News 6/14/11

The ONC names the American National Standards Institute (ANSI) the sole authorized accreditor for EHRs under the permanent certification program.  The temporary program will be sunset at the end of 2011.

The American College of Clinical Information Managers launches itself as a non-profit accreditation organization for medical scribes. The certification process includes testing, proof of employment as a scribe, and a $250 fee, which will be waived through the end of this year. I am not sure if certification will make much difference for scribes working in physician offices, but at least the fee seems reasonable.

The 20-physician River Falls Medical Clinic (WI) attests for Medicare incentive funds for its meaningful use of Cerner’s EHR. The clinic’s medical director says that 70% of the physicians in his area are also on EHRs.

Vermont IT Leaders, the REC for Vermont, announces that 750 primary care providers have signed up to receive EMR adoption assistance. That’s about 75% of all of Vermont’s primary care providers.

The Louisiana HIT Resource Center names SuccessEHS a supported vendor for its REC.

Less than one-third of physicians are expected to remain independent by 2013 as they continue to sell their private practices to healthcare systems. The attraction of larger health systems include greater access to leading edge HIT, facilities, and equipment; a more manageable work schedule; and increased financial stability.

Steven T. Plochocki, CEO of NextGen’s parent company Quality Systems, is named Outstanding Technology CEO in TechAmerica’s 18th Annual High-Tech Innovation Awards.

MedeAnalytics releases a report that summarizes the public comments on the ACO proposed rule. The bottom line from seven national healthcare constituencies, including the AMA, AMGA, and MGMA:

• The ACO program, as proposed, needs revision, not repeal.
• The 65 quality measures in the proposed rule need to be reduced, perhaps to 32, and should include a phase-in period.
• Financial terms need to be more attractive with a standard, minimum savings rate and the elimination of the withhold.
• CMS needs to create a separate model without downside risk.

E-mail Inga.

DOCtalk by Dr. Gregg 6/10/11

HIGH Tech Support

Ohio Medicaid went live last week with their HITECH EHR incentive program, MPIP. Signup availability was announced on the morning of June 1 and I happened to be sitting there when the e-mail came through. So, as I had already done the preliminary stuff at the federal level (which was itself a pretty easy process, I should add), I went straight away to the MPIP link to get on board.

The site was laid out pretty well overall. The process of signing up seemed easy enough. I already had the basic info: identifiers for me, my EHR, and my aforementioned recently-created CMS account. I needed to generate some figures for total number of patients seen during my chosen three-month reporting period, plus determine the number of those patients who were Medicaid insured. Not too hard to gather.

Once I had those numbers generated (and after I had a good, long cry about the fact that my percentage of Medicaid during that chosen period as a walloping 48% !!!) I finished out the process following all the “fill in here” slots and “you are required to do this” red asterisks. When completed, I submitted it … and it went through!!!

Oh,no … wait. Though I did have all four progress areas turn green with a “Completed” check mark, the end summary said I was still “In Progress.” Does that mean it’s “in progress” on their end, or that I still have some unfinished piece of info yet to addend? It wasn’t clear.

I went to their Help section and FAQs, which were actually just links to PDFs. I tried, but my ADHD wouldn’t let me go too long within the many, many pages of their PDF “help” tool.

I could wait, but if it was something on my end, that’d mean unnecessarily delaying my Incentive check. With my 48% Medicaid, you can easily understand why I might need that check sooner rather than later.

I decided to call the support line listed on the MPIP web site. Not unsurprisingly, they were a little busy and weren’t able to take my call right then. I left a voice mail and figured it may take a day or three to hear back. Patients were beckoning, so I left it there.

Later in the day, it crossed my mind that as a member of the board of directors of OHIP (Ohio’s HIE/REC), maybe I should notify some of the important folks there who may want to let folks at MPIP know there might be some glitches worth addressing. I mean, if it wasn’t apparent to me, and I have a bit of an inside track on all this, then I bet others might also find the process a little unclear. So, I e-mailed and/or called a couple of the good folks at OHIP who seemed to appreciate the insights.

A little surprisingly, late in the afternoon I received a call back from MPIP support. A wonderful fellow, Aaron, said they had indeed been busy that day, but he nonetheless took time and listened to each of my concerns or problems. We walked through the process together, I showed him where it appeared confusing to me, and he made notes. I told him I couldn’t tell if I was complete on my end and he assured me I couldn’t be, as they did not yet have anyone in the pipeline for payment.

I told him about the one non-asterisked item I had not submitted since it didn’t appear required. He said, “Let’s try it,” and … VOILA! My submission then popped up on their end as “ready for payment”! WOO HOO!

I hadn’t mentioned to Aaron that I was on the OHIP board until well into our conversation and he had not received any word from any of the OHIP folks I had contacted. Thus, his kind and helpful demeanor was unpretentious and un-persuaded. Ya’ gotta love that in IT support.

Then, within two days of the MPIP help desk call, I had the fun of spending hours and hours with the support folks at two large vendors of wireless routers and the support folks at my ISP vendor, a giant in — or should I say AT? — the telecommunications world. From these three technology firms, I received only attitude, runaround, and resolutionless aggravation.

Tech support calls often a feel like connecting with soulless, uncaring seat-fillers who would rather be somewhere else doing something, anything, else, especially if you have no established relationship with them. But, not always. Not with Aaron at MPIP. He’s high end, HITECH support. I thought he deserved a mention.

Thanks, Aaron. Keep it up.

From the trenches…

“There are no traffic jams along the extra mile.” – Roger Staubach

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 the Future exhibit for the American Academy of Pediatrics, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).

News 6/9/11

The HIT Policy Committee advises ONC to push back the Stage 2 deadline for Meaningful Use to 2014 for providers who qualified for Stage 1 this year. The committee believes the original timeframe does not give providers or vendors adequate time to prepare for Stage 2, especially since the final Stage 2 rules will not be released until June 2, 2012. The proposed change would allow providers to collect Stage 1 and 2 incentive payments for two years without penalizing early Stage 1 adopters with a tight Stage 2 deadline.

Shareable Ink partners with Waiting Room Solutions to combine its digital pen technology with the EHR from Waiting Room Solutions.

Spring Hill Primary Care (WV) contracts with Sage Healthcare Division for the Intergy Meaningful Use Edition.

Initivia will extend special pricing for its InSync EMR/PM product to members of Premier Purchasing Partners, a group purchasing organization.

The Louisiana Care Quality Forum REC designates Greenway’s PrimeSUITE EHR as a supported EHR product.

CRISP, the REC for Maryland, meets its subscription goal with the enrollment of 1,000 primary care physicians.

CMS adds a few questions to its FAQ page on the EHR incentive program. Here are a couple of the better ones:

What information must an EP provide in order to meet the measure of the meaningful use objective for "provide patients with an electronic copy of their health information?”

The minimum required information includes a problem list, diagnostic test results, medication list, and medication allergy list. CMS also notes the four elements must be provided to patients within three business days  of their request.

For the Medicare and Medicaid EHR Incentive Programs, when a patient is only seen by a member of the EP’s clinical staff during the EHR reporting period and not by the EP themselves, do those patients count in the EP’s denominator?

The EP can include or not include those patients in their denominator at their discretion as long as the decision applies universally to all patients for the entire EHR reporting period and the EP is consistent across meaningful use measures. In cases where a member of the EP’s clinical staff is eligible for the Medicaid EHR incentive in their own right (NPs and certain PAs), patients seen by NPs or PAs under the EP’s supervision can be counted by both the NP or PA and the supervising EP as long as the policy is consistent for the entire EHR reporting period.

E-mail Inga.

News 6/7/11

Merge Healthcare acquires Ophthalmic Imaging Systems (OIS) for approximately $30.3 million in stock. OIS’s products include OIS EMR and PM, as well as EMR and PM products through its Abraxas Medical Solutions subsidiary.

EMR costs make adoption difficult for small practices, even with incentives. That was the general consensus of several speakers who testified last week for the House Small Business Committee’s healthcare and technology subcommittee. Sasha Kramer MD, a solo dermatologist from Washington state, summarized the situation nicely:

HIT holds promise as a tool to increase quality and efficiency in the health system. However, there are significant barriers to full-scale adoption and implementation of HIT – specifically, cost, regulatory barriers, financial penalties, an unpredictable marketplace and system integration. It is imperative that Congress ensure small physician practices are able to make the investment in technology that will enable the American healthcare delivery system to coordinate care and make a measurable impact on quality without imposing overly burdensome procedures or failed financial investments upon physician practices.

Meanwhile, AHRQ announces plans to conduct a two-year, $425,000 study of the barriers Medicaid providers encounter in trying to achieve Meaningful Use. Note to AHRQ: save some money and see above because I bet the issues are basically the same.

Boston Laser implements Sage Portal for online appointment scheduling, registration, and messaging.

RIS/PACS provider DR Systems announces plans to release a fully certified ambulatory EHR for imaging specialists later this year.

The AMA names James L. Madara, MD as EVP and CEO. He served as dean at the University of Chicago Pritzker School of Medicine and as CEO of the University of Chicago Medical Center.

Practice Fusion earns full ONC-ATCB certification.

Adena Health System (OH) picks eClinicalWorks EHR for its 150 employed physicians, as well as non-affiliated community practices.

Ingenix says its transition to its new name, OptumInsight, is complete.

Consulting and implementation services firm MD Solutions partners with dashboardMD to enhance its analytics reporting offerings.

Every so often I am reminded how expensive EMRs can be and that EMR can be big business. Case in point: the 15-provider Great Hudson Valley Family Health Center (NY) recently completed a $1 million implementation of GE Centricity. The practice claims that $500,000 was related to training costs. The FQHC includes 11 physicians and four NP/PAs, so the total cost was about $67K per (primary care) provider.

e-MDs says that 21 of its provider clients in Texas have already received Medicaid EHR incentive checks.

Danbury Orthopedic Associates (CT) selects SRS EHR for its 20 provider practice.

CMS issues a proposed rule allowing certain qualified organizations access to patient-protected Medicare data on providers and hospitals. The intent would be for the qualified entities to combine the Medicare data with information from private carriers to evaluate provider performance, and presumably help consumers and employers make better healthcare decisions.

CMS releases a list of providers who have received Medicare EHR Incentive payments. If I were a provider, I am not sure I’d love having this information available for the world to view, even if the money does come from taxpayers.

IPAs may make a resurgence as doctors look for ways to unite with larger systems for the purpose of forming ACOs. The IPA model lost favor about 10 years ago and in many cases became financially unviable. IPAs may be a better solution today, as providers consider options for sharing savings and risk and collecting quality metrics on specific populations. I’ve always known that healthcare and fashion had many similarities. In honor of the returning IPA, I think I will pull out my stone-washed jeans.

E-mail Inga.

News 6/2/11

MGMA concurs with just about everyone else that the proposed ACO rule is unacceptable as written:

Based on feedback received from our members, including those who participated in the PGP demonstrations, as well as similar private sector contractual arrangements, MGMA believes the ACO shared savings model may not be viable as a national strategy unless significant program policies are modified when final rules are promulgated.

MGMA says out that the program is too complex; the development and on-going costs are too high relative to potential benefits;  the benefits are too uncertain and too small; and the regulatory risks too substantial.

Molina Healthcare picks GE Centricity Practice Solution as its primary EMR/PM platform for its 16-state healthcare system.

Nuesoft Technologies and Point and Click Solutions collaborate on the College Health Technology Pathway Program to educate college health professionals of the potential risks of hosted systems. Nuesoft CEO Massoud Alibakhsh offers this warning:

Hosted ASPs take a client-server and provide users remote access via the Internet. This is akin to putting wings on a car and expecting it to perform like a jet airplane. This is not what a client server is intended to do, and unless they can guarantee the fault tolerance and security protocols in place, you are taking chances with your data.

eClinicalworks says that 15 of its clients have received EHR incentive checks from CMS.

Now that it’s June, it’s time to consider potential vacation destinations. Why not attend a user group meeting with your favorite EMR vendor? Here are a few upcoming events:

• Amazing Charts User Conference, Biltmore Hotel, Providence, RI, June 2-5
• Sage Summit, Gaylord National Hotel & Convention Center, Washington, DC, July 10-15
• e-MDs User Conference & Symposium, AT&T Center, Austin, July 28-30
• Aprima National User Conference, Hilton Lincoln Center, Dallas, August 4-7
• Allscripts Client Experience, The Gaylord Opryland Resort, Nashville, August 29-31
• Greenway PrimeLEADER, Gaylord Palms Resort & Conference Center, Kissimmee, FL, September 8-11
• SRS User Summit, Hilton, Woodcliff Lake, NJ, September 21-23
• eClinicalWorks National Users Conference, JW Marriott Desert Ridge Resort, Phoenix, October 1 – October 4

HIMSS teams up with an attorney to answer questions on Meaningful Use for one of its monthly publications. Great idea, however, the answer to this question is a bit confusing:

Q: When an eligible physician is employed by a group practice, who gets the EHR incentive money, the individual doctor or the practice?

A. The answer is most likely yes if the physician and group have a traditional physician employment agreement.

Huh? The attorney does go on to explain that physicians can reassign their payments to their employment or other entity, so the less-confusing  answer is that the money could go to either.

As Mr. H mentioned last night, it’s a slow news period and lots of readers seem to be taking some time off. Mr. H is quite the slave driver, however, so we are still working hard at it. Drop me a note if you have anything juicy to report, words of encouragement, summer vacation suggestions, and/or need my shoe size. And thanks for reading.

E-mail Inga.