October 2016 Newsletter

MAG unveils HOD meeting app + other HOD news | HOD delegates encouraged to attend MagMutual lunch | MAG opposing federal telemedicine measure | MAG staff influence key stakeholders in Georgia & beyond | ‘Top Docs’ shows on medical literacy, end-of-life online | ‘Top Docs’ show on MAG’s new HIT solution online | MAG encouraging Georgians to get flu vaccine | MAG webinar on legal & compliance issues online | Get 15% off, free shipping on Rx pads/EMR paper | Busting some health care innovation myths | GDC flags article on link between patents & drug costs | Slavitt offers flexibility in 2017, but MACRA will live on | New Members | AMA: U.S. ‘needs more competition in health insurance’ | AMA: Physicians making progress on opioid epidemic | Results of Physicians Foundation survey troubling | Study finds physicians leaving private practice | DCH to host free Medicaid Fair in Columbus | DCH: Emergency ambulance telehealth added as service | DCH posts unspecified ICD-10 codes | Measure to help exploited children | Opioid abuse conference to take place in Atlanta | CMS issues Medicare fraud/ID theft fact sheet

 

Top Headlines

MAG unveils dynamic HOD meeting app + other HOD news

The Medical Association Georgia (MAG) Speaker of the House of Delegates (HOD) Frank McDonald Jr., M.D., is encouraging delegates to download MAG’s new HOD meeting app to their mobile devices. The app includes key information on this year’s HOD meeting, which will take place at the Hyatt Regency Savannah on Saturday, October 15 and Sunday, October 16.

“I applaud MAG staff for developing this great resource,” Dr. McDonald says. “It features information on the schedule of events, reports and resolutions, a list of our sponsors and exhibitors, MAG’s social media campaign, information on lodging and parking, and a list of staff and physician leader contacts.”

He also notes that delegates who download the app will be able to receive last-minute notifications from MAG (e.g., reminders about meeting times and locations).

Dr. McDonald explains that delegates can download the app for free in a “matter of moments” by searching for ‘MAG HOD 2016’ in the Apple or Google Play stores.

The HOD meeting information is also available at www.mag.org/HOD.

Contact Mandi Milligan at mmilligan@mag.org with questions related to MAG’s new app.

HOD registration

MAG is reminding applicable members to register for the HOD meeting.

Click to register for 2016 HOD

Early bird check-in and registration will be available in the lobby of the Hyatt from 2 p.m. until 7 p.m. on Friday, October 14.

Attendees and their family members and guests are all encouraged to attend a welcome reception that the SunTrust Medical Specialty Group will host on the terrace on the fourth floor of the Hyatt from 6 p.m. until 7:30 p.m. on Friday, October 14.

New delegate webinar

MAG Speaker Frank McDonald Jr., M.D., will host an orientation webinar for new HOD delegates and alternate delegates from 8 p.m. to 9 p.m. on Thursday, October 6.

Go to https://global.gotomeeting.com/join/431820013 to join the webinar. Delegates and alternates can also participate by conference call by dialing 224.501.3412 and using the access code 431820013.

Contact Dayna Jackson at djackson@mag.org or 678.303.9262 with questions related to the webinar.

Lodging

HOD meeting attendees who need assistance with lodging in Savannah should contact Anita Amin at aamin@mag.org or 404.299.7700.

Handbook

The HOD handbook has been emailed to delegates and alternate delegates as a PDF. It is also available on MAG’s new app and by clicking here. Amendments to the handbook will be posted online and emailed to delegates and alternate delegates.

Elections

MAG members who are interested in running for MAG office for 2016-2017 should contact Donna Glass at dglass@mag.org or 678.303.9251. The elections will take place during the HOD meeting.

The following is the list of candidates who have announced their plans to run for a MAG office for 2016-2017…

– President-elect: Frank McDonald Jr., M.D.

– Second Vice President: Lisa Perry-Gilkes, M.D.

– Speaker of the House of Delegates: Edmund R. Donoghue Jr., M.D.

– Vice Speaker of the House of Delegates: James W. Barber, M.D.

– AMA Delegate (for the seat that is held by Joy A. Maxey, M.D., that expires in 2018): Joy A. Maxey, M.D.

– AMA Alternate Delegate (for the seat that is held by John S. Antalis, M.D., that expires in 2018): John S. Antalis, M.D.

– AMA Alternate Delegate (for the seat that is held by Jack M. Chapman Jr., M.D., that expires in 2018): Jack M. Chapman Jr., M.D.

MAG President-elect Steven M. Walsh, M.D., will be installed as MAG’s president on October 15, while MAG’s Second Vice President Steven M. Huffman, M.D., will automatically become MAG’s first vice president.

GAMPAC

GAMPAC members are invited to attend an exclusive lunch that will take place in the Harborside Ballroom at 12:30 p.m. on Sunday, October 16. The lunch is free for GAMPAC members who have joined at a level or $250 or more. The lunch will feature a unique health care panel discussion that will include Reps. Tom Price, M.D., and Buddy Carter from Georgia and Michael Burgess, M.D., and Phil Roe, M.D., from Texas and Tennessee.

GAMPAC Chair Michelle Zeanah, M.D., has also announced that every GAMPAC member who attends the HOD meeting will be able to get a professional headshot photograph taken for free at their convenience from 8 a.m. to 12 p.m. on Saturday, October 15 or from 8 a.m. to 12 p.m. on Sunday, October 16, at a studio that will be set up next to the GAMPAC exhibit and near the main HOD meeting room.

Contact Bethany Sherrer at 678.303.9273 or bsherrer@mag.org or go to mag.org/affiliates/gampac for additional information or to join GAMPAC.

Pre-purchase dinner tickets & save $50

MAG is reminding HOD meeting attendees to purchase their tickets for the awards dinner that will take place on Saturday, October 15 as soon as possible. The tickets can be purchased for $75 per person in advance, which will increase to $125 per person at the door – assuming there are still seats available. Complete the HOD registration form to purchase awards dinner tickets. Contact Dayna Jackson at djackson@mag.org or 678.303.9262 with questions.

MCG Alumni Reception & Low Country Boil

The Medical College of Georgia Alumni Association is inviting all Medical Association of Georgia (MAG) Board of Directors members to attend a reception and “low country boil” that will take place at the Savannah Golf Club at 1661 East President Street on Thursday, October 13. The event will begin at 6 p.m. The dress code is casual. Call 706.723.0140 or email mcgalumni@gru.edu to RSVP by October 10.

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HOD delegates encouraged to attend MagMutual lunch  

MAG Mutual Insurance Company is encouraging all delegates and alternate delegates to attend a complimentary lunch that it will host in conjunction with the Medical Association of Georgia’s House of Delegates meeting in the Harborside Ballroom at the Hyatt Regency Savannah at 12 p.m. on Saturday, October 15.

The keynote speaker will be Alan Lembitz, M.D., who is COPIC’s chief medical officer. He will give a talk on ‘The Journey from Risk Management to Patient Safety.’

Click for MagMutual’s website

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MAG opposing measure to preempt state telemedicine laws

The Medical Association of Georgia is one of nearly 50 state medical associations that signed a letter to Congressional leaders to express concern over federal telemedicine legislation that would “preempt state laws governing medical licensure, medical practice, and professional liability by changing the originating site of care from where the patient is located to where the physician is located.”

The American Medical Association reports that, “The National Defense Authorization Act for Fiscal Year 2017 (S. 2943) passed the United States Senate on June 14, 2016.  As passed, the bill contains a provision that would preempt state laws governing medical licensure, medical practice, professional liability, and reimbursement by altering the applicable state law from where the patient receives the medical services to the location of the physician, ostensibly to enable telemedicine across state lines for patients in the TRICARE program. [The specific provision is section 705(d), Enhancement of Use of Telehealth Services in Military Health System; Location of Care.] This provision is not contained in the companion legislation that passed the U.S. House of Representatives on May 18, 2016.”

AMA says that it has worked with the Federation of State Medical Boards (FSMB) to highlight how the legislation would threaten the “important and demonstrated patient safety protections [that are] provided by adherence to state licensure and medical practice laws where the patient receives services.” AMA/FSMB say…

– Both organizations strongly support adoption of telemedicine, and have sought to develop and implement policies, rules and mechanisms that would expand access to care via telemedicine in a safe and accountable manner. Since 2015, as an example, 17 states have enacted legislation to participate in the Interstate Medical Licensure Compact, a new pathway to expedite the licensing of qualified physicians seeking to practice medicine in multiple jurisdictions. Additional U.S. states and territories are expected to join the Compact in the years ahead.

– The Compact provides for the key component of regulation at the point of care where the patient is located – a fundamental principle of medical regulation that must remain in place – while dramatically streamlining the licensing process. It accomplishes the major goals that telemedicine advocates promote: faster licensure, reduced barriers, and a system that can be applied nationwide, creating an enhanced environment for multi-state practice.

– The practice of medicine occurs where the patient is located, rather than where the provider is located is patient-centered, time-tested and practice-proven. It ensures that state medical boards have the legal capacity and practical capability to regulate physicians treating patients within the borders of their state, and to attest that those physicians meet the qualifications necessary to safely practice medicine. Each state establishes its own licensing and medical practice standards, regulations, and laws that meet the needs of the individuals receiving care within the state’s borders.

– This legislative provision would compromise patient safety by making it exceedingly difficult and potentially impossible for patients and state medical boards where medical care is rendered to address improper or unprofessional care. The ability of patients, and other interested parties, to quickly and accurately identify and report concerns to the applicable state medical board of jurisdiction and actively support the medical board investigation will be hampered. Currently, patients and others may file a complaint with the state medical board where the medical care is rendered. Altering the applicable law to the state where the provider is located would place the burden solely on the patient to navigate through the complaint filing and investigatory process (once they have identified the state of licensure of the physician and applicable state medical practice laws) across one or more state lines.

– This provision raises constitutional questions and would create an ambiguous medical regulatory structure, as it is unclear if the provider must adhere to the Medical Practice Acts (laws and standards) of their state of licensure, or the state of the patient’s location. The latter would embroil patients, state medical boards, and health care providers in costly conflicts of law litigation ancillary to the issue of whether appropriate medical care was provided.

– This provision creates an inefficient and unworkable system where in theory each individual state board would be required to regulate medical practice across the nation, affecting 9.4 million TRICARE beneficiaries around the world. Yet, a state boards’ legal authority does not extend beyond the state – investigations and application of state medical practice laws stop at the border’s edge.

– The current fee structure of the state board licensing and renewal system allows state boards to use their limited resources to fund investigations and subsequent prosecutions of physicians suspected of unprofessional medical conduct in the state where the medical care was rendered. This proposal would create a significant and unsustainable financial burden on the state board where the physician is licensed, forcing the board to conduct its disciplinary proceedings and utilize their limited resources, at a much greater cost, to be able to conduct investigations in other states which would involve negotiations with state agencies and authorities where the physician is located.

Click for letter

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MAG staff influence key stakeholders in Georgia & beyond

MAG Medical Reserve Corp members at a training exercise at Dobbins Air Force Base in Marietta in September.

Medical Association of Georgia (MAG) staff has met with a number of key stakeholders in the past several months. MAG Executive Director Donald J. Palmisano Jr.’s agenda has included…

– AMA Annual Meeting
– AMA Advocacy Resource Center (TRICARE)
– AMA State Advocacy Roundtable (presentation)
– AMA Federation CEO Advisory Group
– Georgia Board of Workers’ Compensation Medical Authorization Issues Committee
– Georgia DCH Commissioner Clyde Reese (CMOs)
– Georgia State University ‘Health Law Partnership’ (presentation)
– Georgia Campus – Philadelphia College of Osteopathic Medicine (student orientation)
– Georgia Chapter, American Academy of Pediatricians
– Georgia Charitable Care Network
– Georgia Society of Ambulatory Surgical Centers (presentation)
– Georgia Society American College of Surgeons (presentation)
– Georgia Society of Dermatology & Dermatologic Surgery (presentation)
– GHA Center for Rural Health
– HealtheParadigm Advisory Committee
– Southeast Permanente Medical Group
– MAG Foundation Georgia Physicians Leadership Academy
– Physicians Advocacy Institute

In addition to delivering a number of GAMPAC checks and attending a number of fundraisers and meetings with state legislators and their staff, MAG Government Relations Director Derek Norton and MAG Legislative Associate and GAMPAC Manager Bethany Sherrer’s calendar included…

– AMA Advocacy Roundtable Conference
– Georgia Association of Family Physicians (Patient Centered Medical Homes)
– Georgia Chamber of Commerce
– Georgia Composite Medical Board
– Georgia Board of Dentistry
– Georgia Department of Community Health
– Georgia Board of Pharmacy
– Georgians for a Healthy Future ‘Getting Georgia Covered’ event
– MAG Mutual Insurance Company Government Affairs Committee
– Piedmont Healthcare and Resurgens Orthopaedics

Norton and Sherrer also met with U.S Sen. Johnny Isakson, U.S. Rep. David Scott, U.S. Re.-elect Drew Ferguson, Georgia Senate Health and Human Services Committee Chair Renee Unterman (R-Buford), and Georgia House Insurance Committee Chair Richard Smith (R-Columbus). And attended with a number of medical societies’ meetings, including the Medical Association of Atlanta, Cobb County Medical Society, Dougherty County Medical Society, and Peachbelt Medical Society.

In addition to meeting with a number of medical practices to promote the new HealtheParadigm patient data/payer metrics solution, MAG Director of Health Policy and Third Party Payer Advocacy Susan Moore attended…

– Albany Medical Managers Group
– Georgia Clinical Transformation Team (GCT2)
– Georgia Colorectal Cancer Roundtable Policy Workgroup
– ‘Super Meeting’ of Savannah area CMS
– COMPASS Practice Transformation Network (annual meeting)
– MAG Medical Reserve Corps (training at Dobbins AFB in Marietta)

MAG Membership Director Kate Boyenga and her staff hit the road for a variety events, including…

– Emory University (resident orientation)
– Gwinnett Medical Center (resident orientation)
– WellStar Cobb Hospital (resident orientation)
– American Association of Medical Society Executives Leadership Academy
– International Medical School Graduates (annual meeting)
– All-States Membership Meeting
– Medical Association of Georgia Alliance

MAG Director of Education Andrew Baumann conducted an accreditation survey of the Okefenokee Health System in Waycross.

MAG Director of Communications Tom Kornegay attended a meeting state medical associations from the southeast region to exchange best practices in the areas of membership, business development, and communications.

Baumann and Kornegay also toured the Emory Brain Health Center in Atlanta.

Finally, MAG Foundation Program Development Director Lori Cassity Murphy’s schedule included…

– Georgia Attorney General Sam Olens (high school video contest to reduce opioid abuse)
– Georgia Chapter of National Association of Drug Diversion Investigators (presentation)
– Kennesaw State University (opioid abuse)
– Richmond County Medical Society
– Dalton area law enforcement and first responders (presentation)
– Savannah/Chatham Metropolitan Police Department (presentation)
– U.S. Department of Justice Heroin Working Group

Contact Dayna Jackson at djackson@mag.org if you would like to make arrangements to have MAG staff address a group in your area.

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‘Top Docs’ shows on medical literacy, end-of-life now online

C.W. Hall, Susan Moore and Dr. Richard Cohen

Recordings of two Medical Association of Georgia (MAG) ‘Top Docs Radio’ shows that aired in September are now available online.

On September 13, Ruth Parker, M.D., a professor of Medicine, Pediatrics and Public Health at the Emory University School of Medicine in Atlanta, discussed why health literacy is such an important consideration for physicians and patients.

And on September 27, Richard W. Cohen, M.D., the chair of the Georgia POLST Collaborative, discussed key end-of-life issues from both patient and physician perspectives.

MAG sponsors the ‘Top Docs’ program at 12 p.m. on the second and fourth Tuesday of every month.

Listeners can go to https://twitter.com/TopDocsOnBRX to submit questions to ‘Top Docs’ host C.W. Hall during the program. Between downloads and live listeners, MAG’s ‘Top Docs’ show has reached more than 7,000 listeners – which includes people in all 50 states and 84 countries.

Click for ‘Top Docs’ show on medical literacy

Click for ‘Top Docs’ show on end-of-life issues

Click for National Academies of Science ‘Roundtable on Health Literacy’ website

Click for ‘AHRQ Health Literacy Universal Precautions Toolkit’

Click for Georgia POLST website

Dr. Ruth Parker and C.W. Hall

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‘Top Docs’ show on MAG’s new HIT solution now online

The Medical Association of Georgia (MAG) featured HealtheParadigm – a new “health IT solution that will enable physicians to generate sophisticated patient data reports that they can use to improve outcomes and fulfill the new quality-based payer metrics” – during a special edition of its ‘Top Docs Radio’ program that aired on the Business Radio-X on August 30.

The guests included MAG Director of Third Party Payer and Health Policy Susan Moore and Laura McCrary, the senior vice president of KaMMCO Health Solutions and the executive director of the Kansas Health Information Network.

Physicians can contact Moore at smoore@mag.org or 678.303.9275 for details on how HealtheParadigm can help them and their practice.

Click for ‘Top Docs’ show on HealtheParadigm

Click for HealtheParadigm website

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MAG encouraging Georgians to get flu vaccine

The Medical Association of Georgia distributed the following press release on September 23…

The Medical Association of Georgia (MAG) is encouraging Georgians to get vaccinated for the flu by the end of October.

“It is essential for every patient who is six months or older to get vaccinated for the flu once a year,” says MAG President John S. Harvey, M.D. “And they should ideally discuss their vaccination options with their primary care physician as a part of their overall health maintenance program.”

Dr. Harvey believes that it is important for patients to get vaccinated by the end of October. He explains that, “We are already receiving reports of patients who have flu symptoms, so the physician community is taking the initiative to get ahead of any outbreaks – which is consistent with the Centers for Disease Control and Prevention’s recommendations.”

Dr. Harvey points out that, “Once a patient gets vaccinated, it will normally take several weeks for the antibodies to develop in their body – and up to a month and a half before they reach maximum protection.”

He adds that, “An anti-viral medication is also available for patients who show symptoms of the flu, but the patient needs to begin taking that within the first one or two days of the first signs of symptoms.”

He also stresses that, “Young patients, pregnant patients, the elderly, and the immune-deficient are the most vulnerable patient populations.”

Flu symptoms include high fever, headache, fatigue, dry cough, sore throat, and muscle aches. And Dr. Harvey also cautions that, “While most people recover in a few days, the virus can be deadly and it can lead to pneumonia and other serious complications.”

Finally, Dr. Harvey says that, “When it comes to preventing the flu, the best advice I can offer is to remind everyone to wash their hands on a regular basis.”

Go to www.flu.gov, www.cdc.gov/flu or http://dph.georgia.gov/influenza-what-you-need-know for additional information on the flu and flu vaccines.

Also go to https://www.youtube.com/watch?v=ayV7G1E2xso to watch a ‘Move the Needle’ video that was produced by Sandra Fryhofer, M.D., who is a member of the MAG Foundation’s Georgia Physicians Leadership Academy, to increase vaccination rates in Georgia.

Click for CDC Influenza Activity Update

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MAG webinar on legal & compliance issues now online   

The recording of a ‘Top 5 Legal and Compliance Issues for Physician Practices’ webinar that the Medical Association of Georgia (MAG) hosted for its members and their practice staff for free on September 20 is now available on a password-protected basis online.

The event featured Liz Schoen, J.D. – a legal and business advisor with E.S. Schoen & Affiliates in Marietta who has more than 25 years of experience in the health care field.

MAG Director of Third Party Payer and Health Policy Susan Moore reports that, “The webinar provided some incredibly valuable, real-world information and tips that physicians and practice staff can use to run a better and more efficient medical practice.”

Contact Schoen at eswschoen@gmail.com or Moore at smoore@mag.org with questions.

Click for webinar recording

Click for Liz Schoen website

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MAG members can get 15% off + free shipping on Rx pads & EMR paper

Medical Association of Georgia (MAG) members who order 40 or more tamper-resistant prescription pads or 2,000 or more sheets of EMR printer paper from Rx Security will receive free shipping through October 31. This is in addition to the normal 15 percent MAG member discount.

Physicians can add multiple providers and addresses to the prescription pads/EMR printer paper at no additional charge – as well as having access to a full range of customization options.

Go to www.rxsecurity.com/mag-order or call 800.667.9723 and use promo code “MAG103115” to order prescription pads/EMR printer paper from Rx Security, which is one of MAG’s endorsed product vendors.

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Busting some health care innovation myths

By Lance M. Black, M.D., medical affairs manager, Global Center for Medical Innovation

I work with physicians who routinely have incredible ideas that would improve our health care system. These innovators are passionate about the problems they are attempting to solve because they live with them daily. As with all industries, however, the business of medical innovation has to contend with its share of myths and misinformation that can establish some unrealistic expectations for innovators. This article addresses three of the most common myths that are associated with health care innovation.

Myth #1: I have a great idea – so a company is bound to buy it from me

Okay, so this one isn’t completely false. While rare, this does happen. Some physicians are just in the right place at the right time – or they are key opinion leaders (KOL) whose every word device companies hang on. A physician’s idea can sometimes be enough for a company to invest in. This is, however, like getting recruited for major league baseball out of high school. A device company typically needs to see an idea ‘de-risked’ before it will consider licensing, testing or developing it. This process may include the development of a prototype to conduct a feasibility test or require going through FDA’s regulatory pathway.

Myth #2: I’ll be able to run a medical device company in my free time

Medical device and pharmaceutical development requires significant commitment and focus. It is not something one can typically do as a hobby. There are a few super men and women who are able to play a significant role in a medical device start-up while still practicing medicine full-time. This is, however, the exception. Once you have decided that your idea has merit and warrants being pushed through the development process, you should view it as a full-time job. If you are not willing to take a sabbatical, leave your practice, or reduce your hours, that is okay – but someone has to make it a priority. You may still be able to play a role in the development of your idea, but just not as the primary driver.

Myth #3: I’m in health care, so I know how to develop a medical device

It is a common misconception that since physicians are at the ‘pinnacle’ of the health care system, anything that is related to health care is subject to their authority. Physicians sometimes assume that medical device or pharmaceutical development is simply another health care skill set that can be picked up – like learning a new surgical procedure. Unfortunately, this leads physicians to believe that they can see their idea from beginning-to-end by themselves. And the norm is that we, as physicians, were not trained in medical school or residency about how the innovation process works, so it is a requisite to respect and appreciate the process and the need for a team-based approach.

There are a number of groups that are available to support physicians who are interested in the health care innovation arena in Georgia. They can assist you in the development of your idea, and they can help you avoid some common pitfalls. I encourage you to visit the Georgia Health Care Innovation Portal on the Medical Association of Georgia’s website for a list of some of these organizations.

This is part of an ongoing series of exclusive articles that Dr. Black is writing for MAG’s ‘e-News from MAG’ newsletter that address the factors physicians should take into account when they have a concept that they would like to develop for a marketplace application. Dr. Black is a MAG member. Contact him at 850.218.5259 or lblack@devices.net.

Click for MAG’s ‘Georgia Health Care Innovation Portal’

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GDC flags article on link between patents & drug costs

The Georgia Drug Card is flagging an August 23 article (‘Tighter Patent Rules Could Help Lower Drug Prices, Study Shows’) from NPR that says that the “U.S. could rein in rising drug prices by being more selective about giving patents to pharmaceutical companies for marginal developments, a study concludes.”

The article explains, “That’s because brand-name drugs with patents that grant exclusivity account for about 72 percent of drug spending, even though they are only about 10 percent of all prescriptions dispensed, according to the study, published Tuesday in JAMA, the journal of the American Medical Association.”

The Georgia Drug Card is also reminding Medical Association of Georgia members that their patients who have high-deductible plans, who do not have prescription coverage or who take prescription drugs that aren’t covered by their health insurance plan can use the Georgia Drug Card – which is free – to obtain savings of up to 75 percent off the retail price for brand and generic FDA-approved medications.

Georgians can 1) print the Georgia Drug Card at www.GeorgiaDrugCard.com or 2) they can request the Georgia Drug Card savings at any CVS/pharmacy in the state or 3) they can request a hard card by sending an email to John Cenerazzo at johnc@georgiadrugcard.com.

Click for NPR article

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Slavitt offers flexibility in 2017, but MACRA will live on

By Elizabeth Woodcock, Woodcock & Associates

Responding to significant concerns about the impending start of the new reimbursement platform for Medicare as defined by the Medicare Access to Care and CHIP Reauthorization Act of 2015 (MACRA), the head of the Centers for Medicare & Medicaid Services (CMS) announced the creation of flexible options for 2017. On September 8, acting CMS administrator Andy Slavitt posted a blog that outlined the changes, stating the intention to “allow physicians to pick their pace of participation.”

The revelation was prompted by the outcry from physicians who reacted to April’s proposed rule outlining the implementation of MACRA. The new Quality Payment Program (QPP), set to stage the initial performance year in 2017, incorporates two pathways: physicians can either choose to participate as a qualifying member of an advanced Alternative Payment Model (APM), or report through the Merit-based Incentive Payment System (MIPS). Like the existing government incentive plans, to include the Physician Quality Reporting System, the QPP introduces increases for successful participants and reductions in reimbursement for those who are not.

The Advanced APM pathway remains available and was not impacted by the announcement. However, Slavitt’s blog revealed that CMS will exempt physicians from any risk of penalties for choosing one of three temporary reporting options for MIPS. The three options available in 2017 include…

– Full-year reporting, beginning January 1, 2017

– Partial year reporting

– Test submission by reporting a minimal number of data elements

In addition to avoiding penalties, the participation options may provide payment boosts. Opting for a full-year reporting equates to eligibility for a “modest” increase, while partial-year participants will qualify to receive a “small” positive adjustment. Those who choose the test submission option will have no upside, but will not be subject to penalties either.

You may be asking the natural question, “What are the parameters of these new options?” Unfortunately, Slavitt didn’t elaborate, saying instead that the “options and other supporting details will be described fully in the final rule.” These regulations and corresponding details are expected to be released to the public this fall.

In the interim, it is critical to note that MACRA, passed with bipartisan support, is the law. While the particulars of the implementation may have yet to be released, including the new options for 2017 and the remaining details about the program in general, we know that there are four pillars to the program that include: quality, resource use, meaningful use, and clinical practice improvement. Under the law, these pillars are meant to further the existing programs and add a new one related to the reporting activities linked to clinical practice improvement.

Despite the flexibility in reporting for the upcoming year, it is not advised to let your foot off of the gas pedal. Practices should aim to continue their efforts in reporting these elements through the existing programs and make plans to continue to do so in the future.

Even with some flexibility in 2017, the ship has already sailed. The government is – and will continue to – gather data about your medical practice and administer financial consequences should the results not be within the parameters established for their expectations.

Woodcock is a nationally recognized practice management expert. Her company offers an array of consulting services, including practice operations assessments and revenue cycle assessments. Contact Woodcock at elizabeth@elizabethwoodcock.com or 404.373.6195. Go to www.elizabethwoodcock.com for additional information.

© Woodcock & Associates 2016

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New Members

MAG welcomed the following new members during September…

Patrick Kinnebrew, M.D., Atlanta
Stephen Soong, M.D., Atlanta
Taylor Plumer, M.D., Atlanta
Reshma Ravi Chugani, M.D., Atlanta
Robert Edward Younger III, M.D., Chattanooga, TN

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News Briefs

AMA: Data shows U.S. ‘needs more competition in health insurance’

The American Medical Association (AMA) distributed the following press release on September 21…

New data presented today show the nation needs more competition in health insurance markets, and supports antitrust efforts to block unprecedented mergers among four of the nation’s biggest health insurance companies. Left unopposed, Anthem’s acquisition of Cigna and Aetna’s takeover of Humana would collectively quash competition in insurance markets across 24 states according to newly updated market analyses released by the American Medical Association (AMA).

“The AMA analyses show that Anthem-Cigna and Aetna-Humana mergers would significantly compromise market competition in the health insurance industry and threaten health care access, quality and affordability,” said AMA President Andrew W. Gurman, M.D. “With existing competition in health insurance markets already at alarmingly low levels, federal and state antitrust officials have powerful reasons to block harmful mergers and foster a more competitive marketplace that will operate in patients’ best interests.”

The U.S. Department of Justice (DOJ) and numerous state attorneys general joined forces in July to block the mega-merger deals. The AMA has applauded this strong response by federal and state officials to protect patients from a health insurance system dominated by a few corporate Goliaths. The AMA analyses are intended to help federal and state regulators in their continuing effort to identify markets where mergers may cause competitive harm to the local health system.

On an individual basis, the Anthem-Cigna merger would diminish competition in 121 metropolitan areas located throughout the 14 states where Anthem is licensed to provide commercial coverage, including: California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia and Wisconsin. Nine of these 14 states are working to block the Anthem-Cigna merger. States that have yet to take an antitrust position on the merger include: Indiana, Kentucky, Nevada, Ohio and Wisconsin.

A closer look at the Aetna-Humana merger shows the deal would diminish competition in 51 metropolitan areas located throughout 15 states, including: Arizona, Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, Louisiana, Mississippi, Ohio, Tennessee, Texas, Utah, Wisconsin and West Virginia. Four of these 15 states are working to block the Aetna-Humana merger. States that have yet to take an antitrust position on the merger include: Arizona, Indiana, Kansas, Kentucky, Louisiana, Mississippi, Tennessee, Texas, Utah, West Virginia and Wisconsin.

“High-quality medical care is only possible if regulators enforce antitrust laws to prohibit harmful health insurance mergers that run counter to patients’ best interests,” said Dr. Gurman. “It is clear that more can be done in certain states where the attorneys general have not yet taken a strong stance against the mergers. To ensure patients are better served by dynamic and competitive health insurance markets, the AMA will work to expand the bi-partisan group of state attorneys general that has joined the Justice Department to block the massive deals.”

The anticompetitive impact of the potential mergers was assessed using data from the newly released 2016 edition of AMA’s Competition in Health Insurance: A Comprehensive Study of U.S. Markets, which offers the largest and most complete picture of competition in health insurance markets for 388 metropolitan areas, as well as all 50 states and the District of Columbia. The study is based on 2014 data captured from commercial enrollment in fully and self-insured health maintenance organizations (HMO), preferred provider organizations (PPO) and point-of-service (POS) plans, and includes participation in consumer-driven health plans. For the first time, the study also includes newly available data from the health insurance marketplaces, also known as exchanges.

The study assesses competition in the commercial health insurance markets, as well as separately examining competition in the HMO, PPO, POS, and exchange product markets.

The prospect of reducing five national health insurance carriers to just three should be viewed in the context of the unprecedented lack of competition that already exists in most health insurance markets. According to the AMA’s latest study…

– A significant absence of health insurer competition was found in 71 percent of the metropolitan areas studied. These markets are rated “highly concentrated,” based on federal guidelines used to assess the degree of competition in a given market.

– In 40 percent of the metropolitan areas studied, a single health insurer had at least a 50-percent share of the commercial health insurance market.

– Fourteen states had a single health insurer with at least a 50-percent share of the commercial health insurance market – Alabama, Delaware, Hawaii, Illinois, Indiana, Louisiana, Michigan, Nebraska, North Carolina, North Dakota, Rhode Island, South Carolina, Vermont and Wyoming.

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AMA: Physicians making progress on opioid epidemic

The American Medical Association (AMA) has released a new fact sheet that shows that physicians are making progress to reverse the nation’s opioid epidemic. AMA says that, “While much more work remains to reverse the nation’s opioid epidemic, using tools such as prescription drug monitoring programs (PDMP), medication-assisted treatment, and naloxone, physicians are making progress.”

AMA reports that…

– Every state in the nation saw a reduction in opioid prescribing in 2015 – an overall 10.6 percent decrease nationally.

– From 2012 to 2016 there has been an 81 percent increase in physicians certified to treat substance use disorders – more than 33,000 across all 50 states.

– According to the CDC, 15 states saw reductions in the numbers of people dying in 2014 compared to 2013 due to drug overdoses.

– AMA research based on responses from more than 40 states found that state-based PDMP were checked nearly 85 million times in 2015 – a 40 percent increase over 2014. Increases were seen in states with and without mandates to use a PDMP.

– An AMA survey found that nearly 50,000 courses related to opioid prescribing, pain management, or other related areas have been accessed and/or completed by physicians since October 2015. New AMA-created continuing medical education (CME) products will be released soon.

– In the second quarter of 2015, 4,291 prescriptions were dispensed, a 1,170 percent increase over prescriptions in the fourth quarter of 2013. The AMA encourages physicians to co-prescribe naloxone to patients – or their family members where allowed by state law – at risk of overdose.

Go to http://www.rxdrugabuse.org/ to find out how the MAG Foundation is taking steps to reduce prescription drug abuse in Georgia with its ‘Think About It’ campaign.  Also visit that website to support the ‘Think About It’ campaign with a donation.

Click for fact sheet

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Results of Physicians Foundation survey troubling

The Physicians Foundation says that the key takeaway message from its fifth ‘Biennial Physician Survey’ is that “physicians are struggling to maintain morale levels, adapt to changing delivery and payment models, and to provide patients with reasonable access to care.”

The Physicians Foundation stresses that, “While respondents agreed the most satisfying part of their job is the patient relationship, about two-thirds said third-party intrusions detract from the quality of care they can provide.”

It also notes that, “Even more striking, [is that] nearly half (49 percent) of survey respondents say they are either often or always feeling burnt out. This may lead to shifting practice patterns that could reduce the physician workforce by tens of thousands of full-time equivalents (FTEs).”

The Physicians Foundation says that more 17,000 physicians took the survey.

Click for survey report

Click for Physicians Foundation website

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Study finds ‘significant’ number of physicians leaving private practice

The Physicians Advocacy Institute (PAI) has released a “Physician Practice Acquisition Study: National and Regional Employment Changes” that was conducted by Avalere Health that “confirms a significant, nationwide increase in the number of physicians leaving private practice and entering into employment arrangements with hospitals and health systems.”

PAI says that the research found that between 2012-2015…

– The number of practices owned by hospitals and health systems rose nearly 90 percent

– One of out every four practices was owned by a hospital or health system, up from one in seven in 2012

– 38 percent of U.S. physicians were employed by hospital or health systems, up from one in four in 2012

– The rise in physician employment and growth in physician practice acquisitions occurred in every region of the country

The Avalere study is part of PAI’s ongoing effort to “examine the impact that various marketplace forces and private and public sector policies have on physicians and patients.”

Click for summary slides

Click for press release

Click for PAI website

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DCH to host free Medicaid Fair in Columbus

The Georgia Department of Community Health (DCH) is encouraging applicable medical practice staff to register for a free ‘Georgia Medicaid Fair’ that will take place at the Columbus Georgia Convention & Trade Center on Thursday, November 3.

DCH says that, “Attendees must register to reserve a seat for each individual session selected. A confirmation e-mail will be sent to the address you provide during registration. Review the confirmation e-mail for accuracy and note that it will include the facility location and room of each session for which you are registered. Please bring a copy of the confirmation e-mail with you to the Medicaid Fair.”

DCH adds that participants should bring their own lunch.

Contact Hewlett Packard Enterprise at georgiamedicaidfair@hpe.com with questions.

Click for registration and other details

Click for Columbus Georgia Convention & Trade Center website

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DCH: Emergency ambulance telehealth added as service

The Georgia Department of Community Health (DCH) says that, “On August 4, 2016 the Centers for Medicare and Medicaid Services approved the proposed Georgia State Plan Amendment 15-0012 [which adds] emergency ambulance telehealth as a new service.”

DCH reports that, “Emergency ambulance telehealth will allow emergency ambulances to serve as telemedicine facility sites and bill an origination site fee.”

Go to https://www.mmis.georgia.gov/portal/ for details on the fee schedule rates.

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DCH posts unspecified ICD-10 codes

The Georgia Department of Community Health (DCH) says that, “With the transition to ICD-10 in October 2015, [it has] posted a list of unspecified diagnosis codes to its Georgia Medicaid Management Information System (GAMMIS) web portal.”

DCH adds that, “The new listing of ICD-10 unspecified diagnosis codes that has been approved by the ICD-10 Physician Workgroup is now configured in GAMMIS for billing. The approved ICD-10 unspecified diagnosis codes can be billed as primary diagnosis codes when submitted for adjudication. Any other ICD-10 unspecified diagnosis codes not approved will be denied in the GAMMIS payment system.”

And DCH stresses that CMS has posted “updates of the ICD-10 codes sets, CM (diagnoses) and PCS (procedures) codes [on its website] that will become effective on October 1, 2016. Approximately 6,100 additional codes were recently released by CMS to health care professionals.”

Click for GAMMIS website

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Groups encouraging Georgians to support measure to help exploited children

The Georgia Academy of Family Physicians is part of a coalition that is calling for Georgians to support Amendment 2 – a November 8 ballot initiative that would establish a $2 million ‘Safe Harbor for Sexually Exploited Children Fund.’ The funds would be used to support sexually exploited children in the state with safe housing, education, medical care and counseling, and life skill training.

The Safe Harbor Vote Yes group says that child sex trafficking has been reported in “at least 90 counties – from the Tennessee border to the Florida/Georgia line” and that “In 2015 alone, the Georgia Bureau of Investigation conducted nearly 4,000 child exploitation investigations.”

Go to SafeHarborYes.com for additional information and to sign a pledge to support the measure on November 8.

Contact Tricia Holder at 404.310.5618 or triciaholder1@gmail.com with questions.

Pledge to vote “yes” on Amendment 2

Click for ‘Safe Harbor Vote Yes’ fact sheet

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Opioid abuse conference to take place in Atlanta

The University of Georgia College of Pharmacy Office of Continuing Education and Outreach, the Georgia Department of Justice and the Atlanta Division of the Drug Enforcement Administration will host a ‘Curbing the Tide of the Opioid Crisis’ conference at the Cobb Energy Center in Atlanta on October 26.

Click for registration and other details

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CMS issues Medicare fraud/ID theft fact sheet

The Centers for Medicare & Medicaid Services is promoting a new fact sheet that was developed to “assist beneficiaries [to guard] their Medicare number from Medicare fraud and identity theft.”

Click for CMS fact sheet