treatment strategies, including referral for those in need of further care.

AMA will also continue to work with the administration and Congress to develop balanced approaches to end prescription opioid misuse, as well as supporting congressional and state efforts to modernize and fund PDMPs. Finally, AMA has initiated an educational effort and communications campaign to promote safe,
effective and evidence-based prescribing within the medical profession.

Georgia PDMP registration: www.hidesigns.com/gapdmp

MACRA

According to the Centers for Medicare & Medicaid Services (CMS), the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) changed how Medicare health care providers will be paid in several important ways. MACRA
1) eliminated the Sustainable Growth Rate (SGR) formula and 2) created a new framework to “reward health care providers for giving better and not just more care” and 3) combined the existing quality reporting programs (EHR, PQRS) into one new system. According to CMS, this new “Quality Payment Program (QPP)” will replace “a patchwork system of Medicare reporting programs with a flexible system that allows you to choose from two paths that link quality to payments: the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models.”

Special Guest:

Dr. Patrice Harris, Chairman, Board of Trustees, American Medical Association

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Opiod

Dr. Patrice Harris

Summertime Pregnancies

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summertime pregnancies

Dr. Winnie Soufi

 

summertime pregnancies

Dr. Rama Rao

Summertime Pregnancies

CW sat down with Dr. Winnie Soufi and Dr. Rama Rao, of Womens Health Associates.  Dr. Soufi is a board certified OB/GYN, and Dr. Rao is a board certified gynecologic surgeon, and they are part of a 7 member practice on the Northside Hospital campus here in Atlanta.

We got into summertime pregnancies and what expectant mothers should think about, from dealing with heat, hydration, nutrition, and more, as well as advances in gynecologic surgery that benefit patients with problems that warrant a surgical approach.

Check back soon for more info!

Womens Telehealth Logo

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.

 

Adopting Innovation

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adopting innovation

Jim Bross

Adopting Innovation

I sat down with Jim Bross, a long-time healthcare executive who has held leadership roles over hospitals, brings experience/expertise in regulatory compliance, and finance.  He is bringing that knowledge to RevenueSphere, a consultancy focused on helping healthcare organizations navigate successful adoption of technology to solve their most pressing challenges with the most appropriate technology.

Check back soon for more info!

 

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

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MIPS

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  linkedin_small1

woodcock