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EPtalk by Dr. Jayne 12/29/16

December 29, 2016 Dr. Jayne 3 Comments

I’m happy to report that organizations seem to be getting the message that it’s a bad idea to wait until the end of the year to prepare for quality reporting. I’ve already had nearly a dozen clients sign contracts for assistance with quality reporting and similar initiatives in 2017. That’s a big change from last year, when many of my clients didn’t start getting serious about it until after the end of the first quarter.

One of the barriers in 2016 was lack of vendor readiness. It’s hard to get excited about working on metrics when your vendor hasn’t released their reports yet. Even though the changes are usually small and it’s possible to use the previous year’s reports as a proxy, there seems to be a psychological barrier to doing so. Regardless, most of my clients are on systems whose vendors are already prepared for 2017 reporting, so I’m grateful.

For those clients eager to wrap up 2016, CMS released its attestation worksheets for eligible professionals and eligible hospitals. The attestation system opens January 3 and will be accessible through February 28. If you haven’t started gathering your data, it’s time to start, and the worksheets allow organizations to make sure they have dotted the I’s and crossed the T’s before accessing the online registration system. It’s also a good time to test your logins as well as make sure your registration information is correct.

Even if you don’t plan to complete your attestation until the end of February, fixing issues early is definitely the way to go, although the system will be down this weekend for updates prior to the opening of the attestation period.

Still, many organizations aren’t ready to go quietly into 2017, with the American Hospital Association calling for President-elect Trump to put an end to what is still being referred to as Meaningful Use 3. The organization cites concerns over hospitals spending significant amounts of money to upgrade their systems to the point of compliance. They also requested support in avoiding anti-kickback provisions in the event that providers compensate each other as part of value-based care initiatives. Any modifications to the anti-kickback rules would require Congressional intervention.

The hospital trade association is also seeking a streamlined process for reviewing hospital mergers. The current process has different review criteria for the Federal Trade Commission and the Department of Justice to challenge mergers or acquisitions and there is hope that Trump’s past business deals will set the stage for a relaxed climate in the future.

A friend who works in the process improvement space sent me this LinkedIn article by David Feinberg, president and CEO of Geisinger Health System. It discusses his goal to eliminate waiting rooms in the next two years. It’s a fluffy piece with a lot of discussion of patient-centric care, which aids in getting people on the bandwagon. But as a practicing ED physician, I think it misstates some issues or misses them entirely.

“A waiting room means we’re provider-centered – it means the doctor is the most important person and everyone is on their time. We build up inventory for that doctor – that is, the patients sitting in the waiting room.” Sometimes having a waiting room means that many patients showed up at the same time, or that patients are too sick to be quickly dispositioned. Maybe there just aren’t enough rooms for the patient demand. But the mere status of having a waiting room doesn’t mean we’re not patient-centric.

My current practice situation is the most patient-focused organization I’ve ever been in. Nearly 95 percent of our patients are treated and released in less than an hour, including pharmacy services. Nearly 98 percent of our patients are roomed immediately on arrival. But yes, we have a waiting room, and sometimes it is full. Recent weather events prevented patient travel during a 12-hour ice storm, which led to tremendous volume once the roads became passable. You can’t necessarily design processes around mother nature, but we had some in place. We flexed staffing and worked as quickly as possible with scribes and other supports.

“For starters, treatment will start the moment patients enter the emergency room because remember, it’s an emergency.” This statement is a great emotional appeal, but it’s not the reality of what many of us are seeing in emergency facilities around the country. I would wager that nearly 80 percent of the patients I see do not represent a true medical emergency.

I understand that the nature of an emergency is somewhat in the eye of the beholder, but having the sniffles for one day is not an emergency. Nor is being sunburned while drunk in Cabo San Lucas and then coming to the ED two days later when you arrive back in the States. Also, “I can’t be sick for the holidays because I have 20 people coming over” is not an emergency, either. But it’s the reality for many of us in the trenches. And if you have five people that arrive at the same time, I’m going to treat the one with chest pain or a stroke before I treat the person who cut their finger two days ago and is just now coming for stitches because their mother told them they had to. Yes, my comments are emotional appeals also, but hopefully the point is made.

He goes on to say “our industry is ripe to be disrupted,” which jumps on the overused disruption bandwagon.

Let’s talk about what else the patient care industry needs. First, we need to sink resources into greater patient education and health literacy so patients know what is and is not an emergency. I spent some time in the UK, and they’re really great at this, running ad campaigns to educate patients. They have multiple versions of the same theme and make it clear that people who don’t need to be in Emergency are causing delays for those who do need to be there. We don’t see that in the US because we’ve swung the patient-centric bar too far in some cases as we continue to pursue patient satisfaction scores, sometimes at the expense of quality.

We need more primary care physicians who are compensated at a level where they want to stay in practice and not retire or go part-time or switch to urgent care. We need to incent them to provide after-hours care and keep their patients out of the ED. We need to help them put systems in place that protect them from burnout. We need to reduce the burden of legal-driven care interventions so that physicians can trust in multidisciplinary teams without the constant threat of lawsuits. We need to incent them to deliver low-intervention care when it’s warranted, and help them educate patients away from the “you have to do everything” mentality.

We also need streamlined data exchange so that the ED isn’t in the dark because a rival health system is engaging in information blocking. You know who is responsible for ALL the information blocking in my area? The hospitals and health systems themselves. Not the EHR vendors. Every system in town has great exchange capabilities, but the hospitals put up faux HIPAA blockades around my ability to find out whether the patient has just had labs drawn.

They’re also engaging in care blocking, as I recently learned when they refused to accept the printed labs and CT scan on a CD that I sent with my patient during his transfer, instead requiring everything to be repeated in-house for liability reasons. That is insane and needs governmental regulation more than EHR vendors do. The same hospital also removed a patient’s IV and stuck her again after transfer because they “couldn’t trust the sterility of the original vascular access.” Again, it’s insane to cause a patient discomfort and remove a perfectly viable IV because you’re afraid of the lawyers.

We definitely need change, but it’s more than hiring more doctors or building more exam rooms. We need cultural change that addresses not only patient attitudes, but the reality of resource constraints in the US healthcare system. But “don’t go to the hospital because you are afraid of being sick, but are not in fact sick” is not a sexy, attention-grabbing campaign.

It will be interesting to see where Geisinger is in two years and whether they meet their goals.

What are your organization’s goals for 2017? Email me.

Email Dr. Jayne.

Morning Headlines 12/29/16

December 28, 2016 News No Comments

Readmission Rates After Passage of the Hospital Readmissions Reduction Program: A Pre–Post Analysis

A study published in the Annals of Internal Medicine measuring readmission rates before and after ACA’s Medicare Hospital Readmissions Reduction Program went into effect, finds a reduction of 60 to 90 readmissions per 10,000 discharges.

Abbott gets FTC approval for $25 billion St. Jude deal

Abbott Laboratories wins FTC approval to acquire medical device manufacturer St. Jude for $25 billion, under the condition that the two companies divest their cardiac device business units.

Value-based insurance coming to millions of people in Tricare

The recently-signed Defense Spending Bill includes a mandate to test value-based reimbursement initiatives stemming from the DoD’s Tricare insurance program.

Trump Picks Thomas Bossert as Top Counterterrorism Adviser

President-elect Donald Trump names cybersecurity expert Tom Bossert as his homeland security advisor.

Morning Headlines 12/28/16

December 27, 2016 Headlines No Comments

St. Charles dropped med check system before patient’s death

A patient at St. Charles Medical Center (OR) dies after a nurse administers an IV with the wrong medication mixed in. The hospital had stopped using its stand-alone bedside IV administration software when it moved to McKesson’s Paragon EHR, resulting in a safety gap in its medication administration practices.

Postmarket Management of Cybersecurity in Medical Devices

The FDA releases its final guidance on cybersecurity requirements for medical devices.

A disconnect between physicians and laboratory professionals

A CDC study finds that physicians rarely contact laboratory professionals when faced with questions on which tests to order or how to interpret a result.

A Letter to Donald Trump About Health Care

A New York Times opinion piece calls for Donald Trump to stand by his once outspoken support of universal health insurance coverage amid concerns that the GOP will repeal ACA without passing a replacement law designed to expand insurance coverage.

News 12/28/16

December 27, 2016 News 11 Comments

Top News

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An Oregon district attorney says he was “on the verge of filing criminal charges” against St. Charles Medical Center-Bend (OR) for halting the use of Baxter’s DoseEdge barcode-driven IV checking system, thereby contributing to the death of an inpatient who received a mislabeled and ultimately fatal IV. The DA backed down when the hospital agreed to make safety changes.

The hospital said both McKesson and Baxter promised that Baxter’s DoseEdge system was compatible with its newly purchased McKesson Paragon EHR, but the hospital had to revert to manual medication checks when it found those claims to be untrue.

Hospital employees claim the hospital turned the DoseEdge system off in a cost-saving move and complain that the Paragon equivalent was too slow to be used.

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The fatality occurred because of the usual “Swiss cheese effect” of having several safety steps break down sequentially:

  • An expert pharmacy technician who had worked at the hospital for 37 years prepared the patient’s IV with the surgery muscle blocker rocuronium instead of the ordered seizure drug fosphenytoin.
  • A pharmacist at the hospital didn’t notice the pharmacy technician’s mistake and approved the IV to be sent to the patient’s room.
  • A nurse hung the bag even though it was clearly labeled with a “neuromuscular blocker” warning  sticker that she says she didn’t understand.
  • The patient was left unmonitored despite her physician’s order for continuous cardiac and pulse oximetry monitoring, which the nurse admitted she ignored.
  • The nurse had to leave the patient’s bedside when a fire drill was called right after the IV was started.

The patient was found unresponsive 42 minutes later and was taken off life support two days after the incident.

The hospital has improved its processes, but it still won’t have a replacement IV checking system until it goes live on Epic in April 2018.


Reader Comments

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From Ex Epic: “Re: fun with numbers. Epic is replaying the hits related to R&D investment on their site, although they’ve at least left the Google and Apple nonsense out this time. Oddly, the site’s chart doesn’t match the corporate overviews shared across the campus. Epic’s 2014 and 2015 charts showed Allscripts spending more than Cerner, but their 2016 trend line (which includes those years) has Cerner outspending Allscripts. Which is it?” The trend line shows Cerner and Allscripts spending around 22 and 18 percent, respectively, in 2015, while the bar chart shows 19 and 25 percent. I wouldn’t put much faith in the numbers anyway since Epic compares itself with three publicly traded competitors that follow GAAP recognized accounting standards, while privately held Epic is under no such limitation. Companies can also elect to capitalize as R&D such items as allocated indirect costs (such as a portion of expensive office buildings), maintenance costs, support expense, and other gray areas that may provide little customer benefit. The bottom line (no pun intended) is how products perform and are viewed by customers regardless of how the vendor’s accountants book R&D expense, no different than with any other product. McDonald’s supposedly spends a gazillion dollars trying to invent new menu items that never catch on, but that R&D usually earns the company scorn rather than admiration and their food tastes the same regardless.

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From Publius: “Re: Toby Cosgrove as a potential VA secretary. Since Cleveland Clinic is an Epic shop, does this increase the likelihood that the VA procures Epic as its commercial EMR solution, or is Cerner a foregone conclusion given the DoD project?” That’s a tough one. The VA and DoD have disdainfully declined to work together in advancing interoperability until mandated by Congress (and sometimes not even then), so while Cerner might make more sense, I would expect the VA to choose Epic just to be contrary. I think it’s a done deal that they will replace VistA with one or the other. Epic must still be stinging after losing to Cerner for the DoD’s MHS Genesis, so I assume they are using whatever DC influence they have (see: Paul Ryan) to bag the VA deal.

From Meltoots: “Re: integrating state prescription monitoring program (i.e., doctor-shopper) databases with EHRs. We asked our EHR vendor and the state of Ohio for this integration 14 months ago. Here is the click-type data entry nightmare we do today. Does anyone understand this?” Meltoots lists the required steps to perform the patient lookup in the PMP database, which might provide its own deterrent to opiate prescribing:

  1. Find the PMP’s webpage.
  2. Log in using the user name and password that constantly changes.
  3. Click OK that you understand this is private info.
  4. Click Search.
  5. Click and type in first name and last name (spelled perfectly), date of birth, ZIP code, etc., going back and forth locating the information in different EHR areas and then typing it into the PMP’s web form.
  6. Click and hope to find the patient.
  7. If the patient is listed, download the generated PDF file.
  8. Read the PDF and then print it to prove that you read it.
  9. Scan the PDF and attach it to the EHR chart to prove that you did it.

HIStalk Announcements and Requests

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It’s a dead heat between Epic and Cerner in the admittedly subjective “who gained the most ground in 2016” category.

New poll to your right or here: is the increasing use of medical scribes good or bad? Polls need to be simple by design, so if you feel boxed in by my default answers, feel free to click the Comments link after voting to explain your position.

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Fantastically generous donations from Epic Reader, Bucky Badger, Dr. J, Friend at Impact, and Bill – combined with matching money from my anonymous vendor executive and other sources – allowed me to fully fund these DonorsChoose teacher grant requests:

  • 3D pens and printing supplies for Mrs. S’s elementary school class in Oakley, CA
  • Makey Makey circuit kits for Mrs. C’s elementary school class in Walhalla, SC
  • Two Chromebooks for Ms. V’s middle school class in Phoenix, AZ
  • Two Chromebooks for Mr. B’s middle school class in Phoenix, AZ
  • A Chromebook for Mr. S’s second grade class in Buena Park, CA
  • 18 sets of headphones for Mrs. F’s kindergarten class in Hampton, VA
  • Math centers for Ms. R’s kindergarten autism class in Newport News, VA
  • Five Chromebooks for Mr. V’s high school biology class in Lake, MS
  • Four science activity tubs for Mrs. B’s elementary school class in Fayetteville, NC
  • A document camera, projector, laser printer, and other projection supplies for Mrs. A’s middle school class in Oakland, CA
  • 3D printer pens for Mr. C’s robotics competition team in San Jose, CA
  • Five Chromebooks and 15 sets of headphones for Ms. K’s fourth grade class in Detroit, MI
  • Programmable robots for Mrs. O’s elementary school library maker space  in Katy, TX
  • A bamboo building block set for Mrs. B’s kindergarten class in Sumas, WA
  • 30 sets of headphones for Mrs. D’s elementary school class in Sumter, SC
  • $200 toward getting 10 Chromebooks for Mr. P’s 10th-grade class in Plant City, FL

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Ms. L responded quickly even though Detroit schools were closed Tuesday: “I am beyond excited and grateful for your generous contribution! I can’t begin to explain how much these computers, headphones, and Flocabulary subscription will impact my students. We have been struggling with a lack of technological resources that has made it difficult to use the computer programs that are available to us in a meaningful and effective way. Your donation is helping bring up-to-date, WORKING, technology to our classroom. My students and I can’t say enough thank yous!”

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Mrs. E from South Carolina says her students are learning from the programmable robots we provided in funding her DonorsChoose grant request. A snip of her email: “Many of the students come from low-income families that would never have had an opportunity to work with these tools if we didn’t have them at school. One of my students wrote in his thank you letter, ‘I have never in my whole life seen or touched a robot. They do really cool stuff.’ You have made a real difference in the lives of these students, not only by your donation in allowing the purchase of these materials, but also that someone cares enough about them to donate.”

Listening: new from 19-year-old Irish singer Catherine McGrath, who seems to be minimally known even though that should probably change. It’s sort of like pop-oriented US country music sung by Dolores O’Riordan of the Cranberries. Also: new from Columbus, OH-based science fiction-themed hard rockers Starset. One more: the amazing Christian hard rockers Skillet. Check out UK-born drummer-singer Jen Ledger, who plays with hair-flying, thrashing joy that reminds me of a female Keith Moon. Skillet’s tour starts January 28 and includes health IT towns like Madison, Philadelphia, and Indianapolis; they have over 1,000 Ticketmaster reviews with a five-star average and I’m pretty sure they would be entirely worth the $30 or so ticket price.


Last Week’s Most Interesting News

  • The Department of Justice gives anti-trust clearance to the creation of a new health IT company by McKesson and Change Healthcare.
  • CMS indicates that 171,000 Medicare-eligible providers will receive an EHR Incentive Program downward adjustment in 2017.
  • HIMSS announces the retirement of President and CEO Steve Lieber, effective at the end of 2017.
  • A JAMA-published observational study involving Medicare ICU patients finds that those overseen by female intensivists experience better outcomes than those with male doctors.
  • HHS tweaks the Health Insurance Marketplace rules for 2018, with the most significant changes involving risk pools.

Webinars

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

January 26 (Thursday) 1:00 ET. “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.” Sponsored by Healthwise. Presenters: Jim Rogers, RN, RPSGT, director of healthcare solutions, Persistent Systems; Charlotte Brien, MBA, solutions consultant, 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.


Acquisitions, Funding, Business, and Stock

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A business site profiles the South Korea-based hospital-vendor partnership behind Bestcare 2.0, a hospital information system deployed in South Korea and Saudi Arabia that the group hopes to expand into the US market.


Decisions

  • Marina Del Rey Hospital (CA) will switch from Cerner Soarian to Epic.
  • Virginia Gay Hospital (IA) moved from CPSI to Epic In November 2016.
  • St. Mary’s Hospital (CT) will replace McKesson Paragon with Epic in July 2017.

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


Government and Politics

A New York Times opinion piece urges President-elect Trump to follow through on his previously expressed support for universal health insurance, warning him that Republicans in Congress (including his nominee for HHS secretary, Congressman Tom Price, MD) are giving him bad advice in pretending to support such a program while actually pushing “repeal and delay” without any plan of their own to replace the Affordable Care Act and thus driving insurers faced with poor risk pools out of the market. It recommends,

The crucial first step is to avoid repealing the insurance expansion without simultaneously replacing it. The new Congress comes to Washington next week, and its members should know where you stand from the beginning. It won’t work to promise millions of people health insurance on spec. If you avoid this trap, you can then push both parties toward a different version of universal health coverage.

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FDA issues final guidance on post-market medical device cybersecurity.


Other

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Lisa “Venture Valkyrie” Suennen posts her annual holiday song lyrics parody “Thriving Here in Venture Fundingland,” sung to the tune of “Walking in a Winter Wonderland.” She just took a job as managing director of GE Ventures.

A Black Book poll of C-suite provider executives predicts these trends for the first half of 2017:

  1. Hospital IT budgets will remain flat while physician practices will cut their technology spending an average of 13 percent from 2016.
  2. Electronic data warehouses will top the list of short-term priorities.
  3. Hospital interest in enterprise resource planning systems will be restored in a value-based care environment.
  4. Most hospitals haven’t budgeted for projects that would increase interoperability.
  5. Large hospital groups fear that cyberattacks will move upstream from the mostly small facilities that were impacted in 2016, expressing concerns about insufficient threat detection systems and the possibility of security alert fatigue.
  6. Hospitals are confident about their cloud application strategies even though most of them haven’t bought cloud-based disaster recovery solutions or don’t understand what they have purchased.
  7. Small-hospital CFOs will revise their RCM strategies and increase their focus on coding and clinical documentation improvement, with many of them considering outsourcing.
  8. Salaries for hard-to-find skills such as healthcare analytics, big data, security, mobile, and cloud technologies will jump as competition heats up and H-1B visa programs could be scaled back.
  9. Providers are interested in precision medicine, but nobody’s really buying systems to address it due to expected implementation difficulty.

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The New York Times profiles the failed attempt of North Carolina physician group Cornerstone Health Care to transition to an ACO care model. The practice lost a third of its doctors (especially its high-revenue specialists) to higher-paying hospitals such as UNC Health Care; it had to borrow $20 million for capital projects such as new IT systems; and some of its doctors sued it in claiming that their compensation was reduced arbitrarily to cover debts incurred due to mismanagement. The practice ended up selling out to Wake Forest Baptist  Health, which experts say is likely to raise costs as the focus changes from keeping patients healthy to feeding the hospital’s revenue-generating departments.

A CDC survey finds that physicians rarely collaborate with laboratory professionals in the 15 percent of encounters in which they aren’t sure how to order diagnostic tests and the 8 percent in which they received results they don’t understand. The primary barriers are that doctors don’t know who to contact or don’t have the time to do so. Physician respondents suggested adding lab ordering criteria to CPOE systems, publishing mobile clinical decision support apps, and adding lab professionals to multidisciplinary rounding teams.

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Medical University of South Carolina will open an Apple-sanctioned retail computer store in its library that will offer discounted Apple and Dell products to students and faculty. It’s also considering using the store to provide health-focused technology, such as healthcare apps, to patients.


Sponsor Updates

  • Horses for Sources and its research division cover a patient experience redesign project at Lawrence General Hospital led by  Sutherland Global Services.

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 12/27/16

December 26, 2016 Headlines No Comments

The Truth About Blockchain

In an interesting but non-healthcare specific piece, Harvard Business Review recounts the 30-year path TCP/IP took to transform business and draws parallels to the pace and transformative nature that blockchain technology could have on business practices in the future.

Fearing Medicaid cuts, states wield health data as a political weapon

CMS Acting Administrator Andy Slavitt is pointing to diagnostic and cost of care data from states that expanded Medicare under ACA to make a case against a full repeal of the law.

Got a chronic disease? There will soon be a prescription app for that

Wired UK covers the NHS program aimed at developing and prescribing apps to help manage chronic diseases.

Morning Headlines 12/26/16

December 25, 2016 News 3 Comments

Cornerstone: The Rise and Fall of a Health Care Experiment

The New York Times profiles provider group and accountable care organization Cornerstone Health Care (NC), telling the story of its transition to ACO status and its eventual sale to Wake Forest Baptist Medical Center.

Year in Review: Cerner presses forward despite year of uncertainty

Cerner closes out 2016, a year that brought with it CEO Neal Patterson’s cancer diagnosis, delays on its DoD implementation, and ongoing construction at its new Kansas City campus.

Medical scribes free doctors to spend more time with patients

A local paper reports on the introduction of medical scribes in the CHI Memorial (TN) emergency department, linking the rise of scribes to ARRA and the resulting increase in EHR use by providers.

Morning Headlines 12/23/16

December 23, 2016 News No Comments

Google Deepmind and Imperial in streams deal

Google’s UK artificial intelligence company, Deepmind, will implement its only non-AI app, Streams at Imperial College Healthcare NHS Trust. Streams monitors clinical information and alerts doctors of deteriorating patients.

Analysis of Nearly 51,000 Geisinger Patient Exomes, EHRs Reveal Actionable Variants, Drug Targets

A study analyzing the DNA and EHR data of 51,000 patients finds that 3.5 percent of the study participants had clinically actionable variants.

Eight More Health Systems Join Growing Support for Surescripts National Record Locator Service

Eight new health systems have joined the Surescripts National Record Locator Service, which runs patient record searches within the Carequality HIE.

UMass Memorial posts $68M surplus for 2016

UMass Memorial Health Care reports a $68 million surplus in 2016, up from $47 million last year, despite $125 million in new debt that it is using to implement Epic.

News 12/23/16

December 22, 2016 News 6 Comments

Top News

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The Department of Justice gives anti-trust clearance to the previously announced creation of a new health IT company by McKesson and Change Healthcare, clearing the way for the deal to go through as planned in the first half of 2017.

McKesson will own 70 percent of the new company, to which it will contribute most of McKesson Technology Solutions.


Reader Comments

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From CCOW, MUCOW: “Re: Meaningful Use penalties. A CMS document says it will apply a downward payment adjustment to 171,000 EPs in 2017 for failing to demonstrate MU.” I’ve long lost interest in Meaningful Use and its offspring. We as taxpayers have paid $35 billion to bribe doctors to use old, poor-selling EHRs they wouldn’t use voluntarily, which is maybe a first in any industry. I suppose that as a stimulus package, it delivered the expected economic benefit (although it was late to the party by the time the details were worked out), but I’m not seeing much difference in cost or quality so far. Maybe it’s a laying-the-tracks sort of thing that will pay for itself downstream. Meanwhile, I read somewhere that ONC now has 400 employees, reproducing itself like typically virulent federal agencies, departments, and offices.

From Piezo DeVoltaic: “Re: equipment. Other than the Wi-Fi adapter you mentioned, what else do you use to write HIStalk?” I have a Toshiba laptop that I got from Office Depot for less than $300 several years ago and a 27-inch Acer monitor that I think cost around $130. That’s it other than keyboards, which I go through frequently due to the volume of writing I put out – I buy the basic Microsoft wired keyboards three at a time since they’re only around $12. Starting on a new keyboard is like a new beginning because I’m always snacking while working due to lack of time, so the crumb load is significant (shaking my keyboard upside down looks like a snowstorm). On the non-work front, I have an iPad Mini and my beloved Chromebook. I also need to replace my iPhone 5 at some point, I suppose, although I can’t get excited about the iPhone 7 Plus that seems like its logical successor.

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From LFI Masuka: “Re: article comparing medicine to ‘Moneyball.’ The movie was really about using statistics to better value assets in an environment of limited money to spend on those assets. The vision was not getting the best possible Oakland A’s – it was getting the best Oakland A’s for a reasonable price. The equivalent for medicine would not be best practices – it would be to set up budgeted compensation guidelines to more realistically address those activities that promote long-term health. Getting more bang for our collective bucks. Without the financial aspect, Medicineball is what we used to call ‘science.’” I like that. I would also say that it’s a subtle but important mistake to assume that hospitals are best equipped to do anything more than patch people up and send big bills after they treat ‘em and street ‘em. Somehow everybody just accepts that hospitals are the logical overseers of population health management. I disagree. Most of us see our PCPs a lot more often than we have a hospital encounter, not to mention that hospitals are notoriously bureaucratic and inefficient. Maybe it’s because the doors of medical practices are locked at least 75 percent of the time, sticking hospitals with less-convenient coverage hours but making them the most reliable and accessible provider. I’ve spent most of my career working in hospitals and I would never (a) donate money to them, (b) trust them; or (c) become their inpatient without having someone sitting at the foot of my bed at all times to catch their inevitable mistakes. They’re like universities – too much emphasis on money, overly large employee egos, and an inflated sense of entitlement and global self-importance.


HIStalk Announcements and Requests

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Donations from three HIStalk readers, paired with matching money from my anonymous vendor executive, allowed me to fund these DonorsChoose projects:

  • An Osmo Wonder Kit for Ms. F’s sixth grade class in Costa Mesa, CA
  • Science, STEM, and weather books Ms. H’s second grade class in Fayetteville, NC
  • Scientific calculators for Ms. H’s seventh grade class in Indianapolis, IN

Ms. H responded quickly to the news that her project was funded. “I am so grateful that you are helping us out. We do not get a lot of science materials in second grade. This is exactly what I needed for my students when we come back from the winter break. I can’t tell you how much this means to me to give my students the best so they can learn. My kids love science and now you are giving us materials for them to really dig in and learn. You are the best.”

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Ms. C sent photos from her California middle school showing the daily news show equipment we provided in funding her DonorsChoose grant request (microphones, a $50 camera-equipped drone, iPhone tripods and clips, and accessories).

A TV show is on in the background as I’m writing, in which a limelight-seeking singer is butchering a Christmas carol with overwrought vocal gymnastics in an ill-advised attempt to “make it her own” instead of just singing the damned thing without gimmicking it up. The only worse thing I’ve heard is when a “Nashville recording artist” wearing a laughably misplaced cowboy hat hacks up the National Anthem before a Nascar race, providing 10 bad, rambling notes for every one that was originally written. Even the “artists” who follow the Star-Spangled Banner reasonably well still feel compelled to wing it toward the end, probably in relief for remembering all the words. Apparently they are mistaken in thinking they know better than the composer.

This week on HIStalk Practice: Fallas Family Vision selects RevolutionEHR. Greenwood Genetic Center launches telegenetics program in South Carolina. Michigan will implement Appriss Health’s prescription monitoring program tech. Orthopedic + Fracture Specialists goes with Odoro patient self-scheduling software. MedStar NRH’s John Brickley outlines the challenges PTs face when selecting health IT. Our Children Our Future selects TenEleven Group’s behavioral health EHR. Walgreens looks to Matter for innovation inspiration as it works out Theranos kinks. Palo Alto Networks’ Matt Mellen offers ways to spot spoofing in healthcare emails.

I’m leaning toward taking the weekend off from writing HIStalk, so if indeed I do, have a Merry Christmas or whatever holiday (if any) you celebrate. I don’t gain much wisdom from Facebook, but I liked a quote I saw there: “It’s not what’s under the Christmas tree — it’s who’s around it.”


Webinars

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

January 26 (Thursday) 1:00 ET. “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.” Sponsored by Healthwise. Presenters: Jim Rogers, RN, RPSGT, director of healthcare solutions, Persistent Systems; Charlotte Brien, MBA, solutions consultant, 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.


Sales

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In England, Allscripts PAS customer Dudley Group NHS Foundation Trust adds Sunrise and dbMotion.

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Deborah Heart and Lung Center (NJ) will upgrade to Meditech Web Ambulatory and 6.1.

In England, Imperial College Healthcare NHS Trust will implement Google-owned DeepMind clinical deterioration detection system.


Announcements and Implementations

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Eight large health systems go live with the Surescripts National Record Locator Service. The company offers EHR vendors free access to the system, which operates under Carequality’s framework, until 2019.


Privacy and Security

From DataBreaches.net:

  • A security firm’s analysis finds that the black market price of a patient’s complete medical record has dropped over several years from $50 to less than $10, which has caused cybercriminals to refocus their efforts on spreading the more profitable ransomware.
  • Fairbanks Hospital (IN) notifies an unspecified number of patients that their information was visible to unauthorized employees for several years, adding that it’s not even sure who viewed the information.
  • Henry County Health Department (OH) alerts 500 of its home health and hospice patients that their information was contained on a nurse’s stolen laptop, adding that it will start encrypting laptops.
  • Community Health Plan of Washington notifies 400,000 current and former members that a security vulnerability in the network of contractor NTT Data exposed their information. 

Innovation and Research

A Geisinger study in which patient genomes were matched to their EHR information finds actionable variants for familial hypercholesterolemia in 3.5 percent of those studied.


Other

The $125 million that UMass Memorial Health Care (MA) borrowed for its Epic implementation reduced its fiscal year operating profit, but it still made $47 million vs. $58 million last year.

Saint Vincent Hospital (PA) is forced by the Equal Employment Opportunity Commission to rehire six former employees it fired in 2013 for refusing to take a flu shot and then providing questionable clergy-signed documentation of their claimed religious beliefs. EEOC says the hospital’s requirement constitutes religious discrimination. The hospital must now accept any excuse an employee offers for declining to be immunized.

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Denver Health (CO) fires $360,000-per-year pediatric anesthesiologist Michelle Herren, MD for posting Facebook comments about First Lady MIchelle Obama that said, “Doesn’t seem to be speaking too eloquently here, thank god we can’t hear her! Harvard??? That’s a place for ‘entitled’ folks said all the liberals! Monkey face and poor ebonic English!!! There! I feel better and am still not racist!!! Just calling it like it is!" She apologized, saying she didn’t realize “monkey face” might be taken as racist, that her comments were taken out of context,  and that she thinks it’s a double standard that everyone can make fun of Melania Trump but the First Lady is off limits. Unlike Ms. Obama’s degrees from Princeton and Harvard, the exclamation point-shrieking Dr. Herren earned her medical degree from Nebraska’s Creighton University, ranked among the bottom 15 US medical schools.

Weird News Andy offers his Merry Christmas story. New Mexico Department of Health epidemiologists investigate their own agency’s catered holiday lunch after 70 of its employees get sick afterward. I don’t usually worry about catered food, but I’m nervous  about eating at potlucks or picnics, where you can’t verify the food safety standards employed by well-intentioned people who don’t understand that food needs to be refrigerated as soon as it’s cooked and until it’s heated and eaten. Compounding the problem is that hospitals and office buildings don’t always have a real kitchen with big enough refrigerators to hold everybody’s dishes for several hours or a range to heat them up, so there’s always a big line waiting for the cheap, countertop microwave. Think twice before you take leftovers home. Sometimes I think that every American should take a food safety course since it’s surprising how many people leave food out after cooking or after eating, somehow thinking that simply covering it keeps bacteria out.  


Sponsor Updates

Holiday Activities

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PeriGen and its new acquisition WatchChild hold their first combined team meeting in Cary, NC, with employees also building 10 bicycles for the local Big Brothers, Big Sisters organization, They were surprised afterward to be joined by the children whose bikes they had just built.

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Xerox Healthcare donates gifts to the Northern Rivers Holiday Giving Campaign.

  • Consulting Magazine awards Impact Advisors VP Jenny McCaskey a Lifetime Achievement Award.
  • Everest Group places NTT Data Services in the Leader quartile for three of the 2016 Peak Matrix Assessments, including the new EHR category.
  • PatientKeeper releases a new video featuring customer reviews of their charge-capture solution.
  • The SSI Group raises money to place over 400 wreaths on the graves of veterans.

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 12/22/16

December 22, 2016 Dr. Jayne No Comments

There has been a lot of information coming out of CMS over the last couple of weeks, and I’m sure some organizations are missing it in the holiday rush. I know I missed some of the announcements when they came out last week. Sometimes I’m not sure whether subscribing to multiple news feeds and aggregators helps me or adds to the issue.

Some of the hottest debate is around changes to the CMS bundled payment programs, including two new mandatory programs for heart attack care and bypass surgery. The other changes are to the hip and knee replacement program. The new programs will qualify as Advanced Alternative Payment Models for the purposes of MACRA. Within the Acute Myocardial Infarction Model and the Coronary Artery Bypass Graft Model, flat fee payments will occur instead of line-item payments for procedure-related services.

These models will launch on July 1, 2017 and run through December 31, 2021. Hospitals from 98 metropolitan areas were selected for participation, which again is mandatory. Any savings during the first two performance years can be kept by the facilities, but starting in the third year, hospitals will be required to repay a portion of the extra costs with a gradual increase in that repayment portion. Bonuses for demonstration of defined quality metrics will be available, starting at 5 percent in the first three years and moving up to 20 percent in the fifth year.

There is also an incentive for providers to refer heart attack patients for rehabilitation under the Cardiac Rehabilitation Incentive Payment Model. Hospitals will receive $25 per service provided to patients post-MI or bypass for up to 11 services per patient. After that, the payment goes up to $175 per service. Cardiac rehabilitation has proven value in the clinical realm, so it’s nice to see CMS putting money in play to incent desired behaviors.

Bundled payments under the Comprehensive Care for Joint Replacement Model are also expanding, adding hip and femur fracture care. The Surgical Hip and Femur Fracture Treatment Model will also count as an Advanced APM under MACRA. CMS webinars are forthcoming and will detail the new payment programs and the hoops that providers must jump through to qualify for bonuses. As is usual for new CMS programs, there will be a flurry of fact sheets and open forums where providers and organizations can ask their questions. Response to the announcement has been mixed, with the American Medical Association in support and the American Hospital Association against, largely due to the fact that participation is mandatory.

Hospitals in the impacted regions have a little over six months to prepare, which isn’t a lot of time when you’re talking about the need to analyze current state and apply interventions to support a new paradigm. Those of us in the consulting space would encourage everyone to start thinking about this, even if you’re not in one of the mandated performance areas, to start making changes as well. It’s highly likely that these programs will expanded and the sooner you prepare, the easier the transition will be.

CMS also announced two new Accountable Care Organizations, one of which is tantalizingly named “Track 1+.” It has less downside risk than the existing tracks in the Medicare Shared Savings Program and is designed to bring smaller practices into the risk-assumption fold. It is set to launch in 2018 and the hope is to bring up to 70,000 providers on board. Smaller or rural hospitals could have less risk than their larger counterparts, which could be attractive to those organizations who are on the fence about being an ACO. Interested groups can submit an intent to apply as soon as May 2017. Whether they’re admitted to the track or not, there is good reason to start preparing now.

The second one, the Medicare-Medicaid ACO Model is designed to address the needs of dual-eligible beneficiaries who are covered under both programs. Although these patients could previously participate in Medicare ACOs, there was no financial accountability for the Medicaid spending for these patients. The new ACO allows for management of both sets of costs. States can submit letters of intent to work with CMS to design the state-specific requirements. Up to six states will be selected with priority given to states with lower Medicare ACO participation. Once states are identified, applications will be released to ACOs and providers.

Regardless of the proliferation of new models, some analysts have suggested that they may not be fully rolled out or may be significantly changed after new leadership hits HHS after the inauguration. That’s exactly the same kind of thinking we’ve seen intermittently over the last decade, where providers wait to take action because they think there’s a chance of change. For some, that has caused a lot of angst when they realized that their watch-and-wait attitude only served to cause a flurry of activity later. I sympathize with their hope that a new administration will come in and wipe the slate clean, but given the continued escalation in healthcare costs and the political pressure to drive them down, it’s not entirely realistic. I still would love to see regulation in the health insurance space but that’s not entirely realistic either.

As of early 2016, nearly 30 percent of Medicare payments were tied to quality and value and the next milestone is to try to tie 50 percent of payments to those parameters by 2018. We’re going to continue to see a proliferation of new programs that can be confusing and maddening. I hope those in the trenches are considering New Years’ Resolutions that promote serenity and relaxation, because it’s going to continue to be a slog.

Have you started thinking about your resolutions yet? Email me.

Email Dr. Jayne.

Morning Headlines 12/22/16

December 21, 2016 Headlines 2 Comments

2017 Medicare Electronic Health Record (EHR) Incentive Program Payment Adjustment Fact Sheet for Hospitals

CMS releases EHR Incentive Program performance statistics stating that 98 percent of eligible hospitals and CAHs successfully demonstrated meaningful use, but noting that there are about 171,000 Medicare eligible providers subject to a downward payment adjustment in 2017.

McKesson, Change Healthcare get antitrust clearance for IT deal

The proposed merger between McKesson’s technology business and Nashville-based Change Healthcare receives approval from the US Justice Department.

Interoperability Standards Advisory

ONC publishes its 2017 Interoperability Standards Advisory.

9 Healthcare Tech Trends in "The New Year of Uncertainty", Black Book Survey Results

Black Book releases results from a health IT-related survey of hospital executives, finding broad consensus that IT budgets will stagnate in the coming year.

Readers Write: Integrating EHRs and PDMPs: A Trend for 2017

December 21, 2016 Readers Write 1 Comment

Integrating EHRs and PDMPs: A Trend for 2017
By Connie Sinclair, RPh

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The opioid epidemic will continue to be a big story in 2017 and the statistics get grimmer by the minute. We just learned from the government that more than 33,000 people died from opioid overdoses in 2015, making it the deadliest year ever.

In response, states will continue to enact legislation to mandate prescribers to use the Prescription Drug Monitoring Program (PDMP) and will encourage making electronic health records (EHRs) more interoperable with PDMPs by integrating access into prescriber workflows. For example, Massachusetts and Ohio are subsidizing statewide projects to facilitate the integration of the state PDMP into EHR solutions used by providers. PDMP usage has been associated with fewer overdose deaths and lack of integration into prescriber workflow has been shown to be a barrier to utilization, so we anticipate more states will follow suit.

While PDMP and EHR integration is an important policy goal, making it a reality has been easier said than done. PDMPs are independent, state-run databases of controlled substance prescriptions that have been reported from pharmacy dispensers. They are operational in all states except Missouri. Because PDMP systems have evolved outside the health IT ecosystem, significant barriers to interoperability have resulted. In contrast to electronic prescribing, for example, there is not a standard method to exchange and integrate the prescription drug data available in PDMPs into EHRs.

That is changing. In 2013, the Office of the National Coordinator (ONC) created a pilot initiative to bring together the PDMP and health IT system communities. The goal was to standardize the data format, transport, and security protocols to exchange controlled substance history information between PDMPs and EHRs as well as pharmacy systems. 

These actions are beginning to bear fruit. These pilots have recently concluded and seven of 10 participating vendors are now moving PDMP functionality into production, leveraging the pilot’s final implementation guide. Appriss has indicated that many EHRs are indeed integrating to their PDMP gateway. 

It is clear that 2017 will see increased legislative movement to require EHRs to integrate with PDMPs and prescriber workflows. The ONC pilots have shown a technical path forward. Now is the time for forward-thinking EHRs to capitalize on that progress and get ahead of the legislative curve. It will create competitive advantage, serve as a tremendous value-add to prescribers, act as a proactive means to improve patient care, and potentially save lives.

Connie Sinclair, RPh is director of the Regulatory Resource Center of  Point-of-Care Partners of Coral Springs, FL.

Readers Write: Seven HIT Talent Trends to Watch in 2017

December 21, 2016 Readers Write No Comments

Seven HIT Talent Trends to Watch in 2017
By Frank Myeroff

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Here are seven talent trends that are shaping the HIT workforce.

  1. C-level title of chief robotics officer rises. Expect more than half of healthcare organizations to have a chief robotics officer (CRO) by 2025. Since healthcare is an industry where robotics and automation play a significant role, the CRO will have a similar status to that of the CIO today within the next few years. The CRO and their team will manage the new set of challenges that comes with Robotics and Intelligent Operational Systems (RIOS). They will translate how to use this technology and how it is linked to customer-facing activities, and ultimately, to organizational performance.
  2. Talent raids to acquire HIT leaders. Top-tier HIT talent is a core factor in the success of any healthcare organization. Yet there is an insufficient talent pool from which to acquire IT leadership. This labor shortage is causing those on the front lines to talent poach from other healthcare organizations. Right now, the competition for highly qualified and experienced leaders is at an all-time high due to several factors including an underinvestment in leadership development and tighter operating margins that influence workforce strategies.
  3. Videoconferencing for telehealth grows in popularity and jobs. While not exactly new, videoconferencing is gaining popularity in healthcare due to the advances in HIT infrastructure and communication as well as the need to serve the aging population and those residing in remote areas. Healthcare practitioners are increasingly adopting these interactive video applications to offer better access to healthcare as well as deliver improved patient care at reduced prices. Additionally, patients are finding benefits to using this real-time, two-way interaction since it enables healthcare providers to extend their reach of patient monitoring, consultation, and counseling. The most popular HIT professionals sought after in videoconferencing are implementation specialists and telehealth directors.
  4. Burgeoning cybersecurity job market. Healthcare organizations of all sizes are in the hunt for skilled cybersecurity professionals. Just about every day there’s a story regarding a data breach incident within the healthcare industry. Many of these incidents could be attributed to unfilled cybersecurity jobs. Since the current demand is greater than the supply, a career in this sector can mean a six-figure salary, job security, and upward mobility. The cybersecurity industry as a whole is expected to grow from $75 billion in 2015 to $170 billion by 2020, according to Forbes.com. In addition, the demand for the cybersecurity workforce is expected to rise to 6 million by 2019 with a projected shortfall of 1.5 million.
  5. Working remotely fully takes off. Working from anywhere and at any time will become a normal every day thing. By 2020, it is expected that 50 percent of workers in the US will be working either from home or another remote location. Having virtual employees is not only a way to get things done round the clock, without commuting, and with hard-to-find skill sets, but is also a way to meet the needs of employees who don’t live near the organization.
  6. Boomerang employees more common. Boomerang employees are employees who leave an organization only to return back to that same employer sometime later. Rehiring these former workers are on the rise. With HIT talent at a premium, it only makes sense. HIT Managers know that hiring back someone they know is easier than recruiting new blood plus it saves money on training and development. In addition, there’s an immediate ROI.
  7. 3D technology careers wide open. Everyone is talking about 3D printing these days. It is expected to be the top medical innovation in 2017 for the reason that it could change everything for transplants and prosthetics through customization. As the 3D industry continues to evolve in 2017, the job market is wide open. In fact, jobs are appearing faster than candidates can be recruited. Young HIT professionals, especially software developers, should see this market as having huge potential for beginning a new career.

Frank Myeroff is president of Direct Consulting Associates of Cleveland, OH.

Morning Headlines 12/21/16

December 20, 2016 Headlines 1 Comment

HIMSS CEO to Retire at End of 2017; Search Underway

HIMSS president and CEO Stephen Lieber will retire at the end of 2017, after assuming the role in April 2000.

MedicineBall is the new MoneyBall

Jordan Shlain, MD argues that medicine has reached the point where data science, statistics, and predictive modeling are becoming too important to ignore.

UHealth and Walgreens Team Up on Retail Clinics and Pharmacies

UHealth acquires 17 Walgreens clinics across South Florida and integrate the retail pharmacies into its own care delivery network.

Under law effective Jan. 1, Massachusetts patients entitled to access medical docs electronically

A new Massachusetts law that will go into effect January 1 grants residents electronic access to their medical records. The law requires that providers implement an EHR, and that mechanisms be put in place to grant patients direct electronic access to their records.

News 12/21/16

December 20, 2016 News 15 Comments

Top News

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HIMSS announces that President and CEO Steve Lieber will retire at the end of 2017. The organization has opened a search for his successor.

Lieber seems a bit young (63) to be retiring. The timing is interesting since EVPs John Hoyt and Norris Orms announced their retirement in February 2016, yet both are still working – Hoyt is consulting back with HIMSS Analytics and Orms is a VP of a recruiting firm.

About the only long-time senior executive left will be Carla Smith, who would seem to have a good shot at replacing Lieber unless the intention is to start over with a clean slate for whatever reason.


Reader Comments

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From Spilt Infinitive: “Re: like/dislike buttons for comments. Have you considered adding them? I like that online articles in the Economist, WSJ, NYT, etc. show me which comments are most liked by readers. It’s also satisfying when people ‘like’ my comments.” Good idea. I’ve added that capability to both articles and comments. You are now free to like and be liked as much as you like.


HIStalk Announcements and Requests

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An anonymous vendor executive has once again donated $10,000 for use as DonorsChoose matching funds, meaning that for every dollar donated by HIStalk readers, the executive will match it (along with likely other available  matching money from the corporate partners of DonorsChoose). I’m not soliciting donations since charitable contributions are a personal decision, but those who want to get extra bang for their educational donation buck can do this:

  1. Purchase a gift card in the amount you’d like to donate.
  2. Send the gift card by the email option to mr_histalk@histalk.com (that’s my DonorsChoose account).
  3. I’ll be notified of your donation and you can print your own receipt for tax purposes.
  4. I’ll pool the money, apply the matching funds, and publicly report here (as I always do) which projects I funded, with an emphasis on STEM-related projects as the matching funds donor prefers.

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Ms. M from Illinois expressed a lot of appreciation for our funding of her small DonorsChoose grant request (around $100) to provide nine sets of headphones for the reading center of her elementary school special education class. Students started using them the day they arrived, as she explains, “The morning of this grant getting funded, I had to throw away all of our classroom headphones because the ear pieces broke from wear and tear. All I can say, is that you made my students feel so special and they had the biggest smiles on their faces. I sincerely thank you for making such a significant sacrifice to our classroom.”

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HISsies nominations remain open. I’ve received only 12 responses that may or may not be representative of popular opinion (I can tell you for sure that some of them are way out there), so don’t blame me if major omissions creep onto the final ballot because you didn’t nominate obvious choices.

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Welcome to new HIStalk Gold Sponsor Dynamic Computing Services. The nationwide staffing and IT consulting firm — founded in 1990 by Gary Sherrell — has offices in Austin, TX and Maple Valley, WA. Healthcare makes up more than 50 percent of its business, where it has placed more than 3,100 resources and earned an 80 percent repeat business rate. DCS services include staff augmentation, legacy support, optimization, project management, analytics, and technical services. The company has completed 1,200 health IT projects – 200 of them involving Epic’s systems – and supports all major EHR vendors. Candidates can check out their open positions. Thanks to Dynamic Computing Services for supporting HIStalk.

A slight majority of poll respondents think I should list contract extensions and upgrades in my “Sales” section, but some commenters agree with me that we’re mostly interested when a hospital switches vendors. Others, however, point out that the hospital may have undertaken a full product search before re-upping with their same vendor (even though we have no way of knowing if that’s the case) and that might make it newsworthy. I think I’ll go this route – I won’t run contract extensions or seemingly minor expansions of the original agreement (like adding one more minor module when re-upping), but a product conversion like Meditech Magic to EHR or Soarian to Millennium is probably newsworthy.

To my fellow progressive music fans: Yes is finally chosen for induction in the Rock and Roll Hall of Fame after three tries. The Hall-accepted lineup contains the obvious choices from the dozens of musicians who have been part of Yes over its nearly 50 years – Anderson, Bruford, Howe, Rabin, Squire, Wakeman, White, and Kaye (I would have omitted Rabin and included Peter Banks). Yes shares a dubious distinction with its fellow 2017 inductee Journey: both bands tour today with a sound-alike replacement lead singer they found by watching YouTube videos of crappy tribute bands covering their hits, keeping the cash registers ringing from non-purist fans who just want to hear familiar heyday hits in a slightly elevated form of karaoke. It will be awkward if the bands play at their induction since they have three choices: (a) reconfigure in an uncomfortable, temporary reconciliation that omits current members who weren’t named; (b) play without key personnel from their glory years; or (c) fill the stage with a bevy of former and current members like Yes did on its cobbled-together and dishonestly named Union tour of 1991 that was more of a redundancy-filled, synergy-seeking corporate merger than an organic (no Wakeman pun intended) artistic effort.


Webinars

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

January 26 (Thursday) 1:00 ET. “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.” Sponsored by Healthwise. Presenters: Jim Rogers, RN, RPSGT, director of healthcare solutions, Persistent Systems; Charlotte Brien, MBA, solutions consultant, 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.


Acquisitions, Funding, Business, and Stock

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TPG Capital will acquire healthcare software vendor Mediware from its private equity owner Thoma Bravo. TPG’s portfolio also includes Evolent Health, PatientSafe Solutions, and Quintiles.

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India-based cloud services provider 8K Miles will acquire healthcare consulting firm Cornerstone Advisors Group for $10.25 million in cash and stock. Cornerstone was founded in 2008 by Keith Ryan, who was previously CIO at Stamford Health System and Elmhurst Memorial Hospital. Reader Dave notes that the acquiring US entity had $5 million in profit on $27 million in revenue last year, with the overall entity reporting $40 million in revenue.

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Active aging app vendor GreatCall acquires remote monitoring technology company HealthSense.


People

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Gil Enos (EHealth Intelligence) joins WiserMazars LLP’s healthcare consulting group as principal.

Digital rehab technology vendor Reflexion Health hires Sudipto Sur, PhD (Signal Genetics) as CTO.


Announcements and Implementations

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BayCare (FL) implements an electronic screening system for newborns that allows sending EHR-stored patient information electronically to the state’s department of health.

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University of Miami Health System (FL) will take over 17 Walgreens retail clinics in South Florida and will use the drug chain as its exclusive retail pharmacy provider. Both organizations use Epic.

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Caradigm enhances its population health management solutions to support MACRA and bundled payments, adding Care Bundles, Content Builder, MACRA solutions, Advanced Computation Engine, and Utilization and Financial Analytics.

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A Healthgrades survey finds that most consumers would choose a doctor who has limited appointment openings but who offers online scheduling over a more available doctor who schedules appointments only by telephone. Two-thirds would be willing to trade a convenient location for being able to schedule online. The company’s new physician directory enhancements include online scheduling, smart reminders, and Google Maps integration. I only wish Healthgrades would eliminate the entirely incorrect inclusion of the non-specific, redundant social title “Dr.” in front of the name that already includes the correct designation of “MD.”

Iatric Systems is developing IV-EHR interoperability with Hospira’s smart infusion pumps using its Accelero Connect technology. 


Government and Politics

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ONC’s Director of Public Affairs and Communications Meghan Roh joins Epic as director of public affairs. I don’t know if this is a newly created position, but it’s interesting that Epic is hiring someone with quite a bit of political and government experience.

A Massachusetts law takes effect January 1, 2017 that requires doctors to give patients electronic access to their medical records and to use EHRs that are connected to the Massachusetts Health Information Highway.


Privacy and Security

From DataBreaches.net:

  • A Texas company that provides elective ultrasound baby pictures exposes its images, physician reports, and employee information to Web searches after misconfiguring a server to activate an unsecured RSYNC directory synchronization protocol.

TMZ reports that UCLA Medical Center (CA) may discipline several dozen employees who couldn’t resist snooping around in the medical records of Kanye West during his recent breakdown-triggered stay. It’s not the most reliable source, but the story is easily believable since not only is Kanye a big celebrity, he lost it publicly while performing


Innovation and Research

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Glytec earns its sixth patent for precision diabetes management technologies related to its SaaS-powered eGlycemic Management System that provides personalized insulin dosing, enterprise glucose surveillance, and analytics.


Other

An AHRQ-authored Health Affairs article raises concerns about the financial burden caused by high-deductible health insurance policies. I might take the contrarian approach in suggesting that high-deductible plans were created for exactly that reason – to encourage better self-care and rational health choices while exposing high prices in hopes healthcare competition will kick in (note: it hasn’t – the big just keep getting bigger). Our healthcare dollars provide way too much profit for the companies and people involved, but we also need to change the attitude that health and healthcare costs should be convenient.

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Jordan Shlain, MD is a good writer whose latest work, “Medicineball is the new Moneyball,” argues that doctors need to develop a data perspective for the good of patients. He says,

The crazy thing is that doctors, and I am one, have historically not participated in the data collection game. This was just a artifact of geeky computer science engineers building crappy code that doctors hated using (and still, mostly do.) Data will give us a new perspective — A data perspective. This new illuminating presence is an opportunity that presents itself once in a generation. We can now see things in a new light.

This puts doctors into the precarious position of being in the “if you’re not at the table, you may be on the menu” paradigm. Physician data is currently collected by EMR vendors, insurance companies, laboratory and radiology companies, pharmacies, revenue cycle management companies, and a host of other third parties — but not the doctor….or if they do, it’s the exception. I have a hard time believing that your friendly, local insurance company will happily supply doctors all they data they want. This data is expensive, comes at a premium, and is viewed through the lens of market share; not necessarily patient care. Doctors need to step up and start collecting their own data.

A New York Times article questions whether taxpayers get a good deal when NIH researchers help develop promising immunotherapy cancer drugs that are then licensed to drug companies that will make millions of dollars. Critics point out that taxpayers paying for the drugs twice — once to develop them, then again in buying them at high list prices since Medicare isn’t allowed to negotiate prices. NIH gets a tiny chunk of the proceeds as royalties, but has removed from its contracts a requirement that the drug companies sell the products at a “reasonable price.” The article notes that a  prostate cancer drug that sells for $129,000 per year in the US (two to four times what other countries pay) netted UCLA $500 million when it sold its royalties, but NIH says it’s not qualified to determine whether the price is reasonable and thus likely to make it unavailable to most people. 

An article notes indignantly but unsurprisingly that “pharmaceutical distributors have been quietly stocking pharmacy shelves with these pills in areas where addiction is the highest,” with a single West Virginia pharmacy in a town of 300 people receiving 9 million narcotics tablets to resell in two years. The article fails to mention that those doses were dispensed because they were prescribed by doctors and presumably requested by patients, both of whom escape the article’s misplaced wrath in shooting the literal messenger. The same investigative reporting methods could probably self-righteously proclaim that McDonald’s, during the same time period, sold a lot of hamburgers to massively overweight West Virginians. The key in both cases is to reduce demand, not complain that suppliers meet it.

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A JAMA-published observational study finds that Medicare patients managed by female intensivists experience lower mortality and readmission rates than those who are managed by their male counterparts. The authors cite previous studies in which female doctors were found to be more likely to practice evidence-based medicine, deliver more patient-centered care, and approach problem-solving more deliberately. The difference is not large enough to get excited about (despite the moronic USA Today headline above), but my takeaways are: (a) anyone who thinks female doctors are somehow less competent – if indeed any of those folks are still around — can see how wrong they are; and (b) it would also be interesting to similarly look at outcomes by country of medical training and the age and personality type of the doctor. I’ve worked with some flamingly incompetent physicians and many of them were questionably qualified foreign medical graduates, but that was a long time ago when standards were lower and this was in geographically undesirable areas where most of the dangerous docs were unmotivated locals or overseas opportunity-seekers. I would be happy now to have a doctor who graduated outside the US, especially since their educational system is a lot better than ours.


Sponsor Updates

Holiday Activities

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PerfectServe employees are supporting charitable programs that include donating duffel bags packed with personal items for adolescents completing treatment services; providing financial support to a co-worker who lost belongings in an apartment fire; collecting food and supplies for families affected by the Gatlinburg, TN fires; and collecting food for the Chicago food bank.

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Cumberland Consulting Group team members wrap presents for the Youth Villages Holiday Heroes Program in Nashville.

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The Ingenious Med sales team creates care packages for The Packaged Good.

  • The Chartis Group publishes a white paper titled “Post-Election Analysis: Strategic Imperatives for Providers in an Uncertain Landscape.”
  • Besler Consulting releases a new podcast, “The potential impact of the Tom Price nomination as HHS Secretary.”
  • MModal is awarded a three-year agreement as an awarded supplier to Vizient’s Novaplus, its exclusive provider of clinical documentation improvement.
  • Black Book’s latest user survey ranks Oracle Healthcare Cloud the number one ERP solution for value-based care processes.
  • InstaMed opens registration for its User Conference 2017 March 27-29 in Philadelphia.

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
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Morning Headlines 12/20/16

December 19, 2016 News No Comments

How Geisinger Health System Uses Big Data to Save Lives

Harvard Business Review profiles Geisingers use of analytics and natural language processing to drive earlier identification of sepsis, improve post-acute follow up care for patients who have non-critical conditions diagnosed during a hospitalization, and track surgical outcomes and costs.

The Children of Agent Orange

ProPublica and the Virginian-Pilot analyze decades-old data from the Department of Veterans Affairs and find that the odds of having a child born with birth defects is significantly higher among veterans exposed to Agent Orange during the Vietnam War.

Amidst Political Uncertainty, the shift to Value Continues: PwC Health Research Institute’s Top Health Industry Trends for 2017

PwC publishes its list of top issues healthcare issues for 2017, which includes shifting to value-based reimbursement models, engaging patients more effectively, modernizing payment processes, and adopting new technologies to drive each of these initiatives.

Curbside Consult with Dr. Jayne 12/19/16

December 19, 2016 Dr. Jayne 3 Comments

Winter roared across much of the US this week, reminding many people that no matter how good we think our technology might be, mother nature sometimes has the last laugh. Our region’s weather went way beyond what forecasters expected, bringing the transportation infrastructure of several metropolitan areas to a complete stop. Conditions went from bad to worse right before the evening rush hour, stranding people in their cars for hours. It was bad enough throughout the weekend that fire trucks were skidding off the road and airplanes were sliding off the runways.

Unfortunately, that kind of weather doesn’t stop those of us in healthcare who are responsible for manning the patient care trenches and for supporting the systems that make our work easier. Sometimes that means getting up an hour earlier than usual to make sure that the car is defrosted and there is plenty of extra time to get to the hospital or office. Other times it means staying late to make sure everyone is taken care of, regardless of what might be going on in our own lives.

I was seeing patients this weekend and we had several rushes, seeing nearly 50 patients in the first few hours we were open. One of my staff was uncharacteristically attached to her cell phone, as she worried about her son heading home on the icy roads from his first semester at college.

In patient care, though, we’re expected to be “on” all the time. We don’t necessarily get a break to check in with our kids or family and make sure they’re OK, especially when we have dozens of needy patients in front of us. And in this era of consumer-driven healthcare, there doesn’t seem to be much room for the caregivers to be human.

Normally our center delivers high-quality care in an efficient manner, but this weekend we were just swamped, as were the rest of the centers in our group. Normally we have some providers who float between the locations, but there was no room for that as patients tried to be seen between the freezing rain and the impending snow. Patients were calling from location to location checking out the wait times. My scribe and I scurried from room to room as fast as we could, with him literally finishing one patient’s visit documentation as I started our introductions in the next exam room. Despite our efforts, there was still an hour wait at one point, with a couple of patients leaving without being seen.

Regardless of the wait, we’re still significantly faster than the emergency department. This was confirmed by the patients who arrived in our waiting room after giving up elsewhere first. At least at our practice, patients generally wait in their own private space, with cable TV and comfortable chairs.

As a physician, I feel awful when patients leave without being seen, whatever the reason. It means that we missed an opportunity to treat an illness or maybe to just provide reassurance. Sometimes those missed opportunities can have life or death consequences, and that possibility is always on our mind even if most of what we’re seeing is colds or sniffles. I’m glad my patient who had an acute appendicitis decided to brave the weather and come in and to take me up on the CT scan I offered to confirm it. For a while, he had debated not seeking care, which could have been disastrous.

Due to the ice, we saw a fair number of people who slipped and fell, sometimes hitting their heads. Especially with elderly patients or those on blood thinners, we have to be vigilant about evaluating them since the margin for head injuries can be small. I know the weather created chaos in many people’s schedules, but I don’t think I’ve seen as many patients trying to talk me out of an appropriate workup as I saw this weekend. On the other hand, there were quite a few patients trying to talk me into treatments they didn’t need, such as antibiotics for their viral illnesses or the illnesses they are afraid of catching.

No amount of embedded clinical decision support in my EHR is going to help me through those conversations. I can give the patient an antibiotic and lower my clinical quality metrics, but raise my patient satisfactions scores. Or I can hold the line against antibiotic resistance and risk bad reviews. Despite a patient mix that was similar to my last few shifts, my patient satisfaction scores were lower than usual. Comparing them to the patient wait times, though, showed a trend – regardless of the care, patients who waited longer gave lower scores.

When I first got into informatics, I worked on projects that involved preventable harms and straightforward, evidence-based medicine. The data often helped identify situations where a change in behavior could improve patient outcomes and where the interventions needed were clear. Those were my bread and butter, and I have to admit I feel completely unprepared to deal with the kind of data that is now in front of me. It’s not just the data in our system that I have to address with our providers, but the public-facing reviews. When potential patients see the low scores and negative reviews for today on Yelp, they’re not going to know that it was in the context of a major ice storm and below-zero temperatures.

Patient engagement is supposed to be a good thing, but sometimes it’s a double-edged sword. There’s enough to learn in medical school and residency already, and adding the need to learn how to manage social media and online patient reviews is something that feels foreign to many clinicians. Add the stresses of managing EHRs that can be less than cooperative, the usual staffing and office dramas, insurance headaches, and more, and you have a recipe for burnout.

I’ve been keeping my eyes peeled for continuing education courses or informatics presentations that discuss dealing with this situation. I know that good rapport with the patient along with empathy, discussing the situation, etc. can help avoid low patient satisfaction scores when we err on the side of clinical quality. But in the pressure cooker of most care delivery organizations, those discussions can be hard to execute.

I’m hoping some of my CMIO and CMO readers will have some suggestions because I’m somewhat at a loss here. I know I’ve written about this before, but it is definitely weighing heavier on me after this weekend. Although being at the forefront of a new specialty’s growth can be exciting, it’s sometimes maddening especially when you’re not connected to an academic center. As clinicians, we’re focused on getting to the root cause and trying to fix things. When we don’t have the answers, we tend to dig in and keep investigating until we find them, or at least something we can test drive.

How do you react to low or decreasing patient satisfaction scores, especially around events out of your control? Email me.

Email Dr. Jayne.

Rethinking the Role of Retail Clinics

December 19, 2016 News 3 Comments

HIStalk takes a deeper dive into a recent study that found retail clinics have a negligible impact on nearby ED admissions.
By
@JennHIStalk

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Retail clinics have gotten a bad rap lately, thanks to an Annals of Emergency Medicine-published study that found the clinics had a less-than-hoped-for impact on local ED visits. While that particular statistical nugget certainly made for good headlines, a deeper dive into the research finds that such clinics may well be on their way to not only alleviating low-acuity ED visits, but to finally becoming a trusted part of the care continuum.

Evolution of a Business Model

Since debuting in 2001, retail clinics seem to have grown exponentially, taking up valuable real estate in strip malls, pharmacies, shopping malls, and even the local commuter train station. Accenture predicts that their numbers will close in on 3,000 within the next several months – a 46 percent increase over 2014 figures. Patients – primarily those with private insurance – have become accustomed to their convenient hours, accessibility, and increasingly transparent pricing.

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Health systems have certainly jumped on the retail clinic bandwagon for a variety of reasons. “Hospitals and health systems are employing a variety of strategies to reduce the use of emergency department and hospital readmissions,” says Nancy Foster, AHA’s vice president of quality and patient safety policy. “One such strategy is partnering with existing retail clinics or creating their own. This helps patients by giving them an additional access point for critical follow-up care after a hospitalization. And by having a formal partnership, the hospital or health system can more easily share follow-up instructions with clinical staff at the retail clinics.”

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Mount Sinai Health System (NY) is one such health system that has recognized the need to offer additional access points as part of broader population health programs. The system, which has seven hospitals and over 140 physician practices, announced a partnership with urgent care company CityMD earlier this month, and seems intent on closing the loop between urgent care and primary and specialty care visits. The partners plan to jointly establish quality metrics for a shared network of preferred providers, ensuring that CityMD patients have immediate access to specialty care through Mount Sinai providers. They will also share EHRs for faster data access, though they haven’t gotten into specifics as to how their respective Epic and EClinicalWorks systems will talk to one another.

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Some clinics, like the new Westmount Place Walk-in Clinic in Ontario, are opening with the express intent of alleviating the local ED’s physician shortage. “We know we are in a crisis from an emergency room perspective if our hospital is fundraising for an emergency room resident,” explains local government official Catherine Fife. “Having urgent care centers like this, which are community based, is an important asset we need to have in more communities across the province.”

Rethinking the Results

Though the Westmount clinic’s provenance puts it outside the purview of the AEM study, it provides a concrete example of the potential role retail and urgent care clinics can play in a community’s care continuum, including significantly reducing ED visits.

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This potential did not show up in study results because, according to MinuteClinic President and CVS Health Executive Vice President and Associate Chief Medical Officer Andrew Sussman, MD, it looked at data from 2,053 EDs between 2007 and 2012 – a time when awareness and general usage of retail clinics was very early on.

“The results show statistically significant reductions in low-acuity ED use for commercially insured patients in communities where retail clinics were open,” he explains. “While the reduction may be small (1.2 percent), you should keep in mind that the old data evaluated in this study had only 1,200 clinics at its peak. MinuteClinic alone has 1,100 clinics today across 33 states. The effect of retail clinics today is far greater than the early phase of their development in this study.”

“The study also doesn’t take into account the presence of any urgent care clinic sites in a particular area,” he adds. “There are far more urgent care sites, around 9,000, than retail clinics in the US overall. Urgent care has been growing at about 8 percent annually, compounding their effect. Without knowing the precise location of the large number of urgent care sites, it is impossible to interpret the trends of low-acuity care seen in EDs.”

From Concept to Cost-Savings

Sussman goes on to point out that the study’s results should ultimately be viewed through the lens of today’s healthcare ecosystem rather than that of five years ago, when “coordinated care” was still in its infancy and “value-based care” was a concept confined to a cocktail napkin. “We have far more clinics, much higher levels of utilization, and higher awareness of retail clinic services,” he says. “Also, transparent retail clinic pricing is particularly attractive to today’s growing number of Americans with high-deductible health plans, not present prior to 2012, and as consumerism in healthcare grows. In addition to private insurance, today more retail clinics accept Medicaid than they did during the study period.”

Sussman brings up a good point: Retail clinics, which traditionally have opened in suburban communities with higher-income, privately-insured consumers, are seeing reimbursement opportunities increase thanks to Medicaid expansion. Couple that with the burgeoning interest of health systems – especially where shared referral networks and healthcare technology are concerned – and you have a recipe for retail clinic success when it comes to significantly impacting ED visits and even hospital readmissions.

Sussman sums up by saying, “in today’s retail clinic world, we would expect to see even more significant reductions in ED low-acuity visits due to retail clinic presence. Many millions of patients appreciate the access to care and cost savings that retail clinics provide.”

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