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May 5, 2016 News 6 Comments

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BIDMC CIO John Halamka, MD dissects the nearly 1,000-page MACRA NPRM and makes interesting points:

  • It’s a zero-sum redistribution rather than a stimulus program –  some clinicians will be paid more while others will be paid less based on performance.
  • MACRA doesn’t impact hospitals or Medicaid EHR incentive participants. For them, Meaningful Use and quality reporting continue.
  • ONC in March gave itself more authority over how EHRs are used in the field, with the proposed MACRA wording requiring clinicians to sign off that they have cooperated with ONC and that they haven’t disabled the interoperability capabilities of their EHRs. He says a lot of people are going to see ONC’s self-proposed surveillance role as overly intrusive.
  • Clinicians can meet the secure messaging and view-download-transmit measures by having a single patient participate.
  • Clinicians must participate for the full 2017 year, use a 2014 or 2015 certified EHR, and report to either eight Stage 2 or six Stage 3 measures in the Advancing Care Information objectives that replace Meaningful Use.
  • Halamka also dryly notes a requirement that clinicians “continue to practice medicine” and that “listening to each patient’s story, being empathetic, and healing are optional.”
  • He concludes that “sometimes when you remodel a house, there is a point where additional improvements are impossible” and says that nobody can understand the 962-page MACRA document, concluding that clinicians probably only have two choices – become a salaried employee or take a hospital job to avoid the complexity.
  • The usually-optimistic Halamka summarizes darkly, “As a practicing clinician for 30 years, I can honestly say that it’s time to leave the profession if we stay on the current trajectory.” That’s a significant development since he called for rolling Meaningful Use into a less-prescriptive quality measurement program, but he’s not happy with how it turned out.

Reader Comments


From EMR Expert: "Re: King Khaled Eye Specialist Hospital in Saudi Arabia. It will become the first hospital in the Middle East to reach HIMSS EMRAM Stage 7.  That’s very good news for InterSystems, hard luck for Cerner and Epic.” Unverified. The InterSystems TrakCare-using hospital, a Johns Hopkins partner, reached Stage 6 in December 2014.

From Compressed Coal: “Re: Quintiles-IMS Health merger. Quintiles acquired Envoy in 1998 to create a competitor to IMS. It didn’t work and Quintiles eventually sold the business to Healtheon / WebMD. Envoy is one of the core assets of Emdeon, which is now Change Healthcare. I guess Quintiles finally got what it wanted all those years ago.” I wince remembering those irrational dot-com days of 2000, when Quintiles sold Envoy to Healtheon / WebMD for $2.7 billion after acquiring it in a $1.4 billion stock swap just a year earlier.

From Chili Dog: “Re: SPARC. CMS has notified the winners of its 10-year, $24 billion Strategic Partners Acquisition Resource Contract (SPARC). Here’s the small business winner list that CMS hasn’t announced yet.” I wasn’t familiar with SPARC, but the RFP description says it’s a multiple award, indefinite delivery / indefinite quantity contract divided into two pools – small business and unrestricted – with a $25 billion ceiling. It is described as, “This contract will provide strategic, technical, and program management advice, guidance, and support services to CMS to facilitate the modernization of business processes and supporting systems and their operations. These systems will include the Federal Healthcare Exchange and Medicare / Medicaid information technology systems. Other Department of Health and Human  Services Operating Divisions (HHS OPDIVs) may place orders under this contract as well.”

HIStalk Announcements and Requests

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Mrs. M from Pennsylvania is using the three iPad Minis, cases, and document camera we provided in funding her DonorsChoose grant request to challenge her second graders with STEM skill exercises and games. She adds that the students who don’t have access to technology at home are especially excited about learning and working hard.

Listening: new from reader-recommended Purson, an inexplicably obscure female-led British psychedelic band that sounds like all the best musical parts of the trippy early 1970s (Deep Purple, Jefferson Airplane, and The Doors come to mind). The female lead singer-songwriter, Rosalie Cunningham, can and does shred it on guitar. They just started a small-venue US tour. They are outstanding, including their choice of name.

This week on HIStalk Practice: CMS, AMA offer resources for physicians struggling with MACRA. Jonathan Bush sounds off on Athenahealth’s trajectory, gives thanks for Obamacare. DAS Health acquires EHR/PM assets of Jackson Key Practice Solutions. "HIPPA" loses its luster thanks to a fraudulent letter to patients. Tandigm Health rolls out virtual visits courtesy of TouchCare. Warburg Pincus acquires DocuTap. Dr. Gregg channels Prince in his ode to MACRA.

You can rekindle your (hopefully) fond memories of HIStalkapalooza in Las Vegas by checking out Elsevier’s great video. Thanks to Elsevier for creating the video, sponsoring the event, and sponsoring HIStalk for several years. I guess I need to decide soon whether to do it again in Orlando since venue booking is always the first step, but it’s also the scary one where I sign on the line which is dotted an agreement to pay many dozens of thousands of dollars in hopes that sponsors will step up to keep me financially solvent.


May 11 (Wednesday) noon ET. “Measuring the Impact of ACA on Providers.” Sponsored by Athenahealth. Presenters: Dan Haley, general counsel, Athenahealth; Josh Gray, VP, AthenaResearch. Athenahealth will share the findings of real-time analysis of its provider network. The presenters will describe how patient financial obligations have changed, how physician reimbursement is trending, the patterns created by increased ACA coverage, and the effect of the latest ACA trends on physician practices.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock


DocuTap, which offers an urgent care PM/EHR, is acquired by private equity firm Warburg Pincus.


Envero Health, which offers care management and analytics systems, raises $14 million. CEO Dan Neuwirth was previously president and CEO of MedCPU Americas. The company’s website is irritatingly vague and artsy in failing to explain exactly what they’re selling, but a news search turns up its recent acquisition of two other Richmond, VA firms owned by local health systems, one that offers an HIE and another selling call center services. 


McKesson reports Q4 results: revenue up 7 percent, EPS $1.97 vs. $1.69, meeting revenue expectations but falling short on earnings. Technology Solutions wasn’t mentioned much in the earnings call except to say that margins are improving and hospital revenue is decreasing. Stock analysts didn’t even ask any technology questions as they focused exclusively on McKesson’s core drug business.


CPSI announces Q1 results: revenue up 51 percent, EPS –$0.07 vs. $0.49, missing expectations for both with the company blaming the timing of its $250 million January Healthland acquisition closing. From the earnings call, Healthland CEO Chris Bauleke has left CPSI well before the 12 months he agreed to stay on to help with the transition.


Cerner reports Q1 numbers: revenue up 14 percent, adjusted EPS $0.53 vs. $0.45, meeting earnings expectations but falling short on revenue.


Allscripts reports Q1 results: revenue up 3 percent, adjusted EPS $0.13 vs. $0.08, beating earnings expectations but falling short on revenue.


The Advisory Board Company reports Q1 results: revenue up 12 percent, adjusted EPS $0.46 vs. $0.30, beating earnings expectations but falling short on revenue.


The dour German engineers that run the gray metal conglomerate Siemens inexplicably turn their marketing people loose to justify their existence in creating a forcibly fun new identity for the healthcare business, with the end result being that Siemens Healthcare will now be known as – it’s making me retch as I type it – Siemens Healthineers, which sounds overly cheery for a company best known for supporting the Third Reich and bribing government officials. Feel free to sing along with the video above that celebrates the “innovators and family of friends” who mostly seem embarrassed by the corporate misstep that is exploding with mandated joviality around them, with the Disney-esque song running way too long before it finally ends to stunned, half-hearted applause. The only people who seem to be actively engaged in the white-bread proceedings are two on-stage suits, who I assume were in charge since their beaming faces and stiff dancing are the exceptions among an otherwise borderline hostile crowd who would clearly rather be anywhere else. They should have passed out the faux Blue Man Group costumes at the door to prevent the friends and families of employees from recognizing them. Surely the out-of-touch executives that approved the name without thinking it through are horrified by the scorn it is generating, leading to my prediction that it will be quietly retired within a few weeks and everybody who was involved will claim they didn’t know anything about it or were just following orders.


Startup Ns1ghter offers free, unlimited online access to its board-certified doctors. It boasts of a machine learning platform whose contribution is not described, but that appears to be intended for developing care algorithms. The “free” part is made possible by “funding and marketing partnerships.” The choice of name is bizarre without being memorable (they apparently pronounce it “insighter” without acknowledging the presence of the numeral) and the company’s address on its privacy policy page is a residence in Austin, TX.



Salem Regional Medical Center (OH) selects Meditech 6.1 to replace McKesson Horizon.



Rock Health Founder and Managing Director Halle Tecco announces via Twitter that she is leaving the venture capital firm for unstated reasons and destination.


Kaleida Health (NY) hires Cletis Earle (St. Luke’s Cornwall Hospital) as VP/CIO.


David Chou (University of Mississippi Medical Center) joins Children’s Mercy Hospital (MO) as VP/CIO.

Announcements and Implementations

Optum, Medecision, and TriZetto launch a set of software and service offerings for state Medicaid Management Information Systems, taking advantage of a CMS change that provides federal funds for states to modernize their Medicaid enrollment, eligibility, and claims systems incrementally.

Government and Politics


Farzad Mostashari tweets out this CMS actuary’s graphic that shows the expected impact of MACRA on physician payments, which he describes as “financial suicide” for small practices. It suggests that 87 percent of solo practices will be paid $300 million less, or about $3,400 less per doctor. It’s interesting that the bigger the practice, the lower the expected rate of negative adjustment (dropping to just 18.3 percent for practices of 100 or more clinicians). The inevitable consolidation might sound like a good thing economically, but note that hospital consolidation has raised rather than reduced prices and patients are dealing with an even larger indifferent bureaucracy.

Privacy and Security

A hacker called “The Collector” offers 1.7 billion email passwords for sale, stolen from all of the most popular online email services. The hacker is selling the entire package for $1, asking only that positive reviews be posted on a hacker forum. Experts recommend changing passwords for email as well as any other sites where the same password was used.


Privacy advocates question Sharp Grossmont Hospital’s (CA) use of OR video surveillance in trying to determine which team members were stealing drugs. The hospital hid motion-activated cameras inside the computer monitors of anesthesia machines, thereby capturing video of every delivery and tubal ligation over a year without patient consent. The hospital says the videos show the doctor they suspected pocketing drugs, but the doctor says he was just keeping them handy and other videos show the doses being used on patients. The hospital doesn’t want to give the doctor’s lawyers access to the videos, saying they would invade the privacy of Sharp HealthCare, employees, and physicians.



The mainstream press picks up an FDA MAUDE database adverse event report filed by Merge Healthcare in which an unnamed hospital customer ignored the company’s antivirus configuration instructions for its Merge Hemo cath lab documentation system, failing to exclude huge medical imaging and data files. The hourly scans caused an incident described as, “A customer reported to Merge Healthcare that, in the middle of a heart catheterization procedure, the hemo monitor PC lost communication with the hemo client and the hemo monitor went black … there was a delay of about five minutes while the patient was sedated so that the application could be rebooted.”

A TransUnion Healthcare survey finds that three-quarters of consumers are worried about increasing healthcare costs as they watch their premiums, co-pays, and deductibles increase even before the 2017 rate increases. I have to assume that the 25 percent who don’t care about healthcare costs are funded in some way by taxpayers who do.

Study authors determine that medical mistakes kill more Americans than all other causes except heart disease and cancer. The study involves quite a few assumptions since death certificates don’t include codes for medical errors and BMJ seems awfully promotional in touting the article, but regardless of methodology, all of us working in healthcare know that patients die because of our screw-ups. Still, it’s hard to say definitively that a given medical error killed a patient, just like it’s hard to say that a given patient died of cancer rather than of chemotherapy complications.


An LA Times investigative report finds that Purdue Pharma, which has sold $31 billion worth of the narcotic OxyContin, knew that the drug didn’t really offer 12-hour relief as its packing claims, but it  stuck to those claims because the 12-hour dose was the only advantage the patented drug had over older, cheaper alternatives. The company instructed sales reps to tell doctors to increase the dose rather giving it more often, causing many patients to be ordered dangerously high doses and to go into withdrawal even while failing to achieve pain relief, feeding a cycle of addiction in which seven million Americans have abused the drug. Meanwhile, the company’s owners (the Sackler family whose name adorns several art museums) have amassed a $14 billion fortune.

Sponsor Updates

  • Ingenious Med launches a year-long bus tour to offer guidance to providers on how to lower costs through improved care.
  • Influence Health announces the 2016 EHealth Excellence Award winners.
  • Cumberland Consulting Group is rated by KLAS as the top-performing targeted Epic consulting firm.
  • InstaMed sponsors the 21st annual Taste for a Cure at UCLA Health.
  • PokitDok joins CommonWell Health Alliance.
  • Visage Imaging will exhibit at ACR 2016 May 16-17 in Washington, DC.
  • Netsmart will exhibit at the Decision Coordinated Health Care Summit May 9 in Baltimore.
  • Obix Perinatal Data System will exhibit at the Philadelphia Pregnancy Center Prenatal Summit May 5-7 in Philadelphia.

Blog Posts


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Currently there are "6 comments" on this Article:

  1. Regarding the new HIMSS level 7 organization in the Middle East. It’s great news that there is now a HIMSS Level 7 hospital site in the Middle East. This is the success of that organization, who undoubtedly worked very hard to achieve this recognition, not their vendor. Cerner and Epic have proven their system abilities, I doubt they will even care, so let’s not make this news about vendors and celebrate the eye hospital’s success.

  2. I don’t believe any ME organizations running Epic have been live long enough to apply for Stage 7…

  3. @ Hal Baker,
    Do not believe everything you read on vendors websites.
    I just checked HIMSS website below and King Faisal in Riyahd is nowhere to be seen.
    There are currently only 3 Hospitals and China and 1 in Korea in the whole Asian continent with Stage 7. So if the Intersystems site achieves stage 7 as per this rumor, they will undoubtedly be the first. Let’s all wait and see.


  4. @ John Jones – The claim in the original post was that King Khaled Eye will be the first hospital in the middle east to achieve himss Stage 7, not just one department within a primary care service within a hospital.
    One could argue that Hal Baker’s post is wrong not to say misleading.

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