News 11/5/15

Top News

Walgreens decides to move its Healthcare Clinics over to Epic beginning in early 2016. The chain of over 400 clinics, which is currently using a proprietary EHR, cites Epic’s Care Everywhere interoperability network as a deciding factor in the transition. Walgreen is no stranger to vetting vendors, having selected Greenway’s EHR for its pharmacies in 2012 as part of the company’s HealthCloud initiative. A Walgreens rep declined to comment on how much the retailer will pay for the technology, other vendors considered, and the proposed implementation timeline.

Webinars

November 11 (Wednesday) 2:00 ET. “Trouble Upstream: The Underinsured and Cash Flow Challenges.” Sponsored by TransUnion. Presenter: Jonathan Wiik, principal consultant, TransUnion Healthcare. The average person spends nearly $15,000 per year on healthcare as deductibles keep rising. Providers must educate their patients on plan costs and benefits while controlling their own collection costs by using estimation tools, propensity-to-pay analytics, and point-of-sale collections. This webinar will highlight industry trends in managing underinsured patients and will describe ways to match patients to appropriate funding.

November 12 (Thursday) 1 :00 ET. “Top Predictions for Population Health Management in 2016 and Beyond.” Sponsored by Medecision. Presenters: Tobias C. Samo, MD, FACP, FHIMSS, CMIO, Medecision; Laura Kanov, BS, RRT, MBA, SVP of care delivery organization solutions, Medecision. With all the noise and hype around population health management, the presenters will share their predictions for 2016 and their insight into meeting the mounting pressures of value-based reimbursement and the tools and technology needed to manage care delivery.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Announcements and Implementations

Vision Source partners with The Health Council of East Central Florida, a nonprofit planning agency that offers research, education, and program support to regional healthcare stakeholders. Vision Source’s 27 member optometry practices will become a part of the council’s HealthSpan Coordinated Chronic Care Network, set to launch later this month. The network will offer physicians centralized patient referral,  chronic care management services, tools to help reduce hospital readmissions, and home patient monitoring through their practices.

BreezyNotes EHR launches cloud-based mental health PM software for solo and small-group therapists. Founded by father and son team Jim and Paul Jonas, the Eden Prairie, MN-based startup worked with 7 Medical, Visible Technology Solutions, and Vibe Behavioral Health Consultants to develop the new platform.

Acquisitions, Funding, Business, and Stock

The Atlanta-based Forge Founders Forum invites digital health startups to apply to its 2016 accelerator program, which kicks off in January and ends with a demo day in mid-March. Accepted applicants will receive seed money, work space, access to mentors, and networking and demo opportunities. Applications are due November 13.

Kareo announces that nearly 100 percent of ICD-10 coded claims from its independent practice customers have been successfully processed. Nearly 90 percent have been paid successfully for at least one of those claims. Eleven days seems to be the average time to payment.

Telemedicine

TouchCare adds new features to its telemedicine platform including a Practice Dashboard that enables physicians to delegate certain tasks to staff, integrated credit card payment capabilities, and appointment-verification improvements. The upgrades come a week after the company welcomed former US Senator Joseph Robert “Bob” Kerrey and Brad Wilson (BCBS of North Carolina) to its Board of Directors.

Iowa’s Medicaid program begins reimbursing providers for telemedicine services thanks to new rules that take effect this week. The services must be “to the same extent as such services covered under Medicaid when they are rendered in person.” The rule seems to be the state’s first official take on the matter. As of July 2015, 48 state Medicaid programs (including Iowa) and Washington, DC offer reimbursement for live-video telemedicine.

Research and Innovation

Vanderbilt University School of Engineering transitions its medical capsule robot hardware and software to open source in an effort to help further research and development in the field. “We’ve done custom capsule design – one for the colon, one for the stomach, another one with a surgical clip to stop bleeding – but we saw we were basically reusing the same components,” explains Pietro Valdastri, director of Vanderbilt’s Science and Technology of Robotics in Medicine (STORM) Lab. “Like it is with Lego bricks, you can reassemble them for different functions. We wanted to provide the people working in this field with their own Lego bricks for their own capsules.”

University of Pennsylvania researchers discover that nine out of 10 websites leak user data to other sites like WordPress, Google (the worst perpetrator), and Facebook without the user’s knowledge. While I don’t find it surprising that so many sites leak user data, I am concerned by the facts that at least six out of 10 sites generate third-party cookies, eight out of 10 load external Javascript code onto a user’s computer, and most ignore a user’s Do Not Track Me settings.

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Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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From the Consultant’s Corner 11/5/15

The Competitive Advantage: IT and Operations Building a Shared EHR Vision

Many healthcare organizations task IT departments with a narrow focus: Keep hardware technology current, software competencies high, and downtime to a minimum. Meanwhile, financial and clinical operations run the business of providing healthcare. Under these directives, IT and operations behave as separate entities managing distinct visions, budgets, and priorities.

Today, this business-as-usual approach simply doesn’t foster collaboration and innovation. With high capital costs for enterprise systems, federal program changes, and market consolidation, staying competitive demands an interdependence between IT and operations unlike never before. In fact, 66 percent of CIOs note that EHR optimization is a critical area of focus for their health systems.

It goes without saying that technology solutions are no longer just enablers. Decisions made by IT stakeholders can impact — either positively or negatively — nearly every operations function. Executing almost any healthcare transformation initiative needs a shared vision, mutual governance and prioritization, and long-term optimization.

From budgeting and scoping upgrades, to usability and adoption, important process changes can establish a collaborative culture that leads to IT and operations becoming solution partners. Here are four best practices that help to create a new marriage:

1) Best practice: Establish a harmonious governance
Appoint co-chairs for steering committees, and require pre-work. However regular clinical, financial, consumer, and business governance meetings may be, seldom do we require a pre-meeting between Ops and IT co-chairs before each session. When co-chairs pre-meet, review proposals, and coach presenters together, the time in governance is spent on solution adjustment, less so solution debate. This approach drives faster decision making, more refined solutions, and more pleased leadership.

Having co-chairs requires collaboration before meetings and permits equal accountability for creativity and solution generation. For example, if operations is working to change the provider reimbursement model, IT can generate RVU reporting capabilities and provide a corresponding solution for the business needs. Too often today, we don’t do our homework together.

2) Best practice: Create true FTE liaisons
Liaisons are a secret sauce for EHR optimization and ongoing collaboration. Liaisons assigned as a half or full FTE function as eyes and ears on the units, in the medical offices, business offices, and more. They know who is frustrated, what’s broken, what workarounds persist, and who is succeeding and innovating. Liaisons ideally have operations and IT backgrounds, and are very comfortable shadowing, listening, training, and becoming a trusted peer to users. They play a key role in educating decision-makers about culture, readiness, and support for change.

Clinicians, former billing office managers, and ancillary staff all make good liaisons. They can be budgeted by IT and operations to share accountability, and can split time between IT work and extra hands on the floor.

3) Best practice: Internally market your initiatives
From the C-suite to individual work teams, explaining what, how, and why decisions are made — and marketing the rationale behind new initiatives — is key to achieving organizational alignment and buy-in. Governance teams should share this information on intranets, at medical executive committees, in nurse manager meetings, at lunch sessions, and more. Transparent decision making drives earlier reaction, timely feedback, and a sense of inclusiveness that retains talent and prevents isolation.

For key decisions, mature organizations circulate a one-page memo (perhaps about the future of device integration) that includes the names of decision committee members, a summary of the discussion, and the challenges and decisions that help all stakeholders become a part of the conversation.

EHR Champions have the responsibility of working with the communications team to market priorities collaboratively and secure support.

4) Best practice: Make optimization a “forever” plan
Business optimization must become a "forever" effort. There is debate in the community around establishing dedicated optimization teams. Whether a distinct team or one with matrixed responsibility, prioritizing together with PMO support, communicating to the organization, and delivering continuously relevant optimization is key to the health of the business.

Aligning and re-aligning transparent drivers such as patient engagement, user personalization, system replacement, KPI reporting, and more to specific initiatives and departments should be a continuous exercise.

Aligning visions benefits all stakeholders
Aligning the corporate vision accrues benefits from governance to work team execution. The healthcare enterprise can — and must — evolve more quickly to keep a competitive advantage and improve quality. Building the web of trust requires strengthening connections from the patient to the user to the CFO, and transparency is key.

Achieving such a shared vision enables faster adoption of solutions. Innovation allows organizations to attract and retain talent, improve clinical productivity and enhance reimbursement potential — all of which can lead to a better position in the marketplace. Although creating a competitive advantage through alignment is challenging, organizations that consistently follow best practices can ensure steady progress, happier users and healthier patients.

Jaffer Traish is the Epic Practice Director at Culbert Healthcare Solutions.

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Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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News 11/4/15

Top News

The State Health Information Network for New York (SHIN-NY) connects all eight RHIOs across the state, a milestone funded by $100 million in taxpayer money over the last several years. While the achievement is significant, the state and managing New York EHealth Collaborative aren’t resting on their laurels. They are now focusing on connecting physician practices to the HIE, a challenging endeavor given the capital investment and boots-on-the ground training required. While over 80 percent of FQHCs and hospitals in the state now participate, just 12 percent of physician practices are connected.

HIStalk Practice Announcements and Requests

My fifth trip to the Health IT Leadership Summit in Atlanta was highlighted by the morning’s first panel, which featured reps from Epic, Cerner, RelayHealth, and Greenway. It’s the first time I’ve seen all four vendors together on stage, a subdued bunch if ever there was one. All four seemed to agree with each other on most every talking point – the main one being whether interoperability is a fantasy or a reality that will someday be achieved. I was hoping for fisticuffs, but no such luck. I attempted to stir things up by raising my hand when moderator Shahid Shah asked, “Who in the audience believes these guys are the reason interoperability doesn’t yet exist?” Most of the 800-plus attendees were either too polite or too inattentive to answer honestly, keeping their hands firmly in their laps.

Webinars

November 11 (Wednesday) 2:00 ET. “Trouble Upstream: The Underinsured and Cash Flow Challenges.” Sponsored by TransUnion. Presenter: Jonathan Wiik, principal consultant, TransUnion Healthcare. The average person spends nearly $15,000 per year on healthcare as deductibles keep rising. Providers must educate their patients on plan costs and benefits while controlling their own collection costs by using estimation tools, propensity-to-pay analytics, and point-of-sale collections. This webinar will highlight industry trends in managing underinsured patients and will describe ways to match patients to appropriate funding.

November 12 (Thursday) 1 :00 ET. “Top Predictions for Population Health Management in 2016 and Beyond.” Sponsored by Medecision. Presenters: Tobias C. Samo, MD, FACP, FHIMSS, CMIO, Medecision; Laura Kanov, BS, RRT, MBA, SVP of care delivery organization solutions, Medecision. With all the noise and hype around population health management, the presenters will share their predictions for 2016 and their insight into meeting the mounting pressures of value-based reimbursement and the tools and technology needed to manage care delivery.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

The Toledo Clinic (OH) joins the Ohio Independent Collaborative, citing the fact that OIC’s members are on the same EHR as a contributing factor to its membership. The clinic joins six other physician groups in the collaborative, which now covers a combined 900,000 patient lives. OIC members plan to work on clinical quality, patient care, and provider access initiatives in hopes of eventually creating a competing care option in the health system-dominated marketplace.

Nonprofit crowdfunding site Watsi receives a $3.5 million Series A-like investment from a bevy of investors, which it will use to hire additional engineers and to stave off internal fundraising. Since graduating from Y Combinator in 2012, Watsi has helped 5,000 patients in 20 countries raise money for healthcare procedures. It hopes to help 1 million patients by 2020.

MinuteClinic opens its first retail clinics in Maine. There are now over 1,000 such clinics in 33 states.

Announcements and Implementations

Kansas Imaging Consultants implements RCM solutions from Zotec Partners across its team of 28 radiologists and four facilities.

Kaiser Permanente Northwest (OR) becomes the first physician group in the state to offer online patient ratings of its 1,300-plus physicians. Ratings are based on cumulative, after-visit patient surveys administered by Press Ganey.

The 450 square-foot AMA Interaction Studio opens at Matter, a healthcare collaborative and co-working space in Chicago. The organizations launched an official partnership in February, bringing together physicians and entrepreneurs for educational workshops, interactive simulations, and collaboration events focused on healthcare improvement. The new studio offers a “unique technological test bed” for creating products in  simulated medical settings.

Government and Politics

As part of a broader focus on battling the US “opioid epidemic,” CMS releases an online interactive mapping tool that shows de-identified Medicare Part D opioid prescription claims by location and percentage. “The opioid abuse and overdose epidemic continues to devastate American families,” says CDC Director Tom Frieden, MD. “This mapping tool will help doctors, nurses, and other healthcare providers assess opioid-prescribing habits while continuing to ensure patients have access to the most effective pain treatment. Informing prescribers can help reduce opioid use disorder among patients.” I sincerely hope the military community of physicians pays particular attention to prescription rates on US bases. It saddens me that our nation’s armed forces have developed a reputation for over prescribing painkillers.

Healthcare.gov rolls out a beta Doctor Lookup feature, enabling one in four random users to search for health plans by preferred physician or facility. The site will also roll out a corresponding Prescription Drug Check tool, which will allow consumers to search for plans that cover their prescription drugs.

People

Robert Pepper (Visicu) joins Orion Health as vice president of marketing for North America.

Telemedicine

Behavioral health specialty pharmacy services vendor Genoa offers telepsychiatry services after acquiring New York City-based telepsychiatry vendor 1DocWay for an undisclosed sum.

Research and Innovation

A survey of 5,000 patients shows there’s still quite a gap between the availability of patient engagement tools and physicians that offer them. Just one in five of those surveyed have access to online appointment scheduling, while less than half receive even traditional appointment reminders via phone. Just 15 percent communicate with their physician via secure email, and only 9 percent receive reminders via text. Researchers attribute the low utilization numbers to a lack of appropriate physician incentives, plus regulatory and legislative adoption barriers. Consumer awareness may also play a part, highlighting what seems like an ever-increasing need for patient and physician education on the benefits of such technologies.

A Colorado study finds “staggering cost differentials” between care settings for identical ailments. Treatment for a common cold in the ER averaged $709 versus $114 in a physician’s office or urgent care clinic. Headaches racked up the biggest difference – $2,010 in the ER versus $375 in the outpatient setting. Close to 40 percent of the state’s ER visits occur for non-emergency reasons, leading researchers to conclude that the state could save up to $800 million annually if patients seek office-based care first.

Other

AMA adds 20 medical schools to its Accelerating Change in Medical Education Consortium, which is working to develop the “medical school of the future.” Launched with 11 schools in 2013, the latest round of academic institutions will receive $75,000 each over the next three years to develop innovative curriculums that will better prepare students for the challenges of working in today’s healthcare system. “By working together,” explains Susan Skochelak, MD AMA group vice president for medical education, “we believe that during the next several years this effort will produce physicians who are not just skilled clinicians, but system-based thinkers, change agents, technology champions, and inter-professional team players.”

Ada Igonoh, MD the only female medical doctor to survive Ebola, gives birth to a healthy baby girl at Greater El-Monte Community Hospital (CA). In addition to being a mom and physician, the Nigerian-born Igonoh is now a public health advocate and motivational speaker.

Sponsor Updates

• Medicity celebrated Halloween with an ICD-10 graveyard titled “You Don’t Want to Die on This Hill.”
• Aprima will exhibit at the American College of Rheumatology Annual Meeting November 8-10 in San Francisco.
• Nordic releases a video titled “After ICD-10: Minimizing pain, increasing gain.”
• EClinicalWorks and Healthwise will exhibit at the mHealth Summit November 5-6 in National Harbor, MD.

Blog Posts

• 10 Objectives for EHR Incentive Programs (AdvancedMD)
• Lessons Learned – Allscripts PM V14 Upgrade (Culbert Healthcare Solutions)

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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News 11/3/15

Top News

Teladoc announces Q3 results: total revenue of $20 million, up 83 percent over Q3 2014; membership of 12.6 million users; and nearly 118,000 visits, up nearly 90 percent year over year. The company experienced an operating loss of $13.2 million, and expects to see revenue of between $21 and $22 million at the end of Q4. CEO Jason Gorevic noted during the earnings conference call that the company had signed up 500 new clients in Q3 alone, including Starbucks,  Dell, Merck, Marriott, and Mercedes-Benz.

Webinars

November 11 (Wednesday) 2:00 ET. “Trouble Upstream: The Underinsured and Cash Flow Challenges.” Sponsored by TransUnion. Presenter: Jonathan Wiik, principal consultant, TransUnion Healthcare. The average person spends nearly $15,000 per year on healthcare as deductibles keep rising. Providers must educate their patients on plan costs and benefits while controlling their own collection costs by using estimation tools, propensity-to-pay analytics, and point-of-sale collections. This webinar will highlight industry trends in managing underinsured patients and will describe ways to match patients to appropriate funding.

November 12 (Thursday) 1 :00 ET. “Top Predictions for Population Health Management in 2016 and Beyond.” Sponsored by Medecision. Presenters: Tobias C. Samo, MD, FACP, FHIMSS, CMIO, Medecision; Laura Kanov, BS, RRT, MBA, SVP of care delivery organization solutions, Medecision. With all the noise and hype around population health management, the presenters will share their predictions for 2016 and their insight into meeting the mounting pressures of value-based reimbursement and the tools and technology needed to manage care delivery.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Announcements and Implementations

Aprima selects Kno2’s Direct messaging platform to better enable its customers to meet requirements for electronic transmission of Transition of Care documents as required by Stage 2 of Meaningful Use.

Office Ally integrates TSI’s collections interface into its Practice Mate PM and EHR platform. In addition to making a practice’s collection log and activities more transparent, the integrated system will aid in the transfer of delinquent patient accounts to TSI for collections.

The NC Medical Society Foundation receives a three-year, $440,500 grant from the Kate B. Reynolds Charitable Trust, which it will use to help up to 15 rural physician practices transition to value-based care. The foundation has tapped Highpoint, NC-based Chess to lead the program. The healthcare services firm will offer the practices healthcare IT support, training in care coordination and patient engagement, and advice on how to integrate with community health and faith-based resources, with the ultimate goal of preparing the practices to transition to a Medicare ACO business model.

Sanctus Healthcare implements chronic-care management services from McKesson Business Performance Services across its multispecialty Pacific Private Practice network of 212 independent physicians in Orange County, CA.

Acquisitions, Funding, Business, and Stock

RCM and analytics vendor Encoda acquires Strategic Management Consultants. Terms of the deal were not disclosed. SMC President and CEO Bobby Mehan will join Philadelphia-based Encoda as vice president of business development. SMC will take on the Encoda name; its operations will remain in Carrollton, GA.

SCI Solutions acquires referral management vendor Clarity Health for an undisclosed sum. SCI gains 20 employees through the deal and plans to hire more staff in the coming months, according to CEO Joel French. The newly combined company will ultimately be headquartered in Seattle.

People

Richard Cassidy, MD (Teladoc) joins ACO Health Partners as CEO.

Peter McClennen joins Best Doctors as CEO, and joins the company’s Board of Directors.

Other

New York University School of Medicine puts its first- and second-year students through their paces, assigning them a “healthcare by the numbers” project that aims to help train them on accessing and interpreting health data. Students are given access to a database of over 5 million anonymous patient hospital records, plus a database of over 50,000 outpatient records that goes by the name of Lacidem Care Group. (“Lacidem” is medical spelled backwards, in case you were wondering.) Students are encouraged to look at quality measures for a variety of conditions, and to drill down into individual physician and practice performance.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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Readers Write: Climbing Out of the Pool of Unpaid Patient Payments

Climbing Out of the Pool of Unpaid Patient Payments
By Hanny Freiwat

Feel like you’re swimming in unpaid patient invoices? It’s a common problem in physician practices today. In fact, when a patient leaves the office without paying, 79 percent of those fees owed end up going uncollected. Studies have shown that it’s not that patients don’t want to pay, but that there isn’t a convenient option for paying. In this changing landscape, healthcare operations have not quite caught up with consumer-centric technology needs and expectations. You can change that for your practice.

Here are four easy ways for physician practices to increase patient payments before the end of the year, decrease accounts receivables, and avoid high bad-debt rates.

Number One: Offer an easy-to-access online payment link on the practice’s website. If you already have one available on your patient portal, ask your accounts receivable manager how many payments come through there. If it is near zero, which is the case with most practices, find an easier way that doesn’t require a user name and password. Look for payment partners who understand HIPAA and PCI compliance, and set up a link today. Make sure that you advertise the new payment link on your invoices and in the office. Patients and guarantors want convenience – not more passwords to remember. This solution should take one to two hours to implement, in addition to the research time.

Number Two: Add a card-on-file policy to your existing financial policy, complemented by any pro bono services you offer. Find a technology and payment partner who has a PCI-compliant service and implement it immediately. The solution should be patient friendly and have a limit on how much you can charge their credit or debit card. Train your staff on usage, and more importantly, on having the conversation with the patients before they get the service. If your patients are not willing to vault (secure) a card on file with you, there is a good chance they will not pay the bill. This solution is more involved and can take 10-15 hours to implement due to integration and staff training.

Number Three: Validate the patient’s insurance eligibility days prior to the service date, or at least when the patient walks in if you’re an urgent care clinic or similar walk-in practice. Make sure that the technology you’re using is delivering the data you need for your specialty and not a generic data dump. Use that data to determine your risk and the amount you should collect at the time of service, and how much to vault on your card-on-file solution for post-claim collections. If you’re not sure how much copay you should collect, vault a card on file to avoid confusion and refund expenses. This solution should be available through your current EHR and PM systems. If not, start thinking about getting a complementary solution as soon as possible. With ACA and MCOs, this is more important than ever. You need a “Know Your Patient” solution in place in 2016 or expect to get double hit by narrow networks and confused patients. Depending on your practice size, this could take as little as a week or as many as two to three months.

Number Four: Get on the cutting edge and look for other ways for your patients to pay. Medical mobile bill pay and price estimator vendors are out there. Find and partner with those that understand your patient needs. This might sound foreign in healthcare, but we’re all consumers and know how to use the tools. Time spent to implement this will depend on the solution and vendor you choose.

Going forward, look at your job descriptions and make sure that you have financial counseling and payment collections as part of the duties of your scheduling and front office teams. Fully implementing this strategy will drive your patient responsibility revenue to near 100 percent. In addition, you should see savings from less billing and less traditional payment collections. Once you fully make the shift, you and your staff will be free to get back to the business you love – caring for patients.

Hanny Freiwat is president of Wellero in Portland, OR.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

More news: HIStalk, HIStalk Connect.

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