Top Docs Radio

Kevin Rainwater

MAG’s Sponsored MEP 401k Plan

MAG member practices can reduce their fiduciary liability, lower plan expenses, and retain

their employees by participating in the MAG-sponsored 401(k) retirement plan that’s available

through ACG Wealth. The MAG 401(k) Plan is treated like one large plan from a government

Form 5500 reporting standpoint. In short, the MAG 401(k) Plan offers the advantages and

flexibility of a stand-alone plan while avoiding the expenses and administrative headaches

associated with sponsoring a stand-alone plan.

Member benefits include…

* Cost savings on the investments

* No individual Form 5500 reporting

* Minimal plan maintenance

* Flexible plan features, including safe harbor

* Roth and profit sharing

* Customizable 401(k) plan design options involving eligibility, matches, and vesting schedules

* No audit at member level

By participating in the MAG 401(k) Plan, virtually all of the administrative tasks can be offloaded from the practice to ACG Wealth and MAG.

Kevin Rainwater is a managing partner with Atlanta Capital Group. He specializes in retirement planning.  Kevin began his career in the financial services industry more than 16 years ago. He has a passion for helping employees, executives and business owners reach their retirement goals. Kevin provides investment and plan advisory services to companies and individuals throughout the nation.

He relies on his extensive knowledge of qualified plan design and investment offerings to provide business owners and participants with the most competitive retirement plan option available.

Paula Eichenbrenner

AMCP Foundation Executive Director Paula Eichenbrenner

I sat down with Executive Director of the AMCP Foundation, Paula Eichenbrenner, to talk about some of the emerging research trends likely to have an impact on managed care pharmacy over the next few months and years.

Susan Cantrell and CW Hall

AMCP CEO Susan Cantrell

I sat down with AMCP CEO Susan Cantrell at the spring conference in Denver.  She shared an update on a few of the issues leaders and pharmacy clinicians are dealing with this year.  Some top areas of focus include contracting with pharmaceutical companies.  Value-based reimbursement is emerging as a new trend that will likely gain traction over the coming year.

Jim Kenney, Manager of Specialty and Pharmacy Contracts at Harvard Pilgrim, lead a session titled “Approaches to Managed Care Contracting with Pharmaceutical Manufacturers.” This session discussed innovations in managed care pharmacy contracting, including indication-based contracts and price protection arrangements.

The Boston Globe recently reported on two Harvard Pilgrim pay-for-performance programs focused on rheumatoid arthritis and osteoporosis aligned with adherence and effectiveness measures. The strategy is designed to curb spending while giving patients access to costly treatments.

Healthcare Risk Management Review described the launch of an Enhanced Medication Therapy Management (MTM) program by Tabula Rasa HealthCare. This pilot program of the Part D Enhanced MTM Model involves seven states: Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming. The article shared requirements of the Centers for Medicare and Medicaid Innovation (CMMI), which oversees the model.

And of course, the AMCP conference featured speakers discussing the possibility of repeal/replacement of the ACA and the impacts such a change would have on the pharmacy landscape.

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!

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 tha...

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

[email protected] for details.

Don O’Neill 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 […]

 

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 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.”

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.