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Morning Headlines 1/20/17

January 19, 2017 Headlines No Comments

Tim Draper keeps defending Theranos

Despite exhaustive examples of corporate irresponsibility and ineptitude, early Theranos investor Tim Draper continues to defend the company, calling the unrelenting bad press a conspiracy to take down Elizabeth Holmes.

The Final Days of Obama’s Tech Surge

As the Obama administration winds down, speculation over the future of the United States Digital Service mounts. The group, made up of high-profile Silicon Valley tech minds, was launched to rescue Healthcare.gov and help transform the government with technology.

CBO Scoring: The Issue Is Not How It’s Done, But How It’s Used

Health Affairs explains the role of the Congressional Budget Office in the overall legislative process, and outlines CBO cost estimates associated with repealing ACA. The article also notes that House rules were recently passed that contain a provision forbidding the CBO from generating long-term estimates on the impact of repealing ACA.

HIMSS Media Lab is Launched to Lift Audience Engagement and Revenue

HIMSS acknowledges that it will begin selling member data to support vendor sales efforts, explaining “We’re leveraging the HIMSS database of over one million health and technology experts…This enables us to identify the emotional and business triggers…and that’s really the key to understanding buying intent.”

News 1/20/17

January 19, 2017 News 4 Comments

Top News

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Theranos announced in October 2016 that it would close all of its testing labs, but the Wall Street Journal finds that Theranos didn’t mention at that time that its Arizona lab had failed an unannounced CMS inspection several days earlier.

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Meanwhile, Theranos investor and friend of CEO Elizabeth Holmes Tim Draper still maintains that Holmes is a victim of a Wall Street Journal vendetta, claiming that, “the guy is getting $4 million to continue this charade,” referring to the book and movie deal signed by WSJ reporter John Carreyrou, who Draper calls a “mouthpiece” for Theranos competitors.

Draper says big lab companies, drug companies, and insurers don’t like the idea of people taking control of their health and competing with a company selling tests for less. He adds that even though Theranos admitted that some of its lab results were unreliable, “I like that they’re self-policing.”


Reader Comments

From I See Light: “Re: HIStalkapalooza. HIMSS … what a freak show of excessive marketing budgets. At least there is HIStalkapalooza to set one’s mind right!  Listening suggestion: Pet Clinic, from my adopted hometown of Pittsburgh.” I’m listening to Pet Clinic on Spotify now and am struck by how much they sound like Frank Black and the Catholics at times, especially the singer’s phrasing. I’m also reminded of how much I like the Dirty O’s fries, although it’s hard to understand why their hundreds of available beers don’t include Iron City, often pronounced “Ahrn City” in the ‘Burgh, at least by those who still care now that its blue collar heyday is long past and it has moved out of town.


HIStalk Announcements and Requests

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We funded the DonorsChoose grant request of Ms. L from Michigan, who asked for a portable PA system so the class could easily hear her and students who are presenting their work. I was touched by her description of the impact made by a few dozen of our donation dollars:

Just today a student told me that he loves it when I wear the microphone because then he knows I am about to "say something important" and he can shift to listening mode. Another student wanted to write and perform a rap song for you but I did not have a way to upload video so he settled on writing a poem. You’ll see it in the pictures. He hopes you enjoy it. But surely my favorite was when one student saw and heard the mic for the first time and declared, "Ms. Lab, you’re crispy." You’ve made the impossible happen: fifty-eight years old and crispy! Kudos! This technology has allowed me to speak to my students and be assured that every student has an opportunity to hear instruction. Another benefit: I no longer leave work at night with a strained voice!

This week on HIStalk Practice: MDlive ups its employer offerings. UnitedAg expands relationship with Teladoc. Essex County Mental Health Services goes with TenEleven HIT. United Medical Laboratories connects to physician EHRs. AccentHealth’s Sara Johnston advocates for digital point-of-care education during flu season. Aprima acquires Healthcare Data Solutions. Oculus Health raises funds for further CCM, CPC+ offerings. Modernizing Medicine’s Mandy Long attempts to make MIPS a little less fear-inducing.


Webinars

January 26 (Thursday) 1:00 ET. “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.” Sponsored by Healthwise. Presenters: Jim Rogers, RN, RPSGT, director of healthcare solutions, Persistent Systems; Jason Burum, chief client officer, Healthwise. This webinar will explain how to implement a patient-centered care coordination program that will increase quality as well as margins. It will provide real-world examples of how organizations used care coordination to decrease readmission rates, ED visits, and costs.

February 1 (Wednesday) 1:00 ET. “Get your data ready for MACRA: Leveraging technology to achieve PHM goals.” Sponsored by Medicity. Presenters: Brian Ahier, director of standards and government affairs, Medicity; Eric Crawford, project manager, Medicity; Adam Bell, RN, senior clinical consultant, Medicity. Earning performance incentives under MACRA/MIPS requires a rich, complete data asset. Use the 2017 transition year to identify technology tools that can address gaps in care, transform data into actionable information, and support population health goals and prepare your organization for 2018 reporting requirements. 


Acquisitions, Funding, Business, and Stock

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Aprima acquires Coral Gables, FL-based EHR/PM reseller Healthcare Data Solutions.

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Spok will add 60 positions at its Eden Prairie, MN office.

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Athenahealth’s accelerator invests an unspecified amount in The Right Place, which helps hospitals place patients in SNF beds. The company had previously raised $2 million in a single October 2015 seed round.


Sales

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Phelps Memorial Health Center (NE) selects Parallon Technology Solutions as implementation partner for its Meditech 6.1 upgrade and expansion.

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BJC HealthCare (MO) chooses MModal for speech recognition and clinical documentation improvement as it transitions from NextGen and Allscripts to Epic.


People

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Philips hires Roy Smythe, MD (Valence Health, HX360) as chief medical officer for health informatics.

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Allscripts hires Lisa Khorey (EY) for the newly created position of EVP/chief client delivery officer and Alan Fowles (Nuance) as president of Allscripts International.

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Next Wave Health Advisors, a Huntzinger Management Group company, hires Greg Walton (El Camino Hospital) as an advisor.


Announcements and Implementations

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Coordinated Care Oklahoma will shut down following the requirement of an unnamed payer that providers submit their data to a competing HIE. CCO announced in June 2016 that it was the first Cerner-powered HIE to connect to the DoD. We interviewed CCO Chief Administrator Brian Yeaman, MD a couple of months ago, who gave no hint that the wind-down was imminent.


Government and Politics

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A Backchannel article profiles the successes and uncertain future of the US Digital Service, created by tech-savvy President Obama, spearheaded by Todd Park, and enlisted to save Healthcare.gov but now wondering whether the Trump administration will keep the program. It’s a good article, although obvious election results bitterness makes it less effective (referring to the incoming President by last name only, slipping in smug put-downs, and ending with “God help us all” make it clear that the author doesn’t mind turning a nice feature into yet another ugly personal editorial). Here’s a snip of the less-whiny part:

Then came October 2013, when technology — once supposed to be an Obama strength — almost took down his administration. The signature legislation of his presidency, the Affordable Care Act, depended on a website that matched individuals to health insurers. It was a thermonuclear failure. When Park swooped into the situation with some of his PIF team, he realized that the only solution was to tap outside talent. Drawing on connections to the Obama campaign’s digital warriors and Silicon Valley companies, Park tapped a very small group of great coders and developers to rebuild in weeks, on the fly, what $500 million worth of contractors and government employees couldn’t do. In fact, an expensive, mishandled disaster was almost routine for government IT, where overpaid contractors with little oversight used outdated processes to work with jaded government workers. But this time the lifers had to cooperate. “The message that they got loud and clear from the White House was, This is bad enough that none of you is getting out of this alive,” Mikey Dickerson, a former Google engineer who led the team, later recalls. “Your only way out is if you get your act together and make the site work.”

CMS gives hospitals a couple of extra weeks to submit their eCQM data for the FY2018 EHR incentive program, extending the reporting deadline to March 13, 2017.

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A Health Affairs blog addresses the Congressional Budget Office’s estimates of the effects of ACA repeal, noting that House rules implemented on January 3, 2017 specifically prohibit CBO from talking about the effects of ACA changes. The article says, “Congress has thus placed itself in the position of appearing to prefer no information at all to information that might conflict with its political objectives.” Recent CBO estimates that ACA repeal would cause 32 million more citizens to lose insurance and that premiums will jump 25 percent in the first year were based on a study that was performed before the ban.

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Maryland-based Evergreen Health Cooperative – one of the last ACA-authorized, CMS-funded insurance co-ops that hasn’t gone belly up – converts itself to a for-profit, investor-owned insurance company.

Massachusetts plans to cap provider price growth rates and charge employers who don’t offer health insurance $2,000 per full-time employee. The state’s budget is getting hit hard by Medicaid enrollment that will grow to nearly 2 million in 2017 as full-time workers skip employer-provided coverage to take advantage of federal subsidies. The state’s previous universal coverage plan required employers to offer insurance and prohibited insurance-eligible employees from buying MassHealth coverage, but both requirements were eliminated with passage of the ACA.

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CMS Chief Medical Officer Patrick Conway, MD of the CMS Innovation Center will serve as acting CMS administrator with the administration change starting January 20 pending the Senate’s approval of Seema Verma. He replaces Andy Slavitt.


Privacy and Security

MAPFRE Life Insurance Company of Puerto Rico pays $2.2 million to settle HIPAA charges involving the 2011 theft of an unencrypted flash drive from its IT department that stored the information of 2,209 customers. MAPFRE also failed to follow through on correct measures assigned by OCR. The HHS announcement suggests that it scaled the settlement to the size of the multi-national company rather than the extent of disclosed information, which is an interesting way to assess penalties.

The daughter-in-law of a man who died 2014 says she was billed for new surgical procedures in the fall of 2016 by a specialty practice owned by Sentara, which recently announced that 5,400 of its patient records were exposed in a breach of one of its contractors.


Innovation and Research

An interesting New York Times article notes the startling finding by The Johns Hopkins Hospital that fewer female patients were receiving blood clot prevention treatment than male patients, leading the hospital to develop a computerized decision support system that collects information at admission and recommends treatment, taking human bias and subjectivity out of the equation.


Other

What a difference a domain makes: insurance shopping site Healthcare.com connected 2 million people with insurance brokers in 2016, all of whom confused it with the official Healthcare.gov.

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A study with a ton of flaws (old data, small sample size, lack of analysis to determine the appropriateness of ordering, failing to account for the demographic difference in non-EHR practices) suggests that doctors who use EHRs order more diagnostic imaging and laboratory tests than those who don’t.

Drug maker Mallinckrodt will pay a $100 million Federal Trade Commission fine for jacking up the price of H.P. Acthar Gel from $40 per vial to $34,000 and for blocking competition by outbidding another drug company for a similar drug. The company’s predecessor was an early dodger of US taxes in taking an Ireland tax address instead of St. Louis, reducing its taxes by more than half. Most its actions, however unsavory, were legal.  

A medical resident’s New York Times opinion piece warns that the volunteer army of people who care for their older relatives is stretched too thin due to longer life expectancy, more complex medical care, smaller family sizes, and greater geographic separation. The current ratio of seven potential family caregivers for each person over 80 will drop to three-to-one by 2050 with the resulting loss of income as they either leave their jobs or work fewer paid hours to focus on attending to their family member’s needs. The author suggests that doctors list family caregivers in the medical record, include them in decision-making, and train them to perform medical tasks.

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HIMSS finally acknowledges creation of its Media Lab that will “leverage the HIMSS database of over one million health and technology experts as our laboratory” to “lift audience engagement and revenue.” The Media Lab will use your personal information to “identify the emotional and business triggers” that will help it sell advertising-driven webinars, videos, and conferences to vendors. ”We know what information they [meaning you] consume,” HIMSS brags in describing members like a scientist talking about lab rats and highlighting that whatever “news” it produces should be taken with a grain of salt. The announcement adds, “Many healthcare IT vendors are struggling,” failing to mention that maybe the failing ones could use better products or leadership instead of more aggressive marketing. Every time I think HIMSS can’t possibly do anything more commercial or member-intruding in chasing vendor dollars, they prove me wrong (imagine the Salvation Army or Doctors Without Borders selling marketing advice and leads). As you might expect, the lengthy roster of the Media Lab people includes basically nobody with any education or background in healthcare or technology – their life’s work is to push whatever widgets they’re paid to promote. HIMSS Media runs the Privacy & Security Forum, so perhaps that’s a good venue in which to consider the privacy implications of selling member data to advertiser-stalkers. I wish I had Photoshop skills so I could superimpose Steve Lieber’s head onto that of Alec “Always Be Closing” Baldwin in the “Glengarry Glen Ross” shots above featuring “the good leads,” as HIMSS envisions those of us who pay dues and conference registrations.

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West Virginia Public Radio notes that the one bright spot in a state ravaged by drugs and unemployment is WVU Medicine, which thanks to the Affordable Care Act’s $12 million boost to its bottom line has been able to build new buildings and hire more than 2,000 people last year. The health system is the state’s largest employer and its flagship hospital runs at 98 percent capacity, with the CEO saying, “There’s almost an insatiable appetite for everything we do.” That’s good news for everyone except us federal taxpayers footing most of the bill. The health system’s 15,000 employees mean that nearly 1 percent of the state’s declining population works there.

A study finds that around-the-clock hospital chaos can cause and accelerate dementia in elderly patients that can ultimately kill them.


Sponsor Updates

  • Kyruus adds two physicians to its clinical advisory board.
  • Ivenix will demonstrate the integration of its Infusion Management System with EHRs and alarm management systems at the HIMSS17 Interoperability Showcase.
  • The Red Hot Healthcare podcast features Medicity’s Brian Ahier.
  • Optimum Healthcare IT publishes a new case study, “Security Remediation at a Large Academic Medical Center.”
  • NCQA certifies ZeOmega’s Jiva for five HEDIS 2017 measures.
  • Fortune ranks Health Catalyst one of the 30 best workplaces in the US technology industry.
  • GetWellNetwork’s All-In-One PatientLife Console achieves Electronic Product Environmental Assessment Tool certification.
  • InstaMed and PatientMatters will exhibit at the HFMA Mid-South Institute January 25-27 in Memphis, TN.
  • InterSystems will exhibit at the CIO Exchange January 22-24 in Orlando.
  • Intelligent Medical Objects will exhibit at the Allscripts 2017 South ARUG January 21-22 in Raleigh, NC.
  • TransUnion publishes a new white paper, “Money talks: Rethinking what it means to put patients first.”
  • MedData will exhibit at the American Society for Anesthesiologists Practice Management event January 27-29 in Grapevine, TX.
  • Meditech will exhibit at the 50th MHA Annual Mid-Winter Leadership Forum January 27 in Framingham, MA.
  • NTT Data team members support local children in need by volunteering at Cradles to Crayons.
  • Obix Perinatal Data System will exhibit at the SMFM Annual Pregnancy Meeting January 25-27 in Las Vegas.
  • Experian Health will present at the HFMA LA Women in Healthcare Luncheon January 24 in Baton Rouge.
  • Phynd will exhibit at the North Carolina Epic Users Group Meeting February 8-9 in Greensboro.

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
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EPtalk by Dr. Jayne 1/19/17

January 19, 2017 Dr. Jayne No Comments

CMS announced today that over 359,000 providers are confirmed for four CMS Alternative Payment Models in 2017. This includes over 2,800 primary care practices participating in the Comprehensive Primary Care Plus initiative.

Although CMS is celebrating this as a victory for improved quality and reduced costs, there are a couple of things to note about the numbers. First, CPC+ was originally opened for up to 5,000 practices and CMS recently expanded that to 5,500. The cohort is barely over half full, which could mean a couple of things.

First, it could mean that practices aren’t exactly clamoring to participate in these models, which require more documentation and increased compliance requirements in exchange for higher payments. Practices might be nervous that they can’t recover the increased outlay needed to participate. Second, it could mean that practices applied but weren’t qualified to move forward, which would be a sad commentary on the state of value-based care transformation. One would expect that at this stage in the game they’d be able to do better than half capacity.

The Medicare and Medicaid EHR Incentive Program attestation website is open for business. Participants have until the end of the day February 28 to attest to Medicare 2016 program requirements. State deadlines for Medicaid programs vary. There are plenty of resources out there and a handy dandy Attestation User Guide that I wish more of my prospective clients would read before they call me. It outlines the process in gory detail with lots of screenshots and answers a good number of the questions I frequently receive.

Lots of chatter around the physician lounge about Atul Gawande’s recent piece. His premise, that the US health system rewards “heroic” care at the expense “incremental” care is an issue that I’ve written about in the past. We’re always looking for the newest, most high-tech interventions, but we neglect to really advocate for (or fully fund) things like public health, disease prevention, cancer screening, and more. It’s not glamorous to sit in an exam room and have the same discussions over and over with patients about weight loss, smoking cessation, moderation in diet, and increased activity.

Gawande lays it out like it is: “As an American surgeon, I have a battalion of people and millions of dollars of equipment on hand when I arrive in my operating room. Incrementalists are lucky if they can hire a nurse.” That’s the unfortunate reality for many primary care and non-procedural specialists in our healthcare system. Technology and incentive programs are supposed to help us better manage patients and level the playing field, but for some physicians, it’s too little, too late. Two more of my favorite physicians retired at the end of the year and I think we’re going to continue to see attrition in the generalist ranks.

The biggest chatter, though, has of course been about the upcoming inauguration and the pending repeal of the Affordable Care Act. One rumor making the rounds is that MACRA will also be repealed, which is an entirely different situation. It doesn’t help that plenty of people don’t understand the difference between the two, which adds to the confusion. Patients are also extremely worried about the potential loss of insurance coverage and increased premiums, regardless of whether their coverage is through employers or individual purchase.

The HIMSS17 invitations have started rolling in, but I happened across the Salesforce Trailblazer Party at BB King’s Blues Club on Tuesday night. I’m guessing I might be out of touch with some pop culture phenomenon, but I’m not following what is going on with the character in scrubs with mittens and an animal suit. There are also plenty of one-off marketing emails coming in. Pro tip: please make liberal use of spell check and grammar check. The plural of customer is “customers” not “customer’s.” Don’t just say you’re revolutionary – tell me why and what you do.

An informatics colleague handed me an article about the new Forward clinic in San Francisco. They’re advertising “AI and doctors working together to better manage your health.” Billing it as a “Health membership” they charge $1,800 a year, which they cleverly market as “$149/month billed annually.” Although they say they have a world-class medical staff, I didn’t see any names listed on the website. They do have a body scanner to give a “rapid picture of overall health.” One article about the practice has some interesting premises. It talks about the ability to re-engineer the user experience at the physician office. One example is a “hidden alcove for urine samples in the bathroom, and no need for an embarrassing walk down the hall.” Many physician offices (especially those that perform a lot of urine testing) already had those, so not revolutionary.

It also mentions the body scanner: “a machine that takes a few cents of electricity to run replaces the traditional 20-minute examination for blood pressure, heart rate, and other vital signs.” I hate to tell the Silicon Valley folks, but if 20 minutes was their baseline, that’s terrible. Very few primary care physicians (at least those of us working on the hamster wheel) would tolerate a staffer that took 20 minutes to perform basic patient intake. The efficiency nut has already been cracked by vital signs monitors that integrate to the EHR and smart beds that perform weight when the patient sits down. The article does include a comment from a physician and former venture capitalist who notes that the complexity of the healthcare market is often underestimated and I would tend to agree.

Another article mentions that “people with longer term issues such as obesity, high blood pressure, or skin problems will go home with sensors that can transmit data back to Forward.” I get the obesity and blood pressure hook, but skin problems? What are they sensing? And is it evidence-based? Has it been peer reviewed or approved by the FDA? Or is it digital snake oil? Health policy expert Paul Ginsberg is cited in the piece and notes the risk of unnecessary tests being triggered by use of sensors: “The notion of scanning people who don’t have a problem has been very solidly dismissed by the medical profession for a while.”

What do you think of Forward? Email me.

Email Dr. Jayne.

Morning Headlines 1/19/17

January 19, 2017 Headlines No Comments

CMS announces extension of 2016 reporting deadline and intends to modify 2017 requirements

CMS notifies eligible hospitals participating in Meaningful Use that the deadline for submitting eCQM data for the 2016 reporting period has been moved from February 28 to March 13 and reports that additional changes are being considered to further ease reporting burdens.

Using the Electronic Health Record to Understand and Minimize Overuse

A JAMA article suggests that EHRs will deliver value by helping identify and minimize unnecessary, low-value care which the authors say accounts for “substantial health care expenditures and may cause harm.”

Theranos just made another major leadership change

Just prior to news broke that Theranos failed a second CMS inspection at one of its blood testing labs, the company announced a new advisory board that will focus on technology.

Trump HHS pick Tom Price faces Senate questioning on Obamacare, stock buys

Representative Tom Price, MD, President-elect Trumps pick to lead HHS, faces questions before the Senate HELP committee.

CIO Unplugged 1/18/17

January 18, 2017 Ed Marx 2 Comments

The views and opinions expressed are mine personally and are not necessarily representative of current or former employers.

Baking with Oma

Oma — my mom and the grandmother of my kids — was dying a slow death at the hands of ovarian cancer. While cruel, it allowed us four years to say goodbye. Often life ends suddenly and you never get a chance to say goodbye. We had a long farewell. I wrote extensively about Oma’s influence on my career in 2010.

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Growing up, Oma used November to bake. She baked thousands of German Christmas cookies for family and select friends. Under the cover of darkness (or so it seemed), Oma carefully placed the treasure of spitzbuben, haselnussmakronen, and weihnachtsplätzchen in large tins in the cool, dry utility room. They were sealed until the first advent of Christmas.

Through the Advent season, we sang carols, read scripture, and lit the candles on the Advent wreath. With the spice of mulled cider in the air, Oma distributed plates full of cookies to each of us kids, and to Opa — if he behaved. Christmastime was near, which also meant it was time for cookie trading. Cookies displaced dollars as currency during the holidays.

When Oma took ill, something nudged me to carry on the German Christmas cookie-baking tradition to honor her and keep our heritage alive.

The Christmas before her death, we flew Oma and Opa for a visit – and to bake. Oma baked from scratch and out of love, following secret family recipes that had been handed down through generations. With my kids, we dutifully watched and practiced the art of German Christmas cookie-baking with Oma.

Today, despite careful translation, calculations, and experimentation, our creations are not as tasty as Oma’s, but we remain determined. One of my sisters also continues the tradition and we now have annual cookie-tasting contests to see whose baking finesse is closest to Oma’s.

I cherished the times we baked with Oma and I know she loved to teach her kids and grandkids. I still can see our flour-covered aprons, smell the sugar and cinnamon melting in the oven, and hear the retelling of stories about previous generations and their baking escapades. Rat Pack Christmas records would play in the background and texts and phone calls would not interrupt us. We relished in the pure joy of togetherness and enjoyed laughter, silliness, and I confess, raw cookie dough.

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This year, our baking tradition grew to include my two daughters plus the girlfriends of our youngest boys. There I was, like Oma years before, converting grams to ounces and reminiscing. Oldest daughter Talitha is now the baking matriarch and organized our novice bakers. Seven hours later, we had baked a dozen dozen German Christmas cookies. We even managed to bake some gluten-free cookies since we wanted to be politically correct.

Lessons learned baking with Oma:

  • If you want to know people, you have to spend time with people. That’s pretty obvious, but ask yourself how many hours you spend with family or direct reports really getting to know them. My relationship with Oma grew exponentially after I left home because of the uninterrupted hours we were able to spend together being silly, doing things like baking cookies.
  • Magic happens when you create together. Watching movies is fun and taking walks enables conversation and touch. But when you create together, it takes relationships to another dimension. While certain deliverables may take longer to create, I am increasingly amicable to working with others to develop presentations and other work products.
  • Learning stimulates creativity. I am not averse to the kitchen, but I have never really enjoyed cooking. However, baking with Oma stimulated my creativity by forcing me to learn new things, such as how the mixture of various ingredients and the addition of heat can bring about change. I now recognize that there are many parallels between baking and many work activities that can lead to transformation and innovation.
  • There is joy in cooking. It’s not so much the cooking that brings the joy, but the uninterrupted time spent with the ones you love. There is no joy in multitasking. I continue to struggle, but I am getting better at putting my phone away.
  • Serving is good for the soul. Many of us don’t take the opportunity to serve enough. Baking cookies and sharing them is a simple act of service (though arguably it matters whether or not they taste good.) Delivering cookies you baked to friends and families is powerful. It reflects the money, time, and energy you poured into creating something for the benefit of others.
  • Understand the workflow. There is no substitute for being there and walking the walk. Had Oma sent emails that we followed ingredient by ingredient, line by line, our cookies would have been OK. It was not until she was with us and we watched and emulated her, however, that we really understood. Understanding the workflow turned out to be the ultimate secret ingredient.
  • Create memories that lead to legacies. Oma was absolutely the queen of cookie baking! The memories that my siblings and kids have of Oma are forever etched in our minds and we fondly retell our stories of German Christmas cookie-baking hundreds of times. Memories and legacies matter, as evidenced by my own family’s commitment to annual bake-offs to see whose cookies most closely emulate Oma’s. Consider what you are best known for in the workplace and decide if it’s the legacy you want to create.

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I could continue with lessons learned, but these are the ones that quickly come to mind as I reflect on this past holiday season. The pictures and videos don’t do justice to the bonding that takes place when you take time to be in the moment and create with family, friends, and co-workers. Look for such opportunities in your daily life. I promise you won’t regret the time spent creating new memories.

Cookie, please.

Ed encourages your interaction by clicking the comments link below. He can be followed on LinkedIn, Facebook, Twitter, or on his web page.

Readers Write: Are You Ready for the Quality Payment Program?

January 18, 2017 Readers Write 6 Comments

Are You Ready for the Quality Payment Program?
By Kory Mertz

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With the start of the New Year, the first performance period for the Quality Payment Program (QPP) has officially started. The QPP, part of the MACRA legislation, was passed with strong bipartisan support in Congress and sends a clear signal of the federal government’s accelerating effort to move to value-based payments.

QPP creates two new tracks for Eligible Clinicians (ECs), as program participants are called: the Merit-based Incentive Payment System (MIPS) and the Alternative Payment Models Incentive Program.

MIPS

MIPS consolidates and sunsets three programs focused on ambulatory providers: the Physician Quality Reporting Program, the Value-Based Payment Modifier, and the Medicare EHR Incentive Program for eligible professionals. In 2017, ECs can receive a maximum payment adjustment of plus or minus 4 percent based on their performance in four categories. ECs who are new to Medicare or who bill less than $30,000 or see fewer than 100 Medicare beneficiaries during a year will be exempt from MIPS.

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In response to significant feedback from the provider community, the Centers for Medicare and Medicaid Services (CMS) has simplified the requirements and made 2017 a transition year to help ECs get used to participating in MIPS. Providers have three general approaches they can take:

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Alternative Payment Models Incentive Program

The second track of QPP is focused on increasing EC participation in Alternative Payment Models (APM) (i.e. Accountable Care Organizations, bundled payments, etc.) by offering a 5 percent bonus and exemption from MIPS for ECs who participate in an Advanced APM and meet certain participation thresholds. In 2017, ECs must have at least 25 percent of their Medicare payments or 20 percent of their Medicare patient panel in a CMS Advanced APM to receive the bonus and MIPS exemption. ECs who meet lower payment or patient thresholds have the option to be exempt from MIPS. CMS maintains the list of qualifying Advanced APMs here.

Moving Forward

The overarching framework created in the legislation and initial rulemaking completed by the Obama Administration will continue unchanged in 2017. The Trump Administration will have a chance to put its own twist on the QPP in 2017 by filling in the program implementation details through sub-regulatory guidance (much like CMS has done with the Meaningful Use program) and in 2018 and beyond through rulemaking to establish future program requirements. If Representative Tom Price is confirmed as the Secretary of the Department of Health and Human Services, he may accelerate efforts to reduce provider burden and simplify the QPP.

As providers prepare to participate in the first year of QPP and HIOs prepare to support providers’ success, they should keep the following in mind.

  • While APMs have gained significant attention in recent years, CMS anticipates that the vast majority of providers will participate in MIPS in the early years of the QPP.
  • Providers just beginning to think about the QPP requirements should  generate reports to determine which providers are likely to be an EC during the performance period and which will fall under the low volume exclusion; map out the existing TIN/NPI structure of the organization to help support decision making around group versus individual reporting; and undertake a scan across the organization to determine existing Advanced APM participation by ECs. If an organization participates in an Advanced APM, a report should be generated based on all participating providers to determine if participants will qualify for a bonus and MIPS exemption under the APM track.

HIOs have the opportunity to position themselves to support providers’ success in QPP. HIOs should ensure they have functionality that aligns with program requirements, including:

  • Implement certified tools to collect and submit electronic quality measures to CMS to support ECs and help them achieve bonus points for the quality performance category.
  • Support ECs success with a variety of ACI measures including HIE (send and receive); view, download and transmit; and submitting information to public health and clinical data registries. A key consideration in determining which measures to support include the existing exchange environment the HIO operates in, if certified technology is required to meet the measure, whether the HIO’s technology meets the requirements (i.e. providing machine readable C-CDAs), and the ability to provide ECs necessary audit documentation.
  • Support improvement activities. For example, “Ensure that there is bilateral exchange of necessary patient information to guide patient care that could include one or more of the following: Participate in a Health Information Exchange if available; and/or use structured referral notes.” A key consideration for supporting improvement activities is whether the HIO has the ability to provide ECs with necessary audit documentation.

Kory Mertz is senior manager of Audacious Inquiry of Baltimore, MD.

Morning Headlines 1/18/17

January 17, 2017 Headlines No Comments

How Repealing Portions of the Affordable Care Act Would Affect Health Insurance Coverage and Premiums

The Congressional Budget Office publishes its predictions on the impact ACA’s repeal will have, concluding that premiums will spike and the number of people who are uninsured would increase by 18 million in the first coverage year following the repeal.

Second Theranos Lab Failed U.S. Inspection

Theranos fails an inspection of its Scottsdale, AZ blood testing lab but fails to disclose this information to its investors.

Introducing IMEDS, a Public-Private Resource for Evidence Generation

The FDA launches the Innovation in Medical Evidence Development and Surveillance System, or IMEDS, which will make the FDA’s Sentinel System data and analytics tools available to private researchers.

The Heroism of Incremental Care

In a New Yorker op-ed, Atul Gawande, MD compares the incremental approach primary care providers take in managing conditions with the one-and-done approaches surgeons prefer, conceding that primary care may be doing more good in the long run.

US insurers get inside cars, mouths, grocery carts in profit search

Reuters covers the use of data mining by health insurers to help price policies and target profitable customers more effectively.

News 1/18/17

January 17, 2017 News 7 Comments

Top News

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The Congressional Budget Office says that repealing the Affordable Care Act will cause the number of uninsured Americans to jump by 18 million in the first year, swelling their numbers to 32 million in 10 years.

CBO predicts that Insurance premiums for individual policy-holders will increase by 25 percent in the first year following repeal and will double within 10 years.


Reader Comments

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From James Jones: “Re: Merge Healthcare. The big story is Nancy Koenig leaving, but the positive news is that the reorg relates to growth, not downsizing, and that the first cognitive product will be releases in Q2 2017. Here’s the internal email sent to the team on January 10.” The internal email says that the first cognitive solution release under IBM Watson Health will address aortic stenosis.

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From Pilsner: “Re: Santa Rosa Consulting. Deleted all its past tweets.” I contacted the company, who says they cleaned up their Twitter account following the departure of one of their internal marketing folks. The Twitter account will be put into use again following an upcoming rebranding.

From Willie Slicker: “Re: HIStalkapalooza. You should keep doing them – it’s great for HIStalk branding.” I don’t pay much attention to HIStalk branding, but as it stands, what I am paying attention to is the check I’ll have to write to cover the event’s cost beyond what sponsors are graciously underwriting. That has understandably dampened my enthusiasm from throwing further free parties since I have to ante up nearly double what I paid for my last new car a couple of years ago.


HIStalk Announcements and Requests

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Thanks to our two new HIStalkapalooza sponsors. Lucro offers a digital platform that helps health systems make better, faster, less-risky purchasing decisions. Physician’s Computer Company (PCC) provides EHR/PM for pediatricians that consistently out-KLASses all competitors with a 95.1 overall score.

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We helped Ms. L from Missouri in funding her DonorsChoose grant request for STEM learning materials. Her fourth graders are building the example electronic circuits and will then move on to creating their own designs.

Listening: new from Kvelertak, face-melting heavy metal from Norway that requires all of my limbs for desk drumming, complete with showy flourishes of my imaginary sticks. Face-melting isn’t for everyone, so there’s this: new from Khalid, a stunningly expressive 18-year-old singer and musical newcomer from El Paso, TX who blends R&B with old-school soul. Mark your calendars for six months from now – Khalid is going to be big.


Webinars

January 18 (Wednesday) 1:00 ET. “Modernizing Quality Improvement Through Clinical Process Measurement.” Sponsored by LogicStream Health. Presenters: Peter Chang, MD, CMIO, Tampa General Hospital; Brita Hansen, MD, CHIO, Hennepin County Medical Center. The presenters will describe how they implemented successful quality governance programs, engaged with their health system stakeholders, and delivered actionable information to clinical leadership and front-line clinicians. Q&A will follow.

January 26 (Thursday) 1:00 ET. “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.” Sponsored by Healthwise. Presenters: Jim Rogers, RN, RPSGT, director of healthcare solutions, Persistent Systems; Jason Burum, chief client officer, Healthwise. This webinar will explain how to implement a patient-centered care coordination program that will increase quality as well as margins. It will provide real-world examples of how organizations used care coordination to decrease readmission rates, ED visits, and costs.

February 1 (Wednesday) 1:00 ET. “Get your data ready for MACRA: Leveraging technology to achieve PHM goals.” Sponsored by Medicity. Presenters: Brian Ahier, director of standards and government affairs, Medicity; Eric Crawford, project manager, Medicity; Adam Bell, RN, senior clinical consultant, Medicity. Earning performance incentives under MACRA/MIPS requires a rich, complete data asset. Use the 2017 transition year to identify technology tools that can address gaps in care, transform data into actionable information, and support population health goals and prepare your organization for 2018 reporting requirements. 


Acquisitions, Funding, Business, and Stock

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Document solutions vendor Auxilio acquires healthcare security solutions vendor CynergisTek for $34 million in cash and shares. CynergisTek generated $15 million in revenue and $5 million in EBITDA in 2016.

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Dear Auxilio, you forgot to change your site’s title in WordPress, so it looks really amateurish in Google searches and on the browser tab. Please correct this at your earliest convenience. Yours, Mr. H(TML), who also wonders whether “at your earliest convenience” really means something since it sounds more like something a non-native English speaker would say. At least don’t make “at my earliest convenience” part of your voicemail greeting because what that means is that you’ll call back whenever you feel like it regardless of your caller’s needs.

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Forbes profiles the just-launched Forward, a San Francisco primary care practice started by a serial entrepreneur who sold his artificial intelligence company to Google. Forward describes itself as looking more like an Apple Store than a doctor’s office. Members who pay $1,800 per year are tested on an AI-powered body scanner, are given a wearable device that the practice says it will monitor, and are sold branded nutritional supplements. We’ll have to take their word on having doctors with “world-class backgrounds” since the company is too enamored with its architecture and apps to say who’s actually delivering the care it offers (maybe it’s just a bunch of hipster docs sitting at a Genius Bar). The track record of millennial-pandering “startups” like this is pretty abysmal, both in terms of financial viability as well as making much of a difference in population health. I’ll be shocked if it’s still around two years from now.

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Formativ Health – formed last week by Northwell Health and Pamplona Capital Management – acquires EHR/PM/RCM vendor Etransmedia. It’s probably not relevant, but Northwell – the former North Shore-LIJ – uses Allscripts, which in 2014 lost a $10 million deceptive business practices case to Etransmedia, who bought a bunch of Allscripts MyWay licenses for resale only to get stuck with them when Allscripts abandoned the product. Etransmedia developed and sells the Connect2Care EHR/PM.


Sales

John Muir Health (CA) chooses Sectra’s cloud-based image archive and universal viewer.


People

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CTG hires Hamish Stewart-Smith (Encore Health Resources) as managing director of healthcare sales for North America. He is a United States Air Force Academy graduate who spent 11 years as an officer.


Announcements and Implementations

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HIMSS further blurs the barely visible line it draws between providers and vendors in launching a marketing summit in Las Vegas, with Steve Lieber saying, “We specialize in supporting organizations who market tech solutions to HIT customers.” At least he’s honest in admitting that what HIMSS does best (and most profitably) is to help HIMSS vendor members sell stuff to HIMSS provider members. Another aspect of that blatantly commercial offering is the apparently new HIMSS Media Lab (referenced but not mentioned in the announcement), whose primary objective seems to be selling ad space in HIMSS publications and relentlessly targeting the provider audience in being “obsessed with getting under their skin, on their mind, into their hearts” as they “study professionals in their natural habitat.” It’s interesting that HIMSS is launching a conference targeting marketing professionals while simultaneously trying to take away their business. Provider-siders who feel like lab rats being studied as they attempt to avoid predators now understand that they’re in the HIMSS version of “The Twilight Zone,” where the seemingly normal small town is not as it seems. We are all just paying acolytes in the HIMSS Church of the Generated Lead.

McKesson offers a cloud-based option for InterQual Criteria.


Government and Politics

FDA announces IMEDS, which will give patient safety researchers access to privacy-protected drug and medical device safety reports. 

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I found the ethics disclosure form of HHS Secretary nominee Tom Price, MD, who reports holding shares in Athenahealth and McKesson. Meanwhile, Sen. Al Franken and two colleagues ask to have Price’s confirmation hearing postponed pending an ethics investigation after reports that he traded shares of healthcare companies while sponsoring legislation that could have affected their share prices to his benefit.

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McKesson will pay $150 million to settle federal charges that it violated the Controlled Substances Act by failing to report pharmacy customers that ordered suspiciously large quantities of oxycodone and hydrocodone. The company will also stop filling controlled substances orders from its distribution centers in four states.


Privacy and Security

From DataBreaches.net:

  • Sentara Healthcare (VA) notifies 5,000 patients that their information was exposed in a breach involving an unnamed Sentara vendor.
  • Little Red Door Cancer Services of East Central Indiana is hit with ransomware, with hacker The Dark Overlord demanding a $43,000 payment that the non-profit agency declined to make since it was able to restore from a cloud-based backup.
  • In Canada, a pediatrician who had been accused by several parents of falsely claiming they had abused their children kills himself after sending a media outlet a USB drive with patient information that apparently supports his abuse claims.

Reuters covers the ways insurance companies are using technology to measure customer behavior and potentially to set premium rates accordingly. Examples: a Bluetooth-enabled toothbrush that phones home to a dental insurance company, car monitoring devices that record driving habits, and fitness trackers whose information is reported back to insurers. Those in favor say the information can change behavior positively, while critics are concerned that the information will be used to charge some customers more or to cherry-pick only lower-risk consumers.


Other

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A review of the Orphan Drug Act concludes that drug companies have hijacked the law’s noble intentions (encouraging them to develop drugs for rare conditions) by invoking orphan drug status for mass-marketed drugs to get seven more years exclusive marketing rights. The skyrocketing number of orphan drug approvals includes such bestsellers as Crestor, Ability, Herceptin, and the Humira (the world’s best-selling drug) as companies repeatedly file for protection using new rare conditions. Seven of the 10 best-selling drugs were so-called orphan drugs that earned rare disease approval after the fact. Drug companies are being coached on the process by former FDA officials who have hung out consulting shingles for fees that can approach $100,000, suggesting that the companies employ approaches such as trying out their existing drugs for treating unusual diseases in Africa. 

A Johns Hopkins study finds that privately insured patients get stuck with the high bills of out-of-network doctors hired by in-network hospitals, noting that the doctors with the highest markup (defined as the multiple they charge private patients vs. their Medicare rates) are those the patient doesn’t choose. Anesthesiologists, ED doctors, pathologists, and radiologists charge four times the rate Medicare pays them. Anesthesiologists in 10 cities made up the top 2.5 percent.

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Surgeon-author Atul Gawande, MD admits in a New Yorker article that he has failed to appreciate the role of the primary care physician whose impact on health is less immediately decisive but no less important than the stroke of his well-aimed scalpel. He notes that his OR is equipped with a battalion of people and millions of dollars worth of equipment, while “incrementalists” are lucky to afford a nurse. Some snips:

We will increasingly be able to use smartphones and wearables to continuously monitor our heart rhythm, breathing, sleep, and activity, registering signs of illness as well as the effectiveness and the side effects of treatments. Engineers have proposed bathtub scanners that could track your internal organs for minute changes over time. We can decode our entire genome for less than the cost of an iPad and, increasingly, tune our care to the exact makeup we were born with. Our healthcare system is not designed for this future—or, indeed, for this present. We built it at a time when such capabilities were virtually nonexistent. When illness was experienced as a random catastrophe, and medical discoveries focused on rescue, insurance for unanticipated, episodic needs was what we needed. Hospitals and heroic interventions got the large investments; incrementalists were scanted …But the more capacity we develop to monitor the body and the brain for signs of future breakdown and to correct course along the way—to deliver “precision medicine,” as the lingo goes—the greater the difference health care can make in people’s lives, as well as in reducing future costs. This potential for incremental medicine to improve and save lives, however, is dramatically at odds with our system’s allocation of rewards.


Sponsor Updates

  • HBI Solutions produces a video titled “Spotlight Data Solution Overview.”
  • Agfa Healthcare publishes a new white paper, “How Enterprise Imaging Aligns with Value-Based Care.”
  • Besler Consulting releases a new podcast, “A closer look at patient reported outcomes.”
  • EClinicalWorks will exhibit at the NHMI Annual Orthopaedic Winter Meeting January 20-21 in Stowe, VT.
  • Healthgrades announces the recipients of its 2017 Distinguished Hospital Award for Clinical Excellence.

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates. Send news or rumors.
Contact us.

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Morning Headlines 1/17/17

January 16, 2017 Headlines 1 Comment

Trump Is Considering Another Thiel Associate to Lead FDA

President-elect Trump is reportedly considering Silicon Valley executive Balaji Srinivasan to lead the FDA. Srinivasan has no medical background, but earned consideration because he is a Peter Thiel associate.

Survey Snapshot: What Patient Engagement Technology Is Good For

A recent NEJM Catalyst survey on patient engagement tools finds that providers are excited about the potential benefits associated with new technologies, but do not know which ones to recommend.

You can now book workout classes directly from Google

Google partners with digital health startup MindBody to let users search for, book, and pay for exercises and wellness classes from within Google’s search results.

Why Regulating AI Is A Mistake

Following the recent death of a passenger who was driving in an auto-piloted Tesla, AI experts weigh in on the pros and cons of regulating the use of artificial intelligence.

Curbside Consult with Dr. Jayne 1/16/17

January 16, 2017 Dr. Jayne No Comments

In the hospital, a curbside consult is an informal consultation between physicians that avoids the sometimes cumbersome request and documentation requirements for a “real” consultation. Of course, without the request and documentation piece, it also avoids the billing and payment piece, so it’s essentially a freebie given between colleagues.

Most of the time you never know who the patient is. It just starts out along the lines of, “I wanted to pick your brain about this guy…” Doctors get curbsided by their friends and family members as well, usually about a test result or a visit to the doctor. Most of the time the requests I get from friends are easy to answer. This week though, my IT colleague Jimmy the Greek asked me to translate his MRI and I was digging deep to find anything in my memory about a “pistol grip deformity” of the hip.

Thank goodness for eOrthopod, who was able to quickly answer my question so I could talk intelligently about his situation, which I had been following tangentially over the last few months. As we go boldly where no one has gone before with a new president and the impending repeal of the Affordable Care Act, I thought it was worthy of sharing and discussion. So get your popcorn, wine, tequila, or other beverage of choice and sit back for the first installment of Dr. Jayne’s Journal Club, where we will review a patient case presentation.


A year ago, I injured my hip in martial arts class participating in kicking-for-height competition with a 15-year-old whose flexibility would make Gumby green(er) with envy. I’ll have your loyal readers know that I won that contest, despite the fact that I seem to have lost the war, and have now been set adrift in the murky waters of consumer-driven healthcare. For months, my hip would hurt, so I’d rest it, but then go take another martial arts class, where I’d aggravate the injury again. I finally quit taking lessons in August and I assumed that without the thrice-weekly strain I was putting on the injury, it would heal quickly. Finally, in October, I couldn’t take it anymore and went to see my chiropractor. (Being a savvy consumer of healthcare services, I didn’t want to go see my orthopedist right off, as that’s like asking my barber if I need a haircut).

After a few weeks of adjustments, home exercise, and K-Tape, my chiropractor referred me to a physiatrist. I was warned ahead of time that, “He and his office staff are . . . a bit quirky.” My first impression of this highly-regarded doctor was formed when he blasted the exam room door open, pointed at me, motioned toward the hallway, and said “You – come out here.” While his bedside manner (and as I learned later, professionalism) left quite a bit to be desired, he seemed knowledgeable and capable, and really, that’s what’s important.

I was sent for an x-ray to rule out anything skeletal and told that the office would receive the results electronically and call me to discuss next steps. After completing the x-ray, I left a voice mail in the practice’s general mailbox to let them know. The outgoing message admonished me to wait at least 48 hours for a reply and not to call back before then, as doing so would drop me to the end of the line. I waited a whopping four days for a call back and finally decided to risk my place in line. The not-so-cheery voice on the other end of the phone told me that no, I would not get a call, and no, I did not need an appointment. All I had to do was show up on the practice’s doorstep, imagery in hand, and the doctor would see me immediately. I agreed to come in the next week, as I was on vacation from work.

Fast forward to Monday morning, when I darkened the aforementioned doorstep with my presence. Sadly, that’s all I could darken because the door was locked. It seems that this paragon of all that is good and right with the practice of medicine decided to take Monday off. The desk staff was working, however, and when I bent their collective ear about better communication with patients, I was (quite literally) screamed at for my trouble. For those of you keeping track at home, I had already been given two conflicting pieces of information about how to get my test results, neither of which I would later find out was correct. Dr. Professional reviewed my x-ray early the next morning and decided I was in need of an MRI with contrast agent.

This morning, I dutifully arrived 15 minutes early for the procedure so I could fill out the exact same paperwork I had filled out before the x-ray, despite the fact that I was merely at a different location of the same imaging firm run by the same hospital system. I was told by the technician who was getting me prepped for the procedure that the radiologist performing the arthrogram is notoriously late. When she finally arrived (15 minutes after her scheduled start time), she approached me with a needle that looked like a cross between a whaling harpoon and the drill bits that arctic researchers use to take core samples. Once the lidocaine kicked in, though, it didn’t matter. The staff tried valiantly to get me to use the standard MRI machine, but in the immortal words of Clint Eastwood, a man’s gotta know his limitations. Mine happen to include enclosed spaces. Off we went to the “open” machine, which, much to my chagrin, is about as open as Internet access in North Korea. I only required one break from my incarceration in the evil machine.

Instead of going straight home, I decided to drop in on Dr. Wonderful (CD in hand) to get his take on my MRI. While en route, I called the office to make sure he was there. It only took me three tries to get through to a human. When I told her why I was calling, she was astonished that I would ever think to just drop in, because as everyone knows, an appointment is required to review imaging results with the doctor. So now I wait until next week.


I am familiar with the physician in question, but hadn’t had any patients in common for nearly a decade, so decided to do some Google stalking. He’s on staff at Big Medical Center, so would have access to the clinical data repository at a minimum and most likely would have direct access to the PACS due to his specialty. He’s been recognized multiple times by his peers as one of the community’s “Best Doctors in Town” which can be confusing since patients don’t understand how those honors are usually bestowed. Our city’s magazine that runs the feature every year solicits feedback from other physicians, but many of us think it’s a joke because one colleague had moved away three years prior but continued to be on the “best doctors” honor list.

He’s got four stars on Healthgrades with 28 reviews and no disciplinary actions by the board of healing arts. But it sounds like his practice is disorganized and doesn’t take advantage of patient-friendly technology solutions like a patient portal or secure messaging, even though they have a portal link on the practice website. There’s no information on the website about the processes and procedures that didn’t work so well in this case, so a patient looking to do things the “right way” would have trouble confirming.

Of course, in consumer-driven healthcare, the patient’s main recourse is to vote with his feet, which is sometimes challenging to do when you’re partway into a course of treatment or into a diagnostic process with another provider. Fortunately, our patient has his imaging studies in hand, which sadly not every patient has. Our patient is also a well-educated IT guy with the flexibility to make time during the day to call offices and run down results, and many patients don’t have the ability to do those things, making their diagnostic and treatment course even more fragmented.

When I hear about situations like this, I think about whether technology would have made anything better. There were definitely some opportunities here, but the real issue isn’t something that the current focus of regulation or rulemaking is going to address, other than patient satisfaction scores, which I hope were appropriately low in this case, if they were even solicited.

Our patient has since been referred to an orthopedic surgeon, so we’ll have to check in with him down the line to see if the brave new world of high tech healthcare has done any better for him. As a consultant, I see these situations all the time, and typically the physician is resistant to change as are the members of the office team, who seem to be part of the problem here. The worst cases are often the hardest to fix.

Email Dr. Jayne.

Morning Headlines 1/16/17

January 15, 2017 Headlines No Comments

Justices Will Hear Challenges to Mandatory Employee Arbitration

The Supreme Court agrees to hear a case brought by Epic and two other corporations seeking clarification on the use of arbitration clauses in employment agreements that prohibit employees from banding together to take legal action over workplace issues.

Hospital closes systems after IT attack

In England, Barts Health NHS Trust shuts down several of its IT systems after suffering a “non-ransomware” cyberattack.

The Biggest Changes Obamacare Made, and Those That May Disappear

The New York Times offers point-by-point analysis of the real impact of repealing ACA and outlines possible replacement legislation.

Rudeness and Medical Team Performance

Researchers in Israel finds that when nurses are scolded by rude patients, their performance decreases across all measured clinical quality categories for not only that patient, but all of their patients. Preventative cognitive bias modification programs were shown to help neutralize the impact rudeness has on performance.

Monday Morning Update 1/16/17

January 15, 2017 News 5 Comments

Top News

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The US Supreme Court approves the request of Epic and other companies that asked the court to rule on the use of arbitration clauses in employment agreements to prevent employees from filing labor-related class action lawsuits.

Two federal appeals courts have ruled that the National Labor Relations Act protects the right of employees to engage in “concerted activities,” while a third court has rejected that argument in saying that the arbitration clause prohibits employees from suing their employer as a class.

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Epic wants to the court to set a standard by which such arbitration clauses will or won’t be consistently enforced.


Reader Comments

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From Pappadum: “Re: MD Anderson’s losses and layoffs. Encore ran the selection process and made $48 million, while third parties were paid hundreds of millions of dollars more. The larger story is how companies stand to benefit from an Epic selection (selling services afterward) and Epic’s inability to control the cost of their projects given their third party dependencies. You would think a system as notable and healthy as MDA would generate more discussion in the risk/reward of implementing Epic.” Unverified. I don’t have a lot to say about how consulting firms steer clients toward systems and then sell them more services, or that Epic projects are nearly always eye-poppingly expensive. However, MDA signed every agreement (apparently without a gun to its head) and is responsible for its own implementation no matter who it hired to help or at what price it elected to pay. It has a track record of underperforming EHR implementations, all the way through the homegrown ClinicStation system that Epic replaced, so perhaps the outcome was predictable. Certainly the entire industry could learn from MDA’s experience, but I don’t expect they are anxious to share. Also, to be fair, it’s early in their implementation when a lot of Epic projects look bleak before improving, not to mention that many if not most of MDA’s problems don’t have anything to do with Epic even though it’s an easy target.

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Perhaps this is a good time to refer folks to my report on Epic from almost a year ago, in which I obtained insight directly from Epic-using health systems (22 CEOs, 13 CFOs, 96 CIOs, 39 chief medical officers, and 32 chief nursing officers). All of those CFOs say they would choose Epic again, and even though project cost was Epic’s lowest score by far in my report, only 15 percent of CFOs said their projects ran over budget. The CFOs scored Epic at 7.4 on a 10-point scale on the all-important question of whether Epic’s benefits were worth its initial and ongoing costs.

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From Spiritus Frumenti: “Re: Zynx, Has essentially laid off their entire executive team.” It’s apparently a bit lonely at the top, as the company’s executive page lists only President Kevin Daly and SVP Jim Connolly. Having been expunged in the past six weeks are the other two executive team members, Bertina Yen and Victor Lee, both of them physician VPs who, according to LinkedIn, left in December 2016 (Yen does not list a current employer, while Lee is now VP of clinical informatics at Clinical Architecture). Going back a year ago finds eight executives listed, all of them now missing except for Jim Connolly. Daly was promoted to president from another Hearst company, MCG, in January 2016.

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From Cheesy Goodness: “Re: Epic’s Community Connect program, as at UIHC. It’s a stroke of genius since it takes Epic out of the picture for selling and servicing small community organizations (which Epic is not built for), it creates additional ties with the reselling large provider organization and thus increases barriers to their replacing Epic, and it hits hard at competitors such as Athenahealth and EClinicalWorks.”

From Porkpie Hat: “Re: Merge Healthcare. Lots of major reorgs going on under IBM Watson Health.” Unverified. 

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From Man About Town: “Re: WSJ article claiming Epic is hindering interoperability. This doesn’t bode well. The majority of Judy’s employees very publicly supported Democrat candidates, which served the company well when they were in power, but now could lead to repercussions.” The article was poorly done and full of inexpert opinions more suited for a crappy LinkedIn vanity piece than WSJ, but it did get exposure it didn’t deserve. I don’t think rather modest political donations will have much of an impact either way. I’m also certain Epic’s lobbying firm, Card & Associates (which had strong connections to the George W. Bush White House) is – like all other DC lobbying firms – working overtime to understand the new administration and start whispering to it the messages of its clients. I assume Epic also has a friend in House Speaker Paul Ryan (R-WI).


HIStalk Announcements and Requests

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HIStalkapalooza signups are winding down, both for this year and forever since it’s the last one. We’re at around 900 requests, so it’s about time to call it.

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About a fourth of poll respondents either left for a better job or were promoted in the past year. Desperado expresses appreciation to the less-competent salespeople who allowed him to get promoted last week, while Paragon(e) and J3 lost their jobs to offshoring and acquisition, respectively. Frank’s advice for those who want a real promotion is to do your own thing, where you can focus on what’s important to you and be paid commensurate with your abilities, as hanging out your own shingle is “the last promotion you’ll ever need.”

New poll to your right or here: Has your employer cut expenses or reduced future expectations because of ACA uncertainty? I would be happy to get your poll vote and elated to read your comment explaining it.

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Welcome to new HIStalk Platinum Sponsor Parallon Technology Solutions. The Nashville-based company’s 400 professionals have implemented EHRs in 300 facilities and offer staffing and remote support services for all major acute care and ambulatory EHRs (Meditech, McKesson, Epic, Allscripts, etc.) and related applications. Its services include EHR implementation, help desk, application support, managed services, hosting, technical staffing, and strategic IT consulting services. It can help optimize Meditech investments, being certified to deliver READY Levels 1-3 and Pathway implementations for 6.x. Its Tier 1 Help Desk service alleviates challenges with hold times and first-call resolution rates, freeing up internal resources to work on priority projects and providing legacy system support. Technical services include data extraction and archive, reporting,  wireless network installation and support, voice communications, and integration. The company also outsources hard-to-find talent such as application developers, product analysts, DBAs, and network engineers. President and CEO Curtis Watkins is an industry long-timer with executive IT experience at HCA, St. David’s HealthCare, and Community Health Systems. Thanks to Parallon Technology Solutions for supporting HIStalk.

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We funded the DonorsChoose grant request of Ms. L on the west side of Chicago, who asked for math center materials for her kindergarten class. She is using the games during 25-minute math station rotation, putting out two or three of the games for students to learn from even as they’re having fun. She says they always rush to the Unlock It! game pictured above.


Last Week’s Most Interesting News

  • Two California HIE announce plans to merge.
  • President-elect Trump nominates David Shulkin, MD for the post of Secretary of Veterans Affairs.
  • Congress quickly begins dismantling the Affordable Care Act.
  • IBM Watson Health and the FDA announce plans to study the use of blockchain technology to exchange information between study participants and researchers.
  • President Obama and Vice-President Biden express frustration with lack of healthcare data exchange, with the President saying EHRs are his biggest disappointment of the Affordable Care Act.
  • A Wall Street Journal opinion piece calls Epic the “chief obfuscator” in being primarily responsible for the lack of EHR interoperability.

Webinars

January 18 (Wednesday) 1:00 ET. “Modernizing Quality Improvement Through Clinical Process Measurement.” Sponsored by LogicStream Health. Presenters: Peter Chang, MD, CMIO, Tampa General Hospital; Brita Hansen, MD, CHIO, Hennepin County Medical Center. The presenters will describe how they implemented successful quality governance programs, engaged with their health system stakeholders, and delivered actionable information to clinical leadership and front-line clinicians. Q&A will follow.

January 26 (Thursday) 1:00 ET. “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.” Sponsored by Healthwise. Presenters: Jim Rogers, RN, RPSGT, director of healthcare solutions, Persistent Systems; Jason Burum, chief client officer, Healthwise. This webinar will explain how to implement a patient-centered care coordination program that will increase quality as well as margins. It will provide real-world examples of how organizations used care coordination to decrease readmission rates, ED visits, and costs.

February 1 (Wednesday) 1:00 ET. “Get your data ready for MACRA: Leveraging technology to achieve PHM goals.” Sponsored by Medicity. Presenters: Brian Ahier, director of standards and government affairs, Medicity; Eric Crawford, project manager, Medicity; Adam Bell, RN, senior clinical consultant, Medicity. Earning performance incentives under MACRA/MIPS requires a rich, complete data asset. Use the 2017 transition year to identify technology tools that can address gaps in care, transform data into actionable information, and support population health goals and prepare your organization for 2018 reporting requirements. 


Sales

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Southern New Hampshire Medical Center (NH) chooses the Voalte Platform for smartphone-based secure communication and alert notification.


Decisions

  • Sycamore Medical Center (OH) with switch from BD to Omnicell automated dispensing cabinets in 2017.
  • Optim Medical Center (GA) will switch From Metro MedDispense to BD Pyxis MedStation automated dispensing cabinets in March 2017.
  • Baton Rouge General Medical Center – Bluebonnet (LA) will go live with Omnicell automated dispensing cabinets in 2017.

These provider-reported updates are provided by Definitive Healthcare, which offers powerful intelligence on hospitals, physicians, and healthcare providers.


Government and Politics

In Scotland, 18 clinician organizations respond to the government’s call for input on its digital health strategy, urging the government to increase information-sharing capabilities among clinicians.

The New York Times speculates on the effect of proposed legislation that would dismantle the Affordable Care Act:

  • Eliminating insurance subsidies will cause 22.5 million people to drop their coverage, driving up prices for everyone as fewer healthy people sign up.
  • Eliminating the federal Medicaid expansion will leave 12.9 million people without coverage.
  • Consumer protections such as those involving pre-existing conditions, lifetime limits, and insuring adult children can’t be changed using the budget reconciliation process, so those will remain in place.
  • Eliminating the requirement that people carry insurance and that employers offer it will reduce the incentive of healthy people who can’t get employer-provided insurance to insure themselves.
  • Taxes on high incomes, prescription drugs, medical devices, and health insurance could be rolled back to pre-ACA numbers.
  • Value-based care models and other Medicare payment experiments will likely continue.

Privacy and Security

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In England, Barts Health NHS Trust shuts down some of its systems (but not Cerner Millennium) after an unspecified cyberattack that it says wasn’t ransomware.


Other

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Cleveland Clinic tries to distance itself from the somewhat anti-vaccine comments made by its wellness center medical director, although it draws Twitter wrath for: (a) promoting other “bogus treatments;” (b) not pulling the original article down; (c) downplaying “a series of bad decisions flying in the face of evidence” in calling it “confusion;” and (d) running a wellness center in the first place. There must be tension given that CC is a medical and research powerhouse on the one hand, while on the other the wellness center’s online store offers trendy detox kits, meditation DVDs, and bags of quinoa. Surely patients must be confused as the clinic outsources to them the responsibility to reconcile the separate-but-equal parts of the organization that may or may not offer evidence-based care.

A study in Israel finds that rude patients get their doctors worked up to the point they deviate from practice standards. Teams of NICU doctors and nurses who were scolded by an actress playing an angry mother fell short for the rest of the day in all 11 performance measures reviewed in the study. The researchers then tried two possible solutions. Having the clinicians write about their experience afterward made the situation worse, but assigning them a behavioral modification game raised their rudeness thresholds to the point that their performance was identical to that of the control group, in effect providing them with rudeness resistance. The bad news for patients is that even if you don’t get  nasty yourself, you are equally disadvantaged when following another patient who did (and we all know there’s plenty of them out there).


Sponsor Updates

  • Santa Rosa Consulting migrates Memorial Health System (OH) to Meditech 6.15 Ambulatory.
  • ZeOmega publishes a new case study explaining how its clinical and technology assessment team helped MDwise improve operational efficiencies and increase ROI.
  • The Red Hot Healthcare podcast features Conduent (formerly Xerox Healthcare) VP of Health Strategy Rohan Kulkarni.

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates. Send news or rumors.
Contact us.

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Events and Updates

January 14, 2017 News No Comments

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Morning Headlines 1/13/17

January 12, 2017 Headlines 1 Comment

Merger May Revitalize California’s Flagging Effort To Pool Medical Records

The nonprofit HIE California Integrated Data Exchange will merge with Inland Empire Health HIE, creating an exchange with the medical records of 16.7 million people.

Obamacare is one step closer to repeal after Senate advances budget resolution

The Senate approves a budget resolution that begins the process of repealing ACA.

Arizona Plans to Sue Blood-Testing Company Theranos

The Arizona Attorney General is seeking outside legal counsel as it prepares to sue Theranos, alleging that it defrauded consumers in the state.

HealthTap launches Dr. A.I.— Meet your new, personal AI-powered physician

HealthTap launches an artificial intelligence-powered online symptom checker that “helps route users to doctor-recommended insights and care.”

News 1/13/17

January 12, 2017 News 6 Comments

Top News

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The California Integrated Data Exchange (Cal INDEX) will merge with the Inland Empire HIE.

Cal INDEX, which has had statewide ambitions since its 2014 founding by Blue Shield and Anthem, has struggled with lack of participation by providers in a competitive environment who may not be willing to give an insurer-operated HIE their data. Its only health system members are Dignity Health and the just-signed St. Joseph Hoag Health.

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Former White House and ONC HIE advisor Claudia Williams has been hired as CEO, Cal INDEX’s fourth since 2014.


Reader Comments

From Ray Wrangler: “Re: Merge Healthcare. GM Nancy Koenig is taking a year-long personal leave of absence and will be replaced in interim by Andy Warzecha. A permanent GM is being considered.” Unverified. I’ve asked the company to confirm but haven’t heard back.

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From Snowman: “Re: Epic. Various critical access hospitals in Iowa (such as Virginia Gay in Vinton and Myrtue Medical in Harland) are converting to Epic as part of the University of Iowa Hospital and Clinics Epic Community Connect program. This is being run through an entity called University of Iowa Health Ventures.” Thanks. I had mentioned Myrtue’s conversion recently in my Decisions section from Definitive Healthcare.


HIStalk Announcements and Requests

Signups are still open for the 10th and final HIStalkapalooza, so you won’t want to miss Party on the Moon’s figurative closing rendition of “The Last Waltz.” Meanwhile, I need some help with red carpet duties in a key role, so contact Lorre if you’re a quick-witted, outgoing female willing to spend some time participating in the event instead of spectating. I still need event sponsors, too, for companies interested getting enough tickets to create their own sub-party as well as earning significant industry exposure. Signups so far include 90 CEOs and presidents, 14 CIOs, financial industry bigwigs, and more SVP/VPs than you can shake a stick at (like a post-blackout baby boom nine months later, deals will be announced months from now whose consummation began with a House of Blues twinkle in someone’s eye).

We’ll have another CMIO lunch at the HIMSS conference on Tuesday, February 21, starting at noon at Bistro HIMSS (just off the exhibit hall floor). I’ll buy lunch for up to the 20 attendees we’re allowed and you’ll get to eat something nice while sitting comfortably with CMIO peers. Sign up if you’re interested. Everybody seemed to enjoy it last time.

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We funded the DonorsChoose grant request of Mrs. I in South Carolina, who asked for a Chromebook for class science research. She says students are using it for virtual labs and study drills and adds, “I have inquiring, smart, and engaging students and I am planning a new project on encouraging students to focus more on STEAM , which I believe is the way to go in order to produce engaging and inquiring minds that will be able to compete in a global community.”

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Welcome to new HIStalk Platinum Sponsor Logicworks. The cloud automation and managed services provider offers secure, compliant cloud solutions in helping organizations architect, maintain, and automate custom Amazon Web Services infrastructure with 24x7x365 support, a team of highly qualified engineers, and 100 percent uptime SLAs. They’ll also help extend the data center to the cloud with their hybrid cloud offering, which includes cloud orchestration, 22 years experience in migrating and managing legacy systems to AWS, security management, and maintaining sensitive information in a private cloud to meet HIPAA, PCI, and SOX mandates while taking advantage of AWS’s scalability. Logicworks offers automation software that helps enterprises get to the cloud faster, fueling their next big ideas by allowing developers to spin up servers in seconds. Cybersecurity is implemented and monitored around the clock by best-in-class security experts. The company has completed 400 cloud projects in its 20 years in business, with deep expertise and an average engineer tenure of six years. Clients include 30 state HIEs, the largest health insurance exchange in the country, leading SaaS clinical software providers, global healthcare systems integrators, and healthcare analytics vendors. It just announced a mind-boggling $135 million funding round led by Pamplona Capital. Thanks to Logicworks for supporting HIStalk.

Here’s a Logicworks overview I found on YouTube. They also did an HIStalk webinar called “Cloud Is Not (Always) The Answer” a couple of years ago.

This week on HIStalk Practice: UnitedHealth buys Surgical Care Affiliates in $2.3 billion deal. Teladoc adds lab testing services from Analyte Health. Aledade raises $20 million. HealthTap debuts Dr. A.I. Emmi Solutions CEO Devin Gross shares patient engagement tips for practices facing resource limitations. Northwell Health launches new practice management business. MedEvolve debuts practice analytics. Humana VP of Provider Engagement Caraline Coats explains the ways in which the payer’s quality rewards program is helping physicians transition to value-based care.


Webinars

January 18 (Wednesday) 1:00 ET. “Modernizing Quality Improvement Through Clinical Process Measurement.” Sponsored by LogicStream Health. Presenters: Peter Chang, MD, CMIO, Tampa General Hospital; Brita Hansen, MD, CHIO, Hennepin County Medical Center. The presenters will describe how they implemented successful quality governance programs, engaged with their health system stakeholders, and delivered actionable information to clinical leadership and front-line clinicians. Q&A will follow.

January 26 (Thursday) 1:00 ET. “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.” Sponsored by Healthwise. Presenters: Jim Rogers, RN, RPSGT, director of healthcare solutions, Persistent Systems; Jason Burum, chief client officer, Healthwise. This webinar will explain how to implement a patient-centered care coordination program that will increase quality as well as margins. It will provide real-world examples of how organizations used care coordination to decrease readmission rates, ED visits, and costs.

February 1 (Wednesday) 1:00 ET. “Get your data ready for MACRA: Leveraging technology to achieve PHM goals.” Sponsored by Medicity. Presenters: Brian Ahier, director of standards and government affairs, Medicity; Eric Crawford, project manager, Medicity; Adam Bell, RN, senior clinical consultant, Medicity. Earning performance incentives under MACRA/MIPS requires a rich, complete data asset. Use the 2017 transition year to identify technology tools that can address gaps in care, transform data into actionable information, and support population health goals and prepare your organization for 2018 reporting requirements. 


Acquisitions, Funding, Business, and Stock

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The charitable foundation of the late Helen Diller, who with her husband made billions by investing in San Francisco real estate, donates $500 million to UCSF, the largest gift to a university in history. She had previously funded a cancer research building that bears her name.

Arizona’s attorney general opens bids for law firms to sue Theranos for consumer fraud. Just in case CEO Elizabeth Holmes is reading, she’s leading a couple of HISsies categories, should she be available to receive her honors in person in Orlando (note: wear old clothes).


People

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ID Experts hires Brent VanLoo (HealthSparq) as CTO.


Announcements and Implementations

IBM Watson Health and the FDA will study healthcare data exchange using blockchain technology, initially focusing on oncology data. The two-year project will look at sharing owner-mediated data – from EHRs, clinical trials, genomics, and devices – with researchers.

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Telemedicine provider HealthTap launches Dr. A.I., an artificial intelligence-powered symptom evaluator that “converses” with users, matches their subjective information against their health profile, and then uses the company’s data repository to offer care recommendations and “patients like me” suggestions.

Press Ganey and Kronos will study a subset of their shared clients to measure the impact of workforce characteristics on nursing quality indicators.


Government and Politics

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President-elect Trump nominates VA undersecretary of health David Shulkin, MD for Secretary of Veterans Affairs, who if confirmed would be the first non-veteran to serve in that role. He is also the first Obama administration holdover nominated by the Trump team. Shulkin is best known in HIT-land as having testified to Congress in June 2016 that the VA and DoD will be fully integrated by 2018 in describing the VA’s proposed digital health platform that may or may not include VistA.  

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Another ONC staffer will leave as part of the administration transition – Lucia Savage, JD, chief privacy officer. Deputy National Coordinator Jon White will serve as interim national coordinator with the departure of Vindell Washington, MD.

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The Senate votes along party lines to repeal the Affordable Care Act, using the same budget reconciliation process that was used to approve it seven years ago (with similarly partisan support). The House will vote quickly on the resolution, which if approved will give congressional committees the green light to craft legislation to dismantle major parts of the program. The Senate’s vote did not preserve protections for pre-existing conditions or the ability for parents to keep their children on their insurance plans through age 26. President-elect Trump said in his Wednesday press conference that he will roll out his replacement plan as soon as his HHS Secretary nominee Tom Price is confirmed. 

Here’s something to keep in mind as Congress guts the ACA: a new study finds that 60 percent of Americans don’t have enough savings to cover an unexpected $500 expense. I’m not sure subsidized health insurance helps much anyway considering that deductibles often top $7,000 before insurance pays a penny for non-routine care.

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ONC announces the Phase 2 winners of its Consumer Health Data Aggregator and Provider User Experience challenges that required using FHIR APIs. Winners in the Aggregator category: PatientLink Enterprises (gathering and managing patient data), Green Circle Health (family health dashboard), and 1upHealth (patient data organizer).

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Winners in ONC’s Provider category: Herald Health (alert workflow with push notifications), a team from University of Utah, Intermountain, and Duke Health (baby jaundice clinical decision support), and PHRASE Health (clinical decision support).

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John Halamka offers advice to the new administration about health IT:

  1. Create a national health identifier, a national directory of provider electronic addresses, and a baseline privacy policy and data sharing consent  that covers all 50 states.
  2. Don’t dictate provider workflows – let them decide how to use technology to keep people healthy and hold them to some element of quality and cost reporting.
  3. Align incentives while avoiding regulatory ONC zeal and use the only three clinician influence factors that work: pay them more, improve their professional life, or spare them public embarrassment.
  4. Share cybersecurity threat and mitigation information across the industry.
  5. Let EHR users drive product direction instead of forcing it via certification.

Privacy and Security

From DataBreaches.net:

  • Security experts alert a plastic surgeon and spa owner in Canada that his PHI-containing servers (including photos of unclothed women) are open to web searches. The problem was – as is often the case – an open Rsync device.
  • A two-state cosmetic surgery center is hit with ransomware, but apparently restores its systems without paying.

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Security firm Tresorit releases ZeroKit, which will offer developers using Apple’s open source framework CareKit with user authentication and end-to-end data encryption.

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A newly published book, “Our Bodies, Our Data: How Companies Make Billions Selling Our Medical Records,” says the “hidden trade” in medical information has become a multi-billion dollar business (mostly helping drug companies push their products) without improving outcomes.


Other

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Nearly half of Arizona’s doctors haven’t signed up for the state’s doctor-shopper prescription database, use of which will become mandatory in October. Doctors previously shied away in saying that the system is clunky. One PCP who’s been using it for years say she always checks a patient even though it takes 2-3 minutes.

In Washington, a car crashing into a utility pole on New Year’s Eve takes down the county’s 911 system and the local hospital’s connections to Epic for more than a day. Jefferson Healthcare says it will look for a backup plan in hopes of avoiding future interruptions to the services of its broadband provider, whose cables were damaged in the accident. At least it wasn’t the usual backhoe cut that zapped the hospital’s lifeline to the world.

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In Italy, a hospital suspends two of its ED doctors and its director after social media photos show doctors treating patients who were lying on the floor. The hospital had run out of stretchers after loaning several to an ambulance service. Hospitals were swamped after extreme weather and a meningitis scare happened during a holiday weekend when many doctors were on vacation. The director said that treating patients on the floor was better than not helping them at all.

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Weird News Andy is singing along to “Parentage by the Cell Phone Light.” Doctors at a hospital in China use their cell phone lights to illuminate their delivery of a baby of a woman who had gone into labor in the hospital’s parking lot. WNA wryly concludes, “Of course there are photos.”


Sponsor Updates

  • Rock Health awards Medicity’s Brian Ahier with the Digital Health Evangelist of 2017 award. Snowed in and unable to accept the award in person, Ahier posts his acceptance speech from his blanketed driveway.
  • Iatric Systems will exhibit at the MUSE Executive Institute January 15-17 in Newport Coast, CA.
  • AlleyWatch includes MedCPU in its list of the nine largest health tech startup fundings in New York City in 2016.
  • Meditech releases a new case study, “It’s in Their DNA – Avera Health Drives Precision Medicine at the Point of Care.”
  • Nordic Consulting releases a new podcast, “What the best health IT consultants do at the end of their contracts.”
  • PokitDok CEO Lisa Maki weighs in on the possible repeal and replace of the ACA on Bloomberg News.

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates. Send news or rumors.
Contact us.

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EPtalk by Dr. Jayne 1/12/17

January 12, 2017 Dr. Jayne 1 Comment

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The American Board of Preventive Medicine announced the retirement William Greaves, MD, who has been its executive director since 2012. Greaves helped guide the Board’s inclusion of the Clinical Informatics subspecialty. Benson Munger, PhD will serve as interim executive director. Munger was deeply involved in the creation of the AMIA Clinical Informatics Board Review Course and the informatics community is enthusiastic about his role as the ABPM begins its search for a permanent executive director.

Speaking of physicians considering retirement, Massachusetts General Hospital has a 100-year-old physician who is still coming into work after 65 years. Dr. Walter Guralnick spends his time teaching residents rather than seeing patients. With a strong belief in equal access for all, Guralnick led the charge for dental insurance and founded what became Delta Dental.

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ONC has released the updated Certified Health IT Products List. In addition to the list of products on the “nice” list, there are now two pages for products that are no longer certified and developers who are blocked from certifying health IT products. The “developer ban” page is blank and the “decertified products” page has a lot of 2015 edition software, so it’s hard to know what you’re really looking at.

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Lots of reader mail this week.

From Daredevil: “Re: E&M coding. My hospital made an interesting choice to bill facility charges but no professional fees in its busy (hospital-owned) pediatric urgent care. As such, the providers were not burdened with counting elements in their documentation. We could simply document items required for clinical care and/or general risk management. This made it easier to focus on managing the patient, especially during high-volume times. The providers were compensated based on covered hours and procedures performed. The providers were eventually incentivized for throughput and had plenty of opportunities to work extra hours at a reasonable rate, so things seemed generally equitable. I would love to see E&M billing go away. The surgeons have it right with global billing. Their notes — at least in the hospital setting and for post-op visits — while seemingly sparse, stick to the facts. There is no endless scrolling to see what they are thinking.” This flat-fee approach is similar to what many cash practices do and what my urgent care does for self-pay patients. It’s not hugely profitable, but it keeps the lights on and allows the staff to deliver valuable and often much-needed care. It’s an interesting approach and I will be interested to see what some of my local colleagues think.

From End of Shift: “Re: complexity of the patients at the end of a shift. I found more than once that the last patient on a Sunday evening was the most perplexing or complex for the day. The tendency to want to expedite that patient who made it in right before the doors locked was also met was often met with the reality that this patient / family was the one who was home all day debating whether their concerns warranted a visit to the urgent care. I saw more than a few who needed a trip to the emergency department. It doesn’t seem to matter which setting we are practicing medicine in these days, but there seems to be constant pressure to do more in less time. I think we would all be better clinicians with better outcomes if we had the chance to slow things down a bit.” Thinking about patients debating whether their condition is significant enough for a visit certainly puts a different spin on things. We’re also seeing patients holding off on care due to rising copays. Last year, most urgent care copays were at $50 but we’re seeing a lot this year that are $75 and $100, which means their ED copays are probably $150 or $200. The price point alone is going to have an impact in shifting where care is delivered, even if it doesn’t change the nature of the care required.

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Illinois healthcare organization Presence Health has been fined $475,000 for lack of timely breach notification. The fine centers around an incident in October 2013 where paper operating room schedules went missing from a surgery center. They didn’t notify OCR until January 2014 and the investigation showed that patients were not notified within 60 days of discovery as required. Over 800 patients were affected, so a media notification would also have been required. Details of the investigation reveal similar notification delays from breaches in 2015 and 2016.

The new year seems to be bringing new jobs for many, at least according to my LinkedIn updates. I’m also seeing people update their profiles, potentially in search of new jobs. Pro tip: disable notifications before you start doing a bunch of updates so you don’t look like you’re getting ready to jump ship. I’m helping a client try to expand their EHR support team so I can offer some other job hunting tips based on the resumes I’m seeing:

  • Be sure you meet the minimum qualifications listed in the job posting or explain what equivalent skills you have that make you an attractive candidate. I’ve had more than 40 people apply for a physician informaticist position who are not physicians. My client might consider a nurse or pharmacist, but these folks had literally no clinical credentials. Similarly, if the posting requires five years experience, you might squeak by if you’ve been in the field for four, but if you have never worked in the field, it’s a better idea not to apply and waste people’s time.
  • Spell check your resume and have someone else review it for flow, consistency, and whether it makes sense. One candidate’s “summary” paragraph took up half a page and was a rambling incoherent explanation of why they appeared to job-hop every 18 months. Another’s was riddled with typos. Some include every job the applicant has had since high school, which just adds clutter.
  • Don’t expect clients to relocate you if the posting doesn’t mention relocation assistance. I have an ambulatory client in a small Midwestern city that is looking for a full-time billing office manager. Several people have applied from across the country. Since they were good candidates, we did phone screens, hoping to hear stories about people looking for jobs because they were relocating to be close to family, move with a spouse, etc. At least two of them asked about relocation packages, which is out of character for a 10-doctor practice. Understand your audience and your potential employer.
  • Make sure your contact information is professional. Your email address mustdrinkbeer@domain.com might have seemed like a good idea when you were in college, but it’s a terrible idea when you’re trying to be a professional adult.

What’s your best employee recruiting story? Email me.

Email Dr. Jayne.

Morning Headlines 1/12/17

January 11, 2017 Headlines No Comments

A Senate Vote-a-Rama Primer, in Case You Plan to Sleep Tonight

Wednesday night, the Senate will vote on a budget resolution that will begin the process of repealing ACA.

IBM Watson, FDA to explore blockchain for secure patient data exchange

The FDA signs a two-year joint-development agreement with IBM Watson to investigate the use of blockchain technology for securely sharing patient data from EHRs, clinical trials, mobile devices, and other sources.

Health care must ditch its attachment to outdated software

Athenahealth CEO Jonathan Bush publishes an op-ed in STAT encouraging health systems to ditch legacy health IT software, while acknowledging that there will be no government subsidies to help providers buy more software under the Trump presidency.

Trump ‘Just Killed’ Paul Ryan’s Obamacare Repeal-And-Delay Strategy

Despite progress on ACA repeal efforts, President-elect Trump reported during a press conference Wednesday that the repeal and replacement of ACA would happen simultaneously.

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Reader Comments

  • HIT Girl: That NYTimes piece on women being given anticoagulants at a lower rate due to implicit bias is incredible. Estrogen is ...
  • Seargant Forbin: RE:PM_From_Haities I think you missed the entire point of what VFJ said. The constitution is an old outdated piece of pa...
  • PM_From_Haities: Re: VFJ - so are you saying you're opposed to the Constitution ? First 3 words of the US Constitution "WE THE PEOPLE". ...
  • HIT Girl: Tim Draper sounds completely delusional, and has no business around any company that has anything to do with patient car...
  • Tango #2: Couldn't agree more with your HIMSS Media Lab sentiment (though I struggle to liken them in any way to the Salvation Arm...

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