News 1/16/14

A victory for transparency proponents: CMS announces it will consider on a case-by-case basis requests made under the Freedom of Information Act for information to find out much Medicare pays individual physicians.

CMS reports that as of the end November, approximately 60 percent of Medicare EPs are meaningful users of EHRs and 76 percent of Medicaid EPs have received an EHR incentive payment. Medicaid EPs are not required to attest for MU in advance of payment and a mere 17 percent of Medicaid EPs are considered meaningful users. That’s a pretty alarming gap, in my opinion. As of the end of November, EPs had been paid a total of 68 million in EHR incentives.

Allscripts reveals that its KLAS scores are on the rise with Allscripts Enterprise EHR up 11 percent for the 12-month period ending December 2013; scores for Allscripts Sunrise Clinical Manager increased four percent for the same period. KLAS is scheduled to release its annual “Best in KLAS” awards the week of January 24.

The 20-provider Urology Austin (TX) selects CareCloud Concierge for RCM and PM for integration with the practice’s existing HealthTronics UroChart EHR platform.

The ONC releases the Safety Assurance Factors for EHR Resilience (SAFER) Guides, which include checklists and recommended practices to help providers assess and optimize the safety and safe use of EHRs.

The Drummond Group certified Practice Fusion’s EHR Version 3.0 a 2014 Complete EHR on December 19, which is notable because Practice Fusion guaranteed its users that it would be certified by the end of the year. The guarantee required Practice Fusion to reimburse EPs up to $5,000 for out-of-pocket licensing fees for a third-party EHR if the company failed to meet the year-end certification deadline.

A report by Patient-Centered Primary Care Collaborative finds that practices following a PCMH model demonstrate  decreases in the cost of care; reductions in the use of unnecessary or avoidable services costs, such as ER visits; improvements in access to care; and, improvements in patient satisfaction. The impact on clinician satisfaction remains unclear.

CareCloud reports it closed 2013 with more than 520 new clients and finished its 16th consecutive quarter of triple-digit revenue growth.

Nearly 10,000 scribes work in ERs and physician offices inputting EMR data, according to a New York Times report. Typically scribes earn $8 to $16 an hour and are employed by services that collect $20 to $25 an hour from providers. Despite the cost, many physicians using scribes say they come out even or ahead financially because they are able to see more patients.

Hello Health introduces Hello Health Billing Services, an RCM solution to compliment its no-cost EHR and patient portal. Hello Health charges patients a monthly subscription for portal access that practices can apply against Hello Health’s billing service fees.

Athenahealth announces its roster of 21 solutions available in the athenahealth Marketplace.

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News 1/14/14

MedMatrix Solutions, a North Carolina-based medical billing service, files suit against a former client for prematurely terminating its services contract. The practice had signed a 12-month contract that included a termination option only if the billing service failed to provide adequate services. The billing service contends it provided services according to the contract but the practice canceled the agreement after just six months. It’s not clear why the practice terminated the contract but filing a lawsuit against a customer doesn’t seem like a move that will help MedMatrix win future business.

Practice Fusion will double the size of its existing office space when it moves to its new headquarters in San Francisco in mid-2014.

OB/Gyn-specific EMR provider Artemis Health Group, formerly known as DigiChart, announces that CEO/president Phillip Suiter will step down and be replaced by John Doulis, MD (MedCare).

Emdeon achieves CAQH CORE Phase III Certification, which certifies the company accurately and efficiently exchanges healthcare electronic funds transfer and electronic remittance advise information.

More evidence that the industry is far from ready for ICD-10: half of providers say they haven’t estimated the impact of ICD-10 on their cash flow, according to a KPMG report. Almost three-quarters of industry stakeholders state they have yet or are not planning to conduct testing that involves external entities. Things could get ugly around October.

Another ICD-10 readiness survey by Navicure and Porter Research reveals that 74 percent of physician practices have not yet started implementing their ICD-10 transition plan, though most don’t anticipate any disruptions from their EHR, PM, or clearinghouse vendors. A couple of alarming stats: 27 percent of survey practices are unsure how or where to start preparing for the transition, while 22 percent claim they don’t have the staff or resources to begin preparing.

The free physician social networking site Doximity doubled its network last year and now boasts 250,000 members, or about 35 percent of all US doctors. More than 10,000 physician-to-physician messages are being sent daily and 200 paying clients use TalentFinder, which last year facilitated 70,000 consulting and career offers to physicians.

Almost two dozen EHR vendors selected Surescripts’ clinical network for secure HIE over the last year include Adaptamed, AssistRx, Bizmatics, ChartLogic, ClinixMD, CureMD, ScriptSure by Daw Systems, GeniusDoc, gloStream, HealthFusion, Henry Schein MicroMD, Medical Office Technologies, Intelligent Medical Software (IMS by Meditab Software, Inc.), Merge Healthcare, OA Systems, PatientPoint, SRSsoft, STI Computer, and SuccessEHS.

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News 1/9/14

From K. Systrom: “Figure 1. This is cool app your readers might be interested in.” Figure 1 is a free Instagram-like app for licensed and verified healthcare professionals. The app facilitates the sharing of de-identified  photos of medical conditions while at the same time creates a crowdsourced image library. Looks quite cool and you have to love the price.

CMS proposes a rule that would ban abusive prescribers from government programs, as well as ban providers whose licenses have been suspended or revoked due to drug-related sanctions.

A report from the HHS Office of the Inspector General criticizes the government for inadequately addressing potential fraud and abuse issues as EHR adoption becomes more widespread. Warning that “certain EHR technology features may be used to mask true authorship of the medical record and distort information to inflate health care claims,” the OIG contends that CMS and its contractors have not changed their program integrity practices and recommends that CMS provide its contractors with guidance on detecting fraud associated with EHRs.

I was amused by this New York Times article about doctors that Google their patients. I guess I had never thought about my doctors caring too much about me beyond my blood pressure, pulse, and current meds. On the other hand, I Google people the time, leading me to wonder whether I (like doctors) should spend more time simply asking others the details I want to know.

AMA President Ardis Dee Hoven, MD includes two HIT-related issues on her list of top federal issues affecting physicians in 2014. Hoven notes that the October 1 implementation deadline for the ICD-10 code set and the September 30 MU attestation deadline for physicians wishing to avoid 2015 Medicare penalties are two significant issues that could have a significant impact on physicians and patients.

The AMA, by the way, offers free educational resources to help physicians prepare for the ICD-10 transition.

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News 1/7/14

McKesson announces the general availability of its Paragon Ambulatory Care Practice Management solution, which is an extension of its single database HIS for inpatient facilities and designed for hospital-owned practices. I understand the PM module was developed internally, as opposed to a bolt-on of one of McKesson’s acquired products and that an EHR module is also in the works. Sounds like McKesson is positioning itself to compete with Epic and Cerner in the IDN space.

A 16-provider dermatology practice in Massachusetts agrees to a $150,000 payment and a corrective action plan after admitting to potential HIPAA violations. In October, 2011 an unencrypted thumb containing the PHI of 2,200 patients was stolen from an employee’s car. The provider promptly reported the breach to HHS and patients; HHS then informed the practice that the Office of Civil Rights would launch a compliance review. The OCR concluded that the practice had not conducted an accurate and thorough analysis of potential risk and vulnerabilities as part of its security management process; failed to have written policies and procedures for in compliance with the Breach Notification Rule; and, had not trained its employees on security processes.  The lesson for practices: encrypt those thumb drives, perform risk assessments, and be in compliance with policy and training requirements.

The majority of patients using a txt4health diabetes awareness app reported the tool made them more likely to make diet-related behavior changes and lose weight, though only 39 percent of the participants completed the 14 week program. Researchers concluded that the text messaging program has “potential to significantly influence people’s health habits,” but admits it “may not be appropriate for everyone.”

In a Kaiser Permanente study also involving diabetics, researchers found patients that refilled their medications using online portals increased their medication adherence and improved their cholesterol levels. Medication non-adherence and poorly controlled cholesterol declined six percent among exclusive users of the online refill function, compared to occasional users or non-users.

University Hospital (GA) reports that 16,000 patients from University and its affiliated practices are accessing their medical records through the health system’s Epic patient portal.

HIMSS Analytics awards 14 ambulatory clinics associated with Cincinnati Children’s Hospital (OH) with Stage 7 Ambulatory Awards for EMR adoption. Children’s also earned Stage 7 for its inpatient setting.

Brightree and athenahealth will coordinate the patient referral process for providers using athenaClinicals and athenaCoordinator services and post-acute providers using Brightree’s clinical and billing platform.

Good news for telehealth providers: as of January 1, a new Montana law requires state-regulated insurance companies to reimburse providers for telehealth services at the same rate as in-person visits.

Speaking of telehealth, the California-based Telecure is waiving its $25 telemedicine visit fee for patients who share details of the experience on Twitter or Facebook. The company’s CEO says Telecure is wanting to raise “awareness of alternative ways of receiving quality healthcare.” Am I the only person who is more leery of  taking advantage of medical care that is discounted to “free” versus?

Blue Cross and Blue Shield of Kansas City estimates that 55 percent of area physicians are now employed by hospitals, including virtually all cardiologists and most cancer specialists. Dr. Gregg, by the way, provides some insight on why many physicians are choosing to ignore the trend and remain independent.

Almost three-fourths of physicians using EHRs in 2011 reported clinical benefits, according to a Health Services Research report. The majority of physicians said the EHR alerted them of a potential medication error or critical lab value, while one-third claimed the EHR helped identify needed tests or communicate with patients.

The School of Business at the University of Miami and CareCloud launch CareCloud Scholars, a program to engage graduate students with South Florida’s healthcare community and promote healthcare innovation.

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DOCtalk by Dr. Gregg 1/6/14

Why Does Simon Practice?

Simon – Dr. Simon Princewalleter – is a small practice, primary care provider who works diligently every day, often seven days a week. He keeps his own books, but has an accountant advisor and an outside billing company. He has three staff members who he loves and who seem to appreciate him. (He loses sleep on numerous payday eves worrying that he won’t have enough to meet their payroll.) He efforts to keep current on standards of care and evidence-based guidelines. He takes his own after-hours calls, tries to offer quality online tools for his patients including a nice website and an attractive patient portal, and uses a good electronic medical tool for all his patient records. He tries to keep up with governmental and insurance company rules and regs, maintains HIPAA watchfulness, and protects his digital patient data. He spends many hours doing things for which he was never trained.

He is going into debt to stay afloat.

Why does Simon continue this struggle? Why not sell out to an ACO or join a group? Why does Simon practice?

Simon, it appears, is part of a dwindling breed. He loves his practice, his staff, and his patients. He thinks he provides a value and services that are unique. He likes being entrepreneurial despite the challenges and mounting pressures. He likes being a small practice doctor, with all that entails. He isn’t convinced that a regular paycheck and institutional guidelines would ever provide the warm sense of satisfaction he gleans on his own.

But, he knows that he cannot continue to watch debt mount. He struggles to find new resource avenues. He provides some consulting services which, while detracting from his family time, help keep the lights on and the family fed. He looks for ways to see more patients that don’t entail cutting value and patient care quality. He considers innovative options for increasing practice revenues through digital services offerings. He trims staff benefits though he despises the necessity.

Why does Simon continue to struggle when the “security” of a group might be so much cozier?

Simon loves being innovative. He loves seeing what needs to be done and then defining creative ways to accomplish the job. He loves making decisions and seeing where they lead. He doesn’t mind when his decisions are wrong; he just decides on what needs to be done next to make it better. He likes his mom-and-pop shop ways.

As witnessed all over the country, though, he knows moms and pops are fading from the landscape. Corporate conglomerates have the clout and the monies to push moms and pops aside or, all too often, just steamroll them into oblivion.

He sees the conglomerate writing on the healthcare wall. Simon knows he may not be able to avoid the centralization of healthcare. It may be inevitable that he will one day become subsumed by the healthcare Borg.

Why does Simon continue to buck the trend and keep his individualist ways?

Simon isn’t arrogant or excessively proud. He’s just trying to do a good job and provide the best he can for those for whom he cares, whether patients or staff or family. He also knows that something deep down inside him would probably get lost if he sold out to a corporate structure. He believes strongly in the American ethos of the pioneer spirit upon which his country stands so proud. He thinks innovation, even micro-innovation on a micro-scale such as his little practice, has a value and an intrinsic worth that can never be replicated in an institutional setting. He believes he can make a difference – perhaps a small difference, but nonetheless an important difference – by being true to the values he holds dear. He believes his best is brought forth in his entrepreneurial realm.

Why does Simon practice?

Simon loves what he does, he loves those for whom he cares, and he thinks he has found the best way to repay all that he has been given by being the best “him” that he can be: a small practice doc trying to do what’s right, delivering personal care the best way he can – for as long as he can.

From the trenches…

“We must free ourselves of the hope that the sea will ever rest. We must learn to sail in high winds.” – Aristotle Onassis

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).