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Physicians

Medical providers upset over health plan collections

Despite recent changes to ease employees’ concerns, the State Health Benefit Plan can’t seem to escape controversy.

Medical groups told GHN this week that they’re upset about having to collect money from state employees and teachers – payments that are linked to a benefits shift earlier this year.

These provider organizations say they’re being told by Blue Cross and Blue Shield of Georgia, the main insurer for the SHBP, that they must recoup money from patients in the wake of a change to a co-pay system that became effective in March.

Tyler Riddle

Tyler Riddle

“Providers are being told by Blue Cross that we have to remit this payment,’’ said Tyler Riddle of Albany-based MRS Homecare, a medical equipment company. “Then we have to recoup from the patient.’’

Under that scenario, Riddle said, “We’re expected to be the ‘bad guy.’’’

The largest physicians organization in the state, the Medical Association of Georgia, said Tuesday that it “believes that this recoupment effort represents an unreasonable financial and administrative hardship for medical practices.”

The State Health Benefit Plan covers 650,000 state employees, teachers, other school personnel, retirees and dependents. With those numbers, the plan’s members can be a strong political force in an election year such as this one. full story

Know what they say about Piedmont doctors?

Dr. J. Thomas Taylor’s patient rating is 4.8 on a scale of 1 to 5 — with 5 being the best score. Comments from the internist’s patients include these:

“The best primary care doctor in the world.”

Dr. Thomas Taylor

Dr. J. Thomas Taylor

“Really cares about his patients.”

“Very friendly and upbeat.”

One of the comments is not so complimentary: “Maybe I should attribute his mood to the fact that it was Monday morning and they were off to a late start … but Dr. Taylor was very unfriendly …”

Consumers can now go online and find such feedback on more than 200 Piedmont Healthcare physicians, along with an overall rating score for each.

The Atlanta-based health care system is among the first in the nation to publish the patient satisfaction ratings and reviews of its doctors. The reviews are available for the first time this week on its piedmont.org website. full story

‘Medical homes’ appeal to many doctors, patients

Ronald Whitten, a licensed clinical social worker, is excited about the idea of being a patient in a “medical home.’’

A medical home, in this context, is not a residential institution. It’s a physician practice that aims to provide more comprehensive, patient-friendly treatment while also curbing health costs.

Dr. Jennifer Zreloff

Dr. Jennifer Zreloff

Whitten, 70, a retired Emory faculty member who’s on Medicare, is convinced of the medical home’s benefits. He’s a patient of Dr. Jennifer Zreloff, an Emory Clinic internist.

Care for Whitten’s chronic conditions are coordinated under one medical practice, so he doesn’t have to visit several clinicians. Zreloff’s practice also offers the services of a nutritionist and a psychologist. Patients can communicate with a physician via email.

The concept of a patient-centered medical home — which combines the modern-day advantages of computerized medical data with the old-time convenience of having a familiar doctor — is catching on across the country. More primary care practices have started to provide team care, and almost 7,000 have already been recognized by the National Committee for Quality Assurance as patient-centered medical homes.

In Georgia, health insurers such as Aetna, Blue Cross, Kaiser Permanente and WellCare have launched medical home-style programs. Many seniors and adults under 65 appear to prefer this style of medicine.

Nationally, a recently released survey of adults 65 and older found that medical home services are still relatively uncommon, with just 27 percent reporting receiving this care. Yet 83 percent of those getting this team-based care say it has improved their health. And among those not getting these services, 73 percent would want this type of care, the survey of 1,000 older adults sponsored by the John A. Hartford Foundation. full story

Sullivan discusses health museum, ACA expansion

The Atlanta-based National Health Museum is still in its early stages, but fund raising is expected to ramp up this year, says Dr. Louis W. Sullivan, the organization’s chairman.

The former U.S. health and human services secretary told health journalists gathering in Denver on Thursday that the central goals of the museum are to improve the health literacy of Americans and promote healthy behavior.

Dr. Louis Sullivan's new autobiography

Dr. Louis Sullivan’s new autobiography

As designed, the museum will have a global online network and digital information hub called the Cyber Museum, and a visitor center at Atlanta’s Centennial Olympic Park called the Experience Museum.

The latter is expected to offer a series of self-guided journeys focused on life, health and the human body.

Sullivan is a founder and was a longtime president of Morehouse School of Medicine in Atlanta. As a featured speaker at the Association of Health Care Journalists conference in Denver, he discussed his days as HHS secretary under President George H.W. Bush.

Sullivan criticized Georgia Gov. Nathan Deal and other governors who have decided not to expand Medicaid under the Affordable Care Act, calling it “the wrong decision.’’ full story

Long-delayed doc pay hike finally arriving

The physician pay hike for Medicaid services is finally beginning to reach Georgia doctors, more than a year after it was intended to take effect.

The three managed care organizations serving the majority of Medicaid beneficiaries are sending the extra payments to physicians starting this month, according to a schedule released by the Department of Community Health.

The pay hike was required under the Affordable Care Act, with the goal of paying family physicians, pediatricians and internists the same for Medicaid services as they get under Medicare. full story

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