News 10/4/12

From Patrick Hall: “Re: Official e-MDs response. As of Oct. 1 of this year, e-MDs is pleased to report its continuing consistent pattern of year-over-year overall revenue growth. Compared to last year, e-MDs has a greater number of customers and employees, a larger number of contractors, as well as increased revenue. As a general rule, e-MDs does not comment on individual personnel changes that occur during routine business operations.” Hall is the EVP of business development ffor eMDs and we thank him for sending us this note in response to comments posted earlier this week from Adam Wright.

From San Antonio Rose: “Re: MGMA. Here’s are a couple recommendations for you. Download the MGMA12 app to your iPhone and bring your cowboy boots.” Cowboy boots: why of course! MGMA app: sounds like a great way to  figure out where I want to go when. Too bad it has been stuck on this screen for the last two hours. Maybe the download will finish by Oct. 21.

The 77-physician Optimal Radiology selects McKesson Revenue Management Solutions for billing, reporting, and collections.

The Ohio AFP and the state’s department of health pilot the PCMH Education Pilot Project, which aims to transform 50 primary care practices into PCMHs that will train medical students, primary care residents, and advanced practice nursing students. Participating medical students will receive up to $30,000 per year in scholarship funds in return for a commitment to practice at least three years in Ohio.

Seven percent of physicians plan to become cash-only or concierge practices within the next three years, which will likely exacerbate existing concerns about physician shortages and lead some patients to avoid routine check-ups and screenings.

Patients who have access to their doctor’s notes are more positive about their quality of care, even though physicians are less enthusiastic a note-sharing program. A year-long study of healthcare sites using OpenNotes software found that patients are more likely to understand their health issues, recall what the doctor tells them, and take prescribed medications when they have access to their visit records. Only a third of the doctors agreed that the program changed how well patients managed their care.

E-mail Inga.

News 10/2/12

From Adam Wright: “Re: e-MDs. They laid off 10 of their staff in operations and a couple of sales folks. Something is going on there.” Unverified. We asked e-MDs to comment but did not hear back. [Statement from e-MDs as of 10/3/12 ] “As of October 1st of this year, e-MDs is pleased to report its continuing consistent pattern of year-over-year overall revenue growth. Compared to last year, e-MDs has a greater number of customers and employees, a larger number of contractors, as well as increased revenue. As a general rule, e-MDs does not comment on individual personnel changes that occur during routine business operations.”

My company was “Acquired” today.. 15 years being the middle size guy who bought up small guys. Now we got gobbled bizjournals.com/pittsburgh/new…

— Susanne Bowyer (@2weety13) October 1, 2012

McKesson signs a definitive agreement to acquire MED3OOO. The companies say that once complete, the acquisition will complement the medical billing and PM offerings of McKesson Revenue Management Solutions and accelerate expansion into growth markets, including domain expertise, services, and technologies for building ACOs. I suspect McKesson also found InteGreat EHR superior to its warehouse of legacy EHR offerings, both in terms of technology and scalability for large practices.

PDX-NHIN, a pharmacy management solutions and services provider, will deliver medication histories from its electronic pharmacy record to Emdeon Clinical Exchange, giving providers real-time access to data for medication reconciliation.

Michigan Orthopaedic Institute selects SRS EHR for its 17-provider practice.

Florida International University incorporates the use of CareCloud Charts EHR into its masters program in Health Informatics and Management Systems. Speaking of CareCloud, the company wins an award for Product/Service of the Year in the South Florida Business Journal’s Entrepreneur Awards 2012.

The 90-physician Collom and Carney Clinic Association (TX/AR) chooses MModal Fluency Direct, a speech recognition solution for clinical documentation.

Capsite releases its 2012 Ambulatory EHR and PM Study. Some highlights:

• Epic holds 17 percent of the ambulatory EHR market, followed by Allscripts (15 percent), eClinicalWorks (nine percent), and NextGen (seven percent)
• Allscripts is the leading PM vendor with a 16 percent market share, followed by Epic (10 percent), GE (8 percent), and eClinicalWorks (seven percent)
• 40 percent of organizations are in the market for an EHR and most will buy within two years
• Only 27 percent of organizations intend to buy or upgrade their PM system
• 43 percent say they have successfully attested for Stage 1 MU; an additional 23 percent aren’t sure of their MU attestation status
• Almost half of organizations plan to join an HIE.

AAFP News Now explores an emerging struggle for practice owners and employed providers: how to allocate MU funds, shared savings, and new quality-based incentive payments. Unless addressed in an employment agreement, employed providers are entitled to their own MU incentives, even if they did not pay for the EHR. The advice: new employment agreements must address bonus opportunities, performance expectations, and the distribution of financial incentives.

E-mail Inga.

Practice Wise 9/30/12

Stuck in the Mud!

There is a great nationally coordinated race that raises funds for St. Jude’s called the Warrior Dash. It’s a combo 5K fun run and obstacle course that literally ends in a mud pit.

My husband and his coworkers signed up to do the race last month. Not wanting to be left out, I joined their team. I heard from friends and one of my consultants that it was more “fun” than “run.” Lots of teams wear really fun costumes that I was sure meant they weren’t really running, but loping along a nice wooded trail.

I’m in reasonable shape, power walk three miles, and do yoga, so of course I thought I’d be fine. However, I didn’t actually look at the event website to see what this activity entailed. I didn’t train for it properly. Boy, did I pay for it! The first half mile of the run was up a very steep incline, the first of many steep inclines. Then there was the rope wall to climb, the swimming obstacles, and so on. I shouldn’t have been surprised that it was much harder than I anticipated.

I see this happen all the time with our clients when they take on an EHR implementation. Doctors in particular have a tendency to short shift their training. I wish I had a dollar for every time I’ve heard, “I’m not changing how I practice or chart. I will make it work.” I always have to bite my tongue (and if you know me, that’s a tall order) because I want to ask these physicians if they figured out medical school and made it work as they went along instead of studying!

There is good reason for a project schedule with an implementation plan and required training. The people who do this work for a living know what a tremendous task it is to learn a new EHR. Learning anything new and committing it to habit takes time.

I get it. Doctors spend their lives in the top 10%, applying for medical school, residency match, and fellowships and jobs. They train, study, and work really hard to make these goals. So I marvel at those who spend tens of thousands of dollars on new software and think they can just figure it out with little or no training.

You’re busy trying to practice, and patient care is the goal. However, if you have this new tool to chart your patient encounters, you owe it to your patients, your staff, and yourself to invest your time in training.

Take the plunge and maintain your sanity:

• Do sign up for all training offered by your vendor, show up and participate.
• Don’t blow off the trainer and tell them that you don’t need to know what they are trying to teach you. True, you know how to practice medicine. However, you don’t know how to use your software. Accept it, learn it, and become proficient. You won’t regret it.
• Do invest in the most training offered. Your vendor should know how much you’ll need to be successful (that’s the goal!) based on your specialty, the complexity of the software, staffing demographics, etc.
• Don’t skimp on training and implementation support. If the vendor offers onsite training and go-live support, take it. The money you save in not having the vendor come on site will be lost in productivity.
• Do pay attention to timelines. They are set for a reason. Get your training done or postpone your go-live if you can’t get it done. This is not just about how proficient you are — your inefficiencies negatively affect your staff and patients.
• Don’t set unrealistic expectations for yourself. It’s not unusual for providers to do fine ‘not knowing’ during go-live week and then get very frustrated in the following weeks because they have not mastered the software yet. It takes time.
• Do plan on taking the better part of a year to master the software, for your staff to master the software, for all your customizations and workflows to become fluid, all your interfaces etc. to be setup and adopted by all.
• Don’t blame the software and everyone around you when you fail to master the software if you don’t do the necessary training. Nobody can learn this for you.

I plan on tackling the mud run again next year. This time, I know what I’m getting into. I plan to train appropriately for it (e.g., running hills and getting over my fear of the big, scary rope climbing things).

Do yourself a favor. Train hard for your EHR implementation. And if you’re already on an EHR and struggling, there’s no shame in going back for training. Just do it.

Final push to the end, last obstacle before the mud pit, not that you can tell by my clothes!

Julie McGovern is CEO of Practice Wise, LLC.

News 9/27/12

Parents are 50 percent more likely to fill their children’s medication prescriptions when doctors send the orders electronically to pharmacies.

Physicians are working six percent fewer hours than they did in 2008 and seeing almost 17 percent fewer patients. More than half the physicians participating in a Physicians Foundation survey plan to take additional steps to reduce patient access to their services over the next one to three years. Doctors also report spending 22 percent of their time on non-clinical paperwork.

4medica releases OfficeSuite, a cloud-based EHR with integrated practice management.

Amae Plastic Surgery Center (MI) implements eClinicalWorks EMR.

I’ll be heading to San Antonio in less than a month for the MGMA 2012 Annual Conference. I’ve already penciled in a half dozen sessions I’d like to hit and considering what product demonstrations to squeeze in. If you have any session and exhibitor suggestions, send me your picks.  Attendees will also want to look for our annual Must See Vendor List that we’ll publish the week of October 14. Meanwhile, MGMA is already accepting speaker applications for its 2013 event in San Diego.

MedCity News warns physicians to read end user license agreements before signing up for a “free” EMR. Providers should understand specifics on implementation, training, upgrades, support, and PHI security protocols, as well as any disclaimers related to liabilities and warranties.

Some common EMR implementation pitfalls that can alienate patients, courtesy of AMA News:

• Lack of infrastructure, especially inadequate hardware and network speed
• Lack of workflow assessment to ensure a good match between work flow and the selected EMR
• Inadequate training
• Failure to get employee buy-in
• Failure to communicate with patients about the transition
• Failure to figure out the role of the computer during the patient encounter.

E-mail Inga.

News 9/25/12

Wednesday Oct 3 is the last day for EPs to begin their 90-day reporting period for the 2012 MU EHR incentive program.

Park Avenue Associates in Radiology (NY) selects McKesson to provide revenue management services for its 15-physician group.

MedAptus makes available its Mobile Schedule application for the Apple iOS platform, giving physicians access to their schedules and patient information.

Most patients would like access to their health data online and are interested in emailing their physicians, however most providers don’t offer the capability. An Optum Institute survey also finds that 70% of physicians have at least basic EHR capabilities, though only 40 percent have EMRs that support e-mail communications or patient access to health records.

Wood River Health Services (RI) goes live on NextGen’s EHR; the practice also uses NextGen for its billing and dental applications.

Rosemarie Nelson of MGMA Health Care Consulting Group argues that cost is not the only reason for low EHR adoption rates among small practices. Key issues include a shortage of personnel to oversee the EHR project, staff’s limited knowledge of technology, and insufficient time to stay current with changes:

Implementing an EHR is a full-time position for at least three to six months even in a small practice. And, after that, the ongoing support (optimizing, implementing new releases and features, managing incentive program participation, etc.) will require about .20 or .25 FTE for the system guru in the practice. Given the challenges facing medical practices of all sizes, is it any wonder that it’s a daunting task to select and implement a PM/EHR system in a small practice?

Data conversion failure is the most common issue reported by practices that have replaced their practice management system. Other problems noted include reduced cash flow, increased days in A/R, and increased number of claims denials.

The local paper highlights Duke Primary Care Hillsborough (NC), one of Duke Medicine’s first clinics to go live on Epic’s EHR.

Marketing and communications consultant Cindy Thomas Wright offers several tips for using EHRs as a practice marketing tool and to increase patient satisfaction. Suggestions include using automated test reminders; analyzing practice demographics to develop a targeted media plan; and, analyzing patients’ geographic locations to assess expansion possibilities and identify and foster relationships with referral sources.

E-mail Inga.