News 5/8/14

A new study finds that hospital prices and privately insured patient spending increase when hospitals acquire physician practices. The American Hospital Association calls the study “outdated,”while Paul Ginsberg, a professor of health policy and management at University of Southern California, believes it “could be the evidence the FTC needs to challenge hospital physician practice acquisitions … that they believe have a strong prospect of leading to higher prices for consumers.”

In related news, a report shines a spotlight on the sharp cost difference of 10 common chemotherapy treatments administered to patients in an independent physician’s office versus a hospital or hospital-acquired practice. Hospitals charge on average 189 percent more than their private practice counterparts for these treatments because of the need to support administrative and overhead costs. The easy answer is to advise patients to seek treatment at an oncologists’ office, but opaque health insurance rules no doubt make this an onerous task to already overburdened consumers.

A physician’s plea to Forbes for help in combatting seemingly arbitrary and ongoing RAC audits highlights the “vast array of arcane and indecipherable regulations … physicians are subjected to under the ACA and other laws.” The physician, who is in the midst of a third audit, laments that, “I could understand their repeated requests if they were finding anything wrong with the charts. However, I feel that this is a personal attack and they are just going to come at me again, and again, and again until they find some small mistake and then blow it into something really huge. I am hoping that you can help me. I believe there should be consequences for these auditors who are harassing innocent physicians. We need to eliminate fraud and abuse both within medicine and within the government.” It would be interesting to find out the timeline of these audits, and what recourse the physician has attempted through CMS.

National Coordinator Karen DeSalvo, MD tells a Politico panel that health IT has to “get real for people” in order to see nationwide adoption and acceptance by providers and patients. She optimistically hopes that within a year, government and private sector stakeholders will settle on “rules of engagement” for how health IT systems interact with each other. There’s nothing wrong with optimism, but 12 months seems to fly in the face of the sluggish pace other pieces of the health IT landscape (like ICD-10) are facing.

A survey of 5,000 physicians finds they are now more than twice as likely to see decreasing profits. Top reasons include declining reimbursements, rising costs, requirements from the ACA, and the transition to ICD-10. Also of concern is that 70 percent of surveyed physicians spend more than one day a week on paperwork, compared to 58 percent in 2013. Statistics like these make the trends of hospitals acquiring practices and private practice physicians moving to full-time hospital employment easier to understand.

It’s not all doom and gloom, of course. Many physicians continue moving into the world of value-based business models to help counteract the burdens mentioned above. OncLive.com highlights several ways oncologists are transitioning from fee-for-service to value-driven care, including participating in ACOs, treating patients via clinical pathways, and creating bundled payment business structures.

Arizona Care Network and UnitedHealthcare launch an ACO for 15,000 Phoenix-based residents enrolled in the payer’s employer-sponsored health plans.

Northeast Medical Group (CT) enhances its physician group agreement with Aetna to include rewards for value-based collaborative care.

Mid-Coast Health makes news with its investment of $11 million towards the development of two new clinics as part of its focus on creating patient-centered medical homes. The state of Maine  has close to 175 primary care practices involved in PCMH initiatives.

In other physician financial news, Dayton Outpatient Center (OH) will soon see its name emblazoned on the new field of the Dayton Dutch Lions Football Club (aka, soccer club). A ribbon-cutting ceremony for the Dayton Outpatient Center Stadium is set for May 9.

Rumblings of a plunging athenahealth stock may be premature. Like the predicted demise of Twitter, these forecasts should be taken with a grain of salt, especially given the amount of athenahealth-related news circulating this week, just after the company’s annual user conference. Summit Health Management adds athenahealth’s EHR, patient portal, and population health services to its revenue cycle management service. Ambir Technology makes available a full line of athenahealth-approved solutions to digitize paper-based medical information.

Alere Accountable Care Solutions will build a community-wide HIE for Whittier Independent Practice Association (MA).

In other vendor news, Metrix Medical expands its services to include a new division focused on helping medical practices and hospital groups expedite claims reimbursement while decreasing costs related to recovery of unpaid claims.

ShoreTel launches a suite of IP phone and communications services aimed at physician practices, extended care providers, and hospitals.

MedEvolve announces its EHR 6.0 solution is certified for Meaningful Use Stage 2.

In an interesting twist to the classic gender wage gap debate, a study on Medicare reimbursement finds that male doctors earn 88 percent more than their female counterparts. The study attributes this gap to the fact that men, on average, see more patients and perform more procedures. You have to wonder if seeing a female doctor will cost patients less in the long run.

Opinions on the Medicare physician payment data dump just keep coming. Eldon A. Trame, MD, president of the Illinois State Medical Society, thoughtfully explains why this data doesn’t tell the whole story when it comes to how much a physician truly profits from Medicare reimbursement.

The American Academy of Physician Assistants chimes in with insight on how the data can help PAs gain insight into their practice’s billing patterns, and demonstrate their professional worth. Both Trame and the AAPA point out that the Medicare payment data does not dive deep enough to properly identify who provided care, since all episodes of care are logged under the physician’s name and national provider identification number.

e-MDs recognizes Peggy Rosen, RN, director of quality at Mid-State Health Center (NH), for her work to improve quality initiatives.

A healthcare management project between Appalachian State University and AccessCare of the Blue Ridge (NC) wins a national award for helping rural clinics in three counties implement or enhance quality improvement and cost-reduction measures.

News 5/6/14

The 2014 Medscape Physician Compensation Report finds that 67 percent of family physicians would choose medicine again as a career, but only 32 percent would stay in the same medical specialty. On the flip side,  specialists with the highest compensation in 2013 report they have the least professional satisfaction. It would be interesting to compare this report to one conducted in the days before HITECH. I’m willing to bet levels of career satisfaction were a bit higher all around.

 
New North Carolina Medicaid Director Robin Cummings shares his thoughts with the Asheville Citizen-Times on the benefits that a predicted 20 to 30 accountable care organizations will bring to the state over the next several years.

Rarely do the worlds of celebrity and healthcare IT collide (Dennis Quaid and his patient safety advocacy work is the only example that immediately springs to mind.) Leave it to athenahealth to add a little red carpet spice to its annual user conference. The company presents its 2014 Vision Award to semi-retired super model Christy Turlington Burns for her work with Every Mother Counts, a global non-profit she founded to promote access to maternal healthcare; and Allen Gee, MD, PhD, a neurologist at Frontier Neurosciences (WY), for his innovative work with telemedicine technology.

Perhaps even more rare is news related to wrestling and the local family physician. Martins Ferry High School inducts Dan Jones, MD (OH) into its wrestling hall of fame.

 
The American Nurses Association celebrates National Nurses Week May 6-12. The ANA’s activities and marketing are timely, given recent research that finds 65 percent of Americans aren’t looking forward to the possibility of being cared for by personal robots in their old age. The Japanese may be a bit more receptive. That country’s government is already promoting the use of nursing care robots for the ill and elderly.

 
ITech and MD-Reports partner to offer billing, scheduling, practice management, and integrated EHR software.

VitalWare launches iDocuMint.com, a cloud-based documentation tool that offers physicians guidance on documenting under IDC-9 and ICD-10, as well as favorite lists by specialty.

Even physicians are getting in on the crowd-funding game. Ophthalmologists Vince Deramo, Brett Rosenblatt, and David Rhee launch an equity crowd-funding campaign in hopes of raising $750,000  for a 20 percent equity stake to fund their digital physician on-call answering system. Their choice of investor-friendly, crowd-funding site ReturnOnChange is an interesting one given the popularity of consumer-oriented Kickstarter and healthcare-centric Medstartr.

Ali Pabrai, CEO of ecfirst, offers physicians seven tips for ensuring that the digital PHI of their patients is secure and HIPAA-compliant. While his advice seems sound enough, it’s interesting to note that he takes vendors to task, calling them “lethargic about embedding encryption capabilities.” Perhaps it’s not just healthcare vendors dropping the ball: Pabrai notes the average business experiences 1,400 attacks per week, of which two ultimately accomplish their purpose.

It’s no secret that private practice physicians are contemplating new ways of doing business, with hospital employment and concierge service models (not to mention retirement) often making the news. Vicki Bralow, DO and Scott Bralow, DO, however, take the “company doctor” approach, starting Affordable Care Options LLC (PA) to provide workplace-based healthcare to employers. Employees have the convenience of a healthcare facility at their office, while employers likely benefit from healthier employees and lower costs. Seems like a win-win.

Mergers and acquisitions continue to be the most sustaining option for some. Northwestern Memorial Physicians Group (IL) merges with Northwestern Medical Group (IL) to form the second-largest physician group in Chicago. The combined group, Northwestern Medicine, has the enviable task of combining medical records from the two organizations. The RelayHealth and athenahealth portals the groups used previously have been replaced in the new organization with Epic MyChart.

Other practices and medical groups take a different approach to making sure they stay in business. David Ming Pon, MD (FL) is accused of stealing more than $7 million from Medicare by falsely diagnosing and treating hundreds of seniors for an eye disease they were told causes blindness.

Some doctors have a bad habit of billing Medicare for the treatment of dead patients, to the tune of $23 million in one particularly lucrative year. There’s obviously a disconnect going on. David Williams of the Taxpayer Protection Alliance says, “If you’re getting a blood test, you should be alive. There’s absolutely no excuse to have blood tests on dead people,” while Bill Cheek of Carmichael’s Pharmacy says billing for the dead is “something that’s unavoidable in our industry.” My reaction can be summed up in one word, best spoken by SNL-era Seth Myers: Really?!

Emerald Physicians ACO (MA) selects the eClinicalWorks Care Coordination Medical Record Solution for population health management.

A report finds that the physician industry generates $26.1 billion in sales revenue and supports $14.8 billion in wages and benefits. A state-by-state breakdown could prove to be an interesting economic development tool for area chambers of commerce.

The House Energy and Commerce Subcommittee on Health, following its hearing last week on the benefits of telemedicine, seeks ideas from from healthcare stakeholders and the public by June 16 to telemedicineideas@mail.house.gov.

A study in Pediatrics finds that placing a trained physician facilitator or coach at pediatric and family practices significantly improves patient outcomes in the areas of obesity detection and counseling, lead exposure screening, and fluoride varnish application to prevent tooth decay.

From the Consultant’s Corner 5/1/14

ICD-10: Now Get it Done Correctly

Since the delay of ICD-10 until October 1, 2015, at the earliest, many healthcare organizations have questioned what the delay means to their existing ICD-10 implementation programs. At the time the delay was announced, most organizations fell into one of three categories in terms of ICD-10 readiness:

• The Prepared
• Those Getting Prepared
• Those Who Remain Out to Lunch

Organizations residing in the first two categories expressed frustration at the delay. They had appropriately taken control of their own fate, identified and managed risk, and prepared or were preparing their organization for this change. The third group, however, either held false hope their EHR/PM vendor would take care of everything, or banked on a delay.

Regardless of which category best describes your organization, the plan forward is simple: Take the newly allotted timeline to get it right.

Many organizations have delayed other important  transformative or IT efforts until after ICD-10, given their limited resources and the work necessary just to achieve ICD-10 compliance. Some organizations took a much broader strategy for their conversion, leveraging this challenge as an opportunity to better enable their physicians and clinical staff to optimize clinical documentation workflows; thus, improving quality reporting and patient outcomes.

With the delay now in place, organizations should absolutely continue implementing their ICD-10 program. They should also use this time to prepare to more effectively compete in the era of expanding, value-based reimbursement models. In addition, organizations should take advantage of this opportunity by re-evaluating project scope.

Identify opportunities to include other initiatives into the ICD-10 conversion program in order to more fully streamline your clinical documentation workflows. Ensure your training program is inclusive of new workflows and EHR functionality, not just coding principles and requirements. Engage payers and intermediaries to ensure your testing program is robust. Expand your use of dual coding and evaluate reimbursement variance to prepare your organization for the downstream financial impacts. Optimize the use of informative, specifically predictive analytics and clinical decision support within the EHR.

ICD-10 poses several risks to a physician practice. Take advantage of the delay to not only ensure compliance, but also to improve your ability to manage your patients’ health.

Brad Boyd is vice president of sales and marketing for Culbert Healthcare Solutions.

News 5/1/14

CMS publishes a final rule that will increase Medicare payments to FQHCs by as much as $1.3 billion over the next five years in compliance with the Affordable Care Act. Beginning October 1, FQHCs will transition from the current fee-for-service model to a daily single rate of about $155 per Medicare beneficiary, which may increase a clinic’s payments from Medicare by a third.

Athenahealth will offer its customers PatientPoint’s patient engagement and care coordination services through its More Disruption Please program.

Physicians reviewing EHRs carefully read the impression and plan section, but only quickly scan details on medications, vitals, and lab results, according to a study published in Applied Clinical Informatics. Researchers recommend optimizing the design of electronic notes to include “rethinking the amount and format of imported patient data as this data appears to largely be ignored.”

Ingenious Med will integrate Entrada’s digital voice capture technology into its mobile application to support the mobile charge capture process.

DrFirst will add electronic prior authorization functionality from CoverMyMeds into its Rcopia e-prescribing, RcopiaMU for Meaningful Use, and Patient Advisor medication adherence platforms.

E-MDs recognizes its customer Jennifer Brull, MD for being named a 2013 Million Hearts Hypertension Control Champion. Brull says that the documentation and reporting capabilities in e-MDs EHR and PM “played an important role” in her practice’s success at achieving blood pressure control rates greater than 70 percent.

Medication adherence could be improved if physicians gave more consideration to medication costs and increased follow-up care for their patients with chronic conditions. That’s the conclusion from Canadian researchers who found that almost one-third of patients fail to fill first-time prescriptions. Medication adherence was found to be more likely if the prescription was for an antibiotic, if the patient was older, and if a greater proportion of all physician visits were with the prescribing physician.

Three boxes of medical billing records from the former Western Berks Internal Medicine (PA) practice are returned two years after they were mistakenly left in a former office and then stored at the home of a maintenance service vendor. Particularly troubling is that during that time no one at the practice ever noticed the records were missing. The 1,800 patient records included clinical information, social security numbers, and other demographic details.

Kaiser Health News highlights the rise of more aggressive billing strategies among practices that are struggling to improve collections. Practices that might have once waited 180 days to refer a patient to collections are now taking action sooner, while more practices are requesting patients pay for any out-of-pocket costs in advance of procedures.

While many physicians may be breathing a sigh of relief over the ICD-10 delay, not all providers are happy about the pushback. Physicians such as New York’s David Weiner, MD, have already invested time and money for several ICD-10 training sessions. Likewise Christine Doucet, MD notes that the delay will force her to eventually participate in a refresher course.

Through March 31, CMS has paid $22.9 billion in MU incentive payments, including $8.6 billion to EPs. For the 2014 program year only 32 EPs had received MU payments, which could suggest a slow-down in participation.

Email Inga.

News 4/29/14

Medfusion announces that its relationship with Allscripts has ended “due to unresolved payment disputes.” The termination is hardly a surprise given Allscripts acquisition of the competing JarDogs patient engagement platform last year. Medfusion says it will continue to provide uninterrupted services to the 30,000 Allscripts providers using its products through May 31, 2014; after that time customers wishing to remain on the Medfusion platform must contract directly with Medfusion.

Practice Fusion launches a population health management offering in collaboration with Merck, giving practices a real-time dashboard that compares a provider’s patient vaccination rate with other Practice Fusion providers.

The HIMSS Electronic Health Record Association (EHRA) tells the ONC it opposes the proposed 2015 voluntary certification EHR criteria, saying that by the time the final rules are published there won’t be enough time for vendors to properly code and test enhancements. EHRA also argues that “more frequent certification is not desirable and would be costly.”

AAFP board member Daniel Spogen, MD rants about the administrative hassles of EMR in an AAFP blog post. Among his complaints: EMRs lack interoperability, are not user-friendly, take time away from patient encounters, result in mixed patient outcomes, increase overall costs, and complicate office workflow. I guess his only goal was to fire up his peers since he fails to suggest any solutions and notes that EHR vendors have little incentive to change things.

The Federation of State Medical Boards approves telemedicine guidelines that include a policy to apply the same standards of care for remote medical encounters as for in-person encounters. The guidelines also call for physicians to be licensed where the patient is located; for providers to establish a credible patient-physician relationship; and for an adherence to safety and privacy principles.

Meanwhile, an Idaho medical licensing board has fined a physician $10,000 for prescribing a patient an antibiotic while working for Consult-a-Doctor, a telehealth provider that has since been purchased by Teladoc. The Idaho Board of Medicine sanctioned the physician, who was licensed in the state, for prescribing medicine without an in-person examination of the patient.  A group of  telehealth-friendly legislators are now pushing stakeholders to establish standards for the practice of telemedicine.

Pay-for-performance programs unfairly penalize providers treating large numbers of poor people, according to a panel commissioned by the Obama administration. The panel notes that it is often harder to achieve successful outcomes when treating people who don’t have much income or education because low-income people may be unable to afford medications or transportation to doctors’ offices and the less educated may struggle to understand written instructions for home care and medication use. As a result, the existing payment policies unintentionally worsen disparities between rich and poor by shifting money away from doctors and hospitals that care for disadvantaged patients.

Forty percent of physician practices are looking to replace their existing EHR, according to a Software Advice report. Among buyers replacing their EHR product, the most common replacement reasons: the current solution is too cumbersome and/or integration is needed between applications. Mobile support for tablets and smartphones, e-prescribing, and lab integration were the most desired features among potential buyers. Based on the above time frames, it looks like a pretty good time to be selling EHR if you’ve got a good product.

MGMA Health Care Consulting Group’s Rosemarie Nelson offers insights into the use of kiosks in practices to improve RCM and patient satisfaction and cites several examples of practices that have reduced their claim denial rates and A/R days while also streamlining the patient check-in and registration process.

Email Inga.