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Morning Headlines 2/1/17

January 31, 2017 Headlines 2 Comments

Governor McAuliffe Announces Grant to Help Doctors Identify Potential Opioid Abuse

Virginia Governor Terry McAuliffe announces that the state has received a $3.1 million grant from OxyContin manufacturer Purdue Pharma to help it integrate its prescription monitoring program with the EHRs of local providers.

King’s College Hospital London Selects Cerner’s Clinical and Financial Management System

In England, King’s College Hospital NHS Foundation Trust selects Cerner as the EHR vendor for the 100-bed hospital it is building in Dubai.

After meeting with pharma lobbyists, Trump drops promise to negotiate drug prices

Vox reports that pharmaceutical executives have persuaded President Trump to drop his call for Medicare to begin negotiating lower drug prices, opting instead for a plan that includes lowering drug company taxes and reducing regulations.

Beth Israel, Lahey health systems agree to pursue merger

In Massachusetts, Lahey Health and Beth Israel Deaconess Medical Center announce merger plans. The combined organization would include eight hospitals, 29,000 employees, and $4.5 billion in annual revenue.

News 2/1/17

January 31, 2017 News No Comments

Top News

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OxyContin manufacturer Purdue Pharma will give the State of Virginia a $3.1 million grant to integrate its doctor-shopper prescription drug monitoring database with provider EHRs.

The state will use the PMP Gateway of its Appriss Health NarxCare system, which uses two years of prescription data to visually represent a patient’s usage patterns and to present a calculated risk score. Beyond claims and EHR data, it can incorporate information from EMS and criminal justice systems.

NarxCare offers prescribers a Medication-Assisted Treatment locator map and patient information handouts.

The 450-employee, Louisville-based Appriss Health says its systems process 25 million database inquiries each year. It also offers law enforcement, public safety, and Medicaid fraud detection apps.


Reader Comments

From Firing Line: “Re: HIStalk. I have followed you since I worked at a big health IT vendor, where it was a fireable offense to read your blog back in the early days.” I’ve heard that about a few companies, which encourages me since I must be doing something right if they want to ban employees from reading what I write. I also enjoy hearing from readers who apologize for not evangelizing HIStalk because they consider the information they gain to be a personal competitive advantage.

From Spatial Orientation: “Re: [EHR vendor name omitted]. Has informed users that they are able to supply QRDA III reports but not QRDA I reports, meaning they are in violation of ONC’s certification requirements.” Unverified. I’ve invited the company to respond but haven’t heard back. I’ll repeat this item including their name in Thursday’s post if they don’t respond.


HIStalkapalooza Sponsor Profile

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Spok, Inc., a wholly owned subsidiary of Spok Holdings, Inc. (NASDAQ: SPOK), headquartered in Springfield, VA., is proud to be the global leader in healthcare communications. We deliver clinical information to care teams when and where it matters most to improve patient outcomes. Top hospitals rely on the Spok Care Connect platform to enhance workflows for clinicians, support administrative compliance, and provide a better experience for patients. Our customers send over 100 million messages each month through their Spok solutions. When seconds count, count on Spok. For more information, visit spok.com or follow @spoktweets on Twitter.


HIStalk Announcements and Requests

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I’m getting swamped with HIStalkapalooza emails from people who don’t appreciate the fact that I have around 50,000 readers and I have maybe 1.5 FTEs total other than me to do everything HIStalk-related, of which party planning represents about 0.01 FTE. My plea is this: come if you received an invitation, don’t come if you didn’t, and don’t email us either way because it’s the busiest time of year for us and throwing a free party isn’t our most pressing priority. To summarize the oft-stated rules: (a) don’t ask if I have extra tickets since I’m already turning people away who signed up due to a shortfall in sponsorship funds, so I certainly won’t be inviting someone who didn’t even register; (b) you’ll need to complete your registration online from the email link and bring your barcoded invitation to the event; (c) I can’t help you fix your company’s spam filter that didn’t let your invitation through; (d) you can’t bring a guest if you didn’t register them; and (e) wear whatever you want, but go big if you want to have a shot for the “best shoes” and best dressed” awards. There’s an exception to (a): get your company to sign on as a sponsor of the event and your CEO can come after all — it’s nearly always CEOs who neglect to sign up and then dispatch an underling to demand an exception, usually from vendor companies that don’t support HIStalk in any way.

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Dear HIMSS-owned publication: hi, it’s me again. Thanks for fixing the story you ran over the weekend that I called out, in which you mistook a January 2016 press release for January 2017 and splashed it out as breaking news. I won’t quibble with the fact that you just changed the story to hide your mistake without acknowledging it. On that topic, please note that there’s no such company as “Optum Healthcare IT” that you reference in your list of KLAS winners. What you meant to say was “Optimum Healthcare IT.” At least your HIMSS peer at Healthcare Finance also screwed up the same name, calling it “Optimum IT.” Don’t worry, I don’t read your site, so I won’t be catching your mistakes regularly (but hopefully your readers will!)

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We provided strategic thinking and economics games along with general supplies for Ms. D’s middle school class in Arkansas in funding her DonorsChoose grant request. She reports, “My students have played rounds of critical thinking games every week since we have received the package. This is their favorite time of the week and can’t wait to figure out what new game we are playing. After learning about Milton Bradley and Henry Ford, the students have started creating their own strategy games.”


Webinars

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.

February 8 (Wednesday) 1:00 ET. “Machine Learning Using Healthcare.ai: a Hands-on Learning Session.” Sponsored by Health Catalyst. Presenter: Levi Thatcher, director of data science, Health Catalyst. This webinar offers a tour of Healthcare.ai, a free predictive analytics platform for healthcare, with a live demo of using it to implement a healthcare-specific machine learning model from data source to patient impact. The presenter will go through a hands-on coding example while sharing his insights on the value of predictive analytics, the best path towards implementation, and avoiding common pitfalls.

Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.


Acquisitions, Funding, Business, and Stock

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Thoma Bravo is soliciting bids to buy its supply chain management company Global Health Exchange for up to $1.3 billion, Reuters reports. Thoma Bravo bought GHX in 2014.

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A private equity news site says health information exchange platform vendor Vyne has hired a merchant bank to explore a sale of the company.

Big Massachusetts providers Beth Israel Deaconess Medical Center and Lahey Clinic announce plans to merge to better compete with the huge (and hugely expensive) Partners HealthCare, which also recently announced its own plan to acquire the Massachusetts Eye and Ear specialty hospital.


Sales

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Geisinger Health System (PA) will implement Stanson Health’s clinical decision support and analytics to add real-time, patient-specific intelligence to its EHR.

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In England, King’s College Hospital NHS Foundation Trust chooses Cerner Millennium EHR and revenue cycle for the 100-bed hospital it will build in Dubai.

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Dayton Children’s Hospital (OH) selects InstaMed’s consumer-friendly, encrypted payments solution.


People

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MedEvolve hires Jenny O’Pry (MedSynergies) as SVP of RCM and Matt Seefeld (NantHealth) as SVP of business development.


Announcements and Implementations

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Healthcare Growth Partners publishes its amply-researched and well-written HIT Market Review, which includes M&A, valuation, the year in review, and thoughts about the impact of the new administration.

A new Black Book report finds that population health management technology is a fast-growing sector even though providers are forging ahead using only stopgap tools from their EHR vendor, they’re dealing with community HIEs that offer poor population health modeling data, and they have limited data availability beyond their own EHR’s health snapshots. Hospitals report that they will need new PHM and IT talent, but shortages may limit availability. The top three best-of-breed vendors were IBM Watson Health, Evolent Health, and The Advisory Board Company, while the top three PHM and value-based care consultants were Premier, The Advisory Board Company, and Evolent Health.


Government and Politics

Vox reports that President Trump has abandoned his campaign promise to reduce drug costs by allowing Medicare to negotiate prices, changing his mind after meeting with pharma lobbyists to now favor drug company tax reductions and deregulation.


Privacy and Security

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I’ve seen several recent articles on Cambridge Analytica, the “behavioral microtargeting” analytics firm that was involved (to an arguable degree) with both the Brexit and Donald Trump wins that pollsters failed to predict. The company’s work is relevant to healthcare because: (a) it sounds a lot like how HIMSS describes its new service that will target vendor sales prospects using their personal information; and (b) it could be more positively used for public health in areas such as depression. Either way, lax US personal data laws are making us all targets of companies that train their analytical firepower to profitably sway our decisions. Cambridge Analytica, of which White House advisor Steve Bannon is apparently a board member, mines Facebook data via those mindless quizzes that bored people inexplicably take, thus giving the company access to their Facebook profiles. The company’s technology supposedly requires just 68 of a user’s “likes” to accurately predict their skin color, sexual orientation, political party affiliation, and use of drugs, alcohol, and cigarettes, while it just 10 “likes” allow researchers to “know” a Facebook user better than their work colleagues. The company combined that information with commercially sold personal information databases to develop psychological profiles on every American. It then buys Facebook ads that it micro-targets to individual personality types, which some experts say was the key to the unexpected and lesser-funded campaign victories of Donald Trump and Brexit:

On the day of the third presidential debate between Trump and Clinton, Trump’s team tested 175,000 different ad variations for his arguments, in order to find the right versions above all via Facebook. The messages differed for the most part only in microscopic details, in order to target the recipients in the optimal psychological way: different headings, colors, captions, with a photo or video. This fine-tuning reaches all the way down to the smallest groups … In the Miami district of Little Haiti, for instance, Trump’s campaign provided inhabitants with news about the failure of the Clinton Foundation following the earthquake in Haiti, in order to keep them from voting for Hillary Clinton … These “dark posts”—sponsored news-feed-style ads in Facebook timelines that can only be seen by users with specific profiles—included videos aimed at African-Americans in which Hillary Clinton refers to black men as predators, for example.

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The St. Louis Cardinals will give the Houston Astros $2 million and their two top draft picks as cybercrime compensation. The former director of baseball development for the Cardinals was sentenced to 46 months in prison and a lifetime MLB ban for accessing the scouting reports, contract information, and internal emails of the Astros using passwords he had guessed.

Officials in Missouri, the only state that doesn’t have a doctor-shopper prescription drug monitoring database, are still arguing over privacy requirements and which state agency should oversee it.


Other

Sites are slinging around news headlines saying that medical residents spend half of their time working on the computer, but they fail to note the deal-breaking limitations of the just-published study they reference: it was performed in Switzerland with unknown applicability to the US and it was an observational study (which has unavoidable bias) of only 36 internal medicine residents in a single hospital. There’s probably also the fact that residents are often expected to remain in the hospital outside of normal working hours, so it’s questionable whether EHR usage required extra time or whether they were stuck in the hospital without much else to do anway.

A TransUnion Healthcare consumer survey finds that three-fourths of respondents would look more favorably on a provider who provides upfront cost estimates, but 43 percent said it was hard to get cost information and another 21 percent said they haven’t even bothered trying.

Authors of a JAMA opinion piece say it’s too expensive for patients to get copies of their medical records since providers widely ignore a 2016 federal law that allows them to charge only direct labor and postage costs associated with creating the paper copy. Only Kentucky requires providers to give patients the first copy of their records at no cost.

Small drug company Kaleo, which makes a recently approved naloxone injector for opioid overdoses, has raised the price of its consumer-usable package of the nearly 50-year-old  drug from $690 in 2014 to $4,500 now. The company is donating the product to first responders and drug treatment programs, covering co-pays for buyers with private insurance, and selling it to the VA (which is allowed to negotiate drug prices) at a significant discount, but sticking insurance companies and taxpayers with the bulk of its profits.

In England, a report finds that human error contributed to the failure of the 1980s-era pathology system that delayed surgeries at Leeds Teaching Hospitals NHS Trust. Most of the system’s experienced support employees have left and newer analysts didn’t notice that system backups had grown so large that they were being corrupted.

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OB-GYN doctors and nurses at a hospital in Macedonia are fined when a nurse posts Facebook photos of their in-hospital New Year’s celebration that show alcohol, cigarettes, and cupcakes iced to look like vaginas. Photos of the latter item indicate that though their social media judgment is suspect, their eye for anatomical detail is admirable.


Sponsor Updates

  • Medhost Achieves Stage 3 Meaningful Use Certification (Medhost)
  • Besler Consulting releases a new podcast, “American Healthcare: Worst value in the developed world? Par 1: Looking at the data.”
  • Carevive Systems will present at the Cancer Center Business Summit 2017 February 6-7 in Las Vegas.
  • ECG Management Consultants will present at the American Health Lawyers Association meeting February 1 in Orlando.
  • Elsevier will offer HFMA courses through its healthcare eLearning system.
  • Healthwise will exhibit at EClinicalWorks Day February 1 in New Orleans.
  • The CHIME Foundation appoints Divurgent’s Steve Eckert to its board.

Blog Posts

KLAS-Related Announcements


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 1/31/17

January 30, 2017 Headlines No Comments

Copy Fees and Limitation of Patients’ Access to Their Own Medical Records

A JAMA article addresses the continued problems patients are experiencing when requesting a copy of their medical records, despite the widespread use of EHRs that should minimize the burden and cost of fulfilling these requests.

Fitbit Cutting 6% of Workforce as Results Miss Estimates

Fitbit reports that it  will miss Q4 revenue estimates by a wide margin, citing declining demand for fitness trackers. The company announces that it will eliminate 110 jobs to reduce costs. Share prices fell 16 percent on the news.

Kaiser Permanente faces $2.5M-plus in penalties for Medi-Cal data shortfall

Kaiser Permanente faces $2.5 million in penalties for failing to supply California regulators with properly formatted claims data from its Medicaid managed-care plans. The issue was originally raised in 2016, and a corrective action plan was agreed upon that gave Kaiser until January 1, 2017 to reformat and resubmit its data, but corrected claims were never resubmitted.

Can Big Data Help Cancer Patients Avoid ER Visits?

Penn Medicine using big data to try and forecast when lung cancer patients will end up in the emergency room. Current algorithms are reportedly able to predict one-third of these ER visits, at which point patients can be called and scheduled for a clinic visit.

Curbside Consult with Dr. Jayne 1/30/17

January 30, 2017 Dr. Jayne No Comments

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I’ve finally started getting excited about HIMSS. On Friday, my MagicBand arrived, personalized and ready for Disney to start transferring cash directly to their coffers. After learning hard lessons in the past about the need to book hotel rooms early, I was able to get a room at my hotel of choice. I planned to spend most of HIMSS with a good friend, but she tried to book a couple of days after me and wasn’t able to get a room. She does, however, have connections at Disney, where we were able to get significantly more posh accommodations for a fraction of what we would have paid at the official HIMSS hotels. Sure, we’ll have to deal with parking and traffic, but I’m looking forward to spending time with friends and getting away from the craziness of the show each night.

I was also excited to get my HIStalkapalooza ticket. Even though I’m guaranteed an invitation, I do have to register for a ticket just like everyone else and it’s always exciting when that email arrives. Now I have to figure out what I’m going to wear and of course find the right shoes, so that will be on my to-do list for the next couple of weeks. It’s nice to have a project to work on that doesn’t involve federal regulations, frustrated healthcare organizations, burned out physicians, or medical practices struggling to survive.

Things have also started to slow down at my clinical practice, with the near-epidemic of influenza finally easing up. Our fiscal year runs with the calendar year. Even though we monitor the numbers closely throughout the year, once we close the books, it triggers detailed accounting reviews and the beginning of discussions on our strategy for managed care and occupational health contracting negotiations. That dovetails with planning exercises and review of our recent growth and whether we should continue with our plans for opening new locations or whether we need to re-evaluate. Fortunately, our price transparency and the boom in high-deductible insurance plans continues to support our planned expansions. We have nearly triple the locations we had when I started, with several hundred employees.

I had an opportunity to sit down with our chief operating officer this week. Part of the meeting was a review of my personal metrics. It’s nice to work at an organization that understands the role of metrics and how to use them drive organizational goals. It’s a bit if a luxury to be able to set our own metrics and not be stuck with what CMS and other governmental bodies think we should use, regardless of whether they impact our internal or community-based goals.

We look at a variety of metrics that impact patient satisfaction, such as wait time, treatment time, appropriate referral for advanced imaging, procedural complications, survey results, and response to clinical follow-up outreach. Those metrics vary month to month, and in this cycle we saw a pretty significant impact due to the rate of influenza, norovirus, and other infectious diseases. At one point in December, we were seeing 50 percent more patients on a daily basis than we had ever seen, so it’s not surprising that patients would be a little less satisfied about wait times or congestion in the office.

We also look at quite a few financial metrics, including charges per encounter and the distribution of E&M codes among providers. As you would expect, most of our visits fall under a subset of codes, but there are some outliers that occasionally over- or under-code, so we have to decide how to deal with them. Is it just a blip or part of a larger pattern? Does it increase our risk for audit? Is someone trying to game the system by getting their charges up without appropriate justification?

We know that the cost of care at our facility is about one-eighth that of care at the area’s emergency departments, so it might be tempting for some providers to upcode. We also look at what the EHR suggested the code be, vs. what the provider or scribe actually clicked, vs. what the internal coders think. There is always some wiggle room depending on whether documentation elements were captured as free text or discrete elements, and our visits occasionally move up or down the E&M code spectrum after coding review.

Not surprisingly, I tend to fall at the lower end of the pack as far as charges per encounter, which makes sense with my primary care roots and all of the managed care red tape I’ve had to deal with. I tend to be less free with prescriptions as well, which is understandable given the risks of polypharmacy with patients you don’t know well. It was interesting to see the comparative data and what some of my colleagues are doing though – I average 0.64 prescriptions per patient encounter, where some of my colleagues are in the 1.6 and 1.7 range. Most of our group is in the 0.85 range, so I’m not that far off the mark. Given the range, though, I recommended that next month we slice that data a little differently and look specifically at newer vs. established colleagues, moonlighting residents vs. midlevel providers vs. supervising physicians, full vs. part-time provider status, and distribution by location.

We look at a lot of our data in aggregate, which makes it interesting when you know you have outlier data. Since we have our own in-house ultrasound and CT scanners, we look at the timeliness of referral for those modalities. Since I only work part time, any fluctuations in my practice patterns show up a bit more acutely than my peers who see many more patients each reporting period. My “timely referral for diagnostics” metric was significantly off from last month, and the COO got a kick out of the fact that I could recite the clinical situations of the patients whose visits drove the numbers. I had a flurry of cases that had to be transferred to the emergency department for higher acuity care (and in two cases had to go straight to the operating room) and let me tell you, those are the shifts you don’t forget.

The urgent care keeps trying to lure me into a full-time role, and it’s getting more difficult to resist its call. We agreed to talk again in a few months. In the meantime, we’ll have to see if HIMSS brings any new and exciting opportunities to light my informatics fire.

If you could have any job in the world, what would it be? Email me.

Email Dr. Jayne.

Morning Headlines 1/30/17

January 29, 2017 Headlines 1 Comment

Obamacare Architect Says Silicon Valley Tech Won’t Steer Health Care

ACA architect Ezekiel Emanuel, MD, PhD laughs at the idea that Silicon Valley data gurus will ever replace doctors, saying “I am much more skeptical that the computer is going to replace a doctor. That a computer is going to interface with the patient and take care of them. Not gonna happen.” He is also unimpressed with wearables, saying that continuous monitoring generates data that the healthcare industry is not prepared to take action on.

2017 Top Black Book Electronic Health Records (EHR) Systems Announced for Oncology and Hematology

Black Book names McKesson’s iKnowMedSM as the top performer in its oncology EHR customer satisfaction survey for the sixth year in a row.

Hospital scammed for employee information

A hospital employee sends the W-2s of 1,400 employees at Campbell County Health (WY) to a hacker that posed as a hospital executive and asked for the forms to be emailed to him.

Veritas Capital Agrees to Acquire Government IT Services Business from Harris Corporation

Private Equity firm Veritas Capital will acquire the government IT service business of Harris Corporation for $690 million in cash.

Monday Morning Update 1/30/17

January 29, 2017 News 8 Comments

Top News

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VoteStand vote fraud reporting app developer Gregg Phillips, who President Trump credits with convincing him that 3 million people voted illegally in the November election (all of them for Hillary Clinton), has a healthcare IT connection – he’s the chairman of AutoGov, a Medicaid eligibility decision support tool vendor. The product’s description suggest that it works similarly to his vote fraud analysis methods, merging databases together to provide a full eligibility picture of Medicaid applicants.

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AutoGov markets its big data-powered system to providers as, “You will be able to decide whether or not to admit a Medicaid patient with just a touch of a button.” It is powered by scoring algorithms that use data from 30 million cases.

Phillips, a former Texas Deputy HHS commissioner, says he augmented a 180 million-row voter registration database with other databases and geocoding data, giving him the ability to verify identity, residency, and citizenship status, although others have questioned his claim. He said in a CNN interview Friday he won’t be able to release specifics for several months given the analysis required and the demands of his day job.

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A post-election tweet by Phillips claiming that non-citizens voted was picked up by the then-President-elect, after which an apparently puzzled Phillips told a reporter, “Is a tweet really news? Isn’t everything on Twitter fake?”


Reader Comments

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From Is This Even Still a Thing? “Re: booth babes. I just got this pitch.” An Orlando modeling agency warns HIMSS17 exhibitors of the peril of hiring “below-average young women” to draw traffic, introduce products, and generate leads. I think I should run a honeypot sting operation to focus on the demand instead of the supply, setting up a fake HIMSS booth staffed by an “above-average young woman” from this agency. Each time our booth babe lures a gawking attendee into the booth, I would emerge with microphone in hand like that solemn-voiced talking head Chris Hansen in “To Catch a Predator,” inviting the now-squirming attendee to have a seat and explain to my on-camera audience (and to their colleagues and families) what they hoped to gain. 

From Research Expert: “Re: HIStalk. I read it every day and find it extremely valuable. Good thing it’s not more organized or it could put many of the advisory firms out of business. 🙂” Thanks. I’m more of a real-time fire hose since I don’t like to recycle old news just to earn reader clicks while insulting their intelligence, but I could probably get someone to repackage the already-vetted information stream into something that could be useful in a different way. However, my inherent laziness makes that unlikely.


HIStalkapalooza

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HIStalkapalooza invitations will be emailed by Monday. Every year we invite people who claim we didn’t, as our email was apparently blocked by their overly aggressive spam filters (the invitation will come from eventbrite.com). Important: you MUST click the link on the email invitation link called “Attend Event” to complete your signup, otherwise the check-in system won’t recognize you at the House of Blues and you’ll be slinking away crestfallen to the sounds of the link-clickers inside slurping down drinks, loading up plates, and performing their pre-dance stretching.

A shortfall in sponsor money means I can’t invite everyone who asked to attend, unfortunately. The pecking order is providers first, then two people from each HIStalk Platinum sponsor, then I just try to choose a good mix of job titles and companies until we hit the number I can afford (since I’m paying thousands out of my own pocket). I’ll ignore emails asking for exceptions, explanations, or anything else event related –  it’s just a party and nobody will suffer from starvation, dehydration, or dance deprivation for lack of attendance that Monday evening. Like a concert or sporting event, each person must have an individual ticket that will be scanned at the door.


HIStalkapalooza Sponsor Profile

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Cumberland Consulting Group is a leading healthcare consulting firm that helps some of the nation’s largest payer, provider, and life sciences organizations implement and optimize technologies to maximize operational efficiency. Cumberland delivers comprehensive consulting services with a focus on strategic advisory, implementation, optimization, and outsourcing. The firm excels at system selection and planning, implementation project management, system optimization, and performance improvement. In addition, Cumberland offers high-quality, certified resources to support your most complex IT projects. For more information on Cumberland’s services, visit their site.


HIStalk Announcements and Requests

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Dear HIMSS-owned publication: apparently you failed to notice that the press release you used as the sole, uncredited source for your just-published breaking news article was dated January 6, 2016. You already reworded that press release in calling it news on January 8, 2016 (although even then your sub-headline made no sense). Could you perhaps apologize to the 400 folks who have shared your “news” so far this week since you’ve made them look stupid in mistaking a year-old announcement for something new? Thank you.

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About half of poll respondents reacted negatively to the announcement that HIMSS is starting a conference and media group that will cater to vendor members targeting provider members, while 17 percent like the idea and 31 percent don’t care either way. HIS Junkie sagely comments that if HIMSS were truly member-driven, it would set up a division and conference to teach providers how to negotiate with vendors and to get better contracts, but as he notes, there’s no money in that.

New poll to your right or here: why are you going to the HIMSS conference? (a question I ask myself every year about this time).

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Ms. H asked for financial help via DonorsChoose to continue her New York high school’s “Guest Writers” series, which we provided. She says students have enjoyed getting a behind-the-scenes look of how books are written, edited, and published as described by award-winning authors who visit with the students. 

Iatric Systems donated $500 to my DonorsChoose project, which with matching funds applied (from my anonymous vendor executive and other sources) fully funded these teacher grant requests:

  • Two laptops, computer accessories and cases, a document camera, and supplies as requested by high school senior Julie for her Camden, NJ pre-calculus class
  • An Amazon Fire tablet for Ms. D’s elementary school class in Los Angeles, CA
  • A Chromebook for Mr. D’s elementary school class in Wichita, KS
  • STEAM literature for Ms. M’s fourth-grade class in Minneapolis, MN
  • An activities table for Ms. A’s first-grade class in Manning, SC
  • Hands-on manipulatives and family interactive learning technologies for Ms. A’s elementary school class in Chicago, IL

Ms. A from Chicago emailed soon after I made the donation to say, “This is beyond heart-warming! I am tearing up and smiling at the same time! The education crisis in my state is threatening more teacher layoffs, furlough days, and shortening the school year. Your donation has uplifted my spirit and brought great joy as finding innovative ways to educate my students and their families is a passion that, I learned today, I do not share alone. ”


Last Week’s Most Interesting News

  • McKesson announces that it will acquire CoverMyMeds for up to $1.4 billion.
  • A federal judge rules against the proposed merger of Aetna and Humana, citing anti-competitive concerns.
  • GetWellNetwork acquires Seamless Medical Systems.
  • Former National Coordinator Karen DeSalvo, MD, MPH joins her fellow HHS political appointees in leaving government service with the administration change.

Webinars

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

Harris Corporation will sell its government IT services business to Veritas Capital for $690 million in cash, which doesn’t sound like much for a division that’s generating $1 billion in annual revenue.

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Hospital staffing firm Jackson Healthcare will build a $100 million, 306,000-square-foot expansion to its Alpharetta, GA headquarters that will house 1,400 new employees. It will include a 39,000-square-foot amenities building modeled after the Colosseum in Rome that will house a gym, pool, restaurant, hair salon, dry cleaner, spray-tanning studio, chiropractor, masseuse, and barber. The company took in $800 million in revenue last year.


Sales

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University of Virginia Medical Center (VA) chooses clinical process measurement solutions from LogicStream Health, which it will use to drive evidence-based best practices in managing and improving its EHR’s decision support tools.

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Children’s Healthcare of Atlanta selects Voalte Platform for care team communication and alert notification.

CHI Franciscan Health chooses Clearsense analytics to aggregate and organize patient data for clinical decision-making.


Decisions

  • Memorial Hospital Of Carbondale (IL) will switch from Meditech to Epic in June 2017.
  • Trinity Rock Island (IL) will replace BD Pyxis MedStation with Omnicell in summer 2017.
  • Centura Health – Porter Adventist Hospital (CO) replaced Meditech with Epic in October 2016.
  • Elmhurst Memorial Hospital (IL) went live with Epic in October 2016.

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


People

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Will Plourde (HealthcareSource) joins LiveData as VP of engineering.


Announcements and Implementations

McKesson’s IKnowMed tops Black Book’s oncology-hematology EHR satisfaction ratings for the sixth straight year.


Privacy and Security

An employee of Campbell County Health (WY) sends the W-2 information of 1,400 employees to a hacker impersonating a hospital executive who asked for all forms for 2016.


Other

A Johns Hopkins Medicine study finds that, not surprisingly, clinic doctors who are running behind schedule unintentionally shortchange patients in trying to catch up.

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A woman sues Cone Health (NC) for trying to collect the unpaid medical bills of her deceased husband, seeking class action status under a clause in the state’s constitution that says the property of a woman can’t be attached to pay for the debts of her husband.

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ACA architect Ezekiel Emanuel, MD, PhD scoffs at the idea that technology can replace doctors and that wearables can improve health, arguing that the tech sector is missing the point that resolving a technology-identified problem still requires a face-to-face doctor-patient encounter. He says technologists should focus on solving health problems like heart disease and obesity instead of obsessing about new monitoring tools, saying that even a cure for cancer would have a minor impact on life expectancy compared to reducing smoking and high blood pressure.

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An Ohio man is charged with arson and insurance fraud after police get a search warrant to review his pacemaker data and find no evidence of heavy exertion at the time he claimed he was quickly packing and lugging heavy belongings out of the house as the fire spread.

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A Hauppauge, NY doctor is convicted of selling opioid prescriptions by instructing his assistant to set up phony EHR exam and treatment records for anyone willing to pony up $120 in cash, all while he spent most of his days out of the office playing hockey. 


Sponsor Updates

  • Arcadia Healthcare Solutions wins top honors from Frost & Sullivan for its clinical and claims analytics platform.
  • PeriGen publishes slides from its presentation on “The New Labor Guidelines: Benefit or Harm” presentation at the Steamboat Perinatal Conference.
  • Phynd will exhibit at the North Carolina Epic User Group Meeting February 8-9 in Greensboro.
  • Red Hat technologies support TransUnion’s migration to a new IT environment.
  • Wharton Research Data Services adds SK&A healthcare data.

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 1/27/17

January 26, 2017 Headlines No Comments

CoverMyMeds Signs Definitive Agreement to be Acquired by McKesson

McKesson will acquire prescription electronic prior authorization vendor CoverMyMeds for $1.1 billion, plus an additional $300 million in financial performance incentives that would be paid out over the next two years.

Quality Systems, Inc. Reports Fiscal 2017 Third Quarter Results

Quality Systems, parent company to NextGen, reports Q3 results: revenue climbed 9 percent to $130 million, adjusted EPS $0.23 vs. $0.16.

Former HHS Secretary Burwell Is American University’s Next President

Sylvia Burwell will take over as the next president of American University in Washington DC, effective June 1, 2017.

If You Look at X-Rays or Moles for a Living, AI Is Coming for Your Job

Wired covers the expanding role AI will play in healthcare, noting a recent Nature study that tested the accuracy of deep learning algorithms designed to analyze images and identifying cancerous skin lesions and found that they performed as well as 21-board certified dermatologists.

News 1/27/17

January 26, 2017 News 10 Comments

Top News

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McKesson will acquire privately held prescription electronic prior authorization vendor CoverMyMeds for $1.1 billion plus another $300 million if the company hits performance targets.

McKesson will operate the Columbus, OH-based company as an independent business unit. Francisco Partners must have made a fortune from its November 2014 investment in the company.

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I interviewed co-founder Matt Scantland a couple of years ago, where he explained that drug companies pay for CoverMyMed’s services to avoid unfilled prescriptions. He also agreed then with my assessment that the company was flying under the radar in an obscure niche with $19 million in revenue. That figure jumped to $50 million the same year and $100 million the next. 

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McKesson also announces Q3 results: revenue up 4.7 percent, EPS $3.03 vs. $3.18, meeting earnings expectations but falling slightly short on revenue. Shares dropped 8.3 percent Thursday on the news.


Reader Comments

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From Build That Well: “Re: Becker’s. Changed their story on Erlanger’s loss.” Becker’s focuses on clickbait “10 things to know” listicles written mostly by new liberal arts grads for lazy readers. In this case, they tried to hype Epic as causing Erlanger’s reported loss, but the article they rewrote from the local newspaper didn’t say that at all. Above is the headline before and after. The non-alternative fact, according to Erlanger’s CFO, is that the loss was caused by overtime expense, employee insurance payouts, and drug costs, although he did mention almost as an afterthought that some overtime expense was incurred due to covering employees assigned to the Epic project. Erlanger’s CEO says in another newspaper’s article he’s happy that the hospital is hitting its year-to-date net income targets given that it amortized its $100 million Epic cost over just three years. Erlanger also notes that high-deductible insurance plans and its 33 percent self-pay rate means it can’t collect a lot of what patients owe.

From Clustered: “Re: Epic. I’m not bothered about their position on investment. How many times have there been things truly beautiful, streamlined, and elegant that were designed by committee? Investors are exactly that, collectively — a committee. They dilute decision-making in exchange for access to money and it sounds like Epic already has enough money of its own. Sure, there are things I wish Epic did differently, but I’m not sure inviting a bunch of MBAs and money folks onboard would improve things. Viva la Judy! (disclosure: I don’t work for or with Epic and never have).” Committees are like well-diversified mutual funds – they reduce the chance of both great failure and great success, at least if you’re willing to accept bland mediocrity. The best lessons I’ve learned in writing HIStalk are: (a) people can convey their strong opinion in believing that they represent the majority when in fact they could be dead wrong; and (b) instead of letting a committee tell me what to avoid doing wrong, I would rather just do what I want to do and let readers either come back or move on.

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From Silicon Valley Geek: “Re: Stanford Health Care. Since the new CEO arrived in July, the former CIO (who was promoted to chief digital officer last April) is leaving along with the associate CIO. The bloated 700-employee IT department serving a 600-bed hospital and ambulatory network has been seeing layoffs as the organizational struggles to manage operational costs, new construction, and integration of the newly acquired ValleyCare. IT lost over 50 people yesterday as the CEO announced a $100 million savings target for which non-labor cutbacks weren’t enough. Michael Sauk is now interim CIO – he used to work with the CEO at City of Hope and UW.” Unverified, except the part about Mike Sauk since it’s on his LinkedIn.


HIStalkapalooza

I’ve closed signups, so hopefully if you wanted to attend you either (a) got your name on the list in time, or (b) will be sent an invitation from one of the sponsors of the event, who get to invite a certain number of guests.

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I’m happy that our Industry Figure of the Year (one of the four nominees above) has confirmed attendance at the event, as has our “when ___ talks, people listen” recipient. I’m trying without success so far to get our “person you’d most like to see on stage” and Lifetime Achievement Award winners to stop by, but you never know.

Thanks to our newly participating HIStalkapalooza sponsors:

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HIStalkapalooza Sponsor Profile

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PatientSafe Solutions obsesses over the experience of care to help care teams communicate and work together reliably and efficiently. PatientSafe delivers measurable safety and quality improvements through a mobile platform that extends an organization’s EMR, clinical, and communication infrastructure and fits seamlessly into care team workflows. The company’s context-driven PatientTouch platform unifies communication with workflow by consolidating text, talk, alerts, EMR data, clinical workflows, and customizable care interventions, all in one mobile app, on one device. For more than a decade, PatientTouch has helped clinicians both in and outside the hospital streamline care delivery, increase quality, and lower costs.


HIStalk Announcements and Requests

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Ms. M in Houston sent photos of her students using the listening center and wipe boards we provided in funding her DonorsChoose grant request.

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Welcome to new HIStalk Platinum Sponsor Clearsense. The Jacksonville, FL-based data science company offers a cloud-based analytics solution that works with any data source and can be rolled out in a fraction of the time required for a traditional data warehouse. Its real-time, cloud-based, subscription-priced, scalable system helps healthcare organizations respond to the pressure to use data to make better and faster decisions. Examples: reducing adverse events, improving patient flow, hitting quality and patient satisfaction targets, driving research, and managing cost and payment. Thanks to Clearsense for supporting HIStalk.

I found this excellent YouTube video featuring Clearsense Chief Innovation Officer Charles Boicey MS, RN speaking at the most recent HIMSS SoCal Clinical Informatics Summit. 

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Readers have been asking for years to be able to search HIStalk articles with a company name and date range and I finally figured out how to do that in an admittedly inelegant but somewhat effective way. The date range search box allows specifying a search word (it works best with a single word) and an optional “from” and “to” date range, then shows the results in context. It’s not perfect, but it’s good if you want to see when I mentioned Cerner, let’s say, in just the second half of 2016. 

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We like to have cool people hang out at our HIMSS booth since we don’t have anything to sell and are otherwise sitting alone in our microscopic, unadorned space. Contact Lorre if you would like to entertain, amuse, or otherwise engage HIStalk readers for an hour or so – we tend to like people who are funny and don’t take themselves too seriously, which is harder to find in health than you might expect. 

Does ICD-10 have a code for repetitive stress injury caused by anxiously checking three news sites every 10 minutes, drawn by a combination of fascination and dread?

This week on HIStalk Practice: Northwest Vein & Aesthetic Center rolls out Oncomfort’s anxiety-reducing VR technology. Employee clinic company OurHealth signs on with Athenahealth. Pediatricians take aim at wearables for infants. Eye Care Leaders adds OptimizeRx to partner EHRs. Winners Circle series launches with MTBC winner and Practice Manager Baqar Naqvi. Stakeholders band together to encourage renewed value-based payment reform efforts. Compulink adds Weave’s patient scheduling tech. Sue Kressly, MD advocates for pediatric-specific functionality in EHRs. Sign up for physician practice health IT news.

Listening: the now-defunct After Forever, since Floor Jansen is in my opinion the best singer (of either gender) in the world and the band was crazy talented, as are many of those in the “Beauty and the Beast” metal genre. Now she sings for NIghtwish, where she’s equally good although with less-demanding material. Floor singing “Leaden Legacy” with AF is about as good as it gets.


Webinars

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. 

Here’s the recording of Wednesday’s webinar, “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.”


Acquisitions, Funding, Business, and Stock

Quality Systems (NextGen) reports Q3 results: revenue up 9 percent, adjusted EPS $0.23 vs. $0.16, beating analyst expectations for both.

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Specialty EHR vendor SRSsoft renames itself to SRS Health, unleashing a fury of highfalutin’ buzzwords in which the marketing people congratulate themselves on wresting control of the company’s strategy by turning an orange circle into marketing art whose description will sail right over the heads of customers who squint thoughtfully and say, “I dunno, it just looks like an orange circle to me.” Companies somehow never learn to just make these changes without over-describing them, insisting on involving customers in their contrived logic and convoluted explanation that elicit guffaws instead of praise: 

A brand’s logo is its face to the world. Our new orb-shaped visual identity represents the continuum of how we help our clients engage their patients before, during, and after visits. It signifies the perfect balance of improved efficiency with proven outcomes. And it symbolizes the unending dedication of our team to remain in motion as we continue to pioneer the HCIT solutions of the future. The fiery color of our logo was chosen specifically to depict the passion and commitment to client satisfaction of the people who make up the SRS Health team.


Sales

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Children’s National Health System (DC) adds Millennium Revenue Cycle to its Cerner EHR.

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Local governments in Finland choose Optimum Healthcare IT to staff the 29-hospital Epic implementation of their $615 million Apotti project.


People

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Former HHS Secretary Sylvia Burwell is hired as president of American University in Washington, DC. I wondered about her advanced degree and it turns out she doesn’t have one.

Investment banker Jefferies hires Dmitry Krasnik (Houlihan Lokey) to lead its coverage of healthcare IT.


Announcements and Implementations

InterSystems and Clinical Architecture develop a “clinigraphic” graphical representation of a patient’s most pertinent information contained in medication lists, comorbidities, and test results.

The Gates Foundation donates $279 million to University of Washington’s Institute for Health Metrics and Evaluation, which publishes evidence and trends for global population health that includes the annual Global Burden of Disease report.

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Grady Health System (GA) goes live on Glytec’s eGlycemic Management System of personalized insulin dosing, blood glucose alerts, and analytics integrated with Epic as well as glucose surveillance integrated with Grady’s laboratory information system.


Government and Politics

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A small survey of PCPs published in NEJM finds that only 15 percent think the ACA should be repealed entirely, with three-quarters of them saying it just needs tweaked (some of their suggestions are above). The doctors mirror the general public in supporting existing policies such as prohibiting consideration of pre-existing conditions, allowing parents to keep their children on their insurance through age 26, offering taxpayer-funded small business tax credits and individual subsidies, and expanding Medicaid. Fewer than half support requiring people to carry insurance, however, thus again raising the all-important question of how insurance companies can create cost-effective risk pools among only self-selectors.

Massachusetts Governor Charlie Baker – a former CEO of insurer Harvard Pilgrim Health Care — defends his call for employers to pay the state $2,000 for each employee who either isn’t offered health insurance or who declines to buy it. The state’s MassHealth program is spending $1 billion per year to subsidize health insurance for low-income, full-time employees who could buy employer-offered plans but instead sign up for MassHealth to take advantage of premium subsidies, which the state says is an ACA loophole. Baker is also calling for limiting provider rate increases, with price hikes of the most expensive hospitals capped at the same level as their Medicare increases. MassHealth’s annual cost of $16 billion accounts for 40 percent of the just-released 2018 state budget.

President Trump says in a TV interview that his replacement for the “disaster” of the Affordable Care Act will offer “a better plan, much better healthcare, much better service treatment, a plan where you can have access to the doctor that you want and the plan that you want. We’re gonna have a much better healthcare plan at much less money.” He also says that he expects everyone insured through the exchange to keep insurance coverage.


Privacy and Security

President Trump’s deportation executive order instructs federal agencies to exclude illegal aliens from the Privacy Act, which prohibits the the disclosure of a person’s federal government-held information without their consent. The Act covered only citizens anyway, from what I can tell, and I’m not sure this order has any direct impact on healthcare. Perhaps the significant result is that agencies would need to know (and therefore ask) about immigration status and systems might have to be modified to record it.


Other

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A Wired article notes that improvements in graphics and artificial intelligence technology may render obsolete those doctors who look at an image and then decide what it is, warning that pathologists, radiologists, and dermatologists are at risk of being replaced by machines. It cites the just-published study in which neural networks trained on previous images performed as well as 21 board-certified dermatologists in recognizing cancerous growths.

The Wall Street Journal profiles McKesson Specialty Health’s Practice Insights analytics platform for oncology practices, which extracts EHR information for clinical insight and matches patients with clinical trials.

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A patient of a family practice owned by Carolinas HealthCare (NC) complains after noticing that her problem list included “lesbianism.” The health system said the observation was listed there to avoid offending her, but offered to move it to the notes section of her chart. The patient questions why the health system needs to record her sexual orientation at all. I’m not sure I agree since I assume she told them and thus felt they should know, but perhaps the term “problem list” casts an unintended aspersion. This could be a challenge for the OpenNotes movement – recording patient-reported or observed information in a way that patients don’t take as offensive, although this example is less of a challenge than accurately identifying someone as obese, alcoholic, or depressed.


Sponsor Updates

  • Sutherland Healthcare Solutions publishes a video describing its SmartHealthSolutions analytics platform.
  • ECG Management Consultants will exhibit at the Summit on Bundled Payment January 25-26 in Atlanta.
  • The Chartis Group publishes a white paper titled “What does the Trump Presidency Mean for Providers?”
  • EClinicalWorks and Vocera will exhibit at Arab Health 2017 in Dubai.
  • Imprivata and Obix Perinatal Data System will exhibit at the Arab Health Congress January 30-February 2 in Dubai.
  • PDR will exhibit at the Inspire 2017 Rx30 User Conference & Expo January 27-28 in Orlando, FL.
  • MedData will exhibit at the American Society for Anesthesiologists Practice Management event January 27-29 in Grapevine, TX.
  • The Intrepid Healthcare podcast features Meditech AVP of Marketing Christine Parent.
  • Nordic will host a meetup in Chicago February 3

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 1/26/17

January 26, 2017 Dr. Jayne No Comments

CMS rolls out the MIPS red carpet for small, rural, and underserved practices with a webinar on February 1. CMS will be discussing eligibility, 2017 participation, data submission, performance categories, scoring, and resources available to practices falling into these categories. Figuring out a MIPS strategy is hard enough for large practices who have relatively greater resources, so I can’t imagine how a small independent rural practice might struggle. I’ve done some engagements with that demographic and many of them can’t even figure out how to afford a reasonably priced consultant given their payer mix (lots of Medicaid) and the challenges of treating the medically underserved.

Whether you’re a cash-strapped practice or not, CMS has also given some confusing messages when discussing the Medicare volume threshold for excluding practices from MIPS. There have been questions about whether providers have to meet the charge threshold AND the volume threshold, or whether it should be an OR function. The answer is that it depends on how you ask the question. If you’re asking who is excluded, it’s providers who Medicare Part B allowed charges are less than or equal to $30K OR if they see fewer than 100 Medicare Part B patients annually. If you’re asking who is eligible, it’s providers who meet the charge threshold AND see more than 100 patients. For those who think proper sentence construction is antiquated: case in point.

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I just took a long-term assignment with a client whose basic business processes are in total disarray. They haven’t been looking at their staffing or expenses for months and have dug themselves into a deep hole. Originally, they thought there was some kind of embezzling or theft, but after a thorough investigation, it points to a total lack of management.

Looking at the “at your fingertips” reports available in their online payroll system, I identified a handful of employees who have been logging overtime daily for more than a year. In interviewing the employees and their direct managers, no one has ever noticed it, let alone discussed it or taken steps to mitigate it. When assessing one employee’s daily assignments, it turns out she has been doing various tasks that belong to three other employees and that has been eating up a good chunk of her time. It never occurred to her to discuss this with her manager, which is one issue, but the manager’s failure to notice the overtime is another. And accounting’s failure to notice a significant budget variance is a miss as well as practice leadership failing to notice that accounting didn’t call it out.

We discussed sitting down with the employees and working through their daily tasks to find out what was generating the overtime, but they were uncomfortable leading the discussion. I agreed to work with them, taking the “watch one, do one, teach one” approach to get them to a point where they were at least minimally capable of managing their own resources. It was a painful few days of discussions, coaching, reviewing, role-playing, and revisiting, but we at least stopped the bleeding with a new policy to prevent employees from logging overtime without a direct manager approval that is documented in writing. Although many of the overtime-inducing tasks were administrative, several of them were clinical in nature and we had to make plans to ensure that work didn’t fall through the cracks.

The bigger point here is that if a practice can’t handle Office Management 101, how are they going to handle the increasing data-gathering and reporting demands required as healthcare evolves? And if they can’t figure out how to resource current tasks or how to eliminate non-value-added processes, will the patients suffer? How will they create processes for team-based care, increased coordination with external providers, management of transfers of care, and more? There are plenty of vendors out there pushing technology solutions that will only automate bad processes and it’s challenging to have these hard conversations with organizations about how they do business. If they’re not managing their human resource overhead, they may not be managing their supply overhead, either. And it’s a safe bet that if they’re not on a cloud-based EHR, they’re not managing their servers and hardware, either.

Ultimately some of these practices aren’t going to be financially viable. My primary care physician’s practice recently disbanded. The partners had very different ideas about what “productive” looked like, which resulted in one partner carrying the lion’s share of the overhead. Over time this became untenable, and his aging partners weren’t willing to work harder or longer hours.

My PCP grew increasingly disillusioned and his partners couldn’t afford to buy him out, so they agreed to close. It’s been a culture shock as he moves into the ranks of employed physicians. Fortunately, he didn’t have to join a big health system group, but became an employee of a small independent practice. Based on all the things he no longer worries about, he has more time for patient care, but it’s been an adjustment. We’ve been friends for a long time, so I did a therapeutic intervention and used some of his free time for dinner and a movie. I think we’ll be able to get him through this.

It was interesting watching the wind-down from the patient perspective, however, since I had gotten used to having access to the practice’s patient portal for all my needs. I was glad to see that my records still remain on the vendor portal. They didn’t disable all the features, though, so it still allowed me to send an appointment request, a refill request, and a message to the physician, but I know for a fact that no one is monitoring it because the practice’s servers have been decommissioned and are in a box in his basement. I found the notification that the practice was closed and where patients should contact the physicians, but it was buried three screens deep in an “about our practice” area of the site.

I had taken advantage of their personal health record download functionality after my last visit so I already had what I needed, but it was good to know my records live on with the vendor. My new physician uses the same vendor, so hopefully it will all connect and be good to go.

How portable has your PHI been with system migrations and practice mergers? Email me.

Email Dr. Jayne.

McKesson Will Acquire CoverMyMeds for $1.1 Billion

January 25, 2017 News No Comments

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McKesson announced Wednesday that it will acquire Columbus, OH-based prescription electronic prior authorization platform vendor CoverMyMeds for $1.1 billion plus a potential additional $300 million based on performance.

McKesson announced the acquisition as part of its quarterly earnings report in which it beat earnings estimates but fell short on revenue.

CoverMyMeds is a RelayHealth Pharmacy partner. It will remain an independent McKesson business unit with co-founders Matt Scantland and Sam Rajan staying on.

Morning Headlines 1/26/17

January 25, 2017 Headlines No Comments

Blame Technology, Not Longer Life Spans, for Health Spending Increases

Health economist Austin Frakt pushes back against a CBO conclusion that health spending is increasing due in large part to population aging, suggesting instead that healthcare technology changes are responsible for between one-third and two-thirds of per capita health care spending growth.

Proportion and Cost of Unplanned 30-Day Readmissions After Sepsis Compared With Other Medical Conditions

A JAMA study concludes that readmission-related costs were higher for unplanned sepsis readmissions than any of the conditions included in the Hospital Readmission Reduction Program.

VA health IT platform champion is gone, but project could survive

Despite the January 20 departure of VA CIO LaVerne Council, the Digital Health Platform project may still have a champion in David Shulkin, MD, President Trump’s nominee for VA Secretary and an early supporter of the Digital Health Platform project.

Morning Headlines 1/25/17

January 24, 2017 Headlines No Comments

DirectTrust Reports Record Growth in Direct Transactions, Number of Direct Exchange Addresses and Users

DirectTrust reports that there were 98 million messages exchanged across its network in 2016, while the number of addresses capable of exchanging PHI increased 24 percent and the number of healthcare organizations connected to the network grew 36 percent.

£7m EPR costs blowout predicted after delay

In England, delays implementing Cerner Millennium at Calderdale and Huddersfield NHS Foundation Trust are expected to drive the project’s total cost from $6 million to $15 million.

GetWellNetwork Acquires Seamless Medical Systems, Extends Reach to More Than 150 Clinics

Patient engagement software vendor GetWellNetwork acquires Seamless Medical Systems, the developers of a patient check-in and waiting room app that claims to reduce door-to-door time by 40 percent.

Federal Debt Projected to Grow by Nearly $10 Trillion Over Next Decade

A Congressional Budget Office report says that while the economy is on solid ground and increasing job growth is expected, the deficit is projected to swell, adding $10 trillion in new federal debt over the next 10 years.

News 1/25/17

January 24, 2017 News 15 Comments

Top News

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A federal judge sides with the Department of Justice in ruling that the proposed merger of insurers Aetna and Humana should not be allowed because it would reduce competition.

The judge also scolded Aetna for falsely claiming it exited Affordable Care Act marketplaces because of financial losses, noting that the company’s executives followed through on their threats to punish the market if their merger request was denied. Aetna says that wasn’t a threat, just a reflection of market realities. The companies are considering appealing the ruling.

The “smoking gun” document outlining Aetna’s threat to pull out of even profitable ACA markets came from Aetna Chairman and CEO Mark Bertolini, whom HIMSS invited to give the opening keynote address at HIMSS14, where he talked about integrity and the importance of the ACA marketplace that he predicted would sell insurance to 75 million people.


Reader Comments

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From Norma Rae: “Re: AHIMA. A server problem from December 30 is still not resolved, as members paid for CEU quizzes that still aren’t available. AHIMA is not answering messages and the phone wait time is nearly two hours.” AHIMA’s website says it has extended the CEU reporting deadline from December 31, 2016 to March 31, 2017 due to the unspecified technical difficulties of an unnamed outside technology vendor.

From Two Dull Dew: “Re: Capricorn Healthcare’s Epic stake. The private equity firm acquired a very small number of shares from an outside shareholder several years ago. It’s not a significant investment even though they list it on their portfolio page.” Several readers provided the same explanation, with one adding the obvious fact that if Capricorn had somehow loaded up on Epic shares, they would be crowing more demonstratively than just quietly listing Epic’s logo on their portfolio list.

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From Deck Pitcher: “Re: Theranos. Here is its first pitch deck.” The 2006 slides feature an amateurish logo and the company’s focus on drug companies as a customer base, where Theranos promised to increase drug sales by improving dose customization and monitoring that it hoped would reduce the need for FDA black box warnings. Theranos said it expected to make $50 million per clinical trial by charging $7,500 for each patient enrolled, which it said is up to 30 percent less than drug companies spend in offering testing in physician offices. The company listed as one of its “drivers for success” its management and culture, which we now know were so toxic that they should have had an FDA (or perhaps SEC) black box warning of their own. Thank goodness Theranos pivoted away from convincing drug companies to let it help monitor toxic drugs using its now-discredited lab tests.

From Peace Out: “Re: HIStalk. You have helped me do my job better. I can chit-chat with a CIO and they perk up if I mention that I read something in HIStalk – we can then carry on a well-informed conversation. I have noticed that folks can tell if one reads HIStalk. I mention your site at least three times when I’m at a client site. Your donor-matching program for kids makes my heart sing.” Thanks – you made my day as I do my empty room/empty screen thing.

From PM_From_Haities: “Re: poor customer service in physician practices. At the end of the day, the clinics rates are fixed by their customers who pay via insurance. Why should the clinic change if improving results in almost no change to their compensation? This is why socialism, communism , etc. don’t really work and capitalism with its market functions does. Capitalism has an efficient pricing function that works vis-à-vis the free market. With no real pricing function, guess what? The have no incentive to change. Make that clinic self pay only and I guarantee they would either they find a bigger waiting room or they’d have less patients.” Well said. It is folly to expect people and organizations (even those involving sick people) to behave in any way that decreases their personal benefit. People and companies do what they are paid to do, and in the healthcare system we’ve designed, they are financially encouraged to pack the waiting rooms, overbill, overtreat, and otherwise milk the maximum profit possible from the healthcare abattoir (“immoral” isn’t nearly as much of a motivator as “illegal”). Blame those who designed the game, not those who play it skillfully. As PM notes, your insurance company is the practice’s customer, not you, and you can threaten to seek alternatives to either to see how little they care. Insurers and providers are well aware of how privately lucky you feel you are to have insurance and to get an appointment. There’s plenty more customers where you came from since healthcare creates its own demand.

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From Edumacation: “Re: Betsy DeVos. She invested $1 million in Theranos, according to disclosure paperwork.” Education secretary nominee Ms. DeVos, whose family billions came from creating the Amway pyramid scheme of selling crappy beauty and nutrition products, perhaps earned an education of her own in sinking a micro-chunk of her family fortune in Theranos.


HIStalkapalooza Sponsor Profile

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Since 1975, the Healthwise mission has been to help people make better health decisions. That mission, combined with our innovative spirit, results in health education, technology, and services that make every moment in care matter. By integrating our solutions into your existing workflows, we help you engage patients with consistent, evidence-based health information for improved outcomes, increased satisfaction, and lower costs. Visit us at HIMSS in booth #1523 and check out our demo stations for Point of Care, Care Coordination, Digital & Web Experiences, and Care Transformation. Find out more or schedule a one-on-one meeting at HIMSS at healthwise.org/himss17.


HIStalk Announcements and Requests

Thanks to the several readers who asked about offer of a free pass to the Healthcare IT Marketing and PR Conference in Las Vegas April 5-7. The quick-on-the-trigger CEO who asked about it first got the pass and promises to follow up with a write-up afterward. I had just the one pass to offer for free, but others can at least save $300 by registering using promo code “histalk.” Many of my sponsors came on board due to the efforts of PR and marketing advocates and I appreciate their support.

I’ve been reclaiming my online life by muting Facebook and Twitter connections who just can’t stop spouting political bitterness or extending unsolicited political opinion despite not having any obvious qualifications commensurate with their partisan zeal. I’m also tuning out folks who repeatedly link to biased or sensationalistic news sources, which I define as pretty much all of them other than the New York Times, Washington Post, NPR, The Wall Street Journal, ABC/CBS/NBC, and the news wires. We have happily and indulgently cocooned ourselves off from civic responsibility with niche TV channels, Netflix, and Facebook and thus are collectively not really capable any longer of courteous, informed discussion. The American formula of offsetting a shortage of factual knowledge with an excess of emotional conviction doesn’t generally work (notable exceptions exist). Calling someone stupid or evil just because they have different opinions seems pretty stupid and evil.


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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GetWellNetwork acquires Seamless Medical Systems, which offers a patient check-in and waiting room solution.

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Integration technology vendor Redox raises $9 million in a Series B funding round, increasing its total to $13 million.

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The drug industry’s trade group launches a multi-million dollar, feel-good ad campaign in trying to position itself as a responsible contributor to societal health following a series of embarrassing price-gouging news stories, most recently involving Mylan’s EpiPen. The group’s CEO makes reference to, “less hoodie, more lab coats” in trying to distance itself from non-member companies and former Turing Pharmaceuticals CEO Martin Shkreli, who in response quickly created a “Pharma Skeletons” web page to highlight the pricing misdeeds and tax-dodging “relocations” to Ireland of some of the trade group’s members.

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The Advisory Board Company returns responsibility for the maintenance and marketing of its Quality Compass infection surveillance and antimicrobial stewardship software to its original developer, Vecna Patient Solutions. Vecna offers patient access software but is probably best known for its VGo Telepresence robot. The Advisory Board Company announced the restructuring of its healthcare business three weeks ago, when it said that it will exit its still-profitable businesses of care management workflow, nursing workforce, and infection control analytics.

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The Chan Zuckerberg Initiative will acquire Meta, an artificial intelligence-powered search engine for medical journal articles. The charity, founded by Facebook CEO Mark Zuckerberg and his wife Priscilla Chan, MD, will give researchers free access.


Sales

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In Canada, 656-bed Humber River Hospital will upgrade to Meditech’s Web EHR.

Ballinger Memorial Hospital (TX) chooses CPSI’s Evident EHR.


Announcements and Implementations

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Ability Network announces its FHIR-based API program that allows partners (clearinghouses, payers, RCM companies, and EHR vendors) to connect to its platform for eligibility lookups, claim submission, and acknowledgement and remittance download.

DirectTrust says that 98 million Direct messages were exchanged in 2016, with the number of Direct-issued addresses increasing 24 percent in the year.


Government and Politics

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Former Acting CMS Administrator Andy Slavitt warns that replacement plans for the ACA often label condition exclusions as “patient choice,” highlighting this just-passed Minnesota proposal that allows insurers to sell policies that exclude coverage for cancer, emergency services, diabetes, and outpatient services. Sponsor Rep. Steve Drazkowski (R-Mazeppa) says the plan he championed is “a cure for the regulatory disease” that allows insurers to offer a la carte coverage that doesn’t include all 68 federal mandates. Critics ask the logical question – what crystal ball should consumers consult in buying plans that don’t cover yet-unknown but horrendously expensive conditions? Long-timers will recall when well-intentioned patients would present “insurance cards” pretty much like these policies — they covered basically nothing since they were ridiculous voluntary discount membership cards they bought from late-night TV infomercials in confusing them with being insured.

Here’s something to ponder – if marketplace plans go away, a lot of solo creative people who contribute to the economy (authors, musicians, entrepreneurs who are building companies) will either go back to being uninsured or will have to return to full-time jobs to earn the privilege of paying for health insurance. The ACA isn’t perfect, but making insurance available only to the employees of companies seems to discourage entrepreneurial pursuits that hold a lot more economic promise than chasing long-gone assembly line jobs. It’s a step backward if people have to remain underemployed because seeking better fortunes would preclude them from getting insurance that covers their existing medical conditions. I still recall the anguish of having to lay off a long-time hospital employee who had stuck with her not-so-great job only because she was uninsurable elsewhere because of breast cancer, and I still curse the name of the new VP who was so anxious to earn suck-up points with his executive peers that he got fooled into taking on her entire transferred team without a corresponding budget, thus getting the executioner duties turfed off on him by far more skilled but equally gutless players. He of course wasn’t available when security and I walked them off the property.

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The Congressional Budget Office says the federal budget deficit and tepid economic growth will run the national debt up another $10 trillion in the next 10 years, much of that driven by healthcare and Social Security entitlement programs. CBO still says the economy is solid and job growth is imminent. The national debt stands at around $20 trillion, most of it held by investors. These numbers don’t take into account the $1 trillion infrastructure investment and tax cuts planned by the administration.


Technology

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Health services in Norway are planning to move from Microsoft’s Windows Phone to Android because of high cost and low availability.

Cedars-Sinai chooses eight startups for the next class of its accelerator boot camp:

  • Cerebro Solutions (labor management)
  • Enso
  • FIGS (medical apparel e-commerce sales)
  • Frame Health (identifying non-adherent patients via personality analysis)
  • Healthcare TTU (cash flow and AR analytics)
  • HealthTensor (artificial intelligence)
  • Noteworth (device interoperability)
  • ReferralMD (referrals)

Other

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In England, ongoing delays in implementing Cerner Millennium at Calderdale and Huddersfield NHS Foundation Trust have increased the expected cost from $6 million to $15 million. The overrun is due to the cost of backfilling the positions of clinicians assigned to the project and a harder-than-expected data migration from legacy systems.

In Australia, someone accidentally leaves a backup generator’s switch turned off, with its eventual failure during a power outage causing a hospital blackout that required evacuating ICU patients and that also destroyed its fertility center’s 50 frozen embryos.  

NIST publishes results of a perception and experience study on EHR copy-and-paste, but I’m not going to describe it since it involved a ridiculously small sample size (five nurses and four doctors), all of them using the military’s AHLTA system that’s already being replaced with Cerner. Basically the study supports previous recommendations that (a) text that has been copied and pasted should be clearly identified, and (b) EHRs should display the “chain of custody” of the information when the user wants to see it. As most studies fail to address, it doesn’t question why the EHR requires or desires information to be stored multiple times. My guess is that someone worries that it will be missed, so I’ll fall back to my usual recommendation that EHRs should allow every user to flag individual text as being important in their care decisions rather than just dumping massive amounts of text that must be mined by each clinician for anything relevant. I like the idea of a chart being treated like a long paper document where I could use a highlighter to mark just the important sections, then date and initial them for later lookup by me or by someone else (maybe I just want to see which parts the cardiologist found useful). EHRs were designed to force users to input discrete data elements, but that’s for the convenience of non-clinicians.

I’m fascinated that one of the hottest hospital-related debates in England has always been that hospitals charge for parking. A parking app vendor files a Freedom of Information request to determine that hospital visitors were fined $17 million in a single year. Thus evolved my latest can’t-miss money-making scheme: an independent offsite parking operation that shuttles visitors back and forth directly to hospital campus locations like an airport shuttle. I would never park in an airport garage – it’s silly to pay 3-4 times the cost of an offsite shuttle that will drop me and my bags directly at the gate instead of leaving me to drag my stuff through a poorly lit garage where I have to remember where I parked. I would be equally unlikely to choose hospital garage or valet parking given a low-friction alternative.


Sponsor Updates

  • Obix by Clinical Computer Systems posts a video covering its implementation at Yoakum Community Hospital (TX).
  • Besler Consulting releases a new podcast, “The Future of MACRA in 2017.”
  • Biz Journals includes Caradigm President and CEO Neil Singh in its list of “New Seattle-area CEOs of 2016.”
  • CenterX will exhibit at the NCPDP Workgroup Meeting February 1-3 in San Antonio.

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 1/24/17

January 23, 2017 News 1 Comment

Judge Blocks Aetna’s $37 Billion Deal for Humana

A federal judge has sided with the Justice Department in blocking the proposed $37 billion merger between Aetna and Humana on antitrust grounds.

Cybersecurity Framework Draft Version 1.1

NIST releases a draft update to its Framework for Improving Critical Infrastructure Cybersecurity.

Drug industry unveils massive new campaign to counter criticism

A pharma industry lobbying group has launched a new ad campaign designed to move the industry past recent price gouging stories that have consumed media attention recently. The lobbying group’s president backhandedly calls out Martin Shkreli in describing the campaign as an effort to portray  “Less hoodie, more lab coats” . In response, Shkreli publishes a list of price gouging activities that the pharmaceutical companies funding the campaign have engaged in.

Next Generation ACO Model

CMS reports that 45 ACOs are now participating in its Next Generation model.

Curbside Consult with Dr. Jayne 1/23/17

January 23, 2017 Dr. Jayne 11 Comments

I wrote last week about a real-world curbside consult from my IT colleague, Jimmy the Greek. As promised, here is the second installment of Dr. Jayne’s Journal Club, where we will continue with our patient case presentation.

When we last left Jimmy, he had been referred from the physiatrist to an orthopedic surgeon. I didn’t go into detail about insurance or how much this has been costing him, but since it’s a new year, I’m betting he’s facing a new (and most likely daunting) deductible. When I was a CMIO at Big Health System, we always saw a dip in business during the first month of the year, but things picked up in February as people met their deductibles. I don’t have access to that kind of performance data any more, but I wonder what those curves look like given the expansion of high deductible plans.


At the end of my last piece, I had just made an appointment to review my MRI results with Dr. Professional himself. I arrived at the appointed time (15 minutes prior to the appointed time, actually) and after I explained why I was there, I received a terse “ID and insurance card” along with the outstretched hand of the front desk attendant (who, for reasons unbeknownst to this author, was the only one in the office wearing scrubs.)

After a considerable wait, I was shown to an exam room, where I met a physical terrorist … err, therapist. She took down the same history I had provided the doctor in previous visits, so either my records weren’t updated or she didn’t bother to read them. Finally, the doc comes in and pulls me out into the hall, where he has my MRI results pulled up. Yep, in the hallway, where anyone walking by can take a look. So much for HIPAA.

Dr. Professional explains that he sees some osteoarthritis and he wants me to consult with an orthopedic surgeon to see about laparoscopic surgery. I’m given a referral and sent on my merry way.

A friend of mine is an orthopedic surgical nurse at Big Hospital System, so I asked her about the guy who might shove soda straws into my hip joint (Yes, I watched the YouTube video. Yes, I now know I should not have done that.) She asks around and comes back with a consensus from the docs she asked: “He’s competent.” Not exactly a ringing endorsement, but I’m planning on a second opinion anyway, so I set up an appointment to see Dr. Competent.

Being a savvy healthcare consumer, I obtained Dr. Competent’s new patient forms from his practice website, printed them, and filled them out ahead of time. Confidential to all of you CMIOs and practice managers out there – fillable PDFs are a thing now, and if you don’t have them available for patients, you should. If you can’t figure out how to do it, I’ll do it for you – contact me through Dr. Jayne. I promise my rates are as reasonable as the amount of time I spend in your waiting rooms.

Upon arrival at Dr. Competent’s MegaOrthoMart Practice, I handed in my homework, forked over my ID and insurance card, and was promptly handed two additional forms to fill out, which requested much of the same information that I had provided on the phone when making the appointment and on the forms I filled out ahead of time. Then I got to wait until a registrar became available, and she more or less walked through the forms and asked me if each line item was correct. It’s now 35 minutes past my 8 a.m. appointment time and I’m still stuck in the lobby.

Someone finally comes to get me and the first thing they want to do is take x-rays. Remember the last installment? I’ve had x-rays and an MRI. Despite the fact that I brought the imagery with me, MegaOrtho insisted on doing their own because they “can’t be certain of the technique used to obtain [my] existing films.” I tend to believe the real reason they wanted to take more x-rays was more along the lines of, “This way we can bill your insurance company for more services.” When I get my explanation of benefits, I’m sure I’ll see an office visit from Dr. Competent, a facility fee from MegaOrtho, and imaging fees from MegaRadiology. At least MegaOrtho is independent and not part of Big Hospital System or they would be after their piece of the pie, too.

At 9:15 AM (a full 75 minutes past my appointment time), I finally get to see Dr. Competent in all of his frat-boy glory. Without introducing himself (what is it with doctors just assuming you know who they are?), he proceeds to explain what’s wrong, explains that surgery is an option, but a cortisone shot and physical would be a better first step. I’m all set to get the cortisone done, but he explains that he doesn’t do that for Dr. Professional’s patients. So now I get to make another appointment with him for an ultrasound-guided cortisone injection.

At this rate, I’m going to need to take a second job just to fund my co-pay habit (see “fillable PDF” offer above). The cynical part of me can’t help thinking that this is just a scheme to extract as much money from me and my poor, innocent insurance company as possible. I don’t begrudge anyone the ability to make a living, but this just seems excessive. (For those of you keeping track at home, we’re up to three appointments with Dr. Professional now.)

The one bright spot in this adventure has been the staff at the physical therapy place. Everyone there is friendly and efficient. Here’s to a speedy recovery and success in physical therapy. If I have to have the hip scoped it, it’s a longer recovery than I’d like, so keep those patient information forms coming my way; I’ll apparently have lots of time on my hands to create fillable PDFs.


Looking at this entire saga through my CMIO lens, the element of the story that strikes me most is the fact that we’ve spent billions of dollars trying to make healthcare better and we still haven’t solved the basic problems that patients face. Let’s look at customer service. In some situations, customer services has gotten worse as front desk staff are under increased pressure to ensure collections. Staff members are also encouraged to maximize throughput even if it doesn’t make sense and patients are filling out duplicative information. We haven’t mastered basic technology such as fillable online forms and practices are often reluctant to fully leverage patient portals, especially to collect information on new patients.

We still have clinicians who are too busy to read (or don’t trust) the history in front of them, so they ask redundant questions. We haven’t spent money transforming our office spaces to increase patient privacy or comfort and still show images in the hallway. Despite the advent of provider ratings and online reviews, patients still have limited information to judge a physician’s competency. We’ve also pushed providers and health organizations to the edge of financial viability, leading to increased reliance on provider-based billing and facility fees to get as much money out of the system as possible.

Despite the ability to exchange data or having images on CD in front of us, we repeat testing because we don’t trust our peers or are too pressed for time to look at the films before we decide whether the outside radiology group’s technique was adequate. Or maybe we’re just after the money. We have handshake professional agreements where a consultant doesn’t provide a service to a patient when he could, and instead sends the patient for another visit to the referring provider (and another co-pay and another day off work). I hope our patient’s cortisone injection and physical therapy does the trick because I would hate to see him panhandling for contract PDF work outside the next medical staff meeting.

Unfortunately, the continued push for more use of EHR technology and more metrics and more data points isn’t going to change human behavior. It seems like it’s getting harder to find organizations willing to spend money on the so-called “soft skills” or on truly transforming healthcare. They’re too busy trying to figure out how not to be penalized or worrying about when their vendor is going to release the next version of Certified EHR Technology.

What’s the answer to making healthcare something we can be proud of? Email me.

Email Dr. Jayne.

Morning Headlines 1/23/17

January 22, 2017 Headlines No Comments

Full text: Trump’s executive order on Obamacare

Following through on campaign trail promises, President Trump signs an executive order calling for HHS to “waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the Act that would impose a fiscal burden” on providers, insurers, patients, or States.

Trump Executive Order On ACA: What It Won’t Do, What It Might Do, And When

Health Affairs’ Tim Jost weighs in on the impact President Trump’s executive order is expected to have.

HHS Acting Secretary Norris Cochran

HHS Acting Secretary and former National Coordinator Karen DeSalvo quietly leaves her position with the administration transition.

Monday Morning Update 1/23/17

January 22, 2017 News 10 Comments

Top News

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President Trump follows through on his promise to begin dismantling the Affordable Care Act on his first day in office by signing an executive order Friday that directs HHS and other federal agencies to “ease the burden” in doing whatever they legally can to hamstring the ACA.

Executive orders are more of a policy-signaling device rather than an unchallenged change to laws, but HHS discretion and its choice of which ACA issues to defend in court could affect key ACA elements in halting the payment of insurance subsidies (which were never approved by Congress but are being paid by HHS anyway) and tinkering with hardship waiver requirements to effectively end the “individual mandate” that at least theoretically requires people to carry health insurance.

The executive order happens before “repeal and replace” begins in earnest, before a Trump-appointed HHS secretary is installed, and in the absence of a replacement plan for the program that insures 20 million people.  


Reader Comments

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From Herd Tracker: “Re: HIMSS and overly intrusive marketing with their new Media Lab. Remember a couple of years ago when you wrote about how they were going to track the movement of conference attendees via a badge-implanted chip?” I remember clearly, although I assume HIMSS quietly backed away from that plan. HIMSS10 featured tracking of attendees via RFID badge so that exhibitors could “derive a more accurate score of a visitor’s buying potential,” logging attendee movements that included which booths they visited and for how long. I was obviously upset back then as a dues-paying member:

The conference keeps getting more similar to a cattle-butchering operation: you’re herded into a holding pen (the exhibit hall) since the token educational offerings (getting less useful every year) intentionally go dark during major booth hours. You’re fed and watered in the exhibit hall with vendor snacks until it’s your turn with the the high-paying exhibitors. Now you’ll be tracked like livestock throughout the process … I can imagine what was going through the minds of the HIMSS dim bulbs who approved this — hey, we can charge vendors even more by selling them the personal information of attendees … and HIMSS can justify its exorbitant exhibiting costs by showing who dropped by. People seemed to be resigned to letting HIMSS do whatever it wants in the name of picking the pockets of its vendor members … Being tracked as nothing more than a roving sales prospect is just insulting. HIMSS apparently doesn’t extend its claimed interest in patient privacy to its own paying customers in the Ladies Drink Free model in which it pimps access to low-paying providers to high-paying vendors.

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From Privately Held: “Re: Epic. A private equity group called Capricorn Healthcare lists Epic as one of its holdings, which is surprising given Judy’s repeated statements about being employee-owned and not being acquired.” The PE firm lists Epic as a current holding, but doesn’t specify when or how much it invested.


HIStalk Announcements and Requests

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One-third of poll respondents say their employer has cut expenses or reduced expectations due to ACA uncertainty.

New poll to your right or here: What is your reaction to HIMSS creating a conference and a division to help vendors sell to providers?

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We funded the DonorsChoose grant request of Ms. R in New York, who asked for math manipulatives.

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I like to root for the little guy, so when HIMSS announced its marketing conference last week, I immediately thought of the HITMC conference that John Lynn and Shahid Shah have been putting on for a few years and wanted to help them out (unlike HIMSS, not only do they have no conflict of interest, they also came up with the idea first). HITMC17 is the networking and educational event for those in healthcare marketing and PR, featuring 30 presenters who will cover topics such as social media, brand advocates, online reputation, marketing automation, email marketing, branding, SEO, and content strategy. HITMC will be held at the SLS Las Vegas April 5-7, 2017 and promo code “histalk” will save you $300 on registration. I may ask Lorre or Jenn attend to help us understand how health IT marketing works (I’m a fan of marketing done the right way, but I confess that delight when it’s done hilariously badly). We’ll probably use only one of the two passes John has graciously offered us, so if you want to attend and are willing to write up what you liked and learned afterward in a short HIStalk article, email me and I might give you a free pass.

Listening: One OK Rock, a Tokyo-based foursome of 20-somethings that play hard if not terribly original alt-rock. It’s a bit intentionally boy-bandy at times, but at least it’s different than most of the chart junk.


Last Week’s Most Interesting News

  • The Wall Street Journal discovers that a Theranos lab had failed a surprise CMS inspection right before the company announced that it would exit the testing business.
  • The Coordinated Care Oklahoma HIE announces that it will shut down.
  • HIMSS announces a healthcare IT marketing conference and a new arm that will use the HIMSS database to more aggressively market the offerings of paying vendors.
  • Surgeon-author Atul Gawande, MD admits in a New Yorker article that he has undervalued the health contributions of PCPs that he calls “incrementalists” compared to the decisively curative but less-impactful work of surgeons.
  • The Supreme Court agrees to review the use of arbitration agreements to prevent employees from filing labor-related class action lawsuits, with Epic Systems being one of the handful of companies asking for a definitive ruling.

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. 


Decisions

  • Long Island Jewish Valley Stream (NY) went live with Kit Check medication tracking in December 2016.

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


Government and Politics

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As I expected but haven’t seen mentioned anywhere, HHS Acting Assistant Secretary for Health and former National Coordinator Karen DeSalvo, MD, MPH has apparently left her role with the administration change based on updated HHS web pages. Principal Deputy Assistant Secretary for Health Jewell Mullen, MD, MPH, MPA is listed as having taken over the Acting Assistant Secretary role. DeSalvo, who stepped down as National Coordinator in August 2016, hasn’t mentioned her departure or plans on Twitter.


Privacy and Security

From DataBreaches.net:

  • TriHealth (OH) blames a software problem for sending the information of 1,126 patients to their previous address.
  • An appeals court rules that people whose information was stored on a stolen laptop can sue Horizon BCBS for violations of the Fair Credit Reporting Act even though they suffered no negative consequences.

Other

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Billboard profiles our amazing HIStalkapalooza band Party on the Moon and its longstanding New Year’s Eve gig playing for now-President Donald Trump. It describes their first time playing the Mar-a-Lago event, where they were noodling through harmless dinner music like “The Girl from Ipanema,” when the boss’s assistant passed along his request: “Mr. Trump would like you to stop playing this crap and play something more upbeat.” I was skeptical about hiring a cover band for HIStalkapalooza, but it’s hard to describe their stage-filling show – they play with remarkable skill and enthusiasm. the music never stops for a second, and they literally from their first note pack the dance floor with HIStalk readers who admit that they never dance otherwise.


Sponsor Updates

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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Reader Comments

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