Practice Wise 8/13/11

What’s In an Upgrade?

There is much excitement in the community. EHR software vendors are rolling out their long awaited Meaningful Use product upgrades. There has been so much anticipation for the new features and functionality, as well as standardization across platforms. 

It’s hard to imagine that this process could be painful. In your excitement, are you considering the scope of the upgrade and impact it will have on your practice?

In the ambulatory practice setting, these upgrades should be treated with the same respect and degree of planning as a new software implementation. The phenomenon I am seeing in the community we serve is that many practices are assuming that since they are already users of the software, they can get by the upgrade process with little extra effort.

A few recommendations from the trenches:

1. Recognize the scope of the upgrade and share this with everyone in the practice, providers and staff alike.
2. Set appropriate expectations for everyone.
3. Take full advantage of any and all upgrade training provided by your vendor. Reading a release notes document will not suffice.
4. Plan as if you were getting new software.  Assign an internal project manager or point person to coordinate upgrade expectations with your vendor’s project manager. Document your contingency plan, so when things don’t go according to plan, you are still able to see patients. Print schedules and progress notes for the day of and day after upgrade. Reduce your schedules for the day of/after upgrade. Plan to have vendor support on site for day of/after upgrade if possible, even if it costs you money. It’s more costly to try and figure it out on your own or on the phone with 1-800helpme support when things are going wrong.
5. Coordinate the upgrade with your IT team. If that is an external party who will not be performing the upgrade itself, they still need to be part of the process to ensure that your hardware and network are up to spec and be on hand or on call for any IT issues that arise out of the upgrade or that could prevent the upgrade from completing successfully.
6. Communicate with your patients. If they know that you are in the process of upgrading prior to or on arrival for their visit, they will be less intolerant when there are delays. Let them know that you have taken all the steps possible to anticipate their needs and make their visit as smooth as possible.
7. Breathe! Try to keep your sanity as you move through the changes of your software and adapt your processes. Just like with a new software implementation, it can be difficult to master the new functionality at first, but in time, you will gain proficiency and a sense of normalcy.

If you are fortunate enough to have purchased software from a vendor that continually develops their product, then upgrade planning and implementation will be an ongoing part of your business processes. Work with your vendor to develop an estimated frequency for upgrades and plan and budget for these events so that they are not dreaded disruptions, but rather the valued improvements they are intended to be.

Julie McGovern is CEO of Practice Wise, LLC.

Bowtie Confidential: ACOs –What We Know from the Demonstration Project 8/12/11

One of the few advantages of flying 200,000 miles a year (other than being able to win momentary gratitude from your teenagers when you give them a free ticket or an upgrade) is that you get to see a lot of different organizations. Therefore, you can more easily answer the oft-asked question, “Where have you seen this done before?”

The question that I am now most frequently asked relates to ACOs. The stream of questions usually follows this order:

• Is an ACO right for this organization?
• Where have you seen it work?
• How much will it cost?
• What will we have to do to make it work?

Stopping to take a breath, the inquisitor then continues, but with more specificity about the CMS ACO set of regulations. People are concerned. They feel that they have to make decisions on a new concept that has not been proven. And this is mostly true.

However, let’s talk about what we DO know about ACOs. In CMS’s five-year demonstration project (Physician Group Practice Project), which included 10 leading organizations ended a little more than a year ago, these results were reported: *

• The percentage of quality goals obtained were in the mid-90s.
• All 10 organizations were able to meet or exceed 29 of the 32 quality goals.
• Out of the 40 eligible shared-savings periods (four years), participants only received payments 15 times.

*Additional details can be found in the New England Journal of Medicine (December 22, 2010).

What does this show? To me, it demonstrates that organizations considered to be thought leaders with strong infrastructure STILL could not qualify for payments based on the formula utilized in the demonstration project.

It cautions me against moving too quickly into a CMS contract. It causes me to ask myself if I have the necessary pieces in place (IT systems, good relationship with all the participating providers, a large enough network, a process for case management, a qualified board, enough financial predictive modeling) to feel comfortable accepting risk at that level.

Unfortunately, most organizations will be forced to say no. I say “unfortunately” because I make my living as a consultant.

However, there is a light at the end of the tunnel for organizations considering ACOs: the commercial ACO, which offers many of the benefits of the CMS ACO, but with far fewer regulations, risk ,and other types of restrictions. I will discuss commercial ACOs next month.

Don Michaels, PhD is vice president, strategic and advisory services, for Hayes Management Consulting and teaches healthcare IT for the Harvard School of Public Health.

News 8/11/11

Two legislators introduce a bill that would allow physician assistants and nurse practitioners to qualify for Meaningful Use incentives. PAs and NPs could qualify for EHR incentive payments if Medicaid beneficiaries account for at least 30% of their patient load.

Aprima Medical Software acquires the Richardson, TX-based Health Care Strategies, an RCM provider and Aprima reseller.

CORHIO and the Colorado REC partners with BridgeFront to offer providers discounted pricing for its HIPAA education tools and online education.

eClinicalWorks client Primary Health Medical Group (ID) becomes the first practice in Idaho to attest and certify for Meaningful Use of its EHR.

The NYeC REC reports that it is nearing its capacity for helping primary care providers progress toward Meaningful Use, with 2,857 providers signed on. NYeC is offering its services for free through the end of August for providers already live on EHR and for $750 per provider for practices on paper records. Prices will increase to $4,000 -$5,750 as of September 1.

Epocrates releases its Q2 financials: net sales of $27.9 million, up 10% from 2010; net income of $3.4 million compared to last year’s $0.8 million.

The AMA and 81 other physician organizations request that CMS allow providers to review their data for accuracy before making it public and to standardize the process for developing the public reports and the type of information they will include.

Last month I mentioned a few highlights from AAFP’s 2011 EHR User Satisfaction survey. Surprisingly, AAFP has now made the report available without a subscription (hurry and take a peek just in case it is some sort of mistake!) In addition to providing ratings on 30 EHRs, AAFP offers some insight into physicians’ perceptions of EHRs. For example:

• Only 39% of respondents agreed that they would purchase their current system a second time.
• The lowest-ranking category was vendor support and training.
• Only 49% expressed overall satisfaction with their system.
• Respondents ranked the ability to customize their EHR system at the top of their satisfaction list; 78% said they were satisfied with this aspect of their system. The next highest priorities were electronic prescribing (70%) and electronic messaging  (69%).

I signed up for Google+ a few weeks ago, but  haven’t invested much time figuring out what it could offer me that I didn’t already have with Facebook, Twitter, LinkedIn, and other social networking sites. However, a couple of physicians offer good insight into why Google+ might be a great solution for doctors. Physicians who want an online social presence may find it difficult to  balance their personal and professional online identities. (I know a lot about managing multiple identities, but that is another story.) Google+ allows you to establish multiple circles of acquaintances, such as family, friends, colleagues, and patients. That means a physician could set up a single Google+ account and control the content viewed by his/her connection, based on the connection’s designated circle. It’s an alternative that certainly seems less time-consuming and easier to maintain that having multiple Facebook accounts to handle professional versus personal relationships.

E-mail Inga.

News 8/9/11

Highmark, West Penn Allegheny Health System, Allscripts, and Accenture team up to provide EHR to independent physicians in Western Pennsylvania.

A survey finds that the opportunity to earn Meaningful Use incentives is one of the strongest drivers for most physicians adopting EHRs, while insufficient capital continues to be a key barrier to adoption. Thirty-nine percent of the respondents ranked improved and timely access to accurate patient information as the most important reason to achieve their EHR goals, followed by reduced time spent in information search and management (34%.)

Dell and NextGen announce plans for Dell to sell and support NextGen’s ambulatory and inpatient solutions and to provide hosting services for NextGen clients. Dell also becomes the platform of choice for NextGen solutions and for NextGen’s internal use.

The 300-doctor DuPage Medical Group (IL) will implement Phytel’s population health management tools following a successful three-month pilot.

CMS claims that results from the initial Physician Group Practice (PGP) Demonstration indicate significant improvements in quality and savings in Medicare expenditures. Under the PGP Demonstration, groups earn incentive payments for meeting a minimum quality performance benchmark. Seven of the participating groups achieved benchmark performance in all 32 performance measures, while the other three achieved performance on at least 30 benchmarks. Four of the groups will receive incentive payments totaling $29.4 million, out of a combined savings to Medicare of $36.2 million.

The five-physician Meli Orthopedics (FL) selects the ChartLogic EHR suite.

In a survey of its clients, SuccessEHS finds that customers have increased their production an average of 11% per physician within the first months of go-live on its EHR/PM product. Clients also report average revenue increases of 19% within six months.

CureMD Healthcare announces that its solutions are now 5010 compliant.

The 15-doctor Coastal Eye Associates (TX) contracts with VersaSuite for its EHR, PM, PACS, and inventory optical sales system.

Online scheduling provider ZocDoc expands to the Phoenix area, giving patients the ability to find physicians and make appointments using ZocDoc’s free app for the iPhone and Android.

In support of National Health Center Week, Sage employees are providing volunteer assistance at several CHCs this week and the company is making financial contributions to CHC causes.

e-MDs hosted its 2011 User Conference & Symposium last week in Austin, TX. The e-MD folks tell me the three-day event was sold-out with 800 participants.

Greenway Medical reports that its customers have secured more than $1 million in combined Medicaid and Medicare Meaningful Use incentive funds.

EyeMD EMR Healthcare Systems and Advanced Data Systems (ADS) announce an integrated solution running EyeMD and ADS’s MedicsPremier PM.

Medicare has issued Meaningful Use checks to 2,384 eligible providers and 100 hospitals to date. Another 3,500 providers in 21 states have also received payments, and an additional 137 EPs applied for funds but attested unsuccessfully. A total 77,000 providers have registered under both programs, which suggests it must take awhile to get those checks cut.

Merge Healthcare completes its acquisition of Ophthalmic Imaging Systems.

Want to be hip with the 26 year-old crowd? If you are a physician, using an EMR will definitely score you some points.  An estimated 7.5 million individuals between the ages of 19 and 26 will gain insurance by 2014 as a result of health system reform; at least two-thirds of them want to schedule appointments online and exchange e-mails with their providers. Physicians interested in attracting a bigger share of the 20-something crowd will definitely need to get their digital on.

E-mail Inga.

Readers Write 8/5/11

Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

Why IN-Eligible Professionals Should Still Buy and Implement Certified EHRs
By Mary Stroupe

If you don’t bill Medicare or Medicaid, you don’t qualify for federal Electronic Health Record (EHR) incentives. However, you should still implement a certified EHR if you want to keep patients and fellow physicians highly satisfied.

Our Movement Toward National Information Exchange and Interoperability

The US healthcare system is moving toward electronic health information exchange (HIE). Today, data is shared electronically among providers using Regional Health Information Organizations (RHIOs). Soon, a Nationwide Health Information Network (NHIN) will enable immediate, authorized access to patient data (similar to banking access provided by the ATM network). The goals of a NHIN are to reduce medical errors, duplicate tests and healthcare costs. Another goal is to provide patients with access to medical records, which are currently scattered across multiple medical entities.

How Interoperability Supports that Movement

The goals of the NHIN can only be realized by interoperability among EHRs: the ability to send and receive clinical data that means the same thing in whichever system it is viewed. The key to interoperability is standardized data. Just as data is standardized in other industries (like banking, to make ATMs work), medical data must be standardized so clinicians can properly interpret it.

How Certified EHRs Support that Movement

Certification is the single variable ensuring the EHR you purchase meets national interoperability standards. Two types of certification exist: ONC-ATCB (ARRA) certification and CCHIT Certification 2011. ARRA (or “Meaningful Use”) certification is what is minimally required for government reimbursement. CCHIT Certification 2011 provides an additional level of assurance that the product meets a more rigorous security inspection and complies with specific functionality, workflow, and usability criteria.

Why a Certified EHR? For Patient and Physician Satisfaction

With the steady growth of Personal Health Records (PHRs), patients will expect you to provide their health data electronically. Why? For eligible professionals to receive government reimbursement, they must be able to supply patient data electronically when it is requested of them. Once savvy patients realize they can get it, they will start asking for it – from all their providers, not just the ones who received incentive payments! Without an EHR and data that certifiably meets national standards, you will be unable to provide patients with data that can be shared with their PHR. If patient satisfaction matters, this matters.

As the wave of EHR adoption rolls across the US, physician offices will no longer staff to levels required to deal with paper (e.g., hard copy referral notes). Providers will exchange data electronically, using standardized data sets that make it possible. It is reasonable to expect, then, that referral providers may avoid colleagues who cannot provide data electronically. If physician satisfaction matters, this matters.

The Bottom Line

Providers who do not implement interoperable, certified EHRs risk becoming data islands to their patients and fellow providers (like a bank that cannot connect to the ATM network).

Mary Stroupe is President of Integritas, Inc. in Monterey, CA.