News 4/15/14

AAFP President Reid Blackwelder, MD offers an interesting spin to last week’s disclosure of Medicare payment data. Blackwelder notes that while the release may make some family physicians feel threatened, he points out that the “action taken by CMS will provide a great opportunity for the Academy to highlight the complexity of care that family physicians provide.”  Blackwelder likely hopes the payment details will positively impact family physicians’ bottom lines, noting that the data reflects the disparity in compensation between specialists and family physicians, who “are near the bottom of the list in terms of payment.”

Meanwhile, the AMA emphasizes that CMS released “raw data with little context and considerable limitations” and offers some points of clarification to help physicians answer questions from inquiring patients. Key points include:

• Medicare payments don’t equate to a physician’s personal income. Physicians also have practice overhead and receive payments from other sources.
• The released data may be not include all services performed, could contain errors, and could include figures related to services rendered by residents or other providers.
• Claims data does not provide implicit details on outcomes.

Finally, let’s just hope the financial winners in all this are not the lawyers specializing in healthcare fraud cases. Not surprisingly, so-called whistleblower attorneys pounced on the data in hopes of expanding existing cases against providers and pharma companies and in search of leads for potential new lawsuits. I see a flood of late night commercials in the works urging medical billers to call a special toll-free number to report employers’ billings that might to be out of line with the rest of the industry.

Sermo reports that its online community has grown to 260,000 US physicians, which represents a 30 percent increase since October, 2013.

The 260-provider Phoebe Physician Group (GA) selects athenahealth for EHR/PM and care coordination.

Shenandoah Medical Center (IA) will deploy Allscripts Sunrise solutions, including Allscripts Sunrise Ambulatory Care.

DrChrono raises an additional $2.69 million in convertible debt funding, giving it overall funding of $6.77 million. The company offers a free EHR platform and says  60,000 physicians are “signed up” to use their program. I assume that number includes me after I took about 30 seconds to register my “family practice.” The website says that  DrChrono is Stage 1 certified, however Stage 2 certification is not mentioned. Regardless of my doubts, investors seemed to have found their story compelling enough to pony up additional funds.

CMS offers guidance on how providers can take advantage of the new Attestation Batch Upload option, which allows multiple EPs (and hospitals) to submit attestations in a single file through CMS. Incentive payments are provided to individual providers and not to medical groups or hospital systems, even if attestation is submitted in batches.

Here’s a different twist to the standard privacy breach. A former administrative assistant at a Tennessee urology practices sends a competing practice the names and addresses of 1,114 patients so the competitor could solicit business. No data commonly used for identity theft was provided, nor any clinical information. So far no word on possible charges filed against the terminated employee, nor the competing practice.

The Boston Business Journal names athenahealth the top publically traded Massachusetts software company with the largest market capitalization at $5.5 billion. Nuance Communications was a close second with a market cap of $5.2 billion.

Talksoft Corporation makes its appointment reminder app Talksoft Connect available for Android devices. The app allows patients to confirm or request a reschedule, alerts patients of a payment due, and offers automatic entry and alarms on a device’s calendar.

AdvancedMD introduces the 1.5 version of its iPad release that includes image capturing within notes, patient search enhancements, a refreshed interface for iOS 7, and faster messaging capabilities.

A Texas family physician finds professional satisfaction after ditching insurance and charging his largely uninsured patient base a flat $50 fee per visit. The “direct primary care” model isn’t new but may find new popularity from physicians opting to avoid administrative overhead and billing hassles. Unlike the concierge model where doctors charge higher annual fees and spend more time with fewer patients, Laredo physician Gustavo Villarreal, MD (above, in front of his paper charts) sees 40 to 60 patients a day and says the change has made him feel like he’s a doctor again.

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News 4/10/14

HHS releases data for over 880,000 healthcare providers who collectively received $77 billion in Medicare payments in 2012. The agency notes that “with this data, it will be possible to conduct a wide range of analyses that compare 6,000 different types of services and procedures provided, as well as payments received by individual health care providers.”

Look for many more reports like this one published by The Wall Street Journal as organizations begin downloading and manipulating the Medicare payment data. The WSJ determined that the top one percent of the 825,000 individual medical providers accounted for 14 percent of the $77 billion in payments, and 344 providers received more than $3 million each.

I’m not sure the average physician needs to be too worried that a nosy neighbor will now be able to figure out what the government has been paying him/her because downloading and manipulating the data isn’t the simplest exercise. The data is available in a tab delimited file format which I am sure works great if you have statistical software to do the manipulations. Most folks don’t, so they’ll have to download an Excel version of the data. The files are broken down by the letters of the alphabet and are still huge (“S,” for example, is 168MB.) Because of the size, each file takes a couple minutes to download. When I tried to download a second file/letter of the alphabet, it caused Excel to crash, though admittedly I had quite a few other windows open at the time. But, let’s say you successfully download a file. The next step would be to filter about a million (seriously) lines of data to find a particular physician and then figure out the appropriate payment figure (submitted amount vs. payment amount).  Even if you pick the correct reimbursement figure, you’d then need to multiple it by the correct number of encounters (even more difficult to decipher). Of course, keep in mind that the each provider’s data excludes procedures performed on fewer than 10 Medicare patients, so probably whatever final number you derive, it’s probably incomplete.

The HHS OIG reverses an 2011 advisory opinion that had allowed athenahealth to charge $1 to providers not on the athena network for processing their test orders. The termination means that athena can no longer distinguish between in-network and out-of-network providers and will therefore charge $1 for all orders. In reconsidering its position, the OIG concluded the arrangement could violate anti-kickback statues. Meanwhile, athenahealth calls the reversal a “setback” for sustainable HIE.

Lakeland Regional Health Systems (FL) will expand its use of Allscripts ambulatory EHR and PM, utilize Allscripts managed services, and implement Allscripts Payerpath financial management software. Last year Lakeland acquired Clark & Daughtrey Medical Group, an existing Allscripts customer.

e-MDs adds PDR Brief to its EHR, giving users enhanced drug information and alerts from PDR Network.

CMS develops a Stage 2 Meaningful Use Attestation Calculator to help providers determine if they can successfully meet Stage 2 requirements by identifying a pass/fail summary for each measure.

Individuals posing as patients covered by private insurance were more likely to secure a new-patient appointment with a primary care physician than other “secret shoppers” posing as patients covered by Medicaid or uninsured, according to researchers from the Perelman School of Medicine at the University of Pennsylvania. Researchers placed a total of 12,907 calls to 7,788 primary care practices to secure new appointments. Eighty-five percent of patients with private insurance obtained appointments, compared to 58 percent with Medicaid, 79 percent with no insurance but willing to pay in full with cash, and 15 percent with no insurance but willing to pay $75 or less at the time of service.

An Institute of Medicine report recommends including information on patients’ social influences and behavioral habits in their EHRs, arguing the data can help improve outcomes and advance public health research efforts.

Harmony Healthcare IT, which provides support for 3,000 Medical Manager PM systems, partners with ZirMed to provide users an ICD-10-ready claims submission solution. Wow, who knew there so many practices still running Medical Manager?

Independence Blue Cross (PA) and the physician practice arm of dialysis provider DaVita launch Tandigm Health, a new healthcare business model that aims to reduce care costs of chronically ill patients by working to keep them out of the hospital. Tandigm will offer primary care physicians higher reimbursement rates and access to analytical tools and real-time data  to help patients better self-manage their conditions, as well as provide monitoring tools for use in patients’ homes. The press release is short on details so it’s unclear what penalties the participating physicians will incur if care costs don’t decline.

Health plans must honor physician requests to use the Automated Clearing House (ACH) Network to conduct EFT and ERA transactions, according to a CMS administrative simplification email update. CMS also notes that health plans cannot charge a fee or use any other method to encourage a physician to use an alternative payment method other than EFT through the ACH Network, and, physicians are not required to use EFT.

Since I hate robocalls, I’m thinking about sending a link to this story to all my doctors. Vanderbilt Medical Group (TN) reports a 50 percent response rate for text message appointment reminders, compared to a 30 percent response rate for robocalls. The higher response rate and the associated backfilling of cancelled visits has translated to 50 fewer no-shows per day.

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News 4/8/14

From Luliu: “Re: Public data. Am I the only physician concerned that CMS is releasing Medicare payment data on 880,000 physicians?” As early as Wednesday CMS will begin releasing details on the amount Medicare paid 880,000 individual health providers for their services in 2012. For years physician advocacy groups have fought to prevent having this billing data posted publically, arguing it invades the privacy of doctors. However, consumer groups and employers have finally won the argument that the data helps evaluate clinicians. Sure, plenty of nosy folks will look up the information just to see how much different providers are making, but the data will also help identify doctors’ expertise performing certain procedures and assist with fraud detection efforts. Look for a flood of opportunistic companies to pounce on this new source of big data.

Physician participation in the PQRS program increased 36 percent from 2011 to 2012, while participation in the eRx program jumped 22 percent. Despite the strong growth rates, only 36 percent of all EPs participated in PQRS in 2012; only 44 percent of EPs in the 2012 eRx program.

US practice administrators aren’t the only ones experiencing job stress as a result of increased patient loads, an overabundance of administrative tasks, and tightening budgets. A survey of UK practice managers working for general practitioners found that more than two-thirds have recently contemplated quitting their jobs due to discontent over increased workload complexity, rising intensity, stress, and hours.

Antelope Valley ACO (CA) selects eClinicalWorks Care Coordination Medical Record for population health management to advance its ACO-related objectives.

I found this opinion piece from The Huffington Post pretty offensive. The author, who is listed as an “etiquette expert,” offers tips for people sitting in physician waiting rooms. My irritation started at the first sentence: “We all know that doctors are often unable to meet their appointment times.” Rather than chastise patients for sprwaling on the furniture and not keeping their voices down, how about telling  physician and staff members that it’s wrong to make patients feel as if the clinician’s time is more valuable than the patient’s, aka, the customer? Or, at least encourage providers to  consider process changes to reduce excess waiting times? Of course not all doctors and staff ignore the value of their patients’ time, anymore than all patients steal the four-month-old magazines and ignore the handicapped patient needing help opening the door.

Andrew J. Sussman, president of the CVS MinuteClinic, views the role of retail clinics to be “complementary and supportive” of the broader healthcare landscape and believes retail clinics augment, rather than replace primary care physicians and the PCMH model. Sussman notes that the 800-location MinuteClinic is affiliated with 32 health systems and uses Epic’s EMR platform to communicate with other providers.

The California Medical Association names DocbookMD the association’s preferred provider of HIPAA-secured text messaging for its 39,000 members.

Highlights from a Black Book Rankings customer experience survey on ambulatory EHRs include:

• Thirty-one percent of all medical and surgical specialists are “very dissatisfied” with the ability of the EHR to decrease workload, compared to eight percent of primary care doctors.
• Primary care user satisfaction has jumped in the last six months among practices that implemented an EHR more than two years ago, in part due to improvements in workflow, MU achievements, and better support.
• More than one-third of primary care providers report a return to normal levels of productivity following their EHR roll-out.
• More than half of primary care providers said they’d recommend their EHR vendor to a colleague.
• Top scoring EHRs were Practice Fusion, Greenway, Care360 Quest, and Kareo.

The amended CLIA regulations, which give patients direct access to their lab test reports, goes into effect Monday, the same day Quest Diagnostics launched MyQuest by Care 360. The MyQuest patient portal allows patients to view copies of the lab test reports from Quest Diagnostics and does not require pre- authorization by a physician.

EdgeMED, a provider of medical office software, medical billing services, and HIT solutions, acquires physician billing and collections company  Physician’s Billing Alternatives.

ZirMed acquires the payment processing, patient eligibility, and patient estimation business owned by TransEngen.

How does this happen? A woman with no medical training uses false credentials to get a job as a physician assistant in a medical office. Over an 11 day period last summer she worked unsupervised, seeing about 200 patients before someone anonymously warned the head of the practice. Upon being arrested the woman told police she posed as a PA because it paid $23,000 than her previous job.

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News 4/3/14

The AMA has been pretty quiet about the ICD-10 deadline delay that was part of this week’s SGR patch legislation. AMA has long been quite vocal in its criticism of the transition, but denies it had another to do with its inclusion in the bill. The only item I could find on the AMA’s website, which I can only assume refers to the ICD-10 delay, was a comment that the overall legislation included “some positive provisions.” I wouldn’t be surprised if the AMA leads the charge for skipping ICD-10 altogether in favor of ICD-11.

Also still silent on the ICD-10 delay: CMS, which has yet to offer any official comments.

CareCloud names Lee Horner (Eliza Corporation/Vitera Healthcare) chief sales officer.

McKesson Specialty Health agrees to acquire a majority stake in Oncology Rehab Partners, an oncology rehab company that offers training and certification services for cancer care providers.

Accenture estimates that the use of its X-box based Teki program has saved Spain’s Basque Country $69 million during its first year. Patients are able to use a Kinect system attached to an Xbox in their home to communicate with their doctor using video conferencing, voice, or text messaging and doctors can check patients’ vitals via a wireless heart monitor and spirometer attached to the Kinect box. Accenture says that 18 percent of all primary care interactions in the region are now happening on the phone or online.

Brigham and Women’s Hospital (MA) plans to hire scribes to input EMR data, giving  doctors more time to focus on and talk with patients.

Kaiser Health News provides an insightful look at what is driving primary care physicians to leave independent practice and where they are opting to land. Physicians tired of high stress levels and long hours are giving up private practice for hospital employment, or converting their practices to concierge models, or taking early retirement. EMRs are the greatest source of frustration for many doctors who complain the technology slows them down, interferes with the physician-patient interaction, and turns physicians into data entry clerks.

I was amused by this photo from an article highlighting the growth of the concierge practice model. The two-doctor practice, which charges a $780 a year retainer fee and limits the practice to 600 patients, either does not net enough to buy an EMR, or, the prefers to keep medical charts the old-fashioned way.

Physicians in academic settings report higher compensation when the majority of their time is spent seeing patients, rather than on research activities, according to an MGMA compensation survey. General internists saw four percent pay increases in 2013 to over $180,000 when billable clinical work made up more than two-thirds of their time.

Talk about a complete bust of a day. A South Carolina woman sustains injuries in a car crash following a three-county police chase. She was admitted to the hospital and while in surgery doctors found 19 grams of methamphetamine hidden inside a body cavity. Other aspects of the investigation are ongoing.

The Kansas Senate passes a bill requiring insurance companies to give patients a cost estimate before services are provided. If passed, insurers would be required to inform consumers of all out of pocket costs, plus the amount the provider will be paid. I wonder if physicians really want their patients to have that much transparency in advance of an office visit or procedure.

3M completes is acquisition of Treo Solutions, a provider of data analytics and business intelligence to providers and payers.

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News 4/1/14

The one year delay for the mandatory implementation of ICD-10 is almost a done deal following the Senate’s approval of the legislation on Monday. The bill primarily addresses a Sustainable Growth Rate fix that prevents a 24 percent reduction on physician Medicare payments as of April 1 and will now go to the President for signature. I wonder how many of the 535 voting members of Congress had a clue that the legislation included the ICD-10 date change, much less understood its potential impact to the industry. For all the gloomy predictions about disruptions in cash flow and lack of readiness by various stakeholders, shifting the deadline will come with a whole new set of issues and expenses. For example, what about all the ICD-10 ready software releases that likely include unrelated enhancements? Will vendors have to invest more money to re-engineer updates so that the unrelated enhancements work with ICD-9? And then there is the question of how we can wait one more year without having a specific code for things like being hit by an object falling from an aircraft (V96.31XA) or for an injury caused by a sea lion bite (W56.11XS).

Specialists who are late in adopting EHRs may struggle to meet the patient portal requirements to satisfy Stage 2 MU requirements, according to a study published in the American Journal of Medical Quality. Researchers found that 87 percent of primary care physicians would have met the email communication threshold for Stage 2 in 2013, but only 37 percent of specialists, probably because specialists that don’t provide chronic care generate fewer emails. The authors conclude that other avenues of patient engagement, such as providing patient education or online post-op instructions, would be more appropriate for specialists. This particular Stage 2 requirement is just one of several that is well-intentioned but difficult, if not unrealistic, for specialists to achieve. Is it any wonder that a significant number of specialists are predicted to “drop-out” of the MU program before attesting for Stage 2?

HHS releases a security risk assessment tool for small to medium physician practices. It’s available for the desktop, iPad, or as Word documents and produces a report that can be provided to auditors.

Insight Software will integrate DrFirst’s Rcopia e-prescribing platform into its My Vision Express EHR.

Through February, 2014, a total of 343,204 EPs have been paid $4.4 billion in MU incentives under Medicare,  $2.7 billion under Medicaid, and $315.7 million under Medicare Advantage.

From across the pond: 60 percent of GPs in European Union nations were using eHealth tools in 2013, a 50 percent increase since 2007. Interoperability issues, a lack of regulatory framework, and inadequate resources are some of the most common barriers to adoption (sound familiar?) The Netherlands, Denmark, and the UK led other nations in efforts to digitize patient records.

Best Doctors, which offers remote second opinion services, launches Medting, an online physician collaborative platform that allows doctors to collaborate to make correct diagnoses and to seek guidance for patient treatment plans.

The Government Accountability Office recommends that CMS expand performance benchmarks that assess Medicare physicians to include state or regional averages. In addition, as CMS implements and refines its physician feedback and Value Modifier programs, it should follow the example of private entities that use multiple benchmarks and should disseminate feedback reports more frequently than once a year.

An Alabama legislator reads a letter from constituent Marlin Gill, MD, who clearly is not a big fan of Washington and its “war on doctors.” I wonder how many other physicians share his views and believe all the government’s various initiatives to improve quality and trim costs is wasted effort.  Among his list of complaints:

• Being “forced by ill-informed bureaucrats to implement electronic medical records” that cost is four doctor practice “well over $100,000 plus continuing yearly operational costs . . . all of which does not help take care of one patient while driving up the cost of every patient’s health care.”
• “Destructive regulations” that add costs and “force doctors to focus on things other than patient care and reduce the number of patients we can help each day.”
• The cost of migrating to ICD-10, which is costing his practice $80,000 “without one iota of improvement in health care quality.”

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