My radical, probably very bad idea to solve this problem is to base health insurance premiums on one's ability to…
Third-party firms that implement vendors’ applications outperform the vendors themselves – except in the case of Epic. Deloitte earns the highest overall marks among third-party firms in KLAS’s survey. Coastal and Peer Consulting outscored GE in overall customer satisfaction by 30 or more points; ACS and Vitalize beat Allscripts by 20-plus points, and Encore and Vitalize outscored Cerner by 20-plus points. Epic outperformed them all.
From Johnny “Hot Rocks” Garcia: “Re: making appointments online. Check out ZocDoc and take note of its investors!” ZocDoc allows searching for doctors within a ZIP code by specialty and accepted insurance. It’s pretty cool, although available only in eight metro areas so far. They have an iPhone app. Investors include The Founders Fund (run by the founders of PayPal, Napster, and Facebook), Jeff Bezos (Amazon) and the chairman and CEO of Salesforce.com.
From Jordan: “Re: copied medical records. Kind of expensive for an electronic copy.” Texas Health Resources charges state-mandated fees for medical record duplication: $42.05 for the first 10 pages of a paper record, $64.07 if they’re on microfilm, and a flat fee of $76.20 for electronic records requested in electronic form. The state may set the price, but I would have to guess hospitals had input into the rather large numbers. That makes the paper statements of banks look like a great deal, although their free online option isn’t even offered by hospitals. Charging more for an electronic dump is odd, although if you’ve looked at a hospital chart, your $42.05 isn’t going to go far considering the stacks of paper that go far beyond 10 pages. Maybe they should just charge law firms 10 times that amount and let patients have copies of their own information at no cost. Most hospitals think they’re doing patients a big favor by letting them see what they’ve written about them.
From Viking: “Re: GE Healthcare. A marketing director friend had their job eliminated this morning, saying there’s a sweeping org change underway.” Unverified. GEHC doesn’t respond to personnel rumors, so I didn’t even bother asking.
From Terminator: “Re: PHRs. I wonder if their functions are gaining ground as standalone apps that people actually do use? For example, Walgreens keeps all my prescription records and I can access them from anywhere, so I have no reason to import them to a PHR. I use an online tool for diabetes logging, although it would cool if it were updated automatically from any meter I use. If I see a glucometer that allows batch uploads of data to a site like this one, I’m grabbing it! That’s all I want in a PHR except for lab data and the ability to communicate with providers, but patient portals are adding PHR-like features as well, some of which have access to data and have appointment-setting tools.” That’s the big debate – would consumers prefer an independent but minimally functional tool like Google Health or one that’s rich in function and data, but tied to a specific provider? So far, they seem to be saying B (and who can blame them, given that both are free?) Notice above that Walgreens even offers online pharmacy chat right from the public Web page, although it would be interesting to know who’s on the other end.
From LaidOffInDallas: “Re: UT Southwestern Medical Center. Just laid off several IT employees.” UT Southwestern just announced that, due to the loss of $31 million in state funding, it has cut 350 staff positions, laying off 105 employees.
From Former CIO: “Re: Epic art. I would suggest that Mr. Ciotti’s opinions about wasting client money are focusing on the wrong target. The vendors who are wasting money are those that spend more on marketing and less on development, thus producing products that are not integrated and do not support patient care needs. Perhaps the artwork enhances employee attitudes and they get more work done for the money. The cost of the product is a fraction of the true cost of ownership when one considers clinician time and effort. Even so, the cost of the product is still competitive.” At least Epic is sharing the investment with employees instead of hogging the goodies for its executives in a “we’re better than you” kind of way, such as companies that give the suits reserved parking spaces, private bathrooms, and offices that would hold 20 of the veal pen cubicles that the real workers toil in. I can’t vouch for Judy’s office since I haven’t seen it, but I picture it as quirky but modest. That’s a fun challenge: e-mail me with a description of the top dog’s office wherever you work – I will run them anonymously. If they have really splendid digs, make sure to snark it up some.
HIStalk Announcements and Requests
Stuff you’ll want to check out this week on HIStalk Practice: Micky Tripathi details the difficulties associated with tracking and reporting clinical quality measures for Meaningful Use. HHS halts its mystery shopper program for measuring access to primary care. Experts suggest reasons practices are behind schedule for the HIPAA 5010 transition. Dr. Gregg struggles with HITECH guilt and living on the dole. Costco jumps into the EHR world with deals on Allscripts MyWay. AAFP launches its $90/year clinical messaging system. While you are over on HIStalk Practice, sign up for the e-mail updates like the rest of HIT’s coolest kids.
Listening: reader-recommended Belle and Sebastian, 70s-style indie pop from Scotland. A nice sample is here, if you can overlook the fact that the preachy announcer sounds like Mike Myers playing the Scottish dad in So I Married an Axe Murderer.
I’m thinking about refreshing the look of the site and maybe even changing the smoking doc logo in some way. I’ve been using this layout for years, and while I don’t really care all that much one way or another, I guess it’s time for an update (I think Inga is interested). If you have ideas, let me know. Most of the responses I’ve received in the past have been of the “don’t change anything” variety, so that’s the default course of action to challenge.
I’ll probably publish a Monday Morning Update even though it’s Independence Day (please call it that rather than the Fourth of July). You can amuse me over the weekend by connecting on LinkedIn and Facebook, signing up for e-mail updates, or just checking in to let me know that I’m not the only one with HIStalk on my mind. Have a great holiday. I’ll be taking a few days off starting next weekend, leaving the fabulous Inga and Dr. Jayne in charge.
Jobs on the sponsors-only Job Board: Director of Marketing – Hospital Segment, Director Sales Operations, Senior Enterprise Sales Executive Hospital Southeast. On Healthcare IT Jobs: CEO & President, Clinical Nurse Analyst, Epic Resolute Consultant.
Aspirus (WI) signs a clinical documentation contract for MedQuist’s DocQment EP.
University of Utah selects Authentidata Holding Corp. for its three-year telehealth project that includes health information exchange, workflow management services, and remote patient monitoring solutions.
University of Oklahoma chooses OmniMD as a preferred provider for medical transcription services.
VHA signs an agreement with Deloitte to offer RCM consulting services to its 1,350 not-for-profit community hospitals.
Ochsner Health System (LA) signs up for Philips VISICU, which will make it the first eICU program in the state when implementation is finished next year.
Announcements and Implementations
InterSystems names Gila River Health Care (AZ) the winner of its Breakthrough Applications Award for using InterSystems DeepSee BI technology with its Diabetic Analysis Management System.
Scripting automation vendor Boston Software Systems celebrates its 25th anniversary.
Medtronic announces a free smart phone app for its CareLink telemetry system for implantable cardiac devices.
Innovation and Research
Cisco announces its Android-powered Cius tablet, due out at the end of July, with the video above featuring Palomar Pomerado Health Chief Innovation Officer Orlando Portale (starting at around the 41 minute mark). The Cius will cost $700, has no 4G connectivity, has only a few dozen apps available from Cisco’s own store, and is sure to bring up the puzzled question, “Why would I want this instead of an iPad that costs less?”
Oracle will buy storage startup Pillar Data Systems for an undisclosed price. That company’s CEO and majority shareholder: Larry Ellison, who also happens to be the CEO of Oracle. He claims he recused himself from the acquisition discussions, although he didn’t mention why a guy with an Oracle-generated net worth of $40 billion was off running another company on the side.
The developer of Nashville’s Medical Trade Center says it will not break ground until at least 60% of its space is leased. The developer anticipated this goal would have already been met, but a mere 20% of the space is under contract. Committed lessees so far include HIMSS, Steelcase, and mdi Consultants.
A Florida doctor who moved to a cloud-based EMR a year ago loses access to the records when his Internet connection goes down. He’s been treating patients blindly for three days so far while Comcast tries to fix his broadband. I’ll predict that ONC won’t make his experience the focus of one of its feel-good EMR stories: “If can’t access a patient’s medical records, I’m afraid in the rush of things I might miss something or not do as good a job as I normally would.” His phones are down, too.
Note to companies seeking to become “leading” suppliers in healthcare: your message tends to be more powerful when you reference the correct vertical market in your press release (unless there’s a connection I missed between vehicle dealers and healthcare).
I saw a press release about a survey claiming that more than 50% of consumers would choose a hospital based on their Facebook and Twitter presence. I found that hard to believe, so I e-mailed the company to ask for the methodology. They offered to provide it if I bought the report for $1,250. I guess I’ll just remain skeptical.
The coroner says mistakes made at Marin General Hospital (CA) helped kill an ICU patient. A doctor, a respiratory therapist, and three nurses were identified as putting the patient on a ventilator, then leaving the room without making sure it was working. It wasn’t.
A study of electronic prescriptions finds that about 10% contain at least one error, the same percentage as paper prescriptions. I only have access to the abstract, but I notice that (a) the electronic prescriptions reviewed were form 2008 for some reason; (b) the study treated all errors equally, with the most common being omitted information (which causes no patient harm); (c) it looked at “potential adverse drug events,” which could indicate lack of decision support on the e-prescribing end, but not necessarily (for example, I don’t know if they counted potential drug interactions as “errors” if the electronic prescriber of Drug A was the same one who prescribed Drug B, which is not necessarily either prescriber’s fault).
Weird News Andy says this man couldn’t have picked a better place to have a heart attack. He complains of chest pain during a cardiologist’s lecture on heart disease at Central Maine Medical Center, then collapses with no pulse or respiration. One of three cardiac nurses in the room jump starts him with a defibrillator, whereupon he is treated in the ED and is doing fine.
Strange: a former managing director of bankrupt investment banking firm Lehman Brothers is busted for trying to pass photocopied prescriptions for Oxycontin and Ritalin at the local drug store. Police follow his Range Rover to his $35 million home and arrest him.
- T-System celebrates its 15th anniversary with a five-video series about the history of emergency medicine and of the company.
- ADP AdvancedMD will expand its workforce by 45% this and add up to 100 new jobs in the Salt Lake City area.
- West Penn Allegheny Health System (PA) will continue its rollout of Allscripts EHR to its employed physicians and begin offering Allscripts MyWay to its 2,000 affiliated physicians.
- East End Health Alliance (NY) and its member hospitals choose MedVentive’s Population Manager for sharing clinical information and monitoring performance against evidence-based medicine. MedVentive also announces that former Massachusetts HHS Secretary Charlie Baker is joining its governing board.
- MEDSEEK enters a strategic alliance with Diebold to offer an automated patient check-in, co-payment, and appointment scheduling solution utilizing Diebold’s self-service kiosk.
- ZirMed earns its highest-ever rating in the most release KLAS rankings. In addition, 100% of its surveyed clients indicated they would buy ZirMed again.
- Indiana University Health Centers select eClinicalWorks for two campuses.
- Iatric Systems announces that its PtAccess, Patient Discharge Instructions, PHR Connect, Clinical Document Exchange, Visual Flowsheet, and PHI Interface solutions have received ONC-ATCB 2011/2012 Certification.
- Capsule’s DataCaptor medical device integration software earns a KLAS score of 90.5 with three Konfidence Level check marks in the 2011 mid-term performance review.
- Washington and Idaho Regional Extension Center (WIREC) includes e-MDs as one of the seven vendors chosen for its initial Group Purchase Program.
- LawLogix joins Perceptive Software’s partner developer network to offer a central document repository with forensic-level audit controls using Perceptive’s ImageNow software, allowing HR departments to manage I-9 and E-Verify compliance requirements.
- A new KLAS report on HIEs names MobileMD as the highest-rated vendor serving the private HIE market segment.
EPtalk by Dr. Jayne
Multiple news outlets (including HIStalk Practice) picked up the announcement that the Department of Health and Human Services is scrapping its “Mystery Shopper” initiative, originally aimed at determining whether physicians’ acceptance of new patients depended on type of insurance. Observant folks will notice they left the door open to bring this one back later though, stating, “we have determined that now is not the time to move forward with this research project.”
I don’t need a bunch of grant money to tell you the answer to the question of “can you get seen quicker with good insurance” is “yes.” And if we’re talking about specialist physicians, the answer is “double yes.”
I practice in a major metropolitan area with multiple health systems, numerous tertiary referral centers, and some topnotch medical schools. From experience, if you are a Medicaid patient who needs to see an orthopedic surgeon or a neurologist, there less than a handful of places that will see you at all, and even then you’re going to wait. Most likely, you’re going to wind up being seen in a residency clinic.
I’m fortunate to work for a health system that doesn’t force employed physicians to cap Medicaid patient panels — we have a mission to care for those in need. As a result, I do more than my share of Medicaid care compared to my private practice colleagues, who may cap at 150-200 Medicaid patients if they even take Medicaid at all (and many don’t). Reimbursement doesn’t cover the cost of the visit, and frankly, I don’t remember the last time my practice made a profit. If not for the mission of the health system and their generous subsidy, I’d have had to go out of business before I ever had a chance to make a go of it.
There are some patients who are working the system, but the majority of my Medicaid patients are folks that have fallen on hard times or have had other life-altering events such as an unplanned pregnancy or a severe medical issue impact their lives. Some of the most rewarding patient relationships I have are with these patients, who are genuinely appreciative of the care they get.
I practice evidence-based medicine and don’t refer unless I have to. It breaks my heart to have patients waiting six months or more to see a specialist when I know that if they had a commercial payer, I could get them an appointment within a few weeks. I’ve been forced to expand my scope of practice because specialists won’t see Medicaid patients. It’s almost like being the Little Doctor on the Prairie when in fact, I’m just a few doors down from Starbucks.
(And thank you to my “generous” specialty colleagues willing to proctor me in expanding my procedural techniques because you didn’t want to actually see the needy patients yourselves. Guess what? I don’t just do them on Medicaid patients now — I keep all the procedures in-house.)
I’d be happy to charge CMS, HHS, or anyone else willing to listen a hefty fee to tell them how to increase access for Medicaid patients. States such as Colorado are already at critical shortages of primary care physicians. Articles such as this should be required reading for the politicians deciding how to carve up the healthcare pie. Some ideas:
- Increase the attractiveness of the primary care specialties by increasing Medicaid and Medicare payments for primary care and other cognitive (non-procedural) specialties. The relatively low primary care salaries — coupled with hefty administrative burden, constant on-call and hospital work, and rising patient expectations — are no match for the financial lure of other specialties.
- Increase loan-repayment plans for primary care and/or offer more zero-interest loans for these disciplines. Most of my classmates came out of training with at least a quarter of a million dollars in student loans. Unless you have a vocation for primary care, a salary of $300-$400K each year looks a lot more welcoming than the $130-$140K primary care starting salary when you’re sporting a student loan payment that’s more than most mortgages.
- Increase the availability of case managers, care coordinators, dieticians, health coaches, and social workers for Medicaid patients at no cost to the physician. Don’t tie it to some ACO-type scheme. I promise with this infrastructure, if you build it they will come. (My apologies to William Kinsella for shamelessly poaching your line.)
- Remove administrative barriers for care of medically and/or socioeconomically needy patients, regardless of payer. In addition to the above, remove the requirement that physicians pay for translator services for patients and reimburse this through payers, public or private. I’ve paid over $450 for interpreter services for a visit that I was paid $24. And this is a patient that needed to come in every month because they were complicated – it was a minimum of $150 to get the interpreter to come. Thank goodness my health system is willing to subsidize this, because most private docs don’t have the luxury.
- Reduce the administrative burden related to health IT initiatives. If you’re going to require something (like submission of data to an immunization registry or submission of syndromic surveillance data) ensure that the states actually have an infrastructure to receive the data. Do not send me on a pointless mission to contact department after department across multiple states trying to find someone who has any idea what I’m talking about, only to find out my state can’t accept either kind of data.
- Make quality initiatives make sense. Micky Tripathi’s Pretzel Logic: The Quality measure Conundrum says it all. Most clinicians want to give good quality care. But when it becomes so complicated that the average physician is torn between the spirit of the incentive program and the somewhat malleable calculations to demonstrate it, there are a good chunk of docs that decide it’s just not worth it.
- Understand that the push for healthcare IT has actually made it easier for providers to “cherry pick” the healthy patients or “lemon drop” those that are non-compliant or have poor payers. Back when we had paper charts, it was a lot of work for providers to weed those patients out. Now docs can report on them on a monthly basis with the click of a mouse and decide which patients are too difficult to manage. Probably not what was intended, is it?
So even though it’s dead for now, I’m taking bets on how long it takes the Mystery Shopper program to show itself again. Any takers? E-mail me.