Readers Write: Survey Says – Independence Trumps Hospital Employment

Survey Says: Independence Trumps Hospital Employment
By Lea Chatham

There has probably never been as much uncertainty about the future of healthcare as there is right now. On the heels of the release of the MACRA final rule came the unexpected results of the presidential election. The President-elect has made it clear that he will make changes to the Affordable Care Act, which has been the law of the land for nearly eight years. And MACRA solidifies the industry shift away from fee-for-service to value-based care.

It might seem like with all these challenges, independent physicians would be looking to shift to employment, but the opposite seems to be true. There actually appears to be a slowdown in employment as physicians look for ways to stay in independent practices.

According to the AMA, only 33 percent of physicians currently work in hospitals or hospital-owned practices. The other 67 percent are in private practice, with 60 percent in practices of 10 physicians or less. Half of the physicians in private practices are owners or co-owners of the practice. While that means the other 50 percent are employed, they are working in private, independent practices, and they do find that more satisfying than hospital employment. A recent survey from MedData Group showed that 80 percent of physician owners and 61 percent of employed physicians strongly or somewhat agree that private practices offer satisfying career opportunities.

That same study also showed that 20 percent of employed physicians are considering owning their own practice in the future. This makes a lot of sense when you consider that self-employed doctors have higher satisfaction then employed doctors, according to Medscape. The same survey also showed that 71 percent of doctors said their work satisfaction improved when they left employment.

And it turns out that the physicians who are already owners or co-owners are loathe to sell out or close. Seventy-three percent of practice owners said they would prefer not to sell their practice. Seventy-two percent of practice owners said they envision a significant number of physicians who have been employed returning to independent practice.

“We have seen this trend firsthand,” says Kareo CMIO Tom Giannulli, MD. “In 2015, 15 percent of our new customers were starting new independent practices, and that has remained steady.” He adds that a recent survey of customers about MACRA showed that 85 percent are planning to participate to the best of their ability and only 2 percent are planning to speed up retirement or close or sell their practice. “What this tells me is that they are willing to tackle the challenges to stay in private practice,” he explains.

Giannulli has also been watching a growing trend of independent practices testing alternate payment models, which he attributes to their ability to be more agile and flexible in the way they practice. The 2016 Practice Models Perspectives survey, sponsored by the American Academy of Private Physicians, showed that 25 percent of physicians are already using some form of concierge, direct pay, or membership model in their practice; and another 35 percent are interested in trying something like that as well. The most striking finding of the survey was that most practices testing these models are not making a complete change. Only 30 percent are using a direct pay or membership model with all of their patients. The majority are using these models with only a portion of their patient population.

“They are trying out these options to see how they work and if they help reduce health plan and government program challenges,” says Giannulli. “The survey also showed these practices were more likely to be trying telemedicine and looking to potentially increase virtual visits.”

The nature of smaller independent practices makes it easier to try new payment models, test out new technologies, and either keep moving if it works or try something else if it doesn’t. Considering this and looking at all the latest trends, we may actually begin to see the slowdown turn into a reversal with more physicians choosing independent, private practices over hospital employment in the coming years.

Lea Chatham is an editor at Kareo in Irvine, CA. 

Contacts

Jenn, Mr. H, Lorre

More news: HIStalk, HIStalk Connect.

Get HIStalk Practice updates.
Contact us online.
Become a sponsor.

News 1/2/17

Top News

Walgreens Boots Alliance subsidiary Duane Reade closes its 11 clinics in New York City amidst “scattered closures” in other cities. While the number isn’t exorbitant, it’s a move that makes me wonder if the market has finally reached full walk-in clinic saturation. Walgreens already operates a national chain of 400 Healthcare Clinics within its eponymous retail pharmacies, and has made headlines recently through its clinic partnerships with local health systems. By comparison, CVS operates 800 MinuteClinics within its stores. Accenture predicts 3,000 will be in operation by the close of 2017.

HIStalk Practice Announcements and Requests

Thanks to the following companies that recently supported HIStalk Practice. Click a logo for more information.

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

Ezderm adds MIPS-qualified registry reporting resources from Healthmonix to its EHR and PM software.

Acquisitions, Funding, Business, and Stock

Automotive News profiles a new concept clinic built for employees of auto supplier and diesel-engine manufacturer Cummins. The LiveWell Center, which is run by healthcare management company Premise Health, offers up front pricing for traditional primary care plus chiropractic care and cooking classes. Its 46 employees – many who have come from private practice – are enjoying the move away from fee-for-service. “In private practice, it’s a diagnostic approach,” says Medical Director Jill Beavins, MD. “The tools we had in our toolbox were much more limited. When you’re in a high-volume private practice, it’s hard to do justice to some of these conversations around diet and exercise in a 10-minute conversation. At the LiveWell Center, we have a lot more time.”

People

Healthcare analytics company MetiStream adds Denny Lee (Microsoft) to its advisory board.

Government and Politics

A number of states are using healthcare data in their fight to keep Medicaid expansion efforts alive ahead of potential cutbacks to the $545 billion program. Several, such as Ohio and Alaska, have created dashboards to display the positive effects of Medicaid expansion on care quality and outcomes. Avid tweeter and Acting CMS Administrator Andy Slavitt highlighted Louisiana’s encouraging statistics in an effort to highlight the state’s expansion success. 

NEPR looks at the impact a new law requiring Massachusetts providers to use HIE-friendly EHRs will have on private practices. The law’s “fully interoperable” phrasing has left some physicians scratching their heads. Massachusetts Medical Society President James Gessner, MD admits that it’s not “going to be easy at all, and it might be fairly expensive, and it might be prohibitively expensive for small practices.” Valley Medical Group President Joel Feinman, who admits he wasn’t even aware of the law before being contacted by the media outlet, echoes the time-honored frustrations of independent MDs everywhere: “There’s a gap between what the legislature thinks needs to happen and what’s actually possible in the industry in any given moment.”

Research and Innovation

Researchers at the Israel Institute of Technology develop a breathalyzer test capable of diagnosing up to 17 diseases from a single breath. Early-stage testing of the device has led to accurate disease detection nearly nine out of 10 times.

Other

The Nevada Dept. of Health and Human Services confirms that an unspecified vulnerability in a website portal for residents applying to sell medical marijuana leaked the driver’s license and social security numbers of 11,700 applicants. The portal has been taken offline while the department attempts to fix it.

Did you feel it?: Citizens of the Western hemisphere experienced the world’s 28th leap second on New Year’s Eve. (You can read about the origins of the extra second here.) Those in the Eastern Hemisphere experienced the same phenomena just after the start of 2017.

And speaking of the New Year, my ears perked up when I heard that President-elect Trump celebrated the eve at an event headlined by Party on the Moon – a HIStalkapalooza favorite for several years now. Media outlets reported that tickets to the event rang in at $500 a pop. (That’s 100-percent more than what it costs for dedicated HIStalk readers to attend our HIMSS networking party thanks to Mr. H’s faith in the generous support of our sponsors.)

This would never fly in the workaholic USA: France passes a law giving employees the right to ignore work emails sent outside of typical working hours. Applicable to companies with 50 or more employees, the “right to disconnect” ruling is the country’s attempt to stem the tide of employee burnout and improve work-life balance. Compliance is voluntary, and no penalties have yet been associated with it.

Contacts

Jenn, Mr. H, Lorre

More news: HIStalk, HIStalk Connect.

Get HIStalk Practice updates.
Contact us online.
Become a sponsor.

News 12/22/16

Top News

At the behest of Santa Claus, the American Telemedicine Association establishes a Telehealth Command Center at the North Pole. “Now that my husband spends most mornings in traction recovering from ‘excessive egg nog’ the night before, life now is about making things easier and more affordable,” explains Mrs. Claus. Fred Keebler, head of toy manufacturing, believes the access to virtual consults will especially help Santa deal with such chronic healthcare issues as obesity, sleep apnea, hypertension, and early-stage diabetes. The center’s services will be made available to the elves as an added employee benefit.

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

Sentry Data Systems offers analysis of physician compensation reporting with the launch of Provider Analytics.

The Center for Rheumatology (NY) selects EHR, PM, and cloud hosting services and support from TSI Healthcare.

Acquisitions, Funding, Business, and Stock

Alignment Healthcare launches Alignment Health Services to offer its partner companies access to the managed services company’s clinical model and population health technology. The California-based company serves over 40,000 patients through its work physician groups, hospitals, and payers in three states. The company has promoted COO Jenna Geiger to president of the new business unit, and hired Robert Lonardo (CareMore Health Plan) to take over the COO role.

Government and Politics

Perhaps taking a cue from IBM CEO Ginny Rometty, DirectTrust President and CEO David Kibbe, MD offers President-elect Trump several recommendations, including appointing a National Coordinator who exhibits strong leadership skills – “someone respected by the medical community and thoroughly versed in current and emerging healthcare technologies;” and avoiding “throwing the baby out with the bathwater” when it comes to EHR adoption and interoperability policies. “We’ve made significant progress in the areas of increased HER adoption and interoperability during the past four years,” Kibbe says. “Our hope is that the momentum established to this point will continue under the new administration.”

The HHS Office of the Inspector General highlights the need for IT systems development in an early-implementation review of Quality Payment Program management. The OIG specifically outlines the importance CMS should place on establishing individualized user accounts within the QPP portal, and the necessity of expanding the service desk. As one CMS official relates, “We understood early on that the portal was going to make or break the physician experience with the MIPS program. The way we communicate to them and how much of a hassle it is for them to communicate with us is important.” The review also stresses the need for backend testing of the new systems.

Other

‘Tis the Season: FDA Historian John Swann recounts a time when the FDA was affectionately known as the “Food, Drug, and Toy Administration,” regulating playthings akin to those sold by SNL toy salesman Irwin Mainway – flammable dolls; infant and toddler toys that posed serious puncture, laceration, and crushing risks; and the “infamous” lawn darts. Perhaps none made as much of an impression as “clacker balls,” which the FDA found in the early 70s could “rupture and spew fragments, or become wayward missiles through detachment from or fraying of the cord itself.”

Contacts

Jenn, Mr. H, Lorre

More news: HIStalk, HIStalk Connect.

Get HIStalk Practice updates.
Contact us online.
Become a sponsor.

Readers Write: Spotting a Spoofed Email in Healthcare

Spotting a Spoofed Email in Healthcare
By Matt Mellen

Over the past year, healthcare organizations of all sizes have been impacted by cyberattacks. Most of them involve malware of one sort or another. As a former security operations lead at a hospital network in the San Francisco Bay Area, I learned what my research at Palo Alto Networks has confirmed: By far, the most common way for malware to make its way into Healthcare networks is by spoofed emails.

Spoofed emails are intended to fool the recipient into clicking a link or attachment that’s actually malicious. Once clicked, malware is typically downloaded and executed on the hospital workstation. There are plenty of technical approaches to filtering out these type of emails, but none are perfect. For that reason, it’s always prudent to also take some steps to educate your staff to help prevent them from clicking on malicious links and attachments in emails.

I’ll outline a few ‘tells’ or things your staff should look for to spot spoofed emails.

Tell #1. Look for Warning Signs
Before you click a link, look for warning signs that will help you determine its legitimacy. For example, was it sent by an unknown sender? Is it unsolicited? Are there any missing or replaced characters? Is it a shortened URL? If you’ve answered “yes” to any of these questions, you may have received a phishing link.

Tell #2. Unofficial “From” Address
Look out for a sender’s email address that is similar to, but not the same as, a company’s official email address. Fraudsters often sign up for free email accounts with company names in them (such as “hospitalABC@gmail.com”). Users that don’t carefully review the sender’s email may miss the suspicious sending address.

Tell #3. Emotional Motivators
Fraudsters often prey on emotions to drive users to click on a link immediately. Emotions like fear, urgency, and curiosity are effective and frequently used. Additionally, be wary of emails containing phrases like “your account will be closed,” “your account has been compromised,” or “urgent action required.” The fraudster is taking advantage of your concern to trick you into providing confidential information.

Some examples:

1. You have a new voicemail.
2. Your mailbox is almost full.
3. You have a new e-fax.
4. We have detected a fraudulent credit card charge.
5. Your account has been locked.
6. View your invoice.
7. Your package is at the front desk.

Tell #4. Generic Content
Fraudsters often send thousands of phishing emails at one time. They could have your email address, but they usually don’t know your name. Be skeptical of emails with a generic greeting like Dear Healthcare Professional or Dear Customer.

Tell #5. Grammar and Spelling Mistakes
Fraudsters will often make spelling or grammar mistakes when creating a phishing email. If an email sounds unprofessional, this is a red flag that the email may be a fake.

Tell #6. Fake and Obfuscated Links
Phishers include links in their emails to lure you to fake sites that look like the real ones to steal your login credentials or to sites that will infect your computer with malware. To find out where a link is really taking you, always hover over the hyperlink. If the URL that is displayed is only an IP address, does not match the URL that is shown in the email content. or is long and confusing but includes a familiar term, you are likely looking at a phishing link.

For example: https://login.hospitalXYZ.com.av6shj825.com/login.htm

Next-generation security technologies can stop many threats before they even reach the user, but for those that slip through, whether or not the attack is successful depends on the behavior of the staff. If you educate your personnel on what to look for, they’ll be much less likely to make a mistake and click on that malicious link or attachment.

Matt Mellen is security architect, healthcare at Palo Alto Networks in Santa Clara, CA.

Contacts

Jenn, Mr. H, Lorre

More news: HIStalk, HIStalk Connect.

Get HIStalk Practice updates.
Contact us online.
Become a sponsor.

News 12/21/16

Top News

CMS anticipates that 171,000 physicians will see a “downward payment adjustment” (such an innocuous way to say penalty) in 2017 for not meeting Meaningful Use requirements in 2015. The cut is slightly below the 209,000 who took a penalty in 2016, and far below the 257,000 EPs – almost half of those eligible – who saw punitive penalties in 2015. As you probably already know, Medicare MDs will transition out of the MU program into MIPS beginning with reporting periods in 2017 for the 2019 payment year. Medicaid physicians will attest to their respective states for MU incentive payments.

HIStalk Practice Announcements and Requests

Listening: My absolute favorite Christmas album is the soundtrack to 1965’s “A Charlie Brown Christmas.” Fun facts: The holiday special was sponsored by The Coca-Cola Company, written in just a few weeks, and animated in six months. Both its producers and the network predicted it would flop because it didn’t have a laugh track.

I plan on posting tomorrow, provided there is enough news to warrant readers’ time. HIStalk Practice will take a break next week, returning on Monday, January 2. Wishing you a Merry MACRA in 2017!

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.

Acquisitions, Funding, Business, and Stock

New Jersey-based Allegiance Health Group’s ACO sees $2 million in savings across its 2,867 Medicare patients – a figure it attributes to population health management technology and services from HealthEC. The ACO has 43 physicians working in 28 practices. “We are a small group of providers working with patients from the inner cities of central New Jersey who still managed to achieve federal savings, reduce spending, and significantly have an impact on cost utilization,” says Allegiance ACO CEO Marc Whitman, MD adding that the PHM technology helped to alleviate back-office work so that physicians could spend more time with their patients.

Announcements and Implementations

Behavioral health agency Our Children Our Future (FL) selects EHR and PM technology from the TenEleven Group.

Telemedicine

Fort Worth, TX-based Online Doctor Visit joins what seems like an already saturated market in launching direct-to-consumer virtual consults.

Government and Politics

ONC releases an updated (and more interactive) catalog of interoperability standards and implementation specifications to help stakeholders better understand federal program requirements and utilization. “The Interoperability Standards Advisory is a key step toward achieving the goals we have outlined with our public and private sector partners in the Shared Nationwide Interoperability Roadmap, as well as the Interoperability Pledge announced earlier this year,” explains National Coordinator Vindell Washington, MD. “We incorporated detailed stakeholder feedback to provide a consolidated, public list of standards and specifications that can be put to use to address clinical, public health, and research needs for sharing electronic health information.”

HHS releases details on the Track 1+ ACO model announced as part of the final MACRA rule. In an effort to encourage more small practices to participate, the new track will offer more limited downside risk than Tracks 2 or 3 – a move the department attributes to physician practice feedback. It expects 70,000 clinicians to qualify for Advanced Alternative Payment Model incentive payments in 2018. Those working in the trenches are slightly less confident.

Research and Innovation

Walgreens will tap into Chicago-based incubator Matter’s network of entrepreneurs as it looks to stay on top of innovations in healthcare and pharmacy. The retail clinic and pharmacy chain, which announced this week that it will become the exclusive retail pharmacy provider for the University of Miami Health System and is in the midst of acquiring Rite-Aid for $9.4 billion, will lend its mentoring capabilities and development expertise to Matter’s 150-plus startups. (Perhaps it will share lessons learned from its ties with Theranos, which has resulted in a $140 million lawsuit.) Both organizations are founding members of the new business development-focused Healthcare Council of Chicago.

Other

The local news highlights a new pilot program in New Jersey that provides state employees with free direct primary care through managed primary care company R-Health. Physicians in the three-year pilot will be limited to 1,000 patients and receive a per-member fee per month, as well as incentives based on clinical outcomes and patient satisfaction.

Spoiler Alert: Slate takes a humorous look at the lax cybersecurity practices of the Empire in the new Star Wars film Rogue One. New America’s Open Technology Institute Director Kevin Bankston astutely observes that “best practices dictate that you should at least wait until you’ve ‘been able to conduct a meaningful forensic examination’ before testing out your planet-killing super weapon,” adding, “It seems like the guys who developed digital security for the Empire are the same guys who developed that completely useless storm trooper armor.”

Sponsor Updates

PerfectServe employees are supporting charitable programs that include donating duffel bags packed with personal items for adolescents completing treatment services; providing financial support to a co-worker who lost belongings in an apartment fire; collecting food and supplies for families affected by the Gatlinburg, TN fires; and collecting food for the Chicago food bank.

Blog Posts

• Access to Care … or Lack Thereof (Culbert Healthcare Solutions)
• A Capital Investment Before Year-end Can Save You Big Bucks in 2016 (E-MDs)

Contacts

Jenn, Mr. H, Lorre

More news: HIStalk, HIStalk Connect.

Get HIStalk Practice updates.
Contact us online.
Become a sponsor.