5 Questions with John Brickley, VP, Ambulatory Operations & Network Development, MedStar National Rehabilitation Network

John Brickley is vice president of ambulatory operations and network development at Washington, DC-based MedStar National Rehabilitation Network, which includes one hospital and 50 outpatient facilities in DC, Maryland, Northern Virginia, and Delaware. As part of the larger MedStar Health system, MedStar NRH employs 1,200 FTEs across its network, and sees 500,000 patients at its ambulatory locations each year. The company implemented WebPT’s EHR for physical, occupational, and speech therapists last month. Its outpatient physicians also use Cerner Millenium.

Why did MedStar NRH decide the time was right to implement new EHR technology?
The payer and regulatory environment continues to become more and more complex. Manual systems, or even EHRs that are not specifically suited to the nuances of an outpatient therapy environment, do not allow the therapy provider to effectively and efficiently migrate this environment. Even though our healthcare system was deploying an enterprise-wide solution, after extensive analysis, we determined that WebPT was the tool that best positioned us for long-term success and to support our continued growth. We will continue to determine ways to best integrate their technology into our system’s enterprise solution to maximize communication among caregivers. Through this process, we will promote the safe, high quality and efficient provision of care across not only all of MedStar’s network but throughout MedStar Health.

How do you anticipate it will affect provider workflows and patient outcomes?
We feel that it enhances communication among caregivers and provides both clinicians and administrative operations support personnel with much appreciated efficiencies. In turn, this provides additional direct patient care time for our providers. We believe this will have positive impacts upon care delivery and thus patient outcomes. A key driver in this is finding an EHR/PM system that has a positive versus a negative impact on both MedStar NRH team member efficiency and revenue capture.  

Is this implementation part of the group’s larger preparation for MACRA and its value-based care/payment programs?
Ultimately, we feel the information provided and the overall improvements in clinical, administrative operations, and revenue cycle functionality, positions us all the better for upcoming changes in payer requirements and value-based reimbursement models.

Do PT practices face unique healthcare IT implementation challenges? Can you share a few examples?
Definitely. Many EHRs, particularly those focused on providing an enterprise-wide healthcare solution, tend to be very physician practice focused. The therapy reimbursement and practice environment are very different from that of what physicians use. To effectively provide day-to-day operational efficiencies for therapists, and to address the unique payer environment to best meet the needs of accounts receivable nuances, we felt it was vital to tailor the system to the therapy environment. Additionally, central billing functions need to be tailored for these unique payer requirements and limitations. The EHR must effectively link to the backend AR world, and the billing function must be designed to address the payer requirements specific only to the therapy world.  Some things we did to adapt include:

• Select an EHR that was dedicated to meeting the needs of the therapy environment.
• Create a go-live preparation, launch, and ongoing operational team comprised of clinical, administrative, and revenue cycle personnel. Dedicated time and attention has been extensive, but has led to a very successful launch up to this point in time.
• Create a relationship with the EHR vendor that will promote ongoing evolution of their tools to best meet not only our needs, but those of the evolving therapy environment. We and our EHR vendor have ongoing, open dialogue and working sessions to continue to improve their system, and in essence, a partnership approach to making one another better. Our size, scope, and full spectrum of therapy services and programs has been a tremendous benefit in this relationship.  We have ongoing lists of enhancements that we prioritize together. These enhancements make us both stronger in the marketplace.
• Tie ourselves to a billing component (AdvancedMD) that interfaces very well with both the EHR and ultimately the backend of our EHR.
• Customized billing office operations at this time are distinct from the entire MedStar Health system’s CBO. In time, we plan to integrate these, but not until the overall CBO is prepared.

Christmas is coming! What is on your health IT wish list?
I would like to see us effectively migrate the waters to best integrate for system-wide caregivers, our therapy-specific EHR and PM system, and MedStar Health’s enterprise-wide solution. We feel this is extremely important to our operations.

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Jenn, Mr. H, Lorre

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News 12/19/16

Top News

In an effort to help more physicians join Advanced Alternative Payment Models, CMS will open up new application periods for practices and payers interested in joining Comprehensive Primary Care Plus and Next Generation ACO programs. The agency expects that a quarter of providers in the Quality Payment Program will be eligible to earn incentive payments as part of these APMs by the 2018 performance period.

HIStalk Practice Announcements and Requests

Head over to HIStalk for details on submitting HISsies nominations (please, someone nominate Siemens and its Healthineers for “Stupidest Vendor Action Taken”), New Sponsor Intro Week in mid-February, and HIStalkapalooza invites.

Webinars

None scheduled soon. Contact Lorre for webinar services.

Announcements and Implementations

Aledade will expand its ACOs in Delaware and West Virginia to include 40,000 Highmark Blue Cross Blue Shield plan members. The independent physician-led organizations include 22 and 26 primary care practices and FQHCs, respectively. This expansion marks Aledade’s fifth commercial agreement following announcements earlier this year of contracts with Blue Cross Blue Shield of Kansas, Blue Cross Blue Shield of Louisiana, Florida Blue, and the West Virginia Public Employees Insurance Agency.

Fallas Family Vision (GA) implements RevolutionEHR. The optometry-focused EHR company acquired competitor GetWell including its Visions and Eyebase product lines in June.

The American Board of Family Medicine launches a registry focused on physician quality assessment, improvement, data-reporting requirements, and population management in an effort to promote self-governance and prevent burnout.

Acquisitions, Funding, Business, and Stock

The University of Kansas Hospital partners with Cerner to open an employee health center for the Unified Government of Wyandotte County and Kansas City, KS. The 5,000 square foot Road to Wellness Health Center marks the eighth such facility Cerner has opened in Kansas City and the fortieth nationwide. I interviewed Cerner VP of Population Health Services Mike Heckman (above left) earlier this year.

Global IT services company CSC will invest an undisclosed amount in Smartlink Mobile Systems and integrate its Medicare-friendly chronic care management technologies with new CSC CCM software and services.

Telemedicine

The Greenwood Genetic Center launches telemedicine capabilities between its five locations in South Carolina, thanks to financial support from the South Carolina Telehealth Alliance, the Medical University of South Carolina, the GGC Foundation, and an anonymous $150,000 grant from private donors. The nonprofit provides clinical genetic services, diagnostic testing, educational programs and resources, and conducts medical genetics research.

Government and Politics

Due to consumer demand, HHS extends Healthcare.gov open enrollment though midnight tonight for coverage starting January 1. Last Thursday marked the enrollment site’s busiest day ever, with 670,000 people signing up.

MGMA offers commentary on the final MACRA rule, imploring CMS to:

• Allow more streamlined reporting across the four MIPS categories
• Switch from a hard and fast December 31 pick-your-pace deadline to a more gradual transition period.
• Shorten the mandatory quality and advancing care information reporting periods to any 90 consecutive days.
• Allow participants to use 2014 or 2015 certified EHR technology until at least 2020. (The association points out that ONC lists just 27 products – 14 from the same vendor – as certified for 2015.)

CMS announces a new Medicare-Medicaid ACO model in an effort to bridge the cost gap for dual eligibles already enrolled in MSSPs. CMS will enter into participation agreements with up to six states, provided those states have enough Medicare-Medicaid patients in fee-for-service programs. The ACO’s first year-long performance period is slated to start January 1, 2018.

Contacts

Jenn, Mr. H, Lorre

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Population Health Management Weekly Wrap Up 12/18/16

Dawn Weathersby (Mediquire) joins I2I Population Health as SVP of product strategy and solutions.

Scott Cullen, MD (Valence Health) signs on with Erdman as EVP and CMO.

Medecision appoints Cory Courtney (Alere) to lead its new population health consulting team, which also includes Jackie Luchsinger, RN (Dearborn Advisors) and Carolann Engler, RN (Engler & Associates) (not pictured).

Chicago-based Cook County Health & Hospitals System expands its use of Medical Home Network’s care coordination portal and alert system to its entire Medicaid managed care population including those served by its mental health and substance abuse providers, immediate and urgent care centers, and Cermak Health Services, which cares for inmates within the county’s prison system.

Community Health Network/Indiana ProHealth Network selects ZeOmega’s Jiva population health management software.

MedTek21 incorporates genetics-based clinical decision support technology from Translational Software into its pharmacogenomics-based monitoring for its population health and medication risk management platform. The integration will enable providers to take into account a patient’s genetic profile and corresponding medication risks when prescribing treatment.

Indiana-based payer MDwise extends its contract with ZeOmega and upgrades to the latest version of Jiva.

Sponsor Updates

• Data Sharing: Why Does It Remain Such a Struggle? (Aprima)
• Cocoa is for Coders (SayIt 11/2 is here!) (Nvoq)
• ICD-10 Changes are on the way. Are you ready? (Intelligent Medical Objects)

Contacts

Jenn, Mr. H, Lorre

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News 12/15/16

Top News

CVS Health further creeps into the primary care space with the launch of the Transform Diabetes Care program, the first in a line of such programs that will focus on helping pharmacy benefit management customers better manage the chronic conditions of their patients. The program hopes to improve outcomes and lower medical and pharmacy costs through custom support that will include digital tools like connected glucometers, apps, and backend analytics. No overt mention is made of looping in PCPs, though the company does note that its managed pharmacy network will help simplify medication refills and improve care coordination with its members’ providers.

Webinars

None scheduled in the coming week. Email Lorre for details about webinar services.

HIStalk Practice Musings

This weekend marks the last full one before Christmas – a fact that leaves me with little time to shop for and complete any holiday cooking/baking I had hoped to do. Close to 20 empty cookie tins are waiting to be filled for neighbors, friends, teachers, and service providers so I’ll have to shelve my excuses, put on my snowmen apron and get to the kitchen. I’ll attempt to tackle sausage balls, peppermint bark, and sugar cookies in festive shapes with copious amounts of frosting and edible décor. Thankfully, the new family favorite – pimento cheese topped with pepper jelly baked in phyllo cups – is also the easiest. If you’re looking for more classic takes on holiday cooking, check out Quartz’s compilation of what constituted a holiday meal 100 years ago. Green Sea Turtle Soup, anyone?

Announcements and Implementations

The Los Angeles County Dept. of Health Services expands its use of Safety Net Connect’s physician-to-specialist consulting software to include its 21 mental health facilities.

Lexington Clinic (KY) rolls out Athenahealth’s AthenaOne services including EHR, RCM, and quality management tools across its 30 locations.

The Indiana Health Information Exchange, Michiana Health Information Network, and East Tennessee Health Information Network agree to share data between their respective HIEs.

Telemedicine

Konica Minolta taps private-label telemedicine vendor SnapMD to power its new cloud-based Virtual Care Management technology aimed at physicians looking to launch branded virtual consults.

Concentra signs on with American Well for telemedicine services. The chain of occupational medicine and urgent care clinics, which serves employees at over 400 facilities, will launch the virtual consults in select states early next year. 

A Health Affairs editorial points out that offering telemedicine services in underserved areas may do more harm than good if no in-person follow-up care is available. An evaluation of Direct Dermatology and the Maven Project – both of which offer virtual consult capabilities to PCPs working in underserved areas (presumably with large Medicaid and uninsured populations) – found access to telemedicine to be more of a band-aid on the local dysfunctional health system, rather than an end-all, be-all cure for a patient’s ailment. “Telehealth has great promise but it is important that in introducing it, we do not digitize the same flawed and overcrowded health care system that struggles to meet the needs of patients today,” the authors conclude. “The solution is not to bring in episodic, disconnected telehealth and assume it will fix our problems. Rather, we must experiment with more comprehensive strategies that combine telehealth and the necessary in-person care so that we are digitizing a better, more efficient, and more equitable healthcare system.”

Statistics continue to roll in concerning the enthusiasm patients have for telemedicine. A Rock Health survey of 4,017 people shows that the number of telemedicine utilizers increased from 7 to 22 percent between 2015 and 2016. That’s quite an increase, but it still doesn’t jive with the amount of news I’ve covered this year relating to new telemedicine companies and partnerships. It seems like availability far outstrips demand, and likely will for some time.

On a related note, a Federation of State Medical Boards study finds telemedicine to be the most important regulatory topic to 57 of the 70 state medical and osteopathic boards surveyed. Resources related to opioid prescribing and the telemedicine-friendly Interstate Medical Licensure Compact rounded out the top three topics.

Government and Politics

ONC invites developers to submit methods by which vendors can create a user-friendly “snapshot” of a product’s Model Privacy Notice. One lucky winner will receive $35,000. Submissions are due April 10.

Venice, CA-based startup Pwrdby wins the FDA Naloxone App Competition with its OD Help app, which connects potential opioid overdose victims with a crowd-sourced network of nearby naloxone carriers. The app, which earned its development team a $45,000 prize, is capable of interfacing with a breathing monitor to detect and alert carriers when a victim’s breathing rate drops to levels concurrent with an overdose.

Bon mots from Acting CMS Administrator Andy Slavitt, who appeared at the CMS Quality Conference alongside former administrators Don Berwick, MD and Mark McLellan, MD.

Other

The National Academy of Medicine will launch a collaborative effort of between 20 educational and professional organizations to combat physician burnout. Dubbed the “Action Collaborative on Clinician Well-being and Resilience,” the effort will initially consist of public workshops and meetings held throughout the year.

If only I had known about this while I was at the post office yesterday: The USPS offers a free augmented reality smartphone app that lets priority mail senders choose between two holiday-themed messages, and receivers create similarly animated thank-you messages. FYI: USPS Christmas mail-by dates include December 20 for first-class mail and December 21 for priority mail.

Contacts

Jenn, Mr. H, Lorre

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5 Questions with Dennis Dunmyer, VP, Behavioral Health & Community Programs, Kansas City Care Clinic

Dennis Dunmyer is vice president of behavioral health and community programs at Kansas City Care Clinic in Kansas City, MO. The clinic, previously known as the Kansas City Free Health Clinic, was awarded FQHC status last year. It employs 140 to care for an average of 120 patients each day for primary care, behavioral health, and oral health visits. The clinic sees a similar number of patients for HIV or hepatitis C tests. It also caters to patients seeking a case manager, peer counselor, or community health worker. KCCC uses a variety of health IT, including Greenway’s Success EHS and patient portal, and NextGen’s Scout care coordination software for HIV patients enrolled in its Ryan White HIV/Aids care coordination program. It recently incorporated BluePrint Healthcare IT’s Care Navigator platform in its Community Health Worker program. It plans to attest for Meaningful Use for 2016.

Why did KCCC decide the time was right to implement Care Navigator technology? What are the organization’s goals for the tool and its impact on patient care? 
We run a community health worker (CHW) model care coordination program that serves patients from a regional network of providers, hospitals, and community-based settings, including our own primary care practice. These CHWs are performing intensive, community-based patient navigation with these largely uninsured patients. KCCC decided to adopt Care Navigator primarily to be used with this program to allow for a centralized system to manage the day-to-day workflows of the CHWs, the assessments and care plans for these patients, and to allow cross-provider communication. This platform will allow us to more efficiently create care plans, track referrals, and provide automated prompts to the CHW to ensure that patients are connected to the resources and providers they need to improve their health. After this initial use case, we envision further adoption with our patient-centered medical home team within our FQHC practice.

The final MACRA rule is still making news. What are the clinic’s participation plans?
Since FQHCs have different payment methodology systems for Medicare and Medicaid, we are not planning to do anything with MACRA. We understand that we are not expected to participate in either track.

What has the PCMH journey been like for the clinic? How do you believe this experience will help the clinic transition to value-based programs?
The PCMH journey is a challenge and we continue to travel that road as this practice model is a shift in culture from how most clinicians are trained. The team-based concept requires putting the patient first and thinking about aspects of patient care that do not fall within traditional healthcare interventions. As an FQHC, our patient population often has more social barriers to their health than they do healthcare barriers to health. We certainly believe this framework helps set us up for improved patient outcomes, and value-based reimbursement models make more sense to encourage these additional activities. For us, the challenge has been finding ways to support the additional staff infrastructure required while a large number of our patients remain uninsured, and to make this investment prior to the proliferation of value-based reimbursement that will reward us for improved health of the population we are managing.

Are any other coordinated care initiatives underway?
As I alluded to above, we are an NCQA Level 3 PCMH, Missouri Medicaid Primary Care Health Home and have care coordination processes embedded throughout. Our practice is working to fully integrate our primary care, behavioral health, and oral health services through technology and staff-driven care coordination models. We are also a large Ryan White provider and have a lot of medical case management for those clients, and we run a regional CHW model care coordination program that serves patients from four area hospital systems and several other safety net healthcare providers.

How is the clinic using technology to better integrate behavioral health and primary care? What impact is this having on patient access and outcomes?
The clinic uses the same EHR platform for primary care and behavioral health, and our EHR allows integration of our dental module as well. We made a choice to not blind anyone on the care team from any aspect of patient care in the EHR so that the team can use the information gathered in other disciplines to drive care decisions. A shared medication list, labs reports, and access to care plans and progress notes across the system allow for better coordination of care in an integrated environment. We have not yet found an ideal platform for this type of practice, and have had to sacrifice some functionality on the behavioral health side to allow this shared model. We are hopeful that over time we will make up for some of the limitations in our EHR in this regard as we fully implement the Care Navigator functionality across our system.

Contacts

Jenn, Mr. H, Lorre

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