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Finally, it is highly unlikely that MACRA/MIPS will be revised or repealed in the foreseeable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

Genteel Device Takes Pain Out of Glucose Monitoring

Genteel Device Takes Pain Out of Glucose Monitoring

Genteel LLC manufactures and sells a lancing device for those with

diabetes who either avoid, or limit, their blood glucose checks because of the anxiety and pain of the

dreaded finger stick! Developed by Dr. Christopher Jacobs, biomedical engineer, Genteel is the only

stand-alone lancing device, 510K cleared by the FDA for both fingers and alternate site testing.

Idiopathic Hypersomnia

Womens Telehealth

Cat Rye

Idiopathic Hypersomnia

Sleep Awareness Week is coming up soon, April 23-29, and the slogan is “Sleep Better.  Feel Better.”  A great night’s sleep not only makes us feel better, but it also improves our health.  We are here today to promote improved understanding of a rarely diagnosed, often misunderstood, serious neurological sleep disorder, known as idiopathic hypersomnia (IH).  The hallmark symptom of IH is excessive daytime sleepiness, even with a full night’s slumber.  This central disorder of hypersomnolence (CDH) negatively impacts patients’ lives, as they are often unable to function at work, at school, with machinery (e.g., driving), and in relationships.  Join Catherine Page-Rye (Cat Rye), co-founder and a Board of Director of the Hypersomnia Foundation, as she educates us, raises awareness, and spreads hope across America and on a global scale about IH.  Let’s get #BeyondSleepy!

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.

Rep Sharon Cooper Talks HB 416

Sharon Cooper

Georgia State Representative, Dist. 43, Sharon Cooper

House HHS chair addresses flawed eye care bills on ‘Top Docs’ show 

Georgia Rep. Sharon Cooper (R-Marietta) – the chair of the Georgia House of Representatives Health and Human Services Committee – discussed several bills that she believes would place thousands of Georgians at risk of blindness and other serious eye complications when she appeared on a special edition of the Medical Association of Georgia’s (MAG) ‘Top Docs Radio’ program on the Business Radio-X Network on February 23. Click here to listen to a recording of the show.

Rep. Cooper addressed her concerns surrounding H.B. 416 and S.B. 221, measures that would allow optometrists to perform a variety of extraocular injections.

MAG President Steven M. Walsh, M.D., shares Rep. Cooper’s concerns, stressing that, “MAG is opposing these measures because they would inappropriately expand optometrists’ scope of practice and they would undermine patient care.”

Rep. Cooper also notes that, “Medicine is effectively under attack these days, so it is imperative for doctors to get involved in the legislative process.”

She is encouraging physicians and patients to (to what action…contact who?) to encourage lawmakers to oppose H.B. 416 and S.B. 221.

Rep. Cooper has sponsored key legislation that has been enacted in Georgia, including an HIV screening bill for pregnant women, the Georgia’s Smoke Free Air Act, and the Health Share Volunteers in Medicine Act.

MAG sponsors the ‘Top Docs’ program at 12 p.m. on the second and fourth Tuesday of every month. Between downloads and live listeners, MAG’s ‘Top Docs’ show has reached more than 9,000 listeners – which includes people in all 50 states and 84 countries.

MAG’s ‘Top Docs Radio’ show is supported with a grant from Health Care Research, a subsidiary of Alliant Health Solutions.

Contact MAG Government Relations Director Derek Norton at dnorton@mag.org or 404.274.4210 with questions related to H.B. 416 and S.B. 221.

Representative Sharon Cooper Talks Georgia Healthcare

 

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

 

MAG’s 2017 Legislative Priorities

 

 

MAG’s 2017 Legislative Priorities

Out-of- Network Billing & Network Adequacy: MAG will 1) support reforms that will require appropriate

network adequacy standards for health insurers and 2) call for health insurers to be more transparent in

their contracts with physicians’ practices and 3) support legislation that will result in physician payment

methodologies that are adequate and sustainable for out-of- network emergency care.

Medicaid Payment Parity: MAG will be an advocate for the General Assembly to continue to fund the

Medicaid parity payment program for all areas of primary care.

Maintenance of Certification: MAG will 1) work to ensure that MOC is not a condition of licensure or a

condition of hospital credentialing and 2) support efforts that will alleviate the costly and burdensome

aspects of MOC for physicians.

Patient Safety: MAG will be an advocate for legislation that improves patient safety.

Opioid Abuse

One of the MAG Foundation’s key programs is the ‘Think About It’ campaign to reduce prescription drug

abuse. The MAG Foundation has 1) funded 18 prescription drug disposal boxes, which allows Georgians to

dispose of their unneeded or expired prescription drugs in safe and anonymous and secure manner and 2)

distributed more than one million educational leaflets in the state and 3) given presentations at more than

50 town halls and 20 physician education events and 4) established social media and/or other educational

campaigns on 10 college campuses as part of its ‘Higher Education TAKE-BACK Initiative.’ The MAG

Foundation is also managing ‘Project DAN’ (Deaths Avoided by Naloxone), which has provided first

responders in 13 counties in Northeast Georgia with more than 1,300 doses of naloxone – which can be

used to save patients who are suffering from a drug overdose. This effort has already been credited with

saving 18 lives in northeast Georgia. It’s also worth noting that Georgia DPH Commissioner Dr. Brenda

Fitzgerald recently issued a standing order that authorizes pharmacies to dispense naloxone.

www.rxdrugabuse.org

HealtheParadigm

HealtheParadigm is a new, physician-led health IT solution that enables physicians to generate

sophisticated patient data reports that they can use to improve patient outcomes and fulfill the new quality-

based payer metrics. HealtheParadigm will enable physicians to improve care coordination, establish better

relationships with their patients, fulfill the new payer performance metrics, and reduce the administrative

burden for them and their staff. www.healtheparadigm.com

Centered Pregnancy

centered pregnancy

Anna Cherry, CNM

Centering Pregnancy

On this week’s show, Womens Telehealth’s Tanya Mack sat down with Certified Nurse Midwife, Anna Cherry, of Providence Women’s Health Care of Roswell, to learn about how the centering pregnancy prenatal care program their practice has been participating in is improving outcomes for the patients they serve.

Centering Healthcare Institute explains how centering pregnancy works:  Centering group prenatal care follows the recommended schedule of 10 prenatal visits, but each visit is 90 minutes to two hours long – giving women 10x more time with their provider. Moms engage in their care by taking their own weight and blood pressure and recording their own health data with private time with their provider for belly check.