DOCtalk by Dr. Gregg 4/19/13

The Phrase That Pays

We’ve all heard some radio station running a contest with a “phrase that pays.” You call in or they call you and if you mention the “phrase that pays,” you win a prize. It’s a pretty common promo thing.

Reading a forum thread the other day, I noticed a phrase which really caught my eye. It wasn’t an unusual phrase (nor one “that pays,”) but rather it was a very common phrase that I see used over and over by providers these days. It’s a phrase I’ve found myself using at times and it’s a phrase that I think we all really need to stop using.

The phrase? Well, it’s some form of the following: “…that we are required to do.”

This particular time it was a clinician bellyaching about reducing the number of clicks “that we are required to do” in order to see a patient. I’ll reference neither the particular provider nor the forum; I’m not interested in any bashing. What I would like to do is point out the particularly inappropriate way that we providers have started to bemoan our fate – a fate that we ourselves have chosen.

The perspective which has induced this phraseology is essentially a mental trap, one that is perhaps easy into which to fall. Not all providers have fallen into this trap, but it is a snare into which the vast majority of today’s doctors seem to have been lured.

The trap? Simply this: all of the reimbursement hoops and digital documentation hurdles are obstacles with which we must – I repeat, must – contend.

There is simply no truth whatsoever within this contention.

We as providers are not required to perform clicks. We don’t have to hit bullet points. We’re not forced to follow proper documentation procedures. We actually don’t even need to concern ourselves with structured documentation of patient care at all.

We do all of these things because we choose to do so. We choose to play in the Medicare, Medicaid, third-party-payer reimbursement playground. We choose to accept Meaningful Use monies. We choose to follow SOAP format documentation guidelines. We choose the EHRs we use or at least we choose the institutions for whom to work and, thereby, choose to accept the EHR that they have chosen. We choose to accept these models of reimbursement and these methods of documentation.

We could just as easily choose to employ a concierge practice model that forgoes all third-party payments and, therefore, third-party payment requirements. We could offer our services for barter, for pigs or eggs or maybe handyman or childcare services in trade. We could offer to provide healthcare services for free and use other skill sets to generate maintenance income. We could document in any way felt. We absolutely could make other choices for how we opt to play in the healthcare arena.

Just because the vast majority of us choose to play in the standard healthcare sandbox in no way eliminates the function of choice which we have undertaken. We want the monies, we want to work within the healthcare “box,” and we choose to do so. But, we are not “required” to do so – not in the least.

The alternative? Remember that it’s a choice we’ve made.

Remember that we have all chosen to play within this space. Remember that we have chosen to play by these rules. Remember that we have the option to play differently (though that option may be a tough change to make). Remember that we are all a part of this, that we set the rules together. And, remember that we can change them, too.

We providers are not blameless for the choices we make. We don’t serve at the pleasure of the feds; neither do we function at the whim of EHR vendors. We don’t even serve any institutional or ACO master without consent. As long as we choose to play in the sandbox, we need to remember that the system within which the majority of us have chosen to participate is, in part, of our own making. Bellyaching about it doesn’t do much and whining about things “…that we are required to do” isn’t helping anybody’s cause. It’s simply not a phrase that pays.

A phrase that does pay? Here’s an option that I’m going to try to keep in mind: “I have an idea that might make things better…”

From the trenches…

“There is no phrase without a double meaning.” – African proverb

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 4/18/13

The HHS Office of the Inspector General publishes protocols for providers who wish to voluntarily disclose self-discovered evidence of potential fraud. The OIG notes that physicians and other healthcare providers that follow self-disclosure protocols “deserve to pay a lower multiple on single damages than would be normally required in resolving a Government-initiated investigation,” though the specific multiplier may vary depending on the facts of the case.

NextGen reseller TSI Healthcare recognizes Carolina Orthopaedic and Sports Medicine Center as its Circle of Excellence award winner in the practice management category.

HIMSS Analytics recognizes 54 Essentia Health (MN, ND, WI) ambulatory clinics for achieving Stage 7 on the Ambulatory EMR Adoption Model. The clinics run Epic.

Meditab Software introduces the AllergyEHR Shot Lab, which works with third-party EHRs to provide immunotherapy tracking and management.

The preliminary results are in from our 2013 HIStalk Practice Reader Survey. I’ll summarize the findings in a separate post, but I’m pleased to report that 91 percent of survey participants believe that reading HIStalk Practice has helped them perform their job better in the last year. Readers shared a number of good ideas to make the site even better and Mr. H and I will be weeding through those in the next few days. Thanks to all who took the time to participate.

GE Healthcare IT announces several new initiatives in support of customers at this week’s 2013 Centricity Live USER Conference in Washington, DC. Proposed programs include:

• The GE Centricity Productivity Award for practices that most embody GE’s vision of “connecting productivity with care”
• An expansion of the channel partner program to support small and midsize independent practices

The Wall Street Journal interviews athenahealth CEO Jonathan Bush, who discusses his company’s purchase of Epocrates, physician adoption of cloud-based services, his political family ties, and more. A couple of highlights:

The biggest obstacle to athena’s business success has been the fact that we’re totally unknown. And when we’re known, we’re not trusted because we’re too new, too young, too complicated. Everybody knows Epocrates and trusts them. And so the first benefit is that, is just that we can now be known.

I worked for my uncle George—41’s—campaign when I was a teenager and he has been an idol my whole life. Not at the same level as my dad, who also had a much bigger impression on me. But my uncle is very, very, very loyal, committed to his team, and I am that way as well

Children’s Mercy Hospitals and Clinics announces a telehealth program that will connect allergy patients in Wichita with providers in Kansas City. An RN will facilitate the remote visits and physicians will use a digital stethoscope to assess a patient’s ears, nose, and throat.

E-mail Inga.

News 4/16/13

Physicians should “pause before posting” online, according to recommendations from The American College of Physicians and Federation of State Medical Boards. In order to protect the patient-physician relationship and observe professional conduct, other recommendations for physicians include:

• Not friending or contacting patients through personal social media
• Texting patients only if  they consent, and then only with extreme caution
• Communicating electronically only with established patients that have given consent.

Most physicians support patient self-tracking to collect and share their health data. More than two-thirds of physicians report having at least one patient sharing health measurement data and three-fourths believe self-tracking leads to better patient outcomes.

SuccessEHS integrates its SuccessEHS 6.1 EHR/PM solution with four Welch Allyn medical diagnostic devices.

The Greater Miami Chamber of Commerce names CareCloud the 2013 Technology Company of the Year. CEO Albert Santalo accepted the award on the company’s behalf.

Practice Fusion launches Patient Fusion, which allows patients to schedule online appointments via the Web with any of the free EHR company’s 27,000 physician users and access their health records online. Mobile versions will follow.

Phreesia partners with EHR Integration Services to integrate its self-service patient check in technology with existing PM and EHR systems.

Athenahealth will provide developers access to APIs to connect to athenahealth’s physician network, including appointment data and anonymized billing and medical history. Possible apps could facilitate scheduling, data sharing between practices, and practice-patient communications.

Athenahealth also announces that Cerner has certified athenaNet for interoperability with the Cerner network.

Surescripts awards DrFirst the 2012 White Coat of Quality award for its Rcopia e-prescribing software.

E-mail Inga.

From the Consultant’s Corner 4/12/13

The Next Available Appointment Is…
By Brad Boyd

Have you ever gone to the doctor for a routine checkup, only to be told that you should really see a specialist to take a closer look at that issue you’re having? Perhaps you have frequent migraines or your asthma symptoms are getting worse. As you try to make the appointment, you are told that the only time you can see the specialist is in six weeks, on a Tuesday, at 10:45 a.m., because the doctor is not available any other time.

This situation is not only irritating for you—the patient—it is also aggravating for your primary care physician. When patients have trouble gaining access to specialists, it can mean delayed treatment, potentially compromised patient care, and more headaches for the primary doctor. I’ve observed that some primary care physicians cope with this problem by referring patients to specialists outside their network, which presents issues for both the physician and the network.

As healthcare organizations pursue clinical alignment and integration initiatives—such as Accountable Care Organizations and other value-based reimbursement strategies—I have found they focus on steps like implementing integrated information technology systems, standardizing medical management, and fostering greater physician alignment.

While these are important aspects of an integrated approach, what many organizations fail to realize is that they also have to address patient access issues. If patients have trouble getting in to see their doctor or specialist, there could be some pretty significant patient care, satisfaction, and revenue effects.

I’ve noticed this problem happens most often when academic institutions seek clinical alignment and integration with non-academic organizations, such as physician practices. In these situations, physician compensation in the academic medical center may not be aligned with productivity expectations. In other words, the compensation model for specialists doesn’t incentivize them to see large numbers of patients. They may limit the number they see, choosing instead to focus on research activities or other priorities.

Improving patient access and the overall patient experience requires a holistic view of the academic institution-physician practice partnership, taking into consideration governance, leadership, and management issues. I recently tackled this type of holistic assessment for one of my clients, an academic group practice. Together, we developed a patient access optimization program which we piloted across two departments.

The result was a 25 percent increase in appointment slots and a 14 percent growth rate in ambulatory revenues. Satisfaction scores also improved for employed and aligned practices as well as their patients because patient care was better coordinated across the health system. In addition, referrals to competing health systems went down substantially. Based on the success of the pilot, the organization is deploying a new standardized "patient care model" throughout the remaining clinical departments.

Spending time looking at patient access and figuring out ways to increase specialist availability can ensure that any clinical integration program you pursue is successful. By addressing this issue, you can make the road toward clinical integration a little easier and ultimately reach your goals in this effort.

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

News 4/11/13

Athenahealth files a lawsuit against CareCloud, a four-year-old PM/EHR company that athena claims is infringing on one of its patents. The 2001 patent addresses the way claims processing rules are injected into athenahealth’s billing workflow. Above is a 2011 tweet from Jonathan Bush. Several former athenahealth employees now work for CareCloud. Athenahealth’s director of communication was unable to comment on the lawsuit, but CareCloud CEO Albert Santalo provided us with this statement:

“To the best of our knowledge Carecloud is not infringing on Athenahealth’s 13-year-old outdated method and we won’t be making any additional comment at this time.”

Main Line Health (PA) implements eClinicalWorks EHR across 42 practices.

The Polyclinic (WA) selects Phytel’s Population Health Management solution and Verisk Health’s Provider Intelligence program for population health management.

CMS creates a fact sheet to help providers if they are selected for EHR incentive program audits. CMS notes that documentation supporting attestation responses should be retained for six years and should support all payment calculations, such as cost report data.

Arkansas Heart Hospital selects eClinicalWorks EHR for its physician clinics.

HIMSS Analytics recognizes the ambulatory clinics of NorthShore University HealthSystem as the first group of ambulatory facilities to reach Stage 7 of the Ambulatory EMR Adoption Model.

Clinical effort, teaching, and research are named as the factors that most heavily influence physician compensation in academic settings in an MGMA report on academic practice compensation. Other factors influencing compensation: department rank, specialty, and geographic location.

Intuit Health announces that seven million patients have now registered for the Intuit Health Portal, including one million in the last six months.

Athenahealth celebrates the fifth anniversary of its Belfast, ME location, which now employs 570.

Bankruptcy attorneys and physicians blame a weak economy, shrinking reimbursements, changing regulations, and rising malpractice and drug costs for a recent spike in physician practices filing for bankruptcy. The American Bankruptcy Institute reports at least eight filings by physician practices in recent weeks.

E-mail Inga.