News 12/5/17

Top News

An Atlanta Journal-Constitution investigation finds that, since 2016, over 1,000 physicians have appeared before medical boards in all 50 states for improperly prescribing opioids, and another 150 have been to federal court on opioid drug charges. Reasons range from greed – George Bird, MD for example, pulled in $1 million for pre-signing prescriptions that his employees filled with hydrocodone for cash and carry service – to a “doctor knows best” attitude to blatant disregard for prescribing guidelines.

“They feel they are above the law,” says John Niedermann, a special assistant in the Los Angeles County District Attorney’s Office who has built a career on going after “doctors who deal.” “They have always been so highly respected and deferred to,” he adds. “I can say that, of the dozen or so doctors that I have convicted, whenever a jury returns a verdict of guilty they look absolutely stunned. I look at them and I’m like, you sat through this month-long trial. You heard all the testimony. How are you surprised by this? But they honestly, honestly think they are doing nothing wrong.”

Webinars

None scheduled in the coming weeks. Previous webinars are on our YouTube channel. Contact Lorre for information.

Announcements and Implementations

CyberKnife Center of Miami selects email security services from Identillect.

Worker compensation company One Call Care Management will offer eligible patients Trainer Rx’s digital physical therapy platform.

At its first annual meeting, The Sequoia Project reports that 25,000 clinics, 580,000 providers, and 1,000 hospitals have connected through its Carequality interoperability framework since it was launched in July 2016. Nine vendors have implemented the framework, with another six expected to adopt it early next year.

HASA implements cloud-based HIE functionality from RosettaHealth for more efficient health data exchange among its HIE participants in Texas.

People

HintMD appoints Jay Burns, MD to its Board of Directors. The Pleasanton, CA-based company’s business focuses on membership-based patient engagement solutions for plastic surgeons and other aesthetic-focused providers.

Greenway Health founder and Executive Chairman Tee Green joins blockchain-based PHR startup MintHealth’s Board of Directors.

WEDI adds Laurie Burckhardt (WPS Health Solutions), Crystal Ewing (ZirMed), and Laurie Woodrome (LabCorp) to its 2018 Board of Directors.

Government and Politics

Acting HHS Secretary Eric Hargan and CMS Administrator Seema Verma travel to the CDC in Atlanta to discuss the center’s efforts to combat the opioid epidemic. The CDC will no doubt be instrumental in helping HIS with its five-point strategy, which includes bolstering public health data reporting, collection, and analysis.

Telemedicine

Zeriscope receives a patent for its mobile telemedicine examination kit. Zeriscope is the brainchild of Robert Adams, MD a professor of neurology at the Medical University of South Carolina and founder of its REACH Telestroke Network.

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News 12/4/17

Top News

Teladoc drops its lawsuit against the Texas Medical Board, which has been dragging on since 2015, after the board’s telemedicine-friendly rules permitting first-time patient encounters to take place via phone or video go into effect. Texas is the last state to do away with such in-person requirements.

Webinars

December 5 (Tuesday) 2:00 ET. “Cornerstones of Order Set Optimization: Trusted Evidence.” Sponsored by: Wolters Kluwer. Updating order sets with new medical evidence is crucial to improving outcomes, but coordinating maintenance for hundreds of order sets with dozens of stakeholders is a huge logistical challenge. For most hospitals, managing order set content is labor intensive and the internal processes supporting it are far too inefficient. Evidence-based order sets are only as good as their content, which is why regular review and updates are essential. This webinar explores the relationship between clinical content and patient care with an eye toward building trust among the clinical staff. Plus, we will demonstrate a new evidence alignment tool that can easily incorporate the most current medical content into your order sets, regardless of format, including Cerner Power Plans and Epic SmartSets.

Previous webinars are on our YouTube channel. Contact Lorre for information.

Check out the recording of last week’s webinar titled “Making Clinical Communications Work in Your Complex Environment,” sponsored by PatientSafe Solutions.

Announcement and Implementations

Direct primary care practice management company Freedom Healthworks assists Olp Family Medicine in opening a solo DPC practice in Carmel, IN. The Indianapolis-based DPC PM startup launched in 2014 under the direction of brothers Adam and Christopher Habig, who came to Freedom after several years with clinical intelligence vendor Isprit Systems.

The YMCA selects HIPAA compliance and cybersecurity services from HIPAA Secure Now! to protect the health data of members enrolled in its diabetes prevention program. This isn’t the Y’s first foray into health IT; it signed an agreement with Athenahealth last year that helps end users route pre-diabetics to the DPP via their EHRs.

Acquisitions, Funding, Business, and Stock

Nashville-based data management vendor Trinisys acquires Mica Health, which offers ambulatory EHR decommissioning services. Former Mica President Mike Justice will apparently stay on as Trinisys VP of business development.

People

Medication adherence app startup Medisafe names Henry Ancona (Converge Venture Partners) chairman of the board.

Jeffrey Linton (Applied Proteomics) joins Quality Systems subsidiary NextGen as EVP, general counsel, and secretary.

Health IT software and services company MTBC promotes Stephen Snyder to CEO and A. Hadi Chaudhry to president.

Government and Politics

Minnesota Lt. Governor Tina Smith announces new guidelines to combat the state’s opioid epidemic, which killed 376 people in Minnesota last year – a 12-percent increase over 2015. Though Minnesota’s PDMP isn’t mentioned specifically in the guidelines, they do call for physicians with excessive prescribing habits to participate in a mandated quality improvement program to help them meet the new standards. 

Telemedicine

Abilene Christian University begins offering TimelyMD telemedicine visits to students as part of its new Wildcat Care program. Assuming a student is relatively healthy, I’m not sure the automatic $95 per-semester fee plus $10 a clinic visit is as economical as paying the typical one-off fee of more popular telemedicine companies.

Nonprofit Global/Georgia Partnership for Telehealth adds Trapollo’s remote patient monitoring capabilities to its turn-key telemedicine services.

Other

American Veterinary Medical Association President and official veterinarian of the North Pole Mike Topper gives Santa’s reindeer a clean bill of health ahead of Christmas Eve. Topper will head back to the North Pole on Christmas Day for post-flight checkups. The vet visit will ensure that Santa has his up-to-date North Pole Certificate of Animal Export on board come Christmas Eve. I wonder who provides Santa’s annual physical? Seems like a job for AMA President David Barbe, MD. Given his remote location, I assume Santa relies on telemedicine for the occasional bout of sniffles.

Sponsor Updates

Blog Posts

• What’s the Most Frustrating About EHRs? (Medicomp Systems)
• Meeting MACRA’s call for care coordination through better communication (PerfectServe)

Contacts

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Population Health Management Weekly Wrap Up 12/3/17

Consulting firm Erdman names CEO Brian Happ chairman of its new Healthcare Advisory Council. Additional members include Rustin Becker (Erdman), Mike Bukosky (USMD Holdings), Frank Byrne, MD (SSM Health St. Mary’s Hospital), Allen Kemp, MD (Centura Health), Rob Moss (Erdman), and William Petasnick (Froedtert Health).

Burke Pediatrics (VA) partners with Food for Others as part of a new food prescription program aimed at ensuring patients can put healthy food on their tables. Eligible patients receive paper prescriptions based on family size for “Good Nutrition Health” that they then take to the Food for Others food pantry to exchange for pre-selected items or that they shop for themselves. The partnership came to fruition after the local news uncovered that many middle school students weren’t sure where their next meals were going to come from. Practice staff began bringing up access to food during appointments and quickly realized that food insecurity “was a reality for far too many of their patients.”

CNBC reports that Amazon Web Services and Cerner will soon announce an agreement involving Cerner’s HealtheIntent population health management system, which is already hosted on AWS. The new deal may involve allowing researchers to analyze HealtheIntent data using AI technology.

VillageMD New Hampshire will roll out Geneia’s Theon analytics and care management software to physicians at Derry Medical Center and Southern New Hampshire Internal Medicine Associates – both of which manage ACOs and insurance plans.

Altruista Health integrates Aunt Bertha’s social services search and referral software with its care management technology.

Renown Health (NV) CEO Tony Slonim, MD shares the initial success of the Healthy Nevada Project, a multi-year population healthy study conducted with help from the Desert Research Institute. The organizations are collecting data from 10,000 participants across 135 zip codes in the northern part of the state that, when combined with DRI’s environmental data, will allow them to identify and prepare for public health risks.

“As a healthcare system with the largest market share in our community, this is the ultimate in strategic planning,” writes Slonim. “If our community is more at risk for cardiovascular disease 10 years from now, we can be thoughtful about recruiting cardiologists. If we know that the population is growing in pediatrics, we can start a program for pediatric residents at the University of Nevada, Reno School of Medicine and grow our pool of pediatricians. The horizon for planning can be kept in view because we’re learning about our population’s health and disease. And that’s just good medicine.”

The local news reports on a new trend in population health management and public health initiatives – that of educational opportunities as a health insurance benefit. After surveying its Medicaid members, Select Health in South Carolina found that earning a high school diploma was the most sought after add-on, and so the managed care company started its Mission GED program to cover the cost of the exam and one retake. Eighteen people have graduated from the program so far, which means they will likely pursue further education and move into careers that offer better salaries and benefits, all of which statistically lead to better health.

In Health Affairs, Episcopal Health Foundation VP for Impact Lexi Nolen outlines the ways in which the foundation’s four-year, $10 million Texas Community Centered Health Homes Initiative is working to address the root causes of community health problems. The initiative began in September to implement a number of programs focused on social determinants of health that include establishing a food council, working to create suburbs designed for active living and healthy eating, and designing community-involved approaches to mental health.

Sponsor Updates

Blog Posts

• A Patient-Centric, Independent Clinic in Utah (EClinicalWorks)
• A quick and easy intro to designing an EHR training program (Nordic)

Contacts

Jenn, Mr. H, Lorre

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News 11/30/17

Top News

Attorney General Jeff Sessions announces that Presidential Adviser Kellyanne Conway will oversee the Trump administration’s efforts to combat the opioid epidemic. Sessions made the announcement during remarks that focused on the DEA’s renewed efforts to step in and handle the crisis – efforts that will be fueled by $12 million in grants and a new division over the Appalachian region that will focus on illegal drug trafficking. Conway seems an unlikely choice, given her lack of healthcare experience and former life as campaign manager, pollster, and political pundit. She may surprise some, however, given her tagalongs with former HHS Secretary Tom Price, MD as he traversed (ostentatiously, by all accounts) the country several months ago talking with healthcare stakeholders about the epidemic.

In other opioid-related news, President Trump will donate his third-quarter salary (pegged at $100,000) to help combat the epidemic. He will funnel it to an HHS-sponsored public awareness campaign about the dangers of opioid addiction.

Webinars

December 5 (Tuesday) 2:00 ET. “Cornerstones of Order Set Optimization: Trusted Evidence.” Sponsored by: Wolters Kluwer. Updating order sets with new medical evidence is crucial to improving outcomes, but coordinating maintenance for hundreds of order sets with dozens of stakeholders is a huge logistical challenge. For most hospitals, managing order set content is labor intensive and the internal processes supporting it are far too inefficient. Evidence-based order sets are only as good as their content, which is why regular review and updates are essential. This webinar explores the relationship between clinical content and patient care with an eye toward building trust among the clinical staff. Plus, we will demonstrate a new evidence alignment tool that can easily incorporate the most current medical content into your order sets, regardless of format, including Cerner Power Plans and Epic SmartSets.

Previous webinars are on our YouTube channel. Contact Lorre for information.

Acquisitions, Funding, Business, and Stock

Minnesota lawyers file lawsuits on behalf of dozens of counties against three opioid-based pain medication distributors and six manufacturers in an attempt to recoup some of the money lost in the state’s battle against the opioid crisis. The lawyers have said they’ll base their suits on the deceptive marketing practices of such companies, which highlighted their legitimate uses to physicians but neglected to mention their addictive side effects.

Announcements and Implementations

The Colorado Community Health Alliance will work with Anthem to offer Medicaid patients better coordinated primary and behavioral healthcare. It seems the two organizations will create an as yet unnamed company to solidify the partnership.

Physicians in Pennsylvania come together to form a chapter of the Association of Independent Doctors. Formed in 2013, the association has seven chapters nationwide and is intent on helping local physicians fight hospital mergers. It focused its energy on Pennsylvania last year when it protested the ultimately abandoned merger between Penn State Milton S. Hershey Medical Center and PinnacleHealth System.

People

Will Ostdiek, MD (Think Whole Person Healthcare) joins Charles Drew Health Center as CMO.

EHNAC names Capt. Alicia Morton, DNP, RN-BC a commissioner ex officio through 2020. Morton, an active-duty nurse in the USPHS Commissioned Corps, is also director of ONC’s Health IT Certification Program.

Great Lakes Management Service Organization hires Surya Desiraju (Adeptus Health) as COO.

Government and Politics

The State of Connecticut approves $51 million in requests to fund IT projects that include a new Medicaid information management system and HIE. The state has a somewhat troubled history of dabbling in health information exchange, having spent $4.3 million to launch one several years ago only to eventually dismantle it. The state medical society went live with its own HIE in June.

Two of the more interesting tweets to come out of ONC’s Annual Meeting, which concludes tomorrow. Frankly, much of the subject matter covered thus far seems eerily similar to years past (with the exception of blockchain, perhaps), which is either a testament to how hard solving interoperability is or how slow government is to make it happen.

Telemedicine

MDLive adds chatbot functionality to help new users register on its virtual visit platform.

Other

Oh the irony: The Texas Health and Human Services Commission faces a rat infestation that has prompted the agency to issue a $60,000 contract for emergency pest control services. The agency, which attributes the problem to ongoing construction, has encouraged employees to keep their workspaces free of food and has even instituted an anonymous tip line where staff can “rat” each other out for slovenliness.

Contacts

Jenn, Mr. H, Lorre

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Readers Write: Three Key Things Practices Should Do to Prep for MIPS/MACRA

Three Key Things Practices Should Do to Prep for MIPS/MACRA
By Polly Friend, RN

Providers have had two tracks of MACRA to choose from in 2017 – the merit-based incentive payment system (MIPS) and an advanced alternative payments model (APM). Most providers were, by default, placed in the MIPS program, and they put in a lot of hard work to avoid penalties during the uncertainty of MACRA’s first year. In 2018, there will be even more changes as we transition to full implementation by 2019 and beyond. Some of the new regulations for the second year include allowing providers multiple submission mechanisms within the ACI quality and improvement categories; an exemption allowance for practices with less than $90,000 in allowed charges for up to 200 patients in Medicare Part B; and the option of participating in MIPS as an individual or a group, including a new virtual group option.

As adjustments are being made to MIPS, action needs to be taken now, so providers can stay ahead of whatever curveballs are thrown. To some degree, physician practices will need to “build the plane while flying it.” The 2018 second-year rules were finalized on November 2, giving practices lead time to position themselves for success. After months of helping practices design and execute MIPS action plans, we’ve distilled the information gathered into the top three things medical practices can do to get ready for the 2018 MIPS/MACRA landscape.

1. Choose which measures to report on wisely.

Though there are over 270 MACRA measures available, many are specialty-specific, so not all will apply to your practice. Still, narrowing down which ones you will choose to report on can be complex. There are a few ways to approach this. First, it’s important to understand the definition of each measure. When choosing which measures to report on, your practice will be expected to report only on those that are applicable or relevant to the services you provide. For an in-depth look at specific measures that your practice will need to report on, CMS provides a helpful resource library. Additionally, the Early Implementation Review: CMS’s Management of the Quality Payment Program offers valuable insights that can help your practice understand specific MACRA measures.

Once you’ve narrowed the measures down to only those that you could be eligible for, you can turn to your billing data to identify the most frequently reported procedures and diagnosis codes, and look for measures that include those. Another good way of choosing measures is through patient eligibility. Use the analytics tools in your EHR, PM, and billing systems to look at the data of your patient population and identify which measures would apply to them. It’s important to avoid those that have less than 20 eligible cases because they’ll receive an automatic minimum score, regardless of how good your performance is.

When choosing measures for your practice, it’s important to understand not just which ones are applicable to you, but also which ones you can do well with. Setting your practice up for success under the new MIPS/MACRA laws requires some upfront legwork that ultimately will help you mitigate the risk of a penalty and increase your chance of receiving an incentive.

2. Make sure your clinicians are on board.

The shift toward a value-based healthcare system addresses more than just patient satisfaction and practice revenue. There’s also a heavy, albeit indirect, focus on physician burnout. Put simply, when your physicians are overworked and spread too thin, they won’t be able to deliver the best care to their patients. This directly impacts your MIPS score. Before finalizing the measures you’ll report on, it’s important to get your clinicians on board. They will understand better than anyone else which measures are appropriate for them, and which will allow them to best demonstrate the quality of care they provide. Physicians who have gone through rounds of Meaningful Use policies may feel resentment toward this latest set of changes under MACRA.

The ability and willingness of your staff to adhere to value-based care and strive toward the final measures should be weighted heavily. To encourage engagement and ownership, consider having a brown bag lunch session and soliciting ideas for making the transition a success. Another way to engage your providers is to have them brainstorm ways to track and show progress on the measures they’ll be reporting on. For example, they may want to see weekly reports or monthly posters on the practice walls. The way in which your providers want to show progress should be amply supported as another way to encourage participation.

3. Ask your EHR or vendor for help.

Once your entire team is on board with the MIPS measures your practice will report on, you can work with your EHR vendor to determine what documentation is needed. Most will provide you with the support you need so that you can submit the minimal requirements to avoid a penalty, and prepare a plan for next year to achieve the incentive.

One of the most important things your EHR vendor can provide is a guarantee program of some kind. CareCloud offered a 2017 MIPS Guarantee, which ensured clients received full assurance of avoiding penalties during the uncertainty of MACRA’s first year. With the higher threshold of activity that will be required in 2018 and beyond, guarantees like this aren’t as easy to support. Still, you don’t want to carry a double risk by paying for a technology that can’t support your needs while you’re also trying to navigate a program that has a lot of potential for change. Though you may not be able to get a no-penalty guarantee, your EHR vendor should offer some kind of protection on the technology side.

We don’t know what’s ahead with MIPS/MACRA in the year building up to what should be full implementation. Though uncertainty exists, we can still be ready. Taking action now to prepare for pending changes can help your practice mitigate the risk of a penalty and, ideally, work toward earning an incentive.

Polly Friend, RN is senior director of clinical strategy at CareCloud in Miami.

Contacts

Jenn, Mr. H, Lorre

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