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Adopting Innovation

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innovation

Judy Mod

Adopting Innovation

I sat down with Judy Mod and Trent McEwan of RevenueSphere.  We are in the midst of a significant business transformation – as organizations are redefining their own path to adoption – from recognition of pain through problem resolution. What’s broken?

The fundamental shift in the way buyers are now adopting technology is increasing the complexity surrounding the decisions being made about what strategic business problems to adopt – what operational approaches to adopt to fix the problem – and ultimately technically what to buy.

innovation

Trent McEwan

The rule of thumb is the more complex the organization, the more disruptive your innovation, the more difficult your market development; the bigger drag this adoption problem is likely having on your business growth. The more disruptive the innovation = The more complex the adoption.

One critical effect – 80% of sales today are being lost – not to the competition – but to “non-decision”; RevenueSphere, LLC, the problem we solve is the process of adoption across the entire life cycle (problem, operational, technical, and financial), bridging the widening gap between buyers and sellers.

Special Guests:

Judy Mod, CEO, Chief Adoption Officer, RevenueSphere

 

Trent McEwan, COO/CTO, RevenueSphere

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

MAG’s MEP 401(k)

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MAG's 401(k)

Kevin Rainwater talks MAG’s 401(k) plan

MAG’s MEP 401(k)

We continue our series with Medical Association of Georgia, hosting Kevin Rainwater of Atlanta Capital Group to learn about MAG’s MEP 401(k) plan.  Kevin Rainwater is a managing partner with Atlanta Capital Group, specializing 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.

MAG member practices can save time and money and retain employees by participating in a MAG-sponsored 401(k) retirement plan that’s available through the Atlanta Capital Group and Transamerica.

The MAG 401(k) Plan is treated like one large plan from a government Form 5500 reporting standpoint. The result is a 401(k) plan with competitive investments, outstanding service, and someone else doing a majority of the plan maintenance leg work. With more than 7,800 members, MAG offers a large, unified plan.

When you utilize the MAG 401(k) Plan, you have all of 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 Transamerica, ACG, and MAG.

Special Guest:

Kevin Rainwater, Partner, Atlanta Capital Group  linkedin_small1  twitter_logo_small-e1403698475314

MAG's 401(k)

  • BS, Marketing, University of Alabama
  • Previous Regional Sales Director, First Mercantile
  • Former Director, National Accounts, The Standard

 

Representative Sharon Cooper

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Sharon Cooper

Georgia State Representative, Dist. 43, Sharon Cooper

Representative Sharon Cooper

I hosted MAG CEO/Executive Director, Donald Palmisano, Jr., and Georgia State Representative, Sharon Cooper.  We talked about 2016 legislative priorities affecting healthcare in the state.  More information soon!

Special Guests:

Sharon Cooper, Rep. Dist 43, Georgia State House of Representatives (R) 

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Representative Sharon Cooper

  • MA Education
  • MSN, Nursing
  • Authored 2 books on psychiatric nursing
  • Chair, Georgia Health and Human Services Committee

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

 

Blue Cross Blue Shield of Georgia

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Blue Cross Blue Shield of Georgia

Blue Cross Blue Shield of GA CEO, Jeff Fusile

Blue Cross Blue Shield of Georgia

On this week’s episode with our partner, Medical Association of Georgia, MAG CEO, Donald Palmisano, Jr., joined me in studio.  We hosted Jeff Fusile, the recently-appointed President for Blue Cross Blue Shield of Georgia.  Jeff joined the company in the lead role, coming over from Anthem in November of 2015.

Jeff Fusile is president of Blue Cross and Blue Shield of Georgia (BCBSGa), the state’s oldest and largest health insurance company. He oversees sales, account service, marketing, underwriting, and customer relationships. Jeff is involved in corporate strategy planning and execution, and he serves as the primary contact for state regulators to ensure compliance and manage any state-related matters.

Jeff previously served as Senior Vice President and Chief Financial Officer for the Commercial & Specialty Business Division of Anthem, Inc., which is Blue Cross and Blue Shield’s parent company. He joined Anthem in 2011 after spending 22 years as a strategic management consultant with PricewaterhouseCoopers. Jeff is a licensed CPA. He has qualified as an expert witness in insurance and the broader health care industry. He is widely recognized as an industry leader in health care strategy, corporate governance, compliance, enterprise risk management, HIPAA, and ICD-10.

As the health care landscape undergoes an unprecedented transformation, the traditional relationships between providers and payers are also evolving. With the largest network of providers in the state, Blue Cross and Blue Shield of Georgia (BCBSGa) serves more than 3 million Georgians and is the only plan offered in all 159 counties.  BCBSGa President Jeff Fusile will discuss how BCBSGa is developing programs to facilitate better collaboration with providers, make health care more affordable for consumers and simplify the access to care. Reaching out to rural communities and the impact of technology on delivering innovative solutions was also discussed.

Special Guest:

Jeff Fusile, CEO, Blue Cross Blue Shield of Georgia  linkedin_small1  twitter_logo_small-e1403698475314  facebook_logo_small3  youtube logo

Cryotherapy

  • BS, Accounting & Finance, Florida State University College of Business
  • Certified Public Accountant
  • Previous Managing Partner, PriceWaterhouseCoopers
  • Former Senior VP/CFO, Commercial & Specialty Business, Anthem

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

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