News 6/3/14

Top News

VA Secretary Eric Shinseki succumbs to calls for his resignation (and Washington’s need for a high-profile scapegoat) amidst ongoing investigation into the VA’s “widespread” attempt to cover up long wait times that have contributed to the deaths of veterans. A White House audit of VA facilities across the country found that wait times have likely been manipulated in more than 60 percent of the reports from the 216 sites investigated.

In light of the fact that Shinseki’s ouster will do nothing to fix the VA’s well-documented and systemic wait problems, Sen. Bernie Sanders (I-Vt.) introduces a bill that will potentially give the department long overdue authority to fire poor-performing executives, and allow veterans facing long delays to seek care outside of the VA network, among other provisions. It is this out-of-network idea that might have the greatest impact on veteran care. An entirely new category of physician business model might arise should the bill pass and physicians decide to cater exclusively to veterans.

A HIStalk reader shares an internal memo from National Coordinator for Health IT Karen DeSalvo, MD, which announces that the following will serve as ONC’s leadership team along with Deputy National Coordinator Jacob Reider, MD:

• Office of Care Transformation: Kelly Cronin
• Office of the Chief Privacy Officer: Joy Pritts
• Office of the Chief Operating Officer: Lisa Lewis
• Office of the Chief Scientist: Doug Fridsma, MD, PhD
• Office of Clinical Quality and Safety: Judy Murphy, RN
• Office of Planning, Evaluation, and Analysis: Seth Pazinski
• Office of Policy: Jodi Daniel
• Office of Programs: Kim Lynch
• Office of Public Affairs and Communications: Nora Super
• Office of Standards and Technology: Steve Posnack

While “Anonymous Tipster” calls the reorganization news “[r]earranging deck chairs on the Titanic,” it’s more likely the efforts of DeSalvo to place her stamp on the office and position it for new projects once the Meaningful Use program runs its course.

ONC team members (like the OPAS, above) are likely discussing the reorganization during Healthdatapalooza, taking place this week in D.C. The usual ONC suspects are participating and tweeting, with keynotes scheduled from Atul Gawande, Jonathan Bush, and Kathleen Sebelius, among others. You have to wonder what tone the Sebelius keynote will take, and if the absence of Farzad Mostashari, MD has left attendees just a little less enthusiastic than in years past.

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Announcements and Implementations

The Children’s Health Alliance (OR) selects Wellcentive’s population health management solution and services to support its pediatric quality improvement and medical home programs in Oregon and Washington. The solution will aggregate clinical data from outside providers, specialists, and other services, as well as payer claims data, to give CHA’s 105 primary care pediatricians a comprehensive view of patient care.

The Center for Discovery (NY) announces it will receive an $85,000 HHS grant to develop a telemedicine home network program for patients with severe disabilities living in rural areas. The center will use the funds to perform a cost analysis and needs assessment, provide education and training to fund research, and hire qualified health professionals.

Goldsboro Pediatrics (NC) implements triage software from Keona Health in an effort to improve response time, reduce cost, and increases patient and staff satisfaction. “Eighty percent of phone calls into our practice are low acuity,” says Goldsboro pediatrician Joseph Ponzi, MD. “Keona’s automation facilitates these encounters and allows our staff to focus our attention on the high-acuity cases.”

The National Committee for Quality Assurance recognizes Touchpoint Pediatrics (NJ) as an organization operating at the highest level in its Patient-Centered Medical Home program. Touchpoint physicians emphasized the use of NCQA’s 2011 PCMH standards including systematic, patient-centered, coordinated care that supports access, communication, and patient involvement.

The local paper highlights the mixed feelings many physicians have about medical scribes, especially when it comes to productivity, cost and return on investment. Donald Gehrig, MD notes physicians are willing to accept scribes due to the increased documentation demands created by EHRs. "It’s a perverse adaptation of electronic record keeping required for billable, code-able healthcare, which is not medical care,"  he says. "Doctors like it better than having to go home and type notes until 10 p.m."

Acquisitions, Funding, Business and Stock

Ambulatory surgery center operator Amsurg Corp. announces it will purchase physician outsourcing service provider Sheridan Healthcare Inc. for $2.35 billion. The acquisition will give Amsurg a leading position in radiology, emergency medicine services, children’s services, and anesthesia providers to medical facilities and hospitals on an outsourced basis.

ChartLogic incorporates Kareo’s revenue cycle management solution into its EHR to better enable private-practice physicians to manage the claims continuum. Kareo will provide ChartLogic customers with financial data and graphical dashboards showing key metrics, as well as coach practice administrators on areas for improvement.

Amida unveils its first product just in time for Healthdatapalooza, where ONC’s Blue Button initiative is being highlighted. Amida’s Data Reconciliation Engine is a Blue Button software component that the company claims is the “first production-ready, format-agnostic open source health record interface in the health IT market.” Amida CEO Peter Levin helped lead the Blue Button initiative at the VA during his tenure as chief technology officer.

PMD releases pMD Messaging and a message notification system in Version 8.0 of its charge capture software. The new HIPAA-compliant notification system ensures messages are received and read by users, and utilizes different types of escalating notifications to alert physicians to unread messages.

Physicians Interactive launches an automated voucher and coupon distribution solution within the latest version of Greenway’s PrimeSUITE EHR. The eCoupon solution is designed to improve medication adherence by providing discounts to patients within e-prescribing workflows.

People

Justin Barnes (Greenway) joins the Georgia Institute of Technology’s Advanced Technology Development Center as an Entrepreneur-in-Residence.

Government and Politics

A new report from the HHS Office of the Inspector General finds that Medicare spent $6.7 billion too much for office visits and other patient evaluations in 2010, prompting it to suggest that CMS go after upcoders.  CMS has disagreed, saying it is not cost effective to undertake such a review. One of its contractors recently reviewed 5,200 medical claims of high-coding physicians, and the process cost more than it caught in overpayments. It’s an odd accounting practice, to be sure.

Innovation and Research

A new report highlights the ICD-10 coding and reimbursement challenges faced by pediatric practices who accept Medicaid in Illinois. Twenty-six percent of pediatric diagnosis codes were found to be “convoluted,” representing 21 percent of Illinois Medicaid pediatric patient encounters and 16 percent of reimbursement. The report’s authors ultimately conclude that the “potential for financial disruption and administrative errors from …  reimbursement diagnosis codes necessitates special attention to these codes in preparing for the transition to ICD-10-CM for pediatric practices.”

An app store for EHRs continues to evolve. A Forbes article details the nascent SMART platform, an open-source technology funded by a $15 million ONC grant that will allow developers to create “substitutable” apps that physicians can easily add to or delete from an EHR. “SMART fits the pattern of a successful business idea because the architecture is closed, proprietary, and independent,” says Clayton Christensen,  a member of the SMART advisory committee. Recently announced committee members also include representatives from CMS, Surescripts, NHS, AARP, Eli Lilly, Hospital Corp. of America, BMJ, and Canadian Institutes for Health Research.

Other

A Kansas urologist who is also the president-elect of the Kansas Medical Society says his practice’s biggest problem is electronic medical records. “Now, we’re basically key-punch operators, transcriptionists having to input the data ourselves.  Voice-recognition software and some of those things help, but it has essentially tripled the time to complete a medical record. How do you accomplish that when we are already working 12 to 14 hours a day?” He says EMRs will shake out within 10 years, but doctors are quitting over them now.

Physicians experiencing slow Internet speeds can now take comfort that at least their connectivity is more reliable than Wi-Fi on the moon. Researchers at MIT and NASA have figured out how to beam wireless connectivity to the lunar orb from a New Mexico ground base at a speed comparable to slower Wi-Fi speeds on Earth.

Have wearables finally jumped the shark? You be the judge: GPSports now offers a compression vest to hold athlete monitoring devices in place. Data culled from the devices is used to benchmark training and recovery protocols. As this article points out, wearables may be beneficial when it comes to tracking health and wellness, but the “ridicule factor” still remains high.

Sponsor Updates

• Michael Simon, principal data scientist at Arcadia Healthcare Solutions, provides a recap of eHealth Initiative National Forum on Data and Analytics.
• DrFirst, Forward Advantage, and Imprivata partner to provide e-prescribing of controlled substances for Meditech and MAGIC/OSAL platforms.
• HIStalk Practice sponsors named on the HCI 100 for 2014 include 3M, ADP AdvancedMD, Allscripts, Capario, eClinicalWorks, Emdeon, ESD, Greenway, McKesson, Nordic Consulting, and Optum.

News 5/29/14

Top News

A MGMA survey of large (median of 10 FTE physicians), mostly independent physician practices finds that 44 percent think the impact of the Affordable Care Act insurance exchanges will be unfavorable to their practices. Sixty-two percent are struggling to identify patients whose insurance came from an ACA exchange, and to verify their eligibility or obtain plan details. Most practices also say that patients who got their insurance via an ACA exchange are more likely to have high deductibles and don’t understand that fact. Half of the practices say they can’t provide services to ACA exchange patients because their practice is out of network.

Acquisitions, Funding, Business, and Stock

Atlantic City casino workers take healthcare matters into their own hands when their union Unite Here opens a primary care clinic to serve its 20,000 members and their families. The union partnered with the Continuum Health Alliance to plan for and open the Unite Here Health facility. 

Imprivata, DrFirst, and Forward Advantage partner to enable e-prescribing of controlled substances for users of Meditech Client/Server and MAGIC/OSAL EHR platforms. Physicians using these solutions will be able to electronically prescribe controlled substances using the same authentication method they use to log into Meditech. The three companies predict their technology partnership will provide physicians with streamlined workflows, improved patient satisfaction, and increased security via minimized medication errors.

PatientPay receives a $2.5 million investment from Mosaik Partners, bringing its total financing to $6 million. The company will use this new infusion of capital to increase its client base and provide practices with pricing information for patients.

Athenahealth releases its 2014 PayerView Report to help physicians comparatively assess how easy or difficult it is to work with payers based on financial, administrative, and transactional performance. Humana ranked first in overall performance amongst 148 payers for the second year in a row, while Medicaid was found to perform worse than commercial plans and Medicare on several key metrics. As the report points out, physicians would be wise to pay close attention to their Medicaid enrollment efficiency and denial rates as they prepare for increased patient volumes related to state Medicaid expansions.

In other athenahealth news, the company welcomes healthcare point-of-service vendor Phreesia into its More Disruption Please program. Athenahealth’s network of 52,000 providers will now be able to take advantage of Phreesia’s electronic payment collection, data collection, and consent form management solution.

Insurance software vendor Ebix acquires “ask a doctor” service vendor Healthcare Magic for $6 million, with plans to roll it into its A.D.A.M. Health division.

Government and Politics

Thanksgiving may be six months away, yet turkey and CMS analogies are already flying high. Dr. Jayne enjoys one HIStalk reader’s comparison of the feathered fowl to MU, while this blog compares the proposed CARE tool from CMS to a “technology turkey.” The standardized measurement tool, which has yet to be rolled out, will be used across the healthcare industry to compare the effectiveness of care and resource utilization at post-acute care facilities. Facilities testing the tool, however, report “a steep learning curve and significant implementation challenges.” Poor user reviews should be no surprise to anyone given the abysmal track record the federal government has demonstrated when it comes to rolling out healthcare IT. Also unsurprising is the fact that CMS has the ability to push the CARE tool out to the industry whether it works or not.

Vermont Information Technology Leaders releases the results of a survey of state residents regarding views about EHRs and the state’s HIE. The 502 respondents “overwhelmingly agree” that HIE will:

• Help better coordinate care between health care providers
• Allow healthcare providers access to the most accurate information about healthcare needs
• Allow healthcare providers to make informed decisions regarding patient care
• Increase patient safety and
• Reduce unnecessary tests and procedures

VITL also issues a RFP indicating it will spend $175,000 on awareness advertising campaigns for the public and for providers as it prepares to launch the Vermont HIE, which is about to exit beta testing. VHIE drew controversy a few weeks ago when it announced that any provider will be able to look at any patient’s information, which the CEO says was done to reduce the number of forms patients would need to sign.

The local paper profiles CapitalCare Medical Group (NY) and its experience as part of the CMS Comprehensive Primary Care Initiative, which rewards practices for keeping patients healthy and avoiding costly hospital visits. CapitalCare’s Patient Advisory Councils are part of a patient engagement milestone that the practice must reach under the four years of the federal initiative. Additional milestones include integrating mental health services into the primary care setting and managing the medication of patients.

Colorado Regional Health Information Organization selects Sandlot Solutions clinical and claims data exchange technology to deliver increased connectivity, particularly for ambulatory facilities. CORHIO participants will also have access to Sandlot’s Metrix analytics platform, and Care Assist population health management and care coordination tool.

McKesson and ValueOptions form Nevada Medicaid’s Healthcare Guidance Program to provide more coordinated care for high-need enrollees, particularly those that have a high utilization of services, face one or more chronic conditions, or suffer from mental health or substance abuse disorders. McKesson will coordinate the program’s physical healthcare services across the continuum of care via its care management technologies, while ValueOptions will coordinate the program’s behavioral health component.

The Oregon Outpatient Surgery Center offers to donate free services to veterans who are waiting for surgical care as part of its Save Our Veterans: Surgery Center Assistance for Veterans initiative, set to kick off in July.

Xerox is on the upswing after recently losing Medicaid accounts in Texas and Colorado. The company beats out Hewlett-Packard to win a $500 million Medicaid contract bid for a new claims processing system in New York, which operates the largest Medicaid program in the nation. 

Innovation and Research

A new analysis finds that healthcare and pharmaceutical companies rate even worse than retailers in terms of security performance. Healthcare beat out finance, utilities, and retail companies to achieve the lowest score, reflecting poor security practices. Healthcare companies were also found to take the longest amount of time to fix security problems – 5.3 days on average.

If an eye doctor can see the potential benefits of Glass, there may be hope for it yet in the clinical setting. Ophthalmologist Steve Zeldes, MD makes his case for a “Glassified EMR,” citing improved patient communication, the ability to view multiple images at once, instant access to vitals during surgery, and potential as a teaching tool as top areas for further exploration.

A new report finds that the practice management system market will be worth $247.1 million by 2018, which sounds a little low considering the global scope of the report. Given the U.S. focus on Meaningful Use over the last several years, it’s no surprise that North America is the largest revenue generator for the market, and that the physician segment was the largest and fastest-growing in 2013. The usual suspects – all U.S.-based, of course – include Allscripts, athenahealth, Cerner, GE, Greenway, McKesson, and NextGen.

Other

New calculations show that running Healthcare.gov is more difficult than “rocket science.” An anonymous Redditt commenter who claims to have worked on the post-go-live cleanup disputes the notion that the website required 500 million lines of code, and breaks the site down into lines of code by language. Guesstimates put the total lines of code between 5 million and 15 million – eight times as much code as was required for the NASA space shuttle’s primary flight software.

Five Questions with Seema Rao, MD

Seema Rao, MD is a solo internist at Sparkle Medical P.A. (NJ), where she cares for eight to 10 patients a day. She is the first eligible provider in New Jersey, one of only a handful nationwide, to attest to Stage 2 of Meaningful Use in the first 90-day period of 2014.

The New Jersey Health Information Technology Center mentioned in a recent press release that almost all of your patients were on your patient portal when you went live with your EHR in 2012. How receptive have they been to it?
The receptivity of our patients has been in direct correlation with the amount of time we spend educating them about it. Patient education is a high priority.

Has it eased administrative burdens in any way?
It has not eased administrative burdens, but it has caused patients to take a more active interest in their treatment.

When did you begin working with NJ-HITEC for help with EHR implementation and MU attestation?
I have been working with the regional extension center since I started using Practice Fusion. They have been very helpful, especially Balavignesh Thirumalainambi, NJ-HITEC’s Meaningful Use director. He is very people-oriented and talented.

Are you relieved or frustrated by the further delay of ICD-10?
I am relieved. I have not started transitioning from 9 to 10.

What best practices can you offer other solo and small practice physicians who are in the midst of preparing for MU?

• Work with your REC right from the beginning
• Take advantage of educational resources offered by your vendor
• Educate office staff;  meet with them regularly to define expectations
• Involve patients – obtain patient emails and get them connected on the portal; help them sign in and teach them how to use the site
• Complete notes everyday
• Create templates on the EHR for SOAP notes

Sponsor Updates

• The e-MDs 2014 user conference is scheduled for June 5-7 at the AT&T Executive Education and Conference Center in Austin, TX.
• Greenway Health is recognized by Black Book Rankings as a Top EHR Vendor for ambulatory settings.
• Culbert Healthcare Solutions offers proactive steps in transition to value-based physician compensation.  
• Phoebe Putney Health System is live on the Summit Healthcare Summit Care Exchange platform communicating with RelayHealth. 
• McKesson will be the headline sponsor for the 5th Annual Health IT Leadership Summit on November 20 in Atlanta.

News 5/22/14

The VA’s troubles show no signs of being swept under the rug. The “secret waiting list” allegedly kept at a Phoenix VA facility, as well as the dozens of deaths attributed to its long wait times, has opened a flood gate of justified scrutiny at local, state, and national levels. President Obama convened a press conference to address the issue, saying it’s time to bring “the VA into the 21^st century – which is not an easy task.” U.S. Rep. Tim Walz (MN) has taken a proactive approach in light of the findings from Phoenix, and asked for an accounting of wait times at VA facilities throughout the state. He pointed out during his tour of facilities that “[o]ur nation’s veterans bled enough on the battlefield. They don’t need to bleed at home for preventable errors that could have been fixed with leadership and collaboration.” A national audit of VA facility wait times is underway.  It’s a shame that this Memorial Day will likely see the nation focused on how poorly many veterans are being cared for.

CMS and ONC publish a proposed rule that would slow down the Meaningful Use program by extending Stage 2 through 2016 (starting Stage 3 in 2017) and allowing providers to attest for FY2014 using a 2011-certified EHR. National Coordinator Karen DeSalvo, MD seemed to express concern that EHR vendors would not have their products certified under the 2014 criteria in time, referring to users who would miss the dates “through no fault of their own,” while the bill referred to “availability and timing of product installation, deployment of new processes and workflows, and employee training.” Public comment on the proposed bill will be open for 60 days.

HHS and CDC release the National Ambulatory Medical Care Survey, which finds that 71.8 percent of office-based physicians reported using an EHR in 2012, up from 34.8 percent in 2007. The survey’s findings aren’t unexpected in the areas of EHR adoption and utilization. Larger practices have adopted more robust systems more consistently, while smaller and solo practices have struggled to keep up. More interesting are the facts that between 2007 and 2012:

• Physicians working in practices owned by a medical or academic health center increased by 140 percent.
• The difference in adoption of a basic EHR between the largest practice size category and solo practices increased to 39.2 percent, suggesting solo practitioners may face unique challenges to EHR adoption.
• Electronically sending prescriptions to the pharmacy had the largest percentage increase in availability of the 11 EHR features measured.
• The survey was conducted via in-person interviews and mail-in forms (an irony hopefully lost on no one).

The NAMC Survey results line up nicely with findings from a new Surescripts report on e-prescribing, which reveals that the total volume of prescriptions routed electronically have increased 44 percent, up from 570 million in 2011 to 788 million in 2012.

A more recent survey from the Commonwealth Fund finds that EHR adoption by federally qualified health centers more than doubled from 2009 to 2013, with 93 percent of them running an EHR and 75 percent meeting Meaningful Use requirements. The FQHCs say their biggest EHR-related problems are undertrained staff and loss of productivity.

The federal government considers a national “biosurveillance” system that will give it near real-time access to the private medical information of citizens in the name of national security. Citizens Council for Health Freedom warns that the proposed system, which could potentially pull data from EHRs, would allow the federal government to monitor an individual’s behavior before, during, and after any government-defined health “incident,” and that “anything and everything could become a health threat by the government’s standards.”

A survey finds that patients in Boston experience the longest wait times of the 15 metropolitan markets studied. New patients in the area typically wait just over 45 days to schedule a doctor’s appointment. Denver and Philadelphia take the second and third spots, respectively. Given the fact that Boston is known as a hotbed of healthcare IT and yet its numbers are double that of the other two cities, you have to wonder what sort of systemic problems are taking place, i.e. doctor shortages.

While Hartford, CN, was not one of the markets surveyed for its wait times, the Hartford HealthCare Medical Group obviously realizes shorter wait times are a patient draw. The group announces that patients can now book a primary or specialty care appointment within 24 hours online or by phone. Its online appointment-booking tool is powered by ZocDoc.

This article suggests that physicians like Gregg DeNicola, MD are increasingly paying attention to and acting upon online reviews. After realizing that new patients were canceling appointments because of reviews, DeNicola and his staff at Caduceus Medical (CA) decided to stop ignoring them and instead embraced them. Patients who respond positively to in-office surveys are now asked to leave reviews on Yelp, and practice staff now monitor online reviews daily in an effort to respond to any negative comments in a timely manner. Physicians would do well to take a proactive stance when it comes to online reviews, if only to become more aware of how their “brand” is perceived by patients.

Verizon expands its HIPAA-compliant, healthcare-enabled services, adding five data centers and a wider range of related cloud and data center infrastructure services. The expansion brings its total data centers to seven, now nationwide.

Practice Fusion launches Insight, a free tool that analyzes portions of 81 million de-identified patient records. The analytics tool can potentially provide early signs of seasonal disease outbreaks, shifts in chronic conditions, and diagnoses trends for select patient populations. A paid version offers more detailed analysis, including the market share of drugs within certain subpopulations.

Kareo receives a 2014 Red Herring Top 100 North America award for its innovation, technologies, and commitment to software. The company is among a group of 100 awarded the distinction each year.

Colorado Springs Health Partners (CO) selects CodeBaby’s patient engagement portal solution to offer its patients easier online access to services, and to help it meet Meaningful Use objectives. CSHP seems to be fairly digitally savvy, offering an iTriage symptom checker on its homepage.

Delaware Health Information Network and Halfpenny Technologies partner for the delivery of clinical results to DHIN’s enrolled practices using the EHRs of the physicians and Halfpenny’s integration technology. Founded in 2007, DHIN is the nation’s first statewide health information network, and serves nearly 100 percent of Delaware’s providers.

Accountable Care Options and its physician network earn a $4.2 million bonus from CMS as part of its participation in the Medicare Shared Savings program. The organization achieved a 100-percent quality score and saved Medicare $8 million as a result of its focus on wellness and prevention, and better management of patients with chronic conditions. ACO, which entered the savings program in 2012, was one of only 28 other accountable care organizations to receive a bonus payment.

DOCtalk by Dr. Gregg 5/22/14

HIT Curveballs

As is said: _hit happens. We’ve all heard that phrase (usually the full, four-letter version). It’s a nice, short summation of the inevitabilities of life. No matter what you do or how you plan, life will always throw you curveballs. No matter how well read you are, no matter how highly educated, no matter how credentialed, no matter how exquisitely trained, no matter how closely or loosely you choose whom to trust – everybody gets thrown off stance by an unexpected curveball every so often. (Sometimes, you may even get sliders, knuckle balls, or those throw-you-for-a-real-loop spitballs!)

If you do all the homework you can – study up on types of pitches, watch hours of film on pitchers and their styles, spend innumerable hours in the batting cage, rip yourself with hours on the Nautilus – you’ll still get a ball that you just weren’t expecting. Whiff. Swing and a miss. Steeee-rrrrrr-iiiike!

In the land of HIT, it happens all the time – to vendors and consumers alike. Vendors may not like it any better than their customers, but there is a bit of a difference. HIT vendors get many of their curveballs from regulations, or sometimes from their own poor planning or development. HIT consumers, on the other hand, can get just as many curveballs from regulations, but they can also get really brushed back by those curveballs thrown by HIT vendors. (Vendors rarely get stressed by any consumer pitches, but consumers can’t avoid dealing with HIT vendor pitches.)

Another important difference is that, pretty much across the board, HIT vendors are in this space to make money off of HIT. Consumers, on the other hand, are trying to use HIT to accomplish tasks like delivering healthcare and getting reimbursed for the care they provide.

When a HIT consumer gets a curveball from their HIT vendor, it can really cause the home team strife. It isn’t like the consumer is a reseller; they can’t just find a replacement product to hawk. And, they get no value merely from owning (or leasing) the HIT product. The consumer relies upon HIT tools as critical underpinnings for their mission: to deliver health care. The consumer trusts their HIT to provide the information necessary for medical decisions. They use it to document their efforts and to obtain reimbursement for said efforts. Increasingly, they use it communicate with those for whom they care.

HIT has become central to the mission of healthcare, having become a key member of the care delivery team. If the tools don’t work, if something changes to cause them to work less efficiently, or if they develop “future unfriendliness,” then the care delivery process becomes threatened. That is an unacceptable pitch, for any healthcare team, big or small.

When a provider decides to invest in a HIT tool, it is far more than just a product purchase. Yes, it is an investment of money, but perhaps even more significantly, it’s an investment of time, energies, workflow construction, staff training, sometimes patient orientation and training, and more. The entire healthcare delivery system for that provider office is impacted by these tools. When one of the chosen HIT vendors throws out a curveball – via acquisition, merger, business failure, or product development redirection – the swing-miss impact is felt throughout the practice, from their figurative fingers to their metaphorical toes.

The impacted providers must now either:
(a) hobble along with their lame duck tool for as long as they can,
(b) find a replacement tool into which they can invest even more time, money, energies, workflow construction, etc.,
(c) pull out what’s left of their hair and go back to reliable, old pen-and-paper and suffer the MU consequences, or
(d) find an ACO to wash away all their operational and financial woes.

Being at the plate when one of these vendor pitches comes past is thoroughly frustrating. Whoosh. Whiff. Steeee-rrrrrr-iiiike!

(And there’s no ump with whom to argue the ruling.)

From the trenches…

“Baseball is a game where a curve is an optical illusion, a screwball can be a pitch or a person, stealing is legal, and you can spit anywhere you like except in the umpire’s eye or on the ball.” – Jim Murray

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).

News 5/20/14

HHS representatives weigh the pros and cons of a new program that will use Medicare data to alert public health officials to the potential needs of vulnerable patients during a disaster. HHS tested parts of the program in three states, and is looking to take it nationwide. Critics are concerned about the security of patient data, but ONC head Karen DeSalvo, MD has said the program protects patient privacy and that its benefits outweigh its risks.

The VA’s troubles continue with the resignation of Undersecretary for Health Robert Petzel, MD. In accepting Petzel’s resignation, VA Secretary Eric Shinseki said, “As we know from the veteran community, most veterans are satisfied with the quality of their VA healthcare, but we must do more to improve timely access to that care.” That statement seems questionable given the fact that at least 40 veterans died waiting for appointments at a VA facility in Phoenix, which has also been accused of maintaining a secret waiting list.

In other health data news, the Colorado Rural Health Center launches the Health Awareness for Rural Communities Data Bank to enhance access to streamlined data sharing and collaboration for rural healthcare providers, communities, and other interested stakeholders. The data bank is a collection of over 100 population health measures, as well as demographics, indicators, and projects from the state’s 47 rural and frontier counties. It’s refreshing to hear of big data projects like these that boil patient health information down into usable and hopefully effective population health management tools.

Business administration costs, not physician salaries (as highlighted by the recent release of Medicare physician payment data), are the real cause of skyrocketing healthcare costs, according to a New York Times article. It points out that healthcare is staffed by some of the lowest and highest paid individuals in any industry, with the compensation of health insurance executives topping over $583,000, general physicians reaching $185,000, and EMTs reaching just over $27,000. Perhaps the most telling statement in the piece comes from Abeel A. Mangi, MD cardiothoracic surgeon at the Yale School of Medicine: “Most doctors want to do well by their patients. Other constituents, such as device manufacturers, pharmaceutical companies and even hospital administrators, may not necessarily have that perspective.”

Physicians interested in the transparency of their payment data – Medicare or otherwise – may want to comment on the CMS Open Payments Program, which in September will publish payments that drug and device manufacturers have made to physicians. Those physicians interested in reviewing their open payment data must register with the CMS Enterprise Portal by June 1 for the opportunity to correct any  data discrepancies beginning in July. Physicians who have been less than pleased with the opaque nature of the Medicare physician payment data may want to go over this particular set of information with a fine-toothed comb, if only to equip themselves with explanations for their pharma and med device ties when the media come calling.

Scott Gottlieb, MD gives his two cents on the publication of open payment data: “Washington has little faith in American physicians, and sees a need and a license to regulate just about every aspect of medical practice, even trinkets doctors receive. There’s a clear view that doctors can’t be trusted to have any financial interactions with drug and device makers, no matter how small or simple these transactions. A free mug is as likely to influence a physician’s judgment as a $50,000 consulting fee.”

The National Committee for Quality Assurance recognizes Heritage Valley Medical Group (PA) physicians for their use of evidence-based measures in diabetes care. Ninety-three percent of the group’s 125 employed physicians met the standards for NCQA’s Diabetes Recognition Program. The group participated in the program after a community health needs assessment found that diabetes care was a top concern.

Oncologists list the pros and cons of moving from independent practice to hospital employment. The downsides seem to outweigh the benefits, with one physician venting that, “You don’t make decisions anymore. If you are a physician and you want to buy a widget, you have to go and get permission. It requires an act of Congress.” Loss of autonomy, “having a million different bosses,” longer wait times for on-site lab results, and higher patient copays were also mentioned.

Solo neurologist Robert Steg, MD explains the reasons why he closed his solo neurology practice, citing the requirement to move to a cost-prohibitive EHR as the final straw. The “Near future” category in the chart above ties into his EHR concerns, since Steg’s inability to purchase one would have prevented him from operating within the hospital’s ACO, and gaining referrals from its network.

In additional ACO news, HackensackUMC Mountainside (NJ) announces the formation of Mountainside Medical Group, a network of physicians employed by the hospital. The rise in hospitals creating physician groups  (not to mention investing in urgent care and retail clinics) may seem counterintuitive, but actually plays into the business model of ACOs and their need for coordinated care between physician and hospital networks.

The local paper takes a deep dive into the world of physicians, EHRs, HIE, and Meaningful Use in Michigan, which in 2013 saw  48 percent of its office-based physicians on an EHR. Michigan’s numbers are on par with the national average, according to the ONC. The state’s physicians are likely similar to many others in that the plethora of EHR vendors, and implementation and maintenance costs,  have left many unsure of which way to turn in terms of achieving interoperability to drive HIE efforts.

Tenet Healthcare (TX) announces that it will double the number of its nationwide MedPost Urgent Care centers by the end of the year. Kyle Burtnett, senior vice president of Tenet’s outpatient services, says the move is part of Tenet’s broader strategy to grow its portfolio of outpatient facilities, as well as to expand into “faster-growing, less capital intensive, higher-margin businesses.”

Even public health departments are getting in on the urgent care action. The Rhode Island Department of Public Health announces it will allow CVS to open MinuteClinics in seven of its pharmacies to provide more accessible and convenient care to consumers via a trusted brand name. MinuteClinic is the first retail clinic provider to achieve three consecutive accreditation awards from The Joint Commission. Primary care physicians have expressed their concern, however, commenting that the proposed clinics may erode their practices and further threaten an already beleaguered business model. The health department has incorporated those concerns into 22 stipulations the clinics must meet to set up shop. The guidelines also mandate that the clinics use the state’s EHR.

Athenahealth CEO Jonathan Bush releases his new book, “Where Does it Hurt? An Entrepreneur’s Guide to Fixing Health Care,” amidst continuing debate around the valuation of the company’s stock. While the book has yet to hit the best seller lists, the company got a bit of an uplift recently from analyst Mohain Nadu, who explained that because of athena’s cloud technology advantages, the company can introduce new services and technology much faster than a traditional software vendor. Perhaps Nadu was obliquely referring to Epic, which hedge fund manager and stock naysayer David Einhorn recently called out as one of athenahealth’s biggest threats. It goes without saying that Epic is neither public nor based in the cloud, and for what’s it worth trailed behind athenahealth in the 2013 Best in KLAS Overall Software Vendor award.

My Medical Inventory offers a new Web-based tool to help physicians better manage medical supply inventory. Julio Guerra, MD developed and tested the software in his practice, ultimately deciding to commercialize it based on positive feedback from his office staff.

GloStream introduces GloComplete, a revenue cycle and practice management service that incorporates the company’s EHR and practice management solutions. The company already has 40 practices and 120 physicians using the new tool, and expects an overall growth of 30 percent by the end of the year.

Valence Health launches the Valence Partner Network, a group of health services firms that will offer integrated solutions to Valence Health clients, including more than 30,000 physicians. Founding network companies include Aldera, Dubraski & Associates, Emmi Solutions, Limeade, Navitus, and Warbird Consulting Partners.

IBM announces that Modernizing Medicine is one of three partner companies that will release “Made with Watson” apps this year. The company offers specialty EMRs and is developing an iPad app that will guide physicians through a patient encounter to provide evidence-based medicine suggestions.