At TaraCare DPC, our patients value having a doctor who truly takes the time to understand their health challenges—spending more time with them than is typical in traditional clinics. We focus on keeping you healthy while saving you time and money by working around your schedule and removing the guesswork created by unnecessary healthcare overhead. Our transparent, membership-based pricing is designed to simplify your healthcare experience, offering an affordable all-inclusive access to personalized primary care with no surprise bills.
Lou Samara | Rise Above Health Coaching, LLC
74 % of the Adults in the USA are overweight. Over 80% have tried diets and regained all or more of their lost weight within 18 months. 71% of all US Adults rated their health as good or excellent! There is a disconnect… If they follow the HealthPointe Program anyone can lose weight and improve their health for long term wellness.
Kimberly J. Rask, M.D., PhD is the chief data officer at Alliant Health Solutions, which is a nonprofit companythat supports quality improvement in public sector health care programs under Medicare, Medicaid and End-Stage Renal Disease (ESRD) Networks across the Southeastern U.S. Dr. Rask is a primary care physician andhealth economist.
She also holds joint appointments in health policy and management and medicine at EmoryUniversity. Dr. Rask has published book chapters and peer-reviewed articles on primary care practice, quality improvement, and outcomes measurement. With more than 20 years of experience in quality research and practice, she also serves on national expert panels on value-based purchasing programs and quality measurement.
The Value-based Payment Modifier (VM) is a relatively new pay-for- performance program that is being used by CMS to pay physicians in part based on how their quality and cost compare to other physicians. It is similar to other pay-for- performance initiatives for hospitals, nursing homes, and home health agencies – and it is part of a larger effort by public and private payers to control health care costs.
Although the VM started as part of the Affordable Care Act (ACA), more recent federal legislation has expanded its reach. Medicare uses the VM program to adjust physician pay based on quality and cost measures, which vary by specialty. The reimbursement rates for 2016 are based on 2014 Physician Quality Reporting System (PQRS) data.
There are more than 250 quality metrics. Eligible providers are required to select a number of metrics –typically nine – to report. Failure to report PQRS measures can result in a penalty that is applied to all Medicare payments for the entire year. The program is revenue-neutral, so physicians who score well receive higher payments while physicians who have relatively lower scores receive lower payments.
In 2016, only medical groups with 10 or more eligible professionals will be subject to the program. In 2016, all eligible groups could receive a bonus – but only groups with 100 or more eligible professionals face a penalty in 2016. By 2017, the program is scheduled to apply to all Medicare physicians. Of the nearly 14,000 physician groups that will subject to the VM program in 2016, less than one percent – only 128 groups that include about 4,300 physicians – will receive Medicare bonuses of either 16 or 32 percent; the higher increase will go to the practices with the most high-risk patients.
Meanwhile, more than 5,400 groups that include more than 130,000 physicians will see a two percent pay cut for failing to submit their data. And nearly 60 groups that include more than 10,000 physicians will see a pay cut of one percent or two percent because their quality measures were too low. Under the MACRA legislation that passed in 2015 that permanently replaced the Medicare sustainable growth rate (SGR) formula, the VM will become one component of a new consolidated performance score. There will be two payment options for physicians.
Physicians who participate in Alternative Payment Models (e.g., some types of ACOs) will be eligible for an automatic five percent incentive payment every year. Physicians who are not participating in an APM will receive incentives or be subjected to penalties of up to nine percent based on how they perform relative to other physicians on PQRS measures, their use of EHR, quality improvement efforts, and the cost of care for their patients. Since this “new” payment program is similar to the existing VM program, preparing physician practices for success with today’s VM will position practices for success in the future.
There are several programs that available to assist physician practices with accurate quality reporting and quality improvement, which includes Alliant Quality (www.alliantquality.org) in Georgia.
Jay Shaffer and I sat down with Maribeth Gandy, Principal Research Scientist, and Director of Georgia Tech Wearable Computing Center. We talked about research the university is conducting in conjunction with ShareCare to look at how wearable and mobile technology can impact stress levels for individuals using these devices.
Check back soon for more information!
Special Guest:
Maribeth Gandy Coleman, Principal Research Scientist/Director, Georgia Tech Wearable Computing Center
This week I featured a long-time friend of the show, Dr. Ellie Campbell, of Campbell Family Medicine, located in Cumming, GA. We talked about a topic I am hopeful many of our followers will both listen to and share: Pre-diabetes.
How many times have you gone for your annual check-up and been told, “Your labs are normal,” when your fasting blood glucose is >80mg/dl? Those “normal” results could actually be a red flag that you have Pre-diabetes.
During this phase it’s actually possible to reverse the condition through diet and exercise. But, as Ellie described, many physicians haven’t yet been educated that they need to be concerned with glucose levels that don’t exceed “normal” limits. This means that we, as patients, need to be advocates for ourselves and our loved ones.
It is well-known that diabetes leads to a range of chronic and often, deadly, diseases such as heart disease, kidney disease, blindness, stroke, and more. While we also know it is often challenging to make life-style changes, when you are aware of the risks, it can become more easy to do so.
I am pleased Ellie sat down with us to talk about pre-diabetes, a problem many people can actually do something about if they’re willing to make some of the simple changes she recommends.
Cholesterol Isn't The Bad Guy In Heart Disease - Top Docs Radio
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Cholesterol Isn’t The Bad Guy In Heart Disease
I recently read an article by a former heart surgeon that talked about the fact that cholesterol isn’t the bad guy in heart disease. Instead, he argued that inflammation of the lining of the blood vessels caused by sugars and even the “healthy” oils we eat such as corn, canola (Omega-6 oils) is the real cause of what is still the #1 cause of death in America today.
I sat down with Dr. Ellie Campbell of Campbell Family Medicine in Cumming, GA to talk about the article and she was eager to discuss it. She completely agrees with the premise of the article and shared how the ratio of Omega-3 oils to Omega-6 oils has grown from ~1:1 or 1:2 to as much as 25:1 Omega-6 to Omega-3.
She also talked about the fact that higher levels of cholesterol in the blood don’t necessarily equate to plaque and heart disease/stroke. It’s when cholesterol molecules are oxidized and corrupted by inflammatory substances we eat that they become “sticky” and attach to the irritated walls of the blood vessels.
Dr. Campbell shared numerous suggestions for basic changes we can make that will not only serve to reduce our risk for heart disease but in some cases can actually reverse damage already done.
I also brought back Leana Kart, a chiropractor whose practice, Northwest Chiropractic and a member of the Georgia Chiropractic Association to talk about the fact that May is National Posture Awareness Month. She shared several tips on how to avoid “tech neck”, damage to the spine and neck caused by long periods of chin-down angles to look at a device in our lap. She also talked about why good posture contributes to keeping us healthy.