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Medical Association of Georgia

Does My Practice Still Need To Prepare For MACRA?

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Medical Association of Georgia

Sydney Welch

Does My Practice Still Need To Prepare For MACRA?

Lawmakers changed the way Medicare physicians and other health care professionals are paid
when they passed the Medicare Access and CHIP Reauthorization Act (MACRA) in 2015.
MACRA resulted in the Medicare Quality Payment Program (QPP), which is designed to move
physicians from a fee-for- service program to a value-based payment system.

The actions that physicians take in 2017 will determine what they get paid in 2019. The Centers for Medicare, Medicaid Services’ goal is to tie 90 percent of all Medicare fee-for- service payments to quality or value by the end of 2018. The QPP replaced the Medicare SGR, and it is a zero-sum gain
program – which means that there will be winners and losers. Physicians could see their pay
increase or decrease by as much as four percent in 2019, depending on what they do in 2017.

The QPP established two paths for physicians to take, including the Merit-based Incentive
Payment Program (MIPS), which is a modified fee-for- service system, and Advanced Alternative Payment Models (APMs), which is a track for physicians who are already participating in one of the eligible advanced alternative payment models. It is crucial for physicians to figure out how to fulfill their QPP reporting requirements to avoid any cuts in pay in 2019 – as well as determining whether they will go above and beyond the minimum requirements to position themselves for a pay increase in 2019.

Finally, it is highly unlikely that MACRA/MIPS will be revised or repealed in the foreseeable
future.

Sidney Welch is the chair of Health Care Innovation at Polsinelli PC. Sidney counsels physicians, physician practices, and health care technology clients in transactional, regulatory, administrative law, and litigation matters on a national basis. She serves in leadership roles for the ABA Health Law Section, the America Health Lawyers Association, and the American Society of Medical Association Counsel.

Sidney has a bachelor’s degree from Davidson College, a master’s degree in public health from the George Washington University School of Medicine and Health Sciences, and a law degree from Samford University. It is also worth noting that she has written a regular feature for MAG’s quarterly Journal since 2008.

Talking About Bad Outcomes

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Medical Association of Georgia

Dan Huff

Talking About Bad Outcomes

All medical malpractice cases involve bad outcomes that generally involve significant damages.
In addition to the patient and their family, bad outcomes often devastate the physician and other
care providers. Unfortunately, bad outcomes are unpreventable in many cases.

How a physician handles a bad outcome with the patient and their family is critical when it comes to avoiding litigation, and how a physician responds to a bad outcome can say more about them than the fact that the bad outcome occurred.  In the event of a bad outcome, the interest of the patient must be first and foremost.

A physician must put his or her pride aside and do what is best for the patient under the circumstances – and the patient’s needs and timeliness should always govern the decision-making process.  Good communications and documentation are also important factors when a bad outcome occurs.

All medical malpractice cases involve bad outcomes that generally involve significant damages.
In addition to the patient and their family, bad outcomes often devastate the physician and other
care providers. Unfortunately, bad outcomes are unpreventable in many cases.  How a physician handles a bad outcome with the patient and their family is critical when it comes to avoiding litigation, and how a physician responds to a bad outcome can say more about them
than the fact that the bad outcome occurred.

In the event of a bad outcome, the interest of the patient must be first and foremost. A physician
must put his or her pride aside and do what is best for the patient under the circumstances – and
the patient’s needs and timeliness should always govern the decision-making process.  Good communications and documentation are also important factors when a bad outcome occurs.

MAG’s Sponsored MEP 401k Plan

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ACG Wealth

Kevin Rainwater

MAG’s Sponsored MEP 401k Plan

MAG member practices can reduce their fiduciary liability, lower plan expenses, and retain
their employees by participating in the MAG-sponsored 401(k) retirement plan that’s available
through ACG Wealth. The MAG 401(k) Plan is treated like one large plan from a government
Form 5500 reporting standpoint. In short, the MAG 401(k) Plan offers the advantages and
flexibility of a stand-alone plan while avoiding the expenses and administrative headaches
associated with sponsoring a stand-alone plan.

Member benefits include…

  • Cost savings on the investments
  • No individual Form 5500 reporting
  • Minimal plan maintenance
  • Flexible plan features, including safe harbor
  • Roth and profit sharing
  • Customizable 401(k) plan design options involving eligibility, matches, and vesting schedules
  • No audit at member level

By participating in the MAG 401(k) Plan, virtually all of the administrative tasks can be offloaded from the practice to ACG Wealth and MAG.

Kevin Rainwater is a managing partner with Atlanta Capital Group. He specializes in retirement planning.  Kevin began his career in the financial services industry more than 16 years ago. He has a passion for helping employees, executives and business owners reach their retirement goals. Kevin provides investment and plan advisory services to companies and individuals throughout the nation.

He relies on his extensive knowledge of qualified plan design and investment offerings to provide business owners and participants with the most competitive retirement plan option available.

CopernicusMD sponsored in partnership with MAG

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MAG

CopernicusMD sponsored in partnership with MAG

Dr. Ellen Shaver is the chair of CopernicusMD. After 25 years as a board-certified neurosurgeon,

Dr. Shaver knew there had to be a better way to manage practice cash flow, patient billing

notifications, carrier approvals, and collections. Her desire to enhance practice operations as well

as the patient experience led her to form CopernicusMD.

Don O’Neill is the executive managing director of CopernicusMD. Don is responsible for the

execution, launch and roll-out of the CopernicusMD platform in the private practice and facility

and public and government services sectors. He has a wealth of experience in both consumer-

facing technology solutions and project management. Don previously served as the general

manager of CreditMiner LLC, where he successfully launched a cutting-edge platform for

consumer credit in loan transactions and enabled the company to obtain full reseller status with

the three major credit bureaus.

Guest Information

CopernicusMD

The cost of medical procedures and insurance-related expenses continues to rise. Patients are

increasingly expected to pay a larger sum of money at the time procedures are performed. More

than 60 percent of employed Americans are unprepared for an out-of- pocket expense of $5,000

or more. The market for financing in medical procedures continues to evolve with new lenders

entering the space each year. Each lender has a very specific credit profile which they seek from

potential patients/clients. Managing these options is time consuming and frustrating for both the

provider and the patient.

CopernicusMD queries a patient’s ICD-10 codes against their insurance to determine how much

they will be responsible to pay out-of- pocket. It offers qualifying patients the option of financing

their medical expenses. CopernicusMD (instead of practice staff) takes on the responsibility of

managing the billing and collection of those payments. CopernicusMD pre-qualifies patients for a

loan if they need one. It also matches patients with lenders. CopernicusMD is not a collection

agency; it is a finance solution.

Go to www.copernicusmd.com or call 877.356.4712 or send an email to

info@copernicusmd.com for details.

Distracted Driving

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Distracted Driving

Distracted driving is a serious problem in Georgia. Distracted driving occurs when people aren’t
paying 100 percent of their attention to driving their vehicle. People are killed and disfigured for
life every day as a result distracted driving. And not only does distracted driving endanger the
driver, it also endangers their passengers and innocent bystanders.

According to the Triple-A Foundation for Traffic Safety, distracted driving contributes to about 16
percent of all fatal crashes in the U.S. – which represents about 5,000 deaths every year.
Distracted driving is any activity that could divert a person’s attention away from the primary task
of driving. These types of distractions include texting, using a cell phone or smartphone, eating
and drinking, talking to passengers, grooming, reading, looking at maps, using a navigation
system, watching a video, and adjusting the radio.

During this year’s legislative session, MAG supported a bill by Rep. Betty Price that would have
prohibited drivers in the state from holding a cell phone to text or talk while driving a motor
vehicle. H.B. 163 did not pass in 2017, but MAG will take an active role in a legislative committee
that will study distracted driving this summer.

Dr. Wilmer says that, “Distracted driving is spreading like a deadly cancer throughout Georgia. It
threatens all of us, including our spouses and our children and our friends. A fellow physician I
knew was killed by a distracted driver while he was riding his bike. In that instant, a family lost a
father, a husband, and their economic peace of mind. His 3,000 patients also lost a great doctor.”

Angel Flight Soars

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Medical Association of Georgia

Bert Light, Jeanine Chambers

Angel Flight Soars

Angel Flight Soars is a non-profit organization that is available to help any medically stable and
ambulatory patient who demonstrates a financial need and/or anyone who cannot use or access
commercial transportation. It serves patients who reside in or need to travel to or through
Georgia, Alabama, Mississippi, North Carolina, South Carolina or Tennessee. When there is a
need that extends beyond this region, Angel Flight Soars coordinates with affiliate organizations
through the Air Care Alliance.

Angel Flight has coordinated more than 39,000 mission flights in the last 34 years. In 2016, it
coordinated more than 3,200 missions – which translates into eight missions a day, seven days a
week. It helped patients from 34 states who ranged in age from newborn to 97 years old and who
had nearly 180 medical conditions.

Go to www.AngelFlightSoars.org or call 770.452.7958 to support Angel Flight Soars with a tax-
deductible donation or for additional information.

Jeanine Chambers has served as the executive director of Angel Flight Soars for 18 years.
Under her leadership, Angel Flight’s missions have increased by 950 percent. It is also worth
noting that Jeanine has built Angel Flight’s public awareness to unprecedented levels.

Bert Light is a member of Angel Flight’s Board of Directors. He has been an Angel Flight
volunteer pilot and contributor since 1999. Bert is a partner in a family business, Artlite Office
Supply, that provides Angel Flight with administrative support. He was honored as Angel Flight’s

Medical Association of Georgia

Bert Light, Jeanine Chambers

pilot of the year in both 2000 and 2001.

GA Rep. Allen Peake Discusses Medical Marijuana Legislation

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GA Rep. Allen Peake Discusses Medical Marijuana Legislation

Representative Allen Peake serves the citizens of Georgia’s 141st District, which includes Macon. He is in his sixth term in the Georgia House. In 2015, Representative Peake sponsored Haleigh’s Hope Bill – a measure that was signed into law that allows Georgians who have specific conditions – including children who have seizures – to possess medical cannabis oil in Georgia. He is now sponsoring a bill that would expand the list of conditions that are covered by that law – as well as legislation that would allow a public vote on whether Georgia should allow the production and distribution of medical cannabis.

Surprise Insurance Coverage Gaps

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MAG

Dr. Matt Keady and Dr. Mark Bernardy

Surprise Insurance Coverage Gaps

After receiving emergency care at an “in-network” hospital, patients often discover that they
received care from an “out-of- network” physician and owe a lot of money. This is the “surprise
insurance coverage gap.” The patient pays their monthly premium, yet they receive unexpected
“balance bills” for amounts their insurance company refuses to cover – keeping in mind the
insurers are narrowing their networks to reduce costs and maximize profits by subjecting
physicians to inadequate, take-it- or-leave- it contracts.

Physicians in Georgia believe that it is critical to end the surprise insurance gap in emergency
medicine care settings. Physicians have seen their patients’ financial burden increase in dramatic
ways as health insurance companies have narrowed their networks. Health insurance is so
ambiguous that the most sophisticated patients have trouble understanding the rules.

Many patients try to do the right thing and go to a hospital that is in their insurance network during an
emergency – but they often don’t have any way of knowing when a doctor they need to see is in or
out of their network.  The Medical Association Georgia and other physician and patient advocacy organizations are calling for state lawmakers to put an end to balance billing in emergency care settings by passing legislation that will close the surprise coverage gap. MAG is also supporting the ‘End the Surprise Insurance Gap’ campaign.

Dr. Matthew Keadey has been an emergency physician in the Atlanta area for nearly 20 years. He
began his career at Emory Healthcare. He now works in the Emory and Grady Health systems. He
is the president-elect of the Georgia College of Emergency Physicians, and he is a member of the
Medical Association of Georgia. Dr. Keadey is an expert in emergency department billing, coding
and reimbursement.

Dr. Mark Bernardy has been a private practice general/interventional radiologist in Georgia for 30
years. He is a member of the Georgia Radiological Society’s Board of Directors. Dr. Bernardy is
the vice chair of the American College of Radiology’s Economics Commission and a board
member of the Radiology Business Management Association. He is active in Georgia politics,
advocating for radiologists, physicians, and patients. His advocacy efforts started with colon
cancer screening.

Drs. Keadey and Bernardy are leading advocates for ensuring that patients have access to fair
insurance coverage in emergency care settings in Georgia.

Representative Sharon Cooper Talks Georgia Healthcare

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Sharon Cooper

Georgia State Representative, Dist. 43, Sharon Cooper

Representative Sharon Cooper Talks Georgia Healthcare

The legislative process is an important way to improve Georgia’s health care system and the practice environment. MAG spent a lot of time reaching out to lawmakers and other important stakeholders after the General Assembly ended in 2015 to ensure that it would be in a good position to effect pro-physician and pro-patient change during this year’s legislative session. MAG is focused on several key areas in 2016, including physician autonomy, Medicaid, health insurance, tort reform, and prescription drugs.

Representative Sharon Cooper is the chair of the House Health and Human Services Committee. She has been a champion for key legislation for patients and physicians in Georgia, including an HIV screening bill for pregnant women, Georgia’s Smoke Free Air Act, and the Health Share Volunteers in Medicine Act. She is known for being one of the hardest working and most honest and straightforward legislators in the state. It is also worth noting that she was married to the late Dr. Tom Cooper, who co-founded MAG’s Doctor of the Day program at the State Capitol.

Special Guest:

Sharon Cooper, Georgia House of Representatives Distric 43, Chairman-House Health & Human Services Committee

Sharon Cooper

Sharon Cooper, R-Marietta, GA District 43

 

Infectious Disease

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Infectious Disease Specialists of Atlanta

Infectious Disease

Medicine is becoming increasingly fragmented and complex. The infectious diseases specialty has become especially pivotal in our health care system when it comes to clarifying diagnoses, preserving our antibiotic armamentarium with cautious use of this limited resource, and protecting patients from complications that are associated with these complex treatments.

Unfortunately, the number of young physicians who are going into the infectious diseases specialty is declining. Two years ago, more than 40 percent of infectious diseases training programs (slots?) went
unfilled (i.e., a program seeking three new trainees might only get two and some smaller programs might not get any)  – while last year more than 60 percent of infectious disease training programs were short of fellowship trainees.

It is essential to convince more young physicians to go into the infectious disease specialty if we hope to
ensure that patients have access to the care they need.

After Dr. Dretler graduated from Tufts University Medical School in Boston in 1978, he trained in internal medicine at St. Elizabeth’s Hospital of Tufts University. He completed his infectious disease training at Emory University in Atlanta in 1981. He then started his Infectious Disease Specialists of Atlanta practice at DeKalb Medical where his group is now based.

He has served as president of the Infectious Disease Society of Georgia, as the president of the DeKalb Medical Society, and as both the chief of medicine and the chief of staff at DeKalb Medical. Dr. Dretler also served as the medical chairman of the DeKalb Medical Foundation. He has been heavily involved in medical research and has been a principal investigator for 25 years on more than 100 NIH studies, including clinical research in AIDS, Hepatitis C, Pseudomembranous colitis, and influenza. Dr. Dretler has published more than 25 articles and posters.