News 9/26/13

From Molly Ringwald: “Re: Practice Fusion. Raises an additional $70MM. Looks like they are going to eventually target the inpatient setting if they are raising THAT much money!” An article in VentureBeat offers a few clues on what Practice Fusion may be planning to do next (entering the inpatient market is not one of the options mentioned). The company just closed $70 million in a Series D round, bringing its total funding to $134 million. Practice Fusion CEO Ryan Howard says the company is positioning itself for an IPO and is driving its revenues from pharma, imaging centers, pharmacies, and labs. Practice Fusion has historically relied on revenues generated by advertisements on its EMR platform, but the sale of data and analytics captured from the Practice Fusion platform will become increasingly important. Howard says revenues are up 300 percent this year from 2012, but doesn’t disclose further financial information on the company, including profitability.  Meanwhile, Howard expects Practice Fusion to double its user base over the next year.

The NCQA reports that 6,000 medical practices in 49 states are now recognized as PCMHs.

CMS posts an online calculator that allows physicians to determine their payment adjustments based on 2013 participation in the eRx incentive program, the Medicare MU program, and PQRS.

If you are heading to MGMA, you won’t want to miss our annual list of must-see vendors, which we’ll publish over the weekend. Our compilation of the hottest vendors – all who happen to be faithful HIStalk sponsors – includes booth numbers and company summaries, plus contact information for a few companies that won’t be be exhibiting but will be available for one-on-one meetings.

Speaking of the MGMA conference, I loaded the mobile app that includes the complete schedule of educational sessions, keynote speakers, maps, exhibitors, and more. It was very easy to create a personalized schedule – mine includes Monday’s keynote speaker George Will and several sessions on the HIT track. I wish I had an app for mapping out my Monday night parties since this year I won’t have the navigational expertise of my Wing Gal Dr. Jayne. The meeting runs October 6-9 and I will be posting daily updates.

Georgia Bone & Joint Surgeons selects Pulse Practice Management and EHR.

South Jersey Family Medicine will replace its Alteer platform with e-MDs Solution Series EHR, PM, and patient portal solutions.

Speaking of replacements, KLAS reports that the small practice EHR replacement market is picking up. In the 1-10 physician segment, athenahealth, SRSsoft, and Practice Fusion are having the most success delivering quick and easy installations of value-based products, while McKesson, GE, Allscripts, and Vitera are experiencing the most customer loses due to unmet product expectations, poor upgrade releases, and inadequate relationships. Pediatric-specific EHR vendor PCC earned the overall top performance score.

EClinicalWorks and Epic develop bidirectional interoperability between their EHRs.

In case you missed it, on Monday evening I interviewed the CEOs of Greenway and Vitera about their impending shared ownership. A couple of quotes:

From Vitera’s Matthew Hawkins:

I can’t make too many forward-looking statements other than to say we think that with this transaction and working together to put in place a plan that will allow for a smooth integration at the right time, if and when the transaction occurs. We are very excited about it. Our staff is upbeat, we are upbeat, and we think it is a continuation of our long term goal: to be great partners with our customers in the market.

From Greenway’s Tee Green:

Obviously as the company continues to evolve, maintaining multiple platforms probably isn’t going to be the long term strategy because that doesn’t create value for your customers or your team. You will see some of that evolution over time.

Email Inga.

HIStalk Practice Talks with Greenway’s Tee Green and Vitera’s Matthew J. Hawkins

We spoke with Greenway Medical Technologies CEO and President Tee Green and Vitera Healthcare Solutions CEO Matthew J. Hawkins shortly after the announcement that the two companies would combine. Because Greenway is publicly traded, the leaders were unable to comment on specific aspects of the pending transaction, but shared a few insights:

Hawkins: From a Vitera perspective we are just thrilled with this combination, this transaction that was announced today. We feel it is absolutely a continuation of our commitment to create an incredible business, a platform of healthcare that can take care of our customers’ needs not just today but for years to come.

We mentioned in a note we sent out to our employees that we have had a chance to get to know the Greenway team and know their culture, and the values that they have and their tremendous focus on product innovation and support and service, and felt there is a real alignment with what we are working to build at Vitera as well. So we are really excited about that as well.

We also noted that both Vitera and Greenway solutions are all certified for Meaningful Use 2014 edition and both have achieved patient-centered medical home pre-validation status, and all are ICD-10 ready by the end for this calendar year. So there is a real alignment in taking care of our customers. And that got us excited.

We think that this transaction with Greenway is really a testament to our partner Vista Equity Partners and their vision for what this combination can accomplish in the healthcare space. It’s really a testament to our hard and intense focus on growth and our commitment to take care of our customers today and in the future.

I can’t make too many forward-looking statements other than to say we think that with this transaction and working together to put in place a plan that will allow for a smooth integration at the right time, if and when the transaction occurs. We are very excited about it. Our staff is upbeat, we are upbeat, and we think it is a continuation of our long term goal: to be great partners with our customers in the market.

Green:  As Matt said, this is huge for the industry and certainly huge for our customers and Vitera’s customers –  being able to continue the Greenway brand, the strategy that we developed around electronification and consumerism that is really starting to take hold in this country. We believe there is a going to be a real thirst to improve health and with an innovation platform like this and a customer base like this we think it creates unparalleled opportunities for our teams, our customers, and our business partners.

The leaders could not comment on who would lead the company going forward but noted that plans were being developed for combining the two entities:

Green: A lot of is being worked out right now as far as how as how the synergies are going to roll. Obviously we have some great innovation within these companies and we are putting together that strategic plan over the next 45 to 60 days leading up to closing, and then at that closing we will have the opportunity to share that strategic roadmap with everyone.

The acquisition discussions apparently began fairly recently:

Hawkins: We have been friendly for a while but never had any serious discussion until far more recently. We had a chance to take a friendship in the industry, knowing each other as acquaintances, and feel there is tremendous value to be had by potentially combining these two entities in a transaction like this. Those conversations have been much more recent.

Long term plans for product platforms are still evolving:

Green: If you look at the press release and you look at the brand, obviously as the company continues to evolve, maintaining multiple platforms probably isn’t going to be the long term strategy because that doesn’t create value for your customers or your team. You will see some of that evolution over time.

Hawkins: I will also say the Vitera business has several product platforms today and we expect to continue to support and maintain and provide updates to those product platforms. I will also note that all of our product platforms are set for ICD-10 compliance and we have a clear pathway for our flagship platform Intergy, which is Meaningful Use 2014 edition-compliant, one of very few vendors that have reached that status, so we are pleased by that. We will also continue to support, maintain, and invest appropriately in those products. We need to be emphatic about that.

We are thrilled and excited about the PrimeSUITE of solutions that the Greenway business has. While we don’t have any clear plans as of yet, we like the PrimeSUITE product platform and we also have high regard for the revenue cycle management business that Greenway has put in place. We feel like there are opportunities for the combined entity to be able to take advantage of these RCM solutions while continuing to use the product platforms of their choice.

News 9/24/13

Vista Equity Partners, which owns Vitera, will pay $644 million cash for the publicly held Greenway Medical Technologies. Shareholders will receive $20.35/share, which represents represents a 62 percent premium to Greenway’s 90-day volume weighted average stock price and a 20 percent premium to Greenway’s closing share price the day before the merger agreement was signed. Greenway’s IPO stock price February 2 2012: $10.10. The businesses will continue as Greenway Medical Technologies and market their products under the Greenway name. The combined entity will serve nearly 13,000 medical organizations and 100,000 providers.

Hello Health, which offers a “no-cost” EHR and patient portal, announces integration with CollaborateMD’s billing/PM system. Hello Health has a pretty unique business model that requires patients to pay a monthly subscription fee for access to the practice’s portal. Fees start at $4/month/patient and the revenue is split between Hello Health and the practice. In order words, practices get a free EMR, patients pay for access, and the practice generates a bit of extra revenue. I don’t understand why a patient would pay for portal access when they could visit another doctor down the street and likely get portal access for free; however, the model seems to be working. Practices running the CollaborateMD platform will be able to apply the revenue generated by Hello Health towards their monthly subscription fee.

The American College of Physicians releases ACP Smart Medicine, a web-based clinical decision support tool for internal medicine physicians that provides access to  hundreds of evidenced-based recommendations on diagnosis, therapy, prevention, and screening.

A British Columbian online newspaper offers some insights into the province’s EMR adoption program, which has extended $78 million in subsidies to private practices since 2006. I was aware that the various Canadian provinces offered incentive programs for EMR adoption, but never knew many specifics. The BC’s program is based on the assumption that 30 percent of the benefit of converting to an EMR accrues to the physician, so only 70 percent of the investment is subsidized. If a physician converts to one of four approved EMRs, the government reimburses the lesser of $7,000 or 70 percent of a one-time implementation fee, plus 70 percent of operating costs each year to a maximum of $2,850 the first year and $4,500 in later years. The government will also pay subsidies for non-certified EMRs if the physician can prove it improves health outcomes and meets certain privacy, security, and interoperability expectations. Since 2006, EMR adoption by general practitioners has increased from 15 percent to approximately 80 percent. Interestingly, adoption is higher in rural communities than urban centers, where adoption rates are only about 55 percent; however, fewer solo physician practices have adopted EMRs and solo practices are more prevalent in urban areas than rural locations.

Kyruus joins athenahealth’s More Disruption Please program to offer athenahealth providers access to the Kyruus ProviderMatch system for matching patients with specialists.

Sunshine Pediatric Clinic (PA) goes live on ABEL Medical Software EHR.

The FDA issues a final guidance for mobile medical apps, saying it will exercise “enforcement discretion” for most apps since they pose minimal risk to consumers. The FDA does not intend to exercise enforcement for the majority of health and wellness apps for self-managing a disease or condition, nor for apps to track one’s health information, exercise, or diet. FDA’s oversight focus will be on mobile medical apps that present a greater risk to patients if they do not work as intended, such as those intended for use as a medical device accessory (such as viewing a medical image on a smartphone) or those using a mobile platform as a medical device (like an app that allows a smartphone to be used as an ECG to detect abnormal heart rhythms.)

Email Inga.

From the Consultant’s Corner 9/21/13

Get Ready, Here it Comes: Tips to Prepare for MU Stage 2
By Jason Drusak

This year is flying by. It seems like just yesterday that Meaningful Use (MU) Stage 1 kicked off. As we head into the last half of 2013, we’re thinking about the move from MU Stage 1 to MU Stage 2.

Since 2014 is implementation year for Stage 2, you’ll need to prepare for it in the third and fourth quarters of this year. So, how do you prepare? I haven’t seen any exact steps to follow for Stage 2, so I offer these five tips to help with an effective ramp-up.

Create a review team

You need to involve clinical, financial, and technology stakeholders in MU Stage 2 plans because Stage 2 reporting requirements are more clinical in nature than MU Stage 1. On the technology side, you need someone who’s responsible for the application, plus someone on the reporting side. In fact, I’d say that data gathering and reporting are the most important aspects on the technical side. After all, if everything isn’t entered correctly, the reports won’t be appropriate. 

Learn from what you’ve done

Stage 2 is the same as Stage 1 – but different. Look at what worked well in Stage 1 and learn from any mistakes you might have made. What would you do differently? With Stage 1, you focused on installing workflows to capture data for certain measures. Moving to Stage 2, you need to be sure you’re entering the actual data correctly for those measures. If there was an issue with data entry on a navigator section or an issue with a grouper or measure configuration: review setup and build for data entry, data gathering, and reporting output.

If in Stage 1 a site had issues in one of these areas, now would be a good time to assess how data is being entered for each measure in order to iron out the troubles before they become even larger in Stage 2. It’s important to review the workflows so that data entry is accessible for the clinician, as well as the system build for each measure. Additionally, you’ll want to confirm that data capture pieces are in place and configured correctly. Evaluating which reports are used to monitor progress will help ensure that they are formatted in a way that is easy to read and provides value.

Conduct a gap analysis

Compare Stage 1 work with Stage 2 requirements. Are there areas where you need to catch up? Data measures are changing and you will need to collect additional data; go ahead and set up workflow changes to capture that data now. For example, the threshold for the smoking measure is moving from 50 to 80 percent. Now is the time to put the new threshold in place.

Adjust monitoring reports for these measures so you can see which ones will meet the new requirements and what areas may need to be investigated for any shortcomings. One new core measure is lab orders must be directly entered into CPOE greater than 30 percent. Even though you don’t need the data today, turning this measure on and completing the build now will show your progress for compliance with this measure and will give you time to make any necessary changes before Stage 2 arrives.

Check your software

This is not the time to be retro. Examine the level at which your software is operating and be sure it’s up to date. I’ve noticed that major updates tend to come out about every other year – along with ongoing patches and fixes. Work with your technical team to look at big and small updates, allowing time for any needed upgrades. As obvious as it sounds, make sure you’re getting all the MU updates as soon as they’re available. Don’t wait until 2014 when Stage 2 is being implemented to get the latest versions of your programs. 

Test first

Don’t cram the night before the exam. Your upgrade plan needs to include testing before go-live. I’d say it’s close to impossible to test a report without some type of real data. You may have to scramble it to make it unidentifiable, but you need a realistic data environment for testing something as big as MU Stage 2.

MU Stage 2 is coming whether you’re ready or not. Stay ahead of the game by preparing for the 2014 implementation today.

Jason Drusak is manager of consulting services at Culbert Healthcare Solutions.

News 9/19/13

Despite an increase in hospital employment, more than half of all physicians worked for themselves in 2012 and 60 percent were in practices wholly owned by physicians, according to an AMA report. Other notable findings:

• Last year 29 percent of physicians worked either directly for a hospital or for a practice partially-owned by a hospital, compared to 16 percent in 2007/2008.
• The percentage of physicians who were practice owners in 2012 dropped eight percent from 2007/2008.
• Eighteen percent of physicians were in solo practice, compared to 24 percent five years ago.
• 45.5 percent of physicians are in a single specialty practice.

Despite the AMA’s conclusion that private practice “remains strong,” I predict we’ll see a different story in another five years. The ownership breakdown listed above indicates that younger physicians are less likely to be self-employed than their more senior peers. As the older physicians retire, the percentage of privately-owned practices will surely shrink.

PCMH practices report higher operating costs per patients than non-PCMH practices, according to an MGMA cost survey. Also higher: total medical revenue per patient at PCMH practices. The higher operating costs for PCMH practices are in part attributed to higher staff/patient and provider/patient ratios.

Amazing Charts names John Squire (Microsoft) president and COO.

ONC releases online tools for providers and HIEs to educate patients about the electronic sharing of health information.

MU Stage 2 is accelerating EMR-specific patient portal adoption, though the trend is negatively impacting best-of-breed vendors that are not as well equipped as EMR offerings, according to a KLAS report on patient portals. Athenahealth, Epic, and Allscripts were the top-performing vendors.

Emdeon earns high customer satisfaction ratings in a separate KLAS report that examined enterprise patient access solutions.

Quality Insights of Delaware REC is offering free, one-year subscriptions to NeHC’s Consumer eHealth Readiness Tool to up to 50 of its clients.

The AHRQ offers a toolkit to help office-based physicians and their staff improve their processes for tracking, reporting, and following-up with patients after lab tests. The guide includes an EHR evaluation tool to understand how a practice’s EHR can help with test ordering, tracking, reporting.

New Jersey-based Medical Transcription Billing Corp., a provider EHR/PM/RCM solutions for physicians, announces plans to conduct an IPO of its common stock.

Email Inga.