Practice Wise 5/18/11

Since I didn’t formally introduce myself in my initial posting last month, Inga asked me to take a brief moment to do so now. I’m the founder of a practice management consulting firm. Although we do soup to nuts practice management consulting, we have focused on filling the information gap between the ambulatory medical practice and their technology solution providers. We consult on some software, sell a few products, but mostly consult on practice management and performance as a whole.

This is not a platform for me to sell my products or services, but to do more of what I do every day: share information and opinions. I’m not banking that everyone will agree with what I have to say, nor does it matter.

What I know is that most technology vendors have a disadvantage communicating with their clients – the medical care providers. I come from both a hospital and ambulatory clinic background. My perspective in this blog is to give voice to the needs of the medical staff and providers as they wind their way through this crazy technology landscape.

Where the Workers Are

We keep hearing that with the great rush towards EHR adoption, there is going to be a serious shortage of HIT people to handle all the implementations and support roles. I was recently invited by our local community college (Portland Community College) to speak to a group of students completing their HIT program. A consortium of five Oregon community colleges have joined the nationwide effort to train and find employment for workers to help fill the projected HIT worker gap.

The consortium is targeting unemployed individuals with health care or information technology backgrounds as well as currently employed workers in both fields who are ready to take advantage of the opportunity to expand their professional portfolio. The colleges will use their connections with local employers to help place newly-trained HIT workers in jobs that will promote the adoption and meaningful use of EHR systems in Oregon.

The program received seed money through an ONC 2 year grant. The Health Informatics Concentration of Study Award is a short-term training program, created to meet the needs of two types of professionals:

• The healthcare professional with high computer literacy who is interested in acquiring programming, networking, and database development skills in order to enter the health informatics industry.
• The IT professional who is interested in acquiring knowledge of medical terminology, medical records, and health information management in order to enter the health informatics industry.

Going into it, I knew that this was a program to retrain adult students who were looking to change up their careers. What I didn’t know was that this program is a treasure trove of amazing talent. Although I was there to share my industry experience and an employer’s perspective of the industry to these students, I ended up getting an education about the caliber of students these programs are producing.

If you are an EHR vendor, a hospital HIT manager, an ambulatory medical practice, or a consulting firm, you can’t afford to overlook this deep pool of talented individuals. I stayed after the presentations were done to meet with the students. I found myself talking with a computer programmer with dual degrees, an RN with practical clinic experience in EMR implementation, a SQL programmer/DBA, and a bevy of IT folks who had some health care experience or none at all, but many years of IT experience and a deep desire to break into this industry.

Every one of these folks had a well-crafted resume, an excellent elevator presentation of themselves, and a passion to find a job that offers them some level of security for the near future. As an employer, I’m really excited about the value of the potential employees coming out of this program.

You, too can tap into this gold mine. This program curriculum is currently being used in 82 community colleges that received grants from ONC, but the curriculum is going to be available for free to the 1200-1400 community colleges nationwide this summer.

There was a dual grant for this program, the second part being a curriculum development grant awarded to top universities such as Oregon Health & Science University, Duke, U of Alabama, Columbia, and Johns Hopkins. This ensures a robust and content rich program that guarantees that the students are getting course work that is readily applicable in our industry.

Did I mention that I’m excited about this program for my own business, the industry, and my clients as well? There is a talent pool waiting for us to dive into and show them where the jobs are. I’ve already started interviewing several of these folks for both positions with my company and with clients of ours who are starting EHR implementations. I’ve forwarded a few resumes to local healthcare IT support vendors. Check it out in your community.

Julie McGovern is CEO of Practice Wise, LLC.

News 5/17/11

The City of Philadelphia selects eClinicalWorks to provide its EHR/PM solution for the Department of Public Health, which includes 230 providers and 20 primary care and correctional clinics. The eCW folks reminded me that they are also working with the San Francisco Department of Health and the NYC Department of Health and Mental Hygiene.

Dunes Family Health Care (OR) notifies over 16,000 current and former patients of a potential data breach following the the theft of a hard drive. The clinic says the drive was “stored in a locked, fire-protected building with limited access” and contained medical record information. The practice also indicates that they’ve now encrypted their data, so presumably that wasn’t the case with the information on the missing drive.

McKesson medical director David K. Nace, MD is named first vice chairman of the board of directors for the Patient-Centered Primary Care Collaborative.

Thirty-four percent of all office-based prescribers were using e-prescribing by the end of 2010. Cardiologists had the highest adoption rates (49%) followed by family physicians (47%.) Providers created 326 million e-prescriptions in 2010, up from 190 million in 2009. Still, that’s only about 25% of all eligible prescriptions.

meridianEMR  names CDW Healthcare as its preferred provider of IT infrastructure and services for its meridianEMR solutions.

eClinicalWorks negotiates a Tax Increment Financing plan with the city of Westborough, MA. The city will extend more than $190,000 in tax breaks to eCW in exchange for the company’s decision to keep its headquarters in Westborough. Last year the company purchased a new facility for $4.6 million; eCW is investing over $14 million in the property.

The AMA Board of Trustees argues that any attempts to standardize EMRs would stifle product innovation. Two years ago, the AMA announced it was in favor of standardized user interfaces, but now admits there’s a “lack of evidence about what constitutes an ideal user interface in a health care environment.” The AMA provides an opinion of what characteristics should be considered in the development of an effective user interface, including simplicity, an organized structure, easily visible options, easy-to-interpret user feedback, and a flexible and tolerant structure that helps prevent errors.

Trend alert: demand for workplace health clinics is on the rise as companies attempt to reduce costs and increase worker productivity.

The Association of Black Cardiologists partners with DrFirst to offer its members DrFirst’s clinical solutions. The Association hopes to drive HIT adoption rates among African American cardiologists and close the “digital divide” that separates minority providers from other physicians.

The 10 hospital and physician groups that participated in ACO demonstration projects contend that CMS’s proposed ACO framework holds too much financial risk. Participants in the Physician Group Practice Demonstration said in a letter to CMS that  the proposed structure would cost more than it would save and would penalize physicians who treat the sickest patients. Last week, AMGA and CHIME also raised objections to the preliminary ACO model.

Mr. H is forever giving me a hard time because I love news that involves lots of stats (must be that economics/MBA background.) Someone at Nuesoft must be a number lover, too because the company’s latest newsletter includes all these fun facts. If you prefer visual stimulation over number-crunching, check out NueTube for Nuesoft’s library of well-done training on demand videos. The ABCs of RECs is also a good read.

E-mail Inga.

Joel Diamond 5/14/11

A Few Minutes With Joel Diamond

Can you believe that Andy Rooney still appears on 60 Minutes?  You know who he is — the curmudgeonly commentator who closes the Sunday broadcast with supposed homespun and witty observations. 

Unfortunately, I often think of them as the bizarre rants of a crazy old reporter with cognitive dysfunction. For those of you who have never seen him, it goes something like this:

• Computers make it easier to do a lot of things, but most of the things they make it easier to do don’t need to be done.
• The average dog is a nicer person than the average person.

I never found this to be particularly insightful or funny. In fact, I’m always waiting for him to say something like:

• Did you ever wonder where the phrase ‘too big for your britches’ comes from? It generally refers to men with very large testicles.
• Did you ever wonder what color Papa Smurf changes to when you choke him?
• Why am I wearing Depends brand adult diapers right now? I suppose it ‘depends’ if I am incontinent of urine or feces.

Here’s what I think it would be like if HIStalk closed with some quaint Andy Rooney observations.

• Why do HIT venders always think it’s cute to demo their products with silly made-up names like Dr. Billy Rubin, or Vi Agra? I always found this distracting. If you insist on doing this, please go all the way — have a patient named Mia Butreeks being taken care of by Dr. Wilma Fingerdu.
• Am I the only grown-up who still giggles every time he hears someone mention the company Siemens?
• Why do EMRs have an hourglass to remind us of how slow they are going? An hourglass?! They should be consistent with the antiquities theme by showing an animated apothecary compounding drugs while looking up formulary data, or leeches sucking blood while searching for a CPT code.
• I swear I didn’t make this up. The Episcopal Sisters of Charity’s Web site said that they were looking for used Siemens units.
• Why didn’t anyone notice that the acronym for the National Coordinator’s office is the widely used medical prefix for malignant cancer? As in ONCology. This can’t be good.
• If the Enterprise Master Patient Index (EMPI) and patient identity issue so hard to get right, why could Navy SEALs do it with so quickly with Osama bin Laden … while getting shot at!
• Are they running out of pharmaceutical names? There’s a new cholesterol drug called Livalo. That just sounds wrong.  I suppose it’s not as bad as the stomach med, Aciphex (it’s seriously pronounced ‘ass effects.’)
• Speaking of drug names, shouldn’t they all just give us a hint at what they do? Anusol for hemorrhoids is a great example.
• CIO can also stand for Chief Investment Officer, and CMO can also be Chief Marketing Officer. In texting they, mean ‘Check It Out’ and ‘Count Me Out,’ respectively. Some of you may find this very insightful. I have actually have no idea if this is relevant to anything.
• I never really liked the term COWS for Computers on Wheels. The imagery is disturbing for some reason. I suppose it’s better that Computers on Carts, though.
• Is it possible that Andy Rooney suffers from Typus Degenerativus Amstelodamensis? This is a condition characterized by bushy eyebrows, low-set ears, a webbed neck, and a low-pitched cry. Think about it

Joel Diamond, MD is chief medical officer at dbMotion, adjunct associate professor at the Department of Biomedical Informatics at the University of Pittsburgh, and a practicing physician at UPMC and of the Handelsman Family Practice in Pittsburgh, PA. He also blogs on interoperability.

News 5/12/11

RCM provider MDeverywhere acquires Advanced Health Management Services, a provider of practice management and credentialing services. MDeverywhere’s majority shareholder and equity partner Marlin Equity Partners funded the acquisition.

From Black Book Rankings: MED3OOO is named the top-ranked vendor in terms of customer experience and satisfaction among EMR systems for multispecialty clinics. Other top performers include NextGen, Allscripts, Dr. First/Rcopia, Sage, Epic, LSS, and Greenway.

AMGA, whose members include about 300 multi-specialty groups and 67,000 physicians, tells Donald Berwick that 93% of its members would not enroll in an ACO, based on the currently proposed regulatory framework. AMGA President and CEO Don Fisher submitted a letter to Dr. Berwick saying the proposed rule is “overly prescriptive, operationally burdensome, and the incentives are too difficult to achieve to make this voluntary program attractive.” The biggest concerns of members include risk-sharing, static risk adjustment, retrospective attribution, quality measurement, and minimum savings.

Greenway Medical is hosting a free Webinar May 18 entitled The Future of Meaningful Use, EHRs and Accountable Care. It includes an update from Greenway VP Justin Barnes, who is also the former chair of the EHR Association. Greenway also just announced that Childs Medical Clinic (AL) successfully attested its EHR use under Medicare’s Meaningful Use program, the company’s first.

Fredericksburg Nephrology Associates (VA) attests to Meaningful Use using Acumen nEHR version 6.0.

Florida passes a law allowing doctors to be fined $500 if they ask a patient or their parents whether they have a gun in their home. Physicians would also be fined for making a note about gun ownership in a patient’s medical record.

California HealthCare Foundation estimates that 55% of primary care providers in California have implemented electronic medical records. Only 10% of FQHCs claim full EMR implementation, though 47% of community clinics have EMRs. No surprise here: larger practices report higher adoption rates than smaller groups.

CMS is hosting a couple of teleconferences for providers next week, including a May 18 session entitled ICD-10 Conversion Activities. The target audience is medical coders , physician office staff, and health records personnel. On the clinical side, CMS will host a May 19 call on Medicare and Medicaid EHR Incentive Programs: Understanding Meaningful Use.

In case you were wondering, at least 465 ambulatory EHR products have now been ONC-ATCB certified. Good to have options, I suppose.

From 2009 to 2010, the number of healthcare data breaches in healthcare increased from 171 to 761, though the number of documents involved fell from 144 million to 4 million. According to a Verizon Data Breach Investigation report, small- and medium-sized businesses, including physician practices, are considered easy targets for outside hackers because they tend to lack sophisticated technology to protect against attacks.

Aprima reseller Doctors Administrative Solutions (DAS) announces the hiring of 10 employees to accommodate its growth. Over the last six months, DAS has added 22 practices representing about 250 physicians.

E-mail Inga.

Bowtie Confidential: Is an ACO Right For Your Organization? 5/11/11

Although the acronym ACO (accountable care organization) is relatively new, the basic construct of this type of organization is at least 30 years old. The first PHO (physician hospital organization) was started in 1984. The PHO at Lutheran General (now part of Advocate Health Care) was unique in that it accepted risk on behalf of its physician membership and the hospital. This risk sharing is the same type of financial arrangement currently being promulgated through the ACO.

Most PHOs were not set up as risk-taking or risk-sharing organizations, but established as contracting mechanisms that would be attractive (often due to price reductions) to insurers. Under the Affordable Care Act, risk sharing (gain sharing for the initial time period for certain ACOs) is a cornerstone of the patient care delivery process. The federal government has mandated that there be savings from the delivery of care for designated populations, and have offered the ACO as the preferred alternative delivery model to achieve these savings.

Healthcare organizations are continuously looking at ways to hold down costs, especially as insurers are cutting payments to providers. Will ACOs be the answer to these current issues?

Healthcare organizations will need to determine whether they want to form or be a part of an ACO. Either way, each organization (hospital and other providers) must better organize resources, systems, and processes to be successful in this changing environment.

The elements needed to start a successful ACO are the same as launching any new endeavor:

• Effective leadership
• Patient-centered case management system
• Information technology that can support an ACO
• Diversity of providers
• Legal and actuarial services
• Financial reserves

The first priority is effective leadership. ACOs need effective and committed leadership from the physician community and the organization’s executive leadership. There must be a commitment to work together, to understand the intent of the ACO program, and to align the ACO organization to maximize the chance of success under this different payment method.

Once the leadership is in place, the ACO will need a robust, patient-centered case management system. Many organizations are establishing patient-centered care delivery models, most commonly referred to as the “medical home.”

Another critical success factor is capable information technology that can support an ACO. These requirements include:

• Systems to enable a patient-centered approach, such as CPOE, electronic prescriptions, and up-to-date patient discharge systems.
• An electronic health record (EHR) that is appropriately utilized by all of the providers, delivering the right information to the right provider, in the right format, at the right time.
• The capability to provide additional information in real time, such as which providers are in/out of network, and preferred vendors.
• Information systems that can show physicians their utilization and the costs for providing care to their patient panel need to be considered. This information might be in the form of a robust data warehousing system, which can integrate data from multiple sources. Another concept would be some form of internal claims processing. Some of this is already being done by insurers, but now the responsibility for providing this information will be the ACO’s.

A more obvious ACO requirement is a diversity of provider types. This is lacking among most hospitals and provider groups today. For example, does your organization have contractual arrangements for nursing home beds? Are you guaranteed these beds at a favorable price? Do you have the methodology in place to share risk (sub-capitation) with these providers, or will you have to pay market rates for beds and other essential services for patients that you will be responsible for (medically and financially)?

There will also be a need for professional support for the ACO, such as legal and actuarial services. Legal issues will be related to organizational structure, board creation, payment methodology, and OIG regulations. Actuarial services will help your organization decide how much risk it is willing to take and how to divide payments among the various providers (primary care, specialists, and other in-network providers).

You will also need to thoroughly assess your organization’s ability to put all of the building blocks of the ACO into place. Do you have the financial reserves to account for adverse selection? Do you have the appropriate leadership, including CMO, CIO and CMIO? Will creating an ACO give you a competitive advantage in your market, or at least keep you level with your competition?

You will need to feel confident that you have the elements mentioned above in place before you move forward with the formation of the ACO. The ACO is an opportunity to generate additional income through implementation of an effective care delivery system. However, without the aforementioned components in place, the risk, reward and revenue associated with a successful ACO will not come to fruition. In fact, the opposite can happen – higher risk, lower reward, and revenue loss.

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.