EPtalk by Dr. Jayne 8/6/20

CMS continues to forge ahead as if providers have nothing else going on, releasing final scores for the 2019 Merit-based Incentive Payment System (MIPS) program. Every time I see one of these announcements, I’m again grateful that my practice decided to opt out and take the associated penalties. It’s worth seeing an extra patient here or there to cover any losses so we can focus on care delivery and not clicking boxes.

Other hot federal topics include a Medicare proposal to expand telehealth benefits permanently. I’ve seen what a benefit it can be for patients who don’t want to risk going to a physician office, but I’d like to see more practices offering it as a routine part of their care rather than patients having to go to third-party vendors for care.

A good chunk of what I do in the telehealth arena should ideally be managed by either the primary care provider or a subspecialist managing a particular condition, but our healthcare system continues to be broken in even basic ways. Several recent calls were around medication refills, not only for patients unable to make appointments with their regular physicians, but to even get a response to a refill request for a medication. When you hear some of the stories, you wonder if they’re made up, but based on the recent runaround I’ve had with my own family’s physicians, I have no reason to doubt the stories patients tell.

They also released the 2021 Proposed Rule for the Quality Payment Program via the Medicare Physician Fee Schedule Notice of Proposed Rulemaking. They did at least note that “in recognition of the 2019 Coronavirus (COVID-19) public health emergency and limited capacity of healthcare providers to review and provide comment on extensive proposals, CMS has limited annual rulemaking require by statute to focus primarily on essential policies including Medicare payment to providers, as well as proposals that reduce burden and may help providers in the COVID-19 response.” Although that’s small comfort to the people who have to wade through the original content of any proposed rule, at least they’re recognizing that most of us have other things on our minds. For those of you still in the game, comments are due by October 5 at 5 p.m. ET.

Props to Google Cloud for their “oops, that didn’t go so well” email after a bulk mail failure. It’s always good to tackle errors with a sense of humor, and I appreciate the acknowledgement rather than just getting another email. I also appreciated that their email linked directly to case studies about their products rather than forcing me to give my contact information to download an e-book or other fluff piece.

I’ve heard a lot of talk lately about EHR vendors that plan to use “AI” to help with physician documentation. In reading between the lines of some of these articles and ad pieces, the devil is truly in the details. One client was bragging about his vendor’s plans to add AI to their application and I was glad I was on a voice-only call because I’m sure I wouldn’t have been able to contain my facial expression. You have to have a reasonably robust backbone to add AI to an application, and this particular vendor is far from it. Their EHR is about two steps away from being a Microsoft Word document, and I can’t fathom how they think they’re going to “AI enable” that unless they’re just adding voice recognition and putting a lot of lipstick on it.

I think there is a tremendous amount of promise for AI-enabled documentation technologies, but to be as effective as a live scribe, they also have to be able to handle questions on information recall and analysis. I’m constantly asking my scribes to provide information from previous visits or to see if there are patterns with interactions. There are certainly technologies that can provide these functions as well and I’d love to see them be able to handle mainstream primary care and urgent care encounters like I see day-in and day-out. So far the only ones I’ve seen that are able to do a decent job are only able to do so in the subspecialty realm.

Low tech, but literally cool: Shipping giant UPS is readying freezer farms in preparation for the eventual shipping of vaccines against the novel coronavirus. Each unit can store up to 48,000 vials of medication, with a total of 600 units being placed at facilities in Kentucky and the Netherlands. I’ve only been on the receiving end of vaccination shipping and know what a major logistic undertaking it is for flu season, so I can’t imagine what it might look like when people are clamoring for the vaccine across the globe. (I am betting that for the 60% of US residents that say they won’t get it, there will be plenty of takers in the rest of the world.)

Since we don’t know what COVID will look like when flu season hits, many clinical organizations are already ramping up their plans for vaccination campaigns. There is plenty of good technology out there for the patient outreach piece and getting those patients who typically receive a flu vaccine should be easy. It’s also easy to identify the patients who have high-risk conditions and alert them to the benefits of the vaccine.

What’s not easy, however, is ensuring that practices have enough personal protective equipment for their staff members, which is still a struggle in many practices. Despite the availability of testing supplies in my community, many primary care offices are choosing not to test because of concerns about PPE, which sends patients to urgent cares, other health systems, or the CVS Pharmacy drive through. Fragmentation of care is still the order of the day for many patients, and until we get a national coordinated strategy, I imagine it will continue to be this way.

In the meantime, I’ll keep helping my clients ready their campaigns, prepare their word tracks for patients who are reluctant to vaccinate, and look at creative ways to leverage their technology assets to maximize scheduling and vaccine delivery. Just another day in the clinical informatics trenches.

How is your organization preparing for flu season? Leave a comment or email me.

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