News 2/12/13

Capario realizes double-digit revenue growth from its provider base in 2012 and says it significantly increased adoption of its portal application. Capario also notes that 100 percent of its clients participating in KLAS’s annual satisfaction survey believe the company keeps it promises and say they would buy from Capario again.

Vitera Healthcare Solutions hires Kermit Randa (Surgical Information Systems) as EVP of sales and marketing.

Athenahealth earns the #8 spot on Fast Company’s list of the World’s Top 10 Most Innovative Companies in Healthcare. Forbes says athenahealth “stands out” among other EMR companies because theirs is “a system that doctors actually like to use.” Teledoc, a provider of phone and video medical consultations, came in at #9.

Practices should set expectations early for the distribution of MU payments, suggest industry consultants. The decision should ideally be made prior to attestation so providers know whether they are allowed to keep incentive funds or if they are expected to return monies to the practice.

TransforMED, the AAFP subsidiary that supports practices transitioning to PCMHs, announces the retirement of president and CEO Terry McGeeney, MD.

SimplifyMD launches simpleStart, a program that allows medical practices to  go from a demo of the simplfyMD EHR to live clinical use in the same day.

An AHRQ study finds that projects funded under the “Enabling Patient-Centered Care Through Health IT” initiative have shown that healthcare outcomes are positively impacted when HIT is used to create or enhance patient-centered care.

The Huron Valley Physicians Association selects e-MDs as a preferred partner to provide EMR solutions for its 500 physician members.

Don’t miss the interview we did this weekend with SRSsoft CEO Evan Steele, who discusses a range of topics, including Thoma Bravo’s recent investment in the company, “usable” EMRs,  and MU. Steele has been an outspoken critic of the MU program and shared a few of his concerns:

• The government’s Meaningful Use program has sapped innovation out of the EHR marketplace, and it will continue to do so for the foreseeable future if CMS continues churning out overly complex rules.
• The government has set the development roadmap for all EHR companies with its Meaningful Use certification requirements and the compressed timeframe for development and implementation.
• As Meaningful Use has piled on requirement after requirement, physicians are drowning in program-related minutiae.
• Not understanding the complex requirements has kept many from even attempting to participate, and many who are managing to muddle through are suffering tremendous losses in productivity.
• Dissatisfaction is even greater among specialists. They were included as an afterthought in what is basically a primary care program, and many resent reporting on requirements that are irrelevant to their practices.

E-mail Inga.

News 2/7/13

Forbes recognizes Kareo as the 58th most promising privately held, high-growth company in the country.

CAQH launches a universal electronic funds transfer (EFT) enrollment tool for allows providers to enroll with multiple payers through a single online process.

AHRQ and CMS announce a new EHR format for children’s health that includes recommendations for child-specific data elements such as vaccines, prenatal and newborn screening tests, growth data, and child abuse reporting. The format is designed for EHR developers and providers who wish to augment existing systems with additional features or to build new EHR systems for the care of children.

United Health Centers of the San Joaquin Valley (CA), an FQHC, selects WellFx’s online social platform for its patients and employees.

EClinicalWorks will invest $25 million over the next year to enhance and expand its patient engagement tools under its Health & Online Wellness (healow) business unit. The first product is a soon-to-be-available free mobile app for patients.

The Boston Globe, by the way, profiles eClinicalWorks and the launch of its patient engagement initiative.

Navicure extends its partnership with the MGMA AdminiServe Partner Network through 2015, which gives association member preferred pricing for Navicure’s claims management technology.

An AHIP survey finds that the percentage of medical claims filed electronically has increased from 44 percent in 2002 to 94 percent in 2011. In 2011, 93 percent of electronic claims and 79 percent of paper claims were processed within two weeks.

The Charlotte Observer looks at the shared medical appointment model that allows a single provider to treat a group of patients with similar medical conditions. Proponents say the model allows more patients to see a physician on shorter notice and gives patients the opportunity to learn from one another. Zeev Neuwirth, MD, CMO for Carolinas HealthCare’s physician services group, likes the shared appointment model, saying,

“Our research shows that patient satisfaction was as good as, if not better than, if patients are seen individually. And the outcomes are the same.”

E-mail Inga.

News 2/5/13

CMS awards Emdeon a contract to define the process for testing new HIPAA and ACA transaction standards.

Cerner will integrate Gateway EDI’s claims and remit systems within Cerner PM solutions.

Medicare administrative contractor Palmetto GBA posts the results of a prepayment review for CPT code 99214 (established office visit), which included denial rates between 44 and 65 percent. Documentation inadequacy and coding too high an intensity were the most frequent reasons for denials.

More than half of cardiology practices have sold or leased their practices to hospitals compared to 32 percent in 2011. The primary driver was business expenses.

Five practices within Stellaris Health Network deploy PatientKeeper Charge Capture to send charge information from Meditech to their NextGen billing system.

Mississippi House members approve legislation that would allow insurance companies to pay physicians who consult with rural doctors via telemedicine.

SimplifyMD reports that 100 percent of its customers choosing to file for MU attestation have completed the process.

A study finds that HIT adoption by FQHCs is associated with significant improvements in care quality. FQHCs with higher HIT capacity were found to be more likely to use discharge summaries, notify patients for preventive services and follow-up, and create timely appointments for specialty care.

Greenway Medical announces that is compliant with 37 ONC 2014 Edition criteria and is certified as an EHR Module by CCHIT.

eClinicalWorks announces the availability of billing services charged as 2.9 percent of monthly collected revenue.

E-mail Inga.

DOCtalk by Dr. Gregg 2/3/13

Is Meaningful Use Becoming “Lost In Translation”?

From dear Dr. Jayne in her “Curbside Consult” on HIStalk to enigmatic SRSsoft CEO Evan Steele on EMR Straight Talk and more, the phrase “runaway train” keeps popping up in descriptors of the current state of Meaningful Use. I’m on record as a fan of Meaningful Use, but I’ve been seeing some signs, both external and internal, that have me concerned.

First, the external.

As mentioned above, the increasing clamor in the HIT blogosphere seems to be congealing around a core concept that MU has gone (or is going) off track. Not only are smart folks like Jayne and Evan questioning MU’s current trajectory, we’ve even got some of the original stalwarts for HIT who helped craft our technological rail lines making increasing queries about our train’s timetable and rail network design.

The New York Times article, “In Second Look, Few Savings From Digital Health Records” from January 11, 2013, states , “While there is strong evidence that electronic records can contribute to better care and more efficiency, Dr. [David] Blumenthal said, the systems in place do not always work in ways that help achieve those benefits.”

Later in that same piece, David J. Brailer, MD, PhD is on record as saying, “The vast sum of stimulus money flowing into health information technology created a ‘race to adopt’ mentality — buy the systems today to get government handouts, but figure out how to make them work tomorrow."

How many vendors are spending all of their developmental resources solely addressing MU? I know that every vendor with whom I’ve spoken this past year or two is spending the majority of their dev teams’ time on this. Some are spending all of their dev time on it. If everyone’s development is focused upon MU, that sure doesn’t leave much room for creativity and new “meaningfulness” that may not yet have been considered.

Now, the internal.

More by happenstance than plan, I was the first provider in the State of Ohio to receive payment for Stage 1 Meaningful Use via Medicaid. (I was ready for it, for sure, but I just happened to be looking at e-mail when the sign up announcement came through.) I was grateful to receive it, believe me, because margins in small town pediatrics are about as skinny as a heroin-addicted runway model, i.e., deathly thin.

However, since my lovely EHR was sunsetted, I’ve declined to pay for server software upgrades needed to upgrade to the last version my EHR will ever have. That version would allow for Stage 2 achievement. But this expense just doesn’t make sense to me at this point. That money would basically turn the Stage 2 incentive monies into a pass-through, more for a software vendor’s benefit than my practice’s. (And, it makes even less sense if my next EHR is cloud-based!)

I’d prefer to just find my next system upon which to grow, so that any the Stage 2 incentive dollars that pass through to someone else are at least supporting a system with which I’ll be moving forward. (Finding that next system, the one that’s right for me and mine, is a whole other story!)

But, since being on hold, I’ve also noticed that the lower dollars incentivizing Stage 2 seem less motivating. As I spend more time looking at systems, I spend more time thinking about MU hoops. The more I think about Stage 2, then Stage 3 (and Farzad’s talking Stage 4 stuff), the less incentivized I feel.

Don’t get me wrong. I love the potentials and all of the truly meaningful stuff that connected EHRs will allow, once we’re all connected. The problem is, I’m starting to doubt that a federally-legislated definition of “meaningful” will actually play out as was once hoped by all the brains that crafted MU and all of us who have supported it or who even just went along.

I still support the overall idea of Meaningful Use. I’m just wondering if the meaningfulness part has started to get lost in translation.

There’s a part of me that envisions Bill Murray and Scarlett Johansson, standing somewhere off in the wings of an imagined HIT train station, snickering.

From the trenches…

“But the good news is, the whiskey works.” – Bill Murray as “Bob” in Lost in Translation

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, an HIT and marketing consultant, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).

HIStalk Practice Interviews Jim Riley, President and CEO, Capario

Jim Riley is president and CEO of Capario of Santa Ana, CA.

Tell me about yourself and the company.

Capario is a physician office revenue cycle management company. Our mission is to simplify the healthcare reimbursement process, making it easier for providers to get paid faster and more accurately.

A lot has changed in the past three years. We have emerged from a corporate reorganization with a healthier sense of purpose and increased focus on the provider side of our business. As a result, we’re seeing double-digit year over year growth in that segment, and have just completed our strongest year ever as a company both financially and operationally.

Our focus is on the physician office market, which includes practices of all sizes. Our business is divided between direct sales into physician offices and partnering with PMS/EMR systems to offer wrap-around services to their customer base.

For me personally, I’ve been around the healthcare space for over 15 years. I love the vibe within Capario right now. We’re really finding our momentum. Even with over 20 years in this business, our growth is better than ever, client satisfaction scores are high and climbing, and we just have that startup feel. It’s a fun time for me.

There’s been a lot of activity in the revenue cycle market, including product changes, regulatory requirements, and changes in service-based companies. How would you characterize the major differences in RCM today vs. a couple of years ago?

Even as recently as a few years ago, I think most players in the revenue cycle space were still focused on rounding out traditional offerings – a proper tool to do the basics like claims management and tracking. For the most part, everyone has those tools now.

Looking ahead, most of us are focused on providing solutions to help providers get paid, whether it’s tools to bill patients or collect payments or enhanced suites of services to help providers identify and combat denials. With cost pressures in the physician office space, it all comes down to helping providers understand the financial health of their practice and to collect the most possible from every dollar they bill.

The other big difference is the volume of changes that are coming at this industry. We see change as the only constant within the next 3-5 years. There are more and more regulations and standards coming down the pike that could really revolutionize this space, including ERA, EFT, HPID, attachments and more. 

These are just the start. Provisions put in place with the Affordable Care Act call for new standards to be proposed no less than every two years. Providers will need to continually stay on top of these changes in order to grow and adapt with the market.

Small practices are often too busy taking care of patients to network with other practices and stay on top of vendor and regulatory news. How does your marketing plan address getting your message in front of people in those practices?

This is a great question. We’ve really been shifting our focus over the last couple years to offer more educational services. You’re exactly right — practices are often too busy to hear a hard sales pitch. They need to know what changes and trends are affecting them and what they need to do about it.

To that end, we strive to be a good partner and raise these issues to practices through webinars, video on demand learning, etc. This year, we’re also beginning to offer courses that carry CEUs as well. We’re confident that even with this less direct marketing approach, our customers will still hear our message and will know that Capario is a solid choice for them when they are in the market for a solution.

Capario also tends to do a lot of proactive messaging. We allow customers to sign up for customer notifications via our website. These are targeted messages around activities happening in the industry as well as real-time messages around the status of certain payers and transactions being available. We’re often complimented on providing this service to our customers. To us, it just makes good business sense. The more we all know, the better we can all make decisions.

EMRs get all the attention, but for practices and physicians themselves, is it financial and administrative applications that can make or break their opportunity to keep serving patients?

Truthfully, they are both important. As a physician, you have to take advantage of EMRs and all of the power they possess to revolutionize healthcare in this country. While it’s a big adjustment for many practices, there’s no question that the benefits are ultimately there.

What’s ironic is the number of practices embracing EMRs that still have very little technology around the business side of their practice. I’m constantly amazed when we talk to physician practices and find out how few of them really know how they’re performing as it relates to their revenue cycle, especially in the small to mid-sized markets.

Due to the cost pressures we’ve previously discussed, it’s imperative that every practice has a set of tools that can put key performance indicators at their fingertips. EMRs are needed to help improve the health of patients, but good RCM tools are needed to manage the financial health of the practice.

What are the trends of practices demanding and using “Pay Now” services?

I would say that for most practices, the ability to easily bill and collect payments from patients is at the top of their priority lists for 2013. The facts are just too great to ignore. Nearly 25 percent of payments are coming directly from patients. That number is going to continue to grow.

More and more employers are also advocating high-deductible healthcare plans, HDHP, as a way to control costs, and they’re really starting to gain widespread adoption in the last few years. HDHPs are not just plans for the young, single, and healthy employee any more. I even switched my family over to one this year. It just made financial sense.

However, these moves mean more and more of the first dollars reimbursed in healthcare are coming from the patient. This is a radical shift in just the last few years. Physicians on the whole aren’t ready for it. It brings in an element of consumerism that they haven’t had to think of before. For example, many of us pay our bills online now, but most practices do not have a way to collect payments online. Practices need flexible solutions that will help them answer this critical need.

What regulatory and payment trends do you think will most affect your company and customers over the next 2-5 years?

ICD-10 will be huge for the industry, no question. While 5010 was a change to the technical formats, ICD-10 will be a change in the way physicians and payers conduct business with one another. That said, I have confidence now that the industry is behind the new compliance date next year. I don’t think anyone is under the impression it will be delayed again, and most are taking the courses they need and making adjustments to their billing and coding processes to be ready.

Also, the continued shift of payments moving from insurance companies to the patient is going to continue to trend in upcoming years. This is a reality that the physician office space will need to have solutions to address.

Beyond that, there isn’t any one single regulatory trend – it’s more just the volume and pace of changes coming. As I look out over the next few years, there seems to be something coming at least every 12 months. These changes can and will make a huge difference to the healthcare space