Transcript physician-led - Georgia Medical Group Management Association

Update from the Medical Association of Georgia
Fall Forum
MGMA-Georgia
November 11, 2016
Building a Better State of Health Since 1849
2016 MAG Advocacy Highlights
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MAG has been a leader in opposing the “mega health insurer mergers.” On July 21, the U.S Department of Justice and multiple state attorney generals –
including Georgia’s Sam Olens – filed a lawsuit to block the mergers. More than 600 individual physicians made phone calls and sent emails to the
Georgia Insurance Commission to explain why these deals would have such disastrous results both physicians and patients.
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Key bills that passed during the state legislative session in 2016 included S.B. 158, a health insurance rental networks bill that will result in greater
insurer disclosure and transparency and which will ensure that physicians get paid their contracted rate in the event their network is leased; S.B. 302,
which will require health insurers to maintain more accurate provider directories; and, H.B. 900, which enhanced the state’s prescription drug monitoring
program.
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More than 40 physicians and 40 lawmakers attended the Physicians’ Day at the Capitol event in January, while 50 physicians and 25 legislators
addressed key issues like out-of-network billing, Georgia’s uninsured patient population, and the pending mergers at MAG’s Legislative Seminar in
July.
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MAG served on a Georgia Chamber of Commerce work group that developed three options for expanding health insurance for the uninsured in the state.
These plans would all result in a cost savings compared to the traditional approach to Medicaid expansion while still enabling the state to draw down its
federal funds.
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MAG helped more than 300 practices resolve payment problems with health insurance companies in the last year – resulting in millions of dollars of
savings.
Building a Better State of Health Since 1849
2017 Legislative Priorities
Out-of-Network Billing and Network Adequacy
The Medical Association of Georgia will support reforms that require appropriate network adequacy standards for insurers. We will advocate for transparency for insurers
entering into contracts with physicians’ practices and support legislation that will result in physician payment methodologies that are adequate and sustainable for out-ofnetwork emergency care.
Medicaid Payment Parity
The Medical Association of Georgia will advocate for the General Assembly to continue funding for the Medicaid Parity Payment Program. We will advocate that the
legislature continue to fund all areas of primary care.
Maintenance of Certification (MOC)
The Medical Association of Georgia will work to ensure that Maintenance of Certification is not a condition for licensure or hospital privileges. We will support efforts to
alleviate the costly and burdensome aspects of MOC for physicians.
Patient Safety Options
The Medical Association of Georgia will advocate for measures that improve patient safety.
Covering the Uninsured
The Medical Association of Georgia will work with the legislature and state regulators on solutions for Georgia citizens who currently fall in the insurance coverage gap.
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Total MAG Membership
1996-2015
7835
7676
7619
7500
7422
6929
7053
6990
6724
6599
6500
6703
6663
6525
6523
6508
6447
6288
6216
6156
5924
5819
5500
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
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2010
2011
2012
2013
2014
2015
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Campaign - promoting drug abuse prevention.
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timely information on relevant issues.
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Health Literacy
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Why Manners Matter
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HealtheParadigm
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Medicare Merit-based Incentive
Payment System (MIPS)
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Practice Transformation
Network Resources
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Medicare Value-Based Pay
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Chronic Disease Strategies
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Transition to MIPS
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The Compass PTN, established by the Iowa Healthcare Collaborative, supports physicians and clinicians across six states in Georgia, Iowa, Kansas,
Nebraska, Oklahoma and South Dakota. Quality advisors work with physicians and clinicians to achieve the five phases of transformation to prepare for
the 2019 alternative payment models while improving and sustaining quality care practices:
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Improved health outcomes for patients;
Improved care coordination through connectivity;
Better engaged patients and families in their care;
Improved patient, clinician and staff satisfaction; and
Reduced overall cost of care
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connecting, analyzing, engaging and transforming.
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Meet HealtheParadigm
A physician-led electronic network that connects health care providers to improve health care quality, safety, care
coordination and efficiency.
A physician-led secure interoperable electronic system for real-time sharing of actionable clinical information among
health care professionals.
A physician-led clinical data repository to support health care professionals in value based payment models.
A physician-led suite of tools and services to deliver metrics required by payers to maximize reimbursement.
Fact
50% of polled non-pediatric physicians have never heard of MACRA.
Source: 2016 MACRA survey by Deloitte
Timeline
Consider : MIPS Potential Impact on
$250,000 Annual Medicare Reimbursement
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