News 7/7/11

National Coordinator Farzad Mostashari MD concurs with the HIT Policy Committee’s recommendation to push back the start of Stage 2 Meaningful Use by one year. Reason: the rule includes a January 1, 2013 start date for Stage 2, but the Stage 2 requirements won’t be finalized for another year, leaving EPs, hospitals, and vendors insufficient time to prepare.

Symantec and Allscripts partner to offer an online privacy and risk assessment tool that allows practices to identify potential gaps for complying with HIPAA rules and HITECH. The application can be deployed with any EHR and not just Allscripts products.

No surprise here: a study of HIT implementations in small practices concludes that not early all adopters believe the investment was worth the time and money. The biggest problems cited by providers include technical difficulties, lack of training offered, lost productivity, and the inability to get systems to talk to other EHRs.

Primaris, Missouri’s Medicare QIO, collaborates with e-MDs to provide free assistance to e-MD users interested in earning PQRS incentives for 2011 and 2012.

Premier Purchasing Partners awards SuccessEHS a 36-month contract to offer its group purchasing members special pricing on its EHR, PM, and billing services.

OptumInsight partners with RemitDATA to offer the Web-based Remit Advice Professional service, which gives practices access to analytics of remittance notices from health plans, along with coding and reference tools. OptumInsight (formerly Ingenix) is part of United Healthcare’s Optum business unit, which just named Larry C. Renfro its new CEO. Outgoing CEO G. MIke Mikan is leaving to head up a private equity fund.

CMS issues its proposed fiscal 2012 Medicare payment rule, which includes a 29.5% pay cut for physicians. The drop in reimbursement reflects the current SGR formula, which CMS administrator Donald Berwick, MD says must be fixed to avoid “serious consequences.” The proposed rule also expands CMS’s misvalued code initiative to update codes that over- or under-paying providers. If CMS’s proposed changes to telehealth services are approved, telehealth access and the types of eligible services could be expanded:  the proposed rule places more emphasis on telehealth’s clinical benefits, rather than requiring a telehealth visit to provide all the same exam elements as an in-person visit.

AHRQ and the University of Wisconsin-Madison’s Center for Quality and Productivity Improvement develop a toolkit to help practices in workflow analysis and redesign before, during, and after HIT implementation. There seem to be a good number of toolkit options available, ranging from benchmarking, checklists, and flowcharts, to interviewing, risk assessments, and usability evaluations.

EHR and PM company ACOM Health buys billing service provider Contract Medical Billing. The service will be rebranded as ACOM Medical Billing.

Aria Health (PA) selects Allscripts Community Record to enable data sharing between the Allscripts Ambulatory EHR used by its employed physicians and Allscripts Sunrise used by its hospitals. The community record technology is powered by dbMotion and will also tie in other regional providers who use non-Allscripts EHRs.

E-mail Inga.

News 7/5/11

The top struggle for medical practice managers: preparing for reimbursement models that place a greater share of financial risk on practices. Other pressing concerns, according to the results of MGMA’s annual member survey, include participation in the Meaningful Use incentive program, dealing with rising operating costs, selecting and implementing an EHR, and implementing or optimizing an ACO.

A report in JAMIA concludes that the error rate with e-prescribing is similar to that of handwritten scripts. Mr. H weighs in on the study on HIStalk, pointing out that the data came is a bit dated (from 2008); researchers could not make any conclusions on particular e-prescribing or pharmacy systems; and,  the study did not assess how practices implemented the technology or how physicians were trained to use them. I haven’t seen the full study so I will defer to Mr. H and his lukewarm assessment, though I wouldn’t mind seeing a similar study based on today’s  ever-growing use of e-prescribing (68 million e-rxs in 2008 versus 326 million in 2010.)

Wisconsin Health Information Technology Center identifies six Value Vendors for its REC program, including athenahealth, Cerner, eClinicalWorks, e-MDs, Greenway Medical, and McKesson.

Please join me in welcoming and thanking Bulletin Healthcare as HIStalk Practice’s newest Platinum Sponsor. Bulletin is all about providing medically relevant news to healthcare professionals, including 400,000 physicians a day. The company sends eNewsbriefings on behalf of two dozen medical associations, as well as to the President, the majority of US cabinet members, and a whole lot of Fortune 500 execs. If you are a vendor interested in connecting with Bullentin’s large healthcare audience, check out the company’s advertising opportunities. We appreciate their support of both HIStalk Practice and HIStalk.

gloStream adds Health Network Solutions as a certified partner to sell and support gloStream’s EMR and PM software.

NextGen parent company Quality Systems wins three Stevie awards in the following categories: Investor Relations Campaign/Program of the Year; support staffer of the Year; and, Live Event: Best Internal Recognition/Motivational Event for the NextGen Users Group Meeting. CEO Steven T. Plochocki (left) looks pleased.

Happy Independence Day, if you are still celebrating.  It’s obviously a slow news day, as evidenced by the fact that the only HIStalk-related e-mail I received today came from one of our Canadian sponsors. I found this photo I took a few years back when I celebrated the holiday in DC. Definitely the best fireworks display I’ve ever witnessed and the best city to be in if you prefer to reflect more on Independence than on hot dogs – and don’t mind sticky, hot, humid weather. Wherever you are and whatever you are choosing to celebrate, have fun and be safe.

E-mail Inga.

From the Consultant’s Corner 7/2/11

Workflow Diagrams Improve Customer Satisfaction and Cash Flow

In the business of healthcare, missteps and wrong turns can be disastrous. Workflow diagrams are a proven way to help make sure your organizational strategies are headed in the right direction.

Many organizations don’t see the need for documenting business and clinical workflows, but failure to do so can hurt both the facility’s bottom line and patient retention rates. When a facility takes the time to create workflow diagrams and supporting documentation, there’s nothing left to chance.

By diagramming workflow, healthcare organizations can improve customer satisfaction scores and boost financial performance. Sometimes it’s the most obvious things that can get overlooked, such as having a solid check-in process to collect co-payments and outstanding self-pay balances.

One of our clients, for example, was getting complaints from patients about the fact that they were left standing in the hallway after appointments, trying to figure out for themselves what to do next. The problem: there wasn’t an operational workflow for check-out. Once we documented and evaluated the operational flow, we quickly made the necessary adjustments. Patient satisfaction has greatly improved.

Workflow diagrams can also remedy many puzzling financial problems. For example, it’s not uncommon for a healthcare organization to get discrepancies between actual deposits and amounts posted to the system. When you create a workflow diagram, it’s easy to spot the missing step: posting the co-pay, for instance. By documenting workflow, a facility can improve cash flow and accurately reconcile system information to deposits.

A couple of tips for diagramming workflows successfully:

Keep your eye on two workflows

I recommend creating two separate workflow diagrams, operational and functional. The operational workflow identifies all the steps needed to successfully complete a process from start to finish. A functional workflow shows your employees exactly what to do to accomplish the operation in the most timely, efficient manner.

Let’s use patient check-out as an example. An operational workflow might conclude with a step like, “Nurse escorts patient all the way to check-out.” The functional workflow might include a step that says, “Nurse tells patient, ‘Follow me, and I’ll escort you to our check-out area.’” By documenting this step, the nurse doesn’t have the option to say, “Go down this hall and make a left to get to check-out.”

Document everything!

It’s usually not enough to document one or two problematic operations. Your facility can see major improvements by documenting a wide range of operations, including:

• Registration
• Appointment scheduling
• Co-pay collection and posting
• Eligibility requests and results
• Encounter form documentation and charge posting
• Coding and collection
• Denial management
• Credit card processing and posting
• Return appointment scheduling
• Collecting insurance data
• Third-party payment posting
• Collection agency processes

There’s an old saying in science: “Anything you document will improve.” Once your operational and functional workflows are documented, you can use them as blueprints for even greater improvements down the road. Organizations that implement workflow diagrams have a better chance of consistently outperforming those that don’t in terms of quality, compliance, cost containment, and patient satisfaction.

Rob Culbert is president of Culbert Healthcare Solutions of Woburn, MA.

News 6/30/11

The Washington and Idaho Regional Extension Center (WIREC) includes Allscripts, eClinicalWorks, eMDs, GE, Greenway, NextGen, and Pulse in its EHR Group Purchasing Program.

ADP AdvancedMD announces plans to expand its workforce by 45% this and add up to 100 new jobs in the Salt Lake City area.

In Australia, the government initiates a telehealth incentive program that pays general practitioners about $6,400 for the first time they help a patient take part in a telehealth consult with a specialist. The intent of the program is to encourage GPs to buy the equipment necessary to serve rural patients remotely without the patients having to travel huge distances . Eligible GPs must work at least 12 miles outside of a city center, which is where 62% of Australia’s population lives.

Northeast Valley Health Corporation (CA) and Community Health Center Network (CA) are among 32 community health centers to select NextGen EHR solutions.

HHS says it will shelve its “mystery shopper” survey, which required government employees to pose as patients, call doctors’ offices, and gauge the difficulty of getting an appointments. The program’s intent was to measure access to primary care. I am with Senator Orrin Hatch, however, who said the project was "wasting taxpayer dollars to snoop into the care physicians are providing their patients.”

Earlier this week we posted Micky Tripathi’s latest Pretzel Logic column, The Quality Measure Conundrum. The piece includes many gems, including an explanation of the significant effort required on the part of practices to track and report on clinical quality measures. Micky also shares his findings from a non-scientific random sample of 25 vendors: only five (athenaclinicals, e-MDs, Epic, Greenway, and NextGen) are certified for all 44 quality measures, while the rest were certified for the bare minimum of nine measures. The article is a must-read for anyone wanting to be in the know about EMRs and Meaningful Use.

An MGMA advisor and a Navicure exec share opinions on why practices are behind CMS’s endorsed timeline to implement HIPAA 5010:

• Many vendors, payers, and practices believe the 5010 deadlines will be pushed back as the 4010 deadlines were.
• With an average upgrade price tag of $16,000 per physician, many practices are putting off the expenditure.
• Practices are too busy addressing Meaningful Use and ICD-10.
• Practices are relying on their clearinghouses to take care of the conversion. This approach may be risky because some software packages must also be upgraded by the PM vendor.

Practice Fusion expands its board with the appointment of Cora M. Tellez. She’s the former president of Health Net and CEO of Blue Shield of California-Bay Region.

The AMA and over 100 other state and medical specialty societies send President Obama a letter, urging the elimination of the sustainable growth rate (SGR) formula for paying physicians to treat Medicare patients.  The current temporary Medicare payment fix is set to expire in January 2012, at which time a 30% SGR pay cut is scheduled to go into effect.

Stuff you can do to promote world peace, stimulate the economy, or at a minimum, make my day a little brighter: if you aren’t signed up for the instant e-mail updates, complete the little field at the top right of this page. Learn what our sponsors are all about by clicking on a few of their ads. Connect with Inga and  Mr. HIStalk on LinkedIn or friend us on Facebook. Or, join another 1,500 of HIT’s coolest peeps by liking HIStalk on Facebook. We are so social media savvy that you can also find HIStalk and Inga on Twitter. I also love rumors, insights, and beach recommendations, so drop me a line any time. And thanks for reading.

E-mail Inga.

DOCtalk by Dr. Gregg 6/29/11

HITECH Guilt

Geez. You hear so many jokes about guilt-inducing religions, culturally-related guilt mongers, and mothers who guilt their children onto psychoanalytic couches, but when have you ever heard of legal, free money inducing guilt-laden angst?

And, yet, here I sit, a victim of “HITECH Guilt.” What is HITECH Guilt? The official DSM-5 axis isn’t available until 2013, but I can give you the Wiki version.

HITECH Guilt, also known as “DED-head Dread” (see below), is an extremely bizarre manifestation induced within a certain group of peoples known collectively as “EPs” who receive governmental financial support for trying to do the right thing. Certain EPs are granted these funds to help offset the costs of doing their jobs more efficiently and with greater chances for “interoperability.” (“Interoperability” is an antiquated term used in olden days to describe the abilities of electronic health record systems to work together, to collaborate, and to share information digitally. It has fallen into disuse primarily from lack of applicability.)

Most of the time, these poor EPs initially strove to achieve digital office information management in order to provide higher quality services – for their patients, for their staffs, and for their own geekoid good. Many invested staggering amounts of their already dwindling incomes to achieve this digitization without any promise of direct reimbursement … well, save those of overpromising sales folks and evangelistic health tech industry bloggers. (Gulp.)

Then, when the tipping point for HIT/EHR adoption seemed almost impossible to attain, along came HITECH. In order to help entice the reticent, governmental funds were found amidst all the red-inked ledgers to incentivize providers to digitize up. Not all providers, mind you. Just those deemed “preferred.”

The plan, in its most basic form, is essentially “carrot and stick.” The carrot is a little money. The stick is the withholding of money, a fair amount of money. The stick is definitely bigger than the carrot. Nevertheless, the carrot is not insignificant, especially for the EPs whose incomes are being assaulted on virtually every front.

For EPs who have yet to fire up the electrons in their patient recordkeeping work patterns, these incentive dollars definitely help lower one primary barrier to adoption by helping offset the costs of the transition. Even if the EHR adopted is one of the “free” systems, there are still significant expenses involved with training, implementing, workflow changing, and productivity “deficiting”, whether temporary or permanent.

For those EPs who were already DED-heads (Digitally Entered Data-heads), this HITECH incentive money was an unanticipated value add. I mean, who doesn’t like getting rewarded for doing something they thought was the right thing to do anyway?

However, with the funds came an unanticipated new form of mental pathology: HITECH Guilt. Despite feeling as if their hard work and attempts to move healthcare into the electronic age were worthy of reward, these mournful EPs now had to face the fact that they were contributing to the government’s staggering budget deficit and are, once all the trappings are cast aside, receiving welfare.

So, as I said, here I sit awash in HITECH Guilt. I got my check and, yes, I cashed it. If I had donated it to some worthwhile charity, I’d feel more “clean.” But, as I also don’t like the guilt associated with the harassing phone calls from creditors to whom I’ve had to delay payments, I chose to take the money. Times are hard in solo primary care. HITECH dough definitely helps keep the wolf (the ACO wolf?) from our practice door, at least for a little longer. Regardless, the guilty conscience lingers.

If you’re a provider who is outside of the EP clan, don’t think you’re missing out; there’s definitely a downside to “living on the dole.”

For my DED-head Dread suffering fellow EPers, there is one other little rationalization that helps:

Every time you see welfare patients come in who have better smart phones than you, notice how the angst melts a wee bit. When their kids have better portable video game players in hand than your kids own, you’ll feel better still. When you see them drive away in newer cars than yours, the guilt virtually disappears.

From the trenches…

“When we played softball, I’d steal second base, feel guilty, and go back.” – Woody Allen

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, directs the Pediatric Office of the Future exhibit for the American Academy of Pediatrics, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).