News 5/31/11

A London paper reports that Sage Group has launched a review of its healthcare division that could lead to a sale of the unit, valued by analysts at around $430 million. Sage recently reported a 5% decline in revenues for the North American healthcare division for the first half of the year.

CMS says that the Medicare EHR incentive program has paid out $75 million to providers so far, while the 15 state Medicaid programs have issued $38 million in payments.

Good news for providers who have not yet adopted e-prescribing systems. CMS issues a proposed rule that would expand the definition of an e-prescribing system to include certified EHRs with e-prescribing capabilities. In addition, certain providers would have until October 1 to claim exemptions to avoid potential Medicare pay cuts.  Exemption reasons include having limited prescribing activity and practicing in an area in which regulation prohibit e-prescribing. Providers could also claim an exemption if the delay is a result of a pending implementation of a certified EHR.

Nevada and Utah REC HealthInsight announces that 1,000 primary care providers have signed up for EHR adoption and implementation assistance.

athenahealth says several of its athenaclinical customers have been paid Medicare EHR incentive payments.

Barboursville Internal Medicine (WV) picks Benchmark System for its PM and EHR.

HP EHR Referral Group, an alliance of healthcare billing systems, selects Sevocity EHR as a preferred EHR.

Oncology EHR provider Rabbit Healthcare Systems announces that it is expanding its headquarter space by 70% and expects to increase its staff by 40%.

The local paper highlights Springfield Center Family Medicine (OH) and its use of NextGen EHR. Though quite happy with the solution, one physician notes that his incentive payment of $18,000 only covers half of what the practice spent on server upgrades last year.

Trend alert: two large distributors of medical supplies to doctors’ office report double digit sales growth for the first quarter. PSS World Medical (15.4%) and Henry Schein (12.4%) say the creation of jobs is providing more patients with health insurance, boosting healthcare demand and giving physicians confidence to buy more supplies.

HIMSS names four finalists for Ambulatory Care Davis Award, including Community Care Physicians (Allscripts — NY), Fallon Clinic (Epic — MA), James F. Holsinger MD (e-MDs — IA), and Women’s Health Advantage (Greenway — IN). HIMSS will award up to four winners following site visits to each practice.

A disgruntled patient in Vermont sues her doctor after leaving without seeing him after a wait of more than one hour. The doctor was delayed caring for another patient. The woman asked the practice to reimburse her $139 to cover the cost of hiring a nurse to care for two family members while she waited. She filed suit when the practice refused (and subsequently “fired” her from the practice). The judge rules in the doctor’s favor, noting there would be serious problems if doctors could be billed for missed appointments. The patient says she feels, “like a David-ette against a Goliath.”

E-mail Inga.

From the Consultant’s Corner 5/30/11

ICD-10: Roadmap to a Successful Transition

The transition from ICD-9 to ICD-10 codes is a massive undertaking for all healthcare organizations. It’s a matter of sheer magnitude, of course: diagnosis codes are critical to nearly all patient care and revenue cycle activities. Add to that the additional burden facilities face implementing ICD-10 Procedure Coding System.

With any project this large, success requires carefully mapping out each phase of the journey. In the case of ICD-10, I suggest taking a five-phased approach: 1) program development; 2) impact assessment; 3) project and implementation planning; 4) implementation; and 5) stabilization and optimization. Here’s a look at the key elements in each phase:

Phase 1: Program Development

The very first step is to establish a governance team responsible for oversight of the ICD-10 conversion. It should include representatives from: revenue cycle (hospital and professional, if your organization has both); coding/HIM; clinical informatics and clinical documentation; IT (patient access, clinical and revenue cycle applications); training; and compliance.

You may have one person wearing many of these representative hats in some organizations. That’s OK. Just make sure each of these functional areas is considered in your ICD-10 planning. Your project plan should include a timeline and resource requirements by functional area.

Phase 2: Impact Assessment

Your assessment should focus on understanding the training needed to bring everyone up to speed on ICD-10 requirements. Again, make sure to conduct your assessment by functional area: systems, billing and reporting requirements, and training requirements. Once you’ve assessed each area separately, though, it’s critical that you then aggregate them to create an enterprise-wide view of overall impact. You should end up with a documented inventory of all IT applications.

Phase 3: Project and Implementation Planning

After impact assessment, carry out a separate vendor readiness assessment. The goal is to identify all vendors and interfaces affected by the ICD-10 conversion, then contact the vendors to see if upgrades or other changes are necessary to meet ICD-10 requirements. Any associated costs must be documented, and vendors should be asked to provide you with their ICD-10 test plans.

Phase 4: Implementation

With an implementation that includes as many “moving parts” as ICD-10, it’s important to clearly identify expectations and measure your progress toward them. Among the implementation tasks you’ll need to monitor are:

• System updates (e.g., templates, electronic and paper claims/remits, and reports) and upgrades
• Physician documentation training
• HIM/coding training
• Revenue cycle staff training
• Interface modifications
• Unit testing
• Integrated testing
• Development of new reports

Expect a pretty complex testing plan. In addition to internal testing, you’ll need to test with external parties including payers, clearinghouses, and other EDI partners. And unless you use a home-grown IT solution, you’ll depend on vendors for ICD-10 updates. Don’t underestimate the time and effort vendor coordination and testing will take! Develop a testing schedule that ensures each type of EDI transaction you use processes correctly before the Oct. 1, 2013 compliance date.

Documentation and coding training should be performed in the months prior to implementation, and will be important for reducing coding errors and claims denials after go-live. Once you’ve converted to ICD-10, it’ll be essential to conduct real-time monitoring of clinical documentation, HIM and coding productivity, interface error logs, claim edits, claim denials, remittances, physician productivity, patient visit/encounter volumes, and more.

Phase 5: Stabilization and Optimization

For a successful transition to ICD-10, metrics will be key. Tracking performance metrics throughout implementation is the only way you’ll be able to spot and fix any potential difficulties.

Perhaps the best part of the whole ICD-10 implementation is the opportunity for improvement that it brings you. Think about it: You’ve already created a representative governance team. You’ve already developed a dialog with your vendors and payers. You’ve already started identifying and tracking vital performance metrics.

You’ve already done the legwork. Now, combine your metrics with your avenues of communication to do more than just implement ICD-10. Use them to develop and optimize future goals through additional training, workflow redesign and system modifications.

Rob Culbert is president of Culbert Healthcare Solutions of Woburn, MA.

News 5/26/11

Aetna earned the top spot for major payers in athenahealth’s sixth annual PayerView Rankings, while BCBS-RI was named the overall best performer. The rankings consider ease of doing business based on a variety of performance criteria. Compared to last year, payers averaged payment one day faster with 5% fewer denied claims. State Medicaid providers were the worst performers in terms of AR and denial rates.

Kareo publishes a clever piece entitled, “How to Handle Medical Billing After a Zombie Apocalypse.” The strange title is based on a recent CDC post on how to prepare for a zombie apocalypse (or other emergencies like hurricanes, earthquakes, and the like.) Kareo’s recommendations for medical billing include using a Web-based, easy-to-use software that allows employees to work remotely and includes code-scrubbing tools and free EMR.

The Massachusetts REC leads the country in enrolling primary care providers for its services. Massachusetts eHealth Institute’s goal was to recruit 2,500 PCPs and is the first REC to fulfill its enrollment milestone.

Seven US senators send Secretary Sebelius a letter urging HHS to withdraw its proposed ACO rules, saying “the proposed ACO regulation will fail to accomplish its purpose” of better quality care and lower costs. The senators claim the proposed rules do not align incentives and accountability and include requirements that are too complex and an ROI that is uncertain.

MED3OOO announces the general availability of InteGreat V6.4, which includes the components required to meet Meaningful Use standards. The release also includes an enhanced visit entry module and improved patient communication capabilities.

Doctors behaving badly:  more than 70% of physicians say that disruptive physician behavior occurs at least once a month at their organizations, and more than 10% say that such incidents occur on a daily basis. The types of disruptive behavior physicians encountered range from profanity to refusal to follow established protocols and occasionally physical assault.

Phreesia announces its patient check-in system now integrates with over 85 unique workflow solutions.

Baylor Health Care System (TX) affirms its plans to implement GE Centricity EMR across its entire HealthTexas Provider Network of more than 500 physicians. A reader tells me the “affirm” wording alludes to the fact that Baylor was at one time consider switching vendors, though clearly they changed their mind.

MGMA reports that median compensation for first-year specialists in multispecialty practices was $258,677 in 2010, compared to $240,596 for specialists in single-specialty practices. Median compensation for primary care doctors was $172,400 in multi-specialty groups versus $165,000 in single specialty practices. More than half of first-year doctors were paid signing bonuses and relocation packages.

E-mail Inga.

News 5/24/11

Interesting fact that I’m assuming is true: 17 vendors represent 87% of providers live on EHRs. Keep in mind that so far 487 products have earned ONC-ATCB certification. This statistic comes from Thomas Tsang MD, ONC’s medical director of meaningful use and quality, who made the remark while speaking at last week’s RI Quality Institute Health IT Expo. He also noted that 68,780 primary care providers are now enrolled in the Medicare EHR Incentive Program.

AMA reports profits of $23.9 million for 2010, a 45% increase over the previous year. Membership fell about 5% to approximately 216,000.

PwC’s Health Research Institute predicts medical costs will increase 8% in 2011 and 8.5% in 2012. The report also notes that provider consolidation will continue and more costs will shift to Medicare and Medicaid.

e-MDs reports that its client Dr. Ben Brull is the first physician in Kansas to receive Meaningful Use funds from Medicare. Meanwhile, Greenway Medical says their client Childs Medical Clinic (AL) also picked up a big check.

Kent Rowe, a former GE Healthcare VP/GM and IDX sales VP, joins Culbert Healthcare Solutions as VP of information technology services. He will lead the team that serves the GE and Allscripts client base and will expand the company’s overall service line.

In fashion news, the New York Senate proposes a ban on physicians wearing long sleeves, ties, and watches in an attempt to reduce hospital-acquired infections. Critics of the legislation claim studies have failed to establish a link between contamination of clothing and patient infection.

Florida Pulmonary Consultants picks Benchmark Systems’ EMR/PM solution.

A big welcome to Gateway EDI, our newest HIStalk Practice sponsor. The St. Louis, MO-based EDI provider serves over 21,000 offices in all 50 states and more than 85,000 providers. Gateway submits to over 3,000 payers and  also offers such services as electronic eligibility, remittance, patient statements, and credit card processing. Gateway’s customer support stats are impressive: 98% of calls are answered by a real person and 92% of customer questions are answered on the first call. In addition, clients using Gateway’s claim processing tools typically lower their average error rate below seven percent. Gateway is also sponsoring HIStalk, so a double thank you for the support.

The Minneapolis paper profiles 3M’s Mobile Physician Solution, which allows providers to track patient clinical data, dictate, and capture charges. It was introduced in October and is licensed for $2,000 a year per user.

athenahealth is named a 2011 Best Place to Work in Massachusetts by The Boston Business Journal. Results were based on employee-satisfaction surveys.

Most curious: a Illinois man is arrested for impersonating a doctor and running a medical office without a license. George Fleming ran an advertisement for his “services” in a Bulgarian newspaper. A “patient” visited the office and claims Fleming inserted what appeared to be toothpicks into his chest. He then gave him a bottle of "Prosperous Farmer Dietary Supplements," whose label had a 2002 expiration date. Fleming then asked the patient for $150 cash. The patient called the police.

E-mail Inga.

DOCtalk by Dr. Gregg 5/22/11

A Confident Nobody

Most all of you who read what is written anywhere within the HIStalk realm know that our world, the world which straddles healthcare and technology, is rife with egos galore. (Actually, I should probably write that “EGOS”.)

Doctors are notorious for their inflated senses of self. Heck, even many a nurse or med tech gets in on the medical godhead fun.

Tech-heads aren’t far behind. In fact, sometimes when I listen to two technophiles go at it as to who has the superior program design or some such, the haughty disregard each expresses for the potential validity of the other’s opinion often exceeds that evidenced amongst medicos.

Confidence in our abilities and our decisions is vital to achieving anything. Sadly, its evil cohort, arrogance — which is really just a Girls Gone Wild version of confidence — often takes an otherwise fun time and turns it into a “whose is bigger / better” contest.

This seems particularly counterproductive to our current HIT drive. I say this because of many recent conversations where I see chest-flashing bravado circumvent honest progress. Whether it’s among HIT industry types or between medical folks discussing HIT or medicos taking on HIT-men (or HIT-women), all too often I see chest pounding (or, in keeping with the theme, chest flashing) prevent real potential progress.

Sure, we all like to think we know stuff. But, when “knowing stuff” turns to “showing off,” ears tends to close as pumped out chests start to grow. One knower stops hearing the other knowers. Even though all knowers know they don’t know it all, their know-it-all-manship takes a hold and makes unknown knowing unknowable because the knower thinks they now know no one knows as well as they know. Ya’ know?

I’m seeing more and more really good partial solutions coming down the HIT trail. Some are standalones, some are within larger products. The problem is that virtually none of them do as well on their own as they might if they were hooking up with some of the others. Yet, despite all the chest-flashing going on, few are moving on to the hookup. So many are so mired in the showing off that they forget that the flash is only a part of the fun; the hookup is where the real pay off happens.

With everyone thinking that they have the best answer(s), few are truly open to hearing how the other answers out there might sweeten a mutually satisfying association. Our endless egos, which are probably a large part of the reason for healthcare’s late arrival to the technological party, are also likely a prime source for its continuing negative inertia despite all the beads being thrown about these days. The bountiful beads, it seems, are making it pretty hard for most of the HIT “somebodies” to keep their shirts down. Everybody wants to show what they have; few are really looking at the bigger picture (i.e., it’s the hookup, not the flash, that is the goal.)

I worry about this for myself, too. I’m probably far worse than most since I have both geek and doc genes. I’m probably doubly inclined to start unbuttoning. But, honest, I try to keep an open ear and a closed shirt. I try to keep my brain engaged and my chest hairs covered. I try to think “listen,” not “talk,” because most of the time odds are pretty darn good that I’ll hear something I don’t know. When I’m not in the “gone wild” mode, goodness knows that I know just how little I really know.

So, if you ever catch me writing or talking as anything other than a “confident nobody,” please tell me to button my shirt. And, please, be you on the “H” or the “IT” side, keep your top down, too. There are some really good answers out there and they don’t just come from you or me. Remember: tops down, ears open, and we’ll all get to the hookup.

From the buttoned down trenches…

“In heaven, an angel is nobody in particular.” – George Bernard Shaw

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).