News 8/19/15

Top News

Federal finger-pointing continues as recovered correspondence from CMS Administrator Marilyn Tavenner shows she asked a staffer to delete email related to the troubled launch of Healthcare.gov. “Time and again, the self-proclaimed ‘most transparent administration’ has been anything but,” House Energy and Commerce Committee Chairman Fred Upton, R-Mich., said in a statement. “And now we know that when HealthCare.gov was crashing, those in charge were hitting the delete button behind the scenes.” Adding to the drama is CMS’ refusal to hand over requested documents to the Associated Press about the kinds of security software and computer systems behind the federally funded website. CMS has told the AP that disclosing them could violate health-privacy laws because it might give hackers enough information to break into the service.

HIStalk Practice Announcements and Requests

Thanks to all of the readers who filled out the annual reader survey. I’ll have an overview of the results, plus a gift card winner, in my next post later this week.

If enterprise data is your thing, then be sure to register for the next HIStalk webinar – Enterprise Data – Tapping Your Most Critical Asset for Survival, presented by Encore, a Quintiles Company, happening on August 27 at 1 pm ET. This first in a webinar series called “It’s All About the Data” will describe the capabilities provider organizations need to become data driven. The presenters will provide an overview of the critical role of an enterprise data strategy, creating the right data from source systems beginning with implementation, real-world data governance, how to avoid “boiling the ocean” with an enterprise data warehouse, and the role of performance feedback to transform analytics insights into improved outcomes and efficiencies. Presenters include Jonathan Velez, MD, FACEP, CMIO at Hartford Healthcare; and Randy Thomas, Associate Partner at Encore, A Quintiles Company.

If business intelligence is your thing, don’t miss “For Small Practices, the Time is Right for Business Intelligence.” Matt Barron of ADP AdvancedMD was kind enough to share his take on the topic in a recent HIStalk Readers Write piece.

Speaking of reader contributions, I am looking for guest authors who work in the world of physician practices to regularly write about their experiences with HIT. Do you work at a practice that has seen the writing on the wall and dropped out of Meaningful Use? Are you an Epic ambulatory user with a story to tell? Email me with your ideas for one-time or regular contributions.

Acquisitions, Funding, Business, and Stocks

Walmart trims its earnings forecast due to rising medical costs and increased spending on healthcare for its employees. The news comes just as the company begins to roll out 12 primary Care Clinics across the U.S. I wonder how Walmart will control its own clinic costs and service pricing, not to mention how likely its employees – many of them newly insured – will be to use them. I have little doubt the $4 employee rate for office visits will entice many. Perhaps it will take notice of what Cerner is doing to attract staffers to its on-site clinics and pharmacies, such as using push notifications to alert employees to “ways to save” and highly targeted educational messages and reminders that support specific health and wellness initiatives. No mention has been made yet as to whether the big-box retailer will follow in the Epic EHR footsteps of CVS MinuteClinics.

Speaking of Walmart, I had the opportunity to hear the opinions of several industry representatives on its entry into primary care at the recent Health Care Summit. Two panelists were painfully hesitant in providing their less-than-enthusiastic opinions of the impact retail clinics will have on the ambulatory space. Matt Portch, team leader of Commercial Effectiveness at Pfizer, said, “I’d hate to see an OR in the back of a Walmart,” adding that he’s concerned about retail businesses pushing the limits of healthcare business models. Laura Beaty, MD of concierge medical practice PartnerMD (GA), provided the best sound bite of the event when she said, “If we equate cheap with excellence, it doesn’t work. Value is a different story.” Walmart might have some work to do convincing its new peer group of the value of its services. Cost-conscious Walmart shoppers probably won’t need as much.

Private equity firm GTCR will invest up to $200 million in Cedar Gate Technologies, which it will form with former Medco CEO David Snow, who will add $20 million of his own money and serve as CEO. The company plans to “build a transformative company in the healthcare information technology industry by acquiring outstanding healthcare data and analytics businesses and accelerating their growth.”

InnovaHealth Innovations opens up shop in Portland to help physician practices comply with ACA regulations via audit and compliance reviews. The consulting firm will also offer performance improvement analyses and educational seminars on implementing innovative practice strategies. Roberta Kaplan (Oregon Health Authority) will lead the new company.

National medical group Mednax agrees to acquire medical practice revenue cycle management company MedData for an undisclosed sum. The acquisition will help Mednax expand its relationships with hospitals where its physicians work and build new relationships with MedData’s client base of 3,000 physicians in 43 states.

Announcements and Implementations

Origin Healthcare Solutions and MDS Medical partner to offer mdsAnalytics – a customized version of Origin Analytics – to users of Greenway Health’s PrimeSUITE EHR. The companies report the partnership will enable even the smallest of practices to take advantage of sophisticated reporting, dashboard, and visualization tools.

Navicure launches the Navicure Payments software platform to help providers collect co-pays or balances due before service, estimate patient financial responsibility and secure commitment to pay at the time of service, and collect balances after insurance adjudication.

Azalea Health signs up the physician groups of Georgia-based Dorminy Medical Center and Irwin County Hospital for its EHR and RCM systems.

AMD Global Telemedicine integrates video conferencing software from Vidyo into its Agnes Interactive software to simplify Web-based telemedicine workflow.

National physician specialty services company Sheridan Healthcare chooses VitalWare’s iDocuMint ICD-10 code assignment and bill preparation tool for its 2,800 providers.

Urology Centers of Alabama adds Greenway’s PrimeRCM revenue cycle solution, joining its PrimeSUITE EHR/PM system.

Co-creators of a new behavior health screening kiosk – the first to be installed in a retail clinic in the U.S. – tell me they are developing privacy modifications to the kiosk for future iterations.  These will likely include a curtain (like a voting booth), “blinders” built up around the sides of the device, or use of a flat-screen monitor. As I mentioned when I first wrote about the kiosk, privacy and mental health should go hand in hand when it comes to screening tools in retail spaces, so it’s nice to see the developers take that into consideration. While I agree with the need to more openly discuss mental health issues, I’m not so sure the average patient that suffers from one is ready to shout about it from the rooftops (or from the floor of their local retail clinic).

People

MModal announces that CEO Duncan James will resign from the company, which recently exited Chapter 11. MModal has also brought in a new board.

Family physician Jack Pinney, MD (MidMichigan Health Medical Center) joins the Optimizerx Board of Directors.

Divya Nag, founder of StartX Med, an accelerator to commercialize Stanford research, joins Apple to lead its healthcare initiatives.

People Magazine profiles the family of MedAptus employee Jennifer Crowley, whose six-year-old son Padraig has been diagnosed with stage 4 neuroblastoma, the same rare childhood cancer that killed her infant son in 2006. Friends have started a fundraising page to help cover the family’s medical bills. Padraig was started immediately on chemotherapy and will have a long stay at Memorial Sloan Kettering. 

Government and Politics

Newly released 2013 data from CMS show that 96 percent of federally funded health centers have implemented an EHR, and nearly 85 percent of their providers are receiving Meaningful Use payments. Over 54 percent of the centers have achieved recognition as Patient Centered Medical Homes.

Former House Speaker Newt Gingrich makes the case for smartphones and veterans healthcare at a recent American Enterprise Institute event. He cited applications from ZocDoc and Wello as innovations that will help deliver high-quality, accessible healthcare to veterans. “We have the opportunity to create a 21st century veterans service system empowering veterans to use their smartphones to re-center services on their lives at their convenience,” Gingrich added.

The Texas Health and Human Services Commission awards network security and fraud detection company 21 CT a $19.8 million contract to develop software that is already helping the state detect Medicaid fraud. The new Torch technology pulls data in from the state’s healthcare system, as well as federal data, physician data, business records, background checks, and Google maps. It then links it together and displays it in an easy to understand format, allowing investigators to spot trends in Medicaid reimbursement.

Research and Innovation

Harvard’s Forum on Healthcare Innovation launches the Healthcare Acceleration Challenge, a competition that aims to identify and promote proven innovations that if widely disseminated could lower the cost and increase the quality and access of healthcare delivery in the U.S. Finalists will share $150,000 and the opportunity to present their ideas at the Forum’s invitation-only conference in April 2015. The winner will be awarded an additional $50,000. Applications are being accepted through September 29.

Other

The Major William Adams Veterans TeleHealth Clinic (CO) receives the Caregivers of the Year award from the Colorado American Legion. Formed in 2007, the clinic was one of the first in the nation to utilize video conferencing equipment to connect veterans in rural and remote areas to doctors.

Urgent care and emergency medicine practice Legacy ER (TX) makes the Web pages of Architectural Digest as part of the magazine’s coverage of the American Institute of Architects’ National Healthcare Design Awards. 5G Studio Collaborative has won numerous awards for its design.

In Canada, B.C. Emergency Health Services drops its $2.8 million ambulance electronic patient care record a year after it was supposed to go live, saying that, ”the vendor was unable to meet our business requirements.” The vendor was Interdev Technology.

Local news correspondent Bruce Hensel, MD profiles the use of 3-D printing to create plastic models of bones to practice on before surgery. The report notes that 3-D printing technology is now fast enough and cheap enough for individual doctors to afford, and that some insurance companies are considering covering the cost of making the plastic models.

The local paper profiles nonprofit Community Health IT Inc., which is leading a project aimed at helping small practices connect to the Florida HIE via its MyHealthStory record-sharing service. The service, powered by Relay Health and free to patients, is intended to give clinics and medical offices, especially those in rural areas, a lower-cost alternative for sharing patient information.

Sponsor Updates

• NextGen describes the three tiers of the Patient Centered Medical Home.
• Kareo CMIO Tom Giannulli will present a session on “The Essential Role for Technology in Improving Patient Care” at UBM Medica’s Practice Rx Conference in Philadelphia, September 18-19.

News 8/14/14

Top News

The Healthcare Administrative Technology Association opens for business in California this week to serve as a forum for those in practice management software development. Membership is open to providers, vendors, payers, trade associations, and government entities. Membership fees, ranging from none to $10,000, seem to be based on a sliding scale reflective of annual revenue. HATA will act as a representative voice to advocate and influence key stakeholders and government representatives on healthcare administrative technology issues. Several founding organizations have been reported, including NextGen, ADP AdvancedMD, and eMDs. “ADP AdvancedMD is thrilled to be a founding member and part of the Steering Committee for the Healthcare Administrative Technology Association,” says Jill Finn, director of the company’s Business Solutions Center of Excellence. “This is an incredible opportunity for practice management vendors to collaborate on best practices, to influence regulation, and to be a voice for our customers.  As PM vendors, our central goal should be to ensure the success of our customers and HATA serves as a champion to encourage this unified vision.”

Cerner jumps to the top spot of the Kansas City Business Journal‘s Top Private-Sector Employers List due in large part to the addition of 1,550 local employees in the past year. That’s not counting the 16,000 it will need to hire to fill its recently approved $4.5 billion Three Trails Campus, which the company expects to be completed by 2017.

Acquisitions, Funding, Business, and Stock

GE Healthcare announces it will relocate the headquarters of its life sciences division from Piscataway, N.J., to a yet-to-be-determined city in Massachusetts. Company spokesman Benjamin Fox notes that, “More specific details will be available once they are finalized. Once completed, the new U.S. life sciences headquarters will create a significant number of new jobs and economic activity in Massachusetts.”

Healthcare performance improvement company MedAssets signs a definitive agreement to acquire healthcare market analysis and forecasting services firm Sg2 LLC for $142 million. The agreement brings with it a number of benefits, including improved channel access for Sg2 services, broader data utilization across the two companies, and complementary business intelligence and consulting businesses.

The local paper highlights the appeal of the healthcare scene in Nashville, TN, to outside investors, citing such companies as Unity Physician Partners and Aspire Health. Investors from Sandbox Industries and EDG Partners noted the city’s non-stop innovation and mentorship opportunities as two reasons why they chose to fund Nashville ventures.

Walgreens follows in the footsteps of CVS and Walmart with continued expansion of its retail healthcare clinics. The company will open 13 Healthcare Clinics in the Dallas-Forth Worth area of Texas by the end of this year. The news marks the company’s first foray into the DFW market.

People

Miles S. Snowden, MD (Optum) joins TeamHealth Holdings Inc. as chief medical officer. 

Announcements and Implementations

Allscripts expands its use of Clinical Architecture’s Symedical terminology management system by integrating it with the Allscripts dbMotion HIE platform. The expanded use will leverage Symedical’s interoperability features for code-set mapping, which includes sophisticated matching algorithms, optimized workflow, and the ability to use prior mapping selections to inform current decision processes.

The Willis-Knighton Physician Network (LA) selects InteliChart’s Enterprise Patient Portal to serve as a single portal solution for its system of network clinics. Physician Network Administrator Greg Gavin noted that “[a] vendor-neutral patient portal that provides a single source solution for our patients as well as a consistent brand across the entire Willis-Knighton System were top priorities in selecting a solution” to improve communication, coordinate care, and facilitate patient healthcare goals.

Phreesia becomes the first certified partner to support integrations with Allscripts EHR and Allscripts PM products as part of the Allscripts Developer Program. The integrated systems will offer practices a unified platform from which they can streamline patient check-in and payment processing.

Clinical Support Services Inc. enters into an agreement with Rite Aid through which CSS will provide MTMPath medication management software to pharmacies piloting the pharmacy’s new Health Alliance program. The program, introduced earlier this year, offers coordinated care and support to patients with chronic and poly-chronic conditions like congestive heart failure, diabetes, COPD, hypertension, and high cholesterol. Rite Aid pharmacists will use the MTMPath software to document medication reviews, enabling information to be collected in a standardized way and stored in an easy-to-access database for all members of the patient’s care team.

Government and Politics

HHS Secretary Sylvia Burwell appoints former Citigroup executive Kevin Thurm as senior counselor. Thurm, a former Rhodes Scholar, served as HHS deputy secretary before joining the finance firm in 2001.

The VA expands its Patient Centered Community Care contract with managed care organization Health Net Federal Services to include primary care services for veterans who are unable to obtain primary care at a VA medical center in the three PC3 regions in which Health Net operates. The PC3 program provides eligible veterans with timely access to care through a network of non-VA providers who meet VA quality standards when a local VA medical center cannot readily provide care.

Research and Innovation

A new report finds that using a touchscreen EHR to support and monitor a national antiretroviral therapy program in Malawi faced challenges similar to that of EHR adoption in the U.S.:

• Implementing a point-of-care EHR has been more challenging than initially anticipated.
• The success of a POC system ultimately depends as much on a commitment from system users as on the technologies employed.
• Poor adherence to system use will result in incomplete data.
• Health workers will not adopt a system if they do not find sufficient value in it. Consequently, the primary challenge is to identify and address the value proposition for the user. This is an iterative process that requires a commitment to regular and ongoing dialog with the users if this paradigm shift to POC system use is to be sustainable.

Other

Orthopaedic Specialty Institute Medical Group (CA) reports the theft of 742 boxes of patient X-rays by two employees at an Iron Mountain Record Management storage facility, who then melted down the X-rays to collect the silver. The X-rays were 10 to 15 years old and may have contained patient names, birth dates, and medical record numbers. They did not contain any financial information. Perhaps the thieves took their loot to a company like XpresShred, which offers what I’m sure are competitive rates for X-ray silver recycling.

Square adds online appointment booking to its list of services, which may throw a wrench in the works of physician practices already worried about HIPAA compliance. Square Appointments will link customer booking and staff scheduling tools to its Square Register payment processing app, which does not have to adhere to HIPAA rules because it doesn’t store medical information. I’m willing to bet appointment-related information will throw up many red flags for practices thinking of using the new feature.

Contacts

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

More news: HIStalk, HIStalk Connect.

Get HIStalk Practice  updates.
Contact us online.

News 8/12/14

Top News

HHS works to reconstruct CMS Administrator Marilyn Tavenner’s email inbox in response to requests for missing emails sought by congressional investigators relating to the flawed rollout of Healthcare.gov. The recordkeeping problem was discovered as HHS officials collected documents in response to subpoenas from Republican Rep. Darrell Issa of California, who chairs the House Oversight Committee. HHS expects to recover “most but not all” of the 10,000-12,000 emails Tavenner receives each month. The department has expended over 23,000 staff hours and turned over 135,000 pages of documents in response to the subpoenas. It does my pocketbook good to know my tax dollars are being put to such thorough use.

Acquisitions, Funding, Business, and Stock

United Food and Commercial Workers, Local 293 and meat company JBS USA announce plans to open an off-site medical practice run by an outside contractor for 5,000 employees and family members covered by the self-insured company’s health policy. The company is now evaluating candidates, hospital networks, and boutique clinic providers to operate the Nebraska practice, which will be run as a patient-centered medical home.

CVS Caremark Corp. opens its first walk-in MinuteClinics at select CVS stores across the states of Nebraska and Washington. The company now has clinics in 30 states and Washington, D.C., making it the largest and fastest expanding provider of such retail clinics in the U.S.

This blog highlights the growing threat of patent trolls, particularly to those companies working in EHR software development. “It’s a rapidly growing segment of the healthcare industry that is almost entirely software-based,” notes lawyer Leland Schultz, “and the leading companies don’t appear to be paying sufficient attention to patents, either as a valuable business asset or as a threat to their business.”

DrFirst secures $10 million in debt financing, which it will use to expand its development resources and prepare for international expansion.

Medicity and athenahealth will improve interoperability between their systems.

Announcements and Implementations

Infinity Primary Care (MI) selects population health management and analytics solutions from i2i Systems to help it easily produce reports associated with its quality measures and Meaningful Use participation. The majority of its 12 physician practices serving West Detroit are recognized as patient-centered medical homes.

The California Public Employees Retirement System (CalPERS) launches an online healthcare comparison tool for public-sector workers insured by Anthem Blue Cross. Developed by Castlight Health, the tool enables plan members to compare physicians, hospitals, medical tests, and procedures on a variety of factors including cost, quality, patient satisfaction, and convenience. Users can also track expenses.

Government and Politics

The White House creates the US Digital Service, a new program that will recruit the “country’s brightest digital talent” to provide strategic guidance on major IT projects like Healthcare.gov and iEHR. Mikey Dickerson, the engineer credited with saving Healthcare.gov, has been tapped to run the service. If his LinkedIn profile is any indication (No Fancy Title, Thanks), he’s likely to keep a low profile while getting the job(s) done.

The state of California’s Department of Health and Human Services launches a health portal to display high-value data sets to residents and developers. Initial data sets include popular birth names, birth profiles, poverty rates, locations of vendors that accept vouchers from government assistance programs, a mapped timeline of West Nile virus incidents, asthma statistics, and healthcare facilities data. Future data sets are likely to include healthcare construction and financing, workforce, and data comparing healthcare costs with quality of care.

ONC launches a website designed to collect feedback on its proposed interoperability roadmap. Stakeholders have until September 12 to provide their thoughts and comments, after which ONC will present aggregated feedback to the Federal Advisory Committee for its input and recommendations. An updated version of the roadmap will be posted for public comment early next year.

Research and Innovation

A survey finds that telemedicine could potentially deliver over $6 billion a year in healthcare savings to companies in the U.S. thanks to an expected 68-percent increase in the use of telemedicine services by employers. According to survey findings, 37 percent of employers expect by 2015 to offer employees telemedicine consultations as low-cost alternatives to ER or physician office visits for non-emergency health issues. Another 34 percent are considering offering telemedicine services in 2016 or 2017.

This blog highlights the growing interest in personal health data research and the challenges that set it apart from traditional health research, which is typically controlled, specific, and very focused. Personal health data research involves real-time data that is highly variable and without experimental controls or organized sampling. It is also prone to self-selection thanks to the rise in consumer use of smart phones and wearables. “Analyzing this type of ‘big data’ will require new statistical approaches, drawing from the fields of computer science, atmospheric science, and engineering,” explains Kevin Patrick, principal investigator for the Health Data Exploration project.

People

Shelly Russell is promoted to CEO of Mitchell County Regional Health Center (IA).

Harrison Fox (Continuum Care Improvement Through Information New York) joins the Lantana Consulting Group as product manager/project manager.

Other

IBM, Cornell Tech, and iniLabs continue to make progress on the SyNAPSE chip (Systems of Neuromorphic Adaptive Plastic Scalable Electronics), which emulates the human brain by processing extreme amounts of sensory information with very little power. After two years in development, the chip is now capable of 1 million programmable neurons, 256 million programmable synapses, and 46 billion synaptic operations per second, per watt. Potential applications include assistive glasses that could guide a visually impaired wearer without need of a Wi-Fi connection, and solar-powered, leaf-shaped sensor modules that could send out environmental and forest fire alerts.

St. Lawrence Medical Practice (U.K.) attempts to ban patients from posting negative comments about the practice on social media. The request was made after staff allegedly saw bad language used to describe the surgery’s standard of care on Facebook. Foul language aside, telling patients they’re not allowed to post negative comments on the social network of their choosing will ultimately backfire. Case in point: the New York hotel that attempted to “fine” brides $500 for every negative review left by their guests on any social network. The result: a slew of one-star reviews and comments on the hotel’s “terrible service” and use of intimidation.

HIPAA worries are causing obstetricians to remove “baby boards” that feature photos of babies they’ve delivered from their office walls. An OCR representative confirms that the practice is illegal even if the family sends the picture for that purpose since “implied consent” doesn’t count.

A new regulation in India requires doctors to write prescriptions in all capital letters to avoid sloppy cursive handwriting that was causing medication errors.

Sponsor Updates

• PerfectServe posts an article titled “The Changing Role of the Physician.”
• Allscripts is named among the best EHR vendors according to Black Book rankings data.
• ADP AdvancedMD spotlights three smaller private practices using its cloud solution to stay clinically and fiscally efficient.
• Kareo suggests six steps to take in hiring the right staff for a medical practice.
• NextGen Healthcare announces a new name for its November user group meeting, NextGen One.
• SRSsoft will participate in the American Society for Surgery of the Hand conference September 18-20 in Boston.
• Allscripts shares what “Open” means for healthcare and why it’s so important.

Contacts

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

More news: HIStalk, HIStalk Connect.

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DOCtalk with Dr. Gregg 8/11/14

HIT Leads to HID

What’s that you say? What’s HID? Oh, sorry. That’s a new acronym going around related to the semi-rapidly-changing world of HIT.

HID stands for Health Information Disappointment.

If you’re anything like me, that definition rings both a cord of immediate understanding as well as a bell of bittersweet irony. If you’re a user of HIT to document, derive, or disperse health information, it is almost a guarantee that you intimately know the aches, pains, and disappointment involved.

Despite any (all?) HIT vendor’s best promise to the contrary, documenting digitally can be exasperating. The difficulty of completing virtually any digital documentation of a healthcare task is often harder than performing the task itself. (OK, so maybe certain procedures like quadruple coronary bypasses or triple organ transplants are harder than the documentation thereof, but the comment stands for many of medicine’s more commonplace care tasks.) Some systems do the documentation dance with more fluidity than others, to be sure. However, for many (most?) providers out there, recording their necessary daily data to adequately comply with all requirements – be they reimbursement or incentive – has become decidedly dreary, dull, and a drain upon their day.

(While writing this piece, Dr. Andy Spooner posted a very insightful “rant” entitled Scout’s Honor that highlights one very significant facet of this documentation dilemma. A good read.)

As disappointing as the recording of computerized health information can be, it isn’t nearly as disheartening as trying to derive information from another’s digital documentation – especially if it comes from a system outside your own, and even more so if it’s a printout version thereof. (So few systems actually share digitized data into reciprocally relevant information buckets that the conversation at this point is pretty much limited to printout information sharing, be it faxed or snail mailed.)

Digitized data entry has certainly eliminated the human eye-brain handwriting recognition and interpretation problem from the mix. However, it seems to have replaced that form of crypticism with one that, while legible, is often barely readable. Too long. Too short. Too poorly designed from a readability perspective. Too filled with reimbursement- or incentive-related gibberish that adds nothing of any identifiable value to the clinical narrative. If you’re a provider, you’ve seen each of these and you know how difficult it can be to divine the necessary clinical pearls of relevance from the splattershot of documentation detritus.

As to the distribution of healthcare information, well, that’s pretty much the reason fax machines are still being manufactured. We haven’t made too many advances for health data dispersal since the first commercialized version of the fax machine hit the markets in the mid-60s. (Sort of sad, when you think about it.) Sure, we’re starting to build connectivity and signs of sharing are certainly sprouting up here and there. Yet, the reality for most of us, most of the time, is that we’re still quite some distance from a system that shares data more effectively than our faithful old fax machines.

With healthcare’s current state of digitized over- or under-documentation, with medical storytelling that while legible is still cryptic, and with the ongoing limitations of health information sharing, is it any wonder that we have Health Information Disappointment?

From the trenches…

“I’m disappointed, but I’m not going to run around like Dennis Rodman and head-butt somebody.” – Greg Norman

(“Well … not yet.” – Dr. Gregg)

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 (OHIP).

Contacts

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

More news: HIStalk, HIStalk Connect.

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5 Questions with Mark Gettleman, MD Founder of Goofy Gettwell Pediatrics

Mark Gettleman, MD is the founder of Goofy Gettwell Pediatrics, an independent practice that recently opened in Scottsdale, Arizona. He offers house calls via the GoGo Gettwell mobile, as well as phone, video, and e-mail consultations. Patients can also take advantage of Gettleman’s proprietary, online Electronic-Rash Identification service, which enables parents to securely send images of ailments to Gettleman for consult. Gettleman considers the practice to be a startup business, one with very little overhead thanks to relationships with vendors like PayPal and other HIPAA-compliant business associates. He does not accept insurance and is not participating in the Meaningful Use incentive program. His mobile practice typically sees six to eight patients a day, while his bandwidth for video, phone, E-RID, and e-mail consultations has yet to be reached, though he notes the upcoming cold and flu season may alter that. 

You started Goofy Gettwell Pediatrics after spending 18 years at a brick and mortar practice. What led you to move from that type of business to this one? Was there a final straw that prompted you to make the switch?
I came out of medical school as far from the typical, idealistic, wide-eyed newbie doctor as you could be. I had no ambitions to change the world or cure cancer. I just wanted to do my thing in my small corner. After working for someone for three years, my frustrations with his management style led me to start my own practice. I was managing partner of a thriving, economically successful practice for 15 years.  But, I was becoming more and more despondent over the medical system. I hated this triangular model where the provider, the patient, and the payer are all pulling for different purposes. The patient, without knowing it, had given the power of the purse away and was left with little influence. 

Then I read the ACA (Obamacare) and I realized how bad the system was going to get. The cost-containment feature would be entirely up to the secretary of health and human services, and implemented as metrics and bundling through the government and accountable care organizations. I realized that Washington was now going to control what I was allowed to do in the exam room. 

Under the ACA law, well visits (preventive medicine) are fully covered, or free to patients. The natural repercussion of this was an increase in sick visits not being covered until deductibles were met.  This new model sent shockwaves through our billing department, and unsuspecting patients become irate and hysterical when we tried to collect.  It was a nightmare. 

In addition, issues that the government didn’t deem preventive were not allowed to be discussed.  If a question about asthma or allergies came up in a well check, I was obligated to code the visit accordingly, which kicked it out of the preventive category. Hundreds of dollars of immunizations would then no longer be covered and patients were forced to pay these huge fees, or I was left to cover the costs.  Some practices were audited, charged with fraud, and forced to pay huge fines for not following the guidelines.

The last straw had to do with the metrics. The public “rating” of the physician, which is tied to the reimbursement, had to do with fulfilling a few dozen criteria, from doing certain tests to patient survey results.  While most were reasonable, many should be directed by the situation. For example, one metric insists that I discuss and screen for STDs like chlamydia with all patients 13-years old and above. While this is appropriate for many of my patients, some are prepubescent, immature, and still playing with their Barbies. I would not dream of venturing into a discussion about STD and therefore sex until a parent and I had decided the timing was right. 

Would you consider your business model to be concierge? Has healthcare IT better enabled you to operate in this fashion?
I’m not sure about the monikers. Concierge, direct primary care, fee for service, private physician …  I just took a step back, thought about what patients would like and what I could do for them.  I can not charge a lot, because in pediatrics people are young and just starting to build wealth. I can keep my overhead very low by offering home visits, but I can only see a limited number of people per day. The IT component allows me to see more patients and help greater numbers of kids more quickly and efficiently.

How have your patients reacted to this type of business model? What do they appreciate most about the technologies you offer?
They have LOVED it – mostly the convenience of not having to leave their homes.  I’ve treated kids on Easter; via e-mails; and with photos from a smart phone, which saved long waits in the ED. I saw a three-day old who was feeding poorly and was able to alleviate the tremendous fears of the parents on a Saturday morning.  I did a video visit with one mom during which we discussed issues related to autism and behavior without needing to upset the child with the new and strenuous stimuli of an office visit. These parents are thrilled with the service.

How do you foresee your practice adapting to the wants and needs of an increasingly savvy patient/parent population, especially considering the speed at which digital health is bringing healthcare onto phones and tablets and into the home?
Many of my patients are still leery about using IT. We need to walk a few through the steps. As patients get used to it, they love the system. I envision extending to many more programs as technology becomes both more accepted and affordable. The thought of using heart, lung or blood pressure monitors over a smart phone, or using a picture of the tympanic membrane to diagnose an Otitis Media excites me.

What best practices or advice can you offer physicians looking to take their practices to the next level of healthcare IT?
Don’t be afraid. There are tons of reasons to not to do things, but when push comes to shove, it is up to you.  If you, as the physician, lead the way, the patients who trust you will come along. As Steve Jobs once said, “People don’t know what they want until you show it to them.”

Contacts

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

More news: HIStalk, HIStalk Connect.

Get HIStalk Practice  updates.
Contact us online.