News 10/6/09

Almost one in four providers are using e-prescribing, according a Surescripts report, which also predicts that its own user base of 74,000 will more than double by the end of 2009. Great growth, but three out of four providers apparently don’t find the 2% Medicare bonus enough incentive to make the switch.

Wondering about how adding an EMR will affect your staffing? As this AMA article points out, the effect on staffing is not clear cut.  Some practices are able to reduce staff after implementing an EMR; others add staff, especially if the EMR facilitates practice growth. An implementation expert from Sage suggests that the staffing outcome will vary depending on the practice’s goal for automating: if the goal is to reduce costs, the end result will look much different than if implementation is to improve quality of care or to change a practice’s branding.

The local paper recognizes Heart of Texas Community Health Center for its recent Davies Award of Excellence. My favorite line comes from the clinic’s medical director, who likely had to explain to lots of folks what the Davies is all about: “It’s kind of like winning an Emmy or something.” The health center won the Davies for its ability to demonstrate how technology improved patient care.

athenahealth signs an agreement to purchase AnodyneHealth Partners, a SaaS business intelligence provider. Anodyne will continue to market its BI solution as a standalone product. In addition, athenahealth plans to integrate the service into the athenaCollector platform. The merger agreement includes a cash payment of $22.3 million with the potential for additional consideration of $7.7 million, based on the achievement of certain business and financial milestones. Anodyne has traditionally served large and enterprise-size medical groups. I’m sure athenahealth would like to increase its profile in the large clinic world.

RCM provider ZirMed introduces a new denial management and decision support solution. ZirMed Analytics is designed to help providers with payer- and patient-related revenue issues.

Revenues from medical practices fell 1.9% in 2008, the first nationwide decline in years, according to an MGMA survey. Seems as if the overall reduction in overhead expenses (1.4%) was not enough to compensate for smaller patient volumes and rising patient bad debt (which grew 13% from 2006 to 2008). The findings are based on data from 33,000 providers.

I am heading out to Denver over the weekend to attend MGMA. Look for our Must-See Vendors guide later this week, plus daily coverage while I am there. In looking at the agenda, I was disappointed by the limited number of sessions dedicated to HIT (or maybe the names were so clever that I wasn’t clear on the topics). In any case, I am open to suggestions on sessions to attend. I will, of course, also be making the rounds on the exhibit floor, looking for souvenirs to lug home. Speaking of which, our HIStalk and HIStalk Practice sponsors should have some cool-looking magnets to hand out, so look for the sponsor signs. Dr. Gregg Alexander was our creative genius who designed the magnets, which are sure to be collector items one day.

Two companies that go by clever acronyms form an alliance to help providers with collection efforts before they become bad debt. Internet Payment Exchange (IPayX) provides electronic billing and payment technology and Accelerated Revenue Management (ARM) Solutions offers soft collection capabilities. ARM Solutions will be integrated into the IPayX eInvoice Delivery Service and eCareView Healthcare Billing Portal.

This doctor doesn’t mind using a computer: a former pediatrician is ordered to appear before North Carolina’s medical board, charged with failing to report his DWI arrest and for using the PC of a practice for which he was working to write pornographic stories.

Data on tens of thousands of physicians could be compromised when unencrypted information was stored on a personal laptop that was later stolen. The physician data included personal information, including Social Security numbers, but no patient data.

AHIP and BCBSA team up to create an online tool that gives providers the ability to check patient eligibility with eight major health insurers via a single Web portal. Two pilot projects are set to begin, one in Florida and the other in Ohio.

E-mail Inga.

An HIT Moment with … Brian Beutner

An HIT Moment with ... is a quick interview with someone we find interesting. Brian Beutner is CEO of mPay Gateway.

Are patients really happy about having to arrange payment before they leave the doctor’s office like they would a hotel or restaurant, especially since they don’t know how much will be charged on their credit card until the practice receives the remittance advice from their insurer?

The transparency that we help bring to the doctor-patient financial transaction is something that most patients appreciate. Since we are only collecting authorization at the time of service and because the amount ultimately charged against the patient’s credit card is never more than what is shown to the patient at the time they hand over their card, we find that most patients like it. They like the fact that there are no more unpleasant surprises and the simplicity of taking care of the payment up front, rather than having to wade through numerous statements from the doctor and comparing them to the multiple EOBs and other confusing insurance documents.

We also find that many patients take comfort in the certainty of knowing they will owe no more than the calculated amount. With mPay Gateway, they walk out of the doctor’s office with an itemized receipt and the confidence that they have taken care of their obligation and won’t be surprised later with a larger than expected bill.

I use my wife as an example. This winter, we took our daughter to an allergist. A month or two later, my wife said, “We got the bill from the allergist. It was only $89.” It didn’t hit me until later that evening the relief I heard in my wife’s voice. For the past month or two, she had been worrying about how much that trip to the allergist was going to cost. We had no idea whether it was going to be $100 or $1,000. If we had left the office knowing that the most the doctor was going to charge our credit card was $100, it would have avoided two months’ of needless worry.

The ultimate proof is in the use. When our clients show the patient the most that they will owe and ask for a payment card, more than 90 percent of the time, the patient will hand over a card and conclude the visit.

What are the requirements to use mPay Gateway, how is it implemented, what does it cost, and who does it compete with?

Starting to use mPay Gateway is simple. It works with any computer that has an Internet connection. We provide a cell phone-sized magnetic card swipe device that plugs into any USB port. Because all the financial data is resident on our Level 1 PCI DSS-certified servers, the information is secure.

Our implementation specialists work with our clients to quickly set up the patient payment calculator using the doctor’s own rates and discounts with health plans. With just a few hours of Web-based training for both the staff speaking with patients and the back office staff, the office can be up and running mPay Gateway’s solutions. Once implemented physicians offices can see their receivables drop by 50 percent or more in a matter of weeks.

We charge a monthly license fee to make the service available and cover all costs of getting started on the system. We pass through standard payment card processing charges from VISA and MasterCard, and add a small collection fee on incremental dollars collected through the system.

The biggest competition we see are old, outdated processes that are not very patient friendly. Standard payment processing technology does not handle the unique environment of health care, where the exact amount a patient may owe is not known at the time of service. However, physician practices recognize how difficult it is to collect from patients months after the insurance company settles, so they often use revenue cycle management solutions that leverage outdated technology, resulting in processes that are not very patient friendly.

Typically what we see, if anything, is a process where the practice calculates a patient estimate at the time of service, and then attempts to get the patient to pay on the spot. Not only does this typically frustrate the patient who knows that his or her insurer will pay all or part of the charges, but it creates a second reconciliation when the claim is adjudicated and the staff must reimburse the patient.

Instead, mPay Gateway developed a solution that uses modern software as a service technology to enable practices to resolve patient payments at the point of service, but doesn’t charge the patient until the claim is settled with the provider. The mPay Gateway system runs only one transaction, the right one, making it clear to the patient and easy for the staff.

What will payments to physicians look like in five years in terms of who pays and how?

I believe that we will continue to see cost shifting to the consumer, so that an increasing share of a physician’s revenue will come directly from patients. Much like what the insurers have done, we will see increased use of electronic payments. Five years ago, insurers were making most of their payments to providers by paper check in the mail — hundreds of millions of checks every year. Now much of the payments from insurers are sent electronically to physicians.

A service like mPay Gateway allows physicians to collect authorization from patients electronically at the point of service (rather than by paper check weeks later), much like how the rest of the economy works.

You used to work with high deductible health plans and health savings accounts. Are those going to be more or less important going forward?

I cannot predict what the next alphabet soup of plan design will be, but I am certain that we will continue to see more patient involvement in the financing of health care. The good news is that almost all health care transactions — especially those in the physician office — are for relatively small dollar amounts. Fortunately, the retail industry has long ago solved how to make the payments of small consumer transactions very efficient. mPay Gateway is building on that foundation to bring retail payment transaction efficiencies to health care. Without being dependent on any particular card or plan type, we add transparency and reduce the administrative inefficiencies in the health care payment systems of today.

How does the prospect of healthcare reform impact your business?

The current debate about health care reform is focused primarily on extending insurance coverage to the 47 million people who currently must make direct arrangements to pay for the care they seek. As we add more people to the insurance roles, the complexity increases. Our business is built upon helping physicians deal with insurers that stand between the patient and the physicians.

In general, practices can deal with those who do not have insurance by requiring payment up front. As more people without insurance coverage obtain third-party coverage, the burden on physician practices will increase. Currently physician practices write off as much as $30 billion in bad debt each year, mostly attributable to patients with insurance coverage. Since any plan to increase insurance coverage will require some degree of patient payment responsibility (like a deductible or co-insurance), this problem will only get worse.

We see health care reform as a great growth opportunity for us as we bring cost savings to physicians with a product specifically tailored to dealing with third-party insurers.

News 10/1/09

From: Grizzled Veteran “Re: SSA EHR bid. Social Security Administration on Friday cancelled the Solicitaion for Bid for the EHR system previously mentioned…good move on their part. Inga, you must have put too much heat on them!!” Don’t know about that last part, but, the latest update on SSA website says that the bid for solicitation was canceled the end of last week. The SSA had been seeking bidders for an EHR for its employee health clinics. I sent a note to someone at SSA, asking for more details, but never heard back. I wonder how much it cost taxpayers to have a 68-page RFP created, all for naught?

According to this article forwarded by Weird News Andy, less than half of medical students understand the health care system. A national survey by University of Michigan researchers find that 40-50% of graduating medical students did not feel adequately prepared when it comes to understanding health economics, the health care system, managing a practice, or medical record-keeping. I wonder how those percentages compare to the general population’s understanding of healthcare.

Here’s an interesting piece on the increased use of computer-assisted coding systems, especially in physician offices. Current options are either imbedded into the EMR or PM system, or available in a stand-alone mode.

In an NPR interview, MED-PAC commissioner Arnold Milstein, MD, MPH suggests Medicare data could be used  by patients to find good doctors, to evaluate whether physicians are following clinical guidelines, and to determine physician payment rewards. I suppose as Medicare expands its quality reporting initiatives, it will have better data for analysis, and more than just a bunch of ICD-9 and CPT codes. Still seems like there is plenty of room for inaccuracy without access to a full medical record. But what do I know: Dr. Milstein has a degree in economics from Harvard, co-founded Leapfrog, and altogether has a pretty impressive resume.

The Purchasing & Assistance Collaborative for Electronic Health Records (PACeHR) selects e-MDs and Noteworthy Medical Systems as technology partners to provide EHRs to small and medium-sized group practices in Arizona. Healthcare providers will be eligible to subscribe to one of partners’ web-based EHR/PM applications.

Aprima Medical Software (iMedica) announces a reseller and hosting partnership with MetnetwoRx.

RelayHealth says that both Hill Physicians Medical Group (CA) and Montefiore Medical Center (NY) have improved care collaboration, patient satisfaction, and specialty treatment prioritization using RelayHealth’s referral management service. The product, which was co-developed with Hill Physicians, facilitates secure health information exchange between primary care providers and specialists.

NextGen signs up five new organizations for its NextGen CHS (community health solution) product. The software provides a central data repository to allow the secure exchange of patient health data.

EHR usage by US primary care doctors is considerably lower than a number of countries, according to this report by the Information Technology & Innovation Foundation. A greater percentage of physicians in countries like Finland, Denmark, and Sweden are using EHRs, including creating lab orders electronically and using e-prescribing.

A team of Boston researchers find that by using EMR data, they were able to identify likely victims of domestic abuse an average of two years before a diagnosis was actually made. The study was based on six years of hospital admissions and ER data and looked at patient histories to identify risk factors.

Practice Fusion is the latest EHR company to offer a guarantee that physician users will qualify for Meaningful Use. The company is developing enhancements based on the preliminary DHS matrix and will make the enhancements available across its SaaS-based network.  The website does not give any real details how the guarantee will work; I mean, how does a “guarantee” work when the software is free?

Allscripts announces first quarter numbers, which includes non-GAAP revenue of $167.5 million compared to $164.7 million last year. The non-GAAP revenue numbers take into account the 2008 and 2009 revenue numbers of both Allscripts and Misys Healthcare. GAAP revenue was $164.9 million versus $92.8 last year and earnings were $.15/share. The company exceeded Wall Street estimates of $.14 cents/share earnings. During Allscripts’ investor call, the company indicated its recent deal with North Shore-Long Island Jewish was worth just over $10 million, but had a potential value of more than $75 million, depending on how many physicians sign on. On Wednesday, shares of Allscripts hit their highest price in nearly two years, gaining $.78 (4%) to $20.17. Earlier in the day shares were as high as $20.61.

Allscript also shares news of an agreement with Baptist Memorial Health Center (TN) to automate its 65 employed and 3,100 affiliated physicians. And, at West Penn Allegheny Health System, Allscripts is named the preferred provide of clinical IT solutions across its network of hospitals and owned physician practices. West Penn will expand its use of the Allscripts EHR from 165 doctors to 645, plus add the Allscripts EDIS at its Alle-Kiski Medical Center facility.

E-mail Inga.

News 9/29/09

The North Shore-LIF Health System (NY) announces it is subsidizing up to 85% of the EMR implementation and operating costs for over 7,000 of its affiliated physician. Participating doctors can received subsidies of up to $40,000 each over five years to implement Allscripts EHR. One analyst suggests the deal is worth $20 million to Allscripts and is one of its largest sales ever. North Shore’s subsidy program includes a unique twist: physicians will be subsidized at a rate of  either 85% or 50%, depending on whether or not they are willing to allow North Shore to use the EHR to report and share their performance data and allow them to compare it against a set of nationally care and outcome metrics.

A California physician supports his practice’s move to EMR, believing the practice “can improve outcomes”once it is fully implemented. However, the executive director of the 12-provider group also says they experienced productivity losses when first getting on the system, having to cut out 2,000 patient visits and losing $200,000 in revenue.

The newly opened Jane Pauley Community Health Center (IN), a collaboration between Community Health Network and the local school system, is using the GE Centricity EMR, merging physical and behavioral data.

Amazing Charts is named the fastest growing private company in Rhode Island by Inc. Magazine’s list of “5000 Fastest Growing Private Companies in America.” The company has grown sales 277% over the last three years.

Genesis Physicians Group (TX), a Dallas-based IPA, partners with ProSperus to launch GenPro Practice Management Solutions. The joint venture will help practices to capitalize on stimulus money for EHR adoption and while working to improve a practice’s financial and clinical performance.

The British Columbia Medical Association is pushing for physicians to be paid for phone consultations involving H1N1 influenza cases. The Association is arguing the doctors should take patient calls and encourage them to stay home and risk infecting others, but, receive half ($14.74 Canadian) of their normal office charge.

Newly announced Davies winner Urban Health Plan (NY) was able to create alerts and clinical decision support rules on its eClinicalWorks EMR the same day that CDC issued its H1N1 guidelines.

The Dallas Morning News takes a look at Scott & White Healthcare, a physician-run health system in Central Texas with 800 physicians, nine hospitals, and 50 clinics. The company has reduced much of its competition by merging with it, which has proved appealing to many small-practice physicians. One doctor was drawn to the health system, in part because of the company’s IT infrastructure, which includes a system-wide EMR. He believes it is “impossible” for individual private practices to run EMRs: “You can buy the best system in the world, [but] you have no one to maintain the computers. The best I could get was if I had somebody on a retainer, they might come within a day.” Scott & White’s management model is interesting and is in a stark contrast to more traditional models that reward doctors for running as many patients through the clinic as possible and ordering lots of images and tests.

Hudson Headwaters Health Network, a network of community health centers in upstate New York, receives a $7 million grant to finance HIT and a medical centered home initiative.

Odd lawsuit: a patients’ family sues an ER doctor, claiming the physician allowed the man die so he could steal the patient’s Rolex watch. The family claims the doctor stopped resuscitation efforts, then took the watch and put it in his pocket. A couple of nurses noticed the watch was gone, saw it bulging from the doctor’s pocket, and called security. Last month a grand jury also indicted the doctor for grand theft.

E-mail Inga.

Intelligent Healthcare Information Integration 9/25/09

Speaders, Rearers, and Crinkers

Through the magnanimous good graces of the lovely Inga and the inscrutable Mr. H, I have been blessed with the remarkable forum provided by HIStalk and HIStalk Practice. This has not only allowed me to speak my little HIT mind about issues and observations from my “grunt in the trenches” perspective, it has honored me with an amazing cross section of contacts and comments from people from all over the U.S. Some have even become friends or business associates and I am privileged by my conversations, brief or protracted, with them all.

One of the most interesting aspects of the variety of remarks I have received from the variety of folks representing a variety of fields is the insight it has allowed into the minds of the people who inhabit the realm of healthcare information technology and some of its tangentially associated territories. I have come to the conclusion that there are three primary types of inhabitants within these brave new lands:

1) SPEADERS: The folks who have either a lot to say (speak) or those who show they have a lot to show (leaders). Thus, “speaders.” These are further subdivided into several classes:

a) Those who have a lot to say but rarely say anything. Unfortunately, by their very willingness to speak out, they are often followed, deservedly or not.

b) Those who speak well-spoken and well-considered words, who are often not followed enough because they often speak with such grace and good manners that they are overshadowed by the more brazen and abrasives from a).

c) Those who truly lead by both the power of their example as well as by the power of their well-chosen and well-delivered words.

2) REARERS: People who read or hear what the speaders have to say or write. Rearers often do not feel they have the capacity or the empowerment to actually become speaders, although in my experience, many of the rearers are actually more intellectually capable and competent than many of the speaders. Sadly, many an untapped talent exists within the quiet world of the rearers.

3) CRINKERS: Obvious, at least to themselves, these are the critical thinkers of HIT-land. Crinkers have a high standing in my book; they are not prone to supercilious persuasion by loudspeaking speaders nor to mob mentality promoted by the allure of big bucks or the sparkle of glamorous salesmanship. Crinkers think — for themselves, in spite of others, and often with parsimonious purposes or philanthropic foci.

Be they loud or low key speaders, quiet and contemplative rearers, or the invaluable crinkers (whom I often fear will disavow any knowledge of me), every single one of these folks has something of value to offer this grand HIT conversation.

In medicine, there are “pertinent positives” as well as “pertinent negatives.” So, too, there are comments of similarly equatable categories generated by members of each “caste” of the HIT subcontinent. I have tried to learn to appreciate them all.

Me? I used to be a rearer, but now I like to think I’m a crinker. However, I’m probably more of a speader. I just hope I’m not a subclass “a”.

“Imagination is more important than knowledge, for knowledge is limited, whereas imagination embraces the entire world, stimulating progress, giving birth to evolution.” – Albert Einstein

Dr. Gregg Alexander is a grunt-in-the-trenches pediatrician and geek. His personal manifesto home page…er..blog…yeh, that’s it, his blog – and he – can be reached through http://madisonpediatric.com or doc@madisonpediatric.com.