5 Questions with Rick MacCornack, CEO, Northwest Physicians Network

Rick MacCornack is CEO of Northwest Physicians Network, a Washington-based independent practice association and multispecialty provider network that has experienced record growth in the last 12 months.

NPN has seen an 80-percent increase in membership over the last year – a statistic that highlights the fact that independent physicians want to stay that way. What are the biggest obstacles private practices face when it comes to remaining independent?
The largest obstacle facing private practice today is the increasing administrative burden associated with so-called value-based payer contracts. Performing well on quality metrics, which are now required by all public and private payer contracts, is a challenge when the payment methodology is predominantly fee-for-service within PPO products. Patients are permitted to not have a primary provider, which flies in the face of a practice’s attempt to be actively “accountable” for an individual’s health. Technology cannot solve this issue. This is an adaptive, behavioral issue. Payment methods and consumer incentives are currently not in alignment with policy attempts to achieve the goal of population health.

How does NPN help them to overcome these challenges?
In the NPN network of 1,000 providers, there are 49 different EHR platforms in use. NPN staff supports the primary care providers by collecting and handling their clinical data for reporting and management purposes. This is done through remote access as well as in-clinic, manual abstraction of records. NPN supports a cloud-base registry, warehouse, and analytics platform, which serves as the aggregator and processing center for all reporting for each provider. Both clinical care gap reporting at the practice and patient level and managed care analytics (total cost of care and cost and utilization broken out by service category, per member per month) is provided to each clinician on a scheduled basis. Both sets of reports provide the clinic staff with a means of managing defined populations of patients. Reports to the provider are payer agnostic.

What role does healthcare technology play in this predicament?
Healthcare technology used by NPN is all cloud-based. NPN provides a comprehensive referral and care coordination platform to ease the administrative burden of referral processing, patient tracking, and care coordination. NPN also provides secure messaging via smartphone and desktop. And quality, utilization, and cost analytics are provided to all providers. The cost of providing these services is subsidized by NPN for all primary care providers, who are the least able to afford these technical services on their own.

What type of healthcare technology seems poised to best help private practices keep their doors open and patients satisfied?
All cloud-based solutions used by NPN have been developed and are provided by small startups who are experienced working in heterogeneous care delivery environments like IPAs. The private practice environment is a non-standard environment. True collaboration between vendor and the client in developing and delivering the service is required. NPN has even served as both an alpha and beta site for some of the technology services it uses.

How does NPN plan to help its network prepare for and work through MACRA? What resources do you feel practices are most in need of to make it through this transition?
MACRA adoption is a process of education and learning which track is most appropriate for each practice. One size doesn’t fit all. Across all tracks, data reporting by the practice and performance feedback to the practice are essential to participate under MACRA guidelines. NPN’s approach to supporting private practices under MACRA is to relieve the administrative burden of data collection from the EHR, uploading it into an analytics environment in combination with claims data, and returning results to practices on a scheduled basis for assessment and action. NPN staff serve to educate and support work flow changes in a practice to enable them to reach designated performance targets.

That said, until the payment system in the US is fully converted to “value-based” payment that is attached to administrative requirements that support performance- (cost and quality) based payment, it will be difficult for providers in any delivery system structure to consume practice-level data in a way that achieves better management of resources, one patient at a time. Population health is an unreachable goal when patients are not tied to a primary care provider who has the responsibility and the resources to manage each patient’s individual clinical needs over time.

Contacts

Jenn,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg

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News 11/9/16

Top News

Trump’s presidential win sets the nation abuzz and gets healthcare insiders busy predicting his cabinet picks. Several media outlets have tossed out Ben Carson, MD and Louisiana Governor Bobby Jindal as potential HHS Secretary appointees. Trump representatives have already said he’ll have his cabinet nominated and approved within two weeks of inauguration.

In other post-election news, several medical societies weighed in on the president-elect. The AAFP sent Trump a letter highlighting health policies that need immediate attention, including the need to reduce the administrative burden of family physicians. AAFP President John Meigs, MD added that family physicians and the new administration can work together to “ensure continued progress toward healthcare for all, supported by a payment system that rewards value over volume of services, that promotes prevention and wellness, that protects patients from financial barriers to needed services, and that builds a primary care physician workforce that can meet the growing demand for care.”

AMA President Andrew Gurman, MD issued this rather bland statement: “We look forward to working with President-elect Trump and a new Congress to improve the health of the nation. The AMA has a history of working with all sides as we pursue policies that improve care delivery and the outcomes for our patients. We know there are many health policy issues facing our newly elected leaders, and the AMA is ready to lend its expertise and offer guidance on these complex issues.”

HIStalk Practice Musings

The real winner in all of this is Alec Baldwin, who will likely continue his portrayal of Trump on SNL for the next four years.

Webinars

None scheduled soon. Contact Lorre for webinar services. View previous webinars on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Athenahealth will convene a neighborhood meeting to address grievances from local residents relating to the company’s new construction at the Arsenal on the Charles property it purchased in 2013. Complaints range from the addition of 1,000 more parking spaces than originally planned, a lack of communication about the project, overnight lighting, and enforcement of an employee parking policy. “Since purchasing the property in 2013,” explains SVP & General Counsel Dan Haley, “we unveiled our plan to open up a formerly-sealed off military base, connect a beautiful historical property to the community, and create more outdoor shared space. We have collaborated with the town, and with our neighbors, at each step, and we are committed to continuing that engagement.” Construction began last week and is expected to last 15 months.

Announcements and Implementations

BCBS of Kansas will offer value-based contracts and relevant patient data (presumably claims) to Aledade Kansas ACO members beginning January 1. The ACO started out with 13 practices – mostly rural – earlier this year, and plans to add three more in the coming months.

Telemedicine

Humana expands its partnership with MDLive, offering telemedicine visits to Medicare members in Georgia and South Carolina beginning next year. The payer announced a similar offering to New Mexico members last month.

People

Jesse Gamez (Kaiser Permanente) joins the Northwest Physicians Network as COO.

Government and Politics

Athenahealth CEO Jonathan Bush (who did quite the Donald Trump impersonation at HIStalkapalooza earlier this year) sits down with Fortune (pre-election results) to address the next administration’s likely healthcare plans. A few snippets:

• “This will be the president with the lowest mandate to do anything – in my whole life – so I think what they will tackle is not getting impeached.”
• “I don’t expect a very activist healthcare agenda for the next four to eight years. Remember, we’ve had a really activist healthcare agenda for the last eight. I expect the next chapter will be a digestion of all that new policy and not a lot of change.”
• “I’m imagining a silencing of the federal role and an explosion of the healthcare system’s role, the local health plan’s role, and the employer’s role. Those things will start to spike up as the roar of Washington dampens down.”

Other

It’s not the five-second rule I’m worried about: Baylor College of Medicine Professor Jeffrey Starke, MD advises those who work in office environments to forego washing their beloved coffee mugs with the communal sponge, pointing out that, “The sponge in the break room probably has the highest bacteria count of anything in the office” given that it’s used to clean all manner of dirty dishes and sits damp for hours at a time. “Most people would call that gross.” Also gross: The notion held by some that never cleaning your mug makes coffee taste better.

Sponsor Updates

• Aprima will exhibit at the Practice Management Institute November 9-11 in Las Vegas.
• Medicomp Systems recaps its annual training event that was held October 3-7 in Bangkok, Thailand.
• EClinicalWorks will exhibit at the Kentucky Primary Care Association 2016 Conference November 9-11 in Lexington.
• Healthwise’s Leslie Hall will present at Partnering for Cures November 13-16 in New York City.

Blog Posts

• The Top 10 Reasons Transformation is the New Normal for Healthcare – Reason 5 (GE Healthcare)

Contacts

Jenn,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg

More news: HIStalk, HIStalk Connect.

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News 11/8/16

Top News

ONC submits its HITECH-mandated annual report to Congress, which as those following healthcare IT news already know, focuses on improving interoperability. It also contains several statistics related to the progress physicians and hospitals have made in their use of health IT. The most promising, as far as physician practices are concerned, is the 30-percent jump office-based physicians have seen in their view/download/transmit patient engagement efforts, and a slightly larger increase in their ability to share patient data with outside facilities.

Webinars

November 9 (Wednesday) 1:00 ET. “How to Create Healthcare Apps That Get Used and Maybe Even Loved.” Sponsored by MedData. Presenter: Jeff Harper, founder and CEO, Duet Health. Patients, clinicians, and hospital employees are also consumers who manage many aspects of their non-medical lives on their mobile devices. Don’t crush their high technology expectations with poorly designed, seldom used apps that tarnish your carefully protected image. Your app represents your brand and carries high expectations on both sides. This webinar will describe how to build a mobile healthcare app that puts the user first, meets their needs (which are often different from their wants), creates “stickiness,” and delivers the expected benefits to everyone involved.

Contact Lorre for webinar services. View previous webinars on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Practice Fusion receives an undisclosed amount of financing from Orix Growth Capital, which CEO Tom Langan says the company will use to help fund interoperability initiatives. As of February 2016, the company had raised $150 million. It has been mum on previously announced plans for an IPO in 2017.

Announcements and Implementations

The Great Lakes Practice Transformation Network extends the deadline to apply for MACRA-related grant funding for practice transformation and quality reporting assistance. Backed by funding from the CMS Transforming Clinical Practice Initiative, the grant is open to physicians who see Medicare and/or Medicaid patients and are not already participating in the Ohio Comprehensive Primary Care Initiative and several other value-based payment programs.

Bizmatics adds medication management technology and adherence insights from Surescripts to its PrognoCIS EHR.

Michigan Health Information Network Shared Services implements custom parser technology from OpenAirware that enables it to pull key data out of large CCD/CDA files so that only the data needed for a particular use case is shared.

Research and Innovation

Harvard researchers build a chain-smoking robot to better understand chronic obstructive pulmonary disease. Programmed to smoke at customizable intensities and frequencies, the robot passes the smoke to a “lung on a chip,” which can accommodate living lung cells. This capability helps researchers compare and contrast the effects of chain-smoking with cells from a patient with pulmonary disease and with cells from a healthy patient.

Other

No tipping allowed: Austrian startup SmaXtec sees big potential in its connected, implantable sensors that help dairy farmers remotely monitor a cow’s health data in real time. Embedded in the first of a cow’s four stomachs, the sensors alert users via corresponding app and texts to any changes in the animal’s temperature, movement, pH levels, and milk production.

Quartz highlights the plethora of contracts Apple users digitally sign on a fairly regular basis, noting that those who own at least five Apple devices have signed at least 30 contracts containing over 100,000 words of legalese (most of which, I’m willing to bet, were never read). That word count is greater than either “The Hobbit” or the “Harry Potter and the Sorcerer’s Stone.”

Contacts

Jenn,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg

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5 Questions with Pamela Fletcher, Administrative Director, Glendale MRI Institute

Pamela Fletcher is administrative director at the Glendale MRI Institute, a boutique imaging center in Glendale, CA with one part-time radiologist and 16 additional staff members. With the help of locums radiologists and teleradiology, the practice sees close to 35 patients each day. The practice has partnered with Healthpac Computer Systems in Savannah, GA for its radiology information system, and recently implemented ReferralMD referral management software.

What was the impetus for implementing referral management software?
We needed a marketing tool to keep referrers “sticky” to us and to o make it easier for referring docs to communicate with us. Plus, we also wanted to make ourselves know to providers who weren’t aware of us and thus weren’t referring to us.

How do you hope its utilization will benefit your organization and its patients?
See number one! Also, it was a huge and pleasant surprise to discover how much time it saved our scheduling staff to have the faxed referrals go directly into the new software.

What sort of healthcare technology adoption/implementation challenges are unique to outpatient MRI facilities?
The biggest challenge is to convince our referrers to embrace new ways of communicating with us.

Interoperability continues to be a challenge. Has Glendale MRI connected to local HIEs or joined other interoperability-friendly groups to make data sharing easier?
We have a software service that delivers reports to the desktop of our referring providers. They can configure their EMR to retrieve the reports and put them directly into the patient files.

Healthcare cost transparency has also become a hot topic. Have you noticed an uptick in patients asking for upfront pricing? How is Glendale MRI positioning itself to handle these inquiries?
Oh yes! This is a strategy we implemented several years ago when the big imaging chains and hospitals started taking over our HMO contracts. We are too small to compete, so we put together competitive cash pricing and started marketing it through social media, pay-per-click, and brand awareness campaigns. This has been very successful. We also offer interest-free financing, which has been very popular.

Contacts

Jenn,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg

More news: HIStalk, HIStalk Connect.

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News 11/7/16

Top News

Texas Association of Business CEO Bill Hammond, who will step down at the end of this year to try his hand at lobbying for several industries including healthcare, takes to the local paper to outline three things The Lone Star State needs to immediately do in order to expand use of telemedicine:

• Ensure practice standards for in-person care and telemedicine are consistent with the ultimate goal of increasing access to quality care and lowering costs.
• Adopting a technology-neutral definition of telemedicine so that patients and physicians can choose the type of technology used for telemedicine visits, “rather than the state dictating a one-size-fits-all approach.”
• Require a patient to be examined in-person or travel to a facility only when medically necessary based on a physician’s recommendation.

Hammond’s recommendations come just a few months after a TAB survey of consumers and businesses found an overwhelming majority favored the use of telemedicine to diagnose common medical conditions. Texas has been criticized by many (and famously taken to court by Teladoc) for its view that an initial patient-physician encounter should be face-to-face rather than over phone or video.

HIStalk Practice Musings

I’m thinking it will be a slow news week as everyone focuses their attention on tomorrow’s election and its ensuing aftermath, which means my decision to imitate the pose above while attending a friend’s beachside wedding this weekend is well-timed. The last presidential election found me traveling in the British Virgin Islands, where local eateries and bars held election-night TV-viewing parties. It gave me a unique perspective into the ramifications our elections have on the tourist-dependent economies of our Caribbean cousins.

Webinars

November 8 (Tuesday) 1:00 ET. “A CMIO’s Perspective on the Successful 25 Hospital Rollout of Electronic Physician Documentation.” Sponsored by Crossings Healthcare. Presenter: Ori Lotan, MD, CMIO, Universal Health Services. UHS rolled out Cerner Millennium’s electronic physician documentation to its 6,000 active medical staff members — 95 percent of them independent practitioners who also work in competitor facilities — across 25 acute care hospitals. UHS’s clinical informatics team used Cerner’s MPage development toolkit to improve the usability, efficiency, communications capability, and quality metric performance of Dynamic Documentation, embedding clinical decision support and also using Nuance’s cloud-based speech recognition product for the narrative bookends of physician notes. This CMIO-led webinar will describe how UHS achieved 70 percent voluntary physician adoption within one month of go-live, saved $3 million in annual transcription expense, and raised EHR satisfaction to 75 percent. It will include a short demonstration of the software that UHS developed to optimize the physician experience.

November 9 (Wednesday) 1:00 ET. “How to Create Healthcare Apps That Get Used and Maybe Even Loved.” Sponsored by MedData. Presenter: Jeff Harper, founder and CEO, Duet Health. Patients, clinicians, and hospital employees are also consumers who manage many aspects of their non-medical lives on their mobile devices. Don’t crush their high technology expectations with poorly designed, seldom used apps that tarnish your carefully protected image. Your app represents your brand and carries high expectations on both sides. This webinar will describe how to build a mobile healthcare app that puts the user first, meets their needs (which are often different from their wants), creates “stickiness,” and delivers the expected benefits to everyone involved.

Contact Lorre for webinar services. View previous webinars on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Allscripts notes in its earnings call that the company sees big opportunity in selling RCM services to its ambulatory EHR customers.

Cerner’s latest earnings call provides further insight into Athenahealth’s sluggish sales. As Mr. H noted late last week, the company earned a noteworthy ambulatory win in displacing Athenahealth for ambulatory EHR and business services at what the company believes is Athenahealth’s largest customer, also replacing Athena at two other sites.

Announcements and Implementations

SRSsoft adds InteliChart’s patient engagement technology – including appointment reminders, patient intake and educational materials, and satisfaction surveys – with its specialty-specific line of EHRs for specialists.

People

Bryan Koch (DocuTap) joins Kareo as GM of managed billing.

Darren Hay (Ideal Life) joins Care Angel as chief revenue angel/officer. Hay is also lending his expertise to the Florida Telehealth Advisory Council, which hopes to help pave the way for expansive telemedicine adoption across the state.

Mark Fabian (Life in the Moment) joins Zotec Partners as director of business development.

Other

AMA launches TruthinRx.org, an interactive website that gives patients the opportunity to share stories of how rising prescription prices are impacting their health and finances. The association will also use it as a tool with which to lobby Congress for more transparent (and hopefully fairer) drug pricing – an issue scheduled to be discussed at its interim meeting later this week.

Sidney Stein, MD calls the decision he and his Horizon Medical Group (NY) partners made earlier this year to merge into the 79-physician Weill Cornell Medicine network well worth it. The physicians gained a brand-new office, EHR, digital X-ray machine, and the less tangible brand appeal associated with Weill Cornell. “It would’ve been nice if I didn’t have to change things—we were very happy with our five-person group,” Stein explains, “but I think you have to read the handwriting on the wall and see what the future has in store.”

Cue “Apache:” Max Chiu, MD takes a break from EHR data entry at Presence Saint Francis Hospital in Chicago. “As I was walking past the break room around 3:30 am one morning,” Chiu says, “I realized how much open floor space there was and thought it’d be fun to film a short video of myself ‘breakin’ in the break room. Unfortunately, I don’t get to spend most of my breaks dancing. I usually spend breaks at work catching up on other unfinished work. There definitely is not a large population of breakdancing doctors, but I know there are some others out there!” It seems like his skills would be the perfect addition to ZDoggMD’s next act.

Contacts

Jenn,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg

More news: HIStalk, HIStalk Connect.

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