News 10/11/11

eClinicalWorks takes the top stop on the Worcester Business Journal’s list of top-growing private regional companies for 2011. The publication profiles eClinicalWorks, which has grown from $1 million in revenue in 2003 and should hit $200 million for 2011. CEO Girish Navani says that eClinicalWorks has added 350 jobs and over the last year and predicts adding another 200 people in the near future.

The CEO of Pulse Systems says his company is preparing to release an iPhone app, a self-service patient kiosk, and an online patient portal.

Healthcare employment continues to rise with ambulatory health services adding 26,000 jobs in September and hospitals adding 13,300.

The 15-physician Primary Health Care Marshalltown Clinic (IA) goes live on GE Centricity EMR.

EMRapproved.com, a online EMR consulting resource, launches Tech Savvy Doc Directory, which is purported to be the “first-of-its-kind nationwide listing of physicians who offer EMR and communication tools in their practices.” The idea is that patients can enter their zip code and a specialty and find all the physicians in the area that use EMR. Sounds nifty but when I test-drove it the results were less than impressive (two physicians total in my zip code, which I know is way off.) I wonder how they intend to identify whether a doctors uses EMR?  More importantly, will the use of EMR really influence a patient to select one provider over another?

HIE provider Sandlot partners with EHR provider TactusMD to provide a package solution for pediatric healthcare communities that don’t have an integrated EHR and HIE solution.

Medical residents are the subject of intense recruiting activity, with 78% being contacted more than 50 times about job opportunities at hospitals or physician groups.  A third of the residents say they’d prefer to work for a hospital, while 28% claim a preference for working in a physician group as a partner.

More bleak news on the effect of rising healthcare costs: Americans are spending more on insurance premiums, co-pays, and deductibles, leaving them with less money to spend on out of pocket health services. As a results, patients are putting off doctors’ visits or medical procedures, declining tests, and ordering less expensive drugs.

athenahealth CEO Jonathan Bush tells an HIT Policy Committee Meaningful Use Workgroup that physicians should be required to submit actual performance data to CMS, rather than simply attest they have met Meaningful Use guidelines:

“To increase the integrity of the program and leverage data that should already be maintained in EHRs, CMS should aggressively pursue a registry-based submission process for provider attestation. Until Meaningful Use performance data can be electronically submitted from a provider’s EHR, attestation unnecessarily remains a subjective and qualitative measure of success–forcing undue stress on providers, creating the need for stringent and costly after-the-fact audits, and underutilizing the capabilities of EHRs.”

The Kansas Foundation for Medical Care reports that its REC is now working with 1,002 physicians and practitioners, including 911 primary care providers and 81 specialists.

E-mail Inga.

News 10/6/11

From Elvis 2.0: “Re: MGMA picks. MGMA has posted a series of ‘Webisodes’ highlighting the details of this year’s conference, exhibit hall events, and fun stuff to do while in Las Vegas. Thought you might be interested to know that on Sunday afternoon, you can watch Cirque du Soleil in the exhibit hall while drinking wine and beer.” I am so there. Elvis also recommends the Healthcare Innovation Pavilion, which features 20-minute educational sessions on a variety of topics. Sounds like a good pick, given my limited attention span.

In his latest blog post, SRS CEO Evan Steele  makes an interesting observation about customer satisfaction and company ownership. Turns out that in the latest KLAS rankings,  five of the six top EHR vendors are privately held, while the bottom six vendors are publically traded. Steele’s theory: publicly traded companies are beholden to Wall Street and may sacrifice product and support issues in favor of earnings, while privately held companies are accountable first and foremost to their clients. I am guessing one of the top three vendors is Greenway, which is the process of going public. Based on Steele’s theory, it will be interesting to compare their current rankings with those a year from now.

Speaking of SRS, the company announces a partnership with Omedix to incorporate Omedix’s patient portal technology into the SRS EHR.

RelayHealth adds Blue Button capability to its network, allowing patients to download, print, and share their health information with a single click.

NaviNet introduces the Doc Xchange program, which allows providers to exchange medical documents electronically with other providers, HIEs, and insurance companies.

3M Health Information Systems releases a new version of its 3M Coding and Reimbursement System, which includes an ICD-10 Readiness Tool. The upgrade, which is free to current 3M coding clients, features a translation window that allows coders to complete ICD-9 to ICD-10 code translations.

The local paper highlights Westport Family Medical Center’s (MA) September 12 implementation of eClinicalWorks. The office manager notes that, “Six months from now everyone will love it, but getting from A to B will be arduous,” while one of the doctor says, “This week’s much better than last week and I expect next week to be close to not a problem.” I’d say they have the right attitudes.

eClinicalWorks, by the way, introduced several new products at its National User Conference this week:

• Patient Apps, which will run on any Web-enabled service, and give patients the ability to set reminders for treatment compliance and record pertinent health data.
• Project Scribe,  which allows providers to enter data through dictation or typing free text and have the information automatically populate the patient progress note in the appropriate fields.
• Project Nimbus, which enables practices to view and update patient data during outages.
• eClinicalWorks for iPad.

Almost half of all physicians admit to seeing encounter diagnostic errors in their practice at least monthly, while 75% are “confident” that decision support tools and artificial intelligence aids will help prevent diagnostic errors in the future.

E-mail Inga.

News 10/4/11

From Savvy Shopper: “Re: KLAS ratings. In a quick check of KLAS ratings for some of the top EMR vendors, I was surprised to see athenaclinicals and Greenway PrimeSuite significantly ahead of the likes of eClinicalWorks, Allscripts MyWay, and NextGen.” I have to admit I find the KLAS ratings fascinating to read, especially the user comments. It’s fun to learn what makes users fall in love with their vendors, as well as read details of their dirty laundry. In my vendor days, we always encouraged our happiest clients to rate us and crossed our fingers that those impossible-to-please types would not find the KLAS Web site. Though I know most vendors probably have similar strategies, in the end KLAS seems to do a pretty good job of capturing  both the good and the bad. Congrats to athena and Greenway for a strong showing.

eClinicalWorks President Girish Kumar Navani welcomes 2,700 customers to his company’s annual National Users Conference in Scottsdale. The event includes 140 educational sessions, as well as some dancing Monday night (those are the pics I want to see.) eCW announced several new clients, including Florida State University’s Student Health Services, the 165-provider Women’s Care Florida, and the 12-location Denver Nephrology.

Greenway Medical, which recently filed for a $100 million IPO, expects to add 400 jobs over the next three years at its Carrollton, GA headquarters. According to state officials, the company will also undertake a $12 million expansion and take advantage of $7.55 million in state job tax credits and a $126,000 break in sales and use tax.

Praxis aligns with CollaborateMD as a preferred EMR/EHR partner and will offer CollaborateMD’s PM software integrated with Praxis EMR. CollaborativeMD clients will also be eligible for special pricing on Praxis EMR.

Clearwave Corporation, a provider of patient information exchange software, partners with Zepherella to offer Clearwave customers access to Zepherella’s PatientPay online payment service.

Four out of five physicians use smart phones, tablets, and medical apps to practice medicine, with ER docs the most likely to use to use digital technology. Cardiologists, urologists, and nephrologists are the next biggest techies.

RCM provider Navicure announces that by the end of October, it will be sending claims to all Medicare payers in the HIPAA Version 5010 format. The company will also continue to accept 4010-formatted claims beyond the January 1, 2012 deadline.

The American Academy of Ophthalmology partners with Sophrona Solutions to provide eye care practices access to the Academy’s patient-education materials through Sophrona’s Web-based patient-communication patient portal.

Covisint announces that it is accepting PQRS submissions through its Covisint DocSite service. For 2011, CMS is paying eligible providers a financial incentive of 1% of their total allowed charges for care provided to Medicare Part B fee-for-service patients.

E-mail Inga.

From the Consultant’s Corner 10/1/11

Employing “Subsidiary” Physicians: What Hospitals Need to Know to Do It Right

It’s official: I must be getting old. After 25 years of working with physician practices and hospitals, I am now seeing trends come full circle.

One example is that of hospitals employing physicians. I have watched it become popular, unpopular, and now popular again. It is a topic of conversation with almost every client we work with, and I am incredibly impressed with how dedicated each side is to creating win-win relationships.

Thinking about the historical relationship between physicians and hospitals brings to mind a number of management models. The more traditional models include everything from physician representation on a hospital board to practice-hospital joint ventures. Now there’s a growing national movement toward employing physicians in “subsidiary” organizations that exist underneath the hospital umbrella. That can be a very effective management approach. But in my experience, it is important to point out that its success depends on giving physicians a direct role in controlling those aspects of practice most important to them.

Under many employed physician paradigms, hospitals recruit physicians and align them with in-house programs by medical specialty. It’s common to see an oncologist placed in a hospital cancer clinic, for example. A common drawback to these models is that they typically aren’t designed to offer physicians a governance role as well as responsibility for overseeing their clinical practice.

That harks back to the 1980s, when hospitals and physicians joined to form Health Maintenance Organizations (HMOs) in an effort to control medical costs. I would agree with many experts who believe that HMOs failed in this initiative, in part due to minimal physician involvement in decision-making. The goal now is for hospitals to employ physicians in a way that encourages them to begin building what I think of as, in essence, thriving group practices.

Functioning in an entrepreneurial mode

Over the years, the most successful healthcare organizations I know have learned that the best governance fosters physician responsibility and control over clinical operations. In line with this concept, the latest trend in hospital-physician strategic integration is the subsidiary physician organization (SPO), sometimes called a subsidiary physician company (SPC).

In this model, hospitals employ formally organized physician groups, allowing them a separate corporate structure with the hospital as the parent entity. The hospital, legally responsible for protecting its fiduciary interests, retains control over the bottom line.

The SPO operates independently on a delegated basis, with authority over clinical issues, physician compensation levels, budget, staffing, strategic alignment, policies and procedures, quality assurance, and patient satisfaction standards. Still, the SPO maintains financial operations aligned with hospital policies.

Physicians also may have a role on the hospital’s board of trustees, but through committees retain control over the operations of the medical group — especially as they relate to patient care. Both entities align with the hospital’s mission, operating standards, business practices, quality initiatives, and patient care guidelines.

In addition — and this is a point I consider essential — the hospital is responsible for providing physicians with the tools they need to develop leadership ability, communications skills, decision-making competency, and financial acumen.

Allowing physicians to practice as an entrepreneurial, multispecialty group within the hospital has significant benefits for patients, healthcare institutions, and physicians. Specifically, hospitals have recognized that conceding providers a degree of autonomy:

• Attracts physician accustomed to the private-practice model more easily
• Encourages more satisfied physician employees
• Gives physicians the authority — and willingness — to make business decisions that support financial stability

Physicians, in turn, enjoy more ability to be entrepreneurial as well as focus on patient care quality. This kind of employment with the hospital also allows economy of scale savings, more effectively managed employee benefits, and access to hospital resources including information technology (IT) staff, technicians, and expert financial planning.

In my opinion, a thriving SPO-hospital relationship requires a shared vision, balanced needs, and the ability to work through issues effectively. Hospitals can begin by identifying a small team of physicians who have the respect of their peers and a willingness to work with hospital policies, board structure, and leadership.

To represent the hospital, I advise choosing leaders who understand physicians and have their confidence. Depending on the organization and personalities involved, these individuals could include a chief of medical staff, hospital chief executive officer, or president. What matters most is that each side trusts, respects, and understands the other’s needs. In many cases, a qualified, experienced third-party consultant can facilitate the process and help establish provisions and bylaws.

The SPO offers mutual benefits to both sides, as well as a model for managing our ever-changing healthcare climate. Although hospitals give up a modicum of authority, the resulting partnership fosters fiscal responsibility, negotiating clout, and economies of scale. In the end, it’s all about finding new ways to collaborate for improved continuity and quality of care.

Rob Culbert is founder and president of Culbert Healthcare Solutions, a professional services firm serving healthcare organizations in the areas of operations management, revenue cycle, clinical transformation and information technology.

News 9/29/11

From High-Heeled: “Re: Meaning Use deadline. Your posting of the timeline for physicians  to qualify for 2011 EHR Incentive and the 90-day reporting period for Medicare could be confusing some. The 90 days for the reporting period has to all occur in 2011 calendar year, but they can attest up to Feb 29, 2012 to indicate their 90-day reporting period was October 3 – December 31,2011 (but, NOT begin their 90-day reporting period).” Thanks for the clarification from High-Heeled and others who noted I didn’t explain it exactly right in my last post. Bottom line: start your reporting period October 3 if you want to attest for 2011.

Greenway Medical announces that it is acquiring certain technology assets of CySolutions, a provider of clinical management and EHR solutions for FQHCs and community health centers. Greenway did not disclose the purchase price or the exact technologies it’s buying, but does indicate that CySolutions CEO Bill Young and other development staff members will join the company.

HHS launches the Comprehensive Primary Care initiative which will pay primary care practices $20 per beneficiary per-month for providing better coordinated care for Medicare patients. The initiative calls for participation from private and state insurance providers, requires providers to meet certain quality measures, and will eventually include a shared savings component for participants.

Medical billing company Capture Billing & Consulting forms a separate department focused on ophthalmology and optometry billing.

Blue Cross and Blue Shield of North Carolina collaborates with Allscripts to offer its EHR to more than 750 North Carolina physicians, including over 150 providers in 39 free clinics. BCBSNC will cover 85% of the cost for eligible independent physicians and 100% of the cost for eligible free clinics, including training and support.

SRS hosted its annual User Summit in Woodcliff Lake, NJ last week. CEO Evan Steele tells me the three-day event, which included an entertaining trip into New York City, was a “blowout success” with attendance at “full capacity.” Evan also forward several comments from attendees, whose reviews included such accolades as “well-organized,” “very informative,” “beneficial,” “FUN,” “relevant,” and “excellent.”  I am penciling it in as a must-attend event for next year.

Speaking of user group meetings, eClinicalWorks is heading to Phoenix this weekend. I see that if participants purchase eCW-labeled hats, visors, or wrist bands, the company will donate all proceeds to several Arizona-based charities. If you are attending, buy yourself some eCW swag and send me some pics and updates.

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Greenway Medical reseller iPractice Group completes its acquisition of Nashville-based Doctors Access, a provider of RCM and medical billing services.

HIT outsourcer and integrator Wavelength Information Services partners with Welch Allyn to offer Wavelength clients access to Welch Allyn’s EHR Pre-Select Tool.

E-mail Inga.