News 4/10/14

April 9, 2014 News 1 Comment

HHS releases data for over 880,000 healthcare providers who collectively received $77 billion in Medicare payments in 2012. The agency notes that “with this data, it will be possible to conduct a wide range of analyses that compare 6,000 different types of services and procedures provided, as well as payments received by individual health care providers.”

4-9-2014 11-11-56 AM

Look for many more reports like this one published by The Wall Street Journal as organizations begin downloading and manipulating the Medicare payment data. The WSJ determined that the top one percent of the 825,000 individual medical providers accounted for 14 percent of the $77 billion in payments, and 344 providers received more than $3 million each.

4-9-2014 10-25-51 AM

I’m not sure the average physician needs to be too worried that a nosy neighbor will now be able to figure out what the government has been paying him/her because downloading and manipulating the data isn’t the simplest exercise. The data is available in a tab delimited file format which I am sure works great if you have statistical software to do the manipulations. Most folks don’t, so they’ll have to download an Excel version of the data. The files are broken down by the letters of the alphabet and are still huge (“S,” for example, is 168MB.) Because of the size, each file takes a couple minutes to download. When I tried to download a second file/letter of the alphabet, it caused Excel to crash, though admittedly I had quite a few other windows open at the time. But, let’s say you successfully download a file. The next step would be to filter about a million (seriously) lines of data to find a particular physician and then figure out the appropriate payment figure (submitted amount vs. payment amount).  Even if you pick the correct reimbursement figure, you’d then need to multiple it by the correct number of encounters (even more difficult to decipher). Of course, keep in mind that the each provider’s data excludes procedures performed on fewer than 10 Medicare patients, so probably whatever final number you derive, it’s probably incomplete.

4-9-2014 2-08-21 PM

The HHS OIG reverses an 2011 advisory opinion that had allowed athenahealth to charge $1 to providers not on the athena network for processing their test orders. The termination means that athena can no longer distinguish between in-network and out-of-network providers and will therefore charge $1 for all orders. In reconsidering its position, the OIG concluded the arrangement could violate anti-kickback statues. Meanwhile, athenahealth calls the reversal a “setback” for sustainable HIE.

4-9-2014 12-35-27 PM

Lakeland Regional Health Systems (FL) will expand its use of Allscripts ambulatory EHR and PM, utilize Allscripts managed services, and implement Allscripts Payerpath financial management software. Last year Lakeland acquired Clark & Daughtrey Medical Group, an existing Allscripts customer.

e-MDs adds PDR Brief to its EHR, giving users enhanced drug information and alerts from PDR Network.

4-9-2014 7-36-55 AM

CMS develops a Stage 2 Meaningful Use Attestation Calculator to help providers determine if they can successfully meet Stage 2 requirements by identifying a pass/fail summary for each measure.

Individuals posing as patients covered by private insurance were more likely to secure a new-patient appointment with a primary care physician than other “secret shoppers” posing as patients covered by Medicaid or uninsured, according to researchers from the Perelman School of Medicine at the University of Pennsylvania. Researchers placed a total of 12,907 calls to 7,788 primary care practices to secure new appointments. Eighty-five percent of patients with private insurance obtained appointments, compared to 58 percent with Medicaid, 79 percent with no insurance but willing to pay in full with cash, and 15 percent with no insurance but willing to pay $75 or less at the time of service.

4-9-2014 1-36-05 PM

An Institute of Medicine report recommends including information on patients’ social influences and behavioral habits in their EHRs, arguing the data can help improve outcomes and advance public health research efforts.

4-9-2014 2-28-33 PM

Harmony Healthcare IT, which provides support for 3,000 Medical Manager PM systems, partners with ZirMed to provide users an ICD-10-ready claims submission solution. Wow, who knew there so many practices still running Medical Manager?

4-9-2014 2-54-02 PM

Independence Blue Cross (PA) and the physician practice arm of dialysis provider DaVita launch Tandigm Health, a new healthcare business model that aims to reduce care costs of chronically ill patients by working to keep them out of the hospital. Tandigm will offer primary care physicians higher reimbursement rates and access to analytical tools and real-time data  to help patients better self-manage their conditions, as well as provide monitoring tools for use in patients’ homes. The press release is short on details so it’s unclear what penalties the participating physicians will incur if care costs don’t decline.

Health plans must honor physician requests to use the Automated Clearing House (ACH) Network to conduct EFT and ERA transactions, according to a CMS administrative simplification email update. CMS also notes that health plans cannot charge a fee or use any other method to encourage a physician to use an alternative payment method other than EFT through the ACH Network, and, physicians are not required to use EFT.

Since I hate robocalls, I’m thinking about sending a link to this story to all my doctors. Vanderbilt Medical Group (TN) reports a 50 percent response rate for text message appointment reminders, compared to a 30 percent response rate for robocalls. The higher response rate and the associated backfilling of cancelled visits has translated to 50 fewer no-shows per day.

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CMIO Rant with … Dr. Andy

April 9, 2014 Guest articles No Comments

CMIO Rant with … gives CMIOs a place to air their thoughts or gripes. Yours are welcome.

The Great Prescription Pad Race
By Andy Spooner, MD

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Which is more usable: a prescription pad or a computer?

That’s a no-brainer. For writing a prescription, the pad wins, hands down. Consider its features:

  • Instant-on. No booting up. Just reach in your pocket and you are ready to go.
  • Compact, lightweight. Did I mention your pocket?
  • Self-documenting. No need to print a summary describing the prescription.
  • No irritating pop-ups with irrelevant alerts.
  • Patient-centered. The pharmacist can fill in missing information (liquid or tablet or capsule? brand or generic?) based on patient preferences.
  • Flexible. Can be taken to any pharmacy. No need to route it to a specific place, or even to ask the patient about a preferred pharmacy.
  • Streamlined. No need to worry about pharmacy benefit management rules. The pharmacist can sort all that stuff out.
  • Information-persistent. If the family has a question about an apparently erroneous prescription, they can read the details right off the prescription when talking to the after-hours nurse.
  • No record-keeping clutter. Patients can just tell us about their prescriptions next time we see them. They could just bring in the bottle or something.

With all of these advantages, surely only the geekiest of pencil-necked CMIOs would advocate an electronic method of prescribing, right?

Of course not.

The prescription pad is easier only if we define the work as the minimum possible activity that a doctor can do to get a prescription into a patient’s hands. The truth is, we are not done with the task of prescribing when we hand the slip of paper to the patient. If we think we are, then the pad seems far easier to use—more usable—than any electronic health record or e-prescribing system.

The above competition is absurd, of course, in an era when, according to the CDC’s National Ambulatory Medical Care Survey, over 80 percent of office-based physicians in 2013 used electronic prescribing. That rate rose from less than 60 percent over the past three years. E-prescribing is here to stay.

But we still hear about how unusable electronic medical record systems are. In The Atlantic this month, we read that a doctor who sees 14 patients a day spends “1-3 hours” each day entering orders. Assuming that each patient needs some orders for health maintenance (screening lab work), prescription renewals, and maybe a few diagnostic tests and referrals, it’s hard to take that statistic seriously. It’s clear that the writer is irritated at his EMR, and there may be some legitimate design or implementation issues with it. But 1-3 hours of ordering per day? C’mon.

Somewhere between the slapdash paper prescription and the three hours of daily ordering is the truth. Managing clinical information takes some amount of time, and some of it should be done directly by physicians. Some of this activity serves a “compliance” goal that you may not like, but all of it is a part of building a system of healthcare that serves a worthy goal.

If we insist that all clicks are wasted time, then we can’t have a conversation about usability, because under the prescription pad scenario, the only usable computer is one you don’t have to use at all.

On the other hand, if we insist that our current systems are bad because of hyperbolic, data-free assertions about how the EMR is making our lives miserable, we are similarly blocked from making productive plans to improve usability because, well, it’s just too darn much fun to complain.

My thesis, then, is that EMR usability is not as much about design as about expectations. Variations in what these expectations ought to be between different perspectives will lead to unproductive conversations (or no conversations at all) about what it means to have an EMR that’s easy to use.

All I know for sure as a CMIO is that physicians want all of this stuff to be easier to use. We also want these systems to read our minds, but that’s at least a couple of versions away, if I am understanding the vendor presentations at HIMSS correctly.


Andy Spooner, MD, MS, FAAP is CMIO at Cincinnati Children’s Hospital Medical Center. A general pediatrician, he practices hospital medicine when he’s not enjoying the work involved in keeping the integrated electronic health record system useful for the pediatric specialists, primary care providers, and other child health professionals in Cincy.

News 4/8/14

April 7, 2014 News 1 Comment

From Luliu: “Re: Public data. Am I the only physician concerned that CMS is releasing Medicare payment data on 880,000 physicians?” As early as Wednesday CMS will begin releasing details on the amount Medicare paid 880,000 individual health providers for their services in 2012. For years physician advocacy groups have fought to prevent having this billing data posted publically, arguing it invades the privacy of doctors. However, consumer groups and employers have finally won the argument that the data helps evaluate clinicians. Sure, plenty of nosy folks will look up the information just to see how much different providers are making, but the data will also help identify doctors’ expertise performing certain procedures and assist with fraud detection efforts. Look for a flood of opportunistic companies to pounce on this new source of big data.

4-7-2014 6-56-02 AM

Physician participation in the PQRS program increased 36 percent from 2011 to 2012, while participation in the eRx program jumped 22 percent. Despite the strong growth rates, only 36 percent of all EPs participated in PQRS in 2012; only 44 percent of EPs in the 2012 eRx program.

US practice administrators aren’t the only ones experiencing job stress as a result of increased patient loads, an overabundance of administrative tasks, and tightening budgets. A survey of UK practice managers working for general practitioners found that more than two-thirds have recently contemplated quitting their jobs due to discontent over increased workload complexity, rising intensity, stress, and hours.

Antelope Valley ACO (CA) selects eClinicalWorks Care Coordination Medical Record for population health management to advance its ACO-related objectives.

I found this opinion piece from The Huffington Post pretty offensive. The author, who is listed as an “etiquette expert,” offers tips for people sitting in physician waiting rooms. My irritation started at the first sentence: “We all know that doctors are often unable to meet their appointment times.” Rather than chastise patients for sprwaling on the furniture and not keeping their voices down, how about telling  physician and staff members that it’s wrong to make patients feel as if the clinician’s time is more valuable than the patient’s, aka, the customer? Or, at least encourage providers to  consider process changes to reduce excess waiting times? Of course not all doctors and staff ignore the value of their patients’ time, anymore than all patients steal the four-month-old magazines and ignore the handicapped patient needing help opening the door.

4-7-2014 5-11-05 PM

Andrew J. Sussman, president of the CVS MinuteClinic, views the role of retail clinics to be “complementary and supportive” of the broader healthcare landscape and believes retail clinics augment, rather than replace primary care physicians and the PCMH model. Sussman notes that the 800-location MinuteClinic is affiliated with 32 health systems and uses Epic’s EMR platform to communicate with other providers.

4-7-2014 2-11-16 PM

The California Medical Association names DocbookMD the association’s preferred provider of HIPAA-secured text messaging for its 39,000 members.

4-7-2014 2-28-12 PM

Highlights from a Black Book Rankings customer experience survey on ambulatory EHRs include:

  • Thirty-one percent of all medical and surgical specialists are “very dissatisfied” with the ability of the EHR to decrease workload, compared to eight percent of primary care doctors.
  • Primary care user satisfaction has jumped in the last six months among practices that implemented an EHR more than two years ago, in part due to improvements in workflow, MU achievements, and better support.
  • More than one-third of primary care providers report a return to normal levels of productivity following their EHR roll-out.
  • More than half of primary care providers said they’d recommend their EHR vendor to a colleague.
  • Top scoring EHRs were Practice Fusion, Greenway, Care360 Quest, and Kareo.

4-7-2014 3-55-54 PM

The amended CLIA regulations, which give patients direct access to their lab test reports, goes into effect Monday, the same day Quest Diagnostics launched MyQuest by Care 360. The MyQuest patient portal allows patients to view copies of the lab test reports from Quest Diagnostics and does not require pre- authorization by a physician.

4-7-2014 4-33-15 PM

EdgeMED, a provider of medical office software, medical billing services, and HIT solutions, acquires physician billing and collections company  Physician’s Billing Alternatives.

4-7-2014 4-31-44 PM

ZirMed acquires the payment processing, patient eligibility, and patient estimation business owned by TransEngen.

How does this happen? A woman with no medical training uses false credentials to get a job as a physician assistant in a medical office. Over an 11 day period last summer she worked unsupervised, seeing about 200 patients before someone anonymously warned the head of the practice. Upon being arrested the woman told police she posed as a PA because it paid $23,000 than her previous job.

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From the Consultant’s Corner 4/4/14

April 4, 2014 Guest articles No Comments

Three Factors for Success in Using Informatics

As the healthcare industry continues to experience a growing demand for reporting and analytics, organizations will be required to focus on healthcare informatics. Defined as the science of how to use data, information and knowledge to improve human health and delivery of healthcare services, informatics is more than just data reporting. It encompasses business intelligence, data analysis, and analytics as well.

Historically, data reporting was a lesser priority because healthcare organizations did not know how best to leverage data across business and clinical applications. Now, as healthcare leaders begin to understand how to use data and reports to drive performance and outcomes, informatics is moving to the top of the chart with both clinical and business implications. For example, instead of just identifying patients with diabetes, informatics determines whether specific services have been provided and pinpoints care gaps. On the business side, rather than looking at schedule availability, informatics reviews provider productivity expectations and identifies opportunities to standardize and consolidate visit types and provider schedules.

Why focus on informatics

As healthcare leaders define ROI for large investments in new technology, informatics should be at the center. In my experience, although expanding EHR installations and capabilities provides access to more information, the focus has been on implementing technology rather than using the information. The only way to obtain true ROI is to use the captured data for proactively managing patient care and financial operations.

Government regulations also steer the focus to informatics. While Meaningful Use Stages 1 and 2 require technology to be implemented, they also demand that physicians and hospitals become meaningful users. The ICD-10 conversion requires reporting and capturing clinical data in a discreet fashion and understanding what it means from coding, billing and downstream reimbursement perspectives. To comply with these regulations, organizations must understand and respond to the data.

Value-based reimbursement methodologies are another driver for informatics, as accountable care measures of both quality and cost impact how the organization is paid. For instance, organizations no longer are paid to see a patient 10 times with no health improvement; instead, they are reimbursed for keeping him or her healthy. These opportunities require the organization to marry financial and clinical information in a fully integrated manner.

Three factors for success

Leveraging informatics effectively across an organization requires more than EHR technology; it comes down to strategic decisions made by key executives during and beyond implementation. I believe these three factors help organizations realize the true potential of the data and use it to improve operational performance and patient outcomes.

1. Clearly define success metrics.

Without clear goals, no organization can improve performance, regardless of how many reports are run. It’s important to use leader-defined metrics to create reports and deliverables that measure progress and performance against certain key indicators, keeping in mind that information should be published with an operational rather than technical focus. Additionally, leadership should communicate the overall goal of educating and informing end users on what to do with the data, knowledge, and information provided by informatics.

2. Create a customer service culture.

This operational focus for informatics requires a cultural shift in ownership, moving informatics from IT to operational units, such as the revenue cycle or clinical informatics group. Design the informatics effort based on operational requirements, ensuring information is delivered when and where it is needed in the workflow. As a liaison between the technical focus and those using the information, operationally-driven informatics teams should partner with clinical and business managers to understand needs. In my opinion, organizations that allow IT to drive informatics projects will struggle.

3. Set expectations for report development and dissemination.

Resources are not always sufficient to support the increasing reporting demands in healthcare. One way to mitigate this is by implementing service level agreements to prioritize report requests and establish turnaround times. Define the escalation path when resources are not sufficient to meet the organization’s reporting needs.

Moving beyond technology

EHR use alone will not improve care. Rather, the collective knowledge and data captured in the EHR will impact quality and outcomes through informatics. Beyond simply generating reports, informatics supports clinical and business goals by providing the necessary information to the right decision maker in a manner he or she can understand and use to promote health and improve delivery of healthcare services.

Brad Boyd

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

News 4/3/14

April 2, 2014 News No Comments

The AMA has been pretty quiet about the ICD-10 deadline delay that was part of this week’s SGR patch legislation. AMA has long been quite vocal in its criticism of the transition, but denies it had another to do with its inclusion in the bill. The only item I could find on the AMA’s website, which I can only assume refers to the ICD-10 delay, was a comment that the overall legislation included “some positive provisions.” I wouldn’t be surprised if the AMA leads the charge for skipping ICD-10 altogether in favor of ICD-11.

Also still silent on the ICD-10 delay: CMS, which has yet to offer any official comments.

4-2-2014 4-50-14 PM

CareCloud names Lee Horner (Eliza Corporation/Vitera Healthcare) chief sales officer.

McKesson Specialty Health agrees to acquire a majority stake in Oncology Rehab Partners, an oncology rehab company that offers training and certification services for cancer care providers.

4-2-2014 10-03-26 AM

Accenture estimates that the use of its X-box based Teki program has saved Spain’s Basque Country $69 million during its first year. Patients are able to use a Kinect system attached to an Xbox in their home to communicate with their doctor using video conferencing, voice, or text messaging and doctors can check patients’ vitals via a wireless heart monitor and spirometer attached to the Kinect box. Accenture says that 18 percent of all primary care interactions in the region are now happening on the phone or online.

4-2-2014 4-48-32 PM

Brigham and Women’s Hospital (MA) plans to hire scribes to input EMR data, giving  doctors more time to focus on and talk with patients.

Kaiser Health News provides an insightful look at what is driving primary care physicians to leave independent practice and where they are opting to land. Physicians tired of high stress levels and long hours are giving up private practice for hospital employment, or converting their practices to concierge models, or taking early retirement. EMRs are the greatest source of frustration for many doctors who complain the technology slows them down, interferes with the physician-patient interaction, and turns physicians into data entry clerks.

4-2-2014 1-19-52 PM

I was amused by this photo from an article highlighting the growth of the concierge practice model. The two-doctor practice, which charges a $780 a year retainer fee and limits the practice to 600 patients, either does not net enough to buy an EMR, or, the prefers to keep medical charts the old-fashioned way.

Physicians in academic settings report higher compensation when the majority of their time is spent seeing patients, rather than on research activities, according to an MGMA compensation survey. General internists saw four percent pay increases in 2013 to over $180,000 when billable clinical work made up more than two-thirds of their time.

Talk about a complete bust of a day. A South Carolina woman sustains injuries in a car crash following a three-county police chase. She was admitted to the hospital and while in surgery doctors found 19 grams of methamphetamine hidden inside a body cavity. Other aspects of the investigation are ongoing.

4-2-2014 4-20-05 PM

The Kansas Senate passes a bill requiring insurance companies to give patients a cost estimate before services are provided. If passed, insurers would be required to inform consumers of all out of pocket costs, plus the amount the provider will be paid. I wonder if physicians really want their patients to have that much transparency in advance of an office visit or procedure.

3M completes is acquisition of Treo Solutions, a provider of data analytics and business intelligence to providers and payers.

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