News 2/11/14

Lawmakers propose legislation that repeals the SGR formula and introduces a Medicare physician payment system that rewards merit over quantity of services and incentivizes physicians to participate in alternative payment models. Some specifics include:

• Medicare would eliminate the scheduled three percent reductions in reimbursements for failing to comply with MU criteria, as well as the escalating penalties of up to five percent in 2019
• Medicare would drop the two percent penalty scheduled for 2017 for failing to report PQRS measures
• Physician payments would increase 0.5 percent a year for five years
• EHRs would be required to be interoperable by 2017 and providers would be prohibited from deliberately blocking information sharing with other EHR vendor products
• Technical assistance funding would double for small practices with 15 or fewer professionals
• Beginning in 2017, HHS would monitor clinicians for the appropriate use of advanced diagnostic imaging based on appropriate use criteria. Physicians deemed “outliers” for non-use or non-compliance of appropriate use would be subject to prior authorization for applicable imaging services.

CMS announces a one month extension of the deadline for EPs to attest for MU for the Medicare 2013 reporting period. In its email announcement CMS did not provide an explanation for moving the deadline to March 31.

Georgia Physicians for Accountable Care selects eClinicalWorks Care Coordination Medical Record to advance its ACO objectives.

A screening program for abdominal aortic aneurysms integrated into an EHR reduced the number of unscreened at-risk men by more than 50 percent within 15 months, according to a Kaiser Permanente study.

The NCQA recognizes the 180-provider HealthPoint Medical Group (FL) as the first practice to earn NCQA Patient-Centered Specialty Practice Recognition for its efforts collaborating with patients to improve quality.

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News 2/6/14

The overall readiness for ICD-10 implementation continues to lag, according to an MGMA survey of 570 medical practices. As noted by MGMA president and CEO Susan L. Turney, MD, “Very simply, ICD-10 is behind schedule.” MGMA finds that less than 10 percent of  practices are making significant progress in their overall ICD-10 readiness. Other key findings include:

• More than 80 percent of respondents will require an upgrade or replacement of their PM software to accommodate ICD-10 diagnosis codes.
• Vendors will not cover upgrade costs for the majority of practices. Average upgrade cost for a PM upgrade/replacement is $11,500 per FTE physician and $12,885 for EHR.
• Only 8.2 percent have begun testing with their EHR vendor and only 10 percent with their PM vendor.
• Nearly 60 percent of practices say they have not heard from their health plans regarding ICD-10 testing and nearly 50 percent have not heard from their clearinghouse vendor.
• Concerns remain high over the expected changes to clinical documentation and the loss of clinician and coding staff productivity.

Epic, eClinicalWorks, and Allscripts own about 30 percent of the overall EHR practice market according to an SK&A report from January, 2014. The top 20 EHRs are implemented in almost three-quarters of all practices that use an EHR.

Metro-North ACO (PR) selects eClinicalWorks Care Coordination Medical Record to advance its physician-led ACO objectives.

Surescripts introduces Record Locator & Exchange, which utilizes a master patient index to locate the medical records of a single patient, even when records are held by multiple providers, and, CompletetEPA, an end-to-end prior authorization solution that integrates into a physician’s EHR workflow and enables real-time information exchange between providers and pharmacy benefit managers.

ADP/AdvancedMD customer Jed Shay, MD shares how his use of AdvancedMD’s EHR and PM services have contributed to improved cash flow, productivity, and patient tracking.

North Carolina’s troubled Medicaid billing system goes off-line Tuesday morning for approximately 18 hours, impacting providers’ ability to submit claims. Computer Sciences Corp., which maintains the NCTracks portal, blames the failure of a network switch.

Covenant Surgical Partners will implement gMed’s gGastro EHR within 12 of  its physician offices and endoscopy procedure centers.

HHS finds that most health centers (72 percent) have been able to meet MU objectives related to data capture, but few (24 percent) have met objectives for sharing data. Only 14 percent of the 233 clinics surveyed had the capacity to meet all core Stage 1 objectives and at least five menu objectives.

Compared to patients who visit a doctor’s office for similar conditions, adults taking advantage of telehealth services are younger, more affluent, more technology savvy, and less likely to have used healthcare before their telehealth visit, according to a Health Affairs-published study.

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DOCtalk by Dr. Gregg 2/5/14

City Geek, Country Geek

I’m a pretty lucky guy. Every once in an azure moon, I get the pleasure of hosting someone from “The Big City” here in little Nowhere, Ohio. From big deal technology folks to EHR C-suiters to other IT and healthcare muckety mucks, I’ve had the good fortune of getting to chat with some top shelf folks here in our de-city-fied environ.

The visits are almost always fun and the conversations enlightening. Whether it’s the ambience and atmosphere of the nearby “Red Brick Tavern” (dubbed the “biker bar” by one of my more enjoyable visitors) or the local flavor of “Ronetti’s” which has perhaps the best cheeseburger, fried bologna sandwich, and “Super Sub” this side of Cholesterol County, the friendly chats and shared insights seem to flow with ease when “big” folks take time to share of themselves here in Smallville.

I was graced with another such visit this past week from a longtime pal. We’d given a talk together several years ago where we looked at EMR myths; it was the MOST fun talk I’ve ever enjoyed giving. He came by to spend the day talking all things geek and just getting away from his day to day.

The latter was actually the main inspiration for his visit; he’s the CMIO for one of the nation’s top specialty hospitals and seemed to feel that a day “in the trenches” might be a nice getaway from his multi-problem, multi-committee, multi-pressure work life. He thought it might be good for his psyche to step outside of his institutional realm, to spend some time in the small-practice-make-a-decision-implement-decide-and-move-on world of a solo practice.

I was happy to have him come, though not just because he’s one of the most genuine, friendly, funny, and intelligent people I know; also because it’s fun for me to hear about the large scale side of HIT, from an insider’s perspective – but relaxed, sans board meetings or convention halls. No sales pitches. No corporate protectionism. Just HIT nerds sharing nerdian experiences.

Despite the bad weather and accumulated snow, he made the trip and we spent a wonderful day with only limited interruptions from phone calls or urgent texts. We talked all kinds of geek – from building electronics as kids to dealing with the politics and pressures in our very different domains of healthcare and HIT to comparing the issues of Extormity EHR with those of “Minormity” EMR. We discussed the goods and bads of EHR vendors we’ve known as well as the struggles they face. We discussed family pressures and how they impact on our HIT decisions. We discussed mobile tech and wearable devices. We discussed HIT past and HIT future. It was pure digital doctor geekdom and it was a blast!

I’m not going to expose any of the scandalous nor even the more mundane comments we shared. That isn’t my focus in writing (though some of them might be well worth a headline or three!) What I really want to share is how enlightening it can be to step across the digital and healthcare divides, how spending some time away from your healthcare or IT constructs can be both broadening and restorative.

It’s almost like Neo leaving his Matrixian, computer-generated reality. (At one point I swear I heard Morpheus saying, “Welcome… to the real world.”) Hearing how someone else deals with the same issues of your everyday domain that are similar, but oh so different, is just fascinating, especially when it’s an agenda-free discussion seeking nothing but insight and a little camaraderie across the divide.

I can’t say for sure what my friend took away from our visit, but I can say that it was soulfully reinvigorating for me. While I still prefer my entrepreneurial trench with its day-to-day survival challenges, my view of the world received a shot of bigger picture re-clarification.

We all have our little cubicles. Some are much bigger than others, but they’re all confining, particularly upon our perceptions. If you have a friend or colleague who sits in a different cubby than you, I highly recommend taking time for such a viewpoint renovation visit. It’ll do your HIT spirit good.

From the trenches…

“Better beans and bacon in peace than cakes and ale in fear.” – Aesop

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 2/4/14

CMS issues a final rule allowing patients or their representatives to access completed lab reports directly from laboratories, rather than only permitting physicians to provide their patients with results.

A fee schedule survey of 2,619 practices reveals that 2013 reimbursement levels remained flat for existing patient visits and declined as much as 21 percent for new patient visits.

Spectrum Health (MI) selects PerfectServe’s Clinician-to-Clinician and DocLink platforms for direct and secure clinician communication.

EHR alerts show promise in changing physician behavior when treating overweight and obese children, report researchers from the University of California at Davis. Researchers added obesity-related alerts to the health system’s outpatient EHR and found significant, though not dramatic improvements in treatment. Findings included modest increases (from 40 to 57 percent) in the proportion of children diagnosed as overweight or obese; a 10 percent increase for lab tests for diabetes and dyslipidemia; an increase in follow-up appointments from 24 to 42 percent; and a static number of referrals to dietitians (13 percent.)

Last week on HIStalk we recognized athenahealth for unseating Epic for the first time in eight years as the top overall vendor in the “Best of KLAS” awards, and mentioned all the Best in KLAS winners. In the ambulatory EHR and PM categories the top-ranked vendors and their scores were:

Ambulatory EMR (over 75 physicians) Epic EpiCare Ambulatory (85.7), eClinicalWorks (72.8), Cerner Millennium PowerChart (72.4)

Ambulatory EMR (11-75 physicians) –  EpiCare (84.5) athenahealth, athenaClinicals (83.6), Greenway Medical PrimeSUITE (80.4)

Ambulatory EMR (1-10 physicians) – SRSsoft (90.9), athenaClinicals (87.2), e-MDs (85.2)

PM (over 75 physicians) – Epic Resolute/Prelude/Cadence Ambulatory (87.5), eClinicalWorks (77.9),  NextGen Healthcare (76.4)

PM (11-75 physicians) –  athenaCollector (87.7), Greenway (83.3), NextGen Healthcare (77.0)

PM (1-10 physicians) –  athenaCollector (89.5), Greenway (85), Henry Schein MicroMD (81.8)

KLAS also named the highest rated products in a couple of EMR and PM subset categories:

• 150+ physicians – Epic for ambulatory EMR (85.8) and for ambulatory PM (88.3)
• Single physician EMR – e-MDs (84.2)
• Single physician PM – athenaCollector (81.4)

A small shout-out to PCC Partner, which scored highest in both the EHR (94.4) and PM (91.7) 1-10 physician segments, but was excluded from the overall rankings because KLAS considers them to be “component” products.

CMS reports that through 2013, 436,000 EPs and hospitals have registered for the MU program and 334,000 have been paid incentives for meeting MU requirements, including 63 percent of all EPs. A mere 213 EPs out of 215,288 who attested for Medicare in 2013 were unsuccessful.

The average wait time to schedule a doctor appointment if you live in a large metropolitan area: 19 days, though depending on the specialty and region it could be as little as a day or more than eight months. Boston has the longest average wait times across all specialties at 45 days.

Athenahealth accepts about $6.7 million in state and local incentives to open an R&D office in Austin, TX and pledges to create 600 jobs over the next ten years with an average salary of $132,000. The company will invest $13 million to convert 110,000 square-foot of office space space within the redeveloped Seaholm Power Plant.

CMS gives physicians and their billing staff a chance to assess their ICD-10 readiness during a limited front-end testing session March 3-7. During the testing week, physicians can submit claims using ICD-10 codes for services rendered between October 1, 2013 and March 3 to determine if their Medicare administrator contractors can receive the claims and determine if the claims are accepted or rejected.

The 50-physician Green Clinic (LA) implements Bomgar’s appliance-based remote support solution to provide IT support across its seven locations.

More than 400 Walgreen Healthcare Clinic locations will implement Inovalon’s Electronic Patient Assessment Solution Suite to provide predictive analytics tools at the point of care.

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From the Consultant’s Corner 1/31/14

Optimizing Clinical Documentation
Now Is the Time to Get Started

Many healthcare organizations capture clinical documentation via electronic health records (EHRs) and other technology-enabled channels. The ability to fully leverage clinical documentation to improve care, compliance and reimbursement depends on its quality. In my experience, engaging in clinical documentation optimization is a valuable exercise that can yield tangible benefits.

The October 1, 2014 ICD-10 deadline is probably the most compelling reason to focus on optimizing documentation right now. ICD-10 requires a high degree of specificity, and if your documentation doesn’t have it, you could see a drop in reimbursement and/or an increase in claims denials. On the other hand, if your documentation is detailed and reflects a true picture of the patient experience, coders can more accurately code claims, ensuring you receive full reimbursement for services rendered.

While a significant impetus for improvement, ICD-10 compliance isn’t the only driver for optimization. By striving for more detail and accuracy in clinical documentation, your organization can elevate care quality through better communication among providers. Strong documentation ensures everyone who interacts with the patient is on the same page about diagnosis, treatment and patient response. Embedding care alerts and reminders for patients in documentation can further enhance quality.

Comprehensive documentation also ensures you use technology—electronic health records, for example—to its full potential, which can drive physician productivity as well as adoption.

Thorough documentation can also enhance reporting, which in turn, supports better care delivery. Discreet levels of data are necessary to generate accurate quality reports.

Finally, better documentation fosters more timely claims submission, which results in improved cash flow and reimbursement and leads to fewer denials, ultimately preserving your revenue cycle integrity.

Acknowledging the importance of enriching clinical documentation is the first step toward optimization. To make meaningful progress, I suggest organizations consider and customize the following high-level next steps:

1. Establish goals. Be specific about objectives, timelines, training and who will do the work to drive and manage the improvement process and subsequent changes.

2. Determine early focus. High-volume, high-reimbursement clinical areas and processes make a logical place to start work. In my experience, strengthening documentation in these areas can prevent substantial hits to cash flow and revenue.

3. Examine specialties. Concentrate on those areas that have the most significant changes in documentation requirements, such as cardiology and orthopedics. The physicians in these areas will need to significantly “up their game” when it comes to documentation and can provide valuable input for system workflow retooling.

4. Identify areas of “quick wins.” Give special attention to areas of strong physician support because physician champions can serve as positive role models for adoption in other areas. Identify key players within specialties and promote their demonstrated success to break down change management challenges in other areas.

While ICD-10 makes optimizing clinical documentation a top priority now, improvement work in this area should be an ongoing process with the ultimate goal of elevating clinical care. Organizations that commit to a continuous effort to enhance detail, accuracy and consistency, can see real benefits in terms of both revenue and patient care. Although the idea of revamping clinical documentation may seem daunting, organizations can see big improvements with small changes. The key is acknowledging the importance of the work and getting started on the journey; in my mind, there is no time like the present.

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