News 12/6/12

athenahealth agrees to pay $168.5 million for the 11-building Arsenal on the Charles complex owned by Harvard University, including the two buildings that currently serve as the company’s headquarters. The property includes 760,000 square feet, including 100,000 square feet currently unoccupied that athenahealth can take over immediately.

Field service technicians for Vitera Healthcare Solutions will transition to DecisionOne, an independent technology support organization. Vitera says DecisionOne will assume the hardware infrastructure and support operations for its clients nationwide. The company also notes that it has added more than 270 employees this year and anticipates filling another 200 positions.

Vermont’s eight FQHCs activate EHRs from Allscripts, eClinicalWorks, McKesson Practice Partners, GE Centricity, and NextGen with assistance from the Vermont Information Technology Leaders and Bi-State Primary Care Association.

NoteSwift announces the availability of NoteSwift for Amazing Charts EHR, which works with Nuance’s Dragon Medical Practice Edition.

Martin’s Point Health Care (ME/NH) selects athenahealth to provide EHR, billing, PM, and care coordination services for its 90 providers. The group will also use business intelligence services from Anodyne Health Partners, an athenahealth company.

An Annals of Internal Medicine article suggests that interactive alerts from clinical decision support systems improve outcomes for HIV patients more than static alerts.

EMR vendor Modernizing Medicine raises $12 million in Series B financing to expand into the orthopedic and ENT markets.

A JAMA article finds that the average dentist now out-earns the average physician ($69.60/hour compared to $67.30/hour.) Between 1987 and 2010 the average physician’s salary grew 9.6 percent compared to other health professionals’ average salary increases of 44 percent.

A Black Book survey reveals that 87 percent of e-prescribing providers believe that use of e-prescribing technologies will reduce prescription fraud; 84 percent say e-Rx has a strong effect on therapeutic decision-making; and, 92 percent think it facilitates better decision-making. Practice Fusion earned top honors in customer experience and satisfaction among EHR-based e-prescribing module users and DrFirst was the top stand-alone vendor. Emdeon was recognized for outstanding developments in clinical exchange solutions.

E-mail Inga.

News 12/4/12

The HHS’s Office of Inspector General finds that physicians facing Medicare claims denials have a good chance of having such decisions overturned. In 2010, administrative law judges ruled in favor of all appellants 56 percent of the time; health professionals won their appeals 61 percent of the time.

Ophthalmic Consultants (MA) adopts the Professional Charge Capture solution from MedAptus.

Children’s Hospital of Central California will implement athenaClinicals, athenaCollector, and athenaCommunicator across its 127-provider system.

Emdeon adds former Allscripts Chairman Philip Pead and former Harris Corp. CEO Howard Lance to its board of directors. Each will receive a $100,000 annual retainer plus stock options.

AMA Board Chair Steven J. Stack, MD says his organization opposes pre-payment audits for EHR incentives as proposed by the Office of the Inspector General. The OIG called for more oversight of the MU program, but the AMA believes that pre-pay audits would “impose additional burdens on physicians who already face separate program requirements for multiple Medicare health IT and quality programs.” Stack goes on to say that AMA supports requirements for certified EHRs to produce compliant and accurate report documents for attestation. I tend to think AMA is a bit extreme with its constant opposition to various initiatives, but I think they have it right on both of these points.

GW Medical Faculty Associates (DC) chooses SA Ignite’s MU Assistant for automated MU reporting with its Allscripts Enterprise EHR.

Spring Medical Systems aligns with Clinigence to provide SpringCharts EHR customers with an analytics solution to measure and visually represent clinical quality, patient outcomes, and costs. By the way, Mr. H recently interviewed Clinigence founder and CEO Kobi Margolin.

The New York Times looks at healthcare consolidation, the shift from independent to hospital-employed physicians, and some of the growing conflicts within healthcare communities. Many employed physicians admit to feeling pressured to refer only within the system and to meet the financial goals of their hospital, even if that means performing unnecessary tests and procedures or admitting patients who do not need a hospital stay. Meanwhile, independent physicians complain of declining referrals from their hospital-employed peers and higher prices for patients seeking treatment or testing at hospital facilities.  The bottom line: many stakeholders are skeptical that consolidation will result in better quality and more cost-effective care.

Anthem Blue Cross and Blue Shield (VA) signs up six large physician groups to participate in a primary care initiative aimed at improving care coordination. The practices, which represent 16 percent of Anthem’s total reimbursement to the primary care physicians in Virginia, will receive financial incentives and resources to build the necessary infrastructure for the new care model.

E-mail Inga.

News 11/29/12

RelayHealth announces it will provide users an open, vendor- and payer-neutral platform for patient identity management, patient consent management, and other technology services to enable a longitudinal patient record. The platform will allow providers to embed a cross-entity MPI into their native systems and enable patient identification across multiple systems.

The ONC reports that the percentage of physicians e-prescribing on the Surescripts network through an EHR has jumped from seven percent in 2008 to 48 percent as of June of 2012. Also as of June: more than half the physicians in 23 states were e-prescribing through Surescripts. Massachusetts was the state with the highest e-prescribing rate (77 percent) and Alaska the lowest (32 percent.)

NextGen Healthcare partners Aviacode to offer Aviacode’s ProCoder services integrated with NextGen’s billing system.

Merge Healthcare will connect its imaging network with the Surescripts Network, allowing ordering physicians to access and view images from the Merge Honeycomb solution. Hospitals and imaging centers will also be able to electronically deliver imaging reports to other providers.

EHR provider SOAPware partners with data backup vendor Computer Consulting Service to offer a subscriber-based remote data backup service.

Almost 10 percent of US residents, or as many as 31 million individuals, now receive their healthcare through an ACO. This includes about 2.4 million Medicare beneficiaries under CMS’ Medicare Shared Savings Program.

Optim Healthcare (GA) contracts with MediRevv for A/R management services for self-pay patients.

Capario’s President and CEO Jim Riley shares insights on practice management challenges that may impact reimbursement, IT buying decisions, and patient care in 2013, including true integration, patient engagement, mobile technology, employee impact, and hospital-physician collaboration.

eClinicalWorks customer St. Joseph Health System (TX) selects GroupOne Health Source to provide medical billing services to its 80 providers.

E-mail Inga.

News 11/27/12

NextGen Healthcare and Microsoft launch NextGen MedicineCabinet app, a free app for the Windows 8 platform for the management of personal medication records.

Thirty-eight percent of family physicians participating in AAFP’s Family Practice Management EHR user satisfaction survey are “highly satisfied” with their EHRs while another 37 percent say they “like” their EHR. Praxis was the most highly rank EHR, followed by Medent, HealthConnect, Amazing Charts, and SOAPware. Almost half of the 3,088 participating physicians were from 1-10 physician groups; almost as many came for practices with more than 20 physicians.

Pediatricians, meanwhile, seem to be behind other specialties in terms of EHR adoption. A self-reported 41 percent say they use an EHR, though only 25 percent of those met the definition of a basic EHR and a mere six percent were considered fully functional. The biggest barriers to adoption: financial and productivity concerns and finding systems that meet pediatric-specific needs.

HIMSS honors Dr. Jeremy Bradley Family Practice (KY) a winner of the 2012 Ambulatory HIMSS Davis Award of Excellence for its use of EHR to deliver evidence-based high quality care with measureable outcomes.

Hello Health, a provider of a free EHR platform, secures $11.5 million in financing led by First Generation Capital.

A JAMA-published study finds that patients using a patient portal had a higher number of office visits and telephone encounters than non-users. The study, which reviewed the use of MyHealthManager by patients of Kaiser Permanente Colorado, concludes that just putting up a portal doesn’t reduce demand for clinical services, and in fact may have the opposite effect.

A Journal of General Internal Medicine study offers a more positive spin on the use of HIT, concluding that patients who received personalized messages about their risk of cardiovascular disease generated from EHR data are more likely to get medication to reduce their cholesterol.

E-mail Inga.

Practice Wise 11/25/12

Who is your EMR Vendor?

We are at another critical juncture in the EMR evolution. Meaningful Use Stage 1 is coming to an end and developers at your EMR company are madly coding for Stage 2, or so you hope! We are starting to see the expected migration of the EMR birds that can’t fly the Stage 2 path.

I recently asked a state REC why they chose the vendors on their suggested list. They told me because those are the biggest EMR companies in the country. Is bigger really better? If you have not already chosen an EMR or are in the process, or are looking to change products, there are some key points you want to consider when selecting a vendor.

• As a percentage of total business, how much does the vendor spend on R&D of the specific product you are looking at? If it is a vendor with multiple products, touting the amount spent on R&D is not significant to you if your product is the red headed stepchild of their offerings.
• What percentages of their installed providers have successfully attested for Meaningful Use Stage 1 of the product you are looking at, not their entire client base of all products?
• Does the product allow you to meet all the incentive programs now? (PQRS EHR reporting, e-prescribing incentive, MU Stage 1 and soon to be Stage 2, and so on)
• Does the product itself keep you from being penalized now and in the future for e-prescribing and PQRS EHR reporting?
• If the vendor has multiple products, do all of them have the same level of certifications? Some vendors with multiple products have their premier product CCHIT certified and ONC-ATB certified through CCHIT. The rest of their offerings are not CCHIT certified and their ONC-ATB certification is through another certifying body. This is a red flag. More R&D money is being spent on certain products in their line. Is yours one of them?

It is short sighted for any provider who is looking to purchase an EMR to not know how these programs are being addressed by their vendor. It doesn’t matter if you don’t care about attesting to MU now for the incentive money, you will be penalized in the future. And if you don’t participate in Medicare, understand that this is going to be pay-for-performance for your commercial payers at some point, so don’t blow it off.

I often hear from small practices that they are going with Vendor X because they are a big company and less likely to be sold or go out of business. If you are a 1-5 doctor group, do you really think the biggest companies even have you on their radar? Does being a big company mean that they will never be sold? We have all seen that this is not the security blanket many believe it to be. Even if the company is not sold, underperforming products are sunset all the time when a company has more than one product in their offerings.

If you are dealing with a small company that only focuses on one product, you still have some important questions to ask besides the ones listed above.

• Is yours a specialty specific product? If so, what is your install base? Specialty-specific products traditionally have fewer clients, which can mean fewer dollars for R&D. How do you plan to fund ongoing R&D?
• How do you plan to address ongoing regulatory changes? Can you guarantee that you will meet all regulatory deadlines so the practice can take advantage of incentives and not be penalized? When a sales person says, “Of course we will meet the deadlines,” get it in writing. Get a guarantee that if they can’t meet the regulatory deadlines that they will reimburse you what incentives you’ll lose due to their lack of functionality, or pay for the penalties incurred. If they can’t give that to you in writing, move on — that means they don’t have absolute faith in their own abilities to meet your needs.
• How many people do they have providing implementation and support services? I have a few clients who recently purchased a specialty-specific product. Their training and implementation was done on the Internet — nobody came on site to assist. In my experience, that is not conducive to a successful go-live and ongoing proficiency in the product. We are on the West Coast. This vendor is on the East Coast. Their support becomes “on call” after 2:00 p.m. West Coast time. Doctors who are stuck charting a note or trying to send an electronic prescription are truly stuck waiting for an on-call person to call back within their after-hours guaranteed window of 90 minutes. I wish I could get away with telling my supported clients to wait 90 minutes for me to call them back when they are stuck in the middle of their work day.

If your vendor has multiple products and they decide to sunset one, what does that mean for you? It’s nice to hear that they’ll give you licenses to one of their other offerings, but if their other offerings were a good fit for you to begin with, wouldn’t you have purchased that product instead? A one-for-one license swap may seem like a sweet deal, but what is the ongoing total cost of ownership of this other product? How much additional training and infrastructure will you need? If you are going to have to change products, you should consider this like a new purchase and start your process anew, comparing all your options.

Julie McGovern is CEO of Practice Wise, LLC.