News 8/7/14

Top News

Cerner validates rumors that have been swirling for weeks when it announces it will acquire the assets of Siemens Health Services for $1.3 billion in cash. Cerner Chairman and CEO Neal Patterson told HIStalk that “the broad driver is the post-Meaningful Use era” and the large R&D budgets of both companies. The combined organizations will have 20,000 employees, 18,000 client facilities, and $4.5 billion in annual revenue. Two Cerner executives will join the Siemens leadership team. Only the client experience and administrative functions will be combined in the short term. Cerner expects the transaction to close in Q1 2015.

Acquisitions, Funding, Business, and Stock

Practice Fusion acquires Ringadoc in a timely move into the telemedicine market. Ringadoc provides after-hours answering services to 1,000 physicians, some of which are already Practice Fusion clients, and has been testing a service that allows patients to consult their doctors over the phone for $40. The acquisition formally solidifies the already close relationship the two companies have had for some time. Practice Fusion CEO Ryan Howard is an investor in Ringadoc, which was previously based in Practice Fusion’s San Francisco offices.

Telehealth and medical billing services company GoTelecare introduces a franchising business that will enable physicians and healthcare facilities to provide video consultation services using its online platform. As I mentioned in my musings on the future of telemedicine earlier this week, the industry is likely to see a flood of related technologies (and new business models) pop up in the next several months as reimbursement is optimized and state licensing issues become less of a barrier for physicians.

Core Sound Imaging Inc. joins athenahealth’s More Disruption Please program, through which it will offer athenahealth customers its Studycast cloud PACS software.

MModal exits Chapter 11 bankruptcy following financial restructuring and debt reduction of 55 percent. It too joins the athenahealth More Disruption Please program, offering Fluency Direct and Fluency Flex mobile solutions via the MDP marketplace.

Futura Mobility expands its healthcare division through a partnership with Practice Unite. The two-year collaborative arrangement will enable Futura to integrate Practice Unite’s HIPAA-compliant messaging app with its IT services. Physicians can use the app to send 256-bit encrypted text messages, search for specialists, facilitate outpatient procedure requests, conduct physician surveys, and send emergency alerts.

Government and Politics

CMS temporarily suspends use of its Open Payments system that shows payments made to doctors by drug and medical device companies. CMS found that a batch of payment records from an unnamed company had assigned payments to the wrong doctor by including an incorrect state medical license number. The temporary shut down likely fueled the fire of over 100 medical professional groups that collectively sent a letter to CMS asking it delay launch of the system, which is expected to go live September 30. The letter-writers note that, “There are widespread concerns that the implementation of this new system for data collection — without minimally a six-month period to upload the data, process registrations, generate aggregated individualized reports, and manage the dispute communications and updates — will not be ready and will likely lead to the release of inaccurate, misleading, and false information.”

ONC announces it will hold its 4th Annual Consumer Health IT Summit in Washington, D.C. on September 15. The event will feature an update on the Blue Button Initiative, "bright spots" that demonstrate what digital health data and technology can do, discussions about ways to engage underserved populations and to improve patient participation in clinical trials, and dialogue about frontier areas such as personalized medicine and patient-generated health data and how they can help to improve health.

In other ONC news, it announces chairs and co-chairs for the recently realigned HIT Policy Committee Workgroups.

The HIT Policy Committee provides an update at its recent meeting on the timing of its 10-year interoperability roadmap, outlining three-, six-, and 10-year milestones. A draft of the roadmap is expected to be published in October. A second version including feedback from ONC’s health IT policy and standards committees will likely be available for public comment by January 2015, while the first formal version of the roadmap will be released in March 2015. The committee also covered the latest numbers for Meaningful Use: As of August 1, close to 1,900 physicians and other eligible professionals have attested to Stage 2.  Nearly 90 percent of physicians and other EPs have registered to participate in the EHR incentive payment program; 75 percent of those have received at least one incentive payment. The physician participation numbers look good on paper, but it seems like Stage 2 requirements are giving providers a run for their money (likely already spent on EHR implementations, upgrades or replacements).

Announcements and Implementations

Radiology practice Omnirad (MI) announces a billing partnership with radiology billing and practice management service provider Zotec Partners.

Premier Medical PC (AL) selects revenue cycle management services from McKesson Business Performance Services. The group, which provides emergency services to a nearby hospital and urgent care center, will move from internal billing to McKesson’s coding, billing, claims submission, A/R management, business intelligence reporting, regulatory compliance, physician documentation education, PQRS compliance, and managed care negotiations assistance services.

California Integrated Data Exchange, funded by $80 million from Blue Shield of California and Anthem Blue Cross, announces plans to develop the Cal Index statewide HIE. Cal Index says it will go live in late 2014 with 9 million records online. Initial funding covers the first three years of operating expenses, after which the HIE plans to sell subscriptions.

Research and Innovation

Screening for Mental Health Inc. and the Philadelphia Department of Behavioral Health and Intellectual disAbility Services unveil their behavioral health screening kiosk at a QCare retail health clinic. The kiosk was the winning entry in a contest that challenged contestants to create a way to make mental healthcare education or access available at retail clinics. The assessment tool — thought to be the first in a retail-clinic setting in the U.S. — offers people quick, free, and anonymous behavioral health screenings (“a check up from the neck up”) via mounted tablets in the clinic’s waiting area. The idea is a good one, but if the picture above is any indication, I fear that anyone who wonders if they suffer from mental health issues will be turned off from using the kiosk by the lack of privacy around it.

The American Heart Association launches an Open Innovation Challenge on Medstartr for Midwestern startups with ideas about how to help people prevent or manage cardiovascular disease or stroke. The 10 best ideas move on to a crowdfunding competition, and the top three then pitch to judges and investors in Chicago. The winner gets a $20,000 grant and whatever crowdfunding money they raise. Applications are due September 12.

A study of 51 primary care practices within the Colorado Beacon Consortium finds that they value support and resources that assist them with using healthcare IT, including:

• Translating rules and regulations into individual practice settings.
• Facilitating peer-to-peer connections.
• Providing processes and tools for practice improvement.
• Maintaining accountability and momentum.
• Providing local EHR technical expertise.

Benefits of support included improved quality measures, operational improvements, increased provider and staff engagement, and deeper understanding of EHR data.

People

The Michigan Academy of Family Physicians elects Pierre Morris, MD vice president. Morris is director of the Wayne State University Family Medicine Residency Program.

Nonprofit community health organization Sun Health promotes Jennifer Drago to executive vice president of population health.

Stephen Kahane, MD (athenahealth) and Rick Jelinek (Advent International) join the RedBrick Health Board of Directors.

Other

Forbes highlights the physician entrepreneur phenomenon, citing Aledade founder Farzad Mostashari, MD, and Iora Health founder Rushika Fernandopulle, MD as two of a growing number of physicians that have moved from clinical practice to startup business, often with a stop-off in government or nonprofit work in between. Fernandopulle explains his transition as one prompted by frustration: “I decided that the best way to make change happen quickly was to simply strike out myself and just do it – being an entrepreneur allows you to break what others think are the rules (they aren’t) and take change into your own hands.”

A new paper from the Center for Innovation Technology at Brookings outlines six recommendations to help healthcare progress in the areas of interoperability, privacy, and security:

• Use big data tools.
• Increase interoperability and tracking patients across healthcare systems.
• Increase patient education (and improve user experience).
• Implement a diverse set of patient records with online patient access.
• Ensure privacy.
• Recognize the reality of third-party consultations.

Minnesota ranks first when it comes to healthcare ROI, according to a study that reviewed each state’s death rates, health rankings, and insurance premiums. Utah, Kansas, Hawaii, and Iowa round out the top five, while Mississippi, Louisiana, Arkansas, West Virginia, and Indiana achieve the ominous distinction of being at the bottom.

The Population Health Alliance seeks nominations from within its membership for its Board of Directors. Final approval of nominations will be given at the PHA Forum 2014 in December.

Sponsor Updates

• Greenway extends special pricing for Engage14 in Dallas, September 4-7.
• Greenway suggests how to select the clinical quality measures for a primary care practice.
• Allscripts announces speaker information and the agenda for ACE 2014 in Chicago, August 12-15.

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.

CMIO Rant With … Dr. Andy

Scout’s Honor
By Andy Spooner, MD

“A 10-system Review of Systems was performed and found to be noncontributory.”

Billing compliance auditors get queasy when I put the above language in an electronic note.

Should they? I really did do a review of systems!

Scout’s honor!

The documentation quoted above is not by itself non-compliant. The passive voice is used skillfully in the E & M coding rules to describe the complete review of systems:

“At least ten organ systems must be reviewed. Those systems with positive or pertinent negative responses must be individually documented. For the remaining systems, a notation indicating all other systems are negative is permissible.”

–1997 Documentation Guidelines
for Evaluation and Management Services
U.S. Center for Medicare and Medicaid Services

If you had — in your head — reviewed 10 organ systems during your history, then the above “noncontributory” statement would be compliant. So why the queasiness?

It’s worrisome because it seems like one of those “easier said than done” situations. It’s easy to insert a line of text that describes a complex thought process. But did you really think of all 10 organ systems? The solution to the queasiness is to call for a list of exactly everything you asked the patient about.

Why should we care how many organ systems someone thought about?

We have obligated ourselves (via the E & M guidelines to which we all subscribe in the U.S.) to show that we thought about multiple organ systems in the case of complex patients — if we want to get paid for complex care. There is nothing wrong with this concept, but then we have the problem of how to show that we performed this thinking. The most common way to indicate review-of-symptoms thinking — the method that seems safest to the compliance auditors — is the symptom checklist, where we enumerate everything the patient doesn’t have.

The irony of the checklist solution (there’s always irony when it comes to compliance) is that it tends to transform a valuable thought process (a physician’s internal review of his or her total knowledge of human pathophysiology) into a litany of irrelevant information that we care very little about. We see that performing this checklist process as being beneath us. We begin to care so little about “doing a review of systems” that we gladly detach this process from the act of history taking. We isolate it in several ways:

• We make it a separate part of the chart, as if reviewing systems can be performed independently of taking a history. It can be done separately, but why bother? Thoughtful coding consultants will tell you that the review of systems does not have to be a separate section, but even if it is embedded into the HPI, it still needs to be in some form where one can count “bullets” to assign to the canonical list of organs.
• We delegate this task (via the E & M guidelines) to absolutely anyone else who wants to “do” a review of systems. That’s not to say that a checklist produced by a medical student or nurse or a medical assistant isn’t accurate. The information is usually just fine. But unless it is integrated logically with the history of what is going on, what use is it?
• We gladly accept a patient-completed questionnaire for the information-gathering task. There’s nothing wrong with patient input, but if “doing” a review of systems is supposed to reflect the doctor’s thought process, how does a patient questionnaire do that?
• We work to ignore this separate blob of information. A study published recently by Clarke et al. on the information needs of ambulatory physicians suggests that the review of systems is usually regarded as superfluous — part of the noise. I get feedback from referring physicians that the thing they would most like omitted from letters sent to them by consultants is the review of systems (followed quickly by the past/family/social history and physical exam).

Some medical students buy laminated cards that spell out a review of systems in the form of a giant checklist. The result is what you’d expect:

ENDOCRINE: No blood sugar problems, cold intolerance, growth excess, heat intolerance, abnormal hair growth, impotence, increased thirst, increased appetite, frequent urination, skin discoloration, sweating, excess thirst, increased urination, or weakness

I always love to see that in the chart of a four-month old with bronchiolitis.

What’s going on here? Is it a bad idea to review a patient’s systems? Of course not. The goal is to make sure that we think of disease processes that fall outside our preconceived notions of what the patient has. Since all that wheezes is not asthma, the skilled clinician wants to be sure not to miss one of those unusual causes like a bronchial foreign body, vocal cord dysfunction, or cystic fibrosis. So why can’t the skilled clinician simply say that? We could even have the computer generate a differential based on documented findings, and then we could simply check a box that says something like “yes, I considered all of that.” (Or “yes, I considered all of that, and did not bewilder my patient by asking about cold intolerance or how many pillows he sleeps on because that’s just not relevant here.”)

E & M coding rules are based on the assumption that we are using paper, and that every additional bit of information we record costs us a little bit of energy. The argument goes that if we want to get paid more, we will be more willing to spend the energy to fill the paper with information in proportion to the complexity of the patient’s situation. With electronic systems, this calculus of documentation energy no longer applies. We can create long documents with very little energy. Since the paper-based rules assume a symptom checklist (paper is great for checklists), that’s what we make our electronic systems create for us. The subsequent “review of systems” is almost always meaningless.

If our purpose on reviewing systems is to assure that we consider broad possibilities in the diagnostic evaluation of the patient, why can’t our computer systems help us with that directly? We might be able to design our EHRs to be more useful if we could just let go of the assumption that the unit of analysis is the document, rendered as if on paper.

Ultimately, the rules about how to document are based on skepticism — perhaps a healthy skepticism — that we are going to do the intellectual work required to deal with complex clinical situations. This skepticism is here to stay, but the model of responding to it with bizarre lists of symptoms does not have to. Our clinical systems are capable of recording our efforts at creating a differential diagnosis. That intellectual work should count.

Scout’s honor!

Andy Spooner, MD, MS, FAAP is CMIO at Cincinnati Children’s Hospital Medical Center. A general pediatrician, he practices hospital medicine when he’s not enjoying the work involved in keeping the integrated electronic health record system useful for the pediatric specialists, primary care providers, and other child health professionals in Cincy.

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 8/5/14

Top News

Reps. Mike Thompson (D-CA), Gregg Harper (R-MS), and Peter Welch (D-VT) formally introduce the Medicare Telehealth Parity Act of 2014, which aims to improve Medicare telemedicine coverage in a phased approach over four years. If passed, the bill will expand coverage of telemedicine-provided services and remove barriers that limit access. Provisions include:

• The gradual removal of geographic restrictions to patient care.
• The addition of coverage for healthcare services that take place in locations such as the home and retail health clinics.
• Proposed improvements to covered services such as those provided by diabetes educators, remote-patient monitoring for chronic-disease management, outpatient therapies, home telehealth, hospice, and home dialysis.
• Authorization for the Government Accountability Office to study the cost and clinical effectiveness of these changes.

The legislation, already endorsed by the American Telemedicine Association, has been referred to the House Energy and Commerce Committee and the House Committee on Ways and Means. Its formal introduction comes just a day after the House Committee on Small Business convened a panel to testify on the impact telemedicine currently has on small medical practices. The panelists included representatives from private practice, academia, and industry. All seemed to be in agreement that current reimbursement and licensure models are impeding telemedicine’s growth and efficacy. It will be interesting to see if the new legislation and new CMS telemedicine proposals slated to go into effect in 2015 will significantly lower these barriers. My first assumption is that physicians will jump onto the telemedicine bandwagon, but then I wonder if that enthusiasm will be tempered by a more competitive (i.e. pricier) technology market. I welcome comments from providers and vendors alike as to how this might shake out.

HIStalk Practice Announcements and Requests

There’s still time to take the annual HIStalk Practice Reader’s Survey. I won’t resort to begging yet, as we’ve had a nice response from survey takers so far, but I will stress that reader feedback is key to our improvement. One lucky respondent will receive an Amazon gift card.

Physicians and consultants, don’t forget to submit your “Idea of the Day” – share a short healthcare IT idea that made your practice or that of your clients better, and I’ll highlight it in a future post.

Acquisitions, Funding, Business, and Stock

National medical group Mednax Inc. (FL) acquires Associated Anesthesiologists and its related Illinois-based entities including Madison Avenue Anesthesia Placement Services, Crawford Avenue Anesthesia Placement Services, and Pain Centers of Chicago. Eighty-five anesthesia providers and 12 clinical and administrative staff will become part of Mednax’s American Anesthesiology division. Ronald Hayes, MD, who will lead the new integrated practice, noted that “[b]ecoming part of a national medical group was essential for the future of our practice as hospital needs and data requirements rapidly change in this new era of healthcare reform.”

iMedicor launches the cloud-based iCoreMD EHR system. It includes a practice management system, electronic claims processing, medical billing, patient scheduling, e-prescription functionality, an integrated laboratory information system, and rules-based clinical decision-making algorithms.

Wal-Mart opens two primary care clinics in South Carolina, marking its first foray into that state. The company already has three clinics operating in Texas. The five sites are the big-box retailer’s initial entry into primary care, and mark a growing trend in the business of retail clinics. Stop & Shop Supermarkets in Connecticut recently announced it is partnering with St. Francis Hospital and Medical Center (CT) to open FastCare Clinics at two locations. Whether it’s a big-box retailer or a neighborhood grocery store, evidence continues to affirm that retail clinics will likely account for 10 percent of outpatient primary care visits by 2015.

The Washington Post highlights online medical auction site Medibid, which links patients seeking non-emergency care with doctors and facilities that offer those services. Consumers post procedures they need performed, and physicians bid on them in a business model founder Ralph Weber describes as a “free-market alternative to Obamacare.” Nearly 6,000 physicians or surgery centers and a handful of hospitals have registered as bidders.

Announcements and Implementations

New Albany Pediatrics and New Albany Surgical Associates, both a part of Baptist Medical Group (MS), go live on Epic as part of a system-wide rollout that started in January 2014. The Baptist OneCare EHR will give patients access to the MyChart patient portal for appointment scheduling, secure messaging, and prescription refills. Baptist staff no doubt appreciate the OneCare go-live ticker above, which reminds me of the early days of NASA.

The Electronic Healthcare Network Accreditation Commission announces new criteria for the Health Information Exchange Accreditation Program. The criteria will assess health information and oversight of HIEs to ensure healthcare reform and privacy and security regulations are met. EHNAC also announced formal criteria for the Texas Health Services Authority’s HIE state-level program, which had been under review since March.

Aetna and the Summit Medical Group (NJ) announce a collaboration to improve the health of Aetna’s 1,000 Medicare Advantage members served by Summit doctors in northern New Jersey. SMG is the state’s largest privately held multispecialty medical practice, with more than 325 practitioners in 76 specialties. The collaboration includes a shared-savings model that rewards physicians for meeting quality and efficiency measures such as preventive care and screenings, better management of chronic conditions, and reductions in avoidable hospital readmission and ER visits.

Quincy Medical Group (IL) rolls out the Epic EHR and patient portal at 16 locations.

Resource website KidsHealth and population engagement software developer Sensei join the Population Health Alliance. PHA Interim Executive Director Fred Goldstein noted the alliance is excited by “the growing interest our association is garnering among companies and organizations serving very broad and varied segments of the population health industry.”

Government and Politics

Just days after the GAO released its report on Healthcare.gov’s expensive shortcomings, CMS Principal Deputy Administrator Andy Slavitt tells the House Energy and Commerce Subcommittee that work completing the back end of Healthcare.gov will continue into next year. Features intended to enable payers to easily exchange financial information with the government are still not working. Slavitt noted in his first public testimony with CMS that, “We are still working with brand new processes and technology, we are still establishing an understanding of unique consumer behavior and needs, and we are reacting to and solving new problems.”

Healthcare.gov technology vendor Accenture is selected to serve as the lead Medicaid service vendor by the Texas Health and Human Services Commission. The company, which has has run the Texas Medicaid claims processing technology for the past decade, will work with the Texas Medicaid Healthcare Partnership to support 3.6 million Medicaid recipients and 45,000 providers through the processing of over 12.5 million claims per month. Accenture takes over the work of Xerox, whose contract was terminated in May 2014 because Xerox staff approved thousands of requests for braces that weren’t medically necessary. Accenture seems to have developed a habit of swooping in to clean up other contractors’ messes, while Xerox seems to have developed a habit of making them.

A new CMS rule officially confirms October 1, 2015 as the new ICD-10 deadline.

The state of Florida’s Agency for Health Care Administration works with Harris Corp. and Inpriva to launch Direct Messaging for the state HIE to facilitate data exchange between providers that have adopted EHRs. The secure e-mail service is also available to payers, government agencies, and their business associates. The news comes just a few days after the Florida HIE announced it had joined the eHealth Exchange in order to better communicate with federal agencies.

Research and Innovation

This article points out that progress is being made in affective computing – the science of developing systems and devices that can recognize, interpret, process, and simulate human affects or emotions. It cites the Google Glass MindRDR app, which can detect changes in electrical signals emanating from the brain, as one example. The implications for patients suffering from debilitating conditions are certainly exciting, but I’m not so sure about the “social monitoring” that could result in cars alerting third parties to the state of drivers’ moods or abilities.

XLerate, a Kentucky-based healthcare accelerator, selects eight companies to participate in its second class, which runs through October 30. Three stand out as having the potential to impact physician practices. Myliance has developed a concierge model that provides end-to-end personalized services for the disabled and those aging in place. Personal Medicine Plus uses connected health device data and gamified behavior tracking in an app designed to help people with chronic conditions better manage their health. NeuroAtlas has developed software that uses 3-D non-contrast MRI to detect and develop analyses of several neurological disorders, including Autism.

People

Robert Elliott, MD is named head of the Virginia Academy of Family Physicians. Elliott practices at Central Virginia Family Physicians and is a a clinical assistant professor of family medicine at the University of Virginia Health System.

Kate Dobson (Cancer Clinics of Excellence) joins Physician Resource Management Inc. as vice president, strategic and business development.

Kent Giles (ROI Solutions) joins Jackson Healthcare as president of its newest operating company, Virtual Medical Staff.

Michael Schiller (Streamline Health) joins MedEvolve as CEO.

Other

A Tucson, AZ urology practice notifies 3,000 patients of a data breach after finding that employees don’t always remove stick-on labels from urine sample cups before throwing them away. The labels contained patient name, date of birth, chart number, physician name, and date of service.

As this article points out, “The true measure of notoriety in the world of business comes from a guest spot on the longest running cartoon series in history – The Simpsons.” Tesla Motors founder Elon Musk will soon join such C-suite luminaries as Rupert Murdoch, Mark Zuckerberg, Bill Gates, and Jeff Bezos when he appears in an upcoming episode as a solar energy magnate. I wonder when The Simpsons producers will look to the world of healthcare IT for their next celebrity executive.

A survey finds that Airbnb apartments and rooms aren’t always cheaper than hotels, especially in smaller cities. A quick look into comparison pricing for Las Vegas, where I’ll be for several days in late October during MGMA, finds that hotels average $94 a night, while Airbnb apartments come in at $135 and rooms at $65. I’m not a huge fan of staying in a stranger’s abode, not to mention risking unreliable Wi-Fi, so hopefully I’ll find hotel accommodations somewhere in between. Conference-approved hotel rates range from $124 to $159.

Sponsor Updates

• PerfectServe publishes a blog post called “TeamSTEPPS – Building a Support System for Safety.”
• Microsoft names Allscripts its “US Health Provider Partner of the Year.”

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.

5 Questions with Micky Tripathi, President & CEO, MAEHC

Micky Tripathi is president and CEO of the Massachusetts eHealth Collaborative, a nonprofit consulting firm that helps ambulatory providers of all sizes successfully adopt healthcare IT. It also owns and operates the regional extension center of New Hampshire. Tripathi also serves as chair of the ONC HIT Policy Committee’s Interoperability Workgroup, and as co-chair of its JASON Report Task Force. Look for his regular “Pretzel Logic” posts on HIStalk Practice in the coming weeks.

Your experience in the realms of RECs, HIE, consulting, and on-the-ground implementations likely means you have spent ample time listening to the wants and needs of physicians. At this stage of healthcare IT maturity and the timeline for Meaningful Use, what are physicians most concerned about with regards to technology?
They just want it to live up to the hype, or even to just half of the hype. I think that the vast majority of clinicians see healthcare IT as inevitable, and that’s not just because of Meaningful Use. There are other, more powerful market forces that are pushing in the same direction, such as:

• Higher standards of care
• Risk-based purchasing
• The growing consumerism of patients, including demand for retail service levels and emerging cost-consciousness
• The need for greater efficiency in the face of competition and cost-pressure
• The generational change to tech-savvy providers and
• Pressure for cost and safety transparency.

The healthcare delivery sector has held out for a long time, but no sector of the economy can remain paper-based, and the vast majority of providers now recognize that. However, the bad news is that healthcare IT systems are still very immature from a usability perspective, especially with respect to interoperability. The biggest provider concern that I hear is that healthcare IT all too often still gets in the way of care provision, rather than enhancing it.

MU is increasingly being managed as a “check-the-box” exercise because it has requirements that are seen as more beneficial to the “healthcare system” (whoever that is) than to the day-to-day, point-of-care needs of patients and providers. The only way for systems to really get better is through more feedback from more users, and as with every other industry, that takes time. Steve Jobs didn’t invent the iPhone and iPad on day one – it took the insights gleaned from millions of customer-hours of experience to develop what in hindsight seem like simple and obvious breakthroughs.

Do you think federal groups like the HIT Policy Committee truly understand these perspectives enough to act on them?
I would say that the HIT Policy Committee is becoming increasingly aware of the complexities of the healthcare delivery market and the healthcare IT market. Stage 1 of MU was tremendously successful in terms of creating an imperative for change and catalyzing rapid adoption of EHR systems as tools to help facilitate such change. However, moving beyond basic EHR adoption is exponentially more complex because of the fragmentation of our healthcare system both on the supply side (i.e., providers) and the demand-side (i.e., payers, purchasers, patients).

As we get deeper into it, we see that it’s more complex than anticipated, not less. Just look at the Stage 2 requirements for Direct transport – a seemingly simple technology, yet it still doesn’t work for the vast majority of providers because it takes time and experience to iron out all of the wrinkles in workflows, business conventions, technology, and industry infrastructure.

Earlier this year, the HIT Policy Committee rejected many of the initial Stage 3 recommendations from its Meaningful Use Workgroup and asked them to scale back and simplify their approach. I see that as a good sign that the message is starting to bubble up to the top.

What was your reaction to the ONC’s 10 year interoperability vision statement? Do you think this plan reflects the goals of the physicians you work with?
I think the industry needs a concrete vision statement from the federal government. Not because the government can or should dictate how interoperability unfolds across the industry, but because the industry needs to understand what the government intends to do so that the market (providers and vendors) can take that into account as they make their investments in future technologies and infrastructure.

It’s great that ONC is putting out a vision, and I understand that ONC is going to flesh it out further over the next few months. I highly commend Dr. DeSalvo and her team for actively seeking market and stakeholder input. As a high-level view, the 10-year vision is certainly inspirational, but based on what we’ve learned about the complexity of the market, I fear that many will see it as somewhat unrealistic as well. For example, the three-year agenda is to be able to “send, receive, find, and use health information to improve healthcare quality.” Right now, we still aren’t even close to having the ability to easily send and receive, so “finding and using” in three years seems like an especially large challenge.

In a similar vein, having a “learning health system” in 10 years will also be very difficult to achieve. We shouldn’t be too critical at this stage though. Once we get more details on how ONC defines and anticipates achieving these objectives, we’ll be in a much better position to fully evaluate it. I’m sure we’ll see pockets of activity that achieve these goals. As William Gibson said, the future is here, it’s just not equally distributed. I assume that the 10-year vision is speaking to goals that are achieved across the market. As the market leverage of Meaningful Use draws down, the government’s source of influence in the healthcare IT market will be less about how much it pays and more about how it acts.

I think that the upcoming ONC plan will be helpful to the market if it clearly articulates what role ONC sees the government playing in shaping interoperability in the future, and how that translates into specific actions that the government is going to take.

Was it surprising to learn that only between 1 and 2 percent of EPs have attested for MU in 2014, with fewer than that attesting for Stage 2? What do you think will help accelerate this process?
We work pretty deep in the trenches and have seen first-hand the difficulties that providers and vendors have faced with Stage 2 of MU. However, it is surprising to see how profoundly those difficulties are being felt across the entire industry. Some of that I’m sure was the result of people phasing their ICD-10 and MU efforts. Now that ICD-10 is delayed, I think we’ll see the numbers pick up since there are still significant dollars on the table at this point of MU. That said, I think the message couldn’t be more clear that Stage 2 requirements have tried to push too much change in too short a time, and CMS, ONC, and the HIT Policy and Standards Committees need to take that to heart as they lay out the future of the MU program.

What advice do you have for physicians playing catch up with Meaningful Use?
For most providers, I don’t see how you can practice medicine in the future without an EHR, for all of the reasons noted above. If you want to get Medicare to cover some of the cost, you’re about to miss the payment bus and you’re going to get run over by the penalty bus if you don’t act fast. You’ve missed the opportunity to get the full incentive ($44K), but you can still get $24K if you act now. After this year, there will be no incentives available and you may start getting penalized 1-3 percent of your Medicare billings. Medicaid incentives are larger, last a lot longer and have no downstream penalties, but it’s harder to qualify for them.

I think you’ve got to do the math, though, even if you’re already in the program, and decide whether it’s worth it to keep going. When you do the math, make sure you take into account the penalties that could begin starting in 2015 (and don’t forget to take into account the time value of money – if you don’t know what that is, have someone else do the math for you!).

The reality is that the incremental payments for Stage 3 will be relatively small, but the hard and soft costs of achieving Stage 3 once it’s defined could be quite large, given what we’ve seen from the Stage 2 experience. You don’t want to make hasty decisions that end up costing you more than you gain from the MU program. I know of large and small providers who have done the math and decided to drop out of the program and take their lumps down the road. Remember, it’s not a mandate, it’s an incentive – you don’t have to do it.

Contacts

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

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News 7/31/14

Top News

Lawmakers, political organizations, and associations with healthcare connections celebrate the 49th anniversary of Medicaid and Medicare. President Lyndon B. Johnson signed both into law in 1965, presenting the first two Medicare cards to former President Harry Truman, who had advocated for the program during his presidency, and former first lady Bess Truman. Johnson quoted Truman during that signing, reminding his audience that “Millions of our citizens do not now have a full measure of opportunity to achieve and to enjoy good health. Millions do not now have protection or security against the economic effects of sickness. And the time has now arrived for action to help them attain that opportunity and to help them get that protection.” Truman’s words still ring true to some extent, and the two programs have changed significantly in size and scope. Medicare’s future looks a bit brighter than Medicaid’s at the moment thanks to a recent decision to extend it until 2030. Medicaid, on the other hand, remains a contentious issue, particularly in the 22 states that have thus far refused to expand it.

Announcements and Implementations

The Children’s Health Alliance implements the Wellcentive Advance population health management platform to give its 100-plus pediatricians a fuller picture of patient health. The platform will integrate data from EHRs, insurance claims, schools, and social agencies.

Catholic Health Initiatives St. Francis Health’s Orthopedic and Milnor clinics (MN) implement Allscripts Enterprise Ambulatory EHR as part of the organization’s multi-year OneCare program.

Capital Women’s Care (MD) signs a 10-year agreement with NextGen for continued use of its revenue cycle management services. CWC is one of the largest private OB/GYN practices in the mid-Atlantic region with 45 locations and 178 clinicians.

The Canandaigua VA (NY) plans to offer veterans greater access to care, and likely shorter wait times, via its RV Rural Mobile TeleHealth Care Unit. Launching in September, the unit will visit several towns on a weekly basis.

Acquisitions, Funding, Business, and Stocks

Sage Technologies partners with Medseek to offer care management solution Navigate. The cloud-based population health and behavioral change platform enables providers to identify low-risk, rising-risk, and high-risk patients via the integration and assessment of patient data from multiple financial and clinical systems.

Mobile health question-and-answer service HealthTap launches HealthTap Prime, a $99-a-month subscription service that will give users access to medical consultations with licensed physicians through the company’s mobile app and website. HealthTap Prime plans to differentiate itself from competitors like American Well and Doctor on Demand by providing ongoing support through customized checklists, personalized health news, and reminders and notifications. 

The New Jersey Medicaid Accountable Care demonstration project attracts an unexpected eight applicants. Slated to start in late 2014, the project will include all Medicaid patients within a geographic area, all of the hospitals that serve people who live within the ACO’s ZIP codes, 75 percent of the primary-care providers, and at least four mental-health providers.

Behavioral health software developer Qualifacts Systems secures a majority investment from private equity firm Great Hill Partners. Qualifacts will use the capital to accelerate product development, expand sales and marketing efforts, and identify strategic partnership and acquisition opportunities.

Caspio Inc. releases Caspio HIPAA Enterprise, a HIPAA-compliant edition of its rapid application development platform. The new edition features data encryption in transit and at rest, audit logs and an audit trail, HIPAA-compliant infrastructure, and a business associate agreement.

3-D medical animation and illustration company Nucleus Medical Media joins Greenway Health’s online Marketplace of value-added partners.

Research and Innovation

23andMe, which now bills itself as “the largest DNA ancestry service in the world,” secures a $1.4 million two-year grant from the National Institutes of Health. The company will use the grant to develop Web-based surveys to explore new genetic associations, enhance its survey tools to collect a broader data-set, utilize whole-genome sequencing data, and provide external researchers with de-identified data from its existing genetic database. The announcement follows news earlier this week that 23andMe has published findings from a study on new genetic risks for Parkinson’s disease led by researchers at the National Institute on Aging.

UCLA researchers select TrueVault’s SaaS platform to store and secure protected health information for a behavioral software platform being developed by the UCLA Gambling Studies Program. The platform will use mobile and Web technologies to promote and improve mental healthcare for patients using a data-driven approach, and will initially focus on treating gambling addictions.

UNC-Chapel Hill researchers develop the FutureDocs Forecasting Tool to evaluate the supply of physicians in various specialties down to a local level. The tool, which allows changes in key variables such as Medicaid expansion, changes in physician retirement rates, or the shifts in the locations of residencies and fellowships, has thus far shown that the anticipated lack of physicians is more about how doctors are distributed and what specialties they choose rather than a straightforward shortage.

Government and Politics

Former Procter & Gamble CEO Robert McDonald is unanimously confirmed as VA secretary.

The Government Accountability Office issues a report pointing out what went wrong with the Healthcare.gov roll out. CMS takes the blame for:

• Not clearly defining goals and expectations for the contractors hired to build the site.
• Using potentially risky cost-reimbursement contracts.
• Allowing contractors to use an agile approach to developing the data hub and website.
• Compensating contractors in a high-risk manner.

It will be interesting to see how Andy Slavitt, new principal deputy administrator at CMS, and the as-yet-unnamed marketplace CEO and marketplace CTO address these mishandlings as they prepare for the next go round.

Other

Hangover Heaven “celebrates” the treatment of 20,000 hangovers since its founding in 2012. The Las Vegas-based medical practice, which also offers room-service calls and a mobile clinic, anticipates opening its second location in the next few months.

The Global Partnership for Telehealth and the Jackson Healthcare Foundation travel to Honduras to implement telemedicine at three Predisan Good Samaritan Clinics. The pilot project was initiated to determine the effectiveness of the system in a remote, global setting, and the potential of its clinical applications. Twenty consultations have successfully been conducted to date.

The next time you find yourself frustrated by long security lines at the airport, consider submitting an idea to move things along to the Next Generation Queue Design and Model Ideation Challenge. The contest will award a total of $15,000 to be divvied up between two or three winners. The deadline for submissions is Aug. 15, 2014. If the contest website’s phrase “Active Solvers” is any indication, then close to 4,000 ideas have already been received.

People

Steve Tarnoff, MD is promoted to president and chief medical executive at Group Health Physicians (WA).

Ryan Dorr is promoted to CIO of PhyMed Healthcare Group.

Naomi Fried, PhD (Boston Children’s Hospital) and Alexis Gilroy, JD (Jones Day) join the American Telemedicine Association Board of Directors.

Susan Salka (AMN Healthcare Inc.) is named Director of the Year for Corporate Citizenship by the Corporate Director’s Forum.

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.