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Monday Morning Update 9/11/23

September 10, 2023 News 10 Comments

Top News

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Walmart is reportedly considering acquiring a majority stake in ChenMed, which operates 100 Medicare Advantage primary care clinics in 15 states.

The family-owned ChenMed has made significant executive team changes this year, replacing five of six family members who held C-level roles. My quick eyeball of the leadership team web page changes since February show that only four of the 12 leaders remain.

If the deal goes through, it will likely be Walmart’s biggest healthcare investment, at several billion dollars.


Reader Comments

From Pure Envy: “Re: Epic. Why didn’t DoD and VA choose them in the first place? Will they switch from Cerner like everyone else seems to be doing?” Cerner paired up for the DoD bid with prime contractor Leidos, a skilled lapper at the federal trough, while Epic linked up with comparative federal lightweight IBM. Either that or the feds saw more promise in Cerner and the other companies that were part of the Leidos bid. The DoD has no reason to replace Cerner because its implementation is nearly finished and is free of the drama that has plagued the VA, which may be stuck with VistA forever given the embarrassment, cost, and likely similar outcomes of dumping Cerner for Epic under pressure from Congress. The one thing that is sure, given that the federal government is in charge, is that contractors will profit obscenely and indefinitely no matter which systems the DoD and VA are using, as the VA’s 40-year-old VistA is reportedly costing taxpayers nearly $1 billion per year to keep running. The VA rarely completes IT projects successfully and technology is seldom the problem – VA regions resist any form of central oversight and thus love their custom instances of VistA.

From Bemis Comfy: “Re: Cerner to Epic switches. Two big Cerner losses in one week. The trend will continue.” Probably, for these reasons: (1) Cerner sites that implemented its systems more than 7-8 years ago now have the money and fortitude to switch to the obvious market leader, while the Epic-to-Cerner migration history is minimal; (2) FOMO; (3) to the victor go the IT spoils, as acquisition-happy big health systems seem to have lost their temporary appetite for running multiple systems to avoid rip-and-replace in acquired hospitals and are now looking to reduce vendor complexity; and (4) the disastrous Brent Shafer Cerner years seeded frustration that is just now showing up as defections. Oracle’s interest in Cerner seemed to mostly be driven by the personal fascination of 79-year-old Larry Ellison, the opportunity to increase Cerner margins, and the chance to buy into a massive federal business, none of which necessarily boost the satisfaction of Cerner customers. However, Oracle executives are probably more worried about competing in cloud and AI than counting Cerner hospitals or strategizing how to compete more effectively with Epic. Maybe they will say more at next week’s Oracle Health Conference. If you’re a CIO with recent experience as a customer of both Epic and Cerner, what do you think?

From Pop Smoke: “Re: HIStalk. Have you considered changing the name to something that makes sense?” When I started HIStalk 20 years ago, hospital technology was referred to as “hospital information systems” and the department that operated those systems was “management information systems,” so HIS and MIS were universally understood industry terms that have since faded into obscurity. Readers can probably provide more examples (CPOE comes to mind). The name HIStalk does not refer to possessiveness, gender, religion, or anything else you’ve imagined. I’m too lazy and set in my ways to worry about anything except the content, so I’m not contemplating a rebrand, including canning the satirical smokin’ doc.

From Electric Eel: “Re: subscribing. How does one subscribe to HIStalk nowadays?” There’s a “Subscribe to Updates” menu drop-down under Contact, which takes you to this page. It ignores duplicates, so if you’ve stopped getting updates, just stick your email in there again. It is shocking how often emails aren’t delivered due to being rejected by an overzealous email system on the receiver’s end, and signing up again can’t hurt and might fix it.


HIStalk Announcements and Requests

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Quite a few poll respondents have had a rocky employment year so far in 2023.

New poll to your right or here, as suggested by a reader: In your most recent change to a new medical practice for an ongoing relationship, how did they obtain your medical records? My guess is that a surprising number of practices don’t really care about the laboriously collected and maintained information from other providers, preferring to start over with patient-provided basics such as demographics, meds, allergies, family history, known conditions, and immunizations that their new customer is expected to scrawl onto poorly designed clipboard forms. 

Thanks to the following companies that recently supported HIStalk. Click a logo for more information.

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Webinars

September 21 (Thursday) 2 ET. “Unlock open enrollment best practices to stop future denials.” Sponsor: Waystar. Presenter: Lauren Tungate, solution strategist team lead, Waystar. Nearly half of insured Americans consider changing their insurance coverage each fall, necessitating provider safeguards to stop increased denials, find hidden coverage, and prevent uncompensated care. This webinar will crack open enrollment best practices, such as using different data sources to get an accurate picture of benefit details; leveraging automation to identify hidden coverage, confirm active insurance, and avoid lost revenue; and simplifying eligibility workflows to reduce the financial burden on patients and strain on staff.

Previous webinars are on our YouTube channel. Contact Lorre to present or promote your own.


Acquisitions, Funding, Business, and Stock

Merative, the former IBM Watson Health, will lay off 100 of its 400 employees who work in Ireland, moving their jobs to India. 

A study finds that when PCPs enter into vertical relationships with health systems – by selling out to them, affiliating, or entering joint contracting deals – specialist visits, total patient spending, ED visits, and hospitalizations within the health system all increase. In other words, health systems get exactly what they hope for when they use their large piles of cash to buy independent doctors who are then “encouraged” to steer business their way.

Calibrate, which sells weight loss drugs online to people who sign up for its $1,749-per-year coaching package (which doesn’t include drug cost), is paying out big chunks of its revenue as refunds to address BBB complaints from customers for whom the company can’t provide them with high-demand drugs such as Wegovy. Insiders say the company’s layoffs have left too few employees to manage insurance company authorizations and to respond to customer questions. Its newly released app has earned a 1.1 rating out of five stars on Apple’s App Store as a skeleton crew of engineers can’t keep up with bug fixes. The company says it will pivot to working with employers and health plans, although insiders question whether it has the people and the focus to launch a new business given its low staffing and the competitive environment.


Sales

  • Clalit Health Services, Israel’s largest healthcare provider, will implement Sectra’s digital pathology solution.

People

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Industry long-timer Bill Carmichael, whose held IT roles at Franciscan Alliance, Information Resource Associates, and Eskenazi Health, died August 26. He was 71.

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Georgia-based family practice doctor Jim Morrow, MD, MS, who held health IT executive and advisory roles in his career of nearly 40 years, died August 31 at 69.


Announcements and Implementations

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The Healthtech Leader 3.0 conference – put on by CHIME, AEHIS, AEHADA, and AEHIT — will be held September 27-29 in Cleveland, OH, with CHIME members getting a discounted registration fee of $295 that includes breakfasts, lunches, and receptions. The Cleveland Clinic-connected InterContinental’s conference rate of $189 makes this a pretty inexpensive event, depending on your transportation cost.


Government and Politics

Nigeria’s federal government announces plans for a National Electronic Medical Record Platform that will unify the records of primary and federal medical centers. The newly appointed Minister of State for Health and Social Welfare, Tunji Alausa, MD – a nephrologist who founded and runs the Illinois-based Kidney Care Center and Dialysis Care Center – says:

We will embark on the digitalization of our healthcare system, because in this age,if you don’t have data, validated data, it’s just like still being in the dark. We need to make sure that the data we collect are accurate, they are validated,they can be trusted internally and locally. That will be used to deliver healthcare to our people. When we have validated data that we can trust,we can begin to see the indices where you are getting better,where you are doing well and where you are not doing well and then,you can direct your interventions to improving those outcomes.

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HELP Committee ranking member Senator Bill Cassidy, MD (R-LA) solicits solutions to protecting patient privacy related to wearables, smart devices, and apps, none of which are covered by HIPAA. He seeks input on expanding HIPAA beyond covered entities and traditional health data; whether safeguards that address disclosure to law enforcement officials are sufficient; if organizations that aren’t covered entities should be required to delete consumer data at their request as GDPR mandates; and whether location data should be considered health data. He also asks questions about safeguarding genetic and biometric data, whether HIPAA should address claims data, and the extent to which consumers can opt out of having their data used for AI training. Responses are due September 28.


Other

Odd: the fired CEO of Robert Wood Johnson University Hospital Hamilton sues the hospital, claiming that he was fired because the hospital foundation’s “Under the Italian Sky” fundraising soiree included naked body painting.

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An interesting VCU medical school poster notes that traditional physician clothes and accessories can spread bacteria. On the not-to-wear list: white coats (which are not laundered frequently), stethoscopes (unless they are disinfected between patients), watches, shirts that don’t allow “bare below the elbow,” ties (rarely cleaned), and cell phones. If white coats are required, providers should be given at least two of them with free on-site laundering and coat hooks should be available outside of areas where patients are seen so the coats can be removed. It recommends wearing sleeveless vests instead of white coats, although I wouldn’t want to be the person trying to rip traditional medical regalia from the cold, dead hands of doctors who aren’t about to hold court wearing an egalitarian vest.


Sponsor Updates

  • Lucem Health releases a new “This Week in Clinical AI” podcast.
  • Aga Khan Health Services in East Africa will implement Meditech Expanse.
  • Nordic releases a new Designing for Health Podcast, “Interview with CT Lin, MD, Liz Salmi, and Bryan Steitz, PhD.”
  • Optimum Healthcare IT’s ServiceNow offering, Clinician Connect, is now available in the ServiceNow Store.
  • Verato will exhibit at the ISM + PHSA Conference September 10-13 in Kissimmee, FL.
  • West Monroe launches the third season of its This is Digital Podcast.
  • Wolters Kluwer Health will sponsor the 2023 Patient Experience Summit September 11-12 in Nashville.
  • Ellkay, Nuance, Healthwise, Fortified Health Security, Ronin, Ascom, Elsevier, First Databank, Impact Advisors, Linus Health, Loyal, Nordic, Optum, ReMedi Health Solutions, HCI Group, Wolters Kluwer Health, Net Health, Surescripts, and Waystar will exhibit at the Oracle Health Conference September 18-20 in Las Vegas.

Blog Posts


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Currently there are "10 comments" on this Article:

  1. What not to wear.
    I put my Apple Watch and iPhone in a UV cleaner tray after every shift. Recommended practice as a nosocomial infection almost took me out 20 years ago.

  2. RE: VA choosing Cerner

    I was at Epic during the vendor selection process for the DOD VA implementation and I remember hearing rumors about Judy no bidding them at a certain point due to thier requirements being unacceptable. I never really believed it since no one would willing turn down such a huge customer but it kinda made sense given that Epic didn’t really NEED the sale at the time and even at that point it was shaping up to be a massive headache.

    Epic really dodged a bullet whether by choice or fortune though. I’m sure no one in Verona is losing sleep over not being dragged in front of congress and the media, and it certainly hasn’t slowed Epic’s gowth down at all. Meanwhile Cerner/Oracle has to spend who knows how much development time catering to the unique needs of a dinosaur of a client and spend thier entire PR budget trying to make excuses for problems that probably aren’t even their own.

    • Epic 100% wanted to win that contract, actively reached out to current employees who were veterans, and prioritized veteran status in recruiting for implementation staff at the time. When Epic lost that sale, they were stuck with scores of extra bodies in implementation and tried to come up with creative ways to use the bloated staff on hand. I believe there were some shakeups in sales and implementation leadership as a result of that contract loss. Ultimately you are right – it is a dodged bullet for Epic in terms of headache. But it is a loss for the armed services and ultimately the American taxpayer who will now be stuck with a next-best solution for many years.

      • As another ex-Epic passerby (who believes Epic is the best of the underwhelming options), all I can do is shrug and point to the incredibly messed up situation with the Coast Guard. I can’t rightly say whether it was Leidos kickbacks, Coast Guard corruption, or Hanlon’s Razor that led to that SNAFU…but it doesn’t make me believe that the powers-that-be at the DoD would be genuinely supportive of an Epic implementation. I wonder if an Epic win would have led to a decade-long saga before DoD giving their knee-capped implementation the ‘Old Yeller’ treatment.

        Even though the veterans can’t benefit similarly right now, I’m trying to at least be happy that DoD personnel appear to be receiving care from a functioning EHR that was allowed to go live.

        • I am curious, though, are the US armed forces getting care through a usable EHR system? I keep hearing “look at how it works for the DoD”, but haven’t seen evidence that something actually works.

          • Eddie,

            I have heard that the DoD implementation is also troubled, just not as bad as the VA version. Most likely for many of the reasons noted above, but also because the DoD has a different attitude than the VA. No dissing on the VA, but the concept of “embrace the suck” and “adapt and overcome” is common in DoD. They will find ways to work around limitations, and they share solutions when they work.

            The VA on the other hand is a bureaucracy with turf wars and mini-kingdoms with castles moats of data hiding. Eighteen VISNs, 18 castles, 18 duplicated administrations, 18 sets of decisions to unravel and decipher.

            DoD essentially has three services (Army/AirForce (include SPAAACE FOOOORCE), Navy, Coast Guard) and while different, they are very much the same. Army/Air Force are aligned and share many bases. Navy supports the Marines so will do what the Navy dictates when it comes to medicine. Coast Guard — I have no clue

      • I don’t know if this is the reason that the VA project has gone so badly, but I remember reading at the time that after months of indecision regarding the selection of Cerner vs. Epic, Jared Kushner was put in charge of making the decision. What could go wrong?

      • Epic fully expected to win that contract. We were engaged with Epic the couple week prior to the award announcement and Epic described all of the various manners in which they were preparing for the contract, including which roadmap items were going to be paused to account for DOD/VA needs.

        I also think they dodged the bullet.

  3. I never worked for Cerner or DOD/VA, and have no firsthand knowledge of anything regarding either organization. However, my favorite memory of that situation was that this news was publicly announced by the VA a couple hours after trading had closed, yet I recall seeing Cerner’s stock spike in afternoon trading when I was doing a regular check of the markets.

    Maybe there was a public announcement before the one I saw from the VA or some other legitimate news source that I was unaware of, but that whole situation appeared absolutely filthy to me. Good thing Cerner and the VA both appear to be taking a bath together since. Sounds like the water is getting hot.

  4. AnInteropGuy gets an upvote, entirely for SPAAACE FOOOORCE!

    Reminds me of The Muppet Show and that hilarious space soap opera, Pigs in Space!

    (Remember how the narrator would talk, and the clueless cast would look around, trying to find out who was speaking? LOL!)

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