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March 30, 2010 News 15 Comments

From Stifler’s Mom: “Re: Medicare. Doctors to take a pay cut. Tricare’s getting cut too.” AMA’s president decries the 21% Medicare pay cut that will hit doctors on April 1. It’s a Catch-22 situation: more patients will be insured under healthcare reform, which will eliminate the need to use hospital EDs for basic care, but the scarcity of primary care docs coupled with reduced payments means those patients will wind right back up in the ED because they won’t be able to get appointments otherwise. As long as Medicare richly rewards procedure docs while stiffing PCPs, there will by the law of supply and demand be way too few PCPs. Just giving everybody an insurance card isn’t going to solve that problem. Let’s hope Don Berwick can blast through the bureaucracy, not only at CMS, but throughout the federal government. If anyone can, I’d say it’s him. Personally, I can’t believe he took the job and I’m sure he didn’t do it to fulfill a long-held hope of becoming a bureaucrat.


From The PACS Designer: “Re: Apple’s iPad release. The wait is over. Saturday will usher in the iPad era for Apple. There will be many reviewers to tell us what they think of their new business and play tool. One of our own, the esteemed Dalai, will give us an early indication of its usefulness when he gets his iPad via a shipper from China and starts to play!” I got Mrs. HIStalk a netbook for traveling and I kind of like that, too. It will fit into a mid-sized purse, weighs next to nothing, has a battery life of over 10 hours, and hops onto a wireless network easily. It’s running Win 7 Starter, is fast, has all the hard drive you’d ever need, and sports the usual array of external ports. The keyboard feels pretty good and the display is just fine. It comes with Microsoft Works, which can read and write Word files, but I’ll hook her up with Google Docs. It’s pretty cool for less than $300.

The Charleston, SC business paper writes up Carolina eHealth Alliance’s project, in which 11 hospital EDs are exchanging information using technology from TELUS Health.


Tressa Springman, CIO of Greater Baltimore Medical Center, writes an article called Improving Clinician Communication that describes that organization’s rollout of the TeamNotes clinical documentation system from Salar, which they integrated with their incumbent EMR. “Too often, hospitals are forced to implement technologies to meet an externally mandated deadline. These are the situations where teams are faced with short-changing the required thoughtfulness of the good design, resulting in a bad system that needs to be reworked. In contrast, I feel very good about our implementation of Salar’s clinical documentation at GBMC, because I feel that we are doing it for the right reasons, at the right pace and in a quality manner driven by a high degree of physician engagement.”

Walt Disney Pavilion at Florida Hospital for Children rolls out GetWell Town from GetWellNetwork, offering patient education, entertainment, and Internet access. The company will announce an agreement tomorrow with Child Health Corporation of America that will make GetWell Town available to its 40 leading children’s hospitals.

East Orange General Hospital announces that it will implement GE Centricity Enterprise. This is an interesting quote: “East Orange General Hospital, under EOGH President Kevin Slavin, started community meetings regularly. In one of the meetings, a GE representative happened to be there and they helped introduce the system to the hospital.” Nice work by the salesperson who “happened” to show up and pitch product at a community meeting. They earned that big commission.

A reader asked me which full hospital information systems a 200-bed hospital with light IT resources should look at. I gave my answer, but I’m curious: what would yours have been? E-mail me your thoughts and I’ll compile them here and share what I said.

A doctor who made $1.5 million writing over 100,000 prescriptions for online “patients” he hadn’t examined gets five years in prison.

A good idea from HHS’s Adoption/Certification Workgroup: put feedback buttons on EHR screens so clinicians can report problems. It’s not a new idea and some systems have them, but they all should if you ask me.

E-mail me.

HERtalk by Inga

From Bad Blake: “Re: Scott Freeman. The former territory vice president at McKesson Physician Practice Solutions, has accepted the role as head of business development for Zynx Health out of Los Angeles.” I see that Scott lists the new job title in LinkedIn, even though someone else is credited with the BD title on Zynx’s website.

From Clareece Jones: “Re: Berwick over CMS. Great news for patient safety.”

saudi health affairs

Saudi Arabia National Guard Health Affairs wins the Excellence in Electronic Health Records Award for its use of QuadraMed CPR. The award, which was presented at the Arab Health Exhibition and Congress, is given to the healthcare providing making the most innovative use of EHR to reduce error and increase safety and efficiency.

A Connecticut radiologist who was terminated from his physician group accesses a hospital’s computer system and looks at images and personal data for 957 patients. The doctor then allegedly contacted some of those patients and encouraged them to seek service at a different hospital. Apparently after the doctor left the staff at the original hospital, he hacked into the DPAC system using other radiologists’ passwords. The state attorney general is investigating. If I were investigating, the first thing I’d ask is how the heck did the doctor have access to all those passwords.

patient condition tracker

Eclipsys partners with Rothman Healthcare Research to build Rothman’s Patient Condition Tracker Solution software on the Helios by Eclipsys open architecture platform. The integration will give Eclipsys hospital clients the option to use Rothman’s application in an integrated environment without needing to develop an additional interface.

CPSI’s CPOE, E-Mar, and pharmacy applications achieve “approvable” status from the Ohio Board of Pharmacy. The designation means the software can be installed in Ohio hospitals without further inspection from the Board of Pharmacy.

You can find the list of Thomson Reuters 100 Top Hospitals here. The ratings are based on public information and assess hospitals’ performance in 10 different areas. Thomson Reuters claims that more than 98,000 additional patients would survive each year if those patients received the same level of care as ones treated in Top 100 facilities.

fredrick memorial

Frederick Memorial (MD) expands its relationship with MEDSEEK to develop a comprehensive eHealth ecoSystem. I believe that is a fancy way of saying that Frederick will be combining its existing MEDSEEK physician portal with a consumer-facing Web site.

eClinicalworks says it has implemented 2,000 providers across 400 independent practices in New York City over the last two and half years. Another 600 providers and 100 practices are in the implementation process.

And in the Midwest, physician network Advocate Physician Partners partners with eClinicalWorks and will recommend eCW’s PM/EMR to its 2,600 independent physicians.

North Florida Surgeons selects Allscripts EHR/PM solution for its 34-provider practice. The practice’s CEO says that a key reason they selected Allscripts was the availability of Allscripts Patient Payment Assurance module to to calculate patient responsible amounts and secure payment authorization prior to surgery. I mentioned this in HIStalk Practice yesterday and the Allscripts folks told me that this particular module, which is offered in partnership with mPay Gateway, is proving to be a big competitive advantage.  I suppose that serves as a good reminder that clinical software is not the only thing providers are worried about these days.

Speaking of Allscripts, the former Healthmatics division president David Bond and ISTA CEO Kernie Brashier join Navicure as VP of sales and CTO, respectively. Less that a year ago Mr. H mentioned that Bond had started a social networking site for teen athletes, which I guess wasn’t as fun as the RCM biz.

n hi community hospital

The North Hawaii Health Information Exchange (NHHIE) is leveraging Wellogic technology to connect the North Hawaii Community Hospital, the Hawaii IPA, and independent physicians, as well as labs, pharmacies, and other care providers.

The chairman and CEO of MMR Information Systems tells an HIT investment forum that the company expects that by year end, over one million people will use MyMedicalRecords PRH and MyESafeDepositBox services. I just wonder who all these people are, since I don’t know anyone who actually maintains a PHR.

The trustees for St. John’s Medical Center (WY) approve a $1.2 million software purchase to expand the hospital’s EMR system. I believe that St. John’s currently uses McKesson’s Paragon. The local paper was a bit short on specifics, but it sounds like St. John’s plans to add e-MAR functionality.

choco bunny

Mr. H is graciously allowing me to take Thursday off. Best wishes if you are celebrating Passover or Easter this week. I’ll be feasting on malted eggs, and if I’m lucky, a dark chocolate bunny.


E-mail Inga.

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Currently there are "15 comments" on this Article:

  1. re: feedback button. TPD has a bleeding edge data mining solution that has a collaborate button that permits clinicians to send comments back and forth to each other within their VPN, and also keep a record of all transmissions for training and archiving purposes.

  2. “A good idea from HHS’s Adoption/Certification Workgroup: put feedback buttons on EHR screens so clinicians can report problems.”

    Who is the feedback supposed to go to and what are these guys trained to do? And does this bypass the gag clauses on the vendor’s contract? The “workgroup” should deal with the gag clauses first, because no one is going to push that button and risk getting fired.

    The feedback button is more like the ejection seat button.

  3. The NIH Clinical Center has a suggestion box icon on it’s Sunrise Clinical Manager toolbar that provides all users the ability to send suggestions, feedback, usability issues, or just plain compliments to the Department of Clinical Research Informatics. Since its recent development it has provided invaluable insight into the users’ experiences with the system and uncovered numerous opportunities for system improvement.

    That these kinds of things aren’t standard functionality is pretty surprising and displays a rather unfortunate lack of regard for the user/IT partnership and its myriad opportunities.

  4. To be more clear, I developed this custom device as an add-on. Please be clear that NIH, the Clinical Center, or the Department of Clinical Research Informatics in no way endorses me, my device, or the Sunrise Clinical Manager system.

  5. There are no cuts in payments to doctors for Tricare or Medicare. As most doctors know this is a long standing issue. It’s been kicked down the road for nearly a decade.

    The clear implication of your paragraph is this cut is due to the recent legislation. Actually this same story has been coming up every year since 2003.

    “Because Congress has called off annual SGR-mandated cuts going back 2003, the gap between actual and targeted spending on physician services has continued to widen, resulting in the 21.2% reduction for 2010. Medical societies have urged Congress to replace the SGR formula with one that would set reimbursement rates more in line with practice costs.”

    “Sen. Jim Bunning (R, Ky.) objected each time on the basis that the $10 billion total cost of the bill — roughly $1 billion of which would go toward the doctor pay freeze — would add to the federal deficit.”

    “Democrats still want to postpone the massive reduction in reimbursement until October 1, but they first must find new revenue offsets to replace the old ones. To buy time to do this, the House Wednesday voted to delay the 21.2% cut until May 1. Now the Senate needs to follow suit to avoid a Medicare meltdown, as physicians like to call it, on April 1. Burke said he expects the Senate to ratify a 1-month delay shortly before Congress adjourns on March 26 for a 2-week recess.”

    “March 10, 2010 — The Senate today delayed the effective date of a 21.2% Medicare pay cut for physicians until October 1.”

    Like the photoshoped image you are getting punked by your confirmation bias again Mr HISTalk.

  6. Seems to me a 21% pay cut is still a cut regardless of which piece of legislation its tied to.
    and remember the menaingful use bonus /penalty…if I don’t meet the MU criteria they will reduce my medicare adjustment by 33%…
    so if the 21% finally hits in 2012 my math says… -21% * -33% = +6.9%

    Hope they keep arguing about it till 2012!

  7. Billions of dollars will be wasted on HIT systems that do not work as dreamed. The panic document “Hospitals and doctors should be required to report data glitches that create “hazards and near-misses” that affect patient safety to a national patient safety organization starting in 2013, according to recommendations proposed today by a Health and Human Services Department ” is 15 years late.

    It continues the avoidance of enforcement of the F D and C Act.

    advisory workgroup.

  8. #iPad Release: It’s certainly an exciting release, but there are other tablets out there wanting to get in on the action. In my blog yesterday I spoke about one of them that looks like it could give Apple a run for its money (http://www.occampm.com/blog/general/medical-tricorder-ipad/). With 2010 shaping up to be the year of the tablet, it’ll be interesting to see how these devices (if any) play into the following years of EHR implementation.

    @Blah: I always take everything posted here with a grain of salt and figure it’s up to me, the reader, to confirm anything I read with other sources. I didn’t feel like the paragraph on the Tricare/Medicare cut established a cause/effect relationship between the cut and health care reform; rather, the author drew a conclusion based on two news items that are connected, in that they both apply to medical practitioners who use Medicare.

    Speaking of confirmation, I tried clicking on the links you provided, but the Medscape ones required a login. To anyone wanting to read the articles, you’ll need to Google the first sentence quoted and click the resulting link (I believe these results are cached versions of the articles). In the interest of providing more information on the subject, here are several links that are easily available to the general public:

    “Congress Fails To Prevent Cuts To Medicare, Tricare.” Memphis Daily News Blog. 2 Mar. 2010. http://www.memphisdailynews.com/editorial/Article.aspx?id=48242

    Klein, Ezra. “The true cost of the health-care bill, cont’d: An interview with Rep. Paul Ryan.” The Washington Post: Ezra Klein Blog. 4 Mar. 2010. http://voices.washingtonpost.com/ezra-klein/2010/03/the_true_cost_of_the_health-ca.html

    Trapp, Doug. “Medicare pay formula needs repair, Sebelius says.” American Medical News. 15 Mar. 2010. http://www.ama-assn.org/amednews/2010/03/15/gvsa0315.htm

    Gerencher, Kristen. “Medicare formula adds guesswork for seniors, doctors.” The Seattle Times: MarketWatch. 16 Mar. 2010. http://seattletimes.nwsource.com/html/nationworld/2011361699_medicare17.html

    “Now on to doctors’ fees.” The Miami Herald: Editorials. 23 Mar. 2010. http://www.miamiherald.com/2010/03/23/1542474/now-on-to-doctors-fees.html

    The interview between Washington Post blogger Ezra Klein and Rep. Paul Ryan of the House Budget Committee voiced some of Blah’s complaints about conflating the health care reform bill and the Medicare fee problem. The Medicare problem has certainly been in existence for much longer (since 1997, according to the Memphis Daily News). However, arguing that the two are completely unrelated, or have no effect on each other, is misleading.

    In fact, according to the American Academy of Family Physicians, “The Senate was unable to pass a one-month Medicare payment extension before adjourning for a two-week recess on March 26, thus allowing a 21.2 percent payment reduction to take effect under the sustainable growth rate, or SGR, formula on April 1…. The Senate passed a bill earlier this year that would provide a payment fix until Oct. 1, but the measure included off-setting reductions in spending and increases in taxes that are contained in the larger health reform bill that was just passed. Congress cannot use the same offsets in both bills, leading the House to pass another one-month patch to give lawmakers more time to find new budget offsets to pay for the provisions in the bill.” (http://www.aafp.org/online/en/home/publications/news/news-now/government-medicine/20100329sgrapril.html, published March 29, 2010). I have yet to find any evidence that the cuts will not, in fact, happen tomorrow (April 1); rather, my searchs revealed the opposite to be true:

    Gibbs, Janice. “Physicians urge Congress to take action on Medicare cuts.” Temple Daily Telegram. 31 Mar. 2010. http://www.tdtnews.com/story/2010/03/31/65202/

    Stefanacci, Richard G. “Reform’s impact on Medicare.” The Philadelphia Inquirer: Opinion. 31 Mar. 2010. http://www.philly.com/inquirer/opinion/89579762.html

    Sweet, Craig. “Medicare reductions pose an immediate threat to our patients.” The News-Press: Guest Opinion. 31 Mar. 2010. http://www.news-press.com/article/20100331/OPINION/100330083/1015/opinion/Craig-Sweet–Medicare-reductions-pose-an-immediate-threat-to-our-patients

    Finally, I can’t understand how anyone could argue there’s anything biased about acknowledging that supply and demand will necessarily affect physician availability. In addition to all the articles I have cited, many of which contain impassioned pleas from physicians who certainly believe many among them will not continue to see Medicare patients, there’s also this March 2010 Surgical Coalition survey that asked “If Medicare reimbursement to physicians is cut by over 21%, what changes to your Medicare participation status do you plan to make?” (http://operationpatientaccess.facs.org/userfiles/file/Surgery%20Medicare%20Particpation%20Survey%20Report.pdf)

    @Blah: I’m unsure how any of this information negates Mr. HISTalk’s response, especially since he mostly expressed hope that Dr. Berwick’s appointment would fix this “long-standing issue.” Besides reporting different start dates for the cut to occur, how are your and his assertions in opposition?

    **My apologies to everyone for the exceptionally long comment.

  9. HISJunkie. Sorry to be a stickler here but it’s not tied to any legislation. It’s a patch that’s been expiring for 10 years and every year they kick it down the road.

    I don’t believe this will get resolved until after 2012. But with the passage of this healthcare bill it could be after that.

    “Under the most optimistic of scheduling scenarios, the implementation of a redesigned system is unlikely to occur before January 2013”

    So in 2010 expect to hear “Doctors pay to be cut by 23%!” and it will still be incorrect.

  10. #iPad Release: It’s certainly an exciting release, but there are other tablets out there wanting to get in on the action. In my blog yesterday I spoke about one of them that looks like it could give Apple a run for its money (http://www.occampm.com/blog/general/medical-tricorder-ipad/). With 2010 shaping up to be the year of the tablet, it’ll be interesting to see how these devices (if any) play into the following years of EHR implementation.

    @Blah: I’ve got a lot of questions regarding your responses to the discussion of Medicare cuts, which I’ve posted over at my blog due to length (http://www.occampm.com/blog/general/reponse-to-histalk-medicare-cuts-discussion/). In brief, I’m unsure as to why you feel the reported 21% cut will not happen tomorrow, and where the figure 23% came from in your response to HISJunkie. Would you please provide a source that asserts that no cuts will indeed happen this year?

  11. 98,000 is a magic number. It is the made up real truth that Berwick used when writing the IOM report to escalate the need for his company to provide solutions.

    “Thomson Reuters claims that more than 98,000 additional patients would survive each year if those patients received the same level of care as ones treated in Top 100 facilities.”

    The 23 Everest award winners do not appear to have deployed CPOE systems.The extent of EMR at these hospitals is unknown.

    I can sleep at night knowing that once these 23 hospitals deploy currently inferior CPOE systems, thousands more lives will be lost, opening the door for another non profit savior.

  12. CCHIT has no leader! No one is sure when Mark Leavitt, CCHIT Chair, left CCHIT, since Leavitt’s departure plans have not been openly shared at HIMSS.

    The only two staff ever listed on the CCHIT “About” page were Mark Leavitt and Alisa Ray. Then their photos mysteriously disappeared last September, but the two bios remained.

    Now there is no link to CCHIT staff on their website. CCHIT is a ghost ship with no leader, so the whole HHS “certification” work group is a farce. And there is still no replacement for Mark Leavitt at CCHIT.

    Of the three executives who have left HIMSS’ employment at the end of March, Dave Garets and Mike Davis will be missed. They were well-respected men and straight shooters, who communicated openly with their staff. Very approachable…

    We wish them both the best.

  13. @@@@Of the three executives who have left HIMSS’ employment at the end of March, Dave Garets and Mike Davis will be missed.@@@

    Yeah, they are going to work for the advisor company that guides Leapfrog Group, another for profit not for profit that promotes CPOE as an unproven leap off the cliff to death and injury.

  14. I’m with you Inga – have no idea where those 1M customers/users of the MMR PHR are coming from. Their PHR is one of the worst out there according to Chlimark’s research of the PHR market. As to their founder, he is not exactly the most reputable guy in business (or at least that is what I have been told). Google him

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