News 1/9/17

Top News

UnitedHealth’s Optum health services company acquires ambulatory surgery provider Surgical Care Affiliates in a $2.3 billion deal. SCA, which operates 205 facilities across 30 states, will combine with Optum’s OptumCare primary and urgent care delivery services business. SCA CEO Andrew Hayek believes the deal will “enable us to better support and empower independent physicians, helping them provide high-quality care for their patients while making health care more affordable. The combination of SCA and OptumCare is another step forward toward our vision of becoming the partner of choice for surgeons.”

Webinars

January 18 (Wednesday) 1:00 ET. “Modernizing Quality Improvement Through Clinical Process Measurement.” Sponsored by LogicStream Health. Presenters: Peter Chang, MD, CMIO, Tampa General Hospital; Brita Hansen, MD, CHIO, Hennepin County Medical Center. The presenters will describe how they implemented successful quality governance programs, engaged with their health system stakeholders, and delivered actionable information to clinical leadership and front-line clinicians. Q&A will follow.

January 26 (Thursday) 1:00 ET. “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.” Sponsored by Healthwise. Presenters: Jim Rogers, RN, RPSGT, director of healthcare solutions, Persistent Systems; Jason Burum, chief client officer, Healthwise. This webinar will explain how to implement a patient-centered care coordination program that will increase quality as well as margins. It will provide real-world examples of how organizations used care coordination to decrease readmission rates, ED visits, and costs.

Announcements and Implementations

Privia Health’s Gulf Coast network doubles thanks to the addition of 125 physicians over the last six months. The practice management company, which launched the Houston-based network late 2015, works with 1,400 providers in six states via its network of medical groups.

People

Spurred by an unspecified amount of financing from Kinderhook Industries, Stratus Video appoints Mark Knudsen (CareCloud) VP of product innovation and AnnaMaria Turano as VP of marketing for its new Telehealth division.

Telemedicine

SnapMD closes $3.25 million in Series A financing, bringing its total raised to $9.15 million since getting off the ground in 2013. CEO Dave Skibinski has three goals in mind for the new funding. “First, to continue to add innovative features to our Virtual Care Management Platform to better meet the clinical needs of the medical community,” he explains. “Second, support our numerous channels partners, especially Konica Minolta and Athenahealth to accelerate sales. Third, to continue to raise awareness of our approach to telemedicine and our Virtual Care Management platform.”

Teladoc, which recently celebrated its 2 millionth visit, adds lab testing services from Analyte Health to its virtual consult capabilities. Physicians in the Teladoc network will now be able to order lab tests and review results through the company’s telemedicine technology. Patients will be sent to an offsite location for testing. Both companies envision making these services available in a single day via upgraded mobile capabilities.

The Lewisville, TX-based company reports preliminary 2016 results: $123 million in revenue – a 59-percent increase over 2015; and a 43-percent increase in year-over-year membership, amounting to 17.5 million users.

Government and Politics

HHS Secretary Sylvia Burwell looks back on her two-and-a-half-year tenure with what seems to be a mix of satisfaction and frustration, given the incoming administration’s predicted efforts to repeal and replace the ACA (a phrase she refers to as a “campaign slogan.”) She includes open enrollment as one of her biggest challenges as secretary: “One of the biggest issues is that there are always a number of serious challenges at the same time. When I came to the department, I needed to make decisions on technology for the next Affordable Care Act open enrollment, on issues related to the unaccompanied children crossing the border from Central America and the Ebola crisis. There were other pressing issues, such as how to deal with growing opioid abuse. The department’s jurisdiction is so broad and the challenges come all at once.” Fun fact: National Security Advisor Susan Rice was Burwell’s basketball coach at Oregon University, and indirectly helped Burwell meet her future husband.

OCR decides not to sanction Senator Siobhan Dunnavant, MD (R-VA) for a HIPAA violation related to a letter for political support sent to patients during her 2015 campaign. The sharing of patient contact information with her campaign team, though found to be “impermissible” under HIPAA law, did not result in a fine because the former Ob/Gyn took immediate action to ameliorate the situation. Dunnavant claims she cleared the letter, which was intended to notify patients that her run for office would not affect their care, with her medical practice board and lawyers.

Research and Innovation

A survey of 2,223 adults finds that 19 percent have visited a retail clinic in the last month. I’m a bit surprised that the number isn’t higher given how ubiquitous they’ve become. It would be interesting to ask those who hadn’t if they opted for telemedicine services instead. Good news for retailers: Fifty-three percent of visitors purchased a product before or after their clinic visit.

Other

NPR looks at the role EHRs are beginning to play in using aggregated data to customize patient care. It highlights the data mining Kaiser Permanente clinicians often do to help patients better understand how others going through the same treatments are faring (a concept that sounds very similar to that of ASCO’s CancerLinq). Genetic testing could be the key to taking this type of precision medicine one step further. “Medicine’s got to catch up, and medicine’s got to understand how best to take advantage of all the information that’s been generated every day,” says Yale University Professor Harlan Krumholz, MD. “The quality of data [collected in medical records] is not necessarily research quality.”

This story highlights the ways in which public libraries are adapting to meet the healthcare needs of their patrons. The Philadelphia Free Library, for example added a pediatric and primary care clinic on its top floors last year as part of its transition to the South Philadelphia Community Health and Literacy Center. Arizona’s Pima County library system has teamed with the health department to have employed nurses make rounds throughout its 27 branches – a move that has resulted in the library substantially reducing its 911 calls made for behavioral issues.

Surely there’s a Hallmark card for this: The Iphone celebrates its 10th anniversary amidst declining sales and a corresponding 15-percent pay cut for CEO Tim Cook (who still takes home $8.7 million). Honestly I think just about every healthcare IT startup out there should have a party in honor of the device, given its impact on the industry at large and, on a more granular level, the power it has given to the patients who want it.

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Population Health Management Weekly Wrap Up 1/8/16

The University of Maryland Medical System appoints Stacy Garrett-Ray, MD (VA) president of the University of Maryland Quality Care Network and vice president/medical director of the UMMS population health services organization.

Self-service health kiosk vendor Pursuant Health closes a a $12.8 million Series A round of financing. The Atlanta-based company (fka Solo Health) will use the investment to expand its offerings to include texting, mobile, and incentive management capabilities. It has established several high-profile wellness programs and partnerships over the last year with organizations including the American Diabetes Association and Anthem Blue Cross and Blue Shield.

Dallas-based Christus Health expands its relationship with Phillips, adding the company’s somewhat newly acquired Wellcentive population health management capabilities across its 50 hospitals and 175 clinics. The health system will also use technology to better manage the health plans it offers its employees and the public via state-based exchanges.

Glendale, CA-based Apollo Medical Holdings merges with Alhambra, CA-based Network Medical Management to become one of the country’s “largest integrated population health management companies.” The newly combined company, which will operate under the Apollo name, will provide medical management services for 700,000 patients through its 3,000 clinicians and 400 employees. NMM CEO Thomas Lam, MD will join APM CEO Warren Hosseinion as co-CEO of the new company.

Caradigm enhances its population health management solutions to support MACRA and bundled payments, adding Care Bundles, Content Builder, MACRA solutions, Advanced Computation Engine, and Utilization and Financial Analytics.

University of Missouri Health Care implements Cerner’s HealtheIntent population health management across the Health Network of Missouri’s,six facilities, each of which uses a different EHR. The network serves predominantly rural patient populations through the sharing of health data and best practices.

Vicky Ann Ducworth (The Boeing Company) joins EQHealth Solutions as SVP of government operations.

Sponsor Updates

• What your health IT peers found interesting in 2016 (Nordic Consulting)
• How Front-End Speech Can Assist the Pathology Workflow (NVoq)
• Healthcare is Ripe for Tools to Enable Value-based Collaborative Care (PerfectServe)

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News 1/5/17

Top News

Arcadia Healthcare Solutions lands $30 million in growth capital led by investments from GE Ventures and the Merck Global Health Innovation Fund. The Boston-based company, which has raised a total of $43 million since launching in 2011, will use the financing to further develop its analytics offerings for providers and payers, and to grow its population health management presence across the country. It acquired EHR support services company Concordant in 2011, and managed care services firm Sage Technologies in 2015.

Webinars

January 18 (Wednesday) 1:00 ET. “Modernizing Quality Improvement Through Clinical Process Measurement.” Sponsored by LogicStream Health. Presenters: Peter Chang, MD, CMIO, Tampa General Hospital; Brita Hansen, MD, CHIO, Hennepin County Medical Center. The presenters will describe how they implemented successful quality governance programs, engaged with their health system stakeholders, and delivered actionable information to clinical leadership and front-line clinicians. Q&A will follow.

January 26 (Thursday) 1:00 ET. “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.” Sponsored by Healthwise. Presenters: Jim Rogers, RN, RPSGT, director of healthcare solutions, Persistent Systems; Charlotte Brien, MBA, solutions consultant, Healthwise. This webinar will explain how to implement a patient-centered care coordination program that will increase quality as well as margins. It will provide real-world examples of how organizations used care coordination to decrease readmission rates, ED visits, and costs.

Announcements and Implementations

Mutare Health upgrades its Vital Link secure messaging technology to include voicemail replacement capabilities. Voicemails can now be recorded, converted, and delivered to physicians via Instant Message, email, or text.

Ingenious Med develops a charge-capture app specifically for physician practices that also includes secure messaging, management reports, and dashboards.

People

The California-based Central Coast Medical Association appoints primary care internist David Dodson, MD president of its 2017 Board of Directors.

JC Muyl (Medivo) joins payer-focused behavioral telehealth company AbleTo as SVP of operations.

Laura Hobbs (Bausch & Lomb) joins patient registration kiosk company Clearwave as director of sales.

Government and Politics

New York lawmakers pass legislation giving physicians the ability to access the health data of patients between 10 and 17 through the state’s HealtheLink HIE. Parents must sign a consent form giving physicians permission. Though the new law will help make pediatric medical records more accessible, HealtheLink Executive Director Dan Porreca stresses that, “Participating providers need to be aware that it is possible that the minor patient’s record may contain sensitive information that is protected under New York state law and may not be re-disclosed to the minor’s parent or guardian without the minor’s written consent.” Such information could pertain to mental health or substance abuse treatment, reproductive health services, or STD treatment.

Telemedicine

White-label telemedicine vendor SnapMD joins Athenahealth’s More Disruption Please program. Athenahealth will incorporate the company’s Virtual Care Management software into its EHR and RCM products.

The Indiana Rural Health Association facilitates the launch of three school-based telemedicine clinics in Austin, Crothersville, and Southwestern Jefferson County. The program has avoided outsourcing clinical expertise thanks to employed nurses and specially trained teachers and secretaries. IRHA plans to open clinics in five more school systems by the end of the year. The association is particularly focused on launching the clinics in rural and underserved areas. As I briefly mentioned in yesterday’s post, Indiana does not yet offer Medicaid reimbursement for such visits.

Other

Family physician Henry Hochberg, MD laments the demise of the small, independent practice and the resultant lack of patient-provider relationship-building that such offices can typically provide:

“The reality is that medicine has become largely corporate and depersonalized. The office visit must be recorded electronically, often right in front of the patient. Metrics rule the day. Physicians now get paid and evaluated by codes. There are diagnosis codes, procedure codes and, to a certain extent, ‘time spent’ codes. We can be as precise as coding for a patient who was ‘sucked into a jet engine’ (V97.33X) or suffered from ‘water skis on fire’ (V91.07XA)!

But there is no diagnosis code for ‘loss of eye twinkle.’ And no time code for ‘needing to be heard.’ So, will you miss us when we’re gone? There may come a time in the future when you wave a Bluetooth device over your body, get a diagnosis on your computer and a drone drops a fix at your door. But who will listen to Ms. Smith?”

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Readers Write: Steady Sailing for the Future of Value-based Care

Steady Sailing for the Future of Value-based Care
By Joe Guerriero

Changes are coming for healthcare reform—that is a certainty under President-elect Trump’s incoming administration. However, while some aspects of current legislation may be in question, the future of value-based care remains secure.

The reality is that the accountable care movement has experienced notable growth, and demand for value-based care is not going away. Consider recent statistics published by CMS. The number of ACOs participating in the Medicare Shared Savings Program (MSSP) grew from 200 in 2013 to 432 in 2016, now representing nearly 7.8 million beneficiaries. More importantly, early indicators reveal that value-based models work. Average quality measures by MSSP program participants improved by more than 15 percent between 2014 and 2015, and 31 percent generated savings above their minimum rate in 2015.

For many industry stakeholders, the big questions are: “Will the ACA be repealed?” and “How will changes impact current value-based care models?” By all accounts, eliminating every piece of the legislation is unlikely, and the more probable scenario involves keeping what is popular with voters as well as the most effective measures, and tossing the rest.

To date, President-elect Trump has consistently advocated price transparency and greater consumer empowerment in healthcare. As such, cost management and clinical outcomes are expected to remain a focal point of his administration. That means providers must continue preparing for the future of value-based care by leveraging evidence-based tools that deliver the most effective, cost-efficient clinical guidance.

What to Expect Going Forward

While no crystal ball exists that will foretell the future of value-based care, the Trump administration’s agenda will likely pursue a less-regulated approach to alternative payment models. In addition, Trump’s previous policy statements and the cabinet he is assembling suggest that bundled payment expansion and Medicaid reform may take precedence over MSSPs and ACOs. Meanwhile, providers can expect increased scrutiny of the Center for Medicare and Medicaid Innovation, the arm of CMS that is responsible for assessing the viability of innovative payment and care delivery models. Current political and industry criticism of the program could lead to congressional pursuit of more control, and many insiders expect at least some changes that increase oversight of payment reform decisions.

While the face of value-based care models may change, industry stakeholders — including the American Academy of Family Physicians — consistently assert that implementation of MACRA will continue. Now in effect, MACRA was not only overwhelmingly supported by Congress to address needed payment reform, but also ups the ante on participation in risk-bearing arrangements.

In truth, questions regarding how the new administration will view penalties versus incentives for quality performance are important to consider. While previous programs financially incentivized participation in quality reporting, MACRA is designed to penalize those slow to join the value-based movement. If this trend continues, the stakes for performance improvement will become increasingly heightened. To prepare, providers need to equip themselves with tools to support the efficient delivery of high-quality care. Evidence-based decision support platforms, for example, can help them design the most effective treatment plans in less time. In turn, they can avoid unnecessary care and hospitalizations that increase costs and reduce payment under MACRA and other value-based reimbursement models.

Advancing Evidence-Based Practice

The costly impact of unnecessary care and care variations is well documented, with some estimates pointing to between $158 billion and $226 billion in overtreatment alone, according to a Health Affairs 2012 Health Policy Brief. Recognizing this variation is critical. Providers are increasingly acknowledging the importance of reliable, evidence-based clinical decision support tools in reducing needless variation and increasing care standardization. These tools exist to help physicians and multi-disciplinary clinical teams more accurately and efficiently assess patients and target the most appropriate and effective interventions. Furthermore, clinically validated guidelines help physicians and patients set realistic recovery expectations, building stronger provider-patient partnerships and better overall patient engagement. The result is a faster and more cost-effective return to health.

When shared across the care continuum, point-of-care, evidence-based guidelines empower better care coordination by keeping clinical teams on the same page. Physicians have access to the same clinically validated treatment plans and can review recovery expectations, benchmark progress, and make needed adjustments. Ultimately, care delivery becomes more effective and efficient— the overriding goal of value-based care.

Value-based Care is Here to Stay

There is much hanging in the balance for the healthcare industry as 2017 ushers in a new president, administration, and Congress. In the face of uncertainty, providers can bank on two projections – changes are coming to the ACA and value-based care is here to stay. Thus, the logical response is to stay aware of evolving policy changes and continue preparations for value-based care — especially MACRA. Forward-looking providers are already on this path, recognizing the importance of standardized care and implementing the best evidence-based decision support tools at the point-of-care to guide providers toward higher-quality, cost-effective clinical decisions.

Joe Guerriero is senior vice president of Reed Group’s MDGuidelines in Westminster, CO.

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Readers Write: How Will MACRA Impact Physician Compliance in 2017?

How Will MACRA Impact Physician Compliance in 2017?
By Michael Nusimow

Up until now, providers and practice groups have been worrying about Meaningful Use and using their own certified EHR technology to avoid payment penalties, earn incentives, and increase practice efficiency. With the release of the final MACRA rule, physicians now have two options for payment paths: Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). MIPS is the consolidation of many different programs and regulations in an effort to simplify reporting and achieve goals that include better health outcomes for patients. Programs that will roll up into MIPS include the Physician Quality Reporting System (PQRS), Value-Based Payment Modifier (VBM), and MU, along with the new requirements of showing clinical practice improvement activities.

APMs is the alternative, in which providers can reach out to the AMA and their board specialties to help determine the best way to structure their care to meet the requirements. Following the APM path exempts a provider from the MIPS pathway.

More Background on MIPS

Providers should be aware that PQRS does and will eventually tie into MIPS. CMS will look at some specific key clinical practice activities. These will be the "measures" and/or key performance indicators that providers need to think about during the transition. Clinical practice improvement activities includes processes such as:

• Expanding access to your practice.
• Coordinating care, such as with phone and digital communications.
• Engaging with patients in active care plan participation and shared decision-making.
• Prioritizing patient safety.

Key Dates to Keep in Mind

MACRA went into effect on January 1 (the start of the reporting year) and continues through December 31, 2026, replacing the Sustainable Growth Rate Formula. In 2018, physicians can potentially expect another transition year of reporting and, in 2019, benchmarks and reporting will start to substantially affect reimbursements.

Does This Apply to Physicians?

Prior to 2017, you had to figure out what you qualified for and were required to report based on your specialty, practice setup, and volume of claims made to CMS. For 2017, a low-volume threshold has been set at less than or equal to $30,000 of claims to Medicare Part B and / or less than 100 Medicare patients. Passing over either of these thresholds will qualify you for 2017 reporting.

CMS, in addition to the threshold, has considered the risk to solo and small group practices in making a new reporting group called “virtual group” to allow them to report together. This option is not available for 2017; more information is expected in the future. For practices that are in rural, need-based areas or that are 15 or more providers in a group, additional resources may be available.

How can Physicians Start to Prepare?

A few important points to keep in mind:

• Don’t bury your head in the sand – start communicating with your professional associations to compare and determine how other providers are preparing and how your practice – based on specialty and size – will be affected.
• Be sure to stay tuned to regular updates from CMS and your EHR vendor.
• Providers might be able to opt out of attesting data in 2017, but will receive negative adjustments in 2019. Special assistance and accommodations will be made available to providers in rural settings and larger practice groups.
• Providers can choose between a 90-day and full-year reporting period. Note that most choices of reporting weight bonuses and penalties. MIPS is a program that will work to encourage providers to adopt quickly and with few loopholes or delays.
• PQRS data will be published and used as benchmarks for 2017.
• Providers will not be evaluated on cost or resource use during the first year. Providers are encouraged to track this to help them determine the progress, baseline, and areas of improvement.
• Work closely with your EHR vendor to ensure you understand how to use the product effectively and efficiently – reporting information is only beneficial when it is calculated correctly.
• Even if your EHR is not calculating or ready to start calculating for MACRA in the beginning of 2017, using your EHR correctly will be vital to ensure calculations are useable at a later date.

Common mistakes for larger practices to avoid include:

• Sharing logins: This is not just a HIPAA violation. It will also cause inaccurate credit and penalties to be applied to patient charts and provider calculations. Individuals at the practice should have their own login.
• Starting/signing charts: If your EHR allows charts to be started by one provider and signed off on by another, it is important to understand how that EHR is applying credit and that the appropriate providers are participating as their scope allows.
• Staying up-to-date: Larger practices that fall behind play a constant game of catch up that make it difficult to record all of the necessary information to increase earning potential. Entering backdated information runs the risk of the EHR not calculating information correctly or it being entered inaccurately.

Final Thoughts

MACRA and MIPS will change the dynamic of many compliance measures, but promises to simplify all recent measures in healthcare to create a value-based healthcare model. Updates on the guidelines will continue to be published from CMS. Make sure you continue to look out for any future updates.

Michael Nusimow is CEO and co-founder of Drchrono in Mountain View, CA.

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