From the Consultant’s Corner 6/6/17

Leverage MACRA to Support Long-Term Strategic Goals

MACRA is largely understood throughout the healthcare industry, and the majority of provider organizations are in the process of implementing their go-forward strategies. With 2017 being a transitional year, it is an essential time for healthcare organizations to think of the bigger picture and develop a long-term roadmap for 2018 and beyond.

A truly strategic approach to MACRA leverages the program to reinforce the broader goals of an organization. For example, the Clinical Practice Improvement Activities (CPIA) category details over 90 activities that can not only be used to determine your MIPS Composite Performance Score, but more importantly, support the strategic objectives of your practice. Many of these activities are likely on your project wish list.

CPIA is the area in which there is greater flexibility to utilize the MACRA program to drive operational and cultural changes. Although CPIA will only account for 15 percent of the overall MACRA score in the first year, these activities provide real opportunity to differentiate and grow your practice. For example, Expanding Patient Access is a priority for most organizations. These activities benefit the patient, but also increase practice revenues and resource productivity.

Within the nine CPIA categories, there are over 90 activities an organization can utilize, each earning a “high” or “medium” weight. The nine categories include:

• Expanded patient access.
• Population management.
• Care coordination.
• Behavioral and mental health.
• Beneficiary engagement.
• Achieving health equity.
• Emergency preparedness and response.
• Patient safety and practice assessment.
• Participation in an APM.

An example of a CPIA activity within the Expanded Patient Access category is the use of telehealth, which is rapidly gaining popularity. While today’s reimbursement landscape regarding telehealth poses some ROI challenges from an investment perspective, it is a major patient satisfier and it also provides an organization with a real learning opportunity.

Within the Care Coordination category, CMS’ Transforming Clinical Practice initiatives are highly-weighted initiatives that also support other MIPS categories, such as quality. These are additional examples of how to strategically identify performance improvement activities to support the betterment of the practice – not just MACRA compliance.

How can an organization be sure which CPIA activities are right for them? The best approach is to identify which activities are aligned with the strategic goals of the organization. Every organization faces limited resources and competing priorities, so select activities that will achieve a strategic purpose. Also, many organizations are likely pursuing many of the CPIA activities independent of MACRA. Continuing these initiatives will not require a re-allocation of funding.

Healthcare providers have been inundated with federal regulations over the past several years (Meaningful Use, PQRS, value-based care, etc.). Selecting CPIA activities that are aligned with the strategic goals of your practice is an optimal approach that helps minimize the operational and financial burden of MACRA.

Brad Boyd is president of Culbert Healthcare Solutions in Woburn, MA.

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News 6/5/17

Top News

Recruiting firm Merritt Hawkins publishes its annual Physicians Incentive Review, a comprehensive look at the most requested search assignments and corresponding salary ranges amongst various healthcare facilities, and the underlying industry trends driving such demand. Family medicine and psychiatrists top the list of this year’s most requested assignments, reflecting a nationwide dearth of practitioners in primary and mental health care. Given their rare commodity status, PCPs have seen an upswing in salary, reaching $240,000 so far this year. Placements in solo practice settings have understandably all but dried up (from 22 percent in 2001 to 1 percent in 2017) as burdensome regulatory programs, declining reimbursements, and physician burnout continue to propel MDs into retirement, direct or concierge care, or employment. The report suggests that over 90 percent of physicians looking for new gigs will go the employment route, versus 40 percent in 2001.

Webinars

June 22 (Thursday) 1:00 ET. “Social Determinants of Health.” Sponsored by Philips Wellcentive. Presenter: David Nash, MD, MBA, dean, Jefferson College of Population Health. One of the nation’s foremost experts on social determinants of health will explain the importance of these factors and how to make the best use of them.

June 29 (Thursday) 2:00 ET. “Be the First to See New Data on Why Patients Switch Healthcare Providers.” Sponsored by Solutionreach. As patients pay more for their care and have access to more data about cost and quality, their expectations for healthcare are changing. And as their expectations change, they are more likely to switch providers to get them met. In this free webinar, we’ll look at this new data on why patients switch and what makes them stay. Be one of the first to see the latest data on why patients leave and what you can do about it.

July 11 (Tuesday) 1:00 ET.  “Your Data Migration Questions Answered: Ask the Expert Q&A Panel.” Sponsored by Galen Healthcare Solutions. Presenters: Julia Snapp, manager of professional services, Galen Healthcare Solutions; Tyler Suacci, principal technical consultant, Galen Healthcare Solutions. This webcast will give attendees who are considering or in the process of replacing and/or transitioning EHRs the ability to ask questions of our experts. Our moderators have extensive experience in data migration efforts, having supported over 250+ projects, and migration of 40MM+ patient records and 7K+ providers. They will be available to answer questions surrounding changes in workflows, items to consider when migrating data, knowing what to migrate vs. archive, etc.

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

Announcements and Implementations

Meridian Medical Management adds robotic process automation to its Revenue Acceleration Program to speed up billing processes and eliminate human error.

Georgia Health Connect and Matthews, NC-based Tangible Solutions will work together to help physicians in rural areas of “The Peach State” connect to regional HIEs and adopt health IT, including billing and patient scheduling software.

Surescripts offers complimentary Web-based access to its CompletEPA electronic prior authorization tool to physicians who have not yet incorporated it into their EHR.

People

Stratus Video hires Ryan Barry (CareCloud) and Jim Brown (Eliza Corp.) as vice presidents of sales for its Telehealth Division.

Telemedicine

The Clarke County School District in Athens, GA will install its first telemedicine clinic at a local elementary school in August. Medicaid payer Amerigroup has agreed to donate the necessary equipment, while nearby Athens Regional Medical Center will help to recruit pediatricians. The state of Georgia has several similar clinics in more rural parts of the state where there is a lack of physicians. While Clarke County doesn’t technically fit into that category, many children within the school district are from low-income families who face the same healthcare access issues as their more southern peers.

Government and Politics

Based on historical Medicare Part B claims data, CMS predicts that nearly 100 percent of eligible clinicians in Advanced APMs with data currently available will achieve Qualifying APM Participant status this performance year.

Research and Innovation

California-based startup Mindcotine launches a Kickstarter campaign to fund development of a virtual reality app that will help smokers kick the habit. The app offers users guided mediation and calming images before putting them into a simulated smoking experience. The app will also a virtual support group.

Other

Family physician and incoming AMA President David Barbe, MD outlines several key focus areas of his upcoming tenure, including advocating for more affordable healthcare and the sustainability of Medicaid; combatting opioid abuse via a three-pronged approach that includes physician education, reducing patient stigma, and devoting more money to medication assistance treatment programs; and helping physicians prevent or cope with burnout. He will take the helm from outgoing president Andrew Gurman, MD at the association’s annual meeting next week in Chicago.

Sponsor Updates

• Inc. Magazine includes Nordic in its list of “Best Workplaces 2017.”
• Versus Technology will host an open house at its new Bayside Education & Visitor Center June 7 in Traverse City, MI.

Blog Posts

• The important role nurses play in care transition and reducing readmissions (PerfectServe)

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Jenn, Mr. H, Lorre

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Population Health Management Weekly Wrap Up 6/4/17

Gary Janko (Pain Solutions Management Group) joins Senscio Systems, developer of the Ibis digital therapeutics tool, as COO.

I2I Population Health hires Daniel Bullington (DaVita) as CTO.

The Stanford Center for Population Health Sciences awards $275,000 in grants to 11 pilot projects, many of which aim to look at health beyond the four walls of a doctor’s office. SDOH-related projects include improving food insecurity screenings in a community clinic population, mapping autism and gaps in autism services, and improving school readiness through pediatrics and education.

Siemens Healthineers finalizes its acquisition of Medicalis, first announced in April. Siemens has added the San Francisco-based company’s clinical decision support, imaging workflow, and referral management technologies into its population health management line.

Anthem Blue Cross announces that its Vivity hospital alliance will implement a homegrown population health management tool to help the seven facilities better coordinate care. The Vivity Provider Care Management Solution includes clinical and claims data aggregation and analytics.

Crain’s looks at the evolving ways in which health systems are incorporating population health management leadership into value-based care transition efforts. Kristene Grayem, the new VP of population health management at Akron Children’s Hospital (OH), is still working to develop her team and define its goals. Cleveland Clinic (OH) isn’t far behind: Chief Clinical Transformation Officer Michael Modic, MD is in the process of developing an office around its population health management efforts, and hopes to have leadership in place within the next several months. “From an organizational perspective,” he explains, “we’ve spent a considerable amount of time developing the rationale and the research necessary to help the organization understand that we need to build out a formal population management business.”

Sponsor Updates

• EClinicalWorks will exhibit at the California Primary Care Association Region IX Clinical Excellence Conference June 4-6 in Lahaina, HI.
• Aprima wins Frost & Sullivan’s product leadership award for its RCM platform.

Blog Posts

• Arkansas: Concerns and opportunities (EClinicalWorks)

HIStalk Practice sponsors listed in the Healthcare Informatics 100 highest-revenue healthcare IT companies:

• EClinicalWorks (#34)
• GE Healthcare (#12)
• Nordic (#59)

Contacts

Jenn, Mr. H, Lorre

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News 6/1/17

Top News

HealthTap opens its first office in New Zealand to better serve the local Waikato District Health Board and its digital SmartHealth initiative, which launched last year with HealthTap’s virtual care technology to better connect patients with local healthcare providers. The Palo Alto, CA-based company will also use the new location to sell regional employers on its HealthTap Compass product, a virtual consult package that also includes reminders, tips, and health management tools.

Anita Hogan (Hewlett Packard Enterprise) will head up the Asia-Pacific hub.

Webinars

June 22 (Thursday) 1:00 ET. “Social Determinants of Health.” Sponsored by Philips Wellcentive. Presenter: David Nash, MD, MBA, dean, Jefferson College of Population Health. One of the nation’s foremost experts on social determinants of health will explain the importance of these factors and how to make the best use of them.

June 29 (Thursday) 2:00 ET. “Be the First to See New Data on Why Patients Switch Healthcare Providers.” Sponsored by Solutionreach. As patients pay more for their care and have access to more data about cost and quality, their expectations for healthcare are changing. And as their expectations change, they are more likely to switch providers to get them met. In this free webinar, we’ll look at this new data on why patients switch and what makes them stay. Be one of the first to see the latest data on why patients leave and what you can do about it.

July 11 (Tuesday) 1:00 ET.  “Your Data Migration Questions Answered: Ask the Expert Q&A Panel.” Sponsored by Galen Healthcare Solutions. Presenters: Julia Snapp, manager of professional services, Galen Healthcare Solutions; Tyler Suacci, principal technical consultant, Galen Healthcare Solutions. This webcast will give attendees who are considering or in the process of replacing and/or transitioning EHRs the ability to ask questions of our experts. Our moderators have extensive experience in data migration efforts, having supported over 250+ projects, and migration of 40MM+ patient records and 7K+ providers. They will be available to answer questions surrounding changes in workflows, items to consider when migrating data, knowing what to migrate vs. archive, etc.

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

Announcements and Implementations

Internist Mehnaz Haq, MD (NJ) goes live on MTBC’s cloud-based, voice-enabled TalkSoft EHR. The company brought in Amazing Charts founder Jonathan Bertman, MD in April to lead development and launch of the new technology.

SRS Health adds OBERD’s patient-reported outcomes management capabilities to its data-collection platform.

Presagia Sports will integrate Privit’s physical evaluation and health history registration software with its EHR for athletes, trainers, and sports medicine professionals.

Acquisitions, Funding, Business, and Stock

Heal begins offering its app-powered house calls in Washington, DC and parts of Northern Virginia. The company, which got its start in California, has hired Kari Scantlebury, MD (Inova Fairfax Hospital) as its first East Coast medical director.

Encoda will use an undisclosed amount of funding from Clearwell Group to expand its billing and analytics business. The Tampa, FL-based business plans to grow its sales and marketing team, focus on new product development, and look for acquisition opportunities. Its last purchase was in 2015, when it acquired Carrollton, GA-based Strategic Management Consultants.

Research and Innovation

I would if I could: A Fitbit study finds that seven-plus hours of sleep each night is best for health; fewer hours result in negative impacts to short-term memory, cell regeneration, and mood stability. The wearables company analyzed millions of hours of sleep data from several of its devices to determine that magic number. Results of the study are comparable to those achieved in a sleep clinic, leading head researcher Conor Heneghan to boldly pound the first nail into the sleep clinic coffin: “Fitbit has transformed what people can learn about their sleep habits by taking the ability to track sleep stages out of a lab and putting it on the wrist.”

Telemedicine

Mesa, AZ-based EVisit raises $2 million in a funding round led by Traeger Grills CEO Jeremy Andrus and venture capital firms Kickstart Seed Fund and Arizona Founders Fund. The company has raised $3 million since opening for business in 2013. It will use the financing to accelerate support, sales, and marketing efforts – a timely move given that the press section of its website hasn’t been updated since January 2016.

In other HealthTap news, the company takes advantage of the recent passage of telemedicine-friendly legislation to launch its subscription service in Texas.

Occupational health provider US HealthWorks selects American Well to power its new USHW CareConnectNOW telemedicine service for employers.

Other

A plastic surgeon’s office in Beverly Hills tries to pick up the pieces after a disgruntled ex-employee stole patient files, financial data, and photos of celebrity patients while in surgery, many of which she then shared via social media. Originally hired as a translator and driver for Zain Kadri, MD the former staffer convinced physicians and patients to let her sit in on surgeries, during which she surreptitiously took photos and videos. She is also thought to have been behind a break-in several weeks ago that saw all of the practice’s digital files stolen.

Contacts

Jenn, Mr. H, Lorre

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Readers Write: America’s Doctors Need a Neutral Internet

America’s Doctors Need a Neutral Internet
By Matthew Douglass

In 1984, Stewart Brand, a close friend of the founders of the Internet, famously said, “Information wants to be free. Information also wants to be expensive.” Three years ago, I detailed why classifying the Internet under Title II of the Communications Act was so important to preventing Internet services and accompanying information from becoming expensive for Internet consumers and businesses. An active public debate occurred that year, with a record 3,700,000 public comments submitted to the FCC, including the views of hundreds of top investors, leading technology companies, churches, and civil society groups.

After much public debate and consideration, the FCC in 2015 voted to regulate broadband Internet service as a public utility in an effort to “protect innovators and consumers” and reassert the Internet’s “core of free expression and democratic principles.” Cable and telecommunications companies are now explicitly restricted from discriminating among website providers and content, or treating them in a different manner. Today, the Internet thrives as it has since its invention: There are no fast lanes or slow lanes, and no company’s Web traffic can receive preferential treatment or prioritization.

Just two years after that rulemaking by the FCC, Ajit Pai, the new head of the FCC, has now proposed repealing that critical decision. Changing these existing rules could allow Internet service providers to charge different prices to consumers and businesses based on the influence of the company transmitting data or the type of information being transmitted.

As was successfully argued a few years ago, differently priced lanes on the Internet would primarily benefit incumbent Internet applications and be particularly burdensome for Internet consumers and small businesses fighting to compete with larger, entrenched companies.

The Health IT Connection

Medical practices in the US are becoming increasingly reliant on EHRs to run their businesses and treat patients. The future of EHRs is in the cloud, especially for independent physicians who are particularly sensitive to technology costs for their lean, small businesses. The last thing that independent physicians need is to have to bear additional costs to their business on top of what they already spend on critical medical technology.

Imagine if there were more expensive lanes on the Internet that promised faster speeds. By definition, the less expensive lanes would be slower. Since healthcare applications are now mission-critical for doctors to be able to treat their patients, customers of ISPs that introduce tiered pricing would be forced to choose the faster, more expensive plans. Physicians operating their practices on a shoestring budget would be directly affected and would potentially face significant harm. At a time when the entire healthcare industry is shifting to value-based care, we should be looking at ways to ensure the financial viability of independent practices, rather than endangering their existence by imposing additional, unnecessary costs.

Another ramification of allowing ISPs to determine which traffic belongs in a fast lane is that they could preferentially speed up or slow down the services of specific companies. For instance, a digital health company owned by an ISP could be given preferential speed over the services of competitors. This situation would directly impede competition, discourage startup companies from entering the space, and reduce freedom of choice for physicians and patients. America’s doctors and patients should determine which Internet-enabled healthcare services will thrive based on better functionality, not because of delivery speeds decided by ISPs with potential conflicts of interest.

If it Ain’t Broke, Don’t Increase the Cost

The Internet Association and its member companies, including mine, has reasserted its support of the existing FCC regulation of the Internet: “The [I]nternet industry is uniform in its belief that net neutrality preserves the consumer experience, competition, and innovation online. In other words, existing net neutrality rules should be enforced and kept intact.”

Doctors need new, innovative technologies and freedom from the burden of new, unnecessary costs to be able to do their jobs well in our rapidly evolving, 21st century information economy. The last thing they need is the heavier burden of additional costs required to run technology that is essential for patient care. A neutral Internet without fast or slow lanes is crucial for the US to maintain the innovative and entrepreneurial engine that has driven our powerful information-driven economy for decades.

When medical students begin studying for careers as physicians, they pledge to “first, do no harm.” The FCC would be wise to take a similar approach to net neutrality as it stands today: “If it ain’t broke, don’t fix it.”

Matthew Douglass is co-founder and SVP of customer experience at Practice Fusion in San Francisco.

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Jenn, Mr. H, Lorre

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