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Medical Association of Georgia

Practice Architectural Design

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Medical Association of Georgia

Louise Labus

Practice Architectural Design

Architectural Interiors for medical practice space is ever changing with new technology, medical developments, more complex patient needs, integrated medical professional work patterns, rising cost of construction, new lighting and finish selections based on health and environmental regulations and more.

Balancing the rising cost in construction and the needs within medical spaces can be challenging. It is critical for the design professional to work hand-in- hand the with physician and practice staff and to employ good communication and listening skills. It is the architect/designer’s responsibility to provide the most appropriate options based on the practice’s objectives in creating aesthetically pleasing and optimal spaces for the patients, physicians and staff.

Louise Labus is a senior associate at Collins Cooper Carusi Architects. She is a licensed Interior Designer with the State of Georgia and Professional Member of American Society of Interior Designers (ASID). Louise has been in the interior architecture and design field for more than 30 years. Ms. Labus has an interior design degree from Michigan State University.

She is focused on medical design, but her background also includes corporate offices, retail space, religious facilities, and educational institutions as well. Ms. Labus strives to understand the needs of her clients throughout the design process – going above and beyond due diligence and programming process to provide a truly customized, comfortable space for every client. She takes a “human-centered” design approach to medical practice interior architecture.

End of Life

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End of Life

Dr. Richard W Cohen

End of Life

End-of- life is a significant issue for patients, families and health care teams. The Institute of Medicine and the book ‘Being Mortal’ have increased the awareness of the public and the health care profession. The key to the issue is the ability of a patient to express their wishes for how they chose to live out their life and the ability of the health care team to honor those wishes.

Those wishes are documented in an ‘Advance Directive’ and, when appropriate, in a ‘Physician Orders for Life Sustaining Treatment’ (POLST). The POLST is a medical order that aims to enable seriously
ill patients to designate the treatments they desire and to ensure that those preferences are honored by medical professionals.

The Georgia POLST Collaborative is a part of the National POLST Paradigm. The Georgia POLST
Collaborative aims to educate patients, families and health care professionals throughout the state about end-of- life planning, advance directives, and the Georgia POLST.

Dr. Richard Cohen recently retired as the medical director of the WellStar Health System’s Ethics Department. He founded Wellstar’s Health System Ethics and Advance Care Planning and End-of- Life programs. Dr. Cohen is the chairman of the Board of Georgia Health Decisions, the chairman of the Georgia POLST Collaborative, and a member of the Executive Committee of the National POLST Paradigm Taskforce.

He practiced total joint restoration in Atlanta for 40 years. Dr. Cohen received he medical degree from the Jefferson University Medical School in Pennsylvania.

 

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

 

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

 

 

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.

 

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

Zika Virus

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Zika

Dr. Cherie Drenzek

zika

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

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

 

Georgia’s Philadelphia College of Osteopathic Medicine

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Philadelphia College of Osteopathic Medicine

Dr. Bill Craver

Georgia’s Philadelphia College of Osteopathic Medicine

I hosted Dr. Bill Craver to talk about the Georgia campus of Philadelphia College of Osteopathic Medicine.  Dr. Craver is the dean and chief academic officer of the osteopathic medical program at the Georgia Campus of the Philadelphia College of Osteopathic Medicine, which is also known as GA-PCOM, in Suwanee.

Dr. Craver is a professor of surgery, is board certified by the American Osteopathic Board of Surgery, and is a fellow of the American College of Osteopathic Surgeons. Dr. Craver earned a degree in physical therapy from the University of Delaware. He worked in the areas of physical therapy and sports medicine at the Hershey Medical Center before enrolling at Philadelphia College of Osteopathic Medicine, where he earned a doctor of osteopathic medicine degree with honors.

Dr. Craver completed a residency in general surgery at the Osteopathic Medical Center of Philadelphia. He cared for patients in Jasper, Georgia and Hardinsburg, Kentucky before coming to GA-PCOM.  GA-PCOM is a private, not-for-profit branch of the fully accredited Philadelphia College of Osteopathic Medicine, which has a 117-year tradition of excellence. Located in Suwanee, GA-PCOM was established in 2005.

It offers a Doctor of Osteopathic Medicine degree, a Doctor of Pharmacy degree, a Master of Science degree in Biomedical Sciences, and a Master of Science degree in Physician Assistant Studies.   The campus also includes the Georgia Osteopathic Care Center, which is an osteopathic manipulative medicine clinic that is open to the public by appointment.

What is osteopathic medicine and what does it mean to be a D.O.? Andrew T. Still, M.D., was dissatisfied with the effectiveness of 19th century medicine. He was one of the pioneers of osteopathic medicine – and he was one of the first of his time to study the attributes of good health to better understand disease. Dr. Still’s philosophy is based on the unity of all body parts and views the musculoskeletal system as a key element of health.

Dr. Still introduced the idea of returning the body to health through manipulation based on a thorough understanding of the body’s systems.  Along with M.D.s, today’s D.O.s are licensed to prescribe medication and perform surgery in all 50 states.  Osteopathic physicians practice a “whole person” approach to medicine, treating the entire person rather than just the symptoms.

With a focus on preventive health care, D.O.s help patients develop attitudes and lifestyles that don’t just fight illness but help prevent it as well. D.O.s are trained to be doctors first and specialists second. The majority of D.O.s are family-oriented primary care physicians. Many D.O.s practice in small towns and rural areas,
where they often care for entire families and communities.

Special Guest:

Dr. Bill Craver, Dean and Professor of Surgery, Georgia campus, Philadelphia College of Medicine  issuu  instagram-logo-transparent-png-i11 (16x16)  twitter_logo_small  youtube logo  facebook_logo_small3  linkedin_small1

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WellCare of Georgia and Diabetes

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diabetes

Dr. John Johnson of WellCare of Georgia talks diabetes

WellCare of Georgia and Diabetes

Dr. John Johnson is the Senior Medical Director at WellCare Health Plans, Inc. – which is one of the Medicaid CMOs in Georgia. His areas of responsibility include utilization review, care management, quality improvement and clinical outcomes.  Dr. Johnson graduated from the University of Medicine and Dentistry of New Jersey in Rutgers. He completed his residency at Emory University Hospital. Dr. Johnson is Board Certified in internal medicine.

He also has an MBA from Emory University’s Goizueta School of Business. Dr. Johnson owned and operated a practice in Douglasville that cares for patients with acute and chronic medical conditions for more than 13 years. Before joining WellCare in 2014, Dr. Johnson was the medical director for Blue Cross Blue Shield of Georgia. While there, he oversaw utilization review and case management for more than 600,000 State Health Benefit Plan patients.  Dr. Johnson is a member of MAG, the AMA, and the American College of Physicians.  He is a also colonel in the U.S. Army Reserves Medical Corps.

Diabetes is becoming more common in the United States. It afflicts more than 29 million Americans, including more than one million Georgians. One quarter of the people who are affected by it aren’t aware that they have the disease. An additional 86 million people have pre-diabetes, which means that their blood glucose (sugar) is higher than normal but not high enough to be classified as diabetic. Estimates project that as many as one in three American adults will have diabetes by 2050.

In addition to its detrimental health effects, the American Diabetes Association reports that the U.S. spends $174 billion a year to treat the disease.  The primary risk factors for diabetes include being overweight; sedentary; over the age of 45; and having a family history of diabetes. African Americans, Hispanics/Latinos, Native Americans, Asian Americans, and Pacific Islanders are at an increased risk for developing the disease.

Diabetes is the nation’s seventh-leading cause of death. It is also a leading cause of kidney failure, non-traumatic lower-limb amputations, new cases of blindness, heart disease, and stroke. A significant number of Georgians who are struggling with diabetes, particularly those in low-income and medically underserved populations, do not fully understand how to manage diabetes on a day-to-day basis.

WellCare is working to address the needs the diabetic population by collaborating with patients, providers, family members, and the community using a variety of mechanisms, including value-based care, telemedicine, field-based case management, the patient-centered medical home, and advocacy.

Special Guests:

Dr. John Johnson, MD, Senior Medical Director, WellCare of Georgia  

diabetes

  • Doctor of Medicine, University of Medicine and Dentistry of New Jersey
  • Board Certified, Internal Medicine
  • MBA, Goizueta Business School, Emory University
  • Colonel, US Army

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

Health Care Fraud and False Claims

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false claims

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

false claims

Jason Marcus

false claims