Bowtie Confidential: What I Expect in 2012 12/28/11

As a consultant who spends many hours flying (or more likely, sitting in airports waiting to fly) to various parts of the country to meet with clients, I have ample time on my hands for reflection. Over the past few weeks, I have reflected on how I have spent my time over the past year in client-related work and where I see my time being spent in 2012.

It is clear that there are three major areas where clients want my help. The first is related to Meaningful Use. Three years ago, these clients were asking for my assistance to select an EMR. Now, they are looking for help with implementation of the system they purchased, system maximization, or the amelioration of some problem that is preventing them from successfully attesting to CMS for Meaningful Use dollars.

The second area is ACOs – should they participate, what they need to do to be successful, what IT will they need in place, etc.

The third area is ICD-10. In this particular area, people would like me to convince the feds that conversion is too expensive, too time consuming, too complicated, too (you fill in your choice of adjectives). For this article I will concentrate on the first two topics; the third I will handle next time (maybe the feds will listen to your cumulative prayers and delay implementation so I will need a different topic).

I have always been fascinated with numbers and thought that I would share some very interesting figures put out by our friends at CMS over the past few weeks. I will also be showing you some interesting factoids related to ACO development.

The first set of statistics is related to Meaningful Use and the incentive payments that have been made thus far. These numbers are supplied by CMS and are current through the end of November 2011.

CMS is on schedule to disperse approximately $2 billion in payments to physicians and hospitals (in their terminology – EPs – eligible providers). More than 155,000 physicians have registered to participate in this program, with a 3:1 ratio of physicians participating in the Medicare program compared to the Medicaid program. From those registered participants, slightly more than 21,000 have completed their attestation.

Think of what this means. Fewer than one in seven physicians who have registered have gone on to the attestation process. There will surely be an attestation stampede in 2012 with the final date for qualifying for full first year funding being October 1, only 90 days prior to the end of calendar year 2012. I think that it is safe to predict that tens of thousands of physicians will be submitting their attestation in the second half of 2012. What does this mean for payment speed to these providers? Your guess is as good as mine.

From the 21,000 physicians who have submitted their attestation, 444 were unsuccessful. This says something very positive about the early adopters. On the hospital side, 769 hospitals completed attestation and not one was unsuccessful.

One last set of statistics that may be of interest to you: from the entire universe of physicians, the number of physicians who have registered is 28%. This is 5% less than the generally accepted EMR adoption rate of 33%. On the hospital side, 58% of all hospitals have registered to participate in this program.

According to a recent survey by UnitedHealth Group, only 60% of physicians know what an ACO is. From this group, 28% indicated that they were considering joining/forming an ACO. That translates into the fact that less than 20% of the physicians surveyed are planning to participate in an ACO in some way.

A study by Leavitt Partners indicates that there are 164 identified ACOs spread across 41 states. The states with the most ACOs are CA, MI, OH, TX and WI. States with the no ACOs include AL, AK, AR, DE, DC, ID, KS, MS, NV, ND, RI, VT and WV. These ACOs are being sponsored by hospitals, hospital systems, insurers, joint ventures between insurers and hospitals/hospital systems, etc. Nearly 100 of these ACOs are sponsored by hospital systems, 38 by medical groups, and 27 by insurers.

As I mentioned, multiple physician and hospital organizations are asking me, “Should we participate in an ACO?” My response is usually the same – look at the competitive marketplace, ask yourself if you have several million in cash sitting around collecting dust, an underutilized IT shop, etc. What is your relationship with the medical staff, or conversely, the hospital CEO – do you trust each other to be business partners going forward? Where are you going to find real-time case management services?

The decision to participate in an ACO is a serious and far-reaching decision. Have you done your economic, political, and organizational homework to maximize your chances of success?

Unless you can answer affirmatively to all of these questions, I would be extremely cautious about moving forward.

I spent a part of my afternoon today speaking with a financial analyst from one of Wall Street’s best-known firms (yes, there are still a couple of them still around). The topic of conversation was how quickly will ACOs grow and what will their market penetration be in 2016.

This individual had no doubt that ACOs are here to stay and wanted to know which model would be the dominant player in five years. I tried to explain to him that his view was not a sure thing; that providers are, in most ways, risk averse. Telling a Wall Street venture capitalist that someone is risk averse is not a pleasant thing to do.

I rattled off the usual litany of issues – that of the nine original demonstration projects only one (Marshfield) made a reasonable profit for their efforts. That it was going to be hard enough for physicians to partner with hospitals, but for physicians and hospitals to partner with insurance companies might still be a stretch. That the level of capital that needed to be invested to make ACOs truly functional is unreachable for most provider organizations that I work with, etc.

I don’t think that I was successful in getting my point across. He explained that “The Street” saw this as the next big thing. For anyone who has had their retirement plans delayed or have had to continue working to pay for their kids college, betting on Wall Street’s vision of the ‘next big thing’ should be interesting, to say the least.

Don Michaels, PhD is vice president, strategic and advisory services, for Hayes Management Consulting and teaches healthcare IT for the Harvard School of Public Health.

DOCtalk by Dr. Gregg 12/24/11

The Year’s Biggest HIT Event May Be a Sneaker

Over on granddaddy HIStalk, you’ll see Part One of the annual query of HIT C-suiters and other head honcho types, “What was the biggest HIT-related news or event in 2011 and why?” Some pretty expectable answers about ICD-10, ACOs, the Stage 2 Meaningful Use delay, mergers/acquisitions, and mobile health – often with some also expectable vendor-centric skew on the take – dominate these execs’ considered replies.

I can’t really say that I disagree much with any of these folks’ points of view, but I’ve been watching the land of HIT from a slightly different perspective of late and I think there may be an even more powerful portent percolating in the periphery of our health tech world. It’s sneaking up on us and it has the potential to change virtually anything and everything we do in healthcare. At least when history looks back, I’m thinking it may just be the true lead story for 2011 … and beyond.

Just as in the Middle East where, via the connectivity they can now muster via the Internets [sic], common folks have inflamed the fires of revolution and toppled longstanding authoritarian rule, I think the growing “militia” that is the so-called “e-patient” (“e” for electronic, empowered, engaged, enlightened, etc.) may just be the as yet unsung “biggest HIT-related” development in 2011. This movement is growing by leaps and bounds, yet most of the HIT world has it only on the periphery of their radars.

You all may be familiar with e-Patient Dave DeBronkhart. Dave is a leader in the budding Society for Participatory Medicine which builds upon the foundations laid by the late Dr. Tom Ferguson and his e-Patients Scholars Working Group using the guiding principle, “When the people are well-informed, they can be trusted to govern themselves.” (This, from the genius Thomas Jefferson, famous figure of a previous toppling of authoritarian rule.)

Founded in 2009, their byline is “Bringing together e-patients and healthcare professionals.” I joined SPM a little earlier this year and though I’ve so far just been listening in, getting a feel for the folks and the forum, I gotta tell you, this now fast-rising rabble has one of the most active and spirited multi-thread e-mail conversations going that I have ever seen. With voices from all over the land of healthcare, be they people/patients or medicos, and all over at least three continents, they are very busily debating just what the direction for consumer-centric healthcare delivery should be and just what people/patients should allow.

Recently, the folks at SPM were going back and forth about the value and/or ulterior motives of corporate involvement with the patient engagement realm (e.g., Merck’s MerckEngage.) Regardless of whether we can always trust the big pharma to always do the right thing or to be driven by high-moral motives, their recognition that healthcare is heading toward a consumer-driven model just adds more fuel to the SPM fires. (Personally, I really enjoyed several great little videos which Merck has on their site of Dr. Marie Savard, an advocate for patient rights and former director for the Center for Women’s Health at the Medical College of Pennsylvania, where she discusses how to start down the e-patient path.)

I lean toward a preference for inclusivity and transparency. I think this whole empowered patient movement will perhaps do more to change the course of our traditionally paternalistic medical world (providers and HIT vendors, included) than any governmentally-driven initiatives or any latest and greatest techno-marvel. Engaged folks have skin in the game and understand that their participation matters. Enlightened consumers have the potential to help drive change, both in how we deliver care and how successful the care outcomes will be. (Isn’t that what ACOs want?)

It will be a little scary for providers (and for HIT vendors) to allow access to our somewhat hidden world. Allowing the general public to see what we write, to have the obligation to explain in real “people-speak”, to invite patients into our so dearly regarded ivory towers, and to elevate consumers onto our pedestals (or to just get rid of those silly pedestals altogether) will greatly challenge some long held credos and egos.

Whether you call them “patients”, “consumers”, or just plain “people”, eventually “they is all us.” We all have a stake in this game. We’re all healthcare consumers at some point. I suggest it is long overdue that we open the doors of the hallowed (and somewhat musty) halls of medicine (and HIT) to let a little sunshine in, some e-patient powered sunshine.

From the trenches (and wishing you all great holidays)…

“There’s a war out there, old friend. A world war. And it’s not about who’s got the most bullets. It’s about who controls the information. What we see and hear, how we work, what we think… it’s all about the information!” – Cosmo, from the movie “Sneakers”

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 the Future exhibit for the American Academy of Pediatrics, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).

News 12/22/11

Toronto-based EMR provider Nightingale Informatix Corp. pays $1.75 million cash to buy Medrium, a US-based a practice management company that serves about 1,500 physicians. Nightingale’s CEO believes the acquisition, which includes Medrium’s development and customer support teams, will strengthen the company’s foothold in the US market.

Emdeon’s ePrescribing entity is named a certified Health Data Intermediary by the Minnesota Department of Health.

The seven-physician Elko Clinic (NV) claims that since moving to MedInformatix’s PM/EMR program, it has cut its percentage of over-120-day AR accounts from 30 to one percent while eliminating 10 FTEs.

HealtheConnections, the RHIO for central New York, says over 100 area physicians have attested for Meaningful Use.

CBSMedTech joins MD-IT as a Medical Transcription Service Organization associate and will market the MD-IT platform to its physician clients.

Practice Fusion releases an infographic outlining its 2011 accomplishments and record growth.

MDInteractive introduces a mobile app that allows providers to create patient records and submit PQRS quality measures.

The New York eHealth Collaborative reaches its enrollment goal of 5,107 eligible providers. To date, 7% of NYeC enrollees have achieved Meaningful Use. Keep in mind as of the end of November, CMS reported that only 2.5% of all EPs who had registered for the Meaningful Use program had been paid.

DocBookMD reports that over 80 medical societies in 20 states now offer its HIPAA-compliant smart phone platform to send text messages and photos to patients and other providers.

Saying that the industry is not yet ready to comply, MGMA calls for HHS to immediately issue an expanded six-month contingency plan for the Version 5010 transaction standards. MGMA recommends that for the next six months, health plans continue accepting 4010 standards and adjudicate 5010 claims, even if the 5010 claims lack all the required data. In a recent MGMA member survey, the organization found that less than one third of practices have completed all the upgrades and testing required for the 5010 transition.

Am I the only one troubled by the use of the words “urologists” and “flow” in the same headline?

Ho! Ho! Ho!

News 12/20/11

From CIO on a Mission: “Re: EHRs for surgeons. I’m trying to be helpful to some surgeons who practice at our hospital. They asked me for recommendations of practice-based EHR systems that are more surgeon focused, i.e., manage the episodic care of surgical patients rather than the chronological data of a family practice or internal medicine focused system. I’ve done the usual Google/Bing searches and came up with a few, but wondered if you or your HIStalk Practice readers can help? Thanks.” I passed on a couple of names, but also defer to our expert readers for more suggestions.

Orthopaedic Center of Southern Illinois selects SRS EHR for its nine providers.

The American Telemedicine Association develops a legislative proposal that would expand Medicaid coverage for telemedicine services treating patients with high-risk pregnancy conditions.

Vermont IT Leaders, Inc., the state’s REC and HIE organization, subscribes to CapSite’s online service, giving providers access to CapSite’s  database of HIT vendor pricing and contract terms.

Allscripts partners with clinical decision support and analytics company DiagnosisOne to offer DiagnosisOne’s smartPath platform to its Allscripts’ Professional EHR clients. DiagnosisOne will also provide real-time PQRS patient alerts and reporting to CMS on PQRS measures for Professional clients participating in the PQRS incentive program.

The Arizona REC selects PatientClick EHR as a Tier 3 participant in its Vendor Alliance Program. Tier 1 participants include Allscripts, athenahealth, e-MDs, GE, Greenway, NextGen, and Office Ally.

AHRQ introduces an online guide for reducing unintended consequences of EHRs. The guide, which was developed by RAND, is designed for all types of healthcare organizations from solo physicians to large hospital systems and addresses problems that can occur when implementing and using an EHR.

The New York Times highlights Micky Tripathi and his organization’s data breach tale. Tripathi, who is CEO of Massachusetts eHealth Collaborative, provided the full low-down on the data breach earlier this month on HIStalk Practice. On MAEHC’s blog, Tripathi posted a few follow-up comments about the Times piece, including his opinion that electronic systems are actually more secure than paper and fax. The photo above accompanied the Times story — check out his computer screen.

We mentioned the new KLAS ratings on HIStalk last week, but here is a summary of which vendors took the top three spots in the ambulatory EHR and practice management categories:

• EHR >75 Physicians: EpicCare Ambulatory, eClinicalWorks, GE Centricity
• EHR 11-75 Physicians: athenaClinicals, Greenway PrimeSuite, Allscripts Professional
• EHR 1-10 Physicians: Amazing Charts Greenway PrimeSuite, athenaClinicals
• PM >75 Physicians: Epic, McKesson Practice Plus, eClinicalWorks
• PM 11-75 Physicians: Greenway PrimeSuite, athenaCollector, McKesson Practice Plus
• PM 1-10 Physicians: Greenway PrimeSuite, athenaCollector, OptumInsight Ingenix CareTracker

In the Claims and Clearinghouse Services category, ZirMed, Office Ally, and Navicure were the highest ranked vendors.

Naughty or nice? Tell Inga.

News 12/15/11

The Orthopaedic Group, a 36-provider group in Mobile, AL, replaces its legacy EHR with SRS EHR.

Emdeon and HHS announce a program through which Emdeon will donate Emdeon Clinician EHR licenses to 100 New Jersey healthcare providers practices in medically underserved areas. License fees will be waived for one year from the date a qualified provider contracts with Emdeon. I found this demo of Clinician from this year’s HIMSS conference.

athenahealth CEO Jonathan Bush speaks out in The Hill’s Congress Blog, calling for greater transparency and accountability in the Meaningful Use incentive program. Bush points out that the current program includes no verification process to prove physicians are actually using HIT in a meaningful way. He argues that the lack of verification could potentially lead to billions of wasted taxpayer dollars and “enormous disparities between what physicians and hospitals are able to do with the EHRs and their actual ability to improve care.”

The Maine REC (MEREC) reaches its enrollment target of 1,000 primary care providers. MEREC, by the way, does not charge for its services, and, the statewide HIE will not charge small practices a connection fee for the first year.

The New England Chapter of HIMSS names practicing physician Daniel J. Nigrin, MD (Children’s Hospital, Boston) Clinician of the Year. Nigrin is also CIO at Children’s and a faithful HIStalk/HIStalk Practice reader.

The White House announces that more than $2.9 billion in healthcare fraud has been recovered in 2011, which represents a 167% increase over 2008.

In article highlighting HIPAA privacy, The Boston Globe profiles Leon Rodriguez, director of the Office of Civil Rights. Also getting a mention: Massachusetts eHealth Collaborative CEO Micky Tripathi and his recent HIStalk Practice post, which details his organization’s handling of a patient security breach earlier this year.

E-mail Inga holiday greetings.