News 2/18/14

The Colorado Health Institute analyzes the state’s looming shortage of primary care providers, which mirrors deficits across the country. The CHI offers several recommendations to address the estimated shortfall of 258 providers, including the use of emerging technology to increase patient self-care of common ailments and to advance options for self-diagnostic testing. The CHI also encourages streamlined policies to increase the use of telemedicine.

ONC reports that RECs have “far exceeded” their goal to support the adoption and use of HIT by 100,000 small practices, CHCs, and rural and public hospitals, while continuing to support providers to reach MU. I found the ONC’s announcement a little confusing since only 85,000 PCPs had met the MU milestone by the end of November, which is clearly short of the 100,000 goal.

The Worcester Business Journal looks at EHR adoption in the state of Massachusetts, which is requiring all providers to sign onto the Mass HIway HIE by 2017. Small practices and certain specialized providers are most resistant to automation, largely due to cost concerns and skepticism over potential benefits. Girish Navani, CEO for the Worcester-based eClinicalWorks, notes that it will be “only a matter of time before providers everywhere will convert” to meet regulatory requirements and to recognize the benefits of sharing patient records electronically.

I was looking at the latest MU Workgroup Stage 3 recommendations and noted a few new items that could potentially impact EPs, should these requirements be included in the final rule. Recommendation requirements include:

• The EHR would assist with follow-up on orders, including the return of results from specialty consults to the ordering provider.
• The EHR would provide EPs with access to medication fill information from pharmacy benefit manager
• Patients would have an easy way to request an amendment to their record online to offer corrections, updates, or additions.
• Patient-generated health information could be added electronically through a questionnaire, survey, or intake form, or, through secure messaging.

The National Testing Program for ICD-10 readiness of HIPAA transactions extends certification to Greenway’s SuccessEHS solution.

Benchmark Systems will offer its customers electronic statements and online pay solutions from PatientPay. Benchmark also announces several new customers including Comprehensive Pediatrics of Brooklyn (NY) for EHR and PM, Advent Medical Group (MO) for EHR, and, Dawn’s Medical Billing (VA) and American Self (VA) for PM.

SimplifyMD version 14.0 achieves 2014 Edition Complete EHR Ambulatory ONC HIT Certification from ICSA Labs.

Researchers from the University of Pennsylvania find that dermatologists that evaluated hospitalized patients using teledermatology provided nearly identical assessments as doctors examining the conditions in person.

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News 2/13/14

ICD-10 implementation costs for physician practices could be almost three times higher than estimated five years ago according to an AMA report that considered such factors as training materials, consulting fees, software upgrades, testing, payment disruptions, and physician productivity losses. The study predicts that small practice costs will range from $56,639 to more than $226,000; medium practices will pay between $213,364 and $824,735; and, large practices could spend between $2 and $8 million. Vendor/software upgrade costs represent a major cost variable that most, though not all,  practices will face. Meanwhile, the AMA “strongly urges CMS to reconsider the ICD-10 mandate,” which the organization believes is financially disastrous for physicians, impedes progress to a performance-based environment, and is unlikely to improve the care physicians provide their patients.

Sobering: a survey of 1,000  (seemingly self-selected) physicians finds that 70 percent don’t think the HITECH program was worth its cost. Other key findings:

• 65 percent say their EHR implementation has led to financial losses.
• 45 percent believe care has become worse since implementing EHR.
• 73 percent of the largest practices would not purchase their current EHR system again.
• 67 percent dislike the functionality of their EHR systems.
• Nearly half believe the cost of these systems is too high.
• More than two-thirds say that coordination of care with hospitals has not improved.
• Nearly 38 percent doubt their system will be viable in five years.
• 26 percent doubt their vendor will be in business in five years.

RelayHealth Financial achieves full EHNAC HNAC accreditation for the 14th consecutive year.

Privia Medical Group (VA) will implement athenahealth’s PM, EHR, patient communication, and care coordination services for its 154 providers and affiliated ACO.

Also from athenahealth: the company  announces that it has integrated drug monographs from its Epocrates acquisition into athenaClinicals.

Four Ellis Medicine (NY) primary care locations deploy PCMH transformation management and analytics tools from Arcadia Healthcare Solutions to earn Level 3 NCQA PCMH recognition.

HIMSS Analytics recognizes 51 clinics of Northeast Georgia Physicians Group with its Stage 7 Ambulatory Award.

CMS and ONC introduce Randomizer, a tool that allows providers to exchange data with a test EHR in order to meet measure #3 of the Stage 2 transitions of care requirement.

Kareo launches a new MU resource center that includes links to articles, websites, and white papers, as well as FAQs that cover basics about MU and attestation.

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News 2/11/14

Lawmakers propose legislation that repeals the SGR formula and introduces a Medicare physician payment system that rewards merit over quantity of services and incentivizes physicians to participate in alternative payment models. Some specifics include:

• Medicare would eliminate the scheduled three percent reductions in reimbursements for failing to comply with MU criteria, as well as the escalating penalties of up to five percent in 2019
• Medicare would drop the two percent penalty scheduled for 2017 for failing to report PQRS measures
• Physician payments would increase 0.5 percent a year for five years
• EHRs would be required to be interoperable by 2017 and providers would be prohibited from deliberately blocking information sharing with other EHR vendor products
• Technical assistance funding would double for small practices with 15 or fewer professionals
• Beginning in 2017, HHS would monitor clinicians for the appropriate use of advanced diagnostic imaging based on appropriate use criteria. Physicians deemed “outliers” for non-use or non-compliance of appropriate use would be subject to prior authorization for applicable imaging services.

CMS announces a one month extension of the deadline for EPs to attest for MU for the Medicare 2013 reporting period. In its email announcement CMS did not provide an explanation for moving the deadline to March 31.

Georgia Physicians for Accountable Care selects eClinicalWorks Care Coordination Medical Record to advance its ACO objectives.

A screening program for abdominal aortic aneurysms integrated into an EHR reduced the number of unscreened at-risk men by more than 50 percent within 15 months, according to a Kaiser Permanente study.

The NCQA recognizes the 180-provider HealthPoint Medical Group (FL) as the first practice to earn NCQA Patient-Centered Specialty Practice Recognition for its efforts collaborating with patients to improve quality.

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News 2/6/14

The overall readiness for ICD-10 implementation continues to lag, according to an MGMA survey of 570 medical practices. As noted by MGMA president and CEO Susan L. Turney, MD, “Very simply, ICD-10 is behind schedule.” MGMA finds that less than 10 percent of  practices are making significant progress in their overall ICD-10 readiness. Other key findings include:

• More than 80 percent of respondents will require an upgrade or replacement of their PM software to accommodate ICD-10 diagnosis codes.
• Vendors will not cover upgrade costs for the majority of practices. Average upgrade cost for a PM upgrade/replacement is $11,500 per FTE physician and $12,885 for EHR.
• Only 8.2 percent have begun testing with their EHR vendor and only 10 percent with their PM vendor.
• Nearly 60 percent of practices say they have not heard from their health plans regarding ICD-10 testing and nearly 50 percent have not heard from their clearinghouse vendor.
• Concerns remain high over the expected changes to clinical documentation and the loss of clinician and coding staff productivity.

Epic, eClinicalWorks, and Allscripts own about 30 percent of the overall EHR practice market according to an SK&A report from January, 2014. The top 20 EHRs are implemented in almost three-quarters of all practices that use an EHR.

Metro-North ACO (PR) selects eClinicalWorks Care Coordination Medical Record to advance its physician-led ACO objectives.

Surescripts introduces Record Locator & Exchange, which utilizes a master patient index to locate the medical records of a single patient, even when records are held by multiple providers, and, CompletetEPA, an end-to-end prior authorization solution that integrates into a physician’s EHR workflow and enables real-time information exchange between providers and pharmacy benefit managers.

ADP/AdvancedMD customer Jed Shay, MD shares how his use of AdvancedMD’s EHR and PM services have contributed to improved cash flow, productivity, and patient tracking.

North Carolina’s troubled Medicaid billing system goes off-line Tuesday morning for approximately 18 hours, impacting providers’ ability to submit claims. Computer Sciences Corp., which maintains the NCTracks portal, blames the failure of a network switch.

Covenant Surgical Partners will implement gMed’s gGastro EHR within 12 of  its physician offices and endoscopy procedure centers.

HHS finds that most health centers (72 percent) have been able to meet MU objectives related to data capture, but few (24 percent) have met objectives for sharing data. Only 14 percent of the 233 clinics surveyed had the capacity to meet all core Stage 1 objectives and at least five menu objectives.

Compared to patients who visit a doctor’s office for similar conditions, adults taking advantage of telehealth services are younger, more affluent, more technology savvy, and less likely to have used healthcare before their telehealth visit, according to a Health Affairs-published study.

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DOCtalk by Dr. Gregg 2/5/14

City Geek, Country Geek

I’m a pretty lucky guy. Every once in an azure moon, I get the pleasure of hosting someone from “The Big City” here in little Nowhere, Ohio. From big deal technology folks to EHR C-suiters to other IT and healthcare muckety mucks, I’ve had the good fortune of getting to chat with some top shelf folks here in our de-city-fied environ.

The visits are almost always fun and the conversations enlightening. Whether it’s the ambience and atmosphere of the nearby “Red Brick Tavern” (dubbed the “biker bar” by one of my more enjoyable visitors) or the local flavor of “Ronetti’s” which has perhaps the best cheeseburger, fried bologna sandwich, and “Super Sub” this side of Cholesterol County, the friendly chats and shared insights seem to flow with ease when “big” folks take time to share of themselves here in Smallville.

I was graced with another such visit this past week from a longtime pal. We’d given a talk together several years ago where we looked at EMR myths; it was the MOST fun talk I’ve ever enjoyed giving. He came by to spend the day talking all things geek and just getting away from his day to day.

The latter was actually the main inspiration for his visit; he’s the CMIO for one of the nation’s top specialty hospitals and seemed to feel that a day “in the trenches” might be a nice getaway from his multi-problem, multi-committee, multi-pressure work life. He thought it might be good for his psyche to step outside of his institutional realm, to spend some time in the small-practice-make-a-decision-implement-decide-and-move-on world of a solo practice.

I was happy to have him come, though not just because he’s one of the most genuine, friendly, funny, and intelligent people I know; also because it’s fun for me to hear about the large scale side of HIT, from an insider’s perspective – but relaxed, sans board meetings or convention halls. No sales pitches. No corporate protectionism. Just HIT nerds sharing nerdian experiences.

Despite the bad weather and accumulated snow, he made the trip and we spent a wonderful day with only limited interruptions from phone calls or urgent texts. We talked all kinds of geek – from building electronics as kids to dealing with the politics and pressures in our very different domains of healthcare and HIT to comparing the issues of Extormity EHR with those of “Minormity” EMR. We discussed the goods and bads of EHR vendors we’ve known as well as the struggles they face. We discussed family pressures and how they impact on our HIT decisions. We discussed mobile tech and wearable devices. We discussed HIT past and HIT future. It was pure digital doctor geekdom and it was a blast!

I’m not going to expose any of the scandalous nor even the more mundane comments we shared. That isn’t my focus in writing (though some of them might be well worth a headline or three!) What I really want to share is how enlightening it can be to step across the digital and healthcare divides, how spending some time away from your healthcare or IT constructs can be both broadening and restorative.

It’s almost like Neo leaving his Matrixian, computer-generated reality. (At one point I swear I heard Morpheus saying, “Welcome… to the real world.”) Hearing how someone else deals with the same issues of your everyday domain that are similar, but oh so different, is just fascinating, especially when it’s an agenda-free discussion seeking nothing but insight and a little camaraderie across the divide.

I can’t say for sure what my friend took away from our visit, but I can say that it was soulfully reinvigorating for me. While I still prefer my entrepreneurial trench with its day-to-day survival challenges, my view of the world received a shot of bigger picture re-clarification.

We all have our little cubicles. Some are much bigger than others, but they’re all confining, particularly upon our perceptions. If you have a friend or colleague who sits in a different cubby than you, I highly recommend taking time for such a viewpoint renovation visit. It’ll do your HIT spirit good.

From the trenches…

“Better beans and bacon in peace than cakes and ale in fear.” – Aesop

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).