CMS provides results from its July round of ICD-10 testing in which no claims were rejected due to CMS software problems. Around 2 per cent of submitted claims had invalid ICD-10 codes, less than the number of claims that had incorrect ICD-9 codes. It’s important to note that the overall 87 percent claim acceptance rate includes claims that were submitted with intentional errors just to make sure CMS would kick them out. Also, the claims originated in test environments, which created errors that would not have occurred in real life.
From Beltway Bandido: “Re: VA and Lockheed/Epic. I hear from talking to multiple groups that there’s a real risk to the success of the VA’s MASS scheduling system. Mainly concerns about the program’s long-term viability and the risk of adding a best-of-breed bolt-on for scheduling vs. a wholly integrated solution. Somewhat related, I’ve heard that the Coast Guard’s move to InterSystems for interoperability could be a transitional play as they downshift away from Epic. Lots of moving parts in DC right now.” The VA’s very existence was threatened by their appointment wait time scandal, so they had to fast-track their selection of a commercial solution even though, as is nearly always the case, the problem was caused by the VA’s people and the incentives provided to them rather than their technical tools. The VA neatly sidestepped Congressional demands for firings, reorganization, and funding decreases by simply throwing its scheduling system under the bus and signing up for Epic. I don’t know what it will take to compartmentalize Cadence to run without any other Epic apps and then integrate it with the VA’s systems, but I do know that standalone healthcare scheduling systems have fallen by the wayside given the need for integration. It also seems that $624 million is a lot to spend for automating a single function, but then again both the VA and DoD are used to squandering mountains of taxpayer money on systems that are often failures in every way except as never-ending revenue streams for the chosen contractor. Epic now has a foot in the VA’s door should it ever decide to part ways with VistA. The other unspoken aspect of both the VA and DoD is that a lot (most?) of the care received by current and former service members is delivered by the private sector using non-government IT systems, creating a big information flow problem no matter which systems are used internally. I’ve often argued that the VA’s hospitals and clinics should be closed or privatized since it seems unnecessary to run a separate domestic healthcare system for civilians whose history includes military service, as long as their special needs are recognized and accommodated (which even the VA struggles to do).
From Lavosh: “Re: VA scheduling announcement. How did you get the information before anyone else? Leaks?” There were no leaks, but readers tipped me off that the announcement would be made that day and also provided the unstated major point that Epic is the subcontractor. I try to deliver only three things via HIStalk: (a) well curated and highly condensed news; (b) ideas that someone might use to create or improve something in healthcare; and (c) occasional entertainment.
From Beefy Goodness: “Re: healthcare IT contract gag clauses. I saw proof they exist in an online summary.” Of course they exist – any of us who have signed contracts on behalf of hospitals know they are common. You could have looked them up in CapSite’s database of signed contracts (obtained under Freedom of Information Act requests) until HIMSS bought that company in 2012. The most restrictive, controlling, and sometimes irrational terms I’ve seen were in Epic contracts, copies of which are almost impossible to get since Epic tells customers to forward any FOIA requests to its attorneys to be fought tooth and nail (or at least that used to be the case). The important aspect to note is that clients sign the contract willingly and knowingly, so any muzzling is voluntary and nobody else’s business. Still, I’ve always been amazed in looking at contracts from all vendors that hospitals don’t negotiate well and just accept the vendor’s favorable boilerplate.
From HIT Wannabe: “Re: CHIME. So disheartening to come across this tweet. Aare they so hurting for cash that they are willing to go to any lengths on social media for a vendor? Forget that this vendor’s solution isn’t certified for any of the leading EMRs used by CIOs that follow CHIME.” Tweeting a link to a vendor’s promotional material is a pretty lame thing for a non-profit member organization to do. The vendor in question is equally stupid – they require anyone interested in their crappy white paper to provide 15 data fields of information, some of which are maddeningly clueless, like asking which industry the requestor works in (maybe they get a lot of hospital white paper requests from people in the mining and entertainment sectors.) CHIME is apparently in cahoots with a big media company and is now shilling for it, judging from some of its tweets. I feel equally violated when I get webinar and white paper spam from HIMSS, to whom I’m paying dues for the privilege of having them pimp out my electronic access to any willing vendor.
Speaking of CHIME tweets, this one about the AMDIS Fall Symposium showcases either atrocious spelling or keen wit.
HIStalk Announcements and Requests
I’ve been frustrated for months with iPhone charging problems. The Lightning socket seemed to be loose, forcing me to use one specific cord (of the handful I have) and wiggling it just right. Googling seemed to indicate that the most likely problem was gunk in the port, so I dug around with a toothpick even though I couldn’t see anything in there with a flashlight. I figured I needed a socket replacement since it seemed quite loose, but the Genius Bar guy at the Apple Store fixed it by doing what I had tried only more professionally — he used a small tool to clean the port out and then blew it clean with canned air. The looseness was caused by the cable not being able to seat itself. He also cleaned out the microphone and speaker holes that were stopped up. This is apparently a frequent, gender-related problem caused by guys like me who carry their phones in linty pockets.
This week on HIStalk Practice: HelloMD CMO Perry Solomon, MD explains the company’s pivot from telemedicine to digital health for medical marijuana. The FSMB relaunches Docinfo database. Jaan Health secures $1 million for its Phamily care coordination platform. Arete Urgent Care goes with DocuTap tech, while The Iowa Clinic selects VirtuMedix for telemedicine services. Texas physicians just can’t catch a break. DuPage Medical Group CEO Mike Kasper details the impact BCBSIL claims data will have on patient care. Telemedicine comes to Ghana cocoa farmers. Patchy EHRs could be Precision Medicine Initiative’s biggest stumbling block.
This week on HIStalk Connect: Google shuts down its Google Flu Trend project, but will continue to provide public health researchers with access to its data. Bayer unveils the second class of startups to join its Berlin-based Grants4Apps accelerator program. Researchers with UC San Diego develop a fish-shaped microrobot with forward propulsion and sophisticated remote steering capabilities. Cambridge, MA-based PillPack raises a $50 million Series C funding round to expand its online pharmacy and add brick and mortar locations.
September 9 (Wednesday) 2:00 ET. “Need to cleanse, unify and manage the provider data in your EMR master file and other IT systems?” Phynd’s Unified Provider Management platform allows healthcare organizations to maintain a single, verified, customized profile for each provider across legacy IT systems. This 30-minute presentation will explain how Phynd’s system can help synchronize internal provider information in real time; create provider interoperability among systems; and manage, update, and analyze provider information with workflow tools to improve revenue cycle and clinical communication.
Acquisitions, Funding, Business, and Stock
Medical Specialties Distributors acquires VerbalCare, whose app allows inpatients to communicate with nurses.
Adventist Health System (FL) chooses MyRounding’s patient feedback collection tool.
Ted Schwab (Strategy&) joins Huron Healthcare as managing director.
Health Catalyst hires Dan Strong (Control4) as CFO, moves co-founder/EVP Tom Burton from product development to client operations, and promotes Dale Sanders to EVP of product development.
Jim Pesce has retired from McKesson Enterprise Information Solutions after over 50 years in healthcare IT. Industry historian Vince Ciotti provides this review of Jim’s career: “Jim started his career in the mid-1960s with GE’s Medinet product in Boston – he actually had Larry Polimeno of later Meditech fame working for him as a night-shift computer operator. He went to McAuto in the 1970s, where he ran implementations in their Northeast region. He left McAuto for Micro Healthsystems in NJ, where his major mistake was to hire me to head up sales of their MedTake bedside system – I failed miserably! Graham King took over Micro after leaving SMS and the two of them then went to McKesson when it acquired Microin the late 1990s. Graham sent Jim to Charlotte to shut down the failing Paragon project in 2001, but Jim was so impressed by it he went back to Atlanta and told Graham they should save it. Graham said OK, then you head it up. The rest is HIS-tory.”
Announcements and Implementations
CVS will expand its in-store telemedicine capabilities and is working on pilot projects with American Well, Doctor On Demand, and Teladoc.
Government and Politics
CMS announces that William Rogers, MD, director of its physician regulatory issues team, will serve as its ICD-10 ombudsman.
The White House has always downplayed concerns that insurers would jack up rates following implementation of the Affordable Care Act, but state regulators are approving big increases that include a 36.3 percent hike by BCBS Tennessee and a 25.1 percent jump for Kentucky Health Cooperative. Experts say insurance companies bid low in the first two years of the ACA but have incurred losses because enrollees were sicker than they expected. Everybody else, being wary of insurance companies, assumes it’s just greedy business as usual. So much for “affordable.”
Privacy and Security
A KPMG survey finds that 80 percent of healthcare organizations have experienced at least one cyber breach, but the survey’s methodology is too shaky to earn the big headlines it’s getting: (a) only 223 healthcare executives responded and the method of their selection was not stated; (b) the survey mixed providers and payers, with fewer than half of respondents working for non-profits; (c) seventy percent of respondents were from companies with more than $1 billion in revenue, meaning either large health systems or large vendors. Perhaps the lack of a valid respondent cohort is responsible for the survey’s most questionable finding – employees (via theft, breaches, and negligence) came in at only #3 on the list of greatest vulnerability concern despite the fact that nearly every large healthcare breach is caused by successfully phishing employee emails.
The VA OIG finds that VA employees are using the Yammer collaboration tool without approval, to the point that its former CIO broke the VA’s rules in conducting an open chat using the Microsoft-owned platform. OIG notes that the Yammer setup had no defined administrator, the access of departed employees wasn’t removed, it encouraged employees to break VA policy by sharing files, and it gave employees a convenient way to waste time much as they would using Facebook. The report says the Yammer “network” was created inadvertently when the first VA employee signed up for it using their @va.gov domain without approval. The VA had considered buying an enterprise license before Microsoft bought the company, but said it wasn’t worth $30 per seat.
Microsoft announces that Windows 10 is running on 75 million devices just four weeks since its release. My experience has been perfect since I had to get an expert to fix the networking DLLs that were trashed in a Windows update. I can’t say Win10 has changed my life, but my laptop seems to run more smoothly with lower CPU and disk utilization and some of the app replacements (the Edge browser and whatever the new media player is called) work much better.
Fast Company profiles Zoom, an ambitious, design-focused company that has expanded from walk-in clinics to offering full medical care and insurance from 28 locations in Portland, OR. The company focuses entirely on tech-savvy young people in offering its lifestyle product, saying that “one of the weaknesses of healthcare is trying to be all things to all people.” Founder Dave Sanders, MD admires Apple’s philosophy of not letting someone else control the user experience, saying that “we have to own you” as contrasted to the fragmented, wholesaler-like approach of health systems.
North Shore-LIJ Health System (NY) posts patient survey-generated ratings of its doctors online.
A study finds that medical students who were asked to evaluate their instructors rated a fictitious one, not noticing that the instructor name and photo were unrelated to their coursework. The authors conclude that basing faculty promotions and course design on student evaluations is probably not a good idea. Perhaps they will next look at how patients review doctors and hospitals.
Weird News Andy headlines this article“Suicide prevention? There’s an app for that.” Researchers find biomarkers that when used with a mood questionnaire, can predict suicidal thoughts with 90 percent accuracy. Most interesting is that the questionnaire alone was 80 percent predictive, but just the blood analysis by itself was correlated with suicidal thoughts with 70 percent accuracy. However, WNA questions the results of a researcher who, judging from the photo, “is apparently not wise enough to close a freezer with valuable samples inside.”
- Medicity offers “Keeping the Data Thieves Away.”
- Wolters Kluwer Health will exhibit its Health Language solutions at Epic UGM next week.
- Hayes Management Consulting posts “The Imperfect Checkout Process: 6 Steps to Enhance Patient Experience.”
- MEA/NEA offers “How to Encrypt Email Attachments, and Why You Should.”
- MedData posts “The ABC’s of ICD-10: Comparing ICD-9 to ICD-10, Code Structure and Organization.”
- Navicure offers “The Importance of Price Transparency – and How to Achieve It.”
- Nordic publishes “Super users forever! Setting up an Epic super user program and keeping it running.”
- NTT Data offers “The Transition to Data Science Architecture.”
- NVoq asks “Are you ready for ICD-10? SayIt can help!”
- Orion Health oposts “The Role of Open APIs in Healthcare Interoperability.”
- Patientco offers “Consolidating Patient Payment Channels for Revenue Cycle Success.”
- PatientKeeper writes “Big Data, Big Company, Big Possibilities.”
- PatientPay releases a video showcasing its services (and Sharpie prowess).
- PerfectServe offers “Patient Centered Medical Home model – Rewards of a successful transformation.”
- PeriGen’s PeriCalm CheckList is named a finalist in the Annual Innovations in Healthcare ABBY Awards.
- Phynd Technologies offers “The Differences between Phynd’s Unified Provider Management Platform and a Data Warehouse.”
- PMD offers “It Takes a Village: Shared Accountability in Patient Care.”