Re: "People preferred the [patient] portal over the telephone for getting test results, updating personal information, getting medical records copies,…
Monday Morning Update 5/8/17
Billionaire investor Warren Buffett says in the annual Berkshire Hathaway shareholders’ meeting that the American Health Care Act would be “a huge tax cut for guys like me,” adding that, “Medical costs are the tapeworm of American economic competitiveness.”
Buffett also complained that private equity firms load their acquired companies with debt, announced that the company has sold one-third of the IBM shares it holds, and joked in answering a question about how much his successor will be paid (Buffett is 86) that, “If the board hires a compensation consultant, I’m coming back.”
From Chiming In on CHIME: “Re: CHIME. You asked why people are quitting HIMSS. I’d like to see the same anonymous question about why people are quitting CHIME. I’m considering it since it has changed from a CIO networking organization to a vendor-driven one, where companies pay for CIO time.” I created a rather awkwardly worded survey here and will report the results next week.
From 300-Buck Gyp: “Re: radiology report. A friend’s pelvic CT scan had this radiologist comment in the report: ‘CT pelvis. Reproductive organs – the uterus and ovaries are normal. I guess the fee includes copy/paste issues since the patient is a male.” Perhaps “normal” could be loosely construed as meaning that the lady parts are “absent” in male patients, thus streamlining the radiologist’s report template even more.
From Privy Pathway: “Re: Brigham and Women’s. Any thoughts on the offering voluntary buyouts as a cost-cutting measure? It used to be that Epic only got the C-suite fired, but Brigham, MD Anderson, and Southcoast are proving a trend. I’ve also heard that a notable health system is cutting annual compensation increases for the rank and file given capital and operating constraints associated with their Epic go-live.” My cheap-seats view would be this. Epic is fanatical about forcing customers to budget the entire project’s expense. My survey of C-level execs of health systems that use Epic (which got pretty big participation) found that 75 percent of projects came in at or under budget, with just 15 percent saying they spent a lot more than they expected. Therefore, I’ll postulate that it’s probably simplistic to assume that Epic is guilty just because it was present at the crime scene:
- Health systems that choose Epic should not be surprised by its upfront and ongoing costs. That would seem to be the case with most of its customers since few have had disastrous, permanent financial challenges purely because of Epic, especially those that have been live for a few years.
- Leaders of financially challenged hospitals typically find a scapegoat, whether it’s unions, government payments, IT, or regulatory compliance costs. They haven’t blamed Epic all that often, but even when they did, the reality might not be quite so simple, especially if the executives are looking to justify unpopular decisions.
- The type of health systems that choose Epic (large, aggressive, market-leading health systems) are those most likely to have had their bottom line hit by government, payment, and marketing challenges as the emphasis shifts away from heads in the bed and the extraordinarily high cost of hospital-provided care, especially in those with massive market clout that drives negotiation with insurers.
- Timing is everything. Epic gained a lot of customers in the past 3-4 years and financial conditions have changed considerably since then, so those significant upfront costs may be hitting at an inopportune time for some health systems.
- Having poor financial performance after Epic doesn’t necessarily mean Epic was the problem. Some hospitals screwed up their implementations with bad decisions, while others were poorly managed both before and after Epic. Sometimes you read about a high-profit health system choking on Epic and think to yourself, based on what I know about them, I’m not too surprised they managed to mess it up. Software ROI is usually more related to the client than the vendor.
- Some of the hospitals are cutting back because of future expectations, not necessarily due to concerns about their current bottom lines.
- It’s going to get a lot worse of the ACA is repealed and many millions of hospital patients go back to being charitable write-offs, shrinking health system profits.
HIStalk Announcements and Requests
Nearly 80 percent of poll respondents haven’t bypassed insurance to pay cash for a better ongoing PCP. Stephen pays an $149 annual fee to belong to One Medical even though the actual visits are still covered by insurance. Nonsequitur took the concierge route for his father since few decent doctors in his area accept Medicare, adding that the new practice provides nearly 24/7 secure communications via Twistle. Amy says she hasn’t done it for a PCP, but does so for other services because some providers offer a cash price that’s cheaper than paying her high-dollar insurance deductible. Rose goes out of network to keep a particular PCP even as insurance contracts change frequently, although she’s cautious to get orders for expensive lab and rad tests ordered by an in-network provider since some plans won’t pay for them otherwise.
New poll to your right or here: what was your reaction to the House’s passage of the American Health Care Act last week? Feel free to elaborate further by clicking the poll’s “Comments” link after voting.
HIStalk readers provided an Amazon Fire TV and accessories for Ms. D’s California elementary school class in funding her DonorsChoose grant request. She reports, “Technology is always changing, so my teaching strategies need to accommodate the needs of my students. Most of them are visual learners, so I play YouTube clips and videos all the time when I am teaching science. In addition, the Amazon Fire TV has allowed my students to visually see the concept as they are watching science videos on TV. Now, my students are extremely excited about science! On behalf of my students, thank you for supporting them as they continue to reach for their goals!”
This Week in Health IT History
One year ago:
- Theranos announces a reorganization that includes the retirement of President and COO Sunny Balwani.
- HHS spells out details of its proposed MACRA program.
- NextGen ceases development of its NextGen Now cloud-based PM/EHR as it moves focus to its acquired HealthFusion product.
- The FDA rejects the application of the “digital pill” that uses technology from Proteus Digital Health.
- Apple releases the CareKit developer’s framework.
- Internal documents from University of Texas indicate that MD Anderson Cancer Center blames its Epic implementation for a nearly 60 percent year-over-year income decrease, although noting that it had already assumed some negative impact.
- Siemens changes the name of Siemens Healthcare to Siemens Healthineers.
Five years ago:
- Partners HealthCare chooses Epic to replace Siemens Soarian.
- ONC launches its Health IT Dashboard.
- The Nashville Medical Trade Center names six companies that will join HIMSS as tenants.
- Medseek announces plans to conduct a management buyout of the company.
Weekly Anonymous Reader Question
I asked readers to describe the best career advice they have received:
- You can do better without working more hours.
- From Ben Franklin: ask people for help in order to make them like you.
- From my first professional manager who that had been employed for our then-current employer for the previous 30 years, "Don’t make the same mistake as me and think that you need to stay with the same company your whole career." Knowing what I know now, and having held various positions with several different employers over the course of 25 years, I would have loved the opportunity to have been given the option to stay put.
- Perception is reality. It doesn’t matter what you think — if people perceive X, then X is true.
- Always put yourself in the other person’s shoes — most people have good intentions, so if they don’t behave in a good way, understand why from their point of view.
- When I was thinking of starting my own independent, HIT consultancy in 1985 — terrified every step of the way, but more terrified not to do it — my mentor at the HIT company where I was employed advised me that, so far, my track record for getting through rough days is 100 percent and that’s pretty good.
- Be nice to the administrative assistants.
- When you walk somewhere, go fast so you look like you’re actually on your way to do something.
- Realize when it’s time to recalibrate. Your vision of your life when you were 18 is probably different than it has turned out to be when you reach 40, so focus on the accomplishments rather than regrets.
- Being told that I was not a good writer, and as such would never be published in one of the B2B magazines owned by the publishing company I worked for. While not your typical piece of advice, I took it as a challenge to prove the naysayers wrong. I believe my ensuing track record of published pieces for a variety of media outlets speaks for itself.
- My daughter just became an RN and has started working at our local hospital. In her first week or so, she was introduced in passing to an OB/GYN who happens to be my wife’s and also happened to be the doctor who delivered my daughter. She says "Hello, Dr. A," to which he replies "Get out of healthcare, kid."
- People will always remember how you’ve made them feel. Don’t be a jerk.
- Don’t listen to your parents. They really think they know you, but they can’t because you only become you by following your nose and that takes time, experimentation, trial and error, and the occasionally do-over. In fact, don’t listen to anyone. Do something that is new every day, and when it stops being new at least a little every week, then move on.
- Listen. You may be the smartest person in the room. Listen anyway. You’ll learn something.
- If it’s not going to matter in five years, it doesn’t matter now. Pull back and reconsider your response to the situation.
- You need to read HIStalk.
- When the horse has died, dismount. (Ross Perot)
- Your boss cares about results, not the path you took to get there.
- If you are young and take a travel job for the higher pay, have an exit plan. Otherwise, you’ll find yourself still on a plane traveling every week when you are 65 years old, having missed so many family and friends moments because you were always on the road.
- You can love your job, but it will never love you back. No job — no matter how rewarding either financially or emotionally — is worth destroying your peace or sanity for.
- Do not let one person ruin your job. (Advice I should have taken.) I left a job after 6.5 years because I could not stand my boss. Other people just ignored or tolerated him. Many of them are still there today, 15 years later. He has since retired.
- Back in the early 1980s: learn to type. Sounds dated now, but as my mother said, you can always fall back on being a secretary if needed. Thankfully I took four years of typing in high school, and went onto college to get my bachelors. I type for a living now in IT.
- Earlier in my career, I was really ambitious and wanted a promotion after my direct manager left. I wasn’t ready to be the department manager but i met with the VP making the decision anyway. He learned more about my background and experience and said to me, "You have to ask for the job you want, otherwise no one will know you want it." It was a revelation to me. A plain spoken truth and something so simple would be the best career advice I ever received.
- My first CIO taught me not to ever say “no” to my business partners. Say “how long” what they want will take to acquire and/or develop, and “how much” it might cost. This is our obligation as IT professionals serving an organization.
- Taking the path of integrity and good character will not always result in promotion within an organization. You must be willing to stick to your professional values and be ready to move on to new adventures if your superiors do not like your answers.
- You hold yourself back more than anyone or anything. You are good at what you do. Have faith in yourself, be heard, make a difference.
- Spend more personal time with your team. Show your human side. Both will build more trust, which will make the team closer and stronger.
- Never talk to a reporter. Your response should always be "no comment."
- Don’t do anything rash.
- When you have an issue with the way the organization is being run, address it by tying it to core values or customers, not by calling out the way a specific person does things.
- You should spend 10 percent of your time looking for your next gig.
- Do what you say you’re going to do, when you say you’re going to do it. Return the call or email promptly even if you don’t have the answer. In other words, be there. If colleagues and customers know they can count on you, you’ll be given more opportunities (and responsibilities) to grow your career and, at the same time, build a network that will be increasingly valuable.
- Arrive at a meeting at least five minutes early, and if you are leading, a meeting ensure that it ends on time or earlier.
- I was having trouble getting what I needed professionally from a boss. The advice I received from a mentor was, "She will never be the kind of boss you need. So how do you make the most of what she has to offer and get your other needs met elsewhere?"
- Live on what you currently make so your employer will never "own" you. I stayed in positions because I wanted to be there, not to get a paycheck.
- Worry about the sale. The margin will take care of itself.
- Advice to a just promoted CIO: "Remember that you are a VP of the organization, not just of IT."
- Don’t apologize if you have not done anything wrong. Said to me by the late great Steve Macaleer, of the Macaleer/SMS family, who died way too young at 49.
- Every five years or so, change jobs. You have probably developed bad habits that are best discarded. You can do this within your current employer or by getting a new employer.
- Ninety-five percent of the time you are right, but 95 percent of the time your delivery sucks. You need to work on your delivery AND timing.
This week’s question: what specific event crystallized your decision to leave your last job? (or another previous job if you’ve got a good story from there).
Welcome to new HIStalk Platinum Sponsor CSI Healthcare IT. The Jacksonville, FL-based company, which has offered services nationally for 20 years, provides training and implementation solutions for EHR and coding as well as IT staff augmentation, legacy system support, and infrastructure staffing. Case studies: Houston Methodist (CPOE activation), Norton Healthcare (a 300-contractor Epic go-live), Sutter Health (Epic training), and Grady (big-bang Epic go-lives). The company’s consultants voted it to Inavero’s Best of Staffing Talent List, which recognizes fewer than 1 percent of staffing agencies in North America. The company provides customized consulting and staffing solutions that provide unmatched results at a fraction of the cost. Thanks to CSI Healthcare IT for supporting HIStalk.
Thanks to the following companies that recently supported HIStalk. Click a logo for more information.
Last Week’s Most Interesting News
- The House passes the American Health Care Act that would repeal most of the Affordable Care Act, sending the bill to the Senate.
- Thoma Bravo buys Lexmark’s Perceptive Software business and moves it under its Hyland Software portfolio company.
- Computer systems at University Hospitals (OH) go down for several days due to unspecified causes.
- ONC launches a patient matching algorithm challenge.
- Meditech announces Q1 earnings per share of $0.39 vs. $0.51 in the same quarter last year.
- Internal medicine physicians at Canada’s Nanaimo General Hospital are disciplined for going back to paper orders in declaring patient safety concerns with Island Health’s Cerner system.
None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.
Acquisitions, Funding, Business, and Stock
From the Allscripts earnings call, following the quarterly report in which the company beat expectations on earnings and met on revenue:
- A strong segment was Payer and Life Science.
- The company expects its acceptance into the UK’s NHS London Procurement Partnership to help it maintain UK momentum.
- The Netsmart acquisition contributed around $50 million of the quarter’s bookings.
- Paul Black says the company is watching the market evaluation being performed by the VA and Coast Guard, noting that the Allscripts loss in the DoD bid wasn’t due to technology, applications, workflow, security, or company background – it didn’t make it to the final round because of price.
- The company is not seeing the decline in claims volume as reported by Athenahealth, although it notes that Athenahealth has greater exposure than Allscripts because of its business model.
- Allscripts will focus on increasing the client base’s adoption of Sunrise Financial Manager rather than trying to roll out outsourced inpatient revenue cycle management services.
- Central Montana Medical Center (MT) will switch from Evident to Infor supply chain management in 2017.
- Children’s Hospital Of New Orleans will go live with Epic in 2018.
- New Orleans East Hospital (LA) will switch from Cerner/Siemens Soarian to Epic in 2018.
- Thomas Memorial Hospital (OH) replaced Siemens with Meditech on March 1, 2017.
These provider-reported updates are provided by Definitive Healthcare, which offers a free trial of its powerful intelligence on hospitals, physicians, and healthcare providers.
New York-Presbyterian Hospital (NY) promotes Rosemary Ventura, MA, RN, DNP to the newly created position of CNIO.
Announcements and Implementations
Reaction Data publishes its “Big Mega HIT Purchasing Report,” which finds that the top spending item of health systems and standalone hospitals in the next 12 months will be inpatient and ambulatory EHRs (Epic was #1 in mindshare for both, followed Cerner and Meditech that were nearly equal in score). Hospital-owned physician groups will focus on information security, while independent practices place telehealth as #1 with equal interest in four vendors.
Definitive Healthcare adds quarterly inpatient and outpatient Medicare claims data for hospitals, clinics, and long-term care providers to its provider data, intelligence, and analytics product line.
Government and Politics
VA Secretary David Shulkin reiterates that he will announce the VA’s plans for VistA in July, choosing to either replace it with a commercial system or turn VistA over to a private company to convert it into a single, cloud-based, externally managed instance. When asked about the historic lack of technology cooperation between the VA and the Department of Defense, Shulkin promised better, saying, “We’ve always found ways not to do that.”
Privacy and Security
Hacker The Dark Overlord posts records of 180,000 patients online from medical practice hacks last year, most likely because those facilities declined to pay the extortion demanded.
A Utah-based orthopedic surgeon is ordered to turn over 10 website domains to Intermountain Health Care, which complained that the doctor had no legitimate reason to have purchased domains related to Intermountain’s Cedar City Hospital and was instead was trying to use them to convince an insurance company to add him as an in-network provider.
Here’s the finale of Vince and Elise’s series on physician practice vendors, this time looking at the “other” ones.
- #JoinTheConversation with Phillip Scott of NCPDP (Experian Health)
- Value-Based Purchasing: A Bad Deal for Safety-Net Hospitals? (Definitive Healthcare)
- Reduce Paper Fat with a Health Check (Access)
Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
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Regarding the discussion that Privy Pathway brings up on Epic. I have one very simple question. How many customers does Epic have that are For Profit? I believe the answer is none. And if it is none or close to it, what does that tell you? Companies that pay very close attention to the bottom line will not take the bait. They can deliver a platform what will get the job done for much less money. Period. While I do not have an ax to grind with Epic, it astonishes me to this day that so many have selected it then complain and take draconian measures after facing the reality of the total cost of ownership. I have been on both sides of this argument and while Epic is good to work with and the product is solid, I have always questioned if it is worth it.
Prime Healthcare (CA) is for-profit. They are an Epic customer. I am sure there are others.
Good synopsis Mr. H., but I don’t know how you solve for a C-Suite that is largely held captive by such a capital expense. Regardless of Epic, Cerner, whomever – those C-Levels have an incentive to make the supplier look good.
Agree with Mr. H’s general comments…but if Epic isn’t to get much blame for a major overrun, perhaps they should back off of claiming they make hospitals more profitable and margin efficient. You can’t have it both ways. Same discussion this site has been having re: correlation/causation related to Epic’s value for over a year.
Who’s the health system cutting halving planned compensation
I don’t think epic has been saying they make hospitals more profitable. They’ve been showing DATA that says that… And even then only in response to anecdotal attacks.
Epic’s “data” is inherently biased. Their data set excludes most hospitals, including all for-profit hospitals. The Epic employees that wrote their operating margin improvement study admitted this when it was brought to their attention at HIMSS this year.
I have only seen one study of pre-live to post-live changes in operating margin split by EHR which used an unbiased data set and documented its methodology. Below is a link to that study.
I agree that there is not causation between the EHR chosen and hospital operating margins other than where an EHR directly drives a significant increase in IT costs.
I don’t think Epic would hesitate to admit that while most customers start off strong, a few have initially struggled financially – which, of course, is what is always broadcast in headlines across the industry. However, do any sort of follow-up on those organizations and you’ll find that almost all are doing well and becoming financially stronger than they were with their previous system.It’s hard to argue with over 100% increase in operating margin, in just four years, for organizations that switch from Cerner to Epic.
Cerner works with 6 or 7 of the Top 10 for-profits in the U.S. per Modern Healthcare’s rankings. If those health systems weren’t profiting with Cerner, they’d make a change. Instead, Cerner’s footprint continues to grow with for-profits chains – something’s working. Case closed.
To Mr. H’s earlier point, looks like industry pressures aren’t impacting only Epic customers.