Readers Write: Family Physicians Set the Path for America’s Healthcare

Family Physicians Set the Path for America’s Healthcare
By Javette Orgain, MD

Family physicians, students, residents, and others from across the US descended on Denver earlier this month to learn about the latest research in medical care and procedures, elect their leadership, and network with one another during AAFP’s annual meeting, the 2015 Family Medicine Experience.

The message they took away from the meeting: Family medicine continues to lead the nation in identifying the policies that are building a healthcare system of efficient, high-quality care that improves individual and community health.

“Our time is now,” said newly installed AAFP President Wanda Filder, MD.  “America is hungry for answers to a broken US healthcare system. We have tapped into what America needs. We are the answer to what ails the US healthcare system.” Noting the success of the Family Medicine for America’s Health initiative and its public education counterpart, Health is Primary, Filer said legislators, policy makers, and the public now realize that family physicians provide ongoing, coordinated, and comprehensive care for both patients in overall good health and those with multiple, highly complex health conditions. Policy makers now understand the healthcare system must pay for the medical expertise and time that family physicians invest in each of their patients.

Community Health Moves to Center Stage
If one theme dominated the 2015 AAFP Congress of Delegates, it was the commitment of family physicians to their patients. From speeches to resolutions, family physicians demonstrated their focus on ensuring all patients have what is needed to enjoy good health.

The resolutions put before the Congress addressed multiple issues: affordable access to care and medications; an environment in which physicians can focus on patient care without heavy administrative burdens or cumbersome reporting requirements; healthy communities; preservation of rural hospitals; and a host of other issues affecting individual and community health.

Among the resolutions that passed were those that called on the AAFP to:

• Collaborate with public health agencies to reduce the negative effects of income, education, and nutrition inequality in order to improve health outcomes.
• End non-medical exemptions for immunizations.
• Support a federally funded adult vaccine program.
• Support expanded use of Naloxone to allow first responders and other non-physicians to administer the medication in an emergency overdose.
• Support decriminalizing the possession of marijuana for personal use and encourage NIH to conduct appropriate research on the health effects of marijuana use.
• Urge Congress and federal agencies to investigate policies that result in pharmaceutical price increases that create barriers to generic medications.

Educational Sessions Bring Medical Research to the Exam Room
With their work complete, AAFP’s 116 delegates joined more than 3,800 of their colleagues for four days of continuing medical education on research, diagnosis, and treatment of illnesses, chronic-care management and patient-centered care. Attendees chose from more than 140 sessions on prenatal care, cardiovascular disease, cancer, fibromyalgia, chronic kidney disease, diabetes, chronic obstructive pulmonary disease, and psychiatric and neurological conditions.

Family physicians came away from their four days inspired by their leaders and their colleagues. “This is a time that we can network, this is a time that we can become educated,” said another attendee, summing up the meeting. “This is a time that we can get to meet our leaders. This is something we can learn, we can create, and then we can take back home. I’m in rural medicine. I need something new. We need to be stimulated and we get it from the conference.”

Javette Orgain, MD is vice speaker of AAFP and medical director of Village of Park Forest Health Department.

Contacts

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

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News 10/15/15

Top News

Lyra Health raises a $35 million Series A round of financing led by Greylock Partners and Venrock. The company, which has developed technology to help patients find the best care for mental health and substance abuse issues, will use the new funding to make its solution available to employers, payers, and providers. The startup was founded earlier this year by an executive team with previous experience at Facebook, Genentech, and Castlight Health.

#HIStalking Tweet Chat

Check out the recap of today’s #HIStalking tweet chat, hosted by @loranstefani.

Webinars

None in the next few days. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Forbes focuses on one Atlanta-based pediatric practice feeling the pinch from ICD-10 after spending $50,000 on IT upgrades. “With that much money we could have probably hired an additional nurse,” explains Roy Benaroch, MD. “We quickly discovered that if our [ear infection] coding didn’t specify ruptured or not ruptured, we wouldn’t get paid. I’m on vacation and our billing guru just called and said all of our ear infection claims are getting denied and have to be re-filed. Now our claims are delayed. [U]ntil it’s resolved, the doctors are taking no bonuses and we don’t know if or when we’ll get paid.”

Announcements and Implementations

The Toledo Clinic & Outpatient Surgery Center (OH) implements the EClinicalWorks EHR across the its 62 locations. The clinic, the largest independent physician group in Northwest Ohio, is already using the company’s CCMR solution for population health management.

Government and Politics

The VA and Indian Health Service receive accreditation from EHNAC and DirectTrust, making them the first federal agencies to gain interoperability via the Direct exchange network.

Telemedicine

Saratoga, CA-based ARC Fertility launches a telehealth system for practices specializing in fertility treatments such as in-vitro fertilization.

PCP services company Tandigm Health partners with mobile health company TouchCare to offer telemedicine services to over 350 patients in Philadelphia. The first phase of the partnership will focus on rolling out telemedicine services to high-risk patients that already engage with Tandigm Health’s Care Team over the phone.

Research and Innovation

A Health Affairs study finds that common medical procedures become more expensive in areas where large medical practices are clustered, confirming the theory that increased market power enables physicians to bargain for higher prices from payers. “We know from some good examples that larger, well-run practices can provide high-quality care,” says researcher Laurence C. Baker, MD “and many of our current policies are built around the notion that we should encourage the formation of larger organizations in the hope of improving the quality of care and fostering improvements in value. It is also important that we factor in these kinds of effects on prices and the downstream impacts this can have on our health-care costs.”

Other

The Verge gives President Obama props for being a “wearables nerd” due to the fact that he’s eight months in to a relationship with his Fitbit. Wearables, as you may have read, have developed a notorious reputation for being discarded after several months of use.

Contacts

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

More news: HIStalk, HIStalk Connect.

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#HIStalking Tweet Chat Recap

News 10/14/15

Top News

DrFirst firms up $25 million in equity financing from Goldman Sachs, bringing its total financing over the last year to $42 million. The company, which announced last week the integration of its medication management software and secure communications with the Rx30 Pharmacy Management System, will use the investment to ramp up sales, marketing, and product development.

#HIStalking Tweet Chat – Patient Engagement Outside the Office

Loran Cook (@loranstefani) will host the next #HIStalking tweet chat on Thursday, October 15 at 1pm ET. Check out discussion topics here.

Acquisitions, Funding, Business, and Stock

Sunnyvale, CA-based Health Gorilla secures a $2.4 million Series A led by Data Collective with additional financing from True Ventures, Harris Barton, Orfin Ventures and Venture Investment Associates. The company has also expanded its diagnostic test automation platform to include electronic ordering and secure messaging. Complete health history capture and sharing will be added to the new Clinical Network in the coming months. 

Nightingale Informatix finalizes the sale of its US-based PM business to Pulse Systems, with gross proceeds totaling $11 million. As part of the transaction, Nightingale and Pulse will refrain from selling into each other’s markets for three years.

Announcements and Implementations

Georgia Health Information Network successfully connects to Alabama’s One Health Record HIE. The state-to-state connection is the second for GaHIN, which connected with South Carolina’s HIE late last year.

Three Pennsylvania-based HIEs – ClinicalConnect HIE, HealthShare Exchange of Southeastern Pennsylvania, and Keystone HIE – join the Pennsylvania EHealth Partnership Authority’s Pennsylvania Patient & Provider Network. (You can read my interview with Pennsylvania EHealth Partnership Authority Executive Director Alix Goss here.)

Smartphone patient scheduling vendor Everseat joins Athenahealth’s More Disruption Please program.

People

Pam Stampen (American Family Insurance) joins Nordic as vice president of human resources.

Research and Innovation

A two-year study of eight primary care practices and three mental health clinics determines that there’s no seamless way to bring behavioral health and primary care data together into their different EHRs. Clinicians developed workarounds to handle duplicate data entry, different templates for primary care and mental health, and reliance on physician or patient recall for inaccessible EHR information. Researchers conclude that vendors and physicians work together to design EHRs that better support: integrated care delivery functions, including data documentation and reporting; integrated teams working from shared care plans, template-driven documentation for common behavioral health conditions; and improved registry functionality and interoperability.

Other

Peer60’s new standalone ambulatory facility EHR report (not ambulatory EHRs in general as other sites misinterpreted) finds that Epic and Cerner are tied for mind share leadership, with Epic holding a big market share lead. Meditech and Allscripts have decent market share in hospital-owned facilities, but zero mind share, meaning their customers are at risk for defecting. NextGen is also at risk since it has the highest market share among independently owned facilities, but also zero mind share in which Cerner, Epic, and eClinicalWorks dominate. Respondents said vendors should make their product easier to use, improve reporting, and improve practice management capabilities, although 32 percent say it won’t matter since the hospital dictates the EHR used.

Quartz takes a refreshing crack at removing unnecessary business jargon from Twitter CEO Jack Dorsey’s memo announcing 336 layoffs. My inner journalist only wishes the editors had used red lines instead of black. 

Sponsor Updates

• Influence Health will sponsor, exhibit, and present at the AHA’s Society for Healthcare Strategy & Market Development Conference in Washington, DC next week.
• Aprima will exhibit at the Oklahoma Primary Care Association event October 14-16 in Oklahoma City.
• EClinicalWorks will exhibit at The National Conference on Correctional Healthcare October 17-21 in Dallas.

Blog Posts

• How New Technologies are Expanding Care (Billian’s HealthData)
• ICD-10 Applying Lessons from Implementation (Greenway Health)
• 6 Steps to Building Your Own Plain-Language Glossary (Healthwise)

Contacts

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

More news: HIStalk, HIStalk Connect.

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MGMA 10/13/15

My third and final day at MGMA got started bright and early with a session led by Aledade CEO Farzad Mostashari, MD on the ways in which independent practices can thrive in an era of risk-based contracting. Dixieland jazz and clogging were not part of his presentation, though he did take the still-sleepy audience through his very own “I Decide to Cha Cha” mnemonic:

I = Incentives. Mostashari explained that independent practices need to align incentives with the outcomes they want to achieve.
D = Decision. Going the risk-based route takes courage, and once that decision is made there’s no going back successfully. I thought his observation,“People don’t hate change; they hate being changed,” was spot on given a previous day’s speaker’s belief that doctors are called doctors because they’ve been “indoctrinated” to hate change and love the status quo. 
T = Teams. Mostashari stressed the need for independent MDs to partnering with other organizations when moving to value-based payment models. “Just because you’re independent doesn’t mean you have to go it alone,” he added. Abiding by Amazon’s two-pizza rule is a good place to start when contemplating collaboration.
C = Change. Pull the trigger on those new partnerships and contracts, and commence transitioning.
A = Assess. All the change in the world won’t do you much good if your practice isn’t learning along the way.

Mostashari ended his dancing analogy by stressing a second “cha” – taking another look at ways the practice still might need to change and assess. I had the opportunity to chat afterwards with several folks from Aledade client Arkansas Foundation for Medical Care, a nonprofit that assists physicians with practice transformation. I pumped them for information related to the pain points their practices have experienced over the last year or two, learning that their clients have shown a lot of interest in figuring out how to engage patients in the use of healthcare IT tools, not to mention taking ownership of their own health. A lack of consistency around quality measures has also been a problem area for the Arkansas-based organizations. The entire AFMC team agreed that there needs to be standardization around quality measures, a problem they told me is exacerbated by the fact that EHRs are neither equipped or required to report on all of them.

I headed to the next session by way of a very popular and presumably comfy stairwell. I suppose this sort of thing is par for the course when you pull busy practice managers away from their daily routines. I’m sure I wasn’t the only one who was thankful for the speedy and reliable WiFi throughout the conference center.

I was happy that MGMA attendees were not shy about letting me share their well-shod feet with HIStalk Practice readers. I don’t think I’ve ever seen so many pairs of cowboy boots in my life. After my quick fashion digression, I headed to a session focused on creating high-performing medical groups, which was somewhat underwhelming when compared with the previous one. Where Mostashari had emphasized doing good for the good of the patient, representatives from Sutter Health and The Camden Group seemed totally focused on keeping physicians happy. An understandable consideration given the setting, but I was still surprised that the role of patient as a vital partner in creating that high performance was never brought up.

I sat next to Teri Paluso, administrator at ambulatory surgery center IPC Surgical in Louiston, ID. Paluso is living in an interesting world right now. Her practice is in the process of being acquired by the local hospital due in large part to the desire of the practice’s three physicians to retire within the next several years. IPC is literally picking up shop and moving to a new location as a result of the acquisition. Practice staff aren’t looking forward to jumping from their CompuGroup Medical system to the hospital’s new “latest and greatest” version of Meditech, which Paluso tells me by all accounts is very buggy. She confessed that she wonders if she’ll become part of the 30 percent of practice administrators that typically quits after a hospital acquisition.

After another quick lunch in the exhibit hall, I walked the show floor one last time, where I ran into folks from patient messaging vendor Dialog Health, CoverMyMeds, and Influence Health. I also got the chance to catch up with American Well Sales Executive Whitney Jordan, who took me through a tour of the company’s consumer app. To my knowledge, American Well was the only telemedicine vendor on the show floor – a smart move on the company’s part given several MGMA speakers’ observations that practices need to get ready to compete with up-and-coming business models like telemedicine and house calls.

My last stop in the exhibit hall was at the Skywriter MD booth, where President and CEO Tracy Rue walked me through the genesis of the Colorado-based startup, which has developed a real-time EHR documentation tool that incorporates remote scribes. Rue emphasized that while in-office scribes can slow down productivity, virtual scribes working in real time alongside the physician keeps the vital human element of coding intact.

My last stop of the day was into a session led by Marni Jameson, a former journalist, PR agency owner, and hospital marketer who now serves as executive director for the Association of Independent Doctors. Passions ran high as she recounted the ways in which a lack of independence hurts the local economy, physician employment prospects, and care quality. Her action items were fairly media heavy. I don’t see how a practice can effectively ward off a hospital acquisition by simply creating literature that explains to patients why it’s important not to cheat with hospital-employed MDs. While I found some of her pointers to be fairly pie-in-the-sky, the audience gobbled it up, even cheering at one point when Jameson sarcastically pointed out the “benefits” nonprofit hospitals bring to communities. 

My biggest takeaways from the conference include:

• ICD-10 is soooo September 30. Everyone seems to be moving on to more pressing issues and/or getting back to business as usual.
• Patient access (getting into urgent care, competing with/adopting telemedicine, etc.) seems to have replaced patient engagement on physician to-do lists.
• Collaboration is key, especially when moving from fee-for-service to value-based care.
• Chronic-care management is fun to talk about, but at this point challenging to understand and implement. Early adopters will find themselves popular speakers at next year’s event if they’re willing to share best practices.

I’d love to learn what other attendees thought of the show. Feel free to leave your observations in the comments below. We can compare retrospective notes at next year’s event in San Francisco.

Contacts

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

More news: HIStalk, HIStalk Connect.

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