Top Docs Radio

Cryotherapy for Early Stage Breast Cancer On this week’s episode I sat down with award-winning Atlanta-area breast surgeon, Dr. April Speed regarding treatment options for breast cancers, including cryotherapy.  She shared what motivated her to enter the medical field as her chosen profession and how she is pleased to have brought her expertise in treating […]

CW Hall and Dr. April Speed

Cryotherapy for Early Stage Breast Cancer

On this week’s episode I sat down with award-winning Atlanta-area breast surgeon, Dr. April Speed regarding treatment options for breast cancers, including cryotherapy.  She shared what motivated her to enter the medical field as her chosen profession and how she is pleased to have brought her expertise in treating cancers of the breast to a community that has limited access to cancer care.

Dr. Speed discussed the process through which she determines best course of action for treating a worrisome lump of the breast, be that a lumpectomy (removing the lump but leaving the healthy breast tissue), mastectomy (removing the affected breast), or a minimally-invasive approach.

Given the short recovery time of the minimally-invasive option, it is desirable when the tumor type and size fall within established guidelines.  In many cases, patients are able to return to work the same day and typically results in less pain for them. One such procedure is the Visica 2 Procedure, made by Sanarus. (Visica 2 is the Treatment system, the Visica Procedure is the procedure.)

This technology allows the breast surgeon to use a small, super-cooled probe that is guided to the abnormal tissue within the breast by imagery.  The probe is below freezing, and is used to freeze the cancerous tissue, destroying it.  Over time, once the procedure is complete, the destroyed tissue is slowly reabsorbed.

I was pleased to talk about this with Dr. Speed, as she is one of fewer than 10 breast surgeons in the state of Georgia who are able to perform this minimally-invasive, early stage breast cancer treatment.

About Sanarus/the Visica Procedure – In 2001, the Visica® Treatment System was the first system available for cryoablation of fibroadenomas. Since then, our systems have been used to successfully treat thousands of patients. Since 2007, the Visica 2 Treatment System has been used to treat cancer in hundreds of cryoablation-assisted surgeries and dozens of cryoablation-only procedures in clinical trials.

Disclaimer:  The Visica 2 Treatment system is FDA-cleared for the ablation of cancerous or malignant tissue and benign tumors. It’s been used in over 5,000 cryo-assisted surgeries and cryo-only procedures.

Special Guest: 

Dr. April Speed, MD, Global Breast Health & Wellness Center; Just Breast, LLC

   

* Doctor of Medicine, Morehouse School of Medicine

* Residency, MD Anderson Cancer Center

* Board of Directors, Susan G. Komen for the Cure

* Board of Directors, Southeastern Primary Care Consortium

Blue Cross Blue Shield of Georgia On this week’s episode with our partner, Medical Association of Georgia, MAG CEO, Donald Palmisano, Jr., joined me in studio.  We hosted Jeff Fusile, the recently-appointed President for Blue Cross Blue Shield of Georgia.  Jeff joined the company in the lead role, coming over from Anthem in November of […]

Blue Cross Blue Shield of GA CEO, Jeff Fusile

Blue Cross Blue Shield of Georgia

On this week’s episode with our partner, Medical Association of Georgia, MAG CEO, Donald Palmisano, Jr., joined me in studio.  We hosted Jeff Fusile, the recently-appointed President for Blue Cross Blue Shield of Georgia.  Jeff joined the company in the lead role, coming over from Anthem in November of 2015.

Jeff Fusile is president of Blue Cross and Blue Shield of Georgia (BCBSGa), the state’s oldest and largest health insurance company. He oversees sales, account service, marketing, underwriting, and customer relationships. Jeff is involved in corporate strategy planning and execution, and he serves as the primary contact for state regulators to ensure compliance and manage any state-related matters.

Jeff previously served as Senior Vice President and Chief Financial Officer for the Commercial & Specialty Business Division of Anthem, Inc., which is Blue Cross and Blue Shield’s parent company. He joined Anthem in 2011 after spending 22 years as a strategic management consultant with PricewaterhouseCoopers. Jeff is a licensed CPA. He has qualified as an expert witness in insurance and the broader health care industry. He is widely recognized as an industry leader in health care strategy, corporate governance, compliance, enterprise risk management, HIPAA, and ICD-10.

As the health care landscape undergoes an unprecedented transformation, the traditional relationships between providers and payers are also evolving. With the largest network of providers in the state, Blue Cross and Blue Shield of Georgia (BCBSGa) serves more than 3 million Georgians and is the only plan offered in all 159 counties.  BCBSGa President Jeff Fusile will discuss how BCBSGa is developing programs to facilitate better collaboration with providers, make health care more affordable for consumers and simplify the access to care. Reaching out to rural communities and the impact of technology on delivering innovative solutions was also discussed.

Special Guest:

Jeff Fusile, CEO, Blue Cross Blue Shield of Georgia        

* BS, Accounting & Finance, Florida State University College of Business

* Certified Public Accountant

* Previous Managing Partner, PriceWaterhouseCoopers

* Former Senior VP/CFO, Commercial & Specialty Business, Anthem

Insurance Reimbursement This week’s show was part of our monthly series with MAG and we focused our conversation on legal issues around commercial insurance reimbursement for physicians.  Former insurance commissioner for the state of GA, attorney, and expert on the subject, John Oxendine, joined me in the studio to talk about some important things physicians […]

John Oxendine talks insurance reimbursement.

Insurance Reimbursement

This week’s show was part of our monthly series with MAG and we focused our conversation on legal issues around commercial insurance reimbursement for physicians.  Former insurance commissioner for the state of GA, attorney, and expert on the subject, John Oxendine, joined me in the studio to talk about some important things physicians need to know relating to commercial insurance reimbursement.

There are laws that lay out requirements for timeliness of payment and/or communications regarding submitted claims that must be adhered to by insurance companies.  Additionally, there are also rules around documentation of assignment of representation that can be the difference between losing five or six figures to insurance company claw back or being able to deny those requests to return payment for previously-delivered care.

John Oxendine is uniquely qualified to provide advice and information to physicians on the subject of health insurance reimbursement.  He spent over 15 years as Georgia’s State Insurance Commissioner.  He has worked closely with MAG, the Georgia Association of Physicians of Indian Heritage, AMA, and numerous other health care provider organizations.

While Insurance Commissioner, John created a division at the Department of Insurance to help physicians with claims payment issues.  Additionally, he was the first commissioner in the country to levy large fines against insurance companies not in compliance with the state’s prompt pay law.

Special Guest:

John Oxendine, Attorney, John Oxendine PC

* Doctor of Law, Mercer University, Walter F. George School of Law

* Former Commissioner, Georgia Department of Insurance, 1995-2011

Health Insurance Mergers On this week’s episode I continued my monthly series with Medical Association of Georgia. MAG CEO, Donald Palmisano, Jr., and MAG delegate from Bibb County, Dr. John Rogers joined me in studio to talk about the challenges and concerns arising from recently-proposed mergers between large health insurance companies that will significantly reduce […]

Donald Palmisano Jr.

Dr. John Rogers of Coliseum Northside Hospital

Health Insurance Mergers

On this week’s episode I continued my monthly series with Medical Association of Georgia. MAG CEO, Donald Palmisano, Jr., and MAG delegate from Bibb County, Dr. John Rogers joined me in studio to talk about the challenges and concerns arising from recently-proposed mergers between large health insurance companies that will significantly reduce amount of competition in the space for Georgians to choose from.

Aetna/Humana and Anthem/Cigna are in the process of merging. At the same time, health insurers are offering insurance policies to the public that do not have adequate coverage resulting in more out of network charges by physicians.

Aetna/Humana and Wellpoint/Cigna have proposed mergers in the health insurance market. If these inadequate policies are being offered in the current environment, MAG is concerned about how patients will be negatively impacted with a further narrowing of the networks and increased physician reliance on out of network charges.

MAG recently sent a letter to the U.S. Department of Justice to call for it to scrutinize the mergers for antitrust violations.

MAG believes the mergers would reduce competition and place physicians and their patients at an even greater disadvantage as a shrinking number of health insurance companies gain increasingly-dominant positions in the marketplace.

The new Aetna (58 percent) and Anthem (30 percent) entities would control nearly 90 percent of the individual market in Georgia. In the small group market, Aetna would control more than 49 percent, while Anthem would control more than 33 percent. Each new company would control about 26 percent of the Medicare Title XVIII marketplace. And for large group market, Aetna would control more than 12 percent while Anthem would control nearly 55 percent.

Physicians have little-to-no leverage to negotiate contract terms with these multi-billion dollar conglomerates – which are imposing take-it-or-leave it agreements and unilateral, mid-term amendments with growing impunity.

Gone unchecked, a few insurers will be in a position to manipulate the marketplace to institute policies that will exacerbate the physician shortage and undermine the economic viability of the practice environment in the state and limit the accessibility of care and individual patient choice.

Georgia Department of Insurance has expressed concerns that the Aetna/Humana merger would violate Georgia’s standards for competition. Specifically, DOI has shared that the Aetna/Humana merger may violate Georgia’s competitive standard in the individual, small group, and Medicare Title XVIII markets while raising concerns of substantially reduced competition in the large group market.

More than 30 percent of the physicians in Georgia who participated in a survey that MAG conducted in the last several months said that they believe that the Aetna/Humana merger would threaten the long-term viability of their practice.

Special Guests:

Donald Palmisano, CEO, Executive Director of Medical Association of Georgia     

* JD Law,

Self Funded Insurance Plans On this week’s episode I sat down with Alan Conner, of Your Professional CFO.  Alan is a tax and accounting expert who works with a wide range of companies and professionals, including physicians. I met Alan a few weeks ago in the hall of our office building.  After learning about how […]

Alan Conner talks self funded insurance plans with CW Hall

Self Funded Insurance Plans

On this week’s episode I sat down with Alan Conner, of Your Professional CFO.  Alan is a tax and accounting expert who works with a wide range of companies and professionals, including physicians.

I met Alan a few weeks ago in the hall of our office building.  After learning about how he helps physicians, I knew we needed to have him stop by to talk about it.  In addition to providing basic accounting/payroll functions, Alan also helps physicians develop effective, legal tax strategies, including self funded insurance plans to reduce their tax burden and risk at the same time.

Alan shared the story of his older brother, an ER physician in Florida.  He explained the fact that his brother, as do many physicians, work as 1099 contractors for the respective practice they serve.  In this relationship, the doctor receives a gross paycheck with no tax withheld.

In this situation it is vital for the provider to plan for their tax obligation and pay it in a timely fashion (at least quarterly) or they face between 5-10% penalties, which can quickly add up to significant amounts, based on the numbers they’re working with.

Alan explained several options available to physicians that work as 1099 contractors, including self funded insurance plans, pension plans, SEP IRA’s, and others, that will help them preserve their hard-earned revenue for later while protecting them from risk such as loss of medical license should that occur.

It’s clear after speaking with him that it is advisable for our colleagues in the community to partner with experts such as Alan to develop a solid plan for managing their tax obligations as well as helping to secure their financial future.

Special Guest:

Alan Conner, CEO, My Professional CFO   

* MBA, Finance, Nova Southeastern University

* Previous Investment Banker, Orosey & Pepe Capital Markets

* Former Investment Manager, Arduus Asset Management