Giving a patient medications in the ER, having them pop positive on a test, and then withholding further medications because…
News 1/25/13
Top News
Quality Systems (NextGen) reports Q3 results: revenue up two percent, EPS $0.26 vs. $0.36, missing analyst estimates on both. The company reported a 29 percent drop in system sales revenue as operating expenses rose six percent. The earnings call transcript is here. The results were announced before Thursday’s market open, with shares closing down only 0.16 percent by the market’s close.
Reader Comments
From Kojak: “Re: Intuit Health changes. Medfusion founder Steve Malik is retiring in June and Sanjiv Waghmare is taking over as Intuit Health’s new GM.” The e-mail announcement was attached. Malik (above) was named president of the Intuit Health Group when Intuit purchased Cary, NC-based portal vendor Medfusion for $91 million in 2010. Waghmare is a VP of product marketing.
From WHIMSSical: “Re: booth demo stations. PowerPoint or video? Should vendors use PPT since nobody can hear the video?” I say video and/or a live demo backed by a credible and engaging demonstrator, but perhaps also a fast-paced and highly graphical looping PowerPoint on a big projection screen as a billboard to grab attention as attendees streak by. Readers, what would get your attention?
From Doc Tari: “Re: Allina. Did know if you heard Allina having a bit of restructure. CMIO Shrift left to Cleveland and now CIO over all the IS areas.”
From Carrie Prejean: “Re: HIStalkapalooza. What exactly does one wear to HIStalkapalooza this year? Bowling shoes? I want to come prepared because I am determined to win the ‘Inga Loves My Shoes’ contest!” When I first heard that this year’s bash was going to be in a (very cool) bowling alley, I was also perplexed on the proper attire. We are fine-tuning things, but suffice it to say that just about anything will go. We will once again have a red carpet, so arriving in stiletto heels and sequins will be totally acceptable. Alternatively, if you own a vintage bowling shirt, this could be the time to pull it out of the back of the closet. The shoe contest will include categories for those partial to high fashion as well as those who choose to adorn more functional bowling shoes. We will also be crowning a HIStalk King and Queen based on their total fashion package. Winners will be awarded amazing prizes, so don’t show up in your “straight off the exhibit floor” attire, especially if the look includes a company logo’d tee shirt.
From RFP: “Re: MD Anderson. Posts an EHR RFP.” The RFP strongly suggests that prospective bidders attend the pre-proposal conference on Wednesday, January 30 just in case you want to thrown your electronic hat into the ring.
From Slim: “Re: Optum. I read your update confirming that Humedica was bought by Optum. Wouldn’t it have to be announced since Optum is part of UnitedHealth Group, which is publicly traded?” I’m not an expert, but I believe SEC disclosure requirements cover only “material events,” meaning companies must file an 8-K form only if a merger, loss of a key customer, or policy change could reasonably be expected to impact share price in the company’s subjective judgment. UnitedHealth Group’s market cap of $58 billion and annual revenue of $111 billion would make all but a huge acquisition non-material.
From Bill O’Plenty: “Re: SB 1275. Crazy law introduced in Virginia.” Virginia State Senate Bill 1275, introduced January 14, would prohibit any organization that stores electronic medical information from (a) participating in the Nationwide Health Information Network; (b) performing analytics on multiple patient records for diagnosis, treatment, or population health management; and (c) processing medical data within Virginia if most of the patients represented live out of state. It also mandates that providers cannot be penalized for refusing to implement EHRs, that patient consent for electronically storing their information is valid only for healthcare coverage purposes, and that the state is prohibited from starting or operating an HIE. I e-mailed the office of the bill’s sponsor, Republican Senator Stephen H. Martin, to ask what he’s trying to accomplish with the bill, but I haven’t heard back. Senator Martin is running for lieutenant governor, which could ironically pit him against Democrat Aneesh Chopra, former White House CTO and advocate for all the items that the bill would prohibit, so perhaps he’s just trying to pick a fight.
From Wearing Dad’s Suit: “Re: Epic’s non-compete. Does it cover this?” Applicants for the head football coaching job posted on the University of Wisconsin’s HR website include a Walgreens pharmacist whose only relevant experience was as a season ticket holder, a Fedex driver who said he’d take $60K to lead the Badgers, and a financial analyst with Epic whose college athletics experience consists of having been a practice player for Tulane’s basketball team. I give our young Epic friend credit for trying even though he lost the $2 million job to a more experienced candidate who responded to the online posting, Utah State Coach Gary Andersen.
HIStalk Announcements and Requests
The latest highlights from HIStalk Practice include: Epocrates says its app has helped clinicians avoid more than 27 million adverse drug events. Farzad Mostashari, MD highlights some of the ONC’s 2012 achievements. Pharmaceutical companies and other businesses embrace advertising opportunities within cloud-based EMRs. E-visits may be as effective as in-person office visits for uncomplicated ailments. Dr. Gregg describes a day in the office in the Year 2063 (quite fun.) You know the drill: catch up on all the latest ambulatory HIT news, click on a few sponsor ads to find a goodie or two that might improve your life, and sign up for the e-mail updates. Thanks for reading.
On the Jobs Board: Cerner Experienced Providers, Product Marketing Manager, Healthcare Strategy Communications Specialist, Project Specialist.
Acquisitions, Funding, Business, and Stock
Healthcare social networking site iMedicor acquires iPenMD, which offers a digital pen solution to capture clinical data. iPenMD apparently bought the intellectual property of nextEMR this past July per a reader’s rumor report.
Merck Global Health provides $6 million in growth capital to eHealth Technologies, a provider of continuity of care solutions.
Praesidian Capital invests second lien debt capital in eTransmedia Technology to replace debt and fund growth.
Revenue cycle systems vendor Recondo Technology receives a $20 million growth investment from private equity firm Bregal Sagemount.
Healthcare Growth Partners releases its 2012 HIT Market and M&A review that summarizes capital markets, M&A, and capital raising activity for the healthcare IT and services sector.
Sales
Tampa General Hospital (FL) selects Merge’s CTMS for Investigators solution for enterprise management of clinical trials.
People
Huron Consulting Group adds Jim Agnew (Navigant Consulting) and Jeffrey McLaren (VHA, Inc.) as managing directors in its Huron Healthcare practice.
HIMSS promotes Thomas M. Leary to VP of government relations, taking the place of Dave Roberts, who was elected to the San Diego Board of Supervisors.
Iatric Systems promotes Frank Fortner from SVP of software solutions to president.
The Northeast Business Group on Health honors Truven Health Analytics president and CEO Mike Boswood at its 18th Annual Tribute to Leadership.
Clinical data integration provider Apixio hires Jonathan Murray (Aetna) as chief business development officer.
Intellect Resources announces triple-digit growth in 2012 and announces several promotions and hires, including the promotion of Eileen Dick to VP of technology and Cindy Orr to VP of go-live services.
Robert Rowley, MD (Practice Fusion) is named medical advisor for personal health care vendor LifeNexus.
Announcements and Implementations
CareCloud and HealthTronics partner to combine CareCloud’s PM product with HealthTronics’ UroChart EHR and meridianEMR urology-specific EHR platforms.
Fletcher Allen and Dartmouth Hitchcock Medical Center (above) announce the creation of OneCareVermont, the nation’s first statewide ACO that includes 13 hospitals and hundreds of primary care physicians. We announced their plans in September.
Three Ontario hospitals go live on PatientKeeper Physician Portal, Mobile Clinical Results, and NoteWriter, including Alexandra Marine & General Hospital and two hospitals in the Huron Perth Alliance.
The RFID in Healthcare Consortium and Intelligent Hospital.org recognize six organizations for their advanced use of healthcare technology solutions.
GE Healthcare introduces Centricity Practice Solution 11.
Other
Winthrop Resources is conducting a survey on cloud solutions and bring-your-own-device practices. If you’d like to take about 10 minutes to help them out, the survey is here.
HIMSS finds yet another way to offer preferential treatment for its higher-ranking provider members whose purchasing influence makes its vendor members salivate. Healthcare Transformation Project offers “exclusive access” to services, meaning of course that someone has to be excluded (like the rest of us dues-paying members). For example, invitation-only HTPers get “up-front VIP seating at the HIMSS13 Keynote Address by President Bill Clinton” (I was going to insert a cigar joke, but decorum prevailed). The Transformers who are willing to spend $295 of their employer’s money to attend its annual forum at the HIMSS conference get to hear a bizarrely HIT-unrelated group of political speakers – former Florida Governor Jeb Bush, Democratic political strategist Donna Brazile, and former Nixon speechwriter Pat Buchanan. HIMSS says that “participants will make commitments that will translate goals into meaningful and measurable results in their own organization or community,” so we can all look forward to seeing how those work out for patients. Meanwhile, HIMSS offers vendors a bunch of expensive ways to get in or near those decision-making faces, with $50K buying you a podium speaking slot and free tickets for prospects who would be impressed by Pat Buchanan.
Cerner and Sporting KC take heat for failing to keep their promise to build a $35 million youth soccer complex in return for the $200 million in taxpayer-funded incentives they received to build their professional soccer stadium and Cerner office buildings. The youth fields were supposed to in use by now, but work hasn’t started.
Spain’s leading newspaper says it was duped when it ran a fake photo of Venezuelan President Hugo Chavez in his hospital bed, which the paper was told had been taken illicitly by a hospital nurse. The image, widely panned as unconvincing, turned out to be a screen shot of a YouTube surgery video from 2008 featuring an acromegaly patient being intubated.
The local TV station covers the use by Georgetown University Hospital (DC) of the iPad-based patient data collection system from Tonic Health that replaces paper forms in the doctor’s office. The story says other Tonic users include Mayo, UCLA, the VA, and Kaiser. The company says the product integrates with EHRs via HL7 or can send a CCD record. It offers a free version with limited functionality. Founder and investment information is here.
As tweeted by @Cascadia: a Virginia medical practice charges patients for using its patient portal, billing $125 per year for Gold access to make appointments and refill requests, while the $250 per year Platinum plan adds three electronic visits. That’s the opposite of every other industry, where free online services encourage customers to do it themselves without tying up an expensive employee. This is like banks offering free teller service but charging for ATM access, or maybe McDonalds adding a drive-through surcharge.
A Texas judge orders the deposition of two partners of a CPA firm accused by a medical practice of failing to secure the accounting system it installed in the practice, which the practice says allowed an employee of the practice to embezzle $1 million over five years.
Weird News Andy says this man wears his nose on his sleeve, also wondering if he will pick his nose in public. British scientists are using a man’s own cells to grow a new nose to replace the one he lost to cancer. They have two noses underway (“just in case someone drops one,” the researcher said) and the patient will chose one of them to be implanted under the skin of his arm until it’s ready to transplant.
I had a feeling where WNA’s story was going when I saw his best-ever headline, “Nothing like having a cold one after work,” but I still nearly choked on my soda when I saw the story, in which a male hospital nurse is arrested on suspicion of having sex with the body of a deceased patient.
Sponsor Updates
- Nuesoft Technologies CEO Massoud Alibakhsh discusses data security and Nuesoft’s technology platform in the video above.
- Awarepoint celebrates its tenth anniversary and recaps key successes.
- GetWellNetwork Founder and CEO Michael O’Neil delivered Thursday’s keynote address on interactive patient care technologies at the IPC Symposium at Hasbro Children’s Hospital (RI).
EPtalk by Dr. Jayne
Your tax dollars at work. On Tuesday, the US Supreme Court rejected an attempt to reopen Medicare claims that are more than two decades old. The hospitals assert that CMS miscalculated payments between 1987 and 1994 that were intended to compensate their treating large numbers of low-income patients. Based on the fact that it took my local academic medical center over a year to settle the bill for a routine eye care visit, it doesn’t surprise me that it takes years for hospitals to figure out they’re missing money.
Attention vendors: Mayo Clinic releases a new list of the top reasons for visiting US health care providers. Maybe you should use this as a starting point for your primary care office visit templates rather than some of the bizarre things I sometimes see on your screens. Granted the data is from Olmsted County, MN, but it looks surprisingly similar to my clinic roster this week except for the absence of “flu” and “freaking out that spouse has the flu.”
I received my first HIMSS-related mailing today. It was so underwhelming I can’t even remember who it was from. When I went to dig it out of my recycling bin, I couldn’t find it – which means it was nondescript as well. Great job, marketing team!
A wise man once told me to always spend a small amount of time “looking for your next gig” because things are constantly shifting in the world of medicine. For those of you who think the same way, ONC is looking for a policy advisor “who knows meaningful use policy backwards and forwards.” I was curious, so I checked out the link and got the best laugh of the day. The low end of the salary range is $123,758. Leave it to the federal government to specify it down to a bizarre dollar amount.
I had lunch with four of the smartest women in the world today. Three have been my boss in the past while the fourth who taught me everything I know about billing. Here’s a shout out for leaders who not only know their fields but “get it” as far as motivating employees to excellence. Thanks for keeping me grounded and reminding me that although I currently work in chaos, I can always count on your listening ears. And your unbiased opinions when I text you pictures of shoes I’m thinking of buying. And your assistance with crafting the “Typhoon Jayne” cocktail for HIStalkapalooza. Salud!
Contacts
Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.
More news: HIStalk Practice, HIStalk Connect.
Wow- amazing how people mix up and misunderstand these banking and McDonald’s analogies. Our current “pay for volume”/Fee-for-service reimbursement model is like banks loaning money without interest if you borrow online, or McDonalds not giving away free food just because you used the drive-through service. They don’t do that… so we can’t expect doctors to do that either… If we get paid to see patients in the clinic, then why would we give away the same care for free just because the patient emailed us? Obviously, this is one of the reasons we need to shift to a “pay for value” system where we get paid “to take care of a patient”, not simply to “see a patient in the office”. Believe me – docs want this to happen as much as anyone!
It’s fascinating to think that most concierge docs highlight that they do free web and email based care… which is actually cheaper for the docs than if the concierge patient came into the office. And the real irony is that in the 1980s-1990s with managed care, trying to take care of an HMO patient via phone (or email) was considered “bad care” by doctors trying to not let patients come into the office – we can’t win! 🙂
In the end, as it’s been said again and again… Incentives Matter (whether you think they do or not). So let’s incentivize the right things and let the system be innovative in figuring out the best way to do the right things!
Re: Cerner, Sporting KC and the missing soccer fields – – Cerner never confuses ‘selling’ with ‘installing’.
Surprised you didn’t catch the WNA reference to growing two noses “just in case someone drops one” as a refernce to Woody Allen’s film “Sleeper.”
@DrLyle
I think the bigger issue is charging to make an appointment or using other services that otherwise they could do over the phone. That’s the kick. You don’t charge the patient for every phone call to schedule an appointment. Or a call to ask for a refill. Or a call to talk about their most recent lab results. Why charge for the patient to do something that they would otherwise do for free?
To take it to a McDonald’s analogy…it’s like charging the user a fee to use the outside order prompt when they could go inside for free.
Sorry for the cross post, I accidentally commented on the News section first:
Charging for portal access isn’t as rare as some might think. Many smaller, primary care practices are passing along the fees they get charged by their vendors. Here’s an example:
http://www.thecenterforadvancedpediatrics.com/portal.html
Access to the portal requires membership in the Patient Service Plan, which is $40/patient or $100/family.
Dr Lyle,
By requesting a refill or obtaining my own immunization record through a portal, I am not monopolizing the time of an office staff member by reaching out over the phone to place a request which then requires further attention within the office. Allowing patients portal access to information that is readily available in the EMR saves your staff time; not to mention the time savings that your office staff gain by completing the portal request with a few clicks rather than having to make further phone calls, copying/printing, etc, to complete the patient request.
Being compensated for e-visits is one thing, and I agree that physicians should be compensated for such visits. But patient portals offer conveniences for medical practices, not just the patient. Patients shouldn’t have to pay for that.
Abe Froman, the Sausage King of Chicago??
Johnny B and Nurse D… You are right, I was focusing on the issue of charging for e-Visits. I agree that charging for portal access to view info, or make an appointment, handling refills, or providing lab results or handling minor questions can and should be a free service – that has always been our group’s philosophy. Although others can make a reasonable argument that someone still has to pay to set those up, and for a primary care doc- charging patients might be the only way to recoup. Additionally, for issues like minor questions and med refills… they do take up time and cognitive load – your lawyer would charge you for extra questions, why don’t doctors? It’s not fully black and white… but I do think it will get easier as decision support tools allow for easier ways to handle these questions without needing doctors, and as reimbursement aligns with taking care of the whole patient, not simply face to face visits.
I find it a bit bizarre that people understand that lawyers can charge for every little second of time – whether it’s a phone call, an email, drafting a document, or just expert cognitive time – yet medical providers are begrudged the same. Perhaps it’s because medical practices haven’t always charged for such service provision components (e.g., some charge for signing school forms or records copying; some don’t.) Lawyers have always been very good at billing for all such work.
Just because online access requires less staff time than a phone call and/or record copying, etc., it doesn’t mean that providing access to those online services is cost-free to the practice. So how is a medical practice supposed to recoup the cost for providing such enhanced services?
Banks and McDonalds do it by increasing their charges in other areas. Goodness knows they don’t implement such things as ATMs and drive-thru lines out of their desire to make our lives easier. The cost to build, install, and maintain those conveniences are added elsewhere into the fees and prices of their services and burgers. We may not see it as a “convenience charge” on a sales receipt, but it’s there nonetheless.
Certainly no one begrudges any business the need to generate income sufficient to offset the costs of doing business along with some margin of profit to maintain their financial viability. But, where does a small primary care practice “hide” such fees?
The Center for Advanced Pediatrics (the link that T Bolin provided) offers access to viewing the portal for free, but interaction with it has a relatively nominal surcharge (< $0.11 per day). Their explanation for their service and fees is pretty good as follows:
————
"IS THERE A COST TO ACCESS THE PATIENT PORTAL?
No, however use requires your family to participate in the Patient Service Plan. This plan is to help defray the large cost associated with monitoring and hosting such an extensive patient resource. It also replaces the many fees associated with non-medical services that were previously incurred. If you require forms and are not part of the PSP, you may still obtain them for a fee…"
"Families that do not register will continue to receive excellent pediatric care but will be charged accordingly for any of the services above that they may need. Those who do not register will not be able to communicate with physician or office staff via email. If the doctor’s signature is required for school, sports or camp on any form, there will be a fee of $25 per form. In addition, any items that you need from our office must be picked up; they will not be mailed or faxed home. Our office staff will adhere strictly to this policy."
————
So, they actually are charging their families LESS to access services via the online portal than they do for traditional phone calls, records copying, form signing, etc.
Personally, I'd be happy if insurance companies offered to pay me to build out and maintain such online conveniences for the patients they are "caring for" so that I wouldn't need to ask families to cover such costs directly. But, until the inscos do (ahem…cough…sputter), I see no moral or ethical issues with asking customers (i.e., patients) to pay a little extra in order to receive a little extra benefit and convenience, and, in the long term, save them money and time.