From MGMA 10/12/09

I arrived in Denver late Sunday afternoon. Fortunately, the snow from Saturday had all melted away.

I arrived at the convention center in time to hear Ezekiel Emanual, MD, PhD, the bioethics chair for the NIH and a senior advisor at the White House OMB on health policy. His talk focused on the need for the industry to move towards high-touch medicine, e.g., spending more time with patients, better care coordination, etc. Once we get the payment system figured out, the high-touch model will lead to lower costs. Not too much original stuff, but he was an engaging speaker.

I then hit the opening reception, which seemed pretty well attended (as happens most any time you provide free drinks). I was never quite sure what the theme was, but there were a couple women on tall stilts dressed as birch trees (I couldn’t get a shot without looking too conspicuous, darn it).

Monday morning I walked though about half the exhibit floors. Vendors said that Sunday was pretty slow, but busier today. Official total attendance, by the way, is about 4,500, including 2,150 paid attendees. MGMA says the numbers are down 21% from last year, which is similar to what other associations are seeing.

Thank you, Eclipsys, for being the first booth I saw displaying an HIStalk sponsorship sign! I did notice that SRSsoft also had the magnets available to hand out. I personally think they are a must-have souvenir, so stop by the booths of our sponsors to pick one up.

By far the busiest booth seems to be the MGMA bookshop. Who would have thunk?

NextGen has the same booth they had at HIMSS, which is this modern, almost spaceship-looking thing with cool lights. I’ll try to take a picture. GE has a very large space that looked a bit empty. The problem with a big space is that if it is not crowded, it really looks empty.  If you have a good location, maybe a small booth is not a bad thing. It’s a lot easier to look crowded and make others wonder what the buzz is all about.

Speaking of buzz, I haven’t heard much of any so far, although perhaps I did hear MGMA’s thoughts on what practices are doing as it relates to EHR/meaningful use/ARRA. MGMA thinks that perhaps 75% of its members do not have EHRs yet. Many are sitting on the sidelines waiting for more clarification on meaningful use.

I was surprised to learn that many practices really don’t understand how the whole stimulus funding process works. Seems to be some confusion that you have to buy an EHR out of pocket, install it, and then prove meaningful use, rather than simply apply for grant money up front.

And, even though you would expect the whole ARRA/EHR issue to be what the buzz is all about, at least at this conference, the RCM vendors are still getting their share of booth traffic.

More updates to come.

E-mail Inga.

Going to MGMA? Visit Our HIStalk and HIStalk Practice Sponsors

Allscripts
Booth 933
222 Merchandise Mart
Suite 2024
Chicago, IL 60654-1034
Phone:919.329.1070
www.allscripts.com
Allscripts uses innovation technology to bring health to healthcare. More than 160,000 physicians, 800 hospitals and nearly 8,000 post-acute and homecare organizations utilize Allscripts award-winning offerings like electronic health records and revenue cycle management solutions to improve the health of their patients and their bottom line.

Culbert Healthcare Solutions Inc
Booth 642
800 West Cummings Park
Suite 6000
Woburn, MA 01801
Phone:781.935.1002 ext. 13
www.culberthealth.com
Culbert Healthcare Solutions is a professional services firm serving healthcare organizations in the areas of operations management, revenue cycle, clinical transformation and information technology.  CHS Consultants act as trusted advisors to group practices and academic medical centers seeking to improve patient care, enhance the patient experience and drive financial performance. Stop by the booth to register to win an iPhone with a 1 year subscription!

eClinicalWorks LLC
Booth 2023
112 Turnpike Road
Suite 200
Westborough, MA 01581
Phone:508.836.2700
Fax:508.836.4466
www.eclinicalworks.com
eClinicalWorks® unified EMR/PM solution manages patient flow and streamlines processes for customers in all 50 states regardless of practice size, specialty and number of locations. Its products extend the use of electronic health records beyond practice walls with the latest technologies and create community-wide records.

Eclipsys Corporation
Booth 1739
Three Ravinia Drive
Atlanta, GA 30346
Phone:404-847-5000
www.eclipsys.com
Eclipsys is a leading provider of advanced integrated clinical, revenue cycle, and performance management software, clinical content and professional services that help healthcare organizations improve clinical, financial, operational and client satisfaction outcomes. Whether independent or hospital-owned, Eclipsys PeakPractice™ helps improve patient care with an integrated EMR/PM solution.

Greenway Medical Technologies
Booth 1233
121 Greenway Boulevard
Carrollton, GA 30117
Phone:770.836.3100
Fax:770.836.3200
www.greenwaymedical.com
Greenway Medical Technologies is a leading provider of single database electronic health record (EHR), practice management and interoperability solutions and on-demand services for physician practices and hospital community EHR strategies. Greenway’s 08 CCHIT Certified EHR solution, PrimeSuite® 2008, streamlines a practice’s clinical, financial and administrative processes.

Henry Schein
Booth 1725
135 Duryea Rd.
Melville, NY 11747
Phone:631.390.8000
www.henryschein.com
Henry Schein Medical is the largest distributor of healthcare products and services to office-based practitioners. We offer more than 90,000 brand and Henry Schein Brand items in stock. In addition we provide practice solutions from financing, EMR/PMR, to equipment leasing, repair and total office warranty coverage.

McKesson
Booth 717
5995 Windward Parkway
Alpharetta, GA 30005
Phone: 404.338.3807
Fax: 404-338-5121
www.mckesson.com
McKesson delivers solutions across all care settings; providing  physicians with more products, services, and resources than any other healthcare company – including practice management systems and EHR, billing and accounts receivable management and connectivity services, medical supplies and equipment, and pharmaceuticals.

MED3OOO
Booth 1249
680 Andersen Drive
Foster Plaza 10
Pittsburgh, PA 15220
Phone:412.937.8887
Fax:412.937.9221
www.MED3OOO.com
MED3OOO, experts in healthcare management and information technology, advances performance of group medical practices, clinics, and hospital-employed physicians with RCM and ASP PMIEHR systems. Stop by our booth for a demonstration of our InteGreat EHR the intuitive browser-based solution. Put your group ahead of the curve, and visit www.MED3OOO.com.

MedAptus
Booth 1107
176 Federal Street
4th Floor
Boston, MA 02110
Phone:617.896.4000
Fax:617.482.1110
www.medaptus.com
With the most powerful, yet easy-to-use, Intelligent Charge Capture technologies available, MedAptus enjoys enterprisewide adoption at many prestigious, academic healthcare organizations. Our full-scale Professional and Facility offerings increase revenue, re-engineer archaic processes, enhance EMR investments and save busy providers time.

NextGen Healthcare
Booth 1533
795 Horsham Road
Horsham, PA 19644
Phone:215.795.1050
www.nextgen.com
NextGen Healthcare is a leading provider of electronic health record (EHR) and enterprise practice management (EPM) systems, plus revenue cycle management services. With full connectivity solutions and a patient portal, NextGen products support over 25 medical specialties, making it ideal for the small or mid-size practices or the multi-provider enterprise.

Nuance
Booth 535
One Wayside Rd
Burlington, MA 01803
Phone:781.565.5000
www.nuance.com/healthcare
Nuance’s healthcare solutions optimize clinical workflow, reduce transcription expense, raise standards of care via more thorough documentation, deliver results rapidly, and heighten clinician satisfaction by making EHR systems easy to use. These solutions accelerate the adoption of clinical information systems, so provider organizations can maximize the return from IT investments.

PatientKeeper
Booth 907
275 Washington Street
2nd Floor
Newton, MA 02458
Phone:617.987.0300
www.patientkeeper.com
Only PatientKeeper is designed to support a physician throughout the entire day, across all settings of care—both inpatient and at the office. PatientKeeper’s applications allow physicians to access electronic medical records, clinical results, capture charges, write prescriptions, document encounters, and more—anywhere, from any device.

RelayHealth
Booth 2017
1145 Sanctuary Parkway
Suite 200
Alpharetta, GA 30004
Phone:510.637.7722
www.relayhealth.com
RelayHealth streamlines clinical, administrative and financial interactions between patients, physicians, hospitals, pharmacies and payors, helping them collaborate to improve the quality of care and reduce administrative costs. Visit the RelayHealth booth to learn more about utilizing Health Information Exchange, clinical and financial connectivity and pharmacy solutions to increase your revenue and productivity while reducing costs. Also, check out the session “Patient/Provider Connectivity: Leading the Transformation of Healthcare Delivery.” David K. Nace, MD, Chair of the McKesson Clinical Council, will discuss how the uninsured, higher co-pays and consumer-directed plans are changing the dynamics of the physician economic relationship. RelayHealth is the exclusive sponsor of the Conference Express (trolley that moves attendees in the Convention Center between sessions and the exhibit hall).

SRSsoft
Booth 1207
95 Chestnut Ridge Road
Montvale, NJ 07645
Phone:201.802.1300
Fax:201.802.1301
www.srssoft.com
SRS makes innovative, sophisticated digital technology practical for high-volume, practices. The award-winning SRS hybrid EMR offers powerful, flexible solutions to the complexities of clinical workflows, patient care, and practice operations. Stop by the booth to register for your chance to win $500 cash!

News 10/8/09

From Axing Al: “Re: MGMA and the Integrated Digital Physician Educational Pavilion. You’ll want to check out the Integrated Community EHR demonstration site in the exhibit hall. The AC Group is sponsoring it.”  The demonstration is to include two communities and total of six different physician practices using six different forms of clinical documentation, including CCHIT-certified EHRs, hybrids, and DRT-enabled documentation. I’ll definitely be stopping by.

From Evan Steele: “Re: trinkets and logos. I hope you will stop by the SRS booth and stock up on the SRS Nemo fish. This is a perennial favorite among conference attendees. Also, our booth graphics this year consists solely of a collage of 106 client logos on a 20-foot-wide by 8-foot-high display. We believe that no other vendor in the conference hall can confidently display this many happy client logos at their booth. Please stop by and take a look.” Thanks, Evan. One can never have too many Nemo fish.

Aprima Medical Software (originally iMedica) partners with Intelligent Medical Objects (IMO) to offer IMO’s medical code and terminology mappings, as well as its vocabulary products, to clients.

Blue Shield of California makes $29.6 million available for pay-for-performance bonuses. Medical groups and IPAs can qualify by demonstrating the performance of quality care using such measures as diabetes care, patient experience, managing ER visits, and deployment of IT.

Provider’s Choice Medical Billing, a billing service serving 170 physician offices, selects HealthFusion as its clearinghouse and claims provider.

Two-thirds of providers think that adopting new technologies will improve patient care. At least that is the opinion of IT companies serving healthcare providers. I suppose that IT companies do have conversations with clients to understand why they are adopting new IT, which gives the survey some validity. Over 80% of the providers using electronic records claim they added EMR to improve patient care, save time, and improve efficiencies.

CCHIT announces that vendors and developers can start applying for modular certification programs focused on meeting meaningful use requirements. The Preliminary ARRA 2011 program is limited to meaningful use standards spelled out in the ARRA legislation and will provide a certification label identifying which objectives the EHR technology supports. CCHIT is also launching its 2011 Certification program.

Routine use of electronic health records can improve the quality of preventive care and help manage chronic disease in primary care practices, according to a primary care study.

Microsoft enters the H1N1 scene (months after Google) and introduces a new Web site designed to help people assess their need for medical attention. The site is based on the triage procedure used at Emory University. I talked a sick friend through the short assessment and, based on her symptoms, we told informed she might be “very sick” and needed to call her doctor “now!” (Interestingly, she had chatted with the doctor’s nurse, who told her it sounded like H1N1 and the best thing for her was to stay home, drink fluids, and call back if symptoms got worse.) I suspect if the masses read enough messages like the one above, hospitals will be forced to invest in more tents to treat flu patients.

More details emerge about the laptop stolen from the car of a BCBS employee. Officials now say the laptop had a file that contained identifying information for every physician in the country that has a contract with a Blues-affiliated insurance plan. The names, addresses, tax IDs, and NPI numbers for about 850,000 doctors were compromised. Of those, about 187,000 use their Social Security number as their tax ID or NPI number. A BCBS official calls it “an unfortunate mistake.”

Physicians with Massachusetts General Hospital’s outpatient clinics are trying to reduce wait times using new active-tag RFID technology. Patients are asked to wear a wrist coil with a tag and clinicians click on the tags as patients move through the clinic. The process is more efficient that manual tracking and patients are compliant with the process when told it is helping doctors to find ways to spend time providing better care. I guess. But seems kind of big brother-ish, doesn’t it?

The use of smart phones by physicians is expected to increase from 64% today to 81% by 2012. A more “mature” and proficient physician audience will emerge and the Internet will become physicians’ primary professional resource. Look for physicians to use their smart phones for everything from administrative tasks to patient monitoring.

At this week’s Health 2.0 conference, various start-up companies showed off new technologies to change the way doctors and patients interact. For example, Hello Health is a service practices can use to communicate with patients. The company claims it can decrease the number of receptionists and nurses by half. VisionTree gives patients the ability to complete medical histories online, request prescription refills, and make appointments over the Web. RelayHealth offers doctors and patients the ability to communicate online and share health information. Physician can also write electronic prescriptions and share information with other doctors. AAFP advisor David Kibbe predicts that eventually providers will need a single platform that can all use, rather than a variety of different applications.

The Mafia is increasingly taking part in Medicare fraud because of the easy money and shorter prison terms relative to other crimes. Scammers focus on billing Medicare for medical equipment and drugs that patients never received or needed. Medicare fraud can net at least $25,000 a day while risking a relatively modest 10 years in prison if convicted on a single count. Much faster money than dealing cocaine, which carries the risk of life in prison. I see a TV series waiting to be made.

E-mail Inga.

News 10/6/09

Almost one in four providers are using e-prescribing, according a Surescripts report, which also predicts that its own user base of 74,000 will more than double by the end of 2009. Great growth, but three out of four providers apparently don’t find the 2% Medicare bonus enough incentive to make the switch.

Wondering about how adding an EMR will affect your staffing? As this AMA article points out, the effect on staffing is not clear cut.  Some practices are able to reduce staff after implementing an EMR; others add staff, especially if the EMR facilitates practice growth. An implementation expert from Sage suggests that the staffing outcome will vary depending on the practice’s goal for automating: if the goal is to reduce costs, the end result will look much different than if implementation is to improve quality of care or to change a practice’s branding.

The local paper recognizes Heart of Texas Community Health Center for its recent Davies Award of Excellence. My favorite line comes from the clinic’s medical director, who likely had to explain to lots of folks what the Davies is all about: “It’s kind of like winning an Emmy or something.” The health center won the Davies for its ability to demonstrate how technology improved patient care.

athenahealth signs an agreement to purchase AnodyneHealth Partners, a SaaS business intelligence provider. Anodyne will continue to market its BI solution as a standalone product. In addition, athenahealth plans to integrate the service into the athenaCollector platform. The merger agreement includes a cash payment of $22.3 million with the potential for additional consideration of $7.7 million, based on the achievement of certain business and financial milestones. Anodyne has traditionally served large and enterprise-size medical groups. I’m sure athenahealth would like to increase its profile in the large clinic world.

RCM provider ZirMed introduces a new denial management and decision support solution. ZirMed Analytics is designed to help providers with payer- and patient-related revenue issues.

Revenues from medical practices fell 1.9% in 2008, the first nationwide decline in years, according to an MGMA survey. Seems as if the overall reduction in overhead expenses (1.4%) was not enough to compensate for smaller patient volumes and rising patient bad debt (which grew 13% from 2006 to 2008). The findings are based on data from 33,000 providers.

I am heading out to Denver over the weekend to attend MGMA. Look for our Must-See Vendors guide later this week, plus daily coverage while I am there. In looking at the agenda, I was disappointed by the limited number of sessions dedicated to HIT (or maybe the names were so clever that I wasn’t clear on the topics). In any case, I am open to suggestions on sessions to attend. I will, of course, also be making the rounds on the exhibit floor, looking for souvenirs to lug home. Speaking of which, our HIStalk and HIStalk Practice sponsors should have some cool-looking magnets to hand out, so look for the sponsor signs. Dr. Gregg Alexander was our creative genius who designed the magnets, which are sure to be collector items one day.

Two companies that go by clever acronyms form an alliance to help providers with collection efforts before they become bad debt. Internet Payment Exchange (IPayX) provides electronic billing and payment technology and Accelerated Revenue Management (ARM) Solutions offers soft collection capabilities. ARM Solutions will be integrated into the IPayX eInvoice Delivery Service and eCareView Healthcare Billing Portal.

This doctor doesn’t mind using a computer: a former pediatrician is ordered to appear before North Carolina’s medical board, charged with failing to report his DWI arrest and for using the PC of a practice for which he was working to write pornographic stories.

Data on tens of thousands of physicians could be compromised when unencrypted information was stored on a personal laptop that was later stolen. The physician data included personal information, including Social Security numbers, but no patient data.

AHIP and BCBSA team up to create an online tool that gives providers the ability to check patient eligibility with eight major health insurers via a single Web portal. Two pilot projects are set to begin, one in Florida and the other in Ohio.

E-mail Inga.

An HIT Moment with … Brian Beutner

An HIT Moment with ... is a quick interview with someone we find interesting. Brian Beutner is CEO of mPay Gateway.

Are patients really happy about having to arrange payment before they leave the doctor’s office like they would a hotel or restaurant, especially since they don’t know how much will be charged on their credit card until the practice receives the remittance advice from their insurer?

The transparency that we help bring to the doctor-patient financial transaction is something that most patients appreciate. Since we are only collecting authorization at the time of service and because the amount ultimately charged against the patient’s credit card is never more than what is shown to the patient at the time they hand over their card, we find that most patients like it. They like the fact that there are no more unpleasant surprises and the simplicity of taking care of the payment up front, rather than having to wade through numerous statements from the doctor and comparing them to the multiple EOBs and other confusing insurance documents.

We also find that many patients take comfort in the certainty of knowing they will owe no more than the calculated amount. With mPay Gateway, they walk out of the doctor’s office with an itemized receipt and the confidence that they have taken care of their obligation and won’t be surprised later with a larger than expected bill.

I use my wife as an example. This winter, we took our daughter to an allergist. A month or two later, my wife said, “We got the bill from the allergist. It was only $89.” It didn’t hit me until later that evening the relief I heard in my wife’s voice. For the past month or two, she had been worrying about how much that trip to the allergist was going to cost. We had no idea whether it was going to be $100 or $1,000. If we had left the office knowing that the most the doctor was going to charge our credit card was $100, it would have avoided two months’ of needless worry.

The ultimate proof is in the use. When our clients show the patient the most that they will owe and ask for a payment card, more than 90 percent of the time, the patient will hand over a card and conclude the visit.

What are the requirements to use mPay Gateway, how is it implemented, what does it cost, and who does it compete with?

Starting to use mPay Gateway is simple. It works with any computer that has an Internet connection. We provide a cell phone-sized magnetic card swipe device that plugs into any USB port. Because all the financial data is resident on our Level 1 PCI DSS-certified servers, the information is secure.

Our implementation specialists work with our clients to quickly set up the patient payment calculator using the doctor’s own rates and discounts with health plans. With just a few hours of Web-based training for both the staff speaking with patients and the back office staff, the office can be up and running mPay Gateway’s solutions. Once implemented physicians offices can see their receivables drop by 50 percent or more in a matter of weeks.

We charge a monthly license fee to make the service available and cover all costs of getting started on the system. We pass through standard payment card processing charges from VISA and MasterCard, and add a small collection fee on incremental dollars collected through the system.

The biggest competition we see are old, outdated processes that are not very patient friendly. Standard payment processing technology does not handle the unique environment of health care, where the exact amount a patient may owe is not known at the time of service. However, physician practices recognize how difficult it is to collect from patients months after the insurance company settles, so they often use revenue cycle management solutions that leverage outdated technology, resulting in processes that are not very patient friendly.

Typically what we see, if anything, is a process where the practice calculates a patient estimate at the time of service, and then attempts to get the patient to pay on the spot. Not only does this typically frustrate the patient who knows that his or her insurer will pay all or part of the charges, but it creates a second reconciliation when the claim is adjudicated and the staff must reimburse the patient.

Instead, mPay Gateway developed a solution that uses modern software as a service technology to enable practices to resolve patient payments at the point of service, but doesn’t charge the patient until the claim is settled with the provider. The mPay Gateway system runs only one transaction, the right one, making it clear to the patient and easy for the staff.

What will payments to physicians look like in five years in terms of who pays and how?

I believe that we will continue to see cost shifting to the consumer, so that an increasing share of a physician’s revenue will come directly from patients. Much like what the insurers have done, we will see increased use of electronic payments. Five years ago, insurers were making most of their payments to providers by paper check in the mail — hundreds of millions of checks every year. Now much of the payments from insurers are sent electronically to physicians.

A service like mPay Gateway allows physicians to collect authorization from patients electronically at the point of service (rather than by paper check weeks later), much like how the rest of the economy works.

You used to work with high deductible health plans and health savings accounts. Are those going to be more or less important going forward?

I cannot predict what the next alphabet soup of plan design will be, but I am certain that we will continue to see more patient involvement in the financing of health care. The good news is that almost all health care transactions — especially those in the physician office — are for relatively small dollar amounts. Fortunately, the retail industry has long ago solved how to make the payments of small consumer transactions very efficient. mPay Gateway is building on that foundation to bring retail payment transaction efficiencies to health care. Without being dependent on any particular card or plan type, we add transparency and reduce the administrative inefficiencies in the health care payment systems of today.

How does the prospect of healthcare reform impact your business?

The current debate about health care reform is focused primarily on extending insurance coverage to the 47 million people who currently must make direct arrangements to pay for the care they seek. As we add more people to the insurance roles, the complexity increases. Our business is built upon helping physicians deal with insurers that stand between the patient and the physicians.

In general, practices can deal with those who do not have insurance by requiring payment up front. As more people without insurance coverage obtain third-party coverage, the burden on physician practices will increase. Currently physician practices write off as much as $30 billion in bad debt each year, mostly attributable to patients with insurance coverage. Since any plan to increase insurance coverage will require some degree of patient payment responsibility (like a deductible or co-insurance), this problem will only get worse.

We see health care reform as a great growth opportunity for us as we bring cost savings to physicians with a product specifically tailored to dealing with third-party insurers.