From the Consultant’s Corner 11/4/11

5010: Just the Tip of the Iceberg

I’m still firmly stuck in October and all the fiscal year activities that go with it. But my kids already are looking forward, getting excited about the holidays just around the corner. And that got me thinking. Ready or not, the 5010 transaction standards will be in place in just a couple of months.

It really is time to look forward. Not just to 5010, which will bring more clarity and consistency to claims transactions, but also to the conversion to the ICD-10 code sets. Together, these two changes will support more granular healthcare data capture in the future.

Ultimately, that will help us shift healthcare toward reimbursement based on quality outcomes—instead of today’s volume-based “eat what you treat” reimbursement mentality. On the administrative side, these changes should aid efforts to reduce costs and gain more accurate coding, billing, and reimbursement. On the clinical side, all of this should lead to better patient care quality.

But contrary to popular belief, compliance with 5010 doesn’t get you halfway down the road to ICD-10 compliance. Although the two initiatives are related, ICD-10 is far more complex. 5010 readiness is just the tip of the iceberg. Expect ICD-10 to encompass every asset used to treat patients, bill for services, and receive appropriate payment.

Where 5010 affects only electronic claims and remittances, ICD-10 will radically alter the workflow of literally every clinical and operational procedure in healthcare. It will significantly impact the way physicians capture and document clinical data, and will affect the data flow from the electronic health record (EHR) to all other clinical, administrative and billing systems—and all the interfaces in between. Every third-party interface or tool will require testing, evaluation, upgrades and staff training.

Everyone now is intently focused on the fast-approaching 5010 compliance deadline and Meaningful Use. And it’s true that for a short while, meeting Meaningful Use can make some incentive money for you. But ICD-10 can bankrupt you if you’re not prepared.

The level of preparedness varies among industry stakeholders. Some progressive healthcare organizations — including many of our clients—already are getting down to work. One provider I recently visited has budgeted $10 million for ICD-10 so far and considers the investment to be “worth every penny.” Another, an organization that offers a variety of specialties and subspecialties, has more than 1,000 custom-designed EHR templates that need to be redesigned by 2012.

Unfortunately, too many providers expect practice management system (PMS) and EHR vendors to take the initiative. Some PMS and EHR providers are, in fact, well along in their plans and efforts to educate clients about testing and implementation timelines. Others haven’t yet shared their plans. Suffice it to say, if you’re expecting your software vendors to do all the heavy lifting, you may be in for a rude awakening.

You must plan and budget for this massive workload now. I recommend that all healthcare organizations:

1) be cognizant of ICD-10 as they plan all of their upcoming initiatives, and

2) understand their budget constraints and balance resources for ICD-10 appropriately.

Another initiative I recommend for many organizations is to work with payers proactively to negotiate terms to protect cash flow during transition periods based on your claims history (volume, type of services, reimbursement history, etc.). In my experience, some payers will agree to guarantee a percentage of a provider’s account volume according to prior reimbursement levels. At the end of a mutually agreed-upon timeframe, the two parties “settle up” any differences. Obviously, if you’re a large organization with a significant market share, you’ll have more leverage in this kind of negotiation. But because the potential risk to cash flow is so great with ICD-10, it may be an idea worth pursuing.

Like it or not, the 5010 and ICD-10 transitions will strain healthcare IT resources, staff resources, administrators, providers, and capital budgets. But we don’t have a choice about compliance with Meaningful Use, 5010 standards, ICD-10 diagnosis codes, and other government regulations. Savvy providers, IT professionals, administrators, and vendors realize the importance of conducting impact assessments, budgeting for IT and other resources, and planning framework changes to support ICD-10 code sets. Those that do not are in danger of going the way of the Titanic.

Brad Boyd is vice president of sales and marketing for Culbert Healthcare Solutions, a professional services firm serving healthcare organizations in the areas of operations management, revenue cycle, clinical transformation, and information technology.

News 11/3/11

The New Jersey HITEC and Chicago HITREC  sign agreements with Welch Allyn to provide that company’s EHR Prep-Select services to their members.

Blackstone completes its acquisition of Emdeon in a transaction valued at approximately $3 billion.

athenahealth and its recruitment marketing agency HireClix win an onrec Award for Best College Recruiting Program. Last May athenahealth sponsored a mobile food truck and gave away free organic meals during the breaks between MIT final exams. During the event,  recruiters and software developers encouraged students to apply for open positions.

An estimated 20% more physician practices will be involved in mergers and acquisitions this year compared to 2010. As of the end of the third quarter, the number of 2011 deals involving physician practices hit 70, compared to 60 for all of 2010.

OrthoArkansas (AR) selects the SRS EHR for its 33 providers.

CMS issues a final rule updating 2012 payment polices and rates for Medicare providers and upholds the current SGR payment reduction. CMS Administrator Donald Berwick stresses that unless Congress fixes the SGR formula, provider reimbursement will fall 27.4% and create a situation with “dire consequences.”

eClinicalWorks employees come together in honor of Breast Cancer Awareness month. OK, I am a few days late, but it’s still a great cause worth mentioning.

The Florida Academy of Family Physicians names Point of Care Solutions’ Agile Medical Platform a recommended EHR/PM solution for its members. Point of Care Solutions, whose offering includes Practice Fusion’s EHR, will extend a discounted monthly subscription rate to Academy members.

Several providers speak out in favor of digital pen technology as a means of capturing clinical data and streamlining documentation. Shareable Ink CEO Steve Hau notes that digital pen applications have an accuracy rate of nearly 100% for checked boxes and 94% for free text.

Most physicians believe EHRs are safer than paper records, though patients are unsure. A GfK Roper survey finds that 54% of doctors think EHRs are safer, though only 39% of patients agree. Both physicians and patients cite accessibility as a top EHR benefit.

The AMA launches an online group for practices, payers, and intermediaries  to share tips, questions, and success stories on getting claims processed and paid electronically.

CMS adds a number of new FAQs about the EHR incentive program, including this one: does a provider have to record all clinical data in their certified EHR technology in order to accurately report complete clinical quality measure data for the Medicare and Medicaid EHR Incentive Programs? The bottom line answer is that currently CMS does not require providers to record all clinical quality measures, in part because many providers aren’t able to capture all the data in their EHR. Instead, CMS is requiring providers to report the clinical quality measure data exactly as it is generated as output from the EHR in order to successfully demonstrate Meaningful Use. CMS recognizes that this may yield numerator, denominator, and exclusion values for measures in the EHR  that are not identical to the values generated from other methods (such as record extraction.) If I am interpreting this right, CMS is saying that in order to demonstrate Meaningful Use, you may have to report meaningless data. Nice.

 E-mail Inga.

News 11/1/11

From Y-factor: “Re:  American Academy of Ophthalmology meeting. Physicians are much more vocal about their experiences with EHR than administrators who don’t want to admit to their colleagues that they led a failed EHR implementation. At AAO, the exhibit hall was rife with physicians that were beset with their EHR implementations. This is just the tip of the iceberg. Meaningful Use-fueled EHR purchases with rushed implementations will exacerbate this situation.” Y-factor has participated in his share of MGMAs, as well as specialty-specific meetings like AAO. It’s an interesting observation, though I wonder how many of those physicians actually selected their own EHRs versus had their EHRs selected for them.

Central Ohio Primary Care Physicians, the country’s second-largest privately-owned primary care group, chooses eClinicalWorks EHR for its 230-physician practice.

MGMA calls on HHS to issue a contingency plan for HIPAA 5010, noting that many practices and their trading partners may not be ready by the January 1, 2012 deadline. MGMA research finds that about 25% of practices still have not yet heard from their software vendors regarding the transition and only 35% have begun their internal testing. MGMA contends that if all parties are not ready by the deadline, practices could face cash flow issues that affect their operations.

Special thanks to the reader who posted this on my Facebook page, just in time for Halloween. I am thrilled that the true meaning of this movie has finally been revealed in terms that I can relate to.

Overall EHR adoption in physician offices hovers around 40%, but exceeds 75% in practices with 26+ providers. The same study finds that EHR adoption rates are higher in practices with more exam rooms (because of the space they have recouped since their paper charts are gone?) and in practices with higher average patient volume.

SilverTree Health, a provider of physician billing and PM services, merges with Essential Health Care Solutions, a medical reimbursement consulting company.

Epocrates introduces Epocrates App Directory, which features reference, educational, and clinical apps for clinicians.

The Colorado REC adds Office Ally as an approved integration EHR vendor.

The Raleigh Hand Center (NC) selects the ChartLogic EHR Suite.

A Texas physician is sentenced to 11 years in federal prison for her role in a scheme that fraudulently billed Medicare and Medicaid $45 million over a 2 1/2 year period. A US district judge ordered Christina Joy Clardy to pay $15 million in restitution after finding she knowingly permitted fraudulent billing under her provider number.

The number of office visits per physician FTE dropped 8% in September compared to a year ago and the trend is likely to continue. Blame a tough economy, higher insurance deductibles, and efforts by health plans to reduce utilization.

Greenway Medical Technologies and ChartLogic become the first EHR solution providers to send controlled substance prescriptions electronically. Both companies are pilot participants in DrFirst’s EPCS Gold controlled substance e-prescribing program.

St. Peters Bone & Joint Surgery (MO) says it realized an annual savings of $30,000 by optimizing its Sage EHR with MD-IT’s EMR optimization software and iConnect for iPhone.

Chiropractors are getting their HITECH payments, too.

American Medical News highlights the growing popularity of texting between physicians, despite the risk of HIPAA violations. Though encryption-enabled devices exist, most physicians don’t have the tools in place and are more focused on the efficiency of text instead of its potential privacy risks. As the executive director of a hospitalist group points out, “Physicians are not so much concerned with HIPAA compliance as they are about work flow and physician communication.”

No surprise here: physicians’ overall satisfaction with their EHRs is correlated with their level of involvement in the EHR selection process. In addition, the more training clinicians receive, the higher the reported usability of advanced EHR features. At least three to five days of training is necessary to achieve the highest level of overall satisfaction.

E-mail or send Halloween greetings to Inga.

DOCtalk by Dr. Gregg 10/29/11

Inside the Show Inside the Show Inside the Show

“Behind the scenes is the most enlightened place to be.”

I’m a firm believer in that statement. From way back in my early years as a sound engineer to my current HIT-related years, that message has been repeatedly driven home, over and over and over. Lemme ‘splain…

Back when rock was king and no one trusted anyone over 30, I started learning how to do audio mixing – after a short stint as a regular roadie – working weekends, starting when I was just 13. (Geez…I’m into my fifth decade paying into Social Security … really?!) In smoky bars where it was a slow night if there wasn’t a brawl or knife fight through coliseums, college shows, and Carnegie Hall, I watched and worked with all sorts of musical acts, always seeing the show from the inside.

From the blank slate of an empty hall through set-up, through show time, through tear-down – the evolution/devolution of the show was always more fascinating to me than the actual show. For instance — and not to burst anyone’s star-struck bubble — most celebrities aren’t really that cool off-stage. But, even this revelation was far more interesting to me than any performance ever was. (OK, Randy Newman is like the nicest guy ever and B.B. King is so good, so fun to watch, but they’re more exception than rule.)

Move now into the current century and the realm of HIT. I’ve been lucky enough to be able to use some of those very same skills that I learned on the rock-n-roll road helping drive the creation and expansion of the Pediatric Office of the Future (POF) exhibit for the American Academy of Pediatrics (AAP) which is all about helping advance the understanding and use of superior tech for better healthcare delivery. I’m still recovering from this year’s event, which featured 31 mostly very generous sponsors in our 4,500 square foot exhibit. (Vendor tradeshow folks: imagine your exhibit headaches multiplied times 31.)

Our “show” runs inside of the much larger AAP exhibition hall “show” – a “show within a show.” As with most such academies – I’m sure – it’s challenging when trying to do outside-the-box stuff while following inside-the-box rules and regs. But, then, that’s what driving into the future is always about, right? Pushing boundaries, asking “Why not?”, figuring out how to make that new square peg actually fit the old, round hole. I can say with confidence that building our POF show inside the confines of the larger AAP show has been one of the greatest learning experiences and one of the most challenging chapters of my life.

Remember, we’re not an exhibit hall; we’re just another exhibit within the hall, except we had many different sponsors that we needed to organize into one harmonized space. And, our sponsors came in all sizes, from health industry giants to HIT start-ups. Adding to fun is the seemingly inbred bent within the world of HIT for smoke and mirrors!

As I’ve been the primary point of contact for all of these folks, I’ve also often been privy to what happens behind many of their “curtains.” Sometimes, it’s pretty; sometimes, not so much. Many little “shows” inside our “show inside the show.” And it doesn’t matter if they’re large or small; some can be just as dysfunctional in their early stages as others who have grown that way in their older, bureaucratic stages. On the other hand, some rookies “get it” right off and some powerhouses run like silk over satin.

Given the convention hall rules, the union crew rules, the AAP rules, the sponsors’ needs, the attendees’ needs, the mirrored smoke, and our own limited resources, we pulled off one heck of a show. It was good enough to get great buzz back from the upper AAP levels about our boundary-bending exhibit, an acknowledgement sometimes difficult to attain when you’re a bleeding edge pusher. And, most of our sponsors were happy – especially those that understand how hard it can be to bring “new” into people’s lives (or into academy confines!)

I always hope everything goes perfectly and that each generous sponsor and every attendee glows from their experience. For me, though, it isn’t the “Did it all work?” or the “Was everybody perfectly satisfied?” questions that matter so much. No show goes exactly how you plan it. There are always let-downs, learning points, and little lemons you can’t turn into lemonade. But, just as I learned as a road-ravaged, rock-n-roll sound man, you have to expect the unexpected, learn how to deal with all of the “fourth and forty” moments (crises, which happen in every show, that force you to “punt”), and figure out how to better the show for both “the talent” and the fans next time.

Being a part of the backstage drama is the best seat in the house, way better than the front row. You get to see all of the gory details that eventually produce what (hopefully) ends up looking like a well-rehearsed show. Knowing what makes it all tick, where the duct tape and staples are, what is smoke and what is mirrors, makes it so much more fascinating.

From the trenches…

PS: I recently discovered that there’s an ultra-secret board of directors pulling all of the healthcare information technology strings consisting of David Copperfield, Lance Burton, Criss Angel, David Blaine, and run, of course, by the sardonic Penn & Teller. (By the way, I’m pretty sure this is the same board covertly running all health insurance payors.)

“The little foolery that wise men have makes a great show.” – William Shakespeare

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).

MGMA Wrap-Up 10/27/11

MGMA11 is history and I’m happy to be home. My poor feet are swollen from extensive walking in non-sensible shoes and I’m more than a little sleep deprived. Other than those small complaints, it was a great convention I learned more than a few new things. A few final bits of news and impressions:

Official attendance, according to MGMA: more than 5,700, including 3,500 attendees and representatives from 399 exhibiting companies. Those numbers represent a 19% jump over 2010. MGMA is no HIMSS in terms of size, but it did seem busier than the last couple of years. I don’t know if there is an official explanation for the increase in attendance, but I’m sure it helps that Vegas hotels are affordable this time of year and flights are reasonably inexpensive. Practices are also facing a host of pressing issues, including Meaningful Use, looming deadlines for ICD-10 and 5010, evolving reimbursement models, and declining reimbursement. There was no shortage of sessions covering each of these topics.

During the meeting, MGMA and the American College of Medical Practice Executives (ACMPE) announced their official merger, effective January 1, 2012. MGMA is the much bigger organization, with 22,500 members, compared to ACMPE’s 6,750. The new MGMA-ACMPE is creating a unified board of directors. Both organizations will automatically transfer members into the new entity.

The most popular giveaway: the iPad2. MED3OOO awarded 100 iPads to attendees who were randomly selected to participate in short demos of Quippe and InteGreat EHR. Medicomp provided the Quippe overview and handled the live drawings. Needless to say, booth traffic was heavy for both companies.

Other seemingly hopping  booths: athenahealth, Allscripts, Greenway, and Pulse. No coincidence that all have big booths and central locations.

I have a preference for booths that are very open, such as Sage’s and ZirMed’s. This photo of GE’s booth was taken from the main aisle. To “enter” the booth, you had to walk around to the other side. Granted there was an exhibit hall entrance near the other side, but it would seem the traffic was heavier on the less uninviting side.

I’ve said in the past that I like NextGen’s booth, which has cool lighting and these arches that go over the top of the booth. I didn’t take a picture this year and this photo was from a previous convention. Despite the eye-catching look, it’s a bit intimidating to have to walk into the booth to get a peek if you want to look over someone’s shoulder at a demo. NextGen, by the way, was promoting the fact its customers have submitted $8 million in Meaningful Use applications. I’m not sure if that was just ambulatory or if it also included inpatient.

The monorail that runs along the Strip was down at least part of the time during the convention. MGMA had provided attendees with monorail passes (in lieu of buses) to transport people from outlying hotels to the convention center. No monorail meant people had to pay $10 to $20 for cab rides, and taxi lines were often long. I am sure MGMA was not happy about the glitch.

McKesson had a smaller booth than in years past, while Cerner’s looked a bit bigger (though smaller than McKesson’s.) It seems to me that the size of the booth matters less than the location. As expected, the vendors with far outside booths spent a lot of time talking to each other rather than attendees. Or, more likely, looking at their phones and checking e-mail.

Some people don’t like Las Vegas, but I find it a great for people watching and I love the wide variety of food and and entertainment options. Next year MGMA heads to San Antonio, a less-flashy but still fun locale. Hopefully my feet will recover by then.

E-mail Inga.