News 10/4/16

Top News

Wolters Kluwer acquires patient engagement technology vendor Emmi Solutions for $170 million in cash. Emmi’s ambulatory products include services that combine online multimedia programs with automated phone calls to aid in post-acute care transitions, population health management, and health literacy. Wolters Kluwer Health CEO Diana Nole says the company will integrate Emmi’s technologies with its UpToDate and drug data offerings to offer customers a more complete evidence-based decision-support solution.

HIStalk Practice Announcements and Requests

Reading: “The Mistresses of Cliveden – Three Centuries of Scandal, Power, and Intrigue in an English Stately Home.” Author Natalie Livingstone, whose family purchased the estate in 2012, takes readers through nearly four centuries of British culture and politics as told from the vantage point of Cliveden owners. It’s a great read that kept me up late during my mountain escape last week.

It’s time to start putting together the annual MGMA Exhibitors Guide. If you’re a HIStalk Practice, HIStalk, or HIStalk Connect sponsor exhibiting at MGMA, complete this form and I’ll include your company in our downloadable attendee guide. The conference kicks off October 30 in San Francisco.

Webinars

October 13 (Thursday) 2:00 ET. “Glycemic Control During Therapeutic Hypothermia.” Sponsored by Monarch Medical Technologies. Presenter: Tracey Melhuish, RN, MSN, clinical practice specialist, Holy Cross Hospital (FL). Using therapeutic hypothermia (TH) as a method of care can present risks of hyperglycemia, hypoglycemia, and blood glucose variability. Maintaining safe glucose levels during the cooling and rewarming phases of TH reduces the risks of adverse events. Tracey Melhuish, author of “Linking Hypothermia and Hyperglycemia,” will share best practices for optimal glucose control during TH and the success Holy Cross Hospital sees while using a computerized glucose management software.

Contact Lorre for webinar services. View previous webinars on our HIStalk webinars YouTube channel.

Announcements and Implementations

ABC Pediatrics (IL) implements IPatientCare’s PM software.

People

The Connecticut State Medical Society appoints Jeffrey Gordon, MD (who apparently has quite the Lego collection) president.

The Washington State Medical Association elects Shane Macaulay, MD (Center for Diagnostic Imaging) president.

Acquisitions, Funding, Business, and Stock

StartUp Health’s latest venture capital report confidently predicts that “2016 is on pace to be the biggest year yet for digital health funding.” Funding for the year thus far has already surpassed the 2015 total of $6.1 billion. Investments in patient and consumer experience and wellness companies lead 2016’s funding pack.

Telemedicine

San Clemente, CA-based startup Telehealthcare develops a provider-to-provider secure messaging app.

Teladoc joins the the steering committee of Health IT Now, a coalition of healthcare stakeholders that seems focused on raising awareness of healthcare IT’s role in achieving the Triple Aim, largely through high-profile commentary on federal regulations.

Government and Politics

No doubt tying in with National Cybersecurity Awareness Month, HHS awards $350,000 to the Florida-based National Health Information Sharing and Analysis Center to develop a cyber information-sharing ecosystem for public and private healthcare organizations. This ecosystem will enable HHS to send cyber threat information to NH-ISAC, which will then disseminate it to stakeholders; in turn, NH-ISAC will be able to receive information from stakeholders. I wonder if stakeholders will include Intermountain (UT) and the cybersecurity center it seems to still be in the process of opening with the University of Utah.

Surgeon General Vivek Murthy, MD notifies his staff – 600 employees of the Public Health Service – that their personal data may have been compromised as the result of a personnel system breach. HHS Acting Assistant Secretary Karen DeSalvo, MD, who co-signed the notifying email, explained that, “Teams across the Department and across government are working to learn as much as we can as quickly as we can, and to further improve our systems to prevent this type of issue in the future. … Next steps could include offering identity protection services to affected individuals.”

Research and Innovation

Navicure’s latest survey highlights the escalating need for greater healthcare price transparency. Of the 296 providers surveyed (37 percent of which were practice managers), nearly 70 percent reported that their patients don’t understand their payment responsibility versus their payer’s responsibility. Over 40 percent believe estimating service prices to be a top barrier to price transparency, which is a disappointing revelation given that 56 percent of respondents note that their patients do indeed ask about total treatment cost. Not surprisingly, most patients ask about their financial responsibility after their visit.

Other

Cybersecurity firm co-founder and Internet icon Dan Kaminsky advocates for a National Institutes of Health for Cybersecurity:

“I advocate a ‘NIH for Cyber’ because we didn’t stop our cities from burning by making fire illegal or heal the ill by making sickness a crime. This is not the first time a new technology has showed up with tremendous potential and a lot of problems. Cybersecurity is ultimately an engineering problem of human communication – we have programming languages, not programming equations, after all. This will be expensive, long term, difficult and sometimes boring work, that needs armies of nerds, and funding not threatened by next quarter’s earnings. Government can support that. An NIH for Cyber, focused on our genuine engineering challenges, could save this Internet.”

Contacts

Jenn,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg

More news: HIStalk, HIStalk Connect.

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HIStalk Practice News 10/3/16

Top News

Time to decorate those firewalls: President Obama declares October “National Cybersecurity Awareness Month” in light of the exponentially increasing number of industry-agnostic cyberattacks over the last several years. Data breaches in healthcare rang in at 112 million records last year, and show signs of keeping up with that figure as the last half of 2016 gets into full swing. I’m willing to bet greeting cards commemorating the month are not far off.

HIStalk Practice Announcements and Requests

My nearly week-long excursion in the Smokies was both relaxing and physically challenging. (If you’ve ever hiked – and then climbed – to the Chimney Tops and hit the hot tub afterwards, then you’ll understand where I’m coming from.) I missed National Health IT Week festivities, but am back in the news-gathering saddle just in time for National Primary Care Week, which seems to focus mainly on helping medical school students understand the importance of this increasingly understaffed and underpaid profession. I’m sure the #NPCW tweet stream will have some interesting resources to share over the course of the week.

A big thank you to the authors and physicians who stepped in with content while I was out of the health IT loop. Check out their contributions:

• DOCtalk with Dr. Gregg: Vendor Apologies Work
• Readers Write: Improving Clinical Documentation Through Better Physician Engagement
• 5 Questions with Shawn Purifoy, MD Malvern Family Medical Clinic
• 5 Questions with Gary Singer, MD Midwest Nephrology Associates
• Readers Write: Population Health Must-Haves for Primary Care

Finally, MGMA is just a few weeks away, which means it’s time to start putting together the annual MGMA Exhibitors Guide. If you’re a HIStalk Practice, HIStalk, or HIStalk Connect sponsor exhibiting at MGMA, complete this form and I’ll include your company in our downloadable attendee guide.

Webinars

October 13 (Thursday) 2:00 ET. “Glycemic Control During Therapeutic Hypothermia.” Sponsored by Monarch Medical Technologies. Presenter: Tracey Melhuish, RN, MSN, clinical practice specialist, Holy Cross Hospital (FL). Using therapeutic hypothermia (TH) as a method of care can present risks of hyperglycemia, hypoglycemia, and blood glucose variability. Maintaining safe glucose levels during the cooling and rewarming phases of TH reduces the risks of adverse events. Tracey Melhuish, author of “Linking Hypothermia and Hyperglycemia,” will share best practices for optimal glucose control during TH and the success Holy Cross Hospital sees while using a computerized glucose management software.

Contact Lorre for webinar services. View previous webinars on our HIStalk webinars YouTube channel.

Announcements and Implementations

The Central Virginia Coalition of Healthcare Providers, an ACO serving patients in Virginia and North Carolina, selects chronic care management software from Smartlink Mobile Systems.

New York City-based urgent care chain CityMD signs on for referral management technology from Par80.

Brevard Eye Center (FL) implements Compulink’s Ophthalmology Advantage EHR and PM technology.

People

Mark Wilhelm (Aramark Healthcare) and Andrea Velasco (Greenway Health) join Specialdocs Consultants as executive directors of business development.

Al Knowles (Dynamix Healthcare Innovations) joins Scribe as VP of coding, RCM and PM.

Telemedicine

Physician practice marketing company Officite will offer customers access to SkyMD’s teledermatology services.

MarijuanaDoctors.com adds telemedicine capabilities to its resources for physicians and patients looking to offer and access medical cannabis services.

Government and Politics

Rhode Island announces 100-percent enrollment in its PDMP, created via legislation in 2014. The local news, however, reports that utilization is less than 25 percent. Health department officials plan to improve this number next year by working with providers to connect their EHRs to the PDMP for more streamlined access.

AHRQ and CMS award $13.4 million to six grantees associated with the National Committee for Quality Assurance, Seattle Children’s Hospital, Children’s Hospital Corp., and several universities to study the feasibility and usability of newly developed pediatric quality measures at the provider, payer, and state levels.

Research and Innovation

A Black Book survey of 2,000 independent practices and 200 hospital-based practices paints a rather bleak picture when it comes to physician preparation for value-based care models. A few stats:

• 96 percent of practice managers report inefficient billing processes.
• 97 percent of practices experience high business staff turnover.
• 95 percent of practices with less than five physicians believe themselves to be “not tech savvy.”
• 90 percent of practices identify as unprepared financially and technologically for the transition to value-based care.
• Physicians gave Cerner and Navicure top marks in RCM outsourcing services and end-to-end tech and software, respectively.

Other

The local paper profiles the patient-centered medical home journey of Pediatric & Adolescent Health Partners. With the assistance of Anthem, the 40 year-old practice underwent the transformation in about 12 months. Founder Ted Abernathy, MD says that staff satisfaction has gone up despite the additional workload. Technology seems to have played a minor part in the practice’s move to a more value-based care model. Most interesting to me is the addition of discussions around social determinants of health: “Everybody was uncomfortable,” Abernathy says of having to ask patients about barriers to good health in their homes. “Everybody’s still a little uncomfortable. Until you get that first parent that says, ‘Yes.’ It’s easy when they say no, but what happens when a mom says she doesn’t have enough food? We’ve had to build a system of resources that we can call.”

A new kind of news: Vitenas Cosmetic Surgery issues a press release to announce the practice has received 2,000 online reviews – “an exciting achievement few plastic surgery practices ever accomplish.” I suppose the announcement speaks to the social media saviness of the practice’s staff, but it also gets into the murky waters of incentive reviews. Are staff pushed to persuade patients to leave them? Are patients compensated in some way? Readers, feel free to weigh in on your personal/professional experiences with online reviews.

Sponsor Updates

• PerfectServe will exhibit at ANCC 2016 October 5-7 in Orlando.

Blog Posts

• Need help meeting your 2016 goals? Finish the year strong! (Nordic)
• Nordic’s 5th annual Open House Recap (Nordic)
• Who’s Ready for MACRA/MIPS? Why Aprima Is, of Course! (Aprima)

Contacts

Jenn,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg

More news: HIStalk, HIStalk Connect.

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Contact us online.
Become a sponsor.

Readers Write: Population Health Must-Haves for Primary Care

Population Health Must-Haves for Primary Care
Three critical priorities as value-based care moves closer to home
By William Gillespie, MD

Value-based care is progressively becoming reality for primary care practices. Some, for example, have just considered participating in Comprehensive Primary Care Plus (CPC+), a new reimbursement model CMS calls the “largest-ever multi-payer initiative to improve primary care in America.” While the stated aim is to give doctors more control over care delivery, at its core the model is simply data- and incentive-driven population health management.

In response to such initiatives, providers are actively seeking best practices for managing their patient populations. Yet the quest for guidance poses its own fundamental challenge: Despite the endless industry buzz about population health management, fully tried-and-true best practices are still emerging. That makes it tough for primary care providers who must learn how to “quarterback” patient care at a practical level, despite ever-present manpower and resource shortages that often seem to put proactive care coordination out of reach.

However, with infrastructure and workflow designs that leverage existing data, primary care providers can realize the advantages of a sustainable population health management initiative built on these three fundamental components:

1. Stratify clinical condition within your practice population.

Managing value-based reimbursement begins with an understanding of the inherent risks within your patient populations. Practices have to identify their highest-cost, highest-risk patients — such as those with chronic conditions or complicated, comorbid conditions — to accurately predict the clinical and financial risk they face.

Armed with clinical condition stratification information, care teams can help practices minimize both clinical and financial risk by devising tailored plans to close gaps in care, manage medication adherence and heighten patient engagement. What’s important to recognize, though, is that you likely lack this crucial visibility whether or not your practice has an EHR.

While EHRs provide a nice starting point for collecting and accessing data, many don’t have the analytics capabilities needed to effectively stratify populations based on clinical condition. Acquiring this actionable intelligence, which can help capitalize on your EHR investment, requires infrastructures that overcome barriers to data exchange.

2. Stratify current and future risk.

Once a practice understands patient clinical conditions and associated risks, the next priority is preventing healthy patients from developing chronic conditions. A chronic condition equates to treating a problem that’s already arisen. The question is, how do you prevent that from happening in the first place?

The answer, again, is visibility; this time into those patients who are displaying the tell-tale signs of clinical decline. For instance: Which patients are gaining weight? Which are coming into the practice more often? Which have an increased number of complaints?

Rules-based infrastructures that track and monitor key indicators like these can enable practices to identify patients at risk of progressing toward undesirable co-morbidities and potentially chronic (and costly) clinical conditions. Through risk stratification, practices can more effectively utilize resources to prioritize treating these patients, driving down the cost of care while improving clinical outcomes.

3. Invest in your patients between and outside of office visits.

Patients spend very little time face-to-face with their doctors and care teams — even if they have, or are on the road to having, a chronic illness. What happens to patients between visits? Although it has a direct bearing on outcomes, providers historically have lacked this critical information. To thrive under value-based care, this must change.

Mobile communication can make a dramatic difference in health status and cost by allowing patients to easily engage with care teams, nutritionists, therapists, and other support systems. For instance: A care team interacting with a patient on a regular basis might determine that connecting the patient with transportation assistance increases the likelihood of care plan follow-through. This can also ensure that when patients do need care, they come to the practice rather than defaulting to an expensive emergency department. Ultimately, providers must have ways to extend care delivery outside the walls of their practices to control clinical outcomes and limit cost.

As reimbursement models and government mandates push population health forward, the real question for primary care providers is how to make the transition practical. Practices can start by embracing infrastructures and workflows that stratify clinical conditions, stratify risk, and strengthen patient communications. By focusing on these three “must-haves,” primary care providers can become elite quarterbacks for their patient care teams.

William Gillespie, MD is EVP of population health and CMO at Medecision in Philadelphia and Dallas.

Contacts

Jenn,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg

More news: HIStalk, HIStalk Connect.

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5 Questions with Gary Singer, MD Midwest Nephrology Associates

Gary Singer, MD is the owner of Midwest Nephrology Associates in Missouri. The practice, which uses EClinicalWorks and PHR technology from Healow, achieved Stage 2 of Meaningful Use last year and is still actively participating in the program. It employs three physicians, one NP, one practice manager, and five staff members to care for an average of 25 patients each day. As an EClinicalWorks customer, the practice will be able to take advantage of the Carequality Interoperability Framework, which will enable it to exchange data with practices using participating EHRs.

How do you foresee the Carequality framework aiding in your practice’s ability to share health data with other providers?
The Carequality framework will provide significant improvements, specifically allowing organizations utilizing Epic to directly access our progress notes, eliminating the time consuming process of faxing. The process will save time and increase efficiency.

What are your thoughts on vendors opening up the Carequality network directly to patients?
Although I’m certain patients will widely accept and adopt the patient portals on the Carequality [framework], security has to be the highest priority.

Do you think your patients will take advantage?
Yes, specifically the older population. More than ever, people are wanting to be in control of their health and in turn, request access to their medical information. By providing patients access to the data via Carequality, it will finally give them the control they desire and deserve.

In your experience, what barriers do physician practices most often face in their interoperability efforts?
Located in southern Wisconsin, we are a small private practice surrounded by numerous hospital-owned organizations. Unfortunately, like many organizations, our systems don’t communicate and the cost of building interfaces is prohibitive to us. Once more practices adopt interoperability, we will have the ability to communicate, exchange data, and better serve our patients.

Who do you see as the biggest driver of interoperability efforts – the government, vendors, providers, or patients?
While providers and staff should be the drivers for universal adoption of interoperability, in reality the EHR vendors are driving the change. The answer should be providers, but I think it is vendors who want to facilitate interoperability between clinical systems in community-wide settings.  Providers have similar goals, but are uncertain as to how to begin the process.

How do you anticipate greater interoperability will impact patient satisfaction, access, and outcomes at your facility?
As adoption of interoperability increases, I believe patient satisfaction will improve immensely. It will increase patient safety, security and well-being, and improve their overall quality of care. 

Contacts

Jenn,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg

More news: HIStalk, HIStalk Connect.

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5 Questions with Shawn Purifoy, MD Malvern Family Medical Clinic

Shawn Purifoy, MD is the owner of Malvern Family Medical Clinic in Malvern, AR. With the help of two NPs, a dozen full-time staff, and two part-time employees, the clinic cares for an average of 70 to 100 patients per days depending on the season. The clinic, which is an EClinicalWorks shop, is working on the first year of Stage 2 Meaningful Use, has applied for the Comprehensive Primary Care Plus program, and is also participating as a PCMH in the Arkansas Medicaid program. The clinic recently signed on to join Aledade’s first ACO in the state.

Why did your practice decide the time was right to participate in an ACO?
As an independent practice in a small town, we have been very worried about the changes in healthcare delivery, as well as the new requirements on the horizon. It is my intention to remain independent for as long as possible. We knew that we needed a support system including a way to better utilize our own practice data, and I did not want to partner with a hospital. It seemed like joining an ACO was the natural fit for us. This is our first ACO experience.

Why did you decide to partner with a third party like Aledade, rather than building it out on your own?
I think trying to coordinate with other practices without some entity to manage the data, as well as the personalities that go along with multiple medical practices, would be extremely difficult at best. In our case, we had absolutely no experience in this arena, and I would not have even considered taking on the task of learning the ins and outs of being a part of an ACO without the help of outside expertise.

What role will the Arkansas Foundation for Medical Care play in the ACO?
The AFMC has been a blessing for us on many levels. They provide us with an onsite practice transformation specialist who comes to our office on a weekly basis. She assists us in making the transformation from a totally fee-for-service model to a more accountable care-type system by working directly with my office manager, clinical care coordinator, and myself. AFMC offers training and support while aligning our efforts with other programs we are working on. They play a key role in helping us manage a steep learning curve, and I really don’t know if we would have been able to succeed without their assistance.

What goals does your practice have for its ACO participation?
We want to help the ACO achieve savings, but honestly, we did not join with the intention of making money. We felt that joining was our way to learn the skills we will need to be able to survive in a new world of medicine. We are striving to use the tools that Aledade provides in order to better understand our patients and their needs. We hope to be able to provide smarter and more focused care for our patient population. I believe that if we make our best effort to adopt the advice that we are getting from Aledade, we will not only accomplish these goals, but probably also be able to save money as well.

What technology benefits are you most excited about with regard to setting up and running the ACO?
Aledade has made a wonderful app that assists us on a daily basis. It targets high-risk patients, frequent ER users, and patients who have been admitted to the hospital. We can use this information to contact these patients and get them into the office for follow up. We can also see exactly what charges have been applied to the patient, and we can drill down to actually see which physicians and specialists have billed the patient. More importantly, I can use this information to compare specialists and how they are charging the patients. This can potentially help me to identify duplicate tests and unnecessary procedures. All of this helps me be a more effective primary care provider for my patients.

They have also been very responsive to all of the physician and staff suggestions for improving the app as it has been used, and I am excited about how this will help streamline much of the work that primary care practices are now required to do. I wonder sometimes if other independent practices will be able to make it without this type of support. I certainly don’t believe my practice would be able to do it, and I’m very thankful for the support they’ve given me.

Contacts

Jenn,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg

More news: HIStalk, HIStalk Connect.

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