Listen Now!

Business Talk 24-7

Surprise Insurance Coverage Gaps

MAG

Dr. Matt Keady and Dr. Mark Bernardy

Surprise Insurance Coverage Gaps

After receiving emergency care at an “in-network” hospital, patients often discover that they
received care from an “out-of- network” physician and owe a lot of money. This is the “surprise
insurance coverage gap.” The patient pays their monthly premium, yet they receive unexpected
“balance bills” for amounts their insurance company refuses to cover – keeping in mind the
insurers are narrowing their networks to reduce costs and maximize profits by subjecting
physicians to inadequate, take-it- or-leave- it contracts.

Physicians in Georgia believe that it is critical to end the surprise insurance gap in emergency
medicine care settings. Physicians have seen their patients’ financial burden increase in dramatic
ways as health insurance companies have narrowed their networks. Health insurance is so
ambiguous that the most sophisticated patients have trouble understanding the rules.

Many patients try to do the right thing and go to a hospital that is in their insurance network during an
emergency – but they often don’t have any way of knowing when a doctor they need to see is in or
out of their network.  The Medical Association Georgia and other physician and patient advocacy organizations are calling for state lawmakers to put an end to balance billing in emergency care settings by passing legislation that will close the surprise coverage gap. MAG is also supporting the ‘End the Surprise Insurance Gap’ campaign.

Dr. Matthew Keadey has been an emergency physician in the Atlanta area for nearly 20 years. He
began his career at Emory Healthcare. He now works in the Emory and Grady Health systems. He
is the president-elect of the Georgia College of Emergency Physicians, and he is a member of the
Medical Association of Georgia. Dr. Keadey is an expert in emergency department billing, coding
and reimbursement.

Dr. Mark Bernardy has been a private practice general/interventional radiologist in Georgia for 30
years. He is a member of the Georgia Radiological Society’s Board of Directors. Dr. Bernardy is
the vice chair of the American College of Radiology’s Economics Commission and a board
member of the Radiology Business Management Association. He is active in Georgia politics,
advocating for radiologists, physicians, and patients. His advocacy efforts started with colon
cancer screening.

Drs. Keadey and Bernardy are leading advocates for ensuring that patients have access to fair
insurance coverage in emergency care settings in Georgia.

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

 

Telemedicine in Neurology and Beyond

telemedicine

Tanya Mack

Emory

Dr. Gregory Esper

Telemedicine in Neurology and Beyond

Womens Telehealth CEO, Tanya Mack sat down with Emory Healthcare’s Dr. Gregory Esper.  Gregory Esper, MD, MBA is currently Associate Professor and Vice Chairman of Clinical Affairs for the Department of Neurology, and he also is Director of General Neurology and Neuromuscular Diseases. He serves Emory Healthcare in the capacity as the Director of New Care Models.

Dr. Esper shared his perspective of the role of telemedicine in neurology, as well as how Emory Healthcare is evaluating other areas of need for access to care where telemedicine can be deployed to simultaneously provide greater efficiency for patient and care provider, as well as improving the health of the population served.

 

We talked about how patient information is protected while using this technology, as well as some of the current limitations that confound expansion of telemedicine to the patient’s home on a larger scale.

Throughout the world and US, there is a shortage of neurologists, which is expected to worse, not improve in the coming years. The access is outstripped by the demand, especially in rural areas, where
geographical disparities exist. Georgia has over 100 counties that have no neurologist.

Telemedicine improvements and patient and provider adoption, especially over recent years, has proven that in many cases, reliable remote diagnosis can be made, patient outcomes are positive and costs can be saved.

Treatment of stroke, multiple sclerosis, Parkinson’s, epilepsy and some urgent neuro problems can be
managed via telestroke medicine. In 2016, Emory University opened a remote telemedicine service.
Listen in as Dr. Greg Esper updates us on new developments in telestroke and Emory’s new program.

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

Talking Depression With Dr. Mark Rappaport

depression

Dr. Mark Rappaport

Talking Depression With Dr. Mark Rappaport

Mark Hyman Rapaport, M.D., the chair of the Department of Psychiatry and Behavioral Sciences and the Reunette W. Harris Professor at the Emory University School of Medicine and the chief of Psychiatric Services at Emory Healthcare, will discuss depressive disorder when he appears on the Medical Association of Georgia’s (MAG) ‘Top Docs Radio’ program on the Business Radio-X Network at 12 p.m. today, Tuesday, December 27.

“Major depressive disorder has a lifetime prevalence rate of more than 15 percent,” says Dr. Rapaport. “That means some 900,000 people in the Atlanta region alone will suffer from an episode of major depressive disorder at some point in their lives.”

He explains that, “Major depression is associated with increased overall mortality, increased suicide rates, and marked dysfunction at work and in social settings. In addition to the individual, depression affects the patient’s loved ones and colleagues and friends.”

According to Dr. Rapaport, depression is highly comorbid with other medical conditions such as heart disease or high blood pressure or diabetes, and it adds exponential costs to the treatment of those disorders.

He also points out that a World Health Organization study determined that depression is the second greatest cause of disability in the world – and the first among women who are over the age of 18.

Dr. Rapaport will discuss major depressive disorder care, including evidence-based psychotherapies, pharmacological treatments, and somatic therapies – stressing that, “One in three patients who suffer from depression have a form of depression that tends to be resistant to most typically employed treatment interventions…more than 300,000 people suffer from treatment resistant depression in the Atlanta area.”

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 8,300 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.

Click to listen to ‘Top Docs Radio’

Click for Emory Department of Psychiatry and Behavioral Sciences web page

Mental Health Resources

Emory Outpatient Clinic: 404.778.5526

Emory Treatment Resistant Depression Clinic: 404.712.8732

National Suicide Prevention Hotline: 800.273.8250

Georgia Crisis and Access Line (for immediate assistance): 800.715.4225

Depression and Bipolar Support Alliance/Atlanta Chapter: www.atlantamoodsupport.com

Mental Health America/Georgia Chapter: www.mhageorgia.org

National Institute of Mental Health: www.nimh.nih.gov

National Alliance on Mental Illness: www.nami.org

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.

 

Final MACRA Rules

MAG

Elizabeth Woodcock

Final MACRA Rules

On October 14, CMS issued the final MACRA rule. This new Medicare reimbursement system is
known as the Quality Payment Program (QPP). It offers two reimbursement options for physicians, including the Advanced Alternative Payment Model (APM) and the Merit-based Incentive Payment System (MIPS). CMS says 2017 will be a “transition year and iterative learning and development period.” 2018 will be the “second transition year.”

CMS will provide more information for 2020 and beyond beginning next year.   Key points: 1) If a physician doesn’t bill at least $30,000 in Medicare Part B allowable charges or they see less than 100 Medicare patients per year, they are exempt from QPP. This includes more than 30% of all physicians who are billing for Medicare Part B services (more than 380,000) 2) CMS will collect data on costs – but only behind the scenes. This MIPS pillar will not count for the 2017 performance year; its “weight” was transferred to the Quality category 3) Only four activities need to be reported by physicians – and none if they are already recognized as a medical home 4) CMS is committed to increasing the number of physicians who are in APMs – and it estimates that 70,000 to 120,000 physicians (5% to 8% of all physicians billing under the Medicare Part B) will qualify as an APM participant in 2017 5) The number of EHR “meaningful use” (now known as “Advancing Care Information”) requirements dropped from 11 to five – but it is still necessary for physicians to report on most of them to achieve a score of 100%.

The QPP begins in 2017 – with MIPS reporting required by March 31, 2018. This initial performance year establishes a provider’s Medicare payments in 2019 – with an adjustment of 4% up or down. If a physician fails to submit any 2017 data (i.e., qualify for the program), they will receive a negative 4% payment adjustment. If a physician transmits a “test” – e.g., one quality measure, one improvement activity, or the required ACI measures – they will avoid the penalty; a partial year of reporting will result in a neutral or small positive adjustment. The full year provides for a “moderate” positive payment adjustment.

Qualifying participants who achieve a final score of 70 or higher will be eligible for the exceptional performance adjustment – which will be funded from a pool of $500 million.  MIPS allows reporting by an individual or group. Qualifying professionals are defined as physicians, physician assistants, nurse practitioners, clinical nurse specialists and certified registered nurse anesthetists.  The cost category is eliminated for the first performance year (2017) – so Medicare reimbursement is tied to the remaining three: Quality, Clinical Improvement Activities, and ACI, which account for 60%, 15% and 25%, respectively, of the composite score that will determine your Medicare adjustment in 2019.

Participating in an APM offers an automatic 5% incentive payment for all Medicare patients. Less
than 100 organizations qualify for an APM today – and many physicians in those organizations
won’t reach the CMS threshold of receiving 25% of Part B payments or seeing 20% of its
Medicare patients through the APM. More importantly, the application period to join an APM in
2017 has passed. CMS expects about 25% of eligible clinicians to be part of the second path of
APMs in 2018.

Elizabeth Woodcock

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.

Talking Depression

depression

Dr. Mark Rapaport

Talking Depression

Major depressive disorder has a lifetime prevalence rate of more than 15 percent. That means
some 900,000 people in the Atlanta region will suffer from an episode of major depressive
disorder at some point in their lives. Major depression is associated with increased overall
mortality, increased suicide rates, and marked dysfunction at work and in social settings.

In addition to the individual, depression affects the patient’s loved ones and colleagues and friends.
Depression is highly comorbid with other medical conditions such as heart disease or high blood
pressure or diabetes, and it adds exponential costs to the treatment of those disorders. The WHO
Global Burden of Disease study found that depression is the second greatest cause of disability in
the world.

And when it comes to women who are over the age of 18, depression is the most disabling disorder in the world. Medical professionals have developed an expanding array of approaches to help people who have major depressive disorder, including evidence-based psychotherapies, new pharmacological treatments, and new somatic therapies. Yet one on three patients who suffer from depression have a form of depression that tends to be resistant to most typically employed treatment interventions. In fact, more than 300,000 people suffer from treatment resistant depression in the Atlanta area – and many of them are suffering in silence.

Dr. Mark Rapaport is the Reunette W. Harris Professor and the Chairman of the Department of
Psychiatry and Behavioral Sciences at Emory University School of Medicine and the Chief of Psychiatric Services at Emory Healthcare. Dr. Rapaport has received peer-reviewed grant funding from a number of institutions. His research interests are focused on psychopharmacology, and he has investigated the biologic genesis of anxiety disorders, bipolar disorder, depression and immunity abnormalities in schizophrenia.

Dr. Rapaport has trained and mentored students, physicians and researchers in the fields of psychopharmacology, outcomes research, and psychoneuroimmunology. A board-certified psychiatrist, Dr. Rapaport has written over 190 articles for peer-reviewed publications, he serves as the editor of several journals, and he has co-edited five books on maintenance of certification and life-long learning in psychiatry. Dr. Rapaport is a member of the Medical Association of Georgia and a number of specialty societies.

Diabetes Telehealth Network

Telemedicine education

Tanya Mack of Womens Telehealth

Diabetes Telehealth Network

As patients want more control and visibility to their health data and mHealth (mobile health) and
technology are evolving daily, remote patient monitoring has emerged as a viable way to manage chronic diseases, such as diabetes. Remote home monitoring works by collecting health care data at the
patient’s home and then transmitting this data to health care providers in real time to make modifications if needed, avoid unnecessary hospital visits and prevent some serious long term
complications.

The University of MS has been one of the nation’s leading telehealth providers logging over 500K patient encounters, covering 35 medical specialties and serving 218 locations statewide. In 2014, the university developed the Diabetes Telehealth Network.

It has been estimated that the cost of diabetes in the US exceeds $2.7B/ yr. Real time insights and the ability to talk to patients remotely can lead to improved patient outcomes. The results of their pilot program have been astounding and now serve as a model for other states with access and limited provider resources to follow.

Join us today as we listen to Michael Adcock, Director of Network Strategies talk about this innovative and effective RPM solution.

Turning Point Breast Rehabilitation

breast cancer

Jill Binkley

Turning Point Breast Rehabilitation

TurningPoint Breast Cancer Rehabilitation improves quality of life for women with breast
cancer by providing, promoting and advocating specialized and evidence-based rehabilitation.
TurningPoint is a non-profit 501(c)3 healthcare organization. Services offered include physical
therapy, massage therapy, exercise classes, educational seminars, counseling, and nutritional counseling.