DOCtalk by Dr. Gregg 11/17/12

International Paper Co. Merges with Bic Pen to Build EHR

Now there’s a headline I just might love.

Why? Because it occurred to me that back in the days of paper and pen, I never once thought about the financial stability of the companies that provided the tools for documenting my trade. Those companies just seemed so rock solid, so just “always there.”

Seriously…for any of you who’ve been around long enough, did you ever once worry about the market status or potential acquisitions of Mead Paper or Pilot Pens? Did you ever have to consider pen technical support or paper training sessions? Did you ever think about what would happen if your pen supplier went belly up?

Remember when “system downtime” was a break for lunch?

I was conversing with perhaps the wisest and savviest person I know the other day when this thought occurred. (He’s HIT smart, yes, but generally all around brilliant, too … and even comes with a charmingly mannered personality.) I was picking his brain about some potential EHRs and he helped walk me through some of the current industry status for factors anyone must consider these days when thinking about their HIT needs, such as:

• Company financial viability
• Stock prices
• Market forces
• Potential for acquisition
• R&D resources
• Corporate culture
• Future technological anticipations
• Etcetera, etcetera, etcetera

Granted, my brain is now fuzzed with age, silicon dust, and/or lack of sleep, but I’m pretty sure I never used to have to consider such commercial concepts when trying to document patient care. And, I know my practitioner predecessors never once gave a single thought to any of these factors when trying to provide healthcare services.

Having been through the private and public corporate acquisition mills, having had my choice of digital documentation deleted, and having lost countless hours of family time trying to interpret the HIT tea leaves, it has become clear to me that I am spending far too much of my professional life thinking about and doing things that I never anticipated and for which I was miserably undereducated in school. The “learn as you go” for this new side of healthcare considerations has been… well… interesting.

So, would the footprint of our old friends, the pen and paper manufacturers, help relieve this corporate chaos which HIT hath wrought upon healthcare provision? Naaaah. But the nostalgia for those carefree days of documentation is such an agreeable daydream…

…until I remember I can barely read my own handwriting.

Everything’s a tradeoff.

From the trenches…

“The act of putting pen to paper encourages pause for thought, this in turn makes us think more deeply about life, which helps us regain our equilibrium.” – Norbet Platt

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, directs the Pediatric Office of Today! exhibit for the American Academy of Pediatrics, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).

News 11/15/12

From Soak Zone: “Re: NextGen UGM. Great logistics and sessions and a Shamu encounter. Got to love it. You should go to next year’s meeting in Vegas!” Thanks for the invite – you never know. I read many of the comments from the Twitter feed and Facebook and almost all were very positive. Just a couple of complaints about bus logistics to Sea World, but I’m sure transporting 4,000 people has its challenges. Thanks to the readers who sent comments and pictures.

No surprise here: MGMA-ACMPE finds that its members are more satisfied with payers that pay promptly and respond to their inquiries rapidly and accurately. Medicare Part B was the highest-rated payer, though none of seven payers included in the survey earned overall satisfaction ratings in the “moderately” or “completely” satisfied range.

Culbert Healthcare Solutions expands its customer base to more than 150 organizations and gains the 159th spot in the healthcare industry segment on Forbes list of fastest-growing private companies.

Greenway adds a rules engine to its PrimeRCM service that integrates billing intelligence with clinical care. Greenway expects the added technology to produce cleaner claims and lead to better collection rates, as well as to advise providers of payer care guidelines when ordering tests and procedures.

Vitera Intergy EHR/PM client MU Medical Management (AZ) selects ClearDATA Networks for hosting services.

The US will need at least 52,000 more family doctors by 2025 as the population continues to age. Policy officials offer several possible fixes, including better pay for primary care physicians, increased care from PAs and NPs, and, more care provided through PCMHs.

Worcester Business Journal awards eClinicalWorks top honors for its employee rewards and recognition.

Barry Pointe Family Care (MO – above) and Desert Ridge Family Physicians (AZ) are named finalists in the NextGen Healthcare/Intel Innovation Awards, while Hunterdon Healthcare Partners wins Grand Champion honors.

Also from NextGen: the company will connect to the Surescripts Network for Clinical Interoperability for secure messaging and clinical data sharing.

What’s not to love about this story? Patients of Russell Dohner, MD of Rushville, IL don’t seem to mind that he does not accept insurance and doesn’t have a computer or fax machine. Every morning patients from a four-county area line up to see the 87-year-old physician, who charges a mere $5 for an office visit. He barely makes enough to pay his staff, which includes an 86-year-old nurse and 85-year-old secretary, and says this of his 57-year career:

“I always just wanted to be a doctor to help people with their medical problems, and that’s all it’s for. It was never intended to make a lot of money.”

E-mail Inga.

News 11/13/12

Emdeon reports a Q3 loss of $15.2 million, which represents a 341 percent decline over a year ago. Revenue was up 5.3 percent to $297 million. Emdeon attributes the loss to increased interest expenses and costs associated with the company’s acquisition by Blackstone a year ago.

The 2013 Medicare fee schedule includes a new program that pays physicians between $160 and $230 (assuming no SGR cuts) per care coordination incident associated with the transfer of patients to skill nursing facilities. Also new for 2013: physicians must participate in the physician quality reporting system (PQRS) to avoid Medicare payment reductions of 1.5 percent in 2015.

The American College of Physicians will provide free access to its online Medical Home 2.0 practice management tool to physician offices participating in Wellpoint’s PCMH program.

SplashData publishes a list of Worst Passwords for 2012 based on stolen passwords posted online by hackers. Happy to say none of my passwords made the list, but if any of yours did, you might want to consider some of these anti-hacker password tricks.

Aprima announces that it has settled the lawsuit brought against it by Allscripts, which had claimed that the wording of Aprima’s advertised “MyWay Rescue Upgrade Program” violated state and federal laws. Aprima agreed to changed its advertising, but will continue to market its product to users of the Allscripts MyWay EHR. Allscripts previously announced that MyWay will not be upgraded to handle ICD-10 or Meaningful Use Stage 2, but customers will be offered a free conversion to its Professional product.

One in three cell phone owners use their phone to look up health information. Among adult smartphone users, almost 20 percent use their device to monitor or manage their health.

NextGen kicks off its 2012 User Group Meeting this week in Orlando with over 240 individual educational and networking sessions. We have a new Twitter feed box for sponsors on your right that’s running tweets from the conference. If you’re there and have any insights or photos to share, please send them my way.

The Reedsburg Area Medical Specialty Center’s Orthopedics & Consulting Services, Reedsburg Physicians Group, and Surgical Specialists go live this week on GE Centricity EMR.

E-mail Inga.

Bowtie Confidential 11/10/12

Accountable Care Act and its Effects on the Board of Directors

Most boards have for some time received updates on the Accountable Care Act (ACA) and other significant changes to the healthcare environment. However, there has been an understandable unwillingness to step forward into the ACA realm despite the fact that the organization’s future may hang in the balance.

In June of this year, it became time to take that step and up the education and awareness process to the board concerning ACA and the eventual system transformation. Leadership and the board should know how to react to these new requirements. They should also know the impact on their organization (and the industry). If ACA board education and awareness has not taken place in your healthcare organization, then you’re behind!

The Supreme Court’s decision in June 2012 to support the Accountable Care Act (ACA) further enabled the use of Accountable Care Organizations (ACO) as one of the principal tools for addressing healthcare costs and improving care.

Many hospitals and health systems have begun planning efforts that include communication regarding ACA. This process provides updated briefings for the board on the decisions regarding primary implications and imperatives of the ruling. The briefings are consistent with the board’s responsibilities related to their fiduciary and legal obligations. Executive leadership, general counsel and external strategic advisors are well suited to provide these briefings and information sharing sessions.

Board members do not need to fully understand the legal statutory fundamentals for the decision and/or read the ACA in its entirety. However, they should be familiar with key themes. Although board members will not be required to be subject matter experts in the law of reform — they will need to look to the advice of leadership, executive management, and external consultants. The bottom line is that the board will be expected to have sufficient understanding of ACA that will allow each member to ask the appropriate questions and evaluate the advice of advisors and consultants.

The board should assess the need for focus on the following:

• Information technology. Technology will become an ever-increasing component as the reliance on EMR, data gathering and analysis become key to operations. The ability of the organization’s technology architecture to address new relationships between data and payment will be essential for survival.
• Finance. Understand the impact of the changes brought about by ACA reform. The organization’s responses will affect its financial standing and survival.
• Strategic planning. Both internal and external. Review and assess potential options for relationships and alignment with other organizations and services provided.
• Compliance. Government enforcement of the ACA’s new anti-fraud provisions and its supplemental requirements for maintaining tax-exempt status.
• Human resources. How will the organization address and incorporate ACA’s implications on the organization as a major employer?
• Delivery network. Are all of the necessary provider groups appropriately aligned? This includes hospitals (including referral centers), physicians (primary and specialists), post-acute care providers, etc. In addition, what is the strategy for patient medical home models?

In summary, the ACA ruling establishes a singularly important teaching moment. Attentive management will take the initiative to educate the board frequently and thoroughly on the ACA ruling, its importance to the national and local healthcare environment, and its financial implications to a specific hospital or health system. The awareness and understanding will position the board to respond to the expected and unexpected impacts, the rate of change and the availability of strategic opportunities.

These sessions also provide leadership with the opportunity to remind the board of the organization’s strategic plan and the necessary elements to address these challenges. In this way, your organization can have a board that is more informed and effective in their fiduciary responsibilities.

Rob Drewniak is vice president, strategic and advisory services, for Hayes Management Consulting.

News 11/8/12

Healthcare software and services company iMedX acquires Greenlight Transcription.

In its 2013 physician fee schedule published last week, Medicare adds two additional categories of hardship exemptions for the e-prescribing rule. Doctors and practices who achieve MU  by June 30, 2013 and those who demonstrate intent to use EHRs can apply for an exemption to the reimbursement cuts slated to start next year.

Eye Health Services (MA) selects SRS EHR for its 21 providers and 11 locations.

The Medicare Payment Advisory Commission estimates facility fees tacked on to routine office visits will add $2 billion a year to Medicare spending by 2020. As more hospitals acquire physician practices, look for increased pushback from insurance companies and employers.

Through the end of September over 300,000 EPs have signed up to participate in the EHR incentive program. Since the program’s inception, Medicare has paid 82,535 EPs over $1.4 billion in incentives while Medicaid has issued more than $1.2 billion to over 60,000 EPs.

SRS reportsthat power has been restored in its Montvale, NJ headquarters and staff will be back in the office Thursday. The company’s Sandy Relief Drive, by the way, generated almost $5,000 in employee donations, which the company matched in purchasing supplies  for affected Staten Island residents and schools.  The balance of the money will be donated to the Red Cross and Governor Christie’s Relief Fund.

eClinicalWorks receives full NCQA certification as a CAHPS PCMH survey vendor to conduct NCQA HEDIS surveys.

Almost half of primary care physicians expect to participate in an ACO model within the next year.

The Washington Post profiles physicians who aren’t necessarily enamored with EHRs and would prefer to hang on to their paper charts. Naysayers include physicians who say EHRs haven’t “lived up to the hype”  and worry about gaps in technology. On balance, one cardiologist notes:

“When you first go to EHR, it’s really a nightmare for the first three months in terms of trying to get comfortable with the system. But now, it helps our work flow, and we have fingertip access to information.”

CMS posts a couple new FAQs, including a question on how to handle transitions of care summary of care records for Stage 2 MU. For the Stage 2 transition of care and referrals objective, CMS provides details on  different ways providers can meet the measure that more than 10% of summary of care records for transitions and referrals be transmitted electronically. One approach is to use certified EHR technology to electronically transmit summary care records for transitions of care and referrals. Alternatively providers can use their EHRs to create a summary care record and use an eHealth Exchange to facilitate electronic transmission.

E-mail Inga.