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Does My Practice Still Need To Prepare For MACRA?

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Finally, it is highly unlikely that MACRA/MIPS will be revised or repealed in the foreseeable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

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

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.

AMCP Foundation Executive Director Paula Eichenbrenner

AMCP

Paula Eichenbrenner

AMCP Foundation Executive Director Paula Eichenbrenner

I sat down with Executive Director of the AMCP Foundation, Paula Eichenbrenner, to talk about some of the emerging research trends likely to have an impact on managed care pharmacy over the next few months and years.

AMCP CEO Susan Cantrell

AMCP

Susan Cantrell and CW Hall

AMCP CEO Susan Cantrell

I sat down with AMCP CEO Susan Cantrell at the spring conference in Denver.  She shared an update on a few of the issues leaders and pharmacy clinicians are dealing with this year.  Some top areas of focus include contracting with pharmaceutical companies.  Value-based reimbursement is emerging as a new trend that will likely gain traction over the coming year.

Jim Kenney, Manager of Specialty and Pharmacy Contracts at Harvard Pilgrim, lead a session titled “Approaches to Managed Care Contracting with Pharmaceutical Manufacturers.” This session discussed innovations in managed care pharmacy contracting, including indication-based contracts and price protection arrangements.

The Boston Globe recently reported on two Harvard Pilgrim pay-for-performance programs focused on rheumatoid arthritis and osteoporosis aligned with adherence and effectiveness measures. The strategy is designed to curb spending while giving patients access to costly treatments.

Healthcare Risk Management Review described the launch of an Enhanced Medication Therapy Management (MTM) program by Tabula Rasa HealthCare. This pilot program of the Part D Enhanced MTM Model involves seven states: Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming. The article shared requirements of the Centers for Medicare and Medicaid Innovation (CMMI), which oversees the model.

And of course, the AMCP conference featured speakers discussing the possibility of repeal/replacement of the ACA and the impacts such a change would have on the pharmacy landscape.

Risk Adjusted Patient Care

MAG

Dr. Ronnie Smith

Risk Adjusted Patient Care

Dr. Ronnie Smith is an internist with Vidalia Medical Associates. He has practiced medicine for
nearly 40 years. He has a medical degree from the Medical College of Georgia. Dr. Smith
graduated from the Executive Medical Management Program at the Wharton School at the
University of Pennsylvania. He is an expert in outpatient and inpatient risk adjustment documentation and coding and reimbursement, and he is passionate about educating his fellow
physicians and their practice staff on how to master risk adjustment and simplify the transition to
the new value-based care model.

Dr. Smith has developed innovative, point-of- care reference tools to assist physicians and medical practices that streamline the workflow process.

Risk-Adjusted Reimbursement

Physicians in the United States find themselves in a seismic paradigm shift from volume-based
reimbursement to value-based reimbursement. This is being driven by escalating health care
costs and an increasingly-sicker population. Pay-for- performance is consequently based on
patient risk scoring, and quality measures are being used at every level of our health care system.
These changes are meant to stimulate quality improvement and cost-efficiency within the health
care system.

Physician reimbursement that is tied to patient risk scoring is here to stay, so it is imperative for
physicians to understand how patient risk scoring works because it will affect their income in
significant ways.  Risk adjustment uses a patient’s health status in a base year to predict or estimate what utilization costs should be the following year. If a physician fails to recognize risk-adjusting diagnoses and under code them, they will likely fail under today’s value-based reimbursement system. The clinical management of the utilization-based spending that will be required to qualify for any shared savings incentives will be challenging.

If a physician can accurately and thoroughly document how sick their patients are, they stand a far
better chance of achieving their budget objectives. This, then, gives them the best opportunity to
receive the shared savings incentives and to minimize their risk for shared losses.  Dr. Smith’s key steps to succeed under the new value-based, pay-for- performance reimbursement models include…

  • Verifying that your EHR is capable of submitting at least 12 diagnosis codes per clinical
    encounter.
  • Retrieving, analyzing and understanding your Quality and Resource Use Reports (QRURs) for
    Medicare Part B.
  • Getting informed and trained on risk adjustment methodology.
  • Scheduling all of your attributed patients in your managed care plans, including Medicare Part
    B and Medicare Advantage plans, for an office visit at least once, and preferably twice, during
    each calendar year.

Dr. Ronnie Smith is an internist with Vidalia Medical Associates. He has practiced medicine for
nearly 40 years. He has a medical degree from the Medical College of Georgia. Dr. Smith
graduated from the Executive Medical Management Program at the Wharton School at the
University of Pennsylvania. He is an expert in outpatient and inpatient risk adjustment documentation and coding and reimbursement, and he is passionate about educating his fellow
physicians and their practice staff on how to master risk adjustment and simplify the transition to
the new value-based care model.

Dr. Smith has developed innovative, point-of- care reference tools to assist physicians and medical practices that streamline the workflow process.

CopernicusMD sponsored in partnership with MAG

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

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

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

 

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.