News 8/29/13

From Sue Orman: “Re: Credit cards from payers. In addition to the exorbitant merchant fees, a problem with insurers using credit cards to reimburse providers is that there tends to be a lot of issues with practices not receiving electronic remits. That violates the spirit of administrative simplification under HIPAA and ACA. Not only does CMS need to make sure that payers are paying physicians their contracted rates, they need to encourage payers to immediately begin using the EFT standard ACH CCD+, which conforms with HIPAA and is less costly than credit card transactions.” Readers more familiar with the payer world and electronic standards can likely speak more knowledgably than me on this, but my understanding is that beginning January 1, 2014, payers will be required to accept EFT in the new standard format if requested by a provider. If a provider does not request the new format, the payer can continue using credit cards for reimbursements, which translates to more fees and less money in the hands of the physician.

eClinicalWorks names HealthNet (IN) the winner of its Improving Healthcare Together video contest. Auburn Medical Group (GA) and Open Door Family Medical Centers (NY) took second and third places.

Doximity, which is like LinkedIn for physicians, now boasts 200,000 licensed physician members, or about 30 percent of the doctors in the country. The platform allows physicians to share patient information in a HIPAA-compliant format and look up colleagues or relevant specialists. Sermo, another physician-only online community has a reported 125,000 users.

HBMA introduces Professional Billing Service Locator, a free platform to help practices locate medical billing companies that serve their region and their specialty.

Physician RCM provider MedData promotes Ann Barnes from president to CEO.

The benefits of a practice’s ACO participation reach beyond the patients covered by the ACO, according to a JAMA-published study. Researchers found that medical groups’ participation in commercial ACOs was associated with savings for Medicare beneficiaries as well, though the quality of care for Medicare patients did not consistently improve. The “spillover” effects may be the result of organizational changes in care delivery, such as incorporating computer reminders to reduce unnecessary and expensive tests.

New York doctors must now check an electronic prescription drug database before writing prescriptions for painkillers and other controlled substances, and, pharmacists must consult the database before filling the prescriptions; pharmacists must also report in real-time when a prescription is filled. The requirement, the first of its kind in the country, is part of the state’s I-STOP law, which also mandates electronic prescribing for all drugs by December, 2014.

In HIT fashion news, Vestagen Technical Textiles secures $8.25 million in financing. The company develops a variety of textile products and technologies, including scrubs that don’t absorb liquids and thus protect workers from potential contaminants. I guess the scrubs’ practicality and safety benefits are suppose to make up for the lack of spicy colors and patterns.

The San Diego newspaper highlights some of the more innovative ways area physicians are using smartphone apps and other technology to engage patients and monitor such things as weight, exercise, blood sugar, depression, and medication adherence. My favorite: Scripps offers pre-recorded videos of doctors so patients can become familiar with their physician prior to the first appointment.

Physicians are split when it comes to whether or not Medicare should make data about Medicare payments available to the public, according to an ACPE poll. Forty-six percent of ACPE members participating in the survey are in favor of keeping the data private and believe the information could “too easily be misinterpreted by the public and be used to portray physicians in a negative and unfair light.” I am with the 42 percent who are in favor of transparency and believe the public has a right to know how tax dollars are being spent.

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News 8/27/13

From Vendor Bob: “Re: Delaying Stage 2. As an HIT vendor I am annoyed by all these calls to push back the Stage 2 MU deadline. All vendors learned of the new requirements at the same time, yet many have waited too long to complete the 2014 certification process. Why should these late-starters get a pass just because they failed to manage their R&D timelines?” Over the weekend I published a post highlighting the potential delay of the Stage MU program. My suggestion: keep the original start date but give providers more time to attest. As Vendor Bob suggests, some software release delays are likely the result of management mistakes but  it’s the providers and not the vendors who are ultimately penalized by late-arriving software updates. Feel free to weigh-in.

MGMA releases tools for creating personalized schedules for its October 6-9 annual conference.  As I dug into the schedule a bit I was surprised to see the exhibit hall is only open 7.75 hours over three days. The schedule may be ideal for both vendors and attendees, however, since very few sessions are offered while the exhibits are open. I played around with the customized conference schedule utility and then created an “expo plan” (above) for the booths I want to visit. Both tools are easy to use and presumably my schedules will be available on my iPhone once the mobile version is released. I’ll be heading to San Diego for the event and posting daily updates on sessions, speakers, the exhibit hall, and of course the parties.

Emdeon launches a self-service testing exchange solution for ICD-10, allowing providers and channel partners to submit ICD-10 test claims and receive claim status feedback. The Emdeon Testing Exchange for ICD-10, which Emdeon purports is the first of its kind in the industry, requires no additional software and is a free service to Emdeon provider, channel partner, and payer customers. Sounds like a great service that would be even more valuable if more payers were ready and if providers already had ICD-10-ready software updates from their vendors.

The theft of four unencrypted computers at Advocate Medical Group (IL) results in the second biggest HIPAA breach ever reported. More than four million patients were notified last week that their personal information, including names, addresses, Social Security numbers, and dates of birth, may be at risk following the July 15 burglary. The 1,000-physician practice is offering patients one free year of credit monitoring.

More than 90 percent of office-based physicians accept new Medicare patients, according to the HHS. The share is only slightly higher than the percentage reported in 2005 and similar to the percentage of physicians who report accepting new privately insured patients.

The AMA urges CMS to prohibit insurers from paying physicians less than contracted amounts when using electronic payment methods, namely payments in the form of plastic and virtual credit cards. The chief complaint is that fees as much as five percent per transaction are associated with the cards, resulting in providers getting less than their negotiated prices for services. The use of such cards has increased as health plans abandon sending paper checks in favor of cards that offer payers cash-back incentives. I assume that a lot of providers are unaware of the fees and that’s how payers have gotten away with the practice.

Athenahealth will work with the non-profit Primary Care Development Corporation to advise primary care practices in underserved communications on the best HIT strategies for improving care.

Steve Malik, who founded patient portal company Medfusion and sold it to Intuit for $91 million in 2010, buys back the business for an undisclosed amount. In May Intuit wrote down the Intuit Health division $46 million following the announcement that Allscripts, the division’s largest reseller, had purchased patient portal vendor Jardogs. Malik’s future plans include moving into the community health space and offering the portal solution to organizations that support multiple IT environments.

HealthproMed (PR) selects eClinicalWorks EHR for its two-location FQHC.

The 150-provider Sansum Clinic (CA) reports that it reduced medical transcription costs more than 90 percent since implementing Epic.

An analyst for Motley Fool looks at the market potential for EHRs. The commentary is largely focused on potential investment opportunities (GE, athenahealth,and Allscripts in particular), but also offers a nice summary on the general state of the ambulatory HIT industry.

Greenway Medical will develop an HIE for more than 500 physician members of the Denver-area Rose Medical Group, Rose Medical Center, and their patients. The platform will aggregate, standardize, and organize clinical and financial data from disparate systems and include a patient portal and options for data analytics and reporting.

Speaking of Greenway, the company hosted over 2,200 customers, staff, and partners at last week’s PrimeLEADER user conference, which included a keynote address by the ONC’s Farzad Mostashari. Greenway recognized Boulder Community Hospital Physician Clinics (CO), Regional Obstetrical Consultants (TN), and Albuquerque Health Care for the Homeless(NM) with its annual Greenway Innovation Awards.

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Stage 2: The Delay Dilemma

In the last few weeks multiple professional organizations have called for some form of extension for  Stage 2 of the EHR Meaningful Use program. While the general theme is “delay,” the specific recommendations have varied:

MGMA – Requests that HHS extends the reporting period for Stage 2 incentives for a minimum of one year. MGMA also calls for a moratorium on penalties for providers that have completed Stage 1 requirements.

AAFP – Proposes three distinct “cohorts” of EPs, each with a different schedule depending on what year they first attested for MU. The timeline would require vendors to be ready for Stage 2 by January 1, 2014 but extend the implementation period from nine months to 21 months, depending on the cohort.

CHIME – Calls for a one year delay for implementation of Stage 2.

AMA/AHA – In a joint letter to HHS Secretary Kathleen Sebelius, the associations call for providers at Stage 1 to meet MU requirements for Stage 2 using either a 2011 or the 2014-certified EHR; the establishment of a 90-day reporting period for the first year of each new stage of MU; more flexibility in meeting Stage 2; and, an extension for each stage of no less than three years for all providers.

HIMSS – Recommends Stage 2 start as scheduled but that the attestation period  be extended through April 2015 for EHs and June 2015 for EPs. Providers would have 18 months to  attest to quarterly MU requirements.

One theme that is consistent from all the organizations is that the delay is necessary because vendors need more time to prepare and certify the required software upgrades and because providers need additional time to implement and optimize their EHR technology.

I must admit that when the various associations and industry leaders first began rumbling about a delay, my first thought was, “You’ve got to be kidding!” Lest anyone forget, HHS already extended the Stage 2 deadline once in November, 2011. By delaying again, HHS would be repeating its long history of telling vendors and providers that deadlines are made to be broken.

Regardless, there now seems to be a groundswell of sentiment in favor of a Stage 2 delay. No one at HHS, including Secretary Sebellius or the soon-to-be-departing Farzad Mostashari, has indicated that a postponement may happen, though my money is on policymakers agreeing to an extension for meeting and reporting on Stage 2 requirements and for delaying penalties for providers that have met Stage 1. I would hope that the January 1, 2014 start date remains intact.

Why? Maintaining the original start date means vendors must continue moving forward to ready their products. If the start date were also delayed, software release dates would undoubtedly be pushed and providers could again find themselves without adequate time to fully test, train, and implement the required updates and make any necessary changes to workflow. Keeping the original date also means early adopters would have the opportunity to attest early in 2014 and thus be paid their MU incentives.

Readers, I’d love to hear your thoughts on the possibility of a Stage 2 delay and how that delay might look.

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News 8/22/13

MGMA sends HHS a recommendation to immediately institute an indefinite moratorium on penalties for physicians that successfully complete Stage 1 MU requirements. The association is concerned that a lack of vendor readiness may hinder physicians ability to meet Stage 2 requirements and thus unfairly penalize physicians starting in 2015. MGMA also recommends extending the reporting periods for both Stage 1 and Stage 2 incentives.

Greenway Medical launches PrimePATIENT, a patient portal integrated with PrimeSUITE, giving patients the ability to request appointments, pre-register, pay bills, and maintain personal health records. Greenway also adds Seamless Medical Systems to its online Marketplace as a value-added partner.

Allscripts announces its Client Outcomes Excellence award winners, including Professional EHR customer Elmwood Health Center (NY) and Eastern Nephrology Associates’ (NC) IT administrator Kenneth Waters.

Allscripts also names Healthfinch the winner of its Open Apps Challenge for its automated prescription renewal request app. We interviewed Healthfinch’s CEO and co-founder Jonathan Baran on HIStalk Connect last year.

Medicare reimburses physicians up to five times more for performing procedures than for cognitive care, according to a  study published in JAMA Internal Medicine. Physicians make 368 percent more doing a colonoscopy and 486 percent more removing a cataract than a primary care physician generates providing cognitive care, meaning specialists can generate more revenue in one to two hours than a primary care physician makes in a day. Not great news for the recruitment of primary care physicians and highlights why specialists may resist efforts to transition from procedure-based  payment models.

Zirmed partners with Catch Data Systems to provide GE Centricity customers integration with ZirMed’s RCM, clinical communications, and analytics solutions.

The Air Force’s 62nd Air Division posts details of its Relay Health secure messaging program, which allows Airman  to securely message their primary care providers at the 62nd Medical Squadron’s Airmen’s Clinic. Patients of the Washington-based clinic are using the Relay Health service to schedule appointments, request medication refills, or communicate with physicians, even when off-based on temporary duty assignment or vacation.

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News 8/20/13

The AHRQ examines the findings from more than 20 studies that were funded by the agency’s Ambulatory Safety and Quality program and concludes that the use of HIT in ambulatory care settings has a positive impact on evidence-based preventive and chronic care delivery, chronic disease control, provider satisfaction, and health outcomes.

Southern New England Ear, Nose, Throat and Facial Plastic Surgery Group (CT) selects ChartLogic’s EHR suite for its 11 physician practice.

More companies are purchasing cyber insurance to cover potential losses and fines in the event of a cyber security breach. About 32 percent of healthcare organizations now have some sort of cyber insurance policy in place and an additional 41 percent are considering purchasing coverage. Industry experts note that in the last six to nine months more smaller practices are expressing an interest in coverage, especially as more data breaches are being publicized and fines are accessed.

The 11-provider Orthopaedic Associates of Augusta (GA) selects SRS EHR.

Physicians across all organizations can expect an average salary increase of 2.4 percent in 2014, which is on par with last year. Physicians in group practices can expect the largest pay increases at 3.7 percent; hospital-based physicians will see increases of only about 2.2 percent.

The most useful patient record strikes a good balance between structured data and a physician’s narrative according Lesley Kadlec, director of AHIMA’s HIM Practice Excellence. Kadlec notes that EHR templates are a great tool but don’t always support good documentation, so she recommends the smarter use of free text and/or the use of speech recognition technology.

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