News 9/13/12

From Green Shades: “Re: EMR garbage. An ophthalmologist forwarded me this EHR-generated note from another physician, saying this is ‘typical of what I see.’ Note that this patient has been BLIND in the right eye since childhood. Garbage in, garbage out. EMRs that have pre-populated fields or standardized data that create bad data are much worse than medical records with missing data.” Is the garbage the result of a low-end EMR that doesn’t offer more customization for the specialty? Or is the problem that the EMR has an inefficient workflow and selecting anything beyond the standard defaults is too time consuming? Or is the physician and his/her staff not taking the time (or lack the time) to customize the templates and documentation? Even if a “bad” EMR is to blame, isn’t it ultimately the physician’s responsibility to make sure the documentation is accurate?

From L. Sternin: “Re: specialists and Meaningful Use. I can only comment for psychiatry and why more are not attesting for MU. The MU provisions aren’t particularly meaningful for us and require a lot of extra documentation that we wouldn’t otherwise do, such as check vital signs every visit. It’s straightforward to do when indicated, but not simply to meet arbitrary MU criteria since the time would be taken from other important tasks. Many EHRs do not have psychiatry-specific documentation templates and the choice of menu items for quality measures under MU are not straightforward for all psychiatric patients. Even a requirement such as giving a visit summary seems rather inane if seeing someone every few weeks for psychotherapy when medications or other information is unchanged. Furthermore, many EHR systems are not well designed in terms of protecting the privacy of sensitive information which makes clinicians (and patients) reluctant. The amount of incentive that would be received can be fairly paltry depending on how many Medicare patients one sees. There are some good reasons to implement an EHR, if it’s well designed to begin with, but for most of my psych colleagues, MU doesn’t seem to be one of them.”

Vitera Healthcare kicks off its VIBE 2012 user conference this week in Orlando.

CMS hosts a National Provider Call on September 13 to clarify details of the Stage 2 final rule.

Key-Whitman Eye Center (TX) selects Versus Advantages RTLS from Versus Technology to track patient progression and staff workflows.

St. Vincent Health (IN) offers iSALUS Healthcare’s OfficeEMR to its independent physicians.

UC Davis researchers find that health expenditures are 10% less for patients that have access to office-based care on evenings or weekends, versus patients with no after-hour care options. The study, which was published in the Annals of Family Medicine, found an association with lower prescription drug and office visit-related expenditures for tests when patients had access to care after-hours.

E-mail Inga.

HIStalk Practice Advisory Panel: Impact of ACA on Patient Volumes

In our most recent HIStalk Practice Advisory Panel post, we asked physicians what they thought the potential impact of the Affordable Care Act would be on patient volumes. The general the consensus was that even though providers may have an opportunity to increase their income by seeing more patients, providers don’t care and would rather just go home on time. That’s an ominous message for those expecting PCPs to pick up the slack just because they’ll make more money since it appears that many are not motivated to increase their workload. We asked the panel to comment further.

• As one of six family physicians in a practice in New England, I can report we had essentially no decline in patient volume through our transition to an EHR, and we are now able to realize more appropriate payment for our services. However, we too are not necessarily interested in seeing more patients to increase our income.  Rather we’re interested in learning to do a better, more organized job of seeing the patients who do present, and – ultimately – to rebalance services we provide to our community such that those who need more care (more complex, less confident in self-management) receive the care they need. Income is important, but doing a quality job for the individual patient as well as our broader community is also critical.
• I do not believe that a central solution to our nation’s primary healthcare problem is to simply see more patients. Our profession cannot continue to provide care in the manner to which we (and our society) have become accustomed. Ultimately, we will benefit if we train ourselves as patients to become confident in self-management, and if – as providers – we learn to identify and care well for those in most need of our services.
• I find it rather incredulous that anyone might think PCPs aren’t already, for the most part, working to capacity. Sure, there may be some who have a little room for growth, but most every PCP I know is pretty much stretched as thin as they’re capable of being stretched. Speaking for myself, while I love what I do and am honored to be able to serve my community and my patients/families, there’s only so much you can ask of yourself before something gives (i.e., burnout). I believe we – myself and most of my colleagues – are usually walking right along the edge between giving all that we can and giving too much.
• I want to see all patients receive care, but as Clint in his Dirty Harry role so famously said, “A man’s got to know his limitations.”
• Medicine is a calling. Many of us are not motivated by money. It’s professional satisfaction that makes a difference. That’s the root of burnout – lack of professional satisfaction. The hours and pay are just the straws that broke the camel’s back.

News 9/11/12

Have pledged to let patients view/download/transmit by @himss: @eclinicalworks @athenahealth @soapware @greenwaymedical #ONCPledge #VDTnow

— Farzad Mostashari (@Farzad_ONC) September 8, 2012

National coordinator Farzad Mostashari asks EHR vendors to pledge to allow patients to view/download/transmit their data by HIMSS13 in March. Committed vendors include eClinicalWorks, athenahealth, Greenway, SOAPware, Allscripts, and Cerner.

Loyola University Health System (IL) selects Phytel’s population health management tools for its 75 primary care physicians.

digiChart, a provider of EHR/PM systems for OB-Gyn practices, will integrate the Dialog Health mobile engagement module with its digiChart PracticeSmart software, allowing physicians to communicate with patients via texts about appointments and procedures.

Yul Ejnes, MD, an internal medicine physician and former chair of the American College of Physicians Board of Regents, grades his EHR, which his practice implemented six years ago. In terms of  time (both his own and that of his staff), reliability, and safety, the EHR has met expectations. He rates the EHR “above expectations” for  practice finances and notes his staff is more efficient, claims are cleaner, and the practice has qualified for several EHR incentives. Ejnes gives a “below expectations” rating for quality of care, primarily because of the EHR’s lack of decision support tools. Finally, he says  information exchange has been below expectations, as the practice still must rely heavily on faxes and paper mail. Great exercise.

Navicure names Jeff Wood (MedAssets) VP of product management.

Medical technology and services company Millennium Healthcare announces that its acquisition of physician practice management firm Premier Healthcare Resources should be completed by October 3.

athenahealth identifies its top HIT priorities for the remainder of 2012, including its “More Disruption Please” initiative to connect HIT stakeholders to promote disruptive innovation in healthcare; Meaningful Use transparency on how its athenaClinicals providers are performing against MU standards; and its Leadership Forum initiative to create and nurture healthcare leaders.

I was looking at the latest Meaningful Use figures from CMS and am intrigued by the breakdown by specialty. Medicare reports that almost 60,000 EPs have been paid $1 million in incentives since the program’s inception. About 42% of those are family practice and internal medicine physicians. Family practice and internal medicine each represent three times as many EPs as cardiology, the third-highest specialty identified. Why are specialists not being paid MU payments at the same rate as primary care? Is it because the the specialists are not embracing EHRs for MU because they find workflow unfriendly and a hindrance to productivity? Do specialists find the incentives too small to justify making necessary changes to software and workflow? Or, are there really that many more practicing FPs and IMs providers, compared to cardiologists, OB/GYNs, and other specialties?  I suspect it is a combination of all these factors, but wonder what theories readers might have.

E-mail Inga.

From the Consultant’s Corner 9/7/12

Collaboration: The Key to Future Success for Independent Practices

For the last few years, there’s been a lot of talk about healthcare’s transition to collaborative care. But all that stuff about a “paradigm shift” goes in one ear and out the other if there’s no financial incentive to get on board.

If you’re part of an independent physician practice, that day has arrived. There are plenty of sound financial reasons for jumping on the collaborative care bandwagon—and a distinct financial downside for not doing so.

In short, small independent practices can’t do it alone any more. While Marcus Welby could afford to be a maverick, I believe all practices now need to work closely with other physicians and hospitals to be able to document the quality care that leads to higher reimbursements.

For independent physicians, this requires a completely new mindset: moving from individual episodes of care to a focus on improved outcomes for entire populations. It also requires electronic medical record data to document quality improvements as well as greater teamwork with other area physicians and hospitals.

You have to demonstrate that you’re helping improve care for, say, all of your diabetic patients and helping to lower the number of avoidable hospital readmissions. Your practice’s financial health will be directly tied to how well you meet these metrics.

Now’s the time for small independent practices to begin leveraging data to prove that they can hit the quality and financial benchmarks that will land them a share of the reimbursement pie. Here are four strategies that can help independent practices access the systems that can help them enjoy the financial benefits of quality-based care:

• Take the EMR plunge. Access to an EMR is critical to future viability as a practice. There are affordable EMRs many practices can implement right now.
• Get help from a Health Information Exchange (HIE). This strategy works well in some localities like Rochester, New York, where the HIE is already selling information technology services to independent practice associations (IPAs) in the region.
• Start or join an IPA in your area. This is arguably the best choice because you get more negotiating leverage when you join forces with other independent practices. You can band together to get the best pricing on EMRs, risk contracting, and incentives from commercial payers. Better yet, focus on clinical integration – providing the right care for your patients at the right time.
• Work closely with your hospital’s medical staff.  Many forward-looking medical staffs are actively reaching out to independent practices, offering to share strategies and the hospital’s formidable IT resources.

In recent years, we’ve seen countless articles about how cooperation and care coordination are the pathways to a brighter healthcare future. But now those aren’t clichés—they’re the key to your practice’s financial performance.

In the state of Massachusetts, for example, there’s already been a sea change due to Blue Cross/Blue Shield’s Alternative Quality Contract (AQC) program, which provides incentives for large physician groups to meet quality care metrics. Physicians who meet those metrics get a sizeable bonus—up to 20 percent of total reimbursement.

Working closely with other physicians and your hospital isn’t optional any more. It’s the only way to gather the quality data that leads to higher reimbursements.

Jeff Wasserman is vice president of strategic and executive leadership services for Culbert Healthcare Solutions.

News 9/6/12

Greenway Medical Technologies certifies Patient Prompt’s patient communication solution for use with PrimeSUITE. Greenway’s PrimeLEADER 2012 user conference, by the way, begins Thursday at the Gaylord Palms Resort in Orlando.

Today’s young doctors embrace technology and teamwork, according to this AP article. Unlike older generation physicians, Gen X physicians want a life outside of work, rely heavily on EMRs and smartphone apps, and like sharing the load with other doctors. Thirty-two year-old medical resident Emal Nasiri is not unlike many of his peers:

He likes the idea of working in a large health plan group where doctors, specialists and other medical staff work as teams, with easy access to patients’ electronic medical records. That kind of setup is more likely to be “wired’’ than smaller practices, and Nasiri can’t imagine working without his iPad.

Most physicians and staff are concerned with the transition to ICD-10 and its potential impact on operations and finances, according to a Nuesoft Technologies report. Of the 480 physicians, administrators, and billing staff participating in Nuesoft’s survey, 96% say they are concerned and 60% indicated they are significantly or highly concerned. Also from Nuesoft: a video highlighting the challenges facing medical practices today.

In a letter to CMS regarding the proposed 2013 fee schedule, MGMA urges CMS to combine its e-prescribing incentive program and the EHR incentive program. MGMA says that the duplicate requirements “unfairly penalize providers,” even with proposed hardship exemptions and recommends that all providers meeting MU requirements automatically receive PQRS bonus credit for e-prescribing.

Over the weekend we published a new post from our HIStalk Practice Advisory Panel.  We asked providers about patient volumes and the impact of EMRs and other technologies and the anticipated impact of the Affordable Care Act. Interestingly – and perhaps surprisingly to some policy makers – the potential for additional income may not be adequate motivation for primary care physicians to work harder and see more patients. It could be a Gen X/life balance thing as the above AP article suggests, or it could be that physicians are already working at capacity. As one of our physician members noted, “There may be some who have a little room for growth, but most every PCP I know is pretty much stretched as thin as they’re capable of being stretched.” Your comments are welcome and appreciated.

Surescripts acquires Kryptiq, a company in which Surescripts had invested $8 million in 2010 for a 21% share. Surescripts uses Kryptiq’s secure messaging technology for its network. Other healthcare IT vendors are also among its customers (GE Healthcare and Vitera), and its other offerings include clinical messaging, a patient portal, and electronic prescribing. Kryptiq announced earlier this year that its revenue grew 60% and its user count exceeded 40,000.

E-mail Inga.