News 9/20/11

From Jiminy Cricket: “Re: dueling free EHRs. I thought this press release was funny, not to mention horribly written. But like a street fighter swinging wildly and skillessly against a pro boxer, sometimes a punch lands, and I’d say this one might have connected with the Practice Fusion jaw a couple of times.” Mitochon Systems issues a press release to “debunk” the “hyperbole, myths and over-reaching claims” on the part of fellow free EHR provider Practice Fusion. Among Mitochon assertions: Mitochon — not Practice Fusion – offered the first free, complete ONC-ATCB certified EHR; Practice Fusion probably doesn’t have the largest MU physician community since its MU product was just released last week; and if 5,000 Practice Fusion customers attest for MU this year, it would only represent 5% of the Practice Fusion client base. Maybe some of the punches have connected and maybe it’s really a whole lot of bunk about nothing. Regardless, Practice Fusion clearly seems to have struck a nerve with its competition.

Southern Illinois Hand Center announces plans to upgrade from Sage Medical Manager to Sage Intergy Meaningful Use edition and add Sage’s patient portal.

These numbers surprised me: almost 90% of physicians use at least one social media site for personal use and over 65% have at least one site to support their professional practice. Most physicians also see potential for physician-patient online interactions, including the sharing of educational materials and for monitoring patients’ health. Liability, privacy, and compensation remain big concerns for providers.

SuccessEHS expands into the electronic dental record market with the purchase of MediaDent. The acquisition strengthens the SuccessEHS offerings for community health centers.

Quixote partners with ZirMed to offer ZirMed’s RCM services to Quixote’s practice management customers.

The 230-physician Hattiesburg Clinic moves to Epic’s EMR.

McKesson integrates its iKnowMed EHR and Lynx Mobile drug inventory management system, giving oncology practices a single chemotherapy orders workflow management system.

Thirteen thousand additional physicians and hospitals signed up for the MU incentive program in August, bringing the total number of registrants to 90,000. CMS paid Medicare incentives to 1,000 EPs in August, with 1,300 receiving checks under the Medicaid incentive program. YTD payments: $652 million.

Meanwhile, the Office of the Inspector General estimates that Medicare contractors have overpaid physicians $28.8 million for incorrectly coded services provided during 2008 and 2009. OIG recommends the recovery of at least $7 million of the identified overpayments.

CMS issues an ICD-10 transition guide for Medicare providers that includes information on how to handle claims for services during the ICD-9 and ICD-10 transition.

E-mail Inga.

Practice Wise 9/17/11

Compassionate Expectations

Boy, I never thought I’d have such a love-hate relationship with a word as I do this one: expectations.

It’s been a long, hard summer in my world. We’ve been buried in Meaningful Use software upgrades and a rush of new practices starting up.

Who said all the small practices are selling to the hospital systems? Not in my neck of the woods! We usually start up one or two practices a year. We’re on #6 this year and they keep calling, and they all want to be open in three months. But I digress …

I started this summer with great anticipation of MU product releases. Although I knew that the upgrades would be arduous, what I didn’t anticipate fully was the varying degrees of expectations — met and unmet — around these upgrades.

My greatest expectation was that our clients would be thrilled with over 450 new features and functionality in their software. So thrilled, in fact, that they would embrace all the free training we offered and be enthusiastic at upgrade. We delivered a fully certified MU product in time for them to attest for Phase 1 this year if they desired. I was confident we met their expectations, in spades!

Suffice it to say that we met our own expectations of what we thought they wanted. But in the end, everyone had different expectations and perceptions of how this would play out.

In our experience, doctors expected us to provide an amazing product and it would just work. They wouldn’t have to learn anything new, even though it did a gazillion new things. Practice administrators expected their staff to participate in the training we provided and sign off when they actually did it. What we found is many signed off and never really did the work. When we showed up post-upgrade, they were lost and expected us to do training on the spot while we were troubleshooting technical issues.

Everybody in the practice had differing expectations and it was our challenge to meet them all.

Our own expectations of how our software vendor would handle their product release and ensuing support was the surprise of the summer. I have been doing medical practice software support and consulting for 11 years now and it hasn’t all been wine and roses. We expected reduced response for our support cases since our vendor was as overwhelmed as we were, but they didn’t leave us hanging.

They even pulled off a few miracle saves. A big was bug found at our favorite client’s office, a show-stopper that brought them to their knees. The developers fixed it in 48 hours.

Of course, the doctor’s expectation was that the code should haven been rewritten before end of business the same day it was found. I was praising the 48-hour miracle and she was complaining that it took so long. Our expectations were clearly out of alignment.

Just when I realized the toll this was taking on my staff and our clients, I was moved by the HIStalk post by Ed Marx on 8/17/11 titled Connect. This article motivated me to take action — first with myself and my staff, then with our customers.

It was posted the day before our quarterly user group, an informal meeting with all of our customers to check in, share ideas, and work together towards solutions. We were all feeling a little ragged from the first round of upgrades. Customers still waiting to be upgraded were anxious.

I started the meeting by sharing Ed’s discussion of compassion. It really touched a nerve (I still had a few left). It helped me refocus on what our intentions are. We are here to help providers and their staffs provide excellent patient care. We are not purely consultants with solutions. We are partners in the patient care they provide.

With this as the theme, I started our meeting on a different tact.  I did a level-set of expectations for all of us. It was a gamble, but I spoke from the heart to my customers about the challenges we were facing, the stress of the upgrades and their reactions to the changes, and the challenges within their own practices. I showed compassion for myself, my staff, and most of all, for our customers. How the interruptions of software changes often take their focus off caring for their patients while they battle data entry in their EHR.

They shared the same. It was transformative. We found commonality in purpose and compassion for each other.

We have continued to soldier on through the remaining upgrades. We continue to remind ourselves that compassion for the role and position of everyone involved is the key to getting through stressful encounters when they arise.

Did I mention that my Outlook crashed this summer during all this stress? I guess my expectation that this awesome piece of software can hold an unlimited amount of data (48,385 messages in fact) in a .pst file was unrealistic. Luckily, I have a compassionate engineer on board who took pity on me and didn’t berate me (too much) for not deleting more than three emails a day for the past nine years, and not launching our mail server years ago! We are currently planning a migration and setting appropriate expectations, because you never know how these things will go.

It’s been a great summer. I’ve learned to set clear expectations and practice doing so with compassion, every day. Thanks, Ed!

Julie McGovern is CEO of Practice Wise, LLC.

News 9/15/11

From Cleve Van Valen: “Re: Jonathan Bush. Hate to say it, but Jonathan Bush makes my CEO look like he is driving a horse and buggy.” I assume Cleve is referring to our recent interview with JB and athena’s MU transparency initiative. The transportation reference reminded me of this cartoon produced for the 2008 HISsie awards, which features Jonathan Bush in a DoLorean sports car, a la’ Back to the Future. It still makes me laugh.

McKesson introduces McKesson Practice Choice, a Meaningful Use-certified, Web-based integrated EHR/PM solution for small, independent primary care practices.  The company also announces McKesson Practice Care, a service line that offers patient-centered medical home consulting in conjunction with AAFP’s TransforMed and available exclusively for practices running Practice Partner, Medisoft Clinical, Lytec MD, and Practice Choice.

Practice Management Associates (VA) selects the ADP AdvancedMD PM for RCM services.

The 14 physicians of Sandhills Pediatrics (SC) receive $184,000 in government incentives for their Meaningful Use of the SRS EHR.

The Physician Services technology division of Inland Northwest Health Services (WA) announces plans to offer implementation and hosting services for Greenway’s PrimeSUITE EHR/PM solution.  INHS serves and connects 38 hospitals and over 4,000 physicians on its HIE.

Practice Fusion forecasts that 5,000 of its eligible provider customers will qualify for 2011 Meaningful Use incentives worth up to $90 million. That’s a big number, especially considering that through July only 4,491 EPs, regardless of EHR, have received MU checks. On the other hand, HHS Secretary Kathleen Sebelius reports that 80,000 providers have applied for funds, so perhaps the 5,000 EP estimate is on target.

Medicaid managed care provider AmeriHealth Mercy launches a program to offer its network providers free mobile technology. Physicians will have access to care alerts and e-prescribing at the point of care using the NaviNet Mobile Connect platform.

Phreesia introduces an electronic Medicare Annual Wellness Visit form, which can be presented to patients during check-in.

Integrating telehealth tools with care management for chronically ill patients may result in significant savings ($312 to $542 savings per patient per quarter.) The coordinated approach may also improve health outcomes.

Speaking of telehealth, Mount St. Mary’s Hospital and Health Center launches a telehealth practice to address acute health issues and follow-up care, as well as provide chronic care virtual visits. Mount St. Mary’s says its Online Care practice, which uses American Well technology, is the first medical group in the country to be formed as a telehealth practice.

E-mail Inga.

News 9/13/11

From Lauren Alaina: “Re: exemption from 2012 eRx penalties. Providers can access the exemption request form at www.qualitynet.org/pqrs. In the ‘Related Links’ box on the upper left, click on ‘Communication Support Page,’ which displays the online form.  Once a provider finds the site, the process seems pretty straightforward!” Thanks, Lauren. Apparently the portal just went live last week. It looks like it will take providers about a minute to file an exemption.

HHS, AT&T, and the American Association of Diabetes Education announce a diabetes self-management training project that uses mobile health technology. AT&T is contributing $100,000 to cover the cost of 150 smartphones for diabetes educators, who will use a video application on the mobile devices to educate patients.

AT&T, by the way, names its first CMIO, rheumatologist Geeta Nayyar MD, MBA. She most recently served as principal medical officer at Vangent.

North Clinic (MN) chooses eClinicalWorks EHR for its 84 employed providers. The clinic will integrate eCW with Epic’s in-patient system at a nearby hospital (North Memorial, I am guessing.)

Wasatch Pediatrics (UT) integrates Phreesia’s automated patient check-in solution with its existing Greenway PrimeSUITE EHR/PM product.

In its first three months of general availability, NaviNet signs up more than 1,000 providers for its PM/EMR solution.

The 317-provider Piedmont Clinic (GA) partners with MD On-Line for electronic claims submission and RCM services.

The100-provider Wilmington Health (NC) will integrate its Allscripts Professional EHR with Humedica MinedShare’s clinical analytics solution. Wilmington Health will also join Ancenta, AMGA’s collaborative data warehouse, which was co-developed with Humedica.

Kareo partners with MD-IT to offer an integrated solution with Kareo’s PM/RCM software and MD-IT’s medical documentation solution.

American Well and Numera announce a strategic collaboration that will deliver real-time health monitoring over American Well’s telehealth network. During online visits, providers will have live access to biometric information through Numera’s gateway. Clinical information can then be captured and stored as part of a Continuity of Care Record.

ENT and Allergy Associates (NY) integrates Intuit Health’s patient portal with NextGen’s EMR, giving its patients the ability to complete medical histories online prior to appointments.

Ophthalmology EMR provider Integrity Data Solutions promotes Chris Moore from COO to CEO.

US doctors, particularly orthopedic surgeons, earn more than their counterparts in Europe, Canada, and Australia. Primary care doctors are paid 27% to 70% more than their foreign peers, while orthopedic surgeons earn 70% to 120% more. The difference in earnings is attributed to higher fees rather than factors such as higher practice costs, volume of services, or education debt.

McKesson announces the creation of a new division, McKesson Specialty Health, which will focus on improving the health of community-based physician practices and their patients.

E-mail Inga.

DOCtalk by Dr. Gregg 9/9/11

An Operational Luddite

Tech-oriented I am. Born geek I was. So how bizarre it feels to note that today I declare myself a Luddite.

Not a traditional Luddite in the current sense who eschews all things tech and opts to forego modernity in the information age by going about sans smart phone, without an e-mail address, and reading books that really are books … you know, made of paper and ink. (Really. Real ink!)

And not in the historical sense from the earlier backlash against the Industrial Revolution in the late 1770s and early 1800s when mechanized looms, or “stocking frames,” threatened to bring mass chaos to the world and the rather mythical Ned Lud (later exalted to “King Lud” or “Captain Lud”) first destroyed such a loom in a still-unclear fit of rage or passion.

No, I like my tech. I cringe when my power goes out, when my smart phone battery starts flashing less than 5% battery remaining, or when I’m assaulted by some insurance company multi-page form that I must complete … gulp … by hand!

My “Ludditious” nature centers around the current trend for all things healthcare going conglomerate: hospitals buying up solo and small group practices willy-nilly; ACOs appearing almost like morel mushrooms out of the droppings of not-so-distant failed doctor-hospital coops of the late 20th century; HIT talking heads portending the end of the small “onesy-twosy” doc practices.

I’ve worked in large institutions, and even now, with some of my other current dealings, I have to try to work within large organizational frameworks. Much, if not most of the time, I personally find these “frameworks” to be more spider web than scaffolding. Navigating many larger bureaucracies has often reminded me of advanced trigonometry. I know some folks get it with ease and grace, but it’s akin to an Escher landscape when I look.

In fact, I mentioned to my little “onesey” practice staff (all three of them) yesterday that I’ve come to believe that any group of people beyond about five in a work environment just seems to have a pall or haze of bureaucratic entanglements that seem virtually unavoidable. And the really weird part for me is that individually, many — even most — of the folks who make up said bureaucracies are all good folk with good intent. But get five-plus people involved in an endeavor and you can just watch the red tape, boring meetings, and meaningless uselessness start to almost magically sprout, just like morel mushrooms from the dung – overnight.

Being a small business owner is tough, no doubt. Sleepless nights wondering if you’ll make payroll in the morning, stretching yourself micron-thin, lack of certain freedoms of escape — all weigh notably on the “con” side. But if I can keep my head above the red ink water, I will proudly try to maintain my “Operational Luddite” status and avoid the ACO / hospital-acquired / multi-provider group bandwagon.

The cons for this entrepreneurial work style are there, but the “pros” are just too fun. We can make a decision, act on it, decide if it works or not, and make a new decision that builds upon the successes or failures of the prior one – and we can do all that without one single meeting, PowerPoint, org chart, or study. Heck, I don’t even have to ask anyone for permission, no less a board or committee. I can make experimental choices – some mistakes, some huge successes – and then redirect as soon as the needs change. Snap — just like that.

So, if all of healthcare is going to conglomerates, to ACOs, and to “big-buy-the-small” corporations, I think I’ll just have to accept the fact that, at least in one sense, I’m a Luddite, an “Operational Luddite.” I like being a “onesy.”

From the trenches…

“Bureaucracy is the art of making the possible impossible.” – Javier Pascual Salcedo

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, directs the Pediatric Office of the Future exhibit for the American Academy of Pediatrics, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).