News 4/8/14

From Luliu: “Re: Public data. Am I the only physician concerned that CMS is releasing Medicare payment data on 880,000 physicians?” As early as Wednesday CMS will begin releasing details on the amount Medicare paid 880,000 individual health providers for their services in 2012. For years physician advocacy groups have fought to prevent having this billing data posted publically, arguing it invades the privacy of doctors. However, consumer groups and employers have finally won the argument that the data helps evaluate clinicians. Sure, plenty of nosy folks will look up the information just to see how much different providers are making, but the data will also help identify doctors’ expertise performing certain procedures and assist with fraud detection efforts. Look for a flood of opportunistic companies to pounce on this new source of big data.

Physician participation in the PQRS program increased 36 percent from 2011 to 2012, while participation in the eRx program jumped 22 percent. Despite the strong growth rates, only 36 percent of all EPs participated in PQRS in 2012; only 44 percent of EPs in the 2012 eRx program.

US practice administrators aren’t the only ones experiencing job stress as a result of increased patient loads, an overabundance of administrative tasks, and tightening budgets. A survey of UK practice managers working for general practitioners found that more than two-thirds have recently contemplated quitting their jobs due to discontent over increased workload complexity, rising intensity, stress, and hours.

Antelope Valley ACO (CA) selects eClinicalWorks Care Coordination Medical Record for population health management to advance its ACO-related objectives.

I found this opinion piece from The Huffington Post pretty offensive. The author, who is listed as an “etiquette expert,” offers tips for people sitting in physician waiting rooms. My irritation started at the first sentence: “We all know that doctors are often unable to meet their appointment times.” Rather than chastise patients for sprwaling on the furniture and not keeping their voices down, how about telling  physician and staff members that it’s wrong to make patients feel as if the clinician’s time is more valuable than the patient’s, aka, the customer? Or, at least encourage providers to  consider process changes to reduce excess waiting times? Of course not all doctors and staff ignore the value of their patients’ time, anymore than all patients steal the four-month-old magazines and ignore the handicapped patient needing help opening the door.

Andrew J. Sussman, president of the CVS MinuteClinic, views the role of retail clinics to be “complementary and supportive” of the broader healthcare landscape and believes retail clinics augment, rather than replace primary care physicians and the PCMH model. Sussman notes that the 800-location MinuteClinic is affiliated with 32 health systems and uses Epic’s EMR platform to communicate with other providers.

The California Medical Association names DocbookMD the association’s preferred provider of HIPAA-secured text messaging for its 39,000 members.

Highlights from a Black Book Rankings customer experience survey on ambulatory EHRs include:

• Thirty-one percent of all medical and surgical specialists are “very dissatisfied” with the ability of the EHR to decrease workload, compared to eight percent of primary care doctors.
• Primary care user satisfaction has jumped in the last six months among practices that implemented an EHR more than two years ago, in part due to improvements in workflow, MU achievements, and better support.
• More than one-third of primary care providers report a return to normal levels of productivity following their EHR roll-out.
• More than half of primary care providers said they’d recommend their EHR vendor to a colleague.
• Top scoring EHRs were Practice Fusion, Greenway, Care360 Quest, and Kareo.

The amended CLIA regulations, which give patients direct access to their lab test reports, goes into effect Monday, the same day Quest Diagnostics launched MyQuest by Care 360. The MyQuest patient portal allows patients to view copies of the lab test reports from Quest Diagnostics and does not require pre- authorization by a physician.

EdgeMED, a provider of medical office software, medical billing services, and HIT solutions, acquires physician billing and collections company  Physician’s Billing Alternatives.

ZirMed acquires the payment processing, patient eligibility, and patient estimation business owned by TransEngen.

How does this happen? A woman with no medical training uses false credentials to get a job as a physician assistant in a medical office. Over an 11 day period last summer she worked unsupervised, seeing about 200 patients before someone anonymously warned the head of the practice. Upon being arrested the woman told police she posed as a PA because it paid $23,000 than her previous job.

Email Inga.

From the Consultant’s Corner 4/4/14

Three Factors for Success in Using Informatics

As the healthcare industry continues to experience a growing demand for reporting and analytics, organizations will be required to focus on healthcare informatics. Defined as the science of how to use data, information and knowledge to improve human health and delivery of healthcare services, informatics is more than just data reporting. It encompasses business intelligence, data analysis, and analytics as well.

Historically, data reporting was a lesser priority because healthcare organizations did not know how best to leverage data across business and clinical applications. Now, as healthcare leaders begin to understand how to use data and reports to drive performance and outcomes, informatics is moving to the top of the chart with both clinical and business implications. For example, instead of just identifying patients with diabetes, informatics determines whether specific services have been provided and pinpoints care gaps. On the business side, rather than looking at schedule availability, informatics reviews provider productivity expectations and identifies opportunities to standardize and consolidate visit types and provider schedules.

Why focus on informatics

As healthcare leaders define ROI for large investments in new technology, informatics should be at the center. In my experience, although expanding EHR installations and capabilities provides access to more information, the focus has been on implementing technology rather than using the information. The only way to obtain true ROI is to use the captured data for proactively managing patient care and financial operations.

Government regulations also steer the focus to informatics. While Meaningful Use Stages 1 and 2 require technology to be implemented, they also demand that physicians and hospitals become meaningful users. The ICD-10 conversion requires reporting and capturing clinical data in a discreet fashion and understanding what it means from coding, billing and downstream reimbursement perspectives. To comply with these regulations, organizations must understand and respond to the data.

Value-based reimbursement methodologies are another driver for informatics, as accountable care measures of both quality and cost impact how the organization is paid. For instance, organizations no longer are paid to see a patient 10 times with no health improvement; instead, they are reimbursed for keeping him or her healthy. These opportunities require the organization to marry financial and clinical information in a fully integrated manner.

Three factors for success

Leveraging informatics effectively across an organization requires more than EHR technology; it comes down to strategic decisions made by key executives during and beyond implementation. I believe these three factors help organizations realize the true potential of the data and use it to improve operational performance and patient outcomes.

1. Clearly define success metrics.

Without clear goals, no organization can improve performance, regardless of how many reports are run. It’s important to use leader-defined metrics to create reports and deliverables that measure progress and performance against certain key indicators, keeping in mind that information should be published with an operational rather than technical focus. Additionally, leadership should communicate the overall goal of educating and informing end users on what to do with the data, knowledge, and information provided by informatics.

2. Create a customer service culture.

This operational focus for informatics requires a cultural shift in ownership, moving informatics from IT to operational units, such as the revenue cycle or clinical informatics group. Design the informatics effort based on operational requirements, ensuring information is delivered when and where it is needed in the workflow. As a liaison between the technical focus and those using the information, operationally-driven informatics teams should partner with clinical and business managers to understand needs. In my opinion, organizations that allow IT to drive informatics projects will struggle.

3. Set expectations for report development and dissemination.

Resources are not always sufficient to support the increasing reporting demands in healthcare. One way to mitigate this is by implementing service level agreements to prioritize report requests and establish turnaround times. Define the escalation path when resources are not sufficient to meet the organization’s reporting needs.

Moving beyond technology

EHR use alone will not improve care. Rather, the collective knowledge and data captured in the EHR will impact quality and outcomes through informatics. Beyond simply generating reports, informatics supports clinical and business goals by providing the necessary information to the right decision maker in a manner he or she can understand and use to promote health and improve delivery of healthcare services.

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

News 4/3/14

The AMA has been pretty quiet about the ICD-10 deadline delay that was part of this week’s SGR patch legislation. AMA has long been quite vocal in its criticism of the transition, but denies it had another to do with its inclusion in the bill. The only item I could find on the AMA’s website, which I can only assume refers to the ICD-10 delay, was a comment that the overall legislation included “some positive provisions.” I wouldn’t be surprised if the AMA leads the charge for skipping ICD-10 altogether in favor of ICD-11.

Also still silent on the ICD-10 delay: CMS, which has yet to offer any official comments.

CareCloud names Lee Horner (Eliza Corporation/Vitera Healthcare) chief sales officer.

McKesson Specialty Health agrees to acquire a majority stake in Oncology Rehab Partners, an oncology rehab company that offers training and certification services for cancer care providers.

Accenture estimates that the use of its X-box based Teki program has saved Spain’s Basque Country $69 million during its first year. Patients are able to use a Kinect system attached to an Xbox in their home to communicate with their doctor using video conferencing, voice, or text messaging and doctors can check patients’ vitals via a wireless heart monitor and spirometer attached to the Kinect box. Accenture says that 18 percent of all primary care interactions in the region are now happening on the phone or online.

Brigham and Women’s Hospital (MA) plans to hire scribes to input EMR data, giving  doctors more time to focus on and talk with patients.

Kaiser Health News provides an insightful look at what is driving primary care physicians to leave independent practice and where they are opting to land. Physicians tired of high stress levels and long hours are giving up private practice for hospital employment, or converting their practices to concierge models, or taking early retirement. EMRs are the greatest source of frustration for many doctors who complain the technology slows them down, interferes with the physician-patient interaction, and turns physicians into data entry clerks.

I was amused by this photo from an article highlighting the growth of the concierge practice model. The two-doctor practice, which charges a $780 a year retainer fee and limits the practice to 600 patients, either does not net enough to buy an EMR, or, the prefers to keep medical charts the old-fashioned way.

Physicians in academic settings report higher compensation when the majority of their time is spent seeing patients, rather than on research activities, according to an MGMA compensation survey. General internists saw four percent pay increases in 2013 to over $180,000 when billable clinical work made up more than two-thirds of their time.

Talk about a complete bust of a day. A South Carolina woman sustains injuries in a car crash following a three-county police chase. She was admitted to the hospital and while in surgery doctors found 19 grams of methamphetamine hidden inside a body cavity. Other aspects of the investigation are ongoing.

The Kansas Senate passes a bill requiring insurance companies to give patients a cost estimate before services are provided. If passed, insurers would be required to inform consumers of all out of pocket costs, plus the amount the provider will be paid. I wonder if physicians really want their patients to have that much transparency in advance of an office visit or procedure.

3M completes is acquisition of Treo Solutions, a provider of data analytics and business intelligence to providers and payers.

Email Inga.

News 4/1/14

The one year delay for the mandatory implementation of ICD-10 is almost a done deal following the Senate’s approval of the legislation on Monday. The bill primarily addresses a Sustainable Growth Rate fix that prevents a 24 percent reduction on physician Medicare payments as of April 1 and will now go to the President for signature. I wonder how many of the 535 voting members of Congress had a clue that the legislation included the ICD-10 date change, much less understood its potential impact to the industry. For all the gloomy predictions about disruptions in cash flow and lack of readiness by various stakeholders, shifting the deadline will come with a whole new set of issues and expenses. For example, what about all the ICD-10 ready software releases that likely include unrelated enhancements? Will vendors have to invest more money to re-engineer updates so that the unrelated enhancements work with ICD-9? And then there is the question of how we can wait one more year without having a specific code for things like being hit by an object falling from an aircraft (V96.31XA) or for an injury caused by a sea lion bite (W56.11XS).

Specialists who are late in adopting EHRs may struggle to meet the patient portal requirements to satisfy Stage 2 MU requirements, according to a study published in the American Journal of Medical Quality. Researchers found that 87 percent of primary care physicians would have met the email communication threshold for Stage 2 in 2013, but only 37 percent of specialists, probably because specialists that don’t provide chronic care generate fewer emails. The authors conclude that other avenues of patient engagement, such as providing patient education or online post-op instructions, would be more appropriate for specialists. This particular Stage 2 requirement is just one of several that is well-intentioned but difficult, if not unrealistic, for specialists to achieve. Is it any wonder that a significant number of specialists are predicted to “drop-out” of the MU program before attesting for Stage 2?

HHS releases a security risk assessment tool for small to medium physician practices. It’s available for the desktop, iPad, or as Word documents and produces a report that can be provided to auditors.

Insight Software will integrate DrFirst’s Rcopia e-prescribing platform into its My Vision Express EHR.

Through February, 2014, a total of 343,204 EPs have been paid $4.4 billion in MU incentives under Medicare,  $2.7 billion under Medicaid, and $315.7 million under Medicare Advantage.

From across the pond: 60 percent of GPs in European Union nations were using eHealth tools in 2013, a 50 percent increase since 2007. Interoperability issues, a lack of regulatory framework, and inadequate resources are some of the most common barriers to adoption (sound familiar?) The Netherlands, Denmark, and the UK led other nations in efforts to digitize patient records.

Best Doctors, which offers remote second opinion services, launches Medting, an online physician collaborative platform that allows doctors to collaborate to make correct diagnoses and to seek guidance for patient treatment plans.

The Government Accountability Office recommends that CMS expand performance benchmarks that assess Medicare physicians to include state or regional averages. In addition, as CMS implements and refines its physician feedback and Value Modifier programs, it should follow the example of private entities that use multiple benchmarks and should disseminate feedback reports more frequently than once a year.

An Alabama legislator reads a letter from constituent Marlin Gill, MD, who clearly is not a big fan of Washington and its “war on doctors.” I wonder how many other physicians share his views and believe all the government’s various initiatives to improve quality and trim costs is wasted effort.  Among his list of complaints:

• Being “forced by ill-informed bureaucrats to implement electronic medical records” that cost is four doctor practice “well over $100,000 plus continuing yearly operational costs . . . all of which does not help take care of one patient while driving up the cost of every patient’s health care.”
• “Destructive regulations” that add costs and “force doctors to focus on things other than patient care and reduce the number of patients we can help each day.”
• The cost of migrating to ICD-10, which is costing his practice $80,000 “without one iota of improvement in health care quality.”

Email Inga.

DOCtalk by Dr. Gregg 3/31/14

HIT’s Next Big Role

MU has done its duty. Providers are adopting EHRs.

Patient charts are no longer merely a massive collection of indecipherable scribbles within mountains of paper. Great. Providers are digitizing. Great. Healthcare data is becoming mineable. Great. But what movement in the outcomes needle has been driven?

Notes in legible digital format are of little more value than paper records if EHR X can’t share digitally equivalent data with EMR Y. Digital data is worthless without aggregation, analytics, and evaluative proceedings.

Thank goodness HIEs are starting to connect, even though mostly with hospitals thus far. But, we are finally starting to see signs of data sharing, and buzz terms like “data analytics” and “big data” are replacing “meaningful use” and “interoperability.”

As a whole, EHRs may not be beautiful, nor fully functionally friendly, but that’s mainly an issue of refinement. As a whole, our collected data isn’t very well connected, but that’s a “yet” thing; it’s happening. Data input and capture, data sharing, and data analytics are important – nay, vital – to changing healthcare, to be sure. Most of these are on a roll, and there are some up-and-comers in process to take this data and its analyses to exciting new heights. The challenges of grabbing and scrutinizing data are becoming overcome.

Well then, now that we’re seeing reports of some 60% or so of providers gathering data digitally, and now that HIEs are starting to show signs of respectable life beyond the mostly (or wholly) defunct RHIOs and CHINs, the question becomes: what’s the next big step for HIT? If changing healthcare is all about improving outcomes – and who can argue that good outcomes should always be the goal for healthcare? – will digitized data and its analyses be enough to drive us to, and through, that hoop? (Can you tell I’ve been catching some March Madness?!) Will better measurements yield better results?

Maybe. Some, anyway. I’m a huge fan of smart data used smartly. However, we’re talking about human beings here, not just manipulable metamessages and figurable facts.

People are full of subtext, subplots, and subtly subversive subterfuge, especially when it comes to lifestyle choices, and healthy – or non-healthy – behaviors. We all have our daily rationalizations and self-interest self-deceptions. We say we want one thing, but proceed to act in complete contraindication to that end.

HIT’s next big challenge will be more about the marketing to, and motivation of, the men and women of healthcare, both in front of and behind its delivery. How do we persuade human beings to change their health habits, and healthcare delivery habits, given the inherent difficulties of being human?

How will the 40% of providers not yet on EHRs become driven to adopt? Obviously, the MU carrot-stick thing hasn’t been enough.

How will we motivate independent or non-institutional providers to connect to HIEs? There won’t be any more MU-esque goodwill monies flowing from the feds.

How will providers be motivated to continue to collect data? It seems inefficient to think that “prizes” and “beatings” (i.e., carrots and sticks) will suffice to keep the data collectors feeding the data miners.

How will providers be inspired to change communication habits (with other providers and with patients) and alter longstanding workflow patterns to capitalize on the new values that connected HIT can bring? Change is hard, even if it’s good change; changing habits is even harder.

Lastly, how will Jane and Joe Sixpack become aware of the advantages of connected data and motivated to both gather and share it? Beyond the tech-heads, fitness-buffs, early adopters, and fad-focused, there’s a whole wall of folks that will need inspiration before the full-bore, major-shift, healthcare-change tipping point is reached.

This challenge – the inspiration of consumers – may just be the key to all the rest. If HIT can motivate and massage consumers to become fully actualized healthcare participants on a grand scale, their participation will spur the remaining provider change.

Providers are inspired by need; they respond to it. That’s what got most healthcare folks into the field in the first place. If consumers of health services display or voice a specific need to their healthcare providers, their providers respond. That’s what they (we) do.

Here’s where HIT has its next big role. We must develop more user-friendly patient portals, portals that are less one-way, more interactive, and which become integral to the consumers’ thought processes for healthcare information and communications. We must tie these portals to the nascent but burgeoning world of wearable tech and smart phone tools that measure body metrics and provide insights into behavior patterns. Then, we must bring HIT analytics into the mix to enable a massive shift in personal health data that can be aggregated and utilized for both provider scrutiny and patient empowerment. And, it’s imperative that dashboards presenting this info be made human eyes-friendly.

Consumers need a new, friendly, non-intimidating healthcare face. They have had enough of the world of medicine’s non-transparency and egoism. They want to understand health issues without obtaining a degree in medical terminology. The whole patient empowerment movement arose from such needs.

If HIT steps up to help fill that order, consumers will find unprecedented empowerment. When they do, they will begin to spur their providers with new needs to which the providers must, by training and by inclination, respond. If healthcare consumers start expecting easier, more understandable access to healthcare data, if they begin to demand simpler communications via IT, if we all share with our healthcare providers the need to empower us as partners, not paternalized patients, then providers will respond. As I said: that’s what providers do.

The unadopted providers will adopt or die. The unconnected will connect or fail. The old style communicators will learn new methods or face extinction.

HIT can motivate change in consumers that will drive transformation in providers. That’s its next big role. When the men and women both behind and in front of healthcare delivery are playing together in a friendlier and more equitable sandbox, well, that’s when the outcomes needle starts its shift.

From the trenches…

“Step with care and great tact, and remember that Life’s a Great Balancing Act.” – Dr. Seuss

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).