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Dental Deserts

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GDHA

Misty Mattingly, Charlie Craig, and Sarah Smith explain GA HB 684

Dental Deserts

In the state of Georgia, 118 counties out of 159 have too few dentists to treat those residents.  16 Georgia counties have NO DENTIST at all.  Clearly, this leaves a large, rural population in the state with limited or NO access to even basic, preventive dental care.

Today, there are only 5 states that do not allow hygienists to operate under a dentist’s supervision unless the dentist is physically on site where the dental hygiene care is provided.  One of those is Georgia.

President of Georgia’s Dental Hygienist Association, Misty Mattingly, stopped by, along with Sarah Smith and Charlie Craig of Solution Road to talk about a measure before the Georgia House of Representatives that will address the lack of access to preventive screenings and treatments that are provided by hygienists.

Currently, Georgia law requires that a dentist is ON SITE while a hygienist administers care.  Obviously, this is impossible in 16 counties without some sort of medical mission on the part of dentist and hygienist, and limited in 118 Georgia counties.  Under HB 684, hygienists would be able to be supervised remotely by a dentist rather than requiring them to physically be on site.  This would empower hygienists to provide diagnostic screening and preventive care in these areas with limited to no access.

When problems requiring restoration such as a filling or crown would be identified by the hygienist during these visits, they would be referred to a dentist for appropriate care.  Without question this is a win for all parties, particularly the patients who today, have problems often going undiagnosed until serious, often resulting in an ER visit for evaluation.

Insurance Reimbursement

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John Oxendine PC

John Oxendine talks insurance reimbursement.

Insurance Reimbursement

This week’s show was part of our monthly series with MAG and we focused our conversation on legal issues around commercial insurance reimbursement for physicians.  Former insurance commissioner for the state of GA, attorney, and expert on the subject, John Oxendine, joined me in the studio to talk about some important things physicians need to know relating to commercial insurance reimbursement.
There are laws that lay out requirements for timeliness of payment and/or communications regarding submitted claims that must be adhered to by insurance companies.  Additionally, there are also rules around documentation of assignment of representation that can be the difference between losing five or six figures to insurance company claw back or being able to deny those requests to return payment for previously-delivered care.
John Oxendine is uniquely qualified to provide advice and information to physicians on the subject of health insurance reimbursement.  He spent over 15 years as Georgia’s State Insurance Commissioner.  He has worked closely with MAG, the Georgia Association of Physicians of Indian Heritage, AMA, and numerous other health care provider organizations.
While Insurance Commissioner, John created a division at the Department of Insurance to help physicians with claims payment issues.  Additionally, he was the first commissioner in the country to levy large fines against insurance companies not in compliance with the state’s prompt pay law.
Special Guest:
John Oxendine, Attorney, John Oxendine PC
John Oxendine PC
  • Doctor of Law, Mercer University, Walter F. George School of Law
  • Former Commissioner, Georgia Department of Insurance, 1995-2011

Health Insurance Mergers

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Medical Association of Georgia

Donald Palmisano Jr.

Medical Association of Georgia

Dr. John Rogers of Coliseum Northside Hospital

Health Insurance Mergers

On this week’s episode I continued my monthly series with Medical Association of Georgia. MAG CEO, Donald Palmisano, Jr., and MAG delegate from Bibb County, Dr. John Rogers joined me in studio to talk about the challenges and concerns arising from recently-proposed mergers between large health insurance companies that will significantly reduce amount of competition in the space for Georgians to choose from.

Aetna/Humana and Anthem/Cigna are in the process of merging. At the same time, health insurers are offering insurance policies to the public that do not have adequate coverage resulting in more out of network charges by physicians.

Aetna/Humana and Wellpoint/Cigna have proposed mergers in the health insurance market. If these inadequate policies are being offered in the current environment, MAG is concerned about how patients will be negatively impacted with a further narrowing of the networks and increased physician reliance on out of network charges.

MAG recently sent a letter to the U.S. Department of Justice to call for it to scrutinize the mergers for antitrust violations.

MAG believes the mergers would reduce competition and place physicians and their patients at an even greater disadvantage as a shrinking number of health insurance companies gain increasingly-dominant positions in the marketplace.

The new Aetna (58 percent) and Anthem (30 percent) entities would control nearly 90 percent of the individual market in Georgia. In the small group market, Aetna would control more than 49 percent, while Anthem would control more than 33 percent. Each new company would control about 26 percent of the Medicare Title XVIII marketplace. And for large group market, Aetna would control more than 12 percent while Anthem would control nearly 55 percent.

Physicians have little-to-no leverage to negotiate contract terms with these multi-billion dollar conglomerates – which are imposing take-it-or-leave it agreements and unilateral, mid-term amendments with growing impunity.

Gone unchecked, a few insurers will be in a position to manipulate the marketplace to institute policies that will exacerbate the physician shortage and undermine the economic viability of the practice environment in the state and limit the accessibility of care and individual patient choice.

Georgia Department of Insurance has expressed concerns that the Aetna/Humana merger would violate Georgia’s standards for competition. Specifically, DOI has shared that the Aetna/Humana merger may violate Georgia’s competitive standard in the individual, small group, and Medicare Title XVIII markets while raising concerns of substantially reduced competition in the large group market.

More than 30 percent of the physicians in Georgia who participated in a survey that MAG conducted in the last several months said that they believe that the Aetna/Humana merger would threaten the long-term viability of their practice.

Special Guests:

Donald Palmisano, CEO, Executive Director of Medical Association of Georgia  twitter_logo_small  linkedin_small1  facebook_logo_small3

Medical Association of Georgia

  • JD Law, Loyola School of Law
  • Board of Directors, Physician Advocacy Institute
  • Medical Payment Subcommitte Member, State Board of Workers’ Compensation
  • Treasurer, Board of Directors, Physicians’ Institute for Excellence in Medicine
  • Former Director, Government Relations/General Counsel/Director, GAMPAC

Dr. John Rogers, Co-Medical Director, Coliseum Northside Hospital

Coliseum Northside Hospital

  • Member, Board of Directors, Bibb County Medical Society
  • Vice President, American College of Emergency Physicians
  • Doctor of Medicine, University of Iowa Carver College of Medicine
  • Residency, Medical Center of Central Georgia

Self Funded Insurance Plans

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My Professional CFO

Alan Conner talks self funded insurance plans with CW Hall

Self Funded Insurance Plans

On this week’s episode I sat down with Alan Conner, of Your Professional CFO.  Alan is a tax and accounting expert who works with a wide range of companies and professionals, including physicians.

I met Alan a few weeks ago in the hall of our office building.  After learning about how he helps physicians, I knew we needed to have him stop by to talk about it.  In addition to providing basic accounting/payroll functions, Alan also helps physicians develop effective, legal tax strategies, including self funded insurance plans to reduce their tax burden and risk at the same time.

Alan shared the story of his older brother, an ER physician in Florida.  He explained the fact that his brother, as do many physicians, work as 1099 contractors for the respective practice they serve.  In this relationship, the doctor receives a gross paycheck with no tax withheld.

In this situation it is vital for the provider to plan for their tax obligation and pay it in a timely fashion (at least quarterly) or they face between 5-10% penalties, which can quickly add up to significant amounts, based on the numbers they’re working with.

Alan explained several options available to physicians that work as 1099 contractors, including self funded insurance plans, pension plans, SEP IRA’s, and others, that will help them preserve their hard-earned revenue for later while protecting them from risk such as loss of medical license should that occur.

It’s clear after speaking with him that it is advisable for our colleagues in the community to partner with experts such as Alan to develop a solid plan for managing their tax obligations as well as helping to secure their financial future.

Special Guest:

Alan Conner, CEO, My Professional CFO  twitter_logo_small-e1403698475314  facebook_logo_small3

My Professional CFO

  • MBA, Finance, Nova Southeastern University
  • Previous Investment Banker, Orosey & Pepe Capital Markets
  • Former Investment Manager, Arduus Asset Management

 

Interventional Radiology

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Atlanta Interventional Institute

Dr. John Lipman joins CW Hall talking interventional radiology

Interventional Radiology

We talked interventional radiology with Dr. John Lipman of Atlanta Interventional Institute on this week’s show.  Interventional radiologists are radiologists who are trained to perform a wide array of procedures using various radiologic images to guide their work.

In fact, as Dr. Lipman explained, it was interventional radiologists who invented the technology to perform procedures such as balloon angioplasty that was later used to open blocked arteries in the heart.

We talked about uterine fibroid embolization, a minimally-invasive procedure where a catheter is passed into the femoral artery and maneuvered to the arteries feeding uterine fibroids, where a chemical is instilled, caused the vessel to occlude.  This blocks bloodflow to the fibroid, causing it to shrink and die, allowing for easy removal.

The alternative for these women is hysterectomy, which is the surgical removal of the uterus, after which, the woman will need to take hormones to compensate for its loss.  Additionally, it takes days longer to recover from the surgery and bears the risk of anesthesia and post-surgical infection.

Dr. Lipman talked about other procedures interventional radiologists are able to perform such as treatment of migraine headaches, and reversing infertility related to blocked fallopian tubes.

It is important for patients and their loved ones to be sure to ask lots of questions and to inquire about other available treatment options when surgery is recommended, particularly when it involves removal of an organ or amputation.

In this way, patients can limit risk associated with surgery in many cases, and save cost and time away from work.  Dr. Lipman offered a number of questions patients and loved ones can ask to determine if an interventional radiologist is the one they should choose.

Special Guest:

Dr. John Lipman, MD, FSIR, Atlanta Interventional Institute  facebook_logo_small3  twitter_logo_small  linkedin_small1

  • Doctorate of Medicine, Georgetown University School of Medicine
  • Radiology Residency, Brigham & Women’s Hospital, Harvard Medical School
  • Fellowship, Vascular & Interventional Radiology, Yale New Haven Hospital, Yale University School of Medicine
  • Board Certified, Radiology, Vascular & Interventional Radiology
  • Fellow, Society of Interventional Radiology

 

Telemedicine

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Sidney Welch

Healthcare attorney, Sidney Welch

Telemedicine

We sat down with legal expert on healthcare matters, attorney, Sidney Welch, of the Polsinelli law firm on our monthly episode with Medical Association of Georgia.  What is it?  How is it utilized?  And, what are the licensing, regulatory, and legal concerns around it?

Georgia Composite Medical Board (GCMB) has stressed that it is essential for telemedicine patients in the state to receive the same high standard of care they would in a traditional office setting.  GCMB adopted a number of telemedicine rules in 2014 that “allow the Composite Board to take disciplinary action against licensed physicians and allied health professionals who practice telemedicine if they do not provide the minimum standard of care.”

Georgia’s rules require physicians and other allied health care professionals who deliver care by way of telemedicine to…

  • Be the ones who provide all of the treatment and/or consultations via telehealth.
  • Have access to the patient’s medical history if they are providing the services.
  • Have personally seen and examined the patient if they are referring the patient to a telehealth provider.
  • Maintain records on the patient’s evaluation and treatment if they are providing a service via telehealth and to provide a copy of those records to the referring physician.
  • Provide telehealth services only within their specialty.
  • Give their name, credentials and emergency contact information to the patient when they provide a telehealth treatment or consultation.
  • Provide the patient with “clear, appropriate, accurate instructions” on follow-up care.

Controlled substances for pain or chronic pain treatment cannot be prescribed through telehealth – but a physician or a nurse practitioner or a physician assistant can order appropriate labs or other diagnostic tests.

The physician who provides the care via telemedicine must make a “diligent” effort to ensure that the patient is seen and examined in person at least once a year by a Georgia-licensed physician or other appropriate health care professional.

Special Guest:

Sidney Welch, JD, of Polsinelli  linkedin_small1  twitter_logo_small-e1403698475314  facebook_logo_small3  

Sidney Welch

Apex Animal Hospital

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Apex Animal Hospital

Apex Animal Hospital

On this episode I sat down with Dr. Kimberly Cary and her office manager, Jamie Cary.  We talked about their rapidly-growing Austell animal hospital that has seen rapid expansion of their patient base due to referrals from happy clients.

Kimberly explained there are numerous health issues that can be transmitted between humans and their pets or that both humans and our pets can suffer from that we can benefit from being aware about.  Examples are ringworm, Lyme disease, giardiasis, rabies, and others.

The Carys talked about measures we can take to reduce the risk of our pets contracting these illnesses as well as how we can limit the risk of being affected ourselves.  In many cases, simple preventive measures are very effective at protecting both pet and owner.  These include annual exams and keeping vaccinations up to date.

Problems related to tick- and flea-borne diseases can easily be prevented by a regular dose of topical or edible medications.  And in areas of high likelihood of ticks, there is a vaccination available for dogs to prevent Lyme disease.

The practice offers a full array of pet services and has been specially designed to accommodate both dogs and cats to minimize the stress they experience when they have to be seen or stay in the animal hospital.  The office is located on East-West Connector in Austell, GA near Floyd Road.

Special Guests:

Dr. Kimberly Carey, DVM of Apex Animal Hospital   google-plus-logo-red-265px  twitter_logo_small  facebook_logo_small3  

Apex Animal Hospital

  • Doctorate Veterinary Medicine (with honors), Texas A&M University School of Veterinary Medicine
  • Values educating pet owners who are her clients to help them best care for their pets
  • President, Cobb County Veterinary Medical Association
  • Owner of 2 cats and a dog of her own

Clostridium Difficile

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Clostridium Difficile

Dr. David Dickensheets, CW Hall talk Clostridium Difficile

Clostridium Difficile

On this week’s episode we talked about one of the leading causes of hospital-acquired infections: Clostridium Difficile, or “C. Diff.”  I sat down with Dr. David Dickensheets, infectious disease specialist with Infectious Disease Services of Georgia in his Cumming, GA office.

According to the CDC nearly half a million persons experienced a Clostridium difficile infection last year.  Their website explains:

“Approximately 29,000 patients died within 30 days of the initial diagnosis of C. difficile.  Of those, about 15,000 deaths were estimated to be directly attributable to C. difficileinfections, making C. difficile a very important cause of infectious disease death in the United States.  More than 80 percent of the deaths associated with C. difficile occurred among Americans aged 65 years or older. C. difficile causes an inflammation of the colon and deadly diarrhea.

Previous studies indicate that C. difficile has become the most common microbial cause of healthcare-associated infections in U.S. hospitals and costs up to $4.8 billion each year in excess health care costs for acute care facilities alone.  The new study found that 1 out of every 5 patients with a healthcare-associated C. difficile infection experienced a recurrence of the infection and 1 out of every 9 patients aged 65 or older with a healthcare-associated C. difficile infection died within 30 days of diagnosis.”

Clearly it’s a big problem.  Dr. Dickensheets shared some great information on how the infection is diagnosed and why it’s so hard to eradicate from a hospital environment.  He also talked about an interesting treatment approach–the fecal transplant.

That’s right, in some instances, patients have been able to resolve the infection by having fecal material from a healthy human instilled into their bowel, allowing a repopulation of normal flora bacteria that compete with the C. Diff., helping to eliminate the infection.

Special Guest:

Dr. David Dickensheets, MD, of Infectious Disease Services of Georgia

Clostridium Difficile

  • Doctor of Medicine, Thomas Jefferson University
  • Residency, Roger Williams Medical Center
  • Fellowshp, Brown University
  • Board Certified in Infectious Disease

Pre-diabetes

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Dr. Ellie Campbell

Dr. Ellie Campbell talks pre-diabetes

Pre-diabetes

This week I featured a long-time friend of the show, Dr. Ellie Campbell, of Campbell Family Medicine, located in Cumming, GA.  We talked about a topic I am hopeful many of our followers will both listen to and share:  Pre-diabetes.

How many times have you gone for your annual check-up and been told, “Your labs are normal,” when your fasting blood glucose is >80mg/dl?  Those “normal” results could actually be a red flag that you have Pre-diabetes.

During this phase it’s actually possible to reverse the condition through diet and exercise.  But, as Ellie described, many physicians haven’t yet been educated that they need to be concerned with glucose levels that don’t exceed “normal” limits.  This means that we, as patients, need to be advocates for ourselves and our loved ones.

It is well-known that diabetes leads to a range of chronic and often, deadly, diseases such as heart disease, kidney disease, blindness, stroke, and more.  While we also know it is often challenging to make life-style changes, when you are aware of the risks, it can become more easy to do so.

I am pleased Ellie sat down with us to talk about pre-diabetes, a problem many people can actually do something about if they’re willing to make some of the simple changes she recommends.

Special guest:

Dr. Ellie Campbell, DO, Family Practice & Integrative Medicine at Campbell Family Medicine

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Campbell Family Medicine

  • Doctor of Osteopathic Medicine, Kirksville College of Osteopathic Medicine
  • Family Medicine Residency, Medical College of Georgia
  • Board Certified Family Medicine

ICD-10

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ICD-10

CW Hall and Dr. James Dunnick

ICD-10

This week I continued my monthly series featuring experts from Medical Association of Georgia.  Our conversation focused on the upcoming implementation of ICD-10 codes, which will significantly change how we document and are reimbursed for care provided to our patients.

I sat down with Dr. James Dunnick, a former practicing cardiologist of over 25 years who began to enhance his level of understanding of coding, compliance, and quality review later in his career.  He now provides consulting services to healthcare practices and hospitals on these important components of their businesses.

Within the healthcare industry, providers, coders, IT professionals, insurance carriers, government agencies, and others use ICD codes to properly note diseases on health records, track epidemiological trends and assist in medical reimbursement decisions.

The World Health Organization (WHO) owns, develops, and publishes ICD codes, and national governments and other regulating bodies adopt the system.

The differences between ICD-9 and ICD-10 are significant and physicians and practice management staff need to start educating themselves now about this major change so that they will be able to meet the ICD-10 compliance deadline of October 1 – in less than one month.

ICD-10-CM codes are the ones designated for use in documenting diagnoses. They are 3-7 characters in length and total 68,000, while ICD-9-CM diagnosis codes are 3-5 digits in length and number over 14,000. The ICD-10-PCS are the procedure codes and they are alphanumeric, 7 characters in length, and total approximately 87,000, while ICD-9-CM procedure codes are only 3-4 numbers in length and total approximately 4,000 codes. ICD-10-PCS is only used for coding hospital inpatient procedures. CPT remains the code set for reporting procedures and services in offices and outpatient settings.

Moving to ICD-10 is expected to impact all physicians. Due to the increased number of codes, the change in the number of characters per code, and increased code specificity, this transition will require significant planning, training, software/system upgrades/replacements, as well as other necessary investments.

WHO is expected to release ICD-11 in 2017.

Special Guest:

Dr. James Kennedy, MD, of

Within the healthcare industry, providers, coders, IT professionals, insurance carriers, government agencies, and others use ICD codes to properly note diseases on health records, track epidemiological trends and assist in medical reimbursement decisions.

The World Health Organization (WHO) owns, develops, and publishes ICD codes, and national governments and other regulating bodies adopt the system.

The differences between ICD-9 and ICD-10 are significant and physicians and practice management staff need to start educating themselves now about this major change so that they will be able to meet the ICD-10 compliance deadline of October 1 – in less than one month.

ICD-10-CM codes are the ones designated for use in documenting diagnoses. They are 3-7 characters in length and total 68,000, while ICD-9-CM diagnosis codes are 3-5 digits in length and number over 14,000. The ICD-10-PCS are the procedure codes and they are alphanumeric, 7 characters in length, and total approximately 87,000, while ICD-9-CM procedure codes are only 3-4 numbers in length and total approximately 4,000 codes. ICD-10-PCS is only used for coding hospital inpatient procedures. CPT remains the code set for reporting procedures and services in offices and outpatient settings.

Moving to ICD-10 is expected to impact all physicians. Due to the increased number of codes, the change in the number of characters per code, and increased code specificity, this transition will require significant planning, training, software/system upgrades/replacements, as well as other necessary investments.

WHO is expected to release ICD-11 in 2017.

Special Guest:

Dr. James Dunnick, MD, of SESEDN, LLC and The Dunnick Group, LLC

Dr. James Dunnick

  • Board Certified Cardiologist with 25 years of clinical practice
  • Certified Professional Coder (CPC) through the American Academy of Professional Coders (AAPC)
  • Certified in Quality and Utilization (CHCQM) by the American Board of Quality Assurance, Utilization Review Physicians (ABQAURP)
  • Certified in Compliance (CMDP) by the American Institute of Healthcare