5 Questions with Kian Raiszadeh, MD CEO, SpineZone

Kian Raiszadeh, MD is founder and CEO of SpineZone, a clinic-based operating system for back pain that includes a treatment protocol and software platform for managing patients through the lifecycle of back pain – from prevention and inception to resolution and recovery. The system is used by 120 patients a month across four SpineZone clinics in San Diego. These clinics have served as test sites to perfect the system’s clinical protocols and software platform. It is in the process of integrating scheduling and billing technologies from Athenahealth into the third generation of its home-grown EHR.

What role do analytics play in SpineZone’s treatment plans?
Analytics is central to the success of SpineZone. We have a treasure trove of data from all of the clinics that have been using the SpineZone system over eight years. Each additional back-pain patient adds data to our system, which in turn helps improve the diagnosis and treatment for every patient after them. Our analytics experts, academic researchers, data scientists, and PhDs are also helping us publish our results and build a clinical outcomes predictor. We exemplify the moniker “data-driven healthcare.”

All of the equipment patients use is set up to quantify strength, so we truly live by the phrase, “You can’t improve what you can’t measure.” We also track behavior by both patients and providers, and this is one of the main levers for impacting outcomes.

What coordinated care initiatives are currently underway?
All the medical groups who are seeing value from SpineZone are ACOs and IPAs (Independent Physician Associations) who are incentivized by the ACA to provide efficient, outcomes-based care. The teams running SpineZone consist of a multi-disciplinary team of providers ranging from PAs, PTs, MDs, and surgeons so each patient entering the system will get the appropriate level of service in each of their 20 visits. We require that “SpineZone Certified” providers are tightly integrated in treating back-pain patients, and we have very precise measurements to determine how successful each is.

Is SpineZone looking at utilizing telemedicine, wearables or apps in any of its treatment plans?
Absolutely. Currently, SpineZone has the technical ability to monitor patients over videoconference and we are testing use cases for how this can keep patients engaged in their back-pain recovery and lower costs for organizations using our technology. We are currently evaluating a posture sensor wearable from LumoBodyTech called the Lumo Lift, which provides patients with vibration reminders to correct their posture. Additionally, we are jointly working on a clinical study proposal for providing Lumo Lift posture sensor to SpineZone patients.

Do you foresee greater importance being placed on behavioral health in terms of healthcare IT innovation and government regulations?
Behavioral health is critical to account for and is one of the four pillars to treating patients with the SpineZone treatment protocol: Strength, Posture, Flexibility, and Behavioral Health. There is a wealth of knowledge, which we incorporate into our system, around the psychology of pain. We continuously strive to improve our screening and treatment of patients with concomitant anxiety, depression, and other behavioral health issues.

What do the next five years look like for the business?
Within the next five years, our system will be expanded to medical groups treating back pain throughout the country. We will own the non-operative as well as the post-surgical aspects of back pain, then we will expand our system to manage to all orthopedic conditions. Our plan is to also manage other chronic diseases and we are in talks with practitioners treating diabetes and obesity.

Contacts

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

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HIStalk Practice Interviews Ken Comée, CEO, CareCloud

Ken Comée is CEO of CareCloud.

Tell me about yourself and the company.
My focus over the past 20 years has been on working with high-growth tech companies, particularly those who are at an inflection point, helping them scale their operations and evolve into market leaders. I’ve been working with CareCloud for the past three years now, and have had a front-row seat to the unique opportunities we have ahead of us. My role as CEO is centered on bringing my experience in these situations to help accelerate our potential.

How do you and Albert Santalo plan on working together? What will next steps be for the company with this new leadership structure?
I’ve had the pleasure of getting to know Albert over the past few years. Albert will continue being the entrepreneurial visionary he’s always been, and he remains the chairman and founder. He and his team have accomplished so much in such a short amount of time. For me, I’m really impressed with the opportunities emerging in healthcare. It’s an exciting time, and I look forward to continuing to work with Albert as we drive the industry forward through a cloud-based and open platform.

Can you give us specifics about what the new investment of $15 million will go towards?
We plan to enhance our product offerings and to continue providing a world-class customer experience. We’re laser-focused on helping healthcare organizations successfully navigate the myriad regulatory and business challenges they face. CareCloud is, and always has been, committed to building the premier platform in healthcare.

HIStalk Practice readers have expressed skepticism about CareCloud’s operational performance given the change in leadership and history of investments. How would you counter that skepticism?
It’s not uncommon for a company that is scaling as fast as we are to experience some growing pains. I’ve seen this storyline play out a few times and it’s almost expected given the circumstances and where we are today as a company. Regarding the recent investment, the current funding climate favors companies in CareCloud’s enviable position. We’re doing really well, and if the first quarter of 2015 is any indication, we’re poised to see incredible momentum throughout the year, especially as we help more and more large medical groups move onto the cloud.

What healthcare IT tools do you see as essential to the success of physician practices? How is CareCloud making a play in this space?
The suite of solutions physicians need to excel at clinical, financial, and administrative operations continues to expand. What we’re seeing is customers increasingly asking for flexibility and freedom of choice. CareCloud has always believed that too many vendor options are overly restrictive – essentially forcing medical groups to agree to an entire package up front and adopt all of their services. We don’t believe this all-or-nothing approach is the right solution; rather, we want to offer our customers an ecosystem of options that extends our core product suite. The cloud is really the only way to make that seamless integration experience a reality.

How do you foresee the partnership with Marshfield Clinic Information Services progressing?
We’re really excited about the tremendous potential of this partnership. It just makes sense to us on so many levels. MCIS brings its incredible clinical solutions, including its physician-designed EHR, patient portal, and population health management tools. CareCloud contributes our core strengths surrounding workflow and operational efficiencies.

Have you had any provider feedback related to the scaled back Meaningful Use criteria, particularly pertaining to the lowered patient engagement threshold?
We have not heard strong reactions either way, and we still believe patient engagement remains essential.

Where do you foresee taking CareCloud in the next five years?
We see our largest customers dealing with a whole host of challenges & opportunities. Our goal is to help them meet and exceed their business and operational needs by leveraging the premier cloud-based platform for healthcare.

Do you have any final thoughts?
It’s amazing what CareCloud has managed to accomplish in such a short amount of time. I’m honored and elated to take the helm of this young growth company, one that Albert and his team have built and positioned so well. The mission of the company remains to deliver beautiful software that is easy to use and powerful rather than burdensome and complex. My charge going forward is to make CareCloud operationally excellent, accelerate our growth, and continue to drive us toward future innovations as yet unseen in the industry.

Contacts

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

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News 5/20/15

Top News

Ohio-based Updox secures a $3.5 million line of credit from SaaS Capital with which it will add more features to its secure messaging and CRM solution for physicians. The company received Edition 2 ONC-HIT Modular Certification for Direct Secure Messaging last month.

Webinars

Here’s the video and Twitter recap from Tuesday’s webinar with Imprivata, which featured tips on how to prevent phishing attacks at healthcare facilities, as well as lessons learned from Yale New Have Health System.

May 27 (Wednesday) 1:00 ET. “Introducing Health Catalyst Academy: An Innovative Approach for Accelerating Outcomes Improvement.” Sponsored by Health Catalyst. Presenters: Tommy Prewitt, MD, director, Healthcare Delivery Institute at Horne LLP; Bryan Oshiro, MD, SVP and chief medical officer, Health Catalyst.  The presenters, who are graduates of Intermountain’s Advanced Training Program, will introduce the Health Catalyst Academy’s Accelerated Practices program, a unique learning experience that provides the tools and knowledge for participants to improve quality, lower cost, accelerate improvement, and sustain gains.

Acquisitions, Funding, Business, and Stock

Beverly Hills, CA-based National ACO taps consulting firm Risarc to manage its participation in the Medicare Shared Savings Program, including oversight of its population management metrics for quality improvement.

Announcements and Implementations

Reno Sparks Tribal Health Center (NV) selects NextGen’s EHR, PM, and EDR to replace its “end-of-life” software system and prepare for Meaningful Use Stage 2 and transition to ICD-10.

The Palm Beach County Medical Society endorses the HealthFusion MediTouch EHR for its 1,400 physician members in Florida.

ADP AdvancedMD launches patient and administrative kiosk apps, plus corresponding electronic check-in and consent forms.

Southeast Texas Imaging implements business intelligence tools from Zotec Partners, including Comprehensive Zotec Analytics and Reporting.

WebPT chooses NobilityRCM to handle the revenue cycle component of its EHR and PM systems for physical, occupational, and speech therapists.

CollaborateMD launches a patient payment portal and integrated credit card processing.

Forerun Inc. joins the ADP Advanced MD Marketplace to offer ADP PM clients its UrgiChart EHR for urgent care.

Kareo unveils an EHR app for the Apple Watch. Features include appointment reminders and information, secure messaging, agenda, pre-set messages, and “glances” at key practice metrics.

Government and Politics

Twelve patient advocacy groups write to CMS on behalf of the Coalition for Better Care, urging it to include Meaningful Use as a quality measure in Next Generation ACOs, a criteria the agency dropped earlier this year. The authors also point out the importance of primary care: “We believe that the most successful ACOs will be grounded in comprehensive and well-coordinated primary care – a truly patient-centered medical home. As CMS evaluates Next Generation ACO applicants and considers future evolution of the program, these core elements must be a driving force.”

Don’t forget: EPs who wish to apply for Meaningful Use hardship exemptions must do so by July 1. Exemptions are available to providers who show they couldn’t comply with the program’s requirements because of circumstances beyond their control.

Telemedicine

Fruit Street Health taps Validic to integrate wearable devices and applications into its telehealth software, PHR, and video-conferencing platform.

The Broadband Opportunity Council seeks comments from all interested parties who would like to “share their perspectives and recommend actions the Federal Government can take to promote the deployment, adoption, and competition for the use of broadband technology.” Established two months ago by President Obama, the council includes 25 government agencies who are working to better understand the barriers to and opportunities of broadband adoption, particularly in rural communities. I can only assume that telemedicine will tie into the council’s future reports and projects. Comments are due June 10.

The Connecticut Senate passes a bill establishing standards for telemedicine, including prohibiting physicians from using it to prescribe controlled substances and requiring that the telehealth provider give records of the interaction to the patient’s primary care provider if consent is obtained. The standards also state that providers offering telemedicine services to people in Connecticut would have to be licensed here, but wouldn’t be required to have a physical office in the state. The measure would also require insurance plans to cover telemedicine services.

Research and Innovation

A Surescripts report finds that just 1.4 percent of physicians prescribe controlled substances electronically, despite the fact that the ability to do so is now legal in 49 states and 73 percent of pharmacies are ready to receive them.

An AmericanEHR Partners report breaks down EHR use by vendor and practice size. Given that the report would cost me $499 to dig into, I can only share high-level nuggets: Practice Fusion holds the most market share within solo practices, while Epic and Allscripts have a hold on the most end users.

People

Jonathan Scholl (Texas Health Resources) joins Leidos as health and engineering sector president.

The American College of Physicians appoints Daniel “Danny” Sands, MD (Society for Participatory Medicine) to the new Advisory Board of its Center for Patient Partnership in Healthcare.

Other

Cardiologist Aseem Malhotra points out what many healthcare technophiles may not want to admit: FitBits and other wearables won’t turn the obesity epidemic by themselves. Healthy eating should be the first step in a weight-loss program – not plunking down hundreds of dollars on the latest smart gadget.

Vermont Information Technology Leaders President and CEO John Evans lays out the ways in which the state’s HIE is improving care coordination and access to health data across the state. The VHIE collects and indexes health data from 17 hospitals and over 170 other healthcare locations, and works with three of the state’s ACOs and its Blueprint for Health chronic disease management program.

Sponsor Updates

• ADP AdvancedMD explains “What the Meaningful Use deadline means for your practice” in a new blog.
• Culbert Healthcare Solutions offers a new blog on “Improving Population Health using Epic’s Healthy Planet.”
• Microsoft blogs about its experience demonstrating nVoq’s SayIt speech-recognition solution on Surface Pro 3 tablets at HIMSS.

Contacts

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

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HIStalk Practice Interviews Robert Wah, MD President, AMA

Robert Wah, MD is president of the American Medical Association and serves as CMO of Computer Sciences Corp. He also practices and teaches at the Walter Reed National Military Medical Center and National Institutes of Health in Bethesda, MD.

How did AMA’s relationship with Matter Chicago come about? I got the chance to stop by the health IT startup hub’s new offices while in Chicago for HIMSS last month, and am looking forward to seeing the AMA “Physician Office of the Future” that will eventually be housed there.
I’ve been on the board for about 10 years, and during that time we’ve been really pressing to expand our horizons to look more at innovations, as well as what I call service delivery excellence, in all that we do in the AMA. The Matter relationship is just a fruition of some of the work that we’ve been doing to think about how we, as a 107 year-old organization, can continue to look to the future. Because we’re co-located in Chicago, it’s an easy geographic relationship to establish, plus Matter is also on the cutting edge of providing a structure, framework, and physical location where we can start working on these innovations that we’ve been talking about. It will be a good ecosystem where we can start testing new ideas to see how they work together and actually fit in place.

Given AMA’s focus on innovation, how have you seen that buzzword take on more concrete meaning over the last several years?
Innovation today is tomorrow’s reality. As we’ve talked about innovation over the years, many of those things have come to fruition and are real today. Some didn’t progress as we might have expected five years ago. My background is in health information technology. We certainly are seeing a significant conversion from paper-based systems to digital-based systems. The innovation that’s going to follow after that conversion I think we have yet to completely see. Obviously, it’s a big step just to get off of paper onto a digital platform. I think we are all expecting and hoping to see the benefits of moving from paper to digital. That’s where I think the future innovations will come from.

We’ve got some examples of it. The example I often use comes out of the DoD. I haven’t written a prescription on a piece of paper in a military facility in over 20 years, and that’s a remarkable statement. The benefit is that now I have the ability to check against a real-time database to make sure that anything I’m prescribing today isn’t going to interfere with something the patient’s already on or duplicate it, or interfere with an allergy. That’s pretty remarkable. We’ll see more of that expand as more information becomes available digitally and it’s networked together. I’m pretty excited about all that. I think there’s been a lot of bumps in the road and probably more to come as we progress down this pathway, but the promise is great. There’s still a lot of pitfalls along the way, though.

How do you foresee innovation impacting interoperability? Will that ultimately come from the government, established businesses in the private sector, or startups?
It’s going to come from all three. I think that there is potential for all of them to have significant impact on interoperability. The DoD will certainly play a leadership role. On the industry side, it’s going to be new companies we’ve never imagined before coming into the industry to disrupt the status quo, which may lead to interoperability. At the same time, they will put pressure on the established systems in the market to also move towards interoperability because that’s the nature of competition. I think all three of those entities will have a hand in moving us to an interoperability ecosystem.

There’s been a lot of talk lately around “information blocking.” How do you foresee digital health tools moving data exchange forward?
I think that in many way the big “aha” moment in most technology industries was the establishment of enterprise resource planning systems, where the data is pulled from around the enterprise and made available to everyone, making the whole enterprise much more effective and efficient.

As in a manufacturing company, they used to have a sales part of the organization, a manufacturing part of the organization, a finance part of the organization, and logistics to get raw materials. When ERP came in, all of those functions were putting data into the same system so each part could see what the other area of the enterprise was doing. When somebody took an order in on the sales side, it immediately alerted the logistics people to get raw materials to make the manufacturing part of the company ready to produce whatever the sales person just sold. That’s an example of an ERP radically improving an enterprise.

In some ways we’ve had an expectation that the EHR would be the ERP for healthcare. Physicians are frustrated about having to be the data source and the data entry system for the ERP of healthcare. We as physicians would like the electronic record to return to its roots of being a clinical record of information rather than also being a compliance tool, finance tool, and a resource tool. All of the functions that we’ve laid onto the EHR that are more appropriate to an ERP system requires a doctor to meet all those requirements. That’s one of the big frustrations we have. I’m hoping that in the future there’s going to be a new layer that gets established that serves all those ERP functions and allows the electronic record to go back to its natural roots, which is to be a depository of clinical information.

You mentioned freeing up the doctor. How do you see physicians responding to the increasing role of patients in their own care?
I think we as physicians want to find a way for them to be able to fulfill that desire to engage. Electronic records and digital systems are one way that they can do that. I think we’re all interested in finding better ways for us to be able to engage our patients.

Last fall, the AMA put out our paper on the things that we’d like to see happen to improve electronic records. We convened a group of health IT experts and practicing physicians to develop a paper that answers the question, “If you were able to sit down with an EHR vendor tomorrow, what would you ask for?” There were eight major points they wanted to see improved in EHRs. One of those eight points was that EHRs should be able to accommodate this desire of our patients to engage, as well as use mobile devices.

When it comes to patient engagement, what are your thoughts on the scaled back Meaningful Use criteria? Are physicians breathing a sigh of relief?
We’re encouraged by the fact that it appears CMS and the ONC have heard the concerns we’ve been raising about Stage 2. It does look like they’re trying to respond to some of them. We have been concerned that, in many cases, physicians are responsible and at risk to be penalized for things that they don’t ultimately control, like how often a patient decides to connect to the office via a patient portal. That’s very hard for us to have any control over. We can’t follow them home and ask them to log in. It’s a very desirable thing that we do it, but it’s just hard to see how a doctor can necessarily control that. That was a big challenge for us. Fortunately, it looks like there’s going to be more flexibility coming from CMS and the ONC.

Your military background is fascinating to me. How do you see digital health innovations impacting the care of service members and veterans?
Obviously I’m biased, but I think the military healthcare system provides some of the best care in the world. I certainly believe we provide some of the best medical education and training anywhere in the world. I’ve been privileged to be a part of the military health system for most of my career. At the same time, I’ve had the opportunity to be on the faculty of several medical schools, including Harvard. From that perspective, I can say very confidently that military and federal medicine provides some of the greatest care in the world. I’m very optimistic and encouraged that they will continue on that trajectory of always providing great care for our military service members, their families, the retired, and our veterans. I think they are at the forefront in many cases of using technology to do that.

As I noted earlier, that real-time database is a really unique thing and it’s all powered by the fact that we’ve had the ability to write electronic prescriptions for so very long. I think we’re way ahead of private healthcare in that regard. I think right now they are in the process of looking at how we take the next leap in health information technology, both from the DoD and the VA. They are looking for flexibility and agility, and how to use technology to take better care of your patients. I’m very encouraged by that.

What are your plans once your time as AMA president ends next month?
I hope to continue to see patients and teach. I really find that very rewarding. I’ll continue to serve on the AMA board for an additional year as the immediate past president. Beyond that, I’ve had a lot of offers and some pretty exciting opportunities come my way, and I’ll be looking at those over the next 12 months.

Contacts

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

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From the Consultant’s Corner 5/19/15

Patient Access and Physician Compensation: Why Marrying These Two Concepts is Critical to Success

At first glance, there might seem to be little correlation between patient access and physician compensation. Access models have always affected a patient’s ability to receive appropriate healthcare in a timely manner, yet providers seldom have any vested interest in actually fostering access to their services.

Healthcare organizations can overcome that challenge by aligning access goals with physician compensation. In turn, they stand to realize greater patient satisfaction and loyalty, improved care quality, and overall increased provider and staff productivity and utilization.

Access Matters
Access to care is a primary requisite for managing a patient’s overall health throughout the care continuum. After all, patients who cannot get timely access to the appropriate care are likely to look for it elsewhere — thus preventing a health facility from being able to effectively manage the patient’s outcomes and care costs.

Unfortunately, barriers exist in many healthcare organizations that prevent unfettered patient access. For example, primary care providers who migrate from private practice to hospital employment frequently have difficulty referring patients to specialists — particularly newly employed ones — within the system. This issue is especially problematic in organizations such as academic medical centers, where specialists must balance time between patient care, teaching, and research. Specialist scheduling templates often fail to accommodate an appropriate mix of patient volume by visit type and payer.

Unfortunately, we have identified far too many schedule templates that were not set up to treat enough patients to cover base salary productivity expectations. The health system therefore loses money on both the employed primary care providers and the specialists — not to mention the negative impact on patient satisfaction.

Patients caught in situations such as these may either leave or be referred outside the health system. The factors behind leakage not only frustrate patients, but also thwart the health system’s goals to acquire and retain new patients. Likewise, leakage hampers a healthcare organization’s ability to manage patient care in terms of quality and cost containment.

To address this problem, organizations must consider patient access as part of provider compensation. For instance, employed physician compensation plans should include baseline targets for new patient visits, as well as overall physician productivity expectations. Moreover, clinical integration models including full employment or clinical alignment programs should contain a financial model for monitoring the downstream revenue captured by the hospital or specialty areas.

Steps Toward Better Compensation Alignment
Adjusting an organization’s compensation strategy to re-enforce patient access goals requires a concerted approach. Here are a few strategies for practices and hospitals to keep in mind:

· Review the current plan. Look first at physician compensation from a historical perspective. Then, determine to what degree the current plan reflects productivity and performance objectives. As part of this process, review industry and regional benchmarks by practice specialty as a guide to reasonable productivity and compensation levels. Planning carefully and making small changes over time can help ensure the effective alignment of compensation with long-term goals.

· Examine scheduling. Make sure schedules are set up to support patient volume by specialty and visit type. For example, the number of patients a cardio-thoracic surgeon is expected to see should be very different from that of a primary care physician. As a result, it is necessary to consolidate and standardize visit types and duration within various specialties. For example, one practitioner should not be allowed to spend an average of an hour with each patient if other practitioners in the same specialty spend an average of 15 minutes.

In addition, to achieve organizational growth objectives, compensation plans should encourage providers to see some combination of new and existing patients. New patients represent incremental revenue not just to the practice, but to the entire health system. Remember that in order to access downstream revenue from employed physician models, new patients must be able to see the employed primary care physicians and specialists, plus have access to the full range of health system services.

· Regularly review the plan. An organization should establish a periodic review process to ensure that the plan is working and that it incentivizes the intended behaviors—all while mitigating any unintended consequences. Equally important is a degree of on-going physician dialog and engagement around the plan. Organizations should provide a forum that allows providers to ask questions and voice concerns. This type of communication platform allows leadership to resolve issues before they become larger problems.

Achieving synergy between patient access and physician compensation should be an ongoing exercise. Although it may seem like a daunting task, healthcare organizations do not have to go it alone. By consulting with peers and outside experts, practices, hospitals and health systems can design compensation plans that successfully align with their overall patient access and performance goals.

Brad Boyd is vice president of sales and marketing for Culbert Healthcare Solutions.

Contacts

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

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