DOCtalk by Dr. Gregg 12/7/12

The Center Scepter of Healthcare

I recently attended the Ohio Patient-Centered Primary Care Collaborative (OPCPCC) Fall Conference (which is, I suppose, the OPCPCCFC, for those keeping acronymic records). It was an entire day of people from all across the healthcare spectrum talking about putting the consumer at the center of their healthcare world.

Isn’t it rather strange that we have been dealing for so long with a system of healthcare that has placed everybody but the consumer at the center?

Oh, sure, providers have always needed consumers (i.e., “patients”) in order to have subjects upon which to “practice.” But, we providers of healthcare services traditionally presumed that we held the rights to the center of healthcare provision. Provider training has long included, either overtly or subliminally, the concept that we held the scepter in the Land of Healthcare. (We even built an ivory tower within which to wield it!) We were the ultimate power, the primary axle around which healthcare spun.

But then the costs of healthcare provision grew so awe-inspiringly that it was perhaps unavoidable when the moneymen and their bottom line mentalities began to think that they held the rights to the center of the healthcare world. Thus, in recent decades, there was a fairly successful usurpation of the healthcare focal point by the “moneychangers.” Indeed, the whole healthcare system is built upon the wallets of healthcare consumers, but it is the middlemen who control the ebb and flow of these dollars (i.e., the IRS, CMS, third-party payers, employers, and such). It is they who have usurped the crown. They now own the center spot.

More recently, though, we’ve added yet another middleman to the mix, another axle within the axle around which healthcare delivery revolves: health information technology. Some of these HIT/EHR companies, as handlers or carriers of healthcare data, imagined that they could make a rightful claim to ownership of that data. They did so, of course, knowing that whoever controls the information controls the money. (This concept that controlling the data allows for access to, and control of, the flow of healthcare funds was always apparent to the moneychangers.) The HIT middlemen sought to wedge their healthcare data facilitation role into a stakeholder’s position at the center of the healthcare realm.

However, this additional claim to healthcare’s royal center by the techno-centric junta seems to have brought attention to the notion that a consumer’s healthcare data might actually belong neither to the consumer nor to the provider, but to the middlemen. When HIT tried to stake its claim to this power position, the absurdity of anyone other than the consumer owning ultimate rights to the information about their bodies and their health seems to have become clearer.

In fact, the notion that healthcare providers own a consumer’s health data now seems arrogant with this added clarity. Sure, providers assess the health status and assemble and compile the data, but ultimately the data is intimate to one stakeholder and one stakeholder only – the consumer. Everyone else is but a pretender to the crown.

The patient-centered medical home (PCMH) model that is gaining wider and wider recognition now is basically a returning of the scepter back to the one rightful and true heir to throne of healthcare – the consumer. After all, the individual is the ultimate source for the health we’re all discussing, right? Their lives are the headwaters for this whole industry, no? Aren’t they the real center, the ones about whom we’re all exchanging data and trading futures?

And, by the way, aren’t they – the consumers of healthcare – us?

From the trenches…

“America’s health care system is neither healthy, caring, nor a system.” – Walter Cronkite

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, directs the Pediatric Office of Today! exhibit for the American Academy of Pediatrics, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).

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.