Archive for June, 2017

Medicaid Changes – Effective July 1 – Check Patient’s Insurance

Dear Providers:

 
Beginning July 1, 2017, the Georgia Families® program will provide Members a choice of four Care Management Organizations (CMOs): Amerigroup, CareSource, Peach State Health Plan, and WellCare. Georgia Families® Members were given the opportunity to select a CMO during the Open Enrollment process which took place during the month of March 2017. Some Members who did not make affirmative selections were auto-assigned to a CMO. During the choice change period of July 1, 2017 through September 30, 2017, all Members will have a one-time opportunity to change their assigned CMO without cause. The change will become effective on the first day of the month after the change is requested. In order to ensure a smooth transition and that all Members have access to care, each CMO has implemented Transition of Care processes which include the following:

Existing/Open Prior Authorizations:

 
If you are rendering services to a Member who has a newly assigned CMO effective July 1, 2017, the newly assigned CMO will honor any current/open Prior Authorizations for forty-five (45) days beginning on July 1, 2017 through August 14, 2017. This applies to in-network and out-of-network (non-par) Providers. Thus, if you are rendering services to a Member who has a newly-assigned CMO, and you are not contracted with the newly-assigned CMO, the newly-assigned CMO will honor any current/open Prior Authorizations for forty-five (45) days beginning on July I, 2017 through August 14, 2017. If the Member requires services beyond August 14, 2017, Providers must contact the Member’s new CMO to obtain authorization to continue services. Providers will be required to follow the new CMO’s prior authorization process for any continued services the Member needs.

New Requests for Prior Authorization (i.e., requests submitted on or after July 1, 2017):

Providers will be required to submit new requests for Prior Authorization based upon the applicable CMO’s guidelines. This applies to in-network and out-of-network (non-par) Providers. Prior authorization decisions for non-urgent services will be made within three (3) business days. Expedited service authorization decisions will be made within twenty-four (24) hours.

Pharmacy-Related Prior Authorizations:

Each CMO will honor prescriptions ordered/issued prior to July 1, 2017. All current prescriptions (including medication step therapy) will be transitioned and honored by the new CMO for a period of forty-five (45) days, beginning on July 1, 2017 and ending on August 14, 2017. This is part of the Transition of Care process. Claims Reimbursement for Office Visits and Sick Visits for Out-of-Network Providers (Non-Par)

Providers:

If you are rendering services to a Member who has a newly-assigned CMO effective July 1, 2017, and you are an out-of-network Provider, you may submit claims for reimbursement for office-based and sick visits rendered to Georgia Families® Members and Planning for Healthy Babies® enrollees without an authorization. Claims may be submitted to Amerigroup, CareSource, Peach State Health Plan, and WellCare by out-of-network Providers for services provided from July 1, 2017 through August 14, 2017. In all instances timely filing requirements must be met.

Please Note: Effective Friday, June 23, 2017, Providers will be able to submit CareSource PAs via the Centralized PA Portal. All PAs associated with the Centralized PA Portal will be processed for CareSource members beginning on July 1, 2017.

The following forms are currently associated with the Centralized PA Portal:
• Newborn Delivery Notification
• Pregnancy Notification
• Inpatient Hospital Admissions and Outpatient Procedures
• Hospital Outpatient Therapy
• Durable Medical Equipment
• Children ‘s Intervention Services
• Outpatient Behavioral Health

For any other CareSource PA submissions, please refer to https:/iwww.caresource.com/providers/georgia/, call 1-855-202-1058, or email gamedmgt@caresource.com.

Regards,

 

Department of Community Health

View Georgia Families® Frequently Asked Questions & Answers

Loy “Chip” Cowart, MD Named “Your Giving is Great Medicine” Capital Campaign Chair

 

The Georgia Healthy Family Alliance (GHFA) Board of Trustees is pleased announce that Loy “Chip” Cowart, III MD will serve as Chair of the “Your Giving is Great Medicine” five year capital campaign to expand the reach and funding of the Community Health Grant program and Tar Wars in communities where Georgia Academy of Family Physicians (GAFP) members live and serve.

 
With a challenge investment of $1,000,000 from the GA Academy, GHFA is seeking to raise an additional $3 million to sustain funding for essential healthcare initiatives like the 38 GAFP member sponsored community health grant projects that have been funded since 2012 for projects including obesity prevention, chronic disease management, women’s health screenings and more.

 
To date, the Alliance has awarded more than $163,000 to GAFP member sponsored community health projects. Last year, GHFA received more than 25 applications from members with available resources to fund just nine of the projects. Overall grant funding in 2016 had to be reduced to $3500 per applicant, as opposed to the $5,000 per applicant available in previous years.

 
The need and growing demand for these vital programs is real. The Kaiser Foundation ranks Georgia fifth in the nation in uninsured residents with 19 percent of the population – nearly 2 million Georgians- lacking health insurance. Charitable health initiatives supported by GHFA serve as essential providers of care to uninsured families and strengthen the state’s healthcare safety net by fostering collaborative partnerships.

 
Currently in its “quiet phase,” the five year “Your Giving is Great Medicine” capital campaign seeks to further the organizational capacity of the Alliance by securing funding from the health care community at large, foundations and businesses to increase the number of Community Health Grants and Tar Wars presentations in the years ahead.

 
More campaign details and information on how you can join us to expand the reach of these vital community health initiatives is forthcoming. We hope you will join us in our efforts to sustain the long term capacity of GHFA programs. GHFA staff will be reaching out to you in the coming weeks to share our progress and gain your support.

 
The time to prepare for the future is now. And, working together and investing together, GHFA can continue our work toward fulfilling our mission of ensuring healthy futures for thousands of underserved men women and children in Georgia.

 
Founded in 1987, the Georgia Healthy Family Alliance, formerly known as the Foundation of the Georgia Academy of Family Physicians (GAFP), is the philanthropic arm of the GAFP and a charitable public foundation recognized by the Internal Revenue Service as a 501(c)(3) tax-exempt organization.

The 2017 Summer Family Medicine Weekend Was a Beach Blast!

June 8-10, 2017 marked the GAFP’s 2017 Summer Family Medicine Weekend in Isle of Palms, SC.  This year we hosted more than 125 family physicians and other health care professionals at Wild Dunes Golf & Beach Resort.  We offered 35 CME credits to attendees and many opportunities to engage with our Industry Partners while also offering time to network with colleagues, and plenty of family fun activities.

With an expansive number of lectures, attendees were able to attain as much as 35 AAFP prescribed credits on a wide variety of topics pertinent to the broad range of practice needs of our members.  Several lectures included- Community-Acquired Bacterial Pneumonia: Is There Anything New, Burn Therapies & Pediatric Specialty Burn Care Management, Addressing HPV Vaccine Hesitancy and Myths, Treating IBS: Listen, Look, and Learn from Your Patients, Adult Inattention, and a Dementia update.

In addition to lectures and workshops, the GAFP offered three Self-Assessment Modules (KSAs) to attendees in an effort to fulfill the Maintenance of Certification, Part II – Self-Assessment and Lifelong Learning.  More than 35 attendees successfully completed the modules.

We also hosted an Alliant Quality Workshop – Designing and Implementing Your Improvement Activity to Satisfy the MIPS Requirement, which was facilitated by. Adrienne Mims MD, and included faculty from Alliant GMCF (the State’s QIO), and a representative from GA-HITEC.  The workshop was well received and participants noted that this was a great start to improving their clinical processes.

Attendees considered the meeting a success and offered the following comments on their post-meeting evaluations:

  • Excellent CME program. Thank you for having the KSA’s available!
  • Great location…
  • Great conference and topics! Thank you for your hard work and time to make it successful! Looking forward to October!
  • Overall great meeting. Sessions were interactive. Good breakfast, healthier options always a plus. Thank you for keeping coffee out the whole time. Thanks, GAFP staff, for putting on a great CME. You did it!
  • … Enjoyed all 4 presentations and the KSA on pain.
  • These have all been good and practical presentations.

The meeting’s success was based on the hard work, time, and effort of the Education Committee.  The 2017 Education Committee members are Theresa Jacobs, MD – Chair; Ken Howard, MD – Vice Chair; Karla Booker, MD; Mike Busman, MD; Clark Gillett, MD; Alice House, MD; Alison Lauber, MD; Yvonne Maduka, MD; Carl McCurdy, MD; Yuan-Xiang Meng, MD; Adrienne Mims, MD; Saida Omarova, MD; Harry Strothers, MD; Monique Merritt-Atkins, MD – resident; Blake Rudeseal – student.

Thank you to the Education Committee for all the hard work that went into making this meeting a success.

Mark your calendars now with the dates of the 2017 Annual Scientific Assembly!  This year’s Annual Meeting will be held Friday, October 27 – Sunday, October 29 at the Westin Buckhead in Atlanta, GA. We look forward to seeing you there!

Member Access to June Board Minutes and Leadership Decisions

In an effort to keep GAFP members more informed of Board decisions, members can now access the June Board minutes.
Even though major activities tend to be reported in our newsletter, members may keep track of leadership decisions and adherence to the GAFP mission and strategic plan by reviewing quarterly Board minutes via a simple request to staff. If you are interested in obtaining a copy of the GAFP Board minutes, please contact the staff by email at gafp@gafp.org. Only GAFP members have the privilege to review the GAFP’s Board of Director’s minutes.

Who Will Mentor the Next Generation of Family Doctors?

We all have had great teachers in our lives; one of mine lived and worked in rural southern Georgia. Dr. B. was a wise family physician who introduced me to his practice of medicine, which included a busy office and working in the hospital when his patients landed there. He taught me not only about medicine but also about his community. He knew more about his patients, I thought, than I would ever know about mine.
Today, as the associate dean of the Medical College of Georgia, I am constantly looking for preceptors who will engage with students, as well as with patients, and energize both to want to know more.

I’m not alone. The Society of Teachers of Family Medicine (STFM) held a summit last summer to address a shortage of high-quality family medicine community preceptors. According to STFM, nearly half of allopathic family medicine clerkship directors report difficulty finding clinical preceptor sites

Finding preceptors is especially tough in this era of transition from fee-for-service to quality metrics and value-based care. We physicians can feel at times that we are in service to our electronic health records and have only limited time for students. After all, teaching takes time, and time is money.

But if we don’t make time for students, where will that leave us? Who will be the next generation’s Dr. B.?

A 2015 survey of fourth-year medical students who were AAFP members revealed that 93 percent of respondents who matched into family medicine residency programs said strong family medicine mentors influenced their specialty choice. Conversely, of those who didn’t match in family medicine, only 60 percent said they had a strong mentor in the specialty.

Other factors play a role in student choice, but clearly, students are less likely to choose family medicine without strong mentoring and role modeling.

We know what’s at stake, but you still might be asking, “What’s in it for the practicing physician?”

Before taking my current position, I was in practice in a small community, and later became faculty with the family medicine residency program in my hometown. The experience was as rewarding for me as seeing patients. Students keep you on your toes, challenge you to stretch your knowledge base and compel you to stay up-to-date. I recall one young man from Germany, for example, who was doing a rotation in the States. I learned as much about health care in another country from him as he did about family medicine from me.

Today, it is my privilege to teach third-year medical students. At our campus, we connect students with patients and have them follow those patients during their third year. What we see are young people getting in touch with the real reason they went to medical school in the first place.

Students have stresses of their own — competition for residency positions and concerns about school loan debt, to name just a couple. It takes a special person to mentor or precept them. Students need to see the best among us, and we need them to see the joy of family medicine.

If you’ve lost that joy, having a student in your office might just help you rediscover it. I have seen this become a new mission in physicians’ lives — giving back to the profession and the field we love.

Think about it, we need to train the next generation of family physicians, family physicians who will one day take care of us. What better way to ensure our future health care than to have helped trained those who come along the path behind us?

Family medicine is about teaching. We teach our patients about the concerns they have about their health, and it naturally follows that we can teach students about our job on a day-to-day basis. But it also is about relationships. The relationship between physician and patient, between physician and community, between physician and student.

For me, family medicine is like visiting with friends every day. I know each patient personally. We talk about their health issues, but also about their families. Establishing those relationships is what makes it worthwhile. As a new physician, I soon came to realize I knew more about my patients than I ever thought I would, just like Dr. B.

Leonard Reeves, M.D., is a member of the AAFP Board of Directors.