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Finally, it is highly unlikely that MACRA/MIPS will be revised or repealed in the foreseeable

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.

AMA Talks Opioid Abuse and MACRA


AMA Talks Opioid Abuse and MACRA

Patrice A. Harris, M.D., M.A., is a psychiatrist from Atlanta. She is the chair of the American Medical Association’s Board of Trustees (BOT), and she is the chair of AMA’s Task Force to Reduce Opioid Abuse. Dr. Harris has been the president of the Georgia Psychiatric Physicians Association, and she has served on the Medical Association of Georgia’s Council on Legislation.

In 2001, Dr. Harris was honored as the Georgia Psychiatric Physicians Association’s
Psychiatrist of the Year. After she earned her medical degree at West Virginia University, she did her residency in psychiatry and fellowships in child psychiatry and forensics at Emory.

She was also a Barton senior policy fellow at the Emory University School of Law. Dr. Harris was the director of Health Services for Fulton County, and she served as the medical director for the Fulton County Department of Behavioral Health and Developmental Disabilities.

Opioid abuse is a crisis in America. More than 40 people in the U.S. die from an opioid overdose every day, while many more are becoming addicted. The American Medical Association (AMA) Task Force to Reduce Opioid Abuse – which is comprised of 27 physician organizations and the American Dental Association – has announced several recommendations to address this epidemic.

It is urging physicians to register for and use state-based prescription drug monitoring programs (PDMPs) as part of the decision-making process when they consider treatment options.  When fully-funded and available at the point of care, PDMPs are an effective tool for physicians to identify patients who may be misusing opioids and can be used to implement treatment strategies, including referral for those in need of further care.

AMA will also continue to work with the administration and Congress to develop balanced approaches to end prescription opioid misuse, as well as supporting congressional and state efforts to modernize and fund PDMPs. Finally, AMA has initiated an educational effort and communications campaign to promote safe,
effective and evidence-based prescribing within the medical profession.

Georgia PDMP registration:


According to the Centers for Medicare & Medicaid Services (CMS), the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) changed how Medicare health care providers will be paid in several important ways. MACRA
1) eliminated the Sustainable Growth Rate (SGR) formula and 2) created a new framework to “reward health care providers for giving better and not just more care” and 3) combined the existing quality reporting programs (EHR, PQRS) into one new system. According to CMS, this new “Quality Payment Program (QPP)” will replace “a patchwork system of Medicare reporting programs with a flexible system that allows you to choose from two paths that link quality to payments: the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models.”

Special Guest:

Dr. Patrice Harris, Chairman, Board of Trustees, American Medical Association

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Dr. Patrice Harris

Medicare’s Merit-based Incentive Payment System (MIPS)


Elizabeth Woodcock

Medicare’s Merit-based Incentive Payment System (MIPS)

On this week’s episode we continue our series with Medical Association of Georgia, talking about the changing reimbursement picture for physician practices by the Centers for Medicare and Medicaid Services.  Medicare’s new Merit-based Incentive Payment System (MIPS) will change, yet again, physician reimbursement over the next couple of years and it is important for practice managers and physicians to make sure they understand all new requirements.

It is imperative for medical practices to make a successful transition to Medicare’s new Merit-based Incentive Payment System (MIPS). Instead of the EHR (Electronic Health Record) or the PQRS (Physician Quality Reporting System) or the Value-based Payment Modifier programs, the government will employ a single payment platform – which is the result of the Medicare Access and CHIP Reauthorization Act (MACRA) that was signed into law in 2015.

The new payment model will be based on a 100-point MIPS Composite Performance Score. That CPS will determine your Medicare payment adjustment – either up or down. This is scheduled to commence in 2019, and the Centers for Medicare and Medicaid Services will use the 2017 calendar year as the basis for the initial reimbursement – keeping mind this is not an optional process.

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.

Special Guest:

Elizabeth Woodcock, Principal, Woodcock & Associates  linkedin_small1


Transforming Clinical Practice Initiative (TCPI)


Dr. Doug Patten

Transforming Clinical Practice Initiative (TCPI)

Dr. Doug Patten is the chief medical officer of the Georgia Hospital Association, which is the leading advocate for Georgia’s hospitals and health systems. GHA supports the efforts of its members as they strive to improve access to health services, improving the health of all Georgians. Dr. Patten was a general surgeon in southern Georgia before he became the chief medical officer of the Phoebe Health System in Albany.

He has been GHA’s chief medical officer for nearly two years. He is focused on improving quality and safety, engaging patients and their families, and physician leadership. He is a member of the Medical Association of Georgia and the American College of Surgeons.

The Transforming Clinical Practice Initiative (TCPI) is designed to help more than 150,000 U.S clinicians improve quality and reduce costs – keeping in mind that the Medicare is changing from a volume-based payment system to a quality-based payment system in the next several years. The four-year, $800 million TCPI initiative is being funded by the Center for Medicare & Medicaid Innovation.

It is aligned with the Affordable Care Act (ACA) and the Medicare Access and Reauthorization Act of 2015 (MACRA). The TCPI includes a network of 29 “practice transformation networks” (PTNs) that are designed to 1) improve health outcomes and 2) improve care coordination and 3) better engage patients and families and 4) improve patient, clinician and staff satisfaction and 5) reduce the overall cost of care.

There is no cost for clinicians or practices to join a PTN. There are four PTNs that support clinicians in Georgia, including the Compass PTN – which has been endorsed by the Medical Association of Georgia given MAG’s “multi-year collaboration with GHA on matters related to quality, safety and community health.”

The Compass PTN will serve more than 7,000 primary and specialty care clinicians in six states. The Compass PTN is led by six non-profit partners, including the Georgia Hospital Association. In Georgia, the Compass PTN hopes to serve 1,000 clinicians, including 150 specialists.

Special Guest:

Dr. Doug Patten, CMO, Georgia Hospital Association  youtube logo  linkedin_small1  twitter_logo_small-e1403698475314  facebook_logo_small3


Value-based Payments

Value-based Payments

Dr. Kimberly Rask

Value-based Payments

Kimberly J. Rask, M.D., PhD is the chief data officer at Alliant Health Solutions, which is a nonprofit companythat supports quality improvement in public sector health care programs under Medicare, Medicaid and End-Stage Renal Disease (ESRD) Networks across the Southeastern U.S. Dr. Rask is a primary care physician andhealth economist.
She also holds joint appointments in health policy and management and medicine at EmoryUniversity. Dr. Rask has published book chapters and peer-reviewed articles on primary care practice, quality improvement, and outcomes measurement.  With more than 20 years of experience in quality research and practice, she also serves on national expert panels on value-based purchasing programs and quality measurement.
The Value-based Payment Modifier (VM) is a relatively new pay-for- performance program that is being used by CMS to pay physicians in part based on how their quality and cost compare to other physicians. It is similar to other pay-for- performance initiatives for hospitals, nursing homes, and home health agencies – and it is part of a larger effort by public and private payers to control health care costs.
Although the VM started as part of the Affordable Care Act (ACA), more recent federal legislation has expanded its reach.  Medicare uses the VM program to adjust physician pay based on quality and cost measures, which vary by specialty. The reimbursement rates for 2016 are based on 2014 Physician Quality Reporting System (PQRS) data.
There are more than 250 quality metrics. Eligible providers are required to select a number of metrics –typically nine – to report. Failure to report PQRS measures can result in a penalty that is applied to all Medicare payments for the entire year. The program is revenue-neutral, so physicians who score well receive higher payments while physicians who have relatively lower scores receive lower payments.
In 2016, only medical groups with 10 or more eligible professionals will be subject to the program. In 2016, all eligible groups could receive a bonus – but only groups with 100 or more eligible professionals face a penalty in 2016. By 2017, the program is scheduled to apply to all Medicare physicians.  Of the nearly 14,000 physician groups that will subject to the VM program in 2016, less than one percent – only 128 groups that include about 4,300 physicians – will receive Medicare bonuses of either 16 or 32 percent; the higher increase will go to the practices with the most high-risk patients.
Meanwhile, more than 5,400 groups that include more than 130,000 physicians will see a two percent pay cut for failing to submit their data. And nearly 60 groups that include more than 10,000 physicians will see a pay cut of one percent or two percent because their quality measures were too low.  Under the MACRA legislation that passed in 2015 that permanently replaced the Medicare sustainable growth rate (SGR) formula, the VM will become one component of a new consolidated performance score.  There will be two payment options for physicians.
Physicians who participate in Alternative Payment Models (e.g., some types of ACOs) will be eligible for an automatic five percent incentive payment every year. Physicians who are not participating in an APM will receive incentives or be subjected to penalties of up to nine percent based on how they perform relative to other physicians on PQRS measures, their use of EHR, quality improvement efforts, and the cost of care for their patients. Since this “new” payment program is similar to the existing VM program, preparing physician practices for success with today’s VM will position practices for success in the future.
There are several programs that available to assist physician practices with accurate quality reporting and quality improvement, which includes Alliant Quality ( in Georgia.
Special Guest:
Dr. Kimberly Rask, MD, Alliant Health Solutions 

MAG 2015 Legislative Update

Medical Association of Georgia


MAG 2015 Legislative Update

This week we continued our ongoing series with Medical Association of Georgia to get the MAG 2015 legislative update.  MAG CEO, Donald Palmisano, Jr. and Director of Government Relations, Marcus Downs came by with Georgia Representative, Rick Jasperse.  We talked about several of the health-related issues Rick and his colleagues have been and continue to work on in the Georgia legislature to promote and protect the health outcomes, safety, and access to care for the citizens of our state.

Rep. Rick Jasperse represents Georgia’s 11th district, which includes all of Pickens and parts of Gordon and Bartow counties. He serves on a number of committees in the House of Representatives – and he is the vice chair of the House Health and Human Services Committee. Rep. Jasperse graduated from UGA with a degree in food science. He retired in 2009 after 29 years as a county agriculture agent.

H.B. 416 by Rep. Carl Rogers (R-Gainesville) will require licensed health care practitioners to wear an ID on their “lab coats or similar distinguishing clothing or uniforms” that states their name and license or educational degree. The only exceptions include optometrists, dentists and chiropractors – except those who practice in hospitals and nursing homes. This has been one of MAG’s legislative priorities for the last two years as voted on by MAG’s Board of Directors. A number of other groups also supported the bill, including speech language pathologists, audiologists, respiratory therapists, marriage and family therapists, ophthalmic technicians, registered dieticians, and APRNs.

The FY 2016 budget (H.B. 76) includes some $23 million in additional funds to increase the reimbursement rate for select Medicaid primary care and OB-GYN codes. This included $17.1 million for primary care physicians (i.e., 90 percent of the 2014 Medicare fee schedule for the applicable codes) and $5.9 million for OB/GYN physicians (90 percent of the 2014 Medicare fee schedule for the applicable codes).

The FY 2016 budget also includes $199,000 to maintain the Prescription Drug Monitoring Program in the state.

H.B. 504 by Rep. Sharon Cooper (R-Marietta) extends the flu vaccine protocol that is in place between physicians and pharmacists and nurses for adults to pneumococcal, shingles, and meningitis. MAG’s Board Directors voted to support this kind of measure given strict limits and notification requirements. MAG worked with Rep. Cooper to ensure that appropriate sanctions are in place for any violations.

S.B. 158 by Sen. Dean Burke, M.D. (R-Bainbridge) would have addressed rental networks, all-products clauses, and other key issues. MAG’s Board of Directors voted to support this measure. The bill evolved into S.R. 561, which is a “study bill” – which means that a group of legislators will develop a report for the General Assembly’s consideration in 2016.

Special Guests:

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

Marcus Downs, Director of Government Relations, MAG  linkedin_small1  

Medical Association of Georgia

  • Recipient, 2012, Outstanding Advocate Award, National Association of School Psychologists
  • National Institutes of Health Research Fellow, 2000
  • Former Director, Government Relations/External Coalitions/Research, Georgia Association of Educators

Representative Rick Jasperse, Georgia 11th District  facebook_logo_small3  twitter_logo_small-e1403698475314  youtube logo  flickr (2)


  • BS, Food Science, University of Georgia School of Agriculture
  • Member, House Committees: Agriculture & Consumer Affairs, Appropriations, Human Relations & Aging, Public Safety and Homeland Security
  • Vice Chair, Health & Human Services Committee
  • Served on numerous boards:  Mountain Conservation Trust Board, Chattahoochee Technical Collegeand Appalachian Cattlemen’s Association’s Board

Dr. Rolf Meinhold MDVIP



Dr. Rolf Meinhold MDVIP

On this week’s show I was joined in studio by Dr. Rolf Meinhold MDVIP.  We were introduced to him by Justin Knott of Intrepy, LLC, a marketing firm with numerous local physician practices they serve.  He’s a family practice physician who’s been practicing in the Atlanta area for around thirty years.  He recently joined MDVIP to provide primary care services in their personalized healthcare program.  Through their service MDVIP and its doctors are able to include access to the physician 24/7, coupled with online resources that give patients access to their health information.  MDVIP offers a membership-based plan that provides such extended access to one’s physician with same-day or next-day appointments and 30 min appointment slots, Dr. Meinhold’s patients get significant time and access to their doctor.

Meinhold Family Practice is a MDVIP-affiliated practice utilizing the MDVIP Wellness Program to prevent little things from becoming big things…enabling patients to enjoy life and stay healthy. 
Patients that truly value their health will appreciate having an enhanced doctor-patient relationship. Our practice through MDVIP has dramatically decreased our practice size to closely work with you. Within our smaller practice, you will receive the comprehensive care and personalized service you deserve to keep you healthy.

Dr. Meinhold’s Approach to Your Wellness: Improving the quality of people’s lives one patient at a time, speaks to two essential elements: Quality and Personalization. Improving quality is all about wellness. The better someone is and feels the more possibilities of enjoying the richness that life has to offer. Being person-oriented means giving respect and reverence to the unique relationship that exists between a doctor and a patient. Only by optimizing trust and care can wellness be achieved.

Because of Dr. Meinhold’s specialized training, he is able to manage middle to late childhood, adolescent and adult patients. He has an ongoing interest in the primary prevention of diabetes and heart disease through nutrition and weight management. In addition,  he is a strong proponent of exploring the scientific basis for the mind-body connection in medicine.

Special Guest:

Dr. Rolf Meinhold, MD, Meinhold Family Medicine/MDVIP  facebook_logo_small3  twitter_logo_small-e1403698475314


  • Doctorate of Medicine, Vanderbilt University School of Medicine
  • Internship, Riverside Regional Medical Center
  • Board Certified, American Board of Family Medicine
  • Fluent in English and German

Justin Knott, Co-Founder, Intrepy, LLC  twitter_logo_small-e1403698475314  linkedin_small1

Intrepy, LLC

  •  Previous VP Business Development, TAGin
  • Former Director, Investments, I4 Capital Partners
  • Previous Team Leader, B.A.S.E. Camp Children’s Cancer Foundation
  • BS, Finance, Investments, & Securities, University of Central Florida

Mitochondrial Diseases and Hyperbaric Medicine

Mito TDR

Mitochondrial Diseases and Hyperbaric Medicine

This week I sat down with experts in the fields of mitochondrial diseases and hyperbaric medicine.  Each cell in our body has an “engine” where the nutrition we consume through eating is converted to the energy we need to function and survive.  These engines are known as “Mitochondria”.  These cellular components use genetic code to function and on occasion there will be problems with the genetic code or with how it is decoded.  In these cases, a variety of health problems can reveal themselves, depending on what sort of tissue is made up by these cells in question.  These can range from challenges with learning, developmental problems, or disease states such as Alzheimer’s, Parkinson’s, Muscular Dystrophy, and others.  Dr. John Shoffner, neurologist and geneticist of Medical Neurogenetics came by with Laura Stanley of the Foundation for Mitochondrial Medicine.


We talked about the research Dr. Shoffner is doing in an effort to find medical therapies that could help patients who are dealing with the variety of disorders caused by mitochondrial dysfunction.  We talked about how challenging it can be to identify a health problem(s) that are caused by mitochondrial disease unless a patient’s family is fortunate enough to be seen by a physician familiar with the genetic tests that can be utilized to diagnose them.

As described by the Foundation for Mitochondrial Medicine, “Every aspect of our beings – seeing, breathing, thinking, moving – requires energy. Mitochondria, often called the cells’ “powerhouses,” supply that energy by turning raw materials found in the food we eat and in the air we breathe into a substance called ATP (adenosine triphosphate), which our cells can use as fuel. ATP is, quite simply, vital to life.  Without enough ATP, children cannot appropriately develop, grow, learn, move, or even sleep. Adults without enough ATP are unable to sustain brain, muscle, and other vital organ function. A deficit of ATP can also cause invisible damage in some disease states, leading to early failure or dysfunction of organs, or just a chronic state of inefficiency leading to pain, fatigue, changes or limitations in thinking and learning, and increased susceptibility to acquired diseases.

Laura and Dr. Shoffner shared how they are working to improve awareness of mitochondrial diseases and through research, uncover treatments to halt or at  least slow the effects of these diseases.  The ultimate goal is to find a way to prevent or reverse these problems.
Dr. Helen Gelly joined us to talk about a recent article she co-authored with Dr. Caroline Fife in Today’s Wound Clinic, called, “Hyperbaric Oxygen Therapy in Wound Care: A Service Under True Pressure“.  In the article, Dr. Gelly and Dr. Fife talked about how numerous Medicare Administrative Contractors and Commercial insurers are making changes to indications they are willing to reimburse hyperbaric oxygen therapy for.  That means that patients with wounds that place them at risk for amputation or for degraded quality of life due to previous radiation therapy may not be able to receive this evidence-based, effective treatment.  We talked about how in some cases where the providers in a given MAC were asked for clinical documentation of their HBO treatments provided, as many as 30% failed to respond.  Dr. Gelly shared how this lack of response leads to suspicions of fraud.

It was clear from the Today’s Wound Clinic article and from our conversation that hyperbaric medicine specialists must begin to activate and collaborate to protect this evidence-proven treatment modality.  HBO providers need to not only be responsive to requests for data but ACTIVE as it relates to advocating on behalf of educated decisions being made as it relates to the availability of the modality for tomorrow’s patients in need.

Special Guests:

Dr. John Shoffer, MD, CEO of  Medical Neurogenics 


  • Former Associate professor of neurology and molecular medicine at Emory University
  • Former Director of the molecular diagnostics program at Children’s Healthcare of Atlanta
  • Discovered some of the first gene mutations causing mitochondrial diseases and one of the first genes causing epilepsy
  • Finalist, 2012 Atlanta Business Chronicle’s Health-Care Heroes Awards

Laura Stanley, of Foundation for Mitochondrial Medicine  feed logo  facebook_logo_small3  twitter_logo_small  youtube logo


  • IMBA, University of South Carolina Darla Moore School of Business
  • Former Senior Associate, Korn Ferry
  • Former Vice President, EzGov
  • Parent of a child with mitochondrial disease

Dr. Helen Gelly, MD of HyperbaRXs  twitter_logo_small  google-plus-logo-red-265px  facebook_logo_small3  linkedin_small1


  • Doctor of Medicine, Emory University School of Medicine
  • Internship/Residency: Pediatrics/Emergency Medicine at Emory University Affiliated Hospitals
  • Board Certified in Emergency Medicine
  • Fellow of the American College of Emergency Physicians
  • Fellow of the American College of Certified Wound Specialists
  • Subspecialty Certified Undersea and Hyperbaric Medicine