News 6/3/15

Top News

Acting CMS Administrator Andy Slavitt announces at Health Datapalooza that CMS data will become available to the private sector via the agency’s Virtual Research Data Center starting September 1. Slavitt also reiterated CMS’ commitment to prevent information blocking, offering an email address providers can use shame data blockers.

Webinars

June 9 (Tuesday) 11:30 ET. “Successful HIEs DO Exist: Best Practices for Care Coordination.” Sponsored by Medicity. Presenters: Dan Paoletti, CEO, Ohio Health Information Partnership; Brian Ahier, director of standards and government affairs, Medicity. Not all HIEs are dead – some, like Ohio’s CliniSync HIE, are evolving and forging a new path to successful care coordination. Brian Ahier will explain how HIEs can help providers move to value-based care models, emphasizing Meaningful Use Stage 3 and FHIR. Dan Paoletti will provide best practices in describing CliniSync’s journey to success in serving 6,000 primary care physicians, 141 hospitals, and and 290 long-term and post-acute care facilities. Attendees will learn how to use a phased approach, establish client champions, help providers meet MU Stage 2, create a provider email directory, deliver care coordination tools, and drive continued ROI.

Tweet Chat

Crohn’s patient and advocate Carly Medosch (@CarlyRM) will host the next #HIStalking tweet chat Thursday, June 11 at 1pm ET. You can brush up on her background here. Stay tuned for chat topics.

Acquisitions, Funding, Business, and Stock

Fitbit looks to raise as much as $478 million in its IPO, according to a prospectus filed earlier this week. The company and its shareholders plan to offer 29.85 million Class A shares for $14 to $16 apiece. All told, the company’s valuation would be somewhere in the range of $3.3 billion. (Lt. Dan dissects the ways in which Jawbone’s lawsuit against FitBit could affect its IPO here.)

Cohero Health receives FDA clearance for its mobile spirometer, which automatically syncs real-time data to a patient’s smartphone, enabling them to review and monitor their medical history, records of medication adherence, and lung function. The device also integrates with the company’s mobile asthma and COPD disease-management platform.

Apple CEO Tim Cook calls for customers to be in charge of their own information during a presentation to the Electronic Privacy Information Center. “We don’t think you should ever have to trade [your personal information] for a service you think is free but actually comes at a very high cost. This is especially true now that we’re storing data about our health, our finances, and our homes on our devices.” Cook seemed to avoid overt references to Google and Facebook, though he made it clear their data-mining practices are not something Apple’s interested in replicating.

Announcements and Implementations

Consulting firm National Endeavors launches a series of consulting services and cloud-based technology solutions for physicians interested in participating in a Medicare Shared Savings Program ACO.

Gastro Health (FL) implements theGIConnection, a virtual support community from Omni Health Media for patients with gastrointestinal conditions.

Solutions Recovery Center (FL) signs a three-year contract with ZenCharts for its behavioral health EHR software. ZenCharts was acquired last month by Sanomedics, best known for marketing and selling the Caregiver TouchFree Infrared thermometer.

People

David Fairchild, MD (UMass Memorial Health Care) joins BDC Advisors as director.

The AMA Foundation will award its Dr. Nathan Davis International Award in Medicine to Kent Brantly, MD the Texas physician who contracted and then overcame Ebola while working as a medical missionary at ELWA Hospital in Monrovia, Liberia. A snippet from his recent commencement speech at alma mater Indiana University School of Medicine sheds some light on his dedication to the art of medicine: “When everyone else is running away in fear, we stay to help, to offer healing and hope.”

Telemedicine

A smartwatch app designed to help people recover from depression wins the Innovative Solution Award from the Ontario Telemedicine Network during its Hacking Health Design Challenge. The Zuubly app sends users a few questions a day to monitor progress, and can message the user’s care circle, and link to them to a local crisis center, when support is needed.

Government and Politics

ONC releases a data brief detailing the disparities in consumer access and use of health IT in 2013. Just 15 percent surveyed consumers had looked at any part of their medical results online, while 23 percent had exchanged emails with their physician. Wide disparities were found across race and wealth. Two-thirds of respondents making over $100,000 a year noted use of a health IT product, and only 5 percent of Hispanic respondents viewed test results online.

CMS reports that 88 percent of claims were accepted during an April end-to-end ICD-10 testing run, a 7-percent increase over the previous testing period in January.

Other

It seems like Switzerland’s state-owned postal service is taking a crack at interoperability: Swiss Post will work with Health Info Net, a joint venture of the Swiss Medical Association and Ärztekasse health insurance fund, to securely send health data electronically between stakeholders through its Vivates e-health mail system. Swiss Post has signed a similar agreement with the Professional Association of Swiss Pharmacists for use of the platform, which will connect close to 70 percent of all Swiss pharmacies.

It looks like the drug wars have reached physician offices in Canada: Medical marijuana producer Tilray has accused competitors of offering physicians kickbacks for prescribing their products. Tilray has withdrawn from the Canadian Medical Cannabis Industry Association after unsuccessfully pushing it to adopt a code of ethics that would prevent such practices. Tilray CEO Greg Engel seems convinced the code wasn’t adopted because the majority of CMCIA’s 12 members are profiting from the scheme.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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Readers Write: What Do Recent Legislative Changes Really Mean to Physicians?

What Do Recent Legislative Changes Really Mean to Physicians?
By Vicki Miller

At a recent appointment for my 90 year-old mother, her physician, charting on paper, said to me, “I met Meaningful Use and thankfully SGR reform eliminated the annual cuts to our fees.” Realizing he had not had the pleasure of reading all the various recent legislation, I resisted engaging in a discussion about the potential impact the Medicare Access and CHIP Reauthorization Act (MACRA) and proposed modified Stage 2 and Stage 3 Meaningful Use rules could have on his practice.

While MACRA may have eliminated the potential annual cuts to Medicare, it has not stopped the movement to value-driven reimbursement or the requirements to demonstrate MU of EHRs and successfully report quality measures (PQRS). In fact, the proposed new legislation places greater emphasis on the use of technology to support care delivery activities and communication by tying 25 percent of the payment to MU of EHR technology. The charts below show the progression of the stages of MU required not only for MU but also to meet new payment model requirements under MACRA. You can download them as a PDF here.

What Does This Mean to Physician Practices?

* Sustained adoption of EHR and PM systems will play an increasingly important role. Today’s EHR and PM systems are expected to evolve to meet the changing requirements of the legislation. These systems will become more than the place to record the visit and generate a bill. They will become the “hub” for data collection and exchange. They will provide the secure framework to facilitate communication between physician, caregivers, patients, and their families. Practices should continually evaluate their workflows to ensure the technology and processes are integrated, streamlined, and standardized.

* Ability to seamlessly exchange, digest, and utilize clinically relevant data is essential. Electronic sharing of data between providers will be the expectation for coordination of care, engagement of patients and their families, and population health management. New technologies will expand this sharing of data to include non-clinical settings and patient self-reported data. Practices should consider whether existing processes need to be changed or new processes are required to capitalize on these data-sharing capabilities. With the right processes, data sharing has the potential to significantly improve efficiency and effectiveness of the practice.

* Availability of quality and cost data will influence selection of providers. The cost and quality rankings of physicians determined under new payment models will be now be publically available. Patients and referring providers may access this information to make decisions when selecting physicians. Payers may utilize this information to negotiate contracts and/or set physician-specific co-payment and deductibles based on the physician’s rankings. Practices will need to monitor and understand how physician cost and quality compare to peers to manage the potential financial and reputation implications to the physician and practice.

* Business Intelligence capabilities will be critical to sustained profitability and growth. The shift to value-driven reimbursement will require both management of the health of the patient and a deeper understanding of the business of the practice. Practices will need information to understand how resource utilization impacts profitability, know what services optimize revenue, and determine what quality-drivers produce the best outcomes. This requires analytics tools typically not available in today’s EHR and PM systems, and practice leaders educated in using information to drive decisions. Practices should develop a practice performance analytics plan to ensure the right tools, data, and training is in place to support data-driven decisions.

Yes, my mother’s physician was right. The annual stress of wondering whether a cut to the Medicare fee schedule is going to happen or not has been averted. And, we now have a better idea of what payments will look like in the future. However, practices are just beginning to understand payment adjustment impact under today’s PQRS, MU, and value-based payment programs. The passage of MACRA is not a call for business as usual but an acceleration of the transition of physician payments away from fee-for-service. Those practices that understand and react to the four areas outlined above will be better positioned to meet the challenges of the unprecedented changes facing practices today and in the future.

Vicki Miller is principal consultant and co-founder of Palm Key Associates.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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News 6/2/15

Top News

CVS Health partners with HHS to offer the myhealthfinder tool at MinuteClinic.com and www.cvs.com/myhealthfinder. The tool offers recommendations from government-recognized clinical experts for the personalized preventive services patients should receive based on their age and gender, many of which are conveniently offered at MinuteClinic. CVS is the first national partner to work with HHS on a technology project of this nature. In announcing the partnership, National Coordinator Karen DeSalvo, MD noted that, “This tool supports physicians and the care team, and is an easy way to help people understand the recommended preventive services that are often available to them at no out of pocket cost thanks to the Affordable Care Act.”

Webinar

June 9 (Tuesday) 11:30 ET. “Successful HIEs DO Exist: Best Practices for Care Coordination.” Sponsored by Medicity. Presenters: Dan Paoletti, CEO, Ohio Health Information Partnership; Brian Ahier, director of standards and government affairs, Medicity. Not all HIEs are dead – some, like Ohio’s CliniSync HIE, are evolving and forging a new path to successful care coordination. Brian Ahier will explain how HIEs can help providers move to value-based care models, emphasizing Meaningful Use Stage 3 and FHIR. Dan Paoletti will provide best practices in describing CliniSync’s journey to success in serving 6,000 primary care physicians, 141 hospitals, and and 290 long-term and post-acute care facilities. Attendees will learn how to use a phased approach, establish client champions, help providers meet MU Stage 2, create a provider email directory, deliver care coordination tools, and drive continued ROI.

Tweet Chat

Crohn’s patient and advocate Carly Medosch (@CarlyRM) will host the next #HIStalking tweet chat Thursday, June 11 at 1pm ET. You can brush up on her background here. Stay tuned for chat topics.

Acquisitions, Funding, Business, and Stock

HCA adds over 800 physicians to its network in the area of San Jose, CA through its acquisition of PM company Pacific Partners Management Services. Included in the acquisition is the Santa Clara County Independent Practice Association, which PPMSI manages. Both groups will be rolled into HCA’s Physician Services Group.

Announcements and Implementations

Hughston Clinic (GA) implements the TrainerRx software platform throughout its network of orthopaedic and trauma facilities. The consumer-facing app provides physicians treating musculoskeletal injuries with diagnosis-specific and individualized step-by-step rehabilitation and recovery treatment plans using audio, video and text-driven computer algorithms.

Practice Fusion incorporates the TrialCard copay savings and free trial offers solution into its EHR, enabling users to transmit savings offers to pharmacies along with prescriptions.

People

Fred Mindermann (FlexLife) joins Solekai Systems as vice president and general manager of its Connected Health practice.

Government and Politics

ONC releases a nine-page data brief on patient perceptions of the privacy and security of medical records. Among the findings:

• Less than 1 in 10 individuals would withhold information from their providers because of privacy and security concerns.
• Privacy and security concerns are no different between individuals whose providers have paper medical records and those whose providers have an EHR.
• Patient concerns regarding sending medical records between health care providers do not differ by whether they are sent electronically or by fax.
• Patient support for EHRs and HIE is high despite potential privacy or security concerns.

Members of the House Ways and Means health subcommittee write to CMS recommending ways to smoothly transition to ICD-10, including expanding end-to-end testing beyond the current 2,500 providers, developing a back-up plan for how CMS will process claims if it can’t handle the new codes, and clarifying whether or not less granular codes will be accepted after October 1. “With the Healthcare.gov debacle a vivid reminder of how technologically complex projects can go wrong despite assurances,” wrote the committee members, “we urge the agency to make information available to providers and the broader public that helps to address concerns.”

Research and Innovation

Researchers with the National Bureau of Economic Research find that EHR adoption is not associated with EHR-driven upcoding, a conclusion at odds with industry assumptions that physicians will go with the most profitable code for a given procedure if given the chance by their EHR.

The inaugural Healthcare Consumerism Index from Alegeus Technologies finds that nearly 80 percent of the 5,000 consumers surveyed were more “engaged and thoughtful” about buying a TV than they were about making healthcare decisions. The results lend some credibility to ONC’s decision to potentially scale back patient engagement thresholds as part of Meaningful Use, but also highlight the work all industry stakeholders will need to do in order to educate consumers about their increasing healthcare responsibilities.

Telemedicine

An Israeli business website reports that American Well has received tens of millions of investment dollars from Teva Pharmaceutical Industries, marking the Israel-based company’s first official foray into digital health. American Well was founded by Israeli brothers Ido and Roy Schoenberg, MDs, and a connection was made to Teva when the sons of Ido and a Teva executive traveled to the U.S. as part of a university delegation. It was either serendipity or pure coincidence that led the delegation to tour American Well’s offices. (You can read my recent interview with American Well CEO Roy Schoenberg, MD here.)

Maven, a digital health clinic for women, completes its Surescripts certification through DoseSpots, a Massachusetts-based company that offers white-label e-prescribing solutions.

Net Medical Xpress Solutions proudly announces that one of its physicians performed several telemedicine consults while on vacation in the Himalayan foothills of northern India. The phrase “remote consultation” has finally been validated.

This article highlights the difference telepsychiatry is making in Idaho, which has one of the highest suicide rates in the nation. The state passed legislation this year requiring its medical licensing boards to develop rules for providing telemedicine. Close to 7,000 physicians are licensed to practice telemedicine in Idaho, but only about a 100 psychiatrists are located within the its borders.

Other

A study in the British Journal of Sports Medicine finds that employees who tap away at their keyboards all day should stand and/or stroll at least two hours during the workday, ideally working up to four hours each day. The effects of too much sedentary living even have researchers advocating for standing desks, mandated breaks, and discussion about it between physicians and their patients. Perhaps we’ll see it pop up as a box to click in future EHRs. 

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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HIStalk Practice Interviews Dave Spalding, COO, TMA PracticeEdge

Dave Spalding is COO of TMA PracticeEdge.

Tell me about yourself and the company.
TMA PracticeEdge, LLC, is a new services company developed by the Texas Medical Association to bring physicians the technology and expertise they need to take advantage of new healthcare payment models. It provides Texas physicians real options to design their own future. Today, we offer physicians a complete tool kit to help them form clinically integrated networks, manage population health, and operate value-based care models. We also provide consulting services in support of practice transformation. We will be seeking to expand our service solution set very quickly.

I am a healthcare executive with experience starting up new, high-growth healthcare services companies. Some of the recent companies I have helped get off the ground successfully include a new management services organization, a no-fee Health Savings Account bank and a five-star Medicare Part D Administrator.

Why did TMA decide the time was right to introduce PracticeEdge? What were you hearing from TMA members that led to its development?
Faced with the rapidly evolving healthcare environment and growing concern from the membership, the TMA leadership and board established a physician-led task force to research the concept of creating a physician services organization. After about two years of design and development work, the company was formally launched in February 2015.

Have any other state medical associations launched similar ventures? If so, did you reach out to them as PracticeEdge was coming together?
My understanding is TMA is the first medical association to launch a venture of this kind.

Why did TMA decide to partner with BCBS in this venture?
BCBSTX shares the TMA PracticeEdge goal of supporting and growing physician-led ACOs in our communities throughout Texas. When they initially expressed an interest in working together jointly on that goal, we welcomed their input and ideas. Ultimately, we were able to develop a mutually beneficial joint venture structure with BCBSTX bringing to the table innovative ideas, strategic capital, and flexible value-based contracting models for physicians.

Are PracticeEdge services only available to TMA members? How does your business model work?
Our services are targeted to our membership base, which is natural given the strength of our brand with independent physicians. We had a strong desire to get to market as rapidly as possible; therefore, we are utilizing a service provider to help us deliver our services. The firm we chose was Innovista Health Solutions, a leading physician-centric provider of population health, network development, and care management. Innovista already has over 120,000 lives under management in ACOs in Texas and Illinois. They bring competency and expertise to our clients, and they are very complementary to our trusted brand.

How many clients do you currently have? Are you seeing a particular type of physician practice express the most interest?
We have already landed three new ACOs for January 2016, and our pipeline is expanding as the word gets out about our services. Interestingly, we are working in a large urban setting, a middle market, and a rural market. We could not be more pleased with the reception we have received from physician leaders.

How do you envision helping them your clients better utilize healthcare IT as part of their overall ACO strategy?
Probably the biggest single IT-driven advantage we can bring to an ACO is access to best-in-class population health management technology. That access comes at a scalable cost, and it levels the playing field for independent physicians looking to compete against larger healthcare provider systems.

What types of ACO models will PracticeEdge steer its clients towards? Pioneer, Next-Generation, eventually commercial?
Every client is different, and we consult with them to assess their specific needs; however, it is safe to say we see real interest already in commercial ACOs as well as Medicare Advantage. Also in Texas, physician ACOs have been successful in working with the CMS Medicare Shared Savings Program ACO model.

Will you eventually offer your services outside of Texas, competing with companies like Aledade?
Our affiliation with our medical association makes us unique in some regards. We plan to grow our business around our membership and that strong historical connection. There is a lot of competition already in our space, and we think that is great for physicians, as competition drives market innovation.

Given that reimbursement models for telemedicine are shifting, do you anticipate your clients incorporating telemedicine services into their practices at a faster rate than previously?
We don’t see anything on the horizon that indicates telemedicine is going to expand in our region. Healthcare is local, and so far, retail telemedicine has not seen great uptake here.

Where are the majority of your clients with Meaningful Use? Are they feeling burdened or empowered by the criteria? How are you helping them to clear any IT hurdles they may be facing?
Physicians are feeling extremely burdened by the Meaningful Use criteria and are dropping out of the program. The unintended consequence is that it will further impact access for Medicare patients as the Medicare penalties increase. The program in its current form is unsustainable. As for helping them clear IT hurdles, the main approach we are taking is to work closely with a couple of EHR vendors that have been vetted by TMA physicians. Once these relationships are finalized, TMA PracticeEdge can help these practices optimize use of their EHRs, not only for Meaningful Use, but for other value-based programs as well.

Do you have any final thoughts?
We are really encouraged by what we are seeing in Texas and nationally with physician-led ACOs. Our estimate is that about 70 percent of the shared savings generated under the CMS MSSP ACOs has been delivered by physician-led ACOs versus a hospital-based ACO. We know from experience that when physicians step up and lead the charge into value-based care and population health, they can produce sustainable results including higher quality healthcare delivery at a lower cost.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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DOCtalk with Dr. Gregg 6/1/15

The Bastardization of HIT

A friend who travels the globe, and who works in the land of health information technology, recently mentioned how much better the potential was for HIT companies in countries beyond the U.S. He went on to say, and I quote:

“Wish I could say the same for the U.S. HIT***kthedocsbehemothpophealthbigdatastickittotheproviders companies.” (Asterisks added, to protect the eyes of the innocent.)

To be clear, my friend isn’t a healthcare provider. Still, he does have a genuine concern for us healthcare trench grunts. He also happens to have perhaps the most impressive overview of the world of health IT that I’ve ever beheld. While my vocabulary doesn’t include words of such magnitude, I certainly got his point. Thus, his long-lettered, contrived adjective gave me cause to pause, and to consider just where we are in U.S. HIT, and compare it with from whence we came.

After some goodly contemplation, I’ve a simple conclusion: My friend was correct – we’ve been bastardized.

According to Merriam-Webster, the definitions of “bastardize” include:

• To produce a poor copy or version (of something);
• To reduce from a higher to a lower state or condition;
• To modify especially by introducing discordant or disparate elements.

I think we might be hitting on all of the bastardization cylinders there.

First, let me say that I truly believe the vast majority of men and women in U.S. healthcare and health IT chose their careers based upon a desire to “do good.” Providers typically start with a desire to help people get and/or stay well. HIT folks often start with a desire to build a better HIT “mousetrap.” Each wants to help. Each has good goals. Most also have good values. How, then, did we go from such a higher plane to the bastardized level to which we have now sunk?

It may be entirely too trite to try and condense this down into a simple “here’s why,” but I’ll risk it. It seems to me that the ultimate evils in both the worlds of healthcare and healthcare IT can be summed up in two words – ego and greed.

Hollywood and professional sports aside, I can’t think of any industries that have as much ego as do healthcare and IT. Docs are notorious for their “God complex.” But, I swear, sometimes I think IT folks are striving to outdo docs for the top spot on “Mount Ego.”

So many think that they have the best ideas, that they have the “real” solutions, that they “know” the truly right answers and solutions better than anyone else. (For example, every EHR on the planet is “industry leading,” is “intuitive,” and “thinks like you do.” Huh. Really? Can they all actually think like me … and like you …and like every other provider out there?) How many times do vendors start off with a great idea or product, only to become subsumed by their own ego believing that because they did this first thing well, they’ll do everything well. A product or service that started superbly becomes bastardized with less functional and far-from-best-of-breed iterations or add-ons. (Producing a “poor copy or version.”)

Bring into this mix insurance company regulations – including the intentional obfuscation of payment and process clarity – and then add in some well-intended, but going-off-track-with-increasing-complexity-and-loss-of-focus government regulations and you further increase bastardization. (Introducing “discordant or disparate elements.”)

(To be fair and balanced, many of us HIT bloggers are no less guilty. Good initial intentions become derailed with egocentric bluster and a feeling that “we are somebody” just because we know how to type using reasonably accurate grammar. We become swayed by our own notoriety – even as relatively limited as it is – and start believing that we somehow know more than the rest of HIT-dom.)

On the greed side of things, that lovely little seductress has probably knocked more of us off of our initial high-minded pedestals than anything (in both healthcare and HIT). Initial grand ideas and success succumb to enhanced lifestyles, and enhanced bills. The need to pay those higher bills starts to drive decisions more and more. Lifestyle improvements often bring a sense of entitlement. Once we have more, we start to believe we deserve more. This seems to happen for both individuals as well as corporations.

What this then leads to is big payrolls, enormous new offices and facilities, large budgets, expensive marketing and promos, and more – all taking more money to support. As the need for more money to continue the ongoing expansion of such grows, decisions become less about the best product or service and more about the economies. Behind closed doors, HIT execs – whether industry or governmental – have often been heard to say, “When it comes down to it, it’s all about the money.” (Reducing “from a higher to a lower state or condition.”)

And, yes, just so I’m not accused of favoritism, this same effect occurs with some HIT bloggers. Big time.

All of this takes away – in focus and in dollars – from our supposed real purpose – healthcare.

There are some truly phenomenal healthcare information technologies in the U.S. There are some truly phenomenal U.S.-based HIT companies. There are some truly phenomenal HIT folks, and HIT bloggers. But, when taken as a whole, when you read all the gripes and complaints about the state of HIT in the U.S. today, from providers or patients or vendors or regulators, it’s really hard not to sense a significant bastardization of what we might be, of what we started out to be.

Of course, nothing this immense can be reduced to one or two causative factors. And, I know that this perspective will likely tick some people off. Others will dismiss these ideas as those of an unimportant little independent doc/blogger. (Which I am!) Still others might think I’m anti-American or anti-Capitalism. (Which I’m not!) But if anyone can step back and look at the state of health IT here in the U.S., from a total gestalt-type view, and not see one big bastardized version of what we could/should be … well … show me, and I’ll buy a round for the whole HIT house.

From the trenches…

PS – Does my little opinion really matter? Naw. Just throwing it out there into the mix with those of all the other grumps.

“America’s health care system is neither healthy, caring, nor a system.” – Walter Cronkite

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, an HIT and marketing consultant, and sits on the board of directors of the Ohio Health Information Partnership.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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