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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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Morning Headlines 1/20/17

January 19, 2017 Headlines No Comments

Tim Draper keeps defending Theranos

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

The Final Days of Obama’s Tech Surge

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

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

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

HIMSS Media Lab is Launched to Lift Audience Engagement and Revenue

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

News 1/20/17

January 19, 2017 News 4 Comments

Top News

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

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

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


Reader Comments

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


HIStalk Announcements and Requests

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

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

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


Webinars

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

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


Acquisitions, Funding, Business, and Stock

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

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

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


Sales

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

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


People

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

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

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


Announcements and Implementations

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


Government and Politics

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

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

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

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

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

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

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


Privacy and Security

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

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


Innovation and Research

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


Other

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

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

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

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

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

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

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


Sponsor Updates

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

Blog Posts


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EPtalk by Dr. Jayne 1/19/17

January 19, 2017 Dr. Jayne No Comments

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

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

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

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

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

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

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

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

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

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

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

What do you think of Forward? Email me.

Email Dr. Jayne.

Morning Headlines 1/19/17

January 19, 2017 Headlines No Comments

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

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

Using the Electronic Health Record to Understand and Minimize Overuse

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

Theranos just made another major leadership change

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

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

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

CIO Unplugged 1/18/17

January 18, 2017 Ed Marx 2 Comments

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

Baking with Oma

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

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

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

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

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

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

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

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

Lessons learned baking with Oma:

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

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

Cookie, please.

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

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

January 18, 2017 Readers Write 7 Comments

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

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

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

MIPS

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

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

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Alternative Payment Models Incentive Program

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

Moving Forward

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

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

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

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

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

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

Morning Headlines 1/18/17

January 17, 2017 Headlines No Comments

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

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

Second Theranos Lab Failed U.S. Inspection

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

Introducing IMEDS, a Public-Private Resource for Evidence Generation

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

The Heroism of Incremental Care

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

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

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

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