News 5/23/13

More than half of all doctors and other EPs (291,000) have received MU incentive payments through the end of April, according to HHS Secretary Kathleen Sebelius. HHS has met or exceeded its goal for 50 percent of doctor offices and 80 percent of eligible hospitals to have EHRs by the end of 2013, leading Sebelius to conclude that, “we have reached a tipping point” for EHR adoption.

Net Health, a provider of clinical solutions for outpatient specialty care, acquires Integris, a provider of an EMR/PM solutions for the urgent care, occupational health, and hospital employee health markets.

The New Jersey chapter of Entrepreneurs’ Organization and the Star-Ledger/NJ.com name SRS CEO Evan Steele the winner of the Garden State Entrepreneur Excellence Award in the $10M+ category.

Greenway Medical adds ClientTell’s ReminderManager patient communications solution to its Online Marketplace as a certified API solution for the PrimeSUITE platform.

Athenahealth names Midland Orthopaedics (SC) the winner of its athenaVision award for helping “make healthcare work as it should.”

DocuTrac, a provider of EMR technology for behavioral health, will add DrFirst’s e-prescribing technology into its QuicDoc EMR Professional and Enterprise edition software.

Cerner’s PowerChart Touch mobile solution receives a bronze award for Best Clinical Health Care Experience at the 2013 International User Experience Awards.

Greenway Medical announces the availability of its PrimeMOBILE mobile access solution for the Windows 8 platform.

PracticeMax, a provider of PM and technology services for physician offices, acquires the Phoenix-based ABC Medical Management, a provider of billing and PM services for anesthesia and pain management specialists.

More than one third of physicians participating in a CareCloud/QuantiaMD survey predict their practices will be less profitable in the next year, compared to 22 percent foreseeing increased profits. The biggest perceived threats to profitability were declining reimbursements, rising costs, ACA-related requirements, and coding and documentation changes. Other key findings from the survey of 5,102 physicians include:

• Almost half believe that increased operational and billing pressures will leave their practice unable to accept any of the expected influx of insured patients from the implementation of the ACA.
• A mere nine percent were “very confident” in the current process for getting paid.
• The majority of physicians spend more than 20 percent of their time coding, documenting, and performing administrative tasks, rather providing than patient care.
• Almost sixty percent of independent physicians were not looking to sell their practices.

E-mail Inga.

News 5/21/13

Mitochon, a provider of a free EHR product, announces it will exit the market and cease its physician service by mid-June. According to the company’s Website, Mitochon had been able to offer its product for free because it used “healthcare related messaging/advertising in a HIPAA, FDA compliant methodology.” On the FAQ page, Mitochon included a question about how a buyer will know if the company “will still be around in five years.”  I wonder how many providers felt re-assured by this response:

We have integrated with AT&T’s Health Cloud, Medicity, and Covisint’s Health Cloud, a major hospital in Southern California, we are an IBM Global Entrepreneurial Partner, and we are fully certified by the government.

As a side note, Dr. Gregg would likely be the first to concur there are really no guarantees that any selected EHR will be around in five years.

CMS posts the 2014 ICD-10-PCS files, including code tables, index, and coding guidelines. CMS notes that the FY 2014 ICD-9-CM diagnosis codes will not be updated.

Blue Ridge Physicians for Women selects Benchmark Systems’ PM software.

River Ranch Radiology (TX) and its affiliate Sendero Imaging and Treatment Center demonstrate Stage 1 MU using eRAD’s RIS.

Kettering Anesthesia Associates (OH) contracts with Zotec Partners for billing services.

e-MDs will integrate dashboardMD’s business intelligence reporting solutions into its PM platform to automate revenue cycle monitoring.

Rob Anthony, deputy director of the HIT Group for CMS’ Office of E-Health Standards and Services offers tips for prepping for a MU audit.

Only 17.2 percent of physicians believe a practice led by a nurse practitioner should be certified as a medical home, though more than 82 percent of NPs feel it should, according to a survey published in the New England Journal of Medicine. Less than four percent of physicians agree that NPs should be paid equally for providing the same service, compared to 64.3 percent of NPs.

DoctorBase, a provider of mobile solution that connects patients with clinicians, announces it has surpassed 10,000 doctors on its platform.

CMS Deputy Administrator Jonathan Blum says that the agency could choose in the future to build on its recently released database of average charges for inpatient services to include charges for outpatient services.

Physician reimbursement Betsy Nicoletti offers tips to ensure medically-compliant billing when using an EHR to document E/M services.

The physician social networking site Doximity collaborates with Cleveland Clinic to include CME for practicing physicians using Doximity to learn on the job.

E-mail Inga.

DOCtalk by Dr. Gregg 5/18/13

Dear Allscripts,

I fully realize that you have bigger fish frying on the Allscripts skillet. Further, you probably don’t really care about what one little solo trench grunt thinks, but I’d like to throw this out there anyway. If it gives you any cause to pause and reconsider any future decisions, maybe that’ll be worthwhile. (Lord knows some Allscripts decisions over the past few years could have benefitted from a pause or three.)

While I know you are aware of most of the backstory, please indulge me a moment for those who may not know it so well as I run through a brief history.

About two and half years ago, you acquired Eclipsys. When you did, you acquired my then-favorite EHR, Peak Practice. (I’ll try to call it Peak Practice, but I still think of it as Bond Technologies’ “Clinician,” which was the original incarnation’s name.) You then built a beautiful set of Web pages devoted to the new “Allscripts Peak Practice” and promised end users that it would continue to be supported.

Not being a corporate insider – and not having fly-on-the-wall transmogrification capability – I have no real clue as to why you decided shortly thereafter to pull Peak’s plug. I was told it was because you had too many products and Peak was more difficult to support, in part because it was so technically sexy. The founders understood how to support it, though Eclipsys certainly had its share of difficulties in learning how to implement it correctly. Maybe the latter colored your go-forward decision. Regardless of the reasons, Peak’s plug was pulled and the Web pages vanished.

At the time of the acquisition, I was working on the Eclipsys design team for Peak Practice’s “Notes 2.0.” (I had moved up the food chain with Clinician, starting with helping the Bond team bulk out the pediatric side of its offering, through MediNotes, and onto Eclipsys. It was a rocky ride, to be sure, but it had really started to get good.) We were fairly far along with the notes engine’s redesign and it was going to be gorgeous! If we’d have been allowed to finish its development, I have no doubt that it would stand up against ANY current EHR for both functionality and user experience.

I know this because two and a half years later, I am still using Clinician…er, Peak Practice. Why? Because frankly, after far too many demos, I haven’t seen much that is truly any better. Most often what I see doesn’t even come close. (OK, I have seen a couple of systems recently that do have some serious knock-my-socks-off wow factor, but, overall… diddly squat.) Most available EHRs/EMRs trail far behind Peak Practice in usability and functionality, if implemented correctly. And this remains true despite Peak having absolutely no development these past two and a half years! If Peak would have gotten development focus in that time … well, I can hardly imagine.

Moving forward, you offered to move existing Peak Practice clients onto your MyWay product for free. Many did. I did not. (Didn’t like it, not one little bit.) Now as you know, you’ve also sunsetted MyWay. If I was one of those poor wretches who had been forced to migrate once and then once again within about two years, I’d be livid – either that or I’d have transitioned into forestry or some other trade wholly non-EHR-related.

Migrating from one workflow to another sucks. Period. Doesn’t matter if it’s a better workflow in the end or not, the transition is still difficult. You know, it’s the whole “providers just want to provide, not become techies or practice redesign experts” thing. Paper to digital, digital to digital – transitioning your processes is an encumbrance, a nuisance, and, honestly, just a pain in the derrière.

Why did I lay out this whole trail of tears? Because I was recently informed that the EDI server which you maintain and which facilitates my e-prescribing and lab interface (for which I had to pay good money to obtain) is to be shut down August 31. I was told I can keep using Clinici…er, Peak Practice on my servers, but will lose those capabilities.

Once you’ve gotten a taste of the future, it’s virtually impossible to consider going back to the meager meals of the past. I want my delicious interfaces. Thus, without intervention or switching to a new system, I’ll be forced into Luddite mode.

Thus, my dear Allscripts, you’ve again left me feeling abandoned and abused. Is it your fault? Not really. You have a business to run and shareholders to satisfy. I get that. But, maybe, just maybe, the decision to tank Peak Practice in place of the now-tanked MyWay was a regrettable decision and one that deserves a revisit. Maybe the following option would be a cause to pause here for a moment to reconsider your choices.

The founder of Bond Clinician once offered to buy Peak Practice back from you. I was told you wouldn’t give it up because you didn’t want the competition. But considering the recent success rate in the outpatient EHR world that you’ve “enjoyed,” perhaps a little creative thinking might be in order. Why not offer Mr. Bond (or anyone else smart enough) the opportunity to buy back the rights to Clinicia…er, Peak Practice, perhaps structuring a royalties deal where you and your shareholders could reap the benefits without worrying about supporting the product?

Sounds like you have your hands full unscrambling some recent events and turning a rather large ship into calmer waters. Perhaps doing the right thing by Peak and letting it go would create some good karma. Besides, do you seriously think competition from a revived Clinician would be something you really need to worry about for the foreseeable future when there’s so much else more pressing on your To Do list? Do you really think letting a great system go to pasture is doing you, your shareholders, or the world of healthcare in general any great service?

Sincerely,

From the trenches…

PS: I know, this is more fantasy than anything, but it was fun to dream just a little.

“You can’t put abandonment and alienation under arrest.” – Carrie P. Meek

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, an HIT and marketing consultant, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).

From the Consultant’s Corner 5/17/13

Vendor Selection Strategy
By Brad Boyd

Many healthcare organizations are evaluating the potential benefits and tradeoffs associated with replacing their legacy application vendors with a core vendor to meet their enterprise-wide patient access, clinical, and revenue cycle requirements. Core vendor solutions promise a variety of benefits, including streamlined workflow efficiencies, business intelligence enhancements, reduced operating costs, and tools to help a healthcare provider meet the various changes facing our industry (ex. bundled payments and value-based contracting).

Making an uninformed decision can have far-reaching consequences in terms of costs, patient care, and revenue cycle performance, so it’s important to approach this evaluation process in a holistic manner.

The CIO of an integrated delivery network recently asked me what I thought were the five most important things to keep in mind when evaluating core vendor solutions. The following contains some of the details of our conversation:

1. Know yourself first. It’s critical to have a full appreciation of not only your current business and clinical needs, but most importantly, the future state requirements of your organization. A comprehensive discovery process should engage C-suite leadership, physicians, patient access executives, revenue cycle management, practice managers, and department administrators.
2. Perform a total cost of ownership analysis. Not all vendors offer similar licensing and support models, and there is great variance in vendors’ implementation methodologies and staffing models, as well as post-live support requirements. As a result, an organization must calculate the costs of acquiring, implementing, and supporting each vendor. For example, a system may be expensive to buy and implement, but the costs of maintaining the system over time could be relatively low. Another system may be less expensive upfront, but the costs of long-term maintenance could be higher. To get a true appreciation of the financial implications of a potential choice, spend time calculating the total cost of ownership over 5-10 years—considering the costs to acquire, implement and maintain the technology.
3. Understand the vendor marketplace. Consolidation is the name of the game in this industry and companies are constantly being acquired and sometimes dissolved. Know where a potential vendor sits in the marketplace and how stable that position is. The last thing you want is to pick a vendor only to have the company acquired, forcing you to convert to another system because the acquiring company will no longer support the initial vendor’s product.
4. Have a conversation with the vendor without the sales people. Although the sales staff serves a purpose in explaining the product and its benefits, I find it valuable to talk with a vendor’s executives without the sales people present. During this time, ask the executives where they think the healthcare industry is going and what the vendor is doing to navigate those changes. I’ve found that this type of strategic discussion can reveal a vendor’s research and development priorities and give a sense of how the organization is preparing for the future.
5. Look at the culture. Basically you want to know whether a vendor is going to play nice in the sandbox. If the vendor is committed to implementing its product in its own way and is not willing to customize the process for your organization, that’s something to know upfront. While I think a detailed plan for implementation is valuable, the vendor should be willing to compromise in certain areas to ensure your organization’s unique needs are met.

As with any big decision, it’s important to garner multiple perspectives. I recommend putting a team together that represents all potential users of the system. In my opinion, an organization should also bring in a consultant who can offer an unbiased perspective on different vendors, cut through the sales speak, and get to the real value and help your organization fully understand the ramifications of your choice.

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

News 5/16/13

INTEGRIS Health (OK) will deploy athenaCollector, athenaCommunicator, and athenaClarity for its 300 physicians.

PeaceHealth Medical Group (OR) begins its Epic go-live at its Florence clinics. 

The AMA board of trustees issues a report that looks at the how patient-physician communication is affected by the use of computers in the exam room. The study finds that a physician’s attitude toward the computer has the biggest impact on a patient’s perception of exam room computing: “The more positive they perceived their doctors’ attitudes toward the computer to be, the more likely respondents were to indicate a preference for computer use.” The board recommends that the “AMA encourage physicians to incorporate questions regarding use of computers and EHRs in patient-satisfaction surveys to provide feedback on how their own patients experience the use of computers in the examination room.”

NextGen Healthcare will integrate PDR Network’s drug information technology with the NextGen Ambulatory EHR platform.

NCQA releases the names of over 100 NCQA-Certified Content Experts on PCMHs who have demonstrated in-depth knowledge of the requirements for PCMH recognition and are interested in providing expertise to practices seeking NCQA PCMH evaluation.

McKesson expands its McKesson Gives Back Program nationwide and will provide up to 100 selected physicians with the McKesson Practice Choice EHR/PM program.

Kaiser Health News profiles two independent physicians who are experimenting with innovative practice techniques and business models in hopes of improving clinical outcomes and preserving healthy incomes. Thomas Bellavia, MD (NJ) has invested about $300,000 since 2011 to train staff and purchase equipment to transition to a medical home model that involves a team of doctors and nurses providing treatment.  He claims the transformation has led to higher insurance reimbursements and an increased emphasis on preventative care. Meanwhile Mark Holthouse, MD (CA) has opted for a concierge model that limits his clinic to 400 patients and offers alternative services such as acupuncture and fitness coaching. Patients pay a monthly fee of $220 for basic services in addition to what their insurance pays. Holthouse contends that patients are spending less on medication and hospital fees and feel providers are giving them time and quality care.

E-mail Inga.