News 4/17/14

US physicians produced $1.6 trillion in direct and indirect economic advantage in 2012 and supported an average of more than 13 jobs apiece, according to an economic impact analysis by the American Medical Association. Some outside observers question the accuracy of those figures but there’s no denying that doctors make a big financial impact on the economy.

MHMD Memorial Hermann Physician Network (TX) will deploy DocbookMD’s mobile communication solution to connect its member physicians with one another and with other area providers.

Kids First Pediatrics Group (GA) integrates PatientPay’s electronic billing and payment solution with its Greenway PrimeSUITE practice management system.

EyeFormatics will bundle ZirMed’s RCM solutions within the EyeFormatics EMR.

Jacob Reider, MD, the ONC’s deputy national coordinator, will provide the keynote address at the 2014 Aprima User Conference in Dallas August 8-10.

Forget Weight Watchers, Jenny Craig, and pricey gym memberships. Boston doctors now have a new option to offer their low-income patients battling obesity: bike riding. The city’s “Prescribe-a-Bike” program allows doctors to write “prescriptions” for patients to buy a $5 yearlong membership to the city’s bike-share system. The list price is $85 for an annual membership.

I liked number crunching and data analysis, even when the final output doesn’t mean much. Case in point: Steven Posnack, who is director of the federal policy division for the ONC, posted on his personal blog some fun findings using details from the recently released Medicare payment data. He cross-referenced the payment data with MU payment data and determined what EHRs were used by the highest paid EPs (based on their Medicare payment data.) What does this tell us? Not a whole lot other than which systems are more commonly used in hematology/oncology, ophthalmology, and cardiology – the three specialties with the highest reimbursements. Altos is an oncology-specific EMR; NextGen and MDIntelleSys are widely used by ophthalmologists, and cardiologists use a variety of systems. Even though this chart doesn’t tell us a whole lot, Steve proved that provider details from multiple data sets can be linked – which may beget juicier output as people keep crunching the data.

Nordic Consulting begins a three-year sponsorship of the complimentary wireless Internet access at the Madison, WI airport. It’s definitely a clever marketing tool directed at all those Epic customers popping into town for training.

A systematic review study published in Perspectives in Health Information Management finds that e-prescribing in the ambulatory care setting improves patient safety, increases efficiencies, and saves money, but implementation costs, alert fatigue, and privacy/legal concerns remain barriers to adoption.

Florida is the latest state considering legislation changes to increase the use of telemedicine and establish requirements for providers who treat patients remotely. Proponents say that an expansion of telemedicine would reduce healthcare costs and improve patient access to physicians.

A NueMD ICD-10 survey conducted prior to the official delay shows that the majority healthcare professionals participating wanted the ICD-10 transition to be pushed back or canceled.

A review of clinical trials reveals that a doctor’s bedside manner can greatly improve patients’ health, aid weight loss efforts, lower blood pressure, or manage a painful symptom. Researchers found a “statistically significant” effect on outcomes when physicians had some sort of relationship-based training, such as building empathy and making eye-contact. I’m not sure I ever before realized how closely patient care parallels dating and marriage.

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News 4/15/14

AAFP President Reid Blackwelder, MD offers an interesting spin to last week’s disclosure of Medicare payment data. Blackwelder notes that while the release may make some family physicians feel threatened, he points out that the “action taken by CMS will provide a great opportunity for the Academy to highlight the complexity of care that family physicians provide.”  Blackwelder likely hopes the payment details will positively impact family physicians’ bottom lines, noting that the data reflects the disparity in compensation between specialists and family physicians, who “are near the bottom of the list in terms of payment.”

Meanwhile, the AMA emphasizes that CMS released “raw data with little context and considerable limitations” and offers some points of clarification to help physicians answer questions from inquiring patients. Key points include:

• Medicare payments don’t equate to a physician’s personal income. Physicians also have practice overhead and receive payments from other sources.
• The released data may be not include all services performed, could contain errors, and could include figures related to services rendered by residents or other providers.
• Claims data does not provide implicit details on outcomes.

Finally, let’s just hope the financial winners in all this are not the lawyers specializing in healthcare fraud cases. Not surprisingly, so-called whistleblower attorneys pounced on the data in hopes of expanding existing cases against providers and pharma companies and in search of leads for potential new lawsuits. I see a flood of late night commercials in the works urging medical billers to call a special toll-free number to report employers’ billings that might to be out of line with the rest of the industry.

Sermo reports that its online community has grown to 260,000 US physicians, which represents a 30 percent increase since October, 2013.

The 260-provider Phoebe Physician Group (GA) selects athenahealth for EHR/PM and care coordination.

Shenandoah Medical Center (IA) will deploy Allscripts Sunrise solutions, including Allscripts Sunrise Ambulatory Care.

DrChrono raises an additional $2.69 million in convertible debt funding, giving it overall funding of $6.77 million. The company offers a free EHR platform and says  60,000 physicians are “signed up” to use their program. I assume that number includes me after I took about 30 seconds to register my “family practice.” The website says that  DrChrono is Stage 1 certified, however Stage 2 certification is not mentioned. Regardless of my doubts, investors seemed to have found their story compelling enough to pony up additional funds.

CMS offers guidance on how providers can take advantage of the new Attestation Batch Upload option, which allows multiple EPs (and hospitals) to submit attestations in a single file through CMS. Incentive payments are provided to individual providers and not to medical groups or hospital systems, even if attestation is submitted in batches.

Here’s a different twist to the standard privacy breach. A former administrative assistant at a Tennessee urology practices sends a competing practice the names and addresses of 1,114 patients so the competitor could solicit business. No data commonly used for identity theft was provided, nor any clinical information. So far no word on possible charges filed against the terminated employee, nor the competing practice.

The Boston Business Journal names athenahealth the top publically traded Massachusetts software company with the largest market capitalization at $5.5 billion. Nuance Communications was a close second with a market cap of $5.2 billion.

Talksoft Corporation makes its appointment reminder app Talksoft Connect available for Android devices. The app allows patients to confirm or request a reschedule, alerts patients of a payment due, and offers automatic entry and alarms on a device’s calendar.

AdvancedMD introduces the 1.5 version of its iPad release that includes image capturing within notes, patient search enhancements, a refreshed interface for iOS 7, and faster messaging capabilities.

A Texas family physician finds professional satisfaction after ditching insurance and charging his largely uninsured patient base a flat $50 fee per visit. The “direct primary care” model isn’t new but may find new popularity from physicians opting to avoid administrative overhead and billing hassles. Unlike the concierge model where doctors charge higher annual fees and spend more time with fewer patients, Laredo physician Gustavo Villarreal, MD (above, in front of his paper charts) sees 40 to 60 patients a day and says the change has made him feel like he’s a doctor again.

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News 4/10/14

HHS releases data for over 880,000 healthcare providers who collectively received $77 billion in Medicare payments in 2012. The agency notes that “with this data, it will be possible to conduct a wide range of analyses that compare 6,000 different types of services and procedures provided, as well as payments received by individual health care providers.”

Look for many more reports like this one published by The Wall Street Journal as organizations begin downloading and manipulating the Medicare payment data. The WSJ determined that the top one percent of the 825,000 individual medical providers accounted for 14 percent of the $77 billion in payments, and 344 providers received more than $3 million each.

I’m not sure the average physician needs to be too worried that a nosy neighbor will now be able to figure out what the government has been paying him/her because downloading and manipulating the data isn’t the simplest exercise. The data is available in a tab delimited file format which I am sure works great if you have statistical software to do the manipulations. Most folks don’t, so they’ll have to download an Excel version of the data. The files are broken down by the letters of the alphabet and are still huge (“S,” for example, is 168MB.) Because of the size, each file takes a couple minutes to download. When I tried to download a second file/letter of the alphabet, it caused Excel to crash, though admittedly I had quite a few other windows open at the time. But, let’s say you successfully download a file. The next step would be to filter about a million (seriously) lines of data to find a particular physician and then figure out the appropriate payment figure (submitted amount vs. payment amount).  Even if you pick the correct reimbursement figure, you’d then need to multiple it by the correct number of encounters (even more difficult to decipher). Of course, keep in mind that the each provider’s data excludes procedures performed on fewer than 10 Medicare patients, so probably whatever final number you derive, it’s probably incomplete.

The HHS OIG reverses an 2011 advisory opinion that had allowed athenahealth to charge $1 to providers not on the athena network for processing their test orders. The termination means that athena can no longer distinguish between in-network and out-of-network providers and will therefore charge $1 for all orders. In reconsidering its position, the OIG concluded the arrangement could violate anti-kickback statues. Meanwhile, athenahealth calls the reversal a “setback” for sustainable HIE.

Lakeland Regional Health Systems (FL) will expand its use of Allscripts ambulatory EHR and PM, utilize Allscripts managed services, and implement Allscripts Payerpath financial management software. Last year Lakeland acquired Clark & Daughtrey Medical Group, an existing Allscripts customer.

e-MDs adds PDR Brief to its EHR, giving users enhanced drug information and alerts from PDR Network.

CMS develops a Stage 2 Meaningful Use Attestation Calculator to help providers determine if they can successfully meet Stage 2 requirements by identifying a pass/fail summary for each measure.

Individuals posing as patients covered by private insurance were more likely to secure a new-patient appointment with a primary care physician than other “secret shoppers” posing as patients covered by Medicaid or uninsured, according to researchers from the Perelman School of Medicine at the University of Pennsylvania. Researchers placed a total of 12,907 calls to 7,788 primary care practices to secure new appointments. Eighty-five percent of patients with private insurance obtained appointments, compared to 58 percent with Medicaid, 79 percent with no insurance but willing to pay in full with cash, and 15 percent with no insurance but willing to pay $75 or less at the time of service.

An Institute of Medicine report recommends including information on patients’ social influences and behavioral habits in their EHRs, arguing the data can help improve outcomes and advance public health research efforts.

Harmony Healthcare IT, which provides support for 3,000 Medical Manager PM systems, partners with ZirMed to provide users an ICD-10-ready claims submission solution. Wow, who knew there so many practices still running Medical Manager?

Independence Blue Cross (PA) and the physician practice arm of dialysis provider DaVita launch Tandigm Health, a new healthcare business model that aims to reduce care costs of chronically ill patients by working to keep them out of the hospital. Tandigm will offer primary care physicians higher reimbursement rates and access to analytical tools and real-time data  to help patients better self-manage their conditions, as well as provide monitoring tools for use in patients’ homes. The press release is short on details so it’s unclear what penalties the participating physicians will incur if care costs don’t decline.

Health plans must honor physician requests to use the Automated Clearing House (ACH) Network to conduct EFT and ERA transactions, according to a CMS administrative simplification email update. CMS also notes that health plans cannot charge a fee or use any other method to encourage a physician to use an alternative payment method other than EFT through the ACH Network, and, physicians are not required to use EFT.

Since I hate robocalls, I’m thinking about sending a link to this story to all my doctors. Vanderbilt Medical Group (TN) reports a 50 percent response rate for text message appointment reminders, compared to a 30 percent response rate for robocalls. The higher response rate and the associated backfilling of cancelled visits has translated to 50 fewer no-shows per day.

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News 4/8/14

From Luliu: “Re: Public data. Am I the only physician concerned that CMS is releasing Medicare payment data on 880,000 physicians?” As early as Wednesday CMS will begin releasing details on the amount Medicare paid 880,000 individual health providers for their services in 2012. For years physician advocacy groups have fought to prevent having this billing data posted publically, arguing it invades the privacy of doctors. However, consumer groups and employers have finally won the argument that the data helps evaluate clinicians. Sure, plenty of nosy folks will look up the information just to see how much different providers are making, but the data will also help identify doctors’ expertise performing certain procedures and assist with fraud detection efforts. Look for a flood of opportunistic companies to pounce on this new source of big data.

Physician participation in the PQRS program increased 36 percent from 2011 to 2012, while participation in the eRx program jumped 22 percent. Despite the strong growth rates, only 36 percent of all EPs participated in PQRS in 2012; only 44 percent of EPs in the 2012 eRx program.

US practice administrators aren’t the only ones experiencing job stress as a result of increased patient loads, an overabundance of administrative tasks, and tightening budgets. A survey of UK practice managers working for general practitioners found that more than two-thirds have recently contemplated quitting their jobs due to discontent over increased workload complexity, rising intensity, stress, and hours.

Antelope Valley ACO (CA) selects eClinicalWorks Care Coordination Medical Record for population health management to advance its ACO-related objectives.

I found this opinion piece from The Huffington Post pretty offensive. The author, who is listed as an “etiquette expert,” offers tips for people sitting in physician waiting rooms. My irritation started at the first sentence: “We all know that doctors are often unable to meet their appointment times.” Rather than chastise patients for sprwaling on the furniture and not keeping their voices down, how about telling  physician and staff members that it’s wrong to make patients feel as if the clinician’s time is more valuable than the patient’s, aka, the customer? Or, at least encourage providers to  consider process changes to reduce excess waiting times? Of course not all doctors and staff ignore the value of their patients’ time, anymore than all patients steal the four-month-old magazines and ignore the handicapped patient needing help opening the door.

Andrew J. Sussman, president of the CVS MinuteClinic, views the role of retail clinics to be “complementary and supportive” of the broader healthcare landscape and believes retail clinics augment, rather than replace primary care physicians and the PCMH model. Sussman notes that the 800-location MinuteClinic is affiliated with 32 health systems and uses Epic’s EMR platform to communicate with other providers.

The California Medical Association names DocbookMD the association’s preferred provider of HIPAA-secured text messaging for its 39,000 members.

Highlights from a Black Book Rankings customer experience survey on ambulatory EHRs include:

• Thirty-one percent of all medical and surgical specialists are “very dissatisfied” with the ability of the EHR to decrease workload, compared to eight percent of primary care doctors.
• Primary care user satisfaction has jumped in the last six months among practices that implemented an EHR more than two years ago, in part due to improvements in workflow, MU achievements, and better support.
• More than one-third of primary care providers report a return to normal levels of productivity following their EHR roll-out.
• More than half of primary care providers said they’d recommend their EHR vendor to a colleague.
• Top scoring EHRs were Practice Fusion, Greenway, Care360 Quest, and Kareo.

The amended CLIA regulations, which give patients direct access to their lab test reports, goes into effect Monday, the same day Quest Diagnostics launched MyQuest by Care 360. The MyQuest patient portal allows patients to view copies of the lab test reports from Quest Diagnostics and does not require pre- authorization by a physician.

EdgeMED, a provider of medical office software, medical billing services, and HIT solutions, acquires physician billing and collections company  Physician’s Billing Alternatives.

ZirMed acquires the payment processing, patient eligibility, and patient estimation business owned by TransEngen.

How does this happen? A woman with no medical training uses false credentials to get a job as a physician assistant in a medical office. Over an 11 day period last summer she worked unsupervised, seeing about 200 patients before someone anonymously warned the head of the practice. Upon being arrested the woman told police she posed as a PA because it paid $23,000 than her previous job.

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From the Consultant’s Corner 4/4/14

Three Factors for Success in Using Informatics

As the healthcare industry continues to experience a growing demand for reporting and analytics, organizations will be required to focus on healthcare informatics. Defined as the science of how to use data, information and knowledge to improve human health and delivery of healthcare services, informatics is more than just data reporting. It encompasses business intelligence, data analysis, and analytics as well.

Historically, data reporting was a lesser priority because healthcare organizations did not know how best to leverage data across business and clinical applications. Now, as healthcare leaders begin to understand how to use data and reports to drive performance and outcomes, informatics is moving to the top of the chart with both clinical and business implications. For example, instead of just identifying patients with diabetes, informatics determines whether specific services have been provided and pinpoints care gaps. On the business side, rather than looking at schedule availability, informatics reviews provider productivity expectations and identifies opportunities to standardize and consolidate visit types and provider schedules.

Why focus on informatics

As healthcare leaders define ROI for large investments in new technology, informatics should be at the center. In my experience, although expanding EHR installations and capabilities provides access to more information, the focus has been on implementing technology rather than using the information. The only way to obtain true ROI is to use the captured data for proactively managing patient care and financial operations.

Government regulations also steer the focus to informatics. While Meaningful Use Stages 1 and 2 require technology to be implemented, they also demand that physicians and hospitals become meaningful users. The ICD-10 conversion requires reporting and capturing clinical data in a discreet fashion and understanding what it means from coding, billing and downstream reimbursement perspectives. To comply with these regulations, organizations must understand and respond to the data.

Value-based reimbursement methodologies are another driver for informatics, as accountable care measures of both quality and cost impact how the organization is paid. For instance, organizations no longer are paid to see a patient 10 times with no health improvement; instead, they are reimbursed for keeping him or her healthy. These opportunities require the organization to marry financial and clinical information in a fully integrated manner.

Three factors for success

Leveraging informatics effectively across an organization requires more than EHR technology; it comes down to strategic decisions made by key executives during and beyond implementation. I believe these three factors help organizations realize the true potential of the data and use it to improve operational performance and patient outcomes.

1. Clearly define success metrics.

Without clear goals, no organization can improve performance, regardless of how many reports are run. It’s important to use leader-defined metrics to create reports and deliverables that measure progress and performance against certain key indicators, keeping in mind that information should be published with an operational rather than technical focus. Additionally, leadership should communicate the overall goal of educating and informing end users on what to do with the data, knowledge, and information provided by informatics.

2. Create a customer service culture.

This operational focus for informatics requires a cultural shift in ownership, moving informatics from IT to operational units, such as the revenue cycle or clinical informatics group. Design the informatics effort based on operational requirements, ensuring information is delivered when and where it is needed in the workflow. As a liaison between the technical focus and those using the information, operationally-driven informatics teams should partner with clinical and business managers to understand needs. In my opinion, organizations that allow IT to drive informatics projects will struggle.

3. Set expectations for report development and dissemination.

Resources are not always sufficient to support the increasing reporting demands in healthcare. One way to mitigate this is by implementing service level agreements to prioritize report requests and establish turnaround times. Define the escalation path when resources are not sufficient to meet the organization’s reporting needs.

Moving beyond technology

EHR use alone will not improve care. Rather, the collective knowledge and data captured in the EHR will impact quality and outcomes through informatics. Beyond simply generating reports, informatics supports clinical and business goals by providing the necessary information to the right decision maker in a manner he or she can understand and use to promote health and improve delivery of healthcare services.

Brad Boyd is vice president of sales and marketing for Culbert Healthcare Solutions.