Weekender 8/30/19

Weekly News Recap

• Life insurance startup Ethos, which uses predictive analytics based on a customer’s EHR data rather than a medical exam to predict lifespan, raises $60 million in Series C funding round.
• A KLAS-convened customer review of Cerner’s revenue cycle management progress finds that the user base feels the Cerner is listening, but they are frustrated with lack of progress since the initial meeting a year ago and are questioning both Cerner’s ability to execute and its sense of urgency.
• Epic holds its UGM in Verona, WI.
• Private equity firm Warburg Pincus acquires a majority interest in therapy EHR vendor WebPT.
• Health Catalyst files its first quarterly earnings report following its July 25 IPO.
• Politico reports that the VA’s initial rollout of Cerner will be delayed several months to October 2020.
• A VA OIG report finds major backlogs of paper records scanning from outside providers at eight VA facilities, with some records going back to 2016 still piled up in storage rooms.

Best Reader Comments

State-specific regs are problematic for HIT and for clinical care in a broader sense, particularly when states have specific documentation or regulatory requirements that differ from national ones. State specific regs include those related to reportable conditions, privacy, mental health or substance use and complicate EHR design since they vary from state to state. Particularly in the electronic era, having a single standard would be much more efficient. (Federalist)

Insurance companies getting their hands on EHR data concerns me less since the ACA restricted what they can base premium prices on. (TheSnarkIsWhyImHere)

Medicare doesn’t hire doctors (like the NHS in England does, paying them salaries). Doctors submit bills to Medicare on a fee-for-service basis. Even Medicare Advantage (private insurers providing Medicare coverage for about 30-40% of the seniors) works through doctors sending bills to someone. There are projects underway to come up with other ways of paying doctors for Medicare, involving reward for achieving better overall costs and how well patients do, as measured in different ways. It still involves sending bills.The lament comes in because seeing patients and sending bills involves dozens of different payers and contracts and systems of rules and mechanics of getting paid. If there was just “one payer,” it would get simpler. (Randy Bak)

Although some like to point to foreign countries like Canada, Finland, etc. as good single-payer systems. every one of those countries has at least a two-payer system. The government system,and the private pay (or private supplemental insurance) to cover faster care or non-covered items. So I wouldn’t worry about the rev cycle folks being on the street to soon. (Frank Poggio)

I’m a fan of the Israeli healthcare system. They have several HMOs, under pretty strict government oversight. The result is a quasi-competitive system that offers a government-mandated basket of services. The cost of their healthcare isn’t outrageous, they have shown they can innovate within their economic structure (a common complaint about single-payer is stifling innovation), and the outcomes are better than the USA. I tire of the arguments against single-payer that suggest we do nothing. Clearly, we have a cost and quality problem in this country. Doing nothing is not a strategy for success. (Jim Bresee)

[With regard to health IT salespeople] I never misrepresent myself to employers or clients. That is how I can hold my head high, even when I’m in a room with one of my sales reps who decides to “do their job” despite my guidance. Because I will interject and say “technically” or “in the interest of full disclosure,” the client will light up with appreciation and the sales rep will be enraged. Those instances typically result in a successful long-term relationship with the client. As Mr.HISTalk shared, there are many good reps. But there are all way too many who are doing their job, which often times doesn’t align with being fully transparent. (Katie Goss)

[On clinical decision support systems replacing EHRs as clinician-facing technology] An EHR is a enterprise-wide. mission-critical transaction system. A CDSS is akin to a Mangement Decision Support System in commercial industry, and I know of no situation where a MDSS has totally replaced a SAP or Oracle transaction system. (Frank Poggio)

I’ve often noticed how many of the sales management folks (from directors to VPs and even to a couple of CEOs) have fallen from grace (they have quotas too!) and eventually end up down the food chain again. Sales is an interesting business and the people at the top making the big decisions and big bucks are not always the best strategists. Sometimes just the best BSers! (Eyes Wide Open)

Watercooler Talk Tidbits

Healthcare long-timer and Tincture editor Kim Bellard quotes an AI expert’s recommendation to substitute “magic fairy dust” for “AI” in any article that mentions it, which helps determine how realistically the author or expert is describing unproven technology. He also quotes healthcare debunker Jen Gunter, MD, who rails against bad information as well as click-desperate news sites that either misrepresent the latest medical study (intentionally or not) or label it with a misleading headline that will be echoed endlessly on social media with no critical review.

An Atlantic writer spends $1,300 on products from the “pretty, blonde 20-somethings” working in the luxurious storefront of Gwyneth Paltrow’s so-called “wellness” company Goop. She emitted foul body order from some wacky vitamin combos, attracted attention with a $80 “healing energy” crystal water bottle, couldn’t figure out how to use the $42 tinted face oil, and found that the Martini Emotional Detox Bath Soak resembled raw sewage when dumped into her bath water. She liked some of the expensive products, but summarizes:

For these products to be considered successful, the result wouldn’t necessarily be a stronger, more resilient, more competent me, or a more peaceful relationship with my body. It would be a person who is better-dressed, who hasn’t succumbed to the indignities of visible aging, whose hair doesn’t frizz, who never goes back for seconds at dinner … the company’s products embrace one of America’s oldest health myths: that physical beauty is proof not only of a person’s health but of her essential righteousness. If the outside is perfect, the inside must be too … Wellness companies can feel predatory, even those not making Gwyneth Paltrow richer. It’s a largely unregulated industry, and it operates in an environment of open desperation. Many women justifiably mistrust the ways conventional doctors address their concerns and treat their pain. Goop, influential in ways that would make most gurus and healers envious, has helped introduce millions of people to “experts” who argue that HIV doesn’t cause AIDS and that drinking celery juice can treat cancer.

NICU staff at Riley Hospital for Children at IU Health North (IN) hold a graduation party for baby born at 23 weeks weighing 20 ounces. Four months later, she was discharged weighing 8 pounds, 6 ounces. I’m assuming that other hospital employees were less enthused at the same moment in trying to collect the massive bill generated as a by-product of the miracle.

The FBI arrests a Michigan doctor who it says planned to kill a condo HOA lawyer and his own attorney by injecting them with fentanyl.

Leaked emails from a regulatory affairs physician with chemical company Monsanto show that the doctor wanted to “beat the sh*t” of members of advocacy group Moms Across America for urging the company to stop selling genetically modified seeds and Roundup. The president of an environmental group says that Bayer is “reeling” after paying $63 billion for Monsanto last year, only to be hit with negative publicity as “the company that gave us DDT, Agent Orange, and PCBs.”

A veteran running late for his appointment at the St. Louis VA hospital uses its valet service to park his new car, following the valet’s instructions to just leave his car with the keys on the dash. Afterward, the valet said someone drove off with it, but the third-party valet company isn’t returning his calls to explain why it would allow someone to take the car without presenting a claim ticket. The car turned up two weeks later damaged, empty of his personal belongings, and tricked out with a new window tint job.

In Case You Missed It

• News 8/30/19
• EPtalk by Dr. Jayne 8/29/19
• HIStalk Interviews David L. Meyers, MD, Emergency Physician Leader
• News 8/28/19
• Curbside Consult with Dr. Jayne 8/26/19
• Monday Morning Update 8/26/19

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