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EPtalk by Dr. Jayne 8/23/18

August 23, 2018 Dr. Jayne No Comments

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Big news for the clinical informatics community last week, as the American Board of Preventive Medicine announces that Diplomates no longer have to maintain a primary medical board certification when they apply to recertify for clinical informatics. This also applies to those certified in addiction medicine, and really is a win for those of us who don’t practice traditional clinical medicine any more but still want to remain board certified in clinical informatics. ABPM already allowed this to happen with the subspecialties of undersea / hyperbaric medicine and medical toxicology, so it’s not clear why there was a disconnect in the first place. The policy becomes effective on January 1, 2019.

I still practice and have to sit for a re-certification exam next year and am not looking forward to re-learning all the areas that will be tested that I no longer practice, such as obstetrics. It will also be my first time using a totally online prep strategy, so we’ll have to see how that goes.

From Change in My Pocket: “Re: NYU’s free medical school tuition offer. What’s your take on it?” I agree with some of the naysayers. I’m not sure it’s going to have the desired effect. I went to medical school with plenty of students who were from families that paid for their medical school expenses outright and it didn’t drive them into the ranks of primary care. Lifestyle is a major factor in choosing a medical career, as well as earnings potential. Those aren’t going to be significantly altered by free tuition, although it may reduce the number of 15-year-old Honda Accords in the physician parking lot since that seems to be the vehicle of choice for primary care physicians who are still paying off their student loans.

Being a primary care physician is extremely demanding  mentally and emotionally as well as temporally, especially if you practice full-spectrum primary care including hospital and taking your own after-hours call. Most of the PCPs I know don’t take the traditional day or half-day off each week like the proceduralists do. Yes, I know most workers don’t get a half day off each week, but that’s how it often works in the medical world (to make up for things like weekend call, after hours call, etc.) and primary care definitely feels the squeeze.

There’s also the lack of respect from colleagues who make comments about “you’re just the primary” or view us as simply gatekeepers who are there to make sure they have a referral base. Free tuition isn’t going to make being a primary care physician sexy, especially since a good chunk of the population is OK with receiving their care from nurse practitioners at retail clinics or from a revolving-door cast of primary physicians that they see over time as their insurance coverage changes.

For me, a few things would make bring a primary physician exciting again. First, salary potential. I have a number in my head that if I could make it as a primary care physician without working 80 hours a week, I would jump at it.

Second, wider networks that allow patients to actually remain with a continuity physician for 10, 20, or 40 years. I would see patients for a year or two, then they’d have to change to the other hospital in town’s network, then their insurance would change, and they’d be back again. I had a dream of seeing patients for their entire lifespan and it just wasn’t reality. But when you could keep a patient for five or more years, it was gold. I’m still friends with some of those patients even though I’m long past being their physician.

Third, fewer insurance hassles and more trust of honest physicians. In my career as a solo physician, I was never denied a treatment that I requested through pre-certification. My orders were justified 100 percent of the time, not only by medical evidence, but by the insurance reviewers. When you have a physician who meets the criteria, can’t we perhaps back off on the pre-certification nonsense? I could have slimmed down at least 0.5 FTE on my balance sheet if I didn’t have to deal with pre-certification and pre-authorization. Sure, there are bad guys out there, but find them and stamp them out — don’t punish the good guys.

I don’t even mind the CEHRT or reporting hassles as long as there are decent EHRs out there. I’d be willing to take those extra clicks if the above conditions could be met. I loved my patients and miss many of them dearly. I felt like I was doing good for my relatively underserved community. I got to do fun things like ride on a float in the Founders’ Day parade. I cried with them when it was sad, went to funerals and hugged their widows, and celebrated when their kids got married. I even caught some babies. But I also worked a lot of late nights dealing with bureaucracy and silliness until finally the siren song of healthcare IT lured me away.

I do have patients who try to have continuity with me in the urgent care environment and will call around to see if I am working at a particular location when they need care. I’m lucky that I can stay in the industry and try to work for change from another angle, but many primary care docs give up when faced with the career they have not being what they thought they signed up for.

The article brings up a couple of interesting points about NYU and their offer. Their freshman class is only 102 students, down from 120-130 previously. Its students are in the 99th percentile for both GPA and MCAT scores. These are not “average” medical students, and in my experience, students with that kind of street cred are typically bound for high-profile subspecialties like orthopedic surgery, plastic surgery, interventional cardiology, etc.

Medical school admissions are very competitive, with only 41 percent of applicants being admitted. My practice employs scribes and previously most of them were applying to med school. This year, nearly all of them applied to and were admitted to physician assistant school. It’s perceived as a way to basically do the same thing as a physician, but in less time and for less money.

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Earlier this week I attended a Medicare Shared Savings Program webinar hosted by the Partnership to Empower Physician-Led Care, which advocates for independent physicians and practices as they transition to value-based care. They put together a nice summary of the proposed Medicare rule and the changes it will bring for independent practices. Overall it should be good for physician-led Accountable Care Organizations. Comments on the proposed rule are due October 16, 2018 and we expect a final rule in early 2019. Delays in rule-making could mean that programs can’t start until mid-2019, which should make for some interesting half-year reporting. According to panelist (and not-so-secret Dr. Jayne crush) Farzad Mostashari, it will probably take 100 pages of regulations to sort out the half-year issue.

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What’s your favorite bowtie? Send a pic – email me.

Email Dr. Jayne.

Morning Headlines 8/23/18

August 22, 2018 Headlines No Comments

The Man Who Used To Run Medicaid Has A New Idea To Make It Better

Former CMS Administrator Andy Slavitt launches The Medicaid Transformation Project to help 17 hospitals improve care for Medicaid patients – efforts that will be aided by digital health firm Avia.

hc1.com Expands Focus on Precision Health Solutions, Completes Series B Round

Healthcare CRM and analytics firm HC1 wraps up a Series B funding round with $10 million from Health Cloud Capital.

Montgomery General Hospital Signs for MEDITECH Expanse with Subscription-Based MaaS Model

Montgomery General Hospital (WV) will become the first to launch Meditech’s cloud- and subscription-based EHR when it goes live in September.

Morning Headlines 8/22/18

August 21, 2018 Headlines No Comments

Paul Singer, Doomsday Investor

A New Yorker article describes the hostile shareholder attack launched last year on Athenahealth by activist investor Paul Singer’s Elliott Management, noting how the firm often uses questionably ethical tactics to pressure recalcitrant CEOs of targeted companies.

Alphabet-backed One Medical is in talks to raise more than $200 million 

CNBC reports that primary care group One Medical is discussing a possible $200 million fund raise from a private equity firm that will also buy $100 million of existing shares.

NCPDP Takes Ownership of NIST ePrescribing Testing Tool

NCPDP takes ownership of NIST’s ERx Validation Suite, an ONC-approved e-prescribing testing tool.

Recondo Acquires Reseller Client Base from Optum

Recondo takes over the contracts of customers who had purchased a subset of its EmpoweredPatientAccess patient access solutions from The Advisory Board Company via a reseller agreement.

How Facebook — yes, Facebook — might make MRIs faster

Facebook’s AI team works with New York University’s medical school to develop an algorithm that could speed up the MRI process.

News 8/22/18

August 21, 2018 News 3 Comments

Top News

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A New Yorker article describes the hostile shareholder attack launched last year on Athenahealth by activist investor Paul Singer’s Elliott Management, noting how the firm often uses questionably ethical tactics to pressure recalcitrant CEOs of targeted companies.

The investment firm denies – not very convincingly —  that it anonymously tipped off journalists about Athenahealth’s company culture, sent copies of Jonathan Bush’s divorce documents to a tabloid, or opened fake social media accounts that featured nude pictures and from which messages were sent to Bush’s girlfriend with the subject line, “Do you know where your man is?” Bush resigned shortly afterward from the company he had co-founded, leaving Athenahealth to choose its path forward without him.

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Elliott Management was previously alleged to have hired private investigators to tail the CEO of another targeted company in hoping to force him out for personal behavior and to present each board member of a targeted company with personalized, dirt-containing dossiers about themselves with the implicit threat that the information could find its way into public hands if Singer didn’t get his way.

A snip:

The idea that companies exist solely to serve the interests of shareholders—rather than also to serve workers, customers, and the larger community — has been dominant in the business world in the past 30 years. As the field of activist investing becomes increasingly crowded, many investors are going beyond their original mission of finding ailing or mismanaged companies and pushing them to improve. Instead, some have been targeting larger, financially prosperous companies … Throughout our conversations, Bush returned to a theme that consumed him. He talked about how investors like Singer — financiers who take the assets built by others and manipulate them like puzzle pieces to make money for themselves — are affecting the country on a grand scale. A healthy country, he said, needs economic biodiversity, with companies of different sizes chasing innovation, or embarking on long, hard projects, without being punished. The disproportionate power of the Wall Street investor class, Bush felt, dampened all that, and gradually made the economy, and most of the people in it, more fragile.


Reader Comments

From Lumbar Puncture: “Re: Optum’s acquisition of Advisory Board’s Crimson business. Optum is forcing customers to migrate to its Claims Analytics platform. Doesn’t seem like adequate notice to retire a product. Maybe they would change their mind if enough customers threaten to walk. They’re also dumping MARA score and switching to another risk score prediction model, probably because it costs them less.” Unverified. Customer comments are welcome.

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From Pin Drop: “Re: hearing aids. They have improved since 2016 in becoming smaller, stronger, more comfortable, and more technologically advanced. I can change the ‘directionality’ of mine via a smartphone app and tune them for the ambient noise. The power and ability to address feedback is far better than just three years ago. I paid $1,800 for them at Costco, much less than the $4,700 quoted in the magazine article. More competition and better technology will improve the market, as the article concludes, but the current situation isn’t as dark as it states.” The article predicts that Apple, Samsung, and other big consumer companies might jump into the market once FDA restrictions are removed. Aging baby boomers would probably flock to  “Hearing by Dre” in the Apple store even as they studiously avoid the audiologist’s waiting room.

From Doublemint Triplets: “Re: Twitter. Who other than HIStalk is worth following for industry news?” These are among the few Twitter accounts I follow: @EricTopol (for research and patient-centered news); @chrissyfarr (a prolific source of healthcare and technology business insight); @ASlavitt (for Medicare news, albeit left-leaning); @JohnsHopkinsSPH (for the public health perspective); @Cascadia (more patient-centered insight); @DrNic1 (he finds all kinds of oddball but usually related stuff); and @TheOnion (for a much-needed break from in-the-weeds discussions). These provide me with the highest hit rate for topics that interest me.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

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CNBC reports that primary care group One Medical is discussing a possible $200 million fund raise from a private equity firm that will also buy $100 million of existing shares. The company was valued at over $1 billion even before the rumored investment. I admit that I’m not financially sophisticated enough to see the lucrative opportunities or efficiency improvement opportunities that a PE-owned primary care chain would offer, at least beyond slashing its highest labor cost (doctor salaries). Or maybe they’re sensing our unmet demand for receiving care in our most vulnerable moments from a private equity-owned business (my irony was not really ironic given that the moneychangers jammed their fingers into the healthcare pie long ago). Venture backers aren’t known for exhibiting patience in playing the long game, although PE owners have more patience than VCs. Both are always on the lookout for the greater fool.


Sales

  • The Iowa Clinic (IA) chooses MyHealthDirect for patient self-scheduling.

People

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Audacious Inquiry promotes Scott Afzal to president.

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University of Iowa Hospitals and Clinics chooses as its new CEO Suresh Gunasekaran (UT Southwestern Health System). He started his health system career as UT Southwestern’s AVP of health systems affairs and CIO from 2004-2014.

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Analytics vendor Unissant promotes Ken Bonner to president and chief growth officer.

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GE Ventures Senior Managing Director and health IT angel investor Lisa Suennen leaves the company after less than two years on the job.

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Goliath Technologies hires Donna Grare (TrialScope) as EVP/CTO.


Announcements and Implementations

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A new KLAS physician scheduling report names Shift Admin and QGenda as the most impactful with high “money’s worth” scores, while Amion offers an easy-to-use, well-supported system that doesn’t provide comprehensive scheduling algorithms and rules engines. 

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A new KLAS nurse and staff scheduling report gives ShiftWizard and Kronos high marks for reducing overtime and agency costs, although Kronos comes with a higher learning curve and cost. The needs of larger health systems are best med by Kronos, Avantas, and Change Healthcare despite their average scores, while some Cerner customers struggle to get even its basic functionality implemented and complain about its manual processes and underwhelming support. The report notes that predictive scheduling isn’t living up to its hype.

NCPDP takes ownership of NIST’s ERx Validation Suite, an ONC-approved e-prescribing testing tool.

AdvancedMD announces GA of its EPayments patient-managed electronic payments solution.

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Recondo takes over the contracts of customers who had purchased a subset of its EmpoweredPatientAccess patient access solutions from The Advisory Board Company via a reseller agreement with that company, with Recondo acquiring the client base from Optum (which acquired Advisory Board’s healthcare business in August 2017). The transaction increases Recondo’s installed based by 33 percent and quadruples the company’s profitability.

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The Dallas business paper profiles Tech Titan Awards finalist Leah Miller, CIO at HCA’s Medical City Healthcare (TX). The article notes that her team came up with the idea of 3-D printing ultrasound images so that blind parents-to-be can visualize their babies.


Government and Politics

The VA announces that its providers will be able to see the Walgreens-maintained medication and immunization histories of patients in a collaboration between the organizations. Criteria for participating in the Veterans Health Information Exchange are here.


Privacy and Security

A small executive survey finds that 70 percent of US healthcare companies don’t carry cybersecurity insurance.


Other

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Forbes profiles UK-based Cambridge Bio-Augmentation Systems, which plans a USB-type interface between the human nervous system and external devices. Co-founder and CEO Emil Hewage explains, “We are focused primarily on these peripheral nerves – not the brain or the spine – as we think the impact starts by listening to the signals that go back and forth to our heart, pancreas, or diseased limb and learning how to decode those signals. The idea is to learn where the hallmarks of a disease or sudden adverse event are being picked up, and then using machine learning tools to send signals back in to immediately treat or triage something.”

In China, a pharmacist who wasn’t willing to burden his parents financially with his newly diagnosed stomach cancer goes into hiding. Despite a $130 billion healthcare reform program, people can’t afford treatments, insurance coverage is poor, and governments don’t have the money to offer free care. The pharmacist’s father, a rice farmer, makes just $150 per year. A government advisor says (referring to China but equally relevant in the US), “China’s healthcare system must find a way to reduce its costs. It is too expensive now and has surpassed what most ordinary people can afford.” Eighty percent of rural cancer patients die within five years.

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St. Louis University will install 2,300 Amazon Echo Dot smart speakers to cover every dorm room with a centrally managed skill (no individual setup required) that will allow students to ask campus-specific questions related to hours of operation, sports schedules, or upcoming events.

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Eric Topol, MD says his short trial of Seqster has given him his first aggregated view of his information from his four Epic-using providers, 23andMe, and fitness trackers, although he notes that it doesn’t accept PDFs (so no scanned paper records), users can’t edit incorrect information. and it doesn’t collect data from very many sensors. The San Diego-based company, which is in early access mode, says it has raised $4 million in seed funding. 

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Facebook and NYU School of Medicine collaborate on a project that will attempt to speed up MRI scans tenfold by using AI. They hope to take a faster, lower-quality MRI that can then be enhanced via a neural network.

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A Politico Florida reporter’s writes her first article in a planned series titled “I’m Coping With Cancer by Reporting On It” after receiving a breast cancer diagnosis at 31.


Sponsor Updates

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  • Over the past four years, attendees at Aprima’s annual user conference have made more than 1,700 blankets and gift bags for the Children’s Medical Center of Dallas.
  • Colorado’s CORHIO deploys Health Language interoperability and data normalization solutions from Wolters Kluwer Health.
  • Bernoulli Health, CoverMyMeds, and Culbert Healthcare Solutions will exhibit at Epic UGM August 27-30 in Verona, WI.
  • Casenet publishes a new report, “The Reasons Why Care Management Platform Implementations Fail.”
  • Griffin Health enhances their FormFast Capture solution with FormFast Go for speedier e-signatures at the point of care.
  • Collective Medical joins the Strategic Health Information Exchange Collaborative (SHIEC) as a strategic business and technology partner.
  • Diameter Health and Zen Healthcare IT partner to deliver comprehensive clinical data connectivity, integration, and normalization.
  • Dimensional Insight will host a regional user meeting August 23-24 in Chicago.
  • DocuTap publishes a new case study, “MedAccess Urgent Care Averages Wait Times Under 15 Minutes with Clockwise.MD.”

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
Contact us.

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Morning Headlines 8/21/18

August 20, 2018 Headlines No Comments

VA, Walgreens collaborate to improve care coordination for Veterans

The VA gives its providers the ability to automatically view the immunization and medication histories of those patients who are also Walgreens pharmacy customers.

SOC Telemed Acquires JSA Health, Becomes Largest Acute TelePsychiatry Provider in the U.S.

Acute virtual care company SOC Telemed acquires behavioral health telemedicine vendor JSA Health for an undisclosed sum.

Audacious Inquiry Announces Promotion of Scott Afzal to President

Healthcare software, services, and strategy company Audacious Inquiry promotes Scott Afzal to president.

Amazon hires a star cardiologist to help its push into health

MIT lecturer and cardiologist Maulik Majmudar, MD joins Amazon in an unstated role.

Curbside Consult with Dr. Jayne 8/20/18

August 20, 2018 Dr. Jayne 1 Comment

Now that we’re in the bottom half of 2018, CMS has published the 2016 Physician Quality Reporting System (PQRS) Experience Report. The report summaries the reporting experience of eligible professionals and group practices, including historical trending data from 2007 to 2016 covering eligibility, participation, incentives, adjustment, and more. I was curious to get a look at the data because it is broken down both by specialty and by state. Here are some of the highlights:

  • Participation in the program was 69 percent in 2015 and 72 percent in 2016
  • Of the providers eligible in 2016, 31 percent were flagged for a payment adjustment in 2018. This represents over 435,000 providers

Of those receiving a penalty (I’ll call that payment adjustment what it is) almost 85 percent didn’t participate in the program. They literally did not submit any data. That means that 370,000 providers essentially said, “no thank you” and walked away from the program. My practice falls into that cohort, and I don’t think our CEO was that polite in deciding to walk away from PQRS. Other tidbits:

  • Being a provider in a small practice was a marker for receiving the penalty, with 71 percent of “adjustments” being levied on practices with fewer than 25 providers
  • Having a low volume of Medicare patients was associated with the penalty – 69 percent of those providers saw 100 or fewer Medicare patients

Having worked with dozens of practices trying to make sense of the value-based payment scheme, those numbers validate what we already knew, which was that to be successful, you need dedicated resources to help you (which small practices typically don’t) and it’s not worth the effort if the penalty is going to be relatively small due to your patient mix. Of course, 2016 was the last year for PQRS, which transitioned to the Merit-based Incentive Payment System (MIPS) which of course now has transitioned yet again. Since it’s been a couple of years since some of us have handled PQRS data (and many of us have blocked out those painful memories), remember it may use claims data, so it may not match your EHR data if you’re trying to look through the retrospectoscope.

CMS has also put together a document called the Value-Based Payment Modifier Program Experience Report, which looks at program results from 2015 to 2018 and includes the upward, downward, and neutral adjustments. In looking at the section on clinical performance rates, CMS admits that there have been numerous reporting mechanisms over the years and that it created a hierarchy that would be applied if the provider participated through multiple means so that only one performance rate for each provider would appear in the results. It’s a rigid hierarchy, so if a provider performed better through a mechanism that is lower in the list, they would retain the lower performance rate.

The report also notes that there have been numerous changes to the PQRS program over the years, with individual measures being added, removed, and redefined. Additionally, providers who shifted from individual to group reporting may be impacted by data artifact, resulting in the ultimate caveat: “It is unclear the extent to which any observed changes in measure performance were artifacts of the aforementioned changes or trends in provided care.” It goes on in true governmental fashion: “Nonetheless, this section of the report aims to describe clinical performance rates and trends.”

I have to admit, I looked at the report pretty quickly, it’s 96 pages long and there are a lot of tables. I would love to talk to someone knowledgeable to dig into why some of the measures that seem easily attained have declined so much over time. For example, measure 317 is screening for high blood pressure and documented follow-up. It dropped from 91.5 percent in 2013 to 62.9 percent in 2016. There were 4,200 providers reporting that measure across the timeframe, which seems like a reasonable sample. On the other hand, measure 310 for chlamydia screening dropped from 100 percent to 83.3 percent, but only 10 providers were reporting across the timeframe, so a change there could be due to sample size.

On the positive side, cervical cancer screening rose from 41.3 percent to 79.8 percent, but only 103 providers reported that measure. As a primary care provider, I think that’s a sad commentary on the state of preventive care in the US today. The clinical data starts on page 51, if you’re interested in taking a peek.

If you’re not on the clinical or operational side of the house, you may not have seen the decision-making process that practices go through when they try to decide what clinical measures to report. It used to be a little more straightforward, with practices wanting to report the measures where they do the best. Everyone likes to earn an A, so being able to show that you were doing something 95 percent of the time is a feel-good move.

Now that we’ve moved into an “adjustment” phase where there are winners and there are losers and the penalties essentially pay for the bonuses, it’s a different game. Providers are incented to report not on measures where they do the best, but where they do better than the next guy. If you’re doing something 50 percent of the time (which feels like a failing grade) but the rest of the population is only doing it 35 percent of the time, you win! It makes the analysis of measures much more challenging, because providers have to analyze their own performance against the performance of their peers, using a multitude of reports and benchmark data sets.

Smaller organizations may not be savvy enough to figure that out and may end up reporting on the “wrong” measures if they don’t understand how the game is played. I’ve seen a couple of EHR vendors that offer education around this, but the larger vendors seem to think their clients understand it or have enough staff to do that analysis. Even where education is offered, it’s not clear that practices are absorbing the information or that they feel they have the tools needed to make good decisions about quality reporting. Some specialties don’t have options for measures that are truly applicable to them, which puts them in the quandary of choosing measures that don’t make clinical sense just so they can get good numbers.

It might feel easier to just opt out rather than doing something that they know is just “checking the box.” I’ve worked with a couple of clients who have trouble getting the data they need to make good decisions – maybe they don’t have ready access to reporting modules in the EHR, or maybe the reports aren’t run on a frequency that allows the practice to drive change. Usually there is concern about the accuracy of the reports, with organizations having different interpretations of some of the measures than what the EHR might be pulling. That results in an unpleasant back-and-forth with the vendor, where it rarely feels like anyone wins.

I certainly don’t have the answers to this one, but would be interested to hear from readers on how their organizations are coping and whether they’re using any of the recently released data. What do you think of the new CMS reports? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 8/20/18

August 19, 2018 Headlines No Comments

Anthem $115 Million Data Breach Settlement Approved by Judge

Anthem settles its huge 2015 data breach for $115 million, of which it will make $15 million available to reimburse the resulting out-of-pocket expenses of its 19 million customers who were represented in the class group.

Mayo Medical Laboratories, National Decision Support Company team up to develop CareSelect™ Blood, a comprehensive approach to patient blood management

Mayo Clinic and National Decision Support Company develop CareSelect Blood, which offers 100 Mayo-maintained transfusion guidelines integrated into EHR ordering workflows.

Choosing Wisely Clinical Decision Support Adherence and Associated Inpatient Outcomes

A Cedars-Sinai study finds that failing to use available real-time clinical decision support was associated with a 7.3 percent increase in encounter cost, a 6.2 percent increase in length of stay, and a higher incidence of readmission and complications.

Monday Morning Update 8/20/18

August 19, 2018 News 2 Comments

Top News

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Anthem settles its huge 2015 data breach for $115 million, of which it will make $15 million available to reimburse the resulting out-of-pocket expenses of its 19 million customers who were represented in the class group (you can do the per-person math here).

The judge also scolded the plaintiff’s lawyers for excessive billing, awarding them $31 million of the $38 million they billed. The judge previously said she was “deeply disappointed” that the plaintiff’s four leading lawyers brought in an additional 49 law firms and an external review suggested setting their hourly rate at $156 instead of $360, with the judge choosing $240.

Anthem’s breach impacted 78 million people.

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The agreement also binds the company to implement better security, including data encryption, that will triple its data security costs for the next three years.

The judge also noted that data breach litigation isn’t yet mature and therefore taking the case to court – which would involve a long, expensive trial in which the laws of all 50 states would need to be studied — could have resulted in the class group getting nothing.


Reader Comments

From Inquiring Mimes: “Re: post-discharge contact. We were working with a vendor who said they would contact discharged patients via an automated system to ask a series of yes-no questions that would then notify our care team for prioritizing contact. They achieved almost none of their promises, so we aren’t going live. Do any of your sponsors handle automated calls with patients?” HIStalk sponsors (since the reader specifically asked for my sponsors), please let me know if you can handle this and I’ll pass your contact information along.


HIStalk Announcements and Requests

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I’m fascinated with responses to my recent polls that looked at health insurance. The great majority of respondents believe that (a) insurance companies shouldn’t use social and lifestyle data to price your policies; (b) people shouldn’t be forced into bankruptcy over medical bills; and (c) from last week’s poll, sicker people shouldn’t pay higher premiums or be denied coverage. Those respondents are apt to be disappointed by the health system we have (or are hurtling toward) since everybody refuses to address the key issue of healthcare costs and instead tries to squeeze their end of the balloon to push the cost problem off onto someone else.

Responses this week included that of Dave, who says enrollees who don’t control their own risks (obesity, smoking, drinking) should pay more. Loss Ratio says insurance can work only if everyone carries it without having their pre-existing conclusions excluded since any of us could be seriously injured or disabled, while Jeremy thinks risk should be priced into premiums like other insurance, no different from homeowners who pay higher premiums to live on the beach. PFS_Guy hopes for Medicare for all with a secondary insurance market to manage out-of-pocket risk, adding that we can choose just two items from the list of price, quality, and service. Inclusive OR also argues for universal coverage since health “insurance” is really not that at all and instead is more of a discount plan. Healthcare Idiot Savant thinks people who make bad health choices should pay more, but worries about the resulting privacy issues, concluding that we need mandatory coverage and to get away from private pay inequities that cause a lot of wasted time and money chasing revenue cycle and other healthcare administrivia.

This week’s poll question: how much impact will result from five big technology companies announcing their support last week for healthcare interoperability? Click the poll’s Comments link after voting to elucidate your thoughts further (beyond just choosing the safe middle option).

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I considered a different poll question – will medical students really flock to lower-paying specialties just because NYU has eliminated medical school tuition? My experience is that people and companies invariably take whatever action pays them the most, so I’m cynical that altruistic med students will happily pass up surgery, cardiology, and dermatology residencies to become PCPs who are endlessly monitored, benchmarked, and regulated away from developing those patient relationships that drew them to primary care in the first place. I’ve known a few people who took lower-paying jobs just for the service and satisfaction aspects while fresh out of school, but not many.

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I suppose it’s hiatus time for my “Wish I’d Known Before” series since I can’t seem to cajole people into responding. Check out responses to the final one about taking time off to do something enriching.

HIMSS is tweaking its annual conference dates yet again, I’m reminded when looking something up on the registration site, with HIMSS19 kicking off with pre-conference sessions on Monday, February 11; the opening session will be Tuesday, February 12; and the exhibit hall will be open Tuesday, Wednesday, and Thursday. That’s 1-2 weeks earlier than previous Orlando iterations.

I was thinking that, for the first time, I’m on a version of Windows (10) that gives me nothing to complain about. This is as close to an invisible operating system that I’ve seen, and that includes IOS and Android on mobile devices .


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

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Here’s a “healthcare is really a business” case study. Hospitals are petitioning Medicare to pay all hospitals to perform the TAVR heart value procedure instead of limiting payment to those hospitals that have high cardiac procedure volumes. Interesting facts:

  • Medicare pays $45,000 for the effective, safe, and quickly recoverable procedure, including the $30,000 that goes to the device’s manufacturer.
  • Hospitals that obtained a TAVR franchise want the policy to remain since it stifles competing hospitals that are anxious to obtain a share of the ancillary revenue and to gain marketing cachet.
  • Hospitals and medical device manufacturers say limiting Medicare payment to specific hospitals discriminates against minorities and rural residents and that Medicare imposes no volume restrictions for other heart procedures.
  • Patient advocacy group Mended Hearts wants access expanded, but that organization gets funding from the device makers.

Announcements and Implementations

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University of Texas Health Science Center at Houston’s School of Biomedical Informatics will offer the country’s first Doctorate in Health Informatics (DHI) degree for working professionals who have executive-level healthcare experience, with the program focusing on solving real-world problems instead of performing a research dissertation. The 63-credit-hour program requires a master’s in health informatics or equivalent.

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Mayo Clinic and National Decision Support Company develop CareSelect Blood, which offers 100 Mayo-maintained transfusion guidelines integrated into EHR ordering workflow to improve outcomes and cost.

A Cedars-Sinai study finds that failing to use available real-time clinical decision support (Choosing Wisely guidelines presented to clinicians via Stanson Health) was associated with a 7.3 percent increase in encounter cost, a 6.2 percent increase in length of stay, and a higher incidence of readmission and complications.

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Respondents to a new Reaction Data survey of mostly C-level health system leaders expect the biggest healthcare disruptor to be Amazon, followed by Apple, Google, and Microsoft. Executives asked about emerging technologies say the biggest impact will be caused by telemedicine (mostly for care delivery to rural or remote areas), artificial intelligence, interoperability, and data analytics.

Aprima will integrate Dolbey’s cloud-based speech recognition solution, which includes voice-powered screen navigation and prompting, with its EHR.


Other

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CNBC’s Chrissy Farr catches up with former ED physician Matthew Wetschler, MD, who was profiled as a “holiday miracle” in November 2017 after a surfing accident made him a temporary quadriplegic. He was saved by aggressive, innovative hospital treatment, but the not-so-feelgood part of the story is that he was taken to San Francisco General Hospital, which isn’t in the network of his insurer (Oscar), and he’s on the hook for the portion of the $500K bill that Oscar wouldn’t pay. The hospital turned his bill over to collections, his credit is shot, and he’s getting daily calls demanding that he pay up. His wheelchair was never delivered and he spent months trying to get his rehab approved to start even though he was pre-approved. As Farr says, “his story is the best and worst of the US medical system.”

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Friday night’s episode of CBS’s “Whistleblower”profiled Brendan Delaney, the former implementation specialist at NYC’s Department of Health and Mental Hygiene who filed a whistleblower lawsuit against EClinicalWorks that the company settled for $155 million in May 2017 (Delaney got $30 million of that).

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The American Nurses Association seeks public comment by September 10 on its draft “Core Principles of Connected Health.” I don’t have any issues with the content, so I’ll focus proofreading: correct the inconsistent use of commas (especially the Oxford comma); stop saying “utilization” when “usage” is synonymous without being pompous; eliminate the word “current” since it is superfluous; and review incorrect hyphenation (such as “in-person” when not used as an adjective).

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Here’s an interesting tweet from Mario Molina, MD, former CEO of insurer Molina Healthcare.

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The St. Augustine, FL newspaper interviews Flagler Hospital CMIO Michael Sanders, MD about its pilot project of Ayasdi, which uses AI for clinical variation management (although the paper’s headline writer might need algorithmic assistance to spell “Flagler” correctly). 

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Mike Funderburk, formerly of Charlotte, NC-based benefits app vendor Novarus Healthcare, writes a Business Insider article covering his experience with the company. He took a 50 percent pay cut to join the small startup team in sales, landed a few customers and potential investors after an initial $750,000 investment, but saw the company shut down after less than a year due to lack of revenue. He says it wasn’t hard to return to a corporate job afterward and still urges people to give their dream a shot. The company’s web page and social media accounts remain active, but frozen in time.

Scientific American covers the planned FDA deregulation and ensuing innovation of hearing aids, noting that they:

  • Haven’t changed since the 1950s
  • Cost $4,700 per set and aren’t covered by most insurance plans
  • Must be obtained through an audiologist or physician
  • Are manufactured by just six companies (who are, predictably, not enthused about new competition)
  • Are used by just 20 percent of people with hearing loss
  • Could be enhanced by big-name tech vendors like Apple or Bose to include a phone interface for reading directions or messages

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New Zealand’s Minister for Women Anne Genter, an avid cyclist, rides her bike to the hospital to give birth, explaining that there “wasn’t enough room in the car.”


Sponsor Updates

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  • Lightbeam Health Solutions employees donate school supplies to the Boys & Girls Clubs of America of Greater Dallas.
  • HCI Group parent company Tech Mahindra will provide the Jacksonville Jaguars football team with next-generation digital technology expertise in areas such as AI and analytics.
  • Medicomp Systems will exhibit at HIMSS AsiaPac18 in Brisbane, Australia November 5-8.
  • Chartis Group posts a white paper titled “Rethinking the Role of IT: The Second Curve of Health IT Value.”
  • Philips Wellcentive publishes a white paper titled “Are You a Data Blocker?”
  • Forrester includes Liaison Technologies in its new report, “Now Tech: iPaaS and Hybrid Integration Platforms, Q3 2018.”
  • MDLive will present at Health:Further August 28 in Nashville, and at the Connected Health Summit August 29 in San Diego.
  • Meditech releases a new video, “How do doctors want to spend their free time?”
  • Netsmart adds MyStrength’s digital, evidence-based content to its EHR.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the AWHONN Indiana Section Conference August 24 in Indianapolis.
  • Pivot Point Consulting will exhibit at the NCHFMA Summer Conference August 22-24 in Myrtle Beach, SC.
  • Sunquest will exhibit at the Public Health Informatics Conference August 20-23 in Atlanta.
  • Frost & Sullivan recognizes Surescripts with its 2018 North American New Product Innovation Award.
  • Vocera publishes a new report, “Co-Architecting Healthcare Transformation: How Leading Health Systems Put Patients and Families at the Forefront of Design.”

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.

Get HIStalk updates. Send news or rumors.

Contact us.

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What I Wish I’d Known Before … Taking Time Off for Doing Something That Turned Out to Be Motivating, Enriching, or Transformative

I wish I’d known that it was something I shouldn’t have been afraid to do sooner. I was always worried that it would be an issue with my employer. Even though I had to burn several years worth of accumulated vacation, it was well worth it.


I tripped into an amazing pseudo-volunteer experience in Spain after taking some time off between jobs, and I think your readers would love looking into it if they have even a week to immerse in another world. The organization Diverbo is an English immersion program for Spanish-speaking professionals looking to further their English. “Volunteers” (native English speakers from all over the world) join the participants for a week at a resort where everyone is prohibited from speaking Spanish, and we spend meals and activities conversing, interacting, developing relationships, and learning about each other, all in the spirit of helping the Spaniards advance their language skills in support of career growth. It was a blast and free for volunteers (English speakers), aside from the cost of getting to in Madrid (transport to the resort, lodging, and meals were all covered by the program). Hoping I can go back soon.
https://www.diverbo.com/


Work isn’t everything.


Everyone else that didn’t have the experience didn’t understand. And I didn’t know how to manage the feeling of frustration that they didn’t get how great the experience was when I tried to explain. Reinserting myself into routine took awhile, but the lessons learned were lifelong and I’d do it again.


That taking more than the standard one business week off for a vacation offers much more opportunity and rejuvenation. I was able to spend 6 weeks in Europe (combined all my time off after a large project- thanks to my boss) and spent a minimum of two weeks off for several years. Most coworkers thought they couldn’t or the office couldn’t survive without them. Not true.


Time off – regardless of what you do – is itself motivating, enriching, and transformative. It isn’t so much about what you do rather, about your attitude while doing it. Time away from work is time well spent; for you, your employer, everyone.


To make sure that there is some type of follow-up plan in place to keep a proportion of the positive momentum going forward once you get back to “reality.”


That you have to make time to grasp opportunities and sometimes planning too far in advance limits special trips. About 15 years ago, we planned to go to Yellowstone because Uncle Tom lived in a big house close to the park. Never made it and Uncle Tom has moved so can’t stay at his place but could still visit. Had an opportunity to visit a special place given to me in January. Pushed my family to do this — one daughter in medical school and the other just starting PA school. Glad we did the trip as that person no longer works in the special place and if we had not taken the opportunity it would be gone.


Weekender 8/17/18

August 17, 2018 Weekender No Comments

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Weekly News Recap

  • Best Buy acquires GreatCall, which offers emergency response services and digital health devices for seniors, for $800 million
  • Alphabet invests $375 million in data- and technology-focused insurance startup Oscar, following participation by two Alphabet subsidiaries in a funding round a few months ago that valued the company at over $3 billion
  • Amazon, Google, IBM, Microsoft, Salesforce, and Oracle pledge to support interoperability at Monday’s Blue Button 2.0 Developer Conference
  • The Wall Street Journal posts another critical review of IBM Watson Health for oncology, saying that “the diagnosis is gloomy” for Watson’s ability to improve cancer treatments.

Best Reader Comments

What do Amazon, Google, IBM, Microsoft, Salesforce, and Oracle have in common? No impact in healthcare interoperability despite multiple attempts. (Fourth Hanson Brother)

How does their “support” of interoperability actually translate into something meaningful? Are they going to somehow put the screws to organizations (both vendors and healthcare groups) who are have a greater incentive to protect their own revenues? (RobLS)

The 10% of reality that isn’t perception trumps the 90% at the most inconvenient times. (LFI Masuka)

Watson for Oncology isn’t an AI that fights cancer, it’s an unproven mechanical turk that represents the guesses of a small group of doctors. (Mechanical Turk)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. C, who asked for LCD writing boards for her Tennessee kindergarten class. She reports, “We have been using our LCD Writing Tablets every day! My students love to use these boards to practice writing sight words, short vowel CVC words, their names, numbers, and so much more. They have eliminated the mess of dry-erase markers and promote student engagement. They allow me to check my students’ answers and work easily, provide corrections, and allow students to make necessary corrections quickly. These boards are currently one of our favorite things in the classroom. Thanks so much!”

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In Spain, a woman who is growing tired of her ED wait (does that make her an impatient patient?) torches the place by igniting an oxygen bottle, requiring the hospital’s evacuation.

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A new University of Vermont Medical Center federal filing is published in the middle of heated negotiations with unionized nurses who are working without a contract, likely to be emboldened by the news that it pays two executives more than $2 million, or 29 times the average RN salary. The health system says what health systems and universities always do when huge salaries are made public – we have to pay competitively compared to other academic medical centers to attract and keep executive talent.

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New York University will make its medical school tuition-free regardless of financial need, hoping that graduates saddled with reduced debt will consider less-lucrative jobs in primary care and research. Students won’t have to pay the medical school’s $55,000 tuition, but they will still need to cover their estimated $29,000 in living expenses. The announcement was made at the med school’s white coat ceremony, drawing a standing ovation since the change takes effect immediately.

A New York hospital requires visitors to show ID to get an ID badge – which contains their photo and destination — printed with invisible ink that disappears after 24 hours. I’m always surprised that hospitals have few visitor-related incidents other than in the ED since visiting hours have been extended, anyone can wander the halls unmolested (except for the nursery), and security guards rarely wander patient floors. I’ve seen visitors fighting with each other and with employees, family members who tried to kill a patient in their bed, and gang or romantic rivals launching beat-downs at the nursing station. I once talked a newly hospitalized patient out of the gun he was waving around in his room, although I’m still not sure why I thought that was a good idea. It was a small hospital without real security guards and I was the only male on the floor at the time, ill-advisedly succumbing to the impulse to help the frightened the nursing staff and hoping that I had accurately characterized the patient as confused but harmless.


In Case You Missed It


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Morning Headlines 8/17/18

August 16, 2018 Headlines No Comments

Cerner to take over MCHS IT department

Cerner ITWorks will take over the IT department of Medical Center Health System (TX) beginning September 10.

Google is reportedly developing an AI assistant that recommends workouts and meal plans

Google is developing an AI-powered wellness assistant for smart watches that will proactively encourage users to make healthy choices based on their appointments, recorded activities, reminders, and location.

Black Book Releases 2018 State of Healthcare IT Consulting Report, Triple Digit Growth Projected for High Demand Expertise

A Black Book report on health IT consulting predicts firms will rake in $53 billion by the end of this year, with the bulk of that coming from software implementation, optimization, integration, and support.

News 8/17/18

August 16, 2018 News No Comments

Top News

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Best Buy acquires GreatCall for $800 million.

GreatCall is perhaps best known for its senior-friendly mobile phones currently being hyped in TV ads by vice chairman and former “America’s Most Wanted” host John Walsh.

The San Diego-based company also offers medical alert wearables, emergency response services, and apps that offer medication reminders and connect a user’s GreatCall device with family members.

This is not the big box retailer’s first foray into healthcare. It launched its smart phone-based Assured Living service for seniors and their family members last fall and added health and wellness content and symptom checking capabilities from Mayo Clinic to the companion app in January.


Reader Comments

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From I’ve Been Everywhere, Man: “Re: US News top 20 hospitals. You are correct (in a technicality) that all 20 use Epic. Mayo Phoenix was one of Epic’s first ambulatory sites in the early 1990s, then was forced off in a Mayo corporate decision to self-develop in hacking Phamis Lastword to try to work in ambulatory. Meanwhile, Mayo Rochester, WI, and MN are live on Epic and Mayo Phoenix will go back on Epic this fall.” 


HIStalk Announcements and Requests

The paucity of interesting news will confirm that we’re in the Summer Doldrums, when everybody is focused on getting the kids back in school and squeezing in those last summer vacations and family cookouts. That’s also the time when I get bored and offer new sponsors a special deal just so I don’t feel ignored as page views and reader interaction take one last break before Labor Day. Contact Lorre, get on board now, and spend that budget money on something useful before it evaporates.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

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Patient payments company AxiaMed raises $12.4 million.

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The USPTO awards Zynx Health a patent related to using machine learning to analyze clinical decision support documents. The company will incorporate the technology into its Knowledge Analyzer clinical content management solution for EHRs.


People

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Patient safety expert Peter Pronovost, MD, PhD has left his position as chief medical officer of UnitedHealthCare after three months on the job. He resigned after seven years at Johns Hopkins Medicine in February 2018 to become UHC’s SVP of clinical strategy, then became CMO in June.

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Healthwise promotes Jay Reynolds to CTO.

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Dan Speicher (Omnitracs) joins Medecision as CTO.

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Fortified Health Security hires William Crank (Medhost) as COO.

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Michael Cantor, MD, MA (Pfizer) joins Regeneron Pharmaceuticals as head of clinical informatics.


Sales

  • Carteret Health Care (NC) and Ozarks Medical Center (MO) choose consulting services from Engage.
  • HIEs HealtheLink, Quality Health Network, Health Current, Indiana Health Information Exchange, and ClinicalConnect select data normalization and cleansing applications from Diameter Health.

Announcements and Implementations

Michigan Health Information Network Shared Services implements 4medica’s master patient index.

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MedStar Health implements several FormFast form management technologies across its facilities in Maryland and Washington, DC.


Privacy and Security

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In an effort to cut through the “white noise” of data breach news, HGP publishes a concise review of cybersecurity incidents in healthcare since 2010. Items of interest include:

  • Email has become a favored entry point for hackers; breaches of personal devices have decreased by 50 percent.
  • Paper and film breaches continue to account for 20 percent of breaches.
  • Business associate-related breaches have decreased by 10 percent, while payer breaches have increased by 5.
  • Of the 23 cybersecurity companies listed, Armor, Imprivata, Olive, and FairWarning have secured the most funding over the past two years.

Other

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A Black Book report on health IT consulting predicts firms will rake in $53 billion by the end of this year, with the bulk of that coming from software implementation, optimization, integration, and support. The top three consulting needs are for cloud technology adoption, increased digitalization, and to supplement a lack of internal resources. Top wish-list engagements include help with transitioning to value-based care, cloud infrastructure, compliance, and decision support and analytics. The Chartis Group, ECG Management Consultants, Huron, and Impact Advisors top the list of favorite consulting firms, according to survey-takers.

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A new KLAS report on business intelligence finds that Epic leads the pack by far in deep adoption despite immature native functionality and a lack of cost effectiveness, while HBI Solutions and Health Catalyst have the highest overall score and Dimensional Insight is #1 in driving outcomes and delivering value. Health Catalyst’s combination of software and services places it high on the list, especially for those looking for help with readmissions, opioid use, length of stay, and sepsis. Cerner’s offering is “still immature” as most clients are just getting started, with users telling KLAS that it lacks a testing environment, it doesn’t bring in external data easily, and it doesn’t yet offer predictive analytics. IBM, Microsoft, and SAS declined to participate.

Google is developing an AI-powered wellness assistant for smart watches that will proactively encourage users to make healthy choices based on their appointments, recorded activities, reminders, and location.


Sponsor Updates

  • Elsevier receives several Digital Health Awards from the Health Information Resource Center.
  • EClinicalWorks will exhibit at the NACHC Community Health Institute & Expo August 26-28 in Orlando.
  • Spok announces that the 20 hospitals named to US News & World Report’s 2018-19 Best Hospitals Honor Roll and the 10 hospitals named to the Best Children’s Hospitals Honor Roll are its clinical communications customers.
  • FormFast will exhibit at the 2018 GHIMA Annual Meeting & Exhibit August 19-20 in Pine Mountain, GA.
  • Glytec publishes a new video, “Digital Diabetes Management from a Patient’s Perspective.”
  • HBI Solutions will exhibit at the SHIEC 2018 Annual Conference August 19-22 in Atlanta.
  • Gartner includes Imat Solutions as a sample vendor in its latest Hype Cycle report for US healthcare payers.
  • Influence Health announces 43-percent bookings growth for its Consumer Experience Platform solutions, and a 131-percent increase for its multi-channel campaign managed marketing services.
  • Intelligent Medical Objects will exhibit at Aprima’s annual user conference August 17-19 in Grapevine, TX.
  • PerfectServe will host the Hospital for Special Surgery Educational and Networking Open House September 21 in New York City.
  • Meditech publishes a new case study, “Clatterbridge Delivers More Efficient Cancer Care to the UK with Meditech, and a video titled “How Do Doctorrs Want to Spend Their Free Time?”
  • PMD successfully completes its first SOC 2 and HIPAA security audit.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
Contact us.

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EPtalk by Dr. Jayne 8/16/18

August 16, 2018 Dr. Jayne 1 Comment

CMS has posted a new presentation covering the proposed rule for the 2019 Medicare Physician Fee Schedule. For those who have not yet started to dig in for review, it’s a nice 35,000-foot summary of the E&M coding and virtual care pieces. Plus, it’s only 17 slides long, which might possibly make it the shortest document to come out of CMS in a long time.

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My fortune cookie revelations are usually pretty bland and I’ve never had my palm read. However, I wonder if my inbox is trying to predict my future. I had back-to-back emails about the best ways to onboard physicians from MGMA and the top 10 things to think about when you’re thinking of leaving your practice from AAFP’s Family Practice Management journal. It made me laugh, particularly because my current clinical situation is the best one I’ve ever worked in. The support team members are great, the owners are extremely supportive of my life in healthcare IT, and I feel energized and valued at the end of the day even when it’s been a very tough shift. I wish I had found that kind of clinical fulfillment earlier than halfway through my career, but I’m glad I found it when I did. Still, the documents were good advice, so I’ll tuck them into my consulting portfolio for the next client.

From Noteworthy: “Re: news. It’s amazing what passes for a news item in healthcare today. It’s not outcomes data, it’s not a new gamma knife offering, or even mobile mammograms — it’s vinyl flooring.”Actually, it’s both vinyl flooring and new blinds to give the practice greater “curb appeal.” The practice administrator is quoted regarding how important it is to have vinyl flooring in order to provide a clean environment for patients. Does that mean that their previous carpet provided a less than sanitary space before this week’s renovation reveal? Inquiring minds want to know. Perhaps I should pitch a new show to HGTV for renovating disastrously outdated physician offices. I’ve definitely seen more than my share.

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Earlier this week, Mr. H mentioned the phenomenon of medical students skipping classes and instead using YouTube videos and other resources to prepare for their licensing exams. There is a great comment posted by reader AndyWiesental, who details the non-content skills that physicians need to learn. The diagnostic process and how to determine the appropriate care for a given patient take time to learn, but despite the push for patient-centered care and individualized medicine, educational and quasi-regulatory bodies are still pushing us towards fact-based testing that quickly becomes obsolete. Board certification exams are a case in point, with questions such as “which of the following drugs is the most effective therapy for XYZ” where the answers are items that are 70, 72, 80, or 85 percent effective. In the world of in-the-trenches medicine, those numbers are not terribly relevant. It’s more complex than lab-based effectiveness; one needs to look at the cost vs. efficacy, tolerability and side effect profile, whether it’s on the insurance formulary, and more. And by the way, there’s a chance that a formerly-effective drug will be recalled, so all the numbers go out the window. It all depends on the patient sitting in front of you, as well as the statistics, and the way we are currently tested doesn’t take that into account.

I recently had a conversation with a physician as I was waiting for a plane, and we were lamenting the idea of recertification exams. His board is taking a more progressive approach and allowing more of an extended open-book format that demonstrates the ability to find knowledge rather than memorize factoids. That’s how we practice now, finding the best evidence through curated sources rather than trying to regurgitate what we learned to pass the exam. Although medical education is progressing, the students I work with tell me it’s not a lot different from when I was in school, just more high-tech. Where we recorded lectures on a cassette tape and had a classmate transcribe them, print them, and stuff them in our student mailboxes, today’s students view recorded videos of the lectures.

I once failed a medical microbiology exam because I actually learned the material and didn’t memorize the old test papers that my classmates circulated. When I sat for the exam, the questions were so poorly written that you often couldn’t tell what the correct answer was, with double negatives, multiple correct answers, typographical errors, and more. Yet, many of the members of the class scored 100 percent where a full third of us failed. The dean actually advised us to spend more time with the old tests and allowed us to retake it. With no studying but time spent memorizing questions, I aced it. Hopefully those days are long gone and we’re testing the ability of students to apply information rather than hoping they know the correct answer to the question about E. coli is D.

In response to Mr. H’s question: “If medical school education is vastly different from the content mastery required to pass Step exams, is either set of knowledge incorrect or are students expected to complete a self-managed, dual-track education?” In my experience the latter is correct. Students have to memorize the minutiae for certain, but it’s also often up to them to identify suitable mentors and clinicians whom they want to emulate, and try to learn how to be “that kind of doctor.” Some professors in academic settings aren’t the kind you want to copy, and it can be challenging to find opportunities to rotate with “regular” physicians in the community. There are similar issues in residency training, with some rotations being irrelevant to the trainee’s chosen career path. Statistically, only 17 percent of family physicians practice obstetrics, yet we’re all required to spend several months on rotation. I’d rather have had that time to take extra behavioral health rotations or emergency rotations since those were areas I was more likely to use in my planned future career.

Other rotations are woefully inadequate. My residency’s family medicine program ran a private practice clinic where we learned to code and bill and how to document, which are key for surviving in medicine today. We received productivity and utilization reports. By the time we were in the second half of the last year of residency, we were running full clinic days seeing a volume of patients equivalent to the faculty attending physicians, mostly in 15-minute visits. The internal medicine program ran a clinic where no one ever had to code or bill and every appointment was 30 or 60 minutes. Which trainees came out better equipped to succeed in practice? It was in those 15 minute slots that we learned how to prioritize patient issues and how to best use limited time and resources for individual patients. Of course, we’d all have preferred at the time to have the half-hour or hour slots that our peers did, but when we made it to the real world we were grateful, and our former classmates were shocked.

I’m coming up on a milestone reunion for medical school and it will be interesting to see where people have landed. Our class was an outlier, with nearly 10 percent of graduates not pursuing residency training. Some went to research, others to the pharmaceutical industry, a few to law school or business school, and a couple left medicine altogether. I’m definitely making a point to connect with some of my former classmates who are in academic settings, to see what they make of all of this.

Are you working at an educational institution? How does your employer support student learning? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 8/16/18

August 15, 2018 Headlines No Comments

HHS awards $125 million to support community health center quality improvement

HHS will award $125 million in grants to 1,352 community health centers to help them improve care access and outcomes, and advance their use of health IT.

Best Buy Acquires GreatCall, A Leading Connected Health Services Provider

Best Buy acquires GreatCall, which offers emergency response services and digital health devices for seniors, for $800 million.

Kindbody Purchases Cloud-Based Software From IVFqc

Women’s health and fertility care company Kindbody purchases the IVFqc cloud-based EHR and billing software assets of Althea Science.

Readers Write: A Person-Centered Approach for Success in Intellectual and Developmental Disability Services

August 15, 2018 Readers Write No Comments

A Person-Centered Approach for Success in Intellectual and Developmental Disability Services
By Andrew Mersman

Andrew Mersman is senior director at Netsmart Technologies of Overland Park, KS.

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It’s no secret that limited resources and funding have historically been a challenge for providers of Intellectual or Developmental Disabilities (I/DD) services. That’s why it’s important for healthcare providers to break down information silos and work collaboratively to achieve the best outcomes possible. With the introduction of value-based care payment models, it will be even more important for providers to find effective and efficient ways to manage resources across the healthcare continuum to deliver the right care for every individual’s needs. The continued evolution of Home and Community Based Services (HCBS) waiver plans and emphasis on conflict-free case management also make person-centered care more important than ever before.

To aid organizations in providing the best I/DD services with a person-centered approach, awe’ve narrowed down four key elements to keep at the forefront of managing an individual’s care.

Person-Centered Planning

To deliver the best services possible, it’s important to address it with a holistic, whole-person outlook. Keep the individual at the center of this universe and take in surrounding factors into consideration as you plan and coordinate delivery. Important items to consider in person-centered planning include:

  • Taking direction and considering feedback from the individual receiving services, including from their support system
  • Integrate the person’s strengths, preferences, and desires – example is integrating pictures into the ISP to help an individual be more active in their services
  • Drawing on insight gained from the individual’s relationships within their community
  • Enabling individuals to express satisfaction with service delivery through feedback, allowing for course correction as needed

Care Coordination

Care coordination should focus on the health, social, and personal desires of the individual. When approaching care coordination for a person with a developmental or intellectual disability, it’s important to ensure that a person’s service plans are self-directed by the individual and are aimed toward meeting their personal goals, including day-to-day living and other life factors such as independent living or employment goals. Additionally, modern reimbursement models demand more accountability for care coordination between different services and settings.

Comprehensive Assessment and Planning

Person-centered care requires the ability to plan and provide the right type of services that can result in the best outcome possible. To do that, providers need to assess many aspects of a person’s life when determining the best plan for them. This is essential to determine the kind of services that should be provided along with the method in which they are delivered, and account for any potential obstacles that may prevent the individual from being successful. Factors to be assessed can include things like housing, family support, social skills, personal care, communication, financial stability, nutrition, activity level, and more.

When developing a person’s care plan, it’s critical to ensure that all essential elements of the person-centered plan drive the planning process. This is also the time to determine that tasks based on valued outcomes are specific, measurable, achievable, relevant, and timely to make sure that an individual can progress and be successful. Planning should also emphasize community inclusion and participation, independence, and the use of informal community supports when possible.

Data Collection, Measurement, and Reporting

Creating a care plan alone isn’t enough. It’s essential to prove the effectiveness of the support and services your organization provides. The way to tackle that is through collecting, analyzing, and reporting data to demonstrate outcomes. Your organization should be able to look at results and determine if the plan was successful, not just that the tasks were completed.

An integral part of applied behavioral analysis requires the ability to measure an individual’s growth and development. You can’t report progress without any data, so the first step is to gather and collect it throughout their journey. Once they are accessing and receiving the services outlined in their plan, it’s time to record progress. What has been the outcome of the services they’ve been receiving? Are they improving with the method of delivery your organization is providing?

Your EHR should allow your support staff to easily record and track a person’s progress through streamlined, intuitive workflows. And in an age where services are delivered in a variety of settings, mobile functionality is essential for entering important data on a tablet or other portable device. Going mobile is an effortless way to build staff efficiencies and supports the move away from a paper-based system, allowing data to be accessed and retrieved in real time.

Once the data is collected, it’s time to look at what it collectively means in the bigger picture. Here’s where robust reporting and analytics comes in. The ability to display data in a variety of outputs (i.e. raw data counts, compliance or achievement percentage, or graphical representation) is important with respect to who is viewing the data. Also, the ability to provide real-time analysis is important to provide on demand.

No matter what care setting, keeping an individual and their needs at the center of their care plan is essential. Remembering these factors while establishing, assessing, and achieving an individual’s personal goals, care providers across all settings – not just I/DD – are sure to provide the best services to meet the unique needs of everyone.

Readers Write: Capturing Patient-Reported Outcomes for Population Health Management Yields Dividends

August 15, 2018 Readers Write No Comments

Capturing Patient-Reported Outcomes for Population Health Management Yields Dividends
By Gary Hamilton

Gary Hamilton is CEO of InteliChart of Fort Mill, SC.

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As the industry pushes towards value-based care, a greater emphasis has been placed on listening to patients, particularly regarding how they view their own health status and quality of life. These patient-reported outcomes (PROs) are essential to help identify obstacles to effectively manage chronic conditions. Patient-reported outcome measures (PROMs), of which there are many across numerous specialties, are also increasingly important to payers under value-based care payment models.

Capturing PRO information can occur in the exam room or hospital, but it is often time-consuming and may be sidetracked if the patient has an acute condition they prefer to discuss. Fortunately, the ubiquity of the Internet, smartphones, and the increasing sophistication of data analytics technology is helping healthcare organizations obtain PRO data and analyze associated measures efficiently so they can improve performance.

PROs are defined by the National Quality Forum (NQF) as “any report of the status of a patient’s health condition that comes directly from the patient, without interpretation of the patient’s response by a clinician or anyone else.” These outcomes are, in some cases, more important to the patient than the clinical outcome because it reflects how they are feeling and their ability to pursue daily activities. For example, how many times has a patient told you that they stopped taking a medication due to its perceived side effects and now feel “better than ever?”

Learning about medication side effects and how a patient feels about other elements of their care plan aligns with many value-based care goals. After all, if patients are not achieving their personal health or quality-of-life goals, they may not perceive any value for their care. A treatment then cannot be considered fully effective, even if clinical indicators of health improved along the way.

Listening to patients’ goals is key to designing a care plan that will yield health status improvements or eliminate symptoms, but also improve quality of life. When a patient notices and reports these improvements, they are likely to engage in their care plan or follow through with a recommended procedure recovery regimen.

Capturing PROs can be tedious and not always accurate, especially when the patient is distracted by another condition or other factors, such as being discharged from the hospital. This is where advanced population health management (PHM) technology helps providers save time while improving the patient’s experience.

At discharge, for example, a patient who underwent a procedure may be so concerned about how they will resume their activities at home, they may not be aware a medication prescribed at the hospital is giving them intolerable side effects. After they adjust to the care transition, an automated survey would be sent from the PHM platform to their smartphone to learn about the recovery from the procedure, as well as the new medication. Based on patient preferences, PROs could be captured through an automated interactive voice response (IVR) phone call or a secure electronic message, both initiated through the PHM technology.

Although automated methods are most efficient, a live phone call with a clinician is just as effective at gathering crucial patient information. The PHM technology assists in these situations by automatically reminding the care manager to conduct the interview and offering to create the electronic questionnaire form to be completed. Based on responses from any of the PRO outreach methods, the physician can then decide to adjust the prescribed treatment.

For patients with chronic conditions, here again, a survey can be sent to a mobile device or patient portal periodically to ensure associated care plans are helping them achieve their goals. Electronic surveys or interviews using an IVR or live phone call would include quality-of-life questions concerning physical function, mental health, sleep, or the ability to participate in daily activities. An analytics platform would then flag and compile negative responses for follow-up.

Remote-captured PRO can also support many elderly and rural patients who may have transportation challenges. Instead of these patients coming to the office for routine consultations regarding their chronic conditions, an automated survey, secure portal message, IVR, or live phone call can capture PROs and allow them to avoid unnecessary travel.

The benefit of using a mobile device or a computer to capture PROs is that patients can report their perspective at the right moment, when they have time to reflect away from the distractions of a busy practice, hospital, or workplace. Surveys or automated interviews delivered on a consistent schedule prove to patients the organization is focused on their care, nurturing engagement, and motivating them to improve their outcomes.

For the provider organization, identifying PROM trends among these populations is easier when the PRO module is part of an advanced PHM platform that is integrated with the electronic health record (EHR) system, other information systems, and fed by comprehensive and aggregated data from around the care continuum. When a physician reviews a patient’s chart, they can view PROM trends at a glance to support their decisions.

PRO insight, in conjunction with other data included in the EHR, can help the physician design an effective treatment plan that achieves clinical objectives as well as the patient’s quality-of-life goals. Combined, improving performance on these outcomes can secure greater reimbursement under value-based care payment models while building stronger engagement from patients throughout the year.

Morning Headlines 8/15/18

August 14, 2018 Headlines 1 Comment

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