News 1/3/17

Top News

Several trade associations quickly weigh in on the Senate’s introduction of a timeline to repeal the ACA. MGMA President and CEO Halee Fisher-Wright, MD assures incoming lawmakers that the association will work with them if the resolution introduced by Senator Mike Enzi (R-WY) comes to pass. “Many elements of the ACA can be amended and improved with an infusion of new ideas,” she writes in what I assume is an unsolicited statement to President-elect Trump. “As Congress considers legislation that impacts the policies or financial underpinnings of the ACA, it should – above all – minimize disruptions to the nation’s healthcare delivery and payment system during any transition.” Minimizing disruptions is all fine and dandy, but I believe ensuring quality (and dare I add affordable?) patient care should be a Congressional priority – above all.

Not to be left out, AMA President James Madara, MD also penned a missive to congressional leaders stressing the need to clearly outline any steps being considered as part of an ACA overhaul, especially policies related to healthcare coverage. He stresses that, “Patients and other stakeholders should be able to clearly compare current policy to new proposals so they can make informed decisions about whether it represents a step forward in the ongoing process of health reform.”

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

India-based RCM vendor ITech Workshop adds patient appointment scheduling capabilities to its billing and PM software.

Cytta upgrades its remote patient monitoring technology to operate on the Oracle Cloud via the company’s VeriSmartPhone technology.

Acquisitions, Funding, Business, and Stock

Charlotte, NC-based startup Tesser Health secures $470,000 in seed funding from a group of investors led by Cofounders Capital. The seven-employee company, which will use the cash to build out its sales team and move into new office space, has developed software that helps employee benefit companies identify cheaper prescription drug options. I’m especially interested in news related to prescription drug pricing thanks to a recent virtual consult that ended up with my MD prescribing $200-plus ear drops that had no generic version available. On the advice of my pharmacist, who also tried to help me find online manufacturer coupons for the drug, I called back to request a different, cheaper medication. The NP who facilitated the second, far less expensive prescription half-jokingly told me that doctors “sometimes have to be nudged” into prescribing generics.

People

Staffing company Supplemental Health Care hires Mary Lucas (Staffmark) as chief talent officer and Donna Carroll (North Highland) as chief sales officer. The Park City, UT-based firm has promoted Missy Blankenship to president of local offices; Monty Houdeshell to chief financial and administrative officer; and Chris Long and Linda McDonnell to SVP of nurse operations and travel nursing sales, respectively.

Telemedicine

EarlySense adds American Well virtual consult access to its wireless home-monitoring technology, which includes the new Live under-the-bed sensor that monitors and analyzes heart, respiratory cycles, stress, and sleep indicators.

New York-based payer MVP Health Care begins offering telemedicine services (including mental health consults) from American Well to its members in New York and Vermont this week. Chief Executive Denise Gonick believes the nonprofit is the only health plan that offers virtual visits to Medicaid beneficiaries.

Research and Innovation

A new survey from payer-focused health data company Healthmine highlights the ongoing disconnect between the plethora of digital health tools available to consumers and their ability to incorporate them into health and wellness programs. Of the 2,500 health plan members surveyed, 75 percent are willing to share health data collected via apps but only 32 percent report this happens automatically. Though 60 percent of consumers access their EHRs to stay informed, just 22 percent use that digital data to make healthcare decisions – a stat that belies the need for more discussion between physician and patient on the role, if any, such tools can play within a particular practice. Most surprising to me is the fact that 39 percent of those surveyed – all users of digital health tools – have never heard of telemedicine. Perhaps I have lived in my health IT bubble for too long …

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Readers Write: Five Predictions for Virtual Care in 2017

Five Predictions for Virtual Care in 2017
By Ralph Derrickson

The New Year is upon us, as is a soon-to-be new administration, a move from fee-for-service to fee-for-value, and increased patient interest in healthcare convenience – all of which could make 2017 a very interesting year for the healthcare industry. What exactly can we expect? There are few certainties, but we have enough information, looking at existing trends, to make some predictions for the coming year.

Consumers Assume Greater Costs and Greater Responsibility

There is little doubt that health plans will become more expensive for patients, as they are asked to take on higher deductibles, accelerating the consumerization of healthcare. Assuming ever greater responsibility for their own healthcare, consumers will seek additional care options and compare related costs. More consumers are becoming increasingly active in their education and healthcare decision-making. It’s essential that physicians prepare for this changing landscape by providing support for cost-conscious patients including strategic pricing options, convenience, and ease of access.

A recent American Telemedicine Association survey of active healthcare consumers revealed that convenience remains the top motivator behind their demand for telehealth services. I predict that greater telemedicine access in 2017 will shift patient thinking to recognizing telemedicine as a cost-conscious option – not just one of convenience.

Value-based Care Will Shape Virtual Care

This year will be the first in a giant shift to value-based payment models through MACRA, which will in turn highlight the need for cost-effective measures focused on quality metrics. At the same time, MACRA will drive physicians to look for solutions to expand practice access. MACRA encourages physicians to focus on the whole patient, providing new guidance on health records tracking and improving population health management. MACRA will also mean pushing the envelope on innovation and new care delivery models. In this new value-based care landscape, integrated telemedicine will offer a new care delivery model that addresses access issues. Configurable EHR integration and population health management will make telemedicine a natural and agile response to MACRA requirements.

Retail Clinics Create Stiffer Competition and Greater Fragmentation

Physicians will face greater competition as more retail and non-health system organizations look to attract patients through direct-to-consumer advertising. A consumer walking into a familiar pharmacy will bring routine retail habits to their interaction with affiliated clinics. This will make them likely to use a convenient option operating in affiliation with a comfortable retail brand, without thought of how that option impacts their larger relationship with their physician.

The retail clinic market will continue to make services even more convenient for consumers, leading to greater competition in local markets; but it will also lead to greater care fragmentation. To compete, physicians will need to adopt and promote integrated telemedicine services that provide 24-7, on-demand access. Digital marketing, value differentiation, and healthcare brand affinity will be increasingly important as physicians compete to keep current patients and attract new patients looking for greater ease of access.

New Legislation Drives Increased Telehealth Reimbursement

The number of states with telemedicine-reimbursing parity laws has almost doubled in the last three years, reflecting legislative understanding of the coverage barrier to telemedicine. With many state medical boards across the country enacting or considering increased requirements for virtual care, legislation on virtual care reimbursement will become more commonplace. As new rules and legislation are considered, telemedicine providers must work with state medical boards to ensure that patients receive the highest quality of care.

Greater Employer-based Health Plan Coverage for Telemedicine

In 2017, the National Business Group on Health estimates that 90 percent of employers will make telemedicine services available to employees in states that allow it. This is a significant increase over the 70 percent of employers who currently offer virtual care to their employees. This is further evidence that employers are ready to throw their weight behind patient preference for convenient healthcare options. Employers realize virtual care is central to meeting this demand while improving outcomes, managing costs, and minimizing the wait time burden of in-person visits.

I expect that increased health plan coverage for telemedicine in 2017 will increase national rates of telemedicine utilization as more patients gain access. I also foresee greater demand for virtual-care training for providers who are entering the digital clinic space.

At the end of 2017, we can be certain that innovation in healthcare will be driven by the needs of patients, that care quality will always be paramount to technology – virtual or otherwise, and that, like its predecessor, the year will be one of continued changes in healthcare.

Ralph C. Derrickson is president and CEO of Carena in Seattle.

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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. 

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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.

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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.

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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.”

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