HIT Vendor Executives on Expectations and Plans for 2014 – Part One of a Series

We asked several vendor executives a series of three questions related to their expectations and plans for 2014.

What will be the biggest challenges facing physicians and physician practices in 2014 and how will these trends impact their use of technology?

Raul Villar, president, ADP AdvancedMD

In 2014, physicians in private practice will be challenged with mastering Meaningful Use, weathering the implementation of ACA within the industry and its impact on patient population and reimbursements, preparing for the switch to ICD-10, and juggling everyday issues and challenges to ensure today’s claims will get paid in a reasonable amount of time.

Compliance complexity in each of these areas dictates the use of automation solutions so physicians can focus on patients. This is especially acute in smaller independent practices that do not have the staff or IT departments to manage compliance.  In this environment it will be critical for practices to work with technologies and vendors with compliance upgrades included in their products and processes vs. those requiring the practice to shoulder the responsibility of upgrading technology to remain compliant.

Under ICD-10, the benefits of fully integrated PM and EHR solutions will be dramatic as practices are required to produce more complex charting and coding in their EHRs. Having ICD-10 compliant charts flow directly into billing in fully integrated systems will reduce errors and rework.

Jim Hewitt, VP of solutions development, Allscripts

2014 is going to be a very busy year for physicians and their practices. The biggest challenge for most practices will be managing their system upgrades for MU2 and ICD10. On top of that, they will continue to move to a value-based care model which will be a major operational and financial shift for them. They’re going to need technology to help them manage their risk-based contracts as well as proactively manage their populations.

The other big challenge for physician practices is implementing a patient engagement strategy to meet MU2 requirements. Not only do they need to implement a solution, they need to engage patient populations to use the technology.

Todd Rothenhaus, MD, CMO, athenahealth

You can’t think of 2014 challenges in health care without thinking of ICD-10. Our annual Physician Sentiment Index survey, completed in 2013, showed physicians’ confidence in their practice’s ability to transition to ICD-10 is extremely low with only 8% saying they were “very confident” that the transition would happen smoothly. ICD-10, for too many, will be difficult and another massive “must do,” that needs to get done – in addition to Meaningful Use stage 2, and perhaps most overwhelming, smack in the middle as physicians and practices work to navigate and understand changing reimbursement models and their associated expectations – most importantly the ability to coordinate care.

I think in 2014 we’ll also see a massive EHR shopping spree and replacement trend that will be driven by significant failings of vendors who didn’t adequately support things like ICD-10, Meaningful Use, and aren’t building network-based open platforms to enable their clients (physicians/health systems) to truly coordinate care across the continuum. The tides in health care are changing and so will the technology that is deemed necessary to survive, let alone thrive.

Albert Santalo, CEO, CareCloud

This is always top of mind for us, so it’s something we’re constantly asking physicians about. Just a few months back, thePractice Profitability Index (PPI) – which surveyed more than 5,000 physician participants regarding issues impacting the financial and operational status of their practices – found that three of the top four issues negatively affecting profitability for all physicians stemmed from healthcare reform, led by declining reimbursements (65 percent), rising costs (57 percent), Affordable Care Act-related requirements (48 percent) and coding and documentation changes, including ICD-10 (44 percent).

Stephen Ober, MD, chief medical officer, Emdeon

The biggest challenges facing physicians and physician practices in 2014 revolve around patient engagement in two themes:

1) continued interaction with patients after they leave the provider’s office, and

2) how to assure that  the practice is meeting the payer performance criteria they signed up for earlier this year. Providers have to engage patients through technologies (portals, cell texts, etc.) to continue the relationship after the acute encounter. From a clinical performance standpoint, practicing providers have to understand the metrics that the payers are evaluating them against. Some provider groups fail to push these criteria down to the practicing clinician.

Patrick Hall, EVP of business development, e-MDs

ICD-10 compliance will present a unique challenge. Practices will need to invest not just in technology, but also the time and effort to learn the new coding system and, depending upon how their vendors/partners deal with the change, potentially modify existing systems and workflows to make the transition.

Many physicians will also need to adapt to an increasingly “open” environment with respect to exposing information to patients through portals and other tools. Patients are starting to expect this and so physicians and their staff will need appropriate protocols in place with respect not to whether information is shared, but how and when in the clinical information cycle.

Tee Green, CEO, Greenway Medical Technologies

There are three fundamental trends that will create both challenges and opportunities for physicians in 2014 while impacting their use of technology. The first is the electronification of healthcare, which will continue to progress rapidly in the ramp-up to ICD-10 compliance, meaningful use Stage 2 and other industry changes. Electronic health records are only one component of this trend, and it’s evolving to include access to real-time clinical insight that is available inside and outside of healthcare settings.

A second trend is consumerism. Consumer expectations now drive fundamental changes to the way healthcare is purchased and delivered in our country. As individuals become increasingly responsible for a greater share of their healthcare costs, they will no longer accept inefficiency and redundancy in care. They also have high expectations around convenience. As a result, physicians must be more transparent about costs and quality, while making it easier for patients to engage in their care.

Another trend is an increased focus on improving population health as physician groups take on greater risk and accountability through value-based medicine payment models. Technology that can give physicians the ability to monitor clinical and financial metrics, while identifying and managing at-risk patients, will be essential to addressing this challenge.

Tom Giannulli, MD, CMIO, Kareo

2014 is going to be a year of big changes for healthcare providers. The biggest challenges are going to be ICD-10, ACA, Meaningful Use, and the ongoing shift to more patient-centered care. Each one of these comes with its own unique issues, and the use of technology will be invaluable all the way around. It’s a given that you need an EHR for MU and a good billing system for ICD-10. The gray areas are the ACA and the growing movement to more patient-centered care. We still don’t know exactly how these things will play out so a practice needs to prepare for the unexpected. To do that you need to optimize your practice with the most seamlessly integrated and robust practice management, billing, and EHR solution you can find.

Nick van Terheyden, MD, CMIO, Nuance

The ICD-10 transition will impact providers and their organizations the most in the year ahead. Under the new coding requirements, physicians will be mandated to document in a more detailed and complete way in order to justify the same care they’ve been delivering for years. From a clinician’s perspective, the transition will pull their focus away from  the patient and force them to devote even more of their time and attention to technology, documentation and administrative tasks. Added to the challenges physicians are already facing with EHRs, ICD-10 will create a perfect storm. As a result, we’re going to see an increasing demand for technologies that re-connect physicians with patients, and bring them back to focusing on the art of medicine, while still enabling them to meet the new regulatory and reimbursement standards.

Irtaza Barlas, director of software engineering NueMD

Biggest challenges facing physicians:

a) Given that the year 2014 may go down as the ‘the mandate year’, physicians in many specialties will be enrolling new patients. New insurance plans for new and existing patients will continue to be created that will make the medical billing potentially more complex.

b) Since 1979, physicians have been happily using the ICD-9 coding to classify diseases. With ICD-10 being introduced later this year, a major learning curve awaits the back office.

c) With more interconnectivity will come more headaches to manage patient data in a secured manner.

Chip Hart, director of strategic marketing/sales director, Physician’s Computer Company

As a practical matter, it’ll be ICD-10 and SNOMED.  The former is going to kill insurance company payments for an unknown period of time, which is a giant cash flow issue. The latter is going to change the EHR flow for many groups as their vendors race to comply with Stage 2 with a lot of time to get used to it.

Frankly, other obligatory demands will also be a problem – particularly from HIEs and the need to integrate with some newly (read: poorly) formed ACO. I really hope that last prediction is wrong.

Michael Brozino, president and CEO, simplifyMD

The impact of the Patient Protection and Affordable Care Act (PPACA), the transition to ICD-10, Meaningful Use Stage 2 and emerging value-based payment models are all challenges physicians and practices will face this year. These changes, along with increased clinical data demands from payers, can distract physicians from their core mission of caring for their patients while maintaining a profitable practice. To succeed in this environment, physicians need a flexible EHR and PM system that helps them work more efficiently so they can improve productivity while monitoring their quality of care metrics.

In 2014, many practices will be replacing their current EHR systems with ONC-certified software that supports their preferred workflow and improves productivity while complying with the demands of the PPACA, transition to ICD-10 and attestation of Meaningful Use Stage 2. These replacement systems will need to be flexible and customizable enough to evolve with the practice allowing physicians the ability to capture additional data for clinical quality improvement initiatives or financial data analysis.

News 1/16/14

A victory for transparency proponents: CMS announces it will consider on a case-by-case basis requests made under the Freedom of Information Act for information to find out much Medicare pays individual physicians.

CMS reports that as of the end November, approximately 60 percent of Medicare EPs are meaningful users of EHRs and 76 percent of Medicaid EPs have received an EHR incentive payment. Medicaid EPs are not required to attest for MU in advance of payment and a mere 17 percent of Medicaid EPs are considered meaningful users. That’s a pretty alarming gap, in my opinion. As of the end of November, EPs had been paid a total of 68 million in EHR incentives.

Allscripts reveals that its KLAS scores are on the rise with Allscripts Enterprise EHR up 11 percent for the 12-month period ending December 2013; scores for Allscripts Sunrise Clinical Manager increased four percent for the same period. KLAS is scheduled to release its annual “Best in KLAS” awards the week of January 24.

The 20-provider Urology Austin (TX) selects CareCloud Concierge for RCM and PM for integration with the practice’s existing HealthTronics UroChart EHR platform.

The ONC releases the Safety Assurance Factors for EHR Resilience (SAFER) Guides, which include checklists and recommended practices to help providers assess and optimize the safety and safe use of EHRs.

The Drummond Group certified Practice Fusion’s EHR Version 3.0 a 2014 Complete EHR on December 19, which is notable because Practice Fusion guaranteed its users that it would be certified by the end of the year. The guarantee required Practice Fusion to reimburse EPs up to $5,000 for out-of-pocket licensing fees for a third-party EHR if the company failed to meet the year-end certification deadline.

A report by Patient-Centered Primary Care Collaborative finds that practices following a PCMH model demonstrate  decreases in the cost of care; reductions in the use of unnecessary or avoidable services costs, such as ER visits; improvements in access to care; and, improvements in patient satisfaction. The impact on clinician satisfaction remains unclear.

CareCloud reports it closed 2013 with more than 520 new clients and finished its 16th consecutive quarter of triple-digit revenue growth.

Nearly 10,000 scribes work in ERs and physician offices inputting EMR data, according to a New York Times report. Typically scribes earn $8 to $16 an hour and are employed by services that collect $20 to $25 an hour from providers. Despite the cost, many physicians using scribes say they come out even or ahead financially because they are able to see more patients.

Hello Health introduces Hello Health Billing Services, an RCM solution to compliment its no-cost EHR and patient portal. Hello Health charges patients a monthly subscription for portal access that practices can apply against Hello Health’s billing service fees.

Athenahealth announces its roster of 21 solutions available in the athenahealth Marketplace.

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News 1/14/14

MedMatrix Solutions, a North Carolina-based medical billing service, files suit against a former client for prematurely terminating its services contract. The practice had signed a 12-month contract that included a termination option only if the billing service failed to provide adequate services. The billing service contends it provided services according to the contract but the practice canceled the agreement after just six months. It’s not clear why the practice terminated the contract but filing a lawsuit against a customer doesn’t seem like a move that will help MedMatrix win future business.

Practice Fusion will double the size of its existing office space when it moves to its new headquarters in San Francisco in mid-2014.

OB/Gyn-specific EMR provider Artemis Health Group, formerly known as DigiChart, announces that CEO/president Phillip Suiter will step down and be replaced by John Doulis, MD (MedCare).

Emdeon achieves CAQH CORE Phase III Certification, which certifies the company accurately and efficiently exchanges healthcare electronic funds transfer and electronic remittance advise information.

More evidence that the industry is far from ready for ICD-10: half of providers say they haven’t estimated the impact of ICD-10 on their cash flow, according to a KPMG report. Almost three-quarters of industry stakeholders state they have yet or are not planning to conduct testing that involves external entities. Things could get ugly around October.

Another ICD-10 readiness survey by Navicure and Porter Research reveals that 74 percent of physician practices have not yet started implementing their ICD-10 transition plan, though most don’t anticipate any disruptions from their EHR, PM, or clearinghouse vendors. A couple of alarming stats: 27 percent of survey practices are unsure how or where to start preparing for the transition, while 22 percent claim they don’t have the staff or resources to begin preparing.

The free physician social networking site Doximity doubled its network last year and now boasts 250,000 members, or about 35 percent of all US doctors. More than 10,000 physician-to-physician messages are being sent daily and 200 paying clients use TalentFinder, which last year facilitated 70,000 consulting and career offers to physicians.

Almost two dozen EHR vendors selected Surescripts’ clinical network for secure HIE over the last year include Adaptamed, AssistRx, Bizmatics, ChartLogic, ClinixMD, CureMD, ScriptSure by Daw Systems, GeniusDoc, gloStream, HealthFusion, Henry Schein MicroMD, Medical Office Technologies, Intelligent Medical Software (IMS by Meditab Software, Inc.), Merge Healthcare, OA Systems, PatientPoint, SRSsoft, STI Computer, and SuccessEHS.

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News 1/9/14

From K. Systrom: “Figure 1. This is cool app your readers might be interested in.” Figure 1 is a free Instagram-like app for licensed and verified healthcare professionals. The app facilitates the sharing of de-identified  photos of medical conditions while at the same time creates a crowdsourced image library. Looks quite cool and you have to love the price.

CMS proposes a rule that would ban abusive prescribers from government programs, as well as ban providers whose licenses have been suspended or revoked due to drug-related sanctions.

A report from the HHS Office of the Inspector General criticizes the government for inadequately addressing potential fraud and abuse issues as EHR adoption becomes more widespread. Warning that “certain EHR technology features may be used to mask true authorship of the medical record and distort information to inflate health care claims,” the OIG contends that CMS and its contractors have not changed their program integrity practices and recommends that CMS provide its contractors with guidance on detecting fraud associated with EHRs.

I was amused by this New York Times article about doctors that Google their patients. I guess I had never thought about my doctors caring too much about me beyond my blood pressure, pulse, and current meds. On the other hand, I Google people the time, leading me to wonder whether I (like doctors) should spend more time simply asking others the details I want to know.

AMA President Ardis Dee Hoven, MD includes two HIT-related issues on her list of top federal issues affecting physicians in 2014. Hoven notes that the October 1 implementation deadline for the ICD-10 code set and the September 30 MU attestation deadline for physicians wishing to avoid 2015 Medicare penalties are two significant issues that could have a significant impact on physicians and patients.

The AMA, by the way, offers free educational resources to help physicians prepare for the ICD-10 transition.

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News 1/7/14

McKesson announces the general availability of its Paragon Ambulatory Care Practice Management solution, which is an extension of its single database HIS for inpatient facilities and designed for hospital-owned practices. I understand the PM module was developed internally, as opposed to a bolt-on of one of McKesson’s acquired products and that an EHR module is also in the works. Sounds like McKesson is positioning itself to compete with Epic and Cerner in the IDN space.

A 16-provider dermatology practice in Massachusetts agrees to a $150,000 payment and a corrective action plan after admitting to potential HIPAA violations. In October, 2011 an unencrypted thumb containing the PHI of 2,200 patients was stolen from an employee’s car. The provider promptly reported the breach to HHS and patients; HHS then informed the practice that the Office of Civil Rights would launch a compliance review. The OCR concluded that the practice had not conducted an accurate and thorough analysis of potential risk and vulnerabilities as part of its security management process; failed to have written policies and procedures for in compliance with the Breach Notification Rule; and, had not trained its employees on security processes.  The lesson for practices: encrypt those thumb drives, perform risk assessments, and be in compliance with policy and training requirements.

The majority of patients using a txt4health diabetes awareness app reported the tool made them more likely to make diet-related behavior changes and lose weight, though only 39 percent of the participants completed the 14 week program. Researchers concluded that the text messaging program has “potential to significantly influence people’s health habits,” but admits it “may not be appropriate for everyone.”

In a Kaiser Permanente study also involving diabetics, researchers found patients that refilled their medications using online portals increased their medication adherence and improved their cholesterol levels. Medication non-adherence and poorly controlled cholesterol declined six percent among exclusive users of the online refill function, compared to occasional users or non-users.

University Hospital (GA) reports that 16,000 patients from University and its affiliated practices are accessing their medical records through the health system’s Epic patient portal.

HIMSS Analytics awards 14 ambulatory clinics associated with Cincinnati Children’s Hospital (OH) with Stage 7 Ambulatory Awards for EMR adoption. Children’s also earned Stage 7 for its inpatient setting.

Brightree and athenahealth will coordinate the patient referral process for providers using athenaClinicals and athenaCoordinator services and post-acute providers using Brightree’s clinical and billing platform.

Good news for telehealth providers: as of January 1, a new Montana law requires state-regulated insurance companies to reimburse providers for telehealth services at the same rate as in-person visits.

Speaking of telehealth, the California-based Telecure is waiving its $25 telemedicine visit fee for patients who share details of the experience on Twitter or Facebook. The company’s CEO says Telecure is wanting to raise “awareness of alternative ways of receiving quality healthcare.” Am I the only person who is more leery of  taking advantage of medical care that is discounted to “free” versus?

Blue Cross and Blue Shield of Kansas City estimates that 55 percent of area physicians are now employed by hospitals, including virtually all cardiologists and most cancer specialists. Dr. Gregg, by the way, provides some insight on why many physicians are choosing to ignore the trend and remain independent.

Almost three-fourths of physicians using EHRs in 2011 reported clinical benefits, according to a Health Services Research report. The majority of physicians said the EHR alerted them of a potential medication error or critical lab value, while one-third claimed the EHR helped identify needed tests or communicate with patients.

The School of Business at the University of Miami and CareCloud launch CareCloud Scholars, a program to engage graduate students with South Florida’s healthcare community and promote healthcare innovation.

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