News 6/2/11

MGMA concurs with just about everyone else that the proposed ACO rule is unacceptable as written:

Based on feedback received from our members, including those who participated in the PGP demonstrations, as well as similar private sector contractual arrangements, MGMA believes the ACO shared savings model may not be viable as a national strategy unless significant program policies are modified when final rules are promulgated.

MGMA says out that the program is too complex; the development and on-going costs are too high relative to potential benefits;  the benefits are too uncertain and too small; and the regulatory risks too substantial.

Molina Healthcare picks GE Centricity Practice Solution as its primary EMR/PM platform for its 16-state healthcare system.

Nuesoft Technologies and Point and Click Solutions collaborate on the College Health Technology Pathway Program to educate college health professionals of the potential risks of hosted systems. Nuesoft CEO Massoud Alibakhsh offers this warning:

Hosted ASPs take a client-server and provide users remote access via the Internet. This is akin to putting wings on a car and expecting it to perform like a jet airplane. This is not what a client server is intended to do, and unless they can guarantee the fault tolerance and security protocols in place, you are taking chances with your data.

eClinicalworks says that 15 of its clients have received EHR incentive checks from CMS.

Now that it’s June, it’s time to consider potential vacation destinations. Why not attend a user group meeting with your favorite EMR vendor? Here are a few upcoming events:

• Amazing Charts User Conference, Biltmore Hotel, Providence, RI, June 2-5
• Sage Summit, Gaylord National Hotel & Convention Center, Washington, DC, July 10-15
• e-MDs User Conference & Symposium, AT&T Center, Austin, July 28-30
• Aprima National User Conference, Hilton Lincoln Center, Dallas, August 4-7
• Allscripts Client Experience, The Gaylord Opryland Resort, Nashville, August 29-31
• Greenway PrimeLEADER, Gaylord Palms Resort & Conference Center, Kissimmee, FL, September 8-11
• SRS User Summit, Hilton, Woodcliff Lake, NJ, September 21-23
• eClinicalWorks National Users Conference, JW Marriott Desert Ridge Resort, Phoenix, October 1 – October 4

HIMSS teams up with an attorney to answer questions on Meaningful Use for one of its monthly publications. Great idea, however, the answer to this question is a bit confusing:

Q: When an eligible physician is employed by a group practice, who gets the EHR incentive money, the individual doctor or the practice?

A. The answer is most likely yes if the physician and group have a traditional physician employment agreement.

Huh? The attorney does go on to explain that physicians can reassign their payments to their employment or other entity, so the less-confusing  answer is that the money could go to either.

As Mr. H mentioned last night, it’s a slow news period and lots of readers seem to be taking some time off. Mr. H is quite the slave driver, however, so we are still working hard at it. Drop me a note if you have anything juicy to report, words of encouragement, summer vacation suggestions, and/or need my shoe size. And thanks for reading.

E-mail Inga.

News 5/31/11

A London paper reports that Sage Group has launched a review of its healthcare division that could lead to a sale of the unit, valued by analysts at around $430 million. Sage recently reported a 5% decline in revenues for the North American healthcare division for the first half of the year.

CMS says that the Medicare EHR incentive program has paid out $75 million to providers so far, while the 15 state Medicaid programs have issued $38 million in payments.

Good news for providers who have not yet adopted e-prescribing systems. CMS issues a proposed rule that would expand the definition of an e-prescribing system to include certified EHRs with e-prescribing capabilities. In addition, certain providers would have until October 1 to claim exemptions to avoid potential Medicare pay cuts.  Exemption reasons include having limited prescribing activity and practicing in an area in which regulation prohibit e-prescribing. Providers could also claim an exemption if the delay is a result of a pending implementation of a certified EHR.

Nevada and Utah REC HealthInsight announces that 1,000 primary care providers have signed up for EHR adoption and implementation assistance.

athenahealth says several of its athenaclinical customers have been paid Medicare EHR incentive payments.

Barboursville Internal Medicine (WV) picks Benchmark System for its PM and EHR.

HP EHR Referral Group, an alliance of healthcare billing systems, selects Sevocity EHR as a preferred EHR.

Oncology EHR provider Rabbit Healthcare Systems announces that it is expanding its headquarter space by 70% and expects to increase its staff by 40%.

The local paper highlights Springfield Center Family Medicine (OH) and its use of NextGen EHR. Though quite happy with the solution, one physician notes that his incentive payment of $18,000 only covers half of what the practice spent on server upgrades last year.

Trend alert: two large distributors of medical supplies to doctors’ office report double digit sales growth for the first quarter. PSS World Medical (15.4%) and Henry Schein (12.4%) say the creation of jobs is providing more patients with health insurance, boosting healthcare demand and giving physicians confidence to buy more supplies.

HIMSS names four finalists for Ambulatory Care Davis Award, including Community Care Physicians (Allscripts — NY), Fallon Clinic (Epic — MA), James F. Holsinger MD (e-MDs — IA), and Women’s Health Advantage (Greenway — IN). HIMSS will award up to four winners following site visits to each practice.

A disgruntled patient in Vermont sues her doctor after leaving without seeing him after a wait of more than one hour. The doctor was delayed caring for another patient. The woman asked the practice to reimburse her $139 to cover the cost of hiring a nurse to care for two family members while she waited. She filed suit when the practice refused (and subsequently “fired” her from the practice). The judge rules in the doctor’s favor, noting there would be serious problems if doctors could be billed for missed appointments. The patient says she feels, “like a David-ette against a Goliath.”

E-mail Inga.

From the Consultant’s Corner 5/30/11

ICD-10: Roadmap to a Successful Transition

The transition from ICD-9 to ICD-10 codes is a massive undertaking for all healthcare organizations. It’s a matter of sheer magnitude, of course: diagnosis codes are critical to nearly all patient care and revenue cycle activities. Add to that the additional burden facilities face implementing ICD-10 Procedure Coding System.

With any project this large, success requires carefully mapping out each phase of the journey. In the case of ICD-10, I suggest taking a five-phased approach: 1) program development; 2) impact assessment; 3) project and implementation planning; 4) implementation; and 5) stabilization and optimization. Here’s a look at the key elements in each phase:

Phase 1: Program Development

The very first step is to establish a governance team responsible for oversight of the ICD-10 conversion. It should include representatives from: revenue cycle (hospital and professional, if your organization has both); coding/HIM; clinical informatics and clinical documentation; IT (patient access, clinical and revenue cycle applications); training; and compliance.

You may have one person wearing many of these representative hats in some organizations. That’s OK. Just make sure each of these functional areas is considered in your ICD-10 planning. Your project plan should include a timeline and resource requirements by functional area.

Phase 2: Impact Assessment

Your assessment should focus on understanding the training needed to bring everyone up to speed on ICD-10 requirements. Again, make sure to conduct your assessment by functional area: systems, billing and reporting requirements, and training requirements. Once you’ve assessed each area separately, though, it’s critical that you then aggregate them to create an enterprise-wide view of overall impact. You should end up with a documented inventory of all IT applications.

Phase 3: Project and Implementation Planning

After impact assessment, carry out a separate vendor readiness assessment. The goal is to identify all vendors and interfaces affected by the ICD-10 conversion, then contact the vendors to see if upgrades or other changes are necessary to meet ICD-10 requirements. Any associated costs must be documented, and vendors should be asked to provide you with their ICD-10 test plans.

Phase 4: Implementation

With an implementation that includes as many “moving parts” as ICD-10, it’s important to clearly identify expectations and measure your progress toward them. Among the implementation tasks you’ll need to monitor are:

• System updates (e.g., templates, electronic and paper claims/remits, and reports) and upgrades
• Physician documentation training
• HIM/coding training
• Revenue cycle staff training
• Interface modifications
• Unit testing
• Integrated testing
• Development of new reports

Expect a pretty complex testing plan. In addition to internal testing, you’ll need to test with external parties including payers, clearinghouses, and other EDI partners. And unless you use a home-grown IT solution, you’ll depend on vendors for ICD-10 updates. Don’t underestimate the time and effort vendor coordination and testing will take! Develop a testing schedule that ensures each type of EDI transaction you use processes correctly before the Oct. 1, 2013 compliance date.

Documentation and coding training should be performed in the months prior to implementation, and will be important for reducing coding errors and claims denials after go-live. Once you’ve converted to ICD-10, it’ll be essential to conduct real-time monitoring of clinical documentation, HIM and coding productivity, interface error logs, claim edits, claim denials, remittances, physician productivity, patient visit/encounter volumes, and more.

Phase 5: Stabilization and Optimization

For a successful transition to ICD-10, metrics will be key. Tracking performance metrics throughout implementation is the only way you’ll be able to spot and fix any potential difficulties.

Perhaps the best part of the whole ICD-10 implementation is the opportunity for improvement that it brings you. Think about it: You’ve already created a representative governance team. You’ve already developed a dialog with your vendors and payers. You’ve already started identifying and tracking vital performance metrics.

You’ve already done the legwork. Now, combine your metrics with your avenues of communication to do more than just implement ICD-10. Use them to develop and optimize future goals through additional training, workflow redesign and system modifications.

Rob Culbert is president of Culbert Healthcare Solutions of Woburn, MA.

News 5/26/11

Aetna earned the top spot for major payers in athenahealth’s sixth annual PayerView Rankings, while BCBS-RI was named the overall best performer. The rankings consider ease of doing business based on a variety of performance criteria. Compared to last year, payers averaged payment one day faster with 5% fewer denied claims. State Medicaid providers were the worst performers in terms of AR and denial rates.

Kareo publishes a clever piece entitled, “How to Handle Medical Billing After a Zombie Apocalypse.” The strange title is based on a recent CDC post on how to prepare for a zombie apocalypse (or other emergencies like hurricanes, earthquakes, and the like.) Kareo’s recommendations for medical billing include using a Web-based, easy-to-use software that allows employees to work remotely and includes code-scrubbing tools and free EMR.

The Massachusetts REC leads the country in enrolling primary care providers for its services. Massachusetts eHealth Institute’s goal was to recruit 2,500 PCPs and is the first REC to fulfill its enrollment milestone.

Seven US senators send Secretary Sebelius a letter urging HHS to withdraw its proposed ACO rules, saying “the proposed ACO regulation will fail to accomplish its purpose” of better quality care and lower costs. The senators claim the proposed rules do not align incentives and accountability and include requirements that are too complex and an ROI that is uncertain.

MED3OOO announces the general availability of InteGreat V6.4, which includes the components required to meet Meaningful Use standards. The release also includes an enhanced visit entry module and improved patient communication capabilities.

Doctors behaving badly:  more than 70% of physicians say that disruptive physician behavior occurs at least once a month at their organizations, and more than 10% say that such incidents occur on a daily basis. The types of disruptive behavior physicians encountered range from profanity to refusal to follow established protocols and occasionally physical assault.

Phreesia announces its patient check-in system now integrates with over 85 unique workflow solutions.

Baylor Health Care System (TX) affirms its plans to implement GE Centricity EMR across its entire HealthTexas Provider Network of more than 500 physicians. A reader tells me the “affirm” wording alludes to the fact that Baylor was at one time consider switching vendors, though clearly they changed their mind.

MGMA reports that median compensation for first-year specialists in multispecialty practices was $258,677 in 2010, compared to $240,596 for specialists in single-specialty practices. Median compensation for primary care doctors was $172,400 in multi-specialty groups versus $165,000 in single specialty practices. More than half of first-year doctors were paid signing bonuses and relocation packages.

E-mail Inga.

News 5/24/11

Interesting fact that I’m assuming is true: 17 vendors represent 87% of providers live on EHRs. Keep in mind that so far 487 products have earned ONC-ATCB certification. This statistic comes from Thomas Tsang MD, ONC’s medical director of meaningful use and quality, who made the remark while speaking at last week’s RI Quality Institute Health IT Expo. He also noted that 68,780 primary care providers are now enrolled in the Medicare EHR Incentive Program.

AMA reports profits of $23.9 million for 2010, a 45% increase over the previous year. Membership fell about 5% to approximately 216,000.

PwC’s Health Research Institute predicts medical costs will increase 8% in 2011 and 8.5% in 2012. The report also notes that provider consolidation will continue and more costs will shift to Medicare and Medicaid.

e-MDs reports that its client Dr. Ben Brull is the first physician in Kansas to receive Meaningful Use funds from Medicare. Meanwhile, Greenway Medical says their client Childs Medical Clinic (AL) also picked up a big check.

Kent Rowe, a former GE Healthcare VP/GM and IDX sales VP, joins Culbert Healthcare Solutions as VP of information technology services. He will lead the team that serves the GE and Allscripts client base and will expand the company’s overall service line.

In fashion news, the New York Senate proposes a ban on physicians wearing long sleeves, ties, and watches in an attempt to reduce hospital-acquired infections. Critics of the legislation claim studies have failed to establish a link between contamination of clothing and patient infection.

Florida Pulmonary Consultants picks Benchmark Systems’ EMR/PM solution.

A big welcome to Gateway EDI, our newest HIStalk Practice sponsor. The St. Louis, MO-based EDI provider serves over 21,000 offices in all 50 states and more than 85,000 providers. Gateway submits to over 3,000 payers and  also offers such services as electronic eligibility, remittance, patient statements, and credit card processing. Gateway’s customer support stats are impressive: 98% of calls are answered by a real person and 92% of customer questions are answered on the first call. In addition, clients using Gateway’s claim processing tools typically lower their average error rate below seven percent. Gateway is also sponsoring HIStalk, so a double thank you for the support.

The Minneapolis paper profiles 3M’s Mobile Physician Solution, which allows providers to track patient clinical data, dictate, and capture charges. It was introduced in October and is licensed for $2,000 a year per user.

athenahealth is named a 2011 Best Place to Work in Massachusetts by The Boston Business Journal. Results were based on employee-satisfaction surveys.

Most curious: a Illinois man is arrested for impersonating a doctor and running a medical office without a license. George Fleming ran an advertisement for his “services” in a Bulgarian newspaper. A “patient” visited the office and claims Fleming inserted what appeared to be toothpicks into his chest. He then gave him a bottle of "Prosperous Farmer Dietary Supplements," whose label had a 2002 expiration date. Fleming then asked the patient for $150 cash. The patient called the police.

E-mail Inga.