News 2/4/14

February 3, 2014 News 1 Comment

CMS issues a final rule allowing patients or their representatives to access completed lab reports directly from laboratories, rather than only permitting physicians to provide their patients with results.

A fee schedule survey of 2,619 practices reveals that 2013 reimbursement levels remained flat for existing patient visits and declined as much as 21 percent for new patient visits.

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Spectrum Health (MI) selects PerfectServe’s Clinician-to-Clinician and DocLink platforms for direct and secure clinician communication.

EHR alerts show promise in changing physician behavior when treating overweight and obese children, report researchers from the University of California at Davis. Researchers added obesity-related alerts to the health system’s outpatient EHR and found significant, though not dramatic improvements in treatment. Findings included modest increases (from 40 to 57 percent) in the proportion of children diagnosed as overweight or obese; a 10 percent increase for lab tests for diabetes and dyslipidemia; an increase in follow-up appointments from 24 to 42 percent; and a static number of referrals to dietitians (13 percent.)

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Last week on HIStalk we recognized athenahealth for unseating Epic for the first time in eight years as the top overall vendor in the “Best of KLAS” awards, and mentioned all the Best in KLAS winners. In the ambulatory EHR and PM categories the top-ranked vendors and their scores were:

Ambulatory EMR (over 75 physicians) Epic EpiCare Ambulatory (85.7), eClinicalWorks (72.8), Cerner Millennium PowerChart (72.4)

Ambulatory EMR (11-75 physicians) –  EpiCare (84.5) athenahealth, athenaClinicals (83.6), Greenway Medical PrimeSUITE (80.4)

Ambulatory EMR (1-10 physicians) – SRSsoft (90.9), athenaClinicals (87.2), e-MDs (85.2)

PM (over 75 physicians) – Epic Resolute/Prelude/Cadence Ambulatory (87.5), eClinicalWorks (77.9),  NextGen Healthcare (76.4)

PM (11-75 physicians) –  athenaCollector (87.7), Greenway (83.3), NextGen Healthcare (77.0)

PM (1-10 physicians) –  athenaCollector (89.5), Greenway (85), Henry Schein MicroMD (81.8)

KLAS also named the highest rated products in a couple of EMR and PM subset categories:

  • 150+ physicians – Epic for ambulatory EMR (85.8) and for ambulatory PM (88.3)
  • Single physician EMR – e-MDs (84.2)
  • Single physician PM – athenaCollector (81.4)

A small shout-out to PCC Partner, which scored highest in both the EHR (94.4) and PM (91.7) 1-10 physician segments, but was excluded from the overall rankings because KLAS considers them to be “component” products.

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CMS reports that through 2013, 436,000 EPs and hospitals have registered for the MU program and 334,000 have been paid incentives for meeting MU requirements, including 63 percent of all EPs. A mere 213 EPs out of 215,288 who attested for Medicare in 2013 were unsuccessful.

The average wait time to schedule a doctor appointment if you live in a large metropolitan area: 19 days, though depending on the specialty and region it could be as little as a day or more than eight months. Boston has the longest average wait times across all specialties at 45 days.

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Athenahealth accepts about $6.7 million in state and local incentives to open an R&D office in Austin, TX and pledges to create 600 jobs over the next ten years with an average salary of $132,000. The company will invest $13 million to convert 110,000 square-foot of office space space within the redeveloped Seaholm Power Plant.

CMS gives physicians and their billing staff a chance to assess their ICD-10 readiness during a limited front-end testing session March 3-7. During the testing week, physicians can submit claims using ICD-10 codes for services rendered between October 1, 2013 and March 3 to determine if their Medicare administrator contractors can receive the claims and determine if the claims are accepted or rejected.

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The 50-physician Green Clinic (LA) implements Bomgar’s appliance-based remote support solution to provide IT support across its seven locations.

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More than 400 Walgreen Healthcare Clinic locations will implement Inovalon’s Electronic Patient Assessment Solution Suite to provide predictive analytics tools at the point of care.

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From the Consultant’s Corner 1/31/14

January 31, 2014 Guest articles No Comments

Optimizing Clinical Documentation
Now Is the Time to Get Started

Many healthcare organizations capture clinical documentation via electronic health records (EHRs) and other technology-enabled channels. The ability to fully leverage clinical documentation to improve care, compliance and reimbursement depends on its quality. In my experience, engaging in clinical documentation optimization is a valuable exercise that can yield tangible benefits.

The October 1, 2014 ICD-10 deadline is probably the most compelling reason to focus on optimizing documentation right now. ICD-10 requires a high degree of specificity, and if your documentation doesn’t have it, you could see a drop in reimbursement and/or an increase in claims denials. On the other hand, if your documentation is detailed and reflects a true picture of the patient experience, coders can more accurately code claims, ensuring you receive full reimbursement for services rendered.

While a significant impetus for improvement, ICD-10 compliance isn’t the only driver for optimization. By striving for more detail and accuracy in clinical documentation, your organization can elevate care quality through better communication among providers. Strong documentation ensures everyone who interacts with the patient is on the same page about diagnosis, treatment and patient response. Embedding care alerts and reminders for patients in documentation can further enhance quality.

Comprehensive documentation also ensures you use technology—electronic health records, for example—to its full potential, which can drive physician productivity as well as adoption.

Thorough documentation can also enhance reporting, which in turn, supports better care delivery. Discreet levels of data are necessary to generate accurate quality reports.

Finally, better documentation fosters more timely claims submission, which results in improved cash flow and reimbursement and leads to fewer denials, ultimately preserving your revenue cycle integrity.

Acknowledging the importance of enriching clinical documentation is the first step toward optimization. To make meaningful progress, I suggest organizations consider and customize the following high-level next steps:

1. Establish goals. Be specific about objectives, timelines, training and who will do the work to drive and manage the improvement process and subsequent changes.

2. Determine early focus. High-volume, high-reimbursement clinical areas and processes make a logical place to start work. In my experience, strengthening documentation in these areas can prevent substantial hits to cash flow and revenue.

3. Examine specialties. Concentrate on those areas that have the most significant changes in documentation requirements, such as cardiology and orthopedics. The physicians in these areas will need to significantly “up their game” when it comes to documentation and can provide valuable input for system workflow retooling.

4. Identify areas of “quick wins.” Give special attention to areas of strong physician support because physician champions can serve as positive role models for adoption in other areas. Identify key players within specialties and promote their demonstrated success to break down change management challenges in other areas.

While ICD-10 makes optimizing clinical documentation a top priority now, improvement work in this area should be an ongoing process with the ultimate goal of elevating clinical care. Organizations that commit to a continuous effort to enhance detail, accuracy and consistency, can see real benefits in terms of both revenue and patient care. Although the idea of revamping clinical documentation may seem daunting, organizations can see big improvements with small changes. The key is acknowledging the importance of the work and getting started on the journey; in my mind, there is no time like the present.

Brad Boyd

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

News 1/30/14

January 29, 2014 News No Comments

CCHIT announces that it will no longer offer ONC testing and certification, nor any of its independently developed certification programs, and will change its business model to become a certification consulting firm. CCHIT is recommending its customers work with ICSA Labs for future testing and certification services.

Mobile charge capture vendor pMD connects its mobile charge capture software with athenahealth’s medical billing and PM software.

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Practice Fusion offers new users a free Google Chromebook and launches a new set of clinical decision support tools. The free Chromebook offer is for first-time Practice Fusion providers only and requires the providers sign up for e-prescribing, and complete a survey. Sounds like a creative way to capture more detailed information on users to help with advertising sales or perhaps to have better data to share with/sell to pharma companies.

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A local paper profiles Express Family Care, a three-physician practice in Virginia that is attracting attention for posting the prices of visits in its waiting room. The physicians say the goal is to provide transparency for their cash-paying patients.

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More than half of doctors say they use a tablet device for professional purposes and 28 percent report using tablets to read articles from medical publications. Overall, physicians prefer smartphones to tablets to perform professional tasks.

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This week KLAS has been tweeting the 2013 Category Leaders for its Best in KLAS report, which will be published Thursday. A few of the winners in ambulatory care-related segments include:

  • Self-service patient kiosk: Phreesia
  • Radiology (ambulatory): FujifilmUS Synapse RIS
  • PACS (ambulatory): INFINITT PACS
  • Laboratory (ambulatory): OrchardSoftware Harvest LIS
  • Computer-assisted coding: 3M HIS 360 Encompass System
  • Eligibility enrollment services: Emdeon

Federal prosecutors charge former Allscripts director of internal audit Steven M. Dombrowski with insider trading, alleging that he used a secret account to trade on non-public information ahead of the release of financial results, netting him $286,000 in profit.

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News 1/28/14

January 27, 2014 News No Comments

From Ross Thomas: “Re: HIT vendor series. I was surprised by the quality of the responses from one or two of the folks (all men, I noticed), but not at all surprised by a few.” It makes me sad that not one of the 12 vendors had a female executive participate. Was this just a fluke or are women in HIT still hitting the glass ceiling in middle management? As to Ross’s veiled comment on quality, I think it’s fair to say that too often vendors obfuscate their message by incorporating too much marketing-speak and not enough straight talk. That being said, I enjoyed reading all the contributions and found many to be very enlightening. Thanks to all the participants.

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In a case considered a key test of the FTC’s efforts to block hospital acquisitions of doctor groups, a federal judge rules that St. Luke’s Health System (ID) must divest itself of the 40-doctor Saltzer Medical physician group. The judge found that the hospital’s ownership of 80 percent of the primary care doctors in Nampa, ID would give the health system an unfair bargaining position with insurance companies, even though the intent of the merger was to improve patient outcomes. The ruling marks the first time the federal courts have decided an FTC case against a physician practice deal.

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Despite the considerable rise in EHR adoption in physician practices between 2009 and 2012, solo physicians lag behind larger groups in terms of implementing certain functions, such as electronic data exchange with other providers. Overall EHR use by primary care physicians rose from 46 percent in 2009 to 69 percent in 2012 according to a Commonwealth Fund study, but EHR adoption in solo practices remained below 50 percent. Physicians associated with integrated delivery systems had the highest rates of HIT adoption.

An AHRQ-sponsored study finds that adding telemonitoring to the routine care of primary care patients with diabetes did not significantly change outcomes.

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CMS reminds EPs that the last day to register and attest to demonstrating MU for the 2013 Medicare EHR incentive program is February 28, 2014.

3M Health Information Systems releases an enhanced version of its Code Translation Tool to convert ICD-9-based custom problem lists into ICD-10 coded problem lists for import back into a provider’s existing EHR.

CareCloud ranks 28 and Kareo 65 on Forbes annual list of America’s 100 Most Promising Companies, which includes high-growth, privately-held companies with under $250 million in revenue.

Doctors spend about one-third of their time looking at their computer when using an EHR in an exam room, according to a study published in the International Journal of Medicine. Researchers conclude that when doctors spend that much time focused on their EHR, patients have difficulty getting their physician’s attention and physicians are less able to listen, problem-solve, and think creatively.

Navicure reports a 24 percent increase in revenue in 2013 to $63.3 million.

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HIT Vendor Executives on Expectations and Plans for 2014 – Part Three of a Series

January 24, 2014 News 2 Comments

We asked several vendor executives a series of three questions related to their expectations and plans for 2014.

What new technologies are on your company’s road map for 2014?

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Raul Villar, president, ADP AdvancedMD

AdvancedInsight is an all-new reporting suite, available this year from ADP AdvancedMD. Private and solo practices will be able to access big data and business intelligence, previously reserved for enterprise level systems, through AdvancedMD’s multi-tenant cloud. Private practitioners will be able to make the right financial decisions based on the right information at the right time with a 360-degree view of their practice’s financial health and key performance indicators.


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Jim Hewitt, VP of solutions development, Allscripts

We are investing heavily in analytics, population health, and proactive patient engagement.  You will also see new solutions around mobility for patients and providers, virtual patient visits, health and wellness, and genomics.


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Todd Rothenhaus, MD, CMO, athenahealth

Well, the good news for us is that it’s no longer cool for CIOs to get their picture taken in front of a datacenter. Provider organizations at all levels are swiftly and confidently moving to the cloud and will continue to do so, because it’s the most open platform from which they can access and share information across health care, because it’s the most nimble platform to adapt to and meet the relentless pace of change for what’s required in health care, because its requires the least amount of capital expenditure and work to get up and running, and finally, because it’s from the cloud that innovation can most quickly grow and become available. Lucky for us, we’ve been there for the past 15 years.

At athenahealth we’ve nearly perfected the art of tracking claims and managing documents for physician practices across the US, we have the top rated patient portal in the country, the most usable EHR according to KLAS, and now we’re taking on bigger, thornier problems. We’re tackling population health and care coordination. Our focus is the leverage our national cloud network to provide clinical and financial visibility into the lifeblood of care, to help our clients (physician practices and health systems) to identify patients in need, to help with engagement and outreach, and to help manage and keep view into the whole care cycle. We want to manage the transitions of care and bridge the information gaps that currently exist. We know we can do this through our unique model of software, knowledge and work. This is our roadmap for 2014.

 


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Albert Santalo, CEO, CareCloud

2014 is shaping up to host the most aggressive phase of product roll out in CareCloud’s history. We are launching significant expansions around our mobile offering in the coming months, as well a new billing rules product that will be provided to our revenue cycle clients at no additional charge. We feel the latter release will dramatically enhance our ability to drive results for clients across our revenue cycle management platform.

Lastly, given what is underway in the market, we will be making significant enhancements to our analytics offering. This will mean more flexible and ad hoc reporting, in addition to scorecards, dashboards and other important capabilities.  We are also working to make reporting much faster and more scalable for our larger clients.


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Stephen Ober, MD, chief medical officer, Emdeon

  • Big Data analytics (numerous versions)
  • Mobile technologies

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Patrick Hall, EVP of business development, e-MDs

e-MDs is launching a unique, patent-pending ICD-10 coding tool. The uniqueness is the approach being taken to help medical professionals derive the correct code.  Many vendor tools are simply arriving at a selection of potential ICD-10 codes based upon publicly available and somewhat generalized mapping tools and which can spawn potentially hundreds of possible matches. These will slow down clinical and billing efficiency and raise costs and denial rates. The e-MDs’ approach focuses on natively deriving the ICD-10 code and provides an opportunity to solve the feared ICD-10 implementation nightmare.

e-MDs is also launching our Cloud Solutions true-SaaS, web-native EHR which has been extremely well received in pilot sites. Our Revenue Cycle Management service is also growing and will be able to accelerate even faster with the Cloud Solutions PM.


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Tee Green, CEO, Greenway Medical Technologies

In late 2013, Greenway strengthened its position as an industry leader by bringing together three innovative solution providers — Greenway Medical Technologies, Vitera Healthcare Solutions, and SuccessEHS. As a result, we now serve a significant percentage of physicians nationwide through our highly integrated clinical, financial and administrative solutions. Thanks to the consolidation of our proven expertise, industry reach and resources, we can provide end-to-end solutions that prepare physicians for a future where electronification, consumerism, and population health are the key drivers of success. We are also investing resources at an industry-leading rate into research and development to build on the strength of our existing solutions. We also continue to focus on providing the ultimate in data liquidity through our interoperability engine, PrimeEXCHANGE. In fact, it is our aim to make this solution one of the largest health information exchanges in the country.


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Tom Giannulli, MD, CMIO, Kareo

Kareo is continuing to expand the features of our EHR and practice management solutions all the time. The big challenge is balancing market-driven features with requirements like MU. I am most excited about the potential of new mobile technologies like Google Glass and the emergence of technology that allows for the use of virtual scribes within the small practice.


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Nick van Terheyden, MD, CMIO, Nuance

We will continue to develop our Clinitegrity 360 suite of solutions and services – providing end-to-end clinical documentation that enables physicians to properly document care and be reimbursed, while working within their existing workflow without distraction from the patient and patient care. These offerings help clinicians capture detailed information that’s necessary for ICD-10, as well as population health management and quality reporting.

In addition, we will continue to advance our mobile speech and clinical language understanding solutions. With these, clinicians are able to document at the point of care – which keeps patient records up-to-date and eliminates hours of charting after each shift. In addition, we continue to partner with innovative companies who are driving change through mobile health – such as our recent partnership with Sharecare on the AskMD app that connects patients with providers helping them take an active role in managing their own care.


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Irtaza Barlas, director of software engineering NueMD

New technologies on company’s road map:

a) Integrating wearable technologies (such as Google Glass) into the physicians’ encounter experience in a secure and hassle-free way. The main intent here is to help the physician interact with the patient and potentially use the capabilities of the Glass at the same time. And at all times still be connected to their Practice Management system (NueMD).

b) New claims-processing techniques to significantly reduce billing errors and rejections.

c) Developing tools to help billers and physicians communicate in a timely manner.


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Chip Hart, director of strategic marketing/sales director, Physician’s Computer Company

Perhaps I’ll be the lone vendor to not try to overextend our position, but there isn’t some truly _new_ technology in our world that will be introduced in 2014. Every Asimovian prediction I can think of has already been played with by us (heck, we were doing remote EHR work on the Newton back in the 90s!), so it’s not really new. For PCC, it’s about improving the engagement with our clients and our clients’ clients on the various platforms they use to communicate.

I suppose one place where we are different is that our patient portal was designed for smartphones from the ground up. Our clients are pediatricians and the model we’ve designed to is the young mom, with a kid or two in tow, who wants to get signed up to get her kids records while in 30 seconds at the checkout window, not wait a few days for something to arrive in the mail and log into her PC. She may not HAVE a PC. So, we’ve got an  extremely iPhone/Android friendly-app that patients can log into at the check out window.


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Michael Brozino, president and CEO, simplifyMD

simplifyMD will be upgrading their solution to offer a few enhancements to help physicians work more efficiently and productively, while complying with new and impending regulatory and industry changes. These features are:

  • simplifyMD Charge Capture which streamlines the billing process with automated diagnosis and procedure codes that are generated during the clinical encounter and then pushed to the PM system or billing company for faster claims submittal and reimbursement.
  • simplifyMD simpleForms that offers providers the flexibility to edit and update EHR forms on any desktop or mobile device as well as data capture capabilities to help physicians create highly detailed reports in only a few clicks.
  •  Enhanced Computerized Physician Order Entry built to help physicians meet Meaningful Use Stage 2 core objectives by electronically submitting lab, medication and radiology lab orders, including to vendors such as LabCorp, Quest Diagnostics and Solstas. Physicians will also have the capability to email or e-fax orders to any radiology center, imaging facility or specialty lab right from the simplifyMD EHR.

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