Medical Association of Georgia Archives - Page 3 of 4

Top Docs Radio on Midtown Business RadioX Spotlights the Medical Association of Georgia – Business RadioX

December 17, 2015 by angishields

ATLANTA, GA–(Marketwired – December 17, 2015) – On November 16, 2015, Top Docs Radio welcomed to the studio Donald Palmisano with the Medical Association of Georgia (MAG) and Dr. John Rogers with Coliseum Northside Hospital. Host CW Hall led this month’s MAG special to talk about the challenges and concerns arising from recently-proposed mergers between large health insurance companies that will significantly reduce the amount of competition in the space for Georgians to choose.

Donald Palmisano is the CEO and Executive Director of MAG. The Medical Association of Georgia (MAG) is the leading advocate for physicians in the state. MAG focuses on legislative, legal and third party payer issues. Serving as the Co-Medical Director of Coliseum Northside Hospital, Dr. John Rogers is also a MAG delegate from Bibb County. The studio discussion focused on the fact that 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. According to Palmisano, “We believe 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.”

“Physicians have little-to-no leverage to negotiate contract terms with these multi-billion dollar conglomerates,” explained Dr. Rogers, “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.

To learn more about MAG’s position on healthcare mergers, listen to the entire interview onTop Docs Radio.

About Top Docs Radio:

Top Docs Radio is a forum for conversations with leading doctors and thought leaders. Discussions are about cutting edge trends and topics in health, wellness and lifestyle issues. Top Docs Radio is presented by Hyperbaric Physicians of Georgia and is hosted by Charles “CW” Hall. The program airs live every Thursday at Noon Eastern.

About Business RadioX®:

Business RadioX® interviews dozens of innovative entrepreneurs and successful leaders each week. Its mission is to help local businesses Get the Word Out about the important work they’re doing for their market, their community, and their profession. With a pro-business slant and a long-form interview format, guests don’t have to worry about being ambushed or talking in “sound bites.” Guests have enough time to tell their whole story and to share their insights and experience without interruptions. Business RadioX® hosts are business professionals interviewing their peers, drilling down on the critical issues, and delivering practical information to an engaged business audience. Business topics that are frequently covered include: Law, Finance, Healthcare, Technology, Trade Shows, B2B Marketing, Venture Capital, Training and Development and other issues impacting the business community. For more information, visit: https://businessradiox.com.

Insurance Reimbursement – Top Docs Radio

December 15, 2015 by angishields

Top Docs Radio

Insurance Reimbursement - Top Docs Radio

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John Oxendine PC — 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 – Top Docs Radio

November 16, 2015 by angishields

Top Docs Radio

Health Insurance Mergers - Top Docs Radio

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Medical Association of Georgia — Donald Palmisano Jr.

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.

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, 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

Dr. John Rogers, Co-Medical Director, Coliseum Northside Hospital

Member, Board of Directors, Bibb County Medical Society
Vice President, American College of Emergency Physicians
Doctor of Medicine, University of Iowa Carver College of Medicine
Residency, Medical Center of Central Georgia

Telemedicine – Top Docs Radio

October 16, 2015 by angishields

Top Docs Radio

Telemedicine - Top Docs Radio

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Telemedicine

We sat down with legal expert on healthcare matters, attorney, Sidney Welch, of the Polsinelli law firm on our monthly episode with Medical Association of Georgia. What is it? How is it utilized? And, what are the licensing, regulatory, and legal concerns around it?

Georgia Composite Medical Board (GCMB) has stressed that it is essential for telemedicine patients in the state to receive the same high standard of care they would in a traditional office setting. GCMB adopted a number of telemedicine rules in 2014 that “allow the Composite Board to take disciplinary action against licensed physicians and allied health professionals who practice telemedicine if they do not provide the minimum standard of care.”

Georgia’s rules require physicians and other allied health care professionals who deliver care by way of telemedicine to…

Be the ones who provide all of the treatment and/or consultations via telehealth.
Have access to the patient’s medical history if they are providing the services.
Have personally seen and examined the patient if they are referring the patient to a telehealth provider.
Maintain records on the patient’s evaluation and treatment if they are providing a service via telehealth and to provide a copy of those records to the referring physician.
Provide telehealth services only within their specialty.
Give their name, credentials and emergency contact information to the patient when they provide a telehealth treatment or consultation.
Provide the patient with “clear, appropriate, accurate instructions” on follow-up care.

Controlled substances for pain or chronic pain treatment cannot be prescribed through telehealth – but a physician or a nurse practitioner or a physician assistant can order appropriate labs or other diagnostic tests.

The physician who provides the care via telemedicine must make a “diligent” effort to ensure that the patient is seen and examined in person at least once a year by a Georgia-licensed physician or other appropriate health care professional.

Special Guest:

Sidney Welch, JD, of Polsinelli

ICD-10 – Top Docs Radio

September 10, 2015 by angishields

Top Docs Radio

ICD-10 - Top Docs Radio

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ICD-10

This week I continued my monthly series featuring experts from Medical Association of Georgia. Our conversation focused on the upcoming implementation of ICD-10 codes, which will significantly change how we document and are reimbursed for care provided to our patients.

I sat down with Dr. James Dunnick, a former practicing cardiologist of over 25 years who began to enhance his level of understanding of coding, compliance, and quality review later in his career. He now provides consulting services to healthcare practices and hospitals on these important components of their businesses.

Within the healthcare industry, providers, coders, IT professionals, insurance carriers, government agencies, and others use ICD codes to properly note diseases on health records, track epidemiological trends and assist in medical reimbursement decisions.

The World Health Organization (WHO) owns, develops, and publishes ICD codes, and national governments and other regulating bodies adopt the system.

The differences between ICD-9 and ICD-10 are significant and physicians and practice management staff need to start educating themselves now about this major change so that they will be able to meet the ICD-10 compliance deadline of October 1 – in less than one month.

ICD-10-CM codes are the ones designated for use in documenting diagnoses. They are 3-7 characters in length and total 68,000, while ICD-9-CM diagnosis codes are 3-5 digits in length and number over 14,000. The ICD-10-PCS are the procedure codes and they are alphanumeric, 7 characters in length, and total approximately 87,000, while ICD-9-CM procedure codes are only 3-4 numbers in length and total approximately 4,000 codes. ICD-10-PCS is only used for coding hospital inpatient procedures. CPT remains the code set for reporting procedures and services in offices and outpatient settings.

Moving to ICD-10 is expected to impact all physicians. Due to the increased number of codes, the change in the number of characters per code, and increased code specificity, this transition will require significant planning, training, software/system upgrades/replacements, as well as other necessary investments.

WHO is expected to release ICD-11 in 2017.

Special Guest:

Dr. James Kennedy, MD, of

The World Health Organization (WHO) owns, develops, and publishes ICD codes, and national governments and other regulating bodies adopt the system.

WHO is expected to release ICD-11 in 2017.

Special Guest:

Dr. James Dunnick, MD, of SESEDN, LLC and The Dunnick Group, LLC

Board Certified Cardiologist with 25 years of clinical practice
Certified Professional Coder (CPC) through the American Academy of Professional Coders (AAPC)
Certified in Quality and Utilization (CHCQM) by the American Board of Quality Assurance, Utilization Review Physicians (ABQAURP)
Certified in Compliance (CMDP) by the American Institute of Healthcare

Medical Malpractice Lawsuits – Top Docs Radio

August 15, 2015 by angishields

Top Docs Radio

Medical Malpractice Lawsuits - Top Docs Radio

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Medical Malpractice Lawsuits

The phrase medical malpractice causes most people’s pulse to quicken. For a physician being named in a medical malpractice case is one of the worst events in their life. This week we discussed medical malpractice in Georgia and how physicians can avoid it.

For the past 23 years, Dan has specialized in representing physicians and hospitals in medical malpractice lawsuits. As one of the founding partners in the Atlanta law firm of Huff, Powell & Bailey, LLC, he has represented defendants in more than 90 jury trials.

Dan has defended and successfully tried cases for every specialty of medicine and numerous hospitals throughout Georgia. His trial record would be a proud career for any defense lawyer and is remarkable because Dan has tried and won this many cases before turning 50. Many of those cases have been against the best plaintiffs’ attorneys in the state. Dan is also a regular contributor to MAG’s quarterly Journal.

Huff shared what malpractice is, and why he chose this area of focus for his legal career. He offered some advice on how healthcare practitioners can avoid a malpractice lawsuit. We discussed his professional advice for how to handle conversations with patient and/or family after a sentinel event has occurred. And we talked about how health professionals need to handle patient records and what to do if served with a lawsuit.

Dan explained how defendants in a suit should behave during the proceedings of the case to reduce the likelihood a jury will rule against them.

Special Guest:

Dan Huff, JD, and co-founder, Huff, Powell, and Bailey

GA SB 158 – Top Docs Radio

July 18, 2015 by angishields

Top Docs Radio

GA SB 158 - Top Docs Radio

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GA SB 158

This week we continue our monthly series with Medical Association of Georgia. I hosted MAG CEO/Executive Director, Donald J. Palmisano, Jr., and Cindy Zeldin, Executive Director for Georgians for a Healthy Future. We talked about the challenges Georgians face regarding the lack of information available to them about how inclusive health plans are regarding what physicians, hospitals, etc., are included in the plans.

Donald talked about how on the healthcare exchanges, patients must review every plan one at a time, checking the physician directories for each one to see if the physician(s) they need are there. In many cases, this means going through as many as 30-80 unique plans.

This is complicated by the fact that in many cases, the listed physician directories are incorrect, or change frequently, leading patients to make their choices based on outdated/inaccurate information.

In the Georgia legislature, the senate is considering SB 158, aimed at addressing the issue of transparency in the health insurance space so patients and physicians can make sense out of this important part of how we access healthcare today.

Cindy joined Donald to talk about how Georgians for a Healthy Future has been advocating on behalf of the state’s citizens to help them get signed up for the newly-available health plans on the exchange. She shared how last year, over 500,000 people gained access to new health plans.

We discussed the need for these patients to get educated about how to

Special Guestsplan for the financial obligations they will face regarding co-pays, co-insurance, deductibles, etc. Folks need to learn what each of these are and have a plan for how to handle them. One such strategy is having a health savings account, which allows them to pay for their healthcare costs with pre-tax dollars out of an account that will grow over time.

We also talked about how important it is for physicians and citizens to engage with their state legislators to talk about how these issues affect them in their daily lives. SB 158 is still in the early stages, with decisions being made on it coming next spring.

Special Guests:

Donald Palmisano, CEO, Executive Director of 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

Cindy Zeldin, Executive Director, Georgians for a Healthy Future

Master of Arts, Public Policy with focus on Women’s Studies, The George Washington University
Master of Public Health, Public Policy, Emory University
Previous Principal Management Analyst, Healthcare Div., Dept. of Audits, State of Georgia
Former Senior Program Associate, Health Policy Program, New America Foundation

Physicians Institute for Excellence in Medicine – Top Docs Radio

June 11, 2015 by angishields

Top Docs Radio

Physicians Institute for Excellence in Medicine - Top Docs Radio

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Physicians Institute for Excellence in Medicine

This week I sat down with Bob Addleman, EVP of the Physicians’ Institute for Excellence in Medicine. We talked about how the organization, a subsidiary of Medical Association of Georgia, got its genesis. Bob shared how his passion for process improvement and healthcare ultimately led to him suggesting the development of an organization focused on improving the work environment as well as patient safety/outcomes.

The Physicians’ Institute for Excellence in Medicine (a nonprofit subsidiary of the Medical Association of Georgia) is a national leader in developing and managing collaborative educational projects, with a focus on outcomes-based and performance improvement activities. To date, the Physicians’ Institute has developed and managed 31 distinct initiatives representing work with over 400 organizations and more than 8000 participants located in 25 states focusing on an array of clinical areas. The Physicians’ Institute also provides leadership training and Patient-Centered Medical Home consulting to healthcare providers and organizations.

Physicians’ Institute is working with Georgia Academy of Family Physicians’ “Patient-Centered Medical Home University” (PCMHU). Now in fourth year, PCMHU has assisted more than 40 Georgia primary care practices achieve recognition from the National Council for Quality Assurance as a patient-centered medical home. Addleton is lead faculty member and practice advisor.

In June, Physicians’ Institute plans to launch new service called “Leadership in Practice,” which will provide leadership training and team development activities to medical associations, health systems, and physician organizations. Model has been adopted by thousands of organizations internationally and has over a 20-year history of application and research behind its design. Gives participants 360 degree feedback about their leadership behaviors. Addleton is a certified administrator and coach.

Physicians’ Institute is known for its collaborative grants system. For example, it awarded $1.2 million in grants to primary care organizations in five states for an ambitious project that is aimed at improving the care of patients experiencing chronic pain. Final report will be available in near future.

Physicians’ Institute has also been national leader in the FDA-mandated effort to promote Risk Evaluation and Mitigation Strategies (REMS) education for extended-release and long acting opioids as a member of CO*RE (Collaboration for REMS Education). Has worked with 15 state medical societies, including MAG, through a grant that was awarded to the MAG Foundation. To date, more than 3,000 physicians have participated in these efforts.

Addleton is the vice president (and president-elect) of the leading international organization is this field – the Alliance for Continuing Education in the Health Professions (ACEHP). He will become ACEHP’s president in January 2016.

Special Guest:

Bob Addleton, EVP, Physicians’ Institute for Excellence in Medicine

Doctorate in Educational Leadership, University of Alabama
Certified in Continuing Professional Development
Fellow and President-Elect, of the Alliance for Continuing Education in the Health Professions
Certified as a Quality Team Facilitator, Six Sigma Green Belt, and Lean Green Belt
Faculty Member, Georgia Academy of Family Physicians’ “Patient Centered Medical Home University”, and is the Dean of the Georgia Physicians Leadership Academy.

MAG 2015 Legislative Update – Top Docs Radio

May 13, 2015 by angishields

Top Docs Radio

MAG 2015 Legislative Update - Top Docs Radio

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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

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

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

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