Executive Roundtable

We are actively looking for stops for The Risk Adjustment Road Show, aimed at helping clinicians, particularly MD's better understand the how's and why's of risk adjustment from a clinical decision-making and documentation perspective. Everywhere Dr. Ronnie Smith MD and his partner, Lisa McFann MSN go to provide education, coaching, and ongoing support their clients see their risk scores, star ratings, Revenue, and shared savings go UP!Call CW at 404-313-3330 and email at cw@executiveroundtable.co

The latest edition of the Medical Association of Georgia’s (MAG) ‘Top Docs Radio’ show addresses adverse childhood experiences (ACEs), early brain development, and how Resilient Georgia is helping young people contend with the long-term effects of toxic stress – and it features Brenda Fitzgerald, M.D., the executive chair of Resilient Georgia.

Risk-Adjusted ReimbursementPhysicians in the United States find themselves in a seismic paradigm shift from volume-basedreimbursement to value-based reimbursement. This is being driven by escalating health carecosts and an increasingly-sicker population. Pay-for- performance is consequently based onpatient 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 healthcare system.Physician reimbursement that is tied to patient risk scoring is here to stay, so it is imperative forphysicians to understand how patient risk scoring works because it will affect their income insignificant 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 farbetter chance of achieving their budget objectives. This, then, gives them the best opportunity toreceive 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 clinicalencounter.Retrieving, analyzing and understanding your Quality and Resource Use Reports (QRURs) forMedicare Part B.Getting informed and trained on risk adjustment methodology.Scheduling all of your attributed patients in your managed care plans, including Medicare PartB and Medicare Advantage plans, for an office visit at least once, and preferably twice, duringeach calendar year.Dr. Ronnie Smith is an internist with Vidalia Medical Associates. He has practiced medicine fornearly 40 years. He has a medical degree from the Medical College of Georgia. Dr. Smithgraduated from the Executive Medical Management Program at the Wharton School at theUniversity of Pennsylvania. He is an expert in outpatient and inpatient risk adjustment documentation and coding and reimbursement, and he is passionate about educating his fellowphysicians and their practice staff on how to master risk adjustment and simplify the transition tothe 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.

The latest edition of the Medical Association of Georgia’s (MAG) ‘Top Docs Radio’ show addresses adverse childhood experiences (ACEs) and “systemic empathy” – which is designed to integrate empathy into our health care experience/system to improve patient outcomes.

Transitional Year Graduate, Dr. Mohit Agarwal joined CW Hall to talk about challenges faced when managing homeless and housing insecure patients.

Ritesh Shah, Founder of the successful medical billing company, HealthTeq Services joined me to talk about how his company is able to provide a high level of personal service to medical practices and laboratories. He shared how he is able to "prove it" to large groups who are unhappy with their current billing solution (particularly when it's internal staff performing the billing functions) with a risk-free trial. If your practice or laboratory is unsatisfied with the rate and pace of collection with your existing billing service you should get to know Ritesh. Since starting in 2006 he has not lost a client due to dissatisfaction with his service and billing outcomes. On the web: www.healthteqservices.com