News 4/25/13

Compensation for medical directors is increasingly tied to quality metrics according to an MGMA report on medical directorship and on-call compensation. Almost 40 percent of medical directors say the scope of their responsibilities and duties are also becoming more aligned with quality metrics. Physicians also report that median compensation for on-call coverage ranges from $75 and $2,000 per day, depending on specialty.

Kareo offers insights from a small practice point of view on the six hottest topics from HIMSS 2013.

TSI Healthcare recognizes Tidewater Physicians Multispecialty Group (VA) with its Circle of Excellence Award for using NextGen EHR to provide a better patient care.

Attorney Paul R. DeMuro offers thoughtful insight into private practices that are successfully maintaining their independence. The practices that are thriving are those that are transforming themselves to newer payment models based on quality and cost-effective care, are making effective use of informatics, and are aligning themselves with hospitals and health plans as part of collaborative care teams.

Greenway Medical will add RemitDATA’s comparative analytics solution into its PrimeDATACLOUD Remittance Intelligence service, giving practices reimbursement and productivity insights and performance benchmarking.

Physicians engaging in Web-based messaging systems are advised to establish standards for response times so that patient satisfaction will not be negatively impacted and healthcare decision-making will not be compromised. Practices that are using secure messaging recommend establishing clear expectations with patients on the type of messages to send and on practice response times.

Providers using the Surescripts Clinical Interoperability network and participating in the Michigan Health Information Network Shared Services will soon be able to use the HIN platform to send electronic health information to the State of Michigan’s public health reporting system.

athenahealth launches athenahealth Marketplace, a site that includes consolidated information on technology and clinical exchange partners that offer products integrated within athenahealth’s network.

Speaking of athenahealth, the Boston Business Journal provides details of the company’s emergency response system,  which went into effect during last Friday’s manhunt for the alleged Boston Marathon bombers. A 15-person crisis management team was convened by conference call shortly after 4:30 a.m. By 5:30 a.m. employees were told via automated e-mails and phone calls that they should remain at home. Only a few glitches occurred, including a few inadvertent phone calls to former employees. Two early-rising employees did not get the message in time and were forced to remain in the office most of the day.

CMS and ONC post a joint fact sheet that breaks down the progress made since the passage of the HITECH Act. Some highlights:

• More than 388,000 EPs have registered for the EHR incentive programs, representing 73 percent of all providers eligible to participate. Over 230,000 (44 percent) had received incentive checks as of March 2013.
• RECs are providing EHR adoption assistance to more than 130,000 (44 percent) of primary care providers and 20,000 (48 percent) of NPs.
• E-prescribing adoption rates for office-based physicians have grown from less than one percent at the end of 2007 to 53 percent as of the end of January 2013.
• Physician adoption of EHR systems with advanced functionalities beyond Stage 1 requirements has grown from 17 percent in 2008 to 40 percent in 2012.

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News 4/23/13

A bipartisan group of senators unveils a discussion draft of a bill to create a nationwide electronic system for tracking the distribution of prescription drugs. The proposed measure would require every entity in the prescription drug supply chain to provide electronic transaction information when there is a change of ownership, plus shift the country from a lot-level drug tracing system to a unit-level tracing system.

The US market for EMRs is predicted to reach $20.7 billion in 2013, according to Kalorama Information. That’s a 15 percent increase from 2011 and includes revenues from ambulatory and inpatient EMRs and CPOE systems, and associated costs for implementation, training, support, and consulting.

Meanwhile, EMR adoption by primary care physicians in Canada has doubled from 23 percent in 2006 to 56 percent in 2012. The estimated value of increased adoption by community-based practices: $1.3 billion, based on increased efficiencies and improved patient care.

T-System, a provider of clinical and financial systems for emergency care, will deploy NextGen PM across its customer base.

Benchmark Systems announces several new clients including St. Louis Allergy Consultants (MO), Abingdon Obstetrics & Gynecology (VA), and James Redington, MD for Benchmark’s PM product, and Neurology Services (VA) for PM and EHR.

Practices that are considering selling out to a hospital because of financial issues or health reform concerns, or because of IT integration worries may have other options according to several practice management consultants. Some alternate hospital alignment models include:

• Limited alignment, including managed care networks, call coverage stipends, and medical directorships
• Moderate alignment, such as MSOs to provide IT or billing services; provider equity options; and, clinical co-management
• Full alignment, with physicians acting as self-employed, independent contractors and/or practices serving as hospital subsidiaries.

Coming soon: the first-ever HIStalk Webinar, Vendor Software Training: What Providers Should Demand, offered May 14 from 1:00 to 1:45 PM EDT and presented by Health Technology Training Solutions. Mr. H mentioned the Webinar in a recent HIStalk post but it’s such big news that I felt the need to give it an additional shout-out here. Hope you can join us.

E-mail Inga.

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.

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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.