News 2/18/14

The Colorado Health Institute analyzes the state’s looming shortage of primary care providers, which mirrors deficits across the country. The CHI offers several recommendations to address the estimated shortfall of 258 providers, including the use of emerging technology to increase patient self-care of common ailments and to advance options for self-diagnostic testing. The CHI also encourages streamlined policies to increase the use of telemedicine.

ONC reports that RECs have “far exceeded” their goal to support the adoption and use of HIT by 100,000 small practices, CHCs, and rural and public hospitals, while continuing to support providers to reach MU. I found the ONC’s announcement a little confusing since only 85,000 PCPs had met the MU milestone by the end of November, which is clearly short of the 100,000 goal.

The Worcester Business Journal looks at EHR adoption in the state of Massachusetts, which is requiring all providers to sign onto the Mass HIway HIE by 2017. Small practices and certain specialized providers are most resistant to automation, largely due to cost concerns and skepticism over potential benefits. Girish Navani, CEO for the Worcester-based eClinicalWorks, notes that it will be “only a matter of time before providers everywhere will convert” to meet regulatory requirements and to recognize the benefits of sharing patient records electronically.

I was looking at the latest MU Workgroup Stage 3 recommendations and noted a few new items that could potentially impact EPs, should these requirements be included in the final rule. Recommendation requirements include:

• The EHR would assist with follow-up on orders, including the return of results from specialty consults to the ordering provider.
• The EHR would provide EPs with access to medication fill information from pharmacy benefit manager
• Patients would have an easy way to request an amendment to their record online to offer corrections, updates, or additions.
• Patient-generated health information could be added electronically through a questionnaire, survey, or intake form, or, through secure messaging.

The National Testing Program for ICD-10 readiness of HIPAA transactions extends certification to Greenway’s SuccessEHS solution.

Benchmark Systems will offer its customers electronic statements and online pay solutions from PatientPay. Benchmark also announces several new customers including Comprehensive Pediatrics of Brooklyn (NY) for EHR and PM, Advent Medical Group (MO) for EHR, and, Dawn’s Medical Billing (VA) and American Self (VA) for PM.

SimplifyMD version 14.0 achieves 2014 Edition Complete EHR Ambulatory ONC HIT Certification from ICSA Labs.

Researchers from the University of Pennsylvania find that dermatologists that evaluated hospitalized patients using teledermatology provided nearly identical assessments as doctors examining the conditions in person.

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News 2/13/14

ICD-10 implementation costs for physician practices could be almost three times higher than estimated five years ago according to an AMA report that considered such factors as training materials, consulting fees, software upgrades, testing, payment disruptions, and physician productivity losses. The study predicts that small practice costs will range from $56,639 to more than $226,000; medium practices will pay between $213,364 and $824,735; and, large practices could spend between $2 and $8 million. Vendor/software upgrade costs represent a major cost variable that most, though not all,  practices will face. Meanwhile, the AMA “strongly urges CMS to reconsider the ICD-10 mandate,” which the organization believes is financially disastrous for physicians, impedes progress to a performance-based environment, and is unlikely to improve the care physicians provide their patients.

Sobering: a survey of 1,000  (seemingly self-selected) physicians finds that 70 percent don’t think the HITECH program was worth its cost. Other key findings:

• 65 percent say their EHR implementation has led to financial losses.
• 45 percent believe care has become worse since implementing EHR.
• 73 percent of the largest practices would not purchase their current EHR system again.
• 67 percent dislike the functionality of their EHR systems.
• Nearly half believe the cost of these systems is too high.
• More than two-thirds say that coordination of care with hospitals has not improved.
• Nearly 38 percent doubt their system will be viable in five years.
• 26 percent doubt their vendor will be in business in five years.

RelayHealth Financial achieves full EHNAC HNAC accreditation for the 14th consecutive year.

Privia Medical Group (VA) will implement athenahealth’s PM, EHR, patient communication, and care coordination services for its 154 providers and affiliated ACO.

Also from athenahealth: the company  announces that it has integrated drug monographs from its Epocrates acquisition into athenaClinicals.

Four Ellis Medicine (NY) primary care locations deploy PCMH transformation management and analytics tools from Arcadia Healthcare Solutions to earn Level 3 NCQA PCMH recognition.

HIMSS Analytics recognizes 51 clinics of Northeast Georgia Physicians Group with its Stage 7 Ambulatory Award.

CMS and ONC introduce Randomizer, a tool that allows providers to exchange data with a test EHR in order to meet measure #3 of the Stage 2 transitions of care requirement.

Kareo launches a new MU resource center that includes links to articles, websites, and white papers, as well as FAQs that cover basics about MU and attestation.

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News 2/11/14

Lawmakers propose legislation that repeals the SGR formula and introduces a Medicare physician payment system that rewards merit over quantity of services and incentivizes physicians to participate in alternative payment models. Some specifics include:

• Medicare would eliminate the scheduled three percent reductions in reimbursements for failing to comply with MU criteria, as well as the escalating penalties of up to five percent in 2019
• Medicare would drop the two percent penalty scheduled for 2017 for failing to report PQRS measures
• Physician payments would increase 0.5 percent a year for five years
• EHRs would be required to be interoperable by 2017 and providers would be prohibited from deliberately blocking information sharing with other EHR vendor products
• Technical assistance funding would double for small practices with 15 or fewer professionals
• Beginning in 2017, HHS would monitor clinicians for the appropriate use of advanced diagnostic imaging based on appropriate use criteria. Physicians deemed “outliers” for non-use or non-compliance of appropriate use would be subject to prior authorization for applicable imaging services.

CMS announces a one month extension of the deadline for EPs to attest for MU for the Medicare 2013 reporting period. In its email announcement CMS did not provide an explanation for moving the deadline to March 31.

Georgia Physicians for Accountable Care selects eClinicalWorks Care Coordination Medical Record to advance its ACO objectives.

A screening program for abdominal aortic aneurysms integrated into an EHR reduced the number of unscreened at-risk men by more than 50 percent within 15 months, according to a Kaiser Permanente study.

The NCQA recognizes the 180-provider HealthPoint Medical Group (FL) as the first practice to earn NCQA Patient-Centered Specialty Practice Recognition for its efforts collaborating with patients to improve quality.

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News 2/6/14

The overall readiness for ICD-10 implementation continues to lag, according to an MGMA survey of 570 medical practices. As noted by MGMA president and CEO Susan L. Turney, MD, “Very simply, ICD-10 is behind schedule.” MGMA finds that less than 10 percent of  practices are making significant progress in their overall ICD-10 readiness. Other key findings include:

• More than 80 percent of respondents will require an upgrade or replacement of their PM software to accommodate ICD-10 diagnosis codes.
• Vendors will not cover upgrade costs for the majority of practices. Average upgrade cost for a PM upgrade/replacement is $11,500 per FTE physician and $12,885 for EHR.
• Only 8.2 percent have begun testing with their EHR vendor and only 10 percent with their PM vendor.
• Nearly 60 percent of practices say they have not heard from their health plans regarding ICD-10 testing and nearly 50 percent have not heard from their clearinghouse vendor.
• Concerns remain high over the expected changes to clinical documentation and the loss of clinician and coding staff productivity.

Epic, eClinicalWorks, and Allscripts own about 30 percent of the overall EHR practice market according to an SK&A report from January, 2014. The top 20 EHRs are implemented in almost three-quarters of all practices that use an EHR.

Metro-North ACO (PR) selects eClinicalWorks Care Coordination Medical Record to advance its physician-led ACO objectives.

Surescripts introduces Record Locator & Exchange, which utilizes a master patient index to locate the medical records of a single patient, even when records are held by multiple providers, and, CompletetEPA, an end-to-end prior authorization solution that integrates into a physician’s EHR workflow and enables real-time information exchange between providers and pharmacy benefit managers.

ADP/AdvancedMD customer Jed Shay, MD shares how his use of AdvancedMD’s EHR and PM services have contributed to improved cash flow, productivity, and patient tracking.

North Carolina’s troubled Medicaid billing system goes off-line Tuesday morning for approximately 18 hours, impacting providers’ ability to submit claims. Computer Sciences Corp., which maintains the NCTracks portal, blames the failure of a network switch.

Covenant Surgical Partners will implement gMed’s gGastro EHR within 12 of  its physician offices and endoscopy procedure centers.

HHS finds that most health centers (72 percent) have been able to meet MU objectives related to data capture, but few (24 percent) have met objectives for sharing data. Only 14 percent of the 233 clinics surveyed had the capacity to meet all core Stage 1 objectives and at least five menu objectives.

Compared to patients who visit a doctor’s office for similar conditions, adults taking advantage of telehealth services are younger, more affluent, more technology savvy, and less likely to have used healthcare before their telehealth visit, according to a Health Affairs-published study.

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News 2/4/14

CMS issues a final rule allowing patients or their representatives to access completed lab reports directly from laboratories, rather than only permitting physicians to provide their patients with results.

A fee schedule survey of 2,619 practices reveals that 2013 reimbursement levels remained flat for existing patient visits and declined as much as 21 percent for new patient visits.

Spectrum Health (MI) selects PerfectServe’s Clinician-to-Clinician and DocLink platforms for direct and secure clinician communication.

EHR alerts show promise in changing physician behavior when treating overweight and obese children, report researchers from the University of California at Davis. Researchers added obesity-related alerts to the health system’s outpatient EHR and found significant, though not dramatic improvements in treatment. Findings included modest increases (from 40 to 57 percent) in the proportion of children diagnosed as overweight or obese; a 10 percent increase for lab tests for diabetes and dyslipidemia; an increase in follow-up appointments from 24 to 42 percent; and a static number of referrals to dietitians (13 percent.)

Last week on HIStalk we recognized athenahealth for unseating Epic for the first time in eight years as the top overall vendor in the “Best of KLAS” awards, and mentioned all the Best in KLAS winners. In the ambulatory EHR and PM categories the top-ranked vendors and their scores were:

Ambulatory EMR (over 75 physicians) Epic EpiCare Ambulatory (85.7), eClinicalWorks (72.8), Cerner Millennium PowerChart (72.4)

Ambulatory EMR (11-75 physicians) –  EpiCare (84.5) athenahealth, athenaClinicals (83.6), Greenway Medical PrimeSUITE (80.4)

Ambulatory EMR (1-10 physicians) – SRSsoft (90.9), athenaClinicals (87.2), e-MDs (85.2)

PM (over 75 physicians) – Epic Resolute/Prelude/Cadence Ambulatory (87.5), eClinicalWorks (77.9),  NextGen Healthcare (76.4)

PM (11-75 physicians) –  athenaCollector (87.7), Greenway (83.3), NextGen Healthcare (77.0)

PM (1-10 physicians) –  athenaCollector (89.5), Greenway (85), Henry Schein MicroMD (81.8)

KLAS also named the highest rated products in a couple of EMR and PM subset categories:

• 150+ physicians – Epic for ambulatory EMR (85.8) and for ambulatory PM (88.3)
• Single physician EMR – e-MDs (84.2)
• Single physician PM – athenaCollector (81.4)

A small shout-out to PCC Partner, which scored highest in both the EHR (94.4) and PM (91.7) 1-10 physician segments, but was excluded from the overall rankings because KLAS considers them to be “component” products.

CMS reports that through 2013, 436,000 EPs and hospitals have registered for the MU program and 334,000 have been paid incentives for meeting MU requirements, including 63 percent of all EPs. A mere 213 EPs out of 215,288 who attested for Medicare in 2013 were unsuccessful.

The average wait time to schedule a doctor appointment if you live in a large metropolitan area: 19 days, though depending on the specialty and region it could be as little as a day or more than eight months. Boston has the longest average wait times across all specialties at 45 days.

Athenahealth accepts about $6.7 million in state and local incentives to open an R&D office in Austin, TX and pledges to create 600 jobs over the next ten years with an average salary of $132,000. The company will invest $13 million to convert 110,000 square-foot of office space space within the redeveloped Seaholm Power Plant.

CMS gives physicians and their billing staff a chance to assess their ICD-10 readiness during a limited front-end testing session March 3-7. During the testing week, physicians can submit claims using ICD-10 codes for services rendered between October 1, 2013 and March 3 to determine if their Medicare administrator contractors can receive the claims and determine if the claims are accepted or rejected.

The 50-physician Green Clinic (LA) implements Bomgar’s appliance-based remote support solution to provide IT support across its seven locations.

More than 400 Walgreen Healthcare Clinic locations will implement Inovalon’s Electronic Patient Assessment Solution Suite to provide predictive analytics tools at the point of care.

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