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Readers Write: Don’t Get Stuck in the Readmissions Penalty Box

November 9, 2016 Readers Write No Comments

Don’t Get Stuck in the Readmissions Penalty Box
By Lisa Lyons

The Hospital Readmissions Reduction Program (HRRP) requires the Centers for Medicare and Medicaid Services (CMS) to reduce payments to inpatient hospitals with relatively high 30-day readmission rates. CMS applies up to a three percent reduction for “excess” readmissions using a risk-adjusted ratio that compares a hospital’s performance to the national average for sets of patients with specified conditions.

Payment adjustments for FY 2017 (based on performance from July 2012 through June 2015) will be applied to all Medicare discharges starting October 1 of this year and running through September 30, 2017. Payment reductions for FY 2017 will be posted on the Hospital Compare website this October.

Total HRRP penalties are expected to reach $528 million for FY 2017, up sharply from about $420 million in FY 2016, with more than half of the nation’s hospitals affected, according to a Kaiser Health News analysis. The average penalty will spike in similar fashion, from 0.61 percent in FY 2016 to 0.73 in FY 2017.

The situation calls for a thorough understanding of the readmissions penalty environment and a strategic mindset for taking action.

Prior to FY 2017, CMS measured excess readmissions by dividing a hospital’s number of “expected” 30-day readmissions for heart attack, heart failure, pneumonia, hip/knee replacement, and COPD by the number that would be expected, based on an average hospital with similar patients.

For FY 2017, CMS expanded the list of cohorts to include coronary artery bypass graft (CABG) procedures. The agency also added to the existing pneumonia cohort: the assignment criterion now includes cases where the principal diagnosis of non-severe sepsis includes secondary diagnosis of pneumonia and aspiration pneumonia. This creates a bigger set of patients from which a hospital could have readmissions — in fact, it may expand the pneumonia cohort by 50 percent in many hospitals.

Complicating matters, excess readmissions found in any of the six cohorts will result in an overall penalty. A hospital gets no credit for making readmissions improvements along the way.

At the same time, all hospitals are working on readmissions, so the average of excess readmissions is decreasing. That means it’s harder than ever for hospitals to stay under the penalty bar.

Also, due to HRRP’s reporting cycle, an excess readmission stays in CMS’s data for three years.

These factors make it hard for hospitals to know if they have passed the tipping point for readmissions penalties before notification from CMS — which typically happens just four months prior to penalties being imposed. In practical terms, there’s not enough time to impact results.

Further, analyzing CMS data is challenging for most hospitals because:

  • CMS data is retrospective. CMS calculates fiscal year penalties by looking back at data over a range of two to five years. As such, current improvements to readmission reduction programs will not be seen right away.
  • CMS data includes readmissions from “non-same” hospitals. Most hospitals can’t view cases where a patient initially admitted to their facility ended up being readmitted in another facility.
  • CMS data only includes readmissions among the Medicare patient population. Many commercial payers have instituted pay-for-performance programs, which should also be analyzed. Limiting your view to the Medicare HRRP program will only reveal part of your overall readmissions.
  • CMS’s Measure Methodology for Readmissions can’t be easily replicated. CMS risk-adjusts each qualifying patient using Medicare Part A and Part B data for a full year prior to admission, and 30 days post-discharge. Since hospitals don’t have access to this information, they can’t replicate the methodology to calculate their excess readmissions.

Fortunately, with the right data, there’s a way to emulate the CMS methodology to help estimate the volume of excess readmissions that will be attributed to your hospital. You can do so well before receiving your hospital-specific reports from CMS.

Here are four ways advanced analytics can help position hospitals to be more proactive in managing their readmissions:

  1. Purchase de-identified Medicare Part A and B claims data from CMS. Advanced analytics makes it possible to match historic claims data with known patients in your hospital information systems. In this way you can see longitudinal care histories for the patients you are discharging today. Algorithms can also predict the rate of non-same hospitalization from current readmission data, effectively filling in the blanks on readmissions that occur outside your hospital. That may give you up to two years advance notice regarding which readmissions will be counted as excessive. With that knowledge, you can do something about readmissions before the end of the evaluation period.
  2. Know how many readmissions will put you in jeopardy of incurring penalties. This is the previously mentioned tipping point. Surprisingly, for many hospitals, only a few excess readmissions per month can send them to the penalty box. Predictive analytics identify patients at greatest risk for unplanned readmissions. Look for algorithms with a high degree of accuracy in matching the CMS dataset to your own database to single out cases that were identified in the assignment criteria. Once you’re able to identify trends, you can fix the issues.
  3. Since CMS measures readmission back to any hospital, partner with other hospitals in your region to which you commonly refer patients back and forth. Concentrate on areas of improvement in either coordination or quality of care.
  4. Analyze clinical conditions across the board among your hospital’s patient population, not just within the six CMS-defined cohorts. Taking a broader view establishes more effective data patterning to help determine if a systemic problem exists. Dashboards and pre-formatted reports signal where to drill down for more detail (for example, whether you discharged the patient to home or a different care setting).

Government policy statements clearly indicate Medicare payments becoming more heavily weighted on quality or value measures, and HRRP will be part of that determination.

What’s more, CMS has proposed that the readmission measure itself be expanded to count excess days associated with readmissions — taking into account ED patients and those assigned to observation status — rather than singular readmission events for inpatients. Expect increased involvement of care management and quality teams in this area, and another layer of potential penalties.

Don’t wait to react to how these measures will impact your hospital’s operations and finances. Now’s the time to implement data analytics tools to intelligently manage your hospital’s readmission risk with a high degree of accuracy.

Lisa Lyons is director of advanced analytics and population health and interim VP of consulting at Xerox.

Morning Headlines 11/9/16

November 8, 2016 Headlines No Comments

Healthcare company laying off 60 workers in Charlotte

McKesson lays off 60 Charlotte, NC-based employees from its Enterprise Information Solutions (Paragon) business.

Knowing When and How to Use Medical Products

CMS Acting Administrator Andy Slavitt co-authors a JAMA article with two senior FDA officials calling for more diverse clinical trial populations and an increased use of data from EHRs, claims, and registries to support the decision to approve and pay for new drugs.

Walgreen Sues Theranos, Seeks $140 Million in Damages

Once a key strategic customer, Walgreens sues Theranos for breach of contract, seeking $140 million in damages, equal to the amount it invested in the startup.

Adelaide hospitals hampered by nine-hour system outage

In Australia, three major hospitals report that a nine hour network outage prevented clinicians from accessing its Allscripts EHR.

News 11/9/16

November 8, 2016 News 2 Comments

Top News

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The Charlotte, NC paper confirms the reader rumors I ran on October 28 that McKesson has laid off 60 employees in its Enterprise Information Solutions (Paragon) business.


Reader Comments

From Look Now: “Re: Shriners Hospitals for Children. Signed a contract with Cerner to implement their EDW solution HealtheIntent across their 21 hospitals live on Millenium. Project started this week.” Unverified.


Webinars

November 9 (Wednesday) 1:00 ET. “How to Create Healthcare Apps That Get Used and Maybe Even Loved.” Sponsored by MedData. Presenter: Jeff Harper, founder and CEO, Duet Health. Patients, clinicians, and hospital employees are also consumers who manage many aspects of their non-medical lives on their mobile devices. Don’t crush their high technology expectations with poorly designed, seldom used apps that tarnish your carefully protected image. Your app represents your brand and carries high expectations on both sides. This webinar will describe how to build a mobile healthcare app that puts the user first, meets their needs (which are often different from their wants), creates “stickiness,” and delivers the expected benefits to everyone involved.

Contact Lorre for webinar services. View previous webinars on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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NantHealth reports Q3 results: revenue up 76 percent, EPS –$0.30 vs. –$0.24, beating earnings expectations but falling short on revenue.

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Siemens Healthineers acquires Conworx Technology, a Berlin-based developer of point-of-care testing device interfaces.

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Clinical communication platform vendor Doc Halo opens its new corporate headquarters in Cincinnati, OH, committing to adding 65 positions in the next few months.

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Silicon Prairie News profiles Kearney, NE-based provider management software vendor Phynd, which chose that location because its software developer Expanxion is located there.

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Walgreens files a $140 million lawsuit against Theranos, claiming that the lab company violated confidentiality agreements about their partnership to offer lab testing in Walgreens drugstores in Arizona. Theranos responded by saying that Walgreens mishandled the partnership and says it will “hold Walgreens responsible to the damage it has caused to Theranos and its investors.”


Sales

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Grand River Hospital (Ontario) selects Wellsoft’s EDIS.


People

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Ann Mendlowitz (Leidos Health Consulting) joins Orchestrate Healthcare as VP of EMR consulting services.

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Telehealth technology vendor Zipnosis hires Scott Brown (Ulfbehrt Software Systems) as CTO.


Announcements and Implementations

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ECRI lists its “Top 10 Health Technology Hazards for 2017:

  1. IV pump errors (hardware failure, staff overriding safety features, and nurse programming mistakes).
  2. Improper cleaning of reusable instruments.
  3. Missed ventilator alarms due to alarm fatigue or notification failures.
  4. Undetected opioid-induced respiratory depression.
  5. Infection risks from cardiothoracic surgery heater-cooler systems.
  6. Software management gaps.
  7. Radiation exposure to clinicians working in operating suites that have built-in imaging systems.
  8. Automated medication dispensing cabinet setup and use errors.
  9. Surgical stapler misuse and malfunction.
  10. Device failures caused by cleaning products and practices.

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Burke Mamlin, MD and Paul Biondich, MD of Regenstrief Institute will receive AMIA’s Donald A.B. Lindberg Award for Innovation in Informatics this week for their work in developing and using open source software in developing countries.

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New York – Presbyterian adds video visit services to its app, offering virtual visits and the ability to ask an ED physician about minor illnesses that may or may not require an in-person ED visit.


Government and Politics

ONC publishes its annual report to Congress.

A JAMA opinion piece by two top FDA officials and CMS Acting Administrator Andy Slavitt says FDA and CMS are coordinating FDA’s approval of drugs with CMS’s decision to pay for them. They urge that clinical trials include diverse populations; that healthcare delivery data from EHRs, claims, and registries be used to reduce the cost of generating evidence and to study more representative populations, and that public-private collaboration groups such as PCORI lead efforts to integrate broader evidence generation into practice.

In New Zealand, the Ministry of Health hires an Accenture-led consortium to help it create a business case for a national EHR.


Privacy and Security

Madison County, IN officials will pay the ransom demanded by an unknown hacker when their systems are taken offline by ransomware. The county’s insurance company recommended payment and will cover part of the cost. Some county offices went back to paper, while others closed due to lack of computer access.


Other

A New York Times article questions whether the US really has a doctor shortage despite low numbers of practicing physicians and medical school slots. Instead, it says, we have a distribution problem in which doctors prefer to live in big cities (often where they trained and are paid more by Medicare for practicing there) and we have too many specialists as high medical school debt steers new graduates into more lucrative areas of practice. The article offers solutions: (a) train more doctors or allow more to immigrate; (b) decrease the number of specialty residency positions and pay primary care doctors more; (c) improve the efficiency of the healthcare system, changing regulations and licensing to use more mid-level practitioners. 

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Ram Raju, MD, CEO of the financially hemorrhaging New York Health and Hospitals, will resign.

The annual physician compensation survey of ECG Management Consultants finds that the income of PCPs and specialists increased by 1.5 percent and 3.6 percent, respectively, in the past year. Most respondents say their compensation models will incorporate value-based metrics such as quality, patient satisfaction, panel size, and adherence to evidence-based medicine.

In Australia, the first three sites to go live on the Allscripts-powered EPAS system go down for nine hours when a software module “consumed the bulk of all the computer resources.”


Sponsor Updates

  • Aprima will exhibit at the Practice Management Institute November 9-11 in Las Vegas.
  • Catalyze CEO Travis Good will present at Voalte’s VUE16 user conference November 9-11 in Sarasota, FL.
  • Medicomp Systems recaps its annual training event that was held October 3-7 in Bangkok, Thailand.
  • Besler Consulting releases a new podcast, “The relationship between EMR and physician documentation.”
  • CoverMyMeds COO Michelle Brown will speak at the BioOhio Women in Bioscience Conference November 9 in Columbus.
  • Visage Imaging will demonstrate its Visage 7 Enterprise Imaging Platform at RSNA later this month.
  • Wolters Kluwer redesigns its UpToDate online clinical decision support website to give clinicians who can’t use the company’s app a robust, Web-based alternative.
  • Impact Advisors VP Jenny McCaskey is named is named to “Women Leaders in Consulting.”
  • Crossings Healthcare Solutions will exhibit at Cerner Health Conference 2016 November 14-17 in Kansas City, MO.
  • Cumberland Consulting Group’s Lori Nobles will present at the NCHIMA Mid-Year Workshop November 11 in Concord, NC.
  • The success of National Decision Support Company CareSelect Imaging users will be highlighted at Cerner Health Conference 2016 November 14-16 in Kansas City, MO.
  • Direct Consulting Associates and HealthCast Solutions will exhibit at the HIMSS Midwest Fall Conference November 13-15 in Bloomington, MN.
  • Dimensional Insight and Extension Healthcare will exhibit at the HIMSS South Florida InteGrate Conference November 14-15 in Davie, FL.
  • EClinicalWorks will exhibit at the Kentucky Primary Care Association 2016 Conference November 9-11 in Lexington.
  • Impact Advisors publishes a white paper titled “The MACRA Final Rule: Key Takeaways on MIPS and Advanced APMs.”
  • Healthwise’s Leslie Hall will present at Partnering for Cures November 13-16 in New York City.

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 11/8/16

November 7, 2016 Headlines No Comments

2016 Report To Congress on Health IT Progress

ONC submits its HITECH-mandated annual report to Congress. The report predictably focuses on the current state of interoperability and the path to improvement.

HealthCare.gov Site Straining to Keep Up With Enrollees

Since the November 1 start of the 2016/2017 enrollment period, HealthCare.gov has been using virtual waiting rooms to temporarily hold end users during peak enrollment periods so that the site does not crash under the increase in traffic.

Head of NYC’s cash-bleeding public hospital system to step down

NYC Health & Hospitals president Ram Raju, MD will retire at the end of this month, and will be temporarily replaced by Stanley Brezenoff, who ran New York’s health system in the 1980s, until a permanent replacement is named.

Dangerous Infusion Errors Top ECRI Institute’s Annual Health Technology Hazards List

ECRI Institute publishes a list of the top 10 health tech hazards for 2017.

Curbside Consult with Dr. Jayne 11/7/16

November 7, 2016 Dr. Jayne 2 Comments

One of the key tenets of the shift towards value-based care is the idea that physicians are increasingly graded on patient outcomes. Not surprisingly, this grates on many physicians.

There are complex issues involved when trying to get a patient to change behavior, even when it’s a relatively straightforward recommendation such as taking a medication. Conventional wisdom and multiple studies have demonstrated that close to half of all prescriptions aren’t taken as directed and many are never even filled. There are many factors involved: cost, convenience, commitment, side effects, etc. Additional factors related to specific patient populations may also include transportation, safety, health literacy, cultural barriers to care, and more.

When a significant lifestyle change is recommended, the factors involved become exponentially more complex. We live in a society that focuses on instant gratification. Health-related lifestyle changes typically challenge that paradigm and require ongoing hard work that results in slow change that can sometimes feel imperceptible. People want quick wins. Any clinician who has tried to discuss the pros and cons of moderation in diet and increased exercise vs. various celebrity-endorsed weight loss programs knows what I’m talking about. Patients see the claims of a dropping significant weight in a short time period and find the contrast of a slow, sustainable loss of a pound a week to be off-putting.

Other lifestyle changes are impacted by socioeconomic factors, including food insecurity, variable availability of healthy grocery options in the urban core, joblessness, homelessness, abuse, and more. Although physicians can refer patients to community supports and programs (assuming that the programs exist in your area and can maintain their funding in the face of increased need), there are limits to what we can do. That is where the idea of being graded on patient wellness starts to feel unwelcome.

Once you’ve considered the logistical issues involved in a change in patient health status, you have to contemplate the ethical ones. Autonomy and personal freedom are major issues in America today. Governments from the national level to the local level are trying to address issues such as the consumption of high-calorie drinks and the inclusion of unhealthy ingredients in foods. I still miss the trans-fat in my Oreo cookies, but I understand why it’s no longer there. But when you try to convince a patient to make a change, things can often get challenging.

Physicians are at the front line of trying to drive outcomes, but often our advice is often challenged. When I recommend diet and exercise for weight loss, patients want a pill. When I recommend a pill for high blood pressure because diet and exercise failed, I’m accused of being in the pockets of the drug companies. Even though 95 percent of the prescriptions I write are for generic drugs and many of those are on the $4 list at the local supermarket, it’s assumed that we’re getting kickbacks and are part of the healthcare cost problem.

Physicians have long been in a position of paternalism, although that is changing with the focus on patient-centered care. Still, there are patients who want to choose their treatments based on what I would do for myself or a family members. They don’t want to be part of their own decision-making, they just want to be told what to do.

But the next room you enter might have a patient and their entire extended family, all of whom have been all over the Internet researching treatment options, and want to discuss each one of them independently. It certainly makes one feel scattered when trying to see patients as well as a bit fragmented when you have to shift back and forth between two completely different frames of mind. Not to mention that it’s difficult to get payers to compensate physicians for the time spent in those conversations, and patients aren’t eager to pay for it out of pocket.

Then, there’s the principle of beneficence. By pushing patients to comply, are we still doing right by the patient? Where is the boundary between trying to engage your patient to take charge of their health and being pushy? At what point do you agree to disagree on the colonoscopy order the patient is never going to complete? I’m on the hook for the patient’s performance regardless of whether they go or not and regardless of how many times I’ve tried to get them to go or how persuasive my arguments might be.

Under the new healthcare payment schemes, our incomes are directly tied to our ability to motivate our patients to do what we recommend. A recent study may shed some light on which approaches are more productive in moving patients towards change. It confirmed the results of a previous study that identified potentially effective strategies for supporting patient self-management:

  • Emphasizing patient ownership
  • Partnering with patients
  • Identifying small steps toward change
  • Scheduling frequent follow-ups
  • Showing care and concern

Researchers created a scale to measure where primary care clinicians stand and found that performance on the scale was associated with patient efforts. I found it interesting that they only looked at primary care physicians. Although everyone assumes we’re “most responsible” when trying to attribute certain elements of care, it really does take the proverbial village to care for patients. The study found that primary care providers who spent more than 60 percent of their time “counseling, educating, and coaching” their patients scored higher than those who spent less time in those activities. For most of us, being able to spend that portion of the visit motivating our patients would be a luxury.

I also found it interesting that some of the strategies they cite are challenging under new reimbursement schemes. Frequent follow-ups aren’t going to happen for patients on high-deductible health plans. The usual response to that concern is telemedicine, but most payers still don’t cover it. That translates to unreimbursed physician work, which is less likely to happen than actually reimbursed work.

Even something that seems relatively simple such as showing care and concern is increasingly difficult under payment reforms and technology incentive programs. Many physicians are stressed to the breaking point. Scarcity of primary care physicians in traditional continuity practice makes for long waits and short visits. When you have to spend time trying to hit as many metrics as possible in as little time as possible, it doesn’t make it very easy to get to know your patient. Adding the stress of technology issues doesn’t help.

Another factor that doesn’t help is the assumption that patient engagement is a software problem. The reality is that patient portals and online interactive education are just part of the toolkit, but it takes time to help physicians learn how to best use those tools, how to best encourage their patients to use them, and how to put processes and policies in place in their offices so that their use doesn’t increase the burden of physician work.

I’ve done formal training in motivational interviewing and healthcare coaching and know that physicians struggle with finding the time away from their practices to get that kind of training. Some of my rural colleagues have difficulty getting coverage for even a few days out of office. Regardless, having those as options for practice improvement activities under some of the regulatory requirements might have been additional motivation to move clinicians in that direction.

What are your plans for greater patient engagement? Email me.

Email Dr. Jayne.

Morning Headlines 11/7/16

November 6, 2016 Headlines No Comments

Grant Aims to Boost Health IT Safety Initiative

ECRI Institute lands a $3 million grant to fund a 3-year project aimed at improving the design, implementation, and use of EHR and other health IT products.

Data Analytics in Healthcare | 2016

A Peer60 report finds that 90 percent of health systems have a data analytics strategy in place, but that 22 percent rely on a homegrown solution, and another 43 percent use multiple analytics vendors to cobble together actionable intelligence.

Tracker flags up failures to report clinical trials

Researchers create an automated tool that identifies organizations that withhold clinical trial results by comparing completed clinical trials listed in ClinicalTrials.gov with reports in PubMed and then calculating what percent of an organization’s trials have no published results. Sanofi was found to be missing results from 65 percent of their trials, while Mayo Clinic is missing 50 percent of its results.

Remarks by Andy Slavitt: The Need to Partner on Drug Innovation, Access and Cost

In a speech given at a pharma conference, CMS Acting Administrator Andy Slavitt warns that significant drug price increases has become the healthcare issues Americans most want action taken on, noting that in the next few years “these costs will put unsustainable pressure on the Medicare program and action is going to be necessary to address them.”

Monday Morning Update 11/7/16

November 6, 2016 News 2 Comments

Top News

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The Gordon and Betty Moore Foundation awards the non-profit ECRI Institute and its Partnership for Health IT Patient Safety a $3 million, three-year grant to study ways to optimize EHRs while avoiding patient harm.

The foundation said in the announcement, “With the increasing presence of health IT in all aspects of health care, we need to remain mindful of safety issues that are unintended consequences of this new technology. We are happy to see the Partnership advising health IT developers, users, and policymakers on how to optimize technology and avoid patient harm.”

The Partnership previously analyzed patient safety incidents that were reported to ECRI’s patient safety organization and issued recommendations for using copy-and-paste in EHRs. Its advisory panel includes experts such as David Bates, MD, MSc; Peter Pronovost, MD, PhD; Hardeep Singh, MD, PhD; Dean Sittig, PhD; and Paul Tang, MD, MS.


HIStalk Announcements and Requests

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Only 20 percent of poll respondents think FHIR will have a lot of impact on interoperability. Cosmos, who works for an EHR vendor, says APIs are like wall sockets in that you can plug in anything and it just works even if you don’t know anything about electricity, with the potential that FHIR can power a new generation of plug-and-play connected health tools. Mobile Man says interoperability has never been a technology problem and ManAboutTown agrees that interoperability will occur only as healthcare’s business models change. Furydelobongo suspects he or she won’t live long enough to see true interoperability where information flows to the point an entry in System A shows up in System B as though it were natively entered there, opining that a unified view isn’t enough. HIT Geek provided a thoughtful response:

FHIR is an API specification. It does not specify how data gets to the API, nor what happens after a corresponding API receives it. Being stateless, it does not support a workflow with state transitions, nor coordination of multiple related actors. The data vocabularies referenced in FHIR, such as clinical code sets, are not controlled within the FHIR standard. The underlying RESTful transport specifications for FHIR are also not controlled within FHIR. The corresponding EMRs, IHRs, and PHRs are outside of the standard, And it says nothing about the end-user interfaces needed to create, read, and update data. The policies and regulations envelope for FHIR is a political and organizational crazy quilt, inhibiting interoperability even if FHIR supports it. Similar things could be said about HL7 v2 and v3, including CDA. While FHIR promises to resolve some technical issues, and that’s certainly a necessary piece of the puzzle, we still have a lot else to do. The referenced and supporting standards for FHIR are relatively easy to coordinate, but will require ongoing effort. FHIR itself will need to evolve to incorporate changes in health care data, also with ongoing effort. Permanent sources of funding for the work, and willing participants, are needed. Volunteerism needs to be obtained from a wider set of sources and disciplines, including patients. Dealing the crazy quilt is the most difficult problem. It’s a whack-a-mole with more moles than whackers.

New poll to your right or here: how well managed did the medical practice where you most recently seen appear to be? Dr. Jayne loves hearing first-person stories, so click Comments after voting and describe what you experienced. 

Jenn is working on a story about telemedicine and would like to hear from doctors who have provided those services. Let me know if you have time for a quick chat (anonymously if you’d rather). We know what a video or telephone visit is like for a patient, but what’s involved on the other side?

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Thanks to Optimum Healthcare IT, Validic, and Healthwise for signing up as sponsors of HIStalkapalooza on Monday of HIMSS week. Contact Lorre to join them – I appreciate the help in covering the cost and we can accommodate most any budget.

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Mrs. W says her South Carolina fifth graders used the math games we providing in funding her DonorsChoose grant request to prepare for state testing, adding, “This was by far the most fun and pumped up math review that I have ever been able to lead thanks to your generous donation … Every day they would ask as they walked into class if we were going to get to play the math games that we received thanks to our donor on DonorsChoose.”

Thanks to the following sponsors, new and renewing, that recently supported HIStalk, HIStalk Practice, and HIStalk Connect. Click a logo for more information.

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Listening: new from Deap Vally, all-female grunge that sounds sort of like Janis Joplin covering Black Sabbath in Courtney Love’s basement. Also: new from Nick Cave & The Bad Seeds.  


Last Week’s Most Interesting News

  • McKesson, Allscripts, and Cerner post disappointing quarterly results.
  • NTT Data completes its acquisition of Dell Services.
  • CMS publishes changes to the EHR Incentive Program that will allow returning participants to use a 90-day reporting period.
  • Athenahealth lays off nearly 150 employees.
  • A hospital in Canada pays doctors extra to keep using its Cerner system after they voice patient safety and productivity concerns.
  • CompuGroup Medical announces its interest in acquiring Agfa.

Webinars

November 8 (Tuesday) 1:00 ET. “A CMIO’s Perspective on the Successful 25 Hospital Rollout of Electronic Physician Documentation.” Sponsored by Crossings Healthcare. Presenter: Ori Lotan, MD, CMIO, Universal Health Services. UHS rolled out Cerner Millennium’s electronic physician documentation to its 6,000 active medical staff members — 95 percent of them independent practitioners who also work in competitor facilities — across 25 acute care hospitals. UHS’s clinical informatics team used Cerner’s MPage development toolkit to improve the usability, efficiency, communications capability, and quality metric performance of Dynamic Documentation, embedding clinical decision support and also using Nuance’s cloud-based speech recognition product for the narrative bookends of physician notes. This CMIO-led webinar will describe how UHS achieved 70 percent voluntary physician adoption within one month of go-live, saved $3 million in annual transcription expense, and raised EHR satisfaction to 75 percent. It will include a short demonstration of the software that UHS developed to optimize the physician experience.

November 9 (Wednesday) 1:00 ET. “How to Create Healthcare Apps That Get Used and Maybe Even Loved.” Sponsored by MedData. Presenter: Jeff Harper, founder and CEO, Duet Health. Patients, clinicians, and hospital employees are also consumers who manage many aspects of their non-medical lives on their mobile devices. Don’t crush their high technology expectations with poorly designed, seldom used apps that tarnish your carefully protected image. Your app represents your brand and carries high expectations on both sides. This webinar will describe how to build a mobile healthcare app that puts the user first, meets their needs (which are often different from their wants), creates “stickiness,” and delivers the expected benefits to everyone involved.

Contact Lorre for webinar services. View previous webinars on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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From the Allscripts earnings call:

  • Sales dropped off unexpectedly as clients held off purchases and upgrades in waiting for CMS to publish its final MACRA rule, although the company does not expect MACRA itself to drive incremental software sales.
  • Netsmart’s bookings were down from the previous quarter, which the company attributes to seasonality and deal delays.
  • RCM services bookings were up 90 percent quarter over quarter.
  • The company sees big opportunity in selling RCM services to its ambulatory EHR customers.

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Meal planning app vendor Zipongo raises $18 million in a Series B funding round, increasing its total to $28 million. The founder and CEO is Jason Langheier, MD, MPH.

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Leidos posts Q3 results: revenue up 44 percent, adjusted EPS $1.25 vs. $0.74, beating earnings expectations but falling short on revenue. Chairman and CEO Roger Krone mentioned the DoD’s MHS Genesis project in explaining that it will contribute lower revenue next year:

I want to make sure that you understand what we said is that relative to revenue, we don’t see the program being delayed. What we’re doing is we’re actually maturing some of the software, we’re conducting some more tests, we’re doing some cyber scans. And so the installation at the first facility will be a few months later than we had anticipated, but the level of activity is essentially the same. And the entire program if you think about deployment to all of the facilities within the Department of Defense will essentially remain on track. So we’ll be a little bit later on the first couple facilities, but we expect to pick that back up as we go into the implementation phase.


Sales

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The Joint Commission chooses Clinical Architecture’s Symedical terminology management platform for semantic normalization, mapping, and value set creation.

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Get Real Health will use technology from Validic to add patient-generated health data to its patient engagement offerings.


Decisions

  • Missouri Delta Medical Center (MO() will replace Infor with Premier for supply chain management in March 2017.
  • UMass Memorial Medical Center (MA) is underway with a PACS change from Philips to Agfa.
  • Throckmorton County Hospital (TX) changed EHR and revenue cycle systems from CSS Health Technologies to CPSI Evident in January 2016.

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


People

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Lisa Stump is promoted to SVP/CIO of Yale New Haven Health System after holding the interim role since November 2015.


Government and Politics

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CMS Acting Administrator Andy Slavitt in a Friday speech to a pharma group expresses his candid opinion about drug prices:

You know, last year when I spoke here, the price increases at Turing were making news, and I told you I didn’t want this industry to be defined by its worst actors. I defended the industry then, but the more data that’s revealed, the more bad actors you find, and I’m telling you now: it’s too many … Drug costs have become the health policy issue Americans are most anxious to see us act on, and we have a responsibility to them to explore all the options available us to make their medications more affordable. I hear occasionally from some that life sciences needs to tell its “value story” better. Perhaps. But it also needs to do the math. If something is growing by 11 percent, unless it’s causing something else to decrease by 12 percent, it’s not going to last forever. The reality is that in the next few years these costs will put unsustainable pressure on the Medicare program and action is going to be necessary to address them.

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China-based laboratories are feeding America’s drug addiction by creating new designer opioids faster than the Drug Enforcement Administration can declare them illegal, allowing addicts to buy them semi-legally and inexpensively over the Internet without seeking out street dealers. Several hundred people have died from known popular drugs like U-47700 and various forms of fentanyl. The labs get their recipes from old drug company research papers that describe painkillers that were never marketed. Ironically, U-47700 was studied by drug company Upjohn as a less-addictive painkiller but was never developed because it had the same addictive properties and side effects as other opioids, exactly what the copycat chemists want.


Privacy and Security

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In England, Papworth Hospital describes its near-miss with ransomware infection after an employee clicks on a malicious email link, allowing the malware to spread via file shares. The ransomware started encrypting the hospital’s files just after its midnight backup had completed, allowing it to quickly restore its systems from its fresh copy. The hospital changed to hourly incremental backups using tape since ransomware often encrypts backups digital backups along with everything else.


Technology

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I’m not sure I need to replace my old iPhone 5, but Wired magazine says the Google Pixel is the best smartphone on the market, giving the company perfect timing as Samsung goes up in smoke and Apple putters around with yawn-inducing iPhone tweaks. The Pixel comes with a “Quick Switch Adapter” for moving everything over, includes deep Google integration, charges for seven hours of use in just 15 minutes, offers Google Assistant that sounds smarter than Siri, and provides a best-in-class camera. I may have to check it out at Best Buy since AT&T isn’t selling it yet.


Other

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Medical device manufacturer Medtronic donates $5 million to the Patient Safety Movement Foundation to help the organization pool de-identified patient data collected from the devices sold by several companies to improve patient safety via predictive analytics.

MD Anderson Cancer Center will lose $450 million in FY2017 following a $267 million loss in FY2016, according to an internal report obtained by The Cancer Letter. The report blames four factors, starting with the cost of its Epic implementation.

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Coulee Medical Center (WA) cancels its Meditech upgrade when the project’s cost swells from the budgeted $1.3 million to at least $4 million. The 25-bed hospital says it didn’t understand the extra costs required for third-party software, with the CEO likening the project to buying “a car without an engine, brakes, or exhaust.” The hospital will keep its existing Meditech system even though it’s on the hook to pay licensing fees for the new system it won’t use.

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The local paper says the switch from Hitachi to EMC storage at Fairview Health Services (MN) has caused three crashes of Epic in the past year, the most recent lasting 10 hours.

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A new Peer60 reports finds that 90 percent of hospitals have an analytics strategy, but it ranges from a piecemeal approach with multiple vendors to homegrown systems to a single enterprise approach. The short-term replacement market for data visualization and enterprise analytics is significant, but consulting services and data warehouses have less short-term demand. Health Catalyst and Cerner are the strongest healthcare-specific vendors.

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A researcher develops a tool to identify which drug companies and universities aren’t publishing the results of their clinical trials, which it determined by matching the studies registered on ClinicalTrials.gov with results published there or in PubMed-covered journals.

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The US Marine Corps profiles use of its TMIP-MC battlefield EHR, recently testing during the DoD’s Global Medic joint patient movement and medical field training exercise at Fort McCoy, WI. Information from the training exercise will be used in designing its MHS Genesis replacement.

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Sutter Health notifies San Francisco area employers that it won’t offer in-network prices to their employees unless the companies sign an arbitration clause that waives their right to sue Sutter over pricing issues. Healthcare software vendor Castlight Health received one of the letters from its plan administrator Anthem (above) even through it is self-insured and has no direct relationship with Sutter. Castlight’s general counsel says Sutter is flexing its market dominance with prices that are 25 percent higher than those of other hospitals. Castlight hasn’t decided if it will sign the letter, but says declining to do so would allow it to “maintain our flexibility in fighting against what we consider to be difficult, anti-consumer provisions in provider networks.”

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Southampton Hospital (NY) bans political conversations in its cardiac rehab gym following an incident in which a treadmill-using patient was stuck between two people arguing over Trump versus Clinton for 15 minutes.


Sponsor Updates

  • Smart Business Magazine includes TeleTracking COO Diane Watson in its “Smart 50” list of executives.
  • TierPoint gains traction in new Gartner DRaaS report.
  • Valence Health will exhibit at the Children’s Hospital Association Annual Leadership Conference November 7-9 in Phoenix.
  • KLAS rates Voalte a top platform vendor for improved care team communication.
  • Huron Consulting Group representatives will present at the Children’s Hospital Association Annual Leadership Conference November 7-9 in Phoenix.

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 11/4/16

November 3, 2016 Headlines 3 Comments

Allscripts announces third quarter 2016 results

Allscripts reports Q3 results: revenue climbs 11 percent to $392 million, adjusted EPS $0.14 vs. $0.13, missing on both.

Cerner (CERN) Q3 2016 Results – Earnings Call Transcript

In its Q3 earnings call, Cerner CFO Marc Naughton explains that revenue and bookings came in below guidance because of lower than expected technology resale and software licensing sales, with technology resale revenue declining 21 percent and software licensing declining 12 percent.

University College London Hospitals set for Epic adventure

In England, University College London Hospitals NHS Foundation Trust selects Epic as its next EHR vendor.

HHS announces Phase 1 winners of the Move Health Data Forward Challenge

HHS selects ten teams as the winners of the first phase of its Move Health Data Forward Challenge, which asks developers to use APIs to help patients securely share their health data with providers, family members or other caregivers.

Inside Magic Leap, The Secretive $4.5 Billion Startup Changing Computing Forever

Forbes profiles Magic Leap, a secretive virtual reality startup that has raised $1.4 billion in investments from major firms, including Google, Andreessen Horowitz, and Kleiner Perkins.

News 11/4/16

November 3, 2016 News 5 Comments

Top News

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Allscripts posts Q3 results: revenue up 11 percent, adjusted EPS $0.14 vs. $0.13, missing analyst expectations for both. The company also issued disappointing earnings guidance.

Allscripts shares are down 17 percent in the past year and have dropped 44 percent in the past five years. The company’s market value is $2.16 billion.

Netsmart contributed $38 million in revenue for the quarter. Allscripts and a private equity firm acquired the behavioral EHR vendor in April 2016 for $950 million and merged it with the homecare software business of Allscripts with the expectation of generating $250 million in annual revenue and $60 million in annual profit, although the Allscripts ownership stake was not specified. Netsmart acquired LTPAC EHR vendor HealthMEDX on October 27, 2016 for $36.3 million in cash.

Allscripts competitor Cerner also posted disappointing results this week.


Reader Comments

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From JB:Re: data blocking. A Politico piece claims Epic and EClinicalWorks are impeding the sharing of data with public and specialty registries. It’s surprising that EMR suppliers aren’t going full-tilt toward open practices given regulatory pressures and pending VA procurement.” Epic says it has a problem with the for-profit companies behind medical association registries that also sell analytics software and apparently patient data. Epic and Practice Fusion say they will submit CCDs, but registry companies complain that CCDs don’t include all the information they need and a fully automated process would require EHR vendor customization. As is always the case, the patient is excluded from the vendor-vendor bickering even though the data in question (although not necessarily the benefit from its use) is theirs. The largely overlooked open.epic.com lists the public health registries to which Epic offers standard integration. There’s also the question of whether specific EHR vendors don’t allow submission of data at all (which is apparently sometimes true in Epic’s case) or simply charge EHR users extra to do so (like EClinicalWorks). Epic is the crown jewel since its refusal to participate means that large academic and government projects (including the FDA’s planned medical device monitoring program) are missing the information of the largest health systems. A point to note: correctly or not, I’ve never seen Cerner mentioned even once as a problem – it’s nearly always Epic and EClinicalWorks that come up, such as in the AMA’s proposed policies to be discussed in its upcoming meeting that call out those vendors specifically (see above).

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From David Watson: “Re: Memorial Health System in southeastern Ohio. We have deployed Meditech 6.15, including ambulatory, of which we are Meditech’s largest client. Physicians and staff alike have joined together with a small army of technology folks committing hundreds of hours to design, build, test, and validate a comprehensive solution. We appreciate their dedication to delivering a system that enhances MHS’s ability to provide exceptional patient care.” Congratulations to MHS and David, who joined the system in July after coming over from Duke.

From Chatty Kathy: “Re: online chats. I would like to see HIStalk provide scheduled ones for readers to share information.” I’m not a fan of Twitter for that purpose since it’s kind of kludgy, but perhaps other tools exist – YouTube and Facebook Live for video chats, GoToWebinar or conference calls for voice chats, and probably something other than Twitter for text chats. I’m skeptical at the level of demand for something like that since Twitter and Facebook seem to draw mostly people who aren’t decision-makers or influencers who just supportively stroke each other’s egos, but I’m open to ideas. My best one to use a moderated GoToWebinar session (one recognized speaker at a time) with the conversation transcribed afterward.


HIStalk Announcements and Requests

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I admit as a card-carrying curmudgeon that I don’t understand why people identify emotionally with sports teams as though they are more than just their paying customers (except maybe for the community-owned, non-profit Green Bay Packers). The most brilliant marketing strategy in history was to brand companies that hire athlete-entertainers with city names, which profitably confuses locals into mustering misplaced civic pride in saying “we won” instead of the accurate “they won while I watched” (I’ll skip my usual porn analogy). Still, Cubs fans seem pretty excited, so perhaps their lives are now complete and at least Facebook will become nearly tolerable again once the World Series and the election are over. I lost what little interest I had when I heard that Charlie Sheen wouldn’t be allowed to reprise his “Wild Thing” Rick Vaughn character to motivate the Indians, although apparently there were some Jobu sightings.

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I’m looking at tweets and streaming video as Robert Herjavec of “Shark Tank” (and founder of two IT security companies) presents at the CHIME Fall CIO Forum in Phoenix. He’s going to be a winner at HIMSS17, along with his co-star Kevin O’Leary. I watch “Shark Tank” only when traveling since as a cord-cutter I can’t get it, but those guys (and their fellow sharks) are insightful and entertaining. The recently released book by the “nice shark” gets pretty good reviews on Amazon, although the “look inside” preview shows mostly the wide-margin, collaborator-written chattiness that boosts page count without necessarily imparting additional wisdom. The CHIME tweets also make it obvious that, as is the case with HIMSS, vendors get a lot of influence, podium time, and questionably designated awards in return for their financial support. The CHIMErs were set to rock out (air quotes optional) Thursday night to Foreigner, featuring the band’s one remaining 71-year-old member from its late-1970s heyday. The best thing I can say about Foreigner is that at least they aren’t Journey.

This week on HIStalk Practice: AdvancedMD includes telemedicine capabilities in its new technology suite. Humana adds EliteHealth primary care practices to its Medicare network. Navicure’s Jeff Wood believes healthcare consumerism is finally taking off. Frederick Primary Care Associates joins Privia Medical Group. Manna Health Professional Services rebrands. MedStar National Rehabilitation Network selects WebPT tech. CMS figures out a way to pay PCPs for more time spent with patients and better coordinated care.


Webinars

November 8 (Tuesday) 1:00 ET. “A CMIO’s Perspective on the Successful 25 Hospital Rollout of Electronic Physician Documentation.” Sponsored by Crossings Healthcare. Presenter: Ori Lotan, MD, CMIO, Universal Health Services. UHS rolled out Cerner Millennium’s electronic physician documentation to its 6,000 active medical staff members — 95 percent of them independent practitioners who also work in competitor facilities — across 25 acute care hospitals. UHS’s clinical informatics team used Cerner’s MPage development toolkit to improve the usability, efficiency, communications capability, and quality metric performance of Dynamic Documentation, embedding clinical decision support and also using Nuance’s cloud-based speech recognition product for the narrative bookends of physician notes. This CMIO-led webinar will describe how UHS achieved 70 percent voluntary physician adoption within one month of go-live, saved $3 million in annual transcription expense, and raised EHR satisfaction to 75 percent. It will include a short demonstration of the software that UHS developed to optimize the physician experience.

November 9 (Wednesday) 1:00 ET. “How to Create Healthcare Apps That Get Used and Maybe Even Loved.” Sponsored by MedData. Presenter: Jeff Harper, founder and CEO, Duet Health. Patients, clinicians, and hospital employees are also consumers who manage many aspects of their non-medical lives on their mobile devices. Don’t crush their high technology expectations with poorly designed, seldom used apps that tarnish your carefully protected image. Your app represents your brand and carries high expectations on both sides. This webinar will describe how to build a mobile healthcare app that puts the user first, meets their needs (which are often different from their wants), creates “stickiness,” and delivers the expected benefits to everyone involved.

Contact Lorre for webinar services. View previous webinars on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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Recondo Technology raises $16 million in debt and capital funding to further develop API-enabled RCM, expanded claims statusing, and authorization automation.

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From the Cerner earnings call:

  • The company’s revenue shortfall was due to lower technology resale and software sales.
  • Cerner expects to spend $30 million on a Q4 voluntary separation plan, estimating that 2 percent of employees will be affected. The company advises that “this should not be viewed as a layoff or a sign that we don’t expect to grow.”
  • The company expects strong contributions from RCM and population health management technology, adding that HealthIntent mostly involves small contracts since most providers aren’t at risk for most of their populations.
  • Cerner says it earned a noteworthy ambulatory win in displacing Athenahealth for ambulatory EHR and business services at what the company believes is Athenahealth’s largest customer, also replacing Athena at two other sites.
  • The company blames lower software sales on the lack of MU-driven urgency among prospects, along with lower contributions from ITWorks and RevWorks.
  • Cerner believes its DoD project gives it a strong competitive advantage if and when the VA decides to replace VistA.
  • The company says its DoD revenue is steady but not significant, but completion of milestones in 2017 will add some modest-sized additional bookings.
  • Cerner says population health represents a “very little piece of bookings growth” and that those deals of $5 million and under don’t change the overall bookings number much.

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Tokyo, Japan-based NTT Data completes its $3.1 billion acquisition of Dell Services, renaming the business NTT Data Services. It was the former Perot Systems, acquired for $3.9 billion in 2009 by Dell, which apparently either overpaid or underperformed in bleeding off a large chunk of its value before offloading it to buy EMC.

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Analytics vendor Inovalon (known as MedAssurant until 2012 and acquirer of Avalere Health) reports Q3 results: revenue flat, adjusted EPS $0.10 vs. $0.09, beating revenue expectations but falling short on earnings. Shares rose sharply on the news, but are still down 24 percent in the past year.

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Israel-based equity crowd-funding organization OurCrowd launches a $50 million digital health fund with Johns Hopkins that will invest in early stage Israel-based companies. Accredited investors can invest as little as $10,000 in each company with pre-emptive rights to future fundraising.


Sales

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Inspira Health Network (NJ) chooses Cerner Millennium, HealtheIntent, and remote hosting, replacing the former Siemens Soarian.

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Penn State Health’s Hershey Medical Center (PA) will implement Cerner Millennium Revenue Cycle.

St. Claire Regional Medical Center (KY), Mary Rutan Hospital (OH), and Bella Vista Hospital (PR) will upgrade to Meditech’s Web EHR.

The DoD’s Dental Information Systems Center chooses the Dicom Systems Unifier Archive VNA.

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In England, University College London Hospitals NHS Foundation Trust chooses Epic to replace GE Healthcare Centricity, citing interoperability as a key factor going with Epic instead of Cerner.


Announcements and Implementations

Great Lakes Health Connect will offer researchers access to “remnant specimens” from lab tests by matching them with patients who match their requests and who have consented to make their de-identified information available.

Catalyze participates in the HITRUST CSF Inheritance Program that allows its customers to demonstrate their security measures without doing their own testing.

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Fortified Health Solutions renames itself to Fortified Health Security and launches new offerings of a virtual information security program, managed loss data prevention, and security event monitoring.

Telemedicine provider HealthTap announces an app developer platform that connects to telemedicine, health data exchange, CRM, and content. The company is also working on a blockchain product.

Mount Sinai Health System (NY) launches Rx Universe, a catalog of curated, evidence-proven mobile health apps that physicians can prescribe. The health system has launched a company, Responsive Health, that will license the app prescribing platform to other health systems.


Government and Politics

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I’m really going to miss Acting CMS Administrator Andy Slavitt when he leaves the job in January. His comment above came when he was asked  why the drug industry is the only group complaining about a national test of a YMCA diabetes prevention program. He also describes healthcare cost issues in Thursday remarks to the American Academy of Actuaries:

Transparency into costs is important in a world where more people are paying their own premium. Hospital profits in many cases are double or more what they were before the ACA. Drug costs are growing at record levels. And there are more endemic issues like the costs of untreated chronic diseases like diabetes or the large “tax” the fee-for-service system imposes on us when care isn’t coordinated or when bad quality is delivered. While people may not equate these costs or inefficiencies to the premiums they pay each month, we need to make those connections clear that this is where the real work needs to happen.

ONC names the 10 Phase 1 winners of its Move Health Data Forward Challenge, which calls for using APIs to enable consumers to share their information with providers and family members. I started to list the 10 and what they offer until I realized I had never heard of any of the companies and the products all sounded the same. Anyway, the 10 will be narrowed to five finalists in the next round and then one or two winners of the final phase.


Privacy and Security

From DataBreaches.net:

  • The city of El Paso, TX is scammed out of $3.3 million when officials pay a phishing hacker posing as a vendor.
  • In Canada, Winnipeg Regional Health Authority reports the latest of several incidents in which paper patient records were stolen from locked cars and offices.
  • Victims of Anthem’s 2015 data breach file a class action lawsuit seeking information on the Office of Personnel Management’s security audit, after which Anthem was rumored to have refused to perform the recommended security tests.
  • An employee of the New Zealand Nurses Organisation sends its 47,000-member database to a hacker whose spear phishing email was disguised to look as though it came from its CEO.

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A corporate lawyer sues a Miami, FL hospital for allowing its telemarketing company MedAssist to call his mother with recorded marketing messages every seven days following her hospital visit. MedAssist says its messages are informational and that the hospital’s patient waiver includes their consent to receive robocalls. The lawyer is seeking class action status.


Technology

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The New York Times covers end-of-life tech startups that are trying to bring technology into the tech-resistant “death care” industry. Investor-funded companies are offering TurboTax-like products for estate planning, online funeral home directories, post-death task automation for families, and online advance directives.

Forbes profiles Magic Leap, a secretive startup valued at $4.5 billion that is developing a next-generation computer interface, a head-mounted display that projects directly onto a user’s retina to create a mixed-reality environment. They’re targeting the consumer market, but possible healthcare uses are extensive (the founder earned a master’s in biomedical engineering). The video above – recorded directly from Magic Leap – shows the possibilities in perhaps showing a patient’s medical record while talking to them, reviewing surgical information in the OR, or reviewing medical literature while rounding.

An analysis finds that Microsoft’s IE and Edge browsers have lost 331 million users so far this year, dropping the company’s browser market share from 44 percent to 23 percent even though those products are bundled with Windows. Google’s Chrome jumped from 35 percent to 55 percent market share. Firefox users (including me) held steady at around 11 percent, while Apple’s Safari represented around 5 percent.


Other

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Facebook panders to drug companies with big advertising budgets in creating a new automatic scrolling for long lists of side effects, allowing drug companies to turn off comments on pages that promote their products to relieve them of their FDA responsibility to report any unverified side effects that patients might enter, and creating condition-specific community pages that drug companies can sponsor to promote their product. Facebook put together a team just to work with drug companies, explaining, “This was borne out of tons of interest we were getting from pharmaceutical advertisers to figure out Facebook.”

A South Florida woman complains that Boca Regional Regional Hospital charged her $7,000 for delivering her baby even though she gave birth in the hospital parking lot before she could get inside. Laypeople will miss the RCM aspect of the story – she didn’t get the bill until seven months later.

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An attorney sues the Popeyes fried chicken restaurant for including only a spork in his drive-through order, claiming that be choked for lack of a plastic knife. In an update, the attorney drops his suit following “extreme comments directed to me and my family.”


Sponsor Updates

  • Intelligent Medical Objects will offer a free workshop titled “Terminology: The Secret to Leveraging your EHR for MIPS and MACRA” at AMIA 2016 on November 12, with non-AMIA attendees invited to participate as well.
  • Gartner lists Medecision as a representative vendor of PHM platforms for providers in its latest “Market Guide for Healthcare Provider Population Health Management Platforms.”
  • KLAS recognizes Uniphy Health for accomplishments in secure messaging in its report, “Secure Communication 2016: Vendors Transitioning to Secure Communication Platforms.”
  • The Tampa Bay Technology Forum recognizes CareSync as 2016 Technology Company of the Year.
  • Ingenious Med releases a major update to its IM1 patient encounter solution, adding real-time care team member interaction.
  • Iatric Systems, Imprivata, InterSystems, MedCPU, Nordic exhibits at the CHIME Fall CIO Forum through November 4 in Phoenix.
  • InstaMed, Intelligent Medical Objects will exhibit at the NextGen One UGM November 6-9 in Las Vegas.
  • Kyruus will exhibit at HCIC November 7-9 in Las Vegas.
  • MedData will exhibit at the HFMA Region 9 Annual Conference November 6-9 in New Orleans.
  • Meditech will exhibit at the American Association of Physician Leadership 2016 Fall Institute November 4-8 in Chandler, AZ.
  • NTT Data will host an Innovation Summit November 10 in Charlotte, NC.
  • Obix Perinatal Data System will exhibit at the South Carolina HIMSS Annual Fall Conference November 9-10 in Columbia.
  • KLAS recognizes PatientSafe Solutions as one of the strongest platform options for care team communication in its 2016 Secure Communication Report.
  • PatientKeeper and Summit Healthcare will exhibit at HealthAchieve November 7-9 in Toronto.
  • The Institute of Healthcare Consumerism features PokitDok on Healthcare Consumerism Radio.
  • The SSI Group and Streamline Health will exhibit at the HFMA Region 9 Annual Conference November 6-8 in New Orleans.

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 11/3/16

November 3, 2016 Dr. Jayne No Comments

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Although many are focused on the Presidential election, it’s important to remember that Congress is responsible for appropriations. Many professional and advocacy organizations are busy at work, encouraging both parties to keep the government funded. The American Academy of Family Physicians continues to ask Congress to continue funding for the Agency for Healthcare Research and Quality (AHRQ) and other programs tied to primary care and public health. One would think that those kinds of efforts would be relative no-brainers for our leaders, but if there’s anything that we’ve learned during this election cycle, it’s that brains are sometimes in short supply.

A recent Advisory Board daily briefing noted that “Most docs are Dems” according to data from Yale University research. Surgeons, anesthesiologists, and urologists are more likely to be registered Republicans, where pediatricians and psychiatrists were more likely to be Democrats. Contributing factors may include salary, age/sex demographics, and specialty culture.

In the “no surprise” department, a recent piece in the September issue of Health Affairs identified a decrease in the number of small practices, defined as those with nine or fewer physicians. Small practices dropped from 40 percent in 2013 to 35 percent in 2015, while the number of large practices (over 100 physicians) increased by a 5 percent margin. Increasing regulatory and administrative burdens will continue to drive physicians to larger groups or employed practice situations.

The meeting season is in high swing, with MGMA just having wrapped up and various vendor user groups including NextGen and Cerner about to take place. The AMIA Annual Symposium starts on the 12th in Chicago. I’m sad that I’m missing AMIA this year due to other responsibilities, but I have a couple of friends going who promised to fill me in. If you’re attending any of the user groups or AMIA, feel free to share your pictures of good times, great shoes, and groovy entertainment.

I’m often overwhelmed by my Twitter feed, but when I see something that is mentioned by both Atul Gawande and Farzad Mostashari, I take note. Both mentioned this Washington Post piece addressing the practice of enrolling non-terminal patients in hospice care. The Office of the Inspector General found that many patients signing up for palliative care weren’t told that it meant giving up curative treatments. Hospice care has grown to a $15 billion industry and patients that require fewer services are more profitable due to the flat fee structure. Hospice care can provide real relief for patients and their families during very difficult times and it’s appalling that shady characters would choose to profit from it.

Speaking of people operating on the fringes, I’m sometimes amazed at the things people say in the course of trying to make a deal. I may be young and my consulting company may be small, but that doesn’t mean I’m clueless. A prospective client that I’ve been meeting with has repeatedly asked me to do some things with my proposal that I’ll call “irregular” for lack of a better description. I’m no stranger to dealing with convoluted corporate accounts payable processes, but if you ask me to do things that require legal fees to determine whether they’re legitimate, we’re unlikely to do business together.

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I came across an interesting statistic today that 20 cents of every dollar in consumer spending goes to FDA-regulated products, including many foods, drugs, medical devices, cosmetics, dietary supplements, and tobacco. Being in healthcare IT, we often think about the FDA in regard to device regulation, but may forget everything else they do.

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The “Mr. Yuk” award of the week goes to Kareo, whose “premium content” Medical Economics piece completely ignores the volume-to-value transition, admonishing physicians that “if you are not seeing enough patients each day, you will never be able to grow your practice.” Their guide gives “three key ways to increase the number of patient visits and the revenue that comes with them,” including an effective recall program, an online presence, and encouraging referrals. I was surprised to see someone pushing a clearly fee-for-service model without even remotely mentioning value-based care. It does talk about adding ancillary services such as a dietician, but mostly in the context of increasing the physician’s bottom line rather than as a quality maneuver.

I loved their advice to “don’t bring a dietician on payroll until they are at least 80 percent contracted with your payers. You don’t want to be paying that extra salary while they are unable to bill for seeing patients.” It seems they need a better understanding of how providers enter into employment arrangements. I’ve never met a provider who was willing to sit it out unpaid until the often unpredictable credentialing process reaches a certain threshold. Although you may delay a start date to allow for the paperwork to move through, clinicians will often begin delivering services to build their patient base or to start contributing to quality efforts. There are many things that providers do that aren’t about the bottom line, but apparently Kareo doesn’t get that.

They go further to suggest that practices should limit the slots for capitated patients “while leaving same-day and extended hours open for fee-for-service patients.” A couple of pages later they mentioned that providers can encourage referrals by “offering low wait times and great access.” I guess that’s just for the fee-for-service patients, though. Although many of their suggestions may appeal to the business side of our brains, I found the piece generally tacky and hope they’re more in tune with emerging software needs than they are with clinical transformation.

Email Dr. Jayne.

Morning Headlines 11/3/16

November 2, 2016 Headlines No Comments

Cerner (CERN) Q3 2016 Results – Earnings Call Transcript

Cerner describes its past quarter in which it failed to meet revenue and earnings expectations — the announcement of which Tuesday sent shares down 7.1 percent Wednesday — saying that the EHR replacement market has slowed as a lack of regulatory mandates has reduced the urgency of prospective customers.

NTT Data Closes Acquisition of Dell Services

NTT Data closes its acquisition of Dell Services, renaming the business NTT Data Services.

NICE Framework Provides Resource for a Strong Cybersecurity Workforce

NIST releases a resource to help employers build and maintain a strong cybersecurity team.

Mount Sinai Health System Launches First Enterprise-Wide Platform to Prescribe Apps to Patients

Mount Sinai Health System develops RxUniverse, which allows physicians to digitally prescribe from a curated list of evidence-based mobile health applications.

Morning Headlines 11/2/16

November 1, 2016 Headlines No Comments

CMS Finalizes Hospital Outpatient Prospective Payment System Changes to Better Support Hospitals and Physicians and Improve Patient Care

CMS reduces the reporting period for the 2017 EHR Incentive Program to 90 days.

Cerner Reports Third Quarter 2016 Results

The company misses expectations for both revenue and earnings.

Meditech Form 10-Q

Meditech announces Q3 results in which revenue dropped 7 percent, but EPS jumped from $0.37 to $0.68 mostly due to reduced costs.

Business of the American Medical Association House of Delegates 2016 Interim Meeting

The AMA will consider policies that address information blocking, EHR vendor interfacing fees, and the cost of EHR conversions in its meeting in Orlando November 12-15.

News 11/2/16

November 1, 2016 News 5 Comments

Top News

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CMS publishes changes to the EHR Incentive Program that will allow returning EPs, hospitals, and CAHs to use any continuous 90-day reporting period between January 1 and December 31 for both 2016 and 2017.

CMS will also eliminate the clinical decision support and CPOE objectives and measures for hospitals and CAHs attesting under the Medicare EHR incentive program.

CMS says it is finalizing the process for a one-time EHR hardship exception for the Medicare EHR Incentive Program for certain eligible professionals for EPs who participate in the EHR incentive program in 2017 who will transition to MIPS in 2017.


Reader Comments

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From Pilsner: “Re: Epic’s posted study showing the change in operating margins after switching from Cerner to Epic. The data are minimally cited and the methodology is not documented. It gives Moody’s as the source, but Moody’s rates only 441 hospitals and therefore the graph must not include all hospitals that implemented Cerner and Epic from 2004 through 2015.” I would be curious about how many hospitals this graphic represents. I’m also skeptical that a change in systems was the cause of the improvement as opposed to other, more impactful changes that coincided with that change (such as being acquired by a Epic-using health system that instituted its own superior revenue cycle practices). Also, the stated average margin improvement from 3.19 percent to 6.45 percent happened over years in which hospital margins improved in general and covered hospitals that could, by definition, afford Epic. There’s too little information to infer further, but Epic’s non-marketing team has done a nice job making a compelling point without providing the details in trying to discount the headlines describing hospitals whose Epic project expense got them in trouble.

From Master Blaster: “Re: [company name omitted]. Can you please remove the rumor you ran about us?” I sometimes get requests to take down a rumor, but I don’t do that, instead offering the company a chance to provide a response or to confirm/deny, which they generally decline to do. Invariably the rumor the company wants removed turns out to be accurate and they just wanted more time to spin it publicly. It’s the same when health system CIOs email me to rather sternly suggest that I contact them before mentioning items from public records indicating the cost and status of their big implementation projects – that information doesn’t seem to require IT clarification, but they’re always welcome to provide a comment. My conclusion after doing this for 13 years: everybody loves to read rumors except those that pertain to them, which instantly transform me from a must-read news-breaker to an irresponsible trouble-maker.


FHIR

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Grahame Grieve provides a response to a reader’s question and my comments regarding FHIR.

World peace — we’ll do that next year. This year we sat it out because we wanted to handicap ourselves. (more seriously, Mr. H already quoted me about this).

From the original question, "After years of implementing HL7 and being able to do just about anything with an HL7 message," well, there’s all sorts of things you can’t do with HL7 v2, and ways you can’t do it, but for all the things you can do with HL7 v2, FHIR is an incremental improvement, not world shaking. But even there — testing, conformance, infrastructure — there’s still a lot in the increment. 

"FHIR without discipline could turn out the same way if customers don’t demand better." Yes, but also vendors understand where the other approach ends up. We’ve lived it, and in today’s social media world, we can do better for much less. So it costs less to be disciplined, and as you said, there are other reasons to get it right this time.

"Providers understandably have no incentive to exchange data with their competitors." But banks exchange data with the customer, etc. Why? In fact, there are reasons to exchange some data, some times. It’s not a binary all-or-nothing, and some providers are keen to do it. Because of cost minimization, for example. And while data sharing might allow patients to shop between systems, it can also allow systems to shop to patients previously locked in. (more about this).

For these reasons, we — the FHIR team — believe that now is a great time to spend our effort creating a better way, and we live in hope that it will make a difference for patients across the world.


HIStalk Announcements and Requests

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Ms. M reports that she’s using the iPad we provided in fulfilling her DonorsChoose grant request to assign specific reading interventions to her Texas first graders. She is also having the students record themselves as they work through the writing process, followed by taking a picture of their work and recording themselves talking the problems out.


Webinars

November 8 (Tuesday) 1:00 ET. “A CMIO’s Perspective on the Successful 25 Hospital Rollout of Electronic Physician Documentation.” Sponsored by Crossings Healthcare. Presenter: Ori Lotan, MD, CMIO, Universal Health Services. UHS rolled out Cerner Millennium’s electronic physician documentation to its 6,000 active medical staff members — 95 percent of them independent practitioners who also work in competitor facilities — across 25 acute care hospitals. UHS’s clinical informatics team used Cerner’s MPage development toolkit to improve the usability, efficiency, communications capability, and quality metric performance of Dynamic Documentation, embedding clinical decision support and also using Nuance’s cloud-based speech recognition product for the narrative bookends of physician notes. This CMIO-led webinar will describe how UHS achieved 70 percent voluntary physician adoption within one month of go-live, saved $3 million in annual transcription expense, and raised EHR satisfaction to 75 percent. It will include a short demonstration of the software that UHS developed to optimize the physician experience.

November 9 (Wednesday) 1:00 ET. “How to Create Healthcare Apps That Get Used and Maybe Even Loved.” Sponsored by MedData. Presenter: Jeff Harper, founder and CEO, Duet Health. Patients, clinicians, and hospital employees are also consumers who manage many aspects of their non-medical lives on their mobile devices. Don’t crush their high technology expectations with poorly designed, seldom used apps that tarnish your carefully protected image. Your app represents your brand and carries high expectations on both sides. This webinar will describe how to build a mobile healthcare app that puts the user first, meets their needs (which are often different from their wants), creates “stickiness,” and delivers the expected benefits to everyone involved.

Contact Lorre for webinar services. View previous webinars on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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Cerner reports Q3 results: revenue up 5 percent, adjusted EPS $0.59 vs. $0.54, missing analyst expectations for both. Shares dropped 2 percent at Tuesday’s close and were down another 6 percent in early after-hours trading. The company announced plans to offer a voluntary separation plan for eligible employees.

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Telemedicine technology vendor Avizia closes its $17 million Series A funding round with a $6 million investment that includes the participation of New York-Presbyterian.

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Meditech posts Q3 results: revenue down 7 percent, EPS $0.68 vs. $0.37. Product revenue declined 26 percent while service revenue increased 2 percent, but a 47 percent drop in sales costs boosted net income to $25.5 million.

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Vital Images will acquire Karos Health, which offers “deconstructed PACS” diagnostic image viewing and sharing tools.

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Private equity firm Blackstone Group will acquire hospital physician staffing outsourcer Team Health for $6.1 billion. The company was previously owned by Blackstone, which paid $1 billion for it in 2005 and then took it public in 2009. Team Health turned down a $7.6 billion acquisition offer last year after running up a pile of debt to finance the acquisition of a competitor that didn’t really work out.

Sunquest owner Roper Technologies announces Q3 results: revenue up 7 percent, adjusted EPS $1.63 vs. $1.61, falling short on revenue expectations but beating on earnings. The company said in the earnings call that Sunquest’s revenue is two-thirds recurring and therefore new orders aren’t usually that important, but the Lab 8.0 release and a new blood bank solution will cause a record number of Q3 orders. 

A federal appeals court affirms dismissal of Fair Warning’s patent lawsuit against Iatric System regarding Iatric’s technology to detect fraud and misuse of PHI.


Sales

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Baylor Scott & White Health will use technology from Pager to provide nurse triage services to patients seeking services.


People

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Aetna promotes Patrice Wolfe to CEO of Medicity, where she will also be responsible for the company’s population health management technology products that include Healthagen Outcomes and HDMS.

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Long-term care technology vendor MatrixCare hires Gary Pederson (Richland Advisors) as SVP of life plan community solutions.

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Healthgrades promotes Andrea Pearson to EVP and chief marketing officer, Christian Dwyer to EVP of product management, and Chris Catallo (not pictured) to GM of hospital solutions.

Athenahealth hires Diane Holman (TE Connectivity) as chief people officer.


Announcements and Implementations

Health services price comparison vendor HealthSparq adds tools so that health insurers can offer their members financial rewards for choosing cost-conscious options, send them secure messages, and send them claims-based alerts to offer money-saving suggestions.

A Spok-sponsored, CHIME-administered survey of 100 CIOs finds that 81 percent name improving data security as their #1 priority over the next 18 months, while the top workflow they hope to improve with technology is care team coordination for treatment planning. Two-thirds are actively implementing secure messaging.

CareCloud will integrate population health management tools from Lightbeam Health Solutions into its EHR/PM.

Availity announces that its health information exchange technology will support the FHIR standard for eligibility, labs, diagnoses, medical attachments, and ADT and is developing a provider solution for member lookups.


Government and Politics

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Healthcare.gov was apparently again overloaded on the first day of open enrollment, but at least the site provided a polite waiting room message instead of just timing out. I put myself in yesterday to compare to today’s new prices for 2017 and the premium for my theoretical coverage would be jumping 68 percent from 2016. I can say with confidence after looking up premiums for different parts of the country that a lot of self-employed folks who earn too much for federal taxpayer subsidies are going to be paying $1,000 per month or more for Silver-level coverage with a $3,500 deductible and $7,150 out-of-pocket maximum. Another option, I suppose, would be to purchase individual coverage directly from the insurance companies that offer it, but I don’t know if that would be a better deal than the exchange. A Wall Street Journal article says Arizona is the best example of the ACA’s problems in that most counties are down to only one insurer, premiums for some plans will more than double, and higher costs and cutbacks in the federal risk corridor program have caused nearly all of the insurers to pull out.

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CMS awards its next round of Recovery Audit Contractor (RAC) contracts.


Privacy and Security

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In England, the three hospitals of the North Lincolnshire and Goole NHS Foundation Trust cancel appointments and elective procedures as they go back to paper following an attack by an unspecified computer virus. The hospital hopes to restore its systems Wednesday following Sunday’s attack. They deny that ransomware is involved.

From DataBreaches.net:

  • In England, a former hospital administrative employee is prosecuted for accessing the medical records of her former girlfriend and her partner.
  • Three former district managers of drug company Warner Chilcott are sentenced for healthcare fraud and HIPAA violations trying to boost sales of the company’s osteoporosis drugs by using patient information to fill out prior authorization forms. The company’s drugs, Atelvia and Actonel, require doctors to justify why less-expensive generic drugs can’t be used, so the drug reps completed and submitted the forms using boilerplate text that was often unrelated to the patient’s condition. The company’s former president was arrested and charged with paying kickbacks last year (including bribing high-prescribing doctors with “honoraria” for speaking at events with no educational component) but was acquitted. Warner Chilcott paid $125 million to settle its criminal and civil liability and was acquired for $5 billion by Actavis.

Other

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Among the proposed policies to be discussed at the AMA’s Interim Meeting in Orlando November 12-15 is integrating mobile health apps and devices into everyday practice. A draft resolution that calls out Epic and EClinicalWorks as “data blockers” would ask federal and state governments to prohibit withholding patient information from non-affiliated physicians and asks AMA to support legislation that would limit EHR vendor interfacing fees. Another proposed item seeks federal legislation that would eliminate medical practice costs involved with converting patient data from a replaced EHR to a new one.

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Weird News Andy notes that this story is a few months old, but still amazing. A 14-year-old girl returns to competitive ballet dancing after having her leg amputated above the knee due to osteosarcoma, when was then repaired by attaching her foot backward to her upper leg in an uncommonly performed procedure called rotationplasty to give her optimal mobility.

WNA may regret going for the feel-good story above since he likes OR-related oddities such as this. A patient undergoing cervical surgery is burned when the laser ignites her passed gas.


Sponsor Updates

  • HCI Group posts a podcast titled “Epic Upgrades: Key Strategies and Cost Considerations.”
  • Aprima will exhibit at the American College of Phlebology event November 3-5 in Anaheim, CA.
  • CenterX, CoverMyMeds, Cumberlad Consulting Group, Dimensional Insight, EClinicalWorks, and HealthCast will exhibit at the CHIME Fall Forum November 1-4 in Phoenix.
  • CompuGroup Medical will exhibit at the National Association of Community Health Centers FOM/IT Conference November 2-4 in Las Vegas.
  • Elsevier Clinical Solutions will present at the US News & World Report Healthcare of Tomorrow Conference November 2-4 in Washington, DC.
  • Evariant will exhibit at the Healthcare Internet Conference November 7-9 in Las Vegas.
  • KLAS names PerfectServe’s Synchrony as a top-performing care team communication platform.
  • Extension Healthcare will exhibit at the HealthAchieve Conference November 7-9 in Toronto.
  • Healthfinch will sponsor DevOp Days November 2 in Madison WI.
  • Healthwise will exhibit at Wellcentive’s annual UGM November 2-4 in Atlanta.

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 11/1/16

October 31, 2016 Headlines No Comments

Red Cross Blood Service data breach: personal details of 550,000 blood donors leaked

In Australia,the personal information of 550,000 blood donors is exposed after a web developer working for the Red Cross inadvertently leaves an unsecured file with the information into the Internet.

Fall 2016 Leapfrog Hospital Safety Grades Out Now

The Leapfrog Group publishes its 2016 Hospital Safety Grades, ranking patient safety across 2,600 US hospitals.

Appeals court revives FTC’s bid to block Advocate/NorthShore merger

The FTC wins an appeal to block the merger of Illinois-based Advocate Health Care and NorthShore University Health System.

Curbside Consult with Dr. Jayne 10/31/16

October 31, 2016 Dr. Jayne No Comments

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There has been a fair amount of swirl and churn with my clients this week as they begin to digest the recently-released MACRA Final Rule. It was released with a comment period, which seems to be having some unintended consequences. Some organizations are interpreting the presence of the comment period as a license to continue to stall in their preparation efforts, as if some magical MACRA Fairy is going to swoop down and change the requirements.

It’s been tough to get some of them moving again, because they stalled after the Proposed Rule and took on other projects. I keep preaching the idea of taking baby steps. Even if we don’t think it is truly final, just pick some subprojects and get moving. It’s a hard sell for some groups, however.

Being in the trenches with small to mid-sized practices is tough. There are a fair number of groups out there who still can’t manage to tackle the basics that haven’t changed in years, particularly on the business side. I see groups with high days in accounts receivable, low net collections, and more. Most of the issues are due to process problems such as being unable or unwilling to adopt essential revenue cycle best practices.

You wouldn’t believe the number of organizations that still haven’t grasped the concept of collecting the co-pay up front, which results in a lot of chasing after the fact. Others aren’t performing insurance eligibility checks so that they know whether the patient needs to be self-pay or not. Yet others don’t have their contracts loaded into their practice management system, which makes it difficult to know whether insurers are paying as expected.

These business processes are fairly cut and dried and haven’t changed in quite some time, so when you see organizations that can’t handle them, it throws up red flags about their ability to handle change in their clinical operations. Medical billing systems were among the first pieces of automation added to the medical practice and quite a few vendors have extremely mature platforms. Compared to the relative immaturity of some clinical platforms and the constantly changing federal requirements, it feels like the business piece should just be more solid.

I also see a fair number of practices that don’t have disaster recovery figured out. No part of the country is immune from natural disasters and there are always the “small things” like power outages, disrupted data lines, water line breaks, etc. to potentially disrupt practice operations. At this point, everyone should have a business continuity plan and disaster recovery plan. For those practices that are still stalling around MACRA requirements, I’m trying to push them to go ahead and address those issues so at least they are doing something and creating some kind of positive momentum for their organization.

One of the practices I’m working with right now that is stalling the most is one where the owner is contemplating retirement just to get away from it all. He’s in his late 50s, so I wouldn’t exactly call him retirement age, but he isn’t sure he wants to move forward with all that is being asked of him. It would be one thing if he was waffling and he only had himself to consider, but there is a relatively new physician who joined his practice in the hopes of possibly buying it in a few years. They’ve dabbled in Meaningful Use in the past, but barriers like not having a patient portal block their progress. Even though their vendor offers one, the owner isn’t willing to spend the money while he debates his future.

I don’t have insight into their contract arrangement, but the junior physician has let me know he has been having second thoughts about staying in the arrangement vs. looking at other employment options. They are both aware that there are a number of large groups and health systems that have open opportunities that I suspect offer comparable working conditions, salaries, and benefits, at least for the younger physician who is still building his patient panel. Unless he’s similarly committed to practicing outside the federal incentive / penalty scheme, one of those opportunities may start to look pretty attractive, which I think is adding to the stall factor in this case.

I’ve been spending a lot of time with the both of them trying to create a strategic roadmap for the practice. Does the senior one plan to retire? Will he sell to the junior one or to a health system? Will they close altogether? Will the junior one eventually make a move to force his employer’s hand? It’s like a soap opera and I’m caught in the middle of it. It’s a blend of change leadership training and relationship counseling but hey, it pays the bills.

On a personal level, my own practice has been reviewing the Final Rule as well. Even though we’ve opted out of Meaningful Use, it’s prudent to review the next iteration and determine whether we still want to stay out of it. I’m fairly confident we’re going to continue to just say no, but it’s refreshing to know that you are working with leaders who consider the options at various turning points so that you don’t wind up simply doing things because you’ve always done them that way or because that’s how you decided to do them before. Our owners are very deliberative and data driven and it’s been refreshing to work in that kind of an environment compared to the highly reactive environments I see with most of my consulting clients.

We’re currently focused on growth and have three new locations under construction, poised to open monthly from now through January. It’s been an interesting ride. I’m not entirely bought in regarding some of the locations they’ve picked for expansion, so we’ll have to see whether their forecasts actually play out. In the meantime, it’s been fun to work with people that are so focused on processes and outcomes, independent of any regulatory shackles.

What’s your favorite Halloween candy? Email me.

Email Dr. Jayne.

Readers Write: Address the Disruption in Provider Data Caused by Clinically Integrated Networks and Value-Based Care

October 31, 2016 Readers Write No Comments

Address the Disruption in Provider Data Caused by Clinically Integrated Networks and Value-Based Care
By Tom White

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Hospitals that became health systems and are now morphing into clinically integrated networks (CINs) are facing increasing struggles managing their expanding patchwork of providers. These include credentialed and referring physicians, APRNs, nurses, other licensed professionals. Their provider count has often grown by five to 10 times.

Not only are there more providers, but also they are working in a wider variety of outpatient care settings. This has been a boon for consumers, as there are now many new retail healthcare locations on neighborhood street corners, but this poses an increasing challenge from a provider data perspective. Who is providing the service? What is their affiliation in the ACOs, next gen ACOs, CINs, or narrow networks? Are they sanctioned?

These problems rise from the emergence of the retail healthcare economy. The resultant growth in provider data is creating obvious and not-so-obvious consequences caused by disruptions in the provider data management process, affecting the accuracy of the provider data.

Poor provider data management tends to hurt healthcare organizations much more than they realize, especially in the context of today’s emerging retail healthcare economy and value-based reimbursement market. For hospitals and providers to succeed in these circumstances it is imperative to drive out unnecessary costs, and outdated or inaccurate provider data is a hidden source of significant costs.

As hospitals and health systems develop new alliances, it is critical to know what providers are included in a CIN, including their roles and affiliations. Efforts to collaborate over large patient populations and control value-based payments require in-depth and proprietary knowledge of provider affiliations, practice scope, and their economic models. This information is mission critical for success. Using a system that manages provider data in these areas should be a business imperative for every health system executive.

Licensed healthcare provider data management programs have historically been managed by numerous, fragmented systems across the healthcare ecosystem. Many healthcare leaders believe that electronic medical records (EMR) systems and their health information exchange (HIE) modules, credentialing, and other modern back-office IT systems have made provider data more accurate, secure, and accessible. Perhaps this is so with patient data, but this is not the case with provider data. These enterprise IT systems provide numerous benefits and may even provide a repository for some provider data, but they are not inherently designed for ongoing management of this business-critical data.

Let’s think for a minute about some specific areas in which provider data plays a vital role. Do CINs know who their providers are? How do they take these new provider networks and build the tools for consumers and providers to search and find them? Simple natural language searching (think Google searches) is how the entire world except for healthcare works. Having accurate provider data who are in-network with modern search tools should be a goal for all health systems and CINs.

Accurate provider data is critical to ensure that provider search tools can be the foundation of a successful referral management program. Potential patients that visit the hospital website and search for a local, in-network doctor or a specialist expect that the information they are presented with is accurate and current. If not, a bad customer experience could mean the loss of a patient, a loss of trust, and perhaps worst of all, a bad online review by the patient.

Physicians who use these search tools to identify specialists they can refer their patients to is a critical aspect of referral management. The range of critical data that is relied upon now goes beyond simple contact information and insurance plan participation. It might include physician communication preferences, licensing data, internal system IDs, exclusionary lists, and other sensitive internal information. This information changes frequently, but users don’t have time to ponder these facts. Inaccurate information wastes time and hurts patient satisfaction.

Inaccurate provider data causes billing delays that hurt cash flow and increases days A/R. Invoices sent to the wrong location or faxed to the wrong office are common in healthcare. Never mind issues stemming from inaccurate or incomplete address information.

Beyond clinical and financial performance gains from having more accurate information on providers is that this data can then be used in consumer and physician outreach programs across the health systems, whether part of a CIN or ACO. Hospitals are businesses, too. Historically many of their patients may be admitted through the ED, but increasingly are referred by in-network physicians or come through another outpatient service. The hospital’s marketing department may want to reach out to a network of physicians within a 200-mile radius to encourage referring patients to their facilities or simply promote a new piece of equipment or innovative procedure that’s now available at their facility. The marketing department might do searches to find these physicians and contact them. Having accurate provider ensures that these efforts are productive and efficient.

A tool is required that makes it easy for the appropriate teams in the health system to curate and update their health system provider data to create a single source of truth. This should include all credentialed and referring providers from across the entire healthcare organization, including acute, post-acute, outpatient, and long-term care environments.

While health systems can develop data governance models that require all departments to verify the accuracy of their provider data and to specify how it should be shared, this is seldom a success. Most organizations don’t know exactly who is in their pool of licensed providers and historically there has not been an IT system that can provide this comprehensive capability.

Healthcare leaders have to take a proactive approach to provider data management and can no longer afford to deny the critical role this information plays in today’s increasingly complex and challenging healthcare system. In a fee-for-service world where practitioners are paid for whatever work they perform, it may not be as critical to have accurate provider data. But in today’s value-based care market, accurate provider data is critical for running an efficient, competitive, and profitable healthcare system.

Thomas White is CEO of Phynd Technologies of Dallas, TX.

Morning Headlines 10/31/16

October 30, 2016 Headlines No Comments

Why McKesson Corporation Shares Fell 23% In A Day

McKesson shares drop 23 percent following a poor Q2 financial report and lowered earnings guidance for 2017.

Athenahealth lays off more than 100 in restructuring effort

Athenahealth eliminates 150 jobs in San Francisco and Atlanta as it consolidates its R&D functions.

Nanaimo MDs offered extra pay to stick with controversial software

In Canada, Nanaimo Regional General Hospital is offering physicians extra money to keep using its recently implemented Cerner system to compensate for “the extra burden the new electronic health record has placed on many physicians during the roll-out phase of IHealth.”

Healthcare IT Trends in the UK — Who’s Winning & Losing | 2016

A Peer60 survey of hospital executives in the UK reveals a high level of concern over physician and nursing staffing shortages.

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Reader Comments

  • HIT Girl: That NYTimes piece on women being given anticoagulants at a lower rate due to implicit bias is incredible. Estrogen is ...
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  • Tango #2: Couldn't agree more with your HIMSS Media Lab sentiment (though I struggle to liken them in any way to the Salvation Arm...

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