News 6/9/11

The HIT Policy Committee advises ONC to push back the Stage 2 deadline for Meaningful Use to 2014 for providers who qualified for Stage 1 this year. The committee believes the original timeframe does not give providers or vendors adequate time to prepare for Stage 2, especially since the final Stage 2 rules will not be released until June 2, 2012. The proposed change would allow providers to collect Stage 1 and 2 incentive payments for two years without penalizing early Stage 1 adopters with a tight Stage 2 deadline.

Shareable Ink partners with Waiting Room Solutions to combine its digital pen technology with the EHR from Waiting Room Solutions.

Spring Hill Primary Care (WV) contracts with Sage Healthcare Division for the Intergy Meaningful Use Edition.

Initivia will extend special pricing for its InSync EMR/PM product to members of Premier Purchasing Partners, a group purchasing organization.

The Louisiana Care Quality Forum REC designates Greenway’s PrimeSUITE EHR as a supported EHR product.

CRISP, the REC for Maryland, meets its subscription goal with the enrollment of 1,000 primary care physicians.

CMS adds a few questions to its FAQ page on the EHR incentive program. Here are a couple of the better ones:

What information must an EP provide in order to meet the measure of the meaningful use objective for "provide patients with an electronic copy of their health information?”

The minimum required information includes a problem list, diagnostic test results, medication list, and medication allergy list. CMS also notes the four elements must be provided to patients within three business days  of their request.

For the Medicare and Medicaid EHR Incentive Programs, when a patient is only seen by a member of the EP’s clinical staff during the EHR reporting period and not by the EP themselves, do those patients count in the EP’s denominator?

The EP can include or not include those patients in their denominator at their discretion as long as the decision applies universally to all patients for the entire EHR reporting period and the EP is consistent across meaningful use measures. In cases where a member of the EP’s clinical staff is eligible for the Medicaid EHR incentive in their own right (NPs and certain PAs), patients seen by NPs or PAs under the EP’s supervision can be counted by both the NP or PA and the supervising EP as long as the policy is consistent for the entire EHR reporting period.

E-mail Inga.

News 6/7/11

Merge Healthcare acquires Ophthalmic Imaging Systems (OIS) for approximately $30.3 million in stock. OIS’s products include OIS EMR and PM, as well as EMR and PM products through its Abraxas Medical Solutions subsidiary.

EMR costs make adoption difficult for small practices, even with incentives. That was the general consensus of several speakers who testified last week for the House Small Business Committee’s healthcare and technology subcommittee. Sasha Kramer MD, a solo dermatologist from Washington state, summarized the situation nicely:

HIT holds promise as a tool to increase quality and efficiency in the health system. However, there are significant barriers to full-scale adoption and implementation of HIT – specifically, cost, regulatory barriers, financial penalties, an unpredictable marketplace and system integration. It is imperative that Congress ensure small physician practices are able to make the investment in technology that will enable the American healthcare delivery system to coordinate care and make a measurable impact on quality without imposing overly burdensome procedures or failed financial investments upon physician practices.

Meanwhile, AHRQ announces plans to conduct a two-year, $425,000 study of the barriers Medicaid providers encounter in trying to achieve Meaningful Use. Note to AHRQ: save some money and see above because I bet the issues are basically the same.

Boston Laser implements Sage Portal for online appointment scheduling, registration, and messaging.

RIS/PACS provider DR Systems announces plans to release a fully certified ambulatory EHR for imaging specialists later this year.

The AMA names James L. Madara, MD as EVP and CEO. He served as dean at the University of Chicago Pritzker School of Medicine and as CEO of the University of Chicago Medical Center.

Practice Fusion earns full ONC-ATCB certification.

Adena Health System (OH) picks eClinicalWorks EHR for its 150 employed physicians, as well as non-affiliated community practices.

Ingenix says its transition to its new name, OptumInsight, is complete.

Consulting and implementation services firm MD Solutions partners with dashboardMD to enhance its analytics reporting offerings.

Every so often I am reminded how expensive EMRs can be and that EMR can be big business. Case in point: the 15-provider Great Hudson Valley Family Health Center (NY) recently completed a $1 million implementation of GE Centricity. The practice claims that $500,000 was related to training costs. The FQHC includes 11 physicians and four NP/PAs, so the total cost was about $67K per (primary care) provider.

e-MDs says that 21 of its provider clients in Texas have already received Medicaid EHR incentive checks.

Danbury Orthopedic Associates (CT) selects SRS EHR for its 20 provider practice.

CMS issues a proposed rule allowing certain qualified organizations access to patient-protected Medicare data on providers and hospitals. The intent would be for the qualified entities to combine the Medicare data with information from private carriers to evaluate provider performance, and presumably help consumers and employers make better healthcare decisions.

CMS releases a list of providers who have received Medicare EHR Incentive payments. If I were a provider, I am not sure I’d love having this information available for the world to view, even if the money does come from taxpayers.

IPAs may make a resurgence as doctors look for ways to unite with larger systems for the purpose of forming ACOs. The IPA model lost favor about 10 years ago and in many cases became financially unviable. IPAs may be a better solution today, as providers consider options for sharing savings and risk and collecting quality metrics on specific populations. I’ve always known that healthcare and fashion had many similarities. In honor of the returning IPA, I think I will pull out my stone-washed jeans.

E-mail Inga.

News 6/2/11

MGMA concurs with just about everyone else that the proposed ACO rule is unacceptable as written:

Based on feedback received from our members, including those who participated in the PGP demonstrations, as well as similar private sector contractual arrangements, MGMA believes the ACO shared savings model may not be viable as a national strategy unless significant program policies are modified when final rules are promulgated.

MGMA says out that the program is too complex; the development and on-going costs are too high relative to potential benefits;  the benefits are too uncertain and too small; and the regulatory risks too substantial.

Molina Healthcare picks GE Centricity Practice Solution as its primary EMR/PM platform for its 16-state healthcare system.

Nuesoft Technologies and Point and Click Solutions collaborate on the College Health Technology Pathway Program to educate college health professionals of the potential risks of hosted systems. Nuesoft CEO Massoud Alibakhsh offers this warning:

Hosted ASPs take a client-server and provide users remote access via the Internet. This is akin to putting wings on a car and expecting it to perform like a jet airplane. This is not what a client server is intended to do, and unless they can guarantee the fault tolerance and security protocols in place, you are taking chances with your data.

eClinicalworks says that 15 of its clients have received EHR incentive checks from CMS.

Now that it’s June, it’s time to consider potential vacation destinations. Why not attend a user group meeting with your favorite EMR vendor? Here are a few upcoming events:

• Amazing Charts User Conference, Biltmore Hotel, Providence, RI, June 2-5
• Sage Summit, Gaylord National Hotel & Convention Center, Washington, DC, July 10-15
• e-MDs User Conference & Symposium, AT&T Center, Austin, July 28-30
• Aprima National User Conference, Hilton Lincoln Center, Dallas, August 4-7
• Allscripts Client Experience, The Gaylord Opryland Resort, Nashville, August 29-31
• Greenway PrimeLEADER, Gaylord Palms Resort & Conference Center, Kissimmee, FL, September 8-11
• SRS User Summit, Hilton, Woodcliff Lake, NJ, September 21-23
• eClinicalWorks National Users Conference, JW Marriott Desert Ridge Resort, Phoenix, October 1 – October 4

HIMSS teams up with an attorney to answer questions on Meaningful Use for one of its monthly publications. Great idea, however, the answer to this question is a bit confusing:

Q: When an eligible physician is employed by a group practice, who gets the EHR incentive money, the individual doctor or the practice?

A. The answer is most likely yes if the physician and group have a traditional physician employment agreement.

Huh? The attorney does go on to explain that physicians can reassign their payments to their employment or other entity, so the less-confusing  answer is that the money could go to either.

As Mr. H mentioned last night, it’s a slow news period and lots of readers seem to be taking some time off. Mr. H is quite the slave driver, however, so we are still working hard at it. Drop me a note if you have anything juicy to report, words of encouragement, summer vacation suggestions, and/or need my shoe size. And thanks for reading.

E-mail Inga.

News 5/31/11

A London paper reports that Sage Group has launched a review of its healthcare division that could lead to a sale of the unit, valued by analysts at around $430 million. Sage recently reported a 5% decline in revenues for the North American healthcare division for the first half of the year.

CMS says that the Medicare EHR incentive program has paid out $75 million to providers so far, while the 15 state Medicaid programs have issued $38 million in payments.

Good news for providers who have not yet adopted e-prescribing systems. CMS issues a proposed rule that would expand the definition of an e-prescribing system to include certified EHRs with e-prescribing capabilities. In addition, certain providers would have until October 1 to claim exemptions to avoid potential Medicare pay cuts.  Exemption reasons include having limited prescribing activity and practicing in an area in which regulation prohibit e-prescribing. Providers could also claim an exemption if the delay is a result of a pending implementation of a certified EHR.

Nevada and Utah REC HealthInsight announces that 1,000 primary care providers have signed up for EHR adoption and implementation assistance.

athenahealth says several of its athenaclinical customers have been paid Medicare EHR incentive payments.

Barboursville Internal Medicine (WV) picks Benchmark System for its PM and EHR.

HP EHR Referral Group, an alliance of healthcare billing systems, selects Sevocity EHR as a preferred EHR.

Oncology EHR provider Rabbit Healthcare Systems announces that it is expanding its headquarter space by 70% and expects to increase its staff by 40%.

The local paper highlights Springfield Center Family Medicine (OH) and its use of NextGen EHR. Though quite happy with the solution, one physician notes that his incentive payment of $18,000 only covers half of what the practice spent on server upgrades last year.

Trend alert: two large distributors of medical supplies to doctors’ office report double digit sales growth for the first quarter. PSS World Medical (15.4%) and Henry Schein (12.4%) say the creation of jobs is providing more patients with health insurance, boosting healthcare demand and giving physicians confidence to buy more supplies.

HIMSS names four finalists for Ambulatory Care Davis Award, including Community Care Physicians (Allscripts — NY), Fallon Clinic (Epic — MA), James F. Holsinger MD (e-MDs — IA), and Women’s Health Advantage (Greenway — IN). HIMSS will award up to four winners following site visits to each practice.

A disgruntled patient in Vermont sues her doctor after leaving without seeing him after a wait of more than one hour. The doctor was delayed caring for another patient. The woman asked the practice to reimburse her $139 to cover the cost of hiring a nurse to care for two family members while she waited. She filed suit when the practice refused (and subsequently “fired” her from the practice). The judge rules in the doctor’s favor, noting there would be serious problems if doctors could be billed for missed appointments. The patient says she feels, “like a David-ette against a Goliath.”

E-mail Inga.

From the Consultant’s Corner 5/30/11

ICD-10: Roadmap to a Successful Transition

The transition from ICD-9 to ICD-10 codes is a massive undertaking for all healthcare organizations. It’s a matter of sheer magnitude, of course: diagnosis codes are critical to nearly all patient care and revenue cycle activities. Add to that the additional burden facilities face implementing ICD-10 Procedure Coding System.

With any project this large, success requires carefully mapping out each phase of the journey. In the case of ICD-10, I suggest taking a five-phased approach: 1) program development; 2) impact assessment; 3) project and implementation planning; 4) implementation; and 5) stabilization and optimization. Here’s a look at the key elements in each phase:

Phase 1: Program Development

The very first step is to establish a governance team responsible for oversight of the ICD-10 conversion. It should include representatives from: revenue cycle (hospital and professional, if your organization has both); coding/HIM; clinical informatics and clinical documentation; IT (patient access, clinical and revenue cycle applications); training; and compliance.

You may have one person wearing many of these representative hats in some organizations. That’s OK. Just make sure each of these functional areas is considered in your ICD-10 planning. Your project plan should include a timeline and resource requirements by functional area.

Phase 2: Impact Assessment

Your assessment should focus on understanding the training needed to bring everyone up to speed on ICD-10 requirements. Again, make sure to conduct your assessment by functional area: systems, billing and reporting requirements, and training requirements. Once you’ve assessed each area separately, though, it’s critical that you then aggregate them to create an enterprise-wide view of overall impact. You should end up with a documented inventory of all IT applications.

Phase 3: Project and Implementation Planning

After impact assessment, carry out a separate vendor readiness assessment. The goal is to identify all vendors and interfaces affected by the ICD-10 conversion, then contact the vendors to see if upgrades or other changes are necessary to meet ICD-10 requirements. Any associated costs must be documented, and vendors should be asked to provide you with their ICD-10 test plans.

Phase 4: Implementation

With an implementation that includes as many “moving parts” as ICD-10, it’s important to clearly identify expectations and measure your progress toward them. Among the implementation tasks you’ll need to monitor are:

• System updates (e.g., templates, electronic and paper claims/remits, and reports) and upgrades
• Physician documentation training
• HIM/coding training
• Revenue cycle staff training
• Interface modifications
• Unit testing
• Integrated testing
• Development of new reports

Expect a pretty complex testing plan. In addition to internal testing, you’ll need to test with external parties including payers, clearinghouses, and other EDI partners. And unless you use a home-grown IT solution, you’ll depend on vendors for ICD-10 updates. Don’t underestimate the time and effort vendor coordination and testing will take! Develop a testing schedule that ensures each type of EDI transaction you use processes correctly before the Oct. 1, 2013 compliance date.

Documentation and coding training should be performed in the months prior to implementation, and will be important for reducing coding errors and claims denials after go-live. Once you’ve converted to ICD-10, it’ll be essential to conduct real-time monitoring of clinical documentation, HIM and coding productivity, interface error logs, claim edits, claim denials, remittances, physician productivity, patient visit/encounter volumes, and more.

Phase 5: Stabilization and Optimization

For a successful transition to ICD-10, metrics will be key. Tracking performance metrics throughout implementation is the only way you’ll be able to spot and fix any potential difficulties.

Perhaps the best part of the whole ICD-10 implementation is the opportunity for improvement that it brings you. Think about it: You’ve already created a representative governance team. You’ve already developed a dialog with your vendors and payers. You’ve already started identifying and tracking vital performance metrics.

You’ve already done the legwork. Now, combine your metrics with your avenues of communication to do more than just implement ICD-10. Use them to develop and optimize future goals through additional training, workflow redesign and system modifications.

Rob Culbert is president of Culbert Healthcare Solutions of Woburn, MA.