DOCtalk by Dr. Gregg 8/30/13

Take the Cannoli

“The Godfather.” What a classic film. Just chocked full of life lessons, some would say. Unfortunately, they’re not the life lessons most moms and dads would try to instill in their children.

You know, things like, “Violence is an acceptable solution to your problems,” or, “If you cross the family, you’ll get whacked,” or even, “It’s OK to spray grandpa in the face with pesticides.”

Watching it with my Sicilian wife the other day – yeah, that’s right; she’s “connected,” so watch your step, pally – a line popped out at me that rang a sad HIT bell. Rocco Lampone and Pete Clemenza are driving along with traitor-to-the-don, Paulie Gatto, toward Paulie’s unbeknownst whacking. Pete says he needs to “take a leak” and has Paulie pull to the side of a country road. As Pete whizzes, Rocco whacks. Paulie slumps over the wheel, minus some of his brain. Pete zips up and walks back to the car telling Rocco to “Leave the gun. Take the cannoli.”

They leave Paulie and the instrument of his demise for all to see. The message is clear: the Corleone family will not tolerate traitors.

But there’s more than this. Leaving the gun shows their confidence, their arrogance that they can’t be touched. Taking the cannoli adds the “this is all just a part of the job” flavor to the message.

“We whack who we want and we keep the sweets.” This appears to be the take home message that far too many of the HIT “family” have garnered from “The Godfather.” It is becoming ingrained into some vendors’ unwritten corporate philosophies and become part of their modus operandi.

Take, for instance, Practice Fusion’s recent opt-out approach to sending emails to patients, addressed as if having been sent from the patients’ own doctor or other healthcare provider and asking patients to review and rate their provider. Regardless of whether Practice Fusion notified their EHR users via email (I’ve signed up for their EMR – though I don’t use it – and never saw such an email) or whether they wrote about it in their blogs or forums, it seems many providers were unaware that these emails were being sent on their behalf. Thus, the real benefit of these emails is obviously not for the loyal PF-using providers; the real benefit of these ratings is for PF, i.e., the cannoli is theirs.

If this wasn’t a bullet to the head for the providers, why wouldn’t they use an opt-in system instead? Do they think they are wiser or more caring about the patients that these providers serve than the providers themselves? Do they really believe, as they said in response to one blogger’s (John Lynn) recent post about this, that they are the correct arbiters to administer a patient feedback program “designed to provide your practice with a controlled, quality channel for accurate patient reviews”? Who provides this control? Who insures the quality? Who judges which reviews are “accurate”?

Seems to me that PF is a Rocco and their providers are Paulies (though Paulies who hadn’t turned out their boss to any enemy). These PF loyalists took a shot from behind and PF walked away with a cannoli in the form of nearly two million reviews that likely helped bolster investor interest.

I’m oversimplifying, I’m sure, and I’m not intending to pick on PF. There are loads of examples of non-healthcare folks (and some from within our midst) stepping into the healthcare IT space, taking what they could get from it, and walking away with some seriously sweet green cannoli, i.e., cash, that is ultimately generated by the labors of healthcare providers.

To us providers, if you take our money, we are making an investment in you. If we commit to the use of your tools, we are establishing a trust with you. If you take our dollars, or our good faith, and walk away – whether by acquisition, merger, or business failure – you are leaving us in a lurch, often a very expensive lurch from which to “unlurch.” If you take our efforts and then profit from them while leaving us with naught but the “you did a good deed” pat on the back, you have essentially stolen from us.

There are numerous HIT vendors, healthcare websites, and other such Roccos that come to mind, but my mission is not to point fingers or even ask for any cannoli back. My motivation for writing today comes from the mere hope that my colleagues – doctors, nurses, PAs, NPs, etc. – will begin to see that all of our so-called “helpmates” in the HIT space are not always goodly intentioned. They may mouth off about serving the greater good, helping providers or patients, and facilitating improved care, but all too often it appears that C-suites are C-suites; they care more about the cannoli than the caregiver – or the cared-for.

We need to watch our backs…and our cannoli.

From the trenches…

“Leave the gun. Take the cannoli.” – Pete Clemenza, in The Godfather

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).

News 8/29/13

From Sue Orman: “Re: Credit cards from payers. In addition to the exorbitant merchant fees, a problem with insurers using credit cards to reimburse providers is that there tends to be a lot of issues with practices not receiving electronic remits. That violates the spirit of administrative simplification under HIPAA and ACA. Not only does CMS need to make sure that payers are paying physicians their contracted rates, they need to encourage payers to immediately begin using the EFT standard ACH CCD+, which conforms with HIPAA and is less costly than credit card transactions.” Readers more familiar with the payer world and electronic standards can likely speak more knowledgably than me on this, but my understanding is that beginning January 1, 2014, payers will be required to accept EFT in the new standard format if requested by a provider. If a provider does not request the new format, the payer can continue using credit cards for reimbursements, which translates to more fees and less money in the hands of the physician.

eClinicalWorks names HealthNet (IN) the winner of its Improving Healthcare Together video contest. Auburn Medical Group (GA) and Open Door Family Medical Centers (NY) took second and third places.

Doximity, which is like LinkedIn for physicians, now boasts 200,000 licensed physician members, or about 30 percent of the doctors in the country. The platform allows physicians to share patient information in a HIPAA-compliant format and look up colleagues or relevant specialists. Sermo, another physician-only online community has a reported 125,000 users.

HBMA introduces Professional Billing Service Locator, a free platform to help practices locate medical billing companies that serve their region and their specialty.

Physician RCM provider MedData promotes Ann Barnes from president to CEO.

The benefits of a practice’s ACO participation reach beyond the patients covered by the ACO, according to a JAMA-published study. Researchers found that medical groups’ participation in commercial ACOs was associated with savings for Medicare beneficiaries as well, though the quality of care for Medicare patients did not consistently improve. The “spillover” effects may be the result of organizational changes in care delivery, such as incorporating computer reminders to reduce unnecessary and expensive tests.

New York doctors must now check an electronic prescription drug database before writing prescriptions for painkillers and other controlled substances, and, pharmacists must consult the database before filling the prescriptions; pharmacists must also report in real-time when a prescription is filled. The requirement, the first of its kind in the country, is part of the state’s I-STOP law, which also mandates electronic prescribing for all drugs by December, 2014.

In HIT fashion news, Vestagen Technical Textiles secures $8.25 million in financing. The company develops a variety of textile products and technologies, including scrubs that don’t absorb liquids and thus protect workers from potential contaminants. I guess the scrubs’ practicality and safety benefits are suppose to make up for the lack of spicy colors and patterns.

The San Diego newspaper highlights some of the more innovative ways area physicians are using smartphone apps and other technology to engage patients and monitor such things as weight, exercise, blood sugar, depression, and medication adherence. My favorite: Scripps offers pre-recorded videos of doctors so patients can become familiar with their physician prior to the first appointment.

Physicians are split when it comes to whether or not Medicare should make data about Medicare payments available to the public, according to an ACPE poll. Forty-six percent of ACPE members participating in the survey are in favor of keeping the data private and believe the information could “too easily be misinterpreted by the public and be used to portray physicians in a negative and unfair light.” I am with the 42 percent who are in favor of transparency and believe the public has a right to know how tax dollars are being spent.

Email Inga.

News 8/27/13

From Vendor Bob: “Re: Delaying Stage 2. As an HIT vendor I am annoyed by all these calls to push back the Stage 2 MU deadline. All vendors learned of the new requirements at the same time, yet many have waited too long to complete the 2014 certification process. Why should these late-starters get a pass just because they failed to manage their R&D timelines?” Over the weekend I published a post highlighting the potential delay of the Stage MU program. My suggestion: keep the original start date but give providers more time to attest. As Vendor Bob suggests, some software release delays are likely the result of management mistakes but  it’s the providers and not the vendors who are ultimately penalized by late-arriving software updates. Feel free to weigh-in.

MGMA releases tools for creating personalized schedules for its October 6-9 annual conference.  As I dug into the schedule a bit I was surprised to see the exhibit hall is only open 7.75 hours over three days. The schedule may be ideal for both vendors and attendees, however, since very few sessions are offered while the exhibits are open. I played around with the customized conference schedule utility and then created an “expo plan” (above) for the booths I want to visit. Both tools are easy to use and presumably my schedules will be available on my iPhone once the mobile version is released. I’ll be heading to San Diego for the event and posting daily updates on sessions, speakers, the exhibit hall, and of course the parties.

Emdeon launches a self-service testing exchange solution for ICD-10, allowing providers and channel partners to submit ICD-10 test claims and receive claim status feedback. The Emdeon Testing Exchange for ICD-10, which Emdeon purports is the first of its kind in the industry, requires no additional software and is a free service to Emdeon provider, channel partner, and payer customers. Sounds like a great service that would be even more valuable if more payers were ready and if providers already had ICD-10-ready software updates from their vendors.

The theft of four unencrypted computers at Advocate Medical Group (IL) results in the second biggest HIPAA breach ever reported. More than four million patients were notified last week that their personal information, including names, addresses, Social Security numbers, and dates of birth, may be at risk following the July 15 burglary. The 1,000-physician practice is offering patients one free year of credit monitoring.

More than 90 percent of office-based physicians accept new Medicare patients, according to the HHS. The share is only slightly higher than the percentage reported in 2005 and similar to the percentage of physicians who report accepting new privately insured patients.

The AMA urges CMS to prohibit insurers from paying physicians less than contracted amounts when using electronic payment methods, namely payments in the form of plastic and virtual credit cards. The chief complaint is that fees as much as five percent per transaction are associated with the cards, resulting in providers getting less than their negotiated prices for services. The use of such cards has increased as health plans abandon sending paper checks in favor of cards that offer payers cash-back incentives. I assume that a lot of providers are unaware of the fees and that’s how payers have gotten away with the practice.

Athenahealth will work with the non-profit Primary Care Development Corporation to advise primary care practices in underserved communications on the best HIT strategies for improving care.

Steve Malik, who founded patient portal company Medfusion and sold it to Intuit for $91 million in 2010, buys back the business for an undisclosed amount. In May Intuit wrote down the Intuit Health division $46 million following the announcement that Allscripts, the division’s largest reseller, had purchased patient portal vendor Jardogs. Malik’s future plans include moving into the community health space and offering the portal solution to organizations that support multiple IT environments.

HealthproMed (PR) selects eClinicalWorks EHR for its two-location FQHC.

The 150-provider Sansum Clinic (CA) reports that it reduced medical transcription costs more than 90 percent since implementing Epic.

An analyst for Motley Fool looks at the market potential for EHRs. The commentary is largely focused on potential investment opportunities (GE, athenahealth,and Allscripts in particular), but also offers a nice summary on the general state of the ambulatory HIT industry.

Greenway Medical will develop an HIE for more than 500 physician members of the Denver-area Rose Medical Group, Rose Medical Center, and their patients. The platform will aggregate, standardize, and organize clinical and financial data from disparate systems and include a patient portal and options for data analytics and reporting.

Speaking of Greenway, the company hosted over 2,200 customers, staff, and partners at last week’s PrimeLEADER user conference, which included a keynote address by the ONC’s Farzad Mostashari. Greenway recognized Boulder Community Hospital Physician Clinics (CO), Regional Obstetrical Consultants (TN), and Albuquerque Health Care for the Homeless(NM) with its annual Greenway Innovation Awards.

Email Inga.

Stage 2: The Delay Dilemma

In the last few weeks multiple professional organizations have called for some form of extension for  Stage 2 of the EHR Meaningful Use program. While the general theme is “delay,” the specific recommendations have varied:

MGMA – Requests that HHS extends the reporting period for Stage 2 incentives for a minimum of one year. MGMA also calls for a moratorium on penalties for providers that have completed Stage 1 requirements.

AAFP – Proposes three distinct “cohorts” of EPs, each with a different schedule depending on what year they first attested for MU. The timeline would require vendors to be ready for Stage 2 by January 1, 2014 but extend the implementation period from nine months to 21 months, depending on the cohort.

CHIME – Calls for a one year delay for implementation of Stage 2.

AMA/AHA – In a joint letter to HHS Secretary Kathleen Sebelius, the associations call for providers at Stage 1 to meet MU requirements for Stage 2 using either a 2011 or the 2014-certified EHR; the establishment of a 90-day reporting period for the first year of each new stage of MU; more flexibility in meeting Stage 2; and, an extension for each stage of no less than three years for all providers.

HIMSS – Recommends Stage 2 start as scheduled but that the attestation period  be extended through April 2015 for EHs and June 2015 for EPs. Providers would have 18 months to  attest to quarterly MU requirements.

One theme that is consistent from all the organizations is that the delay is necessary because vendors need more time to prepare and certify the required software upgrades and because providers need additional time to implement and optimize their EHR technology.

I must admit that when the various associations and industry leaders first began rumbling about a delay, my first thought was, “You’ve got to be kidding!” Lest anyone forget, HHS already extended the Stage 2 deadline once in November, 2011. By delaying again, HHS would be repeating its long history of telling vendors and providers that deadlines are made to be broken.

Regardless, there now seems to be a groundswell of sentiment in favor of a Stage 2 delay. No one at HHS, including Secretary Sebellius or the soon-to-be-departing Farzad Mostashari, has indicated that a postponement may happen, though my money is on policymakers agreeing to an extension for meeting and reporting on Stage 2 requirements and for delaying penalties for providers that have met Stage 1. I would hope that the January 1, 2014 start date remains intact.

Why? Maintaining the original start date means vendors must continue moving forward to ready their products. If the start date were also delayed, software release dates would undoubtedly be pushed and providers could again find themselves without adequate time to fully test, train, and implement the required updates and make any necessary changes to workflow. Keeping the original date also means early adopters would have the opportunity to attest early in 2014 and thus be paid their MU incentives.

Readers, I’d love to hear your thoughts on the possibility of a Stage 2 delay and how that delay might look.

Email Inga.

News 8/22/13

MGMA sends HHS a recommendation to immediately institute an indefinite moratorium on penalties for physicians that successfully complete Stage 1 MU requirements. The association is concerned that a lack of vendor readiness may hinder physicians ability to meet Stage 2 requirements and thus unfairly penalize physicians starting in 2015. MGMA also recommends extending the reporting periods for both Stage 1 and Stage 2 incentives.

Greenway Medical launches PrimePATIENT, a patient portal integrated with PrimeSUITE, giving patients the ability to request appointments, pre-register, pay bills, and maintain personal health records. Greenway also adds Seamless Medical Systems to its online Marketplace as a value-added partner.

Allscripts announces its Client Outcomes Excellence award winners, including Professional EHR customer Elmwood Health Center (NY) and Eastern Nephrology Associates’ (NC) IT administrator Kenneth Waters.

Allscripts also names Healthfinch the winner of its Open Apps Challenge for its automated prescription renewal request app. We interviewed Healthfinch’s CEO and co-founder Jonathan Baran on HIStalk Connect last year.

Medicare reimburses physicians up to five times more for performing procedures than for cognitive care, according to a  study published in JAMA Internal Medicine. Physicians make 368 percent more doing a colonoscopy and 486 percent more removing a cataract than a primary care physician generates providing cognitive care, meaning specialists can generate more revenue in one to two hours than a primary care physician makes in a day. Not great news for the recruitment of primary care physicians and highlights why specialists may resist efforts to transition from procedure-based  payment models.

Zirmed partners with Catch Data Systems to provide GE Centricity customers integration with ZirMed’s RCM, clinical communications, and analytics solutions.

The Air Force’s 62nd Air Division posts details of its Relay Health secure messaging program, which allows Airman  to securely message their primary care providers at the 62nd Medical Squadron’s Airmen’s Clinic. Patients of the Washington-based clinic are using the Relay Health service to schedule appointments, request medication refills, or communicate with physicians, even when off-based on temporary duty assignment or vacation.

Email Inga.