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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News 3/27/14

A newly posted bill to patch the SGR for 12 months includes a minimum one year delay for the adoption of ICD-10. The bill, which was negotiated by House and Senate leaders, is expected to go for a vote Thursday, March 27,  four days ahead of a scheduled 24 percent cut in physician Medicare pay. If passed, the ICD-10 adoption date will be pushed until October 1, 2015 and legislators would have another year to pass a permanent repeal of the SGR payment provision. AHIMA quickly announced opposition to the ICD-10 delay saying it will cost the industry money and wasted time implementing the new code set. Can I just say I am tired of all the politics? Few people want to see doctors getting a 24 percent pay cut so look for the legislation to pass and ICD-10 to be delayed – unless the ICD-10 provision is somehow stripped from the bill.

Aprima Medical and Etransmedia announce an upgrade program for Etransmedia customers using the Allscripts MyWay platform. Etransmedia customers, which include providers that purchased MyWay through Costco, have the option to become an Aprima client, or, to use the Aprima system but remain a hosted client of Etransmedia. Both options provide current Etransmedia customers with one free Aprima licenses for each existing MyWay license.

Surescripts awards e-MDs its White Coat of Quality award for applying best practices to the use of e-prescribing technology.

The 220-physician Summit Medical Group (TN) names Ed Curtis (Hattiesburg Clinic) COO and Joseph Ortiz (4D Imaging Systems) CIO.

CMS reminds Medicare EPs that the deadline to attest for MU to receive a 2013 incentive payment is March 31 at 11:59 p.m. ET. The deadline for Medicaid EPs varies by state. This part of the notice is a bit troubling:

Due to the large volume of providers attesting, please submit your data as soon as possible and during non-peak hours to avoid system delays.

CareCloud launches CollectiveIQ, a billing rules platform that is embedded within the CareCloud platform to improve claims accuracy.

Athenahealth adds Precyse University to its More Disruptive Please program and will offer users access to Precyse’s ICD-10 educational tools.

The American Academy of Ophthalmology launches IRIS Registry (Intelligent Research in Sight), a centralized data repository and reporting tool that aggregates outpatient clinical data from EHRs for practice benchmarking, for monitoring patient care, for tracking interventions, and for evaluating outcomes.

More medical schools are expected to include some EHR requirements in their curricula because the exposure to IT systems is increasingly considered a crucial element of the medical education experience.

California Health Report looks at EHR adoption among the state’s physicians and clinics and finds the process is not always smooth. Implementation issues are related to technology and to human factors and most physicians take two years to become competent on EHRs. An official with the California Healthcare Foundation notes, “there’s still a lot of room for improvement.”

A local paper profiles Sanford Health’s (SD) e-visit program, which is available to  patients for $55 and connects them with a Sanford provider who will prescribe medications and/or offer medical advice within four hours. Currently the only patients eligible for e-visits are adults enrolled in the clinic’s MyChart patient portal program who present with one of seven non-emergency conditions.

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News 3/25/14

EHR usage in small physician offices has helped spur overall EHR adoption to 61 percent, according to an SK&A report on physician office EHR use. Other key findings:

• The adoption rate for single doctor offices grew from 42.3 to 53.7 percent from 2013 to 2014.
• EHR adoption rates increase as the number of physicians practicing at each site rises; as the number of exam rooms at each site increases; and, as average daily patient volume rises.
• Physicians working for integrated health systems have higher adoption levels than providers working under other type ownership models.
• Epic, eClinicalWorks, and Allscripts lead other vendors in terms of market share.

St. Francis Health System (OK) will go live across its 70 physician offices in May and at its hospitals in June.

The AAFP offers an online PCMH planner to help practices achieve medical home practice transformation by assessing a practice’s current program and identifying specific goals to fill any gaps. The subscription-based planner starts at $100 for members and $149 for non-members.

How do these things still happen? A Topeka, KS man opens a dumpster in his office complex and finds discarded medical records, complete with patient names and social security numbers. Perhaps not coincidentally a document scanning service has an office in the same complex. The state attorney general’s office have removed the charts for further investigation.

The Naval Branch Health Clinic Albany (FL) announces the availability of secure email between patients and providers using RelayHealth’s secure messaging service.

GMed introduces a revenue cycle management service that complements its existing gastroenterology-specific EHR and practice management, report writing, and patient portal platform.

The Robert Wood Johnson Foundation launches Flip The Clinic, an initiative meant to transform the average doctor visit to be more satisfying. The idea is to have the Flip The Clinic website serve as a hub for patients, providers, and other stakeholders to share ideas for improving the physician visit experience so that it’s more satisfying for patients and optimizes physician expertise. I like the concept and the mission, but I’m not convinced it’s something the average patient (or physician) will take the time to find and participate in. I hope I’m wrong.

The use of copy and paste functionality in EHRs should only be permitted in the presence of strong technical and administrative controls, which include organizational policies and procedures, requirements for participation in user training and education, and ongoing monitoring. That’s the recommendation of AHIMA in a newly published position paper that warns users that the efficiency and time savings benefits of copy/paste functionality should be weighed against the potential for creating inaccurate, fraudulent, or unwieldy documentation. The use of copy and paste functionality is too entrenched in EHRs to be eliminated so kudos to AHIMA for offering solid and realistic recommendations to reduce the potential risks.

The Federation of State Medical Boards is considering a policy that could impact the delivery of telemedicine services by requiring a physician to be licensed where the patient is located. The policy also requires the same standards of care apply for both virtual and face-to-face encounters.

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News 3/20/14

Saint Peter’s Healthcare System (NJ) selects athenahealth’s athenaOne EHR, PM, and communication system for its 176 hospital- and clinic-based physicians.

American Family Care, which operates 160 urgent care facilities across 26 states, agrees to pay the federal government $1.2 million to resolve allegations that it knowingly submitted claims using billing codes higher than appropriate for the actual service rendered. The case stems from a whistleblower lawsuit filed by one of the organization’s former claims processing directors.

Nationwide 62 million people have no or inadequate access to primary care given local shortages of physicians, according to a report by the National Association of Community Health Centers. Not surprisingly the Association recommends the government provide community health centers with plenty of funding to help address access challenges, but I think the fix requires more than just more money. I’m reminded of a session during  HIMSS featuring occasional HIStalk contributor Lyle Berkowitz, MD, who correctly stresses the need for innovation and technology in healthcare to improve access:

If we don’t adopt new technology and change the way we deliver care, it will be harder and harder to get to see a doctor, it will cost more, the rich will cope, the poor will suffer. Many will die earlier than they would have if cost effective treatments were available. We have to act now before the healthcare system goes into meltdown.”

The Drummond Group certifies Kareo EHR for MU 2014 Stage 2.

CMS releases Road to 10, a free online resource to help physicians in small practices in their transition to ICD-10. The tool to build an action plan (actually a  “catch-up plan”) looks pretty handy and allows providers to customize their roadmap based on practice size, specialty, and  the type of technology used in the practice.

Not so surprising findings from a RWJF-funded study: physician practices participating in ACOs tend to be relatively large, members of an IPA or PHO, less likely to be hospital-owned, and more likely to use care management processes and EHRs as compared to practices not participating in ACOs. Researchers found that 61 percent of practices have no plans to participate in ACO, which raises the question of how to get the balance of practices on board with ACOs, if in fact the ACO model proves to provide better and more cost-effective care.

Welcome to new HIStalk Practice Platinum Sponsor Arcadia Healthcare Solutions, which is headquartered just outside of Boston and has additional offices in New York, Seattle, and Nashville. Arcadia provides services and technology for EHR outsourcing; data integration and population analytics; and care delivery transformation and coaching. Clients of the 12-year-old company include five Pioneer ACOs, leading academic medical centers, national health systems, managed care organizations, and several Blues. Arcadia’s advisors can help practices  improve key ambulatory network measures 15 to 30 percent in six months by bringing together EHR and claims data and helping providers use it. Some of its EHR optimization accomplishments include reducing log-in time by 50 percent, improving system performance by 27 percent, and increasing physician satisfaction by 20 percent. Arcadia provides expert advisors rather than, as it says, “high-priced management consultants who leave nothing behind but PowerPoint.” Thanks to Arcadia Healthcare Solutions for supporting both HIStalk and HIStalk Practice.

InstaMed launches InstaMed Go, which allows providers to collect patient payments via smartphones from any location with the payments posted automatically to their practice management systems and receipts emailed to patients.

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News 3/18/14

From Soothsayer: “Re: Castlight Health fallout. Given Castlight’s tremendous IPO success, look for more HIT companies to follow suit. A few we might see within the year: Practice Fusion, CareCloud, and ZocDoc.” Castlight’s share price surged 149 percent during its Friday IPO, giving the company a valuation of more than $3 billion. That’s a pretty impressive debut, especially considering Castlight had $13 million in revenues and a $62 million net loss in 2013. There’s clearly a lot of interest in the HIT sector so I’m with Soothsayer on this one.

CMS wants to recoup improper payments made through its PQRS and e-prescribing incentive program and will launch a four-year program to look for potential errors, inconsistencies, and gaps related to data handling, program requirements, and clinical quality measure specifications. According to a Federal Register notice, CMS will survey 400 group practices, registries, and data submission vendors and perform a limited number of follow-up interviews.

Disturbing: researchers from the University of Illinois at Chicago find that transitioning from ICD-9 codes to ICD-10 could lead to a significant loss of data, based on an analysis 220 hematology-oncology and outpatient diagnostic codes. Specifically researchers found the transition affected eight percent of state Medicaid codes and one percent of codes in the University of Illinois Cancer center; potential costs associated with the information loss totaled $479,299. What’s particularly troubling is that the study focused on hematology-oncology codes, which involve fewer ICD-10 codes and thus less convoluted mappings than codes in other specialties.

The House passes legislation to permanently repeal Medicare’s SGR payment formula, but, full passage of the law is unlikely because it includes a provision to delay the ACA’s mandate requiring all individuals obtain health insurance. Without a repeal or a temporary patch, doctors face a 24 percent cut in Medicare reimbursements as of April 1.

UnitedHealthcare, Aetna, BlueCross BlueShield, and Humana tell the AAFP they’ll be ready for ICD-10 by the October 1 deadline, though some of the carriers express concerns that small, private practices are behind in their preparations.

What employed physicians like most about not being self-employed: not having to deal with the business of running an office and not having to deal with insurers and billing. According to a Medscape survey of 4,600 doctors, employed physicians complain about the lack of input into how they practice, but 70 percent of physicians who were once self-employed report being happier employed.

On the heels of a recent study questioning the effectiveness of the PCMH model in improving care and reducing costs, the NCQA previews 2014 PCMH recognition standards, which include more emphasis on team-based care. Other areas that NCQA is “raising the bar,” include:

• Care management focus on high-need populations
• Alignment of quality improvement activities
• Additional integration of behavioral health

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