News 7/23/13

From Le Patron: “Black Book report on EHR vendor consolidation. They are spot on. There are too many vendors and way too much physician dissatisfaction to support the status quo. The specialty physicians are especially dissatisfied with the one-size-fits-all vendors. I’ll give you $1,000 for every specialist satisfied with one of the big name vendors if you give me $1,000 for each one who is dissatisfied. I’d be a rich man.” Neither vendor consolidation nor user dissatisfaction are surprising, but don’t put all the blame on vendors. Vendors have had to shift their development priorities to MU and other mandated programs, while workflow enhancements and usability updates have been pushed to the back burner. More vendors, large and small, will be forced to sunset products as ongoing development costs are either deemed unsustainable or not practical , especially for vendors offering multiple EHRs. Look no further than Allscripts MyWay and Mitochon as great examples.

Earlier this month I mentioned the 17 percent drop in EP participation in the MU program from 2011 to 2012.  CMS asked EPs why they had dropped out and learned many felt the program was too time-consuming or too complicated; others claimed they were waiting for Stage 2 requirements; and, more than a third claimed they intended to attest but missed the deadline.

Vitera Healthcare names Jeremy Muench (McKesson Provider Technologies) SVP of client operations.

CIOs and IT system directors in medical groups report median compensation increases of more than seven percent since 2011, according to the MGMA. Compensation for physicians, by the way, grew about three percent from 2011 to 2012.

If House lawmakers have their way, physicians will see five years of 0.5 percent increases in Medicare payments starting next year. The proposed bill repeals Medicare’s SGR payment formula and replaces it with a system based on quality and efficiency, starting in 2019. Physicians choosing to stick with traditional fee-for-service compensation would see a permanent five percent cut after 2018.

E-mail Inga.

News 7/18/13

CMS releases data that demonstrates that the use of EHR is helping providers manage patients’ care and provide more information securely. CMS notes that since 2011, providers have used EHRs to send more than 190 million prescriptions electronically, sent 4.6 million patients an electronic copy of their health information, forwarded more than 13 million patient reminders, checked drug and medication interactions over 40 million times, and shared more than 4.3 million care summaries with other providers.

Approximately 59 percent of physician practices expect the move to ICD-10 will lead to a decline in revenue, according to a eHealth Initiative/AHIMA survey. The most significant barriers for ICD-10 implementation include staffing and training, workflow and productivity, lack of knowledge, and cost of software upgrade.

CMS offers OPEN PAYMENTS mobile apps to facilitate reporting of financial ties between doctors, teaching hospitals, and drug and device manufacturers.

Aprima reports that over 1,000 former customers of Allscripts MyWay have migrated to Aprima PRM since Allscripts’ October announcement that it would not develop new MyWay updates for MU or ICD-10.

Celebration Orthopaedic & Sports Medicine Institute (FL) selects simplifyMD’s EHR/PM system for its 10 providers.

Wishard-Eskenazi Health (IN) selects eClinicalWorks PM for 385 providers across eight locations.

CareCloud releases an update to its CareCloud Charts EHR that includes enhancements to charting, task management, and patient flow management.

A Massachusetts eHealth Collaborative-sponsored study finds that EHR adoption by doctors in three communities generated no statistically significant per-member, per-month cost savings, although EHR usage appeared to be associated with less-rapid cost increases.

A Black Book Rankings survey of 880 EHR consultants finds that most believe the majority of existing EHR vendors will have merged, been acquired, or cease operations within five years. Most of the failing vendors will falter because they delayed usability issues over meeting MU requirements. Well-funded smaller vendors serving niche sectors may do better than vendors who fail to resolve “fundamental flaws caused by being all things to all physicians.”

The AAFP subsidiary TransforMED selects 90 primary care practices in 65 cities as participants in a three-year patient-centered medical neighborhood pilot project.

Allscripts will offer its ambulatory clients LDM Group’s ScriptGuide patient education solutions.

E-mail Inga.

News 7/16/13

Clinical Holdings Corporation, a new physician services business of Ascension Health Alliance, will deploy athenahealth’s RCM/PM services to over 4,000 providers. Analysts believe the deal may be worth $42 million in revenue for athenaheatlh.

Free EMR-provider Practice Fusion is rumored to be closing on a $60 million fourth round of funding, on top of the $34 million raised less than a year ago.

Ambulatory EMR/RCM provider Integrated Solutions Groups, the parent company of Professional Data Services, acquires Data Strategies, a McKesson Practice Partner EMR reseller and the provider of the PDS Cortex PM platform.

Emdeon will integrate the Simplicity Settlement Services by ECHO into the Emdeon Payment Network. Emdeon also announces its recent opening of a 100,000 square-foot facility in St. Louis, MO and the introduction of Virtual Card Services, an electronic payment option to reduce payment distribution costs and payment processes.

Middlebrook Family Medicine (VA) selects Benchmark Systems EHR, billing, and collection software.

Concerned about MU audits? Here are some pre-payment audit preparation best practices, based on the experiences of EPs that have survived pre-payment and post-payment audits:

• Understand core and menu set measures
• Use multi-disciplinary teams
• Document measure compliance
• Analyze security risk
• Have documentation that indicates the installed EHR is certified.

CMS highlights key 2014 deadlines for the EHR incentive initiative and other eHealth programs.

A dozen employees from the Raleigh, NC offices of Allscripts volunteered to help clean up tornado damage in Moore, OK and presented the local hospital with a check for $50,000. Allscripts covered all of their expenses and paid their full salaries.

Physicians in larger states, ER specialists, and pathologists have historically experienced higher levels of PQRS success, according to CMS data.

E-mail Inga.

News 7/11/13

CMS proposes changes to payment policies, including a provision to begin paying providers in 2015 for non-face-to-face care of Medicare patients with multiple chronic conditions. To be eligible, providers will be required to use a certified EHR. Other proposed changes include the addition of new quality reporting measures for 2014; an expansion of telehealth services to include sites designated as health professional shortage areas in rural or urban areas; and, the addition of transitional care management services as an eligible Medicare telehealth service.

The percentage of physicians using at least a basic EHR system increased from 25 percent in 2010 to 38 percent in 2012, according to a Robert Wood Johnson Foundation study, while the percentage of practices participating in an HIE has jumped from three to 10 percent. Other notable findings:

• The highest relative increases in adoption were among physicians with historically low adoption levels, including older physicians and those working in solo practices or community health centers.
• As of 2012, physicians in rural areas had higher rates of adoption than those in large urban areas, and physicians in counties with high rates of poverty had rates of adoption comparable to those in areas with less poverty.
• Small practices continued to lag behind larger practices.

ONC National Coordinator Farzad Mostashari, MD discussed the findings at a press conference and predicted that full EHR adoption will be slow until 2014 – just before penalties for not hitting MU standards start in 2015.

The success of e-prescribing initiatives can be tied to federal programs offering financial incentives for e-prescribing providers, according to a report authored by representatives from the ONC and Surecripts, Federal incentives resulted in the addition of 94,000 new e-prescribers between July 2008 and December 2010, leading the authors to make the less than profound conclusion that “financial incentives can drive providers’ adoption.”

Greenway Medical will add PatientPay’s online patient payment solution to its PrimeSUITE EHR/PM platform. Greenway also announces that providers are successfully exchanging CCDs between the Greenway platform at Doctors May-Grant Associates (PA) and the Epic system installed at Lancaster General Health’s Women’s & Baby Hospital (PA).

The 340-provider UT Medical Group (TN) signs a three-year contract with MediRevv for its Day One Self Pay A/R Management services.

E-mail Inga.

News 7/9/13

From Gloria: “Re: EMR features. Can you please help me understand if there is any major difference in EMR features for practices depending on the number of providers? For example, how would an EMR used by a solo physician differ from an EMR used by a large practice of 41+ physicians? Do both of them not do the same thing..namely treat the patient for conditions?” I am sure many readers can answer this better than me, but here are a few thoughts. While most EMRs include the same basics, such as the ability to track patient history and capture clinical notes, EMRs used by larger groups tend to include more features and functionality. For example, many EMRs catering to small primary care practices have less developed templates and rely more on free-text data entry. Larger groups have a greater need for care coordination, especially if patients are seen by multiple providers within the same practice, and will likely seek a variety of bi-directional interfaces to automate high volumes of orders and results. The architecture behind an EMR is also important since a program designed for small offices may not scale beyond a handful of users. Beyond features and functions, many EMR vendors don’t have adequate training and support resources to satisfy the demands of large groups. Readers, please offer additional insights.

The medical director for 70-provider South Texas Medical Clinics says its recent implementation of EMR has allowed the practice to “substantially” reduce its percentage of medical errors below the national average. I assume that STMC uses eClinicalWorks since it is part of Memorial Hermann Medical Group, a large eCW client.

The American Academy of Ophthalmology plans to implement an eye disease patient database that will enable ophthalmologists to statistically review and analyze their own care and compare it to benchmarks and peer physician performance. The Intelligent Research In Sight Registry (IRIS) will be populated with de-identified data collected from practices’ EHRs and serve as a PQRS EHR submission vendor.

HIMSS Analytics recognizes 31 Bon Secours Health Systems (VA) ambulatory clinics with the HIMSS Stage 7 EMR Ambulatory award for its implementation of Epic.

Almost one-third of physician executives participating in an ACPE survey believe that healthcare costs go up when hospitals buy physician practices.

The doctor shortage and an improved economy has led to an increase in physician recruitment activities. A quarter of practicing physicians report receiving 24 to 40 job solicitations a month.

E-mail Inga.