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Readers Write: Change and Inadequate Tools Pose New Challenges for Physicians

March 14, 2017 Guest articles No Comments

Change and Inadequate Tools Pose New Challenges for Physicians
By Joe Marabito

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Physicians are the most important element in delivering quality, cost-effective healthcare. They are the avenue through which all meaningful improvement in healthcare will occur. However, they find themselves in an era of unprecedented change. They are being asked to:

Fundamentally change how they practice medicine – shifting from art to science using an overwhelming and impossible-to-digest stream of new research and outcomes data from countless different sources, and accessing patient-specific data from a variety of un-integrated, disparate medical record sources in a non-digestible way at the time and place of decision making. Standardization of care is essential to improving quality, but how can the latest care practices be adopted if they are unavailable to the physician when she needs them?

Shift from volume to value. For physicians, the two models are diametrically opposed. Put patients in hospital beds versus keep them out of hospital beds. Get paid for doing more versus get paid for doing less. From a process perspective, it’s kind of like changing our driving convention from the right side of the road to the left. Even worse is that right now it seems like physicians are doing both at the same time.

Refer care to unfamiliar specialists. If you want to know which physicians practice quality care and which do not, just ask physicians. They should know. Today, due to narrower networks and risk-based contracts, they are being forced to refer care to specialists they wouldn’t normally use or wouldn’t voluntarily choose, potentially at the expense of quality outcomes for their patients. Quality care requires effective collaboration between physicians. How effective can that collaboration be when physicians don’t even know each other, haven’t worked with one another, and perhaps otherwise wouldn’t choose to work with one another?

Do more with less. After recently being asked to increase the number of patients he sees every day AND having his compensation reduced, my primary care physician decided to step off the treadmill and shift to a privately funded practice model. Essentially, he felt he could not spend sufficient time with patients in order to deliver care that met his own standards of quality. He believes patients don’t open up about sensitive but vitally important health issues until after 15-20 minutes of interaction. The new patient throughput standards of his practice wouldn’t have permitted the necessary time with each individual patient.

Deal with unprecedented administrative complexity. ICD-10 contains five times more diagnoses codes than ICD-9. Government regulations have never been more complex to administer, and compliance penalties are severe, requiring more extensive documentation of both diagnoses and treatments. Some of this documentation is helpful to delivering quality care and medical research, but most is imposed to inform and justify payment. We’ve effectively increased the administrative burden on physicians – significantly – by requiring them to document items of questionable utility to quality outcomes.

What have we as an industry done to help physicians accommodate all this change? Mainly due to government financial incentives, we’ve purchased and implemented incredibly expensive EHR systems, which, as it turns out, do not talk to one another. Additionally, the expense of EHRs crowds out other innovation inside the health institutions that adopt them. Worse, existing best-of-breed physician tools are being retired in order to fund the cost of implementing and maintaining EHRs. And because the primary function of an EHR is to store medical records, scant attention is paid to how physicians use them to serve patients. The result is a step backward from a physician workflow perspective. EHRs are not designed around doctors. Doctors need to share and receive relevant decision-support information on mobile devices at the point of care and to collaborate with the rest of the care team. Some EHRs don’t even offer a mobile solution that isn’t anything more than an afterthought.

The drive for EHRs, while essential and necessary for better care, has encouraged the adoption of a single central system, closed-architecture model that inhibits innovation. Monolithic systems rarely, if ever, do everything well. Innovation flourishes in other industries by connecting disparate best-of-breed systems and data via open architectures and interface standards. It is an approach that encourages innovation by inviting the best ideas to compete and letting the market determine the best solutions for specific challenges. Apple’s mobile device business has flourished in large part by opening its app store to anyone who provides a useful application that meet their standards. In short, they tap the ingenuity of the world to drive higher utility and value for their customers. The result is incredibly useful smart devices. Healthcare will get there too, eventually, if only because it must. Market forces will drive it. In the meantime, doctors are suffering through a time of unprecedented change, hoping it won’t take long.

Joe Marabito is CEO of Ingenious Med in Atlanta.


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News 3/14/17

March 14, 2017 News 1 Comment

Top News

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Seema Verma is sworn in as CMS administrator after a full Senate vote Monday night confirmed her along party lines. Her appointment comes at a fairly tumultuous time for healthcare. She takes over a $1 trillion agency tasked with overseeing health plans for 130 million people – the majority of which are in a state of semi-panic thanks to the Trump Administration’s decision to repeal and replace. Her boss, HHS Secretary Tom Price, MD will address the GOP’s much-opposed healthcare bill during  a CNN-hosted town hall tomorrow night.


HIStalk Practice Musings

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Today marks the 28th anniversary of Pi Day – a commemoration of the ratio of the circumference of a circle to its diameter. (It literally pained me to type that sentence. There’s a reason I went into journalism – primarily to avoid math.) The tradition, which was started by physicist Larry Shaw and his fellow San Francisco Exploratorium staffers, has without a doubt expanded into the popular zeitgeist. Even folks at the FCC – including Chairman Ajit Pai – seem to be having fun with it.

Fun facts: March 14 is also Albert Einstein’s birthday. Microsoft is offering Pi Day discounts of 31.4 percent on several laptops.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.


Announcements and Implementations

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The Fort Lauderdale, FL-based MediXall Group announces general availability of its new PWeR EHR and PM platform.

Coastal Imaging (NJ) selects RCM software and services from Healthcare Administrative Partners.

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Compulink develops an all-in-one EHR, RCM, and PM software solution for pain medicine providers.

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Entrada makes several improvements to its mobile EHR engagement app, including giving users the ability to view EHR data in real time, and quicker overall access to clinical content.


Acquisitions, Funding, Business, and Stock

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Primary care management services company Primaria Health launches a Medicare ACO in Central Indiana. A join venture between VillageMD and Indianapolis-based health system Community Health Network, Primaria’s network includes 375 independent physicians who care for 130,000 patients across 38 counties in the region.


Research and Innovation

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A small Open Notes-like pilot study finds that patients and providers benefit when patients are given the ability to type their appointment goals into their EHR beforehand. Conducted at the Harborview Medical Center’s (WA) adult medicine safety-net clinic, study participants felt that the exercise improved communication between patients and providers, resulting in a more collaborative and efficient visit. (This sample patient agenda and follow-up commentary from the patient and provider is pretty compelling.) Speaking my with “patient” hat on, I’d enjoy the ability to add my goals for upcoming appointments via my practice’s patient portal, and have that agenda automatically transfer to a universal EHR/PHR managed by me and caregivers of my choosing.

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This is a bit dated, but in light of the current legislative environment I suppose it’s worth mentioning that researchers have found no evidence that ACA-induced insurance expansion resulted in a strain on primary care practices. Overall appointment rates from 2012 to 2014 were stable, with wait times of six to seven days for new patient appointments remaining largely unchanged. The authors cite healthcare IT, including EHRs and secure messaging, among their reasons as to why access remained level despite millions of newly insured consumers.


Other

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AMA, a vocal detractor of the AHCA, launches a new advocacy website to equip patients and providers with tools to voice their dissent with the proposed bill. The association’s formal objectives include:

  • Ensure that covered individuals do not become uninsured.
  • Maintain existing reforms such as coverage for pre-existing conditions and parental coverage for young adults.
  • Ensure that low- and moderate-income patients have access to affordable, adequate coverage.
  • Ensure funding for Medicaid and other safety-net programs.
  • Stabilize the individual health insurance market.

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Pi Day humor gets me every time.

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Anyone else find it funny that Pi Day is celebrated during National Nutrition Month?


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Jenn, Mr. H, Lorre

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News 3/13/17

March 13, 2017 News No Comments

Top News

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IExhale raises $1.86 million seed funding round led by Dorilton Capital. The Beverly Hills, CA-based startup, which launched its messaging and phone-based therapy app for California residents last December, will likely use the investment to add video consult capabilities and expand into additional states.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.


Announcements and Implementations

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ClinicTracker upgrades its behavioral health EHR to be more compatible with new and emerging operating systems. Added features include compliance automation, enhanced reporting, and staff and patient portal enhancements. 

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Curatio develops a social support app for people suffering or recovering from a variety of ailments. Features include the ability to connect with people from similar backgrounds with the same condition, a physical and mental health symptom tracker, patient communities, and educational materials.

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Southwest Behavioral & Health Services (AZ) adopts EnSoftek’s DrCloudEMR at its 15 facilities in the metro Phoenix area.


Acquisitions, Funding, Business, and Stock

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CaptureRx will relocate to larger headquarters in downtown San Antonio early next year thanks to a variety of tax breaks and waivers. The 17 year-old company and its 114 employees have developed technology that helps safety net providers manage inventory and financial transactions for 340B prescriptions. It has pledged to invest in further development of the historic Kress building, and will create an additional 200 full-time jobs within six years. 


Research and Innovation

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Just over half of 1,300 surveyed physicians report using multiple methods to remind patients of appointments, according to a new MGMA poll. I’d like to dig a little deeper and determine what combination improved no-show rates the most. Providers, feel free to share your experience with technology and appointment reminders in the comments below.


Other

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The local business paper covers the opening of a second One Medical practice in Boston, highlighting the ways in which its homegrown technology and membership-based business processes are helping to prevent physician burnout: “The balance of the virtual care means less burn out for us,” says Julie Sugarbaker, a OneMedical nurse practitioner who came from the world of private practice. “I don’t even know what percentage of e-mails or phone calls I don’t deal with during the day, because they’re handled by the virtual team.” She adds with a laugh that patients thank her for “fitting them into her schedule. They don’t know the back end that goes into reserving a percentage of same-day appointments and our process.”

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ProPublica launches aggregates data from several healthcare projects at a new website. Consumers can look at specific providers based on payments received from pharma companies, number of prescriptions written by drug type, their Medicare fees for visits and treatments, and complication rates for surgeons who perform common elective procedures covered by Medicare. The nonprofit will launch a corresponding API later this year to give software developers the ability to integrate the data with their own applications.


Sponsor Updates

  • Intelligent Medical Objects will exhibit at the Cerner UK Collaboration Forum March 13-16 in London.
  • NVoq will exhibit at the AAOS Annual Meeting of Orthopedic Surgeons March 14-18 in San Diego.
  • PerfectServe will exhibit at the Renal Physicians Association Annual Meeting March 17-18 in Nashville.

Blog Posts


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Jenn, Mr. H, Lorre

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News 3/9/17

March 9, 2017 News No Comments

Top News

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Senate Republicans break through the Democratic attempt to stall final voting on Seema Verma’s nomination to head up CMS by passing a cloture vote – a move HIStalk Practice readers may recall from the will-they-or-won’t-they voting process for HHS Secretary Tom Price, MD. It looks like the final confirmation vote will happen within the next several days. As with Price, Verma’s eventual confirmation is expected along party lines.


Webinars

None scheduled in the coming weeks. Contact Lorre for information on webinar services.


Acquisitions, Funding, Business, and Stock

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Global skincare company LEO Pharma’s Innovation Lab invests $5.5 million in five startups, two of which are based in the US. San Francisco-based Pacific has developed an app to help consumers manage stress, anxiety, and depression; and a corresponding dashboard tool for providers. Remedly, also based in San Francisco, has developed an EHR and PM system for dermatologists. 


Announcements and Implementations

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Austin-based startup WeInfuse develops cloud-based infusion center management software that includes patient scheduling, insurance pre-authorization, and medication inventory and delivery capabilities.

Casamba adds MedBridge’s patient engagement technology, including home therapy programs, to its TherapySource EHR and PM solution for post-acute therapy providers.


People

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CareCloud brings on Greg Shorten (Validic) as chief revenue officer.

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Meghan Hendricks (SSM Health) joins prescription drug pricing software company Doc and I as CIO.

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Mordechai Raskas, MD (Children’s National Medical Center) joins specialized pediatric urgent care provider PM Pediatrics as director of telemedicine and clinical informatics.


Telemedicine

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Akos launches its virtual consult business for consumers and employers in Arizona, with plans to expand to 10 more locations within the next few months. The company, formed last year by InstaMed Health Center Chairman Kishlay Anand, MD and neurologist Swaraj Singh, MD has raised $1 million in seed funding thus far. Its preferred brick-and-mortar provider network for patients that need in-person care seems to be the only thing setting it apart from the many other telemedicine companies popping up with increasing frequency.

Greenway Health software reseller and consulting company MDS Medical will add Otto Health’s telemedicine platform to its service line.


Government and Politics

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Athenahealth CEO Jonathan Bush makes the media rounds this week to weigh in on the release of the GOP’s American Health Care Act, which he admits offers a “glimmer of hope” when it comes to prompting consumers to shop around for their care. He believes three things need to happen to make healthcare “shoppable:”

1. Arm patients and providers with cost/quality information to make better decisions, and reward them financially for doing so.

2. Connect our various care settings so when people do go in and out of certain settings, their health information will follow them.

3. Put all of health care on a national network. The industry can build all the software it wants, but without the connected tissue of a network innovation and knowledge-sharing can only happen in silos. One of many missed opportunities in healthcare that could be resolved with a national network is around scheduling; today only 16% of providers have at least some of their appointments available for web scheduling. A two-sided national network would allow patients to book appointments more conveniently, as well as for providers to fill appointments more conveniently. On the clinical side, with a national network doctors could share and access like-clinical scenarios and outcomes in real-time vs. once a year at an annual conference.


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Jenn, Mr. H, Lorre

More news: HIStalk, HIStalk Connect.

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Readers Write: 5 Tips for HIPs to Help Jumpstart MIPS Readiness

March 9, 2017 Guest articles No Comments

5 Tips for HIPs to Help Jumpstart MIPS Readiness
By Chris Gluhak

Despite rumblings among the new administration and some members of Congress about dismantling the ACA, one thing remains certain: The move toward a performance- and outcome-based healthcare economy is critical to ensuring affordable access to quality care. MACRA is designed to do just that by establishing baseline performance requirements aimed at improving both the quality and cost effectiveness of care to benefit patients, providers, and payers.

As part of MACRA compliance, the MIPS Quality Payment Program kicks off this year, requiring healthcare providers to start collecting and reporting on quality metrics to CMS. With the first clinician scores set to be published in 2019, the stakes are high for providers in demonstrating that they meet performance and outcome expectations.

Not only is MIPS required for successful population health management and adequate reimbursement under CMS guidelines, but the trend toward healthcare consumerism will also force providers to compete for market share on the basis of their performance. Consumers care about ease of access, transparency of care and costs, affordability, and outcomes. These factors are driving patients to select providers more carefully. With these kinds of metrics soon to be publicly available, clinicians are under increasing scrutiny to maximize their performance scores to maintain market share.

As a result, Health Information Professionals (HIPs) are in a powerful position to help providers implement accurate, efficient data collection and reporting processes to meet these new standards for reimbursement and market satisfaction. Here’s where your expertise is needed most:

1) Determining performance measures. Clinicians can choose what types of data they will submit to CMS in order to measure performance. Several scoring criteria relate directly to the work of HIPs including the use of end-to-end electronic reporting through certified EHR technology; heavily weighted activities like member outreach and engagement, care coordination and population management; and IT-related requirements, such as establishing reporting structures for measures on individual and group levels, and planning for including Part D cost data into cost reporting. Choosing the right scoring criteria can make a substantial difference in the reportable success of the practice, and HIPs can help practitioners understand which metrics make the most sense for their practice.

2) Implementing MIPS systems. One of the most critical aspects of MACRA will be implementing the necessary infrastructure to support timely and accurate submissions. That means IT systems must provide for efficiency and accuracy in collection, documentation, reporting, tracking, and submission of clinical metrics. One of the biggest obstacles in this process is often the inability to use unstructured data in clinical charts. Manual analysis is exceptionally expensive and time-consuming, and frequently prone to error. To resolve that problem, HIPs should investigate and lobby for a MIPS solution that uses an advanced natural language processing engine to automate the extraction of all data from clinical charts.

3) Integrating data across reimbursement processes. In addition to required MIPS reporting systems, practices may also find that integrating data collection and analysis across all of their reimbursement processes, including clinical data collection, analysis, and tracking, will provide for additional efficiencies, as well as reveal insights into practice management. Again, implementing the right technology can enable this integration. Solutions that provide a versatile data acquisition and integration suite that supports a wide range of interfaces, with the ability to ingest and integrate data from even the most complex and disparate sources are ideal. HIPs can assist in this process by collaborating with payers and other partners to ensure congruency across data fields, ensuring all data fields and patient records are complete and accurate, and monitoring data entry processes for data cleanliness and efficiency.

4) Educating providers. Providers must be made aware that the performance scores for all participating clinicians (or groups of clinicians) will be made public by CMS in 2019. It’s imperative that they understand the implications of this publication, in terms of both reimbursement and competitive positioning. As stewards of the information, HIPs can play a primary role in articulating the importance of positive performance metrics in maintaining a strong CMS relationship, and a successful practice overall.

5) Continuous evaluation. Along with emphasizing the importance of the initial score publication, HIPs can also play a critical role in establishing internal monitoring mechanisms that keep clinicians informed of their performance status relative to others in the organization, and relative to themselves on an ongoing basis. This type of continuous evaluation not only provides benchmarking data to improve practice performance and care quality overall, but also to help maintain a strong position in the marketplace as consumers begin to gravitate toward practices that demonstrate top-notch performance.

With the initial MACRA/MIPS reporting period already underway, HIPs must act quickly to ensure their practices are in compliance both operationally and technologically. In order to earn the maximum benefit through CMS, clinicians must submit a full year of data by March 31, 2018. Implementing the most effective IT systems and processes now will ensure accurate data collection throughout the year, for the most thorough and efficient reporting now and into the future.

Chris Gluhak is director of risk adjustment – solutions consultant at Health Fidelity in San Mateo, CA.


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Jenn, Mr. H, Lorre

More news: HIStalk, HIStalk Connect.

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