HIStalk Practice Interviews Chet Speed, VP, AMGA

August 31, 2010 News 5 Comments

Chet Speed is vice president of public policy at American Medical Group Association of Alexandria, VA.

8-31-2010 6-04-20 PM

Review the concept of Accountable Care Organizations.

The ACO law was patterned after a demonstration project that was going on at CMS. It was called the Physician Group Practice Demonstration, kind of like a P4P demo. That was a five-year demo. It included 10 sites. Out of those 10, nine were AMGA members. It included standalone group practices, a couple of automated delivery systems, and even a hospital MSO.

Later, the way the law evolved was we had a few of our members in the PGP demo present some of their experiences to the Hill staff. The Hill staff was looking for delivery systems for healthcare reform and they asked us to draft the first draft of the ACO statute. The important thing is that if you’re really looking for a model of pre-existing ACOs, the PGP demo is a place for them to look.

The PGP demo essentially had two components to it. One, it had a component to improve quality. It had one to provide some savings in the Medicare program. In a macro sense, all 10 PGP demo sites met the quality metrics. On the cost side, they have to produce cost savings. One of the obstacles to actually making money under the PGP was you have to save 2% off the top before you start ensuring savings. So, only five out of 10 groups actually made money, so to speak, on the PGP demo.

What’s the the elevator pitch for ACOs?

It begins to transform the volume-based, fee-for-service reimbursement system because you do have to hit your quality metrics. And, you do have to be able to produce some sort of a cost savings. This cost savings can’t be the classic churn-and-burn fee-for-service. And to ensure that it’s not just all cost savings, you have to hit quality measures.

If I’m a provider, what’s the advantage of participating in an ACO?

It depends on what kind of provider you are. If you’re an AMGA member and or you’re integrated delivery system like Henry Ford or Ochsner or you’re a standalone practice like Mercy Clinic in Des Moines with 130 docs not affiliated with a hospital, I think the benefits are that your group has already invested a lot of the infrastructure that’s required to: one, improve your quality; and two, hit your cost savings requirements.

In both, I think with that infrastructure, typically, you have primary care industry docs under one roof. You’ve got allied health professionals that do the real care coordination, like your nurses, diabetic managers, etc. Also you invested in the EMR system. I think 85% of our members either have an EMR system up and running or are implementing one right now. If you have that infrastructure in place, you’re actually ready to meet requirements and potentially share in savings paid to you by the Medicare program.

But you indicated only half of the practices in the demo project actually got to take advantage of that savings. Is that right?

Yes, that’s right.

What needs to be tweaked in the model?

That’s a great question, and that’s what everyone’s actually asking. Right now, the statute’s fairly broad like all laws are, and where the rubber hits the road is right now in CMS’s hands. They have to draft the regulations that implement the law. Depending on how those regulations are drafted, you could have a very attractive ACO program or you could have one that doesn’t attract a lot of people at all because some of the things that they have to answer.

So the question you have to answer is, for instance, what is that savings threshold going to be? I know P4P was 2%. The law says that the threshold is pegged at the amount of Medicare beneficiaries you have. So if you have 30,000 beneficiaries if you’re a large group, does that mean your threshold is 2%, 1%, or 0.5%? Depending on what the threshold is, you’re going to get people to join or you won’t get people to join.

Another important question — this all stems from the PGP experience — is patient attribution. You need to know who your patients are so you can measure yourself. You need feedback from CMS on a timely basis so you know how you’re doing with those patients on cost and quality. Because without knowing, you can’t re-engineer your care and management processes to take advantage of this; to either redo or keep doing, depending on the result. What is the shared savings percentage going to be? Under the PGP it was and 80/20 split — the PGP folks got 80% and CMS got 20%. So what are the ACO splits going to be — 80/20, 50/50?

That’s policy related to the ACO threshold issue. You need to have a workable threshold and you need to have a decent shared savings split. Those financial issues are going to be very important.

Will it be mandated how the funds will be distributed within a particular ACO?

The statute basically says ACOs have to have a legal structure that allows them to make and distribute payments. That’s all it says. I don’t know how deep a dive CMS is going to do to how the ACO decides to distribute payments. That seems a little prescriptive.

Let’s say you’re an integrated delivery system. Obviously, legally, you can accept the shared savings amount — let’s say its $10. Then internally, you’re going to make distributions based on an internal plan. That could be at the department level like internal medicine or endocrinology or gastro or cardiology, etc. I think the question’s really up in the air on how the distributions are going to be made.

If CMS essentially says, “Do as you wish,” then it really will be up to the individual provider. That becomes a little trickier if you have say, a group practice and a hospital that aren’t integrated but joined together to be an ACO. That does become tricky. So who does CMS give the money to, the group or the hospital? And once that decision’s made, say we’ll give it to the group, and then the group and the hospital have to decide themselves how that money gets split.

Then let’s say you have outside providers. What if you have a skilled nursing facility that you included in your ACO because you want to take care of the post-acute population? Then you’ve got to figure out, OK, how many patients go to this facility?

Let’s say that you have a neurologist that’s not part of the practice that’s a solo doctor. Theoretically, that neurologist could be part of the ACO. Is that correct?

Absolutely. It’s this hospital medical staff idea that’s the Elliot Fisher model, with ACOs basically being formed out of one community hospital and its medical staff. Say it’s like Sibley Hospital and 100 docs in the northwestern Washington, DC community. How do you distribute payments then becomes very tricky because nobody’s really organized under one tent. You know it’s one hospital administrator and 100 different physicians and there’s not always a cultural cooperation between your community hospitals and community docs. So that’ll be a tricky scenario.

We don’t see a lot of that here because our folks are fairly organized, but that will be interesting.

Who’s going to make that call? Is it going to be a progressive group practice making that, or a progressive hospital system, or is it going to be mandated? What’s your thought?

You mean from CMS’s point of view or just what the market will do?

Both. Will CMS decide to call the shots or will it let the market make that call?

I hope CMS lets the market make those calls. Like I said, the statute’s fairly broad. I hope CMS doesn’t say, “The ACO shall distribute payments based on…with this methodology,” etc. You know, “Just pick something,” I hope they say, “The ACO shall make and distribute payments as required by law” and leave it up to the individual ACO. Within our membership it’s a little easier because it’s organized for the most part.

In an unorganized community, that becomes pretty darn difficult, I’d say, because you really have to have a lot of trust between the community docs and the hospital administrator who will probably receive the money in that type of model.

It seems to me the one that doesn’t win from this model is the solo physician. Or a small physician group won’t because they lack the infrastructure and organization necessary to participate. Is that just the way it is, or is it going to force more consolidation? What’s your impression?

I think when Congress drafted this, they focused on increasing the provider integration. They’re looking at organized group practices as a better way of delivering care. They’re actively looking at care coordination, which is lacking right now in the system, and you get more care coordination from these more integrated delivery models. So I think it’s safe to say that if you’re a solo doc, you’re going to have a much tougher time being part of an ACO than if you’re a doc working at Mayo, for instance.

I think you’re hitting the right thing. Congress does want doctors to become more organized because the evidence is showing that the quality, at least, is measured better in more organized systems and the costs are less. I think Congress paid attention to that.

Do you think could be possible that ACOs become closed systems and refuse admissions for providers whose performance metrics are not at a pre-determined level?

Like an ACO credentialing?


Yes, I think that’s a good question. I hadn’t thought about that, but I think if you’re a physician whose quality is substandard, I’m sure they can say no. There is no requirement in the law that says you must take anyone. So yes, it can be closed.

Actually the groups that I talk to actually want to increase the number of doctors, not necessarily that they employ, but, they want to let more doctors be in a panel, for lack of a better word, than less.

So do you think that, in time, there will be competition for these providers? Let’s say that there are multiple hospital systems with ACOs in a particular region. Do you think that they’ll compete for physician participation?

Yes, I think so. If you’re a community and there’s four hospitals and a couple of organized groups and unorganized community doctors, I think you’re going to see a couple ACOs being developed, sure. And they are going to compete.

How will they compete? How will they differentiate themselves financially to providers? If I’m a neurologist, why do I want to become part of your ACO versus the one down the street?

I think probably whichever you feel is more financially stable and has those better quality platforms. You know, most physicians admit to one hospital because they think the care’s better there. I guess at some point it’s just more convenient, but I think the better providers typically win out in these situations.

I can think of an area in Maryland where there are a couple of hospitals and one just is much better than the other because the doctors view the quality at that hospital as higher than the other. I think that’s probably what will happen with ACOs.

What type of IT infrastructure would be required to meet the quality reporting requirements and satisfy coordination of care needs? Are EHRs a necessity and what other tools do are needed?

I think an EMR is a core necessity. And, as I talk to some of the really smart HIT people, what they say is that if you use your EMR just as, literally, an electronic medical record, you’re wasting 80% of its value. You have to use the EMR as, first, a data collection tool. Obviously, to be measured you have to collect the data and then submit it.

Another critical aspect is the analytical capabilities of the EMR system. Obviously, if you’re going to determine appropriate practice patterns, you need to look at the data that’s input in the EMR and analyze it. For instance, if you have 25 primary care physicians and they all have a number of diabetic patients; and 22 out of the 25 have an appropriate A1C levels and three do not, you need to be able to look at the data and say, “OK, why are those three clinicians not doing as well as their colleagues’?” And presumably, through the EMR you can see, oh, OK, they’re not doing required protocol.

On the other hand, perhaps they’re just the best thought-of physicians and they get the harder cases. But being able to analyze the data which you collect in the EMR is critical to understanding situations just like that.

What else do I need to know?

A lot is alive around ACOs right now. You can say anything you want about ACOs, really, and you’re probably right. That’ll start to be narrowed when CMS comes out with its proposed regulations.

Which will be when?

This fall? I heard September to the end of the year. Once they start to answer some of these questions, that’ll provide a good indication of how successful this program may be.

Are ACOs something to be feared or something to embrace?

I hope it’s something to be embraced, but we just don’t know yet. I think the commercial payers are also intensely looking at ACOs. Obviously, they see savings, particularly on the hospital side, that come along with quality improvements. So I think the commercial payers are going to look at this model and probably pilot it a little bit to see if it’s workable.

News 8/31/10

August 30, 2010 News 1 Comment

CCHIT and Drummond Group are the first two entities selected as ONC-Authorized Testing and Certification Bodies. More organizations applied, but being first at this juncture has to be a mighty good thing. CCHIT says it will launch its certification program September 20 with a Web call explaining the application and testing process. Drummond says it will announce more specifics on August 31.

sage intergy

Sage Healthcare releases Intergy version 6.10, which includes the functionality required for physicians to meet Meaningful Use guidelines. Enhancements include MU dashboards, interoperability tools to connect with HIEs, and additional services within the Sage Intergy Practice Portal.

Interesting data points: practices managers average salaries $64,000 to $72,000 a year, depending on the geographic region. Receptionists in family practice offices make $24,000 a year; those in orthopedic offices earn $36,000. Over 90% of practices provide employees with health insurance.

Women’s Health Partners (OH) chooses the Aprima EHR/PM solution.


Ebix agrees to pay $66 million in stock to merge with A.D.A.M. The Ebix CEO says the deal “is a strategic step forward to establish Ebix as a Health Information Exchange and is likely to be followed by other strategic steps in coming months and years." Ebix is an international supplier of on-demand software and e-commerce services to the insurance industry. Ebix stock closed down 5% on Monday; A.D.A.M. jumped 72%.

AirStrip Technologies strikes a deal with Alere’s Women & Children’s Health division to market the AirStrip OB remote monitoring product. Alere is a provider of specialized health management services and will promote AirStrip’s OB product to physicians and hospitals.

Introducing, to your right, the first HIStalk Practice poll. A HIStalk reader actually suggested a similarly-worded question, which I appreciate. If you are using an EHR that is hosted by a hospital or vendor, please share what you are paying per physician per month.

gloStream adds Red Level Networks (MI) as a gold Partner, giving Red Level the opportunity to will sell and support gloStream products.

I look forward to hearing about how different RECs will set up their operations in terms of vendor selection and training offered. A senior director at the Iowa Foundation for Medical Care says her REC will charge providers between $300 and $2,0000 for two years of consulting services, depending on their needs. The cost for similar services on the open market would range from $25,000 to $50,000 a year.

A PHR embedded into a mobile device could become a game-changing killer app, according to Deloitte Center for Health Solutions. Despite strong potential for mPHRs applications and growing consumer interest, plenty of barriers still exist, including concerns about privacy, data integrity, and lack of standards.


ScriptPad releases a hot-selling, $.99 iPhone app titled “Drug and Prescription Medical Reference Guide.” But, the company’s bigger project is a soon-to-be released e-prescribing app that includes Surescripts access and voice recognition. I see they are looking for beta clients, if that’s of interest.

The head of programming and operations at MacPractice predicts that iPads will replace stationary computers in exam rooms and physicians will embrace them while rounding in hospitals. Look for MacPractice to release its iPad-specific applications this fall.

donkey kong chien

Dr. Hank Chien, the NY plastic surgeon who was crowned the Donkey Kong king last February, has been dethroned. The new champion is a hot sauce magnate who was champion before Chien beat his game record. I predict Chien will seek a comeback.


E-mail Inga.

HIStalk Practice Interviews Greg Waldstreicher, Founder, DoseSpot

August 29, 2010 News No Comments

Greg Waldstreicher is founder of DoseSpot of Baltimore, MD and a student at the University of Maryland. He is one of five college entrepreneurs competing for the Entrepreneur of 2010 award from Entrepreneur Magazine.

8-29-2010 6-27-43 PM

Tell me about DoseSpot.

DoseSpot is like a joint venture between two companies. One is a resell manager, which no longer exists, and Claricode, which is a healthcare software company out of Boston. Together we form DoseSpot.

I’ve noticed, reading the eligibility requirements for the college entrepreneur contest, that you can’t have any employees or made sales or provided any products through June 15, 2010. What does that mean in terms of where DoseSpot is in its current operations?

We don’t have any employees. We have our board of directors and our advisors. Regarding sales, we have been fortunate to do some business after June 15th deadline, which would still make us eligible.

Do you have customers in the queue?

Exactly. I can’t go into too many further details on exactly who those people are, but we’re definitely moving and shaking.

In the application video you did for the award, you mention your father is a doctor and he asked you to help develop a new prescribing tool. Was that the beginning of this and where the whole idea for the product came from?

More or less. He basically couldn’t stand getting all these faxes back and forth from the pharmacy and the fact that his office staff was just wasting so much time with the prescription process. He tasked me and said, “Try to figure out something.” I looked into the idea of e-prescribing and yeah, it was out there, but it was at the very beginning. This was a few years ago way before healthcare talk in Congress.

We stumbled upon Surescripts and we’re like, “We want to get in with these guys. We want to be Surescripts certified.” We entered an application with them awhile back. I don’t know how familiar you are with them, but their wait list is really long so we had to wait a few months. By the time we got off the wait list and we were ready to go, we had everything in place.

I know that you’ve already won a few awards for the DoseSpot concept. Tell me about some of those.

We entered the University of Maryland Business Plan Competition in May of 2009, but at that point, people really didn’t know what EMRs were, at least the people that we were presenting to. They know EMRs, but they didn’t know what e-prescribing was.  We were presenting a concept that these people didn’t really think anything of.

I remember someone had said to me, “Why do you think doctors are going to want to do this e-prescribing stuff if they don’t have computers in all their examining rooms?” So you know, it was a little bit of a vague concept, and then we followed this path for a year. We came back, and now with healthcare reform and all the incentives in play, everybody’s like whoa, you guys are really in this. So the news definitely played in our favor.

Which awards have you won so far?

We won the Undergraduate category for the University of Maryland Business Plan Competition. We’ve also received a few grants from the Warren Citrin fund. Mr. Warren Citrin created a Social Impact Fund for growing startups. And that’s mostly through the University of Maryland.

You’ve taken those award dollars to invest in the company. Is that right?

Yes, exactly. It has all gone towards the company, not towards vacations

Too bad.

Yeah, you’re telling me.

Have you had any other outside funding other than those sources?


You said that you don’t really have any employees. How are you handling the support and building the infrastructure and product development and all that?

All that is being done in conjunction with Claricode, which I mentioned. They’re a healthcare software company. They only do healthcare software, out of Waltham, Massachusetts. They’re a great company, great guys. They’ve been really helpful and they’re helping us with all that.

And they handle the back end? When you call for support, you’re actually getting them?


Do you have plans to move beyond them once you get out of school?

DoseSpot is not just something that as soon as I graduate I’m just going to leave behind. It’s something that I’m definitely planning on working with when I graduate. I work on it all day and all night. I live and breathe this stuff right now. I love health IT. I think it’s the place to be. Claricode is just a great partner right now and we’re sticking with them.

How are you marketing the company and the products?

We do a lot of newsletters. A lot of our leads actually come through the Web site. And just the regular old marketing tactics. We have a great relationship with Lexi-Comp, the drug database company. We’ve been pretty successful, but there are a few of the ways.

I noticed on your Web site that you say you want to target software vendors that have existing applications rather than individual doctors. Why did you elect to go that route?

Initially we had a standalone version and we were planning to market it back to individual doctors. But when we spoke to the doctors, they wanted a completely integrated system. They wanted to use the complete patient demographics. They didn’t want to have medication data in two separate systems that weren’t talking to each other. For example, in their electronic medical records; but it also entered separately in the e-prescribing system. So we basically switched our model to accommodate what the doctors wanted.

Is it safe to assume that the new customers you have going up are vendors?


The Hinman CEO program sounds unique. Tell me a little bit about it and why you chose it.

The Hinman CEOs program was the first living and learning entrepreneurship program in the country. It’s part of the University of Maryland and it’s absolutely amazing. We’re building on the advice that we get, specifically from Director Dr. James Green. It’s pretty amazing.

Also, the access to the funding that they’ve given us through this Warren Citrin Fund, as well as the University — they’re the same competition — has really helped us take DoseSpot to where it is. There are so many other examples of amazing companies that have come out of this program.

Basically, it’s all the students in the program live in a building on campus together. A few times a week, we have classes together, but it’s not the class where you get the unique experience. It’s from living with other kids, young adults or students, that have the same kind of mindset as you. You’re always able to bounce ideas off each other.

You know, if you were just living in any typical dorm and you knock on your neighbor’s door and said, “Oh, I got this great idea,” that kid might not know what to do. Whereas when you’re with kids who have this whole entrepreneurial mindset, everybody’s like, “Oh, this is what we should do,” and, you know, “This is how we might line those up until the next thing.” It’s really been a great experience. I’ll be entering my third year in the program right now.

When do you graduate?

May of 2011.

So it’s not just all keg parties in the dorm?

Well, we still know how to party. We’re still getting the college experience.

Excellent. So what’s your long-term plan for DoseSpot?

We really see healthcare and information technology as the future. We really want to be along for the ride with this healthcare technology wave. We don’t see an exit right now.

Do you have a specific exit strategy for the company?

In my mind probably, but out on paper, no.

How old are you?

I am going to be 21 in less than a month.

Amazing. Well, good for you. Hopefully we’ll get you some votes. When you win the money, you can say it all began with HIStalk.

I’d rather have customers than the votes.

News 8/26/10

August 25, 2010 News 1 Comment

PerfectServe introduces PerfectServe Clinician, a free iPhone application that works with PerfectServe’s hospital communication system. Mr. H chatted with PerfectServe CEO Terry Edwards a couple of months ago. It’s an interesting read about a unique product.

Culbert Healthcare Solutions earns a spot on Inc. Magazine’s Top 5000 Fastest-Growing Private Companies. Culbert says that strong growth from physician practice management services and IT implementation services have helped propel the company to #988 in its first year of eligibility.

Meanwhile, Allscripts earns a #22 spot on the Fortune’s 100 Fastest Growing Companies. Allscripts ranked sixth among healthcare companies and was the only HIT company among that group.

MGMA sends CMS a letter regarding the proposed 2011 fee schedule. A few notable HIT points:

  • MGMA urges CMS to revise its proposal to impose 2012 e-prescribing penalties to reflect 2012 e-prescribing activity versus the first six months of 2011.
  • MGMA says CMS should exercise additional flexibility in assigning e-prescribing penalties. For example, CMS should give consideration to higher-volume prescribers who practice in geographic areas where local pharmacies do not have eRx capabilities, or to prescribers in specialties that require a high volume of controlled substance prescriptions that can’t be sent electronically.
  • MGMA believes CMS should not assign any e-prescribing penalties to providers who meet Meaningful Use objectives. CMS will administer the 2011 EHR incentive program separately from its 2011 e-prescribing program and the criteria varies between the two.

medication reminders

For $10 a month, patients can sign up for GreatCall, a prescription reminder service available through Jitterbug cell phones. The Web site says patients get a “friendly” reminder call for up to 16 medications and consumers can indicate when they’ve taken their meds for compliance tracking. It’s unclear if the “friendly” reminder comes from real person or a computer, but I’m guessing computer.

Feeling the need to learn more about achieving EHR Meaningful Use goals? I noticed on the Industry Events link on HIStalk we have a number of webinar and conference options available. Click over and check them out.

Good read: California physician Rahul K. Parikh writes about his use of Google and the Internet for medical research. He points out it can be a great tool, but warns of potential pitfalls. Parikh recommends that providers become search savvy before relying too heavily on online research tools. “Unless you’re Internet savvy enough and have time to scan pages and pages of websites, skip Googling for diagnoses and just call your nearest specialist for help.”


Novo Nordisk introduces a new iPhone app for physicians. The NovoDose applications gives providers the ability to look up insulin dosing guidelines and blood glucose goals for their diabetic patients.


Ingenix Consulting launches a Strategic Technology Solutions practice, targeting large practices and hospitals. Scott Kolesar, formerly of  Wellspring Partners and EDS, will lead the group.

ISALUS Healthcare jumps into the mobile app craze, with the introduction of a new EMR-EHR app. ISALUS’s mobile app will give physician users the ability to access patient charts via their iPhones.

E-mail Inga.

News 8/24/10

August 23, 2010 News 1 Comment

From Ronnie James Dio: “Re: AAFP comment. What exactly does Waldren mean when he says, ‘Eligible professionals in the Medicare program must bear a heavier burden of full meaningful use compliance in their first payment year to receive the incentive payments’?”  Dio is referring to Steven Waldren’s comments on the final Meaningful Use rules. Dr. Waldren graciously agreed to clarify and I have attached his response to the original HIStalk Practice post.

From Not Clueless: “Accountable Care Organizations. I saw that you were going to be talking about Accountable Care Organizations with someone. To prep for your meeting, you may want to watch this video. Actually, it probably won’t help with your meeting, but it is pretty funny, although in a sad reality kind of way.”  Very funny! The clip features a health system CEO asking a help desk how to form one of those Accountable Care Organizations he read about in Modern Healthcare magazine. Last week I did have an opportunity to talk with Chet Speed, VP of  Public Policy for AMGA, and hopefully the interview will post later this week. Meanwhile, I’ll just say there’s probably more confusion than clarity surrounding the whole ACO concept.

Speaking of ACOs, critics are already speaking out against such networks, claiming they would create monopolies and thus would be more expensive than today’s models. Case in point: an ophthalmologist raises concerns over organizations that bring together large numbers of physicians in a single community to provide “total patient care.” He charges that such set-ups actually reduce or eliminate local competition. “The only way to decrease costs that truly works is increasing competition, but for some reason in health care, we’re supposed to believe that competition drives up costs.’’ I must say I am concerned he could be right.

nyu lagonne

New York Epilepsy and Neurology connects to NYU Langone Medical Center’s Epic system, the first private practice to do so. NYU Langone is offering subsidized access to the Epic system for the 700 affiliated private physicians.

Researchers with the Boston University School of Medicine find that their use of an EMR tracking system reduced diagnostic resolution times for abnormal Pap tests. After controlling for certain abnormalities, resolution times decreased from 108 days prior to implementing an EHR tracking system to 86 days after implementation.

ingenix ad

I’d like to welcome Ingenix aboard as our newest HIStalk Practice sponsor. Ingenix has been a long-time supporter of HIStalk and we appreciate their spilling the love over to HIStalk Practice. Ingenix has made HIT headlines as of late for its purchase of Picis and Axolotl. However, the company has a host of other healthcare IT solutions for hospitals, pharma, payers, and physicians. CareTracker is the company’s integrated financial and clinical solution for physician practices. Other ambulatory care offerings from Ingenix include an RCM solution, EDI services, coding compliance tools, and consulting services. Thanks to Ingenix for supporting HIStalk Practice and our readers.

Preferred Health Partners (NY) and Staten Island Physician Practice each receive $100,000 in incentive payments from the Primary Care Information Project. Both practices leveraged their NextGen Health Quality Measures Reporting Modules and Ambulatory EHRs to document improvements in core quality health measures.


DrChrono.com releases a new version of its iPad EMR Platform, which now includes electronic prescribing and the ability to store and display scanned documents and lab reports.

Health care attorney J. Ryan Williams cautions physicians not to jump on the first hospital-subsidized EHR option that comes their way. Instead providers should develop their own Meaningful Use plans and consider hiring a consultant to test the various systems being offered by affiliated hospitals.

Several receptionists at a busy “surgery” in Brighton, England quit after suffering months for verbal abuse from irate patients. Apparently the doctor’s office is understaffed and patients are irate over not being able to get appointments. From one receptionist: “We get sworn at, get called jumped-up receptionists, and even threatened that someone will come down to the centre and sort us out.” Sad, of course, but why do things always sound so much cooler when the Brits say it?


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