DOCtalk by Dr. Gregg 1/6/14

Why Does Simon Practice?

Simon – Dr. Simon Princewalleter – is a small practice, primary care provider who works diligently every day, often seven days a week. He keeps his own books, but has an accountant advisor and an outside billing company. He has three staff members who he loves and who seem to appreciate him. (He loses sleep on numerous payday eves worrying that he won’t have enough to meet their payroll.) He efforts to keep current on standards of care and evidence-based guidelines. He takes his own after-hours calls, tries to offer quality online tools for his patients including a nice website and an attractive patient portal, and uses a good electronic medical tool for all his patient records. He tries to keep up with governmental and insurance company rules and regs, maintains HIPAA watchfulness, and protects his digital patient data. He spends many hours doing things for which he was never trained.

He is going into debt to stay afloat.

Why does Simon continue this struggle? Why not sell out to an ACO or join a group? Why does Simon practice?

Simon, it appears, is part of a dwindling breed. He loves his practice, his staff, and his patients. He thinks he provides a value and services that are unique. He likes being entrepreneurial despite the challenges and mounting pressures. He likes being a small practice doctor, with all that entails. He isn’t convinced that a regular paycheck and institutional guidelines would ever provide the warm sense of satisfaction he gleans on his own.

But, he knows that he cannot continue to watch debt mount. He struggles to find new resource avenues. He provides some consulting services which, while detracting from his family time, help keep the lights on and the family fed. He looks for ways to see more patients that don’t entail cutting value and patient care quality. He considers innovative options for increasing practice revenues through digital services offerings. He trims staff benefits though he despises the necessity.

Why does Simon continue to struggle when the “security” of a group might be so much cozier?

Simon loves being innovative. He loves seeing what needs to be done and then defining creative ways to accomplish the job. He loves making decisions and seeing where they lead. He doesn’t mind when his decisions are wrong; he just decides on what needs to be done next to make it better. He likes his mom-and-pop shop ways.

As witnessed all over the country, though, he knows moms and pops are fading from the landscape. Corporate conglomerates have the clout and the monies to push moms and pops aside or, all too often, just steamroll them into oblivion.

He sees the conglomerate writing on the healthcare wall. Simon knows he may not be able to avoid the centralization of healthcare. It may be inevitable that he will one day become subsumed by the healthcare Borg.

Why does Simon continue to buck the trend and keep his individualist ways?

Simon isn’t arrogant or excessively proud. He’s just trying to do a good job and provide the best he can for those for whom he cares, whether patients or staff or family. He also knows that something deep down inside him would probably get lost if he sold out to a corporate structure. He believes strongly in the American ethos of the pioneer spirit upon which his country stands so proud. He thinks innovation, even micro-innovation on a micro-scale such as his little practice, has a value and an intrinsic worth that can never be replicated in an institutional setting. He believes he can make a difference – perhaps a small difference, but nonetheless an important difference – by being true to the values he holds dear. He believes his best is brought forth in his entrepreneurial realm.

Why does Simon practice?

Simon loves what he does, he loves those for whom he cares, and he thinks he has found the best way to repay all that he has been given by being the best “him” that he can be: a small practice doc trying to do what’s right, delivering personal care the best way he can – for as long as he can.

From the trenches…

“We must free ourselves of the hope that the sea will ever rest. We must learn to sail in high winds.” – Aristotle Onassis

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 12/26/13

Good news for physicians: CMS adopts final rules extending the Stark exception sunset date from December 31, 2013 to December 31, 2021. The amendment allows healthcare entities to continue subsidizing physician purchases of EHRs and addresses additional rule modifications, including:

• The exclusion of lab companies from donating EHR items and services
• The elimination of the e-prescribing capability requirement
• Updates to the interoperable provision
• Clarification of the requirement prohibiting any action that limits or restricts the use, compatibility, or interoperability of donated items or services.

Ownership of an e-prescribing system jumped from 30 percent in 2007 to more than 56 percent in 2010, according to data from the National Ambulatory Medical Care Survey. Of those practices with e-prescribing capabilities, 85 percent of the providers actually sent prescriptions electronically in 2010. Family medicine providers had the highest ownership rate at 68 percent; psychiatrists had the lowest rate with less than 32 percent.

The Mercy health system (MO) says that use of its e-visits service has quadrupled over the last few months. More than 400,000 Mercy patients have signed up for MyMercy, which also allows patients to schedule appointments, email providers, track medical histories, and pay bills.

Greenway Medical Technologies wins the 2013 Intel Innovation Award for its PrimeMOBILE app for Windows 8.

This week tends to be one of the slowest of the year for HIT news, even though most providers don’t get too much of a holiday break. If you are in the trenches providing care, thanks for your dedication.

Email Inga.

DOCtalk by Dr. Gregg 12/23/13

Dear Digital Santa

Dear Digital Santa,

First, thank you so much for all the digital presents last year. They were really fun and most of them lasted several months before the next version or a completely updated model was released.

For 2013, I have a rather different wish list. I know you told me when I sat on your lap last Saturday at the mega-mall that you didn’t think you’d be able to deliver on most of these, but I still want to put in my official request. (Anything you can do might make up for that weird tukas fondle you tried to say was an accident. Didn’t know what to make of that, Santa, but if you deliver on these, I’m willing to forego consideration of any formal charges.)

That said, I’ve formalized my list. I’d like:

· Tablet and smartphone firmware and software that can upgrade for as long as the hardware still works

· A smartphone app that makes calls from people on otherwise great smartphones sound good so you don’t have to keep straining to hear through muffled mush

· An EHR app that can take excessively long, typically templated EHR reports sent from other systems and extract the truly relevant material (often one third to one tenth the length of the original)

· A way to get EHR vendors back to developing based upon intuitive creativity, not just dictated criteria that may or may not actually make a difference in healthcare outcomes someday

· An HIT governmental hierarchy that doesn’t keep edging toward where almost all government hierarchies end up: excessive bureaucracy piled so high on top of initial good intentions that it smothers the very systems it was designed to assist

· Healthcare IT people and healthcare delivery people speaking a mutually recognizable language where neither is so acronym-heavy that it makes the other feel stupid

· Promises and delivery – neither too big or too small, but juuuust right – as the cornerstones of HIT

· Interoperability that’s about true interoperable interactivity, not buzzwords and sales hype

· A year without buzzwords and sales hype – and maybe a year without sound bites, too

· Throughout HIT-dom, less flash and sizzle, more real and worthy

· Healthcare folks, either HIT-related or just in general, with more fondness for getting work done than fondness for their own egos

· A pocket version of Watson

· Key software, like word processing, email, and such, with real support from a real company that doesn’t cost an arm and a leg, that doesn’t keep costing me ad infinitum, and that can reside on my computer instead of an NSA-accessed cloud server somewhere

· A special app for all my devices that sends a fatal – or at least momentarily heart-stopping – shock to any hacker or identity thief who tries to access with my digital world

· Peace on earth

I’d probably take the last one as a substitute for all of the others, though I might have to think about it for a while.

I know you’ll do your best, Santa.

With holiday love, from the trenches…

“The season wouldn’t feel the same without people going out of their way to be offended by nothing.” – Jon Stewart

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 12/19/13

Over time the use of open notes will become the standard of care, predicts that the authors of a NEJM-published op-ed. The clinician-authors note that increasing patient engagement through transparent medical records contributes to improvements in health, care, and costs, and that patients who access their notes have better recall and understanding of their care plans and better medication adherence.

E-MDs Cloud Solutions v. Cirrus achieves ONC-ACB certification for MU Stage 1 and 2 and is compliant as a Complete EHR 2014.

Deloitte includes Kareo on its Technology Fast 500 list of fastest growing technology, media, telecommunications, life sciences, and clean technology companies in North America based on its 797 percent growth over the last five years. Kareo was ranked fifth in HIT and 156th overall.

Troubling: the healthcare industry is making slow progress on preparing for ICD-10, according to a WEDI readiness survey. About 20 percent of vendors claim they are halfway or less complete with product development, while about half of providers have yet not completed an impact assessment. Meanwhile, about one-third of health plans have not initiated internal testing; two-thirds have not started external testing.

Projected physician shortages can be substantially reduced by using new models of primary care, such as the PCMH and nurse-managed health center (NMHC) models, even without increases in the number of physicians, according to a RAND study. RAND projects that if the prevalence of PCMHs increases from 15 to 45 percent and NMHCs from .05 percent to 5 percent, physician shortages could be cut in half by 2025; researchers also believe that medical homes could handle 20 percent more patients through the use of technology and improved coordination.

Solo physician Stephen T. Imrie, MD handles a potential data breach in an arguably more efficient manner than many larger organizations with presumably more resources and available expertise. The San Jose-based physician sent an appropriately apologetic letter to 8,900 patients notifying them that a password-protected laptop was stolen from his home September 23. The computer included both clinical and financial details on patients, including patient social security numbers. Though no misuse of data has been reported, Imrie automatically signed up his patients for free credit monitoring.

CMS implements an informal review process for EPs and group practices who will be subject to the 2014 eRx payment adjustment. EPs/group practices have until February 28, 2014 to email eRxInformationReview@cmg.hhs.gov to request an informal review.

A big welcome to Optum, HIStalk Practice’s newest Platinum sponsor! Optum, which includes the OptumHealth, OptumInsight, and OptumRx divisions, offers a wide variety of products, tools, and services for various segments of the healthcare system. Their technology offerings for hospitals, physicians, and other stakeholders focus on the delivery of integrated, intelligent solutions for modernizing the healthcare system and improving health. Solutions for physician practices include Optum Claims Manager and Optum Intelligent EDI, which are designed to help practices submit clean claims the first time around and maximize reimbursements. Claims Manager can be directly integrated with third-party clearinghouses, billing systems, and PM systems, as well as with Intelligent EDI, Optum’s claims processing solution that successfully provides first-pass payment rates as high as 97.5 percent. Optum also sponsors HIStalk at the Platinum level and we thank them for supporting of our work.

Greenway Medical adds Digital Assent, a provider of patient satisfaction survey solutions, to its online Marketplace of value-added partners.

If you are a physician and looking for some moonlighting ideas to pay off those holiday bills, here are a few suggestions from Medscape. Options include telehealth consults (pays about $20 for a 10 minute consult); health insurance claims reviewer ($85-$200 an hour); and, cruise ship doctor ($150 a day plus free cruising for you and a guest.) Can’t imagine why anyone would choose to review insurance claims over a free cruise.

Email Inga.

News 12/17/13

The Louisiana Senior Care Coalition selects eClinicalWorks Care Coordination Medical Record as its population health management solution for advancing its ACO objectives.

Athenahealth will integrate Merge Healthcare’s iConnect Network into its athenaClinicals EHR to allow users to receive and view exam results and diagnostic-quality images.

US physicians apparently aren’t the only ones concerned with a decline in compensation. Salaried GPs in the UK made an average hourly rate of $61 this year, down from $75 in 2012. The average US doctor, by the way, earned $80 an hour in 2010, not including benefits.

Practice EMR vendor drchrono releases an API that will allow developers to extend and enhance its platform.

Wolters Kluwer Heath integrates its Health Language Provider Friendly Terminology with Epic EHR for mid-size to large practices, as well as for hospitals.

A mere seven percent of psychiatrists were awarded MU incentives last year, a lower percentage than in any other specialty. Industry analysts blame poor usability of EHR systems, the exclusion of mental health centers from program incentives, and a relative lack of EHR vendors specializing in psychiatry.

In an unrelated study published in JAMA Psychiatry, almost 45 percent of psychiatrics refuse private insurance or Medicare. Sounds like another pretty obvious reason why so few psychiatrists qualified for MU.

CMS issues a final rule that confirms physicians who assign their reimbursement and billing to a CAH under Method II are now eligible to participate in the MU program as EPs.

Physicians participating in a Western NY Beacon Community study used technology to help their patients better control their blood sugar levels and reduce the number of avoidable hospitalizations. Participating physicians implemented new technologies and upgraded their workflows. The Beacon Community also used EHRs to generate diabetes registries to track lab and test results and to generate preventative care reminders and guidance. Among the 57 participating practices, the percentage of diabetes patients with uncontrolled blood sugar levels improved by as much as 10 percent over a one-year period.

Congressmen Erik Paulsen (R-MN) and Jim Matheson (D-UT) propose legislation that would mandate the use of clinical decision support software by physicians receiving Medicare and Medicaid reimbursement when they order diagnostic imaging tests. The goal is to provide doctors with immediate feedback and recommendations for the appropriate tests to order. Sounds like a great idea that would likely create a few administrative nightmares.

Email Inga.