Readers Write 6/21/11

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!

There has been a great deal of debate among physicians about the true value of electronic records. A survey conducted by MGMA earlier this year found that 78% of medical practices that are still using paper-based records thought they would face a “significant” or “very significant” loss of productivity during EHR implementation, while 56.9% said “insufficient expected return on investment" was a barrier to investing in EHR systems.

In that same survey, however, 72% of physician practices who had completed EHR implementation were “satisfied” or “very satisfied” with their systems. In addition, the survey reported that fully optimized EHR systems led to greater financial benefit.

Despite the results of the MGMA survey — as well as other surveys exploring EHR adoption — the hesitation and concern some healthcare providers still have is understandable. However, as the healthcare industry moves towards becoming fully electronic, deadlines related to new CMS Meaningful Use regulations loom. There is a great threat to further reduced payments to providers who lag behind in technology, which must be quickly realized and dealt with by all physicians.

Paper records do not, by definition, demonstrate compliance with Meaningful Use regulations. With Stage 1 deadlines on the horizon, practices will face lower payments from CMS as a penalty for staying with their legacy paper systems.

However, when you look at real-world data of the costs to create a single new patient chart, the dollar figures provide the evidence and support for EMR implementation. According to data based on a six-doctor practice, the elimination of paper charts in favor of implementing an EMR can reduce the cost of maintaining records by as much as 87% while increasing billings by more than $145,000.

The figures just don’t lie.

A clinic and surgery center that has 14 providers seeing an average of 1,800 patients and conducting 240 procedures per month averages the cost to create a new clinic patient paper chart, factoring in printing, stick-on tabs, copying, and labor, at $5.35. Seeing roughly 75 new patients each day, the organization spends a total of $104,325 annually in materials and labor. Creating a new surgery patient chart costs the organization $16,134 annually, for a grand total of $120,500 between the two.

It is also worth noting that some medium-size practices spend $200,000 per year on labor associated with managing and trafficking paper charts.

Overall, when it comes to EMR implementation, physicians must carefully and accurately weigh the long-term benefits with the short-term hassles. Yes, there is an upfront cost to EMR implementation. Yes, there may be a slow-down in productivity at the beginning while staff members are learning the new system. But if the practice takes its time in knowing what its needs are, the goals it wishes to reach and approaches EMR adoption with an open mind, the sooner it, too can start reaping the benefits.

Keith Slater is vice president and general manager at Henry Schein MicroMD of Boardman, OH.

News 6/21/11

From Chris Riley: “Re: Mitochon Systems and CollaborateMD partnership. It is natural to be skeptical about a combined EHR and practice management solution that is available for $7 a day, since many physicians are paying far more for the same services. Nothing is missing, however. This Mitochon mEMR system is the first, free, fully certified (ONC-ATCB) EHR system. It has all the features of the expensive, legacy EHRs that cost $10-25,000 for an annual license. The CollaborateMD practice management solution is in use by 5,000 physicians nationwide, many of whom have virtually eliminated claims denials with its advanced editing software. The reason we can keep the costs so low without sacrificing functionality is that Mitochon’s mEMR system is ad-supported. It is, in effect, subsidized by pharmaceutical advertisers. This is a bargain that our customers, almost all of whom are solo practitioners or in small medical groups, gladly accept. The free, ad supported model as delivered by Google, Gmail and Facebook, has revolutionized the way consumers connect and communicate. This model can have the same impact on EHR adoption and physician connectivity.” I appreciate that Riley, CEO of Mitochon,  took the time to send in his comments. I remain a bit skeptical, not only about functionality but long-term financial viability of the model, but the company tells me it has more than 500 physicians in 22 states using its EMR, most of them solo practitioners or small groups.

MGMA finds that most medical groups have not yet completed the software upgrades necessary for the transition to the new 5010 transactions standards and have not scheduled testing with health plans. A small number of practices claim they will need to replace their software. Getting the new standards in place is not necessarily cheap — practices who have already upgraded or replaced their software have incurred expenses of more than $16,000 per physician, including the cost of software, hardware, and staff training.

Allscripts adds Precision Healthcare Consultants as a reseller of Allscripts MyWay EHR.

MED3OOO’s InteGreat EHR version 6.5 earns CCHIT 2011 pre-market certification in the ambulatory and child heath categories. InteGreat EHR version 6.4 is already ONC-ATCB-certified through CCHIT.  MED3OOO, by the way, was recently recognized by the Pittsburgh Business Times as one of western Pennsylvania’s healthiest employers.

McGraw-Hill Higher Education and Greenway Medical Technologies announce an online HIT course for colleges and universities. Integrated Electronic Health Records: An Online Course and Worktext for Greenway Medical Technologies’ PrimeSUITE will be offered through McGraw-Hill’s Connect Plus teaching solution.

For the sixth straight year, Capario achieves full accreditation with the Healthcare Network Accreditation Program (HNAP) from the Electronic Healthcare Network Accreditation Commission (EHNAC).

ONC makes available its popHealth reference implementation software service for physicians and practices. The open source tool automates the reporting of quality measures for Stage 1 of the EHR incentive program.

OptumInsight (Ingenix) collaborates with InstaMed to offer CareTracker Payment Connect, an electronic bill payment service for patients.

The overall rate of claims processing errors adds about $17 billion in administrative costs to the healthcare system, according AMA’s annual National Health Insurer Report Card.  Commercial health insurers have an average claims processing error rate of 19.3%, which is 2% higher than last year. Seriously, what other industry finds it acceptable only get things right four out of five times? UnitedHealthcare was the top performing health insurance carrier with an accuracy rate of 90%.  Anthem Blue Cross Blue Shield had the worst performance with a 61% accuracy rating.

AMA subsidiary Amagine introduces the health IT index, an interactive program that helps physicians identify their HIT priorities. I am assuming that once the priorities are identified, the program only recommends one of the dozen alternatives available on the Amagine platform.

E-mail Inga.

Bowtie Confidential: How Full Is Your Plate? 6/20/11

The discussion I have most often with clients, especially the C-suite, is about the growing number of federal initiatives and the need to prioritize them all. The list of initiatives includes but is not limited to Meaningful Use, ARRA, HIPAA, health insurance exchanges, health information exchanges, RHIOs, ICD10, Payment Reform, and ACOs.

The list does not include the standard (and just as important) issues such as relationships with medical staff and the board, the recruitment and retention of physicians, reduction in payments by third parties (including Medicare and Medicaid), tighter and tighter margins, shrinking endowments, etc. My apologies to any reader whose concern I have not mentioned.

What should the CEO of a large, complex healthcare organization do about these competing initiatives?

Many require extensive manpower, such as the implementation of an EMR or CPOE system. As of yet, I have not been to a single organization that has a cadre of staff sitting in their office just waiting to work on the next initiative. Nor have I seen an organization that is so capital rich that these type of initiatives can be paid for without a formal internal review, and ultimately, board approval.

It is my suggestion that you do a careful risk analysis of each of the initiatives and determine which ones are really necessary to be done right now.

• Where do you have financial risk (reduction in payments or loss of opportunity to collect additional funding)?
• Where do you have market risk because your competition is moving ahead?
• How much benefit will your organization derive (referrals, downstream revenue, beating the competition) if you provide financial support for your community physicians?

We think that the (proverbial) 500-pound gorilla is going to be the ICD-10 work. When I was in D.C. a couple of weeks back, the rumor (not yet substantiated) was that the federal government may push back Stage 2 of Meaningful Use to allow organizations the necessary time to work on ICD-10. Pushing the dates for compliance for the next Meaningful Use stage would be a great assist to healthcare organizations, as it will allow them to concentrate on meeting the requirements for ICD-10.

We at Hayes have found that far too few of our clients have started to plan for ICD-10. There doesn’t seem to be an accurate understanding of the amount of work that will need to be done.

There is also a general lack of knowledge regarding the financial implications of not being ready for ICD-10. The financial risk can be up to 5% of your monthly revenue. This figure likely dwarfs any of the other initiatives mentioned earlier.

Therefore, given the financial risk, we are advising our clients to move ICD-10 preparation up to the top of their list of priorities. Begin to educate the medical staff and talk to your vendors (almost all of whom will also be affected). Develop a plan so that your organization is ready for ICD-10.

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 6/16/11

HHS’s Office of Minority Health and Quest Diagnostics announce a program to donate approximately 75 MedPlus EHR user licenses to physicians in small practices serving minority populations in Houston. The initiative includes subscription fees for 12 months and educational assistance from the University of Texas Health Science Center at Houston REC.

Hanger Orthopedic Group will deploy NextGen Ambulatory EHR and PM at its 675 orthotic and prosthetic patient care centers in 45 states.

PDR Network launches RxEvent, an online network to collect and distribute adverse drug events. The service is targeted at prescribers, who typically don’t report adverse events to the FDA because it is too time consuming. Greenway Medical, athenahealth, and other ambulatory vendors will be integrating the RxEvent reporting into their EHR applications.

Pinehurst Dermatology (NC) contracts with SRS for its EHR solution.

ABEL Medical Software announces a OEM program for resellers interested in selling its ABELMed EHR-EMR/PM product.

Mitochon Systems partners with CollaborateMD to offer Mitochon’s free mEMR product with CollaborateMD’s PM solution.  Like Practice Fusion, Mitochon’s model displays ads within the application’s workflow.  Meanwhile, CollaborateMD claims a solo physician can spend as little as $7 a day for unlimited claims processing, electronic remittance, and patient eligibility.  Call me a skeptic, but  I have to wonder what’s missing in that $7/day solution that includes EMR and PM.

NaviNet introduces NaviNet Mobile to allow pharmacy benefit managers to deliver patient medical information to physicians via handheld devices.

Physician compensation grew for some specialties in 2010 and decreased for others. For example, emergency medicine compensation increased 5.6%, while urology income fell 4.66%. Median compensation for family practitioners was $189,402; invasive cardiologists averaged $500,993.

A Robert Wood Johnson Foundation report finds that 51% of office-treated diabetics in Cleveland received all the care they needed from practices using electronic medical records vs. 7% from paper-based practices. A similar correlation was found for diabetic outcomes.  Mr. H mentioned in HIStalk not being able to find the study methodology, but I dug a little and found this report by Better Health Greater Cleveland. There is a fair amount of difference in the demographics between the EHR practices and the paper practices, with the paper practices including a heavy number of non-insured and Medicaid patients (69.9% compared to 15.8% of the EHR practices.) The paper practices were also twice as likely to have non-white patients (86.5% compared to 43.9%.) When you take those facts into consideration, the EHR-diabetes care correlation does not seem as strong.

In 2009, the number of paid malpractice claims reported in the outpatient setting was similar to inpatient numbers, suggesting medical mistakes are almost equally common in the two settings. The authors of the NEJM-published study recommend more patient safety efforts in the outpatient setting,  including the implementation of e-prescribing systems and EMRs.

HIMSS Electronic Record Health Association (ERHA), a trade association of 46 EHR vendors, submits generally favorable comments on the proposed ACO rules. No doubt the opinion was influenced by the EHRA’s acknowledgement that ACOs will require robust IT infrastructures. The organization recommends that CMS reduce the required threshold for EHR meaningful use providers from 50% of primary care providers to 25% of all EPs. In addition, EHRA urges CMS to reduce the requirement for quality measurement reporting from 65 items to 20 or fewer.

E-mail Inga.

Practice Wise 6/15/11

What if …?

I don’t like the term disaster recovery. When I try to discuss this with customers or in presentations to practice management groups, nobody likes to think of a disaster striking where they live and work. So they don’t do the work they need to do to prepare a Disaster Recovery plan as part of a Business Continuity Plan.

In light of the past months of natural disasters both near and far, this topic is at the top of mind for many.

A disaster recovery plan is an instrument that documents the actions to be taken before, during, and after a disaster. A disaster is any event that interrupts your routine business operations. The primary objective of disaster recovery planning is to protect the organization in the event that all or parts of its operations and/or computer services are rendered unusable. Good planning should minimize the disruption of operations and ensure some level of organizational stability and an orderly recovery after a disaster.

A well-executed Disaster Recovery Plan should:

• Provide a sense of security
• Minimize risk of delays
• Guarantee the reliability of standby systems
• Provide a standard for testing the plan
• Minimize decision-making during a disaster

Last month I was struck by an image on the news. A few medical practice staff (identified by their cheery scrubs) sifting through the wreckage of their clinic in Joplin, MO, pulling out paper charts and handing them off in an assembly line. I know of another clinic in Joplin who is on EHR that is hosted by an ASP. The doctors were able to fire up their laptops from home and contact all their patients letting them know that the clinic was out of commission and give them instructions for their immediate needs.

This is the most extreme form of disaster, and even the best disaster recovery plans can be thwarted in the face of an act of God. If you have one, it is a step towards restoring normalcy. I was struck that the medical staff were wearing their scrubs, their need to retain a sense of normalcy.

There are daily smaller events that interrupt business continuity. When these smaller events disrupt production, they frustrate staff and patients alike. I prefer to help practices write their “What if ___?” plans. It’s easier to imagine the small business disruptions and build on those for a more comprehensive disaster recovery plan as part of your business continuity plan.

For instance, a practice I was at this week had printer issues on a global level, as if the printer gods were conspiring against them. Nobody could print to any of the four printers in this one doc office, for all different reasons. They didn’t have a “what if” the printers don’t work plan.

Everyone was in a panic. Front desk couldn’t print patient forms that required signatures. Back office couldn’t print prescriptions, chart notes, or lab requisitions. They were taking their angst out on each other. Nobody could see through the “disaster” and find a working solution.

How do we help practices write these plans? It can seem a daunting task when you think about the global issues all at once. I recommend taking a less global, high tech approach and take it back to basics:

1. Create a What If _______, how will I_____? document and distribute it to each person in the practice
2. Have them fill in the blanks for each task that they do for a period of a few days or a week so that all their tasks are adequately captured. It’s important to capture as many tasks as possible, no matter how small, because when the process is broken, the smallest task can become a big issue.
3. Have your internal and/or external IT support people do the same.
4. Have your software vendors do the same.
5. Have your other outside vendors and partners do the same (e.g., your bank — if you scan checks to deposit and the deposit scanner or Web site is down, will they send a courier to pick up your deposit?)
6. The compliance officer (sure we know, all small practices have someone with this title!) or the person who is responsible (practice administrator/manager) for daily operations should compile these documents into a comprehensive business continuity plan. For some, this might be, filing them in a binder and calling it a plan. For others, it will be much more comprehensive. There are many excellent websites that offer free disaster recovery and business continuity plan models.
7. DISTRIBUTE the plan! Make sure everyone in the practice has a copy and an electronic copy is stored somewhere off site that you can access if your practice is down. There’s no point in creating the plan if everyone in the practice does not have immediate access to it.
8. TEST the plan. There’s no point in going to all this effort if you don’t know if the plan will work in the face of a disaster. There’s a reason we had all those fire drills when we were in school!

My husband was on the aircraft carrier Nimitz somewhere out in the vast ocean when there was a deck fire. Now when you are out in the ocean, too far away for anyone to come to your aid, and the planes on deck are on fire and blowing up, you have a life and death disaster at hand. He was asleep when the alarms sounded and said he was dressed and up on deck manning his station before he even knew he was awake.

They had prepared for this type of event over and over again, and groaned and grumbled all the time about the hassle of the training drills. But as they were pushing jets off the deck and fighting fires, he realized that all that their continuous training made their reactions in this crisis automatic, and saved the ship and the many lives aboard.

Hopefully none of us will ever face this type of life and death disaster. The point here is to not make this so daunting a task that you avoid it at all costs. Disruptions small and large are just that – disruptions. They can be not just events that cause anxiety, but also a liability for the practice. We can use all kinds of fancy buzzwords and language around the development of a comprehensive plan, but why not keep is stupid simple (KISS) and get the job done?

Don’t wait for a natural disaster or a Zombie apocalypse to think about disaster recovery and business continuity planning. Every day presents us with what if scenarios that we can easily plan for in advance. Start your What if ___? plan now!

Julie McGovern is CEO of Practice Wise, LLC.