News 11/12/13

From Caymus: “Re: Patient portals. I know a number of practices who already charge patients to access their portal and have for years. Some actually want to have different charges based on tiered portal service. Note that the portal is often wrapped into other concierge-style options.” CMS agrees with me that it’s not “appropriate” for providers to charge patients a fee to access their portal or online PHR. If patients are willing to pay, however, then good for the providers that are successfully collecting fees. I’ll mention that there was a time I paid about $40 a month for home phone service, $15 a month for AOL so I’d have browser and email access, and $5 for movie rentals at the neighborhood Blockbuster store. Perhaps we should re-visit this fee issue in another year or two and see if there are still patients willing to stick with providers that charge for online record access.

NextGen Healthcare hosts 5,000 attendees at this week’s annual User Group Meeting in Las Vegas. During the opening session on Monday, Nextgen introduced NextGen Share, an interoperability solution based on the Mirth HIE platform that facilitates clinical data exchange and referrals from within the NextGen EHR.

The 11-provider Ocean Eye Institute (NJ) selects SRS EHR.

CMS tells MGMA and other stakeholders it might reconsider performing external, end-to-end ICD-10 testing with physician offices following recent problems with its Healthcare.gov site. Previously CMS has said it would not offer external testing and that it was confident with its current internal testing procedures.

Epic, Allscripts, eClinicalWorks, and NextGen customers represent almost half of all EPs that have attested to Stage 1 MU with a 2014 edition base EHR product. CMS reports that through the end of September 47 percent of all EPs (over 325,000) have attested for MU and been paid $2.4 billion.

Medical Radiologists (OH) deploys RadNet’s eRAD technology for its 14-physician group.

Emdeon reports Q3 results: revenues up nine percent, net loss of $16.2 million vs. $15.2 million.

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News 11/7/13

Full implementation of HIT in 30 percent of community-based physician offices would reduce the demand for physicians by four to nine percent, according to researchers from the Johns Hopkins Bloomberg School of Public Health and The Commonwealth Fund. Other predictions, based on a review of previous studies include:

• Physician demand could decline an additional four to seven percent if care was delegated to NPs and PAs and supported by HIT.
• The use of HIT could reduce regional shortages of physicians by enabling as much as 12 percent of care to be delivered remotely or asynchronously.
• If HIT systems were adopted by 70 percent of practices, the estimated impact could more than double.

Kareo hires David Mitzenmacher (Volusion) as VP of customer success and Nitin Somalwar (Flurry) as VP of engineering.

Epocrates’ Bugs + Drugs app reaches 100,000 downloads in less than a month of its release. Epocrates, whose parent company is athenahealth, pulls clinical and billing  information from athenahealth’s data warehouse to track antibiotic resistant bacteria.

A CMS email this week included this FAQ about the EHR incentive program:

Can an eligible professional (EP) or hospital charge patients a fee to have access to the certified EHR technology (CEHRT) solution that is used to meet the meaningful use objective of providing patients the ability to view online, download and transmit their health information?

My initial thought was that if my EP tired to charge me to view or download my records, I would fire him/her. My second thought was that if this is truly a “frequently” asked question, then there are probably providers already charging patients these fees.

Here is what CMS had to say:

We do not believe it would be appropriate for the EP or hospital to charge the patient a fee to access the Certified EHR Technology solution regardless of whether the solution is in the form of a provider-specific portal, an online personal health record, community portal or some other solution.This is consistent with the position taken in the Stage 1 final rule (75 FR 44358) and reiterated in the Stage 2 final rule (77 FR 53999) with regard to the meaningful use objective to provide patients with clinical summaries of office visits. Access to the Certified EHR Technology solution would be provided to satisfy the requirements of the “view online, download and transmit” objective, rather than in response to a request from a patient. We note that the charging of fees for health information provided in response to a patient’s request is governed by the HIPAA Privacy Rule.

HIMSS Analytics recognizes 50 of Truman Medical Centers (MO) ambulatory clinics with its Stage 7 Ambulatory Award.

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News 11/5/13

From Chloe: “Re: ZocDoc. Really questioning their HIPAA compliance. Carecloud should be very careful about ZocDoc breaching HIPAA of its customers’ patients. Several weeks ago I made a doctor’s appointment through ZocDoc, and received an email from the practice stating that the appointment time I booked on ZocDoc was not available (no integration obviously with scheduling) and proposed alternate times. The email thing was a little sketchy by itself from a HIPAA perspective (did I give consent to email me when I booked online? I don’t know.) Things went from bad to worse when someone from ZocDoc left me two voicemail messages apologizing for my rescheduled appointment! Why is ZocDoc leaving me messages about my doctor’s appointments? From my perspective as a patient, I don’t have any relationship with ZocDoc, and why is some guy calling me about my doctor’s appointments? Maybe I didn’t read ZocDoc’s terms of use well enough – and maybe there’s something there where I gave up my patient privacy by booking through that site.”  Has anyone else had a similar experience? Today I attempted to schedule an appointment through ZocDoc with two different doctors, but neither appeared to be  participating in the service. I suspect provider participation varies by geographic region, but it doesn’t look like I will be using it any time soon, regardless of HIPAA compliance.

Vista Equity Partners, parent company of Vitera Healthcare Solutions, acquires all the outstanding shares of Greenway Medical common stock for $644 million, completing the merger of the two companies. The new company will be privately held and operate under the Greenway brand with Tee Green (Greenway) assuming the role of CEO and Matthew Hawkins (Vitera) as president. I interviewed Green and Hawkins when the merger was first announced in September.

The AMA offers free toolkits for electronic funds transfers and electronic remittance advice, including information on how to get started with electronic transactions, guidance on IT solutions, and questions to ask vendors. An ACA provision requires insurers to standardize their business practices for EFTs and ERAs by the first of the year.

Ocean Beach Medical Clinics go live on NextGen EHR in early December.

Lawmakers consider a draft proposal that would phase out fee-for-service billing in favor of a rewards-based  payment system. Key components include:

• A freezing of physician payment rates for 10 years
• Paying doctors five percent bonuses each year from 2016 to 2021 for agreeing to participate in shared-savings, bundled medical services, or other alternative payment methods
• After 2023, increasing reimbursement by two percent a year to doctors opting for alternative payment systems; those opting for fee-for-service payments would get a one percent annual increase in reimbursement.

About half of clinical decision alerts are overridden by providers and about half of overrides are classified as appropriate,according to a study published in JAMIA. The most common alerts to be overridden were formulary substitutions, age-based recommendations, renal recommendations, and patient allergies. While 53 percent of all overrides were classified as appropriate, the likelihood of overriding an alert varied widely by type. The authors recommend refining alerts in order to reduce alert fatigue.

CMS blames the government shutdown on the delayed release of the 2014 Medicare physician fee schedule. Traditionally the payment rules for a new calendar year are released around November 1.

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News 10/31/13

CareCloud will integrate ZocDoc’s appointment booking app into its platform, allowing patients to book appointments online with CareCloud providers via ZocDoc.

WebMD jumps into the patient engagement space with the acquisition of Avado, a developer of patient relationship technologies. Avado offers an EMR-agnostic patient portal that includes messaging, reminders, and appointment scheduling tools.

Rush Health (IL) endorses the eClinicalWorks EHR solution for its 300 affiliated private physician members.

SuccessEHS will integrate the DataMotion Direct secure messaging service into its EHR platform.

Vitera announces the availability of Intergy Mobile 2.0 in the Apple Store.

Physicians continue to be uncertain about how the ACA rollout will impact their workloads or wallets, according to a USA Today news story.  Physicians point to the need for increased efficiencies and a shifting of non-clinical tasks to administrative staff.  AAFP president Reid Blackwelder, MD adds that medical teams need to learn how to “work smarter, not harder” and use electronic systems better.

I am looking for a few volunteers from HIT vendors to participate in a Q&A for HIStalk Practice. Specifically I would like a few sales types (or even former salespeople), as well as implementation and training experts that work with physician offices. I can’t guarantee that your few minutes of  time will result in fame and fortune, but be assured I would be very grateful. Email me for details.

As you get ready for your Halloween office party or a night of treat or tricking with the kids, here are a few Halloween health hazards you may want to avoid – unless you work in a hospital or practice with medical staff close by. Crazy-colored contact lens that may damage eyes are a top concern, as are skin-irritating makeup, pumpkin-carving injuries, and general candy overload. Personally I plan to play it safe and stick with my stand-by Wicked Witch costume and limit my evening intake to chocolate and a side of wine.

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News 10/29/13

Athenahealth will implement Safety Event Manager, a safety reporting solution from Quantros, allowing athenaClinical users to submit patient safety data as part of their EHR workflow to the federally sanctioned Quantros Patient Safety Center

The Government Accountability Office reports that general practice physicians were 1.5 times more likely than specialty practice physicians to have been awarded a MU incentive payment in 2012. A total of 183,712 EPs were awarded payments in 2012, representing 31 percent of all EPs and an increase from the 53,331 (10 percent) of EPs awarded incentives in 2011; 75 percent of EPs awarded incentive payments in 2012 were new to the program.

Greenway Medical Technologies is named a finalist for the 2013 Intel Innovation Award in recognition of its PrimeMOBILE app for Windows 8.

A pediatric mental health study using athenahealth claims data reveals a 29 percent increase in the rate of mental health diagnoses between 2009 and 2013. ADHD accounted for more than half of all pediatric mental health diagnoses.

In 2011, office-based physicians using an EHR were more likely than non-EHR users to exchange lab results, send prescriptions electronically, and provide patients with clinical summaries, according to a study conducted by the CDC’s National Center for Health. Specific data exchange functions included:

• Viewing lab results online: 87 percent with EHRs vs. 67 percent of all physicians
• Sending prescriptions electronically: 78 percent vs. 55 percent
• Incorporating lab results into an EHR: 73 percent vs. 42 percent
• Providing patients with clinical summaries: 61 percent vs. 38 percent
• Sending lab orders electronically: 54 percent vs. 35 percent
• Exchanging clinical summaries with other providers: 49 percent vs. 31 percent.

Not surprisingly, data exchange capabilities varied significantly depending on the EHR: the ability of providers to exchange clinical summaries, for example, ranged from one-fourth of all physicians to three-fourths, depending on the EHR.

In an interview, eClinicalWorks CEO Girish Navani shares various observations and predictions for the industry. Some notable comments:

We are headed for consolidation, without a doubt. It’s not just going to be the smaller or the insignificant. I think you will find companies that have not built customer bases or are strongly relying on investors to fund their next generation of products having to either consolidate or merge. It happens in every industry, and it’s going to happen in our industry. I wouldn’t be surprised if you see some reasonably large businesses next year get acquired or merge with each other.

The right to earn a physician’s business is going to get harder, because you will be in what I would call a replacement market. You need to have a better product and a better service, and you need to be able to keep your customer base. I think size will matter, at some point, just like it did in the cell phone business. Verizon and AT&T built more connections, so they got more subscribers. I think you’ll see some of that, as well. I wouldn’t be surprised if a larger business that can’t invest in research and development, and can’t show the same top line growth will get pressured by stock prices or investors to merge with something else

I think in 2013 we are still amidst the transition where we now understand that our reimbursements will be tied to outcomes. I don’t think we have yet changed the consumers’ behavior around looking at those indicators in terms of how and where they derive their quality or care. But if you ask me, the question over the next 5 years, we’re definitely moving to consumer-centered care. The patients will make decisions based on price, quality, and also convenience in terms of how and where they get their care. Again, it will go faster than you and I expect. My gut tells me if we look back within 12, if not 18 months, we will be pleased that healthcare has moved past digitization of technology to using it as a vehicle for better decision making.

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