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Monday Morning Update 1/23/17

January 22, 2017 News 10 Comments

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President Trump follows through on his promise to begin dismantling the Affordable Care Act on his first day in office by signing an executive order Friday that directs HHS and other federal agencies to “ease the burden” in doing whatever they legally can to hamstring the ACA.

Executive orders are more of a policy-signaling device rather than an unchallenged change to laws, but HHS discretion and its choice of which ACA issues to defend in court could affect key ACA elements in halting the payment of insurance subsidies (which were never approved by Congress but are being paid by HHS anyway) and tinkering with hardship waiver requirements to effectively end the “individual mandate” that at least theoretically requires people to carry health insurance.

The executive order happens before “repeal and replace” begins in earnest, before a Trump-appointed HHS secretary is installed, and in the absence of a replacement plan for the program that insures 20 million people.  

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From Herd Tracker: “Re: HIMSS and overly intrusive marketing with their new Media Lab. Remember a couple of years ago when you wrote about how they were going to track the movement of conference attendees via a badge-implanted chip?” I remember clearly, although I assume HIMSS quietly backed away from that plan. HIMSS10 featured tracking of attendees via RFID badge so that exhibitors could “derive a more accurate score of a visitor’s buying potential,” logging attendee movements that included which booths they visited and for how long. I was obviously upset back then as a dues-paying member:

The conference keeps getting more similar to a cattle-butchering operation: you’re herded into a holding pen (the exhibit hall) since the token educational offerings (getting less useful every year) intentionally go dark during major booth hours. You’re fed and watered in the exhibit hall with vendor snacks until it’s your turn with the the high-paying exhibitors. Now you’ll be tracked like livestock throughout the process … I can imagine what was going through the minds of the HIMSS dim bulbs who approved this — hey, we can charge vendors even more by selling them the personal information of attendees … and HIMSS can justify its exorbitant exhibiting costs by showing who dropped by. People seemed to be resigned to letting HIMSS do whatever it wants in the name of picking the pockets of its vendor members … Being tracked as nothing more than a roving sales prospect is just insulting. HIMSS apparently doesn’t extend its claimed interest in patient privacy to its own paying customers in the Ladies Drink Free model in which it pimps access to low-paying providers to high-paying vendors.


From Privately Held: “Re: Epic. A private equity group called Capricorn Healthcare lists Epic as one of its holdings, which is surprising given Judy’s repeated statements about being employee-owned and not being acquired.” The PE firm lists Epic as a current holding, but doesn’t specify when or how much it invested.

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One-third of poll respondents say their employer has cut expenses or reduced expectations due to ACA uncertainty.

New poll to your right or here: What is your reaction to HIMSS creating a conference and a division to help vendors sell to providers?

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We funded the DonorsChoose grant request of Ms. R in New York, who asked for math manipulatives.


I like to root for the little guy, so when HIMSS announced its marketing conference last week, I immediately thought of the HITMC conference that John Lynn and Shahid Shah have been putting on for a few years and wanted to help them out (unlike HIMSS, not only do they have no conflict of interest, they also came up with the idea first). HITMC17 is the networking and educational event for those in healthcare marketing and PR, featuring 30 presenters who will cover topics such as social media, brand advocates, online reputation, marketing automation, email marketing, branding, SEO, and content strategy. HITMC will be held at the SLS Las Vegas April 5-7, 2017 and promo code “histalk” will save you $300 on registration. I may ask Lorre or Jenn attend to help us understand how health IT marketing works (I’m a fan of marketing done the right way, but I confess that delight when it’s done hilariously badly). We’ll probably use only one of the two passes John has graciously offered us, so if you want to attend and are willing to write up what you liked and learned afterward in a short HIStalk article, email me and I might give you a free pass.

Listening: One OK Rock, a Tokyo-based foursome of 20-somethings that play hard if not terribly original alt-rock. It’s a bit intentionally boy-bandy at times, but at least it’s different than most of the chart junk.

Last Week’s Most Interesting News

  • The Wall Street Journal discovers that a Theranos lab had failed a surprise CMS inspection right before the company announced that it would exit the testing business.
  • The Coordinated Care Oklahoma HIE announces that it will shut down.
  • HIMSS announces a healthcare IT marketing conference and a new arm that will use the HIMSS database to more aggressively market the offerings of paying vendors.
  • Surgeon-author Atul Gawande, MD admits in a New Yorker article that he has undervalued the health contributions of PCPs that he calls “incrementalists” compared to the decisively curative but less-impactful work of surgeons.
  • The Supreme Court agrees to review the use of arbitration agreements to prevent employees from filing labor-related class action lawsuits, with Epic Systems being one of the handful of companies asking for a definitive ruling.


January 26 (Thursday) 1:00 ET. “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.” Sponsored by Healthwise. Presenters: Jim Rogers, RN, RPSGT, director of healthcare solutions, Persistent Systems; Jason Burum, chief client officer, Healthwise. This webinar will explain how to implement a patient-centered care coordination program that will increase quality as well as margins. It will provide real-world examples of how organizations used care coordination to decrease readmission rates, ED visits, and costs.

February 1 (Wednesday) 1:00 ET. “Get your data ready for MACRA: Leveraging technology to achieve PHM goals.” Sponsored by Medicity. Presenters: Brian Ahier, director of standards and government affairs, Medicity; Eric Crawford, project manager, Medicity; Adam Bell, RN, senior clinical consultant, Medicity. Earning performance incentives under MACRA/MIPS requires a rich, complete data asset. Use the 2017 transition year to identify technology tools that can address gaps in care, transform data into actionable information, and support population health goals and prepare your organization for 2018 reporting requirements. 


  • Long Island Jewish Valley Stream (NY) went live with Kit Check medication tracking in December 2016.

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

Government and Politics


As I expected but haven’t seen mentioned anywhere, HHS Acting Assistant Secretary for Health and former National Coordinator Karen DeSalvo, MD, MPH has apparently left her role with the administration change based on updated HHS web pages. Principal Deputy Assistant Secretary for Health Jewell Mullen, MD, MPH, MPA is listed as having taken over the Acting Assistant Secretary role. DeSalvo, who stepped down as National Coordinator in August 2016, hasn’t mentioned her departure or plans on Twitter.

Privacy and Security

From DataBreaches.net:

  • TriHealth (OH) blames a software problem for sending the information of 1,126 patients to their previous address.
  • An appeals court rules that people whose information was stored on a stolen laptop can sue Horizon BCBS for violations of the Fair Credit Reporting Act even though they suffered no negative consequences.



Billboard profiles our amazing HIStalkapalooza band Party on the Moon and its longstanding New Year’s Eve gig playing for now-President Donald Trump. It describes their first time playing the Mar-a-Lago event, where they were noodling through harmless dinner music like “The Girl from Ipanema,” when the boss’s assistant passed along his request: “Mr. Trump would like you to stop playing this crap and play something more upbeat.” I was skeptical about hiring a cover band for HIStalkapalooza, but it’s hard to describe their stage-filling show – they play with remarkable skill and enthusiasm. the music never stops for a second, and they literally from their first note pack the dance floor with HIStalk readers who admit that they never dance otherwise.

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Currently there are "10 comments" on this Article:

  1. There are a plethora of tiny Epic shareholders who don’t have many shares. Capricorn is just another company that came into possession of a few shares and wants to be seen as owning part of Epic. If they owned anything of substance, you can be assured they’d have been crowing from a mountain top.

    • And even if they do own some shares…. who cares? Who is going to buy shares in a company that will likely never go public or sell? Maybe you’re hoping that Epic will buy them back for a profit, but if Epic isn’t in any position to lose control (which seems to be the case) then you don’t have a lot of leverage to ask for a premium.

      Having the Epic logo on your website as an investment seems a lot like having stock of the Green Bay Packers on your wall.

    • I’ve talked to some folks who should know and you are correct. Apparently Capricorn bought up a few shares from former Epic employees some time ago, a practice which may or may not even be possible today given how Epic structures its employee stock ownership plan. I agree that if Capricorn was smart enough or lucky enough to have backed up the truck on Epic shares early on, they would do more than just stick Epic’s logo on their site.

  2. So much to all that talk of being “Main Street versus Wall Street.” Will Capricorn tell the media they will give all their profits to a charity too?

  3. Epic – Capricorn Health: What this could be is a bunch of the private stock holders joining together to try to start moving Epic into an acquisition or IPO. Think about it, if you were are a former employee of Epic and had a handful of shares (probably class B) and wanted to cash out this could be a way to do it. I am sure Epic has an internal formula to cash out any small holders /former employees based on preset formula, but if a big enough group of got together…maybe you can get a big premium.

  4. Judy, Judy, Judy… even in this post-truth era – either you are funded by private equity or you’re not – and people will find out. This is one of many hypocrisies with Epic. They don’t play well with others, partly because they live only in their own truths.

    • “Funded by private equity” and “Someone bought shares from a former employee” are not the same thing. Not that hard to figure out.

  5. It seems like every time something goes south with Epic, Judy does an exclusive interview. Maybe this time it will be with Mr. H! Here’s what I think she should be asked: 1) When do you plan to give your profits to charity? 2) When will interoperability mean interoperability to you? 3) If we can’t trust you on the above, how can we trust what you say on what you’re spending on R&D?

    • I don’t care what Judy does with her money and I also wouldn’t ask the R&D question since it’s still just an unverifiable and not necessarily apples-to-apples answer that I wouldn’t know what to do with. My top questions would involve Epic’s succession plan; how she feels when the financials of a big, new Epic customer go into the toilet even if just temporarily; and how she built Epic’s quirky culture and put leadership into place that allowed it to scale despite hiring fresh college graduates. What I really want to know how a geeky computer science professor cracked the code for starting and running a company almost accidentally while ignoring convention wisdom and what others can learn from that. Declining to take investor money, refusing to make acquisitions, and running an ever-growing organization as a founder who is personally involved in every decision and relationship almost the point of micro-management is nearly unheard of, even in Silicon Valley.

  6. Epic – Capricorn Health: A bit of search around SEC website reveals that Capricorn manages almost $5 billion in funds of very high net worth individuals. Regardless of how the stock was acquired, I doubt they’d waste time and energy on an investment of a few hundred thousand dollars or even a few million dollars. It is certainly not like buying the Packers stock – their Managing Partner would be fired overnight for an investment like that.

    Larger question is – why isn’t Epic more forthcoming on the current ownership structure of the company as well as its succession plan, and actually creates a board of directors that is worth something. Given the fact that 60% of nation’s population has its health data hoarded in a database created by Epic, it is critically important that Epic is more transparent about these things.

    Of course, we live in an era where even the President has been able to successfully stonewall demands for releasing his tax returns. So, Epic may very well likewise just hunker down and continue to be hermetically sealed in Verona.

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