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EPtalk by Dr. Jayne 4/15/16

April 15, 2016 News No Comments

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In follow up to my recent discussion of faxing as a primary mechanism of data sharing, a reader sent this piece with data from a January provider survey. Traditional communication methods (letter, fax, phone) are still in use by the majority of providers. The graphic only tells part of the story, however. In order to have a better understanding of the situation, we’d need to see data from the same providers that shows what percentage of communications falls into each of the buckets. For example, 89 percent of providers are receiving using paper-based methods. Is that one letter or a hundred? The same goes for electronic exchange. Maybe only 40 percent of providers are doing it, but they’re doing it 90 percent of the time. I wanted to dig deeper into the data, but it was behind one of those “enter your email address to access this resource” pages. Those drive me crazy – it seems like it’s always a multi-step process to get the download. I’d look much more favorably on an organization that presented its content up front and asked you to sign up if you wanted to learn more, compared to organizations that require your address and then clutter your inbox.

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Midmark’s announcement that it is acquiring RTLS vendor Versus Technology caught my attention. I’ve always been a fan of Midmark –  its sales team impresses me with their relatively-subdued, knowledge-driven approach as compared to the bluster of some of their competitors. They’ve been innovative in providing solutions that just work, which is always appreciated when you have hundreds of devices to bring online. Midmark is also interesting as a company. Starting more than 100 years ago as an industrial equipment company, they entered healthcare in the 1960s and diversified to veterinary and technology segments. It seems to be a company that works at its own pace and ignores the industry hype. We’ll have to see whether the acquisition changes that.

From Direct Doc: “Thanks for the Curbside Consult on the state of primary care training programs. What do you think about the fact that Harvard doesn’t even bother to train students in family practice?” He didn’t mention that the article he cited clarifies that it’s not just Harvard. There are actually 10 medical schools (many of which are regarded as the nation’s top schools) that don’t have a department of family medicine. Some of them do offer optional family medicine courses, but I can say from first-hand experience that it’s not the same as taking a course in a school with a full-fledged department. I was barraged with comments during my training that I was “too smart for primary care” and our administrators were saddened that my class had more students match into family med than into general surgery. They also allowed some financial aid shenanigans that actually put primary care grads at a disadvantage. Needless to say, I’m not on the alumni donation list.

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Wearable tech vendor Ringly announced the bracelet version of its customizable notification jewelry. Their ring offering was a bit too chunky for my taste but I really like the bracelet concept. I’m not a fan of gold accessories, but I’ve been watching their products for a long time. They have a non-gold option for ring designs, and once they offer one in a bracelet, I will be sold. The idea of being able to receive notifications when messages arrive from a specific sender is an attractive one. I don’t routinely use audio notifications on my phone and turn off the notifications on Outlook and other apps, but I’d like to know if a high-priority client is trying to reach me outside of my normal email-checking periods.

Mr. H mentioned the CMS announcement regarding the Comprehensive Primary Care Plus (CPC+) initiative. It’s designed as a new medical home model that allows practices to choose one of two tracks for value-based reimbursements. One track will provide a smaller, monthly per-patient payment plus bonuses. The second provides a larger payment but has more requirements. It’s slated to run for five years and they want to include 5,000 practices. The launch is scheduled for January 2017, which doesn’t give practices much time to get their acts together unless they’re already doing a medical home model or have started the extensive change management and process work that is needed to make it viable. I have worked with a couple of practices that participated in the original Comprehensive Primary Care (CPC) program that started in 2012 and runs through the end of this year. The ones I worked with were already recognized by NCQA for their Patient Centered Medical Home efforts, and were looking for assistance with reporting and other EHR needs to meet the CPC requirements.

The key Comprehensive Primary Care Functions involved include: access and continuity; care management; comprehensiveness and coordination; patient and caregiver engagement; and planned care and population health. The higher-paying track definitely has more extensive healthcare IT requirements including the ability to manage the payments on the revenue cycle side. Although track 1 maintains regular fee-for-service payments, track 2 delivers hybrid payments with reduction in E&M payments for a percentage of claims. Bonus payments are also tiered, at $2.50 per patient per month on track 1 and $4 on track 2. Interestingly, incentives are prepaid at the beginning of a performance year, but must be refunded if the practice doesn’t meet quality and utilization performance thresholds.

Track 2 partners must submit a letter from their EHR vendor that outlines the vendor’ commitment to “supporting practices with advanced health IT capabilities.” I found it interesting that this wasn’t required for Track 1, because I’m not sure what difference it really makes. Of course vendors are going to say that they’re supportive. What else are they going to do? The devil will be in the details though, and I’d be surprised if this doesn’t lead to a host of de facto requirements that vendors may struggle to meet.

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From The Ghillie: “I know that working with clients during their EHR transitions can be frustrating. You seem like an outdoorsy person, so I’d like to suggest an additional benefit to the paperless office transition.” I have to say, I’m smitten, especially since I’m a big fan of reduce/reuse/recycle. Most of my cast-off file cabinets were only two drawers, but I’m going to keep an eye out for a four-drawer on the yard sale circuit.

Do you have a novel use for cast-off equipment? Email me.

Email Dr. Jayne.

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