5 Questions with Karen Schogel, MD Health Informatics Director, Genesis Medical Associates

Karen Schogel, MD is health informatics director at Genesis Medical Associates (PA). It employs 200 clinical and ancillary staff to care for over 143,000 patients each year across the practices, hospitals, nursing homes, and personal care homes it serves. The organization, which uses the GE Centricity CPS 12.0.7 EHR platform, will attest to Stage 2 of Meaningful Use this year, and has been certified as a Level 3 Patient-Centered Medical Home. It launched Pittsburgh’s first Medicare ACO, Keystone Clinical Partners, late last year with nearby Preferred Primary Care Physicians.

How is the ACO with Preferred Primary Care Physicians coming along? Are patients receptive?
We have 2,500-plus patients enrolled and they are all receptive. Our board and committees (clinical, quality, and finance) are very active. All physicians are engaged.

How has IT played a part in getting the ACO up and running?
Utilizing our IT will make it possible for us to track patients by disease, results, and consults. We’re waiting for specific roster, cost, and quality data from Medicare.

Is GMA looking at participating in population health management programs, or eyeing any PHM-specific IT at the moment? If so, what other organizations are you working with on this?
Yes. Via MU2, we are reporting Immunization status to Pennsylvania. We are working with a local healthcare system, Allegheny Health Network, to become involved in their Tapestry HIE.

How has GMA staff reacted to Stage 3 Meaningful Use criteria? 
We have not yet attested for MU2 and are not aware of the MU3 suggested guidelines. Our biggest challenge remains the measure that relates to patient use of their data online. Each office is being creative to get patients enrolled on our portal, and to encourage them to then view their data. We are using eZaccess from Strategic Business Systems as our patient portal. To help meet MU2, we have begun working with Treatspace in two ways. First, we use their Patient Network product as a means to reach out to patients over a clinical social media-like platform. Secondly, and more importantly, we’re using Treatspace Referral Network as a tool to manage the referral process with specialists and diagnostic facilities. The management of referrals is critical to report on PCMH measures, and as a means to control costs. As a group, we have not tackled MU3 yet.

How have you seen GMA’s business model change to keep up with the rise in retail and urgent care clinics?
This is a big challenge for all primary care providers. Each office has expanded its available hours (i.e. early a.m., lunchtime or after hours). We have advertised the concept of “Call us First” via our website and social media channels to remind patients that PCP involvement in all healthcare encounters is pivotal to their overall health, and to remind patients that we understand all of their concerns, even the simplest. We will have our first smartphone app in June, which will provide secure texting for the purpose of same-day office scheduling.

Contacts

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

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Readers Write: Patients Are Looking for Retail Experience … And They’ll Switch Providers to Get It

Patients Are Looking for Retail Experience … And They’ll Switch Providers to Get It
By Tom Giannulli, MD, MS

Like the retail sector, healthcare is in motion. Money talks, and when people aren’t happy they take their money elsewhere. Nearly 60 percent of patients switch physicians because of better service or treatment. Even more striking is that two thirds of patients say they would switch just to get a provider with an EHR and patient portal.

As a result, physicians have to look at how they find and keep patients in a new way. Patients are no longer just patients; they are healthcare consumers. Service, access, and cost all play a role in who they choose for their provider. To adapt to these changing conditions and stay competitive with larger healthcare systems and retail clinics, independent practices need to understand patient expectations and meet them head on.

Today, 60 percent of patients say digital services play an important role when choosing a physician. Specifically, many are interested in having a provider who offers online scheduling, secure online communication, and text and email reminders and recalls. Beyond that, patients are looking online for information, reviews, and resources. Specifically, they are checking you out on social media. Over 40 percent of consumers say that information found via social media affects the way they deal with their health.

A recent survey conducted by Kareo found that practices are taking notice of these trends. Forty-two percent said they were looking to add social media and online reputation management in 2015. In addition, 36 percent were planning to add text or email reminders, and 21 percent were planning to offer online scheduling.

For providers looking to make these changes, there are some basic steps to take to getting these tools in place.

Before looking at new vendors, practices should always look at current solutions. The PM, billing, and EHR software may already have some of these key features or provide an integrated third-party solution. With so much to do, it is easy for staff to miss news about updates and features.

Since 73 percent of patients are more loyal when there is access to a patient portal, this is a good place to start. The EHR may already offer a patient portal, and it might have some of the key features like secure online communication, an appointment request or online scheduling feature, and other beneficial tools like online bill pay. The PM system might also offer email reminders. If these features are not in existing software, providers should ask about integrated practice marketing tools. An existing vendor partnership could mean valuable discounts and time-saving integration.

If a practice can’t get everything through an existing source, here are some tips to get the most from a third party. Look for a single solution that offers many features. It might not be everything, but perhaps the practice can find an option that provides the top three or four features patients most want:

1. Forty percent of patients prefer to be contacted online or via text or emails, so a solution that can offer text and email reminders and recalls, as well as options for post-visit follow up like surveys is critical.
2. 2. Online scheduling, which over 50 percent of patients think is important, is another key feature. A simple widget on the website can be enough, but this needs to be supported by a good website and SEO so that new patients can find the practice.
3. 3. Since two-thirds of patients used online search prior to booking an appointment, patients need to be able to find the practice. A vendor that offers help with website, SEO, social media, and/or reviews and ratings is a must.

Providers should keep in mind that a small investment for these services will pay off in increased revenue as well as patient satisfaction. Reminders can reduce no-shows and last-minute cancellations by 30-50 percent, and online scheduling can help fill empty appointment slots. If the average practice can prevent one no-show and add one new appointment a day, it can increase revenue by up to $50,000 a year.

It is time for providers to start thinking a little more like retailers. Top stores do everything they can to stay connected to their customers, find out what they want, and offer it. It increases satisfaction and loyalty. Practices can do the same by taking advantage of solutions that may already be available or by finding a practice marketing platform that makes up the difference. The payoff will be more than worth the investment.

Tom Giannulli, MD, MS is CMIO at Kareo of Irvine, CA.

Contacts

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

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News 3/26/15

Top News

President Obama formally unveils the Health Care Payment Learning and Action Network as part of a day of activities marking the fifth anniversary of the ACA. Funded by CMS, the network will help the administration tie Medicare payments to quality via new payment models like ACOs and bundled payments. Over 2,800 providers, payers, and other stakeholders have signed up for the network. According to the administration, the network will:

• Reward doctors who diagnose patients correctly the first time.
• Cut red tape to increase communication between specialists, primary care doctors, and patients. 
• Work with doctors, nurses, and hospitals to ensure the best quality follow-up care after long hospital stays.

HIStalk Practice Announcements and Requests

My college buddy (and HIT marketing whiz) Jessica Clifton has been on the hunt for the perfect pair of shoes to wear to HIStalkapalooza, which she may have already found if her picture to the left is any indication. They’d surely guarantee her a nomination for the HIStalkapalooza award for best shoes. Having judged the shoe competition for the last several years, I can tell you that the male and female winners are always shod in unique, often sparkly footwear. I’m still waiting for one of the guys to beat out Timur Tugberk’s high-flyin’ high-tops. Needless to say, the bar is high, so put down those MUS3 regs and let the shoe shopping begin!

Webinars

March 31 (Tuesday) 1:00 ET. “Best Practices for Increasing Patient Collections.” Sponsored by MedData. Presenter: Jason Bird, director of client operations, MedData. Healthcare is perhaps the last major industry where the consumer does not generally have access to what they owe and how they can pay for their services. Collecting from patients is estimated to cost up to four times more than collecting from payers and patient pay responsibility is projected to climb to 50 percent of the healthcare dollar by the end of the decade. Learn how creating a consumer-focused culture, one that emphasizes patient satisfaction over collections, can streamline your revenue cycle process and directly impact your bottom line.

Acquisitions, Funding, Business, and Stock

PHI disclosure management business MRO Corp. acquires United Records Solutions, a release-of-information service provider, for an undisclosed amount. URS President Bo Stoianoff will join MRO’s management team as Northeast director of client relations.

Aledade partners with the West Virginia Medical Institute to help primary care physicians in the state form and operate an ACO. The company has entered into a similar partnership with HIT consultancy Qsource to create a primary care physician-led ACO in Tennessee.

Humana reconfigures some of its existing population health businesses under the Transcend name: Transcend, which will offer management services (the former Humana MSO) and Transcend Insights, the IT group (the former Certify Data Systems, Anvita Health, and Nliven Systems). The company also made news this week with the sale of Concentra, a chain of 300 clinics and urgent care centers, to Select Medical Holdings Corp for $1.05 billion.

Josh Umbehr, MD makes the case for pulling primary care services out of the insurance system. His direct-pay practice in Wichita, KS charges patients less than $10 for most medications, and nothing for procedures that can be done in office. “Direct primary care is all about creating value,” Umbehr explains. “It’s the same for better products and the same for better price. The workloads are less, but the patient care is maximized. And there’s no wasted effort for billing insurance. You don’t need insurance for blood work that costs a dollar or medicine that’s a penny a pill. I think even insurers were shocked to learn we could do so much.”

Announcements and Implementations

Continuum Health Alliance (NJ) selects Caradigm for population health management.

Advocate Physician Partners selects RCM technology from the Burgess Group to provide network pricing, payment integrity, and claims editing and management services for its Medicaid population.

Practice Fusion integrates Wolter Kluwers Health’s Medi-Span core drug database into its EHR platform.

AMC Health and Qualcomm Life integrate Qualcomm’s 2net Connectivity Platform with AMC’s CareConsole care coordination platform in an effort to increase connectivity and care coordination for patients suffering from heart failure, diabetes, hypertension, asthma or COPD.

AMGA selects Avatar Solutions to provide enhanced services for its Patient Satisfaction Benchmarking Program, including CG-CAHPS surveys.

Telemedicine

Seniors Wireless launches its TeleMed Assist service, which offers the elderly “unlimited access to board-certified doctors 365/24/7 from their phones” for a monthly fee or at pay-as-you-go rates.

A study finds that children with ADHD who received psychiatric and primary care via telemedicine improved significantly more than children who received treatment during a traditional office visit with their PCP.

Research and Innovation

Walgreens adds information from PatientsLikeMe to its personal health dashboard, allowing people who are taking a particular medication to see what side effects others have reported.

An Athenahealth report finds that physician practices have not experienced a sharp increase in new or sick patients scheduling appointments in the year since ACA coverage expansion took effect.

A Journal of Medical Internet Research literature review finds that the combination of systems medicine and large-scale data sharing via technologies like EHRs could help make substantial progress towards stopping, curing, and preventing non-communicable diseases.

Juniper Research determines that revenues from connected healthcare and fitness services will close in on the $2 billion by 2019. That’s almost six times the current estimate of $320 million for this year. I wonder how much of that will be attributed to Apple Watch’s $10,000 price point.

Government and Politics

Congressmen Robert Hurt (R-VA) and Collin Peterson (D-MN) introduce bill H.R. 1446, the Healthcare Consumer Privacy Act, to enable consumers to remove their profiles from Healthcare.gov.

The Daily Show’s Jon Stewart takes the VA to task for its attempts to ameliorate the long appointment wait times the agency has taken so much heat for in the last several years. He also calls out its “continued use of software that is as old as Keira Knightley.” (Knightley is 29, by the way.)

And speaking of the VA … I’m glad I’m not the only one confused by Rep. Phil Roe, MD’s (R-TN) decision to reintroduce legislation that would create an EHR system for military members and veterans. Politico dug into how the Integrated Electronic Health Records for Military and Veterans Act  differs from the $11 billion DHMSM project, learning from Roe’s office that, “The DoD is moving forward with a competition, but they are missing the most important feature of a new EHR system – that it be compatible with the VA system so that service members can have a seamless transition from active duty to civilian life. Why should taxpayers spend $11 billion if they aren’t compatible?”

People

Robert LaPorte (Health Start Partners) joins The Huntzinger Management Group as client executive.

Jitin Asnaani (Athenahealth) joins CommonWell as its first executive director.

Other

John Sotos, MD cardiologist, flight surgeon and former medical technical adviser to the television series “House,” calls for a national patient-record query system that would “complement, not replace, today’s gold-standard source of clinical information, the randomized trial.”

Hugo Campos laments the fact that he can’t access the health data generated by his implantable cardioverter defibrillator, which he has to have surgically replaced every seven years:

“The reasons patients are left out of the equation are numerous, including regulatory and liability concerns. But at the center of it all lies the fact that to manufacturers, the doctor is king and most doctors aren’t asking for data to be shared with their patients. I also suspect that companies fear that giving patients their data may cut doctors out of the care circle, resulting in a loss of revenue. So patients remain without online access to their own heart data and tethered to the clinic for hard copies of reports. This antiquated model is a significant barrier to self-care.”

Sponsor Updates

• RelayHealth Financial announces a new version of its RelayAccount online patient billing solution.
• ADP AdvancedMD offers “6 facets of patient safety within a small private practice.”
• Clockwise.MD Founder Mike Burke shares what he’s learned in the startup world at the #30in30 event at Atlanta Tech Village.

Contacts

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

More news: HIStalk, HIStalk Connect.

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News 3/24/15

Top News

HHS, CMS, and ONC publish proposed rules for Meaningful Use Stage 3 and 2015 Edition EHR certification criteria, alerting their email subscribers at 4:20 pm on Friday afternoon. The Stage 3 rule is here and 2015 certification criteria here. Lt. Dan provides a concise write up of patient engagement key criteria here, while the comments of several passionate HIStalk readers can be found here. Given my interest in physician practices, I reached out to Jim Morrow, MD of Morrow Family Medicine (GA) to gauge his reaction:

“In a nutshell, I am concerned about anything that is out of my hands. I can’t control which patients decide to use the portal or how many. To paraphrase Yogi Berra, ‘If patients don’t want to use the portal, who’s going to stop them?’

That’s my biggest concern. The other is that in order to be able to report on secure messaging, and specific topics as well, vendors will have to spend a great deal of time and money writing all this new code when they could be making the entire EHR better for everyone.

I was a huge proponent of Meaningful Use at the start, and I still believe in it at its foundation, but adding more and more work for vendors and doctors will not make for better care. We need to let these technological wizards work their magic on their solutions in ways that can make patients’ lives, and their care, better. What I have seen of Stage 3 to this point will not do that.”

I’d love to hear the opinions of other physicians on how this next phase of MU will impact patient care and business models. Share your thoughts via the comments section below.

Webinars

March 31 (Tuesday) 1:00 ET. “Best Practices for Increasing Patient Collections.” Sponsored by MedData. Presenter: Jason Bird, director of client operations, MedData. Healthcare is perhaps the last major industry where the consumer does not generally have access to what they owe and how they can pay for their services. Collecting from patients is estimated to cost up to four times more than collecting from payers and patient pay responsibility is projected to climb to 50 percent of the healthcare dollar by the end of the decade. Learn how creating a consumer-focused culture, one that emphasizes patient satisfaction over collections, can streamline your revenue cycle process and directly impact your bottom line.

Announcements and Implementations

Allscripts will market and resell NoteSwift 2.0 for Allscripts Professional EHR. Speech-recognition technology vendor NoteSwift has similar partnerships with Amazing Charts and Aprima.

The Physician Alliance (MI) expands its use of Wellcentive’s population health management solution by adding end users, implementing care management technology, and adopting the company’s quality data management services.

Canada-based Nightingale Informatix Corp. releases version 10 of its EHR product to U.S. physicians using its Medium PM technology. It will be made available to all U.S. and Canadian customers this summer.

Hot on the heels of the MUS3 announcement comes Athenahealth’s  proclamation that nearly 93 percent of physicians using athenaOne services successfully attested for Meaningful Use Stage 2 in 2014. The company also announced expansion of its Guarantee Program to include value-based reimbursement for the Physician Quality Reporting System and Medicare Shared Savings Program.

Acquisitions, Funding, Business, and Stock

A local newspaper interviews several Iowa-based physicians about the pressures of moving to hospital employment and value-based business models. “Most of us are not trained to run a business or do HR or do payroll,” says Mercycare-employed Timothy Sagers, MD. “When those core functions are delivered on a system level, it frees me up to be a doctor. I want to do medicine not run a business. There’s no doubt in my mind that we’re going in the right direction. But it’s costly to adapt.”

IBM invests an undisclosed amount in Modernizing Medicine, which is working on Watson-powered ambulatory clinical decision support.

Population health management system vendor ZeOmega acquires HealthUnity, which offers private and public HIE, MPI, referral management, and patient consent interoperability solutions. Mr. H interviewed ZeOmega EVP and Chief Strategy Officer Nandini Rangaswamy about the acquisition here.

Government and Politics

The IRS takes a cue from Healthcare.gov and attempts to push the majority of its customer service interactions online via tools like Where’s My Refund? The agency, which has answered just 43 percent of taxpayers’ phone calls this tax season (many no doubt having to do with insurance subsidies, penalties, and exemptions), is well aware of the need to take its digital services one step further, but is stymied by lack of funding. 

Meanwhile, Healthcare.gov CEO Kevin Counihan suggests that tax payers with errors on their 1095-A healthcare tax forms call the agency’s 1-800 number for assistance. Hopefully more than 43 percent of those phone calls will get answered.

Acting VA CIO Stephen Warren says that even though the DoD is shopping for a commercial EHR, the VA will stick with VistA because it was developed for patient care rather than built around billing as were commercial systems. 

HCentive will offer state-based health insurance exchange marketplaces for "lease" in an effort to help those states who intend to move from Healthcare.gov to a state-run HIX. The company’s WebInsure State Exchange product has been tested by CMS and includes a Federally Facilitated Marketplace Data Migration Toolkit.

Colorado Governor John Hickenlooper creates the State Innovation Model Office to to coordinate primary care and behavioral health care throughout the state. Vatsala Pathy, director of the new office, believes that “[t]his is an extraordinary opportunity to engage in dialogue and provide solutions for population health and consumer engagement, workforce development, health information technology and data measures, payers, policy and evaluation as well as service delivery and practice transformation for healthcare in Colorado.”

People

Telerent Leasing Corporation, parent company of TeleHealth Services and Avidex, promotes Joel Harris to president and CEO.

Galen Healthcare Solutions promotes Jason Carmichael to CEO, Mike Dow to CIO, Erin Sain to COO, Justin Campbell to vice president of marketing, and Ray Lape to director of technical services.

Research and Innovation

A National Health Council study finds that over one-third of consumers with chronic conditions had a hard time finding information about covered providers and medications on health insurance exchange websites. An overwhelming majority of respondents noted they’d like exchanges to offer a standardized list of covered providers and drugs, and a calculator to assist with determining potential out-of-pocket costs.

A PNC Healthcare study finds that Millenials and Gen-Xers far prefer retail and acute-care clinics over primary care practices, while nearly half of that combined age group use online reviews from sites like Yelp and Healthgrades to help determine which physician to see. Results like these serve to emphasize the seismic shift traditional physician practices are undergoing as they struggle to keep up with burgeoning corner-shop care models and hyper-connected consumers who, in the typical American fashion, want high-quality care 10 minutes ago for next to nothing.

Telemedicine

Nextech integrates health data from Iagnosis teledermatology visits into its patient portal and EHR.

Bill H.B. 1747 dies in the Arkansas House of Representatives, precluding telemedicine companies from practicing in the state. A similar bill is pending before the Senate.

The Saucon Valley School district in Pennsylvania considers paying $21,660 to give its employees access to SwiftMD’s telemedicine services on an annual basis. School board members seemed receptive to the idea, especially when told that the average ER visit costs the district $986 a visit, urgent care $290, and primary care $155.

Other

TAG Heuer announces at the Baselworld watch expo that it will partner with Google and Intel to create a luxury smart watch. TAG will handle design and manufacture, while Intel will provide an SoC platform and Google will offer its Android Wear platform and software-development skills. The watch will launch by the end of the year at a yet-to-be-named price point.

Mental Floss highlights the trials and tribulations of working as a lone physician in some of the world’s most isolated places. “It takes a really broad skill set,” says Scott Parazynski, MD former astronaut and CMO of the National Science Foundation’s U.S. Antarctic Program. “I call it MacGyver medicine. What can you do to diagnose and treat conditions in a really remote environment when the chips are down? You have to invent solutions on the fly.”

Target agrees to pay $10 million to settle a class-action lawsuit related to its 2013 data breach, which may have compromised the credit cards of as many as 110 million people. Settlement terms also require that the company appoint a chief information security officer and maintain a written information security program. It will be interesting to see if the Anthem class-action lawsuit brought in February eventually settles for similar terms.

Sponsor Updates

• E-MDs will exhibit at American Academy of Orthopaedic Surgeons 2015 March 24 in Las Vegas.
• Healthwise will exhibit at the World Health Care Congress March 22-25 in Orlando.
• NVoq offers how to “Avoid Those ‘Few Extra Clicks’ and Improve EMR Workflow.”
• Nordic releases the second episode of its HIT Breakdown podcast entitled, “What does a great population health program look like?”

Contacts

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

More news: HIStalk, HIStalk Connect.

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DOCtalk with Dr. Gregg 3/24/15

Change EHRs? I’ Been Busy

No matter what, if you’re a practicing physician, you can honestly state – at any given moment in time – “I’ been busy.”

Whether it’s actually providing patient care (a much smaller percentage of your work day than ever) or attending to administrative chores (a MUCH larger chunk of your day now) or messing around learning about silly stuff like advances in medicine and healthcare, your day is never one of “oh, not much, what are you doing?” Is it any surprise then that physicians are reluctant to make changes to the digital tools they employ?

Sure, there’s a lot of hubbub about EHR swaps and disgruntlement with first-choice systems. Docs and CIO-types are finding that all their so-called “due diligence” has yielded a system that met Meaningful Use requirements sufficiently to obtain MU dough, but that are oh-so-woefully lacking when it comes to meaningful day-to-day use. Disgruntled docs are dutifully documenting their discouragement with difficult data entry devices and systems on blogs and other fun physician forums. But change EHRs? EHR swaps are not for the faint of heart … nor for the busy.

Sure, if you’ve got nothing better to do, you can spend even more time looking even more deeply into even more EHRs and EMRs than you spent the last time (during your scurry to access MU opportunities and dollars). You can do the demo dance with vendors, dialogue with other docs about their documentation dilemmas, and dig down into digital details that you never really cared about from the get go.

You can ask about data migration. (Good luck on that one!) You can ask about data ownership. (Better read the fine print.) You can listen to the extolled virtues of “cloud-iness” versus local hosting. (Remember to calculate support costs.) You can even find some vendors that will let you use their system for a time without ponying up any payment. (Playing around with fake patients to explore an EHR system – what could sound like more fun in all your spare moments?)

Of course, if you’ve been “institutionalized” or otherwise absorbed by some medical Borgian amalgam, you may not have much say in your EHR choice. Your next system may be thrust upon you just as unceremoniously as was the first. You might, then, even count yourself lucky on this since you don’t have to worry about all the new system search suffering. (You just have to suffer its actual implementation and use.)

But, if you’re still independent or part of a smaller group, or if you’re in charge of seeking out a new, better system for a larger group AND you still actually see patients on a fairly full-time basis, you know how easy it is to just keep using a clunky system. Even an EHR that does documentation with all the simplicity and ease of Fred Flintstone’s flint rock tablet is better than the angst and anguish of change.

There are better systems out there, to be sure. There are EHRs and EMRs that actually make documenting easier. (Honest! Really. It’s true.) But the problem is that finding them, and finding the one that’s right for you and/or your group is about as time-consuming as looking for a new case of smallpox, maybe more so (and perhaps just as fruitful). And then there’s the whole workflow and business processes change thing. Oy.

Poor systems and workflows that may not be the most efficient are nevertheless paying your bills and getting you home sometime before last call (usually). Searching for and living through the transition to your next EHR surely threatens your current homeostasis, even if the potential for improvement – after all is said and done – is real.

It’s tough to think about going through all those process changes again … especially when it’s so true, and so much easier to say, “I’ been busy.”

From the trenches…

“In the choice between changing one’s mind and proving there’s no need to do so, most people get busy on the proof.” – John Kenneth Galbraith

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, an HIT and marketing consultant, and sits on the board of directors of the Ohio Health Information Partnership.

Contacts

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

More news: HIStalk, HIStalk Connect.

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