Listen Now!

Business Talk 24-7

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.

Alcohol Awareness Month

 

Alcohol Awareness Month

Womens Telehealth CEO, Tanya Mack sits down with Dr. Gregg Raduka, Director of Prevention/Intervention Programming and Services at The Council on Alcohol and Drugs   to learn about the scope of population dealing with not just consumption, but abuse and in many cases, addiction.  This month is Alcohol Awareness Month and we had this conversation to draw a picture of how many lives are affected, what options are available for those dealing with abuse or addiction, and research going on around the issue.

 

 

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.”

Global Partnership for Telehealth

telemedicine

Tanya Mack

Global Partnership for Telehealth

In January of this year, Forbes magazine ran an article that asked the question: Will 2017 Be the Year of Telemedicine? With the finding solutions to the US healthcare system is in the news daily, telemedicine expansion helps solve some problems of affordability and access and offers the benefits of faster care, convenience and often lower costs.

The field is exploding with interest. Yet, a gap exists between talking about vs. providing telemedicine services. Recently 74% of patients surveyed said they would be open to a virtual telemedicine encounter, yet only 15% of healthcare providers had used telemedicine!  Join telemedicine industry expert, Rena Brewer of the Global Partnership for Telehealth to bring us up to
date on telemedicine and what is happening in this rapidly developing arena.

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.

Healthcare Attorney Michele Madison Talks Post-election Strategies for 2017

womens telehealth

Michele Madison

Healthcare Attorney Michele Madison Talks Healthcare Reform In 2017

On this week’s episode, healthcare expert, Michele Madison, attorney with Morris, Manning, & Martin LLP, stopped by to talk about healthcare reform, what is coming and what it means for physician practices. 

With November’s national election ushering in a new administration and rapid movement to make significant changes to the Affordable Care Act, healthcare practitioners and organizations have legitimate questions about efforts they should undertake to become compliant with ACA rules.

Michele shared her perspective on how healthcare leadership and practitioners should approach various aspects of ACA compliance in 2017, a year in which major elements affecting reporting and reimbursement were to be implemented.

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.

Neonatal Abstinence Syndrome

 

Neonatal Abstinence Syndrome

This week Womens Telehealth CEO, Tanya Mack hosts Dr. Meg Prado to talk about Neonatal Abstinence Syndrome.  With the continued rise in rates of prescription medications, coupled with high incidence of illicit drug use, it is becoming all-too-common for babies to be born who are addicted to prescription and/or illicit drugs.

Dr. Prado joined us to talk about the scope of this problem, along with what clinicians who care for pregnant mothers and/or newborn infants need to look out for to identify these babies as soon as possible to be able to adequately care for them.

 

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.