News 6/23/11

From O-chit: “Re: ONC FAQs. Saw this new question posted on ONC’s FAQ page. Scary to think that some people are still confused. I hope vendors aren’t contributing to the confusion.” The newly updated question: My EHR system is CCHIT certified. Does that mean it is certified for the EHR incentive program? The answer is clearly no, since the incentive program requires EHRs to be ONC-ATCB certified. And I am optimistic that no vendors are knowingly misleading anyone.

The AMA says it will lobby hospitals and healthcare systems to use standardized EMR interface designs to help physicians working at multiple facilities. Easier said than done, I would imagine. AMA made the resolution during its annual meeting this week. It also disclosed that it lost 12,000 dues-paying member physicians over the last year. The decline is in part blamed on AMA’s support of healthcare reform.

Kareo adds e-mail and chat support options for clients on all subscription levels and introduces an Integrated Credit Card Processing service for its PM application.

Sage Healthcare Division adds nine facilities running Sage Intergy On-Demand, Sage’s cloud-based EHR/PM solution.

RCM provider Navicure names Craig Potts EVP of sales. He’s from Fiserv and TenFold.

An analysis of health data breaches reveals that cloud-based EHRs have a pretty good track record compared to both on-site EHRs and paper records. The report also finds that most HIPAA violations result from insufficient internal security, negligence, or theft.

Physician alignment is named the most serious obstacle for organizations trying to form ACOs, as well as for hospitals and physicians electing not to move forward on ACOs. Physician alignment seems like a fairly broad term, but I am assuming that in this case it has more to do with alignment with economic goals than on issues related to patient care.

Forbes columnist Zina Moukheiber profiles Practice Fusion and CEO Ryan Howard, also explores why PayPal founder Peter Thiel has invested in the company.  Before ARRA, Practice Fusion was barely staying alive. Things turned around when new investors surfaced shortly after the HITECH legislation passed. Here’s some insight on Practice Fusion’s plans for making money by offering a free EHR:

Nothing is really quite free, and Practice Fusion needs to find a way to make money. In the fine print of its licensing agreement, there’s a provision which says that by signing on, doctors agree to transfer their ownership of patient data, stripped of identifiers, to the company. Practice Fusion now sits on a valuable load of information that pharmaceutical companies would love to get their hands on to mine it. There are, for example, one million patients with diabetes in the database; the number for obesity is the highest. I ask Howard whether he plans to sell useful marketing information to a company that wants to know, say, in which parts of the country its newly-released drug is not being prescribed. He balks; he wants to make sure he’s not crossing any ethical lines. He’s looking instead at applications, such as helping pharma companies enroll patients in clinical trials, or monitoring a drug following its release on the market. Practice Fusion’s revenues which are now less than $10 million, come mostly from advertising.

A1 Medical Software donates an EMR system to the soon-to-be opened Lee County Volunteers in Medicine Compassionate Care Clinic (FL).  The clinic will provide free healthcare services to the uninsured and under-insured.

E-mail Inga.

Readers Write 6/21/11

Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

There has been a great deal of debate among physicians about the true value of electronic records. A survey conducted by MGMA earlier this year found that 78% of medical practices that are still using paper-based records thought they would face a “significant” or “very significant” loss of productivity during EHR implementation, while 56.9% said “insufficient expected return on investment" was a barrier to investing in EHR systems.

In that same survey, however, 72% of physician practices who had completed EHR implementation were “satisfied” or “very satisfied” with their systems. In addition, the survey reported that fully optimized EHR systems led to greater financial benefit.

Despite the results of the MGMA survey — as well as other surveys exploring EHR adoption — the hesitation and concern some healthcare providers still have is understandable. However, as the healthcare industry moves towards becoming fully electronic, deadlines related to new CMS Meaningful Use regulations loom. There is a great threat to further reduced payments to providers who lag behind in technology, which must be quickly realized and dealt with by all physicians.

Paper records do not, by definition, demonstrate compliance with Meaningful Use regulations. With Stage 1 deadlines on the horizon, practices will face lower payments from CMS as a penalty for staying with their legacy paper systems.

However, when you look at real-world data of the costs to create a single new patient chart, the dollar figures provide the evidence and support for EMR implementation. According to data based on a six-doctor practice, the elimination of paper charts in favor of implementing an EMR can reduce the cost of maintaining records by as much as 87% while increasing billings by more than $145,000.

The figures just don’t lie.

A clinic and surgery center that has 14 providers seeing an average of 1,800 patients and conducting 240 procedures per month averages the cost to create a new clinic patient paper chart, factoring in printing, stick-on tabs, copying, and labor, at $5.35. Seeing roughly 75 new patients each day, the organization spends a total of $104,325 annually in materials and labor. Creating a new surgery patient chart costs the organization $16,134 annually, for a grand total of $120,500 between the two.

It is also worth noting that some medium-size practices spend $200,000 per year on labor associated with managing and trafficking paper charts.

Overall, when it comes to EMR implementation, physicians must carefully and accurately weigh the long-term benefits with the short-term hassles. Yes, there is an upfront cost to EMR implementation. Yes, there may be a slow-down in productivity at the beginning while staff members are learning the new system. But if the practice takes its time in knowing what its needs are, the goals it wishes to reach and approaches EMR adoption with an open mind, the sooner it, too can start reaping the benefits.

Keith Slater is vice president and general manager at Henry Schein MicroMD of Boardman, OH.

News 6/21/11

From Chris Riley: “Re: Mitochon Systems and CollaborateMD partnership. It is natural to be skeptical about a combined EHR and practice management solution that is available for $7 a day, since many physicians are paying far more for the same services. Nothing is missing, however. This Mitochon mEMR system is the first, free, fully certified (ONC-ATCB) EHR system. It has all the features of the expensive, legacy EHRs that cost $10-25,000 for an annual license. The CollaborateMD practice management solution is in use by 5,000 physicians nationwide, many of whom have virtually eliminated claims denials with its advanced editing software. The reason we can keep the costs so low without sacrificing functionality is that Mitochon’s mEMR system is ad-supported. It is, in effect, subsidized by pharmaceutical advertisers. This is a bargain that our customers, almost all of whom are solo practitioners or in small medical groups, gladly accept. The free, ad supported model as delivered by Google, Gmail and Facebook, has revolutionized the way consumers connect and communicate. This model can have the same impact on EHR adoption and physician connectivity.” I appreciate that Riley, CEO of Mitochon,  took the time to send in his comments. I remain a bit skeptical, not only about functionality but long-term financial viability of the model, but the company tells me it has more than 500 physicians in 22 states using its EMR, most of them solo practitioners or small groups.

MGMA finds that most medical groups have not yet completed the software upgrades necessary for the transition to the new 5010 transactions standards and have not scheduled testing with health plans. A small number of practices claim they will need to replace their software. Getting the new standards in place is not necessarily cheap — practices who have already upgraded or replaced their software have incurred expenses of more than $16,000 per physician, including the cost of software, hardware, and staff training.

Allscripts adds Precision Healthcare Consultants as a reseller of Allscripts MyWay EHR.

MED3OOO’s InteGreat EHR version 6.5 earns CCHIT 2011 pre-market certification in the ambulatory and child heath categories. InteGreat EHR version 6.4 is already ONC-ATCB-certified through CCHIT.  MED3OOO, by the way, was recently recognized by the Pittsburgh Business Times as one of western Pennsylvania’s healthiest employers.

McGraw-Hill Higher Education and Greenway Medical Technologies announce an online HIT course for colleges and universities. Integrated Electronic Health Records: An Online Course and Worktext for Greenway Medical Technologies’ PrimeSUITE will be offered through McGraw-Hill’s Connect Plus teaching solution.

For the sixth straight year, Capario achieves full accreditation with the Healthcare Network Accreditation Program (HNAP) from the Electronic Healthcare Network Accreditation Commission (EHNAC).

ONC makes available its popHealth reference implementation software service for physicians and practices. The open source tool automates the reporting of quality measures for Stage 1 of the EHR incentive program.

OptumInsight (Ingenix) collaborates with InstaMed to offer CareTracker Payment Connect, an electronic bill payment service for patients.

The overall rate of claims processing errors adds about $17 billion in administrative costs to the healthcare system, according AMA’s annual National Health Insurer Report Card.  Commercial health insurers have an average claims processing error rate of 19.3%, which is 2% higher than last year. Seriously, what other industry finds it acceptable only get things right four out of five times? UnitedHealthcare was the top performing health insurance carrier with an accuracy rate of 90%.  Anthem Blue Cross Blue Shield had the worst performance with a 61% accuracy rating.

AMA subsidiary Amagine introduces the health IT index, an interactive program that helps physicians identify their HIT priorities. I am assuming that once the priorities are identified, the program only recommends one of the dozen alternatives available on the Amagine platform.

E-mail Inga.

Bowtie Confidential: How Full Is Your Plate? 6/20/11

The discussion I have most often with clients, especially the C-suite, is about the growing number of federal initiatives and the need to prioritize them all. The list of initiatives includes but is not limited to Meaningful Use, ARRA, HIPAA, health insurance exchanges, health information exchanges, RHIOs, ICD10, Payment Reform, and ACOs.

The list does not include the standard (and just as important) issues such as relationships with medical staff and the board, the recruitment and retention of physicians, reduction in payments by third parties (including Medicare and Medicaid), tighter and tighter margins, shrinking endowments, etc. My apologies to any reader whose concern I have not mentioned.

What should the CEO of a large, complex healthcare organization do about these competing initiatives?

Many require extensive manpower, such as the implementation of an EMR or CPOE system. As of yet, I have not been to a single organization that has a cadre of staff sitting in their office just waiting to work on the next initiative. Nor have I seen an organization that is so capital rich that these type of initiatives can be paid for without a formal internal review, and ultimately, board approval.

It is my suggestion that you do a careful risk analysis of each of the initiatives and determine which ones are really necessary to be done right now.

• Where do you have financial risk (reduction in payments or loss of opportunity to collect additional funding)?
• Where do you have market risk because your competition is moving ahead?
• How much benefit will your organization derive (referrals, downstream revenue, beating the competition) if you provide financial support for your community physicians?

We think that the (proverbial) 500-pound gorilla is going to be the ICD-10 work. When I was in D.C. a couple of weeks back, the rumor (not yet substantiated) was that the federal government may push back Stage 2 of Meaningful Use to allow organizations the necessary time to work on ICD-10. Pushing the dates for compliance for the next Meaningful Use stage would be a great assist to healthcare organizations, as it will allow them to concentrate on meeting the requirements for ICD-10.

We at Hayes have found that far too few of our clients have started to plan for ICD-10. There doesn’t seem to be an accurate understanding of the amount of work that will need to be done.

There is also a general lack of knowledge regarding the financial implications of not being ready for ICD-10. The financial risk can be up to 5% of your monthly revenue. This figure likely dwarfs any of the other initiatives mentioned earlier.

Therefore, given the financial risk, we are advising our clients to move ICD-10 preparation up to the top of their list of priorities. Begin to educate the medical staff and talk to your vendors (almost all of whom will also be affected). Develop a plan so that your organization is ready for ICD-10.

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.

News 6/16/11

HHS’s Office of Minority Health and Quest Diagnostics announce a program to donate approximately 75 MedPlus EHR user licenses to physicians in small practices serving minority populations in Houston. The initiative includes subscription fees for 12 months and educational assistance from the University of Texas Health Science Center at Houston REC.

Hanger Orthopedic Group will deploy NextGen Ambulatory EHR and PM at its 675 orthotic and prosthetic patient care centers in 45 states.

PDR Network launches RxEvent, an online network to collect and distribute adverse drug events. The service is targeted at prescribers, who typically don’t report adverse events to the FDA because it is too time consuming. Greenway Medical, athenahealth, and other ambulatory vendors will be integrating the RxEvent reporting into their EHR applications.

Pinehurst Dermatology (NC) contracts with SRS for its EHR solution.

ABEL Medical Software announces a OEM program for resellers interested in selling its ABELMed EHR-EMR/PM product.

Mitochon Systems partners with CollaborateMD to offer Mitochon’s free mEMR product with CollaborateMD’s PM solution.  Like Practice Fusion, Mitochon’s model displays ads within the application’s workflow.  Meanwhile, CollaborateMD claims a solo physician can spend as little as $7 a day for unlimited claims processing, electronic remittance, and patient eligibility.  Call me a skeptic, but  I have to wonder what’s missing in that $7/day solution that includes EMR and PM.

NaviNet introduces NaviNet Mobile to allow pharmacy benefit managers to deliver patient medical information to physicians via handheld devices.

Physician compensation grew for some specialties in 2010 and decreased for others. For example, emergency medicine compensation increased 5.6%, while urology income fell 4.66%. Median compensation for family practitioners was $189,402; invasive cardiologists averaged $500,993.

A Robert Wood Johnson Foundation report finds that 51% of office-treated diabetics in Cleveland received all the care they needed from practices using electronic medical records vs. 7% from paper-based practices. A similar correlation was found for diabetic outcomes.  Mr. H mentioned in HIStalk not being able to find the study methodology, but I dug a little and found this report by Better Health Greater Cleveland. There is a fair amount of difference in the demographics between the EHR practices and the paper practices, with the paper practices including a heavy number of non-insured and Medicaid patients (69.9% compared to 15.8% of the EHR practices.) The paper practices were also twice as likely to have non-white patients (86.5% compared to 43.9%.) When you take those facts into consideration, the EHR-diabetes care correlation does not seem as strong.

In 2009, the number of paid malpractice claims reported in the outpatient setting was similar to inpatient numbers, suggesting medical mistakes are almost equally common in the two settings. The authors of the NEJM-published study recommend more patient safety efforts in the outpatient setting,  including the implementation of e-prescribing systems and EMRs.

HIMSS Electronic Record Health Association (ERHA), a trade association of 46 EHR vendors, submits generally favorable comments on the proposed ACO rules. No doubt the opinion was influenced by the EHRA’s acknowledgement that ACOs will require robust IT infrastructures. The organization recommends that CMS reduce the required threshold for EHR meaningful use providers from 50% of primary care providers to 25% of all EPs. In addition, EHRA urges CMS to reduce the requirement for quality measurement reporting from 65 items to 20 or fewer.

E-mail Inga.